Subjects were 252 psychology students, 128 male and 124 female; 22% had previously sought counseling and 34% had previously been clinically depressed.
Jupp, J. J.; Collins, J. K.; Walker, W. L. (1989). Relationships between behavioural responsiveness to hypnotic suggestions and estimates of hypnotic depth following 11 sequential instances of hypnosis. Australian Journal of Clinical and Experimental Hypnosis, 17, 93-98.
Behavioral responsiveness to suggestions was assessed in an initial hypnosis session, and hypnotic depth was assessed in this session, followed by 10 weekly standardized hypnotic experiences. Correlations were calculated between behavioral responsiveness, initial and subsequent depth estimates, and between successive trance depth estimates. Levels of trance depth estimates were found to increase through weeks 1 to 11. Significant positive correlations were found between behavioral responsiveness scores and trance depth estimates to the fourth week but not beyond. Significant positive relations were found between successive estimates of trance depth except for the correlation between estimates for the fourth and fifth weeks. These results are discussed in terms of the estimates of trance depth being attributions from self-observations of behavioral responsiveness to hypnotic suggestions.
Ronnestad, Michael Helge (1989). Hypnosis and autonomy: A moderator analysis. International Journal of Clinical and Experimental Hypnosis, 37, 154-168.
The study focused on autonomy as a moderator variable in the prediction of subjectively reported hypnotic depth. Ss in the experimental part of the study were 56 undergraduate psychology and education majors classified as either high or low in autonomy. Ss who were equated on capacity for absorption were individually administered 1 of 3 hypnotic inductions: an authoritarian induction, a permissive hetero- induction, or a self-hypnosis induction. The study had a double-blind design. The data suggest that situational manipulation has greater impact on low than on high autonomy Ss. Individual-difference variables such as absorption, have greater impact on hypnotic depth for high than for low autonomy Ss. The data indicate that the hypnotic behavior of high autonomy Ss is more likely to be self-congruent and less likely to be demand-congruent. A factor-analytic inquiry of absorption confirmed the importance of affective/regressive capacity for hypnotic functioning for high autonomy Ss. The study supported the alternate-path perspective of hypnosis.
NOTES
There is very little research on autonomy and hypnosis. The authors cite studies showing only a modest relationship between hypnotizability and locus of control.
In this study, 176 students were assigned to the high autonomy group if they were in the upper 1/3 of two of 3 autonomy scales (Rotter’s Locus of Control Scale, the Inner- Directedness Subscale of the Shostrom Personal Orientation Inventory, and the Autonomy subscale of Jackson’s Personality Research Form) and not in the lower 1/3 of the third scale. Ss were designated as low autonomy if the obverse obtained. This procedure yielded 27 high and 29 low autonomy Ss.
Ss were hypnotized with one of three inductions: authoritarian with many motor items (Barber Suggestibility Scale), permissive with mostly imagery (Barber & Wilson’s Creative Imagination Scale), or guided self-hypnosis with mostly imagery (taken from Fromm et al, 1981). After hypnosis, Ss rated their own hypnotic depth on a 1-10 scale, and their perception of E or the procedure as authoritarian and directive. Ss’ attitude, expectations, motivation, and experienced effortlessness were measured. E rated Ss for pre-hypnosis rapport and post-hypnosis rapport.
The results indicated that there was no difference in hypnotizability level between high and low autonomy Ss. The correlation between effortlessness of experience and hypnotic depth was high for low autonomy Ss (.51) but not significant for high autonomy Ss (.12). In general the two groups were very similar in terms of mean scores on most variables. The differences appeared in the correlations between self-reported hypnotic depth and the other variables. For low autonomy Ss correlations were not significant between depth and pre-hypnotic variables (rapport-pre, absorption, expectation) but for highs the same correlations were significant (rapport-pre .47, absorption .54, expectation .48).
But for post-hypnosis variables, low autonomy Ss had significant correlations between depth and the two variables measured from post-hypnosis interviews (perceived authoritarian/directiveness .40, effortlessness .51) and the highs did not have significant correlations. The multiple correlation between these variables and depth was R = .28 for low autonomy Ss (with no contribution from rapport-pre) and R = .72 for high autonomy Ss, with absorption contributing most. The more they perceived the induction as authoritarian or directive, the greater depth reported by low autonomy Ss. Although low and high absorption Ss did not differ on the Absorption Scale, absorption predicted hypnotic depth better for the highs.
The author divided the Absorption Scale into four rational factors: Affective/Regressive, Perceptual/Cognitive, Dissociative, and Mystical. Low and high autonomy Ss scored at approximately the same level on these categories, but correlations between these categories and depth for low and high autonomy Ss were somewhat different. (See Table.)
Correlations between Categories of Absorption and Hypnotic Depth for Low and High Autonomy Ss
Absorption Low Autonomy High Autonomy All Ss Category r r r
Affective/Regressive .14 .56** .33** Perceptual/Cognitive .25 .33* .29* Dissociative .32* .57** .47** “Mystical” .07 .16 .11
In their discussion, the authors note that one might assume that high autonomy Ss would be less affected by variations in hypnosis procedures than low autonomy Ss. The differences found in depth scores for these two groups were supportive of this expectation. “Fluctuations in subjectively reported depth scores for low autonomy Ss only, clearly suggest autonomy to be a moderator variable” (p. 163).
Moreover, the results indicate “that high autonomy Ss in comparison to low autonomy Ss are more likely to express their inner dispositions, such as absorption and expectation, in the hypnotic setting. High autonomy Ss may be more reflective of and attuned to individual predisposing characteristics and less influenced by situational demands. … the hypnotic behavior of high autonomy Ss is more likely to be self- congruent and less likely to be demand-congruent. Low autonomy Ss, however, are more likely to be demand congruent and less likely to be self-congruent. The latter finding was suggested both by the significant F ratio for low autonomy Ss across treatments, and also by the stronger relationship found for this group between depth and how authoritarian/directive they perceived the procedure to be” (p. 163).
[Paradoxically, among low autonomy Ss an authoritarian approach yields less depth but greater suggestibility (higher hypnotizability scores).] “The tendency for low autonomy Ss to have a higher behavioral score on the authoritarian procedure is consistent with Tellegen’s (1979) assumption that there are two pervasive dimensions in current hypnotizability measures–a compliance dimension and a true hypnotic responsiveness dimension. According to Tellegen, motor items may be more saturated with compliance, while cognitive items may be more saturated with true hypnotic responsiveness. The BSS has a motor emphasis, and the higher behavioral scores for the low autonomy group of Ss may be interpreted as an expression of compliance.
“In addition to the inner-directedness and self-congruence hypothesis of why autonomy may be a moderator variable, another possible explanation is related to accuracy of self-perception. The intercorrelational and multiple regression data showed repeatedly that a stronger relationship existed between prehypnotic variables and hypnotic depth for high autonomy than for low autonomy Ss. The relational capacity, as tapped by the rapport-pre variable, absorption, which may be conceptualized as a personality trait; and expectation, a cognitive variable, were all related to depth for high autonomy Ss. For low autonomy Ss, none of these variables were individually related to depth. Differences in Ss’ accuracy of self-reporting may explain this. According to ego-psychology theory, highly individuated Ss, with clear self-other differentiation and congruence in self-perception, are better able to make accurate statements about themselves. The self-assessments of Ss with low differentiation capability may be less accurate and possibly more affected by demand characteristics and response set. In other words, their self-assessments have more error. The generally lower correlations for the low autonomy Ss may reflect this” (p. 164).
“A report of subjectively reported hypnotic depth following CIS and the self- hypnosis scales may reflect clarity of imagery, while a report of depth following BSS may reflect experiences of kinesthetic/bodily changes” (p. 165).
1989
de Groh, Margaret (1989). Correlates of hypnotic susceptibility. In Spanos, Nicholas P.; Chaves, John F. (Ed.), Hypnosis: The cognitive-behavioral perspective (pp. 32-63). Buffalo, NY: Prometheus Books.
NOTES
The author describes a non-linear relationship between imagery and hypnotizability and between absorption and hypnotizability. People good at imagery may be high or low on hypnotizability scales; the same is true for people high on absorption trait. However, people low on those traits generally are low on measured hypnotizability.
1988
Elton, D.; Boggi-Cavallo, P.; Stanley, G. V. (1988). Group hypnosis and instructions of personal control in the reduction of ischaemic pain. Australian Journal of Clinical and Experimental Hypnosis, 16, 31-37.
Three groups of students were tested on ischemic pain threshold and pain tolerance. The control group of 95 subjects received a single pain test. The hypnosis group of 42 subjects received a single session of hypnotic induction prior to the pain test. The hypnosis and personal control group of 32 subjects received hypnotic induction and suggestions of personal control prior to the pain test. The hypnotic procedure included the use of a pendulum, coupled with suggestions of arm elevation and lip analgesia. It was found that hypnotic induction resulted in lower [sic] pain threshold and pain tolerance. Suggestions of personal control and hypnosis further lowered [sic] the pain measures.
NOTES
The ABSTRACT appears to have mis-statements, for the word should be “higher” or “raised.” In the article the results are stated as, “The hypnosis conditions with suggestion of personal control produced the higher pain threshold (mm/Hg) and longer tolerance (seconds) than the hypnosis only group and both hypnotic inductions produced higher threshold and longer tolerance than the control condition” (p. 35)
“The results suggest that a single brief group session of hypnosis can produce a significant change in response to ischaemic pain. The added instruction of increased personal control produced a greater effect and reinforces the importance of the self concept in the reaction to pain” (p. 36).
Gorassini, Donald R.; Hooper, Cynthia L.; Kitching, Kathleen J. (1988). The active participation of highly susceptible hypnotic subjects in generating their hypnotic experiences. Imagination, Cognition and Personality, 7 (3), 215-226.
Hypnotized individuals have traditionally been considered to be detached from the control of their own suggested behavior. We tested this and the alternative notion that hypnotized subjects attempt to self-generate the experiences (i.e., mainly of involuntariness) as well as produce the behaviors thought to be prototypical of high hypnotic ability. In an experimental investigation, highly susceptible hypnotic subjects were found to engage in the kind of imaginative activity that would be expected of individuals who were attempting deliberately to generate their experiences of involuntariness; they engaged as actively in imagery-generation as did subjects who were specifically instructed to imagine during suggested responding, and they experienced as much involuntariness as subjects in whom suggested movements were produced by an external physical force. The implications of these findings for the neodissociation and social psychological theories of hypnotic responding are discussed.
Katsanis, Joanna; Barnard, Joanna; Spanos, Nicholas P. (1988). Self-predictions, interpretational set and imagery vividness as determinants of hypnotic responding. Imagination, Cognition and Personality, 8 (1), 63-77.
Two studies assessed the effects of self-predictions and interpretations of suggested demands on hypnotizability. Subjects overestimated their responsiveness to suggestions. Those who believed that they would fail all or almost all suggestions invariably attained low hypnotizability scores. However, those who believed that they would be highly responsive exhibited wide variability in their actual hypnotizability. Among subjects who self-predicted high responsiveness, those who adopted a passive “wait and see” interpretation toward suggestions scored significantly lower in hypnotizability than those who believed that they should actively bring about suggested effects. Study 2 also found that the relationship between adopting an active interpretation and hypnotizability was moderated by subjects’ level of imagery vividness. Theoretical implications are discussed.
Pavia, M.; Stanley, R. O. (1988). Effect of defining induction as hypnosis or relaxation. Australian Journal of Clinical and Experimental Hypnosis, 16, 11-21.
Previous studies have shown that the perceived definition of an induction may sometimes affect the subject’s responses to the induction. These variations in the effect of induction definition may be due to interactions between a subject’s motivations and expectations of the induction technique and the way the induction is defined. These authors explored this interaction with groups of clinical and student subjects. Differing definitions of induction as ‘hypnosis’ or ‘relaxation’ did not result in significant differences in response among either group, though subjects in neither group were found to have high expectations of motivation (sic).
Perry, Campbell (1988, November). An interactionist position on hypnosis. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Asheville, NC.
NOTES
Context makes differential contributions across items on scales, e.g. amnesia depends mostly on individual differences. Yet in the 19th Century it occurred almost inevitably, spontaneously, because of expectancy of therapist and patient.
Success in pain reduction is much greater in clinic (Crasilneck; Melzack et al; Cedercrentz – skull injury) than in lab (Hilgard’s studies of highs and lows).
Central to the disagreement about special state/socio-behavioral theories is the question, “What are the origins of beliefs about hypnosis?” The beliefs can be modified by experience, which is mediated by individual differences.
Author suggests trying to predict which individual will respond to which hypnosis item. Since there are at least 3 factors in hypnotizability scales, one needs a number of variables to do this type of research. Nadon et al (Journal of Personality and Social Psychology 1987) predicted hypnotizability with PICS (an imagery control test) and Absorption scale plus Evans’ Sleep Questionnaire subscale plus Belief in [paranormal events] subscale: predictions were 63% correct. PICS (as compared with other imagery tests) reflects imagery as a _preferred mode_ of thinking. Now, can we predict who will make highly confident errors when asked to remember details of a crime? Who is more vulnerable when told a pseudomemory is veridical?
In a test of this question, mimicking a field setting, the authors weren’t able to predict the people who would make errors, who functioned at the same level following neutral instructions (“We don’t know what we’ll find”) and Reiser-type instructions (“You can use a zoom lens to see the scene up close”) in hypnosis. Also, the effect of an increase in confident errors was greater for highs than for lows. People with high hypnotizability and low PICS made the most errors. N.B. Since lows also increased in errors, one should be cautious in any case.
Creation of pseudomemory research: Using SHSS:C and PICS one can predict 81% of those who accepted and reported the implanted
Bandura, A.; O’Leary, A.; Taylor, C. B.; Gauthier, J.; Gossard, D. (1987). Perceived self-efficacy and pain control: Opioid and non-opioid mechanisms. Journal of Personality and Social Psychology, 53, 563-571.
NOTES
Subjects who were trained to use psychological coping strategies (e.g. imagery, distraction, dissociation, sensation transformation) had both better pain tolerance on a cold pressor test and higher self efficacy ratings. Those subjects who were given naloxone (which blocks pain reduction effects of beta endorphins) showed more pain tolerance than subjects not given the cognitive training experiences. They attributed much of the pain tolerance increase associated with cognitive interventions to opiate release, suggesting that cognitive interventions may have physiological mediating effects on pain perception.
Evans, Frederick J.; McGlashan, Thomas H. (1987). Specific and non-specific factors in hypnotic analgesia: A reply to Wagstaff. British Journal of Experimental and Clinical Hypnosis, 4, 141-147. (Comment in response to Wagstaff, G. (1987). Is hypnotherapy a placebo? Hypnosis, 4, 135-140.)
NOTES
This article is a reply to Wagstaff’s (1984) critique of the McGlashan, Evans & Orne (1969) article which was entitled “The nature of hypnotic analgesia and the placebo response to experimental pain,” published in Psychosomatic Medicine, 31, 227-246. The paper to which the authors are replying is Wagstaff, G. F. (1984). Is hypnotherapy a placebo? Paper given at the First Annual Conference of the British Society of Experimental and Clinical Hypnosis, University College, London. An abridged version appeared in the British Journal of Experimental and Clinical Hypnosis, 1987, 4, 135-140.
The closing comments of this Evans & McGlashan 1987 paper read as follows: “The strategy in this study [i.e. McGlashan, Evans & Orne, 1969] was quite different from the usual experimental design. Our goal was to _maximize_ all of those non-specific factors that we could build into the experimental procedure. Only by attempting to maximize non-specific effects is it possible to see whether hypnosis in appropriately responsive subjects can exceed that degree of pain control which occurs due to the maximal operation of these non-specific effects. These non-specific components of the hypnotic situation may account for a great deal of clinical change. … The critical finding was that hypnosis did add a level of pain control that occurred after maximizing clinically related non-specific factors contributing to change in pain tolerance, and that this increased tolerance occurred only in subjects markedly responsive to hypnosis, in contrast to the significant non-specific effects which were uncorrelated with measured hypnotizability” (pp. 143-144).
The principal findings of the McGlashan, Evans & Orne (1969) study were: “(a) The improved ability to tolerate pain following the ingestion of placebo was roughly the same for high hypnotizable and low hypnotizable subjects. (b) The response to the non-specific aspects of taking a ‘drug’ among low hypnotizable subjects was identical to, and highly correlated (.76) with, their response to the legitimized expectation that change would occur under hypnosis for low hypnotizable subjects. The placebo component of a believe-in ‘drug’ ingestion was the same as the placebo component of a believed-in hypnotic experience for these low hypnotizable subjects. (c) The performance of the highly hypnotizable subjects was significantly greater under hypnotic analgesia conditions than it was under placebo conditions.
“This last finding is important conceptually, though of less clinical relevance. It should be noted that not all high hypnotizable subjects showed this result. Even among highly hypnotizable subjects, not all of them had the experience that profound analgesia had occurred! Thus, based on their subjective experience of the relatively small degree of analgesia, 6 of the 12 highly hypnotizable subjects behaved exactly as the low hypnotizable subjects had — their placebo and hypnotic responses were small, significant, but equal. Only 6 out of 12 carefully screened hypnotizable subjects who subjectively experienced marked analgesia showed dramatic objective changes in pain endurance. Dr. Wagstaff might consider the physiological implications of the observation that we became somewhat frightened about the possibility of tissue damage with two of these six subjects. We had to stop their performance at a point where physiologists had assured us that tissue damage could be expected. They had also assured us, wrongly for these subjects, that we did not have to worry about such a critical point because nobody could endure such a degree of occlusion with this procedure. In fact, for these two subjects, anoxia and muscle cramping were not even apparent!” ( p. 144).
Hilgard, Ernest R. (1987). Research advances in hypnosis: Issues and methods. International Journal of Clinical and Experimental Hypnosis, 35, 248-264.
There are substantial areas of agreement upon the classical phenomena of hypnosis, illustrated by what we now have learned about hypnotic talent, amnesia, hallucinations, analgesia, and dissociative processes. While genuine advances in knowledge about hypnosis have been made in recent decades, differing orienting attitudes have kept some controversy alive, particularly in the interpretation of empirical findings. Differences of interpretation of the phenomenal and behavioral facts are to be expected in the present stage of developmental, cognitive, and social psychology.
NOTES
The author writes of the “domain of hypnosis” as within the larger domain of social psychology (because it is usually interpersonal); cognitive psychology (because of alterations in perception, imagination, memory, and thought); developmental and personality psychology (because of individual differences); and physiological psychology (because of neurophysiological aspects).
In terms of what we know about hypnotic talent, he notes that high hypnotizability is not generally associated with psychopathology; that it may however be associated with a personality measure called absorption; and that there may be some inherited ability (Morgan, 1973). In the author’s view, hypnosis is no longer considered simply a response to suggestion, since imagination and/or fantasy are very important.
In reviewing evidence of posthypnotic amnesia the author writes, “Subtleties in language require making careful distinctions among concepts such as compliance, suggestion, compulsivity, belief, self-deception, automaticity, the voluntary, the involuntary, and a happening. If these distinctions are glossed over, the choice of words (e.g., substituting compliance for response to suggestion) may give the impression that a finding departs more widely from conventional views than it does. We, too, have found that Ss used varied strategies or skills during amnesia, but this need not deny augmentation by suggestion.
“It takes genuinely high Ss to illustrate truly high posthypnotic amnesia… Many of the truly high hypnotizable individuals cannot break amnesia, no matter how hard they try” (p. 253).
Regarding the evidence for hypnotic hallucinations and trance logic, the author suggests that trance logic is not a clear concept because the Subject is capable of good logic while tolerating some inconsistencies. “It is ordinary logic to assume that if your hallucination is your own construction, it is you who can influence it by your own wishes. In the rare cases of transparent or diaphanous hallucinations there is still an ‘out there’ quality. People who report that they see wispy ghosts also see them as ‘out there,’ so that they qualify as hallucinations. The distinction appears to be one of perception and perception-like experiences within hypnosis rather than of logic” (p. 256).
In reviewing the evidence for hypnotic analgesia, the author acknowledges that pain relief is available with other kinds of interventions, or by using other kinds of psychological processes, but that does not diminish the contribution of hypnosis (which has a long and impressive clinical history). Following laboratory studies, it is noted that “the amount of alleviation of pain through hypnosis is positively correlated with the hypnotizability of the candidate for pain reduction. This result is not universally accepted, because some clinicians are convinced that those unsuccessful in hypnotic pain reduction are resisting hypnosis” (p. 256-257). In the present paper he acknowledges but does not review physiological literature on hypnoanalgesia.
Regarding the concept of dissociation, the author indicates that he considers it a more useful concept than the concept of trance or hypnotic state “when a person is only slightly or moderately involved in hypnosis … . The advantage is that dissociations, as compared with altered states, can be described according to limited or more pervasive changes in the cognitive or motor systems that are being activated or distorted through suggestion in the context of hypnosis. Perhaps when all-inclusive enough, such changes can justify the use of the term trance or altered state, but I believe that these terms should be used, if at all, only for those for whom the immersion in the hypnotic experience is demonstrably pervasive” (pp. 258-259).
The author goes on to describe his initial discovery of the ‘hidden observer’ in an experimental context, and to relate the ‘hidden observer’ to others’ earlier observations of a secondary report of an experience previously concealed from S’s consciousness (Binet, 1889-1890/1896; Estabrooks, 1957; James, 1899; Kaplan, 1960). “The issues are still being worked on, but as in the case of trance logic the heart of the problem is not whether to speak of a hidden observer, but to recognize that there may be cognitive distortions in hypnosis even while some more realistic information is being processed in parallel, so that everything is not reportable by S” (p. 260).
1986
Council, James R.; Kirsch, Irving; Hafner, L. P. (1986). Expectancy versus absorption in the prediction of hypnotic responding. Journal of Personality and Social Psychology, 50, 182-189.
The Absorption Scale was administered to subjects in the context of a hypnosis experiment and in a context unrelated to hypnosis. Expectancies of responding to hypnotic suggestions were assessed both before and after trance induction, but before administration of suggestions. Hypnotic depth was assessed by different methods before suggestions were given, and after hypnosis. Absorption was correlated with hypnotic responsivity and expectancy, but only when assessed in a hypnotic context. Completing the Absorption Scale in a hypnotic context appeared to affect responsiveness by altering expectancies. Only postinduction expectancies were predictive of response to suggestions. Results of path analysis suggest that trance inductions alter expectancies for responding to hypnotic suggestions and that these altered expectancies determine subsequent hypnotic behavior.
Echterling, Lennis G.; Emmerling, David A. (1986, August). Contrasting response expectancies of stage and clinical hypnosis. [Paper] Presented at the annual meeting of the American Psychological Association, Washington, DC.
Although both are labeled hypnosis, the experience, behaviors, and effects of hypnosis in stage and clinical settings differ dramatically. We explore these differences between stage and clinical hypnosis and conceptualize them within the framework of nonvolitional response expectancy. Two methods were used to gather information for this study. First, we observed the contrasting styles, strategies and situations in both stage and clinical hypnosis. Second, we identified and interviewed individuals who had experienced trance in both clinical and stage settings. We found significant differences in hypnotist style, subject attribution of causality, trance depth, trance behavior, and outcome. Our discussion contrasts the differing response expectancies of stage and clinical hypnosis in terms of situation, subject’s role, and subject’s perception of hypnotizability.
Hendler, Cobie S.; Redd, William H. (1986). Fear of hypnosis: The role of labeling in patients’ acceptance of behavioral interventions. Behavior Therapy, 17, 2-13.
One hundred and five outpatient cancer chemotherapy patients were interviewed to assess their attitudes toward hypnosis and relaxation as well as to determine their beliefs in and willingness to try a behavioral procedure. Patients were randomly assigned to groups receiving identical descriptions labeled “hypnosis,” “relaxation,” or “passive relaxation with guided imagery.” The description stressed the behavioral components of hypnosis and relaxation rather than the nonbehavioral techniques often associated with hypnosis such as age regression and posthypnotic suggestion. Patients believed hypnosis to be a powerful process that involved loss of control and altered states of consciousness. When compared with a group of college students, patients held significantly more fearful, conservative views about hypnosis. Patients who received a description of an intervention labeled “hypnosis” were significantly less likely to believe the procedure would effectively control their nausea and vomiting and were significantly less likely to state they would try the procedure than patients in the other two label conditions. This reaction to the label occurred independently of patients’ degree of nausea, vomiting, and pain due to their chemotherapy treatments.
Laurence, Jean-Roch; Nadon, Robert (1986). Reports of hypnotic depth: Are they more than mere words?. International Journal of Clinical and Experimental Hypnosis, 34, 215-233.
The empirical work relating hypnotizability, the hypnotic situation, and the reports of hypnotic depth is reviewed and evaluated. Asking Ss to assess their hypnotic depth is a complex task involving the interaction of experiential, cognitive, and contextual variables. Accordingly, future experimental work should take into account this multidimensionality; phenomenological, situational, cognitive, and motivational factors implicated in verbal reports should be explored in terms of their respective relationships with both hypnotizability and self-ratings of hypnotic depth. More sophistication in the experimental inquiries of hypnotic depth is required in order to further our understanding of the cognitive and affective structures underlying the hypnotic experience.
NOTES
In past years, hypnotic susceptibility and hypnotic depth were regarded as the same thing, and depth was inferred from responses to test suggestions on hypnotizability scales (e.g. Davis & Husband, 1931; LeCron, 1953).
There has been little investigation of the relationship between Subjects’ subjective experiences and reported “depth.” Research suggests that “hypnotic depth reports are usually significantly higher for Ss who have undergone a hypnotic treatment than for those who have received task-motivation (Ham & Spanos, 1974; Spanos & Barber, 1968; Spanos, Stam, D’Eon, Pawlak, & Radtke-Bodorik, 1980); imagination-control; or relaxation-control instructions (Connors & Sheehan, 1978; Gilbert & Barber, 1972; Spanos & Barber, 1968; Spanos, Radtke-Bodorik, & Stam, 1980, Experiment 2)” (pp. 217-218). Others have found that changes in inward experiencing (e.g. feelings of unreality, a sense of disappearance of body parts) could not be attributed simply to sitting quietly with the eyes closed (Barber & Calverley, 1979). [A footnote on p. 218 indicates some studies didn’t find this difference between a hypnosis group and a task-motivation control group.]
When Ss are asked to estimate subjective depth after having experienced hypnotizability test items, they are likely to infer depth from whether or not they passed the items (and indeed, early scales promoted that assumption). Reports of subjective depth taken before rather than after the test items still correlate with overall hypnotizability score, though not to as high a degree (E. R. Hilgard & Tart, 1966; Tart, 1970). Although usually depth estimates correlate with hypnotizability in the .50 to .75 range (Perry & Laurence, 1980), the correlations were obtained in the hypnotic context, and Ss may use their own behaviors as one determinant of their estimated depth.
From another line of study it is observed that Ss’ subjective depth may be at variance with behavioral performance on hypnosis scales (Bowers, 1981). High hypnotizables judge their own depth from their performance on cognitive items (e.g. amnesia, hallucinations) while mediums and lows judge their own performance based on their responses to motor items and challenge items (Kihlstrom, 1981). In one experiment on amnesia, it appeared that Ss did not judge their own depth by how well they did on the amnesia task (Spanos, Stam, D’Eon, Pawlak, and Radtke-Bodorik, 1980). “M. T. Orne (1966, 1980) has emphasized that although it is necessary to operationalize S’s responses to hypnotic suggestions, behavioral concomitants are only valid if they accurately reflect subjective alterations in an individual’s experience” (p. 221).
“The social-psychological approach (see Barber, 1969; Radtke & Spanos, 1981, 1982; Spanos, 1982; Wagstaff, 1981) rejects the notion of hypnotic depth as an indicator of a unique state. These authors argue that the reports of having been hypnotized reflect attributions made by Ss when confronted with a hypnotic context. … Bem (1972) and Kelley (1972) have emphasized the idea that the more ambiguous an experience is, the more a person is likely to base his or her judgment primarily on available external information” (p. 222). In this case, defining the situation as involving “hypnosis” is one of the most potent predictors of Ss’ reports of subjective experience (Spanos, Radtke- Bodorik, and Stam, 1980). Other variables that influence subjective depth estimates are the wording of the hypnotizability scale, expectancy, and information provided directly or indirectly. Oh the other hand, McCord (1961) found that his patients had widely disparate expectations for how they thought they would feel when hypnotized, so expectancy as a predictor would not necessarily determine specific experience.
Direct experimental work on predicting response to hypnosis test items from expectancies (Council, Kirsch, Vickery, & Carlson, 1983; Kirsch, Council, & Vickery, 1984) suggests that expectations may predict test response when people are given a cognitive skill type of induction, but not when given a ‘typical trance’ type of induction. Also, another study from that laboratory (Council & Kirsch, 1983) established that only when expectancies are assessed after an induction (but before the test items) do they effectively predict hypnotic behaviors. The present authors express the view that these results are difficult to account for on the basis of social psychology theories that weight heavily the role of expectancy in generating hypnotic response.
When Ss are permitted to use several different descriptors for their experience (being hypnotized, experiencing the effects, being absorbed, and responding to the suggestions), most Ss rated their own experiences as nonhypnotic (Radtke & Spanos, 1982). This was particularly true for medium hypnotizable Ss. Thus, unidimensional scales purporting to measure “depth” actually force Ss to interpret their multi-aspect experience in terms of the investigator’s frame of reference, in this case “hypnotic depth.” Nevertheless, the highly hypnotizable Ss were the least likely to be swayed from their self description of being “deep” when offered alternative ways of describing their experience. This is concordant with results reported earlier by Barber et al. (1968).
“The attribution literature may provide clues as to why most highly hypnotizability Ss retain their high ratings of experienced depth when confronted with situational manipulations. Self-perception theory strictly applies when Ss’ experiences are ambiguous, forcing them to fall back on contextual factors to make self-appraisals. The relationship between expectancies, absorption, effect of scale wording, and hypnotizability scores suggest, however, that high hypnotizable Ss do not rely heavily on contextual factors when assessing their levels of hypnotic depth. Most of these Ss maintain their reports of altered experiences, even when situational determinants are changed (Harackiewicz, 1979; Kihlstrom, 1984; Lepper, Greene, & Nisbett, 1973). Thus, the hypnotizability by depth scale interaction found by Radtke and Spanos (1981) may suggest that experiences reported by high hypnotizable S are _not_ inherently ambiguous. Accordingly, self-perception theory may not apply to them” (pp.226-227).
In their Discussion, the authors state, “Several studies have attempted to relate personal, real-life events to the experience of hypnosis. A number of studies (e.g., As, 1963; Field, 1965; Shor et al., 1962; Wilson & Barber, 1982) have shown that absorption, tolerance of unusual experiences, automaticity, compulsion, and trust are related to the capacity to be hypnotized. Other studies (Bowers & Brenneman, 1981; Tellegen & Atkinson, 1974; Van Nuys, 1973) have shown that certain variants of attention are also related to hypnotizability. Extensive work by J. R. Hilgard (1970, 1979) has shown that patterns of personal development relate to hypnotizability in adult life. If appears then that hypnotizable individuals bring a host of experiences and abilities with them to the hypnotic context. It makes intuitive sense which is supported by the available empirical data, that a complex interaction among these experiences and abilities, the hypnotic context, and hypnotic responsiveness is implicated in Ss’ assessments of their hypnotic depth. Studies are needed in which all of these potential determinants of hypnotic depth reports are taken into account. Only then will a clearer picture of their respective importance emerge” (p. 228).
1985
Kirsch, Irving (1985, November). Response expectancy as a determinant of experience and behavior. American Psychologist, 40 (11), 1189-1202.
Response expectancies, defined as expectancies of the occurrence of nonvolitional responses, have generally been ignored in theories of learning. Research on placebos, hypnosis, and fear reduction indicates that response expectancies generate corresponding subjective experiences. In many cases, the genuineness of these self- reported effects has been substantiated by corresponding changes in behavior and physiological function. The means by which response expectancies affect experience, physiology, and behavior are hypothesized to vary as a function of response mode. The generation of changes in subjective experience by corresponding response expectancies is hypothesized to be a basic psychological mechanism. Physiological effects are accounted for by the mindbody identity assumption that is common to all nondualist philosophies of psychology. The effects of response expectancies on volitional behavior are due to the reinforcing properties of many nonvolitional responses. Classical conditioning appears to be one method by which response expectancies are acquired, but response expectancy effects that are inconsistent with a conditioning hypothesis are also documented.
Patterson, C. H. (1985). What is the placebo in psychotherapy?. Psychotherapy, 22 (2), 163-169.
Although there is an extensive literature on the placebo effect in psychotherapy, the distinction between the placebo and other elements of the therapeutic process has not been clear. This paper analyzes the therapeutic relationship in terms of separating the placebo elements and the specific factors. The so-called nonspecific elements, often equated with the placebo, are proposed as the specific factors. It is contended that those variables focused upon by those studying the social psychological factors are actually part of the placebo.
A class of 145 college students was given Barber’s Creative Imagination Scale (CIS) and Spiegel’s Eye Roll Sign, and later given several opportunities to volunteer for research projects, some of which specified hypnosis was involved. Those S’s who volunteered for the hypnosis experiments took the Harvard Group Scale of Hypnotizability (HGSHS). Hypnosis volunteers differed from the non- hypnosis volunteers by significantly higher grades and more total experimental volunteerism, but were no significantly different on the CIS or Eye Roll Sign. In general, nonwhites scored higher on the CIS. Among hypnosis volunteers, there was a low negative correlation between the Harvard Consciousness scale and volunteering for experiments other than hypnosis.
1984
Critelli, Joseph W.; Neumann, Karl F. (1984). The placebo: Conceptual analysis of a construct in transition. American Psychologist, 39, 32-39.
The placebo in psychotherapy has unfortunately retained the negative connotation of an inert “nuisance variable,” a label that it originally incurred in the field of medicine. In addition, the transition toward more cognitive models of psychotherapy, particularly Bandura’s theory of self-efficacy, has led to problems in defining the placebo within psychology. This transition has resulted in an awkward interface between certain preferred cognitive metaphors and the negative connotations of a presumably cognitive placebo construct. As a result, suggestions have recently been made to dismiss the placebo construct from psychology and to do away with the use of true placebo controls in outcome research. The present analysis maintains that (a) the placebo can be adequately defined within psychology, (b) the negative connotation of the placebo label is largely undeserved, (c) the placebo retains a continuing conceptual and empirical utility for evaluating psychotherapy, and (d) the therapeutic efficacy of current therapies is well established even though they have not generally been shown to be more effective than nonspecific treatment.
Handelsman, Mitchell M. (1984). Self-hypnosis as a facilitator of self-efficacy: A case example. Psychotherapy, 21 (4), 550-553.
This article presents the four-session treatment of Elaine, using self- hypnosis to facilitate the mourning process. It is argued that self-hypnosis– rather than enhancing imagery– increases self-efficacy, a person’s feeling that he/she can perform behaviors that lead to desired outcomes. Elaine’s sense of self-efficacy was increased by allowing her to choose scenes from her life to be explored in the context of the use of imagery. Elaine imagined events surrounding her father’s death, and “rewrote history” in an attempt to permit herself the direct expression of emotions.
Kirsch, Irving; Council, James R.; Vickery, Anne R. (1984). The role of expectancy in eliciting hypnotic responses as a function of type of induction. Journal of Consulting and Clinical Psychology, 52 (4), 708-709.
NOTES
Combined data from a study by J. R. Council et al (see PA, vol 7:4975) and from a study by the present 3rd author (1983) on cognitive skill hypnotic induction to test the hypothesis that the relationship between expectancy and suggestibility varies as a function of type of induction. Analysis of data on 100 Ss shows significant Expectancy x Type of Induction interactions on the Stanford Hypnotic Susceptibility Scale, the Creative Imagination Scale, and an inventory of hypnotic depth. Within-cells correlations revealed a significant relationship between expectancy and responses to skill induction. Correlations between expectancy and responses to a traditional trance induction were nonsignificant.
Lynn, Steven Jay; Nash, Michael R.; Rhue, Judith W., Frauman, David C.; Sweeney, Carol A. (1984). Nonvolition, expectancies, and hypnotic rapport. Journal of Abnormal Psychology, 93 (3), 295-303.
Prior to hypnosis, subjects were informed either that hypnotizable subjects can resist motoric suggestions or that such control does not characterize good hypnotic subjects. During hypnosis, susceptible and simulating subjects received countering suggestions involving inhibiting suggestion-related movements. Susceptible subjects’ responses were found to be sensitive to prehypnotic normative information. There was a corresponding tendency for reports of involuntariness to be sensitive to the expectancy manipulation. Furthermore, subjects were able to feel deeply hypnotized and to rate themselves as good subjects yet concomitantly experience themselves as in control over their actions when normative information supported this attribution. Reports of suggestion-related sensations but not imaginative involvement were associated with movements in response to countersuggestion. Simulators were unable to fake susceptibles’ reports of sensations and involuntariness. However, for all subjects, movements paralleled expectancies about appropriate response, supporting the hypothesis that involuntary experiences are sensitive to the broad expectational context and are mediated by active cognitive processes. Also, rapport with the hypnotist was found to be a factor. Susceptible subjects with highly positive rapport resolved hypnotic conflict, in part, by achieving a compromise between meeting normative expectations and complying with the hypnotist’s counterdemand.
1983
Council, James R.; Kirsch, Irving; Vickery, Anne R.; Carlson, Dawn (1983). ‘Trance’ versus ‘skill’ hypnotic inductions: The effects of credibility, expectancy, and experimenter modeling. Journal of Consulting and Clinical Psychology, 31 (3), 432-440.
A hypnotic induction procedure based on social learning principles (skill induction) was compared with a traditional eye-fixation/relaxation trance induction, a highly credible placebo induction, and a no-induction base-rate control. The trance induction surpassed the skill induction only on the Field Inventory, a measure of hypnotic depth that contains items corresponding to suggestions contained in the trance induction. Experimenter modeling was not found to enhance the effectiveness of the skill induction. Skill and trance inductions elicited slightly higher behavioral scores on the Stanford Hypnotic Susceptibility Scale: Form C than did the placebo induction. However, this difference was not obtained on other measures of hypnotic responsibility and depth. Significant correlations were found between expectancy, absorption, and responsiveness on all dependent measures. Multiple regression analyses indicated that the relationship between absorption and responsivity was mediated by expectancy. The results are interpreted as supporting the hypotheses that hypnotic responses are elicited by the expectancy for their occurrence and that induction procedures are a means of increasing subjects’ expectancies for hypnotic responses.
NOTES
Trance induction resulted in a higher score on subjective experiences (cognitive & perceptual distortions) but not higher suggestibility scores than cognitive- behavioral skill induction. 2) Trance and cognitive-behavioral inductions got slightly higher scores in suggestibility than placebo biofeedback induction. 3) All inductions did better than a “no induction” control group on subjective and behavioral indices of hypnosis.
One of the goals of this research was to examine the contribution of experimenter modeling to the behavioral skill induction that “trains the subject in hypnosis skills and requires the subject’s conscious cooperation in learning cognitive strategies that will enhance hypnotic responsivity” (p. 432). Another goal was to assess the contribution of “a subject’s expectancies for the occurrence of behaviors perceived as being involuntary” (p. 433). A third goal was to determine whether congruence between a subject’s beliefs about hypnosis and the rationale for a particular induction would increase expectancy. Two different skill inductions were employed (one with, one without a model). Subjects were asked to predict their performance, based on a description of the induction that they would receive. The contributions of credibility and expectancy were assessed using a highly credible placebo (pseudo biofeedback of EEG theta rhythm).
The investigation used only subjects who had never experienced hypnosis.
Independent variables included Rotter’s (1966) Internal-External Locus of Control Scale, Rotter’s (1967) Interpersonal Trust Scale, and Tellegen’s Absorption Scale (Tellegen & Atkinson, 1974). Mediating variables included a measure of induction credibility based on Borkovec and Nau (1972), and a 20-item inventory measuring expectancies for hypnotic performance. Dependent variables included 20 standard hypnotic suggestions taken from the Stanford Hypnotic Susceptibility Scale, Form C; the Creative Imagination Scale; ratings of the ‘realness’ or experienced intensity of each suggestion; and the Field Inventory of Hypnotic Depth (Field, 1965).
The authors conclusion reads as follows: “The results of this study may be summarized as follows: (a) Traditional trance hypnotic inductions and cognitive- behavioral skill inductions were shown to be equally effective in eliciting experiential and behavioral responses to hypnotic suggestions, although trance subjects reported a somewhat greater alteration in conscious experience. (b) Experimenter modeling was not found to be an effective component of the skill induction package. (c) Subjects’ expectancies for hypnotic responses, reported prior to hypnotic induction, bore a very strong relationship to hypnotic responsivity. (d) A highly credible placebo induction resulted in levels of expectancy and hypnotic responsivity generally comparable to those produced by trance and skill hypnotic inductions. (e) Absorption was significantly correlated with expectancy, but was not found to be significantly related to responsiveness once variance due to expectancy was taken into account. Thus the relationship between absorption and hypnotic responsiveness appears to be mediated by expectancies.
“In sum, these results suggest that various hypnotic inductions elicit expectancies for responding to hypnotic suggestions and that these expectancies are sufficient to elicit hypnotic responses. Further studies are needed to determine the nature of the relationship between absorption and hypnotic response expectancies” (p. 439).
McConkey, Kevin M. (1983). Behaviour, experience, and effort in hypnosis. Australian Journal of Clinical and Experimental Hypnosis, 11, 73-81.
Subjects were administered the Harvard Group Scale of Hypnotic Susceptibility, Form A, and were afterwards asked to rate the degree to which they experienced the items; subjects also scored their behavioural performance on the items. Data were analyzed to explore the relationships among behaviour, experience, and effort. Findings indicated a significant positive relationship between behaviour and experience on all of the HGSHS:A items, a significant negative relationship between behaviour and effort on the ideomotor items, and a significant positive relationship between behaviour and effort on the cognitive items. A similar pattern was observed between experience and effort. Also, subjects of varying HGSHS:A responsivity differed in terms of overall experience of the scale but not in terms of the overall amount of effort that they expended. Implications of the data are discussed in terms of the factors influencing subjects’ experiential response and behavioural performance as well as the attributions that they make concerning effort during hypnosis.
Myles, (1983, April). Cognition, hypnotic susceptibility, and laboratory induced pain (Dissertation, University of Waterloo). Dissertation Abstracts
International, 43 (10), 3360-B.
Individuals’ experiences of pain, and responses to pain treatments vary greatly. This study attempted to relate two areas of research concerned with this variation: (a) cognitions and pain (thoughts, images, etc.), in particular, catastrophizing versus coping; and (b) hypnotic susceptibility and analgesia. “Subjects were preselected for high or low hypnotic susceptibility. Susceptibility assessment was divorced from the laboratory study to minimize the potential bias of expectancies concerning hypnosis. High hypnotic susceptibility was expected to potentiate therapeutic effects of hypnotic-like treatment that did not involve a hypnotic induction. “Ten high and ten low-susceptible subjects were assigned to each of three groups: (a) a cognitive treatment, encouraging subjects to reduce spontaneous catastrophizing and increase self-generated coping cognitions; (b) a dissociative imagery treatment, encouraging subjects to engage in self-generated engrossing images; (c) an attention- placebo manipulation. “Pre and post-treatment assessments involved tolerance and pain-report measures during the cold-pressor task, and interview and questionnaire information concerning cognitions. “No treatment effects were evident on measures of pain. Cognitive data indicated less catastrophizing and more coping during the post-treatment stressor across all groups. Subjects in the dissociative imagery group did report more imagery during the post- treatment assessment than subjects in the other groups, but this increased use of imagery was not associated with a decrease in pain. “Interview and questionnaire data supported prior reports that catastrophizing is related to increased pain. Low catastrophizing was associated with a high sense of control, high use of a variety of coping strategies, and lower pain reports. These relationships were altered following treatment, however, leading to a caution in generalizing about such variables. “High susceptibility did not potentiate therapeutic effects for either experimental treatment. Nor was susceptibility related in any other consistent way to pain, although high susceptibility was associated with more extensive use of post-treatment imagery. “Methodological inconsistencies and problems in laboratory pain research were discussed, and suggestions made for future work in the area” (p. 3360).
Nogrady, Heather; McConkey, Kevin M.; Laurence, Jean-Roch; Perry, Campbell (1983). Dissociation, duality, and demand characteristics in hypnosis. Journal of Abnormal Psychology.
Examined hypnotic dissociation (as indexed by the “hidden-observer” method), duality in age regression, and the potential impact of situational cues on these phenomena. 12 high- and 9 low-susceptible undergraduates (as determined by the Stanford Hypnotic Susceptibility Scale) were tested in an application of the real-simulating paradigm of hypnosis; 10 high- to medium-susceptible Ss were also employed. Inquiry into Ss’ experiences was conducted through the experiential analysis technique, which involves Ss viewing and commenting on a videotape playback of their hypnotic session. Results demonstrate that neither the hidden-observer effect nor duality could be explained solely in terms of the demand characteristics of the test situation. The hidden-observer effect was observed in high-susceptible Ss only; all Ss who displayed the hidden-observer effect also displayed duality in age regression. High-susceptible Ss were distinctive in their reports of multiple levels of awareness during hypnosis. Findings are discussed in terms of the cognitive skills that Ss bring to hypnosis and the degree to which the hypnotic setting encourages the use of dissociative cognitive processes. (43 ref).
O’Connell, Sean (1983). The placebo effect and psychotherapy. Psychotherapy: Theory, Research and Practice, 20 (3), 337-345.
The power of psychotherapy to cure can be comprehended through an investigation into the efficacy of placebo in medical history. The evolution of “placebo” leads to a conceptualization of psychotherapy as a form of placebo. Explanations for the presence of the placebo effect, as well as guidelines for its elicitation, are outlined.
“Faith in the gods or in the saints cures one, faith in little pills another, faith in a plain common doctor a third, hypnotic suggestion a fourth. … Faith in us, faith in our drugs and methods, is the great stock in trade of the profession (paracelsus, 1570)” (p. 337).
Ross, Sherman; Buckalew, L. W. (1983). The placebo as an agent in behavioral manipulation: A review of problems, issues, and affected measures. Clinical Psychology Review, 3, 457-471.
Need for greater recognition and appreciation of placebo effects was stated, and problems hindering their clear conceptualization are noted. Previous reviews of the history and use of placebos are acknowledged. This review provides a summary of research primarily within the last 20 years, and in particular considers studies reflecting on placebos as agents of psychomotor, physiological, cognitive, affective, and clinical manipulations. General conclusions of manipulative efficacy are provided, and issues and problems related to clarification of placebo phenomena are identified. Psychological and medical evidence reflects increasing attention to the placebo and of effects on a wide range of behavioral functions. While important ethical and methodological questions remain, recent evidence of a physiologic basis for placebo action suggests exciting new insights into placebo phenomena.
Farthing, G. William; Brown, Scott W.; Venturino, Michael (1982). Effects of hypnotizability and mental imagery on signal detection sensitivity and response bias. International Journal of Clinical and Experimental Hypnosis, 30, 289-305.
It was hypothesized that the ability to selectively concentrate attention on mental images would be greater among high hypnotizable Ss than among low hypnotizable Ss, as indicated by a greater interference with visual signal detection by concurrent visual mental imagery in response to specified nouns. This hypothesis was not supported in the overall results, though the finding of a significant interference effect among the high hypnotizable female Ss, but not among other subgroups, indicates that further research with a more refined procedure might be worthwhile. On the control trials without images, the high hypnotizable Ss made more false alarms than lows, and had a significantly different bias index indicating that high hypnotizable Ss were more likely than lows to respond “yes” when uncertain about whether the signal was present; false alarms can be interpreted as a nonhypnotic measure of suggestibility. The high and low hypnotizable Ss did not differ in their times to generate images in response to the specified nouns.
1981
Fling, Sheila; Thomas, Anne; Gallaher, Michael (1981). Participant characteristics and the effects of two types of meditation vs. quiet sitting. Journal of Clinical Psychology, 37 (4), 784-790.
Randomly assigned 61 undergraduate volunteers to Clinically Standardized Meditation (CSM), quiet sitting (SIT), or wait list1 and 19 others to Open Focus (OF) or wait list2. Ss were tested before training and again 8 weeks later. All groups but wait list2 decreased significantly on Spielberger’s trait anxiety. All groups became nonsignificantly more internal on Rotter’s locus of control. On the Myers-Briggs Type Indicator, meditation volunteers were more introverted than extraverted, intuitive than sensing, feeling than thinking, and perceiving than judging. All groups became more intuitive, approaching significance for CSM only. OF became significantly more extraverted than both CSM and SIT, and CSM significantly more so than wait list1. Practice time correlated with anxiety reduction for the combined treatment groups. More evidence was found for correlations of practice time and outcome with growth motivation than with either new experience motivation or expectancy of benefit.
Franck, Jerome (1981, August). Therapeutic components shared by all psychotherapies. [Paper] Presented at the annual meeting of the American Psychological Association.
NOTES
The author summarizes as follows. 1. Patients who receive any form of psychotherapy do better than controls. 2. Followup studies show most patients who show improvement maintain it; the closing of gap between patients who improve and those who don’t is due to those who do less well catching up. Perhaps the main effect is to accelerate improvement which would eventually happen anyway. 3. Determinants of successful treatment are personal qualities of Patient and Therapist. 4. There are a few conditions which have more specific treatment indications. –Behavior therapy – for phobias, obsessive compulsive disorders, sexuality problems –Cognitive therapy – for depression Further advantages of specific treatments for specific conditions may be found.
All patients seek treatment not just for symptoms but because of demoralization. The common elements are: Subjective incompetence, loss of self esteem, alienation, hopelessness, helplessness, a feeling others could help but won’t, feeling of loss of control. Demoralization plus distress leads to seeking treatment.
A small percentage without demoralization seek treatment for specific symptoms (e.g., patients with a simple phobia of height). Anxiety and depression (or loss of self esteem) are most frequent symptoms in Outpatient Departments.
Success in treatment often is due to restoration of morale (which removing symptoms can do very well). 1. Citing Doehrenwald research. 2. People seek treatment only 1-2 years after symptoms appear, after trying other ways of dealing with them. 3. Many patients improve rapidly in treatment (Garfield found the Mean = 5 or 6 sessions.) Mean symptom relief is same after 4 sessions and drop-out than after 6 months; also those on waiting list in phone contact improve as much.
Shared components in the various therapies combat demoralization: 1. Emotionally charged and vital relationship with the helping person (or group). 2. Healing setting (which increases Therapist’s prestige and promotes healing). (a) Therapeutic rituals (which lead to an external reason for abandoning the symptom; the more spectacular the reason, the greater the motivation). (b) Therapeutic bond.
Expectation of help is the best predictor of outcome. (Cites his own placebo study.) One problem found was that responsiveness to placebo didn’t correlate with response to psychotherapy. (Cites Lieberman’s study). Patients receiving psychotherapy role-induction interview improved more. 3. Provision of learning experiences – movement of values toward those of the therapist 4. Emotional arousal. Supplies motivation for change. Cites his experiments on emotional arousal and attitude change, manipulating arousal using ether drip or adrenalin (leads to temporary attitude change). Something else besides arousal may be needed to sustain change. 5. Enhances sense of mastery, control of one’s self and internal states. (a) provides conceptual scheme (b) gives experience of success 6. Provision of opportunities (and incentives) to practice
Properties of Patient which assure success: 1. Distress 2. Earlier relationship with parent which leads to capacity to relate. (Molly Harrower’s predictors) 3. To profit from specific procedures: capacity for insight for psychoanalysis.
Properties of Therapist which contribute to success:
We haven’t gotten farther than Rogers’ empathy, warmth, and positive regard; Whitehorn & Betz’s Type A and B; and [missed reference name] activity level. He thinks success may be related to Therapist’s parapsychological ability, healing power.
Physiology of hope: Placebos for dental pain lead to pain relief for some. Endorphin antagonist made pain re-occur for them.