SUMMARY. The influence of expectancy set with regard to therapy outcome on the effectiveness of systematic desensitization (SD) for reducing public speaking anxiety was investigated. The 7 Ss given a high expectancy set for favorable therapy outcome were informed about psychological research that indicates that SD is effective to reduce public
The 7 Ss given a high expectancy set for favorable therapy outcome were informed about psychological research that indicates that SD is effective to reduce public speaking fears. SD was administered with the standard instructions to the 11 Ss given a neutral expectancy set. This expectancy manipulation did not require deception and perhaps could be used with actual SD therapy clients. As in previous research by Woy and Efran, the expectancy set manipulation significantly modified Ss’ self-report of subjective perceptions of anxiety from pretratment to posttreatment speeches, but did not affect overt behavioral or physiological indices of anxiety. Since subjective perceptions of anxiety responses are psychologically significant behaviors, these data suggest the importance of conveying a high expectation of improvement to SD and perhaps also to other types of therapy clients. SD sessions administered to small groups of clients on consecutive days, as in this study, appeared to be as effective to reduce speech anxiety as SD sessions administered to each client individually at 1-week intervals, as in the Woy and Efran study” (pp. 403-404).
Moore, Mary E.; Berk, Stephen N. (1976). Acupuncture for chronic shoulder pain: An experimental study with attention to the role of placebo and hypnotic susceptibility. Annals of Internal Medicine, 84 (4), 381-384.
One half of 42 Ss treated for painful shoulders received classic acupuncture, and one half received a placebo in which the needles did not penetrate the skin. Half of each of these groups was treated in a positive setting to encourage the subject, and half in a negative setting designed to keep encouragement at a minimum. All patients were independently rated for susceptibility to hypnosis. Although range of motion did not improve, the majority of patients reported significant improvement in shoulder discomfort to a blind evaluator after treatment; placebo and acupuncture groups did not differ in this respect, however. The positive and negative settings did not affect treatment outcome. In all groups, those who were not rated as highly susceptible to hypnosis tended to fail to achieve the highest levels of relief, but such differences were not statistically significant.
NOTES
There were 42 subjects, and they were tested with the Spiegel Hypnotic Induction Profile. “Both acupuncture and placebo proved to be effective in relieving shoulder discomfort. 69% of the total group made lower assessments of discomfort on the post-treatment rating than on the pretreatment rating” (p. 382).
“Acupuncture was not more effective than placebo in relieving discomfort, however. The average percentage of improvement among those who had acupuncture was not, statistically, significantly different from those who had placebo. Indeed, what little difference there was actually was in the opposite direction, the placebo group improving on the average somewhat more than the acupuncture group” (pp. 382-383).
“In the negative setting, however, where the subject was required to suffer in silence, acupuncture seemed to be less effective than the placebo in relieving discomfort” (p. 383).
“Although the subjects perceived that the treatment relieved their shoulder discomfort, there was no objective evidence of improvement in the shoulder as measured by change in the range of motion scores before and after treatment” (p. 383).
(The placebo was needle pricked against the skin at true site, then rapidly and lightly tapped against the surface of the skin without penetration.)
“Those who were not susceptible to hypnosis failed to experience as much relief from discomfort as those who were” (p. 383).
“The fact that acupuncture was not more successful in relieving shoulder discomfort than a sham procedure suggests that its much publicized success may be merely a powerful placebo effect” (p. 383).
Katz, Kao, Spiegel et al (1974) also found that low hypnotizables did not benefit much in terms of pain relief with acupuncture.
“Those who were not susceptible to hypnosis failed to experience as much relief from discomfort as those who were” (p. 383).
“The fact that acupuncture was not more successful in relieving shoulder discomfort than a sham procedure suggests that its much publicized success may be merely a powerful placebo effect” (p. 383).
Katz, Kao, Spiegel et al (1974) also found that low hypnotizables did not benefit much in terms of pain relief with acupuncture.
1975
Ahlberg, D.; Lansdell, H.; Gravitz, M. A.; Chen, T. C.; Ting, C. Y.; Bak, A. F.; Blessing, D. (1975). Acupuncture and hypnosis: Effects on induced pain. Experimental Neurology, 49, 272-280.
The reactions of 14 volunteers to electrical stimulation near the supra- orbital nerve were studied under acupuncture, placebo-acupuncture, and hypnosis. As the intensity of stimulation increased, a minimum sensation, a minimum pain, and then a maximum or intolerable pain sensation were produced. Under hypnosis the average intensity of the stimulus for producing these sensations was higher than before the trance induction. Under acupuncture and placebo-acupuncture no clear increase in current intensity was observed. Acupuncture, as well as hypnosis, did not consistently change the blood, blood pressure, pulse rate, EKG, respiratory rate, or EEG.
Aletky, Patricia J.; Carlin, Albert S. (1975). Sex differences and placebo effects: Motivation as an intervening variable. Journal of Consulting and Clinical Psychology, 43 (2), 278.
NOTES
” … the present findings would suggest that future studies of placebo effects should take into account the nature of the dependent variable and the pertinent differential sex-role expectations” (p. 278). The performance measure was a dynamometer pull task. The placebo was a jelly applied to the forearm “and alleged to relieve muscular fatigue” (p. 278). The motivational instructions were telling Subjects that “individuals in good health and with normal muscle tonus would be expected to show improved performance on the posttreatment trial” (p. 278).
Andrews, Reagan H., Jr. (1975). Placebo effects in EMG biofeedback (Dissertation). Dissertation Abstracts International, 36, 1424.
“Differential instructions were employed in a negative placebo model to alter expectancies of success in achieving criterion frontalis EMG voltage levels in 30 female subjects. The negative placebo model dictated that all subjects receive true feedback during both of two 10-minute experimental trials. On one of the two trials they were informed that feedback would be accurate, and on the other trial, that feedback would be accurate only 50% of the trial period. Data was collected for 20 subjects in a 2 X 2 Latin Square design, while 10 subjects were designated control subjects and received high-success expectancy instructions on both experimental trials.
Pre-trial measures included administration of a standard hypnotic susceptibility scale and a pre-test subjective questionnaire. Dependent variable was the time from onset of feedback to 70% reduction of resting EMG levels of the frontalis. Significant differences were found between high and low-expectancy trials for experimental subjects. Effects were strongest on the first experimental trial and tended to diminish on the following trial. Correlation of hypnotic susceptibility scores with response latencies was not significant, but subjects’ impression of their degree of relaxation during susceptibility scale administration was significantly correlated with criterion latencies. Importance of subject expectancies, instrumentation standards and implications for future studies in the biofeedback area were discussed” (p. 1424).
Berk, S. N. (1975). The mediating effects of hypnosis, suggestibility and placebo in acupuncture therapy (Dissertation). Dissertation Abstracts International, 36, 3020-3021.
“Results strongly support the contention that variables other than physiological mechanisms are involved in acupuncture therapy. It appears as if patient motivation, models, expectations of relief and the quality of the doctor-patient relationship can influence the outcomes of this ancient therapy. However, additional research is needed to confirm these findings. At present, the data seem to suggest that acupuncture therapy may be largely a placebo phenomenon” (p. 3021).
Borkovec, Thomas D.; Kaloupek, D. G.; Slama, Katherine M. (1975). The facilitative effect of muscle tension-release in the relaxation treatment of sleep disturbance. Behavior Therapy, 6, 301-309.
Sleep disturbed subjects were randomly assigned to one of four group therapy conditions: progressive relaxation with muscle tension-release, relaxation without tension-release, placebo, and no treatment. Subjects were instructed not to expect improvement until after the final (fourth) therapy session. Progressive relaxation produced significantly greater improvement in reported latency to sleep onset than the three control conditions prior to the final session and was the only group to display greater improvement than no treatment after the final session. Five month follow-up revealed further gains for the progressive relaxation group. Issues of active mechanisms, demand, and placebo are briefly discussed
Lick, John R. (1975). Expectancy, false galvanic skin response feedback, and systematic desensitization in the modification of phobic behavior. Journal of Consulting and Clinical Psychology, 43 (4), 557-567.
This study compared systematic desensitization and two pseudotherapy manipulations with and without false galvanic skin response feedback after every session suggesting improvement in the modification of intense snake and spider fear. The results indicated no consistent differences between the three treatment groups, although all treatments were significantly more effective than no treatment in modifying physiological, behavioral, and self-report measures of fear. A 4-month follow-up showed stability in fear reduction on self-report measures for the three treatment groups. Overall, the results of this experiment were interpreted as contradicting a traditional conditioning explanation of systematic desensitization. An alternate explanation for the operation of systematic desensitization emphasizing the motivational as opposed to conditioning aspects of the procedure is discussed.
Melzack, Ronald; Perry, Campbell (1975). Self-regulation of pain: The use of alpha-feedback and hypnotic training for the control of chronic pain. Experimental Neurology, 46, 452-469.
Patients suffering chronic pain of pathological origin received alpha- feedback training methods in association with prior hypnotic training. Changes in the intensity and quality of pain were measured with the McGill Pain Questionnaire. The combined procedures produced a substantial decrease in pain (by 33% or greater) in 58% of the patients during the training sessions. Both the sensory and affective dimensions of the pain were diminished. The EEG records indicated that the majority of patients learned to increase their alpha output during the training sessions. In contrast, patients who received the alpha training alone reported no decreases in pain even though they showed increases in alpha output. Patients who received hypnotic training alone also produced increased EEG alpha during the training sessions and showed substantial (though not statistically significant) decreases in pain. The results demonstrate that chronic, pathological pain can be reduced in a significant number of patients by means of a combination of alpha-feedback training, hypnotic training, and placebo effects. It is concluded, however, that the contribution of the alpha training procedure to pain relief is not due to increased EEG alpha as such but, rather, to the distraction of attention, suggestion, relaxation, and sense of control over pain which are an integral part of the procedure.
NOTES
The study employed 24 patients with variety of pains, divided into 3 groups randomly:
hypnosis
alpha/biofeedback
combined procedures – the only group which decreased group mean of pain
significantly.
Hypnosis – 50% of patients showed decrease in pain Combined Treatment – 50% ” ” ” ” ” ” Alpha/biofeedback – None ” ” ” ” ” ”
All patients demonstrated higher alpha levels; the authors inferred it was due to relaxation, distraction, a sense of control over pain, or direct suggestion itself.
Russell, Elbert W. (1974). The power of behavior control: A critique of behavior modification methods. Journal of Clinical Psychology, 30 (2), 111-136.
NOTES 1:
In summarizing the effectiveness of behavior therapy the author states, “At this point there does not appear to be sufficient evidence to demonstrate that all of the effectiveness of various types of behavior therapy is produced by non-specific,
evidence to demonstrate that all of the effectiveness of various types of behavior therapy is produced by non-specific, especially placebo, effects. In fact, it is more probable that many of these techniques will be found to have elements that are not due to non-specific effects and, as such, they will be the treatment of choice for certain limited problems, such as aversive therapy for autistic children or training of the mentally retarded. Nevertheless, concerning the central issue in this monograph, it is increasingly apparent that a very large proportion of the ‘power’ of behavior methods is due to non-specific, suggestion or placebo effects.
“As such, this ‘power’ is neither behavioristic, new, nor particularly threatening. It is not new since it has been known to medicine for many decades. As Shapiro states, ‘the history of both physiologic and psychologic treatment is largely the history of the placebo effect; those who forget it are destined to repeat it’. In support of the age of this problem, Shapiro also quotes from the compiler of the remedies of the Paris Pharmacologia, a century ago, ‘What pledge can be afforded that the boasted remedies of the present-day will not, like their predecessors, fall into disrepute, and in their turn serve only as a humiliating memorial to the credulity and infatuation of the physicians who recommended and prescribed them'” (p. 120-121).
“The large amount of suggestion or placebo effect in behavior therapy does raise at least two vital problems. The first problem involves the ethics of using suggestion or a placebo. Is it ethical to give the patient a false or questionable explanation for the source of the effectiveness of behavior procedures? Such an explanation would be that they are based on proven scientific behavior principles when major people in the field do not believe this and evidence is mounting that the primary source of effect is suggestion. Secondly, what will be the effect on the attitude of the general public toward professional psychology when they realize that the effectiveness of psychological behavior therapy methods is primarily a matter of suggestion? Will they not consider it a modern patent medicine? The damage that could be done to the prestige of psychology might take decades to repair. JH
1973
McReynolds, William T.; Barnes, AllanR.; Brooks, Samuel; Rehagen, Nicholas (1973). The role of attention-placebo influences in the efficacy of systematic desensitization. Journal of Consulting and Clinical Psychology, 41 (1), 86-92.
Systematic desensitization was compared with two attention- placebo control treatments – one taken from Paul and one currently devised as an elaborate, highly impressive “therapeutic” experience – and no treatment. It was hypothesized that (a) fear reductions following desensitization would be no greater than those associated with an equally compelling placebo treatment and (b) fear and control measure changes following the previously used attention-placebo treatment would be less than those following desensitization and the present placebo control manipulations. Both hypotheses were supported, although support for the first was more consistent than for the second.
1969
McGlashan, T. H.; Evans, Frederick J.; Orne, Martin T. (1969). The nature of hypnotic analgesia and placebo response to experimental pain. Psychosomatic Medicine, 31, 227-246.
NOTES
They conceptualized low hypnotizables as providing a placebo condition (p. 230). This is essentially the London-Fuhrer design in experimental situations. It is necessary that the subject be convinced s/he is capable of responding to the hypnotic condition for it to be a good control condition.
1966
Pollack, S. (1966). Pain control by suggestion. Journal of Oral Medicine, 21, 89-95.
NOTES
Studied the effects of a topical anesthetic applied prior to injection of anesthesia. Ss were 500 dental patients. Half the group received a topical and the other half received a placebo. Each half was further subdivided so that one group received suggestion that the topical would be effective and the other group was not told anything More calm ratings were given to the suggestion group. Found that the hypnotist’s suggestion was the most important factor in obtaining or failing to obtain anesthesia.
1961
Glass, Louis B.; Barber, Theodore X. (1961). A note on hypnotic behavior, the definition of the situation and the placebo effect. Journal of Nervous and Mental Disease, 132, 539-541.
Subjects were tested for responses to hypnotizability tests under three conditions: after 20 minute induction, after being told they would not be hypnotized but would take tests of imagination (with motivating instructions to do well), after taking a placebo pill that “would make them deeply hypnotized.” Of 12 Ss who dropped in score between Session 1 and Session 2, 11 attained higher scores following placebo than during the control session; mean scores under placebo and control (5.8 and 3.7) differed significantly, p <.01. Scores were as high in the third as the first session (5.8 and 6.3 respectively). 1959 Conn, Jacob H. (1959). Cultural and clinical aspects of hypnosis, placebos, and suggestibility. International Journal of Clinical and Experimental Hypnosis, 7 (4), 175-185. NOTES The author traces the history of hypnosis, suggestion, and placebo, noting that popularity of hypnosis with professionals waxes and wanes over the years. When practitioners lose faith in a drug, it becomes less effective with their patients. The same holds true for hypnosis. Frequently illness is ameliorated or cured by suggestion without hypnosis. "Hypnosis is nothing more than the suggestive, placebo effect presented in a specific inter-personal setting. It is not just a state of mind, but the end result of various psychologic processes. (2) A patient may be more suggestible when fully awake. ... Another patient may be more suggestible when asleep. There are those who respond best to suggestions in the light stage of hypnosis, while about 10% of subjects are capable of developing the deeper, somnambulistic phase" (p. 181). Polygraph 1990 Wain, Harold J.; Amen, Daniel G.; Jabbari, Bahmann (1990). The effects of hypnosis on a Parkinsonian tremor: Case report with polygraph/EEG recordings. American Journal of Clinical Hypnosis, 33, 94-98. Although Parkinsonian tremors typically disappear during sleep and are reduced during relaxation periods, the effects of hypnosis on this type of movement disorder have been generally ignored. We observed a patient's severe Parkinsonian tremor under hypnosis and monitored it with EEG and EMG studies. The patient was taught self- hypnosis and performed it three to four times daily in conjunction with taking medication. The results suggest that daily sessions of self-hypnosis can be a useful therapeutic adjunct in the treatment of Parkinsonian tremors NOTES The patient scored low on the Hypnotic Induction Profile scale of hypnotizability and was unable to experience any classical hypnotic phenomena, but was motivated to learn self-hypnosis. For self hypnosis he visualized a relaxing scene 1989 Schuyler, Bradley A.; Coe, William C. (1989). More on volitional experiences and breaching posthypnotic amnesia. International Journal of Clinical and Experimental Hypnosis, 37, 320-331. Highly responsive hypnotic subjects, who were classified as having control over remembering (voluntaries) or not having control over remembering (involuntaries) during posthypnotic amnesia, were compared with each other on four physiological measures (heart rate, electrodermal response, respiration rate, muscle tension) during posthypnotic recall. Two contextual conditions were employed: One was meant to create pressure to breach posthypnotic amnesia (lie detector instructions); the other, a relax condition, served as a control. The recall data confirmed earlier findings of Howard and Coe and showed that voluntary subjects under the lie detector condition recalled more than the other three samples that did not differ from each other. However, using another measure of voluntariness showed that both voluntary and involuntary subjects breached under lie detector conditions. Electrodermal response supported the subjects' reports of control in this case. Physiological measures were otherwise insignificant. The results are discussed as they relate to (a) studies attempting to breach posthypnotic amnesia, (b) the voluntary/involuntary classification of subjects, and (c) theories of hypnosis. NOTES The authors suggest that subjects observe themselves not remembering (i.e. not reporting memories) and conclude that they therefore could not remember. Such subjects, they say, are deceiving themselves in so far as they could remember if they were to direct their attention to salient cues. 1985 Coe, William C.; Yashinski, Edward (1985). Volitional experiences associated with breaching posthypnotic amnesia. Journal of Personality and Social Psychology, 48 (3), 716-722. Highly responsive hypnotic subjects classified as having control over remembering (voluntaries) or not having control over remembering (involuntaries) during posthypnotic amnesia were compared during posthypnotic recall. Subjects rerated their voluntariness after the experiment. Two contextual conditions were employed (2 x 2 design): a lie detector condition meant to create pressure to breach amnesia and a relax control condition. In contrast to earlier findings, the recall data showed that both voluntary and involuntary subjects breached under the lie detector condition compared with their counterparts in the relax condition; however, the degree of breaching was not great in any condition. The results are discussed as they relate to studies attempting to breach posthypnotic amnesia and characteristics of the voluntary-involuntary dimension. 1982 Schuyler, Bradley A. (1982). Further investigation of volitional and nonvolitional experience during posthypnotic amnesia (Dissertation, California School of Professional Psychology, Fresno). Dissertation Abstracts International, 44 (n6-B), 1977. (Order No. DA 8324472) "Electrodermal responses were compared between highly responsive hypnotic Ss who were classified as having control over remembering (voluntaries) or not having control over remembering (involuntaries) during posthypnotic amnesia. Three contextual conditions were employed: Two were meant to create pressure to breach posthypnotic amnesia (lie detector instructions alone or with feedback that Ss had been detected as not having told all they could remember); the other provided feedback, in addition to the lie detector instructions, that Ss had told all they could remember. The recall data confirmed earlier findings of Coe and Yashinski and showed that voluntary and involuntary Ss did not differ in response to the contextual conditions. However, lie detector instructions alone did not create pressure to breach as in previous studies. In addition, electrodermal results were insignificant. The results are discussed as they relate to (a) amnesia, (b) the physiological detection of deception and physiological activation, (c) the voluntary/involuntary classification of Ss, and (d) theories of hypnosis" (p. 1977). 1974 Bloom, Richard F. (1974). Validation of suggestion-induced stress. NOTES Technical Memorandum 23-74 (October 1974), US Army Human Engineering Laboratory, Aberdeen Proving Ground, Maryland 21005, AMCMS Code 5910.21.68629, Contract No. DAAD05-73-C-0243, Dunlap and Associates, Inc. (now Stamford, CT), AD002557. Sixty college men, divided into three equal groups, each attended two induced stress sessions in which their physiological, psychological and performance reactions were measured. Their responses were compared to determine if valid stress reactions could be induced through suggestion in an altered state (in this case, hypnosis), and also to determine the validity of such reactions if the subject had never before experienced that stress situation. It was demonstrated that valid stress reactions can be induced in an individual with the aid of suggestions, especially if the real stress situation has been experienced before. If no previous experience with that real situation exists, the subject still exhibits stressful reactions; however, the closest resemblance to real stress is found in the subjective or psychological measures, less similarity is found in the physiological measures, and the least similarity is found in the performance measures. 1973 Crystal, Thomas H.; Gish, Herbert; Bloom, Richard F. (1973, June). Psychophysiological factors affecting speaker authentication and identification. (See Notes field for additional reference information and information about ordering.) NOTES 1: Research and Development Technical Report ECOM-0161-F; AD-913 696L; Contract DAAB07-71-C-0161 with Signatron, Inc. (Lexington, MA). Distribution limited to U.S. Government agencies only; Other requests for this document must be referred to Commanding General, U.S. Army Electronics Command, ATTN: AMSEL-PP-CM-CR4, Fort Monmouth, NJ 07703. NOTES 2: This document reports on a U.S. Army research project using hypnosis to collect high fidelity samples of the voice under "combat stress" conditions in the laboratory. Using hypnotic regression, combat veterans "re-experienced" their own, actual high stress combat situations. Besides subjective reports of stress levels by subjects, physiological stress measures were obtained from polygraph recordings of heart, respiration and GSR activity. The voice samples were later analyzed by spectrographic techniques to determine which factors remain invariant to identify and authenticate the speaker in a military communications situation. Hypnotic techniques were shown to be useful in establishing controlled emotional states for laboratory research purposes. (Richard Bloom) 1961 Germann, A. C. (1961). Hypnosis as related to the scientific detection of deception by polygraph examination: A pilot study. International Journal of Clinical and Experimental Hypnosis, 9, 309-311. Results obtained from 5 college students suggests that hypnotic amnesia does not surreptitiously defeat the polygraphy process, and that hypnotically induced exaggeration of responses may assist the examining process. From Psyc Abstracts 36:04:4II09G. (PsycINFO Database Record (c) 2002 APA, all rights reserved) Post Traumatic Stress Disorder 1998 Eimer, Bruce; Freeman, Arthur (1998). Pain management psychotherapy: A practical guide. New York NY: John Wiley & Sons, Inc.. NOTES "Pain Management Psychotherapy" (PMP) provides a clear and methodical look at pain management psychotherapy beginning with the initial consultation and work-up of the patient and continuing through termination of treatment. It is a thoughtful and thorough presentation that covers methods for psychologically assessing the chronic pain patient (structured interviews, pain assessment tests and rating scales, instruments for evaluating beliefs, attitudes, pain behavior, disability, depression, anxiety, anger and alienation), treatment planning, cognitive-behavioral therapy techniques, and a range of hypnotic approaches to pain management. The book covers both traditional (cognitive and behavior therapy, biofeedback, assessing hypnotizability, choice of inductions, designing an individualized self-hypnosis exercise) as well as newer innovative techniques (e.g., EMDR, pain-relief imagery, hypno-projective methods, hypno-analytic reprocessing of pain-related negative experiences). An extensive appendix reproduces in their entirety numerous forms, rating scale, inventories, assessment instruments, and scripts. The senior author, Bruce Eimer, states in his online comments on Amazon.com that "most therapists hold the belief that 'real' chronic pain patients are quite impossible to help. This book attempts to dispel these misguided beliefs by providing a body of knowledge, theory, and techniques that have proven value in understanding and relieving chronic physical pain." He also states that "the challenge for the therapist is to persuade the would-ne patient/client that he or she has something to offer that can help take way pain and bring back more pleasure. This challenge is negotiated through the therapeutic relationship. However, the therapist just can't be 'warm, accepting, non-judgmental and empathic'. The therapist must also have knowledge and skills relevant to relieving pain. Only then can the therapist impart such knowledge, and in teaching these skills to the pain patient, help the patient become something of a 'self-therapist'. . . I dedicate this book to everyone who wants to find ways to make living with pain more comfortable, and to the ongoing search for better ways to relieve pain." 1997 Duhamel, Katherine N.; Difede, Joan; Foley, Frederick; Greenleaf, Marcia (1997, November). Hypnotizability and posttraumatic symptomatology after burn injury. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Washington, D. C.. NOTES Investigated the relationship between hypnotizability and post traumatic stress disorder (PTSD) symptoms following burn injury, in 43 hospitalized survivors. Authors found an association between these two variables and suggest that assessment of hypnotizability might help identify post-burn patients at risk for PTSD. 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. NOTES "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). 1994 Bloom, Peter B. (1994). Clinical guidelines in using hypnosis in uncovering memories of sexual abuse: A master class commentary. International Journal of Clinical and Experimental Hypnosis, 42 (3), 173-178. "Joan," a clinical psychologist, requested a psychiatric consultation to determine whether hypnosis could recover accurate memories of suspected child abuse by her still living father. Are there clinical guidelines in using hypnosis in uncovering such possible memories of sexual abuse? We asked Dr. Peter B. Bloom to share his views with us. NOTES Gives case example and clinical guidelines for using hypnosis in uncovering memories of sexual abuse. 1. In medical practice, "Primum non nocere," i.e. "First do no harm." 2. "No therapist should ever, either directly or indirectly, suggest abuse outside of a specific therapeutic context--certainly not to a client who is on the phone making a first appointment!" 3. "A therapist must not jump quickly to the conclusion that abuse occurred simply because it is plausible." 4. "A therapist should never simply assume that a client who cannot remember much from childhood is repressing traumatic memories or is in denial." 5. "Remember 'a client is most vulnerable to suggestion and the untoward influence of leading questions when therapy begins to delve into painful life situations from the past, particularly from childhood.'" 6. "Therapists ... should be cautious about suggesting that clients cut off communication with their families." 7. "Therapists should reconsider the 'no pain, no gain' philosophy of treatment." 8. "The context of therapy is as important as the content." 9. "Tolerate ambiguity." (Sincerity and conviction on the part of the patient reporting abuse are not in and of themselves reason to believe the material.) 10. "Respect the current science of memory." 11. "Maintain responsibility for making the diagnosis and choosing the treatment." 12. "Pursue alternative diagnoses to account for the symptoms." 13. "Historical and narrative truth: Understand the difference." from childhood is repressing traumatic memories or is in denial." 5. "Remember 'a client is most vulnerable to suggestion and the untoward influence of leading questions when therapy begins to delve into painful life situations from the past, particularly from childhood.'" 6. "Therapists ... should be cautious about suggesting that clients cut off communication with their families." 7. "Therapists should reconsider the 'no pain, no gain' philosophy of treatment." 8. "The context of therapy is as important as the content." 9. "Tolerate ambiguity." (Sincerity and conviction on the part of the patient reporting abuse are not in and of themselves reason to believe the material.) 10. "Respect the current science of memory." 11. "Maintain responsibility for making the diagnosis and choosing the treatment." 12. "Pursue alternative diagnoses to account for the symptoms." 13. "Historical and narrative truth: Understand the difference." COMMENT: The tenet that insight is necessary for change and growth is not true. Change can occur without insight, although insight may be helpful in maintaining change once it has occurred. SUMMARY: These guidelines are presented to enhance safe practice, however, clinicians should use their own judgement to determine the best path to follow with each patient. NOTE: Guidelines 1, 8, 9, 10, 11, 12, and 13 are those of Peter B. Bloom. Those labeled as Guidelines 2, 3, 4, 5, 6, and 7 were taken with permission from Yapko, M. (1993 September/October). "The seductions of memory. The false memory debate." Family Therapy Networker, 17, pp. 30-37. All discussions, however, are those of Peter B. Bloom. Cardena, Etzel (1994, August). Domain of dissociation. [Paper] Presented at the annual meeting of the American Psychological Association, Los Angeles. NOTES Dissociation (a French term) exists when two or more mental contents are not integrated. Dissociation includes a wide variety of behaviors and experiences. Three Concepts: 1. nonconscious or nonintegrated mental models or processes 2. alteration in consciousness when disconnection from self or environment is experienced 3. defense mechanism Explanation of these three concepts: 1. Within nonconscious or nonintegrated mental models/processes there are three types: (a) absence of conscious awareness of impinging stimuli or ongoing behaviors (broad, vague, not useful, because we are unaware of physiological processes most of the time) (b) co-existence of separate mental systems or identities that should be integrated (Meyers, 1903, said the memorability of an act is better proof of consciousness than its complexity). Examples: dissociative amnesia (Walter Reed Hospital patient); or in hypnosis telling a person that their hand is going to begin raising on its own (c) ongoing behavior that is inconsistent with person's verbal report. May be part of #2. Example: commisurotomized patients - woman who wanted to smoke couldn't get her hand to lift cigarette to her mouth. Example of student, being criticized, breaking out into a rash while saying that she felt calm. Often repression and dissociation are confused. When dissociation is used as in (c) above, they are indistinct; they are the same. Freud used the terms for the same thing. When we talk about a dissociated memory, it is same as repression. 2. Alteration in consciousness (disconnection from the self or environment is experienced). In this case we talk about an experiential event. Caveats: Some use it to refer to *any* kind of alteration of consciousness. Braun, 1993, reported that mystical experiences are dissociative; I maintain that many people feel most in contact with the self during mystical experience. Same with drugs: it may not involve primarily separation, disengagement, from self or environment. As you listen to me, you may disengage at times. I think the only legitimate use of "dissociation" is a radical alteration of consciousness; like Tart's altered states of consciousness, like out-of-body experiences. In clinical situation, distraction or dreaminess is usual; but if a patient disengages and starts reliving a situation, it is legitimately regarded as dissociation. 3. Defense mechanism - a theoretical construct, referring to intentional disavowing things that would cause anxiety or pain. Clinical observations of people in traumatic events, rape, people may have out of body experiences; explained as the person sending the ego somewhere else because they can't bear the pain. But, you get this separation in non-traumatic circumstances (in meditation, revery, etc.) Alternative Paradigm: