Gold, J. I., A. J. Kant, et al. (2007). "Practitioner Review: Clinical applications of pediatric hypnosis." J Child Psychol Psychiatry 48(8): 744-54.
Background: Over the past quarter century, hypnosis has been employed in a broad range of pediatric clinical settings; however, its efficacy and feasibility as a treatment approach for children and adolescents remain in question. Method: Published studies on the role of clinical hypnosis in the management of specific pediatric medical and psychological conditions were identified and reviewed. Results: Pediatric clinical hypnosis has been employed in diverse medical settings to treat primary conditions (e.g., enuresis), as well as to address factors related to management of the condition (e.g., skills training for asthma) or its treatment (e.g., burn dressing changes). Despite great breadth to the possible applications of pediatric hypnosis and many reported successes, much of the present research comprises case histories and small, uncontrolled group studies. Conclusion: To date, research in pediatrics views clinical hypnosis as a promising tool with the potential to help manage a variety of conditions. However, additional research, particularly utilizing randomized, controlled methodologies and adequate sample sizes, is required.

Lee, J. S., D. Spiegel, et al. (2007). "Fractal analysis of EEG in hypnosis and its relationship with hypnotizability." Int J Clin Exp Hypn 55(1): 14-31.
Fractal analysis was applied to study the trends of EEG signals in the hypnotic condition. The subjects were 19 psychiatric outpatients. Hypnotizability was measured with the Hypnotic Induction Profile (HIP). Fifty-four sets of EEG data were analyzed by detrended fluctuation analysis (DFA), a well-established fractal analysis technique. The scaling exponents, which are the results of fractal analysis, are reduced toward white noise during the hypnotic condition, which differentiates the hypnotic condition from the waking condition. Further, the decrease in the scaling exponents during hypnosis was solely associated with the eye-roll sign within specific cortical areas (F3, C4, and O1/2) closely related to eye movements and attention. In conclusion, the present study has found that the application of the fractal analysis technique can demonstrate the electrophysiological correlations with hypnotic influence on cerebral activity.

Lutgendorf, S. K., E. V. Lang, et al. (2007). "Effects of age on responsiveness to adjunct hypnotic analgesia during invasive medical procedures." Psychosom Med 69(2): 191-9.
OBJECTIVES: To assess the effects of age on responsiveness to self-hypnotic relaxation as an analgesic adjunct in patients undergoing invasive medical procedures. MATERIAL AND METHODS: Secondary data analysis from a prospective trial with 241 patients randomized to receive hypnosis, attention, and standard care treatment during interventional radiological procedures. Growth curve analyses, hierarchical linear regressions, and logistic regressions using orthogonal contrasts were used for analysis. Outcome measures were Hypnotic Induction Profile scores, self-reported pain and anxiety, medication use, oxygen desaturation < or =89%, and procedure time. RESULTS: Hypnotizability did not vary with age (p = .19). Patients receiving attention and hypnosis had greater pain reduction during the procedure (p = .02), with trends toward lower pain with hypnosis (p = .07); this did not differ by age. As age increased, patients experienced more rapid pain control with hypnosis (p = .03). There was more rapid anxiety reduction with attention and hypnosis (p = .03). Trends toward lower final anxiety were also observed with attention and hypnosis versus standard care (p = .08), and with hypnosis versus attention (p = .059); these relationships did not differ by age. Patients requested and received less medication and had less oxygen desaturation < or =89% with attention and hypnosis (p < .001); this did not differ by age. However, as age increased, oxygen desaturation was greater in standard care (p = .03). Procedure time was reduced in the attention and hypnosis groups (p = .007); this did not vary by age. CONCLUSIONS: Older patients are hypnotizable and increasing age does not appear to mitigate the usefulness of hypnotic analgesia during invasive medical procedures.

Spiegel, D. (2007). "Commentary: Reversing amnesia about hypnosis." Am J Clin Hypn 49(3): 181-2.

Spiegel, D. (2006). "Wedding hypnosis to the radiology suite." Pain 126(1-3): 3-4.

Butler, L. D., B. K. Symons, et al. (2005). "Hypnosis reduces distress and duration of an invasive medical procedure for children." Pediatrics 115(1): e77-85.
OBJECTIVE: Voiding cystourethrography (VCUG) is a commonly performed radiologic procedure in children that can be both painful and frightening. Given the distress that some children experience during the VCUG and the need for children to be alert and cooperative during the procedure, finding a psychological intervention that helps children to manage anxiety, distress, and pain is clearly desirable. This study was designed to examine whether relaxation and analgesia facilitated with hypnosis could reduce distress and procedure time for children who undergo this procedure. METHODS: Forty-four children who were scheduled for an upcoming VCUG were randomized to receive hypnosis (n = 21) or routine care (n = 23) while undergoing the procedure. The sample consisted of 29 (66%) girls and 15 (34%) boys with a mean age of 7.6 years (SD: 2.5; range: 4-15 years). Ethnic/racial backgrounds were 72.7% white, 18.2% Asian, 4.5% Latino, 2.3% black, and 2.3% Filipino. The mean number of previous VCUGs was 2.95 (SD: 2.51; mode: 2; range: 1-15). Potential participants were identified through computerized hospital records of upcoming VCUGs. Parents were contacted by telephone and invited to participate if their child was eligible. To be eligible for the study, the child must have undergone at least 1 previous VCUG, been at least 4 years of age at that time, and experienced distress during that procedure, and both the child and the participating parent had to be English speaking. Each eligible child and parent met with the research assistant (RA) before the day of the scheduled procedure for an initial assessment. Children were queried regarding the degree of crying, fear, and pain that they had experienced during their most recent VCUG. Parents completed a series of parallel questions. Immediately after this assessment, those who were randomized to the hypnosis condition were given a 1-hour training session in self-hypnotic visual imagery by a trained therapist. Parents and children were instructed to practice using the imaginative self-hypnosis procedure several times a day in preparation for the upcoming procedure. The therapist was also present during the procedure to conduct similar exercises with the child. The majority (83%) of those who were randomized to the routine care control group chose to participate in a hospital-provided recreation therapy program (offered as part of routine care). The program includes demonstration of the procedure with dolls, relaxation and breath work training, and assistance during the procedure. On the day of the VCUG, the RA met the family at the clinic before the procedure, and both the child and the parent rated the child's present level of fearfulness. During the procedure, the RA recorded observational ratings of the child's emotional tone and behavior and timed the overall procedure and its phases. Immediately after the VCUG, the child was asked how much crying, fear, and pain he or she had experienced during the procedure; the parent rated the child's experience on the same dimensions and also how traumatic the procedure had been (both generally and compared with their previous one), and the medical staff rated the degree of procedural difficulty. Outcomes included child reports of distress during the procedure, parent reports of how traumatic the present VCUG was compared with the previous one, observer ratings of distress during the procedure, medical staff reports of the difficulty of the procedure overall, and total procedural time. RESULTS: Results indicate significant benefits for the hypnosis group compared with the routine care group in the following 4 areas: (1) parents of children in the hypnosis group compared with those in the routine care group reported that the procedure was significantly less traumatic for their children compared with their previous VCUG procedure; (2) observational ratings of typical distress levels during the procedure were significantly lower for children in the hypnosis condition compared with those in the routine care condition; (3) medical staff reported a significant difference between groups in the overall difficulty of conducting the procedure, with less difficulty reported for the hypnosis group; and (4) total procedural time was significantly shorter-by almost 14 minutes-for the hypnosis group compared with the routine care group. Moderate to large effect sizes were obtained on each of these 4 outcomes. CONCLUSIONS: Hypnotic relaxation may provide a systematic method for improving the overall medical care of children with urinary tract abnormalities and may be beneficial for children who undergo other invasive medical procedures. Because the VCUG is an essential part of the evaluation of urinary tract infections and vesicoureteral reflux in children, lower distress during the procedure may improve patient and family compliance with initial as well as follow-up evaluations. These findings augment the accumulating literature demonstrating the benefits of using hypnosis to reduce distress in the pediatric setting. The present findings are noteworthy in that this study was a controlled, randomized trial conducted in a naturalistic medical setting. In this context, we achieved a convergence of subjective and objective outcomes with moderate to large effect sizes, including those that may have an impact on patient care and procedure cost, that were consistently supportive of the beneficial effects of hypnosis-a noninvasive intervention with minimal risk. The findings, therefore, have immediate implications for pediatric care. Limitations of this study include the lack of participant and staff blindness to the child's condition assignment, which could have introduced bias into reports. However, the objective procedural time differences between groups were consistent with the other, more subjective outcome findings. The sample was also small and primarily white in ethnic/racial makeup, which may have restricted our ability to detect some differences and may limit the generalizability of findings to more representative samples. In addition, the sample comprised children who had already undergone at least 1 VCUG during which they had had difficulty. Consequently, additional research is needed to determine whether hypnosis would be helpful to those who are undergoing their first VCUG. Additional limitations, clinical observations, and directions for future research are also discussed.

Koch, T., E. V. Lang, et al. (2003). "Adverse short-term effects of attention-control treatment on hypnotizability: a challenge in designing controlled hypnosis trials." Int J Clin Exp Hypn 51(4): 357-68.
Characteristics of patients in test and attention-control groups should be comparable and be unaffected by the intervention to be tested in clinical trials. The authors assessed whether this is the case for measures of hypnotizability in the postoperative period. One hundred and forty-six patients undergoing percutaneous peripheral vascular or renal interventions were randomized into 2 groups. One group received structured empathic attention during their procedures; the other was guided to self-hypnotic relaxation. Hypnotizability was assessed postoperatively by the Hypnotic Induction Profile. The eye-roll scores, which measure the biological hypnotic potential, were not significantly different, but the average induction scores, which measure the expression of the hypnotic performance, were significantly lower in the attention group than the hypnosis group (4.9 vs. 5.9). The authors conclude that patients who were aided by an external focus intraoperatively are postoperatively less able or willing to follow suggestions measuring hypnotizability than patients who had guidance to self-hypnotic relaxation.

Spiegel, D. (2003). "Negative and positive visual hypnotic hallucinations: attending inside and out." Int J Clin Exp Hypn 51(2): 130-46.
Hypnotic perceptual alteration affects brain function. Those hypnotic instructions that reduce perception by creating an illusory obstruction to it reduce brain response to perception in the cognate sensory cortex, as measured by event-related potential (ERP) amplitude and regional blood flow (PET). Those hypnotic instructions that affect the subject's reaction to perception activate the anterior attentional system, especially the anterior cingulate cortex in PET studies. Hypnosis involves activation without arousal and may be particularly mediated via dopaminergic pathways. Hypnotic alteration of perception is accompanied by measurable changes in both perceptual and attentional function of those specific regions of the brain that process these activities, modulated by the nature of the specific hypnotic instruction. Positive obstructive hallucinations seem to allow for a hypnotic focus inward, activating the functioning of attentional neural systems and reducing perceptual ones.

Spiegel, D. (2002). "Mesmer minus magic: hypnosis and modern medicine." Int J Clin Exp Hypn 50(4): 397-406.
The implications and effects of the French commission that passed judgment on Mesmer's work is examined in light of the pioneering role of hypnosis as the first Western conception of a psychotherapy, the ancient philosophical debate between idealism and empiricism, and the conflict in modern medicine between biotechnological emphasis on cure and the need for care as many previously terminal illnesses are converted to chronic diseases. The panel's report is interpreted as negative about the literal theory of animal magnetism but actually supportive of the potential therapeutic power of suggestion and "positive thinking." This aspect of hypnosis is described as a forerunner of modern cognitive therapies of depression and other illnesses. The panel exerted a constructive effect in applying scientific method and rigorous evaluation to hypnotic treatment, an application of Enlightenment philosophy that presaged the Flexner era in modern medicine. Both hypnosis and medicine ultimately benefited.

Spiegel, D. (2001). "Informed dissent regarding hypnosis and its not-so-hidden observers: comment on Lynn." Am J Clin Hypn 43(3-4): 303.

Biswas, A., D. See, et al. (2000). "Hypnotizability and the use of traditional dhami-jhankri healing in Nepal." Int J Clin Exp Hypn 48(1): 6-21.
This study examined the role of hypnotic responsiveness in the practice of a dhami-jhankri, a traditional Nepali healer. The hypnotic capacity of 248 male patients was measured in an allopathic (Western) clinic, an Ayurvedic (ancient Hindu healing art) clinic, and a dhami-jhankri's practice. Hypnotizability was assessed using the Hypnotic Induction Profile (HIP). The Induction scores of the HIP were significantly higher among the dhami-jhankri's patients than among either the Ayurvedic or allopathic patients. Furthermore, patients who returned to the dhami-jhankri were more highly hypnotizable than first-time dhami-jhankri patients. In addition, treatment satisfaction as reported by dhami-jhankri patients was positively correlated with HIP scores. The authors conclude that hypnotic phenomena as measured in the West might be an important component of the dhami-jhankri's treatment in the East.

Kosslyn, S. M., W. L. Thompson, et al. (2000). "Hypnotic visual illusion alters color processing in the brain." Am J Psychiatry 157(8): 1279-84.
OBJECTIVE: This study was designed to determine whether hypnosis can modulate color perception. Such evidence would provide insight into the nature of hypnosis and its underlying mechanisms. METHOD: Eight highly hypnotizable subjects were asked to see a color pattern in color, a similar gray-scale pattern in color, the color pattern as gray scale, and the gray-scale pattern as gray scale during positron emission tomography scanning by means of [(15)O]CO(2). The classic color area in the fusiform or lingual region of the brain was first identified by analyzing the results when subjects were asked to perceive color as color versus when they were asked to perceive gray scale as gray scale. RESULTS: When subjects were hypnotized, color areas of the left and right hemispheres were activated when they were asked to perceive color, whether they were actually shown the color or the gray-scale stimulus. These brain regions had decreased activation when subjects were told to see gray scale, whether they were actually shown the color or gray-scale stimuli. These results were obtained only during hypnosis in the left hemisphere, whereas blood flow changes reflected instructions to perceive color versus gray scale in the right hemisphere, whether or not subjects had been hypnotized. CONCLUSIONS: Among highly hypnotizable subjects, observed changes in subjective experience achieved during hypnosis were reflected by changes in brain function similar to those that occur in perception. These findings support the claim that hypnosis is a psychological state with distinct neural correlates and is not just the result of adopting a role.

Lang, E. V., E. G. Benotsch, et al. (2000). "Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial." Lancet 355(9214): 1486-90.
BACKGROUND: Non-pharmacological behavioural adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures. We tested this assumption for patients undergoing percutaneous vascular and renal procedures in a prospective, randomised, single-centre study. METHODS: 241 patients were randomised to receive intraoperatively standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). All had access to patient-controlled intravenous analgesia with fentanyl and midazolam. Patients rated their pain and anxiety on 0-10 scales before, every 15 min during and after the procedures. FINDINGS: Pain increased linearly with procedure time in the standard group (slope 0.09 in pain score/15 min, p<0.0001), and the attention group (slope 0.04/15 min; p=0.0425), but remained flat in the hypnosis group. Anxiety decreased over time in all three groups with slopes of -0.04 (standard), -0.07 (attention), and -0.11 (hypnosis). Drug use in the standard group (1.9 units) was significantly higher than in the attention and hypnosis groups (0.8 and 0.9 units, respectively). One hypnosis patient became haemodynamically unstable compared with ten attention patients (p=0.0041), and 12 standard patients (p=0.0009). Procedure times were significantly shorter in the hypnosis group (61 min) than in the standard group (78 min, p=0.0016) with procedure duration of the attention group in between (67 min). INTERPRETATION: Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures. Hypnosis had more pronounced effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability.

Nordby, H., K. Hugdahl, et al. (1999). "Effects of hypnotizability on performance of a Stroop task and event-related potentials." Percept Mot Skills 88(3 Pt 1): 819-30.
The effect of hypnotizability on verbal reaction times and event-related potentials during performance of a Stroop color-naming task was studied. The Stroop stimuli (colored words) were randomly presented to 5 high and 5 low hypnotizable subjects in the right and left peripheral visual fields during both waking state and hypnotic induction conditions. Unlike studies in which the Stroop stimuli were foveally presented to the subjects, the highly hypnotizable subjects did not show prolonged verbal reaction times in either waking or hypnotic conditions. There was a marked deterioration in performance accuracy, however, for highly hypnotizable subjects during hypnosis. Event-related potentials indicated that the highly hypnotizable subjects showed a reduced P3a amplitude and a decreased N2b latency to the visual stimuli in both waking and hypnotic conditions, suggesting a lack of orienting to or disengagement from peripherally occurring stimuli.

Kogon, M. M., P. Jasiukaitis, et al. (1998). "Imagery and hypnotizability revisited." Int J Clin Exp Hypn 46(4): 363-70.
The objective of this study was to correlate computer-generated imagery tasks and a self-report measure of imagery ability with hypnotizability, hypothesizing that computer-generated imagery tasks would be better predictors of hypnotizability than will the self-report measure. Hypnotizability of 43 subjects was assessed using the Hypnotic Induction Profile and the Stanford Hypnotic Susceptibility Scale, Form C. Imagery ability was assessed by the Visual Vividness Imagery Questionnaire (VVIQ) and by computer-generated imagery tasks measuring the ability to generate, maintain, and transform images. Although there was no correlation between the VVIQ and hypnotizability, the less hypnotizable subjects made twice as many mistakes in the spatial imagery tasks than did the more hypnotizables, but this difference was not statistically significant. The relationships among hypnotic performance, hypnotizability, and imagery functions are complex.

Spiegel, D. (1998). "Hypnosis." Harv Ment Health Lett 15(3): 5-6.

Spiegel, D. (1998). "Hypnosis and implicit memory: automatic processing of explicit content." Am J Clin Hypn 40(3): 231-40.
Kenneth S. Bowers, in whose honor this issue is written, was, in his own words, "seriously curious" (Bowers, 1983 (originally published 1976)) about hypnosis throughout his career. He brought a lively intellect and an engaging and lucid writing style reminiscent of Freud's (forgive me, Ken, I'm referring to style, not content), and a set of serious questions to the phenomenon of hypnosis. We are indebted to him for his many contributions to the field.

Jasiukaitis, P., B. Nouriani, et al. (1997). "Relateralizing hypnosis: or, have we been barking up the wrong hemisphere?" Int J Clin Exp Hypn 45(2): 158-77.
Research and theory over the past couple decades have suggested that the right cerebral hemisphere might be the focus of brain activity during hypnosis. Recent evidence from electrodermal responding, visual event-related potentials, and Stroop interference, however, can make a case for a role of the left hemisphere in some hypnotic phenomena. Although hemispheric activation on hypnotic challenge may depend in large part on the kind of task the challenge might involve, several general aspects of hypnosis might be more appropriately seen as left-rather than right-hemisphere brain functions. Among these are concentrated attentional focus and the role of language in the establishment of hypnotic reality. A left-hemisphere theory of hypnosis is discussed in light of recent findings and theories about a left-hemisphere basis for synthetic or generational capabilities (Corballis, 1991) and a neuro-evolutionary model of a left-hemisphere dopaminergic activation system for the implementation of predetermined motor programs (Tucker & Williamson, 1984).

Spiegel, D. and R. Moore (1997). "Imagery and hypnosis in the treatment of cancer patients." Oncology (Williston Park) 11(8): 1179-89; discussion 1189-95.
Many patients with cancer often seek some means of connecting their mental activity with the unwelcome events occurring in their bodies, via techniques such as imagery and hypnosis. Hypnosis has been shown to be an effective method for controlling cancer pain. The techniques most often employed involve physical relaxation coupled with imagery that provides a substitute focus of attention for the painful sensation. Other related imagery techniques, such as guided imagery, involve attention to internally generated mental images without the formal use of hypnosis. The most well-known of these techniques involves the use of "positive mental images" of a strong army of white blood cells killing cancer cells. Despite claims to the contrary, no reliable evidence has shown that this technique affects disease progression or survival. Studies evaluating more broadly defined forms psychosocial support have come to conflicting conclusions about whether or not these interventions affect survival of cancer patients. However, 10-year follow-up of a randomized trial involving 86 women with cancer showed that a year of weekly "supportive/expressive" group therapy significantly increased survival duration and time from recurrence to death. This intervention encourages patients to express and deal with strong emotions and also focuses on clarifying doctor-patient communication. Numerous other studies suggest that suppression of negative affect, excessive conformity, severe stress, and lack of social support predict a poorer medical outcome from cancer. Thus, further investigation into the interaction between body and mind in coping with cancer is warranted.

Butler, L. D., R. E. Duran, et al. (1996). "Hypnotizability and traumatic experience: a diathesis-stress model of dissociative symptomatology." Am J Psychiatry 153(7 Suppl): 42-63.
OBJECTIVE: The authors propose a diathesis-stress model to describe how pathological dissociation may arise from an interaction between innate hypnotizability and traumatic experience. METHOD: To support the proposition that pathological dissociation may reflect autohypnotic process, the authors highlight clinical and research data indicating parallels between controlled hypnotic dissociative states and uncontrolled pathological dissociative symptoms and summarize evidence of hypnotizability in persons with psychiatric disorders that manifest these symptoms. The authors present this evidence by examining dissociative symptomatology in four psychological domains: perception, behavior and will, affect, and memory and identity. In addition, modern cognitive and neuropsychological models of dissociation are briefly reviewed. RESULTS: Several lines of evidence converge in support of the role of autohypnosis in pathological dissociation. There is considerable evidence that controlled formal hypnosis can produce a variety of dissociations of awareness and control that resemble many of the symptoms in uncontrolled pathological dissociative conditions; and it is possible to discern in dissociative pathology the features of absorption, dissociation, and suggestibility/automaticity that characterize formal hypnotic states. There is also accumulating evidence of high levels of hypnotic capacity in all groups with dissociative symptomatology that have been systematically assessed. In addition, the widespread and successful therapeutic use of hypnosis in the treatment of many dissociative symptoms and conditions (and the potential for hypnosis to induce dissociative symptomatology) also supports the assumption that hypnosis and pathological dissociation share an underlying process. CONCLUSIONS: High hypnotizability may be a diathesis for pathological dissociative states, particularly under conditions of acute traumatic stress.

Jasiukaitis, P., B. Nouriani, et al. (1996). "Left hemisphere superiority for event-related potential effects of hypnotic obstruction." Neuropsychologia 34(7): 661-8.
Twenty-two highly hypnotizable subjects were run in a visual target detection task which compared hypnotic obstruction of the left and right visual fields over separate blocks. The visual event-related potentials (ERPs) to non-target stimuli revealed that hypnotic obstruction reduced the P200 component to stimuli in the right hemifield, but did not affect P200 for stimulation in the left hemifield. The earlier P100 and N100 were also reduced to hypnotic obstruction but not as preferentially for either hemifield, while the P300 was not significantly changed. Right visual field left hemisphere P200 reduction predicted suppression of behavioral response (button press) to hypnotically obstructed targets in both hemifields. The results are discussed in terms of Farah's model of a left hemisphere mechanism for image generation, and how highly hypnotizable subjects might use this mechanism to comply successfully with the suggestion of a hallucinated visually opaque barrier.

Lang, E. V., J. S. Joyce, et al. (1996). "Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use." Int J Clin Exp Hypn 44(2): 106-19.
The authors evaluated whether self-hypnotic relaxation can reduce the need for intravenous conscious sedation during interventional radiological procedures. Sixteen patients were randomized to a test group, and 14 patients were randomized to a control group. All had patient-controlled analgesia. Test patients additionally had self-hypnotic relaxation and underwent a Hypnotic Induction Profile test. Compared to controls, test patients used less drugs (0.28 vs. 2.01 drug units; p < .01) and reported less pain (median pain rating 2 vs. 5 on a 0-10 scale; p < .01). Significantly more control patients exhibited oxygen desaturation and/or needed interruptions of their procedures for hemodynamic instability. Benefit did not correlate with hypnotizability. Self-hypnotic relaxation can reduce drug use and improve procedural safety.

Spiegel, D. (1995). "Psychiatry disabused." Nat Med 1(6): 490-1; author reply.

Spiegel, D. and A. W. Scheflin (1994). "Dissociated or fabricated? Psychiatric aspects of repressed memory in criminal and civil cases." Int J Clin Exp Hypn 42(4): 411-32.
During the last decade, clinicians, courts, and researchers have been faced with exceedingly difficult questions involving the crossroads where memory, traumatic memory, dissociation, repression, childhood sexual abuse, and suggestion all meet. In one criminal case, repressed memories served as the basis for a conviction of murder. In approximately 50 civil cases, courts have ruled on the issue of whether repressed memory for childhood sexual abuse may form the basis of a suit against the alleged perpetrators. Rulings that have upheld such use underscore the importance of the reliability of memory retrieval techniques. Hypnosis and other methodologies employed in psychotherapy may be beneficial in working through memories of trauma, but they may also distort memories or alter a subject's evaluation of their veracity. Because of the reconstructive nature of memory, caution must be taken to treat each case on its own merits and avoid global statements essentially proclaiming either that repressed memory is always right or that it is always wrong.

Spiegel, D., E. J. Frischholz, et al. (1993). "Predictors of smoking abstinence following a single-session restructuring intervention with self-hypnosis." Am J Psychiatry 150(7): 1090-7.
OBJECTIVE: This study examined the relation of smoking and medical history, social support, and hypnotizability to outcome of a smoking cessation program. METHOD: A consecutive series of 226 smokers referred for the smoking cessation program were treated with a single-session habit restructuring intervention involving self-hypnosis. They were then followed up for 2 years. Total abstinence from smoking after the intervention was the criterion for successful outcome. RESULTS: Fifty-two percent of the study group achieved complete smoking abstinence 1 week after the intervention; 23% maintained their abstinence for 2 years. Hypnotizability and having been previously able to quit smoking for at least a month significantly predicted the initiation of abstinence. Hypnotizability and living with a significant other person predicted 2-year maintenance of treatment response. CONCLUSIONS: These results, while modest, are superior to those of spontaneous efforts to stop smoking. Furthermore, they suggest that it is possible to predict which patients are most likely and which are least likely to respond to such brief smoking cessation interventions.

van der Hart, O. and D. Spiegel (1993). "Hypnotic assessment and treatment of trauma-induced psychoses: the early psychotherapy of H. Breukink and modern views." Int J Clin Exp Hypn 41(3): 191-209.
The role of hypnotizability assessment in the differential diagnosis of psychotic patients is still unresolved. In this article, the pioneering work of Dutch psychiatrist H. Breukink (1860-1928) during the 1920s is used as early evidence that hypnotic capacity is clinically helpful in differentiating highly hypnotizable psychotic patients with dissociative symptomatology from schizophrenics. Furthermore, there is a long tradition of employing hypnotic capacity in the treatment of these dissociative psychoses. The ways in which Breukink used hypnosis for diagnostic, prognostic, and treatment purposes are summarized and discussed in light of both old and current views. He felt that hysterical psychosis was trauma-induced, certainly curable, and that psychotherapy using hypnosis was the treatment of choice. Hypnosis was used for symptom-oriented therapy, as a comfortable and supportive mental state, and for the uncovering and integrating of traumatic memories. For the latter purpose, Breukink emphasized a calm mental state, both in hypnosis and in the waking state, thereby discouraging emotional expression, which he considered dangerous in psychotic patients. In the discussion, special attention is paid to the role and dangers of the expression of trauma-related emotions.

Zimbardo, P. G., S. LaBerge, et al. (1993). "Psychophysiological consequences of unexplained arousal: a posthypnotic suggestion paradigm." J Abnorm Psychol 102(3): 466-73.
This experiment compared the emotional, cognitive, and physiological responses of Ss experiencing induced physiological arousal with and without awareness of the source of their arousal. Nine highly hypnotizable Ss and 9 nonhypnotizable controls were used in a within-subjects design. Each S received posthypnotic suggestions for arousal (increases in heart and respiration rate) with and without amnesia for its source in a two-phase procedure. Only the hypnotizable Ss were expected to differ between conditions. As predicted, for the hypnotizable Ss, unexplained arousal produced significant and dramatic effects when compared with explained arousal, including misattributions. These results are considered within a conceptual framework of the role of discontinuous experiences in the development of psychopathological symptoms in normal persons.

Jaschke, V. A. and D. Spiegel (1992). "A case of probable dissociative disorder." Bull Menninger Clin 56(2): 246-60.
The case of a patient with symptoms suggestive of a dissociative disorder is presented. The consultant reviews the diagnosis of multiple personality disorder (MPD) as defined in DSM-III-R and DSM-IV in relation to the patient's dissociative states, hallucinations, memory loss, and other symptoms. He then highlights the distinctions among MPD, schizophrenia, borderline personality disorder, major depression, and complex partial seizures. After presenting the conceptualization of MPD as a chronic posttraumatic stress disorder, he concludes with a review of treatment approaches that address the traumatic history and that involve hypnosis to gain access to and control dissociative states.

Spiegel, D. (1992). "The use of hypnosis in the treatment of PTSD." Psychiatr Med 10(4): 21-30.

Spiegel, D. and R. King (1992). "Hypnotizability and CSF HVA levels among psychiatric patients." Biol Psychiatry 31(1): 95-8.

Spira, J. L. and D. Spiegel (1992). "Hypnosis and related techniques in pain management." Hosp J 8(1-2): 89-119.
Hypnosis has been used successfully in treating cancer patients at all stages of disease and for degrees of pain. The experience of pain is influenced not only by physiological factors stemming from disease progression and oncological treatment, but also from psychosocial factors including social support and mood. Each of these influences must be considered in the successful treatment of pain. The successful use of hypnosis also depends upon the hypnotizability of patients, their particular cognitive style, their specific motivation, and level of cognitive functioning. While most patients can benefit from the use of hypnosis, less hypnotizable patients or patients with low cognitive functioning need to receive special consideration. The exercises described in this chapter can be successfully used in groups, individual sessions, and for hospice patients confined to bed. Both self-hypnosis and therapist guided hypnosis exercises are offered.

Spiegel, D. (1991). "Neurophysiological correlates of hypnosis and dissociation." J Neuropsychiatry Clin Neurosci 3(4): 440-5.

Spiegel, D. (1991). "Uses of hypnosis in managing medical symptoms." Psychiatr Med 9(4): 521-33.

Spiegel, D. and E. Cardena (1991). "Disintegrated experience: the dissociative disorders revisited." J Abnorm Psychol 100(3): 366-78.
We present proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and review the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of two new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. We conclude that further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality.

Spiegel, D. and F. Cardena (1991). "Comments on hypnotizability and dissociation." Am J Psychiatry 148(6): 813-5.

Spiegel, D. (1990). "Facilitating emotional coping during treatment." Cancer 66(6 Suppl): 1422-6.
Patient resources for coping with breast cancer can be enhanced by attention to cognitive, affective, psychosomatic, and social components of the illness. The diagnosis and treatment of breast cancer constitutes an immediate confrontation with mortality, and sympathetic but direct examination of the patient's vulnerability and means of coping with it will reduce rather than amplify death anxiety. The development and pursuit of realistic goals influenced by the prognosis can help patients adjust constructively. Extremes of emotion are to be expected at times, but persistent depression and/or anxiety should be vigorously treated, including the use of appropriate psychoactive medication when the symptoms are primarily somatic (e.g., sleep disturbance and reductions in energy). Physical symptoms such as pain, nausea, and vomiting can be controlled by teaching patients such techniques as self-hypnosis, biofeedback, and systemic desensitization. Finally, a feeling of social isolation is the rule, not the exception, with cancer patients. Group and family treatment can effectively counter this. Systematic studies of such treatment interventions have shown favorable results, including significant reductions in mood disturbance and pain.

Spiegel, D. and E. Cardena (1990). "New uses of hypnosis in the treatment of posttraumatic stress disorder." J Clin Psychiatry 51 Suppl: 39-43; discussion 44-6.
Hypnosis is associated with the treatment of posttraumatic stress disorder (PTSD) for two reasons: (1) the similarity between hypnotic phenomena and the symptoms of PTSD, and (2) the utility of hypnosis as a tool in treatment. Physical trauma produces a sudden discontinuity in cognitive and emotional experience that often persists after the trauma is over. This results in symptoms such as psychogenic amnesia, intrusive reliving of the event as if it were recurring, numbing of responsiveness, and hypersensitivity to stimuli. Two studies have shown that Vietnam veterans with PTSD have higher than normal hypnotizability scores on standardized tests. Likewise, a history of physical abuse in childhood has been shown to be strongly associated with dissociative symptoms later in life. Furthermore, dissociative symptoms during and soon after traumatic experience predict later PTSD. Formal hypnotic procedures are especially helpful because this population is highly hypnotizable. Hypnosis provides controlled access to memories that may otherwise be kept out of consciousness. New uses of hypnosis in the psychotherapy of PTSD victims involve coupling access to the dissociated traumatic memories with positive restructuring of those memories. Hypnosis can be used to help patients face and bear a traumatic experience by embedding it in a new context, acknowledging helplessness during the event, and yet linking that experience with remoralizing memories such as efforts at self-protection, shared affection with friends who were killed, or the ability to control the environment at other times. In this way, hypnosis can be used to provide controlled access to memories that are then placed into a broader perspective. Patients can be taught self-hypnosis techniques that allow them to work through traumatic memories and thereby reduce spontaneous unbidden intrusive recollections.

Klein, K. B. and D. Spiegel (1989). "Modulation of gastric acid secretion by hypnosis." Gastroenterology 96(6): 1383-7.
The ability of hypnosis to both stimulate and inhibit gastric acid secretion in highly hypnotizable healthy volunteers was examined in two studies. In the first, after basal acid secretion was measured, subjects were hypnotized and instructed to imagine all aspects of eating a series of delicious meals. Acid output rose from a basal mean of 3.60 +/- 0.48 to a mean of 6.80 +/- 0.02 mmol H+/h with hypnosis, an increase of 89% (p = 0.0007). In a second study, subjects underwent two sessions of gastric analysis in random order, once with no hypnosis and once under a hypnotic instruction to experience deep relaxation and remove their thoughts from hunger. When compared to the no-hypnosis session, with hypnosis there was a 39% reduction in basal acid output (4.29 +/- 0.93 vs. 2.60 +/- 0.44 mmol H+/h, p less than 0.05) and an 11% reduction in pentagastrin-stimulated peak acid output (28.69 +/- 2.34 vs. 25.43 +/- 2.98 mmol H+/h, p less than 0.05). We have shown that different cognitive states induced by hypnosis can promote or inhibit gastric acid production, processes clearly controlled by the central nervous system. Hypnosis offers promise as a safe and simple method for studying the mechanisms of such central control.

Spiegel, D. (1989). "Hypnosis in the treatment of victims of sexual abuse." Psychiatr Clin North Am 12(2): 295-305.
The relevance of hypnosis to the treatment of sexual assault derives from two sources: the fact that hypnotic phenomena are mobilized spontaneously as defenses during assault, becoming part of the syndrome of posttraumatic stress disorder (PTSD) and the usefulness of formal hypnosis in treating PTSD. The role of dissociative defenses during and after traumatic experiences is reviewed; an analogy between the major elements of formally-induced hypnosis--absorption, dissociation, and suggestibility, and the major elements of PTSD--is drawn. Special problems relevant to sexual assault in childhood are discussed, including extreme self-blame and a profound sense of personality fragmentation. Uses of hypnosis in the treatment of sexual assault victims are reviewed, with an emphasis on helping such patients restructure their memories of the experience, both by reviewing them with greater control over their physical sense of comfort and safety and by balancing painful memories with recognition of their efforts to protect themselves or someone else who was endangered. The use of a split-screen technique in hypnosis is described with a clinical example. Special considerations in such treatment, including the traumatic transference and forensic complications of such psychotherapeutic work, are enumerated.

Spiegel, D., P. Bierre, et al. (1989). "Hypnotic alteration of somatosensory perception." Am J Psychiatry 146(6): 749-54.
Effects of hypnotic alterations of perception on amplitude of somatosensory event-related potentials were studied in 10 highly hypnotizable subjects and 10 subjects with low hypnotizability. The highly hypnotizable individuals showed significant decreases in amplitude of the P100 and P300 waveform components during a hypnotic hallucination that blocked perception of the stimulus. When hypnosis was used to intensify attention to the stimulus, there was an increase in P100 amplitude. These findings are consistent with observations that highly hypnotizable individuals can reduce or eliminate pain by using purely cognitive methods such as hypnosis. Together with data from the visual system, these results suggest a neurophysiological basis for hypnotic sensory alteration.

Spiegel, D., J. R. Bloom, et al. (1989). "Effect of psychosocial treatment on survival of patients with metastatic breast cancer." Lancet 2(8668): 888-91.
The effect of psychosocial intervention on time of survival of 86 patients with metastatic breast cancer was studied prospectively. The 1 year intervention consisted of weekly supportive group therapy with self-hypnosis for pain. Both the treatment (n = 50) and control groups (n = 36) had routine oncological care. At 10 year follow-up, only 3 of the patients were alive, and death records were obtained for the other 83. Survival from time of randomisation and onset of intervention was a mean 36.6 (SD 37.6) months in the intervention group compared with 18.9 (10.8) months in the control group, a significant difference. Survival plots indicated that divergence in survival began at 20 months after entry, or 8 months after intervention ended.

Spiegel, D. (1988). "Commentary. The treatment accorded those who treat patients with multiple personality disorder." J Nerv Ment Dis 176(9): 535-6.

Spiegel, D. and A. F. Barabasz (1988). "Effects of hypnotic instructions on P300 event-related-potential amplitudes: research and clinical implications." Am J Clin Hypn 31(1): 11-7.

Spiegel, D., T. Hunt, et al. (1988). "Dissociation and hypnotizability in posttraumatic stress disorder." Am J Psychiatry 145(3): 301-5.
The authors compared the hypnotizability of 65 Vietnam veteran patients with posttraumatic stress disorder (PTSD) to that of a normal control group and four patient samples using the Hypnotic Induction Profile. The patients with PTSD had significantly higher hypnotizability scores than patients with diagnoses of schizophrenia (N = 23); major depression, bipolar disorder--depressed, and dysthymic disorder (N = 56); and generalized anxiety disorder (N = 18) and the control sample (N = 83). This finding supports the hypothesis that dissociative phenomena are mobilized as defenses both during and after traumatic experiences. The literature suggests that spontaneous dissociation, imagery, and hypnotizability are important components of PTSD symptoms.

Frances, A. and D. Spiegel (1987). "Chronic pain masks depression, multiple personality disorder." Hosp Community Psychiatry 38(9): 933-5.

Frischholz, E. J., D. Spiegel, et al. (1987). "The Hypnotic Induction Profile and absorption." Am J Clin Hypn 30(2): 87-93.

Spiegel, D. (1985). "The use of hypnosis in controlling cancer pain." CA Cancer J Clin 35(4): 221-31.

Spiegel, D., S. Cutcomb, et al. (1985). "Hypnotic hallucination alters evoked potentials." J Abnorm Psychol 94(3): 249-55.

Spiegel, D. (1984). "Multiple personality as a post-traumatic stress disorder." Psychiatr Clin North Am 7(1): 101-10.
This article examines multiple or dissociative personality syndrome as a multiple post-traumatic stress disorder, discussing these patient's developmental histories, their high hypnotizability, and their profound capacity to dissociate spontaneously to protect themselves from emotional and physical pain.

Spiegel, D. and A. Rosenfeld (1984). "Spontaneous hypnotic age regression: case report." J Clin Psychiatry 45(12): 522-4.
Age regression--reliving the past as though it were occurring in the present, with age appropriate vocabulary, mental content, and affect--can occur with instruction in highly hypnotizable individuals, but has rarely been reported to occur spontaneously, especially as a primary symptom. The psychiatric presentation and treatment of a 16-year-old girl with spontaneous age regressions accessible and controllable with hypnosis and psychotherapy are described. Areas of overlap and divergence between this patient's symptoms and those found in patients with hysterical fugue and multiple personality syndrome are also discussed.

Spiegel, D. (1983). "Hypnosis with medical/surgical patients." Gen Hosp Psychiatry 5(4): 265-77.
The role of hypnosis as a tool in the treatment of problems commonly encountered among medical and surgical patients is examined. Hypnosis is defined as a change in state of mind far more akin to intense concentration than sleep. Diagnostic implications of differences in hypnotic responsivity are explored, and scales suitable for use in the clinic are examined. Uses of hypnosis in treating anxiety, pain, childbirth, psychosomatic symptoms, seizure disorders, neuromuscular dysfunction, and habits are described and evaluated. The phenomenon of hypnosis is presented as a means of exploring the mind-body relationship in a controlled fashion, providing information of diagnostic importance while at the same time allowing hypnotizable patients to intensify their concentration and interpersonal receptivity in the service of a therapeutic goal.

Spiegel, D. (1983). "Hypnosis with psychotic patients: comment on Scagnelli-Jobsis." Am J Clin Hypn 25(4): 289-94.

Spiegel, D. and L. H. Albert (1983). "Naloxone fails to reverse hypnotic alleviation of chronic pain." Psychopharmacology (Berl) 81(2): 140-3.
The hypothesis that the alleviation of chronic pain with hypnosis is mediated by endorphins was tested. Six patients with chronic pain secondary to peripheral nerve irritation were taught to control the pain utilizing self-hypnosis. Each subject was tested at 5-min intervals during four 1-h sessions for the amount of reduction of pain sensation and suffering associated with hypnosis while being given, in a random double-blind crossover fashion, an IV injection of either 10 mg naloxone or a saline placebo through an indwelling catheter. The patients demonstrated significant alleviation of the pain with hypnosis, but this effect was not significantly diminished in the naloxone condition. These findings contradict the hypothesis that endorphins are involved in hypnotic analgesia.

Spiegel, D. and J. R. Bloom (1983). "Group therapy and hypnosis reduce metastatic breast carcinoma pain." Psychosom Med 45(4): 333-9.
The pain and mood disturbance of 54 women with metastatic carcinoma of the breast were studied over the course of one year. A random sample was offered weekly group therapy during the year, with or without self-hypnosis training directed toward enhancing their competence at mastering pain and stress related to cancer. Both treatment groups demonstrated significantly less self-rated pain sensation (t = 2.5 p less than 0.02) and suffering (t = 2.17, p less than 0.03) than the control sample. Those who were offered the self-hypnosis training as well as group therapy fared best in controlling the pain sensation (F = 3.1, p less than 0.05). Pain frequency and duration were not affected. Changes in pain measures were significantly correlated with changes in self-rated total mood disturbance on the Profile of Mood States and with its anxiety, depression, and fatigue subscales. Possible mechanisms for the effectiveness of these interventions are discussed.

Frischholz, E. J., R. Blumstein, et al. (1982). "Comparative efficacy of hypnotic behavioral training and sleep/trance hypnotic induction: comment on Katz." J Consult Clin Psychol 50(5): 766-9.

Frischholz, E. J., D. Spiegel, et al. (1982). "Differential hypnotic responsivity of smokers, phobics, and chronic-pain control patients: a failure to confirm." J Abnorm Psychol 91(4): 269-72.

Spiegel, D., D. Detrick, et al. (1982). "Hypnotizability and psychopathology." Am J Psychiatry 139(4): 431-7.
The authors compared the hypnotic responsivity of 115 chronically ill psychiatric patients with that of 83 nonpatient volunteers. The Hypnotic Induction Profile was administered to all subjects, and diagnoses were established for the patients according to Research Diagnostic Criteria. All of the diagnosed patients (those with thought disorder, affective disorder, generalized anxiety, and miscellaneous disorders) were significantly less hypnotizable than the nonpatient comparison group. This effect was unrelated to age or medication differences. The authors discuss the implication of these findings in relation to a new model of hypnotic responsivity that takes into account the moderating effects of severe psychopathology.

Spiegel, D., W. W. Tryon, et al. (1982). "Hilgard's illusion." Arch Gen Psychiatry 39(8): 972-4.

Frischholz, E. J., H. Spiegel, et al. (1981). "Hypnosis and the unhypnotizable: a reply to Barber." Am J Clin Hypn 24(1): 55-8.

Spiegel, D. (1981). "Vietnam grief work using hypnosis." Am J Clin Hypn 24(1): 33-40.

Spiegel, D., E. J. Frischholz, et al. (1981). "Hypnotic responsitivity and the treatment of flying phobia." Am J Clin Hypn 23(4): 239-47.

Spiegel, D. (1980). "Hypnotizability and psychoactive medication." Am J Clin Hypn 22(4): 217-22.

Spiegel, D. and R. A. Chase (1980). "The treatment of contractures of the hand using self-hypnosis." J Hand Surg [Am] 5(5): 428-32.
The successful treatment of a man with severe posttraumatic contractures of the hand using a combined psychological and physical rehabilitation approach is reported. The contractures had functional and organic components, as did the treatment, which involved teaching the patient self-hypnosis exercises and the use of a splint. The patient obtained virtually complete return of movement after 3 1/2 years of total disability. The importance of identifying and mobilizing rather than challenging the patient's motivation for recovery using a rehabilitation approach is discussed. Hypnosis can facilitate recovery in such psychosomatic disorders in patients with the requisite hypnotic capacity and motivation.

Spiegel, D. and H. Spiegel (1980). "Hypnosis in psychosomatic medicine." Psychosomatics 21(1): 35-41.

Orne, M. T., E. R. Hilgard, et al. (1979). "The relation between the Hypnotic Induction Profile and the Stanford Hypnotic Susceptibility Scales, forms A and C." Int J Clin Exp Hypn 27(2): 85-102.

Spiegel, D. and R. Fink (1979). "Hysterical psychosis and hypnotizability." Am J Psychiatry 136(6): 777-81.
The very existence of hysterical psychosis as a diagnostic entity has been questioned as part of the general difficulty in defining both hysteria and psychosis. However, several recent investigations have documented a syndrome that usually involves brief and intense periods of psychotic behavior, generally with graphic decompensation, severe environmental stress, and rapid recompensation, in individuals with other hysterical features. The authors assert that such a syndrome does exist as a clinical entity and that the differential diagnosis can be facilitated by using a standardized measure of hypnotic trance capacity. They hypothesize that patients with hysterical psychosis are highly hypnotizable, while those who are schizophrenic and psychotic have low hypnotizability. The authors review the literature and present two case examples.

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