NOTES
On pp. 75-76 the author discusses conditioning in hypnosis. Most of the theoretical material is in the first part of the book; the rest consists of case studies. He presents the position that the activity of the cortex and subcortex are different during states of waking and suggested sleep.
Note: Much of the Russian research done during “suggested sleep” involves subjects who are hypnotized for a long period of time–sometimes hours. Routinely, in treatment, they would give corrective suggestions and then tell the person to “sleep” and would leave them in the “sleep” for an hour or longer.
“Thus, it appears from the foregoing that the basic peculiarities of the activity of the cerebral cortex manifesting themselves in the state of suggested sleep are as follows: 1. In addition to the division of the cerebral hemispheres into sections of sleep and wakefulness typical of the hypnotic sleep of an animal, there is also a functional dissociation of the two signal systems and within the second signal system. 2. The activity of the second signal system under these conditions is not only confined to the narrow framework of the rapport zone, but is also frequently of a passive nature being directly dependent on the verbal influences of the hypnotist. Outside these influences there is no (or hardly any) activity. 3. A considerable increase in the coupling function with respect to the stimuli of the second signal system is noted at the same time in the rapport zone. This especially favours the formation of new cortical dynamic structures under the verbal influences of the hypnotist, these structures representing the physiological basis for effectuating the suggested actions and states.
“The foregoing peculiarities manifest themselves in the fact that the entire external second signal activity of the subject is reduced only to direct answers to the questions of the hypnotist with no independent reactions to any influences, including verbal, coming from other people (so-called isolated rapport). This is understandable, since the activity of the second signal system lying outside the rapport zone is inhibited” (pp. 73-74).
“As to the problem of the peculiarities of the conditioned reflex activity during suggested sleep, it will be noted that this problem has not been very extensively studied as yet. Nevertheless, the data of various authors are of indubitable interest, since they have revealed a number of specific peculiarities in the state of the higher nervous activity under these conditions.
“According to these data the conditioned reflex activity in suggested sleep undergoes certain changes. Thus, S. Levin observed in his early studies (1931) that in children under conditions of suggested sleep the motor and secretory conditioned reflexes elaborated earlier in the waking state grew very much weaker and that there was a dissociation both between the motor and secretory conditioned reflexes and between the unconditioned reflexes of salivation and mastication; he also observed the transitional (phasic) states–paradoxical, ultraparadoxical and inhibitory phases, all the way to the onset of complete sleep” (pp. 74-75).
Platonov indicates that conditioned reflexes may disappear during suggested sleep (Povorinsky & Traugott, 1936). Arousal from suggested sleep results in gradual restoration of the reflexes, with speech reactions inhibited first and restored last. Pen & Jigarov (1936) also showed that there is a weakening of conditioned reflexes, with increased latency, in suggested sleep. These authors showed that it is impossible to form new conditioned reflexes in deep states of suggested sleep, and the conditioning is difficult in lighter states.
“Y. Povorinsky’s data (1937) indicate that the conditioned reflexes elaborated in the waking state have a longer latent period during suggested sleep and in some subjects they are completely absent. Under these circumstances, the reactions to the verbal influences of the hypnotist are retained even during the deepest suggested sleep. The more complex and ontogenetically later conditioned bonds of the speech-motor analyzer are inhibited first as the subject lapses into a state of suggested sleep and are disinhibited the last as the subject awakens from this state” (p. 75).
“B. Pavlov and Y. Povorinsky observe (1953) that the conditioned bonds reinforced by the words of the hypnotist are formed during suggested sleep faster than in the waking state. In this case, during the somnambulistic phase of suggested sleep verbal reinforcements, as a rule, provoke a stronger and longer reaction with a shorter latent period than a direct first signal stimulus” (p. 76). The conditioning that occurs during suggested sleep does not manifest during waking periods unless suggestions are given during the sleep to react after wakening. The author takes this to be evidence that conditioned reflex activity can be modified by verbal suggestions.
During the somnambulistic stage of suggested sleep, subjects are less adept at performing addition. This indicates that inhibition has spread to the second signal system. However, inhibition of different sensory systems seems to vary from person to person. Krasnogorsky (1951) reported one subject did not react to light, but hearing seemed to be more sensitive than in the waking state.
“All of the above testifies to the considerable changes in the character of cortical activity regularly occurring during suggested sleep and determining, on the whole, the specific nature of higher nervous activity, the systematic study of which should be the object of further research” (p. 77).
1956
Barber, Theodore Xenophon (1956). ‘Sleep’ and ‘hypnosis’: A reappraisal. Journal of Clinical and Experimental Hypnosis, 4, 141-159.
NOTES
“Summary.
“Some recent experiments and a reevaluation of the electroencephalographic findings indicate that the term ‘hypnosis’ has subsumed at least two more or less distinct phenomena: (a) ‘hypnosis’ preceded by ‘trance-inducing suggestions’ which is closely related to ‘light sleep’ and (b) ‘hypnosis’ without ‘trance-inducing suggestions’ which is often a ‘waking’ state.
“From this viewpoint we can begin to reevaluate the contradictory physiological experiments comparing sleep and hypnosis, the most favorable conditions for producing hypnosis, amnesia and decreased suggestibility in very deep hypnosis, and the reports of waking and sleeping hypnosis. We can also reappraise such thorny problems in hypnotic theory as the production of hypnosis by artificial means, autohypnosis, and animal hypnosis.
“The argument presented calls for further research. We should investigate (a) suggestibility during extreme relaxation; (b) response on hypnotic tests when the subject is told, “Go to sleep and I’ll be back later to give you some tests’; (c) deep trance phenomena during sleep; (d) hypnotizability of good sleepers and insomniacs; (e) beneficial suggestions during sleep; (f) physiological functions during ‘light sleep’ and hypnosis; (g) the response of ‘sleep-walkers’ to standard hypnotic tests; (h) the relationship of ‘light sleep’ dreams to hypnotically induced dreams; and (i) the relationship of sleep amnesia to hypnotic amnesia” (pp. 153-154).
1954
Koster, S. (1954). Experimental investigation of the character of hypnosis. Journal of Clinical and Experimental Hypnosis, 2, 42-54.
NOTES
In waking, hypnosis, and sleep states 6 subjects were tested for knee-jerk height, key pressing to metronome signal, doing sums, recalling a story, etc. The Summary states:
“1. The height of the knee-jerk of all 6 subjects both in T and in “S” was much lower than in (W), the average height of all knee-jerks computed of the 6 subjects was both in T and in “S” only 39% of the average height in (W).
2. The [arm] catalepsy in T and in “S” continually existed.
3. The subjects in T and in “S” could hear well and perform active movements, though they reacted somewhat more slowly, and less forcibly than in (W) and sometimes only after some provocations.
4. The subjects both in T and in “S” could not only hear well, but could also present more or less complicated psychic impressions, reproducing them later again in “S” and also after the end of the experiment” (p. 50).
The author concluded, “Hypnosis is a sleeping-condition, but a special one. The specific difference consists of the fact that the subject’s many impressions, which he would observe in a waking-condition, he does not observe now, and does not react to, aside from impressions coming to him through the hypnotist. It can then be said that there is not an absence but a decrease of the active relation with the outer world. This is exactly the same state as the one during sleepwalking and the writer must repeat after all his investigations, what has already been stated: Essentially there is no difference between the condition of a hypnotized person and that of a sleepwalker” (p. 51).
1947
Kaufman, M. R.; Beaton, L. (1947). A psychiatric treatment in combat. Bulletin of the Menninger Clinic, 11, 1-14.
NOTES
Describes use of hypnosis in treating “combat fatigue” in field conditions during the Pacific campaigne of WWII. Hypnosis was utilized for sleep and rest in tent hospitals in or near combat to avoid chemical sedation as well as for reliving and mastering traumatic events. The milleau was one of expectant recovery with patients pitching tents, digging foxholes and serving as litter bearers. Psychiatric admissions were 12.8% of the total with return to duty rates varying with intensity of combat and duration of campaign with over half returned to comabt duty. Four detailed cases are reported.
SMOKING
2001
Barber, Joseph (2001). Freedom from smoking: Integrating hypnotic methods and rapid smoking to facilitate smoking cessation. International Journal of Clinical and Experimental Hypnosis, 49 (3), 257-266.
Hypnotic intervention can be integrated with a Rapid Smoking treatment protocol for smoking cessation. Reported here is a demonstration of such an integrated approach, including a detailed description of treatment rationale and procedures for such a short-term intervention. Of 43 consecutive patients undergoing this treatment protocol, 39 reported remaining abstinent at follow-up (6 months to 3 years post treatment).
Gibbons, Don E. (2001). Experience as an art form: Hypnosis, hyperempiria, and the Best Me technique. San Jose CA: Authors Choice Press. (([available online:] http//www.iuniverse.com/bookstore/marketplace))
NOTES
The Best Me Technique is a procedure for constructing suggestions which incorporates many different dimensions of experience — beliefs, emotions, sensations, thoughts, motives, and expectations — for maximum involvement and effectiveness. Best Me suggestions may be used with either hyperempiria, an alert induction based on suggestions of mind expansion and increased alertness and sensitivity, or with more traditional forms of hypnotic induction.
2000
Green, Joseph P.; Lynn, Steven Jay (2000, August). Hypnosis and suggestion-based approaches to smoking cessation: An examination of the evidence. [Paper] Presented at the annual meeting of the American Psychological Association, Washington, D. C..
This article reviews 59 studies of hypnosis and smoking cessation from the point of view of whether the research provides support for hypnosis as an empirically supported treatment (Chambless and Hollon, 1998). Whereas hypnotic procedures generally yield higher rates of abstinence relative to wait list and no treatment conditions, hypnotic interventions are generally comparable to a variety of nonhypnotic treatments. The evidence for whether hypnosis yields outcomes superior to placebos is mixed. In short, hypnosis can not be considered to be a specific and efficacious treatment for smoking cessation. Furthermore, in many cases, it is impossible to rule out cognitive/behavioral and educational interventions as the source of positive treatment gains associated with hypnotic treatments. Hypnosis can not, as yet, be regarded as a well-established treatment for smoking cessation. Nevertheless, it seems justified to classify hypnosis as a “possibly efficacious” treatment for smoking cessation. – Abstract taken from Psychological Hypnosis: A Bulletin of [Amer Psychol Assn] Division 30. Fall, 2000.
1999
Capafons, A. (1999). Applications of emotional self-regulation therapy. In Kirsch, I.; Capafons, A.; Cardeqa, E.; Amigs, S. (Ed.), Clinical hypnosis and self-regulation: Cognitive-behavioral perspectives (pp. 331-349). Washington, D.C.: American Psychological Association.
This chapter reviews the main applications of emotional self-regulation therapy, which have received empirical support: smoking reduction, obesity, fear of flying, drug addictions, and premenstrual distress and dysmenorrhea. The logic of each treatment and main empirical results are summarized.
1997
Bayot, A.; Capafons, A.; Cardeqa, E. (1997). Emotional self-regulation therapy: A new and efficacious treatment for smoking.. American Journal of Clinical Hypnosis, 40 (2), 146-156.
We described emotional self-regulation therapy, a recently-developed suggestion technique for the treatment of smoking, and present data attesting to its efficacy. Of the 38 individuals who completed treatment, 82% (47% of the initial sample)stopped smoking altogether and 13% (8% of the initial sample) reduced their smoking. A follow-up at 6 months showed that 66% (38% of the initial sample) of those who had completed the treatment remained abstinent and reported minimal withdrawal symptoms or weight gain. In a no-treatment comparison group, only 8% reduced their smoking or became abstinent.
Johnson, David L. (1997). Weight loss for women: Studies of smokers and nonsmokers using hypnosis and multicomponent treatments with and without overt aversion. Psychological Reports, 80 (3, Pt 1), 931-933.
Study 1 compared 50 overweight adult female smokers (mean age 37.7 yrs) and 50 nonsmokers (mean age 41.2 yrs) in an hypnosis-based, weight-loss program. Smokers and nonsmokers achieved significant weight losses and decreases in Body Mass Index. Study 2 treated 100 women either in an hypnosis only (n = 50) or an overt aversion and hypnosis (n = 50) program. This multicomponent follow-up study replicated significant weight losses and declines in Body Mass Index. The overt aversion and hypnosis program yielded significantly lower posttreatment weights and a greater average number of pounds lost. (PsycINFO Database Record (c) 2003 APA, all rights reserved)
1995
Capafons, A.; Amigs, S. (1995). Emotional self-regulation therapy for smoking reduction: Description and initial empirical data.. International Journal of Clinical and Experimental Hypnosis, 43 (1), 7-19.
Self-regulation therapy (Amigs, 1992)is a set of procedures derived from cognitive skill training programs for increasing hypnotizability. First, experiences are generated by actual stimuli. Clients are then asked to associate those experiences with various cues. They are then requested to generate the experiences in response to the cues, but without the actual stimuli. When they are able to do so quickly and easily, therapeutic suggestions are given. Studies of self-regulation therapy indicate that it can be used sucessfully to treat smoking.
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).
1993
Page, Roger A.; Handley, George W. (1993). The use of hypnosis in cocaine addiction. American Journal of Clinical Hypnosis, 36, 120-123.
An unusual case is presented in which hypnosis was successfully used to overcome a $50-0 (five grams) per day cocaine addiction. The subject was a female in her twenties. Six months into her addiction, she acquired a commercial weight-control tape that she used successfully to stop smoking cigarettes (mentally substituting the word “smoking”), as well as to bring her down from her cocaine high and allow her to fall asleep. After approximately 8 months of addiction, she decided to use the tape in an attempt to overcome the addiction itself. Over the next 4 months, she listened to the tape three times a day, mentally substituting the word “coke.” At the end of this period, her addiction was broken, and she has been drug free for the past 9 years. Her withdrawal and recovery were extraordinary because hypnosis was the only intervention, and no support network of any kind was available.
Spiegel, David; Frischholz, Edward J.; Fleiss, Joseph L.; Spiegel, Herbert (1993). Predictors of smoking abstinence following a single-session restructuring intervention with self hypnosis. American Journal of Psychiatry, 150, 1090-1097.
Examined the relation of smoking and medical history, social support, and hypnotizability to outcome with Spiegel’s smoking-cessation program. A consecutive series of 226 smokers were treated with the single-session approach and followed up for 2 years. With a total abstinence criterion, 52% success was found after 1 week, and 23% abstinence at 2 years. Hypnotizability and having been previously able to quit smoking for at least a month significantly predicted the initiation of abstinence. Hypnotizability and living with a significant other person predicted 2-year maintenance. The results are superior to those of spontaneous efforts to stop smoking and suggest it is possible to predict which patients are most likely to respond and which patients are least likely to respond to such a brief intervention.
1992
Spanos, Nicholas P.; Simulates, Ann; de Faye, Barbara; Mondoux, Thomas J.; Gabora, Natalie J. (1992-93). A comparison of hypnotic and nonhypnotic treatments for smoking. Imagination, Cognition and Personality, 12, 23-43.
Three experiments administered variants of Spiegel’s (1970) smoking cessation procedure to smokers in hypnotic and nonhypnotic treatments. Follow-up periods were from twelve to twenty-four weeks depending on the experiment. Complete abstinence was an infrequent outcome in all three experiments. Greater-than-control reductions in smoking for treated subjects were obtained in two of the experiments but, in both cases treatment and control subjects failed to differ significantly before the end of the follow-up period. Hypnotic and nonhypnotic treatments produced equivalent smoking reductions in all studies, and neither hypnotizability nor questionnaire assessments of motivation to quit correlated significantly with treatment outcome. Implications are discussed. NOTES 1:
NOTES
When the experimenters compared number of treatments they simply compared two sessions of Spiegel’s one-session treatment with four sessions of it. The authors make the point that perhaps they should vary the four sessions.
“In all three of the present experiments the abstinence rates associated with the Spiegel treatment were very low. Our abstinence rates were similar to those reported in one earlier study [4 – Perry et al.], but substantially lower than those reported in three other studies [2, 22, 25]. The reasons for these discrepancies between studies remains unclear, but experiment 3 suggests that these discrepancies cannot be accounted for simply in terms of whether the subjects were drawn from a university or nonuniversity population, and experiment 2 suggests that the discrepancies are unrelated to the number of treatment sessions administered to subjects.
“The finding that hypnotic and nonhypnotic subjects in all three experiments attained equivalent reductions in smoking is consistent with other comparison studies in this area which indicate that hypnotic treatments are no more effective than various nonhypnotic procedures at inducing reductions in smoking [22, 25, 30]. More generally, these findings are consistent with comparison studies on a wide variety of clinical disorders (headache pain, warts, phobias, obesity) which indicate that hypnotic treatments are no more effective than nonhypnotic ones at producing therapeutic change (see [3] for a review).
“The failure to find significant correlations between smoking reduction and hypnotizability among treated subjects is also consistent with the findings of most studies in this area [3], but the reasons why significant correlations between these variables are found in some studies and not others remains unclear. Spanos [3] suggested that significant correlations between these variables are particularly likely when hypnotizability testing is integrated into the treatment protocol. Under these circumstances subjects are likely to form strong expectations about treatment success on the basis of their self- observed responses to the hypnotizability scale. Such expectations may, in turn, influence subjects’ motivations to comply with the treatment regimen, the self-statements they make concerning their likelihood of quitting, etc. In all of the present experiments hypnotizability was assessed at the end of the follow-up period and, therefore, could not influence subjects’ expectations of treatment success” (pp. 40-41).
Spiegel, David (1992, October). Hypnotizability. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington, VA.
NOTES
Dr. Spiegel announced that this was a last minute substitution for Fred Frankel’s presentation on Hypnotizability.
We have ongoing a major replication of the study that we published on group therapy with terminally ill breast cancer patients. The matched control patients get educational materials but not psychotherapy. We are looking at NKC cytotoxicity and delayed hypersensitivity.
Tasks: spend 15 minutes discussing list of problems; 15 minutes discussing things like, “What is your spouse doing that doesn’t help; what can we do to help it?” We get drop in NKC cytotoxicity immediately afterward, returning after 24 hrs to usual levels. Controls don’t drop in NKC cytotoxicity. This measure of stress may be a predictor of survival time.
In Fawzy’s study of group therapy with melanoma patients, they noted a significant difference at 6 months in interferon augmented activity of NK, which didn’t hold up at a year. But at 6 years there were 10 of 40 deaths in control group vs 3 of 40 deaths in treated group. This is a vigorous effect.
Cohen’s study of colds in New England J. of Med is another good clinical study.
There are two broad areas of relevance of hypnotizability to healing: 1. Hypnotizability as a trait: do highs differ in way they regulate body or mind? 2. Is there something you do when in hypnotized state that is different? Studies of treatment of warts with hypnosis are important 3. Transition between states, e.g. circadian rhythms; is there a shift in wakefulness between trance and nontrance states that affects health?
Psychiatric Diagnosis and self regulation. High hypnotizability is associated with certain psychiatric disorders (dissociative reaction, PTSD, MPD, etc.). Schizophrenics score much lower than normals (av. = 4 vs 7; replicated with the Hypnotic Induction Profile (HIP). Stanford Hypnotizability Scales show no difference in means, but do show a difference in range). I don’t know what this means. But schizophrenics can falsely pass some Stanford Scale items, e.g. amnesia which they don’t however reverse; so schizophrenics’ hypnotizability scores may be inflated on Stanford scales. We don’t see extremely high scores in schizophrenics.
Psychoactive medication doesn’t affect scores of schizophrenics, but improves scores of anxiety neurotics (by reducing anxiety). Frischholz has an article coming out in a psychiatry journal that confirms this.
There is a lot of evidence that patients with dissociative disorders are more hypnotizable than other groups. Frischholz et al couldn’t replicate Frankel’s finding of higher scores in phobics. Pettinati et al found higher scores in bulimia and I haven’t seen anything to counter that. Another idea is that high hypnotizables are very good at internal regulation
Spiegel & Ken Kline selected Ss who could regulate gastric activity. They got an 80% increase in gastric acid output while imagining eating; got 40% decrease in output when imagining something pleasant that wasn’t imagining eating. Injected with pentagastrin, which induces gastric output, they still got a decrease in gastric acid output in the relaxation condition.
This suggests that hypnotizability should be a selection criterion for some research. See also Katz et al. 1974 (?) with acupuncture; and McGlashan, Evans & Orne on the placebo response.
Herbert Spiegel found that 2/3 of highs but 1/3 of lows were cured of phobia. Eye roll sign on the HIP, living with spouse/lover, rating self as hypnotizable, and giving a postcard follow-up response at one week post treatment were associated with 89% rate abstinence at 2 years follow-up, when only 23% overall of 223 were abstinent. Absence of those positive predictors was associated with only a 4% rate of abstinence.
1991
Court, John (1991). Lord of the trance. Journal of Psychology and Christianity, 10 (3), 261-265.
A verbatim account of hypnotically-based therapy utilizing Christian imagery serves as the basis for illustrating some of the benefits of this appraoch where therapist and client share the same value system. The interactions challenge some of the familiar objections to Christian involvement with hypnosis.
Holroyd, Jean (1991). The uncertain relationship between hypnotizability and smoking treatment outcome. International Journal of Clinical and Experimental Hypnosis, 39, 93-102.
Literature on the relationship between hypnotizability and smoking treatment outcome was reviewed. 91 private patients treated for smoking with hypnotherapy participated in an investigation designed to correct problems in some of the earlier research. 43% quit smoking by the end of treatment but only 16% abstained at least 6 months. Neither immediate quitting nor continued abstinence correlated with hypnotizability. Other variables hypothesized to predict smoking cessation also were not correlated with outcome: number of treatment sessions, need to smoke, motivation to quit, and gender. The low abstention rate may have impeded verification of a relationship between hypnotizability and treatment outcome.
NOTES
In the Discussion, the author notes that the low overall abstention rate works against finding the predicted relationships, as did restricted range on the hypnotizability measure. “Secondly, the present research design in effect tested the potency of hypnosis (hypnotizable patients) against nonhypnotic treatment (nonhypnotizable control patients) in a research design recommended by Orne (1977). Intensive nonhypnotic involvement with the nonhypnotizable individuals over several sessions may have worked against finding differences between low and high hypnotizables” (p. 99).
“Patients generally did not complete the recommended four sessions … and they generally were non-adherent to recommended follow-up telephone contact. The observed relationship between initial quitting and number of treatment sessions may exist because people who are responding to treatment stay in treatment longer, or because more treatment sessions provide a more potent intervention, or both” (p. 99). “Treatment contracts between patients and therapist increased the number of sessions that patients completed but did not increase their abstinence rate” (p. 100).
1990
Suedfeld, Peter (1990). Restricted environmental stimulation and smoking cessation: A 15-year progress report. International Journal of the Addictions, 25, 861-888.
The first successful use of restricted environmental stimulation therapy (REST) as a method of smoking cessation was reported in this journal in 1972. Since then, close to 20 papers and articles have further investigated this application. The results have been consistently positive and have further shown that–unlike most techniques–REST combines synergistically with other effective treatment modalities. The effect of REST seems to target primarily the major problem with other known treatments in this area: It substantially reduces the relapse rate among clients who quit smoking at the end of treatment. Furthermore, REST is safe, has no known adverse side effects, and is easily tolerated by most participants. Nevertheless, the method has not found wide acceptance among practitioners. This paper explores and answers some of the concerns that may be involved in its relative lack of popularity. NOTES 1:
NOTES
Provides a thorough review of REST (restricted environmental stimulation technique) and smoking cessation, with analysis of why the technique has not been widely adopted, how to set up a lab (including costs and equipment), and the political considerations surrounding REST research (many of which would apply to hypnosis). The author describes how sensory restriction got a bad reputation in Hebb’s lab. But both “brainwashing” and intensive interrogation rely primarily on overstimulation and intense stimulus bombardment; these are occasionally interrupted for brief periods to arouse fear and uncertainty about their resumption.
The optimal approach in treatment of smokers seems to be to combine an approach that maximizes immediate cessation rates, with REST which maximizes continuing maintenance rates. Tikalsky (1984) reported that combining REST with self- management training and the establishment of a social support group, there was a 6-month abstinence rate of 88%. (This was a clinical treatment study rather than a controlled experiment.)
“The estimated maintenance rates after REST converge at about 50%, about twice as high as those commonly accepted as characterizing the literature (see, e.g., Hunt and Bespalec, 1974; Shumaker & Grunberg, 1986). The unusually high maintenance rates (percentage of subjects who were abstinent at every follow-up throughout 12 months, using as the baseline those who had quit at end of treatment) are in most–although not all- -cases combined with only average quit rates (using total number of followed-up subjects as the baseline), indicating that the initial impact of REST is less impressive than its effect on long-term maintenance” (p. 872).
Why is REST underutilized? Some say it is a placebo. But there is evidence that “expectancy has but little effect on objectively quantifiable (as opposed to subjective) measures in REST (Barabasz & Barabasz, 1990; Suedfeld, 1969b; Suedfeld, Landon, Epstein, & Pargament, 1971)” (p. 873). See also Suedfeld & Baker-Brown (1986).
How does REST work? “In REST, the normal flow of exogenous stimuli is suddenly and very drastically reduced. As a result, attention can be (in fact, must be, if the processing of information is a basic human need) refocused to the ongoing internal generation of physiological, cognitive, affective, memorial, imaginal, and other stimulation. This enables REST participants to concentrate on working out personal problems, including (if so desired) those related to the continuation or termination of their smoking habit” (p. 874).
Second, the removal of specific smoking-related cues interrupts automatic, overlearned response sequences so most clients report that they no longer smoke mechanically, and conditioned cravings for a cigarette are extinguished in many Ss.
It appears from the literature that low-arousal treatments such as hypnosis and meditation are reinforced by REST. REST should improve conditioning or cognitive change therapies because it improves learning and memory, and research supports this assumption. REST also should facilitate the acceptance of information (‘messages’) because it decreases defenses against novel or dissonant information, but that has not proven true in research to date.
1988
Jeffrey, L. K.; Jeffrey, T. B. (1988). Exclusion therapy in smoking cessation: A brief communication. International Journal of Clinical and Experimental Hypnosis, 36 (2), 70-74.
This study investigated the effect of exclusion therapy on the outcome of a 5-session treatment protocol for smoking cessation. A total of 120 Ss were randomly assigned to a group hypnotic and behavioral program which required 48 hours of pretreatment abstinence from use of tobacco products, or to an identical treatment which encouraged, but did notinclude, this pretreatment stipulation. Results indicated there were no significant differences between groups in dropout rates or number of Ss abstinent from smoking. For all Ss, including dropouts, the abstinence rate was 59.2% upon completion of treatment. It was 45.5% and 36.7% at 1- and 3-month follow-up, respectively.
Neufeld, V.; Lynn, Steven Jay (1988). A single-session group self-hypnosis smoking cessation treatment: A brief communication. International Journal of Clinical and Experimental Hypnosis, 36 (2), 75-79.
This study was designed to assess the efficacy of a manual-based, single-session group of self-hypnosis intervention. At 3 months follow-up, 25.92% of the total number of participants (14 male, 13 females) reported continuous abstinence, and at 6 months, 18.52% of the participants reported continuous abstinence. Reported social support and motivation to quit were both associated with successful outcome. Comparison of the current data with other findings reported by the American Lung Association (Davis, Faust, & Ordentlich, 1984) suggests that treatment effects may not be solely attributable to the use of a maintenance manual, education, and attention. Limitations of the research associated with issues of experimental control, generalizability of the findings, and outcome measures are discussed.
Williams, J. M.; Hall, D. W. (1988). Use of single session hypnosis for smoking cessation. Addictive Behaviors, 13, 205-208.
Twenty volunteers for smoking cessation were assigned to single-session hypnosis, 20 to a placebo control condition, and 20 to a no-treatment control condition. The single-session hypnosis group smoked significantly less cigarettes and were significantly more abstinent than a placebo control group and a no-treatment control group at posttest, and 4-week, 12-week, 24-week, and 48-week follow-ups.
1987
Gmur, M.; Tschopp, A. (1987). Factors determining the success of nicotine withdrawal: 12-year follow-up of 532 smokers after suggestion therapy (by a faith healer). International Journal of Addictions, 22, 1189-1200.
In 1973, 532 heavy smokers were questioned prior to treatment by the faith healer Hermano and requestioned 4 months, 1 year, 5 years, and 12 years after the therapeutic ritual. From the moment of treatment, 40% of the subjects remained nonsmokers (with no relapse) after 4 months, 32.5% after one year, 20% after 5 years, and 15.9% after 12 years. At the time of the follow-up, 37.5% of the Ss were nonsmokers, the majority of them having stopped smoking again after suffering a relapse. To investigate factors determining success, Ss who for 12 years had uninterrupted abstinence were compared with those who for 12 years had continued to smoke almost without interruption. Personality factors, sociodemographic features, and characteristics of smoking behavior showed no demonstrable connection with the tendency to relapse. On the other hand, it did prove possible to explain 16% of the variance in the responses to treatment: in particular, high alcohol consumption, markedly addictive smoking, rare attendance at church, and the attitude that ‘you have to believe in the treatment’ were found to be conducive to relapse and addiction.
1986
Barabasz, Arreed F.; Baer, Lee; Sheehan, David V.; Barabasz, Marianne (1986). A three-year follow-up of hypnosis and restricted environmental stimulation therapy for smoking. International Journal of Clinical and Experimental Hypnosis, 34, 169-181.
Clinical follow-up data were obtained from 307 clients. Clinicians’ experience level, contact time, and procedural thoroughness varied in 6 interventions for smoking cessation. An additional intervention combined hypnosis with restricted environmental stimulation therapy (REST). The major results suggest positive treatment outcomes to be related to greater hypnotizability, absorption, hypnotist experience level, procedural thoroughness, and client-therapist contact time. The least effective intervention (4% abstinence at 4-month follow-up) involved intern trainees using a short, single-session approach. The most effective procedure (47% abstinence at 19-month follow-up) involved the combination of hypnosis and
REST. Data interpretation limitations are discussed.
Lambe, R.; Osier, C.; Franks, P. (1986). A randomized controlled trial of hypnotherapy for smoking cessation. Journal of Family Practice, 22, 61-65.
NOTES
242 patients who were smokers (49% of all patients in this group family practice) were contacted, and 180 (74%) who were interested in hypnosis as a method of helping them quit were included in the study. These 180 were randomly assigned to control and hypnosis groups. Of the 90 assigned to hypnosis: 50% 45 had at least 1 hypnosis session
7% 6 quit smoking before hypnosis 20% 18 declined hypnosis 23% 21 were lost to follow-up [This gives some idea about volunteer participation in research.]
1985
Jeffrey, Timothy B.; Jeffrey, Louise K.; Greuling, Jacquelin W.; Gentry, William R. (1985). Evaluation of a brief group treatment package including hypnotic induction for maintenance of smoking cessation: A brief communication. International Journal of Clinical and Experimental Hypnosis, 33 (2), 95-98.
Hypnotic, cognitive, and behavioral interventions were used in a 5-session treatment program to assist 35 Ss with maintenance of smoking cessation. 63% of the treated Ss discontinued smoking, and 31% maintained abstinence for 3 months (p <.005). These results include 13 dropouts, all of whom were smoking at 3 months follow-up. No S in the waiting-list-control group quit smoking. The results demonstrate that a brief, group treatment program, including hypnotic techniques, can be effective for smoking cessation. 1980 Holroyd, Jean (1980). Hypnosis treatment for smoking: An evaluative review. International Journal of Clinical and Experimental Hypnosis, 28 (4), 341-357. 17 studies of hypnosis for treatment of smoking published since 1970 were reviewed. Abstinence after 6 months posttreatment ranged from 4% to 88%. Effectiveness of treatment outcome was examined in terms of: S population, individual versus group treatment, standardized versus individualized suggestions, use of self-hypnosis, number of treatment sessions and time span covered by the treatment, and use of adjunctive treatment. At 6 months follow-up, more than 50% of smokers remained abstinent in programs in which there were several hours of treatment, intense interpersonal interaction (e.g., individual sessions, marathon hypnosis, mutual group hypnosis), suggestions capitalizing on specific motivations of individual patients, and adjunctive or follow-up contact. The 17 studies are presented in sufficient detail to permit clinicians to follow the published procedures, and recommendations are made for future research. Powell, Douglas H. (1980). Helping habitual smokers using flooding and hypnotic desensitization techniques: A brief communication. International Journal of Clinical and Experimental Hypnosis, 28 (3), 192-196. A subgroup of individuals who were helped to stop smoking by hypnosis or other means returned to consuming a few cigarettes a day. A flooding and hypnotic desensitization technique assisted 4 of 7 individuals who resumed smoking in becoming and remaining abstinent for a 6- to 9-month follow-up period. 1979 Pederson, Linda L.; Scrimgeour, William G.; Lefcoe, Neville M. (1979). Variables of hypnosis which are related to success in a smoking withdrawal program. International Journal of Clinical and Experimental Hypnosis, 27 (1), 14-20. 65 habitual smokers were randomly assigned to one of 4 groups: live-hypnosis plus counseling, videotape-hypnosis plus counseling, relaxation-hypnosis plus counseling, and counseling alone. The content and mode of presentation of the hypnosis session varied among the first 3 groups. At 6 months posttreatment, the live-hypnosis plus counseling group contained significantly more abstainers than the other 3 groups. The importance of the specific content of the hypnosis session and the presence of the hypnotherapist for the effectiveness of the procedure is discussed. Perry, Campbell; Gelfand, Robert; Marcovitch, Phillip (1979). The relevance of hypnotic susceptibility in the clinical context. Journal of Abnormal Psychology, 88 (5), 592-603. Despite experimental evidence that hypnotic susceptibility is a relatively stable characteristic of the individual, and one that is very difficult to modify, clinical investigators tend to see susceptibility as irrelevant to therapeutic outcome. Such investigators view motivational and interpersonal variables as more essential to the therapeutic change. The evidence for the clinical relevance of hypnotizability is sparse and contradictory. Most existing studies stem from medical hypnosis and indicate that susceptibility plays an important role in the successful treatment of such conditions as clinical pain, warts, and asthma. Two studies are reported that seek to pursue a contrary finding reported by Perry and Mullen, who found that susceptibility was unrelated to the successful treatment of a socially learned behavior (cigarette smoking). Both studies confirmed the earlier finding of a lack of relation. In Study 1, however, stepwise multiple regression analysis located three inventory items concerning the motivation of cigarette smokers. The combination of items was found to predict outcome for 67.39% of 46 clients treated either by hypnosis or by rapid smoking. The finding was replicated in Study 2, which utilized a combined hypnosis - rapid smoking technique and employed a different therapist. The outcome for 9 of the 13 quitters and 37 of the 62 nonquitters across the two studies could be predicted by the three motivational questionnaire variables. 1978 Stanton, Harry E. (1978). A one-session hypnotic approach to modifying smoking behavior. International Journal of Clinical and Experimental Hypnosis, 26, 22-29. Recent literature reviewing attempts to modify smoking behavior through the use of hypnosis is outlined, and an approach utilizing only 1 treatment is described. This single session includes: (a) the establishment of a favorable "mental set" on the part of the patient, (b) a hypnotic induction, (c) ego-enhancing suggestions, (d) specific suggestions directed toward the cessation of smoking, (e) an adaption of the "red balloon" visualization, and (f) success visualization. Of 75 patients treated by this technique, 45 ceased smoking. 6 months after the treatment session, 34, or 45%, were still nonsmokers, attesting to the efficacy of the method. 1977 Barkley, R. A.; Hastings, J. E.; Jackson, T. L., Jr. (1977). The effects of rapid smoking and hypnosis in the treatment of smoking behavior. International Journal of Clinical and Experimental Hypnosis, 25 (1), 7-17.