Hypnosis in Sport and Exercise Psychology

Hypnosis in Sport and Exercise Psychology

William P.

Morgan

t is remarkable that hypnosis has not been used more frequently by

I

workers in the field of sport and exercise psychology, because the

difference between success and failure is often minuscule. Indeed, the

difference between a gold medal in Olympic competition and failure

to even qualify for the final event is sometimes less than a hundredth

of a second. Hence, any intervention that might have the ability to

enhance performance by even a small margin (e.g., 0.001 %), providing

it is legal, would have potential value.

The use of hypnosis has not been banned by the U.S. Olympic

Committee or the International Olympic Committee, nor are there any

regulations against the use of hypnosis by other sport governing bodies,

such as the National Collegiate Athletic Association, or by professional

organizations, such as the American Psychological Association (MA)

and the American College of Sports Medicine. There are, however,

many instances in which the use of hypnosis in the practice of sport

psychology or sports medicine would be questionable from both an eth-

ical and a moral standpoint and, although not in direct violation of

existing rules and codes, such actions would potentially violate the

“spirit” of the law. It is inappropriate, for example, to use drugs such

as morphine or novocaine to manage an athlete’s pain so that she or

he might c:ompete; hence, the use of hypnosis for the same purpose

would be questionable. Adherence to the APAs (1992) ethical code of

This chapter is an expanded and updated version of “Hypnosis and Sport Psychology,”

originally published in 1993 in J. Rhue, S. J. Lynn, & I. Kirsch (Eds.), The Handbook of CZznicuZ

Hypnosis (pp. 649-670). Washington, DC: American Psychological Association.

151

122 Wrinnm F.

MORGAN

conduct should be viewed as necessary but not sufficient in such a case.

It is imperative that psychologists who elect to use hypnosis in the treat-

ment of athletes also become familiar with established ethical and legal

guidelines adopted by sport governing bodies and professional organi-

zations.

Theoretical Formulations

The rationale for the clinical applications described in this chapter is

based on theoretical formulations advanced by Hanin (1978) and

UnestPhl (1981) and on the empirical case studies described by Johnson

(1961a, 1961b). Although the theoretical views of Hanin and UnestHhl

represent independent proposals, these formulations converge in terms

of hypnotic application.

Hanin (1978) presented a theory of performance that maintains

that each athlete possesses a “zone of optimal function,” and this zone

is based on the person’s optimal state anxiety level in precompetitive

settings. Hanin empirically demonstrated that athletes have their best

performances when they fall within this zone, and he has operational-

ized the zone as a given point +4 raw score units on the state anxiety

scale developed by Spielberger (1983). Although Hanin’s theory is

based largely on work carried out with elite Soviet athletes and with the

Russian translation of the State-Trait Anxiety Inventory (STAI; Spiel-

berger, 1983), his research has been replicated with both elite and non-

elite American athletes (Morgan & Ellickson, 1989; Raglin, Morgan, &

Wise, 1990; Raglin & Morris, 1994; Raglin & Turner, 1992, 1993; Turner

& Raglin, 1996; Wilson 8c Raglin, 1997). Overviews of this research can

be found in Morgan (1997) and Raglin (1992).

The external validity of Hanin’s model has been well established

because it has been shown to predict performance in adolescent boys

and girls and in college and elite athletes. The model also has been

shown to work well in various sports such as distance running (Morgan,

O’Connor, Ellickson, 8c Bradley, 1988; Morgan, O’Connor, Sparling, &

Pate, 1987), swimming (Raglin et al., 1990), volleyball (Raglin 8c Morris,

1994), and track and field (Raglin & Turner, 1993; Wilson 8c Raglin,

1997). The theory incorporates retrospective recall of precompetitive

state anxiety levels obtained in the nonhypnotic state. It does not men-

tion hypnotic procedures, but the potential for hypnotic intervention

is obvious.

HYPNOSIS 153

The theoretical views of UnestAhl (1981) are related to those of

Hanin (1978), because both believe that athletes experience unique

affective states when having peak performances. UnestAhl has labeled

this the “ideal performing state.” Although the theoretical views of

Unestihl are in agreement with those of Hanin with respect to the

existence of an ideal or optimal affective state, these theories differ in

one respect: Whereas Hanin believed that these states can be accurately

recalled, Unestihl has emphasized that athletes often have selective or

even total amnesia after perfect performance, which makes it difficult

for them to describe or analyze the ideal performing state afterward.

Therefore, UnestKal has used hypnosis in defining this state, and this

theory has been used with several thousand Swedish athletes (Rail0 &

Unestihl, 1979).

Research and Appraisal

Research involving hypnosis and sport and exercise psychology has been

carried out almost exclusively with laboratory experimentation in which

attempts have been made to elucidate the effectiveness of hypnotic sug-

gestion on the transcendence of baseline measures of physical capacity.

Two principal methodological problems associated with the published

literature warrant mention. First, investigators have used laboratory

tasks (e.g., grip strength and weight-holding endurance) under con-

trolled conditions, and it is unlikely that this work is valid in terms of

competition settings. In other words, the results of research involving

simple motor tasks performed in a laboratory setting with nonathletes

cannot be easily generalized to complex sport skills performed by ath-

letes in emotionally charged competitive settings. Second, performances

in the laboratory following hypnotic suggestion have been compared

with control, or baseline, performances in which suggestion has not

been used. This traditional research paradigm has been characterized

by the confounding of state (hypnosis vs. control) and suggestion. With

few exceptions, it has been difficult to delineate between the effects

caused by hypnosis and those caused by suggestion, because hypnosis

with suggestion has typically been compared with nonhypnotic inter-

ventions without suggestion. Furthermore, the influence of demand

characteristics has been largely ignored in the research literature, and

additional behavioral artifacts known to influence experimental out-

comes have often been overlooked (Morgan, 1972a).

154 Wiiiinm P.

MORGAN

The first comprehensive review of this topic was by Hull (1933),

who focused on hypnotic suggestibility and transcendence of voluntary

capacity. Hull’s principal conclusion was that existing evidence bearing

on this question was contradictory. Furthermore, Hull explained that

the equivocal nature of this experimentation was due to design flaws.

Later reviews by Gorton (1959), Johnson (1961b), Weitzenhoffer

(1953), Barber (1966), Morgan (1972b, 1980a, 1993), and Morgan and

Brown (1983) were inconsistent regarding the ability of hypnotic sug-

gestion to enhance physical performance.

Historically, the most critical review of research in this area was by

Barber (1966), who concluded that hypnosis, without suggestions for

enhanced performance, did not influence muscular strength or endur-

ance. Furthermore, Barber reported that motivational suggestions are

generally capable of augmenting muscular strength and endurance in

both nonhypnotic and hypnotic conditions. Barber presented a com-

pelling argument in that review and, in related writings, about the ne-

cessity of not confounding hypnosis and suggestion. Typical experi-

mental paradigms have compared muscular performance following

suggestions of enhanced or decreased capacity under hypnosis, with

muscular performance following no suggestions under control or non-

hypnotic conditions (e.g., Ikai & Steinhaus, 1961). Exceptions to this

paradigm include one of the earliest findings, by Nicholson (1920), that

suggestions given during hypnosis were much more effective than the

same suggestions given without hypnosis. Another exception is the re-

port by Eysenck (1941) that hypnosis per se resulted in facilitation of

muscular endurance. However, evidence exists that suggestion without

hypnosis can lead to enhanced muscular performance (Barber, 1966;

Morgan, 1981, 1997). Therefore, it is imperative that experimental de-

signs not confound suggestion and procedure.

The reviews by Barber (1966), Gorton (1959), Hull (1933), John-

son (1961b), and Weitzenhoffer (1953) dealt primarily with the influ-

ence of hypnotic suggestion on muscular strength and endurance. Later

research focused on the extent to which the hypnotic suggestion of an

altered work-load can influence the perception of effort (Morgan,

1994) and the extent to which perturbation of effort sense (i.e., per-

ceived exertion) is associated with corresponding changes in metabo-

lism. It has been reported, for example, that hypnotic suggestion can

influence cardiac output, heart rate, blood pressure, forearm blood

flow, respiratory rate, ventilatory minute volume, oxygen uptake, and

carbon dioxide production, at rest and during exercise (Morgan, 1985)-

HYPNOSIS 155

It also has been shown that perception of effort can be systematically

increased and decreased during exercise with hypnotic suggestion

(Morgan, 1970, 1981; Morgan, Hirota, Weitz, & Balke, 1976; Morgan,

Raven, Drinkwater, & Horvath, 1973). Furthermore, when exercise in-

tensity is perceived as being more effortful, a corresponding elevation

in physiological responses takes place even though the actual work-load

remains unchanged.

More recent research has replicated and extended these research

findings to include the assessment of regional cerebral blood flow

(rCBF) following the hypnotic manipulation of effort sense during dy-

namic exercise (Williamson et al., 2001). This more recent work has

shown that hypnotic suggestion of increased and decreased work-load

is associated with cardiovascular responses and brain activation even

though the exercise intensity has not actually changed. The suggestion

of downhill cycling was associated with a decrease in perceived exertion

and rCBF in the left insular cortex and anterior cingulate cortex,

whereas perceived uphill exercise was associated with right insular ac-

tivation and right thalamus activation. The work by Williamson et al.

(2001) revealed there were no differences in rCBF for leg sensorimotor

regions across conditions. These findings indicate that hypnotic sugges-

tion of increased and decreased effort sense during constant load cy-

cling is associated with differential activation in selected brain regions.

Another line of research has examined the study of imagery per-

spectives on the psychophysiological responses to imagined exercise un-

der nonhypnotic conditions (Wang & Morgan, 1992). In this research,

the metabolic, cardiovascular, and perceptual responses of 30 men and

women were studied before, during, and after actual exercise, and these

responses were compared with those observed following internal versus

external imagery of exercise. The perception of effort was higher fol-

lowing the use of an internal compared with an external imagery per-

spective, and the internal imagery resulted in a significant increase in

ventilatory minute volume that exceeded the control condition. How-

ever, both the internal and external imagery resulted in significant in-

creases in systolic blood pressure, and these increases did not differ

from those noted for the actual exercise condition. Both approaches

were associated with psychophysiological responses, but the internal im-

agery perspective produced changes closer to those observed for actual

exercise. Although this study did not include a hypnosis comparison

group, it is apparent that changes often attributed to hypnosis can be

produced under nonhypnotic conditions.

156 WILLIAM P.

MORGAN

In an attempt to quantify the influence of imagined exercise on

cardiovascular responses and rCBF, Williamson et al. (in press) recently

evaluated brain activation during an actual and an imagined handgrip

exercise under hypnosis. In this study, five high-hypnotizable people

were compared with four low-hypnotizable people during 3 minutes of

maximal voluntary contraction at 30% of maximal voluntary contrac-

tion. The results were compared with those obtained during the imag-

ined handgrip exercise. Integrated electromyography was done in both

forearms, ratings of perceived exertion were collected during the 3-

minute period, heart rate and mean blood pressure were recorded, and

rCBF was measured using single photo emission computed tomography

(SPECT) and magnetic resonance imaging (MRI) .

Both groups experienced significant increases in heart rate and

mean blood pressure following three minutes of actual handgrip exer-

cise, but only the high-hypnotizable group experienced significant car-

diovascular increases during imagined exercise. Furthermore, the rating

of perceived exertion was higher for the high-hypnotizable group dur-

ing imagined exercise. The high-hypnotizable group also rated the

imagined exercise as being more vivid. During imagined exercise, the

low-hypnotizable group experienced lower activity in the anterior cin-

gulate and insular cortices, which led Williamson et al. (in press) to

conclude that cardiovascular responses during imagined exercise are

influenced by the activation of these brain regions.

This particular study might explain some of the discrepancies in

the literature involving exercise responses to hypnotic suggestion, be-

cause it appears that level of hypnotizability is a crucial moderator var-

iable. At any rate, not only does this work by Williamson and colleagues

indicate that hypnosis is effective in modifying the perception of effort,

but it also indicates that the hypnotic perturbation of effort sense is

associated with changes in cardiovascular function and brain activation.

This finding is important because it has been recognized for some time

that perception of effort plays an important role in physical perfor-

mance (Morgan, 1997, 2001).

A summary of findings reported in earlier reviews by Morgan

(1972b, 1980a, 1985, 1993, 1996) and Morgan and Brown (1983) and

the principal findings from recent reports by Williamson et al. (2001)

and Williamson et al. (in press) follow:

1. Although some investigators have reported that hypnosis per se

has no influence on muscular strength and endurance, an equal

number have found that hypnosis (without suggestion) can lead

HYPNOSIS 157

to both increases and decreases in muscular performance. The

evidence in this area is equivocal.

2. Hypnotic suggestions designed to enhance muscular perfor-

mance have generally not been effective, whereas suggestions

designed to impair strength and endurance have’

been consis-

tently successful.

3. Individuals who are not accustomed to performing at maximal

levels usually experience gains in muscular strength and endur-

ance when administered involving suggestions in the hypnotic

state. However, suggestions of a noninvolving nature are not ef-

fective when administered to individuals who are accustomed to

performing at maximal levels.

4. Efforts to modify performance on various psychomotor tasks

(e.g., choice reaction time) have effects similar to those ob-

served in research involving muscular strength and endurance.

That is, efforts to slow reaction time are usually effective,

whereas attempts to speed reaction time are not.

5. Case studies involving efforts to enhance performance in ath-

letes by means of hypnosis appear to be universally successful.

However, this observation should probably be viewed with cau-

tion because therapists and journals are not known for empha-

sizing case material depicting failures.

6. Hypnotic suggestion of exercise in the nonexercise state is as-

sociated with increased heart rate, respiratory rate, ventilatory

minute volume, oxygen uptake, carbon dioxide production,

forearm blood flow, cardiac output, and brain activation as mea-

sured by rCBF. Recent work has shown that brain activation dur-

ing imagined exercise is influenced by the individual’s level of

hypnotizability. These physiological changes often approximate

responses noted during actual exercise conditions.

7. Perception of effort during exercise can be systematically in-

creased and decreased with hypnotic suggestion even though

the actual physical work-load is maintained at a constant level.

Furthermore, alterations in effort sense are associated with sig-

nificant changes in metabolic responses and brain activation as

measured by SPECT and MRI.

8. There is evidence that imagined exercise under nonhypnotic

conditions is associated with physiological changes that resemble

those noted during actual exercise, and outcomes have been

shown to be dependent on imagery perspective (i.e., internal

158 WILLIA~

P.

MORGAN

vs. external). Responses tend to be greater for internal (i.e.,

first-person) compared with external (i.e., third-person) im-

agery perspectives.

Qualifications of Practitioners

The question of who is qualified to use hypnosis has been discussed for

many years, and the issue involves a rather complex matter. Hilgard

(1979) offered an interesting perspective on this issue in stating that

“lack of advanced degrees does not necessarily mean incompetence and

society memberships do not guarantee competence either” (p. 5). Hil-

gard also has pointed out that broader professional training extending

beyond hypnosis has various advantages, the principal one being “that

the true professional will know much more that is relevant about per-

sonality and individual differences than is implied by hypnosis” (p. 5).

This is an important point, because a person who lacks training in fields

such as psychology or psychiatry can easily learn how to perform hyp-

notic inductions.

It is reasonable to expect that a person who uses hypnosis has ad-

vanced training in fields such as psychology or psychiatry, and it is

equally reasonable to expect that such a person would hold member-

ship in hypnosis organizations such as the Society for Clinical and Ex-

perimental Hypnosis, Division 30 (Psychological Hypnosis) of APA, or

the American Society of Clinical Hypnosis. However, affiliation with

such professional groups should be regarded as a necessary, rather than

a suf$cient, form of evidence for the reasons stated by Hilgard (1979).

There was a time when Division 30 of AF’A was regarded as a quasi-

licensing group, because applicants for membership in the division were

required to provide letters of recommendation, evidence of training in

hypnosis, and documented evidence of experience in the use of hyp-

nosis. Today, however, membership in Division 30 merely requires ap-

plication and payment of dues. Membership in this division can no

longer be viewed as a sign that a person has competence in the use of

hypnosis. Because the leading scientific and professional societies have

not historically licensed or certified individuals in the use of hypnosis,

Levitt (1981) has proposed that certification by the American Board of

Psychological Hypnosis is the only realistic testimony of a person’s ability

as a hypnotist.

It is difficult to answer the question of who is qualified to use hyp-

HYPNOSIS 159

nosis to everyone’s satisfaction. However, it is possible to provide some

guidelines and principles that can be used by workers in the field of

sport and exercise psychology. All professional organizations concerned

with the use of hypnosis make a clear distinction between its use in

research and its use in clinical practice. Manipulation of an indepen-

dent variable in an experimental setting with hypnotic suggestion is very

different than using hypnotherapy in the treatment of clinical problems

such as anxiety disorder or depression. In other words, although the

use of hypnosis in research and clinical practice may have several pro-

cedural and methodological similarities in technical terms, these appli-

cations require different competencies.

It would seem reasonable to expect that workers in sport and ex-

ercise psychology who use hypnotic procedures as an experimental tool

would possess an advanced degree with a primary focus in psychology,

and these individuals should have affiliations with appropriate hypnosis

organizations such as Division 30 of APA, the American Society of Clin-

ical Hypnosis or the Society for Clinical and Experimental Hypnosis.

Although affiliation with professional organizations does not ensure

that individuals will stay within their areas of competence, such affilia-

tions will enhance the likelihood that a hypnotist will comply with ex-

isting ethical codes. All 50 states and the District of Columbia have

enacted laws regulating the practice of psychology, and certification laws

regulate the use of the title “psychologist” and limit the scope of prac-

tice to those areas in which individuals have competence and training.

Sport and exercise psychologists who use hypnosis for clinical purposes

should have the appropriate certification or licensure. A long-standing

principle in the area of hypnosis, and one that applies to both clinical

and research applications, is that individuals not use hypnosis to per-

form manipulations or treatments that they are not qualified to perform

without hypnosis.

It is imperative that sport and exercise psychologists who use hyp-

nosis in their research and clinical practice be qualified to use this in-

tervention. It is often maintained that sport and exercise psychologists

are concerned only with performance enhancement, and therefore, it

is not necessary that these providers have clinical competencies and

skills. That is, because these individuals do not treat clinical problems

such as depression or anxiety disorders, for example, it is not necessary

for them to have clinical competencies. The fallacy of this argument

has been addressed elsewhere by the author (Morgan, 1997), and some

160 Wntm P.

MORGAN

1.

2.

3.

of the more obvious reasons why the performance versus skill enhance-

ment argument lacks validity follow:

Extensive literature demonstrates that some athletes have psy-

chological problems of a clinical nature when seeking support

(Carmen, Zerman, & Blaine, 1968; Davie, 1958; Morgan, 199’7;

Pierce, 1969; Raglin, 2001; Vanek, 1970).

It has been reported by Meyers, Whelan, and Murphy (1996)

that performance issues represented the presenting symptom in

approximately 60% of the cases seen at the U.S. Olympic Train-

ing Center, but about 80% of these athletes had psychological

problems other than performance issues in the final analysis.

This would suggest that a subset of athletes seeking assistance

involving performance problems potentially have psychological

problems requiring treatment by a psychologist with clinical

competence.

Results from the 1995 National College Health Risk Behavior

Survey has revealed that approximately 11% of the college stu-

dents in a nationally representative sample had engaged in su-

icidal behavior during the 12-month period preceding comple-

tion of the survey (Douglas et al., 1997). Suicidal behavior was

operationalized as thoughts about, plans for, or attempted sui-

cide during the previous 12 months.

Therefore, a conservative estimate of the number of athletes of college

age who might manifest suicidal behavior during a given 12-month pe-

riod would be approximately lo%, or l in 10. However, there is not

agreement on the relationship between sport and physical activity on

the one hand and suicidal ideation on the other in college students

(Brown & Blanton, 1998; Simon & Powell, 1999; Unger, 1997). The

assumption that sport and exercise psychologists work only with perfor-

mance problems is not defensible, and it is important that individuals

who use hypnosis when treating athletes have the necessary clinical

competencies.

Clinical Applications

The cases described in this section were selected on the basis of the

assumption that important information associated with athletic com-

petition is sometimes repressed and that this information can be re-

HYPNOSIS 161

trieved by means of hypnotic age regression. Also, it is assumed that

efforts to retrieve this repressed material should be of a nondirective

nature, and the decision to use this approach is based primarily on the

clinical reports described by Johnson (1961a, 1961b). Furthermore,

these applications are based on a multidisciplinary approach that in-

cludes medical, physiological, and psychological components. Hypnotic

applications should not be attempted in sport settings unless it can be

shown that pathology does not exist and that the requisite physiological

capacity is present.

One of the most widely cited hypnosis cases in sport psychology

was described in a report by Johnson (1961a), who successfully used

hypnosis to treat a professional baseball player. The athlete’s batting

average normally exceeded .300. However, he had not had a hit for the

last 20 times at bat, and neither he nor any of his coaches could detect

any problems with his swing, stance, and so on. The player had become

frustrated about his inability to return to his prior performance level,

and he had requested hypnosis to resolve the problem.

Johnson (1961a) initially asked the player under hypnosis to ex-

plain the nature of his problem, and the player replied that he had no

idea why he was in a slump. Johnson then told the player that he would

gradually count from 1 to 10, and with each number, the player would

become more and more aware of why he could no longer hit effectively.

He also told the player that at the count of 10 he would have complete

awareness of why he was in the slump. Johnson reported that at the

count of 10 a look of incredulity came across the player’s face, and he

then proceeded to give a detailed analysis of his swing. This self-analysis

under hypnosis included elaboration of specific problems that the

player was unaware of in the nonhypnotic state. Johnson asked the

player if he wished to have immediate, conscious recall of his analysis

or have the information ‘Ijust come to him gradually” over time. The

player replied that he would prefer to have this information come back

to him over time rather than all at once. The player’s slump ended at

once, and he went on to complete the season with an impressive batting

average of .400.

This particular case is instructive in several ways, and sport psy-

chologists who elect to use hypnosis in the treatment of such problems

should first consider each of the following points. First, it is widely rec-

ognized that athletes in various sports often have spontaneous remission

of problems (e.g., “slumps”), and it would be difficult to argue that a

hypnotic intervention was responsible for the resolution of a given prob-

162 WILLIAM

P.

MORGAN

lem. Second, the information gained in the hypnoanalysis done by John-

son (1961a) was not available under nonhypnotic conditions. Third, the

player demonstrated unusual insight, according to Johnson, because he

chose to have the wealth of biomechanical information return gradu-

ally. Once a complex motor skill has been learned, athletes are en-

couraged by coaches to “do it” rather than “think about it.” In some

ways, the situation is analogous to the problem of “paralysis through

analysis,” which occurred when the mythical frog asked the centipede,

“Pray tell, which foot do you move first?” As the story goes, the centi-

pede was unable to resume normal locomotion once the question was

considered. Fourth, at the completion of the season, the player re-

turned and thanked Johnson for the hypnoanalysis that led to his im-

proved performance. The player was unable to accept the fact that he,

not the hypnotist, had performed the analysis.

The efficacy of hypnosis in the treatment of pain has been widely

documented. One comprehensive report on the use of hypnosis in the

management of various problems in sports medicine was presented by

Ryde (1964)

, who used hypnosis in 35 individual cases involving prob-

lems such as tennis elbow, shin splints, chronic Achilles tendon sprain,

bruised heels, arch sprains, and other common ailments involving mi-

nor trauma. Hypnosis was so effective in the treatment of minor trauma

resulting from injuries in sports that Ryde reported that he offers “to

treat these disabilities initially by hypnosis and only proceed with con-

ventional methods, should hypnosis fail or be refused” (p. 244). Al-

though Ryde’s report appears to support the value of hypnosis in the

treatment of sports injuries, no evidence was presented to suggest that

it is any more effective than a placebo. This is an important consider-

ation because it is known that placebo treatments can be just as effective

as morphine in the treatment of moderate pain in anxious patients

(Morgan, 1972a). However, the use of hypnosis in the treatment of med-

ical problems associated with sport injuries should be attempted only

by or under the supervision of an appropriately trained physician.

Not much has been written about the use of psychodynamic ap-

proaches involving the use of hypnosis in sport and exercise psychology.

However, in the review by Johnson (1961b), several case studies were

summarized dealing with performance decrements in sports as a con-

sequence of aggression blockage. In each case, hypnotic age regression

was used in an effort to retrieve repressed material, which was followed

by psychoanalytic interpretation and treatment. Also, post-hypnotic sug-

gestion was used to resolve the aggression conflicts. In one case, for

HYPNOSIS 163

example, a cycle of aggression-guilt-aggression was identified, and this

cycle was directly associated with performance. The athlete, baseball

pitcher, performed well when characterized by aggressive affect, but his

performance fell when he felt guilty and lacked aggression. This tran-

sitory affect was found to be governed by feelings of guilt associated

with repressed childhood incidents of aggression. When the athlete felt

guilty, his performance declined, and his performance improved as the

guilt passed and he became aggressive. The therapy in this case focused

on resolution of the repressed guilt. Once this was achieved, the

aggression-guilt-aggression cycle was broken, and the pitcher’s perfor-

mance became more consistent. This general theme is repeated in re-

lated cases described by Johnson (1961b).

Hanin (1978) has shown that some athletes experience their best

performances when precompetition anxiety is low, some when anxiety

is high, and some when anxiety is intermediate. This theoretical view is

supported by empirical research involving athletes from various sports

(Morgan & Ellickson, 1989; Morgan et al., 1988; Morgan et al., 1987;

Raglin, 1992; Raglin et al., 1990; Raglin & Morris, 1994; Raglin &

Turner, 1992, 1993; Turner 8c Raglin, 1996). Therefore, it would be

inappropriate to use psychological interventions designed either to re-

duce or increase anxiety in groups of athletes. In other words, not only

would an intervention such as autogenic training, hypnosis, meditation,

or progressive relaxation with athletes in a precompetitive setting be

ineffective, it also would place many athletes outside of their individual

zone of optimal anxiety (ZOA). In addition, some people experience

increased anxiety, and panic episodes, during and following interven-

tions designed to produce a state of relaxation (Borkovec et al., 1987;

Heide & Borkovec, 1984). However, the mechanisms underlying this

phenomenon, known as relaxation-induced anxiety (RIA),

are not well

understood.

In a Navy diving experiment (Mittleman, Doubt, & Gravitz, 1992),

researchers found that the use of self-hypnosis to produce relaxation

during immersion in cold water led to paradoxical effects. The people

who effectively used self-hypnosis became relaxed and felt warm, but

they also stopped shivering. Because shivering is a normal response and

has the effect of producing heat, these individuals were at increased

risk for developing hypothermia. Hence, relaxation could have the po-

tential for impairing performance in some people, and another subset

could be at risk from a health and safety standpoint. There also seems

to be a tendency to think of many relaxation procedures as being in-

164 Wuim P.

MORGAN

nocuous, but there is evidence that procedures such as autogenic relax-

ation (Schultz Method; Schultz & Luthe, 1969) and quiet rest result in

mood shifts that are comparable to those following hypnosis (Garvin,

Trine, & Morgan, 2001).

Given the phenomenon of RIA described by Borkovec et al. (198’7)

and Heide and Borkovec (1984), it is somewhat surprising that re-

sponses of this nature are seldom reported in connection with routine

hypnotic inductions, because many hypnotic procedures involve sug-

gestions of relaxation. During the course of administering the Harvard

Group Scale of Hypnotic Susceptibility (Shor 8c Orne, 1962) to more

than 2,000 college students, the author has detected only one incident

of RIA during routine debriefings conducted following this hypnotic

induction. It is possible that volunteers for hypnosis demonstrations and

research projects tend to have low anxiety, which might explain the

apparent absence of RIA with “generic” hypnosis procedures. At any

rate, relaxation procedures can result in anxiety and panic attacks in

some individuals, and even when this does not occur, there is strong

evidence that a significant number of people would experience perfor-

mance decrements if they relaxed in precompetitive settings (Morgan,

1997; Raglin, 1992).

The concept of a ZOA for athletes is well established (Hanin, 19’78;

Morgan & Ellickson, 1989; Raglin, 1992), and it is imperative that efforts

designed to manipulate precompetition anxiety (up or down) be car-

ried out on an individual basis. The difficulty, of course, involves the

determination of an athlete’s ZOA. It would be necessary to evaluate

an athlete’s anxiety level before many competitions to arrive at his or

her ZOA. Alternatively, one might use hypnotic age regression to ascer-

tain anxiety levels before an athlete’s best, usual, and worst perfor-

mances. When the person’s ZOA is determined, it would then be pos-

sible to strive, with autohypnosis or post-hypnotic suggestion, for

precompetition anxiety that fell within the athlete’s optimal range. Al-

though this view is speculative, it is based on a sound theoretical ra-

tionale (Hanin, 19’78) and on extensive empirical evidence of an indi-

rect nature (Morgan, 199’7; Raglin, 1992).

Despite the compelling support for the ZOA theory, sport psy-

chologists are more likely to be consulted about problems involving

elevations in precompetition anxiety. Indeed, athletes have been re-

ported to be almost incapacitated before competition, and these anxiety

attacks often prevent customary levels of performance. Although an

equal number of athletes may experience inadequately low levels of

HYPNOSIS 165

anxiety, this problem tends to be less apparent. Naruse (1965) pre-

sented one of the best discussions of how hypnosis can be used with

athletes in the precompetitive setting. Naruse labeled intense anxiety

in the precompetitive setting as “stage fright” and summarized the use

of (a) direct hypnotic suggestions, (b) post-hypnotically produced au-

tohypnosis, and (c) self-hypnosis in conjunction with autogenic training

and progressive relaxation in the treatment of anxiety states in athletes.

There are two important points to be made about Naruse’s (1965)

report. First, the athletes used in this study consisted of elite performers,

and the results may not generalize to pre-elite or nonelite athletes. Sec-

ond, the procedure used with a given athlete in Naruse’s study was

determined on an individual basis. The unique nature of the athlete’s

stage fright and the person’s personality structure were considered to-

gether in deciding on the procedure to be used. This article could be

particularly useful to hypnotherapists involved in the treatment of pre-

competition anxiety in athletes competing at the national or the Olym-

pic level.

Vanek (1970) emphasized that attempts to manipulate anxiety lev-

els before competition must be pursued with caution and that the psy-

chologist should have a complete appreciation for the athlete’s psycho-

dynamic nature. Furthermore, Vanek described the case of a

heavyweight boxer who experienced an anxiety attack before an Olym-

pic contest. The boxer’s anxiety was controlled effectively with the ad-

ministration of a nonhypnotic (i.e., autogenic method) procedure. The

boxer then proceeded to lose his match to an opponent he had previ-

ously beaten. Vanek reported that follow-up study revealed that the

boxer typically experienced anxiety attacks before important competi-

tions, but he apparently performed well in this state. Anxiety reduction,

in retrospect, was judged by Vanek to be contraindicated. This case

serves to confirm the ZOA theory, and makes apparent that indiscri-

minant use of psychological procedures to relax athletes before com-

petition is not appropriate.

Garver (1977) described a novel approach to the use of hypnotic

control of arousal levels to enhance performance. This method requires

that athletes establish a personal arousal scale ranging from 0 (the low-

est possible level of arousal an athlete might experience) to 10 (the

highest level) while in the hypnotic state. The athlete is moved up and

down this arousal scale to have him or her experience how different

arousal intensities feel. Furthermore, the athlete’s optimal level of

arousal is defined as the sensations associated with a score of 5 on the

166 WILLIAM

P.

MORGAN

scale. An effort is made to have the athlete perceive this optimal inten-

sity level and use it as a post-hypnotic cue during competition. Garver

described cases of a gymnast and a golfer who experienced perfor-

mance problems associated with elevated anxiety and anger, respec-

tively. In these cases, post-hypnotic cues and cognitive rehearsal were

used to produce preferred arousal levels, and this approach led to en-

hanced performance.

Case Material

The cases reviewed in this section involve athletes from the sports of

distance running, baseball, and cycling. The overall approach used in

these cases relied on insight training through hypnotic age regression.

The hypnotic procedure can be viewed as nondirective, and it built on

the earlier case reports of Johnson (1961a, 1961b). Also, the theoretical

formulations of Hanin (1978) and Unestihl (1981) specified that op-

timal or ideal affective states characterize peak performance, and both

theories maintain that information of this nature can be retrieved.

Therefore, efforts were made in these cases to retrieve repressed ma-

terial by means of hypnotic age regression. A multidisciplinary approach

was used in each situation, and these case studies demonstrate that per-

formance decrements in sports are sufficiently complex to rule out sim-

plistic, unidimensional solutions.

In the first two cases, hypnosis was used to help a distance runner

and baseball player gain insights about problems they were experienc-

ing during competition. In the third case, it was decided that hypnosis

was contraindicated. In all three cases, the athletes were patients under

the care of a sports medicine physician who participated in the hyp-

noanalysis. The author assumed responsibility in these cases for the hyp-

notic inductions.

Case 1: Distance Runner

This case represents a common problem in which an athlete is no

longer able to perform at his or her customary level. This type of situ-

ation is considerably different from the case in which an athlete is per-

forming at a given level and wishes to enhance his or her performance.

In particular, this case involved an athlete who previously performed at

an elite level but was now unable to do so.

HYPNOSIS 167

The case involved a 21-year-old distance runner who had previously

established a school and conference record but was unable to replicate

the performance. Indeed, the runner was not able to even complete

many of his races, much less dominate a given competition. Problems

of this nature are usually diagnosed in the field of sports medicine as

“staleness,” and the only effective treatment appears to be rest (Mor-

gan, Brown, Raglin, O’Connor, & Ellickson, 1987). However, staleness

was not the problem in this case. The runner’s inability to perform at

his previous level was judged by the coach to reflect inadequate moti-

vation and unwillingness to tolerate the distress and discomfort associ-

ated with high-level performance. However, the athlete reported that

he was “willing to do anything” to perform at his previous level, and

he felt that his principal problem stemmed from inadequate coaching.

Although both the athlete and the coach were interested in the resto-

ration of the runner’s previous performance ability, they were clearly at

odds with one another. The conflict had reached the point where the

two were unable to discuss the matter, and the runner had turned to

his team physician for support. However, a thorough physical exami-

nation, including blood and urine chemistries routinely used in sports

medicine, failed to reveal any medical problems.

The physician proposed that hypnosis be used to resolve this prob-

lem, and the athlete was eager to try such an approach. However, it

seemed appropriate to first evaluate the runner’s physical capacity to

ensure that he was actually capable of performing at the desired level.

It is well documented that aerobic power is an important factor in suc-

cessful distance running. Therefore, the runner was administered a test

of maximal aerobic power on a treadmill. This required that he run at

a pace of 12 miles per hour on the treadmill, and the grade was in-

creased by 2% every minute until he could no longer continue. This

test revealed that he achieved a peak, or maximal, VO, of ’70 ml/kg.

min by the 5th minute of exercise, and his ability to uptake oxygen fell

during the 6th minute. That is, a true physiological maximum, as op-

posed to a volitional or symptomatic maximum, was achieved. The value

of 70 ml/kg-min is the average reported for elite distance runners;

therefore, the runner was physiologically capable of achieving the de-

sired performance level. However, calculations revealed that it would

be necessary for him to average 96% of his maximum throughout an

event to replicate his record performance. This could potentially be

problematic because exercise metabolites such as lactic acid begin to

accumulate and limit performance during prolonged exercise, at 60%

168 WILLIAM P. MORGAN

to 80% of maximum in most trained people. In other words, it would

have been possible for this runner to perform at the desired level, but

such an effort would be associated with considerable discomfort (i.e.,

pain).

The runner was observed to score within the normal range on

anxiety, depression, and neuroticism as measured by the State-Trait

Anxiety Inventory (STAI; Spielberger, 1983), Depression Adjective

Checklist (DACL; Lubin, 1962), and the Eysenck Personality Inventory

(EPI; Eysenck & Eysenck, 1963) respectively. He scored significantly

higher than the population norms on extroversion, but this is a com-

mon finding for many athletes (Morgan, 1980b). He was found to be

hypnotizable following preliminary induction and deepening sessions,

and he was eager to pursue “insight training” through hypnosis and

deep relaxation. The runner was viewed as a good candidate for hyp-

nosis for the following reasons: (a) No medical contraindications were

detected, (b) he possessed the necessary physiological capacity to

achieve the desired goal, (c) there were no apparent psychological con-

traindications, and (d) he was able to enter into a deep trance.

Next, the athlete was age-regressed to the day of his championship

performance, and he was instructed to describe the competition and

any related events that he judged to be relevant. However, rather than

telling him that “the race was about to begin” or instructing him in

the customary “on your mark” command, he was asked to recall all

events leading up to the race on that day. He was instructed,

For example, try to remember how you felt when you awakened that

morning; your breakfast or any foods or liquids you consumed; the

temperature before and during the race; the nature and condition

of the course; interactions with your coach, teammates, and oppo-

nents; your general frame of mind; and then proceed to the starting

line when you are ready.

The athlete’s team physician and the author had previously asked the

runner whether it would be acceptable for either or both of them to

ask questions during the session, and the athlete had no objections.

The athlete had a somewhat serious or pensive look, but within a few

minutes he began to smile and chuckle, saying that he had false-started.

When asked why this was so amusing, he replied that it was “ridiculous,

since there is no advantage to a fast start in a distance race.” This event

can be viewed as a critical incident because runners and swimmers will

intentionally false start at times to reduce tension. Others will do this

to upset or “unnerve” their opponents. At any rate, his facial expression

HYPNOSIS 169

became serious once again, and his motor behavior (e.g., grimacing and

limb movements) suggested the race had begun. The verbatim narrative

follows:

The pace is really fast. I’m at the front of the pack. I don’t think I

can hold this pace much longer, but I feel pretty good. The pace is

picking up. . . . I don’t think I can hold it . . . my side is beginning

to ache . . . I have had a pain in the side many times. It will go away

if I continue to press. There . . . it feels good now. The pain is gone,

but I’m having trouble breathing. I’m beginning to suck air. . . the

pain is unbearable . . . I’m going to drop out of the race as soon as

I find a soft spot. There’s a soft, grassy spot up ahead . . . I’m going

to stop and lay in the soft grassy spot . . . wait, I can’t, three of my

teammates are up on top of the next grade . . . they are yelling at

me to kick.. . I can’t let them down. I will keep going. I’m over the

hill now . . . on level grade . . . it feels ok . . . I’m alright. There’s

another hill up ahead. I don’t like hills. . . It is starting to hurt again

. . . I can’t keep this up . . . I’m going to find a soft spot again and

stop. There’s a spot ahead . . . I’m going to quit . . . I’m slowing

down . . . this is it. Wait, there . . . I see a television set about ten

feet off the ground at the top of the hill . . . hey, I’m on the TV,

but

this race isn’t televised . . . but I can see myself clearly on the TV

. . . I’m not here anymore . . . I’m on the TV. Now there’s another

TV,

but to the right of the first one. My parents are on that TV, and

they are watching me run this race on the other TV. I can’t stop

now. I can’t let them down. Got to keep going. I’m not here . . . I’m

on TV It’s starting to feel better. I feel like I’m in a vacuum now. I

can’t feel anything. My feet aren’t hitting the ground anymore . . .

I can’t feel the wind hitting me. Hey, I’m a Yankee Clipper . . . I’m

on the high seas . . . I’m flying . . . the sails are full . , . the wind is

pushing me . . . I’m going to blow out. . . I’m going to kick. . . I don’t

feel pain anymore . . . This is going to be a PB, maybe a record, I’m

flying now, there is no one in sight, this is my race, there’s the tape,

I’m almost there, the tape hit my chest, it feels weird . . . weird . . .

weird . . . the tape feels weird . . . that’s the end . . . the end . . . the

end . . . the end.

The runner appeared to be deeply relaxed at this point, and he

had previously agreed to answer any questions we might have following

his recall of the race. He was asked, “You almost dropped out of the

race twice. Why didn’t you simply slow your pace? Would that not have

been better than quitting?” The runner replied without any hesitation

that “Oh, no, you really have to take pride in yourself to quit. You have

to be a real man . . . it takes guts to quit. Anybody can continue and

turn in a lousy performance. I have too much pride to do that. I would

rather quit.” Although this view can be judged as somewhat unusual, it

170 Wuim P.

MORGAN

is noteworthy that he had dropped out of more races than he had

completed during the present season.

The runner was asked to clarify the meaning of selected terms or

phrases he had used, and then he was asked the following question:

“Would you like to have complete recall for all of this information, or

would you prefer to forget about it, or perhaps, have it come back to

you gradually?” The decision to ask this question was based on the

earlier demonstration by Johnson (1961a) that athletes sometimes do

not wish to become aware of repressed material in the post-hypnotic

state. The decision to ask whether he would prefer that this information

gradually return also was based on Johnson’s case study, and it was in-

tended to prevent the athlete from becoming overwhelmed or further

confused as a result of this .previously repressed material. At any rate,

the runner responded that he would like to have complete recall fol-

lowing the session. Hence, no effort was made to produce post-hypnotic

amnesia.

The runner also was asked in the hypnotic state whether he wished

to continue with this program of insight training, and he replied that

he would like to give this some thought. For this reason, post-hypnotic

suggestions designed to ensure adherence to future hypnotic sessions

were not administered. In other words, post-hypnotic suggestions de-

signed to produce amnesia regarding the previously repressed material,

and motivating instructions designed to ensure continuation, could

have been, but were not, administered to the runner. This decision was

based on the presumed efficacy of nondirected approaches in such

cases, and on a priori contingency agreements with the runner. These

agreements were of a generic nature, and they were decided on before

intervention with hypnosis.

This case illustrates several points that practitioners in sport psy-

chology or sports medicine should consider before using hypnosis with

an athlete. First, it is important to obtain relevant information concern-

ing an athlete’s physiological, psychological, and medical state. Efforts

to enhance physical performance with hypnosis should not be carried

out within a unidimensional context. Second, the decision to proceed

with hypnosis should be made only after ruling out obvious contrain-

dications (i.e., pathophysiology and psychopathology). Third, peak per-

formances involving the transcendence of usual performance levels can

be associated with cognitive-perceptual processes of a remarkable na-

ture. The record-setting performance of this athlete was found to be

associated with considerable pain, but the sensation of pain had been

HYPNOSIS 171

repressed; that is, the runner was unaware of this pain experience in

the nonhypnotic state. However, the cognitive-perceptual experience

was “replayed” during hypnotic age regression, and the runner elected

to have awareness of this experience in the post-hypnotic state. It is

possible that conscious awareness of this previously repressed material

may have provided the runner with insights he previously lacked.

Fourth, it is noteworthy that the athlete’s record performance was

characterized by the cognitive strategy of dissociation (Morgan, 1984,

1997, 2001). Runners who use this strategy attempt to ignore sensory

input (e.g., muscle pain and breathing distress) by thinking about other

activities (i.e., distraction). Other runners have reported that they ini-

tiate “out-of-body” experiences by entering the body’s shadow cast on

the ground in front of them. These cognitive strategies have been la-

beled as dissociation. Although this strategy can clearly facilitate endur-

ance performance (Morgan, Horstman, Cymerman, & Stokes, 1983), it

is not the preferred strategy of elite distance runners (Morgan & Pol-

lock, 1977). Elite runners have been found to use the cognitive strategy

of association, which is based on systematic monitoring of physical sen-

sations rather than on ignoring them (Morgan, 2001; Morgan et al.,

1987, 1988; Morgan & Pollock, 1977).

It is possible that this athlete could have been taught to use dis-

sociation (Morgan, 1984), in either the hypnotic or the nonhypnotic

state, to help him cope with the perception of pain during competition.

Also, it is possible that such an approach would have led to enhanced

performance, because (a) laboratory research has shown that such an

approach is ergogenic (Morgan, 197213; Morgan et al., 1983), and (b)

the runner had experienced a form of dissociation during his record-

setting performance. However, ignoring sensory input while performing

at a high metabolic level in a sport contest is not without risk, and such

an approach can lead to heatstroke, muscle sprains or strains, and stress

fractures (Morgan, 1984). Cognitive strategies designed to minimize or

eliminate the sensation of pain and discomfort during athletic compe-

tition and training should be used judiciously and with caution.

This runner subsequently elected to terminate insight training, and

this decision was not congruent with his initial statement that he would

do anything to return to his previous level of performance. Keep in

mind that although he did possess the physiological capacity necessary

to perform at a high level, to do so would have been associated with

considerable pain. Also, despite the fact that his subsequent perfor-

mance did not improve, our subjective impression was that he had

172 WILLIAM

P.

MORGAN

“come to terms” with the situation. In a sense, then, he did not ter-

minate the insight training we were providing, but rather, the insight

he gained resolved the problem-at least from his perspective.

Case 2: Baseball Player

Hypnotic age regression was used to resolve a periodic problem expe-

rienced by a college baseball player who was an outfielder on a Division

1 team. The player was introduced to me by his team physician in the

hope that hypnosis might be used to improve the player’s batting per-

formance. He was regarded as a strong hitter, with the exception that

he would “bail out” of the batter’s box at times when he was not in

apparent danger of being hit by a pitched ball. He had been examined

and treated by the team physician and found to be in good physical

health, including unimpaired vision. The player was highly regarded by

several professional baseball teams, and he stood a good chance of earn-

ing a professional contract following graduation in two months. He was

highly motivated to solve his batting problem because several profes-

sional scouts had arranged visits to observe him play. The coach was

somewhat frustrated about the situation, and his only approach had

been to instruct the player to “hang in with the pitch.” This instruction

was of no help to the batter, and the exhortation seemed to exacerbate

the problem.

The player was deeply concerned about the possibility that he

would bail out of the batter’s box during the forthcoming visits by pro

scouts. Because he had a .315 batting average despite bailing out of the

batter’s box periodically, it was decided that he would be a possible

candidate for hypnoanalysis. A battery of psychological questionnaires

was administered, and he was found to score within the normal range

on measures of state and trait anxiety (STAI; Spielberger, 1983); ag-

gression (Thematic Apperception Test and a Sentence Completion Test;

Murray, 1971)

; tension, depression, anger, vigor, and confusion (Profile

of Mood States; McNair, Lorr, & Dropplemann, 1992); and neuroticism-

stability and extroversion-introversion (EPI; Eysenck 8c Eysenck, 1963).

Also, his lie score on the personality inventory was not remarkable. This

screening was followed by administration of the Harvard (Shor 8c Orne,

1962) and Stanford C (Weitzenhoffer & Hilgard, 1962) scales of hyp-

notizability on separate days. He was quite responsive, scoring 9 on the

Harvard Scale and 10 on the Stanford C Scale.

On the basis of the earlier example described by Johnson (1961a),

HYPNOSIS 173

he was initially age-regressed to a recent game in which the problem

occurred, and he was asked to describe the situation. He had previously

agreed that he did not object to the team physician or author asking

him questions as the analysis proceeded. Although the author assumed

responsibility for the hypnoinduction, it was agreed by the athlete, phy-

sician, and author that the physician would be responsible for the clin-

ical dimensions of the process. The athlete was unable to provide any

detail during this age regression that was not available previously in the

non-hypnotic state. The author indicated that he would count from 1

to 10 and that the player would have recall for relevant information

that was not previously available when the number 10 was reached. This,

too, was based on the earlier approach successfully used by Johnson. At

the count of 10, the athlete began to shake his head from side to side,

and he apologized for not remembering additional material. He was

assured that such a response was not unusual, and he was given post-

hypnotic suggestions to the effect that he would feel relaxed and re-

freshed following the session. It also was emphasized that he would look

forward to next week’s session.

The player returned a week later, at which time a second age re-

gression was used, but on this occasion, he was asked to go back in time

and try to recall any events in his baseball career that were of particular

importance to him. Within a brief period, he described an occasion

during his first year at the university in which he was hit on the back

as he turned in an attempt to avoid a pitched ball. He thought the ball

was going to “break,” but it did not, and as he turned away from the

ball, his left scapula was hit and broken. It is remarkable that he had

apparently repressed this event, because it was significant. He had never

mentioned this incident to us during the non-hypnotic state. He then

proceeded to describe a situation in high school when, as a pitcher, he

had attempted to “dust off’ a batter (i.e., throw at the batter rather

than the plate) to distract the batter and increase his apprehension

about succeeding pitches. Unfortunately, he hit the batter in the head

(helmets were not worn at that time). Although the injury was not se-

rious, the batter did not return to the game, and the athlete reported

that he felt badly about the event.

It would have been possible to administer various post-hypnotic

suggestions, but we decided against it for several reasons. The case re-

sembled the one described by Johnson (1961b), discussed previously,

in which a pitcher regularly went through an aggression-guilt-

aggression cycle, with performance decrements during the guilt phase

174 Waitm P.

MORGAN

and enhanced performance during periods of aggression. In this case,

the player may have been experiencing a fear- or guilt-repression cy-

cle, presumably at an unconscious level, in which he felt the fear of

being hit or the guilt associated with the injury of his opponent, and

these states could have created sufficient psychomotor perturbation to

provoke the present problem. In addition, these affective states may

have been repressed periodically, during which time performance was

increased. These explanations are purely speculative, and we elected

not to build on these hypotheses. Also, we felt that it would be inap-

propriate to administer suggestions designed to restrain him in the bat-

ter’s box, because of the potential for injury from a pitched ball. Rather,

we elected to ask the batter whether he wanted to have conscious recall

of this previously repressed material in the post-hypnotic state. He in-

dicated that he would like to recall all of the information, and he was

then given the same concluding suggestions administered in the pre-

vious session.

In the next and final session, the athlete was asked following the

induction to once again go back in time and recall events in his baseball

career that had particular meaning for him. He responded to this re-

quest by saying,

Okay, but I want to tell you something first. I think I have solved

my “bailing out” problem. I have been using a closed stance, and I

crowd the plate as much as possible in order to “control” the plate

and reduce the pitcher’s strike zone. All good batters do this, but

you always run the chance of being “beaned.” Therefore, I’m

changing to an open stance with my left foot dropped back so I will

have a wide open view of all pitches. I’m a good enough hitter that

I can do that without hurting my average.

Because the athlete seemed to have gained insight and resolved

the problem, we elected not to proceed with further age regression. We

talked with him briefly about his decision, and he was encouraged to

review this plan with his coach. He was then given post-hypnotic sug-

gestion so that he would feel relaxed, rested, and confident about his

decision following the session. He also was encouraged to contact us if

he had any further problems.

This case can be judged as representing a successful resolution of

a presenting symptom, because the batter’s performance improved. He

was no longer plagued with the problem of bailing out, he completed

the remainder of the season with a .515 average, and his overall average

ranked near the top for all Division 1 players that year.

HYPNOSIS 175

Case 3 Cyclist

A 27-year-old competitive cyclist approached the author with the request

that hypnosis be used to resolve a problem he was experiencing with

his training. He was unable to complete routine training rides of 50 to

75 km, and he was concerned that he would not be able to compete

effectively in a forthcoming national race. He completed a standard

battery of psychological questionnaires, and the results were remarkable

in that he was found to be depressed and anxious. Because of the ele-

vated scores on these measures, it was felt that his performance problem

should not be addressed with hypnoanalysis. He was referred to a clin-

ical psychologist for evaluation and possible treatment. Not only did

this assessment reveal that he was clinically depressed, but it also showed

that crisis intervention was warranted. Therefore, he was referred to an

outpatient psychiatry clinic where he was treated for several months.

Treatment consisted of time-limited psychotherapy in concert with an-

tidepressan t drug therapy.

During the course of his psychotherapy, he continued to visit our

physiology-ofexercise laboratory, where he had previously completed a

test of maximal aerobic power on the bicycle ergometer. This test re-

vealed that he had a peak V02 max of 66 ml/kg - min. That is, maximal

capacity was defined in terms of physiological capacity rather than a

symptom-limited, or subjective, maximum. He was retested using the

same protocol, and the test was performed by the same laboratory tech-

nician who performed the earlier assessment. The cyclist’s maximal ca-

pacity had fallen to 53 ml/kg emin. Because a reduction of 20% in actual

physiological capacity is both atypical and remarkable, the cyclist was

retested a week later to confirm the test results. The second test yielded

identical results, and these data served to confirm that the decision to

use hypnosis in such a case was contraindicated. That is, he could no

longer perform at his customary level, because he no longer had the

physiological capacity to do so. The unexplained reduction in V02

max

warranted further assessment, and he was referred for a complete phys-

ical examination, including routine blood and urine chemistries. All

results were negative, with the exception that he seemed to have some

suspicious chest sounds. For this reason, he was referred to the pul-

monary function laboratory, where all test results were found to be

negative.

The psychotherapy and drug therapy led to a reduction in this

cyclist’s anxiety and depression, and he was eventually able to resume

customary levels of training. However, the 20% decrement in physical

176 WILLIAM

P.

MORGAN

capacity was not restored, nor was he able to return to competitive

cycling at the national level. The purpose of elaborating on this case

study is threefold. First, the “motivational” problem was based on a

profound and difficult to explain reduction in the cyclist’s physiological

capacity. Second, the use of hypnosis to treat this problem was contra-

indicated owing to the demonstration of both psychopathology (anxiety

and depression) and pathophysiology (reduced VO, max). Third, it is

apparent in retrospect, and on theoretical grounds, that a multidisci-

plinary approach to performance problems was, and is, the only defen-

sible course of action.

Summary

Hypnosis has been used in the field of sport and exercise psychology

for many years as a research tool to elucidate the mechanisms under-

lying physical performance. Also, numerous clinical applications have

been designed to enhance performance in sport settings, and these

interventions have been largely based on theoretical formulations as

opposed to empirical research evidence. These clinical applications

have generally been successful, but little attention has been paid to

behavioral artifacts, such as expectancy effects, placebo effects, and de-

mand characteristics. Furthermore, there is no evidence that effects ob-

tained with these clinical applications exceed those achieved with the

same or comparable approaches in the absence of hypnosis.

Efforts to enhance athletic performance by increasing or decreas-

ing precompetitive anxiety have usually not been effective. This can be

explained by the observation that most athletes perform best within a

narrow ZOA. Hence, efforts to decrease or increase anxiety in athletes

should be discouraged unless the athlete’s ZOA is known. Note that

hypnotic age regression offers considerable promise in defining a per-

son’s ZOA. Furthermore, once this zone has been established, it can be

reproduced with various hypnotic procedures (e.g., autohypnosis and

post-hypnotic suggestion).

An additional area in which hypnosis has proven to be effective in

sport and exercise psychology involves the interpretation of decreased

performance levels (i.e., slumps and failure) in previously successful

people. Examples of nondirective hypnotic age regression are presented

in this chapter, and these cases emphasize the importance of multidis-

ciplinary approaches. Direct hypnotic suggestions of enhanced perfor-

HYPNOSIS 177

mance are not likely to be successful, but the hypnotic tool can be used

effectively in several ways in sport and exercise psychology.

Perception of effort plays an important role in many sport and

exercise settings, and hypnosis has been used effectively in a series of

studies designed to better understand the nature of effort sense. This

research has demonstrated that perceived exertion can be manipulated

hypnotically in a systematic manner. This has been accomplished by

maintaining exercise intensity at a constant power output (e.g., 100

watts) and suggesting that the work-load has increased or decreased.

This perturbation of effort sense has been associated with various phys-

iological changes in variables such as heart rate, blood pressure, venti-

latory minute volume, and brain activation as measured by rCBF. Al-

though the physiological changes have been more consistent and

dramatic for suggestions of increased work-load, modifications have

been noted for decreased effort sense as well. Related research involving

the comparison of actual and imagined exercise has shown that cardi-

ovascular changes and brain activation are similar in high-but not in

low-hypnotizable individuals. It is concluded that hypnosis can be an

effective tool in both the resolution of performance problems and the

experimental study of perceived exertion during exercise.

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