A symptom profile of patients with multiple personalities, including MMPI results

Patients with multiple personalities are excellent hypnotic subjects, a capability demonstrated both clinically and on a standard hypnotizability test. They tend to experience a plethora of symptoms associated with anxiety states, hysteria, obsessional neuroses, phobic states, depression and mania, schizophrenia, alcoholism, sociopathy, and hyperactivity--although there are exceptions to this profile. Both males and females suffer from this disability, and an MMPI profile for female multiples is described.     

Failing to resist hypnotic test suggestions: a strategy for self-presenting as deeply hypnotized

Traditionally, hypnosis has been associated with the idea that highly hypnotizable subjects lose voluntary control over their responses and become incapable of resisting suggestions. We contend instead that even excellent hypnotic subjects retain control over their responses. These subjects are invested in presenting themselves as "deeply hypnotized," and to this end employ relevant contextual information to guide their hypnotic enactments. Contextual demands in the hypnotic test situation usually reinforce the idea that hypnotic behavior is involuntary. Therefore, the enactments of highly hypnotizable subjects are typically designed to convey the impression that responses to suggestions are involuntary happenings that cannot be successfully resisted. This formulation implies that highly hypnotizable subjects will present themselves as unable to resist suggestions or, alternatively, as able to easily resist suggestions, depending upon which of these self-presentations they associate with "deep hypnosis." We tested this and related hypotheses by varying the demands associated with "deep hypnosis" and noting the effects on the tendencies of highly hypnotizable subjects to resist suggestions and to describe their responses as involuntary happenings over which they had lost control.     

Auditory hallucinations and schizophrenia

Forty-five patients with auditory hallucinations were studied. Sixty per cent proved to be excellent hypnotic subjects with multiple personalities. These latter patients received 11 different diagnoses by clinicians, predominantly those related to schizophrenia or an affective illness. Because patients with multiple personalities frequently have hallucinations, delusions, paranoid ideas and bizarre behaviors, they may be misdiagnosed as some form of schizophrenia.     

Some conditions of compliance and resistance among hypnotic subjects

Five experimental approaches to the resolution of the century-old Bernheim/Janet dispute and the issue of involuntariness or coercion (the classical suggestion effect) are presented. Four experiments are reported that follow one of the approaches: attempts to induce hypnotic subjects to resist suggestions made in trance. The design is one in which a "resistance instructor" proposes a reward for the resisting subject. Tentative inferences from the results are that the classical suggestion effect is found with a small number of subjects; for a larger number of subjects there is no classical suggestion effect, and for many subjects the outcome is equivocal. Relational factors in the hypnotic dyad influence responsiveness in the subject, the effect being least for those whose susceptibility is high.     

The challenge of chronic insomnia: is non-nightly hypnotic treatment a feasible alternative?

The adverse effects of insomnia on health and quality of life are matters receiving increasing attention. Yet, surveys have consistently shown that most people suffering from insomnia do not seek medical help, perhaps, in part, because of a concern of becoming dependent on hypnotic medication. The treatment of chronic insomnia poses a particular dilemma in that continuous hypnotic treatment is restricted in many countries to a maximum of 4 weeks, and behavioural treatment is not readily available. Non-nightly hypnotic treatment of chronic insomnia offers a promising alternative option for the many patients whose symptoms do not necessitate nightly drug intake, allaying fears of psychological dependence on medication and respecting regulatory constraints on hypnotic use while providing patients with adequate symptom relief. The practical feasibility and efficacy of this approach has been demonstrated with zolpidem using various treatment regimens and study designs. So far, six clinical trials have been completed on over 4000 patients. Published results show effective treatment of insomnia without any evidence of either adverse event associated with a discontinuous regimen or increased hypnotic use over the treatment period.     

Functional neuroanatomy of hypnotic state.

BACKGROUND: The aim of the present study was to describe the distribution of regional cerebral blood flow during the hypnotic state (HS) in humans, using positron-emission tomography (PET) and statistical parametric mapping. METHODS: The hypnotic state relied on revivification of pleasant autobiographical memories and was compared to imaging autobiographical material in "normal alertness." A group of 9 subjects under polygraphic monitoring received six H215O infusions and was scanned in the following order: alert-HS-HS-HS with color hallucination-HS with color hallucination-alert. PET data were analyzed using statistical parametric mapping (SPM95). RESULTS: The group analysis showed that hypnotic state is related to the activation of a widespread, mainly left-sided, set of cortical areas involving occipital, parietal, precentral, premotor, and ventrolateral prefrontal cortices and a few right-sided regions: occipital and anterior cingulate cortices. CONCLUSIONS: The pattern of activation during hypnotic state differs from those induced in normal subjects by the simple evocation of autobiographical memories. It shares many similarities with mental imagery, from which it differs by the relative deactivation of precuneus.     

Hypnosis and related clinical behavior.

The essential aspect in the experience of the hypnotized person is the altered or distorted perception that is suggested to him. Not all people are capable of the experience, but it is possible that spontaneous distortions occur in those with high hypnotizability. These distortions are frequently experienced as frightening symptoms. The author draws attention to the similarity between hysterical symptoms and events in hypnosis and to the high hypnotic responsivity in hysterical subjects reported in the clinical literature of the nineteenth century. Phobic patients have relatively high hypnotic responsivity. The author believes that it is sometimes possible to predict hypnotizability from clinical behavior, and that hypnotic responsivity can be utilized in psychodynamically sensitive therapy to teach such patients that they can learn to gain control of their symptoms.     

Hypnotic susceptibility and experimental pain reduction

We exposed 24 subjects high in hypnotic susceptibility and 24 subjects low in hypnotic susceptibility to a cold-pressor pain stimulus under either hypnotic or waking conditions, using each of two pain-reduction strategies (analgesia and distraction) separately. Trance depth level was held constant for hypnotized subjects. We used pain-tolerance levels as measures of pain, and we analyzed them by survival analysis. High susceptibles reported significantly lower pain ratings and kept their hands immersed longer in the cold water than low-susceptible subjects. There were no significant differences between hypnotic and waking condition subjects or between the different strategies. We have discussed the results in terms of a relationship in the literature between choice of experimental design (between-subjects or within-subjects) and the effectiveness of a hypnotic induction for suggested pain reduction.     

Hypnotic alteration of somatosensory perception

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.     

Effects of L-tryptophan on sleep onset insomniacs.

Eighteen female subjects with demonstrated laboratory sleep onset latency greater than 20 minutes for two nights participated in this double blind study of the effectiveness of l-tryptophan as a hypnotic. Standard sleep recordings were made on 10 nights over a 3 month period with lights out occurring 20 minutes after drug administration (placebo, 1 gm. l-tryptophan, 3 gms. l-tryptophan). Neither dose of l-tryptophan differed from placebo as to the amount of REM, SWS or wakefulness, but 3 gms. significantly reduced sleep onset latency on some of the nights. Those subjects with latencies longer than 40 mins. had the greatest reduction in latency with 3 gms. and also evidenced high levels of anxiety on the Taylor Manifest Anxiety Scale initially. Subjects with latency between 20 and 40 minutes appeared to receive the longest lasting hypnotic effect from the higher dose. Adaptation to the sleep lab took place across the entire 10 nights of the study. Therefore, valid comparisons between treatments in a sleep study extending over a number of nights should be made between temporally adjacent samples.     

Family process and hypnotic susceptibility. A preliminary investigation.

Prior research has found an association between severe punishment during childhood and adult hypnotic susceptibility. The present study investigated family process variables that potentially underlie this association. Two hundred and five college students completed a self-report family process measure and participated in a group hypnotic induction procedure. A subsample of 128 students rated severity and consistency of the punishment they received as children. Subjects with high hypnotic ability reported significantly higher family cohesion than did subjects of low hypnotic ability. A significant linear relation between family cohesion and hypnotizability was also found. Unexpectedly, punishment severity and consistency did not relate to hypnotic susceptibility. Potential causal mechanisms between family process variables and hypnotizability are discussed.     

Hypnotic techniques for smoking control and psychogenic impotence

In the past 35 years I have used a variety of hypnotic techniques to help patients stop smoking. The most successful method has been to see the patient for 3 consecutive days with a follow-up session about 3 weeks later. With this technique, about 81% of patients stopped smoking. Psychogenic impotence has many possible causes and must be approached with an understanding of the dynamics involved. However, hypnotic suggestions can be helpful in restoring erectile function. I have used the technique described here with almost 3000 patients with a success rate of 88%.     

Tandem hypnosis with identical bulimic twins: case report

Hypnosis has been used in the treatment of bulimia nervosa from the early 1980s. Dissociation theory identified a certain subgroup of eating disordered patients with dissociative signs and symptoms. These patients react well to hypnotherapy. Simultaneous hypnosis ("tandem hypnosis") in the treatment of two female 19-year-old monozygotic twins led to a very successful outcome after 6 sessions. During the therapy, attempts were made to work through the physical abuse the subjects suffered from their father. Hypnobehavioural methods were used and treatment was combined with five individual sessions. In the cases presented here, the subjects' traumatic history, their high hypnotic susceptibility, and the effectiveness of hypnotherapy seem to support the dissociative mechanism of symptom development. A systemic approach involving the integration of family therapeutical and hypnotherapeutical interventions proved to be useful. The role of these types of hypnotherapy interventions is still undervalued.     

Cognitive behavioural therapy with behavioural analysis for pharmacological treatment-resistant chronic insomnia

This study aimed to determine whether (1) cognitive behavioural therapy with behavioural analysis for insomnia (CBTi-BA) is more effective for insomnia and co-morbid depressive symptoms than treatment as usual (TAU) and (2) whether CBTi-BA promotes earlier reduction of the daily dose of hypnotic medication in chronic insomnia resistant to pharmacological treatment. A total of 63 patients with chronic insomnia aged 20–77 years who already received hypnotic medication regularly were assigned to two interventions: combined therapy or TAU alone. The subjects provided demographic information and completed self-rating scales for insomnia and depressive symptoms. After treatment, the combined therapy group showed significant decreases in the symptoms of both insomnia and depression and significant reductions in the daily dose of hypnotic medication compared with the group receiving TAU alone. In the combined therapy group, 71% of the participants reported a reduction in insomnia to normal levels and 79% succeeded in decreasing the daily dose of hypnotics to 50% or less of the baseline dose. These results revealed that CBTi-BA can reduce insomnia and depressive symptoms as well as the daily dose of hypnotic medication in patients with chronic insomnia resistant to pharmacological treatment.     

Intrinsic effects of the benzodiazepine receptor antagonist RO 15-1788 in sleepy and alert subjects

The present paper investigated the differential effects of 5 mg, 60 mg and 120 mg of the benzodiazepine receptor antagonist RO 15-1788 on the ability to resist sleep of sleepy and alert subjects. Repeated administrations of 5 mg potentiated the hypnotic effects of sleep-deprivation in alert subjects and decreased the hypnotic effects in sleepy subjects. Similar differential effects were found with respect to two factors of subjective mood. The two higher levels of the drug decreased sleepiness more in sleepy than in alert subjects. These results are interpreted to support the hypothesis that the effects of RO 15-1788 may be dependent on the level of an endogenous benzodiazepine-like sleep factor.     

EEG P300 event-related markers of hypnosis

Barabasz, Barabasz, Jensen, Calvin, Trevisan, and Warner (1999) showed that, when subjects are stringently selected for hypnotizability and responses are time locked to events, robust markers of hypnotic responding emerge that reflect alterations in consciousness that correspond to subjects' subjective experiences of perceptual alteration. To further test the Barabasz et al. (1999) hypothesis, we obtained EEG visual P300 event-related potentials (ERPs) from 20 high- and low-hypnotizable subjects. The effects of positive obstructive and negative obliterating instructions were tested during waking and alert hypnotic conditions. High-hypnotizables showed greater ERP amplitudes in response to the negative hallucination condition and lower ERP amplitudes in response to the positive obstructive hallucination when compared to the low-hypnotizables. Contrary to socio-psychological or role play conceptualizations, the hypnotic induction resulted in specific psychophysiological responses which could not be produced by waking imagination or by the lows who were trying to mimic hypnotic responding.     

Cognitive behavioral hypnotherapy for dissociative disorders

Dissociative disorders (DD) prevail as sequelae to overwhelming experiences in childhood. These readily formed post-traumatic responses and trance states develop in high hypnotizable subjects whose dysregulations become organized into ego states. A cognitive behavioral hypnotherapeutic treatment model will effectively contain, explore, metabolize, and resolve these life-endangering conditions. This article will detail the cognitive hypnotic world of DD patients, the relational spaces of the ego states, and the triphasic treatment mode to successfully resolve the dissociative pathology. Structured and phase appropriate hypnotic interventions will be described.     

Suggested posthypnotic amnesia in four diagnostic groups of hospitalized psychiatric patients

We studied the parameters of suggested posthypnotic amnesia (initial deficit in recall, reversibility, and temporal disorganization of the initial material partially recalled during amnesia) in 132 psychiatric inpatients with DSM-III diagnoses of schizophrenia (N = 25), eating disorders (N = 77), alcoholism (N = 12), and major affective disorder (depression) (N = 18). We compared the findings on these patients with normal student control groups on the Stanford Hypnotic Susceptibility Scale (SHSS:C) posthypnotic suggestion item. In general, the small patient subgroups showed posthypnotic amnesia on each of these criteria in similar fashion to normal student populations. Highly hypnotizable patients were more likely to recall their hypnotic experiences in a more random order than the temporally more accurate sequence shown by low-hypnotizable subjects. Schizophrenic patients initially recalled fewer of their hypnotic experiences (indicating some cognitive deficit), and eating disorder patients initially recalled more of their experiences than other patient groups or normal subjects. Nevertheless, all patient subgroups showed significant additional recall after the reversibility cue. The results support the robustness of posthypnotic amnesia in psychiatric patients.     

A deeper understanding of hypnosis: its secrets, its nature, its essence

Numerous research projects converge on the conclusion that there are three major types of very good or highly responsive hypnotic subjects: (a) fantasy-prone individuals who have secretly spent much of their time since childhood fantasizing vividly and realistically; (b) amnesia-prone individuals who have developed special abilities for mentally repressing or compartmentalizing undesired memories, thoughts, and emotions; and (c) positively-set individuals who are maximally ready to cooperate, think-with, and imagine what is suggested to the best of their ability while letting go of contrary thoughts. The major principle that provides a deep understanding of hypnosis and hypnotic phenomena is that all hypnotic subjects are affected, albeit in different ways for different types of subjects, by four powerful behavior-determining factors that can be potentially maximized in hypnotic situations: (a) social factors that obligate the socialized subject to cooperate and try to actualize or realize the hypnotist's expectations and explicit suggestions; (b) the hypnotist's unique skills and personal characteristics (including creative ideas, communicative ability, and interpersonal efficacy) and the nature of the hypnotist-subject interpersonal relationship; (c) the effectiveness of the induction procedure in guiding the subject to think-with the suggestions; and (d) the depth of meaning, creativity, and "force" or "power" of the suggested ideas.