Editing Hypnosis (section)

== State vs. nonstate ==
The central theoretical disagreement regarding hypnosis 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.{{citation needed|date=September 2014}}

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 ([[Theodore R. Sarbin|Sarbin]]), active imagination and positive cognitive set ([[Theodore X. Barber|Barber]]), response expectancy (Kirsch), and the active use of task-specific subjective strategies ([[Nicholas Spanos|Spanos]]). The personality psychologist Robert White is often cited as providing one of the first nonstate definitions of hypnosis in a 1941 article:

{{blockquote|text=
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.<ref>{{cite journal|author=White, R.W.|title=A preface to the theory of hypnotism|journal= Journal of Abnormal Psychology|volume=36|pages= 477–505|year= 1941|doi=10.1037/h0053844|issue=4}}</ref>
}}

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.<ref>{{Cite journal |last1=Hasegawa |first1=Harutomo |last2=Jamieson |first2=Graham A. |date=September 2002 |title=Conceptual issues in hypnosis research: explanations, definitions and the state/non-state debate |url=https://onlinelibrary.wiley.com/doi/10.1002/ch.247 |journal=Contemporary Hypnosis |language=en |volume=19 |issue=3 |pages=103–117 |doi=10.1002/ch.247 |issn=0960-5290 |access-date=11 January 2023 |archive-date=11 January 2023 |archive-url=https://web.archive.org/web/20230111191759/https://onlinelibrary.wiley.com/doi/10.1002/ch.247 |url-status=live }}</ref><ref>{{Cite web |title=Theories of Hypnosis {{!}} Hypnosis And Suggestion |url=https://hypnosisandsuggestion.org/theories-of-hypnosis.html |access-date=2022-06-24 |website=hypnosisandsuggestion.org |archive-date=18 June 2022 |archive-url=https://web.archive.org/web/20220618145423/https://hypnosisandsuggestion.org//theories-of-hypnosis.html |url-status=live }}</ref>{{self-published inline|date=June 2022}}

=== 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. In 1933, [[Clark L. Hull]] wrote:

{{blockquote|text= 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.<ref>{{cite book|author=Clark Leonard Hull|title=Hypnosis and suggestibility: an experimental approach|url=https://books.google.com/books?id=CknOAAAAMAAJ|access-date=30 October 2011|year=1933|publisher=D. Appleton-Century company|page=392|archive-date=2 July 2023|archive-url=https://web.archive.org/web/20230702163810/https://books.google.com/books?id=CknOAAAAMAAJ|url-status=live}}</ref>
}}

=== 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:

{{blockquote|text=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.<ref>Pavlov, quoted in Salter, ''What is Hypnosis''?, 1944: 23</ref>}}

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.<ref name="Pavlov">{{cite book | vauthors = Pavlov IP |title=''Experimental Psychology'' |location=New York |publisher=Philosophical Library |year=1957}}{{Page needed|date=September 2010}}</ref><ref>{{cite journal | vauthors = Barker W, Burgwin S | title = Brain wave patterns accompanying changes in sleep and wakefulness during hypnosis | journal = Psychosomatic Medicine | volume = 10 | issue = 6 | pages = 317–26 | year = 1948 | pmid = 18106841 | doi = 10.1097/00006842-194811000-00002 | s2cid = 31249127 }}</ref>

Pavlov's ideas combined with those of his rival [[Vladimir 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 (psychologist)|Andrew Salter]].

=== Neuropsychology ===
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.<ref>{{cite journal | vauthors = Raz A, Fan J, Posner MI | title = Hypnotic suggestion reduces conflict in the human brain | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 102 | issue = 28 | pages = 9978–83 | date = July 2005 | pmid = 15994228 | pmc = 1174993 | doi = 10.1073/pnas.0503064102 | bibcode = 2005PNAS..102.9978R| doi-access = free }}</ref><ref>{{cite journal | vauthors = Derbyshire SW, Whalley MG, Stenger VA, Oakley DA | title = Cerebral activation during hypnotically induced and imagined pain | journal = NeuroImage | volume = 23 | issue = 1 | pages = 392–401 | date = September 2004 | pmid = 15325387 | doi = 10.1016/j.neuroimage.2004.04.033 | s2cid = 16786564}}</ref> The state of light to medium hypnosis, where the body undergoes physical and mental relaxation, is associated with a pattern mostly of alpha waves.<ref>London College of Clinical Hypnosis. "What is Clinical Hypnosis?" [https://web.archive.org/web/20051101055303/http://www.lcch.co.uk/hypnotherapy.htm] . Accessed 14 September 2013</ref>{{Better source needed|date=September 2021}} 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.<ref>{{cite journal | vauthors = Grossman ED, Blake R | title = Brain activity evoked by inverted and imagined biological motion | journal = Vision Research | volume = 41 | issue = 10–11 | pages = 1475–82 | year = 2001 | pmid = 11322987 | doi = 10.1016/S0042-6989(00)00317-5 | s2cid = 6078493| doi-access = free }}</ref> 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.<ref>[http://mbr.synergiesprairies.ca/mbr/index.php/mbr/article/view/515 Functional neuroimaging studies of hypnosis and meditation: A comparative perspective] {{webarchive |url=https://web.archive.org/web/20121008034039/http://mbr.synergiesprairies.ca/mbr/index.php/mbr/article/view/515 |date=8 October 2012}}</ref>

Another study has demonstrated that a colour hallucination suggestion given to subjects in hypnosis activated colour-processing regions of the occipital cortex.<ref>{{cite journal | vauthors = Kosslyn SM, Thompson WL, Costantini-Ferrando MF, Alpert NM, Spiegel D | title = Hypnotic visual illusion alters color processing in the brain | journal = The American Journal of Psychiatry | volume = 157 | issue = 8 | pages = 1279–84 | date = August 2000 | pmid = 10910791 | doi = 10.1176/appi.ajp.157.8.1279 | s2cid = 18060042 }}</ref>{{Primary source inline|date=September 2021}} A 2004 review of research examining the [[EEG]] laboratory work in this area concludes:

{{blockquote|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 wave|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.<ref>{{cite book|author=Horton |title=The Highly Hypnotisable Subject|date=2004|page=140 |author2= Crawford}}</ref>}}

Studies have shown an association of hypnosis with stronger theta-frequency activity as well as with changes to the [[gamma wave|gamma]]-frequency activity.<ref>{{cite journal | vauthors = Jensen MP, Adachi T, Hakimian S | title = Brain Oscillations, Hypnosis, and Hypnotizability | journal = The American Journal of Clinical Hypnosis | volume = 57 | issue = 3 | pages = 230–53 | date = January 2015 | pmid = 25792761 | pmc = 4361031 | doi = 10.1080/00029157.2014.976786 | type = Review}}</ref>{{Primary source inline|date=September 2021}} [[Neuroimaging]] techniques have been used to investigate neural correlates of hypnosis.<ref>{{cite journal | vauthors = Mazzoni G, Venneri A, McGeown WJ, Kirsch I | title = Neuroimaging resolution of the altered state hypothesis | journal = Cortex; A Journal Devoted to the Study of the Nervous System and Behavior | volume = 49 | issue = 2 | pages = 400–10 | date = February 2013 | pmid = 23026758 | doi = 10.1016/j.cortex.2012.08.005 | s2cid = 206984627 | url = https://strathprints.strath.ac.uk/44493/ | type = Review | access-date = 21 July 2021 | archive-date = 14 June 2021 | archive-url = https://web.archive.org/web/20210614142638/https://strathprints.strath.ac.uk/44493/ | url-status = live }}</ref><ref>{{cite journal | vauthors = Landry M, Raz A | title = Hypnosis and imaging of the living human brain | journal = The American Journal of Clinical Hypnosis | volume = 57 | issue = 3 | pages = 285–313 | date = January 2015 | pmid = 25928680 | doi = 10.1080/00029157.2014.978496 | s2cid = 844244 | type = Review}}</ref>

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

{{blockquote|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.<ref>{{cite magazine|last=Gosline|first=Anna| name-list-style = vanc |magazine=New Scientist|url=https://www.newscientist.com/article.ns?id=dn6385|date=10 September 2004|title=Hypnosis really changes your mind|access-date=2007-08-27}}</ref><ref>{{cite journal | vauthors = Egner T, Jamieson G, Gruzelier J | title = Hypnosis decouples cognitive control from conflict monitoring processes of the frontal lobe | journal = NeuroImage | volume = 27 | issue = 4 | pages = 969–78 | date = October 2005 | pmid = 15964211 | doi = 10.1016/j.neuroimage.2005.05.002 | s2cid = 13979703}}</ref>}}

=== 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."<ref name="Weitzenhoffer, 2000">{{cite book | vauthors = Weitzenhoffer AM |title=''Hypnotism – An Objective Study in Suggestibility'' |location=New York |publisher=Wiley |year=1953 |isbn=978-1-258-02536-6}}{{Page needed|date=September 2010}}</ref>

=== Neodissociation ===
[[Ernest Hilgard]], who developed the "neodissociation" theory of hypnotism, hypothesised 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. None mentioned 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.<ref>{{cite book | last1=McEntarffer | first1=Robert | last2=Weseley | first2=Allyson | title=Barron's AP Psychology 2008 | publisher=Barron's Educational Series, Inc | publication-place=Hauppauge, N.Y. | date=2007 | isbn=978-0-7641-3665-8 | oclc=73742844 }}</ref>

=== Social role-taking theory ===
The main theorist who pioneered the influential role-taking theory of hypnotism was [[Theodore R. Sarbin|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 A. Baker|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.<ref name="Baker, 1990">{{cite book |last=Baker |first=Robert A. | name-list-style = vanc |year=1990 |title=''They Call It Hypnosis'' |url=https://archive.org/details/theycallithypnos0000bake |url-access=registration |publisher=Prometheus Books |location=Buffalo, NY |isbn=978-0-87975-576-8}}{{Page needed|date=September 2010}}</ref>{{Primary source inline|date=September 2021}}

=== 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".<ref name="Barber, Spanos 1974"/>{{Primary source inline|date=September 2021}}

Barber et al. noted that similar factors appeared to mediate the response both to hypnotism and to cognitive behavioural therapy, in particular systematic desensitisation.<ref name="Barber, Spanos 1974"/> Hence, research and clinical practice inspired by their interpretation has led to growing interest in the relationship between hypnotherapy and cognitive behavioural therapy.<ref name="Chapman">{{cite book|author=Robin A. Chapman|title=The clinical use of hypnosis in cognitive behavior therapy: a practitioner's casebook|url=https://books.google.com/books?id=u6UpFP2fIqcC|access-date=30 October 2011|year=2006|publisher=Springer Publishing Company|isbn=978-0-8261-2884-3|archive-date=2 July 2023|archive-url=https://web.archive.org/web/20230702163307/https://books.google.com/books?id=u6UpFP2fIqcC|url-status=live}}</ref>{{rp|105}}<ref name="Bolocofsky"/>

=== 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).<ref>Kroger, William S. (1977) ''Clinical and experimental hypnosis in medicine, dentistry, and psychology.'' Lippincott, Philadelphia, p. 31. {{ISBN|0-397-50377-6}}</ref>

=== Systems theory ===
[[Systems theory]], in this context, may be regarded as an extension of Braid's original conceptualisation of hypnosis as involving "the brain and nervous system generally".<ref name=br>{{cite book|author=Braid J|title=Neurypnology or The rationale of nervous sleep considered in relation with animal magnetism.|location=Buffalo, NY|publisher=John Churchill|year=1843}}</ref>{{rp|page=31}} Systems theory considers the [[nervous system]]'s organisation 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.<ref name="Morgan, 1993">{{cite book|author=Morgan J.D.|title=The Principles of Hypnotherapy|publisher=Eildon Press|year=1993}}</ref>

=== Societies ===
{{Unreferenced section|date=September 2021}}
There is a huge range of societies in England who train individuals in hypnosis; however, one of the longest-standing organisations is the British Society of Clinical and Academic Hypnosis (BSCAH). It origins date back to 1952 when a group of dentists set up the 'British Society of Dental Hypnosis'. Shortly after, a group of sympathetic medical practitioners merged with this fast-evolving organisation to form 'The Dental and Medical Society for the Study of Hypnosis'; and, in 1968, after various statutory amendments had taken place, the 'British Society of Medical and Dental Hypnosis' (BSMDH) was formed. This society always had close links with the [[Royal Society of Medicine]] and many of its members were involved in setting up a hypnosis section at this centre of medical research in London. And, in 1978, under the presidency of David Waxman, the Section of Medical and Dental Hypnosis was formed. A second society, the British Society of Experimental and Clinical Hypnosis (BSECH), was also set up a year before, in 1977, and this consisted of psychologists, doctors and dentists with an interest in hypnosis theory and practice. In 2007, the two societies merged to form the 'British Society of Clinical and Academic Hypnosis' (BSCAH). This society only trains health professionals and is interested in furthering research into clinical hypnosis.

The [[American Society of Clinical Hypnosis]] (ASCH) is unique among organisations for professionals using hypnosis because members must be licensed healthcare workers with graduate degrees. As an interdisciplinary organisation, ASCH not only provides a classroom to teach professionals how to use hypnosis as a tool in their practice, it provides professionals with a community of experts from different disciplines. The ASCH's missions statement is to provide and encourage education programs to further, in every ethical way, the knowledge, understanding, and application of hypnosis in health care; to encourage research and scientific publication in the field of hypnosis; to promote the further recognition and acceptance of hypnosis as an important tool in clinical health care and focus for scientific research; to cooperate with other professional societies that share mutual goals, ethics and interests; and to provide a professional community for those clinicians and researchers who use hypnosis in their work. The ASCH also publishes the ''[[American Journal of Clinical Hypnosis]]''.