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Differential effects of hypnotic suggestion on multiple dimensions of pain.

Within the framework of multidimensional pain assessment, this study extended an earlier finding that hypnotic analgesia and relaxation suggestions have differential effects on pain reduction by evaluating these strategies in subjects undergoing a cold pressor protocol. Thirty-two highly susceptible subjects were randomly assigned to an analgesia or a relaxation suggestion treatment group. Six pain reports were taken at 10-sec intervals for each experimental condition. The baseline measures served as covariates. A 2 x 2 x 2 x 6 repeated-measures analysis of covariance (ANCOVA) revealed a significant group (analgesia, relaxation) by pain dimension (intensity, unpleasantness), by condition (suggestion alone, hypnotic induction plus suggestion) interaction. Analysis of the simple-simple main effects, holding both group and condition constant, revealed that application of hypnotic analgesia reduced report of pain intensity significantly more than report of pain unpleasantness. Conversely, hypnotic relaxation reduced pain unpleasantness more than intensity. The clinical implications of the study are discussed.

Female↗

Effect of alfentanil on hypnotic and antinociceptive components of thiopental sodium anesthesia.

STUDY OBJECTIVE: To determine the effects of alfentanil on the hypnotic and antinociceptive components of thiopental sodium anesthesia. DESIGN: Randomized double-blind study. SETTING: Inpatients at a university-affiliated county hospital. PATIENTS: Eighty unpremedicated ASA physical status I or II female patients aged 18 to 60 years, with a weight range of 50 to 90 kg. INTERVENTIONS: Intravenous injection of thiopental sodium in doses ranging from 1.0 mg/kg to 6.0 mg/kg with or without the addition of alfentanil, 0.01 mg/kg. MEASUREMENTS AND MAIN RESULTS: Dose-response curves were determined for the following three endpoints of anesthesia: eye opening in the response to voice command; eye opening in the response to noxious stimulation induced by pressure on the trapezius muscle; and purposeful movement in the response to the same type of noxious stimulation. The addition of alfentanil, 0.01 mg/kg, markedly decreased thiopental ED50 values for all three endpoints: from 2.6 mg/kg to 1.9 mg/kg (p less than 0.02) for eye opening to voice command, from 3.2 mg/kg to 1.9 mg/kg (p less than 0.0005) for eye opening to noxious pressure, and from 4.2 mg/kg to 2.4 mg/kg (p less than 0.0001) for purposeful movement to noxious pressure. The alfentanil-induced increase in thiopental potency for the antinociceptive effect was greater than that for the hypnotic effect (75% vs 36%, p = 0.02). CONCLUSIONS: Alfentanil strengthened both the hypnotic and antinociceptive components of thiopental anesthesia, although to a different degree: the antinociceptive component more so than the hypnotic, possibly because each component of anesthesia has different underlying mechanisms.

Adult↗

Does 'hypnosis' by any other name smell as sweet? The efficacy of 'hypnotic' inductions depends on the label 'hypnosis'.

Hypnosis is associated with profound changes in conscious experience and is increasingly used as a cognitive tool to explore neuropsychological processes. Studies of this sort typically employ suggestions following a hypnotic induction to produce changes in perceptual experience and motor control. It is not clear, however, to what extent the induction procedure serves to facilitate suggested phenomena. This study investigated the effect on suggestibility of (a) a hypnotic induction and (b) labelling that procedure 'hypnosis.' Suggestibility of participants was tested before and after an adapted hypnotic procedure, which was either labelled as 'hypnosis' or as 'relaxation.' The hypnotic procedure produced a modest increase in suggestibility when it was called 'relaxation,' but a very significant increase if it was labelled 'hypnosis.' The results are important for both clinical and experimental applications and indicate that labelling an induction procedure 'hypnosis' is an important determinant of subsequent responses to suggestion.

Adolescent↗

Role of relaxation and specific suggestions in hypnotic emotional numbing.

The cognitive characteristics of highly hypnotizable subjects (Highs) allow them to easily modify their cognitive and autonomic state. Under hypnosis, Highs receiving cognitive, fear-like stimulation exhibit the cardiovascular changes typical of fear/stress, but also show an EEG pattern indicating a balance between fear-induced arousal and hypnotic relaxation. Indeed, hypnosis is effective in the attenuation of both emotional experience and behaviour (emotional numbing). The aim of the present experiment was to investigate the possible different role of relaxation and suggestion in hypnotic emotional numbing. Tonic skin conductance, respirogram, heart rate, systolic and diastolic blood pressure were recorded in 3 groups of hypnotized subjects: Group 1 received a fearful guided imagery associated with threat suggestions (Threat) followed by the same fearful suggestion associated with numbing instructions (relaxation and "No-Threat"); Group 2 received the same instructions in the opposite order of presentation; Group 3 received the fearful suggestion with threat instructions twice. The numbing suggestion reduced fear-related emotional experience and autonomic responses; if No-Threat preceded Threat, the heart rate, heart rate variability and blood pressure were also reduced during Threat, in spite of self reports of high negative emotion. Thus, 1) the subjective experience and the autonomic response to fear can be dissociated; 2) the efficacy of numbing suggestion is extended to a subsequent Threat stimulation; 3) habituation does not contribute to the numbing effect. The results indicate that the specific numbing suggestion is the main factor in hypnotic modulation of the experience of fear.

Adult↗

Functional neuroanatomy of hypnotic state.

BACKGROUND: The aim of the present study was to describe the distribution of regional cerebral blood flow during the hypnotic state (HS) in humans, using positron-emission tomography (PET) and statistical parametric mapping. METHODS: The hypnotic state relied on revivification of pleasant autobiographical memories and was compared to imaging autobiographical material in "normal alertness." A group of 9 subjects under polygraphic monitoring received six H215O infusions and was scanned in the following order: alert-HS-HS-HS with color hallucination-HS with color hallucination-alert. PET data were analyzed using statistical parametric mapping (SPM95). RESULTS: The group analysis showed that hypnotic state is related to the activation of a widespread, mainly left-sided, set of cortical areas involving occipital, parietal, precentral, premotor, and ventrolateral prefrontal cortices and a few right-sided regions: occipital and anterior cingulate cortices. CONCLUSIONS: The pattern of activation during hypnotic state differs from those induced in normal subjects by the simple evocation of autobiographical memories. It shares many similarities with mental imagery, from which it differs by the relative deactivation of precuneus.

Adult↗

The effect of hypnotic-guided imagery on psychological well-being and immune function in patients with prior breast cancer.

OBJECTIVE: To determine the effect of hypnotic-guided imagery on immune function and psychological parameters in patients being treated for Stage I or II breast cancer. METHODS: To determine the effects of hypnotic-guided imagery on immune function and psychological parameters, the following study was undertaken. Psychological profiles, natural killer (NK) cell number and activity were measured at baseline, after the 8-week imagery training program and at the 3-month follow-up. RESULTS: There were significant increases in improvement in depression (P<.04) and increase in absolute number of NK cells, but these were not maintained at the 3-month follow-up. Hypnotic-guided imagery did cause some transient changes in psychological well-being and immune parameters. However, these changes were not retained after the treatment ended. CONCLUSIONS: Many studies during the last 15 years have demonstrated interactions between the central nervous and the immune systems. While a negative effect of stress on immune responses has been demonstrated, there have also been published reports that psychological treatments can positively alter the immune system. However, given the complexities of immune system kinetics, the transient nature of any psychological effect and the insensitivity of immune assays, our study indicates that there is a role for hypnotic-guided imagery as an adjuvant therapy.

Adult↗

Hypnotic analgesia: dissociated experience or dissociated control?

High-hypnotizable subjects (n = 18) were superior to low-hypnotizable subjects (n = 18) in the extent of pain reduction produced by hypnotic analgesia and by a stress-inoculation procedure. However, stress inoculation but not hypnotic analgesia impaired performance on a cognitively demanding task that competed with pain reduction for cognitive resources. This outcome implies that hypnotic analgesia occurs with little or no cognitive effort to reduce pain and challenges the social psychological model of hypnosis. The findings are also inconsistent with the notion of dissociated experience, which proposes that pain and the cognitive efforts to reduce it are cut off from consciousness by an amnesialike barrier. However, the results do support the notion of dissociated control, which proposes that suggestions for hypnotic analgesia directly activate pain reduction and thereby avert the need for cognitive strategies to reduce pain.

Adult↗

Hypnotic blindness and the relevance of cognitive style.

Real, hypnotized and simulating, unhypnotized subjects were instructed to use either a constructive or a concentrative cognitive style when attempting to respond to a suggestion for hypnotic blindness; also, some subjects were administered the suggestion without any instructions about cognitive style. More reals who received the constructive rather than the concentrative instructions reported complete blindness; a similar number of simulators who received the different instructions reported complete blindness. Moreover, reals who received the constructive instruction reported a more rapidly developed belief in their blindness. The findings are discussed in terms of the relevance of cognitive style to subjects' reports of hypnotic blindness, and the possibility is considered that both reports of and belief in hypnotic blindness are determined in part by cognitive style.

Adult↗

Self-fulfilling prophecy and hypnotic response are not the same thing.

The authors used the "bogus-item" methodology originally used by C. Wickless and I. Kirsch (1989) to examine the effects of response expectancy manipulations on subjects' subsequently measured hypnotizability scores. The results of the first experiment failed to replicate Wickless and Kirsch's (1989) findings that surreptitious confirmation of suggested items (the bogus-item manipulation) leads to higher scores on subsequently measured hypnotic responsiveness. The second experiment tested if, in fact, response expectancies were enhanced by the bogus-item manipulation, and the manipulation's effect on behavioral and subjective responsiveness to hypnosis was reexamined. A significant increase was found in response expectancies as a result of the bogus item expectancy manipulation, but again no evidence that this manipulation led to increased hypnotic responsiveness was found. Hypnotic responsiveness may not be as reactive to expectancy manipulations as previously claimed, and it is suggested that the notion of hypnotic responsiveness as a trait-like ability is viable.

Analysis of Variance↗

Enhanced visual memory during hypnosis as mediated by hypnotic responsiveness and cognitive strategies.

To investigate the hypothesis that hypnosis has an enhancing effect on imagery processing, as mediated by hypnotic responsiveness and cognitive strategies, four experiments compared performance of low and high, or low, medium, and high, hypnotically responsive subjects in waking and hypnosis conditions on a successive visual memory discrimination task that required detecting differences between successively presented picture pairs in which one member of the pair was slightly altered. Consistently, hypnotically responsive individuals showed enhanced performance during hypnosis, whereas nonresponsive ones did not. Hypnotic responsiveness correlated .52 (p less than .001) with enhanced performance during hypnosis, but it was uncorrelated with waking performance (Experiment 3). Reaction time was not affected by hypnosis, although high hypnotizables were faster than lows in their responses (Experiments 1 and 2). Subjects reported enhanced imagery vividness on the self-report Vividness of Visual Imagery Questionnaire during hypnosis. The differential effect between lows and highs was in the anticipated direction but not significant (Experiments 1 and 2). As anticipated, hypnosis had no significant effect on a discrimination task that required determining whether there were differences between pairs of simultaneously presented pictures. Two cognitive strategies that appeared to mediate visual memory performance were reported: (a) detail strategy, which involved the memorization and rehearsal of individual details for memory, and (b) holistic strategy, which involved looking at and remembering the whole picture with accompanying imagery. Both lows and highs reported similar predominantly detail-oriented strategies during waking; only highs shifted to a significantly more holistic strategy during hypnosis. These findings suggest that high hypnotizables have a greater capacity for cognitive flexibility (Batting, 1979) than do lows. Results are discussed in terms of several theoretical approaches: Paivio's (1971) dual-coding theory and Craik and Tulving's (1975) depth of processing theory. Additional discussion is given to the question of whether hypnosis involves a shift in cerebral dominance, as reflected by the cognitive strategy changes and enhanced imagery processing.

Adult↗

Mechanisms of hypnotic and nonhypnotic forgetting.

Subjects participated in two experimental sessions designed to study laboratory-induced amnesia, one using a standard hypnosis paradigm and one using a non-hypnotic directed-forgetting paradigm. Two independent sources of variation were derived from the hypnotic amnesia data: retrieval inhibition and inhibition release. In the nonhypnotic directed-forgetting procedure, some items were cued to be forgotten shortly after presentation and some were cued to be remembered. At test, the subjects were asked to recall both the to-be-remembered and the to-be-forgotten items. Over 39% of the variance in the recall of the to-be-forgotten items could be accounted for by the inhibition and release constructs obtained with hypnosis. These relations between the two procedures were not mediated by verbal ability or cognitive style (field independence). We concluded that the mechanisms of forgetting involved in laboratory demonstrations of hypnotic and nonhypnotic amnesia are related, and the implication is that some of them are the same, namely, retrieval inhibition and inhibition release. We also argued that the possible demand characteristics that accompany the hypnosis procedure are not apparent with the nonhypnotic procedure. Therefore, the relationships observed in the present results were taken as evidence that hypnotically induced amnesia is not entirely the result of subjects' reactions to demand characteristics.

Amnesia↗

The hidden observer in hypnotic analgesia: discovery or experimental creation?

Eight highly susceptible subjects were assigned to Hilgard's training procedures for eliciting "hidden" reports during hypnotic analgesia. These procedures indicate to subjects that a "hidden part" of themselves continues to feel high levels of pain while their "hypnotized part" experiences reduced pain. A second group of 8 subjects was given the opposite expectation concerning "hidden-pain"--that their "hidden part" would feel less pain than their "hypnotized part." Results were unambiguous. Subjects expecting high levels of "hidden" pain reported high levels whereas those expecting little "hidden" pain reported low levels. These results are inconsistent with the notion that "hidden" reports reflect the intrinsic activity of a "dissociated state." Instead, they indicate that "hidden" reports result from subjects' attempts to convincingly enact the role of "good hypnotic subject" as this role is defined for them by the experimental procedures they undergo.

Awareness↗

The effects of hypnotic suggestion on pain report.

Forty-five highly susceptible volunteers rated a series of shocks using 32 pain descriptors. Descriptors were given numerical values using magnitude estimation procedures. We assigned the subjects to one of three conditions, analgesia suggestion, relaxation suggestion, or no suggestion. All subjects were administered the shocks and the suggestion appropriate to the group, in both the waking and hypnotic state. The results support the existence of two dimensions of pain which are differentially responsive to suggestion. Hypnotic-analgesia suggestion altered subjects' perceptions of the intensity without changing their perceptions of the unpleasantness of the shocks. Hypnotic-relaxation suggestion reduced the unpleasantness but not the perceived intensity of the stimuli. These findings imply that research into hypnotic pain relief is more easily interpreted if pain is viewed as multidimensional in nature.

Analgesia↗

A validation study of a short-form hypnotic-experience questionnaire and its relationship to hypnotizability.

This study investigated the validity of a 16-item scale inquiring about hypnotic experience, drawn from the Hypnotic Experience Questionnaire developed by Kelly (1985) to measure components of hypnotic experience. We administered the HEQ-S and the Harvard Group Scale of Hypnotic Susceptibility: Form A (HGSHS:A) to 198 students. Factor analysis of the scale produced three stable principal components accounting for 70% of the data variance: Dissociation/Altered State (DAS), Rapport (RAP), and Relaxation (REL). Subscales representing these three factors and a composite measure, "General Depth," were constructed. Subscale correlations with HGSHS:A scores were highest for the DAS subscale (.69) and lowest for REL (.41). Applications of the HEQ-S in clinical and research use are considered.

Adult↗

Literalism and hypnosis: hypnotic versus task-motivated subjects.

To extend previous literalism research with hypnotized and simulating subjects, we compared literalism rates of hypnotized, highly hypnotizable subjects (N = 12) with nonhypnotized, task-motivated subjects (N = 12) who were also highly hypnotizable. Six questions of the type used by Erickson (e.g., "Do you mind telling me your name?") constituted tests of literalism (scored if response is "Yes" or "No," either verbally or nonverbally). Whereas Erickson claimed that 97% of his "deep trance" subjects and 90% of his "medium trance" subjects exhibited literal responses, we found that 87.5% of hypnotized, high-hypnotizable subjects' responses were nonliteral. Hypnotized and task-motivated subjects did not differ in their literal responding to the individual questions or when their scores were summed across questions. No support was secured for Erickson's assertion that literalism is a cardinal feature of hypnosis.

Adult↗

Hypnotic age regression in an experimental and clinical context.

The aim of the present study was to investigate the role of a clinical context in the experience of hypnotic age regression. Twenty-five patients experienced hypnotic age regression in an experimental and clinical context in counterbalanced order. Patients obtained significantly lower scores for experimental age regression than for clinical age regression, in particular when the experimental assessment preceded the clinical assessment of age regression. Moreover, scores for clinical and experimental age regression were only significantly and positively correlated when the clinical assessment of age regression preceded the experimental assessment. These findings give a tentative indication that more patients are able to experience clinical age regression than can be predicted from their responses to an experimental suggestion for hypnotic age regression where almost no opportunities for patient contact or maximizing of hypnotic responsiveness are provided.

Adult↗

The relationship between memory, suggestibility and hypnotic responsivity.

This study investigated the relationship between resistance to misleading information and performance on the Harvard Group Scale of Hypnotic Susceptibility (HGSHS:A), and examined the impact of obtrusive observation on subjects' hypnotic responsivity, memory, and resistance to misleading information. Eighty-five college students were administered the HGSHS:A in its standard form. Three additional bogus items were added to the HGSHS:A response booklet asking subjects to report whether they responded to suggestions that were not actually offered during the procedures. The endorsement of these items was used as an index of resistance to misleading information (suggestibility) for events occurring during hypnosis. Participants were also given a series of misleading questions related to events that occurred prior to the induction. Results indicated that performance on the HGSHS:A was not related to resistance to misleading information for events occurring during hypnosis or for events that occurred prior to the induction. As predicted, resistance to misleading information was consistent for subjects across the waking and hypnotic contexts. Also as predicted, being observed during the hypnotic procedures was related to lower scoring on the HGSHS:A.

Adolescent↗

Filled versus empty intervals in prospective hypnotic time estimation with a real-simulator design.

While interest in hypnotic time perception dates back to the 19th century (St. Jean, 1989) only recently have researchers focused on hypnosis and time estimation under more controlled conditions. Following the work of Jasinski (1986) and Mozenter and Kurtz (1992) we predicted a 2-way interaction between Group (high hypnotizable, low hypnotizable, and simulator) and Condition (waking, hypnotized) across 3 time intervals (30, 60, and 120 seconds). It was further hypothesized that "filled" intervals (with white noise) would be perceived as longer than "empty" intervals across all conditions. Sixty-two undergraduates were screened on the Stanford Hypnotic Susceptibility Scale: Form C and verbally estimated time intervals of 30, 60, and 120 seconds, 5 times each, both while in a waking and a hypnotic condition. Support was found for the predicted 2-way interaction for women only. High hypnotizable women showed a significant increase in overestimation from the waking to hypnosis condition, men did not. The predicted difference between "filled" versus "empty" intervals was not found.

Acoustic Stimulation↗