HYPNOTIC RESPONSIVENESS AND NONHYPNOTIC SUGGESTIBILITY: DISPARATE, SIMILAR, OR THE SAME?

This study examined if participants respond to different types of suggestions, including hypnosis, uniquely or similarly. This study used 9 suggestibility measures and hypothesized a 3-factor model. It was hypothesized that hypnosis, Chevreul's pendulum, and body-sway would load on the first factor; the odor test, progressive weights, and placebo on the second factor; and conformity, persuasibility, and interrogative suggestibility would load on the third factor. The study comprised 110 college students. Factor analyses failed to result in three factors. Additional attempts at two and three-factor models were also rejected. Hypnosis had no strong relationship with the various suggestibility measures. Thus, no clearly delineated factor structure of suggestibility emerged, indicating that the domain of suggestibility seems to be neither a single attribute, trait, or group of related abilities. Implications are discussed.

Moving and Reflective Functioning Under Stress.

According to mentalization theory, reflective functioning is a core feature of healthy affect regulation which involves interactions among implicit and explicit processes across multiple systems of the individual in relation with others. Mother-infant interactions point to the role of whole body movement as a feature of developing affect regulation, promoting self-organization. Using behavioral imaging technology, we examined the legacy of whole body movement in adults undergoing an interpersonal stress task (Trier Social Stress Test; TSST). Movement was assessed as a multidimensional system over time, allowing for examination of rigid recurrence and self-organized determinism in movement dynamics (Multidimensional Recurrence Quantification Analysis). Reflective functioning was assessed using an automated analysis of transcripts. We found flexible yet self-organized movement uniquely predicted reflective function. Self-reported personality organization, assessed at least one week prior, showed some bivariate relationship with indices of movement dynamics, while self-reported attachment styles did not. Using novel methodology, this study demonstrated the cooccurrence of reflective functioning and specific movement dynamics. The authors suggest theoretical approaches from phenomenology to understand these findings and call for further research.

Effects of Combining a Brief Cognitive Intervention with Transcranial Direct Current Stimulation on Pain Tolerance: A Randomized Controlled Pilot Study.

Objective: Cognitive behavioral therapy has been shown to be effective for treating chronic pain, and a growing literature shows the potential analgesic effects of minimally invasive brain stimulation. However, few studies have systematically investigated the potential benefits associated with combining approaches. The goal of this pilot laboratory study was to investigate the combination of a brief cognitive restructuring intervention and transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex in affecting pain tolerance. Design: Randomized, double-blind, placebo-controlled laboratory pilot. Setting: Medical University of South Carolina. Subjects: A total of 79 healthy adult volunteers. Methods: Subjects were randomized into one of six groups: 1) anodal tDCS plus a brief cognitive intervention (BCI); 2) anodal tDCS plus pain education; 3) cathodal tDCS plus BCI; 4) cathodal tDCS plus pain education; 5) sham tDCS plus BCI; and 6) sham tDCS plus pain education. Participants underwent thermal pain tolerance testing pre- and postintervention using the Method of Limits. Results: A significant main effect for time (pre-post intervention) was found, as well as for baseline thermal pain tolerance (covariate) in the model. A significant time × group interaction effect was found on thermal pain tolerance. Each of the five groups that received at least one active intervention outperformed the group receiving sham tDCS and pain education only (i.e., control group), with the exception of the anodal tDCS + education-only group. Cathodal tDCS combined with the BCI produced the largest analgesic effect. Conclusions: Combining cathodal tDCS with BCI yielded the largest analgesic effect of all the conditions tested. Future research might find stronger interactive effects of combined tDCS and a cognitive intervention with larger doses of each intervention. Because this controlled laboratory pilot employed an acute pain analogue and the cognitive intervention did not authentically represent cognitive behavioral therapy per se, the implications of the findings on chronic pain management remain unclear.

Is Primary-Process Cognition a Feature of Hypnosis?

The division of cognition into primary and secondary processes is an important part of contemporary psychoanalytic metapsychology. Whereas primary processes are most characteristic of unconscious thought and loose associations, secondary processes generally govern conscious thought and logical reasoning. It has been theorized that an induction into hypnosis is accompanied by a predomination of primary-process cognition over secondary-process cognition. The authors hypothesized that highly hypnotizable individuals would demonstrate more primary-process cognition as measured by a recently developed cognitive-perceptual task. This hypothesis was not supported. In fact, low hypnotizable participants demonstrated higher levels of primary-process cognition. Exploratory analyses suggested a more specific effect: felt connectedness to the hypnotist seemed to promote secondary-process cognition among low hypnotizable participants.

Further evidence of self-medication: personality factors influencing drug choice in substance use disorders.

According to Khantzian's (2003) self-medication hypothesis (SMH), substance dependence is a compensatory means to modulate affects and self-soothe in response to distressing psychological states. Khantzian asserts: (1) Drugs become addicting because they have the power to alleviate, remove, or change human psychological suffering, and (2) There is a considerable degree of specificity in a person's choice of drugs because of unique psychological and physiological effects. The SMH has received criticism for its variable empirical support, particularly in terms of the drug-specificity aspect of Khantzian's hypothesis. We posit that previous empirical examinations of the SMH have been compromised by methodological limitations. Also, more recent findings supporting the SMH have yet to be replicated. Addressing previous limitations to the research, this project tested this theory in a treatment sample of treatment-seeking individuals with substance dependence (N = 304), using more heterogeneous, personality-driven measures that are theory-congruent. Using an algorithm based on medical records, individuals were reliably classified as being addicted to a depressant, stimulant, or opiate by two independent raters. Theory-based a priori predictions were that the three groups would exhibit differences in personality characteristics and emotional-regulation strategies. Specifically, our hypotheses entailed that when compared against each other: (1) Individuals with a central nervous system (CNS) depressant as drug of choice (DOC) will exhibit defenses of repression, over-controlling anger, and emotional inhibition to avoid acknowledging their depression; (2) Individuals with an opiate as DOC will exhibit higher levels of aggression, hostility, depression, and trauma, greater deficits in ego functioning, and externalizing/antisocial behavior connected to their use; and (3) Individuals with a stimulant as DOC will experience anhedonia, paranoia, have a propensity to mania, and display lower levels of emotional inhibition. MANOVAs were used to test three hypotheses regarding drug group differences on the personality variables that were in keeping with the SMH. The MANOVAs for Hypothesis I (Depressant group) and Hypothesis II (Opiate group) were statistically significant. Findings partially support the SMH, particularly in its characterization of personality functioning in those addicted to depressants and opiates.

Simulation modelling analysis for small sets of single-subject data collected over time.

The behavioural data yielded by single subjects in naturalistic and controlled settings likely contain valuable information to scientists and practitioners alike. Although some of the properties unique to this data complicate statistical analysis, progress has been made in developing specialised techniques for rigorous data evaluation. There are no perfect tests currently available to analyse short autocorrelated data streams, but there are some promising approaches that warrant further development. Although many approaches have been proposed, and some appear better than others, they all have some limitations. When data sets are large enough (∼30 data points per phase), the researcher has a reasonably rich pallet of statistical tools from which to choose. However, when the data set is sparse, the analytical options dwindle. Simulation modelling analysis (SMA; described in this article) is a relatively new technique that appears to offer acceptable Type-I and Type-II error rate control with short streams of autocorrelated data. However, at this point, it is probably too early to endorse any specific statistical approaches for short, autocorrelated time-series data streams. While SMA shows promise, more work is needed to verify that it is capable of reliable Type-I and Type-II error performance with short serially dependent streams of data.

Functional neuroimaging of personally-relevant stimuli in a paediatric case of impaired awareness.

BACKGROUND: Functional neuroimaging studies have observed preserved neural activation to personally relevant stimuli in patients within the disorders of consciousness (DOC) spectrum. As the majority of studies have focused on adult DOC patients, little is known about preserved activation in the developing brain of children with impaired consciousness. CASE STUDY: The aim of this study is to use fMRI to measure preserved neural activation to personally relevant stimuli (subject's own name and familiar voice) in a paediatric patient who sustained a traumatic brain injury and anoxic-ischaemia following a motor vehicle accident at 18 months of age rendering her probable for minimally conscious state. Contrasts revealed activation in the right middle frontal gyrus when hearing the subject's own name and the anterior supramarginal gyrus when hearing a familiar voice. CONCLUSION: This study provides preliminary support for fMRI as a method to measure preserved cognitive functioning in paediatric DOC patients.

Inferential precision in single-case time-series data streams: how well does the em procedure perform when missing observations occur in autocorrelated data?

The case-based time-series design is a viable methodology for treatment outcome research. However, the literature has not fully addressed the problem of missing observations with such autocorrelated data streams. Mainly, to what extent do missing observations compromise inference when observations are not independent? Do the available missing data replacement procedures preserve inferential integrity? Does the extent of autocorrelation matter? We use Monte Carlo simulation modeling of a single-subject intervention study to address these questions. We find power sensitivity to be within acceptable limits across four proportions of missing observations (10%, 20%, 30%, and 40%) when missing data are replaced using the Expectation-Maximization Algorithm, more commonly known as the EM Procedure (Dempster, Laird, & Rubin, 1977). This applies to data streams with lag-1 autocorrelation estimates under 0.80. As autocorrelation estimates approach 0.80, the replacement procedure yields an unacceptable power profile. The implications of these findings and directions for future research are discussed.

Hypnosis in the laboratory creates a window on psychopathology.

The authors describe 3 studies in which hypnosis itself is not studied but instead used to create anomalous states in the laboratory that can be studied under controlled conditions. The 1st article is a comprehensive review of programmatic research using hypnosis to elicit and study clinically relevant delusions. The 2nd article reviews studies comparing the brain activity of hysterical/dissociative patients with nonpatients hypnotized and given suggestions for sensory-motor and cognitive anomalies typical of the clinical syndromes. The authors conclude that the hypnosis analogues are relevant and revealing. The 3rd article describes a single experiment using hypnosis to elicit distressing and intrusive memories, typical of acute anxiety disorders. Findings with hypnotic subjects are in keeping with those from patients suffering intrusive memories. Across all 3 papers, hypnosis is shown to be a viable and helpful tool for experimental psychopathology.

Examining the potential impact of a family session in therapeutic assessment: a single-case experiment.

Most clinicians concede the benefits of conceptualizing children in systemic terms. Yet, many child assessments involve parents only on a limited basis. The Therapeutic Assessment model for children and families (TA-C) emphasizes parental involvement and family-driven collaboration throughout the intervention. Child TA has shown promise as an effective brief intervention (e.g., Smith, Handler, & Nash, 2010; Tharinger et al., 2009). Family intervention sessions (Finn, 2007; Tharinger, Finn, Austin, et al., 2008) are an integral component of the child TA model in facilitating familial changes. However, TA-C research has yet to empirically examine the potential impact of a family session on treatment trajectory. This case study includes an extended presentation of the development and execution of a family session. The authors use a daily measures time-series experiment to empirically examine the clinical effectiveness of the TA-C and the hypothesis that the family session was a tipping point in the trajectory of improvement.

Therapeutic assessment for preadolescent boys with oppositional defiant disorder: a replicated single-case time-series design.

The Therapeutic Assessment (TA) model is a relatively new treatment approach that fuses assessment and psychotherapy. The study examines the efficacy of this model with preadolescent boys with oppositional defiant disorder and their families. A replicated single-case time-series design with daily measures is used to assess the effects of TA and to track the process of change as it unfolds. All 3 families benefitted from participation in TA across multiple domains of functioning, but the way in which change unfolded was unique for each family. These findings are substantiated by the Behavior Assessment System for Children (Reynolds & Kamphaus, 2004). The TA model is shown to be an effective treatment for preadolescent boys with oppositional defiant disorder and their families. Further, the time-series design of this study illustrated how this empirically grounded case-based methodology reveals when and how change unfolds during treatment in a way that is usually not possible with other research designs.

The effectiveness of hypnosis in reducing pain and suffering among women with metastatic breast cancer and among women with temporomandibular disorder.

The authors describe two studies of special interest to clinicians and clinical researchers. Both are randomized controlled studies, exclusively focused on female patients. The first study tests whether a year-long weekly group intervention including hypnosis can reduce cancer pain among women with metastatic breast cancer. Findings suggest the intervention slowed the increase in reported pain over a 12-month period relative to controls. The second study examines the effect of hypnosis in women suffering from temporomandibular disorder (TMD), with a special focus on function as well as pain. Hypnosis reduced TMD pain as measured by a numerical-rating scale.

Testing the effectiveness of family therapeutic assessment: a case study using a time-series design.

We describe a family Therapeutic Assessment (TA) case study employing 2 assessors, 2 assessment rooms, and a video link. In the study, we employed a daily measures time-series design with a pretreatment baseline and follow-up period to examine the family TA treatment model. In addition to being an illustrative addition to a number of clinical reports suggesting the efficacy of family TA, this study is the first to apply a case-based time-series design to test whether family TA leads to clinical improvement and also illustrates when that improvement occurs. Results support the trajectory of change proposed by Finn (2007), the TA model's creator, who posits that benefits continue beyond the formal treatment itself.

Clinical research on the utility of hypnosis in the prevention, diagnosis, and treatment of medical and psychiatric disorders.

The authors summarize 4 articles of special interest to the hypnosis community in the general scientific and medical literatures. All are empirical studies testing the clinical utility of hypnosis, and together address the role of hypnosis in prevention, diagnosis, and treatment of medical and psychiatric disorders/conditions. The first is a randomized controlled study of smoking cessation treatments comparing a hypnosis-based protocol to an established behavioral counseling protocol. Hypnosis quit rates are superior to those of the accepted behavioral counseling protocol. A second study with pediatric patients finds hypnosis critically helpful in differentiating nonepileptic seizure-like behaviors (pseudoseizures) from epilepsy. The remaining 2 papers are randomized controlled trials testing whether hypnosis is effective in helping patients manage the emotional distress of medical procedures associated with cancer treatment. Among female survivors of breast cancer, hypnosis reduces perceived hot flashes and associated emotional and sleep disruptions. Among pediatric cancer patients, a brief hypnotic intervention helps control venepuncture-related pain.

Neurophysiological attributes of the hypnotic state and the utility of hypnosis in pediatric medicine and burn care.

Three articles of special interest to the hypnosis community recently appeared in the general scientific and medical literatures. The first paper is a thoughtful review of the clinical applications of hypnosis in pediatric settings. The second article reports the findings of a randomized, controlled trial of hypnosis for burn-wound care, carried out at the University of Washington Medical School. The third article describes an innovative EEG laboratory case study tracking the cortex functional connectivity of a highly hypnotizable subject across various baseline and experimental conditions. These three articles are sturdy examples of how hypnosis illuminates (and is illuminated by) medical and psychological science.

A parametric control chart adjustment for handling serial dependence in health care quality data.

Numerous tools are available to health care quality managers geared toward helping them make data-based inferences about quality processes. Recently, in this journal, Tukey's control chart technique was promoted as a good option for handling short streams of time series data when the assumption of data normality cannot be confirmed. Although this technique does not appear to perform well with serially dependent (or autocorrelated) data, an autocorrelation-corrected version of the technique is now available. However, when managers wish to capitalize on the superior power of parametric control charts (ie, when data sets are large and normality can be confirmed), there are currently few options available in the way of statistical process control techniques that appropriately handle autocorrelated data. In this article, the authors report the empirical false-positive rates and power performance of the mean-sigma (X-S) control chart technique under various levels of autocorrelation. Results indicate that this popular technique offers poor false-positive control with autocorrelated data. Next, the authors describe a method for autocorrelation correction and finally compare the autocorrelation-corrected X-S chart with the original X-S technique. The autocorrelation-corrected X-S chart demonstrates better type I error control with similar power to the original chart and may offer quality managers an important tool for appropriately handling autocorrelated quality data.

Clinical practice as natural laboratory for psychotherapy research: a guide to case-based time-series analysis.

Both researchers and practitioners need to know more about how laboratory treatment protocols translate to real-world practice settings and how clinical innovations can be systematically tested and communicated to a skeptical scientific community. The single-case time-series study is well suited to opening a productive discourse between practice and laboratory. The appeal of case-based time-series studies, with multiple observations both before and after treatment, is that they enrich our design palette by providing the discipline another way to expand its empirical reach to practice settings and its subject matter to the contingencies of individual change. This article is a user's guide to conducting empirically respectable case-based time-series studies in a clinical practice or laboratory setting.

Hypnotizability and somatic complaints: a gender-specific phenomenon.

The relationship between hypnotizability and somatic illness was measured in 45 college students. Several weeks after completing the Waterloo-Stanford Group C Scale (WSGC), participants filled out a somatic-complaint checklist and measures of psychopathology. Results indicated a positive correlation between hypnotizability and somatic illness, and the relationship was stronger for female participants. In contrast to the quadratic model proposed by Wickramasekera, the current data demonstrated a linear relationship between hypnotizability and somatic complaint. Further analyses showed that somatic complaints were associated with hallucination and imagery items, corresponding to the perceptual-cognitive factor identified in Woody, Barnier, and McConkey's (2005) factor analysis of the Stanford Hypnotic Susceptibility Scale, Form C. The results call into question some claims that high hypnotizability is an adaptive and healthy trait.

How unusual are the "unusual events" detected by control chart techniques in healthcare settings?

Statistical process control (SPC) charts have become widely implemented tools for quality monitoring and assurance in healthcare settings across the United States. SPC methods have been successfully used in industrial settings to track the quality of products manufactured by machines and to detect deviations from acceptable Levels of product quality. However, problems may arise when SPC methods are used to evaluate human behavior. Specifically, when human behavior is tracked over time, the data stream generated usually exhibits periodicity and gradualism with respect to behavioral changes over time. These tendencies can be quantified and are recognized in the statistical field as autocorrelation. When autocorrelation is present, conventional SPC methods too often identify events as "unusuaL" when they really should be understood as products of random fluctuation. This article discusses the concept of autocorrelation and demonstrates the negative impact of autocorrelation on traditional SPC methods, with a specific focus on the use of SPC charts to detect unusual events.