# Hypnosis: Theory and Application Part I and 2



## eric (Jul 8, 1999)

Harvard Health"Hypnosis: Theory and Application Part IAlthough it has been familiar for more than 200 years as a means of entertainment, self-help, and psychotherapy, hypnosis is still a misunderstood practice and the hypnotic experience an elusive state of mind. Most of us think we know what it is to be hypnotizedï¿½until we are asked. But by now enough research has been conducted and enough knowledge accumulated to make it clear that hypnosis is neither a parlor trick nor an occult phenomenon. The ExperienceThe term ï¿½hypnosis,ï¿½ invented in the 19th century, is derived from the Greek word for sleep, but the derivation is misleading. Subjects are often physically relaxed, and they may be told to close their eyes to enter a hypnotic state, but all the while they are fully awake and alert. The best descriptions point to three related features of hypnosis: absorption or selective attention, suggestibility, and dissociation. Selective attention is a tendency to focus narrowly, noting certain aspects of experience while becoming oblivious to others. Suggestibility is high responsiveness to social and other environmental cues, including the instructions of a hypnotist. Dissociation is an apparent loss of the unity and continuity of consciousnessï¿½a seemingly divided awareness or the capacity to shut out certain perceptions and memories. Vivid and unusual phenomena may occur under hypnosisï¿½automatic writing, negative hallucinations (not seeing something that is clearly there), and reliving the distant past as though it were present. During hypnotic age regression, subjects may talk and act like small children while responding like adults to a command to move forward and backward through time. Their physical reactions may indicate pain while they say they donï¿½t feel it. They sometimes have apparent amnesia for the experience or respond to posthypnotic suggestionï¿½instructions given during the hypnotic state to be obeyed afterward on the snap of a finger or other cue. Inducing the state generally takes 10ï¿½20 minutes (sometimes only seconds), and there are many ways to do it. Perhaps the best known is to have the subject stare at a target like a swinging pocket watch or a dot on a blank sheet of paper. Or the subject may be helped to relax and then repeatedly told in a rhythmic and monotonous voice something like, ï¿½Your eyelids are getting heavy.ï¿½ Sometimes it is enough just to repeat, ï¿½Relax, focus, float.ï¿½ Visual imagery may be used to deepen the trance: ï¿½Imagine riding down a long escalator.ï¿½ There are also many indirect ways of diverting and fixing attention. Some practitioners even claim to be able to induce hypnosis over the telephone. To end a session, the hypnotist simply tells the subject to come out of it. Hypnosis is not mind control. People in a hypnotic trance may feel as though their actions are compelled, and they usually respond to instructions and requests from the hypnotist. But hypnotists have no special powers, and they are not necessarily charismatic or flamboyant. Stage magicians, as everyone knows, can get volunteers to do entertainingly ridiculous things. But people cannot be hypnotized against their will or obliged to do or say anything that conflicts with their moral standards or seriously offends their sense of decorum. And they can usually bring themselves out of the hypnotic state whenever they want. In fact, hypnosis does not require a hypnotist. Some people become hypnotized spontaneously as they lose themselves in daydreams or drifting thoughts or become deeply absorbed in work or play. Most can also learn to hypnotize themselves deliberately. The hypnotist is just an instructor or guide. In an important sense, hypnosis is always self-hypnosis. HypnotizabilityResearchers have devised tests of hypnotic susceptibility and scales to measure it, mostly involving the ability to hallucinate, alter physical sensations, forget and remember in unusual ways, and produce seemingly involuntary movements or paralysis. Some common tests are the ability to roll the eyes far upward, the willingness to fall backward on command, the capacity to produce a feeling that an arm or leg is paralyzed or levitating, the capacity to conjure up a sweet taste in the mouth, and the capacity to show no signs of pain when pricked with a pin. Subjects may be told they have no sense of smell and then watched as a bottle of ammonia is waved in front of their noses. There is some dispute about whether these tests are definitive and even whether hypnotic susceptibility can be measured on a single scale. Still, researchers generally agree that individual differences in the capacity to respond to hypnosis exist and are remarkably stable over a lifetime. The capacity peaks at ages 5ï¿½10 and then slowly declines until it levels off in the early 20s. Studies comparing identical and fraternal twins indicate that hypnotizability is highly heritable. It is estimated that, by standard scales, about 90% of us can achieve at least a light hypnotic state, while 10%ï¿½20% are highly (or deeply) hypnotizable, and 10%ï¿½15% are not susceptible at all. It is less clear what kinds of people are most easily hypnotized. It is often said, and seems intuitively plausible, that the best subjects are imaginative, trustful, and emotionally unguarded rather than literal-minded, skeptical, and cautious. But personality tests do not consistently indicate these characteristics, so the issue remains in doubt. Theories of HypnosisA related doubt concerns the nature of hypnosisï¿½whether it is a distinct state of consciousness and how it differs from other experiences of relaxation, suggestion, and imaginative absorption. The most influential theories of hypnosis emphasize dissociation, which is said to explain the amnesia of hypnotic subjects and the fact that they often say their actions are not willed but happening spontaneously. Further evidence for dissociation comes from experiments indicating a so-called ï¿½hidden observer.ï¿½ For example, the hypnotist instructs a subject that he or she is deaf and then says, ï¿½Although you are deaf, perhaps part of you can hear. If so, raise your finger.ï¿½ The finger rises. When asked later, the subject says he heard nothing but suddenly felt his finger rise. The experiment suggests that two distinct systems of consciousness are operating, separated by a partial or total barrier of amnesia. A different understanding is reflected in the social-cognitive theory of hypnosis, which emphasizes suggestibility rather than dissociation. Social-cognitive theorists interpret the hypnotic trance not as an altered state of consciousness but as one striking effect of the human susceptibility to social influence. Their idea is that the hypnotist and the subject have entered into an implicit agreement that certain things will be allowed to happen and the subject will describe or confirm certain experiences. The subject responds to these ï¿½demand characteristicsï¿½ of the situation, doing and saying what is expected to win the hypnotistï¿½s approval. The hypnotic trance is a performanceï¿½not mere playac ting but the sincere adoption of a role. If this view is correct, hypnotic susceptibility is a result of willingness to comply with suggestions, sensitivity to nuances in personal communication, and a high capacity for sincere make-believe and self-dramatization. Social-cognitive theorists say that they can increase or decrease a personï¿½s apparent hypnotic susceptibility simply by changing the instructions and therefore the subjectï¿½s expectations. For evidence, they rely heavily on experiments with people who, according to standard tests, are not easily hypnotized. When these simulators pretend to be hypnotized and act accordingly, they are said to respond just like a person in a ï¿½genuineï¿½ trance. Social-cognitive theorists add that the hidden observer of dissociation theory is not real but a product of suggestion that can also be manipulated by changes in the instructions. Apparent individual differences in hypnotic susceptibility are explained by differences in suggestibility and in the expectations brought to the situation. In response, advocates of the dissociation theory argue that people who are pretending to be hypnotized respond to suggestions only when they are being observed, unlike people who are truly hypnotized. Also, some people who are told to pretend may actually go into a trance, and susceptibility to social influence may itself sometimes be a hypnotic effect. Some believe the dispute between the theories cannot be resolved, because in the end there is no difference between entering a special state of consciousness and immersing oneself in a performance so deeply that it is no longer experienced as playacting. In either case there are likely to be signs of imaginative absorption, divided attention, and selective recall. Resources A therapeutic hypnotist should be a licensed practitioner in one of the mental health professionsï¿½psychology, psychiatry, social work, or psychiatric nursing. The following organizations train and license therapists who use hypnosis and provide referrals for hypnotic therapy. American Society of Clinical Hypnosis, 130 East Elm Court, Suite 201, Roselle , IL 60172-2000 . Telephone: 630-980-4740 . On the Web: http://www.asch.net. Society for Clinical and Experimental Hypnosis, Washington State University, P. O. Box 642114, Pullman , Washington 99164-2114 . Telephone: 509-332-7555 . On the Web: http://www.hypnosis-research.org Hypnosis: Theory and Application Part IIIn Part I we described the hypnotic experience and discussed theories about its nature. This month we cover the results of brain imaging studies and the therapeutic uses of hypnosis. Research has shown that brain activity often changes during the hypnotic state. The brainï¿½s response to pain is reduced, and many hypnotic subjects have high electrical activity of the type that indicates a relaxed state in the left frontal region of the cerebral cortex, which controls planning and decision-making. In one experiment, hypnotized volunteers were instructed to put their hands in hot water and told how intensely to experience the pain. Positron emission tomography (PET) scans showed that changes in pain perception were correlated with changes in blood flow to the anterior cingulate gyrus, a region involved in the control of attention and the relationship of emotions to perceptions. Activity in that area increased in response to a suggestion that the pain was becoming worse and decreased in response to a suggestion that it was milder. Seeing HypnosisAnother experiment using PET scans shows a different correlation between the hypnotic state and brain activity. Volunteers chosen for high hypnotic susceptibility were shown a grid of colored squares, then told they were colorblind and able to see only shades of gray. They performed the experiment both while hypnotized and while not under hypnosis. When they were not hypnotized, blood flow and energy consumption were reduced in color vision areas of the brain, but only in the right hemisphere of the cerebral cortex. Under hypnosis, color vision areas lost blood flow in both hemispheres. If the subjects were not told they were colorblind but simply asked to visualize the images as gray, only the right hemisphere was affected. All the same effects occurred in reverse when subjects were presented with a black-and-white grid and instructed to see it in color. If this result is confirmed, it will be evidence that the hypnotic experience and the exercise of visual imagination correspond to different states of the brain. These experiments do not resolve the dispute about the nature of hypnosis, because other forms of absorption and concentration might produce similar effects. But the brain imaging research at least suggests that hypnotism has a real neurophysiological correlate. Hypnotic TherapyDespite their limited understanding of the nature of hypnosis, physicians and psychotherapists recommend it to manage stress, change physical sensations, and heighten emotional sensitivity. Altered states of consciousness that might now be called hypnotic have been a part of religious and healing rituals for thousands of years. Meditative techniques like the yogic mantra rely on similar procedures. In the late 19th century, Pierre Janet used hypnotic suggestion to reproduce the forms of mind-created anesthesia and paralysis that occur in patients with conversion disorders (at that time called hysteria). He introduced the term ï¿½dissociation of consciousnessï¿½ to describe the condition. Freud was influenced by Janetï¿½s work, and although he eventually abandoned the practice of hypnosis, it left a mark on his idea of the dynamic unconscious. Today, the popularity of therapeutic hypnosis is sustained by the increasing interest in mind-body connections and alternative medicine. Hypnotic therapy attempts to take advantage of hypnotic subjectsï¿½ high sensitivity both to their own sensations and feelings and to everything the hypnotist says and does. One approach is simply to suggest that symptoms will go away. The results are rarely lasting, although even temporary relief can be important in some situationsï¿½acute illness or surgery, for example. Today, hypnosis is also applied in subtler ways, to help patients not by controlling them but by helping them take control. Therapists teach patients self-hypnosis and encourage them to make up their own suggestions. Hypnotic techniques are almost always used not alone but as an aid to psychotherapy or medical treatment. Despite Freudï¿½s rejection of hypnosis, some psychodynamic therapists have hypnotized patients to generate emotional reactions for examination, liberate fantasies and associations, retrieve memories, and accelerate the establishment and resolution of the transference (the relationship between patient and therapist that recapitulates earlier emotional ties). However, there is little evidence that these methods are effective, and they pose some danger of evoking unmanageable emotional reactions. In behavior therapy and cognitive therapy, hypnosis is used to enhance relaxation, generate imagery, heighten the expectation of success, and alter self-defeating thoughts. It can facilitate covert reinforcement, in which a patient imagines a reward after imagining the desired actions; and desensitization, in which relaxation and imagery are used to relieve anxiety and eliminate phobias. Therapeutic UsesOne of the best confirmed therapeutic uses of hypnosis is the control of pain. Under hypnosis, patients can learn to alter their experience of pain by concentrating on the other parts of the body or making the painful area feel numb, warm, or cold instead. Images can be invokedï¿½a switch turning off the pain, an ice cube cooling an aching head, a vision of teeth being removed from the mouth before a dentist goes to work. Hypnosis can reduce the discomfort of medical procedures and, at least partially, control the pain of chronic backache, migraine, childbirth, and cancer. Hypnotic techniques have also been used with varying success to treat other physical symptoms, including bedwetting, sexual problems, asthma, warts, gastrointestinal disorders, and side effects of chemotherapy. Hypnosis has not proved effective for alcohol and drug addictions, although some practitioners believe it can help smokers quit. In the treatment of anxiety and phobias, hypnosis may serve to dissociate physical discomfort from mental anxiety and prevent a spiral of physical and emotional distress. Many people with phobias can use self-hypnosis to help master their fears. Hypnotic methods are also used to treat physical symptoms complicated by anxiety; for example, people with asthma can be taught to control their reactions to breathing difficulties. Hypnosis has been used in the treatment of post-traumatic stress disorder (PTSD) since World War I, when it was introduced as a therapy for shell-shocked soldiers. Experiences like combat, rape, assault, and child abuse often cause pervasive demoralization. Victims feel helpless, emotionally numb, and compelled to avoid reminders of the traumatic event. The experience returns in the shape of nightmares, flashbacks, and involuntary memories. Therapists who advocate hypnotic treatment describe it as a safe, comfortable, and voluntary form of dissociation that can help people suffering from post-traumatic symptoms to interrupt and control intrusive reliving experiencesï¿½and eventually, in some cases, to confront the past and free themselves from it. Dissociative identity disorder (formerly known as multiple personality disorder) is a controversial diagnosis given to people who, apparently because of severe child abuse, have lost access to various aspects of identity, memory, and consciousness. They may describe themselves as possessed, or abruptly enter altered states of consciousness in which they seem to adopt new personalities. These patients are highly hypnotizable, and hypnosis or self-hypnosis has been used to help them integrate disparate personalities by breaking the barriers of amnesia. Hypnosis and MemoryCritics are concerned that a focus on recovering memories and reliving experiences will divert attention from the need to change present behavior, improve general functioning, and reduce symptoms in patients with PTSD or dissociative identity disorder. The hypnotic treatment of people suffering from the after effects of child abuse is particularly controversial because of fears that the recovered memories will be fictions resulting from suggestion acting on an all too lively imagination. There is some evidence that hypnotically induced memoriesï¿½often vivid, emotionally intense, and produced effortlesslyï¿½inspire greater confidence than they deserve. Studies show that hypnosis tends to cause people both to remember and to imagine more, thereby increasing both true and false memories. Responsible psychotherapists warn that autobiographical memories, whether evoked under hypnosis or not, should never be accepted without corroboration as historical truth. Controlled research has found hypnosis helpful in a variety of ways:One study evaluated the effectiveness of self-hypnosis for relieving pain and anxiety in people undergoing local anesthesia for angioplasty and other medical procedures. Compared with a control group, patients trained in self-hypnosis required half the amount of painkilling drugs on average and were less likely to have troublesome variations in blood pressure and heart rate. On average, hypnosis reduced the cost of intravenous sedation by more than $100 per patient and the time needed for the procedure by a third. Another study shows that self-hypnosis can be useful in preparing for childbirth and reducing labor pains. In this study, 66 pregnant adolescents were divided into three groups and assigned to hypnosis preparation, counseling, or standard care beginning in the sixth month of pregnancy. The first group was taught to use labor contractions as a signal to go into a mild hypnotic state. Compared with women in the other two groups, they needed less anesthesia during delivery, took less pain medication afterward, and left the hospital sooner. In a meta-analysis of 18 controlled studies, hypnosis was found to have provided significant pain relief for more than 75% of 900 patients. Another meta-analysis of 18 studies indicated that patients who received cognitive-behavioral therapy along with hypnosis for such problems as pain, obesity, insomnia, anxiety, and high blood pressure showed, on average, greater improvement than 70% of patients who received cognitive-behavioral therapy alone. Therapeutic research and psychological experiments have brought hypnosis out of the realm of magic. The hypnotic experience is not a fraud, not a placebo, not a panacea, but one striking and potentially illuminating effect of a common human capacity to experience changes in consciousness. As brain imaging and other new techniques improve our understanding of hypnosis, we will come to know better when and how it should be used in research and therapy." http://www.health.harvard.edu


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## cookies4marilyn (Jun 30, 2000)

Bump for Sherry


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## cookies4marilyn (Jun 30, 2000)

bump for newbies


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