Ahlberg, D.; Lansdell, H.; Gravitz, M. A.; Chen, T. C.; Ting, C. Y.; Bak, A. F.; Blessing, D. (1975). Acupuncture and hypnosis: Effects on induced pain. Experimental Neurology, 49, 272-280.
The reactions of 14 volunteers to electrical stimulation near the supra- orbital nerve were studied under acupuncture, placebo-acupuncture, and hypnosis. As the intensity of stimulation increased, a minimum sensation, a minimum pain, and then a maximum or intolerable pain sensation were produced. Under hypnosis the average intensity of the stimulus for producing these sensations was higher than before the trance induction. Under acupuncture and placebo-acupuncture no clear increase in current intensity was observed. Acupuncture, as well as hypnosis, did not consistently change the blood, blood pressure, pulse rate, EKG, respiratory rate, or EEG.
Spanos, Nicholas P.; Horton, Carol; Chaves, John F. (1975). The effects of two cognitive strategies on pain threshold. Journal of Abnormal Psychology, 84 (6), 677-681.
Found that goal directed fantasy strategy suggestions were more effective than no goal directed fantasy suggestions in raising pain threshold, even when the suggestions were equated for length.
Stacher, G.; Schuster, P.; Bauer, P.; Lahoda, R.; Schulze, D. (1975). Effects of suggestion of relaxation or analgesia on pain threshold and pain tolerance in the waking and in the hypnotic state. Journal of Psychosomatic Research, 19, 259-265.
The effects of suggestion of analgesia and relaxation respectively under both hypnotic and waking conditions on pain threshold and pain tolerance measured by electrical stimulation of the skin were evaluated. Four healthy female subjects susceptible to hypnosis underwent four experiments each: (A) after two basal 16 min periods hypnotic suggestion of relaxation for 16 min followed by 16 min of hypnotic suggestion of analgesia, (B) as in (A) but suggestion of analgesia in the first and suggestion of relaxation in the second 16 min, (C) as in (A) but suggestions given in the waking state, (D) as in (B) but also suggestions given in the waking state. After all the procedures the experiments were continued for two further 16 min periods. To control for order effects, the experiment was designed as a 4 x 4 Latin square. Pain threshold and tolerance increased in varying degrees under all types of suggestions. Suggestion of relaxation given in the waking or in the hypnotic state was found to be less effective in elevating pain threshold and tolerance than suggestion of analgesia under the same conditions. Suggestion of both relaxation and analgesia resulted in higher increases of threshold and tolerance under hypnotic than under waking conditions.
Each experimental session had 4 periods. During the first 16-minute period pain threshold increased and pain tolerance increased on all experimental days. This may have been due to a habituation effect.
There were “more or less massive elevations of pain threshold and tolerance” in both hypnotic experiments (A and B). The elevations were higher following analgesia suggestions than following relaxation suggestions in all experiments.
“Suggestion of analgesia resulted generally in higher elevations of threshold and tolerance when the period with suggestion of analgesia followed the period with suggestion of relaxation than vice versa” (p. 262). “The analogous comparison for tolerance showed no significant F-values; this, again, might be due to the substitution procedure but also to the higher inhomogeneity of the tolerance values” (p. 263).
the tolerance values” (p. 263).
“The different effects of suggestion of relaxation and of analgesia respectively resulted also in a significant interaction ‘treatment x time’ (both measures: P < 0.1). This result has to be ascribed mainly to the hypnotic experiments: in both treatments A and B the elevations of threshold and tolerance were higher under suggestion of analgesia than under suggestion of relaxation. In the waking conditions (C and D) both measures were, on the average, higher in the second 16-min period of treatment regardless whether relaxation was followed by analgesia or analgesia by relaxation" (p. 263).
"There also seemed to be an influence of the initial values on the treatment effects, as higher initial values led to larger elevations of threshold (P < 0.05) and tolerance (P < 0.1). Therefore, the above reported results of the contrast between treatments A, C, and B, D respectively has to be regarded with care, since this contrast might be slightly overestimated because of the low initial values under treatment B" (p. 263).
In their discussion, the authors wrote: "The results of the present study show, that suggestion of analgesia caused higher elevations of pain threshold and tolerance than suggestion of relaxation in the hypnotic condition. This is not in favour of the hypothesis, that pain relief under hypnosis is due only to a diminution of anxiety and/or to a placebo effect [2, 3, 5], as both the anxiety relieving and the placebo effect are working in the relaxation as well as in the analgetic condition. The higher threshold and tolerance values in the latter condition seem to result from the specific contents of the suggestion of analgesia and might act via a neocortical or higher central nervous process exerting control over the activity in both the discriminative and motivational systems [18]. Our findings are consistent with those of McGlashan et al. [19], who found higher elevations of pain threshold and tolerance to ischemic muscle pain under hypnotic analgesia than under placebo.
"An interesting point is, that in the experiments with suggestions in the waking state, suggestion of analgesia in all instances resulted in higher elevations of pain threshold and tolerance when relaxation was suggested prior to analgesia then [sic] vice versa. This may be interpreted that subjects already relaxed and relatively free from anxiety respond better to explicit suggestion of analgesia.
"Pain threshold is reported to have more physiological determinants while tolerance is regarded to be relatively more s to psychological factors [22]. In our study, threshold and tolerance, apart form a greater variability of the latter, agreed fairly closely with one another in the treatment periods. There is obviously considerable interdependence between these two measures" (p. 264).
1974
Bloom, Richard F. (1974). Validation of suggestion-induced stress.
Technical Memorandum 23-74 (October 1974), US Army Human Engineering Laboratory, Aberdeen Proving Ground, Maryland 21005, AMCMS Code 5910.21.68629, Contract No. DAAD05-73-C-0243, Dunlap and Associates, Inc. (now Stamford, CT), AD002557.
Sixty college men, divided into three equal groups, each attended two induced stress sessions in which their physiological, psychological and performance reactions were measured. Their responses were compared to determine if valid stress reactions could be induced through suggestion in an altered state (in this case, hypnosis), and also to determine the validity of such reactions if the subject had never before experienced that stress situation. It was demonstrated that valid stress reactions can be induced in an individual with the aid of suggestions, especially if the real stress situation has been experienced before. If no previous experience with that real situation exists, the subject still exhibits stressful reactions; however, the closest resemblance to real stress is found in the subjective or psychological measures, less similarity is found in the physiological measures, and the least similarity is found in the performance measures.
valid stress reactions can be induced in an individual with the aid of suggestions, especially if the real stress situation has been experienced before. If no previous experience with that real situation exists, the subject still exhibits stressful reactions; however, the closest resemblance to real stress is found in the subjective or psychological measures, less similarity is found in the physiological measures, and the least similarity is found in the performance measures.
1952
West, Louis Jolyon; Niell, Karleen C.; Hardy, James D. (1952). Effects of hypnotic suggestion on pain perception and galvanic skin response. A. M. A. Archives of Neurology and Psychiatry, 68, 549-560.
A study is reported in which pain perception and galvanic skin responses of seven subjects were measured before and during hypnosis. The depths of hypnotic trance varied from light to deep. Stimuli of measured intensity were administered, and changes in pain threshold were measured. Quantitative estimates of pain intensity were made by the subjects. Alterations in ability to discriminate between pains of differing intensities were noted. Quantitative records of galvanic skin responses were utilized, permitting statistical analysis of data from matched pairs. Data were collected at 45 experimental sessions, during which a total of 478 painful stimuli were administered, the stimuli varying in intensity from threshold to blister- producing levels. At each session, the subject's sensations from and responses to stimuli during a control period were compared with sensations from and responses to identical stimuli administered after hypnotic suggestions of anesthesia. The following observations were made: 1. Hypnotic suggestions of anesthesia influence pain perception by causing elevation of pain threshold, hypalgesia, and analgesia. 2. When hypnotic suggestions of anesthesia caused hypalgesia and elevation of pain threshold, ability to discriminate among stimuli of different intensities was impaired. 3. There was a general correlation between the depth of hypnotic trance and the degree to which pain perception was altered by hypnotic suggestion. 4. The galvanic skin response to noxious stimulation was diminished, and it sometimes disappeared, as a result of hypnotic suggestions of anesthesia. The galvanic skin response was affected even when there was no alteration in pain perception, according to subjective reports.
The authors review literature on the effects of analgesia suggestions on the galvanic skin response and other autonomic nervous system responses. The present study differs from previous studies in the following ways: "1. The subjects were studied in various stages of hypnosis. 2. Quantitatively determined noxious stimuli were used instead of pinching or pinprick. 3. Changes in pain threshold were measured. 4. Quantitative estimates of pain intensity were made by the subject in the hypnotized and the unhypnotized state. 5. Changes in ability to discriminate between pains of differing intensity were noted. 6. Quantitative records of galvanic skin responses in the control and in the hypnotized state were utilized" (p. 552).
Analgesia was defined as "that state in which none of the noxious stimuli administered were reported as painful;" hypalgesia was defined as "a state in which noxious stimuli were reported as less painful than would be expected on the basis of reports of the same subject regarding the same stimuli in control situations" (p. 554).
In their Discussion, the authors state, "As a result of hypnotic suggestions of anesthesia, the following effects on sensation were observed: (1) no alteration in reports of pain intensity; (2) hypalgesia for higher-intensity stimuli without elevation of the pain threshold; (3) definite elevation of pain threshold with hypalgesia; (4) analgesia; (5) disturbances in pain discrimination.
" The third effect was observed in the majority of trials. The threshold elevation in light trances may be similar to that which can be produced by suggestion in the unhypnotized subject, but in deeper trances the effectiveness of hypnotic suggestion is much greater. The progression of effects 1 through 4 appears to be directly related to the depth of trance. The fifth effect was variable and was seen only in conjunction with the third effect. It is described as a separate phenomenon because the disturbance of ability to discriminate relatively between stimuli of differing intensities was only clearly observed when we were remeasuring pain thresholds. In actuality, it may merely represent a facet of altered pain perception, and the variability of its appearance may be related to the variable psychological state of the subject. It must be kept in mind that the hypnotic trance is not a static state" (p. 558). For one Subject, analgesia decreased in successive hypnotic sessions, while for four Subjects analgesia increased; a sixth Subject exhibited overall variability in hypnotic depth and analgesia from session to session.
The authors indicate that their review of the literature found no evidence that hypnosis, absent suggestions for analgesia, affects the galvanic skin response. In the present study, diminishment of the GSR is related to, though not dependent on, the effectiveness of the suggestion of anesthesia. "Thus, in Subject 2, with only moderate hypalgesia, the GSR to noxious stimuli was diminished by 64%; in S 6, with analgesia on nearly all trials, only 57%. It is particularly interesting that S 1 had a reduction in GSR of 26% after hypnotic suggestions which apparently had no effect upon his pain perception, and which seemed even to make him anxious. S 5 showed a direct correlation between depth of trance and decrease of GSR while Subjects 6 and 7 showed no such correlation" (p. 559).
"It is important to realize that on some occasions hypnotic anesthesia apparently led to complete disappearance of the GSR to all stimuli during a given session, such stimuli evoking pain of 6 or 7 dols in the control period. This phenomenon was seen twice with Subject 3, twice with Subject 5, and once with Subject 6. In several trials there was only a very slight GSR to the higher stimuli during hypnosis. In all the control periods there was only one occasion on which a stimulus evoking pain of 6 or 7 dols failed to produce a GSR, while equally intense stimulation failed to produce a GSR on 14 occasions after hypnotic suggestions of anesthesia. This observation is stressed because it suggests a need for caution in the clinical use of the GSR to distinguish organic from hysterical anesthesias" (pp. 559-560).
PAIN TOLERENCE
2000
Willmarth, Eric K. (2000, August). Modification of experienced pain with hypnotically induced positive mood. [Paper] Presented at the annual meeting of the American Psychological Association, Washington, D. C..
This study investigated the relationship between chronic pain and depressed mood within the context of Associative Network Theory and the High Risk Model of Threat Perception. A bi-directional relationship was hypothesized and tested by comparing pain ratings before and after the hypnotic induction of positive mood by suggestion of positive memories. These results were compared to the pain ratings of two control groups: participants who received hypnotic suggestion for relaxation only and participants who received non-hypnotic suggestion for relaxation and enhanced mood. Participants were 96 patients of a hospital-based Pain Management Center. Following assessment of hypnotic ability using the Harvard Group Scale of Hypnotic Susceptibility: Form A, and the Subjective Experiences Scale, participants recorded levels of depressed mood, sensory pain, affective pain, global pain and self control of pain before and after listening to an audio-taped treatment session. Results show that the inducton of a positive mood did influence a decrease in self-reports of pain. In addition, the level of the participants' hypnotic ability was also found to be a significant factor, suggesting that screening for predisposing factors, such as hypnotic ability, and the clinical use of hypnosis for mood enhancement are warranted in a chronic pain population. - Abstract taken from Psychological Hypnosis: A Bulletin of [Amer Psychol Assn] Division 30, Fall 2000.
1999
Milling, Leonard S.; Kirsch, Irving; Burgess, Cheryl A. (1999). Brief modification of suggestibility and hypnotic analgesia: Too good to be true?. International Journal of Clinical and Experimental Hypnosis, 47 (2), 91-103.
A 10-minute training procedure, based ont the Carleton Skill Training Program, has previously been reported to produce substantial increments in responsiveness to hypnotic suggeston. The authors attempted to replicate this effect and also assessed the impact of the training procedure on hypnotically suggested analgesia. Ninety-eight students who had been preselected for high, medium, and low levels of initial suggestibility were randomly assigned to experimental and control gorups. Training failed to increase overall suggestibility scores or to enhance the effects of a suggestion for pain reduction. Suggested pain reduction was more highly correlated with posttreatment suggestibility scores than with pretreatment suggestibility and, in a regression analysis, only posttreatment suggestibility predicted pain reduction uniquely.
1998
Barber, Joseph (1998). The mysterious persistence of hypnotic analgesia. International Journal of Clinical and Experimental Hypnosis, 46 (1), 28-43.
Hypnotic treatment of pain has a long history and, among hypnotic phenomena, pain relief is a relatively commonplace focus for intervention, yet we lack a conceptual explanation for this treatment. Hilgard's neodissociation theory accounts for the phenomenon of acute hypnotic analgesia, but not of persistent pain relief. Perhaps the enduring effect of hypnotic treatment can be explained at either of two levels: a neurophysiological model or a learning model. This explanation leads to the further question: How does hypnotic treatment of recurring pain achieve enduring relief? Clinical experience suggests a two-component model. First, the clnician communicates specific ideas that strengthen the patient's ability to derive therapeutic support and to develop a sense of openness to the unexplored possibilities for pain relief within the security of a nurturing therapeutic relationship. Second, the clinician employs posthypnotic suggestions that capitalize on the patient's particular pain experiences, which simultaneously ameliorate the pain experience, and which, in small, repetitive increments, tend to maintain persistent pain relief over increasing periods of time.
Author's Summary: "When a patient who suffers from recurring pain is treated with hypnotic methods and then reports substantial relief over time, what is significant is that the relief is so long-lasting, and that it endures through the patient's various daily activities. Although I believe that the initial alteration of consciousness via the hypnotic experience greatly facilitates subsequent analgesia, it is not necessary to believe, nor is it even plausible, that subsequent analgesia is accomplished through re-creation of the hypnotic condition. Rather, it appears that the patient is able to generalize from these initial experiences to achieve this analgesia independent of a hypnotic intervention.
"Laboratory research and clinical experience suggest that the persistence of hypnotic analgesia is a function of learning, the therapeutic relationship that fosters that learning, and the neurophysiological changes that subserve that learning. The patient's understandnig of the meaning and purpose of the clinician's suggestions is a primary determiner of their efficacy" (pp. 39-40).
1998
Eimer, Bruce; Freeman, Arthur (1998). Pain management psychotherapy: A practical guide. New York NY: John Wiley & Sons, Inc..
"Pain Management Psychotherapy" (PMP) provides a clear and methodical look at pain management psychotherapy beginning with the initial consultation and work-up of the patient and continuing through termination of treatment. It is a thoughtful and thorough presentation that covers methods for psychologically assessing the chronic pain patient (structured interviews, pain assessment tests and rating scales, instruments for evaluating beliefs, attitudes, pain behavior, disability, depression, anxiety, anger and alienation), treatment planning, cognitive-behavioral therapy techniques, and a range of hypnotic approaches to pain management. The book covers both traditional (cognitive and behavior therapy, biofeedback, assessing hypnotizability, choice of inductions, designing an individualized self-hypnosis exercise) as well as newer innovative techniques (e.g., EMDR, pain-relief imagery, hypno-projective methods, hypno-analytic reprocessing of pain-related negative experiences). An extensive appendix reproduces in their entirety numerous forms, rating scale, inventories, assessment instruments, and scripts.
The senior author, Bruce Eimer, states in his online comments on Amazon.com that "most therapists hold the belief that 'real' chronic pain patients are quite impossible to help. This book attempts to dispel these misguided beliefs by providing a body of knowledge, theory, and techniques that have proven value in understanding and relieving chronic physical pain." He also states that "the challenge for the therapist is to persuade the would-ne patient/client that he or she has something to offer that can help take way pain and bring back more pleasure. This challenge is negotiated through the therapeutic relationship. However, the therapist just can't be 'warm, accepting, non-judgmental and empathic'. The therapist must also have knowledge and skills relevant to relieving pain. Only then can the therapist impart such knowledge, and in teaching these skills to the pain patient, help the patient become something of a 'self-therapist'. . . I dedicate this book to everyone who wants to find ways to make living with pain more comfortable, and to the ongoing search for better ways to relieve pain."
therapists hold the belief that 'real' chronic pain patients are quite impossible to help. This book attempts to dispel these misguided beliefs by providing a body of knowledge, theory, and techniques that have proven value in understanding and relieving chronic physical pain." He also states that "the challenge for the therapist is to persuade the would-ne patient/client that he or she has something to offer that can help take way pain and bring back more pleasure. This challenge is negotiated through the therapeutic relationship. However, the therapist just can't be 'warm, accepting, non-judgmental and empathic'. The therapist must also have knowledge and skills relevant to relieving pain. Only then can the therapist impart such knowledge, and in teaching these skills to the pain patient, help the patient become something of a 'self-therapist'. . . I dedicate this book to everyone who wants to find ways to make living with pain more comfortable, and to the ongoing search for better ways to relieve pain."
1997
Chaves, John F.; Dworkin, Samuel F. (1997). Hypnotic control of pain: Historical perspectives and future prospects. International Journal of Clinical and Experimental Hypnosis, 45 (4), 356-376
Hypnotic analgesia has occupied a pivotal place in experimental and clinical hypnosis. It emerged early in the 19th century when effective clinical techniques for pain management had not yet developed, and the relief of pain and suffering had not even become a well-defined social goal. Its acceptance was further complicated by political struggles surrounding the humanitarian transformation of medicine during this era as well as a redefinition of the physician-patient relationship that wrested control from the patient. The initial struggle for professional acceptance was won only when the debate became almost entirely localized within the professional community. Acceptance of hypnosis by professional organizations has been followed by alternating periods of interest and indifference. While the evidence for the powerful effects of suggestion and related variables has often been observed and reported in nonhypnotic contexts, their relationship to hypnotic phenomena has often not been appreciated. Since the mid-20th century, scientific information about hypnotic analgesia has grown substantially and has had significant influence on strategies for acute and chronic pain management. If recent calls for its wider application in pain management are to succeed, it will require additional data from clinical populations and a balanced and scientifically prudent approach by its advocates. [Journal Abstract]
1998
Wakeman, R. J. (1988). Hypnotic desensitization of job-related heat intolerance in recovered burn victims. American Journal of Clinical Hypnosis, 31, 28-32.
The thermally injured patient who suffers extensive third-degree burns usually finds the adaptation to high temperature environments quite difficult. A 7-year study of 50 thermally injured patients with greater than 45% total body surface second- and third-degree burns was conducted to assess the usefulness of hypnosis for improved heat adaptation at the work site. There were 25 subjects in the experimental group who received hypnotic training and 25 in a matched control group. The experimental group achieved a mean of 6.25 hours worked over 16 weeks and 63.5 days worked out of 80. They worked 4.5 to 6.5 hours per day for an average of 221 days per year for up to 3 years from baseline. The control group achieved a mean of 4.5 hours worked over 16 weeks and 54.33 days worked out of 80. The efficacy of hypnosis in heat desensitization is discussed.
worked over 16 weeks and 54.33 days worked out of 80. The efficacy of hypnosis in heat desensitization is discussed.
Mean age was 38 for the hypnosis group, 33 for the control group; both groups had mean educational level of 8 grades. Mean percentage of total body surface burn was 50% for hypnosis and 54% for control groups.
Each patient was seen for 16 weeks, for 2 hours/week. The hypnosis group received hypnosis, were taught self hypnosis, and were given cassette tapes for use at home. The hypnosis training included a variety of techniques (e.g. progressive deep muscle relaxation, eye-fixation, eye-roll, and visual imagery techniques). They were given suggestions for lower skin temperature, lower 'inner body' temperature, less itching, gradual improvement of time spent on the job, as well as ego strengthening suggestions. The control patients received supportive psychotherapy, family consultation, and cognitive behavior therapy for the same amount of contact time with the same therapist.
The hypnosis group was to do self hypnosis every two hours at the worksite, in addition to home practice. Visual imagery suggestions were things like imagery of a cool waterfall flowing over the skin, having a tall cold glass of beer or soft drink, etc. They also had biofeedback of skin temperature during office visits, to reinforce decreases in skin temperature near the burned sites. They had exposure to heat (in a 95 degree sauna) for in gradually increased periods of time (15 to 120 minutes) before returning to the worksite.
Three years after treatment 20 of 25 control patients had quit their jobs or transferred to a cooler worksite, and all 25 had resigned from their original jobs or applied for further disability benefits. In contrast, only 2 of 25 experimental Ss were working in controlled-temperature settings, and none had applied for permanent disability benefits.
The authors note that family support was essential for the hypnosis patients to carry out their treatment program, and family consultations were essential for every patient. They also found the 'fade-in' technique using the sauna in the hospital occupational therapy area very useful for bridging the gap between practice in the office and going back to the work setting. "This procedure enabled the subject to practice self- hypnosis under controlled physical conditions while performing a work task that was more realistic than 'imagined heat' in the office setting" (p. 31).
1987
Chaves, John; Brown, Jude (1987). Spontaneous cognitive strategies for the control of clinical pain and stress. Journal of Behavioral Medicine, 10 (3), 263-276
The spontaneous cognitive strategies employed by 75 patients undergoing dental extractions or mandibular block injections were elicited using a structured interview. Interest focused on the relationship between these strategies and several personality variables, including state and trait anxiety, locus of control, and absorption. In addition, the effect of strategy utilization on perceived pain and stress was assessed. Fourty-four percent of the patients employed cognitive strategies designed to minimize pain and stress, while 37% catastrophized, engaging in cognitive activity which exaggerated the fearful aspects of their experience. Only 19% of the patients denied any cognitive activity during the clinical procedure, and many of these used noncognitive coping strategies. Discriminant analysis revealed that situational anxiety was associated with the use of cognitive coping strategies. Catastrophizing was associated with increasing age, past dental stress, and higher levels of stress vulnerability (high trait anxiety and external locus of control). Copers reported less stress than catastrophizers but not less pain.
1986
Slomoff, Daniel A. (1986, March). Hypnotic susceptibility, vividness of imagery and the ability to self-regulate pain in a cold pressor test (Dissertation, Fielding Institute). Dissertation Abstracts International, 46 (9), 3231-B.
"Previous studies suggested that subjects who used more vivid images and who are good hypnotic subjects are more involved in their imagery and therefore have better pain control. In this study, subjects were given the Harvard Group Scale of Hypnotic Susceptibility and the Sheehan-Betts Questionnaire Upon Mental Imagery and then exposed to a cold pressor test for pain. Previous studies had limitations using an imagery scale which only tested for visual imagery, asking subjects to learn a new cognitive strategy, and limiting the study to female subjects. This study used both an objective and subjective multisensory test of imagery, tested for both genders, and allowed subjects to use their inherent cognitive strategies. "It was hypothesized that hypnotically susceptible subjects would demonstrate greater pain tolerance and pain intensity. This was not supported. It was also hypothesized that subjects who scored high on pain intensity control and this was also not supported. It was discussed that the instruments may not be strong enough to measure differences when pain tolerance and pain control are being looked at. "It was further predicted that there would be an interaction effect between hypnotizability and vividness of imagery for pain tolerance and pain intensity control. The results did not support this hypothesis. the author felt that it might be necessary to compare high and low imagers rather than high and medium imagers in this study. In that case the degree of difference between the groups might be great enough to demonstrate the interaction effects. As was predicted, it was found that highly hypnotizable subjects who were good imagers did use more imagery and rated this imagery as more effective and more vivid. "It is suggested that future research assess the type of imagery associated with a specific kind of pain experience. Pain as the result of temperature, pressure, or electrical stimulation might require different imagery as a cognitive coping strategy. Appropriate assessment tools will then need to be developed in this regard" (p. 3231).
Williams, David A.; Thorn, Beverly E. (1986). Can research methodology affect treatment outcome? A comparison of two cold pressor test paradigms. Cognitive Therapy and Research, 10 (5), 539-545.
Examined the effect of fixed or open latency instructions on subjective pain report for the cold pressor test using a single cognitive training strategy with 80 undergraduates. The fixed latency paradigm instructed Ss to leave their hand in the cold water for a fixed amount of time (e.g., 3 min), whereas the tolerance paradigm asked Ss to endure pain for as long as possible. Results suggest that the fixed latency paradigm is associated with lower subjective pain ratings especially when a cognitive strategy is used. The tolerance groups failed to decrease their subjective perception of pain but evidenced longer latencies when a cognitive strategy was used. It is concluded that while other research has used these paradigms interchangeably to assess efficacy, these 2 paradigms apparently pose different challenges to Ss. (15 ref).
1985
Spanos, Nicholas P.; Ollerhead, Virginia Gail; Gwynn, Maxwell I. (1985-86). The effects of three instructional treatments on pain magnitude and pain tolerance: Implications for theories of hypnotic analgesia. Imagination, Cognition and Personality, 5, 321-337.
Between baseline and posttesting on the cold pressor test, subjects were assigned to four treatments: a) hypnotic analgesia, b) brief instructions to "Do whatever you can to reduce pain," c) stress inoculation, and d) no instruction control. Participants in the three instructional treatments showed significantly greater baseline to posttest decrements in pain magnitude and significantly greater increments in pain tolerance than controls. However, the instructional treatments did not differ significantly from one another in these regards. Pretested hypnotic susceptibility correlated significantly with degree of pain reduction in the hypnotic analgesia treatment but not in the "Do whatever" or stress inoculation treatments. Theoretical implications are discussed.
1983
Braun, Bennett G. (1983). Psychophysiological phenomena in multiple personalities and hypnosis. American Journal of Clinical Hypnosis, 26 (2), 124-137
"Conclusion. As can be seen from the above example, the final common pathway, physiologic expression, which is seen in multiple peronality is not bizarre when compared with physiologic changes achieved in non-multiples using hypnosis or, in certain cases, non-multiples without the use of hypnosis. A form of hypnosis/autohypnosis* may be a common denominator. The neurophysiologic changes shown by Putnam et. al. (1982), but not observed by Coons (1982), may well have a similar explanation. The question of the neurophysiologic effect of hypnotic suggestion has not as yet been studied with appropriate controls or safeguards.
"That multiples do show significant changes in their psychophysiologic response patterns cannot be denied. To consider that the psychophysiologic chages of multiple personality aer so rare or different as to make multiples 'freaks' is not only a disservice to them, but to medical science, since it blocks thinking. The study of multiple personality will further our understanding, theorizing, and treatment of mental and physical illness" (p. 134). "*These terms are being used here in the generic sense" (p. 134).
1981
Houston, Rodney Earl (1981). The effects of autohypnosis, imagery, or single suggestion on pain threshold and tolerance (Dissertation, University of Cincinnati). Dissertation Abstracts International, 42 (5), 1961-A.
Pain threshold, pain tolerance, and subject's subjective opinion of the pain were studied in 94 volunteer subjects (75 female, 19 male), who had been randomly assigned to three treatment groups (self hypnosis, in-vivo imagery, single suggestion) and a control group. (The original randomized sample included 124 Ss, but 30 were lost to the study-- 22 because of initial baseline scores being above maximum, 2 after reading the consent form, and 6 not returning for post-testing.) Mean age was 25; age range was 18-59 years.
The pain stimulus was 33 degree F. ice water in which the dominant hand was submerged for as long as the subjects were able. Subjects were told to nod when pain was first felt (threshold), and remove their hand when the pain was more than they could tolerate (tolerance). They were then asked to rate the pain on a 7-point scale, from 'none' to 'extreme.' Thus the three outcome measures were threshold time, tolerance time, and degree of perceived pain.
During the week between pretesting and posttesting, the self hypnosis group was to listen to a tape training them in self hypnosis at least twice; the imagery group was to listen to their imagery training tape at least twice; the simple suggestion group received no training. Posttesting was the same as pretesting, except that the simple suggestion group was given the single waking suggestion, "You will be able to withstand the pain much longer this time."
The experimental predictions were that treatment groups would increase in threshold levels and tolerance levels more than the control group; and that the treatment groups would decrease more than the control group in reported pain level. Multivariate analysis of variance of difference scores (pre- to posttest) demonstrated significant differences on the three dependent measures when comparing the three treatment groups to the control group. " Significant differences were also found when comparing treatment groups, autohypnosis and imagery to those given the single suggestion. No significant differences were found when comparing the autohypnosis to the imagery treatment.
"The results indicate that training in autohypnosis and in-vivo imagery has an effect on threshold, tolerance and pain levels. The results also indicate that the use of a single suggestion may not have an effect on threshold, tolerance, and pain levels" (p. 1961).
Spanos, Nicholas P.; Brown, Jude M.; Jones, Bill; Horner, Donna (1981). Cognitive activity and suggestions for analgesia in the reduction of reported pain. Journal of Abnormal Psychology, 90, 554-556.
Assessed 38 undergraduates' pain magnitude and pain tolerance for arm immersion in ice water during a baseline and posttest session. Before the posttest, half the Ss received an analgesia suggestion. On the basis of their written testimony, Ss were classified as having either predominately coped (e.g., imagined event inconsistent with pain or made positive self-statements) or predominantly exaggerated (e.g., worried about and exaggerated the noxious aspects of the situation) during each immersion. On both immersions, copers reported less pain and exhibited higher pain tolerance than exaggerators. Moreover, the suggestion was associated with reductions in reported pain only when it transformed baseline exaggerators into posttest copers.
Worthington, Everett L.; Shumate, Michael (1981). Imagery and verbal counseling methods in stress inoculation training for pain control. Journal of Counseling Psychology, 28 (1), 1-6
Investigated 3 elements of stress inoculation training, a therapeutic package for helping clients control anxiety, anger or pain. 96 undergraduate females were tested twice for ice water tolerance. In a 3 design, the independent variables were the presence or absence of (a) pleasant imagery, (b) a conceptualization of pain as a multistage process, and (c) planned, explicit self-instructions. A multivariate analysis of covariance using the (transformed) pretest tolerance rating and 2 self-ratings of pain. Imagery users (Is) controlled their pain better than nonimagery users (NIs). There was a significant interaction of Imagery and Conceptualization. NIs had longer tolerance and less self- reported pain at withdrawal when they heard no conceptualization. The Is did not derive additional benefit from hearing the conceptualization. Self-instruction did not affect pain control. Results suggest that pleasant imagery effectively relieves pain and may account for much of the effectiveness of stress inoculation training. (23 ref)
-tion of pain as a multistage process, and (c) planned, explicit self-instructions. A multivariate analysis of covariance using the (transformed) pretest tolerance rating and 2 self-ratings of pain. Imagery users (Is) controlled their pain better than nonimagery users (NIs). There was a significant interaction of Imagery and Conceptualization. NIs had longer tolerance and less self- reported pain at withdrawal when they heard no conceptualization. The Is did not derive additional benefit from hearing the conceptualization. Self-instruction did not affect pain control. Results suggest that pleasant imagery effectively relieves pain and may account for much of the effectiveness of stress inoculation training. (23 ref)
1975
Stacher, G.; Schuster, P.; Bauer, P.; Lahoda, R.; Schulze, D. (1975). Effects of suggestion of relaxation or analgesia on pain threshold and pain tolerance in the waking and in the hypnotic state. Journal of Psychosomatic Research, 19, 259-265.
The effects of suggestion of analgesia and relaxation respectively under both hypnotic and waking conditions on pain threshold and pain tolerance measured by electrical stimulation of the skin were evaluated. Four healthy female subjects susceptible to hypnosis underwent four experiments each: (A) after two basal 16 min periods hypnotic suggestion of relaxation for 16 min followed by 16 min of hypnotic suggestion of analgesia, (B) as in (A) but suggestion of analgesia in the first and suggestion of relaxation in the second 16 min, (C) as in (A) but suggestions given in the waking state, (D) as in (B) but also suggestions given in the waking state. After all the procedures the experiments were continued for two further 16 min periods. To control for order effects, the experiment was designed as a 4 x 4 Latin square. Pain threshold and tolerance increased in varying degrees under all types of suggestions. Suggestion of relaxation given in the waking or in the hypnotic state was found to be less effective in elevating pain threshold and tolerance than suggestion of analgesia under the same conditions. Suggestion of both relaxation and analgesia resulted in higher increases of threshold and tolerance under hypnotic than under waking conditions.
Each experimental session had 4 periods. During the first 16-minute period pain threshold increased and pain tolerance increased on all experimental days. This may have been due to a habituation effect.
There were "more or less massive elevations of pain threshold and tolerance" in both hypnotic experiments (A and B). The elevations were higher following analgesia suggestions than following relaxation suggestions in all experiments.
"Suggestion of analgesia resulted generally in higher elevations of threshold and tolerance when the period with suggestion of analgesia followed the period with suggestion of relaxation than vice versa" (p. 262). "The analogous comparison for tolerance showed no significant F-values; this, again, might be due to the substitution procedure but also to the higher inhomogeneity of the tolerance values" (p. 263).
"The different effects of suggestion of relaxation and of analgesia respectively resulted also in a significant interaction 'treatment x time' (both measures: P < 0.1). This result has to be ascribed mainly to the hypnotic experiments: in both treatments A and B the elevations of threshold and tolerance were higher under suggestion of analgesia than under suggestion of relaxation. In the waking conditions (C and D) both measures were, on the average, higher in the second 16-min period of treatment regardless whether relaxation was followed by analgesia or analgesia by relaxation" (p. 263).
waking conditions (C and D) both measures were, on the average, higher in the second 16-min period of treatment regardless whether relaxation was followed by analgesia or analgesia by relaxation" (p. 263).
"There also seemed to be an influence of the initial values on the treatment effects, as higher initial values led to larger elevations of threshold (P < 0.05) and tolerance (P < 0.1). Therefore, the above reported results of the contrast between treatments A, C, and B, D respectively has to be regarded with care, since this contrast might be slightly overestimated because of the low initial values under treatment B" (p. 263).
In their discussion, the authors wrote: "The results of the present study show, that suggestion of analgesia caused higher elevations of pain threshold and tolerance than suggestion of relaxation in the hypnotic condition. This is not in favour of the hypothesis, that pain relief under hypnosis is due only to a diminution of anxiety and/or to a placebo effect [2, 3, 5], as both the anxiety relieving and the placebo effect are working in the relaxation as well as in the analgetic condition. The higher threshold and tolerance values in the latter condition seem to result from the specific contents of the suggestion of analgesia and might act via a neocortical or higher central nervous process exerting control over the activity in both the discriminative and motivational systems [18]. Our findings are consistent with those of McGlashan et al. [19], who found higher elevations of pain threshold and tolerance to ischemic muscle pain under hypnotic analgesia than under placebo.
"An interesting point is, that in the experiments with suggestions in the waking state, suggestion of analgesia in all instances resulted in higher elevations of pain threshold and tolerance when relaxation was suggested prior to analgesia then [sic] vice versa. This may be interpreted that subjects already relaxed and relatively free from anxiety respond better to explicit suggestion of analgesia.
"Pain threshold is reported to have more physiological determinants while tolerance is regarded to be relatively more s to psychological factors [22]. In our study, threshold and tolerance, apart form a greater variability of the latter, agreed fairly closely with one another in the treatment periods. There is obviously considerable interdependence between these two measures" (p. 264).
1954
Thaheld, Feri Herndon (1954). Nonconclusive electrostimulation under narcotic hypnosis. Journal of Clinical and Experimental Hypnosis, 2, 175-177.
Hypnosis was used in an attempt to reduce the side effects of nonconvulsive electrostimulation in a single subject. Subject was given 2 gr of nembutal, followed by hypnotic induction, then repeated suggestions that the "subject could feel no pain and that therefore as a result of this there could not be any physical response at all to this very harmless and quite painless treatment which was being administered" (p. 176).
Subject had 42 treatments (unidirectional, modulated, spiked current averaging 5-9 ma, through electrodes placed above the ears, for usually 3 minutes but sometimes 5-8 minutes) over 3 wk period. Ordinarily in such a situation pain would be experienced, with physiological changes (dilation of pupils, increase in pulse rate, flushing of skin, perspiration, some contraction of muscles) and emotional outbursts observed. In this subject, "none of the usual side reactions were found to be present and the further use of posthypnotic suggestions eliminated any after-effects or complications which might have arisen" (p. 176).
The author discussed the possibility that trance depth was facilitated by the pyramiding action of layering one set of suggestions on top of another, something like Vot's fractionation technique (in which subject is repeatedly hypnotized and de-hypnotized with suggestions of increasing depth).
The author discussed the possibility that trance depth was facilitated by the pyramiding action of layering one set of suggestions on top of another, something like Vot's fractionation technique (in which subject is repeatedly hypnotized and de-hypnotized with suggestions of increasing depth).
PAIN
The author discussed the possibility that trance depth was facilitated by the pyramiding action of layering one set of suggestions on top of another, something like Vot's fractionation technique (in which subject is repeatedly hypnotized and de-hypnotized with suggestions of increasing depth).
Two theories of pain control by hypnosis currently exist: 1. Socio-cognitive model - patient actively copes with noxious stimulus. Hypnotic analgesia should be like cognitive techniques like stress inoculation training. It requires deliberate effort. 2. Dissociative control model - pain reduction requires little cognitive effort.
These 2 theories have different predictions. He explains "ironic effects" theory, in which person must identify pain to reduce pain. Wagner's reflexivity constraint: any process of mental control must be consistent with state we are trying to create.
This investigation involved 25 Highs and 24 Lows who reported pain, produced by strain gauge. Taught either hypnotic analgesia or stress inoculation. Reported every 5 sec (high load) or 45 sec (low load). Subtracted report from baseline to make pain reduction scores. Highs in hypnosis had no difference in pain reduction under high or low mental load. For the other 3 groups (Highs under stress inoculation; Lows under either hypnosis or stress inoculation) the results were different. That is, for Highs in hypnosis the mean of pain reduction scores was the same even when challenged by frequent reports of how much pain was being experienced.
Results are congruent with Miller and Bowers' dissociative control model.
Wagner's ironic process theory is useful. Frequency of pain reporting moderates Ss reports of pain in analgesia. These results challenge the cognitive social model of hypnotic analgesia and support a dissociative control model. Unlike stress inoculation, hypnotic analgesia does not require cognitive effort for high hypnotizable subjects.
1994
Alden, P. A. (1994, October). Hypnotic approaches in pain control with terminally-ill patients. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Francisco.
( These notes do not cover the entire presentation, which was based on clinical practice experience.) One conclusion reached was that J. Barber's Rapid Induction Analgesia (RIA) is more immediately effective than a direct approach to induction, but that a direct approach improves with time. RIA seems to work better for low hypnotizables. Next she plans to study whether patients would benefit from being given a tape of RIA routinely as an adjunct to pain control.
Crawford, Helen J. (1994). Brain dynamics and hypnosis: Attentional and disattentional processes. International Journal of Clinical and Experimental Hypnosis, 42 (3), 204-232.
This article reviews recent research findings, expanding an evolving neuropsychophysiological model of hypnosis (Crawford, 1989; Crawford & Gruzelier, 1992), that support the view that highly hypnotizable persons (highs) possess stronger attentional filtering abilities than do low hypnotizable persons, and that these differences are reflected in underlying brain dynamics
Behavioral, cognitive, and neurophysiological evidence is reviewed that suggests that highs can both better focus and sustain their attention as well as better ignore irrelevant stimuli in the environment. It is proposed that hypnosis is a state of enhanced attention that activates an interplay between cortical and subcortical brain dynamics during hypnotic phenomena, such as hypnotic analgesia. A body of research is reviewed that suggests that both attentional and disattentional processes, among others, are important in the experiencing of hypnosis and hypnotic phenomena. Findings from studies of electrocortical activity, event-related potentials, and regional cerebral blood flow during waking and hypnosis are presented to suggest that these attentional differences are reflected in underlying neurophysiological differences in the far fronto-limbic attentional system.
Crawford, Helen J. (1994). Brain systems involved in attention and disattention (hypnotic analgesia) to pain. In Pribram, Karl H. (Ed.), Origins: Brain and self organization (pp. 661-679). Hillsdale, NJ: Lawrence Erlbaum Associates.
Data are reviewed from regional cerebral blood flow, EEG, and somatosensory event-related potential (SERP; both scalp and intracranial) studies of attention to and disattention (hypnotic analgesia) of painful stimuli to provide further evidence for two neurophysiological systems of pain involving the cortex: (1) the epicritic, sensory system of pain associated with the parietal, posterior region, and (2) the protocritic, distress, comfort-discomfort system of pain associated with the far fronto- limbic region. Studies of neurophysiological changes accompanying suggested hypnotic analgesia support the hypothesis that the executive controller of the far frontal cortex, via the far fronto-limbic attentional system, acts as a gate against the ascent of painful stimuli into conscious awareness by 'directing' downward the inhibition of incoming somatosensory information coming from the thalamic region. In hypnotically responsive individuals who could eliminate the perception of pain, reviewed studies demonstrated increased regional cerebral blood in the frontal and somatosensory regions, shifts in hemispheric dominance of EEG theta power, differential surface SERP topographical patterns in the anterior and posterior regions of the brain, and reduction of the intracranial SERP P160 waveform in the gyrus cingulus.
Paradoxically, there may be physiological reactivity to pain stimuli while the hypnotized Subject reports they are not consciously aware of pain. Posner's proposal of two different attentional systems may account for why there is physiological reactivity concurrent with lack of awareness of pain. Posner suggested that the posterior brain is involved with engaging and disengaging attention while the anterior brain is involved in attention for action or effortful attention. "Thus, the posterior region is involved in space and time, the epicritic processes, whereas the anterior region is involved in comfort- discomfort, the protocritic processes (Pribram, 1991)" (p. 665).
In parallel, there appear to be two systems of pain involving the cortex, as revealed in positron emission tomography research. Also relevant is clinical data showing that "removal of the frontal or cingulate cortex in patients with intractable pain leads to the amelioration of distress while not eliminating sensory pain (Bouckoms, 1989)" (p. 665).
The author proposes a neuropsychophysiology of hypnotic analgesia based on Hilgard's (1986) neodissociation theory of hypnosis, together with Pribram and McGuinness' (1975, 1992) attention model. In this view, "Hilgard's executive control system is the far frontal cortex 'directing' the inhibition of incoming painful stimuli" (p. 666) after determining that the somatosensory signal is 'irrelevant.'
"Highly hypnotizable individuals ('highs') have greater attentional and disattentional abilities than low hypnotizable individuals ('lows'). ... Recent neuroimaging techniques (PET, SPECT, CBF) that assess regional brain metabolism have found no differences in waking conditions between low and highly hypnotizable individuals, but have consistently reported that only highs show increased cerebral blood flow during hypnosis, suggestive of enhanced cognitive effort (Crawford, Gur et al., 1993; Halama, 1989; Meyer, Diehl, Ulrich, & Meinig, 1989; Walter, 1992)" (p. 666).