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Contemporary Hypnosis (1997)Vol. 14, No. 3, pp. 157–166

MAIN PAPER

AN INVESTIGATION INTO THE INFLUENCE OF HYPNOSIS ON THECONFIDENCE AND ACCURACY OF EYEWITNESS RECALL

Mark R. Kebbell* and Graham F. Wagstaff**

*Bolton Institute and **University of Liverpool, UK

ABSTRACT

Research suggests that although confidence–accuracy (C–A) relationships are typi-cally low, investigative interviewing with hypnosis may have a particularly adverseinfluence on C–A relationships. However, it is possible that researchers may havepaid insufficient attention to the issue of item difficulty. To address this issue anexperiment was conducted which measured recall of information seen in a video film.Questions were constructed to range in difficulty and no misleading post-event infor-mation and/or leading questions were presented. Subjects’ were assigned to either ahypnosis condition or one of two control conditions. Higher C–A correlations thanhave been usually reported were found, regardless of interview condition.Also, whensubjects were ‘absolutely certain’ that a piece of information was correct they almostinvariably were accurate, and again interview condition did not influence this. Somepractical implications of these findings are discussed.

INTRODUCTION

Many studies have shown that eyewitnesses who are confident in their testimoniesare more likely to be perceived as accurate than eyewitnesses who are hesitant intheir testimonies (Cutler, Penrod & Stuve, 1988; Cutler, Penrod & Dexter, 1990; Fox& Walters, 1986; Leippe, Manion & Romanczyk, 1992; Lindsay, 1994; Lindsay, Wells& O’Connor, 1989). Consequently, the confidence which eyewitnesses express ininformation that they provide heavily influences both the investigative process, andthe credence which jurors give to eyewitness testimony. Thus, care must obviously betaken to ensure that eyewitnesses are interviewed in a way that does not adverselyaffect the relationship between their expressed confidence and the accuracy of theirtestimony.

The possible use of hypnosis as an interview procedure to enhance eyewitness mem-ory has provoked much debate (see, for example, Reiser, 1980, 1990; Wagstaff, 1993).According to some, forensic investigators should not use hypnosis because it encour-ages various forms of memory distortion (for reviews see, for example, Diamond, 1988;Orne, Sokis, Dinges & Orne, 1984; Sheehan, 1988; Wagstaff, 1993). Such conclusionsare based on a number of investigations that have found that hypnotic subjects,

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especially (but not always) those categorized as highly hypnotically susceptible, oftenshow increased confabulation and a spurious confidence in inaccurate memories (see,for example, Dywan & Bowers, 1983; Rainer, 1983; Sheehan & Tilden, 1983;Sheehan, Grigg & McCann, 1984; Zelig & Beidleman, 1981); though this is not alwaysthe case (see, for example, Redson & Knox, 1983; Sanders & Simmons, 1983). On thebasis of such studies, Sheehan (1988) concludes that probably the most consistentfinding is that, whatever their accuracy, hypnotic subjects express high levels of confi-dence in information that they provide, both accurate and inaccurate. Hence, whilenot all the data support a weak or negative confidence–accuracy (C–A) relationship,the evidence suggests an absence of a large, positive C–A relationship in situations inwhich hypnosis is used to facilitate the retrieval of eyewitness information.

However, the failure to find strong C–A relationships does not appear to be lim-ited to situations in which hypnosis is used. Many studies suggest that in non-hypnoticsituations, there is either no C–A relationship at all, or only a small, positive C–Arelationship (for reviews see, Bothwell, Deffenbacher & Brigham, 1987;Deffenbacher, 1980; Fruzzetti, Tolland, Teller & Loftus, 1992; Wells & Murray,1984). Nevertheless, Kebbell, Wagstaff and Covey (1996) have suggested that previ-ous researchers in this area may have paid insufficient attention to the issue of itemdifficulty.

Typically in work on C–A relationships, researchers attempt to select items toavoid floor and ceiling effects; i.e. they try to avoid items that are either very easy orvery hard to remember. In real life, however, forensic investigators may ask eyewit-nesses some questions that are easier to answer than others. For example, for anassault, an investigator may ask an eyewitness ‘What sex was the attacker?’. Genderis among the first items noticed about an individual and is very likely to be answeredaccurately. Furthermore, most eyewitnesses are likely to be very confident that theidentification of an individual’s sex is correct. Alternatively, an investigator might askan eyewitness, ‘What was the colour of the attacker’s eyes?’ This question might bemore difficult to answer and eyewitnesses may be less confident about their accuracy(see Christianson & Hubinette, 1993). Consequently, for easy questions eyewitnessesmight be both confident and accurate while for difficult questions they might be lessconfident and less accurate. In these circumstances a positive relationship betweenconfidence and accuracy would occur.

It may be the case, therefore, that in an attempt to avoid ceiling and floor effects,previous researchers may have chosen unrealistic and overly homogeneous pools ofitems, thus reducing the variance necessary for high correlations. Consequently,higher C–A relationships might result with the use of a heterogeneous range of ‘hard’or ‘easy’ questions. Another possibly important related factor is the relationshipbetween ‘absolutely certain’ responses and accuracy. ‘Absolutely certain’ responsesmay have a particularly strong impact on the police and jurors but are unlikely tooccur unless items that are easy are included. Regardless of the overall C–A relation-ship, it could be the case that the relationship between these ‘absolutely certain’responses and accuracy remains high (Gruneberg & Sykes, 1993).

Kebbell et al. (1996) addressed these issues by conducting two experiments thatmeasured C–A relationships in response to information seen in video films. In eachcase, questions were used that ranged in difficulty, from easy to hard. Higher C–Acorrelations than usually reported were found in both experiments (r = 0.54 and r =0.78). Furthermore, when subjects were ‘absolutely certain’ that a piece of informa-tion was correct they almost invariably were accurate. These findings have since beenreplicated (Pike, Towel & Kemp, 1995; see also, Sporer, Penrod, Read & Cutler,

158 Kebbell and Wagstaff


1995). This presents the possibility that by using questions of varying difficulty, it maybe possible to compare more sensitively and realistically differences between hypno-sis and control procedures in terms of their effects on the C–A relationship. The aimof the present study was to address this issue.

On the basis of previous research and theorizing we hypothesized that hypnosiswould have more of an adverse effect on C–A relationships than in control condi-tions. Two control conditions were used. A major problem in research in this area isdetermining what features of hypnotic interviewing procedures are responsible foruniquely ‘hypnotic’ effects. A whole host of factors are associated with hypnoticinterviewing quite apart from the hypnotic induction procedure itself (Spanos &Chaves, 1989). These include instructions to the witness to reinstate context mentally,report everything, recall events in different orders and change perspectives(Geiselman, Fisher, MacKinnon & Holland, 1985; Gudjonsson, 1992; Hibbard &Worring, 1981; Reiser, 1980, 1990; Wagstaff, 1982, 1993). Thus, for realism, an evalua-tion of the influence of hypnosis on C–A relationships should include these instruc-tions together with a hypnotic induction procedure. However, such instructionsthemselves form the components of a procedure called the ‘cognitive interview’(Geiselman, Fisher, Firstenberg, Hutton, Sullivan, Avetissian & Prosk, 1984) that canhave a positive effect on eyewitness performance (Fisher, 1995; Fisher & Geiselman,1992; Memon & Bull, 1991). The first control group therefore was a group given iden-tical instructions to the hypnosis group but without any induction procedure or men-tion of hypnosis.

Nevertheless, in ‘standard’ police interviews the above memory enhancementinstructions are not routinely used (Fisher, Geiselman & Raymond, 1987; George,1990). Therefore, the performance of subject-eyewitnesses in a control group usingthese memory enhancement instructions may overestimate that achievable using a‘standard’ police interview (Kebbell & Wagstaff, 1996). Consequently, a further‘standard’ control group was included in which subjects were given minimal instruc-tions to enhance memory.

METHOD

SubjectsFifty-three subjects (34 F; 19 M) of various backgrounds participated. Their mean agewas 22.60 years (range 18–52, SD = 6.19).

Materials and ProcedureSubjects were randomly assigned to one of three conditions; ‘hypnosis’ (N = 18), ‘cog-nitive interview’ (N = 17) or ‘standard’ (N = 16). Subjects were tested either individu-ally or in groups of up to five. They were shown a 5.5 min black and white video filmthat concerned the implied murder of a male by a female. After the film subjectswere given a face-recognition filler task that lasted approximately 10 minutes. Oncethe filler task had been completed subjects received one of the three following proce-dures.

Hypnosis condition. Subjects in the hypnosis condition were given the followinginformation: ‘One method that the Police use that may improve memory is hypnosis.I will now use a hypnotic procedure.’ These subjects were then played a 7.5 min tapedhypnotic induction procedure. This was a slightly modified version of the induction

Hypnosis and confidence 159


procedure provided by Barber (1969, pp. 251–254) for use with the BarberSuggestibility Scale. Subjects were required to report their state of hypnotic depthaccording to the modified Long Stanford Scale (LSS) (Tart, 1970). The LSS wasmodified to enable subjects to write down their answers (see Wagstaff & Ovenden,1979).

After the hypnotic induction subjects were given four taped instructions for mem-ory facilitation, which took 2 minutes. These were based on the four cognitive inter-view mnemonics used by Geiselman et al. (1984), though as mentioned earlier, similarinstructions have been used by hypno-investigators. (References to photographs inthese instructions refer to the previously mentioned face-recognition ‘filler’ task.None of these photographs concerned anyone shown on the film.) The instructionswere as follows:

• Reinstate context. ‘What I would like you to do now is to think carefully about thephotographs and the film that you saw. Think about what you felt and what youthought when you looked at the photographs and the film. Think about how youwere feeling at the time, and of your reactions to the photographs and to the film.Try to reinstate the context in your mind, of the physical environment in whichyou saw the photographs and the film, such as the location of objects and peoplein the room.’

• Report everything. ‘It is known that some witnesses hold back information —because they are not sure about what they can remember or do not know if theinformation is relevant. However, you must try to report everything that youcan.’

• Recall the events in different orders. ‘Most people remember details of an event ina certain order, from beginning to end. However, you should also try to recall thephotographs and the film that you saw in a different order — perhaps starting atthe end of the period that you viewed the photographs or the end of the film andworking backwards. Alternatively, you can start at a photograph or part of thefilm that you can remember particularly well and work either forward or back-wards from there.’

• Change perspectives. ‘People who witness events sometimes try to rememberevents from somebody else’s perspective, so try to remember what you wouldhave seen if you were a different person viewing the photographs or what youwould have felt and seen if you were one of the characters in the film.’

Subjects were then instructed to open their eyes, while remaining hypnotized, and toanswer a 33-item questionnaire (as used by Kebbell et al., 1996) devised to test theirrecall of the film. Questions were open-ended (i.e., not multiple-choice), but subjectswere required to provide an answer, even if this was only a guess. A forced-responsetask was to allow comparison with other work in this area (e.g., Kebbell et al., 1996;Smith, Kassin & Ellsworth, 1989). The questionnaire was devised by two experi-menters who agreed on 11 questions in each of three categories of item difficulty:easy, medium or hard. To reduce the influence of being correct by chance, each ques-tion was devised such that a range of plausible answers was possible. For example, aneasy question was ‘What song was the woman singing?’; a medium difficulty questionwas ‘What was on the dish next to the television set?’; and a hard question was ‘Whatwas behind the Tabasco sauce bottle in the kitchen?’. After answering each questionsubjects were required to rate their confidence in their answer on a 10-point Likertscale, ranging from ‘pure guess’ (1) to ‘absolutely certain’ (10).



On completion of the questionnaire subjects were again required to attempt theface-recognition, filler task (again this was the face-recognition task not describedhere), this also took approximately 10 minutes. Subjects were then ‘woken up’ bycounting from five to one. They were then debriefed and thanked for their participa-tion.

Cognitive interview condition. Subjects in the cognitive interview condition were firstgiven a reading filler activity designed to take the same time as the hypnotic induc-tion procedure. The filler activity consisted of two reasonably interesting magazinearticles. They were then given the following information, ‘One method that the Policeuse that may improve memory is a cognitive interview. I will now use a cognitiveinterview.’ Subjects were then played the tape recording of the four memorymnemonics used for the hypnosis group. This was so that ‘hypnosis’ per se would notbe confounded with differences in memory facilitation instructions between the twogroups. After these instructions subjects were required to complete the 33-item ques-tionnaire. On completion of the questionnaire subjects were again required toattempt the face-recognition, filler task.

Control condition. The procedure for the control condition was identical to that ofthe cognitive interview condition but without the mnemonic instructions. The readingfiller activity was increased in length so that there was a similar delay between stimulipresentation and memory testing as in the other groups. After the filler activity sub-jects were instructed as follows, ‘One method that the Police use that may improvememory is asking witnesses to try hard. Please try hard to remember the film and thephotographs.’ After this they were tested in the same way as the cognitive interviewcondition.

RESULTS

The mean hypnotic depth score for the hypnosis condition was 3.06 (SD = 2.15),approximating to a report of a state slightly deeper than ‘lightly hypnotized’. Therange of these scores, however, was from 0 to 6, ranging from ‘not at all hypnotized’,to ‘quite deeply and strongly hypnotized’ (Tart, 1970).

The questionnaire was analysed in a similar manner to that used by Kebbell et al.(1996). A one-way ANOVA (control/cognitive interview/hypnosis) was conductedfor correct answers, this was not significant. The means and standard deviations wereas follows: control condition M = 15.43 (SD = 2.55); cognitive interview condition M= 15.88 (SD = 2.78); and hypnosis condition M = 16.38 (SD = 2.70).

C–A correlations were calculated for each subject across the 33 questions, produc-ing 51 ‘within-subjects’ correlations (for a discussion of the relative importance of thevarious correlations that follow see Kebbell et al., 1996; and, Smith et al., 1989). Aswith previous work in this area, a Fisher’s z score was calculated for each subject’scorrelation. Average within-subjects C–A correlations were calculated for the differ-ent interview conditions and these were also transformed into z scores and the aver-age z score tested– against zero. The averages of these correlations and their levels ofsignificance (based on the converted z scores) are shown in Table 1. As can be seen inTable 1, all the within-subjects’ C–A correlations are significant. To assess the effectsof interview condition a one-way ANOVA was conducted on the within-subjects’ zscores across interview conditions (control/cognitive interview/hypnosis). This wasnot significant.



Each subject’s average accuracy was correlated with his or her average confidencerating. These ‘average’ correlations are also shown in Table 1. All three correlationsare significant.

Table 1. Within-subjects C–A correlations, each subject’s average confidence corre-lated with his or her average accuracy, between-subjects C–A correlations and theaverage confidence expressed in a question correlated with average accuracy for thatquestion for interview condition

Interview conditionControl Cognitive interview Hypnosis

Within-subjects 0.84** 0.83** 0.79*(0.8) (0.6) (0.08)

N = 16 N = 17 N = 18

Within-subjects (average) 0.69** 0.78** 0.63**N = 16 N = 17 N = 18

Between-subjects 0.59 0.54 0.53(0.39) (0.44) (0.36)N = 20 N = 18 N = 24

Between-subjects (average) 0.97*** 0.96*** 0.96***N = 33 (items) N = 33 (items) N = 33 (items)

Standard deviations are in brackets. *p < 0.05, **p < 0.01, ***p < 0.001

A C–A relationship was also then calculated across-subjects (‘between-subjects’)for each of the 33 questions. These correlations were again averaged, converted to zscores and tested for significance against zero for each interview condition. Thesecorrelations and significance levels for the z scores are shown in Table 1. None wassignificant.

The ’average’ number of correct answers and average confidence score for eachquestion was correlated for the three interview conditions; the results are displayed inTable 1. All three correlations are significant.

Average confidence in correct answers was compared with average confidence inincorrect answers with a 3 × 2 ANOVA (Control/Cognitive interview/Hypnosis ×Confidence in correct/Incorrect answers) with repeated measures on the second fac-tor. Means and standard deviations are shown in Table 2. This analysis indicated thatsubjects showed higher confidence in correct answers than incorrect answers, F(1,47)= 1741.61, p < 0.0001. There was no effect of interview condition and no interactionbetween confidence in correct/incorrect answers and interview condition.

‘Absolutely certain’ responses were considered independently. In the control con-dition subjects made 141 ‘absolutely certain’ responses of which 97.87 % were cor-rect; for the cognitive interview condition 175 ‘absolutely certain’ responses weremade of which 99.42 % were correct; and, for the hypnosis conditions 162 ‘absolutelycertain’ responses were made of which 98.15 % were correct. Clearly there were noobvious differences between the conditions in this respect.



Table 2. Average confidence expressed in correct and incorrect answers (on a 10-point Likert scale) with respect to interview condition and question difficulty

Correct/incorrect Interview conditionControl Cognitive interview Hypnosis

Correct 7.92 7.78 7.35(0.60) (0.88) (1.27)N = 16 N = 17 N = 18

Incorrect 2.25 1.85 2.13(0.83) (0.60) (0.55)N = 16 N = 17 N = 18

Standard deviations are in brackets

For the hypnosis group correlations were calculated between hypnotic depth andthe number of correct answers, number of incorrect answers, confidence in correctanswers, confidence in incorrect answers and within-subjects C–A correlations. Nonewas significant (p > 0.1 in all cases).

DISCUSSION

No significant differences were found between interview conditions in terms of correctanswers (the effects for incorrect answers ‘mirror’ those for correct answers because theparadigm was forced-choice). The failure to find any differences in correct recallbetween groups fits in with much previous work on hypnosis (Sheehan, 1988; Wagstaff,1993), but appears to conflict with previous results regarding the cognitive interview; asmost studies using cognitive interview procedures have shown memory enhancements(for a review see Fisher, 1995; Fisher & Geiselman, 1992; Memon & Bull, 1991). Thisdiscrepancy may be due to the use of a questionnaire and group testing, although previ-ous experiments have shown the cognitive interview to be effective in such situations(Geiselman et al., 1984). However, the experiment presented here differed from previ-ous studies in not physically changing the context, which might enable the context rein-statement mnemonic of the cognitive interview to show its effectiveness.

When C–A relationships were considered, however, considerable support wasfound for the view that, when questions that vary in difficulty are used, and therebythe probabilities of producing ‘absolutely certain’ and ‘pure guess’ responses aremaximized, C–A relationships are considerably higher than have been previouslyreported (e.g., Smith et al., 1989; Perfect, Watson & Wagstaff, 1993). These findingsreplicate those of by Kebbell et al. (1996) and indicate that, in general:

• Subjects are more confident about their correct answers than their incorrectanswers.

• Subjects who express higher confidence in their answers are more likely to beaccurate than subjects who expressed lower confidence.

• Questions that are given high confidence ratings are more likely to be answeredaccurately.

• When subjects are ‘absolutely certain’ that an answer is correct they are almostalways accurate.



Predictably also, non-significant correlations were found between subjects’ accuracyscores and confidence ratings for individual questions (with this particular analysis,floor and ceiling effects drastically reduce the number of correlations it is possible tocalculate and decrease the homogeneity of the responses). However, the three inter-view conditions had virtually no effect whatsoever on these various C–A measures.

Thus, the adverse influence of hypnosis on C–A relationships that might have beenexpected (e.g., Orne et al., 1984; Sheehan, 1988; Wagstaff, 1993) was not shown here. Itshould be pointed out, nevertheless, that no attempt was made in the present experi-ment to use deliberately misleading information, or to assess confabulation during freerecall; that is, manipulations that might have maximized hypnotic memory distortioneffects. Also, although the range of hypnotic depth scores was reasonable, none of thesubjects produced ‘hypnotic virtuoso’ scores on the LSS (Tart, 1970) (though none ofthe correlations between hypnotic depth and the other variables was significant).

Also the subject-witnesses did not take part in one-to-one interactive interviewsbecause we wished to ensure rigorous control of variables. The social situation cre-ated in interactive interviews may influence the recall of eyewitnesses and make themless or more confident in parts of their statements, depending the kind of pressureapplied, and longer retention intervals may also change the C–A relationship. Thesocial situation may be particularly important for both hypnosis and the cognitiveinterview; indeed, recent versions of the latter emphasize manipulating the social sit-uation to enhance recall (Fisher & Geiselman, 1992). Thus, future work might use-fully consider the relationship between interview technique, C–A relationships,question-difficulty and absence/presence of leading questions and/or misleading post-event information in more naturalistic settings. It should be pointed out, nevertheless,that, typically, studies that have been used to support the view that the addition of ahypnotic induction technique to an interviewing procedure renders that procedure‘unsafe’, have not used naturalistic settings either.

Thus although the present results cannot be assumed to support the view that hyp-notic forensic interviewing is ‘safe’; they do, however, suggest that it may be prema-ture to assume that hypnosis will routinely have adverse effects on C–A relationshipswhen no attempts are made to deliberately mislead the subject. This may be impor-tant given that, in more naturalistic field studies conducted in both the USA and theUK, using police interviewers, there is little evidence that interviewers attempt tomislead the witness when their interviews are recorded (Fisher et al., 1989).

ACKNOWLEDGEMENTS

The authors would like to thank the Economic and Social Research Council for fund-ing this project (Award No. R00429234159).

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Address for correspondence:

Mark Kebbell,Department of Psychology,Bolton Institute,Deane Road,Bolton BL3 5AB,UK.Email [email protected] 3 October 1996; revised version accepted 9 April 1997




BRIEF REPORT

ASSESSING HYPNOTIZABILITY AND DISSOCIATION INDIFFERENT CONTEXTS

Peter V. Butler* and Richard A. Bryant

University of New South Wales, Sydney, New South Wales, Australia

ABSTRACT

Subjects who had completed hypnotizability screening with the Harvard GroupScale of Hypnotic Susceptibility, Form A were subsequently administered theDissociative Experiences Scale in an independent context. Half the subjects wereprovided with the standard DES instructions and half were provided with informa-tion that minimized the salience of dissociative experiences. HGSHS:A scores cor-related significantly with both the standard DES (r = 0.31) and the DES-Taxonscale (r = 0.35). The modified instructions did not influence correlations withHGSHS:A scores. Findings are discussed in terms of contextual influences on DESresponses.

INTRODUCTION

The resurgence of interest in dissociation has resulted in considerable debate aboutthe most appropriate measure of dissociation (Kihlstrom, Glisky & Angiulo, 1994).The most common measure of dissociation is the Dissociative Experiences Scale(DES; Bernstein & Putnam, 1986). The DES is widely accepted as a standard mea-sure of spontaneous dissociation in both clinical and non-clinical samples (Waller,Putnam & Carlson, 1996). Recent revision of the DES has developed the DES-Taxon(DES-T), an 8-item abridged version of the scale that purportedly measures patho-logical dissociation (Waller et al., 1996). The extent to which the DES indexes disso-ciative processes has typically been evaluated by correlating scores on the DES withthose on standardized hypnotizability tests. There is divergent opinion, however, con-cerning the relationship between the DES and hypnotizability.

Nine experimental studies have investigated the relationship between the DESand hypnotizability. Five of these have investigated the relationship within the con-text of hypnotizability testing (Faith & Ray, 1994; Frischholz, Braun, Sachs, Schwartz,Lewis, Shaeffer, Westergaard & Pasquotto, 1992; Segal & Lynn, 1992–1993; Smyser& Baron, 1992; Di Tomasso & Routh, 1993). These studies administered batteries ofself-report inventories, including the DES, immediately prior to administering a stan-dard test of hypnotizability (either the Harvard Group Scale of HypnoticSusceptibility, Form A (HGSHS:A) or the Stanford Hypnotic Susceptibility Scale,Form C (SHSS:C) (Weitzenhoffer & Hilgard, 1962). Three of these studies reported

*Peter V. Butler is now at the Department of Behavioural Sciences in Medicine, University of Sydney, Sydney.


significant positive correlations between the DES and hypnotizability (Frischholz etal., 1992; Smyser & Baron, 1992; Di Tomasso & Routh, 1993), with coefficient valuesranging from 0.12 to 0.34. These findings generally have been interpreted as evidenceof the validity of the DES as a measure of dissociative tendencies. This claim is incon-sistent, however, with the findings of two studies that DES and hypnotizability scoreswere not significantly correlated when they were tested in the same context (Faith &Ray, 1994; Segal & Lynn, 1992–1993). Four studies have attempted to investigate therelationship between the DES and hypnotizability outside the context of hypnotiz-ability testing (Nadon, Hoyt, Register & Kihlstrom, 1991; Oakman, Woody &Bowers, 1996; Silva & Kirsch, 1992; Spanos, Arango & de Groot, 1993). Each of thesestudies reported non-significant correlations between hypnotizability and DESscores.

The discrepant correlations reported between hypnotizability and DES haveresulted in much debate over the extent to which contextual factors may influencethe correlations between these two measures. Different theorists have proposed thatthe potential influence of contextual factors on the relationship between the twomeasures has been attributed to an expectancy effect concerning subsequent hypnoticresponding, a need for self-consistency across tests, and a priming of awareness ofcertain dissociative experiences (for a review, see Oakman et al., 1996). The studiesconducted to date have been confounded, however, by variable sample sizes, the dif-ferent number of times the measures were administered, and varying order of admin-istration of the measures. For example, whereas Oakman et al. (1996) administeredthe hypnotizability test prior to the DES in one condition, they reversed this order intheir second condition. Such order effects clearly have an important bearing on inter-pretation of the causal influence of one measure on another (Council & Kirsch,1996). The present study aimed to investigate the relationship between the DES andhypnotizability scores by administering each only once, maintaining a consistentorder of administration, and assessing each measure in different contexts.

Sociocognitive theorists maintain that increasing the ambiguity about the relation-ship between hypnotizability and personality measures will decrease the intercorrela-tions between these measures (Spanos et al., 1993). Accordingly, a second aim of thepresent study was to investigate the influence of manipulating the instructional set ofthe DES by minimizing the salience of the dissociative experiences described in theDES items. Specifically, we administered one form of the DES that included the orig-inal introduction by Bernstein and Putnam (1986) and another that explicitlyinformed subjects that the experiences described in the DES are common experi-ences that may happen in partial or minimal ways. It was predicted that minimizingthe salience of the dissociative nature of the DES items would minimize the correla-tion between the DES and hypnotizability scores.

METHOD

SubjectsSubjects were undergraduate psychology students who participated in return forresearch credit. Subjects were preselected on the basis of previous participation in thegroup-administered, 12-item HGSHS:A (Shor & Orne, 1962). Of the 338 subjectswho participated in the HGSHS:A, 50 (39 females and 11 males) subjects of meanage 20.18 years (SD = 5.11) also completed the DES:A, and 44 (35 F; 9 M) subjects ofmean age 21.36 years (SD = 6.66) also completed the DES:B. Subjects who com-pleted the DES did not differ from those who did not complete the DES in terms of

168 Butler and Bryant


hypnotizability, age, or gender. Subjects who completed the DES but did not partici-pate in the HGSHS:A included 34 subjects who completed the DES:A and 34 whocompleted the DES:B.

ProcedureThe DES:A and DES:B were distributed to subjects during class between one andtwo weeks following completion of the HGSHS:A. In order to minimize any associa-tion between the DES and hypnotizability testing, the DES was packaged togetherwith a separate questionnaire on thought intrusions. Subjects were requested to com-plete the questionnaires at home and return them during their next class.

The instructions for the DES:A were identical to those of Bernstein and Putnam’s(1986) initial version of the DES. The instructions for the DES:B contained an addi-tional paragraph that explicitly informed subjects that dissociative experiences werenormal experiences that may occur to most people to some degree. The amendedinstructions were:

Please note that not everyone will have experiences that exactly match the onesdescribed in the questionnaire. We are interested in how often these experiences sort ofhappen to you. That is, you might find that you experience some of these things in apartial way. Please think about each item and consider if this sort of thing happens toyou in any way at all. Remember, it may happen intensely or it may happen in a mildsort of way. We are interested in all sorts of experiences.

RESULTS

Table 1 presents the correlation coefficients of HSHS:A scores and DES:A andDES:B. Scores on the DES:A and HGSHS:A were significantly correlated, r (50)= 0.31, p < 0.05. Scores on the DES:B and HGSHS:A were not significantly corre-lated, r (44) = 0.24, p = 0.12. A comparison of these two correlations indicated thatthe difference was not significant, z = 0.35, p = 0.36. Table 1 also presents intercorre-lations with the DES-Taxon (DES-T). The DES-T is a recent subscale of the DESthat comprises eight items that purportedly measure pathological dissociation(Waller et al., 1996). Table 1 indicates that the pattern of correlations between theHGSHS:A and DES-T were similar to those between the HGSHS:A and the DES;the correlation between the DES-T subscale and the HGSHS:A was significant forthe DES:A [r (50) = 0.35, p < 0.05] but not for the DES:B [r (44) = 0.27, p = 0.07]. Acomparison of these two correlations indicated that the difference was not signifi-cant, z = 0.37, p = 0.34

Table 1. Correlations of DES and HGSHS:A scores

Form A Form B

DES DES-T DES DES-T

HGSHS:A 0.31 0.35 0.24 0.27

Note. Form A = DES:A, Form B = DES:B.

Dissociation and hypnozability 169


The mean DES score for subjects who completed the DES:A (M = 18.18, SD =13.54) was not significantly different from the mean score of those who completed theDES:B (M = 18.57, SD = 12.75). Similarly, the DES-T scores of subjects who com-pleted the DES:A (M = 11.75, SD = 11.18) was not significantly different from themean score of those who completed the DES:B (M = 13.15, SD = 13.01). Carlson andPutnam (1993) suggest that a score of at least 30 on the DES is indicative of potentialdissociative psychopathology. Fourteen subjects (16.7%) who completed the DES:Aand 20 (25.6%) who completed the DES:B scored at least 30. A Mann-Whitney testindicated that this difference was not significant.

DISCUSSION

The current finding represents the first report of a significant correlation betweenthe DES and the HGSHS:A when administered in independent contexts. Further,the strength of the correlation (0.31) was markedly higher than most previousreported correlations with the DES (Spanos et al., 1993). We recognize that sub-jects may have perceived a connection between DES administration and hypnotiz-ability testing. Considering the novelty of hypnotic responses for manyundergraduate students, and the apparent similarity between some items on theHGSHS:A and some items described in the DES, it is plausible that participation inhypnotic testing may have cued subjects to respond in a hypnotic-like manner onthe subsequently administered DES. Council and Kirsch (1996) have argued thatcontextual influences can be most parsimoniously explained in terms of subjects’need to maintain consistency in their self-presentation. It is possible that our sub-jects responded to the DES in a manner that was consistent with their previoushypnotic performance so that their presentation appeared stable. Further, it is pos-sible that recent hypnotic testing may have had a priming effect that directed sub-jects’ attention to experiences that are associated with items on the HGSHS:A(Roche & McConkey, 1990). The minimum period between test measures in thecurrent study (one week) was shorter than in other studies that have separated thecontexts of testing (Nadon et al., 1991). It is possible that extending the inter-testinterval may have decreased the likelihood that subjects would have perceived thatthe two measures were related, and potentially decreased the correlation betweenthe measures. Finally, we recognize that permitting our subjects to complete theDES at home and return the questionnaire a week later may involve differentdemands from studies that have required completion of the DES within a specifiedand more formal setting. The current finding needs to be replicated in studies withsubstantially increased sample sizes, and with designs that ensure that subjects donot perceive that the two assessments are related.

Manipulating the instructional set for the DES did not affect the correlationbetween the DES and HGSHS:A. This finding is inconsistent with previous studiesthat have manipulated instructions to the DES. For example, Spanos and colleaguesfound that the DES and the Carleton University Responsiveness to Suggestion Scale(CURSS; Spanos, Radtke, Hodgins, Bertrand, Stam & Dubreuil, 1983) were signifi-cantly correlated when a link between the two measures was communicated in thepreliminary instructions to the DES, but not when these instructions were omitted. Itis possible that our instructional manipulation was too subtle and that the instructionsthat preceded DES:B did not communicate to subjects a sufficiently clear messageconcerning the desired perception of the DES items. Similarly, manipulation ofinstructional set did not influence the absolute level of responding on the DES.



Previous studies of contextual influences on DES responding have reported inconsis-tent effects on absolute DES scores. Whereas Nadon and colleagues (Nadon et al.,1991) reported differences in DES scores when tested in and out of the hypnotic con-text, others have found no differences (Oakman et al., 1996; Spanos et al., 1993).These patterns of findings suggest that contextual variables interact with a number ofrelevant factors to mediate the relationship between the DES and hypnotizability.The absence of an effect by our instructions suggests that future studies need to pro-vide clear and directive communications to explore the impact of the instructional seton DES responding.

In summary, the present finding provides initial evidence of a relationshipbetween DES responses and hypnotizability when tested in independent contexts.We suggest that this finding be interpreted cautiously because the possibility of unex-pected contextual influences mediating our subjects’ responses cannot be ruled out.There is a need to more rigorously investigate the relationship between these mea-sures in ways that ensure that overt and covert links between measurement proce-dures are comprehensively masked, and that the contexts are truly independent.

ACKNOWLEDGEMENTS

This study was supported by an Australian Research Council Small Grant. We aregrateful to Gladdis Warda, Fiona MacCallum, and Maree Abbott for assistance indata collection.

REFERENCESBernstein, E.M. & Putnam, F.W. (1986). Development, reliability, and validity of a dissociation

scale. Journal of Nervous and Mental Disease 174, 727–735.Carlson, E.B. & Putnam, J. (1993). An update on the Dissociative Experiences Scale.

Dissociation 6, 16–27.Council, J.R. & Kirsch, I. (1996). Explaining context effects: Expectancy and consistency.

Contemporary Hypnosis 13, 29–32.Di Tomasso, M.J. & Routh, D.K. (1993). Recall of abuse in childhood and three measures of

dissociation. Child Abuse & Neglect 17, 477–485.Faith, M. & Ray, W.J. (1994). hypnotizability and dissociation in a college age population:

Orthogonal individual differences. Personality and Individual Differences 17, 211–216.Frischholz, E.J., Braun, B.G., Sachs, R.G., Schwartz, D.R., Lewis, J., Shaeffer, D.,

Westergaard, C. & Pasquotto, M.A. (1992). Construct validity of the DissociativeExperiences Scale: II. Its relationship to hypnotizability. American Journal of ClinicalHypnosis 35, 145–152.

Kihlstrom, J.F., Glisky, M.L. & Angiulo, M.J. (1994). Dissociative tendencies and dissociativedisorders. Journal of Abnormal Psychology 103, 117–124.

Nadon, R., Hoyt, I.P., Register, P.A. & Kihlstrom, J.F. (1991). Absorption and hypnotizability:Context effects reexamined. Journal of Personality and Social Psychology 60, 144–153.

Oakman, J.M., Woody, E.Z. & Bowers, K.S. (1996). Contextual influences on the relationshipbetween absorption and hypnotic ability. Contemporary Hypnosis 13, 19–28.

Roche, S. & McConkey, K.M. (1990). Absorption: Nature, assessment, and correlates. Journalof Personality and Social Psychology 59, 91–101.

Segal, D. & Lynn, S.J. (1992–1993). Predicting dissociative experiences: Imagination, hypnotiz-ability, psychopathology, and alcohol use. Imagination, Cognition and Personality 12,287–300.

Shor, R.E. & Orne, M.T. (1962). Harvard Group Scale of Hypnotic Susceptibility, Form A. PaloAlto, CA: Consulting Psychologists Press.

Dissociation and hypnozability 171


Silva, C.E. & Kirsch, I. (1992). Interpretative sets, expectancy, fantasy proneness, and dissocia-tion as predictors of hypnotic response. Journal of Personality and Social Psychology 63,847–856.

Smyser, C.H. & Baron, D.A. (1993). hypnotizability , absorption, and subscales of theDissociative Experiences Scale in a nonclinical population. Dissociation 6, 42–46.

Spanos, N.P., Arango, M. & de Groot, H.P. (1993). Context as a moderator in relationshipsbetween attribute variables and hypnotizability. Personality and Social Psychology Bulletin19, 71–77.

Spanos, N.P., Radtke, H.L., Hodgins, D.C., Bertrand, L.D., Stam, H.J. & Dubreuil, D.L.(1983). The Carleton University Responsiveness to Suggestion Scale: Stability, reliability,and relationships with expectancy and ‘hypnotic experiences’. Psychological Reports 53,555–563.

Waller, N.G., Putnam, F.W. & Carlson, E.B. (1996). Types of dissociation and dissociativetypes: A taxometric analysis of dissociative experiences. Psychological Methods 1, 300–321.

Weitzenhoffer, A.M. & Hilgard, E.R. (1962). Stanford hypnotic susceptibility scale: Form C.Palo Alto, CA: Consulting Psychologists Press.


Richard A. Bryant,School of Psychology,University of New South Wales,NSW 2052,Australia.Email. [email protected]

Received 16 July 1996; revised version accepted 13 March 1997




BRIEF REPORT

RESPONSE EXPECTANCIES AND BELIEFS ABOUT HYPNOSIS:ANOTHER LOOK

Roger A. Page, George W. Handley and Joseph P. Green

The Ohio State University, USA

ABSTRACT

The present study found 266 undergraduates’ pre-induction beliefs about hypnosisand their self-reported expectation of experiencing hypnosis to correlate with theirperformance on the Harvard Group Scale of Hypnotic Susceptibility, Form A (Shor &Orne, 1962). Futhermore, participants tended to label their hypnotic experience (on a7-point scale employed by Radtke and Spanos, 1982) in a manner consistent withtheir pre-induction beliefs and expectancies. Finally, the present study showed thatpre-induction expectancies about the likelihood of being hypnotized influenced posthoc ratings of participants apart from actual hypnotic performance. Findings are dis-cussed as supporting Kirsch’s (1985) expectancy model of hypnosis.

INTRODUCTION

It has long been known that beliefs and attitudes can have a powerful impact on bothwaking and hypnotic responding. For example, Barber and Calverley (1964) foundthat waking suggestibility was lowered when participants believed that responding totest items was indicative of gullibility. Others have found this to be the case for hyp-notic responding as well (e.g., Diamond, Gregory, Lenney, Steadman & Talone,1974).

In recent years, Kirsch, Council, and their coworkers have presented strong evi-dence that the key mediating variable in this relationship is expectancies of respond-ing. Kirsch, Council and Vickery (1984) reasoned that the poor correlations betweenpre-induction expectancies and post-induction responsivity may be due to expectan-cies being ‘changed by the experience of a trance induction in a way that cannot bepredicted from hearing a preinduction rationale’ (p. 709). This argument is supportedby the finding of Council, Kirsch and Hafner (1986) that pre-induction responseexpectancies correlated only modestly with responsivity while post-inductionresponse expectancies (obtained prior to hypnotic suggestions) correlated muchhigher with responsivity. Kirsch (1994) has recently concluded, ‘Not only doesexpectancy determine when hypnotic responses occur, but it also determines whatsubjects experience and how they behave in hypnotic situations’ (p. 98).

A lingering debate centres on what participants’ after-the-fact descriptions oftheir hypnotic experiences actually mean. Barber, Dalal and Calverley (1968) foundthat the way a question is worded can dramatically affect what a participant saysabout a hypnotic experience. More recently, Radtke and Spanos (1982) similarly


found that when given a 4-point hypnotic depth scale (where one option was ‘nothypnotized’), 81% of participants selected a ‘hypnotized’ option, whereas only 25%selected a ‘hypnotized’ option when given a 7-point scale (where four options were‘not hypnotized’). However, as Orne (1972) argued earlier in regard to the effect of(biased) wording on participants’ responses, this ‘ought not to be taken as evidencethat the manner in which questions are phrased determines the experience that the Sis reporting’ (p. 424).

Although phrasing of questions is undoubtedly an important determinant of after-the-fact descriptions of hypnotic experiences, expectations cannot be ignored.Specifically, whether certain preinduction beliefs (and expectations) are confirmed ordisconfirmed by the participant’s experience could play an important role in after-the-fact descriptions of one’s hypnotic experience. For example, consider the findingof McConkey (1986) that participants who believed that hypnosis is an altered statewere less likely to experience its effects when later administered the Harvard GroupScale of Hypnotic Susceptibility, Form A (HGSHS:A) (Shor & Orne, 1962). Kirsch(1994) has offered the following possible explanation for their lowered responsivity:

Even if they are eager, rather than afraid of experiencing trance, the idea of a trance stateleads them to hold unrealistically high standards for evaluating whether or not they havebeen hypnotized. When they conclude that they are not in a trance, their responseexpectancies, and hence their subsequent responses, are lowered. (pp. 101–102).

Other of McConkey’s findings might be explained in a similar manner. For exam-ple, many of those who initially believed that hypnosis was an altered state of con-sciousness (before their exposure to a hypnotic induction) viewed hypnosis asinvolving focusing of attention and thinking along with and imagining suggestionsafter their hypnotic experience. It would appear that as a result of having had theirexpectations about hypnosis disconfirmed, some participants redefined hypnosiswhile still believing that they had been hypnotized. For others, it is possible that thisdisconfirmation led them to decide that they had not been hypnotized even if theyfound themselves being highly responsive! Given both hypnotic and non-hypnoticoptions with which to describe their experience, these individuals, as well as thosewho for whatever reason may wish to deny that they experienced hypnosis, would inall likelihood select one of the non-hypnotic options (e.g., ‘I was absorbed but nothypnotized’).

The present one-group correlational study attempts to examine the relationshipbetween some pre-induction beliefs and hypnotic responding, as well as after-the-factdescriptions of hypnotic experience. Beliefs were assessed by a brief 12-item scale(included in Table 3 below). Specifically, a positive correlation was predictedbetween the final two items (11 and 12, ‘Do you think that you will be able to experi-ence hypnosis?’ and ‘If yes, to what extent?’, respectively) of the belief scale andHGSHS:A score. In addition, we also expected participants’ pre-induction beliefs tocorrelate with their post-hypnotic ratings of their experiences. Specifically, a negativecorrelation was predicted between questionnaire items 3, 6, and 8 (beliefs that hypno-sis weakens one’s will, requires a gullible person, and may result in demonic posses-sion, respectively), and susceptibility. In addition, these items were predicted tocorrelate with post-hypnosis subjective ratings. Regarding the pre-induction itemsthemselves, significant intercorrelations were expected for both (expectancy) items11 and 12 and item 1 (i.e., people endorsing ‘everyone can be hypnotized’ should be

174 Page, Handley and Green


more likely to hold a positive expectancy that they will be able to be hypnotized),item 6 (i.e., people endorsing the belief that one has to be gullible or have a ‘weak’mind to be hypnotized are more likely to believe that they will not be able to be hyp-notized), and finally item 8 (i.e., people endorsing the belief that hypnosis may leadto demonic possession are less likely to believe they will be hypnotizable). Other cor-relations were anticipated between items 2 and 9 (i.e., people endorsing the beliefthat hypnosis involves a loss of consciousness are more likely to believe there will beno memory of their experience following hypnosis), and finally between items 1 and 7(i.e., people endorsing the belief that people can be hypnotized against their will aremore likely to believe that everyone can be hypnotized).

METHOD

ParticipantsParticipants were 266 college undergraduates (120 M; 146 F) enrolled in introductorypsychology classes who received credit for completing participation in all aspects ofthe study. Their age ranged between 16–52 years (mean 20.7, SD = 5.61). Seven par-ticipants who indicated that they had previous hypnotic experience were droppedfrom all subsequent analyses.

ProcedureAll participants completed a ‘hypnosis survey’ (HS) consisting of 10 ‘True/False’questions regarding some commonly held beliefs about hypnosis, followed by ques-tions to ascertain whether they believed that they would (‘Yes’ or ‘No’) and to whatextent they would be able to experience hypnosis (on a 7-point Likert scale rangingfrom ‘a little’ to ‘very much’). Three days later, participants were given a tape-recorded version of the HGSHS:A (Shor & Orne, 1962) during their regular classperiod. After completing the HGSHS:A response booklet they then completed thefollowing 7-point scale employed by Radtke and Spanos (1982) to describe theirexperience:

1. I was neither hypnotized nor absorbed while responding to the suggestions.2. I experienced the effects of the suggestions and was absorbed in the suggestions

and was hypnotized while responding to a slight degree.3. I experienced the effects of the suggestions and was absorbed in the suggestions

and was hypnotized while responding to a moderate degree.4. I experienced the effects of the suggestions and was absorbed in the suggestions

and was hypnotized while responding to a high degree.5. I experienced the effects of the suggestions and was absorbed in the suggestions

while responding to a slight degree. However, I was not hypnotized.6. I experienced the effects of the suggestions and was absorbed in the suggestions

while responding to a moderate degree. However, I was not hypnotized.7. I experienced the effects of the suggestions and was absorbed in the suggestions

while responding to a high degree. However, I was not hypnotized.

Finally, participants indicated the extent to which they subjectively experiencedeach HGSHS:A suggestion (SUBJ), and the extent to which those suggestions wereexperienced as involuntary (INVOL) on a 4-point scale ranging from ‘not at all’ to ‘agreat degree’ (as described by Lynn, Neufeld & Matyi, 1987).

Response expectancies and beliefs about hypnosis 175



Tab

le 1

. Cor

rela

tion

s (b

etw

een

pre-

and

pos

t-in

duct

ion

mea

sure

s)

HS1

HS2

HS3

HS4

HS5

HS6

HS7

HS8

HS9

Hs1

0H

s11

HS1

2

HS1

–H

S20.

08–

HS3

0.03

0.16

–H

S40.

06–0

.03

0.01

–H

S50.

070.

16*

0.02

0.25

*–

HS6

–0.1

–0.0

40.

23*

–0.0

7–0

.13

–H

S70.

28*†

0.16

*0.

090.

120.

14–0

.15

–H

S8–0

.02

0.08

0.07

0.02

–0.0

50.

28*

–0.0

3–

HS9

0.15

0.18

*†0.

16*

0.06

0.28

*–0

.06

0.14

0.0

–H

S10

0.18

*0.

2*0.

25*

–0.0

20.

130.

19*

0.1

0.08

0.17

*–

HS1

1–0

.25*

†0.

090.

02–0

.13

–0.0

70.

25*†

–0.1

9*0.

14†

0.04

0.17

*–

HS1

2–0

.23*

†0.

110.

06–0

.09

–0.1

10.

17*†

–0.1

50.

08†

0.1

0.18

*0.

79**

●●–

HA

RV

0.02

–0.0

2–0

.06◆

†0.

01–0

.15

0.13

†–0

.08

–0.0

5◆†

0.04

0.11

0.25

*†0.

3*†

SUB

J0.

020.

02–0

.06◆

†–0

.06

–0.1

7*0.

17*†

–0.1

–0.0

6◆†

0.08

0.07

0.25

*†0.

31*†

INV

OL

0.01

0.03

–0.0

7◆†

–0.0

7–0

.2*

0.15

†–0

.11

–0.0

5◆†

0.08

0.09

0.25

*†0.

32*†

* P

= 0

.01

**

P<

0.0

01

†P

redi

cted

◆O

ppos

ite

dire

ctio

n pr

edic

ted

●●P

arti

ally

ove

rlap

ping


RESULTS

The mean HGSHS:A score for all participants was 5.61 (SD = 2.98), well within therange for previous studies.

Several predicted correlations between pre-induction items did reach signifi-cance, the largest being 0.28 between the belief that everyone can be hypnotized(HS item 1) and that people can be hypnotized against their will (item 7). All testswere two-tailed and an alpha level of 0.01 was adopted due to the large number ofcorrelations.

Table 1 shows that of the 23 predicted relationships for all measures (excludingthe expected intercorrelations of the post-hypnosis dependent measures and betweenHS items 11 and 12), most (17 of 23) were in the expected direction and 13 were sig-nificant. (All six correlations opposite to the predicted direction were small and non-significant.)

Most correlations between pre- and post-induction measures tended to be low,but several were significant (the highest being 0.32 between HS item 12 and theextent to which suggestions were experienced as involuntary (INVOL). The intercor-relations of post-induction measures are presented in Table 2.

Table 2. Correlations of post-induction measures

HGSHS:A SUBJ

HGSHS:A –SUBJ 0.81** –INVOL 0.78** 0.91**

** P < 0.01

To examine the possibility of differential patterns of expectancy among lowthrough to high hypnotizable participants, correlations were computed for HS item12 separately for low (0–3), medium (4–7), and high (8–12) HGSHS:A scorers.Pearson correlations for low (N = 67), medium (N = 112), and high (N = 80) sug-gestable participants were 0.31, 0.18, and 0.21, respectively. Although only the firstreached significance (P = 0.01), the latter two approached significance at the 0.05level (P = 0.053 and P = 0.057, respectively). A χ2 test of homogeneity indicated thatthe three correlations did not differ from one another (χ2 = 0.72, NS). For all partici-pants, the HS 12/HGSHS:A correlation was 0.3. A significant point biserial correla-tion was also obtained between HS item 11 and HGSHS:A score (r = 0.25) indicatingthat participants who believed that they would be able to experience hypnosis provedmore responsive on the HGSHS:A (see Table 1 above).

Participants were grouped on the basis of which of three broad options on theRadtke and Spanos (1982) scale that they selected: ‘neither absorbed nor hypnotized’(N = 25); ‘absorbed but not hypnotized’ (N = 123); or ‘absorbed and hypnotized’(N = 111). A series of c2 tests were then performed to examine the frequency ofendorsing true versus false on the 10 pre-induction HS beliefs, as well as their ‘Yes’or ‘No’ response to item 11 asking if they thought that they would be able to experi-ence hypnosis (see Table 3).



Table 3. χ2 analysis of hypnosis survey item endorsement as a function of subsequentselection on the Radtke–Spanos (1982) scale

Radtke–Spanos categoryItem Neither Hypnotized Absorbed χ2 P

hypnotized and (%)nor absorbed absorbed

(%) (%)

1 12.0 29.7 20.3 4.92 0.092 36.0 27.9 35.8 1.8 0.413 36.0 35.1 30.9 0.57 0.754 8.0 21.6 12.2 5.16 0.085 40.0 64.9 65.0 6.01 0.056 16.0 3.6 6.5 5.45 0.077 20.0 27.0 27.6 0.64 0.738 4.0 3.6 4.1 0.04 0.989 52.0 51.4 71.5 10.94 0.004

10 52.0 48.6 52.8 0.42 0.8111 48.0 90.1 73.2 24.23 0.00001

Item 1: ‘Everyone can be hypnotized’; 2: ‘Hypnosis involves a loss of consciousness’;3: ‘Hypnosis involves a weakening of one’s will’; 4: ‘Hypnosis can cure physical ill-nesses’; 5: ‘Hypnosis can cure psychological illnesses’; 6: ‘Hypnosis requires a personthat is gullible and has a weak mind’; 7: ‘People can be hypnotized even if they don’twant to be’; 8: ‘Hypnosis may result in a person being possessed by demons’; 9 ‘Mostpeople have no memory of their experience after being hypnotized’; 10: ‘Hypnosis isa “mind game”’; 11: ‘Do you think that you will be able to experience hypnosis?’(YES/NO); 12: ‘If “Yes”, to what extent?’(a little bit very much).

The ‘Hypnosis can cure psychological illnesses’ (HS item 5) was significant (χ2 =6.01, P = 0.05) with ‘neither absorbed nor hypnotized’ participants endorsing falsemore frequently. The item ‘Most people have no memory of their experience afterbeing hypnotized’ (HS item 9) was highly significant (χ2 = 10.94, P = 0.004), with the‘absorbed but not hypnotized’ group selecting true more frequently. Finally, the item‘Do you think that you will be able to experience hypnosis?’ (HS item 11) was alsohighly significant (χ2 = 24.23, P = 0.00001). Of those who selected a hypnotizedoption, 90.1% (N = 100) had previously expressed the belief that they would be ableto experience hypnosis. Futhermore, 80.7% (N = 46) of those who selected a non-hypnotized option had previously expressed their belief that they would not be ableto experience hypnosis.

Examination of responses from only those participants who selected either the‘absorbed and hypnotized’ or the ‘hypnotized but not absorbed’ options indicatedthat participants’ expectations regarding the likelihood of being hypnotized (HS item12) as well as actual HGSHS:A performance, correlated with ratings on the Radtkeand Spanos (1982) scale (r = 0.23, P < 0.001 and r = 0.31, P < 0.001, respectively).Futhermore, when controlling for HGSHS:A scores, we obtained a significant partialcorrelation between participants’ expectation of being hypnotized (HS item 12) andresponses on the Radtke and Spanos (1982) scale (r = 0.17, P < 0.005).



DISCUSSIONSince most predicted correlations were significant and in the predicted direction, wecan generally say that pre-induction beliefs tend to be consistent, and that some ofthese (e.g., beliefs about the ability to experience hypnosis) have predictive powervis-à-vis later hypnotic responding and descriptions of their experience. However, itshould be noted that although significant, these correlations tended to be small.Several correlations between pre-induction items reached significance, but were notpredicted a priori. Upon reflection, most of these seem to make sense. For example, acorrelation of 0.28 between equating hypnosis with gullibility and a weak mind (HSitem 6) and belief that hypnosis may result in possession by demons (item 8).

The somewhat low correlation of 0.3 obtained between the expectancy measure(HS item 12) and HGSHS:A score is in the range previously found for pre-inductionexpectancy measures as opposed to higher correlations found for post-induction mea-sures (e.g., Council et al., 1986). The pattern of correlations obtained for low throughto high responsive participants is not consistent with the two-factor model ofBalthazard and Woody (1992) which proposes two mechanisms underlying hypnoticperformance in which ‘although easy hypnotic performances do not require theprocesses tapped by individual differences in absorption, a certain level of absorptionis necessary to pass difficult hypnotic items’ (p. 21). One implication of the model isthat expectancies should be more highly correlated with susceptibility scores amongthose who are relatively unresponsive than among those who are more responsive.Thus, the model would predict that correlations between expectancy (HS item 12)and HGSHS:A score will decrease as the hypnotizability level of the group increases.Yet the correlations of 0.31, 0.18, and 0.21 obtained for low through to high respon-sive groups do not present a consistent decreasing pattern, but instead did not collec-tively differ from one another.* This finding is consistent with those recently reportedby Kirsch, Silva, Comey and Reed (1995).

Of the three significant χ2 analyses, the first (participants who responded true to‘Hypnosis can cure psychological illnesses’ were more likely to select the ‘neitherabsorbed nor hypnotized’ option) is somewhat puzzling since it was not only unex-pected, but does not lend itself to any obvious post hoc rationale. The second signifi-cant analysis (participants who responded true to ‘Most people have no memory oftheir experience after being hypnotized’ also tended to select the ‘absorbed but nothypnotized’ option) could be readily explained by arguing that this unrealistic beliefregarding hypnosis was disconfirmed by their actual experience (i.e., they remem-bered everything) and therefore selected an absorbed (but not hypnotized) optionretrospectively, a similar interpretation to that of Kirsch (1994). The final significantanalysis (participants who responded false to ‘Do you think that you will be able toexperience hypnosis?’ were more likely to later select a ‘non-hypnotized’ option)could be accounted for by Kirsch’s (1994) expectancy model: initial negative expecta-tions ultimately translated into selecting ‘non-hypnotized’ options to describe theirexperiences.

An interesting finding was that participants’ post hoc ratings of hypnotic experi-ences were consistent with their pre-induction beliefs regarding the likelihood thatthey would be hypnotized. Participants who, after hypnosis, described themselves asbeing both ‘absorbed and hypnotized’ were more likely to have a positive pre-induc-


*Even when we used a more stringent criterion to define high responsive group status (i.e.,HGSHS:A score of 10 and above) the correlation between HS item 12 and HGSHS:A score forhigh hypnotizables (N = 22) was essentially the same (r = 0.22).


tion expectancy that they would be hypnotized. Even after controlling for perfor-mance on the HGSHS:A, we found that pre-induction expectancies influenced posthoc ratings. Clearly, pre-induction expectations play an important role in how partici-pants define their subjective experiences retrospectively (see Kirsch, Council &Vickery, 1984).

Our results support Kirsch’s (1994) expectancy model, whilst emphasizing notonly the role that expectancies play in determining hypnotic experiences but also therole they may play in retrospective descriptions of hypnotic experiences when theyhave been either confirmed or disconfirmed. Our results also suggest that in additionto beliefs (and expectancies) having predictive power regarding hypnotic respondingand experiences, some beliefs may be able to predict who will not participate in hyp-nosis studies.*

A final few points are worth making: firstly, it may prove fruitful for future studiesto investigate some of the more predictive beliefs by use of more sensitive measures,for example, an ordinal scale as employed recently by Echterling and Whalen (1995).Secondly, the present study employed a one-group correlational approach.Therefore, one should be cautious about generalizing from these findings. Futureresearch might attempt to manipulate some of the participants’ preinduction beliefsexamined in the present study to more fully investigate how expectancies affect hyp-notic responsiveness and post hoc ratings of hypnotic experience.

ACKNOWLEDGEMENTS

The assistance of Hope Sterling in this research is gratefully acknowledged.

REFERENCESBalthazard, C.G. & Woody, E.Z. (1992). The spectral analysis of hypnotic performance with

respect to ‘absorption’. International Journal of Clinical and Experimental Hypnosis 40,21–43.

Barber, T.X. & Calverley, D.C. (1964). Empirical evidence for a theory of ‘hypnotic’ behavior:effects of pretest instructions on response to primary suggestions. The PsychologicalRecord 14, 457–467.

Barber, T.X., Dalal, A.S. & Calverley, D. (1968). The subjective reports of hypnotic subjects.American Journal of Clinical Hypnosis 11, 74–88.

Council, J.R., Kirsch, I. & Hafner, L.P. (1986). Expectancy versus absorption in the predictionof hypnotic responding. Journal of Personality and Social Psychology 50, 182–189.

Diamond, M.J., Gregory, J., Lenney, E. & Talone, J.M. (1974). An alternative approach to per-sonality correlates of hypnotizability: hypnosis-specific mediational attitudes. InternationalJournal of Clinical and Experimental Hypnosis 22, 346–353.

Echterling, L.G. & Whalen, J. (1995). Stage hypnosis and public lecture effects on attitudesand beliefs regarding hypnosis. American Journal of Clinical Hypnosis 38, 13–21.

Kirsch, I. (1985). Response expectancy as a determinant of experience and behavior. AmericanPsychologist 40, 1189–1202.

Kirsch, I. (1994). Clinical hypnosis as a nondeceptive placebo: empirically derived techniques.American Journal of Clinical Hypnosis 37, 95–106.


*To illustrate, a total of 314 students responded to the initial hypnosis survey, whilst 266 com-pleted participation which included the group induction. A χ2 analysis of responses to HS item8 (demonic possession) with returning versus not returning for the hypnotic induction revealeda highly significant difference: a larger proportion of those failing to return for hypnosisbelieved demonic possession was possible (χ2 = 12.5, P < 0.001).


Kirsch, I., Council, J.R. & Vickery, A.R. (1984). The role of expectancy in eliciting hypnoticresponses as a function of type of induction. Journal of Consulting and Clinical Psychology52, 708–709.

Kirsch, I., Silva, C.E., Comey, G. & Reed, S. (1995). A spectral analysis of cognitive and per-sonality variables in hypnosis: empirical disconfirmation of the two-factor model of hyp-notic responding. Journal of Personality and Social Psychology 69, 167–175.

Lynn, S.J., Nuefeld, V. & Matyi, C.L. (1987). Hypnotic inductions versus suggestions: theeffects of direct and indirect wording. Journal of Abnormal Psychology 96, 76–80.

McConkey, K.M. (1986). Opinions about hypnosis and self-hypnosis before and after hypnotictesting. International Journal of Clinical and Experimental Hypnosis 34, 311–319.

Orne, M.T. (1972). On the simulating subject as a quasi-control group in hypnosis research:what, why, and how? In E. Fromm & R.E. Shor (Eds.). Hypnosis: Research Developmentsand Perspective. Chicago, IL: Aldine–Atherton, pp. 399–443.

Radtke, H.L. & Spanos, N.P. (1982). The effect of rating scale descriptors on hypnotic depthreports. Journal of Psychology 111, 235–245.

Shor, R.E. & Orne, E.C. (1962). The Harvard Group Scale of Hypnotic Susceptibility, Form A.Palo Alto, CA: Consulting Psychologists Press.


Roger A. Page,The Ohio State University,4240 Campus DriveLimaOhio 45804, USA.

Received 22 July 1996; revised version accepted 19 February 1997




CLINICAL REPORT

PARTICIPATING IN THE CULTURE OF CANCER:A DEMILITARIZED APPROACH TO TREATMENT

Douglas G. Flemons and Judith A. Shulimson*

Nova Southeastern University

ABSTRACT

This case study describes the use of hypnosis with an anthropologist diagnosed withbreast cancer. The therapist utilized the client’s sense of identity as a qualitativeresearcher, as well as her knowledge of and respect for indigenous cultures, to helpher actively engage in her chemotherapy treatment and to help her better tolerate theside-effects of the medication. He also used hypnosis to attempt to improve the func-tioning of her immune system, employing, at her request, an alternative approach tostandard military-based images. Considering immunity to be a cognitive process, thetherapist designed metaphors that focused on improving the immune system’s abilityto perceive, learn, and achieve balance.

The second author (JS) approached the first (DF) in the summer of 1990 with arequest for hypnosis. JS had been diagnosed with breast cancer a few months earlier,and had, at the time of her call, undergone a lumpectomy and one round ofchemotherapy. The experience had left her despondent. Feeling betrayed by herbody and depersonalized by the attitudes of her doctors and medical technicians, JSfound herself fighting the treatment regime. She was distressed and angry at, andafraid of, what she deemed ‘the aggressive chemical warfare’ called for by her oncolo-gist. A journal entry at that time reads:

I need time to think through this chemotherapy thing. I can’t continue with it unless Ican change my attitude about it. . . . [It] seems like such a brutal way to treat a body. . . .The cure is worse than the disease, especially since the disease hasn’t really caused meany problems so far; it’s the treatment that has made me so sick. . . . The first chance Iget to think about continuing with chemotherapy I start thinking of running away. . . .Chemotherapy: metaphors of aggression, destruction, violence, warfare.

JS felt like a character in someone else’s novel. Buffeted about by the whims of someinsensitive and controlling author, and not at all liking the way the plot was unfold-ing, she wanted out. It had begun to feel more human, more ‘right’ just to let the can-cer take its course. Surely, she reasoned, there would be more dignity in dying than insubmitting to the ‘military mentality’ of the medical professionals. She thought about

*Dr Shulimson died of breast cancer on January 26, 1993. The original draft of this paper waswritten collaboratively.


giving up, about refusing to eat, but she recognized that her husband and her doctorswould not let her romantically swoon into death. There would be IVs and machinesand nurses and recriminations. And the thought of being hooked up to tubes andmachines scared her as much as, or more than, dying. Feeling hopeless and helpless,she called DF for an appointment.

During our first session, we agreed to work towards minimizing the side effects ofthe chemotherapy and helping JS engage in her medical treatment in a way thatdidn’t leave her feeling like a victim. A few hours after this appointment, JS receivedfurther bad news. A CT scan of her chest revealed metastasis: she had three nodulesin her right lung. This prompted us to discuss the possibilities of also using hypnosisto help bolster her immune system. JS was intrigued by the Simontons’ work on visu-alization with cancer patients; however, she was distinctly bothered by their charac-terization of white blood cells as ‘efficient killers’ (Simonton, Matthews-Simonton &Creighton, 1978). She wasn’t squeamish about death, but she didn’t like their war-tinged metaphors and imagery.

The medical anthropologist Emily Martin (1990) investigated the predominantimages used in popular and scientific explanations of the immune system and foundthat military and police-state metaphors pervade the thinking of lay person and scien-tist alike. Our culture views the body as a ‘nation state at war over its external bor-ders, containing internal surveillance systems to monitor foreign intruders’ (Martin,p. 410). In the realm of this imagery, cancer becomes ‘an illness experienced as aruthless secret invasion’ (Sontag, 1978, p. 5) or as an attack by ‘the self’s malignanttraitor cells’ (Haraway, 1989, p. 26). Martin (1990) interviewed a number of biologicalscientists for her study, but she found none who could offer alternative imagery forthe current ‘warfare/internal purity model’ of the immune system (p. 418). JSdespaired, not only about her own situation, but about this general orientation ofmedical science. A cultural anthropologist and folklorist, she was sensitive to themetaphoric nature of language, to the way it orients and influences our thought andaction (Lakoff & Johnson, 1980). She recoiled from her doctor’s militarized under-standing of her immune system, and she certainly didn’t want us, in our hypnosiswork, to fight death with images of infantry, armored combat units, mines, missiles,bombs, annihilation, assault, execution, and cannibalism (Martin, 1990).

As a systems-oriented therapist, DF had a theoretical foundation from which analternative set of immunity-enhancing hypnotic suggestions could be developed (e.g.,Flemons, 1991); however, the first step was to help JS engage differently with herdoctors and her chemotherapy treatment; to help her stop feeling like a victim. DFsuggested to JS, a professor strongly committed to her discipline, that she was missingan invaluable research opportunity. Why did she not apply her qualitative researchskills to the culture of cancer? What would happen if she were to become a partici-pant observer of her interactions with her oncologist, radiologist, laboratory techni-cians, etc., as well as with the chemotherapy itself? Could she not keep field notesand write an account of her investigation? And why not, while she was at it, conduct aqualitative study of our hypnosis sessions? JS was intrigued by the idea. She becameactively engaged in our hypnosis work (to be described below), developed a varietyof research and writing projects for herself, her classes, and with DF (including thewriting of this paper), and became an active ‘co-author’ of her experience with herdoctors, treatment, cancer, and, ultimately, death.

Participating in the culture of cancer 183


HYPNOSIS FOR CHEMOTHERAPY SIDE EFFECTS AND FEELINGSOF HELPLESSNESS

JS had done the anthropological fieldwork for her dissertation among the Inuit in vil-lages in Alaska, and she was deeply respectful of the healing practices of indigenouspeoples. Accordingly, DF likened hypnosis for her to a shamanic journey. He askedJS, as part of one of his first inductions, to go in search of a talisman that could beused for both facilitating her shamanic travels and focusing her healing process:

Once you can see this talisman, take it into your hand . . . and as you hold it, feel its tex-ture and smell its scent. . . . Breathe it in. . . . This talisman can help you find theentrance to the tunnel down . . . the entrance to your journey into the darkness . . . andit can serve as your Rosetta stone, to help guide your way and guide your healing.

Deepening of the hypnotic experience was facilitated by offering images of theshaman finding new tunnels to descend, each one successively opening onto a differ-ent vista where a particular healing practice could be performed. DF drew analogiesbetween the use of poisons in native cultures — particularly as part of shamanic prac-tice and during rites of passage — and the chemicals used in cancer treatment:

Many cultures have rituals that serve as crucibles, and the participants go through expe-riences they would never voluntarily undertake. E

contemporary hypnosis (1997) · 2020. 7. 6. · contemporary hypnosis (1997) vol. 14, no. 3, pp....

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