Hypnosis as a "state of consciousness": how quantifying the mind can help us better understand hypnosis.

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Hypnosis as a “State of Consciousness”: How Quantifying the Mind Can Help Us Better Understand Hypnosis ab

Ronald J. Pekala a

Private Practice, West Chester, Pennsylvania, USA

b

Coatesville Veterans Administration Medical Center, Coatesville, Pennsylvania, USA Published online: 07 Apr 2015.

Click for updates To cite this article: Ronald J. Pekala (2015) Hypnosis as a “State of Consciousness”: How Quantifying the Mind Can Help Us Better Understand Hypnosis, American Journal of Clinical Hypnosis, 57:4, 402-424, DOI: 10.1080/00029157.2015.1011480 To link to this article: http://dx.doi.org/10.1080/00029157.2015.1011480

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American Journal of Clinical Hypnosis, 57: 402–424, 2015 ISSN: 0002-9157 print / 2160-0562 online DOI: 10.1080/00029157.2015.1011480

Hypnosis as a “State of Consciousness”: How Quantifying the Mind Can Help Us Better Understand Hypnosis


Ronald J. Pekala Private Practice, West Chester, Pennsylvania, USA Coatesville Veterans Administration Medical Center, Coatesville, Pennsylvania, USA

I am excited to see that after two earlier attempts by APA’s Division 30 at a definition of hypnosis, the mind is now being more clearly highlighted as a legitimate area of study. By defining hypnosis as a “state of consciousness,” the new Division 30 definition (Elkins, Barabasz, Council, & Spiegel, 2015) highlights the importance of consciousness: “the state of being characterized by sensation, emotion, volition and thought: MIND” (Webster’s Seventh New Collegiate Dictionary, 1970, p. 177) in trying to understand the nature and essence of hypnosis. The experience of hypnosis is a very subjective or “mental” event, for the client and the research participant, with susceptible “individuals experiencing varying degrees of alteration of awareness and dissociation” (Spiegel & Spiegel, 2004, p. 7), in addition to various changes in imagery vividness, volitional control, and other aspects of consciousness. Hence, it seems that trying to better understand the mind of the client/participant during hypnosis is really the best and most comprehensive means to help decipher the enigma of hypnosis while relating the mind to neurophysiological and cognitive-behavioral domains. Having spent the last three decades trying to do just that (Pekala, 1980, 1985a, 1991b, 2002, 2011, 2014), that is, developing a methodology to quantify the mind of the participant during hypnosis and other states of consciousness, I am even more excited at being able to comment on the new Division 30 definition. This commentary will review why I believe that the mind needs to be fully explored—specifically, quantified, for any comprehensive understanding of the nature of hypnosis. This will be addressed in terms of the epistemological basis for such an approach, research concerning a methodology for quantifying the mind or consciousness not only for hypnosis but also for other states of consciousness as well, how such an approach may allow the various aspects of hypnosis to be better understood, and finally, how the new Division 30 definition can serve as an initial entry point for a more comprehensive understanding of hypnosis. This article not subject to US copyright law. Address correspondence to Ronald J. Pekala, Ph.D., Coatesville Veterans Administration Medical Center, Black Horse Hill Road, Coatesville, PA 19320, USA. E-mail: [email protected]; [email protected] Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/ujhy.


HYPNOSIS AS A “STATE OF CONSCIOUSNESS”

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Lynn, Kirsch, and Hallquist (2008) wrote several years ago that if “researchers fail to operationally define the ‘state’ of hypnosis, and then argue that people are in a trance or altered state (even with no prior induction), their claim cannot be falsified, and is thus not amenable to scientific scrutiny” (p. 129). Now that we are defining hypnosis as a “state of consciousness,” we need to be able to operationally define that term, and probably “altered states of consciousness” as well (Kallio & Revonsuo, 2003). By reviewing the research by myself and colleagues quantifying this “states of consciousness” approach to hypnosis, I hope to demonstrate to the readership not only its strategic importance for better understanding hypnosis, but to illustrate how use of this paradigm can help with the issue of falsification and allow opposing camps of hypnotic theorists/researchers find common ground concerning their differing points of view.

An Epistemological Basis for Quantifying the Mind During Hypnosis Historical Developments Orne (1977) several decades ago suggested that the standard hypnotic assessment instruments measure the hypnotic process only to the extent that the behavioral assessment validly reflects alterations in the individual’s subjective experience. Hypnosis is a quintessential subjective phenomenon, especially for the client, and more so for the highly hypnotizable individual (Heap, Brown, & Oakley, 2004). Yet we, as clinicians and researchers, routinely fail to quantify the client’s subjective experiences as much as we could. Yes, as clinicians we do use the client’s self-reports and nonverbal behaviors to assess and infer subjective phenomena. This, in turn, helps us generate hypnotic interventions to influence the client, his/her mind, and his/her behavior. However, hypnosis researchers and clinicians have not assessed the mind, or state of consciousness of the client, as much as is now possible. This is partly due to biases concerning the reliability and validity of introspection concerning consciousness that spanned the prior century and how those biases impeded research into subjective or phenomenological experience. As psychological science sought to free itself from the methodological hegemony of behaviorism, various theoreticians and researchers (Ericsson & Simon, 1980; Klinger, 1978; Kukla, 1983; Singer & Kolligian, 1987) near the end of the 20th century critiqued the vacuous edifice erected by the behaviorists to bar consciousness as a legitimate area of psychological research. They found this approach lacking and suggested how subjective experience could be reliably and validly assessed. Their theorizing and research paved the way for introspection, or what was called phenomenological assessment (Hilgard, 1980), to become more acceptable. As a result, introspective methods gained legitimacy (Cardeña & Pekala, 2014). Such introspective methodologies now need to be more fully utilized for better understanding hypnosis as a “state of consciousness.”

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Epistemological Underpinnings So why is a change in definition, specifically highlighting “states of consciousness,” so important in better understanding the nature of hypnosis? It concerns having the technology to access the appropriate levels of observation when trying to understand a phenomenon of interest. Without the microscope or the telescope, we would be oblivious to the world of microbes or the cosmos and its galaxies; i.e., having the technology to look at the microscopic and the macroscopic levels of our universe has allowed us to measure phenomena of which we would be otherwise oblivious. There is a famous saying in philosophy that states: “Epistemology precedes metaphysics.” Epistemology, “the study or a theory of the nature and grounds of knowledge especially with reference to its limits and validity,” (Webster’s Seventh New Collegiate Dictionary, 1970, p. 280), must necessarily precede metaphysics, which concerns itself with the nature of being and existence. In short, what we know is a function of how we know what we know. Just as we have a level of analysis to study the neurophysiology of the brain during hypnosis, and a cognitive-behavioral level of analysis to study human cognition and behavior, we need a noetic level of analysis (the Greek word for mind is nous) to study those subjective aspects of the brain typically called the mind. And we need to comprehensively quantify the mind just as physics comprehensively quantifies physical reality. Furthermore, there is no way that we are going to find the mind (the qualia of human consciousness) beneath a scalpel or lifted from functional magnetic resonance imaging (fMRI), i.e., the “hard problem” of human consciousness (Chalmers, 2007): The hard problem of consciousness is the problem of experience. When we think and perceive, there is a whirl of information-processing, but there is also a subjective aspect. . . . Then there are bodily sensations, from pains to orgasms; mental images that are conjured up internally; the felt quality of emotion, and the experience of a stream of conscious thought. (p. 226)

If we are going to make any significant headway in better understanding hypnosis and its relationship to consciousness and the brain, we need a comprehensive quantitative phenomenology to scientifically investigate the mind. This was echoed over a decade ago: “A growing number of cognitive scientists now recognize the need to make systematic use of introspective phenomenological reports in studying the brain basis of consciousness” (Lutz & Thompson, 2003, p. 31). More recently Zelazo, Moscovitch, and Thompson (2007) wrote: “There is also the growing realization, however, that it will not be possible to make serious headway in understanding consciousness without confronting the issue of how to acquire more precise descriptive first-person reports about subjective experience” (p. 2). Neglecting the mind in favor of only neurophysiological or cognitive-behavioral data about the brain is like looking for your car keys under the lamp light because this is easier, even though you lost your keys in the dark, far away from that lamp post. As I will demonstrate below, the mind can be quantified, as can quarks, the economy, or a


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neutron star: precise descriptive first-person reports about subjective experience can be obtained in a reliable and valid manner. Physics became queen of the natural sciences because it wedded mathematics to the description of natural phenomena. By measuring and quantifying the world around us, we have learned how to predict, and, sometimes control, that world. This model from physics has since been applied to chemistry, cosmology, and the various social sciences with great success. By quantifying a phenomenon of interest, we then use mathematical tools and models to better predict and control our universe. The same model can be applied to the mind.

Noetic Analysis The Methodology To do this, phenomenology (i.e., first-person reports about the qualia of consciousness) needs to be wedded to the statistical research methodology of science. The methodology to do this has been previously described by myself (Pekala, 1980, 1991b) and researched by myself and colleagues (Forbes & Pekala, 1993; Kumar & Pekala; 1988, 1989; Pekala, 1985a, 1995a, 1995b, 2010, 2011; Pekala & Forbes, 1988, 1997; Pekala & Kumar, 1984, 1986, 1987, 2000, 2005, 2007; Pekala & Nagler, 1989; Pekala, Kumar, Maurer, Elliott-Carter, Moon, & Mullen, 2010a, 2010b; Pekala & Wickramasekera, 2007). The methodology involves: an empirical-phenomenological approach for mapping the structures and patterns of consciousness. By consciousness I mean one’s awareness of one’s subjective experience, including both the processes of being aware and the various contents of that awareness. This includes both the noeses and the noema of phenomenological consciousness (Kockelsman, 1967) and also one’s “state of consciousness” (Tart, 1975), as one’s stream of subjective experience is apprehended over a period of time. The approach is called retrospective phenomenological assessment (RPA) and involves the retrospective completion of a self-report, phenomenological state instrument in reference to a preceding stimulus condition. (Pekala, 1991b, p. 1)

The methodology generates a reliable and valid “snapshot” of the state of consciousness of an individual or group of individuals in reference to a short preceding stimulus condition, be it hypnosis (Pekala & Kumar, 1986, 1989), a spiritual/religious experience (Wildman & McNamara, 2010), or an anomalous experience/event (Rock & Beischel, 2008). RPA involves assessing well-defined and repeatable short stimulus conditions1 and using standardized self-report questionnaires to retrospectively assess subjective experience in reference to those stimulus conditions. The use of such a quantitative, phenomenological analysis, or noetic analysis, is distinguished from the descriptive, non-quantitative phenomenological analyses of the psychological phenomenologists (Giorgi, 2009; Moustakas, 1994) and also neurophenomenology (Lutz, 2002; Varela, 1996). Previous writings by the undersigned

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(Pekala, 1980, 1985a, 1991b, 2002) have also described this empirical, phenomenological approach as a psychophenomenological approach to introspection or phenomenological observation.


Noetic Analysis Vis-à-Vis Phenomenology and Neurophenomenology The term noetic analysis was chosen to further highlight and differentiate this quantitative approach to assessing the mind and states of consciousness from that of philosophical phenomenology, the phenomenological psychologists, and neurophenomenology. Noetic analysis is involved in quantifying and statistically analyzing the processes and contents of subjective consciousness: the mind. It seeks to go beyond descriptive philosophical phenomenology, attempting to quantify the contents and processes of consciousness, in some sense paralleling Husserl’s (1931/1972) noema/noesis doctrine, i.e., “the traits of the object intended (noema) and the traits of the conscious intending (noesis)” (Ricoeur, 1967, p. 21). The approach allows for the statistical analysis of the processes and contents of subjective consciousness or the mind and their mapping onto psychological, neurophysiological, and individual differences factors. Phenomenological psychology, as espoused by phenomenological psychologists, such as Giorgi (2009) and Moustakas (1994), does not quantify the processes and contents of consciousness in such a way as to make the approach statistically useful in correlating such processes with the brain, human behavior, and individual differences factors (although their approaches do furnish us with very rich, descriptive data about the mind). Neurophenomenology, on the other hand, is a scientific research program that combines neuroscience with phenomenology to better understand consciousness and human experience, especially as it is embodied by the human brain. The term was originally popularized by the cognitive neuroscientist Varela (1996). Neurophenomenology, as defined by Lutz and Thomson (2003) uses “first-person methods,” which are: disciplined practices subjects can use to increase their sensitivity to their own experiences at various time-scales. . . . These practices involved the systematic training of attention and self-regulation of emotion. . . . Using these methods, subjects may be able to gain access to aspects of their experience (such as transient affective state of quality of attention) that otherwise would remain unnoticed and unavailable for verbal report. (p. 33)

Such trained introspection, as was used in classical introspectionism over 100 years ago, resulted in different laboratories “training” introspectionists in different ways: “laboratory atmosphere crept into the descriptions, and it was not possible to verify, from one laboratory to another, the introspective account of the consciousness of action, feeling, choice, and judgment” (Boring, 1953, p. 174). In contrast, noetic analysis uses “untrained” introspectionists, i.e., individuals with no specific training in introspection (such training is not needed since individuals retrospectively rate their subjective experience via standardized questionnaires).


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Noetic Analysis In summary, the noetic approach described herein uses standardized self-report questionnaires that measure dimensions of subjective experience (such as imagery, absorption, volitional control, positive affect) in a reliable and valid manner, allowing the processes and contents of the mind of the client/participant to be quantified. To do this, participants retrospectively rate the items of such questionnaires in reference to a preceding short stimulus condition; thus, the act of introspection is not reactively influencing their stream of consciousness, as might be the case with concurrent observation. Via this methodology and the assumption of stimulus-state specificity: “across groups of randomly selected individuals, the same behaviors in the same stimulus setting (the same stimulus conditions), will be associated with the same intensities and patterns of phenomenological experience (the same phenomenological state), while different stimulus conditions will be associated with different intensities and/or patterns of phenomenological experience” (Pekala & Wenger, 1983, p. 255), subjective consciousness or the mind can be reliably, and validly, quantified. (See Pekala [1991b] for a review of the methodological and statistical assumptions behind this approach, including that of stimulus-state specificity.) The two main questionnaires that the author and colleagues have used with RPA include the Phenomenology of Consciousness Inventory (PCI; Pekala, 1982, 1991d) and the Dimensions of Attention Questionnaire (DAQ; Pekala, 1985b, 1991c). These instruments respectively quantify consciousness, in general, and attention, in particular. The PCI has been especially useful in mapping the subjective experience of hypnosis and has been shown to have adequate construct, discriminant (Kumar & Pekala, 1988, 1989; Kumar, Pekala, & Marcano, 1996; Kumar, Pekala, & McCloskey, 1999; Pekala, 1991b; Pekala & Forbes, 1988; Pekala & Kumar, 1986, 1989; Pekala, Kumar, Maurer, ElliottCarter, & Moon, 2006; Pekala & Nagler, 1989; Pekala, Steinberg, & Kumar, 1986), and predictive validity (Barnes, Lynn, & Pekala, 2009; Forbes & Pekala, 1993, 1996; Hand, Pekala, & Kumar, 1995; Pekala & Kumar, 1984, 1987) for measuring phenomenological experiences associated with hypnosis. In addition, the PCI has also been used to quantify such stimulus conditions (besides hypnosis) as meditation (Venkatesh, Raju, Shivani, Tompkins, & Meti, 1997), fire-walking (Hillig & Holroyd, 1997/1998; Pekala & Ersek, 1992/1993), an out-of-thebody experience (OBE) within a near death experience (NDE; Maitz & Pekala, 1991), shamanistic trances (Rock, Wilson, Johnston, & Levesque, 2008), charismatic leadership (Churches, 2015), religious/spiritual narratives (Wildman & McNamara, 2010), a virtual reality environment (Huang, Himle, & Alessi, 2000), drumming (Maurer, Kumar, Woodside, & Pekala, 1997), schizophrenia (Roussel & Bachelor, 2000/2001), epilepsy (Johanson, Valli, & Revonsuo, 2011), music perception (Nagy & Szabo, 2004), and psi phenomena (Rock & Storm, 2010). Whereas the PCI has been translated into 12 languages, the DAQ has been translated into 4 (see www.quantifyingconsciousness.com).

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The aforementioned approach can be used to quantify and statistically assess states of consciousness associated with various stimulus conditions, hence allowing the new Division 30 definition of hypnosis as a “state of consciousness” to be operationally defined and assessed. States of Consciousness


The Model C. T. Tart is by far the theoretician and researcher who has developed the best theoretical model concerning states of consciousness as described in his books, States of Consciousness (1975) and Altered States of Consciousness (1972). Tart (1972) described a “state of consciousness” as “a unique configuration or system of psychological structures or subsystems, a configuration that maintains its integrity or identity as a recognizable system in spite of variations in input from the environment and in spite of various (small) changes in subsystems” (p. 62). Tart’s approach highlights the importance of the pattern of relationships among dimensions of consciousness in determining a state of consciousness: “A unique, dynamic pattern or configuration of psychological structures” (1977, p. 170, emphasis added). Singer (in Zinberg, 1977), on the other hand, suggested that intensity effects were also relevant and need to be considered in determining if a(n) (altered) state of consciousness is evident: “Are alternate states of consciousness discrete states, to use Tart’s words, or are differences among alternate states of consciousness merely differences of degree, as Singer insists?” (p. 9). Drawing upon the theorizing of Tart, Singer, and Mandler (1985), over 30 years ago, I defined a “state of consciousness” as “the particular intensity and pattern of associated phenomenological parameters that characterize one’s subjective experience during a given time period” (Pekala & Wenger, 1983, pp. 252–253; Pekala, 1991b, p. 83). Quantifying States of Consciousness I believe that both intensity and pattern effects need to be charted when quantifying phenomenological experience. A person’s scores for those items making up a particular (sub)dimension of consciousness, on such a questionnaire as the PCI or the DAQ, are averaged to arrive at an intensity score for each of the various (sub)dimensions of consciousness mapped by the self-report questionnaire. These scores allow for intensity parameters of subjective experience to be assessed and quantified. Then, by means of (multivariate) analyses of variance, dimension intensity scores for the dimensions of consciousness associated with differing stimulus conditions, or differing subject groups (e.g., low versus high hypnotizables), can be statistically compared.


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By administering the PCI to many individuals in reference to a particular stimulus condition, a Pearson correlation matrix of the intensity scores can be computed for the various dimensions of consciousness. The intercorrelation matrix represents a quantification of the pattern of relationships among the various dimensions per Tart’s (1972, 1975, 1977) criteria for his pattern approach to defining states of consciousness. The correlation matrices associated with different stimulus conditions (e.g., hypnosis versus relaxation) or differing subject groups (e.g., low versus high hypnotizables) can then be compared and statistically evaluated via the Jennrich (1970) test, assessing for differences in correlations or patterns of organization among the various dimensions. Psygrams The PCI can be used to not only quantify states of consciousness associated with hypnosis, meditation, and other states of consciousness, and/or across low and high hypnotizables, but the results can then be visually illustrated. A psygram (Pekala, 1985a) represents a “snapshot,” as assessed across a group of individuals, of the psychophenomenological state of consciousness associated with the stimulus condition/participant group assessed. By illustrating the differences in patterns of connectivity among PCI dimensions for individuals of low and high hypnotic susceptibility, researchers can use this methodology to determine how hypnosis may differentially affect the patterns of association (for the PCI dimensions) among low and high hypnotizables during hypnosis. Pekala and Kumar (1986) assessed the pattern of relationships among phenomenological subsystems of consciousness across low and high hypnotically susceptible individuals by means of the PCI. Participants experienced a baseline condition of eyes closed sitting quietly and then retrospectively completed the PCI in reference to that condition. They then experienced the induction procedure of the Harvard Group Scale of Hypnotic Susceptibility: Form A (HGSHS:A; Shor & Orne, 1962) and retrospectively completed the PCI in reference to the sitting quietly period embedded in that induction. These procedures were replicated in a later study (Pekala & Kumar, 1989), with data from the two studies combined to increase the sample size and reported in Pekala and Bieber (1989/1990). Participants were divided into four susceptibility groups based on their HGSHS:A scores: lows, low-mediums, high-mediums, and highs. Correlation matrices were constructed for the susceptibility groups using the 12 major PCI dimensions for the hypnotic induction conditions. The matrices were compared with the Jennrich (1970) test. The pattern difference between the low and high susceptible groups was significant. By converting the correlations to coefficients of determination (which indicate the percentage of variance in common between PCI dimensions), psygrams were constructed for the low and high susceptible participants for the hypnosis condition. Figures 1 and 2 show the patterns of association for low and high susceptibles during hypnosis. Each line represents 5% of the variance in common. The coefficients of


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FIGURE 1 Psygram: Low hypnotizables during hypnosis. Based on Pekala and Bieber (1989/1990). © 1989/1990 SAGE Publishing Co. Reproduced by permission of SAGE Publishing Co. Permission to reuse must be obtained from the rightsholder.

determination are listed besides the lines, with negative correlations (from which the coefficients of determination were computed) listed with a negative number (and dashed lines). Huge differences in the patterns of association are evident among the two groups. For low susceptibles, hypnosis potentiated the magnitude of the associations among the PCI dimensions. The number of significant associations is 21, and the average



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FIGURE 2 Psygram: High hypnotizables during hypnosis. Reproduced from Pekala and Bieber (1989/1990). © 1989/1990 SAGE Publishing Co. Reproduced by permission of SAGE Publishing Co. Permission to reuse must be obtained from the rightsholder.

percentage of variance in common between each pair of dimensions was 37%. In contrast, high susceptibles had only nine significant associations with a variance of 20%. Whereas almost all of the PCI major dimensions are highly coupled for lows, high susceptibles are much more loosely coupled, with only moderate coupling (25% or greater) between rationality and vivid imagery, vivid imagery and positive affect, and altered state and altered experience.


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Increased magnitude and frequency of associations among subsystems may make it much more difficult for lows to experience a hallucinated fly or to dissociate the perceptual experience of one’s arm levitating, since a change in one particular subsystem appears to lead to associated changes in other subsystems. This would make it quite difficult for lows to modify the phenomenological contents of a particular subsystem of consciousness without affecting other subsystems concurrently. Research into the relationships between hypnosis and dissociation (Kluft, 2003), as measured by various questionnaires like the Dissociative Experiences Scale (DES), has found only weak correlations at best (Carlson & Putnam, 1992). The above psygram results suggest a way of quantitatively operationalizing dissociation, not as a function of the dissociation of the contents of consciousness, as is usually assessed with such instruments as the DES (Bernstein & Putnam, 1986; Carlson & Putnam, 1992), but rather as an association or disassociation among the processes of consciousness for high, visà-vis, low susceptibles during hypnosis, that may be much more meaningful. Radar Graphs PCI dimension intensity effects can be illustrated via a variety of means. Figure 3 shows a “radar graph” for the intensity scores for the 12 major PCI dimensions as a function of 3 stimulus conditions—hypnosis (n = 173), with eyes open (n = 110) and eyes closed (n = 173)—sitting quietly, as reported in Pekala et al. (1986). Intensity values are typically coded as follows: center of graph = 0 = intensity effects of “none of little”; circumference = 6 = intensity effects of “much or complete.” Significance levels can also be coded onto the graph. This format allows the reader to visually compare PCI intensity effects associated with differing states of consciousness/stimulus conditions. Measuring Hypnosis Phenomenologically—The Phenomenology of Consciousness Inventory: Hypnotic Assessment Inventory (PCI-HAP) A methodology that combines RPA with a hypnotic assessment protocol to quantify hypnotic responsivity from a predominantly phenomenological perspective has been developed. The PCI-HAP2 (Pekala, 1995a, 1995b; Pekala & Wickramasekera, 2007) is an inventory that can be used to measure hypnotic responsivity from a more state perspective. Unlike cognitive-behavioral instruments like the Harvard (Shor & Orne, 1962) or the Stanford C (Weitzenhoffer & Hilgard, 1962), which measure hypnotic susceptibility from a more “trait” perspective, the PCI-HAP measures what we have called hypnotic responsivity (Pekala et al., 2010a, 2010b) from a more “state” perspective. Trance The PCI-HAP generates an estimate of Weitzenhoffer’s (2002) conceptualization of hypnosis or “trance.” This measure of hypnosis is computed from the 53-item PCI and



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FIGURE 3 Radar plot of the PCI major dimensions across three stimulus conditions.Values from graph taken from Pekala et al. (1986).

is called a “hypnoidal state” score (Pekala & Nagler, 1989). The score is based on cross-validated regression analyses of the PCI in predicting total Harvard Group Scale scores using the unstandardized regression coefficients of 10 of the PCI (sub)dimensions. This score correlates about .60 with the Harvard Group Scale (Forbes & Pekala, 1993; Pekala & Kumar, 1984, 1987). Per Table 1, in the regression equation are the PCI (sub)dimensions indicating loss of volitional control and increases in altered state, altered experiences, absorption, etc., subjective experiences that clinicians would expect to be altered during hypnosis with high hypnotizables (Pekala, 1991b). Self-Reported Hypnotic Depth (srHD) Versus Hypnoidal State The hypnoidal state measure of “trance” is contrasted with the client’s perception of how hypnotized they become, what the PCI-HAP labels the srHD score. Pekala and colleagues (2006) previously reported on the PCI-HAP to measure hypnotic depth using

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TABLE 1 Hypnoidal State Score Regression Equation

PCI (sub)dimension

x

Altered experience Altered state Volitional control Self-awareness Rationality Absorption Memory Altered time sense Internal dialogue Altered body image Constant

x x x x x x x x x x

Unstandardized regression coefficient +0.35 +0.31 −0.28 −0.27 +0.23 +0.19 −0.14 +0.13 −0.11 −0.07 +4.51

Relative percentage 17% 15% 13% 13% 11% 9% 7% 6% 5% 3%

Note. Percentages indicate relative magnitude of the coefficient. Each PCI (sub)dimension is rated on a scale from 0 (none or little) to 6 (much or complete). Source: This table is modified from Pekala and Kumar (1987). © American Society of Clinical Hypnosis. Reprinted by permission of the American Society of Clinical Hypnosis (www.asch.net). Permission to reuse must be obtained from the rightsholder.

the srHD score. Several other works have been published concerning this score (Pekala et al., 2010a, 2010b; Pekala & Maurer, 2013). Additionally, Wagstaff (2010) wrote that the srHD score “is very similar to that found in the Long Stanford Scale of Hypnotic Depth (LSS),” (p. 49), suggesting commonalities between the srHD and LSS scores. Pekala et al. (2010a, 2010b) sought to determine if srHD could be predicted from the variables of the PCI-HAP assessing several of the processes theorized by researchers to be associated with hypnosis: trance or altered state effects (Kihlstrom, 2003, 2005; Weitzenhoffer, 2002; Woody & Bowers, 1994), suggestibility (Shumaker, 1991), and expectancy (Kirsch, 1985; Kirsch & Braffman, 1999, 2001). One hundred eighty participants completed the PCI-HAP. Using regression analyses, srHD scores were predicted from the PCI-HAP prehypnotic and posthypnotic assessment items and several other variables. The results suggested that the srHD scores were found to be a function of imagoic suggestibility, expectancy (both estimated hypnotic depth and expected therapeutic efficacy), and trance state effects, effects that appear to be additive and not (statistically) interactive. The results support the theorizing of many investigators (Holroyd, 2003; Kihlstrom, 2005; Lynn et al., 2008; Weitzenhoffer, 2002) concerning the involvement of the aforementioned component processes with this particular aspect of hypnosis, the srHD score. The aforementioned research predicting the srHD score was recently replicated with an Italian translation of the PCI/PCI-HAP (Pekala et al., 2015). Additional replications by other laboratories are needed.



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FIGURE 4 Self-reported hypnotic depth as a function of hypnoidal state. This figure was reproduced from Pekala and Maurer (2013). © International Journal of Clinical and Experimental Hypnosis. Reproduced by permission of the International Journal of Clinical and Experimental Hypnosis. Permission to reuse must be obtained from the rightsholder.

An article published in the International Journal of Clinical and Experimental Hypnosis (Pekala & Maurer, 2013) did a cross-validation analysis of the hypnoidal and srHD scores; the results suggested that although there is some variance in common, the srHD score appears to be tapping a different construct from the hypnoidal state score. A correlation of .48 (p < .001) was found between the two constructs. Figure 4 illustrates the scatterplot of the two variables. Additionally, the hypnoidal state score was more highly correlated with the PCI-HAP sleep state item (r = .35, p < .001) from the PCI-HAP than the sleep state item correlated with the srHD item (r = .12, not significant). According to Weitzenhoffer (1989), the term “trance” denotes states of consciousness that have the appearance of normal consciousness but seem to differ “as being a sleeplike, or a half awake, half asleep state” (p. 298). Hence, the more participants felt that they were asleep (as measured by the sleep state item from the PCI-HAP), the higher the hypnoidal state score was. This suggests that the hypnoidal state item appears to be functioning as an estimator of Weitzenhoffer’s (1989) conception of trance and appears to be tapping a different construct from the client’s attribution as to how deeply hypnotized they felt they had become (the srHD score), although there is variance in common.

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The Use of Noetic Analysis to Differentiate “Types” of Trance and Its Relevance to the New Division 30 Definition


Trance Typology Previous research (Pekala & Kumar, 2000) suggests that there may be different clusters or typologies of hypnotic experience or trance, depending partly on the responsivity level of the participant. Table 2 shows different typologies of subjective experience, based on cluster and discriminant analyses (Forbes & Pekala, 1996; Pekala, 1991a; Pekala & Forbes, 1997; Pekala, Kumar, & Marcano, 1995b) for low to high hypnotizables, rank ordered according to the hypnoidal state score. The aforementioned data suggest that the subjective experience of hypnosis may subsume various configurations or typologies; those typologies partly dependent upon the hypnotic responsivity/talent of the particular participant, which, in turn, would be presumed to be dependent on differential brain activation (Barabasz & Barabasz, 2008; Oakley, 2008) and the quantitative electroencephalogram (qEEG) frequencies, amplitudes and connectivities among those areas (Budzynski, Budzynski, Evans, & Abarbanel, 2009; Collura, 2008). TABLE 2 Nine Hypnotic Types, Average Trance Depth, and Distinguishing Characteristics

Hypnotic type

Hypnoidal state scorea

Distinguishing characteristics of each of the nine cluster typesb (based on intensity levels of PCI major dimensions)

Classic lows

2.88

Relaxed lows

3.68

Nondialoging mediums Dialoging mediums Visualizers

4.87 5.01 6.06

Rational high-mediums

6.81

Dialoging high-mediums

6.86

Fantasy highs Classic highs

7.10 7.60

Highest level of arousal (muscular tension); most intact memory, rationality, and self-awareness; most internal dialogue; least drop in volitional control Similar to classic lows except have low muscle tension levels and less internal dialogue Similar to dialoging mediums except for lack of internal dialogue Similar to nondialoging mediums except for more internal dialogue Highest level of visual imagery; highest level of self-awareness and intact memory after classic and relaxed lows Similar to dialoging high-mediums except for less internal dialogue and more rationality Second highest level of internal dialogue after classic lows; similar to rational high-mediums except for more internal dialogue and less rationality Second highest level of imagery after visualizers Lowest level of memory, rationality, internal dialogue, imagery, and self-awareness

a Hypnoidal state score: Average level of trance depth; scores go from approximately 1.0 (not hypnotizable) to 9.0 (highly hypnotizable). b Based on Pekala and Forbes (1997). Source: This table was reproduced from Pekala and Kumar (2000). © American Society of Clinical Hypnosis. Reprinted by permission of the American Society of Clinical Hypnosis (www.asch.net). Permission to reuse must be obtained from the rightsholder.


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Relevance to the New Division 30 Definition How such typologies associated with hypnotic states may be similar and/or different, neurophysiologically and noetically, from other states, such as meditation (Pekala, 1987), religious and spiritual experiences (Wildman, 2011), or cross-cultural trance states (Cardeña & Winkelman, 2011), etc., now becomes an empirical research question. Additionally, is there a state of “deep pure hypnosis” (Cardeña, 2005) associated with hypnotic virtuosos that is characterized by activation of the “default mode network (DMN)” (Lipari et al., 2012) in a manner different from the nonvirtuosos? And what are the differences in associated phenomenology? I believe such questions may be more easily addressed by combining neurophysiology with noetic analysis. About 100 Brodmann areas (differing areas of the cerebral cortex, as defined by its cytoarchitecture and structure/organization of cells) are now recognized; it is “therefore convenient to take this as a rough estimate of the number of specialized regions of the cortex” (Baars & Gage, 2010, p. 131). Sorting out these different areas of brain activation may be best assessed by mapping neurophysiological variables while concurrently quantifying subjective states. By using the qEEG, fMRI, and associated technologies to quantify the brain, and the PCI/PCI-HAP (or similar types of inventories) to quantify the mind, the investigator has the technology needed to assess the brain/mind interface in a quantifiable, and potentially useful, manner: “There is some evidence that DMN activity during hypnosis shows a different pattern of brain activity compared to the non-hypnosis condition” (Lipari et al., 2012, p. 394). Assessing such activity while concurrently quantifying subjective state across low and high hypnotizables may allow for finer discrimination of the brain/mind interface during hypnosis. The new Division 30 definition also highlights “focused attention and reduced peripheral awareness” (Elkins et al., 2015, p. 6) as characteristic of the state of consciousness associated with hypnosis. As the reader can see from Table 1, focused attention, as defined by the PCI absorption dimension, is accounting for only 9% of the variance associated with the hypnoidal state score, an estimator of Weitzenhoffer’s definition of trance (Pekala & Maurer, 2013). Alterations in experience and state of awareness, and losses in volitional control and self-awareness, are accounting for more of the variance than is absorption. The aforementioned suggests that it is probably the case that individuals of different hypnotic talent have different activated phenomenologies depending on their hypnotizability level, in addition to the nature of the hypnotic suggestions given, the stimulus context, and the client’s particular personality, as has also been highlighted in other research (Sheehan & McConkey, 1982; Spiegel & Spiegel, 2004). The five-page report (Pekala, 2009) that is generated when the PCI-HAP is scored with the EXCEL program (Pekala Maurer, & Ott, 2009) allows the clinician to determine which aspects of subjective experience are activated in a particular client during an induction. This phenomenological “sample” of the client’s mind during hypnosis allows the clinician to

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begin to determine which process-congruent suggestions (Hammond, 1990) may be best to use with particular clients, each of whom may have different hypnotic talents due to the activation of differing phenomenological processes (Pekala, 2002, 2014). Increased absorption (see Table 1) or focused attention appears to be only one of several dimensions of subjective experience that are significantly, and differentially, modified by hypnosis (Pekala, 2014). Future research will need to determine the extent of absorption’s ubiquity in hypnotic responsivity. Hence, the new APA Division 30 definition should serve as an initial place to begin concerning the various levels of analysis that are probably needed to best understand hypnosis. Conclusions With states of consciousness now officially highlighted as an important aspect of hypnosis, it is hoped that other clinicians and researchers will begin to turn their eyes, and their computers, on the aforementioned noetic level of analysis and related introspective methodologies (Cardeña & Pekala, 2014) while integrating this level of analysis with traditional cognitive-behavioral and neurophysiological levels. Integrating these differing levels of analysis may help us not only generate more comprehensive research perspectives on the nature of hypnosis but allow us to better understand its relationship to other types of phenomena, such as meditation (Lutz, Dunne, & Davidson, 2007), spiritual/religious events (Wildman, 2011), and anomalous experiences (Cardeña, Lynn, & Krippner, 2014). High hypnotizables typically report more spontaneous paranormal and anomalous experiences than lows (Pekala, Kumar, & Cummings, 1992; Pekala, Kumar, & Marcano, 1995a), and hypnosis has been dubbed one of the “facilitators” of psi (Schechter, 1984). Having a technology to quantify the mind can not only help us in better understanding this most subjective of phenomena but can help decipher its relationship to individual differences in hypnotic responsivity and possibly other types of interesting and related stimulus conditions/states of awareness. Acknowledgement The content of this article does not represent the views of the Department of Veterans Affairs nor the United States Government. Notes 1. Whereas the methodology uses groups of individuals randomly assigned to differing stimulus conditions to assess for differences in subjective experiences across those conditions (Pekala, 1991b), it can also be used to explore individual differences in particular personality characteristics, such as the patterns of association among high susceptibles


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(Pekala & Kumar, 1986, 1989) vis-à-vis other groups, i.e., low susceptibles, to determine how the PCI relationships may be different due to such individual differences factors. 2. Copies of the PCI-HAP (Pekala, 1995a, 1995b), the therapist and self-report pre- and post-assessment forms, the administration (Pekala, Kumar, & Maurer, 2009) and interpretative (Pekala, 2009) manuals, and the EXCEL scoring program (Pekala et al., 2009) are available at www.quantifyingconsciousness.com.


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