Hypnosis, Social role -taking theory

The main theorist who pioneered the influential role-taking theory of hypnotism was Theodore Sarbin. Sarbin argued that hypnotic responses were motivated attempts to fulfill the socially-constructed role of hypnotic subject. This has led to the misconception that hypnotic subjects are simply "faking". However, Sarbin emphasised the difference between faking, in which there is little subjective identification with the role in question, and role-taking, in which the subject not only acts externally in accord with the role but also subjectively identifies with it to some degree, acting, thinking, and feeling "as if" they are hypnotised. Sarbin drew analogies between role-taking in hypnosis and role-taking in other areas such as method acting, mental illness, and shamanic possession, etc. This interpretation of hypnosis is particularly relevant to understanding stage hypnosis in which there is clearly strong peer pressure to comply with a socially-constructed role by performing accordingly on a theatrical stage. Hence, the social constructionism and role-taking theory of hypnosis suggests that individuals are enacting (as opposed to merely playing) a role and that really there is no such thing as a hypnotic trance. A socially-constructed relationship is built depending on how much rapport has been established between the "hypnotist" and the subject (see Hawthorne effect, Pygmalion effect, andplacebo effect).

Psychologists such as Robert Baker and Graham Wagstaff claim that what we call hypnosis is actually a form of learned social behaviour, a complex hybrid of social compliance, relaxation, and suggestibility that can account for many esoteric behavioural manifestations.^{[87][page needed]}

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Hypnosis and Mind-dissociation

This surprisingly simple theory was proposed by Y.D. Tsai in 1995^[86] as part of his psychosomatic theory of dreams. Inside each brain, there is a program " I " (the conscious self) which is distributed over the conscious brain and coordinates mental functions (cortices), such as thinking, imagining, sensing, moving, reasoning … etc. "I" also supervises memory. Many bizarre states of consciousness are actually the results of dissociation of certain mental functions from "I". When a person is hypnotized, it might be that his/her imagination is dissociated and sends the imagined content back to the sensory cortex, resulting in dreams or hallucinations; or that some senses are dissociated, resulting in hypnotic anesthesia; or that motor function is dissociated, resulting in immobility; or that reason is dissociated and he/she obeys the hypnotist's orders; or that thought is dissociated and not controlled by reason, hence strives to straighten out his/her body between two chairs. A command can also be acted out long after the hypnosis session, as follows: The subject obeys the voice of reason in normal state, but when hypnotized, reason is replaced by the hypnotist's command to make decisions or believes, and will be very uneasy if he/she does not do things as decided or his/her belief is contradicted. Hypnotherapy is also based on this principle.

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Neodissociation and Hypnosis

Ernest Hilgard, who developed the "neodissociation" theory of hypnotism, hypothesised that hypnosis causes the subjects to divide their consciousness voluntarily. One part responds to the hypnotist while the other retains awareness of reality. Hilgard made subjects take an ice water bath. They said nothing about the water being cold or feeling pain. Hilgard then asked the subjects to lift their index finger if they felt pain and 70% of the subjects lifted their index finger. This showed that even though the subjects were listening to the suggestive hypnotist they still sensed the water's temperature.^[85] Source Wikipedia

Dissociation and Hypnosis

Pierre Janet originally developed the idea of dissociation of consciousness from his work with hysterical patients. He believed that hypnosis was an example of dissociation, whereby areas of an individual's behavioural control separate from ordinary awareness. Hypnosis would remove some control from the conscious mind, and the individual would respond with autonomic, reflexive behaviour. Weitzenhoffer describes hypnosis via this theory as "dissociation of awareness from the majority of sensory and even strictly neural events taking place."^{[84][page needed]} Source Wikipedia

Hypnosis and Neuropsychology

Neurological imaging techniques provide no evidence of a neurological pattern that can be equated with a "hypnotic trance". Changes in brain activity have been found in some studies of highly responsive hypnotic subjects. These changes vary depending upon the type of suggestions being given.^[77][78] However, what these results indicate is unclear. They may indicate that suggestions genuinely produce changes in perception or experience that are not simply a result of imagination. However, in normal circumstances without hypnosis, the brain regions associated with motion detection are activated both when motion is seen and when motion is imagined, without any changes in the subjects' perception or experience.^[79] This may therefore indicate that highly suggestible hypnotic subjects are simply activating to a greater extent the areas of the brain used in imagination, without real perceptual changes. Another study has demonstrated that a color hallucination suggestion given to subjects in hypnosis activated color-processing regions of the occipital cortex.^[80] A 2004 review of research examining the EEG laboratory work in this area concludes:

Hypnosis is not a unitary state and therefore should show different patterns of EEG activity depending upon the task being experienced. In our evaluation of the literature, enhanced theta is observed during hypnosis when there is task performance or concentrative hypnosis, but not when the highly hypnotizable individuals are passively relaxed, somewhat sleepy and/or more diffuse in their attention.^[81]

The induction phase of hypnosis may also affect the activity in brain regions which control intention and process conflict. Anna Gosline claims:

"Gruzelier and his colleagues studied brain activity using an fMRI while subjects completed a standard cognitive exercise, called the Stroop task.

The team screened subjects before the study and chose 12 that were highly susceptible to hypnosis and 12 with low susceptibility. They all completed the task in the fMRI under normal conditions and then again under hypnosis.

Throughout the study, both groups were consistent in their task results, achieving similar scores regardless of their mental state. During their first task session, before hypnosis, there were no significant differences in brain activity between the groups.

But under hypnosis, Gruzelier found that the highly susceptible subjects showed significantly more brain activity in the anterior cingulate gyrus than the weakly susceptible subjects. This area of the brain has been shown to respond to errors and evaluate emotional outcomes.

The highly susceptible group also showed much greater brain activity on the left side of the prefrontal cortex than the weakly susceptible group. This is an area involved with higher level cognitive processing and behaviour."^[82][83]

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Hypnosis and Hyper-suggestibility

Braid can be taken to imply, in later writings, that hypnosis is largely a state of heightened suggestibility induced by expectation and focused attention. In particular, Hippolyte Bernheim became known as the leading proponent of the "suggestion theory" of hypnosis, at one point going so far as to declare that there is no hypnotic state, only heightened suggestibility. There is a general consensus that heightened suggestibility is an essential characteristic of hypnosis.

If a subject after submitting to the hypnotic procedure shows no genuine increase in susceptibility to any suggestions whatever, there seems no point in calling him hypnotised, regardless of how fully and readily he may respond to suggestions of lid-closure and other superficial sleeping behaviour.^[73]

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The state versus nonstate debate

The central theoretical disagreement is known as the "state versus nonstate" debate. When Braid introduced the concept of hypnotism he equivocated over the nature of the "state", sometimes describing it as a specific sleep-like neurological state comparable to animal hibernation or yogic meditation, while at other times he emphasised that hypnotism encompassed a number of different stages or states which were an extension of ordinary psychological and physiological processes. Overall, Braid appears to have moved from a more "special state" understanding of hypnotism toward a more complex "nonstate" orientation. State theorists interpret the effects of hypnotism as primarily due to a specific, abnormal and uniform psychological or physiological state of some description, often referred to as "hypnotic trance" or an "altered state of consciousness." Nonstate theorists rejected the idea of hypnotic trance and interpret the effects of hypnotism as due to a combination of multiple task-specific factors derived from normal cognitive, behavioural and social psychology, such as social role-perception and favorable motivation (Sarbin), active imagination and positive cognitive set (Barber), response expectancy (Kirsch), and the active use of task-specific subjective strategies (Spanos). The personality psychologist Robert White is often cited as providing one of the first nonstate definitions of hypnosis in a 1941 article:

Hypnotic behaviour is meaningful, goal-directed striving, its most general goal being to behave like a hypnotised person as this is continuously defined by the operator and understood by the client.^[72]

Put simply, it is often claimed that whereas the older "special state" interpretation emphasises the difference between hypnosis and ordinary psychological processes, the "nonstate" interpretation emphasises their similarity.

Comparisons between hypnotised and non-hypnotised subjects suggest that if a "hypnotic trance" does exist it only accounts for a small proportion of the effects attributed to hypnotic suggestion, most of which can be replicated without hypnotic induction.

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Psychotherapy/Hypnotherapy

Hypnotherapy is the use of hypnosis in psychotherapy.^[59] It is used by licensed physicians, psychologists, and others. Physicians and psychiatrists may use hypnosis to treat depression, anxiety, eating disorders, sleep disorders, compulsive gaming, and posttraumatic stress.^[60][61] Certified hypnotherapists who are not physicians or psychologists often treat smoking and weight management. (Success rates vary: a meta-study researching hypnosis as a quit-smoking tool found it had a 20 to 30 percent success rate, similar to other quit-smoking methods^[62], while a 2007 study of patients hospitalised for cardiac and pulmonary ailments found that smokers who used hypnosis to quit smoking doubled their chances of success.^[63])

In a July 2001 article for Scientific American titled "The Truth and the Hype of Hypnosis", Michael Nash wrote:

...using hypnosis, scientists have temporarily created hallucinations, compulsions, certain types of memory loss, false memories, and delusions in the laboratory so that these phenomena can be studied in a controlled environment.^[45]

Controversy surrounds the use of hypnotherapy to retrieve memories, especially those from early childhood or (alleged) past-lives. The American Medical Association and the American Psychological Association caution against repressed memory therapy in cases of alleged childhood trauma, stating that "it is impossible, without corroborative evidence, to distinguish a true memory from a false one."^[64] Past life regression, meanwhile, is often viewed with skepticism.^[65]

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Medical Applications

Hypnotherapy has been used to treat irritable bowel syndrome. Researchers who recently reviewed the best studies in this area conclude:

The evidence for hypnosis as an efficacious treatment of IBS was encouraging. Two of three studies that investigated the use of hypnosis for IBS were well designed and showed a clear effect for the hypnotic treatment of IBS.^[39]

Hypnosis for IBS has received moderate support in the National Institute for Health and Clinical Excellence guidance published for UK health services.^[40] It has been used as an aid or alternative to chemical anaesthesia,^[41][42][43] and it has been studied as a way to soothe skin ailments.^[44]

A number of studies show that hypnosis can reduce the pain experienced during burn-wound debridement, bone marrow aspirations, and childbirth. TheInternational Journal of Clinical and Experimental Hypnosis found that hypnosis relieved the pain of 75% of 933 subjects participating in 27 different experiments.^[45]

In 1996, the National Institutes of Health declared hypnosis effective in reducing pain from cancer and other chronic conditions.^[45] Nausea and other symptoms related to incurable diseases may also be managed with hypnosis.^{[46][47][48][49]} For example, research done at the Mount Sinai School of Medicine studied two patient groups facing breast cancer surgery. The group that received hypnosis reported less pain, nausea, and anxiety post-surgery. The average hypnosis patient reduced treatment costs by an average $772.00.^[50][51]

The American Psychological Association published a study comparing the effects of hypnosis, ordinary suggestion and placebo in reducing pain. The study found that highly suggestible individuals experienced a greater reduction in pain from hypnosis compared with placebo, whereas less suggestible subjects experienced no pain reduction from hypnosis when compared with placebo. Ordinary non-hypnotic suggestion also caused reduction in pain compared to placebo, but was able to reduce pain in a wider range of subjects (both high and low suggestible) than hypnosis. The results showed that it is primarily the subjects responsiveness to suggestion, whether within the context of 'hypnosis' or not, that is the main determinant of causing reduction in pain.^[52]

Treating skin diseases with hypnosis (hypnodermatology)has performed well in treating warts, psoriasis, and atopic dermatitis.^[53]

Hypnosis may be useful as an adjunct therapy for weight loss. A 1996 meta-analysis studying hypnosis combined with cognitive-behavioural therapy found that people using both treatments lost more weight than people using CBT alone.^[54]

Source WIKIPEDIA

Stage Hypnosis

The stage hypnotist differs very much in his presentation of his skills to that of a clinical hypnotherapist. Although both induce a trance state, one is strictly for entertainment and the other for therapy. Stage Hypnosis goes through its ups and downs in popularity, but one thing will always be said ---It is a fascinating presentation if done correctly. It extenuates the possibility of the human mind in a way that both mystifies and confuses. The simplicity of the process becomes a dichotomy. Unbelievable to those viewing and self reflective to those participating.

Trance state or hypnosis created by the stage hypnotist triggers a relaxation response that is very apparent to the spectator. The hypnosis creates flaccidity of the muscles, originating at the cortex level and translating to a ”Gumby “ like existence

If the stage hypnotist picks an arm and lets it go the arm will fall disconnected by the individuals body. In many cases the stage hypnotist will use this as a method of determining how successful his hypnotic induction has worked.

At some disassociated level the audience becomes aware of those who are in deep hypnosis and those who are traveling between various brain wave patterns. It becomes very apparent who the stage hypnotist is going to use for his show. If you see enough stage hypnosis shows you will recognize “ hypnotizable subjects” and the very specific anomalies they present.

Everybody can be hypnotized IF THEY ALLOW themselves----All Hypnosis is self hypnosis----The stage hypnotist is nothing more than a facilitator, the recipient either excepts or rejects the process.

Here in lies the skill of the hypnotist and his ability to sell something that in many ways is not tangible.

As a spectator become savvy to the trance like characteristics that a hypnotized subject projects. As a participant allow the hypnotist to guide you through this remarkable journey and remember the only person that can allow this hypnotic process is you.

For further information on stage hypnosis go to www.barryjones.com or call 1(760)635-7785 Comedy hypnotist

Really check out your entertainer before you hire. Be aware of those hypnotists that cannot give you repeat references from a venue or client. Compare their promotional materials with other hypnotists and if at all possible try and get a video, DVD that shows a full show. Viewing highlights is just what you will get.---For some hypnotists the show is about them and not the audience.

When it comes to comedy hypnotists you get the good and the bad----Stay away from the self proclaimed ‘fastest’ and voted the ‘best’ ---. For every hypnotist that proclaims these things there are ten other hypnotists that are better and faster.

Be aware of those who pad their educational backgrounds. The MSc or PhD in Clinical Hypnosis. There really is no such thing that is recognized by any legitimate educational institution. There is just education --. The bottom line is that anybody can practice clinical hypnosis; any body can give out a PhD in clinical hypnosis. Anybody can get up on stage and say they are a comedy hypnotist. There is no governing body, or official licensing--- so understanding this take your time in researching your hypnotist.

Typically comedy hypnotists specialize in a field of entertainment. It may be Corporate, Universities and Colleges, High Schools, the fair industry, comedy clubs or cruise ships and resorts/casinos.

I personally vary my material for the audience. Corporate tends to be squeaky clean and politically correct, the same for high school and fair performances. Of course everything really is based on client needs. I always discuss a show format prior to an event and will suggest a routine, but I am always open to suggestions.

Comedy Clubs expect something a little different and so that is what I give them.

A quick synopsis—Insure that you get a hypnotist that has repeat references, and make sure you have a number that you can call (make sure it is not their mother!) to talk to the client that saw the hypnotist. Try and get a full video of a performance and beware of padded credentials. If the hypnotist sounds pushy or self- proclaimed look for the red lights flashing.

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.

Self-Hypnosis

Self-hypnosis or autohypnosis is a procedure in which the subject both induces the hypnotic state and makes suggestions to himself. When self-hypnosis is to be employed as part of a therapeutic regimen, it is necessary for the therapist to train the patient in its use. Often training is done under heterohypnosis, and the initial self-inductions are aided by a posthypnotic signal to into the hypnotic state. There is some experiemental evidence that inexperienced subjects can hypnotize themselves about as well as they can by hypnotized by another person.

There is ambiguity, however, concerning the nature of the self-hypnosis procedures typoically employed in such studies, involving, as they do, an experimenter giving a subject either initial verbal instructions or a booklet of directions on hypnotizing one's self, as well as a set of suggestions. There may be elements of both self-hypnosis anad heterohypnosis present in such a procedure. The main value of heterohypnosis in training a subject to induce autohypnosis is not providing him with a posthypnotic signal for induction but in letting him experience the subjective feelings of the hypnotic state that he must seek to attain self-induction.

The view is often expressed that all hypnosis is self-hypnosis because it is the subject's imagination that produces all of the effects in heterohypnosis. On the other hand, it could be argued that all hypnosis is basically heterohypnosis, and self-hypnotic effects resulty from posthypnotic suggestions given while training subjects in self-hypnosis. As early as 1928, Young researched this issue. He had hypnotic subhjects instruct themselves prior to hypnosis to modify specific aspects of rapport behavior and posthypnotic amnesia. He found that subjects could do this successfully and concluded that ther was no sine qua non of hypnosis. Posthypnotic amnesia was dependant on the subjects set of expectancy, and hypnotic behavior could be modified in many ways without affecting its depth. He concluded that the essential element in heterohypnosis was the autosuggestion of the subject.

Ruch (1975) also supports the notion that active self-hypnosis is the primary phenomenon and that heterohypnosis is, in effect, a case of guided self-hypnosis. He found that initial self-hypnosis facilitated subsequent heterohypnosis but that conventional heterohypnosis (of a passive subject by an active hypnotist) inhibited later attempts at self-hypnosis. This inhibitory effect was eliminated when "first-person instructions" were used in heterohypnosis. That is, instead of saying to the subject, "I am going to give you suggestions to help you to relax," the experimenter would say, "I am going to give myself instructions to help me relax." Thus the subject was able to regard the hypnotist's voice as his own, making suggestions to himself.

Ruch's view of the primacy of self-hypnosis is contrary to the conventional idea that heterohypnosis is an aid in training a person in self-hypnosis. It is premature to say whether the foregoing results are generalizable or are limited to the particular induction procedures tested. However, it seems questionable to label the procedure used as self-hypnosis, since, in the initial instructions, the experimenter made suggestions concerning the sequence of events that were to occur and then left the subject to count to himself and experience hem. This is similar to the Flower method of heterohypnosis in which all instructions to the subject are massed at the beginning of the induction. For an induction to qualify as an example of true autohypnosis, the subject should be responsible for all elements of the induction, and the hypnotist should make no suggestions of any kind beyond requesting the subject to commence the procedure.

Johnson (1981) notes that any study of self-hypnosis must be contaminated to some degree by heterohypnotic influence unless the study is limited to spontaneously developed trance states. Gardner (1981) proposed making a distinction between self-hypnosis (which she used to indicate self-hypnosis preceded or aided by heterohypnosis) and autohypnosis (which referred to spontaneous autohypnosis with no prior heterohypnosis). However, since these two terms are generally used interchangeably, such a distinction will probably prove as futile as the distinction between susceptibility and hypnotizability made in this book. If such distinctions are to be made (and they probably should be), then perhaps it will be necessary to coin new terms.

Most researchers have found few, if any, differences in success in inducing self-hypnosis as a function of previous heterohypnotic experience (Johnson, 1979; Kroger, 1977a; LeCron, 1964; Sacerdote, 1981; Shor and Easton, 1973). Sacerdote (1981) points out that with the modern trend toward more permissive inductions, the distinction between heterohypnosis and self-hypnosis is becoming vaguer.

Fromm (1975) notes that until recently, most of the serious research in hypnosis was in heterohypnosis; the literature of self-hypnosis was often the product of "quacks and laymen." She questioned on theoretical grounds the common assumption that heterohypnosis and self-hypnosis are basically the same and undertook to investigate the similarities and differences between the two. She conceptualizes hypnosis as an ego-splitting process. In heterohypnosis, the ego splits into two parts: the experimenter (participating ego) and the observer (observing ego). In autohypnosis, the ego splits into three parts: the experimenter and observer plus a director who gives the hypnotic instructions and suggestions. She found that in some subjects, a third or fourth aspect of the ego, a skeptic, was also present.

In a preliminary study, Fromm gave 18 males and 18 females one session each of heterohypnotic and autohypnotic experiences using a counterbal-anced order of presentation. The 12 least susceptible subjects described both experiences as essentially the same, but the 24 most-susceptible subjects de-scribed subjective differences between the experiences. Idiosyncratic fantasy and visual imagery arose spontaneously with a much higher frequency In autohypnosis. There was also more rational, cognitive activity going on In thes condition, and subjects were unanimous in reporting the greater number of ego splits predicted. Autohypnosis was found, as predicted, to require more effort on the part of the subjects.

Some subjects were able to reach a deeper state under heterohypnosis, while others went deeper under autohypnosis. Fromm accounts for this difference in terms of differences between subjects with respect to their need for surrender versus their need for autonomy and control. In a second study, three males and three females were instructed to practice self-hypnosis once a day for a month. Subjects were required to keep a daily diary of their experiences and were interviewed by telephone every few days. They were also subjected to two interviews plus a follow-up group discussion one month after the study.

Fromm found that with practice, self-inductions were easier to achieve. Eventually subjects began to employ methods of induction exclusively of their own design. Some used dissociative methods, such as producing an arm levitation by forgetting about the arm or commanding it to rise. Others simply "let go" and developed a passive-receptive ego state. After 2 or 3 weeks, most subjects who did not incorporate self-hypnosis into their life-style became bored with the procedure and had to be coaxed to continue the experiment. One of the causes of this problem was thought to be the tendency of prolonged self-hypnosis to reduce the transference with the experimenter. It was found that imagery was stimulated to a much greater extent in self-hypnosis but that some effects, such as positive hallucinations, profound ego regression, and role playing, were easier to produce in heterohypnosis.

The major advantage claimed for self-hypnosis in this study was that the subject was always attuned to his own responses during induction, and hence suggestions could be optimally timed. An outside hypnotist can at best make an educated guess as to the subject's subjective state. Johnson and Weight (1976), using factor analysis, found that behavioral and subjective experiences of subjects under heterohypnosis and self-hypnosis were generally similar. However, heterohypnosis invoked more feelings of unawareness of the environment, passivity, and loss of control, while autohypnosis was associated with more feelings of time distortion, disorientation, active control, and variations of trance depth.

In a later longitudinal study, Fromm and her associates (1981) essentially confirmed her earlier results. They concluded that "expansive free-floating attention" and ego receptivity to internal stimuli were state-specific for self-hypnosis, while concentrated attention and receptivity to a single external source of stimuli were state-specific for heterohypnosis. Again imagery was found to be much richer in self-hypnosis, while suggestions of age regression or positive and negative hallucinations were markedly more effective in heterohypnosis.

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.

Miscellaneous Applications of Hypnosis

Hypnosis has been used in education as a learning aid, and as a methodof dealing with examination anxiety, and for self-improvement suggestions (e.g., of greater self-confidence) in social and business situations (Boutin, 1978; Cohen, 1979; Hebert, 1984; Porter, 1978; Spies, 1979; Wollman, 1978). Cole (1979) found that hypnosis was no more effective in improving the academic performance of 31 students in a college preparation course (who were exposed to a 40-minute induction and deepening tape plus four sub- sequent 15-minute hypnotic tapes making suggestions of enhanced academic performance) than exposing students to control tapes making the same sug- gestions without hypnosis or lectures. These results are not particularly sur- prising. Hypnosis would not be expected to improve academic performance unless poor performance was caused by psychological factors (other than a low level of ability) and these factors were identified and addressed by the hypnotic technique used. Van Pelt (1975a, 1975b) suggested the use of hyp- nosis in business as a method of coping with interpersonal problems and in space travel to deal with boredom, nervous strain, and problems produced by weightlessness, interruption of sleep cycles, and space sickness. Christie (1982) discusses a variety of industrial uses of hypnosis, such as attitude change, performance facilitation, vocational counseling, advertising, and consumer research, both with and without formal trance induction.

Hypnotic phenomena play an indirect role in entertainment. Most mem- bers of a movie audience resemble people in a hypnotic trance. The movie itself probably functions similarly to the word picture painted by a hypnotist in a cognitive induction and detaches the audience members from their im- mediate surroundings. Good subjects trained in self-hypnosis can probably use this skill to enhance the vividness of the private fantasies in which all people engage. It is likely that creative people like authors or playwrights can use hypnotic fantasy productively to generate new ideas for their work. Rob- ert Louis Stevenson got the idea for Dr. Jekyll and Mr. Hyde from a nocturnal dream (Dement, 1974). Hypnotic suggestions have not only been used to help actors assume a character but also to generate appropriate facial expres- sions in photographers' models (Kondreck, 1963).

Hypnosis even comes into play in modern religious life. Many people have had the experience of being so entranced by the charismatic style of a tele- vision evangelist that they listened captivated for an entire sermon without having had prior interest in the message being conveyed. Indeed, the ability to attract and hold the attention of an audience is much like a hypnotist's getting a subject to concentrate on a fixation object or instructing him to "at- tend only to the sound of my voice."

Matheson (1979b) points out the similarities between religious experiences and healing and hypnotic phenomena. Tappeiner (1977), a theologian who notes the operation of hypnotic factors in several varieties of religious ex- perience, argues that the fact that religious phenomena can be explained in terms of hypnotic principles does not negate their spiritual validity, that is, God works through natural mechanisms.

The present author would agree that noticing the hypnotic qualities and techniques of an evangelist commits the observer to nothing regarding the spiritual validity of his message.

Walker (1984) notes the common factor of what he calls "inadequate re- ligious attitudes," which can complicate psychotherapy, and suggests a role both for hypnosis and ministers of religion in an effort to correct these and facilitate therapy. This thought-provoking article suggests that perhaps psy- chotherapists, as part of their training, should be exposed to the major tenets of the various religious denominations, for guilt is commonly seen in patients with overly strict religious beliefs, and psychotherapists are often reluctant to address such issues. Perhaps if they were more knowledgeable concerning the beliefs of the major religious denominations, they might recognize when their patient's beliefs were idiosyncratic or "inappropriate" and when a con- sultation with a clergyman might prove helpful in correcting them (just as therapists are trained to recognize when a medical consultation is necessary).

The diverse applications of hypnosis discussed tend to ob- scure the fact that hypnosis is basically a phenomenon rather than a tech- nique. It would be strange indeed if a natural phenomenon like hypnosis did not occur often in daily life, but when it does occur naturally in such prosaic settings as the movies or while watching television, we usually fail to recognize a spontaneous trance for what it is. Sometimes naturally occurring trances can have unfortunate consequences, as in the case of highway hypnosis. Recognizing that effects of this nature can occur makes it possible for engi- neers to design cars and highways to minimize or eliminate such risks.

Training in self-hypnosis opens the door for the employment of hypnosis in many minor applications, such as the control of normal levels of anxiety before giving a speech or prior to an important business interview, where it would normally not be practical to incur the expense of a professional con- sultation.

While this chapter has considered some of the major applications of hyp- nosis, it is not possible to consider all of its potential uses, for these extend to any situation that requires relaxation; the stimulation of imagery, emotion or motivation; or the enhancement of the ability to concentrate on something and become detached from the environment.