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A review of three pilot studies by J.H. Gruzelier examines the effect of relaxation, self-hypnosis and guided imagery on basic immune functions, and offers a wide range of exciting findings. The author and his colleagues investigated self-hypnosis training that incorporated imagery of the immune system. In two of his studies, hypnosis was found to buffer the effects of stress on immune functions in medical students at exam time. When he compared self-hypnosis with and without immune system imagery, the data confirmed that there were advantages to the targeted imagery. Results in the imagery group showed heightened immune function, improvements in mood, and fewer winter viral infections. A third study looked at patients with virulent and chronic herpes simplex virus-2 HSV-2. Six weeks of training almost halved recurrence, improved mood and reduced levels of clinical depression and anxiety in the intervention group. Immune functions were up-regulated, notably functional natural killer cell activity to HSV-1. The review concludes that these preliminary studies show that hypnosis with targeted imagery provides immune control along with enhanced mood and well-being, and that larger studies with controls are warranted.

Over the past 20 years, there as been considerable evidence that psychological factors can play a substantive role in the development and progression of coronary artery disease. There is evidence that hypnosis can be effective in the treatment of coronary artery disease, enhancing the effect of standard cardiac rehabilitation in reducing all-cause mortality and cardiac event recurrences for up to 2 years.

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EEG was registered in healthy volunteers before and after their entry into modeling (hypnotic) catalepsy. The brain activity recorded under standard electrode placement (the 10-20 international classification) was processed using a special computer program. The data obtained were digitally represented as sets of standard parameters of EEG patterns in 0,5-32 Hz diapason (alpha-, beta1-, beta2,-, theta-, delta-rythms). These parameters were compared under different functional tests particularly connected with the control of sensomotor brain activity. Calculated coefficients of interhemisphere asymmetry allow one to evaluate dynamics of neuropsychological processes of deprivating adaptation related to low-frequency bands. EEG-parameters precisely evaluating the level of hypnotic catalepsy have been established.

PMID: 16608110 [PubMed - indexed for

Once again a pilot study shows that self-regulation techniques - this time biofeedback and relaxation - are effective at reducing blood glucose levels

Researchers at the Department of Psychiatry, Medical University of Ohio in Toledo conducted randomized, controlled clinical trials to determine the effects of biofeedback and relaxation on blood glucose and HbA1c (A1C) in patients with type 2 diabetes.

Patients with type 2 diabetes were randomized to either 10 sessions of biofeedback (electromyograph and thermal) and relaxation or 3 sessions of standard patient education. All the sessions were individual. Thirty-nine subjects were entered, and 30 completed the 3-month protocol.

The study assessed average blood glucose, A1C, forehead muscle tension, and peripheral skin temperature. In additon, inventories measuring depression and anxiety were administered before randomization and after completion of the treatment or the control condition.

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In a randomized, controlled, clinical trial, researchers from the Department of Psychiatry at the Robert Wood Johnson Medical School, atThe University of Medicine and Dentistry of New Jersey in Piscataway, evaluated the effectiveness of heart rate variability (HRV) biofeedback as a complementary treatment for asthma.

Ninety-four adult, outpatient, paid volunteers with asthma were randomly assigned to one of four conditions: (1) a full protocol, consisting of HRV biofeedback and abdominal breathing through pursed lips and prolonged exhalation); (2) HRV biofeedback alone; (3) placebo EEG biofeedback; and (4) a wait list control. Subjects were first pre-stabilized, using controller medication, and then medication was titrated biweekly by blinded asthma specialists, according to a protocol based on National Heart, Lung, and Blood Institute guidelines which responds to symptoms, spirometry, and home peak flows.

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Principal Investigator James Halper at Lenox Hill Hospital in New York completed his guided imagery study with asthma patients, showing that although imagery did not seem to influence actual asthma symptoms, it did result in significantly more patients being able to discontinue their medication. Not surprisingly, he also found significantly less depression and anxiety in the guided imagery group than in the control group.

Researchers from the Department of Social and Behavioral Sciences at The University of Virginia report on the first MRI study to report differences in brain structure size between low and highly hypnotizable, healthy, right-handed young adults.

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Placebo effects are believed to be mediated by both cognitive and conditioning mechanisms. Until recently, little was known about the role of these mechanisms in different circumstances. Now, research has shown that placebo responses are mediated by conditioning when unconscious physiological functions such as hormonal secretion are involved, whereas they are mediated by expectation when conscious physiological processes such as pain and motor performance come into play, even though a conditioning procedure is carried out.

Positron emission tomography (PET) scanning of the brain is providing evidence of the release of the endogenous neurotransmitter dopamine in the brain of Parkinson's disease patients in response to placebo.15 Evidence indicates that the placebo effect in these patients is powerful and is mediated through activation of the nigrostriatal dopamine system, the system that is damaged in Parkinson's disease. This result suggests that the placebo response involves the secretion of dopamine, which is known to be important in a number of other reinforcing and rewarding conditions, and that there may be mind-body strategies that could be used in patients with Parkinson's disease in lieu of or in addition to treatment with dopamine-releasing drugs.

Meditation, one of the most common mind-body interventions, is a conscious mental process that induces a set of integrated physiological changes termed the relaxation response. Functional magnetic resonance imaging (fMRI) has been used to identify and characterize the brain regions that are active during meditation. This research suggests that various parts of the brain known to be involved in attention and in the control of the autonomic nervous system are activated, providing a neurochemical and anatomical basis for the effects of meditation on various physiological activities. Recent studies involving imaging are advancing the understanding of mind-body mechanisms. For example, meditation has been shown in one study to produce significant increases in left-sided anterior brain activity, which is associated with positive emotional states. Moreover, in this same study, meditation was associated with increases in antibody titers to influenza vaccine, suggesting potential linkages among meditation, positive emotional states, localized brain responses, and improved immune function.

Clinical hypnosis is an established part of the comprehensive treatment of numerous problems in ambulatory pediatrics. Two cases illustrate its utility with pediatric inpatients. These cases demonstrate clinical hypnosis as a teachable, practical, and nonpharmacologic intervention that warrants further investigation in the inpatient setting.

Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA. barn0139@umn.edu

During hypnosis it is easy to induce hallucinations having, for the hypnotized subject, the characteristics and the concreteness of reality. This study was performed to put in evidence the physical effects of hypnotic suggestion of warm tub bathing. 18 volunteers screened for high hypnotizability were studied. They underwent suggestion of forearm in warm water (30 min), suggestion of body in warm water (30 min), and hypnosis without any thermal suggestion (30 min), while blood pressure, heart rate, body temperature, forearm flow and resistance, stroke volume, cardiac index and total peripheral resistance were monitored. During suggestion of forearm in warm water, local vasodilation was recorded, with decrease of forearm resistance (-18%, P<0.01) and increase of forearm blood flow (+43%, P<0.01) like in real local passive warming. During suggestion of whole-body in a warm water tub, there was a systemic vasodilation with decrease of total peripheral resistance (-29%, P<0.01) and increase of cardiac index (+54%, P<0.01), like in real total-body passive warming. Body temperature, arterial blood pressure and heart rate were unchanged. During simple hypnosis (sham procedure) no haemodynamic variations were observed. These results are in keeping with the possibility to induce through hypnotic suggestion of heat a physical pattern that is typical of hyperthermia, even without increase in body temperature.

Department of Clinical and Experimental Medicine, University of Padova, Via Giustiniani No. 2, Padova, Italy. edoardo.casiglia@unipd.it

In an investigation of the role of cognitive effort in hypnotic responding, high and low hypnotizable participants produced emotionally neutral imagery in response to effortful versus effortless hypnotic suggestions. Heart-rate increase served as an objective index of cognitive effort, and subjective ratings of imagery vividness, absorption, effort, and control were collected. Compared to lows, high hypnotizable participants experienced their imagery as more vivid and absorbing, yet their heart rates indicated no higher level of cognitive effort than lows. Compared to effortless wording, effortful wording of suggestions increased cognitive effort in lows, as indexed by heart-rate increase, but had no effect on the effort expended by highs. Ratings of subjective control were strongly correlated with subjective effort for lows but unrelated for highs. These results support the dissociated-control theory of hypnosis rather than the dissociated-experience or social-cognitive theories.

Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada. psadler@wlu.ca

Health care interventions which respect the mind and body as an integral whole will represent the future of medicine. By respecting the interaction among the brain, mind, body, and behavior we learn the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health. This has implications not only in the area of self-care and self-knowledge, but also leads to an increased number of techniques that can be available to the allopathic practitioner.

Mind-body medicine typically focuses on strategies such as relaxation, hypnosis, visual imagery, meditation, yoga, biofeedback, tai chi, qi gong, cognitive-behavioral therapies, group support, autogenic training, and spirituality.

Mind-body as a concept is not new. It has been used as an integral part of the treatment of illness of Chinese and Ayurvedic medicine, dating back more than 2,000 years. It was also noted that Hippocrates used such techniques around 400 B.C.E. However, even though mind-body concepts were prevalent in the East, developments in the Western world by the 16th and 17th century led to a separation of human spiritual and emotional dimensions from the physical body. During the Renaissance and Enlightenment eras, this led to a redirection of science. As a result, the belief was that as a race we could master (rather than work with) nature. Technological advances (e.g., microscopy, the stethoscope, the blood pressure cuff, and refined surgical techniques) demonstrated a cellular world that seemed far apart from the world of belief and emotion. The discovery of bacteria and later, antibiotics further dispelled the notion of belief influencing health.

During the last century scientists began realizing that the mind-body connection was much more than just beliefs and emotion. In the 1920s, Walter Cannon's work revealed the direct relationship between stress and neuroendocrine responses in animals. Coining the phrase "fight or flight", Cannon describes the primitive reflexes of the sympathetic and adrenal activation in response to perceived danger and other environmental pressures. Hans Selye further defined the deleterious effects of stress and distress on health. At the same time, technological advances in medicine that could identify specific pathological changes, and new discoveries in pharmaceuticals, were occurring at a very rapid pace. The disease-based model, the search for a specific pathology, and the identification of external cures were paramount, even in psychiatry.

Since the 1960's, mind-body interactions have become an extensively researched field. The evidence for benefits for certain indications from biofeedback, cognitive-behavioral interventions, and hypnosis is quite good. There is emerging evidence regarding their physiological effects.

Evidence from randomized controlled trials and, in many cases, systematic reviews of the literature, suggest that:

• Mechanisms may exist by which the brain and central nervous system influence immune, endocrine, and autonomic functioning, which is known to have an impact on health.
• Multicomponent mind-body interventions that include some combination of stress management, coping skills training, cognitive-behavioral interventions, and relaxation therapy may be appropriate adjunctive treatments for coronary artery disease and certain pain-related disorders, such as arthritis.
• Multimodal mind-body approaches, such as cognitive-behavioral therapy, particularly when combined with an educational/informational component, can be effective adjuncts in the management of a variety of chronic conditions.
• An array of mind-body therapies (e.g., imagery, hypnosis, relaxation), when employed presurgically, may improve recovery time and reduce pain following surgical procedures.
• Neurochemical and anatomical bases may exist for some of the effects of mind-body approaches.

Mind-body approaches have potential benefits and advantages. In particular, the physical and emotional risks of using these interventions are minimal. Moreover, once tested and standardized, most mind-body interventions can be taught easily. Finally, future research focusing on basic mind-body mechanisms and individual differences in responses is likely to yield new insights that may enhance the effectiveness and individual tailoring of mind-body interventions. In the meantime, there is considerable evidence that mind-body interventions, even as they are being studied today, have positive effects on psychological functioning and quality of life, and may be particularly helpful for patients coping with chronic illness and in need of palliative care.

One fundamental question that is still not resolved is whether acupuncture needles must be inserted in specific points to have their greatest effects. In the majority of large RCTs recently conducted in Germany, acupuncture was significantly more effective than doing nothing but not than sham acupuncture. Only for one study of chronic knee pain was acupuncture superior to sham. Brain imaging with functional magnetic resonance (fMRI) and positron emission tomography (PET) may be helpful but is still in its early stages. Several studies have shown differences between the way the deep central areas of the brain respond to genuine acupuncture compared with sham. Acupuncture can clearly produce complex changes that are relevant to pain transmission and perception, though it is still uncertain how specific these are. Similar changes have been seen after the application of placebo cream and after hypnosis. A previous paper discussed the likely central role of the limbic system in acupuncture, evidenced by euphoria and out of body experiences. There may be a good deal of common ground between acupuncture, placebo treatments, hypnosis, and even manipulative treatments. This understanding could offer a way out of the sterile debate about whether acupuncture is merely a placebo: acupuncture could be one effective way of stimulating responses within these deep areas of the brain, though not the only way.

Royal London Homeipathic Hospital, London, UK. ac@campbell.org.uk

Department of Orthopaedic Surgery, School of Medicine, University of California-Irvine, UCI Medical Center, 101 The City Drive, Orange, CA 92868, USA. sgreen@uci.edu

Surgeons have conducted placebo-controlled double-blind investigations to determine the value of surgical procedures by comparing the results of real operations with sham operations. The sham operation served as a placebo control, permitting analysis of the alleged benefit of the real operation by eliminating the effect caused by the rest of the surgical experience. A modern operation starts with a series of events resembling ritualistic practices used by shamans. Shamans are traditional healers in cultures that believe communication with the gods and spirits influences health and well being. Shamanistic healing measures include: journeying to a healing place, fasting, wearing ritual garb, ingesting psychotrophic substances, anointment with purifying liquid, an encounter with a masked healer, and inhaling stupefactive vapors. These steps are followed by a central ritual activity that may include extracorporeal, surface, and penetrative components. Postoperative ritual activities reinforce the suggestive value of the healing. These experiences increase a patient's suggestibility, thereby enhancing the likelihood of a favorable outcome. Any research on the effectiveness of surgical procedures, especially those designed to relieve pain, must consider the strongly suggestive effect of the elaborate perioperative ritual.

In this "Reply" paper, the arguments and experimental findings by Pockett, Pollen, and Haggard et al. are analyzed. It had been shown () that a 0.5s duration of repetitive activations of sensory cortex is required to produce a threshold of sensation. The view that this is due to a facilitatory buildup in excitatory state to finally elicit neuronal firing is shown to be incompatible with several lines of evidence. Objections to the phenomenon of subjective referral backwards in time (for the delayed sensation) are also untenable. report that a self-initiated act can, under hypnotic suggestion, appear to the subject to be "involuntary." The act under hypnosis is better viewed as one initiated unconsciously, not as an act of conscious will.

Center for Neuroscience, University of California, Davis, 95616, USA.

Participants' expectancies and hypnotic performance throughout the course of a standardized, individually administered hypnotic protocol were analyzed with a structural equation model that integrated underlying ability, expectancy, and hypnotic response. The model examined expectancies and ability as simultaneous predictors of hypnotic responses as well as hypnotic responses as an influence on subsequent expectancies. Results of the proposed model, which fit very well, supported each of the 4 major hypothesized effects: Expectancies showed significant stability across the course of the hypnosis protocol; expectancies influenced subsequent hypnotic responses, controlling for latent ability; hypnotic responses, in turn, affected subsequent expectancies; and a latent trait underlay hypnotic responses, controlling for expectancies. Although expectancies had a significant effect on hypnotic responsiveness, there was an abundance of variance in hypnotic performance unexplained by the direct or indirect influence of expectation and compatible with the presence of an underlying cognitive ability.

Department of Psychology, University of Texas--Pan American, TX, USA.

The present investigation surveyed attitudes and beliefs about hypnosis across 4 samples of students attending college at the University of New South Wales, Australia; Dortman University, Germany; The Ohio State University, United States; and Shaheed Beheshti University of Medical Sciences, Iran. A total of 280 undergraduate students (70 from each country sampled), ranging in age from 18 to 25 years, completed 3 different questionnaires assessing their opinions and beliefs about hypnosis. Although responses to some items varied by country, there was remarkable similarity across many items suggesting that certain views and attitudes about hypnosis are not culture specific.

The Ohio State University, Lima, Ohio, USA. green301@osu.edu

This clinical pilot study on finger elongation for induction of hypnosis attempts to determine whether the observed response is a hypnotic phenomenon or a simple physiologic reaction. Sixteen volunteers participated in the 5-phase study, which measured relative and absolute changes in the length of each finger prior to and after each phase. A distinctive elongation was statistically significant for the hypnosis condition. In addition, findings suggest changes in the metacarpus. Further investigation is indicated to shed light on this apparent phenomenon.

Friedrich Alexander University, Erlangen-Nuremberg, Germany. seitner@prothetik-erlangen.de

Procedures for estimating hypnotic depth have been used for more than 70 years. This study predicted self-reported hypnotic depth from the phenomenological and behavioral variables of the Phenomenology of Consciousness Inventory-Hypnotic Assessment Procedure (PCI-HAP). Participants were divided into 2 groups; 1 was used to generate regression equations, and the other group was used for cross-validation. Both imagery vividness during hypnosis (imagoic suggestibility) and the PCI pHGS measure of hypnotic depth (hypnoidal state) accounted for most of the variance in self-reported hypnotic depth. The above results, further supported by correlational and 3-D visual analyses, are consistent with other researchers' observations that ratings of hypnotic depth are a function of: (a) alterations in subjective experience, and (b) the perception of responsiveness to suggestions. The findings are also congruent with J. Holroyd's hypothesis that suggestibility and altered-state effects interact to produce hypnotic effects.

Coatesville Veterans Administration Medical Center, Coatesville, Pennsylvania, USA. Ronald.Pekala@med.va.gov

Modern medical technology and economic impositions tend to dehumanize the medical patient. This paper describes a targeted use of the hypnotic modality for relationship building, symptom management, and restoring a sense of self to the patient. To humanize medical care one patient at a time, examples are given for the use of the Hypnotic Induction Profile, the Eye Roll sign and AOD (Apollonian-Odyssean-Dionysian) Mind-Style Questionnaire as a basis for choosing bio-psycho-social treatment strategies. This trio of assessments can be used together, in approximately 10 to 15 minutes, or separately, if treatment decisions need to be made in a few minutes or less. The hypothesis presented is that matching treatment strategies, with or without formal hypnosis, to hypnotic capacity and mind style can increase respectful care and efficacy of treatment outcome. Clinical examples will illustrate this approach to enhance recovery, morale, and maximize patients' ability to become active partners on their own behalf.

Albert Einstein College of Medicine, USA. mgreenleafphd@aol.com

In 1844, an obscure and little-remembered American theorist, A. Yorke (no further identification is available), published a theory of mesmerism based on absorption, i.e., mental concentration. Unlike Mesmer's conceptualization of animal magnetism as a biological fluid, however, Yorke's theory emphasized the psychological importance of the mutual interaction between mesmerist and subject. This paper discusses the latter's theory of absorption as an important development in neo-mesmerism, the circumstances that led him to his conclusions, and his role in advancing our knowledge of the historical origins of modern hypnosis.

George Washington University, School of Medicine and Health Sciences, Washington, DC 20036, USA. melgra@verizon.net

Department of Anesthesiology and Pain Clinic, University of Liege, Sart Tilman, Belgium.

The neural mechanisms underlying hypnosis and especially the modulation of pain perception by hypnosis remain obscure. Using PET we first described the distribution of regional cerebral blood flow during the hypnotic state. Hypnosis relied on revivification of pleasant autobiographical memories and was compared to imaging autobiographical material in "normal alertness". The hypnotic state was related to the activation of a widespread set of cortical areas involving occipital, parietal, precentral, premotor, and ventrolateral prefrontal and anterior cingulate cortices. This pattern of activation shares some similarities with mental imagery, from which it mainly differs by the relative deactivation of precuneus. Second, we looked at the anti-nociceptive effects of hypnosis. Compared to the resting state, hypnosis reduced pain perception by approximately 50%. The hypnosis-induced reduction of affective and sensory responses to noxious thermal stimulation were modulated by the activity in the midcingulate cortex (area 24a'). Finally, we assessed changes in cerebral functional connectivity related to hypnosis. Compared to normal alertness (i.e., rest and mental imagery), the hypnotic state, significantly enhanced the functional modulation between midcingulate cortex and a large neural network involved in sensory, affective, cognitive and behavioral aspects of nociception. These findings show that not only pharmacological but also psychological strategies for pain control can modulate the cerebral network involved in noxious perception.

This paper clears up some misunderstandings of Woodard's Phenomenological and Perceptual Research Methodology presented by Beshai in a recent critique. Beshai's critique helps demonstrate and validate a number of themes in Woodard's Perceptually Oriented Hypnosis. First, for each of us, our historical learnings provide the basis for scientific progress but at the same time may impede new views and even a more comprehensive understanding of hypnosis. Second, hypnosis is fundamentally a process of differentiating personal meanings that can be vastly different for various individuals. Third, Beshai uses a quantitatively based approach to understanding phenomenon different from Woodard's qualitative research process. Last, holistic understanding of hypnosis is impeded when aspects of the phenomenal field are taken quantitatively out of context.

Woodard Hypnosis and Research, Inc, USA. Fredwoodard@aol.com

The symptoms of medical illness often speak through eloquent, embedded metaphors that express deeper unconscious conflicts and meanings. Therapeutic attunement to the multilayered issues associated with a patient's illness can be instrumental in the uncovering and working through conflicts that may impede both physical and emotional healing. Among hypnotically facilitated psychotherapeutic approaches that can be helpful, ego state techniques offer rapid access to these illness-associated issues. This article discusses six different ego states that are key players in the illness drama for many patients. Five of these are indwelling components of the patient's psyche, whereas the sixth player belongs to the therapist's resonant self. All of them are relevant when the practitioner seeks to facilitate deeper healing in patients with mind/body conditions.

McLean Hospital, Harvard Medical School, Boston, Massachusetts, USA. carol_ginandes@hms.harvard.edu

The authors propose that hypnosis and mindfulness-based approaches can be used in tandem to create adaptive response sets and to deautomatize maladaptive response sets. They summarize recent research on the effectiveness of mindfulness-based approaches in clinical and nonclinical contexts and propose that the cognitive underpinnings of mindfulness approaches can be conceptualized in terms of the metacognitive basis of mindful attention, Toneatto's elucidation of the Buddhist perspective on cognition, and Kirsch and Lynn's response-set theory. They also suggest that mindfulness can serve as a template for generating an array of suggestions that provides cognitive strategies to contend with problems in living and to ameliorate stress and negative affect more generally. Many of the ideas the authors advance are speculative and are intended to spur additional research and clinical work.

Psychology Department, State University of New York at Binghamton, Binghamton, New York 13905, USA. slynn@binghamton.edu

Tonic immobility (TI), also known as death feigning or animal hypnosis, is a reversible state of motor inhibition that is not only triggered by postural inversion and/or movement restraining maneuvers but also by repetitive stimulation and pressure on body parts. Evidence has demonstrated that the basolateral nucleus of the amygdala (BLA) is particularly associated with defensive behavior that involves the emotional states of fear and anxiety. In addition, some reports have demonstrated that serotonin (5-HT) released in the amygdala is increased during states of stress and anxiety, principally in the BLA. In the present study, we investigated the effects of serotonergic activation of the BLA on the duration of TI. The results showed that the microinjection of 5-HT (3.0 microg) into the BLA decreased the duration of TI. Similarly, the administration of a 5-HT1A agonist (0.1 microg of 8-hydroxy-dipropylaminotretalin) or 5-HT2 agonist (0.1 microg of alpha-methyl-5-HT) into the BLA reduced the TI duration. The effect of 5-HT2 agonist was reversed by pretreatment with a dose that had no effect per se (0.01 microg) of ketanserin (5-HT2 receptor antagonists) into the BLA. Moreover, the activation of 5-HT1A and 5-HT2 receptors in the BLA did not alter the spontaneous motor activity in the open field test. The results of the present study indicate that the serotonergic system of the BLA possibly produces a reduction in fear and/or anxiety that reduces the TI duration in guinea pigs, but this is not due to increased spontaneous motor activity induced by serotonergic activation, which might affect TI duration non-specifically.

Department of Morphology, Stomatology and Physiology, Dental School of Ribeirao Preto, University of Sao Paulo, 14040-904 Ribeirao Preto, SP, Brazil. christie@forp.usp.br

University of Minnesota, USA. wark@umn.edu

This review summarizes the use of hypnotic inductions while the subject is physically active, open-eyed and focused on the external environment. Research cited from several sources documents that traditional and alert inductions produce similar hypnotic susceptibility scores, but after an alert induction, subjects may report feeling more alert and in control. A case is reported of a client who was able to use such an induction to stay in alert hypnosis for an extended time, and reduce the long-standing anxiety effects of past failure. Finally, a systematic way is discussed to generate inductions that may expand the use of hypnosis to new applications.

The present paper intends to briefly review the most important concepts of the modern neuropsychology of the frontal lobes, and to relate these findings to the phenomenology usually encountered in hypnosis research and practice. The frontal lobes have been studied very intensively during the last several years and some of the results, including the syndromes described in frontal-lobe lesions and psychiatric patients, demonstrate striking similarity with hypnotic phenomena. Based on these similarities, an alternative neuropsychophysiological definition of hypnosis/suggestion is proposed, viewing hypnosis/suggestion as the process of external manipulation with frontal-lobe functions with consequent effects upon the entire brain potential of the subject.

Department of Family Medicine, School of Medicine, University of Rijeka, Rijeka, Croatia. amirmuzur@yahoo.com

To assess the association between complementary and alternative medicine (CAM) use, preventive care practices, and use of conventional medical services among adults with diabetes. RESEARCH DESIGN AND METHODS: We analyzed data on 2,474 adults with diabetes. We created an overall CAM-use category based on use of any of the following: diets, herbs, chiropractic care, yoga, relaxation, acupuncture, ayuverda, biofeedback, chelation, energy healing, Reiki therapy, hypnosis, massage, naturopathy, and homeopathy. We used multiple logistic regression to assess the effect of CAM use on preventive care practices (receipt of influenza and pneumonia vaccines) and use of conventional medical services (number of primary care and emergency department visits). STATA was used for statistical analysis to account for the complex survey design. RESULTS: A total of 48% of adults with diabetes used some form of CAM. CAM use was independently associated with receipt of pneumonia vaccination (odds ratio 1.56 [95% CI 1.26-1.94]) but not significantly associated with receipt of influenza vaccination (1.17 [0.92-1.48]). CAM use was independently associated with visiting the emergency department (1.34 [1.06-1.70]), having six or more primary care visits (1.44 [1.14-1.83]), and having eight or more primary care visits (1.66 [1.22-2.25]). CONCLUSIONS: In contrast to the findings of previous studies, CAM use appears to be associated with increased likelihood of receipt of preventive care services and increased emergency department and primary care visits. CAM use may not be a barrier to use of conventional medical services in adults with diabetes.

Department of Medicine, Division of General Internal Medicine, Medical University of South Carolina, 135 Cannon St., Suite 403, Charleston, South Carolina 29425, USA.

Highly hypnotizable participants were given a posthypnotic suggestion to feel a flash of disgust whenever they read an arbitrary word. They were then asked to rate moral transgressions described in vignettes that either did or did not include the disgust-inducing word. Two studies show that moral judgments can be made more severe by the presence of a flash of disgust. These findings suggest that moral judgments may be grounded in affectively laden moral intuitions.

ational Institutes of Health, Bethesda, Maryland 20892, USA. wheatley@nih.gov

The role of alterations in mismatch negativity (MMN) in hypnosis was examined by recording MMN of the auditory ERP at frontal (F3, Fz, and F4) and mastoid (M1 and M2) placements. Frontal MMN is believed to reflect activity in right anterior cortical generators, whereas MMN at mastoid leads reflects generators located bilaterally in the temporal auditory cortex. MMN recordings were obtained in 11 low and 12 high hypnotically susceptible participants in three successive blocks; pre-hypnosis, hypnosis and post-hypnosis. Frontal (but not temporal) MMN showed a significant quadratic trend across testing conditions. It increased during hypnosis and then dropped post-hypnosis for both susceptibility groups. Linear trends for frontal and temporal MMN showed directly opposite patterns of change in the interaction between hypnotic susceptibility and testing blocks. Frontal MMN built up linearly over the test blocks in high relative to low susceptibility participants. Temporal MMN showed the reverse pattern and increased linearly across test conditions in those with low relative to high hypnotic susceptibility.

Imperial College London, UK. gjamieso@pobox.une.edu.au

This article studies the problem of controlling the drug administration during an anesthesia process, where muscle relaxation, analgesia, and hypnosis are regulated by means of monitored administration of specific drugs. On the basis of a seventh-order nonlinear pharmacokinetic-pharmacodynamic representation of the hypnosis process dynamics, a cascade (master/slave) feedback control structure for controlling the bispectral index (BIS) is proposed. The master controller compares the measured BIS with its reference value to provide the expired isoflurane concentration reference to the slave controller. In turn, the slave controller manipulates the anesthetic isoflurane concentration entering the anesthetic system to achieve the reference from the master controller. The advantage of the proposed cascade control structure with respect to its noncascade counterpart is that the former provides operation protection against BIS measurement failures. In fact, under a BIS measurement fault, the master control feedback is broken and the slave controller operates under a safe reference value. Extensive numerical simulations are used to illustrate the functioning of the proposed cascade control structure.

Programa de Investigacion en Matematicas Aplicadas y Computacion, Instituto Mexicano del Petroleo, Lazaro Cardenas 152, Col. San Bartolo Atepehuacan, CP 07730 Mexico. hpuebla@imp.mx

This paper presents phenomenological research conducted following Woodard's phenomenological and perceptual research methodology for understanding hypnotic experiencing. The research emphasizes examining the internal experiencings of individuals involved in hypnotic experiencing. Examples are presented of Individual Situated Structures and the General Structures from both a group of 8 participants who hypnotized their clients and another group of 17 individuals who volunteered to be hypnotized. The explicated themes identified in hypnotic experiencing (the hypnotic relationship, phenomenology of trance, use of imagination, problem with psychic energy, a gestalt of experiencing, and linear-nonlinear experiencing) are discussed. The author discusses limitations of this study and suggestions for further work.

Woodard Hypnosis and Research, Inc., Milford, New Hampshire, USA. Fredwoodard@aol.com

The critical aspects of recognizing that hypnotic responses are part of everyday life for those who are hypnotizable are considered. The failure of the American Psychological Association (APA) definition to include spontaneous hypnosis is discussed along with the resultant implications for misinforming clinicians, researchers and the public.

Washington State University, P.O. Box 642136, Pullman, WA 99164-2136, USA. arreed_barabasz@wsu.edu

The authors argue that the new definition of hypnosis by Division 30 of the American Psychological Association contains questionable information about the role of imagination in hypnosis, about the use versus omission of the word hypnosis in inductions, and about the nature of individual differences and their relation to the standardized scales. In addition, the definition appears to conflate formal and exemplar-based types of definition, and it does not seem particularly well-tuned to the interests of lay persons. The authors advance some suggestions for future definitional efforts.

Department of Psychology, University of Waterloo, 200 University Avenue, West Waterloo, Ontario, Canada N2L 3G1. ewoody@uwaterloo.ca

The APA Division 30 definition of hypnosis is laudable in some respects. For instance, the committee rightly defines the "induction" as nothing more or less than the first suggestion after the introduction. However, the definition stumbles over its nonposition on whether the word hypnosis must be uttered during the procedure. This equivocation invites research designs that preemptively define a hypnotic group and a control group in terms of whether or not the word hypnosis is used in the protocol. These designs represent a backslide into naive operationism; they reveal little new about human nature or hypnosis. The field deserves an optimally heuristic definition that preserves pluralism and is relatively resistant to the teflon shield of preemptive definition. Researchers and practioners require a definition that recognizes the incompleteness of our concepts, generates a level epistemological playing field, and enables hypnosis theories to "reach."

Psychology Department, University of Tennessee, Knoxville 37996-0900, USA. mnash@utk.edu

Whereas early studies have found moderately high agreement between self- and observer-rated scores on the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A), these studies shared a common confound in that participants were aware of being directly observed. In the present study, confederates made surreptitious observations of group participants' hypnotic responding. Following the hypnotic procedure, participants indicated whether or not they remembered each item and provided self-reports of their hypnotic response. The study assesses the accuracy of participant self-report for hypnosis items when individuals are unaware of being observed. Thirty-two percent of participants failed to recognize at least one item from the hypnosis session, suggesting that the inability to remember items is a common phenomenon. When participants reported not remembering an item, the accuracy of their self-reported response was no better than chance.

Arizona State University, Tempe, USA. Jarred.Younger@asu.edu

Normative data for the Mexican adaptation of the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C) are presented. Twenty-seven raters administered the scale to 513 Mexican volunteers. Score distribution, item analysis, and reliability of the SHSS:C are presented and compared to other international norming studies. The findings show that the Mexican adaptation of the SHSS:C has psychometric properties essentially comparable to those of the Dutch, German, Italian, and United States reference samples. However, the elevated sample mean suggests Mexicans may have an elevated ability to engage in hypnotic behavior, thus they would likely be especially good candidates for hypnotherapeutic interventions that would better the health options currently available.

Attentional Processes/Hypnosis Laboratory, Washington State University, Pullman 99164-2136, USA. omarsac@wsu.edu