Hypnosis Hypnotic Phenomena and Hypnotic

International Journal of Clinical and Experimental
Hypnosis
ISSN: 0020-7144 (Print) 1744-5183 (Online) Journal homepage: https://www.tandfonline.com/loi/nhyp20
HYPNOSIS, HYPNOTIC PHENOMENA, AND

HYPNOTIC RESPONSIVENESS: Clinical and Research
Foundations—A 40-Year Perspective
Steven Jay Lynn, Joseph P. Green, Craig P. Polizzi, Stacy Ellenberg, Ashwin
Gautam & Damla Aksen
To cite this article: Steven Jay Lynn, Joseph P. Green, Craig P. Polizzi, Stacy Ellenberg,
Ashwin Gautam & Damla Aksen (2019) HYPNOSIS, HYPNOTIC PHENOMENA, AND
HYPNOTIC RESPONSIVENESS: Clinical and Research Foundations—A 40-Year
Perspective, International Journal of Clinical and Experimental Hypnosis, 67:4, 475-511, DOI:
10.1080/00207144.2019.1649541
To link to this article: https://doi.org/10.1080/00207144.2019.1649541
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Intl. Journal of Clinical and Experimental Hypnosis, 67(4): 475–511, 2019
Copyright © International Journal of Clinical and Experimental Hypnosis
ISSN: 0020-7144 print / 1744-5183 online
DOI: https://doi.org/10.1080/00207144.2019.1649541
HYPNOSIS, HYPNOTIC PHENOMENA, AND

HYPNOTIC RESPONSIVENESS: Clinical and
Research Foundations—A 40-Year Perspective
STEVEN JAY LYNN
Psychology Department, Binghamton University, New York, USA
JOSEPH P. GREEN
Ohio State University at Lima, Ohio, USA
CRAIG P. POLIZZI, STACY ELLENBERG, ASHWIN GAUTAM, AND DAMLA AKSEN
Binghamton University, New York, USA
Abstract: The authors summarize research findings, their clinical

implications, and directions for future research derived from
40 years of study of hypnosis, hypnotic phenomena, and hypno-
tic responsiveness at Steven Jay Lynn’s Laboratory of
Consciousness, Cognition, and Psychopathology and Joseph
P. Green’s Laboratory of Hypnosis. We discuss (a) the accumu-
lating body of evidence that hypnosis can be used to advantage
in psychotherapy; (b) the fact that hypnosis can facilitate a broad
array of subjective experiences and suggestions; (c) the failure to
find a reliable marker of a trance or radically altered state of
consciousness and reservations about conceptualizing hypnosis
in such terms; (d) determinants of hypnotic responsiveness,
including attitudes and beliefs, personality traits, expectancies,
motivation, and rapport; (e) efforts to modify hypnotic suggest-
ibility; and (f) the need to further examine attentional abilities
and the role of adopting a readiness response set that the authors
argue is key in maximizing hypnotic responsiveness.
In this article, we present our perspective on hypnosis, hypnotic

phenomena, and hypnotic responsiveness featuring research from
Steven Jay Lynn’s Laboratory of Consciousness, Cognition, and
Psychopathology and Joseph P. Green’s Laboratory of Hypnosis
Manuscript submitted December 20, 2018; final revision accepted December 21, 2018.
Address correspondence to Steven Jay Lynn, Ph.D., Psychology Department,
Binghamton University, Binghamton, NY 13902, USA. E-mail: stevenlynn100@gmail.com
475
476 S. J. LYNN ET AL.
conducted over the past 40 years. Our goal is to highlight findings

relevant to understanding the dynamics and determinants of hyp-
notic responding, emphasizing clinical implications and directions
for future research as we proceed.
This invited article is based on SJL’s presentation to the
Research Symposium at the International Society of Hypnosis
World Congress held in Montreal August 22, 2018. The aim of
this event was to build bridges between clinicians and research-
ers. Researchers first met among themselves to discuss the most
significant lines of their research programs, with particular import
for psychotherapy, and then met with clinicians to cross-fertilize
ideas and discuss novel avenues for research and clinical work.
Our essay is a response to this mandate. Such an endeavor will
surely fall short of being inclusive and comprehensive, and our con-
clusions, no doubt, will not be embraced universally. Nevertheless,
they will be empirically informed. We hope that when salient differ-
ences of opinion exist among experts, our viewpoint will spark
inquiry and fruitful debate.
We begin with the question: Why is hypnosis so fascinating?
Hypnosis has inspired our curiosity for numerous reasons, the most
pivotal being the following:
1. Hypnosis researchers and clinicians have documented the ability of

hypnotic interventions to treat psychological and medical
conditions.
2. Hypnosis provides a powerful demonstration not only of the plia-
bility of human consciousness in terms of the dramatic phenomena
historically associated with hypnosis (e.g., pain diminution, halluci-
nations, amnesia) but also of how communications from one person
to another can exert a profound influence on thoughts, feelings, and
behaviors.
3. Suggestion-related thoughts, feelings, and images can affect physiologi-
cal process, illuminating a mind-body link that invites explanation and
can be leveraged to advantage for treatment purposes.
4. The hypnotic context is a microcosm for studying many processes and
phenomena (e.g., suggestion, the experience of involuntariness, mem-
ory, imagination, rapport) central to our everyday lives and of high
interest to scientists. With this general framework in mind, we now turn
to a discussion of what we have learned about hypnosis from our
perspective.
HYPNOSIS IN PSYCHOTHERAPY
As clinical psychologists (and researchers), two of the authors (SJL
and JPG) have been vocal advocates for the use of hypnosis in clinical
HYPNOTIC PHENOMENA AND HYPNOTIC RESPONSIVENESS 477
contexts (e.g., Green & Lynn, 2019; Lynn & Kirsch, 2006; Lynn, Kirsch,
& Rhue, 1996, 2010), and for good reason: Hypnotic interventions are
typically brief, cost-effective, and can be learned easily; suggestions
can be administered either by another person (hetero-hypnosis) or
self-administered (self-hypnosis), adding portability to the mix of
benefits. Hypnosis can prove valuable in psychotherapy because it
capitalizes on (a) the malleability of human consciousness; (b) the
ability to think and imagine along with suggestions and envision
future realities or mentally time travel to the past; (c) suggestions
that can serve a valuable self-regulatory function and harness positive
treatment expectancies; and (d) widespread beliefs that hypnosis can
produce profound changes in thoughts, feelings, and actions relevant
to confronting and coping with psychological problems (see Lynn &
Kirsch, 2006). Importantly, hypnotic suggestions constrain the vast
reservoir of endogenous spontaneous involuntary thoughts, fantasies,
imaginings, and inchoate associations that mark much of our mental
life and channels them in therapeutic directions to transform mala-
daptive beliefs, thoughts, and action tendencies into more adaptive
schemas and goal-directed behaviors. Hypnotic suggestions can thus
deautomatize self-defeating cognitive-affective-behavioral response
sets and automatize more healthy, adaptive response sets, thereby
promoting flexible, present-centered, and creative responses to chal-
lenges in living (Erickson, Rossi, & Rossi, 1976).
We can now report increasingly well-documented findings that
underline the clinical utility of hypnosis. Qualitative reviews
(Covino & Pinnell, 2010; Elkins, 2017; Elkins, Jensen, & Patterson,
2007; Jensen & Patterson, 2014; Lynn et al., in press; Néron &
Stephenson, 2007) and meta-analytic studies consistently affirm the
value of hypnosis in treating psychological (e.g., depression, Shih,
Yang, & Koo, 2009; anxiety, Chen, Liu, & Chen, 2017) and medical
conditions ranging from acute and chronic pain to obesity and irrita-
ble bowel syndrome (Flammer & Alladin, 2007; Flammer & Bongartz,
2003; Flory, Martinez Salazar, & Lang, 2007; Häuser, Hagl, Schmierer,
& Hansen, 2016; Milling, Gover, & Moriarty, 2018; Montgomery,
Duhamel, & Redd, 2000; Schaefert, Klose, Moser, & Häuser, 2014).
Additionally, meta-analyses have shown that hypnosis can be an
adjunct to surgical interventions (e.g., Montgomery, David, Winkel,
Silverstein, & Bovbjerg, 2002; Tefikow et al., 2013) and that it can
mitigate needle-related pain and distress in children and adolescents
(Birnie et al., 2014) and produce quit rates of smoking in excess of 30%
(Green, Lynn, & Montgomery, 2006, 2008).
While it is fair to ask how reliable these findings are, there are
reasons for optimism: Hypnosis shows promise across multiple con-
ditions and disorders with positive outcomes verified with measures
with excellent psychometric properties. Still, definitive conclusions

regarding the effectiveness of hypnosis should be tempered with
caution—the internal validity and methodological rigor of some of
the existing clinical trials could be improved, additional well-powered
randomized controlled studies are called for, and long-term follow-
ups are required to document the longevity and generalizability of
treatment gains. Examining the effects of nonhypnotic suggestions
and hypnotic suggestibility in treatment outcomes, isolating the
impact of various methods combined with hypnosis (e.g., relaxation,
guided imagery), and assessing the role of placebo effects, are neces-
sary to ascertain the specific and active therapeutic ingredients of
hypnotic methods.
In laboratory contexts, hypnotic suggestibility is a strong and reli-
able predictor of response to suggestion (Laurence, Beaulieu-Prévost,
& Du Chéné, 2008; Woody & Barnier, 2008). However, in clinical
contexts its predictive utility is much weaker, but still statistically
significant (Montgomery et al., 2000), probably because common sug-
gestions (e.g., for relaxation, imaginative rehearsal, and positive emo-
tions) are relatively easy to experience. Although Montgomery,
Schnur, and David (2011) reported that only 6% of the variance of
treatment outcomes in clinical care settings was attributable to hyp-
notic ability, we, nevertheless, recommend that future treatment stu-
dies incorporate measures of hypnotic responsiveness to assay the role
of hypnotic experience in accounting for treatment gains.
In popular culture, hypnosis is typically depicted as a stand-alone
intervention. Yet therapists often employ hypnosis as an adjunct to
supplement other interventions. Indeed, hypnosis can be incorporated
into empirically supported psychotherapies (e.g., Alladin, 2007; Green,
Laurence, & Lynn, 2014; Green & Lynn, 2019; Lynn et al., 2010; Nash
& Barnier, 2012; Yapko, 2018) and even used with virtual reality
(Patterson, Jensen, Wiechman, & Sharar, 2010).
Meta-analyses disclose that adding hypnosis enhances the effective-
ness of both psychodynamic and cognitive behavioral psychothera-
pies (Kirsch, Montgomery, & Sapirstein, 1995). Moreover, hypnosis
can also be combined readily with increasingly popular mindfulness-
based approaches. For example, Lynn, Green, and associates (Green &
Lynn, 2019; Lynn, Green, Elinoff, Baltman, & Maxwell, 2016) have
illustrated how hypnosis, mindfulness, and acceptance-based inter-
ventions can be integrated into a multifaceted treatment to facilitate
smoking cessation in a comprehensive cognitive-behavioral
intervention.
Hypnosis can potentially foster facets of mindfulness with sugges-
tions for increased meta- or observational awareness; nonjudgment,
acceptance, and willingness to experience and tolerate the ever-
changing flux of positive and negative thoughts and sensations; and

suggestions to slow breathing and refocus on the breath or other
object of contemplation when attention inevitably wanders (Lynn,
Lama Surya Das, Hallquist, & Williams, 2006). Hypnotic suggestions
can also encourage mindfulness practice on a regular basis and under-
score the fact that negative feelings are typically evanescent and
eventually morph into different feelings. However, researchers have
yet to address to what extent hypnosis can catalyze mindfulness or
other contemplative practices.
HYPNOSIS CAN FACILITATE A WIDE VARIETY OF SUBJECTIVE

EXPERIENCES
The essence of hypnosis resides in subjective experience. Most
anyone who has used hypnosis in clinical contexts appreciates the
transformative ability of hypnotic suggestions to modify thoughts,
perceptions, memories, imaginings, and sensations, not the least
being acute and chronic pain (see Lynn & Kirsch, 2006). Studies
conducted in our laboratory and elsewhere have revealed that some
participants are able to experience (a) suggested compelling hypno-
tic deafness (Nash, Lynn, Stanley, & Carlson, 1987); (b) convincing
out-of-body experiences, sometimes accompanied with mild distress
(Nash, Lynn, & Stanley, 1984); and (c) more recently, experiences
that meet empirically-derived criteria for a mystical-type experience
(Lynn & Evans, 2017). Hypnosis can also produce (a) audio and
visual hallucinations/perceptual alterations (e.g., Kosslyn,
Thompson, Costantini-Ferrando, Alpert, & Spiegel, 2000;
McGeown, Mazzoni, Venneri, & Kirsch, 2009; Szechtman, Woody,
Bowers, & Nahmias, 1998); (b) negative hallucinations (“not seeing”
something that is present in reality; Wagstaff, Toner, & Cole, 2002);
(c) feelings of paralysis (Cojan et al., 2009); and (d) transient com-
pelling delusions (e.g., sex change, Noble & McConkey, 1995; mir-
rored self-misidentification delusion, Connors, Barnier, Coltheart,
Cox, & Langdon, 2012).
Hilgard (1977) first demonstrated that participants could experi-
ence a suggested metaphorical “hidden part” of the mind (hidden
observer) that can report on experiences such as experimentally
induced pain that the “hypnotized part” is reportedly unaware of,
spotlighting the use of suggestion to shift mental perspectives on
ongoing experience (see Green, Page, Handley, & Rasekhy, 2005a,
2005b; Kirsch & Lynn, 1998, for an interpretation of the hidden obser-
ver as a suggested phenomenon).
Hypnotic interventions, designed to treat a specific problem
such as pain, often produce a welter of positive “side effects”
such as increased feelings of happiness, enhanced sense of energy,

and enriched zest for life (see Crawford et al., 1998; Stewart, 2005).
Accordingly, we recommend clinicians routinely weave general
suggestions for living a life consistent with one’s values, increased
joy, and enhanced life satisfaction alongside those addressing
more immediate or problem-focused concerns (Green et al.,
2014). The examples of suggestions we provided illuminate the
immense flexibility of suggestions to produce profound alterations
in participants’ phenomenal worlds and the diversity of responses
that clinicians can access and activate for therapeutic purposes.
Clinicians need not be unduly concerned about whether they pro-
vide authoritative versus permissive worded suggestions: Participants
respond to a comparable number of suggestions when they are
worded in a traditional authoritative manner (e.g., “You will experi-
ence all of the effects of hypnosis that I suggest today”) or in
a permissive manner (e.g., “Sooner or later you might begin to experi-
ence the effects of hypnosis, and you may do that at your own pace,
responding slowly or rapidly in your own unique way to all sorts of
experiences I will suggest”). However, participants report greater
suggestion-related involuntariness in response to authoritative versus
permissively worded suggestions (Lynn, Neufeld, & Matyi, 1987;
Lynn, Weekes, Matyi, & Neufeld, 1988), implying that clinicians can
modify suggestion wording according to participants’ preferences,
particularly those who express concerns about relinquishing control
during hypnosis. Notably, practitioners can enhance feelings of con-
trol by informing clients that they retain voluntary control, as research
indicates that instructed expectancies regarding the experience of
involuntariness mediate perceptions of suggestion-related automati-
city (Kirsch & Lynn, 1999; Lynn, Nash, Rhue, Frauman, & Sweeney,
1984; Lynn, Rhue, & Weekes, 1990).
Future research could examine the effects of individualized proce-
dures, encouraging participants to select among a number of alterna-
tive hypnosis protocols or cocreating imagery that is appropriate to
their experience and imagery ability, versus script-driven or standar-
dized suggestions. Indeed, some participants devise effective ways to
respond to suggestions using creative (nonsuggested) imagery to pass
the suggestion. Lynn and Sivec (1992) have characterized the highly
responsive hypnotic subject as a “creative problem-solving agent” (see
also McConkey, 1991; Sheehan & McConkey, 1982; Spanos, 1986a,
1986b) to underscore the active and creative participation in the events
of hypnosis and the constructive goal-directed nature of successful
responding. Clinicians can capitalize on and encourage participants to
actively utilize and “experiment” with highly personal and even idio-
syncratic ways of maximizing responsiveness to suggestions.
Yet an area where clinicians should exercise particular caution

regarding suggestions is in the domain of memory—the most inten-
sively studied phenomenon in the realm of hypnosis (see Terhune,
Cleermans, Raz, & Lynn, 2017)—where inflated expectancies that
hypnosis can produce accurate recollections can contribute to false
memories that are held with a high degree of confidence independent
of their accuracy (Green & Lynn, 2005; Green, Lynn, & Malinoski,
1998; Lynn et al., 2015). Twenty-three studies we reviewed (see Lynn,
Krackow, Loftus, Locke, & Lilienfeld, 2015) found that hypnosis either
increases confidence compared with a nonhypnotic group, or partici-
pants confidently report false memories of events that they earlier
denied prior to hypnosis. Nine studies found no difference in con-
fidence expressed across hypnotic versus nonhypnotic situations.
Nevertheless, in five of these studies, hypnosis produced more errors
or less-accurate information on some or all measures, and in all of the
remaining studies, with one exception, there were no differences in
memory accuracy across hypnotic and nonhypnotic conditions.
IS HYPNOSIS A TRANCE?
In this section we discuss whether hypnosis produces a trance or

altered state of consciousness. This question touches on numerous
issues that we have grappled with over the years and relates to how
hypnosis is understood and presented in research and clinical prac-
tice. Hypnosis can facilitate a broad swath of subjectively compelling
experiences that do not conform to reality (Orne, 1959). Yet this fact by
no means warrants the conclusion that hypnosis engenders a special
altered state of consciousness often called a “trance.” The popularity
of techniques such as EMDR and, more recently, the swell of interest
in mindfulness-based approaches has arguably upstaged and under-
cut interest in hypnosis for therapeutic purposes. Hypnosis no doubt
holds a certain allure given connotations that it produces a special
state that enhances mundane abilities and human potentials.
Nevertheless, some clinicians might be disinclined to learn hypnosis
and patients might be reluctant to undergo hypnosis because of the
popular idea that hypnosis induces a trance state, with the weighty
baggage of cultural myths and misconceptions surrounding hypnosis
as involving loss of control or willpower, or other unpredictable,
embarrassing, or untoward effects (Barber, 1985; Green, Page,
Rasekhy, Johnson, & Bernhardt, 2006). Montgomery, Sucala, Dillon,
and Schnur (2017) reported that individuals (N = 509, community
sample) with more positive attitudes and fewer misconceptions
about hypnosis were more interested in using hypnosis with
a health care professional, although it is unclear whether such self-
reports mirror actual hypnosis-seeking behaviors or whether people

who test as high hypnotizable would be more willing to partake in
hypnosis than people who are not so highly suggestible.
Fortunately, one need not experience a trance or believe it is neces-
sary to do so to respond to imaginative suggestions (i.e., suggestions
to experience an imaginary state of affairs as if it were real, Kirsch &
Braffman, 2001, as in the following hand levitation suggestion:
“Imagine helium balloons are attached to your wrist, and they are
lifting your hand and arm off the resting surface.”) In one study, we
found that the same level of suggestibility can be achieved when
imaginative suggestions are administered in a nonhypnotic context
in which individuals are instructed prior to hypnosis to remain
“awake and alert” and admonished “not to fall into hypnosis”
(Kirsch et al., 2008). The addition of a hypnotic induction typically
produces only a small increase in responsiveness to imaginative sug-
gestions (about 1.5 suggestions on a 12-point scale or less; Kirsch &
Braffman, 2001; Kirsch & Lynn, 1995) or no increase at all (e.g., Meyer
& Lynn, 2011). In a second study, we found that defining hypnosis as
an altered state or “trance” state prior to hypnosis actually decreased
hypnotic responsiveness relative to defining hypnosis as
a “willingness to cooperate” (Lynn, Vanderhoff, Shindler, & Stafford,
2002). In a third study, we determined that hypnotic responsiveness
was not compromised when we defined hypnosis in distinctly “non-
hypnotic” terms as a “nondeceptive placebo,” compared with when
we defined it as “largely a question of willingness to be receptive and
responsive to ideas, and to allow these ideas to act on you without
interference” (Accardi, Cleere, Lynn, & Kirsch, 2013). However, apart
from these few studies, little is known regarding how varying the
content of generic prehypnotic information affects views of hypnosis
and whether such information could maximize receptivity to
hypnosis.
The experience of hypnosis itself can bear on the belief that hypno-
sis is an altered state of consciousness (Fassler, Lynn, & Knox, 2008;
Green, 2003; McConkey, 1986). Across a pre-post administration of
a hypnosis opinions scale 1 month apart, Green (2003) reported that
after hypnosis, students were less likely to believe that hypnosis is an
altered state of consciousness, involves involuntary or automatic hap-
penings, depends upon the ability of the hypnotist, and that sugges-
tions are powerful (including the power to make people do things
against their will). Students who were not hypnotized between
administrations of the scale reported stable views about hypnosis.
Yet after hypnosis, individuals apparently gravitated from endorsing
hypnosis as state-like to viewing hypnosis in more mundane and
accurate terms. For example, research has shown that people can resist
and even oppose suggestions (Lynn et al., 1986) and that prehypnotic
expectations about hypnosis mediate the extent to which participants
perceive actions during hypnosis as occurring on a voluntary or
involuntary basis (Lynn et al., 1984). More than ever, there exists
solid empirical grounding for clinicians to disabuse participants
about potential therapy-interfering myths and misconceptions about
hypnosis.
The term trance (and altered state of consciousness/ASC) is far too
nebulous to be very meaningful or useful to researchers, clinicians, or
participants. Lest readers think that we are flogging a proverbial straw
man with a critical focus on the popular term “trance,” they need look
no further than major hypnosis journals to discover otherwise:
Published researchers and clinicians still invoke the term liberally
and, by our reckoning, are doing so with increasing frequency in
recent years—yet they rarely, if ever, articulate precisely what they
mean by the term. This is particularly vexing from a research stand-
point, given the widely recognized imperative for investigators to
carefully “operationalize” constructs under study. Accordingly, we
strongly recommend that journal editors and reviewers require that
authors clearly define terms such a “trance,” or altered state, and that
clinicians do the same.
If trance simply refers to whatever happens after hypnosis, then it
could signify most anything, as each individual’s personal experience
is unique, and responses to hypnosis are cued mostly by suggestions
and very little, if at all, as we have noted, by the presence of the
hypnotic induction (Lynn, Laurence, & Kirsch, 2015). If the term
trance implies that the purported state somehow increases suggest-
ibility, then this definition is circular, as hypnotic responsiveness can
at once indicate the presence of a hypnotic trance and be explained by
it (see Braffman & Kirsch, 1999; Lynn & Green, 2011; Sarbin & Coe,
1972).
Kihlstrom (1985, 2018) has suggested a weakened definition of an
altered state of hypnosis. He defines altered state in a descriptive,
rather than a causal, sense as a category or domain that is character-
ized by “ … a typical induction procedure and subjective experiences,
concomitant behavioural responses, and perhaps, a characteristic neu-
rophysiological signature as well” (Kihlstrom, 2018, p. 66; see also
Hilgard, 1973; Kirsch & Lynn, 1995). Of course, defining an ASC this
way naturally has its limits: While providing a workable description,
defining hypnosis in terms of a context-bound “space” in which the
subjective experiences of hypnosis unfold neither specifies how hyp-
notic responses come about, nor the nature of the alterations in con-
sciousness, nor reasons for individual differences in the subjective
experiences associated with them. Yet to demand more of
a definition of an altered state of hypnosis may well be unrealistic, as

we will contend that what actually occurs during hypnosis is
a mélange of thoughts, feelings, images, and behaviors that vary
over diverse suggestions, short and longer time intervals, and indivi-
duals. Thus, Kihlstrom’s approach may well reflect the current limits
of precision and specificity regarding pinning down what occurs in
a situation defined as “hypnosis.”
Although there exists little dispute that hypnosis affects physiolo-
gical processes, after decades of questing for a unique neurophysiolo-
gical signature of hypnosis, researchers have unearthed precious little
treasure to boast for their efforts. In a systematic and comprehensive
review and meta-analytic study of neural dynamics and hypnosis,
Landry, Lifshitz, and Raz (2017) reported that “few reliable brain
patterns emerge across studies” (p. 75) and “little consensus concern-
ing the neural mechanisms and a great deal of inconsistency among
findings” (p. 92) exists, although the authors did contend that support
exists for some role for brain network dynamics associated with
reduced awareness of extraneous events, increased mental imagery,
and decreased mind wandering. Still, these observations, while inter-
esting, do not warrant the conclusion that hypnosis is a trance state
that produces changes in consciousness that can be clearly demarcated
from nonhypnotic states, or the conclusion that these stipulated brain
dynamics stand in a causal relation with hypnotic responding.
Reduced awareness of extraneous events and increased mental ima-
gery, for example, could be produced, respectively, by eye closure and
suggestion-related imaginings, whether in a hypnotic or waking
context.
Nevertheless, one overarching finding that emerges from the extant
stew of studies contradicts the state-dependent nature of hypnosis:
Physiological, cognitive, and behavioral responses covary extensively
with whatever suggestions are administered (e.g., Kihlstrom, 2003; see
also, Lynn, Kirsch, Knox, Fassler, & Lilienfeld, 2007), thereby under-
scoring the formidable role of suggestion in shaping the experience of
hypnosis. Moreover, hypnotic and nonhypnotic imaginative sugges-
tions are highly correlated (Kirsch & Braffman, 2001), and imaginative
suggestibility is arguably the “most powerful correlate” of hypnotic
suggestibility (Kirsch & Braffman, 2001, p. 60). As Kirsch and
Braffman (2001) contend: “Because responses to imaginative sugges-
tions are almost as readily observed outside of hypnosis as in it, they
cannot be ascribed to the presence of a hypnotic trance” (p. 59). That
said, clinicians have at their disposal an extensive array of imaginative
suggestions that can be couched in hypnotic or nonhypnotic terms in
service of participants.
Clearly, much remains to be learned about the neural dynamics of

hypnosis. Advances in this fascinating research area would be facili-
tated by refinements in experimental methodology. For example, scant
studies have included medium suggestible participants (the modal
subject in the population) and have limited comparisons to highly
responsive (roughly 15 to 20% of the population) and minimally
responsive (roughly 15 to 20% of the population) participants. This
approach has precluded firm conclusions, as very low (rather than
medium or high) responders who fail to experience effects of hypnosis
may well account for differences observed across categorically-
defined suggestibility levels. Moreover, most studies to date do not
include a nonhypnotic comparison group that is provided with the
same suggestions but with no induction procedure. Nor have studies
assessed whether individuals in the nonhypnotic comparison condi-
tions experience the same or even similar subjective effects as indivi-
duals in the hypnosis conditions. If, for example, hypnotized
participants and individuals who receive nonhypnotic task motivating
instructions to do their best to experience suggestions report similar
experiences, yet hypnosis has distinct neurological correlates, it would
provide potent evidence for an altered state position (Lynn, Kirsch, &
Hallquist, 2008). Moreover, studies rarely equate for or assay levels of
relaxation, expectancies, and imaginative abilities and activities across
hypnosis and nonhypnotic comparison conditions, complicating inter-
pretation of research findings. Finally, imaginative suggestions, deliv-
ered apart from hypnosis, deserve as much attention as hypnotic
suggestions, as they can also be exploited by clinicians for therapeutic
purposes and used to advantage with people who are reluctant, for
whatever reason, to engage in a hypnotic intervention.
Even with studies that address key methodological issues, we are
skeptical that researchers will succeed in identifying reliable neural
correlates of hypnosis, at least to the extent that they miss the mark
and continue to view hypnotic experience as reflecting or producing
some sort of unwavering ASC. Burgess (2007) has argued that “If
hypnosis is a distinct meta-state, then it should be associated with
(1) a distinct phenomenological experience or behavior and (2)
a neurophysiological correlate that is always present in that state”
(pp. 216–217). Although one might agree or disagree with these cri-
teria, what unfurls experientially after a hypnotic induction resembles
less a uniform or static state than a dynamic and fluid comingling of
mental activities and behavioral responses, which can change online,
moment-to-moment, in response to: (a) expectancies, situational
demands, and appraisals; (b) the nature of suggestions and related
physical sensations; (c) suggestion difficulty; (d) meta-awareness of
the adequacy and appropriateness of responses; (e) participants’ goals
and motivations to respond; and (f) fluctuating levels of distractions,

involvement in suggested images, and rapport with the hypnotist.
Changes in hypnotic responsivity occur not only within a particular
hypnosis session but also over the course of a single day (Rossi, 1982).
Aldrich and Bernstein (1987) reported an increase in responsiveness
across the morning hours. Wallace (1993) divided his sample into day
and night persons based on self-reported levels of alertness and found
that hypnotizability scores peaked at 10 a.m. and 2 p.m. for day
persons and at 1 p.m. and between 6 and 9 p.m. for night persons.
Across a large sample of nearly 700 undergraduate students, Green,
Smith, and Kromer (2015) reported that students were most respon-
sive to hypnotic suggestions during the morning or evening hours,
compared with sessions held in the afternoon. Future research is
needed to more fully examine the potential moderating, mediating,
or interactive roles of personality types, the timing of hypnosis, and
diurnal fluctuations regarding responsiveness to suggestions.
In short, parsing of hypnosis into a more or less discrete state or
a unique category or domain is fraught with complexities, as the
responses that follow hypnotic inductions can be so highly variable
and difficult to distinguish from responses that follow the identical
nonhypnotic imaginative suggestions. And as we commented earlier,
the experience of hypnosis is replete with nonsuggested as well as
suggested images, sensations, emotions, and even physical responses
(e.g., moving, changes in posture). If this characterization is accurate,
and if hypnotic responsiveness reflects an incompletely understood
ability (or abilities more likely) to respond flexibly to a diversity of
imaginative suggestions across changing “waking” and hypnotic con-
ditions (see Lynn et al., 2015), then finding specific and reliable mar-
kers of an altered state specific to hypnosis would prove challenging
at best, if not beyond researchers’ grasp.
We add that the search for cognitive markers of hypnosis, like the
search for brain markers, has proven elusive. Two examples will
illustrate the unfruitful search for such markers. Contrary to
Erickson’s (1980) highly specific (and testable) claim that 97% of his
“deep trance,” subjects and 90% of his “medium trance” subjects
exhibited literal responses (e.g., “Do you mind telling me your
name?” Answer: “No” or “Yes” verbally or nonverbally), we found
that hypnotized subjects typically do not respond to such statements
in a literal manner. In one study (Green et al., 1990), the frequency of
literal responses was not higher among very high suggestible subjects
(29%) compared with low suggestible individuals who simulated
hypnotic responses (58%). Interestingly, literalism rates among highly
suggestible participants were comparable to rates of subjects unse-
lected for hypnotizability approached in or outside a campus library
setting (22%; Green et al., 1990). In a second study (Lynn et al., 1990),
literalism rates were low (12.5%) and indistinguishable across high
suggestible subjects who were hypnotized or who received nonhyp-
notic task motivation instructions, again indicating that literalism is
not a cardinal feature of hypnosis.
Researchers have likewise failed to affirm that hypnotizable parti-
cipants exhibit “trance logic” or the “ability … to freely mix … percep-
tions derived from reality with those that stem from imagination” and
are “fused in a manner that ignores everyday logic” (Orne, 1959,
p. 259). In the imagery transparency response, high suggestible parti-
cipants report that they can “see” a hallucinated experimental assis-
tant, but also that they can simultaneously “see through” the assistant.
Image transparency is nicely captured in Orne’s (1959) comments
regarding a participant’s report of transparency: “This is very pecu-
liar; I can see Joe sitting in the chair and I can see the chair through
him.” However, the transparency response is not unique to hypnosis
—some imagining, nonhypnotized participants report it as well.
Moreover, reports of image transparency are correlated with reports
of active yet unsuccessful attempts to generate and maintain a vivid
lifelike hallucination (e.g., Spanos, de Groot, & Gwynn, 1987; Stanley,
Lynn, & Nash, 1986), implying that difficulty forming a stable hallu-
cination is not inherently “illogical” in the hypnotic context or other-
wise. Based on the accumulated evidence, we suggest that the burden
now falls squarely on those who advocate for an altered state of
consciousness or “trance” to provide countervailing evidence that
contradicts or qualifies the findings we reviewed.
Defining hypnosis as an ASC may have the unfortunate and unin-
tended consequence of participants not reporting experiences incon-
sistent with their beliefs about hypnosis (e.g., hypnosis produces
a trance) or what they deem relevant to report. How clinicians define
hypnosis conveys demand characteristics and expectancies for appro-
priate responses. For example, the latest definition of hypnosis put
forward by a committee of Division 30 of the American Psychological
Association (Elkins, Barabasz, Council, & Spiegel, 2015) describes
hypnosis as a “state of consciousness involving focused attention
and reduced peripheral awareness characterized by an enhanced
capacity for response to suggestion” (p. 6). We refer interested readers
to Lynn et al. (2015) for a critique of this definition, although we do
not contest that inductions and suggestions explicitly or implicitly call
for focal attention and often eye closure, which, as noted above,
reduces stimuli irrelevant to the hypnotic proceedings.
But for our current purposes, we note that presenting hypnosis in
these terms could diminish responsiveness if participants’ conclude
they are not “succeeding at hypnosis” if their attention strays from
suggestions and they become distracted by events in their peripheral

awareness (e.g., sounds in the hall, a clock ticking) or by task-
irrelevant thoughts and sensations that commonly arise during hyp-
nosis (Lynn, Weekes, & Milano, 1989). What is not known is how
definitions of hypnosis (e.g., a procedure, domain, or ASC) advocated
by different societies, organizations, and individuals and subsequently
conveyed by clinical practitioners to participants, affect hypnotic
responsivity and participants’ evaluation of their hypnotic
performance.
We recommend that clinicians eschew presenting hypnosis as
a trance or unique state and acknowledge the possibility—even the
likelihood—of variations in experience over the course of the hypnosis
session to better accord with participants’ probable responses.
Practitioners could explain that researchers are actively searching
for, yet have not so far succeeded in, securing convincing evidence
for an altered state of hypnosis and that “trance” is not a scientifically-
informed way to describe or account for what transpires during hyp-
nosis. Rather, what responsive participants feel, think, and do are
closely yoked to the suggestions they receive and their motivation,
efforts, and abilities to experience them. Notably, this way of present-
ing hypnosis is consistent with the idea that “all hypnosis is self-
hypnosis.” Ultimately, it is participants, not hypnotists, who create
images, mental representations, and physical sensations necessary to
respond successfully to suggestions, whether they are provided by
a hypnotist or self-generated (Green et al., 2014; Green & Lynn, 2019;
Lynn & Kirsch, 2006).
As many participants are imbued with the popular notion that
hypnosis engenders a trance, it is unfortunate that we possess little
knowledge about how participants’ beliefs about hypnosis and their
prior experiences with hypnosis interact with how hypnosis is pre-
sented. This is fertile ground for researchers and clinicians to explore.
If a highly suggestible person were to exclaim, “I went into a deep
trance the last time I was hypnotized,” it would be counterproductive
for a clinician to redefine hypnosis and invalidate the person’s suc-
cessful prior experience. Contrariwise, a low suggestible participant
who voiced concern that she did not “go into trance” the last time she
was hypnotized would probably benefit from the knowledge that
someone could be highly responsive without experiencing
a radically altered state and that perhaps her prior belief interfered
with her ability to enjoy and get the most out of her experience of
hypnosis.
DETERMINANTS OF HYPNOTIC RESPONDING

Traits
One of the tasks of any account of hypnosis is to explain individual
differences in responsiveness: Why are some individuals highly
responsive to suggestions whereas others are less so? The search for
individual differences on trait-like measures has proved to be less
than satisfying, and the failure to find impressive correlations with
hypnosis with such measures cannot be ascribed to a lack of interest
or effort on the part of researchers, the authors included. For example,
hypnotic suggestibility and omnibus measures of personality traits,
widely prevalent in the population, appear to be largely independent.
Green (2004) reported that only about 6% of the variance in hypnotic
responsiveness could be accounted for by the five domain scores
(neuroticism, extraversion, openness to experience, agreeableness,
and conscientiousness) of the NEO-PI-R (Costa & McCrae, 1992),
along with gender. Malinoski and Lynn (1999) reported similar find-
ings using the NEO-FFI (Costa & McCrae, 1989).
Researchers have found better fortune studying personality traits
allegedly closer conceptually to the domain of hypnosis. More than
50 years ago, Hilgard (1965, 1970) contended that imaginative invol-
vement in everyday hypnotic-like experiences is a cornerstone of
hypnotic responsiveness. A few years later, researchers developed
the Tellegen Absorption Scale (TAS; Tellegen & Atkinson, 1974) to
assess the extent that individuals become involved in everyday
imaginative or sensory experiences. Wilson and Barber (1981,
1983a, 1983b) similarly aligned hypnotic responding with imagina-
tive ability and created the Inventory of Childhood Memories and
Imaginings (ICMI), a measure of fantasy-proneness, to capture
a history of and proclivity towards imaginative-fantasy-based activ-
ities. Researchers have determined that scores on the ICMI correlate
strongly with absorption (e.g., r = .6 to .7; Braffman & Kirsch, 1999;
Green & Lynn, 2011).
Correlations between fantasy proneness and hypnotizability hover
in the range of r = .20 to r = .33 (Green & Lynn, 2008, 2011) and fall
close to the magnitude of the association between absorption and
hypnotizability of r = .21 behavioral and r = .25 subjective responsivity
across 18 samples (Council, Kirsch, & Grant, 1996), when the scales are
measured together in the same testing context. Balthazard and Woody
(1992) reported that absorption was a better predictor of responsive-
ness in relation to more challenging suggestions that require greater
cognitive ability compared with easier or lower level suggestions
involving motor movements.
Researchers have also evaluated the link between hypnotic respon-

siveness and the Dissociative Experiences Scale (DES; Bernstein &
Putnam, 1986), the most widely used measure of dissociation. For
example, Green and Green (2010) reported a correlation between the
DES and scores on the Harvard Group Scale of Hypnotic
Susceptibility, Form A (HGSHS:A; Shor & Orne, 1962) of r = . 25,
similar to the correlation they obtained between the TAS and the
HGSHS:A, r = . 23. Silva and Kirsch (1992) secured small positive
correlations (rs ranged from .12 to .17) between the DES and the
objective, subjective, and involuntariness scales of the Carleton
University Responsiveness to Suggestion Scale (CURSS: Spanos,
Radtke, Hodgins, Bertrand, & Stam, 1981). Very small correlations
between dissociation and hypnotic responsiveness have likewise
been reported with other large samples when tested in the same
research context (Faith & Ray, 1994; Nadon, Hoyt, Register, &
Kihlstrom, 1991).
However, when the measures are assessed in purportedly separate
testing contexts, the correlation depreciates to near zero (Dienes et al.,
2009; Green, Kvaal, Lynn, Mare, & Sandberg, 1991; Oakman, Woody,
& Bowers, 1996). So-called “context effects” (Council et al., 1996) also
come into play when absorption and hypnotic responsiveness are
measured in different test contexts, where the estimated population
correlation across 13 samples is r = .12 for behavioral and r = .09 for
subjective measures is appreciably lower than the correlations
obtained when the measures are administered in the same context
(reviewed in Council et al., 1996).
Even when self-report scales of absorption and dissociation are
administered in the same experimental context, they account for
only about 4 to 10% of variability in hypnotic responding. These
findings (a) do not provide support for dissociation-based explana-
tions of hypnotic suggestibility (see Kirsch & Lynn, 1995) and (b)
imply that administering these self-report measures provides no
shortcut for clinicians in predicting hypnotic suggestibility and that
self-report trait measures are no substitute for well-standardized
scales to assess responsiveness. The generally weak correlations
between hypnotic suggestibility and absorption, fantasy-proneness,
and imaginative abilities might be related to the fact that suggestions
themselves provide considerable scaffolding for suggested events
such that only minimal fantasy, imaginative, or absorption abilities
are required to experience and respond to the suggestion (Lynn &
Rhue, 1988). Indeed, Lynn and Rhue (1986) found that nearly a third
of people who reported no significant history of fantasy involvements,
as well as low absorption and low vividness of mental imagery (“non-
fantasizers”) scored as highly suggestible on the HGSHS:A. On the
other hand, extremely high fantasy abilities in no way guarantees high

suggestibility, as attitudinal and motivational factors moderate the
relation between hypnotic suggestibility and measures of fantasy
and imagination (Lynn & Rhue, 1987; Wilson & Barber, 1981).
Research wise, more work is needed to clarify whether highly
fantasy prone people would test as highly suggestible if properly
motivated and encouraged to use their imagination and how partici-
pants’ responses might be affected by the number or order of self-
report scales completed in a single research setting or across different
testing contexts. Scales like the TAS and DES are positively worded
and completing them could instill a “yea-saying” or acquiescence
response bias, artificially inflating correlations between measures.
Green and Council examined this possibility with regard to the TAS
and HGSHS:A (Council & Green, 2004; Green & Council, 2004).
Whereas they failed to find that the response format of the TAS (i.e.,
positive worded items) affected the correlation between the absorp-
tion scale and the HGSHS:A, correlations between hypnotizability and
other individual scales might be affected by the response format, the
order of scale administration, or by completing a given scale within
a larger battery of personality tests. The link between expectances and
trait measures warrants further examination as well, based on
Council, Kirsch, Vickery, and Carlson’s (1983) finding that the associa-
tion between absorption and hypnotic suggestibility no longer
remained significant when the effects of expectancy were controlled
for statistically.
Researchers have fared better in establishing a relation between
hypnotic suggestibility and imaginative/experiential involvement (a
construct akin to absorption) in real-world stimuli—rather than ques-
tions on self-report inventories—that include reading materials (Baum
& Lynn, 1981), highly imagination-eliciting musical passages
(Snodgrass & Lynn, 1989), and film clips (Maxwell, Lynn, &
Condon, 2015). In the Maxwell et al. (2015) study, we also found
that hypnotic suggestibility (HGSHS:A) correlated with absorption
(TAS; r = .26), although suggestibility did not correlate significantly
with dissociation (DES; r = .09).
There appears to be an even tighter link between involvement in
the experience of a suggestion and the associated response. Studies in
our laboratory and elsewhere have found that subjective involvement
in suggestions (Lynn et al., 1987; Spanos, Radtke, Hodgins, Stam, &
Bertrand, 1983) and suggestion-related sensations (Lynn et al., 1984;
Spanos, Rivers, & Ross, 1977) are associated with involuntariness
reports and hypnotic suggestibility. In short, absorption/experiential
involvement in suggestions appears to be a better predictor of sub-
jective experiences and highly correlated hypnotic responsiveness
during hypnosis than self-report trait measures of absorption and

dissociation.
Although dissociative traits alone are not particularly meaningful
predictors of hypnotic suggestibility, clinicians should be cognizant
that researchers have obtained preliminary evidence for a dissociative
subtype (combined high score on the DES and hypnotic suggestibility
scale) of highly responsive participants (about one third of high sug-
gestible individuals) who exhibit deficits in baseline working memory,
poorer cognitive control, greater involuntariness, and fewer cognitive
resources (see Barber, 1999; Terhune et al., 2017, for a summary).
Research is needed to confirm the dissociative subtype, better estab-
lish correlates of the subtype (e.g., types of psychopathology), ascer-
tain its historical (e.g., potential early exposure to highly adverse
events) and contemporary antecedents (e.g., demand characteristics),
and determine whether such individuals pose special challenges for
practitioners.
Terhune, Cardeña, and Lindgren (2011) identified a second subtype
of highly suggestible individuals who exhibited superior imagery
ability, implying that imagery-based suggestions might be especially
efficacious with such participants. These findings reinforce our earlier
observation that hypnosis can be experienced in very different ways
by different participants, even among those who fall in the very high
range of hypnotic responsiveness, and, further, that clinicians should
be alert to individual differences to best leverage participants’ abilities
and propensities to their benefit.
One reason why hypnosis can be experienced in diverse ways is
that different suggestions pose distinct challenges and call for very
different abilities, or in Woody, Barnier, and McConkey’s (2005)
terms, there exist “multiple hypnotizabilities.” The suggestion to
hallucinate a person or object, for example, requires greater ima-
gery/fantasy ability than responding successfully to a so-called
challenge suggestion for a person to experience her arm as stiff
like a bar of iron that it is so stiff that she cannot bend it following
a challenge to do so (“Try to bend your arm, just try”). To pass the
latter suggestion requires a concerted focus on the suggestion-
related sensations of stiffness and not to expend much counterforce
to bend the arm. In contrast, a hand levitation suggestion for the
arm to rise off the resting surface requires generating mental images
of the hand rising (Comey & Kirsch, 1999). Deploying this imagery
strategy reinforces the suggestion and deflects awareness (meta-
cognition) from effortful action required for the arm to lift, thereby
enhancing the experience of suggestion-related involuntariness.
Suggestion-enhancing strategies, whether they breach the surface
of consciousness or not, have not received the research attention

they deserve.
Our discussion suggests that efforts to isolate a single trait to
account fully for the multifaceted skills, strategies, and interpretations
required to respond to heterogeneous suggestions is likely to continue
to reap scant rewards, compared with explicating attention and cog-
nitive strategies and discrete abilities associated with fulfilling the
requirements of disparate suggestions. Researchers and clinicians
would benefit from appraising the phenomenology of hypnotic
responding on a more individual and granular level (Cardeña,
Jönsson, Terhune, & Marcusson-Clavertz, 2013; Lifshitz, Cusumano,
& Raz, 2013; Sheehan & McConkey, 1982) to assist participants in
recognizing and utilizing optimally effective response strategies and
to better characterize and account for the diversity of experiences
elicited by suggestions.
Attitudes and Beliefs

Early work suggested that attitudes about hypnosis are stable with-
out specific attempts to modify them (Green, 2003; Spanos, Robertson,
Menary, & Brett, 1986). Spanos (1986a) argued that hypnotic respon-
siveness could be increased by fostering positive attitudes and beliefs
about hypnosis and encouraging an active rather than a passive set to
respond to suggestions. However, studies have generally found sta-
tistically significant yet not very impressive correlations between atti-
tudinal scales and measures of hypnotic suggestibility when attitudes
are considered independent of an active response set. For example,
McConkey (1986) and Green (2003) failed to find meaningful connec-
tions between hypnotic responsiveness and scores on the Opinions
About Hypnosis Scale (OAH; McConkey, 1986). Green (2003) reported
that OAH scores accounted for less than 5% of the variance in hypno-
tic responsiveness. Similarly, Green and Lynn (2011) obtained a small
but significant correlation between scores on the HGSHS:A and the
OAH (r = . 22), and Fassler et al. (2008) secured correlations in the
range of r = .19 to r = .30 between hypnotic suggestibility and the
Hypnotic Attitudes Questionnaire (HAQ: Spanos, Brett, Menary, &
Cross, 1987). The Valencia Scale of Attitudes and Beliefs Toward
Hypnosis-Client (VSABTH-C; Capafons, Alarcón, Cabañas, & Espejo,
2003) is a psychometrically sound instrument with a confirmed 8-fac-
tor structure across international samples (Green, Houts, & Capafons,
2012). Green (2012) captured 12% of the variance in HGSHS:A scores
with three of the VSABTH-C factors, which suggested that attitudes
and beliefs about hypnosis do play some role in hypnotic responding.
The ICMI captured an additional 6% of variance in predicting scores
on the HGSHS:A.
We tested the hypothesis that the link between attitudes and

responsiveness would be enhanced if participants received feedback
about their attitudes and were explicitly told that positive attitudes
predict later responsiveness. Green and Lynn (2011) informed one
group of participants that attitudes about hypnosis (assessed in an
earlier session) would predict how many suggestions they would pass
during the current hypnosis session; however, these instructions failed
to affect the correlation between the HGSHS:A and the OAH.
Although one might be tempted to conclude that attitudes and
beliefs about hypnosis exert a relatively small influence on hypnotic
responding, the actual state of affairs is somewhat more complicated.
Spanos et al. (1987) examined the distribution of attitude scores and
discovered that participants never scored high in suggestibility if they
possessed strong negative attitudes, but as attitudes increased in
positivity, hypnotic responsiveness increased, implying that very
negative attitudes can suppress hypnotic performance. Similarly,
moderate levels of absorption, fantasy proneness, and imagery vivid-
ness contribute to the prediction of hypnotic suggestibility, yet very
low levels of imaginative propensity are almost always associated
with low suggestibility (see de Groh, 1989; Spanos, 1991).
The findings regarding attitudes and beliefs validate received “clin-
ical wisdom” regarding the necessity of debunking myths about hyp-
nosis (e.g., participants lose control, are gullible, cannot resist
suggestions), inculcating positive beliefs and actively encouraging
imagination and immersion in suggested events (Green & Lynn,
2019; Lynn, Maxwell, & Green, 2017). However, research to date has
not systematically investigated the effects of countering myths and
misconceptions about hypnosis in prehypnotic information that varies
the nature and number of misconceptions “corrected” in clinical and
laboratory contexts and in group versus individual formats.
Expectancies
Sociocognitive theorists have argued that expectancies play
a prominent role in a wide range of hypnotic experiences (e.g.,
Council, Kirsch, & Hafner, 1986; Kirsch, 1990; Kirsch & Lynn, 1995;
Lynn et al., 2008; Spanos, 1986a), including hypnotic amnesia, the
experience of nonvolition in hypnosis, the hidden observer phenom-
enon, response to countersuggestions, and more (see Kirsch, 1991;
Lynn & Rhue, 1991). Kirsch, Silva, Comey, and Reed (1995) reported
that response expectancy was the strongest predictor of hypnotic
responsiveness among a pool of potential predictors including absorp-
tion, fantasy proneness, and personal motivation. Green and Lynn
(2011) administered a brief, 3-item expectancy measure and obtained
a zero-order correlation of r = .53 with HGSHS:A scores. Our expec-
tancy measure predicted scores on the HGSHS:A more strongly than
individual scales measuring attitudes (OAH), absorption (TAS), or

fantasy proneness (ICMI). Braffman and Kirsch (1999), relying on
a more elaborate measure of expectancy which consisted of reading
a description of each suggestion and predicting how they would
respond, reported a similar sized correlation of r = . 59 between
their measure of expectancy and scores on the CURSS. Combining
expectancy, motivation, and nonhypnotic imaginative suggestibility,
Braffman and Kirsch (1999) accounted for slightly more than half the
variance (i.e., 53%) in hypnotic responsiveness. Moreover, expectan-
cies are affected by the experience of hypnosis, such that while they
significantly predict hypnotic responsiveness prior to an initial session
of hypnosis, they are particularly strong predictors of responses to
hypnosis prior to a second follow-up session (Fassler et al., 2008).
Two points should be kept in mind. First, expectancies and hypno-
tic responses stand in a dynamic recursive relation: expectancies affect
responsivity and responsivity affects expectancies during a hypnosis
session (Benham, Woody, Wilson, & Nash, 2006). Moreover, in clinical
settings, hypnosis typically unfolds in a reciprocal, ongoing manner:
Therapists observe clients’ ongoing experiences and suggestion-
related behaviors and tailor their subsequent suggestions based on
feedback during and after the session (Lynn et al., 2017). Second,
considerable variance in hypnotic suggestibility remains unexplained,
even by a combination of variables hypothetically related to hypnotic
suggestibility.
Readiness to Respond
Considering elements of what we term a readiness response set can
add to our understanding of hypnosis and hypnotic responsiveness.
More specifically, highly hypnotizable individuals, in contrast with
less suggestible participants, possess a particularly high readiness to
respond, or put another way, a particularly low threshold to respond
to hypnotic suggestions effortlessly and with minimal critical con-
scious introspection or meta-consciousness (see Dienes & Perner,
2007; Lynn et al., 1990). As Sheehan and McConkey (1982; see also
Sheehan, 1991) observed some years ago, highly responsive indivi-
duals adopt a motivated cognitive commitment or preparedness to
respond (see also Tellegen, 1981). They at once actively and fully
participate in the events of hypnosis while experiencing their
responses to hypnosis as involuntary happenings (Lynn et al., 1990).
This response set that can be distinguished from, yet is related to,
response expectancies regarding future hypnotic performance (Kirsch
& Lynn, 1997).
We suggest that a readiness response set interweaves motivation to
respond with a broad experiential response set that encompasses (a)
discerning the intent of suggestions with little or no deliberate thought
or meta-cognitive awareness; (b) minimizing and decoupling perfor-

mance interfering thoughts and attitudes from a focus on suggested
events so that participants do not “spectator” or otherwise critically
observe or critique their responses; (c) allocating cognitive resources
(e.g., attention, imaginings) in a strategic, effective manner to fulfill
the implicit and explicit requirements of suggestions; (d) focusing on
suggested sensations that reify suggestion-congruent experiences,
which, in turn, bolster response expectancies (Kirsch & Lynn, 1997,
1999; Lynn, 1997); (e) adopting “liberal” performance standards (see
Lynn, Green, Jaquith, & Gasior, 2003) such that participants do not
adopt too stringent or unattainable criteria (e.g., experiencing
a compelling, lifelike hallucination) to view themselves as “passing”
a given suggestion; (f) attributing responsiveness to “hypnosis,” the
hypnotist’s ability or effort, which correlates with the experience of
suggestion-related involuntariness (Lynn, Snodgrass, Rhue, Nash, &
Frauman, 1987) and with a lack of meta-awareness; and (g) feeling
rapport with the hypnotist, which also correlates with the experience
of suggestion-related involuntariness and contributes to the percep-
tion that events flow seamlessly during hypnosis (see Lynn et al.,
1991). To the extent that individuals adopt this response set, they
“go with the flow” of suggested events and, in effect, “surrender,”
in the most positive sense, to what is transpiring so that control or the
lack of control is neither relevant to their experience in the moment
nor a stumbling block to full involvement.
MODIFYING HYPNOTIC SUGGESTIBILITY

Gorassini and Spanos (1986) developed the Carleton Skills Training
Program (CSTP) to modify and maximize hypnotic responsiveness.
More specifically, the CSTP includes (a) information to instill positive
attitudes and expectancies about hypnosis and motivation to respond;
(b) instructions to use imaginal strategies to optimize responding and
how to interpret suggestions (e.g., one must actually lift the hand
while imagining that it is rising by itself); (c) exposure to a video-
taped model who enacts successful responses to suggestions and
verbalizes imagery-based strategies to facilitate subjective response;
and (d) practice in responding to test suggestions.
In more than 15 studies, Spanos and his colleagues (see Gorassini &
Spanos, 1999; Spanos, 1986a) determined that approximately 40–80%
of initially low hypnotizable subjects who participated in the CSTP
scored as high hypnotizables after the training, with gains persisting
for as long as two and a half years (Spanos, Cross, Menary, & Smith,
l988). Research that replicates large magnitude gains conducted in
Spain (Cangas & Pérez, 1998), Poland (Niedzwieñska, 2000), and
England (Fellows & Ragg, 1992) attest to the cross-cultural general-

izability of the effectiveness of the program. Research (Lynn et al.,
2007) has shown that CSTP treatment gains persist even when post
intervention gains are assessed in an entirely different test context (i.e.,
psychology department vs. nursing school) and as part of
a supposedly different study, implying that the observed effect is
not explained by demand characteristics. More specifically, 44% of
initially low suggestible individuals tested as highly suggestible after
training, compared with only 6% participants who did not engage in
the training but received practice in responding to suggestions.
Trained low suggestible individuals who tested as “highs” were indis-
tinguishable from “natural high suggestibles” who did not undergo
the training on indices of behavioral, subjective, and involuntariness
measures of hypnosis.
Although the CSTP training is effective for many individuals, a sizable
number of individuals do not exhibit increases in responsiveness after
the intervention. One reason for this is that some low suggestible indivi-
duals might lack key hard-wired abilities, compared with their highly
suggestible counterparts, related to automatic information processing
and attention (see Lynn et al., 2015). To identify these abilities, we
suggest researchers contrast the responses of highly hypnotizable
untrained individuals (“natural highs”) who do not experience the
CSTP with low hypnotizables who test as highly hypnotizable after the
training. To the extent that differences surface on measures of attention
and automaticity of responding across these two groups, it would shed
light on abilities and experiences that are more intrinsic to high suggest-
ibility rather than coached or trained as a product of the CSTP.
Gfeller and Gorassini (2010) used the CSTP to advocate for a social-
cognitive skills model with direct applicability to clinical work. In fact,
the CSTP formalizes practices that are commonly used by clinicians in
psychotherapy and medicine (e.g., dispelling myths, framing expecta-
tions, providing practice and encouragement, encouraging imagination).
The model focuses on minimizing participant negative attitudes, beliefs,
and expectancies and substituting their opposite counterparts, enhancing
cognitive skills, and the importance of forging an effective therapeutic
alliance. Gfeller and Gorassini (2010) recommend presenting hypnosis as
not far removed from everyday life phenomena; describing hypnosis as
an active process that can be used as a coping skill; and discussing the
importance of imaginative involvement, absorption in suggestions, and
suspending a strict orientation to reality during hypnosis.
Cultivating a positive rapport appears to be particularly important
for low suggestible participants: Lynn et al. (1991) found that enhancing
rapport increased low suggestible participants’ hypnotic responsive-
ness, whereas even when highly suggestible individuals were assigned
to a low interpersonal/low rapport testing context, they continued to

exhibit high levels of responsiveness. We suggest that this finding
reflects the readiness to respond that highly suggestible participants
exhibit in the hypnotic context. Similarly, Gfeller, Lynn, and Pribble
reported (1987) that 50% of initially low suggestible participants in
a high interpersonal rapport CSTP condition tested as highly suggestible
after training, compared with 25% in a low-interpersonal training con-
dition. It remains for future researchers to evaluate tailoring the CSTP
protocol to fit participants’ assessed needs (e.g., identify effective cogni-
tive strategies) and to explore the utility of the CSTP in psychological
and medical interventions such as for acute and chronic pain.
CONCLUSION
Hypnosis has long captured the imagination of the general public,
researchers, and clinicians and will likely do so for the foreseeable
future. Hypnosis remains as fascinating to us today as it did when we
launched our research on hypnosis many years ago. The study of
hypnosis provides valuable insights into the nature of consciousness,
including the role of expectancies, attitudes, imaginings, meta-
awareness, and the experience of involuntariness in generating
responses to suggested events in and out of the context of hypnosis.
Hypnosis functions as an effective stand-alone or more commonly
adjunctive technique that provides clinicians with an efficient, cost-
effective, and flexible methodology to alleviate a myriad of psycholo-
gical and medical conditions, facilitate resilience, and enhance human
potential. We have argued that hypnosis does not produce a trance or
ASC clearly distinguishable from nonhypnotic experiential states, but
that hypnotic interventions, nevertheless, can initiate a broad array of
alterations in consciousness. Research into the neural and experiential
dynamics of hypnosis promises to generate important insights into the
links among verbal communications, subjective reports, patterns of
brain activation and behaviors, and to elucidate mechanisms of adap-
tive and maladaptive psychological functioning. Researchers have
made important strides in debunking myths and misconceptions
about hypnosis, identifying the determinants of hypnotic suggestibil-
ity, and incorporating hypnosis into an expanding roster of psy-
chotherapies. Still, it is clearer than ever that much work remains to
be done to advance our understanding of hypnosis and to increase its
acceptability to a growing number of clinical practitioners and parti-
cipants who stand to benefit from its application.
DISCLOSURE STATEMENT
No potential conflict of interest was reported by the authors.
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Hypnose, hypnotische Phänomene und hypnotische Ansprechbarkeit :

Klinische und Forschungsgrundlagen – Eine 40 Jahre Übersicht
STEVEN JAY LYNN, JOSEPH P. GREEN, CRAIG POLIZZI, STACY ELLENBERG, ASHWIN
GAUTAM, UND DAMLA AKSEN
Abstract: Die Autoren fassen Forschungsergebnisse, deren klinische
Auswirkungen und Richtungen für zukünftige Forschung, abgeleitet von
40 Jahren Studien zu Hypnose, hypnotischen Phänomenen und hypnotis-
cher Ansprechbarkeit am Steven Jay Lynn´s Laboratory of Consciousness,
Cognition, and Psychopathology und Joseph P. Green´s Laboratory of
Hypnosis zusammen. Wir diskutieren (a) die wachsende Evidenzlage, daß
Hypnose in der Psychotherapie zum Vorteil angewendet werden kann, (b)
die Tatsache, daß Hypnose ein breites Feld subjektiver Erfahrungen und
Suggestionen erleichtern kann, (c) die Unfähigkeit, einen verlässlichen
Marker einer Trance oder eines radikal veränderten
Bewußtseinszustandes zu finden und die Zurückhaltung, Hypnose unter
solchen Bedingungen in Begriffe zu kleiden, (d) Bestimmungsgrößen hyp-
notischer Ansprechbarkeit, inklusive Einstellungen und Überzeugungen,
Persönlichkeitseigenschaften, Erwartungen, Motivationen und Rapport, (e)
Anstrengungen, die hypnotische Suggestibilität zu verändern und (f) die
Notwendigkeit, Aufmerksamkeitsfähigkeiten und die Rolle der
Etablierung eines Antwortbereitschaftszustandes von dem behauptet wird,
daß er der Schlüssel zu maximaler hypnotischer Ansprechbarkeit ist, zu
untersuchen.
STEPHANIE RIEGEL, M.D.
Hypnose, phénomènes hypnotiques et réactivité hypnotique: Les fonde-

ments cliniques et scientifiques — Une perspective étalée sur quarante ans
STEVEN JAY LYNN, JOSEPH P. GREEN, CRAIG P. POLIZZI, STACY ELLENBERG,

ASHWIN GAUTAM ET DAMLA AKSEN
Résumé: Les auteurs résument les résultats de la recherche, leurs implica-

tions cliniques et les orientations pour la recherche future dérivée de quar-
ante ans d’étude de l’hypnose, des phénomènes hypnotiques et de la
réactivité hypnotique au laboratoire Steven Jay Lynn’s Laboratory of
Consciousness, Cognition, and Psychopathology et au laboratoire Joseph
P. Green’s Laboratory of Hypnosis. Ils y abordent a) l’ensemble cumulatif
de preuves que l’hypnose peut être utilisée avantageusement en
psychothérapie; b) le fait que l’hypnose peut faciliter un large éventail
d’expériences et de suggestions subjectives; c) l’incapacité de trouver un
marqueur fiable d’une transe ou d’un état de conscience radicalement altéré
et les hésitations à conceptualiser l’hypnose en ces termes; d) les
déterminants de la réactivité hypnotique, notamment les attitudes et les
croyances, les traits de personnalité, les attentes, la motivation et la relation
entre l’hypnotiseur et son sujet; e) les efforts visant à modifier la
suggestibilité hypnotique; et f) la nécessité d’examiner de plus près les
capacités d’attention et le rôle de l’adoption d’un ensemble de réactions
de préparation qui, selon eux, est essentiel à la maximisation de la réactivité
hypnotique.
JOHANNE RAYNAULT
C. Tr. (STIBC)
Hipnosis, fenómenos hipnóticos y capacidad de respuesta hipnótica:

Fundamentos clínicos y de investigación – Una perspectiva de 40 años.
STEVEN JAY LYNN, JOSEPH P. GREEN, CRAIG P. POLIZZI, STACY ELLENBERG,

ASHWIN GAUTAM Y DAMLA AKSEN
Resumen: Los autores resumen los hallazgos de investigación, sus implica-

ciones clínicas y las direcciones de futuras investigaciones derivadas de 40
años de estudio sobre la hipnosis, los fenómenos hipnóticos y la capacidad
de respuesta a la hipnosis en el Laboratorio de Conciencia, Cognición
y Psicopatología de Steven Jay Lynn y el Laboratorio de Hipnosis de
Joseph P. Green. Discutimos (a) la acumulación al cuerpo de evidencia de
que la hipnosis puede ser utilizada ventajosamente en psicoterapia; (b) el
hecho de que la hipnosis puede facilitar un amplio rango de experiencias
subjetivas y sugerencias; (c) la inhabilidad para encontrar un marcador
fiable de trance o de un estado alterado de conciencia radical y las reservas
sobre la conceptualización de la hipnosis en esos términos; (d) determi-
nantes del grado de respuesta a la hipnosis, incluyendo actitudes
y creencias, rasgos de personalidad, expectativas, motivación y rapport; (e)

esfuerzos por modificar la susceptibilidad hipnótica; y (f) la necesidad de
continuar examinando las habilidades atencionales y el rol de adoptar una
respuesta de presteza que argumentan es clave para maximizar el nivel de
respuesta a la hipnosis.
OMAR SÁNCHEZ-ARMÁSS CAPPELLO

Autonomous University of San Luis Potosi, Mexic

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International Journal of Clinical and Experimental

ISSN: 0020-7144 (Print) 1744-5183 (Online) Journal homepage: https://www.tandfonline.com/loi/nhyp20

HYPNOSIS, HYPNOTIC PHENOMENA, AND

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HYPNOSIS, HYPNOTIC PHENOMENA, AND

Psychology Department, Binghamton University, New York, USA

Ohio State University at Lima, Ohio, USA

CRAIG P. POLIZZI, STACY ELLENBERG, ASHWIN GAUTAM, AND DAMLA AKSEN

Binghamton University, New York, USA

Abstract: The authors summarize research findings, their clinical

In this article, we present our perspective on hypnosis, hypnotic

conducted over the past 40 years. Our goal is to highlight findings

1. Hypnosis researchers and clinicians have documented the ability of

with excellent psychometric properties. Still, definitive conclusions

changing flux of positive and negative thoughts and sensations; and

HYPNOSIS CAN FACILITATE A WIDE VARIETY OF SUBJECTIVE

such as increased feelings of happiness, enhanced sense of energy,

Yet an area where clinicians should exercise particular caution

In this section we discuss whether hypnosis produces a trance or

reports mirror actual hypnosis-seeking behaviors or whether people

a definition of an altered state of hypnosis may well be unrealistic, as

Clearly, much remains to be learned about the neural dynamics of

and motivations to respond; and (f) fluctuating levels of distractions,

suggestions and they become distracted by events in their peripheral

DETERMINANTS OF HYPNOTIC RESPONDING

Researchers have also evaluated the link between hypnotic respon-

other hand, extremely high fantasy abilities in no way guarantees high

during hypnosis than self-report trait measures of absorption and

of consciousness or not, have not received the research attention

Attitudes and Beliefs

We tested the hypothesis that the link between attitudes and

individual scales measuring attitudes (OAH), absorption (TAS), or

or meta-cognitive awareness; (b) minimizing and decoupling perfor-

MODIFYING HYPNOTIC SUGGESTIBILITY

England (Fellows & Ragg, 1992) attest to the cross-cultural general-

to a low interpersonal/low rapport testing context, they continued to

Lifshitz, M., Cusumano, E. P., & Raz, A. (2013). Hypnosis as neurophenomenology.

International Journal of Clinical and Experimental Hypnosis, 55, 336–354. doi:10.1080/

American Journal of Clinical Hypnosis, 30, 139–150. doi:10.1080/

Hypnose, hypnotische Phänomene und hypnotische Ansprechbarkeit :

Hypnose, phénomènes hypnotiques et réactivité hypnotique: Les fonde-

STEVEN JAY LYNN, JOSEPH P. GREEN, CRAIG P. POLIZZI, STACY ELLENBERG,

Résumé: Les auteurs résument les résultats de la recherche, leurs implica-

Hipnosis, fenómenos hipnóticos y capacidad de respuesta hipnótica:

STEVEN JAY LYNN, JOSEPH P. GREEN, CRAIG P. POLIZZI, STACY ELLENBERG,

Resumen: Los autores resumen los hallazgos de investigación, sus implica-

y creencias, rasgos de personalidad, expectativas, motivación y rapport; (e)

OMAR SÁNCHEZ-ARMÁSS CAPPELLO

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