hypnosis and psychopathology: retrospect and prospectjfkihlstrom/pdfs/1970s/1979/kihlstrom... ·...

Journal of Abnormal Psychology1979, Vol. 88, No. 5, 459-473

Hypnosis and Psychopathology: Retrospect and Prospect

John F. KihlstromHarvard University

An editorial introduction to a special issue on hypnosis and psychopathologydiscusses several links between the two fields. Historically, observation of theparallels between hypnosis and hysteria played an important role in the dis-covery of unconscious mental processes, the development of psychogenic the-ories of psychopathology, and the rise of psychotherapy. It is proposed thathypnotic anesthesia and analgesia, amnesia, and posthypnotic suggestion mayserve as laboratory models of dissociative phenomena seen in the clinic. Fur-thermore, hypnosis may be useful in the exploration of processes involved inemotional response and the formation of hallucinations and delusions. Withrespect to personality and behavior change, hypnosis has commonly been em-ployed in the treatment of pain and habit disorders by means of direct sugges-tion, but its use is not limited to suggestive therapeutics. Hypnotic relaxation,images and dreams, suggested amnesia, hypermnesia, and age regression may beuseful in both psychodynamic and cognitive-behavioral therapies. Possible linesfor further research on the relation between hypnosis and both experimentaland clinical psychopathology are discussed. A major task for those interestedin hypnosis and psychopathology is to foster the integration of their interestsand research with the rest of scientific psychology.

Since the controversy between Mesmer andthe French Royal Commission in the late 18thcentury, scientific interest in hypnosis haswaxed and waned. Even so, the peculiar alter-ations in perception, memory, and behaviorproduced by hypnosis have always caught theattention of at least some psychologists sincethe time of William James.

In general experimental psychology, Pavlovused hypnosis to illustrate the action of corticalexcitation and inhibition; Hull pointed to it asan example of habit formation; Miller, Galan-

Preparation of this article and editing of the SpecialIssue were supported in part by National Institute ofMental Health Grant MH 29951. I thank Heather A.Brenneman, Ernest R. Hilgard, Martin T. Orne, SusanJo Russell, and Julius Wishner for their commentsduring the preparation of this article. Particular ap-preciation goes to Leonard D. Eron, who conceivedthis Special Issue, for his consistent and enthusiasticsupport of hypnosis research during his tenure aseditor of the Journal of Abnormal Psychology.

Requests for reprints should be sent to John F. Kihl-strom, Department of Psychology and Social Relations,Harvard University, William James Hall, 33 KirklandStreet, Cambridge, Massachusetts 02138.

ter, and Pribram turned to hypnosis as an ex-ample of the operation of plans; and Neisseremployed some hypnotic phenomena to dem-onstrate constructive and reconstructive pro-cesses in perception and memory.

In social psychology, hypnosis was an im-portant influence in the development of Sar-bin's theory of role taking, the concept of thedouble bind articulated by Bateson and his as-sociates, and Orne's notion of demand char-acteristics.

In personality, hypnosis was used as anexperimental technique in Luria's investigationof conflict; research on hypnosis and suggesti-bility provided some of the strands in thenomological net around Eysenck's constructsof neuroticism and introversion-extraversion;Gill and Brenman cited hypnosis as an exem-plar of regression in the service of the ego; E. R.Hilgard's programmatic research on the mea-surement of hypnotizability revealed an im-portant dimension of individual differences hithe behavioral domain; and J. R. Hilgard'scareful clinical inquiry into the characteristicsof hypnotizable and insusceptible subjects

Copyright 1979 by the American Psychological Association, Inc. 0021-843X/79/8805-04S9$00.75

459

460 JOHN F. KIHLSTROM

documented a dimension of imaginative in-volvement that had been ignored in previousconceptualizations of the structure of person-ality.

It is in psychopathology, however, thathypnosis has probably had its farthest reach-ing impact. Many of the 19th century foundersof the field studied hypnosis both clinicallyand experimentally because of the apparentparallels between the phenomena of hypnosisand the symptoms of hysteria. Prior to thistime, hysteria had been considered to be a neu-rological disorder affecting predisposed indi-viduals. The induction of phenotypicallysimilar hypnotic phenomena in normal sub-jects, simply by the hypnotist's spoken word,led these investigators and others to proposetheories of psychological causation that servedas correctives to the strong somatogenic view-point that prevailed at the time. In the handsof Bernheim, Breuer and Freud, and others,the separation of clinical psychology and psy-chiatry from neurology and the evolution of"talking therapies" began.

More generally, as Ellenberger (1970) pointsout, hypnosis played an important role in thediscovery of unconscious mental processes. Inthe early years of the 20th century, Freud'spsychoanalytic notion of the unconscious dom-inated the field, and his early abandonment ofhypnosis as a treatment modality meant thathypnotic phenomena were ignored in favor ofdreams and parapraxes. Nevertheless, interestin hypnosis persisted as Prince and others con-tinued to study the phenomenon as part oftheir exploration of the unconscious as con-ceived by dissociation theory. In the past dec-ade, systematic studies of hypnotic analgesialed E. R. Hilgard to propose a new version ofdissociation theory that incorporates observa-tions of unconscious mental activity made inthe clinic, the laboratory, and everyday life.

Since its inception in 1906 under the editor-ship of Morton Prince, the Journal of AbnormalPsychology has been an important medium forthe publication of empirical and theoreticalpapers on hypnosis. This special issue collectsa group of articles specifically bearing on therelation between hypnosis and psychopathol-ogy. Some of the contributions were writtenat the invitation of the guest editor; severalothers were submitted through normal chan-

nels and scheduled for publication here; stillothers were in preparation at the time the issuewas conceived, and the authors were encour-aged to complete their work in time to be con-sidered for this issue. In this introductoryessay, I wish to sketch some of the contempo-rary issues relating hypnosis and psychopa-thology in order to provide a background forthe other articles.1

Hypnosis and Experimental Psychopathology:Laboratory Models of Behavioral and

Cognitive Disorders

On one level, the relation between hypnosisand psychopathology has always been some-what ambiguous. To be sure, both domains in-volve deviant behavior and experience.However, the notion of psychopathology im-plies not only strangeness and oddness but alsoa characteristic impairment in functioning thatis not present in the individuals who typicallyparticipate in hypnosis experiments. Becausethere is nothing inherently pathological abouthypnosis or the people who are hypnotizable,

1 This essay seeks only to give the reader some flavorfor the relation between hypnosis and psychopathology.No attempt has been made to be comprehensive withrespect to either topics or references. Hilgard (1965,1977) provides an excellent overview of the phenomenaof hypnosis. The latter monograph places them in abroader context of human behavior and experience andcomments on the integration of hypnosis with contem-porary cognitive theory. Like most active fields in psy-chology, a wide variety of theoretical and empirical ap-proaches are applied to hypnosis; these have been sym-pathetically reviewed by Sheehan and Perry (1976).Some years ago Spanos and Barber (1974) saw appreci-able convergence among some of these views, but Hil-gard (1973) entered a demurral, reminding us that thereremained many unresolved conceptual differences. Thisis still the situation today (Coe, 1978; Kihlstrom, 1978).A number of useful anthologies are available coveringaspects of hypnosis. Tinterow (1970) collects importantearly papers on the history of the field, whereas Shor andOrne (1965) emphasize more recent articles that haveattained "classic" status. Edmonston (1977) andFromm and Shor (1979) compliment the present issueby offering other samples of very recent theoretical andempirical work unpublished elsewhere. Recent issuesof the American Journal of Clinical Hypnosis, 1978-1979, 21(2-3) and the International Journal of Clinicaland Experimental Hypnosis, 1979, 27(2) gather a num-ber of articles relating to contemporary trends in themeasurement of hypnotic susceptibility. Additionalspecific references may be found in the individualarticles contained in this issue.

HYPNOSIS AND PSYCHOPATHOLOGY 461

the links between the two must be found else-where. One of these links is certainly prag-matic : As discussed later in this essay, hypnosishas proved useful in treating a variety of dis-orders encountered in the clinic. Another im-portant link is at the level of basic research:Hypnosis permits the study of subjectivelycompelling alterations in the behavior and ex-perience of individuals who are not character-istically impaired. Furthermore, these altera-tions can be induced and removed reliably in asubstantial number of normal human subjectsunder conditions of rigorous experimentalcontrol and without trauma or other hazard.Thus, the phenomena of hypnosis may serve aslaboratory models for the study of basic psy-chological processes highly relevant to psy-chopathology.

Divisions in Consciousness

As noted earlier, clinical observation of thesymptoms of hysteria gave rise to the notion ofunconscious mental contents—percepts, ideas,and memories that were not represented in phe-nomenal awareness but that influenced ongo-ing behavior and experience. In an attempt tounderstand the psychological processes in-volved in this syndrome, Janet, Prince, Sidis,and others formulated the concept of dissocia-tion. They held that in the normal personalitythe individual's thoughts, percepts, and mem-ories were organized into a coherent and inte-grated whole with all mental contents availableto phenomenal awareness. Under certain con-ditions, however, some of these contents couldbe split off from the rest. The result was held tobe two or more separate streams of conscious-ness that are neither in communication withnor controlled by the other (s), but that con-tinue to exert an influence over ongoing be-havior and experience. The concept of dis-sociation entailed a rather different view ofthe unconscious than that portrayed by Freud-ian psychoanalysis, because it held that theunconscious was not restricted to specificmental contents (i.e., those associated withsexual or aggressive impulses), that unconsciouscontents could be rational and even creative,and that rendering material unconscious neednot be motivated by the desire to reduce oravoid conflict.

With the upsurge of psychoanalysis in clin-ical psychology and behaviorism in experimen-tal psychology, however, the popularity ofdissociation thery quickly declined. As Whiteand Shevack (1942) noted, the final blow to dis-sociation theory was the evidence provided bymany experiments that the ideas, memories,and actions in ostensibly separate streams ofconsciousness interfered with each other. Thusthe "dissociated" streams were not separateafter all. Recently, however, Hilgard (1977)has argued that a number of observations inthe clinic, laboratory, and everyday life invitesome sort of dissociation concept in that theyseem to involve parallel processing of differentstreams of information; a reduction in aware-ness of particular actions, percepts, and mem-ories ; and an apparent lack of voluntary controlover behavior and experience. Further, heholds that the concept of dissociation entailsonly changes in awareness and voluntary con-trol and is actually silent on the matter of inter-ference. Neodissociation theory centers ontopics familiar to cognitive psychology, espe-cially the internal processes involved in allocat-ing attention to several tasks at once, con-structing percepts and reconstructingmemories, and monitoring the contents ofthe information-processing system.

The phenotypic similarities between thephenomena of hypnosis and the symptoms ofhysteria (subjectively compelling disruptionsand anomalies in behavior and experience, noevidence of brain insult or injury, behaviorinconsistent with reported awareness) suggestthat hypnosis may serve as a laboratory modelof the clinical syndrome (e.g., Evans, 1979;Sackeim, Nordlie, & Gur, 1979). Hysteria israther rare, however, and it seems more ap-propriate to suggest that hypnosis can serve asa vehicle for the study of the broader domainof divisions in consciousness of which hysteria,fugue, and multiple personality are only themost dramatic examples. A wide variety of dis-sociations are available to the investigator ofhypnosis. The "splitting off" of normally con-scious experience is prominently representedby amnesia, analgesia, automatic writing,blindness and deafness, and posthypnotic sug-gestion. The recovery of normally subconsciousexperiences may be represented by age regres-sion and hypermnesia.


Each of these phenomena may be inducedin hypnotizable subjects and studied both asa topic of interest in its own right and for thelight it may shed on the concept of dissociation.For example, Hilgard's systematic studies ofhypnotic analgesia showed that suggestionsfrequently failed to abolish psychophysiologi-cal responses to painful stimulation (e.g., Hil-gard et al., 1974) and that the pain effectivelyconcealed by the suggestion could be recoveredby means of automatic writing and the "hiddenobserver" method (e.g., Hilgard, Morgan, &Macdonald, 1975). These studies provided theimpetus for the original sketch of neodissocia-tion theory.

Other experiments on the performance ofsimultaneous tasks showed that the degree ofinterference among them was a function of theattentional demands of the activities andwhether one of them was performed outsideawareness (Knox, Crutchfield, & Hilgard,1975; Stevenson, 1976). This work permitteda more detailed analysis of the attentionalprocesses by which divisions in consciousnessare produced. Similar sorts of experiments havebegun in the domain of hypnotic amnesia(e.g., Kihlstrom, in press). The concept of con-sciousness is once again important in psychol-ogy (Shiffrin & Schneider, 1977), and it seemslikely that further study of hypnotic dissocia-tions will contribute to a deeper understandingof the nature and function of consciousnessthat will be important to understanding certainforms of psychopathology.

Anxiety, Conflict, and Defense

Another early use of hypnosis in the investi-gation of psychopathology was in the study ofconflict and emotion (Luria, 1932), and morerecent work has continued in this vein. Forexample, Levitt and his associates (e.g., Levitt,Persky, & Brady, 1964; see also Levitt &Chapman, 1979) turned to direct hypnoticsuggestion as a means of gaining control overthe subject's emotional state. They found thatrapid induction and termination of the state,easy modulation of the emotional experienceas it was occurring, and reduced contaminationby irrelevant factors were all possible with hyp-nosis. With this technique in hand, they ex-plored the psychophysiological correlates of

emotional experience, the influence of emotionson psychological testing, repression, and otherconcerns.

In a somewhat similar vein, Blum (1967) hasdeveloped a "programming" technique inwhich memories of early experiences involvingpleasure or anxiety, for example, are elicitedby interviews or projective testing. Under hyp-notic control, the content of the experience isthen separated from the emotion itself, and theresulting free-floating feelings can be intensi-fied or diminished. In a remarkable series ofexperiments (e.g., Blum & Barbour, 1979), heand his associates have investigated the influ-ence of emotional state on perception andmemory.

A rather different technique for studyingconflict, anxiety, and defense involves the hyp-notic implantation of a paramnesia, or falsememory. In this procedure, hypnotized subjectsare led through a contrived emotional experi-ence; the hypnosis is then terminated with asuggestion for amnesia. Working within an ex-plicitly psychoanalytic framework, Reyher andhis colleagues have conducted a number ofstudies on the effects of conflict over matters ofsex and aggression (Reyher, 1962, 1967; seealso Silverman, 1976). Early studies dealt withthe eruption of symptoms of anxiety and otherdisturbances of affect, and the perception andrecognition of conflict-related words presentedby means of a tachistoscope. Later studies haveexamined the effects of guilt over the conflict,awareness of the forbidden impulse, and therelation of specific defenses to the emergence ofsymptoms (e.g., Sommerschield & Reyher,1973).

Hallucinations

Most psychologists agree that hallucinationsare products of the imagination that are closelyrelated to ordinary mental images (e.g., Horo-witz, 1975; Sarbin & Juhasz, 1975). Followingthe analyses of Neisser (1967, 1976) and Reed(1974), it seems likely that mental images areactive constructions based on informationavailable in memory. Often these images rep-resent the anticipatory phase of perceptualactivity, schemata that under ordinary circum-stances guide the pickup of information fromthe environment; however, these schemata can


also be detached from the perceptual cycle,functioning as products of pure imagination.These processes may be understood by meansof the conventional study of mental images,which is now well advanced (Kosslyn, 1978;Shepard, 1978).

The difficulty arises in understanding howthis constructive activity can be separatedfrom executive monitoring and control, so thatthe individual does not notice that he or shehas formed an image and comes to attributethe percept to an external stimulus objectrather than to internal constructive activity.These processes may be understood only bydirect examination of hallucinations them-selves. Here hypnosis seems to offer the investi-gator a very useful analytic medium. Hypnoticpositive hallucinations are not abolished bystrong honesty demands as hallucination re-ports collected under other circumstances are(Bowers & Gilmore, 1969; Spanos & Barber,1968), and the hallucinations of hypnotizedsubjects are different from those of subjectswho are simulating hypnosis (Orne, 1959;Sheehan, 1977). Hypnotically induced hallu-cinations seem to possess the same qualities ofsubjective conviction as those hallucinationsobserved in the clinic.

Hilgard's (1977) neodissociation theory pro-vides a conceptual framework for understand-ing the qualities of positive hallucinations thatdistinguish them from more usual types ofmental images. For example, it may be thatthe image is formed subconsciously, unmoni-tored by the executive structure in the cogni-tive system. Although certainly the productof constructive activity on the part of the sub-ject, this activity is not represented in phe-nomenal awareness. This subconscious imageformation is experienced as being involuntaryand then, perhaps, attributed to externalsources. (A related attributional account of de-lusions will be found below.) At present, how-ever, this account is entirely speculative; sys-tematic study of the cognitive processes in-volved in hallucinatory experiences is required.

It is already known that the response of hyp-notized subjects to suggestions for positivehallucinations is related to the vividness oftheir mental imagery in the normal wakingstate (Hilgard, 1970). The processes by whichordinary images are formed are therefore im-

plicated in the formation of hypnotic hallucina-tions. The unique contribution of research onhypnotic hallucinations will be a better under-standing of why hallucinations are experiencedas involuntary and external in origin.

Delusions

Delusional thinking, another common symp-tom of psychopathology, has been the subjectof much theoretical speculation. An interestingrecent analysis of schizophrenic delusions byMaher (1974), for example, holds that delu-sions arise as an individual suffering from somepsychological deficit attempts to account forhis or her unusual perceptual-cognitive experi-ences. The schizophrenic, functioning like anyother naive scientist, begins to generate hy-potheses concerning the nature of the experi-ence, the reason that he or she alone has it, andthe reason for its happening at all. In the ab-sence of any other information, the affectedindividual may conclude that he or she is beingpunished for some past sin, victimized by someoutgroup, in communication with alien beings,or in possession of supernatural powers. Thedevelopment of a coherent hypothesis, especi-ally one that does not fail any crucial empiricaltest, leads to the relief of anxiety. Maher's ac-count of delusions is consistent with modernattribution theory, but there is little researchevidence bearing directly on the hypothesis.

Recent hypnosis research by Maslach, Zim-bardo, and Marshall (1979) extending the workon cognitive-physiological interactions in emo-tion by Schachter and Singer (1962) has inde-pendently provided such evidence. Earlier,Marshall and Zimbardo (1979) had attemptedan exact replication of the Schachter-Singerexperiment and found that unexplained arousalconsistently produced a negative emotionalstate rather than the "plastic" emotions dis-cussed by Schachter and Singer. Maslach(1979) extended this work, employing hypnosisto manipulate arousal because it offered betterexperimental control and eliminated otherproblems associated with the use of drug treat-ments. Again, she found that unexplainedarousal produced negative states.

More important for present purposes, Mas-lach (1979) observed that the majority of sub-jects in the unexplained arousal condition made


some specific (albeit incorrect) causal attri-butions regarding their subjective experiences.For example, subjects might state that theywere tense because of upcoming exams, theexperimental procedure, or the confederate'sbehavior. When the subjects were in the pres-ence of a hostile confederate, their statedreasons for feeling bad paralleled those givenby the stooge for being angry. Maslach et al.(1979) suggest that anomalous subjective ex-periences produce anxiety precisely becausethey are unexplained and threaten the person'ssense of self-control and that the individual'ssearch for causes is biased by his or her pastexperiences and customary ways of thinking.Paralleling Maher's (1974) argument, it mightbe said that these causal attributions are thestuff of which delusions are made. Becausehypnosis provides an easy way of inducinganomalous perceptions, memories, behaviors,and internal states in hypnotized individuals,we may expect to see more use made of thetechnique in the study of the processes involvedin the genesis and maintenance of delusions.

Comment

The exploration of laboratory models of psy-chopathology has a long and distinguished his-tory and has yielded valuable insights into thenature of abnormal behavior and experience.In the past, most of these models have centeredon paradigms drawn from animal learning andpsychopharmacology. It seems likely that hyp-nosis can provide additional laboratory modelswith which to study dissociative processes,hallucinatory experiences, and the formation ofdelusions. If the modeling agenda is to succeed,investigators must move beyond mere "demon-stration" experiments and begin to analyzethe underlying psychological processes in de-tail.

At the same time, it should be emphasizedthat there are constraints on the degree towhich information gained from laboratorymodels may be generalized to naturally occur-ring psychopathology. The motivations associ-ated with dissociative experiences, for example,are clearly different in hypnosis and hysteria.Whereas psychopathology is typically unbid-den and unpredictable, laboratory phenomena—whether hypnotically induced or a productof other kinds of manipulations—are episodic

in nature and the product of an interactioncontrolled by an implicit contract between theexperimenter and the subject (Orne, 1962,1973). Thus, even if the laboratory investigatorwere to produce an exact replica of the surfacefeatures of some symptom or syndrome, therewould be no guarantee that the individual's re-sponse to it, or to experimental or therapeuticmanipulations, would match that seen in theoriginal. The experimental context threatens,but does not destroy, ecological validity. It iscrucial that investigators take account of thecontextual alterations involved in moving backand forth between the laboratory, the clinic,and the real world.

Hypnosis and Clinical Psychopathology:Behavior Modification and

Personality Change

The rise of scientific hypnosis correspondedwith the rise of the psychotherapy movementin the late 19th century, and the resurgence ofinterest in the topic among researchers followedthe reintroduction of hypnosis to clinical prac-tice in World War I and again in World WarII. Since that time, hypnosis has found aplace in both dynamic and cognitive-behavioraltherapies.

Beyond Placebo Therapy

There is some tendency among clinical prac-titioners to view hypnosis as placebo therapy—a treatment that yields no specific therapeuticeffect, but gains its power by virtue of the"magic" associated with it in popular cultureand the image of scientific expertise communi-cated by those who practice it. In this view,hypnosis is a potent therapeutic agent becausethe patient (and perhaps the doctor as well)believes it is, much as a sugar pill labeled as apowerful analgesic agent results in pain relief.

There is indeed some evidence that hypnosis,like all therapeutic agents, has a placebo com-ponent. For example, a series of studies on thetranscendance of voluntary capacity showedthat hypnotic suggestions, delivered in an en-vironment in which they were made plausible,effectively enhanced the physical performanceof laboratory subjects who were insusceptibleto hypnosis (London & Fuhrer, 1961; Rosen-han & London, 1963). Similarly, a study of


laboratory pain found that hypnotic sugges-tions for analgesia led to a significant reductionin felt pain for insusceptible subjects who hadbeen previously led to believe that they couldsuccessfully respond to such suggestions. Thisdecrease was comparable to that observed whenthe subjects ingested a placebo capsule (Mc-Glashan, Evans, & Orne, 1969). In the clinic,Lazarus (1973) found that labeling a relaxa-tion procedure as hypnosis yielded better re-sults than leaving the identical procedure un-labeled.

In the pain study by McGlashan et al.(1969), however, hypnotizable subjects ob-tained significantly more pain relief from hyp-nosis than from placebo, and a study by Slot-nick, Liebert, and Hilgard (1965) indicatedthat under some conditions hypnotizable sub-jects can experience a greater increase in physi-cal capacity than insusceptible subjects. Thushypnosis appears to be more than a placebo, atleast for hypnotizable subjects. Placebos canbe very powerful indeed (Evans, 1974), andalthough they can be harmful when purveyedby charlatans, under appropriate conditionsthey can also be very important therapeutictools. Hypnosis, like any other therapeutic pro-cedure, certainly has placebo components, andthe skilled clinician is correct in maximizingthem in order to insure the successful outcomeof treatment. But it is wrong to argue that hyp-nosis is only a placebo. Hypnosis is more thanmerely a plausible agent of behavior change,and the hypnotic interaction does more thansimply manipulate situational demands.Rather, hypnosis permits the practitioner toemploy a number of specific techniques derivedfrom empirical research to achieve specificeffects determined by a careful considerationof the requirements of the individual case. It isto these specific applications that we now turn.

Suggestive Therapeutics

The earliest therapeutic use of hypnosis in-volved direct suggestion for symptom relief orattitude change. This technique was the corner-stone of the Nancy school of Liebeault andBernheim, the chief competitors of Charcot atthe Salpetriere, and was employed by Freud inhis early practice. Symptom removal via sug-gestion has continued to be widely and success-fully employed, particularly in the context ofpain (Hilgard & Hilgard, 1974) and behavioral

medicine (Barber, 1978; Bowers, 1977; Bowers& Kelly, 1979). In these areas, therapeuticefficacy is correlated with the patient's abilityto experience hypnosis, indicating that hypno-sis has specific effects on the problem, and thereappears to be no evidence of symptom substi-tution. More recently, hypnosis has come to beused in the treatment of fears and habit dis-orders such as smoking, alcohol abuse, andovereating. In these domains the relation ofoutcome to hypnotizability seems to dependon the manner in which hypnosis is used.(Horowitz, 1970; Perry, Gelfand, & Marco-vitch, 1979).

On the surface, neither the therapeuticefficacy of suggestions administered to hyp-notizable individuals nor their failure whengiven to those who are insusceptible is particu-larly puzzling. Nevertheless, findings of suc-cessful or unsuccessful outcome are not enough.The scientist-practitioner wants to understandthe processes responsible for the success orfailure of a treatment technique, and here thequestions quickly become quite complex. Partof the answer lies in the nature of hypnosis—that is, with the extra leverage that intense roleinvolvement and divided consciousness canprovide. But part of the answer is also motiva-tional : Response to hypnosis reflects both apti-tude and attitude components, and even hyp-notizable subjects will not become hypnotizedif they do not wish to be. Similarly, studies ofposthypnotic suggestion and the hypnotic co-ercion of antisocial behavior clearly argueagainst the proposition that hypnosis has anyspecial power to compel behavior against theindividual's will. Moreover, hypnotic sugges-tions given to insusceptible individuals mayhave substantial placebo effects, provided thatthey are plausible to the patient and deliveredenthusiastically and convincingly by the hyp-notist. Finally, it is clear that hypnotic treat-ment (or any other treatment, for that matter)may on occasion simply provide a convenientexcuse for personality or behavior change.

Psyckodynamic Therapy

Despite Freud's rejection of hypnosis, thetechnique has long held a place as an adjunctto psychoanalysis and other forms of psycho-dynamic therapy in the exploration and un-covering of the factors responsible for symptom


formation. For example, Brenman and Gill(1947) cited with approval the use of hypnosisin the abreaction of traumatic experiences, re-covery of forgotten events, and the forgettingof distressing ones. They also noted that auto-matic writing might help to sustain an inter-action with an otherwise uncommunicativepatient, and that hypnotic dreams might proveto be a rich source of interpretable material.Finally, they noted the then novel tendency ofsome clinicians to conduct entire analyses withthe patient hypnotized, ostensibly reducingthe time required for treatment. Hypnoanalysisremains popular, and more recently Wolberg(1967) has suggested that it might be especiallybeneficial when the patient lacks motivationfor treatment; has erected barriers to the de-velopment of a good working relation with thetherapist; is unable to verbalize, associatefreely, or remember dreams; has repressedtraumatic memories; or resists producing newsignificant material.

Although there are no systematic clinicaltrials or comparative studies of hypnoanalysisor dynamic hypnotherapy, some experimentalliterature supports the assumptions behindthese developments. For example, it appearsthat hypnosis can enhance memory for mean-ingful material to some degree (Dhanens &Lundy, 1975), although there is the danger thatat least some of the material elicited in thismanner may be entirely confabulated (Stal-naker & Riddle, 1932).

Similarly, although there is little evidencesupporting the notion that hypnotic age re-gression entails an actual return to childhoodmodes of functioning, several well-documentedcases of the return of forgotten childhood lan-guages (e.g., Fromm, 1970) as well as a recentexperiment on emotional responses (Nash,Johnson, & Tipton, 1979) suggest that forgot-ten memories and attitudes might well be re-coverable with the technique. Of course, hyp-notically elicited material may be a source ofclinically relevant information independent ofits truth value. To the extent that the age-regressed individual is able to become absorbedin the child role, it seems possible to gain atleast temporary benefits from substitutingpleasant images of the past for the troubles ofthe present.

There is also a correlation between hypnotiz-

ability and the ease of production of creativeideas, and some evidence as well that the in-duction of hypnosis enhances creative thinkingand insight (Bowers, 1979; Bowers & Bowers,1979). Finally, although the hypnotic dreamis physiologically distinct from the nightdream, and the critical awareness remainingin hypnosis offers more opportunity for censor-ship of the ongoing fantasy, hypnotic dreamsseem rich enough to make interpretive effortsreasonable (Barrett, 1979; Hilgard & Nowlis,1972).

In general, then, hypnosis can aid dynamictherapy by virtue of the amount of control itpermits over the behavior and experience of ap-propriately selected individuals. With it, im-portant affects, ideas, and memories can bebrought to life in the consulting room, ratherthan just discussed retrospectively, providingboth parties with a better opportunity to ap-preciate the psychological aspects of thepatient's situation.

Cognitive-Behavioral Therapy

Hypnosis has not been neglected in the de-velopment of behavioral and cognitive alter-natives to psychoanalysis and other forms ofdynamic psychotherapy (Dengrove, 1976;Lazarus & Karlin, 1978). Following early sug-gestions by Wolpe (1958), many classical be-havior therapists have employed hypnosis tofacilitate relaxation and imagery during sys-tematic desensitization. However, early ana-logue and clinical studies found no difference inoutcome or extent of relaxation achieved be-tween desensitization attempts employingprogressive relaxation and those employinghypnosis. Furthermore, a few experimentalstudies also seemed to show that waking con-ditions were as effective as hypnotic suggestionsin producing auditory and visual hallucina-tions. These results dampened some prac-titioners' enthusiasm for the technique (e.g.,Ascher, 1977). However, the patients in theseearly studies were randomly assigned to thetreatment groups without regard for theirability to experience hypnosis. It is likely thathypnosis did facilitate relaxation and imageryin those patients and subjects who were hyp-notizable and that these effects were obscuredby the lack of an effect in insusceptible sub-jects. Moreover, there is new evidence that


hypnotic suggestions produce images andhallucinations that are more subjectively com-pelling than those produced by waking imagi-nation. When employed with individuals whoare at least moderately hypnotizable, then,hypnotic procedures may provide substantialbenefits.

Because cognitive-behavioral interventionsare dynamically sensitive, some of the hypnoticprocedures employed by behavior therapistshave their roots in the suggestive therapeuticsand hypnotherapy movements discussed ear-lier. For example, Wolpe (1973) does not advo-cate the simple removal of symptoms by meansof suggestion, but he has noted that hypnoticsuggestions may effectively oppose behavioralsymptoms. Similarly, Lazarus and Karlin(1978) hold that direct suggestion and regres-sion can be effective in eliciting emotionalarousal and modulating perceptual experienceas well as in creating specific amnesias. Wolpehas also suggested that hypnotic hypermnesiaand age regression may facilitate the processof abreaction and desensitization.

For example, in an analogue study of snakephobics by Horowitz (1970), hypnosis wasemployed as an adjunct to a variant of flooding.One group was asked to recall snake-relatedevents and also to reexperience the early fear.Another group was also asked to recall theevents, treat the emotion as irrelevant, andkeep it in the past. A third group received aposthypnotic suggestion that they would nolonger be frightened by harmless snakes. As-sessed on a behavioral measure of approach toan actual harmless snake, all three methods ledto a significant decrease in fear compared tountreated controls. The "relaxation" proceduregave the best results of all, showing the poten-tial benefits of hypnotic dissociation betweenmemories and related emotions. Treatment out-come was positively correlated with hypnotiz-ability in both memory conditions, indicatingthat hypnosis played an active role in the ther-apeutic change. Contrary to expectation, theindividuals in the posthypnotic suggestioncondition also improved, but there was nocorrelation between outcome and hypnotiz-ability, suggesting that the active ingredientwas actually nonhypnotic in nature.

More recently, Frankel (1976) has proposedthat hypnosis be used to produce artificial

symptoms in the consulting room that areanalogous to the patient's actual complaint.The patient thus has the opportunity to be-come familiar with the model symptom so thatthe pathological ideas and actions become lessfrightening. By producing and eliminating theartificial symptom at will, he or she gains asense of mastery over an experience that wasonce perceived as ego-alien and out of control.Thus, hypnosis becomes an active part of thecoping process. Frankel's technique containselements of the laboratory modeling approachdescribed earlier and brings us full circle tocouple the experimental and clinical aspects ofhypnosis and psychopathology.

Comment

The use of hypnosis in psychotherapy andbehavior modification appears promising, butmost of this promise is based on laboratory ex-perimentation and anecdotal case reportsrather than controlled clinical trials. There area number of issues that bear further investiga-tion. For example, it is necessary to distin-guish between the placebo and specific effectsof hypnosis in a therapeutic context and toexamine more closely the mechanisms under-lying both effects. In most applications, hyp-nosis will continue to be employed as an ad-junctive technique rather than as an agent ofchange in its own right. As is the case with otherforms of psychotherapy, hypnosis is no pan-acea. More information is needed concerningthe kinds of people and situations in which itsuse is appropriate or contraindicated. Of specialimportance is greater acknowledgment of in-dividual differences in hypnotizability. In thiscontext, the development of abbreviated test-ing procedures suitable for assessing hypnoticsusceptibility in clinical situations (Morgan &Hilgard, 1978-1979a, 1978-1979b) will makesome of the necessary research practicable forthe first time. Additionally, the potential ofhypnosis for controlling cognition and affectsuggests new variants on old techniques.Clearly there is a good deal of research to bedone before hypnosis can assume its properplace in the therapist's repertoire.

Overview of the Special Issue

This issue of the Journal of Abnormal Psy-chology contains a representative selection of


theoretical and empirical articles relevant tothe relation between hypnosis and psycho-pathology. There are several topics and indi-vidual lines of investigation that are notcovered in the studies that follow. Neverthe-less, the articles range widely over the phe-nomena of hypnosis, and each has implicationsfor the understanding and treatment of psy-chopathology. It is hoped that the materialthat is included will convey some idea of cur-rent trends in the field.

Conceptual Overviews

One of the hallmarks of hysterical blindnessis the apparent paradox between the patient'scomplaint of loss of sight and behavioral evi-dence indicating that visual function remainsintact. Sackeim et al. (1979) review the litera-ture on functional blindness and reveal a fur-ther paradox: Behavior is inconsistent withreported awareness only in some cases. Theypropose a model of hysterical blindness thatcombines the cognitive features of dissociationtheory with the motivational features of psy-choanalysis. By relating hypnotic blindness tothe hysterical symptom, they revive an earlyinterest in the relation between hypnosis andhysteria. They suggest using the hypnotic phe-nomenon as a laboratory model of the clinicalsyndrome and present interesting case materialsuggesting what such an experiment would looklike. As indicated earlier, hypnosis and hys-teria are not the same, so the analogy shouldnot be pushed too far. Nevertheless, despiteits rarity hysteria raises interesting questionsabout psychopathology that may be usefullyaddressed within the hypnotic context.

Psychosomatic disorders raise some of thesame issues as hysteria, in that psychologicalfactors such as stress are shown to have con-sequences for somatic functions. Bowers andKelly (1979) review some of the recent researchin this area, revealing the role of stress in phys-ical illnesses of all kinds and the possible in-volvement of the immunological system inmediating stress reactions. They then examinethe results of hypnotic treatment of physicalillness, which sometimes are remarkable indeed.The correlation of outcome with hypnotizabil-ity, obtained in cases of warts and asthma,underscores the importance of individual differ-ences and indicates that hypnosis is having

some specific effect on these disorders. Bowersand Kelly argue that the physiological con-sequences of the perception of stress, and theefficacy of "mere words" in reversing them,raise the old mind-body problem in a new formthat can be profitably pursued by scientificinvestigation.

One of the most important trends in con-temporary hypnosis research is the incorpora-tion of hypnosis into theories covering a widerrange of psychological phenomena. Neodis-sociation theory is one of these; Sarbin's roletheory is another. In their contribution to thisissue, Sarbin and Coe (1979) argue that hyp-nosis and psychopathology are linked at thebehavioral level by counterexpectational andcontranormative conduct. They hold that arole theoretical account of these phenomena,in which people are construed as actors re-sponding to the demands and contingencies ofthe social context, is more appropriate thanthe cognitive or biological accounts that dom-inate in both fields. An interesting feature ofrole theory has been its continuing attempt toeschew mentalistic constructs at a time whenpsychology has become thoroughly cognitive.A new feature of the evolving theory, not pre-sented in detail previously, is a distinction be-tween "doings" and "happenings." Role theoryis implicitly limited to the former, indicatingthat a contextualist analysis does not attemptto provide a complete account of phenomenain either domain.

Of course, the contemporary phenomenaobserved in both the hypnosis laboratory andthe clinic do not occur in a vacuum and areshaped in important ways by the ever-chang-ing social context. Modern hypnosis does notresemble the epileptiform seizures observed byMesmer, the frequency of diagnosis of multiplepersonality is on the upswing, and delusionsnow involve aliens and spies instead of devilsand witches. Spanos and Gottlieb (1979) applya social-psychological approach similar toSarbin's in their attempt to understand thehistorical relations between demonic possession,hysteria, and mesmerism. They delve into arich mass of historical material dating from the16th century to show that the features of thethree states and the reciprocal role relationsinvolved have much in common. Spanos andGottlieb argue cogently that mesmerism, aris-


ing at the height of the Enlightenment, repre-sents a secularization of demonic possessionand exorcism. Some puzzles still remain forhistorians to pursue, however. Chief amongthese is the unexpected occurrence, in an en-vironment containing strong demands for con-vulsive crises, of somnambulistic states. Theaccidental discovery of artificial somnambu-lism suggests that there is a core dissociativephenomenon, observed in hypnosis as well asin certain forms of psychopathology, that isnot a product of social and cultural factors.

Empirical Studies

The phenomenon of age regression, in whichan adult subject behaves in a childlike manner,has long puzzled investigators of hypnosis. Onepopular notion, that the hypnotized subjectactually reverts to modes of functioning char-acteristic of childhood, received some supportfrom early studies employing developmentaltasks. Later studies, however, either failed to•replicate the original findings or suggested thatthey were artifacts of the demand characteris-tics of the experimental situation. Still, manyof these studies have shown that hypnotic be-havior differs from simulation and that thesubjects find the regression experience sub-jectively compelling. Nash, Johnson, and Tip-ton (1979) find that age-regressed subjectsplaced in a moderately frightening situationbehave in a manner appropriate to their sug-gested age, whereas simulating subjects do not.These are the first positive results from a com-parative study of real and simulating subjectson a developmental task. Whether the regres-sion performance is best construed as a rein-statement of childhood modes of functioning oras a revivification of childhood memories is atheoretical issue that can only be resolved byfurther research. Still, the experiment showsthat childlike behavior remains available to theadult and may be used in either an adaptive ora maladaptive manner. Such compelling child-like role enactments, whether strictly veridicalor not, may be very useful in clinical situations.

Posthypnotic amnesia is also a prominenttopic in hypnosis research. This topic is highlyrelevant to psychopathology because of theparallels between the hypnotic phenomenonand a wide variety of functional disorders of

memory encountered in the clinic. Evans(1979) expands on previous work that docu-mented two forms of amnesia: recall amnesia,in which the subject cannot remember theevents and experiences that transpired duringhypnosis, and source amnesia, in which the sub-ject retains access to certain information butcannot remember the hypnotic circumstancesunder which it was acquired. The present ex-periment employs simulators to show thatsource amnesia is not an artifact of subtle de-mand characteristics. Evans argues that thephenomenon represents a dissociation betweenepisodic and semantic memory and links it toboth cryptomnesia (unconscious plagiarism)and to clinical cases in which the sequelae of atraumatic event persist in the absence of mem-ory for the experience itself.

One of the few established personality corre-lates of hypnotic susceptibility has to do withthe components of "creativity": imaginativeinvolvement, mental imagery, and divergentthinking. In a series of studies, some involvingpracticing creative writers, Bowers (1979)analyzes this statistical relation extensivelyand finds that the burden is carried by a con-struct named "effortless experiencing." Thatis, hypnotizable individuals may not be morecreative, but they do tend to produce creativeideas more easily. In extreme cases, the ideasseem to appear nonvolitionally—an observa-tion that again raises the issue of subconsciousmental processes. The cognitive link betweenhypnosis and creativity seems to be nonanalyti-cal, holistic thinking, and at a physiologicallevel, the nondominant brain hemisphere seemsto be implicated. Interestingly, other researchshows that gestalt closure ability and a prefer-ence for activating the nondominant hemi-sphere also correlate with hypnosis. Thus,Bowers' work fleshes out a nomological netthat unites hypnosis, nonhypnotic involve-ments, cognitive style, and brain function.The work also reveals the intricate relationsbetween individual differences and task struc-ture that are central to the study of creativethinking and insight.

Within either laboratory or clinic, hypnosisoccurs in the context of a dyadic relation inwhich one individual responds to suggestionsoffered by another. Sheehan and Dolby (1979)have developed a novel paradigm for assessing


the subject's involvement with the hypnotistthat involves pitting two sets of competingdemands against each other. In the present ex-periment, these assessments are shown to berelated to the subjects' perception of hypnosisand the hypnotist, as revealed in a contentanalysis of hypnotic dreams. The involvementsdocumented here do not resemble archaic, re-gressive transference as conceptualized byclassical psychoanalysis, because the authorityof the hypnotist is contractual rather than par-ental. Nor does the Sheehan-Dolby analysisreduce hypnotic behavior to pleasing the ex-perimenter. Motivated involvement sets thestage for the hypnotic interaction and shapesthe experience as it unfolds, but hypnosis alsoentails other abilities and cognitive processes.Thus, there are aspects of affective involve-ment and the experimenter-subject relationthat distinguish hypnosis, task motivation, andwaking imagination. At a practical level, Shee-han and Dolby suggest a set of convenient as-sessment procedures that may be useful inassessing the clinical patient's readiness to re-spond to therapeutic suggestions.

Hypnotic dreams can be used to study otherthings besides hypnosis. When they are em-ployed as a method to study the individual'sfantasies, as they often are in the clinic, it ishelpful to have some understanding of howhypnotic dreams relate to the individual'simaginative activities in ordinary waking life.Barrett (1979) reports the first direct compari-son of hypnotic, day, and night dreams takenfrom the same subjects. The results showstriking similarities in content between hyp-notic and night dreams, although both differfrom daydreams, at least for those who arehighly hypnotizable. There is also the sugges-tion of rapid eye movement activity in thehypnotic dreams of highly hypnotizable sub-jects which needs to be confirmed psychophy-siologically. Like the research of P. G. Bowers,Barrett's work shows a way in which hypnosiscan be used during the clinical hour to elicitrich fantasy material of potential value to theclinical enterprise.

It seems obvious that the outcome of hyp-notic treatment should be correlated with hyp-notic susceptibility, and as noted earlier thishas been the finding in clinical studies of painand physical disease. Perry et al. (1979), how-

ever, report several studies of smoking in whichthe expected correlation did not emerge.Rather, the important correlate of outcome wasthe patient's motivation to quit or continuesmoking. Because of the great differences inboth the nature of the problem and the hyp-notic treatment applied, the findings withsmoking do not really contradict those withpain and physical disease. It is possible that theexpected correlation would emerge with an in-tervention that made use of the altered per-ceptions that lie at the core of hypnosis. Thestudy calls for similar research on a variety ofother disorders and problem areas. The finalresult should be an increased ability of clini-cians to tailor their use of hypnosis to both thenature of the presenting complaint and thecharacteristics of the individuals involved—necessary features of scientifically based clini-cal practice.

Integrating the Normal and the Abnormalin Hypnosis and Psychopathology

It has been noted that hypnosis and psycho-pathology are linked by a number of elements.The fields share a great deal of history, extend-ing back a century to the beginnings of scien-tific psychology. Experimentalists in both fieldsare attempting to understand the processesunderlying unusual behavior and anomalousexperiences, disorders of perception and mem-ory, and related personality processes. Finally,practicing clinicans, whether they use hypnosisor not, are interested in understanding thefactors responsible for personality and behaviorchange. These considerations provide strongreasons for researchers in hypnosis and psy-chopathology to continue to be interested ineach others' work. The two fields also share acommon future. It is clear by now that neitherhypnosis nor psychopathology stands at theperiphery of scientific psychology looking onwhile striking advances in knowledge are madein other subdisciplines. Whether the investi-gator takes a cognitive, developmental, social,or physiological perspective, work in bothhypnosis and psychopathology is rapidly be-coming part of mainstream psychologicalresearch.

At present, however, the interactions be-tween the "normal" and the "abnormal" in


psychology as a whole are far from common. Amajor task for investigators interested in bothhypnosis and psychopathology will be to workharder to integrate their research with that oftheir colleagues in other areas of psychology.It is to be hoped, moreover, that this integra-tive effort will be bidirectional. The scientificstudy of hypnosis and psychopathology willadvance to the extent that it draws on the con-cepts, methods, and findings derived from thestudy of "normal" individuals and "normal"states, but it is also likely that research in theseareas will make its own special contribution tothe understanding of normal cognitive, social,personality, developmental, and physiologicalprocesses. To the extent that this integrationis achieved, we will have edged much closer tothe comprehensive scientific understanding ofhuman behavior and experience that we allare seeking.

References

Ascher, L. M. The role of hypnosis in behavior therapy.In W. E. Edmonston (Ed.), Conceptual and investi-gative approaches to hypnosis and hypnotic phe-nomena. Annals of the New York Academy of Sciences,1977, 296, 250-263.

Barber, T. X. "Hypnosis," suggestions, and psychoso-matic phenomena: A new look from the standpoint ofrecent experimental studies. In J. L. Fosshage & P.Olsen (Eds.), Healing: Implications for psychotherapy.New York: Human Sciences Press, 1978.

Barrett, D. The hypnotic dream: Its relation to noc-turnal dreams and waking fantasies. Journal ofAbnormal Psychology, 1979, 88, 584-591.

Blum, G. S. Hypnosis in psychodynamic research. InJ. E. Gordon (Ed.), Handbook of clinical and experi-mental hypnosis. New York: Macmillan, 1967.

Blum, G. S., & Barbour, J. S. Selective inattention toanxiety-linked stimuli. Journal of ExperimentalPsychology: General, 1979, 108, 182-224.

Bowers, K. S. Hypnosis: An informational approach.In W. E. Edmonston (Ed.), Conceptual and investi-gative approaches to hypnosis and hypnotic phe-nomena. Annals of the New York Academy of Sci-ences, 1977, 296, 222-237.

Bowers, K. S., & Gilmore, J. B. Subjective report andcredibility: An inquiry involving hypnotic hallucina-tions. Journal of Abnormal Psychology, 1969, 74,443-451.

Bowers, K. S., & Kelly, P. Stress, disease, psychother-apy, and hypnosis. Journal of Abnormal Psychology,1979, 88, 490-505.

Bowers, P. G. Hypnosis and creativity: The search forthe missing link. Journal of Abnormal Psychology,1979, 88, 564-572.

Bowers, P. G., & Bowers, K. S. Hypnosis and creativ-ity: A theoretical and empirical rapprochement. In

E. Fromm & R. E. Shor (Eds.), Hypnosis: Develop-ments in research and new perspectives. New York:Aldine, 1979.

Brenman, M., & Gill, M. M. Hypnotherapy. New York:Wiley, 1947.

Coe, W. C. The credibility of posthypnotic amnesia: Acontextualist's view. International Journal of Clinicaland Experimental Hypnosis, 1978,26, 218-245.

Dengrove, E. Hypnosis and behavior therapy. Spring-field, 111.: Charles C Thomas, 1976.

Dhanens, T. P., & Lundy, R. M. Hypnotic and wakingsuggestions and recall. International Journal of Clini-cal and Experimental Hypnosis, 1975, 23, 68-79.

Edmonston, W. E. (Ed.). Conceptual and investigativeapproaches to hypnosis and hypnotic phenomena.Annals of the New York Academy of Sciences, 1977,296.

Ellenberger, H. F. The discovery of the unconscious: Thehistory and evolution of dynamic psychiatry. New York:Basic Books, 1970.

Evans, F. J. The placebo response in pain reduction.In J. J. Bonica (Ed.), Pain. Advances in neurology(Vol. 4). New York: Raven, 1974.

Evans, F. J. Contextual forgetting: Posthypnotic sourceamnesia. Journal of Abnormal Psychology, 1979, 88,556-563.

Frankel, F. H. Hypnosis: Trance as a coping mechanism.New York: Plenum, 1976.

Fromm, E. Age regression with unexpected reappear-ance of a repressed childhood language. InternationalJournal of Clinical and Experimental Hypnosis, 1970,18, 79-88.

Fromm, E., & Shor, R. E. (Eds.). Hypnosis: Develop-ments in research and new perspectives. New York:Aldine, 1979.

Hilgard, E. R. Hypnotic susceptibility. New York:Harcourt, Brace & World, 1965.

Hilgard, E. R. The domain of hypnosis, with some com-ments on alternative paradigms. American Psycholo-gist, 1973, 28, 972-982.

Hilgard, E. R. Divided consciousness: Multiple controlsin human thought and action. New York: Wiley-Interscience, 1977.

Hilgard, E. R., & Hilgard, J. R. Hypnosis in the reliefof pain. Los Altos, Calif.: Kaufman, 1974.

Hilgard, E. R., Morgan, A. H., & Macdonald, H. Painand dissociation in the cold pressor test: A study ofhypnotic analgesia with "hidden reports" throughautomatic key pressing and automatic talking.Journal of Abnormal Psychology, 1975, 84, 280-289.

Hilgard, E. R., & Nowlis, D. P. The contents of hyp-notic dreams and night dreams: An exercise inmethod. In E. Fromm & R. E. Shore (Eds.), Hyp-nosis: Research developments and perspectives. Chicago:Aldine-Atherton, 1972.

Hilgard, E. R., et al. Heart rate changes in pain andhypnosis. Psychophysiology, 1974, 11, 692-702.

Hilgard, J. R. Personality and hypnosis; A study ofimaginative involvement. Chicago: University ofChicago Press, 1970.

Horowitz, M. J. Hallucinations: An information-pro-cessing approach. In R. K. Siegel & L. J. West(Eds.), Hallucinations: Behavior, experience, andtheory. New York: Wiley-Biomedical, 1975.


Horowitz, S. L. Strategies within hypnosis for reducingphobic behavior. Journal of Abnormal Psychology,1970, 75, 104-112.

Kihlstrom, J. F. Context and cognition in posthyp-notic amnesia. International Journal of Clinical andExperimental Hypnosis, 1978, 26, 256-267.

Kihlstrom, J. F. Posthypnotic amnesia for recentlylearned material: Interactions with "episodic" and"semantic" memory. Cognitive Psychology, in press.

Knox, V. J., Crutchfield, L., & Hilgard, E. R. Thenature of task interference in hypnotic dissociation:An investigation of automatic behavior. InternationalJournal of Clinical and Experimental Hypnosis, 1975,23, 305-323.

Kosslyn, S. M. Imagery and internal representation.In E. Rosch & B. Lloyd (Eds.), Cognition and cate-gorization. Hillsdale, N.J.: Erlbaum, 1978.

Lazarus, A. A. "Hypnosis" as a facilitator in behaviortherapy. International Journal of Clinical and Experi-mental Hypnosis, 1973, 21, 25-31.

Lazarus, A. A., & Karlin, R. A. Hypnosis in the contextof behavior therapy. In F. H. Frankel & H. S. Zaman-sky (Eds.), Hypnosis at its bicentennial: Selectedpapers. New York: Plenum, 1978.

Levitt, E. E., & Chapman, R, H. Hypnosis as a researchmethod. In E. Fromm & R. E. Shor (Eds.), Hypnosis:Developments in research and new perspectives. NewYork: Aldine, 1979.

Levitt, E. E., Persky, H., & Brady, J. P. Hypnotic in-duction of anxiety. Springfield, 111.: Charles CThomas, 1964.

London, P., & Fuhrer, M. Hypnosis, motivation, andperformance. Journal of Personality, 1961, 29, 321-333.

Luria, A. R. The nature of human conflicts. New York:Liveright, 1932.

Maher, B. A. Delusional thinking and perceptual dis-order. Journal of Individual Psychology, 1974, 30,98-113.

Marshall, G., & Zimbardo, P. G. The affective conse-quences of inadequately explained physiologicalarousal. Journal of Personality and Social Psychology,1979, 37, 970-988.

Maslach, C. Negative emotional biasing of unexplainedarousal. Journal of Personality and Social Psychology,1979, 37, 953-969.

Maslach, C., Zimbardo, P., & Marshall, G. Hypnosis asa means of studying cognitive and behavioral control.In E. Fromm & R. E. Shor (Eds.), Hypnosis: De-velopments in research and new perspectives. NewYork: Aldine, 1979.

McGlashan, T. H., Evans, F. J., & Orne, M. T. Thenature of hypnotic analgesia and placebo response toexperimental pain. Psychosmatic Medicine, 1969, 31,227-246.

Morgan, A. H., & Hilgard, J. R. The Stanford HypnoticClinical Scale for Adults (SHCS: Adult). AmericanJournal of Clinical Hypnosis, 1978-1979, 21, 134-147.(a)

Morgan, A. H., & Hilgard, J. R. The Stanford HypnoticClinical Scale for Children (SHCS: Child). AmericanJournal of Clinical Hypnosis, 1978-1979,21,148-169.(b)

Nash, W. R., Johnson, L. S., & Tipton, R. D. Hypnotic

age regression and the occurrence of transitional ob-ject relationships. Journal of Abnormal Psychology,1979, 88, 547-555.

Neisser, U. Cognitive psychology. New York: Appleton-Century-Crofts, 1967.

Neisser, U. Cognition and reality: Principles and implica-tions of cognitive psychology. San Francisco: Freeman,1976.

Orne, M. T. The nature of hypnosis: Artifact and es-sence. Journal of Abnormal and Social Psychology,1959, 58, 277-299.

Orne, M. T. On the social psychology of the psychologi-cal experiment: With particular reference to demandcharacteristics and their implications. AmericanPsychologist, 1962,17, 776-783.

Orne, M. T. Communication by the total experimentalsituation: Why it is important, how it is evaluated,and its significance for the ecological validity of find-ings. In P. Pliner (Ed.), Communication and affect:Language and thought. New York: Academic Press,1973.

Perry, C., Gelfand, R., & Marcovitch, P. The relevanceof hypnotic susceptibility in the clinical context.Journal of Abnormal Psychology, 1979, 88, 592-603.

Reed, G. The psychology of anomalous experience: Aninquiry into the causes of illusion, delusion, hallucina-tions, dejd vu, and other unusual experiences. NewYork: Houghton Mifflin, 1974.

Reyher, J. A paradigm for determining the clinicalrelevance of hypnotically induced psychopathology.Psychological Bulletin, 1962, 59, 344-352.

Reyher, J. Hypnosis in research on psychopathology.In J. E. Gordon (Ed.), Handbook of clinical and ex-perimental hypnosis. New York: Macmillan, 1967.

Rosenhan, D., & London, P. Hypnosis: Expectation,susceptibility, and performance. Journal of Abnormaland Social Psychology, 1963, 66, 77-81.

Sackeim, H. A., Nordlie, J. W., & Gur, R. C. A modelof hysterical and hypnotic blindness: Cognition, mo-tivation, and awareness. Journal of Abnormal Psy-chology, 1979, 88, 474-489.

Sarbin, T. R., & Coe, W. C. Hypnosis and psychopath-ology: Replacing old myths with fresh metaphors.Journal of Abnormal Psychology, 1979, 88, 506-526.

Sarbin, T. R., & Juhasz, J. B. The social context of hal-lucinations. In R. K. Siegel & L. J. West (Eds.),Hallucinations: Behavior, experience, and theory. NewYork: Wiley, 1975.

Schachter, S., & Singer, J. E. Cognitive, social, andphysiological determinants of emotional state. Psy-chological Review, 1962, 69, 379-399.

Sheehan, P. W. Incongruity in trance behavior: A de-fining property of hypnosis? In W. E. Edmonston(Ed.), Conceptual and investigative approaches tohypnosis and hypnotic phenomena. Annals of theNew York Academy of Sciences, 1977, 296,194-207.

Sheehan, P. W., & Dolby, R. M. Motivated involve-ment in hypnosis: The illustration of clinical reportthrough hypnotic dreams. Journal of Abnormal Psy-chology, 1979, 88, 573-583.

Sheehan, P. W., & Perry, C. W. Methodologies of hyp-nosis: A critical appraisal of contemporary paradigmsof hypnosis. Hillsdale, N.J.: Erlbaum, 1976.


Shepard, R. N. The mental image. American Psycholo-gist, 1978, 33, 125-137.

Shiffrin, R. M., & Schneider, W. Controlled and auto-matic human information processing: II. Perceptualleaning, automatic attending, and a general theory.Psychological Review, 1977, 84, 127-190.

Shor, R. E., & Orne, M. T. The nature of hypnosis:Selected basic readings. New York: Holt, Rinehart& Winston, 1965.

Silverman, L. H. Psychoanalytic theory: "The reportsof my death are greatly exaggerated." American Psy-chologist, 1976, 31, 621-637.

Slotnick, R. S., Liebert, R. M., & Hilgard, E. R. Theenhancement of muscular performance in hypnosisthrough exhortation and involving instructions.Journal of Abnormal Psychology, 1965, 70, 38-46.

Sommerschield, H., & Reyher, J. Posthypnotic conflict,repression, and psychopathology. Journal of Ab-normal Psychology, 1973, 82, 278-290.

Spanos, N. P., & Barber, T. X. "Hypnotic" experiencesas inferred from subjective reports: Auditory andvisual hallucinations. Journal of Experimental Re-search in Personality, 1968, 3, 136-150.

Spanos, N. P., & Barber, T. X. Toward a convergencein hypnosis research. American Psychologist, 1974,Z9, 500-511.

Spanos, N. P., & Gottlieb, J. Demonic possession, mes-merism, and hysteria: A social psychological perspec-tive on their historical interrelations. Journal of Ab-normal Psychology, 1979, 88, 527-546.

Stalnaker, J. M., & Riddle, E. E. The effect of hypnosison long-delayed recall. Journal of General Psychology,1932, 6, 429-440.

Stevenson, J. H. The effect of posthypnotic dissociationon the performance of interfering tasks. Journal ofAbnormal Psychology, 1976, 85, 398-407.

Tinterow, M. M. (Ed.). Foundations of hypnosis: FromMesmer to Freud. Springfield, 111.: Charles C Thomas,1970.

White, R. S., & Shevack, B. J. Hypnosis and the con-cept of dissociation. Journal of Abnormal and SocialPsychology, 1942, 37, 309-328.

Wolberg, L. R. Hypnosis in psychoanalytic psycho-therapy. In J. E. Gordon (Ed.), Handbook of clinicaland experimental hypnosis. New York: Macmillan,1967.

Wolpe, J. Psychotherapy by reciprocal inhibition. Stan-ford, Calif.: Stanford University Press, 1958.

Wolpe, J. The practice of behavior therapy (2nd ed.). NewYork: Pergamon Press, 1973.

Received May 25, 1979 •

hypnosis and psychopathology: retrospect and prospectjfkihlstrom/pdfs/1970s/1979/kihlstrom... ·...

Documents