Hypnosis

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Hypnosis is understood to be a psychological condition in which an individual may be induced to show apparent differences in behavior and thinking. Although some individuals experience an increase in suggestibility and subjective feelings of an 'altered state of consciousness', this is not true for everyone. In fact, supposed hypnotic indicators and subjective changes can be achieved without relaxation or a lengthy induction, a fact which increases the controversy around hypnosis.

Intense debate surrounds the topic of hypnosis. Some scientists dispute its very existence, while many therapists insist upon its value. One potential source of controversy is the wide variety of theories of hypnosis which have traditionally been split into 'state' and 'non-state' camps. This controversy may be decreasing as the value of both perspectives is increasingly recognized. Modern brain-imaging techniques offer hope for an increased understanding of the nature of hypnosis.

The applications of hypnosis vary widely. Currently, two distinct applications of hypnosis include its use in entertainment and health applications. The popular perception of the hypnotic experience is that of the entertainment version. The stage hypnotist uses a variety of methods to relax and focus the subjects eventually making it appear to the audience that the subject is asleep or, popularly termed, in trance. During the performance, the subjects seem to obey the commands of the hypnotist to engage in behaviors they might not normally choose to perform.

On the other hand, hypnosis applications in the medical and health-related fields are often experienced very differently. Evidence supports the clinical use of hypnosis for pain control, for weight control, in the treatment of irritable bowel syndrome, and as an adjunct to cognitive behavioral and other therapies. Hypnosis is not a therapy in-and-of-itself but is effectively used as an adjunct to other therapies; hence "hypnotherapy" is less preferable than the use of hypnosis-related techniques as part of an integrated psychological package.

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It is often said that there are as many definitions of hypnosis as there are hypnotists. Researchers and clinicians have different requirements from explanations of hypnosis and consequently the focus of theories from these respective fields can vary dramatically.

One fundamental distinction in hypnosis theory is between 'state' and 'non-state' approaches to hypnosis. State theorists believe that hypnosis is an altered state of consciousness, whereas non-state theorists believe that hypnotic effects are the product of more mundane psychological processes such as absorption and expectancy. Note how the APA definition (below), essentially a consensus statement from a broad range of researchers and clinicians, remains neutral with respect to this argument.

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

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

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Michael Yapko defines hypnosis: "...hypnosis is a process of influential communication in which the clinician elicits and guides the inner associations of the client in order to establish or strengthen therapeutic associations in the context of a collaborative and mutually responsive goal-oriented relationship.

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Steve G. Jones defines hypnosis as "a state of mind similar to driving a car or watching TV." He further asserts that in such situations as weight loss hypnosis sessions, the client can see herself having lost the amount of weight she no longer wants or needs. This vision, of course, is made more powerful by the fact that the client is in a hypnotic state

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Some physiological definitions of hypnosis assert that a predominantly alpha state is required for successful therapeutic change, others assert that predominantly theta activity is the marker of hypnosis. Many lay definitions of hypnosis stem from a misunderstanding of what the EEG data means, and trying to define hypnosis as either an alpha or theta state is likely to be a gross oversimplification. It is important to note that non-hypnotized subjects can be found in any of these states of cortical arousal without also displaying any of the behavior, traits or the enhanced suggestibility associated with being hypnotized. Some sophisticated, and scientifically testable, models of brain activity in hypnosis have been developed (see Gruzelier's Neuropsychological Model below).

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A scientific theory attempts to describe and explain the behaviour of a natural or social phenomenon, following the principles of the scientific method. Good theories produce testable hypotheses which can be supported or refuted by experimental data. There are unfortunately many vague and untestable theories of hypnosis which continue to circulate, but high quality research is still published in peer-reviewed scientific journals.

One fundamental distinction is between 'state' and 'non-state' theories of hypnosis. State theorists believe that an altered state of consciousness is a core part of hypnosis, whereas non-state theoriests believe that more mundane psychological processess such as focussed attention and expectation are sufficient to explain hypnotic phenomena. The precise definition of what constitutes an altered state of consciousness is a matter of some debate. Although many people who are hypnotised describe their experience as 'altered' it is difficult to use these terms in the absence of a prior definition.

One final thing to say about theories is that they can work at different levels of description. Some theories of hypnosis attempt to describe hypnotic phenomenon in terms of brain activity while others concentrate more on the phenomenological experience. Both are valuable and a unified theory is a laudable goal.

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Pierre Janet originally developed the idea of dissociation, literally a splitting-off of some components of consciousness, as a result of his work with hysterical patients. He believed that hypnosis was an example of dissociation: areas of an individual's behavioral control are split off from ordinary awareness. In this case, hypnosis would remove some control from the conscious mind and the individual will respond with autonomic, reflexive behavior. Weitzenhoffer describes hypnosis via this theory as "dissociation of awareness from the majority of sensory and even strictly neural events taking place."

Ernest Hilgard developed Janet's ideas and published his neodissociation theory in 1977. His theory, a classic 'state' theory, postulated an excutive ego (essentially a central executive system in today's cognitive psychological terms) which became dissociated from sub-components via an 'amnesic barrier'. Suggestions from a hypnotist could produce alterations in perception and behaviour, which were explainable in terms of these dissociated sub-systems. Hilgard's ideas were influenced by his discovery of the 'hidden observer' phenomenon, a process by which different components of consciousness were investigated (other researchers, notably Spanos, believed the hidden observer to be an experimental artifact).

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Generally, under hypnosis people become more receptive to suggestion, causing changes in the way they feel, think, and behave. Some psychologists (such as Sarbin and Spanos) have suggested that hypnosis is a social construct, so well-known that strong social expectations are played out by subjects, who believe they are in a state of hypnosis, behaving in a way that they imagine a hypnotized person would behave. Much experimental work has demonstrated that the experiences of hypnotized subjects can be dramatically shaped by expectations and social nuances. This view is often misunderstood: it does not discount the claim that hypnotized individuals are truly experiencing suggested effects, just that the mechanism by which this has taken place has in part been socially constructed and is not necessarily reliant on the idea of an altered state of consciousness

Barber theorizes that hypnosis is not a state or a trance and is not produced as the result of suggestions. He suggests that hypnosis is based on a number of overlapping variables, but, primarily, that interpersonal relationships allow the operator to restructure perceptions and conceptions of the subject. He theorizes that this occurs because the subject is relatively inattentive to the environment and, because of this misdirection of attention, the subject is willing to think as the hypnotist wants them to think.

Nicholas Spanos hypothesized that the behaviors associated with hypnosis are acted out knowingly be the person. He believes that all acts that are performed are done under the complete control of the hypnotized person. Spanos stood against Hilgard’s belief that hypnosis is another state of consciousness. Spanos worked for almost ten years on this theory completing sixteen experiments to reveal that many of the actions performed under hypnosis can be simply explained as something other than hypnosis. Spanos alleged that there are two reasons that cause people to misconstrue their state of consciousness as hypnosis. One of the reasons being that people believe that their behavior is caused by an external source instead of the self. The second is related to the way hypnotic rituals are performed. The hypnotist says certain things which are first interpreted as voluntary and then later on in the procedure as involuntary. An example being “relax the muscles in you legs” and then later “your legs feel limp and heavy.” Spanos argues that the hypnotist as each person two connected requests the first being directly asking the subject to do something and the second being for the subject to infer the request as an involuntary one. Some hypnosis participants follow the first request and realize they are performing the task voluntarily while others do not respond at all. Still others follow both requests and therefore deemed great hypnosis subjects. Using another study, Spanos demonstrates that how people control their hypnotic experience by acting how they believe they are supposed to act during a hypnosis session. The study was performed on two groups of people. One group was given a lecture which included a segment on how arm rigidity was spontaneous during hypnosis and the second group did not. When both groups were hypnotized the group who was informed of the arm rigidity actually had arm rigidity during the session.A second study used by Spanos involved evaluating the analgesia effect in hypnotic and non-hypnotic individuals. The study performed the experiment on two groups of people and the only difference between the groups is that one group was told they were going to be hypnotized. Each participant was asked to put his or her hand in a bucket of ice and hold it there as long as possible. After removing their arm they were asked to rate their perceived pain. While awake those individuals who were expecting hypnosis had a much higher pain rating than those who were not expecting. All participants were hypnotized and then were asked to put their arm in the bucket of ice once more. The people who were not expecting hypnosis had about the same rating of perceived pain as their corresponding awake trial. The expecting participants had a much lower rating then their corresponding awake trial. Spanos claimed that this was due to the subjects wanting to be viewed as a great hypnotic subject. Spanos’ findings were not to prove that the hypnotic state did not exist at all but to prove that the behaviors exhibited by those individuals are due to “highly motivated” individuals.

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Neuropsychological theories of hypnosis attempt to explain hypnotic phenomenon in terms of alterations in brain activity. Gruzelier, based on large amounts of EEG research, proposed that hypnosis is characterised by a shift in brain activity from anterior (front) to posterior (back).

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Charcot postulated that hypnosis was a symptom of hysteria and that only those people experiencing hysteria were believed to be hypnotizable. Although those exhibiting hysteria seem to be more suggestible, normal individuals are, indeed, hypnotizable which calls this theory into question.

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Ivan Pavlov believed that hypnosis was a "partial sleep". He observed that the various degrees of hypnosis didn't significantly differ physiologically from the waking state and hypnosis depended on insignificant changes of environmental stimuli. Pavlov also suggested that lower brain stem mechanisms were involved in hypnotic conditioning.

Some modern well-known hypnotherapists, such as Steve G. Jones, subscribe to this theory. And rightly so, since in hypnosis, the subject typically appears to be asleep because of eye closure that is typically part of the induction procedure, but there is quite a bit of literature on blood pressure, reflexes, physiochemical and EEG studies which indicates that hypnosis more closely resembles complete wakefulness.

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This theory suggests that individuals are playing a role and allowing the hypnotist to create a reality for them. This relationship depends on how much rapport has been established between the hypnotist and the subject (see Hawthorne effect, Pygmalion effect, and the Placebo effect).

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Currently a more popular theory, it states the subject's attention is narrowed by certain techniques used by the hypnotist. As attention is narrowed, the hypnotist's words eventually take over the inner voice of the subject. From this theory comes the implication that only gullible or weak-minded people are suggestible. Some people, however, find the narrowing of attention to be desirable. Milton H. Erickson was said to have told his subjects, "... and my voice will go with you," meaning that Erickson's voice would be a comforting presence in the face of adversity and trouble.

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This theory applies the concept of the brain-as-computer model. In electronic systems, a system adjusts its feedback networks to increase the signal-to-noise ratio for optimum functioning, called a "steady state". Increasing the receptability of a receptor enables messages to be more clearly received from a transmitter primarily by trying to reduce the interference (noise) as much as possible. Thus, the object of the hypnotist is to use techniques to reduce the interference and increase the receptability of specific messages (suggestions).