Following trauma there is a tendency to more dissociation and vulnerability. We completed 3 recent studies. In 1991 Spiegel and Cardena presented review that found: 1. Early childhood abuse is associated with profound dissociation. 2. Repeated abuse is more important and profound than single abuse for producing dissociation. 3. Dissociation in childhood and perhaps in adulthood has been viewed as an adaptive attempt to cope, to take distance in time, place, and person; does that confirm long term adaptation, or is it a risk factor? 4. Dissociation is not limited to childhood trauma; it occurs in adults exposed to overwhelming trauma. 5. In adults with PTSD, there is an increase in hypnotizability, which is interesting because most Axis I disorders are associated with reduced hypnotizability.
Peritraumatic dissociation is defined as an immediate dissociative response to trauma. We developed a scale that robustly captures the phenomena. The scale has both self report and rater versions.
Authors used this measure in many studies: combat trauma, accident trauma, victims of terrorism. The scale predicts who will be a PTSD patient 5 months later, even after controlling for initial response in first week (how many symptoms they had) and for the degree of trauma.
Study 1 (Am. J. Psychiatry, June 1994)
Studied 251 male Vietnam Theater Veterans, mean age 41 at time of study. Had high combat exposure and high risk for PTSD. Rater version of Peritraumatic Dissociative Experiences Questionnaire was used. There was a lot of variability in response, but one underlying dimension resulted from the factor analysis (and this factor accounts for 40- 50% of the variance).
Author hypothesized that those who have a greater response to trauma will have more problems later, and would predict stress symptoms but not necessarily psychopathology. The score correlates highly with: Mississippi Scale for PTSD .51; Horowitz’s scales; Impact of Events Scale (Intrusion .53, Avoidance .60); MMPI derived PTSD .42; Dissociative Experiences Scale (recall of time of event) .41; and War Zone Stress Exposure .48.
MMPI-2 clinical scales had almost no correlation with this scale (using partial r’s, and controlling for MMPI-2 PTSD scores).
Prediction of PTSD case classification from this scale, after taking into consideration other predictors: War Zone Stress War Zone Stress, DES War Zone Stress, DES, PDEQ-RV Kappa is .63
You know much more about who will be a case taking into consideration the DES and DEQ than just knowing the amount of stress. Peritraumatic stress is strongly associated with PTSD but not with psychopathology.
Study 2
Replicated Study 1 using 77 female veterans. Females Ss were more highly educated, older, more likely to be in a health profession role (trauma was working with death and dying, exposure to sex abuse and harassment, given even less support than the males). Yet women have had a better course of recovery, though rates were the same (30% developed PTSD after return from war).
Correlation with Impact of Event Scale (Intrusion .41 and Avoidance .40), but correlations with MMPI-2 are low (and with other PTSD scales are lower than with the males). Hierarchical multiple regression models show R squared doesn’t increase with DES but does with PDEQ to Intrusion (less so to Avoidance).
This study replicates the same pattern, with peritraumatic dissociation strongly related to PTSD symptoms years later, and not to general psychopathology, even after accounting for the nature of the stress and for the degree of dissociation.
Study 3
After the 1989 Loma Prieta earthquake in Northern California we studied emergency services personnel involved in the collapse of a freeway in Oakland. 1000 rescue workers were involved. The workers (police, fire personnel, paramedics, CALTRANS road workers) involved one I-880 cohort and a replication cohort, with two control groups (smaller scale incidents like attending a child drowned in swimming pool, removing someone from a wrecked auto). In all 3 samples, 90% were male.
What characteristics of the person or their exposure account for which workers go on to cope and which will later have PTSD symptoms? Predictors: IES-I IES-A IES-H M-PTSD SCL-GSI.
Variables most associated with problems 1.5 to 3 years afterward were years of experience, exposure, adjustment (measured by the Hogan Personality Inventory measure of adjustment), social support, DES, and PDEQ. Regression analyses used the best predictors first: forced exposure, adjustment, years experience, locus of control, social support. For Intrusion scores there were modest but significant increments by the DES and PDEQ; for avoidance scores, there were very significant contributions (.072 and .078).
There is a robust relationship between the DES and PDEQ and how much hyperarousal there is afterward (.104 and .110 %). DES measures a trait, PDEQ measures a state; yet the latter continues to contribute even after accounting for variance by the DES.
The PDEQ also has been found to predict among rape victims who will have PTSD. This was replicated in different cultures and different language groups.
FUTURE DIRECTIONS. Authors plan to examine people with moderate to high exposure after the L.A. earthquake. They gathered personality and coping style data on the rescue workers to answer the question: what characterizes those who are more vulnerable to dissociative tendencies during trauma?
There are treatment implications: given that those who develop the most profound response are the ones who will have more PTSD later, what are the implications?
Uncovering the trauma that caused the PTSD is often associated with re- dissociation There is a question of how this should be managed.
The authors will attempt to see if they can predict in advance if a person would dissociate if exposed. Do those who dissociate have more childhood abusive environments? Hypothesis: there may be an interaction of childhood trauma and combat trauma that produces PTSD.
Nash, Michael R. (1994, October). Reports of early sexual trauma: The problem of false negatives and false positives. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Francisco.
NOTES
The problem of false positives and problem of false negatives are distinct and should be treated differently. The question involves pseudomemories vs repression.
Evidence for false positives: 1. Memory research 2. Developmental psychopathology 3. Contemporary psychoanalytic theory 4. Clinical field studies
No laboratory researcher has produced false memories that are as gravid, or as emotionally loaded as early abuse.
Evidence for repression: 1. “Repressor Personality” research (Weinberger & Schwartz, who view it as a trait rather than a state). 2. Implicit memory research 3. Hypnosis research on memory (see Nash chapter in Fromm & Nash book on research in hypnosis) 4. Clinical field studies
1993
Alden, Phyllis A. (1993, October). Hypnosis in the treatment of posttraumatic stress. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL.
NOTES
[Author is at Grimsby Hospital in England.] Discussion of practical aspects of treatment of PTSD. Work began with Janoff-Bulman (1985) and Epstein (1990) focuses on cognitive appraisal. Affect and meaning are shunted into unconsciousness. She observes that when patients report intrusions, there are pieces missing from the memory: they recall the horror but not the positive part.
Used the following technique: Ask patient to get comfortable and imagine being in a theater; then go to a projection room where she can control all parameters; then watch herself watching a pleasant film; then the scene; then return to a seat in the theater and watch the upsetting film, freezing it; when uncomfortable, describe associations; then return to projection room where she watched film of what she imagined might have occurred–the image behind the image, that holds the affect; then going back to image and playing it through, with more comfort; then leave the theater and go into the film, into the screen, to go through the scene. Then asked patient to get back the intrusive image and go through it, which she did with comfort.
With another patient she introduced the “current” person into the image to reassure her that everything would be all right–i.e. she would survive. This is called “double dissociation method.”
She also has the patient tell people in the scene what they should have done, or express anger verbally toward them, etc. Or she might have them make the intrusive imagery less threatening or amusing by introducing other imagery.
Balthazard, Claude G. (1993). The hypnosis scales at their centenary: Some fundamental issues still unresolved. International Journal of Clinical and Experimental Hypnosis, 41, 47-73.
Current approaches to the measurement of hypnotic performance can be traced back to the 19th century. In part because of these early origins and in part because of the nature of hypnotic phenomena, the hypnosis scales are unique psychometric instruments. The classic hypnosis scales are based on the notion of a “performance ladder”; items are scored on a pass/fail basis and can be arranged in incrasing order of difficulty. Some of the implications on [sic]this “performance ladder” approach are reviewed. The evidence for two-mechanism models of hypnotic performance is reviewed. It is argued that this kind of formulation is at least as plausible as one that argues that the hypnosis scales measure “one thing” or “mostly one thing.” If it were the case that the hypnosis scales were tapping two different and distinct processes, the label “hypnotic susceptibility” could not be unambiguously applied to scores on the hypnosis scales. The hypnosis scales would appear well-suited to the investigation of underlying mechanisms, yet no consistent picture of the mechanisms underlying hypnotic performance on the scales has emerged thus far. No resolution is presented, but some of the reasons why such a resolution is so elusive are discussed. The future of hypnosis scales is discussed with respect to multidimensional assessment and alternatives to the “work sample” approach.
NOTES
Author discusses the hypnotizability scales’ history and psychometric properties, suggesting that they cannot have construct validity if more than one construct is involved. He states that many of the alternative formulations “posit structurally similar two- mechanisms models, where the relative contributions of one and the other mechanism changes gradually with the difficulty of the hypnotic performance–that is, one mechanism is more important for easy items and the other more important in the difficult range. This kind of formulation has been advanced by a number of authors ….. Although these formulations are structurally similar, the nature of the mechanisms has been variously conceptualized: nonability and ability components (Shor, Orne & O’Connell, 1962), primary suggestibility and somnambulism (Weitzenhoffer, 1962), minor and major dissociations (Hilgard, 1977), compliance and true hypnosis (Tellegen, 1978-1979), and cooperativeness and expectation at one end and absorption at the other (Spanos, Mah, Pawlak, D’Eon, & Ritchie, 1980). … In a formulation such as Hilgard’s (1977), where both mechanisms are dissociative, it may be that it makes some sense to understand both mechanisms as aspects of the same complex construct. In other formulations… it would appear more cogent to speak of two constructs. Spanos et al. (1980) found that ‘cooperativeness and expectation may be particularly important in responding to ideomotor and challenge suggestions, while the ability to convincingly treat imaginings as real (i.e., absorption) becomes increasingly important for more difficult ‘cognitive’ items” (p. 21). Balthazard & Woody (1992) presented evidence that the more difficult items on hypnotizability scales are related to absorption more than the easier items.
Balthazard & Woody (1989) investigated the proposition that hypnotizability scores are distributed bimodally, and concluded that statistical problems clouded the issue. Furthermore, most analyses previously have been of surface structure, which does not relate directly to the underlying mechanisms of hypnosis, and current psychometric methods cannot address the mechanisms that underlie surface relations. “There are two aspects of hypnotic processes … that obscure underlying mechanism: synergisms and overdetermination. Synergisms occur when mechanisms potentiate each other in such a way that a combination of processes becomes more than the sum of its parts. Overdetermination occurs when co-occurring mechanisms do not potentiate each other, such that any one of the mechanisms would have been sufficient to produce the observed effect” (p. 63-64).
The author suggests there are two options at present: Corrective Scoring (like the Curss.OI, an objective-involuntary score which, although unreliable on test-retest, appears it could be more a measure of “pure” hypnotizability) and not using the typical “work sample” approach. Balthazard and Woody (1992) suggested the Absorption Scale may provide a better measure of “hypnotizability” than the standard hypnosis scales because absorption scores are more strongly related to difficult hypnotic performances.
Cardena, Etzel (1993, October). Trance and possession as dissociative disorders: How exotic are they?. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL.
NOTES: Joke: “What happened to the possessed patient who didn’t pay his exorcist?” Answer: “He got repossessed.”
Began with a quotation of Lagerkvist’s book describing possession of a Sybil in Greek temple. Possession is part of religious experience worldwide, that he is not discussing here.
The revised diagnostic manual, ICD-10, has included “dissociative trance disorders.” To diagnose this one must have either trance (narrowing awareness or focusing and stereotyped movements, behaviors) or possession trance (replacement of sense of personal identity by a new identity, with stereotyped culturally-determined behaviors or movements that are experienced as being controlled by the possessing agent), *and* full or partial amnesia for the event. Cardena emphasizes it doesn’t need to be full amnesia.
To be diagnosed as dissociative trance disorder, the trance or possession state observed cannot be a normal part of a broadly accepted cultural or religious practice, and it must produce distress or maladjustment.
These are the most common type of dissociative disorders in non-Western cultures, e.g. 90% in India. So this diagnosis in India is not “atypical.” “Non-Western” applies to 80% of the World and 1/3 of the USA population. DSM is trying to expand cultural relevance.
Also, even in the Western culture Allison and others have published cases of dissociative trance disorder, and others have described trance disorders:
Spiegel & Spiegel’s Grade 5 personality is vulnerable to dissociative disorder. Hartman’s chronic nightmare patients have “boundary thinness” (i.e. they are not clear if they are awake or asleep, lack separation from themselves and others). Lynn & Rhue’s fantasy prone individuals, 22% of people, are vulnerable to maladjustment.
Cardena’s recommended change in diagnosis of dissociation is critiqued in Transcultural Psychiatric Research Review (1992). Criticisms of the new diagnosis, published int that journal, are: 1. Culture-bound syndromes cut across Western diagnostic boundaries. 2. The diagnosis may be insensitive to the cultural context in which phenomena occur (e.g. distress may lead a person to participate in a cult of affliction) and it may require anthropological sophistication of diagnosticians or consultation with someone who has that knowledge. 2a. It may disregard considerations such as who has the power to “authorize” the phenomenon, under what circumstances, etc. [That would be true with any diagnosis however.] 3.Dissociative Trance Disorder may assume greater within and across-culture uniformity for the conditions than is warranted. 4. It may give validity to metaphysical explanations for spirit possession. [But in psychiatry we often use terms that don’t take into consideration validating metaphysical explanations, e.g. “phantom limb” pain. 5. The medical model that underlies DSM is inappropriate for ontological considerations on the nature of the self. [But those with this diagnosis give us some understanding, not what the ultimate nature of the self and consciousness are. Diagnoses are pragmatic ways of dealing with problems.}
At the present time, the diagnosis of Dissociative Trance Disorder is included in the Appendix of DSM-IV.
For further elaboration of this material, see Cardena, E. (1992). Trance and possession as dissociative disorders. Transcultural Psychiatric Research Review, 29, 283- 297.
Crawford, Helen J.; Gur, Ruben C.; Skolnick, Brett; Gur, Raquel E.; Benson, Deborah M. (1993). Effects of hypnosis on regional cerebral blood flow during ischemic pain with and without suggested hypnotic analgesia. International Journal of Psychophysiology, 15, 181-195.
Using 133Xe regional cerebral blood flow (CBF) imaging, two male groups having high and low hypnotic susceptibility were compared in waking and after hypnotic induction, while at rest and while experiencing ischemic pain to both arms under two conditions: attend to pain and suggested analgesia. Differences between low and highly-hypnotizable persons were observed during all hypnosis conditions: only highly-hypnotizable persons showed a significant increase in overall CBF, suggesting that hypnosis requires cognitive effort. As anticipated, ischemic pain produced CBF increases in the somatosensory region. Of major theoretical interest is a highly-significant bilateral CBF activation of the orbito-frontal cortex in the highly-hypnotizable group only during hypnotic analgesia. During hypnotic analgesia, highly-hypnotizable persons showed CBF increase over the somatosensory cortex, while low-hypnotizable persons showed decreases. Research is supportive of a neuropsychophysiological model of hypnosis (Crawford, 1991; Crawford and Gruzelier, 1992) and suggests that hypnotic analgesia involves the supervisory, attentional control system of the far-frontal cortex in a topographically specific inhibitory feedback circuit that cooperates in the regulation of thalamocortical activities.
Eisen, Mitchell (1993). Assessing the hypnotizability of college students from addictive families. Contemporary Hypnosis, 10, 11-17.
The present study examined the relation between hypnotizability and the report of growing up in an addictive family where one or both parents were addicted to drugs and/or alcohol. A sample of 113 college students (47 male, 66 female) were studied for measure of childhood abuse, addiction history, dissociation and hypnotizability. As predicted, subjects from an addictive family were more hypnotizable than subject from a nonaddictive family. However, no relation between family addiction and dissociation was secured. Whereas abuse was found to be related to dissociation, it was not related to hypnotizability. The findings are discussed in terms of the effects of child abuse and neglect on dissociation and hypnotizability as it relates to the addictive family.
NOTES
Author reviews the literature in area of abuse and hypnotizability as well as dissociation. Subjects were unaware of purposes of the experiment when they volunteered. Of 113 Ss, 18% were reared in an addictive family; 13 Ss reported being abused, of whom 6 reported sexual abuse and seven physical abuse. Five of the 21 Ss who reported being reared in addictive families also reported being abused (3 physical, two sexual). Only one S reported both physical and sexual abuse.
Used HGSHS:A, Children of Alcoholics Screening Test, and Dissociative Experiences Scale of Carlson and Putnam (1986). Those with addiction in the family had Harvard scale mean score of 8.05, compared to those who didn’t have it with mean of 6.95. No significant effect was found for ABUSE or the interaction of ABUSE and family addiction. The abuse question was, “Before the age of 12 parent punishment of you resulted in your physical injury (bruises, scarring, broken bones, etc.). Second question was, “Before the age of 12, did you participate in sexual behaviors (either with or without coercion) with a much older person?”
The Discussion thoroughly explores the possible reasons why their results differ from those of others.
Miller, Mary E.; Bowers, K. S. (1993). Hypnotic analgesia: Dissociated experience or dissociated control?. Journal of Abnormal Psychology, 102, 29-38.
High-hypnotizable subjects were found superior to low-hypnotizable subjects in degree of pain reduction produced by hypnotic analgesia and by a stress- inoculation (cognitive-therapy) procedure. But, stress inoculation and not hypnotic analgesia impaired performance on a cognitively demanding task that competed with pain reduction for cognitive resources. This outcome implies that hypnotic analgesia occurs with little or no cognitive effort to reduce pain, challenging the social psychological theory of hypnotic response, at least in high-hypnotizable individuals. The findings are also incompatible with the concept of dissociated experience wherein the pain and cognitive efforts to reduce it are separated from consciousness by an amnesia-like barrier. But the results do support the concept of dissociated control, which proposes that suggestions for hypnotic analgesia directly activate pain reduction and thereby avert the need for cognitive strategies to reduce pain.
1992
Barrett, Deidre (1992). Fantasizers and dissociaters: Data on two distinct subgroups of deep trance subjects. Psychological Reports, 71, 1011-1014.
The study delineated two subgroups of highly hypnotizable subjects. The first subgroup (fantasizers) entered trance rapidly, scored high on absorption (mean of 34 on the 37-item Absorption Scale), and described hypnosis as much like their rich, vivid, and very realistic waking fantasy life. None of the fantasizers experienced unsuggested amnesia, and 5/19 failed to produce suggested amnesia. Only 2/19 fantasizers described hypnosis as very different from their other experiences. The earliest memories of fantasizers were all identified as occurring before age 3, and before age 2 for 11 of 19. The second subgroup (dissociaters) took time to achieve a deep trance (unlike Wilson and Barber’s fantasy-prone subjects, but they did achieve as deep a trance as fantasizers), experienced hypnosis as different from any prior experiences, and were more likely to exhibit amnesia for both hypnotic experience and waking fantasies. None of the dissociaters described their waking imagery as entirely realistic, and the earliest memories in this group were all over the age of 3 (mean age – 5). Of the 15 dissociaters, 7 scored below the norm on the Absorption Scale (Mean – 26).
Christianson, S-A (1992). Emotional stress and eyewitness memory: A critical review. Psychological Bulletin, 112, 284-309.
NOTES
Although not addressing hypnosis specifically, this is a comprehensive review of literature on memory for negative emotional events relevant to issues of hypnosis and memory. The final conclusion is that emotional events are indeed remembered differently than neutral or ordinary events and are well retained with respect to the event itself and concerning central, critical detail (not peripheral detail). Such memories seem less susceptible to forgetting. There is evidence for dissociation between memory for emotional information and memory for specific event information. There is also evidence of amnesia or memory impairment effects after high-arousal events, with memory increasing as more time passes after the event. The functional amnesia effects are probably due to an interaction between altered encoding operations and the specific retrieval circumstances aiding consciously and unconsciously controlled reconstructive processes. There is little evidence to support Loftus’ contentions that emotional stress is bad for memory.
Claridge, Karen (1992). Reconstructing memories of abuse: A theory-based approach. Psychotherapy, 29, 243-252.
The recovery of traumatic memories is an important part of therapy with survivors of abuse. This article describes a conceptual framework for memory reconstruction based on Horowitz’ (1986) theory of stress response syndromes. The client’s history of intrusive symptoms provides a way to anticipate the nature of the trauma, even when no memory of it exists. Ongoing intrusive symptoms are used to retrieve memory fragments, and their emotional impact is used to build the client’s emotional tolerance. Emphasis is placed on preparing for memories by identifying what the client will need when the memories return, building coping skills, and beginning to restructure cognitions at the “what if” stage of remembering. Case material is used to illustrate.
Dixon, Michael; Laurence, Jean-Roch (1992). Two hundred years of hypnosis research: Questions resolved? Questions unanswered!. In Fromm, Erika; Nash, Michael R. (Ed.), Contemporary hypnosis research (pp. 34-66). New York: Guilford Press.
NOTES
These notes summarize only that part of the chapter concerning nonvoluntary behavior (pp 38-39; 58-61).
The concept of ‘nonvolition’ has been and continues to be an important issue in hypnosis research. The concept pertains to the “subjective report that the hypnotic suggestion is enacted without the subject’s conscious and willful participation” (p. 38). When hypnosis was attributed to a magnetic fluid, in the days of Mesmer, the issue did not arise (because of course a person would not have control over something that happened to them physically). However, when hypnosis came to be considered a psychological phenomenon, the issue of how a behavior could be the result of motivated action and yet not perceived as being under conscious influence became important. In 1819 Faria wrote that the nonvolition paradox is due to the hypnotized subject’s tendency to misattribute the source or reason for one’s behaviors; he noted that successful suggestions depended upon the subject falsely attributing to the hypnotist the power to influence them. From that point forward, circular reasoning was used to state that one is hypnotized if one experiences their behavior as nonvolitional, and nonvolitional behavior signifies that a person is hypnotized.
“The observation of the seemingly complete automaticity of response in the highly hypnotizable subject led Liebeault in his 1866 book (followed later on by Bernheim and Liegeois) to describe these subjects as ‘puppets’ in the hands of the hypnotist. This was a quite unfortunate statement, since it would lead to one of the fiercest legal debates surrounding the use of hypnosis in the last 20 years of the 19th century (Laurence & Perry, 1988). …
“The most prominent author (if not the only one) who attempted to tackle this difficult question was Pierre Janet, who would make the investigation of automatisms the basis of his theory of hypnosis, rather than suggestion or suggestibility. This theoretical orientation is best exemplified by his concept of desagregation psychologique seen in some psychopathologies, or the carrying out of a posthypnotic suggestion in the normal individual (Janet, 1889; see also Ellenberger, 1970; Perry & Laurence, 1984; Prevost, 1973). Nonetheless, until the end of the 19th century, and for a good part of the 20th century, these reports of nonvolition were thought to be the end result of some neurological changes happening during hypnosis–an idea that has not been substantiated by contemporary research.” (pp 38-39)
Reports of nonvolition are explained as due to dissociation by Hilgard, or as the results of misattributing the origins of behaviors and experiences by Spanos and by Lynn. Neodissociationists like Hilgard regard misattribution to be a cognitive alteration, mainly an internal triggering mechanism, while social psychologists like Spanos and Lynn regard the misattribution to be the results of situational demands and therefore an external triggering mechanism.
“Regardless of one’s preferred metaphor, the issue of nonvolitional reports remains at the core of an integrated view of hypnosis and hypnotizability. The question remains as follows: By which mechanisms does this occur, and how can we predict a priori who will report involuntariness and under what circumstances? Whereas dissociationists have emphasized general cognitive mechanisms and de-emphasized situational factors, social- psychological theorists have emphasized situational variables and de-emphasized individual differences. Given the limitations of both approaches, emphasis will have to be placed not on their continued separation but on their integration, as more and more investigations demonstrate that they clearly interact with each other (see, e.g., Nadon, Laurence, & Perry, 1991).” (p. 60)
“At the height of the confrontation between the two French schools, hypnosis found its way into the legal arena. Following a series of criminal cases in which hypnosis had been allegedly involved, the two schools once again found themselves on opposite sides of the fence. For La Salpetriere, only those who had a propensity toward criminality (and hystericals were prime candidates) could be the victims of hypnosis. For the Nancy school, in highly responsive individuals suggestions could lead to criminal behavior. Unfortunately for the Nancy school, it soon became evident that the concept of suggestion was not sufficient in explaining the questions raised by the courts, and Bernheim was forced to recognize that in cases where suggestions had played a role, other dispositional and situational factors were probably more important in the genesis of the reprehensible behaviors. His espousing a too extreme position meant that the baby was thrown out with the bathwater. History may indicate that the same fate is now awaiting contemporary theoretical positions that adopt an extreme stance vis-a-vis the phenomenon of hypnosis” (p. 61).
Erdelyi, Matthew, Hugh (1992). Psychodynamics and the unconscious. American Psychologist, 47, 784-787.
The original New Look integrated the constructivist-psychodynamic traditions of Bartlett and Freud. The unconscious (Greenwald’s “New Look 3”) is a logically different idea, although in practice it is often intertwined with constructivist – psychodynamic approaches. The unconscious is a pretheoretic term with a variety of problems: It has multiple and unsettled meanings; null reports need not signify null awareness; the conscious-unconscious dichotomy implied by the limen may not exist; even “absolute subliminality” (chance-level accessibility) is relative to the time interval of testing, as accessibility can increase to above-chance levels over time (hypermnesia). Yet, the phenomena that the unconscious sloppily subsumes are not simple or dumb. The capacity of subliminal perception should not be confused with the capacity of subliminal (unconscious) memory and cognition.
Frischholz, Edward J. (1992, October). Dissociation. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington, VA.
NOTES
There are two approaches for studying dissociation 1. phenomenological: describe difference types of dissociative phenomena, e.g., forgetting, multiple personality disorder or MPD 2.theoretical: explain the physiological/ psychological processes by which things become associated/disassociated, e.g., Freud (repression) vs. Janet (dissociation).
Two types of dissociation: 1. dissociation of awareness (amnesia, unconscious cognitions) 2. dissociation of volition (loss of executive control over behavior, psychological automatisms)
Normal Dissociation is characterized as: 1. content is narrow and specific 2. duration is brief 3. awareness of loss of material exists 4. control can be re-established
Abnormal Dissociation is characterized as: 1. content is broad (self-identity) 2. duration is extended 3. no awareness of loss of material exists 4. no re-establishment of control
The most widely used measure is Dissociative Experience Scale (Bernstein & Putnam) which has .84 to .96 test-retest correlation (Bernstein & Putnam, 1986; Frischholz et al.)
Mean Scores for DES MPDs 55. DD NOS 40.8 Students 23.8
He advocates a cutoff score above 40 as indicating abnormal dissociative experiences (that would yield 6% false negatives). Above 65, suspect faking or over- reporting of dissociative experiences.
Factor Analysis of the DES would associate the following items: 1. Absorption Factor: 2, 14, 15, 17, 18, 20 (normal dissociation) 2. Amnesia Factor: 3, 4, 5, 8, 25, 26 (pathological dissociation) 3. Depersonalization/Derealization Factor: 7, 12, 13, 14, 27, 28
Correlations of DES with other tests:
Tellegen Ambiguity Jenkins
Absorption Tolerance Activity DES Total .39 .24 .04 DES Amnesia .24 .22
See Table from AJCH in July 1992, which replicates a study by Nadon Table 2 r = .12 with hypnotizability (Nadon reported .18).
One could use both the DES and hypnotizability scores to distinguish between different clinical groups. For example, dissociative patients reverse amnesia while schizophrenics don’t.
One could distinguish real MPDs vs Simulators based on Special Hypnotic Phenomena: with Real MPDs half show the hidden observer phenomenon, therefore they hide their MPD; simulators show the hidden observer phenomenon 100% of the time. Another item that discriminates is the Orne Double Person Hallucination item. MPDs 50- 62% show it, but 92-80% [incorrect percentage in these notes?] of simulators do experience the hallucination. Of these 70-75% of the MPDs are able to distinguish the hallucination; only 45-40% of simulators are able to distinguish the hallucination. Real MPDs know, can tell difference between a hallucinated person and the real person whereas simulators maintain they can’t tell who is the real person.
It’s not true that MPDs are extremely high in hypnotizability. They score in 8-10 range. The MPDs score 1 SD above normals but they are not off the end of the scale.
These are good ways of testing whether someone is faking MPD. We have replicated this many times, getting better replication of MPD simulators than high hypnotizable simulators.
Another method for distinguishing true MPDs from simulators involves demonstration of the Einstellung (learning set) effect.
Looking at Water Jar Problems, patients learn to solve the problems the long way. They teach personality A how to solve problem by long solution method (four trials of B – A – 2C); on the fifth trial, 95% of Ss solve the problem by the long method, the Einstellung (learning set) effect. Switch to personality B and give the same test. If there were no transfer, people immediately see A-C, which is a short method for solving the problem. It has been observed that 50-60% of MPDs do not show Einstellung effect; they immediately see the short solution.
Have done this also with retroactive interference word learning model.
Effect of context. Kohlenberg (Behavior Therapy Journal) selectively reinforced one personality of an MPD, which then ‘came out’ more often; during extinction the frequency of seeing that personality went back to baseline.
I used Greenspan’s and Erickson’s learning without awareness paradigm. When a low baseline frequency personality emerged, I’d reinforce the person; when a dominant personality came out I’d start yawning, look out the window, etc. During extinction the frequency went back toward normal baseline level, but not all the way. These indicate you can shape the appearance of one personality, but not that it’s iatrogenic.
Can also do this with schizophrenics, normal highly hypnotizable subjects.
Frischholz, Edward (1992, October). The dimensionality of hypnotic performance. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington, VA.
NOTES:
A 1985 article by Balthazar & Woody in Psychological Bulletin is the best I have read on this topic, and on how factor analysis can be used fruitfully.
Many people using the same data sets have arrived at difference conclusions. My results are based on two data sets: Balthazar & Woody’s, in which they created a unidimensional scale. (If you factor analyze a simplex matrix you obtain a 3 factor matrix; yet you knew it was unidimensional. They pointed out the 2nd factor correlated with item difficulty, and the 3rd factor had a U-shaped correlation with item difficulty.)
Factor analysis may not be best way to demonstrate unidimensionality.
I decided to use non metric multidimensional analysis to confirm unidimension. By this, Form A appears to be multidimensional. The same holds true for Stanford Form C scale.
Interpretability of the different dimensions? I agree with Dr. Stone: unidimensions are better for interpreting tests. But you should start out by constructing one in the first place.
I argue that Form C is unidimensional, because the items were selected by using item/full score correlations, hence a first component was built into it. But what does the scale measure? The only way to know is to correlate it with external measures, like Woody does. There are no studies using factor analysis showing that different factors on hypnotizability tests have different correlations with external measures (e.g. Factor 1 doesn’t correlate differently with Absorption than Factor 3).
We might better start with a theory if we are going to construct new hypnotizability scales. Don’t just use item total correlations. It would be better to find items representing different dimensions, scale the items, then correlate them with different external referents.
Then when we do collect data, make sure the items are unidimensional representations.
Third, we should appropriately validate these dimensions.
Frischholz, Edward J.; Lipman, L. S.; Braun, B. G.; Sachs, R. G. (1992). Psychopathology, hypnotizability, and dissociation. American Journal of Psychiatry, 149, 1521-1525.
This study sought to replicate and extend previous findings regarding the hypnotizability of different groups. They compared the hypnotizability of four psychiatric groups–dissociative disorders (N = 17), schizophrenia (N = 13), mood disorders (N = 13), and anxiety disorders (N = 14), as well as a normal college student group (N = 63). Hypnotizability was assessed by four different measures: the eye-roll sign and the induction score of the HIP, the Stanford Hypnotic Susceptibility Scale, Form C, and two self-ratings of hypnotizability. As predicted, dissociative disorder patients had significantly higher hypnotizability scores on al measures than all other groups. Schizophrenia patients, on the other hand, had significantly lower scores than normal subjects on the eye-roll sign and induction score, but not on the other measures. Some other unpredicted between-group differences were also found. Nevertheless, despite the between-group differences, the intercorrelations between the various hypnotizability measures within the normal group were very similar to those observed in the combined patients groups. Findings suggest that routine hypnotizability assessment may be useful in the differential diagnosis of patients with dissociative disorders.
Giolas, M. H.; Saners, B. (1992). Pain and suffering as a function of dissociation level and instructional set. Dissociation, 5, 205-209.
48 female student Ss who scored above 20 on the Dissociative Experiences Scale and 48 subjects scoring below 20 on the DES were compared for response to ischemic pain. Experimental conditions included (1) a group imagining their arm becoming numb and insensitive, (2) a distraction group focusing on their breathing, and (3) a control group with no instructions. Subjects rated pain at one-minute intervals for the sensory experience of pain and for suffering (the emotional experience). The procedure was ended at subject’s request or after 20 minutes. Across all conditions, the high dissociative group tolerated pain significantly longer than low dissociatives. Analysis revealed lower suffering ratings for high dissociators in the condition where, like in hypnosis, they imagined their arm numb. This is consistent with beliefs that during abuse in childhood the child learns to use imagination to reduce suffering.
Hargadon, Robin M.; Bowers, Kenneth S. (1992, October). High hypnotizables and hypnotic analgesia: An examination of underlying mechanisms. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington, VA.
NOTES
Bowers’ dissociated control adaptation of Hilgard’s neodissociation theory of hypnosis posits that higher control systems are not used if lower systems are activated.
Imagery may be less important for achieving hypnotic effects. It also may contribute differently than previously thought, an uncorrelated factor. If imaginal involvement and imagery is integral to the production of analgesia using hypnosis, one would get results different than if not integral.
Research: 65 Ss rated as high on two hypnotizability tests participated.
Session 1:
Procedure entailed finger pressure pain: baseline, followed by 2 hypnosis treatment trials. Ss were not informed of the second trial before they did the first.
Standard suggestions: imagery congruent with the suggestion (hand like block of wood, protected by a glove)
Imageless condition: your hand will remain comfortably nonresponsive to the pressure; you will not allow other things to come into your mind.
Outcome Measures
Analogue scale for pain 0-10
Nonvoluntary experience rated 0-4
Session 2:
Administered Tellegen Scale, Woody & Oakman Scale, Marks Vividness of Imagery, Bowers’ Effortless Experiencing, and Duality of Experience during age regression.
RESULTS. No difference was found between the standard and imageless conditions in amount of pain reduced. So in high hypnotizables, use of imagery or not doesn’t matter for controlling pain. Some Ss had a clear preference however, for one or the other method (even counter to their own expectations).
Feelings of nonvolition did not differ as a function of imagery use.
Multiple regression showed effects of hypnotizability and effortless experiencing. Ss who have an effortless experiencing of imagery benefit from using it to reduce pain; those who find it more effortful do better without imagery when attempting to reduce pain.
Contrary to last year’s results reported by Bowers, high imagery was related to duality of experiencing in age regression.
Dissociated control theory is consistent with the results but not necessarily demonstrated. It is important to discriminate between imagery as a mediator rather than as a co-occurrence. This research suggests, as did Zamansky’s work on counter suggestions, that imagery is not as critical for hypnotic response as we previously thought.
Hilgard, Ernest R. (1992). Dissociation and theories of hypnosis. In Fromm, Erika; Nash, Michael R. (Ed.), Contemporary hypnosis research (pp. 69-101). New York: Guilford Press.
NOTES:
[These Notes were made from a prepublication copy and the pagination for quotes added later.]
The author reviews the history of dissociation theory, the hidden observer, and the credible-skeptical arguments regarding hypnosis. He briefly summarizes alternative theories about hypnosis, and asserts that we can turn aside from debate by examining the common topic studied, the “domain of hypnosis” or what happens when hypnotist, with consent of subject, attempts to induce hypnosis through conventional procedures: production of hallucinations, contractions, paralyses, age regression, analgesia, posthypnotic amnesia, etc. Even if one disagrees about the nature of these phenomena or the appropriate explanatory concepts, one can agree on the area to be investigated.
The author notes that one never sees these behaviors in the same situation, in any other context. They are distinguishable from other phenomena like meditation, highway hypnosis, responses to a persuasive leader, and even some waking suggestions by several delimiting factors:
1. Hypnosis is not simply a response to suggestion, because that kind of response occurs in other situations. Suggestions can be divided into personal and impersonal (Hull, 1933); and suggestibility can be divided into primary and secondary (Eysenck & Furneaux, 1945). Primary suggestibility includes responses to waking suggestion (e.g. postural sway) that correlate with hypnotizability; secondary suggestibility involves responses to waking suggestion that do not correlate with primary suggestibility. Hypnotizability does not correlate with social suggestibility (i.e. gullibility or conformity) (Burns & Hammer, 1970; Moore, 1964); nor does it correlate with placebo response (McGlashan, Evans, & Orne, 1979).
2. Test-retest correlations are approximately +.70 between scores on hypnotizability scales with and without formal inductions. Thus, responses to the type of suggestion on hypnotizability scales–even when in the waking context–belong within the domain of hypnosis. The individual differences in responsivity to items on hypnotizability scales persist over time (Piccione, Hilgard, & Zimbardo, 1989: r = .64 for 10 years test- retest, .82 for 15 years, and .71 for 25 years, on Stanford Form A); and this persistence is observed in twin studies as well (Morgan, 1973; Morgan, Hilgard, & Davert, 1970).
3. Additional evidence of coherence of the domain comes from reports of hypnotized Subjects about their phenomenological experience.
Hilgard’s discussion of the executive and monitoring functions within hypnosis place his theory within the area of cognitive psychology. He presents a theory of a central regulating mechanism, with a hierarchy of subsystems that may be activated (and once activated may continue with some autonomy). When autonomous action occurs, the conscious representation of the control system may recede. Furthermore, the hypnotist’s suggestions may alter the relationships within the hierarchy of subsystems and may also influence the executive functions. He gives as a common example, when a bilingual person talks in one language, the other language is temporarily inhibited.
There are a number of concepts or positions in the history of psychology that relate to Hilgard’s theory of hierarchical control with executive and subsystems:
1. ‘Cognitive structure’ (Edward Tolman, 1932; 1938; Kurt Lewin, 1935). There may be communication problems between cognitive structures.
2. ‘Habit family hierarchy’ (Clark Hull, 1934). Habits are organized in a preferential system, so that if one is blocked the next is activated.
3. ‘Cell assemblies’ (Hebb, 1949; 1975), which are a physiological counterpart of the ‘hidden observer’ phenomenon.
4. ‘Roles’ (Sarbin & Coe, 1972) may be considered cognitive substructures.
5. ‘Cognitive networks’ (Blum, Geiwitz, & Stewart, 1967) serve similar functions.
6. ‘Images’ and ‘plans’ (Miller, Galanter, & Pribram, 1960) provide for control of thought and action and have some kind of hierarchy.
7. ‘Subordinate ego-structures’ (Gill & Brenman, 1959) with a dominant ego; or the ego-apparatuses in a ‘conflict-free ego sphere’ (Hartmann, 1958).
In hypnosis, central executive functions may be shared between hypnotist and Subject. Hilgard gives extensive examples of varying degrees of split in the executive control system.
“It can be argued that, except for relinquishing control over the subsystems that are specifically dissociated from control by suggestion, and the readiness for relinquishing control, the central executive functions have not been much modified in hypnosis. In superficial hypnosis, these mild dissociations can occur through waking suggestions, with little alteration of the general state of consciousness. When varied suggestions to a talented hypnotic subject have cumulative effects, as in suggestions of relaxation and detachment from the environment, the more general features of the hypnotic state begin to appear. A more massive dissociation, so far as the executive is concerned, may be the consequence of the summing up of many specific subsystems for which control has been relinquished. Such an interpretation permits hypnosis as a state to be a relative matter, the specific dissociations being identifiable, but the general state being a matter of how many specific dissociations are operative and how pervasive they are. Only when they are sufficiently pervasive is it appropriate to speak of a change of state” (p. 96).
Hilgard also discusses the monitoring function extensively, relating it to trance logic and contrasting it with the waking state. Less of the usual monitor is retained when the hypnotic involvement is greater, as in deep hypnosis, or when the subject becomes more deeply engrossed in an activated system that has been aroused. He also relates the monitoring function to the Hidden Observer phenomenon.
Holroyd, Jean (1992). Hypnosis as a methodology in psychological research. In Contemporary hypnosis research (pp. 201-226). New York: Guilford Press.
NOTES:
This chapter deals with how the changes brought about by hypnosis (in cognition, behavior, motivation, etc.) may be used in research in other areas of psychology. “The distinction between experimental effects attributable to a personality trait (i.e. hypnotizability), hypnosis context (i.e. an induction), and interaction between the two is particularly important in using hypnosis as a research strategy.
The author discusses suggestibility, imagery enhancement, and changes in the mind-body relationship (immunology, pain, cognitive neuropsychology, attention, learning and memory, and awareness) as they might be employed in social psychology or psychophysiology research. She reviews problems inherent in using hypnosis as part of the research methodology, while noting that hypnosis nevertheless offers new information when introduced into traditional content areas. “For example, in cognitive psychology it has re-introduced the importance of studying experiential aspects of cognition, i.e. I think, I remember, or self reference (Kihlstrom, 1987)” (p. 223).
She concludes, “Hypnosis as a research method will continue to benefit from contributions of radically different theoretical views of hypnotic phenomena. Social- cognitive psychologists have contributed significantly toward unifying the fields of hypnosis research and general experimental psychology. At the same time, advances in neurophysiology and psychosomatic medicine employing hypnosis indicate that there is a role for hypnosis as a research strategy, solely because of its altered-state characteristics. If theoretical physics can reconcile both wave and particle theories of light, it is conceivable that psychology can accommodate both behavioral and state theories of hypnosis” (p. 224).