Institute of Clinical Hypnotherapy-Psychotherapy

CLINICAL HYPNOTHERAPY – THE WAY FORWARD

2012-02-21T08:38:00.000-08:00

CLINICAL HYPNOTHERAPY – THE WAY FORWARD

© Dr. Peter George, ICHP

Australia

Limestone Coast Division of General Practice, February, 2012.

INTRODUCTION

“Evidence-based practice is one of the important global developments in recent years in the helping professions—including medicine, nursing, social work, psychotherapy, hypnotherapy, counselling and other health services”.

(Dobson & Craig, 1998a, 1998b; Dawes et al., 1999; Sackett et al.,2000); 2002; Briggs & Rzepnicki, 2004; Roberts & Yeager, 2004; Gilgun, 2005; Norcross, J. C. (Ed.). (2010). Evidence-based therapy relationships; Zlotnik, J. L. (2007).

· Evidence-based practice and social work education; The ADAA provides detailed information on anxiety disorders and treatment options. http://www.adaa.org ;

· Improving the Teaching of Evidence-Based Practice. This symposium was held October 16–18, 2006, in Austin Texas..

· Cochrane Collaboration. The Cochrane Collaboration is an international, non-profit organization, which produces and disseminates systematic reviews of health care interventions. www.cochrane.org

For the practicing Clinical Hypnotherapist entrance into the world of Evidence-based Hypnotherapy dramatically increases returns on Clinical practice far beyond the returns that are possible by employing Hypnotherapy in the traditional mode alone as a complementary therapy.

Evidence-based Psychotherapy in which Hypnotic trancework tactics play a leading role (such as enhancing CBT) is increasing in both application and recognition with respect to Clinical effectiveness. In

Australia

this has resulted in trancework enhancements to evidence based therapies such as CBT, ACT, IPT and short term Psychodynamic therapy being routinely applied in the Medical field of Mental Health & Wellbeing.

The fact that a large percentage of the population in Western countries (

Australia

Canada

, the

and

Ireland

quote percentages between 25% and 50%) can expect to suffer a major Mental Health issue in their lifetime has led to massively funded programs in these areas. These programs are, for the large part, administered by Government through the vehicle of Referral from General Practitioners in Family Practices in these countries. Such programs offer enormous opportunities for Clinical Hypnotherapists who choose to engage in Evidence-based Hypnotherapy (EBH), sometimes misleadingly called Hypno-Psychotherapy – since not all of the more than 400 psychotherapies recognized are evidence-based by any means.

SUPPORT FROM NEURO-SCIENCE

In recent years advances in imagery (particularly fMRI techniques) and other areas of neuro-science (for example the role of mirror neurons in developing rapport) have clearly established the role of neuro-plasticity in the human brain. Neuro-plasticity is the mechanism by which the brain re-organises itself throughout life.

The power of neuroplasticity in treating clients suffering mental health and wellbeing disorders lies in the ability of the brain to rewire itself, regardless of age, as a result of new behaviour and new thinking. Evidence-based therapeutic hypnosis provides an ideal context within which to safely facilitate new behaviour and thinking and promote the requisite re-wiring by consistent, repetitive rehearsal in trance. Almost daily new understandings of the power of words is revealed by imaging; not only which words are particularly evocative and effective, but also the mechanism and the time-frame involved in neuro-genesis and the establishment of new pathways.

Given the somewhat chequered career of anecdotal Clinical Hypnotherapy over the last two centuries it is paradoxical that the trance state (notably achieved in Hypnosis and Guided Meditation) is now being used as the research tool of choice in modern neuro-science. However this is leading to in-depth understanding of exactly what is possible in the hypnotic trance state. Thus for example, a range of mental phenomena have been studied including thought suppression, perception, pain, memory, “blindness”, assessment of colour, literary and numerical tasks, the production of “hallucinatory” material and voluntary control of various body systems.

The induced trance state has also been manipulated to develop hypnotic emulations of various psycho-pathological conditions (for example synaesthesia). Modern functional MRI imaging and PET techniques have made it possible to observe the relevant highlighted areas of brain activity associated with particular verbal suggestions and the up and down regulation of brain sub-systems (such as the emotional response of the Amygdala) and the role of “looping” of such systems.

It is becoming apparent that the effects observed in the trance state relate to disturbances in the normal communications connectivity between particular brain areas. In particular there seems to be a de-coupling between cognitive control and conflict monitoring in the frontal lobes. Maintaining an induced delusional belief about self and effecting successful behavioural rehearsal, even when presented with conflicting evidence, seems to be a direct example of the latter de-coupling. The common experience of “timelessness” and sometimes detachment from “self” are typical examples of such disturbances. Post trance state memory loss, as a result of a direct suggestion in trance to display amnesia for the suggestion, also appears to be a viable emulation of actual functional amnesia.

In addition to the relatively common Clinical use of trance techniques to manage difficult medical issues such as pain and IBS for which there are referrals readily available, there are now beginning to appear studies relating to some of the other serious issues presenting themselves in Clinic. For example post traumatic stress-related memory processes with “flashbacks” and other symptoms of PTSD are now beginning to be suppressed by a process of trance-induced emotional “numbing” which, with suitable suggestions, can be induced without affecting the ability to cognitively recall the memories themselves.

There is also now increasing evidence via imaging that the trance experience of an activity seems to create brain states closer to the actual experience of the activity than simply imagining it. This provides validation of the fact that trance experience in the Clinic during behavioural rehearsal of new beliefs and behaviour is more effective in terms of eventual live success, than actual live therapeutic procedures which are always contaminated by some finite failure rate. The classic example of this failure is the demonstrably poor response to ERP (exposure with response prevention) for a great many OCD sufferers. This provides clear support for a vast body of anecdotal Clinical hypnotic experience relating to successful behavioural rehearsal.

Both hypnotic and meditative trance states (particularly the practice of mindfulness) heighten focussed attention, enhance learning-related discrimination, reduce attention to external stimuli and tend to suppress spontaneous interfering thought. Verbal suggestions within the context of evidence-based therapy (such as correction of maladaptive core beliefs and/or cognitive distortions in CBT) therefore lay an efficient basis for cognitive, affective and behavioural re-education and in so doing offer a pathway towards effective Clinical psychotherapy.

FURTHER READING

Article Review: “What Should We Mean By Empirical Validation in Hypnotherapy?”

by Scott Hoye, MA LPC on February 17th, 2010

Alladin, A, Sabatini, L., & Amundson, J.K. (2007). What should we mean by empirical validation in hypnotherapy: Evidence-based practice in clinical hypnosis. International Journal of Clinical and Experimental Hypnosis, 55, (2), 115-130.

Summary

This article takes on several tasks; it reviews the theoretical and experimental basis of empirical studies, gives a history and background of evidence-based practice, delineates both process and content studies, reviews the latest evidence for efficacy of hypnosis with treatment of various presenting issues, and gives suggestions for further studies within the field. The pros and cons of evidence-based therapies are given equal weight, with the importance of balancing the art of therapy and hypnosis with evidence for both efficacy and effectiveness.

The authors begin with a discussion of the movement from theory driven practice, which was at its height in the 1960s, toward an empirical basis in the 1990s. This trend has not been without controversy. The main arguments against have been that practice of therapy is a messy procedure, and that the rigidness of manualized treatment can never be replicated in the real world. Other factors, such as the impact of the clinician on the patient, the therapeutic relationship itself and the personal “intricacies of clinical judgment in the empirical evaluation of treatments” are also part of the debate (p. 118). Yet the obvious support raised in some circles is that manualized treatments can assure consumers receive treatment has been found efficacious.

Evidence-based treatments of hypnosis for several disorders are catalogUed, with mixed results found. Content (efficacy) versus process (effectiveness) types of research are examined for furthering evidence-based practice in hypnosis. The authors give further indications for the development of empirical research and practice for hypnotherapy.

Key Points

Alladin et al review research of hypnosis in six areas: clinical hypnosis with children, analgesia, hypnosis as an adjunct to CBT, hypnosis and medicine, smoking cessation, and PTSD. Child and adolescent studies are abundant in case studies, but little in the way of randomized clinical trials. A meta-analysis of 18 articles and 28 effect sizes for hypnotic analgesia yielded evidence that “hypnosis can be considered a well-established treatment for pain,” and assuring its place as primary method of treatment. CBT and adjunctive hypnosis studies were positive, yet problematic in that they did not match the gold standards of the APA. Medical interventions for such issues as dermatological disorders and irritable bowel syndrome, also have supporting evidence, but it has not been clearly determined whether hypnosis is the main effect involved. Smoking cessation has mixed results, leading some to claim that hypnosis “as a ‘possibly efficacious treatment for smoking cessation,” with the need for improved research. PTSD treatment with hypnosis, as of this publication, lacked any strong, systematic studies.

The authors spend a great deal of the article covering the background of evidence-based practice. Criticisms are aired over the APA’s establishment of empirical studies, Wampold, a major proponent of Rosenweig’s dodo bird effect, argued that the APA task force used an incorrect method of establishing it’s list. According to the dodo bird verdict, all psychotherapies work equally well, with negligible differences between them. Thus the task force would have better created the list of empirical studies by adding all bona fide treatments and removing those that did not meet empirical standards. Other arguments include the fact that some therapies have more experimental support than others, and thus were chosen for the list (CBT and behaviour therapies which are more conducive to studies by their nature), and statistical power differs between studies, making some therapies appear better suited for the APA list (p. 117).

Alladin et al note that the APA released a report on clinical expertise, adding eight elements of the individual therapist to the mix of evidence-based practice. The authors liken this to a quote from Wittgenstein, wherein he “stated that it impressed him very little when a man states he owns a trapeze artist’s suit: he would wait to see how he puts it to use” (p. 124). That is to say just because a treatment meets APA gold standards, does not place it with the context of usefulness or adaptableness for practice, or with use by all practitioners.

The implications of evidence-based hypnotherapy practice are examined, particularly with regard to content versus process variables. Content variables look at efficacy, and can assist hypnotherapists from falling into romantic delusions or theoretical bias regarding their practice. Process variables are of great assistance for hypnosis practice and research as they can focus on rapport, and therapist and client variables involved in treatment (p.125). The authors conclude that evidence-based practice is important for hypnosis, and that that it will generally help to increase the validity of this treatment method.

Critique

Having been trained in, and used hypnosis with patients; I found this article extremely interesting. It also shook some of my current biases, such as the use of hypnosis for smoking cessation, which is generally recognized as a well-established treatment for this area. Further debate over this has continued, but hypnosis is still considered more efficacious than other treatments due to it short term, and slighter costs (Mendoza & Capafons, 2009). The literature review was not as inclusive as it could have been. More current publications list a plethora of other medical, and anxiety and mood disorders for which hypnotherapy has been judged a worthy treatment (Mendoza & Capafons; Barabasz, Olness, Boland, Kahn, 2010). I was also surprised that they did not include weight loss among the list, another standard area for hypnosis practice. However, the authors attempted to cover evidence-based practice as a whole, while making suggestions for the future of hypnosis within APA standards of practice. This was no small undertaking, and they largely succeed.

There are several areas within which a manager or supervisor may need to address when supervising hypnotherapists with APA gold standards in mind. First, the article points out what can be problematic for many practitioners; the difference between theory driven and research drive practice. Whether the APA likes I or not, the bulk of psychotherapist are trained, usually in three of the four hundred-plus, possible psychotherapy orientations–psychodynamic, humanistic and cognitive-behavioural. Thus, they lead theoretically, and case-conceptualize in this manner, not based on evidence for efficacy or effectiveness, but on personal attraction to the orientation. Reversion to “romantic notions” of psychotherapy, or a “my school is better than the other one” attitude is likely to be encountered in many therapists. The problem for the therapist and for a manager or supervisor would be to be able to integrate the manualized procedure into practice. Where world the original practice end and the manualized treatment begin? How would the integration change the treatment, and would it still be considered the same treatment after the integration?

The authors do not cover the individual differences in hypnotherapy practice, not to mention schools of hypnotherapy. One must consider that there is not one operational definition of hypnosis. What actually constitutes this elusive practice is still up for debate. Thus, the manualized treatment must be specific to the hypnotherapeutic school and its definition and practice of hypnosis. Mixing this with a practitioner with another orientation may confound results if viewed through the lens of process research. It may give pause to consult with the therapist after reading the journal reviews of the manualized treatments.

To conclude, Alladin, et al cover a great deal of ground, and manage to create more room for debate within the field of evidence-based psychotherapy. Light is shed on which hypnotherapy interventions to proceed with in practice, though the list is by no means complete. However, since the article manages to place hypnosis squarely in the larger picture, I recommend it as a primer for any psychologist in a clinical supervisory position.

from:

http://chicagopsychology.org/hypnosis/review-of-what-should-we-mean-by-empirical-validation-in-hypnotherapy/

previous related post:

WEDNESDAY, OCTOBER 5, 2011

HYPNOSIS & NEURO-SCIENCE RESEARCH

The patient is 80 years old. She is lying under the bright lights of an operating room at Harvard’s Beth Israel Deaconess Medical Center, where radiologist Elvira Lang is about to thread a catheter through her arteries. The tiny tube will work its way to one of the woman’s kidneys, where it will block the organ’s blood supply. A surgeon is scheduled to remove the kidney the next day. Embolizing the kidney will help keep the operation simple, safe, and tidy. But the woman is running a fever, and her kidney may be infected. Because she ate earlier in the day, she can’t be given a sedative. What should have been a routine procedure has become an ordeal.

“This is your safe and pleasant place to be,” one of Lang’s associates reads from a laminated card. “You can use it in a sense to play a trick on the doctors. Your body has to be here, but you don’t.”

Lang is one of a growing number of hospital physicians who use hypnosis in addition to anesthesia. Together with David Spiegel, a professor of psychiatry at Stanford University School of Medicine, she has conducted extensive studies of hypnosis in the operating room, often with dramatic results. Hypnosis and interventional radiology interest Lang for the same reason: Both are ways of making a visit to the hospital less horrific. A tiny incision is all that’s required. By threading a stent into an artery, for example, Lang can help her patients avoid far more invasive surgery. “I’m your medical plumber,” she says. By adding hypnosis, she can make an operation shorter, less painful, and less dependent on drugs. The hardest part of the procedure is getting other doctors to accept it.

Over the years, a number of rigorously controlled studies have proved that hypnosis reduces pain, controls blood pressure, and can even make warts go away. But because very few studies have attempted to find out how it works, most scientists are skeptical of its power. Critics suggest hypnosis is no different from the placebo effect. They both use the power of suggestion to get the mind to heal the body; both are no substitute for medicine.

That skepticism has driven Spiegel and other researchers to take a hard look at what happens in the brain during hypnosis. Trance, they’ve found, opens a window onto the nature of the imagination. Through it, we are beginning to glimpse how the mind distinguishes daydreams from reality.
Spiegel is a second-generation hypnotist. His father, Herbert Spiegel, is a psychiatrist who first used hypnosis as a battlefield surgeon in World War II. In 1943 he even used the technique on himself when he was struck by a mortar from a German tank in Mateur,Tunisia. A steel shell fragment protruded from his ankle, but he managed to tune out the pain.

Soon after returning home, Spiegel was hired as a professor of combat psychiatry at theSchool of Military Psychiatry at Mason General Hospital in Brentwood, New York. There, he treated hundreds of returning veterans with hypnosis, becoming ever more convinced of its effectiveness. At the same time, the first clinical studies of hypnosis began to appear. In 1961 psychiatrist Ralph August published a study of 850 women who gave birth under hypnosis. Only 4 percent—34 women—required painkillers. Other studies found that hypnotized subjects could resist intense pain for a full minute longer than those who weren’t hypnotized, and for 30 seconds longer than those who had been given a placebo painkiller.

By the 1960s, Spiegel was teaching clinical hypnosis at Columbia University, and his son was among his students. David Spiegel went on to attend medical school at Harvard and to specialize in psychiatry and clinical hypnosis as his father had. In 1978 the two Spiegels coauthored the standard textbook in the field: Trance and Treatment: Clinical Uses of Hypnosis.

Now 58, David Spiegel is tall and a bit disheveled, with his father’s oval face and serene features. He speaks in complex but reasoned sentences and listens with the stoic patience of a man who has faced many disbelievers. “Hypnosis has been controversial since the beginning,” he says. “The thing is, it just won’t go away. There’s so much about the phenomenon that’s interesting.” Among researchers in the field, Spiegel says, there are two schools of thought and a growing chasm between them. One school claims that hypnosis fundamentally alters a subject’s state of mind; the other believes that hypnosis is simply a matter of suggestibility and relaxation. Spiegel belongs to the first school, and over the years he has had a running debate with two scientists on the other side: Irving Kirsch, a psychologist at the University of Connecticut at Storrs, and Stephen Kosslyn, a professor of psychology at Harvard.

Kirsch often uses hypnosis in his practice, and he doesn’t deny that it can be effective. “With hypnosis you do put people in altered states,” he says. “But you don’t need a trance to do it.” He likes to illustrate the point with an ancient talisman of the hypnotic trade: the pocket watch hanging on a chain. Put your elbow on a table, he says, holding the chain between your thumb and forefinger, and let the weight swing freely. Now, keeping your hand as steady as possible, imagine that the pendulum is moving back and forth parallel to your chest. “Just focus on it moving in that direction. Side to side,” he says. “Ignore everything else and imagine it going side to side at its own rhythm.” Once it’s swaying that way, and it inevitably will, imagine it swinging another way—clockwise, say, or toward you—just to prove to yourself that it’s not a coincidence. Once again, the weight will obey your mind. This little trick works on even the most skeptical and unhypnotizable of people. You don’t have to enter a trance for your subconscious and your body—in this case, the tiny muscles in your fingers—to respond to a suggestion. “I could have hypnotized you and done the same thing, but it wouldn’t have been a result of the hypnosis,” Kirsch says. “It would have been a result of your focusing on moving it in a particular direction.”

Spiegel disagrees. One of his best-known studies found that when subjects were hypnotized and given suggestions, their brain-wave patterns changed. He admits that suggestion alone is a powerful tool but believes that hypnosis magnifies its effects. In another of Spiegel’s studies, people under hypnosis were told their forearms were numb, then given light electrical shocks to the wrists. They didn’t flinch or respond in any way, and their brain waves resembled those of people who experienced a much weaker shock.
To Kirsch, this still wasn’t enough to prove the power of trance, but Stephen Kosslyn was willing to be convinced. Kosslyn is an exceedingly polite man, with a gray, philosophical beard and perpetually raised eyebrows. The hypnosis literature is rife with examples of subjects aping what they believe is hypnotic behavior, he says. Such “demand effects” are exactly what make placebos so effective. As for the brain-wave study, other events in the lab—such as interaction with the investigators—could have caused the shift in the subjects’ state of mind. “Is it just playacting?” Kosslyn wondered, when he first saw Spiegel’s data. “Or is there something really going on in the brain?”

To find out, Spiegel and Kosslyn decided to collaborate on a study, focusing on a part of the brain that is well understood: the fusiform circuit. Located on the occipital lobe, the circuit has been found to process the perception of color. Neuroscientists zeroed in on it by placing subjects in a positron-emission tomography (PET) scanner to measure blood flow in the brain, then having them look at cards with color rectangles. Spiegel and Kosslyn wanted to see if subjects could set off the same circuit by visualizing color while under hypnosis.

The first step was to find the right study subjects. Only a small fraction of the population—known as highs in hypnotic circles—can enter a deep trance, just as only a few people cannot be hypnotized at all. The rest of us fall on a spectrum in between. (See “Can You Be Hypnotized?” page 60.) Spiegel and Kosslyn selected eight people from a pool of around 120 subjects, then Kosslyn’s team ran the experiment at Massachusetts GeneralHospital in Boston. As in the previous studies, subjects were put inside a PET scanner, shown a slide with color rectangles, and their brain activity was mapped. Then they were shown a black-and-white slide and told to imagine its having a color. Both tasks were repeated while under hypnosis.

The results, published in the American Journal of Psychiatry in 2000, were striking. When the subjects truly saw the color rectangles, the fusiform circuit lit up on both sides of their brain; when they had to imagine the color, the circuit only lit up in the right hemisphere. Under hypnosis, though, both sides of the brain became active—just as in regular sight. Under hypnosis, imagination seemed to take on the quality of a hallucination.
After the experiment, Kosslyn’s raised eyebrows, for once, came down. “I’m absolutely convinced now that hypnosis can boost what mental imagery does,” he says. “It sort of gives it a shot of vitamin A or something.” But Kirsch remains skeptical. The color experiments demonstrate that people “are really experiencing the effects of hypnotic suggestion,” Kirsch says, but not necessarily that they enter a trance. The subjects were told to see the card in color when they were hypnotized but only to imagine it in color when they weren’t, Kirsch points out. “Being told to pretend that you’re having the experience is a very different thing than the suggestion to have the experience.”

“Technically, he’s right,” Kosslyn says. Because the eight subjects were all highly hypnotizable—or at least highly suggestible—Kosslyn and Spiegel were afraid that if the subjects were told to see the color, just as they had been when hypnotized, they would slip into a trance. Kosslyn doubts that changing the wording would have made a difference. “The hypnotized people would tell you that they could literally see. ‘Lows’ couldn’t even do the task. They simply couldn’t do it.”

To Kosslyn, the hypnosis study shows how the brain distinguishes between imagination and perception. The right side of the brain processes specific examples of things, while the left side processes more general concepts and categories. The left side knows that Spot is a dog, for instance, while the right side knows that the dog is Spot. That’s why the right side of the brain lights up when we imagine a particular color, but the left side is left cold: The details of the daydream may seem real, but they don’t apply to a larger reality.
“The realms of imagination and perception are not entirely distinct,” Spiegel says. “This goes back to philosophers as far as Kant. What we take as reality is our processing of perceptual input.” We make assumptions about what’s real from small cues that are far from the complete picture. If you are expecting to meet a friend at a restaurant and a stranger comes in with the same jacket and hair, you might call out your friend’s name, but as soon as you see his face your mistake will be obvious. “Rather than passively accepting perception, we set up a competition between imagination and perception,” Spiegel says. “Imagination can alter perception—in a sense it always does. But we’re not aware of it.” Under hypnosis, that distinction breaks down.

Kosslyn believes that hypnosis allows the body to tap into hidden reserves. He compares its effect to that of breaking a world record in sports: It changes our sense of the possible. “For years and years and years, no one could run a mile under four minutes,” he says. “It was like the sound barrier—people thought that limbs would start falling off.” Yet only six weeks after the record was finally broken, by British runner Roger Bannister in 1954, it was broken again by another runner. “Nowadays 40-year-olds can do it.” Hypnosis may have the same effect, Kosslyn says. “It shifts what I call the assumed norm. It can play the part that Roger Bannister did in the four-minute mile.”

Neuro-imaging studies may domesticate the long-controversial practice.
SEEDMAGAZINE.COM October 5, 2011

It seems hypnosis has been nearly everywhere over the past few centuries: onstage with entertainers swinging fat, gold watches; on couches with reclining psychoanalysis patients; in movies, books, and even children’s cartoons. But the one gig hypnosis couldn’t get was the scientific laboratory.

Until now.

The long-controversial practice of inducing a trancelike state through suggestion is getting a modern makeover by scientists armed with the latest neuroimaging tools and techniques. These researchers are beginning to offer evidence that, neurologically at least, hypnosis is entirely real.
“It makes sense that we are using modern tools of neuroscience research to understand what is a fascinating phenomenon,” said David Spiegel, a psychiatrist at StanfordUniversity. “It’s good for hypnosis, and it’s good for neuroscience.”

The first report of hypnosis in practice dates back to the 18th century and an Austrian physician named Franz Mesmer, whose alleged otherworldly techniques for putting patients in trancelike states spawned the word “mesmerism.”

Almost from the beginning, the technique was controversial.
Skeptics have charged that the so-called phenomenon is nothing more than social role-playing, its use in medicine simply another form of the placebo effect. Its employment in psychotherapy has been challenged, particularly in light of claims that it can be used to implant false memories. And the idea, espoused by some hypnotists, that hypnosis involves an altered state of consciousness known as “trance,” has only made it seem more questionable.

Though experts quibble over the exact definition of hypnosis, they agree that it involves intense concentration, increased relaxation, and heightened suggestibility. In 2000, Spiegel and others conducted experiments involving perceptual and sensory experiences that demonstrated some of the effects hypnosis has on the brain.
Scientists still lack what would be the ultimate validation of this sort of research: a distinct neurological signature of hypnosis. It has been difficult to disentangle the effects of hypnotic suggestion from those of suggestion alone.

In Spiegel’s study, subjects—some hypnotized, others fully alert—viewed pictures in both color and grayscale. When hypnotized subjects were told they would see photos in color, the brain regions involved in the visual processing of color were activated, even if the subjects were actually viewing the grayscale photos. And when hypnotized subjects were told they would see photos in grayscale, the activation of the color processing regions decreased, regardless of which photos actually appeared.

Many studies have also shown that hypnotic suggestion can prompt changes in the brain’s pain processing centers. Such research has illustrated that when people are hypnotized before painful procedures, the areas of their brains that process pain are less active.

“When they use hypnosis to alter perception, the subjective experience is altered in measurable changes in just the right part of the brain,” Spiegel said. “When people say they are feeling less pain, they really are feeling less pain.”

“It’s providing objective evidence that hypnosis is real,” he continued.
But scientists still lack what would be the ultimate validation of this sort of research: a distinct neurological signature of hypnosis. So far, it has been difficult to disentangle the effects of hypnotic suggestion from those of suggestion alone. Researchers must also differentiate between the brain structures that play a role in hypnosis and those that are merely involved in the perceptual tasks subjects are asked to perform in these studies.
However, scientists are beginning to make some intriguing observations, particularly in the prefrontal cortex, the brain region responsible for the brain’s so-called executive functions: integrating the work of other brain structures, governing decision making, and, perhaps most relevantly, regulating attention. Researchers have long noted that hypnosis can be characterized as an extreme, narrowly focused form of attention.
Some researchers have found that areas in the prefrontal cortex—particularly the anterior cingulate cortex, which seems to be involved in attention, error detection, and resolving conflicts—change their activation patterns during hypnosis.

Scientists are hoping that, as more studies help pin down the brain structures involved in hypnosis, the phenomenon will become a more popular—and acceptable—focus of research, especially since the work could help illuminate other neurological phenomena.

“There’s two basic ways that neuroimaging is used in hypnosis research,” said Michael Nash, a psychologist at the University of Texas and the former editor of the International Journal of Clinical and Experimental Hypnosis. “One is to use neuroimaging to try to understand hypnosis. But the other way is to use hypnosis to produce in-the-laboratory experiences that can be studied through neuroimaging.”

For instance, hypnosis, which can prompt perceptual experiences similar to hallucination, may be a technique researchers can use to induce, and then study, hallucinations. Hypnosis might also be a tool for studying cognitive development—children are much more hypnotizable than adults—and for providing researchers with more information about attentional networks.

“As we do more and more research in laboratories, we can, in a sense, ‘domesticate’ hypnosis,” Nash said. “The neuroscience link adds a component to the credibility of hypnosis.”

So, too, might another modern science: genetics.
People vary widely in their ability to be hypnotized, but studies of identical and fraternal twins indicate that susceptibility to hypnosis may have a genetic component. Amir Raz, a psychiatrist at Columbia University, and his colleagues are now trying to pin down the specific genes that might be responsible for those variations. Researchers hope that finding a gene that modulates hypnosis—and the neurochemical pathway it affects—might finally silence skeptics.

“Part of the reason it hasn’t been explored before is because of the checkered reputation of hypnosis,” said Raz, who has published numerous neuroimaging studies of hypnosis. “Once you see people getting published in good and reputable journals with hypnosis studies, it’s going to prompt a whole wave of interest.”

See Spiegel & Kosslyn’s article on their research here: http://www.wjh.harvard.edu/~kwn/Kosslyn_pdfs/2000Kosslyn_AmJPsychiatry157_HypnoticVisualIllusion.pdf

EYE MOVEMENT DESENSITISATION & REPROCESSING IN HYPNOTHERAPY

2012-02-09T08:43:00.000-08:00

Eye Movement Desensitisation & Reprocessing

This is a technique that has been applied to treating PTSD and there is considerable anecdotal evidence for its usefulness. It was developed by Francine Shapiro, an American psychologist, and involves getting clients to recall traumatic episodes whilst their eyes track the movement of the therapist's hand back and forth in front of them. Several episodes of the eye tracking the hand movements may be required for a particular traumatic sequence to diminish in its emotional intensity.

One of the most exciting developments for Hypnotherapists in recent years is the discovery of EMDR. This simple technique of using finger movements by the therapist to integrate material from the client's left and right brains has greatly improved and speeded up treatment. This powerful clinical method rapidly treats distress caused by anxiety and phobias, depression, anger, guilt, relationship conflicts and chronic pain.

Having been developed originally to treat Vietnam war veterans, EMDR is particularly known for its fast and safe relief for anyone suffering from trauma.

This revolutionary therapy is unique in that it acts on body, mind and spirit simultaneously. It is aimed to "free the mind, clear the body, and open the heart".

Thus it benefits patients who have been resistant to conventional hypnotherapy in chronic conditions such as eating disorders, sexual abuse, and debilitating emotional disorders. Past traumas which seem to have been frozen in time and have resisted other therapeutic approaches such as regression, are witnessed safely by the client and then rapidly released.

While research has not yet proven that the EMDR Approach can treat all disorders beyond its proven efficacy with PTSD, there is research to suggest that people can have a high level of disturbance from events which would not qualify them for a PTSD diagnosis. That level of disturbance, the related emotions, negative beliefs about self, and the distress experienced in the body can be effectively reduced or eliminated with EMDR. In fact, Francine Shapiro, Ph.D. (2001) has stated that EMDR has been reported by therapists throughout the world to be helpful in reducing or eliminating disorders that originate following a distressing experience.

More details can be found about this at www.emdr.com.

There are good research findings to indicate that EMDR is effective with:

• Body Dysmorphic Disorder
• Phantom Limb Pain

There are preliminary reports in the literature that EMDR may be helpful with:

• Phobias
• Dissociative Disorders
• Performance Anxiety
• Personality Disorders
• Depression
• Attachment Issues
• Social Phobia
• Anger Management Problems
• Generalized Anxiety Disorder
• Distress related to infertility
• Body Image Disturbance
• Marital Discord
• Existential Angst

Additionally, there are reports at national and international EMDR Conferences that EMDR may be helpful with:

• Panic Disorder
• Obsessive-Compulsive Disorder

Further scientific research is needed to learn for certain whether the results are enduring in these applications. Clients will need to understand that EMDR is experimental in the above situations while there continues to be much anecdotal support. And more research is in process. Underscored however, is the fact that EMDR is highly regarded and well-researched as an effective treatment for PTSD.

Method

Eye Movement Desensitisation and Reprocessing is an eight phase treatment method which includes history-taking, patient preparation, assessment, desensitisation (counter conditioning), body scan, closure and re-evaluation. It is based on the premise that contiguous pairings of therapist directed eye movements (or bilateral shift of attention in other modalities such as sound or body taps) with traumatic memories allows re-evaluation and reclassification of those memories. After successful EMDR treatment, probes of treated memories fail to produce distress, maladaptive behaviour, feelings or attitudes. The eight phases of the method are designed as a protocol to ensure that all the pre-existing relevant and cross-associated traumatic memories are identified, reproduced, controlled and paired with the eye movement procedure in a safe manner. The main stages of the EMDR treatment are outlined as follows:

Preparation:

Patients are taught that avoidance maintains PTSD and the process of EMDR starts emotional processing. Patients are taught self-control, including methods of reducing ambient anxiety during EMDR. During preparation, patients are instructed to expect vivid re-experiencing of memories in all modalities.

Target Assessment

The target traumatic memory is explored and defined in detail. The memory may be stored in iconic fragments and it is traumatic both to recall and to utilise in the therapeutic process. The patient is trained to assess the negative emotional impact of the memory in terms of the Subjective Units of Disturbance (SUD) scale (Wolpe, 1990). SUDs range from 0 to 10, where 10 is the “worst emotion of my life”. The effects of different memories are ordered using SUDs in order to select therapeutic targets and to assess the effect of the ongoing EMDR on each aspect of trauma memory including associated memories and body feelings.

Desensitisation

Desensitisation refers to the process in which the emotional effect of trauma is altered from being averse to being neutral. In trauma cases that have not been resolved, either by a natural process of emotional processing or by other therapeutic methods, patients are left in a state in which dysfunctional anticipatory defence mechanisms persist. In this situation, abnormal fears are indicated by the persistence of anxiety resulting in the return and incubation of fear.

Installation

The patient is asked to recall the trauma and to hold in mind the (preferred) positive cognition such as “I did the best I could” and is then treated with further repeated sets of eye movements. The validity of the positive cognition is checked by the question “on a scale of 1-7, how true of the memory is the statement ‘I did the best I could’?”.

Closure

Patients are told to expect further between-session processing, that is, repeated changing and fresh emotional memories. They are asked to keep a note of any new material that emerges between sessions and before the end of each session they are taken through a relaxation exercise that was taught as part of the preparation for EMDR treatment.

Why EMDR Works on Traumatic Memory

Traumatic memories are different from non-traumatic memories (van der Kolk 1997). EMDR may transform traumatic memories into ordinary memories.

Several studies have found decreased hippocampal volume in people with PTSD (Bremmer et al 1995. Paige, Reid, Allen, Newton 1990). Increased activiation of the amygdale is present (leDoux 1992).

Hemispheric lateralisation seems to be involved as people with PTSD respond to traumatic memories with increased activation of the right hemisphere, and decreased activation of the left (van der Kolk 1997).

There is also a decrease of left hemisphere activity in Broca’s region, which is why the patient may be unable to translate personal experience into verbal expression.

When there is fear of imminent death, the information becomes sometimes indelibly recorded in the brain and EMDR changes the memory to one which is no longer indelible.

EMDR Case Study

Post Traumatic Stress Disorder: A new eye movement therapy
by Patrick Strudwick, The Times
March 2, 2010

As a 20-year-old, a writer was beaten and left for dead in his home. After years of flashbacks, he found a therapy, based on eye movement, that made his memories bearable

I’m walking gingerly down Whitworth Street in Manchester for the first time in 13 years. A few metres ahead is The Doorway. I’ve avoided going anywhere near The Doorway for more than a decade because, in its arched, Victorian splendour, it is the gruesome face and most taunting reminder of an event that destroyed my life.

In July 1997, when I had just turned 20, three men followed my flatmate (who was returning from a night out) into that doorway, before forcing him through the door of our flat. I was asleep. The intruders held us in our respective, adjacent bedrooms, and set about beating us.

They used bricks, saucepans, sticks — whatever they could find. They were crazed. For a while I could hear Jon’s cries through the wall. When he fell silent I was too preoccupied to consider why that might be. As I knelt in my blood — my teeth had split through my cheek — with kicks and blows pelting down, I could think of only one thing: will I live?

We both survived: Jon had been knocked unconscious. After we left hospital we never moved back. The only time I returned was a few days later, to collect some belongings — those that they hadn’t stolen. Our door was daubed with dustings left by the forensics team. Inside there was more dustings and, then, the blood: splatters up the walls of the hallway, smears on door handles, and, in my bedroom, a now brownish pool on the floor with my mattress and bedding drenched in it, rancid.

I vowed never to go back.

But now, 12 years after leaving the city for London, I am going back. I need to. And finally, I feel able to. Over the years, I have undergone myriad therapeutic treatments to quell the after-effects of the attack: cognitive behavioural therapy, psychodynamic psychotherapy, person-centred counselling and even group anxiety management sessions. But recently, I have tried a treatment called EMDR (Eye Movement Desensitisation and Reprocessing), which has proved by far the most effective. My return to the flat and The Doorway leading to it will be, I hope, the final exorcism.

It wasn’t just my face that ruptured that night. My life became BA and AA: Before the Attack and After the Attack. Before, I was ferociously social. After, I withdrew, and as my wounds turned to fading scars the full extent of my mental injuries became apparent. Anxiety. Flashbacks. Panic attacks. Insomnia. Agoraphobia. And a pesky five-year addiction to sleeping pills.

Despite having learnt to prevent panic attacks, and kick my addiction to sleeping pills, still I had flashbacks, nightmares and hyper vigilance: I never put my key in the front door without checking behind me. It was then that a therapist friend told me about EMDR. Dr Francine Shapiro, an American psychologist, developed it in the 1980s. The technique uses side-to-side eye movements to help people to recover from traumatic memories.

My GP referred me to the psycho- trauma department of St Bartholomew’s Hospital, in London, and I arrived trepidatious but determined. Alison, the gentle, wavy-haired clinical psychologist explained the process. You relive the traumatic event in silence, in chunks of about 30 seconds, while your eyes follow the therapist’s fingers quickly moving back and forth a metre or so from your face.

You start at the most traumatic memory from the incident and allow your mind to explore all the other associated ones. In between the 30-second chunks you describe to the therapist where your mind took you and what you experienced.

“We don’t know exactly how it works,” Dr Shapiro tells me, on the phone from California, “but we think that by using the bilateral eye movements as you access the memories, the brain is able finally to process those memories properly in the way normal, non-traumatic thoughts are processed during the REM stage of sleep. These are then stored just like any everyday memories.” One’s mind is then able to disconnect the intense feelings from the memories. Rather usefully, this prevents “intrusive thoughts” popping into your head when you’re at a supermarket checkout.

After giving me questionnaires to assess the extent of my PTSD (How often do you have flashbacks? Can you distinguish them from reality? How often do you consider suicide?), Alison put our chairs to face each other and began. It’s like watching hectic windscreen wipers, or a metronome at full pelt. Tick tock tick tock. At first I struggled to move my eyes in such an unnatural way, but after a few attempts I was reliving the attack in palpable Technicolor.

After the first successful attempt, Alison asked: “What was happening?”

“I was kneeling down, in my bedroom,” I replied, “pleading with them to stop, telling them that I was haemorrhaging, but one of them just said: ‘So?’ That was the most painful memory — I’d never experienced such inhumanity — that moment changed me. Then it was earlier and I was giving them my bankcard and telling them my pin number. They said if it was the wrong number they’d come back and finish what they started.”

We go again. Tick tock tick tock. And then, for the first time for me in therapy, I start to cry. “Keep going,” she whispered, keeping her fingers going.

“It was once they’d gone,” I said afterwards, composing myself. “I opened my bedroom door and the sight of Jon covered in blood, but standing up, alive, made me break down.”

Sometimes, during the six weeks of hour-long treatments in which every memory, direct or related, was explored, I would have to stop. I would get dizzy. One’s brain, if determined to avoid pain, will stomp its feet and refuse to “go there”.

In the last session, Alison asked me to redo the questionnaires I’d filled out at the start of the treatment. My PTSD had reduced so much that she deemed the process a success. So did I. What distinguished EMDR from other therapies — aside from the crucial eye movements — was, for me, the simple act of reliving what happened in silence. Describing verbally what happened, as I’d done in conventional therapy, actually prevented me from accessing my feelings.

Now, when I thought about that night, the flat, The Doorway, I felt very little. It seemed distant. The flashbacks had stopped. I was sleeping better. I had begun to feel human again.

When EMDR is successful, specialists can encourage their patients to return to the scene of the trauma, to check that it really has been effective.

So here I am approaching The Doorway. I stop outside. It looks remarkably similar to my memory, a little cleaner perhaps. I’m calm. I walk up the steps and well up: on the door are police stickers: “WARNING! Keep this front door secure. Know who you let in!” I ring the buzzer to Flat 1, hoping the current tenants will be in and will agree to let me in. There’s no answer. So, just as the burglars did 13 years ago, I get in to the building behind another tenant. So much for the stickers.

It feels equally strange and normal to be here. I knock at Flat 1. Eventually, a middle-aged woman answers. She tells me it is now the concierge’s office. After much persuasion, she eventually agrees to let me in, but only into the hall.

“It was converted about ten years ago,” she says. “It had been empty for a good couple of years before that.” I realise that Jon and I must have been the last tenants. I feel glad, as if somehow this might stop others going through what I did.

As we talk, I get little flashes of the blood stains that I saw the last time I came, but I feel no anxiety: the flat is different now, and so am I. After a few minutes I thank her and say goodbye: I’m done, I want to cast it all adrift. I walk out into the dank afternoon, cross over the road feeling peaceful and pensive and, as I pass a puffy-cheeked woman with yellow, candyfloss hair, she smiles. I beam back.

RESEARCH

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.

Lynn, Steven Jay; Rhue, Judith W. (1992, October). Memory. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington, VA.

NOTES: [Author presented a dramatic case report of patient who recalled specific events that subsequently he and the patient investigated and disproved. What the patient thought they saw could not possibly have been seen.]

The experimental literature on memory gives us some things to think about. Therapy relies highly on memory, and the therapist shapes the contours of the memory by validating the memories, which are rarely doubted. Tacit acceptance of memories as historical facts is part of the contract of therapy.

Memory studies challenge the idea of accurate storage. Some people are unduly confident of their memory. Bartlett's research demonstrated distortion according to schema, interpretations, embellishments, etc. Jacobi et al indicate people's theories about what happened shape memory.

One theory is that trauma leads to amnesia, repression, dissociation. But research does not show inability to recall early life events indicates presence of a traumatic history. Repression is not prima facia evidence of abuse. The Courage to Heal book states that merely thinking you were abused is evidence that you probably were.

How do vague ideas crystallize? Loftus finds if inability to remember isn't attributed to ordinary forgetting, the person may look for memories, thereby creating them.

Studies of persons who confess to crimes, unsure whether they did or didn't do them, indicate that these people are easily coerced. Doubt in a memory's accuracy can be reframed by a therapist.

Hypothesis: Therapists who confidently state a view risk implanting pseudomemories. Therapists must be cautious.

Clients can confuse sources of information that they receive. Different sources of information can be integrated into a single memory (e.g. what occurred to them and what occurred to siblings can be integrated into a pseudomemory). Some limited evidence that early life experience memories could be implanted has been presented by Loftus.

Certain client characteristics contribute to false memories: 1. Present mood state (mood congruent memory). This effect is reliable when people are clinically depressed. Though clinicians may say it indicates early childhood abuse, the memory might be selective or biased. 2. History of fantasy-proneness. In childhood this type of person might have had problems distinguishing fantasy from reality. LaBelle et al found absorption made it difficult to distinguish sounds in hypnosis from what really occurred, creating pseudo- memories. With this population it is essential to avoid suggesting abuse.

Lynn was successful in implanting an idea of abuse in an alter called Person. He used the Orne technique (from the BBC film "Hypnosis on Trial") to ask a patient what she had told him about her dog during the hypnosis; he did this to convince her of the importance of exploring her amnestic episodes.

Does hypnosis foster a literal re-experiencing of childhood events? NO. Nash, in an exhaustive review, failed to find correspondence between information from hypnotic age regression and childhood events. He notes that literal reliving is not possible. It is possibly an expression of primary process thinking. Hypnosis doesn't ameliorate memory problems; and it may exacerbate memory problems.

Lynn views primary process thinking observed in hypnosis as due to the demand of hypnosis to fantasize and relinquish critical thinking or objectivity. This plus Therapist and Patient expectancies may foster tenacious beliefs that events occurred.

Many hypnotic suggestions may interfere with memory. The AMA 1985 report suggests that hypnosis can influence confidence in a 'memory' with no actual improvement in accuracy.

The effects aren't limited to hypnosis however. Simulators and controls also generate pseudomemories. Repeated questioning of Ss who are led to believe that questioning helps distinguish memories from fantasies, actually diminishes the accuracy of memories.

Hypnotizability is correlated with pseudomemory occurrence. We should evaluate a client's hypnotizability when evaluating for pseudomemories.

Perceived verifiability rate is important, as pseudomemories are higher where you can't verify the reported memory, it is thought. Therefore, approach with caution. Make every effort to corroborate memories.

Subjective reports may tell narrative truths even though inconsistent with the historical record, and could be useful independent of historical accuracy. I agree that those 'memories' could be important, just as age progression or past life regression material could be useful in therapy. But should we base our interpretations or conclusions on events that are not confirmed? A patient's belief in abuse by their parent has enormous implications for a family.

Therapists should understand the dynamics of a request for using hypnosis to recall forgotten memories before using uncovering techniques. Ask yourself, "Why is this being requested?" Also ask other questions: 1. Is the person fantasy prone, dissociative, suggestible, a high hypnotizable? 2. Is the person stabilized enough to focus on an abreaction? 3. Is there conscious or unconscious motivation to avoid responsibility for one's own behavior? 4. Is there a wish to arrive at a facile solution, a magic cure, the royal road to the unconscious; or is there an attempt to control the treatment hour, to avoid issues, to test the therapist? 5. Is therapy stalled, not moving forward? 6. Am I angry with the client because they expect to uncover more?

Instead of using hypnosis to retrieve memories, I may focus on the issues to which I answer 'Yes' in the forgoing list.

I do not believe current research is sufficiently persuasive to throw out hypnosis for retrieving memories. The dangers of pseudomemory are endemic to therapy. Incorporating hypnosis into a broader frame of therapy depends on the skill of the clinician. However, we must use hypnosis with great caution

COMMENTS FROM AUDIENCE. Joseph Dane: In 75% of cases that could be verified, they found corroborating evidence: what should you look for as an index that the memory recalled in hypnosis is more likely to be accurate?

Lynn: Many instances of abuse are corroborated. No one questions the veracity of all memories. To my knowledge there are no ways of corroborating genuine from false memories. We know subjective conviction is not sufficient, and clients' affective experience can be very misleading. Since my experience [in the case study reported at the beginning of this presentation] I have talked with many therapists who have had similar experiences.

David Spiegel - the problem is not the hypnosis: patients go in and out of hypnosis all the time, momentarily. The problem is, how do I explore the material in psychotherapy? There is no substitute for corroboration if you can get it. But you have to be sensitive to the vulnerability of those people.

Howard Hall: What is a genuine memory? No memory is undistorted. More importantly, can we verify significant events that might have had long term consequences, like abuse? We should try to verify memories when we base treatment programs on them. The only memories in the literature that have a reputation of being accurate are highly traumatic events that stand out, and these reports are anecdotal in nature.

1991

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

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

1988

Eimer, Bruce; Freeman, Arthur (1998). Pain management psychotherapy: A practical guide. New York NY: John Wiley & Sons, Inc..

NOTES
"Pain Management Psychotherapy" (PMP) provides a clear and methodical look at pain management psychotherapy beginning with the initial consultation and work-up of the patient and continuing through termination of treatment. It is a thoughtful and thorough presentation that covers methods for psychologically assessing the chronic pain patient (structured interviews, pain assessment tests and rating scales, instruments for evaluating beliefs, attitudes, pain behavior, disability, depression, anxiety, anger and alienation), treatment planning, cognitive-behavioral therapy techniques, and a range of hypnotic approaches to pain management. The book covers both traditional (cognitive and behavior therapy, biofeedback, assessing hypnotizability, choice of inductions, designing an individualized self-hypnosis exercise) as well as newer innovative techniques (e.g., EMDR, pain-relief imagery, hypno-projective methods, hypno-analytic reprocessing of pain-related negative experiences). An extensive appendix reproduces in their entirety numerous forms, rating scale, inventories, assessment instruments, and scripts.

The senior author, Bruce Eimer, states in his online comments on Amazon.com that "most therapists hold the belief that 'real' chronic pain patients are quite impossible to help. This book attempts to dispel these misguided beliefs by providing a body of knowledge, theory, and techniques that have proven value in understanding and relieving chronic physical pain." He also states that "the challenge for the therapist is to persuade the would-ne patient/client that he or she has something to offer that can help take way pain and bring back more pleasure. This challenge is negotiated through the therapeutic relationship. However, the therapist just can't be 'warm, accepting, non-judgmental and empathic'. The therapist must also have knowledge and skills relevant to relieving pain. Only then can the therapist impart such knowledge, and in teaching these skills to the pain patient, help the patient become something of a 'self-therapist'. . . I dedicate this book to everyone who wants to find ways to make living with pain more comfortable, and to the ongoing search for better ways to relieve pain."

Snyder, Arden L.; Deffenbacher, Jerry L. (1977). Comparison of relaxation as self-control and systematic desensitization in the treatment of test anxiety. Journal of Consulting and Clinical Psychology, 45 (6), 1202-1203.

Relaxation as self-control and desensitization were compared to a wait-list control in the reduction of test and other anxieties. Neither active treatment differed significantly from the other, but they did differ significantly from the control treatment on several variables. Subjects in both treatments reported less debilitating test anxiety, whereas desensitization subjects showed greater facilitating test anxiety. Under stressful conditions, treated subjects were less worried and anxious, found the situation less aversive, and perceived themselves and their abilities more favorably than controls. Significant reductions in nontargeted anxieties also were found, suggesting transfer of anxiety-management skills to areas other than test anxiety,

1976

Hemme, Robert; Boor, Myron (1976). Role of expectancy set in the systematic desensitization of speech anxiety: An extension of prior research. Journal of Clinical Psychology, 32 (2), 398-404.

SUMMARY

The influence of expectancy set with regard to therapy outcome on the effectiveness of systematic desensitization (SD) for reducing public speaking anxiety was investigated. The 7 Ss given a high expectancy set for favorable therapy outcome were informed about psychological research that indicates that SD is effective to reduce public speaking fears. SD was administered with the standard instructions to the 11 Ss given a neutral expectancy set. This expectancy manipulation did not require deception and perhaps could be used with actual SD therapy clients. As in previous research by Woy and Efran, the expectancy set manipulation significantly modified Ss' self-report of subjective perceptions of anxiety from pretratment to posttreatment speeches, but did not affect overt behavioral or physiological indices of anxiety. Since subjective perceptions of anxiety responses are psychologically significant behaviors, these data suggest the importance of conveying a high expectation of improvement to SD and perhaps also to other types of therapy clients. SD sessions administered to small groups of clients on consecutive days, as in this study, appeared to be as effective to reduce speech anxiety as SD sessions administered to each client individually at 1-week intervals, as in the Woy and Efran study" (pp. 403-404).

1975

Lick, John R. (1975). Expectancy, false galvanic skin response feedback, and systematic desensitization in the modification of phobic behavior. Journal of Consulting and Clinical Psychology, 43 (4), 557-567.

This study compared systematic desensitization and two pseudotherapy manipulations with and without false galvanic skin response feedback after every session suggesting improvement in the modification of intense snake and spider fear. The results indicated no consistent differences between the three treatment groups, although all treatments were significantly more effective than no treatment in modifying physiologic

al, behavioral, and self-report measures of fear. A 4-month follow-up showed stability in fear reduction on self-report measures for the three treatment groups. Overall, the results of this experiment were interpreted as contradicting a traditional conditioning explanation of systematic desensitization. An alternate explanation for the operation of systematic desensitization emphasizing the motivational as opposed to conditioning aspects of the procedure is discussed.

SMOKING CESSATION - Hypnotherapeutic Intervention in Smoking Cessation

2012-01-12T09:33:00.001-08:00

"Man often becomes what he believes himself to be. If I keep on saying to myself that I cannot do a certain thing, it is possible that I may end by really becoming incapable of doing it. On the contrary, if I have the belief that I can do it, I shall surely acquire the capacity to do it even if I may not have it at the beginning."
- Mahatma Gandhi

“Hypnosis is the most effective way of giving up smoking, according to the largest ever scientific comparison of ways of breaking the habit.”

-New Scientist, 10/92

“There's entrancing news about hypnosis; it's gaining credibility as a treatment for a multitude of troubles, from nicotine addiction to post-traumatic stress disorder.”

-Business Week, Feb 2/04

According to the largest ever scientific comparison of ways of breaking the habit, Hypnosis is the most effective way of giving up smoking. In 1992, Frank Schmidt and research student Chockalingham Viswesvaran of the University of Iowa carried out a meta-analysis statistically combining the results of more than 600 studies covering almost 72,000 people from the U.S., Scandinavia and elsewhere in Europe.

By combining the results from so many separate studies, the meta-analysis enables the real effectiveness of each technique to be picked out from the statistical noise that often blights studies involving smaller numbers of subjects.

The results, published in the Journal of Applied Psychology, Vol. 77 1992, show that out of 6000 smokers, 30% were smoke-free after only one session, the highest success rate among all treatments covered in the study (e.g. combination techniques such as exercise and breathing therapy had a success rate of 29% and acupuncture had a success rate of 24% to name but a few).

The Chairman of the British Society of Medical & Dental Hypnosis said of the research that current hypnosis techniques are a far cry from their popular image of music-hall tricks involving swinging fob watches. The latest relaxation techniques, he said, achieve success rates of up to 60 per cent from a single session.

Hypnotherapy, through the use of the medium of Suggestion Therapy, is the most effective treatment for smoking cessation. There are various states of mind and your mind is working on two levels. The Conscious and Subconscious. The conscious mind is your waking, reasoning mind where as the subconscious mind is much larger and controls tasks such as breathing, driving and habits. When the subconscious mind accepts a habit such as smoking it is unlikely to change that habit easily. How many times have you heard someone say “I won’t smoke”, and the first thing that person does is reach for a cigarette. This is because it is a subconscious habit. With Hypnosis we communicate directly with the subconscious mind and we can change these unwanted habits very easily using suggestion therapy.

New research from Aviva Insurance reveals that approximately a quarter of those completing an online health check admit to being smokers and that a higher proportion of females (24%) than males (22%) smoke. The research also revealed that Irish smokers smoke an average of 13 cigarettes every day costing the smoker approximately €163.80 each month and approximately €2000 a year.

The risk of developing lung cancer for Irish men will increase by 59% and by 136% for Irish woman by 2020 according to the National Cancer Registry2 and with lung cancer accounting for 20% of all deaths from cancer each year, there is a real need to stub out smoking and protect the health of Ireland’s consumers.

Ash Ireland (Action on Smoking and Health) also recently published data revealing 7,500 people die from the effects of tobacco each year in Ireland and thousands of others are ill because of tobacco-related diseases such as lung cancer which accounts for 1,500 of all deaths from cancer in Ireland each year3. The more cigarettes a person smokes per day and the lower the age at which they began smoking, the greater the risk they have of developing lung cancer.

The statistics about smoking in Ireland reflect how much of an issue smoking is in our society:

· 25% of the population of Ireland smoke

· In the late 1960's one half of the population smoked

· 33% of married women smoke

· 46% of smokers do not enjoy all cigarettes

· 46% were in favour of the doubling of cigarette prices

· 63% of the public supported price increase for cigarettes

· 11% of 8 to 17 years olds smoke

· Half of all smokers tried to give up in the past two years

· 61% of people attempted to quit in 2002 compared with 73% in 1997

The research which follows is divided into two sections, Smoking and Suggestion.

The former outlines research undertaken in the treatment of smokers with Hypnotherapy and the outcomes of various trials. The latter is research into the therapy used in the treatment of smoking, as well as weight-loss, nail-biting, etc. This gives a further insight into the therapy being used and the techniques and approaches being applied.

Suggestion is an idea that one accepts uncritically, and favourably, resulting in the initiation of appropriate behaviour. Suggestibility or susceptibility is the degree of patient receptivity.

Suggestion is used every time- a treatment plan is described by a doctor to a patient or a prescription is given. Any instruction, made in a kind, confident, assuring manner, will be of potential aid in bringing about desired results.

Bernheim, in about 1882, said "There is no such thing as hypnosis, there is only suggestion", and Bernheim listed rules governing suggestion which are irrefutable.

When an idea takes root in the subconscious, it must be discharged in the motor action or in thought. "The idea gives birth to an idea". Please bear in mind that the subconscious will just as well discharge a bad idea as a good one.

Bernheim's definition is that "suggestion is an idea which releases itself through the subconscious mind", and that there are certain conditions which are necessary to create auto-suggestion (the passing of a suggestion to the subconscious by oneself):

1. There must be intensity of attention to the idea itself.

2. The intensity of attention and the importance of the idea must be magnified by emotion (although it matters not which emotion is involved).

3. There must be absence of any counter suggestion from the psyche.

The following research findings on Smoking Cessation with Hypnotherapy indicate a success rate ranging from 88% to 25%.

The most successful candidates were those who were reviewed quarterly every 3, 6, 9, and 12 mounts with as many as 90% abstaining from Smoking permanently.

On reviewing the forty eight years of research listed below I have found the average success rate for Stopping Smoking with Hypnotherapy is over 50%.

Those subjects who participated in a number (averaging 4) of Stop Smoking Sessions seem to have shown the highest percentage of success.

Subjects who participated in only one Stop Smoking Cassation also experienced various levels of success at first, but this was to decrease over time with percentages dropping as low as between 18.5% and 25%.

The research listed below will give a brief outline of the progress and advances that have been made in the area of Smoking Cessation by various Hypnotherapy Organizations and Therapists down through the years.

Starting from the most recent date, this data contains in most cases a listing of the amount of subjects that were involved in each research, the procedure used and a follow up to check the long term effectiveness of Hypnotherapy for Smoking Cessation.

The following compilation of Research into Hypnotherapeutic Interventions for Smoking Cessation with specific examples of working with patients at each level of illness, and gives statistical analysis of Hypno-psychotherapeutic interventions which were used in the treatment of these clients. If you have comments on the following research, or simply ideas, approaches, techniques or opinions, please feel free to post below, or on our discussions page on Facebook at http://www.facebook.com/group.php?gid=142527652458782

The Institute of Clinical Hypnotherapy & Psychotherapy Training and Accreditation is running a Smoking Cessation and Addictions Masterclass for Hypnotherapists and like-minded health professionals at the Marino Institute of Education, Griffith Avenue, Dublin 9 on Saturday 4^th December, 2010. Please visit our website www.hypnosiseire.com for details or email ichphq@gmail.com

SMOKING

2001

Barber, Joseph (2001). Freedom from smoking: Integrating hypnotic methods and rapid smoking to facilitate smoking cessation. International Journal of Clinical and Experimental Hypnosis, 49 (3), 257-266.

Hypnotic intervention can be integrated with a Rapid Smoking treatment protocol for smoking cessation. Reported here is a demonstration of such an integrated approach, including a detailed description of treatment rationale and procedures for such a short-term intervention. Of 43 consecutive patients undergoing this treatment protocol, 39 reported remaining abstinent at follow-up (6 months to 3 years post treatment).

Gibbons, Don E. (2001). Experience as an art form: Hypnosis, hyperempiria, and the Best Me technique. San Jose CA: Authors Choice Press. (([available online:] http//www.iuniverse.com/bookstore/marketplace))

NOTES
The Best Me Technique is a procedure for constructing suggestions which incorporates many different dimensions of experience -- beliefs, emotions, sensations, thoughts, motives, and expectations -- for maximum involvement and effectiveness. Best Me suggestions may be used with either hyperempiria, an alert induction based on suggestions of mind expansion and increased alertness and sensitivity, or with more traditional forms of hypnotic induction.

2000

Green, Joseph P.; Lynn, Steven Jay (2000, August). Hypnosis and suggestion-based approaches to smoking cessation: An examination of the evidence. [Paper] Presented at the annual meeting of the American Psychological Association, Washington, D. C..

This article reviews 59 studies of hypnosis and smoking cessation from the point of view of whether the research provides support for hypnosis as an empirically supported treatment (Chambless and Hollon, 1998). Whereas hypnotic procedures generally yield higher rates of abstinence relative to wait list and no treatment conditions, hypnotic interventions are generally comparable to a variety of non-hypnotic treatments. The evidence for whether hypnosis yields outcomes superior to placebos is mixed. In short, hypnosis can not be considered to be a specific and efficacious treatment for smoking cessation. Furthermore, in many cases, it is impossible to rule out cognitive/behavioral and educational interventions as the source of positive treatment gains associated with hypnotic treatments. Hypnosis can not, as yet, be regarded as a well-established treatment for smoking cessation. Nevertheless, it seems justified to classify hypnosis as a "possibly efficacious" treatment for smoking cessation. - Abstract taken from Psychological Hypnosis: A Bulletin of [Amer Psychol Assn] Division 30. Fall, 2000.

1999

Capafons, A. (1999). Applications of emotional self-regulation therapy. In Kirsch, I.; Capafons, A.; Cardeqa, E.; Amigs, S. (Ed.), Clinical hypnosis and self-regulation: Cognitive-behavioral perspectives (pp. 331-349). Washington, D.C.: American Psychological Association.

This chapter reviews the main applications of emotional self-regulation therapy, which have received empirical support: smoking reduction, obesity, fear of flying, drug addictions, and premenstrual distress and dysmenorrhea. The logic of each treatment and main empirical results are summarized.

1997

Bayot, A.; Capafons, A.; Cardeqa, E. (1997). Emotional self-regulation therapy: A new and efficacious treatment for smoking.. American Journal of Clinical Hypnosis, 40 (2), 146-156.

We described emotional self-regulation therapy, a recently-developed suggestion technique for the treatment of smoking, and present data attesting to its efficacy. Of the 38 individuals who completed treatment, 82% (47% of the initial sample)stopped smoking altogether and 13% (8% of the initial sample) reduced their smoking. A follow-up at 6 months showed that 66% (38% of the initial sample) of those who had completed the treatment remained abstinent and reported minimal withdrawal symptoms or weight gain. In a no-treatment comparison group, only 8% reduced their smoking or became abstinent.

Johnson, David L. (1997). Weight loss for women: Studies of smokers and nonsmokers using hypnosis and multicomponent treatments with and without overt aversion. Psychological Reports, 80 (3, Pt 1), 931-933.

Study 1 compared 50 overweight adult female smokers (mean age 37.7 yrs) and 50 nonsmokers (mean age 41.2 yrs) in an hypnosis-based, weight-loss program. Smokers and nonsmokers achieved significant weight losses and decreases in Body Mass Index. Study 2 treated 100 women either in an hypnosis only (n = 50) or an overt aversion and hypnosis (n = 50) program. This multicomponent follow-up study replicated significant weight losses and declines in Body Mass Index. The overt aversion and hypnosis program yielded significantly lower posttreatment weights and a greater average number of pounds lost. (PsycINFO Database Record (c) 2003 APA, all rights reserved)

1995

Capafons, A.; Amigs, S. (1995). Emotional self-regulation therapy for smoking reduction: Description and initial empirical data.. International Journal of Clinical and Experimental Hypnosis, 43 (1), 7-19.

Self-regulation therapy (Amigs, 1992)is a set of procedures derived from cognitive skill training programs for increasing hypnotizability. First, experiences are generated by actual stimuli. Clients are then asked to associate those experiences with various cues. They are then requested to generate the experiences in response to the cues, but without the actual stimuli. When they are able to do so quickly and easily, therapeutic suggestions are given. Studies of self-regulation therapy indicate that it can be used sucessfully to treat smoking.

Holroyd, Jean (1995). Handbook of clinical hypnosis, by Judith W. Rhue, Steven Jay Lynn, & Irving Kirsch (Eds.) [Review]. International Journal of Clinical and Experimental Hypnosis, 43 (4), 401-403.

NOTES
"This is a book for the thinking clinician" (p. 401). "The editors are to be congratulated for making this volume much more coherent than most edited books" (p. 402). "My impression is that the book is best suited for an intermediate or advanced course on hypnotherapy, or for people who are already using hypnosis in treatment. Although there is some material on the basics of hypnotic inductions and a few introductory sample scripts for inductions, a beginners'' course should probably use a different book, or this book could be accompanied by an inductions manual. ... I recommend it very highly" (p. 403).

1993

Page, Roger A.; Handley, George W. (1993). The use of hypnosis in cocaine addiction. American Journal of Clinical Hypnosis, 36, 120-123.

An unusual case is presented in which hypnosis was successfully used to overcome a $50-0 (five grams) per day cocaine addiction. The subject was a female in her twenties. Six months into her addiction, she acquired a commercial weight-control tape that she used successfully to stop smoking cigarettes (mentally substituting the word "smoking"), as well as to bring her down from her cocaine high and allow her to fall asleep. After approximately 8 months of addiction, she decided to use the tape in an attempt to overcome the addiction itself. Over the next 4 months, she listened to the tape three times a day, mentally substituting the word "coke." At the end of this period, her addiction was broken, and she has been drug free for the past 9 years. Her withdrawal and recovery were extraordinary because hypnosis was the only intervention, and no support network of any kind was available.

Spiegel, David; Frischholz, Edward J.; Fleiss, Joseph L.; Spiegel, Herbert (1993). Predictors of smoking abstinence following a single-session restructuring intervention with self hypnosis. American Journal of Psychiatry, 150, 1090-1097.

Examined the relation of smoking and medical history, social support, and hypnotizability to outcome with Spiegel's smoking-cessation program. A consecutive series of 226 smokers were treated with the single-session approach and followed up for 2 years. With a total abstinence criterion, 52% success was found after 1 week, and 23% abstinence at 2 years. Hypnotizability and having been previously able to quit smoking for at least a month significantly predicted the initiation of abstinence. Hypnotizability and living with a significant other person predicted 2-year maintenance. The results are superior to those of spontaneous efforts to stop smoking and suggest it is possible to predict which patients are most likely to respond and which patients are least likely to respond to such a brief intervention.

1992

Spanos, Nicholas P.; Simulates, Ann; de Faye, Barbara; Mondoux, Thomas J.; Gabora, Natalie J. (1992-93). A comparison of hypnotic and nonhypnotic treatments for smoking. Imagination, Cognition and Personality, 12, 23-43.

Three experiments administered variants of Spiegel's (1970) smoking cessation procedure to smokers in hypnotic and nonhypnotic treatments. Follow-up periods were from twelve to twenty-four weeks depending on the experiment. Complete abstinence was an infrequent outcome in all three experiments. Greater-than-control reductions in smoking for treated subjects were obtained in two of the experiments but, in both cases treatment and control subjects failed to differ significantly before the end of the follow-up period. Hypnotic and nonhypnotic treatments produced equivalent smoking reductions in all studies, and neither hypnotizability nor questionnaire assessments of motivation to quit correlated significantly with treatment outcome. Implications are discussed. NOTES 1:

NOTES

When the experimenters compared number of treatments they simply compared two sessions of Spiegel's one-session treatment with four sessions of it. The authors make the point that perhaps they should vary the four sessions.

"In all three of the present experiments the abstinence rates associated with the Spiegel treatment were very low. Our abstinence rates were similar to those reported in one earlier study [4 - Perry et al.], but substantially lower than those reported in three other studies [2, 22, 25]. The reasons for these discrepancies between studies remains unclear, but experiment 3 suggests that these discrepancies cannot be accounted for simply in terms of whether the subjects were drawn from a university or nonuniversity population, and experiment 2 suggests that the discrepancies are unrelated to the number of treatment sessions administered to subjects.

"The finding that hypnotic and nonhypnotic subjects in all three experiments attained equivalent reductions in smoking is consistent with other comparison studies in this area which indicate that hypnotic treatments are no more effective than various nonhypnotic procedures at inducing reductions in smoking [22, 25, 30]. More generally, these findings are consistent with comparison studies on a wide variety of clinical disorders (headache pain, warts, phobias, obesity) which indicate that hypnotic treatments are no more effective than nonhypnotic ones at producing therapeutic change (see [3] for a review).

"The failure to find significant correlations between smoking reduction and hypnotizability among treated subjects is also consistent with the findings of most studies in this area [3], but the reasons why significant correlations between these variables are found in some studies and not others remains unclear. Spanos [3] suggested that significant correlations between these variables are particularly likely when hypnotizability testing is integrated into the treatment protocol. Under these circumstances subjects are likely to form strong expectations about treatment success on the basis of their self- observed responses to the hypnotizability scale. Such expectations may, in turn, influence subjects' motivations to comply with the treatment regimen, the self-statements they make concerning their likelihood of quitting, etc. In all of the present experiments hypnotizability was assessed at the end of the follow-up period and, therefore, could not influence subjects' expectations of treatment success" (pp. 40-41).

Spiegel, David (1992, October). Hypnotizability. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington, VA.

NOTES

Dr. Spiegel announced that this was a last minute substitution for Fred Frankel's presentation on Hypnotizability.

We have ongoing a major replication of the study that we published on group therapy with terminally ill breast cancer patients. The matched control patients get educational materials but not psychotherapy. We are looking at NKC cytotoxicity and delayed hypersensitivity.

Tasks: spend 15 minutes discussing list of problems; 15 minutes discussing things like, "What is your spouse doing that doesn't help; what can we do to help it?" We get drop in NKC cytotoxicity immediately afterward, returning after 24 hrs to usual levels. Controls don't drop in NKC cytotoxicity. This measure of stress may be a predictor of survival time.

In Fawzy's study of group therapy with melanoma patients, they noted a significant difference at 6 months in interferon augmented activity of NK, which didn't hold up at a year. But at 6 years there were 10 of 40 deaths in control group vs 3 of 40 deaths in treated group. This is a vigorous effect.

Cohen's study of colds in New England J. of Med is another good clinical study.

There are two broad areas of relevance of hypnotizability to healing: 1. Hypnotizability as a trait: do highs differ in way they regulate body or mind? 2. Is there something you do when in hypnotized state that is different? Studies of treatment of warts with hypnosis are important 3. Transition between states, e.g. circadian rhythms; is there a shift in wakefulness between trance and nontrance states that affects health?

Psychiatric Diagnosis and self regulation. High hypnotizability is associated with certain psychiatric disorders (dissociative reaction, PTSD, MPD, etc.). Schizophrenics score much lower than normals (av. = 4 vs 7; replicated with the Hypnotic Induction Profile (HIP). Stanford Hypnotizability Scales show no difference in means, but do show a difference in range). I don't know what this means. But schizophrenics can falsely pass some Stanford Scale items, e.g. amnesia which they don't however reverse; so schizophrenics' hypnotizability scores may be inflated on Stanford scales. We don't see extremely high scores in schizophrenics.

Psychoactive medication doesn't affect scores of schizophrenics, but improves scores of anxiety neurotics (by reducing anxiety). Frischholz has an article coming out in a psychiatry journal that confirms this.

There is a lot of evidence that patients with dissociative disorders are more hypnotizable than other groups. Frischholz et al couldn't replicate Frankel's finding of higher scores in phobics. Pettinati et al found higher scores in bulimia and I haven't seen anything to counter that. Another idea is that high hypnotizables are very good at internal regulation

Spiegel & Ken Kline selected Ss who could regulate gastric activity. They got an 80% increase in gastric acid output while imagining eating; got 40% decrease in output when imagining something pleasant that wasn't imagining eating. Injected with pentagastrin, which induces gastric output, they still got a decrease in gastric acid output in the relaxation condition.

This suggests that hypnotizability should be a selection criterion for some research. See also Katz et al. 1974 (?) with acupuncture; and McGlashan, Evans & Orne on the placebo response.

Herbert Spiegel found that 2/3 of highs but 1/3 of lows were cured of phobia. Eye roll sign on the HIP, living with spouse/lover, rating self as hypnotizable, and giving a postcard follow-up response at one week post treatment were associated with 89% rate abstinence at 2 years follow-up, when only 23% overall of 223 were abstinent. Absence of those positive predictors was associated with only a 4% rate of abstinence.

1991

Court, John (1991). Lord of the trance. Journal of Psychology and Christianity, 10(3), 261-265.

A verbatim account of hypnotically-based therapy utilizing Christian imagery serves as the basis for illustrating some of the benefits of this appraoch where therapist and client share the same value system. The interactions challenge some of the familiar objections to Christian involvement with hypnosis.

Holroyd, Jean (1991). The uncertain relationship between hypnotizability and smoking treatment outcome. International Journal of Clinical and Experimental Hypnosis, 39, 93-102.

Literature on the relationship between hypnotizability and smoking treatment outcome was reviewed. 91 private patients treated for smoking with hypnotherapy participated in an investigation designed to correct problems in some of the earlier research. 43% quit smoking by the end of treatment but only 16% abstained at least 6 months. Neither immediate quitting nor continued abstinence correlated with hypnotizability. Other variables hypothesized to predict smoking cessation also were not correlated with outcome: number of treatment sessions, need to smoke, motivation to quit, and gender. The low abstention rate may have impeded verification of a relationship between hypnotizability and treatment outcome.

NOTES

In the Discussion, the author notes that the low overall abstention rate works against finding the predicted relationships, as did restricted range on the hypnotizability measure. "Secondly, the present research design in effect tested the potency of hypnosis (hypnotizable patients) against nonhypnotic treatment (nonhypnotizable control patients) in a research design recommended by Orne (1977). Intensive nonhypnotic involvement with the nonhypnotizable individuals over several sessions may have worked against finding differences between low and high hypnotizables" (p. 99).

"Patients generally did not complete the recommended four sessions ... and they generally were non-adherent to recommended follow-up telephone contact. The observed relationship between initial quitting and number of treatment sessions may exist because people who are responding to treatment stay in treatment longer, or because more treatment sessions provide a more potent intervention, or both" (p. 99). "Treatment contracts between patients and therapist increased the number of sessions that patients completed but did not increase their abstinence rate" (p. 100).

1990

Suedfeld, Peter (1990). Restricted environmental stimulation and smoking cessation: A 15-year progress report. International Journal of the Addictions, 25, 861-888.

The first successful use of restricted environmental stimulation therapy (REST) as a method of smoking cessation was reported in this journal in 1972. Since then, close to 20 papers and articles have further investigated this application. The results have been consistently positive and have further shown that--unlike most techniques--REST combines synergistically with other effective treatment modalities. The effect of REST seems to target primarily the major problem with other known treatments in this area: It substantially reduces the relapse rate among clients who quit smoking at the end of treatment. Furthermore, REST is safe, has no known adverse side effects, and is easily tolerated by most participants. Nevertheless, the method has not found wide acceptance among practitioners. This paper explores and answers some of the concerns that may be involved in its relative lack of popularity. NOTES 1:

NOTES

Provides a thorough review of REST (restricted environmental stimulation technique) and smoking cessation, with analysis of why the technique has not been widely adopted, how to set up a lab (including costs and equipment), and the political considerations surrounding REST research (many of which would apply to hypnosis). The author describes how sensory restriction got a bad reputation in Hebb's lab. But both "brainwashing" and intensive interrogation rely primarily on overstimulation and intense stimulus bombardment; these are occasionally interrupted for brief periods to arouse fear and uncertainty about their resumption.

The optimal approach in treatment of smokers seems to be to combine an approach that maximizes immediate cessation rates, with REST which maximizes continuing maintenance rates. Tikalsky (1984) reported that combining REST with self- management training and the establishment of a social support group, there was a 6-month abstinence rate of 88%. (This was a clinical treatment study rather than a controlled experiment.)

"The estimated maintenance rates after REST converge at about 50%, about twice as high as those commonly accepted as characterizing the literature (see, e.g., Hunt and Bespalec, 1974; Shumaker & Grunberg, 1986). The unusually high maintenance rates (percentage of subjects who were abstinent at every follow-up throughout 12 months, using as the baseline those who had quit at end of treatment) are in most--although not all- -cases combined with only average quit rates (using total number of followed-up subjects as the baseline), indicating that the initial impact of REST is less impressive than its effect on long-term maintenance" (p. 872).

Why is REST underutilized? Some say it is a placebo. But there is evidence that "expectancy has but little effect on objectively quantifiable (as opposed to subjective) measures in REST (Barabasz & Barabasz, 1990; Suedfeld, 1969b; Suedfeld, Landon, Epstein, & Pargament, 1971)" (p. 873). See also Suedfeld & Baker-Brown (1986).

How does REST work? "In REST, the normal flow of exogenous stimuli is suddenly and very drastically reduced. As a result, attention can be (in fact, must be, if the processing of information is a basic human need) refocused to the ongoing internal generation of physiological, cognitive, affective, memorial, imaginal, and other stimulation. This enables REST participants to concentrate on working out personal problems, including (if so desired) those related to the continuation or termination of their smoking habit" (p. 874).

Second, the removal of specific smoking-related cues interrupts automatic, overlearned response sequences so most clients report that they no longer smoke mechanically, and conditioned cravings for a cigarette are extinguished in many Ss.

It appears from the literature that low-arousal treatments such as hypnosis and meditation are reinforced by REST. REST should improve conditioning or cognitive change therapies because it improves learning and memory, and research supports this assumption. REST also should facilitate the acceptance of information ('messages') because it decreases defenses against novel or dissonant information, but that has not proven true in research to date.

1988

Jeffrey, L. K.; Jeffrey, T. B. (1988). Exclusion therapy in smoking cessation: A brief communication. International Journal of Clinical and Experimental Hypnosis, 36(2), 70-74.

This study investigated the effect of exclusion therapy on the outcome of a 5-session treatment protocol for smoking cessation. A total of 120 Ss were randomly assigned to a group hypnotic and behavioral program which required 48 hours of pretreatment abstinence from use of tobacco products, or to an identical treatment which encouraged, but did notinclude, this pretreatment stipulation. Results indicated there were no significant differences between groups in dropout rates or number of Ss abstinent from smoking. For all Ss, including dropouts, the abstinence rate was 59.2% upon completion of treatment. It was 45.5% and 36.7% at 1- and 3-month follow-up, respectively.

Neufeld, V.; Lynn, Steven Jay (1988). A single-session group self-hypnosis smoking cessation treatment: A brief communication. International Journal of Clinical and Experimental Hypnosis, 36 (2), 75-79.

This study was designed to assess the efficacy of a manual-based, single-session group of self-hypnosis intervention. At 3 months follow-up, 25.92% of the total number of participants (14 male, 13 females) reported continuous abstinence, and at 6 months, 18.52% of the participants reported continuous abstinence. Reported social support and motivation to quit were both associated with successful outcome. Comparison of the current data with other findings reported by the American Lung Association (Davis, Faust, & Ordentlich, 1984) suggests that treatment effects may not be solely attributable to the use of a maintenance manual, education, and attention. Limitations of the research associated with issues of experimental control, generalizability of the findings, and outcome measures are discussed.

Williams, J. M.; Hall, D. W. (1988). Use of single session hypnosis for smoking cessation. Addictive Behaviors, 13, 205-208.

Twenty volunteers for smoking cessation were assigned to single-session hypnosis, 20 to a placebo control condition, and 20 to a no-treatment control condition. The single-session hypnosis group smoked significantly less cigarettes and were significantly more abstinent than a placebo control group and a no-treatment control group at posttest, and 4-week, 12-week, 24-week, and 48-week follow-ups.

1987

Gmur, M.; Tschopp, A. (1987). Factors determining the success of nicotine withdrawal: 12-year follow-up of 532 smokers after suggestion therapy (by a faith healer). International Journal of Addictions, 22, 1189-1200.

In 1973, 532 heavy smokers were questioned prior to treatment by the faith healer Hermano and requestioned 4 months, 1 year, 5 years, and 12 years after the therapeutic ritual. From the moment of treatment, 40% of the subjects remained nonsmokers (with no relapse) after 4 months, 32.5% after one year, 20% after 5 years, and 15.9% after 12 years. At the time of the follow-up, 37.5% of the Ss were nonsmokers, the majority of them having stopped smoking again after suffering a relapse. To investigate factors determining success, Ss who for 12 years had uninterrupted abstinence were compared with those who for 12 years had continued to smoke almost without interruption. Personality factors, sociodemographic features, and characteristics of smoking behavior showed no demonstrable connection with the tendency to relapse. On the other hand, it did prove possible to explain 16% of the variance in the responses to treatment: in particular, high alcohol consumption, markedly addictive smoking, rare attendance at church, and the attitude that 'you have to believe in the treatment' were found to be conducive to relapse and addiction.

1986

Barabasz, Arreed F.; Baer, Lee; Sheehan, David V.; Barabasz, Marianne (1986). A three-year follow-up of hypnosis and restricted environmental stimulation therapy for smoking. International Journal of Clinical and Experimental Hypnosis, 34, 169-181.

Clinical follow-up data were obtained from 307 clients. Clinicians' experience level, contact time, and procedural thoroughness varied in 6 interventions for smoking cessation. An additional intervention combined hypnosis with restricted environmental stimulation therapy (REST). The major results suggest positive treatment outcomes to be related to greater hypnotizability, absorption, hypnotist experience level, procedural thoroughness, and client-therapist contact time. The least effective intervention (4% abstinence at 4-month follow-up) involved intern trainees using a short, single-session approach. The most effective procedure (47% abstinence at 19-month follow-up) involved the combination of hypnosis and

REST. Data interpretation limitations are discussed.

Lambe, R.; Osier, C.; Franks, P. (1986). A randomized controlled trial of hypnotherapy for smoking cessation. Journal of Family Practice, 22, 61-65.

NOTES

242 patients who were smokers (49% of all patients in this group family practice) were contacted, and 180 (74%) who were interested in hypnosis as a method of helping them quit were included in the study. These 180 were randomly assigned to control and hypnosis groups. Of the 90 assigned to hypnosis: 50% 45 had at least 1 hypnosis session

7% 6 quit smoking before hypnosis 20% 18 declined hypnosis 23% 21 were lost to follow-up [This gives some idea about volunteer participation in research.]

1985

Jeffrey, Timothy B.; Jeffrey, Louise K.; Greuling, Jacquelin W.; Gentry, William R. (1985). Evaluation of a brief group treatment package including hypnotic induction for maintenance of smoking cessation: A brief communication. International Journal of Clinical and Experimental Hypnosis, 33 (2), 95-98.

Hypnotic, cognitive, and behavioral interventions were used in a 5-session treatment program to assist 35 Ss with maintenance of smoking cessation. 63% of the treated Ss discontinued smoking, and 31% maintained abstinence for 3 months (p <.005). These results include 13 dropouts, all of whom were smoking at 3 months follow-up. No S in the waiting-list-control group quit smoking. The results demonstrate that a brief, group treatment program, including hypnotic techniques, can be effective for smoking cessation.

1980

Holroyd, Jean (1980). Hypnosis treatment for smoking: An evaluative review.International Journal of Clinical and Experimental Hypnosis, 28 (4), 341-357.

17 studies of hypnosis for treatment of smoking published since 1970 were reviewed. Abstinence after 6 months posttreatment ranged from 4% to 88%. Effectiveness of treatment outcome was examined in terms of: S population, individual versus group treatment, standardized versus individualized suggestions, use of self-hypnosis, number of treatment sessions and time span covered by the treatment, and use of adjunctive treatment. At 6 months follow-up, more than 50% of smokers remained abstinent in programs in which there were several hours of treatment, intense interpersonal interaction (e.g., individual sessions, marathon hypnosis, mutual group hypnosis), suggestions capitalizing on specific motivations of individual patients, and adjunctive or follow-up contact. The 17 studies are presented in sufficient detail to permit clinicians to follow the published procedures, and recommendations are made for future research.

Powell, Douglas H. (1980). Helping habitual smokers using flooding and hypnotic desensitization techniques: A brief communication. International Journal of Clinical and Experimental Hypnosis, 28 (3), 192-196.

A subgroup of individuals who were helped to stop smoking by hypnosis or other means returned to consuming a few cigarettes a day. A flooding and hypnotic desensitization technique assisted 4 of 7 individuals who resumed smoking in becoming and remaining abstinent for a 6- to 9-month follow-up period.

1979

Pederson, Linda L.; Scrimgeour, William G.; Lefcoe, Neville M. (1979). Variables of hypnosis which are related to success in a smoking withdrawal program.International Journal of Clinical and Experimental Hypnosis, 27 (1), 14-20.

65 habitual smokers were randomly assigned to one of 4 groups: live-hypnosis plus counseling, videotape-hypnosis plus counseling, relaxation-hypnosis plus counseling, and counseling alone. The content and mode of presentation of the hypnosis session varied among the first 3 groups. At 6 months posttreatment, the live-hypnosis plus counseling group contained significantly more abstainers than the other 3 groups. The importance of the specific content of the hypnosis session and the presence of the hypnotherapist for the effectiveness of the procedure is discussed.

Perry, Campbell; Gelfand, Robert; Marcovitch, Phillip (1979). The relevance of hypnotic susceptibility in the clinical context. Journal of Abnormal Psychology, 88(5), 592-603.

Despite experimental evidence that hypnotic susceptibility is a relatively stable characteristic of the individual, and one that is very difficult to modify, clinical investigators tend to see susceptibility as irrelevant to therapeutic outcome. Such investigators view motivational and interpersonal variables as more essential to the therapeutic change. The evidence for the clinical relevance of hypnotizability is sparse and contradictory. Most existing studies stem from medical hypnosis and indicate that susceptibility plays an important role in the successful treatment of such conditions as clinical pain, warts, and asthma. Two studies are reported that seek to pursue a contrary finding reported by Perry and Mullen, who found that susceptibility was unrelated to the successful treatment of a socially learned behavior (cigarette smoking). Both studies confirmed the earlier finding of a lack of relation. In Study 1, however, stepwise multiple regression analysis located three inventory items concerning the motivation of cigarette smokers. The combination of items was found to predict outcome for 67.39% of 46 clients treated either by hypnosis or by rapid smoking. The finding was replicated in Study 2, which utilized a combined hypnosis - rapid smoking technique and employed a different therapist. The outcome for 9 of the 13 quitters and 37 of the 62 nonquitters across the two studies could be predicted by the three motivational questionnaire variables.

1978

Stanton, Harry E. (1978). A one-session hypnotic approach to modifying smoking behavior. International Journal of Clinical and Experimental Hypnosis, 26, 22-29.

Recent literature reviewing attempts to modify smoking behavior through the use of hypnosis is outlined, and an approach utilizing only 1 treatment is described. This single session includes: (a) the establishment of a favorable "mental set" on the part of the patient, (b) a hypnotic induction, (c) ego-enhancing suggestions, (d) specific suggestions directed toward the cessation of smoking, (e) an adaption of the "red balloon" visualization, and (f) success visualization. Of 75 patients treated by this technique, 45 ceased smoking. 6 months after the treatment session, 34, or 45%, were still nonsmokers, attesting to the efficacy of the method.

1977

Barkley, R. A.; Hastings, J. E.; Jackson, T. L., Jr. (1977). The effects of rapid smoking and hypnosis in the treatment of smoking behavior. International Journal of Clinical and Experimental Hypnosis, 25 (1), 7-17.

29 Ss were assigned to one of 3 treatment conditions and treated for their cigarette smoking over a 2-week period. These conditions were: group rapid smoking, group hypnosis, and an attention-placebo control group. All treatments produced significant reductions in average daily smoking rates during the treatment phase but all Ss returned to near baseline levels of smoking by the 6-week follow-up. The rapid smoking and hypnosis groups did not differ from the control group in smoking rates at treatment termination or at the 6-week follow-up. They also did not differ from the control group in the number of Ss abstaining from smoking by treatment termination but did differ at follow-up. Eventually, at the 9-month follow-up, only Ss from the group rapid smoking condition had significantly more abstainers than the control group. The results suggested that rapid smoking can work as effectively in group procedures as previous individualized approaches had demonstrated. Group hypnosis, while less effective than some previous individualized approaches had indicated, was nevertheless only marginally less effective than the group rapid smoking procedure. The use of abstinence rates as opposed to average rates of smoking was strongly recommended as the best measure of treatment effectiveness for future research in this area.

1976

Watkins, Helen H. (1976). Hypnosis and smoking: A five session approach.International Journal of Clinical and Experimental Hypnosis, 24, 381-390.

An individualized method of treatment aimed at the reduction of smoking is described which is based on a study of the motivations of each client. Specialized suggestions and specifically-tailored fantasies are then initiated to undermine rationalizations and reinforce the person's commitment to stop smoking. A number of different techniques are mobilized within a hypnotic, "concentation-relaxaton" approach and are combined with behavior therapy procedures to achieve strong counter-motivations to smoking. 78% of those who finished the program stopped smoking, and 67% were still not smoking at the end of 6 months. The individuals who were most resistant to the treatment appeared to be those who were using smoking as a way of controlling anger.

1975

Mullen, G.; Perry, C. (1975). The effects of hypnotic susceptibility on reducing smoking behavior treated by a hypnotic technique. Journal of Clinical Psychology, 31, 498-505.

In order to examine the relationship between hypnotizability and treatment outcome in which hypnosis is used, 54 people ages 19-47 who undertook to stop smoking were studied. Although it is logical that there should be a relationship, clinical anecdotal material published by people who used hypnosis (Freud, Weitzenhoffer, Lazarus, Sheehan, Orne) suggests that may not be the case. Hypnotic susceptibility was evaluated with a clinical procedure developed by Orne and O'Connell (the DRP). Patients were taught self hypnosis using a brief procedure developed by Herbert Spiegel. Baseline smoking rate and three-month follow-up with postcards mailed every week were employed as measures. Success in the treatment program was defined as a 50% reduction in smoking behavior. After 3 months, 7 people were abstinent, 10 had reduced smoking to criterion level (50%), 16 people had discontinued the investigation, and 21 did not change. Considering only the 15 most and 15 least hypnotizable, 12 of the 15 high susceptibles had reduced smoking by at least 50%, as compared to 5 of the 15 of the low susceptibles. (chi square = 4.88, df = 1, p<.05).

1972

Suedfeld, Peter; Landon, P. Bruce; Pargament, Richard; Epstein, Yakov M. (1972). An experimental attack on smoking (attitude manipulation in restricted environments, III). International Journal of the Addictions, 7 (4), 721-733.

Forty male cigarette smokers were Ss in a study which involved 24 hr of sensory deprivation (SD) and a brief anti-smoking message. On a measure of belief instability (errors in scaling the extremeness of statements about smoking), SD Ss showed more instability than controls; but the scores of Ss who heard the message were about equal, regardless of SD. Agreement with antismoking statements was highest in the SD-no message and message-no SD groups. While the message induced belief instability and attitude change under normal circumstances, it had the opposite effect in SD. This may have been due to the stimulus value of the message and/or to the overt nature of the manipulation attempt. In spite of this, three months later SD Ss (regardless of message) reported smoking significantly less than controls. The results relate the known cognitive effects of SD to its effects on persuasibility, further explore the cognitive uncertainty model of attitude change, and indicate the potential usefulness of SD as a technique for bringing about significant attitudinal and behavioral change.

1970

Dengrove, Edward; Nuland, William; Wright, M. Erik (1970). A single-treatment method to stop smoking using ancillary self-hypnosis: Discussion. [Comment/Discussion] .

NOTES
Discusses H. Spiegel''s (see PA, Vol. 45:Issue 1) smoking treatment method comparing it to behavior therapy and suggesting modifications to treat smokers not responding to the method as described. It is suggested that certain psychological conditions must become active for nonsmoking status to be achieved or maintained including: (a) recognizing the consequences of smoking to be imminent, (b) identifying oneself as a nonsmoker, (c) expecting and wanting to participate in a satisfying future, and (d) adopting a way by which the individual can gain control over smoking. The technique outlined deals with these 4 dynamic aspects and makes a significant contribution to the treatment of the smoker''s problem. (German & Spanish summaries) (PsycINFO Database Record (c) 2003 APA, all rights reserved)

Hall, J. A.; Crasilneck, H. B. (1970). Development of a hypnotic technique for treating chronic cigarette smoking. International Journal of Clinical and Experimental Hypnosis, 18, 283-289.

4 hypnotic sessions were found successful, in the majority of cases, in eliminating cigarette smoking without undersirable substitution symptoms. Patients were strongly motivated by the referring physicians and by various nonhypnotic techniques incorporated into the treatment program. Examples are given of the specific nature of both the hypnotic and the nonhypnotic suggestions employed. (German & Spanish summaries) (PsycINFO Database Record (c) 2002 APA, all rights reserved)

Kline, Milton V. (1970). The use of extended group hypno-therapy sessions in controlling cigarette habituation. International Journal of Clinical and Experimental Hypnosis, 18, 270-282.

Results of the present experimental approach to the treatment of smoking habituation tend to be consistent with the view of smoking habituation as a dependence reaction, parallel to drug addiction, and with the concept that habituation must be examined as a psychosomatic entity. Therapeutic approaches must take into account the psychophysiological characteristics of deprivation behavior. Hypnosis, and particularly extended periods of hypnotherapy involving the reduction and control of deprivation behavior, seems to offer a promising approach to the therapeutic treatment of smoking habituation. (German & Spanish summaries) (17 ref.) (PsycINFO Database Record (c) 2003 APA, all rights reserved)

Nuland, William; Field, Peter B. (1970). Smoking and hypnosis: A systematic approach. International Journal of Clinical and Experimental Hypnosis, 18, 290-306.

Compared 2 methods of helping cigarette smokers stop smoking using 181 patients. After 6 mo., 60% of those treated with an active, personalized approach were not smoking. This approach emphasized: (a) the feedback, under hypnosis, of the S''''s own reasons for quitting, (b) maintaining contact with the S by telephone, (c) use of meditation during hypnosis to obtain individualized motives, and (d) self-hypnosis. Only 25% of Ss were successfully treated by an earlier hypnotic procedure that did not systematically employ these features. (German & Spanish summaries) (PsycINFO Database Record (c) 2003 APA, all rights reserved)

Spiegel, Herbert (1970). A single-treatment method to stop smoking using ancillary self-hypnosis. International Journal of Clinical and Experimental Hypnosis, 18 (4), 235-250.

Discusses the 1st 615 patient-smokers who were treated with a single 45-min session of psychotherapy reinforced by hypnosis. Technique of treatment, including rationale of approach, induction procedure, assessment of hypnotizability, and training instructions to stop smoking are presented in detail. 6-mo follow-up study results are discussed. Of 44% who returned a questionnaire, hard-core smokers stopped for at least 6 mo. Another 20% reduced their smoking to varying degrees. Results of a 1-session treatment compare favorably with, and often are significantly better than, other longer-term methods reported in the literature. It is suggested that every habitual smoker who is motivated to stop be exposed to the impact of this procedure, or its equivalent, so that at least 1 of 5 smokers can be salvaged. (French & Spanish summaries). (PsycINFO Database Record (c) 2003 APA, all rights reserved)

Spiegel, Herbert (1970). A single-treatment method to stop smoking using ancillary self-hypnosis: Final remarks in response to the discussants. International Journal of Clinical and Experimental Hypnosis, 18 (4), 268.

Reexamines the major points of the author''s papers (see PA, Vol. 45:Issue 1) on smoking modification. Data inclusion, therapy length, Ss'' ability to change, and use of multiple therapists and tape recordings as reinforcement are discussed. It is concluded that the method should be used to "sharpen our techniques that we can relatively quickly learn who has the capacity to change for given goals, and then to help evoke the desired change as efficiently as possible." (PsycINFO Database Record (c) 2003 APA, all rights reserved)

1964

Stein, C. (1964). A displacement and reconditioning technique for compulsive smokers. International Journal of Clinical and Experimental Hypnosis, 12 (4), 230-238.

A procedure for reducing total anxiety in chronic smokers while ostensibly directed toward permissive alteration of the smoking pattern is presented. In light trance the motivated patient is taught: (a) elementary respiratory relaxation (natural sigh), (b) displacement of emphasis from inhaling smoke to _exhaling_ clean fresh air, (c) enhancement of satisfaction from other pleasurable factors -- touch, shape, color, aroma, flame, smoke clouds, and taste, (d) to puff, hold smoke in mouth, inhale fresh air through nose and exhale through mouth. In most cases practice in stressing positive qualitative smoking pleasure soon results in automatic quantitative reduction of cigarette consumption. 5 brief case reports are presented.

1956

Hershman, Seymour (1956). Hypnosis and excessive smoking. Keywords: addiction, medical, smoking

NOTES
"Conclusion: Several methods are described wherein psycho-biologic techniques can be used with hypnotic procedures to treat excessive cigarette smoking with relatively permanent results. These techniques include symptom substitution, reeducation, reconditioning, reassurance and persuasion. The use of fantasy evocation, visual imagery, etc. by means of the hypnotic state produces an increase in the patient's responsiveness to therapy.

"Several case histories have been presented to illustrate some of the various techniques and their reactions. These procedures can readily be made available to a vast number of people with gratifying results. It is felt that all professional people in the therapeutic fields should be aware of the excellent use which can be made of hypnosis, and should acquaint themselves with hypnotic techniques in order to utilize them to the best interests of their patients. It is important to note that psychodynamic orientation is essential to the proper utilization of hypnosis and that the training received by the stage entertainer lacks this important element" (p. 29).

SUGGESTION

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

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

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

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

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

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

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

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

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

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

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

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

EEG was recorded monopolarly at frontal (F3, F4), central (C3, C4) and posterior (in the middle of O1-P3-T5 and O2-P4-T6 triangles) derivations during the hypnotic induction of the Stanford Hypnotic Clinical Scale (SHCS) and during performance following suggestions of hypnotic dream and age-regression as expressed in the before-mentioned scale. 10 low-hypnotizable and 9 highly-hypnotizable and right- handed female students participated in one experimental session. Evaluations were Fast- Fourier spectral analyses during the following conditions: waking-rest in eyes-open and eyes-closed condition; early, middle, and late phases of hypnotic induction; rest-hypnosis in eyes closed condition; hypnotic dream and age regression. After spectral analysis of 0 to 44 Hz, the mean spectral amplitude estimates across seven Hz bands (theta 1, 4-6 Hz, theta 2, 6-8 Hz; alpha 1, 8-10 Hz; alpha 2, 10-13 Hz; beta 1, 13-16 Hz; beta 2, 16-20 Hz; beta 3, 20-36 Hz) and the 40-Hz EEG band (36-44 Hz) for each experimental condition were extracted. In eyes-open and -closed conditions in waking and hypnosis highly-hypnotizable subjects produced a greater 40-Hz EEG amplitude than did low hypnotizable subjects at all frontal, central and posterior locations. In the early and middle hypnotic induction highly-hypnotizables displayed a greater amount of beta 3 than did low hypnotizables and this difference was even more pronounced in the left hemisphere. With posterior scalp recordings, during hypnotic dream and age regression, high hypnotizables displayed, as compared with the rest-hypnosis condition, a decrease in alpha 1 and alpha 2 amplitudes. This effect was absent for low hypnotizables. Beta 1, beta 2 and beta 3 amplitudes increased in the left hemisphere during age regression for high hypnotizable; low hypnotizables, in contrast, displayed hemispheric balance across imaginative tasks. High hypnotizables during the hypnotic dream also displayed in the right hemisphere a greater 40-Hz EEG amplitude as compared with the left hemisphere. This difference was even more evident for posterior recording sites. This hemispheric trend was not evidenced for low hypnotizable subjects. Theta power was never a predictor of hypnotic susceptibility, 40-Hz EEG amplitude displayed a very high main effect (p<0.004) for hypnotizability in hypnotic conditions by displaying a greater 40-Hz EEG amplitude in high hypnotizables with respect to lows. NOTES 1:

NOTES
In the Discussion section, the authors indicate that they have no idea why they didn't replicate results of other theta studies, including their own, except maybe due to complex interaction among personality, subject selection, situation-specific factors, and hypnotizability.
They observe that the alpha results conform with previous findings (p. 163). Beta bands were sensitive. Highs showed left-hemisphere prevalence in all beta bands during age regression; they also showed hemispheric balance in the hypnotic dream condition. Beta 3 amplitude was also greater among highs than lows. "among high hypnotizables, beta 3 amplitude in the early hypnotic condition was greater in the left hemisphere as compared to the right and as the hypnotic induction proceeded hemisphere balancing, with reduced beta 3 amplitude, was displayed. This result appears in agreement with the predictions of the neurophysiological model proposed by Gruzelier et al. (1984) and Gruzelier (1988) as well as with other studies in which beta rhythm was found to discriminate performances between high and low hypnotizables (e.g., Meszaros et al., 1986, 1989; Sabourin et al., 1990)" (p. 163-164).
40 Hz amplitude was higher in highs and increased in right hemisphere during the hypnotic dream, especially in posterior areas. "This pattern of hemispheric activation may be interpreted as an expression of the greater right-hemisphere activation and of the release of posterior cortical functions during the hypnotic dream and is compatible with the predictions of the Gruzelier model of hypnosis, however, the results obtained in this study for 40-Hz EEG amplitude failed to reveal an inhibition of the left-hemisphere activity with the progress of the hypnotic induction" (p. 164).
(They note that De Pascalis & Penna, 1990, agreed with the Gruzelier 1988 model: highs in early induction had increase of 40-Hz in both hemispheres, but as induction proceeded they had inhibition of left and increase in right hemisphere activity. In this current experiment, only beta 3 showed the hemispheric trend of Gruzelier's model. They cite other details of current study, p. 164, not consonant with Gruzelier.)
"The 40-Hz EEG rhythm, which according to Sheer (1976) is the physiological representation of focused arousal, appeared to discriminate between differential patterns of high and low hypnotizables. Both during hypnotic induction and during hypnotic dream and age regression highly hypnotizables exhibit greater 40-Hz EEG amplitude with respect to the lows. These findings support the validity of the assumption that hypnosis is characterized by a state of focused attention (Hilgard, 1965) and that 40-Hz EEG activity reflects differential attentional patterns among subjects high and low in hypnotizability. On the basis of these findings it would appear that 40-Hz EEG and beta 3 spectral amplitudes may prove to be useful measures of individual hypnotizability" (p. 164).

1992
Anonymous (1992, May). Studies: Learning can occur while under anesthesia.Daily Breeze (South Bay, Los Angeles County).

NOTES
"Surgical patients can absorb information while they're knocked out, and even learn tips that help with recovery, researchers reported Friday at a symposium on memory and anesthesia.
"Researchers at Papworth Hospital in Cambridge, England, studied 51 cardiac patients, one-third of whom heard a tape of positive 'therapeutic suggestions' during surgery. Another third heard batches of word associations; the rest heard a blank tape.
"Patients who were played the suggestion tape - which told them they were doing well, or wouldn't feel much pain - left the hospital 1 1/2 days earlier on average than other patients.
"Another study, from the University of Arizona College of Medicine, found that surgical patients who heard specific pain-relief suggestions recovered more easily than those hearing vague advice such as, 'Think of being well.'
"'These are still early days to invest in every operating suite buying a tape recorder to play for the patients,' said Dr. Sunit Ghosh, a researcher with the Papworth team. 'But this definitely does hold promise.'
"Scholars at the second annual Symposium on Memory and Awareness in Anesthesia said patients rarely wake up recalling - unprompted - something that happened during anesthesia.
"But several studies showed subconscious learning while the patients were out cold.
"Not everyone accepted the findings.
"'It shows an enormous sensitivity on the part of the brain, if it can be shown,' said Eugene Winograd, an Emory University psychologist and organizer of the Emory- sponsored conference. 'I'm not confident it has been shown yet.'
"Some researchers in other studies found no association between messages heard during anesthesia and learning.
"Dr. Alan Aitkenhead, professor of anesthesia at the University of Nottingham in England, found no significant difference between patients who heard recuperative suggestions and patients who were treated to a deliberately dull history of the hospital where they were.
"Aitkenhead said his study kept all patients quite deeply anesthetized, and that may be why they might not have learned as much as patients in other studies.
"'By far, most likely, it's a difference in levels of anesthesia,' he said.
"The Papworth researchers, in another study, found that some patients showed strong word associations after hearing tapes of groups of words during surgery; but other patients under a different anesthesia didn't.
"'There needs to be standardization of our testing,' Ghosh said. 'I think it's partly related to the anesthesia technique and partly related to the way in which material is presented to the patient.'
"Dr. Peter Sebel, an Emory anesthesiologist and conference organizer, said that if patients can retain information about a speedy recovery, they probably retain other information, too - for example, a surgeon's discouraging operating-room assessment of their prognosis."

1991
Burish, Thomas G.; Snyder, Susan L.; Jenkins, Richard A. (1991). Preparing patients for cancer chemotherapy: Effect of coping preparation and relaxation interventions. Journal of Consulting and Clinical Psychology, 59 (4), 518-525.

60 cancer chemotherapy patients were randomly assigned to 1 of 4 treatments: (a) relaxation training with guided relaxation imagery (RT), (b) general coping preparation package (PREP), (c) both RT and PREP, or (d) routine clinic treatment only. All patients were assessed on self-report, nurse observation, family observation, and physiological measures and were followed for 5 sequential chemotherapy treatments. Results indicate that the PREP intervention increased patients' knowledge of the disease and its treatment, reduced anticipatory side effects, reduced negative affect, and improved general coping. RT patients showed some decrease in negative affect and vomiting, but not as great as in past studies. The data suggest that relatively simple, 1-session coping preparation intervention can reduce many different types of distress associated with cancer chemotherapy and may be more effective than often-used behavioral relaxation procedures.

DeKoninck, J.; Brunette, R. (1991). Presleep suggestion related to a phobic object: Successful manipulation of reported dream affect. Journal of General Psychology, 118, 185-200.

When compared with subjects who received presleep suggestions for negative affect, subjects who received positive affect suggestions had significantly higher levels of positive emotions in their dreams, rated their own dreams as more pleasant, and had significantly lower levels of anxiety, sadness, and aggression. This supports the hypothesis that presleep suggestion can be an effective technique in influencing the affective dimension of the dream.

1990
Barber, Theodore Xenophon (1990, August). Some things I've learned about hypnosis after 37 years. [Audiotape] Presented at the annual meeting of the American Psychological Association, Boston.

NOTES
"We are a unity of cells. Every cell is a citizen with it's own jobs, communicating all the time; cells send messages; the way we communicate with them is by suggestions. Each _cell_ is a mind-body.... When I do it now [hypnotic inductions], I say, 'We're going to go into hypnosis, we're _both_ going to go into hypnosis. I'm going to close my eyes (etc.)' - modeling hypnosis for them."
Biasutti, M. (1990). Music ability and altered states of consciousness: An experimental study. International Journal of Psychosomatics, 37, 82-85.
The relationship between music and altered states of consciousness was studied with 30 subjects divided into hypnosis and control groups. The "Test di abilita musicale" was applied. The hypnosis group did the retest after posthypnotic suggestions and the second in waking conditions. The hypnosis group had better results than the control group, especially in the rhythm test (p < 0.0001).

1989
Baker, Elgan L.; Levitt, Eugene E. (1989). The hypnotic relationship: An investigation of compliance and resistance. International Journal of Clinical and Experimental Hypnosis, 37, 145-153.

The purpose of this investigation was to assess the ability of hypnotic Ss to voluntarily resist a neutral suggestion when a monetary reward was offered for resistance. 19 of 40 Ss (47.5%) successfully resisted after money was offered by the "resistance instructor." The correlation between resistance/compliance and hypnotizability was -.44 (high hypnotizables were more likely to comply). Ss' impressions of the hypnotist tended to be positive; impressions of the resistance instructor tended to be neutral. There was a tendency for nonresistors to have a more positive view of the hypnotist but it is not as marked as was found in an earlier study (Levitt & Baker, 1983).

NOTES
Twelve (75%) of the high hypnotizables did not resist; two (16.7%) of the low hypnotizable Ss did not resist.
In their discussion, they state that "these data support the conclusion that hypnotizability or talent accounts for a significant portion of the variance in determining compliance with suggestions during trance. ... [Further], this research may be conceptualized as examining the contributions of a trait variable (hypnotizability) as compared with a variety of situational or state variables (motivation, social perception, environmental contingencies) in determining compliance and suggestibility. Inherent in this model of research is the assumption that many observed hypnotic phenomena (such as suggestibility) are interactive in nature, representing the outcome of the interplay between trait and state variables and between historically determined and contemporary forces. Such a perspective is consistent with the emerging view of trance behavior and experience and validly parallels the phenomenology of experimental and clinical hypnosis which describe both consistency and variability in hypnotic responsiveness for a specific subject or patient across varying conditions and time" (p. 151).
"This study also serves to clarify the important role of positive social perception and a positive sense of alliance with the hypnotist as a correlate of compliance with suggestion. It is clear that Ss who complied despite inducements to resist reported a more positive perception of the hypnotist and a more gratifying sense of relatedness with him than did their counterparts who resisted in response to financial inducement. These data do not indicate whether the positive perceptions contributed to compliance, as transference theories of trance involvement would predict, or whether they were consolidated after the fact due to other variables such as management of potential cognitive dissonance. It does seem reasonable to conclude, however, that the relationship is influential in the process of suggestibility and compliance" (p. 151).

1988
Azuma, Nagato; Stevenson, Ian (1988). 'Psychic surgery' in the Philippines as a form of group hypnosis. American Journal of Clinical Hypnosis, 31, 61-67.

Psychic surgeons and their patients were observed in the Philippines during a variety of procedures of 'minor surgery.' In six cases, subcutaneous tissues (cysts and benign tumors) were removed. Histological examination confirmed the gross diagnoses and left no doubt that the skin had been penetrated. Although the psychic surgeons used no analgesics or anesthetics, the patients appeared to experience little or no pain and only slight bleeding. The authors believe that a supportive group 'atmosphere' enables the patients to enter a quasi-hypnotic state that reduces pain and facilitates healing.

Council, James R.; Loge, D. (1988). Suggestibility and confidence in false perceptions: A pilot study. British Journal of Experimental and Clinical Hypnosis, 5, 95-98.

Subjects received audiotaped instructions implying that they would perceive increases in odor or heaviness while comparing stimuli in a sensory-judgment task. Stimuli were actually indiscriminable. Subjects pretested as higher or lower in hypnotizability performed the task in either hypnotic or non-hypnotic conditions. In both treatments, greater hypnotizability was associated with more perceived changes in the stimuli and greater confidence in the reality of those perceptions. Results support a general factor underlying suggestibility in hypnotic and nonhypnotic situations. The findings are discussed in relationship to false confidence effects reported in hypermnesia research.

1986
Chertok, Leon (1986). Psychotherapeutic transference, suggestibility.Psychotherapy, 23 (4), 563-569.

Discusses suggestion in psychotherapy and defines it as a body-affective process, an indissociable psychosociobiological entity that acts at an archaic unconscious level far beyond that of transference, mediates the influence of one individual on another, and is capable of producing manifest psychological and physiological changes. Present in all types of therapy, indirect (nondeliberate, nonintentional) suggestion is the element that plays an important role in change and can be observed in hypnotic experimentation. It is further argued that transference and suggestion are phenomena that do not altogether overlap. Suggestion is the condition of transference without which transference could not be established.

1985
Bennett, Henry L.; Davis, H. S.; Giannini, Jeffrey A. (1985). Non-verbal response to intraoperative conversation. British Journal of Anesthesiology, 57, 174-179.

In a double-blind study, 33 patients (herniorraphy, cholecystectomy and orthopedic) were randomly assigned to either suggestion or control groups. Under known clinical levels of nitrous oxide and enflurane or halothane anesthesia, suggestion patients were exposed to statements of the importance of touching their ear during a postoperative interview. Compared with controls, suggestion patients did touch their ear (tetrachoric correlation 0.61, P <0.02). test, U (Mann-Whitney frequently more so did they and

Bolocofsky, David N.; Spinler, Dwayne; Coulthard-Morris, Linda (1985). Effectiveness of hypnosis as an adjunct to behavioral weight management.Journal of Clinical Psychology, 41 (1), 35-41.

109 17-67 year olds completed a behavioral treatment for weight management either with or without the addition of hypnosis. Results show that, at the end of the 9-week program, both interventions resulted in significant weight reduction. However, at 8-month and 2-year follow-ups, the hypnosis Ss showed significant additional weight loss, while those in the behavioral-treatment-only group exhibited little further change. More Ss who used hypnosis also achieved and maintained their personal weight goals. It is suggested that hypnosis may have been an effective motivator for Ss to continue practicing the more adaptive eating behaviors acquired during treatment. Findings support the utility of employing hypnosis as an adjunct to a behavioral weight management program. (25 ref)

1984
Bryant-Tuckett, Rose; Silverman, Lloyd H. (1984). Effects of the subliminal stimulation of symbiotic fantasies on the academic performance of emotionally handicapped students. Journal of Counseling Psychology, 31 (3), 295-305.

Divided 64 10.8 - 19.3 yr old emotionally disturbed residents of a treatment school into an experimental and control group matched for age, IQ, and reading ability. Both groups were seen 5 times/week for 6 weeks for tachistoscopic exposures of a subliminal stimulus. The stimulus for the experimental group was the phrase, "Mommy and I are one," conceived of as activating symbiotic fantasies that in a number of previous studies with varying groups of Ss had led to greater adaptive behavior. The control group was exposed to the phrase, "People are walking." Results show that experimental Ss manifested significantly greater improvement on theCalifornia Achievement Tests-- Reading than did the controls. On 5 of 6 secondary variables--arithmetic achievement, self-concept, the handing in of homework assignments, independent classroom functioning, and self-imposed limits on TV viewing--the experimental Ss showed better adaptive functioning. It is suggested that activation of unconscious symbiotic fantasies can increase the effectiveness of counseling and teaching. (42 ref)
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.

1983
Borgeat, Francois; Goulet, Jean (1983). Psychophysiological changes following auditory subliminal suggestions for activation and deactivation. Perceptual and Motor Skills, 56, 759-766.

This study was to measure eventual psychophysiological changes resulting from auditory subliminal activation or deactivation suggestions. 18 subjects were alternately exposed to a control situation and to 25-dB activating and deactivating suggestions masked by a 40-dB white noise. Physiological measures (EMG, heart rate, skin-conductance levels and responses, and skin temperature) were recorded while subjects listened passively to the suggestions, during a stressing task that followed and after that task. Multi-variate analysis of variance showed a significant effect of the activation subliminal suggestions during and following the stressing task. This result is discussed as indicating effects of consciously unrecognized perceptions on psycho- physiological responses.

Classen, Wilhelm; Feingold, Ernest; Netter, Petra (1983). Influence of sensory suggestibility on treatment outcome in headache patients. Neuropsychobiology, 10, 44-47.

In 45 headache patients the relationship between sensory suggestibility and three measures of treatment effect-ratings on (1) intensity of headaches; (2) efficacy of drugs, and (3) physician's competence - was investigated in a double-blind long-term crossover study. Subjects scoring high on sensory suggestibility clearly showed more relief of headaches upon the analgesic as well as upon the placebo. The physician's competence was rated higher by high-suggestible patients, whereas ratings on drug efficacy were low in all patients. The seemingly controversial behavior of high-suggestible patients was interpreted as a call for continuation of the physician's efforts in spite of the relief the patients already achieved.

1982
Belicki, Kathryn; Bowers, Patricia (1982, October). Dimensions of dissociative processing, absorption and dream change following a presleep instruction. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Indianapolis, IN.

NOTES
Subjects' tendency to have things pop into their mind when asked to imagine, image them, or to do a divergent thinking task is correlated with behavior change out of awareness (dissociated), change in dream content in response to indirect suggestion - the request to pay attention to a certain element in their dreams. Effortless imagining (as opposed to working at it), a particular type of dissociative phenomenon, is associated with dream change.

Bowers, Patricia G. (1982). The classic suggestion effect: Relationships with scales of hypnotizability, effortless experiencing, and imagery vividness. International Journal of Clinical and Experimental Hypnosis, 30 (3), 270-279.

How well the Stanford Hypnotic Susceptibility Scales assess what Weitzenhoffer (1978) terms the "classic suggestion effect" is addressed by developing an index of nonvolitional behavior (N-VB) for a group form of the Stanford Hypnotic Susceptibility Scale, Form C of Weitzenhoffer and Hilgard (1962) given to 43 Ss. The N- VB index, reflecting the classic suggestion effect's dual criteria of both behavioral responsiveness to suggestion and nonvolition ratings, was correlated highly with the traditional scoring of the group SHSS:C and moderately with the Harvard Group Scale of Hypnotic Susceptibility, Form A. Effortless experiencing of imagination and imagery vividness relate similarly to traditional and N-VB scores of hypnotizability. In addition, the relationship between involuntary ratings and passing and failing an item of the group SHSS:C was examined for each of the 10 items. There was a significant relationship for 7 of the items.

1980
Bauer, Herbert; Berner, Peter; Steinringer, Hermann; Stacher, Georg (1980). Effects of hypnotic suggestions of sensory change on event-related cortical slow potential shifts. Archiv fur Psychologie, 133 (3), 161-169.

"The purpose of this study was to evaluate whether cortical slow potentials related to a S1-S2 paradigm are influenced by hypnotic suggestions of sensory change. Five healthy subjects susceptible to hypnosis participated each in two identical experiments with three conditions. In condition (1) and (2) each three intensities of 800 and 4000 Hz tones were presented. Preceding condition (2) hypnosis was induced and the subjects received the suggestion to hear the 800 but not the 4000 Hz tones. In condition (3), the tones were presented as S1 and a flash as S2. The subjects received the same suggestions as in (2) and a motor response to S2 was required. EEG was recorded from Cz. In (1) 800 and 4000 Hz tones caused negativities of equal amplitude, in (2) only minute negativities developed, possibly due to hypnosis induced deactivation. In (3) the S1-S2 related negativities were significantly smaller in amplitude during 4000 Hz tones than during 800 Hz tones, while the negativities preceding S2 differed only after the most intense S1. Hypnotic suggestions attenuate S1-S2 related negative potentials, possibly by affecting cognitive functions.

1979
Barber, Joseph; Donaldson, David; Ramras, Susan; Allen, Gerald D. (1979). The relationship between nitrous oxide conscious sedation and the hypnotic state.Journal of the American Dental Association, 99, 624-626.

NOTES
Nitrous oxide-oxygen produces a state of consciousness in the patient that is reported to be similar to the hypnotic state. In this investigation, the authors test the hypothesis that nitrous oxide-oxygen heightens a patient's responsiveness.
This study apparently did not have a control group receiving nitrous oxide but no suggestions, to evaluate the amnesia and analgesic effects of the drug alone.

1978
Connors, J. R.; Sheehan, P. W. (1978). The influence of control comparison tasks and between-versus within-subjects effects in hypnotic responsivity. International Journal of Clinical and Experimental Hypnosis, 26, 104-122.

Type of experimental design (between- versus within-subjects) and type of control task were examined for their differential effects on the magnitude of objective and state report test scores associated wtih response to items on the Stanford Hypnotic Scale of Susceptibility, Form C (Weitzenhoffer & Hilgard, 1962). In an integrated program of work exploring design effects in hypnotic research, Ss in each of 7 comparison conditions that involved hypnosis and 4 separate comparison conditions that did not involve hypnosis were tested twice on successive occasions. Three of the control tasks used (waking, imagination, and imagination [alert] instruction) were counterbalanced with hypnosis to analoyze possible order effects associated with hypnotic test conditions. Data indexed the patterns of between- versus within-subjects effects associated wtih standard control tasks and also highlighted the order effects that accompanied them. Imagination instructions, in particular, pose specific difficulties that require attention when Ss are tested as their own controls.

1977
Anderson, J. W. (1977). Defensive maneuvers in two incidents involving the Chevreul pendulum: A clinical note. International Journal of Clinical and Experimental Hypnosis, 25, 4-6.

NOTES
"Hypnosis frequently facilitates increased access to the unconscious. In both of these cases, the hypnotized subject gained contact with a thought which otherwise would likely have remained out of awareness. Then the ego quickly resorted to defensive maneuvers in order to deny the thought" (p. 6).

1976
Chaves, John F.; Barber, Theodore Xenophon (1976). Hypnotic procedures and surgery: A critical analysis with applications to 'acupuncture analgesia'. American Journal of Clinical Hypnosis, 18 (4), 217-236.

Although hypnotic procedures are useful for reducing the anxiety of surgery and helping patients tolerate surgery, they do not consistently eliminate pain. Six factors that are part of or associated with hypnotic procedures help patients tolerate surgery. These factors pertain to patient selection, the patient-physician relationship, the preoperative 'education' of the patient, the adjunctive use of drugs, and the use of suggestions of analgesia and distraction. It appears that the same factors account for the apparent successes of 'acupuncture analgesia' as well. A frequently-overlooked fact, that most internal tissues and organs of the body do not hurt when they are cut by the surgeon's scalpel, is also important in understanding how surgery can be performed with either 'hypnoanesthesia' or 'acupuncture analgesia.'

1975
Barber, Theodore Xenophon (1975). Responding to 'hypnotic' suggestions: An introspective report. American Journal of Clinical Hypnosis, 18 (1), 6-22.

The author first presents an introspective report which describes some of his attitudes, motivations, and expectancies and ongoing thought processes while he is responding to 'hypnotic' suggestions. The introspective report indicates that (a) suggested effects are experienced when a person thinks with and imaginatively focuses on those things that are suggested and (b) a person imaginatively focuses on the suggestions when he sees the test situation as useful and worthwhile and when he wants to and expects to experience those things that are suggested. It is then argued that the responsive subject in a hypnotic situation differs in every important respect from the sleepwalker and closely resembles the person who is involved in reading an interesting novel or in observing an interesting motion picture. Finally, the author outlines a course, now being developed, that aims to teach individuals how to respond to suggestions.

1974
Chaves, John F.; Barber, Theodore Xenophon (1974). Acupuncture analgesia: A six-factor theory. Psychoenergetic Systems, 1, 11-21.

The dramatic successes claimed for acupuncture suggest that Western medicine has failed to identify important factors that pertain to the nature of pain and its control. This may not be the case, as there are at least six factors which are often overlooked by writers describing the absence of pain (i.e., analgesia) during acupuncture: (a) the patients accepted for surgery under acupuncture usually believe that it will work, (b) drugs are frequently used in combination with acupuncture, (c) the pain associated with surgical procedures is less than is generally assumed, (d) the patients are prepared in special ways for surgery under acupuncture, (e) the acupuncture needles distract the patient from the pain of surgery and, (f) suggestions for pain relief are present in acupuncture treatment. It is concluded that more research is needed to determine whether additional factors are needed to help explain the phenomenon of acupuncture analgesia.

1973
Brown, H. Alan (1973). Role of expectancy manipulation in systematic desensitization. Journal of Consulting and Clinical Psychology, 41 (3), 405-411.

Expectancy, relaxation, and hierarchy content were manipulated in a 2X2 factorial design with two additional control groups. It was hypothesized that a major portion of therapeutic change following desensitization could be accounted for by the subjects' responses to positive feedback inherent in the paradigm. Spider-phobic subjects saw either photographs of spiders or blank slides that they believed to be tachistoscopically presented pictures of spiders. In the factorial part of the design, half of the subjects believed their progress through the hierarchy to be contingent on autonomic responses; the others believed rate of progress to be random. Findings did not support the hypothesis that expectancy was the only factor in desensitization, but they did serve to clarify the role of expectancy vis-a-vis the counterconditioning elements typically discussed in the literature.

1972
Barber, Theodore Xenophon; de Moor, Wilfried (1972). A theory of hypnotic induction procedures. American Journal of Clinical Hypnosis, 15 (2), 112-135.

The first part of the paper delineates nine variables in hypnotic induction procedures that give rise to heightened responsiveness to test-suggestions: (a) defining the situation as hypnosis; (b) removing fears and misconceptions; (c) securing cooperation; (d) asking the subject to keep his eyes closed; (e) suggesting relaxation, sleep, and hypnosis; (f) maximizing the phrasing and vocal characteristics of suggestions; (g) coupling suggestions with naturally-occurring events; (h) stimulating goal-directed imagining; and (i) preventing or reinterpreting the failure of suggestions. Data are presented to support the theory that the nine variables augment responsiveness to test-suggestions by giving rise to positive attitudes, motivations, and expectancies which, in turn, tend to produce a willingness to think with and vividly imagine those things that are suggested. The second part of the paper specifies situational variables and variables involved in induction procedures that produce a trance-like appearance, changes in body feelings, and reports of having been hypnotized.
Bowers, Kenneth S.; Kelly, P. (1970). Stress, disease, psychotherapy, and hypnosis. Journal of Abnormal Psychology, 490-505.
Presents evidence for the importance of suggestion and hypnotic ability in the healing or amelioration of various somatic disorders. It is argued that even in some treatment interventions that are not explicitly hypnotic, suggestion and hypnotic ability may be hidden factors that help to promote successful healing. Consequently, hypnotic ability may be an individual difference variable that influences treatment outcome in a manner not heretofore recognized by many investigators and clinicians involved in helping the psychologically and physically ill.

Bartlett, Edmund E.; Faw, Terry T.; Liebert, Robert M. (1967). The effects of suggestions of alertness in hypnosis on pupillary response: Report on a single subject. International Journal of Clinical and Experimental Hypnosis, 15 (4), 189-192.

THE PUPIL SIZE OF A SINGLE S WAS RECORDED UNDER 2 TYPES OF HYPNOTIC SUGGESTION: ALERTNESS INSTRUCTIONS AND TRADITIONAL RELAXATION INSTRUCTIONS. IT WAS FOUND THAT THE SIZE OF THE PUPIL INCREASED SIGNIFICANTLY UNDER ALERTNESS INSTRUCTIONS. THIS RESULT WAS TAKEN AS FURTHER CORROBORATION OF THE HYPOTHESIS THAT CHANGES IN VARIOUS PARAMETERS OF AROUSAL APPARENTLY ASSOCIATED WITH HYPNOSIS MAY BE ATTRIBUTED TO SPECIFIABLE CHARACTERISTICS OF THE INSTRUCTIONS USED RATHER THAN TO STABLE CHARACTERISTICS OF THE "STATE" OF HYPNOSIS. (PsycINFO Database Record (c) 2002 APA, all rights reserved)

1965
Agosti, E.; Camerota, G. (1965). Some effects of hypnotic suggestion on respiratory function. International Journal of Clinical and Experimental Hypnosis, 13 (3), 149-157.

Several respiratory indices were measured in 10 Ss in 3 states: at rest, with hypnotic suggestion of relaxation, and with hypnotic instructions to imagine muscular work. The same suggestions were given to 10 control Ss in the waking state. The suggestion of relaxation produced a decrease in pulmonary ventilation in both groups, although it was substantial only in the hypnotic group which started from a higher baseline level. The imagined work produced an increase in ventilation, especially in the hypnotic group. However, in both instances because of compensatory changes in respiratory efficiency the actual uptake of oxygen remained almost unaffected. (PsycINFO Database Record (c) 2002 APA, all rights reserved)

Barber, Theodore Xenophon (1965). Physiological effects of 'hypnotic suggestions': A critical review of recent research (1960-64). Psychological Bulletin, 201-222.

Recent studies are reviewed which were concerned with the effectiveness of suggestions given under "hypnosis" and "waking" experimental treatments in alleviating allergies, ichthyosis, myopia, and other conditions and in eliciting deafness, blindness, hallucinations, analgesia, cardiac acceleration and deceleration, emotional responses, urine secretion to sham water ingestion, narcotic-like drug effects, and other phenomena. The review indicates that a wide variety of physiological functions can be influenced by suggestions administered under either hypnosis or waking experimental treatments, and direct and indirect suggestions to show the particular physiological manifestations are crucial variables in producing the effects.

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

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

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

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

Black, Stephen (1964). Mind and body. London: Kimber.

NOTES
Defines psychosomatic disease as one that responds to psychotherapy. Believes only 5% are highly hypnotizable, that hypnosis is learnable in 1/2 hour, that hypnosis is not a useful treatment for psychosomatic disorders because you can't use interpretation [of unconscious]. The 'unconscious' is "... a complex of informational systems derived from such primaeval mechanisms" (p. 133). "Primaeval mind is involved in these mechanisms of genetics and immunology" (p. 133). "There is thus a 'somatic mind' which is unconscious and presumably without any means of verbalization of experience--and a 'cerebral mind' which is conscious" (p. 133). The dividing line is not clear.
Rapport is discussed on pp. 160, 169 as one of the spontaneous characteristics of hypnosis, in the absence of suggestion. The same for posthypnotic suggestion (rapport and amnesia). Spontaneous _physiological_ changes in hypnosis relate to mind-body relationships (p. 169)
Conditioned reflex is discussed on p. 161
"...the subjective evidence indicates that a perceptual change involving any sensory modality can be produced by DSUH" [direct suggestion under hypnosis] p. 178. Suggestion can selectively affect different parts of the body p. 197.
Research: "Hypnosis is not only the most important and practical way of _proving_ the existence of the unconscious--which is still in doubt in some circles--but is in fact the only way in which unconscious mechanisms can be manipulated under repeatable experimental conditions for purposes of investigation" (p. 152).
Mind-body is "amenability to control" Catatonia, which characterizes both animal and human hypnosis, seen in hypnosis, is induced by constriction (i.e. disorientation). The Cartesian concept of mind and body tends to confuse the issue p. 157.
Rapport is discussed (p. 157).
Suggestion (p. 159) "It was this concept of 'suggestion'--which so obviously parallels 'amenability to control' in animals--that eventually established hypnosis in the French schools of psychiatry as a state of increased suggestibility. ... still the standard definition of hypnosis in most medical psychiatric textbooks and in lay dictionaries" (p. 159).
Black (1969) did some biochemical sleuthing to learn how information transmitted by words becomes information encoded somatically, as when psychosomatic allergies flare and recede or disappear. What accounts for suggestion "curing" an allergic skin reaction in one part of the body while another part not included in the suggestion remains reactive? What accounts for the instantaneous skin allergy cure which sometimes occurs with suggestion (in 24 hours)?
Skin sensitivity tests in highly hypnotizable Ss who were also very allergic were inhibited by direct suggestion under hypnosis under highly controlled experimental conditions--and in one subject the effect (inhibition) was relatively permanent--ruling out (he suggests) a neurological mechanism. He did further experiments to examine whether the result was due to an instant neurological mechanism and a long-term endocrinal mechanism.
p. 212 He ruled out peripheral blood flow as the cause of diminished skin sensitivity (there was no change in blood flow with suggestions of heat or cold). Therefore decrease in blood flow couldn't explain in neurovascular terms the 'instant' inhibition of skin sensitivity (allergy) tests. Was it due to systemic--especially adrenal-- changes? He demonstrated increases in plasma cortisol under hypnosis with suggestions of fear. On p. 230 he summarizes the facts he established by skin sensitivity tests, plasma- cortisol studies, and histology - endocrinological.

Black, Stephen; Edholm, O. G.; Fox, R. H.; Kidd, D. J. (1963). The effect of suggestion under hypnosis on the peripheral circulation in man. Clinical Science, 26, 223-230.

Summary.
1. The effects on the circulation in the forearm and hand of both direct and indirect suggestion under hypnosis of thermal stimuli have been studied. 2. The induction of hypnosis did not significantly alter the forearm blood flow, but a small reduction in hand blood flow was usually observed. Pulse rate in general slowed slightly as did respiration rate. 3. The effect of body heating on forearm and hand blood flow was not modified by hypnosis. 4. Direct suggestion under hypnosis of body heating or body cooling, with and without body heating, produced only small changes. 5. The changes associated with suggestion were not related to the thermal suggestion. Whatever the suggestion, the usual response was a reduction in hand blood flow and an increase in forearm blood flow. 6. The rise of body temperature with heating was not modified by direct suggestion, under hypnosis, of body cooling. 7. No change in body temperature could be elicited by suggestion. 8. In a few experiments marked changes in forearm blood flow occurred. These appeared to resemble the changes in the circulation produced by emotional stimuli. 9. The smaller changes more frequently observed were also similar to those produced by mild emotional stimuli" (p. 229). [N.B. The Subjects were normal, healthy adults, N = 9, between 21-45 years old; highly hypnotizable, amnesic for trance.]

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

Observation that student subjects often go into a deeper level of hypnosis after suggestions have been given for ending the session has led the writer to explore the reactions of subjects to this phenomenon and to set up a simple experiment using ideomotor responses in ten gynecological patients who needed hypnosis for therapy. In each of the ten patients there was a deepening of the trance after the suggestion to awaken had been given. It was the opinion of the subjects that they deepened the trance in rebellion against the direction for terminating a pleasant experience" (p. 227).

1956
Barber, Theodore Xenophon (1956). 'Sleep' and 'hypnosis': A reappraisal. Journal of Clinical and Experimental Hypnosis, 4, 141-159.

NOTES
"Some recent experiments and a reevaluation of the electroencephalographic findings indicate that the term 'hypnosis' has subsumed at least two more or less distinct phenomena: (a) 'hypnosis' preceded by 'trance-inducing suggestions' which is closely related to 'light sleep' and (b) 'hypnosis' without 'trance-inducing suggestions' which is often a 'waking' state.
"From this viewpoint we can begin to reevaluate the contradictory physiological experiments comparing sleep and hypnosis, the most favorable conditions for producing hypnosis, amnesia and decreased suggestibility in very deep hypnosis, and the reports of waking and sleeping hypnosis. We can also reappraise such thorny problems in hypnotic theory as the production of hypnosis by artificial means, autohypnosis, and animal hypnosis.
"The argument presented calls for further research. We should investigate (a) suggestibility during extreme relaxation; (b) response on hypnotic tests when the subject is told, "Go to sleep and I'll be back later to give you some tests'; (c) deep trance phenomena during sleep; (d) hypnotizability of good sleepers and insomniacs; (e) beneficial suggestions during sleep; (f) physiological functions during 'light sleep' and hypnosis; (g) the response of 'sleep-walkers' to standard hypnotic tests; (h) the relationship of 'light sleep' dreams to hypnotically induced dreams; and (i) the relationship of sleep amnesia to hypnotic amnesia" (pp. 153-154).

RECESSION DEPRESSION - recent publications on the psychological effects of the global recession

2011-12-14T06:34:00.001-08:00

With the global economy in further decline it is up to those of us in the healing profession to help society deal with the psychological effects of debt, unemployment, fear, depression, anxiety, stress, and the many other symptoms that have become all the more common in recent times. As Hypnotherapists we can promote our therapy as the fast, effective modality with which the recession hit client can get relief from the stresses of these financial times. The following are articles published recently in Ireland which outline the truth and pain behind the lives of ordinary people living through recession. I would appreciate all feedback from therapists worldwide about how best we can help people to deal with this recession and hopefully make their lives a little brighter amongst all the doom and gloom.

Depression and the Recession

[ www.irishhealth.com]

By Dr Olivia McElwee*

These days it seems that no matter where we look, we are confronted with the doom and gloom of economic recession. Newscasters and front page headlines are, on an almost daily basis, delivering notice of yet more jobs lost. And what can we expect in the near future; more doom and gloom to come, it would seem.
The financial stress on individuals, in addition to the general negativity felt by the wider community, is already having a huge impact on the mental health of our country.

The mental health of a society is based on key certainties, which are eroded in times such as these.
We are faced with endless uncertainty at present; uncertainty in the job sector - gone is the concept of a job for life, uncertainty in our banking sector, concern over energy reserves resulting in fluctuating oil prices, uncertainty over public finances etc.

The media is partly responsible for propagating this uncertainty. The view projected is a negative one and the picture presented is very black and white.

The portrayal and reporting of an economic recession can lower the general mood of the country people are naturally affected on an individual basis too. Taking redundancy as an example; how does losing one’s job affect an individual?

The attainment of basic physical and material needs is essential in order to move forward with the attainment of more complex psychological needs and aspirations.

With that in mind, we can see how redundancy may lead to significant stress. Being made unemployed, is to be cast adrift at sea. An important avenue of social interaction is terminated and there is a huge sense of abandonment and a loss of that sense of belonging.
In addition, in today’s world, people’s sense of identity is very much enmeshed in their work. Their self-esteem and sense of worth is often determined by how successful they are in the workplace.

Now more than ever, what we do is tied up with who we are. People today, of they are lucky enough to still have jobs, work longer hours. One’s occupation has always been important of course. It fulfils a fundamental need and provides us with challenges and a sense of achievement. It also provides routine and a day to day focus.
However, the pursuit of material success has arguably distorted people’s appreciation of real priorities and perhaps the present economic slowdown will encourage a greater reflection and re-evaluation of what is truly important in life.

It is likely that healthcare professionals and in particular GPs will see a rise in the number of people seeking help for symptoms of general stress, anxiety and depression.

We will see the effects of economic stress and unemployment across all age ranges and members of society. In school leavers who cannot find work, it may lead to a retardation of personal growth and a continuation of the dependency faced at school.
In those retired or near retirement, there exists great concern for the future. Many have pensions tied up in shares and have suffered substantial losses in recent times.

How prepared are we as doctors to assist individuals in such distress?

People stressed by the recession may be suffering from adjustment disorder, which is characterised by a variety of clinically significant behavioural or emotional symptoms occurring as a result of a triggering event or stressor. It may be associated with - depressed mood; anxiety; or disturbance of conduct.
This disworder usually occurs within three months of the stressor. The condition may become chronic (lasting more than six months) should the stressor be chronic or the consequences and impact of the initial event be long-lasting.

Making the diagnosis of adjustment disorder is important as these patients generally benefit from some form of counselling. Rapid identification can prompt early psychological intervention that enhances the patient's quality of life or, at the very least, prevents further erosion of his or her ability to function.

Approximately three in ten people suffer from depression, with twice as many women as men presenting with symptoms warranting clinical intervention.

There is no doubt that healthcare professionals will see an increase in the disorder, given that the background social and monetary environment has an impact on the incidence with a link between depression and financial strain and damage to sense of self.

Research suggests that while employment status and financial strain are causally related to depression, income is not. In other words, a low income earner is not by that fact more prone to depression but should financial strain co-exist, his risk would increase.

Not only can the act of being made redundant lead to depression but the cascade of secondary stressors, such as financial insecurity and relationship strain which may follow on from it, can present as much a risk to the mental health of the job seeker as the job loss itself.

Secondary stressors also have an important impact on the mental health of the partner. Some research suggests that when a man loses a job, the associated stresses of unemployment and financial strain are taken on as common burdens by both members of the couple, whereas when a woman loses a job, she may be more likely to face those burdens alone.

There is a potential for drug or alcohol abuse in those with no known documented history, especially in instances of redundancy where drugs and alcohol provide a perceived escape from the reality of the situation.
Cocaine use among Ireland’s middle classes took off hugely during the years of the Celtic tiger. Numerous redundancies are occurring across all socio-economic groups and healthcare professionals should be alert to the fact that individuals may no longer have the same level of income to sustain a costly habit thus a crisis may ensue.

In the Great Depression of the early 1930s, 13 million people in the United States lost their jobs and the income of an average American family dropped by 40% yet the suicide rate only increased from 14 to 17 per 100,000.

We are familiar with stories of bankers jumping to their deaths from their office windows, after sustaining huge losses in the Wall Street Crash of 1929. However few of these stories are based on fact.

Less than twenty Wall Street bankers are thought to have actually committed suicide at work immediately following the Crash and approximately one hundred professionals involved in the stock markets are believed to have taken their own lives.

The majority of the 23,000 Americans who committed suicide in the year following the Crash were ordinary people who suffered indirectly from the financial fallout. Examples would include the farmers who lost their farms, individuals who lost their jobs or savings, and entrepreneurs who lost their businesses.

We must however, be aware of the risk factors for suicide in our patient population. As well as unemployment, other risk factors include male gender, those living alone, divorced or widowed patients, those with a chronic physical illness, those with a previous psychiatric history, those with recent admission to a psychiatric hospital, patients with a history of attempted suicide or self harm in the past and patients who abuse alcohol or drugs.

The approach to the management of a patient presenting with symptoms thought to be related to recent financial strain could incorporate many of the following:

1. Giving general lifestyle and health advice such as taking more exercise, drinking less coffee, getting more sleep, engaging in some form of meditation or relaxation like yoga or listening to classical music. Quitting cigarettes, cutting down on alcohol consumption and following a better diet are not only beneficial from a health point of view but will also save money.

2. Encouraging the patient to see their circumstances as an opportunity rather than a crisis by reframing the situation and identifying the positives.

For example, in a patient made recently unemployed, one could point out that this may be a natural opportunity to pursue something they’ve always wanted to do. It may be a good time to do a course or attend classes in a new subject. Redundancy may provide an opportunity for one’s spouse to spend more time with their family while giving their partner a chance to re-enter the workplace. It offers a natural time for a reality check and a period to prioritise what’s important.

3. It may be helpful to discuss, where a patient interested in retraining, might start to make enquiries - for example Fas Ireland or night courses in the local vocational school or adult learning centre.

4. Referring to local counselling services may be appropriate.

5. Doctors and health professionals can tactfully discuss the role of local charitable organisations such as St. Vincent de Paul or Barnardos.

6. It may also be fitting to advise a patient to contact their local Money Advice and Budgeting Service (MABS). MABS is a national, free, confidential and independent service for people in debt or in danger of getting into debt and a helpline exists.

7. Antidepressant drugs can be prescribed should the doctor feel they are indicated.

8. The healthcare professional needs to assess whether the patient at risk of harming him or herself and should liaise with psychiatric services/crisis intervention services if appropriate.

9. It may be fitting to discuss the option of working abroad, which may be looked upon more favourably as other economies recover more quickly than ours.

10. In these difficult times, we will likely see an increased reliance on parental support. Patients may have a son or daughter whom they are concerned about, and as parents may choose to pass on some of their inheritance to their children at an earlier stage (hoping to alleviate current financial strain) rather than waiting until their death to do so. It may be advisable to suggest consultation with a solicitor in these circumstances.

The goal must be to assist people in difficulty due to the recession in dignified manner using a holistic approach, aiming to prevent crises and emergency psychiatric presentations. Counselling and robust psychological support services will be seen as crucial components in achieving this.

In the midst of this crisis, we must also advocate politically for the retention of essential services , particularly in the area of retraining, not only for the health of patients but to allow them fulfil their potential.

*Olivia McElwee is a GP registar with the TCD/HSE GP training scheme. This article first appeared in 'Forum', the journal of the Irish College of General Practitioners.

'I refuse to let you force my children to walk behind a hearse'

IRISH TIMES 12^th December 2012

Mounting debt and intimidation from the bank brought George Mordaunt to the brink. When he found himself looking at his sleeping son and imagining his own funeral, he decided enough was enough, writes CONOR POPE

GEORGE MORDAUNT’S story starts in the dead of night, with thoughts of suicide. Mounting personal debt he could not hope to pay, aggression and intimidation from one of the State’s main banks and the constant and stressful struggle to keep his Clonmel car dealership afloat in the face of an almost complete collapse in sales had taken him to the brink.

After months of sleepless nights, it all came to a head in a Dublin bank two years ago.

“Save the sob story. We want our money. If that means

taking your family home, we’ll do it,” he was told at a meeting arranged to discuss his mounting debts.

“I was stunned. Couldn’t believe what I was hearing. This banker, playing with words, puffing his chest out in a display of ego and bravado, telling me how ruthless he would be with my home, my livelihood, my life,” he writes in his recently published book Shepherd’s Pie.

That night he lay in bed “feeling nauseous and gripped with fear”. He couldn’t sleep and try as he might he could not think of a way to keep a roof over his family’s head. He couldn’t see a way out. “My heart was pounding so hard I could hear it in my chest, my mind actively replaying the scene in the bank’s boardroom that morning.”

Convinced he was having a heart attack, he got out of bed and started pacing the corridors of his house. He found himself in his eight-year-old son’s room.

“I gazed down at him and thought about another man, my age, who I had known very well. His kids were the same age as mine and he had lost his battle with control and fear one evening.”

That man had taken his own life. He thought to himself that he couldn’t let that happen. “But, bizarrely, I found myself imagining that it had. I sat on the side of my son’s bed and imagined my own funeral, with my son and my daughter walking behind a hearse. I wondered whether I was losing my mind but knew I wasn’t. I allowed the pain of the image to take hold and then something I wasn’t expecting happened.”

He started to feel anger.

“Are you going to let those f**kers deprive these children of their father? Are you going to allow them to attack your family and everything that your family has created? Are you going to let them inside the gates of your home or are you going to meet them head on and tell them to f**k off?”

He decided on the latter.

The following morning Mordaunt called the bank official who had apparently relished playing hardball with him. This time, instead of being cowed he was raging. The conversation was short and to the point.

“Listen to me very carefully,” he said. “I refuse to let you or any other bank force my wife and children to walk behind a hearse, so do your worst but don’t ever call me again.”

The bank in question backed off. They issued credit notes for his outstanding loans “and they disappeared out of my life”.

DURING THE BOOM years Mordaunt was flash, and his Clonmel car dealership was big. He owned four showrooms and was selling 40 new cars a week. As part of his sales patter, he would offer potential buyers free helicopter rides. It was all terribly Celtic Tiger.

Then, in 2008, the economy fell off a cliff and took most of his business with it.

He called his book Shepherd’s Pie because, he says, he recalls coming home from a particularly stressful meeting with the bank in Dublin one winter evening in 2009 and seeing his children eating that meal at his kitchen table. At that moment he became acutely aware that they were utterly dependent on him and he was in the process of letting them down.

He documents, with unflinching honesty, how he nearly lost control and how he regained it. In the introduction to the book, Fergus Finlay, the chief executive of Barnardos, describes it as “the most searingly honest account I’ve read anywhere about what it was like to ride the Tiger – and ultimately to be almost devoured by it”. Finlay says it is “one of the best books you’re ever likely to read about what went wrong in our country and why” but will also show people “how to come out of it all as a better, stronger person”.

He is not wrong.

Mordaunt’s story is little short of riveting and may act as an inspiration to thousands of people and small businesses who feel they have run out of options because of the levels of debt they have built up.

Speaking to Pricewatch last week, he said he had been overwhelmed by the response from readers, many of whom said his fears of being driven to suicide chimed with their own.

He says that throughout the course of the recession people have been infuriated by reports of self-serving bankers, developers and government ministers. But the personal trauma and the devastating effect this crisis has had on small businesses and those trying to keep them afloat has been under-reported, he says.

Prompted by the response to the book and the steady stream of mails from people who say they have been bullied by banks and are close to breaking point, Mordaunt is embarking on something of a crusade. More needs to be done to highlight the fear people feel, he says.

He has a no-nonsense philosophy on dealing with banks and managing debt. He also says debt forgiveness is a reality, despite frequent denials by the banks. For many, he says, it depends on the approach that is taken.

When dealing with banks people need to talk to the right people and prepare carefully, he says. Crucially, they need to show they “haven’t got the ability to pay” their debts by documenting every outgoing and being straight.

“If you’re meeting your repayments but it is destroying every other aspect of your life then you have to stop, but you can’t just stop: you have to demonstrate that you can’t pay,” he says.

He says “the business people of

Ireland

have been treating the bankers with the same respect their parents gave the clergy in the 1950s. We need to play more hardball with them.

“And the bankers need to be conscious of the mental state of the people they are dealing with. Some of the individuals going in will not have eaten in days, won’t have slept and will be incredibly scared. That makes them very vulnerable.”

Mordaunt’s experience and his correspondence with people who have read the book echo comments made by the Master of the High Court, Edmund Honohan, earlier this year. He criticised banks and other creditors for pursuing “to the bitter end” debtors who simply cannot pay, with the objective of writing off debts to achieve a tax benefit. He said that meaningless “accountancy exercises” were causing social disquiet and driving some people to suicide.

His comments are backed up by extensive research. A study published in the Lancet earlier this year found that suicide rates had risen sharply across Europe since the banking crisis, with growing numbers struggling to cope with debt, unemployment and austerity measures.

Ireland

, it said, the problem was particularly acute. It recorded a 13 per cent rise in suicides between 2007 and 2009, a rise it attributed to unmanageable debts and poor prospects for economic recovery.

Speaking when the study was published this summer, Dr David Stuckler, its lead author and a lecturer in sociology at the University of Cambridge, said human beings were “the real tragedy of an economic crisis, so it is terribly frustrating that government leaders have not only failed to invest in programmes that protect people but have actually done the opposite . . . This has been the pattern for three-and-a-half decades, but lessons have not been learnt.”

Mordaunt has learned lessons. He has completely redesigned his business and dumped the new-car sales in favour of selling

imports all over the country and has launched wesourceNEcar.com, which promises to find second-hand cars based on precise requirements.

“I have recovered. I was able to get fresh money. I sorted my head out and I parked my debt. Who wouldn’t recover in those circumstances?”

Now, he says, he wants to help other people come to terms with their situations, too.

Shepherd’s Pie by George Mordaunt is published by Mercier Press

‘ Don’t bottle things up’

THE DIRECTOR of the Samaritans in

Ireland

, Suzanne Costello, says that while recession and economic difficulties heighten the risk of suicide, they do not make it inevitable.

She says that since 2008 one in 10 calls to the organisation in Ireland have been directly related to financial matters but adds that the issue also permeates many other calls. She says that while it is a “complex set of events” that lead people to develop suicidal thoughts, a financial crisis such as the threat of home repossession can be the straw that breaks the camel’s back.

She points out that many of those in severe difficulty as a result of the recession are people, like George Mordaunt, who are in their 30s and 40s and find they are saddled with enormous debts and can’t see any way out of the crisis.

A lot of men, in particular, regard financial weakness as “a huge blow to their self-esteem”, she says, and adds that books like Shepherd’s Pie by Mordaunt, which show someone coming close to the brink but turning things around, can be very positive and empowering. She stresses the need for people to keep communicating with family, friends, a GP or the Samaritans and stresses that it is “very important not to bottle things up”.

SIGNS TO LOOK OUT FOR – Take notice when someone is:

Withdrawn or unsociable

Low-spirited or depressed

Drinking alcohol excessively or becoming dependent on drugs

Finding it difficult to relate to others

Taking less care of themselves

Acting out of character

Tearful or constantly fighting back tears

Being excessively irritable

Finding it hard to concentrate

Feeling less energetic or particularly tired

Eating much less or much more than usual

Putting themselves down (self-mockingly as well as seriously), eg “nobody loves me” or “I’m a waste of space”

The Samaritans can be contacted on 1850 60 90 90 or jo@samaritans.org

‘I’ve buried five friends since January’

By David Raleigh

Tuesday, December 13, 2011

A MAN who lost his fuel business after 20 years has organised a Facebook help page for people struggling to meet mounting financial debt.

Seamus Sherlock, from Feoghanagh, Co Limerick, started the Life after Debt group after five people he knew took their own lives. The 45-year-old firmly believes stress over financial worries played a major part in the deaths of his friends.

"There are too many people taking their own lives and it has to stop. I’m getting up to 30 phonecalls a day from people who are worried about their future. They’re not all suicidal, but some are. I’m not a professional but a lot of these people just want someone to listen to them. A lot of people are lost."

From 7pm to 10pm are Mr Sherlock’s busiest times for taking calls from concerned members of the public who make contact with him through word of mouth and via Facebook .

"Why do I do it? Well, why not. I’m in the same boat as all these people calling me. I’m barely hanging on. I didn’t intend to be doing this, but it has snowballed through word of mouth. If anything, it helps me keep my mind of my own situation. I’m not a professional, I’m just here to listen to people."

He said more than 70% of people contacting him "are working people", but "they don’t have enough money at the end of the month to eat after the bills are paid".

"I know of some people who are watering down their milk, and driving their cars to work and they can’t afford to pay for car tax. These are people who have jobs but they have creditors screaming down the phone at them and they don’t know what to do."

Mr Sherlock, who organised a march in Limerick at the weekend, said: "I’ve buried five friends since January and that’s five too many and I don’t intend to bury five more this year."

This appeared in the printed version of the Irish Examiner Tuesday, December 13, 2011

Read more: http://www.irishexaminer.com/world/kfqlqlauidey/rss2/#ixzz1gWBaAUKx

Suicidal talk must be taken seriously

By Fiachra Ó Cionnaith

Tuesday, December 13, 2011

YOUNG men are much more likely to admit to suicidal thoughts while out drinking with friends — but the remarks are often dismissed as "drunk talk" the following morning.

Research by a major national suicide prevention charity, 3Ts, has found that personal tragedies could be avoided if the seemingly over-stated comments were taken seriously by those who heard them.

The qualitative study, which was conducted between 2007 and 2010, was based on the views of six separate groups compromising 45 young men aged 18-25 and 15 young men aged 15-30 whose friends had recently taken their lives, and 54 families bereaved by the ongoing national crisis.

It found that those in an emotionally distressed state are far more likely to admit their hidden concerns to a person close to them while drinking, increasing the likelihood of the at-risk individual receiving the support they need.

However, despite the admission, the remarks are instead often passed off as "drunk talk" by both parties when they next meet.

"The alcohol context was identified as an important avenue for disclosure of concerns, emotions and suicidal thinking in the friendship of young Irish males.

"But disclosure within this context was also found to reduced perception of risk in the individual," said Dr Lorna Sweeney, the lead author of the study Young Irish Male Perspectives on Depression and Peer Suicide, explained.

Reacting to the research findings, 3Ts chairman Noel Smyth said while the issue offers a vital insight into suicidal behaviour all year round, the lessons to be taken from it are of particular importance in the weeks before and after Christmas.

"The festive season is often a time of increased alcoholic consumption occasions. In light of these findings, we would ask people to be more aware of disclosures or problems shared by friends when drinking together.

"In particular, we would urge that any disclosures involving suicidal thoughts are followed up the next day and considered in a context more seriously than just ‘drunk talk’," he said.

The suicide prevention campaigner added that anyone who is going through a difficult moment, or someone who is concerned for a friend, should contact the free 24-hour 1Life helpline on 1800 247100, which can also be accessed by texting the word "Help" to 51444.

This service, which was set up in late 2009 by Console and the 3Ts, is staffed by counsellors and medical specialists who can offer support for those in crisis.

It has seen a 30% rise in calls in January and February each year so far.

The HSE also offers a suicide prevention helpline, open from 6pm to 10pm, on 1800 742745, and a farm and rural stress helpline, from 6pm to 10pm, on 1800 742 645.

In addition to the main finding, the major qualitative research — the first of its kind in Ireland — also noted a clear "lack of policy documents" on how young male suicides can be tackled in this country, and how this affects their peers.

Dr Sweeney’s study was supported by the Ad Astra Scholarship in Suicide Studies, supported by 1Life and the Suicide Research Programme at UCD’s Vincent’s University Hospital.

Read more: http://www.examiner.ie/ireland/suicidal-talk-must-be-taken-seriously-177086.html#ixzz1gWCBtet8