The folly of effort: ironic effects in the mental control of pain

The cognitive demands of hypnotic response

This study tests the proposal that hypnotic responding is effortless. The authors compared the responses of high and low hypnotizable participants (N = 70) in and out of hypnosis on a dual-task paradigm in which they were required to maintain hypnotic blindness during presentation of visual stimuli of varying salience intensities while simultaneously completing a secondary task. Whereas high hypnotizable participants in both hypnosis and wake conditions reported comparable levels of conviction in the hallucination suggestion, hypnotized highs performed poorer on the secondary task when the stimulus was present. Performance on the secondary task deteriorated when the visual stimulus was intensified. These findings contradict the notion that hypnotic response is not demanding on cognitive resources and suggest that increased effort is required to resolve the extent of conflict between reality and suggestion.

Manipulations of attention enhance self-regulation

Successful goal-directed behavior requires self-regulation to override competing impulses. Emerging evidence suggests that attention may mediate such acts, but little is known about the specific operations through which attention might influence self-regulation. Here we test this often-implicit assumption by manipulating attention mechanisms in two ways: one controlling the inhibition of inappropriate responses; the other controlling the breadth of attention. Participants significantly improved their performance on a self-regulation task after practice on a response inhibition task (Experiment 1) and after the induction of a broad focus of attention in a visual discrimination task (Experiment 2). We propose that such manipulations enhance self-regulation by engaging mechanisms that enhance the salience of goal-related representations and reduce the activation of competing goal-irrelevant neural representations. By more efficiently resolving conflict among the signals vying to drive behavior, pre-engaging attention may also help to conserve resources needed for continued self-regulation.

Does the more vivid imagery of high hypnotizables depend on greater cognitive effort? A test of dissociation and social-cognitive theories of hypnosis

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.

Hypnosis and clinical pain

Hypnosis has been demonstrated to reduce analogue pain, and studies on the mechanisms of laboratory pain reduction have provided useful applications to clinical populations. Studies showing central nervous system activity during hypnotic procedures offer preliminary information concerning possible physiological mechanisms of hypnotic analgesia. Randomized controlled studies with clinical populations indicate that hypnosis has a reliable and significant impact on acute procedural pain and chronic pain conditions. Methodological issues of this body of research are discussed, as are methods to better integrate hypnosis into comprehensive pain treatment.

Thought suppression

Although thought suppression is a popular form of mental control, research has indicated that it can be counterproductive, helping assure the very state of mind one had hoped to avoid. This chapter reviews the research on suppression, which spans a wide range of domains, including emotions, memory, interpersonal processes, psychophysiological reactions, and psychopathology. The chapter considers the relevant methodological and theoretical issues and suggests directions for future research.

Clinical applications of hypnosis for brief and efficient pain management psychotherapy

This paper describes four specific clinical applications of hypnosis that can make psychotherapy for pain management briefer, more goal-oriented, and more efficient: (1) the assessment of hypnotizability; (2) the induction of hypnotic analgesia and development of individualized pain coping strategies; (3) direct suggestion, cognitive reframing, hypnotic metaphors, and pain relief imagery; and (4) brief psychodynamic reprocessing during the trance state of emotional factors in the patient's experience of chronic pain. Important theoretical and clinical issues regarding the relationship of hypnotizability to the induction of hypnotic analgesia are presented, and attempts to individualize pain treatment strategies on the basis of assessed differences in hypnotizability and patients' preferred coping strategies are described. Some ways are also presented of integrating direct hypnotic suggestion, cognitive reframing, hypnotic metaphors and imagery for alleviating the sensory and affective components of pain with an exploratory, insight-oriented, and brief psychodynamic reprocessing approach during trance for resolving unconscious sources of resistance to treatment and reducing the emotional overlay associated with chronic pain. Some basic assumptions underlying the use of this approach are discussed, and a brief step-by-step protocol is outlined.

Attentional resources in hypnotic responding

Theories of hypnotic responding differ regarding attentional processes. Predictions derived from neodissociation, dissociation control, response set, and ironic process theory were tested by administering suggestions with and without cognitive load to high suggestible participants and low suggestible simulators. Cognitive load interfered with responses to ideomotor and cognitive suggestions but not with responses to challenge suggestions. The effect of cognitive load on suggested amnesia depended on the assessment of that response. Although cognitive load decreased recall on the amnesia trial, it did so even more on recall trials before the amnesia suggestion was given and after it was canceled. These data indicate that attentional effort is required for both recall and memory suppression. Under conditions of low cognitive load, simulators displayed less recall than did nonsimulating participants during suggested amnesia, and they reported smaller subjective responses to ideomotor and challenge suggestions.