Enhancing Suggestibility: The Effects of Compliance vs. Imagery

American Journal of Clinical Hypnosis,  Oct 2004  by Lynn, Steven Jay

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Specific Aims

For more than 30 years, studies based on a social-learning, cognitive skill model of hypnotic responsiveness have documented appreciable increases on behavioral and subjective measures of susceptibility following hypnotizability modification training (Diamond, 1972; Gfeller, Lynn, & Fribble, 1987; Kinney & Sachs, 1974; Sachs & Anderson, 1967; Springer, Sachs, & Morrow, 1977). By far the most impressive demonstration of training-related increments has come from a body of studies conducted by Spanos and his associates (see Spanos, 1986, for a review). In more than fifteen studies (see Gorassini & Spanos, 1999; Spanos, 1991 ; Spanos, Lush, & Gwynn, 1989), Spanos has shown that between 50% and 80% of initially low-hypnotizable subjects who underwent a multifaceted cognitive skill training program (termed herein Carleton Skills Training Program, CSTP) scored as high hypnotizables at posttesting. The CSTP provides participants with accurate information about hypnosis, and uses direct instruction and observation of a videotaped model to teach participants to: (a) physically enact responses, as opposed to waiting passively for the suggested effects to happen to them (Spanos et al., 1986), and (b) use a variety of cognitive and imaginai strategies to facilitate responding to suggestions including goal-directed imagery or fantasies (GDF's; e.g., imagining a hand rising in response to a helium balloon attached to the wrist) to experience the suggestion-related response as involuntary.

What is particularly impressive is that treatment effects have been of large magnitude, persist for an average of two and a half years after training (Spanos, Cross, Menary, & Smith, 1988), and generalize to novel, demanding test suggestions (e.g., see Spanos, 1986). Research in Spain (Cangas & Ferez, 1998), Poland (Niedzwienska, 2000), and England (Fellows & Ragg, 1992) has provided cross-cultural support for the effectiveness of the CSTP.

The fact that the CSTP substantially enhances hypnotic responsiveness constitutes support for the sociocognitive model of hypnosis. Sociocognitive theorists (Barber, 1969; Kirsch, 1991; Lynn & Rhue, 1991; Spanos, 1991) conceptualize hypnotic responsiveness as the byproduct of a constellation of potentially modifiable attitudes, beliefs, and expectations, as well as imaginative skills and strategies. Additionally, participants' accurate interpretation of hypnotic suggestions is posited to be an influential determinant of hypnotizability. According to this view, hypnotic responsiveness is not an immutable trait or propensity locked in at birth. Rather, it can be substantially modified.

Defenders of the idea that hypnosis is largely a trait-like ability or aptitude have criticized the CSTP on the grounds that post-training gains do not reflect valid and enduring enhancements of hypnotizability. More specifically, external demands, social pressure, and expectancies for compliance with suggestions inherent in the training procedures are believed to result in trained subjects simply acquiescing to suggestions in the absence of suggestion-related experiences or genuine modifications in hypnotic responsivity (see Bates, 1990; Bowers & Davidson, 1991 ; Hilgard, 1989).

Leading hypnosis theorists (Bowers & Davidson, 1991 ; Gearan, Schoenberger, & Kirsch, 1995; Hilgard, 1989; Spanos, 1986) concur that the issue of how the CSTP works to achieve treatment gains is of paramount importance from a theoretical perspective. Moreover, empirically supported techniques that augment hypnotic responsiveness may have considerable utility that extends far beyond the laboratory: high hypnotizability can confer a wide range of benefits in a variety of treatment contexts (see Lynn, Kirsch, Barabasz, Cardena, & Patterson, 2000).

Background and Significance

The findings of the CSTP are particularly impressive not only because of the magnitude of hypnotizability increments obtained, but also because treatment gains generalize to novel suggestions. The CSTP has documented treatment gains in response to novel suggestions with the following instruments or test items: the 7-item Carleton University Responsiveness to Suggestion Scale (CURSS; Spanos, Radtke, Hodgins, Stam, & Bertrand, 1983); a 10- item version of the Stanford Hypnotic Susceptibility Scale, Form C (SHSS: C; Weitzenhoffer & Hilgard, 1962); an "untrained" amnesia item (Spanos, Cross, Menary, Brett, & deGroh, 1987; Spanos, deGroh, & de Groot, 1987); and finally, difficult test suggestions that are considered "cognitive items" (e.g., analgesia, age-regression, visual hallucination, selective amnesia, and posthypnotic response) and "trance logic" items (Spanos et al., 1989) purported to reflect key aspects of hypnotic responding (Spanos et al., 1988). In these studies, trained subjects' performance was indistinguishable from that of "natural," untrained hypnotizable subjects who received the generalization measures. Finally, training gains have been shown to persist for an average of 2.5 years after training (Spanos, et al., 1988).