Food For Thought:
The Truth & Hype Of Hypnosis
Wednesday, June 13, 2001
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NHNE: Food for Thought:
The Truth & Hype Of Hypnosis
Wednesday, June 13, 2001
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THE TRUTH AND THE HYPE OF HYPNOSIS
By Michael R. Nash
Scientific American
July, 2001
http://www.sciam.com:80/2001/0701issue/0701nash.html
Though often denigrated as fakery or wishful thinking, hypnosis has
beenshown to be a real phenomenon with a variety of therapeutic uses
-- especially in controlling pain.
"You are getting sleepy. Verrry sleepy ..."
A waistcoated man swings his pocket watch back and forth before the
face of a young woman seated in a Victorian-era parlor. She fixes her
gaze on the watch, tracking its pendular motion with her eyes. Moments
later she is slumped in her chair, eyes closed, answering the hypnotist's
questions in a zombielike monotone.
Everyone has seen a depiction of hypnosis similar to this one in movies
and on television. Indeed, say the word "hypnosis," and many
people immediately think of pocket watches. But it is now much more
common for hypnotists simply to ask a subject to stare at a small, stationary
object -- such as a colored thumbtack on the wall -- during the "induction
patter," which usually consists of soothing words about relaxation
and suggestions to concentrate.
But is hypnosis a real phenomenon? If so, what is it useful for? Over
the past few years, researchers have found that hypnotized individuals
actively respond to suggestions even though they sometimes perceive
the dramatic changes in thought and behavior they experience as happening
"by themselves." During hypnosis, it is as though the brain
temporarily suspends its attempts to authenticate incoming sensory information.
Some people are more hypnotizable than others, although scientists still
don't know why. Nevertheless, hypnosis is finding medical uses in controlling
chronic pain, in countering anxiety and even -- in combination with
conventional operating-room procedures -- in helping patients to recover
more quickly from outpatient surgery.
Only in the past 40 years have scientists been equipped with instruments
and methods for discerning the facts of hypnosis from exaggerated claims.
But the study of hypnotic phenomena is now squarely in the domain of
normal cognitive science, with papers on hypnosis published in some
of the most selective scientific and medical journals. Of course, spectacles
such as "stage hypnosis" for entertainment purposes have not
disappeared. But the new findings reveal how, when used properly, the
power of hypnotic suggestion can alter cognitive processes as diverse
as memory and pain perception.
Wheat from the Chaff
To study any phenomenon properly, researchers must first have a way
to measure it. In the case of hypnosis, that yardstick is the Stanford
Hypnotic Susceptibility Scales. The Stanford scales, as they are often
called, were devised in the late 1950s by Stanford University psychologists
André M. Weitzenhoffer and Ernest R. Hilgard and are still used
today to determine the extent to which a subject responds to hypnosis.
One version of the Stanford scales, for instance, consists of a series
of 12 activities -- such as holding one's arm outstretched or sniffing
the contents of a bottle -- that test the depth of the hypnotic state.
In the first instance, individuals are told that they are holding a
very heavy ball, and they are scored as "passing" that suggestion
if their arm sags under the imagined weight. In the second case, subjects
are told that they have no sense of smell, and then a vial of ammonia
is waved under their nose. If they have no reaction, they are deemed
very responsive to hypnosis; if they grimace and recoil, they are not.
Scoring on the Stanford scales ranges from 0, for individuals who do
not respond to any of the hypnotic suggestions, to 12, for those who
pass all of them. Most people score in the middle range (between 5 and
7); 95 percent of the population receives a score of at least 1.
What Hypnosis Is
Based on studies using the Stanford scales, researchers with very different
theoretical perspectives now agree on several fundamental principles
of hypnosis. The first is that a person's ability to respond to hypnosis
is remarkably stable during adulthood. In perhaps the most compelling
illustration of this tenet, a study showed that when retested, Hilgard's
original subjects had roughly the same scores on the Stanford scales
as they did 10, 15 or 25 years earlier. Studies have shown that an individual's
Stanford score remains as consistent over time as his or her IQ score
-- if not more so. In addition, evidence indicates that hypnotic responsiveness
may have a hereditary component: identical twins are more likely than
same-sex fraternal twins to have similar Stanford scores.
A person's responsiveness to hypnosis also remains fairly consistent
regardless of the characteristics of the hypnotist: the practitioner's
gender, age and experience have little or no effect on a subject's ability
to be hypnotized. Similarly, the success of hypnosis does not depend
on whether a subject is highly motivated or especially willing. A very
responsive subject will become hypnotized under a variety of experimental
conditions and therapeutic settings, whereas a less susceptible person
will not, despite his or her sincere efforts. (Negative attitudes and
expectations can, however, interfere with hypnosis.)
Several studies have also shown that hypnotizability is unrelated to
personality characteristics such as gullibility, hysteria, psychopathology,
trust, aggressiveness, submissiveness, imagination or social compliance.
The trait has, however, been linked tantalizingly with an individual's
ability to become absorbed in activities such as reading, listening
to music or daydreaming.
Under hypnosis, subjects do not behave as passive automatons but instead
are active problem solvers who incorporate their moral and cultural
ideas into their behavior while remaining exquisitely responsive to
the expectations expressed by the experimenter. Nevertheless, the subject
does not experience hypnotically suggested behavior as something that
is actively achieved. To the contrary, it is typically deemed as effortless
-- as something that just happens. People who have been hypnotized often
say things like "My hand became heavy and moved down by itself"
or "Suddenly I found myself feeling no pain."
Many researchers now believe that these types of disconnections are
at the heart of hypnosis. In response to suggestion, subjects make movements
without conscious intent, fail to detect exceedingly painful stimulation
or temporarily forget a familiar fact. Of course, these kinds of things
also happen outside hypnosis -- occasionally in day-to-day life and
more dramatically in certain psychiatric and neurological disorders.
Using hypnosis, scientists have temporarily created hallucinations,
compulsions, certain types of memory loss, false memories, and delusions
in the laboratory so that these phenomena can be studied in a controlled
environment.
What Hypnosis Isn't
As scientists discover more about hypnosis, they are also uncovering
evidence that counters some of the skepticism about the technique. One
such objection is that hypnosis is simply a matter of having an especially
vivid imagination. In fact, this does not seem to be the case. Many
imaginative people are not good hypnotic subjects, and no relation between
the two abilities has surfaced.
The imagination charge stems from the fact that many people who are
hypnotizable can be led to experience compellingly realistic auditory
and visual hallucinations. But an elegant study using positron emission
tomography (PET), which indirectly measures metabolism, has shown that
different regions of the brain are activated when a subject is asked
to imagine a sound than when he or she is hallucinating under hypnosis.
In 1998 Henry Szechtman of McMaster University in Ontario and his co-workers
used PET to image the brain activity of hypnotized subjects who were
invited to imagine a scenario and who then experienced a hallucination.
The researchers noted that an auditory hallucination and the act of
imagining a sound are both self-generated and that, like real hearing,
a hallucination is experienced as coming from an external source. By
monitoring regional blood flow in areas activated during both hearing
and auditory hallucination but not during simple imagining, the investigators
sought to determine where in the brain a hallucinated sound is mistakenly
"tagged" as authentic and originating in the outside world.
Szechtman and his colleagues imaged the brain activity of eight very
hypnotizable subjects who had been prescreened for their ability to
hallucinate under hypnosis. During the session, the subjects were under
hypnosis and lay in the PET scanner with their eyes covered. Their brain
activity was monitored under four conditions: at rest; while hearing
an audiotape of a voice saying, "The man did not speak often, but
when he did, it was worth hearing what he had to say"; while imagining
hearing the voice again; and during the auditory hallucination they
experienced after being told that the tape was playing once more, although
it was not.
The tests showed that a region of the brain called the right anterior
cingulate cortex was just as active while the volunteers were hallucinating
as it was while they were actually hearing the stimulus. In contrast,
that brain area was not active while the subjects were imagining that
they heard the stimulus. Somehow hypnosis had tricked this area of the
brain into registering the hallucinated voice as real.
Another objection raised by critics of hypnosis concerns its ability
to blunt pain. Skeptics have argued that this effect results from either
simple relaxation or a placebo response. But a number of experiments
have ruled out these explanations. In a classic 1969 report, Thomas
H. McGlashan and his colleagues at the University of Pennsylvania found
that for poorly hypnotizable people, hypnosis was as effective in reducing
pain as a sugar pill that the subjects had been told was a powerful
painkiller. But highly hypnotizable subjects benefited three times more
from hypnosis than from the placebo. In another study, in 1976, Hilgard
and Stanford colleague Éva I. Bányai observed that subjects
who were vigorously riding stationary bicycles were just as responsive
to hypnotic suggestions as when they were hypnotized in a relaxing setting.
In 1997 Pierre Rainville of the University of Montreal and his colleagues
set out to determine which brain structures are involved in pain relief
during hypnosis. They attempted to locate the brain structures associated
with the suffering component of pain, as distinct from its sensory aspects.
Using PET, the scientists found that hypnosis reduced the activity of
the anterior cingulate cortex -- an area known to be involved in pain
-- but did not affect the activity of the somatosensory cortex, where
the sensations of pain are processed.
Despite these findings, however, the mechanisms underlying hypnotic
pain relief are still poorly understood. The model favored by most researchers
is that the analgesic effect of hypnosis occurs in higher brain centers
than those involved in registering the painful sensation. This would
account for the fact that most autonomic responses that routinely accompany
pain -- such as increased heart rate -- are relatively unaffected by
hypnotic suggestions of analgesia.
But couldn't people merely be faking that they had been hypnotized?
Two key studies have put such suspicions to rest.
In a cunning 1971 experiment dubbed The Disappearing Hypnotist, Frederick
Evans and Martin T. Orne of the University of Pennsylvania compared
the reactions of two groups of subjects: one made up of people they
knew to be truly hypnotizable and another of individuals they told to
pretend to be hypnotized. An experimenter who did not know which group
was which conducted a routine hypnotic procedure that was suddenly interrupted
by a bogus power failure. When the experimenter left the room to investigate
the situation, the pretending subjects immediately stopped faking: they
opened their eyes, looked around the room and in all respects dropped
the pretense. The real hypnotic subjects, however, slowly and with some
difficulty terminated hypnosis by themselves.
Fakers also tend to overplay their role. When subjects are given suggestions
to forget certain aspects of the hypnosis session, their claims not
to remember are sometimes suspiciously pervasive and absolute, for instance,
or they report odd experiences that are rarely, if ever, recounted by
real subjects. Taru Kinnunen, Harold S. Zamansky and their co-workers
at Northeastern University have exposed fakers using traditional lie-detector
tests. They have found that when real hypnotic subjects answer questions
under hypnosis, their physiological reactions generally meet the criteria
for truthfulness, whereas those of simulators do not.
Hypnosis and Memory
Perhaps nowhere has hypnosis engendered more controversy than over
the issue of "recovered" memory. Cognitive science has established
that people are fairly adept at discerning whether an event actually
occurred or whether they only imagined it. But under some circumstances,
we falter. We can come to believe (or can be led to believe) that something
happened to us when, in fact, it did not. One of the key cues humans
appear to use in making the distinction between reality and imagination
is the experience of effort. Apparently, at the time of encoding a memory,
a "tag" cues us as to the amount of effort we expended: if
the event is tagged as having involved a good deal of mental effort
on our part, we tend to interpret it as something we imagined. If it
is tagged as having involved relatively little mental effort, we tend
to interpret it as something that actually happened to us. Given that
the calling card of hypnosis is precisely the feeling of effortlessness,
we can see why hypnotized people can so easily mistake an imagined past
event for something that happened long ago. Hence, something that is
merely imagined can become ingrained as an episode in our life story.
A host of studies verify this effect. Readily hypnotized subjects,
for instance, can routinely be led to produce detailed and dramatic
accounts of their first few months of life even though those events
did not in fact occur and even though adults simply do not have the
capacity to remember early infancy. Similarly, when given suggestions
to regress to childhood, highly hypnotizable subjects behave in a roughly
childlike manner, are often quite emotional and may later insist that
they were genuinely reliving childhood. But research confirms that these
responses are in no way authentically childlike -- not in speech, behavior,
emotion, perception, vocabulary or thought patterns. These performances
are no more childlike than those of adults playacting as children. In
short, nothing about hypnosis enables a subject to transcend the fundamental
nature and limitations of human memory. It does not allow someone to
exhume memories that are decades old or to retrace or undo human development.
What It's Good For
So what are the medical benefits of hypnosis? A 1996 National Institutes
of Health technology assessment panel judged hypnosis to be an effective
intervention for alleviating pain from cancer and other chronic conditions.
Voluminous clinical studies also indicate that hypnosis can reduce the
acute pain experienced by patients undergoing burn-wound debridement,
children enduring bone marrow aspirations and women in labor. A meta-analysis
published in a recent special issue of the International Journal of
Clinical and Experimental Hypnosis, for example, found that hypnotic
suggestions relieved the pain of 75 percent of 933 subjects participating
in 27 different experiments. The pain-relieving effect of hypnosis is
often substantial, and in a few cases the degree of relief matches or
exceeds that provided by morphine.
But the Society for Clinical and Experimental Hypnosis says that hypnosis
cannot, and should not, stand alone as the sole medical or psychological
intervention for any disorder. The reason is that anyone who can read
a script with some degree of expression can learn how to hypnotize someone.
An individual with a medical or psychological problem should first consult
a qualified health care provider for a diagnosis. Such a practitioner
is in the best position to decide with the patient whether hypnosis
is indicated and, if it is, how it might be incorporated into the individual's
treatment.
Hypnosis can boost the effectiveness of psychotherapy for some conditions.
Another meta-analysis that examined the outcomes of people in 18 separate
studies found that patients who received cognitive behavioral therapy
plus hypnosis for disorders such as obesity, insomnia, anxiety and hypertension
showed greater improvement than 70 percent of the patients who received
psychotherapy alone. After publication of these findings, a task force
of the American Psychological Association validated hypnosis as an adjunct
procedure for the treatment of obesity. But the jury is still out on
other disorders with a behavioral component. Drug addiction and alcoholism
do not respond well to hypnosis, and the evidence for hypnosis as an
aid in quitting smoking is equivocal.
That said, there is strong, but not yet definitive, evidence that hypnosis
can be an effective component in the broader treatment of other conditions.
Listed in rough order of tractability by hypnosis, these include a subgroup
of asthmas; some dermatological disorders, including warts; irritable
bowel syndrome; hemophilia; and nausea associated with chemotherapy.
The mechanism by which hypnosis alleviates these disorders is unknown,
and claims that hypnosis increases immune function in any clinically
important way are at this time unsubstantiated.
More than 30 years ago Hilgard predicted that as knowledge about hypnosis
becomes more widespread in the scientific community, a process of "domestication"
will take place: researchers will use the technique more and more often
as a routine tool to study other topics of interest, such as hallucination,
pain and memory. He forecast that, thus grounded in science, the clinical
use of hypnosis would simply become a matter of course for some patients
with selected problems. Although we are not quite there today, hypnosis
has nonetheless come a long way from the swinging pocket watch.
------------
SCIENTIFIC AMERICAN GETS HYPNOTIZED
Our staff sees what it's like to "go under"
http://www.sciam.com:80/2001/0701issue/0701nashbox2.html
Here at Scientific American we pride ourselves on our skepticism toward
pseudoscience and on our hard-nosed insistence on solid research. So
when we invited Michael R. Nash of the University of Tennessee at Knoxville
to write the accompanying article on the scientific basis of hypnosis,
we warned him that we'd put him through the wringer -- which we did.
But while editing the article, we began to wonder: Isn't this something
we should experience ourselves? How many of us would be hypnotizable?
We invited Nash and research psychologist Grant Benham to New York
so we could see what hypnosis was like firsthand. Six editorial staffers
-- three men and three women, none of whom had been hypnotized before
--were willing to give it a try. What we found surprised us.
Nash and Benham set up two quiet offices for our initiation into hypnosis.
Each researcher hypnotized three people individually, spending about
an hour with each subject. They took us through the Stanford Hypnotic
Susceptibility Scales, which rate an individual's responsiveness from
0 to 12.
One of the most surprising things about our hypnotic experience was
its very banality. To induce hypnosis, Nash and Benham merely asked
us to stare at a yellow Post-It note on the wall and spoke to us in
a calm voice about how relaxed we were becoming and how our eyes were
growing tired. "Your whole body feels heavy -- heavier and heavier,"
they read from the Stanford script. "You are beginning to feel
drowsy -- drowsy and sleepy. More and more drowsy and sleepy while your
eyelids become heavier and heavier, more and more tired and heavy."
That soothing patter went on for roughly 15 minutes, after which all
but one of us had closed his or her eyes without being directly told
to do so.
The Stanford scales consist of 12 different activities ranging from
trying to pull apart one's interlocked fingers and feeling one's elevated
arm lower involuntarily to hallucinating that one hears a buzzing fly.
Of the six of us, one scored an 8, one a 7, one a 6, two a 4 and one
a 3. (A score of 0 to 4 is considered "low" hypnotizable;
5 to 7 is "medium" hypnotizable; 8 to 12 is "high"
hypnotizable.) None of us accurately predicted how susceptible we would
be: some who thought themselves very suggestible turned out to be poor
subjects, and others who deemed themselves tough cases were surprised
to find their two outstretched arms coming together by themselves or
their mouth clamped shut so that they couldn't say their name.
We all had a sense of "watching" ourselves and were sometimes
amused. "I knew what my name was, but I couldn't think how to move
my mouth," recalled one staff member. Another said his fingers
"felt stuck" during the finger-lock exercise. "At first
they pulled apart easily enough, but then they seemed to sort of latch
up. It was interesting to see that it was so difficult."
Only one of us experienced item number 12 on the Stanford scale --
posthypnotic amnesia. In this exercise, the hypnotist tells the subject
not to remember what occurred during the session. "Every time I'd
try to remember," said the staff member who had this sensation,
"the only thing that came back to me was that I shouldn't remember.
But when Dr. Benham said it was okay to remember, it all came flooding
back."
In general, the experience was much less eerie than we had expected.
The feeling was akin to falling into a light doze after you've awakened
in the morning but while you're still in bed. All of us found that we
felt less hypnotized during some parts of the session than during others,
as if we had come near the "surface" for a few moments and
then slipped under again.
All in all, we concluded that seeing is believing when it comes to
hypnosis. Or maybe we should say hearing is believing: I'm the one who
heard -- and swatted -- the imaginary fly.
--Carol Ezzell, staff writer and a 7 on the Stanford scales
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WHAT DO YOU KNOW ABOUT HYPNOSIS?
http://www.sciam.com:80/2001/0701issue/0701nashbox3.html
IF YOU THINK...
It's all a matter of having a good imagination.
THE REALITY IS ...
Ability to imagine vividly is unrelated to hypnotizability.
IF YOU THINK...
Relaxation is an important feature of hypnosis.
THE REALITY IS ...
It's not. Hypnosis has been induced during vigorous exercise.
IF YOU THINK...
It's mostly just compliance.
THE REALITY IS ...
Many highly motivated subjects fail to experience hypnosis.
IF YOU THINK...
It's a matter of willful faking.
THE REALITY IS ...
Physiological responses indicate that hypnotized subjects are not lying.
IF YOU THINK...
It is dangerous.
THE REALITY IS ...
Standard hypnotic procedures are no more distressing than lectures.
IF YOU THINK...
It has something to do with a sleeplike state.
THE REALITY IS ...
It does not. Hypnotized subjects are fully awake.
IF YOU THINK...
Responding to hypnosis is like responding to a placebo.
THE REALITY IS ...
Placebo responsiveness and hypnotizability are not correlated.
IF YOU THINK...
People with certain types of personalities are likely to be hypnotizable.
THE REALITY IS ...
There are no substantial correlates with personality measures.
IF YOU THINK...
People who are hypnotized lose control of themselves.
THE REALITY IS ...
Subjects are perfectly capable of saying no or terminating hypnosis.
IF YOU THINK...
Hypnosis can enable people to "relive" the past.
THE REALITY IS ...
Age-regressed adults behave like adults playacting as children.
IF YOU THINK...
A person's responsiveness to hypnosis depends on the technique used
and who administers it.
THE REALITY IS ...
Neither is important under laboratory conditions. It is the subject's
capacity that is important.
IF YOU THINK...
When hypnotized, people can remember more accurately.
THE REALITY IS ...
Hypnosis may actually muddle the distinction between memory and fantasy
and may artificially inflate confidence.
IF YOU THINK...
Hypnotized people can be led to do acts that conflict with their values.
THE REALITY IS ...
Hypnotized subjects fully adhere to their usual moral standards.
IF YOU THINK...
Hypnotized people do not remember what happened during the session.
THE REALITY IS ...
Posthypnotic amnesia does not occur spontaneously.
IF YOU THINK...
Hypnosis can enable people to perform otherwise impossible feats of
strength, endurance, learning and sensory acuity.
THE REALITY IS ...
Performance following hypnotic suggestions for increased muscle strength,
learning and sensory acuity does not exceed what can be accomplished
by motivated subjects outside hypnosis.
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FURTHER INFORMATION:
HYPNOSIS FOR THE SERIOUSLY CURIOUS
Kenneth Bowers. W. W. Norton, 1983
http://www.amazon.com/exec/obidos/ASIN/0393953394/newheavenneweart
CONTEMPORARY HYPNOSIS RESEARCH
Erika Fromm and Michael R. Nash. Guilford Press, 1992
http://www.amazon.com/exec/obidos/ASIN/0898628938/newheavenneweart
RELATED LINKS:
For an introduction to the history of hypnosis and its modern-day uses,
visit the Web site of the Institute for the Study of Healthcare Organizations
and Transactions at:
http://www.institute-shot.com/hypnosis_and_health.htm
For information on hypnosis research and clinical applications, visit
the International Journal of Clinical and Experimental Hypnosis at:
http://www.sunsite.utk.edu/IJCEH
Video of an actual hypnosis session can be viewed at:
http://www.sciam.com/2001/0701issue/0701nashbox1.html
THE AUTHOR:
MICHAEL R. NASH is associate professor of psychology at the University
of Tennessee at Knoxville and is editor in chief of the International
Journal of Clinical and Experimental Hypnosis. He received his Ph.D.
from Ohio University in 1983 and completed his clinical internship at
the Yale University School of Medicine the same year. He has published
two books, one on the research foundations of hypnosis and the other
on psychoanalysis, both co-authored with Erika Fromm of the University
of Chicago. He is the author of more than 60 publications in scientific
journals on the topics of human memory, dissociative pathology, sex
abuse, psychotherapy and hypnosis. Nash has received numerous awards
for his scientific and clinical writing.
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