Circadian Vs. Ultradian Rhythms

Circadian, twenty-four hour, biological rhythms and their influence on organisms are the most studied biological cycle (Estgate & Groome, 2005).  They have been seen as connected to cellular rhythms, information processing in neurology, and mood.  In essence, they relate to the daily cycle of light and darkness, and can be seen the regulation of sleep and waking.  For example, melatonin, the hormone that plays a part in the regulation of sleep, is inhibited by light, and secreted in the evening (Estgate & Groome).  Research has also suggested that in humans, circadian rhythms are also coordinated by an area of the hypothalamus know as the suprachiasmatic nucleus (SNC) (Estgate & Groome).

By contrast, ultradian rhythms are smaller cycles of activity and rest in organisms (Lavie, 1992).  Nathan Kletmann, an psychologist whose career was spent studying biological cycles, is credited with the discovery of ultradian cycles.  Kleitmann stated that Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM) activity in sleeping humans are only a small part of a larger twenty-four hour cycle (Rossi & Lippincott, 1992).  This is known as the Basic Rest to Activity Cycle (BRAC) that plays out through both waking and sleeping life of organisms, and is the pattern of the ultradian cycle (Rossi & Lippincott; Lavie; Rossi, 2002).  In humans, the basic phase of activity takes place over 90-120 minutes.  The rest phase, or low end of the cycle, lasts anywhere from 15-20 minutes (Rossi & Lippincott; Rossi).  The BRAC is a well-studied phenomenon.  Over fifty studies corroborate the BRAC involvement in regulating hormone secretion, reaction time, intensity of visual hallucinations and motor coordination (Orr, Lavie, Gopher & Lavie as cited in Lavie, 1992).

Ultradian Rhythms in Hypnosis

The rest phase of the BRAC is held to be involved in the phenomenon of the afternoon nap and daydreaming.  Jungian analyst and hypnotherapist, Ernest Rossi, theorizes that the BRAC is associated with normal dissociative phenomenon of the “common everyday trance” (Erickson, Rossi & Rossi, 1976; Rossi, 2002).  As opposed to a stable trait theory of hypnotizability, this theory states that all people are hypnotizable, but that one must find the proper point in time for when the patient is ready to enter trance (Erickson, Rossi & Rossi).   Suggestions are altered to fit the personality style of the subject, depending on whether they are amiable to direct or indirect suggestions (Erickson, Rossi & Rossi).  This is also known as the utilization process of hypnosis and psychotherapy, as all “resistance” that a subject displays is accepted and used in the process of induction and ratification of trance (Erickson, Rossi & Rossi).

Rossi discovered the influence of ultradian biological cycles in hypnosis by watching his mentor psychiatrist Milton H. Erickson work with patients. Erickson would usually hold therapy sessions from 90 minutes to two hours, sometimes more (Rossi, 2002).  During the sessions, Erickson would use conversational or, non-invasive/indirect suggestions to direct a patient to work on her issues (Rossi, 2002).  He would watch for subtle, physical cues from the patient: staring off into space, eye-closure, and swallow reflex, all phenomena associated with hypnotic trance (Rossi).  At such moments, Erickson would suggest for the patient to close her eyes and begin the hypnotic work (Rossi).

Rossi later realized that the temporal aspect of Erickson’s sessions matched Kleitmann’s ultradian BRAC (2002).  Somewhere within the 90-120 minutes of the session, the patient would slip into a rest or low phase of activity, and slip in and out of trance, approximately 15-20 minutes at a time (Rossi).  When asked why he chose to work with patients for this length of time, Erickson simply stated that it seemed the right length of time for him to get work done with patients (Rossi).

Current Body of Evidence

Rossi’s ultradian BRAC concept of hypnosis has so far, has only produced a small body of research.  A review of the literature produces five studies published to date related to Rossi’s chronobiological hypothesis of hypnosis.  Four of them give evidence of chronobiological rhythms involved in hypnosis.

Aldrich & Bernstein (1987) tested a total of 1103 subjects at the University of Illinois for correlations in circadian BRAC rhythms, body temperature and hypnotizability.  A tape was made of an initial session and used at later sessions for a standardized induction.  The Harvard Group Scale of Hypnotic Susceptibility: Form A (HGSHS: A) was administered before the induction, along with a questionnaire concerning activities, such as exercise and eating, that may effect current body temperature.  The inductions were carried out at hourly intervals.  Each participant was hypnotized only once.

Results suggested a positive correlation between times of day, body temperature and hypnotic suggestibility, suggesting that any trait related to hypnotizability is not constant.  The average times for heightened hypnotizability were 12:00 PM, with a cascading drop to a low period of hypnotizability at 2:00 PM, and another high plateau between 5:00 and 6:00 PM (p. 143, Aldrich & Bernstein, 1987) By this standard, the best time for treating a patient with hypnosis that would evoke deep trance phenomenon would be between the hours of 11:00 AM and 1PM, and between 3:00M and 6:00 PM, those being the best circadian points wherein to find ultradian rest cycles to initiate the process.

Sommers (1993) tested 32 subjects with the Barber-Wilson Creative-Imagination Scale (CIS).  These subjects participated in two, two-hour sessions.  In theory, naturalistic trance states would appear at some point within the two hours.  When a subject showed signs of eye fixation and catalepsy, Sommers initiated a non-invasive induction, and a general suggestion to resolve an inner issue via their unconscious minds.  The trance state was timed as starting with eye closure.  Sommers remained quiet during the interim and gave no further suggestions.  Testing for time distortion was accepted a measure of hypnotic depth.

Sommers reports the average mean time for the subjects was 18.06 minutes for the first session and 17.50 for the second, well within the hypothesized 12-20 minutes, and no significant deviation.  Sommers concludes that her statistical analysis of the data “supports the premise that subjects will remain in a natural trance for an average of 15-20 minutes regardless of hypnotizability scores, age, sex, or previous hypnosis experience” (p. 140, 1993).

Rossi & Lippincott (1993) performed two studies, similar in form.  Rossi culled thirty clients from his private practice for his study.  They were, as in Sommer’s study, tested for suggestibility with the CIS.  A typical therapeutic hour was replaced by a 90-120 minute session to give the client enough time to enter a naturalistic trance.  When the client displayed signs of eye fixation or catalepsy, Rossi performed an ideodynamic induction procedure.  Trance was considered to begin with eye closure and end with eye opening.  Depth of trance was determined by asking the patient what their experience was like.   The entire procedure was conducted twice over a two-week period with each subject to confer results.

Lippincott created a variation on the first study with 42 volunteers.  They were told they were taking part in an experiment in the clinical use of hypnosis.  The Spiegel Hypnotic Induction Profile (HIP) was used to test subject suggestibility. Lippincott attempted to reduce context variables from influencing the patients.  A taped induction was utilized to make the procedure standardized across the subjects, and the experimenter left to room to observe them from a partially draped window and recorded length of trance.  Only one session was given (Rossi & Lippincott, 1993).

In Rossi’s study, mean time for trance was 19.40 minutes the first session, and 20.23 the second session.  Lippincott’s remained in trance an average of 18.69 minutes.  Thus, both studies point to the 20 minute time-frame suggested by the BRAC.

Wallace (1994) and Mann & Sanders (1995) both studied correlations between Kleitman’s BRAC and hypnotizablity in subjects who reported being more active either at day or night.  Wallace’s study was a variation on Aldrich & Bernstein’s 1987 study.  Both the HGSHS: A and the Stanford Hypnotic Susceptibility Scale, Form C (SHSS: C) were applied to 60 individuals.  The use of the two scales was to account for both within-group and within-subject variability. The findings suggest a difference in day and night people.  The length of the study went past the original study’s 8:00 AM to 8:00 PM time period to 8:00 to 10:00 PM to encompass the different wake cycles of the two groups.  Wallace states that although the study shows variability in hypnotizability and time of day, members of the day group, or “larks” peaked in hypnotizability at 10:00 AM and 2:00 PM; “night owls” peaked at 1:00 PM and peaked and displayed a constant high level between 6:00 and 8:00 PM.  Within-subject testing showed little variability, and could therefore not account for ultradian rhythms.

Mann & Sanders, also seeking to test Aldrich and Bernstein’s findings, discovered a similar correlation of levels of hypnotizability in larks and night owl groups at earlier and later times of day.  This is consistent with Wallace’s study, yet the authors contend that the findings are inconsistent with Rossi’s hypothesis.  The authors also relate that subjects who experienced a 15 minute trance period reported greater depth of trance (1995).  Sommers (1993) and Rossi & Lippincott  (1993), however, note that high hypnotizables in their studies experienced less time in natural trance than lows, but experienced more classical hypnotic phenomena.  Mann & Sander’s study does not incorporate any of the data from the 1993 studies of Wallace, Sommers or Lippincott work, though it was published two years later (p. 43).

Conclusion

From this small body of research, one can see that there is some evidence indicating to validity of Rossi’s theory, that trance phenomenon is naturally occurring, varies slightly across times of the day.  The studies also appear to lend support for Kleitmann’s original premise.  Rossi has also theorized that the BRAC plays a major part in genetic expression and neural growth, and may have further implications for psychotherapy as a whole (Rossi, 2002).

Perhaps it may be worthwhile to study the effect ultradian cycles on rapport, insight and catharsis, across all therapeutic modalities.  Would extending therapeutic sessions to two hours have a positive correlation with outcome?  Would patients report more rapport and self-efficacy within this type of session format?  This is now merely speculation, but perhaps, with the growth in the study and practice of mind-body therapies,  biological rhythms will one day be seen as an important aspect of the healing processes of medicine and psychotherapy.

References

Aldrich, K.J. & Bernstein, D.A. (1987).  The effect of time of day on hypnotizability: A brief communication. The International Journal of Clinical and Experimental Hypnosis. 35 (3), 141-145.

Erickson, M. H., Rossi, E., Rossi, S. (1976).  Hypnotic realities. New York: Irvington Publishers

Estgate, A, & Groome, S. (2005).  Introduction to applied cognitive psychology. NewYork: Psychology Press.

Lavie, P. (1993).  Ultradian cycles in sleep propensity, or, kleitmann’s brac revisited. In Lloyd, D. & Rossi, E. (Eds.) Ultradian Rhythms in Life Processes:  A Fundamental Inquiry into Chronobiology and Psychobiology (pp. 284-302). New York: Springer-Verlag.

Mann, B.J. & Sanders, S. (1995). The effects f light, temperature, trance length, and time of day on hypnotic depth.  The American Journal of Clinical Hypnosis, 37(3), 43-53.

Rossi, E, & Lippincott, B. (1992).  The wave nature of consciousness and being: Ultradian rhythms in mind-body communication. In Lloyd, D. & Rossi, E. (Eds.) Ultradian Rhythms in Life Processes:  A Fundamental Inquiry into Chronobiology and Psychobiology (pp. 371-402. New York: Springer-Verlag.

Rossi, E. & Lippincott, B.M. (1993).  A clinical-experimental exploration of erickson’s naturalistic approach.  Hypnos, 20 (1), 10-20.

Rossi, E. (2002). The psychobiology of gene expression. New York:  W.W. Norton.

Sommers, C. (1993).  Ultradian rhythms in common everyday trance.  Hypno, 20(3), 135-144.

Wallace, B. (1993). Day persons, night persons, and variability in hypnotic susceptibility. Journal of Personality and Social Psychology, 64 (5), 827-833.

Summary

This article takes on several tasks; it reviews the theoretical and experimental basis of empirical studies, gives a history and background of evidence-based practice, delineates both process and content studies, reviews the latest evidence for efficacy of hypnosis with treatment of various presenting issues, and gives suggestions for further studies within the field.  The pros and cons of evidence-based therapies are given equal weight, with the importance of balancing the art of therapy and hypnosis with evidence for both efficacy and effectiveness.

The authors begin with a discussion of the movement from theory driven practice, which was at its height in the 1960s, toward an empirical basis in the 1990s. This trend has not been without controversy.  The main arguments against have been that practice of therapy is a messy procedure, and that the rigidness of manualized treatment can never be replicated in the real world.  Other factors, such as the impact of the clinician on the patient, the therapeutic relationship itself and the personal “intricacies of clinical judgment in the empirical evaluation of treatments” are also part of the debate (p. 118).  Yet the obvious support raised in some circles is that manualized treatments can assure consumers receive treatment has been found efficacious.

Evidence-based treatments of hypnosis for several disorders are cataloged, with mixed results found.  Content (efficacy) versus process (effectiveness) types of research are examined for furthering evidence-based practice in hypnosis.  The authors give further indications for the development of empirical research and practice for hypnotherapy.

Key Points

Alladin et al review research of hypnosis in six areas: clinical hypnosis with children, analgesia, hypnosis as an adjunct to CBT, hypnosis and medicine, smoking cessation, and PTSD.  Child and adolescent studies are abundant in case studies, but little in the way of randomized clinical trials.  A meta-analysis of 18 articles and 28 effect sizes for hypnotic analgesia yielded evidence that “hypnosis can be considered a well-established treatment for pain,” and assuring its place as primary method of treatment.  CBT and adjunctive hypnosis studies were positive, yet problematic in that they did not match the gold standards of the APA.  Medical interventions for such issues as dermatological disorders and irritable bowel syndrome, also have supporting evidence, but it has not been clearly determined whether hypnosis is the main effect involved.  Smoking cessation has mixed results, leading some to claim that hypnosis “as a ‘possibly efficacious treatment for smoking cessation,” with the need for improved research. PTSD treatment with hypnosis, as of this publication, lacked any strong, systematic studies.

The authors spend a great deal of the article covering the background of evidence-based practice.  Criticisms are aired over the APA’s establishment of empirical studies, Wampold, a major proponent of Rosenweig’s dodo bird effect, argued that the APA task force used an incorrect method of establishing it’s list.  According to the dodo bird verdict, all psychotherapies work equally well, with negligible differences between them.  Thus the task force would have better created the list of empirical studies by adding all bona fide treatments and removing those that did not meet empirical standards.  Other arguments include the fact that some therapies have more experimental support than others, and thus were chosen for the list (CBT and behavior therapies which are more conducive to studies by their nature), and statistical power differs between studies, making some therapies appear better suited for the APA list (p. 117).

Alladin et al note that the APA released a report on clinical expertise, adding eight elements of the individual therapist to the mix of evidence-based practice.  The authors liken this to a quote from Wittgenstein, wherein he “stated that it impressed him very little when a man states he owns a trapeze artist’s suit: he would wait to see how he puts it to use” (p. 124). That is to say just because a treatment meets APA gold standards, does not place it with the context of usefulness or adaptableness for practice, or with use by all practitioners.

The implications of evidence-based hypnotherapy practice are examined, particularly with regard to content versus process variables.  Content variables look at efficacy, and can assist hypnotherapists from falling into romantic delusions or theoretical bias regarding their practice.  Process variables are of great assistance for hypnosis practice and research as they can focus on rapport, and therapist and client variables involved in treatment (p.125). The authors conclude that evidence-based practice is important for hypnosis, and that that it will generally help to increase the validity of this treatment method.

Critique

Having been trained in, and used hypnosis with patients; I found this article extremely interesting.  It also shook some of my current biases, such as the use of hypnosis for smoking cessation, which is generally recognized as a well-established treatment for this area.  Further debate over this has continued, but hypnosis is still considered more efficacious than other treatments due to it short term, and slighter costs (Mendoza & Capafons, 2009).  The literature review was not as inclusive as it could have been. More current publications list a plethora of other medical, and anxiety and mood disorders for which hypnotherapy has been judged a worthy treatment (Mendoza & Capafons; Barabasz, Olness, Boland, Kahn, 2010).  I was also surprised that they did not include weight loss among the list, another standard area for hypnosis practice.  However, the authors attempted to cover evidence-based practice as a whole, while making suggestions for the future of hypnosis within APA standards of practice.  This was no small undertaking, and they largely succeed.

There are several areas within which a manger or supervisor may need to address when supervising hypnotherapists with APA gold standards in mind.  First, the article points out what can be problematic for many practitioners; the difference between theory driven and research drive practice.  Whether the APA likes I or not, the bulk of psychotherapist are trained, usually in three of the four hundred-plus, possible psychotherapy orientations–psychodynamic, humanistic and cognitive-behavioral.   Thus, they lead theoretically, and case-conceptualize in this manner, not based on evidence for efficacy or effectiveness, but on personal attraction to the orientation.  Reversion to “romantic notions” of psychotherapy, or a “my school is better than the other one” attitude is likely to be encountered in many therapists.  The problem for the therapist, and for a manager or supervisor would be to be able to integrate the manualized procedure into practice.  Where world the original practice end and the manualized treatment begin?  How would the integration change the treatment, and would it still be considered the same treatment after the integration?

The authors do not cover the individual differences in hypnotherapy practice, not to mention schools of hypnotherapy.  One must consider that there is not one operational definition of hypnosis.  What actually constitutes this elusive practice is still up for debate.  Thus, the manualized treatment must be specific to the hypnotherapeutic school and its definition and practice of hypnosis.  Mixing this with a practitioner with another orientation may confound results if viewed through the lens of process research.  It may give pause to consult with the therapist after reading the journal reviews of the manualized treatments.

To conclude, Alladin, et al cover a great deal of ground, and manage to create more room for debate within the field of evidence-based psychotherapy.  Light is shed on which hypnotherapy interventions to proceed with in practice, though the list is by no means complete.   However, since the article manages to place hypnosis squarely in the larger picture, I recommend it as a primer for any psychologist in a clinical supervisory position.

References

Barabasz, A. F., Olness, K., Boland, R., & Kahn, S. (2010).  Medical hypnosis primer: Clinical and research evidence. New York: Routledge.

Mendoza, M.E. & Capafons, A. (2009).  Efficacy of clinical hypnosis: a summary of its empirical evidence. Papeles del Psicologo, 30 (2), 98-116.

Hypnosis and Creativity Research

Operational definitions of creativity vary between researchers (Shames & Bowers, 1992; Weisberg, 2006).  Essentially, four areas, as espoused by Rhodes, are emphasized: product, process, person and press (as cited in in Shames & Bowers).   Process is the internal, subjective experience of the creator, and is emphasized in hypnosis and creativity research (Shames & Bowers).  Why single out process only? Much of the theory of hypnosis and creativity has been an extension of the psychoanalytic theories of personality (Lynn & Sivec, 1992; Shames & Bowers).  The idea of regression is considered both an element of psychoanalytic theory and hypnosis (Bowers, 1967; Shames & Bowers).

Regression involves a defensive state that is fixated in a past event or period of personal psychological development (Bowers, 1967; Shames & Bowers, 1992).   Two levels of mental process are referred to —secondary process, the logical, critical mind, and primary process, the child-like, illogical, dreaming or fantasy based mental state (Bower; Shames & Bowers).What do these processes have to do with regression Regression functions as a defense mechanism when considered in terms of pathology, but within the realm of creativity or hypnosis, it is considered to be “in the service of the ego” (Kris, 1953 as quoted in Bowers, 1979; Bowers, 1967; Shames & Bowers).

Kris…proposed that notion of “regression in the service of the ego.” Creativity, for instance, is termed an “adaptive regression” because it represents a healthy, constructive letting go, accompanied by an increase in primary-process thinking (Shames & Bowers, 1992, p. 339).

It is hypothesized that the link between creativity and hypnosis is they that are both adaptations of primary process. But whereas in hypnosis there is generally less control on the part of the subject, in the creative process, an individual does not lose control (Gruenwald, Fromm, Oberlander as cited in Shames & Bowers, 1992).

Research demonstrates a correlation between creativity and hypnosis (Lynn & Sivec, 1992; Shames & Bowers, 1992).  Unfortunately,there is heterogeneity of definitions for both terms, as well as the measures used to rate them due largely to the all-encompassing quality of the terms (Lynn & Sivec).  A 1967 study examined the effects of hypnosis and suggestions of reduced defensiveness on creativity test performance (Bowers). Four hundred and fifty university students were administered the Harvard Group Scale of Hypnotic Susceptibility (HGSHS) Form A (Bowers, 1967).  Random assignment to four groups was given to those who reached a criterion score of seven (N=80, n=20) (Bowers). They included two waking relaxed groups, receiving either Cognitive Set (WCS) instructions or Defensiveness-reducing instructions (WDR) and two groups of Hypnosis, again with either Cognitive Set (HCS) or Defensiveness-reducing suggestions (HRD) (Bowers).

The subjects were also administered a “creativity battery” based on four measures devised by Guilford and a control battery of the Minnesota Clerical Test was used because score would likely not be affected by reduced defensiveness.  Results showed significantly higher scores of originality in task performance by the hypnotic groups (HRD, HCS) than in the relaxed-waking group (Bowers, 1967).  Bowers stated that this indicates, “that hypnotic conditions can increase divergent thinking above its level under circumstances thought to be quite favorable to creativity, i.e. relaxed, motivated Ss with instruction to be clever and creative” (Bowers, 1976, p. 318-319).  Thus, there was evidence that hypnosis is a distinct state or process aside from a normal level of relaxation.

Other studies have found significant correlations between measures of creativity and hypnosis.  In a 1971 study by Bowers and van der Muelen, high and low hypnotizable subjects were administered three creativity measures (Shames & Bowers, 1992).  High subjects produced significantly higher scores on eight of nine items (Shames & Bowers).

Lynn and Rhue (1986) administered scales of absorption, hypnotic susceptibility, responsiveness to waking and suggestion, childhood imagining and creativity to 62 university students (30 males, 32 females, median age 19.1 yrs).  Individuals were separated into groups of fantasizers, medium fantasy prones, and nonfantasizers based on scores on the Inventory of Childhood Memories and Imaginings (Lynn & Rhue, 1986).  Those who had tested high for fantasy proneness displayed higher scores on absorption, hypnotic responsiveness, response to waking suggestion, vividness of mental imagery, and creativity than those in the other groups (Lynn & Rhue).  This supports the authors’ definition of hypnosis as a process of “goal directed fantasy,” which will be explored later (Lynne & Sivec 1992).

Another study of 32 university students with an equal number high and low hypnotizables yielded moderate results of correlations between hypnotizability and effortless experiencing and creativity (Bowers, 1978, p. 195).  The subjects, pooled from university volunteers who were administered the Harvard Group Scale of Hypnotic Susceptibility, form A (HGHS:A), were assigned to  high (n = 16, 8 male, 8 female), and low hypnotizable (n = 16, 8 male, 8 female) groups.  They were administered composite indices of vividness of imagery, effortless experiencing, creativity and an absorption questionnaire. The administration was done blind to group placement, as they were previously tested for hypnotizability by other colleagues.  (Bowers, p. 192).

The most significant correlations were between effortless experiencing and hypnotizability, 61 (p < .001) and creativity, .62 (p < .001) (Bowers, 1978, p.196). The ANOVA yielded no significant results for gender across any of the dependent variables.

A comprehensive review of the literature yields several main findings.  The correlation between hypnotizability and creativity are consistent, but tend to be moderate in most studies (Lynn & Sivec, 1992).  This correlation is seen throughout a sizable volume of research that measures traits across measures of  “hypnosis, imagination, fantasy and daydreaming” (Lynn & Sivec, p.332).  Findings also account for an automatic, or spontaneous, unconscious aspect in both creative and hypnotic scenarios (Lynne & Sivec).

Two Major Theories

Effortless Experiencing

One of the leading proponents of hypnosis and creativity research is Patricia Bowers.  Bowers attempted to synthesize both psychoanalytic and cognitive theory regarding creativity and hypnosis (Shames & Bowers, 1992).  Secondary process is considered analogous to active thinking; the effortful, strategic thinking that is goal directed and primarily ruled by language (Shames & Bowers).  Primary process thinking is considered to be more involuntary, and is termed as effortless experiencing (Shames & Bowers).  It is primarily more involved with imagery, and, in cognitive terms, is more oriented to associational networks (Shames & Bower).  The act of shifting between types of process is the cognitive element in this conceptualization (Shames & Bowers).  For Bowers, effortless experiencing is the bridge between creativity and hypnosis as it is considered the foundation of both.

The creative individual resembles the highly hypnotizable subject in that both have a greater than normal capacity for transition from an active to a passive mode of thinking…the creative process “requires a person who can allow an idea or object to influence associations and responses while bypassing temporarily the ordinary, ego-controlling, intentional processes (Shames & Bowers, 1992, p. 352).

This may be reflected in other studies that show that the ability to shift focus and flexibility in processing is what defines the creative individual (Vartanian, 2006).

Goal-Directed Fantasy

In contrast, but not altogether dissimilar to effortless experiencing, Lynn and Sivec posit that hypnosis is more of a form of goal-directed fantasy (1992).  The authors suggest the hypnotizable subject is a creative problem-solving agent.  Yet they discern more effort to be involved on the part of the subject than Bowers (Lynn & Sivec).  Highly hypnotizable subjects are described as more fantasy prone, an assumption that is based on the work of Spanos (Lynne & Sivec).  According to this hypothesis, a subject recognizes his or her responses to suggestions as involuntary while they are involved in the goal-directed fantasy (Lynne & Sivec).  An example of a goal-directed fantasy can be the imagery of a hot air balloon tethered to a subject’s thumb to elicit arm levitation (Lynne & Sivec).

Highly hypnotizable individuals are cited as generally better able to handle multiple problem-solving tasks (Sacuzzo, Safram, Anderson & Mcneill, 1982, as cited by Lynn & Rhue, 1992).  Thus, the hypnotizable person is considered a creative problem-solver.  Lynn and Sivec do not discount the automatic quality of Bower’s definition.  Instead, they state that much of cognitive processing takes place beneath awareness, and is not necessarily caused by a particular state (Lynn & Sivec, p. 333).  It appears that the main difference between the two theories is that Bowers defines hypnosis as a state, while Lynn and Sivec emphasize the socio-cognitive elements of expectancy and suggestion.

Hypnosis and Creativity Enhancement

Hypnosis and creativity research is not limited to the search for correlations and definitions.  Some researchers argue that there are no significant findings that hypnosis can enhance creativity outside of the hypnotic setting (Lynn & Sivec, 1992).   Others indicate there are studies of hypnotic creative enhancement that involve objective measures, such as the Torrance Tests of Creative Thinking, but nothing that involves practical application outside of the experimental setting (Shames & Bowers, 1992), Nonetheless, a small body of literature, though not altogether scientifically robust, that points to the use of hypnosis for the enhancement for creative activities.

A case study involving the use of Ego State Therapy hypnosis to enhance creativity in a 26-year old singer produced results that helped to resolve stage fright and assisted the subject in song writing (Perri, 2003).  The client reported that he had recently stopped using drugs, and benefited from abstinence, but had also noticed a decrease in song writing and an increase in stage fright (Perri).
Two sessions were used.  The first introduced the subject to hypnotherapy, and the therapist suggested the client elicit the “creative part” of himself (Perri).  The client was then able to create lyrics to a song, “different from any other work he had produced” (Perri, p. 84).  A second session involved the post-hypnotic suggestions for accessing the same part during a performance to provide relief for stage fright (Perri). The subject reported afterwards that he, “felt the presence of this part, and was able to express himself more fully” (Perri, p. 84).  No further follow-up was reported in this study.

A 1976 study attempted to answer the question, “ is it possible to enable an artist to paint or sketch better after the having received hypnotic treatment with post-hypnotic suggestions than without such an influence?” (Mellegren, 1976).  Seventeen patients, ages 29-62, from the author’s practice, were selected on the basis of their work as visual artists, specifically as painters or sketchers Most of them were experiencing anxiety that accompanied a creative block The subjects were not tested for hypnotizability, but had been hypnotized several times as part of therapy, and were not adverse to the process.

The procedure involved having the patient sketch an object).   The patient was then hypnotized and given the suggestions to “feel calmer, more self-confident, and…received (sic) a certain inspiration…feel a joy in sketching” (Mellegren, 1976).  The patients were re-oriented and engaged in casual conversation for fifteen minutes Three of the patients made up another experimental group that received the same procedure, but were given negative suggestions regarding the sketching activity The results of the negative suggestions were that “two of the sketchers drew a few lines, threw the pencil away, and thereafter thoroughly abused me” (Mellegren, p.134).  The third patient did not attempt to draw, but apparently became angry with the author.

Blind ratings by three established artists indicated that there was a marked improvement in the sketches after hypnosis in thirteen of the seventeen patients Mellegren notes that the three who did not show any improvement were not in treatment for anxiety related to a creative block, but were suffering from somatic symptoms (1976).

Barrios and Singer (1981) initiated a study of 48-eight volunteers who reported creative blocks in artistic, scientific, literary and professional projects. Subjects were randomly assigned to four conditions—waking imagery, hypnotic dreaming, rational discussion, and a control group that just allowed the subjects to discuss their problem. A follow-up satisfaction questionnaire delivered a week after treatment showed waking imagery and hypnotic dreaming groups were deemed, “most effective in promoting resolution of creative blocks” The hypnotic dreaming group was given suggestions without the use of the word hypnosis, an attempt to reduce expectancy effects Both the waking imagery and hypnotic dreaming groups were administered a video taped version of the HGSHS a week prior to or after the treatment.  Both of these precautions were taken as to avoid contamination of the subjects during treatment (Barrios & Singer).

The use of hypnosis as an adjunct to dramatic direction was explored in three studies reported by Keith Fowler (1988). Fowler designed a technique combining Michael Checkhov’s Centering technique with hypnotic inductions (Fowler). The Centering technique involves visualizations to “center” the actor for role development and sense training (Fowler).  In three experiments, Fowler worked with student actors to provide them with an “effective technique for dramatic characterization”  (Fowler).  One of the studies employed outside judges (university drama professors) to rate character development (Fowler).  All ten subjects were considered to have “shown aspects of personality never seen in performance before” (Fowler, p. 254).

According to Fowler, results “suggest that in 25 of 26 acting students (aged 18+ years), hypnosis may have facilitated Ss’ apparent adoption of new personae” (Fowler, 1988, p. 249).  Details of the study indicate that the use of hypnosis with highly hypnotizable actors can have significant results, and that precautions should be taken with these subjects.

…we experimented with various techniques, including one in which I used hypnosis to induce trance in a highly hypnotizable actor who was working on the role of Medea.  I naively instructed her to hallucinate that the rehearsal studio was a Greek palace and that her fellow actor was Jason.  What followed was terrifying. She shrieked with grief, then in rage tore open a door and threw a chair at the other actor.  Luckily, she missed, and I had time to signal her out of trance.  This episode taught us that broad, clumsy instruction…is utterly useless from an artistic point of view  (Fowler, 1988, p. 251).

Though Fowler’s work was promising, apparently little research was followed in this area.  An extensive literature review specific to acting and hypnosis produced only this article.

Similar to Perri & Fowler’s work is the Raikov’s use of identification with an imagined expert to enhance creativity (Raikov, 1992).  Artists and musicians were asked to “step into the skin” of the likes of Rembrandt, Horowitz or Rachmaninov and others (Raikov).  Riakov describes his experiments as successful in enhancing creative behavior and performances post-hypnotically (Raikov).

Council, Bromley, Zabelina, and Waters (2007) studied the use of hypnosis to enhance creativity in the process of drawing in sixty-three university subjects.  The subjects were chosen for artistic or hypnotic ability and were separated into groups who were administered hypnosis or task-motivational instructions (Council, et al).  The subjects created two still life drawings, one used as baseline measure of ability, and one after the treatment was induced (Council, et al).   Objective judges, two university art professors and one art and psychology major, rated the drawings based on an objective measure created by the second author, that was tested for reliability (Council, et al).  The results suggest that the hypnotic procedure was “significantly more effective” than the nonhypnotic procedure (Council, et al).  The authors note that their experiment differed from past studies in that subjects did not employ a standardized procedure, but were given the open ended task of creating a drawing (Council et al).  The authors compare their work to the studies of Getzles and Csikzentmihalyi in that they used an objective rating of the products (Council et al).

Conclusion

The study of hypnosis and creativity has generated a significant body of research, yielding a consistent, moderate level of correlation, overall, between the two.  A small but intriguing body of research has been done in the area of hypnotic enhancement of creativity.  Unfortunately, there has been little added to the literature since the reviews of Shames and Bowers, and Lynn and Sivec of 1992  (Council, Bromley, Zabelina, & Waters, 2007).

It has been noted that while hypnosis and creativity research has dwindled, creativity studies have come to the fore in Positive Psychology (Council, et al, 2007).  It is hoped by this author that creativity and hypnosis research can be revived and be expanded upon, especially in the area of practical application of hypnosis and the enhancement of creativity.  Perhaps elements of more psychometrically rigorous correlational studies could be combined with those of creativity enhancement, to produce results that are considered more scientifically sound.  The results may not just prove fruitful to those in the creative professions, but may ultimately produce techniques that could be applied to other fields, and for the enhancement of everyday activities.

References

Barrios, M.V., & Singer, J.L. (1981).  The treatment of creative block: A comparison study of waking imagery, hypnotic dream, and rational discussion techniques. Imagination, Cognition, and Personality, 1(1), 89-109.

Bowers, P.G.  (1967).  Effect of hypnosis and suggestions of reduced defensiveness on creativity test performance.  Journal of Personality, 35, 311-322.

Bowers, P. (1978).  Hypnotizability, creativity and the role of effortless experiencing.  The International Journal of Clinical and Experimental Hypnosis, 26 (3), 184-202.

Bowers, P. (1979).  Hypnosis and creativity: The search for the missing link. Journal of Abnormal Psychology, 88(8), 364-372.

Council, J.R., Bromley, K.A., Zabelina, D.L., &Waters, C.G. (2007). Hypnotic enhancement of creative drawing. The International Journal of Clinical and Experimental Hypnosis, 55 (4), 467-485.

Fowler, K. (1988). Hypnotic transformation–three studies of theatrical role playing: A brief communication. The International Journal of Clinical and Experimental Hypnosis, 36 (4), 249-255.

Lynn, S, J. & Rhue, J.W. (1986).  The fantasy-prone person: Hypnosis, imagination, and creativity.  Journal of personality and Social Psychology, 51 (2), 404-408.

Lynn, S. J.,  & Sivec, H. (1992). Hypnotizable subject as creative problem-solving agent. From: Fromm, E. & Nash, M. R. (Eds.), Contemporary hypnosis research, (pp.292-333). New York: The Guilford Press.

Mellegren, A. (1976).  Hypnosis and artistic creation.  Journal of the American Society of Psychosomatic Dentistry and Medicine, 23(4), 133-135.

Perri, F. B. (2003).  An investigation into the use of ego state therapy in enhancing creative output.  The Australian Journal of Clinical Hypnotherapy and Hypnosis, 24 (2), 77-87.

Raikov. V.L. (1992).  Hypnosis as an active creative act and posthypnotic development of enhanced creativity. Journal of Creative Behavior, 26 (3), 148-155.

Shames, V.A. Bowers, P. G. (1992). Hypnosis and creativity, From: Fromm, E., & Nash, M. R. (Eds.), Contemporary hypnosis research. (pp. 334-363). New York: The Guilford Press

Vartanian, O. (2006).  Variable attention facilitates creative problem solving. Psychology Of Aesthetics, Creativity, and the Arts. 3 (1), 57-59.

Weisberg, R. W. (2006). Creativity: Understanding innovation in problem solving, science, invention, and the arts.  Hoboken, New Jersey: John Wiley & Sons.

The researchers administered the Waterloo-Stanford Group Scale of Hypnotic Susceptibility (Form C), the Dissociative Experiences Scale (normed for non-clinical populations), and a series of cognitive inhibition tasks to 180 study participants. They conclude, decisively, that “the data ruled out even moderate correlations between hypnotic suggestibility and all the measures of dissociation and cognitive inhibition.”

The implications of these findings are uncertain. After all, the idea that hypnotizability exists as a biological or personality trait at all is controversial. From the perspective of those therapists who suspect that everyone is susceptible to some form of hypnotic experience, it is unsurprising that investigations into hypnotic ability should lead to unpredictable and ultimately meaningless results.

But even if we assume the validity of hypnotic susceptibility as an individual trait, then these findings are of questionable value. With regard to dissociation, this study’s findings are not new. Many conflicting studies have found varying levels of relationship between hypnosis and dissociation, which are now generally considered to be related but separate phenomena.

The study’s findings on cognitive inhibition are interesting, but without the use of a reliable measure of inhibitory cognitive control little can be said other than more research in this area may be warranted.

Citation:  Dienes, Z., Brown, E., Hutton, S., Kirsch, I., Mazzoni, G., & Wright, D.B. (2009) Hypnotic suggestibility, cognitive inhibition, and dissociation. Consciousness And Cognition.