Comey, Gail; Kirsch, Irving (1999). Intentional and spontaneous imagery in hypnosis: The phenomenology of hypnotic responding. International Journal of Clinical and Experimental Hypnosis, 47 (1), 65-85.

Students were given 1 of 2 versions of the Carleton University Responsiveness to Suggestion Scale (CURSS): (a) the original version, which contains instructions to intentionally imagine goal-directed fantasies, and (b) a modified version, in which instructions for suggestion-related imagery were deleted. Participants were asked to report their goal-directed fantasies and to indicate whether these occurred spontaneously or were generated intentionally. They were also asked whether they had tried intentionally to generate the suggested experience and to indicate whether they had believed that the suggested states of affairs were real (e.g., whether they thought a hallucinated cat really existed). The deletion of instructions for goal-related imagery significantly increased responsiveness to CURSS suggestions. Spontaneous goal-directed imagery was significantly correlated with behavioral response, but intentional imagery was not. Most successful responders tried to generate suggested experiences intentionally, indicated that they could have resisted challenge suggestions if they really waned to, and reported believing in the reality of suggested ideomotor and challenge experiences but not of cognitive suggestions. Voluntary attempts to generate suggested experiences were correlated with subjective responding.

Bowers, Kenneth S. (1992). Imagination and dissociation in hypnotic responding. International Journal of Clinical and Experimental Hypnosis, 40 (4), 253-275.

A neodissociative model of mind is better equipped than a social-psychological model to deal with the complexities of hypnosis, and of human behavior generally. It recognizes, as Coe’s (1992) model does not, that behavior can be more automatically activated than strategically enacted. In particular, Coe’s emphasis on human behavior as purposeful and goal directed does not distinguish between goal-directed behavior that serves a purpose, and goal-directed behavior that is performed on purpose. It is this distinction that permits goal-directed behavior to be dissociated from a person’s conscious plans and intentions. In addition to offering a critique of Coe’s “limited process” view of hypnosis, 4 main points are made in the interest of developing a slightly modified, neodissociation view of hypnosis. First, it is argued that goal-directed fantasies are more limited in their ability to mediate hypnotic responding than is commonly appreciated; as well, they do not seem to account for the nonvolitional quality of hypnotic responding. Second, it is argued that hypnotic ability is not unidimensional, with compliance and social influence more apt to account for the low than for the high hypnotizable’s responsiveness to suggestion. Third, compared to low hypnotizables, the hypnotic responsiveness of high hypnotizables seems more likely to result from dissociated control. In other words, for high hypnotizables, hypnotic suggestions may often directly activate subsystems of cognitive control. Consequently, the need for executive initiative and effort to produce hypnotically suggested behavior is minimized, and such responses are therefore experienced as nonvolitional. Fourth and finally, while goal-directed fantasies typically accompany hypnotically suggested responses, they are in many cases more a marker of dissociated control than a mediator of suggested effects.

Spanos, Nicholas P.; Gwynn, Maxwell I.; Della Malva, C. Lori; Bertrand Lorne D. (1988). Social psychological factors in the genesis of posthypnotic source amnesia. Journal of Abnormal Psychology, 97 (3), 322-329.

Three experiments assessed the role of social psychological variables in source amnesia. Experiment 1 found that low-hypnotizable subjects instructed to simulate partial amnesia were more likely to exhibit source amnesia than high-hypnotizable hypnotic or task-motivated subjects. Experiment 2 found equivalent rates of source amnesia in low-hypnotizable simulators and high-hypnotizable hypnotic subjects. In addition, the findings of Experiment 2 failed to support the idea that the instructions for partial amnesia given to simulators cued for the occurrence of source of amnesia as well as for the occurrence of partial amnesia. In Experiment 3, preliminary instructions that legitimated source amnesia as a role-appropriate response produced significantly more posthypnotic source amnesia than did neutral or no instructions. Together, the findings of the 3 experiments support the relation of source amnesia to experimental demands and subjects’ expectations.

Sweeney, Carol A.; Lynn, Steven Jay; Bellezza, Francis S. (1986). Hypnosis, hypnotizability, and imagery-mediated learning. International Journal of Clinical and Experimental Hypnosis, 34, 29-40.

The relationship between hypnotizability, imagery utilization ability, and hypnosis was examined in a study described to Ss (N = 157) as an ‘imagery experiment.’ In Session 1, the Tellegen Absorption Scale (Tellegen, 1976) was completed and the imagery-mediated paired-associate learning task was administered as a baseline measure. In Session 2, either hypnosis, task motivation, or no treatment instructions were administered and the learning task was repeated with a different word list (each 15 high, 15 low imagery pairs). In Session 3, the Harvard Group Scale of Hypnotic Susceptibility, Form A (Shor & E. C. Orne, 1962) was administered. Overall, recall was superior for high imagery words. Hypnotizability was not associated with imagery-mediated recall. Recall performance, however, was correlated with Tellegen Absorption Scale scores. Interestingly, learning and recall performance decreased between Sessions 1 and 2 for hypnotized Ss but remained the same for task motivated and control Ss. The decrease in performance was mediated by less concern for performance and diminished anxiety. Self- reports of imagery utilization did not differ among groups of Ss.

The authors review literature on the relationship between hypnotizability, hypnosis, and imagery abilities, noting that results are conflicting. One reason for differing results may be that imagery scales are self-report measures, subject to reporting bias of varying types. The imagery-mediated paired-associate learning paradigm, using high and low imagery paired associates, may address that reporting bias issue.
This investigation used 157 Ss grouped into high (9-12), medium (5-8), and low (0-4) hypnotizability levels on the basis of the Harvard Scale. Given the fact that high imagery words are usually recalled more easily than low imagery words (Paivio, 1971), a relationship observed between hypnotizability and imagery-mediated recall would elucidate the role of imagery utilization for memory functions.
The experimental conditions included hypnosis, task motivation, and a no treatment control condition, in order to evaluate the possible enhancement effects of hypnosis on imagery utilization for memory functions. The task motivation group was included to control for motivational factors, and the no treatment control condition to control for the practice effects of repeated testing.
The word pair stimuli were from Paivio et al (1968): 30 pairs consisting of 15 high and 15 low imagery noun pairs. Each Subject participated in three experimental sessions.
Session 1. Ss were told that they were in an experiment on imagery to remember pairs of words. They completed the Tellegen Absorption Scale, then were given instructions for using imagery for recalling words, and for rating vividness and clarity of each image immediately after it was formed. Finally they performed the learning task.
Session 2. Ss received either hypnosis, task motivation instructions (“try to form good interacting images of the word pairs” with exhortation to score as high as possible), or control (Like Session 1). No one in hypnosis group refused the induction (despite the fact that they were not forewarned in Session 1 that the experiment might involve hypnosis). Ss completed a questionnaire on the percentage of word pairs they used images to remember, how easy it was to block out or ignore distractions, how vivid and clear were images of words during recall, how concerned they were about their performance, and how much anxiety, if any, they experienced during the experiment.
Session 3. The Harvard Scale was administered. Three Ss declined to participate in the Harvard Scale administration.
The results were analyzed with a 3 x 2 x 2 x 2 repeated-measures ANOVA: hypnotizability, instruction (hypnotic induction, task motivation, no treatment), session (1 and 2), and pair imagery (high and low). The expected enhanced memory performance of high hypnotizables with high imagery words in the hypnosis condition did not emerge in the results. However, the expected stimulus-imagery effect was observed (a higher proportion of high imagery words than low imagery words recalled). The expected higher imagery ratings for hypnotized high hypnotizable Ss also was not found. Furthermore, there was a significant interaction effect for recall session by hypnotizability: low hypnotizable Ss rated imagery less vivid in Session 2 than in Session 1, while highs rated it more vivid in Session 2 than in Session 1. Thus, low hypnotizable Ss’ imagery ratings actually decreased between Recall Session 1 and 2, while high hypnotizable Ss’ imagery ratings increased between Recall Session 1 and 2.
While the Absorption Scale correlated with the Harvard (.28, p <.001) and with various measures of recall, hypnotizability did not correlate with any of the recall measures. The questionnaires administered during Session 2 suggested that hypnotized Ss were less concerned and anxious than the no treatment control Ss, and less concerned than the Ss receiving task motivation instructions. In their Discussion, the authors speculate that the strong stimulus-imagery effects might have made it unlikely for them to find differences between high, medium, and low hypnotizable Ss in imagery-based paired associate learning. They suggest including word pairs that range across the continuum of imagery ratings in future research. They also speculate that differences between hypnotizability levels might be found (as 'T Hoen reported in 1978 publication) if Ss were required to respond in a shorter time interval, or if hypnotizability were measured by a scale with more cognitive items than the Harvard Scale--both conditions in 'T Hoen's research protocol. "The most striking finding of the present research is that instead of facilitating performance in an imagery-mediated recall task, hypnosis resulted in a decrement in recall relative to control conditions. In the hypnotic condition, the amount of learning actually decreased from one session to the next (waking-hypnosis) but remained equivalent in the task motivation (waking-task motivation) and no treatment groups (waking-waking)" (p. 37). The authors note that it is not possible to determine from their research design wither hypnosis interfered with the learning task, the retrieval task, or both. "The findings suggest that hypnotizability may be related to reported vividness and clarity of imagery but unrelated to the actual ability to utilize imagery in an imagery- mediated paired-associate learning task. ... Although high hypnotizables' self-report ratings of imagery and vividness increased, their recall performance was not accordingly enhanced. The disparity between subjective and objective measures underscores the importance of including both types of measures in studies of imagery abilities" (pp. 37- 38). To a considerable degree, this study controlled for Ss' expectancies regarding hypnosis better than some earlier studies. This study differs from earlier research in that (1) Experimenters didn't test hypnotizability prior to the imagery-mediation task; and (2) the study was defined as an experiment on imagery, and hypnosis was not mentioned until just before the induction in Session 2. "In conclusion, the present results indicate that, under certain conditions, hypnosis may decrease Ss' motivation and performance. No support was provided for the ability of hypnosis to facilitate imagery utilization and performance on an imagery-mediated task. The results are compatible with the views proferred [sic] by theoreticians who have emphasized the importance of expectancies and the experimental context (e.g., Barber, 1979; Coe & Sarbin, 1977; M. T. Orne, 1951, 1959; Spanos, 1982)" (p. 38). 1985 Ashton, M.A.; McDonald, R.D. (1985). Effects of hypnosis on verbal and non-verbal creativity. International Journal of Clinical and Experimental Hypnosis, 33 (1), 15-26. 60 female volunteers, 30 hypnotizable and 30 unhypnotizable, screened on 2 measures of hypnotizability, were assigned to a hypnosis, simulation, or waking motivated treatment condition to assess whether hypnosis has a differentially enhancing effect upon verbal and non-verbal creativity test performance. Verbal and figural components of the Torrance Tests of Creative Thinking (Torrance, 1974) and the Sounds and Images Test (Cunnington & Torrance, 1965) were the principal dependent variables. Postexperimental measures of absorption and effortless experiencing were also obtained. A 2 x 3 independent groups ANOVA did not sustain the prediction of an interaction effect between S hypnotizability and the presence of hypnosis on 3 composite measures of verbal and nonverbal creativity. Although there was an absence of treatment effects, hypnotizable Ss consistently achieved higher scores on the Torrance scoring categories, and their performance was statistically superior on a composite index of overall creativity. Absorption and effortless experiencing measures were also significantly higher for hypnotizable Ss than for unhypnotizable Ss. Salzberg, H. C.; DePiano, F. A. (1980). Hypnotizability and task motivating suggestions: A further look at how they affect performance. International Journal of Clinical and Experimental Hypnosis, 28 (3), 261-271. An attempt was made to ferret out the separate effects on cognitive performance of hypnotic susceptibility, task motivating suggestions, and the hypnotic trance state. An equal number of susceptible and unsusceptible Ss were given 3 cognitive tasks, first to ascertain their baseline performances, and then again following either a traditional hypnotic induction, an alert trance induction or a short interview. All Ss were given task motivating suggestions prior to administering the alternate form of the 3 tasks. An additional control group of Ss was used to assess practice effects. Results indicated that task motivating suggestions were effective in enhancing performance for all groups on the digit symbol and abstract reasoning tasks but not on the memory task. Waking suggestion Ss performed as well as hypnotized SWs when both groups of Ss were given task motivating suggestions. It was concluded that when the experimental design of a study incorporates necessary controls, hypnosis does not facilitate performance. Spanos, Nicholas P.; Radtke-Bodorik, H. Lorraine; Shabinsky, Michael A. (1980). Amnesia, subjective organization, and learning of a list of unrelated words in hypnotic and task-motivated subjects. International Journal of Clinical and Experimental Hypnosis, 28 (2), 126-139. Hypnotic and task-motivated Ss learned a list of unrelated nouns and were then administered an amnesia suggestion for the list. Hypnotic Ss showed slower learning but more amnesia than task-motivated Ss. Hypnotic and task-motivated Ss showed an equivalent degree of "breakdown" in the subjective organization of their recall following the amnesia suggestion. However, the extent of this breakdown in subjective organization, was unrelated either to Ss' degree of amnesia or to their level of hypnotic susceptibility. A substantial proportion of Ss who failed to recall any words following the suggestion (total nonrecallers) later reported that they remembered but did not say at least some of the words. The theoretical implications of these findings are discussed. 1976 Connors, J.; Sheehan, P. W. (1976). Analysis of the cue characteristics of task motivational instructions. International Journal of Clinical and Experimental Hypnosis, 24, 287-299. This study investigated the assumption of Barber's model of hypnosis that its set of task motivational instructions is thoroughly "nonhypnotic" in character. If this assumption is correct, then the cues associated naturally with task motivational instructions should be more compatible with a suggestibility test situation explicitly defined as nonhypnotic than with one defined as hypnotic, and this affinity should be reflected in both Ss' objective and subjective suggestibility test scores. Barber's (1965) Suggestibility Scale data collected from 90 Ss did not confirm the main prediction under test, but results failed to provide unequivocal support for the model; subjective evidence, in particular, supported least well the assumptions of the paradigm. Spanos, Nicholas P.; Spillane, Jeanne; McPeake, John (1976). Cognitive strategies and response to suggestion in hypnotic and task-motivated subjects. American Journal of Clinical Hypnosis, 18, 254-262. Thirty-two male and 32 female subjects, exposed to an hypnotic induction or task-motivational instruction, were administered either three suggestions which provided a cognitive strategy (i.e., a goal-directed fantasy, GDF) for experiencing suggested effects, or three suggestions that did not provide such a strategy. Subjects provided with GDF strategies were more responsive overtly and subjectively to two out of the three suggestions. Subjects in the No GDF Strategy treatment who spontaneously devised their own goal-directed fantasies were more responsive to suggestions than subjects who failed to devise such a strategy. These results support the contention that goal-directed fantasy helps both hypnotic and non-hypnotic subjects experience suggested effects. 1970 Swiercinsky, Dennis; Coe, William C. (1970). Hypnosis, hypnotic responsiveness, and learning meaningful material. International Journal of Clinical and Experimental Hypnosis, 18 (3), 217-222. RESPONSES TO TEST SUGGESTIONS (E.G., HALLUCINATION AND AMNESIA) WERE ASSESSED UNDER THE FOLLOWING TREATMENTS: MOTIVATIONAL INSTRUCTIONS ALONE, HYPNOTIC PROCEDURE WITH MOTIVATIONAL INSTRUCTIONS, AND IMAGINATION-CONTROL. COMPARISONS WERE MADE ACROSS INDEPENDENT GROUPS, EACH TESTED UNDER 1 TREATMENT, AND ALSO WITHIN THE SAME SS TESTED TWICE UNDER VARIOUS COMBINATIONS OF THE TREATMENTS. ALTHOUGH SS WERE SUGGESTIBLE UNDER THE IMAGINATION-CONTROL TREATMENT, BOTH THE MOTIVATIONAL INSTRUCTIONS ALONE AND THE HYPNOTIC PROCEDURE GIVEN TOGETHER WITH THE MOTIVATIONAL INSTRUCTIONS RAISED SUGGESTIBILITY ABOVE THE CONTROL LEVEL. THE HYPNOTIC-MOTIVATIONAL TREATMENT TENDED TO PRODUCE AN INCREMENT IN SUGGESTIBILITY WHICH WENT SLIGHTLY BEYOND THAT ATTRIBUTABLE TO THE MOTIVATIONAL INSTRUCTIONS. THE LATTER INCREMENT IS INTERPRETED AS DUE TO THE SLIGHTLY GREATER EFFECTIVENESS OF THE HYPNOTIC PROCEDURE IN DEFINING THE SITUATION AS ONE IN WHICH UNUSUAL MANIFESTATIONS, SUCH AS HALLUCINATION AND AMNESIA, ARE WITHIN SS'' CAPABILITIES AND DEFINITELY EXPECTED BY E. (SPANISH + GERMAN SUMMARIES) (23 REF.) (PsycINFO Database Record (c) 2002 APA, all rights reserved) Bowers, Kenneth S. (1968). Hypnosis and creativity: A preliminary investigation. International Journal of Clinical and Experimental Hypnosis, 16, 38-52. 24 HIGHLY SELECTED, HYPNOTICALLY TRAINED COLLEGE STUDENTS WERE CAST INTO HYPNOTIC AND HYPNOSIS SIMULATING GROUPS AND GIVEN SUGGESTIONS TO BEHAVE CREATIVELY ON THE CONSEQUENCES TEST OF ORIGINALITY. NO DIFFERENCES BETWEEN THE 2 GROUPS APPEARED. THEY DID APPEAR, HOWEVER, ON A CONCEPT FORMATION TASK AS A FUNCTION OF TASK-INVOLVEMENT INSTRUCTIONS, IRRESPECTIVE OF WHETHER SS WERE HYPNOTIZED OR SIMULATING HYPNOSIS. MOREOVER, AWARENESS OF RESPONSE REINFORCEMENT CONTINGENCIES WAS STRONGLY INFLUENCED BY THE INVOLVING SUGGESTIONS. THE NEGATIVE FINDINGS ON THE CREATIVITY TEST WERE ATTRIBUTED TO THE EXCELLENT PERFORMANCE OF THE SIMULATOR SS. IT IS SUGGESTED THAT PERHAPS SUSCEPTIBILITY PER SE INTERACTS WITH ROLE PLAYING INSTRUCTIONS IN GENERATING MORE REGRESSIVE MODES OF THINKING. (SPANISH + GERMAN ABSTRACTS) (2 P. REF.) (PsycINFO Database Record (c) 2002 APA, all rights reserved) 1967 Hartman, B. J. (1967). Hypnotizability as affected by attitudinal and motivational variables. International Journal of Clinical and Experimental Hypnosis, 86-90. ATTEMPTED TO DISCOVER WHETHER TASK-MOTIVATED SS WOULD BE MORE HYPNOTIZABLE THAN THOSE NOT GIVEN TASK-MOTIVATION INSTRUCTIONS, AND WHETHER THE ATTITUDE OF THE E WOULD AFFECT SS'' HYPNOTIZABILITY. THE BARBER SUGGESTIBILITY SCALE WAS EMPLOYED FOR MEASURING SUSCEPTIBILITY TO HYPNOSIS. SS WERE DIVIDED RANDOMLY INTO 6 GROUPS OF 10: TASK-MOTIVATED, E NEUTRAL; NON-TASK-MOTIVATED, E NEUTRAL; TASK-MOTIVATED, E FRIENDLY; TASK-MOTIVATED, E HARSH; NON-TASK-MOTIVATED, E FRIENDLY; AND NON-TASK-MOTIVATED, E HARSH. ANALYSES OF VARIANCE, BOTH FOR OBJECTIVE AND SUBJECTIVE SCORES, DID NOT YIELD SIGNIFICANT RESULTS FOR THE TASK-MOTIVATION VARIABLE BUT DID YIELD SIGNIFICANT RESULTS (P = .01) FOR THE VARIABLE DEALING WITH E ATTITUDE. (GERMAN + SPANISH SUMMARIES) (PsycINFO Database Record (c) 2002 APA, all rights reserved) 1961 Glass, Louis B.; Barber, Theodore X. (1961). A note on hypnotic behavior, the definition of the situation and the placebo effect. Journal of Nervous and Mental Disease, 132, 539-541. Subjects were tested for responses to hypnotizability tests under three conditions: after 20 minute induction, after being told they would not be hypnotized but would take tests of imagination (with motivating instructions to do well), after taking a placebo pill that "would make them deeply hypnotized." Of 12 Ss who dropped in score between Session 1 and Session 2, 11 attained higher scores following placebo than during the control session; mean scores under placebo and control (5.8 and 3.7) differed significantly, p <.01. Scores were as high in the third as the first session (5.8 and 6.3 respectively). TECHNIQUE 1993 Lynn, Steven Jay; Neufeld, Victor; Mare, Cornelia (1993). Direct versus indirect suggestions: A conceptual and methodological review. International Journal of Clinical and Experimental Hypnosis, 31, 124-152. The article reviews the literature on the effects of direct versus indirect hypnotic suggestions. A conceptual and methodological analysis of direct versus indirect suggestions is also provided. Three conclusions follow from the review: (a) Contrary to views of Ericksonian hypnotists, suggestion style has little effect on objective responding to hypnotic test items; (b) studies of clinical- and laboratory-induced pain and other measures of subjective experience have yielded contradictory results--however, the best controlled studies have not indicated that indirect suggestions are superior to direct suggestions; and (c) there is insufficient evidence to conclude that hypnotizability level and suggestion wording interact, such that low hypnotizable subjects are particularly responsive to indirect suggestions. Methodological and conceptual problems in defining and studying hypnotic communications, the lack of rigorous experimental controls, and research issues and directions are highlighted. NOTES Although this article is primarily concerned with the nature of suggestion, the review also mentions several studies comparing hypnosis with other interventions for pain, in passing: Crowley (1980) Snow (1979) Omer, Darnel, Silberman, Shuval, & Palti (1988) Stern (1982) Bassman (1983) "Like the clinical studies using the RIA [Rapid Induction Analgesia], pain studies that did not use the RIA lack appropriate control groups: Neither Bassman's (1983) nor Stern's (1982) research explicitly compared direct and indirect suggestions. What our review does suggest is that studies (e.g., Crowley, 1980; Snow, 1979; Van Gorp et al., 1985) that imposed the greatest degree of methodological control yielded the outcomes least favorable to the hypothesis that indirect suggestions are effective and account for the pain relief achieved, above and beyond factors common to placebo treatments" (p. 132). "Lynn and his colleagues' studies indicate that whereas indirect suggestions enhance archaic representations of the hypnotist, direct suggestions facilitate involvement in the events of hypnosis, as measured by subjective involvement and involuntariness" (p. 136). Schoen, Marc (1993). Resistance to health: When the mind interferes with the desire to become well. American Journal of Clinical Hypnosis, 36, 47-54. Secondary gain has long been viewed as a variable that can significantly affect a patient's recovery from such conditions as chronic pain disorders, factitious and somataform disorders, and other psychological disorders. Secondary gain has not been evaluated in terms of its impact on major illnesses such as cancer or autoimmune disorders. In this paper I discuss how secondary gain can be present in such illnesses and how it results in a resistance to health. This resistance to health can lead not only to medical noncompliance, but can also ultimately affect the progression and recovery from the illness. I describe how hypnosis can be used to ferret out this resistance to health and how patients in a hypnotic state will indicate or express their resistance to becoming healthy. The advantage of this approach is that it enables the clinician to deal directly with the patient's unconscious resistance to health. Szabo, Csaba (1993). The phenomenology of the experiences and the depth of hypnosis: Comparison of direct and indirect induction techniques. International Journal of Clinical and Experimental Hypnosis, 41, 225-233. The effect of two hypnotic induction styles on subjective experience was measured in an experiment in which 44 subjects participated in both traditional direct hypnosis, induced by the Stanford Hypnotic susceptibility Scale, Form A, and indirect hypnosis (presented in counterbalanced order), followed by 4 minutes of rest before dehypnosis. The depth of hypnosis was measured retrospectively by a subjective scale, and the structure of experiences was measured by the Phenomenology of Consciousness Inventory. Subjects were subsequently administered the Stanford Hypnotic Susceptibility Scale, Form B, so that awareness of their hypnotizability would not affect their subjective depth reports. No differences were found in a comparison of subjects' structure of experiences in direct and indirect hypnosis. In addition, low and medium hypnotizable subjects reported indirect hypnosis as deeper. This may reflect the possibility that while hypnotized different mechanisms come into play for subjects high in hypnotizability compared to those who are less hypnotizable. 1992 Blankfield, Robert; Scheurman, Kathleen; Bittel, Sue; Alemagno, Sonia; Flocke, Sue; Zyzanski, Stephen (1992, October). Taped therapeutic suggestions and taped music as adjuncts in the care of coronary artery bypass graft patients. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington, VA. NOTES 18 studies have explored the issue with an experimental design; half used tapes, half didn't; majority of studies found benefits; 2 were of heart surgery patients. This study used taped suggestions with coronary bypass patients. Used tape recorder rather than person delivering suggestions because it was more convenient; used tape intra-surgery and post-operatively for more impact. We hypothesized: shorter length of stay, less narcotic analgesia, less anxiety, faster recovery, more positive mental outlook, resume activities sooner, have less symptoms postoperatively, etc. Used a prospective, randomized, single-blind trial in 2 community hospitals in Cleveland with coronary artery bypass graft surgery patients. Study was done between Dec 1989 - Feb 1992. 3 groups were involved: (1) Suggestion, (2) music, and (3) tape. Control subjects had a blank tape. Tapes were played continuously and repeatedly with headphones. Postoperatively, a different tape was played. Excluded: Patients with emergent surgery, hearing impairment, poor comprehension of English, patients who died in hospital, patients whose hospital stay lasted longer than 14 days (3 of them). 5% of sample were eliminated for last 2 reasons. Music: Herb Ernst, Dreamflight II. Suggestions: Music background, permissive, based on Evans & Richardson's study. Outcome Measures: Nurse assessment of anxiety and progress post operatively, Symptom scale, Depression scale. Mean age 62, 3/4 men, 92% white, 75% married. The groups were same on a variety of preoperative variables (status of heart and arteries). Length of stay was 6.5 in all 3 groups. No difference in narcotics use, in nurse assessment of anxiety or of progress; of depression scale, or activities of daily living. Recategorized data into patients who said the tapes were helpful (both music and suggestion) N = 33 vs the other patients N = 62. No difference in the variables evaluated. Herbert, James D.; Mueser, Kim T. (1992). Eye movement desensitization: A critique of the evidence. Journal of Behavior Therapy and Experimental Psychiatry. The scientific evidence supporting the efficacy of eye movement desensitization (EMD), a novel intervention for traumatic memories and related conditions, is reviewed. The sparse research conducted in this area has serious methodological flaws, precluding definite conclusions regarding the effectiveness of the procedure. Clinicians are cautioned against uncritically accepting the clinical efficacy of EMD. Lohr, Jeffrey M.; Kleinknecht, Ronald A.; Conley, Althea T.; Dal Cerro, Steven; Schmidt, Joel; Sonntag, Michael E. (1992). A methodological critique of the current status of eye movement desensitization (EMD). Journal of Behavior Therapy and Experimental Psychiatry. Eye Movement Desensitization (EMD) has been recently advocated as a rapid treatment for the elimination of traumatic memories responsible for the maintenance of a number of anxiety disorders and their clinical correlates. Despite a limited conceptual framework, EMD has attracted considerable interest among clinicians and researchers. The popularity and interest generated by EMD will likely result in wide usage. We present a methodological critique of it with reference to assessment, treatment outcome, and treatment process. We also provide guidelines for judging the methodological adequacy of research on EMD and suggest intensive research to assess effectiveness, treatment components, and comparisons with other procedures. Page, Roger A.; Handley, George W. (1992). Effects of 'deepening' techniques on hypnotic depth and responding. International Journal of Clinical and Experimental Hypnosis, 40, 157-168. The present study attempted to assess the effectiveness of commonly used deepening techniques and of surreptitiously provided stimulation on hypnotizability scores, in-hypnosis depth reports, retrospective realness ratings, and the Field Inventory of Hypnotic Depth (Field, 1965). High, medium, and low hypnotizables were assigned in equal numbers to 1 of 3 groups, each containing 54 Subjects. Controls were compared to Subjects receiving 2 deepening techniques or 2 suggestions for positive and negative hallucinations that were surreptitiously enhanced. Of the 4 dependent measures employed, the only significant different between groups related to a change in depth reports for the manipulation items themselves, leading to the conclusion that the effect of the techniques was at best minimal and transient. Some methodological and conceptual issues are also discussed. Sheehan, Peter W. (1992). The phenomenology of hypnosis and the Experiential Analysis Technique. In Fromm, Erika; Nash, Michael R. (Ed.), Contemporary hypnosis research (pp. 364-389). New York: Guilford Press. NOTES The problem with behavioral assessment methods such as hypnotizability scales is that similar behavioral responses to hypnotic suggestions may occur for very different reasons. It is important to assess the phenomenological experience of hypnotic Ss. The Experience Analysis Technique (EAT) is a method for assessing the phenomenology of hypnosis. The EAT "consists of gathering the comments of hypnotic subjects about their hypnotic behavior and experience, as they view the video playback of their hypnotic sessions" (p. 372). The EAT draws its origins from Kagan's method of Interpersonal Process Recall [IPR], in which "counselors in training could review and react to, their contact with clients immediately after therapy sessions. An independent person, present at the review of the session, would inquire into the interaction between the counselor and client by stopping the tape and questioning the client about his or her underlying feelings and thoughts, so facilitating and clarifying the information being recalled" (p. 371). It is important that the interviewer be a different person than the hypnotist. Hammer, Walker & Diment (1978) applied the IPR to hypnosis, using audiotape. Using the videotape EAT with hypnosis, Sheehan & McConkey (1982; Sheehan, McConkey & Cross, 1978) noted that hypnotic Ss might exhibit any of three different response styles, sometimes related to hypnotic task complexity: 1. Concentrative/cooperative style - S focuses on hypnotist's words, imagining a literal interpretation 2. Independent style - S interprets hypnotist's words in a way that is meaningful to them 3. Constructive style - S considers the communications "from a position of preparedness to process incoming stimuli in a schematic way, so as to structure or re-organize events according to the hypnotist's suggestions" Some Ss who are high in susceptibility show greater flexibility in the use of cognitive styles than low susceptibility Ss. Examples of the use of the EAT to evaluate several phenomena observed in experimental and clinical settings are provided: 'duality' during age regression, trance logic, posthypnotic amnesia, pseudomemories, and rapport. The author reviews the concept of 'countering.' "Countering occurs when a S responds in accord with the wishes of the hypnotist when social influences to respond otherwise are also present in the situation. ... Counterers display a constructive (i.e. active and idiosyncratic) style of cognizing which enables them to make personal sense of the conflicting demands by preserving the integrity of each. ... Counterers, even though they demonstrate a higher degree of involvement with the hypnotist, fail reliably to score as highly on standard tests of susceptibility (e.g. the Stanford Hypnotic Susceptibility Scale, Form C) as subjects who do not counter (Sheehan, 1980). This second finding points to differential effects of rapport on Ss which are not explicable in terms of level of hypnotic susceptibility or simple willingness to comply with anticipated, obvious suggestions. Techniques like the EAT, which are sensitively attuned to detect the personal commitment of subjects to the hypnotist, are needed to detect subtle processes of this kind" (pp. 385- 386). The author evaluates different reporting techniques used to examine the phenomenological experience of hypnosis (the Chicago Paradigm of Fromm & Kahn, 1990; Shor's phenomenological method; the Field's Inventory Scale of Hypnotic Depth) and evaluates the effects of rapport with the E on the measurement of subjective response. He suggests various experimental controls (e.g. disguising the true aims of the experiment). A measure of rapport or psychodynamic transference to the hypnotist, the Archaic Involvement Measure (AIM) has been developed by Nash and Spinler (1989). "Experience cannot simply be observed objectively; it may not be reported spontaneously by the experiencer; and it may not even be elicited through ordinary forms of interaction" (p. 388). "What phenomenological research has shown over the last decade is that hypnotic experience is both multifaceted and complex. It has given us a view of the hypnotic subject as a person who participates actively in the hypnotic process, who is susceptible to the influence of motivations and expectations, and who employs a variety of cognitive strategies so as to manage and respond to multiple levels of communication received in the hypnotic setting. Standard techniques of assessment, especially those emphasizing the primacy of behavioral data and those offering structured choices, are not equipped to reveal the full meaning of hypnotic responsiveness" (p. 388). "If an instrument of assessment assumes a unidimensional underlying process when there are multiple dimensions operating, then that instrument will be deficient in measuring experience by producing equivalent ratings for very different experiences, and thus will be deficient in measuring overall experience. Measurement of trance-depth poses just such a problem, and measurement of hypnotic experience in its full complexity even more so" (pp. 388-389). Spira, James L.; Spiegel, David (1992). Hypnosis and related techniques in pain management. Hospice Journal, 8, 89-119. Hypnosis has been used successfully in treating cancer patients at all stages of disease and for degrees of pain. The experience of pain is influenced not only by physiological factors stemming from disease progression and oncological treatment, but also from psychosocial factors including social support and mood. Each of these influences must be considered in the successful treatment of pain. The successful use of hypnosis also depends upon the hypnotizability of patients, their particular cognitive style, their specific motivation, and level of cognitive functioning. While most patients can benefit from the use of hypnosis, less hypnotizable patients or patients with low cognitive functioning need to receive special consideration. The exercises described in this chapter can be successfully used in groups, individual sessions, and for hospice patients confined to bed. Both self-hypnosis and therapist guided hypnosis exercises are offered. 1991Mauer, D. R. (1991, October). A comparison of cognitive-behavioral and hypnotic techniques in the management of electromyography pain (Dissertation, University of Iowa). Dissertation Abstracts International, 53 (4), 1070-B. (Order No. DA 9217180) "Compared a cognitive behavioral technique that included providing specific sensory and procedural information combined with relaxation with a hypnotic technique (relaxation with guided imagery) and a control group for management of acute EMG pain and anxiety. Pain and anxiety ratings were gathered from 45 EMG patients and observers for both nerve conduction and needle electrode components of the EMG exam. It was found that only the hypnosis group significantly reduced pain and anxiety during the needle electrode portion of the procedure. Patients with unexplained or functional symptoms reported more EMG pain and anxiety than patients who had an organically based disease. Because having had a prior EMG seemed to have an effect on the efficacy of treatment, the data were reexamined. Results determined that inexperienced EMG patients who were treated had less pain and anxiety than patients who experienced EMG before, but inexperienced control patients had an increase in pain and anxiety over experienced patients" (p. 1070). Strauss, Billie S. (1991). The use of a multimodal image, the apple technique, to facilitate clinical hypnosis: A brief communication. International Journal of Clinical and Experimental Hypnosis, 39, 1-5. A 1- to 3-minute exercise involving imagination (of an apple) and ideomotor ideation (hand levitation) is a simple, benign technique that is useful for illustrating to patients the nature of imagery and hypnosis. It avoids power struggles and allows a reasonable approximation of the patient's capacity for imagery and hypnotic responsiveness, without emphasizing the use of a hypnotic procedure. When administered to 35 college students, the hand levitation component of this exercise correlated with the Stanford Hypnotic Susceptibility Scale, Form C (Weitzenhoffer & E. R. Hilgard, 1963) (r = .66, p <.001) and with the Stanford Hypnotic Clinical Scale: Adult (Morgan & J. R. Hilgard, 1975, 1978/79) (r = .60, p<.001). NOTES: Hypnosis is explained as involving imagination and concentration. Then the patient is asked to participate as the clinician checks their imagination. The patient is asked to close their eyes and hold out their hand, after which the clinician says "I'm going to put an apple in your hand; describe the apple to me." The patient is prompted to report multiple sensory modalities with questions Like, "Does the apple have weight? Does it have a smell? Would you Like to take a bite out of the apple? How does it sound as you chew it?" The clinician can obtain useful information about the patient's preferred sensory modalities, the amount of structure required to engage in imaginal activities, etc. If the patient becomes very involved with the image and would Like to continue the experience on into hypnosis, the clinician can ask them to concentrate on the apple's weight, then tell the patient that s/he will take the apple from the patient's hand and the patient will notice that the hand feels light. As this imagery progresses, the clinician can move into suggesting a sense of lightness, and ultimately an arm levitation procedure Like that of Chiasson, i.e. that "when the hand reaches the patient's face, the patient will find himself or herself in a comfortable state of hypnosis" (p. 2). "At any point where the patient does not appear to respond to suggestions or remain involved with the imagery, techniques are shifted. For example, if the patient indicates that the apple does not appear to have weight or the hand does not feel light, I suggest simply that the patient continue to listen to my voice, to breath deeply, and to continue to enjoy this comfortable state, perhaps using imagery commensurate with the skills shown by the patient when he or she first imagined the apple. Finally, patients are roused, with posthypnotic suggestions for alertness, comfort, and control" (p. 2). The author administered this Apple Technique to 12 patients, following the administration with an interview to learn about their subjective responses. Of the 12, 6 showed at least some hand levitation and scored 3-5 on SHCS:A; 6 had no levitation and scored 0-1 on SHCS:A. When administered to 35 college students, only 3 did not experience a sensation of weight when imagining an apple in their hand. A three-point rating (1 = no hand movement; 2 = some hand movement, but not to the face; 3 = hand movement to the face) correlated .66 with SHSS:C and .60 with SHCS:A. The author has found that good Ss can go into hypnosis within 2-3 minutes using the Apple Technique, while poor Ss conversely may reveal limited imaginative involvement or ideomotor skill within the same amount of time. 1990Avants, S. Kelly; Margolin, Arthur; Salovey, Peter (1990-91). Stress management techniques: Anxiety reduction, appeal, and individual differences. Imagination, Cognition and Personality, 10, 3-23. NOTES Four stress management techniques were evaluated for their general appeal, their immediate benefits, and the subjective experiences they evoke. One hundred undergraduates were randomly assigned to one of five treatment groups: (1) progressive muscle relaxation (PMR); (2) distraction imagery; (3) focused imagery; (4) listening to music; (5) sitting quietly (control). Distraction imagery and listening to music were the only techniques found to reduce anxiety to a greater extent than simply sitting quietly. The techniques differed in the way they made subjects feel, but not in their general appeal. Individuals with a 'blunting' coping style were more likely to find all five techniques appealing. Tests used included the Miller Behavioral Style Scale, Cognitive-Somatic Anxiety Questionnaire of Schwartz, Davidson & Golman, Life Orientation Test of Scheier & Carver, Somatic Perception Questionnaire of Landy and Stern, Body Consciousness Questionnaire of L. C. Miller, Murphy, & Buss, Betts' Questionnaire Upon Mental Imagery, Shortened Form, State-Trait Anxiety Inventory, and Technique Evaluation Questionnaire of the authors. Progressive muscle relaxation was according to Bernstein & Borkovec. Distraction imagery involved successively imagining a walk along a beach, a stroll across a flower filled meadow, sitting by a stream, a walk into the woods, sitting in a cabin in the woods listening to the rain against the windowpane, all including images in a variety of sense modalities. Focused imagery involved creating an image of a stressor, then through symbolic imagery experiences Ss were guided through a typical day's events that might lead up to the stressor, reinterpreting cues associated with the stressor as signals that they are in control, visualizing encountering the stressor feeling strong and determined, and any physical sensations reinterpreted as 'energy' that would help them to cope, visualizing enjoying their success (from Crits-Cristoph & Singer. Music was a 20-min tape (10 min of music used in the distraction imagery tape--Natural Light by Steve Halpern & David Smith) and 10 min of music used in background of the focused imagery tape (Structures of Silence by Michael Lanz). A 5th group, Control, was instructed to sit quietly with eyes closed. This data can be used in support of imagery-suggestion types of hypnosis (as in surgery study) reducing anxiety. It shows particularly strong effects for people high in cognitive anxiety or low in optimism, pre-treatment. Discussion: "... we feel confident that our distraction techniques were more effective for the immediate relief of anxiety than was PMR. This conclusion is consistent with the Suls and Fletcher meta-analysis (29) that suggested that 'avoidance' is an effective short-term coping strategy. That distraction (positive) imagery may be a more useful clinical technique than focused (active involvement) imagery was concluded in a study comparing these two techniques in the treatment of phobias (24)" (p. 19. [Ref #24 is Crits-Cristoph & Singer (1983) in Imagination, Cognition, and Personality.] "Pessimism and cognitive anxiety emerged as the only individual difference variables to influence anxiety reduction. Pessimism as measured by the LOT is cognitive in nature, with most of the items relating to expectations of negative outcomes; similarly, cognitive anxiety is characterized by worry and an inability to control negative thoughts and images. That individuals who perceive their world somewhat negatively should have entered the study more anxious than individuals who do not is hardly surprising. What is surprising is that despite an inverse relation between cognitive anxiety and the ability to relax, these individuals were able to benefit from whatever technique they performed to a greater extent than were individuals with a more positive outlook. In fact, after performing the technique, pessimists had reduced their anxiety to the level of optimists" (p. 19). "The stress management techniques used in the current study did not differ in their appeal" (p. 20). "Our finding that PMR produced more somatic effects than did focused imagery and less cognitive effects than did distraction imagery, listening to music, or sitting quietly is consistent with the model of anxiety proposed by Davidson and Schwartz (17). Our findings are also generally consistent with a conclusion reached by Woolfolk and Lehrer (4): that although various techniques are generally stress reducing, they seem to have highly specific effects. However, we found no support for the hypothesis that individuals who express anxiety cognitively (or somatically) prefer and benefit most from techniques that produce cognitive (or somatic) effects. In fact, the extremely high correlation found between the cognitive and somatic anxiety subscales of the Schwartz et al. measure (5) casts some doubt on the usefulness of a cognitive-somatic distinction, as does the corr between the experience of physical symptoms under stress (the Somatic Perception Questionnaire) with the cognitive, as well as the somatic, anxiety subscale. "The finding that blunters experiences more 'somatic effects' regardless of the technique they were assigned may have been the result of a single response--'how much did mind-wandering interfere with performing the technique'--which was the only Factor 2 item that was highly inversely) related to blunting. Since blunters are more likely to perceive mind wandering as the essence of stress management rather than as 'interference,' we do not view this main effect as particularly illuminating" (p. 20). "However, our finding that blunters experienced all techniques as appealing is consistent with the results of Martelli et al. (1) who found that individuals with low information-preference benefitted from what the authors labeled an 'emotion-focused' intervention, but which, in fact, included many of the quite diverse stress management techniques that we compared in the current study. That 'avoiders' failed to benefit from any intervention in the Scott and Clum study (11) may be due to the nature of the stressor [postsurgical pain]. Our undergraduates may have been more like the Martelli dental patients in terms of their level of distress than were the Scott and Clum subjects who were patients undergoing major surgery (hysterectomy or cholecystectomy). Future research needs to examine possible three-way, technique by patient by stressor-type, interactions (cf. 19)" pp 20-21. Evans, Frederick J.; Stanley, R. O. (1990). Psychological interventions for coping with surgery: A review of hypnotic techniques. Australian Journal of Clinical and Experimental Hypnosis, 18, 97-105. Illness, hospitalization, and surgery pose many severe stresses for many patients, to the extent that their ability to understand and cope with what is happening may be significantly reduced. Many of these stresses result from the nature and significance of patients' surgical procedures and post-operative treatment. This paper reviews the range of psychological interventions aimed at helping patients cope with pre- and post-operative treatment regimens. The range and content of hypnotic interventions are examined in detail. It is concluded that more rigorous research studies are required to determine the relative effectiveness of different types of interventions and to evaluate the effects of patients' psychological characteristics on the effectiveness of these interventions. 1989 Bryant, Richard A.; McConkey, Kevin M. (1989). Hypnotic blindness: A behavioral and experiential analysis. Journal of Abnormal Psychology, 98, 71-77. NOTES "This research examined the influence of visual information on a decision task that subjects were administered during hypnotically suggested blindness. Real, hypnotizable subjects and simulating, unhypnotizable subjects were tested in two experiments. Experiment 1 focused on behavioral responses, and Exper. 2 focused on experiential reactions. In both experiments, the findings indicated that the behavioral responses of reals were influenced by visual info. despite their reported blindness. The behavioral responses of reals and simulators were essentially similar. The experiential data in Experiment 2 provided information about the phenomenal nature of subjects' reported blindness. The experiential reactions of reals and simulators were essentially different. The research is discussed in terms of the issues that need to be considered in the development of a model of hypnotic blindness" (p. 71). Eppley, Kenneth R.; Abrams, Allan I.; Shear, Jonathan (1989). Differential effects of relaxation techniques on trait anxiety: A meta-analysis. Journal of Clinical Psychology, 45, 957-974. Conducted a meta-analysis of studies on the effects of relaxation techniques on trait anxiety. Effect sizes for the different treatments (e.g., progressive relaxation, biofeedback, meditation) were calculated. Most treatments produced similar effect sizes, although transcendental meditation (TM) produced a significantly larger effect size than other forms of meditation and relaxation. A comparison of the content of the treatments and their differential effects suggests that this may be due to the lesser amount of effort involved in TM. Meditation that involved concentration had a significantly smaller effect than progressive relaxation. 1988 Dougherty, John E.; Payne, Paul A. (1988). The use of breathing rhythm to enhance the vividness of mental imagery. Imagination, Cognition and Personality, 8 (2), 175-179. The study assessed Jencks' claim that responses to certain suggestions are enhanced by being paced with different phases of the breathing cycle. Following hypnotic induction, twenty-four subjects were given four treatments in counterbalanced order: 1) exhalation-enhanced suggestions paced to exhalation, 2) inhalation-enhanced suggestions paced to inhalation, 3) inhalation-enhanced suggestions counterpaced to exhalation, and 4) exhalation-enhanced suggestions counterpaced to inhalation. Subjects' reports of imagery vividness provided marginal support (p < .06) for Jencks' hypothesis. Post-experimental inquiry indicated subjects were unaware of the breathing contingency. Results suggest that appropriate pacing may make a greater difference for the energy-confidence group of suggestions (inhalation-paced) than for the calm-relaxation group (exhalation-paced). Kuttner, Leora (1988). Favorite stories: A hypnotic pain-reduction technique for children in acute pain. American Journal of Clinical Hypnosis, 30, 289-295. For young children (aged 3 to 6-11) with leukemia, a hypnotic trance consisting of a child's favorite story was found to be statistically more effective than behavioral distraction and standard medical practice in alleviating distress, pain, and anxiety during painful bone marrow aspirations. Measured by a behavioral checklist and judgment ratings by physician, parent, nurse, and observers, the favorite-story hypnotic technique had immediate therapeutic impact on these young patients, and the reduction in distress, pain, and anxiety was sustained on subsequent medical procedures. Self-report measures, however, were nonsignificant. 1985 Matthews, William J.; Kirsch, Irving; Mosher, Donald (1985). Double hypnotic induction: An initial empirical test. Journal of Abnormal Psychology, 94 (1), 92-95. NOTES In separate experimental sessions, 34 undergraduate students experienced audiotapes of a standard hypnotic induction and a double induction similar to that described by Bandler and Grinder (1975). In the double induction, subjects heard a hand- levitation induction through the ear that is contralateral to the dominant cerebral hemisphere and, simultaneously, heard grammatically childlike messages through the other ear. Half of the subjects experienced the double induction first. There were no significant within-subject differences between the two inductions. However, subjects who experienced the double induction prior to the standard induction were significantly less responsive to suggestions following both inductions, which suggests that the double induction as a first experience of hypnosis may have a negative impact on subsequent experiences of hypnosis. 1984 Gillett, Penny L.; Coe, William C. (1984). The effects of rapid induction analgesia (RIA), hypnotic susceptibility and the severity of discomfort on reducing dental pain. American Journal of Clinical Hypnosis, 27, 81-90. The study was designed to address three issues involved in hypnotic analgesia for dental pain: 1) The effectiveness of J. Barber's (1977) hypnotic procedure for producing analgesia in its usual form and a shortened form, 2) the relationship of hypnotic susceptibility to analgesic responsiveness, and 3) the effect of dental procedure discomfort level on hypnotic analgesia. Sixty unselected dental patients were administered either J. Barber's (1977) RIA or a shortened version of it (SI) before their dental treatment. Measures of hypnotic susceptibility were obtained as were dentists' ratings of the discomfort levels involved in the various dental procedures administered. The 52% success rate of the present study failed to replicate Barber's very high (99%) success rate, although procedural differences might explain the lower rate. RIA and SI were equally effective. Hypnotic susceptibility level did not relate significantly to success with hypnotic analgesia. The level of dental procedure discomfort was the clearest predictor of success with hypnotic analgesia. The greater the discomfort rating of a procedure the less likely that hypnotic analgesia would be successful. 1983 Diamond, Michael Jay (1983). Therapeutic indications in applying an innovative hypnotherapeutic technique: The client-as-hypnotist. American Journal of Clinical Hypnosis, 25 (4), 242-247.