International Handbook of Clinical Hypnosis - E-Lib FK UWKS

250 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
Another view of hypnosis is that it re¯ects a stable capacity of the individual.
The hypnotic experience may involve an ability to readily change states of
awareness or levels of consciousness. These changes may be either interpersonallyor
self-induced Bowers, 1976; Evans, 2000; Hilgard, 1965, 1977). Hypnosis is
considered in terms of neodissociation or multiple cognitive pathways. The patient
simultaneously knows, but is unaware of, pain severity, at different levels of
awareness. Pain awareness and analgesia are co-conscious. Hypnosis may involve a
more general ability of cognitive ¯exibility, or switching mechanism, that allows
one to change psychological, cognitive or physiological processes, or readily access
different levels of consciousness Evans, 2000, 1991). Hypnotizability correlates
with several related measures including the ability to utilize imagery effectively;
napping and the ease of falling asleep; the ability to become absorbed in engaging
experiences such as being `lost' in a movie or novel; occasional lateness for
appointments; and the ease with which patients will give up psychiatric and
possibly medical) symptoms, even with non-hypnotic treatment Evans, 1991,
2001).
The correlation between measured hypnotizability and pain control has been
reported by Hilgard 1977) to be around 0.5 in a variety of experimental situations,
con®rming neither general theory. This correlation is signi®cantly less than the
joint reliabilities of the pain reports and the hypnotizability measures. Thus, the
existing data highlight the paradox of hypnotic pain control: clinicians report that
most of their patients can bene®t from hypnotic intervention techniques, while
empirical data suggest that only relatively few people have the complex dissociative)
capacity to experience the sensory and cognitive skills required to signi®cantly
reduce severe pain.
Hilgard's 1977) later elaboration of pain control within the context of neodissociation
theory, particularly using the method of the `hidden observer', helped
document that pain perception takes place at different levels of awareness. Multiple
cognitive pathways may be accessible to the hypnotized subject, enabling him/her
to experience minimal pain at a conscious level, even though at another cognitive
level or to an observing ego) reasonably accurate reports of the actual intensity of
the painful stimulation are made. For example, we experience that the dentist's drill
does not hurt, even though we maintain awareness of the level of painful stimulation
that we would be experiencing without the chemical intervention.
DISSOCIATIVE AND PLACEBO COMPONENTS OF
HYPNOTIC PAIN MANAGEMENT
The signi®cant contributions to understanding the nature of acute pain that have
been made in the hypnosis literature will not be reviewed. The meticulous
psychophysical studies of experimental pain conducted by Hilgard 1969, 1977)
and others have shown that there is a lawful relationship between the intensity of