Stanford Hypnotic Clinical Scale Research Articles

The Association Between Mindfulness and Hypnotizability: Clinical and Theoretical Implications

Mindfulness-based interventions and hypnosis are efficacious treatments for addressing a large number of psychological and physical conditions, including chronic pain. However, there continues to be debate surrounding the relative uniqueness of the theorized mechanisms of these treatments—reflected by measures of mindfulness facets and hypnotizability—with some concern that there may be so much overlap as to make the mechanism constructs (and, therefore, the respective interventions) redundant. Given these considerations, the primary aim of the current study was to examine the degree of unique versus shared variance between two common measures of mindfulness facets and hypnotizability: the Five Facet Mindfulness Questionnaire and the Stanford Hypnotic Clinical Scale. A cross-sectional survey was conducted with a sample of (N = 154) veterans with heterogeneous chronic pain conditions. Bivariate Pearson correlations were used to examine the associations between the target scales. Results showed that the correlations between the Five Facet Mindfulness Questionnaire scales and Stanford Hypnotic Clinical Scale total score were uniformly weak, although significant negative correlations were found between mindfulness facets of observe and nonreact with hypnotizability (ps < 0.05). Thus, not only are the mindfulness and hypnotizability constructs unique, but when significantly associated, hypnotic suggestibility corresponds with a tendency to be less mindful. These findings have important implications for future research aimed toward matching patients to the treatment most likely to be of benefit, and suggest that matching patients on the basis of these theoretically derived “unique” moderators may hold potential.

Translation, Adaptation, and Validation of the Stanford Hypnotic Clinical Scale in Puerto Rico

The only hypnotizability scale that has been translated and validated for the Puerto Rican population is the Barber Suggestibility Scale (BSS). In this article, the Stanford Hypnotic Clinical Scale (SHCS) was translated and validated for this population. The translated SHCS (“Escala Stanford de Hipnosis Clínica” [ESHC]) was administered individually to 100 Puerto Rican college students. There were no significant differences found between the norms of the original SHCS samples and the Spanish version of the SHCS. Both samples showed similar distributions. The Spanish version's internal reliability as well as the item discrimination index were adequate. The authors conclude that the ESHC is an adequate instrument to measure hypnotizability in the Puerto Rican population.

A Concurrent Validity Study between the Hypnotic Induction Profile (HIP) and the Stanford Hypnotic Clinical Scale for Adults (SHCS:A) in an Inpatient Sample: A Brief Report

The Hypnotic Induction Profile (HIP) is a brief, standardized assessment of hypnotizability which takes 5–10 minutes to administer. The Stanford Hypnotic Clinical Scale for Adults (SHCS:A) is a different clinical measure of hypnotizability that takes about 20–25 minutes to administer. Although both scales purport to measure the same thing, they were based on different theories of hypnosis and constructed using different psychometric techniques. The present investigation is a concurrent validation study comparing scores on the two instruments in a sample of 24 inpatients. The correlation between the SHCS:A and HIP Induction score was 0.41 (p < .01). However, the Eye Roll Sign (ERS) did not correlate significantly with either the SHCS:A (.04, ns) or the HIP-IND score (−.05, ns). These results indicate that while scores on the HIP and SHCS:A are significantly correlated the inter-correlations are not high enough to consider them as interchangeable measures. Implications of these findings for future research are discussed.

EEG Correlates of Virtual Reality Hypnosis

The study investigated hypnosis-related electroencephalographic (EEG) coherence and power spectra changes in high and low hypnotizables (Stanford Hypnotic Clinical Scale) induced by a virtual reality hypnosis (VRH) induction system. In this study, the EEG from 17 participants (Mean age = 21.35, SD = 1.58) were compared based on their hypnotizability score. The EEG recording associated with a 2-minute, eyes-closed baseline state was compared to the EEG during a hypnosis-related state. This novel induction system was able to produce EEG findings consistent with previous hypnosis literature. Interactions of significance were found with EEG beta coherence. The high susceptibility group (n = 7) showed decreased coherence, while the low susceptibility group (n = 10) demonstrated an increase in coherence between medial frontal and lateral left prefrontal sites. Methodological and efficacy issues are discussed.

Age Regression: Tailored versus Scripted Inductions

The effects of tailored versus scripted hypnotic inductions were tested with the intention of shedding light on age regression phenomena. From an initial pool of 31 volunteers, 10 males and 10 females who scored 3 or better on the Stanford Hypnotic Clinical Scale, participated in this study. Participants were assigned to either scripted or tailored hypnotic induction conditions for regression to age 5. The age specific developmental task was to indicate for each of 10 abstract figure pairs, which of each pair “was upside down”. Both groups showed significant focal point dependency. However, the tailored induction group showed significantly greater focal point dependency characteristic of 5-year-old children, in contrast to the scripted induction group. It appears that tailored hypnotic inductions may provide a better avenue for the ego to regulate its own degree of regression. The better match to personality style takes advantage of the naturally occurring egosyntonic capacities of the participant, thereby facilitating greater hypnotic responsiveness.

Hypnotizability and Posttraumatic Stress Disorder: A Prospective Study

Although there is converging evidence that posttraumatic stress disorder (PTSD) is associated with higher levels of hypnotizability, there are no studies concerning the stability of hypnotizability levels following trauma. Acutely traumatized participants with acute stress disorder (N = 45) were administered the Stanford Hypnotic Clinical Scale (SHCS) within 4 weeks of their trauma. Participants were subsequently administered a brief cognitive-behavior therapy program. Six months after treatment, participants were re-assessed with the SHCS. Although SHCS scores were generally stable (r = .47), two thirds of participants responded differently across the 2 assessments. Increased SHCS scores at the second assessment were correlated with elevated PTSD avoidance scores. This finding suggests that elevated hypnotizability in PTSD populations may not be entirely stable and may be associated with specific PTSD responses.

A Randomised Controlled Clinical Trial on the Additional Effect of Hypnosis in a Comprehensive Treatment Programme for In-Patients with Conversion Disorder of the Motor Type

Background: The primary aim of this study was threefold: (1) to examine the additional effects of hypnosis aimed at symptom reduction, using symptom-oriented and expression- and insight-oriented techniques in a comprehensive clinical treatment programme for in-patients with a persistent conversion disorder of the motor type; (2) to assess whether the level of hypnotisability was predictive of treatment outcome, and (3) to explore the efficacy of the total clinical treatment programme. Methods: The study population consisted of 45 in-patients between 18 and 65 years of age meeting the DSM-III-R criteria for conversion disorder of the motor type or somatisation disorder with motor conversion symptoms. A randomised controlled clinical trial was undertaken. The primary outcome measures were the Video Rating Scale for Motor Conversion Symptoms, the D(isabilities) code items from the International Classification of Impairments, Disabilities and Handicaps and the Symptom Checklist-90. Measures of the credibility of treatment and patient expectations of treatment outcome were used as manipulation checks. Hypnotisability was measured using the Stanford Hypnotic Clinical Scale. Results: Significant treatment results for all outcome measures were found for the total sample. These effects proved to be clinically significant. The use of hypnosis had no additional effect on treatment outcome. Hypnotisability was not predictive of treatment outcome. Conclusion: A comprehensive treatment programme, either with or without hypnosis, can be worthwhile for patients with long-standing conversion symptoms.

The hypnotic dreams of healthy children and children with cancer: A quantitative and qualitative analysis

In this study, the Stanford Hypnotic Clinical Scale for Children was administered to 52 healthy children and 47 children and adolescents with cancer. Responses to the dream item of this scale were analyzed for the type and detail of imagery. The hypnotizability scores of both groups were similar. However, children with cancer reported more pleasant than unpleasant fantasy in their hypnotic dreams, and their dream reports tended to contain less fantasy and detail overall. Rescoring the dream item based on extent of fantasy and detail resulted in a lower pass rate for that item, especially for children with cancer. Regardless of health status, older children experienced more self-involvement in their hypnotic dreams compared to younger children.

Hypnotizability in acute stress disorder.

This study investigated the relationship between acute dissociative reactions to trauma and hypnotizability. Acutely traumatized patients (N=61) with acute stress disorder, subclinical acute stress disorder (no dissociative symptoms), and no acute stress disorder were administered the Stanford Hypnotic Clinical Scale within 4 weeks of their trauma. Although patients with acute stress disorder and patients with subclinical acute stress disorder displayed comparable levels of nondissociative psychopathology, acute stress disorder patients had higher levels of hypnotizability and were more likely to display reversible posthypnotic amnesia than both patients with subclinical acute stress disorder and patients with no acute stress disorder. The findings may be interpreted in light of a diathesis-stress process mediating trauma-related dissociation. People who develop acute stress disorder in response to traumatic experience may have a stronger ability to experience dissociative phenomena than people who develop subclinical acute stress disorder or no acute stress disorder.

Autonomic Responses to Suggestions for Cold and Warmth in Hypnosis

The goal of the present study was to investigate whether suggestions for cold or warmth during hypnosis affect fingertip skin temperature. Hypnosis without specific suggestions for cold or warmth (`neutral hypnosis') caused a drop in respiration frequency, however, pulse rate, fingertip skin temperature, and electrodermal activity were not affected. The cold and warmth suggestions decreased and increased fingertip skin temperature, respectively. Compared with the neutral trance phase, the other three autonomic variables measured were also affected by suggestions for cold. However, there was no association between the changes in autonomic variables induced by suggestions and hypnotizability scores measured by the `Stanford Hypnotic Clinical Scale for Adults'. Fingertip skin temperature was mostly affected when the images used for the cold and warmth suggestions during hypnosis included experiences of physical temperature and psychological stress or relaxation, indicating that the psychological content of the imagery amplified the autonomic response.

473 Cognitive, visual, auditive and pain-related characteristics of the REM dreams

EEG was recorded monopolarly at frontal (F3, F4), central (C3, C4) and posterior (in the middle of O1-P3T5 and O2-P4-T6 triangles) derivations during the hypnotic induction of the Stanford Hypnotic Clinical Scale (SHCS) and during performance following suggestions of hypnotic dream and age-regression as expressed in the before-mentioned scale. 10 low-hypnotizable and 9 highly-hypnotizable and right-handed female students participated in one experimental session. Evaluations were Fast-Fourier spectral analyses during the following conditions: walking-rest in eyes-open and eyes-closed condition; early middle, and late phases of hypnotic induction; rest-hypnosis in eyes closed condition; hypnotic dream and age regression. After spectral analysis of 0 to 44 Hz, the mean spectral amplitude estimates across seven Hz bands (theta1, 4–6 Hz, theta2, 6–8 Hz; alpha1, 8–10 Hz; alpha2, 10–13 Hz; beta1, 13–16 Hz; beta2, 16–20 Hz; beta3, 20–36 Hz) and the 40-Hz EEG band (36–44 Hz) for each experimental condition were extracted. In eyes-open and -closed conditions on walking and hypnosis highly-hypnotizable subjects produced a greater 40-Hz EEG amplitude than did low hypnotizable subjects at all frontal, central and posterior locations. In the early and middle hypnotic induction highly-hypnotizables displayed a greater amount of beta3 than did low hypnotizables and this difference was even more pronounced in the left hemisphere. With posterior scalp recordings, during hypnotic dream and age regression, high hypnotizables displayed, as compared with the rest-hypnosis condition, a decrease in alpha1 and alpha2 amplitudes. This effect was absent for low hypnotizables. Beta1, beta2 abd beta3 amplitudes increased in the left hemisphere during age regression for high hypnotizables; low hypnotizables, in contrast, displayed hemispheric balance across imaginative tasks. High hypnotizables during the hypnotic dream are also displayed in the right hemisphere a greater 40-Hz EEG amplitude as compared with the left hemisphere. This difference was even more evident for posterior recording sites. This hemispheric trend was not evidenced for low hypnotizable subjects. Theta power was never a predictor of hypnotic susceptibility, 40-Hz EEG amplitude displayed a very high main effect (p < 0.004) for hypnotizability in hypnotic conditions by displaying a greater 40 Hz EEG amplitude in high hypnotizables with respect to lows.

Hypnotizability and dissociativity in sexually abused girls

Research on the relation between hypnotizability and clinical dissociation has led to contradictory findings. Measures of hypnotizability and dissociation are only weakly correlated in general population samples, but studies of posttraumatic stress and dissociative disorders patients have found elevated levels of clinical dissociation and hypnotizability respectively. This study assesses the relationships among hypnotizability, clinical dissociation and traumatic antecedents in 54 sexually abused girls, ages 6–15 years, and 51 matched controls. Hypnotizability was assessed on initial evaluation and again in matched subsamples at one year using the Stanford Hypnotic Clinical Scale for Children. Clinical dissociation was assessed using the Child Dissociative Checklist. Abuse variables were extracted from Child Protective Services reports. There were no significant differences in hypnotizability between abuse and control subjects. There were significant differences in clinical dissociation initially and on 1-year retest. Hypnotizability and clinical dissociation were only weakly correlated ( r(105) = .118, p = NS). However, in the abuse group, highly hypnotizable subjects were significantly more dissociative. Higher levels of clinical dissociation were associated with abuse by multiple perpetrators and co-presence of physical abuse independent of the sexual abuse. A small subgroup of “double dissociative” subjects, high in both hypnotizability and dissociativity, was identified. Double dissociation was associated with multiple perpetrators and earlier onset of sexual abuse.

EEG spectral analysis during hypnotic induction, hypnotic dream and age regression

EEG was recorded monopolarly at frontal (F 3, F 4), central (C 3, C 4) and posterior (in the middle of O 1-P 3T 5 and O 2-P 4-T 6 triangles) derivations during the hypnotic induction of the Stanford Hypnotic Clinical Scale (SHCS) and during performance following suggestions of hypnotic dream and age-regression as expressed in the before-mentioned scale. 10 low-hypnotizable and 9 highly-hypnotizable and right-handed female students participated in one experimental session. Evaluations were Fast-Fourier spectral analyses during the following conditions: walking-rest in eyes-open and eyes-closed condition; early middle, and late phases of hypnotic induction; rest-hypnosis in eyes closed condition; hypnotic dream and age regression. After spectral analysis of 0 to 44 Hz, the mean spectral amplitude estimates across seven Hz bands (theta1, 4–6 Hz, theta2, 6–8 Hz; alpha1, 8–10 Hz; alpha2, 10–13 Hz; beta1, 13–16 Hz; beta2, 16–20 Hz; beta3, 20–36 Hz) and the 40-Hz EEG band (36–44 Hz) for each experimental condition were extracted. In eyes-open and -closed conditions on walking and hypnosis highly-hypnotizable subjects produced a greater 40-Hz EEG amplitude than did low hypnotizable subjects at all frontal, central and posterior locations. In the early and middle hypnotic induction highly-hypnotizables displayed a greater amount of beta3 than did low hypnotizables and this difference was even more pronounced in the left hemisphere. With posterior scalp recordings, during hypnotic dream and age regression, high hypnotizables displayed, as compared with the rest-hypnosis condition, a decrease in alpha1 and alpha2 amplitudes. This effect was absent for low hypnotizables. Beta1, beta2 abd beta3 amplitudes increased in the left hemisphere during age regression for high hypnotizables; low hypnotizables, in contrast, displayed hemispheric balance across imaginative tasks. High hypnotizables during the hypnotic dream are also displayed in the right hemisphere a greater 40-Hz EEG amplitude as compared with the left hemisphere. This difference was even more evident for posterior recording sites. This hemispheric trend was not evidenced for low hypnotizable subjects. Theta power was never a predictor of hypnotic susceptibility, 40-Hz EEG amplitude displayed a very high main effect ( p < 0.004) for hypnotizability in hypnotic conditions by displaying a greater 40 Hz EEG amplitude in high hypnotizables with respect to lows.

Assessment of Hypnotic Processes and Responsiveness in a Clinical Context

The present study was designed to investigate in a clinical situation whether differences in measured hypnotizability validly reflect differences in hypnotic processes and to what extent factors deemed extraneous to hypnosis--such as resistance--influence hypnotic responding. To answer this question, Dutch versions of relevant scales had to first be developed. The factorial validity and reliability of a Dutch translation of the Resistance Toward Hypnosis Scale (DRHS) and a shortened Dutch version of the Phenomenology of Consciousness Inventory (DPCI) were investigated in a sample of 205 psychiatric patients. The DRHS proved to be factorially valid and reliable, and two subscales, Trance and Reality Orientation, derived empirically from the DPCI showed good to satisfactory reliability. In a second study with a subsample of 99 psychiatric patients, hypnotizability as measured by the Stanford Hypnotic Clinical Scale for Adults was strongly and positively related to DPCI Trance scores and moderately and negatively related to DPCI Reality Orientation and DRHS Resistance scores. It is concluded that hypnotizability as measured in a clinical context under standard conditions is strongly related to hypnotic experiences over and above the moderate effects of resistance toward hypnosis and hypnotic suggestions. Standard hypnotizability assessments appear to be similar in their meaning in an experimental and clinical context.

Hypnotic Susceptibility and the Endogenous Eyeblink: A Brief Communication

This study investigated the relationship between hypnotic susceptibility, hypnotic state, and the endogenous eyeblink with 36 undergraduates, who were assigned to four independent groups (waking-low, hypnotized-low, waking-high, and hypnotized-high susceptibles) on the basis of combined cutoff scores on both the Creative Imagination Scale and the Stanford Hypnotic Clinical Scale for Adults. The auditory vigilance task required subjects to discriminate between 200 ms and 300 ms tones over a 35-minute period. Hypnotic depth was controlled across trials using the Long Stanford Scale of Hypnotic Depth. As predicted, high-susceptible subjects had a significantly lower blink rate than low-susceptible subjects. The predicted interaction between susceptibility and hypnotic state was also confirmed. High-susceptible subjects showed a significant decrease in blinking for the hypnotized condition, whereas low-susceptible subjects did not. The need for replication with more adequate measures of susceptibility is discussed.

Prospective time estimation and hypnotizability in a simulator design.

The present study of prospective time estimation examined the effects of hypnosis on short time intervals using a real-simulator design. The major hypothesis predicted a 2-way interaction between group (high hypnotizable, low hypnotizable, and simulator) and condition (waking and hypnotic) across all 4 time intervals (30, 60, 120, and 240 seconds). It was further hypothesized that on a "suggested" task (a measure of hypnotic depth), high hypnotizable Ss and simulators would not differ from each other but would differ from low hypnotizable Ss. 42 undergraduates were screened on both the Creative Imagination Scale (Wilson & Barber, 1977) and the Stanford Hypnotic Clinical Scale for Adults (Morgan & J. R. Hilgard, 1975, 1979) and assigned to 1 of 3 groups (high hypnotizable, low hypnotizable, simulator) based on combined hypnotizability scores. Ss verbally estimated time intervals of 30, 60, 120, and 240 seconds, 3 times each, both while in a waking and a hypnotic condition. Hypnotic depth was assessed once following each time interval. Partial support was found for the first hypothesis where, for both the 60- and 120-second intervals, high hypnotizable Ss increased their overestimation in the hypnotic condition. Low hypnotizable and simulator Ss showed no such increase. The second hypothesis, that high hypnotizable and simulator Ss would differ from low hypnotizables on the "suggested" task, was confirmed. The partial replication of previous research was examined in the context of choice of hypnotizability measure and reliability of time estimation.

Correlates of Hypnotizability in Children: Absorption, Vividness of Imagery, Fantasy Play, and Social Desirability

This study examined correlates of hypnotizability in children that had previously been reported for adults. Forty-two children (ages 7-14) completed the Fantasy Questionnaire (FQ), the Children's Social Desirability Questionnaire (CSDQ), the Zelter and LeBaron (1984) revision of the Stanford Hypnotic Clinical Scale for Children (SHCS:C-R), and the Children's Fantasy Inventory: Absorption and Vividness Scales (CFI: A & V). The nine-item SHCS:C-R yields separate scores for Observed Behavior (OB), and Realness (R), as well as a Total Score (TS). Results indicated significant correlations between SHCS:C-R scores and those for CFI: A & V, and the FQ (r = .42-.53) but not for the CSDQ. On the SHCS:C-R, correlations between R (involuntariness) scores and the above measures were not appreciably different from those found for OB scores. Observations suggested that attitudes towards hypnosis may influence children's hypnotic responsiveness.

The Use of a Multimodal Image, the Apple Technique, to Facilitate Clinical Hypnosis: A Brief Communication

A 1- to 3-minute exercise involving imagination (of an apple) and ideomotor ideation (hand levitation) is a simple, benign technique that is useful for illustrating to patients the nature of imagery and hypnosis. It avoids power struggles and allows a reasonable approximation of the patient's capacity for imagery and hypnotic responsiveness, without emphasizing the use of a hypnotic procedure. When administered to 35 college students, the hand levitation component of this exercise correlated with the Stanford Hypnotic Susceptibility Scale, Form C (Weitzenhoffer & E. R. Hilgard, 1963) (r = .66, p less than .001) and with the Stanford Hypnotic Clinical Scale: Adult (Morgan & J. R. Hilgard, 1975, 1978/79) (r = .60, p less than .001).

Autogenic Training and Future Oriented Hypnotic Imagery in the Treatment of Tension Headache: Outcome and Process

The aim of the present study was (a) to investigate the relative efficacy of autogenic training and future oriented hypnotic imagery in the treatment of tension headache and (b) to explore the extent to which therapy factors such as relaxation, imagery skills, and hypnotizability mediate therapy outcome. Patients were randomly assigned to the 2 therapy conditions and therapists. 55 patients (28 in the autogenic therapy condition and 27 in the future oriented hypnotic imagery condition) completed the 4 therapy sessions and 2 assessment sessions. No significant main effect or interaction effects for treatment condition or therapist was revealed. A significant effect for time in analyzing scores for headache pain, pain medication usage, depression, and state anxiety was found. In the self-hypnosis condition, pain reduction proved to be associated with depth of relaxation during home practice (as assessed with diaries) and capacity to involve in imagery (as assessed with the Dutch version [van der Velden & Spinhoven, 1984] of the Creative Imagination Scale [Barber & Wilson, 1978/79; Wilson & Barber, 1978]). After statistically controlling for relaxation and imagery, hypnotizability scores (as assessed with the Dutch version [Oyen & Spinhoven, 1983] of the Stanford Hypnotic Clinical Scale [Morgan & J.R. Hilgard, 1975, 1978/79]) were significantly correlated with ratings of pain reduction. Results are discussed in the context of the neo-dissociation and social-cognitive model of hypnoanalgesia. The clinical relevance and the methodological shortcomings of the present study are also critically assessed.

Characteristics of dropouts and completers from hypnobehavioral treatment for bulimia nervosa

This study compares demographic and psychological characteristics of a group of dropouts and completers from a hypnobehavioral treatment program for bulimia nervosa. Prior to treatment, 30 dropouts and 30 completers were assessed on the following questionnaires and scales: the Eating Disorders Inventory, the Zung Depression Scale, the General Health Questionnaire, the Eysenck Personality Inventory, the Stanford Hypnotic Clinical Scale, and five Visual Analogue Scales and Expectancy Scales. Results of ANOVA and chi-square analyses showed no significant differences between dropouts and completers on any of the demographic variables or psychological measures or scales. The results suggest that neither demographic nor psychological characteristics play a role in identifying dropouts from bulimia nervosa treatment.