Hypnotizability
and Phobic Behavior
Fred H. Frankel, MB, ChB, DPM, Martin T. Orne, MD, PhD . Hypnotizability ratings of 24 phobic patients interested in the therapeutic use of hypnosis were compared with those of an equal number of smokers keen to quit smoking through hypnosis. The mean Stanford Hypnotic Susceptibility Scale score of phobics was 8.08 on a 12-point scale. The mean of smokers was 6.08. The difference was significant beyond the .01 level (twotailed). Thirty percent of smokers were essentially nonresponsive. No phobics were nonresponsive. Those with multiple phobias scored more highly than those with a single phobia. These findings are in accord with the view that among psychiatric patients whose hypnotizability is assessed in a treatment context, hysterics are most responsive. The implications both for theory and for a specific treatment strategy are
discussed. (Arch Gen Psychiatry 33:1259-1261, 1976)
At the turn of the
century, Janet, in the tradition of . Charcot, interpreted marked hypnotic responsivity as a manifestation of hysteria. Subsequent systematic work has shown that the ability to enter hypnosis is normally distributed in the normal population1; indeed that individ¬ uals able to respond to hypnosis are likely to be somewhat better adjusted- and more normal—outgoing—3 than those who show a lower level of response. Furthermore, an individual's ability to enter hypnosis shows remarkable consistency over time, and it can appropriately be viewed as a stable trait.4 It is all the more surprising, therefore, that hypnotizability has not been shown to be associated with any of the usual tests of personality.5 Even with extensive clinical interviews, it was very difficult to predict an individual's response to hypnosis." Though recent years have witnessed the development of reliable standardized techniques to measure hypnotic responsivity, since hypnosis has been recognized as an attribute of normal individuals, there has been little psychiatric interest in the assessment of hypnotizability. Basing his views on data obtained from self-selected patient populations, Spiegel7 has recently drawn attention to the clinical significance of hypnotizability. Most rele¬ vant to our discussion have been his observations concern¬ ing a group of highly hypnotizable subjects who tend to exhibit a clinically identifiable configuration of person¬ ality traits. Although these subjects are the same group that earlier authors have described as somnambules, he has redirected our attention to them and added to our under¬ standing by emphasizing their behavioral characteristics in the absence of hysterical symptoms and when they are not hypnotized. These patients who have the ability to experience profound hypnotic phenomena easily are de¬ scribed as having traits of trust and faith that go beyond Accepted
publication Aug 5, 1975. Department of Psychiatry, Harvard Medical School, and the Psychiatric Service, Beth Israel Hospital, Boston (Dr Frankel), and the Institute of Pennsylvania Hospital, and University of Pennsylvania, Philadelphia (Dr Orne). Reprint requests to 330 Brookline Ave, Boston, MA 02215 (Dr Frankel). From the
for
reasonable limits, a tendency to suspend critical judgments outside of areas of specific professional competence, an extremely ready affiliation with new events, a frequent disregard for past lessons, excellent memories, and despite a superficial malleability, a strong adherence to behavioral patterns that are deeply important to them. Spiegel emphasizes that treatment of such individuals is likely to be more effective when it takes into account the special above. personality characteristics described One of us (F.H.F.) has reported8 a that some patients who responded with a marked trance when tested for hypnotiz¬ ability in the context of a routine psychiatric evaluation, had occasionally commented spontaneously on the simi¬ larity between the hypnotic experience and some aspects of those psychopathological manifestations that had initially prompted them to seek treatment. It was suggested that individuals who have an unusual trance capacity might respond in terms of this mental function¬ ing, not only following a formal hypnotic induction, but also spontaneously, and that patients who are highly hypnotizable might exhibit identifiable clinical events. Attention was drawn to the effective use of hypnosis in the treatment of phobic behavior that had been reported by several authors, some of whom have been alert to the possibility of an interesting relationship between phobias and hypnotic treatment.10-13 Although anecdotal reports led to the formulation of clinical hypotheses, firmer data concerning the actual hypnotizability of phobies was lacking. The present study utilizes the hypnotizability ratings on consecutive phobic patients applying for treatment at the Beth Israel Hospi¬ tal, who were interested in the possible use of hypnosis in their treatment. Since normative data based on volunteer college student populations are hardly appropriate for comparison because their motivation is not primarily based on therapeutic goals, a specific control group of patients was needed. Ideally, such a group of individuals would be seeking to be hypnotized for treatment purposes but not in order to modify psychiatric symptoms. Accordingly, routine hypnotizability ratings on individuals seeking help by means of hypnosis to quit smoking seemed a suitable control. Such individuals were comparable to phobic patients in that they shared the motivation to succeed in hypnosis, but were not otherwise within the spectrum of psychiatric patients as usually conceived. PROCEDURE All phobic patients who applied for treatment privately or at the clinic and who were interested in the possible use of hypnosis were tested for hypnotizability either on the Stanford Hypnotic Suscep¬ tibility Scale (SHSS)141"· or the Harvard Group Scale (HGS)le administered individually, and compared with a similar number of patients tested in the same manner who applied to the hypnosis clinic of the Beth Israel Hospital for help in quitting smoking. All patients, both phobies and smokers, were told the following before the Hypnotizability Scale was administered to them:
In order for
Downloaded From: http://archpsyc.jamanetwork.com/ by a UQ Library User on 06/14/2015
us
to
plan
the strategy of your treatment with
Table
X
All
subjects 40+
39-
SD
24 8.08 2.12 4 6.00
Table 2.—Distribution of Hypnotizability in Different Groups*
Symptoms
Smokers
Phobies
Age
and
1.—Hypnotizability
.82
24
SD_t_
6.08 2.98
7 7.14 1 86
20 8.50 2.06 17 5.65 3.28
2.68
=
.01
1.40 3.10 < .01
(2-tailed)
in with the needs of your treatment.
Patients were then assured, in keeping with the comments that included in the scale itself, that their responses would be very subjective, that there are no wrong answers, and that there most probably were experiences that they would not be able to have but that this was expected in many cases and would be fine if it are
occurred.
RESULTS
phobic subjects was 8.08 on a scale of 12-point hypnotic susceptibility. The mean score of 24 smokers was 6.08; the difference was significant beyond the .01 level (two-tailed) (Table 1). It is worth noting that the mean age of the phobies was slightly lower than that of the smokers, and since hypnotiz¬ ability tends to decrease in older individuals, the differ¬ ences in scores become even more pronounced when only mean score
of the 24
patients under 39 are compared.
Table 2 shows the distribution of high, medium, and low among the phobies and the smokers. This type of analysis shows that among both the phobic and the smoker groups, hypnotizability was skewed upward as one might anticipate in a highly motivated, volunteer group. However, while among the smokers 30% were essentially nonresponsive, showing scores of 0-4 on a 12-point scale, not a single nonresponsive individual was seen in the phobic group. This difference is not only highly significant, but the total absence of truly low responders among the phobic group suggests a phenomenon of great clinical relevance. Within the phobic group, patients were divided into those reporting multiple phobias and those complaining of only a single phobia. In Table 3, a total of 17 patients reported more than one phobia, whereas 7 had only one. The mean score among the former was 8.53, whereas that among patients with a single phobia was 7.00. This differ¬ ence is significant beyond the .05 level (two-tailed) and supports a further link between the occurrence of phobic symptoms and hypnotizability. scores
COMMENT
The
findings reported here lend strong empirical support phobic patients show a tendency to the
to the view that
kind of mental functioning that is involved in responding to a hypnotic induction. These observations are highly congruent with Spiegel's point of view concerning the importance of hypnotizability as one aspect of psychiatric evaluation. Further, they are in line with the same
Phobies
High (8-12) Medium (5-7) Low (0-4)
14 10
(2-tailed)
hypnosis more effectively, we need to know how you respond to suggestions in hypnosis. We use the same standardized mea¬ surement scale with all our patients. This enables us to know how your responses compare with others, and helps us to assess more accurately how hypnotizable you are. No matter what your responses during this assessment are, we will still be able to use the hypnosis technique in your treatment. Knowing how you respond will enable us to modify the technique so that it can fit
The
Harvard Group Scale
!,X! (High
vs
Table
Low)
=
2.01
5.73
(2-tailed)
3.—Hypnotizability 17 7
Multiple phobia Single phobia •f
=
.05
8 7
0
-
and Phobic Behavior
Fred H. Frankel, MB, ChB, DPM, Martin T. Orne, MD, PhD . Hypnotizability ratings of 24 phobic patients interested in the therapeutic use of hypnosis were compared with those of an equal number of smokers keen to quit smoking through hypnosis. The mean Stanford Hypnotic Susceptibility Scale score of phobics was 8.08 on a 12-point scale. The mean of smokers was 6.08. The difference was significant beyond the .01 level (twotailed). Thirty percent of smokers were essentially nonresponsive. No phobics were nonresponsive. Those with multiple phobias scored more highly than those with a single phobia. These findings are in accord with the view that among psychiatric patients whose hypnotizability is assessed in a treatment context, hysterics are most responsive. The implications both for theory and for a specific treatment strategy are
discussed. (Arch Gen Psychiatry 33:1259-1261, 1976)
At the turn of the
century, Janet, in the tradition of . Charcot, interpreted marked hypnotic responsivity as a manifestation of hysteria. Subsequent systematic work has shown that the ability to enter hypnosis is normally distributed in the normal population1; indeed that individ¬ uals able to respond to hypnosis are likely to be somewhat better adjusted- and more normal—outgoing—3 than those who show a lower level of response. Furthermore, an individual's ability to enter hypnosis shows remarkable consistency over time, and it can appropriately be viewed as a stable trait.4 It is all the more surprising, therefore, that hypnotizability has not been shown to be associated with any of the usual tests of personality.5 Even with extensive clinical interviews, it was very difficult to predict an individual's response to hypnosis." Though recent years have witnessed the development of reliable standardized techniques to measure hypnotic responsivity, since hypnosis has been recognized as an attribute of normal individuals, there has been little psychiatric interest in the assessment of hypnotizability. Basing his views on data obtained from self-selected patient populations, Spiegel7 has recently drawn attention to the clinical significance of hypnotizability. Most rele¬ vant to our discussion have been his observations concern¬ ing a group of highly hypnotizable subjects who tend to exhibit a clinically identifiable configuration of person¬ ality traits. Although these subjects are the same group that earlier authors have described as somnambules, he has redirected our attention to them and added to our under¬ standing by emphasizing their behavioral characteristics in the absence of hysterical symptoms and when they are not hypnotized. These patients who have the ability to experience profound hypnotic phenomena easily are de¬ scribed as having traits of trust and faith that go beyond Accepted
publication Aug 5, 1975. Department of Psychiatry, Harvard Medical School, and the Psychiatric Service, Beth Israel Hospital, Boston (Dr Frankel), and the Institute of Pennsylvania Hospital, and University of Pennsylvania, Philadelphia (Dr Orne). Reprint requests to 330 Brookline Ave, Boston, MA 02215 (Dr Frankel). From the
for
reasonable limits, a tendency to suspend critical judgments outside of areas of specific professional competence, an extremely ready affiliation with new events, a frequent disregard for past lessons, excellent memories, and despite a superficial malleability, a strong adherence to behavioral patterns that are deeply important to them. Spiegel emphasizes that treatment of such individuals is likely to be more effective when it takes into account the special above. personality characteristics described One of us (F.H.F.) has reported8 a that some patients who responded with a marked trance when tested for hypnotiz¬ ability in the context of a routine psychiatric evaluation, had occasionally commented spontaneously on the simi¬ larity between the hypnotic experience and some aspects of those psychopathological manifestations that had initially prompted them to seek treatment. It was suggested that individuals who have an unusual trance capacity might respond in terms of this mental function¬ ing, not only following a formal hypnotic induction, but also spontaneously, and that patients who are highly hypnotizable might exhibit identifiable clinical events. Attention was drawn to the effective use of hypnosis in the treatment of phobic behavior that had been reported by several authors, some of whom have been alert to the possibility of an interesting relationship between phobias and hypnotic treatment.10-13 Although anecdotal reports led to the formulation of clinical hypotheses, firmer data concerning the actual hypnotizability of phobies was lacking. The present study utilizes the hypnotizability ratings on consecutive phobic patients applying for treatment at the Beth Israel Hospi¬ tal, who were interested in the possible use of hypnosis in their treatment. Since normative data based on volunteer college student populations are hardly appropriate for comparison because their motivation is not primarily based on therapeutic goals, a specific control group of patients was needed. Ideally, such a group of individuals would be seeking to be hypnotized for treatment purposes but not in order to modify psychiatric symptoms. Accordingly, routine hypnotizability ratings on individuals seeking help by means of hypnosis to quit smoking seemed a suitable control. Such individuals were comparable to phobic patients in that they shared the motivation to succeed in hypnosis, but were not otherwise within the spectrum of psychiatric patients as usually conceived. PROCEDURE All phobic patients who applied for treatment privately or at the clinic and who were interested in the possible use of hypnosis were tested for hypnotizability either on the Stanford Hypnotic Suscep¬ tibility Scale (SHSS)141"· or the Harvard Group Scale (HGS)le administered individually, and compared with a similar number of patients tested in the same manner who applied to the hypnosis clinic of the Beth Israel Hospital for help in quitting smoking. All patients, both phobies and smokers, were told the following before the Hypnotizability Scale was administered to them:
In order for
Downloaded From: http://archpsyc.jamanetwork.com/ by a UQ Library User on 06/14/2015
us
to
plan
the strategy of your treatment with
Table
X
All
subjects 40+
39-
SD
24 8.08 2.12 4 6.00
Table 2.—Distribution of Hypnotizability in Different Groups*
Symptoms
Smokers
Phobies
Age
and
1.—Hypnotizability
.82
24
SD_t_
6.08 2.98
7 7.14 1 86
20 8.50 2.06 17 5.65 3.28
2.68
=
.01
1.40 3.10 < .01
(2-tailed)
in with the needs of your treatment.
Patients were then assured, in keeping with the comments that included in the scale itself, that their responses would be very subjective, that there are no wrong answers, and that there most probably were experiences that they would not be able to have but that this was expected in many cases and would be fine if it are
occurred.
RESULTS
phobic subjects was 8.08 on a scale of 12-point hypnotic susceptibility. The mean score of 24 smokers was 6.08; the difference was significant beyond the .01 level (two-tailed) (Table 1). It is worth noting that the mean age of the phobies was slightly lower than that of the smokers, and since hypnotiz¬ ability tends to decrease in older individuals, the differ¬ ences in scores become even more pronounced when only mean score
of the 24
patients under 39 are compared.
Table 2 shows the distribution of high, medium, and low among the phobies and the smokers. This type of analysis shows that among both the phobic and the smoker groups, hypnotizability was skewed upward as one might anticipate in a highly motivated, volunteer group. However, while among the smokers 30% were essentially nonresponsive, showing scores of 0-4 on a 12-point scale, not a single nonresponsive individual was seen in the phobic group. This difference is not only highly significant, but the total absence of truly low responders among the phobic group suggests a phenomenon of great clinical relevance. Within the phobic group, patients were divided into those reporting multiple phobias and those complaining of only a single phobia. In Table 3, a total of 17 patients reported more than one phobia, whereas 7 had only one. The mean score among the former was 8.53, whereas that among patients with a single phobia was 7.00. This differ¬ ence is significant beyond the .05 level (two-tailed) and supports a further link between the occurrence of phobic symptoms and hypnotizability. scores
COMMENT
The
findings reported here lend strong empirical support phobic patients show a tendency to the
to the view that
kind of mental functioning that is involved in responding to a hypnotic induction. These observations are highly congruent with Spiegel's point of view concerning the importance of hypnotizability as one aspect of psychiatric evaluation. Further, they are in line with the same
Phobies
High (8-12) Medium (5-7) Low (0-4)
14 10
(2-tailed)
hypnosis more effectively, we need to know how you respond to suggestions in hypnosis. We use the same standardized mea¬ surement scale with all our patients. This enables us to know how your responses compare with others, and helps us to assess more accurately how hypnotizable you are. No matter what your responses during this assessment are, we will still be able to use the hypnosis technique in your treatment. Knowing how you respond will enable us to modify the technique so that it can fit
The
Harvard Group Scale
!,X! (High
vs
Table
Low)
=
2.01
5.73
(2-tailed)
3.—Hypnotizability 17 7
Multiple phobia Single phobia •f
=
.05
8 7
0
-
