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76-3494 MARZELLA, John Nick, 1948- THE EFFECTS OF RATIONAL STAGE DIRECTED THERAPY UPON THE REDUCTION OF SELECTED VARIABLES OF PSYCHOLOGICAL STRESS: A COMPARATIVE STUDY. The Ohio State University, Ph.D., 1975 Education, guidance and counseling

Xerox University ifcrofilm, s Ann Arbor, Michigan 48106

Copyright by

John Nick Marzella 1975

THIS DISSERTATION HAS BEEN MICROFILMED EXACTLY AS RECEIVED. THE EFFECTS OF RATIONAL STAGE DIRECTED THERAPY UPON THE REDUCTION OF

SELECTED VARIABLES OF PSYCHOLOGICAL STRESS: A COMPARATIVE STUDY

DISSERTATION

Presented In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University

By

John Nick Marzella, B.S.J., M.Ed.

The Ohio State University 1975

Reading Committee: Approved By

Donald J. Tosl Joseph J. Quaranta Herman J. Peters W. Bruce Walsh Peter II. Gwynne Adviser Faculty of Special Services To My Family ACKNOWLEDGMENTS

I wish to express my heartiest appreciation to all those persons who have made this study possible.

To my adviser j, colleague and friend, Dr. Donald Tosi, I express my appreciation for his assistance during my studies at

Ohio State.

To my committee members: Dr. Joseph J. Quaranta, Dr. Herman

J. Peters, Dr. W. Bruce Walsh, and Dr. Peter H. Gywnne, I extend my thanks, appreciation and admiration. I would also like to thank all of the persons who participated as subjects in this study.

Also, I wish to express my deepest appreciation to Jerry

Boutin, James Reardon, and Leon White, my peers, who generously volunteered their time and hard work as therapists in this study.

Certainly, my greatest appreciation is extended to my wife,

Nancy, and to my daughter, Amy, whose understanding, love, and patience made working and studying much more meaningful.

iii VITA

September 19, 19*i-8. - . . . Born = Bellaire, Ohio

19T0* • « ...... B.S.J., Ohio University, Athens, Ohio

1971...... M.Ed. Ohio University, Athens, Ohio

1971-1973 ...... Psychiatric Social Work Specialist, United States Army

1973* ...... Planner/Coordinator of Juvenile Services, Belmont Harrison County Board of Mental Health & Mental Ratardation

197^...... Director of Counseling, Freshman Early Experience Program, The Ohio State University

1975...... Psychological Intern, The Ohio State University Counseling and Consultation Center

FIELDS OF STUDY

Major Field: Counselor Education

Studies in Counselor Education. Professor Donald J. Tosi

Studies in Counselor Education. Professor Joseph J. Quaranta

Studies in Counselor Education. Professor Herman J. Peters

Studies In Counseling Psychology. Professor W. Bruce Walsh

Studies in Psychiatry. Professor Peter H. Gywnne iv TABLE OF CONTENTS

Page Acknowledgments...... ill

Vi*t3i os...... iV

List of T a b l e s ...... v

List of Figure ...... vi

Chapter

I. Introduction ...... 1

Purpose ...... 8 Hypotheses...... 8 Need for the Study...... 9 Limitations of the Study...... 11 Definitions of Terms ...... 12 Organization of the Remainder of the Dissertation ...... Ik

II. Review of Related Literature...... 15

Susceptibility...... 25 Rational Cognitive Behavior Therapy . . . 28 Stage Directed Therapy ...... 33

III. Method ...... 39

Selection of Instruments ...... ^0 Selection of S a m p l e ...... 51 Therapists...... 52 Research Design ...... 53 Treatments...... 55 Statistics ...... 59 S u m m a r y ...... 59

IV. Analysis of D a t a ...... 60

V. Summary and Conclusions...... 97

Discussion...... 98 Conclusions and Recommendations ...... 103 Table of Contents (Cont'd.)

Page Reference...... 106

Appendix

A...... 118

B...... 125

c...... 127

Boo...... «...... 0 9 0 0 . 129

E...... 130

F...... 13U

G...... 135

H...... 157

I...... 162

J ...... 16h

K...... 170 LIST OF TABLES

Page Table 1. Correlations of Interater Reliability for the Barber Susceptibility Scale......

Table 2. Product Moment Correlations of Interater Reliability for Therapists' Performance of Treatment...... 53

Table 3* Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists, and Trials for Adjusted Mean MMPI Depression S c o r e s ...... 62

Table 3A. Adjusted Mean Scores of Ss' Performance on the MMPI Depression Scale by Therapists X Susceptibility...... 63

Table U. Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists, and Trials, for Adjusted Mean MMPI Paranoia Scores ...... 6h

Table 1+A. Adjusted Mean Scores of Sjs' Performance on the MMPI Paranoia Scale by Susceptibility X T r i a l s ...... 65

Table 5* Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists, and Trials for Adjusted Mean MMPI Psychasthenia S c o r e s ...... 66

Table 5A. Adjusted Mean Scores of Ss* Performance on the MMPI Psychasthenia Scale by Therapists X Susceptibility X Trials...... 67

Table 5B» Adjusted Mean Scores of Ss' Performance on the MMPI Psychasthenia Scale by Therapists X Treatment...... 68

Table 6. Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists, and Trials for Adjusted Mean MMPI Hypochondriasis S c o r e s ...... 70 List of Tables (cont'd.)

Page Table 7* Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for Adjusted Mean MMPI Hysteria Scores ...... 71

Table 8. Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists, and Trials for Adjusted Mean MMPI Psychopathic Deviate Scores...... "J2

Table 9* Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for Adjusted Mean MMPI Masculinity- Femininity Scores ...... 73

Table 10. Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for Adjusted Mean MMPI Schizophrenia Scores ...... 7h

Table 11. Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists, and Trials for Adjusted Mean MMPI Hypomania Scores...... 75

Table 12. Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists, and Trials for Adjusted Mean MMPI Social Introversion Scores ...... 7&

Table 13. Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists, and Trials for Adjusted Mean Self-Depression Scale Scores...... 77

Table 13A.Adjusted Mean Scores of S_s Performance on the SDS by Therapist X Susceptibility X Treatment...... "jQ

Table 13B.Results of Newman Keuls Test on all Ordered Pairs of Means for Susceptibility X Treatment X Therapist One ...... 79

Table 13C.Results of Newman Keuls Tests on all Ordered Pairs of Means for Susceptibility X Treatment X Therapist T w o ...... 8l List of Tables (cont'd.)

Page Table 13D.Results of Newman Keuls Tests on all Ordered Pairs of Means for Susceptibility X Treatment X Therapist Three ...... 82

Table 13E.Adjusted Mean Scores for Ss' Performance on the SDS by Treatment X T r i a l s ...... 83

Table 13F.Adjusted Mean Scores for Ss* Performance on the SDS by Therapists X Susceptibility...... 8^4-

Table 13G.Piesults of Iiewraan Keuls Tests on all Ordered Pairs of Means for Therapist X Susceptibility ...... 84

Table l4. Factor Analysis of Covariance for Treatment, Hypnotic Susceptibility, Therapists and Trials for Adjusted Mean MAACL Depression S c o r e s ...... ; 86

Table l4A.Adjusted Mean Scores for Ss_' Performance on the MAACL Depression Scale by Therapists X Treatments ...... 87

Table l4B.Adjusted Mean Scores for Ss' Performance on the MAACL Depression Scale by Therapists X Susceptibility...... 87

Table 15. Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for Adjusted Mean MAACL Hostility S c o r e s ...... 89

Table 15A.Adjusted Mean Scores for Ss' Performance on the MAACL Hostility Scale by Susceptibility X Treatments...... 90

Table 15B.Adjusted Mean Scores for _Ss' Performance on the MAACL Hostility Scale by Therapists X Susceptibility...... 90

Table 15C. Ad justed Mean Scores for Ss;' Performance on the MAACL Hostility Scale by Treatments . . 91

Table 16. Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists, and Trials for Adjusted Mean MAACL Anxiety Scores...... 93 List of Tables (cont’d.)

Page Table 1?. Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists, and Trials for Adjusted Mean Depression Inventory Scores ...... $k

Table l8. Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for Adjusted Mean STAI A-STATE Scores...... 95

Table 19. Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists, and Trials for Adjusted Mean STAI A-TRAIT Scores...... 96 LIST OF FIGURE

Figure I CHAPTER I

Introduction

Recently there has "been a renewed interest in the use of imagery, guided fantasies, and hypnosis as viable psychotherapeutic adjuncts. Although many practitioners define each of these generic terms independently, scientists have reported these and similar methods as helpful when properly used In clinical situations

(Goldfried, Decenteceo, & Weinberg, 197^# Lazarus, 197^* Meichenbaum et.al., 1971# and Tosi & Marzella, 1975)•

Although new therapeutic techniques have emerged and show promise for minimizing self-defeating behavior, many of these popular therapies and techniques often lack empirical support. Moreover, evidence supporting the efficacy of counseling and psychotherapy in general is conflicting. Specifically, for the many studies demon­ strating significantly positive correlations or positive therapeutic gains for hypnotic, sensory-imagery, and cognitive restructuring techniques used alone (Palmer & Field, 19^8, Horowitz, 1968,

Gregory & Diamond, 1972), there are others reporting non-significant relationships (e.g. McBain, 1973)• It should not, however, be con­ cluded that counseling and therapy have not been effective (Truax,

1966, Truax & Carkhuff, 1967). Current theorizing regarding counseling and psychotherapy appear to suggest that the popular approaches may need to he augmented with some of the clinically, as well as the empirically, proven methods of hypnosis and sensory-imagery (Fromm, 1972),

Research, however, using hypnosis has been primarily the investi­ gation of emotions, defense mechanisms, dreams, physiological processes, and various forms of psychopathology (Levitt & Chapmen,

1972). The relevance of hypnosis for counseling and psychotherapy is becoming increasingly apparent.

Fromm (1972) predicts that the future will see attempts to integrate hypnotherapy with the emergent psychotherapies, such as desensitization, autogenic control techniques, and the self actualizing theories. This research is such an attempt to combine a hypnotherapeutic technique with an extension or variant of rational- emotive therapy (RET) entitled Rational Stage Directed Therapy (RSDT)

(Tosi & Marzella, 1975).

RET, developed by Albert Ellis (1962, 1971); is a cognitive- behavior therapy emphasizing cognitive control over affective behavioral states, negative emotions are considered the results of illogical ideas or inaccurate appraisals of a real or imagined stimuli

(Arnold, 1968, Lazarus, 19^6, Meicheribaum, 1973; Meihl, 1966,

Moleski & Tosi, 1975). RET employs a rational restructuring of specific irrational ideas underlying self-defeating emotional/ behavioral states.

RSDT has evolved from the works emanating from very different sources. It is a convergence of Ellis*s cognitive restructuring, Maultsby's (1972) Rational Emotive Imagery (REl), Leuner"s (19^9)

Guided Affective Imagery (GAI), Cautela*s (1972) Covert Sensiti­

zation, and the hypnotherapy of Erickson (19&7)> Kroger (19^3) and Barber (1973)• The contributions of each of these author8s cognitive-imagery techniques to RSDT will be briefly outlined.

RSDT follows many of the same theoretical constructs as does

Rational Emotive Imagery (REl). REI is a technique designed to accelerate the self-change process using imagery within a rational- emotive theoretical framework. Maultsby (1972) has synthesized some very fine behavioral techniques with Ellisonian theory to formulate two types of REI: therapeutic imagery and auto-aversive imagery.

Therapeutic imagery includes the client’s basic understanding of his irrational behaviors and the processing of them via rational self-analysis. Once the client has determined his self-talk and has learned to challenge and confront his self-defeating ideas, he is asked to imagine himself in a situation wherein he becomes uncomfortable and/or behaves in self-defeating ways. He then reviews the rational challenges in regard to the particular situation and employs a counter-conditioning model to reduce negative emotions and to become relaxed. The client is then encouraged to participate in the feared event and to think rationally while doing so. With persistent practice, the fear responses can be extinguised.

Auto-aversive imagery is the same imageric process as Cautela's aversive imagery techniques (1972) with the addition of Rational

Emotive Therapy. Auto-aversive imagery is primarily aimed toward facilitating clients to delay immediate gratification in favor of their long term best interest. The idea, as in Cautela, is to pair noxious images and negative emotions with the desired object.

If the client avoids the original behavior, he subsequently avoids the unpleasant immediate consequences associated with the aversive images. RSDT used the same basic cognitive restructuring and imageric procedures as REI; however, unlike REI, Rational Stage

Directed Therapy guides the client through a logical progression os growth stages.

Another important technique rendering utilization of imagery was developed in 1$68 by Hanscall Leuner, a German Psychiatrist. His technique, entitled Guided Affective Imagery (GAI), is based on the results of a long range experiment begun in l^kS to examine the efficacy of imagery in psychotherapy. Leuner (19^9) suggests that

GAI can be used as a subordinate technique with any theoretical view of personality dynamics that recognizes subconscious motivation, the significance of symbols, and the therapeutic importance of the mobili­ zation of affect. Essentially, the patient is encouraged to daydream about specific scenes offered by the therapist. The therapist then guides the patient through these scenes so as to evoke latent intense feelings relative to the patient's problem. The techniques for guiding the patient into imagery and the resultant emotional cathexis can lead to desirable changes in both affect and attitude toward life situations, according to Leuner,

Rational Stage Directed Therapy (RSDT) (Tosi & Marzella, 1972) attempts a synthesis of hypnotherapy and sensory-imagery with rational or cognitive restructuring while simultaneously guiding or directing the client, via imagery, through various growth stages. The growth stages are: awareness, exploration, commitment to rational thinking and acting, implementation of rational thinking and acting, internalization of rational thinking and acting, and change or re­ direction. The stages identified by Tosi & Marzella (1975) are outgrowths and modifications of those identified earlier by Quaranta

(l97l)o

RSDT is a didactic-experiential, cognitive-behavioral intervention designed to guide or direct the client through stages focusing on either one problematic area or a set of related problems. Being an extension of standard cognitive behavior therapy, RSDT uses vivid cognitive-emotive imagery under varying degrees of relaxation induced through hypnosis or any of the standard relaxation procedures. Unlike other cognitive desensitization techniques that employ hypnosis or other relation procedures, RSDT is stage directed and places major emphasis on high level cognitive control over emotive, behavior and situational conditions. Through these various stages, the client using a cognitive-restructuring intervention, specifically Ellis9s

ABC self-analysis, encounters directly (via imagery) external or internal events that serve to activate the irrational cognitions underlying affective/physiological/behavioral disorders (Tosi & Marzella

1975).

During the initial stages of RSDT, the client is exposed to the cognitive or rational restructuring technique, and begins to develop a high level skill regarding its use. Cognitive restructuring skills, a logical-critical-thinking about disturbing internal or external events associated with emotional disturbance, are developed, reinforced, and implemented while the client is relaxed or in hypnosis. RSDT is then augmented with "in-vivo” behavioral tasks corresponding closely to imagery content (Tosi & Marzella, 1975)•

Inherent to the concepts of RSDT is its potential for developing, reinforcing and maintaining logical-critical thinking, relative to affective, physiological, behavioral and situational processes.

Specifically, RSDT is designed to minimize or eliminate internalized beliefs, attitudes and emotions that are self-defeating. RSDT assumes that man has a consciousness of self-an ability to think in constructive ways about himself-and that he does have the capacity to reconstruct, re-evaluate and ascribe new meanings to past, present, and future events and projections, thereby controlling his own destiny

(Tosi & Marzella, 1975).

RSDT may be considered as an inclusive rubric for a rational stage directed hypnotherapy (RSDH) and a rational stage directed imagery (RSDl). RSDH should be practiced by therapists trained professionally in hypnosis. RSDI does not require hypnotic training but does require the therapist be familiar with standard relaxation-

Imagery tehcniques (Tosi & Marzella, 1975).

Other imageric and hypnotic processes have been applied to various therapies to increase their effectiveness; however, a major probelm is encountered based on the conflict that what is being used clinically Is often extremely difficult to research and to control.

Hypnosis, especially, has undergone fire from the experimental!sts, who point toward the ominous lack of controls in hypnotic studies.

Clinicians, practicing in the field, tend to overlook the lack of control, placebo groups, and suggestibility factors, and lean toward practicing "what works" for them. On the other hand, research that over-quantifies, over-controls, and over-sterilizes results and methodologies, tends to negate the notion of a trance state, and attributes any significance to intervening, expectancy, and motivational variables (Barber 1973, Barber 19^2, Barber & Calverley

1963). While being statistically sound and experiemntally precise, most of the "art" and conviction of the hypnotist is sacrificed for sterility; hence, clinicians find little applicability of these techniques outside of the laboratory. It seems then, that experi­ mental findings either wallow in controversy and skepticism raised by disciplined scientists, or they are so sterile that they have little value to clinicians. The question remains whether or not hypnotic research can be experimentally controlled enough to satisfy the rigors of science without inhibiting the art or the natural functioning of the therapist. This study by no means will resolve the dispute between the phenomenologists* and the behaviorists* position on the concept of altered states of consciousness. The present research, however, should make some contribution to the ultimate resolution of that dispute. Purpose

The purpose of this study is to examine the effects of two

Rational Stage Directed Therapies that involve the use of hypnosis and imagery in the reduction of psychological stress. The major research question posed here is whether the application of Rational

Stage Directed Hypnotherapy (RSDH) and/or Rational Stage Directed

Imagery (RSDI) can reduce significantly emotional stress as measured by The Minnesota Multiphasic Personality Inventory (MMPI)

(Hathaway and McKinley, 19^3)> The Depression Inventory (Dl)

(Beck, 1967)# The Multiple Affect Adjective Checklist (MAACL)

(Zuckerman and Lubin, 1965), The Self-rating Depression Scale (SDS)

(Zung, 1967) and The State-Trait Anxiety Inventory (STAI)

(Spielberger, Gorsuch & Lushene, 19^9)• Sub questions involve the extent to which the level of client susceptibility to hypnosis and the therapists themselves contribute to the therapeutic process.

Hypotheses

The hypotheses as stated are:

Main effects: Treatments

Means representing psychological stress as measured by the MMPI, the Depression Inventory, MAACL, the Self-rating Depression Scale and the State-Trait Anxiety Inventory, from groups of subjects defined in terms of various treat­ ments, Rational Stage Directed Hypnotherapy (RSDH), Rational Stage Directed Imagery (RSDI), Hypnosis, Placebo, and Control will not differ significantly across pre, post I and post II conditions. 9

Main effects: Susceptibility

Means representing psychological stress as measured by the MMPI, the Depression Inventory, MAACL, the Self-rating Depression Scale and the State-Trait Anxiety Inventory, from groups of subjects defined as high and low on the Barber Suggestibility Scale (1965) over pre, post I and post II conditions will not differ significantly.

Main effects: Therapists

Means representing psychological stress as measured by the MMPI, the Depression Inventory, MAACL, the Self-rating Depression Scale and the State-Trait Anxiety Inventory, from groups of subjects within RSDH, RSDI, Hypnosis, Placebo, and Control having assigned therapists will not differ significantly across pre, post I and post II conditions.

Interaction effects:

Observed means representing psychological stress as measured by the MMPI, the Depression Inventory, MAACL, the Self-rating Depression Scale and the State-Trait Anxiety Inventory, from groups of subjects defined in terms of and in any combination of treatment, therapist, and hypnotic susceptibility will not differ significantly from the means expected from the simple addition of the appropriate main effects.

Need for the Study

In research involving hypnosis, there is a need for experi­ ments that incorporate rigorous designs. If the rigorous requirements of science are to be met, experiments need to be based upon research designs that carefully control for independent and dependent variables.

In psychotherapeutic or counseling research, however, such control cannot suppress the therapist's art of delivering the science of psychotherapy. Shor (1972) cites an interesting passage depicting a dilemma characteristic of hypnotic research: 10

On one side of the narrow strait lay Scylla, a treacherous rock; on the other side lay an equal danger, Charybdis, a dreadful whirlpool. The only safe passage was to sail the narrow course in between. Sailing to either one side or the other brought unfailing disaster. The only method for avoiding either of these two dangers was therefore to take the terrible risk of succumbing to its counterpart danger. The more leeway the navigator allowed himself in avoiding the danger to port meant just that much less leeway in avoiding the reciprocal danger to starboard. These two entirely distinct and separate dangers of rock and whirlpooi, were thus so situated that unavoidably they had to be faced together, as if one single, unitary problem. The Straits of Messina

In the present study, an attempt was made to narrow those straits by controlling for as much variance as possible while still allowing the therapists to function naturally within theroretical and experimental limits. Built into the design are controls for therapists, hypnotic suggestibility, therapeutic treatments, repeated measures on the dependent variables, and the subjects themselves.

A serious shortcoming in hypnotic research is sampling bias.

There are two major reasons for this: Most studies use volunteers who attain a score of ten or higher on the Stanford Hypnotic

Susceptibility Scale (Levitt & Chapman, 1972). By using such volun­ teers, experimenters limit themselves to about 15$ of the popu­ lations applying for experiments in hypnosis (Weitzenhoffer and

Hilgard, 1959). Subjects in the present study were asked to participate in an experiment designed to help them cope more effectively with emotional stress. No mention of hypnosis was made until each subject was randomly assigned to a treatment group. Hypnosis was then thoroughly explained and the option of dropping

out of the experiment was presented#

Hepps and Brady (1967), Hilgard (1967) and Tart (1966) all

indicate there are a number of responses elicited from subjects

while in hypnosis that are correlated with the hypnotic capacity

of the subject as determined by a standard scale. Inherent in this assumption is that there may be factors influencing the outcomes

of experimental results other than a measure of hypnotizabilityi

hence, possible confounding of variables may occur. To control for

this possibility, all subjects were divided into either high or low

suggestibility as determined by the Barber Suggestibility Scale

(BSS) and the suggestibility variable was accounted for in the

experimental design of the study.

Limitations of the Study

There are several limitations in this study. First, the study uses a special sample. All Ss were graduate students nearing

completion of their M.A. degrees in Guidance and Counseling or

related fields and were for the most part assumed to be normal.

Findings may be generalized to similar populations and certainly

indicate the need for replications on a more psychiatrically disturbed population.

A second limitation includes the concept of socially desirable

responses being elicited from this particular population. The 12 instruments utilized in the study are susceptible to socially desirable answers with such a sophisticated population. Another limitation is the relatively short time span between the post­ test and the follow-up test. The three-week interval may have not been enough time for any significant change to have taken place or for any measured significance to relapse. The monotony and intensity of having to take all five instruments three times within a 10 week period may be a limiting factor as well.

A statistical limitation of the study lies in the number of people within each cell of the design. Although 60 is a fairly sizable N for this type of study, because of the tightly controlled design, a minimum number of subjects are contained within each cell.

Definitions of Terms

The following definitions are offered for a more thorough understanding of terms used throughout the study;

Hypnosis; Conditions of concentrated focused attention as brought about by positive attitudes, motivations, expectancies, and the Ss willingness to cooperate, think, imagine, and respond to the suggestions that are being offered.

Imagery: The ability to cognitively imagine and to mentally picture oneself acting, thinking, and emoting in various real or hypothetical situations. Emotional Stress: Emotional stress is operationalized as what is measured by the clinical scales of the Minnesota Multiphasle

Personality Inventory, the Self-rating Depression Scale, the

Multiple Affect Adjective Checklist, and the State-Trait Anxiety

Inventory. Decremental changes in any of the clinical scales of the dependent variables will be considered a reduction of psychological stress.

Placebo: The treatment condition wherein Ss received direct suggestions that any emotional stress they had would be allieviated.

No specific method for dealing with stress was offered, and all questions were answered in a very non-directive manner.

Bational Stage Directed Therapy: A didactic-experimental cognitive behavioral intervention designed to guide or direct a client through various stages of awareness, exploration, commitment to rational thinking and acting, internalization of rational thinking and acting, and change or redirection. Subsumed under RSDT are Rational Stage

Directed Hypnotherapy (RSDH) and Rational Stage Directed Imagery

(RSDI).

Susceptibility to Hypnosis: Susceptibility to hypnosis is opera­ tionalized as the score each subject attains on the Barber

Suggestibility Scale (BSS). A score greater than "8” implies high susceptibility; a score less than "8" implies low susceptibility.

Susceptibility to hypnosis refers to the responsiveness with which a subject responds to auggestions that are being offered in a situation labeled as hypnosis. lU

Rational: Rationality is a non-static concept based upon logically

correct thinking relative to a given set of data or facts. Sperry

(197*0 suggests that rationality is a method to deal with subjective

and objective reality as one pursues his life goals. The following

criteria may be used in determining whether or not one®s thinking

and acting are "rational" (Maultsby, 1971). Thinking and acting

are rational when

(a) these behavioral processes consider objective and subjective reality - the facts - be they enviornmental, cognitive, affective, physiological, and/or behavioral motoric; (b) these behavioral processes contribute to the pre» servation and enhancement of life; (c) these behavioral processes contribute to the achievement of one9s immediate and long-term life goals (self- knowledge, self-acceptance, self-affirmation); (d) these behavioral processes minimize personal and environ­ mental stress (Tosi & Marzella, 1975).

Organization of the Remainder of the Dissertation

This chapter has included an introduction, a statement of the problem, the hypotheses, the need for the study, limitations of the

study and definition of terms used throughout the study. Chapter II purports a review of literature pertinent to the study. Chapter III

contains the methodological considerations, the data analysis and research design. Chapter IV is a report of the results and findings of the experiment, and Chapter V summarizes the results and conclusions as well as addressing future recommendations. CHAPTER II

Review of Related Literature

The major question of this study focuses upon the efficaciousness of two rational stage directed therapies in reducing psychological stress. A review of research pertinent to the variables contained in the research questions and their relationship to one another will be the concern of this chapter.

The chapter will review related literature concerned with (l) hypnosis, (2) rational emotive and cognitive behavior theory, (3) hypnotic susceptibility, (4) cognitive restructuring, and (5) the concept of Stage Directed Therapy.

The history of the practice of hypnosis has been characterized by periods of intense controversy. From Mesmer through Braid, who in the mid l800's advanced a naturalistic physiological explanation of hypnosis, on through Charcot, the Nancy tradition, Freud,

Erickson, and Barber, hypnosis has been the object of intense fanaticism, criticism, and scientific research.

Frantz Anton Mesmer is popularly considered as the originator of hypnosis; however, Mesmer, a physician and faith-healer, is not credited with the discovery of hypnosis, but for his insistence that his therapeutic results had a scientific explanation. His

15 approach varied only slightly from the faith-healers of his time and combined a laying-on-of-the-hands approach nested in astrological concepts, medieval mysticism and seventeenth century vitalism (Shor, 1972). Mesmer's theory suggested that health was a harmonious distribution of an ethereal cosmic fluid, comparable to Pneuma in the Aristotelian notion, that was evenly dispersed through the mind and body. Disease was fluidic imbalance. Mesmer felt that cosmic fluid could be controlled to some extent by the human will and could even be stored in inanimate objects. He devised elaborate apparatus for storing the cosmic fluid and over­ shadowed the most flamboyant stage hypnotists with his therapeutic manipulations. Often he found that after his "treatments" many of his patients manifested severe agitation, convulsion and even seizures. As Shor (1972) explains:

These original agitated reactions were probably due to three factors: expectations deriving from medieval demonic exorcism rites, the dancing manias (St. Vitus's Dance, for example), and possibly epilepsy! a probable aftereffect of anxiety release after direct symptom suppression (see particularly the case of Maria Theresa von Paradis in Mesmer's Memoire..., first published in 177*0 ; a- derivation of the vapeurs, the hysterical fainting and nervous fits fashionable among society women at that time.

Based on his observations, Mesmer concluded it necessary to allow some of his cosmic fluid to be released into his patients thereby creating an even greater fluidic imbalance in the patient.

This imbalance would cause the patient to rapidly reach a crisis point in therapy; his behavior would then often be reduced to violent convulsive seizures, after which equilibrium would tend to 17 become restored (Shor, 1972).

The Implosive crisis became the focal point of Mesmer's system, and even though he and his followers were convinced the crisis was indispensible to the cure, investigators have since shown that his entire procedure was clearly based upon mutually shared expectations between therapist and patient. Although his theories were dis- credited scientifically, they were functionally, pragmatically true as Mesmer was sensitively attuned to the emotive needs of the people of his era and capitalized upon that insight. Mesmer realized the importance of cooperation between the therapist and patient. He noted that unless the patients were cooperative and sincerely wanted to be cured, they would not allow themselves to entertain the healing influences of the physician (Shor, 1972). Even though his physi- calistic theoretical interpretations were incorrect, Mesmer's insight into the working relationship of the therapist-patient was accurate.

Modern hypnotherapy is predicated on the relationship between the therapist and patient, who is in an altered state of respon­ siveness, in which repressed materials are often more readily available than in the usual waking state. Certainly the arguments surrounding hypnosis have not been resolved, and the explanations of hypnosis are multivaried. Some investigators suggest the trance state is sleep (Hilgard, 19&9); others say it is not (Brady and

Levitt, 1966, Brenman and Gill, 19^7)• Some report that hypnosis is a conditioned reflex (Pavlox, 1923); others say it is produced through dissociation (Weitzenhoffer, 1953). Theoreticians further 18

muddy the water and attribute the trance state to several reasons:

the desire of the Ss to play the role of the hypnotized subject

(Sarbin, 1950; White, 19*H), sensory adaptation (Kubie &

Margolin, 19^0* concentrated states of attention (Orae, 19^5 )*

and neurological change based upon psychological suggestion. The

list goes on and the empirical data to support anyone of these

theories is isolated.

Most present day investigators view hypnosis as a fundamentally

different state from the waking state; however, there is widespread

disagreement among themselves as to the meanings of their terms

(Bowers, 1$66). Hilgard (l$66) states that hypnosis is commonly

considered to be a 'state’ perhaps resembling the condition in which

the sleepwalker finds himself, hence the term ’somnabulist’ is

applied to the deeply hypnotized person. Gill and Brenman (1959)

refer to the hypnotic state as "an induced psychological regression,

issuing, in the setting of a particular regressed relationship between

two people in a relatively stable state which includes a subsystem of

the ego with various degrees of control of the ego apparatuses".

Haley (1959) describes the trance process as an interaction

consisting of "one person persuading another to do something and to deny that he is doing it". Orne (1959) suggests one of the essential

characteristics of the trance state is a tolerance for logical in­

consistencies, i.e., "trance logic". Evans (19^8) views hypnosis primarily as a dissociative process. Certainly any explanation one might purport to account for the hypnotic state can be taken to task; however, there are some generally accepted statements about hypnosis that most theoreticians

can live with according to Haley (1958)* He sayss

(1) The trance has something to do with the relation­ ship between the hypnotist and the subject® (2) It is a focusing of attention. (3) The hypnotist initiates what happens in the session.

Stating anything more specific than these broad parameters would find one embroiled in controversy, subjective judgement, and emotionalism.

Freud and Joseph Breuer were the first to realize the con­ sequences of hypnosis as a doorway into a dynamic psychotherapy.

It was Breuer who first hypothesized that in hypnosis a significant memory might be relived, and this discharge of emotion would have

significant therapeutic value (Brenman & Gill, 19^7)* Assuming the impetus of Breuer, Charcot and many of the early hypnotists,

scientists have sought reasons for the efficacy of hypnosis for over one hundred years.

There are many schools of thought today regarding the hypnotic

state. They are differentiated not so much about the overt responses plausible while under hypnosis, but more so concerning the very definition of hypnosis as a trance or a non-trance state.

Kroger (19^3 ) 3 Erickson (1967) an(i Barber (1961a) all define the trance state differently. Kroger (1963) says the ability to achieve hypnosis lies within the subject®s willingness to accept the 20 efficaciousness of the procedure. He emphasizes quite often that conviction to hypnosis is hypnosis. Erickson (19&7) suggests?

"In a well trained subject, somnambulistic trance Is that type of trance in which the subject is seemingly awake and functioning adequately, freely, and well in the total hypnotic situation in a manner similar to that of a non-hypnotized person."

Much of the time, Erickson’s subjects deny that they are in a deep hypnotic trance, and are very often judged to be quite awake by other investigators® Whenever Erickson says a subject is in a somnambulistic state, it is quite clear that he means something different from a sleeplike state. He reports that most of his subjects are merely highly responsive to suggestions. More specifically he contends that a trance is said to give rise to a high level of response to suggestion, and a subject is said to be in a trance when he manifests a high level of response to suggestion.

(Barber, 1973).

Obviously Erickson, as well as many present day investigators, translates such terras as "somnambulistic state, deep trance, and deep hypnosis", to encompass whatever happens to the subject to make him highly responsive to suggestion. Barber (1973) says:

..."data (regarding the hypnotic state) can be interpreted as indicating that attitudinal, motivational, and expectancy variables in a hypnotic situation (e.g. the experimenter’s statements and manipulations) and the dependent or consequent variable (e.g. the subject’s response to test suggestions of analgesia, hallucination, age regression, amnesia, etc.)."

Erickson (19^7) concurs espousing that the terms somnambulistic state and hypnotic trance are not to imply a condition mimiking that of a sleepwalker, but they may be used to "refer to the 21 mediating variables or intervening variables between the stimulus

situation and the subject's high level of responsiveness

Barber (1973) postulates that subjects will engage in be­ havior typically associated with the mysticism of hypnotism to the extent that certain mediating variables are present. He says

in order for hypnotism to properly work, the subject must have;

A; Positive attitudes toward the hypnotic situation.

B; Positive motivations to try to perform well on suggested tasks, and try to experience those things suggested.

C: Positive expectancies that the tasks and suggested effects will be rather easy to perform and to experience.

D; Positive expectancies that various types of unusual be­ haviors are appropriate in a hypnotic or suggestion situation.

E: Positive ejq>ectancies that they themselves will be hypnotized.

The mediating variables that both Erickson and Barber speak of

have generally been incorporated within all that encompasses the

terms "altered states of consciousness, trance state, etc." Barber

(1973) states

(a) The mediating variable in hypnotic behavior can be fruitfully conceptualized in terms of specific kinds of attitudinal, motivational, and expectancy factors.

(b) These attitudinal, motivational, and expectancy variables are on a continuum with stimulus variables that play an important role when subjects perform well in various types of test situations.

(c) It is misleading to label these variables as an altered state of consciousness or as a hypnotic trance state. 22

As we may readily observe, Barber (l96Ha, 1969, 1973)* views hypnosis from an alternative paradigm that does not include "Special States" of trance or somnambulism. He views hypnosis as not being quali­ tatively different from the waking state.

Barber*s paradigm does not assess any qualitative difference between the "states" of a person who is highly responsive to suggestions and to one who is not. He engages a circulatory definition of hypnosis suggesting that a person is hypnotized if he is highly responsive to suggestion, and that a person highly responsive to suggestions is hypnotized. Barber (1973) states

three factors, attitudes, motivation, and expectancies, vary on a continuum (from negative, to neutral, to positive) and they converge and interact in complex ways to determine to what extent a S will let himself think with and imagine those things that are suggested. The extent to which the subject thinks with and vividily imagines the suggested effects, in turn, determines his overt and subjective responses to test suggestions.

Hypnosis cannot really be explained by any single factor such as corticle inhibition, hypersuggestibility, regression, or dis­ sociation, but rather by a cross fertilization of many areas of human thinking. It is not the purpose of this study to prove the existence of a trance state; however, what is important is to realize that hypnosis in terms of this study is defined as conditions of concentrated focused attention as brought about by positive attitudes, motivations, expectancies and the subject's willingness to cooperate, think, and imagine the suggestions that are being offered. 23

Perhaps the most important variables concentrating on hypnosis are the attitudinal, expectancy, and motivational variables.

Barber (1973)# Paul (19&9)# Gill and Brenman (1959)# Kroger (19^3)#

Gregory and Diamond (1972), Palmer and Field (1968) and Horowitz

(1968) generally agree that if a situation is defined as hypnosis, and the subjects expect to be hypnotized, then variables con­ comitant to the trance can be produced. As Kroger (19^3) so aptly stated, "Conviction to hypnosis is hypnosis,"

As we might well derive from the above references, the hypnotic state, trance, or whatever one prefers to label it, is dependent upon the intervening and mediating variables construed within and around the hypnotic procedure. Logically, one might define specific mediating variables and empirically test them giving rise to more insight into the hypnotic process.

Once one can transcend the theory of the hypnotic state, the next logical question is, Why use it?

If man cannot control himself, his enviornment, and to some extent the reactions of others, he lives with the threat of being overwhelmed by a mind rebelling, a body refusing to obey, a world extracting exorbitant "protection money" to allow him merely to survive and a community being in­ different or hostile to his needs (Zimbardo, Maslach and Marshall, 1972).

Hypnosis has a tremendous potentiating effect for persons taking charge of what is happening to them and how they interact both inter and intra personally with others and their environment.

By focusing concentration on their self-processes and environmental cues, person's may be more able to control their thoughts, feelings 2k and behaviors, Schachter and Singer (1962) demonstrated the

importance of environmental cues in determining the nature and labeling of emotions.

Investigators have reported many incidents of cognitive control of behavioral, physiological and affective responses. Miller (1969) has demonstrated that the control over skeletal muscle responses through operant conditioning methods may be extended to responses of

the glands and vicera. Zimbardo, Rapaport, and Baron (1969) report that biological drives and social motives may be brought under the control of cognitive variables such as choice and Justifi­

cation. On the other hand many investigators, Barber (1961b),

Crasilneck and Hall (1959)* Gorton (19^9)* Levitt and Brady (1963) and Sarbin (1956) have reviewed the literature on physiological

correlates of hypnosis and have found conflicting results.

For instance, Barber (1965a) points out that control groups were often omitted in a number of reports studying the hypnotic

cure for asthma, and that the reportedly improved respiratory rate

could not be attributed to the hypnotic state because of this unparsimonious attribute. Results supporting deafness (Erickson,

1938a), hallucinations (Brady and Levitt, 1966, Underwood, i960), and analgesia (Chertok and Kramarz, 1959* Elliotson, lQ1^* Esdaile,

1850) have all been questioned and found methodologically lacking.

The evidence supporting hypnosis is at best confusing; however,

the controversy does not center only around the outcomes, but around the credibility of the trance state as well. Most of the 2k and behaviors. Schachter and Singer (1962) demonstrated the importance of environmental cues in determining the nature and labeling of emotions.

Investigators have reported many incidents of cognitive control of behavioral, physiological and affective responses. Miller (1969) has demonstrated that the control over skeletal muscle responses through operant conditioning methods may be extended to responses of the glands and vicera. Zimbardo, Rapaport, and Baron (1969) report that biological drives and social motives may be brought under the control of cognitive variables such as choice and justifi­ cation. On the other hand many investigators, Barber (1961b),

Crasilneck and Hall (1959 )> Gorton (l9^9)> Levitt and Brady (19^3) and Sarbin (1956) have reviewed the literature on physiological correlates of hypnosis and have found conflicting results.

For instance, Barber (1965a) points out that control groups were often omitted in a number of reports studying the hypnotic cure for asthma, and that the reportedly improved respiratory rate could not be attributed to the hypnotic state because of this unparsimonious attribute. Results supporting deafness (Erickson,

1938a), hallucinations (Brady and Levitt, 1966, Underwood, i960), and analgesia (Chertok and Kramarz, 1959> Elliotson, I8 U3, Esdaile,

1850) have all been questioned and found methodologically lacking.

The evidence supporting hypnosis is at best confusing; however, the controversy does not center only around the outcomes, but around the credibility of the trance state as well. Most of the 25 debunking studies report lack of control groups, lack of groups receiving direct suggestion, and confounding of variables as their major critical arguments.

Susceptibility

Hypnotic susceptibility refers to the subject's degree of responsiveness to hypnotic suggestion administered under standardized conditions (Hilgard, 1965). Questions such as, Which persons are more susceptible to hypnosis? and What are the important factors determining hypnotizability?, have been the subject of much research that unfortunately yields conflicting results.

Bramwell (1928) cites a few general characteristics that have been agreed upon by most researchers as favorable to hypnotic induction. He states that a good hypnotic Ss must have at least

"fair" intelligence, is usually under 50 years of age, does not have a severe attention disturbance, and most importantly, is willing to cooperate in the experiment. Erickson (1939a) strongly agrees with Bramwell’s last assumption and says: "...any really cooperative

S may be hypnotized...regardless of whether he is a normal person, a hysterical neurotic, or a psychotic schizophrenic patient."

Although most researchers do not agree wholeheartedly with

Erickson, cooperation does seemingly play an integral role in hypnotic susceptibility. For years it has been assumed that good hypnotic subjects have a special set of personality traits or characteristics which allows them to easily become hypnotized. Throughout the history of hypnosis, researchers have suggested that good Ss could be dif­ ferentiated from poor Ss in terms of gullibility, neuroticism, hysteria, extroversion, ego strength, general cooperativeness, tendency to give socially desirable answers, and willingness for self-disclosure (Barber, 1973)* More recent research indicates that these assumptions are misleading as Barber (l961*b), Deckert and West (19^3)# and Hilgard (1965) have all reported that many of the susceptibility studies show either conflicting or negative results. Barber (1973) reports that one study found a positive correlation between hypnotic suggestibility and neuroticism; another found a negative correlation; and still another set of studies re­ ported no signicant correlations whatsoever (Cooper & Dana, 196k}

Eysenck, 19*1-7; Furaeaux & Gibson, 19^1J Heilzer, i960; Hilgard &

Bentler, 19^3j Lang & Lazovik, 1962).

Whereas some studies report that responsiveness to test- suggestions are correlated with a Ss tendencies toward having natural hypnotic like ejqperiences, e.g., vivid daydreams (Shor, Orne &

McConnell, 1962), others have found no correlations (Barber &

Calverley,19&5 j Dermen, l$6h). Davis and Husband (1931) suggest that training plays a large part in the success with which a hypnotist can induce sucessively deeper states of hypnosis. Erickson

(1967) concurs, suggesting that a total of four to eight hours of initial induction training is sufficient for trance development.

Although most of the evidence reporting correlations between susceptibility and personality characteristics is conflicting, these unclear findings lead to several important implications regarding susceptibility.

(1) Susceptibility is not a static process which con­ sistently appears under all circumstances.

Barber (l96Ua) and Hilgard (19&5) suggest that most good hypnotic

Ss remain good hypnotic Ss, and most poor hypnotic Ss remain poor hypnotic Ss when they are tested in the same way twice (test- retest correlations ~ .72 to .82); however, some Ss show marked differences, first performing as good hypnotic Ss and then as poor hypnotic Ss (Barber, 1957; Dorcus, 1963; Meares, i960).

Barber (1973) attributes the variability of a subject's suscep­ tibility to corresponding changes in his attitudes, motivations, and expectancies toward the test situation.

(2) Positive task expectancy plays an integral part in eliciting hypnotic behaviors.

Klinger (1968), Wilson (19^7) and Barber and Calverley (196*0 all report that Ss are significantly more responsive to standardized suggestions when told the tasks they have to perform are easy rather than difficult.

(3) Attitudes and expectancies in regard to hypnosis are important in eliciting hypnotic behavior.

Anderson (19^3)> Barber and Calverley (1966), Shor, Orne and

O'Connell (1966) and Melei and Hilgard (196b) all report positive 28 correlations between subjects' susceptibility to hypnosis and their pre-experimental attitudes towards hypnosis in addition to their pre-experimental expectancies of their own level of hypnotic depth.

In summary, the data, as in all levels of hypnotic research, report conflicting results; however, recent literature, as cited above, has in part accounted for to what degree Ss manifest hypnotic behavior is dependent upon the attitudes, motivations and expectancies toward the experimental situation.

Two instruments used in determing hypnotic susceptibility are the Stanford Hypnotic Susceptibility Scales (SHSS) (Weitzenhoffer &

Hilgard, 1959) and the Harvard Group Scale of Hypnotic Suscep­ tibility (HGSHS) (Shor & Orne, 1962). Both are long and arduous to administer. The present study uses a more manageable measure of hypnotic suggestibility that incorporates both a subjective and objective measure of suggestibility. The Barber Suggestibility

Scale (BSS) (Barber, 1965a) will be more fully explicated In Chapter

III.

Rational Cognitive Behavior Therapy

In spite of the conflicting data, controversy, and disagreement regarding hypnosis, research in the field continues. Some of the reasons for continued research may be as Zimbardo, et.al. (1972) state. They say:

Hypnosis (a) is a state wherein the effects of cognitive processes on bodily functions are amplified; (b) enables the subject to perceive the locus of causality from mind and body control as more internally centered and volitional; (c) is often accompanied by a heightened sense of visually imagery and (d) can lead to intensive concentration and elimination of distractions.

Given this framework, a logical progression in the evolvement of a rigorously controlled, yet artfully administered psychotherapy, would be to couple hypnosis with cognitive behavior; therapy; specifically, rational emotive theory (RET).

As previously stated, RET, developed by Ellis (1961, 1971) is a cognitive behavior therapy recognizing affective states as essentially being derived from cognitive processes. Ellis draws support for the concept that self verbalizations mediate the pro­ duction of emotions from Coue (1922), Korzybski (1933)/ Johnson

(19^6) Kelly (1955)/ an

RET incorporated many methods to clarify and to restructure irrational thinking towards more rational thinking, feeling, and behavior. Tosi (197*0 cites several techniques which may be used within a rational framework: Rational emotive modeling based on

Bandura (19&9); utilization of the Premack principle (Tosi, Briggs,

Sc Morley, 1971); assertive training, thought control (Lazarus, 1971) aversive imagery (Cautela, 1972); REI (Maultsby, 1971); and syste­ matic written homework (Maultsby, 1972). Others lending support to 30 cognitive behavior theory include Meicheribaum and Cameron (197*0* who have demonstrated the clinical potential of modifying client9s self verbalizations. Schachter and Singer (1962) report in their now classic study that emotional states are a function of a state of physiological arousal and a cognition appropriate to that state of arousal. Meicheribaum et. al. (1971) show that clients with high social distress who suffered anxiety in multivaried situations could benefit more from RET than from standard desensitization procedures. Lazarus (1971)* Karst and Trexler (1970), DiLoreto

(l97l)* and Moleski and Tosi (1975) have all shown RET to be effective in various situations.

According to Meicheribaum and Cameron (197*0, "when standard behavior therapy procedures were augmented with a self-instructional package, greater persistence of treatment efficacy, more generali­ zation, and greater persistence of treatment effects were obtained."

A number of investigators suggest that relief from anxiety may be significantly reduced when clients have a specific set of self- instructions or a specific methodology to use (D'Zurilla, 19^9}

Zeisett, 1968; Goldfried, 1971; Suinn & Richardson, 1971)* Further­ more, these same investigators substantiate the efficaciousness of a skills training approach followed by an opportunity for application or practice is effective in the reduction of anxiety.

The support for cognitive control over emotional states is ever growing. Ellis (1962) suggests a person "can be rewarded by his own thinking, even when this thinking is largely divorced from outside 31 reinforcements and penalties.” A number of other studies (Arnold,

1968; Velton, 1968; Lazarus, 1971) have investigated cognitive control over the induction of emotions both pleasant and unpleasant and have found the mediational cognition, or how the S appraises the situation, to have significant effect upon felt emotion.

Further research indicates that therapeutic techniques involving positive self verbalizations can reduce anxiety, just as maladaptive

self-attributed cognitions mediate the production of anxiety

(Kelly, 1955; Phillips, 1956; Ellis, 1962; Schachter, 1966).

Systematic desensitization (Jacobsen, 1938; Wolpe, 1958;

Paul, 1969) and cognitive desensitization (Zeisset, 19&J;

Lazarus, 197^; Meicheribaum, 1971) have also been suggested to

significantly reduce anxiety in clients. Zeisset (1968) most directly substantiates the claims of systematic desensitization as a cognitive change process as he compared the relative effectiveness of standard desensitization procedures (e.g. Wolpe) with a modifi­ cation of it (relaxation training with instructions regarding its application) and found the two virtually equal.

The implication of Zeisset8s work is that it is the learning of a strategy to cope with anxiety that is the crucial aspect of the treatment.

In a study comparing the relative effects of systematic desensitization and rational emotive therapy in the treatment of

speech anxious clients, Meicheribaum et.al., (1971) reports that

RET was equally effective as desensitization in reducing the 32 behaviors and affective indicants of speech anxiety, and in some cases more effective.

The use of cognitive restructuring techniques in counseling presupposes that attitudes, beliefs, values, and perceptions are amenable to modification through the cognitive process, the same cognitive processes that mediate the learning and maintaining of attitudes. Lazarus (1968, 1971) has suggested combining cognitive restructuring with conventional desensitization procedures and has reported producing more rapid and durable clinical results when doing so. Davison and Valins (19^8) have also indicated the importance cognitive restructuring plays during desensitization therapy.

What we might discern from the literature is that there is a need for a convergence and synthesization of some of the cognitive behavioral approaches and the hypnotherapeutic or imagery techniques.

Rational stage directed therapy is such an attempt. RSDT is an intervention designed to help people develop and use their thinking more efficiently in dealing with self-defeating emotional, physio­ logical and behavioral states. It is an attempt to actually restructure a person’s method of appraising situations or events from one that might include over catastrophization and over generalization to a more logical, realistic and self-enhancing appraisal of situations.

The importance of the hypnosis and the imageric processes in

RSDT resides in the fact that actually visualizing, imagining and experiencing cognitive, emotive or physiological states is quite 33 different from merely talking about them. The visualization pro­ cesses in hypnosis and imagery and the stressing of the cognitive coping process, which is an abstract generalization applied to specific stimuli, should result in greater treatment general!zation.

Once a person is comfortably relaxed, images and experiences tend to become more vivid, more concrete and absolute (TOiite, 19^1 ).

The major difference between relaxation training, a la Wolpe, and hypnosis lies in where the subjects8 attention is focused. In hypnosis the use of indirect suggestions of relaxation and warmth with instructions to maintain alertness is employed, rather than direct suggestion of drowsiness and sleep (Paul, 19&9). Support for cognitive control of relaxation has been offered by Valins and Ray

(1967) and Jencks (1973).

Lang (1968) states: "The absence of programs for shaping cognitive sets and attitudes may contribute to the not infrequent failure of transfer of treatment effects." RSDT attempts to generalize treatment effects by having the client engage in in-vivo behavioral tasks corresponding closely to imagery or hypnotic conditions.

Stage Directed Therapy

The concept of employing stages in Rational Stage Directed

Therapy has grown out of the works of Mooney (1963) and Quaranta

(1971). Quaranta (1971) identifies six stages of development in 3^

career education. He purports that a person is continually involved

in either awareness, exploration, commitment, skill development,

skill refinement, and redirection or change. Each stage is a non­

static, free-flowing entity; each is contained within the other.

For instance, if a person were exploring new careers, he would be gaining new awareness as well. Tosi (197*0 adapted these stages

to counseling and psychotherapy, and Tosi and Marzella (1975) have

further adapted and altered these stages for Rational Stage

Directed Therapy. The growth stages of RSDT are self-awareness,

exploration, commitment to rational/constructive action, the

implementation of rational action, the internalization of rational

action, and change and redirection. Rational action implies not only behavior, but thinking and feeling as well. The person’s progress

through these stages is noted not only in the therapeutic context, but in real life situations. In brief these stages are defined as

follows:

Awareness - The client sees in himself and his environment new possibilities for growth. He is introduced to new conditions that are contradictory to his self-defeating thoughts, feelings, and actions. He sees that new thoughts, feelings, and actions (skills) are needed to interact more effectively with his environment and with himself. He comes to consider himself both as subject and object. He realizes that he has consciousness of himself. Awareness implies witnessing, observing, as well as participating in one's innermost thinking, emotional experiences, physiological functioning, motoric functioning, and transactional functioning (Tosi & Marzella, 1975)* 35

In the Awareness stage, the crucial task of having the client become cognizant of the many new possibilities the counseling process may offer him evolves. As the client may lack sufficient

knowledge and information about effective living, as well as the

conditions under which he might achieve a more effective life, the

therapist actively introduces new ideas and possibilities for the

client to think about. The awareness stage includes an introduction

to the basic behavioral modifying process so the client may better

orient himself to the demands of the counseling situation. The

client is guided through the awareness stage and focuses on his

current thoughts, feelings, and behaviors. As the counselor

guides the client through the awareness stage, they tune in to the

client's cognitive processes and identify irrational and rational

thoughts. According to Tosi (197*0* the awareness stage primarily

emphasizes the cognitive functioning of the client, as the counselor

directly assists the client in the acquisition of information and facts about the behavior modifying process. As the client becomes more aware of the facts of counseling, he is able to explore him­

self more deeply with respect to his newly acquired information.

Exploration - The client tests out his new awareness or knowledge about himself in the therapeutic context and in real life situations. He submits his old as well as his new ideas, translated into hypotheses, to the empirical test. He is engaging in high level cognitive restructuring in an experimental way. He experiences or reexperiences situations he previously avoided, tries out new behaviors or roles, and evaluates the consequences of his acts. Awareness is expanded as a result of s elf - in<- si tuation explorations. Resistance "becomes increasingly apparent in this stage. He is exploring and developing skills in this stage (Tosi & Marzella, 1975)*

Basically the exploration stage is a time for the client to look at many different inodes of thinking, feeling, and behaving. Upon exploring many of these methods, he may be ready to commit him­ self to rational action.

Commitment to rational/constructive/action - The client poses his previous awareness and explorations and skills against his tendency to resist or not to resist an authentic encountering of self“and-environment. He is more aware of the innermost thoughts that produce affective/physiological/reactions associated with his tendencies to approach or to avoid significant life situations or to develop the skills necessary to over­ come his cognitive/emotional/behavioral/social difficulties. The stage of commitment represents an act of faith, a risk. A last minute attempt to avoid subjective or objective reality. It is the juncture at which many terminate therapy - the point of choice or decision to act. (Tosi & Marzella, 1975)*

With greater awareness and exploration of self, the client, if he decides to pursue a more effective way of living, must commit himself to enter into working toward change. The focus of this stage lies in having the client imagining himself being committed to more rational ways of thinking, feeling and acting. As the client is capable to develop more effective living skills, the counselor calls essentially for the client to trust himself and the therapist and to imagine himself being committed to more effective means of living. As the client i6 deeply relaxed, many of his resistances will be bypassed and his commitment will be more easily implemented. 37

Implementation - The client, after privately and/or publicaly committing himself to constructive action, implements constructive action or the self and environmental management skills he is in the process of acquiring. His skills at this stage may involve cognitive control over emotional/physical, and behavioral states - bio feedback, meditation, cognitive/behavioral restructuring, problem solving, decision making, self-hypnosis, pro­ gressive relaxation and the like. (Tosi & Marzella, 1975).

The implementation stage is of particular import as it is here that

the client actively tries out the new ways of living he has become

committed to. He is urged by the therapist to apply the behavioral

modifying procedures to which he has become committed. The client

must actually apply his new skills in real-life situations.

Internalization - The client shows signs of making his new learnings and experiences a part of himself. He shows obvious signs of incorporating more reasonable modes of thinking and acting into his behavioral repertoire. The use of behavioral modifying procedures becomes second nature - he implements them with greater ease and proficiency. (Tosi & Marzella, 1957).

The level of internalization is a logical progression from the preceding stages. Once implementation of more self-enhancing

thinking, feeling, and behaving is successfully attained, the

client is likely to internalize these as his new system of living.

Only after the client realizes that he can be more effective and

act in more self-enhancing ways will he internalize the more rational

system of interacting.

Change, redirection - The client observes himself. He notes significant changes in his thinking, he sees that he can control significantly negative emotions and self- defeating actions. He transacts more effectively with his environment - thus maximizing positive consequences. He may reaffirm his process at this point, or redirect himself through the stages once again - relative to some other set of problematic concerns. He realizes the need for further growth. (Tosi & Marzella, 1975)-

In each stage, the client is acquiring, developing, and refining behavioral modifying skills. In the awareness stage, the client learns self-monitoring and observational skills. As he moves into the exploration stage, he develops logical-experi­ mental and hypothesis testing skills. He develops cognitive restructuring skills through practice and testing. The commitment stage forces the client- into decision making or choice. He acquires skill In using his learnings to make difficult choices.

In the implementation stage, the client moves from the safety of the therapy context to real life situations. He Is using his therapeutic skill In his real life environment. As he internalizes new and more effective approaches to life, he continues refining these approaches. CHAPTER III

Method

This chapter will describe the research methodology and statistical procedures used in this study. The chapter will provide sections related to the selection of instruments, sample selection, therapists, design, treatments, statistical procedures, and a general chapter summary.

A 3*5x2x3 factorial design with three levels of therapists, five levels of treatment, two levels of susceptibility, and three repeated measures, was used in the investigation of the effects of two Stage Directed Therapies on the reduction of psychological stress. Specifically, this study was conducted to determine the efficacy of RSDH and RSDI in reducing psychological stress opera­ tionally defined by Ss scores on the Minnesota Multiphasic

Personality Inventory, (MMPl), Multiple Affect Adjective Checklist

(MAACL), the Self-rating Depression Scale (SDS), the State-Trait

Anxiety Inventory (STAl), and the Depression Inventory (Dl).

The design included two treatment groups and three control groups, each having equal numbers of high and low suggestible Ss.

The treatment groups were (l) Rational Stage Directed Hypnotherapy, and (2) Rational Stage Directed Imagery. The control groups included

(l) Hypnosis only, (2) Placebo, and (3) a no-treatment Control group. Ho

The dependent measures for this study were pre, post, and follow-up measures on the (l) Minnesota Multiphasic Personality

Inventory (MMPl), (2) the Multiple Affect Adjective Checklist

(MAACL), (3) the Self Depression Scale (SDS), (H) the State-Trait

Anxiety Inventory (STAI), and (5 ) the Depression Inventory (DI).

Pretreatment measures, including the Barber Susceptibility Scale, were obtained approximately one week prior to the beginning of treatment. Post treatment measures were obtained after six weeks of treatment, and follow-up measures were obtained three weeks after the last session.

Selection of Instruments

Barber Suggestibility Scale (BSS);

All Ss were administered the BSS to determine their basal level of suggestibility. The BSS consists of eight standard test sug­ gestions, including arm lowering; arm levitation; hand lock; thirst hallucination; verbal inhibition; body immobility; posthypnotic­ like response; and selective amnesia. The suggestions were read to all Ss, and a possible eight points could be scored on the objective portion of the BSS. Another eight points could be scored on the subjective part of the BSS. A subject obtaining a score of eight or higher on the entire test was considered high in suscep­ tibility, and a person scoring less than eight was considered low.

(See Appendix A for BSS and administration instructions). A subject obtains points on the objective scale (one point

for each of the eight suggestions passed) if; the right ana moves

down four or more inches; the left arm rises four or more inches;

the S tries but does not unclasp his hands; he exhibits swallowing,

moistening of the lips, or marked mouth movements, and states

postexperimentally that he became thirsty during this test; he

tries but fails in saying his name; he tries but fails in standing

fully erect; he coughs or clears his throat when the cue is pre­

sented postexperimentally; and he forgets that his arm was rising

when asked to name the tests postexperimentally.

The Ss can receive a maximum of eight points for his subjective

score on the BSS. He receives one point for each test if he states,

during the standard postexperimental interview, that he actually

experienced the suggested effects, and that he did not respond

simply to follow the instructions or to please the experimenter.

Barber and Glass (1962) have reported a test retest correlation

of .88 (p.<00l) for the BSS in a study of 60 women college students who were assessed under "base-level" conditions. Other studies

(Barber & Calverly, 19^3b, Barber & Calverly, 196k, and Barber,

1965a) have also obtained test retest correlations of .80 or above for both objective and subjective scores on the BSS. Split half

reliability was computed by correlating scores on the odd-even

items of the BSS, and the Spearman Brown reliability for the scale

indicates internal consistency reliabilities greater than .80

(Barber, 19&9)® Independent raters assessed a random selection of each therapist®s administration of the BSS. The two raters were a faculty member of the Faculty of Special Services at the Ohio

State University, and a student in the same department. Each therapist was rated on 5 randomly selected administrations. The correlations between the raters and the therapists are as follows;

Table 1

Correlations of Interater Reliability for

the Barber Susceptibility Scale

Raters Therapists 1 2

1 ra .96 r® .92

2 rs.98 rs.97

3 r s .9 7 r s .8 7

A Spearman rank order correlation was performed on a random selection of 10 Ss in order to ascertain any changes in suscep­ tibility after the treatment period. The rho coefficient, ps.8.3, was significant suggesting that those Ss who were high in suscep­ tibility prior to treatment remained high in susceptibility after

treatment, and likewise for those who were measured as being low

in suggestibility. The State-Tralt Anxiety Inventory (STAI) (Spielberger, Gorsuch,

Lushene, 19^9) consists of two separate self-report scales that measure state anxiety and trait anxiety. The instrument was developed as a research device for use with non-psychiatrically disturbed adults. The STAI-A-Trait scale consists of 20 statements asking subjects to describe how they generally feel. The A-State scale consists of 20 statements asking the subject to describe how they feel at a particular moment in time. (See Appendix B for

STAI).

According to Spielberger et. al., (19^9)> State anxiety

(A-State) is

a transitory emotional state or condition of the human organism that is characterized by subjective, consciously perceived feelings of tension and apprehension, and heightened autonomic nervous system activity.

Trait anxiety (A-Trait), according to Spielberger et. al., (19^9)# refers

...to relatively stable individual differences in anxiety proneness; that is, to differences between people in the tendency to respond to situations perceived as threatening with elevations in A-State intensity.

Subjects respond to each item on both inventories by rating themselves on a four-point scale. The four categories for A-State are: (l) not at all, (2) somewhat, (3) moderately so, and (*0 very much so. The categories for the A-Trait scale are: (l) almost never, (2) sometimes, (3) often, and (h ) almost always.

Some items are worded in such a manner that a rating of "fe" indicates a high level of anxiety, while on others, a rating of Ufc

"k" indicates a low level of anxiety. A scoring procedure has been worked out to account for these differences by reversing the scores for those items on which a high score indicates a low level of anxiety.

To reduce the potential influence of acquiescence or "response set" the A-State scale has ten items which are directly scored (i.e.; low to high anxiety) and ten reversed items (i.e., high to low anxiety). The A-Trait scale has thirteen items that are scored directly and seven items that are reversed.

Five of the items on the STAI are used in both scales; three of these are worded exactly the same on each scale and two contain the same key terms. The remaining fifteen items on each scale are sufficiently different in content and/or connotation to be re­ garded as independent items (Spielberger, Gorsuch and Lushene, 1969)°

Test-retest correlations for the A-Trait are high, with the reported correlations ranging from .73 to .86 for periods up to

10k days. As might be expected with an instrument that is sensitive to transitory changes in affect states, the A-State has a test- retest correlation that is lower than the A-Trait, and has a reported median Pearson r of .32. When measured in terms of internal con­ sistency, however, the K-R coefficient ranges from .93 to .92 for the A-State scale (Spielberger, et. al., 19^9)•

The A-Trait scale has shown a correlation of .75 with the

IPAT and a correlation of .80 with Taylor's Manifest Anxiety Scale

(TMAS) (Spielberger et. al., 1969)« Both the IPAT and TMAS are purported to measure trait anxiety*

The evidence to indicate that the A-State is sensitive to brief or transitory anxiety states has been summarized by

Spielberger et. al. (1969)* In one study, Ss were administered

the A-State in a single testing session under four different conditions. The first administration occurred at the beginning of the testing sessions (Normal Condition). The second adminis­

tration of the scale followed a 10-minute period of relaxation

training (Relax Condition). The third administration followed a

10-minute period in which the Ss worked on problems on the Terman

Concept Mastery test which was described to Ss as a "relatively easy I.Q. test" (Exam Condition). The final administration of the

scale followed immediately after the Ss viewed a stressful movie

(Movie Condition) depicting several accidents in a woodworking shop.

The mean score for the A-State was lowest in the Relax

Condition and highest after the Ss viewed the stressful film. In

the Normal and Exam conditions, the scores were approximately the

same for males and females, indicating that these conditions had a

similar impact on both sexes. The Movie Condition was particularly upsetting for the females whereas the Relax Condition seemed most

effective in reducing their emotional intensity. This condition

suggests that the A-State scale is a sensitive measure of anxiety

occurring under differing stimulus conditions and also suggests

that females are more emotionally labile than males and/or that

they are more willing to report their feelings. U6

Minnesota Multlphaslc Personality Inventory (MMPI)

The MMPI is designed to provide an objective assessment of some of the major personality characteristics that affect personal and social adjustment (Hathaway & McKinley, 19^7)• The MMPI consists of 550 statements to be answered in a True-False-Cannot

Say manner. There are ten clinical scales on the MMPI; however, the scales are not expected to measure pure traits nor to represent discrete etiological or prognostic entities, but they have been shown to possess meaning within the normal range of behavior and will be considered in that manner (Hathaway & McKinley, 1967).

It is the reduction of these scales which Is of interest in this

study, particularly the D (depression), M (hypomania), and the SI

(social Introversion) scales. Other scales include: Hs (hypo­

chondriasis), Hy (hysteria), Pd (psychopathic deviate), Mf

(masculinity-feminity), Pa (paranoia), Pt (psychasthenia), and

Sc (schizophrenia). There are three validating scales as well: L

(lie), F (validity), and K (correction).

For detailed descriptions of each scale, the reader is referred

to Marks, Seeraan and Haller (197*0* Test retest correlations for

each scale of the MMPI' have been reported by Hathaway and McKinley

and are listed below: Scale and Abbreviation Test-retest reliability Coeffici

Lie (L) M Validity (F) .75 K (K) .76 Hypochondriasis (Hs) .81 Depression (D) .66 Hysteria (Hy) .72 Psychopathic deviate (Pd) .80 Masculinity-femininity (Mf) .91 Paranoia (Pa) .56 Psychasthenia (Pt) .90 Schozophrenia (Sc) .86 Hypomania (Ma) .76 Social Introversion (Si) .93

McKinley and Hathaway (19^3) indicate high validity for the

MMPI stating:

A high score on a scale has been found to predict positively the corresponding final clinical diagnosis or estimate in more than sixty per cent of new psychiatric admissions.... Even in cases in which a high score is not followed by a corresponding diagnosis, the presence of the trait to an abnormal degree in the symptomatic picture will nearly always be noted.

The MMPI has been used extensively in hypnotic research.

Generally, MMPI-based studies in this area have pursued two general questions: (l) What personality characteristics are common across subjects who are highly susceptible to suggestion? and (2) What changes might be brought about through hypnosis as measured by the

MMPI scores obtained under trance conditions (Dahlstrom, Welsh, and Dahlstrom, 1975)?

Sarbin (1950) and Fine (1958) have reported results positing a relationship between highly susceptible subjects and hysteriod personality characteristics. However, Hilgard (19&5), Secter (1961) and Schulman and London (1963) have studied similar relationships w

and offer no supporting evidence for this notion. Dahlstrom et. al.,

(1975) suggest that with the availability of standard scales for

measuring hypnotic susceptibility, there is a need to resolve once

and for all the role of personality variables in hypnosis.

The Multiple Affect Adjective Check List (MAACL), is designed

to fill the need for a self-administered test to provide valid

measures of three negative affects: anxiety, depression, and

hostility. It is the reduction in the intensity of these three

variables that is being observed over the course of this study. The

MAACL consists of 132 adjectives each of which the subject reads and

checks if he feels it describes him generally. The checklist is brief and requires less than five minutes to administer. The General

Form of the MAACL was given to all subjects, as it correlates with a broader range of the MMPI scales than the Today Form. (See Appendix

C for MAACL).

Correlations among the three MAACL scales as administered to

college students, males and females, are reported to be: Anxiety vs

Depression ° .75; Anxiety vs Hostility = .72 ; Depression vs

Hostility = .72. Test-retest reliability over an eight day interval

has been reported as: Anxiety .77; Depression .79; and Hostility .81*

(Zuckerman & Lubin, 1965). The MAACL has been shown to correlate

with a broad range of scales on the MMPI. The MMPI scales most con­

sistently correlated significantly with the MAACL Anxiety scale are:

Depression (D) ,6l; Hysteria (Hy) .75j Psychastenia (Pt) ,62;

Schizophrenia (Sc) .53* and Social Introversion (Si) .75 (Zuckerman &

Lubin, 1965). The MAACL Depression scale most significantly correlates vith the following scales of the MMPI: Hypocondriasis (Hs) AO j

Depression (D) .b-9; Psychasthenia (Pt) .hj, and Schizophrenia

(Sc) .75. The MAACL Hostility scale correlates significantly vith the Depression (D) .35; Paranoia (Pa) .33; Psychasthenia (Pt) .37? and the Schizophrenia (Sc) .33 scales of the MMPI (Zuckerman &

Lubin 1969).

The Self-rating Depression Scale (SDS) (Zung, 19&5) "was developed as a scale for assessing depression in patients whose primary diagnoses were of a depressive order (Zung, 1965).

SDS is constructed so that the less depressed the subjects are, the lower their score. It consists of 20 items that may be answered by checking one of four categories ranging from a little of the time to most of the time. The scale was developed so that 10 items were worded symptomatically positive and 10 symptomatically negative. The 20 items comprising the SDS were constructed on the basis of the clinical diagnosis criteria commonly used in describing depressive disorders. Zung, Richards, and Short (19^5) reported significant positive correlations from a sample of 152 patients with certain MMPI scales and the SDS: D (.70); Hy (.61 ); Pt (.68), and Ma (.13). The low correlation between the Ma scale and the

SDS was expected as Depression and Ma tend to be negatively correlated (Zung, Richards & Short 1965). (See Appendix D for SDS).

The Depression Inventory, (Dl), (Beck, 1967) is designed to measure the depth of depression. Although it is intended to be used primarily with psychiatric patients, the DI is a sensitive measure of changes of the depths of depression, and it is the changes that are of particular import to this study. The inventory is com­ posed of 21 categories of symptoms and attitudes. Each category describes a specific manifestation of depression and offers four or five self-evaluative statements to choose from (Beck, 1967). The statements are ranked to reflect the range of the severity of the symptoms, and numerical values are assigned to each statement for scoring purposes. (See Appendix E for DI).

Internal consistency of the DI, as determined by. split-half reliability measures, yielded a reliability coefficient of .86.

Beck (1967) suggests that certain traditional methods of assessing the stability and consistency of questionnaires, such as the test- retest method and the inter-rater reliability method, were not appropriate for the DI. Specifically, he suggests that if the inventory were re-administered after a short time that the high correlation one might find between the two sets would be due to memory factors.

The DI has been shown to correlate highly (r=.75) with the

MMPI-D scale, and because of its high correlation, the DI may serve as a validation of the MMPI-D scale in this study. Selection of Sample

During the Spring Quarter, 1975* 68 subjects volunteered to participate in an experiment designed to help them better cope

•with psychological stress. No mention of hypnosis, nor any other specific method -was made until each S was assigned to his parti­ cular treatment condition.

Subjects consisted of ^1 females and 19 males, all of whom were upper-level master's degree students in Counselor Education or related areas at the Ohio State University. Volunteers were selected from the Counselor Educator's practicum and upper level courses to insure a homogenous population. All Ss were in academic training programs designed to produce either school or 1 agency counselors. The mean age of the sample was 2 6 . Subjects completed coursework in personality development, individual and group counseling theory, and career development. From the 68 volunteers, 60 persons were randomly selected to participate in the study.

Each person was administered the Barber Suggestibility Scale

(BSS) to determine their basal level of suggestibility. All Ss were also administered the MMPI, MAACL, STAI, DI, and the SDS during a pretesting period which lasted approximately 2^ hours.

Ss were then randomly assigned to a treatment process via a table of random numbers. Each S participated in six treatment sessions lasting approximately 1+5 minutes each. All treatment was completed within a 6 week period. The content for the treatment sessions was suggested by each subjects performance on the Self Directed

Behavior Change Instrument (Tosi, 1973)* All treatment took place in three offices of the Faculty of Special Services.

Therapists

The therapists providing the treatment were three advanced doctoral student in Counselor Education at The Ohio State

University. The ages of the therapists were 23, 27 and 29. All have completed considerable training in rational cognitive be­ havior therapy techniques, imagery and hypnotherapeutic approaches to counseling and psychotherapy. In addition, all therapists have t completed internships in counseling and psychotherapy.

Each therapist treated twenty subjects, an equal number of high and low susceptibles, across all treatments. Independent raters assessed randomly selected performances of each therapist to insure their adherance to each particular methodology. (See

Rating Scale for Therapists, Appendix F). The judges, a faculty member and an advanced doctoral student in the Faculty of Special

Services, each rated 15 randomly selected sessions. The product moment correlations of inter-rater reliability as applied to therapists' performance are as follows: 53 Table 2

Product Moment Correlations of Inter-rater Reliability

for Therapists* Performance of Treatment

Therapist Inter-rater Reliability

1 rs.89

2 rs.92

3 rs.91

Research Design

A 3x5x2x3 mixed model design with 3 between-subjects variables

(therapists, susceptibility, and treatments) and one within-subjects, variable (3 levels of a repeated measure) was used in analyzing the data (See Figure l). All Ss were assigned randomly to one of five treatment modes, with an equal number of high and low sus- ceptibles receiving each treatment. Each person received 6 treat­ ment sessions, approximately forty-five minutes in length, over a six week period. All 60 subjects received the Barber Suggestibility

Scale to determine their basal level of suggestibility, and pre, post, and follow-up tests were administered. Variance due to therapists was accounted for in the statistical analysis. The therapist variable was random. 5h

RSDH ESDI Hypnosis Placebo Control S1 Therapists Hi s2 A1 Si Ld s2 S1 Hi s2 S1 Lo s2 S1 ■ Hi s2 A3 S1 Lo S2

3 Between One Within Anova Treatments

Rational Stage Directed Hypnotherapy (RSDH)

RSDH is an attempt to synthesize a hypnotherapeutic approach with rational or cognitive restructuring while simultaneously

guiding or directing the client through the growth stages of awareness, exploration, commitment to rational action, implemen­

tation, internalization, and change or redirection. After the

client was exposed to the rudiments of rational emotive theory, he was asked to identify specific emotionally disturbing situations, using the Self Directed Behavior Change Instrument (Tosi, 1973*

see Appendix G).

After visualizing the situation and experiencing the emotional

responses associated with that event, the client was then directed

to challenge and confront his earlier identified irrational

cognitions specific to the situation; to rationally challenge them

and finally to supplant them with more rational self-talk.

The client was then hypnotized (see induction in Appendix H) and again directed to visualize specific predetermined situations

and to experience the concomitant emotions associated with the

situations. As the client engaged in more rational self-talk, he was directed to experience the more positive affect elicited by the

rational self-talk. He was also given post-hypnotic suggestions to practice RSDH outside the session in order to facilitate the change process. The therapist guided the client through each stage at the

client*s own pace. For instance, had a particular client needed

to explore more rational behaviors, a number of different modes for attacking problems were suggested by the therapist during the

exploration stage.

The hypnosis is expected to intensify the rational re­

structuring process, allowing it to be more fully realized, and ultimately, to hasten the implementation and internalization of more self enhancing cognitive, affective and behavior-motoric

actions. (See Appendix I for RSDH treatment plan) and Appendix J for an example session).

Rational Stage Directed Imagery (RSDl) is an intervention designed to help people develop and use their thinking more

efficiently in dealing with self-defeating emotional, physio­ logical and behavioral states. It is an attempt to actually restructure a person’s method of appraising situations or events from one that might include over-catastrophization and over­

generalization to a more logical, realistic and self-enhancing appraisal of situations. RSDI is much the same process as RSDH

except there is no hypnotic induction present in RSDI.

RSDI follows the same theoretical process as Rational Emotive

Imagery (REl) (Maultsby, 1972). Just as in REI where the client

is asked to imagine desirable behavior in favor of self-defeating behavior, in RSDI, the client was asked to picture his behavior in

his images as he would ideally like to behave. The Ss, under the guidance of the therapist, attempted to construct visually, methods that would lead him away from his disturbing behavior toward more rational expressions of feelings, thoughts, and self­ enhancing behaviors. Tosi (l9T^) suggested the generalized overall emotional effect of both real and imagined stimuli are often qualitatively the same; therefore, the client can learn to sub­ stitute personally desirable emotional tendencies for undesirable ones via imagery.

RSDI consisted of the following procedures: (l) The Ss were asked to identify and develop a mental image of a situation or event to which they responded with a negative emotion. Imagery content was derived from the Self Directed Behavior Change

Instrument (Tosi, 1973)• (2) The Ss were then instructed to imagine themselves thinking only rational thoughts relative to the problematic situation. (3) £s were then guided by the therapist to experience only positive emotions to their rational thoughts in conjunction with the situation.

With practice outside the therapy session, it is hypothesized that an individual can effectively overcome self-defeating irra­ tional cognitions and learn to supplant them with more self­ enhancing suppositions. (See Appendix K for session by session treatment). Hypnosis

Another treatment administered Ss was a hypnosis-only method.

Subjects receiving hypnosis were essentially a control for the

effects of the trance state or hypnotic phenomenon. The treat­ ment consisted of administering a standardized hypnotic induction

to subjects. Suggestions were given the Ss receiving this treat­ ment that the induction process alone would be enough to deal with

emotional stress. (See Appendix H for induction process).

Placebo

The fourth treatment was a placebo. Ss receiving the placebo treatment met and were given suggestions to relax and to become less anxious without any formalized or patterned method of dealing with the situations producing emotional unrest. Therapists in this treatment were instructed not to answer any questions directly, but to be very reflective and non-directive. The Ss were not given any specific methodology to deal with their problematic situations.

Control

The final treatment condition was the no treatment control group. Ss were assigned randomly to the control group from the same population as the other Ss; however, no one in the control group received any type of treatment. They were administered all tests as were the other Ss. Statistics

Data collected in this study were analyzed by a 3*5x2x3 factorial analysis of covariance. The analysis of covariance was employed using the pre test as the covariate for trials two and three to adjust for any possible initial pre-treatment differences among groups. The Newman Keuls method of post hoc analysis m s used to compare all possible combinations of means following significant F ratios for main effects and interactions.

Summary

Chapter III has presented the procedures and methodology of the study. It contains descriptions of the sample, intrumentation, therapists, design, treatments, and the analysis of the data.

Chapter IV will discuss the findings of the experiment.

Eesults of hypotheses testing will be presented by an examination of each variable and a summation of the findings. CHAPTER IV

Analysis of Data

The analysis of data will be presented in this chapter.

This investigation was undertaken to test the hypotheses stated in Chapter I. Of primary concern were the effects of Rational

Stage Directed Hypnotherapy (RSDH) and Rational Stage Directed

Imagery (RSDI) upon the reduction of psychological stress as measured by the MMPI, MAACL, SDS, STAI, and DI. Also of concern were the extent to which the level of client susceptibility to hypnosis and the therapists contribute to the therapeutic process.

The hypotheses of this study were tested by a three between- subjects one within-sub jects factorial analysis of covariance

(Winer, 1962). The three between-subjects variables included: five levels of treatments; three levels of therapists, and two levels of susceptibility. The one within-sub jects variable was the repeated measure (three trials). F ratios were computed for each main effect and interaction using the Component Analysis of

Covariance program (CANOVA). The analysis of covariance was used to adjust for any pre-treatment differences among groups. Sub­ sequent to significant F ratios, the Newman Keuls test was used in post hoc analysis (Winer, 1962). 60 6l

There vere 17 dependent variables included in this study.

Each dependent variable was discussed in light of the analysis of covariance. A summary table of each analysis was included, and where statistical significance was observed, a table of adjusted means was also included.

MMPI Scales

The ten clinical scales of the MMPI were included in this study as measures of psychological stress. Analysis of covariance for each of the ten scales revealed significant F ratios for depression, paranoia, and psychasthenia (See Tables 3 & k). The hypochondriasis, hysteria psychopathic deviate, masculinity- feminity, schizophrenia, hypomania and social introversion scales did not attain significance (See Tables 5 through 12).

Table 3 presents a complete analysis of covariance for the

Depression scale of the MMPI. Analysis of covariance was performed using the pre test as the covariate for trials two and three. A significant interaction (p< .0 5 ) between therapist and client sus­ ceptibility was disclosed. The significant interaction for therapist X susceptibility suggests that the observed mean depres­ sion scores of Ss were different from those expected by the simple addition of appropriate main effects. Inspection of adjusted depression means (Table 3-A) revealed that high susceptible Ss, treated by therapist one, realized substantially lower depression than did low susceptible Ss with therapist one. Contrariwise, high susceptible Ss treated by therapists two and three attained higher TABLE 3

Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for Adjusted Mean MMPI Depression Scores

df SS MS Between Subjects

Therapists (a ) 2 11.059 5.529 0.153 Susceptibility (B) 1 2.186 2.186 0.061 Treatment (C) if 71.536 17.88lf O.If96 Therapist X Susceptibility (AB) 2 288.933 IbkMG If.006* Therapist X Treatment (AC) 8 211.658 2 6 . If 57 0.73^ Susceptibility X Treatment (BC) If 117.778 29 . if if if O .816 Therapist X Susceptibility X Treatment (ABC) 8 335. Wo 1*1.935 I .163 Residual 29 376.1*66 12.982

Within Subjects

Trials (D) 1 1.083 1.083 0.083 Therapists X Trials (AD) 2 if .028 2 .0llf 0.155 Susceptibility X Trials (BD) 1 5.229 5.229 0.1f03 Treatment X Trials (CD) If 30.299 7.575 0.58!f Therapist X Susceptibility X Trials (ABD) 2 3A79 1.739 0.13if Therapist X Treatment X Trials (ACD) 8 63.739 7.967 O.61U Susceptibility X Treatment X Trials (BCD) 105.595 23.399 2.03*f Therapists X Susceptibility X Treatment X Trials (ABCD) 8 50.5^2 6.318 0.1*87 Error 29 10lf5 .8!f8 36 .061*

o\ * P <.05 ro 63 scores in MMPI Depression than did the low susceptible Ss.

TABLE 3-A

Adjusted Mean Scores of Ss’ Performance on the MMPI Depression

Scale by Therapists X Susceptibility

Susceptibility Therapists High Low

1 46.89 51.31

2 50.00 1*6.61*

3 1*9.15 1*6.32

These results suggest that the presence of low hypnotic sus­ ceptibility qualified by effects of therapist variables is more pre­ dictive of lower depression scores than the presence of high susceptibility to hypnosis in Ss. Post hoc analysis using the Newman

Keuls method failed to attribute the major portion of variance to any specific pair of means defined by therapist X susceptibility.

These data intimate that hypnotic susceptibility accounts for the major portion of the variance for MMPI Depression; however, differences due to therapists qualify this observation.

An analysis of covariance summary table for the MMPI Paranoia scale appears in Table 4. The F ratio for susceptibility X trial interaction was significant (F z l*.3**q P < .05)* Examination of adjusted means (Table 1*-A) for the significant susceptibility X trials TABLE If

Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for ______Adjusted Mean MMPI Paranoia Scores______

df SS MS Between Subjects

Therapists (A) 2 l.lflfl 0.720 0.7*f*f Susceptibility (B) 1 0.005 0.005 0.005 Treatment (C) If 2.JfT5 0.619 0.639 Therapists X Susceptibility (AB) 2 o.l5*f 0.077 0.079 Therapist X Treatment (AC) 8 3.575 0.lfif7 O.U62 Susceptibility X Treatment (BC) If 3.568 0.892 0 .921* Therapist X Susceptibility X Treatment (ABC) 8 if. 181 0.523 0 .5^0 Residual 29 5.880 0.203

Within Subjects

Trials (D) 1 1.119 1.119 5.521 Therapists X Trials (AD) 1 0.199 0.199 0.981 Susceptibility X Trials (BD) 2 0.080 O.OifO 0.198 Treatment X Trials (CD) 1 O .881 0.881 If.31* Therapist X Susceptibility X Trials (ABD) If 0.785 0.196 0.968 Therapist X Treatment X Trials (ACD) 2 0 .7*16 0.373 1.GkO Susceptibility X Treatment X Trials (BCD) 8 1.361 0.170 0.839 Therapists X Susceptibility X Treatment X Trials (ABCD) k 0.186 O.Olf? 0.229 Error 8 3.272 0.1409 2.017

* p < .05 o\ ■t=* 6 5 interaction suggest high susceptible Ss showed a greater reduction in

TABLE U-A

Adjusted Mean Scores of Ss” Performance on the MMPI

Paranoia Scale by Susceptibility X Trials

Trials Susceptibility Trial 2 Trial 3

High It-.91 5-07

Low 5.06 k .96

mean paranoia scores at trial two than did low susceptible Ss. At trial three, the opposite phenomenon was observed. Low susceptible

Ss evidenced a reduction of mean paranoia scores, while high susceptible Ss; increased paranoia.

A Newman Keuls post hoc analysis did not find any significant differences among pairwise comparisons. Hence, the data suggests that it is the combination of all susceptibility X trial means that account for the significant interaction.

The MMPI Psychasthenia scale was found significant for the therapist X susceptibility X trial interaction (F:l4-.59j P< *05)

(See Table 5)* Inspection of adjusted means (Table 5-A) for this interaction revealed that mean scores by all Ss treated by therapist two remained constant over all trials. Ss treated by therapist one experienced differential effects due to susceptibility. High TABLE 5

Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for ______Adjusted Mean MMPI Psychasth.snia Scores ______

df ss MS Between Subjects

Therapists (A) 2 0.879 O .lflfO 0 .890' Susceptibility (B) 1 0.9^3 0 .9^3 1.908 Treatment (C) If 3.731 0.933 1.888 Therapist X Susceptibility (AB) 2 0.696 0.3k8 0 .70k Therapist X Treatment (AC) 8 11.621 1.^53 2.9kO* Susceptibility X Treatment (EC) h 3.005 0.751 1.520 Therapist X Susceptibility X Treatment (ABC) 8 5.08? 0.636 1.287 Residual 29 if. 582 O .158

Within Subjects

Trials (D) 1 0.357 0.357 2.260 Therapists X Trials (AD) 2 0.02k 0.012 0.077 Susceptibility X Trials (BD) 1 0.003 0.003 0.017 Treatment X Trials (CD) k 1.258 0.31U 1.990 Therapist X Susceptibility X Trials (ABD) 2 1A52 0.726 lf.59lf* Therapist X Treatment X Trials (ACD) 8 2.107 0.263 I.667 Susceptibility X Treatment X Trials (BCD) If 1.033 0.258 1 .63k Therapists X Susceptibility X Treatment X Trials (ABCD) 8 1.kkO 0.180 1.139 Error 29 lif.330 0.k9k

*p« .05 67

susceptibility Ss purported higher mean psychasthenia scores on the

final trial than in preceding trials, and low susceptibility Ss

changed from high initial scores to lower mean scores on the final

trial. Therapist three maintained a relatively constant level

among Ss9 psychasthenia means with high susceptibles, but low

susceptible Ss changed from low to high across psychasthenia means.

TABLE 5-A

Adjusted Mean Scores of Ss9 Performance on the MMPI Psychasthenia

Scale by Therapists X Susceptibility X. Trials

Trials Therapists Susceptibility »2

1 High h .63 5.03 Low K .96 k.76

2 High h .92 5.02 Low k .62 fc.72

3 High 5.20 5.10 Low k.6Q 5.08

These data suggest that susceptibility is an extremely important

factor In predicting client psychasthenia scores when qualified by

the differential effects of therapists, A Newman Keuls post hoc

analysis failed to show any statistical significance among pairs of

means for the therapist X susceptibility X trial interaction. The significant therapist X treatment interaction suggest that the observed mean psychasthenia scores of Ss were different from those expected from the simple addition of appropriate main effects#

Perusal of the adjusted psychasthenia means (Table 5~B) for the therapist X treatment interaction show that Ss treated by therapist three exhibited very similar mean scores;

TABLE 5-B

Adjusted Mean Scores of Ss® Performance on the MMPI

Psychasthenia Scale by Therapists X Treatments

Treatments Therapists RSDH ESDI Hypnosis Placebo Control

1 5 .or 5.38 k.5h b.3l M 3

2 b.78 V.07 5.0 9 b.66 5*50

3 5-13 5.15 b.97 b.Qb b.99

those Ss treated by therapist one exhibited a more diverse pattern of means across treatments; and those Ss treated by therapist two showed the greatest variance among treatment means. However, none of the combinations of pairwise comparisons proved statistically significant using the Newman Keuls post hoc analysis. These data suggest that even though there are differences among the treatments; these differences must be qualified by the unspecified effects of therapist variables. * Table 6 through 12 present complete analysis of covariance summary tables for those MMPI scales where statistical significance was not observed. These scales were, hypochondriasis, hysteria, psychopathic deviate, masculinity-feminity, schizophrenia, hypomania, and social introversion.

Self-rating Depression Scale

Table 13 presents a complete summary for the analysis of covariance of Ss9 performance on the Self-rating Depression

Scale (SDS). F ratios were significant for therapist X susceptibility X treatment interaction (F=3*05j P< *05), therapist

X susceptibility Interaction (F=2.80; p< .05), and treatment X trial interaction (F=2.80; p

An examination of therapist X susceptibility X treatment interaction shows that changes in self-rated depression scores were not consistent among treatment conditions, therapists, and susceptibility. Adjusted means (Table 13-A) show a tendency for high susceptible Ss across all treatments to have a greater reduction in self-rated depression than low susceptible Ss. TABLE 6

Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapist and Trials for ______Adjusted Mean MMPI Hypochondriasis Scores______

df SS MS Between Subjects

Therapists (A) 2 3.123 1.562 0.044 Susceptibility (B) 1 54.522 54.522 1.520 Treatment (C) 4 250.809 62.702 1.748 Therapist X Susceptibility (AB) 2 66.667 33-334 0.929 Therapist X Treatment (AC) 8 141.208 17.651 0.^92 Susceptibility X Treatment (BC) 4 120.977 30.244 0.843 Therapist X Susceptibility X Treatment (ABC) 8 154.983 19-373 0.540 Residual 29 282.025 9.725

Within Subjects

Trials (D) 1 1.438 1.438 O.1I18 Therapists X Trials (AD) 2 1.871 0.935 0.096 Susceptibility X Trials (BD) 1 0.086 0.086 0.009 Treatment X Trials (CD) 4 8.173 2.043 0.210 Therapist X Susceptibility X Trials (ABD) 2 2.275 1.138 0.117 Therapist X Treatment X Trials (ACD) 8 100.406 12.551 1.291 Susceptibility X Treatment X Trials (BCD) 6.771 1.693 0.174 Therapists X Susceptibility X Treatment X Trials (ABCD) 8 57.994 7.249 0.745 Error 29 1040.336 35.874 TABLE 7

Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for ______Adjusted Mean MMPI Hysteria Scores______

df SS MS F Between Subjects

Therapists (A) 2 58.519 29.259 O.I+65 Susceptibility (B) 1 10.625 10.625 O .169 Treatment (c) k 132.685 33.171 O .528 Therapists X Susceptibility (AB) 2 7^*889 37»^^ 0.596 Therapist X Treatment (AC) 8 68.506 8.563 O.I36 Susceptibility X Treatment (BC) 1+ 290.571 72.61+3 1*155 Therapist X Susceptibility X Treatment (ABC) 8 50*+. 555 63.069 1.003 Residual 29 I+58.98O 15.827

Within Subjects

Trials (D) 1 3.61+3 3.61+3 0.230 Therapists X Trials (AD) 2 U8.968 21+.1+81+ 1.51+7 Susceptibility X Trials (BD) 1 2.3^ 2 .3I+6 o.ii*8 Treatment X Trials (CD) 1+ 17.811+ 1+ .1+51+ 0.281 Therapist X Susceptibility X Trials (ABD) 2 1 2 .211+ 6.107 0.386 Therapist X Treatment X Trials (ACD) 8 78.766 9 .81+6 0.622 Susceptibility X Treatment X Trials (BCD) 1+ 1+2.301+ 10.576 0.668 Therapists X Susceptibility X Treatment X Trials (ABCD) 8 71*351 8.919 O.56U Error 29 1823.316 62.873 TABLE 8

Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for ______Adjusted Mean MMPI Psychopathic Deviate Scores______

df SS MS Between Subjects

Therapists (a ) 2 0.599 0.300 0.317 Susceptibility (B) 1 0.358 0.358 0.378 Treatment (C) 1* 3.277 0.819 0.866 Therapists X Susceptibility (AB) 2 0.227 0.113 0.120 Therapist X Treatment (AC) 8 2.838 0.355 0.375 Susceptibility X Treatment (BC) It 5.872 1.1*68 1.552 Therapist X Susceptibility X Treatment (ABC) 8 1*.707 O .588 0.622 Residual 29 10.1*80 O.36I

Within Subjects

Trials (D) 1 O .296 O .296 O .819 Therapists X Trials (AD) 2 0.3^ 0.172 0.1*76 Susceptibility X Trials (BD) 1 0.5^5 O.5U5 1.509 Treatment X Trials (CD) 1* , 0.931 0.233 0.61*1* Therapist X Susceptibility X Trials (ABD) 2 O .836 O.klQ 1.156 Therapist X Treatment X Trials (ACD) 8 1.919 0.2l*0 0.661* Susceptibility X Treatment X Trials (BCD) 1* 2.325 O.58I 1.609 Therapists X Susceptibility X Treatment X Trials (ABCD) 8 3 .100 O .388 1.072 Error 29 27.1*29 O.9U6 TABLE 9

Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for ______Adjusted Mean MMPI Masculinity Femininity Score______

df SS MS Between Subjects

Therapists (a) 2 1.770 O .885 1.1+38 Susceptibility (B) . 1 0.135 0.135 0.219 Treatment (C) 1+ 1.076 O .269 0.1+37 Therapists X Susceptibility (AB) 2 1.116 0.558 0.907 Therapist X Treatment (AC) 8 6.086 O.76I I .236 Susceptibility X Treatment (BC) 1+ O .918 0.229 0.373 Therapist X Susceptibility X Treatment (ABC) 8 5.222 O .653 1.06l Residual 29 12.21+2 0.1+22

Within Subjects

Trials (D) 1 0.062 0.062 0 .11+6 Therapists X Trials (AD) 2 1.312 0.656 1.551+ Susceptibility X Trials (BD) 1 0.207 0.207 0.1+90 Treatment X Trials (CD) 1+ 1.708 O.1+27 1.012 Therapist X Susceptibility X Trials (ABD) 2 0.512 0.256 0.607 Therapist X Treatment X Trials (ACD) 8 1.736 0.217 0.511+ Susceptibility X Treatment X Trials (BCD) 1+ 0.756 0.189 0 .1+1+8 Therapists X Susceptibility X Treatment X Trials (ABCD) 8 2.658 0.332 0.787 Error 29 1 7 . 81+8 ’0.615 TABLE 10

Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for ______Adjusted Mean MMPI Schizophrenia Scores______

df SS MS Between Subjects

Therapists (A) 2 0.575 0.288 0.395 Susceptibility (B). 1 0.830 0.830 l.ll+l Treatment (C) 1+ ■ 1+.093 1-023 1.1+06 Therapist X Susceptibility (AB) 2 0.1+02 0.201 0.277 Therapist X Treatment (AC) 8 5 .3O9 0.661+ 0.912 Susceptibility X Treatment (BC) 1+ I.O36 0.259 0.35& Therapist X Susceptibility X Treatment (ABC) 8 5.096 0.637 0.875 Residual 29 6.1+10 0.221

Within Subjects

Trials (D) 1 O.O56 O.O56 0.253 Therapists X Trials (AD) 2 0.049 0.025 0.111 Susceptibility X Trials (BD) 1 0.088 0,088 O .399 Treatment X Trials (CD) 1+ 1.621+ 0.1+06 1.837 Therapist X Susceptibility X Trials (ABD) 2 0.051 0.026 0.116 Therapist X Treatment X Trials (ACD) . 8 1.920 0.21+0 1.086 Susceptibility X Treatment X Trials (BCD) 1+ 0.21+9 0.062 0.282 Therapists X Susceptibility X Treatment X Trials (ABCD) 8 2.056 0.257 1.163 Error 29 21.101 - 0.728 TABLE 11

Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for ______Adjusted Mean MMPI Hypomania Scores______

df SS MS Between Subjects

Therapists (A) 2 0.101 0.050 0.062 Susceptibility (B) 1 1.308 I.308 I .605 Treatment (C) *4 3.275 0.819 1.005 Therapist X Susceptibility (AB) 2 2.632 1.316 I .615 Therapist X Treatment (AC) 8 8.553 I.O69 1.312 Susceptibility X Treatment (BC) *4 I.369 0.3*42 0.*420 Therapist X Susceptibility X Treatment (ABC) 8 9*867 1.233 1.51*4 Residual 29 11.710 O.ifO^

Within Subjects

Trials (D) 1 0.*47*4 0.*47*4 I .173 Therapists X Trials (AD) 2 0.00*4 0.002 0.00*4 Susceptibility X Trials (ED) 1 0.000 0.000 0.001 Treatment X Trials (CD) 1* O.876 0.219 0.5*42 Therapist X Susceptibility X Trials (ABD) 2 0.07*4 0.037 0.091 Therapist X Treatment X Trials (ACD) 8 1.282 0.l60 0.397 Susceptibility X Treatment X Trials (BCD) *4 0.159 0.0*40 0.099 Therapists X Susceptibility X Treatment X Trials (ABCD) 8 0.637 0.080 0.197 Error 29 23.631 0.815

VI TABLE 12

Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for ______Adjusted Mean MMPI Social Introversion Scores______

df SS MS F *een Subjects

Therapists (A) 2 0.312 0.156 0.285 Susceptibility (B) 1 0.008 0.008 o.oii* Treatment (C) 1* !*.0l*7 1.012 1.81*9 Therapist X Susceptibility (AB) 2 1.073 0.537 O.98I Therapist X Treatment (AC) 8 3.3 bQ 0.1*19 0.785 Susceptibility X Treatment (BC) 1* 1.5^3 0.386 0.705 Therapist X Susceptibility X Treatment (ABC) 8 1.9^7 0 .21*3 0.1*1*5 Residual 29 5-991*- 0.207

Within Subjects

Trials (D) 1 0.120 0.120 0.581 Therapists X Trials (AD) 2 0.581* 0.292 1.1*12 Susceptibility X Trials (BD) 1 0.138 0.138 0.668 Treatment X Trials (CD) 1* 1.209 0.322 1.559 Therapist X Susceptibility X Trials (ABD) 2 0.1*19 0.209 1.013 Therapist X Treatment X Trials (ACD) 8 1.1*62 O.I83 0.881* Susceptibility X Treatment X Trials (BCD) 1* 0.6l0 0.153 O .738 Therapists X Susceptibility X Treatment X Trials (ABCD) 8 1.2l*9 O.I56 0.755 Error 29 15.869 0.5^7 TABLE 13

Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for Adjusted Mean Self Depression Scale Scores

df ss MS F Between Subjects

Therapists (A) 2 0.107 0.05^ 0.182 Susceptibility (B) 1 1.098 1.098 3.719 Treatment (C) b 2.322 0.581 1.967 Therapist X Susceptibility (AB) 2 2.290 l.ll*5 3.879* Therapist X Treatment (AC) 8 b.6b6 0.581 1.967 Susceptibility X Treatment (BC) b 0.337 0 .081* 0.285 Therapist X Susceptibility X Treatment (ABC) 8 7.195 0.899 3.01*7* Residual 29 6 .21*1 0.215

Within Subjects

Trials (D) 1 0.176 0.176 0.818 Therapists X Trials (AD) 2 O .219 0.109 0.509 Susceptibility X Trials (BD) 1 0.003 0.003 0 .01U Treatment X Trials (CD) b 2 .in1 0.603 2 .801* Therapist X Susceptibility X Trials (ABD) 2 0.125 0.063 0.291 Therapist X Treatment X Trials (ACD) 8 1.^33 0.179 0.832 Susceptibility X Treatment X Trials (BCD) b 0 .51*0 0.135 0.627 Therapists X Susceptibility X Treatment X Trials (ABCD) 8 2.785 0 .31*8 I .618 Error 29 8.560 0.295

*p < .05 TABLE 13-A

Adjusted Mean Scores of Ss Performance on the SDS by Therapist X Susceptibility X Treatment

Treatments Therapists Susceptibility RSDH RSDI Hypnosis Placebo Control

1 High (a) 2.30 (c) 2.93 (e) 2.83 (s) 3.01 (i) 3.1^ Low (b) 3-9^ (a) 3.63 (f) 3.09 (b) 3.12 (b) 3.76

2 High (a) 2.55 (c) 3.03 (e) 3.39 (g) 2.61 (i) 3.77 Low (b) 3.^8 (d) 3.39 (£) 2.80 (h) 3.06 (b) 3-5^

3 High (a) k.10 (c) 2.83 (e) 2.89 (g) 3.M (i) 3.03 Low (b) 2.91 (d) 2.81 (£) 3.38 (b) 3.21 (b) 3.36

CD 79

The Newman Keuls post hoc analysis of the second order inter­ action (Table 13-B) revealed significant differences between high susceptible Ss, who received RSDH, and all other Ss across treat­ ments and levels of susceptibility treated by therapist one. These data suggest that high susceptible Ss, who received RSDH from therapist one, reported significantly lower levels of depression than did Ss across all other treatments and levels of susceptibility.

TABLE 13-B

Results of Newman Keuts Tests on all Ordered Pairs of Means for

Susceptibility X Treatment X Therapist One b k d i h f g c e a b - .18 .31 .80* .82* .85* •93* 1.01* 1.11* 1.61** k .13 .62* .61** .67* •75* .83* • 93* 1.1*6* d .53* .55* .58* .66* .7^* .81** 1.37* i .02 .05 .13 .21 .31 .81** h - •03 .11 .19 .29 .82* f .08 .16 .26 .79* g ■ » .08 .18 .71* c - .10 .61* e - .53* a

* P .05

In addition, high susceptible Ss, who received RSDI, hypnosis, placebo, and the no-treatment control, from therapist one, all reported significantly less amounts of self-rated depression than did low susceptible Ss who received RSDH, RSDI, and no-treatment control. On the other hand, low susceptible Ss who received hypnosis and placebo from therapist one, rated themselves as significantly less depressed 80 than low susceptible Ss who received RSDH, RSDI, and no “treatment control from the same therapist.

These data suggest that the mere presence of treatment or conditions of high susceptibility, qualified by the effects of different therapists, were enough to attain statistically significant lower means of self-rated depression. The data also offered support for the efficacy of RSDH and RSDI for use with high susceptible Ss.

Results from the Newman Keuls applied to Ss8 performance on the Self-rating Depression Scale are shown in Table 13-C for those Ss who received threatment from therapist two. High susceptible Ss who received RSDH from therapist two, rated them­ selves as significantly less despressed than all other treatments except high susceptible placebo Ss and low susceptible hypnosis

Ss. High susceptible Ss who received RSDI, and low susceptible placebo Ss reported significantly less depression than did both high and low susceptible no-treatment Ss treated by therapist two.

High susceptible Ss who received placebo from therapist two also reported less self-rated depression than low susceptible RSDI,

RSDH and both high and low susceptible no-treatment control Ss.

Low susceptible Ss, who received hypnosis from therapist two, reported less depression than did Ss in high susceptible no­ treatment control, hypnosis, and Ss in low susceptible RSDI,

RSDH, no-treatment control. 81

TABLE 13-C

Results of Newman Keuls Tests on all Ordered Pairs of Means for

Susceptibility X Treatments X Therapist Two i k b d e h c f g a i - .23 .29 .38 .38 .71* ,7k* •97* 1 .16* 1.22* k .06 .15 .15 .1*8* .51* .71** • 93* •99* b - .09 .09 .1*2 .68* .87* .93* d - - .33 .36 .59* .78* .81** e - .33 .36 .59* .78* .81** h - .03 .26 .1*5 .51* c *» .23 .1*2 .1*6* f < a .19 .25 S - .06 a m a

* P .05 •

The efficacy of RSDH and RSDI with high susceptible Ss is condi­ tionally supported. However, this finding must he qualified because of the differential effects of the therapists. Therapist effects in this study appear very much like what occurs in reality. Thera­ pists are differentially effective.

The Newman Keuls test for the adjusted means for susceptibility

X treatment X therapist three (Table 13-D) show that both high and low susceptible RSDI Ss rated themselves as significantly less depressed than did low susceptible hypnosis Ss, no-treatment Ss, and high susceptible placebo Ss, and RSDH Ss. Contrary to expectation, and to results observed by therapists one and two, Ss across all treatments and susceptibility reported significantly less depression than did high susceptible RSDH Ss. 82

TABLE 13-D

Results of Newman Keuls Test on all Ordered Pairs of Means for

Susceptibility X Treatment X Therapist Three

a g f k h i b e C a a .60* .72* .714-* .89* 1 .07* 1.19* 1 .21* 1 .27* 1 .29* S - .03 .05 .20 .38 .50 .52 .58* .60* f - .02 .17 .36 .^7 M .55* .57* k - .15 .33 • ^5 .53* .55* h .18 .30 .32 .38 .ho i 0 .12 .1*4 .20 - .22 b .02 .08 .10 e «• .06 .08 c .02 d

* p .05

The overall effects of the second order interaction suggest that susceptibility, particularly in the RSDH and RSDI treatments, qualified by the effects of the therapist variable, significantly contribute to the variance among Ss' depression scores. Efficacy for the use of RSDH and RSDI with high suggestible Ss has been offered; however, the results must be considered in view of the differential effects of therapists.

Adjusted Self-rating Depression Scale, means for the significant treatment X trial interaction (Fz2.80; p .0 5 ) are shown in Table

13-E. These data show that Ss in RSDH, RSDI, and hypnosis rated themselves as less depressed on the final trial than in preceding trials. 83 TABLE 13-E

Adjusted Mean Scores for Ss' Performance on the

SDS by Treatment X Trials

Trials Treatment Post I Post II

RSDH 3.27 3.02

RSDI 3.18 3.01

Hypnosis 3.31 2.81

Placebo 2.9h 3-19

Control 3.30 3.55

Ss in these three treatments continued to realize a reduction in psychological stress even after the termination of treatment.

Clients who received placebo and no-treatment control across all levels of susceptibility tended to realize higher mean depression scores after the discontinuation of therapy. Differences between group means failed to attain statistical significance following the application of the Newman Keuls post hoc analysis. The results do not confirm the superiority of any treatment. Instead they suggest that combinations of variables account for the significant findings.

Adjusted means (Table 13-F) for the significant therapist X susceptibility interaction and follow-up Newman Keuls post hoc analysis (Table 13*r®) report a significant difference between high 81*

TABLE 13-F

Adjusted Mean Scores for Ss* Performance on the

SDS "by Therapists X Susceptibility

Susceptibility Therapists High Low

1 (a) 2.85 (a) 3.40

2 (b) 3.08 (e) 3.21* -•

3 (c) 3.26 (f) 3.13

and low suggestible Ss treated by therapist one. The data show that high susceptible Ss treated by therapist one, evidenced significantly less self-rated depression, than did low susceptible Ss, regardless of treatment. High susceptible Ss treated by therapist two also recorded lower mean depression scores than did low susceptible Ss treated by the same therapist. Therapist three did better with low

TABLE 13-G

Results of Newman Keuls Tests on all Ordered Pairs of

Means for Therapist X Susceptibility

a b c d e f a .14 .16 .27 .32 .55* b - .02 .13 .18 .41 c - .11 .16 .39 d - .05 .28 e - .23 f •0 O ITS

* p 0 susceptibles regardless of treatment. High susceptible Ss, regardless of the treatment condition, generally rated themselves as less depressed than low susceptible Ss. These results must be considered in light of differences among therapists.

MAACL-Depression

Results of the analysis of covariance of Ss® performance on the MAACL-Depression scale are reported in Table l1!-. Significant

F ratios were attained for therapist X treatment interaction

(Fs2.31; p <.05), and therapist X susceptibility interaction

(F=5.78; P <.05).

Examination of the adjusted means (Table lU-A) for therapist

X treatment interaction suggest that changes in the level of Ss® depression were not consistent in light of the variability among therapists. The Newman Keuls revealed no significant differences among pairs of means as defined by therapists X treatment.

Adjusted means for therapist X susceptibility interaction are reported in Table 1I4—B. High susceptible Ss, who were treated by therapist one, scored lower on the MAACL-Depression scale than high susceptible Ss treated by therapists two and three. Low sus­ ceptible Ss, treated by therapist one scored the highest among all

Ss on the MAACL-D scale. TABLE l4

Factor Analysis of Covariance for Treatments, Hyp'ik>bic Susceptibility, Therapists and Trials ______for Adjusted Mean MAACL Depression Scores______

df SS MS Between Subjects

Therapists (A) 2 0.229 0.114 0 .3^9 Susceptibility (B) 1 0.001 0.001 0.002 Treatment (C) 4 0.673 0.168 0.514 Therapist X Susceptibility (AB) 2 3.783 1.892 5.776* Therapist X Treatment (AC) 8 6.049 0.756 2.309* Susceptibility X Treatment (BC) 4 1.323 0.331 1.010 Therapist X Susceptibility X Treatment (ABC) 8 4.018 0.502 1.533 Residual 29 5.211 0.180

Within Subjects

Trials (D) 1 0.004 0.004 0.022 Therapists X Trials (AD) 2 0.068 0.034 0.190 Susceptibility X Trials (BD) 1 0.004 0.004 0.023 Treatment X Trials (CD) 4 0.260 0.065 0.361 Therapist X Susceptibility X Trials (ABD) 2 0.076 0.038 0.213 Therapist X Treatment X Trials (ACD) 8 1.795 0.224 1.248 Susceptibility X Treatment X Trials (BCD) 0.130 0.033 0.181 Therapists X Susceptibility X Treatment X Trials (ABCD) 8 0.896 0.112 0.623 Error 29 9.498 0.328

* p < .05 03 ON 87

TABLE Ik-A

Adjusted Mean Scores for Ss’ Performance on the

MAACL Depression Scale by Therapists X Treatments

Treatments Therapists RSDH RSDI Hypnosis Placebo Control

1 3.61 10 3.39 3.55 3.85

2 3.68 3.6lt 3.99 3-52 -3.26

3 3.81 3.32 3.59 3.81 3.53

TABLE llt-B

Adjusted Mean Scores for Ss8 Performance on the MAACL

Depression Scale by Therapists X Susceptibility

Susceptibility Therapists High Low

1 3 - ^ 3.95

2 3.78 3.**6

3 3.67 3-55 88

MAACL Hostility

The complete summary table for the analysis of variance for

Ss* performance on the MAACL hostility scale is found in Table 15.

F ratios show significant findings for susceptibility X treat­ ment interaction (F=3.65j p< .05)* therapist X susceptibility interaction (FsS*^* P < »05), and a main effect for treatments

(F:^.17; p < .05). Adjusted cell means in Table 15-A show that changes across treatment and susceptibility were inconsistent.

MAACL hostility mean scores show a trend for high susceptible Ss treated with hypnosis to score slightly higher than low susceptible

Ss in the same categories. On the other hand, high susceptible

ESDI S£ reported lower hostility mean scores than did low sus­ ceptible RSDI Ss;. Both high and low susceptible placebo and no­ treatment control Ss maintained a fairly constant level of hostility mean scores across susceptibility.

The Therapist X susceptibility F ratio (F:3.81j-j p < .05) suggests that changes in adjusted mean scores (Table 15-B) are different across levels of therapists and client suggestibility.

High susceptible Ss, treated by therapists one and two scored lower on the MAACL-Hostility scale than low susceptibles treated by the same therapists. However, low susceptibles, treated by therapist three, attained a lover hostility score than did high susceptibles treated by the same therapist. All Ss treated by therapist two, regardless of the level of susceptibility, recorded higher mean scores in hostility than Ss treated by either of the TABLE 15

Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for ______Adjusted Mean MAACL Hostility Scores______

df SS MS Between Subjects

Therapists (A) 2 2.032 1.016 2.603 Susceptibility (B) 1 0.012 0.012 0.030 Treatment (C) If 6.509 1.627 if. 170* Therapist X Susceptibility (AB) 2 2.996 l.if98 3.839* Therapist X Treatment (AC) 8 6 . if 26 0.803 2.058 Susceptibility X Treatment (BC) if 5-T01 1.U25 3 .652* Therapist X Susceptibility X Treatment (ABC) 8 2.128 0.266 0.681 Residual 29 5.813 0.200

Within Subjects

Trials (D) 1 O.OifT 0.0U7 0.236 Therapists X Trials (AD) 2 0.065 0.032 O .161 Susceptibility X Trials (BD) 1 0.015 0.015 0.073 Treatment X Trials (CD) if 1.103 0.276 1.376 Therapist X Susceptibility X Trials (ABD) 2 0.308 0.15lf O .768 Therapist X Treatment X Trials (ACD) 8 1.253 0.157 0.782 Susceptibility X Treatment X Trials (BCD) I.825 0.1f56 2.276 Therapists X Susceptibility X Treatment X Trials (ABCD) 8 l.lflT 0.177 O .883 Error 29 II.318 0.390

*P< .05 90

TABLE 15-A

Adjusted Mean Scores for Ss* Performance on the MAACL

Hostility Scale "by Susceptibility X Treatments

Treatments Susceptibility RSDH ESDI Hypnosis Placebo Control

High H.3H 3-1^ 3.96 3.5^ 3.76

Low 3.98 3.8H 3.Hi 3.6H 3.73

TABLE 15-B

Adjusted Mean Scores for Ss' Performance on the MAACL

Hostility Scale by Therapist X Susceptibility

Susceptibility Therapist High Low

1 3.H9 3.82

2 3.90 3.93

3 3.85 3.H2 91

other two therapists. The combination of effects of therapists and

client suggestibility are the primary contributors to the significant variance in hostility mean scores, rather than any singularly

isolated effect due to therapists or suggestibility.

Even though a significant main effect for treatments was

obtained, the means (Table 15-C) cannot be meaningfully interpreted

as the types of treatment are qualitatively dissimilar over levels

of susceptibility. Treatment effects must be qualified in light

of the particular therapist administering treatment, and the

conditions of susceptibility tinder which it was administered.

TABLE 15-C

Adjusted Mean Scores for Ss* Performance on the

MAACL Hostility Scales by Treatments

Treatment Adjusted Means

RSDH k.l6

RSDI 3 ^ 8

Hypnosis 3.69

Placebo 3.60

Control 3.75 Tables 16 , Yf, 18 and 19 present complete summary tables of the analysis of covariance for Ss* performance on the MAACL-

Anxiety scale, the Depression Inventory, and the State-Trait

Anxiety Inventory respectively. Mean scores of Ss did not attain statistical significance for any of the above listed scales. TABLE 16

Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for ______Adjusted Mean MAACL Anxiety S c o r e s ______

df SS MS F Between Subjects

Therapists (A) 2 O.k^k 0.237 0.72J+ Susceptibility (B) 1 0.185 0.185 0.618 Treatment (C) k 2.871 0.718 0.1*29 Therapist X Susceptibility (AB) 2 3.550 1.775 0.105 Therapist X Treatment (AC) 8 6.515 0 .81^ 0.379 Susceptibility X Treatment (BC) k 1.887 O.V72 0.632 Therapist X Susceptibility X Treatment (ABC) 8 12.301 1.538 O.O67 Residual 29 10.739 0.370

Within Subjects

Trials (D) 1 0.203 0.203 0.^65 Therapist X Trials (AD) 2 1.22^ 0.612 . 0.209 Susceptibility X Trials (BD) 1 0.1j02 0.k02 0.306 Treatment X Trials (CD) k 0.256 0.06k 0.950 Therapist X Susceptibility X Trials (ABD) 2 0.^55 0.227 0.5W Therapist X Treatment X Trials (ACD) 8 0.910 0.11k 0.957 Susceptibility X Treatment X Trials (BCD) k 1.385 0.3 k6 O.J+58 Therapist X Susceptibility X Treatment X Trials (ABCD) 8 0.877 0.110 0.962 Error 29 21.0^3 0.726

VO co TABLE 17

Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for

df SS MS F jeen Subjects

Therapists (A) 2 0.073 0.037 0.355 Susceptibility (B) 1 0.220 0.220 2.122 Treatment (C) 4 0.331 0.083 0.800 Therapist X Susceptibility (AB) 2 0.058 0.029 0.278 Therapist X Treatment (AC) 8 O.O85 0.011 0.103 Susceptibility X Treatment (BC) 4 0.126 0.031 0.304 Therapist X Susceptibility X Treatment (ABC) 8 0.584 0.073 0.705 Residual 29 0.250 0.009

Within Subjects

Trials (D) 1 0.007 0.007 0.762 Therapists X Trials (AD) 2 0.015 0.008 0.881 Susceptibility X Trials (BD) 1 0.007 0.007 0.755 Treatment X Trials (CD) 4 0.021 0.005 0,616 Therapist X Susceptibility X Trials (ABD) 2 0.015 0.008 0.879 Therapist X Treatment X Trials (ACD) 8 0.054 0.007 0.783 Susceptibility X Treatment X Trials (BCD) 4 o.oa 0.005 0.595 Therapists X Susceptibility X Treatment X Trials (ABCD) 8 0.053 , 0.007 0.771 Error 29 3.002 0.104 vo -p- TABLE 18

Factor Analysis of Covariance for Treatment, Hypnotic Susceptibility, Therapists and Trials for ______Adjusted Mean STAI A-State Scores

df SS MS Between Subjects

Therapists (A) 2 O .578 O .289 0.125 Susceptibility (B) ’ 1 O.I69 0.169 O.O73 Treatment (C) It- ■ 5* 83k I.U58 O .628 Therapist X Susceptibility (AB) 2 5*53**- 2>j6j 1.192 Therapist X Treatment (AC) 8 11.866 I.U83 O .639 Susceptibility X Treatment (BC) k 5*773 1.1*1*3 0.622 Therapist X Susceptibility X Treatment (ABC) 8 7*012 O .876 0.378 Residual 29 12. >4-79 0.1*30

Within Subjects

Trials (D) 1 1.010 1.010 2.31*6 Therapists X Trials (AD) 2 1*358 O .679 1*578 Susceptibility X Trials (BD) 1 O .568 O .568 1.320 Treatment X Trials (CD) 1* O.Ul6 O.lOl* 0.21*1 Therapist X Susceptibility X Trials (ABD) 2 0.557 0.279 0.61*8 Therapist X Treatment X Trials (ACD) 8 0.1*31* 0.05^ 0.126 Susceptibility X Treatment X Trials (BCD) 1* I .638 0.1*10 0.952 Therapists X Susceptibility X Treatment X Trials (ABCD) 8 3*089 O .386 0.897 Error 29 6 7 .330 '2.322

vo VJ1 TABLE 19

Factor Analysis of Covariance for Treatments, Hypnotic Susceptibility, Therapists and Trials for

df SS MS F Between Subjects

Therapists (A) 2 0.294 0.147 0.159

Susceptibility (B) . 1 0.111 0.111 0.120 Treatment (C) 4 3.011 0.753 0.817 Therapist X Susceptibility (AB) 2 1.646 0.823 0.892 Therapist X Treatment (AC) 8 10.003 I .250 1.356 Susceptibility X Treatment (EC) 4 8.916 2.229 2.4i8 Therapist X Susceptibility X Treatment (ABC) 9.680 1.210 1.312 ro Residual 00 VO 8.775 0.303

Within Subjects

Trials (D) 1 0.479 0.479 1.583 Therapists X Trials (AD) 2 0.111 0.056 0.184 Susceptibility X Trials (BD) 1 0.091 0.091 0.300 Treatment X Trials (CD) 4 1.656 0.414 1.369 Therapist X Susceptibility X Trials (ABD) 2 0.367 0.184 0.607 Therapist X Treatment X Trials (ACD) 8 1.679 0.210 O .694 Susceptibility X Treatment X Trials (BCD) O .176 0.044 0.146 Therapists X Susceptibility X Treatment X Trials (ABCD) 8 2.106 0.263 0.870 Error 29 26.738 0.922

VOo\ CHAPTER V

Summary and Conclusions

This investigation studied the effects of two Rational Stage

Directed Therapies that involved the use of hypnosis and imagery upon the reduction of psychological stress. Psychological stress was operationalized as ISs8 mean scores on the Minnesota Multi- phasic Personality Inventory, Self-rating Depression Scale,

Depression Inventory, Multiple Affect Adjective Checklist, and the State-Trait Anxiety Inventory.

Sixty graduate students in guidance and counseling and related areas served as subjects for this experiment. Each person was administered the Barber Suggestibility Scale (BSS) to determine their basal level of suggestibility. Ss were then randomly assigned to one of five treatment groups. Following the adminis­ tration of the BSS, clients were given the MMPI, SDS, DI, MAACL, and the STAI.

A 3^5x2x3 factorial analysis of covariance with three repeated measures was used to test the hypotheses of this study.

The analysis of covariance was employed using the pre test as the covariate for the second and third repeated measures In order to adjust for any pre-treatment differences among treatment groups.

97 The hypotheses of this study consisted of three main effects hypotheses and one interaction effects hypotheses. The three main effects hypotheses were concerned with the effects of treat" ments, susceptibility, and therapists, upon the reduction of mean scores on the five instruments used to measure psychological stress.

The interaction hypotheses predicted that Ss® observed means representing psychological stress, as measured by the MMPI, DI,

MAACL, SDS, and STAI from groups of Ss defined in terms of and in any combination of, treatment, therapists, and hypontic suscepti- bility would not differ significantly from the means expected from the simple addition of the appropriate main effects. The null hypotheses for interaction was rejected supporting the effects of treatments qualified by differential effects of therapists and susceptibility.

Discussion

The data showed significant findings for three of the ten clinical scales of the MMPI. The depression, paranoia, and psychasthenia scales reported significant interaction effects that suggested combinations of variables beyond the simple addition of main effects were accounting for significant findings.

The depression scale of the MMPI showed a significant inter­ action between therapists and levels of hypnotic susceptibility.

Although a Newman Keuls post hoc analysis failed to delineate statistical significance between pairs of means, inspection of adjusted means show that Ss treated by two of the three therapists showed lower mean depression scores in the low susceptibility condition than did high susceptibility Ss. The presence of low susceptibility in clients was more predictive of lower depression scores than was the presence of high susceptibility; however, these effects were qualified by the effects of different therapists.

Perhaps, when compared to high susceptible clients, low susceptible clients may minimize their tendencies to perpetuate self-defeating and self-deluding thoughts thereby minimizing levels of depression.

It may be that low susceptibles, in terms of depression, approach the therapy situation more realistically.

A significant therapist X treatment interaction was observed on the MMPI paranoia scale. These data showed that high susceptible

Ss realized a greater reduction in mean paranoia scores after treatment (trial 2) than did low susceptible Ss. However, on the follow-up tests three weeks later, (trial 3)> the opposite phenomenon was observed. Low susceptible Ss evidenced a reduction of mean paranoia scores, while high susceptible Ss purported in­ creased paranoia scores.

These data corroborate earlier findings that hypnotic susceptibility influences treatment. Paranoia mean scores of high susceptible Ss were lower immediately following treatment than were low susceptible Ss; however, follow-up testing revealed that high susceptible Ss increased their paranoia mean scores while low susceptible Ss evidenced a continued reduction of scores. Persons reporting high MMPI-Pa scores are characterized by classic symptoms of paranoia such as: suspiciousness, interpersonal sensitivity, and rigid and inflexible allegiance to ideas and attitudes. Although this study did not deal with a clinical popu­ lation, two of the therapeutic interventions emphasized a logical rational confrontation of rigid attitudes and ideas. High susceptible Ss while undergoing treatment reduced their mean paranoia scores; however, following the discontinuation of therapy, high susceptible Ss* mean paranoia scores were escalated. High susceptible Ss seem to be more prone to paranoid thought ideations prior to and after specific therapeutic interventions, but not as much during actual treatment. The Newman Keuls post hoc analysis was not significant for any combination of pairs of mean paranoia scores; hence, the overall susceptibility X trial significant interaction was attained because of differences in client suscep­ tibility in regard to trials.

A significant second order interaction, susceptibility X treatments X trials, and a significant first order interaction, therapists X susceptibility were found on the MMPI psychasthenia scale. The second order interaction suggests that low susceptible

Ss treated by therapists two and three, revealed lower mean psychasthenia scores than did high susceptible Ss regardless of treatment and across all trials. High susceptible Ss, treated by therapist one, were observed to increase mean psychasthenia scores across trials two and three, while low susceptible Ss_ decreased mean 101

scores across trials.

Persons exhibiting psychasthenia tendencies are often

characterized by anxieties, excessive doubts, obsessive-compulsive reactions, feelings of guilt, and perfectionistic demandings of themselves. Low susceptible Ss in this study tended not to be as prone toward any of the psychasthenic manifestations as high susceptible Ss. Once more it may be that low susceptible Ss, in terms of psychasthenic responses, approach the therapy situation more realistically than high susceptible Ss.

Qualitatively similar patterns for two of the three therapists were observed in both the M-1PI-D scale therapist X susceptibility interaction, and the MMPI-Pa scale therapist X treatment inter­ action. Even though all therapists were similarly trained and delivered highly structured treatments, the results they obtained were different in many cases. These results must be considered in light of the client's level of susceptibility, the type of treat­ ment and the different effects of therapists.

A concern of this study was the implementation of structured treatments in a manner that adhered to rigorous scientific pro­ cedures, but did not lose the individual effectiveness of therapists.

As the interaction points out, indeed the therapists were different and these differences must be qualified by client susceptibility and type of treatment.

Significant therapist X susceptibility X treatment, inter­ action, therapist X susceptibility interaction, and treatment X 10 2

trial interaction were found in Ss mean Self-rating Depression Scale

scores. The second order interaction indicated that there was

significant changes in the magnitude of simple first order therapist

X susceptibility interaction over levels of treatments. Therefore

since patterns of high and low susceptibility were qualitatively

dissimilar over treatments, the first order therapist X suscepti­ bility interaction was ignored and only therapist X susceptibility

over levels of treatment was meaningfully interpreted.

The data offer conditional support for the efficacy of RSDH,

RSDI, and Hypnotic treatments. Just as with the MMPI mean scores

for depression and psychasthenia, high susceptible Ss, who

received treatment from two of the three therapists, recorded

qualitatively similar mean Self-rating Depression Scale Scores.

Specifically, results show that high susceptible Ss who received

RSDH and RSDI from therapists one and two reported significantly

less amounts of self assessed depression than either control group.

These results suggest that treatments involving the use of sensory

imagery are significantly better than the control groups in the

treatment of depression.

Two significant first order interactions, therapists X

treatment, and therapists X susceptibility, were found for Ss* mean MAACL-Depression scores. The therapist X susceptibility inter­

action on the MAACL-D scale was qualitatively similar to the

therapist X susceptibility interaction on the MMPI-D scale. Both

scales report that Ss treated by therapists two and three had lower mean depression scores than did high susceptible Ss treated by the same therapists. Furthermore, high susceptible Ss treated by therapist one reported lower depression scores than did low

susceptible Ss treated by therapist one.

Ss performance on the Self Depression Scale does not

corroborate these findings; however, the SDS is a much more

transparent instrument than the MMPI and is more subject to transitory states of depression. The three depression scales in

this study that attained statistical significance suggest the

effects of the therapist must be qualified by the level of hypnotic

susceptibility present in clients.

The final scale to report significant findings was the MAACL-

Hostility scale. This scale showed significant F ratios for susceptibility X treatment, therapist X susceptibility, and a main effect for treatment. The most important finding of the MAACL-H

scale suggests support for the effectiveness of ESDI in reducing mean MAACL-H scores.

Conclusions and Recommendation

Some tentative conclusions based on specific limitations of the study may be drawn from the data.

(l) In light of findings on the MMPI and MAACL depression scales, the data suggests that high susceptible Ss were more depressed than low susceptibles Ss;. High susceptible Ss seem to exhibit more of a ’’going along with" or "believing in" the treat­ ments presented by an authority without questioning results or 10k consequences. Somewhat of a Milgram effect or a Hawthorne effect may he operating more with high susceptible Ss_ than with low susceptible Ss thereby accounting for the more erratic changes of high susceptibles than low susceptible Ss, across treatments.

(2) The differential effects of therapists are extremely important regarding therapeutic outcome. Similar training, schooling and experiences among therapists does not necessarily make them all equally good or bad therapists. The data in this study adhere to what reality suggests: therapists are different and they exert multi-differential effects upon their clients.

(3 ) Although only conditional support was found for specific treatments in this study, the data revealed a generally positive finding for sensory imagery approaches. RSDH, RSDI, and hypnosis all showed positive effects in the reduction of emotional stress.

The effects of treatment were qualified by different susceptibility and therapist factors.

Regardless of how structured or how well controlled a treat­ ment intervention may be conceived, operationally there are differences in the way it is presented. These differences are biased predominately by therapist and susceptibility factors. To say that any packaged treatment process may be applied equally effective by all therapists is not only naive, but also is a heartening blow to mechanistic pre-packaged therapies.

These conclusions must be regarded in light of the limitations of this study. Perhaps the most limiting aspect of the study was the very sophisticated relatively normal subjects involved. Their basic knowledge of counseling theory and testing may have biased

results moreso than would a clinical population. A need for

replicating the effects of RSDH and RSDI upon a more deviant

clinical population is recommended.

Some support for the therapeutic approaches involved in this

study have been shown. This study does not imply that Rational

Stage Directed Therapy is the panacea for all therapeutic illsj

far from it. RSDT, an intervention rooted deeply in rational,

cognitive, and imageric' constructs may be applied effectively to populations suffering from emotional stress. Although further

exploration and study of RSDT is needed, especially with clinical populations, the basic foundation has been laid for an innovative

combination of proven therapeutic approaches. Future studies will

need not only to explore and become more aware of the practical applications of RSDT, but also to implement these applications without the grandiose assumption of one cure for all ills. 106

References

Anderson, M.L. Correlates of hypnotic performance: an historical and role-theoretical analysis. Unpublished doctoral dissertation. University of California, Berkeley, 196 3 .

Arnold, M. Emotion and personality. 2 Vols. New York: Columbia University Press, i960 .

Arnold,M. The Nature of Emotion. Middlesex, England: Penguim Books, 19 68.

Bandura, A. Principles of Behavior Modification, New York: McGraw-Hill Book Co., 1969.

Barber, T.X. Hypnosis as perceptual-cognitive restructing: III. From somnambulism to autohypnosis. Journal of Psychology 1957, 44, 299-304.

Barber, T.X. Experimental evidence for a theory of hypnotic behavior: II. Experimental controls in hypnotic age- regression. International Journal of Clinical and Experimental Hypnosis, 1961a, 9, l8l-93»

Barber, T.X. Physiological effects of "hypnosis." Psychological Bulletin, 1961b, 58, 390-419.

Barber, T.X. Toward a theory of hypnosis: Posthypnotic behavior. Archives of General Psychiatry, 19^2, 7 , 321-342.

Barber, T.X. Effects of E's tone of voice on "hypnotic-like" suggestibility. Psychological Reports, 1964a, 15, 139-44.

Barber, T.X. Hypnotizability, suggestibility, and personality: V.A critical review of research findings. Psychological Reports, 1964b, 14, 299-320.

Barber, T.X. Measuring "hypnotic-like" suggestibility with and without "hypnotic induction": Psychometric properties, norms, and variables influencing response to the Barber Suggestibility Scale (BSS). Psychological Reports, 1965a, 16, 809-44. Barber, T.X. Physiological Effects of "hypnotic suggestions": A critical review of recent research (1962-614-). Psychological Bulletin, 1965b, 63, 201-222.

Barber, T.X. Hypnosis: A Scientific Approach, New York: Van Nostrand Co., 1959*

Barber, T.X. Experimental Hypnosis. In B.B. Wolman (ed). Handbook of General Psychology. Englewood Cliffs, New Jersey: Prentice Hall Inc., 1973> 9^2-963.

Barber, T.X. and Calverley, D.S. Towards a theory of hypnotic behavior: Effects on suggestibility of task motivating instruction and attitude toward hypnosis. Journal of Abnormal and Social Psychology, 1963a, 67, 557-65.

Barber, T.X. and Calverley, D.S. "Hypnotic-like" suggestibility in children and adults. Journal of Abnormal and Social Psychology, 1963b, 66, 589-597.

Barber, T.X. and Calverley, D.S. Empirical evidence for a theory of "hypnotic" behavior: Effects of pretest instructions on response to primary suggestions. Psychological Record, 196^, lU, ^57-2j67.

Barber, T.X. and Calverley, D.S. Toward a theory of hypnotic behavior: Effects on suggestibility of defining the situation as hypnosis and defining response to suggestions as easy. Journal of Abnormal and Social Psychology, 196^, 68, 585-92.

Earber, T.X. and Calverley, D.S. Hypnotizability, Suggestibility, and personality: II. Assessment of previous imaginative- fantasy experiences by the As, Barber-Glass, and Shor questionnaires. Journal of Clinical Psychology, 1965* 21, 57-58.

Barber, T.X. and Calverley,D.S. Towards a theory of hypnotic behavior: Experimental evaluation of Hull’s postulate that hypnotic susceptibility is a habit phenomenon. Journal of Personality, 1966, 3k, 14-16-33.

Barber, T.X. and Glass, L.B. Significant factors in hypnotic behavior. Journal of Abnormal and Social Psychology. 1962, 6k, 222-228.

Beck, A. Depression. University of Pennsylvania Press, Philadelphia: 1967. Bowers, K.S. Hypnotic behavior: The differentiation of trance and demand characteristic variables. Journal of Abnormal Psychology, 1966, 71* *42-51.

Brady, J.P. and Levitt, E.F. Hypnotically induced visual hallucinations. Psychosomatic Medicine, 1966, 28, 351-63•

Bramwell, M. Hypnotism: Its History, Practice and Theory. Revised Edition. Philadelphia: J.B. Lippincott Co., 1928.

Brenman, M. and Gill, M. Hypnotherapy. New York: International Universities Press, 19^7•

Cautela, J.R. The treatment of over-eating by covert conditioning Psychotherapy: Theory, Research and Practice. Volume 9, {fyt Fall, 1972.

Chertok, L. and Kramarz, P. Hypnosis, sleep, and electro-ence­ phalography. Journal of Nervous and Mental Disorders, 1959, 128, 227-38.

Cooper, G.W., J.R., and Dana, R.H. Hypnotizability and the Maudsley Personality Inventory. International Journal of Clinical and Experimental Hypnosis, 196*4, 12, 2&-33»

Coue, E. The practice of autosuggestion. New York: Doubleday, 1922.

Coue’, E. My method. New York: Doubleday, Page, 1923•

Crasilneck, H.B. and Hall, J.A. Physiological changes associated with hypnosis: A review of the literature since 19*48. International Journal of Clinical and Experimental Hypnosis, 1959, 7, 9-50.

Dahlstrom, W.G., Welsh, G.S. and Dahlstrom, L.E. An MMPI Handbook Volume 11: Research Applications. Minneapolis: University of Minnesota Press, 1975*

Davis, L.W., and Husband, R.W. A study of hypnotic susceptibility in relation to personality traits. Journal of Abnormal and Social Psychology, 1931» 26, 175-182.

Davison, G. and Valins, S. On self-produced and drug produced relaxation. Behavior Research and Therapy, 1968, 6 , *401-*402.

Deckert, G.H. and West, L.J. The problem of hypnotizability: A review. International Journal of Clinical and Experimental Hypnosis, 1963, 11, 205-235. Dermen, D. Correlates of hypnotic susceptibility, Masters thesis, University of Illinois, 196k.

DiLoreto, A. Comparative psychotherapy: An experimental analysis. Aldine Press, Chicago, 1971*

Dorcus, R.M. Fallacies in predictions of susceptibility to hypnosis based upon personality characteristics. American Journal of Clinical Hypnosis, 1963* 5* 163-70.

D ’Zurilla, T. Reducing heterosexual anxiety. In J. Krumboltz and C. Thorenson (eds.) Behavioral Counseling: Cases and Techniques. New York: Holt Reinhart and Winston, 1959*

Elliotson, J. Numerous Cases of Surgical Operations Without Pain in the Mesmeric Stated London:' H. Bailliere, 18^3.

Ellis, A. Growth Through Reason: Verbatim Cases in Rational- Emotive Therapy. Palo Alto, California: Science & Behavior Books, 1971.

Ellis, A. Reason and Emotion in Psychotherapy. New York: Lyle Stuart, 1962.

Ellis, A. and Harper, R. A Guide to Rational Living. Englewood Cliffs, New Jersey: Prentice-Hall, Inc., 1961; Hollywood, California: Wilshire Book Co., 1961.

Erickson, M.H. A study of clinical and experimental findings on hypnotic deafness: I Clinical experimentation and findings. Journal of General Psychology, 1938b, 19> 127-50*

Erickson, M.H. A study of clinical and experimental findings on hypnotic deafness: II Experimental findings with a conditioned response technique. Journal of General Psychology, 1938a, 19, 151-67.

Erickson, M.H. The Applications of Hypnosis to Psychiatry. Medical Record, 60-65, July 1939a•

Erickson, M.H. The induction of color blindness by a technique of hypnotic suggestion. Journal of General Psychology, 1939^> 20, 61-89 .

Erickson, M.H. Advanced Techniques of Hypnosis and Therapy. New York: Grune and Stratten, 1967.

Esdaile, J. Hypnosis in medicine and surgery. New York: Julian Press, 1957* (Original date of publication I850). Evans, F.J. Recent trends In experimental hypnosis. Behavioral Science, 1968, 13, 1*77-1*87.

Eysenck, H.J. Dimensions of personality. London: Routledge & Kegan Paul, 19V7•

Fine, B.J. The relationship hetveen certain scales of the MMPI and susceptibility to prestige suggestion. Psychology Newsletter, 1958, 9, 200-203.

Fromm, E. Quo Vadis Hypnosis? Predictions of Future Trends in Hypnosis Research. In E. Fromm and R.E. Shor (eds.) Hypnosis. Chicago: Aldine Atherton, 1972, 575“586.

Fumeaux, W.D. and Gibson, H.G. The Maudsley Personality Inventory as a predictor of susceptibility to hypnosis. International Journal of Clinical and Experimental Hypnosis, 1961, 9, 167-76.

Gill, M. and Brenman, M. Hypnosis and Related States. New York: International Universities Press, 1959*

Goldfried, M. Systematic desensitization as training in self- control. Journal of Consulting and Clinical Psychology. 1971, 37, 228-235.

Goldfried, M.R., DeCenteceo, E.T. and Weinberg, L. Systematic Rational Restructuring as a Self-Control Technique. Behavior Therapy, 197**, 5, 2l*7-25l*.

Gorton, B.E. The physiology of hypnosis. Psychiatric Quarterly, 19^9, 23, 317J+3, ^57-85-

Gregory, J. and Diamond, M.J. Increasing hypnotic susceptibility by means of positive expectancies and written instructions. Journal of Abnormal and Social Psychology, 1972, 82, 363-368.

Haley, J. An Interactional explanation of hypnosis. American Journal of Clinical Hypnosis, 1958, 1, 1*1-57*

Hathaway, S. and McKinley, J. Minnesota Multiphasic Personality Inventory. New York: The Psychological Corporation, 19^3, Revised Manual, 1967.

Heilizer, R. An exploration of the relationship between hypno­ tizability and anxiety and/or neuroticism. Journal of Consulting Psychology, i960, 2k, 1*32-36.

Hepps, R.B. and Brady, J.P. Hypnotically Induced tachycardia: An experiment with simulating controls. Journal of Nervous and Mental Disease, 1967, 1**5, 131-137* Ill

Hilgard, E.R. Hypnotic susceptibility. New York: Harcourt, Brace and World, 1965*

Hilgard, E.R. Posthypnotic amnesia: Experiments and theory. International Journal of Clinical and Experimental Hypnosis, 1966, 104-11.

Hilgard, E.R. Individual differences in hypnotizability. In J.E. Gordon (Ed.), 1967, 391-^3.

Hilgard, E.R. Pain as a puzzle for psychology and physiology. American Psychologist, 19&9s 2U, 103-13*

Hilgard, E.R. and Bentler, D.M. Predicting hypnotizability from the Maudsley Personality Inventory. British Journal of Psychology, 1963, 5k, 63-6 9 .

Hilgard, E.R., Cooper, L.M., Lenox, J., Morgan, A.H. and Voevodsky, J. The use of pain-state reports in the study of hypnotic analgesia to the pain of ice water. Journal of Nervous and Mental Disease, 19&7> 1^* 506-13•

Horowitz, M.J. Visual thought images in psychotherapy. American Journal of Psychiatry, 19^8, 22, 55-59*

Jacobson, E. Progressive relaxation. Chicago: University of Press, 193^”

Jencks, B . Exercise Manual for J.H. Schultz’s Standard Autogenic Training and Special Formulas. Salt Lake City, Utah: 1973*

Johnson, W. People in quandaries. New York: Harper, 19^6.

Karst, T. and Trexler, L. Initial study using fixed role and rational-emotive therapy .in treating public speaking anxiety. Journal of Consulting and Clinical Psychology. 1970* 3^* 360-366.

Kelly, G . The psychology of constructs. New York: Norton, 1955.

Klinger, B.I. The effects of peer model responsiveness and length of induction procedure on hypnotic responsiveness. Paper presented at Eastern Psychological Association, Annual Meeting, Washington, D.C., April 18, 1968.

Korzybski, A. Science and Sanity, Lancaster, Pa.: Lancaster Press, 1933* Kroger, W.S. Clinical and Experimental Hypnosis, Philadelphia: Lippincott, 19^3•

Kuhie, L.S. and Margolin, S. The process of hypnotisim and the nature of the hypnotic state. American Journal of Psychiatry, 19kk, 100, 611=622.

Lang, P. Fear Reduction and fear behavior: Problems in treating a construct. In J.M. Schlien (Ed.) Research in Psychotherapy Vol. 3., Washington, D.C., APA 1968.

Lang, P. Fear reduction and fear behavior: Problems in treating a construct. In J.M. Schlien (Ed.) Research in Psychotherapy Vol. 3>j Washington, D.C., American Psychological Association, 1968.

Lang, P.J. and Lazovik, A.D. Personality and hypnotic suscepti­ bility. Journal of Consulting Psychology. 1962, 26, 317-27®

Lazarus, A. Variations in desensitization therapy. Psychotherapy: Theory Research' and Practice, 1968, 5 (l)> 50-52.

Lazarus, A. Behavior Therapy and Beyond: New York: McGraw Hill, 1971.

Lazarus, A. Desensitization and Cognitive Restructuring. Psychotherapy 197^, 11, 98-102.

Lazarus, A. Psychological Stress and the Coping Process, New York: McGraw-Hill, 1966, 53/ 159-161, 250-253.

Leuner, H. Guided Affective Imagery, (GAl). American Journal of Psychotherapy, 19^9y 23, 4-22.

Levitt, E.E. and Chapman, R.H. Hypnosis as a Research Method in E. Fromm and R.E. Shor (Eds.) Hypnosis Chicago: Aldine- Atherton, 1972, 85-114.

Levitt, E.E. and Brady, J.P. Psychophysiology of hypnosis. In J. M. Schneck (ed.), Hypnosis in Modern Medicine (3d ed.). Springfield, 111.: Charles C. Thomas, 19&3> 31^-62.

Marks, P., Seeman, W. and Haller, D. The Actuarial Use of the MMPI with Adolescents and Adults. Baltimore: Williams & Wilkins Co., 19~74.

Maultsby, M.C. Handbook for Rational Self Counseling. Madison: Association for Rational Thinking, 1971. McBain, W.N. Imagery and Suggestibility: A test of the Arnold Hypothesis. Journal of Abnormal and Social Psychology, 1973, 282-29^.

Meares, A. A system of medical hypnosis. Philadelphia: Saunders, i960.

Meicheribaum, D. Cognitive factors in behavior modification: Modifying what clients say to themselves. In Annual Review of Behavior Therapy Theory and Practice. Franks 84 Wilson (eds. Hew York: Brunner/Magel, 1973•

Meicheribaum, D. and Cameron, R. The Clinical Potential of Modifying What Clients Say to Themselves. Psychotherapy, 11, 197^-

Meichenbaum, D., Gilmore, J., and Fedoravicius, A. Group insight vs group desensitization in treating speech anxiety. Journal of Consulting and Clinical Psychology, 1971, 3^, *+10-^21 T~

Meihl, E. Psychologists opinion as to the effects of holding five of Ellis's irrational ideas. Report to the NIMH Research Grant M hk65, 1966.

Melei, J.P. and Hilgard E.R. Attitudes toward hypnosis, self- predictions, and hypnotic susceptibility. International Journal of Clinical and Experimental Hypnosis, 196*1-, 12, 99-108. :

Miller, N.E. Learning of visceral and glandular responses. Science 1969, 163, k3k-kk5. Moleski, R. and Tosi, D. Comparative Psychotherapy: Rational- Emotive Therapy vs. Systematic Desensitization in the Treat­ ment of Stuttering. In press, 1975-

Mooney, R. "A Conceptual Model for Integrating Four Approaches to the Identification of Creative Talent." In Scientific Creativity: Its Recognition and Development, edited by C. Taylor and F. Barron. Hew York: John 'Wiley Sons, 19&3-

Orne, M.T. The Nature of Hypnosis: Artifact and Essence. The Journal of Abnormal and Social Psychology, 1959, 58, 277-299-

Orne, M.T. The mechanism of hypnotic age regression: An experi­ mental study. Journal of Abnormal and Social Psychology. 1959, 58, 277-99- Ilk

Orne, M.T. and Evans, F.J. Social control in the psychological experiment: Antisocial behavior and hypnosis. Journal of Personality and Social Psychology, 19^5* 1* 109-200.

Palmer, R.D. and Field, P.B. Visual images and susceptibility to hypnosis. Journal of Consulting and Clinical Psychology, 1968, 32, V56-W 1 .

Paul, G. Physiological effects of relaxation training and hypnotic suggestion. Journal of Abnormal Psychology, 1959* if, *+25-^37.

Pavlov, I.P. The identity of inhibition with sleep and hypnosis. Scientific Monthly, 1923, 17* 603-6o8.

Phillips, E.L. Psychotherapy. Englewood Cliffs, New Jersey: Prentice-Hall, 1956.

Quaranta, J. "Conceptual Framework for Career Development Programing." In Guidance for Planning and Evaluative Career Development, edited by R. McCormick and J. Wigtil. Project sponsored by the Division of Guidance and Testing. Columbus; Ohio Department of Education, 1971*

Sarbin, T.R. Contributions to role-taking theory r 1, Hypnotic Behavior, Psychological Review, 1950* 57* 255-270.

Sarbin, T.R. Physiological effects by hypnotic stimulation. In R.M. Dorcas (ed.), Hypnosis and its Therapeutic Applications. New York: McGraw-Hill, 1956, Chap. b.

Schachter, S. and Singer, J. Cognitive, social and physiological determinants of emotional state. Psychological Review, 1962, 69* 379-399.

Schachter, S. The interaction of cognitive and physiological determinants of emotional state. In C.D. Spielberger (ed.) Anxiety and Behavior. New York: Academic Press, 1966.

Schulman, R.E. and London, P. Hypnotic susceptibility and MMPI profiles. Journal of Consulting Psychology, 19^3* 27* 157-1^0.

Secter, I.I. Personality factors of the MMPI and hypnotizability. American Journal of Clinical Hypnosis, 19^1* 3* 185-188.

Shor, R.E. The Fundamental Problem in Hypnosis Research as viewed from historic perspectives. In E. Fromm and R.E. Shor (eds.) Hypnosis. Chicago: Aldine-Atherton, Inc., 1972, 15-^2. Shor, R.E. and Orne, C. . The Harvard Group Scale of Hypnotic Susceptibility, Form A. Palo Alto, California: Consulting Psychologists Press, 19^2.

Shor, R.E., Orne, M.T. and O’Connell, D.N. Validation and cross validation of a scale of self-reported personal experiences which predicts hypnotizability. Journal of Psychology, 1962, 53, 55-75.

Shor, R.E., Orne, M.T. and O'Connell, D.N. Psychological correlates of plateau hypnotizability in a special volunteer sample. Journal of Personality and Social Psychology, 1966, 3, 80-95*

Sperry, R.W. Science and the problem of values. Zygon: Journal of Religion and Science, 9 (ll), 7-21, 197^»

Spielberger, C.D., Gorsuch, R. and Lushene, R. The State-Trait Anxiety Inventory (STAl), Test Manual Form X» Palo Alto, California: Consulting Psychologists Press, 19^9.

Suinn, R. and Richardson, R. Anxiety Management Training: A nonspecific behavior therapy program of anxiety control. Behavior Therapy, 1971, 2, ^98-510.

Tart, C.T. Types of hypnotic dreams and their relation to hypnotic depth. Journal of Abnormal Psychology, 19^6, 71, 377-382.

Tosi, D.J. Self-Directed Behavior Change in the Cognitive, Affective, and Behavioral Motoric Domains: A Rational- Emotive Approach. Focus on Guidance, December, 1973*

Tosi, D.J. Youth Toward Personal Growth: A Rational Emotive Approach^ Columbus, Ohio: Merrill, 197^*

Tosi, D., Briggs, R.D., and Morley, R.M. "Study Habit Modification and Its Effects on Academic Performance: A Behavioral Approach. The Journal of Educational Research 6 (1971): 8

Tosi, D.J. and Marzella, J.N. Rational Stage Directed Therapy, (RSDT). Paper Presented at National Conference on Rational Psychotherapy, Chicago, June 7, 1975*

Truax, C.B. Therapist empathy, genuineness, and warmth and patient therapeutic outcome. Journal of Consulting Psychology, 1966, 30, 395-tol.

Truax, C.B. and. Carkhuff, R.R. Toward Effective Counseling and Psychotherapy: Training and Practice. Chicago: Aldine, 19^7* 116

Underwood, H.W. The validity of hypnotically induced visual hallucinations. Journal of Abnormal and Social Psychology, i960, 61, 39-U6 .

Valins, S. and Ray, A. Effects of cognitive desensitization on avoidance behavior. Journal of Personality and Social Psychology, 1967, 7, 3^5-350.

Velten, E. A laboratory task for induction of mood states. Behavior Research and Therapy, 1968, 6,

VJeitzenhoffer, A.M. Hypnotism: An Objective Study in Suggesti­ bility. New York: John Wiley & Sons, 1953•

Weitzenhoffer, A.M. and Hilgard, E.R. Standford Hypnotic Susceptibility Scale, Form C. Palo Alto, California: Consulting Psychologists Press, 1959*

White, R.W. A preface to the theory of hypnotism. Journal of Abnormal and Social Psychology, 19^1, 36, ^77-505•

Wilson, D.L. The role of confirmation of expectancies in hypnotic induction. Unpublished doctoral dissertation, University of North Carolina, 1967.

Winer, B. Statistical principles in experimental design. New York: McGraw-Hill, 1962.

W'olpe, J. Psychotherapy by reciprocal inhibition. Stanford: Stanford University Press, 1958*

Zeisset, R. Desensitization and relaxation in the modification of patients’ interview behavior. Journal of Abnormal Psychology, 1968, 73, l8 -2h.

Zimbardo, P.G. The Cognitive Control of Motivation: The Consequences of Choice and Dissonance. Glenview, 111: Scott, Foresman~& Co., 1969.

Zimbardo, P.G., Maslach, C., and Marshall, G. Hypnosis and the Psychology of Cognitive and Behavioral Control. In Fromm and Shor (eds.) 1972.

Zimbardo, P.G., Rapaport, C. and Baron, J. Pain control by hypnotic induction of motivational states. In P.G. Zimbardo (ed.) 1969, pp. 136-152. Zuckerman, M. and Lubin, B. Manual for the Multiple Affect Adjective Checklist. Educational and Industrial Testing Service, San Diego, California: 19^5•

Zung, W. A Self-Rating Depression Scale. Archives of General Psychiatry. 12: 63, Jan. 1975 •

Zung, W. Factors influencing the Self-Rating Depression Scale. Archives of General Psychiatry. 16: 5U3, May, 1967.

Zung, W., Richards, C.B. and Short, M.J. Self-Rating Depression Scale in an Outpatient Clinic. Archives of General Psychiatry. 13: 508 December, 1965. 118

Appendix A

Eight Test-Suggestions*

1. Arm Lowering. "Hold your right arm straight out in front of you like this." (Guide the subject to extend the right arm directly in front of body at shoulder height and parallel to the floor.) "Concentrate on your arm and listen to me." (Begin timing) "Imagine that your right arm is feeling heavier and heavier, and that it's moving down and down. It's becoming heavier and heavier and moving down and down. It weighs a ton? It's getting heavier and heavier. It’s moving down and down, more and more, coming down and down, more and more; it's heavier and heavier, coming down and down, more and more, more and more." (End 30 seconds) "You can relax your arm now." (If necessary, ask the subject to lower the right arm.) Objective score criterion: 1 point for response of 4 inches or more. (Response is measured by placing a ruler near the sub­ ject's hand at the beginning of the suggestions and noting degree of displacement at the end of the 30-second suggestion period.)

2. Arm Levitation. "(Keep your eyes closed and) put your left aim straight out in front of you in the same way. Concentrate on your arm and listen to me." (Begin timing) "Imagine that the arm is becoming lighter and lighter, that it's moving up and up. It feels as if it doesn't have any weight at all, and it's moving up and up, more and more. It's as light as a feather,it'6 weightless and rising in the air. It's lighter and lighter, rising and lifting more and more. It’s lighter and lighter and moving up and up. It doesn't have any weight at all and it's moving up and up, more and more. It's lighter and lighter, moving up and up, more and more, higher and higher." (End 30 seconds) "You can relax your arm now." (if necessary, ask the sub­ ject to lower his arm.) Objective score criterion: 1 point for response of ^ inches or more during 30-second suggestion period.

3. Hand Lock. "(Keep your eyes closed.) Clasp your hands together tightly, and interlace the fingers." (If necessary, the experimenter states, Press your hands together, with palms touching," and assists the subject to Interlock the fingers and to bring the palms together.) "Put them in your lap. Concentrate on your hands

*Taken from Barber (1969) 119 and hold them together as tightly as you can.” (Begin Timing) "Imagine that your hands are two pieces of steel that are welded together so that it’s impossible to get them apart. They’re stuck, they’re welded, they're clamped. When I ask you to pull your hands apart they'll be stuck and they won’t come apart no matter how hard you try. They're stuck together.; they're two pieces of steel welded together. You feel as if your fingers were clamped in a vise. Your hands are hard, solid, rigid! The harder you try to pull them apart the more they will stick to­ gether! It's impossible to pull your hands apart! The more you try the more difficult it will become. Try; you can't." (End k5 seconds) (5-second pause) "Try harder; you can’t." (10-second pause) "You can unclasp your hands now." Objective score criteria: 1/2 point for incomplete separation of the hands after 5-second effort; 1 point for incomplete separation after 15-second effort.

U. Thirst "Hallucination." (Keep your eyes closed)- (Begin timing) "Imagine that you've just finished a long, long walk in the hot sun. You've been in the hot sun for hours, and for all that time you haven't had a drink of water. You've never been so thirsty in your life. You feel thirstier and thirstier. Your mouth is parched, your lips are dry, your throat is dry. You have to keep swallowing and swallowing. You need to moisten your lips. (3-second pause) You feel thirstier and thirstier, drier and drier. Thirstier and thirstier, dry and thirsty. You're very, very thirsty! Dry and thirsty! Dry and thirsty!" (End ^5 seconds) "Now, imagine drinking a cool, refreshing glass of water." (5-second pause) Objective score criteria: 1/2 point if the subject shows swal­ lowing, moistening of lips, or marked mouth movements; additional l/2 point if the subject indicates during the "post-experimental" questioning that he became thirsty during this test (e.g., "I felt dry," "I was parched," "I felt somewhat thirsty"). (See "post- experimental" questions for final scoring criteria on this test.)

5. Verbal Inhibition. "Keep your eyes closed." (Begin timing) "Imagine that the muscles in your throat and jaw are solid, and rigid, as if they're made of steel. They're so solid and so rigid, that you can't speak. Every muscle in your throat and mouth is so tight and so rigid that you can't say your name. The harder you try to say your name the harder it becomes! You can't talk! Your larynx has tightened up; your throat and jaw feel as if they are in a vise. Your throat is clamped so tightly that you can't talk; you can't say your name. The harder you try the harder It will be. It's useless; the words won’t come out; you can’t speak your name; it's impossible to talk! The harder you try to say your name the harder it will become. Try; you can’t." (End 1*5 seconds) 120

(5 second pause) "Try harder; you can’t." (10 second pause) "You can say your name now." Objective score criteria: 1/2 point if the subject does not say his name after-5-second effort; 1 point if he does not say his name after 15-second effort.

6. Body Immobility. (Keep your eyes closed.") (Begin Timing) "Imagine that for years and years you’ve been sitting in that chair just as you are now. Imagine that you've been sitting in that chair so long that you’re stuck to it! It’s as if you’re part of the chair. Your whole body is heavy, rigid, solid and you weigh a ton. You’re so heavy that you can’t budge yourself. It’s impossible for you to stand up, you're stuck right there! Your body has be­ come part of the chair. When I ask you to stand up you won’t be able to do it! You’re stuck tight. The harder you try the tighter you'll be stuck and you won't be able to get up. You're heavy in the chair! Stuck in the chair; you can't stand up. You’re so heavy and stuck so tight. You can't stand up; you’re stuck. Try; you can't." (End ^5 seconds) (5 second pause) "Try harder; you can't." (10 second pause) "You can relax (or sit down) now." (The subject is considered not standing if he rises slightly from the chair without straightening into an erect posture. In this event, the experimenter says, "Try to stand fully erect; you can't," instead of "Try harder; you can't.") Objective score criteria: l/2 point if the subject is not standing fully erect after 5-second effort; 1 point if not standing fully errect after 15-second effort.

7. "Posthypnotic-Like" Response. (The auditory stimulus consists of tapping once on the metal back of a stop watch with a fountain pen.) (Begin timing) "When this experiment is over in a few minutes and your eyes are open, I'll click like this (experimenter presents auditory stimulus) and you’ll cough automatically. At the moment I click (experimenter presents stimulus) you'll cough. When your eyes are open I'll click (stimulus is presented) and you'll cough. When I click you'll cough." (End 30 seconds) Objective score criterion: 1 point if the subject coughs or clears his throat "post-experimentally" when presented with the auditory stimulus.

8. Selective Amnesia. "Your eyes are still closed but I'm going to ask you to open them in a minute. When they're open I'm going to ask you to tell me about these tests." (Begin timing) "You'll remember all the tests and be able to tell me about them, all except for one. There's one that you'll completely forget about as if it never happened! That's the one where I said your arm was becoming lighter and moving up and up. You'll forget all about that and when you try to think about it, it will slip even further away 121

from your mind. You vill forget completely that I told you that your arm -was becoming lighter. This is the one test that you cannot rememberI You will remember that I said your arm was heavy and all the other tests "will be perfectly clear but the harder you try to remember that I told you your arm was rising the more difficult it will become. You will not remember until I give you permission by saying, *Now you can remember,' and then, and only then, you will remember that I said your arm was rising!" (End h5 seconds) Objective score criterion: 1 point if the subject does not refer to the Arm Levitation item (Test-Suggestion 2) but recalls at least four other items and then recalls Test-Suggestion 2 in response to the cue words.

"Post-Experimental" Objective Scoring Of Test-Suggestions k, 7.» and 8 "

"(Open your eyes,) the experiment is over." Scoring of Test-Suggestion 7* The "Posthypnotic-Like" Response item (item 7) is scored at this point. The experimenter presents the auditory stimulus after the subject has opened his eyes and before conversation commences. Scoring of Test-Suggestion 8 . The experimenter next asks: "How many of the tests can you remember?" The experimenter prompts the subject by asking, "Were there any others?". "Can you think of any more?", and "Is that all?", until the subject mentions at least four of the test-suggestions. If the subject verbalises the Arm Levitation item during his recital, he receives a score of zero on Test-Suggestion 8 (Selective Amnesia). If the subject does not include the Arm Levitation item in his enumeration, the experimenter finally states, "Now you can remember," and, if the subject still does not verbalize the Arm Levitation item, "You can remember perfectly well now!" The subject receives a score of 1 point on Test-Suggestion 8 (Selective Amnesia) if he mentions at least four of the test- suggestions, but does not mention the Arm Levitation item before he is given the cue words, "Now you can remember," or "You can remember perfectly well now!" Final Scoring of Test-Suggestion k. The Objective scoring of Test-Suggestion h is completed when the subject refers to this item during his recital. At this point the experimenter ask: "Did you become thirsty during this test?" If the subject answers Yes to this question he receives the additional l/2 point on item I)-. I f the subject answers Yes but adds a qualifying statement, e.g., he had been thirsty to begin with, he is asked: "Did the imaginary glass of water help quench your thirst?" If the subject now answers 122

Yes he receives the additional l/2 point. The maximum Objective score obtainable on the ESS is 8 points.

Subjective Scores

Immediately after the Objective scores have been assigned, the experimenter mentions each test-suggestion that the subject has passed with an Objective score of either 1/2 of 1 point and asks the subject if he felt the suggested effect or if he went along with the suggestion to follow instructions or to please the experi­ menter. Specifically, the following questions are asked (with respect to those test-suggestions that the subject has passed with an Objective score of either l/2 or 1 point):

1. "When I said that your right arm was heavy and was coming down, did your arm feel heavy or did you just let it come down in order to follow instructions or to please me?"

2. "When I said that your left arm felt light and was rising, did your arm feel light or did you raise it deliberately in order to follow? instructions or to please me?"

3. "When I said that your hands were stuck and you couldn't take them apart, did you actually feel that you couldn't take your hands apart or did you keep your hands together in order to follow in­ structions or to please me?"

h. "When I said that you were becoming very thirsty, did you actually become very thirsty or did you just act as if you were thirsty in order to follow instructions or to please me?"

5. "When I said that you couldn't say your name, did you actually feel that you couldn't speak your name or did you just go along with the suggestion in order to follow instructions or to please me?"

6. "When I said that you -were stuck in the chair, did you feel that you were stuck and unable to stand up or did you just go along with the suggestion to follow instructions or to please me?"

7. "When I clicked and you coughed, did you feel that you coughed automatically or did you cough deliberately in order to follow instructions or to please me?"

8. "Did you actually forget that I had said that your arm was rising or did you just act as if you had forgotten in order to follow instructions or to please me?" A subjective score of 1 point is assigned for each test- suggestion passed -objectively which the subject testifies that he had "felt." The maximum Subjective score obtainable is 8 points.

The blank used to record Objective and Subjective scores on the BSS is shown on the following page. 12k

Subject*s name : S e x ______: A g e _____ :

Date______; : Experimenter’s name

Experimental procedure ______

Objective Subjective Score Score 1. Arm Lowering. Arm dovn: inches

2. Arm Levitation. Arm up: inches______

3. Hand Lock; Hands opened before 5 secs. ___ hands opened after 5 secs. ___ hands not opened after 15 secs. if. Thirst "Hallucination". Swallowed ; moved mouth__ licked lips _____; felt thirsty

5. Verbal Inhibition. Said name before 5 secs. j said name after 5 secs. _____; did not say name after 15 secs.

6. Body Immobility. Got up before 5 secs. _____ ; got up after 5 secs. j did not stand up after 15 secs.

7. "Posthypnotic-Like" Response. Did cough ; didn't cough .

8. Selective Amnesia. Remembered amnesia task______; didn't remember until given permission

Total Score PLEASE NOTE:

Pages 125 - 126, "Self-Evaluation Questionnaire", not microfilmed at the request of the author. also pages 127 - 129, "Multiple Affect Adjective Check List” not microfilmed at the request of the author. Both materials are available for consultation at Ohio State University Library.

UNIVERSITY MICROFILMS 130

Appendix E

Depression Inventory

0 I do not feel sad 1 I feel "blue or sad 2a I am blue or sad all the time and I can't snap out of it 2b I am so sad or unhappy that it is quite painful 3 I am so sad or unhappy that I can’t stand it

0 I am not particularly pessimistic or discouraged about the future la I feel discouraged about the future 2a I feel I have nothing to look forward to 2b I feel that I won’t ever get over my troubles 3 I feel that the future is hopeless and that things cannot improve

0 I do not feel like a failure 1 I feel I have failed more than the average person 2a I feel I have accomplished very little that is worthwhile or that means anything 2b As I look back on my life all I can see is a lot of failures 3 I feel I am a complete failure as a person (parent, husband, wife)

0 I am not particularly disatisfied la I feel bored most of the time lb I don’t enjoy things the way I used to 2 I don’t get satisfaction out of anything any more 3 I am disatisfied with everything

0 I don’t feel particularly guilty 1 I feel bad or unworthy a good part of the time 2a I feel quite guilty 2b I feel bad or unworthy practically all the time now 3 I feel as though I am very bad or worthless 131

0 I don't feel I am being punished 1 I have a feeling that something had may happen to me 2 I feel I am being punished 3a I feel I deserve to be punished 3b I want to be punished

0 I don't feel disappointed in myself la I am disappointed in myself lb I don't like myself 2 I am disgusted with myself 3 I hate myself

0 I don't feel I am any worse than anybody else 1 I am critical of myself for my weaknesses or mistakes 2 I blame myself for my faults 3 I blame myself for everything bad that happens

0 I don't have any thoughts of harming myself 1 I have thoughts of harming myself but I would not carry them out 2a I feel I would be better off dead 2b I feel my family would be-better off if I were dead 3a I have definite plans about committing suicide 3b I would kill myself if I could

0 I don't cry any more than usual 1 I cry more now than I used to 2 I cry all the time now. I can't stop it 3 I used to be able to cry but now I can't cry at all even though I want to

K.

0 I am no more irritated now than I ever am 1 I get annoyed or irritated more easily than I used to 2 I feel irritated all the’time 3 I don't get irritated at all at the things that used to irritate me 132

0 I have not lost interest in other people 1 I am less interested in other people now than I used to be 2 I have lost most of my interest in other people and have little feeling for them 3 I have lost all my interest in other people and don’t care about them at all

M.

0 I make decisions about as veil as ever 1 I try to put off making decisions 2 I have great difficulty 3 I can’t make any decisions at all any more

N.

0 I don’t feel I look any worse than I used to . 1 I am worried that I am looking old or unattractive 2 I feel that there are permanent changes in my appearance and they make me look unattractive 3 I feel that I am ugly or repulsive looking

0 I can work about as well as before la It takes extra effort to get started at doing something lb I don't work as well as I used to 2 I have to push myself very hard to doanything 3 I can’t do any work at all

0 I can sleep as well as usual 1 I wake up more tired in the morning than I used to 2 I wake up 1-2 hours earlier than usual and find it hard to get back to sleep 3 I wake up early every day and can't get more than 5 hours sleep Q.

0 I don't get any more tired than usual 1 I get tired more easily than I used to 2 I get tired from doing anything 3 I get too tired to do anything 133

it's hard to think of much much else of think to hard it's I have lost more than 15 pounds 15 than more lost have I sex I have lost more than 5 pounds more than 5 lost have I I haven't lost much weight, if any, lately any, if weight, much lost haven't I pounds 10 than more have lost I or constipation 3 3 completely in sex lost interest have I 3 3 feel I what in absorbed am I completely 0 in my interest in change any recent noticed not have I 0 0 usual health than my about more am no concerned I 1 1 be used to than I in sex less aminterested I 2 now in sex muchinterested am less I 0 0 My appetite is usual than worse no 1 upset stomach or pains and aches about am I concerned 3 3 more any all at appetite have no I 2 that feel what I or feel howI with am I concerned so 2 2 My appetite is now worse much 1 1 be as as good appetite to usedis not it My O H CM CO R. 13**

Appendix F

Therapist Rating Form

Rate the following dimensions of treatment in terms of the extent of agreement or disagreement of their presence. Rate the questions as follows: (l) Clearly Present (2) Partially Present, or (3) Unclear or (U) Not Present.

Rational Stage Directed Hypnotherapy:

(a) Review of Self Directed Behavior Change identified problems. 1 2 3^ (b) Therapist-client identification of rational and irrational ideas. 1 2 3** (c) Stages Outlined. 1 2 3** (a) Hypnosis induced. 1 2 3** (e) Cognitive restructuring engaged in. 1 2 3**

Rational Stage Directed Imagery:

(a) Review of Self Directed Behavior Change identified problems. 1 2 3** (b) Explanation of stages 1 2 3** (c) Processing of 3s through cognitive restructuring 1 2 3** (d) Processing of Ss through Stages 1 2 3**

Hypnosis:

(a) Ss subjected to deep breathing 1 2 3** (b) Ss subjected to cognitive muscle relaxation 1 2 3** (c) Ss asked to imagine relaxing scene 1 2 3** (d) Ss deepened by counting 1 2 3**

Placebo:

(a) Ss told emotional stress will subside; no reason given 1 2 3** (b) All questions answered non-directly 1 2 3** Appendix G

Self-Directed Behavior Change in the Cognitive, Affective, and Behavioral Motoric Domains:

A R a tiona 1 - E m o t i v e A p p r o a c h

Donald J. Tosi, Ph.D. The Ohio State University TABLE OF CONTENTS

P a g e Introduction ...... 1

A B C D Model of Cognitive, Affective, and Behavioral Processes . 2

PART I - T H E A B C D Irrational Sequence ...... 3

Example of A B C D Irrational Sequence ...... 4

Activating Events ( A ' s ) ...... ' 5

Undesirable Emotional States (Cu's) ...... 6

Undesirable Behaviors (Du's), ...... 7

T h e Irrational Beliefs or Ideas (IB's) ...... 8

A B C D Personal Analysis Form (A) ...... 1 0

PART II - The Reconstruction Process ...... 1 1

Psychological Reconstruction ...... 1 2

The Rational I d e a s ...... 1 3

The Positive Emotions (Cp's) ...... 1 7

The Desirable Behaviors (Dd’s) ...... 1 8

A B C D - The Restructuring Process Form (B) ...... 1 9 INTRODUCTION

This exercise is designed to facilitate self-directed behavioral change in the cognitive, the affective, and the behavioral motoric domains. The value of this exercise is that it c a n be performed in real life situations (in vivo) or in one's imagination (emotive-imagery). The exercise permits persons to develop a greater awareness of self through self-exploration. Moreover, it is intended to help persons acquire skills that they m a y use to excellent advantage in the control of their o w n behaviors.

This self-directed intervention is based upon rational-emotive theory and thus emphasizes cognitive control over emotions and behavior. Rational- emotive theory holds that most sustained negative emotions which interfere with effective behavior (problem solving, self-assertiveness, decision­ making, etc.) are the result of irrational ideas wh ic h take the form of biased, prejudiced, internalized sentences. Rarely do events external to us cause our discomfort. In reality, it is our o w n perceptions, attitudes, or inter­ nalized sentences about those events outside of us that affect us most.

Specifically, this exercise should (1) enable a person to explicate his thinking or ideas about significant events that are associated with areas of ineffective functioning, and (2) help that person to generate more reason­ able thoughts or ideas that would be associated ultimately with more positive emotions and behavior.

In completing this exercise you will be assisted with any questions or difficulties you m a y have by your counselor, teacher, or workshop leader.

If this exercise is being completed at home, you m a y write your questions or comments on the extra sheets provided. 138

ABCD M o d e l o f Cognitive, Affective, and Behavioral Processes

Person Perceives Appraises, Evalu­ ates Event (s) - (Irrational or Rational Ideas A b o u t A )

External or Feelings, Emotion Internal Event(s) or Affect (Positive (Real or Symbolic or Negative) Representations of Present, Past, Future Events) 't*

Overt or Covert Actions Toward or a w ay from A (Depending on B & C, Behavior (D) will be Self- Enhancing or Self-Defeating

(Note) S o m e persons report that their behavior (D) follows feelings (C) about events (A). They appear to be unaware of the thoughts that cause, support, and sustain the feelings. In other cases, s ome persons are not aware of their emotions (C) and attribute their behavior (D) to their thoughts (B). In actuality, both B and C interact to cause or to influence one's behavior (D). Thus, appropriate psychological interventions assist persons initially to b e come fully aware of the entire A B C D sequence.

Since persons have the ability to observe themselves or consider themselves as objects, a B, a C, or a D may become an A. As can be observed, the A B C D process is cyclical in nature.

B and C are states occurring within the person exclusively. A & D are often observable to others, but m a y also occur within the person. PART I

T H E A B C D IRRATIONAL SEQUENCE EXAMPLE Or IRRATIONAL ABCD SEQUENCE

W i f e

"the cognitive appraisal. H e called me a . He shouldn't do that. He doesn’t have a right to put m e d o wn . I can't stand that m a n w h e n he does C that. I can't stand to be called

' t h e e v e n t the emotion"

Husband screams at A n g e r wife a n d calls her a (I c o ul d kill him) dirty name.

S The behavior toward A ' " o v e r t " \ (Irrational Approach) Excessiva n a m e calling and reciprocal putting down. You are a ______and everyone knows it. I hate you. Get away from me.

(Irrational Avoidance) Rejecting and avoiding A. Refusal to resolve or deal with conflict. 1U1

- 5

( A ' s )

Activating Events

Each of us find that m a n y situations or events in our environment are sources of joy or unhappiness. Significant situations for most of us are school, family, friends, church, etc. Examples of events typically associated v/ith personal unhappiness are a mate screaming at you; a boisterous child; a pending divorce; politics; a n undisciplined student; excessive demands m a de by bosses, friends, or relatives; and certain types of deviant behavior (homosexuality, criminality); examinations; social

relationships, and, making career decisions. Events m a y also consist of

your undesirable habits or behaviors such as eating and drinking too much, .

oversleeping and being late for appointments.

First, list three specific and significant events that are sources of

psychological discomfort for you. Second, rank these events that activate

negative emotional reactions from least emotionally upsetting to most

emotionally upsetting.

Ranking of Activating Events from Least Emotionally Upsetting to Most Listing of Activating Events Emotionally Upsetting

1 1.

2 2 1^2

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( C u ' s )

Undesirable Emotional or Affective States Associated with Significant Situational Events

The following is a list of negative emotional or affective reactions associated with certain events (internal or external). Identify those emotional reactions accompanying each of the activating events you have already listed. Record these under C (undesirable emotions) on form A.

Undesirable Affects or Emotions

1. Anger or great irritability 14. Resentful 2. Anxiety, severe worry, or fear 1 5 . L a z y 3 . Boredom or dullness 1 6 . S i n f u l 4. Failure to achieve 17. Self-hate 5. Frustration 18. Excessively shy 6. Guilt or self-condemnation 19. Hating others 7. Hopelessness or depression 20. Vulnerable 8. Great loneliness 21. Dependent 9. Helplessness 22. Mistrust 10. Self-pity 2 3 . R i g i d 11.- Uncontrollability 24. Foolish 12. Worthlessness or inferiority 25. Jealousy 13. Stubbornness 26. Other (specify) _ 1^3

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( D u ' s )

Undesirable Behaviors, Actions, or Habits

This is a list of behaviors generally considered to be self-defeating or undesirable, especially, w h e n they are of a high frequency, intensity, and duration. From the list below, choose those behaviors that are most often associated with the activating event(s) you specified (A) and the undesirable emotional or affective states (C) you have already determined for yourself.

Record these on form A- You m a y need to be more specific than suggested

by the above behaviors.

1. Avoiding responsibility 2 . Acting unfairly to others 3. Being late to appointments 4. Demanding attending 5. Physically,attacking others 6. Procrastinating 7 . Telling people off harshly 8. Whining or crying 9. Withdrawing from activity' 10. Excessive drinking of alcohol 11. Overeating 12. Undersleeping 13. Oversmoking 14. Excessively manipulating. 15. Taking too m a ny drugs or pills 16. Being sarcastic 1 7 . L y i n g 18. Cheating 19. Overprotecting 20. Other (specify) ______- 8 -

( I B ' s )

T h e Irrational Beliefs or Ideas

The following are c o m m o n l y held irrational ideas or beliefs that are causes of emotional disturbance. From the list, choose those irrational ideas (IBs) tnat occur between the Activating Events (A) and the emotions

(C) you generally experience. At first this m a y prove to be difficult because such thinking generally occurs in symbolic or shorthand form and m a y not be In one's awareness. The idea here is to slow d o w n the think­ ing process enough so that those ideas associated with or cause emotional distress will c o me into sharp focus or awareness. It m a y be easier if you can translate the above ideas into words that are more familiar to you.

Record those IBs you select under IB.

W h e n yju have finished this section you have completed the A B C D personal analysis of your specific thoughts, feelings, and actions associated with significant events.

(1) I must be loved or approved by everyone for virtually everything I do. Or, if not by everyone, by persons I d e e m significant to me.

(2) I believe that certain acts are sinful, wicked, or villlanous, and that people w h o perform such acts should be severely punished and blamed.

(3) I can't stand it w h e n things are not the w a y I w o ul d like them to be. lh-5

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(4) W h e n I a m unhappy it is because something external to m e such as persons or events causes m e to be that way.

(5) I should be terribly concerned about things that m a y be dangerous or fearsome to me.

(6) Although I w a n t to face difficult situations a n d self responsibilities it is easier for m e to avoid them.

(7) I need s o me o n e stronger or greater than myself on w h o m t o r e l y .

(8) In order to have a feeling of worth, I should and must be thoroughly competent, adequate, intelligent, and achieving in all possible respects.

(9) W h e n something cnce strongly affected me, it w:ll always or indefinitely affect m e .

0.0) I don't have m u c h control over m y emotions or thoughts.

(11) I should never be angry or express m y anger because such expression is bad and a sign of personal weakness.

(17) I should rarely confront other people or assert m y o w n thouchts or feelings about another person because people m e fragile and are hurt easily. I d o n ’t want to hurt anyone.

(13) M o s t of the time I will please other people even if I have to forgo m y o w n pleasure.

(14) I a m happiest w h e n I just remain inactive and passive.

;i5) In order to be perfectly fulfilled as a h u m a n being I need (must have) a close personal, involved, and intimate relationship with another person especially a m e mb e r of the opposite sex. ABCD PERSONAL ANALYSIS

P A R T I ( F o r m A )

LEAST EMOTIONALLY UPSETTING MOST EMOTIONALLY UPSETTING

A) ACTIVATING EVENTS

IBs) IRRATIONAL I D E A S O R PHILOSOPHIES (THOUGHTS)

C) UNDESIRABLE EMOTIONAL OR A F F E C T I V E REACTIONS

D) BEHAVIORAL CONSEQUENCES OR ACTIONS ASSOCIATED W I T H C + +

«•+ Try’ ie be as specific as possible in describing IBs, Cs, and Ds. iUt

P A R T I I

THE RECONSTRUCTION PROCESS 11*8

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Psychological Reconstruction

The purpose of this section "the reconstruction process" is to assist

persons to move beyond a mere understanding or awareness of those socio-

psychological processes that contribute to personal and/or environmental

conflict. Moving beyond awareness and understanding implies intervention.

That is, self-intervention or simply one's learning to do something about those feelings and behavior that contribute to his personal unhappiness.

T h e central theme of rational emotive theory is "cognitive control" over emotions and behavior. T h u s , since It is man's thinking that is* largely responsible for his emotional distress and ineffective behavior,

it is of greatest import to m a n that he learn to challenge, contradict, and ultimately replace those thoughts, ideas, or beliefs that do not serve

his best interest with more reasonable or self enhancing thoughts , ideas, or beliefs. 1^9

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( R B ' s )

T he Rational Ideas or Beliefs (Contrast to Irrational Ideas)

T h e following ideas (RB's) are contrasts to those irrational ideas presented in the last section. W h e n a person substitutes these ideas for his previously held irrational ideas, he will eventually notice positive changes in his emotional states and resultant behavior.

This exercise is designed to (1) introduce persons to more rational w a y s of thinking about the Activating Events associated with emotional disturbance an d to (2) assist persons in the contradicting and challenging of those self- defeating ideas that support negative emotions and self-defeating behavior.

This exercise can be performed "in vivo" (real life situations) or through

I m a g e r y .

The numbering of the RB's correspond to the numbering of the IB's in the preceeding section. Record those RB's that contrast with those IB's you previously identified under RB in form B. While recording those RB's you select, try to imagine yourself using those ideas in those real settings

(As) which are personal sources of disturbance.

(1) While it is desirable to be approved and accepted by others, it is not an absolute necessity. M y life doesn't really depend upon such acceptance, nor can I really control the minds and behavior of other persons. And, furthermore, a lack of total acceptance is certainly not catastrophic or horrible and doesn't at all m e a n that I a m worthless or a louse. 150

14

(2) M a n y persons do commit acts that are inappropriate, self- defeating, or antisocial. It is desirable to try to induce such persons to act more effectively than to spend needless time and energy blaming, accusing, and becoming upset over their acts. Moreover, needless blame and punishment rarely stops such persons w h o are usually ignorant, emotionally disturbed, or stupid from commitlng such acts. Demanding that persons should not commit stupid acts often times is nothing more than a d e m a n d that reality be different - reality is reality. The crucial question i s , w h a t constructive actions can I initiate to modify reality?

(3) W h e n things don't go the w a y I w a nt them to go, it is too bad or inconvenient - but not catastrophic. And, it m a y be in m y best interest to change them or arrange conditions so that they m a y become more satisfactory. But, if I can't change or modify situations to m y liking, I would be better off accepting their existence rather than telling myself h o w awful they are.

(4) While most people are taught that external events are the direct cause of one's unhappiness, in virtually most cases, h u ma n unhappiness is caused by one's thoughts-, appraisals, evaluations, or perceptions of those events. That is, I create m y o w n disturbance. Since I a m human, I can expect to disturb myself often. But, that doesn't m e a n I have to continually disturb myself forever.

(5) If something is or m a y be dangerous or fearsome, it is probably in m y best interest to face it a n d try to render it less dangerous and, if that is impossible, I could stop dwelling on such fears - especially w h e n little evidence exists that such horrible things will, in fact, occur.

(6) While it is humanly normal to want to take the easy w a y out s uch things as avoiding life's difficulties and self-responsibil­ ities, in the long run, I w o ul d probably be better off confronting openly such difficulties, facing them squarely, and trying to solve them. .

(7) Although the socio-cultural system teaches and reinforces one's tendencies to be dependent on others and things. I would be better off standing on m y o w n two feet in facing life. Moreover, 151

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if I fail to be independent in the short-run, that doesn't m e a n that I will fail in the future. After all, a m I not a fallible person.

(8) Since I a m a h u ma n being with biological, sociological, and psychological limitations, I cannot reasonably expect to be perfect in a n y endeavor. But, I certainly can strive to perform well in those tasks I d e e m as significantly contributing to m y self-development. In those areas I a m deficient, I certainly can strive to improve those areas. If, I fail, tough - too bad.

(9) Although I have been influenced greatly by m y past experiences and that specific instances of the past greatly affect m e today, I can profit by such experiences but not be overly prejudiced or biased by them. Nor do I need to be dominated by them in the f u t u r e .

(10) H u m a n beings, including myself, are happiest w h en they are actively involved in creative pursuits or w h e n they devote themselves to people or projects outside cf themselves. Long term withdrawal from the world or inaction rarely are associated with happiness. Therefore, it would be in m y best interest to force myself into productive or creative activity.

(11) I could probably develop the skills necessary to control enormously m y o w n emotions or feelings if I decide to commit myself to that process. And, it would be in m y best interest if I wo ul d take the necessary risks in order to achieve a greater control over m y o w n destiny. Of course, I don't really expect to develop these skills overnight.

(12) Anger is a normal h u m a n emotion and its expression is not a sign of personal worthlessness. Moreover, being aware of m y anger and expressing it as a communication of current feelings without indiscriminantly attacking the personal worth of others m a y be in m y best interest. Denying m y anger is rarely in m y best interest.

(13) If I share m o st of m y thoughts a n d feelings (negative or positive) honestly and openly, it will probably help m e communicate more effectively with others in the long run - even though in the short run, I might experience s ome temporary discomfort.

(14) Striving to k n o w and to accept others for their h u ma n n es s is a reasonable goal. Moreover, it is in m y best Interest to try to 152

- 16

act fairly with others so I m a y receive the full benefit of their humanness. However, trying to please others at the expense of m y o w n well being is not personally growth enhancing. Therefore, I can only do m y best in trying to please others. If I fail - tough!

(15) It is desirable for m e to be able to develop meaningful a n d intimate relationships with persons especially those of the opposite sex. However, if I demand intimate and satisfying relationships with others, I will tend to focus on the outcome of such interpersonal relationships rather than the process of getting to k n ow and accept another person. Therefore, I would be better off not demanding but trying to be spontaneous, responsive, and accepting towards significant persons. 153

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(Cp's)

Positive Emotions

This list is comprised of emotions that are generally positive or desirable.

Although persons do not experience these a l wa y s , these emotions are experienced or m a y be experienced under a variety of conditions with varying degrees of frequency, intensity, and duration. From this list, choose those emotional responses that would be more desirable associated with those

Activating Events (As) and rational ideas (RBs) you have already listed.

Also, it is important that you imagine these more positive feelings as emotional responses to those activating events (As) and rationaL beliefs

(RBs). Record your choices under C or form B.

Desirable Affects or Emotions

1 . R e l a x e d 1 4 . C o n f i d e n t 2 . J o y 1 5 . Self-Accepting 3. Worthwhile 1 6 . D e p e n d a b l e 4 . L o v i n g 1 7 . C a r i n g 5 . H o p e 1 8 . A b l e 6 . W a r m t h 1 9 . L i v e l y 7. Guiltless 2 0 . H a p p y 8. Shameless 2 1 . P a t i e n t 9 . E l a t i o n 2 2 . T r u s t i n g 1 0 . G e n t l e 2 3 . S a t i s f i e d 11. Energetic 2 4 . S t a b l e 1 2 . M e r r y 2 5 . P l e a s a n t 1 3 . Cheerful 26. Other (specify) 1 5 1*

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( D d ' s )

Desirable Behaviors, Actions, or Habits

The following behaviors are generally considered desirable or self­ enhancing. More often persons engaging in these are more effective than they are ineffective. C hoose those behaviors (Dds) that are associated with more reasonable w a ys of thinking (RBs) and feeling (Cds). You m a y need to be more specific than suggested by the above behaviors. Again, try to imagine yourself utilizing these more self enhancing behaviors as a response to the As, Rbs, and Cds you have already determined:

1. taking responsibility 2. acting fairly 3. being punctual 4. self-assertiveness 5. spontaneity 6. moderate drinking of alcohol 7. being kind 8 . h o n e s t y 9. considerate 10. helpful 11. reliable 1 2 . t e n d e r 13. responsive 1 4 . f r a n k 15. eating normally 16. sleeping normally 17. patient 18. minimizing dependence on people, drugs, etc. 19. taking decisive actions 20. efficient A BCD ANALYSIS THE RESTRUCTURING PROCESS

P A R T I I

( F o r m B )

LEAST EMOTIONAL UPSETTING ______MOST EMOTIONAL UPSETTING

A) ACTIVATING • [~ E V E N T S ______■ ______

R b s RATIONAL IDEAS OR PHILOSOPHIES

C) DESIRABLE EMOTIONAL OR A F F E C T I V E REACTIONS **(Real or Imagined) ______

D) DESIRABLE BEHAVIORAL CONSEQUENCES *«(Real or Imagined) ______

** In this exercise, the more preferred C s and D s m a y need to be Imagined first before they m a y actually occur In behavior. 1 5 6

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Thoughts, emotions, and behaviors you would like to change as a result of completing this exercise:

Strategies or solutions you might develop and use in achieving desirable cognitive (thinking), emotional and behavioral outcomes: Appendix H

Induction Procedure

Part I: Deep Breathing

Start taking in deep breaths and feel the air circulating around your lungs to the very pit of your stomach. Breathe deeply and continue to inhale relaxation so that with each deep breath that you take, you find yourself becoming very relaxed... and very comfortable. Concentrate on becoming relaxed; on inhaling relaxation, and exhaling tension. So that -with each deep breath that you take, you find that you are becoming very... very relaxed....and very...very comfortable. Your eyes may feel heavy, and if they are not already closed, you might allow them to do so...and as you do, you find yourself becoming even more

comfortably relaxed. You may notice outside noises and talking, but nothing will bother you...nothing will effect your becoming very deeply...comfortably...relaxed, so that with each deep breath

that you take, you find yourself slipping deeper and deeper into relaxation. You find yourself becoming very relaxed...further relaxed...deeply relaxed....You find yourself in a very comfortable a very warm...a very relaxed state...a very deeply relaxed state...

I want you to stop your deep breathing now and concentrate on the

second part of our relaxation process...the muscle relaxation. Part II: Cognitive Muscle Relaxation (Deepening Technique)

I vant you to concentrate on allowing all of the muscles

in your body to become completely relaxed. You will find as

you let your muscles relax, you can get even deeper into

relaxation.

Concentrate now on all of the muscles in your forehead;

feeling them losing tension...becoming very very soft and

relaxed...absolutely relaxed and comfortable. With all the

muscles in your forehead relaxed, I want you to allow the

relaxation to spread through your face...around your eyes, and

chin...around your mouth and nose...so that every muscle in

your face is becoming very softly, beautifully, and pleasantly

relaxed. As each muscle relaxes, the relaxation very easily flows

to the next set of muscles, and you find yourself becoming even more exquisitely relaxed.

Now with all the muscles in your face relaxed, concentrate

on all of the muscles in your neck...Allow them to become re­

laxed. ...Allow every muscle to relax. There is no need for any

tension...your neck muscles are very..very relaxed. Now, with

all of the muscles in your neck relaxed, concentrate on allowing

your shoulders and back to become very relaxed...You can feel these very powerful muscles relaxing...a feeling of comfort comes over

you...from your shoulders to your back...around your sides...to

your chest. Your muscles automatically relax...As you concentrate

on allowing them to become even more relaxed...they do so. Your chest -wall moves effortlessly up and down...up and down...you can

feel It floating as you become absolutely relaxed. You may be

experiencing a very warm and a very comfortably floating sensa­

tion....a very safe feeling. Now, with each muscle In your chest absolutely relaxed...beautifully relaxed, concentrate on all the muscles In your arms. Allow your upper arms to become relaxed,

to lose any tension that might be left...your lower arms are be­

coming very relaxed and the relaxation seems to flow through your fingers...and you are finding yourself very comfortably...very beautifully, very softly relaxed.

Now with every muscle in the entire upper half of your body very very relaxed, concentrate on allowing every muscle in the lower half of your body to become completely and totally relaxed.

Starting with all the muscles in your hips and going to your knees, allow every muscle in your hips to become very relaxed...very com­ fortably relaxed. You can feel your strong thigh muscles be­

coming soft and comfortable...becoming very relaxed. The muscles feel like they are just hanging on your bones...they are completely relaxed. Now concentrate on the lower half of your legs becoming

relaxed. From your knees to the tips of your toes, you find your­

self in a very deep state of relaxation; a very deep and pleasant

state...a very beautiful and comfortable state.

As you are in this very relaxed comfortable, safe, state, you will find that you can go very easily and automatically into the third stage of relaxation which is the scene we discussed earlier. Part III: Description of Scene (Further Deepening)

The particular scene described to the subject is important in that it includes the following four essential elements:

(1) The scene should include a very serene setting which is loosely described by the therapist, e.g., a nature setting, or a peaceful seashore.

(2) A rhythm must be established using some facet of the scene, e.g., the waves are rolling, rolling, rolling, into the shore, in and out...in and out...

(3) Suggestions must be given that elicit peace, comfort, and serenity, as well as, the visualizing and hearing of sights and sounds within the scene, e.g., you find your­ self at peace and extremely comfortable, so that you can actually see and possibly even hear the gulls grace­ fully floating overhead...

(U) Direct suggestion that it is easy for the S to experience the scene Is important, e.g., you are more able to get into the scene.. .becoming more relaxed...as you get into it more, the details become clearer to your... there is no need for any tension...only relaxation.

The therapist must be careful not to describe the scene too rigidly, because his suggestions may conflict with the subject's projections thereby lessening the relaxation rather than deepening it. After the scene has been described, the therapist says:

Now I'm going to count from one to twenty. At twenty, you will be absolutely relaxed.

1 ..2 ..3 ..further and further relaxed... Ij-. .5 . .6 . .deeper and deeper into relaxation... 7•.8..9 ••extremely well relaxed... 10..11..12..very deeply relaxed... 13..1.. .beautifully relaxed..exceedingly well relaxed... 15..18..almost there, almost completely relaxed... 17..18..beautifully relaxed... 19...more relaxed than ever before, beautifully relaxed... 20...you are now absolutely relaxed. l6l

I vill let you savor and enjoy this relaxation for a moment, then I vill count to five and you vill awaken. You vill feel inevitably much more refreshed and relaxed and able to carry on throughout the rest of the day (evening) in a very relaxed and very attentive state....

I am nov going to vake you by counting to five and you will feel very good.. .1 . .2 . .3 . A. .5* • • 162

Appendix I

Rational Stage Directed Hypnotherapy (RSDH)

Treatment Plan

Session y^l;

A. Self-Directed Behavior Change Instrument 1 . pass out instruments 2 . explain how to use it 3 . identify specific problems or areas to work on for the rest of the treatment

Session #2:

A. Explain hypnosis 1 . method of gaining more self-control 2 . state of concentrated attention 3 . more able to obtain and intensify relaxation k. dispell old myths of loss of control, sleep state, weak-mindedness, etc.

B. Explain Stage Directed Approach 1 . Awareness 2 . Exploration 3. Commitment to Rational Action k. Implementation 5. Internalization 6 . Redirection or change

C. Present induction process didactically 1 . deep breathing 2 . cognitive muscle relaxation 3 • relaxing scene k. deepening by counting 5 . working stage a. explain how stage directed approach will be used here, i.e., the client will be put through the stages while under hypnosis to intensify his experiences. The stages will be separately focused on.

D. Put £s through the hypnotic induction up to working stage only: 1 . allow them to dream or relax for a minute or two 2 . bring them out by counting to five

E. Discuss reactions and clarify process Session #3:

A. Review Self Directed Behavior Change identified problems

B. Outline problems and process through the six stages 1. concentrate on Awareness and Exploration stages 2 . identify appropriate irrational and rational ideas 3 . emphasize the more rational thought, emotions, and behaviors k. Instruct Ss that once hypnosis is induced, you will guide him through all the stages once more concentrating especially on the awareness and exploration of rational thoughts.

C. Induce hypnosis 1. Work on problems concentrating on Awareness and exploration stages. 2. Give post-hypnotic suggestion that they will practice at home three times per week for fifteen minute intervals. 3. De-hypnotize subjects it-. Obtain self-report of depth of hypnosis

Session

A. Record the number of times each Ss practiced

B. Review problems, processing them through all stages concentrating on the Commitment to Rational Action and Implementation Stages.

C. Induce hypnosis 1. Have Ss work on problems concentrating on the commitment to Rational Action and Implementation stages 2. Give post-hypnotic suggestion regarding practice 3. De-hypnotize Ss k. Obtain self-report of depth of hypnosis

Session

Same as Session -jjb, only concentrate on Internalization and Redirection or Change Stages

Session //6 ;

Same as above sessions. Give equal weight to each stage. 16k

Appendix J

Rational Stage Directed Therapy:

An Example

An "ABCDE" model will be utilized in Rational Stage Directed

Hypnotherapy while processing the client through stages of Aware­ ness, Exploration, Commitment to rational action, Internalization, and Change. Prior to the hypnotic induction procedure, the therapist will guide the client through each of the six stages delineating rational parameters concomitantly. During the initial sessions, the therapist will have the client focus on the

Awareness and Exploration of rational and irrational ideas. As the counseling'progresses, the client is guided through the rest of the stages, focusing on each one and concentrating on the particular characteristics contained in each stage. Both the therapist and the client decide when to progress to the next stage.

After practicing and understanding the RSDH process, the client is then put through the hypnotic induction and guided through the entire stage-directed approach. The following is an example of the process concentrating on the Awareness and Exploration stages: 165

T: I want you to focus on the specific events or situations that you have determined to be disturbing. (Describe a client-identified specific event) e.g. Imagine that you are at a party and you want to meet new people, but find yourself avoiding people you don't know. If you can imagine this event, please use your right index finger. (If ideomotor response is elicited, proceed to the next phase; if it isn't, ask Ss to relax and to go deeper into relaxation, then repeat the suggestion.)

Allow yourself to feel the (specify emotion) e.g. anxiety in conjunction with this situation; notice how uncomfortable it is and realize how self-defeating this emotion is in this particular instance. Describe to yourself the ways in which these emotions are preventing you from experiencing or acting in ways that you would like. What about the situation would you like to change? Now concentrate on the thoughts you are associating with this event. Concentrate on specific irrational thoughts. Imagine saying to yourself (state specific irrational idea) e.g. If I attempt to make new friends, they will most surely reject me and if they reject me, that is terrible and horrible. Not only is that terrible, but if they don't like me, then how can I possibly be of any value. I must be totally worthless ....Continue to concentrate on those irrational self­ verbalizations and notice how you tend to become more anxious.

As you continue to see those thoughts in your mind, allow yourself to experience the emotional discomfort . . . . The more you continue to tell yourself irrational, self- defeating thoughts, the more you will tend to feel these negative emotions. Continue to concentrate on those irrational self-defeating thoughts and notice how you tend to become even more anxious.

You can very clearly understand how those irrational thoughts are causing you to upset yourself. Now, I want you to tell yourself to stop thinking those irrational thoughts and we will begin to explore and become aware of more rational ways of thinking.

Let yourself imagine that you are thinking rational thoughts in conjunction with the same situation as before. Explore the rational thoughts. Become aware that you are thinking (state specific rational thoughts) e.g. Even if those people do reject me, their rejection doesn't mean that I am a terrible, worthless and stupid person, it simply means that they may not like me, and since I realize I cannot and do not need the love and approval of every person that I meet, at most, the situation is merely inconvenient and simply because they rejected me doesn't mean that I'll be rejected by everyone all of the time.

Think those rational thoughts; explore them and become aware of your feelings when you tell yourself these rational thoughts. Notice how your negative emotions tend to subside. As the negative emotion, e.g., anxiety subsides, picture yourself in your mind engaging in rational actions and behaviors in con­ junction with your rational thinking and feeling. Notice yourself becoming more effective when you think rationally Explore new behaviors; think of new ways of acting in these situations, and continue to think rationally about them. (Allow the client a few moments to consider some of the more rational behaviors that you have previously outlined with him. You may wish to discuss rational exploration at length.)

Now, I want you to allow yourself to relax very deeply clear your mind and return to a nice comfort­ able relaxing scene...go deeper and deeper into relaxation Allow yourself to relax completely and concentrate on what I am saying to you. Between now and the next time we meet, I want you to allow yourself to practice this entire method of relaxation and rational thinking (the ABODE method). Allow yourself to practice the relaxa­ tion and the ABODE procedure at least three times a week for 15 minutes each time.

Once more relax...I am going to count to five, and when I reach the number five, you will be wide awake, feeling very refreshed and very alert. You may not remember everything we have talked about immediately; however, as the week progresses, you will remember every­ thing you need to know. When I reach the number "5" you will feel very refreshed and very alert. 1-2-3-1*— 5*

During later sessions the process is very much the same, only the focus is on higher level stages. After the therapist and the client feel they have sufficiently explored and have become aware of both irrational and rational ideas and behaviors, the client is guided into the third-and fourth stages of Rational Stage

Directed Hypnotherapy; Commitment to Rational Action and Imple­ mentation. The commitment stage involves the client imagining himself being publicly and privately commited to more rational vays of thinking and acting. A relaxed or hypnotic state often permits the lessening of resistance inhibiting commitment.

The Implementation Stage implies that the client is to actively engage in the nevly acquired skills he has become com­ mitted to. He is asked to imagine his active participation in heretofore problematic situations in a more rational self-enhancing manner. The Implementation state is the testing ground for the client's nev behaviors. He is encouraged and reinforced to apply what he has learned in the therapy session to situations outside of therapy.

T: I want you to concentrate only on the rational thoughts you have recently become aware of and have explored. Focus on these rational thoughts (identify specific thoughts) and images in your mind. You are committed toward acting, thinking, and feeling in more rational ways, e.g., imagine that you are at a party and rather than avoiding people, you have com­ mitted yourself to actively seeking out others.

Notice how you are becoming increasingly committed toward acting in a more self-enhancing way. As you become committed towards thinking more rationally you find yourself more in control of your emotions and your behaviors. As you act in more rational -ways and are able to assess your life’s situations more effectively, you become increasingly committed to rational action.

Now imagine that you are actually implementing the rational thoughts, feelings, and actions that you have committed yourself to. Notice how much more self enhancing It is to act in rational manners and how pleasant it is to control your own behavior and emotions. 168

Recall some of the different ways of acting rationally that we earlier explored. In your mind implement' these ways of behaving; test them out; you will find them easier to transfer outside the sessions after you have practiced implementing them here.

Once the commitment to rational action and implementation of more self-enhancing thinking, feeling, and behaving is attempted,

the client may then be ready to internalize the process and proceed to the internalization stage.

Internal!zation is a logical progression from the preceding

stages. Once implementation of more self-enhancing thinking,

feeling, and behaving is sucessfully attained, the client is more

likely to internalize these.

T: Once you have committed yourself to acting, feeling, and thinking more rationally and have actually implemented all of the processes (therapist may outline specific self-enhancing situations) you find it much easier to internalize the process. You can now imagine that you are in the act of internalizing a process of rational thinking and acting as well as desirable feelings. As you continue to think more rationally, you will further internalize a more self-enhancing way of perceiving, feeling, acting, and interacting.

Finally the client reaches the final stage of RSDH, the

redirection/change stage. In this stage, the therapist observes

the client engaging in self-directed activity and assuming

responsibility for his behavior. The client is reinforced in his

strivings to change. He is encouraged to generalize his newly

acquired ideas for effective living to other problematic situations.

If counseling was of a type requiring minimum change and was

limited to one specific client concern, it may be terminated at

this point. Should the client desire to continue working on his problems, he is redirected through the entire process once more, focusing on the particular stage wherein he may be having difficulty.

Note that all stages are reviewed in each session and all stages are contained within each other. While the client is exploring new rational thoughts he is also becoming more aware of them. As he becomes increasingly aware of rational thoughts he can more easily become committed to them and so on.

The stages present a specific, logical problem solving progression that the client be guided through by the therapist.

As the therapist outlines the purpose of each stage the client can concretely focus on his problems and hopefully improve upon them. 170

Appendix K

Rational Stage Directed Imagery (RSDl)

Treatment Plan

Session jfl;

A. Self-Directed Behavior Change Instrument 1 . pass out instruments 2 . explain how to use it 3 . identify specific problems or areas to work on for the rest of the treatment

Session 7pg;

A. Explain Stage Directed Approach 1 . Awareness 2 . Exploration 3. Commitment to Rational Action b . Implementation 5. Internali zation 6 . Redirection or Change

B. Put Ss_ through RSDI using their examples 1. Ask them to close their eyes and imagine them­ selves at each stage. 2. Concentrate on Awareness and Exploration

Session //3:

A. Review Self Directed Behavior Change Identified problems

B. Outline problems and process through the six stages. 1. concentrate on Awareness and Exploration stages. 2 . identify appropriate irrational and rational ideas. 3 . emphasize the more rational thoughts, emotions, and behaviors.

C. Ask Ss to practice RSDI at home three times per week for fifteen minute intervals.

Session

A. Record the number of times each Ss practiced

B. Review problems, processing them through all stages con­ centrating on the Commitment to Rational Action and Implementation Stages. C. Ask Ss to practice relaxation at home three times per week for fifteen minute intervals.

Session

A. Same as Session #4, only concentrate on Internal!zatlon and Redirection or Change Stages

Session $6 ;

A. Same as above sessions. Give equal weight to each stage.

Hypnosis

Treatment Plan

Session #1:

A. Explain hypnosis 1 . method of gaining more self-control 2 . state of concentrated attention 3. more able to obtain and intensify relaxation k. dispell old myths of loss of control, sleep state, weak-mindedne s s, etc. 5 . discuss and field reactions

B. Present briefly the Induction Method didactically 1 . deep breathing 2 . cognitive muscle relaxation 3. relaxing scene deepening by counting

Session ?^2;

A. Discuss induction and review briefly

B. Induce Hypnosis 1. proceed only to counting to twenty, then allow Ss to enjoy the relaxation and dream for a moment or two 2. de-hypnotize Ss

C. Discuss reactions 1 . suggest this method might be useful in relieving anxiety, depression, or hostility

Session #3 through #6 ;

A. Same as above 17 2

Placebo

Treatment Plan

Sessions tfl through 7/6 :

A. Meet and discuss various problems of anxiousness, depression and hotility

B. Offer no methodology for dealing with these problems 1 . suggest problems will dissipate by themselves 2 . answer no questions directly 3 . be extremely reflective and non-directive

No Treatment Control Plan

Sessions ;fl through //6 ;

A. This group will not meet

B. Will be given appropriate pre, post and follow-up tests,