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Chapter 28: Psychotherapies
that the clinician projects the hypnotic trance onto the patient or
has the power to influence the patient. In reality it is the patient
who has the hypnotic gift, and the clinician’s role is to assess
the patient’s capacity to capitalize on this asset and to help the
patient discover and use it effectively. Patient motivation, per-
sonality style, and biological predisposition may contribute to
the manifestation of this talent.
During the hypnotic trance, focal attention and imagination are
enhanced and simultaneously peripheral awareness is decreased.
This trance may be induced by a hypnotist through formalized
induction procedures, but it can also occur spontaneously. The
capacity to be hypnotized and, relatedly, the occurrence of spon-
taneous trance states is a trait that varies among individuals but is
relatively stable throughout a person’s life cycle.
History
Descriptions of trance states, ecstatic states, and spontaneous
dissociative states abound in the Eastern and Western reli-
gious, literary, and philosophical traditions. Anton Franz Anton
Mesmer (1734–1815) first formally described hypnosis as a
therapeutic modality in the 18
th
century and believed it to be the
result of a magnetic energy or an invisible fluid that the therapist
channels into the patient to correct imbalances, restoring health.
James Braid (1795–1860), an English physician and surgeon,
used eye fixation and closure to induce trance states. Later, Jean
Martin Charcot (1825–1893) theorized the hypnotic state to be
a neurophysiologic phenomenon that was a sign of mental ill-
ness. Contemporaneously, Hippolyte Bernheim (1840–1919)
believed it to be a function of the normal brain.
Early in his career, Sigmund Freud (1856–1939) used hyp-
nosis as part of his psychoanalysis and noticed that patients in a
trance could relive traumatic events, a process called
abreaction.
Later, Freud switched from hypnosis to free association because
he wanted to minimize the transference that sometimes accom-
panies the trance state. Importantly, the switch did not eliminate
the occurrence of spontaneous trance during the analysis.
World War I produced many shell-shocked soldiers and
Ernst Simmel (1882–1947), a German psychoanalyst, devel-
oped a technique for accessing repressed material that he named
hypnoanalysis.
During World War II, hypnosis played a promi-
nent role in the treatment of pain, combat fatigue, and neurosis.
Formal recognition of hypnosis as a therapeutic modality did
not occur, however, until the 1950s. The British Medical Society
recommended its teaching in medical schools in 1955 and the
American Medical Association and American Psychiatric Asso-
ciation officially stated its safety and efficacy in 1958.
Definition
Hypnosis is currently understood as a normal activity of a
normal mind through which attention is more focused, critical
judgment is partially suspended, and peripheral awareness is
diminished. The trance state, being a function of the subject’s
mind, cannot be forcibly projected by an outside person. The
hypnotist, however, may aid in the achievement of the state and
use its uncritical, intense focus to facilitate the acceptance of
new thoughts and feelings, thereby accelerating therapeutic
change. For the subject, hypnosis is typified by a feeling of
involuntariness and movements seem automatic.
Trait of Hypnotizability
A person’s degree of hypnotizability is a trait that is relatively
stable throughout the life cycle and is measurable. The process
of hypnosis takes the hypnotizability trait and transforms it into
the hypnotized state. Experiencing the hypnotic concentration
state requires a convergence of three essential components:
absorption, dissociation, and suggestibility.
Absorption
is an ability to reduce peripheral awareness that
results in a greater focal attention. It can be metaphorically
described as a psychological zoom lens that increases attention
to the given thought or emotion to the increasing exclusion of all
context, even including orientation to time and space.
Dissociation
is the separating out from consciousness ele-
ments of the patient’s identity, perception, memory, or motor
response as the hypnotic experience deepens. The result is that
components of self-awareness, time, perception, and physical
activity can occur without being known to the patient’s con-
sciousness and so may seem involuntary.
Suggestibility
is the tendency of the hypnotized patient to
accept signals and information with a relative suspension of nor-
mal critical judgment; it is controversial whether critical judg-
ment can be completely suspended. This trait will vary from an
almost compulsive response to input in the highly hypnotizable
to a sense of automaticity in the less hypnotizable individual.
Table 28.9-1 lists the indicators of trance development.
Quantification of Hypnotizability
Quantifying a patient’s degree of hypnotizability is useful in a
clinical setting because it predicts the effectiveness of hypnosis
as a therapeutic modality. Quantification also provides useful
information about the way patients relate to themselves and
the social environment. Highly hypnotizable patients have an
increased incidence of spontaneous trance-like states and so
may be unduly influenced by ideas and emotions that are not
being appropriately self-critiqued.
Neurophysiological Correlates
of Hypnosis
Neurological testing of individuals in the hypnotized state and
those with a high degree of hypnotizability has led to some
interesting findings, but no set of changes has been shown to be
sensitive or specific for the trance state or hypnotizability trait.
Electroencephalographic (EEG) studies have shown that
hypnotized persons exhibit electrical patterns that are similar
to those of fully awake and attentive persons and not like those
found during sleep. Increased alpha activity and theta power
in the left frontal region has been reported in highly hypnotiz-
able patients as compared with those who are less hypnotizable;
these differences exist in the trance and nontrance states.
Positron emission tomography (PET) studies that compare
regional blood flow in the brain in both hypnotized and non-
hypnotized subjects lend further evidence to the hypothesis that
hypnosis exerts some of its effects at lower-level modalities of
the brain. Hypnotic suggestions to add color to a visual image
result in increased blood flow to the lingual and fusiform gyri,
the color vision processing centers of the brain; suggestions to
remove color have the opposite effect. Similarly, the intensity
