hypnosis

Hypnoanesthesia

Hypnosis is not used as often as an anesthetic agent as it is to control nonsurgical pain. On at least two occasions, the author was unable to find a local obstetrician who employed hypnosis in deliveries for pregnant women desiring such a referral (both of whom were excellent hypnotic subjects).

Probably the principal reason for this state of affairs has been the development of reasonably safe, rapidly effective chemical changes. It has been estimated that only 25% of the population are capable of developing a sufficient degree of hypnoanesthesia for its use as the sole anesthetic in relatively minor procedures, such as fracture settings, tooth extractions, the changing of burn dressings, or the removal of sutures in frightened children.

Other reasons advanced for reluctance to use hypnoanesthesia include: the amount of time, training, and skill required for a hypnotic induction; the fact that hypnosis may be contraindicted in patients with psychological problems such as psychotics, borderlines, or depressives; and the fact that hypnosis is regarded as Òquasi-scientificÓ in some professional circles

With respect to the contraindication of hypnosis and hypnoanesthia in patients with certain psychological disorders, some clarification is required. There is no absolute contraindication for hypnosis in any patient. Some patients may present a higher risk of developing adverse reactions such as spontaneous regression and aberrations, that are undesirable in a nonpsychotherapy context, and control of these require some skill on the part of the hypnotist. Hence, with these patients, hypnoanesthesia requires a hypnotist who is well trained in psychotherapy. It should not be attempted by a physician who lacks such training. It is unfortunate that physicians in general and anesthesiologists in particular, do not receive more training in psychodynamic concepts and hypnosis, for it is usually convenient to have a psychologist induce hypnoanesthia except in an emergency situation.

If initial hypnotic inductions are performed are performed in a leisurely, unhurried atmosphere and the patient is given the opportunity to develop an anesthesia and experience it tested successfully, his confidence in the adequacy of the procedure will be greater. Patients should be trained to enter a trance state either on a posthypnotic signal or by self-induction to save time in the operating room and render them independent of the presence of the particular hypnotist who trained them.

A patient so trained may be able to have a successful hypnotic delivery under the care of another obstetrician should the one who trained her in hypnosis be available at her delivery. Also, the ability to reenter hypnosis rapidly on a signal is a valuable safeguard should a patient inadvertently awaken during surgery. This contingency is quite unlikely, particularly if the hypnotist instructs the patient not to awaken until directed to and if he or she continues a steady flow of trance maintaining chatter throughout the operation. Preliminary trials of hypnosis may be presented to patients with reservations about the procedure as exercises in relaxation to prevent their fears from producing reactions that may lead to false impressions of their abilities as subjects.

The value of hypnosis may also extend to the prenatal period------It not possible to do successful hypnoanesthia, or for that matter any other hypnotic procedure, unless the therapist takes the time necessary to establish a proper rapport with the patient and the latter develops confidence in the hypnotists ability and concern for his welfare In addition to its use as an anesthetic, hypnosis can be a valuable pre-operative and postoperative adjunct to the care of surgical patients.

J. Barber and Mallin (1977) advocate the use of hypnosis during the fitting of contact lenses and emphasize the careful choice of words in the framing of suggestions. Words that denote the same thing may vary widely in their connotations and implications and thus may not be equally effective in framing suggestions.

Signs of Hypnosis

The responses of a subject to induction suggestions are what we collectively refer to as a trance. These responses are a function of what suggestions are made and the subject's own preconceptions of what a hypnotic state is like.

These suggestions and preconceptions in turn are usually similar enough, even in nominally different methods of hypnosis, the produce common reactions in different subjects, which are usually taken as evidence of hypnotic induction. Indeed, hypnotic induction proceedings are often stereotyped enough so that what is really remarkable is not the similarity of the reactions among different subjects but the fact that there is so much variability.

With respect to an individual subject, the initial induction is a very important event. Although little has been written on this topic, it appears likely that the reactions obtained in this sessions will determine the subject's personal expectations concerning the hypnotic state and will tend to reappear in all subsequent sessions. Thus, individual reactions to hypnotic inductions tend to remain similar from session to session unless specific suggestions are made to vary them.

The signs of hypnotic induction can be divided into objective signs that the hypnotist can observe directly and subjective signs that the subject must be asked to describe. Some of the more common objective signs of hypnosis are the following:

1. Initial eyelid fluttering followed by eye closure.

2. Deep relaxation as evidenced by limpness of the limbs, lack of facial expression, and marked disinclination to move of talk spontaneously.

3. Literalness in the understanding and following of suggestions. Often hypnotic subjects behave as though their understanding of language is more primitive; metaphoric expressions or idioms may be given their literal meanings. A subject told to raise his hand, for example, may simply raise the hand alone while leaving the arm unmoved, or a subject told to write their name, may literally write "Your name."

4. In some subjects, there may be excessive salivation and swallowing or excessive tearing of the eyes during hypnosis.

5. A characteristic of a hypnotized subject that some would call a defining feature of hypnosis is the tolerance of the subject for inconsistencies or anomalies in experience or perception, that is, trance logic.

The signs of hypnosis, while common, are all high individual. One subject may display most of these responses and be only in a very shallow state, as measured by his responsiveness to suggestions.

Another may not show and of these signs and yet be in a very deep hypnotic state. After working with an individual subject often enough, the hypnotist will be able to gauge this subject's trance depth from his objective responses.

The subjective feeling accompanying hypnotic induction are even more variable. They often include one or more of the following:

1. Feelings of deep relaxation and disinclination to expend any kind of effort during hypnosis.

2. Feelings of bodily heaviness, more likely in the limbs during hypnosis.

3. Feelings of numbness, tingling, or dullness in the limbs and/or hands during hypnosis.

4. A feeling of floating.

A common phenomenon in hypnotic sessions is the development of what is usually called rapport between the subject and the operator. This means that the subject reacts only to suggestions made by the hypnotist and treats suggestions made by anyone else as part of the background stimuli or noise, which he ignores.

Some operators believe that this is an essential aspect of hypnosis, but, like all other characteristics of a trance, it probably results from either an explicit or an implicit suggestion. For example, if the hypnotist tells the patient, "Attend only to the sound of my voice," as is commonly done during induction, he or she is in effect specifically telling the subject in a literal manner not to respond to suggestions from any other person.

In experimental work, the subject's doubt that hypnosis occurred is usually irrelevant to the study. If it is important to convince a patient of the reality of trance induction and the preceding steps leave him unconvinced, then hypnosis should be re induced and the subject given some posthypnotic suggestions to perform, such as developing an amnesia for the number 6.

Psychological Problems Concerning Hypnosis Continued

Kleinhauz and Beran (1981, 1984) present six cases of severe and/or chronic reactions to hypnosis, five Involving either Inadequate dehypnotlzlng of the subject by a lay or stage hypnotist and one Involving a dentist ex ceeding his area of competence by treating a patient for smoking without consideration of the dynamic value of the symptom to the patient. One of the patients was reported to be a member of the audience at a stage dem onstration, and another claimed to have stolen a pistol as a result of the misinterpretation of a remark by a stage hypnotist that he should act like a cowboy and crack shot. The present author is skeptical of this latter case since the claim was raised as a defense in a criminal prosecution. The authors con clude that all therapists should inquire about prior hypnotic experiences to discover such influence in the genesis of the patient's condition so that they can provide adequate treatment. They also advocate the outlawing of stage hypnosis and criticize the "contamination" of the relationship with the subject by the hypnotist by using it not for the benefit of the patient but to make him an instrument for the purpose of entertaining an audience.

On the other hand, they do not object to experimental hypnosis because, while the researcher seeks to accomplish research goals rather than help the subject, the latter is aware of this, and the procedures are carefully designed and monitored. This position seems to present a problem in logical consis tency. The subject in stage hypnosis is also aware of the purposes of the hypnotist (often to a greater extent than in experimental hypnosis), and there is usually little concern with the subject in most experimental work but rather a focus on some hypnotic phenomenon. Often researchers are not clinically experienced, and little follow-up work on possible sequelae is undertaken. It is possible that the unstated reason for the belief of the authors that experi mental hypnosis is acceptable while stage hypnosis is not is that the value of the former justifies whatever risks may be involved.

Other reactions to hypnosis reported to have occurred in the course of psychotherapy include a spontaneous 72-hour atypical paranoid reaction, a spontaneous cataleptic reaction, and a spontaneous age regression (Hall, 1984; Kornfeld, 1985a; J. Miller, 1983; D.Spiegel and Rosenfeld, 1984). Although such reactions would be a disaster to a lay hypnotist, when they occur in the course of therapy and are properly managed, they may con tribute to a dynamic understanding of the patient. Certainly anyone under taking to do hypnotherapy needs to be prepared for such atypical reactions. Orne (1965a) suggests that some of the severe anxiety reactions that may occur in therapeutic inductions result from the fact that the patient expects permanent changes in his personality and that he is ambivalent about these changes. This ambivalence is demonstrated by the fact that the anxiety re actions can often be controlled by assuring the patient that the induction is intended simply to test his ability as a subject and that no therapeutic sug gestions will be made during the session. Also, transference and counter-transference issues may contribute to this anxiety. Orne believes that these issues should be dealt with under hypnosis, for if the therapist awakens the patient, the latter may interpret this as meaning that the therapist is unable to deal with the anxiety reaction.

J. Hilgard also reported on the incidence of sequelae in laboratory hypnosis and agrees with Orne's conclusion that most reported cases of serious difficulties with hypnosis arise in clinical rather than laboratory settings (Hil gard, Hilgard, and Newman, 1961; J. Hilgard, 1974). Hilgard concludes that most of the fears expressed concerning reactions to hypnosis are groundless and are based on inaccurate preconceptions of the hypnotist having undue influence over a subject. Untoward reactions obtained from subjects experi encing experimental hypnosis, although theoretically interesting, are not se vere. The 1974 study was undertaken because of a change in the charac teristics of the student body available for research since the study of 1961. It was found that of the 120 university students studied, 15% had some kind of reaction to the hypnotic experience (SHSS, form C) that lasted an hour or longer. This figure rose to 31% if short-term reactions (lasting from 5 min utes to an hour) were included. Thus, she warns against the premature dis missal of hypnotic subjects.

Some of the reactions (e.g., headache, confusion, or anxiety) began dur ing hypnosis and either terminated with it or persisted for a while after the session. The chief short-term aftereffects reported were drowsiness and con fusion (16 of 19 sequelae). Hilgard suggests that these may be regarded as a continuation of the hypnotic state rather than a reaction to it. It is similar to the experience of many people who require a period of readjustment after awakening in the morning.

Longer sequelae were experienced by 18 of 120 subjects in the 1974 study as opposed to only 7 of 220 subjects in the 1961 study. The much higher percentage in the later study may be due to the fact that form A of the SHSS was used in the earlier study, and form C, which includes age regression and dream induction, was used in the later one. Half of the long-term reactions (9 of 18) were a continuation of drowsiness and confusion, but more complex ones were also reported. One delayed response reported involved nocturnal dreaming about hypnosis, but it is not clear whether this response should be considered a sequelae or the hypnosis simply regarded as a day residue that appeared in the dream. Headaches were also reported that lasted from 1.5 to 2 hours but disappeared following sleep. Headaches were interpreted as representing a conflict between the desire to be hypnotized and anxiety con cerning the experience or a desire to avoid it. Little, if any, relationship was lound between hypnotic susceptibility and sequelae. There was, however, a positive relationship between pleasant aftereffects (which were not considered sequelae, such as feelings of relaxation, calm, and well-being) and suscep­tibility. Although these reactions were always suggested at the termination of hypnosis, only about 60% of the subjects reported experiencing them. It was found that there were wide individual differences in how subjects react fol lowing a hypnotic experience, but, in an experimental setting at least, thert were no alarming sequelae. In the 1961 study, a significant relationship was found between sequelae and adverse childhood experience with anesthesia, the patients was reported to be a member of the audience at a stage dem onstration, and another claimed to have stolen a pistol as a result of the misinterpretation of a remark by a stage hypnotist that he should act like a cowboy and crack shot. The present author is skeptical of this latter case since the claim was raised as a defense in a criminal prosecution. The authors con clude that all therapists should inquire about prior hypnotic experiences to discover such influence in the genesis of the patient's condition so that they can provide adequate treatment. They also advocate the outlawing of stage hypnosis and criticize the "contamination" of the relationship with the subject by the hypnotist by using it not for the benefit of the patient but to make him an instrument for the purpose of entertaining an audience.

On the other hand, they do not object to experimental hypnosis because, while the researcher seeks to accomplish research goals rather than help the subject, the latter is aware of this, and the procedures are carefully designed and monitored. This position seems to present a problem in logical consis tency. The subject in stage hypnosis is also aware of the purposes of the hypnotist (often to a greater extent than in experimental hypnosis), and there is usually little concern with the subject in most experimental work but rather a focus on some hypnotic phenomenon. Often researchers are not clinically experienced, and little follow-up work on possible sequelae is undertaken. It is possible that the unstated reason for the belief of the authors that experi mental hypnosis is acceptable while stage hypnosis is not is that the value of the former justifies whatever risks may be involved.

Other reactions to hypnosis reported to have occurred in the course of psychotherapy include a spontaneous 72-hour atypical paranoid reaction, a spontaneous cataleptic reaction, and a spontaneous age regression (Hall, 1984; Kornfeld, 1985a; J. Miller, 1983; D.Spiegel and Rosenfeld, 1984). Although such reactions would be a disaster to a lay hypnotist, when they occur in the course of therapy and are properly managed, they may con tribute to a dynamic understanding of the patient. Certainly anyone under taking to do hypnotherapy needs to be prepared for such atypical reactions.

Orne (1965a) suggests that some of the severe anxiety reactions that may occur in therapeutic inductions result from the fact that the patient expects permanent changes in his personality and that he is ambivalent about these changes. This ambivalence is demonstrated by the fact that the anxiety re actions can often be controlled by assuring the patient that the induction is intended simply to test his ability as a subject and that no therapeutic sug gestions will be made during the session. Also, transference and counter-transference issues may contribute to this anxiety. Orne believes that these issues should be dealt with under hypnosis, for if the therapist awakens the patient, the latter may interpret this as meaning that the therapist is unable to deal with the anxiety reaction.

J. Hilgard also reported on the incidence of sequelae in laboratory hypnosis and agrees with Orne's conclusion that most reported cases of serious difficulties with hypnosis arise in clinical rather than laboratory settings (Hil gard, Hilgard, and Newman, 1961; J. Hilgard, 1974). Hilgard concludes that most of the fears expressed concerning reactions to hypnosis are groundless and are based on inaccurate preconceptions of the hypnotist having undue influence over a subject. Untoward reactions obtained from subjects experi encing experimental hypnosis, although theoretically interesting, are not se vere. The 1974 study was undertaken because of a change in the charac teristics of the student body available for research since the study of 1961. It was found that of the 120 university students studied, 15% had some kind of reaction to the hypnotic experience (SHSS, form C) that lasted an hour or longer. This figure rose to 31% if short-term reactions (lasting from 5 min utes to an hour) were included. Thus, she warns against the premature dis missal of hypnotic subjects.

Some of the reactions (e.g., headache, confusion, or anxiety) began dur ing hypnosis and either terminated with it or persisted for a while after the session. The chief short-term aftereffects reported were drowsiness and con fusion (16 of 19 sequelae). Hilgard suggests that these may be regarded as a continuation of the hypnotic state rather than a reaction to it. It is similar to the experience of many people who require a period of readjustment after awakening in the morning.

Longer sequelae were experienced by 18 of 120 subjects in the 1974 study as opposed to only 7 of 220 subjects in the 1961 study. The much higher percentage in the later study may be due to the fact that form A of the SHSS was used in the earlier study, and form C, which includes age regression and dream induction, was used in the later one. Half of the long-term reactions (9 of 18) were a continuation of drowsiness and confusion, but more complex ones were also reported. One delayed response reported involved nocturnal dreaming about hypnosis, but it is not clear whether this response should be considered a sequelae or the hypnosis simply regarded as a day residue that appeared in the dream. Headaches were also reported that lasted from 1.5 to 2 hours but disappeared following sleep. Headaches were interpreted as representing a conflict between the desire to be hypnotized and anxiety con cerning the experience or a desire to avoid it. Little, if any, relationship was lound between hypnotic susceptibility and sequelae. There was, however, a positive relationship between pleasant aftereffects (which were not considered sequelae, such as feelings of relaxation, calm, and well-being) and susceptibility. Although these reactions were always suggested at the termination of hypnosis, only about 60% of the subjects reported experiencing them. It was found that there were wide individual differences in how subjects react following a hypnotic experience, but, in an experimental setting at least, thert were no alarming sequelae.

Psychological Problems Concerning Hypnosis

Minor problems with result from carelessness on the part of the hypnotist and can usually be prevented by the use of proper technique. They include delayed effects of posthypnotic or uncancelled hypnotic suggestions, misunderstanding by the subject of the suggestions made, and the rare difficulties encoun tered in the termination of hypnosis.

All hypnotic suggestions given during a session that are not intended to affect posthypnotic behavior should be cancelled prior to terminating hypnosis, even if the subject did not appear to accept them. Subjects should be tested in the waking state prior to being dismissed to ensure that these sug gestions have in fact been cancelled. The evidence is that in most cases the subject himself will cancel these suggestions, but it is better not to rely on his implicit understanding that the suggestions were not meant to outlast the ses sion.

Because of the literalness with which most hypnotic subjects react to sug gestions, hypnotists should always avoid the use of idiomatic expressions that, if taken literally, would produce results different from those sought. (For example, a patient told to "Let her hair down" and describe how she really feels about something may actually undo her hair arrangement.) Particular care is required when making suggestions to subjects with limited ability in English who are foreign born, uneducated, or of low intelligence. Precautions must also be taken to ensure that a child patient understands the suggestions clearly. Often very bright children give the hypnotist the illusion that he or she is dealing with a small adult; but even bright children may not understand some words in a suggestion.

Orne (1965a) notes that amateurs are the hypnotists most likely to have difficulty with subjects refusing to terminate a hypnotic state, probably because such a reaction is an ideal passive-aggressive response on the part of a subject who has become angry at the hypnotist. The reason that profes sionals using hypnosis rarely get such reactions is that they fail to reinforce them by getting upset, as does a suddenly frightened and terrified amateur hypnotist.

The possibility of problems with symptom substitution has also been pre viously discussed. It should be noted that this is not properly considered a problem of hypnosis but is a problem of any type of psychotherapy that seeks to directly remove a symptom having a dynamic value to the patient. Some symptoms may have such value; many do not. There is no general agree ment as to what percentage of symptoms fall into either category. The sig nificance of a particular symptom in an individual patient is always a matter of clinical judgment on the part of the therapist.

The remaining psychological problems to be considered here are those reactions that occur either during or immediately after hypnosis and are usually discussed under the rubric of sequelae.

Orne (1965a) finds both qualitative and quantitative differences in the types of hypnotic sequelae seen in the laboratory and in therapeutic settings. If the hypnosis is perceived by the subject as episodic and he has no expectation of permanent change, there are very few sequelae, and any that do occur of a minor nature. This is the case in laboratory research, where the emphasis is impersonal and on the phenomena studied, not the subject, or in dental treatment where effects are also perceived by the subject as temporary.

In experimental work with thousands of "normal college students," in a setting specifically de'ined as experimental and with subjects told that no treatment, however minor, would be given, Orne reports virtually no serious reactions to hypnosis. Anxiety reactions, symptom formations, depressions, or decompensations, which have occasionally been reported in clinical con texts did not occur. The complications that did appear were such minor dis-turbances as an occasional mild and transient headache, drowsiness, nausea, or dizziness. If these complications occur, they typically do so on the first induction and are easily suggested away. The incidence of such reactions was reported by Orne to be from 2% to 3%, which is in close agreement with J. Hilgard's (1965) findings. Orne points out that due to the superficial screening of his subjects and the large numbers of them, it is quite likely that some of them may have had serious psychopathology. Since these results were in an experimental context, they are more likely to reflect the effects of hypnosis per se than the effects of either a therapeutic relationship or therapeutic sug gestion, and these results suggest that hypnosis itself is a safe procedure.

Orne further notes that although minor problems experienced by amateur hypnotists might be concealed, it would be hard for them to hide major problems. Although major problems can occur, they are quite rare, in spite of the incompetence and irresponsibility of the hypnotist. This scarcity of untoward reactions is probably due to the episodic and nontherapeutic nature of the hypnotic session.

The low incidence of serious aversive reactions in experimental work is in contrast to their relatively high incidence in the reports of experienced clini cians. Levitt and Hershman (1961, 1963) surveyed 866 hypnotherapists and found that about 27% of the 301 respondents reported observing major or minor untoward reactions to hypnosis, including anxiety, panic, depression, headache, crying, vomiting, fainting, dizziness, excessive dependency, and eight cases of sexual difficulties and psychotic behavior. Forty-three percent of the psychologists (as compared to 27% of the other respondents) reported these difficulties. J. Hilgard (1974) notes that often the more experienced hypnotists reported the most problems.

Orne (1965a) and Conn(1972) interpret this finding quite differently. Conn believes the prevalence of sequelae reflects an incompetence on the part of the hypnotist, who failed either to dehypnotize subjects properly or to screen them adequately prior to hypnosis. Orne, on the other hand, suggests that only the better-trained therapists adequately observed and recorded sequelae.

Wineburg and Straker (1973) report an acute, self-limiting depersonali zation reaction in a 26-year-old female paraprofessional hospital worker. This woman was used as a demonstration subject in a hospital training course in hypnosis and was given weight reduction suggestions. They believe that the adverse reaction was due to the subject's misconceptions about hypnosis and the fear that it could weaken superego controls over her sexual fantasies. The authors recommend that to prevent reactions such as this, all patients should be observed after hypnotic treatment. Moreover, the patients' beliefs and ex pectations concerning hypnosis should be investigated beforehand, at which time they should be given an explanation of the true nature of hypnosis. This type of reaction, although certainly a risk in hypnotherapy, seems clearly to be the result not of hypnosis but of the patient's fears and inrrapersonal dy namics. It should be preventable by an adequate consideration of these fac tors prior to and during hypnosis. Straker (1973) presents two other cases in which patients developed emotional upsets during a therapeutic induction because of intrapersonal dynamic reasons. In one instance, the induction re sulted in a rapid regression and enhanced transference that flooded the pa tient with childhood memories of early fears and recurrent nightmares. In the other instance, a hypnotic induction took on the significance of a sexual at tack to a 36-year-old female patient because of her previous beliefs about hypnosis. This resonated with earlier rape fantasies, greatly upsetting her. These types of reactions are not different from those obtained in ordinary psychotherapy, but the fostering of regression and transference by hypnosis can make them occur more rapidly and dramatically and give the illusion that they are caused primarily by hypnosis.

Sometimes the unusual nature of the hypnotic state causes even an ex perienced therapist to forget that a hypnotic induction does not cause all of the usual principles of human behavior and interaction to cease to operate. As an illustration, Orne (1965a) cites the case of a dentist whose wife was constantly asking him to hypnotize her for weight reduction suggestions, which he steadfastly refused to do. Instead, he insisted that she see a physician to get diet recommendations. The dentist finally relented and hypnotized his wife, but, instead of making weight loss suggestions, he made the suggestion that she would see her doctor. This suggestion was unsuccessful and resulted In the formation of a minor symptom. The idea of consulting a doctor was unacceptable to this woman in the waking state, and it was equally unacceptable under hypnosis.

Rosen (1960a) cited clinical examples of what he considered to be very serious dangers of hypnosis. These included the development of psychoses and a suicide following the hypnotic removal of phantom limb or low back pain and pruritus. He believes that pain that persists for emotional reasons may be a depressive equivalent and hold a severe depression in check. He is quite critical of weekend hypnotic courses touting hypnosis as an uncov- ering device and believes that neither uncovering techniques nor regressions are safe in the hands of persons ignorant of psychodynamics. Although it is hard to disagree with his contention that no one should treat a patient under hypnosis beyond his competence to treat him while awake, it is equally hard to agree with his view concerning the dangers of hypnosis. The cases he cited are clinical examples and as such cannot establish the causal agency of either the hypnosis or the symptom removal in producing the sequelae claimed. The fact that a psychosis follows hypnosis does not logically demonstrate that II was caused by the hypnosis. Conn (1972), after 30 years of practicing hypnotherapy on over 3,000 patients, denies ever seeing a psychosis pre cipitated by hypnosis. Also, even if such causality could be established, It Hems clear that the cause of adverse reactions reported is less likely to be the hypnosis than the method of psychotherapy. These cases really relate to the issue of symptom substitution, not hypnosis, and the weight of the lit-erature does not support the view that symptom substitution involving new, psychotic, or life threatening symptoms is a high-risk phenomenon.

Posthypnotic Amnesia

Posthypnotic amnesia is a condition that occurs when, with or withoutexplicit or implicit suggestions to do so, a subject is unable to remember some or all of the events that occurred in the hypnotic state when he is subsequently awakened. Typically these unavailable memories can be restored suddenly and without any intervening opportunity for relearning by means of a prear- ranged release signal. These memories are also freely retrievable in a sub- sequent hypnotic session. It is this property of reversibility or retrievability that differentiates true posthypnotic amnesia from some types of pseudo-amnesia, which may be caused by simple forgetting or by the failure to attend to or learn material while in the hypnotic state. The material lost as a result of this kind of pseudo-amnesia is not recoverable posthypnotically; the loss is per- manent. The phenomenon of reversibility also demonstrates that posthyp- notic amnesia is not caused by a failure to record material in the hypnotic state but by an interference with the normal retrieval or playback mechanism for gaining access to material in memory (Kihistrom, 1977; Kihisrrom and Evans, 1976; Nace, Orne, and Hammer, 1974; Orne, 1966b; Spanos and Bodorik, 1977). This conflicts with Hilgard's hypothesis that posthypnotic amnesia occurs because subjects under hypnosis suffer from a reduced ability to retain memories just as sleeping subjects do. This is particularly so in view of the findings of Nace, Orne, and Hammer (1974) that there were no sig- nificant differences between high- and low-susceptibility subjects in total recall of events experienced under hypnosis. Furthermore, Orne (1966b) dem- onstrated that the suggestion made to subjects in stage 1 sleep that their noses would itch when a cue word was spoken elicited scratching behavior in sub- sequent stage 1 sleep. This suggestion was also effective on the following night, even though the subjects were amnesic for the suggestion during the waking interval between the two laboratory sessions. This suggests that even sleeping subjects may have more capacity to retain memories than is gen- erally indicated (by studies showing that nocturnal dreams are usually for- gotten if a subject is not awakened within 10 minutes of the REM period during which the dream occurred). Perhaps it was the active response of the subject to the suggestion that enabled the memory trace to be recorded. While spontaneous posthypnotic amnesia is commonly regarded as a sign of somnambulism and is thought by some to be one of the signs of a deep hypnotic state, the experimental literature is in agreement that this phenom- enon rarely occurs in the laboratory (Barber and Calverley, 1966c; Kihistrom, 1977; Kihistrom and Evans, 1977).

Kihistrom and Twersky (1978) found that not only is posthypnotic am- nesia not caused by poor waking memory but subjects displaying marked posthypnotic amnesia actually had superior long-term retention of intention- ally learned material in the waking state.

Young and Cooper (1972) demonstrated the effect of implicit suggestion on the development of posthypnotic amnesia in subjects whose expectancies concerning the development of amnesia following hypnosis were manipu- lated. Half of their subjects were exposed to a prehypnotic lecture on hyp- nosis stating that posthypnotic amnesia invariably follows hypnosis, and the other half were told that it never occurs spontaneously. A significantly greater number of subjects expecting to develop posthypnotic amnesia developed it spontaneously.

In a study involving suggested rather that spontaneous posthypnotic am- nesia, Ashford and Hammer (1978) found a nonsignificant relationship be- tween inferred subject expectancies of posthypnotic amnesia and its subse- quent development following its suggestion on the HGSHS'.A. Simon and Salzberg (1985) also found that manipulating subjects' expectations had no effect on the occurrence of posthypnotic amnesia on the SHSS form A but hypnotic suggestion did. Hypnotic subjects given no specific suggestion for amnesia had less memory than nonhypnotized control groups, which sug- gests the possibility of self-suggestion. Perhaps the reason for the apparent conflict between this study and the findings of Young and Cooper was that in the present study subjects' expectancies were manipulated by having some of them read a paragraph denying the spontaneous occurrence of posthyp- notic amnesia. None was cued to expect this phenomenon, and since the initial expectancy of posthypnotic amnesia in these subjects seemed to have been low to begin with, this "manipulation" may not have produced two groups differing in expectancies. Orne (1966b), on the other hand, cites the cross-cultural occurrence of spontaneously developed posthypnotic amnesia, particularly in hypnotic-like religious and mystic experiences. He believes that this phenomenon deserves more attention than a glib dismissal of it as being due to implicit suggestion. Orne further notes that emotionally charged ma- terial relived by patients during hypnosis is usually forgotten spontaneously on awakening. This material is often related in language appropriate to an earlier stage of life, and he suggests that part of the difficulty in memory may involve the need to translate this material into adult patterns of thought. He reports that patients have difficulty in integrating this type of material into present consciousness even after they have the opportunity to listen to a tape recording of their hypnotic session while awake. Kline (1966) also notes that amnesia is more common following hypnotherapy than other types of hyp- nosis, and its extent seems to be related more to the material brought up under hypnosis than to the depth of the trance.

As in many other areas of controversy in hypnosis, perhaps both sides in this conflict are right. Although the development of spontaneous amnesia is rare in the laboratory, typical hypnotic research does not deal with affect- laden events, and there is no dynamic need for subjects to display an un- suggested amnesia. In clinical practice, however, where affect-laden material is routinely dealt with under hypnosis, spontaneous amnesia may be more common. Indeed, under these circumstances, the amnesia may be caused by the same dynamic factors that produced the original repression rather than by any special properties of the hypnotic state. Thus, as Orne suggests, there may be two different mechanisms involved in the production of posthypnotic amnesia: one based on suggestions in experimental work and one based on repression in clinical phenomena. His idea that dissociation may result from essential differences between the hypnotic and waking thought processes is more difficult to square with the apparent lack of spontaneous amnesia in experimental work, unless it is realized that clinical investigations typically deal with personal memories as opposed to material learned under hypnosis. Suggested posthypnotic amnesia has many subclassifications. Generally it is not an all-or-none phenomenon and can vary in degree from complete to slight. This is indeed fortunate, for the occurrence of partial posthypnotic amnesia makes it possible to study the effects of hypnotic suggestions on the mechanisms of memory retrieval. This would not be possible if amnesia were complete (Evans and Kilhstrom, 1973).

Suggested posthypnotic amnesia can be general—all memories of the hyp- notic experience are interfered with—or specific—only certain memories (either acquired under hypnosis or previous to it) are inhibited. In the former case, the subject may develop pseudo-memories and fill in the gaps with confabulations, as sometimes b . with patients having organic memory defects (Orne, 1966b). If a specific amnesia is suggested for a familiar name or a number, there will be marked differences in both the subjective experi- ence and objective behaviors of subjects responding to such a suggestion. Some subjects will report totally forgetting the name or number, while others will report remembering it but be unable to pronounce it when challenged to do so. It is quite common for such a suggestion made to a group of subjects to be interpreted differently by individual subjects. Hence these differences in responses are not due merely to the wording of the suggestions but also to the individual interpretations of these words made by each subject (and possibly to individual differences in hypnotic depth and the resulting literal- ness of understanding).

There was a time when it was widely believed that in order for a post- hypnotic suggestion to be effective it was necessary at the time of making the suggestion also to suggest a specific posthypnotic amnesia for it. Although this is no longer regarded as essential, Orne (1966b) believes that posthyp- notic suggestions made with suggestions of amnesia tend to last longer. In any event, subjects carrying out posthypnotic suggestions without awareness of the source of their behavior tend to justify their seemingly odd conduct with rationalizations. Subjects aware of the cause of their behavior tend to experience a compulsion to carry out the suggested actions (Estabrooks, 1957; Orne,1966b).

Posthypnotic amnesia may be divided into source amnesia or content am- nesia. Source amnesia is commonly produced when a hypnotized subject is given some obscure bit of information that he would have been unlikely to be aware of prior to hypnosis. Following a suggestion for a general posthyp- notic amnesia, it is found that he is immediately aware of this information on waking but is unaware of its source. This reaction, like most other hypnotic alterations of memory, is similar to the normal waking characteristics of mem- ory. Most people retain factual information of the type learned in school in isolation from the context in which it was learned. Thus the average adult will be unable to tell the circumstances under whic** ''" '"arned the date of the discovery of America or the Pythagorean theorem, source amnesia can be a source of torment for an author who remembers an appropriate quo- tation but cannot remember who said it. Memory that includes the contextual situation surrounding the information recalled is referred to as redintegration. It usually is related to personal experiences rather than factual or theoretical data. Unlike content amnesia, source amnesia is not often suggested explicitly under hypnosis and usually occurs spontaneously (Kilhstrom, 1977; Nace Orne, and Hammer, 1974; Orne, 1966b; Thorne, 1969).

Evans (1979) found that source amnesia occurred in 31% and 33% 29 and 12 deeply hypnotized subjects, respectively, who displayed a total recall amnesia for all other events under hypnosis, but it did not occur in 15 simulating subjects. Hence he concluded that it resulted from a dissociative phenomenon rather than the demand characteristics of the hypnotic situation or subtle cues given concerning the expectations of the experimenter (who was blind as to the hypnotic or simulating status of the subject).

Like all other posthypnotic phenomena, a posthypnotic amnesia can last for a variable period of time following termination of hypnosis. In some sub- jects, this period can be quite lengthy. A posthypnotic suggestion that a sub- ject will not develop a posthypnotic amnesia or that one developed will ter- minate is usually effective in preventing any spontaneous amnesia. Besides being terminated suddenly by a posthypnotic release cue or the reinduction of hypnosis with suggestions that the subject will now be able to regain all memories from the previous hypnotic experience, hypnotic amnesia can be permitted to dissipate with the passage of time.

A 1949 ftim, Unconscious Motiuation, was designed to demonstrate the effect of ui ous ideation on behavior. A male and a female college stu- dent were given the suggestion under hypnosis that as children they had failed to return a pocketbook they had found containing two coins and had used the coins to buy candy. The subjects were given a suggestion of post- hypnotic amnesia for this fantasy, and it was found to produce an unpleasant affective state in them, although they were unable to assign a reason for their feelings. In spite of their lack of conscious awareness of this ideation, it af- fected their responses on TAT-like and Rorschach-like tests, as well as word association responses. The amnesia was broken down without a prearranged release signal by the kinds of associations used in psychotherapy. Often in- complete memories obtainable under conditions of posthypnotic amnesia can be used as a starting point for associations to break the amnesia, and some- times total recall can be obtained soon after the first breakthrough is attained.

Orne (1966b) believes that memories retained during a suggested post- hypnotic amnesia relate to events during relatively light periods of the trance. Thus, he believes that the effectiveness of a suggestion for posthypnotic am- nesia is determined not by the overall depth of the trance but by its depth immediately preceding the suggestion of amnesia. A subject's failure to re- spond to suggestions early in the trance may not interfere with the devel- opment of the suggested amnesia, provided that he is given suggestions that he can respond to just prior to the suggestion for amnesia. The converse is also true; failed suggestions just prior to suggesting amnesia may interfere with its being developed in spite of previous successful tests of trance depth. This was demonstrated by giving the Harvard Group Scale of Hypnotic Sus- ceptibility (HGSHS) to two groups of subjects. Test items were given to one group in ascending order of difficulty and to the other in descending order of difficulty.

Physiological Effects of Hypnosis Continued

The limited supply of blood in the body is normally differentially routed to the various viscera and skeletal muscles as needed by the action of the AND on the sphincter muscles of the arterioles. The vascularization of the skin is under the exclusive control of the sympathetic division of the ANS. To the extent that both divisions of the ANS are represented in the other regions of the body, they function as antagonists. The effect of the sympathetic system is to put blood into skeletal muscle, while the action of the parasympathetic system is to route it into the viscera.

Although there is conflict in the literature over the issue of whether neutral hypnosis produces any change in the peripheral distribution of blood, the evidence seems consistent that hypnotic suggestions can influence the distribution of blood to the skin and other structures. Many of the effects reported on skin temperature, galvanic skin response (GSR), mammary gland development, and the production and alleviation of skin eruptions are probably explainable in terms of alteration of blood flow to these areas (Barber, 1978c). Timney and Barber (1969) replicated earlier findings that subjects in neutral hypnosis developed a significant increase in oral temperature, while Jackson and Hastings (1981) found no significant difference in oral temperature between hypnotic and simulating subjects. In a second study, they found a marginally greater decrease in oral temperature in high-susceptibility female subjects. By imagining that their hands are in cold or hot water, subjects are able to produce temperature differences of up to 20°F between their two hands. Maslach, Marshall, and Zimbardo (1972) have found that while hypnotized subjects were able to change the skin temperature in their two hands in the opposite direction simultaneously, waking controls were unable to do so. Similar effects have been produced using biofeedback. Piedmont (1981) and Crosson (1980) confirmed that skin temperature is alterable by suggestion under hypnosis, and Raynaud and her colleagues (1984) found that neutral hypnosis did not affect rectal or skin temperature, but the suggestion of the sensation of heat decreased rectal temperature and raised mean skin temperature.

McDowell (1953) reported vasodilation in a subject's leg following suggestions of the leg being immersed in warm water, and Nallapa (1952) reported increasing circulation in a case of Buerger's disease (thromboangiitis obliterans) by hypnotic suggestion. Reiter (1956) reported that suggestions of increasing blood flow to the thyroid gland increased the basal metabolism rate (BMR) to 110, resulting in body weight being reduced to normal in an obese patient.

Hypnosis itself does not affect BMR, but emotions produced by hypnotic suggestions may increase or decrease it (Wallis, 1951; Whitehorn et al., 1932). Posthypnotic suggestions have induced body temperature elevation, but Kline (1957, 1958c) believes that direct suggestions are ineffective and that emotive or hallucinatory suggestions are needed. Contrary to Pavlov's theory that hypnosis involved vasoconstriction in the cerebrum, Nygard found no difference in cerebral circulation in waking or hypnotized subjects.

The GSR refers to the electrical resistance of the surface of the skin. Skin resistance is lowered by the activity of the sweat glands, which secrete an electrolyte onto the surface of the skin. Crasilneck and Hall (1959) report conflicting studies concerning the effects of neutral hypnosis and suggestions of anesthesia on GSR. Using six subjects, Barber and Coules (1959) found no change in skin resistance during induction and a gradual increase of resistance throughout the remainder of the experiment, which was punctuated by responses to individual suggestions. Since sweating is a response to stress produced by the sympathetic division of the ANS, it is likely that what happens is a function of an individual subject's reactions to suggestions. If the subject views the induction procedure as a relaxing event, he will probably respond with lowered sweat gland activity and a higher skin resistance. If he is apprehensive, either about the procedure in general or about some specific suggestion, he is likely to sweat more and thus have a lowered skin resistance. Often the subject's subjective feeling that he is about to go into an unusual state of consciousness may be enough to frighten him into producing a sudden change in GSR level.

A large variety of skin conditions appear to be affected by hypnotic suggestions. Congenital ichthyosiform erythroderma, a scalelike eruption, has been improved by hypnotic suggestion, and in some cases, results have been reported that were limited to the specific areas of the body to which suggestions were directed (Mason, 1952; Schneck, 1954). Large nevi and warts have been reported successfully treated by hypnotic suggestion (Asher, 1956; Fernandez, 1955; McDowell, 1949). Asher reported 15 out of 25 susceptible patients cured of warts. Barber (1978b) reported a rapid cure in 3 out of 11 patients, but an attempt to limit a cure to warts on only one hand by suggesting an alteration of the blood supply to the warts and "feeling them tingle and dry up" was unsuccessful. Both hands cleared up.

In 1941, Pattie reviewed the literature on blister formation. In a typical experiment of the time, blister development was attempted by telling a subject that he was being touched with a hot iron. Results were mainly negative, and, since many of the cases reported were poorly documented or controlled, there is conflict in the reports. The issue of whether a blister can be produced is still unresolved, but the weight of the evidence is negative. On occasion, erythema or a welt may be produced in a susceptible subject, and these may have been reported as blisters in some studies.

Johnson and Barber (1976) were unable to produce a blister in 40 subjects, although two developed a localized inflammation. One of these reactions was attributed to self-injury, a problem that Pattie noted in this type of research. Evidently some good subjects are so anxious to produce the effect the hypnotist seeks, they will actually injure themselves to produce it. The researcher must be able to observe subjects constantly or make the skin area in question inaccessible to them from the time of the suggestion until the time of observation of effects. Spanos, McNeil, and Stam (1982) age regressed 17 previously burned subjects to the time of their injuries and suggested that a blister was forming. None showed evidence of blister formation or even skin discoloration, but one did develop an elevated skin temperature at the site of the injury compared to the contralateral site. Barber reports that cold sores can be produced in susceptible subjects by suggestion, and probably even without hypnosis. Ikemi and Nakagawa (1962), using high school students in Japan who were sensitive to a poisonous plant (similar to poison ivy), had both hypnotized and control subjects touch this plant. Both groups were told that it was not the plant they were allergic to. The vast majority of both groups developed no dermatitis. The study was then reversed; both hypnotized and control subjects were instructed to touch a nonpoisonous plant they were told was poisonous. All subjects in both groups developed a dermatitis from slight to marked. Thus, psychological factors have been demonstrated to affect the course of allergic reactions both with and without hypnosis.

A number of studies suggest that breast size may be increased by hypnotic suggestion. Williams (1974), employing controls for weight gain, phase of the menstrual cycle, and measurement position, reported an average increase of 2 inches in bust size in 13 subjects after 12 weekly treatments involving suggestions of warmth, blood flow, tingling, and so on. Home practice sessions were also employed. Willard (1977) replicated this experiment and reported an average gain of 1.5 inches in nine sessions. Staib and Logan (1977) found these gains were retained after 7 months. Erickson (1977b) reported successful hypnotic breast development in a clinical setting.

Respiration rate can be changed by direct or indirect emotion-producing suggestions (Crasilneck and Hall, 1959). Hypnosis per se probably lowers the respiration rate. Reiter (1956) reports that suggestions of pain, anxiety, and grief increase both the depth and frequency of respiration.

Arterial oxygen level is increased by the induction of a pleasant emotion under hypnosis and decreased by the induction of an unpleasant one (Lovett, 1953a, 1953b). Hypnosis per se decreased the waking levels of oxygen saturation. The blood glucose level is closely related to the level of arousal and can be varied by hypnotic suggestion (Barber, 1961b). Olness and Conroy (1985) found that nine out of eleven children between the ages of seven and seventeen were able to increase tissue oxygen in response to taped suggestions. Eight children were experienced in self-hypnosis; three were not. Of the children successful in this task, only one had no previous self-hypnosis training; two children without this training were unable to increase their tissue oxygen.

Hypnosis has often been reported as a treatment for an asthmatic attack (Franklin, 1957; Solovey and Milechnin, 1957; Van Pelt, 1953). Thome and Fisher (1978) found that high- and medium-susceptibility subjects who were given hypnotic suggestions of experiencing an asthmatic attack were convinced that they had experienced one, though physiological measures failed to "'veal a typical asthmatic pattern. Low-susceptibility subjects were unconvinced of the effect.

In a book published in 1953, the same year that Aserinsky and Kleitman published their paper on rapid eye movements (REMs) in sleeping infants that was to revolutionize concepts concerning the stages of sleep and dream research, Weitzenhoffer concluded that hypnosis resembled a stage of light sleep more than either deep sleep or the waking state. In an early article, Barber (1956a) came to the same conclusion. More recent evidence indicates that EEG records obtained during hypnosis are about the same as are obtained in the waking state or in stage 1 sleep (the lightest stage). The EEG record in stage 1 sleep is identical to a waking EEG record except for the appearance of periodic REMs, which is why this stage is sometimes referred to as paradoxical sleep.

No change in a preexisting alpha level is noted on induction (Dynes, 1947). On the other hand, alpha waves were inhibited in nine out of eleven subjects who were given suggestions for visual hallucinations while under deep hypnosis with their eyes closed. Such disruption in an alpha pattern would normally be produced by a subject either thinking or opening his eyes and permitting a visual pattern to stimulate his occipital cortex.

In addition to being capable of producing deep relaxation of the voluntary muscles, hypnosis may be capable of increasing the capability of muscle. Weitzenhoffer (1951) concluded that hypnotic transcendence of voluntary muscular capability is a valid phenomenon. Mead and Roush (1949) noted a significant increase in strength during hypnosis when measured by an arm dynamometer but not when measured with a hand dynamometer. Watkins (1949) suggests that this enhanced muscular ability may be due to the anesthetic effect of hypnosis on pain and fatigue.

Barber and Calverley (1964e), using 60 female volunteers, found that strength of grip was not increased by hypnotic suggestion or by task-motivational instructions. On the other hand, hypnosis per se depressed weight-holding endurance, but task-motivational instructions, with or without a preceding hypnotic induction, increased endurance. In a review of the literature on the subject in 1966, Barber concluded that hypnosis by itself does not increase either strength or endurance, but motivational instructions increase both—with or without hypnosis. Albert and Williams (1975) examined the effects of posthypnotic suggestions on physical endurance. Endurance was found to be lowered with posthypnotic suggestions of fatigue but not increased with facilitating instructions. Nonhypnotized control subjects were not affected by either suggestion. The Borge ratings of perceived exertion indicated that the subjects subjectively perceived the effects suggested subjects, and a control group. When tested posthypnotically, high-susceptibility subjects given motivating suggestions under hypnosis and subjects given waking motivating suggestions performed equally well and better than control subjects. Low-susceptibility subjects given motivational suggestions under hypnosis and subjects exposed to neutral hypnosis did not improve their performance.

Performance on a pursuit rotor task was significantly improved equally by posthypnotic or waking suggestions (Pearson, 1982). Abramson and Heron (1950) found a significant reduction in labor time with hypnotic analgesia during childbirth, suggesting that hypnosis may produce a more effective contraction of the uterine muscles, a more effective cervical dilation, or both.

Neutral hypnosis depresses gastric secretion, while emotion-producing suggestions under hypnosis may alter it in either direction (Crasilneck and Hall, 1959). Suggestions of eating a delicious meal increased gastric acidity and secretion in 34 of 36 subjects. Barber (1965d) makes the point that in most of the studies investigating the physiological effects of hypnosis or hypnotic suggestions, no evaluation was made of the relative effects of the specific suggestions, the positive motivation on the part of the subjects, general suggestions of relaxation, or defining the situation as hypnosis. In cases where these parameters are investigated, he asserts, it is usually found that direct, indirect, or even waking suggestions are effective.

Physiological Effects of Hypnosis

A number of common effects of hypnotic induction were described under the rubric of signs of hypnosis. If conventional methods of Induction, utilizing suggestions of relaxation and sleep are used, these effects commonly include slight to profound muscular relaxation, with consequent alterations in facial expression and posture, eye closure, and lack of spon­taneous movement or speech. Other usual concomitants of the hypnotic state Include a literalness and specificity in the understanding of suggestions (mak ing it imperative that the operator carefully phrase suggestions) and in some cases the development of rapport, a condition in which the subject ignores all suggestions except those made by the operator. It is tempting to describe reactions that result from the induction of the hypnotic state per se, or so-called neutral hypnosis, as general responses to distinguish them from those made only in response to specific instructions. This, however, would be mis leading; these reactions, like any other obtained under hypnosis, are most likely made in response to suggestions. In the case of these general responses, the suggestions are being made explicitly or implicitly in the sug gestions used for trance induction. If an individual subject interprets the hypnotist's exhortation to "respond only to the sound of my voice" as meaning the institution of a state of rapport, he will develop one; if not, he will not.

Thus, although the present author agrees with Edmonston (1977b) that re laxation is a common concomitant of hypnosis, he disagrees with his thesis that it is the equivalent of neutral hypnosis. It results simply because of the usual way in which hypnosis is induced—by suggestions of drowsiness and relaxation—and is not essential to hypnosis, as demonstrated by the work of Gibbons (1974, 1976, 1979). The equating of relaxation and neutral hyp nosis is another common misconception and was the reason that Swartz (l982), in a review of the first edition of this book, took exception to the author's statement that, by itself, hypnosis is neither helpful nor harmful, since he (as the author), believes relaxation is valuable in tension-related conditions.

In this section we consider what physiological reactions can bemodified by suggestions, direct or indirect. Responses involving the autonomic nervous system (ANS) are of special interest since such responses are normally not under voluntary control and hence cannot be produced directly. However they can probably be altered by the mediating action of thoughts, ideation, or goal-directed fantasies.

Crasilneck and Hall (1959), Gorton (1949a, 1949b), and Barber (1961) 1965) have reviewed the literature on the physiological effects of hypnosis This literature is often in conflict because of the absence of adequate controls, especially in the earlier studies. Thus several studies have reported a decrease in heart rate in neutral hypnosis, while others have reported a rise. Probably both effects occur. Heart deceleration may result from the relaxation instruc-tions used to induce hypnosis and heart acceleration from the idiosyncratic reactions of subjects to the subjective feelings aroused by trance-induction procedures. If the subject is frightened by the prospect of hypnosis, may increase. Gorton (1949a, 1949b) reports that except for a slight low. due to relaxation, cardiac activity is about the same for subjects under hypnosis as it is when they are awake. Cardiac rate is much lower during sleep than in either hypnosis or waking.

Bauer and McCanne (1980b) found no significant differences in decrease in heart rate, alpha activity, skin conductivity, or respiratory rate between six hypnotized female subjects and six female simulators.

Barber (1961b, 1965d) reports that hypnotized and waking subjects can increase or decrease their heart rate in response to specific suggestions to do so, but hypnosis does not enhance this effect. It is not possible to determine whether direct suggestions to vary the heart rate are effective without the help of mediating ideation because it is not possible to control what the subject is thinking. Since the autonomic nervous system (ANS) is not under direct voluntary control, if heart rate is to be controlled by a subject, it probably must be done indirectly by an emotional response to ideation produced gestions. Barber also points out that alterations in respiration rate, which can be made voluntarily, can affect heart rate. However, it is difficult to distinguish the direct effects of suggestions, if any, from the emotional concomitants of mediating ideation, goal-directed fantasies, or simply relaxation.

Barber cites a study by Van Pelt in which the latter appeals to have pro-duced cardiac acceleration in a calm subject while controlling for the level of adrenaline in the blood. Raginsky (1959) produced a cardiac block for a brief period by hypnotic suggestion. He also produced extra systoles in labile jects (Raginsky, 1953). Linton and colleagues (1977) found no evidence concordance of heart rate between subject and hypnotist based on empathy as some have suggested, but found some concordance during induction. Morgan and coworkers (1976) reported that suggestions of heavy work produced no alteration in cardiac rate in either hypnotized or waking subjects, but they were effective in producing an increase in ventilation. Barber found that in neutral hypnosis, muscle tension, measured by electromyograph (EMG), was significantly lower, but pulse rate was unchanged. Hilgard and colleagues (1974) reported a significant difference in heart rate following sug-gestions of analgesia that was unrelated to the amount of subjective pain reduction but no significant rise in heart rate with hypnotically hallucinated Electrocardiogram changes have been reported following emotion-producing suggestions (Bennett and Scott, 1949; Berman, Simonson, and Heron, 1954) Blood pressure is affected by both cardiac rate and the peripheral resis-tance in the arterioles produced by the activity of sphincter muscles under control of the ANS. As in the case of heart rate, neutral hypnosis usually neither raises nor lowers blood pressure, but the relaxation effect may reduce the systolic pressure slightly, and any apprehensions that the subject has may raise it. On the other hand, suggestions can produce marked changes of up to 40 millimeters of mercury systolic pressure and 20 millimeters of mercury effect on the systolic pressure, and suggestions of temperature change primarily affect the diastolic pressure. Suggestions of warmth lower the diastolic pressure, and suggestions of cold raise it. Holroyd, Nuechterlein, and Shapiro 982) found that hypnosis reduced systolic blood pressure when bio-feedback did not, but biofeedback was superior to hypnosis in reducing forehead muscle tension. These effects were independent of subjects' hypnotic susceptibility.

A large number of clinical reports are cited by Crasilneck and Hall (1959) to the effect that bleeding can be increased or decreased by hypnotic sug-gestion, although they report a failure to demonstrate such a relationship experimentally. Some clinical sources describe reduction in bleeding as a concomitant of hypnoanesthesia even in the absence of specific suggestions to this effect. Arons believes that only capillary bleeding can be controlled hypnotically because veins have no sphincter muscles. A research difficulty results from the fact that venous, and certainly arterial, bleeding requires immeditate control, so anything less than immediate and total control over them produced by hypnosis is not likely to be experimentally measurable.

Misconceptions Concerning Hypnosis(continued)

Misconception 4: Hypnosis is an unusual, abnormal, or artificial condition.

With a little thought, readers will be able to think of dozens of examples of spontaneously induced mental states that are highly similar or identical to a hypnotic trance. The common experience of daydreaming while commut ing to work or becoming completely absorbed in a book to the exclusion of everything else going on around you are common examples. There is a con dition called highway hypnosis, which is produced by a driver staring straight ahead on a monotonously straight road, possibly with the added influence of windshield wipers in steady operation. This phenomenon is probably responsible for an unknown number of highway accidents each year. Good human engineering of highways requires taking this phenomenon into account by providing enough turns in a road to break up the monotony of travel. A straight line may be the shortest distance between two points, but It Is not always the best roadway design. Other common examples of spon taneously induced trance states may be found in a person's staring at a television set or reading a book without noticing what he is watching or reading. Most members of a movie audience exhibit many of the characteristics of people in a hypnotic state.

Misconception 5: Hypnosis is a form of sleep.

There are several reasons for this common misconception. First, the word hypnosis Itself is a misnomer (Goldstein, 1982). It derives from Hypnus, the name of the Greek god of sleep. Second, the lack of facial expression and spontaneous movement coupled with slumping of the head or body fre quently seen in hypnotized people is suggestive of sleep. Last, many methods of induction make use of exhortations directing the subject to sleep. Indeed, it is possible to bore a subject to the point where he will actually fall into a real state of sleep instead of hypnosis.

In spite of the superficial similarity between a hypnotic trance and normal sleep, the two states are quite different (Evans, 1977, 1982). During stage 1 sleep (the phase in which vivid visual dreams are most common), the skel etal musculature is effectively paralyzed, and, thus, reflexes like the knee jerk are diminished. However, under hypnosis, there is no paralysis (unless sug gested), and there is no diminution of the basic reflexes or muscle tone.

Electroencephalograph (EEG) patterns are often said to be different for the hypnotic state and for sleep, but during stage 1 sleep, the EEG pattern is similar to the normal waking state except for the presence of rapid eye movements (REMs). Hence, stage 1 sleep is called arousal or paradoxical sleep. In stage 2, sleep spindles appear on the EEG record. Delta waves begin to appear in stage 3, becoming over 50% of the record by the deeper stage 4. None of these events occurs under hypnosis, where the EEG record is consistently similar to the waking state.

Misconception 6: The subject is under the control of the hypnotist and can be made to do things that he ordinarily would not do or to reveal secrets.

This misconception makes it difficult for some subjects to permit them-selves to be hypnotized because they fear loss of control. It is also the subject of much controversy and will be dealt with in more detail later. The weight of the evidence seems to support the notion that if a subject is directly re quested to do something that is objectionable to him, he will simply refuse to do it or in some cases "awaken" from the trance. On the other hand, It may be possible to get a subject to perform an act he would not normally do by deceiving him into believing a situation is different than it actually is. For example, he may be told that a person that he is being asked to attack It about to harm him.

All subjects should be informed prior to an induction that they will be In complete control; and if the hypnotist suggests anything that offends them, they will be free not to follow the suggestion. Such an instruction will allay the fears of the subject and will also serve to protect the hypnotist from charges of misconduct or of exercising undue influence over the subject. There is no legitimate reason in therapy why a subject would ever be asked to do some-thing repugnant to him. Indeed, one of the great advantages of a passive therapist is that he or she permits a patient to limit the production of anxiety-producing material to what the patient feels he can currently tolerate. This is a built-in safety valve. If the therapist is to make the decision about how much anxiety a patient can handle, he or she had better be an extremely good prognosticator or there is a risk of driving the patient out of therapy.

Although a hypnotist does not have complete control over a subject (and, in fact, if he or she did, hypnosis would be a dangerous procedure at best), the hypnotic state creates an atmosphere where suggestions, if ac ceptable to the subject, are more influential than they would be if the subject were not hypnotized. However, it must be kept in mind that people do in­fluence the behavior of other people with words, whether their listeners are hypnotized or not. Although hypnosis does not produce a zombie-like de pendence on a hypnotist, words can be potent and have the power to cure or harm, whether the recipient is hypnotized or awake. The danger lies not in the hypnotic state but in the use made of it. If any method of psycho therapy has the potential to help a patient, it must necessarily also have the power to harm him if not competently handled.

As an example of the misuse of a valid psychological technique, the prac- tice of a certain industrial plant that utilized a psychological screening test to select its employees may be cited. An applicant had to have a certain personality profile on this instrument before being hired. The net result of this selection process was the hiring of an undue number of neurotic employees and the failure to hire many potentially productive people. The reason for this regrettable state of affairs was not that this particular test or psychological tests in general are not useful. In fact, it was a very good test; for if it caused the selection of neurotic candidates, it could just as readily have been used to exclude them. The real difficulty in this case was caused by the incom petent use of a valid test by an untrained personnel manager. The same is true in the case of many examples cited to show the dangers of hypnosis, which are really examples of the danger of its incompetent use.

Misconceptions Concerning Hypnosis

Misconception 1: Hypnosis is a condition induced in the subject by the hypnotist.

This erroneous idea is the natural result of our use of English. We collo quially refer to hypnotizing subjects, and books are written and courses are given to train therapists and others "to hypnotize" subjects. Actually all hyp nosis is self-hypnosis in the sense that any effect produced, including the trance state itself, is produced by the concentration and imagination of the subject, not the operator. The real role of the hypnotist is to guide and teach the subject how to think and what to do to produce the desired result. The operator no more imposes this state on a subject than a teacher learns the content of a course for a student. Both teacher and hypnotist can only fa cilitate the efforts of the student or subject.

Once a trance state is induced, the hypnotist may seem to utilize it for whatever result is sought, but even in the area of trance utilization, whatever phenomena occur do so because of the imagination of the subject, not the operator. For this reason the term trance capacity is preferable to the more common term hypnotic susceptibility to refer to the likelihood of a given sub ject's achieving a given trance depth. The latter term implies that the subject is having the state imposed on him, while the former recognizes that the capacity to achieve a given trance level is an ability of the subject, not the operator.

This is not to imply that the hypnotist is not important or does not have to be highly skilled. Self-hypnosis is extremely difficult to achieve without help and training from an external hypnotist in the beginning. Even with experi ence in self-hypnosis, it is always easier to achieve and utilize the trance state with the help of an external operator.

Inexperienced subjects should always be advised that they, not the hyp notist, are responsible for producing whatever results are obtained. This will have the effect of taking the onus of any difficulty in induction away from the operator and preventing the subject from losing the confidence in the hypnotist's ability that is so essential to a successful induction. Also, it is the truth. Some feel it undermines the probability of success in the induction if the hypnotist uses such equivocal language as "We will try to hypnotize I you," or "We will see how deep a state you can attain." They believe that the hypnotist should always speak as though the induction is certain to be successful. If the responsibility for the success of the induction is placed fully on the subject, such unprofessional assurances of success are unnecessary. It is possible to reflect confidence in the subject's success by both word and manner without adopting the unwarranted behavior of a charlatan.

Misconception 2: A hypnotist must be a dynamic, forceful, or charismatic person.

Since the subject and not the hypnotist is ultimately responsible for the induction of the trance state, it follows that the abilities of the subject and his motivation for hypnosis are more important than the personality of the hyp notist—unless this personality is such that it is incompatible with the needs or expectations of the subject. Different subjects require different types of hypnotists or different techniques. Some subjects can respond successfully to a wide range of hypnotists; others may require a specific type of approach to be successful. Certainly if the hypnotist is personable and has a good rap-port with the subject, it is a positive factor. On the other hand, some out standing hypnotists are not very good speakers and often have poor diction or marked accents. These characteristics evidently do not interfere with their success.

Kroger (1977b) makes the point that hypnosis is a "prestige" type of phe nomenon and that it is the belief in the imminence of hypnosis that produces it. Hence, it is an advantage to a hypnotist to be known to the subject as an authority in the field or to have a title like "Doctor," for this will enhance the subject's expectations of success. For this reason, psychotherapists who use hypnosis frequently in their practice would do well to have their diplomas and degrees on exhibition in their office or waiting room.

Misconception 3: Hypnosis involves a battle of wills with the hypnotist, who needs a stronger will than the subject.

This is a common misconception of many subjects that probably came from watching old Bela Lugosi movies. Unless it is dispelled, it can make the induction of hypnosis difficult or impossible since the subject will see it is an admission of inferiority. If a subject comes to the therapist's office with the attitude that he is chal lenging the latter to be able to hypnotize him, he must be informed that there is no contest and if he chooses to resist hypnosis he will, of course, be suc cessful. He must be made to understand that the hypnotic state can be pro duced only with his active cooperation and help. Incidentally, it is possible to achieve a hypnotic state without the subject's being aware that he is being hypnotized. This can be done simply by avoiding the use of the words hypnosis or sleep in the induction procedure, or by saying that what the hypnotist is trying to do is get him to relax deeply. On the surface, this may seem as if the operator is unethically hypnotizing a sub ject without his consent, but bear in mind that no effect will occur unless the subject is willing to produce it. Such a procedure may be justified in the case of a patient who could profit from hypnosis but who cannot get over his fear of being hypnotized because of some unfounded ideas he has about it. A good question to ask at this point is whether there is any real difference be tween a deep state of relaxation as produced by the Jacobson method (see p. 66) and hypnosis? In other words, what is being suggested is that hypnosis often occurs in therapy when even the therapist does not consciously intend to produce it. In any event, this issue deals more with names than with reality. Not only is the ability to be hypnotized not a sign of a weak will, gullibility, or stupidity, but it in fact requires a good degree of intelligence in order to be able to concentrate and to think in the unfamiliar manner that the operator requests. Generally the author has found that bright people make good sub jects, and it is a good idea to so inform subjects prior to induction attempts.

Hypnosis and Legislative Problems

The arguments that Stage Hypnosis is dangerous are for the most part based on atypical and anecdotal reports, such as the case Kline cited of a woman who sustained a serious burn to her hand because of the incomplete removal of suggested of anesthesia made by a Stage Hypnotist. The bulk of the evidence appears to indicate that Stage hypnosis, even in incompetent hands, is no more dangerous than experimental hypnosis because of the episodic character of the session and the fact that neither the subject nor the hypnotist expects to produce permanent changes in the subject's behavior.

The argument that Stage hypnosis can be humiliating to the subject or in bad taste is a more interesting one but would be difficult to resolve. The problem is in deciding whose standards of good taste to adopt. The argument that hypnosis is a medical device is neither true nor relevant. First, if hypnosis were to be looked upon as a device, it would clearly be a psychological and not a medical one. Second, it is neither a device nor the exclusive property of any professional group but is, in fact, a naturally occurring phenomenon. If it were a medical device, it would make no sense to restrict its nonmedical uses to physicians anymore than it would to prevent an auto mechanic from listening to a noisy engine with a stethoscope to localize the noise. Stage hypnosis is neither a medical nor a psychological use of hypnosis.

There are three major reasons why legislation restricting the practice of stage hypnosis should not be enacted. First, there is no need for such legislation to protect subjects. If a stage hypnotist did something either to harm or embarrass a subject, he or she would presently be fully liable in tort for these actions. Merely consenting to be a subject in such a performance in no way waives the participants rights against the hypnotist for any injury sustained, and if a demonstration subject (or an experimental subject for that matter) were induced to sign a release of all claims prior to the procedure, such a document would be without legal effect in most jurisdictions.

A more important reason for opposing this type of legislation is that hypnosis involves nothing more than a hypnotist talking to a subject. Legislation restricting the freedom of one person to talk to another seems to be a dangerous violation of the freedom of speech assurances of the Constitution. If the government can restrict the freedom of one citizen to talk to another, to protect the latter from some undefined danger of hypnosis, it is a simple step to take similar action to protect him from the dangers intrinsic in unpopular political ideas. For this reason alone, legislation to limit stage hypnosis should be opposed, even if it could be shown to have substantial capacity to harm a subject.

A third reason for reluctance to support antistage hypnosis legislation is of particular concern to psychologists. Kline (1976) believes that hypnosis can be defined clearly enough to enable legislation concerning ------Psychologists need to be particularly cautious in supporting legislation restricting the practice of hypnosis. Often medical lobbyists have used such legislation as a means of downgrading psychologists. For example, although some states, such as California, have statutes defining the practice of psychology and specifically listing hypnosis as included within it, other states, such as Florida, have a hypnosis law that reduces a psychologist to the level of a hypnotechnician and authorizes only physicians, dentists, and a variety of other unqualified practitioners, to practice hypnosis without medical supervision. In effect, such a law requires a psychologist with over six years of graduate training to be supervised in the practice of his or her profession by a layperson who may have no training at all in either psychiatry or hypnosis.--------In addition, the proper method for using hypnosis with a particular patient must take into account the underlying dynamics of his personality. There is no doubt that many lay hypnotists are extremely skillful in inducing hypnosis, and some have taught this technique to professional people. There is no reason why they should not do so; but it is a very different thing to be able to induce a hypnotic state, which can be learned in a few minutes, and to use it to help a patient, which takes many years of training.

--------Although the author believes that stage hypnosis is a proper activity, he does not believe that the practice of hypnosis by hypnotechnician is. Professionals should decline to refer patients to such individuals for treatment. This view may seem to contradict the view that stage hypnosis should not be outlawed because it involves the issue of freedom of speech. Hence, this matter needs clarification. After all, the practice of psychotherapy also is nothing more than two people talking to each other. It is the authorÕs belief that freedom must necessarily include the right to do something that others may consider ill advised or even stupid If a person wants to be treated psychologically (or medically for that matter) by an untrained layperson, he should have the right to do so, and this treatment should not be made illegal. What should be illegal is not the conducting of therapy by a layperson to charge a fee for practicing psychotherapy; this restraint would effectively prevent him or her from making a living by practicing psychology and at the same time preserve the rights of the patient.

Hypnotic Susceptibility

Hypnotic susceptibility or trance capacity refers to the ability of a subject to achieve a given level of hypnotic trance. This in turn makes two assumptions:

1. There is such a phenomenon as a trance state.

2. This state can be meaningfully measured along a depth scale from shallow (hypnoidal) to deep (somnambulistic).

With respect to the first issue, Sutcliffe (1961) has oriented theoretical views about the nature of hypnosis on a scale ranging from "credulous" to "skeptical." At the credulous end of the scale are the "hypnotic state" theorists, who regard a trance state as a phenomenon that enhances the suggestibility of a hypnotized subject. At the skeptical end of the scale are theorists like Barber, who take the view that a hypnotic state is neither a necessary nor sufficient condition to produce the classic effects of hypnosis, or Gibbons, who refers to the notion of a trance state as a "shared delusion."

Barber points out that well-motivated subjects who have not been hypnotized can produce all of these phenomena, while some subjects in a deep trance cannot.

Implicit in the idea of measuring hypnotic susceptibility is the notion that it is a stable personality characteristic as opposed to a situational variable. If susceptibility is, in fact, a stable characteristic of a person, questions arise about what factors cause some people to develop a markedly greater capacity for hypnosis than others and how readily this capacity can be modified.

Does repeated experience with hypnosis improve a subject's ability to achieve a deeper state, in the sense of being able to do things under hypnosis that he formerly was incapable of achieving?

In order to be hypnotized a subject not only has to have the trance capacity, but must also want to be hypnotized and must actively cooperate in the process. It is conceivable that a person with a lot of ability as a hypnotic subject may be afraid of being hypnotized, react negatively to the hypnotist, or be suffering from some physical or mental distraction at the time of an original attempt at hypnosis. The subject will thus appear to be a poor subject.

If after repeated hypnotic sessions these fears abate, the subject's rapport with the hypnotist improves, or his motivation to be hypnotized increases, he may achieve a much deeper trance. This result may give the illusion that the practice has improved the subject's basic trance capacity when in fact it has not. It is clear that the best subject cannot be hypnotized unless he wants to be.

Thus, tests of hypnotic susceptibility are valid only when the tester is certain that the subject is will motivated and doing his best.

To avoid semantic confusion the term hypnotic susceptibility or trance capacity will be used when referring to the stable or long-term ability of a subject to be hypnotized, and the term hypnotizability will denote the net effect of susceptibility plus any operative situational factors affecting the hypnotic ability of a subject at a given time.

Unfortunately, this distinction is not generally made in the literature, and usually the terms susceptibility and hypnotizability are used interchangeably, resulting in a great deal of confusion in research dealing with the issue of whether susceptibility is modifiable.

It is a common experience that subject exposed to repeated hypnotic sessions tend to enter the trance state more rapidly on successive sessions and often appear to develop greater depth. It is for this reason a good idea not to give up therapeutic efforts on what may seem like a poor subject without at least a few trials. (Fortunately many therapeutic applications do not require a very deep trance.)

Hypnotic Induction Profile (HIP)

The Hypnotic Induction Profile (HIP) was developed by Herbert Spiegal for clinical use. Like any clinical instrument, it is designed to be individually administered. The main advantage claimed for it is its speed of administration. It expresses Hypnotic susceptibility on a 5-point scale and requires only about 5 minutes to administer. Like all of the foregoing instruments, this one is based on the induction of a Hypnotic state, but the induction procedure never uses the word hypnosis, trance or sleep, and in this sense it is an indirect procedure that might be useful with a patient fearful of being hypnotized

Scoring criteria are based on the amount of roll produced in a subject requested to roll his eyes upward and then slowly close his lids, arm levitation, posthypnotic response, amnesia, and subjective reports. Although the test manual does not give either reliability or validity data, or clear scoring instructions, this information is published elsewhere by Spiegal (1977)

While the reliability coefficient reported by Spiegel seems too low to make this instrument a measure of choice in experimental work, it may be adequate of susceptibility is more important than obtaining an accurate or the most sensitive measure possible

Standard hypnotic Arm Levitation Induction and Test  (SHALIT)

Like the HIP, the SHALIT is a brief test designed for clinical usage. It scores the amount coefficient of 0.88, and it correlates 0.63 with a 10-item abbreviation of the SHSS form A. Thus, it is probably a useful scale for clinical work although not sensitive enough for experimental usage because it is limited to a single factor measurement (an ideomotor task)

Barber Suggestibility Scale (BSS)

Unlike any of the foregoing instruments, the Barber Suggestibility Scale does not depend on the induction of a hypnotic state under standardized conditions. It does not purport to be a test of hypnotic susceptibility but of suggestibility, the ability of a subject to produce hypnotic-like behavior whether or not previously subjected to a hypnotic induction procedure. In order to understand the need for this scale and why it was developed, it is necessary to describe BarberÕs theoretical orientation toward hypnosis.

Barber believes that the concept of a hypnotic state is not useful in the study of hypnotic phenomena. He advocates (as did Hull before him) that psychologists should study what precedent conditions (independent variables) are necessary and sufficient to produce responses ( dependent variables), such as catalepsy, analgesia, hallucinations, and so on, that are normally labeled hypnotic behavior. For example, he notes that in most hypnotic induction procedures, at least four specific kinds of independent variables are confounded under the label hypnotic induction:

  1. The situation is defined to the subject as hypnosis
  2. Suggestions of drowsiness, eye closure, and sleep are made
  3. The subject is told that it will be easy to respond to suggestions
  4. The subject is motivated to make the suggested responses

Barber has investigated the effect of each of these factors individually in producing the kinds of behavior commonly labeled as hypnotic. Barber calls instructions including items 3 and 4 only task motivational; he finds that by themselves they are just as effective as hypnotic induction in eliciting hypnotic like behavior on the BSS. Because of his theoretical and methodological orientation, Barber and his students like to put quotes around the terms hypnosis and hypnotic, leading some of his critics to conclude, unjustifiably, that his position denies the existence of hypnotic phenomena. This criticism is inaccurate; his position is not that the phenomena are not real but that the hypnotic state is not a useful explanatory concept to account for them.

Since Barbers theory holds that hypnotic phenomena are produced by some antecedent events that should be isolated, it follows that a test of hypnotic-like behavior-one that does not depend on the prior induction of a hypnotic state-is needed to test these factors. Hence, the BSS can be used to elicit hypnotic-like responses either with or without a prior induction procedure.

As a result of his research, Barber reports that in addition to task-motivational instructions, the tone of the operator’s voice and the subjects attitudes and motives (due to pretest instructions and what the subject is told regarding the purpose of the study) affect results on the test. Variables that do not seem to affect suggestibility measures are whether the subject’s eyes are open or closed, whether instructions are given personally or by tape recording, and the personality of the subject as measured by most standardized test instruments.

The types of items on the BSS are similar to those given on standardized tests of susceptibility; the main difference is that the instructions make no mention of hypnosis. Items tested include the following:

  1. Arm Lowering
  2. Arm Levitation
  3. Hand Lock
  4. Hallucination of thirst
  5. Verbal inhibition
  6. Body immobility
  7. Posthypnotic-like response
  8. Selective amnesia

Following the test and the objective scoring, the subject is asked if he really felt the effect suggested or just went along to please the examiner. The subject is given a subjective score of 1 for each item that he says he really experienced. Thus, subjects get both objectives and subjective scores on this scale, each having a maximum value of 8 (Barber and Wilson, 1978-1979).

Hypnosis in Sports

A major part of an athleteÕs performance is a function of his mental state, which can be profoundly influenced by suggestions, both hypnotic and waking. One of the major functions of the sympathetic division of the autonomic nervous system (ANS) is the mobilization of bodily resources for emergency situations for emergency situations, enabling the organism to fight or flee more efficiently when angry or frightened. Increases of up to 33% in strength or endurance can be produced by the emotions of anger or fear. Hence, hypnotic or self-hypnotic suggestions are often used to psych up athletes prior to a performance. In addition to its use in mobilizing appropriate emotional responses, hypnosis is valuable in providing relaxation and increased self-confidence. This is particularly important in athletic activation that requires highly developed skills and concentration such as golf or archery. Kroger (1977b) improves the confidence of golfers in their putting ability by suggesting to them that the hole is the size of a sewer. Training in self-hypnosis is a valuable adjunct to the use of hypnosis in sports, and it renders hypnotic aid available to the athlete whenever needed. Heavyweight boxer Ken Norton habitually used self-hypnosis to prepare himself psychologically for a fight.

Callen ( 1983 ) had 423 long-distance runners complete a questionnaire concerning their thoughts and events commonly occurring during hypnosis

Fifty-four percent of respondents reported subjective feelings of being in an altered state of consciousness, which they produced by such methods as rhythmical breathing, repeating a phrase, counting, imagining music, or imagery. Fifty-nine percent claimed to be more creative while running, and 58% engaged in imagery, often to improve their time or distance. Callen suggests the large population of runners is a valuable resource for the study of spontaneous self-hypnotic phenomena.

Simek and Brien (1981) used hypnosis to develop the mental state required for optimal performance in members of a collegiate fencing team and in a professional boxer. One fencer was given the effective suggestion that every opponent with whom she fenced would remind her of a rival for her boyfriend. Relaxation instructions were given to the boxer to deal with his anxiety, which was causing him to freeze up in the first round. These instructions were followed with suggestions that his opponent was responsible for all of his problems, to marshal anger.

Professional sports are major industries with large amounts of money dependent on successful team performances. Hence, organizations like major league baseball teams have not been hesitant to employ staff psychologists to deal with players personal problems that may interfere with their job performance or to use hypnosis in the securing of peak performance from players.

Although hypnosis may be an aid in optimizing an athletes performance, it cannot create an ability that he does not have. A fighter may be made more aggressive by hypnosis suggestion but, if he cannot box well, hypnosis may result in his being hurt more than if he retained his more cautious boxing style. One major league pitcher who had problems with wild pitches and loss of control was aided by hypnosis in getting the ball over the plate more regularly, only to have the number of hits against him dramatically increase.

The use of hypnosis in sports, both professional and amateur, gives rise to ethical questions as to whether the practice should be prohibited. It is theoretically possible to use pain-reducing suggestions to improve the performance of a runner or even to permit an athlete with an unhealed injury to play, in a manner analogous to drugging a racehorse that has an injured leg. There is a distinction of course, between a racehorse and a human professional athlete who is able to understand the risks involved and provide an informed consent to the procedure. On the other hand, a high school or even a college athlete is often not mature enough to resist the pressure produced by feelings of duty to his teammates or school. He may thus be subjected to undue influence to consent to such an ill-advised procedure. The author regards the employment of hypnosis by psychologist in such a case as both a violation of professional ethics and malpractice.

Hypnosis Defined

Hypnosis is popularly understood to be a psychological condition in which an individual may be induced to exhibit apparent changes in behavior or thought patterns-in particular an increase in suggestibility and subjective feelings of relaxation. The procedure by which this is achieved is called hypnotism

Intense debates surround the topic of hypnosis Many scientists dispute its very existence, while many therapists insist upon its value. One of the problems that creates controversy is the wide variety of theories of hypnosis. The definitions of hypnosis are as varied as the definers. Dr William S. Kroger states:

Like the nature of human behavior, there will be different theories about hypnosis since all hypnotic phenomena have their counterpart in the various aspects of human behavior (1977)

The applications of hypnosis vary widely. Currently, two distinct applications of hypnosis include its use in entertainment and in health applications and in health applications. The popular perception of the hypnotic experience is that of the entertainment version. The stage hypnotist uses a variety of methods to relax and focus the subject eventually making it appear to the audience that the subject is asleep or, popularly termed, in trance. During the performance, the subjects seem to obey the commands of the hypnotist to engage in behaviors they might not normally choose to perform.

On the other hand, hypnosis applications in the medical ion, and health-related fields are often experienced very differently. Clinical hypnosis is used in attempts to increase the ability to recall memories, assist with dieting, smoking cessation, pain reduction or elimination, eliminating irritable bowl syndrome (IBS) as well as resolving mental disorders such as post traumatic stress disorder( PTSD), anxiety and depression ion

Hypnosis Defined By The American Psychological Association

In 1933, the American Psychological Association defined hypnosis as “a procedure which a health professional or researcher suggests that a client, patient, or experimental participant experiences changes in sensations, perceptions, thoughts, or behavior”

This definition was revised and expanded March 2005. It begins, ÒHypnosis typically involves an introduction to the procedure during which the subject is told that suggestions for imaginative experiences will experience will be presented”

Hypnosis Defined In Physiological Terms: Alpha and Theta State-based Definitions

Through data collected via electroencephalography (EEGs), four major brain wave –patterns-frequency of electrical impulses firing from the brain-have been identified. The Beta state (alert/working) is defined as 14-32 cycles per second (CPS), the Alpha state (relaxed/reflecting) falls in the 7-14 CPS range, the Theta state (drowsy) from 4-7 CPS,

And Delta state (sleeping/dreaming/deep sleep) is defined as approximately 3-5 CPS.

One physiological definition of hypnosis states that the brainwave level necessary to work on issues such as stopping smoking, weight management, reduction of phobias, sports improvement, etc, is the alpha state. The alpha state is commonly associated with closing oneÕs eyes, relaxation, and daydreaming.

Another physiological definition states that the theta state is required for therapeutic change. The theta state is associated with hypnosis for surgery, hynoanesthesia andhypnoanalgesia, which occur more readily in the theta and delta states. It should be noted that hypnoanalesia of the skin is a common test for somnambulism. Arm and body catalepsy are one of a few tests done to determine readiness for these surgical applications.

However, it is important to reflect upon the fact that both arm and body catalepsy can be induced in non-hypnotized subjects. Indeed, arm catalepsy is a standard stage-hypnotist test of susceptibility. Moreover, normal, non-hypnotized subjects can be found in any of these states of cortical arousal without also displaying any of the behavior, traits or the enhanced suggestibility associated with being hypnotized

Dave Elman Definition Of Hypnosis

He defines hypnosis as “a state of mind in which the critical faculty of the human mind is bypassed, and selective thinking established.” The critical faculty of your mind is that part which passes judgment. It distinguishes between concepts of hot and cold, sweet and sour, large and small, dark and light. If we can bypass this critical faculty in such a way that you no longer distinguish between hot and cold, sweet and sour, we can substitute selective thinking for conventional judgment making

Michael Yapko defines hypnosis: hypnosis is a process of influential communication in which the clinician elicits and guides the inner associations of the client in order to establish or strengthen therapeutic associations in the context of a collaborative and mutually responsive goal-oriented relationship”

Stage Application Of Hypnosis

Stage hypnosis is where a hypnotist chooses volunteers from the audience, puts the volunteers into a trance using hypnosis, and then has them perform certain silly, funny, or supposedly “amazing” suggestions. This could be like having the volunteers believe they are: drunk: aliens speaking a strange alien language and having another volunteer translate the language; naked or seeing others naked; 6-year-old children; ballet dancers-and the list goes on. All suggestions are temporary and usually only last during the show. When performed correctly, stage hypnosis is basically having fun with the subconscious is basically having fun with the subconscious mind without any serious detrimental side effects. It’s all performed for entertainment and with the welfare of the volunteers in mind. Stage hypnosis can be the most entertaining field because it involves “ real” people from the audience responding in a variety of ways which usually makes no two shows the same.

Hypnosis and Creativity

Creativity, like intelligence, is regarded positively on our culture but probably is much rarer. Whether the comparative rarity of creativity is due to the fact that it is not reinforced in our mass-production educational system, where it can be a source of problems for teachers, is a question that remains to be answered.

There is little, if any, well-controlled research concerning the effects of hypnosis on creativity because of the immature state of the art with respect to studies on creative behavior.

In theory, hypnosis would not be expected to improve creative behavior unless there were some psychological factors at work that prevented the full expression of a subject's creative abilities that could be removed by hypnotic suggestion.

An example of this type of factor can be seen in the theoretical foundation for a method of group problem solving called brainstorming. A common difficulty in problem solving is that many problems require the skills and knowledge of more than one person for solution.

To extrapolate from brainstorming, if creative ability is being inhibited by fear of ridicule or criticism, then hypnosis may be able to increase creativity under these circumstances. Sanders (1976) discusses factors believed to facilitate or inhibit creative behavior and reports results that suggest group hypnosis may be effective in improving the ability of subjects to solve real-life problems more creatively.

Gur and Reyher (1976) report that hypnotized subjects performed significantly better than simulators and waking controls on figural and overall creativity scores of the Torrance Test of Creativity and McDonald (1985) found hypnosis did not generally improve creative performance as measured by the T.T.o.C. but not on verbal creativity. Although these results can hardly be taken as an indication that hypnosis is incapable of modifying scores on that instrument since no specific suggestions of better performance seem to have been made.

In addition to removing factors that inhibit creative expression, hypnosis may be useful in encouraging the imagery and imagination that are often involved in creative thinking. Gur and Reyher (1976) suggest that the psychoanalytic concept of "regression in the service of the ego" may be an appropriate description of how hypnosis may aid creativity. In other words, a per is regressed to permit a more promitive type of pictoral imagery in thinking, which my be better for solving some problems creatively than the usual adult patter of verbal thought.

Simon (1977) and Khatami (1978) speculate on the role of altered states of consciousness in the genesis of creative thinking and compare this type of thought process with conventional logical thinking.

Since persons with a good imagination and the ability to generate imagery are typically good hypnotic subjects, it would appear likely that future research may disclose a relationship between hypnotic susceptibility and creativity. This is also suggested by Patricia Bower's (1978) work, in which she found that highly creative people and good hypnotic subjects report their creative behavior or hypnotic responses as occurring effortlessly.

She thus investigated the possibility that the capacity for "effortless experiencing" might be a common denominator between creativity and hypnosis. She found a high degree of correlation between susceptibility and both effortless experiencing and creative abilities.

Hypnosis

What is hypnosis? ---It is movement of brain wave states; I say movement because at any point in time an individual can be drifting through multiple brain wave patterns.

These patterns can be measured as a frequency response and can be measure by an EEG machine.

These frequency responses are described as Beta, Alpha, Theta and Delta. The state of hypnosis is typically related to the Theta brain wave response. However in my opinion theta shows constant vacillation with other brain wave states.

In simplified terms these brain wave states can be measured on a graph. The amplitude or height of the response is indicative of how are mind is functiong. Beta brain waves show a very active mind and therefore they spike the highest on a graph. This the brain wave state that would describe daily activity

Alpha state is slightly meditative; almost a feeling of melancholy if anybody is in to yoga it is the feeling you get right at the end of the class when you take shabasa. You’re not asleep but just floating on that cusp.

We then come to Theta, which is the highly responsive part of the brain that is associated with hypnosis

This state of hypnosis shows less amplitude on our graph due to the fact that the conscious mind is in a state of hibernation. The sub conscious is still hyperactive and very open to suggestion. The conscious mind although in hibernation still knows what is going on but is quite happy to kick back and observe ---If conflict occurs with its personal values it will quickly revert to an active conscious state.

Do not

Although as simple as these sounds this is the best way to think about hypnosis. Far to many people intellectualize the state of hypnosis and subsequently prevent them from experiencing it.

Delta describes a deep deep state of relaxation—This is the brain wave state where we heal and recuperate, where we charge our engines for the following day. It is often difficult to get an individual to awaken from this state. The conscious mind will step in, but it does not like to----It is self-preservation, it knows that it needs deep rest. Do not ignore this restorative state or you will end up physically and emotionally exhausted

As a hypnotist I remove the way of communicating between Beta and Theta. The way we access hypnosis is to travel through alpha- It is the bridge to the hypnotic state. With your permission you allow me to guide you across this bridge –In essence my voice becomes the bridge that carries you to the highly receptive hypnotic state

Although all hypnosis is self-hypnosis autohypnosis for most is still difficult. The need to have a therapist or facilitator takes away the thought process allows for a more successful experience.

Understanding basic brain wave patterns gives a better handle of what hypnosis is. An incredible self-development tool that can have a profound effect on every aspect of our life. Keep hypnosis simple stupid and sit back and reap the rewards.

If you need further information on the subject do not hesitate to call me at 1(760)635-7785 or go to my web page at www.barryjones.com

Hypnoanesthesia

Hypnosis is not used as often as an anesthetic agent as it is to control nonsurgical pain. On at least two occasions, the author was unable to find a local obstetrician who employed hypnosis in deliveries for pregnant women desiring such a referral (both of whom were excellent hypnotic subjects).

Probably the principal reason for this state of affairs has been the development of reasonably safe, rapidly effective chemical changes. It has been estimated that only 25% of the population are capable of developing a sufficient degree of hypnoanesthesia for its use as the sole anesthetic in relatively minor procedures, such as fracture settings, tooth extractions, the changing of burn dressings, or the removal of sutures in frightened children.

Other reasons advanced for reluctance to use hypnoanesthesia include: the amount of time, training, and skill required for a hypnotic induction; the fact that hypnosis may be contraindicted in patients with psychological problems such as psychotics, borderlines, or depressives; and the fact that hypnosis is regarded as Òquasi-scientificÓ in some professional circles

With respect to the contraindication of hypnosis and hypnoanesthia in patients with certain psychological disorders, some clarification is required. There is no absolute contraindication for hypnosis in any patient. Some patients may present a higher risk of developing adverse reactions such as spontaneous regression and aberrations, that are undesirable in a nonpsychotherapy context, and control of these require some skill on the part of the hypnotist. Hence, with these patients, hypnoanesthesia requires a hypnotist who is well trained in psychotherapy. It should not be attempted by a physician who lacks such training. It is unfortunate that physicians in general and anesthesiologists in particular, do not receive more training in psychodynamic concepts and hypnosis, for it is usually convenient to have a psychologist induce hypnoanesthia except in an emergency situation.

If initial hypnotic inductions are performed are performed in a leisurely, unhurried atmosphere and the patient is given the opportunity to develop an anesthesia and experience it tested successfully, his confidence in the adequacy of the procedure will be greater. Patients should be trained to enter a trance state either on a posthypnotic signal or by self-induction to save time in the operating room and render them independent of the presence of the particular hypnotist who trained them.

A patient so trained may be able to have a successful hypnotic delivery under the care of another obstetrician should the one who trained her in hypnosis be available at her delivery. Also, the ability to reenter hypnosis rapidly on a signal is a valuable safeguard should a patient inadvertently awaken during surgery. This contingency is quite unlikely, particularly if the hypnotist instructs the patient not to awaken until directed to and if he or she continues a steady flow of trance maintaining chatter throughout the operation. Preliminary trials of hypnosis may be presented to patients with reservations about the procedure as exercises in relaxation to prevent their fears from producing reactions that may lead to false impressions of their abilities as subjects.

The value of hypnosis may also extend to the prenatal period------It not possible to do successful hypnoanesthia, or for that matter any other hypnotic procedure, unless the therapist takes the time necessary to establish a proper rapport with the patient and the latter develops confidence in the hypnotists ability and concern for his welfare In addition to its use as an anesthetic, hypnosis can be a valuable pre-operative and postoperative adjunct to the care of surgical patients.

J. Barber and Mallin (1977) advocate the use of hypnosis during the fitting of contact lenses and emphasize the careful choice of words in the framing of suggestions. Words that denote the same thing may vary widely in their connotations and implications and thus may not be equally effective in framing suggestions.

Hypnosis - Hallucinations Continued

Barber (1964e) concluded that the research failed to demonstrate that hypnosis produces auditory or visual hallucinations that are the same as per ceptions or different from imagination. Erickson (1938a; 1938b), on the other hand, took the position that often hallucinations are quite real and reported that suggestions of negative auditory hallucinations, or deafness, could not be distinguished from organic deafness by ordinary means. His subjects dis played no startle response to an unexpected loud sound, failed to raise their voices in speaking when background noise was increased, or failed to blush to auditory stimuli that would normally produce such a response in a particular subject. He also found that a conditioned finger withdrawal response to an auditory-conditioned stimulus disappeared during hypnotically suggested deafness and reappeared after the hypnosis. Black and Wigan (Barber, 1964c) found a similar result with an autonomic nervous system response not under conscious control as a finger flexion is. Pattie (1935) reported the failure to produce uniocular blindness in a small group of subjects as disclosed by ster eoscopes, filter, and Flees box tests. To reconcile these conflicting views, it will be necessary to sample a number of lines of research.

Barber and Calverley (1964;) report that suggestions of deafness were ef fective in 15 hypnotized and 15 nonhypnotized subjects. However, if these subjects were subjected to delayed auditory feedback where the sound of their own voices was delayed slightly, they reacted as do typical subjects with normal hearing by stuttering, mispronouncing words, increasing vocal inten sity, and talking more slowly.

Barber (1964c) reports that in hypnotically suggested deafness in one ear, subjects who display positive results still report hearing a beat note if stimu lated with slightly different frequencies in each ear. Weitzenhoffer criticized this study on the grounds that the frequency applied to the "deaf" ear could have reached the other by bone conduction, but it is interesting to note that the one subject who did not experience the beat note was a physics major presumably familiar with the phenomenon of beat notes. In a study providing results analogous to the common finding that hypnotic pain control has little effect on physiological measures correlated with pain, Sabourin, Brisson, and Deschambault (1980) found that hypnotically in duced deafness did not influence a conditioned heart rate response or the response time in a key-pressing task to an auditory stimulus in subjects re porting a positive subjective effect.

Spanos, Jones, and Malfara (1982) found that high-susceptibility subjects reported greater deafness than low-susceptibility subjects in response to suggestions of unilateral deafness but did not differ objectively in impairment from the latter as measured by responses to words presented in dichotic pairs. Crawford, MacDonald, and Hilgard (1979) found that reduction in hearing in response to hypnotic suggestion correlated 0.59 with hypnotic suscepti bility but the "hidden observer" technique (see p. 116) disclosed that covert hearing was at least 20% greater than reported overtly by the subjects. Subjects who are instructed to hallucinate a background (which normally produces an optical illusion effect) over a figure do experience such an illusion but not as strongly as they would with a real picture of the background added and no more than nonhypnotized subjects instructed to imagine the back ground (Barber, 1964e). Miller, Hennessy, and Leibowitz (1973) found that if such an illusion-producing background was negatively hallucinated away, the Ponzo illusion did not disappear. Hypnotic subjects capable of negatively hallucinating portions of visual stimuli showed varying degrees of ability to attenuate the Tatchner-Ebbin-ghaus circles illusion posthypnotically (Blum, Nash, Jansen, and Barbour, 1981). Miller and Leibowitz (1976) found that a hypnotically produced re-striction of the visual field produced behavior no different from that obtained from a group of simulators. Similar results were reported by Leibowitz, Lundy, and Guez (1980). Leibowitz, Post, Rodemer, Wadlington, and Lundy (1980) found that the amount of visual field narrowing occurring in response to in-structions to simulate such narrowing was a function of the method of mea surement, with direct measurement by perimetry yielding the most effect. Dorcus (1937) found no pupillary reflex in response to suggestions of light intensity change. He also found that the postrotational eye movement (nystagmus) produced in four subjects after hypnotic suggestions that the subject was rotating in a chair were voluntary and not the same as the eye movement produced by the same subjects when actually rotated. Also, falling responses following rotation suggestions did not appear unless the subjects had prior experience actually being rotated, and when produced under these circum stances, they were in the wrong direction for the rotation direction suggested.

Wallace (1980) reports that perceived autokinetic movement of a hyp notically hallucinated light was a function of hypnotic susceptibility as mea sured by the HGSHS. Since the subjects were all psychology students, it is not possible to confirm the present author's opinion that performance was also a function of the subject's knowledge of psychology. The suggestion of a hallucinated light in a dark room is an indirect suggestion to produce au- J tokinetic motion to a knowledgeable subject. Erickson (1939b), using very deeply hypnotized subjects, produced some degree of color blindness as measured by the Ishihara plates. Barber and Deeley (1961) report producing color-blind responses in nonhypnotized sub jects by instructing them to "concentrate away from red and green." Cunningham and Blum (1982) and Harvey and Sipprelle (1978) found significant differences between the subjective experience reported by subjects success fully experiencing hypnotically suggested color blindness and the behavior of people with congenital defects in color vision.

Some subjects who are instructed to hallucinate colors either under hyp-nosis or task-motivational instructions report the occurrence of negative af-terimages. Barber (1964c, 1959b) suggests that such reports do not occur in subjects who are naive concerning the phenomena of negative color after-images, but if they do occur, the afterimage colors reported are those com monly described in elementary psychology texts—that is, the complementary color of the one hallucinated (e.g., red-green, blue-yellow) instead of the somewhat different (more pastel) colors usually reported in actual negative afterimages. Similarly, if an actual color was shown and the subject was told it was different, the actual color, not the hallucinated one, determined the nature of the afterimage (Barber, 1964d).

In view of the foregoing studies, the question arises about which view point, Barber's or Erickson's, is correct concerning the reality or validity of positive and negative hypnotic hallucinations. In the view of the author, both are correct. Erickson is right that these are real experiences; Barber is right that hallucinations are different from ordinary sensations. Hypnotic blindness or deafness is not the same as organic blindness or deafness any more than hysterical blindness or deafness is. Of course, negative afterimages do not occur in subjects not familiar with this phenomenon. How could they? A negative afterimage produced by a real external stimulus is a retinal phenomenon produced by the differential fatigue of different visual receptors. A hallucinated color does not result from retinal activity but from suggestions reaching the cerebral cortex. Sensations or physiological responses in sense organs are not modified in hypnotic hallucinations; perceptions or higher-level mental processes are.

An afterimage produced to a hallucinated color is as much a suggested effect as the color Itself. It is an excellent example of an indirect suggestion. This does not mean that it is not experienced. The real question asked when we inquire about the reality of a hypnotically Induced hallucination is, How vivid is it, or How similarly does the subject experience it to a real external stimulus? This is an unanswerable question. Trying to render the question answerable by equating "real" with similarity to a sensory experience in a physiological sense only introduces confusion. In spite of their rather divergent views, the work of Barber (1958d) and Erickson (1944) seems to support the general conclusion that subjects given hypnotic suggestions of deafness or blindness for a particular person or object behave as though they are trying to avoid perceiving that person or object. Subjects try to avoid focusing or looking at the subject of the negative hal lucination or report perceiving it vaguely. A similar result is reported by Hil-gard and colleagues for negative hallucinations of pain in that a subjectable to ignore the suffering aspects of pain will still report experiencing the sen sations in some manner if he is instructed that there is a hidden observer who can report these sensations (Hilgard, Morgan, MacDonald, 1975).

Barber claims that to get a subject not to experience the object of a negative hallu cination, it is necessary to convince him of the objective truth of the exper imenter's statement that the object is no longer present. Thus, if a subject is told that a chair is no longer present, he will try to look away from it but will not bump into it if it is directly in his path of travel. If, on the other hand, noises are made simulating the removal of the chair while the subject's eyes are shut, he will act as though he really does not see it at some level and will walk directly into it. Erickson reported a similar effect when a subject acted at though he really did not see one negatively hallucinated person but did show some signs of perceiving another for whom the suggestions were made more recently. He ascribed this difference in reactions, in accordance with his characteristic view that a very deep trance is required for this effect, to the fact that it takes time for the suggestions to become fully effective.

Although it seems clear that a positive hallucination of a complex sense modality like vision originates in the cortex, not in a sense organ, some of the easier-to-elicit tactile hallucinations may, partially at least, involve paying attention to a certain amount of dermal stimulation normally present and customarily ignored.

Hypnosis - Hallucinations

A hallucination is defined as a perception in the absence of a real external stimulus. Usually the occurrence of a hallucination is a symptom of a psychotic disorder, but under certain circumstances, normal people may hallucinate. These situations include conditions of sensory deprivation, extreme hunger or thirst, fever, drugs, REM sleep (nocturnal dreams), and, in some cases, scrying (crystal ball gazing). Normal people may also hallucinate under the influence of suggestions, hypnotic or otherwise.

Psychotic hallucinations in general have both a characteristic sensory mo dality and a characteristic content that vary between diagnostic categories. For example, schizophrenic hallucinations are predominantly auditory and have a characteristic obscene or self-critical content. Most psychotic hallucinations are accompanied by a delusional belief in their objective reality that is often absent in the hallucinations of normal people. This phenomenon is not intrinsically unreasonable, for psychotic hallucinations tend to be consis tent with past experience. For example, a hallucinated image will usually ob scure parts of real images lying in back of it in the visual field, and it will cast a reflection in a mirror. All of his life the patient has been correct in believing the information his sense organs have communicated to him about the ex­ternal world, and there is no reason why he should not believe in the ver-idicality of these images when they are hallucinated.

In the case of the hypnotically suggested hallucination, the modality and the contect of the hallucination are functions of the suggestions made. Hallucinations can be suggested in any sense modality; the ones most commonly used are vision, audition, olfaction, gustation, touch, heat, and cold. : hallucinations may be suggested in specific modalities or it may produce multimodality effects. For example, the hallucinated fly in the Stanford test (SHSS:A) may produce visual, auditory, fects. In addition to positive hallucinations, negative hal-the subject fails to perceive some real external stimulus, ted. These are analogous, if not identical, to the everyday >erson is looking directly at an object that he is searching :e it. Those portions of the external environment that are lotic suggestions are generally perceived accurately if not (Orne, 1962d).

Hallucinations in general are difficult to elicit under hypnosis, and there is ilty between the various sensory modalities. Tactile hallucinations are comparatively easy to produce. Suggesting to a group of nons that they should notice that their noses are beginning to in effect in many of them. So will reading a paragraph iing that might be used in making such a suggestion. The rises of olfaction and gustation are also more amenable to ! more highly developed senses of audition and vision.

Orne (1962d) points out that when a visual hallucination is suggested In a subject he may react in a variety of ways. He may act as though he sees 1 what has been suggested or seem disturbed because he does not experience it. In the former case, if he is questioned after the experience, he may say that (1) he saw nothing but felt compelled to act as if he did; (2) he expeFrienced a visual image but knew it was unreal; (3) he experienced a real external image but it had illogical aspects to it (e.g., he could see a chair j through a hallucinated person); or (4) he experienced an image indistinguish able from reality. Thus Orne categorized the subject's subjective experience into one of four categories. He considers only the last two as true halluci nations. In actuality, there is probably an infinite series of gradations of subject responses, and individual investigators differ in what they define as a positive | response to a suggested hallucination.

Another point needs to be made: there is no way for an experimenter to observe the subject's hallucination directly. Hence he or she must rely on the subject's verbal report of his or her experiences. Thus it is possible, and in deed probable, that one subject who experiences a hallucination more vividly than another may report it as less vivid because of individual differences in the use of language and subjective standards of what the term vivid means. This is the same problem experienced by dream researchers who purport to be studying dreams but are actually studying verbal reports of dreams. The only hallucinations that an investigator can observe directly are his or her own, and these are necessarily individual and atypical. The question about the relative subjective experiences of two different subjects reporting their own hallucinations, no matter how similar or different their verbal descriptions, is as unanswerable by observation as is the question of whether two subjects describing the same stimulus as blue are having the same or radically different subjective experiences.

Such questions are philosophical, not scientific, ones. Although the degree of the apparent reality of a hallucination can only be estimated by a verbal report, Orne (1962d) attempts to distinguish effects that are actually experienced from those that are simulated by subjects motivated to produce what the experimenter wants them to by the use of stimulating subjects. These are subjects who have not been hypnotized but have been instructed to act as if they have been and to attempt to deceive the experi menter making the behavioral observations (who is not told which subjects are actually hypnotized). Simulators are usually informed that if the experi menter discovers that they are simulating, he or she will halt the procedure; hence, its continuation lets the simulator know he is successful in efforts at deception. The logic behind the use of simulating subjects is that both hyp notized subjects and simulators are equally motivated to produce the sug gested behavior, but if only the hypnotic subjects actually experience the ef fects suggested, their behavior may be different to some degree from that of the subjects who are faking an effect. The lack of knowledge on the part of the experimenter of the real or simulating status of a subject eliminates experimenter bias and prevents any unconscious systematic differential treatment of the two types of subjects.

There are behavioral differences between real subjects and simulators. If a subject is told to hallucinate the experimenter sitting in a chair and is then told to turn around and look at where the experimenter really is, he will often appear surprised and report seeing him twice. He may not know which image is real. (Some subjects will distinguish the real from the hallucinated image by having the hallucinated one raise his hand.) Simulating subjects will usually deny seeing the experimenter when looking at him because they believe they are not supposed to.

If a negative hallucination is suggested so that the subject is told he can no longer see a chair and then is asked to walk in a direct line with the chair, hypnotized subjects will avoid bumping into the chair, while simulators will Usually walk into it. Spanos, Churchill, and McPeake (1976) found that a cooperative attitude toward hypnosis and involvement in everyday fantasy were each positively correlated with the ability of a subject to experience visual and auditory hal lucinations. Visual hallucinations were more difficult to produce than auditory hallucinations, but they found that the abilities to produce these two types of hallucinations were correlated. They reported no sex difference in the ability to hallucinate. A large majority of their subjects reported their experiences as Imagined rather than seen or heard. Ham and Spanos (1974) report that with 60 male and female subjects equally assigned to hypnotic and task-motivational groups, the task-moti vated subjects performed better in response to suggestions of visual or au-ditory hallucination. Spanos, Mullens, and Rivers (1979) in a 2 x 3 factorial study compared hypnotic and task-motivated subjects in performance of vis ual and auditory hallucinations in response to brief suggestions, long sug gestions, and suggestions providing an imaginary context. Task-motivated subjects performed better than hypnotic subjects on auditory hallucinations, I and the authors report a "trend toward significance" in this direction on visual hallucinations. Both long and image-involving suggestions were equally more effective than short suggestions for auditory hallucinations but were not sig nificantly different for visual hallucinations.

Hypnosis and ESP

There are a number of articles discussing a purported relationship betweenhypnosis and ESP phenomena thai are cited here because they raise issues that require comment (Eisenberg, 1978, Fourie. 1981; Nash, 1982: Sargent, 1978; Shaposhnikov. 19S2). The author is not unprejudiced concerning the ESP literature- He tends to have a mechanistic view of the world and psychological phenomena. Thus, when someone talks about clairvoyance (communication from inanimate ob- jects to people), telepathy (communication between people via non-sensory means) or psychokineiics (the influence of thoughts on inanimate objects), he would ask what is the medium of communication and upon what receptor it acts. This is not !Q soi-1 iha: research in ESP canr'.o; be v-i-'l: designed and scientifically valid Such research is respectable and II should be conducted, bui it seems thai if there were any basis for ihe belief that ESP phenomena are real, then the amount of such rf^tirrli conducted since ihe 1920'- ought to have produced more coni.lnciny evidence than is currently available as well as some reasonable theory ot the mechanisms involved. Tests of statistical significance can never establish that a difference between an experimental and control group is not due to chance, only that the prob- ability of it being so is at some given level Tims, if there is only one chance in 100 that this difference occurred by chance, and the null hypothesis is rejecied cil the 0.01 level, ihii particular result may still be due to chance. If enuugli le-iiiaich is done, such spuriously significant reiuli-i '-'.'ili occur.

Most [ournals are reluctant 10 publish nonsignificant findings unless they contradict previously published results (although it is |ust as much an incre- ment oi knowledge to learn lhal an Independent variable does no; produce an effect as it is to learn thai it does). Thus. mosi rese^rrh r tested at the 0.05 level of significance to make ii easier to gel il publi^li^d It therefore follows that fully 5% of the psychological and other scientific literature is Spu- rious, reporting as real results lhal are actually due to chance.

Such spurious results are usually noi repiicable, but many journals will not publisli replicaiion studies, ihereby preventing the necessary verification of results. To evaluate whether a particular experimental result found to be si9- nificant is in fact real, it would be helpful to know how many times this ex- periment was run without finding significance. This information is not gen- erally available.

If a researcher proposes a view that is intrinsically reasonable, it is generally accepted in scientific circles that he or she has the burden of establishing this view by a certain amount of evidence. If the view advocated is contrary to all prior human experience and intrinsically unreasonable, then its propo- nents ought to have an even greater burden of proof imposed on them.

There may be a certain amount of heuristic value in much ESP research. For example, the author would be inclined to attribute Sargent's (1978) find- ing that a hypnosis group performed better than a waking control group in a clairvoyance task with ESP cards either to a greater sensitivity on the part of hypnotic subjects to subtle, unintended cues (which are not apparent in the report of the study) or to hypnotic relaxation and concentration facilitating the subjects "playing bridge" or counting the cards correctly guessed.

The problem with ESP research involving hypnosis is basically a public relations one. Most people regard ESP phenomena as having a supernatural basis, with the ordinary laws of the universe not applying. Hypnosis has suf- fered much in the past from its association with magic, mysticism, and the like, and even today many professional people have misgivings about its sci- entific validity because of these past associations. Hence, claims that hypnosis can enhance ESP abilities, like some extravagant claims for its clinical effec- tiveness, are likely to make many professionals leery of its use in situations where it may be quite appropriate and helpful.