The word “hypnosis” has many connotations. For some people, it conjures up visions of a stage entertainer who uses hypnosis to make volunteers behave foolishly for the audience’s amusement. At the other extreme are those who, in our self-help era, see hypnosis as a quick and easy cure-all for their problems, from smoking to chronic back pain. Hypnosis is neither a tool to control other minds nor a panacea. It is, rather, a natural phenomenon that helps people harness their inner resources to improve their physical, emotional, and mental well-being. The ability to hypnotize or to be hypnotized is latent in everyone. Hypnosis can be induced without a formal induction procedure and is part of everyday existence. When we become so absorbed in a book or a film that we are oblivious to external stimuli, we have put ourselves in a light hypnotic trance. When a mother kisses a child’s hurt to “make it better,” she is using the principle of hypnotic suggestion. In a clinical setting, these principles are applied in such a way that their effects are heightened and directed to specific problems. We are being hypnotized—allowing ourselves to change states of consciousness—to some degree all the time. Many “miraculous” cures can be attributed to the physician’s (or faith healer’s or shaman’s) power of suggestion—the ability to convince the patient that a particular treatment will bring the desired results. People in advertising have long understood the power of suggestion to influence the consumer. We are bombarded with both direct and indirect suggestions about what we should eat, drink, own, and do; what we should look like, read, and believe. Many evangelists use hypnotic techniques intuitively. On the basis of studying the communication patterns of highly effective therapists, including Milton Erickson, the grand master of modern clinical hypnosis, Bandier and Grinder (1975, 1976) developed a neurolinguistic programming model that can be used to enhance the communication skills of other therapists. Moine (1982) found that successful salespeople in a variety of fields, from insurance to jet airplanes, used the same communication patterns, and he concluded that “superior sellers use the techniques of the clinical hypnotist; mediocre ones do not” (p . 52). The pervasiveness of hypnotic phenomena has been summarized by Muses (1974), who expressed the view that all acculturation is essentially slow hypnosis. Clinical hypnosis is entering a modern renaissance, dovetailing with a growing interest in biofeedback, natural approaches to healing, neurolinguistic programming, and non-pharmacological paths to altered states of consciousness. In 1955, the British Medical Association formally approved hypnosis as a valid and supported therapeutic technique. In 1958, the American Medical Association and the American Dental Association sanctioned its use in treatment. Today, the number of medical schools, dental schools, and graduate schools in psychology that offer courses in hypnotic techniques is steadily increasing. Historically considered to be “unscientific” or faddish, hypnosis is gradually being applied in most medical specialties. Hypnotic techniques also are being popularized under many names- including visualization, mental rehearsal, and guided imagery- for the purpose of self-improvement. Mind-Play (Singer and Switzer, 1980), the Inner Athlete (Nideffer, 1976), and Visualization: Directing the Movies of Your Mind (Bry, 1978) are a few of many such publications in recent literature. The use of hypnosis to improve human life is more widespread than ever. As interest in hypnosis increases, research continues to extend its applications to a variety of approaches to physical and psychological change.
[Hypnosis] is a universal agent, there is nothing new in it but the name; and it is a paradox only to those who are disposed to ridicule everything and who ascribe to the influence of Satan all those phenomena which they cannot explain.
-Jan Baptist van Helmont De Magneticum Vulneratum Curatione
MISCONCEPTIONS
Hypnosis has not yet been completely demystified. In most bookstores, books on the subject of hypnosis are still shelved under “Occult.” Stage hypnotists and sensational stories in the media often perpetuate false ideas about hypnosis that are unrelated to clinical use and that can make the use of hypnosis in a clinical situation more difficult. The following common fears are often mentioned by patients who are considering hypnosis for the first time. Any practitioner must address these misconceptions before using hypnosis with a patient. Hypnosis is a state of sleep or unconsciousness. The word “hypnosis,” from the Greek hypnos (to sleep), is a misnomer. Under hypnosis, a patient is not asleep, but in a state of relaxed attentionalert, able to hear, speak, move around, and think. The electroencephalogram (EEG) of a hypnotized person is that of someone who is awake rather than asleep. Reflexes, such as the knee jerk, which are absent during sleep, are present under hypnosis. It is common for persons who have achieved a light trance to argue that they haven’t been hypnotized at all. Only gullible, weak-willed, or passive people can be hypnotized. The reverse is true. More intelligent, strong-willed, creative people tend to be the most responsive to hypnosis because their powers of concentration are better. The role of the practitioner using hypnosis is to direct this concentration as an orchestra conductor directs the orchestra. In any case, strong motivation is the most important factor in the ability to participate in the hypnotic experience. Hypnosis allows someone else to control your mind. Stage hypnotists sometimes give the impression that they are exercising power over a subject, that they can make people act any way that they want them to act. In fact, people cannot be hypnotized against their will and, once under hypnosis, cannot be forced to do something they find objectionable. A hypnotic suggestion is only effective to the extent that it is accepted by the patient. (See Conn, 1981, for a further discussion of this myth.) Clinical hypnosis is a means of giving people more, not less, control over their lives and behavior. A hypnotized person might be unable to come out of a trance. It is more difficult to induce and maintain a trance state than it is to slip out of one. If a hypnotherapist stops talking or leaves the room, a patient will either come out of the trance or drift into slumber and awaken naturally. A hypnotized person will give away secrets. Only in film or fiction can hypnosis be used to extract secrets from an unwilling subject. In life, a hypnotized person is aware of everything that happens both during and after hypnosis unless the person accepts and follows a specific suggestion for amnesia. While hypnosis can help patients to express what they want or need to express, it cannot force them to reveal secrets unwillingly. I probably cannot be hypnotized. Although some people are more responsive to hypnosis than others, nearly everyone can achieve at least a light trance. Factors that may interfere with patients’ responsiveness to hypnosis include trying too hard, maintaining fears or misconceptions about hypnosis, or desiring unconsciously to retain the problem ·for which treatment has been sought. An experienced practitioner can help the patient to overcome such resistance. Hypnosis is a quick, easy cure-all. This misconception is at the opposite extreme from the notion that hypnosis is a mysterious and dangerous phenomenon. Hypnosis loses more credibility by such extravagant and inaccurate claims than it does from arguments voiced against it. In a clinical setting, hypnosis is a vehicle for change, often used in conjunction with psychotherapy or medical treatment. In some cases, dramatic results can be achieved in a few sessions. However, treatment for habits or symptoms that have developed over years can be very complex and may take much longer. People seeking therapy or medical treatment are not the only ones with these misconceptions. Similar misunderstandings about hypnosis may have kept many physicians, dentists, and psychologists from incorporating hypnotic principles into their professional practices.
DANGERS
To dispel the myths about hypnosis is not to say that there are no dangers associated with it. Like any tool or technique, it can be misused. The biggest problem is the use of hypnosis outside of a clinical setting, especially for entertainment. Stage hypnotists are adept at direct, rapid inductions and at choosing responsive subjects from an audience. Their expertise usually ends there. Hartland (1971) recounts the incident of a secretary who was given the post-hypnotic suggestion by a stage hypnotist that she would fall asleep every time she heard the tune “I’m So Tired.” When the orchestra played the tune from time to time, she did fall asleep, much to the amusement of the audience. Unfortunately, the performer neglected to remove the suggestion. Two days later, when the secretary heard an office boy whistling the tune, she immediately fell asleep at her desk. Forgetting to remove a suggestion is only one of the potential problems caused by the untrained hypnotist. The amateur might underestimate a subject’s physiological reaction to a suggestion of physical activity, for example, possibly producing disastrous effects in someone with a heart condition. It also is possible to awaken accidentally a traumatic memory in a subject (Kleinhauz, Dreyfuss, Berna, Goldberg, and Azikiri, 1979), stimulating reactions the entertainer is not equipped to handle. For these reasons, the American Society of Clinical Hypnosis (ASCH), the Society for Clinical and Experimental Hypnosis (SCEH), and trained practitioners everywhere overwhelmingly oppose the use of hypnosis as entertainment. Unfortunately, there are no federal laws governing the use of hypnosis, and few states have licensing procedures. In most states, anyone can adopt the title of “hypnotist” and advertise in the yellow pages. Clinical hypnosis, as discussed in this book, refers only to the use of hypnosis by a professional who is qualified to treat a patient in other ways as well and who chooses to use hypnosis as an adjunct to clinical practice. Like any treatment modality, hypnosis can be misused, even in a clinical setting. In such instances, however, it is not hypnosis per se that is the problem, but rather the practitioner’s misdiagnosis or mismanagement of the psychotherapeutic situation. Some traditional therapists express the concern that, if hypnosis is used to remove a symptom such as compulsive overeating or phobia, another, possibly worse, symptom will take its place. This issue has been addressed by many authors (Cheek and LeCron, 1968; Hartland, 1971; Hershman, 1980; Kroger, 1977; Wolberg, 1945), who agree that there is no evidence that unless the cause is treated another ailment will appear. If a patient has a strong need to retain a symptom, hypnosis usually will not be effective in removing it. As stated above, suggestions are only effective when they are accepted by the patient. By wording suggestions permissively and teaching the patient self-hypnosis (see Chapters 4 and 6), the practitioner can reduce if not eliminate the likelihood of symptom substitution. Furthermore, the authors have found that the improvement in well-being resulting from the removal of a distressing symptom is often generalized to other areas of a patient’s life. Kroger (1977) summarized the situation: The incontrovertible fact is that it is doubtful if, when properly used, there is another modality less dangerous in medicine than hypnosis. Yet there is no medical technic which makes a better “whipping boy” than hypnosis! (p. 104) Conn (1972) came to the same conclusion: “There are no significant or specific dangers associated with hypnosis per se” (p. 61). In a combined 40 years of experience with clinical hypnosis, the authors of this book have observed no dangerous side effects resulting from the use of hypnosis in a clinical setting.
DEFINITIONS AND THEORIES OF HYPNOSIS
Hypnosis is difficult to define because no one knows exactly how it works or why. According to the ASCH (1973), “none of the definitions of hypnosis satisfies the criteria for a good scientific theory” (p. 1). As in many fields, practical application has far outdistanced scientific comprehension. For example, the fact that the mechanisms through which chemoanesthetics operate upon the body are not clearly understood has not prevented their widespread use in medicine. Similarly, many practitioners find hypnosis an effective treatment modality for a wide variety of problems, even though researchers have not yet provided a comprehensive scientific explanation for its effectiveness . Hypnosis lends itself easily to laboratory study, and considerable research has been conducted on the physiological, behavioral, and phenomenological indices of the trance state. The results of research have raised as many questions as they have answered. No single set of physiological correlates has been identified with hypnosis; certain behaviors closely associated with hypnosis also have been observed to occur in nonhypnotic states; and self-reports of the hypnotic experience do not necessarily correlate with other measures. In the eighteenth century, Franz Mesmer hypothesized the physiological basis for hypnosis as a magnetic fluid that flowed inside all animate and inanimate bodies. Although his theory has long since been discounted, researchers have continued to search for the physiological foundations of hypnosis. In the nineteenth century, behavioral manifestations of the hypnotic trance led James Braid to coin the word “neurohypnotism,” or nervous sleep. In the twentieth century, Ivan Pavlov still believed that hypnosis was a “partial sleep” that involved inhibition of some brain functions. To his credit, Braid soon realized that hypnosis bore no resemblance to actual sleep (a fact that research has long since corroborated) and tried to substitute the word “monoideism,” or single idea, because he found that trance induction relies on fixation of attention. But “hypnosis” had caught on. Nearly 140 years later, we are still trying to explain hypnosis exactly. The complexity of hypnosis is indicated by the sheer number of theories advanced to explain it over the past two centuries. The following include a sampling of theories that at one time or another have enjoyed some degree of popularity. Psychoanalytic theories claim that the hypnotized person regresses to childhood and associates the hypnotist with a parent he or she then strives to obey. Although age regression is one of the phenomena associated with hypnosis, childhood regression theories run counter to modem clinical practice, which understands the power of hypnosis to reside in the patient, and not in the practitioner. Dissociation theories contend that the hypnotized person is dissociated from the conscious mind or external events. Dissociation is characteristic of the hypnotic state, but like many hypnotic phenomena, it is also characteristic of other states, such as dreaming. A lowered sensory threshold, in which colors seem more vivid and hearing is more acute, also is common in hypnosis. The role-playing theory asserts that a hypnotized person behaves the way he or she believes a hypnotized person is supposed to behave. Although most patients do try to cooperate with and please the practitioner using hypnosis, this theory cannot encompass indirect methods of hypnosis, spontaneous hypnotic states, and the fact that young children with no concept of hypnosis can be hypnotized. Atavistic theories describe hypnosis as a regression to a primitive mode of mental functioning like that exhibited by animals as a defense mechanism to ward off fear or danger. That some people will spontaneously put themselves into a trance when they are undergoing medical or dental procedures suggests that this ability may have developed as a phylogenetic adaptive response mechanism. The theory of hypersuggestibility postulates that hypnosis merely focuses the patient’s attention on the words of the hypnotist to the exclusion of everything else. Again, this theory explains one aspect of hypnosis-increased suggestibility-but fails to include other hypnotic phenomenon. It also emphasizes the role of the practitioner and underplays the choices of the patient. The altered state of consciousness theory views hypnosis as an altered state similar to that achieved through meditation, biofeedback, and autogenic training. (See Chapter 3 for a detailed dicussion of this approach to understanding hypnosis.) One of the most respected practitioners in the field, Erickson (Erickson, Rossi, and Rossi, 1976) never formulated a theory of hypnosis and maintained a pragmatic approach to its discussion and application. The authors of this book agree with Fromm (1972) that “as interest in the subjective aspects of hypnosis increases . . . the search for physiological and neuroelectric substrata of hypnosis as proof of the existence of a hypnotic state will fade into the background” (p. 583). There remains a need, however, to clarify the term hypnosis, which can refer either to a state of mental functioning or to the process by which that state is achieved. Although most authors agree that hypnosis involves a focus or concentration of attention away from the external environment and towards a set of ideas suggested by oneself (self-hypnosis) or another (hetero-hypnosis), there is no single generally accepted definition of this condition. There are as many definitions as there are authors; in a sample of definitions, hypnosis is, variously: … a complex of two fundamental processes. The first is the construction of a special, temporary orientation to a small range of preoccupations and the second is the relative fading of the generalized reality-orientation into nonfunctional awareness. (Shor, 1959, p. 592) . . . not a sharply delineated state, but a process along the broad, fluctuating continuum of what is loosely referred to as awareness …. (Kroger, 1977, p. 312) . . . an altered state of consciousness usually involving relaxation, in which a person develops heightened concentration on a particular idea or image for the purpose of maximizing potential in one or more areas. (Olness and Gardner, 1978, p. 228) . . . a state in which the critical mental faculties are temorarily suspended and the person uses mainly imagination or primary process thinking. (Araoz, 1982, p . 9) It is generally accepted among researchers and practitioners that suggestibility is closely connected to hypnosis. In the opinion of Gindes (1973), for example, “the entire procedure of hypnosis, from induction to awakening, is founded upon suggestion” (p. 175). The Russians call hypnosis “suggestology,” highlighting their view of the important role suggestion plays in hypnotic induction and treatment. However, as Erickson (Erickson et al., 1976) has pointed out, the trance state does not guarantee that suggestions will be accepted. There still is controversy over whether hypnosis is a sharply delineated state for which researchers will be able to develop objective indices or merely a shift from one form of consciousness to another, from an external to an internal reality somewhere along a continuum of awareness. Is goal-directed daydreaming the same thing as hypnosis, or do we need signs, such as eye closure or limb rigidity, to guarantee that a person has been hypnotized? The authors agree with Erickson et al. (1976), who refer to the hypnotic trance as an extension of common, everyday processes of living, and who believe that the experience of trance can vary from one person to another. For the moment, however, definitions and theories are of less concern than function in modern clinical practice.
TRENDS IN CLINICAL HYPNOSIS
The use of hypnosis in medicine, dentistry, and psychotherapy has greatly increased over the past 20 years. Articles on the use of hypnosis are regularly contributed to the American Journal of Clinical Hypnosis and the International Journal of Clinical and Experimental Hypnosis, by physicians, psychotherapists, dentists, and other clinicians and researchers. Since ASCH was organized in 1957, its membership has increased from 20 to approximately 4,300 members. ASCH members must have a doctoral degree in psychology, dentistry, or medicine; they must have training and experience in clinical hypnosis, as well as meet additional criteria. As a treatment methodology, hypnosis is unique in the wide variety of problems to which it can be applied. The rapidly growing body of research demonstrating that the mind has a direct influence on bodily processes has paved the way for increasing use of hypnosis in medical treatment and therapy. Biofeedback studies have shown that people can bring autonomic functions, such as heart rate and temperature, under conscious control. Yogis able to perform amazing feats of selfregulation have come under Western scientific scrutiny. Throughout history, the placebo has been found to have a variety of positive physiological effects, depending on which drug the patient believes he or she is receiving. In the past, hypnosis has been associated with dramatic or impressive cures. Since the 1950s, its use has been extended to routine procedures as well. Hypnosis can help to alter perceptions of pain, eliminate warts, and control bleeding and inflammation. It is being used before, during, and after surgery to help the patient relax, feel comfortable, and heal quickly. Hypnosis for pain management is used in a variety of contexts, from brief medical or dental procedures to terminal illnesses. Recently there has been increasing interest in the ability of patients to increase immune function through hypnosis; both clinical and research evidence have supported that hypothesis (see Hall, Longo, and Dixon, 1981). Hypnosis also is used to treat organic conditions with a psychogenic component. There is no longer any doubt that strong emotional states or unconscious psychological conflicts can in time cause organic symptoms or exacerbate existing organic pathology. By current estimates, 50%-80% of all illness is psychosomatic rather than organic. Hans Selye (1974), an authority in the physiology of stress, believes that stress plays a role in all diseases because it reduces the ability of the immunological system to function properly. Hypnosis helps people deal with stress or anxiety without relying on external sources. Although as Kroger (1977) pointed out, a patient is not treated by hypnosis, but in hypnosis, there is considerable evidence that for many problems the relaxation that accompanies the hypnotic state is beneficial in itself (see Chapter 3). Hypnosis in combination with psychotherapy can help patients understand the cause of symptoms and ameliorate or eliminate them. Under hypnosis, someone can be trained to relive an experience, modify disturbing mental images, and initiate new defenses or patterns that are healthier and more functional. As a technique for reaching the unconscious, hypnosis is an effective treatment methodology for many problems, from phobias to sexual dysfunction and obesity. A more recent use of hypnosis has been its application to nonpathological populations. Practitioners work with athletes to enhance athletic performance and with students to increase concentration and optimize test-taking ability. Both professional and recreational athletes are using hypnosis to reduce performance anxiety, build confidence, and promote concentration. Recent years have seen not only new applications of hypnosis, but a shift in our approach to clinical hypnosis. The realization that all hypnosis is essentially self-hypnosis is basic to modern clinical practice. Understanding of the patient’s innate ability to experience a change in consciousness, and even more importantly, the patient’s willingness to experience that change, is replacing the traditional conception of the “hypnotist” as one who does something to the patient. As a result, the practitioner’s role is now one of teacher or facilitator of change. This attitude is consistent with the larger trend toward holistic approaches to health, in which responsibility for well-being is returned to the individual, who has the inner resources for growth and change. More and more, hypnosis is seen as a process of learning on a new level rather than just obedience to suggestions formulated by the practitioner. The trend is away from formal, authoritarian inductions and toward the indirect, permissive techniques introduced by Erickson. The indirect approach gives the patient more freedom to create personally meaningful images and suggestions. Self-hypnosis is also becoming a greater part of clinical practice, as patients are asked to reinforce therapy or treatment by practicing self-hypnosis at home. Finally, the gap between experimental and clinical hypnosis seems to be widening to the extent that concepts that are useful for one are not always applicable to the other. For example, such issues as “hypnotizability” and depth of hypnosis are of less concern to many practitioners who have found that nearly everyone can be hypnotized. When hypnotic techniques facilitate desired change, the issue of whether or not the patient has actually been “hypnotized” becomes moot. As clinical work with hypnosis becomes more creative and more individualized with our current medical and psychological techniques, it becomes more difficult to offer empirical proof how and why hypnosis works.
THE HYPNOTIC SESSION
A typical session in a therapeutic situation begins with a discussion of the patient’s history (including likes and dislikes, current situation, and past experiences), the patient’s understanding of his or her problems, and the nature and purpose of treatment using hypnosis. This preliminary work is necessary if the practitioner is to tailor the induction procedure and suggestions to each patient’s needs and strengths. In other situations, such as emergency rooms or operating rooms, surgeons, anesthesiologists, or psychologists sometimes work with people they are seeing for the first time and must rely on brief conversations and external cues to personalize inductions and suggestions to the extent possible. An induction is a method of achieving a trance, moving from a usual state of consciousness into the hypnotic state. Because successful induction of hypnosis depends on concentration and relaxation, patients are asked to relax and make themselves comfortable; sometimes the practitioner will take a patient through specific techniques for muscle relaxation. In inducing hypnosis, the main concern is to quiet the conscious mind, the source of our judgmental, evaluative, and critical abilities, and to make the unconscious more accessible. The relationship of the unconscious mind, the seat of all of our memories, all our past experiences, all our associations, and all that we have ever learned, may be seen in perspective by analogy: If the conscious mind is a beach in San Diego, then the unconscious is the Pacific Ocean. Speculating on the power of hypnotic suggestion, Lewis Thomas (1979) talked about “a kind of superintelligence that exists in each of us, infinitely smarter and possessed of technical know-how far beyond our present understanding” (p. 65). When suggestions penetrate the unconscious mind, which exercises very little critical faculty, they are realized more completely and effectively than if they were given in a normal waking state. Using the technique of misdirected attention is an excellent way of bypassing the conscious mind. A mother trying to feed a recalcitrant child will dangle a toy in front of his eyes, and, once he is engrossed, put a spoon in his mouth. Similarly, the practitioner may have a patient focus attention on a target, such as an external object or the patient’s own breathing, and when the patient “isn’t paying any attention,” make suggestions for comfort and relaxation. Although there are as many kinds of inductions as there are practitioners, there are several common denominators. Ideally, the physical environment should be as distraction-free as possible, although hypnosis can be achieved under even the most chaotic conditions. The effect of any method of induction depends largely on the patient’s belief in the validity of the hypnotic phenomenon and in the practitioner’s integrity. Therefore, the practitioner must develop a good rapport with the patient and dispel any misconceptions about hypnosis. Closely related to belief, expectation is another powerful force at work. The person who expects to respond to hypnosis usually does so. The potency of expectation may be seen in an apprehensive patient who can feel the pain of the dentist’s drill before it touches him—or in the young girl waiting in anticipation, who hears the doorbell ring several times before her date arrives. This same principle is at work in faith healing, in which a certain ritual or suggestion has the expected effect on the physical organism. The induction process usually takes from a few minutes to an hour in a clinical setting. The resulting trance state has traditionally been characterized as light, medium, or deep, although these are not distinct states but rather points on a continuum. Studies using self-report scales to measure hypnotic depth have shown that trance depth fluctuates during any given session (Tart, 1972). Research also has shown that 90% of people can achieve what is considered to be a light trance; 70% can achieve a medium trance; and 10%-20% can enter a deep trance or somnambulistic state. For the most part, hypnotic depth is not related to the outcome of treatment. However, a deep state is required in some instances, such as when hypnosis is used as the sole anesthetic for major surgery. The type and length of induction varies according to the preference of the practitioner, the situation, the personality of the patient, and the goals of therapy or treatment. In general, inductions have moved away from traditional, direct, lock-step authoritarian approaches that use gadgetry such as spinning discs or pendulums, toward more permissive, indirect approaches that are more individualized, make greater use of symbol and metaphor in phrasing suggestions, and emphasize the patient’s responsibility and power of choice. The indirect method is often clinically more effective because patients feel more in control and have the sense that they are doing something for themselves rather than having something done to them. Chapter 4 provides a more specific discussion of the many approaches to hypnotic induction and treatment. Once a patient is in a relaxed state of attention, the practitioner makes positive, functional, and constructive suggestions. If the patient has no strong objections to the suggestions, they will be accepted uncritically without the interference of the conscious mind, which may intellectualize or rationalize. Suggestions may be phrased in many ways: permissive or commanding, direct or indirect, positive or negative. Research has shown that the way in which suggestions are phrased has a great influence on their effectiveness and outcome. After the specific suggestions have been made, the practitioner asks the patient to return to full waking or normal consciousness, usually incorporating the suggestion that he or she will feel refreshed and relaxed. Before ending the session, the practitioner discusses the patient’s experiences to gain insight for further sessions.
HYPNOTIC PHENOMENA
People who have been hypnotized usually recognize the experience as distinctly different from their usual waking or sleeping states, but beyond that realization, words often fail them. Most describe it as a relaxed, pleasant experience in which they feel detached, very reluctant to move, and have a lowered or increased sensory threshold, depending on the goals of the session. The outward signs of hypnosis may vary from person to person and from one time to another. In a neutral trance state, before the introduction of suggestions, most people show signs of lethargy and muscular relaxation. Breathing is heavier and slower, arms are limp, and the head may fall to one side or onto the chest. In this relaxed state, the heartbeat slows; blood pressure and heart rate decrease. With the introduction of suggestions, physiological reactions may vary according to the nature of the suggestions. Several kinds of behavior occur in a hypnotic trance, although not all occur every time. Some are routinely present even in a light trance; others are most often manifested in a medium to deep trance state; and still others are demonstrated as the result of specific suggestions. The phenomena associated with a light to medium trance depth are usually effective in cases where a practitioner would employ hypnosis as an adjunct to psychotherapeutic, medical, and dental treatment. Since these phenomena overlap one another, it is best to view them on a continuum rather than as a series of distinct occurrences. Release of inhibitions. (Light to deep trance.) Inhibitions normally present in the waking state partially disappear in a trance state, making it easier to express emotions, thoughts, and opinions concerning behaviors. Demonstrating to patients in trance that they can relax makes the next step- behavioral conditioning or insight-oriented psychotherapy- easier. Changes in capacity for volitional activity. (Light to deep trance.) In a trance state, people become reluctant to initiate actions arising from their own will. For example, when a telephone rings, a person normally jumps up to answer it. Under hypnosis, the same person hears the phone but has less interest in answering it because attention is focused elsewhere. This phenomenon can be used to increase trance depth through suggestions that external sounds become cues for entering a progressively deeper and deeper level of relaxation. Suggestibility. (Light to deep trance.) The ability to respond positively to ideas, whether given by oneself or another, heightened suggestibility is the sine qua non of hypnosis. Increased receptivity to suggestion is associated with decreased activity of the critical ego and increased activity of what might be called the observing ego, making the unconscious more accessible. Detachment. (Light to deep trance.) This phenomenon is a splitting process in which the perception of the body’s position in space and time is altered. People who have been hypnotized report, for example, that their arms or legs seemed to be very long or that they seemed to be watching themselves from a distance. Detachment can be used to facilitate the deepening phase of induction through suggestions that, as patients feel themselves moving away from their bodies, they can allow themselves to experience an increased sense of relaxation. This phenomenon also has obvious implications for pain control. Dissociation. (Medium to deep trance.) The ability to view oneself from a safe and comfortable distance, which is primarily a cognitive phenomenon, theoretically allows the process of emotional dissociation to occur. In hypnosis, a person can relive a negative experience without its discomfort or become dissociated from a present context that may be unhappy or painful. For example, through age regression, one can return to the death of a parent, see the event from a distant perspective, and leave behind or “disrupt” a representative portion of the old emotion associated with the event. Catalepsy. (Medium to deep trance.) With this form of muscular rigidity, a limb will remain in almost any position, such as an arm raised in the air or extended to the front or side. This phenomenon is sometimes used to demonstrate the ability of the unconscious to control muscular activity and also is useful as a deepening technique. Age regression. (Medium to deep trance.) Reliving past experiences in all five senses in a present context can occur in two forms: total regression and partial regression. In total regression, a person returns experientially to an earlier state of development and may write or behave in a way that is appropriate to that age, with no recall of subsequent events. Referred to as revivification, this type of regression usually requires a deep trance. In a partial regression, a person relives a childhood experience but retains recall of later events and a point of view appropriate to present age. Amnesia. (Medium to deep trance.) A dissociation from the ability to remember, amnesia sometimes occurs naturally during medium to deep hypnosis. It is often produced through posthypnotic suggestion that a painful memory, for example, may best be left in the unconscious. Ideomotor activity. (Medium to deep trance.) The involuntary capacity of muscles and the nervous system to respond to thoughts, feelings, and ideas is useful to therapists, who employ ideomotor question techniques (see Cheek and LeCron, 1968) as a means of communicating with the unconscious mind. Different fingers are designated to signify “yes,” “no,” “I don’t know,” or “I don’t wish to respond”; the appropriate finger lifts in response to questions posed by the practitioner. Hallucination, positive and negative. (Medium to deep trance.) The ability to delete sensory information in the immediate physical environment or to experience stimuli that are not present can be used as a deepening technique. Hallucination also has a range of other therapeutic uses, from hallucinating a balloon, putting old grief in it and letting it float away, to hallucinating a television or movie screen and watching something happen on it. Hypermnesia. (Medium to deep trance). With this vivid recall of past memories to an extent not possible in the waking state, a patient can alter conscious negative memories by remembering and re-experiencing past positive ones. Time disorientation. (Medium to deep trance.) Time may be accelerated or slowed down in the hypnotic state, and the boundaries between past, present, and future can be blurred. Suggestions for time disorientation may be used to aid a patient in tolerating uncomfortable appliances or positions following surgery or to reduce the time between meals experienced by people in a weight reduction program. From a psychotherapeutic perspective, this phenomenon can enable patients to see themselves at a future time, when treatment goals have been accomplished. This process helps patients to realize the degree of control they have over their own recovery. These phenomena are not exclusive to the hypnotic trance. Many occur in other states as well. For example, most of us experience momentary amnesia when we forget the name of a close friend in the midst of an introduction. The sight of an oasis to a thirsty desert traveller is a classic hallucination. Ideomotor activity is manifested when a passenger in a car reflexively slams on an imaginary brake to avoid a collision. And for all of us, our sense of time varies according to our circumstances. Time can crawl by for a parent awaiting the birth of a child or a student sitting in a boring class. For lovers, an entire day can rush by in what seems like only a few moments. Such occurrences remind us again that hypnosis is not an otherworldly phenomenon, but a natural, fascinating, and valuable resource available to each of us. FURTHER READING Araoz, D. L. (1982). Hypnosis and sex therapy (Chapt. 1). New York: Brunner /Mazel. Cheek, D. B., & LeCron, L. M. (1968). Clinical hypnotherapy. New York: Grune & Stratton. Crasilneck, H. B., & Hall, J. B. (1974). Clinical hypnosis: Principles and applications. New York: Grune & Stratton. Erickson, M. H., Rossi, E. L., & Rossi, S. I. (1976). Hypnotic realities. New York: Irvington Publishers. Hartland, J. (1971). Medical and den tal hypnosis. London: Bailliere Tindall. Kroger, W. S. (1977). Clinical and experimental hypnosis (2nd ed.). Philadelphia: Lippincott. REFERENCES American Society of Clinical Hypnosis ASCH (1973). A syllabus on hypnosis and a handbook of therapeutic suggestions. Des Plaines, IL: Author. Araoz, D. L. (1982) . Hypnosis and sex therapy. New York: Brunner/Mazel. Bandier, R., & Grinder, J. (1975). The structure of magic, I. Palo Alto, CA: Science and Behavior Books. Bandier, R., & Grinder, J. (1976). The structure of magic, II. Palo Alto, CA; Science and Behavior Books. Bry, A. (1978). Visualization: Directing the movies of your mind. New York: Harper and Row. Cheek, D. B., & LeCron, L. M. (1968). Clinical hypnotherapy. New York: Grune & Stratton. Conn, J. H. (1972). Is hypnosis really dangerous? International Jou rnal of Clinical and Experimental Hypnosis, 20, 61-79. Conn, J. H. (1981). The myth of coercion through hypnosis. International /ournal of Clinical and Experimental Hypnosis, 29, 95-100. Erickson, M. H., Rossi, E. L., & Rossi, S. I. (1976). Hypnotic realities. New York: Irvington Publishers. Fromm, E. (1972) Quo vadis hypnosis? Predictions of future trends in hypnosis research. In E. Fromm & R. Shor (Eds.), Hypnosis: Research developments and perspectives. Chicago: Aldine• Atherton, Inc. Gindes, B. C. (1973). New concepts of hypnosis. Hollywood, CA: Wilshire. Hall, H., Longo, S., & Dixon, R. (1981, October). Hypnosis and the immune system: The effect of hypnosis on T and B cell function. Paper presented to the Society for Clinical and Experimental Hypnosis, 33rd Annual Workshop and Scientific Meeting, Portland, OR. Hartland, J. (1971). Medical and dental hypnosis. London: Bailliere Tindall. Hershman, S. (1980). Methods for habit disruption. In H. J. Wain (Ed.), Clinical hypnosis in medicine. Miami, FL: Symposia Specialists. Kleinhauz, M., Dreyfuss, D. A., Berna, B., Goldberg, T., & Azikiri, D. (1979). Some after-effects of stage hypnosis: A study of psychopathological manifestations. International Journal of Clinical and Experimental Hypnosis, 27, 219-226. Kroger, W. S. (1977). Clinical and experimental hypnosis (2nd ed.). Philadelphia: Lippincott. Moine, D. J. (1982, August). To trust, perchance to buy. Psychology Today, pp. 51-54. Muses, C. M. (1974). Introduction. In C. Muses & A. M. Young (Eds.), Consciousness and reality. New York: Avon Books. Nideffer, R. M. (1976). The inner athlete. New York: Crowell . Olness, K., & Gardner, G. G. (1978). Some guidelines for uses of hypnotherapy in pediatrics. Pediatrics, 62, 228- 233. Selye, H. (1974). Stress without distress. New York: New American Library. Shor, R. E. (1959). Hypnosis and the concept of the generalized reality-orientation. American Journal of Psychotherapy, 13, 582-602. Singer, J. L., & Switzer, E. (1980). Mind-play: The creative uses of fantas y. Englewood Cliffs, NJ: Prentice-Hall. Tart, C. (1972). Measuring the depth of an altered state of consciousness, with particular reference to self-report scales of hypnotic depth. In E. Fromm & R. E. Shor (Eds.), Hypnosis: Research developments and perspectives. Chicago: Aldine· Atherton. Thomas L. (1979). The medusa and the snail. New York: Viking Press. Van Helmont, J. 8. (1661) . De magneticum vulneratum curatione. Paris. Wolberg, L. R. (1945). Hypnoanalysis. New York: Grune & Stratton.