Hypnotherapy: State and Non-State Theories - Term Paper Example

Hypnotherapy Introduction Hypnosis as a therapeutic practice has been studied and debated for centuries. The uninitiated generally consider the term hypnosis to define a trance-like state of consciousness. The subject is transformed into complete submissiveness by the hypnotist who assumes control of the subject’s mind and actions. This presumption is, of course, untrue, however; a comprehensive explanation of hypnotic phenomenon, specifically the altered state theory continues to be debated among scholars and scientists. Disagreements regarding the altered state theory have served to create differing conceptions of hypnosis, most entrenched in hypotheses concerning an individual’s social composition and their anticipation of results. The contemporary cognitive-behavioral conception of hypnosis has separated from the traditional views by defining hypnosis in a differing manner while the conventional theories of hypnosis continue to be allied by the definition of hypnosis as an altered state. Throughout the undertaking to discover a modern definition of hypnosis, supporters of distinct modern hypnotic theories steadfastly maintain their own unique conceptions. The cognitive-behavioral perspective has spawned numerous other significant concepts related to hypnosis that do not follow the traditional perspective. Following a historical perspective of hypnosis, this paper contrasts the differing concepts of the ‘state’ and ‘non-state’ theories. It also considers contemporary theoretical perspectives of hypnotherapy and particular associations with psychotherapy. Historical perspective As a therapeutic technique, hypnotherapy predates psychoanalysis by more than 100 years. Before shelving the technique to pursue his theories of psychoanalysis, Sigmund Freud used hypnosis therapeutically. Hypnosis is thought to be as old as humankind itself and until recent times, has been cloaked in mystery. It has been associated with witchcraft, Satanism, the supernatural, and practiced by Shamans, Druidic high priests and physicians of Greece. It has been practiced under various descriptions in numerous places throughout the centuries. The art of hypnosis went from being associated with the healing arts to one of witchery and generally thought of as something that possessed sinful supernatural powers during the period that included the Middle Ages. It remained thought of in this way until Franz Mesmer founded the concept of hypnosis in the late 18th Century. He initially placed magnets on the body believing that would produce the hypnotic effect but discovered that it was he who was actually generating this result. He was the first to suggest that, more significant than material introductions, the human imagination was the actual influence producing the hypnotic effect. Hypnotherapy can be even today viewed as the “therapeutic use of a person’s imagination” (Shelp, 2003). Following the coining of the term, a division arose between those attracted by hypnosis as a tool for personal contentment and those who sought hypnosis’ spiritual or magical nature. The ‘operator-assisted altered state induction’ theory asserted that hypnosis is a sleep-like state brought about by the particular activities of the hypnotist resulting in an intense willingness to respond to suggestion. James Braid, a British surgeon’s theory, ‘monoideism,’ stated that un-conflicted thoughts involuntarily led to actions. The ‘Paris School’ theory, theorized in the late 1800’s stated that a solitary neurological and physiological state is the cause of all hypnotic phenomena. The beginning of the 1900’s witnessed the ‘Nancy School’ which theorised that suggestion alone mechanically produced involuntary responses. This perspective was noteworthy for “deemphasizing the hypnotic ritual (induction) emphasizing rather the suggestion as a key element in hypnosis” (Shelp, 2003). Theodore Sarbin pioneered the ‘skeptical’ conception of hypnosis in 1950 contradicting the mechanistic theories. He viewed hypnotism as a social experience in which the subject and hypnotist ‘acted out’ prearranged roles. “This was the first time hypnotic behavior was seen as creative and goal-directed, rather than automatic and mechanical” (Shelp, 2003). It was not until the early 1980’s that the arguments regarding neo-dissociation as opposed to traditional state theories merited the modification in thinking with respect to the cognitive-behavioral hypnotic viewpoint. State Theory of Hypnosis After centuries of observation and research, two theories, State and Non-State, have emerged which define both fundamental centralized concepts of hypnosis. At the most basic level, these theories oppose one another principally in regard to the significance that non-state theories place upon associations with cognitive activities. The most prominent of State theories, dissociation, considers hypnosis as a state in which the subject is an inactive party (Spanos & Chaves, 1991). Advocates of the dissociation perspective indicate that suggestions by the hypnotist are transformed by the subjects which in turn facilitate involuntary actions. Hypnotized subjects are in a trance-like state in which multifaceted behaviors can be easily extracted by the hypnotist without the conscious consent of the subject (Spanos & Chaves, 1989). “This supports the view that hypnosis is a special state of consciousness and without this state hypnotic phenomenon would not occur” (Ross, 1981). Ernest Hilgard named this conception as the neo-dissociation perspective of hypnosis. “This perspective conceptualizes hypnotic behavior as events that happen to passive subjects (as observers of the hypnotic experience rather than active initiators) when particular cognitive subsystems become separated (dissociated) from one another” (Spanos & Chaves, 1989). The new or ‘neo-dissociation’ perspective evolved from Pierre Janet’s theory of dissociation which postulated that thought and behavioral patterns that typically occurred could be separated, or disassociated, from each another. According to the theory, not everyone is predisposed to dissociation techniques, therefore only particular individuals have the ability to dissociate by hypnotist suggestion or command. Dissociation refers to a literal dividing of some components of consciousness and hypnosis is seen an example of dissociation as areas of an individual’s behavioral control becomes separated from everyday awareness. Hypnosis eliminates some control from the conscious mind and the individual responds with autonomic, reflexive actions. “The dissociation theory gained popularity as it attempted to explain multiple personality, the existence of intelligent ‘selves’ that appeared to be isolated from an individual’s ‘conscious self.’” (Spanos & Chaves, 1991). The supplemental analysis of this theory generated the definition of neo-dissociation hypnosis which theorizes that fractional dissociations of cognitive structures in the brain allows for hypnosis. Janet initially founded the concept of dissociation as a by-product of his work with hysterical patients in 1925. Using this theory, in 1953, A.M. Weitzenhoffer describes hypnosis as a “dissociation of awareness from the majority of sensory and even strictly neural events taking place” (Weitzenhoffer, 1953). Hilgard’s neo-dissociation theory in 1977 hypothesized an “executive ego, essentially a central executive system in today’s cognitive psychological terms, which became dissociated from sub-components via an amnesic barrier,’” (Spanos & Chaves, 1989). In other words, hypnotic suggestions generate alterations in perception and behavior which are explainable in terms of these dissociated sub-systems. “Hilgard’s ideas were influenced by his discovery of the ‘hidden observer’ phenomenon, a process by which different components of consciousness were investigated” (Spanos & Chaves, 1989). Although there is no scientific research that positively substantiates the altered state theory of hypnosis, many acknowledged scholars subscribe to the theory. In 1980, Milton Erickson, the most well-known advocate of this viewpoint suggested that hypnosis was a special state of highly-focused attention. “During this state, the conscious mind could be shifted, transformed, or bypassed with relative ease, making unconscious memories more accessible than during a normal waking state” (Erickson, 1980). The conviction that hypnosis was chiefly a process of the inner-self was a departure from the more conventional theories. Though the hypnotic response was facilitated by the hypnotist, according to this theory, it occurred only as a result of the subject’s own inner characteristics. “The hypnotic trance belongs only to the subject; the operator can do no more than learn how to proffer stimuli and suggestions to evoke responsive behavior based upon the subject’s own experiential past.” (Erickson, 1980). Although Erickson perceived hypnosis as a special state of consciousness; he rejected the idea that the process concerned special powers, it instead utilizes similar abilities and processes people would ordinarily experience.  An ache or pain, for example, is temporarily forgotten during an exceptionally thrilling movie or superhuman strength summoned under stressful situations. This is an example of what Erickson called a ‘common everyday’ trance. From this point of view, hypnosis is advantageous because it supplies a method in which to deliberately set in motion these ordinary procedures and use them to direct the hypnosis subject toward a particular objective. The majority of hypnotic phenomena such as “regression, amnesia, dissociation, hypnotic anesthesia, time distortion have common everyday correlates” (Erickson, 1980). This rationalization is in distinct contrast to Theodore Barber’s observations that theorize hypnosis occurs as a result of interpersonal dynamics. Non-State Theory of Hypnosis According to the non-state theory, “the vital functions and behavior of someone in a hypnotic trance are not dissimilar to those of someone who is not in a trance” (Barber, 1969, p. 7). People do many of the same things during normal everyday activities as they do while hypnotized such as imagine themselves as others, acting, concealing and fantasizing. While under the influence of either a hypnotic or an everyday trance, people have the capability to consciously or subconsciously concentrate on a particular motivation and block out all others. Additionally, non-state theorists suggest that what occurs to subjects during hypnosis can be accounted for principally in terms of the rapport between the hypnotist and the subject, based on the subject’s “psychology, motivations, and drives. As children, they try to please their parents; as students, they seek approval from teachers; and as hypnotic subjects, they do the same” (Barber, 1969, p. 7). For the non-state theorist, hypnosis is not at all an extraordinary phenomenon or a method by which to control behavior. According to Barber, the susceptibility to being hypnotized is the result of interpersonal factors. The subject has the innate need to make the hypnotist happy by effectively executing what is requested of them, much of the same sort of relationship that occurs between a subject and therapist in any type of psychotherapy. The many attempts by learned researchers to define hypnosis have involved a never ending argument of ‘chicken and the egg’ style semantics. A person is said to behave a certain way because they are hypnotized but it is hardly sufficient evidence to prove they are hypnotized simply because they behave by a prescribed means. Another definition is that a person is under a trance because they are hypnotized as evidenced by the fact that they are hypnotized so therefore they must be in a trance. According to Barber, “proof that hypnosis is a special state of consciousness requires the discovery of behavior other than that used to describe it” (Barber, 1969, p. 7). The terms ‘hypnosis’ and ‘trance’ are often used interchangeably without knowing precisely the definition of either. Scientific research and instruments should be able to clearly indicate the distinction between an asleep and alert condition if hypnosis is indeed a distinctive state. “For nearly one hundred years, researchers have been trying to delineate an objective physiological index that differentiates the hypnotic state from non-hypnotic states. The attempt to find a physiological index of ‘hypnotic trance per se’ has not succeeded” (Barber cited in Brown, 1991, p. 175). More specifically, physiological procedures such as blood pressure, EEG, pulse rates, etc. do not reveal dissimilarities between the ‘hypnotic’ and ‘normal’ state. Expounding on Barber’s theory, Peter Brown studied the underlying phenomenon of hypnotic transmission. “Though there are changes in brain functioning during hypnosis, they are not unique to hypnosis nor are they uniform across all subjects. The changes in brain function that occur in hypnosis are similar to the normal variations in activity and do not appear to differ from changes found in other types of absorbed concentration” (Brown, 1991, p. 175). In addition, Brown said “It is easy to speak of an altered state of consciousness or of dissociation, as if we know precisely what these terms mean. The evidence suggests that the trance state involved substantial changes in cognition, emotion, perception, and physiologic regulation. But these changes do not exist in a vacuum. Intermingled with them will be the surrounding context for the individual; their previous history, current concerns, and the quality of the interaction and degree of rapport they experience with the hypnotherapist” (Brown, 1991, p. 241). Contrast and compare ideologies According to the state theory, an altered state of consciousness is the central element of hypnosis. Non-state theorists think that more commonplace psychological procedures such as focused attention and expectation satisfactorily explain the hypnotic experience. Hypnotic literature’s most broadly disputed issue is whether hypnosis is an amalgamation of ordinary conscious psychological implementation processes or an altered state of consciousness. “Is hypnosis a state of consciousness (trance), induced via myriads of induction techniques as neo-disassociation theory proposes? Certainly, the majority of practicing clinicians who work with hypnosis within the disassociation model think so” (Oakley, Alden & Mather, 1996). However, the social cognitive proponents would counter questioning the vast variation in subjects’ ability to obtain that ‘trance’ state and then respond to suggestions within this state if the hypnotic condition is simply a state of mind. These points are corroborated by the various attempts to increase the suggestibility level of hypnotic subjects that have failed to demonstrate positive outcomes.  Although non-state theorists challenge the conception of a distinctive state, they do not dispute the experience or subjective reality of subjects who maintain that they were hypnotized. A study presented a summary supporting the non-state theorist which can be defined by three statements. “No unique physiological markers of the hypnotised state have been identified. All phenomena produced by suggestion following a hypnotic induction can also be produced without the hypnotic induction. Increases in suggestibility following induction can be duplicated and exceeded by a variety of other techniques” (Lynn & Rhue, 1991, p. 602). For example, Barber compared the hypnotic condition with persons given motivational and assignment suggestions. He established through all of his experimentation that each of the acquired outcomes was not appreciably different from the other, both conditions provided comparable results. Barber deduced that the studies provided verification that hypnosis is not a ‘state of mind’ but can be explained by means of the subject’s motivations and expectations.  Many researchers including Barber have concentrated their efforts on comparing the hypnotic condition to other psychological processes, ones that generate non-hypnotic behaviour. This is the fundamental difference between hypnotic techniques used in the applied settings and the scientific reductionism experiments.  “While it may be crucial for the continuing understanding of psychological processes to adopt this reductionist experimental approach unfortunately, it has not been constructive in providing findings that are representative of, or able to be generalised to the applied setting.  Hypnosis is simply not used in the applied setting as a single process, rather, it is combined with other techniques (task motivation instructions, imagery, mental rehearsal etc.) to produce the desired effects” (Oakley et al, 1996). The majority of hypnotherapy clinicians operate within the disassociation model despite the general disagreements among researchers as to which concept best characterises hypnosis. However, this dynamic is not indicated by the direction of contemporary studies as the preponderance of researchers examines the theory of hypnosis within the social cognitive ideology. On many occasions in the past, researchers either did not understanding the hypnotic process or controlled for too many variables in an attempt to work within a theoretical construct which adversely affected the probability for credible results.  “This reductionist approach although important for establishing the essential components of the hypnotic process, adds to the body of literature a negative bias on the effectiveness hypnotic intervention has in the applied setting” (Oakley et al, 1996). Approaches to counseling and psychotherapy best served by particular theories We consider first the neo-disassociation viewpoint of hypnosis; defined as an atypical state of consciousness from the normal waking state induced by the hypnotic stimulation process. From hypnotic suggestions the trance state can influence and change the decision-making functions of the brain. The hypnotist can therefore suppress naturally accessible cognizant occurrences and make processes which are normally repressed, more easily reached. This method of hypnotherapy, especially when combined with supplementary techniques, such as cognitive behavioral therapy, is used to treat many types of human conditions which include but are not limited to anxiety, stress, insomnia, pain and issues relating to obesity. This type of therapy endeavors to alter the subject’s behaviors by adjusting or removing specific thought patterns that are causing the subject’s symptoms. In other words, it is used to change the subject’s negative thoughts to a positive nature. In this vein, subjects are typically taught to replace self defeating thoughts such as ‘I can’t venture outside my home’ with subconscious substitutions such as ‘I can and want to go outside.’ Hypnosis, when combined with cognitive psychotherapy, has been shown to improve weight loss results appreciably compared to subjects who have experienced unaided cognitive behavioral therapy. Research has shown that the subjects that received cognitive-behavioral hypnotherapy experienced improvement at a rate of 70 percent more than those not receiving supplemental hypnotic therapy. Positive effects appeared predominantly pronounced for subjects involved in obesity treatments especially with long-term follow-up procedures in place. Unlike those utilising non-hypnotic therapy, persons subject to hypnotic inductions continued to maintain or lose additional weight well after treatment concluded. These results were especially prominent because of the “few procedural differences between the hypnotic and non-hypnotic treatments” (Kirsch et al, 1995). Cognitive behavioral therapy and hypnotherapy have also proven successful in “the treatment of a variety of chronic syndromes, including common functional disorders of the gastrointestinal tract, such as irritable bowel syndrome” (Frank, 2006). Though much research reports benefits, most studies are not sufficiently designed because hypnotherapy remains an enigmatic means of healing. Conclusions on having considered contemporary theoretical perspectives Despite the growing research by cognitive-behavioral hypnotic theorists, “state theorists still support their theoretical perspectives.” (Conn, 1957). Regardless with which faction theorists associate, a hypnotic experience has “the potential to increase access to vivid imagery, increase awareness of bodily sensation, and increase the possibility for cognitive alteration” (Dengrove, 1973). However, the theses purported by the cognitive-behavioral supporters represent a historical alteration of research direction. The consequential implication of this theory holds potentially profound research applications for the discernment of the hypnotized subject and for varied hypnotic functions. The perception of hypnosis as a multifaceted arrangement of variables is a key contribution to the field of clinical hypnosis. “From a cognitive-behavioral perspective, recognizing the importance of such cognitive-motivational variables such as expectancy and volition in hypnotic behavior can enhance clinical practice of hypnosis. The history of this perspective has revealed that the interactional framework of the hypnotic relationship will strongly affect the outcome of hypnotherapy” (Hart & Hart, 1997). Historical connotations for particular hypnotic experiences provided by the cognitive-behavioral theory are important with respect to the patient’s outlook and expectations. In other words, when utilising hypnotic techniques, the cognitive-behavioral perspective eases the subject’s misconceptions regarding hypnotherapy, “negative attitudes, lack of motivation to change, or situational variables that interfere with a patient’s attention might all affect the hypnotic experience and its subsequent effectiveness” (Hart & Hart, 1997). An additional consequence of the cognitive-behavioral theory is in the risks of hypnotic non-compliance. The cognitive behavioral perspective asserts that the communication framework of the hypnotist-subject and the social context within which a hypnotic experience occurs is very significant. This understanding also places much importance upon the condition of the hypnotic subject. Thus, “negative expectancies about hypnosis or a failure to understand that responsiveness to suggestions involves active involvement and not passive responsivity (which) might obstruct the use of hypnosis from a cognitive-behavioral approach.” (Dengrove, 1973). Considering the factors presented in this discussion, the cognitive-behavioral split has been shown as essential for a successful hypnotic experience. Works Cited Barber, Theodore X. Hypnosis: Scientific Approach. New York: Van Nostrand Reinhold, (1969), p. 7. Brown, Peter. The Hypnotic Brain: Hypnotherapy and Social Communication. New Haven and London: Yale University Press, (1991). 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