Item Pass Percents Intercorrelations were reported as follows:
HGS 1.00 ISHb .72 1.00 ISHt .70 .82 1.00
ISHb = time calculated by breaths ISHt = time calculated by timer
The Inventory of Self Hypnosis (ISH) consists of 12 items, the same ones as in the Harvard scale with a few minor exceptions. Subjects are told that the inventory “is designed to teach self-hypnosis and that all of the information needed for a person to induce hypnosis in himself and to give himself a series of simple suggestions is contained in the inventory booklet” (p. 40). Therefore, there is more emphasis on hypnosis as an active imagination (cognitive) skill. An example, using a suggestion for Immobilization of the Right Arm, follows.
“This set of instructions is devoted to having it become very difficult for you to lift your right arm. These instructions involve a count of 33 breaths. The first 30 breaths is the _suggestion phase_ and the final three breaths is the _trial phase_.
“When ready close your eyes and pay close attention to your right arm. Notice how your arm shares in the general feeling of heaviness that you feel all over your body. Throughout the count of 30 breaths concentrate your thoughts on the idea of how heavy it feels; think about it growing more and more heavy, heavy like lead. Although you should try not to lift it until later, notice how the arm seems to become much too heavy to lift.
“At the end of the 30 breaths take 3 extra breaths. During this new count try to lift your arm to see how heavy it is. Perhaps in spite of being so heavy you will be able to lift it a little, although by then it may be too heavy even for that. You will notice that there is some resistance because of the relaxed state you are in. After the three breaths stop trying and relax. In a few moments your arm will feel normal again, no longer heavy; you can easily lift it if you want to. At that point open your eyes and continue reading below the double lines.
“Summary of instructions:
“Initial actions: Close your eyes. Pay close attention to the feelings in your right arm.
“During count of 30 breaths — Main Actions: Concentrate on the idea of your arm becoming so heavy that you would not be able to lift it.
“3 breaths — Try to lift your arm.
“Post actions: Let normal feeling return to your arm. Open your eyes and continue reading” (p. 41).

Sutcliffe, J. P. (1972). Afterimages of real and imaged stimuli. Australian Journal of Psychology, 24 (3), 275-289.

Tested 45 university students and 15 7-10 yr. olds for after-images of images and of real stimuli. 8 different colored stimuli were used and observations made enabled a check on reliability. Real stimuli typically produced negative afterimages in most Ss. Only half the Ss could project images of the stimuli, only 1/3 reported afterimages of those images, and of those images only 7% were negative. Afterimages of images had a longer latency and a shorter duration than afterimages of real stimuli. Thus qualitatively and quantitatively afterimages of images differ from afterimages of real stimuli. Findings are related to individual differences in general vividness of imagery. (18 ref.) (PsycINFO Database Record (c) 2002 APA, all rights reserved)

Duke, J. D. (1969). Relatedness and waking suggestibility. International Journal of Clinical and Experimental Hypnosis, 17, 242-250.

Volunteering pairs of Ss took 9 waking tests (WT) of hypnotic susceptibility. Pairs included siblings, friends, and strangers. Concordance correlations from 20 sibling pairs were positive for 7 of the 9 WT, 2 significantly so. For 19 pairs of strangers, correlations were insignificant, 5 positive, 4 negative. Data reopen nature-nurture questions about the origins of individual differences in hypnotic aptitude. For 20 pairs of cross-sex friends, 7 of 9 correlations were negative, 1 significant, and 2 approaching significance. 6 of 9 concordance correlations from 16 spouse pairs were also negative, but none was significant. (Spanish & German summaries) (17 ref.) (PsycINFO Database Record (c) 2002 APA, all rights reserved)
Garmize, L. M.; Marcuse, F. L. (1969). Some parameters of body sway. International Journal of Clinical and Experimental Hypnosis, 17, 189-194.
Investigated the effects of 4 variables on body sway with 160 undergraduates. A 4-dimensional analysis of variance was performed on the body sway scores obtained. None of the main effects were significant. 1 of the interactions was significant, but might have been due to chance. Results are consistent with those of past researchers. (Spanish & German summaries) (16 ref.) (PsycINFO Database Record (c) 2002 APA, all rights reserved)

Barber, Theodore Xenophon; Calverley, David S. (1968). Toward a theory of ‘hypnotic’ behavior: Replication and extension of experiments by Barber and co-workers (1962-65) and Hilgard and Tart (1966). International Journal of Clinical and Experimental Hypnosis, 16, 179-195.


Tart, Charles T.; Hilgard, Ernest R. (1966). Responsiveness to suggestions under ‘hypnosis’ and ‘waking-imagination’ conditions: A methodological observation. International Journal of Clinical and Experimental Hypnosis, 14, 246-256. (Abstracted in American Journal of Clinical Hypnosis, 1966, 2, 158)

2 groups of Ss were selected, on the basis of previous experimental participation, for a study of hypnotic analgesia. 1 group was highly responsive to suggestions in a waking suggestion condition as well as following a formal hypnotic induction procedure. The other group was unresponsive to suggestions unless given a hypnotic induction, following which they became highly responsive. It was found that the former group was no longer highly suggestible under waking conditions: their self-reports as to how hypnotized they felt strongly suggested that they had been highly responsive to waking suggestion previously because the experimental conditions had allowed them to spontaneously enter hypnosis. The difference in responsiveness when this was not allowed was striking, even with only 11 Ss. Methodological implications of this finding are discussed. (Spanish & German summaries) (16 ref.) (PsycINFO Database Record (c) 2002 APA, all rights reserved)

Das, J. P. (1965). Relationship between body-sway, hand-levitation, and a questionnaire measure of hypnotic susceptibility. International Journal of Clinical and Experimental Hypnosis, 13 (1), 26-33.

67 randomly selected college students were administered the body-sway test, a questionnaire measure of tranceability, and an induction procedure utilizing hand-levitation to determine hypnotic susceptibility. The 6 Es varied in age, sex; 5 of them had little experience as hypnotists. All reference to “hypnosis” was omitted from the induction procedure. Significant phi-coefficients between body-sway and levitation (.52), levitation and tranceability frequency (.28) and intensity (.25), and body-sway and tranceability intensity (.33) were obtained. (16 ref.) (PsycINFO Database Record (c) 2002 APA, all rights reserved)

Anderson, Milton L.; Sarbin, T. R. (1964). Base rate expectations and motoric alterations in hypnosis. International Journal of Clinical and Experimental Hypnosis, 12 (3), 147-158.

Degree of responsiveness to “suggestion” in an experiment which did not utilize hypnotic induction (the Berkeley Sample) was comparable to that obtained in an experiment which did utilize hypnotic induction (the Stanford Sample). Procedural differences between the 2 experiments–self-scoring vs. objective-scoring, and group vs. individual testing–were regarded as not crucial in making a comparison of the 2 experiments. The distribution of responses in the Berkeley Sample may be taken as the base rate. The slightly higher degree of responsiveness over the base rate in the Stanford Sample (on some tests) may be attributed to the “degree of volunteering” that characterized the sample. The importance for experiments in the future to create equal levels of motivation and expectation to perform well under both the hypnotic and the nonhypnotic conditions is stressed, and brief mention is made of a new metaphor to be used in the conceptualization of the problems of hypnosis. (25 ref.) (PsycINFO Database Record (c) 2002 APA, all rights reserved)

Furneaux, W. D. (1964). The heat-illusion test and the structure of suggestibility. International Journal of Clinical and Experimental Hypnosis, 12 (3), 169-180.

2 similar forms of the heat-illusion test are shown to correlate to a smaller degree than would be expected if they measure the same attribute. The 2 versions also differ in the way in which they correlate with other suggestibility tests. It is shown that linear regression techniques are not appropriate for analyzing the data concerned. The interaction of various nonlinear relationships with a difference in “difficulty,” as between the 2 forms of the illusion, seems to provide an adequate explanation for the results. It is suggested that these nonlinear relationships may indicate the existence of an attribute which prevents some Ss from responding to any suggestibility test, irrespective of what the specific mechanisms of response may be. (PsycINFO Database Record (c) 2002 APA, all rights reserved)
Evans, Frederick J. (1963). The Maudsley Personality Inventory, suggestibility and hypnosis. International Journal of Clinical and Experimental Hypnosis, 11, 187-200.

An attempt to replicate the claim of Furneaux and Gibson (1961) that stable extraverts and neurotic introverts were more susceptible to hypnotic suggestion than neurotic extraverts and stable introverts, using the MPI dimensions, was unsuccessful. Some “trends” are discussed. (PsycINFO Database Record (c) 2002 APA, all rights reserved)

Furneaux, W. D. (1963). Neuroticism, Extraversion, answer suggestibility: A comment. International Journal of Clinical and Experimental Hypnosis, 11, 201-202.
Author develops hypotheses about the relationships between scores on the Maudsley Personality Inventory (MPI) and suggestibility.
“(a) The effective-drive experienced by a S in a suggestibility test, or hypnosis situation, is positively correlated with both neuroticism and with extraversion, as measured by the MPI.
(b) Effective-drive is also a function of the ”press” of the test situation, and of the S”s previous experience.
(c) Within the range of values of effective-drive lower than the Yerkes-Dodson optimum for the test being studied, the magnitude of response to a suggestibility test (or hypnosis) is a positive function of drive.
(d) For values of effective-drive greater than the Yerkes-Dodson optimum, response is a negative function of drive” (p. 201).

Hoskovec, J.; Svorad, D.; Lanc, O (1963). The comparative effectiveness of spoken and tape-recorded suggestions of body sway. International Journal of Clinical and Experimental Hypnosis, 11, 163-166.

The relative effectiveness of tape-recorded vs. spoken suggestions of body sway was measured. Both types of suggestion produced increased body sway. Spoken suggestions following recorded suggestions were the most effective. The expectation by Ss of a greater effectiveness of live presentation may have produced this result. (PsycINFO Database Record (c) 2002 APA, all rights reserved)

Gibson, H. B. (1962). Furneaux’s discussion of extroversion and neuroticism with regard to suggestibility. International Journal of Clinical and Experimental Hypnosis, 10, 281-287. (Abstracted in Index Medicus, 63, March, S-676)

Hypotheses suggested by Furneaux (see 36: 4II95F) are criticized on the grounds that his basic assumption that extraverts attend more closely in the interpersonal situation is unwarranted. It is maintained on the contrary that introverts are the less distractible and it is shown that the data published earlier by Furneaux and Gibson (see 36: 3II67F) accord with a theoretical model derived from Spence. The results are also discussed in terms of an alternative interpretation. It is further contended that Furneaux”s treatment of the data leads to other inconsistencies. (PsycINFO Database Record (c) 2002 APA, all rights reserved)

Kuhner, Arthur (1962). Hypnosis without hypnosis. International Journal of Clinical and Experimental Hypnosis, 10 (2), 93-99.

The traditional concept of hypnosis that seeks a “sleep” state through employment of formal induction techniques seriously limits its general clinical applicability. It fails to fit the special needs of the patient. An approach designed to counteract this shortcoming manipulates the interpersonal relationship factor. Case illustrations from dental practice support the viewpoint that the proper relationship is akin to the hypnotic one and comparable results obtain without resort to ritualistic induction methods. (PsycINFO Database Record (c) 2002 APA, all rights reserved)

Das, J. P. (1961). Body-sway suggestibility and mental deficiency. International Journal of Clinical and Experimental Hypnosis, 13-15.

50 mental defectives were subjected to the body-sway test of suggestibility. Contrary to expectations the defectives did not differ from each other when taken according to grades of deficiency, nor do they differ, as a group, from normal (college) controls. From Psyc Abstracts 36:02:2JI13D. (PsycINFO Database Record (c) 2002 APA, all rights reserved)

Furneaux, W. D. (1961). Neuroticism, extroversion, drive, and suggestibility. International Journal of Clinical and Experimental Hypnosis, 9, 195-214. (Abstracted in Psychological Abstracts, 62: 4 II 95F)

In the group studied, the body-sway scores of stable extraverts and neurotic introverts tended to be large, whereas they were smaller for stable introverts and neurotic extraverts. This result was explained in terms of a theoretical model in which the effective drive produced in a S by a test-situation is a function of both his neuroticism and his extraversion. The author believes that the theoretical model generates a number of predictions and suggestions which can serve to guide future experimental work in this field. From Psyc Abstracts 36:04:4II95F. (PsycINFO Database Record (c) 2002 APA, all rights reserved)

Klopp, Kirk K. (1961). Production of local anesthesia using waking suggestion with the child patient. International Journal of Clinical and Experimental Hypnosis, 9, 59-62.

Author describes the use of waking suggestion with children, as opposed to hypnosis. The technique “is simply the presentation of an idea which is sold to the child with such emphasis that when it is communicated to him, he accepts it with conviction. As children reason for the most part paralogically, the absence of logical grounds for the acceptance of the idea is arrived at easier than with the more mature mind of the adult” (p. 59).

Conn, Jacob H. (1959). Cultural and clinical aspects of hypnosis, placebos, and suggestibility. International Journal of Clinical and Experimental Hypnosis, 7 (4), 175-185.

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).

Dittborn, Julio M. (1958). Expectation as a factor of sleep suggestibility. Journal of Clinical and Experimental Hypnosis, 6 (4), 164-170. (Abstracted in Psychological Abstracts 61: 2390)

Authors studied expectation (“the attitude of waiting attentively for something usually to a certain extent defined, however vaguely,” as defined by Drever) as a factor of sleep suggestibility. They tested young soldiers in the Chilean army using the posteral sway test of suggestibility, repeated twice, to yield 12 Subjects. Afer a third postural sway test the Subjects were required to respond to a series of visual, then later oral, stimuli. [Experimental instruments are not clearly described in this article.]
The Subjects returned a week later and were asked to respond to the stimuli by using the word “sueno” (dream) for two Ss and “dormir” (sleep) for another two. The word “sleep” was used in the third experiment, following suggestions like “As you read more and more or as you hear yourself repeating the word ‘sleep or dream’ over and over again you will become more and more sleepy” (p. 166).
Apparently the outcome measure was the number of stimuli to which the Subject responded before lack of response indicated a trance. [Description is unclear.]

Solovey, Galina; Milechnin, Anatol (1957). Concerning the induction of the hypnotic state. Journal of Clinical and Experimental Hypnosis, 5 (2), 82-98.

The hypnotic state has four attributes: “an effect of emotional stabilitization, a retrogression to an infantile psychological functioning, suggestibility, and transmissibility of the hypnotic relationship” (p. 82). “SUGGESTIBILITY is a special motivation to accept, incorporate within one’s self, and execute direct or implicit propositions, which is equivalent to the motvation of a child to accept, assimilate and carry out the propositions of its parents” (p. 84). The authors propose that verbal and non-verbal suggestions are incorporated during the course of education, lasting years and thus becoming in effect post-hypnotic suggestions. “The person will have in the future a _special responsiveness,_ that may be more or less pronounced according to the circumstances, _for those data_ (coming from books, movies, conversations, etc.) _which agree with his emotionally-incorporated post-hypnotic suggestions_” (p. 85). If while in an auto-hypnotic condition he comes in contact with someone “who appears to be the embodiment of the convictions or prejudices that on being stimulated started the process of emotional activation that led to the development of the hypnotic state, _there may be a transformation of the auto-hypnotic condition into an interpersonal hypnotic relationship_ (p. 86).
According to the authors, this theory can explain post-hypnotic (negative) sequellae. It also accomodates explantions of both Natural or Direct Orientation inductions and Indirect Orientation inductons, and explains phenomena such as patients entering hypnosis rather automatically while awaiting the appearance of Mesmer in his waiting room.
“To conclude, we will stress that the psychological mechanism of hypnotic induction is exactly _the same_ in everyday life and in the experimental environment. The apparent differences like [sic] in the _behavior_ of the subject in the hypnotic state, and are due to the motivation that arises from the circumstances and to the convictions, capacities, psychologicl maturity, and degree of retrogression of the individual” (p. 96).

Solovey, Galina; Milechnin, Anatol (1957). Concerning the nature of hypnotic phenomena. Journal of Clinical and Experimental Hypnosis, 5 (2), 67-76.

The authors write about the place of the hypnotic state in general psychology: “the study of the _psychological mechanisms_ that make the appearance of the phenomenon _possible, which need not be different from the normal and current psychological mechanisms in everyday life_” (p. 67). They classify hypnotic phenomena into three groups:
“I. Phenomena _which are a function of the state of psychological_ retrogression (hypnotic depth), appearing in spontaneously [sic] or when proposed by the operator.
II. Phenomena which appear without any specific suggestion, as _a side issue of other suggestions,_ capable of originating emotional states in the subject.
III. Phenomena _which are independent of all suggestion,_ being a constituent part of the hypnotic state itself, in its ‘positive’ or ‘negative’ forms” (p. 68).
Using this framework, the authors describe several aspects of hypnosis: catalepsy, anesthesia, retrogression, the taking of a role, negativism and resistance, visceral changes, emotional stabilization, psychotherapeutic benefits (indirect). They observe that direct suggestions are often not necessary for therapeutic benefit, and give as an example the tendency for less bleeding when dentists suggest that patients will not feel less pain.
“For the elucidation of this point, the authors carried out an experiment in a dental clinic, taking six easily hypnotizable subjects in whom dental extractions were to be performed. They were given only the suggestions that they would feel the doctor working, but not experience pain … that they would pay no attention to it … or even if they felt a little pain, this would not trouble them and they would bear it perfrectly … Nothing was said about the loss of blood. As a result, in all the cases the loss of blood was slight, practically insignificant, though technically difficult extractions of roots were included” (p. 74).
“The explanation of hypnotic phenomena as natural and normal consequences of the hypnotic emotional state, and of the state of psychological retrogression, eliminates the supposed mysterious powers of suggestion. _Suggestion is thus relegated to the modest role of a litmus paper which reveals the psychological functioning of the individual_ in an experimental environment. On the other hand, in everyday-life hypnosis, in the principal hypnotic relationships of parents with their children, of teachers with their pupils, etc. (11), suggestibility plays an important role in education or re-education” (p. 75).

Kline, Milton V. (1955). Freud and hypnosis: II. Further observations on resistance and acceptance. Journal of Clinical and Experimental Hypnosis, 3 (2), 124-129.

Freud’s rejection of hypnosis in the development of psychoanalytic psychology becomes upon closer examination a two fold process. It involves on the part of Freud the conventional recognition that suggestion plays a basic role in the primitive emotional energy that binds people together and influences the acting out of primary libidinal drives. From an ontogenetic (and presumably phylogenetic) point of view, Freud viewed suggestibility as a repressive element in the organization of behavior and one which in effect had to be dealt with indirectly. To deal with it directly was to create a state within which powerful emotions of an unpredictable nature could emerge. Hypnosis to Freud was a ‘condition’ which led to general heightened suggestibility and was identical with it. To make use of this condition was in essence an attempt to make use of an individual’s energies in a dependent and essentially uninhibited manner. It seemed to Freud that having produced the hypnotic ‘condition,’ one actually had achieved a state of suspension or ablation of certain critical ego functions and this could lead to an intense and perhaps unmanageable interpersonal relationship. It was almost an ‘ethical’ rather than a scientific view as Freud discussed it in his thinking and theorizing about a general psychology.
“To a great extent the basic concepts of psychoanalysis were developed as the result of Freud’s awareness of the existance of hypnotic phenomena and his need to circumvent and indirectly deal with the ego manifestations of this ‘condition.’ Thus Freud never really rejected hypnosis as a mechanism of human behavior. His comment of the psychosocial development of man (from which psychoanalytic psychology is influenced) was heavily weighted by his awareness of ‘suggestibility’ and the ‘condition’ descriptively called hypnosis.
“The simple equation of hypnosis with suggestibilty is now scientifically outmoded and incorrect. The role of suggestion and its psychosomatic equations has taken on a drastically changed perspective in social psychology, particularly with regard to the early concepts of Le Bon, Freud and McDougall (5). For these reasons alone, Freud’s circumvention of hypnosis becomes increasingly unsound scientifically and adherence to such a perception of hypnosis serves only to obscure theoretical research in psychology and to maintain a rigidity born essentially of emotional ties and ethics alien to the nature of scientific inquiry” (pp 128-129).


Lee DY. Barak A. Uhlemann MR. Patsula P. Effects of preinterview suggestion on counselor memory, clinical impression, and confidence in judgments. Journal of Clinical Psychology 1995;51(5):666-75 This study examined the effects of schematic preinterview suggestion on counselors’ (a) recognition memory of the information presented by the client; (b) clinical impression rating of the client; and (c) confidence in rating clinical impression. Fifty-two Master’s-level counselor-trainees were assigned randomly to two conditions of preinterview suggestion about the status of the client (i.e., depression and no depression). After subjects had received appropriate preinterview information (i.e., depression or no-depression content) and had viewed a videotaped counseling interview, information was gathered from them. The results indicated that the preinterview suggestion (a) did not affect counselor-trainees’ clinical impression rating of the client; (b) did not affect confidence of rating; and (c) yielded a weak, but significant, confirmatory memory. Implications for the interview setting are discussed.

Barnier, Amanda J.; McConkey, Kevin M. (1995, November). Posthypnotic suggestion: Knowing when to stop helps to keep it going. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Antonio, TX.

Posthypnotic suggestion sometimes leads to compulsive and involuntary responding, but we have little information about the parameters of such a response. In some research in our laboratory, we found that subjects who were given a posthypnotic suggestion that encouraged them to experience a desire to respond, showed a different pattern of response from those simply told to make a specific behavioral response. In another study, we gave subjects a posthypnotic suggestion to mail a postcard every day to the experimenter; some subjects were told to respond until they saw the hypnotist again (termination), others were given no specific information about how long they should respond (no termination). Those expecting a termination to the suggestion showed a different pattern of response across 16 weeks of testing. Thus, the information included in the suggestion about how or when to respond influences posthypnotic responding.
Present Experiment: Laboratory test of including specific information in the posthypnotic suggestion about how long to respond – cancellation cue vs. no cancellation cue. Responding indexed on four different tests: formal, embedded, informal, postexperimental. Also used real/simulating methodology. We expected that responding would decline across the four tests, but that the decline would be slowest for those expecting a cancellation cue.
Methodology: High hypnotizable subjects scored 8-10 on SHSS:C, lows scored 0- 3 on SHSS:C. Given real/simulating instructions (Orne, 1959). Formal test was given immediately after deinduction; embedded test was given during an inquiry question; informal test was given as the hypnotist appeared to terminate the experiment and leave the room; postexperimental test was given by another experimenter during a postexperimental inquiry. The suggestion was to cough when Ss heard a particular response cue.
Results: On the forma test, there was no difference between reals or simulators in either the cue or no cue condition, although simulators in the cue condition tended to overplay their response. Across the tests, responding declined. In particular, the majority of reals and simulators in the no cue condition stopped responding after the formal test. In the cue condition, reals and simulators responded similarly on the embedded test, but differently on the informal test; more reals than simulators continued to respond across the tests. Few subjects responded on the postexperimental test. Subjects’ postexperimental comments indicated that reals and simulators in the no cue condition believed that one response was sufficient; simulators in the cue condition were confused about whether to keep responding, and reals in the cue condition responded compulsively across the test.
Conclusions: The inclusion of a cancellation cue in a posthypnotic suggestions maintains responding for a longer period. Responding posthypnotically is not explained solely by demand characteristics. Rather, individuals respond on the basis of their interpretation of the implied intent of the hypnotist’s message (c.f., Sheehan, 1971). Responding changes across test types. These findings contribute to a model of posthypnotic responding. They point to the active responding of hypnotized individuals (c.f., Kihlstrom: experimental subjects try to make sense of the message of the suggestions and instructions they receive).

Barber, Joseph (1994, October). How to use and abuse boundaries with hypnosis. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Francisco.

(for only part of the presentation) I would like to focus on how we can productively use boundaries. Hypnosis experience reactivates archaic experiences with parents; if therapist can evoke trust, the patient can feel increasingly that they can relax into the experience.

Bejenke, Christel J. (1993, October). A clinician’s perspective. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL.

Presents point of view of a private practice anesthesiologist in Santa Barbara, California. Used hypnosis for 20 years.
Use of hypnosis as hypnoanesthesia is rare since Esdaile, with brief resurgence in 50’s, because surgery techniques advanced before anesthesias did in areas that were very risky. Now it is a matter of choice, and may be undertaken because of a patient’s extreme fear of anesthesia, previous bad experience with anesthesia, fervent belief in holistic method, allergy, or previous experience with hypnosis. Still advised to use hypnosis for MRIs, radiation procedures, former drug addicts (who may have problems with drugs), burn patients, release of neck contractions, and medical procedures–especially with children–like lumbar puncture.
She disagrees with Kroger’s estimate of only 10% of patients being able to use hypnoanesthesia; she does not believe it requires a lot of training, or profound muscle relaxation.
There is no indication of how many cases are actually done with hypnosis. Also, published cases are not representative of the quantity or complexity of cases; most published cases have a few extraordinary characteristics. The Irish surgeon Jack Gibson has done more than 4000 cases, some very complicated.
I have used it for D & Cs, and complex cases that were not published. Most of my patients elected to be alert during the hypnosis and conversed with their surgeons. The most common benefit is that recovery from anesthesia is not necessary; but these days with newer anesthesias recovery from anesthesia is rapid anyway. However, if as we suspect anesthesia affects immune function, that would be another reason to use hypnosis.
Preparation for surgery may be of three types: 1. formal hypnosis techniques 2. “hypnoidal” techniques that aren’t formal 3. unprepared patients in whom hypnosis is used at last moment.
Examples. 1. Formal hypnosis: This symposium deals with this type of approach. Three groups derive particular benefit — those requiring prolonged artificial ventilation postoperatively (because otherwise sedation must be used, which leads to complications), where prepared patients tolerate interventions calmly and comfortably — cancer patients, for whom this can be first experience of patient to see self as active participant in care rather than a victim of the illness and of complicated technology — pediatric patients. 2. Hypnoidal (hypnosis like) techniques: This is the most important application. Time doesn’t permit much discussion here. Patients are in an altered state when they come for surgery, highly suggestible, and suggestions appear to be as effective as during formal trance state. The doctor can elicit positive responses during “casual conversation” while seemingly giving information to the patient. (The reverse is true also, with inadvertent negative suggestions, to the detriment of the patient.) Scrupulous adherence to medical facts is important during this type of conversation.
Operating room fixtures are useful for focus of attention, and I have published this information in an article.
Recovery room also is place where case specific information and appropriate suggestions can be given. Patient can experience his ability to alter sensations, for the first time, following suggestions.
Remainder of the hospitalization offers opportunity for reinforcing case specific positive suggestions.

Bennett, Henry L. (1993, October). Hypnosis and suggestion in anesthesiology and surgery. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL.

He began by saying that he is opposed to using hypnosis for surgery, though he favors a theory of how hypnosis effects physiological change, and cites T. X. Barber’s classic “Changing Unchanging Bodily Processes.”
Relaxation puts patient in a “psychological strait jacket” because surgery is so highly stressful. He gives information “about how to go through the surgery more comfortably,” gets across the idea about coping style, tells them surgery is exertional and that they are tired afterward, that he can help them “using things you already know how to do,” and specifies exactly what they can do–using model of himself as a trainer.
In some recent research he used pairs of pictures, some of which lead to pupillary constriction (blood pressure goes down) or dilation (blood pressure goes up). Instructing them to look, patients looked twice as long at the pictures than they did during free gaze. When not instructed to look, heart rate went down; when told to look, heart rate went up. So the researchers went back to free gaze. He uses this as a metaphor for many of the pre- surgery preparation activities that encourage relaxation “inappropriately.”
He cites Cohen & Lazarus re vigilant copers, Price et al (1957), and some other studies on epinephrine effects. He uses examples of work patients may have done (e.g. planting a garden) when talking with patients prior to surgery, that gives them a sense of accomplishment later.
You have to give specific instructions or suggestion, not general relaxation suggestions.
Question from the audience: Can preoperative instructions (not hypnosis) diminish blood loss.
In Bennett’s answer he seems to be reporting the earlier study: they found 150- 4000 cc blood loss, high variability. Extent of blood loss was determined by extent of surgery, by instructions to patients vs no instructions.
This study was replicated by Enqvist, Bystedt, & von Konow in the Anesthesia conference at Emory University in 1992.
May 1993 Western Journal of Medicine article, Disbrow, Bennett, & Owinos, with 40 lower abdominal surgery patients who got specific instructions or not. The SHCS was used to measure hypnotizability: highs resolved quicker than low hypnotizable patients. They also found that instructed patients did better than those who did not get specific instructions.
There are now 3 replications of McClintock’s study: people use less medications after surgery, when tapes about rapid recovery are played *during* surgery.
Bennett is now using tapes with suggestions for recovery during surgery.

Blankfield, Robert P. (1993, October). Suggestion, hypnosis, and relaxation as adjuncts for surgery patients: Lessons from studies involving cardiac surgery patients. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington Heights, IL

The author stated that his research and the few other studies of cardiac surgery patients do not support idea that cardiac surgery patients benefit from hypnosis and suggestion.
Types of intervention have varied: hypnosis, suggestion, relaxation; pre-op, during, or post-op; with many different outcome variables.
Aiken & Henrichs (1971) study was nonrandomized, nonblinded, for 30 patients getting open heart surgery. Treated patients had benefits.
Surman, Hackett, Silverberg, & Behrendt (1974) had a randomized, single-blind design for 40 patients taught Self Hypnosis (S-H), for elective mitral valve surgery. No difference in benefits. But 45% of patients taught S-H reported a subjective sense of benefit (though objective indicators didn’t support that). [He says the difference between subjective/objective outcome ratings is important.]
Hart (1980) used randomized, single-blind design for 40 patients who had open heart surgery. No differences found except initial 3 days post surgery.
Greenleaf et al (1992) – see her paper presentation of this date.
Blankfield et al (presented at Society of Clinical and Experimental Hypnosis meeting in 1992) used a randomized, single-blind design for 95 patients, who were randomly assigned to taped suggestions, music, or controls. No differences were found in benefits.
Our data were re-analyzed: patients who felt tape was helpful were compared to the remaining 62 patients, but there again were no differences in amount of narcotics used for pain, though there was a trend in the right direction; nursing assessments failed to identify less anxiety.
The point is, whereas the bulk of publications suggest benefits, there is little evidence with this population. Could these patients be different in personality, ability to respond to intervention, amount of external stimuli? They should be studied because there are a lot of these patients with only a few surgeons and you don’t have to gain the cooperation of a lot of different surgeons to do this kind of research. Also, there is uniformity in cardiac surgery whereas standard operating surgery is in a state of flux in other areas (e.g. movement from generous incisions to micro procedures, and patients receiving this type of surgery remain in hospital for a week whereas this opportunity to study them during inpatient post-surgical period is disappearing in other areas). It is my opinion that cardiac patients may not be highly receptive to suggestion.
Curiously, according to Surman and my research, 1/2 the subjects report benefits. Either some benefits are subtle, or they are reporting a placebo effect.
Future studies need more patients, and the investigators must stratify on personality inventory variables such as Type A personality, hypnotizability, motivation, anxiety, depression, family support, social support systems. This is labor intensive, to determine which characteristics determine differing outcomes. The patients used in this type of research require more presurgery evaluation than previously has occurred.
The MMPI can be self administered and is widely acceptable, but is cumbersome, not well suited to people who are acutely ill. Assessment of Type A personality is important because Type A’s might be less receptive to suggestion. Structured interview is time consuming, but a 52-item questionnaire can be self administered. Other factors listed above are important.
Bruehl, Stephen; Carlson, Charles R.; McCubbin, James A. (1993). Two brief interventions for acute pain. Pain, 54, 29-36.
This study evaluated two brief (3-5 min) interventions for controlling responses to acute pain. Eighty male subjects were randomly assigned to 1 of 2 intervention groups (Positive Emotion Induction (PEI) or Brief Relaxation (BR)) or to 1 of 2 control groups (No-instruction or Social Demand). The PEI focused on re-creating a pleasant memory, while the BR procedure involved decreasing respiration rate and positioning the body in a relaxed posture. All subjects underwent a 60-sec finger pressure pain trial. Analyses indicated that the PEI subjects reported lower ratings of pain, fear, and anxiety, and experienced greater finger temperature recovery than controls. The BR procedure resulted in greater blood pressure recovery, but did not alter ratings of pain or emotion relative to controls. Further research is needed to explore the clinical use of the PEI for acute pain management.

De Pascalis, Vilfredo (1993). EEG spectral analysis during hypnotic induction, hypnotic dream and age regression. International Journal of Psychophysiology, 15, 153-166.

EEG was recorded monopolarly at frontal (F3, F4), central (C3, C4) and posterior (in the middle of O1-P3-T5 and O2-P4-T6 triangles) derivations during the hypnotic induction of the Stanford Hypnotic Clinical Scale (SHCS) and during performance following suggestions of hypnotic dream and age-regression as expressed in the before-mentioned scale. 10 low-hypnotizable and 9 highly-hypnotizable and right- handed female students participated in one experimental session. Evaluations were Fast- Fourier spectral analyses during the following conditions: waking-rest in eyes-open and eyes-closed condition; early, middle, and late phases of hypnotic induction; rest-hypnosis in eyes closed condition; hypnotic dream and age regression. After spectral analysis of 0 to 44 Hz, the mean spectral amplitude estimates across seven Hz bands (theta 1, 4-6 Hz, theta 2, 6-8 Hz; alpha 1, 8-10 Hz; alpha 2, 10-13 Hz; beta 1, 13-16 Hz; beta 2, 16-20 Hz; beta 3, 20-36 Hz) and the 40-Hz EEG band (36-44 Hz) for each experimental condition were extracted. In eyes-open and -closed conditions in waking and hypnosis highly-hypnotizable subjects produced a greater 40-Hz EEG amplitude than did low hypnotizable subjects at all frontal, central and posterior locations. In the early and middle hypnotic induction highly-hypnotizables displayed a greater amount of beta 3 than did low hypnotizables and this difference was even more pronounced in the left hemisphere. With posterior scalp recordings, during hypnotic dream and age regression, high hypnotizables displayed, as compared with the rest-hypnosis condition, a decrease in alpha 1 and alpha 2 amplitudes. This effect was absent for low hypnotizables. Beta 1, beta 2 and beta 3 amplitudes increased in the left hemisphere during age regression for high hypnotizable; low hypnotizables, in contrast, displayed hemispheric balance across imaginative tasks. High hypnotizables during the hypnotic dream also displayed in the right hemisphere a greater 40-Hz EEG amplitude as compared with the left hemisphere. This difference was even more evident for posterior recording sites. This hemispheric trend was not evidenced for low hypnotizable subjects. Theta power was never a predictor of hypnotic susceptibility, 40-Hz EEG amplitude displayed a very high main effect (p<0.004) for hypnotizability in hypnotic conditions by displaying a greater 40-Hz EEG amplitude in high hypnotizables with respect to lows. NOTES 1: NOTES In the Discussion section, the authors indicate that they have no idea why they didn't replicate results of other theta studies, including their own, except maybe due to complex interaction among personality, subject selection, situation-specific factors, and hypnotizability.