by Alfred A Barrios, PhD
Part I of this article may be found here.
Hypnotizability of Patients
Freud abandoned hypnosis because of "the small number of people who could be put into a deep state of hypnosis" at that time and because in the cathartic approach, symptoms would disappear at first, but reappear later if the patient-therapist relationship were disturbed (Freud, 1955, p. 237). In the above studies the only hypnotic induction failures were reported by Chong Tong Mun (eight failures out of 108 patients.) This can mean one of two things: the hypnotic induction procedures have improved since Freud's day, or that the reconditioning approach used in these studies (as opposed to Freud's cathartic approach) does not require very deep levels of hypnosis. There is evidence that both factors may be involved.
Although many have thought that hypnotic susceptibility was a set character trait, there are a number of studies which now seem to indicate that this is not the case, and that responsiveness can be increased by certain changes in the hypnotic induction procedure (Pascal and Salzberg, 1959; Sachs and Anderson, 1967; Baykushev, 1969), as well as by means of a pre-induction talk aimed at insuring a positive attitude, an appropriate expectancy and a high motivation toward hypnosis (Dorcus, 1963; Barber, 1969; Barrios, 1969).
With regard to the depth of hypnosis required for the reconditioning approach to work, there are a number of therapists who feel that only a light state of hypnosis is necessary (Van Pelt, 1958; Kline, 1958; Kroger, 1963) A study by Barrios (1969) gives this contention some support; it was found that an increase in the conditioning of the salivary response could be produced almost as effectively by lighter levels of hypnosis as by deeper levels.
The latter point brings us to the question of whether hypnotic induction is necessary at all for the re-conditioning approach to work. Judging from the work of Wolpe (1958) it would appear that hypnosis is not an absolutely necessary requirement. This would also be supported by the work of Barber (1961, 1965) who found that hypnotic phenomena could be produced without a prior hypnotic induction. However, the real question to be answered is not whether hypnotic induction is absolutely necessary, but whether it can further facilitate the conditioning process. Wolpe, himself, concedes the hypnosis apparently does facilitate the conditioning:
"Patients who cannot relax will not make progress with this method. Those who cannot or will not be hypnotized but who can relax will make progress, although apparently more slowly than when hypnosis is used." (Wolpe, 1958, p. 141; italics added). Also, although Barrios' (1969) study indicated that conditioning could be increased during lighter levels of hypnosis, it was also found that there was no increase in conditioning with those subjects indicating no response to the hypnotic induction.
As pointed out in the theory (Barrios, 1969), hypnotic and waking suggestion are on the same continuum and hypnotic induction should be looked upon as a procedure whereby we can increase the probability of getting a more positive response to suggestion. The next question to be decided now is not so much whether hypnotic induction procedures increase responsiveness (this is fairly well accepted – e.g., Barber, 1969) but what variables in the hypnotic induction are playing the key roles and what can be done to strengthen the effectiveness of these factors.
Comparison with Psychoanalysis and Behavior Therapy
In Wolpe's comparison of his and the psychoanalytic approaches (Wolpe, Salter, and Reyna, 1964), we find the following: Based on all psychoneurotic patients seen, the number of patients cured or much improved by psychoanalysis was 45% in one study involving 534 patients and 31% in the other study involving 595 patients (the only two large scale studies in the literature on psychoanalysis). The average duration of treatment for the improved patients (given only for the first study) was three to four years at an average of three to four sessions per week, or an average of approximately 600 sessions per patient. For Wolpe's approach we find that, based on all patients seen, the recovery rate was 65% in his own study involving 295 patients (usually reported as 90% of 210 patients) and 78% in a study by Lazarus involving 408 patients. The duration of treatment for the improved patients was an average of thirty sessions in the former and fourteen in the latter.
Averaging the above figures, we find that for psychoanalysis we can expect a recovery rate of 38% after approximately 600 sessions. For Wolpian therapy, we can expect a recovery rate of 72% after an average of 22 sessions, and for hypnotherapy we can expect a recovery rate of 93% after an average of 6 sessions.
It is interesting to note the negative correlation between number of sessions and percentage recovery rate. At first sight this seems paradoxical. However, if a form of therapy is truly effective, it should not only increase recovery rate, but also shorten the number of sessions necessary (as well as widen the range of cases treatable).
The Need for a Rational Explanation
In spite of all the encouraging reports, there continues to be considerable hesitation on the part of psychotherapists to use hypnosis. Hypnosis is still looked upon as an "unknown" by most therapists. They are as yet not aware of any reasonable rational explanation for hypnotic phenomena that would satisfy them, one that would tie these phenomena down to observable facts and laws. As long as hypnosis continues to exude an air of mysticism and charlatanism, it will continue to be rejected by many, no matter how great the claims on its behalf.
An Explanation Based on Principles of Conditioning
The experienced therapist really should not be so surprised at the effectiveness of hypnosis in facilitating therapy. Hypnotic induction can be looked upon as a technique for establishing a very strong rapport, for establishing a greater confidence, a greater belief in the therapist, whereby the latter's words will be much more effective. As Sundberg and Tyler (1962) point out, one of the common features among all methods of psychotherapy is the attempt to "create a strong personal relationship that can be used as a vehicle for constructive change... It is a significant fact that many theoretical writers, as their experience increases, come to place much more emphasis on this variable" (pp.293-294).
The question still remains, however – what exactly is the process whereby "mere words" can produce such great changes in personality.
As pointed out in Barrios' (1969) theory of hypnosis, the ability of words to produce behavior changes is really not so difficult to understand if we are familiar with the principles of higher-order conditioning.
First of all, we know that words can act as conditioned stimuli.
Pavlov recognized this fact:
Obviously for man speech provides conditioned stimuli which are just as real as any other stimuli... Speech, on account of the whole preceding life of the adult, is connected up with all the internal and external stimuli which can reach the cortex, signaling all of them and replacing all of them, and therefore it can call forth all those reactions of the organism which are normally determined by the actual stimuli themselves (Pavlov, 1960, p. 407).
Now, according to principles of high-order conditioning we know that by paring word B with word A we should transfer the response produced by word B to word A and consequently anything that would evoke word A. Thus, for example, if we wanted to condition a person to be more relaxed in the presence of people, we would pair the words "people" (A) and "relaxed" (B), using a sentence or suggestion such as, "From now on you will find yourself more relaxed in the presence of people." Mower's theoretical formulations on the sentence as a conditioning device (Mowrer, 1960) tend to support this contention.
Of course, we know that under ordinary circumstances suggestions are not always accepted (and thus conditioning doesn't always result when an appropriate suggestion is given). Why is this? Osgood (1963) holds that a suggestion will tend to be rejected if it is incongruent with the subject's previously held beliefs and attitudes or his present perceptions. It would seem that if there were some means of eliminating the latter we should be able to have a suggestion more readily accepted and thus facilitate the higher-order conditioning. Hypnosis is such a means.
Thus we come to the reason hypnosis is so effective in facilitating therapy: the incongruent perceptions, beliefs, and attitudes are kept from interfering with the suggestion (and thus with the conditioning). As put by Pavlov:
The command of the hypnotist, in correspondence with the general law, concentrates the excitation in the subject (which is in a condition of partial inhibition) in some definite narrow region, at the same time intensifying (by negative induction) the inhibition of the rest of the cortex and so abolishing all competing effects of contemporary stimuli [present perceptions] and traces left by previously received ones [previously held beliefs and attitudes]. This accounts for the large and practically insurmountable influence of suggestions as a stimulus during hypnosis as well as shortly after it (Pavlov, 1960, p. 407; italics added).
As an illustration, let us say we wanted to change a patient's self-image from that of an inadequate person to a more self-confident one. If under ordinary circumstances we suggested that he would no longer feel inadequate, it would most likely accomplish little. This is because the patient's negative self-image, usually ever-present and quite dominant, would quickly suppress any positive image suggested, or at least keep it from being too vivid or real. But in the hypersuggestible hypnotic state conditions are different. The patient's negative self-image is now more easily inhibited and should therefore be less likely to interfere when we attempt to evoke the positive self-image through suggestion. As a result, the conditioning can take place and new associations can be made. The person can truly picture himself feeling self-confident in various situations and these new conditioned associations in turn can lead to new behavior. This new attitude can now become permanent by means of self-reinforcement, just as his old negative attitude had been kept permanent by self-reinforcement. As long as the patient has negative attitudes, these are self-reinforcing. They lead to his tensing up, acting awkward and making numerous mistakes. Also, he is unlikely to believe any praise or any positive occurrences should they chance his way. But if this negative self-image has been replaced by a positive one, the opposite cycle can result. Being more confident and relaxed he will naturally be more likely to be accepted. Also, he will now be more open to believing and accepting praise and positive outcomes.
For more information and to read more of Dr. Barrios' articles, visit www.stresscards.com.
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Posted: 05/06/2010
