Journal of Abnormal Psychology 1995, Vol. 104, No.

3,508-516

Copyright 1995 by the American Psychological Association, Inc. 0021-843X/95/$3.00

Does Counterpain Imagery Mediate Hypnotic Analgesia?
Robin Hargadon, Kenneth S. Bowers, and Erik Z. Woody
University of Waterloo
Sixty-six high hypnotizable individuals received a baseline exposure to pain and 2 counterbalanced hypnotic analgesia conditions. Standard analgesia invoked counterpain imagery, whereas imageless analgesia proscribed imagery. The mean level of pain reduction in these 2 conditions was virtually identical and significantly less than the pain rated in the baseline condition. Furthermore, cognitions experienced as active efforts to cope with the pain occurred far less often and were associated with less pain reduction than cognitions experienced as passive concomitants of pain reduction. The results cast considerable doubt on the widespread assumption that imaginative involvement mediates hypnotic responding.

We may then lay it down for certain that every representation of a movement awakens in some degree the actual movement which is its object; and awakens it in a maximum degree whenever it is not kept from so doing by an antagonistic representation present simultaneously to the mind (James, 1890, II, p. 526).

There are two ways in which William James's concept of ideomotor action has been extended and generalized into an understanding of hypnotic responding (e.g., Arnold, 1946). First, it has been invoked to account not only for overt behavior such as arm levitation, but also for alterations in subjective responses, such as hallucinations and analgesia. Second, investigators have emphasized the importance of becoming imaginatively involved in the various ideas that are suggested during hypnosis (J. R. Hilgard, 1979; Sarbin & Coe, 1972). Thus, despite their disagreement on many other important issues, advocates of both a neodissociative (E. R. Hilgard, 1977) and a social psychological model (Spanos, 1986) of hypnosis seem to agree that "imaginative involvement constitutes a generalized cognitive ability central to the performance of hypnotic tasks" (Spanos & McPeake, 1974, p. 689; see Lynn & Sivec, 1992, for a similar assessment). In addition, advocates of a social psychological model of hypnosis argue that imaginative involvement is critical for the experience of nonvolition, presumably because hypnotized individuals misattribute their hypnotic responses to the accompanying imagery, rather than to their own willful efforts to generate the suggested state of affairs (Lynn, Rhue, & Weekes, 1990; Lynn & Sivec, 1992). In light of the above considerations, it is not surprising that advocates of both the neodissociative and social psychological models of hypnosis typically reinforce target suggestions with supportive imagery. Consider, for example, hypnotic analgesia: Suggestions that a person's hand, say, will become in-

Robin Hargadon, Kenneth S. Bowers, and Erik Z. Woody, Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada. The research herein reported was supported in part by a Social Sciences and Humanities Research Council grant and is part of Robin Hargadon's doctoral dissertation. Correspondence concerning this article should be addressed to Kenneth S. Bowers or Erik Z. Woody, Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1.

sensitive to pain are ordinarily reinforced with various counterpain images—for example, suggestions that the hand is made of wood or stone, or that it is enclosed in a heavy, protective glove. Presumably, the more highly hypnotizable people are, the more talent they have for fantasy and imagination and therefore, the more imaginatively involved they become in hypnotically suggested reductions in pain. Moreover, when people are later asked about their cognitions during the pain trial, they will often report counterpain images that accord with the suggested state of affairs (E. R. Hilgard & Hilgard, 1975). Thus, observation and theory converge on the conclusion that imaginative involvement in counterpain imagery help mediate pain reduction. However, this conclusion overlooks an important consideration: To the extent that suggestions for counterpain imagery are always present in suggestions for analgesia, it is impossible to determine whether they actually mediate reductions in pain. Perhaps in highly hypnotizable individuals, suggestions for analgesia and suggestions for counterpain imagery generate cooccurrent but independent effects, such that the imagined state of affairs does not mediate reductions in pain any more than reductions in pain mediate counterpain imagery (K. S. Bowers, 1992b). One way of evaluating this possibility is to compare the degree of pain reduction when analgesic suggestions invoke versus proscribe counterpain imagery. To our knowledge, this comparison has never been made, perhaps because of the consensual view that involved imagining mediates effects suggested during hypnosis. However, three studies reported by Zamansky and his colleagues (Bartis & Zamansky, 1990; Zamansky, 1977; Zamansky & Clark, 1986) and one reported by Spanos, Weekes, and de Groh (1984) present a strong challenge to this view. In these studies, participants were instructed to imagine a state of affairs that opposed or contradicted the suggested experience or behavior (e.g., people were asked to imagine bending an arm after hypnotic suggestions had rendered it stiff and rigid). High hypnotizable people typically did not bend their arms, even while vividly imagining themselves doing so. Those who responded this way often expressed surprise at the outcome, which is also the typical reaction of researchers who hear about these results for the first time. Such studies raise important questions about the centrality of imagery and imagination in responses suggested during hypnosis.
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participants also completed a 4-point scale. they could use pain reports of higher than 10. they were not informed until after the first treatment intervention that a second intervention was forthcoming. During exposures to the pain stimulus.e. We do so. participants rated the intensity of experienced pain on a scale from 0 (no pain) to 10 (pain so great you would like to remove your finger). Bowers. but by proscribing imagery and imaginative involvement of any kind during the course of painful stimulation. the experimenter probed for greater detail about any thoughts. Following each exposure to the painful stimulus. they were told: . we ask whether counterpain imagery mediates hypnotic analgesia or the experience of nonvolition. on arrival. However. and informed consent was obtained before proceeding with the experiment. Subsequently. Participants who scored between 8 and 12 on both scales were contacted by telephone and invited to participate in a study involving hypnosis. If. Form A (HGSHS:A. 1993). without focusing their attention on it. were informed that the experimenter was interested in examining responses to hypnotic suggestion for analgesia. They were told that if they reached a rating of 10 on the scale but felt that they could keep their finger in the device longer.e. & Hart. "as if it was a block of wood or stone that has no feeling or sensation whatsoever. 1992). For example. without allowing yourself to focus on it. the experimenter conducted a nondirective interview in which participants were asked to relate everything that had gone through their minds.COUNTERPAIN IMAGERY AND HYPNOTIC ANALGESIA 509 In the present investigation. deepening suggestions. not by opposing an imagined and suggested state of affairs. Focal pressure was produced on the exposed finger between the first and second knuckles by a somewhat sharpened edge that was lowered onto the finger. and end of exposure. and (c) hypnotic depth. concerning the extent to which they had experienced pain reduction as effortlessly (i. Procedure Participants were seen individually in the laboratory and. the experimenter lifted the bar and instructed the participant to remove his or her finger. 66 highly hypnotizable individuals participated in this investigation. and the effort required to initiate and maintain it. Nonetheless. and subsequent suggestions for analgesia were approximately 20 min long.066 g of weight was delivered to the point at which the edge contacted the finger. or as a passive concomitant of pain reduction. Laurence. and the treatment and baseline trials were counterbalanced for the use of the dominant and nondominant hands. A secondary goal of this investigation was to examine pain ratings as a function of how individuals experienced their cognitions during hypnotic analgesia—as an active effort to reduce pain.. Participants received the second hypnotic treatment after providing verbal consent. which typifies hypnotic responding. If participants reported experiencing any imagery. The middle and index fingers were counterbalanced for baseline exposures across participants and for each participant's two treatment exposures. 1962). The carefully selected high hypnotizable individuals used in this study were exposed to both conditions in counterbalanced order. The equivalent of 1.during the time that yourfingeris in the device." For the imageless analgesia condition. Ratings were given orally at the sound of a beep that was presented at 10 s intervals. Finally.g. Bowers. or as if it was protected by a thick. they should simply let it go. . While your finger is in the device. your hand will remain comfortably unresponsive to the pressure and your finger will continue to feel numb and insensitive throughout. leather glove. or whether they catastrophized the pain experience (in a manner to be detailed later). No one refused to participate. The hypnotic inductions. thereby averting the possibility of "hold back" effects during the first treatment trial (see Stam & Spanos. S. Bowers. by contrast. do not concentrate on it. experienced control over imagery was rated. If in the present research participants' introspections prove to be consistent with the other data and provide a coherent overall perspective. just let it go. Participants were also asked to complete a number of 7-point scales tapping their inner experience during the hypnosis trials. including (a) extent of thought. Participants underwent a baseline exposure to pain followed by two treatment interventions. during this time. Also. but the important thing is that if a thought or image does occur. Freedom from thoughts or images may or may not come easily to you. feelings. they may clarify the issue of whether cognitions that accompany hypnotic analgesia actually mediate reductions in pain. or images that passed through their minds at the beginning. participants were instructed not to allow themselves to become involved in imagery either during the hypnotic induction or the subsequent analgesia trial. The results of this "imageless analgesia" intervention are then compared with the outcome of standard analgesia suggestions that include counterpain imagery. modeled after items from the Choice Scale of non volitional experience (see P. Apparatus The pain stimulus consisted of a finger pressure apparatus modified from Forgione and Barber's (1971) strain-gauge pain stimulator. volitionally) enacted. images or other distractions to enter your mind. Lynn & Sivec. but simply allow it to pass on. G. The finger-pressure appa- . After 90 s.. perchance. These interviews were later coded for whether participants were active or passive in how they coped with the pain. they were then asked to rate its vividness. you will not allow any thoughts. 1980). Specifically.. The same hand was used for both treatment trials. using a different finger for each trial. & Oakman. individuals' perceptions of what they are doing in hypnosis have long been a topic of interest and controversy (e. your mind will be emptied of all thoughts or images. middle. They were told that if an image or thought did occur to them. so that comparisons in pain reduction—and in participants' retrospective appraisal of the two interventions—could be made on a within-subjects basis. or simply accompany them as a co-occurrent suggested effect. Individuals who scored at least 8 on this scale were invited to undergo a second assessment of hypnotic ability using the Waterloo-Stanford Group C (WSGC) scale of hypnotic susceptibility (K. 1992). Treatment order was counterbalanced so that 33 participants received standard analgesia first and 33 received the imageless analgesia first. for details). Shor & Orne. ratus was introduced. a thought or image does drift into awareness. Participants underwent three pain stimulation trials. nonvolitionally) versus purposefully (i. (b) extent of imagery. Pain Treatment Conditions The hypnotic induction and suggestions administered in the standard hypnosis treatment trial included images congruent with analgesia. Method Participants Participants were initially screened on the Harvard Group Scale of Hypnotic Susceptibility. . 1988. The same limits on how accurately people can introspect on their cognitive activities hold in hypnosis as elsewhere (Woody. In total. After each treatment condition. participants were told that their hand was becoming increasingly numb and insensitive to sensations. their absorption in this imagery.

rated each participant's posttreatment interviews on a 5point scale regarding the extent to which each of the following 1 The finding that high hypnotizable individuals who were in the imageless condition first and the standard condition second showed more imagery across conditions may be a result of their interpretation of the experimental demands of each condition in the context of experiencing the other hypnosis treatment condition. HARGADON. confirms that pain ratings made during the baseline trial (M = 49.001. 64) = 36. Overall. The ANOVA indicated a significant main effect for treatment condition.63) = 42. as major dependent variables.005. Similarly. In addition. Pillai's F(\6.001. involuntariness of pain reduction (1-4).1 However. 8 were in the standard analgesia condition first. involuntariness. such that participants in the imageless condition reported a slightly more nonvolitional experience during pain reduction than those in the standard condition. pain ratings across the two treatment conditions did not differ.. As illustrated by Figure 1.17.71. Mean pain ratings across nine report intervals for baseline (represented by points) and two hypnotic analgesia conditions (the standard condition.01). . who were blind to treatment conditions.85. Pillai's F(2. Thus.05. An analysis of variance (ANOVA) indicated significant main effects for treatment order. participants who received the imageless condition first reported more imagery in both the imageless and the standard conditions than did those who received the treatment conditions in the reverse order.510 Results R.06.00. SD = 19. "I thought about my finger being a powerful force. participants reported lower pain ratings in the standard and the imageless conditions as compared to baseline. and a significant interaction of condition by time. F(l. In other words. The ANOVA for participants' ratings of involuntariness during pain reduction excluded those who rated themselves as not experiencing pain reduction at all (« = 14. The remaining data in Table 1 reflect means and standard deviations of participants' ratings of thoughts (1-7).3. K. participants who had previously received the imageless condition. participants receiving the imageless condition first may have allowed themselves to experience more imagery. and so on. in which suggestions for goaldirected imagery were included." "I thought about a movie I saw last night") indicated a significant main effect for treatment condition. for imageless analgesia condition.50) = 4. p < . the more powerful (and expected) effect was the higher level of imagery in the standard than in the imageless condition. Two independent judges.001. Without this context. Participants were equally successful at reducing pain regardless of whether the suggestions included counterpain imagery. F( 1. (b) whether pain ratings differ over time in the standard and imageless analgesia conditions. p < . which permitted the use of all nine pain ratings in the following analyses. 49) = 3. 10 20 30 40 50 60 70 80 90 TIME OF PAIN REPORT (seconds) Figure 1.64) = 65. Participants in the standard condition reported more such thoughts than those in the imageless condition. and this factor did not interact to a significant level with condition or time of pain report. We now turn to judges' ratings of participants' posttreatment interview data. A significant main effect for condition. Participants' Posttreatment Ratings of Various Experiences During the Pain Challenge The means and standard deviations of the participants' imagery ratings (1-7) are presented in the top row of Table 1. The final ANOVA conducted on self-report ratings of depth of hypnosis indicated no significant effects.07) were higher than those made following treatments (for standard analgesia condition.71. Pillai's F(8. M = 29. SD = 20. the instruction not to allow oneself to become absorbed in thoughts or images in the imageless condition may have been clearer to participants who had previously received the standard condition. and treatment condition.5. p < . p < . indicates that the magnitude of the difference between pain ratings in the baseline and treatment conditions increased over time. An ANOVA performed on participants' ratings of thoughts (e. p < .001.52.001. indicates that pain ratings increased over time for all three conditions. p = . and 6 were in the imageless analgesia condition first). there was no significant main effect for treatment order. AND E.00. SD = 18. This finding serves as a manipulation check: The standard and imageless analgesia conditions did in fact generate anticipated differences in the amount of imagery participants experienced. WOODY Pain Reports All participants tolerated the pain stimulus for the maximum exposure of 90 s. A repeated measures multivariate analysis of variance (9 pain reports X 3 conditions X 2 treatment orders) was used to examine (a) whether participants reduce pain from baseline to posttreatment. may have been more aware of the image-based phrases included in the induction and suggestions (that were otherwise the same as what they had previously received) and more readily surmised the expectation for them to use the suggested goal-directed imagery. imagery. during which they were explicitly told not to use imagery. BOWERS. participants did not vary in their self-reports of hypnotic depth as a function of the presence or absence of suggestions for counterpain imagery concomitant with suggestions for analgesia. As Figure 1 also shows. p < .67. F( 1. M = 29. Use Versus Nonuse of Imagery The above analyses focused on participants' ratings of pain. A significant main effect for time. represented by asterisks). 64) = 9. 57) = 36.g. and (c) whether there was an effect of treatment order on pain ratings. F ( l . represented by crosses and the imageless condition. and depth of hypnosis (1-7).

35 3.e. this effect is clearly due to higher pain reports by participants coded as focusing on the pain.00 1. 2 (occasionally present or slightly characteristic).e. or as a passively experienced concomitant of pain reduction. in both analgesia conditions.88 5. followed by imageless analgesia.84 3.81 to . corrected by the Spearman-Brown formula. similarly.COUNTERPAIN IMAGERY AND HYPNOTIC ANALGESIA 511 Table 1 Means and Standard Deviationsfor Self-Report Ratings of Various Experiences Reported During Standard and Imageless Hypnotic Analgesia Standard first Experience Imagery ( 1 -7) Standard Imageless Standard second Standard Imageless M SD Thoughts (1-7) 3. cate2 These dimensions were arrived at on the basis of pilot work and prior studies that have identified these. participants did not differ in the amount of pain reduction as a function of whether imagery was the dominant mode of experiencing during the pain challenge. A mean score higher than the midpoint (i. with nine pain reports and three categories of experience. imageless analgesia.42 2. or noticing-catastrophizing the pain). (f) imaginative inattention (e. imageless analgesia was the dominant mode of experiencing.96 3.46 1. 5 (highly predominant or present throughout). Alpha coefficients for judges' coding of experimental participants' protocols ranged from .2 Rating categories for each of these dimensions were as follows: 1 (not present or characteristic). p < . Standard first means standard analgesia conditions were received first.001. I didn't think about anything"). Within each treatment condition. 4 (often present or largely characteristic). Pain reports for each treatment condition were analyzed with a repeated measures multivariate analysis of covariance.83 M SD Involuntariness (1-4) M SD Hypnotic depth (1-7) M SD Note. For 73% of the participants in the imageless condition.99 2. In other words.. the mean rating across the two judges within each experience category was used for subsequent analyses. for people who scored below 2.32 4.. . "I noticed that the pain increased quite quickly"). nonimagery was considered to be the dominant mode of experiencing. according to the following arbitrary (but orderly) way of proceeding. F(2.23 1.5 indicated that imagery was the dominant mode.00 2. "I imagined myself cycling up a hill"). dimensions as potentially important and scorable from self-reports (Tan. This latter finding further substantiates the virtually identical average pain reduction by participants in the imageless and the standard analgesia conditions. F(2..5 on nonimagery.18 5.18 1.42 1. However.81 5. 3 (fairly often present or moderately characteristic).g. (d) relaxation.5 on imagery but above 2. The data for these comparisons are presented in the two panels of Figure 2. 62) = 5. the standard and imageless analgesia conditions yielded 40 and 9 such participants. the mean rating across the two image-based experiences (imaginative transformation and imaginative inattention) was then calculated for each participant. In both the standard (upper panel) and imageless analgesia (lower panel) conditions.. Cognitions were rated as active when participants described them as a deliberate and effortful use of goaldirected strategies to reduce pain. There were 10 such participants in the standard analgesia condition and 9 in the imageless analgesia condition.. numbness. 2. Among the remaining participants.26 0. regardless of the participants' scores on imagery or nonimagery.006.3 For each participant.42 1.32 0.54. imagery experience.. noncoping. regardless of the nonimagery score. a main effect for category of experience was detected—standard analgesia.99 5.08 3. There were 16 nonimagery participants in the standard condition and 48 in the imageless analgesia condition.82 1.00 1.93. using corresponding baseline pain reports as covariates. the comparable figure for those in the imageless condition was 14%.88 0. (b) blanking (e. Turk. thereby showing a high level of interrater reliability for both the standard and for the imageless analgesia conditions. Meichenbaum. p < . "I thought my finger was going to be sliced off").30 1." "the weight was made of feathers"). This finding on the basis of judges' ratings confirms similar findings (reported earlier) indicating that participants' ratings of imagery and nonimagery corresponded well with whether they were in the standard or imageless condition. & Genest.73 1.52 1. nonimagery experience. imagery was the dominant mode of experiencing. Standard second reverses this order. "it was as if I had no hand"). (g) noticing pain (e. "I pictured my hand with a thick leather glove on it. and relaxation) and for noticing pain-catastrophizing. respectively.73 1. and (h) catastrophizing (e. Cognitions were rated as passive when participants reported them as occurring in an effortless manner.70 1. (c) numbness. For 61% of the participants in the standard analgesia condition.g. blanking. the comparable figure for those in the standard condition was 24%.. "my mind was a blank. 1983). participants' reports of whether they experienced imagery accorded quite well with the condition they were in. Judges were familiarized and trained with the above coding scheme using the protocols of 15 pilot participants.58. 1982.g. pain ratings of participants in each category of experience were compared (i.g. or when they reported being "gone" or "tuned out" during the pain trial. 62) = 7. A third.81 3.g. (e) imaginative transformation of pain or stimulus (e. or similar. experience dimensions were present: (a) denial (e. an average imag- ery score above 2.46 1.85 0. an average was calculated across all the nonimage-based experiences (denial. Active Versus Passive Experience of Imagery-Nonimagery Judges also rated each participant's reported cognitive experiences during each pain trial as an active effort to cope with the pain.5) on noticing-catastrophizing indicated that this was the predominant mode of experiencing. Finally. alpha is equivalent to the correlation between judges.. On a priori conceptual grounds. 3 In this circumstance. This condensation of data into three indices permitted us to identify each participant's primary mode of experiencing.g.

p < . Discussion The most striking and important finding of the present study is this: In high hypnotizable participants. passive cognitive experiences were again associated with more pain reduction than active cognitive experiences. A trend in the same direction occurred in the standard analgesia condition. we are not interested in pain ratings unless they reflect some significant alteration in the experience of pain. and the imageless analgesia condition. . F(2. BOWERS..93. or who noticed-catastrophized pain. f(l. pain reports for three categories of cognitive experience were submitted to a multivariate analysis of covariance. HARGADON. 1992).001. 1981) disagreement with Wagstaff (1981) on this score. K. Participants tended to report their cognitions as passive rather than active—regardless of whether they were in the standard or imageless analgesia condition. pain reports had to be examined separately for each condition as a function of participants' mode of experiencing. and lines with asterisks represent the noticing pain condition (top: n = 10. passive. however. Spanos seemed to be leaning more in this direction (e. 1977)—imagery accompanying hypnotic analgesia did not account for the experience of nonvolition that is so characteristic of hypnotic responding (P.003. Spanos. & McLeod. Indeed. F(l. The three post hoc . Mean (adjusted) pain ratings for participants who did or did not experience imagery. metapsychological issue here that can not be completely resolved in this article. WOODY groups constituted a between-subjects factor. Some participants shifted their cognitive mode of experiencing (i. more than twice as many participants had their imagery or nonimagery experiences rated as passive (« = 40) rather than as active (n = 16). 1976/1983). in the standard (top panel) and the imageless (bottom panel) analgesia conditions. participants coded as noticing pain reported higher pain ratings than those coded as active or passive. There is clearly a fundamental. rather than an alteration in experience.09. The issue raised by the reviewer reflects a traditional skepticism about hypnotic phenomena—that they represent an overt compliance with demand characteristics. the same was true in the imageless analgesia condition. By contrast.p<. 62) = 6. In the imageless condition (see top panel of Figure 3). S. p < .36. Wagstaff (1991) is perhaps the main contemporary spokesman for this claim.01. and the nine pain reports constituted a within-subjects factor.g. 62) = 10. bottom: n = 9).512 R. & Weekes. and that we have made "the classic mistake of discussing 'pain reduction' instead [of a] 'reduction in pain ratings'. Cross. lines with crosses represent the condition without imagery (top: n = 16. p < . participants coded as passive reported significantly less pain than those coded as active. F{1. However. using corresponding baseline pain reports as covariates.4 Furthermore. though in some of his later writings. Therefore. AND E. Second—and contrary to the claim by advocates of a social psychological model of hypnosis (e. bottom: n = 9). participants whose dominant mode of experience actually corresponded to the suggestions prescribing or proscribing imagery did not differ from each other in the extent of pain reduction from baseline.18. Lynn.e. indicating that when the standard analgesia condition was administered second (see bottom panel. Disagreements about how to rate participants' cognitions were resolved by discussion. Spanos. gory of cognitions involved focusing on the pain experience or catastrophizing it (or both).02. Figure 3). A main effect for cognitive experience was found for both the standard analgesia condition.82 in the imageless analgesia condition. 10 20 30 40 50 60 70 90 Time of Pain Report (seconds) 10 20 30 40 50 60 70 90 Time of Pain Report (seconds) Figure 2. 1990. Rhue. Rivers. Although we were mainly interested in any differences in pain associated with active and passive cognitions. Bow4 One reviewer of this article alleged that the pain reports in this study are very susceptible to bias. bottom: n = 48). Lines with points represent the condition with imagery (top: n = 40. participants who noticed-catastrophized pain represented a noncoping comparison group.." Clearly. hypnotic analgesia 'suggestions that proscribe counterpain imagery engender mean levels of pain reduction virtually identical to those achieved by hypnotic suggestions for analgesia that invoke such imagery. One of us has elsewhere grappled with the skeptical view of hypnosis at some length (K. and ..78. F\2. 51) = 2.83 in the baseline condition. Burgess. & Ross. 54) = 6.16. the interaction of treatment order and active-passive experience was significant. The (Cohen's kappa) reliability of these ratings was . active. there was little difference in the pain ratings of participants when the standard condition was administered first (see middle panel.51) = 7. Evidently—and contrary to the received view—suggestions for analgesia need not be elaborated with imagery in order to promote a substantial reduction in pain.85 in the standard analgesia condition. or noticing-catastrophizing) from the standard to the imageless condition. in the standard analgesia condition. Figure 3). In both conditions. Bowers. For each analgesia condition. despite his earlier (Spanos & Radtke.g. where the corresponding figures were 39 and 18. p < .

which was more difficult than the initial screening instrument. 1992b. respectively). 1991. S. middle. Mean (adjusted) pain ratings for participants whose experiences were rated as active (lines with points).21. n = 18. they are apt to be less hypnotizable than their scores indicate. 5. and bottom panels. see K. but it may well be due to differences in participant selection. K. The issue of selecting truly high hypnotizable individuals is important. However. because those who are well selected seem to exert little or no effort to achieve suggested effects. Weitzenhoffer. Bowers & Davidson. Bowers. The reason for this discrepancy is not completely clear. S. respectively). 1990. unlike many others. and bottom panels. for two reasons: (a) selecting high hypnotizable individuals on the basis of a single measure of hypnotic ability means that unregressed scores represent an overestimate of participants' true hypnotic ability. 1992a. 1991. respectively). studies using a relatively lax criterion of high hypnotizability may find successful hypnotic responding accompanied by more cognitive effort than studies using a stricter criterion. (b) even taking such regression effects into account. Miller & Bowers. This follows from the fact that pain reduction was accompanied by significantly higher ratings of nonvolition in the imageless than in the standard analgesia condition. 1994). n = 9. For the active experience. Briefly put. Indeed. dissociated control implies that suggestions directly activate hypnotic responses. high-scoring individuals on a relatively easy scale of hypnotizability will not. score as high on a more difficult scale of hypnotic ability. middle. middle. 1994. 1978). the more likely they are to exert cognitive effort to achieve hypnotically suggested effects.) The active-passive findings are at odds with other research (reviewed by Lynn & Sivec. For the pain experience. (This difference also occurred in the standard analgesia condition. S. relatively easy scale of hypnotic ability (as is typically the case in hypnosis research. high hypnotizable individuals were selected partly on the basis of their performance on a second. 1993). Accordingly. without requiring high-level cognitive resources to engender the target behavior. The situation for individuals in the moderate range of hypnotic ability is presumably somewhat mixed. For the passive experience. passive (lines with crosses). at least in the imageless analgesia condition. Bowers (1990. K. standardized scale of hypnotic ability. which typically reports superior hypnotic responding in participants who actively engage in cognitive strategies. as a group. (b) active efforts to reduce pain did not lead to superior pain reduction. A third finding flows from the judges' ratings of whether participants' thoughts and images during the pain challenge were experienced as passive concomitants of pain reduction. The main point of this investigation was to examine the role of counterpain imagery in hypnotic analgesia. 1992). participants who rated their cognitions as passive showed significantly more pain reduction than those whose cognitions were rated as active efforts to reduce pain. 7. S.COUNTERPAIN IMAGERY AND HYPNOTIC ANALGESIA 513 10 20 30 40 50 60 70 Time of Pain Report (seconds) 10 20 30 40 50 60 70 Time of Pain Report (seconds) 20 30 40 SO 60 70 80 90 Time of Pain Report (seconds) Figure 3. and 5 (top. and bottom panels. Woody & Bowers. When high hypnotizable individuals are selected only on the basis of their performance on a single. but only when it was administered second. and 9 (top. 1993. the less well-selected high hypnotizable individuals are. In the present investigation. 1991. Thus. or as active. An important assumption behind the notion of dissociated control is that responses (whether overt behavior or subjective . n = 39. the findings are quite consistent with the notion of dissociated control as recently formulated by K. Bowers. deliberate attempts to reduce pain. or noticing-catastrophizing pain (lines with asterisks) in the imageless analgesia condition (top panel). and in the standard analgesia condition when it was administered first (middle panel) and second (bottom panel). ers. whereas evidence is beginning to indicate that low hypnotizable individuals achieve their relatively modest success by exercising considerable cognitive effort (Bartis & Zamansky. Relevant analyses of judges' ratings yielded two major outcomes: (a) participants' cognitions were judged to be passive concomitants of pain reduction more than twice as often as they were judged to be strategic efforts to reduce pain. and 19 (top.1994). 1982.

perhaps. II. 1993). Woody & Bowers. Hilgard and Hilgard (1975) state that "For the highly hypnotizable subject within hypnosis. (1946).. Glisky. Wagstaff. The supervisory attentional system (SAS) is required for action that opposes routine or habitual responses. Woody and Bowers (1994) have argued that hypnosis tends to minimize SAS control of behavior. the present results confirm some previous studies (e. p.5 The possibility that imaginative involvement functions differently for people differing in hypnotic ability is perhaps one reason why measures of hypnotic ability and absorption (Tellegen & Atkinson. but hypnotic analgesia spared. Finally. After all. Bowers. 1994. to James's insistence that "a willed movement is a movement preceded by an idea of itself" (1890. 1989. 1984. because hypnotically suggested behavior is typically experienced as unwilled and nonvolitional (Lynn et al. Bowers. Such suggestions therefore have an increased probability of triggering hypnotic responses directly. It has been extraordinarily difficult to appreciate the possibility that imaginative involvement may have a very limited role in mediating hypnotic responses. Woody. However. 1991). Meichenbaum. 1992b. and ingenuity to achieve success" (p." Mindless responses are typically more automatic than their willful counterparts. Zamansky & Clark. Contention scheduling is a lower level. 1994. on occasion. K. Norman. Accordingly. Bowers. the progenitor of the dissociative model of hypnosis and hysteria. Miller & Bowers. 1989. 1990. is always an active and motivated effort to reduce pain (Farthing. On one hand. The latter was true even though counterpain imagery was included in the analgesia suggestions and was later reported by many participants. people may mindlessly dial a more familiar telephone number rather than the one they intended to dial. 580). BOWERS. it is responsive to environmental "triggers" that automatically activate relatively routine responses. This ambivalence about whether hypnotically suggested analgesia is effortlessly or effortfully achieved reflects the fact that the relative roles of dissociation and of imaginative involvement are not completely clear in his neodissociation model. decentralized system of control. S. the secondary task. The outcome was clear: Deliberate and strategic efforts to reduce pain impaired. 1992). 1981. In the latter case. 1994). Weitzenhoffer. 1979. pain reduction is essentially effortless" (p. it should interfere with the performance of the secondary task. HARGADON. 1992). 1983). On the other hand.g. and get on with the business of formulating a more cognitively sophisticated notion of how hypnotic responding is engendered (e. Woody etal.. & Oakman... 1990. M. 41. Zamansky. the mechanisms underlying successful pain reduction are quite different. Tobias. the SAS is quite active in the deliberate reduction of pain through stress inoculation techniques (Tan. References Arnold. imagery doesn't so much mediate the suggested effect as accompany it—thereby serving as a convenient marker of dissociated control. By way of contrast. In part. Perhaps it is time to take seriously the possibility that imaginative involvement has a far more limited role in generating hypnotic behavior than has heretofore been assumed. Participants in this experiment performed a cognitively demanding secondary task while reducing pain—either by hypnotic analgesia or by deliberate use of counterpain strategies. 1984. 1991. less sensitive to context. it also has access to overarching intentions and goals. 1990). 1986) that tell against an ideomotor account of hypnotic responding. 5 It is worth pointing out that Hilgard's neodissociative model is somewhat "ambidextrous" on the role of effort vis-a-vis hypnotic analgesia. 1990. Roche & McConkey. 1993. S. 1994). without interference from the SAS. On the mechanism of suggestion and hypnosis. Spanos et al. 1978). 1986. the more important imaginative involvement becomes as a mediator of successful hypnotic responding (Bartis & Zamansky. 1992). the Miller and Bowers (1993) study challenges—or at least qualifies—the widespread view that strategically invoked counterpain imagery mediates hypnotic analgesia. 107-128.514 R. 1984. Woody et al.g. 156). initiative. Barrett. Kihlstrom. this difficulty has resulted from the almost inevitable inclusion of supportive imagery in hypnotic suggestions—a nod. & Genest. 1994. Tataryn. A recent experiment demonstrates the difference (Miller & Bowers. and more subject to error (Bargh.. 1977. WOODY experience) are somewhat independent of how the response is engendered. Turk. Clearly. To illustrate. hypnotic responding has two quite distinct modi operandi—dissociated control and imaginative involvement (cf. & McConkey. The emphasis on imagery and imaginative involvement is especially ironic for advocates of a dissociation model of hypnosis. Reason. the term imaginative involvement suffers an important ambiguity: It does not distinguish between imagery experienced as a deliberate and effortful attempt to achieve the suggested state of affairs. this "dual mediator" proposal contrasts with a social psychological model of hypnosis. Pierre Janet (1907/1965). which can inform response selection. 181). 1974) are consistently related at such modest levels (e. . 1982. Thus. de Groh. A unidimensional measure of absorption will not correlate at very high levels with hypnotic ability if in fact hypnotic responding has two or more underlying mechanisms (Balthazard & Woody. They argue that there are two complementary levels of control that operate to engender behavior. the less hypnotizable a person is. K. Spanos. 1992b).. "the successful subject must use considerable effort. 1990). S. Bartis & Zamansky. 1992. & Brown. argued that an important condition of hypnotic responding (and hysterical symptoms) is the absence of various influential ideas from consciousness (K. the SAS is less apt to inhibit the effect of hypnotic suggestions on contention scheduling. B. and even though hypnotic analgesia reduced pain as much as deliberate strategies of pain control. and effortless imagery qua suggested effect. Woody & Bowers. AND E. even though the amount of pain reduction may be similar through stress inoculation and hypnotic analgesia. Journal of Abnormal and Social Psychology. However. Tiffany. K. for instance. Venturino. It is somewhat of an historical oddity that James's (1890) ideomotor account of willed behavior should ever have been adopted to explain hypnotic phenomena. Thus. Hilgard (1977) argues that to reduce pain. A recent theory of Norman and Shallice (1986) provides one way of understanding the willful-mindless distinction in the context of hypnosis (see also Woody & Bowers. dialing a particular telephone number can be generated willfully or "mindlessly.. which argues that hypnotic analgesia. Bowers. 1991. Together with the present investigation. To the extent that pain reduction requires cognitive effort.g. By our understanding.

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S. DC 20002-4242. K. income protection. (1978). Suggestion and countersuggestion.). Cognitive competition and hypnotic behavior: Whither absorption? InternationalJournal of Clinical and Experimental Hypnosis. Z. In E. Hypnosis: The Bulletin of the British Society of Experimental and Clinical Hypnosis. (1994). BOWERS. In S. For more information. In S. New York: Guilford Press.1994 • Low Publication Prices for APA Members and Affiliates Keeping You Up-to-Date: All APA members (Fellows..516 R. B. and they can subscribe to the American Psychologist at a significantly reduced rate. Members. and semantics in hypnosis: A nonstate. 1994 Revision received October 18. 52-79). belief. Nash (Eds. E. Membership Services. E. 3-33). S. J. sociocognitive perspective. & Bowers. New \brk: Guilford Press. Academic Press. Rhue (Eds. F. (1986).. Zamansky. NE. individual differences. (1992). the American Association for Counseling and Development. Z. 183-225). write to American Psychological Association. student/school liability. professional liability. Sugarman & R. Hypnotism and altered states of consciousness. the Master Lectures. 34. Woody. Fromm & M. 1981. Woody. K. as well as significant discounts on subscriptions from cooperating societies and publishers (e. and Student Affiliates) receive-as part of their annual dues-subscriptions to the American Psychologist and APA Monitor. (1977). accident protection. Washington. J. A frontal assault on dissociated control. 1994 Accepted December 20. 346-351. Rhue (Eds.g. Theories of hypnosis: Current models and perspectives (pp. Other Benefits of Membership: Membership in APA also provides eligibility for low-cost insurance plans covering life. A. & Oakman. and student health. M. E. 362-396).). Associates. Zamansky. 750 First Street. HARGADON. hospital indemnity. Essential Resources: APA members and affiliates receive special rates for purchases of APA books.). office overhead. 14-15. and Human Sciences Press). Journal of Abnormal Psychology. all members and affiliates are eligible for savings of up to 60% (plus a journal credit) on all other APA journals. Contemporary hypnosis research (pp. H. Expanding dimensions of consciousness (pp. and context. 205-214. including the Publication Manual of the APA. USA . S. Lynn & J. WOODY analysis of hypnotic responsiveness: Experience. and Journals in Psychology: A Resource Listing for Authors. L.. A conceptual Received February 21. Bowers. M.). Tarter (Eds. AND E. E.. Dissociation: Theoretical and research perspectives (pp. research/academic professional liability. Lynn & J. 86. A. Weitzenhoffer. (1991). High School Teacher and International Affiliates receive subscriptions to the APA Monitor. In addition.. health care. encoding specificity. Wagstaff. New York: Guilford Press. H. W. Compliance. & Clark. K. New York: Springer. S. In A.

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