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Hypnosis
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A Comparison of the Effects of

Hypnosis and Relaxation Training
on Stress Reactions in a Dental
Situation
a a
Diane M. Mc Ammond M.Sc. , Park O. Davidson Ph.D. &
a
David M. Kovitz D.D.S.
a
The University of Calgary , USA
Published online: 20 Sep 2011.

To cite this article: Diane M. Mc Ammond M.Sc. , Park O. Davidson Ph.D. & David M. Kovitz
D.D.S. (1971) A Comparison of the Effects of Hypnosis and Relaxation Training on Stress
Reactions in a Dental Situation, American Journal of Clinical Hypnosis, 13:4, 233-242, DOI:
10.1080/00029157.1971.10402119

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 T m Annnnxx JOVBWAL
or CLnncu, H ~ O Q ( I
Volume 13, Number 4, April lO7l
Prinfedin U.B.A.

A Comparison of the Effects of Hypnosis and Relaxation

Training on Stress Reactions in a Dental Situation‘

DIANE M. MCAMMOND, MBc., PARK 0. DAVIDSON, PhD.,

and DAVID M. KOVITZ,DDB.
The Univetgity of Calgaty
Downloaded by [University of New Hampshire] at 01:41 08 February 2015

Skin conductance and eelf-report anxiety of frightened dental patients were

measured during a pain tolerance test and an anesthetic injection procedure.
On the skin conductance measure, relaxation and hypnosis were more ef-
fective than control for highly aroused Ss. There were no daerences be-
tween treatment9 for Be showing low arousal. Pain tolerance scores and
self-report anxiety scores also showed no merences. A five month follow-up
indicated that hypnosis Se showed more post-treatment approach behavior
ta the dentd situationthan relaxation Ss.

The fields of psychology, psychiatry, in- A considerable amount of research has

ternal medicine, physiology, sociology, and
anthropology have all been concerned with
the study of stress in recent years. Stress
research has come to include the investiga-
tion of such topics as conflict, frustration,
anxiety, ego-defense, emotion, disaster,
threat to security, tension, and arousal
(Appley & Trumbull, 1967; Lazarus, 1967).
The importance of stress in the field of den-
tistry is apparent. Dental patients are nec-
essarily exposed to direct physical stressors
such as injection of anesthetic, dental sur-
gery, or tooth extraction. Many patients are
also subject to psychological stress in the
form of anxiety or emotional reaction to the
threat of harm. The experimental and clini-
cal literature is replete with reports of
methods for alleviating stress reactions. The
present study investigated the efficacy of
two of these methods (relaxation training
and hypnosis) in reducing the stress reac-
tions of patients who professed to be fright-
ened of having dental work done.
‘TI& study waa supported in part by National
Research Council Grant APA-213.
233
been directed at procedures for reducing ex-
perimentally induced stress. Lasarus and
his colleagues (Lasarus & Alfert, 1964;
Lasarus & Opton, 1966; Lazarus, Opton,
Nomikos & Rankin, 1965; Speisman, Lasa-
rus, Mordkoff, & Davison, 1964) have at-
tempted to induce changes in the appraisal
of stressful film scenes through the manipu-
lation of “ego-defense processes” (Lazarus
& Opton, 1966, p. 227). They provided de-
nial and intellectualization narratives as
sound tracks for stressful films, and found
that experimental groups provided with
these “ego-defense” narratives displayed re-
duced stress responses in comparison with
control groups.
Folkins, Lawson, Opton and Lazarus
(1968), using a film as the vicarious stres-
sor, tested systematic desensitization and
two of its components-relaxation and cog-
nitive rehearsal-f or their effectiveness in
altering experimentally induced stress reac-
tions. A self-report stress measure (the Af-
fect Adjective Check List; Zuckerman,
1960) indicated that all three treatments
were more effective than the control proce-
 234
dure in reducing stress responses to the film,
with cognitive rehearsal the most effective
method and systematic desensitization the
least effective. Skin conductance data also
revealed significant differences between
groups, with conductance highest in the
control group, lower in the desensitization
group, still lower in the relaxation group,
and lowest in the cognitive rehearsal group
-the same ranking as found with the self-
report data.
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Paul (1969) compared the effects of re-
laxation training, hypnotic suggestion, and
a self -relaxation procedure in reducing
subjective tension and physiological
arousal. Although the study was concerned
with reducing reactivity below normal rest-
ing levels, the findings have some relevance
for the present study. Ss received two ses-
sions of training under the various treat-
ment conditions, with measures of skin con-
ductance, heart rate, respiratory rate, tonic
muscle tension, and self-reported tension or
anxiety recorded after each session. It was
found that in the first session, relaxation
training produced significantly greater
changes than control (self-relaxation) on
all measures except skin conductance. Hyp-
nosis resulted in decreases in respiratory
rate and self-reported anxiety compared to
control. During the second session, both re-
laxation training and hypnotic suggestion
produced significant decreases compared t o
control all measures except skin conduct-
ance. Significantly greater reductions in
heart rate and muscle tension were found
for relaxation than for hypnosis.
Bobey and Davidson (1970) argued that,
since pain can be viewed as a stressor, ex-
perimental manipulations of the type dis-
cussed above should increase an individual’s
tolerance level for pain. Using both a ra-
diant heat method and a pressure method of
pain tolerance measurement, they investi-
gated the effects of relaxation training, cog-
nitive reheasal, “stress,” and a control pro-
cedure on pain tolerance. The “stress” con-
MCAMMOND ET AL.
dition involved listening to a tape recording
of the cries and screams of women during
labor. The relaxation group heard the same
training tape as that used by Watkins and
Davidson (1970). The cognitive rehearsal
group listened to a tape giving detailed de-
scriptions of the procedures and sensations
involved in the pain tolerance measurement
situation. The control group listened to the
study habits tape used by Folkins et al.
(1968). Results of this study showed that
all treatments were effective in raising pain
tolerance scores above control levels. The
relaxation group showed the highest toler-
ance scores, with “stress” and the cognitive
rehearsal scores no different than each other
but higher than control scores.
Hypnosis has often been cited as an
effective method for reducing or altering
pain reaction. Doupe, Miller, and Keller
(1963) found that hypnotically suggested
analgesia reduced the vasoconstriction re-
sponse to a pinprick. West, Niell, and
Hardy (1952) found that GSR to painful
stimulation was significantly reduced under
hypnotically suggested analgesia compared
to a waking control condition, and Dynes
and Poppen (1932) showed that heart rate
and respiratory rate to pinch and pinprick
were lower in a hypnotic analgesia condi-
tion that in a waking control condition.
However, Barber (1963) notes that in both
the Dynes and the West et al. experiments
the same Ss were used in hypnosis and con-
trol trials, and hypnosis trials almost al-
ways followed control trials. Therefore it
appears possible (following Hiebert and
Davidson’s [1970] findings) that reductions
in autonomic reactivity under hypnotically
suggested analgesia may have been due to
adaptation effects. In addition, these four
studies compared hypnotic analgesia with
an uninstructed waking condition. Barber
and Hahn (1962) also found that, com-
pared with an uninstructed waking condi-
tion, hypnotically suggested analgesia re-
duced subjective reports of pain and physi-
 STRESS FCEACTION IN A DENTAL SITUATION
ological responses (muscle tension and ir-
regularities in respiration) to noxious stim-
ulation. However, the same degree of reduc-
tion in subjective and physiological re-
sponse was found in a “waking” group that
was instructed to imagine vividly a pleas-
ant situation during exposure to the noxious
stimulation.
On the other hand, Brown and Vogel
(1938), Sutcliffe (1961) and Shor (1962)
found that autonomic reactions (increase in
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skin conductance, heart rate, or blood pres-
sure) to noxious stimulation were as great
in magnitude under hypnotically suggested
analgesia as under a waking control condi-
tion.
Blitz and Dinnerstein (1968) contend
that hypnotic analgesia is an extreme ex-
ample of the effectiveness of suggestion and
instructions in altering pain perception.
They further note that clinical experience
with pain illustrates the potency of sugges-
tion, instructions, and placebos and suggest
that placebo effects share with hypnotic an-
algesia and “voluntary attempts to imag-
ine” (Barber & Hahn, 1962) the common
process of re-organizing or reinterpreting
somesthetic experience so as to perceive it
as less painful.
Lazarus (1966) notes that “not only does
the dental context provide an excellent area
in which to study the principles of stress
but, conversely, the analysis of stress as a
general phenomenon also offers great possi-
bilities of applying principles of stress pro-
duction and reduction to dental practice [p.
16201.”
The present study, therefore, investigated
the effects of relaxation training and hyp-
nosis in reducing the stress reactions of
frightened dental patients to pain stimuli
applied in the dental setting. The pain
stimuli consisted of an anesthetic injection
procedure administered by the participating
dentist and a pressure algometer pain toler-
ance test.
Relaxation training was chosen as one
235
treatment because it has been demonstrated
to be effective in reducing stress reactions to
both vicarious stressors (Folkins et al.,
1968; Hiebert and Davidson, 1970) and to
direct pain stressors (Bobey and Davidson,
1969), as well as to feared objects with pho-
bic subjects (Rachman, 1965; Lang, 1969).
Hypnosis was chosen as the second treat-
ment. Although well controlled experimen-
tal evidence concerning the effectiveness of
hypnosis in reducing stress reactions is
sparse and in some instances conflicting, the
technique is highly recommended by den-
tists who use the method in dealing with
anxious patients (Erickson, Hershman, &
Secter, 1961; Frost, 1959; Kovitz, 1967;
Moss, 1952).
METHOD
Subjects
The Ss were 27 adults who were selected
from a group of 120 persons who responded
to a newspaper advertisement requesting
volunteers who were frightened of the den-
tal situation. All 120 volunteers were
screened. Only those Ss showing a marked
rise in skin conductance (SC) in compari-
son with the rest of the group when given
an anesthetic injection (or when an injec-
tion was attempted in the case of some Ss) ,
and who were judged by the participating
dentist t o be in need of dental care, were
selected. Ss ranged in age from 18 to 50
years, and included 5 males and 22 females.
One S who was selected and completed hyp-
nosis training was not included in the anal-
ysis of results because her polygraph record
was not obtained due to equipment failure.
Apparatus
Skin resistance (SR) was recorded with a
Grass Model 7 polygraph. The active elec-
trode was applied to the palm of the left
hand while the reference electrode was
placed on the proximal inner surface of the
left forearm.
 236 MCAMMOND ET AL.

Pain tolerance measures were obtained they became proficient a t inducing deep
with a pressure algometer similar to that muscular relaxation.
described by Mersky and Spear (1964)and Hypnosis group. Ss in this group met as a
identical to that used by Davidson and group twice a week for seven sessions. Hyp-
McDougall (1966).It consisted of a plun- nosis training was conducted by the partici-
ger mounted on a spring which was cali- pating dentist whose office was used during
brated from 0 to 5 kg. pressure. The flat screening and test sessions and who admin-
circular end of the plunger had a diameter istered the injection procedure. The induc-
of .5 cm. and was applied to the distal pha- tion technique utilized eye fixation, visual
lanx of the thumb, with pressure increased imagery, and progressive relaxation. Ss
a t a constant rate of one kg. per second. were repeatedly given suggestions that they
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Tolerance level was recorded in kg. at the would no longer be afraid to have their den-
point where S indicated that he could no tistry done and that they would feel no dis-
longer tolerate the pressure pain. Two pain comfort in the dental situation.
tolerance measures were taken, one before Control group. SS in the group received
treatment during the screening procedure no treatment between the time they were
and one after treatment during the test ses- first seen by the dentist during screening
sion. and the test day when they returned to the
The second pain stimulus consisted of a dentist’s office. Barber (1963,1969)has sug-
standard anesthetic injection procedure in- gested that an uninstructed no-treatment
volving the insertion of a hypodermic nee- group is not an adequate control in hypno-
dle for a mandibular injection, without ac- sis research. Since Barber and Hahn (1962)
tual injection of anesthetic. found that suggestions of pain relief given
without defining the situation as hypnosis
Procedure or utilizing a hypnotic trance were as &ec-
The Ss were randomly assigned to three tive as hypnotically suggested analgesia,
groups. Distributions of age, sex, and pre- the control group in the present study re-
treatment pain tolerance scores were not ceived brief pain relief and relaxation in-
significantly different between the three structions immediately before noxious stim-
groups. ulation was encountered.
Relaxation group. A relaxation training On the test day, Ss came to the dentist’s
tape (16 minutes duration) recorded by C. office a t an appointed time with the knowl-
G. Costello of the Psychology Department, edge that they were to be exposed to some
University of Calgary, based on the relaxa- dental procedure. Ss were seated in the den-
tion techniques outlined by Wolpe and Laz- tal chair by a nurse and recording elec-
arus (1966,Pp. 177-180) was used to in- trodes were then attached by the experi-
struct Ss in the technique of deep muscular menter ( E ) . Although the electrodes had
relaxation. The tape was identical to that been attached previously and their purpose
used by Watkins and Davidson (1970).Ss explained during the screening procedure, E
met twice a week for seven training sessions again assured S that the electrodes would
and heard the tape via headphones. Al- do no harm but were simply “sensors” to
though most studies using relaxation train- record 8’s reactions. After the electrodes
ing provide only one or two training ses- were attached, E asked S to sit back and
sions, the present study used seven sessions relax for about 10 minutes. E then left the
and Ss were encouraged to practice the room and a 10 minute resting baseline pe-
technique between sessions to ensure that riod was recorded for Ss in all groups. Ss in
 STRESS REACTION IN A DENTAL SITUATION
the relaxation group then put on a set of
headphones and listened to the relaxation
training tape while still sitting in the dental
chair. Following the baseline period, Ss in
the hypnosis group were put in hypnotic
trance by the dentist and given suggestions
of deepening trance, relaxation and comfort.
They were then brought out of trance. Ss in
the control group were just asked to sit
back and relax.
Following these treatments, the pressure
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algometer pain tolerance test was adminis-
tered to all Ss by E. Following the pain
tolerance test, the injection procedure was
conducted. Ss in the relaxation group were
instructed by the dentist to relax com-
pletely before the injection. 6 s in the hyp-
nosis group were put in trance by the den-
tist and given suggestions that they were
relaxed, happy, and felt no discomfort. The
injection was given while Ss were in the
hypnotic trance. Ss in the control group
were given suggestions of pain relief and
relaxation before the injection was adminis-
tered. SR was recorded continuously from
before the baseline period until one minute
after the injection.
After the electrodes were removed, Ss
completed the State-Trait Anxiety Inven-
tory (STAI) (Spielberger, Gorsuch, &
Lushene, 1969).
Ss were then asked to give an answer on B
seven point rating scale ranging from “very
successful” to “not successful a t all” to the
question “HOWsuccessful has participation
in this study been in alleviating your fears
of the dental situation?”
No further dental work was carried out
after the injection procedure. Ss were en-
couraged to make appointments with their
own dentist or with the participating den-
tist if they had no family dentist.
Five months after this test session all
subjects were contacted to determine if they
had visited a dentist since completion of
treatment.
237
mULm
As noted above, SR was recorded contin-
uously throughout the test session. How-
ever, three discrete data points were ab-
stracted from each 8’s record. Readings
were sampled every two seconds for the last
two minutes of the resting baseline period,
and the arithmetic mean of these readings
constituted the first data point. The second
point was the lowest resistance recorded in
the period from the beginning of the appli-
cation of pressure during the pain tolerance
test to 10 seconds after the removal of the
pressure algometer. The third data point
was the lowest resistance recorded during
the injection procedure or in the 20 seconds
following removal of the needle. The SR
data, as read off the polygraph chart in
ohms, were converted to conductance in mi-
cromhos (Montagu & Coles, 1966).
Raw scores on the STAI were converted
to normalized T-scores according to stand-
ardization data for general medical and
surgical patients provided in the test man-
ual (p. 15).
It was felt that differences between
groups on resting baseline might obscure
treatment differences. SC data from the
present study were therefore stratified
within each group according to baseline SC
level. Mean baseline SC level for each
group was calculated, and baseline levels
falling one-half standard deviation above
the mean were assigned to the high baseline
group. Scores falling one-half standard de-
viation below the mean constituted the low
baseline group, with scores falling between
the two making up the medium baseline
group. Two two-factor analyses of variance
(ANOVA) were then performed, one for
baseline and treatment effects at pain toler-
ance test and one for baseline and treat-
ment effects at injection. Summary tables
for these analyses appear in Tables 1 and 2.
Figures 1 and 2 present the treatment base-
line interactions at pain tolerance test and
injection.
 238 MCAMMOND ET AL.

TABLE 1 and control a t medium baseline, and there

ANOVA SUMMARYTABLEFOR TREATMENT AND were no treatment differences a t low base-
BASELINEEFFECTSON SC LEVELAT PAIN line.
TOLERANCETEST
Source
Pain Tolerance Scores
Since pain tolerance wag measured before
Treatments (A) 2 11.04 <1 and after treatment, a repeated measures
Baselines (B) 2 689.42 33.66*
AXB 4 129.76 6.33* ANOVA was utilized to determine (a) if
Error 18 20.48 pain tolerance scores changed as a result of
treatments, (b) if treatment groups differed
* p < .05 on post-treatment pain tolerance scores, (c)
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if pain tolerance scores were related to rest-

TABLE 2 ing baseline SC levels. This third factor was
ANOVA SUMMARY TABLEFOR TREATMENT AND
included since it was shown to have an im-
BASELINE EFFECTS
O N SC LEVEL AT INJECTION
portant interactive effect with treatments in
Source df MS F the analyses of SC results. It was found
that pain tolerance scores did not change
Treatments (A) 2 3.45 <1 from pre-treatment to post-treatment meas-
Baselines (B) 2 897.87 28.28*
A X B 4 212.44 6.69*
urement for any of the groups, that the
Error 18 31.74
50 -
*p < .05

45 - 04Relaxation
I n order to determine which treatment Q----Q Hypnosis
groups differed significantly, Duncan Mul- - A--A Control
tiple Range Tests (Kirk, 1968) were carried
out. It was found that relaxation training
40
I
was more effective than hypnosis or control 35 -
\
and that hypnosis was no more effective
w
0
2
\
a
than control in reducing stress reactions to 5 30-
3
the pain tolerance test for Ss with high 0
z
baseline SC levels. However, the difference 8 25-
between hypnosis and control group means v)
0
was just short of the required significance 2 20-
range. For 8s with medium baseline SC 0
a
levels, relaxation was less effective than 0
f 15-
hypnosis and control procedures, with no
differences between hypnosis and control
procedures. There were no significant dif- 10 -
ferences between treatments for Ss showing
low baseline SC levels. The treatment ef- 5-
fects were similar at injection, with one ex-
ception. Hypnosis was significantly more 01 I I I
effective than control for high baseline Ss at HIGH MEDIUM LOW
injection. At pain tolerance test this differ- BASELINE
ence was just short of significance. Again, FIQ.1. Treatment x baseline interaction at pain
relaxation was less effective than hypnosis tolerance test.
 STRESS REACTION I N A DENTAL SITUATION 239
treatments had no differential effects on tol- 50 -
erance scores, and that baseline SC level A
\ Q.--Q Relaxation
was unrelated to pain tolerance scores. 45- ~ - - - - m Hypnosis
\ *-A Control
State-Trait Anxiety Inventory Data \
40 -
The grouping of Ss according to resting \
baseline SC level was also included as a \
factor in the ANOVA of STAI scores. It w
0
35-
was found that the treatments had no effect z
a
on state or trait anxiety scores, and that 53 30-
n
STAI scores were unrelated t o baseline SC
Downloaded by [University of New Hampshire] at 01:41 08 February 2015

levels.
Response to Rating Scale
Responses to the question concerning suc-
cess of participation in the study in alle-
viating fears of dentistry were analyzed by
an ANOVA. Results of this analysis showed
a significant treatments effect (3’ = 9.90,df
= 2/24,p < .05).A Duncan’s Range Test
indicated that all groups differed from one
another, with the hypnosis group rating
treatment as most effective and the control
group rating treatment as least effective.
Follow-up Results
Five months after testing, all eight of the
Ss in the hypnosis group and five of the ten
Ss in the control group had returned for
dental treatment. However, only one of the
nine Ss in the relaxation group had received
dental care in the intervening five months.
Fisher Exact Probability Tests (Siegel,
1956) indicated that relaxation did not dif-
fer from control, hypnosis did not differ
from control, but significantly more Ss in
the hypnosis group than in the relaxation
group had returned to have dental work
done.
DISCUSSION
The skin conductance results do not offer
any simple answers to the question of which
of the three treatments constituted the most
effective method for reducing the stress re-
actions of these frightened dental patients.
z
0
o 25-
v)
0
g 20-
0
a
0
5 15-
10-
5-
I I I
0‘
The interaction of treatment effects with
resting SC baseline makes it necessary t o
consider the relative effectiveness of treat-
ments separately for each baseline level.
Resting or basal SC level has been used
most commonly as an index of arousal, acti-
vation (Schlosberg, 1954) or energy mobili-
zation (Duffy, 1951). Martin (1961)notes
that such a conception of SC level is
strengthened by the low conductance levels
found during sleep and the rapid rise in
conductance observed upon awakening. If
basal SC level can be considered to repre-
sent a continuum of arousal, then it follows
that low baseline Ss in the present study
were not as highly aroused as Ss with high
baseline SC levels. Low baseline Ss showed
no differential treatment effects on SC level
a t either pain tolerance test or injection. It
 240
would appear, then, that those Ss who were
not highly aroused in the dental situation
were equally affected by all three treat-
ments. On the other hand, the highly
aroused Ss were benefited most by relaxa-
tion training and hypnosis. For Ss showing
medium levels of arousal, relaxation was
not as effective as hypnosis or the control
procedure in reducing SC stress reactions.
Paul (1969) failed to find any differences
between treatment groups (relaxation, hyp-
Downloaded by [University of New Hampshire] at 01:41 08 February 2015
nosis and self-relaxation control) on his SC
measure. Since Paul’s study was concerned
with reduced levels of arousal, it would be
expected that the SC levels of his Ss would
be low. The low baseline group in the pres-
ent study also failed to show differential
treatment effects on the SC measure.
The failure of hypnosis to raise pain tol-
erance scores above control levels may have
been due to the fact that the tolerance
measure was taken while Ss were in a wak-
ing state immediately after coming out of
the hypnotic trance. This procedure was
followed to determine if the relaxation and
feelings of well-being suggested during the
hypnotic trance would have an effect on
pain tolerance in the waking state. Four Ss
were also tested while in the hypnotic
trance, without suggestions of analgesia but
with suggestions of relaxation and well-
being. The mean tolerance score in the wak-
ing state for these four Ss was 2.60 kg. and
the mean score while in trance was 4.56 kg.
(with three of the four Ss reaching the max-
imum measurable pain tolerance level of 5
kg.) . The difference between these means
was significant ( t = 3.43,p < .05).
Using independent groups, Barber and
Hahn (1962) found pain tolerance levels
(using the cold pressor test) to be signifi-
cantly increased over waking control levels
by both hypnotically suggested analgesia
and “task motivational instructions.” The
results of the present study suggest that,
when the tolerance measure is taken while S
is in trance, hypnotically suggested relaxa-
MCAMMOND ET AL.
tion and well-being also serve to raise pain
tolerance over waking levels. Barber and
Hahn used student volunteers as Ss in a
non-anxious situation. Since anxiety has
been related to pain tolerance (Kornetsky,
1954), it might be fruitful for a future
study to compare the effects of hypnotically
suggested analgesia, hypnotically suggested
relaxation and well-being, waking suggested
relaxation and well-being, and task motiva-
tional instructions on pain tolerance in anx-
ious and non-anxious 8s. Barber (1969) has
suggested that the hypnotic trance and the
definition of the situation as hypnosis are
not necessary variables in eliciting the be-
haviors commonly attributed to hypnosis.
He feels that suggestions and task motiva-
tional instructions given in a close interper-
sonal setting are the variables of primary
importance. However, Barber’s studies have
used student volunteers in non-anxious situ-
ations as Ss. It may be that defining the
situation as hypnosis and using a hypnotic
trance are necessary parts of the procedure
when dealing with highly anxious Ss. Fu-
ture experiments are required to determine
the necessity or sufficiency of the variables
discussed by Barber when dealing with the
pain tolerance of highly anxious Ss. It
should be noted that the present study did
compare Ss given the injection while in
trance (with suggestions of relaxation and
well-being) with Ss given the injection after
waking suggestions of relaxation and pain
relief. In this situation, there were no dif-
ferences between the groups in self-reported
anxiety although there were complex differ-
ences in SC response to the injection.
The results of the rating scale concerning
success of treatment suggest that the pa-
tient’s perception of the effectiveness of
treatment in alleviating fears is not closely
related to self-reported anxiety in the pres-
ence of the stressor or to physiological in-
dices of stress reaction. In addition, the
post-experimental approach behavior to the
stress situation was similar to rated success
 STRESS REACTION IN A DENTAL SITUATION
of treatment, but unrelated to physiological
or self-report measures of stress reaction.
This failure of physiological, self-report,
and behavioral measures of stress reaction
to agree with one another is a commonly
reported finding (Lazarus & Opton, 1966;
Martin & Sroufe, 1970).
It could be argued that, in a study of the
present sort, the most important measure
from a practical standpoint is the patient’s
future approach behavior to the feared ob-
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ject (ie.,the dental situation). The conclu-
sion reached from this measure would be
that hypnosis was the most effective treat-
ment. However, since the hypnosis group
did not vary consistently from the other
groups on the self-reported anxiety measure
or on the physiological measure, it would
appear that hypnosis somehow allows the
patient to restructure his experience of pain
and anxiety cognitively in such a way as to
allow approach to the feared and stressful
object.
Davison (1968)found that snake phobic
Ss treated by systematic desensitization
showed significantly more snake approach
behavior than Ss receiving relaxation train-
ing, gradual exposure to snake stimuli, or
no treatment. However, systematic desensi-
tization Ss still reported considerable anxi-
ety (ranging from 4 to 10 on a 10 point
scale) when approaching the snake after
treatment. It appears, then, that both eys-
tematic desensitization and hypnosis pro-
vide Ss with some means of cognitively re-
structuring their anxiety reactions to the
feared object rather than completely elimi-
nating their anxiety. Future research should
perhaps focus on the variables which allow
Ss to approach anxiety arousing situations
in spite of their anxiety, rather than con-
centrating on variables which reduce their
self-reported and physiologically measured
anxiety responses. The distinction here is
between the study of the variables affecting
stress reactions of SS who are already in the
stressful situation and the study of varia-
241
bles which enable Ss to approach the stress-
ful situation. Much of the stress research
(Bobey & Dsvidson 1970;Watkins & Dav-
idson, 1970) has implicitly assumed that
the variables which reduce stress responses
are also the variables which will increase
approach responses. The present study indi-
cates that approach responses may be mod-
ified by hypnosis even when self-report and
physiological reactions to the stressor are
not modified appreciably.
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