28.9 Hypnosis
885
behavioral compliance and suggestibility. The HIP is a shorter
test that uses the eye-roll sign as a biological indicator and mea-
sures cognitive flow, which differentiates those with no hypnotic
capacity because of mental pathology from those mentally nor-
mal patients with any inherent hypnotic capacity (Fig. 28.9-1).
Induction
Many different induction protocols follow the same basic prin-
ciples and pattern, but may be better suited to the patients with
different levels of hypnotizability.
Table 28.9-1
Indicators of Trance Development
Autonomous ideation
Balanced tonicity (catalepsy)
Changed voice quality
Comfort, relaxation
Economy of movement
Eye changes/closure
Facial features ironed out
Feeling distant
Feeling good after trance
Lack of body movement
Lack of startle response
Literalism
Objective and impersonal ideation
Pupillary changes
Response attentiveness
Retardation of reflexes:
Swallowing
Blinking
Sensory, muscular, and body changes
Slowing pulse
Slowing and loss of blink reflex
Slowing respiration
Spontaneous hypnotic phenomena:
Amnesia
Anesthesia
Catalepsy
Regression
Time distortion
Time lag in motor and conceptual behavior
(From Erickson M, Rossi EL, Rossi SI.
Hypnotic Realities: The Induction of
Clinical Hypnosis and Forms of Indirect Suggestion
. New York: Irvington;
1976:98, with permission.)
and noxiousness of pain are believed to be processed by differ-
ent regions of the brain, because different areas of reduced blood
flow result when each is minimized through hypnosis.
The role of the anterior brain regions, such as the frontal
lobes, in hypnosis has been shown physiologically by the posi-
tive correlation between homovanillic acid concentrations in the
cerebrospinal fluid and degree of hypnotizability. The frontal
cortex and basal ganglia have a large number of neurons that use
dopamine, of which the metabolite is homovanillic acid. This
may explain why pharmacological enhancement of hypnotiz-
ability, although difficult, is primarily accomplished with dopa-
minergic agents, such as amphetamine. The increased activation
of the basal ganglia may relate to the increased automaticity of
hypnotic motor behavior.
Clinical Assessment of
Hypnotic Capacity
Two major procedures exist to clinically evaluate hypnotic
capacity: the Stanford Hypnotic Susceptibility Scale and the
Hypnotic Induction Profile (HIP) (Table 28.9-2). The Stan-
ford Hypnotic Susceptibility Scale is a long laboratory-based
test that has been modified for clinical evaluation and requires
approximately 20 minutes to perform. It primarily measures
Table 28.9-2
Hypnotic Induction Profile–Derived Method of
Self-Hypnosis
One, look up toward your eyebrows, all the way up; two, close
your eyelids slowly and take a deep breath; count to three,
exhale, let your eyes relax, and let your body float.
As you feel yourself floating, you permit one hand or the other
to feel like a buoyant balloon and allow it to float upward.
As it does, your elbow bends, and your forearm floats into an
upright position. When your hand reaches this upright position,
it becomes a signal for you to enter a state of meditation and to
increase your receptivity to new thoughts and feelings.
In this state of meditation, you concentrate on this feeling of
imaginary floating and, at the same time, concentrate on the
following critical points (e.g., the three critical points to stop
smoking in the following discussion).
Reflect on the implications of these critical points, and then bring
yourself out of this state of concentration called self-hypnosis by
counting backward in this manner: Three, get ready; two, with
your eyelids closed, roll up your eyes (do it now); and, one,
let your eyelids open slowly. Then, when your eyes are back in
focus, slowly make a fist with the hand that is up; and, as you
open your fist slowly, your usual sensation and control returns.
Let your hand float down. That is the end of the exercise, but
you can retain a general overall feeling of floating.
By doing this exercise ten different times each day, you can float
into this state of buoyant repose. Give yourself this island of
time, 20 seconds, ten times a day, in which to use this extra
receptivity to reimprint these critical points. Reflect on them,
then float back to your usual state of awareness, and then
continue with what you ordinarily do.
(Courtesy of Herbert Spiegel, M.D., Marcia Greenleaf, Ph.D., and David
Spiegel, M.D.)
Doctor:
Take a long, deep breath—inhale and exhale; now close
your eyes and relax. Pay particular attention to the muscles in and
about your eyes—relax them to the point that they just won’t work.
Are you trying to do that? Good. If you really have them relaxed,
right at this very moment, no matter how hard you try, they just
won’t open. Test them. The harder you try, the faster they stick
together, just as if they were glued together. That’s fine!
Now you can open your eyes; that’s good. When I tell you to
and not before, open and close your eyes once more, and, when you
close them this time, you will be ten times as relaxed as you are
right now. Go ahead, open and close, and feel that surge of relax-
ation go through your whole body, from the top of your head to the
tip of your toes. Very good!
Now once again, open and close your eyes, and this time, when
you close them, you will double the relaxation that you now have.
Fine.
