The essence of Erickson’s therapy lay in the unexpectedness of his comments or instructions, the shock element, the surprises, and the tasks that he assigned the patient to carry out in the real space-time world or in fantasy. There was often doubt whether other than light hypnosis was involved” (p. 129).
As an example, Hilgard reports on a published case in which both the husband and wife had enuresis and Erickson treated them in a very authoritarian fashion. Erickson told them that he “would make a bargain with them: If they got well, they would not have to pay; if they did not benefit from the therapy, they would have to take full financial responsibility for the time he gave to them. He obtained their promise that they would do what he told them, and then he proceeded to tell them: ‘This is what you are to do.’ He then laid out the scenario. The most important part was that they were to take fluids frequently, drink a glass of water 2 hours before going to bed, and then lock the bathroom door. At bedtime, they were to get into their pajamas, kneel side by side on the bed and deliberately and jointly wet the bed. Wetting the bed would then be over for the night, and they could sleep through the night in the wet bed. They must do this every night for 2 weeks; on the Sunday night to follow, they may lie down and sleep in a dry bed. If the bed is wet the next morning, they will have to kneel and wet the bed each night for another 3 weeks.
“You have your instructions. There is to be no discussion and no debating between you about this, just silence. There is to be only obedience, and you know _and will know what to do_. I will see you again in five weeks’ time. You will then give me a full and amazing account. Goodbye! [Volume IV, 1954, p. 100, emphasis in original].
“When they reported–cured after the first 2 weeks–they asked whether Erickson had used hypnosis. He dodged their question by saying that they were entitled to full credit for what they accomplished” (p. 130).
Hilgard makes the point that Erickson’s authoritarianism might seem to contradict claims made that he had a high degree of respect for patients, their autonomy, and their responsibility for solving their own problems. “There need be no contradiction, if it is recognized that the planned behavior may not in itself be the cure, but may only be the occasion that leads to patient to reorient and solve the personal problems that led to the seeking of therapy. Another way of putting this is that the _strategy_–that is, the plot of the drama–was entirely Erickson’s, although the _tactics_–that is, beyond the fixed actions required by him, how the part was played–were left to the resources of the patient. This is not the permissiveness of Rogers (1951) with respect to the patient’s responsibility for his or her own life, nor does it have the freedom of expression of Moreno’s (1946) spontaneity theater” (p. 131).
Hobson, J. Allan (1988). The dreaming brain. New York: Basic Books.
Hypnosis and Sleep_ Ramon y Cajal and Freud shared an interest in hypnosis, as an experimental method of inducing an altered state of consciousness, introducing dynamic principles into both neurology and psychiatry (rather than simply static descriptions). The author contrasts the hypnosis “artificially altered state of consciousness” with sleep as a “naturally altered state of consciousness, asking whether similar rules govern the transition of state change in both cases. He notes that induction of both states involve rhythmic stimulation and eye fixation, and both may facilitate gaining control over brain-stem centers implicated in conscious-state regulation.
The brain stem is the nightly battleground of warring neuronal factions, and REM sleep and dreaming are the result of temporary domination of one neuronal population over another. Victorious is a troop of reticular-formation neurons concentrated mainly in the pontine portion of the brain stem; owing to their fusillades of firing in association with REM-sleep events, these pontine reticular neurons are likely to play the executive role in the generation of REM sleep and dreaming. Sharing the white flag of temporary surrender is a population of aminergic neurons located in the locus ceruleus, the raphe nuclei, and the peribrachial regions of the anterior pontine brain stem; hardly a shot is fired by this neuronal phalanx during REM sleep. By virtue of this cease-fire, these aminergic neurons are likely to play a permissive role in the generation of REM sleep” (p. 183).
The Reciprocal-Interaction Model suggests that “the continuous competition between the excitatory reticular neurons and the inhibitory aminergic neurons is the basic physiological process underlying sleep-cycle alternation” (p. 184). Neurotransmitters (aminergic for inhibition, cholinergic for excitation) are implicated as well. The width of the brain stem correlates with sleep-cycle. The brain seems to “undergo a periodic shift in neurotransmitter ration, from a predominantly aminergic mode in waking to a predominantly cholinergic mode during REM sleep” (p. 192). Thus, there is a major shift in metabolic orientation as we change from waking externally generated information and action to REM-sleep internally generated information and suppressed action.
The author proposes an activation-synthesis hypothesis to account for dreaming and envisions the brain as a “Dream Machine.” “The recognition that the brain is switched on periodically during sleep answers the question of where dreaming comes from: it is simply the awareness that is normal to an auto-activated brain-mind. This causal inference is continued in the term _activation_ in the new dream theory’s title. The question of why dreams are paradoxically both coherent and strange is in turn suggested by the term _synthesis_ , which denotes the best possible fit of intrinsically inchoate data produced by the auto-activated brain-mind.
“The original dream theory thus had two parts: activation, provided by the brain stem; and synthesis, provided by the forebrain, especially the cortex and those subcortical regions concerned with memory. The physiology that is now in hand best supports the first part of the theory; much more work needs to be done on the synthetic aspects of the process. But I now add a third major component to the theory, the concept of _node switching_ , which accounts for the _differences_ in the way the activated fore-brain synthesizes information in dreaming (compared with waking): for the twin paradoxes of dream bizarreness and insight failure (where the system has lost self-reference as well as its orientation to the outside world) and for dream forgetting” (p. 204).
The author assumes a formal isomorphism between subjective (dream report) and objective (brain activity) levels of investigation. Thus, the report of experiencing visual images in dreams implicates the brain’s visual system.
In terms of psychophysiology, Hobson proposes that “the on-off switch for dream mentation is the reciprocal-interacting neuronal populations comprising the aminergic neurons and the reticular neurons of the brain stem” (p. 205). For sleep (and dreaming) to be maintained, stimulation from the outside world must be minimized. This is accomplished in at least two ways. There is active inhibition of nerves at the pre-synaptic level (e.g. by depolarization by signals coming from the brain stem; Pompeiano, 1978) so that the nerves are less efficient in transmitting information from the environment, as there is less neurotransmitter available. Secondly, there is competition among higher levels of sensory and associative circuits, so that they ignore incoming signals (or incorporate them into internally generated dreaming activity). Hobson refers to these mechanisms as the sensory input blockade.
Hobson also describes the motor output blockade, which prevents us from taking actions based on dream content. There seems to be inhibition of motor-command neurons in the brainstem and spinal cord.
When dreams arise, there seems to be brain activation as evidenced by PGO (Pons, lateral Geniculate, Occipital cortex) waves originating in the brain stem. They are found in association with REM sleep and go via independent pathways to both visual and association cortex. “According to the activation-synthesis hypothesis of dreaming, the now auto-activated, disconnected, and auto-stimulated brain-mind processes these signals and interprets them in terms of information stored in memory” (p. 207).
Hobson states that the activation-synthesis hypothesis can account for five aspects of dreaming: visual and motor hallucinations, the acceptance of these hallucinations as ‘real’, bizarre spatial and temporal distortion, strong emotions, and amnesia for the events after waking up. The experiences of dreams are accepted as real because there is no concomitant external input.
1987
Bandura, A.; O’Leary, A.; Taylor, C. B.; Gauthier, J.; Gossard, D. (1987). Perceived self-efficacy and pain control: Opioid and non-opioid mechanisms. Journal of Personality and Social Psychology, 53, 563-571.
Subjects who were trained to use psychological coping strategies (e.g. imagery, distraction, dissociation, sensation transformation) had both better pain tolerance on a cold pressor test and higher self efficacy ratings. Those subjects who were given naloxone (which blocks pain reduction effects of beta endorphins) showed more pain tolerance than subjects not given the cognitive training experiences. They attributed much of the pain tolerance increase associated with cognitive interventions to opiate release, suggesting that cognitive interventions may have physiological mediating effects on pain perception.
Gorassini, Donald R. (1987). Use of concurrent verbalization to assess the dissociation of conscious controls. Journal of Abnormal Psychology, 96 (3), 218-222.
The degree of dissociation of conscious controls that occurred when, according to the neodissociation theory (Hilgard, 1977, 1979), conditions were optimal for such an event was assessed. A task that required subjects to locate specified sentences in a textbook was conducted under these optimal conditions, as well as under conditions that were expected to mitigate against the occurrence of dissociation. The sentence- search task necessitated rehearsal for its successful completion The correspondence between task rehearsal and task performance did not differ between optimal and mitigating conditions, thus suggesting a failure to dissociate. Nevertheless, search behavior was self- rated as substantially more involuntary under the optimal than under the mitigating conditions. The implications of these findings for the neodissociation and social role theories of hypnosis were discussed.
Hilgard, Ernest R. (1987). Research advances in hypnosis: Issues and methods. International Journal of Clinical and Experimental Hypnosis, 35, 248-264.
There are substantial areas of agreement upon the classical phenomena of hypnosis, illustrated by what we now have learned about hypnotic talent, amnesia, hallucinations, analgesia, and dissociative processes. While genuine advances in knowledge about hypnosis have been made in recent decades, differing orienting attitudes have kept some controversy alive, particularly in the interpretation of empirical findings. Differences of interpretation of the phenomenal and behavioral facts are to be expected in the present stage of developmental, cognitive, and social psychology.
NOTES
The author writes of the “domain of hypnosis” as within the larger domain of social psychology (because it is usually interpersonal); cognitive psychology (because of alterations in perception, imagination, memory, and thought); developmental and personality psychology (because of individual differences); and physiological psychology (because of neurophysiological aspects).
In terms of what we know about hypnotic talent, he notes that high hypnotizability is not generally associated with psychopathology; that it may however be associated with a personality measure called absorption; and that there may be some inherited ability (Morgan, 1973). In the author’s view, hypnosis is no longer considered simply a response to suggestion, since imagination and/or fantasy are very important.
In reviewing evidence of posthypnotic amnesia the author writes, “Subtleties in language require making careful distinctions among concepts such as compliance, suggestion, compulsivity, belief, self-deception, automaticity, the voluntary, the involuntary, and a happening. If these distinctions are glossed over, the choice of words (e.g., substituting compliance for response to suggestion) may give the impression that a finding departs more widely from conventional views than it does. We, too, have found that Ss used varied strategies or skills during amnesia, but this need not deny augmentation by suggestion.
“It takes genuinely high Ss to illustrate truly high posthypnotic amnesia… Many of the truly high hypnotizable individuals cannot break amnesia, no matter how hard they try” (p. 253).
Regarding the evidence for hypnotic hallucinations and trance logic, the author suggests that trance logic is not a clear concept because the Subject is capable of good logic while tolerating some inconsistencies. “It is ordinary logic to assume that if your hallucination is your own construction, it is you who can influence it by your own wishes. In the rare cases of transparent or diaphanous hallucinations there is still an ‘out there’ quality. People who report that they see wispy ghosts also see them as ‘out there,’ so that they qualify as hallucinations. The distinction appears to be one of perception and perception-like experiences within hypnosis rather than of logic” (p. 256).
In reviewing the evidence for hypnotic analgesia, the author acknowledges that pain relief is available with other kinds of interventions, or by using other kinds of psychological processes, but that does not diminish the contribution of hypnosis (which has a long and impressive clinical history). Following laboratory studies, it is noted that “the amount of alleviation of pain through hypnosis is positively correlated with the hypnotizability of the candidate for pain reduction. This result is not universally accepted, because some clinicians are convinced that those unsuccessful in hypnotic pain reduction are resisting hypnosis” (p. 256-257). In the present paper he acknowledges but does not review physiological literature on hypnoanalgesia.
Regarding the concept of dissociation, the author indicates that he considers it a more useful concept than the concept of trance or hypnotic state “when a person is only slightly or moderately involved in hypnosis … . The advantage is that dissociations, as compared with altered states, can be described according to limited or more pervasive changes in the cognitive or motor systems that are being activated or distorted through suggestion in the context of hypnosis. Perhaps when all-inclusive enough, such changes can justify the use of the term trance or altered state, but I believe that these terms should be used, if at all, only for those for whom the immersion in the hypnotic experience is demonstrably pervasive” (pp. 258-259).
The author goes on to describe his initial discovery of the ‘hidden observer’ in an experimental context, and to relate the ‘hidden observer’ to others’ earlier observations of a secondary report of an experience previously concealed from S’s consciousness (Binet, 1889-1890/1896; Estabrooks, 1957; James, 1899; Kaplan, 1960). “The issues are still being worked on, but as in the case of trance logic the heart of the problem is not whether to speak of a hidden observer, but to recognize that there may be cognitive distortions in hypnosis even while some more realistic information is being processed in parallel, so that everything is not reportable by S” (p. 260).
1986
Goldberg, Benjamin Mark (1986, October). The role of selective attention in hypnotic susceptibility: An empirical study (Dissertation, City College of New York). Dissertation Abstracts International, 47 (4), 1774-1775-B.
This study tested the hypothesis that in hypnotic situations high as opposed to low susceptible subjects evidence a more pronounced restriction of attention to hypnotic suggestions. Also tested was the hypothesis that high susceptible subjects evidence attentional behavior aimed at enhancing the subjective reality of these suggestions. Fifteen high susceptible and 15 low susceptible subjects participated in a hypnotic procedure while ostensibly extraneous phrases emanated from an adjacent cubicle. Hypnotic suggestions coincided with phrases that were consonant, neutral, and dissonant with the theme of each suggestion. In a control condition, high and low susceptible subjects performed nonhypnotic tasks while exposed to the same phrases which were neutral with relation to the theme of each task. Contrary to the present hypothesis, subsequent phrase recognition was equal and poor for all groups. Moreover, all groups showed an identical pattern of differential phrase recognition which consequently precluded thematic value as an organizing factor. The findings suggest that selective attention is not a critical factor, underlying hypnotic responsiveness. Alternatives to attentional conceptions of hypnosis are discussed” (pp. 1774-1775).
1984
Bowers, Kenneth S. (1984). On being unconsciously influenced and informed. In Bowers, Kenneth S.; Meichenbaum, D. (Ed.), The unconscious reconsidered (pp. 227-273). New York: John Wiley & Sons.
Research on confirmatory bias has uncovered additional cognitive processes that are frequently automatic in function and significant in modifying behavior, affect, and cognition. Snyder and Swann (1976, 1978) provided subjects with set inducing hypotheses about the personalities of certain target individuals. Subjects were then asked to test these hypotheses by interviewing the target individuals. It was found that subjects regularly looked for and found evidence that was consistent with their initial hypotheses rather than for evidence which could show these hypotheses to be incorrect. This biased search strategy of the subjects had more profound effects as well, for it also influenced the behaviors of the target individuals in a manner leading them to produce behaviors that seemed to confirm the original mental set of the subjects. Subjects were unaware that their manner of interviewing was producing a biased sample of behavior from the targets. Here too an automatic cognitive process was affecting perception and thinking without conscious awareness” (p. 280).
Burnham, John C. (1984, October/1986). The fragmenting of the soul: Intellectual prerequisites for ideas of dissociation in the United States. In Quen, Jacques M. (Ed.), Split minds/split brains (pp. 63-84). New York: New York University Press. (Based on symposium in Bear Mt., N.Y., by Section on the History of Psychiatry of Cornell University Medical Center)
Reductionism was a relentless pursuit of the idea that knowledge of components led to knowledge of causes. In this context, I propose to show how, in the psychological-medical realm, the initial concept was the soul, and the final intellectual product was dissociative phenomena” p. 64.
Carlson, Eric T. (1984, October/1986). The history of dissociation until 1880. In Quen, Jacques M. (Ed.), Split minds/split brains (pp. 7-30). New York: New York University Press. (Based on symposium in Bear Mt., N.Y., by Section on the History of Psychiatry of Cornell University Medical Center)
NOTES
Provides summary of the history of associationism. Refers to Beddoes’ essays (1802-03) which state that (1) emotions play a significant role in strengthening associations, and a study of emotions would be the ‘chief secret for unriddling the inconsistencies of dreams,’ and (2) variations could occur in associations (from very strong to very weak).
In the 19th century there was an ongoing debate about the role of the reflex in the nervous system, about how high up it could function, and whether it could still take place if it reached areas that subserved consciousness. Dr. William Carpenter postulated three levels: (1) excitomotor reflex (spinal, and maybe lower brain), (2) sensorimotor or consensual (midbrain) which was unconscious, (3) ideomotor (cerebral) – based on evidence from hypnosis in which volition appeared suspended and the subject became ‘a mere thinking automaton’ whose flow of ideas resulted from external suggestions only. The ideomotor response could be unconscious.
In the 1830’s and 40’s Thomas Laycock brought Associationism together with the concept of reflex. “By bringing the reflex into ‘cerebral processes,’ he proposed a model that made fast and automatic responses possible in the realm of ideas. Automatic thinking, speaking, writing, and more complex actions became topics of increasing interest to psychologists later in the century. As early as 1868, Prosper Despine had been speaking of ‘psychological automatisms.’ Laycock proclaimed most of these responses as being unconscious, that ideas could be charged with varying amounts of energy, and that ideas could act as causes of human disturbances, both psychological and physiological” (pp. 25- 26).
1860’s – 90’s saw the rise of hypnotism, with Eugene Azam using it in surgery and psychiatry; Durand de Gros’s book on Braid; Liebeault publishing a book; Bernheim launching his career; Charcot shifting interest from organic neurological conditions to functional conditions; and Charcot teaching both Janet and Freud.
The author notes that “in July 1880, a bright and educated young woman of 20 started to nurse her dying father. Like the shamans before her, she had to grapple with the spectre of death and in her own fashion, she developed a creative illness. Her symptoms were myriad, but many had to do with changes in her consciousness (including ‘absences,’ clear-cut trances) and splits in her memory, including the loss of an entire language. At one point her current personality disappeared and another took its place: in this case it was herself but existing a year before in a state in which she lived without any apparent awareness of what had happened to her in the interim. It is this case of Anna O. and her doctor, Josef Breuer, which became important to the next epoch in our review and who had so much to do in inspiring the studies that followed” pp. 27-28.
Critelli, Joseph W.; Neumann, Karl F. (1984). The placebo: Conceptual analysis of a construct in transition. American Psychologist, 39, 32-39.
The placebo in psychotherapy has unfortunately retained the negative connotation of an inert “nuisance variable,” a label that it originally incurred in the field of medicine. In addition, the transition toward more cognitive models of psychotherapy, particularly Bandura’s theory of self-efficacy, has led to problems in defining the placebo within psychology. This transition has resulted in an awkward interface between certain preferred cognitive metaphors and the negative connotations of a presumably cognitive placebo construct. As a result, suggestions have recently been made to dismiss the placebo construct from psychology and to do away with the use of true placebo controls in outcome research. The present analysis maintains that (a) the placebo can be adequately defined within psychology, (b) the negative connotation of the placebo label is largely undeserved, (c) the placebo retains a continuing conceptual and empirical utility for evaluating psychotherapy, and (d) the therapeutic efficacy of current therapies is well established even though they have not generally been shown to be more effective than nonspecific treatment.
Heide, F. J.; Borkovec, T. D. (1984). Relaxation-induced anxiety: Mechanisms and theoretical implications. Behaviour Research and Therapy, 22, 1-12.
Literature evidence documenting the occurrence of relaxation-induced anxiety is reviewed, and several hypothesized mechanisms to explain the phenomenon are discussed. Possible avenues for circumventing the problem in therapy are offered. Finally, a theoretical model is presented wherein the phenomenon is viewed with a broader framework designed to explain the development and maintenance of the more generalized anxiety disorders. That framework emphasizes the emergence of fear of somatic anxiety cues and fear of loss of control from more fundamental interpersonal anxieties.
Baars, B. J. (1983). Conscious contents provide the nervous system with coherent, global information. In Davidson, Richard J.; Schwartz, Gary E.; Shapiro, David (Ed.), Consciousness and self regulation (3, ). New York: Plenum Press.
NOTES
We are conscious of some content when there exists an internal representation that is global, stable, and informative.
Author views nervous system as a distributed information. processing system, in which highly complex & efficient processing is performed by specialized processors in a relatively independent way. These processors may be ‘data driven’–i.e. they may decide by their own criteria what is worth processing…” p. 41 [See also Gazzaniga’s (1985 Psychology Today article) idea that mind/brain consists of modules.]
p.44 gives references substantiating the above, e.g. Geschwind, Hilgard, La Berge, Shiffrin & Schneider.
p. 45 We are in habit of thinking hierarchically about nervous system rather than distributively.
p. 45 “Consciousness seems to be closely associated with a mechanism that permits interaction between specialized, dedicated processors” The ‘global’ data base’ is like a TV station sending out information that can be processed or not by the viewer. It is not an executive, and in fact can sometimes be controlled by the processors. ‘Consciousness …[is] a certain operating mode of this medium, & consciousness can likewise be used by processors acting as executives, without itself being an executive “(p.49).
The global data base is a lengua franca, so that one sense modality can communicate with others. p. 51. [Synesthesia reported by high hypnotizables implicates this system–either the communicating tracks are greased between color and smell, or the name of the destination, in computer language, is lost, or equivalent.]
p. 52 Repression and the dynamic unconscious. explained in terms of controlled access to the global data base, with certain specialized processors given high priority.
Context, taken by itself, is unconscious; & input, taken by itself & in the absence of the appropriate context, is also unconscious. Only when both of these conditions exist- -when there is input that can be organized within a current context–are we conscious of some percept.
Contextual factors become conscious only when they are challenged.
1981
Fromm, Erika; Brown, Daniel P.; Hurt, Stephen W.; Oberlander, Joab Z; Boxer, Andrew M.; Pfeifer, Gary (1981). The phenomena and characteristics of self-hypnosis. International Journal of Clinical and Experimental Hypnosis, 29 (3), 189-247.
Self-hypnosis and hetero-hypnosis were compared, and self-hypnosis was studied longitudinally. Results indicated that absorption and the fading of the general reality orientation are characteristics of both hetero-hypnosis and self-hypnosis. The differentiating characteristics lie in the areas of attention and ego receptivity. Expansive, free-floating attention and ego receptivity to stimuli coming from within are state-specific for self-hypnosis, while concentrative attention and receptivity to stimuli coming from one outside source–the hypnotist on whom the subject concentrates his attention–are state- specific for laboratory defined hetero-hypnosis. Attempts to produce age regression and positive or negative hallucinations are markedly more successful in hetero-hypnosis. Imagery is much richer in self-hypnosis than in hetero-hypnosis. Self-hypnosis requires adaptation to the state: in the beginning of self-hypnosis there is a good deal of anxiety and self-doubt. As the subject feels more comfortable in the self-hypnotic state, he spends less time worrying about failures in self-suggestion, his ability to enter trance quickly and easily increases, as does the fading of the general reality orientation, trance depth, and absorption. An attempt was also made in the present study to find personality characteristics related to the ability to experience self-hypnosis.
1980
Hilgard, Ernest R. (1980, October). Hypnotic modification of sensitivity and control. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Chicago.
The author presents a factor analysis of several scales in the hypnosis domain: HGSHS:A, Wilson-Barber CIS, Stanford Hypnotic Susceptibility Scale Form C, Questionnaire on Mental Imagery (Sheehan’s modification of Betts) and the Tellegen- Atkinson Absorption Scale. Scales were broken down into components first. He didn’t report all of the factors, but shows how these tests fall on a graph defined by Factor 1 (Amnesia/Cognitive) and Factor 4 (Absorption/Imagery). “Capacity for fantasy and amnesia are so different that hypnosis probably includes both.”
Hilgard concludes that he doesn’t like a state theory for hypnosis or the idea of “trance” because it is unidimensional. He prefers “dissociation” because we think of it as a continuum. Even Highs differ one from another in the nature of their responses. Altered- state-of-consciousness theories don’t readily explain partial dissociation (e.g. persistence of a suggestion such as arm rigidity after hypnosis is terminated; or hysterical paralysis).
TINNITUS
Attias J, Shemesh Z, Sohmer H, Gold S, Shoham C, Faraggi D Comparison between self-hypnosis, masking and attentiveness for alleviation of chronic tinnitus. Audiology 1993;32(3):205-12 The efficacy of self-hypnosis (SH), masking (MA) and attentiveness to the patient’s complaints (AT) in the alleviation of tinnitus was evaluated. Forty-five male patients close in age with chronic tinnitus related to acoustic trauma were assigned to three matched subgroups: SH, AT or MA. The therapeutic stimuli in the SH and MA sessions, recorded on audio cassettes, were given to the patients for use when needed. SH significantly reduced the tinnitus severity; AT partially relieved the tinnitus; MA did not have any significant effect.
Marks NJ. Karl H. Onisiphorou C. A controlled trial of hypnotherapy in tinnitus. Clinical Otolaryngology 1985;10(1):43-6 A group of 14 patients with unilateral tinnitus were selected because of the constant nature of their tinnitus, and its resistance to all other forms of therapy. They were subjected to hypnosis in three forms in random order. The induction of a trance state alone formed the control arm of the trial. Compared to this were the effects of ‘ego boosting’ and active suppression of tinnitus whilst in a trance state. One of the 14 patients showed a highly significant response to the latter treatment as judged by visual analogue scales. Five of the 14 patients (36%) found the induction of a hypnotic state of value.
This seemed to help them tolerate their tinnitus better, although its loudness and quality were unaltered.
Mason JD. Rogerson DR. Butler JD. Client centred hypnotherapy in the management of tinnitus–is it better than counselling?. Journal of Laryngology & Otology. 1996;110(2):117-20 The aim of this study was to assess whether client centred hypnotherapy (CCH) which required three sessions with a trained therapist was superior to a single counselling session in reducing the impact of tinnitus. Patients were randomly allocated to receive either counselling (n = 42) or CCH (n = 44). The outcome measures were: tinnitus loudness match, subjective tinnitus symptom severity score, trend of linear analogue scale, request for further therapy and whether the patient had an impression of improvement in their tinnitus after treatment. CCH was no better than counselling in reducing the impact of tinnitus using the three quantative measures of tinnitus, and requests for further follow up. The only significant difference between the two therapies was that 20 (45.5 per cent) of the CCH group reported a general sense of improvement compared to six (14.3 per cent) in the counselling group, this is significant p < 0.01. The study did not demonstrate whether this was a genuine hypnotic effect or simply a response to the additional attention from the therapist.
U RESEARCH
Ulcers
1991
Schwarz, Shirley P.; Blanchard, Edward B. (1991). Evaluation of a psychological treatment for inflammatory bowel disease. Behaviour Research and Therapy, 29 (2), 167-177.
Compared the effectiveness of a multicomponent behavioral treatment package, which included inflammatory bowel disease (IBD) education, progressive muscle relaxation, thermal biofeedback, and training in use of cognitive coping strategies, with the effectiveness of symptom-monitoring as a control condition. The treatment group consisted of 11 IBD patients (aged 25-62 yrs); 8 of 10 persons (aged 25-71 yrs) in the control group completed treatment. At posttreatment, the treatment group showed fewer reductions in symptoms (5) than the symptom-monitoring controls (8). However, treated Ss perceived themselves as coping better with IBD and as feeling less IBD-related stress. It is hypothesized that the differences in treatment responses may be related to differences between Ss with ulcerative colitis and Ss with Crohn's disease.
Whorwell, P. J. (1991). Use of hypnotherapy in gastrointestinal disease. British Journal of Hospital Medicine, 45, 27-29.
Recent controlled studies in the field of gastroenterology have shown that hypnotherapy is unequivocally beneficial in conditions such as irritable bowel syndrome and peptic ulceration. There is also some evidence for influence on certain physiological functions. Further research should help to define more clearly the role of this controversial form of therapy.
NOTES
This is a summary of work the authors are doing in gastroenterology. The authors are doing pilot work with inflammatory bowel disease and also ulcerative colitis. Patients are given an idea of the pathophysiology. "First subjects are asked to place a hand on their abdomen and feel warmth and then to relate this sensation to the relief of pain, spasm, bloating etc. Second they are asked to visualize a river and imagine that it is their gut. They are then told to modify the flow in order to achieve a more satisfactory bowel habit. For instance it would be suggested to a subject with loose bowels that a fast- flowing river with broken water is changed into a much more slow, smoothly flowing one. To the trainee therapist these suggestions sound very unconvincing but they do seem to work.
Patients often take many weeks to respond and this can be very testing for the resolve of both patient and doctor alike. Some patients seem to adopt a very passive approach to treatment, expecting the therapy to work rather akin to taking a tablet--they attend once a week and wait for something to happen." (p. 29). [They have to be taught that they must make the treatment work for themselves.]
1990
Schwarz, Shirley P.; Taylor, Ann E.; Scharff, Lisa; Blanchard, Edward B. (1990). Behaviorally treated irritable bowel syndrome patients: A four-year follow-up. Behaviour Research and Therapy, 28 (4), 331-335.
A 4-yr longitudinal study evaluated 19 patients (aged 23-60 yrs) suffering from Irritable Bowel Syndrome (IBS) who had completed a multicomponent treatment involving progressive muscle relaxation, thermal biofeedback, cognitive therapy, and IBS education at baseline. 17 Ss rated themselves as more than 50% improved. Six of the 12 Ss who submitted symptom monitoring diaries met the criteria for clinical improvement, (i.e., achieving at least a 50% reduction in primary IBS symptom scores). The means on all measures at long-term follow-up were lower than those obtained prior to treatment. When follow-up symptom means were compared with pretreatment means, significant reductions were obtained on abdominal pain/tenderness, diarrhea, nausea, and flatulence.
1989
Klein, Kenneth B.; Spiegel, David (1989). Modulation of gastric acid secretion by hypnosis. Gastroenterology, 96, 1383-1387.
NOTES
The ability of hypnosis to both stimulate and inhibit gastric acid secretion in highly hypnotizable healthy volunteers was examined in two studies. In the first, after basal acid secretion was measured, subjects were hypnotized and instructed to imagine all aspects of eating a series of delicious meals. Acid output rose from a basal mean of 3.60 to 6.80 ... with hypnosis, an increase of 89% ( = .0007). In a second study, subjects underwent two sessions of gastric analysis in random order, once with no hypnosis and once under a hypnotic instruction to experience deep relaxation and remove their thoughts from hunger. When compared to the no-hypnosis session, with hypnosis there was a 39% reduction in basal acid output ... and an 11% reduction in pentagastrin-stimulated peak acid output ... p<.05. We have shown that different cognitive states induced by hypnosis can promote or inhibit gastric acid production, processes clearly controlled by the central nervous system. Hypnosis offers promise as a safe and simple method for studying the mechanisms of such central control
Tosi, D. J.; Judah, S. M.; Murphy, M. A. (1989). The effects of a cognitive experiential therapy utilizing hypnosis, cognitive restructuring, and developmental staging in psychological factors associated with duodenal ulcer disease: A multivariate experimental study. Journal of Cognitive Psychotherapy, 3, 273-290.
This study evaluated the effects of a Cognitive Experiential Therapy (CET)--in the past referred to as Rational Stage Directed Hypnotherapy--Cognitive Restructuring (CR), Hypnosis Only (HO), and a no-treatment control condition on the duodenal ulcer syndrome. CET is a systematic, stage-directed therapy that employs hypnosis and the cognitive restructuring of self-defeating cognitive, emotional, physiological, and behavioral tendencies. Seven criterion variables were assessed using two standardized instruments and questionnaire data. The standardized instruments included the Millon Behavioral Health Inventory (MBHI) and the Common Beliefs Survey III (CBS). Twenty-five volunteer duodenal ulcer patients were subjects in a 4 x 3 factorial design with repeated measures consisting of the four treatments and pretest, posttest, and follow-up. There was a significant treatment effect, and effects were observed on personality coping styles, beliefs and locus of control scales, and on gastrointestinal disturbance. CET appeared to have an ameliorative effect on psychological factors associated with duodenal ulcer.
1988
Colgan, S. M.; Faragher, E. B.; Whorwell, P. J. (1988, June 11). Controlled trial of hypnotherapy in relapse prevention of duodenal ulceration. Lancet, 1299-1300.
30 patients with rapidly relapsing duodenal ulceration were studied to assess the possible benefit of hypnotherapy in relapse prevention. After the ulcer had healed on treatment with ranitidine, the drug was continued for a further 10 weeks during which time patients received either hypnotherapy or no hypnotherapy. The two randomly selected groups were comparable in terms of age, sex, smoking habits, and alcohol consumption. Follow-up of both groups of patients was continued for 12 months after the cessation of ranitidine. After 1 year, 8 (53%) of the hypnotherapy patients and 15 (100%) of the control subjects had relapsed. The results of this study suggest that hypnotherapy may be a useful therapeutic adjunct for some patients with chronic recurrent duodenal ulceration.
NOTES
The aetiology of duodenal ulceration is poorly understood but it is probably multifactorial. ... Stress, both psychological and physical, has since been shown to affect gastric emptying and the secretion of acid and pepsin, but attempts to causally link stress and peptic ulcer disease have produced conflicting results.
"Hypnotherapy can modify the response to betazole-stimulated gastric acid secretion, although the mechanism by which this is mediated remains unclear" (p. 1299).
"The active [treatment] group received 7 sessions of hypnotherapy and were given an audio tape for daily autohypnosis; the other group were seen as often, but did not receive any hypnotherapy. The ranitidine was then stopped and both groups were reviewed every 3 months for a further year, with the active group receiving hypnotherapy at their follow-up visits. All subjects had an endoscopy at the end of the study, or sooner if a symptomatic relapse occurred.
"Hypnosis was induced as previously described, with attention focused on the abdomen by the use of the patient's hand. They were asked to imagine warmth beneath the hand and to relate this to the control of gastric secretion. Reinforcement by visualization was used if the patient had this ability" (p. 1299).
At the end of a year, on follow up, the patient relapse rate was 53% and controls relapse was 100%, a difference significant at p = 0.01.
In their Discussion, the authors state, "This study shows that hypnotherapy is helpful in maintaining remission in those patients with duodenal ulceration who are particularly prone to relapse. ... In this model, hypnotherapy might operate at a variety of levels in the disease process: it could act in a nonspecific psychotherapeutic sense increasing 'coping' capacities and decreasing perceived stress. Alternatively, hypnotically induced relaxation may affect gastric acid secretion, and there is some experimental evidence for this.
"The early relapse rate in the hypnotherapy subjects was similar to that of controls, but subsequently the curves showed a much greater separation. This finding could indicate that there is a subgroup of subjects who are particularly response to therapy. However, a detailed review of psychological and clinical parameters did not reveal any specific feature that could be used to predict a response to this form of treatment" (pp. 1299-1300).
NOTES 2:
Current etiology of duodenal ulcers includes the presence of bacteria Helicobacter pylori which is important in relapse. In order to compare treatments we must know what is the status of each group regarding the presence of this bacteria. Current treatment of duodenal ulcer includes metronidazole, amoxicillin and tetraciclin to kill it. [Editor's Note: This appears to be a critique of the research methodology rather than notes on the article itself.]
1966
Zane, M. D. (1966). The hypnotic situation and changes in ulcer pain. International Journal of Clinical and Experimental Hypnosis, 14 (4), 292-304.
This is a study of internal and external hypnotic conditions associated with changes in pain developed during 5 hypnosis sessions in a patient with an acute duodenal ulcer. The 12 increases and 8 decreases in pain studied were found to be related to the interaction of coexisting reactions directed toward shifting social and private goals. Pain was associated with conflict among these reactions; intensification of pain occurred as a train of self-propagating internal events increased the conflict; relief of pain accompanied a reduction in the conflict. Increasing bodily disorganization resulted as shifts in focus of attention among social and private goals resulted in the rapid growth of conflicting mental and physical processes. An external stimulus, in the form of a highly individualized hypnotic suggestion, was often required to stop the disorganizing processes.
1936
Chappel, P. M.; Stevenson, T. (1936). Group psychological training in some organic conditions. Mental Hygiene, 20, 588-597.
NOTES
This article was cited by Stoyva, J. & Anderson, C. (1982) and notes are taken from that article. Stoyva, J. & Anderson, C. (1982) A coping-rest model of relaxation and stress management. In L. Goldberger & S. Breznetz (Eds.) Handbook of Stress: Theoretical and Clinical Aspects. N. Y.: The Free Press. Pp. 745-763:
Unconscious
1995
Pribram, Karl H. (1995). Brain in perception: From Kohler's fields to Gabor's quanta of information. In Proceeding of the 39th Congress of German Society for Psychology (pp. 53-69).
[The following material was taken from a paper provided by the author as a replacement for a presentation he made on the same topic at the Annual Meeting of the American Psychological Association, 1994, Los Angeles.]
Pribram presents the view that neuroelectric field theory (similar to theories proposed by Kohler and by Lashley earlier in this century) account for complexities observed in the relationship between awareness/perception and sensation. "Nerve impulse generation and transmission in neuronal circuits is but one of the important electrical characteristics of neural tissue. Another characteristic is the production of patterns of pre- and post-synaptic polarizations in axonal and dendritic arborizations. ... [which] are produced everywhere in the brain cortex when nerve impulses arrive at synapses as a result of the fact that the impulses become attenuated due to decreased fiber size resulting from the branching of axons" (p. 53). The polarizations develop a wave front.
Georg von Bekesy performed experiments on tactile perception that demonstrated the complex relationship between sensation and awareness. We often 'perceive' an object as external to us, even though the immediate specific neural stimulation is of receptors and from there activity is transmitted to the neurons of the brain. Thus we 'see' an object as external to us, even though the light reflected from that object produces an image on our retina. The same kind of externalized projection occurs for hearing. Touch is ordinarily perceived as at the same location as the stimulation (i.e. in the body), except that the von Bekesy experiments demonstrated that touch could also be perceived at a distance, that is, outside the body, if conditions were appropriate.
In the von Bekesy experiments, a pair of vibrators were used to stimulate two fingers, with each vibrator actuated by the same series of clicks and with the delay of time between the clicks varied. "The interesting point in this experiment is that for the condition in which there is no time delay the vibrations are localized between the two fingers where no skin is present" (p. 55). When two vibrators are placed on the thighs, the experimental subject can, by moving the knees apart, experience the vibratory sensation localized in the open space between the knees! Such an externalization of tactile perception is observed in everyday life, as when in using a knife we seem to sense the edge of the knife in order to make the appropriate movements.
Following from von Bekesy's work, it seems that only some neural processes lead to awareness. "In fact, instrumental (often automatized) behavior and awareness are to a large extent opposed; the more efficient a performance, the less aware we become. ... for the neuroscientist, the question becomes: What kinds of neural activity allow awareness to be inversely related to automatized action?
"Patterns of synaptodendritic polarizations and nerve impulses are two kinds of processes that function reciprocally. A simple hypothesis states that the more or less persistent designs of dendritic field polarization patterns are coordinate with awareness (Pribram, 1971, Chapter 6). This view carries the corollary that circuits of nerve impulses per se and the behavior they generate are unavailable to immediate awareness. Even the production of speech is 'unconscious' at the moment the words are spoken" (pp. 55-56).
Some additional information comes from the experimental work of Ben Libet (1966, 1994), in which direct stimulation of brain tissue in waking subjects yields reports of awareness (of a particular part of the body tingling or being in a certain position). However, the awareness occurs 0.5 to 5 seconds post-stimulus, indicating that "electrical stimulation must set up some state in the brain tissue, and only when that state has been attained does the patient become aware" (p. 56).
The evidence of electrical fields comes from using both high pass filters and low pass filters on the electrical activity generated by the brain and picked up on EEG. There are 'bursts' of spikes, and onset of the field effect precedes the initiation of spikes. "Just as depolarization of axon membranes is a necessary precursor of the generation of action potentials, so also is the local build up of synaptodendritic field potentials a precursor to the recruitment of action potentials in post synaptic neurons" (p. 57).
Maps of the receptive field of an axon can be developed (e.g. using Kuffler's procedure). However, stimulation outside of that receptive field can change that axon's response--a field effect "produced in a more extended field of potentials occurring in neighboring synaptodendritic fields" (p. 58). In this investigation, the relationship between local field potentials of the rat somatosensory system (whisker stimulation) is studied using the Kuffler procedure. Whiskers were stimulated by rotating cylinders which varied in spacing of grooves and speed of rotation. The resulting variation in density of stimulation yielded a map or manifold of cortical bursts/spikes. Pribram's research fits the experimentally generated data to a theoretical model derived from signal processing theory, using "a rectangular window in the spatiotemporal domain to constrain the two dimensional sinusoidal signal" (p. 62). They noted that the manifolds obtained from somatosensory cortex recordings were similar to receptive field characteristics measured at the primary visual cortex, which "suggests that this process is ubiquitous in the cortical synaptodendritic network" (p. 63).
Referring to the Fourier theorem (that "the original pattern can be reconstituted, reconstructed, by performing the inverse transform" p. 65), the author notes that experimental data are more complex than would be predicted. The author suggests that it would be helpful to employ the Gabor uncertainty principal, in which Gabor (1946) described as a fundamental unit a 'quantum' of information. "Gabor became interested in describing a joint spacetime-spectral domain because he noted that there is a limit on the precision to which simultaneous measurement of spectral components and [space]time can be made. ... the Gabor relation describes the composition of a sensory channel, and the residual uncertainty defines the limits of channel processing span" (p. 65). The Gabor relationships are similar to those described in quantum physics by Heisenberg, so Gabor referred to a quantum of information, which he named a Logon.
The author describes his experimental results as exhibiting Gabor elementary functions, which "are composed in dendritic arborizations, receptive fields of the neurons from which we are recording. ... Each logon, i.e. each such receptive field module, is a channel. According to Gabor, the ensemble of such channels is a measure of the degrees of freedom, the number of distinguishable dimensions or features (e.g., spatial and temporal frequency, degrees of orientations, preferred direction, color). The minimum uncertainty relation expressed by Gabor elementary functions sets the limits on the information processing competence of each of these channels" (pp. 65-66).
In a Coda to this chapter, the author notes that there is a discrepancy between fields (composed of arrival and departure patterns of synapto-dendritic polarizations) and perceptual awareness which "occurs within spacetime coordinates." Discussion of the discrepancy my be found in Pribram and Carlton (1986). Holonomic brain theory in imaging and object perception. Acta Psychologica, 63, 175-210; and in Pribram (1991), Lecture 6 of Brain and Perception. Basically, there is top-down organization imposed by the cortical system on peripheral sensation/perception. "These various systems not only relate to one another in a hierarchical manner but that the higher order systems operate on lower order systems by interpenetrating. Thus, we ordinarily, immediately perceive named and categorized objects, not just sets of images (though we are capable of 'imaging' by suspending the higher order processes). There is abundant evidence of such top-down penetration in the visual, auditory and somatosensory neural systems" (p. 66).
1994
Erickson III, James C. (1994). The use of hypnosis in anesthesia: A master class commentary. [Comment/Discussion] .
NOTES
The author answers questions sent by a reader: "When and how can I use hypnosis or hypnotic principles in preparing patients for surgery and while undergoing surgery? Are there studies or experiential evidence to use as guides for the selection of appropriate cases or types of operations?" (p. 8). SUMMARY "There are unequivocal benefits derived from the use of positive suggestion and hypnotic techniques in all patients who must submit to surgical and obstetrical procedures with modern general or regional anesthesia. We must learn, and we must teach our colleagues, the advantages of consistent use of the semantics of positive suggestion. When we help patients focus on the desired comfort, safety, and satisfaction obtained with well-managed modern anesthesia and surgery, they will enjoy great benefit, especially when we use the auditory perception that often exists during general anesthesia. Rather than regarding hypnotic suggestion as a mere adjunct to anesthesia, it should be regarded as an integral part of surgical and obstetrical care" (pp. 11-12).
Tellegen, Auke (1994, October). Comments on Symposium "Hypnosis Reconsidered". [Comment/Discussion] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Francisco, , as part of Symposium titled: Hypnosis reconsidered.
NOTES
I agree that the topography of issues has become more complicated. I would want to look at the distinction between "special process" theories and other views. I still think there is some non-trivial element of difference between the two groups; but it's not one well defined group vs another, with people now distributed across a continuum and to some degree moving around. At the poles of these theoretical positions are real differences (e.g. in favorite hypotheses, research methods). But there has been some closing of the gap between these two poles.
Historically, rapprochement in psychological theories has been the result of hard nosed behaviorism going soft and cognitive in the last 15 years. The behavioral paradigm is the ancestor of the social cognitive view within hypnosis research. You can see the evolution in Ted Barber, and eventually it was carried forward by Spanos. Today all major views of hypnosis have become systems models, requiring flow diagrams. We are comparing more parsimonious (social cognitive) with more surplus meaning positions. Parsimony is a good way to advance knowledge, making a theory more complex only when you have to. The major social psychological positions are widely shared; many are close to common sense. The question is, are they sufficient to the data? The behavioral approach recognizes individual differences but doesn't weight them heavily; it may treat individual differences as a curve fitting issue, or may treat them as training outcome. Associated with the behavioral approach is a tendency not to explore fully individual differences from a naturalistic perspective. The difference in research approaches between the two poles is loosely aligned with Cronbach's correlational vs experimental approaches to psychology.
The role of individual differences in hypnotizability however may be structural, in which case different flow diagrams may be needed, depending on trait levels, on the eliciting circumstances, etc. Thus we might need different flow diagrams for different levels of hypnotizability.
The role of imagination remains unexplicated across theoretical positions. Everyone since the Franklin committee thinks imagination is important in hypnosis; it is urgent to explore it. Even the most constructivist perspective on perception doesn't equate perception with imagination.