International Handbook of Clinical Hypnosis - E-Lib FK UWKS

252 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
the hypnotic context and the placebo component of ingesting a pill are about
equal, and highly correlated 0:76, N ˆ 12). 1 This is the `placebo' component
of the hypnotic induction procedure. The expectation that hypnosis can be
helpful in reducing pain produced similar signi®cant reductions in pain to the
expectation derived from taking a pain-killing pill, particularly in those
individuals who otherwise have no special hypnotic skills. Signi®cant pain
relief was achieved under both the placebo analgesia and placebo hypnosis
conditions, even though this relief was not nearly as great as that obtained with
hypnotic analgesia in hypnotizable subjects.
The study by McGlashan, Evans & Orne 1969; Evans, 1984, 1987, 1990b,
2001) documented that the mechanisms by which a placebo pill and hypnosis
produced analgesia were different in subjects with high hypnotic capacity. Several
studies using different methodologies have produced similar results. For example,
Knox, Gekoski, Shum & McLaughlin 1981) compared acupuncture with
hypnosis. 2 The pain reduction with acupuncture was equal in high and low
hypnotizable subjects, but the pain response of highly hypnotizable subjects was
signi®cantly greater with hypnosis than with acupuncture. A similar result was
found by Miller & Bowers 1986) in a study in which Meichenbaum's 1977) stress
inoculation procedure was compared to hypnotic analgesia.
In summary, these and other studies show that hypnosis can facilitate cognitive
strategies that are helpful in alleviating pain. Speci®c interventions such as
acupuncture, attention/distraction, medication, placebo, relaxation, stress inoculation,
all have a signi®cant effect on pain, but these effects are independent of
individual differences in hypnotic capacity Evans, 1989, 2001). The use of the
label `hypnosis' produces a strong connotation that change is expected by the
therapist as well as in the patient. The communication of con®dence and the
message to the patient that help is on its way is a powerful therapeutic intervention.
The magical connotations and ritual of the hypnotic induction process produce
meaningful non-speci®c pain-reducing effects, even in many patients with limited
hypnotic capacity. Hypnosis may `work' for everybody except the treatmentresistant
patient), even though some of the clinical improvement is produced by the
context of hypnosis rather than the hypnotic condition itself. On the other hand,
these studies show that at least for some highly selected individuals, hypnosis
produces a means of controlling and mastering pain that is different from all other
interventions studied so far. In clinical management these interpersonal and
individual trait aspects of hypnosis cannot be separated easily. It is not surprising
that many patients with moderate to low hypnotizability will be responsive to
hypnotic manipulations, particularly if they are ready to respond at that time. The
fact that there are two interacting mechanisms involved helps to explain why
clinicians often see compelling pain relief in patients who otherwise seem
unhypnotizable Evans, 1987, 1989, 1991, 2000, 2001). The capacity to experience
hypnosis may be at best a bonus. If hypnosis is useful with chronic pain cases