Comparative study of distraction versus topical anesthesia for pediatric pain management during immunizations.

This study compared distraction, an anesthetic (eutectic mixture of local anesthetics [EMLA]), and typical care during pediatric immunizations. Participants were 39 4th graders receiving a 3-injection vaccination series over a 6-month period. Children displayed low distress despite reporting moderate anxiety and pain. Distraction resulted in more nurse coaching and child coping and less child distress than did EMLA or typical care on an observational measure. EMLA did not result in increased child coping or decreased distress. In fact, the nurse coached more, and trends suggested that children coped more with typical care than with EMLA. Whereas participant ratings and heart rate did not differ among conditions, all 3 conditions demonstrated improvements over time with these measures. Satisfaction ratings suggested that children preferred the treatments to typical care, whereas the nurse appreciated aspects of each of the conditions. Finally, distraction was more economical than EMLA.     

Analgesic effects of posthypnotic suggestions and virtual reality distraction on thermal pain

The individual and combined effects of posthypnotic suggestion (PHS) and virtual reality distraction (VRD) on experimentally induced thermal pain were examined using a 2 x 2, between-groups design. After receiving baseline thermal pain, each participant received hypnosis or no hypnosis, followed by VRD or no VRD during another pain stimulus. Consistent with the hypothesis that hypnosis and VRD work via different mechanisms, results show that posthypnotic analgesia was moderated by hypnotizability but VRD analgesia was not. The impact of PHSs for analgesia was specific to high hypnotizables, whereas VRD was effective independent of hypnotizability. Results also show a nonsignificant but predicted pattern for high hypnotizables: Audio hypnosis combined with VRD reduced worst pain 22% more and pain unpleasantness 25% more than did VRD alone. Theoretical and clinical implications are discussed.     

Hypnotic predictors of agency: Responsiveness to specific suggestions in hypnosis is associated with involuntariness in fibromyalgia

Hypnosis is associated with alterations in the sense of agency which can play a role in its utilization as a nonpharmacological option for pain management. The goal of the current study was to examine the relationships between responsiveness to suggestions in hypnosis and alterations of the sense of agency among patients with fibromyalgia. Ninety-eight participants with fibromyalgia underwent two hypnotizability assessments followed by the Sense of Agency Rating Scale. Clinical pain measures were also collected. Involuntariness was predicted by responsiveness to control, ideomotor, and dissociation suggestions. Effortlessness was predicted by responsiveness to control and ideomotor suggestions, and age. Hypnotizability was associated with main clinical pain outcomes, but agency alterations were not. Results suggest a shared mechanism between responsiveness to specific suggestions and the sense of agency in hypnosis. We discuss theoretical and clinical implications for pain management and the need for further research.     

AN ATTEMPT AT EXPERIMENTAL MODIFICATION OF HYPNOTIZABILITY THROUGH REPEATED INDIVIDUALIZED HYPNOTIC EXPERIENCE

In an initial attempt to investigate whether the level of hypnotic susceptibility can be experimentally modified, ten subjects of moderate susceptibility were given individualized hypnotic experience in 4–10 sessions and tested with objective hypnosis scales before and after the experience. Some quantitative and qualitative results are presented. They indicate that in most individuals routinely measured hypnotizability can be changed for the better within a certain range, but that dramatic changes as a rule will not take place.     

Changes in the sense of agency during hypnosis: The Hungarian version of the Sense of Agency Rating Scale (SOARS-HU) and its relationship with phenomenological aspects of consciousness

Changes in the sense of agency are defining feature of hypnosis. The Sense of Agency Rating Scale (SOARS) is a 10-item questionnaire, administered after a hypnosis session to assess alteration in the sense of agency. In the present study, a Hungarian version of the measure (SOARS-HU) is presented. The SOARS-HU and the Phenomenology of Consciousness Inventory (PCI) were administered to 197 subjects following hypnotizability screening with the Harvard Group Scale of Hypnotic Susceptibility Scale, Form A (HGSHS:A). Confirmatory factor analysis and correlations with hypnotizability demonstrate the reliability and validity of the SOARS-HU. Changes in the Involuntariness and Effortlessness subscales of the SOARS-HU were associated with alterations in subjective conscious experience, as measured by the PCI. These changes in subjective experience remained significant after controlling for HGSHS:A scores. These results indicate that changes in the sense of agency during hypnosis are associated with alterations of consciousness that are independent of hypnotizability.     

Hypnotic suggestibility predicts the magnitude of the imaginative word blindness suggestion effect in a non-hypnotic context

The present study investigated how the magnitude the word blindness suggestion effect on Stroop interference depended on hypnotic suggestibility when given as an imaginative suggestion (i.e. not post-hypnotic suggestion) and under conditions in which hypnosis was not mentioned. Hypnotic suggestibility is shown to be a significant predictor of the magnitude of the imaginative word blindness suggestion effect under these conditions. This is therefore the first study to show a linear relationship between the imaginative word blindness suggestion effect and hypnotic suggestibility across the whole hypnotizability spectrum. The results replicate previous findings showing that highs respond to the word blindness suggestion to a greater extent than lows but extend previous work by showing that the advantage for those higher on the hypnotizability spectrum occurs even in a non-hypnotic context. Negative attitudes about hypnosis may not explain the failure to observe similar effects of the word blindness suggestion in less hypnotizable individuals.     

Uses of hypnosis in evaluating malingering and deception

Hypnosis, as a method of detecting deception, is examined with respect to its forensic applications. The degree of hypnotizability and whether formal hypnotic procedures may be employed are discussed with both the relevant clinical and legal issues in mind. Finally, the use of hypnosis in determining the authenticity of psychosomatic conditions is addressed.     

Alteration of hypnotic experience following transcranial electrical stimulation of the left prefrontal cortex

BackgroundRecent studies of neurostimulation reported alteration of hypnotizability and hypnotic phenomena after inhibition of the dorsolateral prefrontal cortex (DLPFC), but the different assessments of hypnosis and the stimulation parameters still left open many questions about the role of this brain region in hypnotizability. We aimed to administer inhibitory transcranial direct current stimulation (tDCS) over the left DLPFC to observe effects of stimulation on the hypnotic experience and the feeling of agency.Methodsa procedure of hypnotic induction with suggestions was repeated twice: before and after the unilateral cathodal tDCS over the left DLPFC. The experience was assessed through a phenomenological assessment of hypnosis and sense of agency in thirty-three participants randomly assigned to the sham or the active group.Resultsactive (inhibitory) tDCS enhanced the hypnotizability by 15.4% and altered a few dimensions of consciousness such as self-awareness and absorption. No changes emerged on the feeling of agency and pass rates for suggestions.ConclusionstDCS reflects a promising tool to alter the hypnotic phenomena and the responsiveness to hypnotic procedures. Neurocognitive implications are discussed for the construct of hypnotizability as well as for the role of the left DLPFC in the dimensions of consciousness such as self-awareness.     

Hypnotizability, imaginative involvement, and anxiety

Forty-five undergraduate students were investigated to determine the relationship between hypnotizability, imaginative involvement (absorption), and anxiety responses. Hypnotizability was measured independently with the Creative Imagination Scale (CIS), and imaginative involvement was measured with the Absorption Scale (ABS). The results indicated moderate significant correlations between CIS, ABS, and several of the anxiety measures. In particular self-reported physiological aspects of anxiety/activation were associated with the CIS and the ABS. Three of the subjects reported having panic attacks. These subjects also exhibited high hypnotic responsiveness, and their scores on the ABS and several of the anxiety scales were considerably elevated as compared with the group mean level.     

Distignuishing the source of memories reported during prior waking and hypnotic recall attempts

Subjects attempted to identify the occasion on which they first reported particular responses to questions that were asked twice during an experiment on hyphosis and memory 1 week earlier. During this earlier experiment, subjects of high and low hypnotizability had been randomly allocatd to one of two recall test sequences: wake-hypnosis ro wake-wake. Recall improved from the first (R1) to the second test (R2) in a comparable manner for both test sequences, indicating a failure of hypnosis to enhance memory. It is noteworthy that, when later queried about the origins of specific recollections, the majority of subjects exhibited a bias to attribute their responses to R1, regardless of whether hypnosis was used during R2. Moreover, low hypnotizables exposed to the hypnotic procedure and, to a lesser extent, high hypnotizables who recalled both times in the waking condition displayed and exaggerated tendency to overattribute recollections to R1. These data indicate that individuals cannot distinguish between memories retrieved prior to hypnosis and those that occured during hypnosis. Implications for implementing judicial standards regarding hypnosis are discussed.     

Effects of active alert and relaxation hypnotic inductions on cold pressor pain

We contrasted relaxation and active alert hypnotic inductions with or without a specific suggestion for cold pressor pain analgesia. Groups of high (n = 38) and low (n = 27) hypnotizable subjects were tested; hypnotizability had been determined from results of the Stanford Hypnotic Susceptibility Scale, Form C. Cold pressor pain data were obtained after counterbalanced exposure to relaxation and active alert inductions. Highly hypnotizable subjects demonstrated lower pain scores than did low hypnotizable ones. Pain reports did not differ between induction conditions. Highly hypnotizable subjects given an analgesic suggestion showed lower pain scores than did those exposed only to hypnosis. The findings, conceptualized within E.R. Hilgard's (1977a) neodissociation theory, show that relaxation is not necessary for hypnotic analgesia.     

Multiple hypnotizabilities: differentiating the building blocks of hypnotic response

Although hypnotizability can be conceptualized as involving component subskills, standard measures do not differentiate them from a more general unitary trait, partly because the measures include limited sets of dichotomous items. To overcome this, the authors applied full-information factor analysis, a sophisticated analytic approach for dichotomous items, to a large data set from 2 hypnotizability scales. This analysis yielded 4 subscales (Direct Motor, Motor Challenge, Perceptual-Cognitive, Posthypnotic Amnesia) that point to the building blocks of hypnotic response. The authors then used the subscales as simultaneous predictors of hypnotic responses in 4 experiments to distinguish the contribution of each component from general hypnotizability. This analysis raises interesting questions about how best to conceptualize and advance measurement of the ability to experience hypnosis.     

Interpretive sets, expectancy, fantasy proneness, and dissociation as predictors of hypnotic response.

College students with no prior experience of hypnosis were assessed for fantasy proneness and dissociation. In a totally separate context, they were subsequently tested for their interpretations of hypnotic suggestions, hypnotic response expectancies, and hypnotizability. Contrary to Spanos and Gorassini's (1984) hypothesis, strategic enactment of suggested responses was rarely reported, and its endorsement was not correlated with hypnotic responsiveness. Suggestibility was significantly predicted by fantasy proneness and response expectancy, but not by dissociation. A path analysis suggested that the relation between fantasy proneness and hypnotizability was partially mediated by expectancy.     

Pain anxiety among chronic pain patients: specific phobia or manifestation of anxiety sensitivity?

Rather than viewing anxiety among chronic pain patients as simply a component of negative affectivity, investigators have developed a model of "pain anxiety" in which patients develop fear and avoidance of activity linked to pain. We examined whether pain anxiety can be conceptualized as a specific phobia, or whether evidence supported the notion that pain anxiety is better understood as a manifestation of anxiety sensitivity in the context of chronic pain. Chronic musculoskeletal pain patients (N=70) underwent cold pressor and mental arithmetic tasks while cardiovascular, self-report, and behavior indexes were recorded. They completed measures of pain anxiety, anxiety sensitivity, fear of negative evaluation, depression and trait anxiety. Correlation analyses showed pain anxiety was related to pain-relevant responses during cold pressor, but it was also related to evaluation-relevant responses during cold pressor, and to pain- and evaluation-relevant responses (including subtraction accuracy) during mental arithmetic. Regression analyses showed that almost all effects of pain anxiety on task responses were accounted for by anxiety sensitivity. Fear of negative evaluation, in contrast, correlated only with evaluation-relevant responses, and mostly during mental arithmetic. These effects remained significant when depression, trait anxiety, or anxiety sensitivity were statistically controlled. Pain anxiety may be an expression of anxiety sensitivity rather than a circumscribed phobia; a distinction that could profitably guide treatment strategies.     

Literalism as a marker of hypnotic "trance": disconfirming evidence

The responses given by highly hypnotizable, hypnotic subjects and those of unhypnotizable subjects who simulated hypnosis to questions of the type, "Do you mind telling me your name?" and "Do you mind standing up?" were contrasted. The purpose was to examine Erickson's (1980) assertion that literalism (answering "yes" or "no" verbally or nonverbally without any cognitive elaboration) is a marker of hypnotic "trance." Simulators exhibited a greater rate of literalism than hypnotic "virtuosos" (i.e., extreme scorers on both group and individual hypnotizability measures). Hypnotized subjects and nonhypnotized subjects approached in the campus library responded comparably. Because less than a third of hypnotic virtuosos responded literally, our results strongly refuted Erickson's assertion that literalism is a cognitive feature of hypnosis.     

Hypnosis and interrogative suggestibility

An attempt was made to induce memory errors through the use of misleading questioning in hypnosis. Subjects heard a short newslike story and gave initial free recall for the story details, then 4 days later were given three free recall trials: prior to hypnosis, following hypnotic induction and suggestion for enhanced memory, and after hypnosis was terminated. During hypnosis subjects were also twice interrogated with either misleading or objective questions for the story details. Accurate memory increased over the three free recall trials for all subjects regardless of hypnotizability. In recognition testing, subjects given misleading questions during the interrogation gave fewer correct responses, had more errors-in-fact as well as forgetting, and showed an increase in yielding to interrogative suggestibility over trials than subjects given objective questions. All subjects subsequently confabulated more information on the final awake free recall trial as a result of errors introduced during hypnotic interrogation process. These results help to clarify the inherent dangers in relying on hypnosis to enhance memory.     

Enhancing hypnotic susceptibility: interpersonal and rapport factors

This research supported the hypothesis that hypnosis can be thought of as a set of potentially modifiable social-cognitive skills and attitudes. A low-interpersonal-training treatment devised by Gorassini and Spanos (1986) was compared with a treatment designed to modify not only cognitive factors but also to augment rapport with the trainer and diminish resistance to responding (high-interpersonal training). Fifty percent of the initially unhypnotizable subjects in the high-interpersonal condition tested as being highly susceptible to hypnosis (high susceptibles) at posttest on the Harvard Group Scale of Hypnotic Susceptibility (Shor & Orne, 1962); 25% of the unhypnotizable subjects in the low-interpersonal condition responded comparably. Eighty-three percent of the medium-susceptibility (medium susceptibles) subjects tested as being highly susceptible at posttest in both conditions. Practice-alone control subjects' performance was stable across testings. The study was the first to demonstrate that treatment gains generalize to a battery of novel, demanding suggestions (generalization index) that have been found to differentiate highly susceptible subjects from unhypnotizable simulating subjects. The importance of rapport was evidenced by the finding that rapport ratings paralleled group differences in hypnotic responding and that rapport correlated substantially with susceptibility scores at posttest and with the generalization index. Whereas initial hypnotizability scores correlated significantly with retest susceptibility scores, initial hypnotizability failed to correlate significantly with the generalization index.     

Reappraisal mitigates overestimation of remembered pain in anxious individuals

Anxiety sensitivity, a trait characterised by fear of anxiety-related body sensations, has been linked to heightened attention to pain, appraising body sensations as threatening, and remembering threat-related information. We assessed whether individuals with greater anxiety sensitivity overestimate in remembering pain. We also assessed whether emotion regulation strategies that direct attention away from pain (distraction), or alter appraisals of pain (reappraisal), alleviate memory bias. Participants (N = 137) were randomly assigned to one of two emotion regulation conditions or to a control condition before taking part in a cold pressor task. Greater anxiety sensitivity was associated with overestimation in remembering pain. Engaging in reappraisal mitigated this memory bias but engaging in distraction did not. This is the first study to examine the relations among anxiety sensitivity, emotion regulation and memory for pain. The findings suggest that health-care practitioners can encourage reappraisal to promote more positive memories of procedural pain, particularly in patients high in anxiety sensitivity.     

Absorption and hypnotizability: context effects reexamined

Two independent studies failed to find evidence consistent with Council, Kirsch, and Hafner (1986), who argued that the repeatedly observed correlations between Tellegen's (1981) Absorption Scale (TAS) and hypnosis measures were artifacts of testing context, and de Groot, Gwynn, and Spanos (1988), who claimed evidence for a Gender x Context moderator effect. In the present studies, Ss completed the TAS and other personality questionnaires on 2 occasions: during an independent survey and later immediately prior to an assessment of hypnotizability. In Experiment 1 (N = 475), the effect of context on the relation between questionnaire scores and hypnotizability was weak and variable; in Experiment 2 (N = 434), these weak effects were reversed. The results reaffirm the construct validity of absorption as both a major dimension of personality and as a predictor of hypnotic responsiveness.     

MECHANISMS OF PLACEBO PAIN REDUCTION:

Abstract— Identical experimental pain stimuli were applied to the right and left index fingers of 56 university students, following the application of a placebo in the guise of a topical anesthetic to one of the fingers. The pain stimuli were administered simultaneously to treated and untreated fingers for half of the subjects and sequentially for the others Significant and equtvalent reductions in pain were reported in both conditions as a function of placebo administration. These data indicate that reductions of experimental pain produced by placebos presented in the guise of local anesthetics are not mediated by such global mechanisms as anxiety reduction or the release of endogenous opioids.