International Handbook of Clinical Hypnosis - E-Lib FK UWKS

DENTAL ANXIETY DISORDERS 301
nosis provides an additional approach that may enhance the effectiveness of these
other strategies Stanley, Burrows & Judd, 1990).
The primary goals of psychological therapies for anxiety states are: the
exposure of the patient via imagery or reality) to the situation provoking the
anxiety, thereby allowing deconditioning, habituation or desensitization; cognitive
re-evaluations of the situation to alter the perception of threat; determining the
personal signi®cance symbolic) of the anxiety provocation; increasing the sense
of self-ef®cacy, behaviorally or cognitively, in the patient's ability to deal with the
anxiety-eliciting situation and the symptoms; and the rehearsal and effecting of
coping strategies.
More speci®cally, hypnosis may be used to facilitate the use of dissociation,
altered perceptions, cognitions and memories, the enhanced control over anxiety
symptoms, cued self-control techniques and uncovering for psychodynamic psychotherapy.
HYPNOTIZABILITY AND CLINICAL POPULATIONS
Hypnotizability, that is the individual's capacity to experience hypnosis, is generally
described and conceptualized as a stable trait which is relatively resistant to
modi®cation Hilgard, 1975). An opposing view Spanos, Cross, Menary & Smith,
1988) indicates that cognitive skill training aimed at inculcating positive attitudes
and appropriate interpretational sets towards hypnotic responding can produce
signi®cant and very substantial enhancement in susceptibility. However, reanalysis
of this study using analysis of covariance instead of analysis of variance Frischolz,
1997) showed that the trait or personal effect accounted for 50% of the variance
while the situational effect type of induction ceremony) accounted for only 17%
of the variance, disproving Spanos's claims and con®rming that hypnotizability was
a trait relatively resistant to modi®cation.
Although hypnotizability has been described as an ability within the repertoire
of normal cognitive functioning it appears that individuals manifesting certain
psychiatric disorders may be hypnotizable to different degrees. Frankel 1974) was
the ®rst to report elevated hypnotizability scores in phobic patients in comparison
to different reference groups. This ®nding was replicated by researchers in mixed
clinical populations Foenander, Burrows, Gerschman & Horne, 1980; Gerschman
et al., 1979, 1987; Gerschman & Burrows, 1989; John, Hollander & Perry, 1983;
Kelly, 1984). However, Frischolz, Spiegel et al. 1982) and Owens, Bliss, Koester
& Jeppsen 1989) failed to replicate these ®ndings Table 21.1).
There are further disorders which are characterized by high levels of hypnotizability.
These include hysteria, multiple personality, post-traumatic stress disorder
and some categories of eating disorders such as bulimia Coman, 1992). Such high
hypnotizable groups stand in contrast to schizophrenics Spiegel et al., 1982),
obsessive compulsives and anorexics Coman, 1992) who have been found to
possess lower levels of hypnotizability.