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The BasicsA Brief History of Hypnosis Health Applications of Hypnosis Recommended Reading
What is Hypnosis? Hypnosis is a social interaction in which one person responds to suggestions given by another person (the hypnotist) for imaginative experiences involving changes in perception, memory, and the voluntary control of action. Click on the picture at the right to see an enlarged photograph of Svengali hypnotizes Trilby, from Georges Du Maurier's Trilby (1894).
Can Anyone be Hypnotized? There are large individual differences in response to hypnosis. Hypnosis has little to do with the hypnotist's technique, and very much to do with the individual's capacity, or talent, for experiencing hypnosis. Most people are at least moderately hypnotizable. However, while relatively few people absolutely cannot be hypnotized, by the same token, relatively few people fall within the highest level of responsiveness (so-called hypnotic virtuosos).
There is some controversy over whether hypnotizability can be modified. Some clinical practitioners believe that virtually everyone can be hypnotized, if only the hypnotist takes the right approach. However, there is little evidence favoring this point of view. Similarly, some researchers believe that developing positive attitudes, motivations, and expectancies concerning hypnosis can enhance hypnotizability. However, there is also evidence that such interventions may only affect behavioral compliance with suggestions, not the subjective experiences that lie at the core of hypnosis. As with any other skilled performance, hypnosis is probably a matter of both aptitude and attitude: negative attitudes, motivations, and expectancies can interfere with performance, but positive ones are not by themselves sufficient to create hypnotic virtuosity.
How is Hypnotizability Measured? Hypnotizability is measured by standardized psychological tests such as the Stanford Hypnotic Susceptibility Scale or the Harvard Group Scale of Hypnotic Susceptibility (click on to the figure to see an enlarged view). These instruments are work-samples that are similar to other performance tests. Hypnotizability, so measured, yields a roughly normal (i.e., bell-shaped) distribution of scores.
What Happens During Hypnosis? A typical hypnosis session begins with an induction procedure in which the person is asked to focus his or her eyes on a fixation point, relax, and concentrate on the voice of the hypnotist. Although suggestions for relaxation are generally part of the hypnotic induction procedure, people can respond positively to hypnotic suggestions while engaged in vigorous physical activity. The hypnotist then gives suggestions for further relaxation, focused attention, and eye closure. After the person’s eyes are closed, further suggestions for various imaginative experiences are given. For example, individuals might be asked to extend their arms and imagine a heavy object pushing their hands and arms down or to hear a voice asking questions over a loudspeaker. Or, the hypnotist might suggest that when they open their eyes, they would not be able to see some object that has been placed in front of them. Posthypnotic suggestions may also be given for responses to occur after hypnosis has been terminated, including posthypnotic amnesia, the inability to remember events and experiences that took place during hypnosis. Response to each of these suggestions is scored in terms of objective behavioral criteria – did the arm drop a specified distance over a period of time, did the person answer questions realistically, did the person deny seeing the object, etc.?
Does the Ability to be Hypnotized Vary with Age? Cross-sectional studies of different age groups show a developmental curve, with very young children relatively unresponsive to hypnosis. Hypnotizability reaches a peak at about the onset of adolescence but then scores generally drop off among middle-aged and elderly individuals. Longitudinal studies indicate that hypnotizability assessed in college students remains about as stable as IQ over a period of 25 years.
Can I Hypnotize Myself? The role of individual differences makes it clear that, in an important sense, all hypnosis is self-hypnosis. The hypnotist does not hypnotize the individual. Rather, the hypnotist serves as a sort of coach or tutor whose job is to help the person become hypnotized. While it takes considerable training and expertise to use hypnosis appropriately in clinical practice, it takes very little skill to be a hypnotist. Beyond the hypnotist's ability to develop rapport with the person, the most important factor determining hypnotic response is the hypnotizability of the individual.
Is the Ability to be Hypnotized Related to Personality? Hypnotizability is not substantially related to other individual differences in ability or personality, such as intelligence or adjustment. Interestingly, it does not appear to be related to individual differences in conformity, persuasibility, or response to other forms of social influence. However, research has found that hypnotizability is related to an individual’s disposition to have hypnosis-like experiences outside of formal hypnotic settings. Similarly, an extensive interview study by Josephine Hilgard showed that hypnotizable individuals tend to display a high level of imaginative involvement in domains such as reading and drama.
In 1974, Auke Tellegen and Gilbert Atkinson developed a scale of absorption to measure the tendency to have subjective experiences characterized by the full engagement of attention (narrowed or expanded), and blurred boundaries between self and object. Absorption is the most reliable personality correlate of hypnotizability. By contrast, vividness of mental imagery is essentially unrelated to hypnosis. So far as the measurement of hypnotizability itself is concerned, there is no substitute for performance-based measures such as the Stanford and Harvard scales.
What Happens to the Brain during Hypnosis? Researchers have been interested in biological correlates of hypnotizability as well as in those that can be measured by paper-and-pencil tests. Although hypnosis is commonly induced with suggestions for relaxation and even sleep, brain activity in hypnosis more closely resembles that of a person who is awake. The discovery of hemispheric specialization, with the left hemisphere geared to analytic and the right hemisphere to nonanalytic tasks, led to the speculation that hypnotic response is somehow influenced by right-hemisphere activity. Studies employing both behavioral and electrophysiological mechanisms have been interpreted as indicating increased activation of the right hemisphere of the brain among highly hypnotizable individuals, but positive results have proved difficult to replicate and interpretation of these findings remains controversial.
Hypnosis is influenced by verbal suggestions, which must be interpreted by the individual in the course of responding. Therefore, the role of the left hemisphere of the brain should not be minimized. One proposal is that hypnotizable individuals show greater flexibility in using the left and right hemispheres in a task-appropriate manner, especially when they are actually hypnotized. Because involuntariness is so central to the experience of hypnosis, it has also been suggested that the frontal lobes (which organize intentional action) may play a special role. A better understanding of the neural substrates of hypnosis awaits studies of neurological patients with focalized brain lesions, as well as brain-imaging studies (e.g., PET, fMRI) of normal individuals.
How do People Become Hypnotists and Who is Reputable? Anyone can hypnotize, because the talent for hypnosis lies in the person being hypnotized. The most practiced hypnotist of all time was a professional radio announcer who recorded the Harvard Group Scale of Hypnotic Susceptibility, which has been used in laboratories and clinics worldwide since 1962. However, that person had no special training in hypnosis, and he never personally hypnotized anyone in his life. All that was required was that he possess a pleasant voice and the ability to read a script with expression.
With respect to clinical hypnosis, it is most important is that the practitioner be qualified to treat the problem at hand without the use of hypnosis. A professional who has the appropriate training to treat a particular disorder is in the best position to decide, with the patient, whether hypnosis is the most appropriate and promising approach.
There are several organizations that purport to "certify" hypnotists, and many individuals advertise themselves as "hypnotherapists" in the Yellow Pages, however, the most important credential is a diploma from an accredited university and state licensure as a physician, dentist, clinical psychologist, clinical social worker, etc. Hypnosis is not a profession. Rather, it is a technique that professionals employ as appropriate.
While anyone can be a hypnotist, it takes a great deal of skill and training to use hypnosis appropriately and effectively in clinical practice. Many professional schools offer courses in clinical applications of hypnosis, but many, if not most, professionals receive hypnosis training in postgraduate continuing education. In the United States, two societies offer specialized training in hypnosis to professionals with appropriate credentials: the Society for Clinical and Experimental Hypnosis (SCEH) and the American Society for Clinical Hypnosis (ASCH). Neither organization certifies professional hypnotists.
Many other countries have national organizations that are affiliated with the International Society of Hypnosis. Outside the United States, among the most active societies are the Australian Society of Hypnosis and the British Society for Experimental and Clinical Hypnosis. If you are considering hypnosis as a treatment for a problem, you should first obtain a referral from your health care professional. The SCEH or ASCH may be able to help you to locate members in your region who may be able to provide a consultation.
A Brief History of Hypnosis
Ancient History The origins of hypnosis extend back to the ancient temples of Aesculapius, the Greek god of medicine, where advice and reassurance uttered by priests to sleeping patients was interpreted by the patients as the gods speaking to them in their dreams.
Roots in Mesmerism The more recent history of hypnosis begins with Franz Anton Mesmer (1734-1815), who theorized that disease was caused by imbalances of a physical force, called animal magnetism, which affects various parts of the body (click on the picture to see an enlarged picture of Franz Anton Mesmer). Mesmer also believed that cures could be achieved by redistributing this magnetic fluid -- a procedure that typically resulted in pseudoepileptic seizures known as "crises". In 1784, a French royal commission chaired by Benjamin Franklin and including Lavoisier and Guillotin among its members concluded that the effects of mesmerism, while genuine in many cases, were achieved by means of imagination and not by any physical force. In the course of their proceedings, the commissioners conducted what may well be the first controlled psychological experiments.
Mesmer's theory was discredited, but his practices lived on. A major transition occurred when one of Mesmer's followers, the Marquis de Puysegur, magnetised Victor Race, a young shepherd on his estate. Instead of undergoing a magnetic crisis, Victor fell into a somnambulistic (sleeplike) state in which he was responsive to instructions, and from which he awoke with an amnesia for what he had done. Later in the 19th century, John Elliotson and James Esdaile, among others, reported the successful use of mesmeric somnambulism as an anesthetic for surgery (although ether and chloroform soon proved to be more reliably effective).
James Braid, another British physician, speculated that somnambulism was caused by the paralysis of nerve centers induced by fixation of the eyes on an object. In order to eliminate the taint of mesmerism, Braid renamed the state "neurhypnotism" (nervous sleep); a term later shortened to hypnosis. Later, he concluded that hypnosis was due to the subject's concentration on a single thought (monoideism) rather than physiological fatigue.
Revival in Europe Interest in hypnosis was revived in France in the late 1880s by Jean Martin Charcot, a neurologist, who thought that hypnosis and hysteria both reflected a disorder of the central nervous system. In opposition to Charcot's neurological theories, A.A. Liebeault and Hippolyte Bernheim, two other French physicians, emphasized the role of suggestibility in producing hypnotic effects. Pierre Janet and Sigmund Freud also studied with Charcot, and Freud began to develop his psycho-social theories of mental illness after observing the suggestibility of hysterical patients when they were hypnotized.
In the United States William James and other early psychologists became interested in hypnosis because it seemed to involve changes in conscious awareness. The first systematic experimental work on hypnosis was reported by P.C. Young, in a doctoral dissertation completed at Harvard in 1923, and by Clark Hull in an extensive series of experiments initiated at the University of Wisconsin in the 1920s and continued at Yale into the 1930s. Also at Wisconsin during Hull's time was Milton Erickson, a physician whose provocative clinical and experimental studies stimulated interest in hypnosis among psychotherapists (Hull knew Erickson at Wisconsin, but the immediate source of Hull's interest in hypnosis was Joseph Jastrow, a prominent psychologist, who was Hull's mentor). After World War II, interest in hypnosis rose rapidly. Ernest Hilgard, together with Josephine Hilgard and Andre Weitzenhoffer, founded a laboratory for hypnosis research at Stanford University. Hilgard's status as one of the world's most distinguished psychologists helped establish hypnosis as a legitimate subject of scientific inquiry. Also important in this revival were Martin Orne, Theodore X. Barber, Theodore Sarbin, and Erika Fromm.
Health Applications of Hypnosis
Can Hypnosis Improve the Quality of Life for Individuals with Chronic Illnesses? Hypnosis has been used as a psychological treatment for a variety of illnesses with apparent success. While it is unlikely that hypnotic suggestions are capable of curing physical disease, they can be used to enhance relaxation and alleviate pain and other physical discomforts, and therefore they may make a positive contribution to the overall quality of care and of life. For example, several controlled studies have shown that hypnotic suggestions administered to patients who suffer from asthma can reduce both bronchodilator use and attacks of "wheezing", as well as increase peak expiratory flow rates. Hypnosis has also been used effectively in the treatment of irritable bowel syndrome, hyperemesis gravidarum (persistent nausea and vomiting) in pregnant women, and anticipatory nausea experienced by cancer patients who receive chemotherapy. Hypnotic suggestions have been observed to stimulate and inhibit allergic responses, and may also speed the healing of burns and wounds, but these issues require further carefully controlled study.
Even though the use of hypnosis may be associated with positive therapeutic outcomes, it is not clear that hypnosis itself is responsible for the effects observed. The active ingredient in some treatments labeled "hypnosis" might be mere relaxation, or a kind of placebo effect attributable to the use of a hypnotic ritual. It is well known, for example, that the "relaxation response" meditation technique introduced by Benson can alter blood pressure, heart rate, oxygen consumption, and the levels of certain neurotransmitters. The relaxation response is not the same as hypnosis, but hypnotic techniques may achieve some of their effects by virtue of the high levels of relaxation commonly associated with them. In the case of asthma, however, hypnosis seems to have a specific effect over and above relaxation.
The professional and popular literature contains occasional reports of clinical improvements and even cures of cancer in patients who have been treated with hypnosis or related techniques, such a relaxation and imagery. However, these apparent successes are typically poorly documented, and in the final analysis it is difficult to distinguish such "miracle cures" from spontaneous remissions which sometimes occur in these conditions. The most appropriate use of hypnosis in cancer treatment is as a complement to traditional medical treatments, such as chemotherapy, with the goal of enhancing the patient's quality of life while treatment is in progress.
Can Hypnosis be used in Pain Reduction? Hypnosis has been employed in the clinic for both medical and psychotherapeutic purposes. By far the most successful and best documented of these has been hypnotic analgesia for the relief of pain. Clinical studies indicate that hypnosis can effectively relieve pain in patients suffering pain from burns, cancer and leukemia (e.g., bone marrow aspirations), childbirth, and dental procedures. In such circumstances, as many as half of an unselected patient population can obtain significant, if not total, pain relief from hypnosis. Hypnosis may be especially useful in cases of chronic pain, where chemical analgesics such as morphine pose risks of tolerance and addiction. Hypnosis has also been used, somewhat heroically perhaps, as the sole analgesic agent in abdominal, breast, cardiac, and genitourinary surgery, and in orthopedic situations, although it seems unlikely that more than about 10% of patients can tolerate major medical procedures with hypnosis alone.
A comparative study of experimental pain found that, among hypnotizable people, hypnotic analgesia was superior to morphine, diazepam, aspirin, acupuncture, and biofeedback (Click on to the figure at the right to see an enlarged view). Hypnotic analgesia relieves both sensory pain and suffering. It is not a matter of simple relaxation or self-distraction. It does not appear to be mediated by endorphins or other endogenous opiates. There is a placebo component to all active analgesic agents, and hypnosis is no exception; however, hypnotizable people receive benefits from hypnotic suggestion that outweigh those of plausible placebos.
Does Hypnosis Increase Physical Performance? From the beginning of the modern era, a great deal of research effort has been devoted to claims that hypnotic suggestions enable individuals to transcend their normal voluntary capacities -- to be stronger, see better, learn faster, and remember more. However, research has largely failed to find evidence that hypnosis can enhance human performance. Many early studies, which seemed to yield positive results for hypnosis, possessed serious methodological flaws such as the failure to collect adequate baseline information. In general, it appears that hypnotic suggestions for increased muscular strength, endurance, sensory acuity, or learning do not exceed what can be accomplished by motivated individuals outside hypnosis.
Can Hypnosis Improve Recall? A special case of performance enhancement has to do with hypnotic suggestions for improvements in memory -- what is known as hypnotic hypermnesia. Hypermnesia suggestions are sometimes employed in forensic situations, with forgetful witnesses and victims, or in therapeutic situations, to help patients remember traumatic personal experiences or the events of early childhood. While field studies have sometimes claimed that hypnosis can powerfully enhance memory, these anecdotal reports have not been duplicated under laboratory conditions.
A 1994 report by the Committee on Techniques for the Enhancement of Human Performance, a unit of the U.S. National Research Council, concluded that gains in recall produced by hypnotic suggestion were rarely dramatic, and were matched by gains observed even when individuals are not hypnotized. In fact, there is some evidence that hypnotic suggestion can interfere with normal hypermnesic processes. To make things worse, any increases obtained in valid recollection are met or exceeded by increases in false recollections. Hypnotized individuals (especially those who are highly hypnotizable) may be especially vulnerable to distortions in memory produced by leadingquestions and other subtle, suggestive influences.
Hypnosis is sometimes used therapeutically to recover forgotten incidents, as for example in cases of child sexual abuse. Although the literature contains a number of dramatic reports of the successful use of this technique, most of these reports are anecdotal in nature and fail to obtain independent corroboration of the memories that emerge. Given what we know about the unreliability of hypnotic hypermnesia, and the risk of increased responsiveness to leading questions and other sources of bias and distortion, such clinical practices are not recommended. Similar considerations obtain in forensic situations. In fact, many legal jurisdictions severely limit the introduction of memories recovered through hypnosis, out of a concern that such evidence might be tainted. The Federal Bureau of Investigation has published a set of guidelines for those who wish to use hypnosis forensically, and similar precautions should be employed in the clinic.
Similar conclusions apply to hypnotic age regression, in which individuals receive suggestions that they are returning to a previous period in their lives (this is also a technique that is used clinically to foster the retrieval of forgotten memories of child abuse). Although age-regressed individuals may experience themselves as children, and may behave in a childlike manner, there is no evidence that they actually lose adult modes of mental functioning, or return to childlike modes of mental functioning. Nor do age-regressed individuals retrieve forgotten memories of childhood.
Does Hypnosis have an Effect on Psychosomatic Disorders? Hypnotic suggestion can have psychosomatic effects, a matter that should be of some interest to psychophysiologists and psychoneuroimmunologists. A famous case study convincingly documented the positive effects of hypnotic suggestion on an intractable case of congenital ichthyosiform erythroderma, a particularly aggressive skin disorder. Carefully controlled studies have shown that hypnotic suggestions can have a specific effect on the remission of warts. However, the same effects can be achieved by suggestions administered nonhypnotically. The mechanisms by which these "psychosomatic" effects are produced are theoretically interesting, and possibly clinically significant, but it is not yet clear that they have anything to do with hypnosis.
Can Hypnosis be used in Psychotherapy? Hypnosis has been used in psychotherapy—both in psychodynamic or cognitive-behavioral oriented therapy. In the former case, hypnosis is used to promote relaxation, enhance imagery, and generally loosen the flow of free associations (some psychodynamic theorists consider hypnosis to be a form of adaptive regression or regression in the service of the ego). However, there is little evidence from controlled outcome studies that hypnoanalysis or hypnotherapy are more effective than nonhypnotic forms of the same treatment. By contrast, a 1995 meta-analysis by Kirsch and colleagues showed a significant advantage when hypnosis is used to complement cognitive-behavioral therapy for a number of problems, including anxiety and hypertension. In an era of evidence-based mental health care, it will be increasingly important for practitioners who use hypnosis to document, quantitatively, the clinical benefits of doing so.
Can Hypnosis help with Weight Control? In the Kirsch study (mentioned above in the Psychotherapy section), the prospects for hypnosis appeared to be especially favorable in the treatment of obesity, where individuals in the hypnosis group continued to lose weight even after formal treatment had ended. In one study, for example, women who received personally tailored hypnotic suggestions for specific food aversions, in the context of a traditional self-monitoring and goal-setting treatment, lost approximately twice as much weight as a comparison group. This comparison group received the behavioral treatment alone (no hypnotic suggestion). However, the actual weight lost by the hypnosis group was only about 14 lb. on average. Given that the patients were approximately 50% overweight at the outset, it is not clear that the treatment actually improved their clinical status. Studies that document the clinical efficacy of hypnosis should pay careful attention to the terms in which outcome is assessed. While hypnosis may seem to offer an advantage over some other treatments, it is not clear that the statistical significance or experimental results translates into meaningful clinical significance or real results for individuals.
Can Hypnosis Help People Stop Smoking? There have been many attempts to use hypnosis for habit control, however, hypnosis has no coercive power. That is, one cannot be hypnotized against his or her will, and even deeply hypnotized individuals cannot be made, by virtue of hypnotic suggestions, to do things that run against their own or others' interests. You cannot cajole a smoker to the local hypnotist and expect him or her to stop smoking. However, where the patient is appropriately motivated, as in the obesity study described earlier, hypnosis may offer a boost to treatment.
One popular hypnotic treatment for smoking involves a single session in which patients are taught to repeat a simple persuasive message during self-hypnosis. In one large-scale study of this technique, about 50% of patients stopped smoking immediately after treatment; at follow-up one and two years later, however, this figure had dropped to about 25%. Although this study did not include a nonhypnotic control group, this is about the same success rate as achieved with other cognitive-behavioral interventions. However, these other treatments are typically more intensive, so that the single-session hypnotic treatment may have some advantage in terms of efficiency. Interestingly, long-term abstinence was not related to traditional measures of hypnotizability, suggesting that the success of the treatment may have had more to do with the persuasive message than with hypnosis per se.
Caveats for Health Practitioners in the Use Hypnosis with Patients An important but unresolved issue is the role played by individual differences in the clinical effectiveness of hypnosis. As in the laboratory, so in the clinic: a genuine effect of hypnosis should be correlated with hypnotizability.
It is possible that many clinical benefits of hypnosis are mediated by placebo-like motivational and expectational processes -- that is, with the "ceremony" surrounding hypnosis, rather than hypnosis per se. An analogy is to hypnotic analgesia, which appears to have a placebo component available to insusceptible and hypnotizable individuals alike, and a dissociative component available only to those who are highly hypnotizable. Unfortunately, clinical practitioners are often reluctant to assess hypnotizability in their patients and clients, out of a concern that low scores might reduce motivation for treatment. This danger is probably exaggerated. On the contrary, assessment of hypnotizability by clinicians contemplating the therapeutic use of hypnosis would seem to be no different, in principle, than assessing allergic responses before prescribing an antibiotic. In both cases, the legitimate goal is to determine what treatment is appropriate for what patient.
It should be noted that clinicians sometimes use hypnosis in non-hypnotic ways -- practices which tend to support the hypothesis that whatever effects they achieve through hypnosis are related to its placebo component. There is nothing particularly "hypnotic", for example, about having a patient in a smoking-cessation treatment rehearse therapeutic injunctions not to smoke and other coping strategies while hypnotized. It is likely that more successful use of hypnosis as an adjunct to the cognitive-behavioral treatment of smoking, overweight, and similar habit disorders would be to use hypnotic suggestions in order to control the patient's awareness of cravings for nicotine, sweets, and the like. Given the ability of hypnotic suggestions to control conscious perception and memory, such strategies might well have therapeutic advantage -- but only, of course, for those patients who are hypnotizable enough to respond positively to such suggestions.
Hypnosis is now a thriving topic for both scientific inquiry and clinical application, and is represented by such professional organizations as the Society for Clinical and Experimental Hypnosis, the American Society of Clinical Hypnosis, and other affiliates of the International Society of Hypnosis. The American Psychological Association has a special Division (Division 30, Psychological Hypnosis), devoted to hypnosis research and practice.
The International Journal of Clinical and Experimental Hypnosis, the American Journal of Clinical Hypnosis, the Australian Journal of Clinical and Experimental Hypnosis, and Contemporary Hypnosis (formerly the British Journal of Experimental and Clinical Hypnosis are among the leading journals publishing hypnosis research.
This article is derived from "Hypnosis and the Psychological Unconscious", by J.F. Kihlstrom, which appeared in the Encyclopedia of Mental Health, Vol. 2, pp. 467-477 (Academic Press, 1998). The point of view represented in this article is based on research supported by Grant #MH-35856 from the National Institute of Mental Health.
Svengali hypnotizes Trilby, from Georges Du Maurier's Trilby (1894).
Franz Anton Mesmer, from Henri Ellenberger's The Discovery of the Unconscious (1970).
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John F. Kihlstrom, PhD
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Last modified: 03.26.2004 11:03 PM