Hypnosis, Placebo, and Suggestion in the Treatment of Warts

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N. SPANOSetal.lost fewer warts than hypnotic subjects andalso reported less intense experiencing ofsuggested sensations than did hypnoticsubjects. These findings may indicate thathypnotic subjects were more subjectivelyinvolved in their treatment than were placebosubjects and that subjective involvementin the treatment process is helpfulin bringing about wart regression. Thefinding that placebo group subjects failedto differ significantly from controls in wartloss was somewhat surprising given thesignificant placebo effect reported byMemmesheimer and Eisenlohr (12). Perhapsour rather complicated "cold laser"placebo was simply less convincing thansuch relatively simple procedures as havingmedical personnel (instead of psychologists)paint the warts or inject subjectswith innocuous substances definedas powerful wart medications. Futurestudies that employ a range of differentplacebo procedures, and that independentlyassess each procedure for believability,might provide useful information.In hypnotic subjects, wart regressioncorrelated significantly with the reportedvividness of suggested imagery and suggestedsensations. Interestingly, in thesesame subjects wart regression failed to correlatesignificantly with either an attributemeasure of the propensity to imagine vividly(The Betts Questionnaire) or withhypnotizability dimension. These findingsindicate that in the case of wartregression, situation specific indicators ofsubjects' cognitive involvements and motivationsmay be better outcome predictorsthan global indexes of fantasy pronenessand suggestibility. The global indicatorsmay simply be too far removed from theparticular constellation of context specificmotivations, imaginings, and beliefs thatdetermine subjects' responses to the treatmentsuggestions. On the other hand, thesefindings may simply point to limitationsin the particular indexes of imagery andhypnotizability employed in our study. Toexamine this possibility, our second experimentemployed a second standardizedtest of hypnotizability and two differentattribute measures of imaginal activity.Our finding that treatment effects werelarger for females than for males was surprising,because five previous studies (6,12, 13, 17, 22) found no sex differences inwart regression in subjects treated witheither hypnotic suggestion or placebo.Thus, our findings with respect to sex differencesshould be considered highly tentativeuntil replicated.Our finding that subjects with manywarts showed a better treatment responsethan those with only a few is consistentwith the results of at least two earlier studies(12, 22). In one study (22), for example,30% of the 10 subjects with four or morewarts showed wart regression followinghypnotic treatment, while none of the 12subjects with three or fewer warts showedany treatment effect.EXPERIMENT 2A good deal of experimental work indicatesthat hypnotic and motivated nonhypnoticsubjects respond equivalentlywhen given the same suggestions. Equivalentlevels of responding in these twogroups have been found for suggestionsthat call for such varied responses as analgesia,age-regression, hallucination, motoricand sensory alterations, and allergicreactions (for reviews, see 25, 26). Onlyone study (22) compared hypnotic andnonhypnotic subjects given the same suggestionfor wart regression. Unfortunately,the number of subjects per treatment wassmall, a no-treatment control condition was252 Psychosomatic Medicine 50:245-260 (1988)
HYPNOSIS IN WART TREATMENTnot employed, and very few subjects ineither treatment lost warts. Consequently,the results were ambiguous.The major components in hypnotictreatments for wart regression usually includethe definition of the situation ashypnosis, the administration of an inductionprocedure that emphasises relaxation,and suggestions to imagine the warts disappearing.In order to determine whetherdefining the situation as hypnosis or relaxationfacilitated any wart regression effectsproduced by the suggestion alone, wecompared the following four conditions;a) hypnotic induction plus suggestion, b)the same suggestion preceeded by nonhypnoticrelaxation instructions, c) thesuggestion alone, and d) a no-treatmentcontrol condition. Each subject was administeredtheir treatment twice separatedby a 1-week interval. Following each treatmentsession, subjects rated the vividnesswith which they imagined the sensationssuggested to them their degree of relaxation,and the extent to which they experiencedgeneralized alterations in consciousness(e.g., "I felt dazed," "time stoodstill"). A number of investigators (e.g., 27)have emphasized the importance of subjects'expectations of treatment success inbringing about wart regression. In fact, ithas been argued (27) that expectation isthe only important psychological mediatorof wart regression. Supposedly, otherpsychological variables (such as engagingin the suggested imagery) are importantonly to the extent that they bolster subjects'expectations of treatment success.Alternatively, other investigators havesuggested that subjects' expectations arelargely unrelated to treatment outcome andhave reported successful treatment inhighly skeptical subjects (e.g., 28, 29). Unfortunately,no studies have systematicallyassessed the relationship betweenexpectations and treatment outcome. Inorder to examine this issue, subjects in eachof our treatments estimated how effectivethey believed their treatment would be atremoving their warts.At the end of the 6-week follow-up period,all subjects were tested on two differenthypnotizability scales and were administeredTellegen and Atkinson's (30)questionnaire measure of absorption inimaginative activities, as well as the versionof the Betts' imagery questionnaireused in Experiment 1 (23).METHODSubjectsForty-five males and 31 females (ages 15-66 years)with warts on one or both hands were recruited forparticipation in a study on the psychological treatmentof warts in the same manner as in Experiment1.ProcedureSubjects were randomly assigned to four conditionswith 19 subjects in each condition. The fourconditions were a) the same hypnotic induction procedureplus wart remission suggestion used in Experiment1, b) the wart remission suggestion preceededby relaxation instructions in place of thehypnotic induction, c) the suggestion alone withoutpreliminary hypnotic or relaxation instructions, andd) no treatment control.The relaxation instructions were modelled afterthe hypnotic instructions used in Experiment 1. Theywere the same length as the hypnotic instructions.However, they defined the situation as relaxationrather than hypnosis, and all references to drowsiness,sleep, and hypnosis were replaced with referencesto relaxation and comfort.Subjects in the three treatment groups were administeredtheir respective treatment procedurestwice, with a week separating the two administrations.Within each treatment, 11 subjects were administeredthe procedures by a male experimenter,and eight were administered them by a female experimenter.Subjects in all conditions returned forfollow-up evaluation 6 weeks after their initial ses-Psychosomatic Medicine 50:245-260 (1988) 253
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Hypnosis, Placebo, and Suggestion in the Treatment of Warts

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