Boosting the hypnotic experience. Inhibition of the dorsolateral prefrontal cortex alters hypnotizability and sense of agency. A randomized, double-blind and sham-controlled tDCS study.

Hypnotizability refers to the individual responsiveness to hypnosis, and literature shows that the greater the hypnotizability, the more effective the hypnotic suggestions. So far, few studies attempted to enhance hypnotizability, and only two adopted brain stimulation with magnetic pulses. In the present study, we aimed to boost hypnotizability through transcranial direct current stimulation (tDCS). To this aim, bilateral tDCS was applied over the dorsolateral prefrontal cortex (DLPFC) with the target electrode providing negative current (cathodal stimulation) over the left hemisphere. Twenty-nine subjects participated in the study and they were randomly assigned to the sham or the active group in a double-blind design. The hypnotic experience was assessed before and after the stimulation through a phenomenological measure of consciousness (the PCI-HAP). The main findings revealed that a single tDCS session enhanced the hypnotic depth by 11% and reduced the volitional control by 30%, while no differences emerged in the sham group. This is the first study adopting the electrical neurostimulation to produce an alteration of hypnotizability and sense of agency, and confirmed the key-role of the DLPFC and executive control in the hypnotic phenomena. If confirmed, these findings could have relevant implications as enhanced hypnotizability could be translated into better outcomes for many hypnotic interventions.

Hypnotism as a Function of Trance State Effects, Expectancy, and Suggestibility: An Italian Replication.

Previous research using stepwise regression analyses found self-reported hypnotic depth (srHD) to be a function of suggestibility, trance state effects, and expectancy. This study sought to replicate and expand that research using a general state measure of hypnotic responsivity, the Phenomenology of Consciousness Inventory: Hypnotic Assessment Procedure (PCI-HAP). Ninety-five participants completed an Italian translation of the PCI-HAP, with srHD scores predicted from the PCI-HAP assessment items. The regression analysis replicated the previous research results. Additionally, stepwise regression analyses were able to predict the srHD score equally well using only the PCI dimension scores. These results not only replicated prior research but suggest how this methodology to assess hypnotic responsivity, when combined with more traditional neurophysiological and cognitive-behavioral methodologies, may allow for a more comprehensive understanding of that enigma called hypnosis.

The "Mysteries of Hypnosis:" Helping Us Better Understand Hypnosis and Empathic Involvement Theory (EIT).

Wickramasekera II (2015) has penned a comprehensive and thoughtful review article demonstrating how empathy is intimately involved in the psychology and neurophysiology of hypnosis and the self. Hypnosis is a very "mental" or subjective phenomenon for both the client and the research participant. To better assess the mind of the client/participant during hypnosis, it is my belief that we need to generate more "precise" phenomenological descriptors of the mind during hypnosis and related empathic conditions, as Wickramasekera II (2015) has suggested in his article. Although any phenomenological methodology will have its limits and disadvantages, noetics (as defined in the article below) can help us better understand hypnosis, empathic involvement theory, and the brain/mind/behavior interface. By quantifying the mind in a comprehensive manner, just as the brain is comprehensively quantified via fMRI and qEEG technologies, noetic analysis can help us more precisely assess the mind and relate it to the brain and human behavior and experience.

Empathic Features and Absorption in Fantasy Role-Playing.

This study examined the levels of empathy and absorption of individuals who regularly play fantasy and science fiction role-playing games. A hypothesis was developed that higher levels of empathy would be found in individuals who fantasy role-play based upon previous research in hypnosis such as J. R. Hilgard's (1970) imaginative involvement hypothesis, research into the "fantasy prone" personality type (Wilson & Barber, 1981), and the empathic involvement hypothesis (Wickramasekera II & Szlyk, 2003). The participants in the current study were 127 fantasy role-players who volunteered and completed the Davis Interpersonal Reactivity Index (empathy) and the Tellegen Absorption Scale (absorption). The results demonstrated that those who play fantasy role-playing games scored significantly higher than the comparison group on the IRI scale of empathy, confirming the hypothesis that fantasy role-players report experiencing higher levels of empathic involvement with others. Correlational analysis between the measures demonstrated a significant positive correlation between empathy and absorption (r = .43, p < .001). These results collectively suggest that fantasy role-players have a uniquely empathically-imaginative style. The results also confirm and extend previous findings on the relationship between empathy and absorption as predicted by the Empathic Involvement Hypothesis (Wickramasekera II & Szlyk, 2003).

Imagery vividness before and during the PCI-HAP: a partial replication.

This study sought to replicate an earlier study wherein imagery vividness before and during a phenomenological hypnotic assessment procedure was assessed, while also measuring trance (hypnoidal) state effects and several other variables. Correlational and regression analyses for that study suggested that imagery vividness during hypnotism was predicted by combined imagery vividness before hypnotism and trance (altered) state effects during hypnotism. The present study procured a larger sample employing a similar design and a similar subject pool. With the current study, although trance state effects and imagery vividness before hypnotism still significantly predicted hypnotic imagoic suggestibility (imagery during hypnotism), the variance accounted for was appreciably less. The meaning of these results as a function of the methodology used is discussed.

A cross-validation of two differing measures of hypnotic depth.

Several sets of regression analyses were completed, attempting to predict 2 measures of hypnotic depth: the self-reported hypnotic depth score and hypnoidal state score from variables of the Phenomenology of Consciousness Inventory: Hypnotic Assessment Procedure (PCI-HAP). When attempting to predict self-reported hypnotic depth, an R of .78 with Study 1 participants shrank to an r of .72 with Study 2 participants, suggesting mild shrinkage for this more attributional measure of hypnotic depth. Attempting to predict hypnoidal state (an estimate of trance) using the same procedure, yielded an R of .56, that upon cross-validation shrank to an r of .48. These and other results suggest that, although there is some variance in common, the self-reported hypnotic depth score appears to be tapping a different construct from the hypnoidal state score.

Reply to Wagstaff: "Hypnosis and the relationship between trance, suggestion, expectancy, and depth: some semantic and conceptual issues".

Wagstaff (2010) reviews and comments on two recent papers by Pekala et al. (2010a, 2010b), concluding that "many of the problems relating to the definition and conceptualization of terms associated with hypnosis... may stem from insufficient attention to the role of suggestion and expectancies in producing hypnotic phenomena, and an over-reliance on the role of the procedures and mechanics of the induction process" (p. 47). Although I agree with his semantic and conceptual focus, I believe that a number of these problems are due to not operationally defining terms such as hypnosis, hypnotic state, or trance in a comprehensive phenomenological manner. By using the PCI (Phenomenology of Consciousness Inventory) via retrospective phenomenological assessment, and using a phenomenological state instrument like the PCI-HAP (Phenomenology of Consciousness Inventory - Hypnotic Assessment Procedure) to obtain a state measure of hypnotic responsiveness, a means is available to define and empirically address some of these issues in a way that can significantly further our understanding of the nature of hypnotism. Such an approach might also address Kallio and Revonsuo's (2005) admonition concerning the need to develop "an internally coherent and widely shared theoretical vocabulary" (p. 51) to better understand consciousness, altered states of consciousness, and related phenomena, such as hypnosis/hypnotism.

Trance state effects and imagery vividness before and during a hypnotic assessment: a preliminary study.

This preliminary study explored the relationship between imagery vividness before and during a hypnotic phenomenological assessment procedure, the Phenomenology of Consciousness Inventory-Hypnotic Assessment Procedure (PCI-HAP), while also assessing trance (hypnoidal) state effects and several other variables. The PCI-HAP allows the assessment of trance state effects associated with hypnotism to be quantified and statistically assessed. The 102 subjects completed the PCI-HAP along with several other questionnaire items. Correlational and regression analyses suggested that imagery vividness during hypnotism (hypnotic imagoic suggestibility) was predicted by combined imagery vividness before hypnotism and trance (altered) state effects during hypnotism. When measuring several additional variables, imagery vividness during hypnotism was found to be a function of self-reported hypnotic depth and additional other variables. The usefulness of these results for better understanding imagery vividness before and during hypnotism is discussed.

Suggestibility, expectancy, trance state effects, and hypnotic depth: I. Implications for understanding hypnotism.

This paper reviews the relationships between trance or altered state effects, suggestibility, and expectancy as these concepts are defined in the theorizing of Weitzenhoffer (2002), Holroyd (2003), Kirsch (1991), and others, for the purpose of demonstrating how these concepts can be assessed with the PCI-HAP (Phenomenology of Consciousness Inventory: Hypnotic Assessment Procedure; Pekala, 1995a, b). In addition, how the aforementioned variables may relate to the nature of hypnosis/hypnotism as a function of self-reported hypnotic depth are discussed, along with how the PCI-HAP may be used as a means to measure hypnotic responsivity from a more phenomenological state perspective, in contrast to more traditional behavioral trait assessment instruments like the Harvard, the Stanford C, or the HIP. A follow-up paper (Pekala, Kumar, Maurer, Elliott-Carter, Moon, & Mullen, 2010) will present research data on the PCI-HAP model and how this model can be useful for better understanding hypnotism.

Suggestibility, expectancy, trance state effects, and hypnotic depth: II. Assessment via the PCI-HAP.

This study sought to determine if self-reported hypnotic depth (srHD) could be predicted from the variables of the Phenomenology of Consciousness Inventory - Hypnotic Assessment Procedure (PCI-HAP) (Pekala, 1995a, 1995b; Pekala & Kumar, 2007; Pekala et al., 2010), assessing several of the processes theorized by researchers to be associated with hypnotism: trance (altered state effects), suggestibility, and expectancy. One hundred and eighty participants completed the PCI-HAP. Using regression analyses, srHD scores were predicted from the PCI-HAP pre-hypnotic and post-hypnotic assessment items, and several other variables. The results suggested that the srHD scores were found to be a function of imagoic suggestibility, expectancy (both estimated hypnotic depth and expected therapeutic efficacy), and trance state and eye catalepsy effects; effects that appear to be additive and not (statistically) interactive. The results support the theorizing of many investigators concerning the involvement of the aforementioned component processes with this particular aspect of hypnotism, the self-reported hypnotic depth score.

Not all group hypnotic suggestibility scales are created equal: individual differences in behavioral and subjective responses.

To examine the influence of hypnotic suggestibility testing as a source of individual differences in hypnotic responsiveness, we compared behavioral and subjective responses on three scales of hypnotic suggestibility: The Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS: A; Shor, R. E., Orne, E. C. (1962). Harvard Group Scale of Hypnotic Susceptibility. Berlin: Consulting Psychologists Press); the Carleton University Responsiveness to Suggestion Scale (CURSS; Spanos, N. P., Radtke, H. L., Hodgins, D. C., Stam, H. J., Bertrand, L. D. (1983b). The Carleton University Responsiveness to Suggestion Scale: Normative data and psychometric properties. Psychological Reports, 53, 523-535); and the Group Scale of Hypnotic Ability (GSHA; Hawkins, R., Wenzel, L. (1999). The Group Scale of Hypnotic Ability and response booklet. Australian Journal of Clinical and Experimental Hypnosis, 27, 20-31). Behavioral and subjective responses to the CURSS were significantly different than those on the HGSHS: A and GSHA. More participants were classified as "low suggestible" on the CURSS and they reported subjective experiences more similar to everyday mentation. Attitudes and expectancies of participants who received the GSHA were less predictive of responding, but rates of responding and subjective experiences were similar on the GSHA and the HGSHS: A. Discussion focuses on implications for the use of group hypnotic suggestibility scales.

Positive affect, negative affect, and negative effects during a phenomenological hypnotic assessment within a substance abuse population.

Positive and negative affect generated while using the Phenomenology of Consciousness--Hypnotic Assessment Procedure (PCI-HAP) on a sample of drug and alcohol users were predicted using several variables. The results were then cross-validated on a second, smaller sample. The results suggest that, although some negative affect was reported, the PCI-HAP was more likely to generate positive, rather than negative, affect. Positive affect was related to the vividness of a suggested hypnotic dream during hypnosis and also hypnotic depth; these findings were replicated upon cross-validation. Although negative affect correlated with the Dissociative Experiences Scale scores and falling asleep, these results did not replicate upon cross-validation. Mild transient negative effects (e.g., headache) were reported by about 10% of the participants in a smaller, second sample. Implications of the results are discussed.

"How deeply hypnotized did i get?" Predicting self-reported hypnotic depth from a phenomenological assessment instrument.

Procedures for estimating hypnotic depth have been used for more than 70 years. This study predicted self-reported hypnotic depth from the phenomenological and behavioral variables of the Phenomenology of Consciousness Inventory-Hypnotic Assessment Procedure (PCI-HAP). Participants were divided into 2 groups; 1 was used to generate regression equations, and the other group was used for cross-validation. Both imagery vividness during hypnosis (imagoic suggestibility) and the PCI pHGS measure of hypnotic depth (hypnoidal state) accounted for most of the variance in self-reported hypnotic depth. The above results, further supported by correlational and 3-D visual analyses, are consistent with other researchers' observations that ratings of hypnotic depth are a function of: (a) alterations in subjective experience, and (b) the perception of responsiveness to suggestions. The findings are also congruent with J. Holroyd's hypothesis that suggestibility and altered-state effects interact to produce hypnotic effects.

Direct and indirect scales of hypnotic susceptibility: resistance to therapy and psychometric comparability.

Groups of participants were randomly assigned to receive either direct hypnotic procedure using the Harvard Group Scale of Hypnotic Susceptibility: Form A (HGSHS:A) or its indirect counterpart, the Alman-Wexler Indirect Hypnotic Susceptibility Scale (AWIHSS). Prior to hypnosis, participants completed the Inventory of Childhood Memories and Imaginings (a measure of fantasy proneness) and the Therapeutic Reactance Scale (TRS, a measure of resistance to therapeutic directives). The Phenomenology of Consciousness Inventory was completed in reference to a 2-minute sitting-quietly period embedded in the hypnotic procedure. Although results generally suggest that the two scales are alternate measures of hypnotizability, some differences were observed: (a) item difficulty levels differed on 4 of the 12 items; (b) subjects reported greater altered awareness with the direct method; and (c) contrary to the results of previous research, the more resistant subjects showed a tendency toward higher hypnotizability scores with the HGSHS:A, while the less resistant subjects responded better with the AWIHSS.

Self-hypnosis relapse prevention training with chronic drug/alcohol users: effects on self-esteem, affect, and relapse.

This study evaluated the effectiveness of a self-hypnosis protocol with chronic drug and alcohol patients in increasing self-esteem, improving affect, and preventing relapse against a control, a transtheoretical cognitive-behavioral (TCB), and a stress management (attention-placebo) group. Participants were 261 veterans admitted to Substance Abuse Residential Rehabilitation Treatment Programs (SARRTPs). Participants were assessed pre- and postintervention, and at 7-week follow-up. Relapse rates did not significantly differ across the 4 groups at follow-up; 87% of those contacted reported abstinence. At follow-up, the participants in the 3 treatment conditions were asked how often they practiced the intervention materials provided them. Practicing and minimal-practicing participants were compared against the control group for each of the 3 interventions via MANOVAs/ANOVAs. Results revealed a significant Time by Groups interaction for the hypnosis intervention, with individuals who played the self-hypnosis audiotapes "at least 3 to 5 times a week" at 7-week follow-up reporting the highest levels of self-esteem and serenity, and the least anger/impulsivity, in comparison to the minimal-practice and control groups. No significant effects were found for the transtheoretical or stress management interventions. Regression analyses predicted almost two-thirds of the variance of who relapsed and who did not in the hypnosis intervention group. Hypnotic susceptibility predicted who practiced the self-hypnosis audiotapes. The results suggest that hypnosis can be a useful adjunct in helping chronic substance abuse individuals with their reported self-esteem, serenity, and anger/impulsivity.

Operationalizing trance II: clinical application using a psychophenomenological approach.

Although many clinicians use the word "trance" to describe the subjective effects associated with being hypnotized, heretofore there has been no means to operationalize that concept. In a prior paper (Pekala & Kumar, 2000) the authors operationalized the notion of trance by using a retrospective, self-report instrument, the Phenomenology of Consciousness Inventory (PCI), to quantify the subjective experience of being hypnotized. Trance was operationalized in terms of: hypnotic depth via a pHGS (predicted Harvard Group Scale) score (derived from regression analysis using subdimensions of the PCI) that gives a quantitative measure of subjective trance depth; and trance typology profiles (derived from cluster and discriminant analyses of the PCI dimensions and subdimensions) that give a qualitative measure of empirically derived clusters of subjective trance experiences. These measures, when used in conjunction with data on the individual PCI dimensions and subdimensions, provide the clinician with specific information on phenomenological events experienced by the client during hypnosis which can be used in better adapting hypnotic suggestions to the client's phenomenological world. Two clinical cases are presented in which use of the above approach has been helpful in facilitating treatment planning.