Hypnotherapy Information

Author: Adam Eason, UKHC Strategy Officer

“Go into any large bookshop nowadays and you will most likely find that their shelves are liberally stocked with books about hypnosis, and its numerous applications. Pick out any such book at random, open it anywhere and look anywhere on the page. The chances are that what you are reading is plainly wrong, is misleading, is questionable, has little support, or requires significant qualification for it to be accepted as a valid statement.” (Heap, ‘Hypnosis: the modern perspective’, 2006)

This quote by hypnosis academic and researcher Michael Heap demonstrate some of the difficulties that the field of hypnosis faces when attempting to explain hypnosis to the public. With media portrayals and lay-professionals perpetuating myth and misconception, hypnosis is often described in non-evidence based ways.

Defining Hypnosis:

Typically, the term “hypnosis” means an interaction between an individual, the ´hypnotist´, and another individual, the ´subject´. Within this collaborative interaction the hypnotist will educate and inform the subject about hypnosis and they subsequently work together to create a therapeutic change in perceptions, feelings, thinking and behaviour. The hypnotist will give ´suggestions´ to the subject who also actively uses related imagery, which aims to bring about therapeutic change.

To date, there is no single universally accepted definition of hypnosis, it has historically proven very difficult to garner agreement upon and much myth and misconception still circulates and populates the public consciousness. Here are some of the well-known definitions given by popular authors from the field of hypnosis;

“Hypnosis is an altered state of awareness in which the individual withdraws his peripheral awareness and concentrates all attention on a focal goal… is related to the ability to concentrate in an attentive, responsive manner, even to the point of dissociation” (Spiegel, 1972).

“…a communication of ideas and understandings to a patient in such a fashion that he will be most receptive to the presented ideas and thereby motivated to explore his own body potentials for the control of his psychological and physiological responses and behaviour” (Erickson & Rossi, 1980)

“Hypnosis is a procedure during which a health professional or researcher suggests that a client, patient, or subject experience changes in sensations, perceptions, thoughts, or behavior. The hypnotic context is generally established by an induction procedure. Although there are many different hypnotic inductions, most include suggestions for relaxation, calmness, and well-being. Instructions to imagine or think about pleasant experiences are also commonly included in hypnotic inductions”. (Irving Kirsch 1994)

“The term hypnosis´ is used to denote an interaction between two people (or one person and a group) in which one of them, the hypnotist, by means of verbal communication, encourages the other, the subject or subjects, to focus their attention away from their immediate realities and concerns and on inner experiences such as thoughts feelings and imagery. The hypnotist further attempts to create alterations in the subjects´ sensations, perceptions an, feelings, thoughts and behaviour by directing them to imagine various events or situations that, were they to occur in reality, would evoke the intended changes” (Heap & Aravind 2002)

If you’d like to examine and understand in more depth the issues related to definitions of hypnosis, then a paper entitled ‘Definitions of Hypnosis and Hypnotizability and Their Relation to Suggestion and Suggestibility’ (Kirsch et al, 2011) is available.

You might also benefit from reading this article by Dr Matthew Whalley.

We also recommend reading Hypnosis: The Modern Scientific Perspective By Michael Heap

Here is the American Psychological Association’s definition of hypnosis. This short explanation outlines a scientific account of hypnosis which attempts to avoid some of the theoretical disagreements.

APA 2003 / 2007 The Division 30 Definition and Description of Hypnosis:

“Hypnosis typically involves an introduction to the procedure during which the subject is told that suggestions for imaginative experiences will be presented. The hypnotic induction is an extended initial suggestion for using one´s imagination, and may contain further elaborations of the introduction. A hypnotic procedure is used to encourage and evaluate responses to suggestions. When using hypnosis, one person (the subject) is guided by another (the hypnotist) to respond to suggestions for changes in subjective experience, alterations in perception, sensation, emotion, thought or behavior. Persons can also learn self-hypnosis, which is the act of administering hypnotic procedures on one´s own. If the subject responds to hypnotic suggestions, it is generally inferred that hypnosis has been induced. Many believe that hypnotic responses and experiences are characteristic of a hypnotic state. While some think that it is not necessary to use the word “hypnosis” as part of the hypnotic induction, others view it as essential.Details of hypnotic procedures and suggestions will differ depending on the goals of the practitioner and the purposes of the clinical or research endeavor.

Procedures traditionally involve suggestions to relax, though relaxation is not necessary for hypnosis and a wide variety of suggestions can be used including those to become more alert. Suggestions that permit the extent of hypnosis to be assessed by comparing responses to standardized scales can be used in both clinical and research settings. While the majority of individuals are responsive to at least some suggestions, scores on standardized scales range from high to negligible. Traditionally, scores are grouped into low, medium, and high categories. As is the case with other positively-scaled measures of psychological constructs such as attention and awareness, the salience of evidence for having achieved hypnosis increases with the individual´s score.”

Prominent Models of Hypnosis:

A number of approaches have adopted taken to explain hypnosis and models developed accordingly. Here are some brief explanations of the more prominent models and explanations of hypnosis. There are other models and other explanations and this is by no means exhaustive.

1. The Neuroscience Perspective of Hypnosis

Recent functional neuroimaging studies show that brain activity varies when a task is performed in a waking state and again under hypnosis. Also, hypnotic suggestions can alter neural activity, most notably in pain and colour perception.

Pain is a complex, subjective phenomenon. To define pain, researchers therefore measured brain activity and found characteristic neural activity patterns commonly referred to as “pain matrix” (Peyron et al., 2000). Several studies used positron emission tomography (PET) to determine cerebral structures under pain, both in normal conditions and under hypnosis. Rainville and colleagues performed a series of experiments where the subjects – waking and again hypnotised – left one hand immersed in either neutral or hot water and in painfully hot water under hypnosis with suggestion. In the latter condition, suggestions for high or low unpleasantness of pain were given. Results showed characteristic changes in regional cerebral blood flow (rCBF) when hypnotised with or without suggestions. These conditions, Rainville et al. (1999) concluded that the changes in rCBF reflect different emotional reactions (i.e. of high/low unpleasantness) to pain perception in hypnotic consciousness. Using PET monitoring of brain activity, Faymonville (2003) recently found that pain perception of highly-sensitive subjects was reduced by 50% when hypnotised.

There is wide evidence that hypnosis and suggestion can influence brain activity patterns underlying colour perception and colour naming. This is usually demonstrated on the base of the ‘Stroop task’, a standardised cognitive exercise where the subject is presented with a series of coloured dots (1) and coloured words (2).

For each series, the task is to name the colour the symbols are printed in. This means, if in a series of coloured words, the word reads “blue” but is coloured in red, the correct answer is “red”.

Measuring the subject’s response time, Stroop (1935) found a significant gap while completing task (1) and (2), the latter taking the subjects longer to respond (so-called ‘Stroop effect’).

On the grounds of Stroop’s results, Amir Raz and colleagues (2005) undertook an experiment to demonstrate that the Stroop effect can be manipulated by hypnosis. Highly- suggestible subjects performed the critical task (2) much faster in hypnosis than in the waking state, in fact reducing the Stroop effect to a minimum.

“Mean ERP (i.e. effective refractory period) and derived source waveforms from eight highly suggestible individuals (±1 SE). (A and B) Midoccipital (A) and midfrontal (B) activity under both no-suggestion and a specific posthypnotic suggestion to view Stroop words as meaningless” (see functional magnetic resonance imaging, fMRI).

2. Dissociation and neo-dissociation theory

The so-called “Dissociated control theory of hypnosis” (DCT) is based on the model of executive control developed by Donald Norman and Tim Shallice (1986), which gives a framework for the understanding of human actions. All human actions can be divided into either automatic or willed actions. Automatic actions are performed without interference of supervisory attention control. Having learned a number (although a finite number) of functional schemata, familiar, recurrent situations are managed by automatically following the appropriate scheme, allowing the person to perform a determined thought and action sequence without active attention control. Only when the individual is confronted with complex novel situations and preexisting schemata are failing, a Supervisory Attentional System (SAS) is called to action. The SAS allows a conscious, strategical planning of a series of thoughts and actions to solve complex non-routine problems, i.e. it plans willed actions.

Woody and Bowers (1994) tested the functioning of automatic vs. willed executive control in subjects under hypnosis. They found that SAS was disabled in highly-hypnotisable individuals, leaving the subject unable to perform willed actions under hypnosis, instead being lost in automatised action schemes (see DCT).

It is therefore, Woody and Bowers concluded, that any cues or suggestions from the hypnotist are followed automatically, without resistance.

However, DCT does not stand all further testing as conducted by Jamieson et al. (2004). Asking subjects with high vs. low susceptibility to perform an enhanced

Stroop task under hypnosis (the task requiring strong SAS involvement), it resulted that highly susceptible subjects produced significantly more errors than low susceptibles, as predicted by DCT. Other tests (Jamieson, 2007) showed evidence that – contrary to DCT – supervisory attention control does still exist to some extent under hypnosis.

Dissociation theories of hypnosis generally ground on the idea that the hypnotic mind is in another state than the waking mind. The so-called “state theory” was originally represented by Pierre Janet, director at the Salpêtrière in Charcot’s time. Janet assumed that hypnosis dissociated the individual’s awareness and behavioural control.

A modern (“neo”-) dissociation theory was suggested by Weitzenhoffer and Hilgard (1959), after studying hypnotised subjects in 12 suggestion tests. Hypnotic induction (following a standardised eye-fixation method) was presumed to split the executive control system (ECS), where part of it still continues to function normally, nonetheless unconsciously (“amnesic barrier”). The dissociated part of the ECS can be manipulated with hypnotic suggestions, and the subject may even react to these suggestions with complex actions which require executive control in the waking state. However, under hypnosis there exists a complete unawareness of the process by which these actions come about. In one experiment, Hilgard (1973) subjected his testees to a bath in ice water under the hypnotic suggestion of analgesia. In consequence, they did not utter feelings of pain or being cold. Nevertheless, 70% lifted their fingers, when asked to do so if they felt pain. Hilgard concluded that hypnotic suggestion can act only on part of the ECS.

3. Cold control theory

Dienes’ and Perner’s (2007) “cold control theory” again draws on the different states of consciousness under hypnosis. Using Rosenthal’s (2008) higher-order theory of consciousness, which distinguishes between states and awareness about states on different levels of reflection, Dienes and Perner saw the hypnotised subjects able to form intentions to perform actions or the hypnotist required; however, it lacks any awareness about its own intentions, contray to the ‘normal’ state of consciousness. From here stems the experience of easiness and involuntariness of actions under hypnosis, stressed as the ‘classical suggestion effect’ by Weitzenhoffer (1980).

4. Sociocognitive perspectives of hypnosis

In contrast to the ‘state’ theories’ above, ‘non-state’ theories do not describe hypnosis as an “altered state of consciousness” but rather emphasise the similarity of the conscious and hypnotic mind. Hypnosis is not seen as the effect of some sort of ‘sleep’ or ‘trance’, but as mere role-enactment.

The pioneer of this idea was Theodore Sarbin (1972). He argued that the subject has concepts of an hypnotisee’s role, even before being hypnotised. Therefore, when subduing to hypnotic manipulations, it will act and feel ‘as if’ being hypnotised, i.e. it will not only follow the role of a ‘typical’ hypnotisee, but also identify with it. Sarbin’s results indicated that hypnosis may be nothing else than a learned social behaviour. Accordingly, Barber et al. (1974) saw susceptibility to hypnosis does imply self-motivation, compliance, relaxation, in all a “positive cognitive set” before the induction. In this perspective, hypnosis is a cognitive-behavioural process.

Most prominently, it was Spanos (1986) who elaborated on strategic role enactment under hypnosis. Rather than experiencing a special state of dissociation, the hypnotic subject actively transforms its feelings, thoughts and behaviour congruent with its concept of the hypnotic role. ‘Being hypnotised’ consequently is a self-constructed role, shaped after social models and expectancies.

From here, Kirsch et al. (1997) concluded that hypnotic reactions differ from willed, attention controlled reactions only in perception. Whereas the subject usually acts in its own responsibility, during hypnosis it attributes will power and control to an external source, i.e. the hypnotist. Therefore, actions performed under hypnotic suggestions are experienced as involuntary.

No definition of hypnosis

Modern studies have effectively deconstructed all traditional notions of hypnosis. To date, there does not exist a consistent definition of hypnosis, only concurrent theories. Here at the Professional Hypnotherapy Network, our ethos is to adhere to the evidence base as much as is possible and for members of the public to benefit from the evidence based applications used by our members as much as possible.

References:

K.S. Bowers: Imagination and dissociation in hypnotic responding. In: International Journal of Clinical and Experimental Hypnosis 40 (1992) 253–275.

E. Woody, K.S. Bowers K: A frontal assault on dissociated control. In: Steven Jay Lynn, Judith W. Rhue (ed.s): Dissociation. Clinical and theoretical perspectives. New York 1994. 52–79.

Zoltán Dienes, Josef Perner: Executive control without conscious awareness. The cold control theory of hypnosis. In: G.A. Jamieson (ed.): Hypnosis and conscious states. The cognitive neuroscience perspective. Oxford 2007. 293–314.

M.E. Faymonville et al.: Increased cerebral functional connectivity underlying the antinocioceptive effects of hypnosis. In: Cognitive Brain Research 17 (2003) 255–62.

Ernest Hilgard: A neurodissociation interpretation of pain reduction in hypnosis. In: Psychological Review 80 (1973) 396–411.

Ernest Hilgard, H.J. Crawford, A. Wert: The Stanford Hypnotic Arm Levitation Induction and Test (SHALIT). A six minute hypnotic induction and measurement scale. In: International Journal of Clinical and Experimental Hypnosis 27(2) (1979) 111–124.

Graham Jamieson, P.W. Sheehan: A critical evaluation of the relationship between sustained attentional abilities and hypnotic susceptibility. In: Contemporary Hypnosis 19 (2002) 62–74.

G.A. Jamieson, P.W. Sheehan: An empirical test of Woody and Bowers’s dissociated-control theory of hypnosis. In: Int J Clin Exp Hypn 52,3 (2004) 232–249.

Graham Jamieson: Hypnosis and conscious states. The cognitive neuroscience perspective. Oxford 2007.

Donald Norman, Tim Shallice: Attention to action: willed and automatic control of behaviour. In: R.J. Davidson, G.E. Schwartz, D. Shapiro (ed.s): Consciousness and self-regulation: Advances in research and theory. Plenum Press 1986.

R. Peyron, R., B. Laurent, B., L. Garcia-Larrea, L.: Functional imaging of brain responses to pain. A review and metaanalysis. In: Neurophysiologie Clinique 30 (2000) 263–288.

P. Rainville, D.D. Price: Cerebral mechanisms of hypnotic induction and suggestion. In: Journal of Cognitive Neuroscience 11 (1999) 110–125.?– –: Hypnosis phenomenology and the neurobiology of consciousness. In: International Journal of Clinical and Experimental Hypnosis 51 (2003) 105–129.

Amir Raz, Jin Fan, Michael I. Posner: Hypnotic suggestion reduces conflict in the human brain. In: ProcNatlAcadSciUSA 102 (7/2005) 9978–9983.?– –: Hypnotic suggestion and the modulation of the Stroop interference. In: Arch. Gen. Psychiatry 59 (2002) 1155–1161.

John Ridley Stroop: Stroop, John Ridley (1935). Studies of interference in serial verbal reactions. In: Journal of Experimental Psychology 18,6 (1935): 643–662.

David Rosenthal; Josh Weisberg: Higher-order theories of consciousness. In: Scholarpedia 3,5 (2008) 54407.

André Muller Weitzenhoffer, Ernest Hilgard: Stanford Hypnotic Susceptibility Scales, Forms A and B. Palo Alto, CA 1959.

Ernest Hilgard: A neurodissociation interpretation of pain reduction in hypnosis. In: Psychological Review 80 (1973) 396–411.

Ernest Hilgard, H.J. Crawford, A. Wert: The Stanford Hypnotic Arm Levitation Induction and Test (SHALIT). A six minute hypnotic induction and measurement scale. In: International Journal of Clinical and Experimental Hypnosis 27(2) (1979) 111–124.

André Muller Weitzenhoffer: Hypnotic susceptibility revisited. In: American Journal of Clinical Hypnosis 22 (1980) 130–146.

Theodore Sarbin, William Coe: Hypnosis. A Social psychological analysis of influence communication. Dumfries, 1972.

Theodore Xenophon Barber, Nicholas P. Spanos, John F. Chaves: Hypnosis, imagination, and human potentialities. Oxford 1974.

N.P. Spanos: Hypnosis and the modification of hypnotic susceptibility. A social psychological perspective. In: P. Naish (ed.): What is hypnosis? Philadelphia 1986, 85–120.

I. Kirsch, S.J. Lynn: Hypnotic involuntariness and the automaticity of everyday life. In: American Journal of Clinical Hypnosis 40 (1997) 329–348.