“The results were as follows:
1. There was no significant variation in skin conductance during the ‘hypnotic induction procedure.’
2. Skin conductance generally increased throughout the remainder of the experiment, ie., when the Ss wre given suggestions of ‘sensory hallucinations,’ ‘age-regression,’ ‘analgesia,’ ‘negative hallucinations,’ and ‘post’-hypnotic behavior.
3. The Ss usually showed a GSR when they were given ‘hallucinatory’ suggestions, i.e., when they were told that they were becoming ‘itchy,’ ‘thirsty,’ and ‘very hot.’
4. The GSR to a pinprick was essentially the same before the experiment and during ‘hypnotic analgesia.’ Also, the GSR was essentially the same, during ‘hypnotic analgesia,’ (a) when three Ss were told they would receive a pinprick but did _not_ receive the pinprick, (b) when they were told they would receive a pinprick and _did_ receive the pinprick, and (c) when they received a pinprick without being told they would receive it.
5. Four Ss showed a GSR each time they were asked to look at a ‘negatively hallucinated’ object and person. Two Ss did _not_ show a GSR when they were asked to look at the ‘negatively hallucinated’ object (or person). The four Ss who showed a GSR stated, during or after the experiment, that they were by no means convinced that the person or object was no longer in the room. The two Ss who did not show GSR stated, after the experiment, that they had been ‘certain’ that the object (or person) was not present in the room.
6. Although the Ss stated that they did not ‘remember’ the ‘post’-hypnotic suggestion (or anything else about the experiment), they usually showed a GSR when the E made the _preliminary_ movements to give the signal for the ‘post’-hypnotic behavior. (They also showed a GSR when E gave the signal for the ‘post’hypnotic behavior.)
“Since skin conductance is an index of the S’s level of ‘activation,’ ‘arousal,’ or ‘excitation,’ these results indicate the following:
1958
Duncan, Irma W.; Dressler, Robert L.; Lyon-James, Sara; Sears, Alden B. (1958). The search for an index of hypnosis. Journal of Clinical and Experimental Hypnosis, 6 (2), 95-108.
NOTES 1
“Summary
“Blood and urine samples were obtained from 18 university students at the beginning and end of two experimental sessions, one with and one without hypnosis. Some of the subjects relaxed during the sessions; others imagined or hallucinated a traumatic experience.
“Of a variety of measurements made, urinary volumes and 17-ketosteroids, the eosinophil count and psychogalvanometer recordings appear to give useful information about any changes due to the hypnosis. The biochemical changes caused by the experimentally produced emotions seem to depend on the individual and his past experience rather than the hypnosis. The data suggest that if the experience hallucinated is known to the subject, the biochemical changes indicate a relaxed state during the hypnosis. The psycho-galvanometer recordings may indicate an agitated state while the biochemical indices suggest a relaxed state” (pp. 106-107).
state while the biochemical indices suggest a relaxed state” (pp. 106-107).
1956
Bigelow, Newton; Cameron, G. H.; Koroljow, S. A. (1956). Two cases of deep hypnotic sleep investigated by the strain gauge plethysmograph. Journal of Clinical and Experimental Hypnosis, 4 (4), 160-164.
NOTES 1
“Summary.
“Two subjects, studied by means of a strain gauge plethysmograph, have shown greater changes in the peripheral pulse and the finger volume during deep hypnosis than they did immediately before or after. In the absence of external stimuli, the presence and the degree of such changes reflect the activity of the autonomic nervous system. This result suggests that in hypnosis the inhibiting tendency of the cortex on the autonomic nervous system is reduced or nullified” (p. 164).
Placebo
2000
Rossi, Ernest L. (2000). In search of a deep psychobiology of hypnosis: Visionary hypotheses for a new millennium. American Journal of Clinical Hypnosis, 42 (3/4), 178-207.
This search for the deep psychobiological foundations of hypnosis begins with a review of some of the paradoxes of historical hypnosis and the impasse of current theory. It is proposed that further progress requires a deeper investigation of how psychosocial cues can modulate the mechanisms of healing at the CNS, autonomic, neuroendocrine and cellular-genetic levels. The dynamics of hypnotic communication and healing from the cognitive-behavior level to the cellular-genetic are outlined in 4 stages: (1) information transduction between the experiences of consciousness and the limbic-hypothalamic-pituitary system; (2) the psychosomatic network of messenger molecules and their receptors; (3) the immediate early gene protein cascade; and (4) state dependent memory, learning and behavior. Neuroscience research is outlined for its contributions to a mathematical model of how a psychobiological approach to the therapeutic applications of hypnosis and the placebo response could facilitate neurogenesis in the human hippocampus and healing at the cellular-genetic-protein level throughout the body. A series of 10 hypotheses is proposed as a guide for theory and research in therapeutic hypnosis. (PsycINFO Database Record (c) 2002 APA, all rights reserved)
1999
De Pascalis, V.; Magurano, M. D.; Bellusci, A. (1999). Pain perception, somatosensory event-related potentials and skin conductance responses to painful stimuli in high, mid, and low hypnotizable subjects: Effects of differential pain reduction strategies. Pain, 83 (3), 499-508.
In this study, pain perception, somatosensory event-related potential (SERP) and skin conductance response (SCR) changes during hypnotic suggestions of Deep Relaxation, Dissociated Imagery, Focused Analgesia, and Placebo, compared with a Waking baseline condition, were investigated. SERPs were recorded from frontal, temporal, central, and parietal scalp sites. Ten high, 9 mid, and 10 low hypnotizable right-handed women participated in the experiment. The following measures were obtained: (1) pain and distress tolerance ratings; (2) sensory and pain thresholds to biphasic electrical stimulation delivered to the right wrist; (3) reaction time and number of omitted responses; (4) N2 (280+/-11 ms) and P3 (405+/-19 ms) peak amplitudes of SERPs to target stimuli delivered using an odd-ball paradigm; (5) number of evoked SCRs and SCR amplitudes as a function of stimulus repetition. Results showed, high, mid and low hypnotizables exhibited significant reductions of reported pain and distress ratings during conditions of Deep Relaxation/Suggestion of Analgesia, Dissociated Imagery and Focused Analgesia. High hypnotizable subjects displayed significant reductions in pain and distress levels compared to mid and low hypnotizables during Dissociated Imagery, Focused Analgesia and, to a lesser degree, during Deep Relaxation. Placebo condition did not display significant differences among hypnotizability groups. High hypnotizables, compared to mid and low hypnotizables, also showed significant increases in sensory and pain thresholds during Dissociated Imagery and Focused Analgesia. High, mid, and low groups showed significant reductions in P3 peak amplitudes across all hypnosis conditions and, to a lesser degree, during Placebo. The temporal cortical region was the most sensitive in differentiating SERP responses among hypnotizability groups. On this recording area the subjects highly susceptible to hypnosis displayed significantly smaller P3 and greater N2 peaks during Focused Analgesia than did the other hypnotizable groups. In this condition highly susceptible subjects also reported the highest number of omitted responses and the shortest Reaction Times. These subjects also showed faster habituation of SCRs when compared with mid and low hypnotizables. During Dissociated Imagery and Focused Analgesia, highly hypnotizable subjects also disclosed a smaller total number of evoked SCRs than did mid and low hypnotizable subjects. The results are discussed considering possible common and different mechanisms to account for the effects of different hypnotic suggestions.
Abstract from National Library of Medicine, PubMed
cortical region was the most sensitive in differentiating SERP responses among hypnotizability groups. On this recording area the subjects highly susceptible to hypnosis displayed significantly smaller P3 and greater N2 peaks during Focused Analgesia than did the other hypnotizable groups. In this condition highly susceptible subjects also reported the highest number of omitted responses and the shortest Reaction Times. These subjects also showed faster habituation of SCRs when compared with mid and low hypnotizables. During Dissociated Imagery and Focused Analgesia, highly hypnotizable subjects also disclosed a smaller total number of evoked SCRs than did mid and low hypnotizable subjects. The results are discussed considering possible common and different mechanisms to account for the effects of different hypnotic suggestions.
Abstract from National Library of Medicine, PubMed
1999
Kirsch, Irving; Lynn, Steven Jay (1999). Automaticity in clinical psychology. American Psychologist, 54 (7), 504-515.
The authors provide an overview of the literature on the ability of response expectancies to elicit automatic responses in the form of self-fulfilling prophecies and link it to the broader psychological investigation of automatic processes. The authors review 3 areas of research in which response expectancies have been shown to affect experience, behavior, and physiology: placebo effects, the effects of false biofeedback on sexual arousal, and the alteration of perceptual and cognitive functions by hypnotic and nonhypnotic suggestion. Also reviewed are data suggesting that all behavior, including novel and intentional behavior, is initiated automatically. Following this review, the authors summarize some of the ways in which knowledge of response expectancy effects and other automatic processes that influence experience and behavior can enhance clinical practice.
NOTES 1
Although expectancy accounts for some variance in the development of classical hypnosis effects, it is also true that “experimental data suggest that faking accounts for relatively few of these effects” (p. 507). “The best predictors of hypnotic suggestibility are waking suggestibility and response expectancy, and expectancy remains a significant predictor of hypnotic response even with waking suggestibility controlled (Braffman & Kirsch, in press; Kirsch, 1997)” (p. 508). The authors theorize that automatisms (like Chevreul pendulum) are “responses that are primed for automatic activation by two response sets: an intention and an expectancy for their occurrence” (p. 508). They suggest that most behavior is routine, virtually automatic, because cognitive structures like schemas, scripts, or plans that are outside immediate awareness trigger the behavior. They cite research by Libet (1985) and hypotheses developed by Nisbett & Wilson (1977) and Dennett (1991), concluding that “the feeling of will is a judgment, rather than an introspected content” (p. 509). The authors discuss the Chevreul pendulum phenomenon in terms of expectancy theory and explore how their theory would apply to psychotherapy
Price, D. D.; Milling, L. S.; Kirsch, I.; Duff, A.; Montgomery, G. H.; Nicholls, S. S. (1999). An analysis of factors that contribute to the magnitude of placebo analgesia in an experimental paradigm. Pain, 83 (2), 147-156.
Placebo analgesia was produced by conditioning trials wherein heat induced experimental pain was surreptitiously reduced in order to test psychological factors of expectancy and desire for pain reduction as possible mediators of placebo analgesia. The magnitudes of placebo effects were assessed after these conditioning trials and during trials wherein stimulus intensities were reestablished to original baseline levels. In addition, analyses were made of the influence of these psychological factors on concurrently assessed pain and remembered pain intensities. Statistically reliable placebo effects on sensory and affective measures of pain were graded according to the extent of surreptitious lowering of stimulus strength during the manipulation trials, consistent with conditioning. However, all of these effects were strongly associated with expectancy but not desire for relief. These results show that although conditioning may be sufficient for placebo analgesia, it is likely to be mediated by expectancy. The results further demonstrated that placebo effects based on remembered pain were 3 to 4 times greater than those based on concurrently assessed placebo effects, primarily because baseline pain was remembered as being much more intense than it actually was. However, similar to concurrent placebo effects, remembered placebo effects were strongly associated with expected pain levels that occurred just after conditioning. Taken together, these results suggest that magnitudes of placebo effect are dependent on multiple factors, including conditioning, expectancy, and whether analgesia is assessed concurrently or retrospectively.
Abstract from National Library of Medicine, PubMed
Wickramasekera, Ian (1999). How does biofeedback reduce clinical symptoms and do memories and beliefs have biological consequences? Toward a model of mind-body healing. Applied Psychophysiology and Biofeedback, 24 (2), 91-105.
Changes in the magnitude and direction of physiological measures (EMG, EEG, temperature, etc.) are not strongly related to the reduction of clinical symptoms in biofeedback therapy. Previously, nonspecified perceptual, cognitive, and emotional factors related to threat perception (Wickramasekera, 1979, 1988, 1998) may account for the bulk of the variance in the reduction of clinical symptoms. The mean magnitude of these previously nonspecified or placebo factors is closer to 70% when both the therapist and patient believe in the efficacy of the therapy. This powerful placebo effect is hypothesized to be an elicited conditioned response (Wickramasekera, 1977a, 1977c, 1980, 1985) based on the memory of prior healing. These memories of healing are more resistant to extinction if originally acquired on a partial rather than continuous reinforcement schedule. High and low hypnotic ability in interaction with threat perception (negative affect) is hypothesized to contribute to both the production and reduction of clinical symptoms. High and low hypnotic ability respectively are hypothesized to be related to dysregulation of the sympathetic and parasympathetic arms of the autonomic nervous system. Biofeedback is hypothesized to the most effective for reducing clinical symptoms in people of low to moderate hypnotic ability. For people high in trait hypnotic ability, training in self-hypnosis or other instructional procedures (e.g., autogenic training, progressive muscle relaxation, meditation, CBT, etc.) will produce the most rapid reduction in clinical symptoms.
self-hypnosis or other instructional procedures (e.g., autogenic training, progressive muscle relaxation, meditation, CBT, etc.) will produce the most rapid reduction in clinical symptoms.
1996
Kirsch, Irving (1996). Hypnosis in psychotherapy: Efficacy and mechanisms. Contemporary Hypnosis, 13 (2), 109-114.
Meta-analyses have established that different psychotherapies have different outcomes. Cognitive-behavioural therapies are significantly more effective than psychodynamic therapies, and their superiority increases when long-term follow-up is assessed. Hypnosis enhances the efficacy of both psychodynamic and cognitive- behavioural psychotherapy, and this effect is especially strong in long-term outcome of treatment for obesity. The paucity of procedural differences between hypnotic and non- hypnotic treatments in many of the studies demonstrating a substantial advantage for hypnosis suggests that the effect depends on the use of the word ‘hypnosis’. Hypnosis can be regarded as an empirically-validated, non-deceptive placebo, the effects of which are mediated by response expectancies.
Montgomery, Guy H.; Kirsch, Irving (1996, August). Conditioned placebo effects: Stimulus substitution or expectancy change. [Paper] Presented at the annual meeting of the American Psychological Association, Toronto, Canada.
Stimulus substitution models posit that placebo responses are due to pairings of conditional and unconditional stimuli. Expectancy theory maintains that conditioning trials produce placebo response expectancies, rather than placebo responses, and that the expectancies elicit the responses. I tested these opposing models by providing some participants with information intended to impede the formation of placebo expectancies during conditioning trials and by assessing placebo expectancies. Although conditioning trials significantly enhanced placebo responding, this effect was eliminated by adding expectancies to the regression equation, indicating that the effect of pairing trials on placebo response was mediated completely by expectancy. Verbal information reversed the effect of conditioning trials on both placebo expectancies and placebo responses, and the magnitude of the placebo effect increased significantly over 10 extinction trials. These data disconfirm stimulus substitution models and provide strong support for an expectancy interpretation of conditioned placebo effects. (ABSTRACT from Bulletin of Division 30, Psychological Hypnosis, Fall, 1996, Vol. 5, No. 3.)
1995
Montgomery, Guy H. (1995). Mechanisms of placebo analgesia: Expectancy theory and classical conditioning (Dissertation, University of Connecticut). Bulletin of Division 30, Psychological Hypnosis, APA, 5 (3), 2.
Stimulus substitution models posit that placebo responses are due to pairings of conditional and unconditional stimuli. Expectancy theory maintains that conditioning trials produce placebo response expectancies, rather than placebo responses, and that the expectancies elicit the responses. I tested these opposing models by providing some participants with information intended to impede the formation of placebo expectancies during conditioning trials and by assessing placebo expectancies. Although conditioning trials significantly enhanced placebo responding, this effect was eliminated by adding expectancies to the regression equation, indicating that the effect of pairing trials on placebo response was mediated completely by expectancy. Verbal information reversed the effect of conditioning trials on both placebo expectancies and placebo responses, and the magnitude of the placebo effect increased significantly over 10 extinction trials. These data disconfirm stimulus substitution models and provide strong support for an expectancy interpretation of conditioned placebo effects. (ABSTRACT from Bulletin of Division 30, Psychological Hypnosis, Fall, 1996, Vol. 5, No. 3.)
1994
Amigo, S. (1994). Self-regulation therapy and the voluntary reproduction of stimulant effects of ephedrine: Possible therapeutic applications. Contemporary Hypnosis, 11 (3), 108-120.
NOTES 1
“Emotional self-regulation therapy is comprised of three phases. In the first phase, several sensory recall exercises are used to teach subjects how to voluntarily reproduce various physical sensations (hand numbness and heaviness, smell and taste) that are initially provoked by real stimuli (cold water, a heavy book, cigarette ashes, and lemon juice). Subjects are asked to associate these sensations with images, words, or other cues that will help them to later reproduce the sensations without the physical stimuli.
“In the second phase, subjects reproduce these sensations without the physical stimuli and are asked to generate them in response to various cues suggested by the therapist (e.g., touching a pencil, pen, book, etc.) ….
“In the last phase … a demand of any kind generates the suggested effects. In the beginning of this phase, subjects are told that because of previously performed exercises, their minds are highly activated and receptive, so that they can respond to the therapist’s verbal suggestions, without needing training for each new sensation. At this point, therapeutic suggestions are given to the patient” (p. 109).
Kirsch, Irving (1994). Clinical hypnosis as a nondeceptive placebo: Empirically derived techniques. American Journal of Clinical Hypnosis, 37 (2), 95-106.
Many psychological problems are maintained, in part, by dysfunctional response expectancies, and changing those expectations is an essential part of treatment. Hypnotic inductions alter response expectancies and have been shown empirically to substantially enhance the effects of psychotherapy. Therefore, hypnosis can be used therapeutically as a nondeceptive placebo. Expectancy plays a major role in hynotic inductions and their effects. Clinical procedures suggested by these data are explored.
Zachariae, Robert; Bjerring, Peter (1994). 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 and Experimental Hypnosis, 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.
1993
Baker, Sharon L.; Kirsch, Irving (1993). Hypnotic and placebo analgesia: Order effects and the placebo label. Contemporary Hypnosis, 10 (3), 117-126.
Hypnotic and placebo pain reduction were compared in a sample of subjects whose hypnotic susceptibility was broadly representative of the general population. Replicating the order effect reported by Stam and Spanos in 1987 for highly hypnotizable subjects, hypnosis produced more pain relief than a ‘pain-reducing analgesic’ placebo only when the hypnosis trial followed the placebo trial. When the placebo was described to subjects as a ‘hypnotic drug’ that ‘increases suggestibility’, no differences were found regardless of order of presentation. Both hypnotizability and pain reduction were correlated with subjects’ expectancies, and the partial correlation between hypnotizability and pain reduction, with expectancy controlled, was non-significant. These data suggest that, for most subjects, hypnotic analgesia is analogous to a placebo effect, although it may be more useful than a placebo because its administration does not require deception.
1992
Garssen, Bert; de Ruiter, Corine; Van Dyck, Richard (1992). Breathing retraining: A rational placebo?. Clinical Psychology Review, 12, 141-153.
Breathing retraining of patients with Hyperventilation Syndrome (HVS) and/or panic disorder is discussed to evaluate its clinical effectiveness and to examine the mechanism that mediates its effect. In relation to this theoretical question, the validity of HVS as a scientific model is discussed an is deemed insufficient. It is concluded that breathing retraining and related procedures are therapeutically effective, but probably due to principles other than originally proposed, namely decreasing the tendency to hyperventilate. An alternative principle is the induction of a relaxation response, presenting a credible explanation for the threatening symptoms, giving a distracting task to practice when panic may occur, and promoting a feeling of control.
-posed, namely decreasing the tendency to hyperventilate. An alternative principle is the induction of a relaxation response, presenting a credible explanation for the threatening symptoms, giving a distracting task to practice when panic may occur, and promoting a feeling of control.
NOTES
Goal of treatment is to (1) reduce respiratory rate, and (2) cognitive reattribution of physical symptoms to hyperventilation instead of other more catastrophic causes. Reviews a number of studies, mostly small sample, including panic disorder studies, and concludes that the majority point to a therapeutic effect of breathing retraining and cognitive reattribution of physical symptoms to hyperventilation for patients suffering HVS and the closely related panic disorder with or without agoraphobia. However, the _specificity_ of these techniques for HVS is questionable. Vlaander-van der Giessen (1986) found relaxation training just as effective as breathing retraining; and Hibbert & Chan (1989) found breathing retraining equally effective as a placebo treatment, and not more effective with patients who had recognized symptoms at a hyperventilation provocation test than with those who had not.
Tosi, D. J.; Rudy, D. R.; Lewis, J.; Murphy, M. A. (1992). The psychobiological effects of cognitive experiential therapy, hypnosis, cognitive restructuring, and attention placebo control in the treatment of essential hypertension. Psychotherapy, 29, 274-284.
Evaluated the effects of cognitive experiential hypnotherapy (CEH), which includes hypnosis, cognitive restructuring, and developmental staging, on essential hypertension. CEH, Hypnosis alone, cognitive restructuring, and attention-placebo control conditions were randomly assigned to 39 subjects. There was a significant interaction effect with the nine psychobiological outcome measures. Discriminant analysis found a stronger overall effect over time for CEH when compared with its components
Wall, Patrick D. (1992). The placebo effect: An unpopular topic [Editorial]. Pain, 51, 1-3.
NOTES
The author presents a useful, brief review of the placebo effect. He suggests three hypotheses about the placebo response mechanism: 1. The effect is attributable to a decrease in anxiety (Evans, 1974). This view has not been validated (White, Tursky, & Schwartz, 1985). 2. Expectation, cognitively mediated, leads to behavioral effects. Certain personalities, described as placebo responders, report a stronger analgesia with a fixed dose of morphine than do people who are placebo non-responders (Beecher, 1968). White et al. (1985) proposed that simply asking what is expected of a medicine will identify who the placebo responders will be. Also, the placebo response to morphine is stronger than the placebo response to aspirin. Physician or nurse expectancy is influential as well as patient expectancy, and that means that ‘blind’ experimental trials are not truly blind. Kanto et al. (1966) found that the placebo effect is stronger when the placebo is given second than when it is given first in a crossover design. 3. The effect is due to a classical conditioned Pavlovian response (Wickramasekera 1980). Support for this comes from experiments on normal subjects whose pain and tolerance threshold had been established (Voudouris et al. 1989, 1990). For example, in one experiment in which electric current was the stimulus, a purportedly anesthetic ointment was applied to the locus of stimulation; some of the subjects showed a placebo response of diminished pain. A second group, treated in the same manner, had the pain producing electric current secretly reduced by the Experimenter. This second group, who had experienced reduction in pain that suggested the cream was truly analgesic,
A second group, treated in the same manner, had the pain producing electric current secretly reduced by the Experimenter. This second group, who had experienced reduction in pain that suggested the cream was truly analgesic, subsequently became strong placebo responders to the originally painful current and cream.
The author views the expectancy hypothesis and the conditioning hypothesis as not necessarily incompatible. Unlike the cognitively mediated expectation hypothesis, conditioning does not necessarily require cognition. But there is little support for the idea that human conditioning does not involve cognition [See Brewer, W. F. (1974). There is no convincing evidence for operant or classical conditioning in adult humans. In W. B. Weimer and D. S. Palermo (Eds.) Cognition and the Symbolic Processes. N.Y.: Wiley, pp 1-42.]
“If then the expectation and conditioning hypotheses are not clearly separate, it may be relevant to add an apparently unrelated group of phenomena. Humans and animals frequently show no signs of pain in the presence of overt injury (Wall 1979). It seems that pain appears only when reaction to injury is biologically appropriate. Could it be that expectation-conditioning is one of the factors which determines which item of our behavioural repertoire with its associated sensation is appropriate?” (p. 3).
1991
Moret, V.; Forster, A.; Laverriere, M. C.; Lambert, H.; Gaillard, R. C.; Bourgeois, P.; Haynal, A.; Gemperle, M.; Buchser, E. (1991). Mechanism of analgesia induced by hypnosis and acupuncture: Is there a difference?. Pain, 45, 135-140.
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 < 0.001) and placebo (P < 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 < 0.002). Analog scales for pain intensity and pain relief showed a good correlation (r = 0.94). Plasma levels of B-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 B- endorphins are not significantly affected by HA or AA nor by naloxone or placebo administration. NOTES The authors measured blood pressure, heart rate, skin conductance, mood (Clyde Mood Scale), beta endorphin levels, and hypnotizability. Before the experimental sessions they obtained Ss' opinions about the analgesia effectiveness of hypnosis and acupuncture. For each Subject they established a value for 'intolerable' pain (the longest duration of arm immersion in cold water). Efficacy of treatment was defined as none (0% on the efficacy scale) for this Control session.. During the experimental sessions they gave hypnosis or acupuncture analgesia for 20 minutes, then an injection of either naloxone or placebo. Double-blind controls were used. Five minutes after the injection they began CPT and the Subject was told to maintain their hand in the water for the same amount of time as in the control session. Pain intensity and treatment efficacy were scored, then the S completed a mood scale. Five blood samples were collected over the course of the procedure: (a) first rest period, (b) treatment period, (c) after injection, (d) after CPT, (e) second rest period. Results (see Abstract). "When naloxone was administered, HA was no more effective than AA in alleviating pain (P = 0.109). However HA was significantly more effective than AA when placebo was administered (P<0.05). Whichever technique was used there was no significant alteration in pain relief by either naloxone or placebo (P = 0.426 within the HA group and P = 0.519 within the AA group)" (p. 137). "Compared to the control session, the pain relief was significantly better with HA, both when placebo (62.53%, P < 0.001) and when naloxone (49.3%, P < 0.001) was administered. This was not true with AA and placebo (15.21%, P = 0.1) nor with AA and naloxone (13.38%, P = 0.5)" (p. 137). "When naloxone or placebo was administered, the mean pain relief scores did not differ significantly with HA (P = 0.56) or with AA (P = 0.852). There was a good correlation (r = .94) between ratings of pain and treatment efficacy" (pp. 137-138). Outcome was not related to Subjects pre-experimental beliefs about efficacy of hypnosis or of acupuncture. During the experimental sessions, all Ss reported that hypnosis was more effective than acupuncture. Neither hypnosis nor acupuncture affected beta endorphin plasma levels; neither naloxone nor placebo affected beta endorphin plasma levels. Mood was somewhat affected by treatments. "When compared with the baseline value (i.e., before each session), mean scores for happiness were significantly lower after AA with placebo than after AA with naloxone (P = 0.05). The other evaluated categories of mood (friendliness, aggressiveness, clear thought, sleepiness and dizziness) were not affected by either session" (p. 139). In the Discussion, authors indicated that "variables such as heart rate, arterial blood pressure and skin conductance were very insensitive indices for assessing pain or pain relief as well as intensity of acupuncture stimulation or depth of hypnotic trance" (p. 139). Why was hypnoanalgesia better than acupuncture analgesia? "Firstly, a preconceived opinion could favor hypnosis; this was not the case amongst these subjects. Secondly, the influence of what was felt to be a more pleasant experience (HA) might help to lower pain ratings. Subjective preference for hypnosis was frequently expressed informally; however, scores from the Clyde Mood Scale did not suggest mood enhancement after HA. Thirdly, the intensity of analgesia might have been more uniform with HA than with AA. ... Interestingly, we found no difference in pain ratings between good and poor hypnotic subjects, even if theoretically poor hypnotic subjects could be expected to experience less pain relief with HA" (p. 139). Effect of naloxone. "Although the failure to achieve statistical significance may be due to the small number of subjects, our results suggest that, if opiate receptors play a role in HA or AA, it is not of primary importance" (p. 139). The authors go on to state that the data on plasma beta-endorphin and CSF beta-endorphin are confusing, and elaborate the discussion of that variable on p. 139. 1990 Clark, Duncan B.; Agras, W. Stewart (1990). The assessment and treatment of performance anxiety in musicians. American Journal of Psychiatry, 148 (5), 598-605. 94 adults with a performance anxiety problem were recruited by mass media announcements and were seen in a university-based outpatient psychiatric clinic. Assessments were questionnaires for all 94 ss, diagnostic interview of 50 ss, and laboratory performance of 34 ss. Treatment conditions were 6 weeks of buspirone, 6 weeks of placebo, a five-session group cognitive-behavior therapy program (CBTP) with buspirone, or the CBTP with placebo. All Ss fulfilled criteria for Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) social phobia. Of the 15 full-time professional musicians, 10 had tried propranolol and 3 had stopped performing. Most Ss had substantial anxiety and heart rate increases during lab speech and musical performances. CBTP resulted in significant reductions in subjective anxiety, improved quality of musical performance, and improved performance confidence. Kirsch, Irving (1990). Changing expectations: A key to effective psychotherapy. Pacific Grove, CA: Brooks/Cole. (Reviewed in American Journal of Clinical Hypnosis, 34, 138) NOTES This is a clinical hypnosis textbook written from the perspective of a cognitive therapist, and based on response-expectancy theory. The author discusses how expectancy theory can account for results obtained with hypnosis, cognitive behavioral, and psychodynamic psychotherapy, as well as with psychopharmacology. The book draws heavily upon psychological research in psychotherapy as well as hypnosis, and discusses how therapists can mobilize patient positive expectations for change. Hypnotic responses are viewed as 'genuine' responses that subjectively are not perceived to be under voluntary control (similar to other classes of response behavior). Rokke, Paul D.; Carter, Alice S.; Rehm, Lynn P. (1990). Comparative credibility of current treatments for depression. Psychotherapy, 27, 235-242. Current treatments of depression were evaluated for credibility. Interpersonal, communication, self-control, cognitive, social skills, and relaxation placebo therapies were rated significantly more credible and efficacious than psychodynamic and activity-change therapies, which were rated significantly more credible than biological (drug) therapy. Implications were addressed. NOTES The authors presented the basic theoretical rationale and procedures associated with the nine therapies. They used the Beck Depression Inventory and the Eysenck Personality Inventory to investigate individual differences. Subjects were 252 psychology students, 128 male and 124 female; 22% had previously sought counseling and 34% had previously been clinically depressed. Spanos, Nicholas P.; Williams, Victoria; Gwynn, Maxwell I. (1990). Effects of hypnotic, placebo, and salicylic acid treatments on wart regression. Psychosomatic Medicine, 52, 109-114. 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. NOTES Study involved 15 females, 25 males (18-35 yrs old) with warts on at least one hand or foot, recruited through posters and newspaper ads; N = 10 in each condition. Hypnotic treatment consisted of 10 minute induction (modified from T. X. Barber's 1969 book) and a suggestion for wart regression that was 2 minutes in duration (the skin around warts was 'beginning to tingle and grow warm'; 'vividly imagine the warts shrinking and dissolving away'; 30 second break; repeated the suggestions). For Ss with warts on more than one limb the complete suggestion procedure was repeated for each wart-infected limb. Results indicate psychological factors can influence course of some virally produced disorders; that self-medicating with over-the-counter products doesn't explain suggestion-induced wart regression; that expectation of treatment success is the most important variable in psychologically induced wart regression. "Hypnotic subjects attained significantly higher CURSS:S scores than did control subjects. Nevertheless, it is unlikely that between group differences in hypnotizability accounted for the group differences in wart regression. Two previous experiments (3) that used the CURSS found that hypnotizability failed to predict wart loss in either hypnotic suggestion, nonhypnotic suggestion, or placebo treatments, and even in the present study the hypnotic treatment failed to differ from either the real or placebo treatment on CURSS:S scores, and none of the treatments differed significantly on the CURSS:O scores. Our finding and earlier findings that hypnotic subjects reported more intense suggested sensations than placebo subjects is consistent with the hypothesis that vivid suggested imagery facilitates wart loss (7, 8) . "An alternative hypothesis emphasizes that only our hypnotic suggestion treatment encouraged subjects to see themselves as developing cognitive control over their own wart regression. This hypothesis suggests that subjects' subjective sense of cognitive involvement in and control over treatment outcome (as opposed to the vividness of their suggested imagery) may have been the important psychological factor in wart regression. It would be of interest in a future study to manipulate subjects' sense of cognitive involvement in their treatment independently of suggested imagery in order to assess the relative contributions of these variables to wart regression" (pp. 113-114). of these variables to wart regression" (pp. 113-114). Van Dyck, R.; Hoogduin, K. (1990). Hypnosis: Placebo or nonplacebo?. American Journal of Psychotherapy, 44, 396-404. Examines experimental evidence for the view that hypnosis is a placebo in light of A. Grunbaum's (see PA, Vol 74:10891) reconceptualization. According to Grunbaum's definition of placebo, a therapeutic procedure is a non-placebo if it can be demonstrated that its effects are produced according to the theory on which the therapy is based. Evidence suggests that placebo effects are not related to hypnotizability. Clinical outcome studies show that results of hypnotherapy are related to hypnotizability in some disorders (e.g., anxiety, pain), but not in the treating addiction or habit disorders. An example is given in which hypnosis is usefully applied for its placebo value as a method to generate positive expectancies. 1989 Joubert, P. H.; Van Os, B. E. (1989). The effect of hypnosis, placebo, paracetamol, and naloxone on the response to dental pulp stimulation. Current Therapeutic Research - Clinical and Experimental, 46, 774-781 Healthy volunteers with varying degrees of hypnotic susceptibility, as measured by the Stanford Clinical Hypnotic Scale [sic] (SCHS), participated in a trial to evaluate analgesia induced by an indirect hypnotic technique, rapid induction analgesia (RIA). RIA produced increases in the pain threshold, as measured by dental pulp stimulation, in nine of ten subjects. The magnitude of the response was unrelated to SCHS scores. Neither placebo nor paracetamol capsules affected pain threshold measured by this technique. The effect of RIA on pain threshold was not reversed by naloxone, mitigating the possible involvement of endorphins in this phenomenon. NOTES Rapid Induction Analgesia, developed by Joseph Barber, was employed in this study of pain that was generated with dental pulp stimulation. RIA involves an induction followed by several kinds of suggestion, e.g. "Nothing is going to be done to you and you are free to respond and to experience what is acceptable to you. ... You have the ability to notice things. ... The way things are noticed might change. ... Memory is changeable and you may choose to remember or forget things. ... The comfortable feelings you are experiencing can be experienced easily and quickly again and again. ....To the latter was coupled the idea that this could happen again if the hypnotist put his hand on the subject's arm" (p. 776). The lowest electrical current that produces slight discomfort was used as the measure of pain threshold.. RIA produced increases in pain threshold for 9 of 10 Ss. The 10th Subject was not used in the rest of the experiment, and one other Subject withdrew due to scheduling problems. The remaining 8 Ss experienced the following sequence of events in the experiment: --Rest 15 minutes --Pain threshold measure --Two 500-mg capsules of paracetamol or two of placebo --Wait 2 hours; then pain threshold measure --RIA (10 minutes); aroused from hypnosis; pain threshold measure with E's hand on arm --Insert IV; give 8 mg naloxone or 0.9% saline --Pain threshold measure with E's hand on arm The four possible combinations (placebo-saline, placebo-naloxone, paracetamol- saline, and paracetamol-naloxone) were administered to each S on four occasions, in randomized order, with at least one week in between visits. Whereas pain threshold was elevated by RIA above both the first (p<.025) and the second (p<.05) baselines, neither placebo nor paracetamol (like Tylenol) raised the threshold. Naloxone did not reverse the RIA effect of elevated threshold; in fact, there was a tendency for RIA pain threshold to increase even more after injections of either Naloxone or saline. The Experimenters noted that the baselines apparently changed over time. They were significantly lower than the RIA threshold during visits 1 and 2, but during visits 3 and 4 the baselines seemed to approach RIA values. In their Discussion, the authors wrote, "This study appears to have raised more questions than it answered. There is no doubt that RIA, as used in this study, produced a significant shift in pain threshold as assessed by means of dental pulp stimulation. The fact that we were unable to detect an effect with paracetamol or placebo [N.B. which were given before the hypnosis procedures] means either that we were not really measuring something that was relevant to clinical pain or that the measurements were not sensitive enough for the detection of placebo effects or the analgesic effects of paracetamol. "It furthermore appears that the success of RIA does not depend on the hypnotic susceptibility of the subjects. This is contrary to the findings of Van Gorb [sic] et al but agrees with the studies of Barber and Fricton and Roth. "The temporal effects are also quite interesting. Firstly, it appears that the RIA was potentiated by the injection of either saline or naloxone. This could have been a placebo manifestation of the intravenous injection, but this appears unlikely in terms of the prior explanation given to the subjects. Subjects were told that the injections were to see whether the analgesic effects of RIA, if present, could be reversed. At no time was it suggested that the injections could have an analgesic effect. Another explanation might be that RIA is potentiated by repetition and that the second employment of the technique is more effective than the first. The other temporal effect seen was the tendency for baseline values to increase at later visits (Figure 4). This might mean progressive relaxation of the subject as he/she became more accustomed to the experimental situation with each subsequent visit or that the RIA state induced at the initial visits became associated with the experimental situation and that the posthypnotic suggestion became operative without the cue of the hypnotist's hand on the subject's arm. It does, however, appear that the maximum RIA effect was reached at the first visit and remained constant throughout. "From our findings several conclusions may be made. Firstly, that RIA appears to be an effective method for producing analgesia in the majority of subjects and does not appear to depend on hypnotic susceptibility. Secondly, endorphins do not appear to be involved in the analgesia produced by this method. Thirdly, dental pulp stimulation using a standard apparatus commonly used in dental practice does not appear to be appropriate for demonstrating placebo effects or for assessing analgesic efficacy of simple analgesics. Pain thresholds determined in this way would therefore not be of use in clinical pharmacology in comparing different simple analgesics. Finally, trial designs should take the temporal shift in baseline values into consideration" pp 779-780. Kirsch, Irving; Silva, C. E.; Carone, J. E.; Johnston, J. D.; Simon, B. (1989). The surreptitious observation design: An experimental paradigm for distinguishing artifact from essence in hypnosis. Journal of Abnormal Psychology, 98, 132-136. Administered a hypnotic induction and five standard hypnotic suggestions twice via audiotape to a group of high- hypnotizable subjects and a group of low- hypnotizable simulators. During the first administration, Ss were led to believe that they were alone. However, their behavior was surreptitiously recorded on videotape and observed on a video monitor. The second administration occurred in the presence of an experimenter who had not been informed of group assignment. When unaware that they were being observed, simulators were significantly less responsive to suggestions than they were when openly observed. In contrast, the behavior of nonsimulating subjects was not affected by the presence of an experimenter. These data indicate that the responses of high- hypnotizable Ss to standard hypnotic suggestions cannot be accounted for in terms of simple compliance with experimental demand. Spanos, Nicholas P.; Perlini, Arthur; Robertson, Lynda (1989). Hypnosis, suggestion, and placebo in the reduction of experimental pain. Journal of Abnormal Psychology, 98 (3), 285-293. Two experiments compared placebo and hypnotic analgesia in high and low hypnotizable subjects. Experiment 1 demonstrated that hypnotic and placebo analgesia were equally ineffective in low hypnotizables, but that hypnotic analgesia was much more effective than placebo analgesia in high hypnotizables. Experiment 2 replicated these results, but also included low and high hypnotizables who were given a nonhypnotic suggestion for analgesia. Both the low and high hypnotizables in this group reported greater suggested than placebo analgesia and as much suggested analgesia as high hypnotizable hypnotic subjects. Both experiments found substantial discrepancies between the amount of pain reduction subjects expected from the various treatments and the amount of pain reduction they actually reported following exposure to those treatments. In Experiment 2, subjects in all treatments who reduced reported pain engaged in more cognitive coping and less catastrophizing than those who did not reduce pain. Theoretical implications are discussed.