Hypnosis As a Therapeutic Technique: a Historical Examination of Contrasted Perspectives and Domains
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Hughes, A. A. (1999). Hypnosis As a Therapeutic Technique: a Historical Examination of Contrasted Perspectives and Domains. National Undergraduate Research Clearinghouse, 2. Available online at http://www.webclearinghouse.net/volume/. Retrieved December 17, 2017 .

Hypnosis As a Therapeutic Technique: a Historical Examination of Contrasted Perspectives and Domains
ASHLEY A. HUGHES
HANOVER COLLEGE DEPARTMENT OF PSYCHOLOGY

Sponsored by: JOHN KRANTZ (krantzj@hanover.edu)
ABSTRACT
This paper will examine the state and cognitive-behavioral theories of hypnosis while emphasizing the historical shift made by the cognitive-behavioral perspective from the traditional perspective. The historical shift has been accompanied by a corresponding shift in numerous hypnotic concepts and has important implications for specific hypnotic domains. Specifically, the concepts of methodology, consciousness, volition, posthypnotic responding, and treatment of distant history will be examined. These concepts will be examined in terms of their understanding from a cognitive-behavioral perspective and subsequent historical split from the traditional hypnotic perspective. Implications for the application of the cognitive-behavioral perspective to hypnotherapy will be discussed.

INTRODUCTION
Hypnosis as a therapeutic technique has been historically investigated and debated for many years. For most laypeople, the term hypnosis connotes an altered state or trance state of consciousness. Within this conception, a hypnotist transforms their subjects into passive individuals whose experiences and behaviors are now in control of the hypnotist. However, currently a struggle to reach a consensus about how to explain hypnotic phenomenon, specifically the altered state theory, exists. Controversies surrounding the altered state theory have created alternate conceptions of hypnosis rooted in theories involving social construction and expectation. The traditional theories of hypnosis remain fixated to the definition of hypnosis as an altered state. However, more contemporary theories of hypnosis, the cognitive-behavioral conception, have split from the traditional views and have defined hypnosis in a differing manner. Throughout the endeavor to find a modern definition of hypnosis, individual modern hypnotic camps maintain their radically distinctive conceptions of hypnosis. However, the historical shift made by the cognitive-behavioral perspective from the traditional perspective has been accompanied by a corresponding shift in numerous critical concepts related to hypnosis. In this paper, I will first outline brief histories of the state and cognitive-behavioral hypnotic perspectives and discuss the historical shift of the cognitive-behavioral hypnotic perspective from the traditional state theories of hypnosis. Next, I will consider the historical shift in terms of the implications for specific hypnotic domains. Finally, I will discuss the implications of cognitive-behavioral application to current hypnotic therapy.


BRIEF HISTORY OF DOMINANT THEORIES

STATE THEORY OF HYPNOSIS
Currently, two theories remain dominant throughout the quest for the definition of hypnosis. These theories differ from one another primarily with respect to the emphasis they place upon hypnosis as an operation of cognitive activities. The most traditional of theories, coined as neodissociation, views hypnosis as a state in which the subject is a passive observer (Spanos & Chaves, 1991). This theory stems from the notion of ideomotor responding, one of the earliest psychological theories that aimed to account for the automaticity of hypnosis and the influence of the hypnotist’s expectations. Ideomotor responding embraces the idea that a hypnotist communicates a particular idea to the subject and the mere focusing by the subject on that idea leads the subject to automatically respond. For example, a hypnotist might communicate the idea that the subject’s hand is becoming stiff and rigid. According to the theory of ideomotor responding, the mere focusing on the idea by the subject will automatically cause the stiffening of his or her hand. This theory claims that the suggestions of the hypnotist are interpreted by the patient into representations or ideas. These ideas then facilitate the automatic behaviors. The notion of the automaticity of a hypnotized subject is key to the theory of ideomotor responding. While simplistic, this theory became the cornerstone of many of the early hypnotic perspectives (Spanos & Chaves, 1991). Embracing the concept of ideomotor responding, the neodissociation perspective affirms that the suggestions of the hypnotist are translated by the subjects and the translations subsequently facilitate automatic behaviors. Thus, after the suggestions are translated by the subject, he or she becomes a passive observer during the hypnotic process. In 1959, Orne initiated this perspective and described hypnotized subjects as being in a trance-like state in which complex behaviors can be elicited automatically by the hypnotist and independently of conscious control (Spanos & Chaves, 1989). In 1977, E.R. Hilgard named this conception as the neodissociation perspective of hypnosis. This perspective conceptualizes hypnotic behavior as events that happen to passive subjects (as observers of the hypnotic experience rather than active initiators) when particular cognitive subsystems become separated (dissociated) from one another (Spanos & Chaves, 1989). This supports the view that hypnosis is a special state of consciousness and without this state hypnotic phenomenon would not occur (Ross, 1981). The modern neodissociation perspective stems from Janet’s (1925) concept of dissociation. According to this hypothesis, ideas or behavioral patterns that normally occurred together could be separated from one another. This theory explained that only particular individuals were predisposed to dissociation and only these individuals consequently dissociate by suggestion or command of a hypnotist. The dissociation theory gained popularity as it attempted to explain multiple personality, the existence of intelligent “selves” that appeared to be isolated from an individual’s “conscious self”. A re-interpretation of this theory spawned the definition of hypnosis as a neodissociation. According to this theory, the partial dissociation of cognitive structures in the brain facilitates hypnosis (Spanos & Chaves, 1991).

COGNITIVE-BEHAVIORAL THEORY OF HYPNOSIS
Historical origins of the cognitive-behavioral hypnotic perspective can be most effectively explained through discussion of their split from the traditional state theories of hypnosis. Thus, the history of the cognitive-behavioral perception of hypnosis can best be interpreted as a reaction to the established state theories of hypnosis. Criticisms of the state theories of hypnosis began with the Royal Commission that investigated Mesmerism in the late eighteenth century in France. According to Mesmerism, disease was produced by an imbalance of fluids that permeated the body. Curative procedures consisted of passes made with the hands along a patient’s body in attempt to redistribute the imbalanced fluid (Ellenberger, 1970). Traditional theorists cite the curative procedures used in Mesmerism as precursors to modern state conceptions of hypnosis. However, the Royal Commissioners concluded that the effects attributed by Mesmer to animal magnetism could be accounted for in terms of imagination and expectancy. In other words, these early critics reduced Mesmer’s ideas and the foundation of state theories of hypnosis to claiming that these early conceptions of hypnosis were a result of “faking” subjects and subjects who suffered from nervous or hysterical disorders rather than an imbalance of bodily fluids (Sarbin, 1962). In the 1940’s and 1950’s, theorists explicitly began rejecting the notion that hypnotic responding could be explained as an altered state of consciousness or an imbalance of fluid, as was supported by state theorists (Lynn et al, 1989). However, not until the beginning of the early 1980’s did the controversies surrounding neodissociation and other traditional state theories warrant the labeling of this shift in thinking as the cognitive-behavioral hypnotic perspective. Early researchers (Sarbin and Barber) and more contemporary theorists (Spanos, Chaves, Coe, Lynn, Rhue) decided that instead of focusing solely upon the hypnotist or subject, more emphasis should be placed upon an interaction between the two. These researchers conceptualized hypnosis as a result of a unique interaction between hypnotist and subject. In support of this idea, researchers began to explore the interactional framework of hypnosis and heavily apply this emphasis to in depth studies of discrete hypnotic phenomena (Banyai, 1998). As a result of this shift in thinking, the cognitive-behavioral hypnotic perspective arose as an explicit rejection of hypnotic state construct (Banyai, 1998). The support of a hypnotic state separates the more traditional views of hypnosis from the most modern conception of hypnosis, cognitive-behavioral, as a goal-directed behavior in which the subject is actively involved. Researchers such as Barber, Spanos, and Sarbin defined this non-state approach to hypnosis as hypnotic responding that is actively generated by subjects who used contextual information to create the experiences and behaviors that comprised the hypnotic role (Barber, 1969).


IMPLICATIONS FOR HYPNOTIC CONCEPTS
After generally having explained the historical shift by the cognitive-behavioral hypnotic perspective from the state hypnotic perspective, I will demonstrate that this shift has important implications for the way in which specific domains of hypnosis are viewed. The focus of this section will be on the history of the cognitive-behavioral split, rather than the history of the state perspective. Specifically, the concepts of methodology, consciousness, volition, post-hypnotic responding and the treatment of distant history will be examined.

METHODOLOGICAL APPROACH
Hypnosis research aimed to investigate theoretical tenets of specific camps has been shaped most recently by the manner in which the cognitive-behavioral perspective approaches investigation of the state theories of hypnosis. According to the cognitive-behavioral camps, early state theorists did not concentrate upon methodological processes. Instead, they made assumptions and drew conclusions about the hypnotic domain as a result of visual evidence and verbal reports. Contemporary non-state theorists began to realize the implicit mistrust associated with verbal reports and quantifiable response indices upon which the state theorists grounded their understanding of hypnosis(Spanos & Chaves, 1991). Hypnotic research beginning with C.L. Hull (1933) focused on the systematic application of methodological processes to hypnotic phenomena. After the introduction of the methodological tradition and empirically based research by Hull, modern investigators were provided with empirical standards and a shared set of language with which to discuss and anchor theoretical ideas. Empirical research only became earnest by cognitive behaviorists in the late 1950’s and early 1960’s with the work of Orne (1959) and Barber (1969). Since the induction of the methodological tradition to the hypnotic research perspective, empirically based research has become the foundation for the cognitive-behavioral split from the state theories (Spanos & Chaves), 1991). The cognitive-behavioral perspective and traditional perspectives differ with respect to many characteristics of the hypnotic domain. These differences arise primarily as a result of the empirically based cognitive-behavioral hypnotic theory’s historical shift from the traditional hypnotic state theories.

CONSCIOUSNESS
Traditional conceptions have viewed hypnosis as a state related to sleep throughout history. They cite Asclepian dream healings as a historical root of their conception of hypnosis as a state related to sleep. In these dream healings, subjects sleep in a temple dedicated to Asclepos and during their sleep they are healed of disease and anxieties (Banyai & Hilgard, 1976). Contrary to the state conception, the contemporary perspectives view hypnotic responding as role enactments, rather than automatic happenings. Responding is viewed as context dependent and is determined by subjects willingness to adopt and understand the hypnotic role. From this perspective, hypnotic responding is contingent upon goal directed actions (Spanos & Chaves, 1989). In 1950, T.R. Sarbin became the first theorist to explicitly reject the notion that hypnotic responding could be explained as an altered state of consciousness. While initially relatively little empirical research was conducted to support this perspective, T.X. Barber’s research in 1969 empirically demonstrated that nonhypnotic subjects showed changes in responsiveness to suggestion that were as large as the changes produced by hypnotic procedures. Barber (1969), a forerunner of the cognitive-behavioral perspective, also rejected the notion of an altered state of consciousness necessitating hypnotic procedures. Traditional perspectives involve their subjects in hypnotic induction procedures in order to place them in a trance like state. Barber, being interested in this controversial area, performed empirical studies that focused on the area of consciousness within hypnosis. He randomly split his subjects into three groups. To one group he administered a hypnotic induction procedure, to another brief instructions asking them to try their best to respond to the forthcoming suggestions, and to the third (control group) instructions asking them to simply imagine whatever was suggested to them (Barber, 1969). Results indicated that control subjects administered no special procedures frequently enacted the suggestions for age regression, amnesia, pain reduction, etc. Furthermore, the use of induction procedures produced only a small increment in responsiveness to suggestion. Barber described age regressed subjects as behaving in the ways that they believed children to behave. In other words, to the extent that their conceptions of child behavior were unrealistic, so were their subsequent responses to hypnotic age regression suggestibility. Thus, the occurrence of such responding was shown to be tied most closely to subjects’ knowledge about specific suggestion rather than to effects produced by hypnotic procedures (Spanos & Chaves, 1989). While traditional theories have held fast to ideas surrounding altered states of consciousness, Barber’s study demonstrates that the behavior of nonhypnotic subjects (subjects not exposed to hypnotic induction procedures) provided empirical evidence that validated hypnotic responding as a goal-directed socially constructed action. In other words, this research concludes that despite external appearances, hypnotic responses are not particularly unusual and thus do not require particularly unusual states of consciousness (Barber, 1969).

VOLITION
Another aspect of the hypnotic domain between which state theories and cognitive-behavioral conceptions of hypnosis differ is the notion of hypnotic nonvolition. Since the dawn of thinking about hypnotic phenomena, the involuntary aspect of hypnosis has been associated with everything from Mesmer’s animal magnetism fluids to most generally the conception of the passive hypnotic subject being hypnotized by the movement of a watch. However, debates over signs of willpower exhibited by hypnotic subjects have become recent commonplace. State theories highlight the helplessness of the subject while fundamental to the cognitive-behavioral viewpoint is the subject’s control over suggested responses (Coe, 1989). Earliest conceptualizations of hypnotic nonvolition were a product of Braid’s theorizing. In 1843, Braid declared hypnotic procedures a result of involuntariness based on his observation that subjects responded as suggested by the hypnotist despite being “asleep”, as the state theorists claimed. Thus, according to Braid, asleep subjects were incapable of exercising choice and initiating actions (Gorassini, 1987). Moreover, in 1880, Bernheim concluded that hypnosis is “the unconscious transformation of the thought into movement, unknown to will” (Bernheim, 1900). More contemporarily, Arnold (1946) described nonvolition as a relinquishing of the control of one’s imagination process. In accordance with state theories, Arnold supported automatic ideomotor action with an inability to resist suggested behavior. Contemporary theories reacted to the state conception of hypnotic nonvoltion by arguing that hypnotic behavior remains within the subjects’ realm of control. Their volition position split from the state theorists beginning in the early 1940’s. Ironically, White (1941), the theorist who most influenced the cognitive-behavioral camp, initially supported state theories and conceived of hypnosis as an altered state. However, he began to conceptualize hypnosis as a goal-directed process that was cognitively understood by the subject. His views of hypnotic nonvolition stemmed from two basic tenets. White claimed that subjects can successfully resist responding to suggestions that are in contrast to their “own deeper tendencies”. Also, he noted that hypnotized individuals often elaborate on and improvise hypnotic suggestions. Thus, White concluded that the notion of subjects eliciting spontaneous additions supports the idea that volition is involved in hypnotic procedure.

POSTHYPNOTIC RESPONDING
The contemporary conception of posthypnotic responding, suggestions that that inform subjects to respond to a cue and perform certain acts after experiencing a hypnotic session, has shifted along with the cognitive-behavioral hypnotic perspective. Traditionally, posthypnotic responding has been viewed as automatic occurrence. State theorists base their conception of posthypnotic responding on two characteristics: The subject experiences a compulsion to perform the act and a lack of awareness that the act was performed (Erickson & Erickson, 1944). Conversely, cognitive-behaviorists conceive posthypnotic responding as mediated by situational cues and expectancies, therefore, can be considered a goal-directed, non-automatic happening. Fischer (1954) became the first theorist to examine the notion of post-hypnotic responding from a goal-directed perspective. In his study, Fischer gave thirteen subjects (who had experienced a hypnosis session) the suggestion to scratch their ear every time they heard the word “psychology”. After the posthypnotic response was elicited, the hypnotist began speaking with a colleague to create the impression that the experiment had ended. During this time, the cue was used informally by the hypnotist. Next, the hypnotist restructured the subjects to suggest that the experiment was still in progress (Lynn, Rhue, & Weekes, 1989). Results showed that all of the subjects responded to the cue when the hypnotist formally presented it. However, only four subjects responded to suggestion during the informal session. Finally, when the experiment was restructured and the subjects believed the experiment to be again in-progress, eleven out of the thirteen subjects responded to the cue. Furthermore, in 1959, St. Jean found that when the experimenter left the room to attend to what was described to the subjects as an “emergency situation”, almost all subjects did not respond posthypnotically to a prerecorded auditory stimulus eliciting the suggestion cue word (Lynn, Rhue, & Weekes, 1989). These results suggest that subjects do not behave automatically and are not compelled to respond to the posthypnotic suggestion. In other words, when the cue was embedded in a context that the subjects did not associate with the experimental situation, subjects exhibited no posthypnotic responding. These studies provided the initial empirical evidence for the cognitive-behaviorists to suggest that post-hypnotic responding is an expectancy-mediated, goal-directed action (Spanos, Menary, et al., 1991).

DISTANT HISTORY
Another concept upon which contemporary theories have split from traditional state theories is the emphasis they place on the relevancy of the distant history of hypnosis. The traditional perspectives argue that hypnosis conceptualized as state theories makes itself evident in historical events. These traditional historians of hypnosis endorse the notion that hypnosis conceived as a passive state manifests itself during earlier historical periods. They cite that ignorance has prevented these historical events from being recognized as hypnosis until modern times. However, without an acknowledgment and realization of the complicated social and historical cues that surround their cited history, cognitive-behavioral hypnotic theorists contend that direct connections used as historical origins of state theories of hypnosis are not warranted (Spanos & Chaves, 1991). Traditional theorists trace the most distant origin of hypnosis to Asclepian temple dream healings. In the 4th century AD, Greco-Roman healing temples dedicated to the god Asclepos were common and played a central role in cultural and religious life. Traditional historians cite origins of suggestibility in these healings. While the patients waited for the appearance of Asclepos in a dream, priests made the patients more susceptible to hypnosis through relaxing activities and chanting (Spanos & Chaves, 1991). The cognitive-behavioral perspective claims that traditional theorists fail to acknowledge that Asclepian dream healing accounts are based solely on secondary sources. However, traditional state theories contend that temple healing is an ancestor to modern conceptions of hypnosis (specifically, traditional conceptions) because, when separated from historical and social context, Asclepian temple healing resembles modern hypnotic practice. Specifically, they cite that Asclepian priests are, as modern hypnotists, authority figures. Furthermore, the dream healings are associated with psychological healing as are modern clinical hypnotic procedures. Finally, both, according to the traditional hypnotic perspectives, occur in a state of relaxation. Based on these similarities, the traditional theorists assume that Asclepian healings must have involved hypnosis and offer this history as evidence of state theories of hypnosis (Spanos & Chaves, 1991). Traditional theorists also cite New Testament healings as demonstrations of modern hypnosis. However, the assumptions made by historians of hypnosis that New Testament stories can be associated with hypnosis is highly scrutinized by the cognitive-behavioral hypnotic perspective (Wagstaff, 1998). According to the cognitive-behavioral perspective, traditional theorists have first assumed that the notion of an altered state is present in New Testament healing, then, have re-interpreted these descriptions of healing to prove evidence of hypnosis on the basis of similarities (Spanos & Chaves, 1991). Furthermore, without considering the social and historical context in which the New Testament stories were written, these stories cannot be understood. In other words, most Biblical historians cite these stories as mythohistory. These stories are fables that illustrate stories in the form of a historical narrative for the purpose of conveying religious messages. Moreover, many of the healings described in the New Testament may have been derived directly from local custom or tradition (Spanos & Chaves, 1991). Thus, without examining the historical and social context within the supposed historical ties to hypnotism exist, the cognitive-behavioral perspective maintains that the cited historical origins cannot be considered distant origins of the state theory. Cognitive-behavioral perspectives claim that they do not attempt to split social and cultural roots from this modern perspective of hypnosis (Lynn et al, 1989). However, they also do not attempt to reject the hypnotic ties to Asclepian or New Testament healing. The cognitive-behavioral approach asserts that they reject the notion that historical ties have been discovered and can now be used as origins of modern conceptions of state theories of hypnosis. Instead, this approach recognizes the traditional historical view and suggests that these ties provide the groundwork from which the roles of the subject and hypnotist have emerged (Lynn et al, 1989). This perspective contends that the social roles of historical characters have acted as social templates and have influenced the ever-transforming structure of the modern conception of hypnosis. For example, the cognitive-behavioral perspective suggests that the concept of social interaction has evolved out of and were patterned after the social roles of magnetizer and magnetized patient present in the theory of Mesmerism (Spanos & Gottleib, 1979). Rather than recognizing distant history as direct antecedents to modern hypnotic conceptions, cognitive-behaviorists, in contrast to traditional state theorists, believe that ancient notions of possession and religious healing have created the groundwork from which hypnotic subject and hypnotist have emerged. As a reaction to the state theorist’s treatment of distant history, the cognitive-behavioral perspective maintains that the history of hypnosis is culturally relativistic. It cannot be conventionally conducted and thus hypnotic cognitive-behaviorists uphold that the traditional historical roots that attempt to verify specific hypnotic perspectives should be not be considered complete precursors to a modern understanding of hypnosis (Spanos & Chaves, 1991).


CONCLUSIONS
Today, despite the growing research by cognitive-behavioral hypnotic theorists, state theorists still support their theoretical perspectives (Conn, 1957). Regardless with which camp theorists identify, a hypnotic experience has the potential to increase access to vivid imagery, increase awareness of bodily sensation, and increase the possibility for cognitive alteration (Dengrove, 1973). However, the assumptions made by the cognitive-behavioral historical shift and subsequent implications have profound effects for the understanding of the hypnotized patient and the implications for hypnotic application. The historical conception of hypnosis as a complex configuration of variables is a major contribution to the field of clinical hypnosis. From a cognitive-behavioral perspective, recognizing the importance of such cognitive-motivational variables such as expectancy and volition in hypnotic behavior can enhance clinical practice of hypnosis. The history of this perspective has revealed that the interactional framework of the hypnotic relationship will strongly effect the outcome of hypnotherapy (Hart & Hart, 1997). Historical implications for specific hypnotic phenomena provided by the historical shift of the cognitive-behavioral perspective are important with respect to the patient’s attitudes and expectations. In other words, when using hypnotic techniques, the cognitive-behavioral perspective cautions that patient’s misconceptions about hypnosis, negative attitudes, lack of motivation to change, or situational variables that interfere with a patient’s attention might all effect the hypnotic experience and its subsequent effectiveness (Hart & Hart, 1997). Another implication of the cognitive-behavioral shift and its ramifications are in the threat of hypnotic non-compliance. Throughout the historical shift, the cognitive-behavioral perspective contends that the interactional framework and social context within a hypnotic experience occurs is remarkably significant. Again, this understanding places much emphasis upon the attitude of the hypnotic patient. Thus, negative expectancies about hypnosis or a failure to understand that responsiveness to suggestions involves active involvement (not passive responsivity) might obstruct the use of hypnosis from a cognitive-behavioral approach (Dengrove, 1973). Considering the aforementioned factors that have been provided by the historical implications of the cognitive-behavioral split is essential for a successful hypnotic experience.


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