Hypnosis, Placebo, and Suggestion in the Treatment of Warts

N. SPANOS et al.periment 2 employed two different scalesto assess behavioral and subjective indexesof hypnotizability, and two differentattribute measures of imaginal propensity.Consequently, the failure of these variablesto predict treatment outcome cannotbe attributed to properties or deficienciesunique to one particular index of hypnotizabilityor propensity for imagery. Morelikely, the failure of these indexes to predicttreatment outcome was related to theirlack of relevance to the treatment. Hypnotizabilityand imaginal propensity werealways assessed at the end of the study.Consequently, the constellation of situation-specificattitudes, expectations, andmotivations that influenced subjects' levelsof responding to these postexperimentallyadministered indexes was probablyvery different from the constellation ofmotives and attitudes that determined theirpsychological response to the treatmentsuggestion.Unlike the attribute indexes, subjects'ratings of suggested imagery vividnesscorrelated significantly with wart regression.Interestingly, ratings of relaxation andof general alterations in experiences failedto predict wart regression. Thus, the extentto which subjects employed their imageryskills in the treatment context, for the specificpurpose called for by the suggestion,predicted treatment outcome. On the otherhand, subjects' propensities to imagine incontexts other than the treatment session(indexed by the attribute questionnaires),their propensities to subjectively and behaviorallyenact hypnotic responses in acontext unrelated to the treatment, and theirlikelihood of experiencing psychologicaleffects that were not directly called for bythe suggestion (i.e., relaxation, generalizedalterations in experience), were simply irrelevantto treatment success. The findingthat degree of suggested imagery predictedtreatment outcome is open to at least twointerpretations. On the one hand, it maybe that imaginal processes are, for somereason, particularly important in initiatingor modulating the chain of physiologicalresponses that leads to wart regression. Alternatively,the important psychologicalvariable may not be imagery per se, butinstead subjects' degree of subjective involvementin a process that they considerto be therapeutic. In the present study, thesevariables were confounded. It would be ofinterest in a future study to compare animagery-suggestion treatment to some procedurethat encourages subjects' involvementin a wart-regression treatment thatdoes not involve generating wart-regressionimagery.The finding in Experiment 2, that expectationsfor treatment success failed topredict wart regression, contradicts thehypothesis that expectations of treatmentefficacy are the only important psychologicalfactors in the induction of wart regression(27). On the other hand, our findingthat subjects with low expectations fortreatment success never exhibited wartregression suggests that moderate-to-highexpectations of success may be necessarybut not sufficient for the production ofpsychologically induced wart regression.Psychologically induced wart regressionmay require the occurrence of cognitivefactors that are distinct from expectationsof treatment success, but that are more likelyto occur when subjects hold strong ratherthan weak expectations of success.The combined findings of our two experiments,like most earlier findings, (7-9, 13, 22), provided no evidence for theoccurrence of a side-specific suggestion effectin subjects with bilateral warts. Instead,our findings suggest that the resultsof the one study (18) that reported such aneffect may have been artifactual. In that258 Psychosomatic Medicine 50:245-260 (1988)