Stanton, Harry E. (1989). Hypnotic relaxation and the reduction of sleep onset insomnia. International Journal of Psychosomatics, 36, 64-68.

A hypnotic relaxation technique was compared to stimulus control and placebo conditions as a means of reducing sleep onset latency (SOL). Forty-five subjects were matched on their baseline SOL as measured through sleep diaries. They were randomly assigned to one of the three groups and experienced four weekly sessions of 30- minutes’ duration, with demand effects being controlled through the use of counter- demand instructions. Data generated by the study suggested that the particular hypnotic relaxation treatment used was effective in helping Ss sleep more quickly. Neither stimulus control nor placebo groups recorded similar improvement.

Zane, Nolan W. S. (1989). Change mechanisms in placebo procedures: Effects of suggestion, social demand, and contingent success on improvement in treatment. Journal of Counseling Psychology, 36, 234-243.

Investigated the treatment effects of three social influence variables frequently implicated in psychotherapy placebos. Socially anxious male Subjects participated in an experimental treatment for reducing dating anxiety. Subjects were either given or not given specific suggestions for decreasing social anxiety, placed in conditions of high or low social demand, and received feedback indicating either high or moderate success on the therapy task. Results support the importance of social influence variables in therapeutic change. Contingent success had its greatest impact on personal attributes; suggestion affected skill behaviors; and social demand effects were found in the self- evaluation of heterosocial performance. Various social influences appear to mediate change differently and do not exert the generic effects commonly assumed to be characteristic of therapy placebos. Implications for outcome research are discussed.

Council, James R.; Loge, D. (1988). Suggestibility and confidence in false perceptions: A pilot study. British Journal of Experimental and Clinical Hypnosis, 5, 95-98.

Subjects received audiotaped instructions implying that they would perceive increases in odor or heaviness while comparing stimuli in a sensory-judgment task. Stimuli were actually indiscriminable. Subjects pretested as higher or lower in hypnotizability performed the task in either hypnotic or non-hypnotic conditions. In both treatments, greater hypnotizability was associated with more perceived changes in the stimuli and greater confidence in the reality of those perceptions. Results support a general factor underlying suggestibility in hypnotic and nonhypnotic situations. The findings are discussed in relationship to false confidence effects reported in hypermnesia research.

Malone, M.; Strube, M. (1988). Meta-analysis of non-medical treatment for chronic pain. Pain, 34, 231-234.

Conducted a meta-analysis of 109 published studies which assessed the outcome of various nonmedical treatments for chronic pain, 48 of which had sufficient information to calculate effect sizes. The remainder were examined according to proportion of patients rated as improved. Mood and number of subjective symptoms consistently showed greater responses to treatment than

than did pain intensity, pain duration, or frequency of pain, indicating the importance of using a multidimensional framework for pain assessment. Effect sizes for treatments were 2.74 for autogenic training, 2.67 for hypnosis, 2.23 for pill placebo, 1.33 for package treatments that allowed patients to choose from diverse pain management strategies, .95 for biofeedback, .76 for cognitive therapy, .67 for relaxation, .55 for operant conditioning, and .46 for TENS units. However, the largest numbers of studies were in the area of biofeedback, a treatment package, and relaxation, and we must be cautious in interpreting the effect sizes due to the small number of studies in the sample.

Spanos, Nicholas P.; Stenstrom, Robert J.; Johnston, Joseph C. (1988). Hypnosis, placebo, and suggestion in the treatment of warts. Psychosomatic Medicine, 50, 245-260.

Two experiments assessed the effects of psychological variables on wart regression. In Experiment 1, subjects given hypnotic suggestion exhibited more wart regression than those given either a placebo treatment or no treatment. In Experiment 2, hypnotic and nonhypnotic subjects given the same suggestions were equally likely to exhibit wart regression and more likely to show this effect than no treatment controls. In both experiments, treated subjects who lost warts reported more vivid suggested imagery than treated subjects who did not lose warts. However, hypnotizability and attribute measures of imagery propensity were unrelated to wart loss. Subjects given the suggestion that they would lose warts on only one side of the body did not show evidence of a side-specific treatment effect.

Evans, Frederick J.; McGlashan, Thomas H. (1987). Specific and non-specific factors in hypnotic analgesia: A reply to Wagstaff. British Journal of Experimental and Clinical Hypnosis, 4, 141-147. (Comment in response to Wagstaff, G. (1987). Is hypnotherapy a placebo? Hypnosis, 4, 135-140.)

This article is a reply to Wagstaff’s (1984) critique of the McGlashan, Evans & Orne (1969) article which was entitled “The nature of hypnotic analgesia and the placebo response to experimental pain,” published in Psychosomatic Medicine, 31, 227-246. The paper to which the authors are replying is Wagstaff, G. F. (1984). Is hypnotherapy a placebo? Paper given at the First Annual Conference of the British Society of Experimental and Clinical Hypnosis, University College, London. An abridged version appeared in the British Journal of Experimental and Clinical Hypnosis, 1987, 4, 135-140.

The closing comments of this Evans & McGlashan 1987 paper read as follows: “The strategy in this study [i.e. McGlashan, Evans & Orne, 1969] was quite different from the usual experimental design. Our goal was to _maximize_ all of those non-specific factors that we could build into the experimental procedure. Only by attempting to maximize non-specific effects is it possible to see whether hypnosis in appropriately responsive subjects can exceed that degree of pain control which occurs due to the maximal operation of these non-specific effects. These non-specific components of the hypnotic situation may account for a great deal of clinical change. … The critical finding was that hypnosis did add a level of pain control that occurred after maximizing clinically related non-specific factors contributing to change in pain tolerance, and that this increased tolerance occurred only in subjects markedly responsive to hypnosis, in contrast to the significant non-specific effects which were uncorrelated with measured hypnotizability” (pp. 143-144).

The principal findings of the McGlashan, Evans & Orne (1969) study were: “(a) The improved ability to tolerate pain following the ingestion of placebo was roughly the same for high hypnotizable and low hypnotizable subjects. (b) The response to the non-specific aspects of taking a ‘drug’ among low hypnotizable subjects was identical to, and highly correlated (.76) with, their response to the legitimized expectation that change would occur under hypnosis for low hypnotizable subjects. The placebo component of a believe-in ‘drug’ ingestion was the same as the placebo component of a believed-in hypnotic experience for these low hypnotizable subjects. (c) The performance of the highly hypnotizable subjects was significantly greater under hypnotic analgesia conditions than it was under placebo conditions.
“This last finding is important conceptually, though of less clinical relevance. It should be noted that not all high hypnotizable subjects showed this result. Even among highly hypnotizable subjects, not all of them had the experience that profound analgesia had occurred! Thus, based on their subjective experience of the relatively small degree of analgesia, 6 of the 12 highly hypnotizable subjects behaved exactly as the low hypnotizable subjects had — their placebo and hypnotic responses were small, significant, but equal. Only 6 out of 12 carefully screened hypnotizable subjects who subjectively experienced marked analgesia showed dramatic objective changes in pain endurance. Dr. Wagstaff might consider the physiological implications of the observation that we became somewhat frightened about the possibility of tissue damage with two of these six subjects. We had to stop their performance at a point where physiologists had assured us that tissue damage could be expected. They had also assured us, wrongly for these subjects, that we did not have to worry about such a critical point because nobody could endure such a degree of occlusion with this procedure. In fact, for these two subjects, anoxia and muscle cramping were not even apparent!” ( p. 144).

Stam, Henderikus J.; Spanos, Nicholas P. (1987). Hypnotic analgesia, placebo analgesia, and ischemic pain: The effects of contextual variables. Journal of Abnormal Psychology, 96, 313-320.

Two experiments examined the relation between hypnotic and placebo analgesia using ischemic pain. The first experiment examined an artifact in a previously used ischemic-pain stimulus. Experiment 2 investigated the relation between hypnotic and placebo analgesia using a submaximum-effort tourniquet technique to produce ischemic pain. High- and low-susceptible subjects who received placebo analgesia followed on a subsequent trial by hypnotic analgesia showed significant increases in tolerance from placebo to hypnotic analgesia. When presented in the reverse order, however, placebo analgesia and hypnotic analgesia led to equivalent levels of tolerance in both high- and low-susceptible subjects. A similar pattern of findings emerged for Ss’ magnitude estimates of pain, but it was not related to hypnotic susceptibility. These findings indicate that both hypnotic and placebo analgesia may be contextually dependent phenomena.

Critelli, Joseph W. (1985). Placebo effects, common factors, and incremental effectiveness. [Comment/Discussion] .

This is a comment on Kirsch, Irving (1985). The logical consequences of the common-factor definition of the term placebo. American Psychologist, 40, 239-240.
“It seems apparent that psychologists have underestimated the difficulty of proving incremental effectiveness. Unlike the situation in medicine, placebo controls in psychology rarely if ever attain true double-blind status. They are alsmost invariably administered by therapists who do not believe in the efficacy of their own procedures. It is hard to believe that this would not affect therapeutic effectiveness. In addition, present measures of credibility-expectancy are rather crude, and they do not control for other placebo variables such as attention, demand for improvement, and emotional investment in being cured. Under these circumstances, it is difficult to maintain the conviction that any current psychological treatment has demonstrated effects beyond those of adequate placebo controls” (p. 851).

Kirsch, Irving (1985, November). Response expectancy as a determinant of experience and behavior. American Psychologist, 40 (11), 1189-1202.

Response expectancies, defined as expectancies of the occurrence of nonvolitional responses, have generally been ignored in theories of learning. Research on placebos, hypnosis, and fear reduction indicates that response expectancies generate corresponding subjective experiences. In many cases, the genuineness of these self- reported effects has been substantiated by corresponding changes in behavior and physiological function. The means by which response expectancies affect experience, physiology, and behavior are hypothesized to vary as a function of response mode. The generation of changes in subjective experience by corresponding response expectancies is hypothesized to be a basic psychological mechanism. Physiological effects are accounted for by the mindbody identity assumption that is common to all nondualist philosophies of psychology. The effects of response expectancies on volitional behavior are due to the reinforcing properties of many nonvolitional responses. Classical conditioning appears to be one method by which response expectancies are acquired, but response expectancy effects that are inconsistent with a conditioning hypothesis are also documented.

Kirsch, Irving (1985). The logical consequences of the common-factor definition of the term placebo. American Psychologist, 40, 237-238.

According to the comments of Critelli (1985 American Psychologist, p. 850), Kirsch “maintained that the common factors definition of placebo is unacceptable because it (a) fails to encompass placebos such as false biofeedback, and it (b) overinclusively identifies as placebos traditional procedures such as contingent reinforcement. He argued that it would be unwise to adopt a definition that ‘requires us to conclude that effective … procedures are placebos’ (p. 238). Kirsch suggested that the placebo label be restricted to pharmacologically inert substances and that placebo control groups in psychotheapy be called ‘expectancy modification controls’ (p. 238). In effect, he suggested formally defining the placebo only within medicine, while retaining for psychotherapy both the concept of placebo and the use of (relabeled) placebo control groups” (p. 850). Editor’s Note: Critelli (1985) is a secondary source.

adopt a definition that ‘requires us to conclude that effective … procedures are placebos’ (p. 238). Kirsch suggested that the placebo label be restricted to pharmacologically inert substances and that placebo control groups in psychotheapy be called ‘expectancy modification controls’ (p. 238). In effect, he suggested formally defining the placebo only within medicine, while retaining for psychotherapy both the concept of placebo and the use of (relabeled) placebo control groups” (p. 850). Editor’s Note: Critelli (1985) is a secondary source.

Patterson, C. H. (1985). What is the placebo in psychotherapy?. Psychotherapy, 22 (2), 163-169

Although there is an extensive literature on the placebo effect in psychotherapy, the distinction between the placebo and other elements of the therapeutic process has not been clear. This paper analyzes the therapeutic relationship in terms of separating the placebo elements and the specific factors. The so-called nonspecific elements, often equated with the placebo, are proposed as the specific factors. It is contended that those variables focused upon by those studying the social psychological factors are actually part of the placebo.

Critelli, Joseph W.; Neumann, Karl F. (1984). The placebo: Conceptual analysis of a construct in transition. American Psychologist, 39, 32-39.

The placebo in psychotherapy has unfortunately retained the negative connotation of an inert “nuisance variable,” a label that it originally incurred in the field of medicine. In addition, the transition toward more cognitive models of psychotherapy, particularly Bandura’s theory of self-efficacy, has led to problems in defining the placebo within psychology. This transition has resulted in an awkward interface between certain preferred cognitive metaphors and the negative connotations of a presumably cognitive placebo construct. As a result, suggestions have recently been made to dismiss the placebo construct from psychology and to do away with the use of true placebo controls in outcome research. The present analysis maintains that (a) the placebo can be adequately defined within psychology, (b) the negative connotation of the placebo label is largely undeserved, (c) the placebo retains a continuing conceptual and empirical utility for evaluating psychotherapy, and (d) the therapeutic efficacy of current therapies is well established even though they have not generally been shown to be more effective than nonspecific treatment.

Handelsman, Mitchell M. (1984). Self-hypnosis as a facilitator of self-efficacy: A case example. Psychotherapy, 21 (4), 550-553.

This article presents the four-session treatment of Elaine, using self- hypnosis to facilitate the mourning process. It is argued that self-hypnosis– rather than enhancing imagery– increases self-efficacy, a person’s feeling that he/she can perform behaviors that lead to desired outcomes. Elaine’s sense of self-efficacy was increased by allowing her to choose scenes from her life to be explored in the context of the use of imagery. Elaine imagined events surrounding her father’s death, and “rewrote history” in an attempt to permit herself the direct expression of emotions.

Lewith, G. T.; Kenyon, J. N. (1984). Physiological and psychological explanations for the mechanism of acupuncture as a treatment for chronic pain. Social Science & Medicine, 1367-1378.

Many suggestions have been made about the possible mechanism of acupuncture as an analgesic therapy. This review provides a comprehensive account of the neurological, neurohumoral and psychologically-based hypotheses put forward. Although the exact mechanism of this treatment remains unclear, it is apparent that reproducible neurological and chemical changes occur in response to acupuncture, and that these changes almost certainly modify the response to, and perception of, pain. The mechanism of chronic pain is incompletely understood, but within this framework we understand acupuncture as completely as most other types of analgesic treatment.

Morrow, Gary R. (1984). Appropriateness of taped versus live relaxation in the systematic desensitization of anticipatory nausea and vomiting in cancer patients. Journal of Consulting and Clinical Psychology, 52 (6), 1098-1099.

Investigated the suggestion that the relaxation part of systematic desensitization–an effective treatment for the nausea and vomiting experienced by approximately 25% of cancer patients in anticipation of chemotherapeutic treatments– could be learned from a prerecorded audiotape prior to meeting a psychologist for treatment. 10 cancer patients who had developed anticipatory nausea or vomiting were assigned to either a live-relaxation or a tape-relaxation group. Results show that 4 of 5 Ss assigned to the tape-relaxation group experienced nausea while listening to the prerecorded audiotape, while none of the patients in the live-relaxation group reported nausea when subsequently listening to an audiotape made during the live presentation of relaxation.

Boutin, Gerald E.; Tosi, Donald J. (1983). Modification of irrational ideas and test anxiety through rational stage directed hypnotherapy (RSDH). Journal of Clinical Psychology, 39 (3), 382-391.

Examined the effects of four treatment conditions on the modification of Irrational Ideas and test anxiety in female nursing students. The treatments were Rational Stage Directed Hypnotherapy, a cognitive behavioral approach that utilized hypnosis, and vivid emotive imagery, a hypnosis-only treatment, a placebo condition, and a no-treatment control. The 48 Ss were assigned randomly to one of these treatment groups, which met for 1 hour per week for 6 consecutive weeks with in-vivo homework assignments also utilized. Statistically, significant treatment effects on cognitive, affective, behavioral, and physiological measures were noted for both the RSDH and hypnosis group at the posttest and at a 2-month follow-up. Post-hoc analyses revealed the RSDH treatment group to be significantly more effective than the hypnosis only group on both the post- and follow-up tests. The placebo and control groups showed no significant effects either at posttreatment or at follow-up.

Classen, Wilhelm; Feingold, Ernest; Netter, Petra (1983). Influence of sensory suggestibility on treatment outcome in headache patients. Neuropsychobiology, 10, 44-47.

In 45 headache patients the relationship between sensory suggestibility and three measures of treatment effect-ratings on (1) intensity of headaches; (2) efficacy of drugs, and (3) physician’s competence – was investigated in a double-blind long-term crossover study. Subjects scoring high on sensory suggestibility clearly showed more relief of headaches upon the analgesic as well as upon the placebo. The physician’s competence was rated higher by high-suggestible patients, whereas ratings on drug efficacy were low in all patients. The seemingly controversial behavior of high-suggestible patients was interpreted as a call for continuation of the physician’s efforts in spite of the relief the patients already achieved.

O’Connell, Sean (1983). The placebo effect and psychotherapy. Psychotherapy: Theory, Research and Practice, 20 (3), 337-345.

The power of psychotherapy to cure can be comprehended through an investigation into the efficacy of placebo in medical history. The evolution of “placebo” leads to a conceptualization of psychotherapy as a form of placebo. Explanations for the presence of the placebo effect, as well as guidelines for its elicitation, are outlined.
“Faith in the gods or in the saints cures one, faith in little pills another, faith in a plain common doctor a third, hypnotic suggestion a fourth. … Faith in us, faith in our drugs and methods, is the great stock in trade of the profession (paracelsus, 1570)” (p. 337).

Ross, Sherman; Buckalew, L. W. (1983). The placebo as an agent in behavioral manipulation: A review of problems, issues, and affected measures. Clinical Psychology Review, 3, 457-471.

Need for greater recognition and appreciation of placebo effects was stated, and problems hindering their clear conceptualization are noted. Previous reviews of the history and use of placebos are acknowledged. This review provides a summary of research primarily within the last 20 years, and in particular considers studies reflecting on placebos as agents of psychomotor, physiological, cognitive, affective, and clinical manipulations. General conclusions of manipulative efficacy are provided, and issues and problems related to clarification of placebo phenomena are identified. Psychological and medical evidence reflects increasing attention to the placebo and of effects on a wide range of behavioral functions. While important ethical and methodological questions remain, recent evidence of a physiologic basis for placebo action suggests exciting new insights into placebo phenomena

Frankel, Fred H. (1982). Hypnosis and hypnotizability scales: A reply. International Journal of Clinical and Experimental Hypnosis, 30, 377-392.

The use of the hypnotizability scales in the experimental setting is briefly reviewed, as is the need to separate the effect of hypnosis from the influence of factors such as relaxation and placebo which accompany the use of hypnosis clinically. The clinical relevance of the scales, most of whichwere developed primarily for experimental work, is affirmed by several
studies conducted in the clinical context, in which the scales were used. Levels of hypnotizability have correlated well with patterns of clinical behavior. Although the scales are useful in many instances in helping to plan treatment strategy, their value in investigative studies is emphasized. Sacerdote’s (1982) criticisms of the scales are considered. While it is true that the scales are blind to some of the qualitative aspects of the hypnotic experience, the great majority of clinically hypnotizable patients are able to respond to the items on the scales. Sacerdote’s reluctance to learn about the value of the scales is evident in his preference for conjecture when he could readily have gathered irrefutable data through the administration of the scales, without the least risk to the treatment of his patients, once the course of treatment was underway or complete.

Stoyva, J. M.; Anderson, C. (1982). A coping-rest model of relaxation and stress management. In Goldberger, L.; Breznitz, S. (Ed.), Handbook of stress: Theoretical and clinical aspects (pp. 745-763). New York: The Free Press.

“Patients with psychosomatic or stress linked disorders are likely to show signs of high physiological arousal, and they are likely, under stress, to react strongly in the symptomatic system and to show evidence of being deficient in the ability to shift from the coping to the rest mode (e.g., slowness of habituation to, and recovery from, stressful stimulation). A corollary inference is that such patients … show activity in the symptomatic system for a higher percentage of the time that [sic] do normal subjects. We suggest that this defect in the capacity to shift to a rest condition is the principal reason that various relaxation procedures have so often proved successful in the alleviation of stress related symptoms” (p. 748).
The authors refer to a number of different stress management procedures. Among those associated with primary focus on the rest phase they include: Relaxation training (progressive relaxation, autogenic training, EMG feedback, meditation [Zen, TM]), Specific biofeedback (hand temperature, electrodermal response [EDR], EMG from particular muscle group), and Systematic desensitization. Among those associated with primary focus on coping phase are: Assertiveness training, Social skills retraining and motor skills retraining, Self-statements, Imagery (Guided waking imagery, autogenic abreaction, covert reinforcement and covert sensitization, behavior rehearsal). These various procedures may reflect three dimensions or aspects of the stress response, with some addressing physiology and others addressing cognition or behavior change.
“Rachman (1978) … found it useful to divide the phenomenon of fear into physiological, cognitive, and behavioral components. Similarly, Davidson and Schwartz (1976) conceptualized relaxation as consisting of somatic, cognitive, and attentional components. Phillips (1977) argued that pain, such as headache pain, can be viewed as consisting of cognitive, behavioral, and physiological aspects (and that, consequently, we should not expect high correlations between headache pain and a particular physiological measure such as forehead EMG level). …
“… In discussing contemporary studies of dreaming, they [Stoyva and Kamiya (1968)] proposed that there is no single, totally valid indicator of dreaming as a mental experience. Instead, there are several imperfect indicators of the dream experience–verbal report, rapid eye movements, and certain electroencephalographic (EEG) stages. … Discrepancies among the indicators can serve to generate hypotheses” (p. 749).

The authors discuss different ways of retraining the capacity to rest: relaxation training (including biofeedback, etc.), systematic desensitization; and of reshaping the coping response: assertiveness training, social skills and motor skills retraining, self- statements, imagery techniques; and discuss controllability. These notes cover only a very small part of their extensive review, the material most relevant to hypnosis and suggestion.
“Although imagery techniques are often employed by stress management therapists, one approaches this area with ambivalence. In part, this uneasiness springs from the unsettling awareness that imagery techniques have been embraced by a freewheeling assortment of lay psychologists such as Emil Coue, Dale Carnegie, and Norman Vincent Peale, not to mention a diverse throng of contemporary ‘mind controllers’ and self-styled healers. A more serious source of uneasiness is ignorance of the specific processes at work. What are the mechanisms by which imagery affects the stress response?” (p. 756).
“There is intriguing recent evidence that simply the illusion of control may exert beneficial effects. Stern, Miller, Ewy, and Grant (1980) noted that subjects who were led to believe by means of bogus information feedback that they were successfully lowering their heart rates showed a reduction in stress type symptoms, especially those of a cardiovascular nature. It seems possible that the feeling of control may be an important part of what we have called ‘placebo responding.’ Stoyva (1979b) suggested that this phenomenon is probably not a unitary entity but, rather, a cluster of processes, of which the feeling of developing control over factors affecting one’s disorder is an important and potentially manipulable component of therapeutic interventions” (p. 758).

Franck, Jerome (1981, August). Therapeutic components shared by all psychotherapies. [Paper] Presented at the annual meeting of the American Psychological Association.

The author summarizes as follows. 1. Patients who receive any form of psychotherapy do better than controls. 2. Followup studies show most patients who show improvement maintain it; the closing of gap between patients who improve and those who don’t is due to those who do less well catching up. Perhaps the main effect is to accelerate improvement which would eventually happen anyway. 3. Determinants of successful treatment are personal qualities of Patient and Therapist. 4. There are a few conditions which have more specific treatment indications. –Behavior therapy – for phobias, obsessive compulsive disorders, sexuality problems –Cognitive therapy – for depression Further advantages of specific treatments for specific conditions may be found.
All patients seek treatment not just for symptoms but because of demoralization. The common elements are: Subjective incompetence, loss of self esteem, alienation, hopelessness, helplessness, a feeling others could help but won’t, feeling of loss of control. Demoralization plus distress leads to seeking treatment.
A small percentage without demoralization seek treatment for specific symptoms (e.g., patients with a simple phobia of height). Anxiety and depression (or loss of self esteem) are most frequent symptoms in Outpatient Departments.
Success in treatment often is due to restoration of morale (which removing symptoms can do very well). 1. Citing Doehrenwald research. 2. People seek treatment only 1-2 years after symptoms appear, after trying other ways of dealing with them. 3. Many patients improve rapidly in treatment (Garfield found the Mean = 5 or 6 sessions.) Mean symptom relief is same after 4 sessions and drop-out than after 6 months; also those on waiting list in phone contact improve as much.
Shared components in the various therapies combat demoralization: 1. Emotionally charged and vital relationship with the helping person (or group). 2. Healing setting (which increases Therapist’s prestige and promotes healing). (a) Therapeutic rituals (which lead to an external reason for abandoning the symptom; the more spectacular the reason, the greater the motivation). (b) Therapeutic bond.
Expectation of help is the best predictor of outcome. (Cites his own placebo study.) One problem found was that responsiveness to placebo didn’t correlate with response to psychotherapy. (Cites Lieberman’s study). Patients receiving psychotherapy role-induction interview improved more. 3. Provision of learning experiences – movement of values toward those of the therapist 4. Emotional arousal. Supplies motivation for change. Cites his experiments on emotional arousal and attitude change, manipulating arousal using ether drip or adrenalin (leads to temporary attitude change). Something else besides arousal may be needed to sustain change. 5. Enhances sense of mastery, control of one’s self and internal states. (a) provides conceptual scheme (b) gives experience of success 6. Provision of opportunities (and incentives) to practice

treatment (Garfield found the Mean = 5 or 6 sessions.) Mean symptom relief is same after 4 sessions and drop-out than after 6 months; also those on waiting list in phone contact improve as much.
Shared components in the various therapies combat demoralization: 1. Emotionally charged and vital relationship with the helping person (or group). 2. Healing setting (which increases Therapist’s prestige and promotes healing). (a) Therapeutic rituals (which lead to an external reason for abandoning the symptom; the more spectacular the reason, the greater the motivation). (b) Therapeutic bond.
Expectation of help is the best predictor of outcome. (Cites his own placebo study.) One problem found was that responsiveness to placebo didn’t correlate with response to psychotherapy. (Cites Lieberman’s study). Patients receiving psychotherapy role-induction interview improved more. 3. Provision of learning experiences – movement of values toward those of the therapist 4. Emotional arousal. Supplies motivation for change. Cites his experiments on emotional arousal and attitude change, manipulating arousal using ether drip or adrenalin (leads to temporary attitude change). Something else besides arousal may be needed to sustain change. 5. Enhances sense of mastery, control of one’s self and internal states. (a) provides conceptual scheme (b) gives experience of success 6. Provision of opportunities (and incentives) to practice
Properties of Patient which assure success: 1. Distress 2. Earlier relationship with parent which leads to capacity to relate. (Molly Harrower’s predictors) 3. To profit from specific procedures: capacity for insight for psychoanalysis.
Properties of Therapist which contribute to success:
We haven’t gotten farther than Rogers’ empathy, warmth, and positive regard; Whitehorn & Betz’s Type A and B; and [missed reference name] activity level. He thinks success may be related to Therapist’s parapsychological ability, healing power.
Physiology of hope: Placebos for dental pain lead to pain relief for some. Endorphin antagonist made pain re-occur for them

Carr-Kaffashan, Lucille; Woolfolk, Robert L. (1979). Active and placebo effects in treatment of moderate and severe insomnia. Journal of Consulting and Clinical Psychology, 47 (6), 1072-1080.

This study examines the efficacy of relaxation training and a highly credible placebo in the treatment of both severe and moderate sleep onset insomnia. The placebo treatment was designed to elicit an expectation for improvement comparable with that of relaxation training. Expectancy of improvement was further controlled by informing subjects to expect improvement only after the third week of therapy, thus allowing comparisons of the treatments to be made during the counterdemand period (first 3 weeks) and the positive demand period (fourth week and beyond). Responses of severe and moderate insomniacs were similar across treatment conditions, over weeks, and in response to the counterdemand/positive demand manipulation. Only subjects trained in relaxation techniques improved significantly during the counterdemand period. The active treatment was significantly more effective than the placebo in reducing sleep onset latency during the counterdemand period. After the introduction of positive expectancy of therapy outcome, relaxation was no longer superior to placebo. Findings are discussed in terms of the methodological difficulties inherent in controlling for subject expectancy of therapeutic effects in treatment studies of insomnia.

Snow, Lorraine L. (1979). The relationship between ‘rapid induction’ and placebo analgesia, hypnotic susceptibility, and chronic pain intensity (Dissertation, University of Rhode Island). Dissertation Abstracts International, 40 (n2-B), 937.

Found that the RIA [Rapid Induction Analgesia] was no more effective than oral placebo analgesia in relieving the pain of 30 paraplegics suffering from chronic pain syndrome. Although Snow found that the RIA was unrelated to hypnotizability when the effect of chronic pain experience was controlled, Crowley (1980) did find that hypnotizability was related to multiple chronic pain indices.

Karlin, Robert; Mann, David; Carracher, John (1978, September). Placebo considerations in clinical hypnosis. [Paper] Presented at the annual meeting of the American Psychological Association, Toronto, Canada. (Reprinted in part in American Psychological Association Division of Psychological Hypnosis Newsletter, April, 1979)

While the last 20 years have seen great progress in understanding factors underlying hypnotic phenomena in the laboratory, underlying process in clinical settings is much less clear. It is suggested that hypnosis, like most other psychotherapeutic techniques, derives most of its efficacy from its value as a placebo. Its assumed efficacy legitimizes high levels of therapist demand for change and increases the patient’s efficacy expectations and perceived control. Conceptual distinctions are made between syndromes that should respond well to hypnotic treatment and those that should not. A rationale for the differing views of clinical and experimental workers in hypnosis is suggested. Finally, the central importance of the patient-therapist relationship is noted.

Parwatikar, Sadashiv D.; Brown, Marjorie S.; Stern, John A.; Ulett, George A.; Sletten, Ivan S. (1978). Acupuncture, hypnosis and experimental pain – I. Study with volunteers. Acupuncture and Electro-Therapeutic Research: International Journal, 3, 161-190.

An experiment was designed to evaluate the protective effects of different agents – acupuncture, hypnosis, Morphine, aspirin, Diazepam and placebo – upon experimentally-induced pain in humans. Twenty normal, healthy volunteers were subjected to cold water and tourniquet- induced pain and the protective effects of 35 minutes of hypnotic suggestion, electro- stimulation of both acupuncture points and non-acupuncture points, 10 mg/kg of Morphine, 5 grains of aspirin, 10 mg of Diazepam and a mild sugar placebo were evaluated. Data was collected on subjective evaluation of pain, EKG, EEG, respiration, skin temperature, peripheral vascular activity and EMG. A special study was also done to evaluate the effects of all the above agents on the somatosensory evoked potentials and EEG. The data were further analyzed on the basis of hypnotic susceptibility of the volunteers. The results indicated: 1) Hypnosis, acupuncture at specific sites with electrical stimulation and Morphine Sulphate had about the same reduction in experimental pain. 2) Hypnosis produced different effects from those resulting from acupuncture stimulation on EEG. 3) Acupuncture stimulation in specific loci resulted in a latency increase in the early secondary response on somatosensory evoked potential. 4) Cold water pain was remarkably reduced after true acupuncture point stimulation. 5) Tourniquet (ischemic) pain was reduced by both hypnosis and true acupuncture site stimulation. 6) Skin temperature was significantly reduced on the side of acupuncture points (true) stimulation.

-nificantly reduced on the side of acupuncture points (true) stimulation.

Slutsky, Jeffrey; Allen, George J. (1978). Influence of contextual cues on the efficacy of desensitization and a credible placebo in alleviating public speaking anxiety. Journal of Consulting and Clinical Psychology, 46 (1), 119-125.

This investigation was designed to determine the extent to which contextual cues mediated the effectiveness of systematic desensitization and a plausible placebo in alleviating public speaking anxiety. After participating in a public speaking situation that allowed the collection of self-report, physiological, and behavioral manifestations of anxiety, 67 subjects were randomly assigned to receive five sessions of either desensitization, “T scope” therapy, or no treatment. Each of these conditions was conducted in a context that either stressed the clinical relevance of the procedure or presented the procedure as a laboratory investigation of fear without therapeutic implications. Analysis of changes both between groups and within individuals indicated that desensitization reduced public speaking anxiety in both contexts, whereas the placebo was effective only in the therapeutic setting. The superiority of desensitization was most pronounced on the physiological variables. The results are interpreted as indicating support for a counterconditioning, rather than an expectancy, interpretation of desensitization.

Berk, Stephen N.; Moore, Mary E.; Resnick, Jerome H. (1977). Psychosocial factors as mediators of acupuncture therapy. Journal of Consulting and Clinical Psychology, 45 (4), 612-619.

This study investigated a number of psychosocial variables that have been suggested as possible mediating factors in acupuncture therapy. Forty-two volunteers with bursitis and/or tendonitis of the shoulder served as subjects. All were randomly assigned to one of four treatment groups: acupuncture – positive milieu, acupuncture – negative milieu, placebo acupuncture – positive milieu, and placebo acupuncture – negative milieu. Pretreatment and posttreatment subjective pain reports and shoulder motion studies, as well as pretreatment assessments of hypnotic susceptibility and suggestibility, were determined for each subject. Results indicated that (a) acupuncture and placebo acupuncture were equally effective in producing highly significant (p <.001) reductions in subjective pain reports; (b) neither treatment effectively improved objective shoulder motion; (c) subjects treated in the positive milieu reported more improvement than those in the negative milieu (p <.053); and (d) hypnotic susceptibility, suggestibility, belief in the treatment, and the satisfaction of expectations showed no relationship to treatment outcome. It is concluded that acupuncture therapy provides a powerful placebo. Treatment milieu variables warrant future study in the attempt to understand the acupuncture phenomena. Lick, John R.; Heffler, David (1977). Relaxation training and attention placebo in the treatment of severe insomnia. Journal of Consulting and Clinical Psychology, 45 (2), 153-161. This study compared the effectiveness of progressive relaxation training with and without a supplementary relaxation recording, which the subjects played at home, and an attention placebo manipulation in the modification of severe insomnia in adult volunteers. The results indicated that the relaxation training procedures were significantly more effective than placebo and no-treatment controls in modifying several parameters of sleeping behavior, in reducing consumption of sleep-inducing medication, and in influencing a self-report anxiety measure. The supplementary relaxation tape did not increase the effectiveness of relaxation training conducted in the clinic, and there was no difference in the efficacy of the placebo and no-treatment conditions. Physiological data gathered during the last treatment session indicated few significant correlations between reductions in arousal associated with relaxation training and treatment outcome. MacMillan, M. B. (1977). The cathartic method and the expectancies of Breuer and Anna O.. International Journal of Clinical and Experimental Hypnosis, 25, 106-118. Expectancies about the consequences of the suppression of behavior and about the effects of expressing emotions are proposed as sources of the "talking cure" which developed during Breuer's treatment of Anna O. and which later became known as the cathartic method. Although the argument is similar to one proposed by Ellenberger (1970, 1972) it sets out a more rational alternative to his explanation that the method was partly a creation of the mytho-poetic unconscious. The analysis of the interaction between Breuer and Anna O. makes explicit the expectancies underlying each of the steps through which the cathartic method developed and traces these expectancies to the general beliefs and the specific theoretical interests shared by them. Orne, Martin T. (1977). The construct of hypnosis: Implications of the definition for research and practice. In Edmonston, William E., Jr. (Ed.), Conceptual and investigative approaches to hypnosis and hypnotic phenomena (296, pp. 14-33). New York: New York Academy of Sciences. NOTES These notes are concerned with only a small part of the article. The author discusses various ways of defining hypnosis, and then states, "In its simplest form one would define hypnosis as that state or condition which exists when appropriate suggestions will elicit hypnotic phenomena. Hypnotic phenomena are then defined as positive responses to test suggestions which on analysis all turn out to involve suggested alterations of perception or memory. The construct of hypnosis as a subjective state in which alterations of perception or memory can be elicited by suggestion is operationalized in standardized scales of hypnotic susceptibility..."(pp. 18-19). "Though it is necessary to specify responses in behavioral terms, it should be emphasized that the resulting scores validly reflect the hypnotic process only to the degree that the behavior reflects alterations in the individual's subjective experience" (p. 19). "We would, however, be loath to conclude that hypnosis would not result in increased performance on some of the many dependent variables that have not yet been rigorously studied. For example, I find it difficult to believe that simulating subjects would calmly tolerate major surgery without benefit of anesthesia, although we have long since learned to be cautious about even such improbable possibilities" (p. 25). "Perhaps the best clinical evidence for the subjective reality of hypnotic effects derives from the treatment of chronic pain and the use of hypnosis as an anesthetic. Though environmental contingencies certainly affect the expression of pain, the repeated choice of hypnosis as an analgesic when alternatives are readily available is difficult to explain without assuming that the anesthesia suggestions effectively alter the individual's experience" (p. 26). [[The author also describes the transparent hallucination phenomena, source amnesia, and the disappearing hypnotist phenomena.] Stern, John A.; Brown, M.; Ulett, George A.; Sletten, Ivan (1977). A comparison of hypnosis, acupuncture, morphine, Valium, aspirin, and placebo in the management of experimentally induced pain. Annals of the New York Academy of Sciences, 296, 175-193. NOTES 1 "What general conclusions can we come to on the basis of these investigations? We conclude that hypnosis and suggestions of analgesia, morphine, and acupuncture stimulation (of LI 4, 14, and 15 on the arm exposed to painful stimulation) are effective in reducing experimentally induced pain. This is true for both a cold pressor pain-induction procedure and an ischemic pain-induction procedure. Hypnotic suggestibility does not account for the effectiveness of acupuncture stimulation, though good hypnotic Ss show better protection against pain with hypnotic suggestion and morphine. "Good hypnotic Ss experience more pain than is true for Poor hypnotic Ss when exposed to the same pain-induction procedure. The effect is more marked for the cold-pressor than the ischemic pain procedure. Good hypnotic Ss are more responsive -- i.e., show grater reduction in pain perception -- to drugs and intervention procedures that produce significant subjective sensations (morphine and diazepam) than is true of Poor hypnotic Ss. This is not true for aspirin and p0lacebo. Last, but not least, Ss low in hypnotic susceptibility tend to perceive painful stimuli as more painful when under the influence of diazepam as compared to the nondrug condition" (p. 192). Wickramasekera, Ian (1977). The placebo effect and medical instruments in biofeedback. Journal of Clinical Engineering, 2 (3), 227-230. This article defines a "placebo effect" and identifies some of its parameters in pain control and in other areas of medicine. It proposes a new model of the placebo effect and advances the hypothesis that biomedical instruments used in biofeedback studies, like drugs, can acquire and generate placebo effects. Such placebo effects can complicate the interpretation of specific experimental treatments in human clinical research in which biomedical instruments are used. 1976 Hemme, Robert; Boor, Myron (1976). Role of expectancy set in the systematic desensitization of speech anxiety: An extension of prior research. Journal of Clinical Psychology, 32 (2), 398-404.