The role of compliance in hypnotic and nonhypnotic analgesia

We modified the standard procedure for administering finger pressure pain in order to assess the extent to which subjects biased their reports of pain reduction when exposed to compliance-inducing instructions. Experiment 1 used only highly hypnotizable subjects and found that compliance-induced reductions in reported pain were about half as large as the reported reductions produced by hypnotic analgesia suggestions. Experiment 2 used low as well as high hypnotizables and administered hypnotic or nonhypnotic analgesia instructions and compliance instructions to the same subjects on separate pain trials. Reported pain reductions produced by hypnotic and nonhypnotic analgesia suggestions and those produced by compliance instructions were substantially and significantly correlated. Furthermore, hypnotizability correlated with compliance-induced reported pain reductions as highly as it correlated with the reported reductions produced by hypnotic analgesia suggestions. Among high hypnotizables (but not low hypnotizables) compliant responding was predicted by social desirability. The findings of both studies indicate that compliance strongly influences the reports of hypnotic and nonhypnotic analgesia proffered by high hypnotizables. The role of compliance in the pain reductions reported by low hypnotizables is less clear-cut.     

Hypnosis, suggestion, and placebo in the reduction of experimental pain

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.     

Hypnotic enhancement of cognitive-behavioral interventions for pain: an analogue treatment study.

Recent meta-analyses have shown that adding hypnosis enhances the effectiveness of cognitive-behavioral psychotherapy. This hypnotic enhancement effect was evaluated in the analogue treatment of pain. Individuals scoring in the high (n = 135) and low (n = 150) ranges of hypnotic suggestibility were randomly assigned to 1 of 6 conditions: Stress Inoculation Training, the same treatment provided hypnotically, nonhypnotic analgesia suggestions, hypnotic analgesia suggestions, a hypnotic induction treatment, or a control condition. The 5 analogue treatments reduced experimental pain more than the control condition, but were not different from one another. Under circumstances optimized to detect an enhancement effect, neither Stress Inoculation Training nor analgesia suggestions produced more relief when delivered in a hypnotic context than identical treatments provided nonhypnotically.     

Suffering for science: the effects of implicit social demands on response to experimentally induced pain

In two experiments subjects rated their pain during baseline trials of cold pressor and finger pressure pain. After various instructional treatments, they were posttested with these same stimuli. As in previous studies, we found in both experiments that coping suggestions significantly reduced reported pain. Experiment 1, however, demonstrated that subjects often refrained from using available cognitive coping strategies to reduce pain unless they had been given explicit permission to do so. Experiment 2 replicated this finding and also showed that explicit permission to "do whatever you can to reduce pain" was as effective as a coping suggestion in decreasing reported pain. These findings indicate that subjects' interpretation of what is appropriate responding in the test situation determines how they choose to cope with the painful stimulation. Thus standard experimental procedures for assessing baseline levels of pain implicitly lead subjects to refrain from coping and thereby tend to underestimate their ability to control pain. Moreover, suggestions and other instructional techniques for coping with pain may produce much of their effect not by teaching subjects new coping skills but instead by giving them permission to use already available coping strategies.     

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.     

Expectancy, redefinition and reported pain

Three groups of subjects were administered a redefinition strategy which asked them to focus on sensations during noxious stimulation. Those in one group were informed that the strategy would reduce pain (positive expectancy), those in a second were informed that it would augment pain (negative expectancy), and those in a third were given no information on expectancy. Subjects in a fourth group received neither redefinition nor instructions on expectancy. The four groups did not differ either in expectancy of pain reduction or in reduction of reported pain. Subjects in all groups expected more pain than they reported, and expectations for pain reduction showed only a small correlation with degree of reported pain reduction. In all groups, men reported less pain than women.     

Hypnotic deafness: a psychophysical study of responses to tone intensity as modified by hypnosis.

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

Hypnotic blindness and the relevance of cognitive style

Real, hypnotized and simulating, unhypnotized subjects were instructed to use either a constructive or a concentrative cognitive style when attempting to respond to a suggestion for hypnotic blindness; also, some subjects were administered the suggestion without any instructions about cognitive style. More reals who received the constructive rather than the concentrative instructions reported complete blindness; a similar number of simulators who received the different instructions reported complete blindness. Moreover, reals who received the constructive instruction reported a more rapidly developed belief in their blindness. The findings are discussed in terms of the relevance of cognitive style to subjects' reports of hypnotic blindness, and the possibility is considered that both reports of and belief in hypnotic blindness are determined in part by cognitive style.     

Expert judgments of hypnosis from subjective state reports.

Suggestibility was assessed in 60 college students after a traditional hypnotic induction, an alert induction, progressive relaxation training, or instruction in goal-directed imagery. Responsiveness to suggestion did not differ between groups. Subjects also generated open-ended reports of their states of awareness and of their experience of 3 hypnotic suggestions. A sample of these reports from 24 moderately to highly suggestible subjects were evaluated by 18 experts in the field of hypnosis. Expert ratings of subjects' open-ended reports indicated that (a) traditional hypnotic inductions produce a state of consciousness that is indistinguishable from nonhypnotic relaxation training, (b) the subjective experience of hypnotic suggestions after imagination training is indistinguishable from that after hypnotic inductions, and (c) suggestibility is unrelated to state of consciousness as assessed by experts.     

Seeing is believing: the reality of hypnotic hallucinations

Two experiments investigated the reality attributed to hypnotic suggestion through subtle projection of a visual image during simultaneous suggestion for a visual hallucination that resembled the projected image. In Experiment 1, high and low hypnotizable participants were administered either a hypnotic induction or wake instructions, given a suggestion to hallucinate a shape, and then the projected image was subsequently introduced. Although highs in both conditions rated the projected image more vividly than lows, highs in the hypnosis (but not wake) condition made comparable reality ratings when the projected image was absent and present. In Experiment 2, high hypnotizable participants were administered a suggestion to see a shape on a wall. For half the participants the suggested image was projected on the wall and then removed, and for half the projection was initially absent and then introduced. Participants who had the projection absent and then present reported comparable reality and vividness ratings when the projection was absent and present. These findings indicate that elevated hypnotizability and hypnosis are associated with attributions of external reality to suggested experiences.     

Imposed and chosen monitoring and blunting strategies in the dental setting: Effects, self-efficacy, and coping preference

Abstract In the present study, 94 dental patients received either monitoring (i.e., paying attention) or blunting (i.e., distraction) coping instructions during treatment. Half of the patients were given the possibility of choice, whereas the other half were offered one of both strategies without choice. A majority of the patients (n=61) indicated that the intervention had resulted in a decrease of their anxiety. Some indications were found for the monitoring strategy to be more effective than the blunting strategy. More specifically, monitoring strategy subjects reported that they had experienced less distress during treatment than blunting strategy subjects. In agreement with this finding, self-efficacy ratings of monitoring strategy subjects were higher than those of blunting strategy subjects. Possibility of choice and coping preference had no substantial influence on effectiveness of the interventions.     

A comparison of coping strategies in patients with fibromyalgia,chronic neuropathic pain,and pain‐free controls

Patients suffering from chronic pain may benefit from learning adaptive coping strategies. Consensus on efficient strategies for this group of patients is, however, lacking, and previous studies have shown inconsistent results. The present study has examined coping strategies in two distinctly different groups of chronic pain patients and a group of healthy controls. Thirty neuropathic pain (NP) patients, 28 fibromyalgia (FM) patients, and 26 pain‐free healthy controls completed the Coping Strategy Questionnaire (CSQ‐48/27) and rated their daily pain. The results showed that FM and NP patients did not cope differently with pain. The only difference between the groups was that FM patients felt more in control of their pain than NP patients. Both patient groups used more maladaptive/passive coping strategies, but surprisingly also more adaptive/active coping strategies than healthy controls. However, FM patients with high levels of passive strategies felt less in control than FM patients with low levels of passive strategies. This was not seen in NP patients. An important implication for clinical practice is therefore that passive coping strategies should be restructured into active ones, especially for FM patients. Otherwise, the same psychological treatment model can be applied to both groups since they use similar coping styles.     

Hypnosis, reporting bias, and suggested negative hallucinations.

We examined the role of reporting bias in hypnotic negative hallucinations by using a paradigm in which reporting bias was assessed independently of perceptual change. In Experiment 1, highly hypnotizable subjects reported significant loudness reductions when tested for hypnotic deafness. Later, however, these subjects biased their reported loudness reductions in the absence of perceptual change, and their reporting bias scores were almost as large as their hypnotic deafness reports. Subjects also biased their ratings of strategy use. In Experiment 2, ratings of blindness given in response to a hypnotic negative visual hallucination suggestion were significantly correlated with reporting bias scores obtained in this paradigm. Although hypnotic blindness and hypnotic deafness correlated significantly, the partial correlation between these variables was nonsignificant when reporting bias scores were statistically controlled. Theoretical implications are discussed.     

An attempt to induce lower moral reasoning under hypnotic and task-motivated age regression

In this study, we attempted to partially replicate and extend the findings of the Page (1985) study of hypnotic age regression and moral reasoning. The Kohlberg (1976) Moral Judgment Interview (MJI) was used to assess the initial stage of moral reasoning in 32 adults who were preselected on the basis of their hypnotic susceptibility. Subjects were hypnotized and age regressed to two of four possible ages (16, 13, 10, and 7), or were given task-motivation instructions before being age regressed. All were then administered the MJI, which involves the resolution of certain dilemmas. Both groups were able to lower their moral reasoning scores when given age regression instructions, but no significant differences were found between groups. Thus the results of this study are inconsistent with those of Page (1985), but are consistent with those of O'Brien et al. (1977). Reasons for the failure to reaffirm the earlier results of Page (1985) are discussed.     

The treatment of tension headache—II. EMG ‘normality’ and relaxation

A selected group of patients complaining of severe and chronic tension headache (without muscular abnormality) were given a short 3-week course of relaxation treatment. Half of the subjects received progressive relaxation instructions, while the other half received relaxation plus calming imagery. Both groups showed substantial improvements in pain behaviour and in pain experience. The improvements were synchronous and still present at the 6–8 week follow-up assessment. Although no significant differences were found between the groups, the addition of imagery appeared to produce larger improvements on a number of measures. These results were compared with those reported obtained in a previous biofeedback study and the implications of both the studies were discussed with respect to tension headache and its treatment.     

The influence of instructions on the adjustment of scales

In each of three experiments, one group of subjects first judged the eight largest and another group first judged the eight smallest of a graded series of 16 squares according to size. After four blocks of trials, both groups were shifted to the total series. The subjects changed their scales only slightly when no specific instructions were given at the point of shift (Experiment 1). They were able to maintain their old scales or construct new ones, if instructed to do so (Experiment 2). They were also able to do both things in parallel (Experiment 3). An additional finding was that responses to the "old" stimuli (those being part of the training series) were slower than responses to the "new" ones (those introduced after the shift), independently by of instructions. Furthermore, responses to the old stimuli were faster when these had to be rated on the new scale, and responses to the new stimuli were faster when these had to be rated on the old scale. The findings are interpreted as supporting a conditioning theory of judgment.     

Mechanisms of hypnotic and nonhypnotic forgetting

Subjects participated in two experimental sessions designed to study laboratory-induced amnesia, one using a standard hypnosis paradigm and one using a non-hypnotic directed-forgetting paradigm. Two independent sources of variation were derived from the hypnotic amnesia data: retrieval inhibition and inhibition release. In the nonhypnotic directed-forgetting procedure, some items were cued to be forgotten shortly after presentation and some were cued to be remembered. At test, the subjects were asked to recall both the to-be-remembered and the to-be-forgotten items. Over 39% of the variance in the recall of the to-be-forgotten items could be accounted for by the inhibition and release constructs obtained with hypnosis. These relations between the two procedures were not mediated by verbal ability or cognitive style (field independence). We concluded that the mechanisms of forgetting involved in laboratory demonstrations of hypnotic and nonhypnotic amnesia are related, and the implication is that some of them are the same, namely, retrieval inhibition and inhibition release. We also argued that the possible demand characteristics that accompany the hypnosis procedure are not apparent with the nonhypnotic procedure. Therefore, the relationships observed in the present results were taken as evidence that hypnotically induced amnesia is not entirely the result of subjects' reactions to demand characteristics.     

Cognition and Self-Control: Cognitive Control of Painful Sensory Input

Eighty Ss were first tested for base-level response to a pain-producing stimulus and then were re-tested on the same pain stimulus after receiving 1 of 8 experimental treatments. The 8 treatments were arranged in a 2 x 2 x 2 factorial design: presence or absence of hypnotic induction procedure; presence or absence of instructions for anesthesia; and presence or absence of demands for honest reports. Neither the hypnotic-induction procedure nor the demands for honesty affected the Ss'reports of the degree of pain experienced. The anesthesia instructions--"think of the hand as numb and insensitive as if it were a piece of rubber..."--produced an equal degree of pain reduction in hypnotic and non-hypnotic Ss and in Ss who were and those who were not exposed to demands for honesty. The results indicate that (a) Ss' reports of pain are less affected by demands for honesty and are more closely related to their actual experiences than has been previously assumed and (b) instructions which direct Ss to exercise cognitive control over painful sensory input are effective (with or without 'hypnosis') in reducing the experience of pain.