For the chronic low back pain Ss there were reductions in reported low back pain during the experimental sessions, and significant improvements in psychological well-being and sleep quality across the three sessions. “The importance of developing self-efficacy through learning to control experimental pain and the understanding of one’s own attentional and disattentional abilities was demonstrated as being a significant intervention in the modulation and control of chronic pain” (p. 123).
Danziger, N.; Fournier, E.; Bouhassira, D.; Michaud, D.; De Broucker, T.; Santarcangelo, E.; Carli, G.; Chertock, L.; Willer, J. C. (1998). Different strategies of modulation can be operative during hypnotic analgesia: A neurophysiological study. Pain, 75 (1), 85-92.
Nociceptive electrical stimuli were applied to the sural nerve during hypnotically-suggested analgesia in the left lower limb of 18 highly susceptible subjects. During this procedure, the verbally reported pain threshold, the nociceptive flexion (RIII) reflex and late somatosensory evoked potentials were investigated in parallel with autonomic responses and the spontaneous electroencephalogram (EEG). The hypnotic suggestion of analgesia induced a significant increase in pain threshold in all the selected subjects. All the subjects showed large changes (i.e., by 20% or more) in the amplitudes of their RIII reflexes during hypnotic analgesia by comparison with control conditions. Although the extent of the increase in pain threshold was similar in all the subjects, two distinct patterns of modulation of the RIII reflex were observed during the hypnotic analgesia: in 11 subjects (subgroup 1), a strong inhibition of the reflex was observed whereas in the other seven subjects (subgroup 2) there was a strong facilitation of the reflex. All the subjects in both subgroups displayed similar decreases in the amplitude of late somatosensory evoked cerebral potentials during the hypnotic analgesia. No modification in the autonomic parameters or the EEG was observed. These data suggest that different strategies of modulation can be operative during effective hypnotic analgesia and that these are subject-dependent. Although all subjects may shift their attention away from the painful stimulus (which could explain the decrease of the late somatosensory evoked potentials), some of them inhibit their motor reaction to the stimulus at the spinal level, while in others, in contrast, this reaction is facilitated.
Nociceptive electrical stimuli were applied to the sural nerve during hypnotically-suggested analgesia in the left lower limb of 18 highly susceptible subjects. During this procedure, the verbally reported pain threshold, the nociceptive flexion (RIII) reflex and late somatosensory evoked potentials were investigated in parallel with autonomic responses and the spontaneous electroencephalogram (EEG). The hypnotic suggestion of analgesia induced a significant increase in pain threshold in all the selected subjects. All the subjects showed large changes (i.e., by 20% or more) in the amplitudes of their RIII reflexes during hypnotic analgesia by comparison with control conditions. Although the extent of the increase in pain threshold was similar in all the subjects, two distinct patterns of modulation of the RIII reflex were observed during the hypnotic analgesia: in 11 subjects (subgroup 1), a strong inhibition of the reflex was observed whereas in the other seven subjects (subgroup 2) there was a strong facilitation of the reflex. All the subjects in both subgroups displayed similar decreases in the amplitude of late somatosensory evoked cerebral potentials during the hypnotic analgesia. No modification in the autonomic parameters or the EEG was observed. These data suggest that different strategies of modulation can be operative during effective hypnotic analgesia and that these are subject-dependent. Although all subjects may shift their attention away from the painful stimulus (which could explain the decrease of the late somatosensory evoked potentials), some of them inhibit their motor reaction to the stimulus at the spinal level, while in others, in contrast, this reaction is facilitated.
INSOMINIA & DEPRESSION
1976
Barabasz AF. Treatment of insomnia in depressed patients by hypnosis and cerebral electrotherapy. American Journal of Clinical Hypnosis 1976;19(2):120-2
Investigated the influence of suggestion on recovery in the treatment of sleep disturbances by cerebral electrotherapy (CET). 60 adult psychiatric outpatients (diagnostic classification–mild depressive neurosis) were randomly assigned to 4 groups. Group A received CET only; Group B received a CET placebo; Group C received CET with hypnosis; and Group D received a CET placebo with hypnosis. Group A reported a significantly higher recovery than Group B, Group C a significantly higher recovery than Group A, and Group D a significantly higher recovery than Group B. No significant differences were found between Group C and Group D or between Group A and Group D. Findings support suggestion via passive hypnosis with CET as a powerful variable in the treatment of sleep disturbances with depressed patients.
K RESEARCH
Kinesthesia
1988
Council, James R.; Loge, D. (1988). Suggestibility and confidence in false perceptions: A pilot study. British Journal of Experimental and Clinical Hypnosis, 5, 95-98.
Subjects received audiotaped instructions implying that they would perceive increases in odor or heaviness while comparing stimuli in a sensory-judgment task. Stimuli were actually indiscriminable. Subjects pretested as higher or lower in hypnotizability performed the task in either hypnotic or non-hypnotic conditions. In both treatments, greater hypnotizability was associated with more perceived changes in the stimuli and greater confidence in the reality of those perceptions. Results support a general factor underlying suggestibility in hypnotic and nonhypnotic situations. The findings are discussed in relationship to false confidence effects reported in hypermnesia research.
Jones, Lynette A. (1988). Motor illusions: What do they reveal about proprioception. Psychological Bulletin, 103 (1), 72-86.
Five illusions involving distortions in the perception of limb position, movement, and weight are described in the context of their contribution to understanding the sensory processes involved in proprioception. In particular, these illusions demonstrate that the position sense representation of the body and the awareness of limb movement results from the cross-calibration of visual and proprioceptive signals. Studies of the vibration illusion and phantom-limb phenomenon indicate that the perception of limb movement and position are encoded independently and can be dissociated. Postural aftereffects and the illusions of movement induced by vibration highlight the remarkable lability of this sense of limb position, which is a necessary feature for congruence between the spatial senses. Finally, I discuss the role of corollary discharges in the central processing of afferent information with respect to the size-weight and vibration illusions.
1981
Dosamantes-Alperson, Erma (1981). Experiencing in movement psychotherapy. American Journal of Dance Therapy, 4, 33-44.
Experiencing is a process variable in psychotherapy which deals with the manner with which individuals use their internal, ongoing bodily-felt flow of experience to gain self-awareness and to communicate about themselves. A consistent finding across research process studies in psychotherapy is that successful clients start, continue, and end therapy at higher experiencing levels than do less successful clients. The implication of this finding for all therapists, irrespective of their theoretical framework, is that they need to help their clients process the content they raise in therapy at a high level of experiencing throughout the course of therapy. This paper discusses and demonstrates several body movement based procedures that enhance clients’ experiencing level while working within the context of experiential movement psychotherapy, a form of psychotherapy which emphasizes the acquisition of personal meanings by clients from any of the following three experiential and expressive modalities: body movement, kinetic imagery, or verbal communication.
1979
Dosamantes-Alperson, Erma (1979). The intrapsychic and the interpersonal in movement psychotherapy. American Journal of Dance Therapy, 3, 20-31.
The adaptive function of two states of consciousness and corollary movement experiences is described. Movement in which a relaxed state of attention is maintained on inner kinesthetic sensations and imagery is contrasted with movement which is characterized by conscious, active interacting with the external world of people and events. Clinical examples from individual and group psychotherapy sessions are cited to demonstrate how meaning and conflict resolution may be achieved by clients while moving in either mode.
L RESEARCH
Language
1985
Kerry Buhk; Rhue, Judith; Henry, Stephanie; Lynn, Steven Jay (1985, November). Fantasy proneness: Are their word associations richer?. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Asheville, NC.
NOTES
Experimenters screened 7000 students to get 6 samples of fantasy prone Ss (top 2.4% on Wilson and Barber’s ICMI). They found less association between fantasy proneness and hypnotizability than did Wilson and Barber.
They had fantasizers hallucinate a second cup next to a first styrofoam cup. Results were that 87% of High fantasizers, < 50% Medium fantasizers, < 25% Low fantasizers could do it, but they didn't describe seeing the hallucinated cup "as real as real" as Wilson and Barber said they did.
Experimenters were concerned about context effects (expectancy) because the Creativity and Fantasy Proneness tests were run proximal in time, so they separated in time the administration of Fantasy Prone and Creativity tests and also looked at word associations.
23 High and 20 Low fantasy prone students selected by ICMI, which was administered to Subjects 18 mos before the creativity study. At the time of the creativity study, Ss were informed they were randomly picked. There were two 90' sessions, counterbalanced.
Sessions: 1. Hallucinate image of R.A. and of styrofoam cup. Other tests were administered for intelligence and personality: Shipley-Hartford, MMPI, Crowne-Marlowe, etc. 2. Creativity tests (Revised Art Scale, Hilgard's Alternate Uses; story production which was scored on detail, imagery and fantasy and on imagery nouns.)
Results of this study which was independent of context (i.e. the tests being correlated were administered independently of each other, separated by time). 1. Fantasizers were more creative than low fantasizers on both Creativity Scales. 2. Fantasizers show more divergent thinking on Hilgard Alternate Uses test, but relationship between fantasy proneness and creativity were not strong, r = .30. 3. Fantasizers and non fantasizers did not differ on the story measures! This diverges from Wilson and Barber's results. Fantasizers may have more vivid images, but storytelling does not capture that.
1954
Dittborn, Julio (1954). Dehypnotization and associated words. Journal of Clinical and Experimental Hypnosis, 2 (2), 136-138.
NOTES
Author tested Freud's hypotheses about signs of emotional conflict gleaned from a word association test. A highly hypnotizable subject who had been accused of theft was tested with the word association test repeatedly. He had been given the suggestion, while in deep hypnosis, that any word provoking emotional conflict would automatically bring him out of hypnosis. That is, "dehypnotization was used as a new method to investigate the conflict-provoking quality of certain stimulus-words in an association word test" (p. 139). Freud's predictions were only partially supported.
Laterality
1990
Cikurel, Katia; Gruzelier, John (1990). The effect of an active-alert hypnotic induction on lateral asymmetry in haptic processing. British Journal of Experimental and Clinical Hypnosis, 7, 17-25.
In order to elucidate further left hemispherical inhibitory dynamics in response to instructions of hypnosis, bilateral haptic processing times were compared before and during a traditional hypnotic relaxation procedure and an active-alert procedure in which subjects pedaled a bicycle ergometer and instructions on mental alertness were incorporated with hypnosis. Previous evidence suggesting a slowing of left hemispherical processing and a facilitation of right hemispherical processing in susceptible subjects was replicated, and was shown to characterize high rather than medium susceptibles, the latter showing a bilateral slowing of processing. These effects occurred with both induction procedures whose influence on susceptibility was highly correlated. In fact the lateral shift in processing in the direction of left hemispherical inhibition and right hemispherical facilitation was favoured by the active-alert procedure, indicating that neuropsychological changes which occur with hypnosis cannot be discounted as a by-product of relaxation.
1989
Bick, C. H. (1989). An EEG-mapping study of 'laughing': Coherence and brain dominances. International Journal of Neuroscience, 47, 31-40.
Laughter is triggered by pleasurable psychoemotional stimuli and may have healing potential. According to split-brain studies, psychoemotional stimuli are bound up with emotional activity in the right side of the brain. This suggested the idea of studying laughter generated by different sources with regard to electrical brain activity in the right and left hemispheres. This study first used subjects in normal consciousness and with laughter under hypnosis to study the neurophysiological processes connected with laughter.
1985
Banyai, Eva I.; Meszaros, Istvan; Csokay, Laszlo (1985). Interaction between hypnotist and subject: A social psychophysiological approach (preliminary report). In Waxman, David; Misra, Prem C.; Gibson, Michael; Basker, M. Anthony (Ed.), Modern trends in hypnosis (pp. 97-108). New York: Plenum Press.
There is a vast amount of literature demonstrating that hypnotic susceptibility is a stable personality trait. In the course of our practice of teaching beginners to hypnotize, however, it occurred to us that hypnotists without sufficient previous training frequently measured a lower level of hypnotic susceptibility than the true score. It has to be emphasized that hypnosis is a special altered state of consciousness which develops as a result of an interaction between a hypnotist and a subject. The failure of beginners to induce hypnosis could be explained by considering an insufficient participation of the hypnotist in this interaction. The purpose of the present study was to analyze the necessary and sufficient subjective, behavioral and physiological alterations in both participants of the hypnotic interaction. During successful and unsuccessful hypnotic inductions the subjective experiences, behavioral manifestations and physiological indicators including respiration, ECG, EMG, EOG, GSR and bilateral fronto- occipital EEG leads, were recorded simultaneously in the hypnotists and the hypnotized subjects. The results indicate that hypnotic induction is successful if a mutual "tuning" of the other person occurs not only on the subjective and behavioral levels, but first of all on the psychophysiological level.
1984
Bakker, Dirk J. (1984). The brain as a dependent variable. Journal of Clinical Neuropsychology, 6, 1-16.
The mainstream of neuropsychological research and practice has been devoted to the impact of the brain as an independent variable on behavior as a dependent variable. Evidence is currently available to make clear that the order of causation may be reversed: Behavioral changes can have a durable impact on the brain. The results of extensive research indicate that a large number of neuroanatomical, neurophysiological, neurochemical, and neuropsychological parameters of the animal brain can be modified through environmental manipulation, sensory experience, and systematic training. Some evidence is available to show that psychological stimulation has certain effects on the physiology of the human brain. For instance, hemisphere-specific stimulation through the presentation of words flashed in a visual hemifield appears to modify the electrophysiological activity of the contralateral hemisphere in dyslexic children and to affect their subsequent reading performance. Neuropsychology may profit from paying more attention to the ecology of the human brain.
NOTES
An 18th Century anatomist in Italy, Malacarne, demonstrated increased cerebellar folds in the brains of trained (vs. untrained) dogs and birds. His approach to neuroanatomy was not continued because psychology has been more concerned with innate traits of the individual, and because of philosophical rationalism (citing Walsh, 1981). Until very recently, scientists have viewed the brain as "structurally insensitive to environmental experience" (p. 3).
Now we have evidence that animal brains are modifiable by experience, in gross morphology, fine (synapse) morphology, and neurochemicals. "Rich environments [for rats] ... produce heavier and thicker cerebral cortices and callosal connections (Walsh, 1981), larger cortex/subcortex weight ratios, larger cell bodies and nuclei (Walsh, 1981), and higher metabolic activity as suggested by increased RNA/DNA ratios (Rosenzweig, Bennett, & Diamond, 1972)" (p. 4). Enrichment leads to more extensive dendritic fields (occipital and temporal cortex, some hippocampal regions); this implies that each neuron has more synapses. Researchers have found large Purkinje-cell bodies and many dendrites in richly educated monkeys.
"Some evidence is available to show that 'preventive' and 'therapeutic' environments positively affect behavioral performances of brain-lesioned animals. However, knowledge about the brain mechanisms which underly these effects is, as yet, lacking" (p. 6). Rats that were handled during the first 21 days of life exhibited different brain lateralization from rats that were not (Denenberg, cited by Marx, 1983). Those stimulated early stored memories mainly in the right hemisphere.
The author also reviews evidence that human brains are psychologically modifiable. Children with astigmatism generate weakened cortical response to visual stimulation (Freeman & Thibos, 1973), because they experience difficulty in processing some visual-spatial patterns. People who have visual-field defects due to brain damage can improve in vision when forced to make eye movements toward lighted targets flashed in the blind areas (Zihl, 1981).
Bakker theorizes that hemispheric control of reading shifts from right to left during the learning-to-read process of normal readers; at least some aspects of reading are successively mediated by the right hemisphere at age 6 and by the left hemisphere at age 8, according to electrophysiological data in a longitudinal study (Licht, Bakker, Kok, & Bouma, 1983). He thinks P-type dyslexia results from continuing to rely on right- hemispheric strategies, leading to slow reading with fragmentation errors and repetitions. L-type dyslexia results from prematurely adopting a left-hemispheric strategy, i.e. at the very beginning of the learning process, making child insensitive to the perceptual features of script with consequent substantive errors such as omissions and additions. Thus, P- type dyslexics presumably show functional overdevelopment of the right hemisphere and L-types of the left hemisphere. Treatment would involve specific stimulation of the hemisphere that they are ignoring.
He presents data suggesting that "some electrophysiological parameters of the cerebral hemispheres can be modified in dyslexic children through hemisphere-specific stimulation and loading, and that these modifications may induce better reading" (p. 12).
1982
Brende, Joel O. (1982). Electrodermal responses in post-traumatic syndromes: A pilot study of cerebral hemisphere functioning in Vietnam veterans. Journal of Nervous and Mental Disease, 170, 352-361.
This paper summarizes the findings of a pilot study which found a relationship between the post-traumatic symptoms of a) psychic numbing, b) intrusive recollections of traumatic events, and c) hypervigilance and lateralization of electrodermal response (EDR) measurements in six victims of psychological trauma. Hypnotically induced imagery of past traumatic events was often associated with left-sided EDR increases, psychic numbing with left-sided EDR decreases or bilateral EDR unresponsiveness, and revivifications of hypervigilant states with right-sided EDR lateralization. In several cases control of the experience of fear was associated with left- sided or bilaterally decreased EDR. These pilot study findings support previously stated hypotheses: a) EDR obtained from an extremity reflects contralateral cerebral hemisphere functioning; b) left hemisphere functioning is associated with hypervigilance; and c) right hemisphere functioning is associated with emotions and imagery. In addition, the pilot study findings suggest additional hypotheses: a) Post- traumatic symptoms are associated with poorly controlled or integrated cerebral hemisphere functioning; b) psychic numbing and intrusive images, flashbacks, and nightmares are associated with abnormal activation, suppression, or integration of right hemisphere functioning in relationship to the left; c) aggressive behavior, hypervigilance, and character pathology are associated with abnormal activation, suppression, or integration of functioning of the left hemisphere function in relationship to the right; and d) "splitting" as a psychological defense in Vietnam veterans with Borderline Personality Disorders is associated with physiologically impaired interhemispheric integration.
NOTES
The authors report that previous research suggests that electrodermal asymmetry may be related to emotional factors. They further suggest that electrodermal responsiveness reflects contralateral cerebral hemispheric functioning, with lower GSR associated with higher activation of the opposite cerebral hemisphere (see Lacroix and Comper, 1979). They indicate that the right hemisphere, which is involved in experience of emotion, also is associated with depression (when there is abnormal inhibitory function of right hemisphere) and affective disorders. The left hemisphere is involved in vigilance (Dimond & Beaumont, 1974). "Based on these findings, the post-traumatic symptoms hypervigilance, anxiety, and behavior disorders appear to be associated with atypical left hemisphere activation, intrusive recollections of traumatic memories and disturbing emotional states with atypical right hemisphere activation, and psychic numbing or emotional unresponsiveness with diminished right hemisphere activation, or overactivation of the left hemisphere" (p. 354).
In this pilot study, the therapist, who used hypnosis in all but one case, interviewed the patient for 30-50 minutes, focusing on helping the S to recall experiences of a traumatic nature. The therapist was supportive when disturbing emotions were evoked, responding flexibly by monitoring S's anxiety and moving back and forth between uncovering and supportive techniques.
SUMMARY
There were observably variable changes and bilateral differences in EDR within each of the six subjects in relationship to varying verbal, emotional, and imagery content, postulated to reflect contralateral hemispheric functioning. These observed changes were considered conclusive evidence of such functioning in post-traumatic states" (p. 358). "1. Lateralization of EDR to the left is associated with unpleasant emotions and traumatic imagery. ... "2. Lateralization of EDR to the right is associated with hypervigilance and aggressive outbursts. ... "3. Psychic numbing is associated with inhibition of bilateral EDRs (for example, lack of bilateral EDR activation occurred in every case at times) or with suppression of the left EDR. ... "4. General physiological arousal, a normal response to fear, is associated with increased EDRs bilaterally. ... "5. Relaxation and the subjective experience of safety and well-being, which have been reported to foster interhemispheric integration in normal subjects ... were observed to be associated with bilaterally decreased EDR in case I, an example of a less severe post- traumatic condition, but not observed during attempts at relaxation in Vietnam veterans with more severe post-traumatic symptoms. "6. Voluntary efforts to cognitively control fear were related to left hemispheric functioning, as observed in case IV when the subject attempted to control intrusive thoughts with cognitive activity and in Case III following the revivification of a frightening event when he made a shift from the hypnotic trance state to waking cognitive activity. In both cases, such cognitive activity was associated with a decreased right-sided EDR" (p. 359).
DISCUSSION
The results of this pilot study, which demonstrated frequent EDR differences between hands during subjects' recollections of or attempts to suppress recollections of prior traumatic experiences, alters the traditional belief that increased skin conductance is always a predictable physiological measurement when the electrode is placed on only one hand, as Lacroix and Comper (46) have pointed out.
"The finding of EDR lateralization is consistent with the findings of deBonis and Baque (10) who reported that the degree of anxiety determines the presence of lateralization of EDR responses, of Gruzelier and Venables (30, 32) and Myslobodsky and Horesh (53) who reported that the presence or absence of psychopathology determines the direction of the lateralized response, and of Lacroix and Comper (46) that activation of one hemisphere may suppress
Crawford, Helen J. (1982). Cognitive processing during hypnosis; much unfinished business. Research Communications in Psychology, Psychiatry and Behavior, 7, 169-179.
Studies of cognitive processing during hypnosis per se are reviewed suggesting that hypnotically responsive individuals not only experience subjective changes during hypnosis that are seen as often being discontinuous from their normal consciousness but also may exhibit measurable cognitive changes. Evidence (ego functioning changes, enhanced creativity, enhanced imagery processing, etc.) is presented to support the hypothesis that hypnosis may involve a shift in cognitive functioning away from a verbal, detail-oriented strategy towards a more imaginal, non-analytic, holistic- oriented strategy. Limitations of present research and potentially valuable research areas are discussed.
NOTES
The author reviews evidence for cognitive changes during hypnosis--evident especially in high hypnotizables but also to some degree in moderate hypnotizables. She concludes that there may be changes in ego functioning, imagery functioning, creativity, and strategy preferences and that high hypnotizables are more flexible in cognitive processing . "The question remains whether or not there are accompanying objectively measurable cognitive changes during hypnosis" (p. 170).
In normal waking consciousness, the hypnotically responsive individual is typically found to be more involved in nonhypnotic imaginative activities and experiences (Hilgard, 1979; Tellegen & Atkinson, 1974), more able to image things (for review, see Sheehan, 1979) and daydream vividly and positively (Crawford, 1982), more able to perceive gestalt closure figures (Crawford, 1981), more able to divert attentional process (e.g., Karlin, 1979), and more creative on certain tasks (e.g., P. Bowers, 1979). Experiential reports indicate that it is these very cognitive processes, amongst others, which are perceived to be enhanced or changed during the hypnotic state" (p. 170).
"Levin and Harrison (1976) found that hypnosis ego changes occurred most in those individuals who also demonstrated good capacity for adaptive regression in the waking state" (p. 171).
"Dave (1979) compared hypnotically induced dreams with rational-cognitive treatment as to their effects on creative problem solving of the problems or projects. 'Conditional support' was given to the significantly stronger effect form the hypnotically induced dreams" (p. 172).
There are many investigations of the effect of hypnosis on imagery, with a number of methodological problems. "Self-reports can be criticized on the grounds that they are easily subject to demand characteristics, subject expectations, and social desirability influences. Coe et al. (1980) found order of condition influenced their findings, while Crawford (1979) found that imagery rating scales suffered from a low ceiling effect among high imagers" (pp. 172-173).
"Surprisingly, while the field of cognitive psychology has devoted extensive attention to the study of the enhancing effects of imagery upon memory, few of their paradigms have been applied to the study of hypnotic processing of information. Germaine to the field of hypnosis are three operational approaches to the investigation of imagery: (a) the manipulation of the availability of imagery as a coding device, such as varying the degree to which stimuli may evoke imagery, (b) the manipulation of the processing strategy in cognitive performance, such as asking subjects to use imagery in the mediation of stimuli information, and (c) the comparing of information processing strategies and performance in subjects who are low and high in imagery ability (Paivio, 1971)" (p. 173).
"Several studies (Nomura, Crawford, & Slater, 1981; Walker, Garrett, & Wallace, 1976; Wallace, 1978) found that a very few high hypnotizables can successfully produce eidetic imagery, using nonfakable stereograms, during hypnosis even though they cannot during waking. Spanos, Ansari, & Stam (1979) were unable to replicate these findings. It was only self-reported childhood eidetikers who exhibited eidetic imagery during hypnosis, and then only a few. This research suggestions that hypnosis permits certain individuals to access the "lost" ability to image eidetically, possibly through a shift in cognitive strategies" (p. 174).
"An underlying emphasis of this paper is the need for hypnotic investigators to integrate findings form cognitive psychology into their research, as well as apply the many new approaches to understanding brain functioning which are now being developed, inn their search for a better understanding of what occurs during hypnosis" (p. 176).
1981
Chen, Andrew C.; Dworkin, Samual F.; Bloomquist, Dale S. (1981). Cortical power spectrum analysis of hypnotic pain control in surgery. International Journal of Neuroscience, 13, 127-136.
Cortical power spectrum (CPS) of brain potentials was recorded from the scalp between prefrontal and parietal regions in both right hemisphere (RH) and left hemisphere (LH). A pattern of laterality shift in CPS occurred at different stages during an extensive oral surgery, performed under hypnosis, in a young female patient. Video and audio recordings as well as psychophysiological recordings were obtained through the following 6 stages: Baseline, Hypnosis, Surgery (1 hr, no cortical recording), Immediate Postsurgery Procedure, Hypnotic Re-experience, Hypnotic Rest, and Posthypnotic Baseline. Indications of anxiety and pain scores were reported in writing by the patient through verbal command by the hypnotist. In each stage, 10 min of CPS (10 spectrum/stage, 8 epochs/spectrum, 6 seconds/epoch) were analyzed by a PDP-11 computer. The results of CPS analysis demonstrated significant large total power reduction at different stages. There was significant correlation between both hemispheres at baseline, but dissociation of hemispheric power output occurred during hypnosis stages. LH was more dominant than RH during baseline and presurgery hypnosis, but both were leveled- off immediately following the surgery procedure. However, RH became more dominant during all postsurgery hypnosis stages. Interestingly, this pattern shifted back to the original relationship during the posthypnotic baseline stage. Specific changes of spectral power in theta and alpha of EEG activities in both hemispheres also occurred in conjunction with hypnosis.
NOTES
Subject was a 25 year old woman, described as only medium in hypnotizability. She scored 3 on the 5-point Stanford Hypnotic Clinical Scale, 7 on the 12-point Stanford Hypnotic Susceptibility Scale, and 3 on up-gaze, between 2 and 3 on eye roll, on the Spiegel eye roll test.
The principal hypnotic approach was a suggestion of dissociation, i.e. that the patient "experience herself swimming freely and powerfully, in a deep cold mountain lake, pre-occupied with the intensity of the blue-black color of the water, the shimmering of light from above, and the possibilities of exploration of rock formations, caves, etc. It was suggested that while she was experiencing the exhilaration and strenuous stimulation of the cold water and the vigorous exercise, an 'observing-self' would remain on the shore, watching and ensuring that no harm would come to the person. The suggestion was reinforced that any stimulation experienced was experienced in the body, not in the person" (p. 129).
The patient was trained in inductions and dissociation first in the therapist's office, then with two sessions in the research laboratory (where tooth pulp stimulation pain thresholds were measured), and then two sessions in the hospital dental operatory.
The results of the computerized CPS were analyzed by hemispheres. "Large reductions in total power occurred at different stages associated with hypnosis and these reductions in power output of the CPS showed significant left-right differences" (p. 130).
"The total energy output of LH [left hemisphere] continued to diminish as hypnosis continued by as much as 80% of baseline value, while RH [right hemisphere] power output tended to be stabilized from the initial hypnosis recording stage until the awake baseline stage" (p. 130).
"Those stages involving hypnosis were characterized by dominant RH energy output in the alpha spectrum. ...
"Alpha output for the LH decreased an average of 65% between awake baseline levels and postsurgery hypnosis stages, while RH alpha only decreased approximately 50% of resting levels. This resulted in a relative shift of alpha output which was approximately equal in both hemispheres prior to surgery, to a 2:1 shift in favor of RH alpha output as hypnosis progressed. This differential shift in laterality of alpha was reversed when the subject awakened from hypnosis.
"Of interest was the observation that total power reductions and laterality shifts associated with hypnosis were not altered by the profound instrumentation of surgery and postoperative pain, nor were observed laterality shifts affected by hypnotic suggestions aimed at recreating the surgical experience (see Stage 5)" (p. 130).
During the experiment when the investigators used hypnotic suggestion to recreate the surgical experience, LH output continued to diminish while RH output did not change, making the LH-RH contrast highly significant. "This suggests that the RH is active during deep stages of hypnosis and can remain so despite hypnotic suggestions which are presumed to be intensely aversive" (p. 131).
In their Discussion, the authors reinforced the conclusion that overall cortical functioning is reduced during hypnosis, and that the left cerebral hemisphere shows a greater reduction than the right. They discuss the increased theta density in RH and LH during the postsurgery hypnosis stage in terms of reports that theta is associated with altered states of consciousness (Tebecis et al., 1975; Ulett et al., 1972; Anad, China, & Singh, 1961; Banquet, 1973; Kasamatsu & Hirai, 1966; Wallace, 1970) and with cognitive tasks like mental arithmetic (Dolce et al., 1974).
The authors note that their results are congruent with Hilgard's neodissociation theory of hypnosis, and add that since their suggestions were dissociative in nature rather than of local anesthesia, the EEG may reflect the brain physiology of dissociation.
Finally, they comment on the implications for pain neurophysiology. "The total power changes and shifting patterns in laterality of cortical functioning observed more closely tracked the hypnosis experience than the pain experience; this is, in fact, a very puzzling issue. It appears on the face of it that the EEG measurements recorded are not reflective of EEG-related pain phenomenology despite the strenuous and invasive surgical procedures used. The observations that overall power output continued to decrease during the several hypnosis stages after strenuous surgery and then increased as the patient came out of hypnosis makes reasonable the possibility that _hypnosis_ has some functional brain correlates; we cannot conclude from the present cortical power spectrum analysis that any brain correlates of surgical _pain_ were revealed. We are well aware that EEG recordings were not available during actual surgery itself, because of artifacts resulting from head movements, etc. Nevertheless, it can be fairly claimed that recordings obtained immediately after such oral surgery of one hour duration, could reasonably be expected to be associated with a person in pain. But, both by verbal report and available objective data, any surgically induced traumatic pain was of brief duration under hypnosis" (p. 135).
1970
Bakan, Paul (1970). Handedness and hypnotizability. International Journal of Clinical and Experimental Hypnosis, 18, 99-104.
Carried out 2 studies with 251 and 228 undergraduates to determine the relationship between self-reports of handedness and scores on a shortened version of the Harvard Group Scale of Hypnotic Susceptibility, Form A. It was found that left-handed Ss were more likely than right-handed Ss to score at the extremes of the hypnotizability scale, either low or high, and less likely to score in the middle of the scale. Results of 2 independent studies were in agreement. (Spanish & German summaries) (15 ref.) (PsycINFO Database Record (c) 2003 APA, all rights reserved)
Learning
1992
Appel, Philip R. (1992). Performance enhancement in physical medicine and rehabilitation. American Journal of Clinical Hypnosis, 35, 11-19.
Performance enhancement or mental practice is the "symbolic rehearsal of a physical activity without any gross muscular movements" to facilitate skill acquisition and to increase performance in the production of that physical activity. Performance- enhancement interventions have been well known in the area of sports psychology and medicine. However, clinical applications in physical medicine and rehabilitation have not flourished to the same extent, though the demand for improved physical performance and the acquisition of various motor skills are as important. In this paper I will describe how hypnosis can potentiate mental practice, present a model of mental practice to enhance performance, and describe how to help patients access an ideal performance state of consciousness.
1991
Block, Robert I.; Ghoneim, M. M.; Sum Ping, S. T.; Ali, M. A. (1991). Efficacy of therapeutic suggestions for improved postoperative recovery during general anesthesia. Anesthesiology, 75, 746-755.
There have been claims that the postoperative course of patients may be improved by presentation during general anesthesia of therapeutic suggestions which predict a rapid and comfortable postoperative recovery. This study evaluated the effectiveness of such therapeutic suggestions under double-blind and randomized conditions. A tape recording predicting a smooth recovery during a short postoperative stay without pain, nausea, or vomiting was played during anesthesia to about half the patients (N = 109), while the remaining, control patients were played a blank tape instead (N = 100). The patients were primarily undergoing operations on the fallopian tubes, total abdominal hysterectomy, vertical banding gastroplasty, cholecystectomy, and ovarian cystectomy or myomectomy. The anesthesia methods consisted of either isoflurane with 70% nitrous oxide in oxygen to produce end-tidal concentrations of 1.0, 1.3, or 1.5 MAC; or 70% nitrous oxide in oxygen combined with high or low doses of opioids. Assessments of the efficacy of the therapeutic suggestions in the recovery room and throughout the postoperative hospital stay included: the frequency of administration of analgesic and antiemetic drugs; opioid doses; the incidence of fever; nausea, retching, and vomiting; other gastrointestinal and urinary symptoms; ratings of pain; ratings of anxiety; global ratings of the patients' physical and psychological recoveries by the patients and their nurses; and length of postoperative hospital stay. There were no meaningful, significant differences in postoperative recovery of patients receiving therapeutic suggestions and controls. These negative results were not likely to be due to insensitivity of the assessments of recovery, as they showed meaningful interrelations among themselves and numerous differences in recovery following different types of surgery. Widespread utilization of therapeutic suggestions as a routine operating room procedure seems premature in the absence of adequate replication of previously published positive studies. (Key words: Anesthesia, depth: Awareness, Memory, Recall, Learning.)
NOTES
Patients ages 19-55 were accepted into the study and they were paid for participation. (Older patients were excluded to guard against memory or hearing problems.) Other criteria for exclusion were: ASA physical status 4 or 5 indicating significant systemic disease, visual or hearing problems, middle ear disease (because it increases probability of nausea and vomiting), if their condition might require heavy sedation, if they were currently taking medication that interferes with memory (e.g. benzodiazepines, if there were intolerance to opioids, or if there were a likelihood of using postoperative pain treatment other than opioids.
The Spielberger State-Trait Anxiety Inventory was administered before surgery. Either suggestions (lasting 6 minutes) or a blank tape were played through headphones, starting 5 minutes after the surgical incision. The tape was played once for the first 59 patients, continuously for the remaining 150 patients. The first 139 patients received additional verbal materials on the tape, for memory tests to test possibility of learning under anesthesia. Operating room sounds were recorded by a tape recorder near the patient's head, throughout period of unconsciousness (except when tape was being played).
After the first 25% of cases, the team decided that lack of effect on therapeutic suggestions attributable to type of anesthesia did not warrant restriction to a single anesthetic method; also, multiple presentations of the suggestions on tape did not show an effect different from a single presentation.
After the patient regained consciousness and was reoriented, pain, nausea, retching, and vomiting were assessed every 30 minutes. Pain was rated orally on a scale from 1 to 10 in the recovery room, then on visual analogue scales every 2 hours on the day of surgery and the second day, and every 4 hours on subsequent hospital days during waking hours. Variables that were rated by staff every 24 hours included: opioids, other analgesics, antiemetics, nausea, vomiting, retching, presence or absence of nasogastric tube, passage of flatus, bowel movement, fluid intake, solids intake, urination. Temperature was recorded every 4 hours for the first 2 days after surgery, and after that less often. The anxiety measures were repeated on Day 3 postsurgery, as well as self ratings and nurse ratings on physical and psychological recovery. Staff recorded length of postoperative hospital stay and reasons for any delay of discharge. Separate analyses were performed for patients receiving opioids via patient-controlled analgesia (52%) vs traditional administration (48%), but no differences were found for effects of therapeutic suggestions except on postoperative Day 8.
"The inability to detect beneficial effects of therapeutic suggestions probably was not due to insensitivity of the measures of recovery. These measures were sensitive enough to show numerous significant differences in recovery after different types of surgery" (p. 751). The authors supported their contention that the measures were sufficiently sensitive by demonstrating meaningful correlations among the measures themselves; and by demonstrating adequate statistical power for detecting the effects of theoretical interest--at least 1 day in postoperative hospital stay or one half day in fever.
Discussion: The authors note that a recent investigation that found positive results in a double-blind, randomized design with 39 hysterectomy patients (Evans & Richardson, 1988. Improved recovery and reduced postoperative stay after therapeutic suggestions during general anaesthesia. Lancet, 2:491-493) may not have controlled for variables such as presence of malignancy, physical status of patients before surgery, or ethnicity. Authors note that Evans and Richardson observed shorter periods of pyrexia despite there being no relevant suggestions, but no differences in pain intensity, nausea, vomiting, or urinary difficulties despite there being suggestions relating to those symptoms. There also were no differences in mood and anxiety test scores postoperatively for the experimental and control groups.
The authors note that McLintock, Aitken, Downie, & Kenny (Postoperative analgesic requirements in patients exposed to positive intraoperative suggestions. Br M J 301:788-790. 1990) reported a 23% reduction in opioids by patients receiving suggestions, but no reduction in pain, nausea, or vomiting. They contrast the present study with these earlier studies that had obtained positive results.
"We studied patients who had more than one type of surgery to obtain a large sample size and to assess the possibility that beneficial effects of therapeutic suggestions would be restricted to certain types of operations. Had this been the case, interactions of therapeutic suggestions with type of surgery would have been significant in the overall analyses, and follow-up analyses would have indicated that they were attributable to beneficial effects of therapeutic suggestions for certain surgeries. This did not occur. The two types of surgeries involving the largest numbers of patients seemed particularly promising for demonstrating beneficial effects. It has been reported that therapeutic suggestions presented during anesthesia are likely to be less successful with major and extensive surgery. Certainly, surgery on the fallopian tubes and gastric stapling did not involve a great deal of tissue trauma and blood loss. Patients were motivated to have the surgery and to recover quickly; particularly motivated were those having operations on the fallopian tubes, who were very eager to become pregnant, and those having vertical banding gastroplasties, who wanted desperately to lose weight" (pp. 753-754).
"In practice, we observed no beneficial effects of therapeutic suggestions, and there was no hint that anesthesia methods influenced the efficacy of the therapeutic suggestions. Interestingly, anesthetic methods also did not influence learning under anesthesia in the implicit memory tests we have used previously. Patients anesthetized with nitrous oxide and opioids did not differ from those anesthetized only with inhalational agents. In general, implicit or unconscious memory occurs in patients regardless of anesthesia methods or dosages of drugs" (p. 754).
"The few significant effects of therapeutic suggestions in our study did not point toward a beneficial influence of these suggestions. We found, in fact, an increased frequency of retching (but not nausea or vomiting) in the experimental group. The multiple variables examined in this study increased the likelihood of significant differences arising by chance, such that the null hypothesis was rejected when it should have been accepted. This is the way we interpret the effect on retching---i.e., as a type I error. We used in our therapeutic suggestions one negative or exclusionary sentence, 'You won't feel nauseous or have to vomit', among several positive or affirmative statements, e.g., 'You will enjoy eating, drinking...You will swallow to clear your throat and everything will go one way, straight down. . . The food will taste good....Your stomach will feel fine.' We do not think that the negative sentence led to paradoxical results. Evans and Richardson (personal communication) used in their therapeutic suggestions a negative sentence ('You will not feel sick'), which they repeated, yet the reported incidence of nausea and vomiting did not differ between the experimental and control groups" (p. 754).
Life experience
1994
Sivec, Harry; Lynn, Steven Jay; Segal, David; Malinoski, Peter; Crothers, Marie K.; Wilson, Holly; Roche, C. (1994, October). Autobiographical memories in hypnosis, relaxation, and waking conditions. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Francisco.
This is an update of what was presented at last year's meeting. It presents data on waking relaxation vs waking hypnosis conditions.
Research Design: 3 groups: relaxation, hypnosis, and control All Ss were highs (scoring at least 9) and also high on Fantasy Proneness. But Ss were informed that they were randomly selected from the subject pool.
Administered the SCL-90R [?], POMS, and PES (a measure of hypnosis related experiences), and the Stanford-Form C. Early memory protocol required that Ss report the earliest specific childhood event that they could recall; they were told to remember that the time is the present [?].
Recalled two early and two recent memories, in counterbalanced order.
Ss completed the PES for a second time. Positive affect, negative affect, affect intensity, and primary process were evaluated.
Hypotheses about more primary process and affect were not supported.
When early memory was probed first, it was about age 3; when recent memory was probed first, the earliest memory was about 4. The second memory recalled was older (among younger memories) for hypnotized Ss than for non-hypnotized Ss.
For negative affect the relationships were different. Relaxation might have diminished the negativity of affect that was remembered.
1991
Smith, William H. (1991). Antecedents of posttraumatic stress disorder: Wasn't being raped enough? A brief communication. International Journal of Clinical and Experimental Hypnosis, 39, 129-133.
Many rape victims, like those traumatized by war, accidents, and natural disasters, are able to recover from their ordeal with supportive, crisis-oriented treatment. For others, however, symptoms may persist and require more intensive treatment. Hypnosis allows a modulated re-experiencing and abreaction of the traumatic event that can help to provide the victim with a relieving sense of mastery, and it fosters a receptive context for reassurance and interpretation regarding the irrational or exaggerated thoughts and feelings involved. 2 case examples are presented in which earlier conflicts appeared to play a role in perpetuating the patients' symptoms. Detecting and addressing these antecedents resulted in complete alleviation of long-standing problems through relatively brief treatment using hypnosis.
1985
Gottschalk, Louis A. (1985). Hope and other deterrents to illness. American Journal of Psychotherapy, 39, 515-524.
Reviews animal and human research demonstrating that events during early development influence vulnerability to physical and mental illness. In addition, effectiveness of coping methods used to deal with problems of living can affect susceptibility to illness. The intervening mechanisms between stressful life experiences and illness appear to involve physiological homeostasis and immune competence.
1962
As, Arvid; Lauer, Lillian W. (1962). A factor analytic study of hypnotizability and related personal experiences. International Journal of Clinical and Experimental Hypnosis, 10 (3), 169-181.
To throw further light on the exclusivity of "primary suggestibility" as reported by other investigators, a factor analysis was performed in a sample of 102 female college students on the basis of the intercorrelations of 23 items of personal experiences earlier shown to be related to hypnotizability, and 19 items from 2 hypnosis scales. No simple factor structure emerged. 2 factors were interpreted: the 1st as a hypnotic factor with special emphasis on the capability to sustain the effect of suggestion over time, and the 2nd as a combination of psychological changeableness and social influencibility. A brief discussion was given of the composite picture of hypnotic susceptibilty emerging from the fact that many hypnotic items loaded on both factors. (PsycINFO Database Record (c) 2002 APA, all rights reserved)
Rose, J. T. (1962). The use of relevant life experiences as the basis for suggestive therapy. International Journal of Clinical and Experimental Hypnosis, 10, 221-229. (Abstracted in Imagery 63: Mar., S-543)
A brief, directive method of hypnotherapy is described which combines limited insight therapy with hypnotic suggestions based on relevant life experiences of the patient. By integrating suggestions and experiences familiar to the patient, the former are more likely to have greater meaning to the patient and are therefore more effective. (PsycINFO Database Record (c) 2002 APA, all rights reserved)
Shor, Ronald E.; Orne, Martin T.; O'Connell, D. N. (1962). Validation and cross-validation of a scale of self-reported personal experiences which predicts hypnotizability. Journal of Psychology, 53, 55-75. (Abstracted in Psychological Abstracts, 62: 4 II 55S)
A paper-and-pencil self-report questionnaire was designed to measure the incidence of "hypnotic-like" experiences which have occurred naturally in the normal course of living. The questionnaire as evolved was found to predict hypnotizability, especially in the deepest region of the hypnotizability, especially in the deepest region of the hypnotizability continuum. Ramifications of the data are presented in terms of theoretical formulations where both ability factors and nonability factors (such as attitudes and motives) are viewed as components of achieved hypnotizability. From Psyc Abstracts 36:04:4II55S. (PsycINFO Database Record (c) 2002 APA, all rights reserved)