Hypnosis is a state of human consciousness involving focused attention and reduced peripheral awareness and an enhanced capacity for response to suggestion. Theories explaining what occurs during hypnosis fall into two groups. Altered state theories see hypnosis as an altered state of mind or trance, marked by a level of awareness different from the ordinary conscious state. In contrast, Non-state theories see hypnosis as a form of imaginative role-enactment.
During hypnosis, a person is said to have heightened focus and concentration. The person can concentrate intensely on a specific thought or memory, while blocking out sources of distraction. Hypnotised subjects are said to show an increased response to suggestions. Hypnosis is usually induced by a procedure known as a hypnotic induction involving a series of preliminary instructions and suggestions. The use of hypnotism for therapeutic purposes is referred to as "hypnotherapy", while its use as a form of entertainment for an audience is known as "stage hypnosis".
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.
Hypnosis is normally preceded by a "hypnotic induction" technique. Traditionally, this was interpreted as a method of putting the subject into a "hypnotic trance"; however, subsequent "nonstate" theorists have viewed it differently, seeing it as a means of heightening client expectation, defining their role, focusing attention, etc. There are several different induction techniques. One of the most influential methods was Braid's "eye-fixation" technique, also known as "Braidism". Many variations of the eye-fixation approach exist, including the induction used in the Stanford Hypnotic Susceptibility Scale (SHSS), the most widely used research tool in the field of hypnotism. Braid's original description of his induction is as follows:
James Braid's Original Eye-Fixation Hypnotic Induction Method
Take any bright object (e.g. a lancet case) between the thumb and fore and middle fingers of the left hand; hold it from about eight to fifteen inches from the eyes, at such position above the forehead as may be necessary to produce the greatest possible strain upon the eyes and eyelids, and enable the patient to maintain a steady fixed stare at the object.
The patient must be made to understand that he is to keep the eyes steadily fixed on the object, and the mind riveted on the idea of that one object. It will be observed, that owing to the consensual adjustment of the eyes, the pupils will be at first contracted: They will shortly begin to dilate, and, after they have done so to a considerable extent, and have assumed a wavy motion, if the fore and middle fingers of the right hand, extended and a little separated, are carried from the object toward the eyes, most probably the eyelids will close involuntarily, with a vibratory motion. If this is not the case, or the patient allows the eyeballs to move, desire him to begin anew, giving him to understand that he is to allow the eyelids to close when the fingers are again carried towards the eyes, but that the eyeballs must be kept fixed, in the same position, and the mind riveted to the one idea of the object held above the eyes. In general, it will be found, that the eyelids close with a vibratory motion, or become spasmodically closed.
Braid later acknowledged that the hypnotic induction technique was not necessary in every case and subsequent researchers have generally found that on average it contributes less than previously expected to the effect of hypnotic suggestions. Variations and alternatives to the original hypnotic induction techniques were subsequently developed. However, this method is still considered authoritative: "It can be safely stated that nine out of ten hypnotic techniques call for reclining posture, muscular relaxation, and optical fixation followed by eye closure."
When James Braid first described hypnotism, he did not use the term "suggestion" but referred instead to the act of focusing the conscious mind of the subject upon a single dominant idea. Braid's main therapeutic strategy involved stimulating or reducing physiological functioning in different regions of the body. In his later works, however, Braid placed increasing emphasis upon the use of a variety of different verbal and non-verbal forms of suggestion, including the use of "waking suggestion" and self-hypnosis. Subsequently, Hippolyte Bernheim shifted the emphasis from the physical state of hypnosis on to the psychological process of verbal suggestion.
I define hypnotism as the induction of a peculiar psychical [i.e., mental] condition which increases the susceptibility to suggestion. Often, it is true, the [hypnotic] sleep that may be induced facilitates suggestion, but it is not the necessary preliminary. It is suggestion that rules hypnotism.
Bernheim's conception of the primacy of verbal suggestion in hypnotism dominated the subject throughout the twentieth century, leading some authorities to declare him the father of modern hypnotism.
Contemporary hypnotism uses a variety of suggestion forms including direct verbal suggestions, "indirect" verbal suggestions such as requests or insinuations, metaphors and other rhetorical figures of speech, and non-verbal suggestion in the form of mental imagery, voice tonality, and physical manipulation. A distinction is commonly made between suggestions delivered "permissively" and those delivered in a more "authoritarian" manner. Harvard hypnotherapist Deirdre Barrett writes that most modern research suggestions are designed to bring about immediate responses, whereas hypnotherapeutic suggestions are usually post-hypnotic ones that are intended to trigger responses affecting behavior for periods ranging from days to a lifetime in duration. The hypnotherapeutic ones are often repeated in multiple sessions before they achieve peak effectiveness.
The conscious and the unconscious mind
Some hypnotists view suggestion as a form of communication that is directed primarily to the subject's conscious mind, whereas others view it as a means of communicating with the "unconscious" or "subconscious" mind. These concepts were introduced into hypnotism at the end of the 19th century by Sigmund Freud and Pierre Janet. Sigmund Freud's psychoanalytic theory describes conscious thoughts as being at the surface of the mind and unconscious processes as being deeper in the mind. Braid, Bernheim and other Victorian pioneers of hypnotism did not refer to the unconscious mind but saw hypnotic suggestions as being addressed to the subject's conscious mind. Indeed, Braid actually defines hypnotism as focused (conscious) attention upon a dominant idea (or suggestion). Different views regarding the nature of the mind have led to different conceptions of suggestion. Hypnotists who believe that responses are mediated primarily by an "unconscious mind", like Milton Erickson, make use of indirect suggestions such as metaphors or stories whose intended meaning may be concealed from the subject's conscious mind. The concept of subliminal suggestion depends upon this view of the mind. By contrast, hypnotists who believe that responses to suggestion are primarily mediated by the conscious mind, such as Theodore Barber and Nicholas Spanos, have tended to make more use of direct verbal suggestions and instructions.
The first neuropsychological theory of hypnotic suggestion was introduced early on by James Braid who adopted his friend and colleague William Carpenter's theory of the ideo-motor reflex response to account for the phenomenon of hypnotism. Carpenter had observed from close examination of everyday experience that under certain circumstances the mere idea of a muscular movement could be sufficient to produce a reflexive, or automatic, contraction or movement of the muscles involved, albeit in a very small degree. Braid extended Carpenter's theory to encompass the observation that a wide variety of bodily responses besides muscular movement can be thus affected, for example, the idea of sucking a lemon can automatically stimulate salivation, a secretory response. Braid, therefore, adopted the term "ideo-dynamic", meaning "by the power of an idea", to explain a broad range of "psycho-physiological" (mind-body) phenomena. Braid coined the term "mono-ideodynamic" to refer to the theory that hypnotism operates by concentrating attention on a single idea in order to amplify the ideo-dynamic reflex response. Variations of the basic ideo-motor, or ideo-dynamic, theory of suggestion have continued to exercise considerable influence over subsequent theories of hypnosis, including those of Clark L. Hull, Hans Eysenck, and Ernest Rossi. It should be noted that in Victorian psychology the word "idea" encompasses any mental representation, including mental imagery, memories, etc.
Braid made a rough distinction between different stages of hypnosis, which he termed the first and second conscious stage of hypnotism; he later replaced this with a distinction between "sub-hypnotic", "full hypnotic", and "hypnotic coma" stages. Jean-Martin Charcot made a similar distinction between stages which he named somnambulism, lethargy, and catalepsy. However,Ambroise-Auguste Liébeault and Hippolyte Bernheim introduced more complex hypnotic "depth" scales based on a combination of behavioural, physiological and subjective responses, some of which were due to direct suggestion and some of which were not. In the first few decades of the 20th century, these early clinical "depth" scales were superseded by more sophisticated "hypnotic susceptibility" scales based on experimental research. The most influential were the Davis-Husband and Friedlander-Sarbin scales developed in the 1930s. André Weitzenhoffer and Ernest R. Hilgard developed the Stanford Scale of Hypnotic Susceptibility in 1959, consisting of 12 suggestion test items following a standardised hypnotic eye-fixation induction script, and this has become one of the most widely referenced research tools in the field of hypnosis. Soon after, in 1962, Ronald Shor and Emily Carota Orne developed a similar group scale called the Harvard Group Scale of Hypnotic Susceptibility (HGSHS).
Whereas the older "depth scales" tried to infer the level of "hypnotic trance" from supposed observable signs such as spontaneous amnesia, most subsequent scales have measured the degree of observed or self-evaluated responsiveness to specific suggestion tests such as direct suggestions of arm rigidity (catalepsy). The Stanford, Harvard, HIP, and most other susceptibility scales convert numbers into an assessment of a person's susceptibility as 'high', 'medium', or 'low'. Approximately 80% of the population are medium, 10% are high and 10% are low. There is some controversy as to whether this is distributed on a “normal” bell-shaped curve or whether it is bi-modal with a small “blip” of people at the high end. Hypnotizability Scores are highly stable over a person’s lifetime. Research by Deirdre Barrett has found that there are two distinct types of highly susceptible subjects, which she terms fantasizers and dissociaters. Fantasizers score high on absorption scales, find it easy to block out real-world stimuli without hypnosis, spend much time daydreaming, report imaginary companions as a child and grew up with parents who encouraged imaginary play. Dissociaters often have a history of childhood abuse or other trauma, learned to escape into numbness, and to forget unpleasant events. Their association to “daydreaming” was often going blank rather than creating vividly recalled fantasies. Both score equally high on formal scales of hypnotic susceptibility.
Individuals with dissociative identity disorder have the highest hypnotizability of any clinical group, followed by those withposttraumatic stress disorder.
In the latter half of the twentieth century, two factors contributed to the development of the cognitive-behavioural approach to hypnosis:
- Cognitive and behavioural theories of the nature of hypnosis (influenced by the theories of Sarbin) and Barber became increasingly influential.
- The therapeutic practices of hypnotherapy and various forms of cognitive-behavioural therapy overlapped and influenced each other.
Although cognitive-behavioural theories of hypnosis must be distinguished from cognitive-behavioural approaches to hypnotherapy, they share similar concepts, terminology, and assumptions and have been integrated by influential researchers and clinicians such asIrving Kirsch, Steven Jay Lynn, and others.
At the outset of cognitive-behavioural therapy during the 1950s, hypnosis was used by early behaviour therapists such as Joseph Wolpe and also by early cognitive therapists such as Albert Ellis. Barber, Spanos and Chaves introduced the term "cognitive-behavioural" to describe their "nonstate" theory of hypnosis in Hypnosis, imagination, and human potentialities. However, Clark L. Hull had introduced a behavioural psychology as far back as 1933, which in turn was preceded by Ivan Pavlov. Indeed, the earliest theories and practices of hypnotism, even those of Braid, resemble the cognitive-behavioural orientation in some respects.
Hypnotherapy is a use of hypnosis in psychotherapy. It is used by licensed physicians, psychologists, and others. Physicians and psychologists may use hypnosis to treat depression, anxiety, eating disorders, sleep disorders, compulsive gaming, and posttraumatic stress, while certified hypnotherapists who are not physicians or psychologists often treat smoking and weight management.
Hypnotherapy is a helpful adjunct having additive effects when treating psychological disorders, such as these, along with scientifically proven cognitive therapies. Hypnotherapy should not be used for repairing or refreshing memory, because hypnosis results in memory hardening which increases the confidence in false memories.
Modern hypnotherapy has been used in a variety of forms with varying success, such as:
- Cognitive-behavioral hypnotherapy, or clinical hypnosis combined with elements of cognitive behavioral therapy
- Age regression hypnotherapy (or "hypnoanalysis")
- Ericksonian hypnotherapy
- Fears and phobias
- Habit control
- Pain management
- Skin disease
- Soothing anxious surgical patients
- Sports performance
- Weight loss
In a January 2001 article in Psychology Today Harvard psychologist Deirdre Barrett wrote:
A hypnotic trance is not therapeutic in and of itself, but specific suggestions and images fed to clients in a trance can profoundly alter their behavior. As they rehearse the new ways they want to think and feel, they lay the groundwork for changes in their future actions...
and she described specific ways this is operationalized for habit change and amelioration of phobias. In her 1998 book of hypnotherapy case studies, she reviews the clinical research on hypnosis with dissociative disorders, smoking cessation, and insomnia and describes successful treatments of these complaints.
In a July 2001 article for Scientific American titled "The Truth and the Hype of Hypnosis", Michael Nash wrote:
...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.
Irritable bowel syndrome
Hypnotherapy has been studied for the treatment of irritable bowel syndrome. Hypnosis for IBS has received moderate support in the National Institute for Health and Clinical Excellence guidance published for UK health services. It has been used as an aid or alternative to chemical anesthesia, and it has been studied as a way to soothe skin ailments.
A number of studies show that hypnosis can reduce the pain experienced during burn-wound debridement, bone marrow aspirations, and childbirth. The International Journal of Clinical and Experimental Hypnosis found that hypnosis relieved the pain of 75% of 933 subjects participating in 27 different experiments.
Hypnosis is effective in reducing pain from and coping with cancer and other chronic conditions. Nausea and other symptoms related to incurable diseases may also be managed with hypnosis. Some practitioners have claimed hypnosis might help boost the immune system of people with cancer. However, according to the American Cancer Society, "available scientific evidence does not support the idea that hypnosis can influence the development or progression of cancer."
Hypnosis has been used as a pain relieving technique during dental surgery and related pain management regimens as well. Researchers like Jerjes and his team have reported that hypnosis can help even those patients who have acute to severe orodental pain. What is more, Meyerson and Uziel have suggested that hypnotic methods have been found to be highly fruitful for alleviating anxiety in patients suffering from severe dental phobia.
For some psychologists who uphold the altered state theory of hypnosis, pain relief in response to hypnosis is said to be the result of the brain’s dual-processing functionality. This effect is obtained either through the process of selective attention or dissociation, in which both theories involve the presence of activity in pain receptive regions of the brain, and a difference in the processing of the stimuli by the hypnotized subject. Myers, David G. (2014). Psychology: Tenth Edition in Modules (10th ed.). Worth Publishers. pp. 112–113.
The American Psychological Association published a study comparing the effects of hypnosis, ordinary suggestion and placebo in reducing pain. The study found that highly suggestible individuals experienced a greater reduction in pain from hypnosis compared with placebo, whereas less suggestible subjects experienced no pain reduction from hypnosis when compared with placebo. Ordinary non-hypnotic suggestion also caused reduction in pain compared to placebo, but was able to reduce pain in a wider range of subjects (both high and low suggestible) than hypnosis. The results showed that it is primarily the subject's responsiveness to suggestion, whether within the context of hypnosis or not, that is the main determinant of causing reduction in pain.
Other medical and psychotherapeutic uses
Treating skin diseases with hypnosis (hypnodermatology) has performed well in treating warts, psoriasis, and atopic dermatitis.
The success rate for habit control is varied. A meta-study researching hypnosis as a quit-smoking tool found it had a 20 to 30 percent success rate, while a 2007 study of patients hospitalised for cardiac and pulmonary ailments found that smokers who used hypnosis to quit smoking doubled their chances of success.
Hypnosis may be useful as an adjunct therapy for weight loss. A 1996 meta-analysis studying hypnosis combined with cognitive-behavioural therapy found that people using both treatments lost more weight than people using CBT alone. The virtual gastric band procedure mixes hypnosis with hypnopedia. The hypnosis instructs the stomach it is smaller than it really is and hypnopedia reinforces alimentary habits.
Controversy surrounds the use of hypnotherapy to retrieve memories, especially those from early childhood or (supposed) past-lives. The American Medical Association and the American Psychological Association caution against recovered-memory therapy in cases of alleged childhood trauma, stating that "it is impossible, without corroborative evidence, to distinguish a true memory from a false one." Past life regression, meanwhile, is often viewed with skepticism.
Psychiatric nurses in most medical facilities are allowed to administer hypnosis to patients in order to relieve symptoms such as anxiety, arousal, negative behaviors, uncontrollable behavior, and improve self-esteem and confidence only when they have been completely trained about their clinical side effects and while under supervision when administering it.