NOTES 1:
Group Hypnotizability Scale: Means for Behavioral (B), Experiential (E), Involuntariness (I) and Behavioural/Involuntariness (B/I) measures
GROUP n B E I B/I
Range 0-6 0-18 0-18 0-6 CSTP 39 4.67 12.46 11.54 3.64 Booklet 39 4.62 12.18 11.31 3.77 Practice 31 3.58 9.81 8.42 2.32 Control 32 3.44 10.66 9.22 2.75
Spanos, Nicholas P.; DuBreuil, Susan C.; Gabora, Natalie J. (1991). Four-month follow-up of skill-training-induced enhancements in hypnotizability. Contemporary Hypnosis, 8, 25-32.
Low hypnotizability subjects were exposed to skill training aimed at enhancing hypnotizability, and post-tested 2 weeks later. Those in a short delay condition were administered a second hypnotizability post-test within 2 weeks of the first, whilst those in a long delay condition were administered the second post-test 16-18 weeks after the first post-test. Skill-trained subjects in the two delay conditions did not differ on the first post-test. Skill-trained subjects in the two delay conditions did not differ significantly on behavioural or subjective indices of hypnotizability at either post-test. However, skill- trained subjects attained significantly higher hypnosis scores on both post-tests than did no-treatment control subjects. Attitudes towards hypnosis were also significantly enhanced by skill training, and these enhancements were maintained across the post-test intervals. Among the skill-trained subjects, post-tested hypnotizability was predicted by subjects’ attitudes and by the trainer’s ratings of subjects’ receptivity and resistance towards the training.
NOTES:
Immediately before each hypnotizability test, subjects’ attitudes towards hypnosis were assessed with a 14-item questionnaire taken from Spanos, Cross et al. (1987). On this instrument higher scores indicate more positive attitudes” (p. 27).
“Immediately following each skill-training session, the trainer evaluated the subject’s receptivity to the training using a nine-item checklist. The items described aspects of the training which experienced trainers in our laboratory have judged to be indicators of successful modification. The items (e.g. ‘Does the subject volunteer that they found the ideas presented interesting/fun?’) were scored dichotomously (yes/no), and summed to yield a receptivity to training score for each subject. The trainer also rated the degree to which each subject displayed resistance to the training on a global three-point scale” (p. 27)
The correlation between receptivity towards the skill training procedure and baseline attitudes toward hypnosis was .50.
“Some evidence indicates that untrained subjects (high hypnotizables included) exhibit substantial decrements in responsiveness to suggestions when they are exposed between testings to negative information about hypnosis (Barber & Calverley, 1964; Spanos & McPeake, 1975) or to information that alters their expectations about their responsiveness (Spanos, Gabora, Jarrett & Gwynn, 1989)” (p. 30)
“These findings suggest that the subjects who initially hold the most negative attitudes towards hypnosis are the least receptive to skill-training procedures. After training, these subjects continue to hold relatively negative attitudes towards hypnosis which limit the extent of their hypnotizability gain” (p. 30).
1990
Bates, Brad L.; Brigham, Thomas A. (1990). Modifying hypnotizability with the Carleton skill training program: A partial replication and analysis of components. International Journal of Clinical and Experimental Hypnosis, 38, 183-195.
3 standard components of the Carleton Skills Training (CST) program – information, modeling, and instructions – were administered in 1 of 3 sequences to 12 low- hypnotizable Ss. Hypnotizability measures were obtained after each component was given, as well as before and after training. Although objective scores showed significant gains from screening to testing, subjective scores did not, suggesting that while training encouraged behavioral compliance, few Ss learned to have the subjective experiences traditionally associated with hypnosis. Results from the component analysis were clear and consistent: whether instructions were presented first, second, or third in the training sequence, no significant changes occurred until this component was provided.
NOTES:
Gains shown by CURSS:O scores in the present study are larger than those obtained by Bates et al. (1988), and comparable to those reported by Spanos and his colleagues. Perhaps the attempt by trainers in the current study to develop rapport with Ss enhanced testing scores; this would be consistent with findings by Gfeller et al. (1987) who found that rapport enhances the efficacy of the CST program. Alternatively, administering the components of the CST program separately may have facilitated training.
“Unlike CURSS:O scores, subjective experience measures did not show significant gains . In addition, created highs had significantly lower CURSS:S and FIHD scores than natural highs. These findings contrast with previous work by Spanos and his associates, who consistently find large subjective gains and few if any differences between created and natural highs (e.g., Gorassini & Spanos, 1986; Spanos et al., 1987b).
“The fact that so much of the CST program is either audiotaped, videotaped, or read from a transcript suggests that important extraprogrammatic variables have not yet been identified by Spanos and his colleagues” (p. 191).
Regarding compliance issues, “Spanos refers to the fact that created and natural highs typically respond comparably on subjective hypnotizability dimensions. Yet, results from the present study would appear to cast doubt on this finding. Moreover, demonstrating that created and natural highs report comparable subjective experiences does not preclude the possibility that the former are merely complying with experimental demands” (p. 192).
” trained Ss consistently obtain lower hypnotizability scores during testing than simulators (Spanos & Flynn, 1989; Spanos et al., 1986). According to Spanos, this indicates that the testing behavior of trained Ss involves more than compliance with experimental demands.
“In actuality, the issue is more complicated than this. … Since trained Ss are never explicitly told to respond like “excellent hypnotic Ss,” the instructions they receive are different from those given simulators. Given different instructions, it is reasonable to expect that compliance will look different for these two groups. In short, Ss given the CST program may be complying, but with experimental demands quite different from those experienced by simulators.
“In summary, the present investigation demonstrates quite clearly that the instructional component is the primary change agent in the CST program. In addition, while objective scores increased substantially in the current study as a result of the training, subjective scores did not, suggesting that behavioral compliance, but not hypnotic ability, was enhanced by the CST program. Although Spanos maintains that recipients of the CST program learn to have the subjective experiences traditionally associated with hypnosis, the available data cannot distinguish between this possibility and the equally plausible hypothesis that trained Ss act as if hypnotized and report “hypnotic” experiences only because they are instructed during training to do so, and not because their hypnotic ability has been enhanced” (pp. 193-194).
1990
Spanos, Nicholas P. (1990). More on compliance and the Carleton Skill Training Program. British Journal of Experimental and Clinical Hypnosis, 7, 165-170.
NOTES
In this paper the author counters Bates’ (1990) criticisms of the Carlton Skills Training Program, e.g. that the program induces Subject compliance rather than genuine increases in hypnotizability. The author states that the training program is designed to induce conformance rather than simply compliance with suggested demands.
He notes that in order to avoid the twinges of conscience associated with a self- definition of cheating, most Ss fail suggestions to which they are unable to generate the requisite subjective response. (Most Ss fail most of the suggestions on standardized hypnotizability scales despite the fact that all of these suggestions are easily fakable.)
“The findings of the Spanos et al. (1987) and Cross and Spanos (1988) studies suggest that, given appropriate attitudes and interpretations, subjects who benefit most from skill training are those who possess the cognitive abilities that enable them to vividly create and become absorbed in the imaginary scenarios called for by test suggestions. It is much less clear how these findings could be accounted for in terms of compliance. There is no evidence to indicate that imaginal propensity indexes are strongly related to a general tendency towards compliance and, at any rate, low hypnotizables who undergo skill training are, by definition, subjects who failed to comply with test demands during initial hypnotizability testing.
“In summary, when taken together the available data suggest that compliance cannot account adequately for CSTP-induced gains in hypnotizability. Obviously, this conclusion should not be interpreted as saying that compliance plays no role in training induced hypnotizability gains, or that the role of compliance in this regard should not be thoroughly investigated. As Wagstaff (1981) has repeatedly emphasized, compliance appears to be an integral component of hypnotic responding. Recent evidence from our laboratory (Spanos et al., 1989a) supports Wagstaff’s (1981) contention by indicating that untrained high hypnotizables engage in substantial levels of compliance when the ‘pass’ at least some difficult test suggestions. Given that natural high hypnotizables engage regularly in some compliant responding, it would be rather surprising to find that created highs did not do the same. However, examining this issue empirically requires the application of experimental paradigms that allow compliance to be differentiated from conformance.
Spanos, Nicholas P.; Warnock, Sean; de Groot, Hans P. (1990). Cognitive skill training, confirming sensory stimuli, and responsiveness to suggestions in subjects unselected for hypnotizability. Journal of Research in Personality, 24, 133-144.
Subjects unselected for hypnotizability were administered cognitive skill training which taught them to actively generate hypnotic responses or expectancy enhancing procedures that provided them with sensory stimuli aimed at confirming the false belief that they had successfully experienced suggested effects. Subjects were tested for suggestibility / hypnotizability at the end of their experimental treatment session and again in two follow-up posttests. Skill trained subjects exhibited significantly higher scores than subjects in all other treatments on the behavioral and subjective dimensions of the three suggestibility / hypnotizability tests. Subjects who received confirming stimuli showed higher behavioral scores than no treatment controls only on the behavioral dimension of the first suggestibility test, and no differences from controls on the subjective dimensions of any of theory tests. Theoretical implications are discussed.
1989
Spanos, Nicholas P.; Flynn, Deborah M. (1989). Compliance, imaginal correlates and skill training. [Comment/Discussion] .
NOTES
The authors defend the Carlton skill training program against accusation that the trained Ss are simply complying in the context of social pressure. They also discuss characteristics of high hypnotizables (absorption and imagery), noting that the majority of lows do not have low absorption/imagery scores (citing de Groh, 1988, and noting the research on context dependency for absorption).
“Despite all of this, it is worth noting that the results of our modification studies are not inconsistent with the hypothesis that high hypnotizability requires imaginative skills that some subjects do not possess in sufficient degrees. For example, two recent studies (Spanos et al., 1987; Cross and Spanos, 1988) found that the extent to which low hypnotizables showed gains following administration of the CSTP was predicted by their pre-tested levels of imagery vividness. Lows with good imagery benefitted substantially more from the CSTP than did lows with poor imagery ability. When it is kept in mind that most low hypnotizables do not score low on measures of imagery/absorption (de Groh, 1988), then the findings that substantial numbers of low hypnotizables can be taught to attain high hypnotizability is not at all inconsistent with the notion that high hypnotizability requires at least moderate levels of imagery/absorption ability” (p. 14).
1989
Spanos, Nicholas P.; Flynn, Deborah M. (1989). Simulation, compliance and skill training in the enhancement of hypnotizability. British Journal of Experimental and Clinical Hypnosis, 6, 1-8.
Subjects who underwent cognitive skill training were compared to no treatment controls and to subjects in two simulation treatments on the behavioural and subjective dimensions of two hypnotizability post-tests. Ss in a trained simulation treatment received skill training but were instructed to fake the responses of someone who had been transformed by training into an excellent hypnotic subject. Standard simulators did not receive skill training, but were instructed to fake their responses to the two post- tests. A final group of untrained Ss (i.e. naturals) who attained the same behavioural scores on a hypnotizability index as did post-tested skill-trained Ss, was also compared to the treated groups. Ss in the two simulation treatments performed similarly on all hypnotizability indexes. Simulators out-performed both skill-trained and natural subjects (who failed to differ from one another) on all indexes, and skill-trained and natural subjects, in turn, out-performed the no treatment controls. These findings suggest that sustained faking cannot account adequately for the enhancements in hypnotizability produced by skill training.
Spanos, Nicholas P.; Flynn, Deborah M.; Niles, Judy (1989-90). Rapport and cognitive skill training in the enhancement of hypnotizability. Imagination, Cognition and Personality, 9 (3), 245-262.
The role of interpersonal rapport in facilitating the enhancements in hypnotizability produced by cognitive skill training was examined in two experiments. In Experiment 1 low hypnotizable subjects either received skill training or passively oriented training that was designed to facilitate rapport with the trainer without teaching subjects how to generate the responses called for by test suggestions. Subjects in the two treatments reported equivalently high levels of rapport with their trainer, but only those given skill training attained large gains on two hypnotizability posttests. Subjects given passive training did not differ from untreated controls at posttesting. In Experiment 2 subjects received skill training under conditions designed to either heighten or minimize rapport with the trainer. Those in the high rapport condition showed large hypnotizability gains on both posttests, whereas those in the low rapport condition failed to differ from no treatment controls in the regard. Our findings indicate that high rapport is not sufficient for producing training-induced enhancements in hypnotizability. However, the absence of such rapport may interfere with subjects’ learning and applying skills that can enhance hypnotizability
Spanos, Nicholas P.; Lush, Nancy I.; Gwynn, Maxwell I. (1989). Cognitive skill-training enhancement of hypnotizability: Generalization effects and trance logic responding. Journal of Personality and Social Psychology, 56 (5), 795-804.
Compared low-hypnotizable subjects who simulated hypnosis, underwent cognitive skill training, or served as no- treatment controls to subjects who scored as high hypnotizables without training (natural highs) on response to analgesia, age-regression, visual hallucination, selective amnesia, and posthypnotic suggestions. Subjects who attained high hypnotizability following skill training (created highs) did not differ from natural highs on any response index. Natural and created highs scored lower than simulators but higher than controls on the behavioral and subjective aspects of test suggestions. Simulators, however, were significantly less likely than natural highs or skill- trained subjects to exhibit duality responding or incongruous writing during age regression or transparent hallucinating. Results suggest that the hypnotic responses of natural and created highs are mediated by the same cognitive variables and that enhancements in hypnotizability produced by skill training cannot be adequately explained in terms of compliance.
Spanos, Nicholas P.; Cross, Wendi P.; Menary, Evelyn; Smith, Janet (1988). Long term effects of cognitive-skill training for the enhancement of hypnotic susceptibility. British Journal of Experimental and Clinical Hypnosis, 5 (2), 73-78.
Twelve initially low susceptible subjects, who scored in the medium or high susceptibility range on the Carleton University Responsiveness to Suggestion Scale (CURSS) following skill training, were posttested 9 to 30 months later with a group version of the Stanford Hypnotic Susceptibility Scale, Form C. Skill trained subjects scored significantly higher on behavioral and subjective dimensions of the Stanford Hypnotic Susceptibility Scale, Form C than low susceptible untrained control subjects who were posttested after an equivalent interval. Furthermore, the posttraining CURSS scores of the skill trained subjects were matched to those of subjects who received the same CURSS scores without training. Matched subjects were posttested on the Stanford Hypnotic Susceptibility Scale, Form C after only a brief delay. Skill trained and matched subjects failed to differ significantly on Stanford Hypnotic Susceptibility Scale, Form C susceptibility dimensions, but skill trained subjects showed higher levels of suggested amnesia than matched subjects. These findings support the idea that hypnotic susceptibility is modifiable and that training induced gains in susceptibility can be enduring.
1987
Spanos, Nicholas P.; Robertson, Lynda A.; Menary, Evelyn P.; Brett, Pamela J.; Smith, Janet (1987). Effects of repeated baseline testing on cognitive-skill-training-induced increments in hypnotic susceptibility. Journal of Personality and Social Psychology, 52 (6), 1230-1235.
Subjects who pretested as low in hypnotic susceptibility either received or did not receive a second baseline susceptibility test. Half of the subjects in each baseline test condition were administered cognitive skill training to enhance susceptibility, and half were given no training. Trained subjects exhibited much higher scores than untrained subjects on the objective and subjective dimensions of two different susceptibility posttests. The number of baseline tests given to subjects did not significantly affect posttest responding. These findings support the notion that hypnotic susceptibility can be substantially modified. They argue against the idea that training-induced gains in susceptibility are an artifact of giving subjects only a single- baseline test.
Spanos, Nicholas P.; de Groh, Margaret; de Groot Hans (1987). Skill training for enhancing hypnotic susceptibility and word list amnesia. British Journal of Experimental and Clinical Hypnosis, 4 (1), 15-23.
Subjects who pretested as low on hypnotic susceptibility received either cognitive skills training aimed at inculcating positive attitudes and interpretations concerning hypnotic responding, or no treatment. Trained subjects scored significantly and substantially higher on subjective and behavioral dimensions of susceptibility than controls. A second posttest assessed amnesia for a previously learned word list. Trained subjects showed more word list amnesia than either no treatment controls or subjects who had been matched to the trained subjects in terms of posttest susceptibility. Theoretical implications for theories of hypnotic susceptibility are discussed.
1986
Spanos, Nicholas P.; Robertson, Lynda A.; Menary, Evelyn P.; Brett, Pamela J. (1986). Component analysis of cognitive skill training for the enhancement of hypnotic susceptibility. Journal of Abnormal Psychology, 95, 350-357.
Four treatments to enhance the hypnotic responsiveness of subjects who pretested as low in hypnotic susceptibility were compared. Complete skill training included information aimed at encouraging (a) positive attitudes, (b) the use of imagery strategies, and (c) an interpretation of hypnotic behavior as active responding. Partial training included only components (a) and (b). Both training packages enhanced attitudes toward hypnosis to an equivalent degree. However, complete training was much more effective than either partial training or no treatment at enhancing behavioral and subjective responding on two different posttest scales of hypnotic susceptibility. More than half of the subjects who received complete training, but none of the partial training or control subjects, scored in the high-susceptibility range on both posttests. Subjects explicitly instructed to fake hypnosis and those in the complete skill-training treatment exhibited significantly different patterns of posttest responding. Findings support social psychological perspectives that emphasize the importance of contextual factors in hypnotic responding.
CASE STUDY
1993
Becker, Philip M. (1993). Chronic insomnia: Outcome of hypnotherapeutic intervention in six cases. American Journal of Clinical Hypnosis, 36, 98-105.
Chronic dyssomnia is highly prevalent and has multiple etiologies. Hypnotherapy has been reported as beneficial for insomnia, but the description of the subject populations has been limited. A group of patients was evaluated at a sleep disorders center for a dyssomnia that occurred on at least 3 nights per week for 6 months or more. Six patients accepted hypnotherapy for their persistent psychophysiological insomnia and other sleep disorder diagnoses. Three patients responded to two sessions of structured hypnotherapy. The three responders remained improved at 16-month follow- up. Factors that seemed to contribute to long-term response in this small group of patients included a report of sleeping at least half of the time while in bed, increased hypnotic susceptibility, no history of major depression, and a lack of secondary gain.
LaGrone, Randy G. (1993). Hypnobehavioral therapy to reduce gag and emesis with a 10-year-old pill swallower. American Journal of Clinical Hypnosis, 36, 132-136.
A 10-year-old child experienced severe nausea and psychogenic vomiting that resulted in refusal to take oral medication in pill form. The youngster was treated with hypnobehavioral therapy consisting of mental imagery, relaxation, direct suggestion, adaptive self-talk, self-monitoring, and self-reinforcement. The child’s parents were instructed to reinforce approximations of successful pill swallowing while withdrawing attention for avoidance, whining, gagging, and vomiting. A one-year follow-up revealed successful pill swallowing without significant distress.
Nadon, Robert (1993, October). Nomothetic and idiographic approaches to hypnosis. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL.
NOTES
Scientists and practitioners are not benefitting from each other’s contributions. The central contribution to hypnosis, both basic and applied, is the logic and validity of study designs. The false memory issue is an example. Clinicians supply an answer the public likes, but scientist provide data based on nomothetic (group average) models that are not useful here.
Most of my own work is nomothetic, but it can work together with case study approach. We use a synergistic model: the combined effects of traits, cognitive, social, and affective factors are investigated. Interactions are tricky to detect, but we need a spirit of enquiry that encourages designs sensitive to interactions.
One example is Radke & Spanos’ study that used a scale rating whether subject was hypnotized and another indicating degree of absorption-and-hypnotized vs absorption-and-not-hypnotized. Nadon’s reanalysis showed a scale by Ss interaction: mediums were different on the 7 point scale but highs were not. (Highs were less manipulated by the scale manipulation).
Jean-Roche Laurence and Nadon replicated the interaction. Then Nadon did a study to test the idea that highs were less affected by scale manipulation because they relied more on subjective experience. They measured Absorption in a different context and hypothesized that the highs here would be less affected on the 7 point scale in the other context; it was validated. There seemed to be a linear absorption by a quadratic hypnotizability interaction.
Another simple example of interaction at work: there are different lines predicting hypnotic ability based on the Absorption scale, representing need for control on the scale. Those low in need for control have a stronger prediction of hypnotizability from Absorption scale. With high need for control, Absorption doesn’t predict hypnotizability. This may explain why the correlation isn’t stronger between Absorption and hypnotizability.
Nadon investigated how level of relaxation could be affected by an interaction. Measured muscle tension of masseter (?) while listening to music (half of Ss) or focusing on relaxing (50%). In an experiential condition there was a negative correlation between Absorption and muscle tension (highs relaxed more); in an Instrumental condition it was the opposite. So both high and low Absorption people were capable of relaxation, but to get the best relaxation you would have to know their Absorption score.
A second study hypothesized that predispositions for certain kinds of affect (Tellegen’s positive affect, like extroversion) and negative effect (like neuroticism). High Absorption extraverts low in neuroticism worked best with music; and [missed words]. This supports Tellegen’s hypothesis re the effects of positive and negative affect and Absorption.
Now we can discuss individual characteristics that suggest which relaxation strategy will benefit. The practical implications can be validated by case studies.
Page, Roger A.; Handley, George W. (1993). The use of hypnosis in cocaine addiction. American Journal of Clinical Hypnosis, 36, 120-123.
An unusual case is presented in which hypnosis was successfully used to overcome a $50-0 (five grams) per day cocaine addiction. The subject was a female in her twenties. Six months into her addiction, she acquired a commercial weight-control tape that she used successfully to stop smoking cigarettes (mentally substituting the word “smoking”), as well as to bring her down from her cocaine high and allow her to fall asleep. After approximately 8 months of addiction, she decided to use the tape in an attempt to overcome the addiction itself. Over the next 4 months, she listened to the tape three times a day, mentally substituting the word “coke.” At the end of this period, her addiction was broken, and she has been drug free for the past 9 years. Her withdrawal and recovery were extraordinary because hypnosis was the only intervention, and no support network of any kind was available
1992
Adams, P. C.; Stenn, P. G. (1992). Liver biopsy under hypnosis. Journal of Clinical Gastroenterology, 15, 122-124.
Two patients underwent outpatient percutaneous liver biopsy under hypnosis without complications. One patient had severe anxiety about the procedure because of a previous adverse experience with liver biopsy, and the other had a history of severe allergy to local anesthesia. Both patients had undergone a session of hypnosis at least once prior to the biopsy. One received no local anesthesia, and the other received 1% lidocaine as a local anesthetic. Both patients were completely cooperative during the procedure with the required respiratory maneuvers. Both patients stated that they were aware of the procedure under hypnosis but described no pain and would be most willing to have the procedure done under hypnosis in the future.
Chantler, Lisa J. (1992). The treatment of irritable bowel syndrome using hypnosis. Australian Journal of Clinical and Experimental Hypnosis, 20, 39-47.
ABSTRACT: A single case is reported of the hypnobehavioural treatment of a patient with chronic irritable bowel syndrome. The success of this treatment suggests that it has potential over and above relaxation and other behavioural techniques alone.
Kraft, Tom (1992). Counteracting pain in malignant disease by hypnotic techniques: Five case studies. Contemporary Hypnosis, 9, 123-129.
ABSTRACT: Five cases of patients suffering from cancer are described in which hypnotic visualization techniques were successfully employed to relieve pain and anxiety. This study supports the view that hypnosis can be an effective tool for pain relief in malignant disease, particularly when traditional methods have been exhausted.
Haanen, Huub C.M.; Hoenderdos, Henk T.W.; Van Romunde, Leo K.J.; Hop, Win C.J.; Malle, Constant; Terwiel, Jack P.; Hekster, Gideon B. (1991). Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia. Journal of Rheumatology, 18 (1), 72-75.
In a controlled study, 40 patients with refractory fibromyalgia were randomly allocated to treatment with either hypnotherapy or physical therapy for 12 weeks with followup at 24 weeks. Compared with the patients in the physical therapy group, the patients in the hypnotherapy group showed a significantly better outcome with respect to their pain experience, fatigue on awakening, sleep pattern and global assessment at 12 and 24 weeks, but this was not reflected in an improvement of the total myalgic score measured by a dolorimeter. At baseline most patients in both groups had strong feelings of somatic and psychic discomfort as measured by the Hopkins Symptom Checklist. These feelings showed a significant decrease in patients treated by hypnotherapy compared with physical therapy, but they remained abnormally strong in many cases. We conclude hypnotherapy may be useful in relieving symptoms in patients with refractory fibromyalgia.
NOTES
The patients in this study were 38 women and 2 men, ages 30-65, who had had fibromyalgia for an average of 8.5 years (range 1.5 – 40 years). Of these, 25 were on sick leave or incapacitated, and 6 were unemployed. Patients were randomly assigned to hypnotherapy, or to training in muscle relaxation plus massage (designated “physical therapy”). They were withdrawn from analgesics, except for paracetamol (like Tylenol), at the beginning of this program. Hypnotizability was not measured.
Hypnosis treatment consisted of an arm levitation induction, imagery deepening techniques, ego strengthening suggestions, and suggestions for control of muscle pain, relaxation, and improved sleep. Patients received eight one-hour sessions in decreasing frequency over three months; after Session 3 they were given a 30-minute audiotape to assist in daily self hypnosis. Seventeen patients completed hypnotherapy but three were dissatisfied and withdrew after 3 sessions.
Patients did self ratings on (1) duration of morning stiffness, (2) muscle pain, (3) fatigue on awakening, (4) sleep disturbance, and (5) global assessment, the last four using visual analog scales (VAS). Patient assessment at 12 and 24 weeks was the primary outcome measure, since fibromyalgia is diagnosed principally from patient’s self described symptoms.
Independent observers did not know to which group the patient belonged. The physician’s evaluation included (1) dolorimeter measures of point tenderness (for a Total Myalgic Score, TMS), (2) presence of tender points at 30 points, with 5 control points, (3) overall pain rating with visual analogue scale.
The Hopkins Symptom Checklist (HCL-90) also was used to evaluate outcome.
Using analysis of variance techniques and correcting for initial values, the study found significantly more favorable values in the hypnosis group than in the physical therapy group for muscle pain, fatigue on awakening, sleep disturbance, patient’s overall assessment, and HCL total score. However, differences were not significant for morning stiffness, physician’s overall assessment, or T.S. There were no differences between Weeks 12 and 24 for both groups; therefore the mean value for weeks 12 and 24 for each patient were used to calculate percentage change relative to baseline.
The reduction in pain medication used by the hypnosis group was quite remarkable. “Median (range) analgesic drug use at the initiation of the study (mostly paracetamol) was in the hypnotherapy group 3.0 (0-42) tabletsweek and in the physical therapy group 4.5 ( 0-21)/week. At Week 12 this was 1.0 (0-21) tablet/week for the hypnotherapy group and 7.0 (0-34) tablets/week for the physical therapy group. At the end of the study, 10 of 12 patients in hypnotherapy group and 3 of 12 patients in the physical therapy group had reduced their paracetamol use (Fisher exact test: p = 0.006)” (pp. 73-74).
Although it was observed that the total number of tender points decreased (regardless of treatment group), the Total Myalgic Score assigned by the physician had not changed either at week 12 or at week 24. In fact, even the control points were tender in 44% of the patients; most patients showed some pain response to a control point in one or two sessions of the three. “Only 12 of 40 patients had consistently nontender control points, 4 in hypnotherapy group and 8 in the physical therapy group. … No relation was found between the initial HCL total score and the changes in the other variables studied” (p. 74).
Figures taken from Table 2, showing percent change as compared to baseline:
Physical Therapy (%) Hypnotherapy (%) Morning stiffness (minutes) 0.0 -25.0 Muscle pain (VAS) -6.8 -10.2** Fatigue on awakening (VAS) -0.3 -16.7** Sleep disturbance (VAS) -1.0 -23.1** Overall assessment
patient -8.4 -33.2**
physician +5.7 -3.2 T.S. (kg/3 cm2) -11.1 -2.4 HCL total score -0.9 -13.0**
In their Discussion, the authors write, “In this controlled therapeutic trial in patients with refractory fibromyalgia hypnotherapy was more successful than physical therapy in improving complaints. The assessment of fatigue on awakening, sleep disturbance, muscle pain, the patient’s overall assessment and the total score of the HCL showed a significant decrease in the hypnotherapy group at the end of the hypnotherapy at 12 weeks. This decrease persisted for 3 months after finishing the hypnotherapy. The variables studied in the physical therapy group had not changed significantly at 12 and 24 weeks.
“However, the patients in the hypnotherapy group improved only subjectively. This improvement was not seen via more objective variables (T.S. and number of tender points), in accordance with others [Carette et al., 1986]. This suggests that coping with the disease may be positively influenced by hypnotherapy though the underlying disorder is still present.
“Correction of the sleeping disturbance by hypnotherapy was the most consistent finding and possibly played an important role in the subjective improvement of fibromyalgia” (p. 74).
The authors noted that the HCL yielded scores in the pathological range during the baseline period. “Thus, in our study, patients with long-standing fibromyalgia often showed pathological feelings of discomfort. In the hypnotherapy group the total score of the HCL decreased significantly suggesting that the physical disturbance may be secondary to long-standing fibromyalgia. It is worth noting that only 3 of the 57 questions on the HCL-90 concern fibromyalgia” (p. 74).
The authors express the opinion that their data do not support a distinction between fibromyalgia and psychogenic rheumatism [Simms, Goldenberg, Felson, & Mason, 1988; Campbell, Clark, & Tindall, 1983] based on pain reported at control points. “Most patients in our study had variable tender control points. The finding of tender control points in fibromyalgia is consistent with others [Wolfe, Smythe, Yunus, et al., 1990; Scudds, Rollman, Harth, & McCain, 1987]. Also we found a positive correlation between the number of tender points and the presence of tender control points. Therefore, it seems more likely that there is a fairly large overlap between fibromyalgia and psychogenic rheumatism (tender all over)” (p. 75).
1991
Madrid, Antonio D.; Barnes, Susan v.d.H. (1991). A hypnotic protocol for eliciting physical changes through suggestions of biochemical responses. American Journal of Clinical Hypnosis, 122-128.
We employed brief hypnotherapy to effect physical changes in patients suffering from medical disorders including allergies, rectal bleeding, systemic lupus, hyperemesis, headache, asthma, and chronic pain. We present, in language appropriate to the individual patient, considerations and suggestions to effect the release of healing biochemicals. Ideomotor signals indicated the patient’s awareness of the healing. We hypothesize that the technique triggered novel state-dependent memory, learning, and behavior.
NOTES
They hypothesize that the technique they use triggers novel state-dependent memory, learning, and behavior (See for example Rossi, 1987, and Rossi & Cheek, 1988).
Hypnotic Protocol: “1. Tell the patient that he can heal himself by allowing his body to supply its own biochemicals needed to make him well. If a specific biochemical is known, such as cortisone or endorphins, name it. “2. Hypnotize the patient. Resistant or hard to hypnotize patients need not be deeply hypnotized because the patients, using this protocol, will automatically go into trance while accomplishing the next task of accessing and using ideomotor signals (Erickson, 1980; Rossi & Cheek, 1988). “3. Tell the patient that his index finger will automatically and involuntarily twitch and float when his body releases the biochemicals he needs. This ideomotor response (Rossi & Cheek, 1988) is the sole physical response required of the patient. Rossi hypothesizes that the ideomotor response correlates with biochemical changes (Rossi & Cheek, 1988). “4. Next, ask the patient to consider some things (as described below). Present the considerations one after another until one of them triggers the ideomotor response. “5. In some instances, ask the patient to practice on his own. Many patients who have dramatic emotional reactions during or at the completion of the task may not need to practice on their own” (p. 123).
They present several ‘considerations’ to the patient, one after the other, tailored to the patient’s specific case, until his finger twitches or floats, indicating a biochemical response. For example, the following ‘considerations’ have been used: “1. Psychodynamic: ‘Consider that you are not blamed for anything; that you are in fact perfect just the way you are; that you are loved by those you care about.’ ‘Consider that you can forgive whoever needs forgiving for hurting you.’ ‘Consider that there are no longer any threats; everything is better; everything is as it used to be.’ “2. Autosuggestion: ‘Tell your body to heal. It knows what to do; so ask it to do it.’ ‘Tell your adrenal glands to produce the steroids that your body needs.’ ‘Allow a glowing light to permeate that injured back, filling it with healing energy.’ “3. Incompatible responses: ‘Cover yourself with a cool breeze, cooling the injured leg.’ ‘Imagine your back getting slack and limp and relaxed.’ ‘Imagine your stomach lining becoming smooth and moving with easy, ocean-like waves.’ “4. Emotion calling: ‘Consider yourself feeling very happy with everything, for no reason at all.’ ‘Consider yourself getting angry at someone–your mother, your wife (husband), your boss, your lawyer.’ “5. Bargaining: ‘Tell yourself that you will heal if you agree to stay away from that job.’ ‘Tell yourself you will heal by allowing your right arm to begin to hurt when you are over- exerting yourself.’ ‘Tell yourself that you will heal in exchange for something else, not so serious, to replace this disease and to serve the same function'” (pp. 123-124).
They present seven cases involving, respectively, allergies, rectal bleeding, systemic lupus, hyperemesis of pregnancy, adult onset asthma, chronic pain, and cluster headaches. Two cases were particularly interesting because they represented patients who did not respond initially.
Their procedure involves reframing the state or emotion originally associated with the onset of disease using considerations, and then giving a suggestion that it is within the power of the person, rather than factors outside, to heal the body. First they instruct the patient that the body can heal itself; then they give the list of suggestions for the patient to consider, persisting with different considerations until they get an ideomotor response. Incorporation of the patient’s psychodynamic issues appears to be very important.
The authors regard it as unimportant if the patient cannot by hypnotized; “As Cheek (Cheek & LeCron, 1968; Rossi & Cheek, 1988) points out, the patient’s inability to be hypnotized may be synonymous with his disease. It is actually beneficial if the patient cannot achieve ideomotor responses at first because both he and the therapist then trust the validity of the response when it does occur after the appropriate
1990
Hoencamp, Erik (1990). Sexual abuse and the abuse of hypnosis in the therapeutic relationship. International Journal of Clinical and Experimental Hypnosis, 38, 283-297.
In the Netherlands, individuals charged with rape may be prosecuted only in instances in which the suspect could have known that the victim was unconscious or in a state of powerlessness. Hypnosis might be looked upon as a method by which an unscrupulous person could sustain such a state of powerlessness in a victim. As an expert witness, the present author participated in a court case against a lay hypnotist who was accused of abusing 9 women. The methods and strategy used by the lay hypnotist are presented as well as are the diverse reactions of the women involved in the case. Feelings of nonvolition appear to have been a relevant factor in the coercion, especially in women who demonstrated hypnotic phenomena such as arm levitation, catalepsy, etc. The basis for sexual coercion was established only after the interpersonal relationship had been redefined as a therapeutic relationship. Introduction within the pseudotherapeutic relationship of a sexual rationale for the presented complaints helped to provide a framework for actual sexual acts to occur. With certain individual patients, the introduction of hypnosis enhanced the subjective experience of nonvolition and with it the vulnerability for abuse. It may be hypothesized that patients with a tendency for external attribution and high hypnotizability are specifically at risk for this kind of abuse when hypnosis is used in the context of a therapeutic relationship.
Mason, Albert A. (1990, January). A psychoanalyst looks at a hypnotist; or, where the elephant skinned boy took me. [Paper] Presented at the Psychoanalytic Center of California Scientific Meeting.
NOTES
The results of working with hypnotism experimentally in the production of anaesthesia for surgery, dentistry and obstetrics; in controlled series of treatments of asthmatics, skin disorders, and allergic manifestations; as well as its clinical use, have convinced me that it is a delusional state akin to mania which depends on the omnipotent denial of mental pain. The mania is stimulated by the hypnotized subject having phantasies of an omnipotent object that it fuses with and shares in the omnipotence. The hypnotist has similar unconscious phantasies about himself. Both subject and hypnotist projectively identify with each others’ phantasies, and together produce phenomena like anaesthesia which can be likened to delusional states. In fact, true hallucinations can also be deliberately produced.
“I believe that similar psychotic mechanisms can also occur in life between parents and children and in other relationships, and produce delusional states. These form a continuum from intractable narcissism on the one side, through Christian Science and the denial of evolution in the center, to frank folie a deux and transexualism on the other side. The therapeutic course of these states seems quite dissimilar from that of psychosis arising without the encouragement of external objects.”
O’Hanlon, W. H.; Hexum, A. L. (1990). An uncommon casebook: The complete clinical work of Milton H. Erickson, M.D.. New York: W. W. Norton & Co.. (Reviewed by Elgan Baker, American Journal of Clinical Hypnosis, 34, 137)
NOTES
According to the review by Elgan, cases are organized into sections by the presenting problems of the patients treated and include a wide range of psychopathology. Each case is given an identifying number for ease of cross-referencing and is presented in a standard form: case summary, presenting problem, age group, modality of treatment, problem duration, treatment length, result of treatment, follow-up (if available), a summary of techniques used, and sources for the case description.
Page, Roger A.; Handley, George W. (1990). Psychogenic and physiological sequelae to hypnosis: Two case reports. American Journal of Clinical Hypnosis, 32 (4), 250-256.
Two cases of hypnotic sequelae occurring in a research context (with a non-clinical college population) are reported. Case 1 was a male who experienced retroactive amnesia following hypnosis: He was unable to recall familiar telephone numbers later that day. This was not a continuation of an earlier confusion or drowsiness (as is often found) since he indicated he was wide awake following hypnosis. Two parallels exist with previous reports: unpleasant childhood experiences with chemical anesthesia and a conflict involving a wish to experience hypnosis but a reluctance to relinquish control. Case 2 was a female who, while in hypnosis, experienced an apparent epileptic seizure that had characteristics of both petit mal and grand mal seizures. Although having a history of epilepsy, she had not had a seizure in 7 years. We suspect that the seizure was psychogenic and may have been triggered by wording used in the hypnotic scale or other similarities. Possible mechanisms are discussed and preventative recommendations are made.
Perry, Campbell (1990). Coercion by hypnosis? Invited discussion of Levitt, Baker, and Fish: Some conditions of compliance and resistance among hypnotic subjects. American Journal of Clinical Hypnosis, 32 (4), 242-243.
NOTES
A postexperimental inquiry (following Orne, 1959) might have informed the reader of the degree to which operationalization of the coercion in terms of disobedience was successful. Without this additional step, it is difficult to determine whether what was found in the laboratory by these investigators applies to what has been reported in clinical and field settings for almost 200 years” (p. 242).
“In particular, elsewhere, the authors equate coercion with involuntariness and appear to view involition as a euphemism for coercion. While I agree that perceiving involition of one’s own behavior may contribute to the commission of unconsenting acts in hypnosis, the two are easily distinguished at the conceptual level. Laboratory subjects ordinarily report much behavior in hypnosis that is experienced involuntarily, without the issue of it being coerced ever being broached” (p. 242).
Author describes cases in which patients claimed they participated in sex with hypnotist against their wills because they were hypnotized. “What may be happening in both of these reports is that the hypnotized subjects found themselves responding involuntarily; from this, they appear to have adduced that they could not resist the hypnotist’s suggestion. That is, they were coerced not by hypnosis but by their belief, which was a direct function of the experience of involuntariness, that they could not resist” (p. 243). “In short, if a hypnotized person equates involuntary behavior with powerlessness, “coercion” may occur in this limited sense. Conceptually, this appears to be a far cry from equating involition with coercion” (p. 243).
1989
Bierman, Steven F. (1989). Hypnosis in the emergency department. American Journal of Emergency Medicine, 7, 238-242.
Five cases are presented wherein hypnosis was used by the emergency physician either as the primary mode of treatment or as an adjuvant to standard medical care. Common hypnotic phenomena (e.g. anesthesia, analgesia), as well as novel effects, are reported. The technique used for trance induction and utilization is briefly outlined, and criteria are set forth for the bedside recognition of hypnotic trance.
Holroyd, Jean; Hill, Alexis (1989). Pushing the limits of recovery: Hypnotherapy with a stroke patient. International Journal of Clinical and Experimental Hypnosis, 37, 189-191.
Hypnotherapy was used to assist recovery of left arm function following stroke in a 66-year-old woman. Treatment protocol is described, and results are discussed in terms of how hypnosis may facilitate voluntary motor movement. Recent literature on cortical changes in hypnosis and motor improvement during hypnosis is discussed in relation to the present results.
NOTES:
The patient was 6 months post-stroke and physicians did not expect much additional improvement. She improved despite the fact that she measured as a low hypnotizable on the Stanford Scale, Form C. However, she appeared very absorbed in the hypnotic imagery, and she was highly motivated and exhibited much hope or positive expectation. Also, the author notes that “remarkable improvements in brain functioning have been reported through the use of sophisticated behavioral technology,” (p. 124), as in the use of EEG biofeedback to treat untractable seizures (Sterman & Lanz, 1981).
In rehabilitation cases, hypnotic dissociation may enhance pain control during the performance of exercises; more vivid hypnotic imagery may facilitate mental rehearsal of movements; attitudes may be reframed using hypnotic suggestion; and focusing attention on bodily sensations may be enhanced with hypnosis. Hypnosis also may improve expectancy, reduce anxiety, increase hope, provide general relaxation (reducing involuntary spasticity), increase cerebral blood flow, or in other ways promote healing.
Research by Pajntar, Roskar, & Vodovnik (1985) has demonstrated improved motor response during hypnosis for patients with hemiparesis. They attributed EMG changes under hypnosis “to a facilitory influx from supraspinal motor centers. They hypothesized that new motor units of paretic muscles were being activated or that there was an increased recruitment of the motor units already active, and they suggested that relaxation of the spastic antagonist muscle permits the paralyzed muscle to move” (p. 125).
1988
DeBenedittis, Giuseppe; Sironi, Vittorio A. (1988). Arousal effects of electrical deep brain stimulation in hypnosis. International Journal of Clinical and Experimental Hypnosis, 36, 96-106.