“… stress alone may not impair memory processes. Indeed, stress can lead to arousal, heightened attention, and improved encoding (Deffenbacher, 1983). However, stress that results from intimidation may lead to either impairment in encoding or problems in recalling or reporting memories” (p. 14).
“Because the effect of suggestion on material that has been well encoded tends not to be significantly different across age groups (Cohen & Harnick, 1980), it may be that younger children’s inferior performance on suggestive tasks results from inferior encoding” (p. 15).

Putnam, Frank W. (1992). Using hypnosis for therapeutic abreactions. Psychiatric Medicine, 10, 51-65.

Abreaction, the dramatic reliving of traumatic events under hypnosis, is a powerful therapeutic intervention useful in the treatment of victims of trauma. First systematically applied in World War I, abreaction coupled with psychotherapeutic processing of the recovered material is increasingly being used with victims of child abuse and chronic PTSD. Abreactions are helpful in recovering dissociated or repressed traumatic material, reconnecting missing affect with recalled material and for transforming traumatic memories. Although abreactions can be induced with medications, hypnosis is the method of choice except in acute situations where it is not possible to establish rapport. A variety of hypnotic techniques for the induction and management of abreaction are discussed, together with the indications and contraindications for their use.

Summit, Roland C. (1992, Summer). Opinion: Misplaced attention to delayed memory. The Advisor (Published by American Professional Society on the Abuse of Children), 5 (3), 21-25.

“I believe this is the time to cap a century of progress with a monumental achievement in awareness. We must cherish and develop the concept that what we don’t know can hurt us. We can establish, for the first time, that our lives and even the nature of our society can be shaped by experiences so terrible that they are, in the words of Josef Breuer a century ago, ‘forbidden to consciousness’ (1895, p. 225). We may learn that huge chunks of oppositional thought, cruelty, perversity, helplessness, self-destruction and mental illness are derived from this hidden reservoir of suffering, and we could inspire unprecedented achievements in healing, prevention and enlightened peacemaking” (p. 21).
“We have been slow to consider the implications of dissociation for protective awareness of child sexual abuse” (p. 22).
“And we should respect the painful threat that enlightenment poses for our comforting faith in a just and fair society. We would have to consider that we may be capable as a people of hiding our most grotesque activities under the cover of dissociation, so that we don’t know we’re doing it, our victims can’t say it’s happening, and as an outer society we will insist that no such thing could possibly exist” (p. 22).
“While it is urgently important to know that dissociation is real, it is doubly important not to endorse as accurate, in fact, details or encounters that may be part of a still unknown process of distortion” (p. 22).
“The most distinguished clinicians, the people who occupy the platform of authority as scientists and educators, are joining with those who, until now, have been recognized mainly for their adversarial positions. Now those two poles are coming together in aroused opposition to the phenomenon of delayed memory, especially when acquired in therapy with young women in their 30’s, especially when those therapists lack an M.D. or a Ph.D. diploma. We face, once again, an ageist, sexist, elitist professional standoff around an issue that deserves to be explored in harmony” (p. 24).
“In California and several other states the statute of limitations has been suspended for individuals who can demonstrate delayed discovery of childhood trauma” (p. 24).
“The rush to judgment is not confined to civil litigation. There is no statute of limitations on murder” (p. 24).
“How many kids have hidden the memory of unspeakable assaults which can be unearthed years later to plunge them into courtroom testimony? How many free citizens could be sued or imprisoned by such remote discoveries? What should we do as scientists in support of or in opposition to those delayed memories?” (P. 24).
“We know that skepticism can quash the emergence of dissociated memories. Can we prove that therapeutic zeal cannot enhance such memories? Survivors who gain a clear picture of sexual assault in the climactic period of discovery tend to fade out the sharp edges as they achieve resolution and healing. The most seasoned survivors may discount the intermediate memories which once provided the impetus for their recovery” (p. 25).

Vijselaar Joost; Van der Hart, Onno (1992). The first report of hypnotic treatment of traumatic grief: A brief communication. International Journal of Clinical and Experimental Hypnosis, 40 (1), 1-6.

In 1813 the Dutch physicians Wolthers, Hendriksz, De Waal, and Bakker reported the hypnotic treatment of a woman suffering from traumatic grief, in which the therapist had to deal directly with the patient’s spontaneous reenactments of the circumstances surrounding the death. This report, summarized in the present article, has historical value, as it is probably the first known precursor of the uncovering hypnotic approach. The original authors’ views on the case are discussed, and a modern view for understanding the patient’s traumatic grief and its treatment is presented.

Friedrich, William N. (1991). Hypnotherapy with traumatized children. International Journal of Clinical and Experimental Hypnosis, 39 (2), 67-81.

The psychological impact of trauma can include cognitive, affective, and behavioral components. The degree to which a child is either overwhelmed by or unable to access the traumatic event can make the working through of the event in therapy difficult. Hypnotherapy is a useful modality not only for alleviating symptoms but also for uncovering the traumatic event(s) with associated affects, integrating and making sense of the experience. 4 case studies are reported to illustrate the utility of hypnotherapy with young, traumatized children.

Smith, William H. (1991). Antecedents of posttraumatic stress disorder: Wasn’t being raped enough? A brief communication. International Journal of Clinical and Experimental Hypnosis, 39, 129-133.

Many rape victims, like those traumatized by war, accidents, and natural disasters, are able to recover from their ordeal with supportive, crisis-oriented treatment. For others, however, symptoms may persist and require more intensive treatment. Hypnosis allows a modulated re-experiencing and abreaction of the traumatic event that can help to provide the victim with a relieving sense of mastery, and it fosters a receptive context for reassurance and interpretation regarding the irrational or exaggerated thoughts and feelings involved. 2 case examples are presented in which earlier conflicts appeared to play a role in perpetuating the patients’ symptoms. Detecting and addressing these antecedents resulted in complete alleviation of long-standing problems through relatively brief treatment using hypnosis.

Spiegel, David (1991, August). New directions in traumatic stress research. [Paper] Presented at the annual meeting of the American Psychological Association, San Francisco.

Trauma is the experience of being made into an object of someone else’s rage. It is a sudden discontinuity in experience: our physical and mental state can be changed radically. The experience of loss of control is what is most horrifying, more than fear of death. Guilt, (blaming oneself) helps deny the loss of control. People who experience trauma distance from the information but the cortex maintains the traumatic memories.
Author reviewed literature on effective interventions with trauma victims. 1. Harbor & Pennebaker: Contrast how earthquake victims can talk about it but rape victims often are isolated. The importance of having someone listen raises the question of usefulness of only writing about the trauma. 2. Greenberg: Studied 103 trauma cases; employed a clever methodology, using 2 control groups (but it is difficult for the imaginary control group to be free of associating to their own traumas). I believe the health findings, but it troubles me that there were intrusions (thoughts); the control group utilization [of health services?] went up. 3. Kilpatrick: It is important not to blame the victim for being traumatized. But there may be some people who for sociological or other reasons do not get out of dangerous situations. 4.Terri Orbach: There is a process of “going public” about the trauma, like in Alcoholics Anonymous disclosures. Trauma victims create an account and they go to someone else to tell about it.
Summary of what seems important about treatment: There are three means of working with trauma, with thinking, writing, and talking. If you just think but don’t talk, assault rate goes up (Pennebaker); and if you don’t talk with someone else you feel worse physically. In simply writing about the trauma, there may be an increase of mental intrusions, or avoidance. What seems to be beneficial is not just making sense to oneself about the experience cognitively, but the traumatized person must get feedback from another individual that they are not transformed as a person.

Van Der Kolk, Bessel; Van Der Hart, O. (1991). The intrusive past: The flexibility of memory and the engraving of trauma. American Imago, 48, 425-454.

Describes the work of Janet concerning narrative versus traumatic memory, dissociation, and subconscious fixed ideas. Janet (1904) believed PTSD patients suffer from a phobia for the traumatic memory. Repression and dissociation are distinguished. Contemporary concepts of memory processing and the concept of schemas are then reviewed. Finally, a model is presented about how the mind freezes some memories. Evidence for the involvement of autonomic hyperarousal, triggering, and state dependent learning in PTSD is reviewed. They conclude that helplessness and the inability of the PTSD victim to take action (psychological and physical immobilization) facilitates dissociation. Includes practical ideas for the working through of trauma.

Traumatic memories are triggered by autonomic arousal … and are thought to be mediated via hyper-potentiated noradrenergic pathways originating in the locus coeruleus of the brain… The locus coeruleus is the ‘alarm bell’ of the central nervous system, which properly goes off only under situations of threat, but which, in traumatized people, is liable to respond to any number of triggering conditions akin to the saliva in Pavlov’s dogs. When the locus coeruleus alarm gets activated, it secretes noradrenaline, and, if rung repeatedly, endogenous opioids. These, in turn, dampen perception of pain, physical as well as psychological (van der Kolk et al. 1989). These neurotransmitters which are activated by alarm affect the hippocampus, the amygdala and the frontal lobes, where stress-induced neurochemical alterations affect the interpretation of incoming stimuli further in the direction of ’emergency’ and fight/flight responses” (p. 443).

Wolpe, Joseph; Abrams, Janet (1991). Post-traumatic stress disorder overcome by eye-movement desensitization: A case report. Journal of Behavior Therapy and Experimental Psychiatry, 39-43.

Post-traumatic stress disorder is an exceptionally stressful syndrome that has been extremely difficult to treat. The prognosis was recently dramatically improved by the introduction of eye-movement desensitization. This paper reports, in substantial detail, a case that was precipitated by a rape 10 years earlier, describing its manifestations and various unsuccessful attempts to treat it: followed by a detailed exposition of the eventual, completely successful treatment by eye-movement desensitization.

Somer, E. (1990). Brief simultaneous couple hypnotherapy with a rape victim and her spouse: A brief communication. International Journal of Clinical and Experimental Hypnosis, 38 (1), 1-5.

This paper presents a case involving a rape victim and her emotionally affected spouse. Although the assault occurred before the couple met, the husband was too upset to concentrate when the victim wanted to share her rape-related feelings, nor could he provide the much needed empathy and support. This, apparently, was due to his difficulties in handling his own rage. Simultaneous couple hypnotherapy was used to allow the victim to share her experience under conditions safe for both her and her spouse. As he imagined in trance the rape account described by his age-regressed wife, he learned to identify his emotions and experience them in a controlled manner. During subsequent sessions, the husband was encouraged to include himself in his wife’s abreaction and reshape the traumatic scene for both of them. The husband’s rescuing behavior and the expressions of violent anger towards the perpetrator had several positive consequences. Not only did they change the abandonment component of the victim’s traumatic memory, but they also helped the husband deal in better ways with his own feelings of anger. It also provided the couple with a helpful coping mechanism they later effectively applied under different circumstances.

Spiegel, David; Cardena, Etzel (1990, October). New uses of hypnosis in the treatment of posttraumatic stress disorder. Journal of Clinical Psychiatry (Supplement), 51, 39-43.

Vietnam veterans with PTSD and those abused as children have above average hypnotizability. Hypnosis provides controlled access to memories that may otherwise be kept out of consciousness. New uses of hypnosis with PTSD victims involve coupling access to the dissociated traumatic memories with positive restructuring of those memories. Hypnosis can be used to help patients face and bear a traumatic experience by embedding it in a new context, acknowledging helplessness during the event, and yet linking that experience with remoralizing memories, such as efforts at self-protection, shared affection with friends who were killed, or the ability to control the environment at other times. In this way, hypnosis can be used to provide controlled access to memories that are then placed into a broader perspective. Patients can be taught self-hypnosis techniques that allow them to work through and thereby reduce spontaneous, unbidden, intrusive recollections.

Cooper, Nancy A.; Clum, George A. (1989). Imaginal flooding as a supplementary treatment for PTSD in combat veterans: A controlled study. Behavior Therapy, 20 (3), 381-391.

14 Vietnam veterans suffering from posttraumatic stress disorder (PTSD) were assigned either to standard treatment (control group), or standard treatment plus imaginal flooding (experimental group). The 2 groups were closely matched on medications and combat roles and tours of duty were comparable. Experimental Ss received up to 14 sessions of flooding for a maximum of one and one-half hours per session. Self-report measures were administered at pre-treatment, post-treatment, and at 3-mo follow-up. These measures included the Behavioral Avoidance Test, the Beck Depression Inventory, and a Modified Vietnam Experiences Questionnaire. Results indicate that flooding increased the effectiveness of usual treatment, particularly in such areas as re-experiencing symptoms and sleep disturbances. However, flooding had no effect on level of depression, trait anxiety, and violence-proneness.

Eisen, Marlene R. (1989). Return of the repressed: Hypnoanalysis of a case of total amnesia. International Journal of Clinical and Experimental Hypnosis, 37 (2), 107-119.

A case study is presented of a woman suffering from global amnesia so profound that she had lost all sense of personal identity. Hypnotherapy was used to establish, through imagery, a solid inner core on which to rebuild a sense of self. From the image of a strong column on which rested a book with a golden lock (her history), to reading about other lives, books and stories were utilized to establish a safe external environment in which the reawakening of repressed memories was not longer perceived as dangerous. A discussion of relevant literature on the subjects of global amnesia, loss of personal identity, and post-traumatic stress is offered as a basis for discussing the present case.
Litz, Brett T.; Keane, Terence M. (1989). Information processing in anxiety disorders: Application to the understanding of post-traumatic stress disorder. Clinical Psychology Review, 9, 243-257.

Several of the key defining features of PTSD are symptoms that reflect problems related to perception, attention, and memory processes (hypervigilance, flashbacks, nightmares, psychogenic amnesia, and concentration difficulties). Although there have been several recent attempts to explain such phenomena through facets of cognitive psychology, little empirical work has been completed to confirm or explicate such processes in PTSD. This paper critically reviews the theoretical and empirical work done to date in the area of information processing in anxiety disorders, so as to provide a context for future empirical work to identify the specific psychological mechanisms and controlling variables responsible for symptoms of PTSD. A working theoretical model of information processing variables in PTSD is also proposed to stimulate future research in this area.

Peebles, M. J. (1989). Through a glass darkly: The psychoanalytic use of hypnosis with post-traumatic stress disorder. International Journal of Clinical and Experimental Hypnosis, 37, 192-206.

A severe case of post-traumatic stess disorder stemming from consciousness (with auditory and pain perception) during surgery was treated with 8 sessions of hypnosis. Abreaction and revivification used alone initially retraumatized the patient, and her symptoms worsened. Ego-mastery techniques were then added; emphasis was placed on the role of the therapist as a new object presence to be internalized in restructuring the traumatic memory; memory consolidation and working-through techniques were instituted. The patient’s symptoms abated and her condition remitted. The similarities between hypnotic and analytic work are highlighted. In addition, the case material provides a clinical example of the existence and potential traumatic effects of conscious awareness during surgery.

Pillemer, D. B.; White, S. H. (1989). Childhood events recalled by children and adults. In Reese, H. W. (Ed.), Advances in child development and behavior. New York: Academic Press.

Authors discuss a dual memory theory. The first memory system is prominent in early childhood, and is a system in which are organized and evoked by persons, locations, and emotions. Such memories are not easily “transportable” outside the original experience. These memories are accessed through images of face and place, actions, or feelings. The second memory system begins to develop in early childhood, is verbally mediated, and stores experiences in narrative form. Such memories are accessible through verbal interaction, and can be reviewed and shared with others verbally. For a small child, to access all of a memory one would need to tap into both memory systems. The authors suggest that the first memory system continues to be available throughout one’s life, especially when strong emotion was associated so that verbal cues are not attached. [This has implications for retrieval of “lost” memories using imagery-based approaches like hypnosis.]

Chu, James A. (1988). Ten traps for therapists in the treatment of trauma survivors. Dissociation, 1, 24-32.

Patients who have survived trauma, particularly those who have experienced early childhood abuse, stand out in the clinical experience of many therapists as being among the most difficult patients to treat. These patients have particular patterns of relatedness, along with intense neediness and dependency which make them superb testers of the abilities of their therapists. They often push therapists to examine the rationales and limits of their therapeutic abilities, and frequently force therapists to examine their own personal issues and ethical beliefs. A conceptual framework for understanding treatment traps is presented, along with 10 traps which these patients present, consciously and unconsciously, in the course of treatment. Included are traps around trust, distance, boundaries, limits, responsibility, control, denial, projection, idealization, and motivation.

Kingsbury, Steven J. (1988). Hypnosis in the treatment of posttraumatic stress disorder: An isomorphic intervention. American Journal of Clinical Hypnosis, 31, 81-90.

Reviews literature on hypnosis treatment for PTSD and presents a rationale, based on the type of symptoms presented (blunting vs intrusions). Case presentations are provided.
“Several types of physiological processes may underlie dissociation. State- dependent learning, in which that learned during drug-induced alterations in consciousness may only be recalled during later similar alterations, is believed to be dependent upon hippocampal mechanisms (Gerrien & Chechile, 1977).The relationship of state-dependent learning to hypnosis has remained at the level of theory (Hilgard, 1977; Rossi, 1986). A second possible explanatory construct suggests everyday experience is primarily (but not exclusively) mediated by verbal, dominant hemisphere functioning. The images and sets mediating hypnosis, PTSD, and other forms of dissociation may be mediated by analogic processing and the nondominant hemisphere (Carter, Elkins, & Kraft, 1982; Galin, 1974; Hilgard, 1977; Watzlawick, 1978)” (p.83).

Loewenstein, R. J.; Putnam, F. W. (1988). A comparison study of dissociative symptoms in patients with complex partial seizures, MPD, and posttraumatic stress disorder. Dissociation, 1, 17-23.

Depersonalization and dissociative symptoms have been widely reported in chronic seizure disorder patients, especially those with temporal lobe involvement and complex partial seizures (CPS). It has been theorized that development of multiple personality disorder may be related to temporal lobe pathology. We administered the Dissociative Experiences Scale (DES) to 12 male patients with severe chronic epilepsy, primarily of the complex partial type. Patients had epilepsy from 1 to 30 years. Most were being evaluated for intractable seizures occurring several times per week. DES data on the epileptic patients were compared with DES data on 9 male MPD patients and 39 PTSD patients. MPD and PTSD patients were significantly different from CPS patients in median DES scores and all DES subscale scores. MPD and PTSD patients were far more similar on the DES, although MPD patients had a significantly higher score on the dissociation/psychogenic amnesia subscale of the DES. The authors conclude that there is little data to support a relationship between MPD, dissociation, and epilepsy.

Spiegel, David; Hunt, Thurman; Dondershine, Harvey E. (1988). Dissociation and hypnotizability in posttraumatic stress disorder. American Journal of Psychiatry, 145 (3), 301-305.

: The authors compared the hypnotizability of 65 Vietnam veteran patients with posttraumatic stress disorder (PTSD) to that of a normal control group and four patient samples using the Hypnotic Induction Profile. The patients with PTSD had significantly higher hypnotizability scores than patients with diagnoses of schizophrenia (N=23); major depression, bipolar disorder-depressed, and dysthymic disorder (N=56); and generalized anxiety disorder (N=18) and the control sample (N=83). This finding supports the hypothesis that dissociative phenomena are mobilized as defenses both during and after traumatic experiences. The literature suggests that spontaneous dissociation, imagery, and hypnotizability are important components of PTSD symptoms.(Am J Psychiatry 1988; 145:301-305)

Terr, Lenore C. (1988). What happens to early memories of trauma? A study of twenty children under age five at the time of documented traumatic events. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 96-104.

The verbal and behavioral remembrances of 20 children who suffered psychic trauma before age 5 were compared with documentations of the same events. Ages 28 to 36 months, at the time of the trauma, serves as an approximate cutoff point separating those children who can fully verbalize their past experiences from those who can do so in part or not at all. Girls appear better able than boys to verbalize parts of traumas from before ages 28 to 36 months. Short, single traumas are more likely to be remembered in words. At any age, however, behavioral memories of trauma remain quite accurate and true to the events that stimulated them.

Venn, Jonathan (1988). Hypnotic intervention with accident victims during the acute phase of posttraumatic adjustment. American Journal of Clinical Hypnosis, 31, 114-117.

Victims of accidents or other trauma often experience acute symptoms of confusion, disorganization, and intrusive memories. Victims can be extremely suggestible during their initial adjustment, and they readily comply with suggestions to enter hypnosis. Reframing and other hypnotic interventions can be useful in managing acute symptoms and may facilitate long-term adjustment. A case is presented in which hypnosis was successfully used with a man who was acutely distressed after accidentally killing a pedestrian. Whether the heightened suggestibility experienced during acute posttraumatic adjustment entails an increase in hypnotizability is an interesting topic for future research, and one which has theoretical import.

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.

Herman, Judith; Russell, Diana; Trocki, Karen (1986). Long-term effects of incestuous abuse in childhood. American Journal of Psychiatry, 143, 1293-1296.

Studied 2 groups of adult women with histories of incest, a nonclinical sample (n – 152) and an outpatient sample (n – 53) to investigate long-term outcomes of sexual abuse. Results indicate that Ss in the community sample reported a range of long- term effects from the incest. Most said they had recovered well from their trauma. Most Ss who had suffered forceful, prolonged, or highly intrusive sexual abuse, or who had been abused by their father or stepfather, reported long-lasting negative effects. The patient sample reported histories comparable to the most severe traumatic histories in the community sample.

MacHovec, Frank J. (1985). Treatment variables and the use of hypnosis in the brief therapy of post-traumatic stress disorders. International Journal of Clinical and Experimental Hypnosis, 33 (1), 6-14.

This paper describes treatment variables in the use of hypnosis in the brief treatment of 4 post-traumatic stress disorder cases. The number of sessions varied with the length of time between trauma and treatment, severity of stressor, and the personality of the patient. Individual differences in response to treatment are reported, as well as considerations for differential diagnosis to prevent misdiagnosis.

Stumpfe, Von Klaus-Dietrich (1985). Psychosomatic reactions of near-death experiences. A state of affective dissociation. Zeitschrift fur Psychosomatische Medizin, 31, 215-225.

The feelings of persons who had encountered life-threatening danger were analyzed and compared with the feelings of persons, who are in hypnoses or trained in autogenic training. The symptoms are widely alike. The result of the comparison is, that there exists a state of affective dissociation, which can be caused by conscious or unconscious actions

Stutman, Randall K.; Bliss, Eugene L. (1985). Posttraumatic stress disorder, hypnotizability and imagery. American Journal of Psychiatry, 142 (6), 741-743.

Administered a posttraumatic stress disorder (PTSD) scale, the Stanford Hypnotic Susceptibility Scale–Form C, a vividness of imagery scale, and a self-report of 313 symptoms found in 11 major psychiatric disorders to 26 Vietnam veterans to determine the relationship between posttraumatic stress disorder and hypnotizability. Ss with low or no PTSD scores had normal hypnotizability scores and normal imagery scores, whereas those with high PTSD scores had high hypnotizability scores and high imagery scores. It is concluded that either combat traumas enhanced hypnotic potential in some Ss or that Ss with excellent hypnotic potential to begin with were more susceptible to posttraumatic stress. It is suggested that some humans may revert to spontaneous self-hypnosis as a primitive coping tactic.

Nash, Michael R.; Lynn, Steven Jay; Givens, Deborah L. (1984). Adult hypnotic susceptibility, childhood punishment, and child abuse: A brief communication. International Journal of Clinical and Experimental Hypnosis, 32, 6-11.

Earlier empirical and theoretical work has suggested that there is a relationship between higher hypnotic susceptibility and severity of childhood punishment. Experiment 1 surveyed the parents of 14 extremely high and 11 extremely low susceptible Ss concerning punishment. Low susceptible Ss were found to be more frequently punished than highs; no significant differences were found on the severity measure. Experiment 2 assessed the hypnotizability of 16 adult Ss who reported being physically abused before the age of 10 and compared these scores to those of 300 adult Ss who had not reported being abused. The mean hypnotizability of abused Ss was greater than that of controls, and the distribution of their scores appeared bimodal. Limitations of both experiments are discussed and suggestions are made for future investigations.

Brende, Joel O. (1982). Electrodermal responses in post-traumatic syndromes: A pilot study of cerebral hemisphere functioning in Vietnam veterans. Journal of Nervous and Mental Disease, 170, 352-361.

This paper summarizes the findings of a pilot study which found a relationship between the post-traumatic symptoms of a) psychic numbing, b) intrusive recollections of traumatic events, and c) hypervigilance and lateralization of electrodermal response (EDR) measurements in six victims of psychological trauma. Hypnotically induced imagery of past traumatic events was often associated with left-sided EDR increases, psychic numbing with left-sided EDR decreases or bilateral EDR unresponsiveness, and revivifications of hypervigilant states with right-sided EDR lateralization. In several cases control of the experience of fear was associated with left- sided or bilaterally decreased EDR. These pilot study findings support previously stated hypotheses: a) EDR obtained from an extremity reflects contralateral cerebral hemisphere functioning; b) left hemisphere functioning is associated with hypervigilance; and c) right hemisphere functioning is associated with emotions and imagery. In addition, the pilot study findings suggest additional hypotheses: a) Post- traumatic symptoms are associated with poorly controlled or integrated cerebral hemisphere functioning; b) psychic numbing and intrusive images, flashbacks, and nightmares are associated with abnormal activation, suppression, or integration of right hemisphere functioning in relationship to the left; c) aggressive behavior, hypervigilance, and character pathology are associated with abnormal activation, suppression, or integration of functioning of the left hemisphere function in relationship to the right; and d) “splitting” as a psychological defense in Vietnam veterans with Borderline Personality Disorders is associated with physiologically impaired interhemispheric integration.

The authors report that previous research suggests that electrodermal asymmetry may be related to emotional factors. They further suggest that electrodermal responsiveness reflects contralateral cerebral hemispheric functioning, with lower GSR associated with higher activation of the opposite cerebral hemisphere (see Lacroix and Comper, 1979). They indicate that the right hemisphere, which is involved in experience of emotion, also is associated with depression (when there is abnormal inhibitory function of right hemisphere) and affective disorders. The left hemisphere is involved in vigilance (Dimond & Beaumont, 1974). “Based on these findings, the post-traumatic symptoms hypervigilance, anxiety, and behavior disorders appear to be associated with atypical left hemisphere activation, intrusive recollections of traumatic memories and disturbing emotional states with atypical right hemisphere activation, and psychic numbing or emotional unresponsiveness with diminished right hemisphere activation, or overactivation of the left hemisphere” (p. 354).
In this pilot study, the therapist, who used hypnosis in all but one case, interviewed the patient for 30-50 minutes, focusing on helping the S to recall experiences of a traumatic nature. The therapist was supportive when disturbing emotions were evoked, responding flexibly by monitoring S’s anxiety and moving back and forth between uncovering and supportive techniques.
SUMMARY: “There were observably variable changes and bilateral differences in EDR within each of the six subjects in relationship to varying verbal, emotional, and imagery content, postulated to reflect contralateral hemispheric functioning. These observed changes were considered conclusive evidence of such functioning in post-traumatic states” (p. 358). “1. Lateralization of EDR to the left is associated with unpleasant emotions and traumatic imagery. … “2. Lateralization of EDR to the right is associated with hypervigilance and aggressive outbursts. … “3. Psychic numbing is associated with inhibition of bilateral EDRs (for example, lack of bilateral EDR activation occurred in every case at times) or with suppression of the left EDR. … “4. General physiological arousal, a normal response to fear, is associated with increased EDRs bilaterally. … “5. Relaxation and the subjective experience of safety and well-being, which have been reported to foster interhemispheric integration in normal subjects … were observed to be associated with bilaterally decreased EDR in case I, an example of a less severe post- traumatic condition, but not observed during attempts at relaxation in Vietnam veterans with more severe post-traumatic symptoms. “6. Voluntary efforts to cognitively control fear were related to left hemispheric functioning, as observed in case IV when the subject attempted to control intrusive thoughts with cognitive activity and in Case III following the revivification of a frightening event when he made a shift from the hypnotic trance state to waking cognitive activity. In both cases, such cognitive activity was associated with a decreased right-sided EDR” (p. 359).
DISCUSSION: “The results of this pilot study, which demonstrated frequent EDR differences between hands during subjects’ recollections of or attempts to suppress recollections of prior traumatic experiences, alters the traditional belief that increased skin conductance is always a predictable physiological measurement when the electrode is placed on only one hand, as Lacroix and Comper (46) have pointed out.
“The finding of EDR lateralization is consistent with the findings of deBonis and Baque (10) who reported that the degree of anxiety determines the presence of lateralization of EDR responses, of Gruzelier and Venables (30, 32) and Myslobodsky and Horesh (53) who reported that the presence or absence of psychopathology determines the direction of the lateralized response, and of Lacroix and Comper (46) that activation of one hemisphere may suppress contralateral EDR” (p. 359).
Nichols, Michael P.; Bierenbaum, Howard (1978). Success of cathartic therapy as a function of patient variables. Journal of Clinical Psychology, 34 (3), 726-8.

Treated sample of 42 patients with cathartic psychotherapy and evaluated differential effectiveness on types of patients. Patients without mental disorders experienced more emotional catharsis than all others, and those with obsessive compulsive personality disorders improved more than all others as a result of emotive treatment. Contrary to popular notions, neither women nor hysterics experienced more catharsis or improved more in cathartic therapy. Although women and hysterics may cry more easily in daily life, obsessives are apparently more able to maintain focus on unhappy experiences and are therefore able to express more emotion in cathartic therapy. Furthermore, it seems that cathartic treatment is beneficial by disrupting long-standing defenses against emotional experience, rather than by releasing stored-up affects.

Fisher, R. (1977). On flashback and hypnotic recall. International Journal of Clinical and Experimental Hypnosis, 217-235.

This essay deals with both the intra-individual and inter-individual varieties of arousal state-bound experiences. The former are labelled as “flashbacks” while the latter embrace the great fantasms and repetitive schemes, the ever re-written plots and images of literature, art, and religion.
Flashbacks are both arousal-state and stage (i.e., set and setting) bound experiences.
Flashback and hypnotic recall differ only in the ways by which they are induced. Induction methods should be distinguished from induced states on the hyperaroused perception-hallucination and hypoaroused eprception-meditation continuum.
Flashbackers may be characterized by their (a) variability on perceptual-behavioral tasks; (b) tendency to minimize (or reduce) sensory input; (c) high resting heart rates; (d) hypnotizability; and, hence (e) preferential right-cerebral-hemispheric cognition; and (f) a display of EEG-alpha dominance in the resting, waking state.


Desmangles, Leslie G.; Cardena, Etzel (1996). Yearbook of Cross-Cultural Medicine and Psychotherapy, 1994. Berlin: Verlag fur Wissenschaft und Bildung. (Theme Issue: Trance, possession, healing rituals, and psychotherapy)

In this paper, we analyze trance possession in its cross-cultural, psychological and religious contexts, and describe its role specifically within Haitian Vodou and society. In contrast with the earlier analysis of spirit possession as a form of psychopathology, more recent scholarships (sic) has emphasized its import as a common and meaningful religious practice. Vodou is a synchretic religion that, for historical reasons, fused African traditions with Catholicism. In Haiti, the possessed individual plays a liminal function that bridges the sacred and the secular, and temporarily transcends the limitations imposed provided by social or economic status.

The article lists the following as Contents. 1. Possession in context 2. Possession and psychotherapy 3. Vodou and Haiti 4. Vodou rituals (A brief history – The many faces of the Lwas) 5. Deutsche Zusammenfassung 6. Literature

Cardena, Etzel (1994, August). Spirit possession in Haiti. [Paper] Presented at the annual meeting of the American Psychological Association, Los Angeles.

THREE DIMENSIONS OF POSSESSION: 1. Shift from one identity into another (e.g. substituting the everyday identity for that of a spirit) 2. Transitional (you are not having one type of identity substituted for another); involves a transition between states of consciousness (e.g. confusion, dizziness) 3.Transcendent possession – you have a human identity that is not quite there, but another identity has not taken over, like the oracle.
He disagrees with Eliade and Roger Walsh who imply that shamanism is a higher form than possession because possession is “out of control.”
Flight of mind – you are able to remember and bring back the information, mostly visual/imaginal.
vs Possession – involves an embodied alteration of consciousness and, frequently, amnesia.
For further information, consult Cardena, E. (1989). The varieties of possession experience. Association for the Anthropological Study of Consciousness Quarterly, 5 (2- 3), 1-17.

Cardena, Etzel (1993, October). Trance and possession as dissociative disorders: How exotic are they?. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL.


Joke: “What happened to the possessed patient who didn’t pay his exorcist?” Answer: “He got repossessed.”
Began with a quotation of Lagerkvist’s book describing possession of a Sybil in Greek temple. Possession is part of religious experience worldwide, that he is not discussing here.
The revised diagnostic manual, ICD-10, has included “dissociative trance disorders.” To diagnose this one must have either trance (narrowing awareness or focusing and stereotyped movements, behaviors) or possession trance (replacement of sense of personal identity by a new identity, with stereotyped culturally-determined behaviors or movements that are experienced as being controlled by the possessing agent), *and* full or partial amnesia for the event. Cardena emphasizes it doesn’t need to be full amnesia.
To be diagnosed as dissociative trance disorder, the trance or possession state observed cannot be a normal part of a broadly accepted cultural or religious practice, and it must produce distress or maladjustment.
These are the most common type of dissociative disorders in non-Western cultures, e.g. 90% in India. So this diagnosis in India is not “atypical.” “Non-Western” applies to 80% of the World and 1/3 of the USA population. DSM is trying to expand cultural relevance.
Also, even in the Western culture Allison and others have published cases of dissociative trance disorder, and others have described trance disorders:
Spiegel & Spiegel’s Grade 5 personality is vulnerable to dissociative disorder. Hartman’s chronic nightmare patients have “boundary thinness” (i.e. they are not clear if they are awake or asleep, lack separation from themselves and others). Lynn & Rhue’s fantasy prone individuals, 22% of people, are vulnerable to maladjustment.
Cardena’s recommended change in diagnosis of dissociation is critiqued in Transcultural Psychiatric Research Review (1992). Criticisms of the new diagnosis, published int that journal, are: 1. Culture-bound syndromes cut across Western diagnostic boundaries. 2. The diagnosis may be insensitive to the cultural context in which phenomena occur (e.g. distress may lead a person to participate in a cult of affliction) and it may require anthropological sophistication of diagnosticians or consultation with someone who has that knowledge. 2a. It may disregard considerations such as who has the power to “authorize” the phenomenon, under what circumstances, etc. [That would be true with any diagnosis however.] 3.Dissociative Trance Disorder may assume greater within and across-culture uniformity for the conditions than is warranted. 4. It may give validity to metaphysical explanations for spirit possession. [But in psychiatry we often use terms that don’t take into consideration validating metaphysical explanations, e.g. “phantom limb” pain. 5. The medical model that underlies DSM is inappropriate for ontological considerations on the nature of the self. [But those with this diagnosis give us some understanding, not what the ultimate nature of the self and consciousness are. Diagnoses are pragmatic ways of dealing with problems.}
At the present time, the diagnosis of Dissociative Trance Disorder is included in the Appendix of DSM-IV.
For further elaboration of this material, see Cardena, E. (1992). Trance and possession as dissociative disorders. Transcultural Psychiatric Research Review, 29, 283- 297.

Don, Norman S. (1993, October). Trance surgery in Brazil. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL.

Showed a videotape of a Brazilian trance surgeon, who cuts without analgesia or asepsis. Patients later report no pain, infections, etc. The healer/surgeon is believed by everyone to be in a trance state, and the body is believed to be taken over by a spiritual doctor. The people involved deny that the patient is in trance.

Ofshe, Richard J. (1992). Inadvertent hypnosis during interrogation: False confession due to dissociative state; mis-identified multiple personality and the satanic cult hypothesis. International Journal of Clinical and Experimental Hypnosis, 40, 125-156.