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Journal of Clinical Sport Psychology, 2013, 7, 228-247

© 2013 Human Kinetics, Inc. www.JCSP-Journal.com


ORIGINAL RESEARCH

Using Hypnosis to Enhance Self-Efficacy


in Sport Performers
Jamie B. Barker and Marc V. Jones
Staffordshire University, United Kingdom

Iain Greenlees
University of Chichester, United Kingdom

High levels of self-efficacy have been documented to be associated with optimal


levels of sport performance. One technique, which has the potential to foster
increased self-efficacy, is hypnosis. Hypnosis is based upon the power of sug-
gestion and, while often shrouded in myth and controversy, has been used in a
number of domains including medicine, dentistry, and psychotherapy. In contrast,
sport psychology is one domain where the use of hypnosis has yet to be fully
explored. The aim of this review is to add to the extant literature and delineate
how hypnosis potentially can enhance self-efficacy. By drawing on neodissocia-
tion and nonstate theories of hypnosis, a combined theoretical basis is established
to explain how hypnosis may be used to influence sport performers’ sources of
self-efficacy information. Furthermore, the review examines these theoretical
postulations by presenting contemporary research evidence exploring the effects
of hypnosis on sport performers’ self-efficacy. The review concludes with future
research directions and suggestions for sport psychologists considering the use
of hypnosis within their practice.

Keywords: neodissociation theory; self-efficacy; hypnosis; mental skills; sport;


performance

Self-efficacy is one of the most important psychological variables associated


with levels of sport performance (see Feltz, Short, & Sullivan, 2008). Because of
the importance of self-efficacy, a variety of mental skills and techniques are used
by sport psychologists to help athletes regulate self-efficacy levels (Short & Ross-
Stewart, 2009; Williams, Zinsser, & Bunker, 2010). One technique overlooked in
this regard is hypnosis.
Preliminary evidence exists supporting the use of hypnosis in the domains of
medicine, dentistry, and psychotherapy (Alladin & Alibhai, 2007; Heap, Alden,

Jamie B. Barker and Marc V. Jones are with the Centre for Sport, Health, and Exercise Research, School
of Psychology, Sport, and Exercise at Staffordshire University. Iain Greenlees is with the School of
Sport and Exercise Science at the University of Chichester.

228
Hypnosis and Sport Performers’ Self-Efficacy   229

Brown, et al., 2001; Kuttner, 1989; Schoenberger, 2000; Wain, 1980; Wark,
2008). For example, hypnosis has been reported to relieve acute and chronic pain
(e.g., Blankfield, 1991; Genuis, 1995) and has been used, in some instances, as
an alternative to anesthetic in open-heart surgery and dental extractions (Heap &
Aravind, 2002). Further, in psychotherapy, there are data suggesting hypnosis as
a potential technique for the treatment of anxiety disorders, self-esteem issues,
phobias, obesity, smoking, and psychosomatic issues including asthma, skin dis-
orders, tension headaches and migraines, and gastrointestinal complaints (e.g.,
Baker, 1987; Braun & Horevitz, 1986; Brown & Fromm, 1987; Collison, 1980,
Crasilneck, 1990; Hawkins, 2006; Horowitz, 1970). In addition, the amount and
breadth of sport psychology literature demonstrating support for the use of hypnosis
is scant (Stegner & Morgan, 2010). In sport, hypnosis research consists of a limited
and disparate range of studies, typically with a lack of systematic research efforts.
However, research has examined the efficacy of hypnosis for increasing flow and
peak performance (e.g., Pates, Cummings, & Maynard, 2002), enhancing mental
imagery (Liggett, 2000a), reducing precompetition anxiety (Newmark & Bogacki,
2005), influencing the perception of effort and physiological responses (at rest
and during treadmill running exercise; e.g., Morgan, Raven, Drinkwater, & Hor-
vath, 1973), and increasing regional cerebral blood flow (rCBF; e.g., Williamson,
McColl, Mathews, Mitchell, Raven, & Morgan, 2001). Until recently, the viability
of hypnosis as a technique for enhancing sport performers’ self-efficacy has not
been explored. This review adds to the extant literature by drawing upon theory
and contemporary research to delineate how hypnosis may enhance sport perform-
ers’ self-efficacy. Accordingly, the review is organized into six sections: (1) we
briefly discuss the importance of self-efficacy in relation to sport performance and
outline the determinants and consequences of self-efficacy; (2) we define hypnosis
and describe the use and influence of suggestion(s); (3) we draw upon pertinent
hypnosis theories to explain hypnotic functioning and hypnotic phenomena; (4)
we use Bandura’s (1997) model of self-efficacy to postulate how hypnosis can
influence sources of efficacy information and review current research which has
explored the effects of hypnosis on self-efficacy using idiographic and nomothetic
approaches; (5) we outline directions for future research; and (6) we present sug-
gestions for practitioners considering the use hypnosis in sport in relation to sport
performers’ self-efficacy.

Applying Self-Efficacy Theory to Sport


Self-efficacy beliefs are considered to be one of the most influential psychological
constructs mediating achievement in sport (Feltz et al., 2008; Moritz, Feltz, Fah-
rback, & Mack, 2000; Treasure, Monson, & Lox, 1996). Bandura (1997) defined
self-efficacy as “a belief in one’s capabilities to organize and execute the courses
of action required to produce given attainments” (p. 3). Self-efficacy, agency, and
personal control are critical components of what Bandura refers to as social cogni-
tive theory (SCT).
Self-efficacy levels are proposed to impact performance by determining levels
of motivation, which will be reflected in the challenges individuals take (Bandura,
1997). For example, research supports the notion that athletes will choose to
230  Barker, Jones, and Greenlees

undertake physical challenges and set goals that they believe they can master and
hence will avoid those that they consider exceed their capabilities (e.g., Feltz &
Albrecht, 1986). Those with higher perceptions of self-efficacy will choose more
challenging goals than those with lower levels of self-efficacy (Locke, Frederick,
Lee, & Bobko, 1984). The strength of self-efficacy has been suggested to influence
the amount of effort athletes will expend along with their levels of perseverance
(Bandura, 1997). Self-efficacy judgments have been shown to influence certain
thought patterns (e.g., goal intentions, worries, causal attributions) and emotional
reactions (e.g., pride, shame, happiness, sadness) that also influence motivation.
According to Bandura (1997), persons exhibiting high self-efficacy levels typically
work harder, persist in the task longer, and achieve at a higher level above persons
who doubt their capabilities.
Self-efficacy judgments, while predominately influenced by behavioral his-
tory (e.g., performance outcomes), are also a product of a complex process of
self-appraisal and self-persuasion that relies upon cognitive processing of diverse
sources of efficacy information (Bandura, 1997). Sources of self-efficacy informa-
tion presented in hierarchical order include performance accomplishments (e.g.,
mastery experiences), vicarious experiences (e.g., watching successful people),
persuasory information (e.g., self-talk), and physiological states (e.g., somatic
feelings; Bandura, 1986). Both imagined experiences (e.g., positive imagery) and
emotional states (e.g., a fear response) also may contribute as additional sources
of self-efficacy information (Maddux, 1995; Schunk, 1995).
To date, some evidence exists supporting various psychological strategies
(including modeling, feedback, imagery, and self-talk) bring about positive changes
in athletes’ self-efficacy beliefs (see Short & Ross-Stewart, 2009; Williams et al.,
2010). Typically, these strategies are suggested to be effective by influencing one
or more sources of self-efficacy information, which in turn influence expectations
and then behavior. To illustrate, observing competent models successfully perform
actions or the self-modeling of actions can convey information to observers about
the sequence of actions one could use to succeed, and thus can influence self-
efficacy (e.g., Bandura, 1997; Clark & Ste-Marie, 2007; Dowrick, 1999; Schunk,
1995). Research also has examined the impact of feedback on self-efficacy (Ban-
dura, 1986; Gernigon & Delloye, 2003). For example, Escarti and Guzman (1999)
investigated the effect of feedback on self-efficacy, performance, and task choice,
and the mediating effects of self-efficacy in the feedback-performance and task
choice relationships. Through the use of manipulated feedback and estimates of
self-efficacy relative to an athletic task (i.e., hurdling), it was concluded that per-
formance feedback was significantly related to self-efficacy, performance, and task
choice. Self-efficacy also can be maintained via images of successful performance
(Bandura, 1997). Therefore, the use of mastery-orientated (i.e., motivational general-
mastery, MG-M: Martin, Moritz, & Hall, 1999) imagery focusing upon images of
competence and success has been found to elicit a positive relationship between
imagery use, self-efficacy, and performance (e.g., Callow, Hardy, & Hall, 2001;
Jones, Mace, Bray, MacRae, & Stockbridge, 2002). Finally, there is some research
evidence demonstrating preliminary support for self-talk (i.e., verbal persuasion) on
efficacy expectations (e.g., Hanton & Jones, 1999; Thelwell & Greenlees, 2003).
In sum, self-efficacy is an important psychological factor associated with sport
performance, and various strategies commonly used in sport psychology have
Hypnosis and Sport Performers’ Self-Efficacy   231

been applied and investigated in relation to fostering positive changes in athletes’


efficacy beliefs. One technique that has potential but has typically been overlooked
in this context is hypnosis.

Understanding Hypnosis:
Definitions and Suggestion
The term hypnosis is shrouded in misconception, myth, and apprehension for many
individuals (Heap et al., 2001). Typically, views about hypnosis are built around
entertainment stage shows. These shows highlight hypnosis to be a controlling
technique, where participants are made to engage in strange behaviors and experi-
ences in an immediate and flamboyant manner (Heap, 2000). However, hypnosis is
more commonly used as a therapeutic procedure in which alterations in thoughts,
perceptions, feelings, behaviors, and memory can theoretically be induced through
suggestion. Successful hypnosis is associated with a situation(s) in which sugges-
tions are more readily accepted and acted upon by the involved participants (Ham-
mond, 1990; Liggett, 2000b). It is a process that involves an interaction between
one person (e.g., the hypnotherapist) and people who agree to be hypnotized (e.g.,
the participants). Through this interaction, the practitioner influences participants
by prompting them to focus on ideas, thoughts, and images that intend to evoke
desired effects and facilitate long-term behavior change (Heap et al., 2001). The
hypnotic state (influenced via suggestion) usually is characterized by intense con-
centration, extreme relaxation, and high suggestibility (Heap & Aravind, 2002).
In sum, hypnosis may be considered as “an induced temporary condition of
being, a state, that differs mentally and physiologically from a person’s normal state
of being” (Weitzenhoffer, 2000; p. 221), which is characterized by the “the uncriti-
cal acceptance of a suggestion” (Ulett & Peterson, 1965; p. 13), and influenced by
“ . . . procedures wherein changes in sensations, perceptions, thoughts, feelings,
or behaviors are suggested” (Kirsch & Lynn, 1995; p. 846).
Suggestion is an important facet of hypnosis and refers to the issuing of verbal
statements by the hypnotherapist to a participant to bring about long-term changes
in behavior patterns (Hammond, 1990). Suggestion can be operationally defined as:
“A communication, conveyed verbally by the hypnotist, that directs the sub-
ject’s imagination in such a way as to elicit intended alterations in sensations,
perceptions, feelings, thoughts and behaviour” (Heap & Aravind, 2002; p. 17)
Suggestions theoretically can be used to bring about a number of effects during
hypnosis. These may include relaxation, ideomotor behaviors (e.g., arm levitation),
ideosensory behaviors (e.g., analgesia), amnesia, regression, posthypnotic sugges-
tions, and hallucinatory behaviors (Hawkins, 2006; Wagstaff, 1991). Posthypnotic
suggestions are generally considered to be the “therapy,” whereby desired behaviors
(postsession) and thoughts are presented via suggestions to facilitate change or
gain a response sometime after the initial presentation during hypnosis (Heap &
Aravind, 2002). For example, posthypnotic suggestions may be presented to help
an archer feel more composed, confident, and calm during training and competi-
tive situations. For the purposes of the present review, we postulate that hypnosis
is a state that is induced (via relaxation) and comprises the use of suggestion(s) to
232  Barker, Jones, and Greenlees

bring about changes in thoughts, perceptions, and behavior in a sport setting. It is


the use and influence of suggestion(s) during hypnosis that make hypnosis distinc-
tive from imagery and relaxation-based psychological strategies (Armatas, 2009).

Explaining Hypnotic Functioning:


State and Nonstate Theories
The debate regarding hypnotic functioning (i.e., what happens to a person during
hypnosis) is long-running (see Kallio & Revonsuo, 2003). Generally, theorists
fall into one of two camps: state or nonstate. From a state perspective, hypnotic
phenomena are viewed as consequences of trance states (Kirsch & Lynn, 1995)
and altered or divided consciousness (e.g., special processes; Hilgard, 1977); a
nonstate perspective takes a sociocognitive and behavioral perspective of hypnotic
responding (Spanos, 1991; Wagstaff, David, Kirsch, & Lynn, 2010). The following
sections explore these two major perspectives.

Special-Process Theories: Neodissociation Theory


A consistent failure to identify markers of presumed altered or trance states pro-
vided the basis for special process theories (e.g., neodissociation theory; Hilgard,
1977), where the concept of ‘dissociation’ is used to explain hypnotic functioning
(see Sadler & Woody, 2010). Such theories are based on Prince’s (1929) classi-
cal dissociation theory that proposes two tasks can achieve a state or condition
of functional independence when one task is performed subconsciously. When
functional independence is achieved (i.e., dissociation), the performance of the two
tasks (one subconsciously) ought to result in less interference than when both are
performed consciously. In dissociation theories, easier access to the unconscious,
a shift toward primary process thinking, greater ego receptivity, and regression of
the ego are defining characteristics of the special process of hypnosis (Fromm,
1992; Nash, 1991). Theories of dissociation are grounded on the assumption that
behavior is organized as a hierarchical series of subsystems of control that carry
out habitual action sequences (Hilgard, 1986). These subsystems are governed by
a central control structure referred to as the executive ego. The functions of the
executive ego are to initiate action sequences (i.e., its output function) and monitor
their consequences (i.e., an input function). The executive ego also monitors input
from external sources that are independent of activated action consequences. Once
activated, cognitive subsystems carry out habitual action sequences with limited
involvement of the executive ego, for example, someone arriving at a habitual
destination without remembering the process of navigation (Kirsch & Lynn, 1998).
Hilgard (1977) revived interest in the notion of dissociation and its relevance
to hypnotic responding with neodissociation theory (Hilgard, 1979, 1991, 1992,
1994), in which he contended that dissociations can be partial and the act of dis-
sociating requires attentional effort, leading to increased task interference. The
theory’s major premise is to explain hypnosis and related phenomenon through
the process of dissociation rather than the concept of the hypnotic trance (Kallio
& Revonsuo, 2003). For example, one may cycle to work while focused on any-
thing but the actual riding of bike, and then suddenly arrive at the destination with
Hypnosis and Sport Performers’ Self-Efficacy   233

little recall of the ride. It is this process of dissociation that is suggested to explain
hypnotic responding and the associated hypnotic phenomena in neodissociation
theory. Dissociation in the context of hypnosis has been defined “ . . . as a division
of consciousness in which affective effort and planning are carried out without
awareness” (Hilgard, 1977, p. 2).
Hilgard’s (1977, 1991, 1994) neodissociation model (see Figure 1) of hypnosis
is based upon three assumptions. First, there is a central control system (executive
ego) that performs planning and monitoring functions (e.g., decision making).
Second, beneath the control system there are relatively autonomous subordinate
cognitive-behavioral systems (e.g., movement control, perception, and memory).
One of these is a control substructure for an ordinary movement, such as lifting
or bending an arm. In neodissociation theory, responses to ideomotor suggestions
may occur because the person making the suggestions has direct access to the
participants’ cognitive and behavioral substructures; thus, it is the central control
structure or the executive ego that must move or inhibit any movement in the arm.
Although the movement or any inhibition is an intentional act, the participant
experiences it as involuntary because it is controlled by a part of the ego that has
been separated from awareness. The second substructure displayed in Figure 1 is a
control structure for pain perception. It has been speculated that suggested analgesia
(i.e., suggestions relating to the inability to feel pain) might be accomplished by
the voluntary redirection of attention (Hilgard, 1977). For example, the important
feature of dissociative analgesia is not whether a participant is aware of intention-
ally reducing pain, but that the pain is perceived only by the dissociated part of
the ego. Similarly, during suggested amnesia, output from a memory substructure
may only be received by the dissociated part of the executive ego (Kirsch & Lynn,
1998). Third, the subsystems of control are arranged hierarchically.
In a normal waking state, the two control systems work in harmony with each
other; however, during hypnosis the central control system and the cognitive-
behavioral systems are dissociated from one and other. Hypnotic suggestions
(e.g., feeling confident, focused, positive, recalling a successful past performance)
are believed to act upon the central-control structure, causing it to create a com-
munication or amnesic barrier that separates a segment of itself from conscious
awareness (Hilgard, 1994). Hypnotic suggestions are also proposed to modify
the normal hierarchical relationship among the various systems and subsystems
of central cognitive control, resulting in functional changes (Hilgard, 1994). To
illustrate, although most executive functions recede during hypnosis, the monitor-
ing and observing functions remain active but lack normal criticality (Kirsch &
Lynn, 1995). This dissociation in cognitive functioning in conjunction with the
existence of a communication or amnesia-like barrier between the dissociated
parts explains the experience of involuntariness or automaticity that accompanies
many hypnotic responses.
The most direct empirical evidence supporting neodissociation theory relates to
the concept of the hidden observer. Hilgard (1977, 1979). This concept was intro-
duced to describe phenomenon by which a person registers and stores information
in memory, without the person being aware that the information has been processed
(e.g., being able to ride a bike while thinking about a future holiday). In an classic
pain study detailing the hidden observer effect, participants were required to keep
their hands in a bucket of ice-cold water and rate the degree of pain experienced
234  Barker, Jones, and Greenlees

Figure 1 — A neodissociation theory of hypnosis highlighting a participant’s response to


hypnotic suggestions. Adapted from Kirsch, I., & Lynn, S.J. (1995). The altered state of
hypnosis. The American Psychologist, 50, 846–858, published by the American Psycho-
logical Association.

on a scale of 0–10 (Hilgard, Morgan, & Macdonald, 1975). Without suggestions


of analgesia, the ratings given were more toward the upper end of the scale. In
response to suggestions of analgesia, these ratings were down toward the lower
end of the scale. In accordance with neodissociation theory, the experimenter then
suggested that there is an ‘unhypnotized’ part of the person that is still experienc-
ing the pain in the usual manner. This hidden observer was then asked to rate the
Hypnosis and Sport Performers’ Self-Efficacy   235

pain experienced on the 0–10 scale in writing, using the free hand. Typically, these
ratings corresponded to the pain ratings given without suggestions of analgesia
during hypnosis. In Hilgard’s model, the hidden observer of consciousness is there
all along, experiencing pain despite analgesic suggestions (see Figure 1). It is for
this reason that the hidden observer is open to communication through hidden
observer suggestions.
The phenomenon of the hidden observer and the separation of the central
control structure into two insulated compartments are illustrated in part (b) of
Figure 1. Part (a) of the figure shows the normal coordinated relationship between
the central control structure and the subordinate cognitive-behavioral systems of
movement, pain perception, and memory. The central control system is very aware
of both input and output to the subcontrol systems in a normal waking state and
the two are in perfect coordinated harmony. Part (b) of Figure 1 highlights the
phenomenon of hypnosis as explained by neodissociation theory. In response to a
suggestion, the subconscious part of the control structure attenuates to the given
suggestion (e.g., you will have more belief in your ability when standing on the
start line) without the conscious part of the central control structure’s knowledge
(Hilgard, 1994). To illustrate this, even though an athlete does not consciously hear
the presented suggestions about having more self-belief, they are aware of them via
the hidden observer. Therefore, the unconscious part of the central control system
is able to maintain contact with the subordinate control system for memory, while
the conscious part is not (except for the hidden observer). As illustrated in Figure
1, hypnotic suggestions are proposed to act upon the central-control structure (or
executive ego) causing it to create a communication or amnesic barrier that separates
for use in conscious awareness (Hilgard, 1994).
Neodissociation theory has a number of strengths in relation to explaining
hypnotic functioning (Sadler & Woody, 2010). First, the theory explains a variety
of suggestive phenomena (e.g., analgesia, amnesia, positive and negative hallucina-
tions, ideomotor and challenge suggestions) via the same underlying mechanism
of dissociation (Kirsch & Lynn, 1998). Second, the theory helps to explain self-
hypnosis as readily as it explains hetero-hypnosis (Hilgard, 1986). For example,
there is nothing in the theory that necessitates an external hypnotherapist to insti-
gate the division of consciousness. Third, data continue to support the existence
of the hidden observer following hypnotic suggestions (Kihlstrom, 1998; Sadler
& Woody, 2010). Despite initial support, typically evidence for neodissociation
theory has been provided by the main proponent of the theory (i.e., Hilgard). To
this end, the challenge for researchers is to demonstrate a strong empirical base
for the theoretical postulations of neodissociation theory through further research.
Overall, neodissociation theory focuses principally on dissociation processes
to explain hypnotic functioning. A contrasting theoretical perspective recognizes
nonstate processes (e.g., the interpersonal relationship between hypnotherapists
and participant) as plausible hypnosis explanations.

Nonstate Theories
In contrast to neodissociation theory, researchers also identify that social-psycho-
logical, social-cognitive, and cognitive-behavioral processes (e.g., hypnotic expec-
tancy and preconceptions toward hypnosis, compliance, and attribution) may also
236  Barker, Jones, and Greenlees

explain hypnotic responding (e.g., Barber, 1969; Kirsch & Lynn, 1995; Sarbin &
Coe, 1972; Wagstaff, 1991, Wagstaff et al., 2010). For example, a hypnotherapist
is able to create expectancy in participants that they will have certain experiences
and responses. A theory of role-taking to explain hypnosis (Sarbin & Coe, 1972) is
based on the sociological concept of role enactment and proposes that role-taking
behaviors may help to explain hypnotic functioning (Weitzenhoffer, 2000). To
illustrate, hypnosis is argued to be an active, goal directed role-enactment in which
the participant and therapist are enacting roles appropriate to their conceptions of a
developed script (Spanos, 1991). Therefore, hypnotic responses are not automatic
occurrences but purposeful activities (Wagstaff et al., 2010).
There is some initial support for the view that preconceptions about hypnosis
affect the way hypnosis is experienced and how the demand characteristics, rather
than experimental variables may be the major determinant of hypnotic behavior
(e.g., Barber, 1969; Spanos, 1982, 1986, 1991). Indeed, such postulations oppose
dissociation theories, where the participant is not passively letting things happen,
but actively making things happen.
Another view posits the social role or compliance to please the hypnothera-
pist as being the main reason for hypnotic phenomena (e.g., Wagstaff, 1981).
For example, a ‘good’ hypnotic participant will be able to involve themselves in
imaginative processes to enact the role demanded in the hypnotic context (e.g.,
laboratory or stage show). Hypnosis also may appear to be largely a matter of willing
compliance to the implied demands by the hypnotherapist. Thus, the hypnotized
person is not in an altered condition, they are responding to expectations and social
obligations (Wagstaff, 1981). Research exploring the concept of compliance sug-
gests that individuals who are highly hypnotizable may be complying or faking
their experience to keep up the pretense of being a deeply hypnotized person (e.g.,
Coe & Sluis, 1989).
In sum, nonstate theories draw attention to the important role played in hypnosis
by attitudes, motivations, beliefs, and expectancies; these factors are considered
very disparate from dissociation. Although some researchers have contended
nonstate explanations to lack necessary theoretical underpinning (Weitzenhoffer,
2000), social-cognitive factors have been reported to be important to the hypnosis
process and in hypnotic responding (e.g., Hawkins, 2006). Therefore, a more
balanced view of hypnotic functioning could recognize the importance of both
dissociation and nonstate factors (Kirsch & Lynn, 1998; Sadler & Woody, 2010;
Woody & Sadler, 1998).

A Combined Theoretical Approach and Working Definition


The hypnosis literature has typically viewed theoretical explanations in isolation
rather than considering integration to more clearly explain hypnotic functioning
and associated phenomena (Kallio & Revonsuo, 2003; Sadler & Woody, 2010).
Therefore, in-line with contemporary views and based upon the authors’ experience
of applying hypnosis to the sport domain, we recognize the value of dissociation
and nonstate processes in explaining hypnotic behavior and present a combined
theoretical approach.
We propose a combination of Hilgard’s (1977, 1994) neodissociation theory,
and nonstate theories (e.g., Spanos, 1986, 1991; Wagstaff et al., 2010) because
Hypnosis and Sport Performers’ Self-Efficacy   237

we recognize hypnosis may not be brought about by one particular process but a
combination of processes working in unison (Woody & Sadler, 1998). By combin-
ing the two theories, we incorporate a number of processes including: hierarchical
control systems, associative memory networks, automatic activation of behavior,
motivation, intention, and response expectancy to provide a more complete under-
standing of hypnotic functioning (Kallio & Revonsuo, 2003). Both neodissociation
and nonstate theories have a number of key strengths regarding their combination.
For example, neodissociation theory explains a variety of suggestive phenomena
(e.g., analgesia, amnesia, and ideomotor suggestions) via the same underlying
mechanism of dissociation, more than other theoretical postulations (Kihlstrom,
1998; Kirsch & Lynn, 1998). In addition, nonstate researchers agree to the sub-
stantial effect which attitude, motives, beliefs and expectancies, views expressed
by a hypnotherapist, and the interpersonal nature of hypnosis can have on hypnotic
functioning (Wagstaff et al., 2010).
In sum, the separate consideration of hypnosis theory has stagnated the con-
ceptual understanding of hypnosis and failed to recognize the collective impact
and meditational effects of key factors on hypnotic behavior (e.g., dissociation
and attitudes). Therefore, we have posited an integrated theoretical approach to
explain hypnotic functioning along with providing a stimulus for future concep-
tual research. We also draw upon this combined approach to explain the impact of
suggestion(s) during hypnosis and hypnotic functioning in relation to data reported
later in this review.
We also present a working definition of our combined theoretical suggestion
including both dissociation and nonstate aspects (e.g., Hilgard, 1994; Wagstaff et al.,
2010), and the views of other leading authorities on hypnosis (Kirsch & Lynn, 1995;
Weitzenhoffer, 2000). Therefore, the following working definition of hypnosis is
presented and used in reference to the data reported in the remainder of this review:
Hypnosis is an induced temporary condition of being, a state of dissociation
(divided consciousness) differing mentally and physiologically from a person’s
normal state of being. This state can be influenced by attitudes, motivations,
beliefs, and expectancies, by participants and hypnotherapist, and procedures
in which a person in a usually relaxed state responds to suggestions for
making alterations in perceptions, feelings, thoughts, actions, behavior, and
or emotions.

The Effects of Hypnosis on Sport Performers’


Self-Efficacy: Current Findings
In our recent program of research, we have suggested that hypnosis may enhance
self-efficacy through the combined use of self-modeling, feedback, imagery, and
self-talk techniques (see Barker & Jones, 2005, 2006, 2008; Barker, Jones, &
Greenlees, 2010). For example, hypnosis may help to recreate a mental picture
of a model or of a self-modeling experience. Further, it is possible that hypnosis
could provide feedback to an athlete with hypnotic suggestions that replicate past
performances. In addition, it is plausible that hypnotic suggestions could contain
imagery-mastery information relative to successful performances. Finally, hypnosis
238  Barker, Jones, and Greenlees

also could possibly be used as a way of facilitating the content and delivery of
athletes’ self-statements. Hypnosis therefore may have the potential to be a time-
efficient and effective technique to increase self-efficacy in sport, as it can draw
upon a range of techniques simultaneously, although these postulations remain
open empirical questions.
We hypothesized that hypnosis will facilitate cognitions and behaviors that will
influence all of the antecedent sources of self-efficacy information as presented in
Bandura’s (1997) self-efficacy theory (see Barker et al., 2010). First, with regards
to performance accomplishments, the use of suggestions regarding effective
coping and the mastery of challenging situations may help a performer to recall
past (and imagine future) mastery experiences, along with reappraising past poor
performances. For example, MG-M imagery, which refers to effective coping and
mastery of challenging situations, and motivational-specific (MS) imagery referring
to setting and attaining specific training and performance goals, have been found
to be effective at increasing self-efficacy (e.g., Callow et al., 2001; Jones et al.,
2002). Second, hypnosis could be used to provide information on vicarious experi-
ences. Moreover, an athlete could be presented with suggestions that relate to the
successful performance or confident behaviors of a teammate. To illustrate, models
provide vicarious experience information, and accordingly, they may impact and
facilitate levels of self-efficacy (Bandura, 1997; Clark & Ste-Marie, 2007). Third,
hypnosis could be used as an internal verbal persuasive technique, whereby sug-
gestions could be given to give a performer encouragement and support, and hence
possibly build self-efficacy about a particular task. For example, self-talk has been
proposed to be positively related to an individual’s self-efficacy beliefs (Bandura,
1997). Finally, hypnosis could theoretically impact the physiological and emotional
state (e.g., reduce arousal and increase relaxation) as well as improve the imaginal
experience (i.e., the quality of the athlete’s imagery ability) of the athlete before
and during performance, achieved via the use of suggestions to control and alter
perceptions, emotions, and behavior. For example, motivational general-arousal
imagery (MG-A), which involves focusing on the affective responses associated
with sport performance, such as feeling excited before an important competition, has
been associated with changes in athletes’ emotional responses (Martin et al., 1999).
According to neodissociation theory responses to suggestions focusing on
mastery experiences, vicarious experiences, internal verbal persuasion, emotional
and physiological arousal control, and the imaginal experience of the individual
will cause the subconscious part of a sport performers’ central-control structure
to attenuate to the given suggestion(s) without the conscious part of the central
control structures’ knowledge (Hilgard, 1994). In turn, by communicating with
the subconscious part of the mind, long-term behaviors and cognitions may be
impacted upon without the conscious part interfering. For example, athletes may
respond positively to suggestion(s) and imagery during hypnosis (e.g., a greater
acceptance of persuasory information, and a greater belief in images of future
success) because the nonconscious part of the cognitive control structure responds
to the given suggestion and image without engaging potentially critical conscious
awareness (Hilgard, 1986). In addition to suggestions facilitating dissociation, we
posited by drawing on nonstate theories that hypnotic suggestions may also be
effective due to positive expectations, beliefs, attitudes held by participants, and the
interpersonal nature of hypnosis (Wagstaff et al., 2010). Overall, we proposed that
Hypnosis and Sport Performers’ Self-Efficacy   239

during hypnosis, athletes may be provided with important self-efficacy informa-


tion (via hypnotic suggestions) that enhances self-efficacy beliefs, and associated
athletic performance.
To explore our predictions, we have undertaken a line of research using both
idiographic and nomothetic approaches and the use of ego-strengthening posthyp-
notic suggestions. Ego-strengthening, popularized by John Hartland (1966, 1971),
has been suggested to facilitate self-confidence and self-efficacy in clinical hypnosis.
The concept of ego-strengthening revolves around helping participants to enhance
feelings of self-confidence, self-worth, and to minimize anxiety and worrying. The
essence of this approach is to repeat suggestions of confidence and belief over and
over so that the suggestions take hold in the person’s subconscious mind and exert
an automatic influence on feelings, thoughts, and behavior (Hammond, 1990).
Typically, throughout our research we have used the original ‘authoritarian’ routine
from Hartland (1966, 1971) to increase hypnotic acclimatization for participants.
Afterward, this original routine has been amended to make it more sport-specific,
and therefore more meaningful to participants. Scripts have included suggestions
relating to previous sport experiences, sport-specific terms, reference to practice
and competition settings, and the use of individual self-statements. The task-specific
posthypnotic suggestions that were added to Hartland’s original script were done
following recommendations made by Hammond (1990). To illustrate, suggestions
were included if they were appropriate to the context (e.g., competition scenario),
valued by or acceptable to the participants (e.g., feeling more self-confident), and
demonstrable within the participant’s repertoire or potentialities (e.g., performing
successfully). For example, combining mastery experiences into ego-strengthening
suggestions has been observed to promote positive ego-strengthening changes (e.g.,
Gardner, 1976). Overall, the posthypnotic suggestions used throughout our research
have focused on elevating feelings of self-efficacy, improving sport performance,
inducing feelings of relaxation, focused attention, effort, persistence, skill develop-
ment, and decreased anxiety.
To date, our research has provided preliminary support for our theoretical
and empirical postulations regarding the effects of hypnosis on sport performers’
self-efficacy. First, Barker and Jones (2005) explored the effects of a hypnosis
intervention on an elite judo athlete who reported a debilitating level of self-
efficacy. Using a single-subject A-B design with a six-month follow-up phase, self-
efficacy data were collected via a specifically designed questionnaire comprising
seven-items relating to good judo performance from 35 judo training sessions. An
intervention program (devised specifically for the study) including eight hypnosis
sessions (three general ego-strengthening, three sport-specific ego-strengthening,
and two self-hypnosis) was delivered to the client. A preperformance routine using
self-hypnosis was developed which the client used before training and competi-
tion. Visual inspection of self-efficacy data across the study revealed a substantial
improvement from pre- to postintervention phases; moreover, social validation
data (Kazdin, 1982) from the client indicated that the hypnosis had been the main
influence for the increase in her self-belief.
Second, Barker and Jones (2006) explored the effects of an intervention
comprising hypnosis, technique refinement, and self-modeling on the self-efficacy
of a male cricket leg-spin bowler. Using a single-subject A-B design, data were
collected across 24 games (i.e., eight baseline, 16 postintervention including eight
240  Barker, Jones, and Greenlees

collected seven months after the intervention). The multimodal intervention was
comprised of three aspects. Aspect #1 focused on using hypnosis and self-hypnosis
procedures. To this end, based on a similar procedure as used by Barker and Jones
(2005), 10 hypnosis sessions in total were delivered including both general-and
sport specific ego-strengthening suggestions and self-hypnosis. A preperformance
routine was developed for the client to use the night before, and on the morning
before each match. Aspect #2 was based around refining the bowler’s technique,
focusing on the run-up, head position, and follow-through. Aspect #3 focused
on self-modeling through the use of an edited videotape. Overall, the results
revealed a statistically significant difference between pre- and postintervention
self-efficacy levels, with this positive change being maintained in the long-term
follow-up data. An increase in bowling performance was also noted across the
postintervention phases.
Finally, Barker and Jones (2008) reported the effects of a hypnosis intervention
on a professional soccer player who reported low self-efficacy and a negative mood
state relative to his soccer performance. Using a single-subject A-B design, pre-
and postintervention data were collected via a Soccer Self-Efficacy Questionnaire
(SSEQ) that comprised 10-items relating to good soccer performance, a subjective
Soccer Performance Measure (SPM), and the Positive and Negative Affect Schedule
(PANAS; Watson, Clarke, & Tellegen, 1988). An intervention program consisting
of eight hypnosis sessions was conducted. These sessions comprised the presenta-
tion of ego-strengthening suggestions. Both visual and statistical analysis revealed
substantial increases in self-efficacy, positive affect, and soccer performance, as
well as a substantial decrease in negative affect over the course of the intervention.
Furthermore, social validation data indicated the client considered the intervention
to have had a substantial effect upon the belief he had in his ability and as well as
his mood state before soccer performance.
These three idiographic studies provide some preliminary evidence for the
potential of hypnosis interventions in bringing about changes in self-efficacy,
affect, and sport performance. To illustrate, postintervention data in all three studies
demonstrated self-efficacy levels to have substantially increased and become more
consistent in comparison with baseline. The studies also indicated hypnosis to be a
potentially effective technique in differing modalities of delivery (e.g., client led,
self-hypnosis and as part of a multimodal intervention).
While the three idiographic studies reveal hypnosis to be potentially effec-
tive in enhancing athletes’ self-efficacy, between-group designs and statistical
evaluation of the results have traditionally been used to evaluate treatment and
intervention techniques in psychological research (Bodner, 2006). Therefore,
using a nomothetic approach Barker et al. (2010) evaluated the immediate and
maintained effects of hypnosis on self-efficacy and soccer performance. A total
of 59 collegiate soccer players were randomly allocated to either a hypnosis (n
= 30) or video attention-control group (n = 29). A pretest-posttest design with
an additional four-week follow-up was used. Self-efficacy was measured via a
task-specific questionnaire comprised of 10 items relating to good performance
on a soccer wall-volley task. The hypnotic intervention was comprised of three
45-min sessions using ego-strengthening suggestions. The control group watched
edited videos of professional soccer games across three 45-min sessions. Results
Hypnosis and Sport Performers’ Self-Efficacy   241

indicated that, following the intervention, the hypnosis group were more self-
efficacious and performed better on the soccer wall-volley task than the control
group. These differences were also seen at the four-week follow-up stage. Social
validation data supported the findings with the entire hypnosis group, indicating
that the intervention had helped them to feeling more confident while perform-
ing the soccer task.

Future Research Directions


Our recent research provides some promising data regarding the effect of hyp-
nosis in facilitating athletes’ self-efficacy beliefs and performance in a variety of
sporting tasks and activities. However, the between-groups study did not evaluate
soccer competitive performance per se, and so the possibility of hypnosis resulting
in competitive performance outcomes remains an open empirical question. Data
also offer some initial support to our postulations that hypnosis (comprising ego-
strengthening suggestions) can potentially facilitate self-efficacy beliefs by influ-
encing the antecedent sources of self-efficacy (i.e., performance accomplishment,
vicarious experience, verbal persuasory, physiological and emotional state, and
imaginal experience; Bandura, 1997). Future researchers should consider replica-
tion of our data and further exploration of our theoretical postulations.
While much research has been devoted to the study of self-efficacy beliefs in
sport, SCT also postulates that attainments sought after by teams, develop through
a shared sense of collective efficacy (Bandura, 1986, 2000). The constructs of
self- and collective efficacy are proposed to share similar antecedents and conse-
quences. That is, analogous to self-efficacy, collective efficacy is associated with
tasks, level of effort, and persistence (Bandura, 1997). Identifying strategies that
help facilitate a strong sense of collective efficacy among sports teams is necessary
(Feltz et al., 2008). Therefore, hypnosis in-group settings may be expected to impact
upon teams’ collective efficacy beliefs using similar mechanisms as postulated for
self-efficacy. Despite this suggestion, to date no research has considered whether
collective efficacy beliefs can be enhanced through the use of hypnosis.
A potential caveat of our data and an area for future researchers relates to
the measuring or determining if participants were experiencing hypnosis. This is
indeed a complex issue due principally to a lack of precise measures and markers.
Throughout our research, hypnosis was determined by triangulating information
from observing objective behavioral responses to suggestions by subjective par-
ticipant feedback about feelings during hypnosis, and the assessment of hypnotic
depth. While all of these markers have been contended to be useful in determining
whether someone is in a hypnotic state (Hawkins, 2006; Heap & Aravind, 2002;
Sapp & Evanhow, 1998), there are obvious limitations in terms of their accuracy
and interpretation. It could be argued that psycho-physiological measures such
as electroencephalogram (EEG) may have provided more objective and accurate
indices of hypnosis. However, measurement issues, including limited electrode
placement, and inadequate signal processing technologies have rendered the draw-
ing of conclusions about psycho-physiological markers of hypnosis difficult and
inconclusive (e.g., Graffin, Ray, & Lundy, 1995). Accurately measuring a hypnotic
state is a contentious issue and will remain so until more valid and reliable measures
242  Barker, Jones, and Greenlees

are obtained. Clearly, determining whether someone is hypnotized, although ardu-


ous, will provide pertinent stimulus for future researchers.
Finally, in this review, we presented a combined theoretical approach and
working definition to help explain hypnotic functioning. We further challenge
researchers to explore the major tenets and foundations of our approach. To
illustrate, future researchers may wish to establish which processes (e.g., special-
state or nonstate) have the most substantial effect on hypnotic functioning in the
combined approach.

Suggestions for Practitioners


Some useful practical findings for coaches, athletes, and sport psychologists have
been identified from our use of hypnosis in sport. First, our research and experience
has provided some initial data supporting the potential use of both one-to-one and
group based ego-strengthening hypnosis. Practitioners may therefore consider such
approaches, dependent on the nature of their consultancy (i.e., working with one
athlete or a small team sharing a similar performance related problem). Second,
when using hypnosis, it is possible that sport psychologists will encounter negative
views, experiences, and prejudice from those involved in sport. In such cases, it
is recommended that education procedures be used to break these barriers down
(see Table 1). Third, the use of the term hypnosis with athletes may create as
many problems as it does intrigue. Practitioners also may consider using the term
sparingly in situations where they are trying to gain entry into sports and there is
skepticism toward sport psychology and mental skills. Fourth, case histories of
any potential athlete for hypnosis should be collected and checks made for mental
illness, medication, and the use of recreational drugs (Heap & Aravind, 2002).
Individuals who reveal any of the above issues should be counseled regarding
more appropriate interventions (Hawkins, 2006). Fifth, hypnosis requires a strong
rapport between the practitioner and athlete to reduce client anxiety and facilitate
overall treatment efficacy (Hammond, 1990). Therefore, time should be taken
before hypnosis exposure to become accustomed with the athlete and their train-
ing and competition situations. Sixth, specific emphasis may be placed in allowing
athletes to contribute to the content of the mental skills sessions and the hypnosis
scripts. We have discovered that allowing athletes to have an active role in the
content of future sessions greatly enhanced their overall motivation and adherence
to the mental skills training program. Having their input in the development of the
hypnosis scripts was seen as an integral part of facilitating rapport and the impact
of the hypnotic suggestions. Hypnosis scripts containing athletes’ self-talk, sport-
specific speak, and terms may be more likely to resonate with the athlete and bring
about the desired changes rather than a script developed solely by the practitioner.
Finally, from our experiences we suggest athletes consider the use of self-hypnosis
to foster less reliance on hetero-hypnosis and autonomous use of the technique.
Practitioners may monitor athletes’ use and progression of self-hypnosis closely
and make changes to scripts and procedures where appropriate. In some situations,
the use of self-hypnosis may be deemed inappropriate and removed due to indi-
vidual characteristics (e.g., low imaginative skill and poor attentional focus) and
thus hetero-hypnosis could be considered the primary strategy (Hawkins, 2006;
Heap & Aravind, 2002).
Hypnosis and Sport Performers’ Self-Efficacy   243

Table 1  Guidance for Hypnosis Education in Sport


Guidelines
1) Initially, discuss any hypnotic experiences or perceptions. This would typically be
undertaken during the collation of a case history during the first contact.
2) Use sporting or other examples to illustrate to athletes the efficacy of hypnosis.
3) Educate athletes on how stage shows bring about changes in behavior.
4) Highlight the differences between stage and clinical hypnosis. For example,
emphasize how athletes are not made to engage in embarrassing behaviors or divulge
personal information during clinical practice.
5) Educate athletes about how hypnosis works and what they will experience during
hypnosis. For example, instructions may be presented that illustrate the following:
hypnosis is not the same as sleep; individuals are in control throughout; during hypnosis,
slight twitches or tremors may be felt; time may appear distorted; being hypnotized does
not indicate gullibility; and the athletes will remember everything. Be careful not to
overstate the efficacy of hypnosis.
6) Allow an opportunity for athletes to take away and digest information pertaining to
hypnotic procedures (e.g., develop and use an information sheet).
7) Allow an opportunity for athletes to discuss hypnosis and the procedures. Typically,
this may be done following the reading of hypnosis information.
8) Provide an opportunity for athletes to experience ‘taster’ hypnosis procedures; this
builds confidence in the technique, educates, and reduces negative perceptions.

Conclusion
Given the significant association between self-efficacy and sport performance
research exploring effective techniques that facilitate such beliefs are worthy
additions to the sport psychology literature. The aim of this review was to add to
the extant literature and present theoretical postulations and preliminary empiri-
cal data indicating the potential of hypnosis as a strategy to influence athlete’s
self-efficacy. To this end, data provide some initial promise for hypnosis as a
potential strategy to bring about changes in self-efficacy and performance. Despite
the current line of research, hypnosis still remains relatively under-researched
in the sport domain and thus there is a continued need for future researchers to
explore the efficacy of hypnosis upon other psychology performance variables
such as concentration, emotions, and motivation. The intrigue of hypnosis and the
pursuit of meaningful psychological gains in sport-related research and practice
are ubiquitous, and much remains to be discovered about hypnosis and the most
efficacious ways of facilitating psychological states associated with optimal sport
performance.

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