However, in 1843, James Braid proposed the theory of hypnotism as a radical alternative, in opposition to Mesmerism. Braid argued that the occult qualities of Mesmerism were illusory and that its effects were due to a combination of "nervous fatigue" and verbal suggestion. A bitter war of words developed between Braid and the leading exponents of Mesmerism.
I beg farther to remark, if my theory and pretensions, as to the nature, cause, and extent of the phenomena of nervous sleep [i.e., hypnotism] have none of the fascinations of the transcendental to captivate the lovers of the marvellous, the credulous and enthusiastic, which the pretensions and alleged occult agency of the mesmerists have, still I hope my views will not be the less acceptable to honest and sober-minded men, because they are all level to our comprehension, and reconcilable with well-known physiological and psychological principles. (James Braid, Hypnotic Therapeutics, 1853: 36)
In their original committee report on hypnotherapy, the British Medical Association (BMA), likewise, made a point of condemning the occult theories of Mesmerism and sharply distinguishing them from hypnotism.
The Committee, having completed such investigation of hypnotism as time permitted, have to report that they have satisfied themselves of the genuineness of the hypnotic state. No phenomena which have come under their observation, however, lend support to the theory of ‘animal magnetism’. ('Report on Hypnotism', British Medical Journal, 1892).
Nevertheless, as Eysenck complains, the confusion of Mesmerism and hypnotism continued to be perpetuated by popular fiction, the media, and its portrayal in comedy stage hypnosis shows. Basically, whereas Mesmerism is a supernatural theory, hypnotism attempted to explain the same phenomena in more established scientific terms, by reference to psychology and physiology. As Braid puts it, it is a scientific and 'psycho-physiological' (mind-body) discipline.
Techniques of Hypnotherapy
Age regression - by returning to an earlier ego-state the patient can regain qualities they once had, but have lost. Remembering an earlier, healthier, ego-state can increase the patients' strength and confidence.
Revivification - remembering past experiences can contribute to therapy. For example; the hypnotist may ask "have you ever been in trance?" and then find it easier to revive the previous experience than attempt inducing a new state.
Guided imagery - a method by which the subject is given a new relaxing and beneficial experience.
Parts therapy - a method pioneered by Charles Tebbetts to identify conflicting parts that are damaging the well being of clients, then helps those parts negotiate with each other through the therapist to bring about a resolution.
Confusion - a method developed by Milton H. Erickson in which the subject is more likely to be receptive to indirect suggestion due to an altered state of confusion.
Repetition - the more an idea is repeated the more likely it is to be accepted and acted upon by the patient.
Direct suggestion - suggesting directly. "You feel safe and secure".
Indirect suggestion - using "interspersal" technique and other means to cause effect.
Mental state - people are more receptive while relaxed, sleeping, or in a trance.
Hypnoanalysis - the client recalls moments from his past, confronting them and releasing associated emotions, similar to psychoanalysis.
Post-hypnotic suggestion - a suggestion that will be carried out after the trance has ended. "When you re-awaken you will feel refreshed and happy!"
Visualization - being told to imagine or visualize a desired outcome seems to make it more likely to actually occur.
Hypnotic susceptibility is a measurement of how easily a person can be hypnotized. There are several types of scales used, however the most common are the Harvard Group Scale of Hypnotic Susceptibility and the Stanford Hypnotic Susceptibility Scales. The Harvard Group Scale, as the name implies, is administered predominantly to large groups of people while the Stanford Hypnotic Susceptibility Scale is administered to individuals. No scale can be seen as completely reliable due to the nature of hypnosis. It has been argued that no person can be hypnotized if they do not want to be. Therefore a person who scores very low may not want to be hypnotized, making the test scores invalid.
Harvard Group Scale
Ronald Shor and Emily Carota Orne developed the Harvard Group Scale in 1962. It consists of 12 items of progressive difficulty (as defined, psychometrically, by the percentage of subjects in a normative sample that reports experiencing each particular item) and usually takes around forty-five minutes to complete. The items usually consist of motor tasks and cognitive tasks with the motor tasks being easier to complete. The average score is 5 out of 12. The test is self-scored leaving it open to criticism concerning the validity of the scores.
The Stanford Scale was developed by Andre M. Weitzenhoffer and Ernest R. Hilgard in 1959. The Scale consists of three Forms: A, B, and C. Similar to the Harvard Group Scale, each Form consists of 12 items of progressive difficulty and usually takes fifty minutes to complete. Each form consists of motor and cognitive tasks but vary in their respective intended purpose. The administrator scores each form individually.
Based upon the scale developed by Joseph Friedlander and Theodore Sarbin (1938), this form was developed to measure susceptibility to hypnosis with items increasing in difficulty in order to yield a score. The higher the score, the more responsive one is to hypnosis. Following a standardized hypnotic induction, the hypnotized individual is given suggestions pertaining to the list below.
Item NumberTest Suggestion and Responses
1 Postural Sway
2 Eye Closure
3 Hand Lowering (left)
4 Immobilization (right arm)
5 Finger Lock
6 Arm Rigidity (left arm)
7 Hands Moving Together
8 Verbal Inhibition (name)
9 Hallucination (fly)
10 Eye catalepsy
11 Post-hypnotic (changes chairs)
Form B was designed to be used as a follow-up to Form A when doing experiments involving a second session of hypnosis. The items are similar but are changed somewhat (e.g. the use of the opposite hand in a particular item). The changes were made to "prevent memory from the first exerting too great an influence upon the recall of specific tasks..".
Created a few years after Forms A and B, Form C contains some items from Form B, but includes more difficult items for "when subjects are being selected for advanced tests in which knowledge of their capacity to experience more varied items is required" (pgs v-vi Weitzenhoffer & Hilgard 1962).
Following a standardized hypnotic induction, the hypnotized individual is given suggestions pertaining to the list below.
Item NumberTest Suggestion and Responses 0 Eye Closure (not scored) 1 Hand Lowering (right hand) 2 Moving Hands Apart 3 Mosquito Hallucination 4 Taste Hallucination 5 Arm Rigidity (right arm) 6 Dream 7 Age Regression (school) 8 Arm Immobilization 9 Anosmia to Ammonia
10 Hallucinated Voice
11 Negative Visual Hallucination (Three Boxes)
12 Post-Hypnotic Amnesia
In more modern experiments, a scent such as pepperment has been used in place of ammonia for Item 9.
Other scales of Hypnotic susceptibility
These tests are not widely used because they are usually seen as less reliable than the Stanford Scale and Harvard Group Scale. Many professionals think that these tests produce results because they involve concentration and a certain level of concentration is required to be hypnotized.
Hypnotic Induction Profile
The Hypnotic Induction Profile (HIP) or the eye roll test, first proposed by Herb Spiegel, is a simple test to loosely determine if a person is susceptible to hypnosis. A person is asked to roll his or her eyes upward. The degree to which the iris and cornea are seen is measured. The less of this part of the eye observed, the more hypnotically susceptible a person is. Research has shown that the scale does not carry as strong a relationship with other hypnotic scales as originally thought, with correlations ranging from 0.1 to 0.15.
Individuals are asked to stare at a small light in a dark room. Many people think the light is moving and those who see it change direction the most are thought to be suitable for hypnosis.
Evidence for Hypnotherapy
Evidence from Systematic Reviews
In 1892, the British Medical Association (BMA) commissioned a team of doctors to undertake an extensive evaluation of the nature and effects of hypnotherapy, they reported,
The Committee, having completed such investigation of hypnotism as time permitted, have to report that they have satisfied themselves of the genuineness of the hypnotic state. (British Medical Journal, 1892)
The Committee are of opinion that as a therapeutic agent hypnotism is frequently effective in relieving pain, procuring sleep, and alleviating many functional ailments [i.e., psycho-somatic complaints and anxiety disorders]. (Ibid.)
This report was approved by the general council of the BMA, thereby forming BMA policy and rendering hypnotherapy a form of "orthodox", as opposed to complementary or alternative, medicine.
Subsequent research on hypnotherapy has tended to highlight four main areas in which it's efficacy as a treatment has been demonstrated,
Psycho-somatic disorder, i.e., stress-related illness.
Hypnotherapy has many other applications but efficacy research has tended to focus upon these issues. More mixed results have been obtained for its efficacy in relation to the treatment of addictions, an area where high relapse is common with most treatments.
In 1955, the Psychological Medicine Group of the BMA commissioned a Subcommittee, led by Prof. T. Ferguson Rodger, to deliver a second, and more comprehensive, report on hypnosis. The Subcommittee consulted several experts on hypnosis from various fields, including the eminent neurologist Prof. W. Russell Brain, and the psychoanalyst Wilfred Bion. After two years of study and research, its final report was published in the British Medical Journal (BMJ), under the title ‘Medical use of Hypnotism’. The terms of reference were:
To consider the uses of hypnotism, its relation to medical practice in the present day, the advisability of giving encouragement to research into its nature and application, and the lines upon which such research might be organized. (BMA, 1955)
This is a much more thorough and extensive report, and constitutes one of the most significant documents in the history of hypnotherapy research. With regard to efficacy, it concludes from a systematic review of available research that,
The Subcommittee is satisfied after consideration of the available evidence that hypnotism is of value and may be the treatment of choice in some cases of so-called psycho-somatic disorder and psychoneurosis. It may also be of value for revealing unrecognized motives and conflicts in such conditions. As a treatment, in the opinion of the Subcommittee it has proved its ability to remove symptoms and to alter morbid habits of thought and behavior.
In addition to the treatment of psychiatric disabilities, there is a place for hypnotism in the production of anesthesia or analgesia for surgical and dental operations, and in suitable subjects it is an effective method of relieving pain in childbirth without altering the normal course of labor. ('Medical use of hypnosis', BMJ, April, 1955)
According to a statement of proceedings published elsewhere in the same edition of the BMJ, the report was officially ‘approved at last week’s Council meeting of the British Medical Association.’ (BMA Council Proceedings, BMJ, April 23rd, 1955:1019). In other words, it was approved as official BMA policy. This statement goes on to say that,
For the past hundred years there has been an abundance of evidence that psychological and physiological changes could be produced by hypnotism which were worth study on their own account, and also that such changes might be of great service in the treatment of patients.
Soon afterwards, in 1958, the American Medical Association (AMA) commissioned a similar (though more terse) report which endorses the 1955 BMA report and concludes,
That the use of hypnosis has a recognized place in the medical armamentarium and is a useful technique in the treatment of certain illnesses when employed by qualified medical and dental personnel. ('Medical use of hypnosis', JAMA, 1958).
Again, the AMA council approved this report rendering hypnotherapy an orthodox treatment,
The Reference Committee on Hygiene, Public Health, and Industrial Health approved the report and commended the Council on Mental Health for its work. The House of Delegates adopted the Reference Committee report.
(AMA Proceedings, JAMA, Sep. 1958: 57)
In 1995, the National Institute for Health (NIH), in the US, established a Technology Assessment Conference that compiled an official statement entitled ‘Integration of Behavioral & Relaxation Approaches into the Treatment of Chronic Pain & Insomnia.’ This is an extensive report that includes a statement on the existing research in relation to hypnotherapy for chronic pain. It concludes that:
The evidence supporting the effectiveness of hypnosis in alleviating chronic pain associated with cancer seems strong. In addition, the panel was presented with other data suggesting the effectiveness of hypnosis in other chronic pain conditions, which include irritable bowel syndrome, oral mucositis [pain and swelling of the mucus membrane], temporomandibular disorders [jaw pain], and tension headaches. (NIH, 1995)
In 1999, the British Medical Journal (BMJ) published a Clinical Review of current medical research on hypnotherapy and relaxation therapies, it concludes,
'There is good evidence from randomized controlled trials that both hypnosis and relaxation techniques can reduce anxiety, particularly that related to stressful situations such as receiving chemotherapy.
'They are also effective for panic disorders and insomnia, particularly when integrated into a package of cognitive therapy (including, for example, sleep hygiene).
'A systematic review has found that hypnosis enhances the effects of cognitive behavioural therapy for conditions such as phobia, obesity, and anxiety.
'Randomized controlled trials support the use of various relaxation techniques for treating both acute and chronic pain.
'Randomized trials have shown hypnosis to be of value in asthma and in irritable bowel syndrome.
'Relaxation and hypnosis are often used in cancer patients. There is strong evidence from randomized trials of the effectiveness of hypnosis and relaxation for cancer related anxiety, pain, nausea, and vomiting, particularly in children.'
(Vickers & Zollman, 'Clinical Review: Hypnosis & Relaxation Therapies', BMJ, 1999)
In 2001, the Professional Affairs Board of the British Psychological Society (BPS) commissioned a working party of expert psychologists to publish a report entitled The Nature of Hypnosis. Its remit was 'to provide a considered statement about hypnosis and important issues concerning its application and practice in a range of contexts, notably for clinical purposes, forensic investigation, academic research, entertainment and training.' The report provides a concise (c. 20 pages) summary of the current scientific research on hypnosis. It opens with the following introductory remark:
Hypnosis is a valid subject for scientific study and research and a proven therapeutic medium. (BPS, 2001)
With regard to the therapeutic uses of hypnosis, the BPS arrive at much more positive conclusions.
Enough studies have now accumulated to suggest that the inclusion of hypnotic procedures may be beneficial in the management and treatment of a wide range of conditions and problems encountered in the practice of medicine, psychiatry and psychotherapy. (BPS, 2001)
The working party then provide an overview of some of the most important contemporary research on the efficacy of clinical hypnotherapy, which I summarize as follows (omitting their detailed references).
'There is convincing evidence that hypnotic procedures are effective in the management and relief of both acute and chronic pain and in assisting in the alleviation of pain, discomfort and distress due to medical and dental procedures and childbirth.
'Hypnosis and the practice of self-hypnosis may significantly reduce general anxiety, tension and stress in a manner similar to other relaxation and self-regulation procedures.
'Likewise, hypnotic treatment may assist in insomnia in the same way as other relaxation methods.
'There is encouraging evidence demonstrating the beneficial effects of hypnotherapeutic procedures in alleviating the symptoms of a range of complaints that fall under the heading 'psychosomatic illness.' These include tension headaches and migraine; asthma; gastro-intestinal complaints such as irritable bowel syndrome; warts; and possibly other skin complaints such as eczema, psoriasis and urticaria [hives].
'There is evidence from several studies that its [hypnosis'] inclusion in a weight reduction program may significantly enhance outcome.' (BPS, 'The Nature of Hypnosis', 2001)
Meta-analysis of Success Rates
In 2003, perhaps the most recent meta-analysis of the efficacy of hypnotherapy was published by two researchers from the university of Konstanze in Germany (Flammer & Bongartz). The study examined data on the efficacy of hypnotherapy across the board, though studies included mainly related to psychosomatic illness, test anxiety, smoking cessation and pain control during orthodox medical treatment. Most of the better research studies used traditional-style hypnosis, only a minority (19%) employed Ericksonian hypnosis.
The authors considered a total of 444 studies on hypnotherapy published prior to 2002. By selecting the best quality and most suitable research designs for meta-analysis they narrowed their focus down to 57 controlled trials. These showed that on average hypnotherapy achieved at least 64% success compared to 37% improvement among untreated control groups. (Based on the figures produced by binomial effect size display or BESD.)
According to the authors, however, this was meant as a deliberate underestimate. Their professed aim was to discover whether, even under the most skeptical weighing of the evidence, hypnotherapy was still proven effective. They showed conclusively that it was. In fact, their analysis of treatment designs concluded that expansion of the meta-analysis to include non-randomized trials for this data base would also produce reliable results. When all 133 studies deemed suitable in light of this consideration were re-analyzed, providing data for over 6,000 patients, the findings suggest an average improvement in 27% of untreated patients over the term of the studies compared with a 74% success rate among those receiving hypnotherapy. This is a high success rate given the fact that many of the studies measured included the treatment of addictions and medical conditions. The outcome rates for anxiety disorders alone, traditionally hypnotherapy's strongest application, were higher still (though a precise figure is not cited). (Flammer & Bongartz, 'On the efficacy of hypnosis: a meta-analytic study', Contemporary Hypnosis (2003), 179 – 197.)
Hypnotherapy in pop culture
The progressive metal band Dream Theater released a conceptual album in 1999 about a character named Nicholas who believes to have led a past life. He starts to take hypnotherapy sessions to try to solve this intricate mystery. There are hypnotherapist voiceovers in various songs on the album, as the doctor takes a supportive role in Nicholas' journey into the past.
In the X-Files episode "The Field Where I Died", there are two long hypnotherapy sessions in which Mulder and another character recount their past life as citizens of Nazi Germany and later participants in the American Civil War. Hypnotherapy is used in several other episodes too, when Mulder tries to recall the abduction of his sister, and when Scully tries to recall her own abduction.