Hypnosis as an empirically supported clinical intervention: The state of the evidence and a look to the future

Abstract

Drawing on the literature reviews of this special issue of the
International Journal of Clinical and Experimentnl Hypnosis (2000), this
article summarizes the evidence for the effectiveness of hypnosis as an
empirically supported clinical intervention. As a whole, the clinical
research to date generally substantiates the claim that hypnotic procedures
can ameliorate some psychological and medical conditions, as
judged against the Chambless and Hollon methodological guidelines.
In many cases, these clinical procedures can also be quite cost-effective.
It is probable that with some key empirical refinement a number of
other hypnosis treatment protocols will have sufficient empirical documentation
to be considered "well-established." However, it is noted
that the Chambless and Hollon guidelines are not particularly wellsuited
for assessing hypnosis' impact when used adjunctly with other
interventions. The article concludes with recommendations regarding
the efficacy questions that need to be more fully addressed empirically
and offers methodological guidelines for researchers and practitioners.

Full text

This article was downloaded by: [Washington State University Libraries ],
[Heather McGehee]
On: 28 August 2015, At: 19:30
Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954
Registered office: 5 Howick Place, London, SW1P 1WG
International Journal of
Clinical and Experimental
Hypnosis
Publication details, including instructions for
authors and subscription information:
http://www.tandfonline.com/loi/nhyp20
Hypnosis as an empirically
supported clinical intervention:
The state of the evidence and
a look to the future
Steven Jay Lynn a , Irving Kirsch b , Arreed Barabasz
c , Etzel Carden~a d & David Patterson e
a State University of New York , Binghamton
b University of Connecticut , Storrs
c Washington State University ,
d Uniformed Services University of the Health
Sciences, University of Valencia , Spain
e University of Washington ,
Published online: 31 Jan 2008.
To cite this article: Steven Jay Lynn , Irving Kirsch , Arreed Barabasz , Etzel Carden~a
& David Patterson (2000) Hypnosis as an empirically supported clinical intervention:
The state of the evidence and a look to the future, International Journal of Clinical
and Experimental Hypnosis, 48:2, 239-259, DOI: 10.1080/00207140008410050
To link to this article: http://dx.doi.org/10.1080/00207140008410050
PLEASE SCROLL DOWN FOR ARTICLE
Taylor & Francis makes every effort to ensure the accuracy of all the
information (the “Content”) contained in the publications on our platform.
However, Taylor & Francis, our agents, and our licensors make no
representations or warranties whatsoever as to the accuracy, completeness,
or suitability for any purpose of the Content. Any opinions and views
expressed in this publication are the opinions and views of the authors, and
are not the views of or endorsed by Taylor & Francis. The accuracy of the

Content should not be relied upon and should be independently verified with
primary sources of information. Taylor and Francis shall not be liable for any
losses, actions, claims, proceedings, demands, costs, expenses, damages,
and other liabilities whatsoever or howsoever caused arising directly or
indirectly in connection with, in relation to or arising out of the use of the
Content.
This article may be used for research, teaching, and private study purposes.
Any substantial or systematic reproduction, redistribution, reselling, loan,
sub-licensing, systematic supply, or distribution in any form to anyone is
expressly forbidden. Terms & Conditions of access and use can be found at
http://www.tandfonline.com/page/terms-and-conditions
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

HYPNOSIS AS AN EMPIRICALLY
SUPPORTED
CLINICAL INTERVENTION:
The State
of
the Evidence
and a
Look
to the Future
STEVEN JAY
LYNN'
State University
ofNew
York
at Binghamton
IRVING KIRSCH
University
of
Connecticut,
Storrs
ARREED
BARABASZ
Washington State University
ETZEL CARDENA
Uniformed
Services University
of
the Health
Sciences,
University
of
Valencia, Spain
DAVID PATTERSON
University
of
Washington
Abstract:
Drawing on the literature reviews of this special issue
of
the
International Journal
of
Clinical and Experimentnl
Hypnosis
(2000),
this
article summarizes the evidence for the effectiveness of hypnosis as an
empirically supported clinical intervention.
As
a whole, the clinical
research to date generally substantiates the claim that hypnotic proce-
dures can ameliorate some psychological and medical conditions, as
judged against the Chambless and Hollon methodological guidelines.
In many cases, these clinical procedures can also be quite cost-effective.
It
is probable that with some key empirical refinement
a
number of
other hypnosis treatment protocols will have sufficient empirical docu-
mentation to be considered "well-established." However, it is noted
that the Chambless and Hollon guidelines are not particularly well-
suited for assessing hypnosis' impact when used adjunctly with other
interventions. The article concludes with recommendations regarding
the efficacy questions that need to
be
more fully addressed empirically
and offers methodological guidelines for researchers and practitioners.
Manuscript submitted September 5,1999;
final
revision received September 7,1999.
'Address correspondence
to
Steven
Jay
Lynn,
Ph.D.,
Psychology
Department, State
University
of
New
York
at
Binghamton,
NY
13902
The
International Iournal
of
Clinical and Experimental Hypnosis,
Vol.
48,
No.
2,
April
2000 239-259
0
2000
The
International
Ioumal
of
Cfinical
and
Experimental
Hypnosis
239
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

240
SEVEN
JAY
LYNN
ET
AL.
Hypnosis has a rich and venerable history as a treatment in itself and
as an adjunct to a variety of psychotherapeutic and medical procedures
(Gauld, 1996). This special issue reveals that hypnotic procedures have
received a great deal of empirical attention in many areas, comparable
to, if not exceeding, the attention lavished on some of the most rigor-
ously researched psychotherapies. Even a cursory reading of the articles
in this special issue would impress most readers with the value of hyp-
nosis as a psychotherapeutic procedure. Although a number of hypnotic
procedures have not, as yet, earned a place among the few therapies that
have met the platinum standard for well-established procedures of the
rigorous criteria delineated by Chambless and Hollon (1998), it is, never-
theless, apparent that cost-effective hypnotic procedures can ameliorate
an array
of
psychological
and
medical conditions. Indeed, it is evident
that hypnosis
is
well positioned to thrive in a managed-care environ-
ment (Ballen
&
Jarratt, 1997). We hope that this article, which celebrates,
as it were, the success of clinical hypnosis and which advances a research
agenda for less-studied areas of clinical practice, will stimulate the
research needed to convince even the most die-hard skeptics of the value
of hypnotic procedures.
To
place our review of the state of the evidence in perspective, it is nec-
essary to describe the criteria for evaluating the empirical status of thera-
pies, as delineated by Chambless and Hollon (1998) and described in
Green and Lynn’s article in this issue
(2000).
It must be emphasized that
these standards are among the most rigorous of any that have been
promulgated to date, and that the failure of a particular study to satisfy
all of the standards by no means indicates that the treatment under study
is ineffective.
Chambless and Hollon (1998) argue that to meet the least stringent
criteria of a ”possibly efficacious treatment,” it is required that at least
one study show that the treatment is superior to a no-treatment control,
placebo group, or alternate treatment, or that the treatment in question
matches the effectiveness of an alternative treatment of established
efficacy.
To
meet these current notions regarding criteria of an “efficacious
treatment,” the above criteria must be fulfilled with the additional stipu-
lation that two studies, rather than one, must be demonstrably effective
in
two independent research settings, with no well-controlled research
providing contradictory evidence.
In
addition, to fulfill the most strin-
gent criteria of ”efficacious and specific,” the treatment must be shown
to be superior to pill or psychological placebo or an alternative estab-
lished treatment in at least two independent research settings.
A number of methodological criteria are also recommended by
Chambless and Hollon (1998). That is, the studies must be conducted in
the context of
a
randomized controlled trial and must adequately
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

STATE
OF
THE
EVIDENCE
24
1
describe the treatment procedures (i.e., preferably a treatment manual),
employ valid and reliable outcome measures, and specify patient inclu-
sion criteria in a reliable, valid manner. Chambless and Hollon recom-
mend a sample size of 25 to
30
per condition in controlled (nonsingle-
case) studies to ensure adequate statistical power. However, the authors
also note that controlled single-case experiments or equivalent time-
series designs are acceptable with as few as three participants. Accord-
ingly, clinicians with relatively small caseloads can make substantial
contributions to the literature on the clinical effectiveness of hypnotic
interventions.
It is worth noting that guidelines for evaluating the empirical support
of psychotherapy are not cast in stone and have, already, shown consid-
erable evolution since their inception in response to thoughtful criticism
and analysis. In fact, the question of how to assess therapy outcome is
controversial and has received attention from government institutions,
managed-care organizations, and traditional scientific organizations
(see Andrews, 1995; Seligman, 1995; Strupp, Horowitz,
&
Lambert,
1997).
The guidelines
in
vogue today do not necessarily lend themselves to
certain issues specific to hypnosis. For example, Barabasz and Barabasz
(1992) explain how hypnosis can produce significant findings with rela-
tively small samples, particularly when within-subjects comparisons
and
stringent controls for hypnotic suggestibility are used. Hence, the
recommendations that are presented later in this article, following a
summary of the evidence, are designed to move the field of hypnosis for-
ward, rather than to slavishly adhere to any set of currently
in
vogue
guidelines as the final word in the evaluation of treatment efficacy.
A
SUMMARY
OF
THE
EVIDENCE
Hypnotically induced analgesia.
Arguably, the property of hypnosis that
has the greatest potential for social good resides in the ability of partici-
pants to radically reduce, or in some cases eliminate, both chronic and
acute pain. Indeed,
a
1996 National Institute of Health Technology
Assessment Panel Report judged hypnosis to be a viable and effective
intervention for alleviating pain with cancer and other chronic pain con-
ditions. This, in addition to a voluminous clinical literature
and
an
increasingly robust research literature, leaves
no
doubt that patients
undergoing bum wound debridement, or children enduring bone mar-
row aspirations, or mothers in the delivery room can sometimes achieve
a dramatic reduction in pain with hypnosis. In some cases, the degree
of
analgesia matches or exceeds that derived from morphine, and hypnosis
has served as sole anesthetic in surgery in thousands of documented
cases.
Accordingly, it is not surprising that Montgomery, DuHamel, and
Redd's meta-analytic review
(2000
[this issue]) concludes that
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

242
STEVEN
JAY
LYNN
ET
AL.
hypnotically suggested pain reduction can be classified as a well-
established treatment. Meta-analysis is a powerful statistical technique
that provides a cumulative analysis of research findings in a given area
by calculating effect sizes (an estimate of the magnitude of an interven-
tion effect) across studies. This permits a direct comparison of treatment
outcomes that span diverse methodological approaches and
interventions.
Montgomery et al.’s review (2000) of 18 articles and 27 effect sizes,
based on the pain reports of
933
participants, revealed that hypnotic
sug-
gestions relieve pain for 75% of the population, across different types
of
experienced pain. Equally encouraging is the finding that the magnitude
of the hypnoanalgesic effect was comparable for clinical and healthy vol-
unteer samples, and that individuals who scored in the midrange
of
hypnotic suggestibility-the majority
of
the population-responded
comparably in terms of effect size to persons who scored in the high
range of hypnotic suggestibility.
Although it is necessary to more closely examine the effects of hypno-
sis in acute versus chronic pain conditions and the role of dissociation
and other individual difference variables in moderating treatment gains,
the available evidence implies that hypnotic analgesia has a wide range
of application.
In
fact, the findings reviewed were
so
positive that Mont-
gomery et al. recommended expanding hypnotic procedures to a wider
clientele and broaching hypnotically suggested analgesia with patients
as a viable treatment modality. The fact that hypnosis can now be consid-
ered a well-established treatment for pain should
go
a long way to
ensure that hypnotic interventions move into the mainstream of first-
line interventions for pain-related disorders and conditions.
Hypnosis
in
medicine.
From antiquity to the present time (Gauld, 1996),
hypnosis and hypnotic-like procedures have had
a
role in medicine.
Over the years, a steady stream of case reports and anecdotal observa-
tions has spurred interest in the healing effects of hypnotic procedures.
Yet, it was not until the 1980s that well-controlled studies systematically
evaluated the role of hypnosis in the treatment of medical conditions
and began to provide convincing evidence for the efficacy of hypnosis-
based interventions.
Pinnell and Covino’s panoramic review
(2000
[this issue]) of hypnosis
in
medicine indicates that reasonably well-controlled studies with care-
fully selected patients support the use of hypnosis in the preoperative
preparation of surgical patients (Blankfield, 1991; Enqvist, von Konow,
&
Bystedt, 1995;
S.
A.
Lambert, 1996; Lang, Joyce, Spiegel, Hamilton,
&
Lee, 1996), the treatment of a subgroup
of
patients with asthma (Ewer
&
Stewart, 1986), and the treatment of patients with dermatological disor-
ders (Spanos, Stenstrom, &Johnston, 1988; Spanos, Williams,
&
Gwynn,
1990; Zachariae, 0ster, Bjerring,
&
Kragballe, 1996), irritable bowel syn-
drome (Harvey, Hinton, Gunary,
&
Barry, 1989; Whorwell, Prior,
&
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

STATE
OF
THE EVIDENCE
243
Faragher, 1984; Whorwell, Prior,
&
Colgan, 1987), hemophilia (Swirsky-
Sacchetti
&
Margolis, 1986),
and
postchemotherapy nausea and emesis
(Lyles, Burish, Krozely,
&
Oldham, 1982; Zeltzer, Dolgin, LeBaron,
&
LeBaron, 1991). There are strong indications that hypnosis is helpful in
the treatment of these diverse conditions, strengthening confidence in
the possibility that larger studies with fully elaborated procedures will
ultimately satisfy the criteria for empirical support for hypnotic inter-
ventions in these areas.
Hypnosis and smoking cessation.
The literature on hypnosis and smok-
ing cessation indicates that hypnotic interventions, by promoting
abstention, can prevent smoking-related illnesses. Based on their review
of 59 studies, Green and
LYM
(2000
[this issue]) noted that hypnotic
interventions generally yield higher rates
of
abstinence relative to wait-
list and no-treatment conditions. Whereas hypnotic procedures are not
necessarily more effective than alternative treatments, and the evidence
for whether hypnosis yields outcomes superior to placebos is mixed,
hypnotic procedures are very cost-effective and have earned a place
among entry-level treatments in stepped-care approaches that begin
with the least costly and time-consuming interventions.
Studies designed to demonstrate the specificity
of
hypnotic proce-
dures and move hypnosis into the arena of empirically supported treat-
ments should endeavor to include biochemical measures of abstinence
and should establish whether the addition of hypnosis enhances the
effects of the cognitive-behavioral and educational interventions with
which it
is
coupled.
Clinical hypnosis with children.
Hypnosis has seen
a
wide range of
application with children, spanning the treatment of learning problems,
acute pain, basic physiological processes, general medical problems,
and nausea and emesis from chemotherapy. The lion’s share
of
the 15
studies that Milling and Costantino
(2000
[this issue]) review focus on
the relief of chemotherapy distress and acute pain. Although the authors
note that research on hypnosis with children is in a relatively early stage
of development, one study by Edwards and van der Spuy (1985)
of
clini-
cal hypnosis for nocturnally enuretic children has already fulfilled the
criteria for a
possibZy efficacious treatmenf.
Other promising studies
reviewed include research
on
imagination-focused hypnosis for nausea
and vomiting related
to
chemotherapy (Zeltzer et al., 1991), pain from
bone marrow aspirations and lumbar punctures (Zeltzer
&
LeBaron,
1982), and pain reduction
in
hypnotically suggestible children undergo-
ing venipuncture and bone marrow aspirations (Smith, Barabasz,
&
Barabasz, 1996). Future researchers could well build on these encourag-
ing findings by formalizing the description of the procedures imple-
mented and examining treatment and patient variables theoretically
related to successful outcome.
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

244
STEVEN
JAY
LYNN
ET
AL.
Cognitive-behavioral treatments.
Early reviews of the research literature
suggested that disorders involving “self-initiated” difficulties, espe-
cially those that impair concentration, such as alcoholism and drug
abuse, were fairly resistant to hypnosis. However, disorders involving a
substantial “nonvolitional” component (pain disorders, asthma,
skin
disorders) were indeed responsive.
In
reality though, the cohort of first-
rate empirical work at that time was just not large enough to make
refined distinctions about differential effects across specific disorders.
Later, Kirsch
and
his colleagues (Kirsch, Montgomery,
&
Sapirstein,
1995)
conducted a more broad-spectrum meta-analysis of empirical
studies that had compared the effectiveness of cognitive-behavioral
treatments
(CBT)
with and without hypnosis across a number of disor-
ders (e.g., obesity, insomnia, anxiety, pain, and hypertension). The find-
ings
were instructive. First, there was a substantial effect size for CBT
with hypnosis, when compared to the same treatments without hypno-
sis. Patients receiving CBT with hypnosis showed greater improvement
than at least
70%
of patients who received standard CBT. Second, mere
relaxation did not appear to be the mechanism. Third, there was a hint
that the advantages of adding hypnosis to CBTmight increase over time,
though this was not definitive. After publication of these findings, hyp-
nosis as
an
adjunct procedure for the treatment of obesity was cited as
“probably” empirically validated by a task force of the American Psy-
chological Association.
Schoenberger
’s
review
(2000
[this issue]) provides further substantia-
tion of the value of hypnotic interventions insofar as hypnotic treat-
ments, combined with cognitive-behavioral methods, generally pro-
duce outcomes superior to wait-list and no-treatment control
conditions. Although no hypnotically augmented cognitive-behavioral
treatment has as yet met the criteria for a well-established treatment,
especially promising treatment gains have been observed in relation to
obesity, anxiety disorders,
and
pain management. Given that many
cognitive-behavioral procedures can easily be conducted with hypno-
sis
or simply relabeled as ”hypnosis,” it seems that behaviorally ori-
ented clinicians with training in hypnosis could readily establish a
hypnotic context as a simple, cost-effective means of enhancing treat-
ment efficacy.
Treatment
of
trauma.
It is virtually impossible to locate
a
compendium
of chapters or articles
on
clinical hypnosis that does not contain material
touting the value
of
hypnosis in the treatment of posttraumatic reac-
tions. An abundance
of
anecdotal reports and case studies laud hypnosis
as
an
effective treatment of the repercussions of trauma. However, Car-
defia’s review
(2000
[this issue]) found only one study (Brom, Kleber,
&
Defare, 1989) on this topic that approaches fulfilling the Chambless and
Hollon (1998) criteria. More research
in
this area is urgently needed,
given the fact that people with posttraumatic stress disorder (PTSD)
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

STATE
OF
THE
EVIDENCE
245
have been shown to be highly hypnotizable
(D.
Spiegel, Hunt,
&
Don-
dershine, 1988; Stutman
&
Bliss,
1985) and, therefore, may be particu-
larly amenable to hypnotic interventions.
It would be useful, for example, to compare exposure therapies with
and without hypnosis.
In
such studies, hypnosis could be used to
enhance visual imagery during flooding, for example, and to have
a
calming influence on patients after anxiety-eliciting procedures are
implemented. The nature and severity of trauma (e.g., immediately
experienced versus witnessed; physical injury versus no injury),
whether the traumatic event was in the recent or remote past, and the
intensity of posttraumatic and dissociative symptoms may be important
variables to consider in research on the use
of
hypnosis in the treatment
of
posttraumatic reactions.
For hypnosis to achieve the coveted status
of
a well-established pro-
cedure
in
this
and other treatment areas, only a few well-controlled stud-
ies are needed that either (a) document the value of hypnotic procedures
compared with already established empirically supported techniques,
or
@)
show that hypnotic interventions are superior to placebo control.
In
conducting such investigations, researchers can remedy past design
and reporting deficits and sidestep the pitfalls encountered by previous
researchers by heeding
the
recommendations in the following section
(for related discussions, see Barabasz
&
Barabasz, 1992; From, 1981).
RECOMMENDATIONS
Reporting Considerations
1.
Define thepopuZution carefully.
Description of the population is neces-
sary to gauge the representativeness of the sample chosen, to replicate or
extend previous findings in meaningful ways, and to evaluate the poten-
tial specificity versus generalizability of the treatment gains to diverse
populations.
To
this end, researchers should identify the diagnostic pro-
cedures used to categorize the patient sample
as
well
as
report the pati-
ent’s age, treatment history, medications taken, duration of the disorder
or condition, comorbid diagnoses, tests administered, and demographic
information
to
determine potential mediators and moderators of treat-
ment effects.
2.
Report
the
procedures
in
suficient detail
to
permit replication.
Failure to
describe the parameters
of
an intervention studied hinders evaluation of
the procedures employed and precludes replication and extension of the
treatment under study. Understandably, treatment manuals that specify
the nature and sequence of procedures implemented or, alternately, pro-
cedural descriptions that consist of session-by-session outlines of inter-
ventions or delineation of broad principles and phases of treatment with
examples of interventions are required for a particular treatment to be
considered empirically supported.
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

246
STEVEN
JAY
LYNN
ET
AL.
These requirements provide a reasonably elastic standard for the
specification of treatment procedures insofar as they can accommodate a
variety of hypnotic interventions, including ones that involve substan-
tial customizing of suggestions to patient characteristics, as might be the
case
in
the treatment of someone with
FED,
for example (see Watkins
&
Watkins,
1997,
for an example of a well-documented yet individually tai-
lored approach). Indeed, we recognize that one of the advantages of
hypnotic interventions
is
that they are flexible and individually tailored
to the needs of patients. Accordingly, it
is
important to approach the
ideal of conducting ecologically valid treatment studies that have fidel-
ity to the way hypnosis is often practiced in the ”real world,“ while pro-
viding detailed and accurate descriptions of research protocols in treat-
ment studies.
In terms of the studies reviewed in this issue, procedures were often
reported in detail insufficient to determine whether the intervention
could be considered a manualized or replicable approach to treatment.
Standardized hypnotic suggestibility scales, which follow a specified
protocol, while widely used for laboratory research purposes, were
rarely used for purposes of induction in the studies reviewed. More
commonly, idiosyncratic suggestions were employed that were specific
to the treatment implemented. These procedures were often described in
vague terms, such as ”ego-strengthening suggestions” and ”guided
imagery,” that encompass a broad range of interventions. Exemplary
suggestions were not provided, nor were broad principles
of
treatment
articulated. Clearly, this is an area in which considerable progress can be
made in future studies.
3.
Clearly indicate whether participants were randomly assigned to treat-
ments.
Not infrequently, studies cited
in
this issue failed to specify
whether participants were randomly assigned to treatments, and it was
necessary to glean this information from descriptions of the sampling
procedures. In some cases, this was difficult, and in other cases, impossi-
ble to do
so
from the information provided.
In
still other cases, assign-
ment to treatment was initially carried out on a random basis; however,
random assignment was ultimately precluded by participant selection
factors, such as medical problems or limitations, that made it impossible
for individuals to participate in a particular treatment, such as rapid
smoking to facilitate smoking cessation. Individuals who were not able
to participate in rapid smoking treatment because of hypertension, for
example, were, by default, assigned to the non-rapid-smoking group,
compromising the randomization
of
the procedures. When randomiza-
tion is incomplete, the rationale ought to be clearly indicated, and the
implications vis-2-vis the issue of empirical support discussed.
4.
Report hypnotic suggestibility
of
the samples.
Whereas randomization
is a laudable goal in most studies, in hypnosis research it does carry a risk
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

STATE
OF
THE
EVIDENCE
247
that disproportionate numbers of extremely high or low hypnotizable
persons in between-groups studies will skew treatment effects. That is,
randam assignment of patients to hypnosis or nonhypnosis groups can
erroneously produce statistical significance (Type
1
or alpha error) by
the chance occurrence of disproportionate numbers of extremely high or
extremely low hypnotizable responders in either group. Accordingly, it
is important to evaluate hypnotic suggestibility across groups and to
consider matching or stratifying the sample in question on the basis of
hypnotic suggestibility across hypnotic and nonhypnotic groups. At the
very least, researchers should fully report the hypnotic suggestibility of
each group in terms of scores on well-validated scales and use these
scores as covariates in statistical analyses when groups differ in terms of
this variable.
5.
Report complete descriptive data.
Not infrequently, the studies
reviewed failed to provide a complete report of the data secured. The
inclusion of pretreatment and posttreatment means and standard devia-
tions by experimental condition is essential to the conduct of meta-
analytic techniques
(Milling
&
Costantino,
2000).
In
addition to mean
differences, researchers should report effect sizes to document the mag-
nitude of treatment effects obtained across conditions.
Finally, differential dropout rates across treatments should be
reported, and a logical, consistent approach to handling the problem
of
dropouts or missing data should be articulated. For example, in the
smoking cessation literature, it is now considered appropriate to con-
duct analyses in which dropouts are considered as treatment failures.
Design
Considerations
1.
Ensure
that
the
number ofparticipants is adequate.
The claim that a par-
ticular finding is generalizable to a relevant population of individuals is
often less than compelling when the sample size
is
small. Of course, a
small sample also limits the statistical power necessary to discern treat-
ment effects when they are, in fact, present. The minimum number
of
25
to
30
participants per condition recommended by Chambless and Hollon
(1998)
seems like a serviceable goal for many studies, particularly those
intended to generalize findings to large populations, such as smokers in
the general population. However, significant effects shown with rela-
tively small samples may well be clinically meaningful and constitute
important demonstrations of treatment efficacy. Therefore, it would be a
mistake to dismiss studies that demonstrated significant effects
with
small samples.
One way that the inclusion of small samples can be justified is
by
con-
ducting a power analysis. A general understanding of what is involved
in
statistical power analysis can be far reaching, because it can help avoid
potentially irrevocable investigation-planning errors. The investigator
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

248
SEVEN
JAY
LYNN
ET
AL.
will have an estimate of how many patients to study
and
will know what
kind of data to collect for a major hypothesis-testing study. The process
also discourages the all too common treatment efficacy research practice
of post hoc analyses, which might most charitably be viewed as fishing
expeditions with a variety of statistical tests as hooks.
However, it is important not
to
ignore data collection opportunities
with small numbers of patients. Power calculation can become particu-
larly inaccurate for the sample cell sizes available in most clinical and
hospital settings. Clinicians should not be discouraged from conducting
research because of the large numbers of patients predicted to be neces-
sary by power analysis. For example, despite a total number of 20
patients and cell sizes of only
5
patients per group, statistically signifi-
cant reductions of both experimental
and
clinical pain were demon-
strated for chronic pain patients independent of expectancy (Barabasz
&
Barabasz, 1989).
2.
Conduct
single-
or
multiple-case experiments.
Whereas it can be argued
that even greater confidence in the representativeness of the findings can
be secured with relatively large samples, guidelines for empirically sup-
ported treatments include provisions for evaluating the efficacy of treat-
ments based on single- or multiple-case experiments. Given that multi-
ple replications of treatment efficacy with as few as
3
patients each by
two independent research groups are required to establish empirical
support for a given treatment, practicing clinicians can play an instru-
mental role
in
establishing a hypnotic treatment’s effectiveness.
Case studies that compare individuals on a within-subjects, rather
than
a
between-group, basis may have particular relevance for hypnosis
studies. For example, Hilgard and Tart (1966) argued that the between-
group approach may fail to show a true effect, even when one exists (a
Type
I1
or beta error). Their hypothesis is that patients who are high in
hypnotic suggestibility
can
experience spontaneous hypnotic effects in
response to suggestive interventions, even without a prior induction.
Support for this contention was secured in three independent studies
(see Barabasz, l990,1990a, 1990b; Barabasz
&
Barabasz, 1992) that imply
that a within-subjects research design may be of critical importance if
effects of hypnosis are to be detected. That is, the changes from nonhyp-
notic conditions to hypnosis for highly hypnotizable persons can easily
be minimal or nonexistent. Whereas an ideal research program might
combine within-subjects and between-group designs, with small as well
as relatively large samples, much can be learned from scrupulously
designed (e.g., adequate baseline and hypnotic suggestibility testing)
single-case studies with as few as
3
participants.
3.
Compare
nonhypnotic
treatments
with hypnotic
inductions and sugges-
tions
added.
Rarely, if ever, is hypnosis the sole form of treatment with
a
patient: It is a technique, not a type of therapy. In fact, the position of the
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

STATE
OF
THE
EVIDENCE
249
Society for Clinical and Experimental Hypnosis is that hypnosis can-
not and should not stand alone as the sole medical or psychological
intervention for any disorder. Instead, hypnosis is used in addition to
some recognized medical or psychological treatment protocol (e.g.,
cognitive-behavioral therapy, standard postsurgical procedures, psy-
choanalytic psychotherapy). For years now, hypnosis has been recog-
nized as a legitimate component of medical treatment by the American
Medical Association and the American Psychiatric Association. At issue,
then,
is
not the effectiveness of some mythical hypnosis treatment, but
whether hypnosis adds anything to the effectiveness of standard clinical
interventions. Accordingly, additional studies comparing the same
treatment with and without hypnosis (e.g., Schoenberger, Kirsch,
Gearan, Montgomery,
&
Pastyrnak, 1997) would help to address the
question of whether hypnosis augments treatment outcome, above and
beyond the intervention within which it is embedded.
Another issue is that many different treatments are categorized as
hypnosis, despite significant differences among them (Pinnell
&
Covino,
2000).
For instance, in the studies reviewed, psychological treatments
that included hypnotic interventions for medical conditions ranged
from specific direct suggestions to control symptoms
to
complex sugges-
tions for relaxation, guided imagery, and well-being. Conversely, the
authors offered examples of instances when treatments that involved
commonly used hypnotic techniques and suggestions were not defined
as hypnosis. Under these conditions, the specific role of defining the
situation as hypnosis versus the impact of suggestion-related effects is
difficult to tease apart.
In
selected cases, direct hypnotic suggestions may constitute
an
effec-
tive intervention in the absence of a more encompassing treatment.
Whereas the relief of acute pain not accompanied by secondary gain or
other noncomplicated symptoms, such as warts, may respond to direct
hypnotic suggestions, more complex problems, such as chronic pain or
depression, demand that hypnosis be conducted within the context of a
more comprehensive therapy.
An
important task for researchers is to dif-
ferentiate the effects of hypnosis when it is used as
an
intervention in
itself as opposed to when it is used to facilitate a more comprehensive
therapy.
4.
Conduct
adequatefollow-up.
Follow-ups are essential insofar as there
is
no guarantee that treatment gains that are apparent at the end of treat-
ment willbe stable over time. The possibility exists that treatment effects
degrade or improve across different conditions at different rates or dis-
appear completely in one condition while they are only manifested later
in another condition. For instance, in Bolocofsky, Spider, and
Coulthard-Morris’s (19851 study, participants in a hypnosis condition
for weight reduction continued to lose weight over the course of the
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

250
STEVEN
JAY
LYNN
ET
AL.
2-year follow-up period, whereas participants in the nonhypnotic treat-
ment did not. It would be profitable for investigators to examine the fol-
lowing mechanisms of change that enhance versus delimit treatment
effects during
and
after treatment.
Mechanisms
1.
Assess
hypnotic
suggestibility.
Individuals who exhibit relatively
high hypnotic responsiveness, such as those diagnosed with bulimia
(Pettinati, Home,
&
Staats,
1985)
or
PTSD
(D.
Spiegel, Hunt,
&
Donder-
shine,
1988;
Stutman
&
Bliss,
1985),
may be particularly good candidates
for hypnotic treatments. Yet, this hypothesis has not been adequately
tested. Treatment studies have not incorporated measures of hypnotic
suggestibility on a systematic basis with respect to these and many other
conditions. It can be argued that
if
hypnotic suggestibility is not associ-
ated with treatment outcome then hypnotic procedures have little bear-
ing on any positive gains achieved. However, there are a number of rea-
sons
to believe that the hypnotic context could potentiate treatment
gains, even though hypnotic suggestibility fails to moderate these gains.
Not all clients can benefit from hypnotic treatment (Wadden
&
Anderton,
1982;
Brown
&
Fromm,
1987).
Nevertheless, most of the inter-
ventions reviewed
in
this journal require little special hypnotic or imagi-
native abilities and, instead, rely on relatively easy suggestions (e.g.,
relaxation, guided imagery, imaginative rehearsal) that the majority of
the population can successfully pass. Accordingly, it would not be
expected that extreme hypnotic suggestibility would confer any particu-
lar advantage on a patient, or that relatively low levels
of
hypnotic
responsiveness would preclude successfully responding to many thera-
peutic suggestions.
In
short, the reliance on relatively "easy" sugges-
tions in a given treatment would be expected
to
attenuate correlations
between measured hypnotic suggestibility-which entails assessment
of
a broad range of suggestions that vary in difficulty-and treatment
outcome
.
Relatedly, the relationship between the ability to achieve a suggested
state of affairs and treatment outcome may vary from remote to strong.
Relaxation suggestions for
smoking
cessation, for instance, may well
promote mental and physical relaxation, yet such suggestions may not
be
sufficient to curb strong urges to smoke. Relatedly, relaxation sugges-
tions incorporated in cognitive-behavioral treatments for anxiety may
not be effective unless they promote exposure and eventual habitua-
tion/ extinction to anxiety-evoking stimuli. Not surprisingly, the evi-
dence for a link between hypnotic responsiveness and smoking absti-
nence and the outcome
of
cognitive-behavioral therapies for anxiety is
mixed.
On
the other hand, the ability to experience
an
analgesia
sug-
gestion
is
associated with both indices of pain relief and measured hyp-
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

STATE
OF
THE
EVIDENCE
251
notic suggestibility (Montgomery et al.,
ZOOO),
observations understand-
able in terms of the correspondence between the experience
of
analgesia
and
the ability to alter
cognitive-perceptual-sensory
processes that
typ-
ify the person who
is
highly responsive to hypnotic suggestion.
The link between hypnotic suggestibility and treatment outcome is
potentially mediated by other factors, such as expectancies (Schoen-
berger, 2000).
If
hypnotic suggestibility is measured before treatment,
then there can be a carryover of expectancies regarding hypnotic respon-
siveness to the treatment itself. Conversely, contamination by the per-
ceived effects of treatment can occur when hypnotic suggestibility is
assessed after treatment. In examining the literature on hypnosis in
medicine, Pinnell and Covino (2000) noted that when hypnosis was
assessed at a later time, after the conclusion of treatment, and in a context
seemingly unrelated to treatment, hypnotic suggestibility was not asso-
ciated with treatment gains. Clearly, expectancies and hypnotic sug-
gestibility should be assessed in tandem, permitting an examination
of
the independent and interactive effects of these two variables on treat-
ment outcome.
Researchers can use any number of hypnosis scales to provide a quan-
titative assessment of hypnotic suggestibility. Two sensible choices for a
short yet informative multidimensional assessment are the Hypnotic
Induction Profile
(H.
Spiegel
&
Spiegel, 1978) and the Stanford Hypnotic
Clinical Scales
(SHCS)
of Morgan and Hilgard (1978-1979a, 1978-1979b),
which offer measures for both adults and children
in
less than 15 min-
utes. Barabasz and Barabasz (1992), as well as Nadon and Laurence
(1994), strongly recommended the much longer Stanford Hypnotic Sus-
ceptibility Scale,
Form
C (SHSSC; Weitzenhoffer
&
Hilgard, 1962) or a
tailored version (Hilgard, Crawford, Bowers,
&
JSihlstrom, 1979) "pri-
marily because of its stringency and its broad sampling
of
hypnotic
sug-
gestions" (Nadon
&
Laurence, 1994, p. 91) that are potentially relevant to
treatment. However, the
SHSS:C
frequently takes more than an hour
to
administer, thereby limiting its use in many clinical situations. The
SHSS:C has more "top" due to the greater number and difficulty
of
items, making it essential for interventions that require high levels of
hypnotic involvement (e.g., hypnosis as the sole anesthetic for surgical
procedures for patients for whom general anesthesia
is
contraindicated).
2.
Assess
expectancies.
Expectancies can account for
a
significant
amount of variability in response to a variety of hypnotic and nonhyp-
notic interventions (Kirsch, 1990). One possibility is that treatment suc-
cess varies as
a
function of the positive expectancies for treatment gains
that the procedures engender. Accordingly, the relaxation or vivid imag-
inings evoked by suggestions contained
in
hypnotic protocols may pale
in influence compared with the positive expectancies for treatment gains
generated by the mere label of the procedures as "hypnotic
"
(Barber,
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

252
STEVEN JAY LYNN
ET
AL.
1985; Kirsch, 1990).
In
hypnotically augmented smoking cessation treat-
ments, success may be contingent on the ability of hypnosis to catalyze
positive expectancies
and
the motivation to quit, which seem to be pre-
requisite to the achievement of abstinence. The potentially powerful role
that therapist
as
well as patient expectancies play implies that active as
well as placebo treatments ought to be equated for treatment credibility.
Furthermore, researchers should consider manipulating expectancies
and demand characteristics to examine their influence (Barabasz
&
Bara-
basz, 1989). If that
is
impractical, expectancies ought to be assessed
and
their influence controlled by way of analysis of covariance of the results
obtained.
3.
Assess motivation.
Motivation can be thought of as the commitment
to
fully
comply with a given psychological treatment
and
participate
fully
in
activities associated with the achievement of personal goals
and
durable treatment gains. Motivation can operate quite independently of
positive expectancies for treatment gain. For instance, motivation
and
engagement
in
suggested activities may decrease in proportion to the
belief that hypnosis has special healing qualities independent of per-
sonal effort. Accordingly, pretest as well as posttest measures of motiva-
tion, compliance, or adherence, and perceived achievement
of
treatment
goals provide useful information above and beyond what can be
gleaned from measures of expectancy alone.
4.
Consider measures
of
the interpersonal and dynamic aspects
of
engage-
ment in treatment.
Assessment batteries often ignore measures that are
relevant to psychological theories. For instance, we could locate no
study among those reviewed that included measures pertinent to the
therapeutic alliance with the hypnotist/therapist or that assessed
mechanisms deemed relevant by psychodynamic theory to treatment
outcome, such as psychological defenses.
This
is unfortunate insofar as
patients who improve in psychotherapy often show changes in the
degree of positivity
in
their relationship interactions with the therapist
(Crits-Christoph
&
Luborsky, 1990) and
in
the maturity of their psycho-
logical defenses (Greyner
&
Luborsky,
1996).
In
addition, future researchers should consider administering Nash
and Spinler’s (1989) measure of archaic involvement.
This
measure
assesses dimensions thought to be relevant to the affectively laden, inter-
personal dimension of hypnosis. The scale, which includes subscales
that assess the dimensions of the perceived power
of
the hypnotist, the
positive emotional bond with the hypnotist, and fear of negative
appraisal, has been shown to be positively correlated
(r
=
.52) with hyp-
notic suggestibility at posttreatment.
5.
Examine
a
variety
of
determinants
of
positive and negative treatment
efects.
Study of the contraindications
of
hypnosis is warranted.
To
what
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

STATE
OF
THE
EVIDENCE
253
extent does minimal hypnotic suggestibility preclude embarking on a
treatment that includes hypnosis? Are there
any
pathological conditions
or personality characteristics that would disqualify an individual from
participating in a hypnotic treatment? For instance, obsessive-
compulsive patients have been shown to be less responsive to hypnotic
suggestion than both other patient groups and normal controls (Spinho-
ven, Van Dyck, Hoogduin,
&
Schaap, 1991). Patients with little or no
hypnotic ability may be better served with nonhypnotic treatments
(Bates, 1993).
Measures of dissociation lend themselves to inclusion in treatment
efficacy studies given the theoretical
link
between dissociation and hyp-
notic suggestibility (e.g., Hilgard, 1986). Recently, Barber (1999) has for-
warded the intriguing hypothesis that individuals have distinct styles of
responding to hypnotic suggestions, such that some individuals
respond primarily in terms of situational demand characteristics,
whereas perhaps a much smaller percentage
of
individuals become
more imaginatively or dissociatively (e.g., experience spontaneous
amnesia) involved with suggestions. Accordingly, measures of imagina-
tion and dissociation might help to select subgroups of patients who are
particularly responsive to different treatment interventions. Relatedly,
studies that examine the ability of measures of general and specific psy-
chopathology
to
predict treatment outcome would substantially con-
tribute to our knowledge base that now consists mostly of studies that
examine openness to experience, absorption, and hypnotic suggestibil-
ity as predictors
of
responsiveness to treatment.
Outcome measures that assess these various domains and address the
above questions
can
be costly and time-consuming to administer.
Accordingly, their selection should be made with care and based on a
variety of considerations, including the psychometric properties
of
available instruments, relevance to the target group, sensitivity to
change and treatment effects, cost-effectiveness, and compatibility with
the theoretical mechanisms posited to influence successful outcome
(M.
J.
Lambert, Horowitz,
&
Strupp, 1997).
CONCLUSION
The evidence reviewed in this special issue affords
much
in the way
of
encouragement
to
practitioners who already use hypnotic techniques
and to practitioners who wish to incorporate hypnotic procedures into
their clinical repertoire. In fact, hypnosis fares well
in
comparison with
the quantity and quality of research regarding many other psychothera-
peutic endeavors. Although this special issue underscores the cost-
effectiveness of hypnotic procedures and their utility
in
treating many
conditions, it
also
underlines the need for continued evaluation and
assessment of the empirical status of hypnotic interventions.
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

254
STEVEN
JAY LYNN ET AL.
As
noted by Nash
(2000
[this
issue])
in
his preamble to this special
issue, Ernest Hilgard predicted that as the scientific community contin-
ues to use hypnosis as a routine laboratory tool to examine human emo-
tion and cognitive functioning, there willbe
a
kind of laboratory spin-off
to the clinical community. That is, there will be a process
of
domestica-
tion within the clinical sphere as well. This prediction has clearly been
realized. However, even more important, the findings reviewed
in
this
special issue document that clinical hypnosis is securely grounded in a
foundation of careful empirical work that fully substantiates efficacy
under certain circumstances. If the ethos and tone
of
the Report of the
Royal Commission (Franklin, Majault, Le Roy, Sallin, Bailly, D'Arcet, De
Borie, Guillotin,
&
Lavoisier,
1785)
was our touchstone in producing this
report, ihen indeed
Franklin's
and Lavoisier's notion of science as disci-
plined wonderment
is
as
relevant now as it was
216
years ago. The har-
vest has been rich, but the field requires careful and inspired husbandry
to yield yet more. Surely, our stem
Age
of Enlightenment progenitors
would have it no other way.
REFERENCES
Andrews,
G.
(1995). Best practices
for
implementing outcome management:
More
science,
more art, worldwide.
Behavioral Healthcare Tomorrow,
4,19-24.
Ballen, W.,
&
Jarratt,
K.
(1997). Hypnotherapy and managed care. In
R.
M. Alperin
&
D.
Phillips (Eds.),
The impact of managed care on the practice ofpsychotherapy: Innovation,
implementation, and controversy
(pp. 145-167) New York Brunner/Mazel.
Barabasz, A.
F.,
&
Barabasz, M. (1989). Effects
of
restricted environmental stimulation:
Enhancement of hypnotizability for experimental and chronic pain control.
Interna-
tional Journal of Clinical and Erperimental Hypnosis,
37,217-231.
Barabasz, A. (1990a) Eingeschranke stimulation durch die Umwelt
ruft
spontane Hypnose
fur die Schmerrzkontrolle beim cold pressor test hervor.
Experimentelk und Klinishe
Hypnose,
4,95-105.
Barabasz, A. (1990b) Flotation restricted environmental stimulation elicits spontaneous
hypnosis. In R. Van Dyck, A.
J.
Spinhoven,
W.
Vander Does,
Y. R.
Van Rood,
&
W.
DeMoor (Eds.),
Hypnosis: Current theory, research and practice
(pp.113-119). Amsterdam:
Free University Press.
Barabasz, A. F., &Barabasz,
M.
(1992). Research designs and considerations. In
E.
Fromm
&
M.
Nash (Eds.),
Contemporary hypnosis research
(pp. 173-200). New
York
Guilford.
Barber, T.
X.
(1985). Hypnosuggestive procedures as catalysts for all psychotherapies.
In
S.
J.
Lynn
&
J.
P.
Garske (Eds.),
Contemporary psychotherapies: Models and methods
(pp.
333-
376). Columbus,
OH.
Merrill Press.
Barber, T.
X.
(1999). A comprehensive three-dimensional theory of hypnosis. In Kirsch,
I.,
Capafons, A,, Cardefia, E.,
&
Amig6,
S.
(Eds.),
Clinical hypnosis and self-regulation:
Cognitive-behavioral perspectives
(pp. 21-48) Washington,
DC:
American Psychological
Association.
Bates, (1993). Individual differences in response
to
hypnosis. In
J.
W. Rhue,
S.
J.
Lynn,
&
I.
Kirsch (Eds.),
Handbook ofclinical hypnosis.
Washington,
DC
American Psychological
Associa tion.
Blankfield,
R.
P.
(1991).
Suggestion, relaxation, and hypnosis as adjuncts
in
the care
of
sur-
gery patients: A review of the literature.
American Journal of Clinical Hypnosis,
33,
172-186.
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

STATE
OF
THE
EVIDENCE 255
Bolocofsky,
D.
N., Coulthard-Morris, L.,
&
Spinler,
D.
(1984). Prediction
of
successful
weight management from personality and demographic data.
Psychological Reports,
55,
795-802.
Brom,
D.,
Kleber,
R.
J.,
&
Defare,
P.
B.
(1989). Brief psychotherapy for post-traumatic stress
disorder.
Journal
of
Consulting and Clinical Psychology,
57,607-612.
Brown,
D.
P.,
&
Fromm,
E.
(1987).
Hypnosis and behavioral medicine.
Hillsdale,
NJ:
Lawrence
Erlbaum.
Cardefia, E.
(2000).
Hypnosis in the treatment of trauma:
A
promising, but not fully
sup-
ported, efficacious intervention.
International Journal of Clinical
and
Experimen tal Hypno-
sis,
48,221-234.
Chambless,
D.
L.,
&
Hollon,
S.
D. (1998). Defining empirically supported therapies.
Journal
of
Consulting and Clinical Psychology,
66, 7-18.
Crits-Christoph,
P.,
&
Luborsky, L. (1990). The measurement of self-understanding. In
L.
Luborsky
&
P.
Crits-Christoph (Eds.),
Understanding transference: The CCRT method
(pp. 189-196). New
York
Basic Books.
Edwards,
S.
D.,
&van der Spuy,
H.
I.
(1985). Hypnotherapy as a treatment for enuresis.
Journal
of
Child Clinical Psychology, Psychiatry, and Allied Health Disciplines,
26,
Enqvist,
B.,
von Konow, L.,
&
Bystedt, H. (1995). Pre- and perioperative suggestion in max-
illofacial surgery: Effects on blood
loss
and recovery.
International Journal of Clinical
and
Experimental Hypnosis,
43,284-294.
Ewer,
T.
C.,
&
Stewart,
D.
E.
(1986). Improvement in bronchial hyper-responsiveness in
patients with moderate asthma after treatment with a hypnotic technique:
A
random-
ized controlled trial.
Brifish Medical Journal,
293,
1129-1132.
Franklin,
B.,
Majault, Le
Roy,
Sallin, Bailly, DArcet, De Borie, Guillotin,
&
Lavoisier,
A.
(1785).
Report of Dr. Benjamin Franklin and the other commissioners churged by
the
King
of
France with the examination
of
the animal
magnetism
as now practiced at Paris
(W.
Godwin,
Trans.). London: St. Paul's Church Yard.
Fromm,
E.
(1981). How to write a clinical paper: Abrief communication.
InternationalJour-
nu1
of
Clinical and Experimental Hypnosis,
29,s-9.
Gauld, A. (1996).
A
history of hypnotism.
Cambridge, England: Cambridge University
Press.
Green,
J.
I?,
&Lynn,
S.
J.
(2000). Hypnosis and suggestinn-based approaches to smoking
cessation: An examination of the evidence.
lntcrnational Journal of Clinical and Experi-
mental Hypnosis,
48, 191-220.
Greyner,
B.,
&
Luborsky, L. (1996). Dynamic change in psychotherapy: Mastery
of
interper-
sonal conflict.
Journal of Consulting and Clinical Psychology,
64,411-416.
Harvey,
R.
F.,
Hinton,
R.
A.,
Gunary,
R.
M.,
&Barry,
R.
E.
(1989). Individual and group hyp-
notherapy in treatment of refractory irritable bowel syndrome.
Lancet,
1,424-425.
Hilgard,
E.
R.
(1986).
Divided
consciousness:Multiplecontrols
in
human thought and action
(rev.
ed.). New York Wiley.
Hilgard,
E.
R,
Crawford,
H.
J.,
Bowers, P.
G.,
&Kihlstrom,
J.
R.
(1979). A tailored SHSSC,
permitting user modification
for
special purposes.
Internationaf Journal
of
Clinical
and
Experimental Hypnosis,
27,
125-133.
Hilgard, E.
R.,
&
Tart, C.
T.
(1966). Responsiveness to suggestion following waking and
imagination instructions and following induction of hypnosis.
Journal ofAbnormal
Psy-
Kirsch,
I.
(1990).
Changing expectations:
A
key
to
effective psychotherapy.
Belrnont, CA:
Brooks/Cole.
Kirsch,
I.,
Montgomery, G.,
&
Sapirstein,
G.
(1995). Hypnosis as an adjunct to cognitive-
behavioral psychotherapy: A meta-analysis.
Journal of Consulting and Clinical Psychol-
Lambert, M.
J.,
Horowitz, L.
M.,
&
Strupp,
H.
H.
(1997). Conclusions and recommenda-
tions. InH.
H.
Strupp, L. M. Horowitz, &M.
J.
Lambert
(Eds.),Measuringpatient
changes
161-170.
chology,
72,196-208.
ogy,
63,214-220.
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

256
STEVEN
JAY LYNN ET AL.
in mood, anxiety,
and
personality disorders: Toward
a
core battery.
(pp. 491-502) Washington,
DC: American
Psychological
Association.
Lambert,
S.
A. (1996). The effects of hypnosis/guided imagery on the postoperative course
of children.
Developmental and Behuvwral Pediatrics,
17,307-310.
Lang,
E.,
Joyce,
J.
S.,Spiegel, D., Hamilton,
D.,
&Lee,
K. K.
(1996). Self-hypnotic relaxation
during interventional radiological procedures: Effects on pain perception and intrave-
nous drug use.
International Journal
of
Clinical and Experimental Hypnosis,
44,106-119.
Lyles,
J.
N.,
Burish,
T.
G.,
Krozely,
M.
G.,
&
Oldham, R.
K.
(1982). Efficacy
of
relaxation
training and guided imagery in reducing the aversiveness of cancer chemotherapy.
Iournul
of
Consulting and Clinical Psychology,
50,509-524.
Milling, L.
S.,
&
Costantino, C. A. (2000). Clinical hypnosis with children: First steps
toward empirical support.
International Journal ofClinical and Experimental Hypnosis,
48,
Montgomery,
G.
H., DuHamel,
K.
N.,
&
Redd,
W.
H.
(2000). A meta-analysis of hypnoti-
cally induced analgesia: How effective is hypnosis?
International Journal
of
Clinical and
Experimental Hypnosis,
48,134-149.
Morgan, A.
H.,
&
Hilgard, J.
R.
(1978-1979a). The Stanford Hypnotic Clinical Scale for
Adults.
American Journal
of
Clinical Hypnosis,
21,134-147.
Morgan, A.
H.,
&Hilgard, J.
R.
(19781979b). The Stanford Hypnotic Clinical Scale for Chil-
dren.
American
Journul
of
Clinical Hypnosis,
21,148-169.
Nadon,
R.,
&Laurence,
J.
-R.
(1994). Idiographic approaches to hypnosis research: Or how
therapeutic practice can inform science.
American Iournal
of
Clinical Hypnosis,
37,85-94.
Nash,
M.
R.
(2000).
The status of hypnosis as an empirically validated clinical intervention:
A
preamble to the special issue.
International Journal ofclinical and Experimental Hypno-
sis,
48,103-108.
Nash, M. R., &Spider, D. (1989). Hypnosis and transference: Ameasure of archaic involve-
ment with the hypnotist.
International Iournal
of
Clinical and Experimental Hypnosis,
37,
NIH Technology Assessment Panel on Integration of Behavioral and Relaxation
Approaches to Treatment of Chronic Pain and Insomnia. (1996).
Journal
ofthe
American
Medical Association,
276,313-318.
Pettinati, H. M., Horne,
R.
L.,
&
Staats,
J.
S.
(1985). Hypnotizability in patients with ano-
rexia nervosa and bulimia.
Archives
of
Genera! Psychiatry,
42,1014-1016.
Pinnell, C. M.,
&
Covino, N.
A.
(2000).
Empirical findings on the use of hypnosis in medi-
cine:
A
critical review.
International Journal
of
Clinical and Experimental Hypnosis,
48,
Schoenberger, N. E. (2000). Research on hypnosis as an adjunct to cognitive-behavioral
psychotherapy.
International lournu1
of
Clinical and Experimental Hypnosis,
48,
150-
165.
Seligman, M.
E.
P. (1995). The effectiveness of psychotherapy: The Consumer Reports
study.
American Psychologist,
50,965-974.
Smith,
J.
T.,
Barabasz, A.,
&
Barabasz,
M.
(1996). Comparison of hypnosisand distraction in
severely ill children undergoing painful medical procedures.
Iournal of
Consulting and
Clinical Psychology,
43,187-195.
Spanos, N.
P.,
Stenstrom,
R.
J.,
&Johnston,
J.
C. (1988). Hypnosis, placebo, and suggestion
in the treatment of warts.
Psychosomatic Medicine,
50,109-114.
Spanos, N.
P.,
Williams,
V.,
&
GWYM,
M.
(1990). Effects of hypnotic placebo, and salicylic
acid treatments
on
wart regression.
Psychosomatic Medicine,
52,109-114.
Spiegel,
D.,
Hunt, T.,
&
Dondershine, H.
E.
(1988). Dissociation and hypnotizability in post-
traumatic stress disorder.
American Journal
of
Psychiutry,
145,301-305.
Spiegel, H.,
&
Spiegel,
D.
(1978).
Trance
and
treatment: Clinical uses
of
hypnosis.
New York
Basic Books.
109-133.
129-144.
166-190.
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

STATE
OF
THE
EVIDENCE 257
Spinhoven,
E,
Van Dyck,
R.,
Hoogduin,
K.
&
Schaap,
C.
(1991). Differences in hypnotiz-
ability
of
Dutch psychiatric outpatients according
to
two
different scales.
Australian
Journal
of
Clinical and Experimental Hypnosis,
19,107-116.
Stutman,
R.
K.,
&
Bliss,
E. L.
(1985). Posttraumatic stress disorder, hypnotizability, and
imagery.
American
loumal
of
Psychiatry,
142,741-743.
Swirsky-Sacchetti,
T.,
&
Margolis,
C.
G.
(1986). The effects
of
a comprehensive self-
hypnosis training program on the use
of
factor VlII in severe hemophilia.
International
journal
of
Clinical and Experimental Hypnosis,
34,7143.
Wadden,
T.
A.,
&
Anderton,
C.
H. (1982).
The
clinical use
of
hypnosis.
Psychological Bulletin,
Watkins,
J.,
&
Watkins, H. (1997).
Ego
states:
Theory
and practice.
New York Norton.
Weitzenhoffer,
A.
M.,
&
Hilgard, E.
R.
(1962).
Stanford Hypnotic Susceptibility Scale,
Form
C.
Palo Alto,
CA
Consulting Psychologists Press.
Whorwell,
P.
J.,
Prior,
A.,
&
Faragher,
E.
B.
(1984). Controlled trial of hypnotherapy in the
treatment of severe, refractory irritable bowel syndrome.
Lancet,
2,1232-1234.
Whorwell,
I?.
J.,
Prior,
A.,
&
Colgan,
S.
M.
(1987). Hypnotherapy in severe irritable bowel
syndrome: Further experience.
Gut,
28,423425.
Zachariae,
R.,
Plster,
H.,
Bjerring,
E,
&
Kragballe,
K.
(1996). Effects
of
psychologic interven-
tion on psoriasis.
A
preliminary report.
Journal
ofthe
American Academy
ofDermatology,
Zeltzer,
L. K.,
Dolgin,
M.
J.,
LeBaron,
S.,
&
LeBaron,
C.
(1991).
A
randomized, controlled
study of behavioral intervention
for
chemotherapy distress in children with cancer.
Pediatrics,
88,3442.
Zeltzer,
L.
K., &LeBaron,S.
M.
(1982). Hypnosis and nonhypnotic techniques for reduction
of
pain and anxiety during painful procedures in children and adolescents with cancer.
Behavioral Pediatrics,
102,
1032-1035.
92,215-243.
34,1008-1015.
Hypnose
als empirisch gestiitzte klinische
Intervention:
Gegenwartige Situation
und
Blick auf
die
Zukunft
Steven Jay Lynn, Irving Kirsch, Arreed Barabasz,
Etzel Cardeiia, und David Patterson
Zusammenfassung:
Dieser
Artikel stiitzt sich auf
die
Analysen
der
Fachlitera-
tur in
einem
Sonderheft des International Journal
of
Clinical
and
Experimen-
tal Hypnosis
(2000)
und
faBt
die
Nachweise zur Wirksamkeit
von
Hypnose
als
einer
empirisch gestiitzten klinischen Intervention
zusammen. Insgesamt
erhartet die gegenwartige klinische Forschung
im
allgemeinen
den
Anspruch, daf3 hypnotische Behandlung auf einige psychische
und
physische
Storungen
bessemd
einwirken kann,
wobei
die
methodologischen Richt-
linien
von
Chambless und Hollon zugrunde gelegt
wurden.
In
vielen Fallen
konnen
diese
klinischen Behandlungen durchaus kostengiinstig
sein.
Es
ist
wahrscheinlich, dai3 bei zunehmender
Verfeinerung
empirischer Methoden
und Weiterentwicklung von Schliisseldaten
eine
Anzahl
von
weiteren
Hypnose-Behandlungsprotokollen
ausreichend empirisch gestiitzt
werden,
so
daB
sie
als
”fest
etabliert” gelten
konnen.
Es
wird
jedoch festgestellt, daB
die
Richtlinien
von
Chambless
und
Hollon
sich nicht
besonders
dafur
eignen,
den
Impact
von
Hypnose
als begleitende Behandlungzusammen mit anderen
Interventionen
zu
bewerten.
Der
Artikel schlief3t
mit
Empfehlungen in
bezug
auf
Fragen
der
Wirksamkeit, die
griindlicher
empirisch untersucht
werden
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

258
STEVEN
JAY
LYNN ET
AL.
miissen, und schlagt methodologische Richtlinien fur Forscher und Thera-
peuten vor.
ROSEMARIE GREENMAN
University
of
Tennessee, Knoxville,
TN,
USA
UHypnose comme intervention clinique empiriquement appuyCe
par l'expCrience: Ctat de l'kvidence et regard vers le futur
Steven Jay Lynn, Irving Kirsch, Arreed Barabasz,
Etzel Cardeiia, et David Patterson
RCsumC: En dessinant les contours d'une revue de la littCrature pour une Cdi-
tion spkciale du Journal International
d'
Hypnose Clinique et Exphimentale
(ZOOO),
cet article rCcapitule 1'Cvidente efficacitk de l'hypnose comme une
intervention clinique empiriquement proposCe. Dans
1'
ensemble, la recher-
che clinique justifie gCnCralement la rkclamation que les procidures hypno-
tiques peuvent amCliorer quelques Ctats psychologiques et mCdicaux, bien
que jugCes de facon nkgative par les directives mCthodologiques de Cham-
bless et de Hollon. Dans beaucoup de cas, ces procCdures cliniques peuvent
Cgalement Ctre tout
b
fait rentables. I1 est probable qu'avec une certaine am&
lioration empirique un certain nombre d'autres protocoles de traitement
d'hypnose auront suffisamment de documentation empirique pour Ctre con-
sidCrCs comme "bien Ctablis." Mais on note que les directives de Chambless et
de Hollon ne sont pas particulikrement bien adaptCes pour donner de l'impact
1
l'intervention hypnotique quand elle est adjointe
b
d'autres interventions.
L'article se termine par des recommandations passant en revue les questions
efficaces qui ont besoin d'Ctre posCes empiriquement et il offre des procCdu-
res mCthodologiques aux chercheurs et praticiens.
VICTOR
SIMON
Psychosomatic Medicine
&?
Clinical
Hypnosis Institute, Lille, France
La hipnosis como una intervenci6n clinica con una base empirica:
La naturaleza de la evidencia y una mirada a1 futuro
Steven Jay Lynn, Irving Kirsch, Arreed Barabasz,
Etzel Cardeiia, y David Patterson
Resumen: Bashdonos en las revisiones de literatura de este numero especial
de la International Journal of Clinical and Experimental Hypnosis
(ZOOO),
este
articulo resume la evidencia de la eficacia de la hipnosis como una interven-
ci6n clinica con una base empirica. En general, la investigacicin clinica hasta el
momento concuerda con la aserci6n de que 10s procedimientos hipn6ticos
pueden mejorar algunas condiciones psicol6gicas y medicas, de acuerdo a las
directivas metodol6gicas de Chambless y Hollon. En muchos casos, estos pro-
cedimientos clinicos pueden tambiCn ser bastante econ6micos.
Es
probable
que con algunos refinamientos empiricos claves, otros protocolos de trata-
miento hipndtico obtendriin suficiente documentaci6n empirica para que se
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015

STATE
OF
THE EVIDENCE
259
les considere "bien establecidos." Pero seiialamos tambikn que 10s lineamien-
tos de Chambless y Hollon no se ajustan muy bien a la evaluaci6n del impact0
de la hipnosis cuando se usa como adjunto de otras intervenciones.
El
articulo
concluye con recomendaciones dirigidas a ireas de eficacia clinica que necesi-
tan mayor atenci6n empirica, y ofrece lineamientos metodol6gicos a investi-
gadores y clinicos.
ETZEL
CARDERA
Uniformed Services University
of
the
Health
Sciences-Bethesda,
MD,
USA
Downloaded by [Washington State University Libraries ], [Heather McGehee] at 19:30 28 August 2015