ac.uk m.heap@sheffield. e-mail: United Kingdom. of Sheffield, Sheffield, , University turer, Department of Lec Honorary * - the same phenomenon. same the theoreticians and practitioners the are describing is oftenthatwide so we may doubtthewhether resented and applied different inthese contexts disparity the whether way inthe is rep clinic. raise basisquestion Ishall the Onthis place, taking notablybe laboratory the and the various contexts hypnosis inwhich is said to historical development of hypnosis and inthe explore significance the afforded eachthe to in identified above two the key componentsbetween of hypnosis ent responsiveness of subject the to . ity or , is which inher the can distinguish afourth component, suggestibil subjectthe into hypnotic the state. Finallyone of is aseries self that directs or guides of hypnosis’, two; the induction the links also it state’. Athird component, namely ‘induction the to suggestions he when or she ahypnotic is ‘in inthat linked to be subject the is more responsive and of use the suggestion. Thetwo are presumed notic trance’ (or ‘altered state of consciousness’) nosis are two key components, namely ‘hyp the Implicit or explicit inmost descriptions of hyp Introduction other contexts hypnosis inwhich isapplied. literature.the academic matters These areaddressedalso bybriefly reference to certain tousing said be clinicianshypnosis be whether can asit in isnowand understood defined applicationcal of hypnosiseven and isinformedevidence by scientific thenon-clinical other. In thispaper it issuggested that there isreason to question how much theclini onresearch theone application hand and and theory thepractical of hypnosis on the neurosciences. Normally there one tocontinuity would be expect experimental between vestigated inthelaboratory interms and understood of mainstream and the psychology we now understand it hypnosis phenomenon isanormal psychological that in be can of and methods thephysicianthe ideas Franz Anton Mesmer Europe. in18thcentury As Hypnosis originated to andback practice its asahealing historical traced roots be can Michael Heap, PhD* Hypnosis?Experimental Hypnosis Clinical Does Have Anything to with Do In paper this Iexamine relationship the —

trance and suggestion 17 ||MBR ||Volume : 1||Issue — and and ------practice, such as bacquet, the mesmerist’s the knowledgement that of central mesmeric aspects In (Heap, summary 2008a)firstthere the was ac Gauld,(see 1992, for acomprehensive history). mesmerism is afascinating and instructive story day evolved and of from ideas methodology the his salons inParis and 80s. 1770s inthe famously group he devised treatment at methods of stupor in eyes. their look Most with a glazed wouldetc). Finallythey appear to enter some kind convulsing, laughing hysterically, shaking, crying, patientsthis, would ‘crises’ experience (swooning, frombody to head the toe. the In response to make slow with his passes hands over patient’s the patient. the heal His preferred technique was to mer claimed ability the to restore and this thus flow of body the andanimal magnetism in Mes associated with disturbances natural inthe tidal eventually ‘animal called magnetism’. Illness was proposed existence the of auniversal force that he Anton that Mesmer Mesmer Recall (1734–1815). and practices of Austrianthe physician Franz directly back to 18 hypnosis, origins of true the traced which can be ourselves of historical the development of modern starting pointA good for is to remind enquiry this modern hypnosis The historicalantecedentsof : 1 How and practice of theory the hypnosis to The Journalof th centuryEurope and ideas the article - - - - -

mbr.synergiesprairies.ca article The Journal of Mind-Body Regulation

passes, and the patients’ crises, were unneces- nosis (or its forerunner, mesmerism) with a key sary for the purposes of treatment. Mental and individual continued throughout much of this physical relaxation became the more characteris- period. However, unlike earlier formulations, the tic response of the patient from the start of the theories and models proposed by these writers procedure. Secondly we see the development of were based on well-controlled laboratory experi- theories based on biological accounts of the hu- ments on normal participants. I refer the reader man nervous system at the time. Later, psycho- to Lynne and Rhue (1991) and Nash and Barnier logical explanations were advanced and verbal (2008) for comprehensive accounts. suggestion became the core feature of hypnosis, Before proceeding, it is important to briefly both procedurally and theoretically. Finally it acquaint the reader unfamiliar with this work was established quite early on that people varied with what a laboratory session of hypnosis may in their responsiveness to hypnosis, only a minor- consist of. Firstly the experimenter will perform ity being very susceptible. a procedure that usually One way of characterising this evolutionary consists of suggestions of mental and physical process is to say that gradually the role of a spe- relaxation and an inner focus of attention (say cial state or trance assumed less significance and on pleasant imagery). Then he or she will ad- the role of suggestion became more pivotal, along minister various suggestions that certain things with . This process in fact occurred are happening to the subjects or that they are in very early on with the investigation by the 1784 certain situations that would, if they were real, Royal Commission of and significantly affect the way they are perceiving, its conclusion that mesmeric phenomena were thinking, feeling and behaving. Examples of sug- attributable to the subject’s imagination (Salas gestions are as follows: that one arm is becoming & Salas, 1996). A later illustration is the resolu- light and will float in the air; that an arm is too tion of the dispute that continued for around 20 heavy for the subjects to lift; that one hand is im- years, again in France, during the latter part of the mersed in ice and is feeling numb and insensitive; 19th century between Jean-Martin Charcot and that subjects can smell their favourite perfume; and their associates (Gauld, that they see their best friend in front of them; 1992). Charcot drew comparisons between hyp- that they cannot see an object in front of them or notic phenomena and neurotic symptoms in his hear a particular sound; and that they are reliving Post-hypnotic suggestion hysterical patients. He proposed a three-stage an event from childhood. Some suggestions are model of hypnosis, namely lethargy, then cata- intended to take effect after the subject has been A suggestion that is admin- istered during hypnosis but lepsy, then somnambulism. However, Bernheim alerted and are termed ‘post-hypnotic’. The ex- is intended to take effect demonstrated that the entire range of hypnotic tent to which the subjects respond to these sug- following termination of the phenomena could be elicited in 15% of the normal gestions and experience the effects as realistic and mbr.synergiesprairies.ca hypnotic experience. population. He was also very critical of Charcot’s automatic varies from person to person; some are three-stage model and demonstrated that these highly responsive, some do not respond at all, stages were not representative of the usual re- and most lie somewhere in between. sponse of subjects to hypnosis. According to The main issue of contention amongst mod- Bernheim (1888/1973) hypnosis is ‘the induction ern theorists has been whether, in order to explain of a peculiar psychical condition which increases hypnotic phenomena such as enhanced suggest- susceptibility to suggestion’ (p. 15). This emphasis ibility, it is necessary to posit an altered state of on suggestion can be seen in the titles of several consciousness or whether all can be accounted of his writings including his book whose title in for by reference to concepts and processes from the English translation is Hypnosis and sugges- mainstream social and cognitive psychology such tion in psychotherapy: A treatise on the nature and as imagination, expectancy and role enactment. uses of hypnotism (Bernheim, 1988/1973). One The assault on state theories of hypnosis has been of his students, Émile Coué, became famous for quite intense, to the extent that sceptics have felt establishing a system of psychotherapy based on entitled to say that ‘hypnosis is a myth’ or ‘there is repeated without the induction of no such thing as hypnosis’ (see Baker, 1990, for a hypnosis. highly sceptical exposition of hypnosis). Despite the ferocity of the debate between the Modern theoretical ‘state’ or ‘special process’ supporters and those approaches to hypnosis who adopt the socio-cognitive position, there is good evidence that over the last 10 years or so I shall now fast-forward this brief account of the a greater consensus on the fundamental nature evolution of hypnosis to developments during the of hypnosis has emerged in the academic litera- second half of the 20th century. The identifica- ture. (A comparison between the chapters in, tion of a particular theoretical position on hyp- say, Lynne and Rhue, 1991, and the theoretical

18 || MBR || Volume : 1 || Issue : 1 article The Journal of Mind-Body Regulation

accounts in Nash and Barnier, 2008, bears this 1991; Spanos, Cross, Menary & Smith, 1988). out.) It is my belief that the modern state-versus- According to this approach, unlike low respond- non-state controversy parallels the earlier conflict ers, highly responsive subjects have a positive between the relative significance of the induction attitude to hypnosis and willingly become ‘stra- of ‘trance’ on the one hand and the process of sug- tegically involved’. Hence unresponsive individu- gestion and suggestibility on the other, and that als can be trained to become more responsive by this is how it is being resolved. Let me explain changing their attitudes and encouraging them further. to adopt a ‘strategic’ approach when responding First, laboratory studies of hypnosis on nor- to suggestions. There is, however, good evidence mal volunteers have demonstrated that the tradi- now that a person’s suggestibility is constant over tional hypnotic induction procedure is not essen- time and is, at least in part, genetically deter- tial in enhancing the suggestibility of the subject. mined (Horton & Crawford, 2004; Lichtenberg, In fact, responsiveness following an induction is, Bachner-Melman, Ebstein & Crawford, 2004; overall, only moderately higher than when sug- Morgan 1973). gestions are administered without an induction It is instructive for the present thesis to stay (‘waking suggestions’) and for some subjects for a moment on the subject of measuring re- there is no increase and even a decrease (Kirsch sponsiveness to hypnotic suggestion. It is has & Braffman, 1999). Moreover, when the tradi- long been recognised that there are significant tional induction is replaced by ‘task-motivational and reliable differences between hypnotic sugges- instructions’ or an ‘alert-active’ induction (sug- tions in terms of the proportion of subjects who gestions of increasing awareness, alertness and respond to (i.e. ‘pass’) them. For example on the energy and sometimes substitution of the chair Stanford Hypnotic Susceptibility Scale Form C or couch with an exercise bicycle), or injection of (SHSS:C; Weitzenhoffer & Hilgard, 1962), 92% of a (inert) ‘hypnosis pill’ or inhalation of a (inert) subjects in the normative group passed the ‘hand ‘hypnosis gas’, then the same increase in suggest- lowering’ suggestion, 43% passed ‘age regression’, ibility is found (Baker & Kirsch, 1993; Bányai & and only 9% passed ‘negative visual hallucination’. Hilgard, 1976; Barber & Calverley, 1963; Glass & In this sense it is meaningful to talk about some Barber 1963). Hence, the role of the hypnotic in- suggestions being more ‘difficult’ than others and duction may simply be to enhance the subject’s in earlier clinical texts (e.g. Hartland, 1971) the expectancy and his or her commitment and moti- ability of subjects to respond positively to sug- vation to engage in the suggestions to follow. gestions was interpreted as indicating the ‘depth This conclusion is consistent with a recent of trance’ that they had attained (light, medium investigation by McGeown, Mazzoni, Venneri, or deep). Traditionally, the deeper the trance the and Kirsch (2009) who analysed fMRI scans of more profound the subjective response to sugges- mbr.synergiesprairies.ca subjects undergoing a hypnotic induction con- tions of changes in experience, such as hallucina- sisting of suggestions of mental and physical re- tions, analgesia, amnesia, and age regression. laxation. Highly suggestible participants showed Nowadays, at least for research purposes, a decreased activity in the anterior parts of the ‘de- person’s ‘hypnotisabilty’ is measured by various fault mode’ circuit but no increase in other cor- standardised scales that are well-researched and tical regions. The ‘default mode’ network refers have good psychometric properties (Woody & to cortical areas that are active in the absence of Barnier, 2008). The most widely used are those goal-directed activity. In low suggestible partici- developed in the 1950s and 1960s by André pants the hypnotic induction produced no such Weizenhoffer and , namely the changes but appeared to deactivate areas involved Stanford Scales of Hypnotic Susceptibility in alertness. These results suggest that the mode (Weitzenhoffer & Hilgard, 1959, 1962). They each of action of the hypnotic induction, at least with consist of a range of suggestions, and the sub- highly suggestible people, is to prime them to re- ject’s responsiveness to each suggestion is scored. spond more effectively to the suggestions to fol- Collectively the scores attained for the sugges- low. Importantly the data confirm that relaxation tions yield a total score that, within the general is not a critical factor in this regard. population, has a broad distribution and a clear Secondly, there is good evidence that hypnot- central tendency. The scales typically include a ic suggestibility is a stable trait (Piccione, Hilgard traditional hypnotic induction but this may be & Zimbardo, 1989). This is in contrast to a strong dispensed with and some scales do not include socio-cognitive position such as that adopted by an induction at all. Suggestions not preceded Nicholas Spanos and his colleagues, namely that by an induction are often called ‘waking sugges- differences in suggestibility are determined by tions’ and Kirsch (1997) has cogently pointed out the subjects’ attitudes to hypnosis and their re- that the correlation between waking and hyp- sponse styles (Gorassini & Spanos, 1999; Spanos, notic suggestibility is as high as the test-retest

19 || MBR || Volume : 1 || Issue : 1 article The Journal of Mind-Body Regulation

reliability of the standard scales. He proposes that A modern definition of hypnosis hypnotisability may be defined as the increment Throughout its history, writers have struggled to in suggestibility following a hypnotic induction Imaginative agree on a definition of hypnosis. The following suggestibility procedure and that imaginative and hypnotic sug- definition by a well-respected authority in the A person’s responsivity gestibility denote suggestibility before and after field is an example of a consensus understanding to suggestions when they induction respectively. of hypnosis based on current theories and experi- are not preceded by a The point to note here is that the histori- hypnotic induction proce- mental research: dure (also termed ‘waking cal development of hypnosis, with the change in suggestibility’). emphasis from trance to suggestion and suggest- Hypnosis is a process in which one per- ibility, has left writers with an embarrassment of son, designated the hypnotist, offers sug- names for the instruments designed to measure gestions to another person, designated subjects’ responsivity. Are they suggestibility the subject, for imaginative experiences scales, hypnotisability scales, hypnotic suggestibil- entailing alterations in perception, mem- ity scales, hypnotic susceptibility scales, hypnotic ory and action. . . . (T)hese experiences responsivity scales, or what? The present writer’s are associated with a degree of subjective opinion is that they are primarily suggestibility conviction bordering on delusion, and an scales but, in view of the fact that the term ‘sug- experienced involuntariness bordering on gestibility’ can refer to a number of different and compulsion.’ Kihlstrom (2008, p. 21) unrelated human characteristics, to avoid ambi- Contrast this with the ideas and practices of guity the term ‘hypnotic suggestibility’ may be the Mesmer and his followers. Note also the empha- preferred one. sis on suggestion and suggestibility rather than The third reason for the emerging consen- on the assumption of some special state of con- sus is the increasing body of evidence from sciousness as a prerequisite for experiencing the neuroscientific research using behavioural and suggested effects. brain scanning techniques that indicate that subjects who score high on hypnotic suggestibil- ity scales are different from those who score low, Clinical hypnosis not merely when responding to suggestions but on other measures outside of the hypnotic con- If we simply define hypnosis as what takes place text (Gruzelier, 1998; Horton & Crawford, 2004; when people say they are ‘doing hypnosis’ then by Oakley & Halligan, 2010; D. Spiegel, 2008). This far the greatest proportion of this activity is un- research not only provides strong support for the dertaken by people such as physicians, psycholo- trait interpretation of suggestibility, but also in- gists, dentists, psychotherapists, counsellors and dicates that those subjects who appear to be re- hypnotherapists with their patients and clients. mbr.synergiesprairies.ca sponding to suggestion are indeed having experi- Indeed, as we have seen, the historical roots of Dissociation ences that seem real to them and correspond with hypnosis lie in the practice of medicine and not The suppression from con- scious awareness of experi- the intended effects. They are not merely comply- the study of general psychology. Concerning ences, memories, percep- ing, acting the part, or using conscious cognitive this, the behaviourist Clarke Hull, who pioneered tions and so on of which one strategies available to all subjects, even those who the laboratory investigation of hypnosis and sug- would normally be aware; present as unsusceptible. gestion, had this to say: this includes the ability to One of the main focuses of current theory and be aware of or engage in We have already seen the dominant mo- experimental research is the construction and re- two or more incompatible tive throughout the history of hypnotism experiences, cognitions or finement of neurophysiological and neurocogni- has been clinical, that of curing human activities without con- tive models that account for successful respond- sciously acknowledging any ills. A worse method for the establish- ing to suggestion and the differences between inconsistency. ment of scientific principles amongst responsive and unresponsive individuals. A key highly elusive phenomena can hardly be concept is dissociation or, as some writers prefer, devised. (Hull, 1933, p. 18) ‘cognitive inhibition’ and there has been much de- Cognitive inhibition bate where this process is located within the cog- This makes sense when we consider that, just The active suppression of a nitive-behavioural system. Excellent reviews of as the practice of medicine is rigorously ground- cognitive response such as a current developments are to be found in Section ed in academic sciences such as anatomy, physi- thought or memory. II of Nash and Barnier (2008). The experimental ology and biochemistry, so we would expect the methodology is characterised by a rigorous scien- clinical application of hypnosis to be informed by tific approach and both research and theory are mainstream disciplines such as cognitive and so- informed by developments in the field of cogni- cial psychology and the neurosciences. tion and the neurosciences in general, an essential My experience over the last 33 years of requirement for any modern theory aimed at ac- studying hypnosis, attending numerous train- counting for the range of hypnotic phenomena. ing events and international conferences, and

20 || MBR || Volume : 1 || Issue : 1 article The Journal of Mind-Body Regulation

communicating with academic and clinical col- Understandably, hypnosis is often com- leagues across the world has consistently caused pared to relaxation procedures such as progres- me to wonder how much the rationale of clini- sive muscular relaxation, autogenic training and cal hypnosis is based on the experimental re- biofeedback. It is also compared with Eastern search findings and theoretical refinements that meditative practices such as transcendental med- are summarised in the previous section. I also itation, mindfulness, and Qigong (Edmonston, wonder to what extent hypnotic processes as elu- 1981; Holroyd, 2003; Huang, 2008; Lynn, Das, cidated by laboratory research are instrumental in Hallquist & Williams, 2006). For example the therapeutic hypnosis, even when the outcome is a Taiwanese psychiatrist Wei-Ching Huang (2008) successful one. has this to say about the growth of interest in hyp- If we approach hypnosis from the standpoint nosis in Taiwan: of its various therapeutic or clinical applications, It is worthwhile to point out that, with- a common assumption is that the patient is placed in the Chinese society, the traditional in some kind of psychophysiological state that is Qigong of the Daoists and Zen meditation beneficial in itself (e.g. some form of mental and of the Buddhists, all involve the altered physical relaxation in which self-healing is pro- conscious state by developing hypnotic- moted) and which facilitates the person’s respon- like condition. . . . If Qigong or Zen medi- siveness to healing or persuasive influences in the tation is guided by the master for the stu- form of hypnotic suggestions. There is one fur- dents, it even becomes more similar to the ther claim that many practitioners make, namely induction of hypnosis by the therapist to that hypnosis facilitates access to ‘the unconscious the clients. . . . In another word, the prac- mind’. tice of hypnosis is observed in the Eastern There are a number of assertions here that I and Western traditional customs and it is shall now expand on, though only to the extent a pan-culture phenomenon. (p. 29) that is possible within a single article. Hypnosis as a special state A modern approach to understanding hyp- nosis that incorporates relaxation as its pivotal A principle assumption of clinical hypnosis has process is that described by Edmonston (1991). always been that it is a special state of the mind. He has postulated that ‘neutral hypnosis’, that However what has emerged from laboratory stud- is hypnosis limited to a standard induction and ies of hypnosis is that this does not play a central deepening routine, is equivalent to relaxation role, if it plays any role at all, the emphasis being and that phenomena that are labelled ‘hypnotic’ on suggestion and suggestibility.

are merely facilitated by relaxation. He proposed mbr.synergiesprairies.ca A more general description of hypnosis is that that we use the word ‘anesis’ as a more appropri- of profound relaxation. In their descriptions of ate label, but this has not proved a popular term. hypnosis, for example in their brochures and on The theory has not been instrumental in gener- their websites, clinicians often inform potential ating much research activity and is not generally clients or patients that hypnosis is a state of physi- accepted. cal and mental relaxation. The description of A state of relaxation and an inner focus of hypnosis on the website of the European Society attention is indeed an accurate description of of Hypnosis (ESH) is fairly standard and includes what people usually experience when undergoing the following: hypnosis in the clinical context and there is good During the induction of trance, concen- reason for this. There is convincing evidence tration is distracted from external stim- that relaxation procedures such as those that uli and directed to internal sensations. are used as traditional hypnotic inductions have Usually a state of physical relaxation is therapeutic value in treating a range of conditions achieved as a first sign. Hypnosis is not a such as stress, anxiety disorders, and psychoso- stereotyped ‘relaxation programme’ but is matic problems, as well as helping patients cope tailored individually. Relaxation in hyp- with uncomfortable medical and dental proce- nosis is associated with a calming of bio- dures and childbirth (see Lynn, Rhue & Kirsch, logical rhythms like breathing and heart 2010, for comprehensive reviews of this work). rate. This makes it possible for every pa- However, as we have seen in the previous section, tient to individually focus on inner expe- a state of relaxation is not a defining feature of riences. Hypnosis promotes the ability to hypnosis as it is studied in the laboratory, whereas relax during various treatments and thus suggestion and suggestibility are. to take responsibility for one’s own well- being. (Schulze, undated)

21 || MBR || Volume : 1 || Issue : 1 article The Journal of Mind-Body Regulation

Of course, hypnotic relaxation procedures do stronger and steadier… your mind calmer and use suggestion to achieve their ends. However, clearer… more composed… more placid… more there is little to indicate that the state of mental tranquil’. (Hartland, 1971, p. 201) and physical relaxation thus achieved is funda- In the laboratory it has been found that al- mentally different from that derived by other though responding to suggestions during hypno- methods, including the various forms of medita- sis and post-hypnosis feels very compulsive and tion (Benham & Younger, 2008; Wagstaff, 1981). automatic to the highly suggestible subject, there Also, there are many occasions during hypnotic are limitations on their influence once the hyp- treatment when a patient may not be particular- notic context is terminated. Firstly, responding ly relaxed and may even be in a highly aroused does involve cognitive effort on the subject’s part state, as when he or she is reliving an exciting or a (Barnier & McConkey, 1996, 1998, 2001) and may traumatic memory. No one suggests that at such be over-ridden by the subject’s own volition or by times the patient has ceased to be ‘hypnotised’. competing habits. Very importantly, the influ- Now, it is certainly the case that in the labo- ence of a suggestion is determined by the explicit ratory, just as in the clinic, induction procedures and implicit demands of the context; when those incorporating suggestions of mental and physi- demands are perceived as no longer operative, the cal relaxation are commonly used and hence, in subject stops responding. For example, in experi- this context also, participants are likely to find ments on highly susceptible subjects the response the experience very relaxing. However, the point to post-hypnotic suggestion ceases when the ex- I am making is this: in the laboratory relaxation periment appears to have been temporarily sus- is found not to be an essential property of hyp- pended or when the subjects perceive themselves nosis whereas in the clinic it is considered to be as no longer under an obligation to behave in the so. Thus in this fundamental way, hypnosis as it manner required by the experimenter, or even, al- is studied and understood in the laboratory is not though not always, when they are no longer under the same as hypnosis as it is understood in the his or her surveillance (Damaser, Whitehouse, clinical context. Orne, Orne & Dinges, 2010; Fisher, 1954; Spanos, Suggestions in the laboratory and Menary, Brett, Cross & Ahmed, 1987; St Jean, in the clinic 1978). For this reason also, the influence of the suggestion is likely to diminish over time. I have already described the kinds of hypnotic The question I am now posing is this: to what Covert sensitisation suggestions that are studied in the laboratory. Ex- extent are therapeutic suggestions (including A form of conditioning in amples of hypnotic suggestions that are regularly post-hypnotic suggestions and self-suggestions) which an imagined stimulus, used in treatment are those intended to produce in the clinical context equivalent to hypnotic sug- such as a cigarette, is paired physical relaxation and calmness, control or dim- gestions in the laboratory and to what extent do mbr.synergiesprairies.ca with an imagined aversive inution of pain and other symptoms, the reliving they operate in the same way? There is not a great stimulus or event until the aversive reaction is triggered of an important memory (perhaps by suggestions deal of direct evidence that in the experimental by the first stimulus alone. of age regression), and the experience of an un- context hypnotic suggestion itself can bring about pleasant sensation (as in covert sensitisation for such significant and enduring changes in a per- smoking). son’s life of the kind that are witnessed when a Unlike in the laboratory, in the clinic the aim person responds successfully to therapy. That the of many hypnotic suggestions is that they bring therapeutic protocols provided by clinical hypno- about desirable behavioural, cognitive and emo- sis are of proven efficacy is not in question here; tional changes of an enduring nature, not changes however one is entitled to ask whether their effi- that last only for the duration of the therapy ses- cacy is due to hypnosis as it is studied in the labo- sion; hence the extensive use of post-hypnotic ratory and on which current theoretical models suggestion. For example it is often suggested to are based or whether non-hypnotic processes are patients that as soon as they start to experience at work. their problem in their daily life (undue anxiety, By ‘non-hypnotic’ processes I do not just Ego strengthening pain, negative self-referential thoughts, a compul- mean general effects such as the therapeutic al- Refers to a series of sugges- sion to perform an undesired habit, and so on) liance and the patient’s expectation of change. tions, usually of a general their symptom- or habit-control strategies will Many hypnotherapeutic manoeuvres are very nature, that are intended to immediately take effect and they will thus success- similar to behavioural methods such as various enhance the subject’s self- fully deal with the situation (see Heap & Aravind, relaxation and anxiety management procedures, confidence and self-esteem. 2002, for examples of these). Some post-hypnotic imaginative rehearsal of coping strategies, and suggestions are more general; these include confi- covert conditioning techniques such as imaginal dence building or ‘ego strengthening’ suggestions desensitisation, sensitisation, reinforcement, and such as ‘Every day… your nerves will become modelling (Cautela & Kearney, 1986; Cautela &

22 || MBR || Volume : 1 || Issue : 1 article The Journal of Mind-Body Regulation

McCoullough, 1978). The rationale for adopt- of the treatment being carried out; hence its rela- ing such procedures is not hypnotic suggestion tive contribution to outcome may be difficult to and suggestibility but learning and conditioning quantify. processes. There is one difference between the labora- One way of addressing the above question tory and the clinical context that should be noted, is by investigating whether there is any relation- namely that laboratory studies of suggestion and ship between outcome of and the suggestibility normally consist of one session patients’ scores on hypnotic suggestibility scales. whereas a course of therapy usually consists of This point was made by Evans (1991) when he several treatment sessions. Also the patient is of- asked, ‘Can obtained treatment changes be spe- ten encouraged to practise ‘self-hypnosis’ or ‘au- cifically attributed to hypnosis rather than to the to-hypnosis’ (using a taped recording). Perhaps non-specific effects of the hypnotic relationship?’ the potency of the hypnotherapeutic suggestions He then goes on to say, ‘Such an attribution can is thereby strengthened. This may be the case, but be made only if individual differences in hypnoti- we would still expect a clear relationship between sability correlate with the extent of treatment suc- hypnotic suggestibility and outcome. Also there cess’ (page 159). Of course one still expects other are non-hypnotic processes whereby treatment predictors of outcome to be influential such as efficacy is enhanced with repeated sessions, nota- rapport with the therapist, positive expectation, bly covert rehearsal and practice of the therapeu- and commitment to the therapy. tic techniques and strategies. There are numerous published clinical trials In summary, the weakness, elusiveness and investigating hypnosis in the treatment of a vari- inconsistency of any relationship between hyp- ety of conditions and problems in which the hyp- notic suggestibility, as measured formally, and notic suggestibility of the patients has been mea- the outcome of hypnotic treatment raise doubts sured by standard scales. Several reviews of this about the extent to which clinical hypnosis, even work have been undertaken (Barnier & Council, when it is effective, involves the same processes 2010; Flammer & Alladin, 2007; Lynn, Boycheva and mechanisms as hypnosis studied in the lab- & Barnes, 2008; Lynn, Meyer & Shindler, 2004; oratory and upon which existing theories are Pinnell & Covino, 2000; Waddern and Anderton, based. 1982). The results give a very mixed and confus- Should hypnotic suggestibility scales be used ing picture. There are many papers reporting suc- routinely in the clinic? Some clinicians have de- cessful outcomes for a wide range of problems in veloped protocols whereby decisions about treat- which the hypnotic suggestibility of the patients ment are informed by the patient’s measured was not a significant factor, and in many others hypnotic suggestibility or susceptibility (e.g. H. the relationship proved to be weak. There ap- Spiegel, 2007; Wickramasekera, 1993). More gen- mbr.synergiesprairies.ca pears to be a tendency for hypnotic suggestibility erally, writers often lament the reluctance of clini- to correlate with outcome in those problems that cians to adopt this procedure (see, e.g., Barnier have a somatic component (e.g. pain — includ- & Council, 2010). However, if there is strength ing headaches — warts, asthma and dermatologi- in the above conclusion then we may question cal conditions) in contrast to problems involving whether there is any good reason for clinicians to voluntary behaviour such as smoking and obesity formally measure hypnotic suggestibility prior to (Barnier & Council, 2010; Flammer & Alladin, embarking on treatment. 2007; Wadden and Anderton, 1982), but this has Hypnosis and the unconscious not proved to be a consistent finding. One problem with these investigations is Earlier modern texts on the clinical applications that the mere indication that the patient is not of hypnosis made extensive use of ‘the uncon- responsive to suggestions, either while formally scious mind’ in two ways. The first, perhaps un- testing his or her hypnotic suggestibility or dur- der the influence of Émile Coué, is the idea that ing therapy itself, may weaken the confidence and suggestions are effective when they, in a manner expectations of both patient and therapist that a of speaking, become ‘implanted in the uncon- successful outcome will be forthcoming and this scious (or subconscious) mind’ (Hartland, 1971). itself can have a deleterious effect on outcome. This notion is, in my experience, not evident in Significantly, Pinnell & Covino (2000) note that more recent texts with the exception of the Er- the relationship between outcome and hypnotic icksonian literature, which I shall mention later. suggestibility may be absent if the latter is mea- The second claim concerning hypnosis and sured after the conclusion of treatment and in a the unconscious is that hypnosis allows access to different context. Also, probably more often than repressed feelings, ideas and memories that are not, hypnosis is just one adjunctive component not expressed consciously. According to Yapko (1990):

23 || MBR || Volume : 1 || Issue : 1 article The Journal of Mind-Body Regulation

Because of the dual nature of the human related to something that happened in the past?’. mind (i.e. conscious and unconscious), Other methods are dream suggestion and the memories and details that may have been ‘theatre technique’ whereby it is suggested that repressed or else simply escaped detec- the patient is watching a play or a movie that will tion by the conscious mind may not have help explain in some way the reasons for his or escaped the person’s unconscious mind. her problems and their possible resolution. (p. 74) The usefulness of these procedures is not being disputed here (for further discussion see Hypnosis is considered to be a way of access- Heap & Aravind, 2002), only their relationship to ing this material. (Nowadays it is more custom- the understanding of hypnosis that has emerged ary to refer to these experiences as ‘dissociated’ from laboratory research. It seems that once rather than ‘repressed’.) again the interpretation of hypnosis by the clini- This property that is ascribed to clinical hyp- cal hypnotist places much more emphasis on the nosis is not one that is generally claimed by those ‘special state’ concept as opposed to suggestion researching hypnosis in the laboratory. However, and suggestibility which is the focus of experi- a rationale is provided by Hilgard’s neo-dissocia- mental and theoretical interpretations. tion theory and its investigation in the laboratory It is appropriate to ask if this really matters, (Hilgard, 1986). This theory adopts an everyday since the main concern of the clinician is to ob- understanding of dissociation whereby we assign tain good therapeutic results, even if the assump- attentional priority to particular activities or ex- tions on which the treatment are based do not periences while simultaneously engaging in other match those derived from experimental investi- activities or while unaware of other ongoing expe- gations. In this case it matters a great deal. riences (e.g. not being aware of pain while attend- During the 1990s and up to the present day, ing to an emergency). In simple terms, hypnotic thousands of adults in America, Europe and suggestions are a means of directly controlling Australia have come genuinely to believe that one this process. Thus, for example, when responding or both of their parents or other members of their to arm levitation, the subject is consciously aware family sexually abused them, often quite exten- that the arm is rising but is unaware of the effort sively, when they were children, despite there be- of lifting it; thus the arm appears to him or her to ing no evidence that this had occurred. The ma- be moving ‘on its own’. jority of these cases of ‘false memories’ of abuse One way that Hilgard demonstrated his mod- have been due to the suggestive influence of psy- el was by the ‘hidden observer’ effect (Hilgard, chotherapists (Brandon, Boakes, Glaser, Green, 1979, 1986). The classic demonstration of this MacKeith & Whewell, 1997). Prior to therapy involves the elicitation of ‘true’ ratings of isch- the patients had no knowledge or memory of mbr.synergiesprairies.ca aemic pain by highly hypnotisable subjects who any such abuse. In a survey of 4,400 families of are responsive to suggestions of profound analge- the US False Memory Foundation (42% response sia. During hypnotic analgesia the experimenter rate), in 86% of members charged with incest suggests that there is a hidden or ‘unhypnotised’ their accusers had undergone psychotherapy or part of the mind that can give the pain ratings ‘out psychiatric treatment (McHugh, Lief, Freyd & of awareness’. These ratings are duly revealed in Fetkewicz, 2004). In the UK, Boakes reports a writing or by pressing numbered keys. rate of 75% in around 100 cases referred to her The exact mechanism of the hidden observ- (Waterhouse, 2003). er remains a topic of some controversy (see e.g. Amongst the methods that have been used Kirsch & Lynn, 1998). However it may provide a to elicit these false memories are the hypnoana- rationale, albeit a rather tenuous one, for the idea lytic procedures mentioned above. Here we do that hypnosis allows access to information that is have an instance where it is important to ground already dissociated — i.e. inhibited from conscious clinical practice in theory based on solid research expression by, in terms of Hilgard’s theory, ‘an evidence, even when that evidence is derived amnesic barrier’. Hypnotherapeutic procedures from experimental work in the laboratories of that exploit this idea include what are termed ‘ex- non-clinicians. ploratory’ and ‘uncovering techniques’ or simply Ericksonian hypnotherapy ‘hypnoanalysis’ (Cheek & Le Cron, 1968; Kroger, 1977; Waxman, 1989). For example it may be sug- The present discussion of hypnosis would be in- gested to the patient that slight involuntary finger complete without examining a significant devel- movements signal the messages ‘yes’, ‘no’, ‘don’t opment in clinical hypnosis over the last 30 years, know’ and ‘don’t want to say’ in response to ques- namely the influence of the American psychiatrist tions by the therapist such as ‘Is your problem and psychologist Milton Erickson (1901–1980)

24 || MBR || Volume : 1 || Issue : 1 article The Journal of Mind-Body Regulation

and his followers (Lankton, 2008). This influence (Fricton & Roth, 1985; Groth-Marnet & Mitchell, is part of a wider approach to psychotherapy in 1998; Lynn, Weekes, Matyi & Neufield, 1988; Van general that is often termed ‘strategic’ although Gorp, Meyer & Dunbar, 1985). there are many components of Ericksonian psy- chotherapy, both theoretical and practical, that Other hypnotic contexts are quite distinctive (Haley, 1973, 1993). One fun- damental tenet is that clients have the personal So far I have focused on two important contexts resources to solve their problems but these are involving hypnosis: the academic and experi- not immediately obvious or accessible to them. mental on the one hand and the clinical on the In other words the possible solutions can be said other. There are however other contexts in which to be ‘unconscious’. hypnosis is involved and where it is again relevant Hypnosis is one way of facilitating access to ask to what extent ideas and practice are in- to these resources, the key concept being what formed by current research findings on the na- Ericksonians term the ‘naturalistic trance’, in ture and properties of hypnosis in the non-clini- which it is possible for the client to suspend his cal population. The contexts that I shall mention or her ‘habitual frame of reference’ and thus dis- here are those in which assistance from an expert cover choices otherwise not accessible to him or on hypnosis is required in a legal, medico-legal or her. Thus hypnotic communication may be said forensic setting. to bypass the critical faculties of the conscious A pertinent example is the use of hypnosis mind (Yapko, 1990). in the interrogation of eyewitnesses in criminal The ‘naturalistic trance’ is an altered state of cases, a practice that goes back over 150 years consciousness that is continuous with everyday (Gravitz, 1983). This application appears to be ‘trance’ experience – times when we are deeply in- based on the idea that when ‘in the hypnotic volved in an experience such as listening to some state’ a subject’s memory is much clearer than thrilling music, but also moments of surprise, otherwise. There is in fact no theoretical justifi- shock, anticipation, suspense, confusion, inspira- cation for believing this; the laboratory evidence tion, and insight. Hypnotic phenomena, that is is very inconsistent and hypnotic procedures may the responses to hypnotic suggestions, are also lead to memory distortion and even confabula- expressed in ‘naturalistic’ terms. For example, an tion (American Medical Association, 1985; Heap, arm lifting without apparent conscious effort is an 2008b; Wagstaff, 1999). Because of these difficul- everyday occurrence, likewise not noticing a pain, ties, in several countries this particular applica- seeing something that is not there, not seeing tion of hypnosis is now deprecated (Heap, 2008b). something that is right in front of one, recalling Another relevant context is in legal cas- a past event so vividly that it seems real, failing es — civil and criminal — in which it is asserted mbr.synergiesprairies.ca to recall something one has only just been told or that hypnosis or a related procedure has been even done, and so on. involved and the hypnosis expert is instructed to Although radical in many ways, the provide the court with his or her opinion. I have Ericksonian approach to hypnosis retains the fea- published a number of accounts of my own work tures of the traditional model summarised earlier: in this field (Heap, 1995, 2000a, 2000b, 2006, the patient is placed in some kind of psychophysi- 2008b). These have included claims of negligence ological state that is beneficial in itself and which against therapists and stage hypnotists, allega- facilitates his or her responsiveness to healing tions of sexual assault during hypnosis or simi- or persuasive influences. We also have the idea lar procedures, and cases of defendants claiming that hypnosis facilitates access to the unconscious they were hypnotised when committing the al- mind, albeit one that is conceived of in positive leged offence. terms. As such we may question what the ap- In these accounts I have summarised existing proach has in common with the understanding of published work by authorites in these areas and, hypnosis that has emerged from laboratory inves- in some cases (e.g. Heap, 1995), the opinions of tigations based on mainstream cognitive science. expert witnesses instructed by the opposing side This may not unduly trouble practitioners of in the cases described. I have noted that in ex- Ericksonian hypnosis, but the ideas summarised pressing their opinions, many writers and expert above sit very uneasily with the latter. witnesses have preferred the conceptualisation of Unlike existing theories, Ericksonian ideas hypnosis that largely informs clinical practice and have not spawned a great deal of research. The po- have not drawn on the current experimental re- tency of indirect methods of suggestion claimed search evidence on suggestion and suggestibility by Ericksonians in the therapeutic context has as well as social and cognitive psychology gen- not been demonstrated in laboratory conditions erally. For example they rely on the concept of

25 || MBR || Volume : 1 || Issue : 1 article The Journal of Mind-Body Regulation

‘the hypnotic trance’ in explaining the aggrieved have agreed and reliable methods of measuring person’s experience and behaviour, for instance the subject’s response. These measuring instru- his or her apparent inability or unwillingness to ments reveal that responsiveness is enhanced take protecive action against the hypnotist’s un- when the subject is motivated, focused and en- welcome advances; they make no reference to gaged with the procedures, whatever method is laboratory research on hypnotic suggestions for used to achieve this, but that an upper limit is set committing antisocial and harmful actions (e.g. by his or her inherent level of suggestibility. Levitt, Aronoff, Morgan, Overley & Parrish, Just from this description of hypnosis alone 1975; Orne & Evans, 1965; see also Gibson, 1991) one can reasonably propose that hypnotic proce- and compliance and obedience in general (e.g. dures may have therapeutic applications. It is the Milgram, 1974); and they do not consider the lab- business of therapists to help bring about desir- oratory evidence on the determinants and limi- able changes in feelings, perceptions, thoughts tations of post-hypnotic responding summarised and behaviour in their clients and patients. This earlier in this paper. also describes the work of physicians or dentists In fact, in my own experience the research when they are endeavouring to make a difficult literature on social and cognitve psychology in clinical procedure more comfortable and less general provides convincing explanations of the anxiety-provoking. claimant’s or complainant’s experiences and be- I have, however, in this paper questioned the haviour in most of these cases. extent to which ‘hypnosis’ as investigated in the laboratory and on which existing theories are Discussion based, is the same as ‘hypnosis’ that is represented and practised by clinicians. For example I have Over the years, the scientific investigation of hyp- raised the matter of whether, in those clinical ap- nosis has been hampered by the lack of an agreed plications in which enduring changes are sought, definition of hypnosis and discussion continues such changes are really effected by the process of about what should and should not be included hypnosis as currently defined or whether they are (Green, Barabasz, Barrrett & Montgomery, 2005). due to non-hypnotic aspects of the treatment. Without an agreed definition researchers can- That there is often no relationship, or only a weak not properly investigate hypnotic phenomena. one, between hypnotic suggestibility and outcome If, say, as is often the case, an investigator runs indicates that, for the most part, hypnosis — hyp- two groups of subjects or patients, ‘hypnotic’ and nosis as defined here and as understood by those ‘non-hypnotic’, then one ought to ask what it is researching it — plays only a limited role in what is that defines this difference? One answer may be called clinical hypnosis or hypnotherapy. that the first group experienced a hypnotic induc- It has also been noted that, whereas mental mbr.synergiesprairies.ca tion procedure and the second group experienced and physical relaxation is usually described by something else – say they listened to some music. clinicians as an essential property of hypnosis, In that case we have to define what distinguishes this has not proved to be the case for hypnosis in a procedure that is termed ‘a hypnotic induction’ the laboratory. However, it is acknowledged that from one that is not. Instead of this, researchers hypnotic suggestions may be used to promote simply assumed that ‘a hypnotic induction’ is a mental and physical relaxation and this is a very procedure that encourages relaxation and an in- common purpose of hypnosis in the clinic. ner focus of attention. In fact this is based on an Finally I have observed that psychotherapists understanding of hypnosis that is no longer char- who use hypnosis claim that it improves recall acteristic of modern theoretical approaches. and facilitates access to the unconscious mind, Perhaps as a conquence of all of this the sci- leading, say, to the recovery of ‘repressed memo- entific investigation of hypnosis has not simply ries’. Laboratory evidence for improvement or shaped how hypnotic pheneomena are to be ex- recovery of memory due to hypnosis is weak and plained but how hypnosis itself is to be defined hypnotic procedures aimed at such may lead to in the first place. Definitions similar to that pro- memory distortion and confabulation. Indeed vided by Kilstrom (2008) given earlier are now evidence from clinical practice itself has indi- fairly non-contentious (Green et al 2005; Heap & cated that detailed confabulation, in the form of Aravind, 2002). They have two components, one false memories of sexual abuse in childhood, may procedural – the hypnotist administers sugges- result from this application of hypnosis. tions – and one experiential – the subjects respond How much of this matters? There is sufficient accordingly with changes in feelings, perception, evidence that treatment protocols that are based cognition and behaviour that are experienced as on the assumptions of clinical hypnosis that I having an involuntary and realistic or even ‘de- have described are efficacious (Lynn et al, 2010). lusional’ quality. It is therefore fortunate that we Efficacy is the main concern of the clinician, even

26 || MBR || Volume : 1 || Issue : 1 article The Journal of Mind-Body Regulation

if the reason why the treatment works is not fully gastrointestinal activity (e.g. Klein & Spiegel, understood or the ‘working model’ turns out to 1989; Whorwell, Houghton, Taylor, & Maxton, be wrong. The obvious rejoinder to this is that the 1992), blood flow (Barabasz & McGeorge, 1978; ‘recovered memories’ controversy of the last 20 Dikel & Olness, 1980), and respiratory function- years has exposed the dangers of failing to ensure ing (Isenberg, Lehrer & Hochron, 1992). Clearly that therapeutic practice is based on models and investigations such as these are relevant to the theories that have robust scientific support from hypnotherapeutic treatment of problems. There mainstream psychology and related disciplines. has also been great interest in the effect of sug- And when hypnosis enters the legal and forensic gestion on immunological functioning (Moore & arena, opinion should be grounded in the experi- Tasso, 2008). mental research evidence and not assumptions Laboratory studies of how suggestion and about its clinical mode of operation. An expert imagery may influence these physiological pro- witness who is not so informed would be given a cesses has obvious relevance to their application very difficult time in a court of law. to somatic disorders (e.g. irritable bowel syn- Notwithstanding the above, there are areas of drome, headaches, asthma and dermatological clinical practice which are clearly influenced and complaints) but well-controlled clinical trials, of guided by experimental research. I shall now de- which there are a growing number, are necessary scribe, albeit briefly, three examples these. to ascertain if any changes that may be effected Firstly, it has been noted that although relax- are enduring and of clinical significance. Also ation types of induction are often the most useful the role of hypnotic suggestion, as distinct from in clinical practice, if the purpose of the induction more general effects such as relaxation, needs to is primarily to enhance the patient’s responsive- be clarified. ness to suggestions then experimental research Finally it is worth recalling what was earlier indicates that other inductions may be used when noted about the role of hypnotic suggestibility in appropriate. For example, some practitioners oc- treatment outcome. It may be more than coinci- casionally report using inductions that emphasise dence that it is in the two aforementioned areas of mental alertness and increasing energy rather application – pain and somatic disorders – where than relaxation (Bányai, Zseni, & Forenc, 1993; positive relationships have more often been ob- Capafons & Mendoza, 2010; Gibbons, 1979; Heap served in clinical studies. & Aravind, 2002). A second area of cross-fertilisation of theory Conclusion and practice is that of pain control. There are var- ious ways one can use hypnosis to assist in pain Does clinical hypnosis have anything to do with relief and pain management (Jensen & Patterson, experimental hypnosis? The message of this paper mbr.synergiesprairies.ca 2008; Patterson, Jensen & Montgomery, 2010) is not that clincal practitioners of hypnosis must and laboratory and clinical investigations have always pay heed to the academic research litera- jointly contributed to developing effective pro- ture and must amend their ideas and practices ac- cedures (Montgomery, DuHamel & Redd, 2000) cordingly. The working models of hypnosis that and elucidating what may be the mechanisms that they adopt will be those best suited to their needs underly their efficacy. and those of their patients or clients and these Thirdly, both laboratory and clinical research may not necessarily coincide with those of the into the influence of hypnotic suggestion (includ- experimentalists. The aim of this paper is simply ing self-suggestion and imagery) on physiologi- to raise the question of how much experimental cal functioning may indicate how and in what and clinical hypnosis have in common with each circumstances hypnosis may be used in treating other and how much the former informs the lat- a number of medical condtions including those ter. Perhaps the answer to both these questions is that have been termed (though less so nowa- ‘not as much as is often implied’. days) ‘psychosomatic’. These include studies of

27 || MBR || Volume : 1 || Issue : 1 article The Journal of Mind-Body Regulation

References

American Medical Association (1985). Bernheim, H. (1888/1973). Hypnosis and Fricton, J. R., & Roth, P. (1985). The effects Council on Scientific Affairs report on suggestion in psychotherapy: A treatise on of direct and indirect suggestion for anal- ‘Scientific status of refreshing memo- the nature and uses of hypnotism. North- gesia in high and low susceptible subjects. ries by the use of hypnosis’. Journal of vale, NJ: Jason Aronson Inc. American Journal of Clinical Hypnosis, 27, the American Medical Association, 253, 226–231. Brandon, S., Boakes, J., Glaser, D., Green, 1918–1923. R., MacKeith, J., & Whewell, P. (1997). Gauld, A. (1992). A history of hypnotism. Baker, R. A. (1990). They call it hypnosis. Reported recovered memories of child Cambridge: Cambridge University. Buffalo, New York: Prometheus. sexual abuse: Recommendations for good Gibbons, D. E. (1979). Applied hypnosis and practice and implications for training, Baker, S. L., & Kirsch, I. (1993). Hypnotic hyperempiria. New York: Plenum Press. continuing professional development and and placebo analgesia: Order effects and research. Psychiatric Bulletin, 21, 663–665. Gibson, H. B. (1991). Can hypnosis compel the placebo label. Contemporary Hypnosis, people to commit harmful immoral and 10, 117–126. Capafons, A., & Mendoza, M. E. (2010). criminal acts?: A review of the literature. “Waking hypnosis” in clinical practice. In Bányai, E. I., & Hilgard, E. R. (1976). A com- Contemporary Hypnosis, 8, 129–140. S. J. Lynn, J. W. Rhue & I. Kirsch (Eds.), parison of active-alert hypnotic induction Handbook of clinical hypnosis (2nd ed., Glass, L. B., & Barber, T. X. (1961). A note with traditional relaxation induction. pp. 293–317). Washington, DC: American on hypnotic behavior, the definition Journal of Abnormal Psychology, 85, Psychological Association. of the situation and the placebo-effect. 218–224. Journal of Nervous and Mental Disease, Cautela, J. R. and Kearney, A. J. (1986). The Bányai, E. I., Zseni, A., & Forenc, T. (1993). 132, 539–541. covert conditioning handbook. New York: Active-alert hypnosis in psychotherapy. Springer. Gorassini, D. R., & Spanos, N. P. (1999). In J. W., Rhue, S. J. Lynn & I. Kirsch The Carleton Skill Training Program (Eds.), Handbook of clinical hypnosis (pp. Cautela, J. R., & McCullough, L. (1978). for Modifying Hypnotic Suggestibility: 271–290). Washington, DC: American Covert conditioning: A learning-theory Original version and variations. In I. Psychological Association,. perspective on imagery. In J. L. Singer & Kirsch, A. Capafons, E. Cardeña-Buelna K. S. Pope (Eds.), The power of human Barabasz, A. F., & McGeorge, C. M. (1978). & S. Amigó (Eds.), Clinical hypnosis and imagination (pp. 225–254). New York: Biofeeback, mediated biofeedback and self-regulation: Cognitive-behavioural per- Plenum Press. hypnosis in peripheral vasodilation spectives (pp. 141–177). Washington DC: training. American Journal of Clinical Cheek, D. B., & LeCron, L. M. (1968). Clini- American Psychological Association. Hypnosis, 21, 28–37. cal hypnotherapy. New York: Grune & Gravitz, M. A. (1983). An early case of hyp- Stratton. Barber, T. X., & Calverley, D. S. (1963). nosis used in the investigation of a crime. Toward a theory of hypnotic behavior: Damaser, E., Whitehouse, W. G. Orne, M. International Journal of Clinical and Effects on suggestibility of task motivat- T. Orne, E. C., & Dinges, D. F. (2010). Experimental Hypnosis, 31, 224–226. ing instructions and attitudes toward Behavioral persistence in carrying out Green, J., Barabasz, A., Barrrett, D., & hypnosis. Journal of Abnormal and Social a posthypnotic suggestion beyond the Montgomery, G. (2005). Forging ahead:

Psychology, 67, 557–565. hypnotic context: A consideration of the mbr.synergiesprairies.ca The 2003 APA Division 30 Definition of role of demand characteristics. Interna- Barnier, A. J., & Council, J. R. (2010). Hypnosis, International Journal of Clinical tional Journal of Clinical and Experimental Hypnotizability matters: The what, why and Experimental Hypnosis, 53, 259–264. Hypnosis, 58, 1–20. and how of measurement. In S.J. Lynn, Groth-Marnet, G., & Mitchell, K. (1998). J. W. Rhue & I. Kirsch (Eds.), Handbook Dikel, W., & Olness, K. (1980). Self-hypnosis, Responsiveness to direct versus indirect of clinical hypnosis (2nd ed.., pp. 47–77). biofeedback, and voluntary peripheral hypnotic procedures. International Jour- Washington, DC: American Psychological temperature control in children. Pediat- nal of Clinical and Experimental Hypnosis, Association. rics, 66, 335–340. 46, 324–333. Barnier, A. J., & McConkey, K. M. (1996). Edmonston, W. E. (1991). Hypnosis and Gruzelier, J. (1998). A working model of the Action and desire in posthypnotic re- relaxation: Modern verification of an old neurophysiology of hypnosis. Contempo- sponding. International Journal of Clinical equation. New York: Wiley. rary Hypnosis, 15, 3–21. and Experimental Hypnosis, 44, 120–139. Evans, F. J. (1991). Hypnotisabilty: Individual Hartland, J. (1971). Medical and dental Barnier, A. J., & McConkey, K. M. (1998). differences in dissociation and the flexible hypnosis and its clinical applications (2nd Posthypnotic responding: Knowing when control of psychological processes. In S. ed.). London: Baillière Tindall. to stop helps keep it going. International J. Lynn & J. W. Rhue (Eds.), Theories of Journal of Clinical and Experimental Hyp- hypnosis: Current models and perspectives Haley, J. (1973). Uncommon therapy: The nosis, 46, 204–219. (pp. 144–168). New York: Guilford Press. psychiatric techniques of Milton H. Erick- son, MD. New York: Norton. Barnier, A. J., & McConkey, K. M. (2001). Fisher, S. (1954). The role of expectancy Posthypnotic responding: The relevance in the performance of posthypnotic Haley, J. (1993). Jay Haley on Milton H. of suggestion and test congruence. Inter- behaviour. Journal of Abnormal and Social Erickson. New York: Brunner/Mazel. national Journal of Clinical and Experi- Psychology, 49, 503–507. Heap, M. (1995). A case of death following mental Hypnosis, 49, 207–219. Flammer E., & Alladin, A. (2007). The ef- : Analysis and implications. Benham, G., & Younger, J. (2008). Hypnosis ficacy of hypnotherapy in the treatment of Contemporary Hypnosis, 12, 99–110. and mind-body interactions. In M. R. psychosomatic disorders: Meta-analytical Heap, M. (2000a). A legal case of a man Nash & A. J. Barnier (Eds.), The Oxford evidence. International Journal of Clinical complaining of an extraordinary sexual handbook of hypnosis: Theory, research and Experimental Hypnosis, 55, 251–274. disorder following stage hypnosis. Con- and practice (pp. 393–435). Oxford: Ox- temporary Hypnosis, 17, 143–149. ford University Press.

28 || MBR || Volume : 1 || Issue : 1 article The Journal of Mind-Body Regulation

Heap, M. (2000b). The alleged dangers of Kirsch, I. (1997). Suggestibility or hypnosis: Lynn, S. J., Weekes, J. R, Matyi, C. L, & stage hypnosis. Contemporary Hypnosis, What do our scales really measure? Inter- Neufield, V. (1988). Direct versus indirect 17, 117–126. national Journal of Clinical and Experi- suggestions, archaic involvement, and mental Hypnosis, 45, 212–225. hypnotic experience. Journal of Abnormal Heap, M. (2006). Assessing allegations of Psychology, 97, 296–301. sexual assault during hypnosis and related Kirsch, I., & Braffman, W. (1999). Corre- procedures. Australian Journal of Clinical lates of hypnotisability: The first empiri- McGeown, W. J., Mazzoni, G., Venneri, A., and Experimental Hypnosis, 34, 41–54. cal study. Contemporary Hypnosis, 16, & Kirsch, I. (2009). Hypnosis decreases 224–230. anterior default mode activity. Conscious- Heap, M. (2008a). Foreword to D. Rob- ness and Cognition, 18, 848–855. ertson, The discovery of hypnosis: The Kirsch, I., & Lynn, S. J. (1998). Dissociation complete writings of , the father theories of hypnosis, Psychological Bul- McHugh, P. R., Lief, H. I., Freyd, P. P., & Fet- of hypnotherapy (pp. 2–3). UK: National letin, 123, 100–115. kewicz, J. M. (2004). From refusal to rec- Council for Hypnotherapy. onciliation: Family relationships after an Klein, K. B., & Spiegel, D. (1989). Modula- accusation based on recovered memories. Heap, M. (2008b). Hypnosis in the courts. tion of gastric acid secretion by hypnosis. Journal of Nervous and Mental Diseases, In M. Nash & A. Barnier (Eds.), Oxford Gastroenterology, 96, 1383–1387. 192, 525–531. handbook of hypnosis. Oxford: Oxford Kroger, W. S. (1977). Clinical and experimen- University Press. Milgram, S. (2004). Obedience to authority: tal hypnosis (2nd ed.). Philadelphia: J. B. An experimental view. London: Pinter Heap, M., & Aravind, K. K. (2002). Hart- Lippincott Company. & Martin Ltd. (Original work published land’s Medical and Dental Hypnosis (4th Lankton, S. (2008). An Ericksonian approach 1974) ed.). London: Churchill Livingston/ to clinical hypnosis. In M. R. Nash & A. J. Harcourt Health Sciences. Montgomery, G. H., DuHamel, K. N., & Barnier (Eds.), The Oxford handbook of Redd, W. H. (2000). A meta-analysis of Hilgard, E. R. (1979). Divided consciousness hypnosis: Theory, research and practice hypnotically induced analgesia: How ef- in hypnosis: The implications of the hid- (pp. 467–485). Oxford: Oxford University fective is hypnosis? International Journal den observer, In E. Fromm & R. E. Shor Press. of Clinical and Experimental Hypnosis, 48, (Eds.), Hypnosis: developments in research Levitt, R. E., Aronoff G., Morgan C. D., 138–53. and new perspectives (2nd ed., pp. 45–79). Overley T. M., & Parrish M. J. (1975). New York: Aldine. Moore, M., & Tasso, A. F. (2008). Clinical Testing the coercive power of hypnosis: hypnosis: The empirical evidence. In Hilgard, E. R. (1986). Divided consciousness: Committing objectionable acts. Interna- M. R. Nash & A. J. Barnier (Eds.), The Multiple controls in human thought and tional Journal of Clinical and Experimental Oxford handbook of hypnosis (pp. 697– action (expanded ed.). New York: Wiley. Hypnosis, 23, 59–67. 725). Oxford: Oxford University Press. Holroyd, J. (2003). The science of meditation Lichtenberg, P., Bachner-Melman, R., Morgan, A. H. (1973). The heritability of and the state of hypnosis. American Jour- Ebstein, R. P., & Crawford, H. J. (2004). hypnotic susceptibility in twins. Journal nal of Clinical Hypnosis, 46, 109–208. Hypnotic susceptibility: Multidimen- of Abnormal Psychology, 82, 55–61. sional relationships with Cloninger’s Horton, J. E., & Crawford, H. J. (2004). tridimensional personality questionnaire, Nash, M. R., & Barnier A. J. (Eds.). (2008). Neurophysiological and genetic determi- COMT polymorphisms, absorption, and The Oxford handbook of hypnosis: Theory, nants of high hypnotisability. In M. Heap, attentional characteristics. International research and practice. Oxford: Oxford

R. J. Brown & D. A. Oakley (Eds.), The mbr.synergiesprairies.ca Journal of Clinical and Experimental Hyp- University Press. highly hypnotisable person (pp. 133–151). nosis, 52, 47–72. London: Brunner-Routledge. Oakley, D. A., & Halligan, P. W. (2010). Lynn S. J., Boycheva, E. and Barnes, S. Psychophysiological foundations of Huang, W.-C. (2008). Application of hyp- (2008). To assess or not to assess hyp- hypnosis and suggestion. In S. J. Lynn, nosis in psychotherapy for the Chinese notic suggestibility? That is the question. J. W. Rhue & I. Kirsch (Eds.), Handbook in Taiwan. World Cultural Psychiatry American Journal of Clinical Hypnosis, 51, of clinical hypnosis (2nd ed., pp. 79–117). Research Review, January, 28–31. Avail- 213–239. Washington, DC: American Psychologi- able at http://www.wcprr.org/pdf/03- cal Association. 01/2008.01.028031.pdf Lynn, S. J., Das, L. S., Hallquist, M. N., & Williams, J. C. (2006). Mindfulness, ac- Orne, M. T., & Evans, F. J. (1965). Social Hull, C. (1933). Hypnosis and suggestibility. ceptance, and hypnosis: Cognitive and control in the psychological experiment: New York: Appleton Century Crofts. clinical perspectives. International Journal Antisocial behavior and hypnosis. Journal Isenberg, S. A., Lehrer, P.M., & Hochron, of Clinical and Experimental Hypnosis, 54, of Personality and Social Psychology, 1, S. (1992). The effects of suggestion and 143–166. 189–200. emotional arousal on pulmonary function Lynn, S. J., Meyer, E., & Shindler, K. (2004). Patterson, D. R., Jensen, M. P., & Mont- in asthma: A review and a hypothesis Clinical correlates of high hypnotisability. gomery, G.H. (2010). Hypnosis for pain regarding vagal mediation. Psychosomatic In M. Heap, R. J. Brown & D. A. Oakley control. Handbook of clinical hypnosis Medicine, 54, 192–216. (Eds.), The highly hypnotisable person (pp. (2nd ed., pp. 521–549). Washington, DC: Jensen, M. P., & Patterson, D. R. (2008). 187–212). London: Brunner-Routledge. American Psychological Association. Hypnosis in the relief of pain and pain Lynn S. J., & Rhue J. W. (Eds.) (1991). Piccione, C., Hilgard, E. R, & Zimbardo, disorders. In M. R. Nash & A. J. Barnier Theories of hypnosis: Current models and P. G. (1989). On the stability of measured (Eds.), The Oxford handbook of hypnosis perspectives. New York: Guilford Press. hypnotisability over a 25-year period. (pp. 503–533). Oxford: Oxford University Journal of Personality and Social Psychol- Press,. Lynn, S. J., Rhue, J. W., & Kirsch, I. (Eds.) ogy, 56, 289–295. (2010). Handbook of clinical hypnosis (2nd Kihlstrom J. F. (2008). The domain of hypno- ed.). Washington, DC: American Psycho- Pinnell, C. M., & Covino, N. A. (2000). Em- sis revisited. In M. R. Nash & A. J. Barnier logical Association. pirical findings on the use of hypnosis in (Eds.), The Oxford handbook of hypnosis: medicine: A critical review. International Theory, research and practice (pp. 21–52). Journal of Clinical and Experimental Oxford: Oxford University Press. Hypnosis, 48, 170–194.

29 || MBR || Volume : 1 || Issue : 1 article The Journal of Mind-Body Regulation

Salas, C., & Salas, D. (1996). Testing the St Jean, R. (1978). Posthypnotic behavior as Weitzenhoffer, A. M., & Hilgard, E. R. claims of mesmerism. Skeptic, 4(3), 66. a function of experimental surveillance. (1962). Stanford Hypnotic Susceptibility American Journal of Clinical Hypnosis, 15, Scale: Form C. Palo Alto, CA: Consulting Schulze, W. (undated). General remarks 250–255. Psychologists Press. about hypnosis. European Society of Hypnosis. Retrieved May 12, 2010, from Van Gorp, W. G., Meyer, R., & Dunbar, K. Whorwell, P. J., Houghton, L. A, Taylor, http://www.esh-hypnosis.eu/index. (1985). The efficacy of direct versus indi- E. E., & Maxton, D. G. (1992). Physi- php?folder_id=11&file_id=0 rect hypnotic induction on reduction of ological effects of emotion: Assessment experimental pain. International Journal by hypnosis. Lancet, 340, 69–92. Spanos, N. (1991). A sociocognitive ap- of Clinical and Experimental Hypnosis, 33, proach to hypnosis. In S. J. Lynn & J. W. Wickramasekera, I. (1993). Assessment 319–328. Rhue (Eds.), Theories of hypnosis: Current and treatment of somatization disorders: models and perspectives (pp. 324–361). Wadden, T. A., & Anderton, C. H. (1982). The high risk model of threat percep- New York: Guilford Press. The clinical use of hypnosis.Psychological tion. In J. W. Rhue, S. J. Lynn & I. Kirsch Bulletin, 91, 215–243. (Eds.), Handbook of clinical hypnosis (pp. Spanos, N. P., Cross, W. P., Menary, E. P., & 587–621). Washington, DC: American Smith, J. (1988). Long term effects of cog- Wagstaff, G. F. (1981).Hypnosis, compliance Psychological Association. nitive skill training for the enhancement and belief. Brighton: Harvester Press. of hypnotic susceptibility. British Journal Woody, E. Z., & Barnier, A. J. (2008). Hyp- Wagstaff, G. F. (1999). Hypnosis and forensic of Experimental and Clinical Hypnosis, 5, nosis scales for the twenty-first century: psychology. In I. Kirch, A. Capafons, E. 73–78. What do we need and how should we Cardeña-Buelna & S. Amigó (Eds.), Clini- use them? In M. R. Nash & A. J. Barnier Spanos, N. P., Menary, E. P., Brett, P. J., cal hypnosis and self-regulation: Cognitive- (Eds.), The Oxford handbook of hypnosis: Cross, W. P., & Ahmed, Q. (1987). Failure behavioral perspectives (pp. 277–308). Theory, research and practice (pp. 255– of posthypnotic responding to occur Washington, DC: American Psychological 281). Oxford: Oxford University Press. outside the experimental setting. Journal Association. of Abnormal Psychology, 96, 52–57. Yapko, M. D. (1990). Trancework: An intro- Waterhouse, R. (2003). When the mind plays duction to the practice of clinical hypnosis. Spiegel, D. (2008). Intelligent design or tricks: Observations on sexual abuse. The New York: Bruner/Mazel. designed intelligence? Hypnotizability as Newsletter of the British False Memory neurobiological adaptation. In M. R. Nash Society, 11, 17–18. & A. J. Barnier (Eds.), The Oxford hand- Waxman, D. (1989). Hartland’s medical and book of hypnosis: Theory, research and dental hypnosis (3rd ed.). London: Ballière practice (pp. 179–199). Oxford: Oxford Tindall. University Press. Weitzenhoffer, A. M., & Hilgard, E. R. Spiegel, H. (2007). The neural trance: A new (1959). Stanford Hypnotic Susceptibility look at hypnosis. International Journal of Scale: Forms A and B. Paolo Alto, CA: Clinical and Experimental Hypnosis, 55, Consulting Psychologists Press. 387–410. mbr.synergiesprairies.ca

30 || MBR || Volume : 1 || Issue : 1