Schoenberger, Nancy E.; Kirsch, Irving; Gearan, Paul; Montgomery, Guy; Pastyrnak, Steven L. (1997). Hypnotic enhancement of a cognitive behavioral treatment for public speaking anxiety. Behavior Therapy, 28, 127-140.

The effectiveness of a multidimensional cognitive behavioral treatment for public speaking anxiety was compared with that of the same treatment supplemented by hypnosis. The hypnotic treatment included all components of the cognitive behavioral treatment. It differed from the nonhypnotic treatment only in that relaxation training was presented as a hypnotic induction, automatic thoughts were referred to as self-suggestions, and explicit hypnotic suggestions for improvement were added. Participants in both treatment conditions improved more than those in a wait-list control group. Moreover, labeling the treatment “hypnotic” appeared to enhance treatment effectiveness. The hypnotic treatment generated expectancies for greater change among participants than did the nonhypnotic treatment, and these expectancies were correlated with treatment outcome. Implications for the use of hypnosis in treatment are discussed.

Wormnes, Bjorn (1994, October). Hypnosis in working with performance anxiety and peak performance. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Francisco.

Better training facilities and procedures combined with scientific methods and knowledge bring athletes’ performance continuously to a higher standard. Being able to perform at their very best in important competitions depends on mental training and mental ability. Hypnosis is important to integrate in systematic training programs for peak performance. Important psychological factors influencing peak performance are discussed. Self-confidence, ability to concentrate, imagery training, goal-setting capacity, openness to communication and body signals, team building, delay capacity, and secure relations with coaches are shown to be significant. Integrating hypnosis into mental training is valuable both for working on temporary obstacles and in long-term programs.

Cochrane, Gordon J. (1991). Client-therapist collaboration in the preparation of hypnosis interventions: Case illustrations. American Journal of Clinical Hypnosis, 33, 254-262.

Therapists can use hypnosis in a variety of situations to help clients utilize their own resources effectively. In both heterohypnosis and tape-assisted self-hypnosis, the respectful collaboration of therapist and client in the development of specific intervention strategies can be effective. I have described four cases to illustrate the collaborative aspect of heterohypnosis in a surgical setting and tape-assisted self-hypnosis for anxiety, tinnitus, and situational depression. In each case the clients were willing and able participants.

“Hypnotic interventions as adjunctive therapeutic modalities for a variety of surgical procedures have been well documented (Frankel, 1987; Gravitz, 1988; Nathan, Morris, Goebel, & Blass, 1987). The availability, relative safety, dependability, and ease of use have made chemical agents the anesthetic of choice in the majority of surgical situations, but hypnosis, either alone or in conjunction with chemical agents, can have a number of advantages for some patients (Udolf, 1987, p. 248). Some patients who have extreme preoperative pain and anxiety can learn to use self-hypnosis (Frankel, 1987); others may use hypnosis when experiencing postoperative nausea and other uncomfortable side effects of chemical anesthetics. Some may fear death under general anesthesia or react to a previous trauma arising from general anesthesia and the operating room procedures in general (Udolf, 1987, p. 250) and therefore choose hypnotic strategies. In the following case illustration the patient feared general anesthesia because of a previous negative postoperative experience” (p. 255).
While collaboratively planned hypnosis often empowers the patient, contributing to a sense of personal control and well being, some patients are not able to participate in that manner. Cochrane cites patients who are severely depressed or “who struggle with narcissism and other severe pathologies” (p. 260). He notes that audiotapes are useful for supplementing in-session therapy, contributing to skill development, attitude change, and a sense of self-worth. He cites Eisen and Fromm (1983) as indicating that self hypnosis is also useful for clients “who struggle with issues of control and intimacy” (p. 260).

Wagaman, Jeffrey D.; Barabasz, Arreed F.; Barabasz, Marianne (1991). Flotation rest and imagery in the improvement of collegiate basketball performance. Perceptual and Motor Skills, 72, 119-122.

22 expert collegiate basketball players were exposed to either imagery training only or restricted environmental stimulation (REST) with imagery training. The REST group showed significantly better performance on both objective game performance and coaches’ blind ratings.

Clark, Duncan B.; Agras, W. Stewart (1990). The assessment and treatment of performance anxiety in musicians. American Journal of Psychiatry, 148 (5), 598-605.

94 adults with a performance anxiety problem were recruited by mass media announcements and were seen in a university-based outpatient psychiatric clinic. Assessments were questionnaires for all 94 ss, diagnostic interview of 50 ss, and laboratory performance of 34 ss. Treatment conditions were 6 weeks of buspirone, 6 weeks of placebo, a five-session group cognitive-behavior therapy program (CBTP) with buspirone, or the CBTP with placebo. All Ss fulfilled criteria for Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) social phobia. Of the 15 full-time professional musicians, 10 had tried propranolol and 3 had stopped performing. Most Ss had substantial anxiety and heart rate increases during lab speech and musical performances. CBTP resulted in significant reductions in subjective anxiety, improved quality of musical performance, and improved performance confidence.

McAleney, Patrick J.; Barabasz, Arreed; Barabasz, Marianne (1990). Effects of flotation restricted environmental stimulation on intercollegiate tennis performance. Perceptual and Motor Skills, 72, 1023-1028.

The study investigated the effects of flotation Restricted Environmental Stimulation (REST) with an imagery message on the competitive performance of intercollegiate tennis players (10 men, 10 women). Pre- and posttreatment athletic performance was measured during intercollegiate competition. Posttreatment results indicated that subjects exposed to flotation REST with an imagery message performed significantly better than subjects exposed to imagery only on a measure of first service accuracy. Findings suggest that flotation REST can be used to enhance the performance of a well learned skill by athletes of high ability.

Palan, B.M.; Chandwani, S. (1989). Coping with examination stress through hypnosis: An experimental study. American Journal of Clinical Hypnosis, 31, 173-180.

Fifty-six volunteer medical students participated in three groups balanced for number of subjects, performance at last examination, and hypnotizability. The hypnosis and waking groups attended eight group sessions once a week with general ego- strengthening and specific suggestions for study habits, with a ninth session of age progression and mental rehearsal. Subjects in these two groups practiced self-suggestions (in self-hypnosis or waking respectively) daily for the study period of 9 weeks. The control group experienced sessions of passive relaxation induced by light reading for the same period of time. The hypnosis group improved significantly in coping with examination stress, but there was no significant change in performance on examinations by any of the groups.

Neiss, Rob (1988). Reconceptualizing arousal: Psychobiological states in motor performance. Psychological Bulletin, 103 (3), 345-366.

This review of research dealing with psychologically induced arousal and motor performance focuses on the hypothesized inverted-U function relating arousal to performance. The inverted-U hypothesis is supported only in a weak and psychologically trivial fashion. More useful research in human motor performance would investigate discrete psychobiological states, which include affect and cognition as well as physiology. Examination of profound individual differences in response to incentive and threat suggests that psychobiological states have their genesis in response expectancies and hypnotic-like self-inductions. The cognitive and affective components of these states are highly interactive and perhaps not profitably separated. Because performance anxiety is a central problem in the motor realm, it is carefully delineated and the test anxiety literature is scrutinized. Psychophysiological test batteries and other investigations in the area are described, and guidelines for future research are provided.

Neiss, Rob (1988). Reconceptualizing relaxation treatments: Psychobiological states in sports. Clinical Psychology Review, 8 (2), 139-159.

Reviews studies relating relaxation treatments to motor performance and attempts to explain these treatments from a psychological perspective. The inverted-U hypothesis is based on arousal, which has construct validation problems and is a physiological, rather than a psychological, construct. Arousal cannot distinguish among fear, anger, sexuality, and other psychobiological states; predictive validity is low in the area of motor performance. The inverted-U hypothesis is effectively refutable in current usage, and empirically weakly supported. Relaxation treatments are reconceptualized as relatively nonspecific psychological therapies, potentially useful in alleviating dysphoric, debilitating psychobiological states. These treatments are particularly apt for athletics, where performance anxiety is a pervasive problem.

Jacobs, Sharon B.; Salzberg, Herman C. (1987). The effects of posthypnotic performance-enhancing instructions on cognitive-motor performance. International Journal of Clinical and Experimental Hypnosis, 35, 41-50.

The effects of performance-enhancing instructions on a cognitive-motor task (typing) was assessed using 3 groups: hypnosis and control groups with performance-enhancing instructions, and a control group without instructions. Unlike previous hypnosis research, the performance-enhancing instructions were given after substantial learning had occurred. Results indicated that posthypnotic performance- enhancing instructions, or performance-enhancing instructions alone, did not have a facilitative effect on performance. The results also suggested potential negative performance effects following hypnotic induction, depending on Ss’ initial typing ability. The implications of these findings are discussed.

The research investigated whether hypnotic suggestions could influence various factors thought to inhibit peak performance by increasing confidence, increasing motivation, and decreasing performance anxiety. 84 undergraduates of varying levels of typing ability were recruited, not mentioning in advance that the research involved hypnosis (in order to avoid selection bias). The experimental materials included a modified version of the Apple Typing Tutor program, which measures words per minute (WPM), key strokes missed (KM), and net words per minute (NWPM, which was obtained by subtracting 2 (KM) from WPM). These measures were obtained for the average of every 9 paragraphs.
Subjects received nine practice sessions and then were assigned to Experimental or Control group based on NWPM and sex. The hypnosis group received the Stanford Hypnotic Susceptibility Scale, Form C, minus suggestions for drowsiness, sleepiness, or posthypnotic amnesia. Additional suggestions for performance enhancement were introduced. The control group watched a film. The average of every nine paragraphs was used.
The analyses of variance for dependent measures revealed no significant effects except for one interaction effect that actually was in the unexpected or wrong direction. That effect appeared to be spurious as it was due to extreme errors produced by one subject.

“Only speed of typing (WPM) changed from pre to posttreatment, and this effect interacted with ability level. Post hoc analyses (Scheffe) indicated that beginner typists became less proficient, intermediate typists did not change, and advanced typists became more proficient” (p. 46).

Hypnotizability on SHSS:C did not correlate with change on NWPM.
A 3 x 3 x 2 ANOVA indicated a significant change over time on KM. “Although no change occurred from pretreatment to posttreatment, there was a decrease in errors at follow-up. There was also a significant Group x Level x Time interaction for KM (F = 2.57, p < .05). This was accounted for by post hoc analyses showing that hypnotized beginner Ss changed over time, while control beginner Ss did not. Hypnotized Ss made significantly more errors following hypnosis than at pretreatment or follow-up" (p. 46). "There was a significant main effect for time on NWPM. ... The Ss' overall typing performance decreased from pretreatment to posttreatment, but increased at follow-up. Only the advanced Ss demonstrated significant improvement between pretreatment and follow-up. "There was also a significant interaction between time and ability level on WPM. ... beginner Ss typed significantly slower at posttreatment than at pretreatment or follow- up" (p. 47). In their Discussion, the authors note that the outcomes of their investigation are consonant with results obtained by other investigators studying hypnosis effects on skills (Arnold, 1971; Edmonston & Marks, 1967). In contrast, earlier studies on reaction time demonstrated that either motivational instructions and/or alert hypnotic inductions improved performance (e.g. Ham & Edmonston, 1971; Rader, 1972). They raise the question whether Ss' relaxation following hypnosis may have slowed response time and canceled the effects of motivating instructions. "When looking at all groups combined, Ss did not improve between pretreatment and posttreatment. At follow-up, however, Ss showed significant improvement on two out of the three measures. This suggests that learning had occurred, but that temporary inhibitory factors such as S restlessness and indifference observed by Es may have affected performance at posttreatment. The length of the task (90 minutes in one sitting) may have been responsible for the fatigue and boredom that seemed to set in. It is probable that the performance-enhancing instructions were not potent enough to counteract these effects. At follow-up (which took much less time) fatigue and boredom were apparently absent, hence typing improved. In addition, other factors may have affected performance (e.g., anxiety, lack of motivation). The data indicate that Ss of different ability levels responded differently over time. "The results of the present study cast doubt on the utility of hypnosis in improving performance on a cognitive-motor task. Although there are many anecdotal reports of hypnosis improving performance, research studies indicate that hypnosis, with motivational instructions, is effective only in improving reaction time and not more complex measures of performance. This apparent inconsistency may be explained by considering the level of motivation of participants. It is likely that a person requesting hypnosis to help improve performance is more motivated than experimental Ss" (p. 48). 1981 Wallace, Benjamin; Hoyenga, Katharine Blick (1981). Performance of fine motor coordination activities with an hypnotically anesthetized limb. International Journal of Clinical and Experimental Hypnosis, 29, 54-65. 3 experiments were conducted to determine the effects of induced hypnotic anesthesia in S's dominant arm upon the performance of various motor coordination tasks. Experiment 1 assessed the ability of Ss to tap a pencil within a 20 mm diameter circle while the limb performing the task was or was not anesthetized. Experiment 2 determined the effect of hypnotic anesthesia upon the ability to perform a hand-turn task. Experience 3 considered the effects of hypnotic anesthesia on the ability to draw and duplicate a sine- wave pattern. IN all 3 experiments, hypnotic anesthesia adversely affected task performance. Their results were interpreted as indicating a possible relationship between induced hypnotic anesthesia and mimicked cerebellar dysfunction. notic anesthesia on the ability to draw and duplicate a sine- wave pattern. IN all 3 experiments, hypnotic anesthesia adversely affected task performance. Their results were interpreted as indicating a possible relationship between induced hypnotic anesthesia and mimicked cerebellar dysfunction. "Although the induction of hypnotic anesthesia in a limb appears to mimic cerebellar dysfunction or damage, the present authors are not implying that this is actually happening. In fact, there are few physiological correlates of hypnosis or hypnotic anesthesia (Evans, 1979; Sarbin & Slagle, 1979) and, to date at least, cerebellar involvement does not appear to be one of them. There appears to be a curious relationship, however, between performance on a motor task as a function of induced hypnotic anesthesia in a limb and as a function of cerebellar damage. This relationship may simply be coincidental at best but before it can be dismissed as such, further experimentation should take place to study this interesting phenomenon" (p. 61). 1980 Russell, Robert J. (1980). The effects of hypnosis and mastery imagery on task performance (Dissertation, Western Michigan University). Dissertation Abstracts International, 41 (n6-B), 2368. (Order No. DA 8027229) "The purpose of this study was to determine the efficacy of combining mastery imagery with hypnosis to facilitate performance on a motor task, and to identify the variables which are responsible for such an effect. 99 students were pretested on the Pursuit Rotor Task and screened for hypnotic susceptibility. From this screening, 40 high susceptibility Ss were randomly assigned to one of four conditions: (1) hypnosis and mastery imagery, (2) hypnosis, (3) mastery imagery (H) and (4) no-treatment control. Ten low susceptibility Ss were directly assigned to a second mastery imagery (L) condition which served as a special comparison group. Following the treatment intervention, Ss were posttested on the Pursuit-Rotor Task and were asked to complete a questionnaire regarding their experience in the experiment. ANOVA found no significant differences among the five groups" (p. 2368). Salzberg, H. C.; DePiano, F. A. (1980). Hypnotizability and task motivating suggestions: A further look at how they affect performance. International Journal of Clinical and Experimental Hypnosis, 28 (3), 261-271. An attempt was made to ferret out the separate effects on cognitive performance of hypnotic susceptibility, task motivating suggestions, and the hypnotic trance state. An equal number of susceptible and unsusceptible Ss were given 3 cognitive tasks, first to ascertain their baseline performances, and then again following either a traditional hypnotic induction, an alert trance induction or a short interview. All Ss were given task motivating suggestions prior to administering the alternate form of the 3 tasks. An additional control group of Ss was used to assess practice effects. Results indicated that task motivating suggestions were effective in enhancing performance for all groups on the digit symbol and abstract reasoning tasks but not on the memory task. Waking suggestion Ss performed as well as hypnotized SWs when both groups of Ss were given task motivating suggestions. It was concluded that when the experimental design of a study incorporates necessary controls, hypnosis does not facilitate performance. This paper reviews a long term research project relating hypnotic susceptibility to performance and personality variables. Several experiments indicated that people who are low in hypnotic susceptibility try harder than high susceptibles for maximum performances on strength, endurance, psychomotor coordination, and cognitive tests, though high susceptibles are generally more pleased with their own performances. Other experiments indicated that people of high hypnotic susceptibility have slower brain- wave patterns under relaxed, nonhypnotic conditions, than do low susceptibles. These findings, together with a third set of findings on the developmental character of hypnotic susceptibility, led to the theory that hypnotic susceptibility and brain-wave patterns are both inversely correlated with achievement motivation and with its developmental roots in childhood independence training. An elaborate research program was initiated to investigate the hypothesized relationships. 1974 Bloom, Richard F. (1974). Validation of suggestion-induced stress. 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. 1970 Sakata, Kenneth I.; Anderson, John P. (1970). The effects of posthypnotic suggestion on test performance. International Journal of Clinical and Experimental Hypnosis, 18 (1), 61-71. Tested 45 undergraduates preselected for hypnotizability on 2 learning tasks by E and retested on the tasks by other Es a mo. later. Before being retested Ss were randomly assigned to 1 of 3 treatment conditions: (a) a posthypnotic suggestion condition, (b) a waking suggestion condition, and (c) a hypnosis-no-suggestion condition in which Ss were merely dehypnotized without exhortative instructions. Es were blind to the experimental design. Analyses of covariance indicate that the posthypnotic suggestion group performed more rapidly and accurately on a Rational Learning Test (RLT), but not on a Digit Symbol Test (DST), than the waking suggestion group. The posthypnotic suggestion group did not differ from the hypnosis-no-suggestion group, which also performed more accurately but not more rapidly than the waking suggestion group on the RLT. There were indications that posthypnotic suggestions had interfered with performance on the DST, which involved motor manipulations. Findings supported previous studies indicating differences between a posthypnotic and waking suggestion group in task performance. No definite conclusions to account for the differences could be offered. (Spanish & German summaries) (18 ref.) (PsycINFO Database Record (c) 2003 APA, all rights reserved) 1965 Evans, Frederick J.; Orne, Martin T. (1965). Motivation, performance, and susceptibility to hypnosis. International Journal of Clinical and Experimental Hypnosis, 13 (2), 103-116. Earlier reports found that the waking base level performance of Ss who are relatively insusceptible to hypnosis is higher than the waking base level of highly susceptible Ss on tasks of muscular strength, endurance, coordination, and verbal learning and that any increment in performance under hypnosis tends to be at least as great with insusceptible Ss as with highly susceptible Ss. These previous studies were carefully replicated, but the results were not confirmed. No differences in base level or hypnosis performance were found, except for poorer hypnosis performance of Ss of medium susceptibility to hypnosis, arising in part from the emphasis on relaxation in the induction procedure, and in part because of subtle demand characteristics present in the counterbalanced experimental design. (22 ref.) (PsycINFO Database Record (c) 2002 APA, all rights reserved) McCord, Hallack (1965). Trance induction under unusual circumstances. International Journal of Clinical and Experimental Hypnosis, 13, 96-102. In order to obtain a test under naturalistic field conditions of the possible facilitory or inhibitory effects of ongoing tasks on hypnotizability and the interaction of such effects with S''s set either to oppose or not oppose entering hypnosis, a series of Ss were hypnotized either singly or in groups while they were performing a variety of tasks typical of those encountered in office or factory situations. Included were such tasks as typewriting, reading a book, engaging in creative writing, performing the Bennett Hand Tool Dexterity and the Minnesota Rate of Manipulation tests, and performing the Pennsylvania Bi-Manual Worksample. In many cases, it was found that hypnosis could be induced under these conditions. (PsycINFO Database Record (c) 2002 APA, all rights reserved) Naruse, Gosaku (1965). The hypnotic treatment of stage fright in champion athletes. International Journal of Clinical and Experimental Hypnosis, 13 (2), 63-70. The use of direct hypnotic suggestion, posthypnotically produced autohypnosis, and self-hypnosis in conjunction with autogenic training and progressive relaxation in the treatment of "stage fright" in athletes is discussed. Illustrative case histories drawn from a sample of athletes participating in the 1960 Olympic Games are presented. (PsycINFO Database Record (c) 2002 APA, all rights reserved) 1964 Levitt, Eugene E.; Brady, J. P. (1964). Muscular endurance under hypnosis and in the motivated waking state. International Journal of Clinical and Experimental Hypnosis, 12, 21-27. 8 female Ss scoring at least 10 on the Standford Hypnotic Susceptibility Scale were required to hold a weight in the outstretched hand in 3 states: (a) under hypnosis, (b) under hypnosis with the upper arm and shoulder anesthetized hypnotically, and (c) in the waking state with motivation provided by a verbal exhortation and monetary payment. Order of performance in the 3 states was varied. No significant differences among states were found. The interaction between states and orders was significant, but it appears more likely to be the result of intersubject variability rather than of position or fatigue effects. Ss'' expectancies and estimates of performance time, obtained postexperimentally, did not appear to be related to performance itself. (PsycINFO Database Record (c) 2002 APA, all rights reserved) states and orders was significant, but it appears more likely to be the result of intersubject variability rather than of position or fatigue effects. Ss'' expectancies and estimates of performance time, obtained postexperimentally, did not appear to be related to performance itself. (PsycINFO Database Record (c) 2002 APA, all rights reserved) Moskowitz, Arnold E. (1964). A clinical and experimental approach to the evaluation and treatment of a conversion reaction with hypnosis. International Journal of Clinical and Experimental Hypnosis, 12 (4), 218-227. A combination of hypnotherapeutic techniques within a clinical and experimental context provided a method of understanding, evaluating, and predicting the course of a conversion reaction. During waking and hypnotic conditions, 5 trials of dynamometer presses were obtained from a patient having primary symptoms of paralysis of his left arm. Difference scores between the left and right hands during waking and hypnotic conditions were evaluated. Findings were: (a) At the beginning of treatment, significant differences were found between the waking and hypnotic conditions (b) The largest differences between the waking and hypnotic conditions occurred during the early stages of treatment, while the smallest differences occurred on the final day of treatment. (c) With a complete remission of the patient''s symptoms, no significant differences between the waking and hypnotic conditions were found. (PsycINFO Database Record (c) 2002 APA, all rights reserved) 1960 Salzberg, Herman Carl (1960). The effects of hypnotic, posthypnotic, and waking suggestion on performance using tasks varied in complexity. International Journal of Clinical and Experimental Hypnosis, 8, 251-258. 5 Ss were instructed to respond with a reaction time key to colors and figures presented tachistoscopically. In the 1st series of experiments a steady reaction to figures (with the right hand) and to colors (with the left hand) was established. In the 2nd series figures and colors were presented 1 by 1 at random, and the Ss had to react according to the previously established habit. In the 3rd series combinations of figures and colors were shown and the Ss had to react with both hands at the same time. 4 different types of reactions were observed in the last series depending upon the shifting or the distribution of attention. From Psyc Abstracts 36:01:3CE87P. From Psyc Abstracts 36:01:3CF06N. From Psyc Abstracts 36:01:3CF14L. From Psyc Abstracts 36:01:3CF17S. (PsycINFO Database Record (c) 2002 APA, all rights reserved) Personality Disorder 2002 McNeal, Shirley A. (2002). A character in search of character: Narcissistic personality disorder and ego state therapy. American Journal of Clinical Hypnosis, 45 (3), 233-243. The individual diagnosed with narcissistic personality disorder presents with grandiosity, extreme self-involvement, and lack of interest in and empathy for others. This paper reviews current theories concerning the development and treatment of this disorder, and presents a case study in which ego state therapy was successfully utilized and integrated into hypnotically facilitated psychotherapy with a 48-year-old man diagnosed with narcissistic personality disorder. The ego state model of treatment is described and demonstrated with case material. Initially ego states that reveal the grandiosity are accessed. As therapy progresses, ego states that hold the underlying feelings of emptiness, rage, and depression are able to emerge. With further treatment, transformation and maturation of the ego states occur, reflecting the changes in internal structure and dynamics as well as improvement in external interpersonal relationships. Issues concerning ego state therapy as utilized with personality disorders are discussed and contrasted with more traditional methods of treatment. (PsycINFO Database Record (c) 2003 APA, all rights reserved) 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 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." 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." 1995 Holroyd, Jean (1995). Handbook of clinical hypnosis, by Judith W. Rhue, Steven Jay Lynn, & Irving Kirsch (Eds.) [Review]. International Journal of Clinical and Experimental Hypnosis, 43 (4), 401-403. "This is a book for the thinking clinician" (p. 401). "The editors are to be congratulated for making this volume much more coherent than most edited books" (p. 402). "My impression is that the book is best suited for an intermediate or advanced course on hypnotherapy, or for people who are already using hypnosis in treatment. Although there is some material on the basics of hypnotic inductions and a few introductory sample scripts for inductions, a beginners'' course should probably use a different book, or this book could be accompanied by an inductions manual. ... I recommend it very highly" (p. 403). 1991 Chu, James A.; Dill, Diana L. (1991). Dissociation, borderline personality disorder, and childhood trauma. American Journal of Psychiatry, 148 (6), 812. Comments on the article by S. N. Ogata et al (see PA, vol 78:4681) on the high prevalence of childhood physical and sexual abuse in inpatients with borderline personality disorder. It is suggested that dissociative symptoms in borderline patients may simply be a less severe form of intrapsychic fragmentation than multiple personalities. 1990 Fink, D.; Golinkoff, M. (1990). Multiple personality disorder, borderline personality disorder, and schizophrenia: A comparative study of clinical features. Dissociation, 3, 127-134 Found that MPD was differentiated from schizophrenia on the great majority of test measures. MPD could not be distinguished from borderline personality on the MMPI or MCMI but differed in many clinical features, severity of abuse, and dissociative symptoms 1988 Kemp, Kristen; Gilbertson, Alan D.; Torem, Moshe (1988). The differential diagnosis of multiple personality disorder from borderline personality disorder. Dissociation, 1 (4), 41-46. Considerable controvery [sic] surrounds the relationship between multiple personality disorder (MPD) and borderline personality disorder (BPD). Some authors argue that MPD is a variant of BPD, and most agree that the differential diagnosis of the two is often very difficult. In this article data are presented from a study comparing historical, demographic and psychological testing variables between the two groups. No statistically significant differences were found between the two groups on these variables. However, certain trends emerged which may serve as a catalyst for further research. The relationship between the disorders may be complex; clinicians may need to use more sophisticated research techniques and develop more sensitive diagnostic criteria before it is understood. -ians may need to use more sophisticated research techniques and develop more sensitive diagnostic criteria before it is understood. 1987 Fromm, Erika (1987). Significant developments in clinical hypnosis during the past 25 years. International Journal of Clinical and Experimental Hypnosis, 35 (4), 215-230. In the past 25 years, important changes have taken place in clinical hypnosis. It has become scientifically respectable as the field has moved from publishing anecdotal case reports to testing hypotheses on significant samples of patient populations. In addition, new treatment approaches have been introduced, foremost among them hypnoanalysis of psychotic, borderline, narcissistic, and post-traumatic stess disorders, as well as hypno-behavioral methods for the treatment of habit disorders and somatic and psychosomatic diseases. The former treatment approaches combine hypnotic techniques with the newer psychoanalytic methods derived from object relations and self-theories; the latter combine hypnosis with the methods of behavioral medicine and attempt to teach the patient voluntary control over ordinarily involuntary somatic processes. In general, while formerly the therapeutic use of hypnosis involved mainly direct and indirect suggestion, in the last 25 years hypnotherapists of all persuasions have become more and more convinced of the important role imagery plays in the application of hypnosis for therapeutic purposes. Several areas of clinical application are described. Kluft, Richard P. (1987). Unsuspected multiple personality disorder: An uncommon source of protracted resistance, interruption, and failure in psychoanalysis. Hillside Journal of Clinical Psychiatry, 9 (1), 100-115. Multiple personality disorder (MPD) is being recognized with increasing frequency. A great imitator, it may be encountered among patients who appear to have a wide range of other diagnoses, and have been in treatment for years without the presence of MPD being discovered. Nine of 241 MPD patients interviewed by the author, 3.7%, had been accepted for psychoanalysis. In only one case had the diagnosis been appreciated by the analyst prior to his accepting the patient for analytic treatment. Four patients were profoundly resistant and/or inaccessible to analysis for protracted periods. In one of these cases the diagnosis became clear and successful analysis was concluded, but three analyses ended unsuccessfully with the diagnosis still unknown. Two patients' analyses ended unsuccessfully with the diagnosis still unknown. Two patients' analyses were interrupted due to abrupt regressive events initially perceived to indicate severe ego weakness incompatible with sustaining an analytic process, but later appreciated as signs of MPD. In three cases it appeared that the patients' being accepted for analysis triggered the emergence of the dissociative process, and either the patient or the analyst decided to pursue a different form of therapy. Unsuspected MPD appears to account for a small percentage of stalemates, failures, interruptions, and early flights from analysis. "In most other literatures, dissociation is considered reflective of a capacity for hypnotizability, without any connotation of a particular level of psychopathology. There is solid evidence that hypnotizability is intrinsic to MPD (Bliss, 1980, 1983, 1984Lipman, Frischholz, and Braun, 1984), and a borderline level of organization is not (Horevitz and Braun, 1984). It is more parsimonious and consistent with clinical experience and research findings to infer that the splitting noted in pregenital pathologies and the splitting found in MPD are different although enticingly similar phenomena, and that in some patients they coexist in such a way that one could easily agree that a patient was both MPD and borderline. The linguistic confusion is to be deplored, and hopefully to be remedied in the near future" (p. 111). Malon, Don W.; Berardi, Deborah (1987). Hypnosis with self-cutters. American Journal of Psychotherapy, 41 (4), 531-541. Contends that hypnotic techniques can add to effective therapy with self-cutting patients in the context of a strong, communicative, and flexible relationship. "Neutral hypnosis" (i.e., the trance state in which specific suggestions are avoided so that physiological arousal is minimized) and relaxation techniques can be employed to counteract the frightening depersonalization that leads to the cutting. Techniques of uncovering and controlled regression are also possible. Hypnotic relaxation techniques, such as breath counting, positive imagery, and clinical vignettes are provided as illustrations. 1986 Copeland, Donna R. (1986). The application of object relations theory to the hypnotherapy of developmental arrests: The borderline patient. International Journal of Clinical and Experimental Hypnosis, 34 (3), 157-168. The present paper reviews the literature on object relations theory with respect to the borderline patient and, within this perspective, discusses its application to hypnotherapy. Emphasis is placed on developmental aspects of the attachment-separation-individuation process that relate to certain characteristics of the hypnotic experience and the therapeutic relationship, including transference, regression, and the internalization of positive aspects of the therapeutic alliance. The therapeutic process as described parallels normal developmental phases. Specific techniques to facilitate therapeutic integration are outlined and illustrated with case examples. These help to structure the internalization of the therapeutic relationship as a foundation to restructuralization of the patient's representational world. 1984 Jensen, Peter S. (1984). Case report of conversion catatonia: Indication for hypnosis. American Journal of Psychotherapy, 38 (4), 566-570. Describes the successful hypnotic treatment of a 25-yr-old Black male who displayed symptoms of suicidal ideation, insomnia, and feelings of depression alternating with emptiness and boredom that led to an acute catatonic reaction. S met DSM-III criteria for borderline personality disorder. It is contended that since conversion mechanisms may underlie some presentations of catatonia, hypnosis may assist clinicians in the differential diagnosis of acute catatonic conditions. Stava, L. (1984). The use of hypnotic uncovering techniques in the treatment of pedophilia: A brief communication. International Journal of Clinical and Experimental Hypnosis, 32 (4), 350-355. This case study describes the use of the hypnotic uncovering techniques of induced dreams (Sacerdote, 1967) and the affect bridge (Watkins, 1971) in reducing inappropriate sexual arousal in a male pedophile. Treatment effects were examined through the use of both psychophysiological measures of penile tumescence and psychological tests. The hypnotherapeutic treatment regime consisted of 25 sessions over approximately 9 months. At the end of treatment, psychophysiological measures revealed a definite reduction of sexual excitation to slides of prepubescent children. Psychological testing indicated reduced defensiveness as well as reduced sexual anxiety to adult women. Various hypnotherapeutic experiences which may have contributed to the treatment effects are discussed. Watkins, John G. (1984). The Bianchi (L.A. hillside strangler) Case: Sociopath or multiple personality?. International Journal of Clinical and Experimental Hypnosis, 32 (2), 67-101. The case of Kenneth Bianchi (the Los Angeles "Hillside Strangler") has been controversial ever since he was first arrested in January, 1979. This contributor saw Bianchi as a consultant on March 21st and 22nd, 1979. Under hypnosis, he manifested what appeared to be a multiple personality. An underlying personality, "Steve," whose existence was apparently unknown to Bianchi, claimed responsibility for the 2 murders in Bellingham and those in Los Angeles. As a consequence, the court appointed 5 other consultants to examine the defendant. On April 20, 1979, I activated the Steve personality without a hypnotic induction. It described many murders in Los Angeles, indicating which ones he (Steve) had done and which ones Bianchi's cousin (Angelo Buono) did. The major personality (Ken) appeared to be amnesic to all this. 2 additional "personalities" were elicited by Martin Orne, another consultant. However, Orne would not accept the diagnosis of multiple personality. He diagnosed Bianchi as an "Antisocial Personality" (Sociopath) and claimed that he was a clever malingerer. He also asserted that Bianchi had never been hypnotized. The evidence, Rorschach tests, intelligence tests, handwriting samples, art creations, plus recorded sessions by Watkins, Orne and others, are analyzed. This writer concludes that the diagnosis of multiple personality is strongly supported. 1983 Baker, Elgan L. (1983). Resistance in hypnotherapy of primitive states: Its meaning and management. International Journal of Clinical and Experimental Hypnosis, 31 (2), 82-89. This paper examines varous aspects of resistance that become manifest in hypnotherapy with borderline, narcissistic, and psychotic patients. Specific clinical presentations are described and contrasted with forms of resistance encountered in work with neurotic patients. An ego psychology theoretical perspective is presented to conceptualize these more primitive resistance phenomena in terms of transference issues and dynamics relating to separation/attachment conflicts, and specific suggestions for management are outlined. 2 case examples are presented to demonstrate both conceptual and technical aspects of this approach.