Hypnosis

Hypnosis is a psychological state with physiological attributes superficially resembling sleep and marked by an individual's level of awareness other than the ordinary conscious state. Another description of the phenomenon is that of an altered mental state, while another links it to imaginative role-enactment.

A person under hypnosis is said to have heightened focus and concentration with the ability to concentrate intensely on a specific thought or memory, while blocking out sources of distraction. Hypnosis is usually induced by a procedure known as a hypnotic induction involving a series of preliminary instructions and suggestions. The use of hypnotism for therapeutic purposes is referred to as "hypnotherapy", while its use as a form of entertainment for an audience is known as "stage hypnosis".

The term "hypnosis" (Greek: ὕπνωσις) comes from the Greek word hypnos, "sleep", and the suffix -osis, or from hypnoō, "(I) put to sleep" (stem of aorist hypnōs-) and the suffix -is. The words "hypnosis" and "hypnotism" both derive from the term "neuro-hypnotism" (nervous sleep) coined by the Scottish surgeon James Braid around 1841. Braid based his practice on that developed by Franz Mesmer and his followers ("Mesmerism" or "animal magnetism"), but differed in his theory as to how the procedure worked.

There is a belief that hypnosis is a form of unconsciousness resembling sleep, but contemporary research suggests that hypnotic subjects are fully awake and are focusing attention, with a corresponding decrease in their peripheral awareness. Subjects also show an increased response to suggestions. In the first book on the subject, Neurypnology (1843), Braid described "hypnotism" as a state of physical relaxation accompanied and induced by mental concentration ("abstraction").

Characteristics
A person under hypnosis experiences heightened suggestibility and focus accompanied by a sense of tranquility. It could be said that hypnotic suggestion is explicitly intended to make use of the placebo effect. For example, in 1994, Irving Kirsch distinguished hypnosis as a "nondeceptive placebo," i.e., a method that openly makes use of suggestion and employs methods to amplify its effects.

The hypnotized individual appears to heed only the communications of the hypnotist. He seems to respond in an uncritical, automatic fashion, ignoring all aspects of the environment other than those pointed out to him by the hypnotist. He sees, feels, smells, and otherwise perceives in accordance with the hypnotist's suggestions, even though these suggestions may be in apparent contradiction to the stimuli that impinge upon him. Even the subject's memory and awareness of self may be altered by suggestion, and the effects of the suggestions may be extended (posthypnotically) into the subject's subsequent waking activity.

Definitions
The earliest definition of hypnosis was given by Braid, who coined the term "hypnotism" as an abbreviation for "neuro-hypnotism", or nervous sleep, which he opposed to normal sleep, and defined as: "a peculiar condition of the nervous system, induced by a fixed and abstracted attention of the mental and visual eye, on one object, not of an exciting nature."

Braid elaborated upon this brief definition in a later work:

"[...] the real origin and essence of the hypnotic condition, is the induction of a habit of abstraction or mental concentration, in which, as in reverie or spontaneous abstraction, the powers of the mind are so much engrossed with a single idea or train of thought, as, for the nonce, to render the individual unconscious of, or indifferently conscious to, all other ideas, impressions, or trains of thought. The hypnotic sleep, therefore, is the very antithesis or opposite mental and physical condition to that which precedes and accompanies common sleep [...]"

- Braid, Hypnotic Therapeutics, 1853

Therefore, Braid defined hypnotism as a state of mental concentration that often leads to a form of progressive relaxation, termed "nervous sleep". Later, in his The Physiology of Fascination (1855), Braid conceded that his original terminology was misleading, and argued that the term "hypnotism" or "nervous sleep" should be reserved for the minority (10%) of subjects who exhibit amnesia, substituting the term "monoideism", meaning concentration upon a single idea, as a description for the more alert state experienced by the others.

A new definition of hypnosis, derived from academic psychology, was provided in 2005, when the Society for Psychological Hypnosis, Division 30 of the American Psychological Association (APA), published the following formal definition:

Hypnotic Induction
Hypnosis is normally preceded by a "hypnotic induction" technique. Traditionally, this was interpreted as a method of putting the subject into a "hypnotic trance"; however, subsequent "nonstate" theorists have viewed it differently, seeing it as a means of heightening client expectation, defining their role, focusing attention, etc. There are several different induction techniques. One of the most influential methods was Braid's "eye-fixation" technique, also known as "Braidism". Many variations of the eye-fixation approach exist, including the induction used in the Stanford Hypnotic Susceptibility Scale (SHSS), the most widely used research tool in the field of hypnotism. Braid's original description of his induction is as follows: Braid later acknowledged that the hypnotic induction technique was not necessary in every case and subsequent researchers have generally found that on average it contributes less than previously expected to the effect of hypnotic suggestions. Variations and alternatives to the original hypnotic induction techniques were subsequently developed. However, this method is still considered authoritative: "It can be safely stated that nine out of ten hypnotic techniques call for reclining posture, muscular relaxation, and optical fixation followed by eye closure."

Suggestion
When James Braid first described hypnotism, he did not use the term "suggestion" but referred instead to the act of focusing the conscious mind of the subject upon a single dominant idea. Braid's main therapeutic strategy involved stimulating or reducing physiological functioning in different regions of the body. In his later works, however, Braid placed increasing emphasis upon the use of a variety of different verbal and non-verbal forms of suggestion, including the use of "waking suggestion" and self-hypnosis. Subsequently, Hippolyte Bernheim shifted the emphasis from the physical state of hypnosis on to the psychological process of verbal suggestion.

I define hypnotism as the induction of a peculiar psychical [i.e., mental] condition which increases the susceptibility to suggestion. Often, it is true, the [hypnotic] sleep that may be induced facilitates suggestion, but it is not the necessary preliminary. It is suggestion that rules hypnotism. (Hypnosis & Suggestion, 1884: 15)

Bernheim's conception of the primacy of verbal suggestion in hypnotism dominated the subject throughout the twentieth century, leading some authorities to declare him the father of modern hypnotism.

Contemporary hypnotism uses a variety of suggestion forms including direct verbal suggestions, "indirect" verbal suggestions such as requests or insinuations, metaphors and other rhetorical figures of speech, and non-verbal suggestion in the form of mental imagery, voice tonality, and physical manipulation. A distinction is commonly made between suggestions delivered "permissively" and those delivered in a more "authoritarian" manner. Harvard hypnotherapist Deirdre Barrett writes that most modern research suggestions are designed to bring about immediate responses, whereas hypnotherapeutic suggestions are usually post-hypnotic ones that are intended to trigger responses affecting behavior for periods ranging from days to a lifetime in duration. The hypnotherapeutic ones are often repeated in multiple sessions before they achieve peak effectiveness.

The conscious and the unconscious mind
Some hypnotists view suggestion as a form of communication that is directed primarily to the subject's conscious mind, whereas others view it as a means of communicating with the "unconscious" or "subconscious" mind. These concepts were introduced into hypnotism at the end of the 19th century by Sigmund Freud and Pierre Janet. Sigmund Freud's psychoanalytic theory describes conscious thoughts as being at the surface of the mind and unconscious processes as being deeper in the mind. Braid, Bernheim and other Victorian pioneers of hypnotism did not refer to the unconscious mind but saw hypnotic suggestions as being addressed to the subject's conscious mind. Indeed, Braid actually defines hypnotism as focused (conscious) attention upon a dominant idea (or suggestion). Different views regarding the nature of the mind have led to different conceptions of suggestion. Hypnotists who believe that responses are mediated primarily by an "unconscious mind", like Milton Erickson, make use of indirect suggestions such as metaphors or stories whose intended meaning may be concealed from the subject's conscious mind. The concept of subliminal suggestion depends upon this view of the mind. By contrast, hypnotists who believe that responses to suggestion are primarily mediated by the conscious mind, such as Theodore Barber and Nicholas Spanos, have tended to make more use of direct verbal suggestions and instructions.

Ideo-dynamic reflex
The first neuropsychological theory of hypnotic suggestion was introduced early on by James Braid who adopted his friend and colleague William Carpenter's theory of the ideo-motor reflex response to account for the phenomenon of hypnotism. Carpenter had observed from close examination of everyday experience that under certain circumstances the mere idea of a muscular movement could be sufficient to produce a reflexive, or automatic, contraction or movement of the muscles involved, albeit in a very small degree. Braid extended Carpenter's theory to encompass the observation that a wide variety of bodily responses besides muscular movement can be thus affected, for example, the idea of sucking a lemon can automatically stimulate salivation, a secretory response. Braid, therefore, adopted the term "ideo-dynamic", meaning "by the power of an idea", to explain a broad range of "psycho-physiological" (mind-body) phenomena. Braid coined the term "mono-ideodynamic" to refer to the theory that hypnotism operates by concentrating attention on a single idea in order to amplify the ideo-dynamic reflex response. Variations of the basic ideo-motor, or ideo-dynamic, theory of suggestion have continued to exercise considerable influence over subsequent theories of hypnosis, including those of Clark L. Hull, Hans Eysenck, and Ernest Rossi. It should be noted that in Victorian psychology the word "idea" encompasses any mental representation, including mental imagery, memories, etc.

Susceptibility
Braid made a rough distinction between different stages of hypnosis, which he termed the first and second conscious stage of hypnotism; he later replaced this with a distinction between "sub-hypnotic", "full hypnotic", and "hypnotic coma" stages. Jean-Martin Charcot made a similar distinction between stages which he named somnambulism, lethargy, and catalepsy. However, Ambroise-Auguste Liébeault and Hippolyte Bernheim introduced more complex hypnotic "depth" scales based on a combination of behavioural, physiological and subjective responses, some of which were due to direct suggestion and some of which were not. In the first few decades of the 20th century, these early clinical "depth" scales were superseded by more sophisticated "hypnotic susceptibility" scales based on experimental research. The most influential were the Davis-Husband and Friedlander-Sarbin scales developed in the 1930s. Andre Weitzenhoffer and Ernest R. Hilgard developed the Stanford Scale of Hypnotic Susceptibility in 1959, consisting of 12 suggestion test items following a standardised hypnotic eye-fixation induction script, and this has become one of the most widely referenced research tools in the field of hypnosis. Soon after, in 1962, Ronald Shor and Emily Carota Orne developed a similar group scale called the Harvard Group Scale of Hypnotic Susceptibility (HGSHS).

Whereas the older "depth scales" tried to infer the level of "hypnotic trance" from supposed observable signs such as spontaneous amnesia, most subsequent scales have measured the degree of observed or self-evaluated responsiveness to specific suggestion tests such as direct suggestions of arm rigidity (catalepsy). The Stanford, Harvard, HIP, and most other susceptibility scales convert numbers into an assessment of a person's susceptibility as 'high', 'medium', or 'low'. Approximately 80% of the population are medium, 10% are high and 10% are low. There is some controversy as to whether this is distributed on a “normal” bell-shaped curve or whether it is bi-modal with a small “blip” of people at the high end. Hypnotizability Scores are highly stable over a person’s lifetime. Research by Deirdre Barrett has found that there are two distinct types of highly susceptible subjects, which she terms fantasizers and dissociaters. Fantasizers score high on absorption scales, find it easy to block out real-world stimuli without hypnosis, spend much time daydreaming, report imaginary companions as a child and grew up with parents who encouraged imaginary play. Dissociaters often have a history of childhood abuse or other trauma, learned to escape into numbness, and to forget unpleasant events. Their association to “daydreaming” was often going blank rather than creating vividly recalled fantasies. Both score equally high on formal scales of hypnotic susceptibility.

Individuals with dissociative identity disorder have the highest hypnotizability of any clinical group, followed by those with posttraumatic stress disorder.

Precursors
According to his writings, Braid began to hear reports concerning various Oriental meditative practices soon after the release of his first publication on hypnotism, Neurypnology (1843). He first discussed some of these oriental practices in a series of articles entitled Magic, Mesmerism, Hypnotism, etc., Historically & Physiologically Considered. He drew analogies between his own practice of hypnotism and various forms of Hindu yoga meditation and other ancient spiritual practices, especially those involving voluntary burial and apparent human hibernation. Braid’s interest in these practices stems from his studies of the Dabistān-i Mazāhib, the “School of Religions”, an ancient Persian text describing a wide variety of Oriental religious rituals, beliefs, and practices.

Last May [1843], a gentleman residing in Edinburgh, personally unknown to me, who had long resided in India, favored me with a letter expressing his approbation of the views which I had published on the nature and causes of hypnotic and mesmeric phenomena. In corroboration of my views, he referred to what he had previously witnessed in oriental regions, and recommended me to look into the “Dabistan,” a book lately published, for additional proof to the same effect. On much recommendation I immediately sent for a copy of the “Dabistan”, in which I found many statements corroborative of the fact, that the eastern saints are all self-hypnotisers, adopting means essentially the same as those which I had recommended for similar purposes.

Although he rejected the transcendental/metaphysical interpretation given to these phenomena outright, Braid accepted that these accounts of Oriental practices supported his view that the effects of hypnotism could be produced in solitude, without the presence of any other person (as he had already proved to his own satisfaction with the experiments he had conducted in November 1841); and he saw correlations between many of the "metaphysical" Oriental practices and his own "rational" neuro-hypnotism, and totally rejected all of the fluid theories and magnetic practices of the mesmerists. As he later wrote:

In as much as patients can throw themselves into the nervous sleep, and manifest all the usual phenomena of Mesmerism, through their own unaided efforts, as I have so repeatedly proved by causing them to maintain a steady fixed gaze at any point, concentrating their whole mental energies on the idea of the object looked at; or that the same may arise by the patient looking at the point of his own finger, or as the Magi of Persia and Yogi of India have practised for the last 2,400 years, for religious purposes, throwing themselves into their ecstatic trances by each maintaining a steady fixed gaze at the tip of his own nose; it is obvious that there is no need for an exoteric influence to produce the phenomena of Mesmerism. […] The great object in all these processes is to induce a habit of abstraction or concentration of attention, in which the subject is entirely absorbed with one idea, or train of ideas, whilst he is unconscious of, or indifferently conscious to, every other object, purpose, or action.

Franz Mesmer
Franz Mesmer (1734–1815) believed that there is a magnetic force or "fluid" within the universe that influences the health of the human body. He experimented with magnets to impact this field in order to produce healing. By around 1774, he had concluded that the same effect could be created by passing the hands in front of the subject's body, later referred to as making "Mesmeric passes." The word "mesmerize", formed from the last name of Franz Mesmer, was intentionally used to separate practitioners of mesmerism from the various "fluid" and "magnetic" theories included within the label "magnetism".

In 1784, at the request of King Louis XVI, a Board of Inquiry started to investigate whether Animal Magnetism existed. Among the board members were founding father of modern chemistry Antoine Lavoisier, Benjamin Franklin, and an expert in pain control, Joseph-Ignace Guillotin. They investigated the practices of a disaffected student of Mesmer, one Charles d'Eslon (1750–1786), and though they concluded that Mesmer's results were valid, their placebo-controlled experiments using d'Eslon's methods convinced them that mesmerism was most likely due to belief and imagination rather than to an invisible energy ("animal magnetism") transmitted from the body of the mesmerist.

In writing the majority opinion, Franklin said, "This fellow Mesmer is not flowing anything from his hands that I can see. Therefore, this mesmerism must be a fraud." Mesmer left Paris and went back to Vienna to practise mesmerism.

James Braid


Following the French committee's findings, Dugald Stewart, an influential academic philosopher of the "Scottish School of Common Sense", encouraged physicians in his Elements of the Philosophy of the Human Mind (1818), to salvage elements of Mesmerism by replacing the supernatural theory of "animal magnetism" with a new interpretation based upon "common sense" laws of physiology and psychology. Braid quotes the following passage from Stewart:

It appears to me, that the general conclusions established by Mesmer’s practice, with respect to the physical effects of the principle of imagination [...] are incomparably more curious than if he had actually demonstrated the existence of his boasted science [of "animal magnetism"]: nor can I see any good reason why a physician, who admits the efficacy of the moral [i.e., psychological] agents employed by Mesmer, should, in the exercise of his profession, scruple to copy whatever processes are necessary for subjecting them to his command, any more than that he should hesitate about employing a new physical agent, such as electricity or galvanism.

In Braid's day, the Scottish School of Common Sense provided the dominant theories of academic psychology and Braid refers to other philosophers within this tradition throughout his writings. Braid therefore revised the theory and practice of Mesmerism and developed his own method of hypnotism as a more rational and common sense alternative.

It may here be requisite for me to explain, that by the term Hypnotism, or Nervous Sleep, which frequently occurs in the following pages, I mean a peculiar condition of the nervous system, into which it may be thrown by artificial contrivance, and which differs, in several respects, from common sleep or the waking condition. I do not allege that this condition is induced through the transmission of a magnetic or occult influence from my body into that of my patients; nor do I profess, by my processes, to produce the higher [i.e., supernatural] phenomena of the Mesmerists. My pretensions are of a much more humble character, and are all consistent with generally admitted principles in physiological and psychological science. Hypnotism might therefore not inaptly be designated, Rational Mesmerism, in contra-distinction to the Transcendental Mesmerism of the Mesmerists.

Despite briefly toying with the name "rational Mesmerism", Braid ultimately chose to emphasise the unique aspects of his approach, carrying out informal experiments throughout his career in order to refute practices that invoked supernatural forces and demonstrating instead the role of ordinary physiological and psychological processes such as suggestion and focused attention in producing the observed effects.

Braid worked very closely with his friend and ally the eminent physiologist Professor William Benjamin Carpenter, an early neuro-psychologist who introduced the "ideo-motor reflex" theory of suggestion. Carpenter had observed instances of expectation and imagination apparently influencing involuntary muscle movement. A classic example of the ideo-motor principle in action is the so-called "Chevreul pendulum" (named after Michel Eugène Chevreul). Chevreul claimed that divinatory pendulae were made to swing by unconscious muscle movements brought about by focused concentration alone.

Braid soon assimilated Carpenter's observations into his own theory, realising that the effect of focusing attention was to enhance the ideo-motor reflex response. Braid extended Carpenter's theory to encompass the influence of the mind upon the body more generally, beyond the muscular system, and therefore referred to the "ideo-dynamic" response and coined the term "psycho-physiology" to refer to the study of general mind/body interaction.

In his later works Braid reserved the term "hypnotism" for cases in which subjects entered a state of amnesia resembling sleep. For other cases, he spoke of a "mono-ideodynamic" principle to emphasise that the eye-fixation induction technique worked by narrowing the subject's attention to a single idea or train of thought ("monoideism"), which amplified the effect of the consequent "dominant idea" upon the subject's body by means of the ideo-dynamic principle.

Hysteria vs. suggestion
For several decades Braid's work became more influential abroad than in his own country, except for a handful of followers, most notably Dr. John Milne Bramwell. The eminent neurologist Dr. George Miller Beard took Braid's theories to America. Meanwhile, his works were translated into German by Wilhelm T. Preyer, Professor of Physiology at Jena University. The psychiatrist Albert Moll subsequently continued German research, publishing Hypnotism in 1889. France became the focal point for the study of Braid's ideas after the eminent neurologist Dr. Étienne Eugène Azam translated Braid's last manuscript (On Hypnotism, 1860) into French and presented Braid's research to the French Academy of Sciences. At the request of Azam, Paul Broca, and others, the French Academy of Science, which had investigated Mesmerism in 1784, examined Braid's writings shortly after his demise.

Azam's enthusiasm for hypnotism influenced Ambroise-Auguste Liébeault, a country doctor. Hippolyte Bernheim discovered Liébeault's enormously popular group hypnotherapy clinic and subsequently became an influential hypnotist. The study of hypnotism subsequently revolved around the fierce debate between Jean-Martin Charcot and Hippolyte Bernheim, the two most influential figures in late 19th-century hypnotism.

Charcot operated a clinic at the Pitié-Salpêtrière Hospital (thus, known as the "Paris School" or the "Salpêtrière School"), while Bernheim had a clinic in Nancy (known as the "Nancy School"). Charcot, who was influenced more by the Mesmerists, argued that hypnotism was an abnormal state of nervous functioning found only in certain hysterical women. He claimed that it manifested in a series of physical reactions that could be divided into distinct stages. Bernheim argued that anyone could be hypnotised, that it was an extension of normal psychological functioning, and that its effects were due to suggestion. After decades of debate, Bernheim's view dominated. Charcot's theory is now just a historical curiosity.

Pierre Janet
Pierre Janet (1859–1947) reported studies on a hypnotic subject in 1882. Charcot subsequently appointed him director of the psychological laboratory at the Salpêtrière in 1889, after Janet had completed his PhD, which dealt with psychological automatism. In 1898 Janet was appointed psychology lecturer at the Sorbonne, and in 1902 he became chair of experimental and comparative psychology at the Collège de France. Janet reconciled elements of his views with those of Bernheim and his followers, developing his own sophisticated hypnotic psychotherapy based upon the concept of psychological dissociation, which, at the turn of the century, rivalled Freud's attempt to provide a more comprehensive theory of psychotherapy.

Sigmund Freud
Sigmund Freud, the founder of psychoanalysis, studied hypnotism at the Paris School and briefly visited the Nancy School.

At first Sigmund Freud was an enthusiastic proponent of hypnotherapy. He "initially hypnotised patients and pressed on their foreheads to help them concentrate while attempting to recover (supposedly) repressed memories", and he soon began to emphasise hypnotic regression and ab reaction (catharsis) as therapeutic methods. He wrote a favorable encyclopedia article on hypnotism, translated one of Bernheim's works into German, and published an influential series of case studies with his colleague Joseph Breuer entitled Studies on Hysteria (1895). This became the founding text of the subsequent tradition known as "hypno-analysis" or "regression hypnotherapy."

However, Freud gradually abandoned hypnotism in favour of psychoanalysis, emphasizing free association and interpretation of the unconscious. Struggling with the great expense of time that psychoanalysis required, Freud later suggested that it might be combined with hypnotic suggestion to hasten the outcome of treatment,

"It is very probable, too, that the application of our therapy to numbers will compel us to alloy the pure gold of analysis plentifully with the copper of direct [hypnotic] suggestion."

However, only a handful of Freud's followers were sufficiently qualified in hypnosis to attempt the synthesis. Their work had a limited influence on the hypno-therapeutic approaches now known variously as "hypnotic regression", "hypnotic progression", and "hypnoanalysis".

Émile Coué
Émile Coué (1857–1926) assisted Ambroise-Auguste Liébeault for around two years at Nancy. After practising for several years as a hypnotherapist employing the methods of Liébeault and Bernheim's Nancy School, Coué developed a new orientation called "conscious autosuggestion." Several years after Liébeault's death in 1904, Coué founded what became known as the New Nancy School, a loose collaboration of practitioners who taught and promoted his views. Coué's method did not emphasise "sleep" or deep relaxation and instead focused upon autosuggestion involving a specific series of suggestion tests. Although Coué argued that he was no longer using hypnosis, followers such as Charles Baudouin viewed his approach as a form of light self-hypnosis. Coué's method became a renowned self-help and psychotherapy technique, which contrasted with psychoanalysis and prefigured self-hypnosis and cognitive therapy.

Clark L. Hull
The next major development came from behavioral psychology in American university research. Clark L. Hull, an eminent American psychologist, published the first major compilation of laboratory studies on hypnosis, Hypnosis & Suggestibility (1933), in which he proved that hypnosis and sleep had nothing in common. Hull published many quantitative findings from hypnosis and suggestion experiments and encouraged research by mainstream psychologists. Hull's behavioural psychology interpretation of hypnosis, emphasising conditioned reflexes, rivalled the Freudian psycho-dynamic interpretation which emphasised unconscious transference.

Dave Elman
Although Dave Elman was a noted radio host, comedian and (song)writer, he also made a name as a hypnotist. He led many courses for physicians and wrote in 1964 the classic book: 'Findings in Hypnosis', later to be re-titled 'Hypnotherapy' (published by Westwood Publishing). Perhaps the most well known aspect of Elman's legacy is his method of induction, which was originally fashioned for speed work and later adapted for the use of medical professionals; his students routinely obtained states of hypnosis adequate for medical and surgical procedures in under three minutes. His book and recordings provide much more than just his rapid induction techniques, however. The first heart operation using hypnosis rather than normal anesthesia (because of severe problems with the patient) was performed by his students with Dave Elman in the operating room as "coach".

Milton Erickson
Milton H. Erickson, M.D. was one of the most influential post-war hypnotherapists. He wrote several books and journal articles on the subject. During the 1960s, Erickson popularized a new branch of hypnotherapy, known as Ericksonian hypnotherapy, characterised primarily by indirect suggestion, "metaphor" (actually analogies), confusion techniques, and double binds in place of formal hypnotic inductions. However, the difference between Erickson's methods and traditional hypnotism led contemporaries such as André Weitzenhoffer to question whether he was practising "hypnosis" at all, and his approach remains in question.

Erickson had no hesitation in presenting any suggested effect as being "hypnosis", whether or not the subject was in a hypnotic state. In fact, he was not hesitant in passing off behaviour that was dubiously hypnotic as being hypnotic.

Cognitive-behavioural
In the latter half of the twentieth century, two factors contributed to the development of the cognitive-behavioural approach to hypnosis:
 * 1) Cognitive and behavioural theories of the nature of hypnosis (influenced by the theories of Sarbin) and Barber became increasingly influential.
 * 2) The therapeutic practices of hypnotherapy and various forms of cognitive-behavioural therapy overlapped and influenced each other.

Although cognitive-behavioural theories of hypnosis must be distinguished from cognitive-behavioural approaches to hypnotherapy, they share similar concepts, terminology, and assumptions and have been integrated by influential researchers and clinicians such as Irving Kirsch, Steven Jay Lynn, and others.

At the outset of cognitive-behavioural therapy during the 1950s, hypnosis was used by early behaviour therapists such as Joseph Wolpe and also by early cognitive therapists such as Albert Ellis. Barber, Spanos snd Chaves introduced the term "cognitive-behavioural" to describe their "nonstate" theory of hypnosis in Hypnotism: Imagination & Human Potentialities (1974). However, Clark L. Hull had introduced a behavioural psychology as far back as 1933, which in turn was preceded by Ivan Pavlov. Indeed, the earliest theories and practices of hypnotism, even those of Braid, resemble the cognitive-behavioural orientation in some respects.

Applications
There are numerous applications for hypnosis across multiple fields of interest including medical/psychotherapeutic uses, military uses, self-improvement, and entertainment.

Hypnotism has also been used in forensics, sports, education, physical therapy and rehabilitation. Hypnotism has also been employed by artists for creative purposes, most notably the surrealist circle of André Breton who employed hypnosis, automatic writing and sketches for creative purposes. Hypnotic methods have been used to re-experience drug states and mystical experiences. Self-hypnosis is popularly used to quit smoking and reduce stress, while stage hypnosis can persuade people to perform unusual public feats.

Some people have drawn analogies between certain aspects of hypnotism and areas such as crowd psychology, religious hysteria, and ritual trances in preliterate tribal cultures.

Hypnotherapy


Hypnotherapy is a use of hypnosis in psychotherapy. It is used by licensed physicians, psychologists, and others. Physicians and psychiatrists may use hypnosis to treat depression, anxiety, eating disorders, sleep disorders, compulsive gaming, and posttraumatic stress, while certified hypnotherapists who are not physicians or psychologists often treat smoking and weight management.

Modern hypnotherapy has been used in a variety of forms with varying success, such as:


 * Cognitive-behavioral hypnotherapy, or clinical hypnosis combined with elements of Cognitive-Behavioral Therapy
 * Age regression hypnotherapy (or "hypnoanalysis")
 * Ericksonian hypnotherapy.
 * Fears and phobias
 * Addictions
 * Habit control
 * Pain management
 * Psychological therapy
 * Relaxation
 * Skin disease
 * Soothing anxious surgical patients
 * Sports performance
 * Weight loss

In a January 2001 article in Psychology Today Harvard psychologist Deirdre Barrett wrote: "A hypnotic trance is not therapeutic in and of itself, but specific suggestions and images fed to clients in a trance can profoundly alter their behavior. As they rehearse the new ways they want to think and feel, they lay the groundwork for changes in their future actions..." and she described specific ways this is operationalized for habit change and amelioration of phobias. In her 1998 book of hypnotherapy case studies, she reviews the clinical research on hypnosis with dissociative disorders, smoking cessation, and insomnia and describes successful treatments of these complaints.

In a July 2001 article for Scientific American titled "The Truth and the Hype of Hypnosis", Michael Nash wrote:

"...using hypnosis, scientists have temporarily created hallucinations, compulsions, certain types of memory loss, false memories, and delusions in the laboratory so that these phenomena can be studied in a controlled environment."

Irritable bowel syndrome
Hypnotherapy has been studied for the treatment of irritable bowel syndrome. Hypnosis for IBS has received moderate support in the National Institute for Health and Clinical Excellence guidance published for UK health services. It has been used as an aid or alternative to chemical anesthesia,  and it has been studied as a way to soothe skin ailments.

Pain management


A number of studies show that hypnosis can reduce the pain experienced during burn-wound debridement, bone marrow aspirations, and childbirth. The International Journal of Clinical and Experimental Hypnosis found that hypnosis relieved the pain of 75% of 933 subjects participating in 27 different experiments.

Hypnosis is effective in reducing pain from and coping with cancer and other chronic conditions. Nausea and other symptoms related to incurable diseases may also be managed with hypnosis. Some practitioners have claimed hypnosis might help boost the immune system of people with cancer. However, according to the American Cancer Society, "available scientific evidence does not support the idea that hypnosis can influence the development or progression of cancer.".

The American Psychological Association published a study comparing the effects of hypnosis, ordinary suggestion and placebo in reducing pain. The study found that highly suggestible individuals experienced a greater reduction in pain from hypnosis compared with placebo, whereas less suggestible subjects experienced no pain reduction from hypnosis when compared with placebo. Ordinary non-hypnotic suggestion also caused reduction in pain compared to placebo, but was able to reduce pain in a wider range of subjects (both high and low suggestible) than hypnosis. The results showed that it is primarily the subject's responsiveness to suggestion, whether within the context of hypnosis or not, that is the main determinant of causing reduction in pain.

Other medical and psychotherapeutic uses
Treating skin diseases with hypnosis (hypnodermatology) has performed well in treating warts, psoriasis, and atopic dermatitis.

The success rate for habit control is varied. A meta-study researching hypnosis as a quit-smoking tool found it had a 20 to 30 percent success rate, while a 2007 study of patients hospitalised for cardiac and pulmonary ailments found that smokers who used hypnosis to quit smoking doubled their chances of success.

Hypnosis may be useful as an adjunct therapy for weight loss. A 1996 meta-analysis studying hypnosis combined with cognitive-behavioural therapy found that people using both treatments lost more weight than people using CBT alone. The virtual gastric band procedure mixes hypnosis with hypnopedia. The hypnosis instructs the stomach it is smaller than it really is and hypnopedia reinforces alimentary habits.

Controversy surrounds the use of hypnotherapy to retrieve memories, especially those from early childhood or (supposed) past-lives. The American Medical Association and the American Psychological Association caution against repressed memory therapy in cases of alleged childhood trauma, stating that "it is impossible, without corroborative evidence, to distinguish a true memory from a false one." Past life regression, meanwhile, is often viewed with skepticism.

Psychiatric nurses in most medical facilities are allowed to administer hypnosis to patients in order to relieve symptoms such as anxiety, arousal, negative behaviors, uncontrollable behavior, and improve self-esteem and confidence only when they have been completely trained about their clinical side effects and while under supervision when administering it.

Military applications
A recently declassified document obtained by the Freedom of Information Act archive shows that hypnosis was investigated for military applications. However, the overall conclusion of the study was that there was no evidence that hypnosis could be used for military applications, and also that there was no clear evidence for whether 'hypnosis' actually exists as a definable phenomenon outside ordinary suggestion, high motivation and subject expectancy. According to the document,

"The use of hypnosis in intelligence would present certain technical problems not encountered in the clinic or laboratory. To obtain compliance from a resistant source, for example, it would be necessary to hypnotise the source under essentially hostile circumstances. There is no good evidence, clinical or experimental, that this can be done."

Furthermore, the document states that:

"It would be difficult to find an area of scientific interest more beset by divided professional opinion and contradictory experimental evidence…No one can say whether hypnosis is a qualitatively unique state with some physiological and conditioned response components or only a form of suggestion induced by high motivation and a positive relationship between hypnotist and subject…T.X. Barber has produced “hypnotic deafness” and “hypnotic blindness”, analgesia and other responses seen in hypnosis—all without hypnotizing anyone…Orne has shown that unhypnotized persons can be motivated to equal and surpass the supposed superhuman physical feats seen in hypnosis."

The study concludes:

"It is probably significant that in the long history of hypnosis, where the potential application to intelligence has always been known, there are no reliable accounts of its effective use by an intelligence service."

Research into hypnosis in military applications is further verified by the MKULTRA experiments, also conducted by the CIA. According to Congressional testimony, the CIA experimented with utilizing LSD and hypnosis for mind control. Many of these programs were done domestically and on participants who were not informed of the study's purposes or that they would be given drugs.

The full paper explores the potentials of operational uses.

Self-hypnosis
Self-hypnosis happens when a person hypnotises oneself, commonly involving the use of autosuggestion. The technique is often used to increase motivation for a diet, quit smoking, or reduce stress. People who practice self-hypnosis sometimes require assistance; some people use devices known as mind machines to assist in the process, whereas others use hypnotic recordings.

Self-hypnosis is claimed to help with stage fright, relaxation, and physical well-being.

Stage hypnosis
Stage hypnosis is a form of entertainment, traditionally employed in a club or theatre before an audience. Due to stage hypnotists' showmanship, many people believe that hypnosis is a form of mind control. Stage hypnotists typically attempt to hypnotise the entire audience and then select individuals who are "under" to come up on stage and perform embarrassing acts, while the audience watches. However, the effects of stage hypnosis are probably due to a combination of psychological factors, participant selection, suggestibility, physical manipulation, stagecraft, and trickery. The desire to be the centre of attention, having an excuse to violate their own fear suppressors and the pressure to please are thought to convince subjects to 'play along'. Books by stage hypnotists sometimes explicitly describe the use of deception in their acts, for example, Ormond McGill's New Encyclopedia of Stage Hypnosis describes an entire "fake hypnosis" act that depends upon the use of private whispers throughout.

The state versus non-state debate
The central theoretical disagreement is known as the "state versus nonstate" debate. When Braid introduced the concept of hypnotism, he equivocated over the nature of the "state", sometimes describing it as a specific sleep-like neurological state comparable to animal hibernation or yogic meditation, while at other times he emphasised that hypnotism encompasses a number of different stages or states that are an extension of ordinary psychological and physiological processes. Overall, Braid appears to have moved from a more "special state" understanding of hypnotism toward a more complex "nonstate" orientation.

State theorists interpret the effects of hypnotism as due primarily to a specific, abnormal, and uniform psychological or physiological state of some description, often referred to as "hypnotic trance" or an "altered state of consciousness." Nonstate theorists rejected the idea of hypnotic trance and interpret the effects of hypnotism as due to a combination of multiple task-specific factors derived from normal cognitive, behavioural, and social psychology, such as social role-perception and favorable motivation (Sarbin), active imagination and positive cognitive set (Barber), response expectancy (Kirsch), and the active use of task-specific subjective strategies (Spanos). The personality psychologist Robert White is often cited as providing one of the first nonstate definitions of hypnosis in a 1941 article:

Hypnotic behaviour is meaningful, goal-directed striving, its most general goal being to behave like a hypnotised person as this is continuously defined by the operator and understood by the client.

Put simply, it is often claimed that whereas the older "special state" interpretation emphasises the difference between hypnosis and ordinary psychological processes, the "nonstate" interpretation emphasises their similarity.

Comparisons between hypnotised and non-hypnotised subjects suggest that if a "hypnotic trance" does exist it only accounts for a small proportion of the effects attributed to hypnotic suggestion, most of which can be replicated without hypnotic induction.

Hyper-suggestibility
Braid can be taken to imply, in later writings, that hypnosis is largely a state of heightened suggestibility induced by expectation and focused attention. In particular, Hippolyte Bernheim became known as the leading proponent of the "suggestion theory" of hypnosis, at one point going so far as to declare that there is no hypnotic state, only heightened suggestibility. There is a general consensus that heightened suggestibility is an essential characteristic of hypnosis.

If a subject after submitting to the hypnotic procedure shows no genuine increase in susceptibility to any suggestions whatever, there seems no point in calling him hypnotised, regardless of how fully and readily he may respond to suggestions of lid-closure and other superficial sleeping behaviour.

Conditioned inhibition
Ivan Pavlov stated that hypnotic suggestion provided the best example of a conditioned reflex response in human beings, i.e., that responses to suggestions were learned associations triggered by the words used. Pavlov himself wrote:

"Speech, on account of the whole preceding life of the adult, is connected up with all the internal and external stimuli which can reach the cortex, signaling all of them and replacing all of them, and therefore it can call forth all those reactions of the organism which are normally determined by the actual stimuli themselves. We can, therefore, regard ‘suggestion’ as the most simple form of a typical reflex in man."

He also believed that hypnosis was a "partial sleep" meaning that a generalised inhibition of cortical functioning could be encouraged to spread throughout regions of the brain. He observed that the various degrees of hypnosis did not significantly differ physiologically from the waking state and hypnosis depended on insignificant changes of environmental stimuli. Pavlov also suggested that lower-brain-stem mechanisms were involved in hypnotic conditioning.

Pavlov's ideas combined with those of his rival Bekhterev and became the basis of hypnotic psychotherapy in the Soviet Union, as documented in the writings of his follower K.I. Platonov. Soviet theories of hypnotism subsequently influenced the writings of Western behaviourally-oriented hypnotherapists such as Andrew Salter.

Neuropsychology
Neurological imaging techniques provide no evidence of a neurological pattern that can be equated with a "hypnotic trance". Changes in brain activity have been found in some studies of highly responsive hypnotic subjects. These changes vary depending upon the type of suggestions being given. The state of light to medium hypnosis, where the body undergoes physical and mental relaxation, is associated with a pattern mostly of alpha waves However, what these results indicate is unclear. They may indicate that suggestions genuinely produce changes in perception or experience that are not simply a result of imagination. However, in normal circumstances without hypnosis, the brain regions associated with motion detection are activated both when motion is seen and when motion is imagined, without any changes in the subjects' perception or experience. This may therefore indicate that highly suggestible hypnotic subjects are simply activating to a greater extent the areas of the brain used in imagination, without real perceptual changes. It is, however, premature to claim that hypnosis and meditation are mediated by similar brain systems and neural mechanisms.

Another study has demonstrated that a color hallucination suggestion given to subjects in hypnosis activated color-processing regions of the occipital cortex. A 2004 review of research examining the EEG laboratory work in this area concludes:

"Hypnosis is not a unitary state and therefore should show different patterns of EEG activity depending upon the task being experienced. In our evaluation of the literature, enhanced theta is observed during hypnosis when there is task performance or concentrative hypnosis, but not when the highly hypnotizable individuals are passively relaxed, somewhat sleepy and/or more diffuse in their attention."

The induction phase of hypnosis may also affect the activity in brain regions that control intention and process conflict. Anna Gosline claims:

""Gruzelier and his colleagues studied brain activity using an fMRI while subjects completed a standard cognitive exercise, called the Stroop task. The team screened subjects before the study and chose 12 that were highly susceptible to hypnosis and 12 with low susceptibility. They all completed the task in the fMRI under normal conditions and then again under hypnosis. Throughout the study, both groups were consistent in their task results, achieving similar scores regardless of their mental state. During their first task session, before hypnosis, there were no significant differences in brain activity between the groups. But under hypnosis, Gruzelier found that the highly susceptible subjects showed significantly more brain activity in the anterior cingulate gyrus than the weakly susceptible subjects. This area of the brain has been shown to respond to errors and evaluate emotional outcomes. The highly susceptible group also showed much greater brain activity on the left side of the prefrontal cortex than the weakly susceptible group. This is an area involved with higher level cognitive processing and behaviour.""

Dissociation
Pierre Janet originally developed the idea of dissociation of consciousness from his work with hysterical patients. He believed that hypnosis was an example of dissociation, whereby areas of an individual's behavioural control separate from ordinary awareness. Hypnosis would remove some control from the conscious mind, and the individual would respond with autonomic, reflexive behaviour. Weitzenhoffer describes hypnosis via this theory as "dissociation of awareness from the majority of sensory and even strictly neural events taking place."

Neodissociation
Ernest Hilgard, who developed the "neodissociation" theory of hypnotism, hypothesized that hypnosis causes the subjects to divide their consciousness voluntarily. One part responds to the hypnotist while the other retains awareness of reality. Hilgard made subjects take an ice water bath. They said nothing about the water being cold or feeling pain. Hilgard then asked the subjects to lift their index finger if they felt pain and 70% of the subjects lifted their index finger. This showed that even though the subjects were listening to the suggestive hypnotist they still sensed the water's temperature.

Mind-dissociation
This theory was proposed by Y.D. Tsai in 1995 as part of his psychosomatic theory of dreams. Inside each brain, there is a program "I" (the conscious self), which is distributed over the conscious brain and coordinates mental functions (cortices), such as thinking, imagining, sensing, moving and reasoning. "I" also supervises memory storage. Many bizarre states of consciousness are actually the results of dissociation of certain mental functions from "I".

There are several possible types of dissociation that may occur:
 * the subject's imagination is dissociated and sends the imagined content back to the sensory cortex resulting in dreams or hallucinations
 * some senses are dissociated, resulting in hypnotic anesthesia
 * motor function is dissociated, resulting in immobility
 * reason is dissociated and he/she obeys the hypnotist's orders
 * thought is dissociated and not controlled by reason, hence, for example striving to straighten the body between two chairs.

A hypnotist's suggestion can also influence the subject long after the hypnosis session, as follows. In a normal state of mind, the subject will do or believe as his reason dictates. However, when hypnotized, reason is replaced by the hypnotist's suggestions to make up decisions or beliefs, and the subject will be very uneasy in later days if he/she does not do things as decided or his/her belief is contradicted. Hypnotherapy is also based on this principle.

Social role-taking theory
The main theorist who pioneered the influential role-taking theory of hypnotism was Theodore Sarbin. Sarbin argued that hypnotic responses were motivated attempts to fulfill the socially constructed roles of hypnotic subjects. This has led to the misconception that hypnotic subjects are simply "faking". However, Sarbin emphasised the difference between faking, in which there is little subjective identification with the role in question, and role-taking, in which the subject not only acts externally in accord with the role but also subjectively identifies with it to some degree, acting, thinking, and feeling "as if" they are hypnotised. Sarbin drew analogies between role-taking in hypnosis and role-taking in other areas such as method acting, mental illness, and shamanic possession, etc. This interpretation of hypnosis is particularly relevant to understanding stage hypnosis in which there is clearly strong peer pressure to comply with a socially constructed role by performing accordingly on a theatrical stage.

Hence, the social constructionism and role-taking theory of hypnosis suggests that individuals are enacting (as opposed to merely playing) a role and that really there is no such thing as a hypnotic trance. A socially constructed relationship is built depending on how much rapport has been established between the "hypnotist" and the subject (see Hawthorne effect, Pygmalion effect, and placebo effect).

Psychologists such as Robert Baker and Graham Wagstaff claim that what we call hypnosis is actually a form of learned social behaviour, a complex hybrid of social compliance, relaxation, and suggestibility that can account for many esoteric behavioural manifestations.

Cognitive-behavioural theory
Barber, Spanos and Chaves (1974) proposed a nonstate "cognitive-behavioural" theory of hypnosis, similar in some respects to Sarbin's social role-taking theory and building upon the earlier research of Barber. On this model, hypnosis is explained as an extension of ordinary psychological processes like imagination, relaxation, expectation, social compliance, etc. In particular, Barber argued that responses to hypnotic suggestions were mediated by a "positive cognitive set" consisting of positive expectations, attitudes, and motivation. Daniel Araoz subsequently coined the acronym "TEAM" to symbolise the subject's orientation to hypnosis in terms of "trust", "expectation", "attitude", and "motivation".

Barber et al., noted that similar factors appeared to mediate the response both to hypnotism and to cognitive-behavioural therapy (CBT), in particular systematic desensitization. Hence, research and clinical practice inspired by their interpretation has led to growing interest in the relationship between hypnotherapy and CBT.

Information theory
An approach loosely based on Information theory uses a brain-as-computer model. In adaptive systems, feedback increases the signal-to-noise ratio, which may converge towards a steady state. Increasing the signal-to-noise ratio enables messages to be more clearly received. The hypnotist's object is to use techniques to reduce interference and increase the receptability of specific messages (suggestions).

Systems theory
Systems theory, in this context, may be regarded as an extension of Braid's original conceptualization of hypnosis as involving a process of enhancing or depressing nervous system activity. Systems theory considers the nervous system's organization into interacting subsystems. Hypnotic phenomena thus involve not only increased or decreased activity of particular subsystems, but also their interaction. A central phenomenon in this regard is that of feedback loops, which suggest a mechanism for creating hypnotic phenomena.

Historical figures

 * Vladimir Bekhterev
 * Hippolyte Bernheim
 * Alfred Binet
 * James Braid (surgeon)
 * John Milne Bramwell
 * Jean-Martin Charcot
 * Émile Coué


 * Emile Dantinne
 * John Elliotson
 * James Esdaile
 * George Estabrooks
 * Abbé Faria
 * Sigmund Freud
 * Pierre Janet
 * Ambroise-Auguste Liébeault


 * Franz Mesmer
 * Albert Moll
 * Julian Ochorowicz
 * Ivan Pavlov
 * Morton Prince
 * Marquis de Puységur
 * Otto Georg Wetterstrand

Modern researchers

 * Theodore X. Barber
 * Deirdre Barrett
 * Etzel Cardeña
 * Dave Elman
 * George Estabrooks


 * Milton Erickson
 * Hans Eysenck
 * Jack Stanley Gibson
 * Ernest R. Hilgard
 * Clark L. Hull
 * Irving Kirsch


 * Ainslie Meares
 * Dylan Morgan
 * Martin Orne
 * Theodore Sarbin
 * Nicholas Spanos
 * Andre Weitzenhoffer

Related subjects
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