Blankfield, Robert P. (1991). Suggestion, relaxation, and hypnosis as adjuncts in the care of surgery patients: A review of the literature. American Journal of Clinical Hypnosis, 33, 172-186.
He notes that the authors provide little information re complications, and length of stay (LOS) is one of the most sensitive response measures used in these studies. The mean difference in LOS for 5 studies that have randomized assignment is 1.3 days. The N’s are 80-100 for 3 of the studies, 39 and 60 for others. For two well controlled studies that did not achieve significance, the N’s were 40 and 45. Many studies mixed the diagnosis and types of surgeries, making it difficult to interpret the results
Bodden, Jack L. (1991). Accessing state-bound memories in the treatment of phobias: Two case studies. American Journal of Clinical Hypnosis, 34, 24-28.
Two cases of simple phobia demonstrate the inadequacies of both behavioral and psychodynamic theories. These cases and their treatment outcomes provide support for the state-dependent memory and learning theory. Hypnosis and ideomotor signaling proved to be not only effective treatments but also useful means of illuminating the role and nature of symptom function. Issues of symptom removal and substitution are also discussed in relation to these cases
The authors state that Rossi and Cheek (1988) summarize a number of experimental studies on animal memory that demonstrate that different information substances are involved in different learning situations. For example, ACTH and cortisol are involved in avoidance learning while angiotensin is involved in operant conditioning. In hypnosis, state dependent memory seems to be implicated. “Hilgard (1977) interpreted the state-dependent memory studies by Overton and others as entirely consistent with and supportive of his theory of hypnosis. Milton Erickson (1948) has also strongly suggested that it is the altered levels of arousal and affect that are responsible for the encoding and recall of stress-related problems with hypnosis” (p. 26).
“Affective experiences are apparently stored independently from their intellectual counterparts, or the emotional unit form one set may attach itself to a constellation of cues that make up a totally different cognitive set. Hypnosis may facilitate recall by providing relevant cues during an altered state of consciousness” (p. 27).
“In commenting upon [one of Erickson’s cases], Rossi (1986) states that Erickson was effective because he helped the patient access state-bound memories by reviewing the context and sensory-perceptual cues that surrounded their original acquisition” (p. 27).
When traditional behavior therapy fails it may be because the original fear stimulus is state bound or unconscious. What is conscious to the patient are those stimuli that are similar in some important respect to the original phobic stimulus and are acquired by stimulus generalization. Desensitization may reduce the patient’s reactivity to the associated or acquired stimuli but cannot desensitize the original stimulus until it can be accessed consciously” (p. 27).
“The two main psychological explanations of phobic behavior are psychodynamic and behavioral. The psychodynamic approach is built upon the early writings of Freud (1956) on the traumatic basis of neurosis. Freud speculated that the intense anxiety (psychic pain) associated with the emotional trauma lead to dissociation, repression, and amnesia. Symptoms represented a dissociated or symbolic vestige of the repressed (‘forgotten’) trauma.
“Behavioral explanations (e.g., Rimm & Masters, 1974) are built upon classical and operant conditioning models of learning. Classical conditioning explains how a neutral stimulus (e.g., a bridge) can acquire reactivity and elicit a fear response. Avoidant behavior, which preserves the phobia, is acquired and maintained by operant conditioning. Treatment apparently involves gradual extinction of the fear response.
“These two divergent explanations have spawned quite different therapeutic approaches, with the behavioral approach (systematic desensitization) demonstrating greater empirical support for its effectiveness (Kaplan & Sadock, 1986). The problem is made complex theoretically by the fact that desensitization doesn’t always work, even when applied in a competent fashion” (p. 25).
“Freud’s early work on the traumatic basis of neurosis pointed to but offered an incorrect explanation of phobias whose origins were unconscious or state bound (i.e., not available to recall during the normal conscious state)” (p. 25).
Dennett, Daniel C. (1991). Consciousness explained. Boston: Little, Brown & Co..
Material in this book is relevant to discussions about ‘nonvoluntary’ behavior and (un)conscious experiencing. It combines information from cognitive neuroscience with the philosophy of mind. The author presents a view that consciousness (the ‘mind’) is the consequence of the brain’s activities which give rise to illusions about their own properties. He presents the Multiple Drafts model of consciousness, which reformulates the concept of a ‘stream of consciousness.’ This provides a basis for consideration of concepts central to cognitive neuroscience and phenomena associated with hypnosis, e.g. experiential states and the nature of the self.
The author gives various examples of phenomenology and notes that although these examples are familiar to us, they are totally inaccessible to materialistic science; e.g. the way the sunset looks to someone. He treats people’s descriptions of what they experience as a record of speech acts. Thus, observing and interpreting speech acts, inferring from them the speaker’s inner states, is like a reader who is interpreting a work of fiction. He gives as examples of how one can scientifically study what does not ‘exist’ (a) literary theorists who describe fictional entities, (b) anthropologists who study cultural artifacts like gods and witches, and (c) physicists who study a center of gravity.
In Dennett’s theory, multitrack processes of interpretation of sensory inputs and elaboration of those inputs amounts to a kind of ‘editorial revision’ by the brain. For example in the phi phenomenon a red dot is displayed, followed by a green dot in a different location; the first spot seems to begin moving and then change color in the middle of its illusory passage toward the second location. He points out that awareness of the change in color must occur after seeing the green spot, but one consciously experiences a single spot first red, then red-turning-to-green, finally green. In an example that relates directly to the words used for his theory, he cites contemporary publishing practices, in which several different drafts of an article are in circulation even while the author is revising it. Deciding on some specific moment of brain processing as the moment of consciousness is arbitrary, according to his Multiple Drafts model.
“Visual stimuli evoke trains of events in the cortex that gradually yield discriminations of greater and greater specificity. At different times and different places, various ‘decisions’ or ‘judgments’ are made; more literally, parts of the brain are caused to go into states that discriminate different features, e.g., first mere onset of stimulus, then location, then shape, later color (in a different pathway), later still (apparent) motion, and eventually object recognition. These localized discriminative states transmit effects to other places, contributing to further discriminations, and so forth. The natural but naive question to ask is: ‘Where does it all come together’? The answer is: Nowhere. Some of these distributed contentful states soon die out, leaving no further traces. Others do leave traces, on subsequent verbal reports of experience and memory, on ‘semantic readiness’ and other varieties of perceptual set, on emotional state, behavioral proclivities, and so forth. Some of these effects–for instance, influences on subsequent verbal reports–are at least symptomatic of consciousness. But there is no one place in the brain through which all these causal trains must pass in order to deposit their content ‘in consciousness'” (pp. 134-135).
The author describes the evolution of the brain, along Darwinian lines, and introduces the idea of culture as a repository and
“Visual stimuli evoke trains of events in the cortex that gradually yield discriminations of greater and greater specificity. At different times and different places, various ‘decisions’ or ‘judgments’ are made; more literally, parts of the brain are caused to go into states that discriminate different features, e.g., first mere onset of stimulus, then location, then shape, later color (in a different pathway), later still (apparent) motion, and eventually object recognition. These localized discriminative states transmit effects to other places, contributing to further discriminations, and so forth. The natural but naive question to ask is: ‘Where does it all come together’? The answer is: Nowhere. Some of these distributed contentful states soon die out, leaving no further traces. Others do leave traces, on subsequent verbal reports of experience and memory, on ‘semantic readiness’ and other varieties of perceptual set, on emotional state, behavioral proclivities, and so forth. Some of these effects–for instance, influences on subsequent verbal reports–are at least symptomatic of consciousness. But there is no one place in the brain through which all these causal trains must pass in order to deposit their content ‘in consciousness'” (pp. 134-135).
The author describes the evolution of the brain, along Darwinian lines, and introduces the idea of culture as a repository and transmission medium for innovations (including innovations of consciousness) as a medium of evolution. Through learning, we humans evolve an American or a Japanese brain. Once we have evolved the ‘entrance and exit pathways’ for language, they become ‘parasitized’ by _memes_ (entities that have evolved to thrive in such a niche).
Richard Dawkins coined the term _memes_ to describe the smallest idea elements that replicate themselves reliably (e.g. wheel, alphabet, wearing clothes, right triangle). “The transformation of a human brain by infestations of memes is a major alteration in the competence of that organ” (p. 209).
Dennett discusses the similarities and dissimilarities of brains and computers. He suggests that human minds are like serial virtual machines implemented on parallel processing hardware. The stream of consciousness results from our rehearsal of brief experiences, to commit them to memory; language then permits us to describe to ourselves the process of thinking which leads to judgement and action.
The author’s discussion of how a verbal expression evolves and becomes manifest is related to how so-called intentional action occurs. [This relates to discussions of nonvoluntary actions in hypnosis.] We assume that because our actions make sense, they are the product of serial reasoning. However, there are multiple channels “in which specialist circuits try, in parallel pandemoniums, to do their various things … (pp. 253- 254). Bernard Baars has suggested “that consciousness is accomplished by a ‘distributed society of specialists that is equipped with a working memory, called a _global workspace_, whose contents can be broadcast to the system as a whole (p. 42)'” (p. 257). Dennett states that there is no line dividing the events that are definitely in consciousness from those that are outside consciousness. He urges scientists to forgo the concept of the ‘inner observer’ implied by Cartesian materialism.
Examples of perception that is unaccompanied by consciousness include blindsight (in which the subject does better than chance on visual tests but denies consciousness, and the denials are given credence by neurological evidence of brain damage) and hysterical blindness, which is given less credence because subjects often use the visually provided information in ways blindsight Ss do not. Other behaviors not controlled by conscious thought include blinking when things approach the eye, walking without falling over, regulating our body temperature, adjusting our metabolism, etc. “If I am trying to see a bird that I hear, and stare at the spot but do not distinguish the bird from its background, can I say that it is present in the background of my (visual) consciousness or not?” (p. 336).
The author maintains that if an event doesn’t linger and the person is unable to identify and reidentify the effect, it cannot be reported. But such reportability can be improved, as with training the palate of wine tasters. Often, however, we continue disregarding stimuli that impinge on us. There are minor oversights, such as our ‘blind spots’ or proof reading errors, and major oversights such as a brain-damaged patient’s hemi-neglect. In the Multiple Drafts theory, the Observer is replaced by ‘coalitions of specialists’ that are distributed around in the brain, distributed in both time and space.
Though discrimination or discernment happens, there is no one Discerner doing the work. However, Dennett takes the middle ground on the question of whether a self exists: it is simply a creation like the nest of the Bower bird, or the organized colony of termite ants. “So wonderful is the organization of a termite colony that it seemed to some observers that each termite colony had to have a soul (Marais, 1937). We now understand that its organization is simply the result of a million semi-independent little agents, each itself an automaton, doing its thing. So wonderful is the organization of a human self that to many observers it has seemed that each human being had a soul, too: a benevolent Dictator ruling from Headquarters” (p. 416). The sense of self is a creation, like a physicist’s center of gravity.
Thus, multiple personality disorder is viewed as a self that has gaps; and our sense of self might include different aspects from one year to the other. Hence, “selves are not independently existing soul-pearls, but artifacts of the social processes that create us, and, like other such artifacts, subject to sudden shifts in status. The only ‘momentum’ that accrues to the trajectory of a self, or a club, is the stability imparted to it by the web of beliefs that constitute it, and when those beliefs lapse, it lapses, either permanently or temporarily” (p. 423).
Finally, the author has an extensive discussion of the concepts of ‘qualia’ and of ‘epiphenomena’ and seems to have little use for either term in trying to understand Mind.
of my (visual) consciousness or not?” (p. 336).
The author maintains that if an event doesn’t linger and the person is unable to identify and reidentify the effect, it cannot be reported. But such reportability can be improved, as with training the palate of wine tasters. Often, however, we continue disregarding stimuli that impinge on us. There are minor oversights, such as our ‘blind spots’ or proof reading errors, and major oversights such as a brain-damaged patient’s hemi-neglect. In the Multiple Drafts theory, the Observer is replaced by ‘coalitions of specialists’ that are distributed around in the brain, distributed in both time and space.
Though discrimination or discernment happens, there is no one Discerner doing the work. However, Dennett takes the middle ground on the question of whether a self exists: it is simply a creation like the nest of the Bower bird, or the organized colony of termite ants. “So wonderful is the organization of a termite colony that it seemed to some observers that each termite colony had to have a soul (Marais, 1937). We now understand that its organization is simply the result of a million semi-independent little agents, each itself an automaton, doing its thing. So wonderful is the organization of a human self that to many observers it has seemed that each human being had a soul, too: a benevolent Dictator ruling from Headquarters” (p. 416). The sense of self is a creation, like a physicist’s center of gravity.
Thus, multiple personality disorder is viewed as a self that has gaps; and our sense of self might include different aspects from one year to the other. Hence, “selves are not independently existing soul-pearls, but artifacts of the social processes that create us, and, like other such artifacts, subject to sudden shifts in status. The only ‘momentum’ that accrues to the trajectory of a self, or a club, is the stability imparted to it by the web of beliefs that constitute it, and when those beliefs lapse, it lapses, either permanently or temporarily” (p. 423).
Finally, the author has an extensive discussion of the concepts of ‘qualia’ and of ‘epiphenomena’ and seems to have little use for either term in trying to understand Mind.
Grossarth-Maticek, R.; Eysenck, H. J. (1991). Creative novation behaviour therapy as a prophylactic treatment for cancer and coronary heart disease: Part II – Effects of treatment. Behaviour Research and Therapy, 29, 17-31.
Reports on what they call creative novation behavior therapy or “autonomy training” to prevent cancer and coronary heart disease in prone individuals. This individually tailored cognitive-behavioral program includes the use of hypnosis and of imagery. When administered individually (20-30 hours) in a group (6-15 sessions of up to several hours) or via bibliotherapy with 4-6 hours of individual therapy, the outcome was better than that of control subjects. After 13 years, 45 of 50 cancer-prone subjects in individual treatment were still alive (and none of the 5 deaths were from cancer), while among 50 control subjects, 31 died, 16 from cancer. This study along with Spiegel et al. (1989) article in Lancet have important implications for health care.
Hopkins, Mildred B.; Jordan, Jeanette M.; Lundy, Richard M. (1991). The effects of hypnosis and of imagery on bleeding time: A brief communication. International Journal of Clinical and Experimental Hypnosis, 39, 134-139.
2 studies are reported, one using hypnotized Ss selected on hypnotizability and one using Ss selected on imagery vividness, whose purpose is to examine whether non-patient Ss can control their bleeding in a laboratory setting. All Ss were cut on both arms with the “Surgicutt” device, an instrument that automatically makes a cut that will bleed from 2 to 10 minutes. Results suggest that Ss, who are instructed to reduce the bleeding time in one arm and to let the other arm bleed normally, are not able to control bleeding time.
an instrument that automatically makes a cut that will bleed from 2 to 10 minutes. Results suggest that Ss, who are instructed to reduce the bleeding time in one arm and to let the other arm bleed normally, are not able to control bleeding time.
Morse, Donald R.; Martin, John; Moshonov, Joshua (1991). Psychosomatically induced death: Relative to stress, hypnosis, mind control, and voodoo: Review and possible mechanisms. Stress Medicine, 7, 213-232.
A common denominator in psychosomatically induced death is stress. Death can occur slowly, as from the preponderance of chronic stressor, or it can come on suddenly, as from an acute stressor. Sudden death is more likely in an individual with preexistent serious medical conditions, which were outlined. Seven types of individuals more prone to sudden death were outlined. Most cases of sudden death are related to the presence of a severely stressful situation in which there appears to be no means of control or escape. With mind control, hypnosis, and voodoo curses, circumstances can be manipulated to achieve severe stress and uncontrollability.
Palan, Bhupendra M.; Lakhani, Jitendra D. (1991). Converting a ‘threat’ into a ‘challenge’: A case of stress-related hemoptysis managed with hypnosis. American Journal of Clinical Hypnosis, 33 (4), 241-247.
A 24-year-old patient was treated using hypnosis for chronic repeated episodes of hemoptysis. The symptom episodes were related to academic examinations (perceived as a threat by the patient). Clinical examinations and laboratory investigations failed to indicate an organic cause for hemoptysis. He did not respond to empirical treatment trials. These negative findings suggested the psychosomatic nature of the illness. We used hypnotherapeutic ego-strengthening and guided-imagery approaches. This reduced his acute anxiety but failed to check hymoptysis. Use of explorative hypnotic dreaming revealed an emotional trauma as the possible cause of origin of the symptoms. We restructured the trauma experience during hypnotic regression. We advised him to skip the upcoming examination and conducted a total of six therapeutic sessions. The patient continued using self-hypnosis throughout the follow-up period of 3 years during which he remained symptom free and achieved remarkable academic progress. He now perceives an examination as a challenge.
1990
Barber, Theodore Xenophon (1990, August). Some things I’ve learned about hypnosis after 37 years. [Audiotape] Presented at the annual meeting of the American Psychological Association, Boston.
“We are a unity of cells. Every cell is a citizen with it’s own jobs, communicating all the time; cells send messages; the way we communicate with them is by suggestions. Each _cell_ is a mind-body…. When I do it now [hypnotic inductions], I say, ‘We’re going to go into hypnosis, we’re _both_ going to go into hypnosis. I’m going to close my eyes (etc.)’ – modeling hypnosis for them.”
Hajek, P.; Jakoubek, B.; Radil, T. (1990). Gradual increase in cutaneous threshold induced by repeated hypnosis of healthy individuals and patients with atopic eczema. Perceptual and Motor Skills, 70, 549-550.
Gradual increase in cutaneous pain threshold was found in healthy subjects and patients with atopic eczema during repeated hypnotic sessions with specific suggestions. This increase was less in the former than in the latter group. Repeated threshold measurements did not influence the threshold. The analgesic effect outlasted the hypnotic sessions by several months. It could be, however, suddenly reduced by appropriate hypnotic suggestion.
Cutaneous pain threshold was measured in “time in seconds from onset of heat source of defined size, distance from skin, and temperature, to subjective threshold percept of pain” (p. 549). Used two symmetrical locations on both forearms, at healthy areas of the skin. Ten hypnotic sessions were induced in each S three times weekly, each lasting one hour.
Suggestions were the following type: “The “conduction of switch to the brain is interrupted.” Your “immunologic system will digest the damaged skin cells like a shark.”
Subjects were 14 healthy subjects and 13 patients with atopic eczema treated for years with the usual medications, unsuccessfully or with complications.
There was gradual increase in cutaneous pain threshold across the 10 sessions, especially for the patient group. Control experiments with repeated threshold measurements in repeated sessions without hypnosis showed no changes.
“Time of increases in cutaneous pain threshold was associated with improvement of atopic eczema. Both effects correlated significantly (r = 0.8) with hypnotizability as measured by the Stanford scale” (pp. 549-550).
“In 9 patients without further hypnotic sessions a slow spontaneous decay of the cutaneous pain threshold was observed during a 17-mo. period. Special experiments performed with six repeatedly hypnotized healthy subjects showing increased thresholds did prove, however, that the cumulative analgesic effect could be reduced to control values immediately by using the hypnotic suggestion that the ‘skin sensitivity returns to normal values.’
“These results suggest a close association between hypnosis and activation and/or deactivation of endogenous analgesic systems (irrespectively whether they are of opioid or nonopioid nature)” (p.550)
Holroyd, Jean (1990). How hypnosis may potentiate psychotherapy. In Fass, Margot L.; Brown, Daniel (Ed.), Creative mastery in hypnosis and hypnoanalysis (pp. 125-130). Hillsdale, NJ: Lawrence Erlbaum Associates.
This chapter is a reprint of an article published in the American Journal of Clinical Hypnosis in 1987. It provides a conceptual framework for understanding psychotherapy processes in the context of a hypnotic state. Based on empirical and theoretical considerations, the author identified nine changes occurring with hypnosis: changes in attention and awareness, imagery, dissociation, reality orientation, suggestibility, mind-body interactions, initiative or volition, availability of affect, and relationship. “This chapter proposes that hypnotherapy exploits hypnotic phenomena– takes advantage of them–in the service of standard therapy endeavors” (p. 125).
Lazarus, A. A.; Mayne, T. J. (1990). Relaxation: Some limitations, side effects, and proposed solutions. Psychotherapy, 27, 261-266.
Deep-muscle relaxation has been widely regarded as anxiety inhibiting, and the relaxation response an antidote to tension and stress. However, some relaxation techniques have been shown to have negative effects. These include relaxation-induced anxiety and panic, paradoxical increases in tension, and parasympathetic rebound. Specific indications and contraindications are discussed.
The following unpleasant side effects have been observed: “unpleasant sensations of heaviness, warmth, perspiration, tingling, numbness, dizziness, floating, coolness; paradoxical increases in tension; rapid heart rate; feelings of physical and psychological vulnerability; depression; fear of losing control; depersonalization; dissociation; myoclonic jerks; spasms; headache; akathesia; negative auditory, gustatory, and olfactory reactions; intrusive images and thoughts; anxiety; irritability; guilt; regressive urges; hallucinations; and panic” (p. 261).
People have been observed to have “negative or untoward reactions to meditation ([Lazarus, 1976]; French, Schmid & Ingalls, 1975; Kennedy, 1976), relaxation (Borkovec & Grayson, 1980; Carrington, 1977; Edinger & Jacobsen, 1982), and biofeedback (Miller & Dworkin, 1977). In his doctoral dissertation Heide (1981) found that more than half of his subjects under focused relaxation reported increased tension due to the relaxation session. Recently, the concept of RIA–relaxation-induced anxiety–has appeared in the literature (Heide & Borkovec, 1983; 1984). Clients suffering from generalized anxiety appear to be especially prone to RIA” (pp. 261-262).
Others have suggested that relaxation may be counterindicated for asthmatics, because the small airways dilate with sympathetic nervous system arousal. The specific instructions of autogenic training may be counterindicated for patients with gastrointestinal disease because focusing on a sense of warmth in the abdomen tends to produce more peristalsis, increased blood flow in the gastric mucosa, and acidity in the gastric juice (Luthe & Schultz, 1979). Even the standard relaxation therapy for tension headache (as well as other pain problems) is being replaced with cognitive behavioral therapy, which may have relaxation as only one component. “The point again is that relaxation is not a panacea, and that an informed selection and administration of treatments is mandated, even in disorders where relaxation has traditionally been held second only to medication” (p. 264).
Interviews suggest people with relaxation induced anxiety (RIA) fear losing control. “Some are afraid of heightened arousal; others refer to helplessness, depression, some unidentified internal or external danger, a fear of going crazy, a negative association with anesthetics, a fear of falling from heights, plus any number of catastrophic expectations (Chambless & Goldstein, 1980)” (p. 264). Lazarus recommends that if someone displays RIA, the therapist may try alternative techniques, which might include for example tensing-relaxing muscles, passive receptivity, positive or pleasant imagery, focus on breathing, subvocal monotonous chant or mantra, or the Vipassana meditation practice of achieving awareness of spontaneous sensations and thoughts. The relationship with the therapist, differences in room illumination, amount of time per session, and sitting or reclining may be important.
“If a therapist deduces that a client is likely to derive benefit from relaxation training, three obvious questions arise: (1) Which of the many types of relaxation training programs is this particular client likely to respond to? (2) How frequently, and for what length of time, should the client practice the selected relaxation sequence? (3) Will treatment adherence be augmented or attenuated by the supplementary use of cassettes for home use?” (P. 262).
The authors describe their Structural Profile Inventory (SPI; Lazarus, 1989), a 35- item questionnaire, which may be used to predict the preferred sequences and forms of relaxation to employ with individual clients. “A predominantly imagery/sensory reactor, for example, may do well with visualization and autogenic training, whereas a highly active/cognitive client might be better advised first to engage in strenuous exercise followed by calming self-statements (Zilbergeld & Lazarus, 1988)” (p. 265). They suggest that for those patients who are perfectionistic and simply can’t “just let go,” they might simply fill a bathtub with warm water and sit in it for 10-20 minutes and rest with a magazine (rather than “relax”) once or twice a day.
Mason, Albert A. (1990, January). A psychoanalyst looks at a hypnotist; or, where the elephant skinned boy took me. [Paper] Presented at the Psychoanalytic Center of California Scientific Meeting.
“The results of working with hypnotism experimentally in the production of anaesthesia for surgery, dentistry and obstetrics; in controlled series of treatments of asthmatics, skin disorders, and allergic manifestations; as well as its clinical use, have convinced me that it is a delusional state akin to mania which depends on the omnipotent denial of mental pain. The mania is stimulated by the hypnotized subject having phantasies of an omnipotent object that it fuses with and shares in the omnipotence. The hypnotist has similar unconscious phantasies about himself. Both subject and hypnotist projectively identify with each others’ phantasies, and together produce phenomena like anaesthesia which can be likened to delusional states. In fact, true hallucinations can also be deliberately produced.
“I believe that similar psychotic mechanisms can also occur in life between parents and children and in other relationships, and produce delusional states. These form a continuum from intractable narcissism on the one side, through Christian Science and the denial of evolution in the center, to frank folie a deux and transexualism on the other side. The therapeutic course of these states seems quite dissimilar from that of psychosis arising without the encouragement of external objects.”
Prior, A.; Colgan, S. M.; Whorwell, P. J. (1990). Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Gut, 31, 896-898.
Fifteen patients with irritable bowel syndrome were studied to assess the effect of hypnotherapy on anorectal physiology. In comparison with a control group who received no hypnotherapy, significant changes in rectal sensitivity were found in patients with diarrhoea-predominant irritable bowel syndrome both after a course of hypnotherapy and during a session of hypnosis (p<.05). Although patient numbers were small, a trend towards normalization of rectal sensitivity was also observed in patients with constipation- predominant syndrome. No changes in rectal compliance or distension-induced motor activity occurred in either subgroup nor were any changes in somatic pain thresholds observed. The results suggest that symptomatic improvement in irritable bowel syndrome after hypnotherapy may in part be due to changes in visceral sensitivity Sensitivity. This research involved 15 patients diagnosed with irritable bowel syndrome (IBS), which was defined as abdominal pain with abdominal distension and 'an altered bowel habit'--10 had diarrhea mostly and 5 had constipation mostly. Patients with this disease usually have an exaggerated colon sensitivity to many different stimuli, as well as lower threshold to a balloon inflated in the bowel for diagnostic purposes. The patients were treated with ten sessions of hypnosis, 30 minutes each, over a three month period. Dependent variables included self ratings of abdominal pain, abdominal distention, and 'bowel habit disturbance.' Each of the three variables received a score of 0-10; the total score therefore could range from 0-30. Other ratings were obtained using the inflation of a rectal balloon as stimulus. "After a basal period of at least 15 minutes the rectal balloon was serially inflated with air at intervals of 1 min in 20 ml increments up to 100 ml and then in 50 ml increments up to the sensation of discomfort. The study was repeated after a rest period of 15 minutes. After hypnotherapy the S was restudied first in the waking state and then, after 15 min, following induction of hypnosis" During this procedure they measured balloon volume, rectal compliance (a function of volume and pressure), and presence or absence of repetitive rectal contractions. In order to learn whether the analgesia being experienced in the rectal or bowel area transferred to other areas, patients experienced cold water immersion induced pain on one hand, for a measure of time until discomfort was felt (pain threshold, essentially). The control group of 15 patients diagnosed with IBS received the same measures of balloon volume, rectal compliance, and presence or absence of repetitive rectal contractions. The total symptom score (which might have ranged 0-30) dropped from 23.5 to 9.6, and 13 of the 15 patients rated their symptoms as much improved. The two Ss who did not experience improvement also did not return for the assessment using the balloon. Therefore, the physiological assessment included only 13 Subjects, the ones who rated themselves as 'improved.' "In patients with diarrhoea-predominant irritable bowel syndrome a decreased rectal sensitivity occurred after hypnotherapy which was significant for the sensations of gas and urgency. This was most pronounced in patients who could initially tolerate only small rectal balloon volumes (Fig 1). During hypnosis the results for rectal sensitivity in the diarrhoea-predominant group were similar to those noted after the course of hypnotherapy but were of a greater magnitude, reaching significance for all sensations (Fig 2). "In the constipation-predominant Subjects there was a tendency for rectal sensitivity to move towards normal values both after the course of hypnotherapy and during hypnosis. Patient numbers in this subgroup were small, however, and the changes were not significant (Figs 1 and 2). Rectal compliance and distension induced motor activity were unaffected by hypnotherapy in both the diarrhoea and constipation- predominant patients" (p. 897). It was noted that of patients who had manifested depression and/or anxiety (8 of 13), most showed psychological improvement--3 of them to a great degree--but there was no correlation between psychological improvement and the degree that visceral sensitivity was diminished. Also, the ten sessions of hypnotherapy did not affect length of time subjects could tolerate hand immersion in cold water. "In the control group of 15 patients with the irritable bowel syndrome who did not receive hypnotherapy no changes in rectal sensory or motor parameters occurred when manometry was repeated on the same day or on a second study day nine to 12 weeks later (Table II)" (p. 897). In their Discussion, the authors remark that "hypnotherapy seemed to produce a trend towards normalization of visceral sensitivity (Figs 1 and 2). This was most pronounced in the patients with diarrhoea-predominant irritable bowel syndrome who initially had particularly low sensation thresholds" (p. 898). They continue, "The pathophysiological abnormalities which lead to the symptoms of the irritable bowel syndrome remain unclear. The increased visceral sensitivity found in the large [7-9] and small intestine [18, 19] in some patients with the irritable bowel syndrome may contribute to their perception of pain. In addition, an increase in rectal sensitivity might also contribute to the symptoms of urgency and frequency of defecation seen in many patients with diarrhoea-predominant irritable bowel syndrome. ... Hypnotherapy also induces an improvement in well being by increasing coping capacities, and may therefore decrease perceived stress" (p. 898). "The present study suggests therefore that hypnotherapy might operate by a variety of mechanisms in patients with the irritable bowel syndrome. In those with visceral hypersensitivity it seems to alter the perception of rectal sensation, although the mechanism by which this is achieved is unknown. Modification at a cortical level or more locally along afferent pathways are possibilities. This does not, however, explain the symptomatic improvement in all subjects and hypnotherapy is probably also acting in a non-specific psychotherapeutic sense" (p. 898). In their Discussion, the authors remark that "hypnotherapy seemed to produce a trend towards normalization of visceral sensitivity (Figs 1 and 2). This was most pronounced in the patients with diarrhoea-predominant irritable bowel syndrome who initially had particularly low sensation thresholds" (p. 898). They continue, "The pathophysiological abnormalities which lead to the symptoms of the irritable bowel syndrome remain unclear. The increased visceral sensitivity found in the large [7-9] and small intestine [18, 19] in some patients with the irritable bowel syndrome may contribute to their perception of pain. In addition, an increase in rectal sensitivity might also contribute to the symptoms of urgency and frequency of defecation seen in many patients with diarrhoea-predominant irritable bowel syndrome. ... Hypnotherapy also induces an improvement in well being by increasing coping capacities, and may therefore decrease perceived stress" (p. 898). "The present study suggests therefore that hypnotherapy might operate by a variety of mechanisms in patients with the irritable bowel syndrome. In those with visceral hypersensitivity it seems to alter the perception of rectal sensation, although the mechanism by which this is achieved is unknown. Modification at a cortical level or more locally along afferent pathways are possibilities. This does not, however, explain the symptomatic improvement in all subjects and hypnotherapy is probably also acting in a non-specific psychotherapeutic sense" (p. 898). 1989 Alvarado, C. S. (1989). Dissociation and state-specific psychophysiology during the nineteenth century. Dissociation, 2, 160-168. Reviews examples of state-specific psychophysiology in nineteenth century reports of dissociative disorders. These cases occurred in the context of rapid developments both in neurology and in the understanding of phenomena suggesting the possible influence of the mind, emotions, or psychological states on general health and specific bodily functions (e.g., the study of hypnosis and hysteria). It is argued that interest in such cases was part of a general concern with mind/body interactions. The explanations offered to account for these cases reflected different orientations to the mind/body problem prevalent during this era. Barabasz, Arreed F.; Barabasz, Marianne (1989). Effects of restricted environmental stimulation: Enhancement of hypnotizability for experimental and chronic pain control. International Journal of Clinical and Experimental Hypnosis, 37, 217-231. Enhancement of hypnotizability and pain tolerance has been demonstrated using restricted environmental stimulation therapy (REST) with university students as Ss (A. F. Barabasz, 1982). The purpose of the present study was to determine whether or not similar results could be obtained with chronic pain patients. Ss consisted of outpatients in treatment for conditions in which pain is prominent who also demonstrated low hypnotizability after repeated hypnosis plateau sessions. 2 groups of Ss were exposed to REST. Situational demand characteristics (Orne, 1962) favored an increase in hypnotizability for REST Group 1 (high demand). REST Group 2 (low demand) was exposed to situational demand characteristics designed to disguise the experimental hypothesis. 2 groups of control Ss were exposed to the same alternative demand characteristic manipulations as the experimental groups, but environmental stimulation was maintained. The Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C) of Weitzenhoffer and E. R. Hilgard (1962), including a posthypnotic suggestion for an anesthetic reaction, and an ischemic pain test were administered prior to treatment and again immediately following treatment. After 6 hours of REST, significant increases in SHSS:C scores were found for high-demand and low-demand experimental Ss, as well as for high-demand control Ss. No such increase was found for low-demand controls. Significant decreases in pain scores were found for both high- and low-demand experimental groups. No significant pain score decreases were found for either control group, suggesting a relatively weak effect of demand characteristics. An independent postexperimental inquiry suggested all Ss believed they received active treatments. The inquiry, conducted 10-15 days after the experiment, also revealed a majority of experimental Ss were using hypnosis on a daily basis to reduce pain with a substantial decrease in pain medication. Only 2 control Ss (highest in hypnotizability) reported similar success. Anecdotal reports of pain reduction experiences using hypnosis after REST intervention were supportive of E. R. Hilgard's (1977) neodissociation theory. Enhancement of hypnotizability and pain tolerance has been demonstrated using restricted environmental stimulation therapy (REST) with university students as Ss (A. F. Barabasz, 1982). The purpose of the present study was to determine whether or not similar results could be obtained with chronic pain patients. Ss consisted of outpatients in treatment for conditions in which pain is prominent who also demonstrated low hypnotizability after repeated hypnosis plateau sessions. 2 groups of Ss were exposed to REST. Situational demand characteristics (Orne, 1962) favored an increase in hypnotizability for REST Group 1 (high demand). REST Group 2 (low demand) was exposed to situational demand characteristics designed to disguise the experimental hypothesis. 2 groups of control Ss were exposed to the same alternative demand characteristic manipulations as the experimental groups, but environmental stimulation was maintained. The Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C) of Weitzenhoffer and E. R. Hilgard (1962), including a posthypnotic suggestion for an anesthetic reaction, and an ischemic pain test were administered prior to treatment and again immediately following treatment. After 6 hours of REST, significant increases in SHSS:C scores were found for high-demand and low-demand experimental Ss, as well as for high-demand control Ss. No such increase was found for low-demand controls. Significant decreases in pain scores were found for both high- and low-demand experimental groups. No significant pain score decreases were found for either control group, suggesting a relatively weak effect of demand characteristics. An independent postexperimental inquiry suggested all Ss believed they received active treatments. The inquiry, conducted 10-15 days after the experiment, also revealed a majority of experimental Ss were using hypnosis on a daily basis to reduce pain with a substantial decrease in pain medication. Only 2 control Ss (highest in hypnotizability) reported similar success. Anecdotal reports of pain reduction experiences using hypnosis after REST intervention were supportive of E. R. Hilgard's (1977) neodissociation theory. The authors note that because they used the posthypnotic suggestion of anesthesia for all Subjects, "it is not possible to determine whether the lowered pain reports of REST Ss were due to the posthypnotic suggestion because of enhanced hypnotizability or whether the lowered pain sensitivity was a nonsuggested collateral consequence of REST" (p. 226). The data support the conclusion that REST enhances hypnotizability and concomitantly decreases ischemic pain reports after a posthypnotic suggestion. This effect, of course, may or may not be mediated by a response to hypnotic suggestion. "It is important to recognize the quality of the anecdotal pain control reports as remarkably consistent with E. R. Hilgard's (1977) neodissociation theory of hypnosis. Successful pain controllers did not anesthetize their clinical pains, as asked to do for the ischemic pain, but rather dissociated their pain to other parts of their bodies or outside their bodies" (p. 227). Griffiths, M. D.; Gillett, C. A.; Davies, P. (1989). Hypnotic suppression of conditioned electrodermal responses. Perceptual and Motor Skills, 69, 186. With 5 subjects who had previously been aversively conditioned to a stimulus, during hypnosis previously acquired electrodermal responses were found to be significantly lower than in 12 control Ss. Thus previously conditioned electrodermal responses were suppressed. This contradicts findings of Edmonston (1968) who found that neutral hypnosis does not influence conditioned electrodermal responses and the validity of Pavlov's (1927) conditioning (inhibition) theory of hypnosis. Hall, H.; Minnes, L. (1989). Psychological modulation of auditory responses. International Journal of Psychosomatics, 36 (1-4), 59-63. Psychological modulation of auditory response, the effects of imagery and suggestion on auditory thresholds were examined in naive subjects. After a hypnosis-like induction, the subjects, who were not aware of the purpose of the study, were asked to generate and maintain a specific set of images before, during, and after which their auditory thresholds were tested. Following the imagery, which represented cooling and vasoconstriction in the cochlea, audiograms revealed a temporary auditory threshold shift (TTS) in the experimental group only. This TTS pattern was similar to that produced by exposure to loud noise. Information carried in the image is suggested as the basis for the observed auditory changes. Although a hypnosis-like induction was employed, the subjects' level of hypnotizability did not appear to be related to the findings. Hall, Howard R. (1989). Research in the area of voluntary immunomodulation: Complexities, consistencies, and future research considerations. International Journal of Neuroscience, 47, 81-89. It is speculated that the successful voluntary alteration of one's immune functioning is a complex phenomenon associated with a number of possible factors. Evidence suggests the importance of prior experience in self-regulation and the role of practice, the ability of subjects to become relaxed and reduce sympathetic arousal, the importance of the nature and content of images, the complex role of hypnosis and hypnotizability, the importance of individual differences, and the choice of immune measures. Conclusions are drawn about the need for more experimental attention to these variables and future research with both experienced and inexperienced subjects. Harvey, R. F.; Hinton, R. A.; Gunary, R. M.; Barry, R. E. (1989). Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet, 1 (8635), 424-425. Thirty-three patients with refractory irritable bowel syndrome were treated with four 40-minute sessions of hypnotherapy over 7 weeks. Twenty improved, 11 of whom lost almost all their symptoms. Short-term improvement was maintained for 3 months without further formal treatment. Hypnotherapy in groups of up to eight patients was as effective as individual therapy. DISCUSSION The mechanisms by which hypnotherapy improves symptoms of IBS remain unclear. A placebo effect alone is unlikely, because few patients who improved on hypnotherapy suffered a relapse after formal treatment ended at 7 weeks; many patients continued to improve after the end of formal treatment. There was no disproportionate improvement in the feeling of wellbeing of patients who improved, and most of the patients who became nearly symptom-free had no initial tension or anxiety, as judged by GHQ scores. This suggests that the treatment is not just producing a psychological effect. The effects... were less striking than those reported by Whorwell and colleagues. Nevertheless, the results were encouraging because all 33 had been refractory to conventional medical treatment." Holroyd, Jean; Maguen, Ezra (1989). And so to sleep: Hypnotherapy for lagophthalmos. American Journal of Clinical Hypnosis. We used hypnosis to facilitate eye closure during sleep for a 44-year-old woman whose nocturnal lagophthalmos prevented use of a contact lens following cataract surgery and could have resulted in severe corneal damage. On three separate occasions the symptoms remitted following a very brief course of treatment. We discuss the results in terms of alternate theories of hypnotic performance. The Discussion section notes, "There was an excellent correlation between the onset of hypnotherapy and the cessation of the recurrent corneal erosion secondary to nocturnal lagophthalmos. Healing of corneal erosion, disappearance of the superficial punctate keratopathy, and alleviation of ocular foreign body sensation occurred promptly following hypnotherapy (with two separate therapists)" (pp. 267-268). The authors present the view that "heightened suggestibility, more vivid imagery, and more specific influence of thoughts upon organ systems probably came into play (Brown & Fromm, 1986; Holroyd, 1987). Social influence explanations (role taking, expectancy, compliance) seem less relevant as explanations. This highly motivated patient had not been able to keep her eyes closed during sleep despite her conscious efforts, her ''good-patient'' role, her positive expectations about the benefits of standard treatments, and respectful incorporation of the assistance provided by her ophthalmologist" (p. 268). Jirout, J. (1989). Reaction of the cerebral vertebrae in imagined changes in the shape of the cervical spine. Ceskoslovenska Neurologie a Neurochirurgie, 52, 75-77. Postural reaction of the cervical vertebrae on imagined, but actually not performed, changes in the shape of the cervical spine in the sagittal plane are described. The percentage of reacting vertebrae is relatively high. The findings seem to indicate that, (1) the described phenomena belong to the constant features of the spinal dynamics, (2) that there probably exist residual traces of preceding activities, and (3) that these changes are due to the activation of the polymetameric system of the intrasegmental muscles. Abstracted in American Journal of Clinical Hypnosis, 1990, v. 32, p. 213. Klein, Kenneth B.; Spiegel, David (1989). Modulation of gastric acid secretion by hypnosis. Gastroenterology, 96, 1383-1387. "The ability of hypnosis to both stimulate and inhibit gastric acid secretion in highly hypnotizable healthy volunteers was examined in two studies. In the first, after basal acid secretion was measured, subjects were hypnotized and instructed to imagine all aspects of eating a series of delicious meals. Acid output rose from a basal mean of 3.60 to 6.80 ... with hypnosis, an increase of 89% ( = .0007). In a second study, subjects underwent two sessions of gastric analysis in random order, once with no hypnosis and once under a hypnotic instruction to experience deep relaxation and remove their thoughts from hunger. When compared to the no-hypnosis session, with hypnosis there was a 39% reduction in basal acid output ... and an 11% reduction in pentagastrin-stimulated peak acid output ... p<.05. We have shown that different cognitive states induced by hypnosis can promote or inhibit gastric acid production, processes clearly controlled by the central nervous system. Hypnosis offers promise as a safe and simple method for studying the mechanisms of such central control." session, with hypnosis there was a 39% reduction in basal acid output ... and an 11% reduction in pentagastrin-stimulated peak acid output ... p<.05. We have shown that different cognitive states induced by hypnosis can promote or inhibit gastric acid production, processes clearly controlled by the central nervous system. Hypnosis offers promise as a safe and simple method for studying the mechanisms of such central control." Meyer, H. K.; Diehl, B. J.; Ulrich, P. T.; Meinig, G. (1989). Changes in regional cortical blood flow in hypnosis. Zeitschrift fur Psychosomatische Medizin und Psychoanalyse, 35, 48-58. Regional cerebral blood flow (rCBF) was measured by means of the 133-Xenon inhalation method in 12 healthy male volunteers who had several months of experience in doing self-hypnosis (autogenic training). During hypnotically suggested right arm levitation, as compared to resting conditions, they found an increase in cortical blood flow and an activation of temporal areas; the latter finding was considered to reflect acoustical attention. In addition, a so-far-unexplained deactivation of inferior temporal areas was observed during successful self hypnosis and hypnosis. While there was a global absolute increase of cortical blood flow bilaterally, they could not observe a relative increase of the right as compared to the left hemisphere during hypnosis. Several subjects successfully performed the levitation of the right arm, despite a relative left hemispheric activation, provided the absolute right hemispheric activation remained dominant. Murphy, A. I.; Lehrer, P. M.; Karlin, R.; Swartzman, L.; Hochron, S.; McCann, B. (1989). Hypnotic susceptibility and its relationship to outcome in the behavioral treatment of asthma: Some preliminary data. Psychological Reports, 65, 691-698. Twelve subjects from an experiment on relaxation therapy for asthma were given the Harvard. Hypnotizability was positively correlated, at a borderline significance, with improvement in the methacholine challenge test, a measure of asthma severity. Performance on the amnesia item of the Harvard was correlated with improvement in self- reported symptoms of asthma. Reid, S. (1989). Recalcitrant warts: Case report. British Journal of Experimental and Clinical Hypnosis, 6, 187-189. Recalcitrant warts which persisted for 5 years despite treatment cleared in 51 days with hypnotherapy. A cause/effect relationship between hypnotherapy and resolution was shown by at first excluding and then including the left hand from the suggestions given. Rossi, Ernest L. (1989). Mind-body healing, not suggestion, is the essence of hypnosis: Invited discussion of Cohen's 'Clinical uses of measures of hypnotizability'. American Journal of Clinical Hypnosis, 32 (1), 14-15. Initially, the 'classical' hypnotic phenomena were observed as part of normal or abnormal behavior, and then later it was noted that these phenomena could often be elicited with 'suggestion.' Therefore suggestion is not a necessary cause for the classical hypnotic phenomena. The mind-body connection has in recent years been under- emphasized by those who developed scales of hypnotizability, whereas James Braid (who originated the word 'hypnosis') wrote about 'psychophysiological' phenomena, and Wetterstrand (1902) distinguished between suggestibility and mind-body interaction (p. 14). wrote about 'psychophysiological' phenomena, and Wetterstrand (1902) distinguished between suggestibility and mind-body interaction (p. 14). "Wetterstrand (1902), who was one of Bernheim's foremost students, made a careful distinction between suggestibility and mind-body communication (what he termed the 'ideo-plastic faculty') that has been ignored by the makers of hypnotic susceptibility scales: 'Suggestion, or rather suggestibility, is composed of two elements: an ability to receive an impulse from without and the ideo-plastic faculty. As these are absolutely independent of each other, we must distinguish between them. There are patients who are very impressionable and who accept a suggested idea with absolute confidence; the influence, however, of the idea upon their physiological functions is feeble. They do not realize the suggestions and their morbid symptoms yield with great difficulty, as their ideoplastic conception is small. Others, on the contrary, accept suggestions slowly, are incredulous, and even resist them. Nevertheless, we find that the physiological and pathological processes are easily modified by the psychic influence, sometimes by auto- suggestions'" (Wetterstrand, 1902, p. 14). The author suggests that clinicians need a way of measuring (and facilitating) this type of mind-body communication and healing, which is an interpersonal process, just as suggestibility is an interpersonal process. 1988 Anderson, Edgar L.; Frischholz, Edward J.; Trentalange, Mark J. (1988). Hypnotic and nonhypnotic control of ventilation. American Journal of Clinical Hypnosis, 31, 118-128.