The Efficacy of Hypnotherapy for Ego Strengthening and Negative Self-Talk in Female Heads of Households

Abstract

Purpose: Females who are heads of households, due to considerable life difficulties, are a vulnerable population that needs more support, including psychological treatment and empowerment programs. The current paper aims at ego strengthening and decreasing negative self-talk as useful strategies to achieve this goal. Methods: This paper was a quasi-experimental study that aimed to strengthen the ego and reduce the negative selftalk through hypnotherapy in female-headed households. In this study, a sample of 30 Iranian women were selected by purposive Sampling from all female-headed households who had been referred for treatment was randomly divided into two groups (experimental and control), and eight 45-minute sessions of hypnotherapy were performed for them. The ego strength and self-talk of the subjects were measured using Psychosocial Inventory of Ego Strengths and Self-Talk Inventory. Results: Multiple Analysis of Covariance indicated there was a significant difference between the control and the experimental group in terms of ego strength Wilks' Lambda = 0.29,F = 25.6,p < .001, and negative self-talk scores, Wilks' Lambda = 0.49,F = 10.6,p = .001, on the posttest. And ego strength. In other words, after controlling the effect of pretest or a covariate, ego strength was higher in the experimental group than in the control group, and the experimental group had less negative self-talk after treatment. Conclusions: The result of this study indicates that ego-strengthening-based hypnotherapy can be effective in reducing negative self-talk.

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1
ORIGINAL ARTICLE
The Ecacy of Hypnotherapy for Ego
Strengthening and Negative Self-Talk in
Female Heads of Households
Mosayeb Yarmohamadi Vasel1, Mehran Farhadi1, Mohamad Reza Zoghi Paidar1, Ali Asghar Chegini1*
1University of Bu-Ali Sina
Sleep Hypn 2016;XXX:XXX
http://dx.doi.org/10.5350/Sleep.Hypn.2016.18.0111
ABSTRACT
Purpose: Females who are heads of households, due to considerable life diculties, are a vulnerable population that
needs more support, including psychological treatment and empowerment programs. The current paper aims at ego
strengthening and decreasing negative self-talk as useful strategies to achieve this goal.
Methods: This paper was a quasi-experimental study that aimed to strengthen the ego and reduce the negative self-
talk through hypnotherapy in female-headed households. In this study, a sample of 30 Iranian women were selected by
purposive Sampling from all female-headed households who had been referred for treatment was randomly divided into
two groups (experimental and control), and eight 45-minute sessions of hypnotherapy were performed for them. The ego
strength and self-talk of the subjects were measured using Psychosocial Inventory of Ego Strengths and Self-Talk Inventory.
Results: Multiple Analysis of Covariance indicated there was a significant dierence between the control and the
experimental group in terms of ego strength Wilks’ Lambda = 0.29,F = 25.6,p < .001, and negative self-talk scores, Wilks’
Lambda = 0.49,F = 10.6,p = .001, on the posttest. And ego strength. In other words, after controlling the eect of pre-
test or a covariate, ego strength was higher in the experimental group than in the control group, and the experimental
group had less negative self-talk after treatment.
Conclusions: The result of this study indicates that ego-strengthening-based hypnotherapy can be eective in reducing
negative self-talk.
Keywords: ego, hypnotherapy, self-talk, female
INTRODUCTION
One of the most important criteria for assessing the status
of development within a country is the prestige and
credibility of its women. Some women, for different
reasons, have the householder role which, along with
other difficulties, can lead to their vulnerability to social
and economic problems (Ozawa, Lee, & Wang, 2011).
The problems and challenges facing female heads of
household can lead to the reorganization of mental
structure to cope with these challenges. Self-talk, which
increases in difficult or stressful situations, can be used in
these circumstances (Vygotsky, 1986).
Self-verbalization is also sometimes called self-
statement, self-instruction, inner speech, or self-talk
*Correspondence: aachegini@gmail.com
Ali Asghar Chegini, Department of Economics and Social Sciences,
University of Bu-Ali Sina, Hamadan, Iran.
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www.sleepandhypnosis.org
Sleep and Hypnosis
A Journal of Clinical Neuroscience and Psychopathology

Vasel / Sleep and Hypnosis 2016;XXX:XXX
2
(Alderson-Day & Fernyhough, 2015; C. L. Jacobs, Yiu,
Watson, & Dell, 2015; Smith, Shepley, Alexander, & Ayres,
2015). The term self-talk used in this paper. Self-talk is an
internal dialogue that has the role of self-regulation
(Vygotsky, 1986) and can influence behavior (Ellis &
Maclaren 2005; Meichenbaum, 1977) and emotion (Beck,
Steer, & Brown, 1996).
Studies have indicated that using positive self-talk and
reducing negative self-talk will lead to beneficial outcomes
such as increased self-esteem (Clore & Gaynor, 2006),
decreased negative emotions (Calvete et al., 2005),
decreased anxiety(Shi, Brinthaupt, & McCree, 2015),
increased self-awareness (Morin, 1993), and improved
cognitive functions (Alderson-Day & Fernyhough, 2015).
Vygotsky considers self-talk to be a consequence of
normal growth (Vygotsky, 1986), Baddeley connects it
with working memory (Baddeley, 2013), and ego
psychologists regard it as one of the executive function
within the ego (Bateman & Holmes, 2001). Shapiro
considers speech as a window to the ego organization
and to the functions of the central nervous system
(Shapiro, 1975).
Ego is the rational, fact-centered, and executive part of
personality. A strong and well-developed ego can help
individuals employ coping strategies in the face of
challenging situations. It can also be useful in the
evaluation of existing reality (Freud 2010). The developed
and strong ego is linked with strong self-concept, more
happiness, and less anxiety (Mishra, 2013).
Erickson states that ego strengths are a consequence of
conflict resolution at eight psychosocial stages of
development across the life span. Although all ego strengths
exist from the beginning, only one of them obviously shows
up in each step. The eight ego strengths from Erikson’s point
of view are: hope, will, goal, competence, fidelity, love, care
and wisdom (Erikson, 1963).
The ability to cope with life and potential threats
depends on ego strength to contain tensions (Markstrom,
Sabino, Turner, & Berman, 1997). When ego is strong,
malfunctions like irrational thinking and faulty reality
testing are modified (Schmeichel, Vohs, & Baumeister,
2003). Impulsive function, worry, low self-awareness and
black-and-white thinking are some of the features of low
ego functioning (Loevinger, 1983). Thus ego strengthening
is an important factor in improving executive functions,
especially modification of negative self-talk.
Ego strengthening was suggested by Hartland in order
to reply to criticisms centering on disease relapse after
hypnotherapy (Hartland, 1971). Hartland introduced a
method for ego strengthening with the aim of increasing
patient’s confidence, raising self-esteem and adaptive
ability, and reducing anxiety. Ego strengthening is an
essential technique for all patients and can be likened to
health and food in that it is useful for everybody
(Hammond, 1990).
Since hypnotic trance is regularly associated with
relaxation, it can reduce tension and disturbance by itself.
Psychotherapists who use hypnosis consider ego
strengthening a key factor in their treatment. Most
hypnotherapy sessions include enjoyable and desirable
situations such as light and floating feelings and deep
physical and mental relaxation that result in therapeutic
effects of hypnosis. With the help of hypnosis, patient
learn that they have more control over their body than
they thought (Wehbe & Safar, 2015)
Previous studies have revealed that hypnotherapy can
be effective in treatment of anxiety, pain, and sleep
disorders as well as in enhancing self-esteem (Lam et al.,
2015; Shenefelt, 2013; Stafrace & Evans, 2004; Steel,
Frawley, Sibbritt, Broom, & Adams, 2016)
Since hypnosis is a useful technique that can lead to
ego strengthening (Hartland, 1971) and valuable
cognitive changes (Van Dyck & Spinhoven, 1994), further
research is necessary in this regard. Accordingly, the effect
of hypnotherapy on ego strengthening and self-talk
modification in female-headed households will be
pursued in this paper.
METHOD
Participants
The experimental and control groups, each containing
15 subjects, were selected by purposive sampling from
750 female-headed households supported by Imam
Khomeini Relief Foundation (A charity organization in Iran
to provide support for female-headed households and

Vasel / Sleep and Hypnosis 2016;XXX:XXX
3
poor families). One out of each selected pair of subjects
was assigned at random to the experimental group and
the other to control group. Participants in this research
were 30-45 years old with a mean age of 32±1.1 years.
They were head of their families for at least six months
and were under Imam Khomeini Relief Foundation
coverage. The inclusions criteria were: interest to
participate in the study, signed an informed consent form,
do not having a medical illness or psychotic disorder,
having no hearing impairment
MATERIALS
Self-talk inventory (STI). Prepared by Calvete et al.
(2005), this inventory is a self-report instrument to assess
positive and negative self-talk in adults. It has negative
and positive subscales. Reported alpha coefficients for
the negative and positive self-talk scales are .90 and .80,
respectively. Relationships between the scores of this
inventory and depression, anxiety, and stress indicate the
convergent validity of the inventory (Calvete et al., 2005).
Participants are asked to imagine specific situations, then
answer each of the 52 items in the inventory by using a
4-point Likert scale. The validity and reliability of the STI
in Iran have been confirmed. Alavi et al. reported that
Cronbach’s alpha was .89 for the negative self-talk scale
and .72 for the positive self-talk scale (Alavi, Amirpour, &
Modarres Gharavi, 2013). They also indicated that
negative self-talk has a significant positive correlation with
depression and anxiety.
Psychosocial Inventory of Ego Strengths (PIES).
Developed by Markstrom et al. The first version of the
inventory consisted of 128 items in a 5-point Likert scale.
Some of the items are reverse scored. The current version
of the inventory contains 64 items. A 32-item short
version of the inventory is used in this paper (Markstrom
et al., 1997).
The face and content validity of the inventory were
confirmed by Markstrom et al. Internal consistency has
been confirmed, and its concurrent validity has been
shown by investigating its relationship with self-esteem,
goal in life, gender roles, and internal locus of control. Its
discriminant validity has been confirmed through a
significant negative correlation between the ego and
hopelessness, confusion of identity, and distress.
Researches demonstrate the internal consistency of the
scale. Cronbach’s alpha for the overall scale was .94.
Validity and reliability of the 32-item short version have
been confirmed (Markstrom et al., 1997). Haghighat et al.
reported that Cronbach’s alpha for 32-item short version
was .86 in Iran (Haghighat, 2013).
Procedure
The process of selection of participants for this study
was as follows: having been referred to a private
counseling and psychotherapy center from Imam
Khomeini Relief Foundation, Malayer branch, those in
need of psychological services first attended two
preparatory sessions, where their histories were taken,
research questionnaires were distributed, and initial
clinical interview were conducted. Then the experimental
group received eight 45-minute sessions of hypnotherapy
(see Appendix). Psychotherapy sessions were also
conducted with the members of the control group after
the end of the study. After the end of the psychotherapy
sessions, the same inventories were completed again by
the participants (Experimental and Control).
RESULTS
Multiple Analysis of Covariance (MANCOVA) was
done with Group (Experimental and Control) as IV, post-
test NST and ES as DVs, and pre-test NST and ES as
covariates. Because initial screening showed that there
were four outliers, four cases were excluded. After we
evaluated assumptions of MANCOVA, the normality of
data distribution for each group was performed with
Kolmogorov–Smirnov test. As illustrated in table 1, data
distribution within groups was normal, ps > .05.
The results of Levene’s test indicates the homogeneity
of error variance. Levene’s test is not significant, hence the
error variances is equal across groups, for negative self-
talk, F (1, 24) = 2.6, p = .11 and for ego strength, F (1, 24)
= 1.15, p = .29.
Box’s Test of Equality of Covariance Matrices indicates

Vasel / Sleep and Hypnosis 2016;XXX:XXX
4
that the observed covariance of the dependent variables
is equal across groups, F (3, 103680) = 2.21, p = .085.
MANCOVA results indicate that there is a significant
difference between the control and the experiment
groups, in terms of their scores on the DVs ( Wilks’ Lambda
=0.072, F = 135.7, p < .001). As seen in Table 3, there are
considerable differences between the groups in term of
negative self-talk and ego strength, ps < .001.
Given that there are two groups, we use an average of
DVs to demonstrate the difference between the control
Group Kolmogorov-Smirnov
Statistic df P
Ego strength pretest Experimental .19 15 .11
Control .12 15 .2
Ego strength posttest Experimental .097 15 .2
Control .17 15 .2
Negative self-talk posttest Experimental .11 15 .2
Control .16 15 .2
Negative self-talk posttest Experimental .17 15 .2
Control .14 15 .2
Table 1: Kolmogorov-Smirnov Test For normality of data distribution
Group Mean Std. Deviation N
Negative self-talk Experiment 44.4 8.33 13
Control 70.3 6.69 13
Total 57.4 15.1 26
Ego strength Experiment 106.1 7.25 13
Control 81.7 9.67 13
Total 94 15 26
Table 2: Descriptive Statistics for Negative self-talk and Ego strength
Eect Value F df Partial Eta Squared Observed Power
Intercept Wilks’ Lambda .51 10*** 2 .49 .97
NST Wilks’ Lambda .49 10.6*** 2 .50 .97
ES Wilks’ Lambda .29 25.6*** 2 .71 1
group Wilks’ Lambda .072 135.7*** 2 .92 1
Note. NST= Negative self-talk, ES= Ego strength, *** p < .001.
Table 3: Multivariate Tests
Source DV SS df MS F PES OP
Corrected Model Negative self-talk 5020.1 3 1673.3 51.2*** .87 1
Ego strength 5115.8 3 1705.2 74.2*** .91 1
Negative self-talk Negative self-talk 651.9 1 651.9 20*** .47 .98
Ego strength Ego strength 1221.8 1 1221.8 53.2*** .70 1
Group Negative self-talk 4408.7 1 4408.7 135*** .86 1
Ego strength 2794.7 1 2794.7 121.7*** .84 1
Error Negative self-talk 718.2 22 32.6
Ego strength 505 22 22.9
Total Negative self-talk 91471 26
Ego strength 235169 26
Note. DV= Dependent Variable (posttest), *** p < .001.
PES = Partial Eta Squared, OP = Observed Power
Table 4: Tests of Between-Subjects Eects

Vasel / Sleep and Hypnosis 2016;XXX:XXX
5
and experiment groups in terms of ego strength and
negative self-talk. As seen in table 2, subjects in the
experimental group had significantly higher ego strength
scores and significantly lower negative self-talk scores
than those in the control group.
Results in Table 4 indicate the correlation between the
covariate and the dependent variable for negative self-
talk and for ego strength (ps < .001).
Also after controlling for the pretest effect, there is a
significant difference between the scores of the
experimental and control groups, F = (1, 22) = 135, p <
.001 for negative self-talk and F = (1, 22) = 121.7, p < .001
for ego strength. Therefore, we can conclude that
hypnotherapy has a significant effect on ego strength and
negative self-talk.
DISCUSSION
The aim of this paper was to recognize the effects of
ego strengthening hypnotherapy on negative self-talk
and ego strength in Iranian female‐headed households.
MANCOVA results comparing ego strength and negative
self-talk in before and after a hypnotherapy intervention
indicate a significant effect (p < .01).
This research shows that hypnotherapy can increase
ego strength and reduce negative self-talk.
In the research literature on the efficacy of hypnosis,
this paper is the first to explore the efficacy of hypnosis
for self-talk modification.
Two basic mechanisms can be mentioned for hypnosis
efficacy in changing ego strength and self-talk: (1) verbal
suggestion and (2) imagery.
Other people’s speech or dialogue play a great role
both in the process of formation and development of
cognitive processes (Luria, 1961) and in the establishment
of the ego (St.Clair, 2000). The other people’s speech or
individuals’ self-talk can increase internal capabilities
(Luria, 1961; Meichenbaum, 1977; Vygotsky, 1986).
Hypnosis enters from the same window, but more
efficiently due to use of dissociation. During hypnosis and
dissociative states, lower-level units of the control system,
or the cognitive system related to the hidden observer,
are directly activated by suggestion. However, the
executive control and the critical factor of mind reach the
lowest rate or are bypassed. Therefore, hypnotic
suggestions engender responses with minimal effort or
conscious control (Lynn & Green, 2011). However, a
feature of hypnotic suggestion is repetition that is
repeated suggestions in different sessions or at intervals
in a meeting. The Repetition of self-talk or other-talk can
change the system of individual beliefs (Ellis & Maclaren,
2005).
The hypnotherapist, by saying sentences directly or
metaphorically, focuses on increasing self-confidence,
self-esteem, hope, and purposefulness in the subject as
the ego strength components (Erikson, 1963; Jacobs,
Pugatch, & Spilken, 1968). Once components of a concept
has strengthened, the concept will be strengthened too.
For example, In Garver ego strengthening suggestions, a
sense of security and self-confidence and having positive
feeling and experiences are instilled into the subject by
saying that “everything you remember makes you feel
good about yourself, security and confidence”
(Hammond, 1990).
In the tree metaphor, the statement “You have more
ability in comparison to the tree,” can lead to improved
self-esteem and ego strength: “Well, think about it; you’re
better than that tree; you can think; move, cautious, and
decide; you can love others: others can love you; you Can
do many things the tree cannot do; feel your power and
ability; think about anything you are.”
Having a sense of greater strength, more energy,
elevated motivation, and further concentration is targeted
in Heartland’s ego strengthening suggestions: “In this
comfortable state, you feel more power and ability in any
field; you are feeling more energetic; every moment you
are happier, stronger, more urged to progress and
remedy; every moment you are more determined and
more efficient, happier and healthier, day by day,
becoming more interested and motivated in any field of
work and communication, further focused, and more
efficient” (Hartland, 1971).
This study revealed that hypnosis is effective in
strengthening the ego and decreasing negative self-talk of
female-headed households. Therefore, this method can
be used for empowerment programs and therapeutic

Vasel / Sleep and Hypnosis 2016;XXX:XXX
6
interventions in this group of society, especially since the
intervention was short term. The paper might be of
interest to feminist mental health professionals, as the
sample is female heads of households. This is a group that
has not been researched much by psychologists, so this is
a very useful aspect of the research. One of the main
limitations of this study, are the lack of comparing the
hypnotherapy and other psychological interventions in
increasing ego strength. Therefore, it is suggested that
another researcher makes these comparisons. Another
limitation of this study that may reduce the generalizability
of study is the lack of random sampling. Therefore, it is
recommended that the complete experiment design, to
be applied in future researches.
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Appendix
Therapy protocol.
First session.
Take the patient’s history and performing questionnaires.
Second session.
Perform the initial interview and familiarity with therapy method and its rationale.
Third session. (First session of hypnosis)
The hand levitation suggestion and hypnosis facilitation in the next meetings: suggestions are given to the patient
based on this fact that her hand is going to light. This perceived lightness smooth and flat path for the acceptance of
therapist verbal suggestions. In other words, it increases the suggestibility.
Fourth session.
The imagery related to the sea and cottage metaphor (a metaphor for the unconscious and a method to identify
the Disturbing factors) (Hammond, 1990).
In this session, the patient is asked to imagine herself at the beach and walk slow and take a deep breath and then with
the help of imagination inter to a cottage that has two rooms. They called good and bad or dreadful and beautiful rooms
and asked her to say anything she sees.
Fifth Session.
Imagination of climbing and Garver (Hammond, 1990) ego strengthening suggestions: In this session, the patient
is asked to imagine herself climbing a mountain that after a hard distance (a metaphor for the challenges of life), and
reaching the mountaintop, to be calm. Then offered suggestions to have positive feelings and experiences, a sense of
security and confidence.
Sixth Session.
Imagination of forest and tree metaphor for raising self-esteem and ego strength (Hammond, 1990,): In this
session, the patient is asked to imagine herself walking on a forest path, after reaching a stout tree her similarities and
distinctions with that tree are said so that she would be able to use the internal strengths.
Seventh session.
Progressive muscle relaxation and Heap (Heap and Aravind, 2002) ego strengthening suggestions: At the meeting
after the patient muscle relaxation, presented suggestions that indicative comfort, ability to control thoughts and feelings.
Eighth Session.
Imagination of throwing stones in the lake and Hartland (Hartland, 1971) ego strengthening suggestions: At this
meeting the concerns and difficulties of life to be as small and large rocks that she could throw them away in the water.
Furthermore, we give her the suggestions to feel greater strength, further energy, better motivated and more focus.
Ninth session.
Sensory awareness and central core metaphor to increase self-confidence and ego strength (Hammond, 1990): In
this session, patient focus to her body senses and receive suggestions about having the power, aware and wise inner core.
Tenth Session.
Self-hypnosis training to prevent relapse.