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Hypnosis and the placebo effect are "so heavily reliant upon the effects of suggestion and belief that it would be hard to imagine how a credible placebo control could ever be devised for a hypnotism study." -R Barker Bausell
Hypnosis is a process involving a hypnotist and a subject who agrees to be hypnotized. Being hypnotized is usually characterized by (a) concentration, (b) relaxation, (c) suggestion, and (d) expectation.
The versatility of hypnosis is unparalleled. Hypnosis occurs under dramatically different social settings: the showroom, the clinic, and the police station.
Showroom hypnotists usually work bars, clubs, and state fairs. Their subjects are usually people who have some experience with hypnosis. The subjects may have never been hypnotized themselves, but they have a pretty good idea of what to expect. They know, for example, that the hypnotist may get one of the participants to cluck like a chicken or go back to his seat in the audience and later stand up and shout something. They also often have "plants" in the audience to give credence to their powers. A favorite trick of stage hypnotists is to have somebody adopt a board-like posture, supported only by the heels and back of the head—any reasonably fit person can do this.* Depending on the inhibitions and amount of alcohol imbibed by the participants, such shows can produce behavior the participants would describe as "out of their control" and "not typical" for them. Some psychologists argue that showroom hypnosis is a form of learned social behavior. Robert Baker (1990), for example, argued that the hypnotist and subject have learned that certain kinds of things are expected of them in the showroom setting. They know they have roles to play and they reinforce each other by their performances. The hypnotist provides suggestions and the subject responds to the suggestions. The rest of the behavior—the hypnotist’s repetition of sounds or gestures, his soft, relaxing voice, snapping of fingers, counting backward from 10 to 1, and the trance-like pose or sleep-like repose of the subject—are just window dressing, part of the drama that makes hypnosis seem mysterious.
The hypnosis showroom provides a social setting where behavior that would usually be considered inappropriate is allowed. If alcohol is involved, an additional excuse for inappropriate behavior is introduced. Looked at this way, showroom hypnosis is a kind of release, a socially acceptable way to let go.
A rather bizarre practice in Malaysia and Indonesia called latah is somewhat reminiscent of what goes on in some demonstrations of showroom hypnosis.
Upon being startled, ordinarily timid, exceedingly polite women sometimes respond with vulgar obscenities and outrageous sexual gestures. Severe cases experience "automatic obedience," doing whatever they are told, afterward claiming amnesia and thus not held responsible for their actions. (Bartholomew and Radford 2003: 93)
Latah seems to involve a tacit social agreement to act as if one has lost one's self-control. The benefit to the hypnotic subjects of the stage hypnotist may even be the same as the benefit of latah: attention.
In any case, stage hypnosis seems to be done for entertainment purposes and is quite different from the more serious aims of those who work in a clinical setting: the hypnotherapists. But even this group exhibits a great deal of variety in what they do.
The subjects of clinical hypnotists are usually people with problems who have heard that hypnotherapy works for relieving pain or overcoming an addiction or a fear. Some use hypnosis to recover repressed memories of sexual abuse, memories of past lives, or hidden memories of crimes the subject has witnessed or been victim to. Some use hypnosis to discover alleged truths hidden from ordinary consciousness in the unconscious mind. Each of these should be discussed separately: the hypnotherapists, the repressed memory therapists, the past lives therapists, and the New Age therapists. We'll take them in reverse order.
New Age therapists. This group thinks that hypnosis is a gateway to occult knowledge about the self and mystical insights about the universe. Hypnosis is seen as a way to open up the unconscious mind where these alleged truths and insights have taken up residence. Scientific support for this view is lacking and few psychologists take this approach seriously.
Past Life therapists. These folks use hypnosis to do past life regression. This use of hypnosis seems a perfect fit for the notion that hypnosis is learned behavior issuing out of a socio-cognitive context, a view put forth by psychologist Nicholas Spanos. Like Robert Baker, Spanos argued that "hypnotic procedures influence behavior indirectly by altering subjects’ motivations, expectations and interpretations." Despite the performance put on by the subject in past life regression sessions, their behavior has nothing to do with being in a trance, opening up the subconscious mind, or accessing past lives. The subject acts in accordance with the expectations of the hypnotic situation and behaves as she thinks she is supposed to behave in response to the suggestions of the hypnotist. A compliant subject can have reveries about future lives if the therapist leads her that way. Depending on the desires and expectations of the therapist-patient dyad, people can imagine they are in the Roman coliseum two thousand years ago or on another planet a thousand years into the future.
Spanos compares the popularity of hypnosis with the nineteenth century phenomenon we now call mesmerism. Furthermore, he draws an analogy between the belief in hypnosis and the belief in demonic possession and exorcism. Each can be explained in terms of socio-cognitive context. The conceptions of the roles for the participants in all of these beliefs and behaviors are learned and reinforced in their social settings. They are context-dependent and depend on the willingness of participants to play their established roles. Given enough support by enough people in a social setting, just about any concept or behavior can become adamantly defended as dogma by the scientific, theological, or social community.
Another psychologist, E. M. Thornton (1976), extends the analogy between hypnotism, mesmerism, and exorcism. She maintains that hypnotic subjects are asked basically to take on "what really amounts to a parody of epileptic symptoms." If some hypnotic or mesmerized subjects seem possessed, that is because possession involves a similar socio-cognitive context, a similar role-playing arrangement and rapport. The central beliefs differ and the dominant idea of an altered state, of animal magnetism, or of invading demons gives the experiences their distinguishing characteristics. Deep down, however, hypnotism, mesmerism, hysteria, and demonic possession share the common ground of being social constructs engineered mainly by enthusiastic therapists, showmen, and priests on the one side, and suggestible, imaginative, willing, fantasy-prone players with deep emotional needs or abilities on the other.
Those claiming that hypnosis is a trance state often cite studies that show that during hypnosis (1) the brain’s electrical states change and (2) brain waves differ from those during waking consciousness. Critics of this view point out that these facts are irrelevant to establishing hypnosis as an altered state of consciousness. One might as well call daydreaming, concentrating, imagining the color red, or sneezing altered states, since the experience of each will show electrical changes in the brain and changes in brain waves from ordinary waking consciousness.
Anyway, investigations into alleged cases of past life regression support the view that what is brought forth during the hypnotic sessions are memories from this life and confabulations. For example, see the entries on Bridey Murphy and the Bloxham tapes.
Repressed Memory therapists. These folks have completely mucked up both treatment and criminal investigation by using hypnosis and other suggestive techniques to evoke memories of sexual abuse by relatives or by aliens in spaceships. In some cases, hypnosis has been used to encourage patients to believe events that probably never happened (false memories). If these "memories" were not of horrible and painful events, they would be of little concern. But by nurturing delusions of evil suffered, therapists often do irreparable harm to those who put their trust in them. They do this in the name of healing and caring, as did the priests of old when they hunted witches and exorcised demons. Worse, they do this when there is scarcely any evidence that repression of traumatic experiences is a common fact.*
Some hypnotic subjects are people who have been victims of or witnesses to a crime. Police sometimes encourage them to undergo hypnosis to help them remember details from their experiences. If not done very carefully, however, these sessions can implant false memories rather than draw out true ones. Hypnosis is dangerous in the police setting because of the tendency of too many police officers to believe in truth serums, lie detectors, and other magical and easy ways to get to the truth.
The repressed memory therapists have taught us not to underestimate the power of suggestion through word, gesture, tone of voice, omission, and a host of other things. Those who hope to purify hypnosis by stripping it of its suggestive power seem to hope in vain. Take away suggestion and whatever you have left isn't hypnosis. Use hypnosis to stimulate memory and whatever you get isn't any more accurate than what you'd get if you didn't use hypnosis.*
Contrary to what many people believe, hypnosis does not significantly aid memory’s accuracy. Because subjects are extremely suggestible while hypnotized, some states do not allow as evidence in a court of law testimony made while under hypnosis (Loftus 1979). Minnesota’s Supreme Court was the first state court to rule that recollections under hypnosis would not be admissible as evidence in court. The American Medical Association (AMA) agrees. An AMA committee reported that there was “no evidence to indicate that there is an increase of only accurate memory during hypnosis.” ... Defenders of hypnosis cite cases such as the bus driver who, while under hypnosis, recalled most of the license plate number of a van he saw. This helped break the Chowchilla kidnapping case. (On July 15, 1976, a busload of school children and their bus driver were abducted on their way back from a swim outing.) Opponents point to the fact that people can have vivid memories under hypnosis that are false and that a hypnotized person, because of being very suggestible, runs a great risk of using the imagination to fill in memory-gaps. But even if some hypnotic memories are accurate, there is no significant probability that a memory is any more reliable simply because it has been hypnotically induced. (Carroll 2005: 10)
For more on the evidence for not trusting memories evoked by hypnosis, see the Skeptical Inquirer, Vol. XII No. 2, Winter 1987-88: "The Power of Suggestion on Memory" by Robert A. Baker and "Fantasizing Under Hypnosis: Some Experimental Evidence" by Peter J. Reveen. Three witnesses to a staged armed robbery were hypnotized by Reveen. Their accounts were very detailed, but none agreed with the others and none was close to the actual facts of the event.
Hypnotherapists. While it is true that some hypnotherapists can help some people lose weight, quit smoking, or overcome their fear of flying, it is also true that cognitive-behavioral therapy (CBT) can do the same without any mumbo-jumbo about trance states or brain waves. There have been many scientific studies on the effectiveness of CBT. For example, one systematic study found that CBT improves weight loss in people who are overweight or obese. Another systematic study found that CBT appears to be an effective and acceptable treatment for adult out-patients with chronic fatigue syndrome. Finding high quality scientific evidence for hypnotherapy, however, poses a major problem. As R. Barker Bausell says: hypnosis and the placebo effect are "so heavily reliant upon the effects of suggestion and belief that it would be hard to imagine how a credible placebo control could ever be devised for a hypnotism study" (2007: 268). Even if you could devise a hypnosis study that isolated the role of suggestion and belief, how would you do "fake" hypnosis?
Hypnotherapy is said to be effective for such things as helping people lose weight, quit smoking, or overcome a phobia. Most of the evidence for the effectiveness of hypnotherapy is anecdotal, despite the claims of such groups as the American Society of Clinical Hypnosis (ASCH). Not surprisingly, all the anecdotes are positive! Nobody collects examples of failures or tells the world about their "incomplete successes." If one compares the characteristics of the placebo effect and those of hypnotherapy it is hard to distinguish the difference between these two ducks. Both work because participants believe they work and they occur in a clinical setting where the client is highly motivated for the therapy to work and the provider has all the accoutrements of the healing arts. Suggestion is the heart and soul of both. Hypnosis adds such things as asking the client to relax (important for suggestion to work) or to concentrate on something (which may be completely superfluous).
Some hypnotherapists seem to use CBT in their work and it may well be that the CBT and the placebo effect are what accounts for a success here or there with a highly motivated client.* One practitioner, Ronda Graf, says that most people respond to visual suggestions and imagery. She guides smokers to see themselves as nonsmokers, fat people to see themselves as thin, etc., and gives them "anchors" to reinforce the imagery. For example, she teaches her clients to say to themselves, "Cancel, cancel, cancel, I'm in control," when they're tempted to smoke or go for the cheesecake.* We usually have no way of knowing whether the client could have lost weight or quit smoking without the hypnosis because all we know for sure is that in the past the client tried to lose weight or quit smoking, and she failed; but during the hypnotherapy she lost weight or quit smoking. Since we have nothing to compare it to, we have no way of knowing how much hypnosis contributed to the changed behavior and how much came from the person's strong motivation to change, her belief in the therapy, etc.
To those who say "what difference does it make why something works, as long as it works" I reply that it is likely that there is something that works even better and might even be cheaper or more effective. While many hypnotherapists may be generally reliable, help many clients with some of life's minor problems, and are unlikely to take on cases beyond their expertise, many are going to be quacks. Depending on where they are practicing, their education and training might be minimal and dangerous. People with serious physical or mental issues might seek out one of these quacks for a serious disorder that could be relieved or cured by scientific medicine or therapy. Furthermore:
Patients can become dependent on nonscientific practitioners who employ placebo therapies. Such patients may be led to believe they're suffering from imagined "reactive" hypoglycemia, nonexistent allergies and yeast infections, dental filling amalgam "toxicity," or that they're under the power of qi or extraterrestrials. (The Mysterious Placebo by John E. Dodes, Skeptical Inquirer, Jan/Feb 1997).
In other words, placebo therapies can be an open door to quackery.
science and hypnotherapy
One systematic review of studies on the effectiveness of hypnotherapy for the treatment of irritable bowel syndrome found that the effectiveness "is uncertain." A systematic review of studies on hypnosis and cancer patients found that there have been six randomized control studies in this area. They were evaluated for the effectiveness of hypnosis in treating chemotherapy-induced nausea and vomiting. In five of these studies, the participants were children, a highly suggestible class of subjects. "Meta-analysis revealed a large effect size of hypnotic treatment when compared with treatment as usual, and the effect was at least as large as that of cognitive-behavioural therapy." This is what one would expect if the hypnosis were accompanied by elements of cognitive-behavioral therapy or if both were no more effective than a placebo.
One small study (40 participants) done in 1991 found that hypnotherapy may be useful in relieving symptoms in patients with refractory fibromyalgia.* The study compared hypnotherapy with physical therapy but had no control (not surprisingly!) for the placebo effect.
There is an interesting note on the ASCH website:
Because some hypnosis practitioners have been utilizing EMDR, some persons have felt that it may be related to hypnosis, and some individuals have suggested that it may be more effective than hypnotic techniques.*
Others might note that EMDR uses CBT techniques and takes advantage of the placebo effect, as do some hypnotherapists.
Scientific studies have found out a few things about hypnosis. We know that there is a significant correlation between being able to be absorbed in imaginative activity and being responsive to hypnosis.* We know that those who are fantasy-prone are also likely to make excellent hypnotic subjects. We know that vivid imagery enhances suggestibility. We know that those who think hypnosis is rubbish can’t be hypnotized. We know that hypnotic subjects are not turned into zombies and are not controlled by their hypnotists. We know that hypnosis does not enhance the accuracy of memory in any special way. We know that a person under hypnosis is very suggestible and that memory is easily “filled-in” by the imagination and by suggestions made under hypnosis. We know that confabulation is quite common while under hypnosis and that many states do not allow testimony that has been induced by hypnosis because it is intrinsically unreliable. We know the greatest predictor of hypnotic responsiveness is what a person believes about hypnosis.
We also know that the usual personality traits measured on the typical personality inventory such as the Myers-Briggs or introversion/extraversion scales do not correlate well with hypnotizability:
There are 12 standard tests in the SHSS (Stanford Hypnotic Susceptibility Scale) which measure how well a subject conforms to the behavior of a classically hypnotized person. By these scales, about 5% of people are classically unhypnotizable, most people show moderate scores, and about 10% are hypnotizable to extreme depths and show the classical deep trance phenomena such as somnambulism, visual and auditory hallucinations, and ability to remain deeply in hypnosis with eyes open.
....hypnotizability does not appear to show any obvious correlation with any of the usual personality traits or characteristics. Not only is gullibility not directly correlated, but gender, extraversion/introversion, and neurotic tendencies have also been shown not to correlate well with hypnotizability.*
One of the fathers of modern hypnosis was the 18th century Viennese doctor, Franz Anton Mesmer. Mesmer stumbled on the power of suggestion by a charismatic character over believing clients. In his early career, he used magnets and magnetized objects to do what today's hypnotists do in the showroom and the clinic, and what faith healers do in tents and churches. With Louis XVIs and Marie Antoinette's help, Mesmer set up a Magnetic Institute where he had his patients do such things as sit with their feet in a fountain of magnetized water while holding cables attached to magnetized trees. He quickly learned that he got the same results without the magnetic props. King Louis was not as fond of Mesmer as was his wife. He set up a scientific commission to investigate his claims, one of which was that he could channel "animal magnetism" (his term for the "energy" he claimed he was directing to bring about his cures) into objects like trees, which would then have curative powers. He was later denounced as a fraud by the French medical establishment and by a commission that included Benjamin Franklin that had performed a rather simple but revealing test involving a "magnetized tree" and a blindfolded 12-year-old boy who was overcome by the force of the energy the farther away from it he traveled.*
Something similar seems to happen with techniques like hypnotherapy: the farther one gets from the science, the more powerful the effect of the therapy.
See also acupuncture, alien abduction, altered state, Bloxham tapes, conditioning, exorcism, fantasy-prone personality, homeopathy, memory, mesmerism, Bridey Murphy, New Age therapies, past-life regression, placebo effect, repressed memory, repressed memory therapy, Charles Tart, unconscious mind, and mesmerized by hypnotherapy and Is Hypnotherapy a Con? by R. T. Carroll.
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books and articles
Baker, Robert. "The Aliens Among Us: Hypnotic Regression Revisited," The Skeptical Inquirer, Winter 1987-88.
Harris, Melvin. Investigating the Unexplained (Prometheus Books 2003). Chapters 16-18 concern reincarnation and past-life regression.
Spanos, Nicholas. "Past-life Hypnotic Regression: A Critical View," Skeptical Inquirer 12, no.2 (Winter 1987-88) 174-180.
Thornton, E. M. Hypnotism, Hysteria, and Epilepsy: An Historical Synthesis (London: Heinemann, 1976).
Wilson, Sheryl C., and Theodore X. Barber. (1983). The fantasy-prone personality: Implications for understanding imagery, hypnosis, and parapsychological phenomena. In Imagery, Current Theory, Research and Application, ed. by Anees A. Sheikh, New York: Wiley, pp. 340-390.
The Truth and the Hype of Hypnosis by Michael Nash
A Case of Reincarnation -- Reexamined Joe Nickell (the case of Jenny Cockell)
Cat registered as hypnotherapist Cats in both the UK and the US have been registered as hypnotherapists.
Hypnosis reduces pain perception (This study is too small - only 13 participants - to draw the conclusion that hypnosis reduces pain perception; it measured pain by brain activity rather than by subjective report or objective attempt to self-administer amounts of an analgesic or placebo.)
How hypnosis can color the mind ("This is scientific evidence that something happens in the brain, that doesn't happen ordinarily, when people are hypnotized, said the researcher." Why is this surprising?)
Hypnosis does not help accurate memory recall (Had we forgotten this?)