Hypnosis, Placebo, and Suggestion in the Treatment of Warts

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N. SPANOS et al.of 8 or above) in at least one treatmentsession, and nine (75%) reported moderateexpectations (scores of 4-7). None of thesesubjects reported low expectations of successin either session (scores below 4). Onthe other hand, among the 45 treated subjectswho failed to lose warts, the correspondingfigures were 14 (31%) with highexpectations, 16 (36%) with with moderateexpectations, and 15 (33%) with lowexpectations. In other words, subjects wholost warts and those who did not lose wartswere about equally likely to hold high expectationsfor treatment success. However,subjects who held very low expectationsfor treatment success never lost anywarts. This pattern of findings may indicatethat suggestion-induced wart regressionis likely to occur only when subjectshold moderate-to-high expectations fortreatment success. However, positive expectations,in and of themselves, provideno assurance that a treatment effect willoccur.This pattern of findings is consistent withthe following hypothesis. Cognitive involvementin the suggested strategies facilitatesphysiological processes that leadto wart regression. Subjects with low expectationsfor treatment success are unlikelyto initiate or become involved in thesuggested strategies, and consequently, areunlikely to lose warts. Subjects who develophigh expectations for treatment successtend to lose warts if their high expectationslead them to become involvedin the suggested strategies. However, subjectswho cannot or will not develop suchinvolvements are unlikely to exhibit wartregression even when they hold relativelypositive expectations for treatment success.In order to test these ideas, we selectedthose subjects who held moderateor high expectations for treatment successbut did not lose warts (N = 30). Thesesubjects (M = 35.93, SD = 7.71) reportedsignificantly less vivid imagined sensationsthan did the 12 subjects who lost allwarts (all of whom reported moderate orhigh expectations and whose vividnessscores are given in Table 8 (t (40) = 1.93,p < 0.02 one-tailed). In other words, whensubjects who lost and did not lose wartswere equated for expectations, those wholost warts indicated higher involvement inthe suggestion (reported more vivid suggestedimagery) than those who did notlose warts.Post-follow-up VariablesThe bottom portion of Table 8 shows themeans on hypnotizability measures, Bettsimagery, and absorption for subjects wholost and did not lose warts. None of thesevariables differed significantly between thelost/did not lose groups.Side-specific Treatment EffectsRecall that in both experiments, subjectswith bilateral warts were given atreatment aimed at the warts on only onehand. In order to examine any selectiveeffect of the treatment on the target hand,we combined subjects from the two experimentswho a) had bilateral warts, b)received a treatment, and c) lost at leastone wart from either hand. Fifteen subjectsmet all of these criteria. Twelve of thesesubjects (seven hypnotic, five placebo) werefrom Experiment 1, and three subjects (twohypnotic, one suggestion only) were fromExperiment 2.Table 9 shows the number of warts eachof these subjects possessed at baseline onboth their treated and untreated hands, thenumber of warts lost from each hand, andthe percentage of warts lost from each hand.It is clear from this table that subjects tended256 Psychosomatic Medicine 50:245-260 (1988)
HYPNOSIS IN WART TREATMENTTABLE 9. Number of Warts and Number ofWarts Lost on Treated and Untreated HandsBaseline numberof wartsPost-test—number lost(percent lost)SS Treated Untreated Treated Untreated11238225415512223513122110122212523814 (36.4)2 (10.0)10 (26.3)1 (50)12 (48)7(17)1 (20)2 (40)1 (100)0(—)1 (50)2 (100)1 (33.3)0(—)1 (100)1 (4.5)2 (20)1 (50)0(—)2(100)1 (20)2 (100)2 (66.6)3 (37.5)1 (100)Ss 1-8 had more baseline warts on the treated hand. Ss9-15 had as many or more baseline warts on the untreatedas on the treated hand.to have more baseline warts on the treatedthan on the untreated hands. Consequently,any tendency for subjects to losemore warts on the treated rather than theuntreated hand might be due to baselinedifferences rather than treatment specificity.We addressed this issue by dividingthese 15 subjects into those with morebaseline warts on the treated hand (N = 8)and those with an equal number or fewerbaseline warts on the treated than the untreatedhand (N= 7).Subjects with more baseline warts onthe treated hand lost a significantly greaterpercentage of warts on the treated hand(M = 42.13, SD = 26.37) than on the untreatedhand (M = 9.25, SD = 17.85, F [1,7] = 8.71, p < 0.05). In fact, five of theseeight subjects (62.5%) lost warts exclusivelyon the treated hand, and none lostwarts exclusively on the untreated side.Taken in isolation, these findings wouldsuggest a strong side-specific treatment effect.However, in subjects who had at leastas many baseline warts on the untreatedas on the treated side, the "specificity effect"disappeared. For these seven subjects,there was no significant differencein the percentage of warts lost from thetreated hand (M = 54.76, SD = 45.86) orfrom the untreated hand (M = 60.71,SD = 41.89, F (1, 6) < 1). Moreover, onlyone of these subjects (14%) lost warts exclusivelyfrom the treated hand, while twoof them (28%) lost warts exclusively fromthe untreated hand.DISCUSSIONIn Experiment 2 hypnotic subjects andsubjects given the suggestion alone wereequally likely to lose warts, and more likelyto lose warts, than no-treatment controlsubjects. These findings are consistent witha large body of data that indicates that hypnoticand motivated nonhypnotic subjectsrespond similarly when they are administeredthe same suggestions (25). Morespecifically, these findings indicate thatneither an hypnotic induction procedurenor instructions for relaxation enhance theefficacy of suggestions at inducing wartregression. From a practical perspective,the equivalent outcomes in the hypnoticsuggestionand suggestion-alone conditionsindicate that therapists can offer psychologicaltreatment for warts without expendingthe extra time required to employhypnotic procedures, familiarize patientswith such procedures, divest patients offears and negative attitudes toward hypnosis,and so on.Neither hypnotizability nor attributemeasures of imagery propensity predictedwart regression in either experiment. Ex-Psychosomatic Medicine 50:245-260 (1988) 257
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Hypnosis, Placebo, and Suggestion in the Treatment of Warts

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