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Hypnosis Trials 1976 - 1998

Agras WS. Horne M. Taylor CB. Expectation and the blood-pressure lowering effects of relaxation. Psychosomatic Med. 1982; 44(4):389-95 In a study of the blood-pressure-lowering effects of relaxation training in patients with essential hypertension, instructions concerning the relaxation procedure were varied so that one group was told to expect delayed blood-pressure-lowering and the other group immediate lowering. The systolic blood pressure decrease during the training period in the immediate lowering group was 17.0 mm Hg, compared with 2.4 mm Hg for the delayed group (p = 0.001). Diastolic blood pressure changes were not significantly different. Measures of therapy credibility and perceived relaxation failed to differentiate the groups. The implications of these findings for future research and for clinical practice are considered.


Aikins Murphy P. Alternative therapies for nausea and vomiting of pregnancy. Obstetrics & Gynecology 1998;91(1):149-55 OBJECTIVE: To review available evidence about the effectiveness of alternative therapies for nausea and vomiting of pregnancy. DATA SOURCES: MEDLINE and 13 additional US and international data bases were searched in 1996-1997 for papers that described use of alternative medicine in the treatment of pregnancy and pregnancy complications, specifically those addressing nausea, vomiting, and hyperemesis. Bibliographies of retrieved papers were reviewed to identify additional sources. METHODS OF STUDY SELECTION: All relevant English language clinical research papers were reviewed. Randomized clinical trials addressing specifically the use of nonpharmaceutical and nondietary interventions were chosen for detailed review. TABULATION, INTEGRATION, AND RESULTS: Ten randomized trials studying the effects of acupressure, ginger, and pyridoxine on nausea and vomiting of pregnancy were reviewed. Evidence of beneficial effects was found for these three interventions, although the data on acupressure are equivocal. Insufficient evidence was found for the benefits of hypnosis. Other interventions have not been studied. CONCLUSION: There is a dearth of research to support or to refute the efficacy of a number of common remedies for nausea and vomiting of pregnancy. The best-studied alternative remedy is acupressure, which may afford relief to many women; ginger and vitamin B6 also may be beneficial. [References: 36]


Allison DB. Faith MS. Hypnosis as an adjunct to cognitive-behavioral psychotherapy for obesity: a meta-analytic reappraisal. Journal of Consulting & Clinical Psychology 1996;64(3):513-6 I. Kirsch, G. Montgomery, and G. Sapirstein (1995) meta-analyzed 6 weight-loss studies comparing the efficacy of cognitive-behavior therapy (CBT) alone to CBT plus hypnotherapy and concluded that "the addition of hypnosis substantially enhanced treatment outcome" (p.214). Kirsch reported a mean effect size (expressed as d) of 1.96. After correcting several transcription and computational inaccuracies in the original meta-analysis, these 6 studies yield a smaller mean effect size (.26). Moreover, if 1 questionable study is removed from the analysis, the effect sizes become more homogeneous and the mean (.21) is no longer statistically significant. It is concluded that the addition of hypnosis to CBT for weight loss results in, at most, a small enhancement of treatment outcome.


Amigo I, Cuesta V, Fernandez A, Gonzalez A The effect of verbal instructions on blood pressure measurement. Journal of Hypertension 1993 Mar;11(3):293-6 AIM: To determine whether orally delivered instructions can modify the intensity and direction of blood pressure and heart rate fluctuation. METHODS: The blood pressure of 120 subjects, 60 hypertensive and 60 normotensive, was measured before and after oral instructions. The normotensive subjects were selected from a sample of university students and the hypertensive patients were selected at a routine medical screening. Each sample of 60 subjects was randomly divided into four groups of 15. Each subject was left seated alone in a room for 5 min. The researcher then measured the subjects' blood pressure and heart rate. Following this, each group of normotensives and hypertensives was told that their blood pressure would diminish, or that it would not change or that it would increase. The control group was given no instructions. After 5 min the blood pressure and heart were measured again. RESULTS: In the normotensive and hypertensive groups who were told that their blood pressure would increase, systolic blood pressure increased by 4.3 and 2.5 mmHg, respectively. In the groups who were told that their blood pressure would decrease, systolic pressure fell by 7.8 and 7.4 mmHg, respectively. Those who were told that no change would occur showed a systolic pressure decrease of 3.5 and 1.8 mmHg, respectively. In the control groups systolic blood pressure decreased by 5.6 and 4.2 mmHg, respectively. CONCLUSIONS: These results show that oral instructions are a source of variation in the assessment of blood pressure and emphasize the need for 24-h blood pressure monitoring to eliminate this type of variation.


Anderson JA, Basker MA, Dalton R Migraine and hypnotherapy International Journal of Clinical & Experimental Hypnosis 1975;23(1):48-58 Compared the treatment of migraine by hypnosis and autohypnosis with the treatment of migraine by the drug prochlorperazine (Stemetil). Random allocation of 47 patients was made to one or other prophylactic measure, followed by monthly assessments and independent evaluation of 1 yr of continuous care. Criteria of improvement were the number of attacks/month, number who had Grade 4 attacks, and complete remission. Results show that the number of attacks and the number who suffered blinding attacks were significantly lower for the group receiving hypnotherapy than for the group receiving prochlorperazine. For the group on hypnotherapy, these 2 measures were significantly lower when on hypnotherapy than when on previous treatment. Prochlorperazine seemed about as effective as previous treatment. 10 out of 23 patients on hypnotherapy achieved complete remission during the last 3 mo of the trial, compared to only 3 out of 24 on prochlorperazine. It is concluded that further trials of hypnotherapy are justified against some other treatment not solely associated with the ingestion of tablets. (German, French, & Spanish summaries)

Anderson JA. Dalton ER. Basker MA. Insomnia and hypnotherapy. Journal of the Royal Society of Medicine 1979;72(10):734-9

Andreychuk T, Scriver C Hypnosis and biofeedback in the treatment of migraine headache Int J Clin Exp Hypn 1975; 23: 172-3


Anonymous. Hypnosis for asthma--a controlled trial. A report to the Research Committee of the British Tuberculosis Association. BMJ 1968;4(623):71-6 Investigated the use of hypnosis in the treatment of asthma in patients, 10-60 yr. old with paroxysmal attacks of wheezing or tight chest capable of relief by bronchodilators. 1 group was given hypnosis monthly and used autohypnosis daily for 1 yr. Comparisons were made with a control group prescribed a specially devised set of breathing exercises aimed at progressive relaxation. Treatment was randomly allocated and Subjects were treated by physicians in 9 centers. Results were assessed by daily diary recordings of wheezing and the use of bronchodilators, and by monthly recordings of forced expiratory volume (FEV) and vital capacity (VC). Independent clinical assessments were made by physicians unaware of Subjects' treatment. 176 out of 252 patients completed the program. Both treatment groups showed some improvement. Among men the assessments of wheezing score and use of bronchodilators showed similar improvement in the 2 groups; among women, however, those treated by hypnosis showed improvement similar to that observed in the men, but those given breathing exercises made much less progress, the difference between the 2 groups reaching statistical significance. Changes in FEV and VC between the control and hypnosis groups were closely similar. Independent clinical assessors considered the asthma to be better in 59% of the hypnosis group and in 43% of the controls, the difference being significant. There was little difference between the sexes. Physicians with previous experience of hypnosis obtained significantly better results than did those without such experience.


Ashton C Jr. Whitworth GC. Seldomridge JA. Shapiro PA. Weinberg AD.Michler RE. Smith CR. Rose EA. Fisher S. Oz MC. Self-hypnosis reduces anxiety following coronary artery bypass surgery. A prospective, randomized trial. Journal of Cardiovascular Surgery 1997;38(1):69-75 OBJECTIVE: The role of complementary medicine techniques has generated increasing interest in today's society. The purpose of our study was to evaluate the effects of one technique, self-hypnosis, and its role in coronary artery bypass surgery. We hypotesize that self-hypnosis relaxation techniques will have a positive effect on the patient's mental and physical condition following coronary artery bypass surgery. EXPERIMENTAL DESIGN: A prospective, randomized trial was conducted. Patients were followed beginning one day prior to surgery until the time of discharge from the hospital. SETTING: The study was conducted at Columbia Presbyterian Medical Center, a large tertiary care teaching institution. PATIENTS: All patients undergoing first-time elective coronary artery bypass surgery were eligible. A total of 32 patients were randomized into two groups. INTERVENTIONS: The study group was taught self-hypnosis relaxation techniques preoperatively, with no therapy in the control group. MEASURES: Outcome variables studied included anesthetic requirements, operative parameters, postoperative pain medication requirements, quality of life, hospital stay, major morbidity and mortality. RESULTS: Patients who were taught self-hypnosis relaxation techniques were significantly more relaxed postoperatively compared to the control group (p=0.032). Pain medication requirements were also significantly less in patients practising the self-hypnosis relaxation techniques that those who were noncompliant (p=0.046). No differences were noted in intraoperative parameters, morbidity or mortality. CONCLUSION: This study demonstrates the beneficial effects self-hypnosis relaxation techniques on patients undergoing coronary artery bypass surgery. It also provides a framework to study complementary techniques and the limitations encountered.


Ashton RC Jr. Whitworth GC. Seldomridge JA. Shapiro PA. Michler RE.Smith CR. Rose EA. Fisher S. Oz MC. The effects of self-hypnosis on quality of life following coronary artery bypass surgery: preliminary results of a prospective, randomized trial. Journal of Alternative & Complementary Medicine 1995;1(3):285-90 The effects of complementary techniques and alternative medicine on allopathic therapies is generating much interest and research. To properly evaluate these techniques, well controlled studies are needed to corroborate the findings espoused by individuals practicing complementary medicine therapies. To this end, we evaluated the role of one of these therapies, self-hypnosis relaxation techniques, in a prospective, randomized trial to study its effects on quality of life after coronary artery bypass surgery. Subjects were randomized to a control group or a study group. Study group patients were taught self-hypnosis relaxation techniques the night prior to surgery. The control group received no such treatment. Patients then underwent routine cardiac management and care. The main endpoint of our study was quality of life, assessed by the Profile of Moods Scale. Results demonstrated that patients undergoing self-hypnosis the night prior to coronary artery bypass surgery were significantly more relaxed than the control group (p = 0.0317). Trends toward improvement were also noted in depression, anger, and fatigue. This study demonstrates the beneficial effects of self-hypnosis relaxation techniques on coronary surgery. This study also identifies endpoints and a study design that can be used to assess complementary medicine therapies. Results of this preliminary investigation are encouraging and demonstrate a need for further well-controlled studies.


Attias J, Shemesh Z, Sohmer H, Gold S, Shoham C, Faraggi D Comparison between self-hypnosis, masking and attentiveness for alleviation of chronic tinnitus. Audiology 1993;32(3):205-12 The efficacy of self-hypnosis (SH), masking (MA) and attentiveness to the patient's complaints (AT) in the alleviation of tinnitus was evaluated. Forty-five male patients close in age with chronic tinnitus related to acoustic trauma were assigned to three matched subgroups: SH, AT or MA. The therapeutic stimuli in the SH and MA sessions, recorded on audio cassettes, were given to the patients for use when needed. SH significantly reduced the tinnitus severity; AT partially relieved the tinnitus; MA did not have any significant effect.


Aydin S. Ercan M. Caskurlu T. Tasci AI. Karaman I. Odabas O. Yilmaz Y. Agargun MY. Kara H. Sevin G. Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction. Scandinavian Journal of Urology & Nephrology 1997;31(3):271-4 We have examined the effects of acupuncture and hypnotic suggestions, and compared them with placebo in the treatment of male sexual dysfunction with no detectable organic cause. The study comprised 15 men (mean age 36.7 +/- 10.43 years) who received acupuncture treatment, 16 men (mean age 38.4 +/- 10.75 years) who underwent hypnosis (mean age 35.3 +/- 11.52 years) and 29 men (mean age 36.2 +/- 11.38 years) who served as controls. They were interviewed periodically; the patients' reports were verified by interviewing their partners. Men who received placebo had a 43-47% improvement in sexual function, while the rates of improvement in the treated groups were higher, but not significantly so. The success rates of acupuncture and hypnotic suggestions were 60% and 75% respectively. Although the improvement was not statistically significant, treatment with acupuncture could be used as an adjuvant therapy in non-organic male sexual dysfunction. The only treatment superior to placebo seemed to be hypnosis. A more effective treatment may be obtained by combining these therapeutic modalities, but this needs further study.


Aydin S. Odabas O. Ercan M. Kara H. Agargun MY. Efficacy of testosterone, trazodone and hypnotic suggestion in the treatment of non-organic male sexual dysfunction. British Journal of Urology. 1996;77(2):256-60 OBJECTIVE: To examine the effects of hypnotic suggestions or the administration of testosterone or trazodone to impotent men with no detectable organic cause for the impotence. PATIENTS AND METHODS: The study comprised 79 men in whom clinical and laboratory examinations revealed no organic cause for their impotence: 20 men (mean age 38.7 +/- 11.47 years) received testosterone, 21 men (mean age 39.5 +/- 10.73 years) received trazodone, 20 men (mean age 34.2 +/- 11.69 years) underwent hypnosis and 18 men (mean age 39.1 +/- 11.46 years) served as controls. They were assessed by interview 4, 6 and 8 weeks after starting treatment: the patient's reports were verified by interviewing their partners. RESULTS: Men who received a placebo had a 39% improvement in sexual function, while the rates of improvement in the treated groups were higher, but not significantly so. The success rates of testosterone and trazodone treatment and hypnotic suggestions were 60%, 67% and 80%, respectively. CONCLUSION: Although the improvement was not statistically significant, treatment with testosterone and trazodone could be used as an adjuvant therapy in nonorganic male sexual dysfunction. The only treatment superior to placebo seemed to be hypnosis. A more effective treatment may be obtained by combining these therapeutic modalities, but this needs further study.


Baltar Lopez E La autorrelajacion como medio para reducir la algestesia en pruebas diagnosticas dolorosas Natura Medicatrix 1995;41:12-8 It taked place a study of painful perception and psycho-emotional component in two groups of patients in a random selection. It was made bone marrow biopsy and iliac crest myelogram in the patients. In the control group received a session of hypnosis of forty minutes; in this session were trained in autohypnosis technique to be applied in the moment of the painful tests. The comparison of outcomes shows a significant reduction of algesthesia and unpleasant emotions in the experimental group. The application of this technique was workable, effective and inexpensive.


Banerjee S. Srivastav A. Palan BM. Hypnosis and self-hypnosis in the management of nocturnal enuresis: a comparative study with imipramine therapy. American Journal of Clinical Hypnosis 1993;36(2):113-9 Various therapeutic modalities have been used for treating enuresis due to the lack of a single identifiable cause. We carried out a comparative study of imipramine and direct hypnotic suggestions with imagery used for the management of functional nocturnal enuresis. Enuretic children, ranging in age from 5 to 16 years, underwent 3 months of therapy with imipramine (N = 25) or hypnosis (N = 25). After termination of the active treatment, the hypnosis group continued practicing self-hypnosis daily during the follow-up period of another 6 months. Of the patients treated with imipramine, 76% had a positive response (all dry beds); for patients treated with hypnotic strategies, 72% responded positively. At the 9-month follow-up, 68% of patients in the hypnosis group maintained a positive response, whereas only 24% of the imipramine group did. Hypnosis and self-hypnosis strategies were found to be less effective in younger children (5-7 years old) compared to imipramine treatment. The treatment response was not related to the hypnotic responsivity of the patient in either group.


Barabasz AF. Treatment of insomnia in depressed patients by hypnosis and cerebral electrotherapy. American Journal of Clinical Hypnosis 1976;19(2):120-2 Investigated the influence of suggestion on recovery in the treatment of sleep disturbances by cerebral electrotherapy (CET). 60 adult psychiatric outpatients (diagnostic classification--mild depressive neurosis) were randomly assigned to 4 groups. Group A received CET only; Group B received a CET placebo; Group C received CET with hypnosis; and Group D received a CET placebo with hypnosis. Group A reported a significantly higher recovery than Group B, Group C a significantly higher recovery than Group A, and Group D a significantly higher recovery than Group B. No significant differences were found between Group C and Group D or between Group A and Group D. Findings support suggestion via passive hypnosis with CET as a powerful variable in the treatment of sleep disturbances with depressed patients.


Barber TX. Wilson SC. Hypnosis, suggestions, and altered states of consciousness: experimental evaluation of the new cognitive-behavioral theory and the traditional trance-state theory of "hypnosis". Annals of the New York Academy of Sciences 1977; 296:34-47 Sixty-six subjects were tested on a new scale for evaluating "hypnotic-like" experiences (The Creative Imagination Scale), which includes ten standardized test-suggestions (e.g. suggestions for arm heaviness, finger anesthesia, time distortion, and age regression). The subjects were randomly assigned to one of three treatment groups (Think- With Instructions, trance induction, and Control), with 22 subjects to each group. The new Cognitive-Behavioral Theory predicted that subjects exposed to preliminary instructions designed to demonstrate how to think and imagine along with the suggested themes (Think-With Instructions) would be more responsive to test-suggestions for anesthesia, time distortion, age regression, and so on, than subjects exposed to a trance- induction procedure. On the other hand, the traditional Trance State Theory predicted that a trance induction would be more effective than Think-With Instructions in enhancing responses to such suggestions. Subjects exposed to the Think-With Instructions obtained significantly higher scores on the test-suggestions than those exposed either to the traditional trance-induction procedure or to the control treatment. Scores of subjects who received the trance-induction procedure were not significantly different from those of the subjects who received the control treatment. The results thus supported the new Cognitive- Behavioral Theory and contradicted the traditional Trance State Theory of hypnosis. Two recent experiments, by De Stefano and by Katz, confirmed the above experimental results and offered further support for the Cognitive-Behavioral Theory. In both recent experiments, subjects randomly assigned to a "Think-With Instructions" treatment were more responsive to test-suggestions than those randomly assigned to a traditional trance-induction treatment.


Barkley RA. Hastings JE. Jackson TL. The effects of rapid smoking and hypnosis in the treatment of smoking behavior. International Journal of Clinical & Experimental Hypnosis 1977;25(1):7-17. 29 young adult volunteers were assigned to one of 3 treatment conditions and treated for their cigarette smoking over a 2-wk period. These conditions were group rapid smoking, group hypnosis, and an attention-placebo control group. All treatments produced significant reductions in average daily smoking rates during the treatment phase, but all Subjects returned to near baseline levels of smoking by the 6-wk follow-up. The rapid smoking and hypnosis groups did not differ from the control group in smoking rates at treatment termination or at the 6-wk follow-up. They also did not differ from the control group in the number of Subjects abstaining from smoking by treatment termination but did differ at follow-up. Eventually, at the 9-mo follow-up, only Subjects from the rapid smoking condition had significantly more abstainers than the control group. Results suggest that rapid smoking can work as effectively in group procedures as previous individualized approaches had demonstrated. Group hypnosis, while less effective than some previous individualized approaches had indicated, was only marginally less effective than the rapid smoking procedure. The use of abstinence rates as opposed to average rates of smoking is strongly recommended as the best measure of treament effectiveness for future research in this area. (German, French & Spanish summaries)



Beaugerie L. Burger AJ. Cadranel JF. Lamy P. Gendre JP. Le QuintrecY. Modulation of orocaecal transit time by hypnosis. Gut 1991;32(4):393-4 The ability of hypnosis to modulate the orocaecal transit time of 10 g lactulose was tested in six healthy volunteers. Orocaecal transit time was measured by the hydrogen breath test during three periods in random order. During the control period the subjects remained throughout the test in a semirecumbent position without moving. During the hypnotic relaxation period subjects were hypnotised before lactulose ingestion and were instructed to experience relaxation till the orocaecal transit time had elapsed. During the acceleration suggestion period subjects were hypnotised before lactulose ingestion and were repeatedly instructed to imagine the acceleration of lactulose through the intestine until transit time had elapsed. The mean orocaecal transit time was significantly longer during the hypnotic relaxation period (mean (SEM) 133 (8) min) than during the control period (93 (13) min). The mean orocaecal transit time during the acceleration suggestion period was 105 (26) minutes and was not significantly different from the mean transit time during the control period. The individual values during the acceleration suggestion period were scattered. We conclude that lactulose orocaecal transit time is delayed during hypnotic relaxation.


Bennett HL. Davis HS. Giannini JA. Non-verbal response to intraoperative conversation. British Journal of Anaesthesia 1985;57(2):174-9 In a double-blind study, 33 patients (herniorraphy, cholecystectomy and orthopaedic) were randomly assigned to either suggestion or control groups. Under known clinical levels of nitrous oxide and enflurane or halothane anaesthesia, suggestion patients were exposed to statements of the importance of touching their ear during a postoperative interview. Compared with controls, suggestion patients did touch their ear (tetrachoric correlation 0.61, P less than 0.001) and they did so more frequently (Mann-Whitney U test, P less than 0.02). All suggestion patients were completely amnesic for the intraoperative spoken suggestion, despite inquiries which included hypnotic regression to the operation.


Benson H. Frankel FH. Apfel R. Daniels MD. Schniewind HE. Nemiah JC. Sifneos PE. Crassweller KD. Greenwood MM. Kotch JB. Arns PA. Rosner B. Treatment of anxiety: a comparison of the usefulness of self-hypnosis and a meditational relaxation technique. An overview. Psychotherapy & Psychosomatics. 1978;30(3-4):229-42 We have investigated prospectively the efficacy of two nonpharmacologic relaxation techniques in the therapy of anxiety. A simple, meditational relaxation technique (MT) that elicits the changes of decreased sympathetic nervous system activity was compared to a self- hypnosis technique (HT) in which relaxation, with or without altered perceptions, was suggested. 32 patients with anxiety neurosis were divided into 2 groups on the basis of their responsivity to hypnosis: moderate-high and low responsivity. The MT or HT was then randomly assigned separately to each member of the two responsivity groups. Thus, 4 treatment groups were studied: moderate-high responsivity MT; low responsivity MT; moderate-high responsivity HT; and low responsivity HT. The low responsivity HT group, by definition largely incapable of achieving the altered perceptions essential to hypnosis, was designed as the control group. Patients were instructed to practice the assigned technique daily for 8 weeks. Change in anxiety was determined by three types of evaluation: psychiatric assessment; physiologic testing; and self-assessment. There was essentially no difference between the two techniques in therapeutic efficacy according to these evaluations. Psychiatric assessment revealed overall improvement in 34% of the patients and the self-rating assessment indicated improvement in 63% of the population. Patients who had moderate-high hypnotic responsivity, independent of the technique used, significantly improved on psychiatric assessment (p = 0.05) and decreased average systolic blood pressure from 126.1 to 122.5 mm Hg over the 8-week period (p = 0.048). The responsivity scores at the higher end of the hypnotic responsivity spectrum were proportionately correlated to greater decreases in systolic blood pressure (p = 0.075) and to improvement by psychiatric assessment (p = 0.003). There was, however, no consistent relation between hypnotic responsivity and the other assessments made, such as diastolic blood pressure, oxygen consumption, heart rate and the self-rating questionnaires. The meditational and self-hypnosis techniques employed in this investigation are simple to use and effective in the therapy of anxiety.


Blankfield RP. Zyzanski SJ. Flocke SA. Alemagno S. Scheurman K. Taped therapeutic suggestions and taped music as adjuncts in the care of coronary-artery-bypass patients. American Journal of Clinical Hypnosis. 1995;37(3):32-42 A randomized, single-blinded, placebo-controlled trial examined the benefits of taped therapeutic suggestions and taped music in coronary-artery-bypass patients. Sixty-six patients listened to either suggestion tapes or music tapes, intraoperatively and postoperatively; 29 patients listened to blank tapes intraoperatively and listened to no tapes postoperatively. Half the patients who listened to a tape found it helpful. There were no significant differences between groups in length of SICU or postoperative hospital stay, narcotic usage, nurse ratings of anxiety and progress, depression, activities of daily living, or cardiac symptoms. There were no significant differences in these same outcomes between the patients who were helped by the tapes and the patients not helped. These results suggest that if taped therapeutic suggestions have a measurable effect upon cardiac surgery patients, demonstrating this effect will require more detailed patient evaluations to identify subgroups of patients responsive to this type of intervention.


Block RI. Ghoneim MM. Sum Ping ST. Ali MA. Efficacy of therapeutic suggestions for improved postoperative recovery presented during general anesthesia. Anesthesiology 1991;75(5):746-55 There have been claims that the postoperative course of patients may be improved by presentation during general anesthesia of therapeutic suggestions which predict a rapid and comfortable postoperative recovery. This study evaluated the effectiveness of such therapeutic suggestions under double-blind and randomized conditions. A tape recording predicting a smooth recovery during a short postoperative stay without pain, nausea, or vomiting was played during anesthesia to about half the patients (N = 109), while the remaining, control patients were played a blank tape instead (N = 100). The patients were primarily undergoing operations on the fallopian tubes, total abdominal hysterectomy, vertical banding gastroplasty, cholecystectomy, and ovarian cystectomy or myomectomy. The anesthesia methods consisted of either isoflurane with 70% nitrous oxide in oxygen to produce end-tidal concentrations of 1.0, 1.3, or 1.5 MAC; or 70% nitrous oxide in oxygen combined with high or low doses of opioids. Assessments of the efficacy of the therapeutic suggestions in the recovery room and throughout the postoperative hospital stay included: the frequency of administration of analgesic and antiemetic drugs; opioid doses; the incidence of fever; nausea, retching, and vomiting; other gastrointestinal and urinary symptoms; ratings of pain; ratings of anxiety; global ratings of the patients' physical and psychological recoveries by the patients and their nurses; and length of postoperative hospital stay. There were no meaningful, significant differences in postoperative recovery of patients receiving therapeutic suggestions and controls. These negative results were not likely to be due to insensitivity of the assessments of recovery, as they showed meaningful interrelations among themselves and numerous differences in recovery following different types of surgery. Widespread utilization of therapeutic suggestions as a routine operating room procedure seems premature in the absence of adequate replication of previously published positive studies.


Boeke S. Bonke B. Bouwhuis-Hoogerwerf ML. Bovill JG. Zwaveling A. Effects of sounds presented during general anaesthesia on postoperative course. British Journal of Anaesthesia 1988;60(6):697-702 In a double-blind, randomized study, patients undergoing cholecystectomy were administered one of four different sounds during general anaesthesia: positive suggestions, nonsense suggestions, seaside sounds or sounds from the operating theatre. The effect of these sounds on the postoperative course was examined to assess intraoperative auditory registration. No differences were found between the four groups in postoperative variables.


Bonke B, Schmitz PI, Verhage F, Zwaveling A Clinical study of so-called unconscious perception during general anaesthesia British Journal of Anaesthesia 1986;58(9):957-64 Ninety-one patients undergoing biliary tract surgery were randomly assigned to one of three treatment groups in which different sounds were administered, by means of earphones, in a double-blind design. The effects of the administration of positive suggestions, noise or operating theatre sounds on the postoperative course were studied. Results showed that exposure to positive suggestions during general anaesthesia, as compared with noise or operating theatre sounds, protected patients older than 55 yr against prolonged postoperative stay in hospital.


Bonke B. Van Dam ME. Van Kleff JW. Slijper FM. Implicit memory tested in children during inhalation anaesthesia. Anaesthesia 1992;47(9):747-9 Memory for stimuli presented during inhalation anaesthesia was tested in 80 children undergoing eye surgery. Two groups were exposed, in a random double-blind study, to repeated neutral phrases including either the colour orange or green. A postoperative colouring task was used as a test of implicit memory to detect any preference for the colour named under anaesthesia. No colour preference attributable to implicit memory could be demonstrated. One patient had a distinct preference for the named colour. No patient remembered any intra-operative events.


Bornstein PH. Devine DA. Covert modeling-hypnosis in the treatment of obesity. Psychotherapy: Theory, Research Practice 1980;17(3):272-276. Investigated the efficacy of a covert modeling/hypnosis treatment package in the control of obesity. 48 overweight female volunteers (who had been administered the Harvard Group Scale of Hypnotic Susceptibility, Eating Patterns Questionnaire, and Rotter's Internal-External Locus of Control Scale) were randomly assigned to 1 of the following groups: (a) covert modeling/hypnosis, (b) covert modeling, (c) no-model scene control, and (d) minimal treatment (where Subjects received a shortened version of the covert modeling/hypnosis procedure following an 8-wk no-treatment period). Results indicate a significant effect for weight loss from pretreatment to follow-up across all groups combined. Proportion weight loss measures indicated significantly greater weight loss only for the covert modeling/hypnosis group as compared to the no-model controls. Implications for combining behavior therapy and hypnotic techniques are discussed.


Boutin GE. Tosi DJ. Modification of irrational ideas and test anxiety through rational stage directed hypnotherapy RSDH. Journal of Clinical Psychology 1983;39(3):382-91 Examined the effects of four treatment conditions on the modification of Irrational Ideas and test anxiety in female nursing students. The treatments were Rational Stage Directed Hypnotherapy, a cognitive behavioral approach that utilized hypnosis and vivid-emotive-imagery, a hypnosis-only treatment, a placebo condition, and a no-treatment control. The 48 Ss were assigned randomly to one of these treatment groups, which met for 1 hour per week for 6 consecutive weeks with in-vivo homework assignments also utilized. Statistically significant treatment effects on cognitive, affective, behavioral, and physiological measures were noted for both the RSDH and hypnosis group at the posttest and at a 2-month follow-up. Post-hoc analyses revealed the RSDH treatment group to be significantly more effective than the hypnosis only group on both the post- and follow-up tests. The placebo and control groups showed no significant effects either at post-treatment or at follow-up.


Bregman NJ. McAllister HA. Role of suggestions in digital skin temperature: implications for temperature biofeedback research. International Journal of Neuroscience 1985;27(1-2):115-20 The purpose of the present experiment was to explore the role suggestions and assessment procedures play in affecting digital skin temperature. Four different types of suggestions were given subjects (warm, cool, pseudo (electronic terms), and no suggestions). Twenty-five subjects were randomly assigned to the four experimental conditions. The data were analyzed by three popular assessment procedures typically found in the literature. As predicted, subjects displayed significant decreases in skin temperature each day regardless of the training condition they were in. The assessment procedures produced differential results.

Brodeur JB, Kurtz RM, Strube MJ Hypnotic susceptibility order effects in walking analgesia Int J Clin Exp Hypn 1998 Jul;46(3):240-9 This study reexamined Spanos, Hodgins, Stam, and Gwynn's (1984) contention that susceptibility testing order effects generated a relationship between walking analgesia pain reduction and level of hypnotic responsiveness. Undergraduate volunteers with no previous hypnosis experience were randomly assigned to 2 groups. Group 1 (n = 69) first received a cold pressor pain protocol, and then was administered the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C). Group 2 (n = 69) was administered the SHSS:C prior to the cold pressor pain protocol. Our findings do not support Spanos, Hodgins et al.'s contention that sucsceptibility testing order effects generate the often reported relationship between walking analgesia and level of hypnotic responsiveness. We found significant partial correlation coefficients between the SHSS:C and nonhypnotic pain reduction regardless of order of susceptibility testing. Implications regarding the adequacy of design-generated expectancies to explain hypnotic analgesia phenomena were examined.

Bruck M. Ceci SJ. Francoeur E. Barr R. "I hardly cried when I got my shot:" Influencing children's reports about a visit to their pediatrician. Child Development 1995;66(1):193-208 We examined, in 2 phases, the influence of postevent suggestions on children's reports of their visits to a pediatrician. Phase 1 examined the effect of giving one of 3 types of feedback to 5-year-old children immediately following their Diphtheria Pertussis Tetanus (DPT) inoculation. Children were given pain-affirming feedback (the shot hurt), pain-denying feedback (the shot did not hurt), or neutral feedback (the shot is over). 1 week later, they did not differ in their reports concerning how much the shot hurt or how much they cried. In Phase 2, the same children were visited approximately 1 year after their inoculation. During 3 separate visits, they were either given additional pain-denying or neutral feedback. They were also given misleading or nonmisleading information about the actions of the pediatrician and the assistant. Children given pain-denying feedback reported that they cried less and that the shot hurt less than did children given neutral feedback. Those who were given misleading information about the actions of the assistant and the pediatrician made more false allegations about their actions than did children who were not given this information. These results challenge the view that suggestibility effects are confined to peripheral, nonaction events; in this study children's reports about salient actions involving their own bodies in stressful conditions were influenced.

Buchser E. Burnand B. Sprunger AL. Clemence A. Lepage C. Martin Y.Chedel D. Guex P. Sloutskis D. Rumley R. Hypnosis and self-hypnosis, administered and taught by nurses, for the reduction of chronic pain: a controlled clinical trial. Schweizerische Medizinische Wochenschrift - Supplementum 1994;62:77-81 Hypnosis is a technique whereby an individual can reach a particular state, quite unrelated to sleep, characterized by aroused, attentive and focused concentration. Although there are numerous clinical applications of hypnosis, there are virtually no controlled clinical trials to support its effectiveness. We propose a controlled randomized clinical trial comparing a "control" group of chronic pain patients treated by a programme including conventional oral medication combined with various nerve blocks and/or spinal administration of drugs, with a "treatment" group having a similar treatment programme plus hypnosis carried out by nurses. Outcome measurements include mainly the variation of pain intensity, the amount of analgesic drug consumption, spontaneous physical activity, and the change in health-related quality of life. The assessment of the outcome variable is done at the initial workup, weekly for the first 3 weeks, and at 6 and 12 weeks. A follow-up survey is conducted at 6 months.


Campbell DF. Dixon JK. Sanderford LD. Denicola MA. Relaxation: its effect on the nutritional status and performance status of clients with cancer. Journal of the American Dietetic Association 1984;84(2):201-4 Relaxation was used to promote normal food consumption patterns among persons with cancer. As part of a larger study, 22 persons with cancer were randomly assigned to receive instruction and reinforcement in a relaxation technique to be used preprandially. The relaxation procedure included four components: (a) deep abdominal breathing, (b) tensing and relaxing of various body parts, (c) relaxation by autosuggestion, and (d) voluntary image control. Twelve clients complied with relaxation instructions in part, and 10 did not. Among compliers, 75% experienced desirable weight change over a six-week period. Performance status, measured by the Karnofsky scale, improved for 33% and worsened for 17% over eight weeks. Research has shown relaxation to be an effective measure in relation to pain, hypertension, and other conditions. These preliminary results now suggest that relaxation may also be effective in treating the eating problems of the person with cancer, leading to improvement in weight and performance status.


Cochrane G. Friesen J. Hypnotherapy in weight loss treatment. Journal of Consulting & Clinical Psychology 1986;54(4):489-92 Investigated the effects of hypnosis as a treatment for weight loss among women. The sample consisted of 60 women (aged 20-65 yrs) who were at least 20% overweight and were not in any other treatment program. Six client variables (suggestibility, self-concept, quality of family origin, age of obesity onset, education level, and socioeconomic status (SES)) and 1 process variable (multimodal imagery) were analyzed in relation to the dependent variable (weight loss). Two experimental groups, hypnosis plus audiotapes and hypnosis without audiotapes, and the control group were investigated for weight loss immediately after treatment and again after a 6-mo follow-up. The primary hypothesis that hypnosis is an effective treatment for weight loss was confirmed, but the 7 concomitant variables and the use of audiotapes were not significant contributors to weight loss.


Colgan SM, Faragher EB, Whorwell PJ Controlled trial of hypnotherapy in relapse prevention of duodenal ulceration Lancet 1988;1(8598):1299-300 30 patients with rapidly relapsing duodenal ulceration were studied to assess the possible benefit of hypnotherapy in relapse prevention. After the ulcer had healed on treatment with ranitidine, the drug was continued for a further 10 weeks during which time patients received either hypnotherapy or no hypnotherapy. The two randomly selected groups were comparable in terms of age, sex, smoking habits, and alcohol consumption. Follow-up of both groups of patients was continued for 12 months after the cessation of ranitidine. After 1 year, 8(53%) of the hypnotherapy patients and 15(100%) of the control subjects had relapsed. The results of this study suggest that hypnotherapy may be a useful therapeutic adjunct for some patients with chronic recurrent duodenal ulceration.


Council JR. Kirsch I. Vickery AR. Carlson D. "Trance" versus "skill" hypnotic inductions: the effects of credibility, expectancy, and experimenter modeling. Journal of Consulting & Clinical Psychology 1983;51(3):432-40 A hypnotic induction procedure based on social learning principles (skill induction) was compared with a traditional eye-fixation/relaxation trance induction, a highly credible placebo induction, and a no induction base rate control. The trance induction surpassed the skill induction only on the Field Inventory, a measure of hypnotic depth that contains items corresponding to suggestions contained in the trance induction. Experimenter modeling was not found to enhance the effectiveness of the skill induction. Skill and trance inductions elicited slightly higher behavioral scores on the Stanford Hypnotic Susceptibility Scale: Form C than did the placebo induction. However, this difference was not obtained on other measures of hypnotic responsivity and depth. Significant correlations were found between expectancy, absorption, and responsiveness on all dependent measures. Multiple regression analyses indicated that the relationship between absorption and responsivity was mediated by expectancy. The results are interpreted as supporting the hypotheses that hypnotic responses are elicited by the expectancy for their occurrence and that induction procedures are a means of increasing subjects' expectancies for hypnotic responses.


Crawford HJ. Allen SN. Paired-associate learning and recall of high and low imagery words: moderating effects of hypnosis, hypnotic susceptibility level, and visualization abilities. American Journal of Psychology. 1996;109(3):353-72 Relationships between recall of low and high imagery paired-associate (P-A) words and hypnotic susceptibility, and the influence of hypnosis on recall as moderated by hypnotic level were examined. Subjects were assessed on 2 hypnotic susceptibility scales [Harvard Group Scale of Hypnotic Susceptibility; Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C)]. Forty-one low (0-4 SHSS:C) and 41 highly (9-12 SHSS:C) hypnotizable college students were assigned to 1 of 4 experimental groups: waking-hypnosis, hypnosis-waking, waking-waking, or hypnosis-hypnosis. Recall was significantly better for high than low imagery words. In the more sensitive within-subjects design, high hypnotizables recalled more P-A words during hypnosis than waking, and lows did not differ. In the between-subjects design, hypnotic level was not a moderator of performance during hypnosis. Low hypnotizables recalled more words in the within-subjects design. Visualization ability was a poor moderator of imagery-mediated learning. High imagery recall correlated significantly with Marks's (1973) Vividness of Visual Imagery Questionnaire (.25) and Paivio and Harshman's (1983) Individual Differences Questionnaire (IDQ) Verbal scale (.29 1973;), but not with the IDQ Imagery scale, the Mental Rotations Test (Vandenberg & Kuse


Crawford HJ. Harrison DW. Kapelis L. Visual field asymmetry in facial affect perception: moderating effects of hypnosis, hypnotic susceptibility level, absorption, and sustained attentional abilities. International Journal of Neuroscience. 1995;82(1-2):11-23 Effects of hypnotic level, affect valence and cerebral asymmetry on reaction time (RT) in the discrimination of Ekman and Friesen's (1978) stimuli of angry and happy faces were studied in counterbalanced conditions of waking and hypnosis. Assessed previously on two hypnotic susceptibility scales [Harvard Group Scale of Hypnotic Susceptibility; Stanford Hypnotic Susceptibility Scale, Form C (SHSSC)], non-depressed subjects were 16 low (0-4 SHSSC) and 17 highly (10-12 SHSSC) hypnotizable, right-handed college students. Subjects were required to identify affects of faces, presented tachistoscopically to left (LVF) or right (RVF) visual fields, by using a forced-choice RT paradigm. Highs were significantly faster than lows in angry and happy affect recognition. Hypnosis had no significant effects. For highs only, angry emotional valence was identified faster when presented to the right hemisphere (LVF), but there were no significant hemispheric effects for happy emotional valence. For lows there were no hemispheric differences. Gender was a nonsignificant factor. Significant correlations showed that faster reaction times to angry and happy stimuli, in both LVF and RVF in waking and hypnosis, were obtained by subjects who reported more deeply absorbed and extremely focused and sustained attention on the Tellegen (1982) Absorption Scale and a subscale of the Differential Attentional Processes Inventory (Grumbles & Crawford, 1981). Vividness of Visual Imagery Questionnaire (Marks, 1973) and Affect Intensity Measure (Larsen, 1985), in general, did not correlate with RTs. The potential role of the fronto-limbic attentional system in the recognition of external visual sensory affect is discussed.


Crawford HJ. Macdonald H. Hilgard ER. Hypnotic deafness: a psychophysical study of responses to tone intensity as modified by hypnosis. American Journal of Psychology 1979;92(2):193-214 Hypnotic deafness was suggested for 1000 Hz tones presented in random orders at seven intensities between 17 and 70 db. Subjects were 70 college students stratified into four levels of hypnotic susceptibility, ranging from low to high. Four conditions were presented within a single session. Two conditions tested normal hearing, one in waking and one in hypnosis; two tested reported loudness of the tones as reduced by hypnotic suggestion. The method of magnitude estimation was employed. Hearing reduction was found to correlate .59 with hypnotic susceptibility in the total sample. Few high hypnotizables reduced their hearing to zero; their mean residual hearing during the deafness conditions was 55% of normal. Power functions for the relationship between tone intensity and magnitude estimates for conditions of normal hearing and deafness were found to be relatively parallel and orderly, differing primarily in intercept value. Order effect anomalies are discussed. The "hidden observer" method showed that for 4 of the 70 subjects the covert hearing was found to be at least 20% greater than that reported overtly within hypnotic deafness and approached normal hearing. As in our previous hypnotic analgesia research, not all subjects who reduced their hearing significantly gave subsequent covert reports which differed from reported overt hearing. Discussion is given for evidence of two levels of information processing during hypnotically suggested perceptual distortions.


Crowther JH. Stress management training and relaxation imagery in the treatment of essential hypertension. Journal of Behavioral Medicine 1983;6(2):169-87 The present study compared the effectiveness of three procedures in the treatment of 34 individuals with essential hypertension: (1) stress management training plus relaxation imagery, which consisted of an adaptation of existing stress management techniques in conjunction with extensive relaxation training using relaxation imagery; (2) relaxation imagery alone; and (3) weekly blood pressure checks. The relaxation imagery technique involved visualization of a relaxing image along with concentration on suggestions of relaxation, heaviness, and warmth. Treatment was individualized and lasted 8 weeks. Results indicated stress management plus relaxation imagery and relaxation imagery alone were significantly more effective than blood pressure checks in reducing systolic and diastolic blood pressures during treatment and in maintaining diastolic blood pressure reductions during follow-up. However, no significant differences were found between the two treatment procedures. Clinical implications of these findings are discussed.


Cruise CJ. Chung F. Yogendran S. Little D. Music increases satisfaction in elderly outpatients undergoing cataract surgery. Canadian Journal of Anaesthesia 1997;44(1):43-8 PURPOSE: Music has long been known to reduce anxiety, minimize the need for sedatives, and make patients feel more at ease. The purpose of the study was to evaluate the effect of music in elderly outpatients undergoing elective cataract surgery with retrobulbar block and monitored anaesthetic care using fentanyl or alfentanil and midazolam. METHODS: One hundred and twenty one patients were prospectively and randomly assigned to hear: relaxing suggestions, white noise, operating room noise or relaxing music via audio-cassette headphones. Vital signs were documented before and after retrobulbar block and every 15 min thereafter. Anxiety was assessed using the State-Trait Anxiety Inventory (STAI) before and after surgery. Visual analogue scales (VAS) were used to assess anxiety and patient satisfaction postoperatively with a standardized questionnaire. Between group comparisons were made using Chi-Square, or ANOVA, where appropriate. RESULTS: There were no differences between groups in STAI or anxiety VAS scores at any time. Differences were noted in systolic blood pressure, but not in other vital signs. Patients' ratings of the whole operative experience, satisfaction with the tape played, general level of relaxation and preference for the chosen tape for subsequent surgery were different (music > relaxing suggestions > white noise and OR noise, P < 0.05). CONCLUSIONS: Elderly patients undergoing cataract surgery under retrobulbar block were more satisfied with their experience if they heard relaxing music, rather than relaxing suggestions or white noise or OR noise. The type of auditory stimuli to which the patients were exposed did not influence the level of anxiety.


Dahlgren LA. Kurtz RM. Strube MJ. Malone MD. Differential effects of hypnotic suggestion on multiple dimensions of pain. Journal of Pain & Symptom Management. 1995;10(6):464-70 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.


De Pascalis V. Caddia F. Effect of suggestion on perception: replication of Gheorghiu and Reyher's study. Perceptual & Motor Skills 1985;61(1):123-30 Gheorghiu and Reyher in 1982 described a Scale of Sensory Suggestibility consisting of an indirect-direct method of assessing suggestibility. In this study a further sample of 81 women was tested on Gheorghiu and Reyher's scale. The scale has tactual, auditory, and visual items. Each item was administered to the left and right sides of the body in random sequence and the method of presentation was varied. The scale is indirect in that the announced stimuli are never presented to participants, contrary to their expectations; it is direct because the subjects are cautioned that a stimulus might not actually be presented. The scale showed acceptable internal consistency. There were no right-left side differences. The methods of presentation were not equally successful. Progressive Intensification and Progressive Decrease in Intensification of stimulation were the most successful, whereas Expectation of series without objective stimuli was the least successful, contrary to Georghiu and Reyher's results. Finally, item analysis showed that all the items had high reliability coefficients, except two auditory and one visual items. Implications for clinical practice were discussed.


DeBenedittis G. Cigada M. Bianchi A. Signorini MG. Cerutti S. Autonomic changes during hypnosis: a heart rate variability power spectrum analysis as a marker of sympatho-vagal balance. International Journal of Clinical & Experimental Hypnosis 1994;42(2):140-52 Spectral analysis of beat-to-beat variability in electrocardiography is a simple, noninvasive method to analyze sympatho-vagal interaction. The electrocardiogram is analyzed by means of an automatic, autoregressive modeling algorithm that provides a quantitative estimate of R-R interval variability by the computation of power spectral density. Two major peaks are recognizable in this specter: a low-frequency peak (LF, -0.1 Hz), related to the overall autonomic activity (ortho+parasympathetic) and a high-frequency peak (HF, -0.25 Hz), representative of the vagal activity. The LF/HF ratio is an index of the sympatho-vagal interaction. This technique was applied, using a computer-assisted electrocardiograph, to 10 healthy volunteers (6 high and 4 low hypnotizable subjects as determined by the Stanford Hypnotic Susceptibility Scale, Form C) in randomized awake and neutral hypnosis conditions. Preliminary results indicated that hypnosis affects heart rate variability, shifting the balance of the sympatho-vagal interaction toward an enhanced parasympathetic activity, concomitant with a reduction of the sympathetic tone. A positive correlation between hypnotic susceptibility and autonomic responsiveness during hypnosis was also found, with high hypnotizable subjects showing a trend toward a greater increase of vagal efferent activity than did low hypnotizables.


Dikel W. Olness K. Self-hypnosis, biofeedback, and voluntary peripheral temperature control in children. Pediatrics 1980;66(3):335-40 Forty-eight children, aged 5 to 15 years, were tested for their ability to raise and lower their index finger temperature with self-hypnosis and/or biofeedback. Group A (self-hypnosis only) and group B (self-hypnosis with biofeedback) were children who had previous successful experience with self-hypnosis (eg, for the treatment of enuresis, pain, asthma, or obesity). Group C (biofeedback only) were children with no experience with hypnosis. All three groups showed significant success with warming and cooling. The range of warming for the three groups was 0 to 3.7 F, and for cooling, 0 to 7.3 F or 0 to 8.8 F for attempts exceeding the ten-minute trial period. No significant difference in ability to warm or cool was noted when the children were compared by group, age, or sex. Some of the children in group A who had little or no success with hypnosis only were very successful with the addition of biofeedback monitoring, suggesting a synergistic effect between biofeedback and hypnosis. A significant temperature rise was also noted in groups A and B accompanying a neutral hypnotic induction relaxation-imagery exercise in which no mention of temperature change was made. This rise varied from 0 to 6 F, averaging 1.7 F. Possible therapeutic implications include the treatment of migraine headaches, Raynaud's syndrome, sickle cell anemia, and the use of temperature monitoring as a diagnostic and therapeutic adjunct to clinical hypnosis.


Disbrow EA. Bennett HL. Owings JT. Effect of preoperative suggestion on postoperative gastrointestinal motility Western Journal of Medicine. 1993;158(5):488-92 Autonomic behavior is subject to direct suggestion. We found that patients undergoing major operations benefit more from instruction than from information and reassurance. We compared the return of intestinal function after intra-abdominal operations in 2 groups of patients: the suggestion group received specific instructions for the early return of gastrointestinal motility, and the control group received an equal-length interview offering reassurance and nonspecific instructions. The suggestion group had a significantly shorter average time to the return of intestinal motility, 2.6 versus 4.1 days. Time to discharge was 6.5 versus 8.1 days. Covariates including duration of operation, amount of intraoperative bowel manipulation, and amount of postoperative narcotics were also examined using the statistical model analysis of covariance. An average savings of $1,200 per patient resulted from this simple 5-minute intervention. In summary, the use of specific physiologically active suggestions given preoperatively in a beleivable manner can reduce the morbidity associated with an intra-abdominal operation by reducing the duration of ileus.


Donk LJ. Vingoe FJ. Hall RA. Doty R. The comparison of three suggestion techniques for increasing reading efficiency utilizing a counterbalanced research paradigm. International Journal of Clinical & Experimental Hypnosis 1970;18(2):126-133. Reports an experiment in which both Barber-type and alert-trance procedures significantly increased reading speed while maintaining comprehension when compared to a control group; a traditional hypnotic procedure followed by the specific suggestions failed to obtain these results. 32 volunteer undergraduates were randomly assigned to 4 groups in terms of a counterbalanced design. 2 groups were administered trance inductions (traditional and alert) followed by specific suggestions, a 3rd simply the suggestions, while the 4th served as control. Reading suggestions were to eliminate specific problems, increase speed, and increase or maintain comprehension. (Spanish & German summaries)


Dubreuil DL. Spanos NP. Bertrand LD. Does hypnotic amnesia dissipate with time? Imagination, Cognition Personality 1982;832(2):103-113. Investigated, in 2 experiments, the hypothesis that hypnotic amnesia dissipates "spontaneously" over time. Subjects were 94 undergraduates (mean age 19 yrs) who obtained scores of 2 or above on the Objective dimension of a responsiveness to suggestion scale. Subjects were assigned at random to 4 groups. Subjects in the Remember More, Remember Less, and Retest control groups showed partial amnesia on the 1st of their 2 challenge trials. After the administration of a hypnotic amnesia suggestion for a previously learned word list, Retest Subjects in Exp I received 2 successive recall challenges before cancellation of the suggestion. Delay Subjects received only 1 challenge. It occurred at the same time that Retest Subjects received the 2nd challenge. No differences in amount of amnesia were found between the Delay trial and either of the Retest trials, thereby failing to provide support for the dissipation hypothesis. Exp II manipulated Subjects' expectations concerning the amount of amnesia typically shown on a 2nd challenge. Subjects in the Remember More or Remember Less conditions were led to believe that they would recall either more or less critical material on the 2nd amnesia challenge. Both Retest (no expectancy) and Remember More Subjects recalled significantly more words on the 2nd challenge than on the 1st one. However, a significantly greater proportion of Remember More Subjects than Retest Subjects showed recall increments on the 2nd challenge. Results do not support the dissipation hypothesis of hypnotic amnesia.


Eberhart LH. Doring HJ. Holzrichter P. Roscher R. Seeling W. Therapeutic suggestions given during neurolept-anaesthesia decrease post-operative nausea and vomiting. European Journal of Anaesthesiology 1998;15(4):446-52 A double-blind randomized study was performed in 100 patients undergoing thyroidectomy to evaluate the effect of positive therapeutic suggestions made during neurolept-anaesthesia. The classic droperidol-fentanyl-N2O technique was used as these drugs preserve the neurophysiological functions required to process the information in the therapeutic suggestions given during general anaesthesia. Patients in the suggestion group heard positive non-affirmative suggestions during the whole operation. An autoreverse tape player was used. The control group listened to an empty tape. Both groups were comparable with respect to demographic variables, anaesthetic technique, drug dosage, duration of anaesthesia and surgery. Patients in the suggestion group suffered significantly less from post-operative nausea or vomiting (suggestion: 47.2% vs. control: 85.7%) and required less anti-emetic treatment (suggestion: 30.6% vs. control: 68.6%). We conclude that therapeutic suggestions heard during neurolept-anaesthesia are processed and decrease post-operative nausea and vomiting in patients after thyroidectomy.


Echterling LG. Whalen J. Stage hypnosis and public lecture effects on attitudes and beliefs regarding hypnosis. American Journal of Clinical Hypnosis. 1995;38(1):13-21 Stage hypnosis shows, designed to entertain and amaze, and public lectures, designed to explain and educate, provide dramatically different introductions to hypnosis. This study examined how audience members' attitudes and beliefs regarding hypnosis are affected by these two different experiences. Two hundred and five college students completed pretest measures before either watching a stage hypnosis show, or attending a lecture on hypnosis, or participating in a control group. Subjects completed posttest measures between one to three weeks later. Both the stage hypnosis show and the lecture increased attendees' motivation to use hypnosis in treatment and decreased their belief that hypnotizability reflects lower intelligence. Moreover, the lecture also increased beliefs that hypnotizability reflects creativity and inner strength. Finally, while the lecture reduced the belief that a hypnotized person is robotlike and automatically acts on all suggestions, the stage hypnosis show increased this attitude among its audience members.



Enqvist B. Bjorklund C. Engman M. Jakobsson J. Preoperative hypnosis reduces postoperative vomiting after surgery of the breasts. A prospective, randomized and blinded study. Acta Anaesthesiologica Scandinavica 1997;41(8):1028-32 BACKGROUND: Postoperative nausea and vomiting (PONV) after general anesthesia and surgery may have an incidence as high as 70% irrespective of antiemetic drug therapy. The use of preoperative hypnosis and mental preparation by means of an audio tape was investigated in the prophylaxis of nausea and vomiting before elective breast reduction surgery. Similar interventions have not been found in the literature. METHODS: Fifty women were randomized to a control group or a hypnosis group; the latter listened to an audio tape daily 4-6 days prior to surgery. A hypnotic induction was followed by suggestions as to how to relax and experience states incompatible with nausea and vomiting postoperatively (e.g. thirst and hunger). There was a training part on the tape where the patients were asked to rehearse their own model for stress reduction. Premedication and anesthetic procedures were standardized. RESULTS: Patients in the hypnosis group had significantly less vomiting, 39% compared to 68% in the control group, less nausea and less need of analgesics postoperatively. CONCLUSIONS: Preoperative relaxation and/or hypnotic techniques in breast surgery contribute to a reduction of both PONV and postoperative analgesic requirements.


Enqvist B. Fischer K. Preoperative hypnotic techniques reduce consumption of analgesics after surgical removal of third mandibular molars: a brief communication. International Journal of Clinical & Experimental Hypnosis 1997;45(2):102-8 The effects of hypnosis in connection with surgery have been described in many clinical publications, but few controlled studies have been published. The aim of the present study was to evaluate the effects of preoperative hypnotic techniques used by patients planned for surgical removal of third mandibular molars. The patients were randomly assigned to an experimental (hypnotic techniques) or a control (no hypnotic techniques) group. During the week before the surgery, the experimental group listened to an audiotape containing a hypnotic relaxation induction. Posthypnotic suggestions of healing and recovery were given on the tape together with advice regarding ways to achieve control over stress and pain. The control group received no hypnotic intervention. Only one surgeon who was not aware of patient group assignments performed all the operations. Thirty-six patients in the control group were compared to 33 patients in the experimental group. Anxiety before the operation increased significantly in the control group but remained at baseline level in the experimental group. Postoperative consumption of analgesics was significantly reduced in the experimental group compared to the control group.


Enqvist B. von Konow L. Bystedt H. Pre- and perioperative suggestion in maxillofacial surgery: effects on blood loss and recovery. International Journal of Clinical & Experimental Hypnosis 1995;43(3):284-94 The basic assumption underlying the present study was that emotional factors may influence not only recovery but also blood loss and blood pressure in maxillofacial surgery patients, where the surgery was performed under general anesthesia. Eighteen patients were administered a hypnosis tape containing preoperative therapeutic suggestions, 18 patients were administered hypnosis tapes containing pre- and perioperative suggestions, and 24 patients were administered a hypnosis tape containing perioperative suggestions only. The patients who received taped suggestions were compared to a group of matched control patients. The patients who received preoperative suggestions exhibited a 30% reduction in blood loss. A 26% reduction in blood loss was shown in the group of patients receiving pre- and perioperative suggestions, and the group of patients receiving perioperative suggestions only showed a 9% reduction in blood loss. Lower blood pressure was found in the groups that received pre- and perioperative and perioperative suggestions only. Rehabilitation was facilitated in the group of patients receiving perioperative suggestions only.


Ernst E. Rand JI. Stevinson C. Complementary therapies for depression: an overview. Archives of General Psychiatry 1998;55(11):1026-32 Depression is one of the most common reasons for using complementary and alternative therapies. The aim of this article is to provide an overview of the evidence available on the treatment of depression with complementary therapies. Systematic literature searches were performed using several databases, reference list searching, and inquiry to colleagues. Data extraction followed a predefined protocol. The amount of rigorous scientific data to support the efficacy of complementary therapies in the treatment of depression is extremely limited. The areas with the most evidence for beneficial effects are exercise, herbal therapy (Hypericum perforatum), and, to a lesser extent, acupuncture and relaxation therapies. There is a need for further research involving randomized controlled trials into the efficacy of complementary and alternative therapies in the treatment of depression. [References: 95]


Evans C, Richardson PH Therapeutic suggestions during general anesthesia Advances 1988;5(4):6-11 Tested the hypothesis that the quality and duration of recovery from surgery would be improved by therapeutic suggestions made while patients were under general anesthesia, in a double-blind randomized controlled study of 39 adult hospital patients who were admitted for an abdominal hysterectomy. Results support the hypothesis.


Evans C. Richardson PH. Improved recovery and reduced postoperative stay after therapeutic suggestions during general anaesthesia. Lancet. 1988 Aug 27;2(8609):491-3. The clinical value of therapeutic suggestions during general anaesthesia was assessed in a double-blind randomised placebo-controlled study. 39 unselected patients were allocated to suggestion (n = 19) or control (n = 20) groups who were played either recorded therapeutic suggestions or a blank tape, respectively, during hysterectomy. The patients in the suggestion group spent significantly less time in hospital after surgery, suffered from a significantly shorter period of pyrexia, and were generally rated by nurses as having made a better than expected recovery. Patients in the suggestion group, unlike those in the control group, guessed accurately that they had been played an instruction tape.


Everett JJ. Patterson DR. Burns GL. Montgomery B. Heimbach D. Adjunctive interventions for burn pain control: comparison of hypnosis and ativan: the 1993 Clinical Research Award. Journal of Burn Care & Rehabilitation. 1993;14(6):676-83 Thirty-two patients hospitalized for the care of major burns were randomly assigned to groups that received hypnosis, lorazepam, hypnosis with lorazepam, or placebo controls as adjuncts to opioids for the control of pain during dressing changes. Analysis of scores on the Visual Analogue Scale indicated that although pain during dressing changes decreased over consecutive days, assignment to the various treatment groups did not have a differential effect. This finding was in contrast to those of earlier studies and is likely attributable to the low baseline pain scores of subjects who participated. A larger number of subjects with low baseline pain ratings will likely be necessary to replicate earlier findings. The results are argued to support the analgesic advantages of early, aggressive opioid use via PCA or through careful staff monitoring and titration of pain drugs.


Ewer TC, Stewart DE Improvement in bronchial hyper-responsiveness in patients with moderate asthma after treatment with a hypnotic technique: a randomised controlled trial BMJ Clinical Research Edition. 1986;293(6555):1129-32 A prospective, randomised, single blind, and controlled trial of a hypnotic technique was undertaken in 39 adults with mild to moderate asthma graded for low and high susceptibility to hypnosis. After a six week course of hypnotherapy 12 patients with a high susceptibility score showed a 74.9% improvement (p less than 0.01) in the degree of bronchial hyper-responsiveness to a standardised methacholine challenge test. Daily home recordings of symptoms improved by 41% (p less than 0.01), peak expiratory flow rates improved by 5.5% ( p less than 0.01), and use of bronchodilators decreased by 26.2% (p less than 0.05). The improvement in bronchial hyper-reactivity occurred without a change in subjective appreciation of the degree of bronchoconstriction. A control group of 17 patients and 10 patients undergoing treatment with low susceptibility to hypnosis had no change in either bronchial hyper-responsiveness or any of the symptoms recorded at home. This study shows the efficacy of a hypnotic technique in adult asthmatics who are moderately to highly susceptible to hypnosis.


Faymonville ME. Mambourg PH. Joris J. Vrijens B. Fissette J. Albert A. Lamy M. Psychological approaches during conscious sedation. Hypnosis versus stress reducing strategies: a prospective randomized study. Pain 1997;73(3):361-7 Stress reducing strategies are useful in patients undergoing surgery. Hypnosis is also known to alleviate acute and chronic pain. We therefore compared the effectiveness of these two psychological approaches for reducing perioperative discomfort during conscious sedation for plastic surgery. Sixty patients scheduled for elective plastic surgery under local anesthesia and intravenous sedation (midazolam and alfentanil upon request) were included in the study after providing informed consent. They were randomly allocated to either stress reducing strategies (control: CONT) or hypnosis (HYP) during the entire surgical procedure. Both techniques were performed by the same anesthesiologist (MEF). Patient behavior was noted during surgery by a psychologist, the patient noted anxiety, pain, perceived control before, during and after surgery, and postoperative nausea and vomiting (PONV). Patient satisfaction and surgical conditions were also recorded. Peri- and postoperative anxiety and pain were significantly lower in the HYP group. This reduction in anxiety and pain were achieved despite a significant reduction in intraoperative requirements for midazolam and alfentanil in the HYP group (alfentanil: 8.7 +/- 0.9 microg kg(-1)/h(-1) vs. 19.4 +/- 2 microg kg(-1)/h(-1), P < 0.001; midazolam: 0.04 +/- 0.003 mg kg(-1)/h(-1) vs. 0.09 +/- 0.01 mg kg(-1)/h(-1), P < 0.001). Patients in the HYP group reported an impression of more intraoperative control than those in the CONT group (P < 0.01). PONV were significantly reduced in the HYP group (6.5% vs. 30.8%, P < 0.001). Surgical conditions were better in the HYP group. Less signs of patient discomfort and pain were observed by the psychologist in the HYP group (P < 0.001). Vital signs were significantly more stable in the HYP group. Patient satisfaction score was significantly higher in the HYP group (P < 0.004). This study suggests that hypnosis provides better perioperative pain and anxiety relief, allows for significant reductions in alfentanil and midazolam requirements, and improves patient satisfaction and surgical conditions as compared with conventional stress reducing strategies support in patients receiving conscious sedation for plastic surgery.

Fellows BJ. Creamer M. An investigation of the role of 'hypnosis', hypnotic susceptibility and hypnotic induction in the production of age regression. British Journal of Social & Clinical Psychology 1978;17(2):165-71 In response to criticisms of the methodology of Barber's(1969)experiments, a 2x2 factorial design, varying hypnotic susceptibility and hypnotic treatment, was used to study the role of 'hypnosis' in the production of age regression by suggestion. Twenty subjects of high hypnotic susceptibility and 20 subjects of low hypnotic susceptibility were randomly allocated to one of two treatment conditions:hypnotic induction procedure or motivational instructions. Both treatments were followed by suggestions to regress to the age of seven years. Two measures of age regression were taken:the Draw-A-Man-Test and a subjective rating of the reality of the experience. The results showed significant effects of both variables, with high suceptibility and induction treatment producing better regression on both measures than low susceptibility and motivation treatment. Hypnotic susceptibility was the stronger of the two variables. The ranking of the four conditions corresponded with predictions of hypnotic depth from the state theory of hypnosis, but the findings were not inconsistent with the non-state theory. The drawings of all regressed groups were more mature than the norms for the age of seven and the drawings of a group of seven year old children.

Freeman RM. Macaulay AJ. Eve L. Chamberlain GV. Bhat AV. Randomised trial of self hypnosis for analgesia in labour. BMJ Clinical Research Edition. 1986;292(6521):657-8 We undertook a randomised trial to evaluate the effect of selfhypnosis on pain relief, satisfaction, and analgesic requirements for women in their first labour.

Fry L, Mason AA, Pearson RS Effect of hypnosis on allergic skin responses in asthma and hayfever BMJ 1964; i: 1145-8

Gearan P. Kirsch I. Response expectancy as a mediator of hypnotizability modification: a brief communication. International Journal of Clinical & Experimental Hypnosis. 1993;41(2):84-91 The role of response expectancy in bringing about increases in hypnotic susceptibility by use of the Carleton Skill Training Program (CSTP) was assessed with 27 subjects selected for their low hypnotizability scores. Subjects were randomly assigned to one of two conditions: 13 received the CSTP to increase their hypnotic susceptibility, and 14 received no training. In addition to assessing hypnotizability, hypnotic response expectancies were assessed before and after training. With pretreatment hypnotizability controlled, subjects in the training group scored significantly higher than control subjects on all self-report measures of hypnotizability but not on a measure of observed behavioral response. Changes in response expectancy were found to be highly correlated with changes in hypnotizability. With changes in expectancy controlled, no significant differences between the trained and control groups were found.

Gearan P. Schoenberger NE. Kirsch I. Modifying hypnotizability: a new component analysis. International Journal of Clinical & Experimental Hypnosis 1995;43(1):70-89 The effects of the Carleton Skills Training Program (CSTP) on hypnotizability were compared to those of a modified training program in which instructions for physical enactment of the response were omitted. After training, subjects in the original CSTP reported an increase in the extent to which they intentionally enacted suggested behaviors. In contrast, subjects in the modified training program reported increased fantasy without voluntary physical enactment. Nevertheless, both training programs increased behavioral and subjective responsiveness to suggestion, and there were no significant differences in response enhancement between the two programs. Across conditions, increases in behavioral and subjective responses to suggestion were correlated with increased use of fantasy. In contrast, increases in enactment were correlated only with compliance. The modified training program is recommended as a means of enhancing suggestibility with less likelihood than the original CSTP of engendering compliance.

Godeby J. Erdt G. Canavan T. Revenstorf D. Experimental hypermnesia: Effects of hypnosis on learning and memory processes Experimentelle und Klinische Hypnose 1993;9(2):71-95. Studied the effects of hypnosis on learning and memory to test the hypothesis that hypnotic trance facilitates learning and memory processes by changing the form and depth of verbal processing. Subjects included 36 normal male and female German adults (aged 21-45 yrs) (university students). Subjects were randomly assigned to 1 of 4 experimental groups. Group 1 learned a list of 48 neutral words in a waking state and had to recall it later under hypnosis. Group 2 learned the list under hypnosis and was tested during a waking state. Group 3 learned and recalled the list under hypnosis, and Group 4 learned and recalled the list in a waking state. Intergroup differences in recall performances were analyzed. (English abstract)

Goldmann L. Ogg TW. Levey AB. Hypnosis and daycase anaesthesia. A study to reduce pre-operative anxiety and intra-operative anaesthetic requirements. Anaesthesia 1988;43(6):466-9 Fifty-two female patients who underwent gynaecological operations as day cases received either a short pre-operative hypnotic induction or a brief discussion of equal duration. Hypnotized patients who underwent vaginal termination of pregnancy required significantly less methohexitone for induction of anaesthesia. They were also significantly more relaxed as judged by their visual analogue scores for anxiety. Less than half of the patients were satisfied with their knowledge about the operative procedure even after discussions with the surgeon and anaesthetist. A significant correlation was found between anxiety and perceived knowledge of procedures. The results suggest that pre-operative hypnosis can provide a quick and effective way to reduce pre-operative patient anxiety and anaesthetic requirements for gynaecological daycase surgery.

Greenberg RP. Land JM. Influence of some hypnotist and subject variables on hypnotic susceptibility. Journal of Consulting & Clinical Psychology 1971;37(1):111-5 Randomly assigned 48 21-56 yr. Old females to 1 of 4 groups given different information with regard to a hypnotist's warmth and experience. The 6 male graduate student hypnotists had previously been judged on their objective warmth and competent appearance. Following structuring, all ss underwent individual hypnotic induction. As predicted, ss run by the objectively warmer, more competent appearing es obtained significantly higher susceptibility scores. Structured warmth produced significant differences only in ss run by the objectively less warm es. Both structured warmth and experience affected ss' subjective impressions of whether they thought they had been hypnotized. The complex relationship between antecedent variables and the various objective and subjective dependent indicators of hypnotic phenomena are discussed.

Greenleaf M. Fisher S. Miaskowski C. DuHamel K. Hypnotizability and recovery from cardiac surgery. American Journal of Clinical Hypnosis 1992;35(2):119-28 We studied 32 coronary bypass patients to examine the effect of hypnosis on recovery from surgery. The patients were assessed for hypnotizability with the Hypnotic Induction Profile (HIP) and assigned to experimental groups with a random stratification procedure to equate for differences in hypnotizability, age, and severity of illness. We taught patients in groups one and two formal hypnosis with different treatment strategies; patients in group three were not taught formal hypnosis or a treatment strategy. Scores on the HIP were significant predictors of recovery, independent of experimental treatment with formal hypnosis. Patients who scored "Midrange" stabilized more quickly in the intensive care unit (ICU) than those who scored "High" or "Low" (p = < .05). Patients who scored "High" had more labile blood pressure in the ICU compared to the "Midrange" and "Lows" (p = < .05). Measured hypnotizability was associated with the recovery sequence from surgery.

Gregory J. Diamond MJ. Increasing hypnotic susceptibility by means of positive expectancies and written instructions. Journal of Abnormal Psychology 1973;82(2):363-7 Investigated the extent to which hypnotic susceptibility could be modified by means of induced positive expectancies and written instructions that were designed to correct misconceptions concerning hypnosis as well as to provide concrete methods for experiencing hypnosis. 40 undergraduates were given a baseline test of hypnotic susceptibility and then randomly assigned to 1 of 4 conditions. Subjects receiving the positive expectancy were given false personality test feedback that they were good hypnotic Subjects prior to a criterion hypnotic scale. Subjects receiving the written instructions were given 10 min to read the information prior to the hypnotic test. Other Subjects browsed through magazines prior to testing in hypnosis. Both positive expectancies and written instructions were significantly effective in increasing susceptibility in comparison with practice only. Theoretical explanations are advanced and the implications of these findings are considered.

Griffiths RA, Channon-Little L The hypnotizability of patients with bulimia nervosa and partial syndromes participating in a controlled treatment outcome study Contemporary Hypnosis 1993;10(2):81-7 This is a report of the hypnotizability of a large sample of bulimia nervosa and partial syndromes (n = 113) who participated in a controlled treatment outcome study. Data from the HGSHS:A (Harvard Group Scale of Hypnotic Susceptibility, Fom A) confirmed previous findings of high hypnotizability in these patients compared with normal populations. Furthermore, there was evidence that the responses of bulimia nervosa and partial syndrome patients differed significantly to the responses of the normal population on seven of the 12 items of the HGSHS:A.

Griffiths RA, Hadzi Pavlovic D, Channon Little L A controlled evaluation of hypnobehavioural treatment for bulimia nervosa: Immediate pre post treatment effects Eur Eating Disord Rev. 1994;2(4):202-220 The study reports the pre post findings from a controlled comparative evaluation of treatments for bulimia nervosa. These pre post results allow comparison of the hypnobehevioural and cognitive behavioural treatments with a waiting list control group and a comparison of the immediate effects of the two modalities. One hundred and thirty subjects were screened to enter the study. Seventy eight subjects entered the investigation after being randomly allocated to either a waiting list control group, or to hypnobehavioural or cognitive behavioural groups. The treatments were delivered individually and matched in duration (8 weeks) and the number of sessions. Pre to posttreatment outcome indicated significant differences between the control group and the two treatments in reductions in bulimic behaviours and related eating pathology. The immediate effects of both treatments were equal. There were no differences at posttreatment between the treatments in abstinence from either bingeing or purging. The treatment effects were also similar to the immediate effects obtained by longer therapeutic approaches.

Grond M. Pawlik G. Walter H. Lesch OM. Heiss WD. Hypnotic catalepsy-induced changes of regional cerebral glucose metabolism. Psychiatry Research. 1995;61(3):173-9 In an attempt to elucidate the physiological basis of hypnosis, we investigated the changes of whole-brain and regional cerebral glucose metabolism, from a state of resting wakefulness to a hypnotized state with whole-body catalepsy, using positron emission tomography and the 2[18F]fluorodeoxyglucose method in 15 highly hypnotizable adults. Neither the random order of study conditions nor any of the other experimental factors had a measurable effect, and there was no statistically significant global activation or metabolic depression. However, repeated measures analysis of variance revealed a statistically significant heterogeneity of symmetric regional responses: Mainly the occipital areas, including visual and paravisual cortex, became relatively deactivated, while some metabolic recruitment was found in structures involved in sensorimotor functions. The observed pattern of changes of regional cerebral activity corresponds with the shift of attention away from normal sensory input that hypnosis is known to produce.

Groth-Marnat G. Mitchell K. Responsiveness to direct versus indirect hypnotic procedures: the role of resistance as a predictor variable. International Journal of Clinical & Experimental Hypnosis 1998;46(4):324-33 Empirical research attempting to demonstrate that indirectly phrased hypnotic suggestions result in greater responsiveness than do direct approaches generally has not shown any differences on formal hypnotizability scales. However, empirical research in related areas along with clinical observation suggests that client resistance might be a crucial moderating variable. Specifically, participants with greater resistance would be expected to be more responsive to indirect approaches, whereas those with low levels of resistance would be more responsive to direct hypnotic procedures. To test this hypothesis, participants were given either a standardized test of hypnotic responsiveness that used direct suggestions (Harvard Group Scale of Hypnotizability) or a comparable indirect scale (Alman Wexler Indirect Hypnotic Susceptibility Scale) followed by administration of a measure of resistance (Therapeutic Reactance Scale). The hypothesis was not confirmed, in that those with higher (or lower) reactance/resistance did not score differently than those on either the indirect or direct hypnotizability measures.

Grunberger J. Linzmayer L. Walter H. Hofer C. Gutierrez-Lobos K.Stohr H. Assessment of experimentally-induced pain effects and their elimination by hypnosis using pupillometry studies. Wiener Medizinische Wochenschrift 1995;145(23):646-50 Hypnotherapeutical technique were often used for control of pain. However, an objective examination of this phenomenon was seldom carried out. The aim of the study was the psychophysiological objectivation of the effect of experimental induced pain and the elimination of pain by means of hypnosis. 22 healthy volunteers (11 female and 11 male) aged between 22 and 35 years participated in the study. In the 1st phase of the experiment static pupillometry was carried out before randomized presentation of a light stimulus (143 lux, 0.3 sec) and of a pain stimulus (coldness-spray, -50 degrees C, 0.5 sec) respectively. Afterwards the dynamic pupillary measurement was done. Additionally the Fourier analyses of pupillary oscillations reflecting central nervous activation during the static measurement (25,6 sec) was calculated. In the 2nd phase the subjects were investigated by means of the same techniques during hypnosis with specific suggestions for elimination of pain. Under light condition as well as after induction of pain an autonomic deactivation could be observed during hypnosis. Furthermore under pain condition a central deactivation could also be found, reflecting the depth of the hypnosis and the reduced perception of pain.

Haanen HC. Hoenderdos HT. van Romunde LK. Hop WC. Mallee C. Terwiel JP. Hekster GB. Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia. Journal of Rheumatology 1991;18(1):72-5 In a controlled study, 40 patients with refractory fibromyalgia were randomly allocated to treatment with either hypnotherapy or physical therapy for 12 weeks with followup at 24 weeks. Compared with the patients in the physical therapy group, the patients in the hypnotherapy group showed a significantly better outcome with respect to their pain experience, fatigue on awakening, sleep pattern and global assessment at 12 and 24 weeks, but this was not reflected in an improvement of the total myalgic score measured by a dolorimeter. At baseline most patients in both groups had strong feelings of somatic and psychic discomfort as measured by the Hopkins Symptom Checklist. These feelings showed a significant decrease in patients treated by hypnotherapy compared with physical therapy, but they remained abnormally strong in many cases. We conclude hypnotherapy may be useful in relieving symptoms in patients with refractory fibromyalgia.

Haddock CK. Rowan AB. Andrasik F. Wilson PG. Talcott GW. Stein RJ. Home-based behavioral treatments for chronic benign headache: a meta-analysis of controlled trials. Cephalalgia 1997;17(2):113-8 Controlled clinical trials have consistently demonstrated that behavioral treatments for chronic benign headache produce clinically beneficial outcomes both post-treatment and at follow-up. Given these results there is interest in cost-reduction and redesign of these treatments to improve their accessibility. One promising approach in this regard is home-based headache treatment. These treatments seek to provide the same amount of treatment as clinic-based treatments; however, some of the material typically presented to the patient by a clinician is presented through home-study materials (e.g., manuals, audiotapes). To date, the published literature contains 20 controlled clinical trials which have examined the outcomes produced by home-based treatments. This article presents the first comprehensive meta-analysis of these clinical outcome studies. Results of the quantitative analyses suggest that home-based treatments produce comparable, or with certain outcome measures, superior results to clinic-based treatments. Moreover, costeffectiveness scores of home-based treatments were found to be more than five times larger than those of clinic-based therapies. Methodological analyses are also presented along with suggestions for future research.

Hammarstrand G. Berggren U. Hakeberg M. Psychophysiological therapy vs. hypnotherapy in the treatment of patients with dental phobia. European Journal of Oral Sciences 1995;103(6):399-404 The aim of this study was to compare two different modes of behaviorally-oriented therapies for dental fear. The subjects were chosen consecutively from the waiting-list of a Dental Fears Research and Treatment Clinic. In addition, a control group was selected from patients treated under general anesthesia to compare levels of dental and general fear with the experimental groups. Twenty-two women, with a mean age of 31.8 yr, were included and randomly assigned to two groups. The median time of avoidance of dental care was 9.5 yr. One group received hypnotherapy (HT) and one group a behavioral treatment based on psychophysiological principles (PP). Both therapies included eight sessions followed by standardized conventional dental test treatments. Pre- and posttreatment measures were dental fear, general fear, mood, and patient behavior. Nine patients were not able to conclude the treatment sessions (6 HT and 3 PP); these patients did not differ significantly from the remaining patients before treatment. The PP group reported a statistically significant decrease in dental fear as well as a rise in mood during dental situations, as opposed to the HT group. General fear levels decreased but not significantly. Eleven patients completed conventional dental treatment according to a dentist's behavioral rating scale, indicating that they were relaxed, and no problems occurred during the treatments. These patients were referred to general practitioners within the community dental service. In conclusion, this small size study showed that a majority of the patients, who accomplished the behavioral therapy and the dental test treatments, became less fearful of dental care and were able to manage conventional dental care, including changing dentist.

Hammond DC. Haskins-Bartsch C. Grant CW= Jr. McGhee M. Comparison of self-directed and tape-assisted self-hypnosis. American Journal of Clinical Hypnosis 1988;31(2):129-37 48 inexperienced adult volunteers were hypnotized and taught self-hypnosis by posthypnotic suggestion and immediate practice in the office. Subjects were randomly assigned to 1 of 2 experimental orders to practice self-directed and tape-assisted self-hypnosis. No differences were found between heterohypnosis or either type of self-hypnosis in response to behavioral suggestions. Experiential ratings, however, consistently favored heterohypnosis over either type of self-hypnosis. Tape-assisted self-hypnosis was consistently evaluated as superior to self-directed practice by newly trained Subjects.

Harmon TM. Hynan MT. Tyre TE. Improved obstetric outcomes using hypnotic analgesia and skill mastery combined with childbirth education. Journal of Consulting & Clinical Psychology 1990;58(5):525-30 The benefits of hypnotic analgesia as an adjunct to childbirth education were studied in 60 nulliparous women. Subjects were divided into high and low hypnotic susceptibility groups before receiving 6 sessions of childbirth education and skill mastery using an ischemic pain task. Half of the Ss in each group received a hypnotic induction at the beginning of each session; the remaining control Ss received relaxation and breathing exercises typically used in childbirth education. Both hypnotic Ss and highly susceptible Ss reported reduced pain. Hypnotically prepared births had shorter Stage 1 labors, less medication, higher Apgar scores, and more frequent spontaneous deliveries than control Ss' births. Highly susceptible, hypnotically treated women had lower depression scores after birth than women in the other 3 groups. We propose that repeated skill mastery facilitated the effectiveness of hypnosis in our study.

Hartman BJ. Hypnotizability as Affected by Attitudinal and Motivational Variables. International Journal of Clinical & Experimental Hypnosis 1967;15(2):86-91 Attempted to discover whether task-motivated subjects would be more hypnotizable than those not given task-motivation instructions, and whether the attitude of the E would affect subjects' hypnotizability. The Barber suggestibility scale was employed for measuring susceptibility to hypnosis. Subjects were divided randomly into 6 groups of 10: task-motivated, E neutral; non-task-motivated, E neutral; task-motivated, E friendly; task-motivated, E harsh; non-task-motivated, E friendly; and non-task-motivated, E harsh. Analyses of variance, both for objective and subjective scores, did not yield significant results for the task-motivation variable but did yield significant results (p = .01) for the variable dealing with E attitude.

Harvey RF. Hinton RA. Gunary RM. Barry RE. Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet 1989;1(8635):424-5 33 patients with refractory irritable bowel syndrome were treated with four 40-minute sessions of hypnotherapy over 7 weeks. 20 improved, 11 of whom lost almost all their symptoms. Short-term improvement was maintained for 3 months without further formal treatment. Hypnotherapy in groups of up to 8 patients was as effective as individual therapy.

Hendler CS, Redd WH Fear of hypnosis: The role of labeling in patients' acceptance of behavioral interventions Behav Ther. 1986;17(1):2-13 One hundred and five outpatient cancer chemotherapy patients were interviewed to assess their attitudes toward hypnosis and relaxation as well as to determine their beliefs in and willingness to try a behavioral procedure. Patients were randomly assigned to groups receiving identical descriptions labeled 'hypnosis', 'relaxation', or 'passive relaxation with guided imagery'. The description stressed the behavioral components of hypnosis and relaxation rather than the nonbehavioral techniques often associated with hypnosis such as age regression and posthypnotic suggestion. Patients believed hypnosis to be a powerful process that involved loss of control and altered states of consciousness. When compared with a group of college students, patients held significantly more fearful, conservative views about hypnosis. Patients who received a description of an intervention labeled 'hypnosis' were significantly less likely to believe the procedure would effectively control their nausea and vomiting and were significantly less likely to state they would try the procedure than patients in the other two label conditions. This reaction to the label occurred independently of patients' degree of nausea, vomiting, and pain due to their chemotherapy treatments.

Hockenberry-Eaton MJ. Cotanch PH. Evaluation of a child's perceived self-competence during treatment for cancer. Journal of Pediatric Oncology Nursing 1989;6(3):55-62 The purpose of this study was to evaluate the effect of self-hypnosis on the perceived self-competence of children undergoing treatment for cancer and to determine longitudinal differences in perception of self-competence over time. Twenty-two children were randomized into an experimental group (taught self-hypnosis) and a control group (given standard care). Data were collected using the Harter Perceived Self-Competence Profile (HPSCP) during four courses of chemotherapy. A decrease in mean scores for the control group was found compared with the hypnosis group, which showed an increase in mean scores in five of six domains. Both groups showed a statistically significant increase in the scholastic cognitive domain and social acceptance domain from the time of diagnosis compared with the second test period. Ten children had a visible physical disability. These children were found to have significant decreases in the domains of athletic competence, social acceptance, and global self-worth. Decreases remained significant throughout all test periods in the athletic competence domain for the children with a visible physical disability. This study is unique in that the researchers evaluated children's perception of self-competence over time. These findings support previous studies and identify the need for nurses to become actively involved in helping children develop effective coping skills during chemotherapy for cancer.

Houle M. McGrath PA. Moran G. Garrett OJ. The efficacy of hypnosis- and relaxation-induced analgesia on two dimensions of pain for cold pressor and electrical tooth pulp stimulation. Pain 1988;33(2):241-51 This study evaluated the efficacy of hypnosis- and relaxation-induced suggestions for analgesia for reducing the strength and unpleasantness dimensions of pain evoked by noxious tooth pulp stimulation and by cold pressor stimulation. The Tellegen Absorption Questionnaire was used to assess hypnotic susceptibility for 28 subjects in order to match treatment groups according to sex and susceptibility scores. Tooth pulp stimulation consisted of a 1 sec train of 1 msec pulses at a frequency of 100 Hz, applied at 20 sec intervals to the central incisor. Six stimuli, selected between subject's pain and tolerance thresholds, were presented 3 times each in random order. Cold pressor stimulation consisted of forearm immersion in a circulating water bath maintained at 0-1 degrees C. Subjects made threshold determinations of pain and tolerance and used Visual Analogue Scales to rate the strength and the unpleasantness of both noxious stimuli before and after receiving either hypnosis- or relaxation-induced analgesia. There were no significant differences in pain reductions between hypnosis- and relaxation-induced interventions. However, the percent reduction in both strength and unpleasantness varied significantly as a function of the type of pain. Both hypnosis and relaxation significantly reduced the strength and the unpleasantness of tooth pulp stimulation, but only the unpleasantness dimension of cold pressor pain. The pain reductions were not correlated with subjects' hypnotic susceptibility levels. The results indicate that the extent and the quality of the analgesia produced by these cognitive-based therapies vary not only according to subjects' characteristics and the efficacy of the intervention, but also according to the nature of the noxious stimuli. Tooth pulp and cold pressor stimulation represent qualitatively different stimuli with respect to both the type of nerves activated and the mode of stimulus application. Discrete, randomly presented levels of noxious electrical stimulation to the teeth activate predominantly small fibers and produce brief pain sensations that vary unpredictably in intensity. In contrast, continuous cold stimulation to the forearm activates a variety of nociceptive and non-nociceptive fibers and produces progressive cold and pain sensations with a predictable increase in intensity from cold sensations to paresthesia and severe pain.

Howard WL. Reardon JP. Changes in the self concept and athletic performance of weight lifters through a cognitive-hypnotic approach: an empirical study. American Journal of Clinical Hypnosis 1986;28(4):248-57 Examined the effects of a cognitive-hypnotic-imagery approach (CHI), cognitive restructuring, and hypnosis only treatments on neuromuscular performance, muscular growth, reduction of anxiety, and enhancement of self-concept in 32 male weightlifters (mean age 22.5 yrs). Subjects were randomly assigned to 4 treatment conditions conducted over a 4-wk period. The CHI group showed significant treatment effects over the other groups on 6 dependent variables from pretest to posttest 1. From posttest 1 to posttest 2, a 1-mo period in which no treatment was conducted, self-concept and muscular growth measures for CHI Subjects showed significance. The CHI group was superior to the other conditions. Neuromuscular performance and muscular growth were positively modified by CHI. Data suggest that combining hypnotic relaxation and imagery with cognitive restructuring enhances both the immediate and long-range effects of treatment.

Hughes JA. Sanders LD. Dunne JA. Tarpey J. Vickers MD. Reducing smoking. The effect of suggestion during general anaesthesia on postoperative smoking habits. Anaesthesia. 1994;49(2):126-8 In a double-blind randomised trial, 122 female smokers undergoing elective surgery were allocated to receive one of two prerecorded messages while fully anaesthetised. The active message was designed to encourage them to give up smoking whilst the control message was the same voice counting numbers. No patient could recall hearing the tape. Patients were asked about their postoperative smoking behaviour one month later. Significantly more of those who had received the active tape had stopped or reduced their smoking (p < 0.01). This would suggest a level of preconscious processing of information.

Hurley AE. The effects of self-esteem and source credibility on self-denying prophecies. Journal of Psychology 1997;131(6):581-94 Self-fulfilling prophecies are a well-studied phenomenon. The study of self-denying prophecies, however, is rare. Self-denying prophecies shift people's behavior in the direction opposite to the prophecy. The existence of self-denying prophecies was investigated in 222 students. The effects of self-esteem and the source of the prophecy were also investigated. The results suggest that self-denying prophecies exist and that self-esteem is an important moderator of self-denying prophecies. If managers and industrial/organizational psychologists had an understanding of self-denying prophecies, they might be better able to structure negative performance reviews in a way that could lead to improved employee performance.

Hurley JD. Differential effects of hypnosis, biofeedback training, and trophotropic responses on anxiety, ego strength, and locus of control. Journal of Clinical Psychology 1980;36(2):503-7 Pretested 60 college students on three scales: The IPAT Anxiety Scale, the Barron Ego-strength scale, and the Rotter I-E scale. The Ss then were assigned randomly to one of four treatment groups designated: Hypnotic treatment, biofeedback treatment, trophotropic treatment, and control. Three of these groups met separetely for 60 minutes once a week for 8 weeks. The control group did not meet during this time. During the sessions, each group was trained in a different technique for self-regulation. At the end of the 8-week period the scales were readministered to all groups. A series of covariance analyses indicated that hypnosis was a more effective self-regulatory technique for lowering anxiety levels when compared to biofeedback or trophotropic response procedures. With regard to increasing ego strength, both the hypnotic training group and the biofeedback training group proved to be significant. No significant difference was found between the experimental and control gorups on the I-E scores.

Hyman GJ. Stanley RO. Burrows GD. Horne DJ. Treatment effectiveness of hypnosis and behaviour therapy in smoking cessation: a methodological refinement. Addictive Behaviors 1986;11(4):355-65 Studies in smoking cessation have generally failed to adequately control for active treatment effects and have assumed that measures of smoking behaviour (i.e., estimated smoking rate, self-monitoring and chemical analysis) are equally reliable measures. Sixty smokers were randomly assigned to one of four different smoking cessation treatment groups: hypnosis, focussed smoking, attention placebo and a waiting list control. Subjects were asked to estimate and monitor their own smoking behaviour. Blood samples were also taken for thiocyanate analysis before treatment. Smoking rates were similarly measured directly, at 3 months and 6 months after treatment. The results indicate that the three measures of smoking behaviour were all highly correlated. No significant differences were found between treatments, directly after treatment or at the 3- and 6-month follow-ups. These results suggest that active treatment effects may not be responsible for behavioural change in a smoking cessation program. The implications of these findings are discussed.

Jacknow DS. Tschann JM. Link MP. Boyce WT. Hypnosis in the prevention of chemotherapy-related nausea and vomiting in children: a prospective study. Journal of Developmental & Behavioral Pediatrics 1994;15(4):258-64 To study the effectiveness of hypnosis for decreasing antiemetic medication usage and treatment of chemotherapy-related nausea and vomiting in children with cancer, we conducted a prospective, randomized, and controlled single-blind trial in 20 patients receiving chemotherapy for treatment of cancer. Patients were randomized to either hypnosis or standard treatment. The hypnosis group used hypnosis as primary treatment for nausea and vomiting, using antiemetic medication on a supplemental (p.r.n.) basis only, whereas the control group received a standardized antiemetic medication regimen. Nausea, vomiting, and p.r.n. antiemetic medication usage were measured during the first two courses of chemotherapy. Anticipatory nausea and vomiting were assessed at 1 to 2 and 4 to 6 months postdiagnosis. Patients in the hypnosis group used less p.r.n antiemetic medication than control subjects during both the first (p < .04) and second course of chemotherapy (p < .02). The two groups did not differ in severity of nausea and vomiting. The hypnosis group experienced less anticipatory nausea than the control group at 1 to 2 months postdiagnosis (p < .02). Results suggest self-hypnosis is effective for decreasing antiemetic medication usage and for reducing anticipatory nausea during chemotherapy.

Jacobs AL, Kurtz RM, Strube MJ Hypnotic analgesia, expectancy effects, and choice of design: a reexamination. Int J Clin Exp Hypn 1995 Jan;43(1):55-69 Previous research by Stam and Spanos suggests that if waking analgesia is followed by hypnotic analgesia, subjects refrain from maximally responding during the waking trial so they report less pain under hypnosis (i.e., a holdback effect). This hypothesis was re-examined using more stringent controls. Thirty-six highly susceptible subjects chosen by a combination of the Harvard Group Scale of Hypnotic Susceptibility, Form A and the Stanford Hypnotic Susceptibility Scale, Form C were randomly assigned to one of three treatment groups (waking analgesia followed by hypnotic analgesia, waking analgesia followed by waking analgesia, or hypnotic analgesia followed by waking analgesia). Each group received three 60-second immersions of cold pressor pain stimulation (baseline, Immersion 1, Immersion 2) and rated pain using a magnitude estimation and a category rating scale. The obtained results failed to support the hypotheses of a holdback effect or a reverse-order holdback effect. Properties of within-subjects and between-subjectsdesigns were considered in explaining the superiority of hypnotic analgesia over waking analgesia typically found in within-subjects models.

Jansen CK. Bonke B. Klein J. van Dasselaar N. Hop WC. Failure to demonstrate unconscious perception during balanced anaesthesia by postoperative motor response. Acta Anaesthesiologica Scandinavica 1991;35(5):407-10 Eighty patients undergoing a standardized balanced anaesthesia were randomly assigned to either a suggestion group (N = 38) or a control group (N = 42), in a double-blind design. Anaesthesia was maintained with nitrous oxide, enflurane and fentanyl. Patients in the suggestion group were played seaside sounds, interrupted by statements of the importance of touching the ear during a postoperative visit, by means of a prerecorded audiotape and headphones. Tapes containing these suggestions were played from 30 min after the first incision, for a duration of 15 min. Patients in the control group were only played seaside sounds. There were no significant differences between the groups in either the number of patients touching their ears postoperatively or the number and duration of ear touches.

Jasiukaitis P. Nouriani B. Spiegel D. Left hemisphere superiority for event-related potential effects of hypnotic obstruction. Neuropsychologia. 1996;34(7):661-8 Twenty-two highly hypnotizable subjects were run in a visual target detection task which compared hypnotic obstruction of the left and right visual fields over separate blocks. The visual event-related potentials (ERPs) to non-target stimuli revealed that hypnotic obstruction reduced the P200 component to stimuli in the right hemifield, but did not affect P200 for stimulation in the left hemifield. The earlier P100 and N100 were also reduced to hypnotic obstruction but not as preferentially for either hemifield, while the P300 was not significantly changed. Right visual field left hemisphere P200 reduction predicted suppression of behavioral response (button press) to hypnotically obstructed targets in both hemifields. The results are discussed in terms of Farah's model of a left hemisphere mechanism for image generation, and how highly hypnotizable subjects might use this mechanism to comply successfully with the suggestion of a hallucinated visually opaque barrier.

Javel AF. One-session hypnotherapy for smoking: a controlled study. Psychological Reports 1980;46(3 Pt 1):895-9 Not randomised

Jeffrey LK. Jeffrey TB. Exclusion therapy in smoking cessation: a brief communication. International Journal of Clinical & Experimental Hypnosis 1988;36(2):70-4 Investigated the effect of exclusion therapy on the outcome of a 5-session treatment protocol for smoking cessation. 120 adult Subjects were randomly assigned to a group hypnotic and behavioral program that required 48 hrs of pretreatment abstinence from use of tobacco products, or to an identical treatment that encouraged, but did not include, this pretreatment stipulation. Results indicate no significant differences between groups in dropout rates or number of Subjects abstinent from smoking. For all Subjects, including dropouts, the abstinence rate was 59.2% upon completion of treatment. It was 45.5% and 36.7% at 1- and 3-mo follow-up, respectively.

Johnson LS. Johnson DL. Olson MR. Newman JP. The uses of hypnotherapy with learning disabled children. J Clinical Psychology. 1981; 37(2):291-9 Three hypnotic training sessions and instructions for 6 weeks of daily self-hypnotic practice that contained suggestions for imagery related to improvement in these areas were given to 15 children (12 males and 3 females, ages from 7 to 13), their reading teacher, and both their parents, and their responses were compared to a similar but untreated control group of 18. No overall differences were observed between groups. A multiple regression analysis revealed important predictors of self-esteem improvement for the experimental group. The child's hypnotic susceptibility score and self-hypnotic practice by children and parents were the most relevant. These LD children were at least as hypnotically susceptible as a normative sample. Hypnotherapy is seen as feasible in group administration by persons only moderately trained in hypnosis and of potential benefit to self-esteem improvement in LD children, depending on individual difference factors.

Johnson PR. Thorn BE. Cognitive behavioral treatment of chronic headache: group versus individual treatment format. Headache 1989;29(6):358-65 Two hypotheses were tested in this study: (1) that a short course of cognitive behavioral therapy (CBT) is effective in the treatment of chronic headache; and (2) that group CT is as effective as individually administered CBT. Twenty-two chronic headache sufferers were randomly assigned to one of three treatment conditions: group administered CBT, individually administered CBT, or no treatment (wait list) control. Wait list subjects ultimately received treatment identical to that offered to subjects in the group treatment condition. Treatment outcome measures included the Brief Symptom Inventory, the McGill Pain Questionnaire, and several measures calculated from self-monitoring data. Tentative support was found for the hypothesis that CBT as provided in this study is effective in the treatment of chronic headache. There was no evidence that group versus individually treated subjects differed significantly on any of the measures used, although the small N and large variance among subjects limit us to preliminary conclusions for our findings. Clinical implications and suggestions for future research are discussed.

Johnson RL. Johnson HC. Effects of anxiety-reducing hypnotic training on learning and reading-comprehension tasks. Journal of the National Medical Association 1984;76(3):233-235. 15 college students who reported having test-taking anxiety were randomly assigned to an experimental or a control group. The experimental group received hypnotic training to reduce anxiety prior to taking a learning and reading-comprehension test. No significant difference was found between the experimental and the control group on the simple-recall task. However, on the reading-comprehension test the experimental group scored significantly higher than the control group. Further examination of the total score revealed that the experimental group difference was due to superior performance on the inference items. There was no difference between groups on items that required the recall of information from the passage. Findings support the notion that hypnotic training may be useful to reduce anxiety and improve test performance.

Johnson VC, Walker LG, Heys SD, Whiting PH, Eremin O Can relaxation training and hypnotherapy modify the immune response to stress, and is hypnotizability relevant? Contemporary Hypnosis 1996;13(2):100-8 A study was carried out with the following aims: (1) to evaluate the psychological and immunological effects of 3 weeks' relaxation practice; (2) to investigate the effects of relaxation training and hypnosis on the modulation of the immune response to an experimental stressor, and (3) to relate changes to hypnotic susceptibility. Twenty-four healthy volunteers were assigned, according to a stratified, permuted blocks, random allocation procedure, to relaxation training with hypnosis or to a control condition. Subjects attended of three occasions: day 1, day 21 and day 22 or 23. Various psychological tests were carried out on each of the occasions and, in addition, samples of urine and blood were collected for immunological and biochemical analysis. Two samples of blood were taken at the second visit, one before exposure to an experimental stressor on day 21 and one immediately thereafter. Relaxation had several effects including improvement on a number of measures of mental state and a reduction in lymphocyte responsiveness and IL-1 secretion. However, on exposure to the stressor, previous relaxation training and pre-exposure hypnotic suggestion led to increased lymphocyte responsiveness and IL-1 secretion. The extent to which IgA increased as a result of relaxation therapy for 3 weeks was positively correlated with Creative Imagination Scale (CIS) scores (changes in the control group during the same period were not correlated with CIS scores). Moreover, immediate changes in IL-1 following exposure to the stressor were positively correlated with CIS scores in the experimental groups and negatively in the control group. Hypnotizability, as assessed by the CIS, may be an important moderator of the psychneuroimmunological response to relaxation training and exposure to acute stress.

Johnston M, Vogele C Benefits of psychological preparation for surgery: A meta analysis Ann Behav Med. 1993;15(4):245-256 There is now substantial agreement that psychological preparation for surgery is beneficial to patients. It is important, however, to establish which benefits can be achieved by psychological preparation and if all forms of preparation are equally effective. The results of randomized controlled trials of psychological methods of preparing adult patients for surgery were analyzed in terms of eight outputs (negative affect, pain, pain medication, length of stay, behavioral and clinical indices of recovery, physiological indices, and satisfaction). In order to reduce publication bias, published as well as unpublished studies were included in the meta analysis. It was concluded that significant benefits can be obtained on all of the major outcome variables that have been explored. Procedural information and behavioral instructions show the most ubiquitous effects in improving measures of post-operative recovery. The results have implications for the improvement of patient care in surgical units.

Kaplan GM, Barabasz AF Enhancing hypnotizability: differential effects of flotation restricted environmental stimulation technique and progressive muscle relaxation Australian Journal of Clinical & Experimental Hypnosis 1988 May;16(1):39-51 Investigated the effectiveness of flotation restricted environmental stimulation technique (REST) for enhancing hypnotizability. 30 Subjects were randomly assigned to flotation REST, progressive muscle relaxation (PMR), or no-treatment control conditions. Subjects were tested with the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C), and readministered the SHSS:C after treatment and at follow-up. Results show that PMR enhanced hypnotizability more than no-treatment control. Flotation REST was not found to enhance hypnotizability more than PMR. Both REST and PMR Subjects significantly increased hypnotizability over time while control Subjects did not. The role of relaxation in hypnosis is discussed.

Katcher A. Segal H. Beck A. Comparison of contemplation and hypnosis for the reduction of anxiety and discomfort during dental surgery. American Journal of Clinical Hypnosis 1984;27(1):14-21 Used complex moving visual stimuli to induce states of relaxation, hypnosis, and revery in 42 dental patients (aged 21-60 yrs). To test the efficacy of using aquarium contemplation to induce relaxation, Subjects were randomly assigned to 1 of 5 treatments prior to elective oral surgery: contemplation of an aquarium, contemplation of a poster, poster contemplation with hypnotic induction, aquarium contemplation with hypnosis, and a nonintervention control. Subjects were administered 5 tests of susceptibility adapted from the Stanford Hypnotic Susceptibility Scale; blood pressure, heart rate, and subjective and objective measures of anxiety were also taken. It was found that pretreatment with aquarium contemplation and hypnosis, either alone or in combination, produced significantly greater degrees of relaxation during surgery than poster contemplation or the control procedure. Two-way ANOVA demonstrated that a formal hypnotic induction did not augment the relaxation produced by aquarium contemplation. Findings suggest that aquarium contemplation can alter patients' subjective experiences and overt behavior during oral surgery. Other clinical applications of the contemplation procedure are discussed.

Katz ER. Kellerman J. Ellenberg L. Hypnosis in the reduction of acute pain and distress in children with cancer. Journal of Pediatric Psychology 1987;12(3):379-94 12 female and 24 male 6-11 yr olds with acute lymphoblastic leukemia who were undergoing repeated bone marrow aspirations (BMAs) were randomized to hypnosis or play comparison groups. Subjects were selected on their behavioral performance on baseline procedures and received interventions prior to their next 3 BMA procedures. Major results indicate an improvement in self-reported distress with both interventions. Girls exhibited more distress behavior than boys on 3 of 4 dependent measures. Suggestions of an interaction effect between sex and treatment groups were noted. The role of rapport between patient and therapist in therapeutic outcome is discussed.

Katz NW. Hypnotic inductions as training in cognitive self-control. Cognitive Therapy Research 1978;2(4):365-369. Compared the efficacy of the traditional trance induction, the author's cognitive training induction, and a combination of cognitive training and active-alert instructions. In the context of a guest lecture on hypnosis, volunteer undergraduates were randomly assigned to 1 of 3 groups. The Harvard Group Scale of Hypnotic Susceptibility and a measure of attitudes toward hypnosis and conceptions of the hypnotic process were used. Results show the following: (a) The 2 inductions containing training procedures were significantly more effective than the trance induction in enhancing suggestibility but did not differ from each other. (b) Subjects exposed to the combined training and fantasy inductions saw themselves as more hypnotizable in the future than Subjects exposed to training alone.

Kaufert JM. Rabkin SW. Syrotuik J. Boyko E. Shane F. Health beliefs as predictors of success of alternate modalities of smoking cessation: results of a controlled trial. Journal of Behavioral Medicine 1986;9(5):475-89 The primary objective of this study was to determine whether health beliefs influenced the outcome of the three alternate modalities of reducing cigarette consumption. The study randomized volunteers either to a control group or to one of three cessation programs, using behavior modification, health education, or hypnosis. A questionnaire was used to document health beliefs, demographic characteristics, and smoking history. Blood samples were taken before and after the completion of intervention programs to measure changes in serum thiocyanate. A follow-up questionnaire was used to assess smoking behavior after 6 months. Statistically significant decreases in serum thiocyanate levels followed participation in each of the three programs. Factor analysis and reliability tests were used to identify four scales reflecting major variable dimensions in the health belief model. Significant correlations between change in serum thiocyanate and two of the scales (general health concern and perceived vulnerability) were found only for the group randomly assigned to the health education intervention program.

Kirsch I. Hypnotic enhancement of cognitive-behavioral weight loss treatments--another meta-reanalysis Journal of Consulting & Clinical Psychology 1996;64(3):517-9 In a 3rd meta-analysis of the effect of adding hypnosis to cognitive-behavioral treatments for weight reduction, additional data were obtained from authors of 2 studies, and computational inaccuracies in both previous meta-analyses were corrected. Averaged across posttreatment and follow-up assessment periods, the mean weight loss was 6.00 lbs. (2.72 kg) without hypnosis and 11.83 lbs. (5.37 kg) with hypnosis. The mean effect size of this difference was 0.66 SD. At the last assessment period, the mean weight loss was 6.03 lbs. (2.74 kg) without hypnosis and 14.88 lbs. (6.75 kg) with hypnosis. The effect size for this difference was 0.98 SD. Correlational analyses indicated that the benefits of hypnosis increased substantially over time (r = .74).

Kirsch I. Montgomery G. Sapirstein G. Hypnosis as an adjunct to cognitive-behavioral psychotherapy: a meta-analysis. Journal of Consulting & Clinical Psychology 1995;63(2):214-20 A meta-analysis was performed on 18 studies in which a cognitive-behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive-behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments.

Klein KB. Spiegel D. Modulation of gastric acid secretion by hypnosis. Gastroenterology 1989;96(6):1383-7 The ability of hypnosis to both stimulate and inhibit gastric acid secretion in highly hypnotizable healthy volunteers was examined in two studies. In the first, after basal acid secretion was measured, subjects were hypnotized and instructed to imagine all aspects of eating a series of delicious meals. Acid output rose from a basal mean of 3.60 +/- 0.48 to a mean of 6.80 +/- 0.02 mmol H+/h with hypnosis, an increase of 89% (p = 0.0007). In a second study, subjects underwent two sessions of gastric analysis in random order, once with no hypnosis and once under a hypnotic instruction to experience deep relaxation and remove their thoughts from hunger. When compared to the no-hypnosis session, with hypnosis there was a 39% reduction in basal acid output (4.29 +/- 0.93 vs. 2.60 +/- 0.44 mmol H+/h, p less than 0.05) and an 11% reduction in pentagastrin-stimulated peak acid output (28.69 +/- 2.34 vs. 25.43 +/- 2.98 mmol H+/h, p less than 0.05). We have shown that different cognitive states induced by hypnosis can promote or inhibit gastric acid production, processes clearly controlled by the central nervous system. Hypnosis offers promise as a safe and simple method for studying the mechanisms of such central control.

Kohen DP Relaxation-mental imagery (self-hypnosis) for childhood asthma: behavioral outcomes in a prospective, controlled study Hypnos 1995 Sep;22(3):132-44 Twenty-eight (28) 7-12 yr old children entered a controlled study of the effects of self-hypnosis on asthma. Asthma belief and behavioural inventories were collected before, and at one and two yrs after intervention. Asthma diaries were kept daily and mailed monthly. Subjects were randomly assigned to (1) Experimental (self-hypnosis), (2) Waking suggestion (no Hypnosis), (3) attention placebo (no hypnosis or asthma discussion), or (4) traditional control groups. Twenty four (24) completed 1 month follow-up, 16 completed 6 months, and 13 completed 2 yrs. Results included fewer Emergency Room visits in the experimental group (p greater than 0.05); (2) less school missed in the experimental group compared to the traditional controlled group (p greater than 0.001) and to the waking suggestion group (p greater than 0.005); (3) no differences in psychological evaluations between groups, and (4) surprising findings regarding hypnotic and hypnotic-like experiences among subjects.

Kohen DP Relaxation/mental imagery (self-hypnosis) for childhood asthma: behavioural outcomes in a prospective, controlled study Australian Journal of Clinical & Experimental Hypnosis 1996 May;24(1):12-28 Twenty-eight 7-12-year-old children entered a controlled study of the effects of self-hypnosis on asthma. Asthma belief and behavioural inventories were collected before, and at one and two years after intervention. Asthma diaries were kept daily and mailed monthly. Subjects were randomly assigned to (a) experimental (self-hypnosis), (b) waking suggestion (no hypnosis), (c) attention placebo (no hypnosis or asthma discussion) or (d) traditional control groups. Twenty-four completed one-month follow-up, 16 completed six months, and 13 completed two years. Results included: (a) fewer emergency room visits in the experimental group; (b) less school missed in the experimental group compared to the traditional control group and to the waking suggestion group; (c) no difference in psychological evaluations between groups; and (d) surprising findings regarding hypnotic and hypnotic-like experiences among subjects.

Kurtz RM. Strube MJ. Multiple susceptibility testing: is it helpful?. American Journal of Clinical Hypnosis. 1996;38(3):172-84 This study explored whether or not the use of combined group and individually administered susceptibility tests improve the predictive power over the use of a singly administered test. Two hundred and eighty undergraduates were assigned to one of five groups: Group 1 received the HGSHS: A and then the SHSS:C; Group 2 the CIS and SHSS:C; Group 3 the HGSHS: A and the SHCS:A; Group 4 received the CIS and the SHCS:A; and Group 5 was tested on the SHSS:C alone. After the susceptibility screening the subjects were hypnotized and tested on four types of target hypnotic behaviors. From the RSPSHS:I&II the following four factors were chosen (1) cognitive distortion, (2) positive hallucination, (3) negative hallucination, (4) dreams and regression. The items were matched on difficulty level. The data were subjected to a series of stepwise multiple regression and logistic regression analyses. The results confirmed previous research; i.e., (1) The SHSS:C is the best single measure, (2) the SHCS:A is a poor substitute for the SHSS:C; (3) the HGSHS:A is not adequate substitute for SHSS:C; (4) the CIS is weak in predictive power compared to the HGSHS:A; (5) Only for a weak measure such as SHCS:A does combined testing produce an advantage; (6) There appear to be no warm-up effects for SHSS:C when preceded by HGSHS:A.

Kuttner L. Bowman M. Teasdale M. Psychological treatment of distress, pain, and anxiety for young children with cancer. Journal of Developmental & Behavioral Pediatrics 1988;9(6):374-81 The study compared the efficacy of hypnotic "imaginative involvement," behavioral distraction and standard medical practice for the reduction of pain, distress and anxiety in children with leukemia, during bone marrow aspirations. Two age groups of children, 3 to 6, and 7 to 10 years, were randomized to the three treatment groups. Two intervention sessions were given. At first intervention, observational ratings of distress indicated significant reductions for the younger group in the hypnotic treatment, whereas the older group achieved significant reductions in both treatment conditions for observer-rated pain and anxiety. At second intervention, all groups showed reductions and the control group appeared to be contaminated. The hypnotic method with its internal focus had an all-or-none effect, whereas distraction appeared to require that coping skills be learned over one session or more.

Lambe R. Osier C. Franks P. A randomized controlled trial of hypnotherapy for smoking cessation. Journal of Family Practice 1986;22(1):61-5 A randomized controlled study in a family practice setting was conducted on the use of hypnosis in helping people quit smoking. In the hypnosis group 21 percent of patients quit smoking by the three month follow-up compared with 6 percent in the control group. By six months there were no significant differences between the two groups, and at one year 22 percent in the hypnosis group and 20 percent in the control group had quit. The only significant predictor of success with quitting was having a college education.

Lambert SA. The effects of hypnosis/guided imagery on the postoperative course of children. Journal of Developmental & Behavioral Pediatrics. 1996;17(5):307-10 Hypnosis, guided imagery, and relaxation have been shown to improve the postoperative course of adult surgical patients. Children have successfully used hypnosis/guided imagery to significantly reduce the pain associated with invasive procedures and to improve selected medical conditions. The purpose of this study was to examine the effect of hypnosis/guided imagery on the postoperative course of pediatric surgical patients. Fifty-two children (matched for sex, age, and diagnosis) were randomly assigned to an experimental or control group. The experimental group was taught guided imagery by the investigator. Practice of the imagery technique included suggestions for a favorable postoperative course. Significantly lower postoperative pain ratings and shorter hospital stays occurred for children in the experimental group. State anxiety was decreased for the guided imagery group and increased postoperatively for the control group. This study demonstrates the positive effects of hypnosis/guided imagery for the pediatric surgical patient.

Lang EV. Joyce JS. Spiegel D. Hamilton D. Lee KK. Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use. International Journal of Clinical & Experimental Hypnosis 1996;44(2):106-19 The authors evaluated whether self-hypnotic relaxation can reduce the need for intravenous conscious sedation during interventional radiological procedures. Sixteen patients were randomized to a test group, and 14 patients were randomized to a control group. All had patient-controlled analgesia. Test patients additionally had self-hypnotic relaxation and underwent a Hypnotic Induction Profile test. Compared to controls, test patients used less drugs (0.28 vs. 2.01 drug units; p < .01) and reported less pain (median pain rating 2 vs. 5 on a 0-10 scale; p < .01). Significantly more control patients exhibited oxygen desaturation and/or needed interruptions of their procedures for hemodynamic instability. Benefit did not correlate with hypnotizability. Self-hypnotic relaxation can reduce drug use and improve procedural safety.

Larison G. Exploring an experimental method for producing the spontaneous repressions of impulses. Proceedings of the 81st Annual Convention of the American Psychological Association, Montreal Canada 1973;8:1097-1098. Attempted to identify the necessary and sufficient conditions for producing psychopathology upon the posthypnotic motivation of anger in a study with 16 female Subjects. Subject's feelings and amnesia for the paramnesia serving as a matrix for the anger were assessed. A paramnesia which previously had not produced psychopathology was used in a 2 * 2 randomized design. Mild symptoms of psychopathology were elicited, but neither of the variables was significant. However, the amnesia condition was associated with significantly greater repression of the posthypnotically activated anger and significantly less GSRs. The success in producing psychopathology is discussed in the light of earlier failures with this paramnesia.

Lee DY. Barak A. Uhlemann MR. Patsula P. Effects of preinterview suggestion on counselor memory, clinical impression, and confidence in judgments. Journal of Clinical Psychology 1995;51(5):666-75 This study examined the effects of schematic preinterview suggestion on counselors' (a) recognition memory of the information presented by the client; (b) clinical impression rating of the client; and (c) confidence in rating clinical impression. Fifty-two Master's-level counselor-trainees were assigned randomly to two conditions of preinterview suggestion about the status of the client (i.e., depression and no depression). After subjects had received appropriate preinterview information (i.e., depression or no-depression content) and had viewed a videotaped counseling interview, information was gathered from them. The results indicated that the preinterview suggestion (a) did not affect counselor-trainees' clinical impression rating of the client; (b) did not affect confidence of rating; and (c) yielded a weak, but significant, confirmatory memory. Implications for the interview setting are discussed.

Lieberman J. Lavoie G. Brisson A. Suggested amnesia and order of recall as a function of hypnotic susceptibility and learning conditions in chronic schizophrenic patients. International Journal of Clinical & Experimental Hypnosis 1978;26(4):268-280. Investigated the influence on suggested amnesia of hypnotic susceptibility and active vs passive learning. 36 chronic schizophrenic patients, 18 low in hypnotic susceptibility and 18 medium or high in hypnotic susceptibility, were randomly assigned to active or passive learning conditions. Subjects were first tested in a hypnosis condition (Day 1) and were retested in a nonhypnosis condition (Day 2) with the presence of waking suggestion. Results for the hypnosis condition indicate that (a) there were no differences between low and medium-high susceptible Subjects on recall amnesia and reversibility, (b) recall amnesia and reversibility were significantly higher in passive than active learning conditions, and (c) in all conditions recall was consistently ordered. Results for the nonhypnosis condition were similar, except that reversibility was not significantly higher in passive than active learning conditions. A secondary analysis, which partitioned high susceptible from medium susceptible Subjects, revealed that reversibility was significantly higher in the high than in the low susceptible Subjects; medium susceptible Subjects did not differ from either high or low susceptible Subjects. The data suggest that the chronic schizophrenics' failure to recall hypnotic events may involve different mechanisms from those that account for posthypnotic amnesia in normal Subjects. (German, French & Spanish summaries)

Lieberman LR. Fisher JR. Thomas R. King W. Use of tape recorded suggestions as an aid to probationary students. American Journal of Clinical Hypnosis 1968;11(1):35-41. A controlled study of the effectiveness of tape recorded hypnotic-like techniques on probationary students was performed. 35 pairs of probationary students, matched in curriculum predicted grade, sex, marital status, and age, were randomly assigned to control and experimental conditions. Both groups were tested for intelligence and hypnotic susceptibility; no differences were found. Results showed no significant difference in final grades for the 2 groups; however, there were significantly more experimental Subjects (14 to 8) removed from probation at the end of the quarter.

Linton CP, Sheehan PW The relationship between interrogative suggestibility and susceptibility to hypnosis Australian Journal of Clinical & Experimental Hypnosis 1994 May;22(1):53-64 Using the Gudjonsson Suggestibility Scale (GSS; Gudjonsson, 1984) and Harvard Group Scale of Hypnotic Susceptibility (HGSHS:A, Shor and Orne, 1962) as measures of interrogative suggestibility and hypnotic susceptibility, 117 subjects were tested to examine the hypothesis that a relationship exists between these two measures of suggestibility. Subjects were assigned randomly to conditions within a 2 (susceptibility: high, low) x 2 (state instruction: hypnosis, waking) x 2 (feedback on the GSS: neutral, negative) design. The data suggest that the two types of suggestibility are, in fact, associated. Analyses indicated that suggestibility scores on the GSS differed appreciably for high versus low susceptible subjects, and the HGSHS:A was significantly correlated with yield scores on the interrogative suggestibility scale. Results challenge previous claims that the two types of suggestibility are independent of one another and have forensic implications that may be usefully explored.

Liu WH. Standen PJ. Aitkenhead AR. Therapeutic suggestions during general anaesthesia in patients undergoing hysterectomy. British Journal of Anaesthesia 1992;68(3):277-81 In a double-blind, randomized study, we have examined the influence of positive therapeutic suggestions, presented to anaesthetized patients undergoing total abdominal hysterectomy, on postoperative morbidity and duration of hospital stay. Seventy-five patients were allocated randomly to be exposed to one of three tapes containing positive therapeutic suggestions, a modified history of the Queen's Medical Centre, or no message. We found that neither therapeutic suggestions nor the presence of a voice during anaesthesia improved postoperative outcome or reduced duration of hospital stay after total abdominal hysterectomy.

Llaneza-Ramos ML. Hypnotherapy in the treatment of chronic headaches. Philippine Journal of Psychology 1989;22:17-25. 35 chronic headache patients were assessed on frequency, duration, intensity, amount of medication, and number of difficulties associated with headaches. 25 Subjects were randomly assigned to 2 psychotherapists who administered Ericksonian hypnotherapy; 10 Subjects became the comparison group. Prior to treatment, all 25 Subjects were nonsignificantly different on their baseline measures. Posttreatment measures showed all Subjects with complete relief from headaches. Two months later, 20 Subjects experienced complete recovery while 5 had a single attack of headache. For the 2 experimental groups, there were no significant differences in symptomatic manifestations before and after treatment. At the delayed posttreatment period, post hoc test analysis evidenced a shared pattern of significant differences between each of the 2 treatment groups and the comparison group.

Locke SE. Ransil BJ. Zachariae R. Molay F. Tollins K. Covino NA. Danforth D. Effect of hypnotic suggestion on the delayed-type hypersensitivity response. JAMA. 1994;272(1):47-52 OBJECTIVE--To determine whether individuals selected for good general health, high hypnotizability, and the ability to alter skin temperature under hypnotic suggestion can influence the delayed-type hypersensitivity (DTH) response to varicella-zoster (VZ) antigen under hypnotic suggestion. DESIGN--A blinded clinical trial using a repeated measures design with subjects serving as their own controls. Subjects were randomly assigned to undergo a predetermined sequence of four different experimental conditions, occurring at weekly intervals, with each condition including VZ skin testing: (1) hypnosis with suggestions to enhance the DTH response to VZ antigen; (2) hypnosis with suggestions to suppress the DTH response; (3) hypnosis with suggestions for relaxation only; and (4) skin testing without hypnosis. SETTING--A National Institutes of Health-supported clinical research center in a teaching hospital. SUBJECTS--A stratified sample of 24 ambulatory, healthy, highly hypnotizable, volunteer college students selected for their above-average ability to alter skin temperature after hypnotic suggestions and their positive baseline responses to VZ antigen. There were 11 males and 13 females with a mean +/- SD age of 22 +/- 6 years. The mean +/- SD hypnotizability score (Harvard Group Scale of Hypnotic Susceptibility) was 11 +/- 1. INTERVENTIONS--Intradermal skin testing with VZ antigen (Mantoux method) and hypnotic suggestion. MAIN OUTCOME MEASURES--Areas of induration of the DTH response measured at 24 and 48 hours after injection of antigen. RESULTS--The area of the DTH response was not affected by the experimental interventions. The area of erythema was likewise unaffected. CONCLUSIONS--Our subjects were unable to alter their DTH responses using hypnotic suggestion.

Long N. Labeling relaxation procedures: impact on adolescent's self-report of effectiveness. Journal of Adolescent Health 1992;13(8):686-92 Adolescents are being taught relaxation techniques by health-care professionals with increased frequency. The present study examined the effect, on self-reported relaxation, of labeling passive relaxation techniques as "hypnotic relaxation" or as "relaxation training." Subjects were 64 adolescent college students who scored above the 50th percentile, from a subject pool of 189 potential subjects, on the Spielberger Trait Anxiety Inventory. A two by two by two factorial design was utilized with sex, label (hypnotic relaxation versus relaxation training) and relaxation technique (hypnotic induction versus autogenic training) as the independent variables. Under the guise of an investigation of the physiologic correlates of relaxation, subjects were assigned at random to one of four groups. Manipulations of label and relaxation technique were presented on tape via an intercom system. The dependent variable, perceived degree of relaxation, was obtained using a form presented as a "double check" of the accuracy of the physiologic monitoring equipment to which subjects seemingly were attached. Results indicate that the label attached to relaxation techniques can have a significant effect on an individual's subjective report of relaxation depending on the subject's sex.

MacHovec FJ. Man SC. Acupuncture and hypnosis compared: fifty-eight cases. American Journal of Clinical Hypnosis 1978;21(1):45-7 Fifty-eight volunteers seeking to eliminate cigarette smoking were treated in a general hospital "smoking clinic" by being divided into five groups: placebo-site acupuncture; correct-site acupuncture; group hypnosis; individual hypnosis; untreated control. Six months after treatment, correct-site acupuncture and individual hypnosis proved to be the most effective treatment. Differing rates of improvement suggest these interventions are separate and distinct rather than involving suggestion or reinforcement of already existing motivation. (Referenced in ter Riet et al. A meta-analysis of studies into the effect of acupuncture on addiction. Br J Gen Pract 1990;40:379-82 Scored 43 point, positive result)

Maher-Loughnan GP, McDonald M, Mason AA, Fry L Controlled trial of hypnosis in the symptomatic treatment of asthma BMJ 1962; ii: 371-6

Manganiello AJ. A comparative study of hypnotherapy and psychotherapy in the treatment of methadone addicts. American Journal of Clinical Hypnosis 1984;26(4):273-9 This study sought to examine the effects of hypnotherapy on the ability of methadone maintained patients to reduce and/or eliminate their drug taking behavior. Seventy adult volunteers at a methadone maintenance program were randomly assigned to experimental and control groups. The experimental group received hypnotherapy for six months in addition to the psychotherapy offered as standard clinic treatment. The control group received only psychotherapy. After treatment, a six month follow up was conducted by interviews. Groups were compared to determine significant differences in the number of successful withdrawals, the mean change in methadone dose level, incidence of illicit drug use, and degree of discomfort. Significant differences were found on all measures. The experimental group had significantly less discomfort and illicit drug use, and a significantly greater number of withdrawals. At six month follow up, 94% of the subjects in the experimental group who had achieved withdrawal remained narcotic free.

Mann BJ. Sanders S. The effects of light, temperature, trance length, and time of day on hypnotic depth. American Journal of Clinical Hypnosis. 1995;37(3):43-53 We evaluated predictions derived from the ultradian theory of hypnosis regarding the effects of temperature, light, trance length, and time of day on reported trance depth in 95 college undergraduates. Temperature and light showed no relation to trance depth. However, as predicted by ultradian theory, subjects who were kept in trance for 15 minutes reported greater trance depth than those who experienced a 5-minute trance. Time of day interacted with subjects' self-reported time of peak alertness in the following way: Subjects who reported greatest alertness in the morning achieved greater trance depth in the morning than in the evening, whereas those subjects who reported greater evening alertness reported deeper trance in the evening than in the morning. This latter finding was inconsistent with ultradian theory and prior research. Alternative explanations for this finding are discussed. Overall, the results from the present study do not provide strong support for Rossi's ultradian theory of hypnosis.

Marks NJ. Karl H. Onisiphorou C. A controlled trial of hypnotherapy in tinnitus. Clinical Otolaryngology 1985;10(1):43-6 A group of 14 patients with unilateral tinnitus were selected because of the constant nature of their tinnitus, and its resistance to all other forms of therapy. They were subjected to hypnosis in three forms in random order. The induction of a trance state alone formed the control arm of the trial. Compared to this were the effects of 'ego boosting' and active suppression of tinnitus whilst in a trance state. One of the 14 patients showed a highly significant response to the latter treatment as judged by visual analogue scales. Five of the 14 patients (36%) found the induction of a hypnotic state of value. This seemed to help them tolerate their tinnitus better, although its loudness and quality were unaltered.

Maroof M. Ahmed SM. Khan RM. Bano SJ. Haque AW. Intra-operative suggestions reduce incidence of post hysterectomy emesis. JPMA - Journal of the Pakistan Medical Association 1997;47(8):202-4 The influence of therapeutic intraoperative auditory suggestions on the incidence and severity of emetic episodes was investigated in 50 adults ASA I and II patients undergoing elective abdominal hysterectomy. The patients were randomly divided into two groups, each consisting of 25 patients. In group I, a blank tape was played and in group II, positive suggestion was played via headphones throughout the anaesthetic period. It was observed that there was statistically significant difference (P < 0.05) between the incidence of vomiting in group I (60%) and group II (36%). The number of vomiting episodes per patient in group I was 3.1 +/- 1.2 as compared to 1.7 +/- 0.6 in group II. This difference was statistically significant. The patients requiring rescue antiemetic was significantly higher (P < 0.05) in group I (66.6%) as compared to group II (22.2%). It is concluded that positive therapeutic suggestion may be considered as an alternative to antiemetic therapy.

Mason JD. Rogerson DR. Butler JD. Client centred hypnotherapy in the management of tinnitus--is it better than counselling?. Journal of Laryngology & Otology. 1996;110(2):117-20 The aim of this study was to assess whether client centred hypnotherapy (CCH) which required three sessions with a trained therapist was superior to a single counselling session in reducing the impact of tinnitus. Patients were randomly allocated to receive either counselling (n = 42) or CCH (n = 44). The outcome measures were: tinnitus loudness match, subjective tinnitus symptom severity score, trend of linear analogue scale, request for further therapy and whether the patient had an impression of improvement in their tinnitus after treatment. CCH was no better than counselling in reducing the impact of tinnitus using the three quantative measures of tinnitus, and requests for further follow up. The only significant difference between the two therapies was that 20 (45.5 per cent) of the CCH group reported a general sense of improvement compared to six (14.3 per cent) in the counselling group, this is significant p < 0.01. The study did not demonstrate whether this was a genuine hypnotic effect or simply a response to the additional attention from the therapist.

McCabe MP. et . al. The role of sex of therapist and group vs. individual therapy in treatment outcome using hypnosis with obese female patients: A research note. Australian Journal of Clinical & Experimental Hypnosis 1983;11(2):10-109. 44 18-66 yr old obese females were randomly assigned to either a male or female therapist and either to group (with 5 Subjects in each group) or individual therapy. The treatment program involved 10 therapy sessions with interspersed measurement sessions. There were 2 components of clinical sessions: (1) counseling focused on modification of current maladaptive behaviors related to obesity, and (2) a standardized hypnotic session using the Macquarie Hypnotic Script C (W. L. Walker et al (see PA, Vol 70:10892)). The hypnotic session covered the areas of general motivating suggestions; acquisition of new habits and attitudes related to eating, diet, and exercise; and the promotion of coping skills and an increased sense of inner locus of control. ANOVA revealed no differences in Subjects' weight loss due to therapist gender or type of therapy.

McCauley JD. Thelen MH. Frank RG. Willard RR. Callen KE. Hypnosis compared to relaxation in the outpatient management of chronic low back pain. Arch Phys Med Rehab 1983;64(11):548-52 Chronic low back pain (CLBP) presents a problem of massive dimensions. While inpatient approaches have been evaluated, outpatient treatment programs have received relatively little examination. Hypnosis and relaxation are two powerful techniques amenable to outpatient use. Seventeen outpatient subjects suffering from CLBP were assigned to either Self-Hypnosis (n = 9) or Relaxation (n = 8) treatments. Following pretreatment assessment, all subjects attended a single placebo session in which they received minimal EMG feedback. One week later the subjects began eight individual weekly treatment sessions. Subjects were assessed on a number of dependent variables at pretreatment, following the placebo phase, one week after the completion of treatment, and three months after treatment ended. Subjects in both groups showed significant decrements in such measures as average pain rating, pain as measured by derivations from the McGill Pain Questionnaire, level of depression, and length of pain analog line. Self-Hypnosis subjects reported less time to sleep onset, and physicians rated their use of medication as less problematic after treatment. While both treatments were effective, neither proved superior to the other. The placebo treatment produced nonsignificant improvement.

McGarry J Mesmerism vs hypnosis: a comparison of relaxation responses and evaluation of mental and psychophysiological outcomes Aust J Clin Hypnother Hypn 1987 Nov;8(1):7-36 Examined the concept put forward by L. Pulos (see PA, Vol 66:5078) that a distinction may be made between hypnotic and mesmeric phenomena. To test for psychophysiological differences in these 2 states, 45 undergraduates were randomly allocated to 1 of 3 groups that received a hypnotic induction, a hypnotic induction with mesmeric passes, or no induction and no passes. It was found that the mesmerism group showed a relaxation response similar to the hypnosis group in terms of muscle tension. However, heart rate readings for the groups were divergent, and both groups differed from the control group on both measures. Subjective reports also indicated a difference between mesmerism and hypnosis. Findings demonstrate that hypnosis alone does not produce the same physiological measures as hypnosis and mesmerism combined.

McKelvie SJ. Pullara M. Effects of hypnosis and level of processing on repeated recall of line drawings. Journal of General Psychology 1988;115(3):315-29 Moderately susceptible subjects (N = 30) initially judged 30 line drawings of objects for pleasantness (deep processing) and 30 line drawings for visual complexity (shallow processing), after which they were given two immediate recall tests. Following a 48-hr delay, subjects were allocated randomly to hypnosis, simulation, or neutral control conditions and were tested four more times. Subjects produced more correct and incorrect responses over the six trials and gave a higher number of correct responses for deep items than for shallow items. Over the last four trials, hypnosis had no general facilitative effect relative to the other two treatments, but the effect of depth was strongest for hypnotized subjects, who recalled more deep items than did the controls. Finally, both hypnotized and simulating subjects rated their recall as more involuntary and their experimental treatment as more helpful than did the controls. Caution is urged in the forensic use of hypnosis as a retrieval device.

McLintock TT. Aitken H. Downie CF. Kenny GN. Postoperative analgesic requirements in patients exposed to positive intraoperative suggestions. BMJ 1990;301(6755):788-90 OBJECTIVE--To establish whether positive suggestions given to a patient under general anaesthesia reduce postoperative pain and analgesic requirements. DESIGN--Prospective double blind randomised study. SETTING--Operating theatre and gynaecology ward of a teaching hospital. PATIENTS--63 Woman undergoing elective abdominal hysterectomy were randomised to be played either a tape of positive suggestions or a blank tape during the operation through a personal stereo system. INTERVENTIONS--Three women were withdrawn from the study. Anaesthesia was standardised for all of the women. Postoperative analgesia was provided through a patient controlled analgesia system for the first 24 hours. Pain scores were recorded every six hours. MAIN OUTCOME MEASURES--Morphine consumption over the first 24 hours after the operation; pain scores. RESULTS--Mean morphine requirements were 51.0 mg (95% confidence interval 42.1 to 60.0 mg in the women played positive suggestions; and 65.7 mg (55.6 to 75.7 mg) in those played a blank tape. The point estimate (95% confidence interval) for the difference of means was 14.6 mg (22.4%) (1.9 (2.9%) to 27.3 mg (41.6%] (p = 0.028). Pain scores were similar in the two groups. CONCLUSION--Positive intraoperative suggestions seem to have a significant effect in reducing patients' morphine requirements in the early postoperative period.

McWilliams JL. Using hypnotic suggestions to reduce postoperative nausea and pain following lumbar laminectomies Unpublished: MISSISSIPPI STATE UNIVERSITY 1990 PH.D. The purpose of this study was to predict the effectiveness of general anesthesia and hypnotic suggestions in reducing pain and nausea in the postoperative period for patients having lumbar laminectomy surgery. The 60 subjects were patients at the Mississippi Baptist Medical Center in Jackson, Mississippi. The subjects were randomly assigned to treatment in the order that they were scheduled for surgery. The 30 experimental subjects listened to prerecorded hypnotic suggestions and environmental sounds, under general anesthesia, via a tape player equipped with ear phones. The instructions given to the experimental group included suggestions regarding reduction of nausea and pain following lumbar laminectomy surgery while the 30 subjects in the control group listened only to environmental sounds during anesthesia. For the purpose of statistical analysis, a multivariate analysis of variance was used. The multivariate F-value (F(6,49) = 4.03, p <.05) for the group effect (experimental versus control) indicated a significant difference between the mean vectors of the six dependent variables which were the nurses' patient postoperative questionnaire, the patient postoperative self-rating questionnaire, the measures of nausea and pain medication for patients (intramuscular and oral), and the total number of times patients touched their ear postoperatively when in contact with the experimental team. The univariate F-ratios reveal which of the dependent variables are contributing (ear touch) to the multivariate significance and, thus, provide tests for the specific hypotheses of the study. The significant difference in the mean number of ear touches for the experimental and control groups (p <.001) supports the position that patients do, at some level "hear" suggestions given under anesthesia. However, the present study failed to find statistical support for the contention that patients receiving suggestions experience a "better" postoperative recovery from those who did not receive suggestions, at least as that recovery was characterized by the dependent variables used in this experiment to measure pain and nausea reduction. (Scientific symbols modified where possible in accordance with CINAHL policy.)

Megas JC. Coe WC. Hypnosis as role-enactment: the effect of positive information about hypnosis on self-role congruence. American Journal of Clinical Hypnosis 1975;18(2):132-7 Evaluated the effect on self-role congruence of providing favorable information about hypnosis while establishing rapport on the Stanford Hypnotic Susceptibility Scale (SHSS), Form A. A questionnaire was developed to assess 66 undergraduates' congruence with the hypnotic role before they were hypnotized. Subjects were divided into high, medium, and low congruence samples, and 1/2 of each sample was randomly assigned to 1 of 2 conditions: (a) Information condition Subjects were administered the SHSS in the standardized manner. (b) No-information Subjects were administered the SHSS with the usual rapport section omitted. All Subjects were reassessed with the self-role congruence questionnaire before they were hypnotized. Results show that positive information had no significant effect on congruence scores, and positive information had no effect on hypnotic susceptibility.

Melis PM. Rooimans W. Spierings EL. Hoogduin CA. Treatment of chronic tension-type headache with hypnotherapy: a single-blind time controlled study. Headache 1991;31(10):686-9 We investigated the effectiveness of a special hypnotherapy technique in the treatment of chronic tension-type headache. A waitinglist control group was used to control for the changes in headache activity due to the passage of time. The results showed significant reductions in the number of headache days (p less than 0.05), the number of headache hours (p less than 0.05) and headache intensity (p less than 0.05). The improvement was confirmed by the subjective evaluation data gathered with the use of a questionnaire and by a significant reduction in anxiety scores (p less than 0.01).

Melnick J. Russell RW. Hypnosis versus systematic desensitization in the treatment of test anxiety. Journal of Counseling Psychology 1976;23(4):291-295. Assessed the comparative effectiveness of systematic desensitization (SD) and the directed experience hypnotic technique (HT) in reducing self-reported test anxiety and increasing the academic performance of 36 test-anxious undergraduates. Subjects were assigned randomly to either the HT or SD conditions or to 1 of 2 control groups. All Subjects had previously scored above the 50th percentile on Sarason's Test Anxiety Questionnaire (TAQ) and below the 85th percentile on a midterm exam. Results indicate that only the SD treatment significantly reduced TAQ scores. No significant improvement in academic performance was observed for either treatment. An additional analysis of high- vs moderate-anxious subgroups failed to show differential treatment effects on either dependent measure.

Michael AM Hypnosis in childbirth BMJ 1952; 1: 734-7

Millar K. Efficacy of therapeutic suggestions presented during anaesthesia: re-analysis of conflicting results. British Journal of Anaesthesia 1993;71(4):597-601 Re-analysis has been made of two clinical studies which used similar methodologies but found different effects of so-called therapeutic suggestions presented to anaesthetized patients undergoing abdominal hysterectomy. The re-analysis suggested that when data from the two studies were examined jointly, it was uncertain if positive suggestions had a reliable influence upon the recovery measure of "days to discharge". The supposed positive effect reported in one of the studies may arise from a rather different distribution of data in the control group. It is proposed that the effect may be attributable to chance bias in allocation of patients to the control group, or to some other chance anomaly in the composition of the group as a result of relatively small sample size. The importance of sample size is discussed in relation to detection of effects when only a few patients may be in a state susceptible to intra-anaesthetic suggestions. The importance of presenting data distributions in addition to summary statistics is also emphasized.

Miller LS, Cross-HJ Hypnotic susceptibility, hypnosis, and EMG biofeedback in the reduction of frontalis muscle tension Int J Clin Exp Hypn. 1985;33(3):258-272 Biofeedback and hypnosis have been used in the treatment of similar disorders. While each has been useful, it is unclear whether they involve similar or conflicting processes. Bowers and Kelly (1979) have hypothesized that high hypnotizable Ss are more likely to benefit from hypnosis and similar procedures, than moderate and low hypnotizable individuals. In contrast, Qualls and Sheehan (1979, 1981a, b, c) have argued that hypnosis and biofeedback involve antithetical abilities. In the present study, high, moderate, and low hypnotizable individuals (N = 60) were randomly assigned to either EMG biofeedback or hypnosis conditions and instructed to relax. It was found that the mean percent reduction in frontalis muscle tension over the last 5 trials was significantly greater for the high hypnotizable Ss during hypnosis than the moderate and low hypnotizable Ss. The moderate and low hypnotizable Ss demonstrated greater reductions in frontalis muscle tension during EMG biofeedback than during hypnosis. These findings are partly supportive of the predictions of Qualls and Sheehan (1979, 1981a, b, c) that hypnosis and biofeedback involve antithetical processes.

Miller ME. Bowers KS. Hypnotic analgesia and stress inoculation in the reduction of pain. Journal of Abnormal Psychology 1986;95(1):6-14 The influence of hypnotic ability on three methods of reducing cold pressor pain was investigated. Following a baseline immersion, 30 high and 30 low hypnotizable undergraduates were randomly assigned to one of three treatment groups: stress inoculation training, stress inoculation training defined as hypnosis, or hypnotic analgesia. Analysis of pain reports indicated a significant Hypnotic Ability X Treatment interaction. Among subjects receiving hypnotic analgesia, high hypnotizables reported significantly less intense pain than lows. There was no differential response for high and low hypnotizable subjects receiving stress inoculation training, whether or not it was defined as hypnotic. Moreover, subjects in the stress inoculation condition (whether or not defined as hypnosis) reported using cognitive strategies to reduce pain, whereas this was not the case for subjects in the hypnotic analgesia condition. The present findings seem inconsistent with the social psychological account of hypnosis and are discussed from a dissociation perspective, which views hypnosis as involving changes in the way information is processed.

Moller AT. Kotze HF. Sieberhagen KJ. Comparison of the effects of auditory subliminal stimulation and rational-emotive therapy, separately and combined, on self-concept. Psychological Reports. 1993;72(1):131-45 The present study investigated the effects on self-concept of Rational-Emotive Therapy and auditory subliminal stimulation (separately and in combination) on 141 undergraduate students with self-concept problems. They were randomly assigned to one of four groups receiving either Rational-Emotive Therapy, subliminal stimulation, both, or a placebo treatment. Rational-Emotive Therapy significantly improved scores on all the dependent measures (cognition, self-concept, self-esteem, anxiety), except for behavior. Results for the subliminal stimulation group were similar to those of the placebo treatment except for a significant self-concept improvement and a decline in self-concept related irrational cognitions. The combined treatment yielded results similar to those of Rational-Emotive Therapy, with tentative indications of continued improvement in irrational cognitions and self-concept from posttest to follow-up.

Montgomery G. Kirsch I. The effects of subject arm position and initial experience on Chevreul pendulum responses. American Journal of Clinical Hypnosis. 1996;38(3):185-90 Some clinicians maintain that responses to the Chevreul pendulum illusion are facilitated by resting one's elbow on a table. Others claim the reverse. We compared these two methods in a counterbalanced crossover design by having 32 university students perform the Chevreul pendulum illusion with their elbows supported on a table and with their elbows unsupported. Although there was no main effect for method (elbow supported versus elbow unsupported), subjects who rested their elbows on a table on the first trial were more successful in responding on both trials. This suggests that supporting the elbow does facilitate responding, but only on the initial trial. Performance on subsequent trials is determined by degree of success on the first trial. Similar data from a previous study comparing different hypnotic inductions suggests that this phenomenon is generalizable beyond the Chevreul pendulum illusion and supports the hypothesis that the test-retest reliability of suggestibility scales may be due to a stabilization of response expectancy by a person's first experience of imaginative suggestions.

Moore LE. Wiesner SL. Hypnotically-induced vasodilation in the treatment of repetitive strain injuries. American Journal of Clinical Hypnosis. 1996;39(2):97-104 The study examined the effectiveness of behaviorally-induced vasodilation (hypnosis with biofeedback and autogenics) in the treatment of upper extremity repetitive strain injuries (RSI). Thirty patients with recent onset of upper extremity RSI symptoms were randomly assigned to 1 of 2 treatment conditions, i.e., hypnotically-induced vasodilation or a waiting-list control. Treatments were given on an individual basis, once a week for 6 weeks. Patients in the treatment condition showed highly significant increases in hand temperature between pre- and post-treatment. Patients in the treatment condition also showed highly significant reductions in pain in comparison to the waiting list condition.

Moore ME. Berk SN. Acupuncture for chronic shoulder pain. An experimental study with attention to the role of placebo and hypnotic susceptibility. Annals of Internal Medicine 1976;84(4):381-4 One half of 42 subjects treated for painful shoulders received classic acupuncture, and one half received a placebo in which the needles did not penetrate the skin. Half of each of these groups was treated in a positive setting to encourage the subject, and half in a negative setting designed to keep encouragement at a minimum. All patients were independently rated for susceptibility to hypnosis. Although range of motion did not improve, the majority of patients reported significant improvement in shoulder discomfort to a blind evaluator after treatment; placebo and acupuncture groups did not differ in this respect, however. The positive and negative settings did not affect treatment outcome. In all groups, those who were not rated as highly susceptible to hypnosis tended to fail to achieve the highest levels of relief, but such differences were not statistically significant.

Moret V, Forster A, Laverriere MC, Lambert H, Gaillard RC, Bourgeois P, Haynal A, Gemperle M, Buchser E Mechanism of analgesia induced by hypnosis and acupuncture: is there a difference? Pain 1991 May;45(2):135-40 Hypnosis and acupuncture can alleviate experimentally induced pain but the mechanism of analgesia remains unclear for both techniques. Experimental pain was induced by cold pressor test (CPT) in 8 male volunteers. Analgesic effect of hypnosis (HA) and acupuncture (AA) was assessed before and after double-blind administration of placebo or naloxone, in a prospective, cross-over study. We found that pain intensity was significantly lower with HA as compared with AA, both with naloxone (P less than 0.001) and placebo (P less than 0.001). Within HA or AA groups, pain scores did not differ significantly when naloxone or placebo was administered. During AA, however, pain scores were similar to control values when naloxone was given (P = 0.05) but decreased significantly with placebo (P less than 0.002). Analog scales for pain intensity and pain relief showed a good correlation (r = 0.94). Plasma levels of beta-endorphins did not change significantly in any combination. Heart rate, peripheral arterial blood pressure and skin conductance were very insensitive indices to assess pain intensity or relief, as well as intensity of acupuncture stimulation or depth of hypnotic trance. We conclude: (1) HA and AA can significantly reduce pain from CPT, and HA is more effective than AA: (2) HA and AA are not primarily mediated by the opiate endorphin system; and (3) plasmatic levels of beta-endorphins are not significantly affected by either HA or AA nor by naloxone or placebo administration.

Mount GR. et . al. The effects of relaxation techniques on normal blood pressure. Behavioral Engineering 1978;5(1):1-4. Randomly assigned 30 normotensive and medication-free college students to 1 of 2 control and 4 treatment groups. Control Group 1 relaxed for 20 min while control Group 2 received noncontingent EMG feedback via a hidden tape recorder. Treatment Group 1 received contingent EMG feedback, Group 2 received hypnosis with A. A. Meares' (1960) suggestions for well-being, Group 3 received hypnosis and EMG feedback in a counterbalanced presentation, and Group 4 received E. Jacobson's (1938) deep muscle relaxation training. All Subjects attended 6 sessions during a 3-wk period. Pre/post blood pressure readings were taken for all Subjects. Results indicate that both diastolic and systolic blood pressure scores decreased significantly for all groups across the 6 sessions. Pre- minus postscore analysis failed to show significant differences in blood pressure scores.

Myles PS. Cessation of smoking following tape suggestion under anaesthesia. Anaesthesia & Intensive Care 1992;20(4):540-1

Myles PS. Hendrata M. Layher Y. Williams NJ. Hall JL. Moloney JT. Powell J. Double-blind, randomized trial of cessation of smoking after audiotape suggestion during anaesthesia. British Journal of Anaesthesia. 1996;76(5):694-8 We studied the use of intraoperative tape suggestion to improve the rate of cessation of smoking in 363 smokers who wanted to stop smoking. They were allocated randomly to hear a taped message encouraging them to stop smoking or to a blank tape, played during general anaesthesia. Overall 56 patients (15.4%, 95% confidence interval (CI) 11.7-19.1%) had claimed to have stopped smoking at 2 months and 29 patients (8.0%, 95% CI 5.9-10.1%) were confirmed to have stopped smoking at 6 months. There was no significant difference between the groups at either 2 or 6 months (risk ratios 1.06 and 1.09, respectively, P = 0.78). A preoperative:postoperative ratio of a visual analogue scale measuring the patient's motivation to stop smoking was not significantly different (control group 1.13 vs message group 1.10, P = 0.55). This study does not support the hypothesis that intraoperative tape suggestion can change smoking behaviour.

Neild JE. Cameron IR. Bronchoconstriction in response to suggestion: its prevention by an inhaled anticholinergic agent. BMJ Clinical Research Edition. 1985;290(6469):674

Neumann W. Kugler J. Seelbach H. Kruskemper GM. Effects of nondirective suggestions on pain tolerance, pain threshold and pain intensity perception. Perceptual & Motor Skills 1997;84(3 Pt 1):963-6 In this experiment, we followed the issue whether nondirective suggestions have an effect on pain threshold, pain tolerance, and perception of pain intensity. 48 healthy subjects consented to take part. At intake into the study (t1), pain threshold and pain tolerance were assessed in all subjects using a pressure algometer. Perception of maximum pain intensity perception was rated on a scale of 0 to 25. Seven days later, the session was repeated (t2). Subjects were randomly assigned to one of two groups. One group received nondirective suggestions as pretreatment. Subjects listened to a tape of 20 min. which consisted of general information about pain theory. In this context, suggestions for coping with pain were placed. The other group served as a control and received no pretreatment. Analysis showed that pain tolerance was significantly prolonged in the group who received nondirective suggestions, while pain threshold and perception of maximum pain intensity did not differ across groups. This study demonstrates that nondirective suggestions are effective in prolonging pain tolerance. It can be stated that, beside information, cues on coping with pain may be helpful in clinical practice.

Newcombe PA. Siegal M. Explicitly questioning the nature of suggestibility in preschoolers' memory and retention. Journal of Experimental Child Psychology 1997;67(2):185-203 In research designed to investigate children's suggestible responses on memory tests, 190 preschoolers were read a short story. The same day or six days later, they were exposed to information that was either consistent with the original story details or inconsistent and misleading. One and seven weeks after hearing the story, the children were tested on two types of recognition tasks that involved a choice either between the original and misleading information or between the original and new information with questions that were either explicit or nonexplicit as to the time of the information to be reported. At the 1-week test, children who were exposed to misleading information were significantly less accurate under nonexplicit questioning in recognizing the original from the misleading information than were children presented with consistent information. With explicit questioning, this difference was not significant. When the choice for the children was between original and new items following exposure to delayed misleading postevent information, explicit questioning resulted in significantly more accurate responses at the 7-week test than did nonexplicit questioning. Children questioned explicitly rather than nonexplicitly were more likely to maintain correct responses on both tests. The results are discussed in terms of conversational processes and competing forms of representation in memory retention.

Nikles CD= 2nd. Brecht DL. Klinger E. Bursell AL. The effects of current-concern- and nonconcern-related waking suggestions on nocturnal dream content. Journal of Personality & Social Psychology 1998;75(1):242-55 In previous research, presleep suggestions influenced nocturnal dream content. It was hypothesized that suggesting topics associated with participants' current concerns would influence dream content more than suggesting other topics. Ten students spent 4 nights in a sleep laboratory: an adaptation night, a baseline night, and 2 nights under suggestions to dream about a concern-related or other topic. Concern-related suggestions influenced dream content--largely its central imagery--more than did other suggestions, which did not differ from nonsuggestion. Number of transformations within dreams was uncorrelated with dream vividness, contrary to extended activation-synthesis theory. Thus, the concern-related status of suggestions moderates their effectiveness and, inconsistent with extended activation-synthesis theory but consistent with current-concerns and distributed-activation theories, motivational and volitional processes actively influence dream content.

Nilsson KM. The effect of subject expectations of "hypnosis" upon vividness of visual imagery. International Journal of Clinical & Experimental Hypnosis 1990;38(1):17-24 This study explored how the expectation of hypnosis and the expectation of relaxation affected the vividness of visual imagery. 63 Ss who volunteered for a visual imagination study were randomly assigned to 4 groups. Ss were administered the vividness subscale (VS) of the Vividness and Control of Imagery Scale twice. In the 3 experimental groups, expectations were varied during the 2 VS administrations. All 3 groups were presented with a relaxation exercise between VS administrations. In 2 groups, it was labeled "hypnosis," and in the third group it was correctly labeled "relaxation." A control group listened to a neutral tape between their VSs. All groups were administered the Harvard Group Scale of Hypnotic Susceptibility, Form A (Shor & E. C. Orne, 1962) after the 2 imagery tests. The results indicated that the vividness of visual imagery was significantly enhanced (equally) in the experimental groups but not in the control group.

O'Brien RM. Hypnosis and task-motivation instructions for "post-experimental"-post-hypnotic suggestions. Perceptual & Motor Skills 1977;45(3 Pt 2):1274 16 college students who had scored well on the Stanford Hypnotic Susceptibility Scale (Form C) were randomly assigned to hypnotic and nonhypnotic task motivation groups. All Subjects were given a suggestion for a response to occur to a cue word at the end of the session. They were then given the cue 4 times into the next day by a friend-confederate. The 2 groups did not differ significantly in the number of responses to the postexperimental cue.

O'Brien RM. Kramer CE. Chiglinsky MA. Stevens GE. Nunan LJ. Fritzo JA. Moral development examined through hypnotic and task motivated age regression. American Journal of Clinical Hypnosis 1977;19(4):209-13 Thirty 17-28 yr old volunteers who had scored above 8 on the Stanford Hypnotic Susceptibility Scale, Form C, were randomly assigned to 3 groups (hypnosis, task motivation, and control). The 2 treatment groups were age regressed to the 1st grade. They were then examined through 5 moral dilemma stories to ascertain their level of functioning on L. Kohlberg's (1968) stage theory of moral development. The control group experienced the same examination without age regression. Results show that both treatment groups were at a significantly lower moral stage than the control group but that there was no significant difference between the 2 groups of age-regressed Subjects. In addition, it was found that a group of 10 actual 1st graders gave answers that were at a much lower level than those of the age-regressed Subjects. These results demonstrate cognitive age regression on Kohlberg's stages of moral development. They also suggest that task motivation situations are as efficient as hypnosis in producing this phenomenon.

O'Brien RM. Rabuck SJ. Experimentally produced self-repugnant behavior as a function of hypnosis and waking suggestion: a pilot study. American Journal of Clinical Hypnosis 1976;18(4):272-6 Randomly assigned 7 19-40 yr old females who had scored above 9 on the Stanford Hypnotic Susceptibility Scale, Form C, to 1 of 3 treatment groups (hypnosis, posthypnotic suggestion, and waking suggestion). Subjects in all 3 groups were asked to make a verbal homosexual approach to a female they had not previously met. Only the 2 waking-suggestion Subjects carried out the instructions. Hypnosis may be less effective than waking-suggestion in eliciting a self-repugnant response when attitudinal and motivational variables are maximized.

Oddby-Muhrbeck E. Jakobsson J. Enquist B. Implicit processing and therapeutic suggestion during balanced anaesthesia. Acta Anaesthesiologica Scandinavica 1995;39(3):333-7 The effect of therapeutic suggestion--implicit processing during balanced anaesthesia was studied in 70 female patients scheduled for elective breast surgery. The patients were randomly allocated to listen to a message with reassuring information focused on minimising postoperative nausea and vomiting, or just a blank tape during surgery. Occurrence of nausea and vomiting was studied during the postoperative period. No patient recalled any explicit memories during the peroperative period. No major differences were observed in the number of patients who experienced nausea or vomiting during the 24 hour observation period. The patients exposed to positive suggestion did, however, have a lower frequency of recall for nausea and vomiting compared to those just listening to the blank tape. We did not observe any major effect of peroperative suggestion for postoperative nausea and vomiting. However, we cannot rule out some implicit processing during balanced anaesthesia.

Olness K. Culbert T. Uden D. Self-regulation of salivary immunoglobulin A by children. Pediatrics 1989;83(1):66-71 In a prospective randomized controlled study, the possibility that children could regulate their own salivary immunoglobulins was investigated using cyberphysiologic techniques. Fifty-seven children were randomly assigned to one of three groups. Group A subjects learned self-hypnosis with permission to increase immune substances in saliva as they chose; group B subjects learned self-hypnosis with specific suggestions for control of saliva immunoglobulins; group C subjects were given no instructions but received equal attention time. At the first visit, saliva samples (baseline) were collected, and each child looked at a videotape concerning the immune system and was tested with the Stanford Children's Hypnotic Susceptibility Scale. At the second visit, an initial saliva sample was collected prior to 30 minutes of self-hypnosis practice or conversation. At the conclusion of the experiment, a third saliva sample was obtained. Salivary IgA and IgG levels for all groups were stable from the first to the second sampling. Children in group B demonstrated a significant increase in IgA (P less than .01) during the experimental period. There were no significant changes in IgG. Stanford Children's Hypnotic Susceptibility Scale scores were stable across groups and did not relate to immunoglobulin changes.

Olness K, Hall H, Schmidt W, Theoharides T Mast cell activation in child migraine patients before and after training in self regulation Alternative Therapies in Health and Medicine 1997;3(2):100-1

Olness K. MacDonald JT. Uden DL. Comparison of self-hypnosis and propranolol in the treatment of juvenile classic migraine. Pediatrics 1987;79(4):593-7 In a prospective study we compared propranolol, placebo, and self-hypnosis in the treatment of juvenile classic migraine. Children aged 6 to 12 years with classic migraine who had no previous specific treatment were randomized into propranolol (at 3 mg/kg/d) or placebo groups for a 3-month period and then crossed over for 3 months. After this 6-month period, each child was taught self-hypnosis and used it for 3 months. Twenty-eight patients completed the entire study. The mean number of headaches per child for 3 months during the placebo period was 13.3 compared with 14.9 during the propranolol period and 5.8 during the self-hypnosis period. Statistical analysis showed a significant association between decrease in headache frequency and self-hypnosis training (P = .045). There was no significant change in subjective or objective measures of headache severity with either therapy.

Omer H. Sirkovitz A. Failure of hypnotic relaxation in the treatment of postterm pregnancies. Psychosomatic Medicine 1987;49(6):606-9 An attempt to utilize hypnotic relaxation in the induction of labor with women with postterm pregnancies had no results. These negative findings contrast with previously shown success of hypnotic relaxation in inhibiting preterm labor.

Papp LA. Welkowitz LA. Martinez JM. Klein DF. Browne S. Gorman JM. Instructional set does not alter outcome of respiratory challenges in panic disorder. Biological Psychiatry 1995;38(12):826-30 In an attempt to reproduce the findings of Rapee et al (1986) that instructional set could alter the anxiogenic effects of carbon dioxide inhalation, 45 patients with panic disorder received two sets of instructions and then underwent a series of respiratory challenges (room air hyperventilation, 5% and 7% CO2 inhalation). The instructions failed to alter the anxiogenic response to any of the interventions.

Parwatikar SD, Brown MS, Stern JA, Ulett GA, Sletten IS Acupuncture, hypnosis and experimental pain - I. Study with volunteers Acupuncture & Electro-Therapeutics Research 1978;3:161-90

Passchier J. Hunfeld JA. Jelicic M. Verhage F. Suggestibility and headache reports in schoolchildren: a problem in epidemiology. Headache 1993;33(2):73-5 In a sample from the general population of school children of 15 years of age, we studied whether receiving information about the prevalence of headaches had any effect on their subsequent headache report. Sixty children in the fourth year at four secondary schools were allocated at random to two conditions: a biased condition emphasizing the high prevalence of headaches and a neutral condition. Subjects in the biased condition reported more headaches but they did not report more other physical symptoms than the subjects in the neutral condition. The results are discussed in terms of Pennebaker's theory on reporting symptoms. It is concluded that epidemiological research using the general population should deal more explicitly with the way in which subjects are motivated to participate.

Patterson DR. Ptacek JT. Baseline pain as a moderator of hypnotic analgesia for burn injury treatment. Journal of Consulting & Clinical Psychology 1997;65(1):60-7 Sixty-one patients hospitalized for severe burns were randomly assigned to conditions in which they received either hypnosis or a control condition in which they received attention, information, and brief relaxation instructions from a psychologist. The posttreatment pain scores of the 2 groups did not differ significantly when all patients were considered. However, when a subset of patients who reported high levels of baseline pain were examined, it was found that patients in the hypnosis group reported less posttreatment pain than did patients in the control group. The findings are used to replicate earlier studies of burn pain hypnoanalgesia, explain discrepancies in the literature, and highlight the potential importance of motivation with this population.

Pederson LL, Schrimgeour WG, Lefcoe NM Incorporation of rapid smoking in a community service smoking withdrawal program International Journal of the Addictions 1980;15(5):615-29 Post-treatment abstinence rates of 50% had been found in a smoking withdrawal program which included group hypnosis and group counseling. A session of rapid smoking was added to the procedures with the intention of further increasing abstinence rates. Only 13% of the smokers exposed to the combined program quit smoking as compared to 38% of the smokers who participated in the same program but with the session of group hypnosis excluded. Possible explanations of the obtained results include motivational reduction, procedural deviations, and medical screening. Suitability of rapid smoking for community service programs is discussed.

Pederson LL. Scrimgeour WG. Lefcoe NM. Comparison of hypnosis plus counseling, counseling alone, and hypnosis alone in a community service smoking withdrawal program. Journal of Consulting & Clinical Psychology 1975;43(6):920

Pederson LL. Scrimgeour WG. Lefcoe NM. Variables of hypnosis which are related to success in a smoking withdrawal program. International Journal of Clinical & Experimental Hypnosis 1979;27(1):14-20 65 habitual smokers were randomly assigned to 1 of 4 groups: live hypnosis plus counseling, videotape hypnosis plus counseling, relaxation hypnosis plus counseling, and counseling alone. The content and mode of presentation of the hypnosis session varied among the 1st 3 groups. At 6 mo posttreatment, the live hypnosis plus counseling group contained significantly more abstainers than the other 3 groups. The importance of the specific content of the hypnosis session and the presence of the hypnotherapist for the effectiveness of the procedure is discussed. (German, French & Spanish summaries)

Philipp RL, Wilde GJS, Day JH Suggestion and relaxation in asthmatics J Psychom Res 1972; 16: 193-204

Podolnick EE. Field PB. Emotional involvement, oral anxiety, and hypnosis. International Journal of Clinical & Experimental Hypnosis 1970;18(3):194-210. 48 undergraduates were randomly assigned to either a high or low emotional arousal manipulation and then underwent a tape-recorded hypnotic induction and test of depth. The high-arousal group was exposed to infantile oral objects and were led to believe that they would have to suck on them as part of a physiological psychology experiment in which the cutaneous sensitivity of the human mouth was being mapped. The low-arousal group believed they only had to blow on whistles or pipes. While both groups were anticipating these experiences, hypnosis was induced. Subjects in the high-arousal group were significantly more hypnotizable (p < .001) than their counterparts in the low-arousal group. Subjects in the high-arousal group were significantly less anxious after hypnosis than they were before hypnosis, while the low-arousal Subjects did not show a reduction in anxiety. The groups did not differ on several background personality tests given as checks on the randomization. (Spanish & German summaries)

Puente AE. Beiman I. The effects of behavior therapy, self- relaxation, and transcendental meditation on cardiovascular stress response. Journal of Clinical Psychology 1980;36(1):291-5 Compared Behavior Therapy (BT), self-relaxation (SR), transcendental meditation (TM), and a waiting-list control group (WL) on measures of cardiovascular and subjective stress response. Male and female respondents (N = 60) to an ad for therapy were evaluated in assessment sessions before and after treatment. The results indicate that BT and SR were more effective than either TM or WL in reducing cardiovascular stress response. These data were interpreted as resulting from therapeutic suggestion and positively reinforced client progress.

Rabkin SW. Boyko E. Shane F. Kaufert J. A randomized trial comparing smoking cessation programs utilizing behaviour modification, health education or hypnosis. Addictive Behaviors 1984;9(2):157-73 The purpose of this study was to determine the efficacy of hypnosis, health education, and behaviour modification programs for cigarette smoking cessation. A randomized clinical trial comparing these three programs and a control group was conducted in 168 volunteers. Follow-up data three weeks after completion was available in 140 subjects. Each program showed significant reductions in reported cigarette consumption and serum thiocyanate levels, an indicator of long-term cigarette consumption, compared to entry and to the control group. However, there were no significant differences between the hypnosis, health education, or behaviour modification groups with respect to the proportion who reported quitting smoking, the number cigarettes smoked or change in serum thiocyanate levels. Reported cigarette consumption ascertained six months later again showed no significant differences between these three approaches. Factors such as subject age, age at starting cigarette smoking, educational level, marital status, spouse or partners smoking did not identify subgroups with differences between treatment responses. Thus, hypnosis, health education, and behaviour modification are each effective programs for changing cigarette smoking and each is equally effective in this regard.

Radtke-Bodorik HL. Spanos NP. Haddad MG. The effects of spoken versus written recall on suggested amnesia in hypnotic and task-motivated subjects. American Journal of Clinical Hypnosis 1979;22(1):8-16 80 undergraduates and other volunteers chosen for moderate to high scores on the Harvard Group Scale of Hypnotic Susceptibility were randomly assigned to 1 of 4 treatments in a 2 * 2 factorial design (hypnosis/task-motivation * spoken/written recall). Subjects were administered the learning-amnesia suggestion sequence employed by N. P. Spanos and H. L. Bodorik (1977). Partially amnesic Subjects who wrote their recall had continued visual access to the words they had already recalled. It was hypothesized that the written words would serve as cues and facilitate further recall. Therefore, it was predicted that Subjects in the written recall condition would show less partial amnesia than those in the spoken recall condition. Results fail to confirm the prediction; Subjects in written and spoken recall conditions were equally likely to exhibit partial amnesia. However, previous findings replicated are as follows: (a) Hypnotic Subjects showed more amnesia than task-motivated Subjects; (b) partially amnesic Subjects showed disorganized recall, whereas full recall Subjects did not; (c) nonrecall Subjects obtained higher susceptibility scores than full recallers; and (d) hypnotic Subjects rated themselves as more deeply hypnotized than task-motivated Subjects.

Rankin EJ. Gilner FH. Gfeller JD. Katz BM. Efficacy of progressive muscle relaxation for reducing state anxiety among elderly adults on memory tasks. Perceptual & Motor Skills 1993;77(3 Pt 2):1395-402 Cognitively intact anxious elderly subjects were randomly assigned to either a progressive muscle relaxation-training condition or control condition (ns = 15) and then completed selected subtests from the Wechsler Memory Scale--Revised. Despite significant reductions in state anxiety in the relaxation group, no significant differences were detected between the two groups on memory measures. These results are discussed within the context of previous research, and suggestions for further research are made.

Rapkin DA. Straubing M. Holroyd JC. Guided imagery, hypnosis and recovery from head and neck cancer surgery: an exploratory study. International Journal of Clinical & Experimental Hypnosis 1991;39(4):215-26 The value of a brief, preoperative hypnosis experience was explored with a sample of 36 head and neck cancer surgery patients. 15 patients volunteered for the experimental hypnosis intervention. 21 patients who received usual care (no hypnosis) were followed through their hospital charts and were used as a comparison group. Hypnotic intervention and usual care groups were comparable in terms of relevant demographic variables. Postoperative hospitalizations for the hypnotic intervention group were significantly shorter than for the usual care group. Within the hypnotic intervention group, hypnotizability was negatively correlated with surgical complications and there was a trend toward a negative correlation between hypnotizability and blood loss during surgery. Findings suggest that imagery-hypnosis may be prophylactic, benefitting patients by reducing the probability of postoperative complications and thereby keeping hospital stay within the expected range. Recommendations are presented for a controlled, randomized, clinical trial with a sufficiently large sample to provide the opportunity for statistical analysis with appropriate power.

Ready DJ. Bothwell RK. Brigham JC. The effects of hypnosis, context reinstatement, and anxiety on eyewitness memory. International Journal of Clinical & Experimental Hypnosis. 1997;45(1):55-68 The effects of hypnosis, context reinstatement, and motivational instructions on accuracy of recall for factual information and facial recognition accuracy following a stressful event were assessed. None of the three techniques had a significant effect on factual memory or susceptibility to suggestion as assessed by true-false and multiple-choice tests. However, participants high in hypnotic susceptibility showed somewhat better memory on the true-false test, and hypnosis affected performance on the two photograph line-ups. In addition, hypnosis appeared to enhance facial recognition accuracy for participants who were low in anxiety, but not for those high in anxiety. Finally, there was evidence of a curvilinear relationship between self-reported anxiety at time of retrieval and facial recognition accuracy.

Reed SB. Kirsch I. Wickless C. Moffitt KH. Taren P. Reporting biases in hypnosis: suggestion or compliance?. Journal of Abnormal Psychology. 1996;105(1):142-5 The tendency of highly hypnotizable participants to bias their retrospective perceptual reports in response to instructional demands was reexamined with the addition of low-hypnotizable control participants instructed to simulate hypnosis. Mean scores of high-hypnotizable participants and simulators did not differ, but the responses of simulators to the demand instruction was less variable than those of high-hypnotizable participants, and the shape of the response distribution was different. Unlike simulators, some high-hypnotizable participants who had reported changes in perception that were consistent with a hypnotic suggestion subsequently reported changes opposite to those suggested by a demand instruction. These data were interpreted as suggesting that the responses of high-hypnotizable participants to both the demand instruction and the preceding hypnotic suggestion were not entirely due to compliance.

Reich BA. Non-invasive treatment of vascular and muscle contraction headache: a comparative longitudinal clinical study. Headache 1989;29(1):34-41 The purpose of this investigation was to evaluate the long-term course of non-invasively treated chronic headache. A total of 1015 adult patients with primary diagnosis of vascular/migraine or muscle contraction headache participated in the study investigating symptom frequency and severity over a 36 month period after receiving treatment. Treatment consisted of either: relaxation training (stepwise relaxation/hypnosis/autogenic training/cognitive behavior therapy); biofeedback (thermal/photoplethysmograph/EMG); micro-electrical therapy (TENS/Neurotransmitter Modulation) or multimodal treatment (combination of any of the above two treatments). Seven hundred and ninety-three patients returned sufficient data to be included in the analysis. Patients were randomly assigned to treatment groups and received either short term intervention (15 or less treatments) or long term intervention (greater than 15 treatments). Results indicate that all treatment conditions significantly reduced frequency and intensity of cephalalgia. Repeated measure analysis of variance indicated that grouping variables of Biofeedback treatment, symptoms being evidenced less than 2 years and receiving over 15 treatment sessions best predicted successful intervention.

Reid WH. Ahmed I. Levie CA. Treatment of sleepwalking: a controlled study. American Journal of Psychotherapy 1981;35(1):27-37 A single-blind, rater-blind, modified crossover design was used to evaluate a simple, practical method of clinical treatment of sleepwalking. Subjects who had severe somnambulism, but were otherwise free of psychiatric illness, responded well to six brief sessions of specialized hypnotherapy. Follow-up at one year has revealed lasting improvement of both subjective and objective symptoms. A brief review of the subject of sleepwalking, as well as detailed information concerning histories of sleep symptoms and emotional problems in these and other sleepwalkers, is presented.

Richardson MA, Post-White J, Grimm EA, Moye LA, Singletary SE, Justice B. Coping, life attitudes, and immune responses to imagery and group support after breast cancer treatment. Alternative Therapies in Health and Medicine 1997;3(5):62-70 BACKGROUND: The pilot study used clinical trial methodology to differentiate the effects of imagery and support on coping, life attitudes, immune function, quality of life, and emotional well-being after breast cancer. METHODS: Women (N = 47) who completed treatment for primary breast cancer, excluding stage IV, were randomly assigned to standard care (n = 15) or six weekly support (n = 16) or imagery (n = 16) sessions. Self-report measures included Ways of Coping-Cancer, Life Attitude Profile, Quality of Life (FACT-B), Profile of Mood States, and Functional Support. Immune measures included natural killer cell activity, plasma neopterin, interferon-gamma, interleukins 1 alpha, 1 beta, and 2, and beta-endorphin levels. Differences between groups over time were tested using general linear models, adjusted for pretest score and covariates (age, stage, and months posttreatment). RESULTS: For all women, interferon-gamma increased, neopterin decreased, quality of life improved, and natural killer activity remained unchanged. Compared with standard care, both interventions improved coping skills (seeking support) and perceived social support, and tended to enhance meaning in life. Support boosted overall coping and death acceptance. When comparing imagery with support, imagery participants tended to have less stress, increased vigor, and improved functional and social quality of life. CONCLUSION: Although imagery reduced stress and improved quality of life, both imagery and support improved coping, attitudes, and perception of support. The clinical implications of these changes warrant further testing.

Ruzyla-Smith P. Barabasz A. Barabasz M. Warner D. Effects of hypnosis on the immune response: B-cells, T-cells, helper and suppressor cells. American Journal of Clinical Hypnosis. 1995;38(2):71-9 This study tested the effects of hypnosis on the immune response. High and low hypnotizable Ss were exposed to hypnosis, relaxation or control conditions. Blood samples obtained before treatment and twice thereafter were subjected to flow cytometry analysis. Significant alteration of the immune response as measured by B-cells and helper T-cells was shown only for highly hypnotizable Ss exposed to hypnosis.

Ryan ML. Sheehan PW. Reality testing in hypnosis: Subjective versus objective effects. International Journal of Clinical & Experimental Hypnosis 1977;25(1):37-51. 64 undergraduates and 26 graduate students were assigned randomly to a 2 * 3 (Request for Honesty * Suggestibility Instruction) factorial design to test the hypothesis that hypnotic Subjects would show pronounced impairment of reality testing by expressing a degree of conviction substantially out of phase with their objective performance. T. X. Barber's (1969) operational model of hypnosis was adopted to test the prediction on an unusually distinctive auditory comprehension task, administered to the Subjects prior to the Barber Suggestibility Scale. The 2 interdependent measures, confidence and accuracy, were highly positively related, indicating that, generally speaking, hypnotic Subjects performed adaptively as did task motivated and control Subjects. Results for the difficult aspects of the task were distinctive. Here, degree of confidence about behavior as expressed by Subjects who performed well on the suggestibility tests was relatively greater than the confidence expressed by those who performed poorly; further, hypnotic Subjects were distinctively willing to respond on the least intelligible parts of the task. The inconsistent nature of certain features of hypnotic behavior is discussed in detail. (German, French & Spanish summaries)

Sabourin M. Brisson MA. Deschambault A. Evaluation of hypnotically-suggested selective deafness by heart-rate conditioning and reaction time. Psychological Reports 1980;47(3 Pt 1):995-1002 20 undergraduates highly susceptible to hypnosis were randomly assigned to 1 of 4 groups: hypnotic, posthypnotic, motivational, and control. After the establishment of the heart-rate conditioned response, a suggestion of selective deafness for the CS was given, followed by 15 trials of extinction; subsequently, the suggestion was lifted and 15 additional trials were given. Results show that the suggestion did not influence the heart-rate CR, nor did it influence RT.

Sackeim HA. Paulhus D. Weiman AL. Classroom seating and hypnotic susceptibility. Journal of Abnormal Psychology 1979;88(1):81-4 Conducted 2 experiments to investigate the relations among hypnotic susceptibility (Stanford Hypnotic Susceptibility Scale), lateralization of actual seating behavior, and seating preference. In Exp I, it was found that females who sat on the right side of a classroom were more hypnotically susceptible than females who sat on the left. Males who preferred right-side seating were more susceptible than males with left-side p In Exp II, 55 Subjects were randomly assigned to seats to determine whether seating location itself affected responsiveness to hypnosis. No association between lateralization of actual seating and hypnotic susceptibility was found. Replicating Exp I, males who preferred right-side seating were more hypnotically susceptible than males with left-side p Lateralization of seating behavior has been found previously to be a function of hemisphericity. The results of both experiments indicate that lateralization of seating behavior may be used to investigate the relation between hemisphericity and hypnotic susceptibility.

Sakata KI. Anderson JP. The effects of posthypnotic suggestion on test performance. International Journal of Clinical & Experimental Hypnosis 1970;(1):61-71. Tested 45 undergraduates preselected for hypnotizability on 2 learning tasks by E and retested on the tasks by other Es a mo. later. Before being retested Subjects were randomly assigned to 1 of 3 treatment conditions: (a) a posthypnotic suggestion condition, (b) a waking suggestion condition, and (c) a hypnosis-no-suggestion condition in which Subjects were merely dehypnotized without exhortative instructions. Es were blind to the experimental design. Analyses of covariance indicate that the posthypnotic suggestion group performed more rapidly and accurately on a Rational Learning Test (RLT), but not on a Digit Symbol Test (DST), than the waking suggestion group. The posthypnotic suggestion group did not differ from the hypnosis-no-suggestion group, which also performed more accurately but not more rapidly than the waking suggestion group on the RLT. There were indications that posthypnotic suggestions had interfered with performance on the DST, which involved motor manipulations. Findings supported previous studies indicating differences between a posthypnotic and waking suggestion group in task performance. No definite conclusions to account for the differences could be offered. (Spanish & German summaries)

Schlutter LC. Golden CJ. Blume HG. A comparison of treatments for prefrontal muscle contraction British Journal of Medical Psychology. 1980;53(1):47-52 A comparison of hypnotic analgesia, frontalis electromyographic feedback, and frontalis electromyographic feedback in conjunction with Jacobson progressive relaxation for treating chronic prefrontal muscle contraction headache was done. There were four 1-hour treatment sessions for each type, and a follow-up. Measures were the number of headache hours per week, a subjective estimate of pain intensity, and an objective ratio of pain intensity found by using the submaximum tourniquet technique. No significant differences were found between treatments on these dependent measures, although all produced significant change in the desired direction. The current study utilized 48 patients with chronic prefrontal headache, and was performed in a clinical situation. Certain responses to the Headache Questionnaire used in screening were significantly correlated with improvement in headache. The current study controlled for class of medication the patient may have been taking for headache, thereby giving a more realistic assessment of the effectiveness of psychological treatments in a clinic.

Schnyer DM. Allen JJ. Attention-related electroencephalographic and event-related potential predictors of responsiveness to suggested posthypnotic amnesia. International Journal of Clinical & Experimental Hypnosis 1995;43(3):295-315 Higher frequency electroencephalographic (EEG) activity around 40 Hz has been shown to play a role in cognitive functions such as attention. Furthermore, event-related brain potential (ERP) components such as N1 and P1 are sensitive to selective attention. In the present study, 40-Hz EEG measures and early ERP components were employed to relate selective attention to hypnotic response. Participants were 20 low hypnotizable individuals, half assigned as simulators, and 21 high hypnotizable individuals. Each of these groups was subsequently divided into two groups based on recognition amnesia scores. The four groups differed in 40-Hz (36-44 Hz) EEG spectral amplitude recorded during preinduction resting conditions but not in EEG amplitude postinduction. The groups also differed in N1 amplitudes recorded during hypnosis. Regression analysis revealed that these effects only distinguish the high hypnotizable participants who experienced recognition amnesia from all other groups. The findings support the role of selective attention in hypnotic responsiveness, and the utility of subdividing high hypnotizable individuals is discussed.

Schreiber EH. Use of group hypnosis to improve college students' achievement. Psychological Reports 1997;80(2):636-8 To examine whether group hypnosis would improve college students' achievement examination grades, including a midterm and final test of 30 educational psychology students who were hypnotized were compared with those of two control groups of 34 and 32 students. Analysis indicated for these intact classes the hypnotized group had a significantly higher mean score on final examination than those of the control groups, although differences in examination scores were nonsignificant at midterm. Suggestions for further research are made.

Schubert DK. Comparison of hypnotherapy with systematic relaxation in the treatment of cigarette habituation. J Clinical Psychology. 1983;39(2):198-202 Because of the methodological deficiencies in this area of research, it is impossible to make any valid conclusions about whether hypnosis itself is effective in the treatment of cigarette habituation. In this study, 87 volunteers who wanted to quit cigarette smoking were assigned randomly to the experimental hypnosis group, the comparison relaxation group, and the waiting list control group. Ss in the treatment groups had four weekly 50-minute, individual sessions. Four months after the completion of treatment, Ss were administered a questionnaire and a hypnotic susceptibility scale. Ss in the hypnosis group who were in the upper two-thirds of the group in terms of hypnotic susceptibility reduced their cigarette consumption substantially more than Ss in the relaxation group who were in the upper two- thirds of the group in terms of hypnotic susceptibility. Therefore, the hypnotic state appears to be therapeutic for individuals who can enter medium or deep states of hypnosis.

Sellick SM, Zaza C Critical review of 5 nonpharmacologic strategies for managing cancer pain Cancer Prev Control 1998 Feb;2(1):7-14 Purpose: Health care professionals at 2 Ontario cancer centres were surveyed to determine their familiarity with, perceptions of and interest in learning more about nonpharmacological strategies for the management of cancer pain. Evidence-based education sessions were subsequently developed for the 5 strategies in which participants were most interested. This article presents the results of critical literature reviews concerning the effectiveness of the 5 strategies: acupuncture, massage therapy, hypnosis, therapeutic touch and biofeedback. Methods: The databases MEDLINE (1966 to June 1997) CINAHL (1982 to June 1997) and PsycholINFO Lit (1980 to June 1979) were searched systematically for randomized controlled trials (RCTs) of the 5 nonpharmacologic strategies. The authors' personal files and reference lists of relevant papers and main texts were also searched. The quality of the trials was reviewed according to established criteria. Results: The search yielded 1 RCT of acupuncture, 1 of massage therapy and 6 of hypnosis. The studies of hypnosis suggested that there is much support for its use in the management of cancer pain. The evidence was either lacking or less clear for the other therapies examined. Conclusion: Because patients use a wide variety of nonpharmacologic strategies regardless of their effectiveness, clinicians need to be familiar with available research and able to discuss those strategies for which the evidence is strong, weak or nonexistent. More research on the effectiveness of nonpharmacologic strategies for pain management is needed.

Sellick SM. Zaza C. Critical review of 5 nonpharmacologic strategies for managing cancer pain. Cancer Prevention & Control 1998;2(1):7-14 PURPOSE: Health care professionals at 2 Ontario cancer centres were surveyed to determine their familiarity with, perceptions of and interest in learning more about nonpharmacologic strategies for the management of cancer pain. Evidence-based education sessions were subsequently developed for the 5 strategies in which participants were most interested. This article presents the results of critical literature reviews concerning the effectiveness of the 5 strategies: acupuncture, massage therapy, hypnosis, therapeutic touch and biofeedback. METHODS: The databases MEDLINE (1966 to June 1997), CINAHL (1982 to June 1997) and PsychoINFO Lit (1980 to June 1997) were searched systematically for randomized controlled trials (RCTs) of the 5 nonpharmacologic strategies. The authors' personal files and reference lists of relevant papers and main texts were also searched. The quality of the trials was reviewed according to established criteria. RESULTS: The search yielded 1 RCT of acupuncture, 1 of massage therapy and 6 of hypnosis. The studies of hypnosis suggested that there is much support for its use in the management of cancer pain. The evidence was either lacking or less clear for the other therapies examined. CONCLUSION: Because patients use a wide variety of nonpharmacologic strategies regardless of their effectiveness, clinicians need to be familiar with available research and able to discuss those strategies for which the evidence is strong, weak or nonexistent. More research on the effectiveness of nonpharmacologic strategies for pain management is needed. [References: 35]

Serewel A. Haggie JA. Cade D. A randomised controlled trial of medroxyprogesterone acetate in mastalgia. Annals of the Royal College of Surgeons of England 1990;72(4):273

Sharav Y, Tal M Masseter inhibitory periods and sensations evoked by electrical tooth-pulp stimulation in subjects under hypnotic anesthesia Brain Res 1989; 479(2): 247-54 Sensation and masseter inhibitory periods (MIP) to electrical tooth pulp stimulation were recorded under hypnotic anesthesia and placebo to local anesthesia. In the first experiment, 8 subjects were tested for the effect of hypnotic anesthesia on sensory detection and MIP at non painful stimulus levels (x = 42.1 mu A) and painful levels (x = 86.5 mu A). The percentage of detection for non-painful stimuli changed from 94.3% to 14.1% and for painful stimuli from 100% to 28%; both changes were significant (P < 0.001). Hypnotic anesthesia blocked sensation without interrupting the initiation of the early component of the MIP, but did suppress its late component. In the second experiment, 8 subjects were tested for the perceived intensity of 5 levels of electrical tooth pulp stimulation under hypnotic anesthesia and placebo. Sensory intensity was measured by the visual analog scale (VAS). Hypnotic anesthesia was significantly more effective than placebo (P < 0.001) in reducing sensation. The differential effect of hypnotic anesthesia on the early and late component of the MIP lends further support to the hypothesis that hypnotic anesthesia operates primarily at suprasegmental, higher levels in the brain.

Simon MJ, Salzberg HC The effect of manipulated expectancies on posthypnotic amnesia Int J Clin Exp Hypn. 1985;33(1):40-51 The effects of manipulated S expectancy and direct suggestions for amnesia on posthypnotic amnesia were assessed. 120 undergraduate students were randomly assigned to 6 groups: negative expectancy (for amnesia)/suggestions (for amnesia); no expectancy/suggestions; negative expectancy/no suggestions; no expectancy/no suggestions; and 2 control groups. The results indicated that the expectancy manipulation had no effect on the occurrence of posthypnotic amnesia measured by the Stanford Hypnotic Susceptibility Scale, Form A (Weitzenhoffer & Hilgard, 1959), whereas suggestions for amnesia were found to have a significant effect. Hypnotized suggestion and no suggestion Ss remembered significantly less than Ss in the nonhypnotized control groups. The implications of the findings were discussed.

Sokel B, Kent CA, Lansdown R, Atherton D, Glover M, Knibbs J A comparison of hypnotherapy and biofeedback in the treatment of childhood atopic eczema Contemporary Hypnosis 1993;10(3):145-54 44 children (aged 5-15 yrs) with atopic eczema took part in a controlled trial in which they were treated with hypnotherapy or encouraged to use a biofeedback device based on galvanic skin resistance (as relaxation techniques) to control their symptoms. A 3rd group discussed the problems of having eczema without being given specific suggestions to help reduce the symptoms. Complete data were available for 31 Subjects. The total amount of body surface affected by eczema was not altered in any of the groups. 20 wks after entry to the trial, Subjects in the 2 relaxation groups showed a significant reduction in the severity of surface damage and lichenification compared with the control group. Girls in the hypnotherapy group showed greater improvement than the girls in other groups and showed greater improvement than the boys in the hypnotherapy group.

Spanos NP. De Groh M. Structure of communication and reports of involuntariness by hypnotic and nonhypnotic subjects. Perceptual & Motor Skills 1983;57(3 Pt 2):1179-86 We hypothesized that phrasing a communication to move the arm as either a suggestion, a directive, or an instruction would differentially affect subjects' interpretations of the movement. 45 hypnotic and 45 nonhypnotic subjects who responded positively to a suggestion tended to describe the movement as involuntary both on open-ended questionnaires and later on an explicit involuntariness scale. Subjects given a directive to move the arm, or an instruction to reach for a pencil, rarely described their experience as involuntary on the open-ended questionnaires but sometimes rated it as involuntary on the scale. The ratings of involuntariness by subjects given suggestions seem likely to reflect interpretations made concurrently with the movement suggested. However, such ratings by subjects given directives or instructions are likely to reflect retrospective interpretations cued by the instrument used to assess subjects' experiences.

Spanos NP, de Groot HP, Tiller DK Trance logic duality and hidden observer responding in hypnotic-imagination control, and simulating subjects: a social psychological analysis Journal of Abnormal Psychology 1985;94(4):611-23 Tested the hypothesis that a tolerance for logical incongruity characterizes hypnotic responding and is related to reports of duality experiences during age regression and hidden-observer responding during suggested analgesia. 30 undergraduates (the "reals") with high scores on a responsiveness-to-suggestion scale were randomly assigned to hypnotic or imagination control treatments, while 15 undergraduates with low scores were assigned to a simulation treatment in which they were instructed to fake hypnosis. Subjects were assessed on 6 indicators of logical incongruity, given age-regression suggestions and perception tasks, administered a suggestion for analgesia and hidden observer instructions, and interviewed. Results do not support the hypothesis. The differences in responding that did emerge between reals and simulators were accounted for by the different task demands to which Subjects were exposed. These behavioral differences, which have been previously interpreted in terms of intrinsic characteristics of hypnosis, may instead reflect a combination of between-treatments differences in demands and between-Subjects differences in the interpretation of those demands and in the ability to fulfill them.

Spanos NP. Gottlieb J. Rivers SM. The effects of short-term meditation practice on hypnotic responsivity. Psychological Record 1980;30(3):343-8. 81 male undergraduates were pretested on absorption and 3 measures of hypnotic responsiveness and were then randomly assigned to 1 of 3 conditions: meditation for 8 sessions, attendance at lectures on hypnosis for 8 sessions, and no treatment. Subjects were posttested on absorption, hypnotic responsivity, and Harvard Group Scale of Hypnotic Susceptibility, Form A, measures. Degree of meditating remained stable across sessions, and meditating Subjects were much more likely than those who listened to lectures to report intrusions into their attending. Neither the meditation nor the listening treatments enhanced hypnotic responsivity or absorption.

Spanos NP. McNeil C. Gwynn MI. Stam HJ. Effects of suggestion and distraction on reported pain in subjects high and low on hypnotic susceptibility. Journal of Abnormal Psychology 1984;93(3):277-84 84 18-30 yr old undergraduates high or low in hypnotic susceptibility (the Carleton University Responsiveness to Suggestion Scale) immersed an arm in ice water on 2 separate trials. Within susceptibility levels, Subjects were randomly assigned to 3 groups, with an equal number in each group. Between trials, Subjects in 1 group were administered a suggestion to imagine their hand as numb and insensitive, those in a 2nd group practiced a distraction task to be used during the 2nd trial (shadowing words), and those in a 3rd group (controls) received no special instructions. The suggestion significantly lowered rated pain in high but not in low susceptibles. Contrary to dissociation accounts of hypnotic susceptibility and suggested analgesia, low-susceptible shadowers showed as much reduction in rated pain as high susceptibles given suggestion. The social psychology of the experimental pain assessment situation is discussed.

Spanos NP, Mondoux TJ, Burgess CA Comparison of multi-component hypnotic and non-hypnotic treatments for smoking Contemporary Hypnosis 1995;12(1):12-9 Cigarette smokers who volunteered to participate in a free smoking session programme were administered a two session multi-component hypnotic or non-hypnotic treatment, a two session psychologocal placebo treatment, or no treatment. All subjects monitored the number of cigarettes they smoked during the three month period. The hypnotic and non-hypnotic treatment produced a significant, but temporary reduction in smoking. Placebo and control subjects did not report significant changes in smoking.

Spanos NP. Saad CL. Prism Adaptation in hypnotically limb-anesthetized subjects: more disconfirming data. Perceptual & Motor Skills 1984;59(2):379-86 Two experiments assessed the effect of hypnotically suggested arm anesthesia on adaptation to displacing prisms. In Study 1, 30 highly susceptible subjects adapted to prisms by pointing at a visual target for 2 min. with their hypnotically anesthetized dominant arm. Suggestion and hypnosis were then "lifted," and subjects were randomly assigned to three groups: subjects in one group were asked to move the hand slowly during the posttest (slow motion); those in a second group were told that hypnotic anesthesia would enable them to overcome displacement aftereffects (hypothesis informed); the remaining subjects (controls) were given no special instructions. During posttesting, all groups showed a significant displacement aftereffect, with no differences occurring between groups. Study 2 followed the same procedure except that during adaptation the usual target was removed and subjects pointed towards a homogeneous backboard. 20 highly susceptible subjects were assigned to an hypothesis-informed or control group immediately before posttesting. All subjects showed a significant displacement aftereffect. Both studies provide further evidence that hypnotic suggestions do not influence automatic perceptual processes. The results of Exp. 2 contradict the suggestion that hypnotic limb anesthesia eliminates the displacement aftereffect when the target is removed during adaptation trials.

Spanos NP. Williams V. Gwynn MI. Effects of hypnotic, placebo, and salicylic acid treatments on wart regression. Psychosomatic Medicine 1990;52(1):109-14 Subjects with warts on their hands and/or feet were randomly assigned to a hypnotic suggestion, topical salicylic acid, placebo, or no treatment control condition. Subjects in the three treated groups developed equivalent expectations of treatment success. Nevertheless, at the six-week follow-up interval only the hypnotic subjects had lost significantly more warts than the no treatment controls. Theoretical implications are discussed.

Spiegel D. Albert LH. Naloxone fails to reverse hypnotic alleviation of chronic pain. Psychopharmacology 1983;81(2):140-3 The hypothesis that the alleviation of chronic pain with hypnosis is mediated by endorphins was tested. Six patients with chronic pain secondary to peripheral nerve irritation were taught to control the pain utilizing self-hypnosis. Each subject was tested at 5-min intervals during four 1-h sessions for the amount of reduction of pain sensation and suffering associated with hypnosis while being given, in a random double-blind crossover fashion, an IV injection of either 10 mg naloxone or a saline placebo through an indwelling catheter. The patients demonstrated significant alleviation of the pain with hypnosis, but this effect was not significantly diminished in the naloxone condition. These findings contradict the hypothesis that endorphins are involved in hypnotic analgesia.

Spiegel D. Bloom JR. Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosomatic Medicine 1983;45(4):333-9 The pain and mood disturbance of 54 women with metastatic carcinoma of the breast were studied over the course of one year. A random sample was offered weekly group therapy during the year, with or without self-hypnosis training directed toward enhancing their competence at mastering pain and stress related to cancer. Both treatment groups demonstrated significantly less self-rated pain sensation (t = 2.5 p less than 0.02) and suffering (t = 2.17, p less than 0.03) than the control sample. Those who were offered the self-hypnosis training as well as group therapy fared best in controlling the pain sensation (F = 3.1, p less than 0.05). Pain frequency and duration were not affected. Changes in pain measures were significantly correlated with changes in self-rated total mood disturbance on the Profile of Mood States and with its anxiety, depression, and fatigue subscales. Possible mechanisms for the effectiveness of these interventions are discussed.

Spiegel D. Bloom JR. Kraemer HC. Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989;2(8668):888-91 The effect of psychosocial intervention on time of survival of 86 patients with metastatic breast cancer was studied prospectively. The 1 year intervention consisted of weekly supportive group therapy with self-hypnosis for pain. Both the treatment (n = 50) and control groups (n = 36) had routine oncological care. At 10 year follow-up, only 3 of the patients were alive, and death records were obtained for the other 83. Survival from time of randomisation and onset of intervention was a mean 36.6 (SD 37.6) months in the intervention group compared with 18.9 (10.8) months in the control group, a significant difference. Survival plots indicated that divergence in survival began at 20 months after entry, or 8 months after intervention ended.

Spinhoven P. Linssen AC. Education and self-hypnosis in the management of low back pain: a component analysis. British Journal of Clinical Psychology 1989;28 ( Pt 2):145-53 The aim of this study was to conduct a component analysis of a group programme for chronic low back pain patients. Forty-five patients participated in the pain control course, consisting of education about pain and a training in self-hypnosis. A pain diary was used as a measure of pain intensity, up-time and use of pain medication. Psychoneuroticism and depression were assessed using the Symptom Checklist-90 (SCL-90). No evidence was found for a differential efficacy of education or self-hypnosis on pain diary and SCL-90 scores. On completion of the total treatment package, patients manifested statistically significant changes on all measures except reported pain intensity. It is suggested that the pain control course is a non-invasive, inexpensive means of treatment which could be of some value in teaching even more severely disabled low back pain patients to cope more adequately with their pain problem. For this group of patients, a better adjustment to continuing pain may prove to be a more realistic therapy goal than pain reduction.

Staats P. Hekmat H. Staats A. Suggestion/placebo effects on pain: negative as well as positive. Journal of Pain & Symptom Management 1998;15(4):235-43 This study explores the effect of positive and negative placebo suggestions on pain induced by hand exposures to ice water. Thirty-six participants were randomly assigned to one of the following interventions: (a) positive placebo suggestion, (b) negative placebo suggestion, and (c) control. The positive placebo-suggestion participants were given favorable messages about the beneficial effects of ice-water hand immersion. The negative placebo-suggestion group was given messages depicting the negative effects of exposure to ice water. The control groups were given neutral messages about exposure to ice water. Participants rehearsed the messages and focused on them during their second hand exposures. Results indicate that both the positive and negative placebo-suggestion interventions significantly altered participants' pain threshold, pain tolerance, and pain endurance. Participants exposed to a positive placebo condition tolerated pain better than a neutral condition. Participants exposed to a negative placebo did not tolerate pain as well as participants with a neutral condition.

Stam HJ. McGrath PA. Brooke RI. The effects of a cognitive-behavioral treatment program on temporo-mandibular pain and dysfunction syndrome. Psychosomatic Medicine 1984;46(6):534-45 Sixty-one patients clearly diagnosed as suffering from Temporo-Mandibular Pain and Dysfunction Syndrome (TMPDS) were randomly assigned to one of three groups, 1) hypnosis and cognitive coping skills, 2) relaxation and cognitive coping skills, or 3) a no-treatment control group. All patients were evaluated with a standard hypnotic susceptibility scale before treatment. The two treatment groups received four weekly sessions of their respective treatments. Patients in the hypnosis and relaxation groups reported equivalent decrements in pain, abnormal sounds in the temporomandibular joint, and limitations of jaw mobility. Hypnotic susceptibility was significantly correlated with reductions in reported pain for the treatment groups. Patients' age and the duration of pain before treatment were not related to treatment outcome. Patients who dropped out of treatment had fewer limitations in jaw movement but did not differ in any other variable from patients who remained in treatment. These findings are discussed in relation to the hypothesis that Temporo-Mandibular Pain and Dysfunction Syndrome is stress-related muscular pain and dysfunction.

Stanton HE A comparison of the effects of an hypnotic procedure and music on anxiety level Australian Journal of Clinical & Experimental Hypnosis 1984 Nov;12(2):127-32 A hypnotic procedure involving a relaxing induction, positive suggestion, and mental imagery was compared with music as a means of reducing anxiety level defined in terms of scores on the Willoughby Questionnaire. Sixty adults seeking help in handling their anxiety were divided, at random, into three groups, one experiencing three weekly half hour sessions of the hypnotic procedure, another listening to music for the same amount of time, and the third serving as a non treatment control. Results indicated that both experimental treatments reduced anxiety level with the hypnotic procedure being significantly more effective. A 6 months follow up confirmed this superiority.

Stanton HE Overcoming fear of public speaking with the diagnostic trance Australian Journal of Clinical & Experimental Hypnosis 1991 May;19(1):41-7 24 male executives (aged 34-53 yrs) were matched on their fear of public speaking thermometer scores and allocated at random to either an experimental or a control group. Controls read articles describing how performance anxiety might be overcome, while the experimental Subjects had 2 treatment sessions learning a diagnostic trance procedure. After the 1st stage of the study had been completed, controls experienced the same 2 treatment sessions as had the experimental group. Subjects in both the experimental group of the 1st stage and the control group of the 2nd stage were able to reduce their fear of public speaking level significantly through use of the diagnostic trance procedure. Three months later, this improvement had been maintained.

Stanton HE Self-hypnosis: one path to reduced test anxiety Contemporary Hypnosis 1994;11(1):14-8 Examined the efficacy of a 5-step self-hypnosis technique in reducing test anxiety among 40 high school students (aged 12-15 yrs). Subjects were paired on the basis of sex and scores on the Test Anxiety Scale for Children (TASC), and were randomly allocated to experimental and control groups. Subjects in the experimental group learned the self-hypnosis technique in 2 50-min sessions, spaced 1 wk apart. The TASC was administered following the intervention period and once again 6 mo later. Results indicate a significant reduction of TASC scores in the experimental group, maintained over a 6-mo period, which was not matched by the control group.

Stanton HE. Is hypnotic induction really necessary?: A study of ego-enhancing suggestions and their effects. Psychotherapy Psychosomatics 1975;26(6):330-336. 60 university students in an experiment involving ego enhancement through the use of positive suggestion were randomly allocated to 3 groups. Group A experienced a hypnotic induction before hearing a series of ego-enhancing suggestions, Group B simply closed their eyes and listened, and the control group had no exposure to suggestions. All Subjects completed the Willoughby Questionnaire, the Assertiveness Scale (A. A. Lazarus, 1971), and 2 social interaction scales before and after the experiment which involved 4 20-min sessions over a period of 2 wks. Subjects of the 2 experimental groups experienced significant gains, as operationalized by inventory scores. Differences between these groups were apparent only on the social interaction scales, where Group A showed significantly greater improvement. Reasons for this are discussed, and implications for hypnotherapy outlined.

Stanton HE. Reduction of performance anxiety in music students. Australian Psychologist 1994;29(2):124-127. Investigated the use of hypnotherapy for music students with stage fright. 40 2nd- and 3rd-yr students at a music conservatory were paired by their scores on the Performance Anxiety Inventory (PAI) by J. Nagle et al (1981). One member of each pair was randomly assigned to the experimental group (EG), and the other was placed in the control group (CG). The EG Subjects received 2 50-min treatment sessions (TSs) of hypnotic relaxation suggestions, 1 wk apart. The TSs included breathing induction, visual imagery (clouds and a lake), and verbal suggestions linking the images to increased mental control. The CG met for 2 50-min discussion sessions. The PAI was administered before and after the TSs and 6 mo later. A significant improvement in the EG PAI scores was noted after the TSs, but not in the CG scores. Follow-up scores showed a modest improvement by the CG and continued improvement by the EG.

Stanton HE. Hypnosis and rational-emotive therapy--a de-stressing combination: a brief communication. International Journal of Clinical & Experimental Hypnosis 1989;37(2):95-9 It has been suggested that teacher stress might be reduced through cognitive restructuring which is aimed at improving the rationality of their thinking. To test this hypothesis, 40 high school teachers were paired on their level of reasonable thinking, operationalized in terms of scores on the Teacher Idea Inventory (Bernard, Joyce, & Rosewarne, 1983), and allocated at random to one of 2 groups. They also completed the Face Valid Stress Test. The experimental group participated in 4 weekly treatment sessions involving a hypnotic induction and suggestions derived from key elements of Rational-Emotive Therapy. These focused on the reduction of what Ellis (Ellis & Grieger, 1977), the originator of this treatment, calls "irrational thinking." The control group spent the same amount of time discussing stress reduction methods. Both the Face Valid Stress Test and the Teacher Idea Inventory were re-administered at the end of this period and again 12 months after conclusion of the experiment. Results indicated that both the experimental and control groups significantly reduced their levels of irrational thinking and stress, although the former's improvement was more marked, particularly at the 12-month follow-up.

Stanton HE. Hypnotic relaxation and the reduction of sleep onset insomnia. International Journal of Psychosomatics 1989;36(1-4):64-8 In the present study, a hypnotic relaxation technique was compared to stimulus control and placebo conditions as a means of reducing sleep onset latency (SOL). Forty-five subjects (Ss) were matched on their baseline SOL as measured through sleep diaries. They were randomly assigned to one of three groups: hypnotic relaxation; stimulus control; and placebo. These groups experienced four weekly sessions of 30-minutes duration with demand effects being controlled through the use of counter-demand instructions. Data generated by the study suggested that the particular hypnotic relaxation treatment used was effective in helping Ss go to sleep more quickly. Neither stimulus control nor placebo groups recorded similar improvement.

Stanton HE. Gurdjieff and ego-enhancement: a powerful alliance. American Journal of Clinical Hypnosis 1997;40(1):376-84 24 housewives wishing to take more control over their lives were matched on their Control of Life Thermometer scores, one member of each pair being randomly allocated to either an Experimental or a Control group. While this latter group read material on how they might achieve the increased control they desired, the Experimental group had two 50-minute sessions during which they learned how to embed suggestions derived from the work of Gurdjieff into a framework designed to maximize their acceptance. The Control of Life Thermometer was administered on two further occasions, one immediately after completion of the second training session and one as a follow-up six months later. After completion of this first stage of the study, Control group housewives experienced the same two treatment sessions as had the Experimental group. Results indicated that control of life, as operationally defined by the Thermometer, was significantly greater both immediately after treatment and at the six month follow-up.

Stern GS. Miller CR. Ewy HW. Grant PS. Perceived control: bogus pulse rate feedback and reported symptom reduction for individuals with accumulated stressful life events. Biofeedback & Self Regulation 1980;5(1):37-49 The present investigation tested the hypothesis that perceived control reduces reported symptom incidence for individuals with stressful life events. Subjects (undergraduate psychology students from an urban university) were divided into two groups, high and low in stress, based on their life change unit scores as measured by the Schedule of Recent Events (Holmes & Rahe, 1967). Subjects participated in a study in which they attempted to reduce pulse rate (PR) and were informed of their successes (i.e., PR reductions) through bogus feedback. High and low stress subjects were assigned randomly to one of the following conditions: bogus ascending success feedback (AS), wherein successes were concentrated more in the later stage of a PR reduction period; bogus equally distributed success feedback (EDS), wherein successes were equally distributed in the early and later stages of a PR reduction period; or no feedback (NF). The study consisted of three sessions held on 3 consecutive days. Each session consisted of a 3-minute baseline (nonfeedback) period followed by a 10-minute PR reduction period. Self-reports on 13 symptom items were measured 2 weeks before the study (pretest), after the final session of the study (posttest), and 3 weeks after the study (follow-up). Results indicated that on 5 of the 13 symptom items, the AS condition produced a significant reduction in reported symptom incidence for high-stress subjects only, and this effect was maintained for 3 weeks after the experiment. Results are discussed in terms of the effect perceived control may have on perceptions of physical health. Suggestions are made regarding the use of biofeedback treatment as a method by which perceptions of symptom distress may be reduced for individuals exposed to cumulative stressful experiences.

Stradling J. Roberts D. Wilson A. Lovelock F. Controlled trial of hypnotherapy for weight loss in patients with obstructive sleep apnoea. International Journal of Obesity & Related Metabolic Disorders 1998;22(3):278-81 OBJECTIVE: To assess if hypnotherapy assists attempts at weight loss. DESIGN: Randomised, controlled, parallel study of two forms of hypnotherapy (directed at stress reduction or energy intake reduction), vs dietary advice alone in 60 obese patients with obstructive sleep apnoea on nasal continuous positive airway pressure treatment. SETTING: National Health Service hospital in the UK. MEASURES: Weight lost at 1, 3, 6, 9, 12, 15 and 18 months after dietary advice and hypnotherapy, as a percentage of original body weight. RESULTS: All three groups lost 2-3% of their body weight at three months. At 18 months only the hypnotherapy group (with stress reduction) still showed a significant (P < 0.02), but small (3.8 kg), mean weight loss compared to baseline. Analysed over the whole time period the hypnotherapy group with stress reduction achieved significantly more weight loss than the other two treatment arms (P < 0.003), which were not significantly different from each other. CONCLUSIONS: This controlled trial on the use of hypnotherapy, as an adjunct to dietary advice in producing weight loss, has produced a statistically significant result in favour of hypnotherapy. However, the benefits were small and clinically insignificant. More intensive hypnotherapy might of course have been more successful, and perhaps the results of the trial are sufficiently encouraging to pursue this approach further.

Sullivan DS. Johnson A. Bratkovitch J. Reduction of behavioral deficit in organic brain damage by use of hypnosis. Journal of Clinical Psychology 1974;30(1):96-8 Assessed the effects of "catastrophic anxiety" on the functioning of organically brain-damaged 15-35 yr olds. Subjects were randomly assigned to either a control group, a relaxation group, or a hypnosis group. All Subjects were pre- and posttested on the Bender-Gestalt Test and the WAIS Picture Completion subtest. On the WAIS, the hypnosis group performed significantly better than the other 2 groups. On the Bender-Gestalt, there were similar differences between groups when those Subjects who were less susceptible to hypnosis were not included in the analysis. There was a highly significant correlation between hypnotic susceptibility and improvement on the dependent measures.

Surman OS. Hackett TP. Silverberg EL. Behrendt DM. Usefulness of psychiatric intervention in patients undergoing cardiac surgery. Archives of General Psychiatry 1974;30(6):830-5

Syrjala KL, Cummings C, Donaldson GW Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: a controlled clinical trial Pain 1992; 48(2): 137-46 Few controlled clinical trials have tested the efficacy of psychological techniques for reducing cancer pain or post-chemotherapy nausea and emesis. In this study, 67 bone marrow transplant patients with hematological malignancies were randomly assigned to one of four groups prior to beginning transplantation conditioning: (1) hypnosis training (HYP); (2) cognitive behavioral coping skills training (CB); (3) therapist contact control (TC); or (4) treatment as usual (TAU; no treatment control). Patients completed measures of physical functioning (Sickness Impact Profile; SIP) and psychological functioning (Brief Symptom Inventory; BSI), which were used as covariates in the analyses. Biodemographic variables included gender, age and a risk variable based on diagnosis and number of remissions or relapses. Patients in the HYP, CB and TC groups met with a clinical psychologist for two pre-transplant training sessions and ten in-hospital "booster" sessions during the course of transplantation. Forty-five patients completed the study and provided all covariate data, and 80% of the time series outcome data. Analyses of the principal study variables indicated that hypnosis was effective in reducing reported oral pain for patients undergoing marrow transplantation. Risk, SIP, and BSI pre-transplant were found to be effective predictors of inpatient physical symptoms. Nausea, emesis and opioid use did not differ significantly between the treatment groups. The cognitive behavioral intervention, as applied in this study, was not effective in reducing the symptoms measured.

Talone JM. Diamond MJ. Steadman C. Modifying hypnotic performance by means of brief sensory experiences. International Journal of Clinical & Experimental Hypnosis 1975;23(3):190-199. Examined the extent to which hypnotic performance could be modified by means of 2 types of prehypnosis sensory experiences: (a) auditory stimulation in the form of recorded music and (b) a variant of sensory restriction in the form of a short period of silence with eyes closed. 39 university students were administered the Harvard Group Scale of Hypnotic Susceptibility, Form A, as a baseline test of susceptibility and were then randomly assigned to 1 of 3 conditions. Subjects in the music and silence groups were exposed to 10 min of either recorded music or silence prior to completing an adaptation of the tape recorded posttest version of the Stanford Scale of Hypnotic Susceptibility, Form C. Control-group Subjects were exposed only to the hypnotic test scale. All Subjects reported their experienced hypnotic sensations. Music- and silence-group Subjects completed a self-report scale assessing the role played by relaxation and receptive perception in the manipulation. Although the results were not consistent, both music and silence were significantly effective in increasing responsivity in comparison with practice only. Findings are discussed with reference to possible mediating mechanisms, and implications of these findings with regard to modifying hypnotic ability, along with the need for replication studies, are considered.

Tamalons AM, Mitchell J An empirical comparison of Ericksonian and traditional hypnotic procedures Aust J Clin Hypnother Hypn 1997 Mar;18(1):5-16 Researchers have investigated the effect of direct and indirect hypnotic procedures upon performance of various tasks. None, however, had used thoroughly stringet controls nor examined the effect of these procedures upon improving memory of visual stimuli. This study compares these procedures with a memory task using 80 high to low susceptible female subjects randomly assigned to 4 experimental groups. Taped traditional hypnosis (TH); taped Ericksonian hypnosis (EH); Ericksonian hypnosis presented by an experimenter (LEH) and contro group (CG). The visual data recalled was significantly greater in the EH and LEH than that of the TH and CG groups. These results are discussed in terms of how a conversational induction with an indirect suggestion phase which accessed prior unconsciousness associations contributes to the power of the Ericksonian technique. Directions for further research and implications for more effective hypnosis are discussed.

Taylor DN. Effects of a behavioral stress-management program on anxiety, mood, self-esteem, and T-cell count in HIV positive men. Psychological Reports. 1995;76(2):451-7 This study evaluated the effects of a behavioral stress-management program on anxiety, mood, self-esteem, and T-cell count in a group of HIV-positive men who were asymptomatic except for T-cell counts below 400. The program consisted of 20 biweekly sessions of progressive muscle relaxation and electromyograph biofeedback-assisted relaxation training, meditation, and hypnosis. Ten subjects were randomly assigned to either a treatment group of a no-treatment control group, and the 2 groups were compared on pre- to posttreatment changes in the dependent measures. Analysis showed that, compared with the no-treatment group, the treatment group showed significant improvement on all the dependent measures, which was maintained at a 1-mo. follow-up. Since stress is known to compromise the immune system, these results suggest that stress management to reduce arousal of the nervous system and anxiety would be an appropriate component of a treatment regimen for HIV infection.

Tebecis AK. Provins KA. Further studies of physiological concomitants of hypnosis: skin temperature, heart rate and skin resistance. Biological Psychology 1976;4(4):249-58 Forehead skin temperature, heart rate and palmar skin resistance were recorded during passive hypnosis and compared with corresponding data obtained during the resting awake condition in a group of highly hypnotizable subjects experienced in self-hypnosis. Similar physiological measures were also monitored during experimental periods when subjects were experiencing suggested environmental conditions of cold and heat in hypnosis as compared with imagining the stress conditions. The data from these subjects were also compared with those obtained from a randomly selected group of people who were low in waking suggestibility and had never been hypnotized. The results indicate that the differences in mean physiological parameters were greatest between the two subject groups, although some noteable differences were also apparent between hypnosis and the awake condition within the experimental group.

ter Kuile MM. Spinhoven P. Linssen AC. van Houwelingen HC. Cognitive coping and appraisal processes in the treatment of chronic headaches. Pain 1996;64(2):257-64 The purpose of the present study was to investigate the active cognitive ingredients of change in psychological treatments for long-term chronic headache complaints. The primary questions this study addressed were: (1) Is a cognitive self-hypnosis training which explicitly attempts to change appraisal and cognitive coping processes more effective in producing these changes than a relaxation procedure, and (2) are changes in pain appraisal and cognitive coping related to changes in pain and adjustment in the short and long term? A total of 144 patients were assigned at random to a cognitive self-hypnosis (CSH) treatment or autogenic training (AT) with a duration of 7 weeks. Measures used were: Headache Index (HI), Symptom Checklist-90 (SCL-90), Coping Strategy Questionnaire (CSQ), Multidimensional Locus of Pain Control Questionnaire (MLPC) and treatment expectations. The results indicated that patients successfully changed their use of coping strategies and pain appraisals. Cognitive therapy was more effective than relaxation training in changing the use of cognitive coping strategies which were the direct targets of treatment. However, treatment effects were only related with changes in the use of coping strategies and appraisal processes to a limited extent and the mediational role of cognitive processes in pain reduction and better adjustment was inconclusive.

ter Kuile MM. Spinhoven P. Linssen AC. Zitman FG. Van Dyck R. Rooijmans HG. Autogenic training and cognitive self-hypnosis for the treatment of recurrent headaches in three different subject groups. Pain. 1994;58(3):331-40 The aims of this study were to (a) investigate the efficacy of autogenic training (AT) and cognitive self-hypnosis training (CSH) for the treatment of chronic headaches in comparison with a waiting-list control (WLC) condition, (b) investigate the influence of subject recruitment on treatment outcome and (c) explore whether the level of hypnotizability is related to therapy outcome. Three different subjects groups (group 1, patients (n = 58) who were referred by a neurological outpatient clinic; group 2, members (n = 48) of the community who responded to an advertisement in a newspaper; and group 3, students (n = 40) who responded to an advertisement in a university newspaper) were allocated at random to a therapy or WLC condition. During treatment, there was a significant reduction in the Headache Index scores of the subjects in contrast with the controls. At post-treatment and follow-up almost no significant differences were observed between the 2 treatment conditions or the 3 referral sources regarding the Headache Index, psychological distress (SCL-90) scores and medication use. Follow-up measurements indicated that therapeutic improvement was maintained. In both treatment conditions, the high-hypnotizable subjects achieved a greater reduction in headache pain at post-treatment and follow-up than did the low-hypnotizable subjects. It is concluded that a relatively simple and highly structured relaxation technique for the treatment of chronic headache subjects may be preferable to more complex cognitive hypnotherapeutic procedures, irrespective of the source of recruitment. The level of hypnotic susceptibility seems to be a subject characteristic which is associated with a more favourable outcome in subjects treated with AT or CSH.

Thorne DE. Amnesia and hypnosis. International Journal of Clinical & Experimental Hypnosis 1969;17(4):225-241. Explored the relative effects of 2 factors on short-term memory for a paired-associate learning task. 36 undergraduate and graduate paid volunteers were stratified, according to their Harvard Group Scale of Hypnotic Susceptibility, Form A scores, into 3 groups of 12 Subjects each. The Subjects within each of the 3 groups were then evenly but randomly assigned to 3 treatment conditions, which differed in terms of the kind of motivational procedure in which suggestions of amnesia for a recently learned paired-associate task were given. Results did not directly support or were sometimes contrary to predictions derived from popular hypnosis theories, which assert that posthypnotic amnesia is a reliable behavioral criterion for the "hypnotic state." (Spanish & German summaries)

Thorne DE. Is the hypnotic trance necessary for performance of hypnotic phenomena?. Journal of Abnormal Psychology 1967;72(3):233-9 The performance of 2 so-called hypnotic phenomena (selective awareness and auditory hallucinations) were compared between highly susceptible subjects in the waking or hypnotic states. 40 subjects (from an original 148 paid, volunteer, university students) were trained in deep hypnosis and subsequently assigned randomly to 4 groups of 10 subjects each. Each group was tested on its performance of the 2 "hypnotic phenomena" while experiencing 1 of 4 combinations of 2 variables, namely, the waking or hypnotized state of each subject, and the suggestion to hallucinate during or after exposure to a paired-associate word list given audibly to each s. Quantitative and qualitative changes in subject responses to 2 separate administrations of a word-association test were used as an index of each subject's level of awareness to the paired-associate word list, and his objective and subjective effectiveness in auditory hallucinations. Results indicate no differences attributable to state, but significant differences attributable to the suggested time of hallucinating.

Thorne DE. Hall HV. Hypnotic amnesia revisited. International Journal of Clinical & Experimental Hypnosis 1974;22(2):7-178. Randomly assigned 60 high- and 60 low-susceptible undergraduates (12 groups of 10 Subjects each) to 6 experimental procedures which differed in terms of the type of amnesia suggestions given (i.e., permissively or authoritatively worded amnesia suggestions) and the kind of motivation accompanying the amnesia suggestions (i.e., hypnotic motivation, waking motivation, and waking nonmotivation). High susceptible Subjects performed more effectively in the direction of the amnesia suggestions, but these suggestions were not totally effective for any of the 12 groups. There were no differences in response either to permissively or authoritatively worded amnesia suggestions or to hypnotic or waking procedures, but there were differences in response to task-motivating and non-task-motivating procedures (task-motivated Subjects were ostensibly more amnesic). (German, French, & Spanish summaries)

Timm HW. Effect of posthypnotic suggestions on the accuracy of preemployment polygraph testing. Journal of Forensic Sciences 1991;36(5):1521-1535. Examined the efficacy of both a posthypnotic (PTH) polygraph countermeasure suggestion and a PTH ideomotor lie detection suggestion within an analog preemployment screening context. 45 Subjects (aged 18-37 yrs) were randomly assigned to 1 of 3 equal-sized groups, controlling for their performance on the Harvard Group Scale of Hypnotic Susceptibility, Form A. Subjects assigned to one of the groups received the PTH suggestion that the Subject's index finger would rise whenever he or she lied during the polygraph test; Subjects in another group were given a PTH countermeasure designed to help them appear innocent whenever they lied; and those in the 3rd group were not given either hypnotic intervention. None of the Subjects given the ideomotor suggestion raised his or her finger when he or she lied during the polygraph test. The countermeasure suggestion also was ineffective, as was demonstrated by its failure to produce significantly more false negative responses.

Trussell JE. Kurtz RM. Strube MJ. Durability of posthypnotic suggestions: type of suggestion and difficulty level. American Journal of Clinical Hypnosis. 1996;39(1):37-47 This study investigated the impact of Difficulty Level and Type of Suggestion upon the durability of posthypnotic suggestion over an 8-week period. Seventy-eight highly susceptible subjects selected by both the Harvard Group Scale of Hypnotic Susceptibility: Form A (HGSHS:A) and Stanford Hypnotic Scale of Susceptibility: Form C (SHSS:C) were assigned to six groups (two levels of Difficulty x three Types of Suggestion). S's were tested for posthypnotic suggestion at 1, 3, 6, and 8 weeks. A 2 x 3 x 4 (Difficulty x Suggestion x Time) factorial ANOVA was conducted, with Time treated as a repeated-measure. The outcome variable at each time was either pass or fail for relevant suggestion. We found a significant Time effect, a significant Difficulty effect, and a significant Time x Difficulty interaction. Fewer subjects passed the difficult suggestions than passed the easy suggestions; fewer passed suggestions at a latter time; and the decay in pass rate was more pronounced for the easy suggestion condition, due largely to the higher initial pass rate. Type of Suggestion was not significant, nor were any of the other interactions. Clinical implications were discussed.

Turtz JS The effects of stress management training on stress level, death anxiety for persons with type II diabetes mellitus Dissertation Abstracts International, 1986;47(3):1289, University of Southern California This study examined the effects of stress management training on stress level, general anxiety, diabetic control, mental health, and death anxiety for persons with Type II diabetes. This study also sought to determine the relationships among the dependent variables. The 21 subjects who completed the study were female Type II diabetics ranging in age from 51.94 years to 77.50 years. All were volunteers, and all were obtained from a physician's private practice in the Century City area of Los Angeles. The subjects were randomly assigned to either the experimental group (n+10) or the waiting list control group (n=11). The treatment given to the members of the experimental group consisted of an 8-week stress management course that included instruction in diaphragmatic breathing, progressive muscle relaxation, a Hatha Yoga technique, Autogenics, and self-hypnosis. Level of stress was measured by the Hassles Scale; general anxiety was measured by the State-Trait Anxiety Inventory; diabetic control was measured by the glycosylated hemoglobin test, a test of long-term blood sugar control; mental health was measured by the Mental Health Inventory; death anxiety was measured by the Templer-McMordie Scale. All subjects were pretested before the treatment and posttested after the treatment. The ANCOVA procedure was used to test for the treatment effects on the dependent variables. Pearson Product-Moment Correlation Coefficients were used test for the relationships among the dependent variables at the time of pretesting. The level of significance for all statistical analyses was set at p = less than 0.05. The findings indicated that the only dependent variable that was significantly affected by the treatment was state anxiety. Although no significant increase in diabetic control was found, a trend toward lowered glycosylated hemoglobin values in the experimental group was observed. Significant correlations among the dependent variables at the time of pretesting occurred between stress level and general anxiety, stress level and diabetic control, state anxiety and diabetic control, frequency of hassles and mental health, and general anxiety and mental health.

Valbo A. Eide T. Smoking cessation in pregnancy: the effect of hypnosis in a randomized study. Addictive Behaviors. 1996;21(1):29-35 At Buskerud Central Hospital in Norway, a county hospital with 2000 deliveries per year, an intervention study, using hypnosis, aimed at smoking cessation and reduction among pregnant women still smoking around 18th week of pregnancy was carried out during the period 1992-1993. Two sessions (each lasting 45 minutes) using conventional induction into a superficial nonsomnabulistic stage of trance were performed. A tape was played, encouraging the pregnant woman's wish to quit smoking and her capacity to do so. Relaxation techniques together with self-hypnotic methods were introduced to combat craving. Changes in smoking pattern were investigated at delivery time. No significant effect on smoking cessation or smoking reduction was obtained (p > 0.05). We recorded a 10% quit rate in both intervention group and control group, and 42% and 31% reduced their smoking in the intervention group and control group, respectively.

van der Laan WH. van Leeuwen BL. Sebel PS. Winograd E. Baumann P. Bonke B. Therapeutic suggestion has no effect on postoperative morphine requirements. Anesthesia & Analgesia. 1996;82(1):148-52 This study was designed to confirm the effect of therapeutic intraoperative auditory suggestion on recovery from anesthesia, to establish the effect of preoperative suggestion, and to assess implicit memory for intraoperative information using an indirect memory task. Sixty consenting unpremedicated patients scheduled for elective gynecologic surgery were randomly divided into three equal groups: Group 1 received a tape of therapeutic suggestions preoperatively, and the story of Robinson Crusoe intraoperatively; Group 2 heard the story of Peter Pan preoperatively and therapeutic suggestions intraoperatively; Group 3 heard the Crusoe story preoperatively and the Peter Pan story intraoperatively. A standardized anesthetic technique was used with fentanyl, propofol, isoflurane, and nitrous oxide. After surgery, all patients received patient-controlled analgesia (PCA) with a standardized regimen. In the 24 h postsurgery, morphine use was recorded every 6 h and at 24 h an indirect memory test (free association) was used to test for memory of the stories. Anxiety scores were measured before surgery and at 6 and 24 h postsurgery. There were no significant differences between groups for postoperative morphine use, pain or nausea scores, anxiety scores, or days spent in hospital after surgery. Seven of 20 patients who heard the Pan story intraoperative gave a positive association with the word "Hook," whereas 2 of 20 who did not hear the story gave such an association. Indirect memory for the Pan story was established using confidence interval (CI) analysis. (The 95% CI for difference in proportion did not include zero). No indirect memory for the Crusoe story could be demonstrated. This study did not confirm previous work which suggested that positive therapeutic auditory suggestions, played intraoperatively, reduced PCA morphine requirements. In contrast, a positive implicit memory effect was found for a story presented intraoperatively.

Van Dyck R. Spinhoven P. Depersonalization and derealization during panic and hypnosis in low and highly hypnotizable agoraphobics. International Journal of Clinical & Experimental Hypnosis. 1997;45(1):41-54 The primary aim of the present study was to investigate the association between spontaneous experiences of depersonalization or derealization (D-D) during panic states and hypnosis in low and highly hypnotizable phobic individuals. Secondarily, the association among level of hypnotizability, capacity for imaginative involvement, and severity of phobic complaints was also assessed. S 1987;ixty-four patients with panic disorder with agoraphobia according to the DSM-III-R (American Psychiatric Association, Proneness to experience D-D during hypnosis was positively related to hypnotizability, but only for agoraphobic patients who had already experienced these perceptual distortions during panic episodes. Correlations of level of hypnotizability and capacity for imaginative involvement with severity of agoraphobic complaints were not significant. These findings suggest that hypnotizability may be a mediating variable between two different, although phenotypically similar, perceptual distortions experienced during panic states and hypnosis. Implications for both theory and clinical practice are discussed.

Van Dyck R. Spinhoven P. Does preference for type of treatment matter? A study of exposure in vivo with or without hypnosis in the treatment of panic disorder with agoraphobia. Behavior Modification 1997;21(2):172-86 There is evidence that preference for a given therapy may influence results. Literature also suggests that hypnotizability may be elevated in agoraphobic patients, making hypnosis a potentially powerful method for treatment. Agoraphobic patients (N = 64) were treated with either exposure in vivo or exposure combined with hypnosis in a crossover design. Half of the patients started with the treatment they preferred and the other half received the other treatment first. Although patients' preference clearly shifted in favor of the combined therapy in the course of the study, no effect of preference on outcome was evident. Although hypnotizability clearly correlated to outcome in the combined therapy, no difference in effect between the two therapies was found on behavioral, self-report, and observer measures. No additional effect of hypnosis could be shown and preference was not found to be a powerful mediator of effect.

VanDyck R. Zitman FG. Linssen AC. Spinhoven P. Autogenic training and future oriented hypnotic imagery in the treatment of tension headache: outcome and process. International Journal of Clinical & Experimental Hypnosis 1991;39(1):6-23 The aim of the present study was (a) to investigate the relative efficacy of autogenic training and future oriented hypnotic imagery in the treatment of tension headache and (b) to explore the extent to which therapy factors such as relaxation, imagery skills, and hypnotizability mediate therapy outcome. Patients were randomly assigned to the 2 therapy conditions and therapists. 55 patients (28 in the autogenic therapy condition and 27 in the future oriented hypnotic imagery condition) completed the 4 therapy sessions and 2 assessment sessions. No significant main effect or interaction effects for treatment condition or therapist was revealed. A significant effect for time in analyzing scores for headache pain, pain medication usage, depression, and state anxiety was found. In the self-hypnosis condition, pain reduction proved to be associated with depth of relaxation during home practice (as assessed with diaries) and capacity to involve in imagery (as assessed with the Dutch version [van der Velden & Spinhoven, 1984] of the Creative Imagination Scale [Barber & Wilson, 1978/79; Wilson & Barber, 1978]). After statistically controlling for relaxation and imagery, hypnotizability scores (as assessed with the Dutch version [Oyen & Spinhoven, 1983] of the Stanford Hypnotic Clinical Scale [Morgan & J.R. Hilgard, 1975, 1978/79]) were significantly correlated with ratings of pain reduction. Results are discussed in the context of the neo-dissociation and social-cognitive model of hypnoanalgesia. The clinical relevance and the methodological shortcomings of the present study are also critically assessed.

Velten E= Jr. A laboratory task for induction of mood states. Behaviour Research & Therapy 1968;6(4):473-82 Administered to 100 female college students the Harvard Group Scale of Hypnotic Susceptibility, Form A, to provide a measure of primary suggestibility. In a 2nd hr., each Subject was randomly assigned to 1 of 5 individual treatments of 20 Subjects each. 1 group read and concentrated upon 60 self-referent statements intended to be elating; a 2nd group read 60 statements intended to be depressing. A 3rd group read 60 statements which were neither self-referent nor pertaining to mood. This group controlled for the effects of reading and experimental participation per se. 4th and 5th groups received demand characteristics control treatments designed to produce simulated elation and simulated depression, respectively. 2 measures of pretreatment mood level were obtained from each Subject at the beginning of her individual treatment. Following treatment, as criteria for elation and depression, seven behavioral task measures were obtained. 4 of these distinguished significantly among the treatment groups. The comparative performance of Subjects in the 3 control groups indicated that the obtained mood changes could not be attributed to artifactual effects. Moreover, postexperimental questionnaire data strongly supported the conclusion that Elation and Depression treatments had indeed respectively induced elation and depresssion.

Vingoe FJ, Hobro N, Milner-Whitaker I Response to a modified hypnosis experience questionnaire (HEQ-44) following alert and relaxation hypnotic procedures Contemporary Hypnosis 1993;10(3):159-65 40 patients were randomly assigned in a counterbalanced design to 2 recorded hypnotic inductions (alert-relaxation or relaxation-alert). Following each induction, Subjects were required to complete a modified version of the Hypnosis Experience Questionnaire, which included an Alert subscale. Subjects also rated which procedure was best for them in terms of focusing on pleasant experience. Differences were found only on the Relaxation subscale in favor of the relaxation procedure. While no difference between procedures was found on the Alert subscale, because 13 of 40 Subjects selected the alert procedure as being best for them as a component of treatment, further research with alerting procedures is suggested.

Voss H. Meyer H. Relationships between trait and state measures of anxiety and curiosity under conditions of self-appraised risk Psychologische Beitrage 1981;23(1):97-114. 96 college students (50% males) were randomly assigned to 1 of 4 conditions (control, hypnosis, shock, or drug). State and trait measures of curiosity and anxiety were administered. Results showed medium negative correlations between both state and trait measures. Measures of both curiosity and anxiety were positively intercorrelated, whereas correlation coefficients between the 2 types of measures were low. Results are seen as a partial confirmation that increasing stress over situations is related to increasing anxiety state (linear trend) and to an increase followed by a decrease or to a decrease in state curiosity. The modulating effects of cognitive processes, leading to reappraisal of the given situation and therefore mediating between states and overt behavior, are discussed. (French abstract)

Wagstaff GF, Mercer K Does hypnosis facilitate memory for deep processed stimuli Contemporary Hypnosis 1993;10(2):59-66 Evidence previously presented by I. W. Shields and V. J. Knox (see PA, Vol 74:12488) suggests that hypnosis can facilitate recall and recognition memory for target words deep processed in terms of the levels of processing theory of F. I. Craik and R. S. Lockhart (1972). No facilitation effect is indicated, however, for shallow processed words. The present study attempted to replicate this finding, using 20 undergraduates in the hypnotic condition and 2 nonhypnotic control groups (10 undergraduates each) who were unaware they were participating in a hypnosis experiment. The findings of the present study failed to confirm those of Shields and Knox. The untreated control group recalled fewer shallow processed words than the other hypnotic and waking conditions and produced fewer intrusions than the relaxed/motivated waking group. It is concluded that Shields and Knox's findings may have resulted from underperformance by their waking control groups.

Wagstaff GF, Royce C Hypnosis and the treatment of nail biting: a preliminary trial Contemporary Hypnosis 1994;11(1):9-13 Examined the efficacy of hypnotherapeutic suggestions alone or preceded by hypnotic induction in the treatment of nail biting. The influences of motivation to improve, belief in effectiveness of treatment, and level of imaginative involvement were also examined. Subjects were 17 undergraduates (aged 19-22 yrs). Results indicate that only suggestions preceded by hypnotic induction resulted in symptom improvement. Belief in efficacy predicted treatment success better than motivation, hypnotic induction, or scores on the Creative Imagination Scale. Within the group receiving hypnotic induction, hypnotic depth scores significantly correlated with treatment success.

Wall VJ. Womack W. Hypnotic versus active cognitive strategies for alleviation of procedural distress in pediatric oncology patients. American Journal of Clinical Hypnosis 1989;31(3):181-91 This study provided a differential comparison of the efficacy of standardized instruction in hypnosis or active cognitive strategy for provision of relief from procedurally induced pain and anxiety. Subjects were instructed to self-direct in the use of strategies during medical procedures. Twenty pediatric oncology patients participated in the study. They were not informed that hypnosis was one of the strategies. Subjects were screened for hypnotizability and randomly assigned to treatments. Demographic data were collected. Pre-strategy training observations were made during a Bone Marrow Aspiration or Lumbar Puncture (BMA/LP) using visual analog scales, the McGill Pain Questionnaire, State-Trait Anxiety Inventory, pulse and temperature readings, and interview. Following strategy training, data were collected during a second BMA/LP using the same measures as employed pre-intervention. Results indicated that both strategies were effective in providing pain reduction. Neither technique provided for anxiety reduction. Hypnotizability scale scores failed to correlate with degree of pain reduction.

Weaver DB Hypnotherapy audiotapes for the treatment of chronic insomnia Alternative Therapies in Health and Medicine 1996;2(4):94-5

Whitehouse WG. Dinges DF. Orne EC. Keller SE. Bates BL. Bauer NK. Morahan P. Haupt BA. Carlin MM. Bloom PB. Zaugg L. Orne MT. Psychosocial and immune effects of self-hypnosis training for stress management throughout the first semester of medical school. Psychosomatic Medicine. 1996;58(3):249-63 This study was a 19-week prospective conducted to determine the effectiveness of a self-hypnosis/relaxation intervention to relieve symptoms of psychological distress and moderate immune system reactivity to examination stress in 35 first-year medical students. Twenty-one subjects were randomly selected for training in the use of self-hypnosis as a coping skill and were encouraged to practice regularly and to maintain daily diary records related to mood, sleep, physical symptoms, and frequency of relaxation practice. An additional 14 subjects received no explicit training in stress-reduction strategies, but completed similar daily diaries. Self-report psychosocial and symptom measures, as well as blood draws, were obtained at four time points: orientation, late semester, examination period, and postsemester recovery. It was found that significant increases in stress and fatigue occurred during the examination period, paralleled by increases in counts of B lymphocytes and activated T lymphocytes, PHA-induced and PWM-induced blastogenesis, and natural killer cell (NK) cytotoxicity. No immune decreases were observed. Subjects in the self-hypnosis condition reported significantly less distress and anxiety than their nonintervention counterparts, but the two groups did not differ with respect to immune function. Nevertheless, within the self-hypnosis group, the quality of the exercises (ie, relaxation ratings) predicted both the number of NK cells and NK activity. It was concluded that stress associated with academic demands affects immune function, but immune suppression is not inevitable. Practice of self-hypnosis reduces distress, without differential immune effects. However, individual responses to the self-hypnosis intervention appear to predict immune outcomes.

Whitehouse WG. Dinges DF. Orne EC. Orne MT. Hypnotic hypermnesia: enhanced memory accessibility or report bias?. Journal of Abnormal Psychology 1988;97(3):289-95 Laboratory studies of hypnotic hypermnesia have yielded inconsistent evidence of memory enhancement, and the process responsible for the occasional positive findings have eluded identification. The present experiment assessed delayed recall for filmed material under conditions in which subjects were required to answer all questions, by guessing if necessary. They also rated confidence in the accuracy of each response. After an initial wake-baseline forced-recall test, subjects were randomly assigned to hypnosis or waking conditions for a second forced-recall test. Both groups of subjects recalled additional correct details on the second test, but the magnitude of this hypermnesia was no greater for subjects exposed to the hypnosis treatment. Hypnotized subjects did, however, exhibit a significantly greater increase in confidence for responses designated as "guesses" on the prior waking test--a finding consistent with the view that hypnosis engenders a shift in the subjective criterion for what constitutes a "memory." Implications of these findings for the use of hypnosis in forensic situations are discussed.

Whorwell PJ. Houghton LA. Taylor EE. Maxton DG. Physiological effects of emotion: assessment via hypnosis. Lancet 1992;340(8811):69-72 Assessment of the physiological effects of physical and emotional stress has been hampered by a lack of suitable laboratory techniques. Since hypnosis can be used safely to induce specific emotional states of considerable intensity, we studied the effect on distal colonic motility of three hypnotically induced emotions (excitement, anger, and happiness) in 18 patients aged 20-48 years with irritable bowel syndrome. Colonic motility index was reduced by hypnosis on its own (mean change 19.1; 95% CI 0.8, 37.3; p less than 0.05) and this change was accompanied by decreases in both pulse (12; 8, 15) and respiration (6; 4, 8) rates (p less than 0.001 for both). Anger and excitement increased the colonic motility index (50.8; 29.4, 72.2; and 30.4; 8.9, 51.9, respectively; p less than 0.01 for both), pulse rate (26; 22, 30; and 28; 24, 32; p less than 0.001 for both), and respiration rate (14; 12, 16; and 12; 10, 14; p less than 0.001 for both). Happiness further reduced colonic motility although not significantly from that observed during hypnosis alone. Changes in motility were mainly due to alterations in rate than in amplitude of contractions. Our results indicate that hypnosis may help in the investigation of the effects of emotion on physiological functions; this approach could be useful outside the gastrointestinal system. Our observation that hypnosis strikingly reduces fasting colonic motility may partly explain the beneficial effects of this form of therapy in functional bowel disorders.

Whorwell PJ. Prior A. Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut 1987;28(4):423-5 Fifteen patients with severe intractable irritable bowel syndrome previously reported as successfully treated with hypnotherapy, have now been followed up for a mean duration of 18 months. All patients remain in remission although two have experienced a single relapse overcome by an additional session of hypnotherapy. Experience with a further 35 patients is reported giving a total group of 50. This group was divided into classical cases, atypical cases and cases exhibiting significant psychopathology. The response rates were 95%, 43%, and 60% respectively. Patients over the age of 50 years responded very poorly (25%) whereas those below the age of 50 with classical irritable bowel syndrome exhibited a 100% response rate. This study confirms the successful effect of hypnotherapy in a larger series of patients with irritable bowel syndrome and defines some subgroup variations.

Whorwell PJ. Prior A. Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet 1984;2(8414):1232-4 30 patients with severe refractory irritable-bowel syndrome were randomly allocated to treatment with either hypnotherapy or psychotherapy and placebo. The psychotherapy patients showed a small but significant improvement in abdominal pain, abdominal distension, and general well-being but not in bowel habit. The hypnotherapy patients showed a dramatic improvement in all features, the difference between the two groups being highly significant. In the hypnotherapy group no relapses were recorded during the 3-month follow-up period, and no substitution symptoms were observed.

Wickramasekera I. Effects of sensory restriction on susceptibility to hypnosis: a hypothesis and more preliminary data. Journal of Abnormal Psychology 1970;76(1):69-75 Randomly assigned 45 young adult white male prisoners to 1 of 3 groups of equal size. Experimental Subjects (Groups 2 and 3) were exposed to 1 hr. of sensory restriction. Subjects in Group 2 were given a set of neutral instructions prior to sensory restriction, and Subjects in Group 3 were given a set of nonneutral instructions. Controls (Group 1) were exposed to conditions similar to experimentals, but without sensory restriction per se. All Subjects were tested before and after the above procedures with the Stanford Hypnotic Susceptibility Scale. On posttesting, experimental Subjects appeared to have increased in hypnotizability.

Wigal JK. Stout C. Kotses H. Creer TL. Fogle K. Gayhart L. Hatala J. Experimenter expectancy in resistance to respiratory air flow. Psychosomatic Medicine 1997;59(3):318-22 OBJECTIVE: The effect of experimenter expectancy was investigated on the resistance to respiratory air flow, measured as total respiratory resistance (Rt) in healthy individuals. METHOD: Each of three naive experimental assistants collected air flow resistance responses from 30 subjects who they had been told were either likely or unlikely to respond to the suggestion of breathing difficulty. RESULTS: The subjects were assigned to the two conditions at random. The subjects who were described to the experimenters as being likely to respond exhibited greater Rt increases to bronchoconstriction suggestion than did the subjects who were described as unlikely to respond. CONCLUSIONS: These findings confirmed the presence of a source of variance that has not been considered previously in suggestion studies.

Williams AR. Hind M. Sweeney BP. Fisher R. The incidence and severity of postoperative nausea and vomiting in patients exposed to positive intra-operative suggestions. Anaesthesia. 1994;49(4):340-2 In a double-blind study, the effects of positive intra-operative suggestions on the incidence and severity of postoperative nausea and vomiting were studied in 60 patients randomly selected to undergo routine major gynaecological surgery. Patients who received positive suggestions suffered significantly less nausea and vomiting in the 24 h after surgery.

Williams JM. Hall DW. Use of single session hypnosis for smoking cessation. Addictive Behaviors 1988;13(2):205-8 Twenty of sixty volunteers for smoking cessation were assigned to single-session hypnosis, 20 to a placebo control condition, and 20 to a no-treatment control condition. The single-session hypnosis group smoked significantly less cigarettes and were significantly more abstinent than a placebo control group and a no treatment control group at posttest, and 4-week, 12-week, 24-week and 48-week follow-ups.

Wojcikiewicz A, Orlick T The effects of post-hypnotic suggestion and relaxation with suggestion on competitive fencing anxiety and performance Int J Sport Psychol 1987;18(4):303-13 Investigated the relative effectiveness of (1) post-hypnotic suggestion and (2) relaxation with suggestion, induced on site preceding a national competition. 33 fencers were randomly assigned to 1 of 3 groups: experimental hypnotic, experimental relaxation, and control. Subjects were tested and retested during 2 consecutive competitions on perceived anxiety, perception of task difficulty, and competition performance. Significant differences were found between the hypnotic group and the control group for perceived level of competition anxiety. On the estimated level of task difficulty, significant differences were found for both the hypnotic and the relaxation groups when compared with the control group. No significant differences were found on fencing performance measures. (French, Spanish, German & Italian abstracts)


Zachariae R. Bjerring P. Laser-induced pain-related brain potentials and sensory pain ratings in high and low hypnotizable subjects during hypnotic suggestions of relaxation, dissociated imagery, focused analgesia, and placebo. International Journal of Clinical & Experimental Hypnosis. 1994; 42(1):56-80 Pain reports and amplitudes of painful argon laser-induced brain potentials were obtained for 10 high and 10 low hypnotizable volunteers following placebo and a randomized sequence of four hypnotically induced conditions of (a) neutral hypnosis, (b) deep relaxation, (c) pleasant dissociated "out of body" imagery, and (d) focused analgesia of the hand. Both high and low hypnotizable subjects exhibited significant reductions of reported pain during conditions of neutral hypnosis, relaxation, dissociated imagery, and focused analgesia. High hypnotizable subjects displayed significantly greater reductions than low hypnotizables in all conditions except placebo. Both high and low hypnotizables exhibited significant reductions of reported pain in all five conditions as well as in the posthypnotic condition, when amplitudes of evoked potentials were compared to the prehypnotic baseline. Only the high hypnotizable group showed significant reductions in amplitudes when the data were recalculated to reflect relative changes compared to the average amplitude of the pre- and postconditions to compensate for a possible habituation effect indicated by the significantly lowered amplitudes in the posthypnotic condition. The results are discussed in light of a number of hypotheses concerning mechanisms of hypnotic analgesia.

Zachariae R. Bjerring P. Arendt-Nielsen L. Nielsen T. Gotliebsen K. The effect of hypnotically induced emotional states on brain potentials evoked by painful argon laser stimulation. Clinical Journal of Pain 1991;7(2):130-8 The relationship between pain perception and emotional states is well known. However, the nature of this relationship and how different emotional states affect sensory and cognitive dimensions of pain remains uncertain. Results from experimental investigations are often contradictory, which may be due to methodological difficulties in inducing pain and monitoring physiological responses. In addition, most studies have focused on a single emotion, and data on the relative effects of different emotional states are lacking. In the present study we attempted to eliminate some of these methodological problems. Laser evoked potentials were used as a quantitative correlate to pain perception and were measured in 12 highly hypnotically susceptible subjects during seven conditions: (a) a prehypnotic baseline condition; (b) a neutral hypnotic control condition; (c-e) hypnotically recalled anger, fear, and depression in randomized order; (f) a hypnotically recalled happy condition, and (g) a posthypnotic awake control condition. The pain evoked potentials were significantly decreased in the angry condition and significantly increased in the depressed condition compared with baseline. No differences could be detected for either the happy or the fear-related condition compared with the baseline or neutral hypnotic condition. A significant positive correlation between the subjective intensity of depression and the increase in evoked potentials was found, but none for the other three emotions. The results support earlier findings that clinical depression is related to increased pain perception, and findings that the expression of anger can inhibit the experience of pain.(ABSTRACT TRUNCATED AT 250 WORDS)

Zachariae R. Hansen JB. Andersen M. Jinquan T. Petersen KS. Simonsen C. Zachariae C. Thestrup-Pedersen K. Changes in cellular immune function after immune specific guided imagery and relaxation in high and low hypnotizable healthy subjects. Psychotherapy & Psychosomatics 1994;61(1-2):74-92 This article presents the results of two investigations, each measuring cellular immune function on 3 investigation days 1 week apart in 15 high and 15 low hypnotizable healthy subjects randomly selected for three groups: (1) a guided imagery group receiving instructions to enhance cellular immune function: (2) a relaxation group which did not receive instructions regarding the immune system, and (3) a control group. Study 1 investigated changes in monocyte chemotaxis (MC) and lymphocyte proliferative response (LPR) to three mitogens, while natural killer cell activity (NKCA) was measured in study 2. The results show similar patterns of brief decreases in LPR and NKCA immediately after intervention on all investigation days in both the imagery and relaxation groups. Increases in MC were found in both intervention groups on day 1. On a follow-up investigation day in study 2, a brief stress task yielded a slight increase in NKCA. In study 2, the control group showed decreases in NKCA similar to those observed in the two intervention groups. In general there were no significant changes in preintervention immune function throughout the investigation period. When comparing the effects in high and low hypnotizable subjects, we found that high hypnotizables showed greater decreases in LPR and NKCA than low hypnotizables. There are several inconsistencies between the results of the limited number of investigations studying the effects of guided imagery and relaxation on immune function. These differences may in part be explained by differences in methodology, time intervals between blood sampling, and subject characteristics such as age, health status and hypnotizability. The inconsistent results make it premature to make inferences about possible benefits of the application of these techniques in the treatment of immune related diseases, and further investigations are needed.

Zachariae R. Oster H. Bjerring P. Effects of hypnotic suggestions on ultraviolet B radiation-induced erythema and skin blood flow. Photodermatology, Photoimmunology & Photomedicine 1994;10(4):154-60 Results from both animal and human studies have indicated that inflammatory skin reactions such as the flare response to histamine prick test involve a neurogenic regulatory component. It is still unknown to which degree inflammation induced by ultraviolet (UV) radiation may be mediated by the central nervous system. To investigate this, the effect of hypnotic suggestions to increase and decrease the response to UVB radiation on erythema and cutaneous blood flow was investigated in 10 highly hypnotizable subjects. The results showed a significant effect of hypnotic suggestions on cutaneous blood flow compared with the responses of a control group. For erythema no conclusive evidence was found. The results indicate the possibility of separate regulatory mechanisms behind central nervous system influence on UVB-induced erythema and skin blood flow respectively, and further investigations are needed.

Zachariae R. Oster H. Bjerring P. Kragballe K. Effects of psychologic intervention on psoriasis: a preliminary report. Journal of the American Academy of Dermatology. 1996;34(6):1008-15, BACKGROUND: Case reports have indicated that psychologic treatments may have a beneficial effect on psoriasis activity. OBJECTIVE: Our purpose was to further investigate the hypothesis that psychologic intervention has a beneficial effect on psoriasis activity in a blinded, controlled manner. METHODS: Fifty-one patients with psoriasis vulgaris were randomly assigned to a treatment or a control group. Patients in the treatment group participated in seven individual psychotherapy sessions in 12 weeks. Intervention techniques included stress management, guided imagery, and relaxation. The Psoriasis Area Severity Index (PASI), Total Sign Score (TSS), and Laser Doppler Skin Blood Flow (LDBF) of a selected reference plaque was measured in a blinded fashion at baseline (week 0), week 4, week 8, and after treatment (week 12). RESULTS: Slight, but significant, changes in TSS and LDBF were found in the treatment group but not in the control group. When analyses were performed for both groups separately, the treatment group displayed significant reductions for all three psoriasis activity measures, whereas no changes were seen in the control group. CONCLUSION: Our preliminary results suggest that psychologic intervention may have a moderate beneficial effect on psoriasis activity.

Zachariae R. Oster H. Bjerring P. Kragballe K. Effects of psychologic intervention on psoriasis: a preliminary report. Journal of the American Academy of Dermatology 1996;34(6):1008-15 BACKGROUND: Case reports have indicated that psychologic treatments may have a beneficial effect on psoriasis activity. OBJECTIVE: Our purpose was to further investigate the hypothesis that psychologic intervention has a beneficial effect on psoriasis activity in a blinded, controlled manner. METHODS: Fifty-one patients with psoriasis vulgaris were randomly assigned to a treatment or a control group. Patients in the treatment group participated in seven individual psychotherapy sessions in 12 weeks. Intervention techniques included stress management, guided imagery, and relaxation. The Psoriasis Area Severity Index (PASI), Total Sign Score (TSS), and Laser Doppler Skin Blood Flow (LDBF) of a selected reference plaque was measured in a blinded fashion at baseline (week 0), week 4, week 8, and after treatment (week 12). RESULTS: Slight, but significant, changes in TSS and LDBF were found in the treatment group but not in the control group. When analyses were performed for both groups separately, the treatment group displayed significant reductions for all three psoriasis activity measures, whereas no changes were seen in the control group. CONCLUSION: Our preliminary results suggest that psychologic intervention may have a moderate beneficial effect on psoriasis activity.

Zeltzer L. LeBaron S. Hypnosis and nonhypnotic techniques for reduction of pain and anxiety during painful procedures in children and adolescents with cancer. Journal of Pediatrics 1982;101(6):1032-5 Hypnosis was compared with nonhypnotic behavioral techniques for efficacy in reducing pain and anxiety in 27 children and adolescents during bone marrow aspiration and in 22 children and adolescents during lumbar puncture. The patients and independent observers each rated (scale of 1 to 5) pain and anxiety during one to three procedures prior to intervention and one to three procedures with intervention. Prior to intervention for both groups, pain during bone marrow aspiration was rated as more severe (P less than 0.01) than pain during lumbar puncture. During bone marrow aspiration pain was reduced to a large extent by hypnosis (P less than 0.001) and to a smaller but significant extent by nonhypnotic techniques (P less than 0.01), and anxiety was significantly reduced by hypnosis alone (P less than 0.001). During lumbar puncture only hypnosis significantly reduced pain (P less than 0.001); anxiety was reduced to a large degree by hypnosis (P less than 0.001) and to a smaller degree by nonhypnotic techniques (P less than 0.05). Thus hypnosis was shown to be more effective than nonhypnotic techniques for reducing procedural distress in children and adolescents with cancer.

Zeltzer L. LeBaron S. Zeltzer PM. The effectiveness of behavioral intervention for reduction of nausea and vomiting in children and adolescents receiving chemotherapy. Journal of Clinical Oncology 1984;2(6):683-90 Fifty-one children 6-17 years of age rated the severity of nausea, vomiting, and the extent to which chemotherapy bothered them during each course of chemotherapy. Sixteen patients had no symptoms and the doses administered to 16 others were not constant so that matched courses could not be assessed. After baseline measurement of two matched courses, the remaining 19 patients were randomized to receive hypnosis or supportive counseling during two more matched courses. An additional course with no intervention was assessed in half of the patients. No significant reduction of symptoms was demonstrated prior to intervention. However, intervention with both hypnosis and supportive counseling was associated with significant reductions in nausea, vomiting, and the extent to which these symptoms bothered patients (all p less than 0.001). Also, after termination of intervention, symptom ratings remained significantly lower than baseline. The data indicate that chemotherapy-related nausea and emesis in children can be reduced with behavioral intervention and that reductions are maintained after intervention has been discontinued.

Zeltzer LK. Dolgin MJ. LeBaron S. LeBaron C. A randomized, controlled study of behavioral intervention for chemotherapy distress in children with cancer. Pediatrics 1991;88(1):34-42 Fifty-four pediatric cancer patients were studied to determine the relative efficacy of two forms of behavioral intervention for reducing chemotherapy-related distress. Following baseline assessment, subjects were randomly assigned to receive either hypnosis, non-hypnotic distraction/relaxation, or attention placebo (control) during the subsequent identical chemotherapy course. Observational and interview measures of anticipatory and postchemotherapy nausea, vomiting, distress, and functional disruption served as outcome data. Results indicated that treatment condition was the single best predictor of change from baseline to intervention, with children in the hypnosis group reporting the greatest reduction of both anticipatory and postchemotherapy symptoms. The cognitive distraction/relaxation intervention appeared to have a maintenance effect in which symptoms did not get much worse or much better, while children in the control group had symptoms that consistently became worse over time. Emetic potential of the chemotherapy and the prophylactic use of antiemetics each appeared to contribute to the overall severity of symptoms. While the efficacy of hypnosis in the management of chemotherapy distress is supported, the complexities of interacting biologic and psychologic factors are highlighted.

Zeltzer LK. Fanurik D. LeBaron S. The cold pressor pain paradigm in children: feasibility of an intervention model (Part II). Pain 1989;37(3):305-13 The purpose of this study was to examine the feasibility of testing a psychological approach (hypnosis) to pain reduction in children using the cold pressor paradigm. Children's pain ratings at 10 sec intervals and duration of arm immersion (40 sec maximum) in 15 degrees C (n = 37) and 12 degrees C water (n = 29) were assessed in 6-12-year-old children during 2 baseline trials (alternating arms), followed by 2 more trials after randomization to a control or hypnosis treatment condition. Hypnosis was found to reduce pain significantly more than the control condition in both 15 degrees C and 12 degrees C water. Hypnotic susceptibility was not strongly related to hypnotic pain reduction. However, age was significant, with younger children showing higher pain ratings and early arm withdrawal rates and less response to hypnosis than older children. In 15 degrees C water, females had higher pain ratings and early withdrawal rates than males, but this sex discrepancy disappeared in 12 degrees C water. This study demonstrated the feasibility of the cold pressor paradigm for testing intervention strategies and its potential for enhancing our understanding of pain in children.

Zitman FG. van Dyck R. Spinhoven P. Linssen AC. Hypnosis and autogenic training in the treatment of tension headaches: a two-phase constructive design study with follow-up. Journal of Psychosomatic Research 1992;36(3):219-28 Tension headaches can form a chronic (very long duration) condition. EMG biofeedback, relaxation training and analgesia by hypnotic suggestion can reduce the pain. So far, no differences have been demonstrated between the effects of various psychological treatments. In a constructively designed study, we firstly compared an abbreviated form of autogenic training to a form of hypnotherapy (future oriented hypnotic imagery) which was not presented as hypnosis and secondly we compared both treatments to the same future oriented hypnotic imagery, but this time explicitly presented as hypnosis. The three treatments were equally effective at post-treatment, but after a 6-month follow-up period, the future oriented hypnotic imagery which had been explicitly presented as hypnosis was superior to autogenic training. Contrary to common belief, it could be demonstrated that the therapists were as effective with the treatment modality they preferred as with the treatment modality they felt to be less remedial.





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