Mass suggestion or mass hypnosis is relatively easy to establish in a group. The reasons for this are: (1) there is an “emotional contagion” that takes place with other members of the group; (2) persons identify with what they see; (3) the inherent competitiveness is mobilized; and (4) there is usually an intense desire to please the leader (father-figure) of the group.
The beginner should use a suggestibility test such as the handclasp method to find out which persons are likely to make the best subjects. Those whose hands stick together are asked to act as volunteers. It is also advantageous for an inexperienced operator first to induce hypnosis in one whom he has already hypnotized. This produces a favorable mind-set and is highly motivating to the rest of the group.
Following demonstration of successful hypnosis in a volunteer, the group can be hypnotized as a whole, or from six to ten persons can be taken at one time. A comfortable sitting position is preferred, as deeply hypnotized persons are likely to fall off their chairs if not carefully observed. The audience is invited to ask questions about hypnosis. This not only enlightens the individuals but also helps facilitate rapport for those who volunteer.
PRELIMINARY DISCUSSION FOR GROUP HYPNOSIS
The following is a verbatim transcript of the preliminary discussion with a group, and some of the typical questions asked of the medical hypnotist. The actual induction technic is not included, but one similar to the author's progressive relaxation technic is used. Also included is the author's technic for inducing autohypnosis.
“All of you know that hypnosis and autohypnosis are being used for group training for childbirth, obesity, and other psychotherapeutic medical conditions.
“First, understand that there are many misconceptions about hypnosis. (These, as well as everyday aspects of hypnosis, are discussed.) There are many different degrees of hypnosis. May I enlighten you to the best of my ability about these matters? Please ask any questions you have, regardless of how elementary they may seem to you.”
Q. “In autohypnosis, do I get the impression that I am inducing myself? And in such a situation, can I bring myself out of it, or is it necessary for someone else to do so?”
A. “You will always bring yourself out of autohypnosis. If you can produce it yourself, you can readily come out of it.”
Q. “What makes a person go into a hypnotic state?”
A. “It's your belief, your faith, your confidence, your willingness to cooperate with my suggestions and the attention that you pay to my words that produce the necessary susceptibility leading to hypnosis.”
Q. “Doctor, could you make me do something contrary to my moral code?”
A. “I can't make you do a single thing against your wishes.”
Q. “What do I have to do, Doctor, in order to be hypnotized? That is, besides being cooperative?”
A. “If I ask you to close your eyes, you close your eyes—not because you have to, but because you want to. If I say to you, ‘Raise your arm,’ you do not have to do it, but you raise your arm under your own control because you want to raise it. Now, why do we have you go through these simple exercises? Because hypnosis is learned exactly as you learn your ABC's in school. First, you learn simple, elementary words. You start with A … B … C. If you learn A … B … C …, then you will learn X … Y … Z. It's as simple as that.”
Q. “Are all people suggestible? Also, how does hypnosis help one to get better?”
A. “We are all suggestible. Haven't you had the experience of being told, ‘Say, you are looking bad. Are you working too hard?’ Or, if another person says, ‘Are you losing weight?’ and if a third person says, ‘You look awfully pale; are you getting enough sleep?’, you are apt to look at yourself in the mirror, be horrified by what you see, and then make an appointment with your doctor. Actually, you can be ‘salestalked’ into being healthy! And it's much better if you do it through autohypnosis—the really scientific ‘power of positive thinking.’ Here your own affirmations that you will get better are accepted uncritically, and also you can better explore the nature of your problems.”
Q. “Doctor, do you also give us medication?”
A. “Yes. Usually, if indicated, I use a comprehensive approach. Hypnotic suggestion can be combined with drugs and medical procedures. A combined approach is better than either alone.”
Q. “Once I'm hypnotized, will I know everything that is happening?”
A. “You are always in control. You will remember everything you say unless a loss of memory for specific events is produced.”
Q. “What is the difference between entertainment and medical hypnosis?”
A. “The stage hypnotist makes it appear as if he induces the hypnosis. The medical hypnotherapist knows that the patient really induces the hypnosis. Also, medical hypnosis is used for serious purposes, so naturally you will not be made to bark like a dog or perform other ‘shenanigans,’ as in entertainment hypnosis.”
Q. “Suppose you have a problem that requires the use of autohypnosis. Can I still perform my normal duties afterward?”
A. “Yes, an individual can perform his normal duties and often can carry them out more effectively after posthypnotic suggestions.”
Q. “Why not use suggestion instead of hypnosis? What is the difference?”
A. “Performance can be enhanced by hypnosis. Sometimes it is difficult to determine where suggestion ends and hypnosis begins. Between halves, a good football coach gives a strong pep talk that inspires the players. This is a mild form of hypnosis. Hypnosis is the acme of scientifically applied suggestion. However, I can't promise you that hypnosis is going to change your attitudes toward a given problem, but let us assume that you are only 10 per cent better. This is still 10 per cent better than nothing, is it not?”
Q. “Does one go to sleep at all during hypnosis?”
A. “No, you do not. Under hypnosis, you are more alert and better able to follow all suggestions because you are concentrating.”
Q. “Why is hypnosis more effective than ordinary persuasion?”
A. “The purpose of hypnosis is to get an individual to respond with a pinpoint literalness. If you can get another person's attention just as a good orator or entertainer does, then the other person can be influenced by what you say because he does not realize that he is being persuaded. Otherwise he would have his guard up. This is the technic of an effective salesman. He get his suggestions through without you realizing that you are being given a ‘soft sell.’ This is the reason why hypnosis is more effective than strong persuasion.”
Q. “Could I not use my will power instead of hypnosis?”
A. “No. Hypnosis is better than will power; it uses the imagination. You can't will yourself into salivating or ‘goose-pimpling,’ but you can salivate or develop goosepimples if you can imagine the experiences or memories which once produced such responses. A fundamental law of hypnotism is that you can't beat the will. You can't will yourself into a sickness, but you can imagine yourself into or out of an emotional sickness! Hence, we always use the imagination.”
Q. “How do you account for having chronic pains when my doctor tells me it's all in my head? How is hypnosis going to help that?”
A. “Once an idea is launched in the central nervous system, it becomes like a ‘satellite’ which ‘orbits’ around the nerve pathways of the brain. Just as the rocket site for launching a rocket loses its importance and is forgotten, so is the original cause forgotten. Often a chronic discomfort is due to what is referred to as a conditioned pain pattern. The painful event which originated the response is no longer present, but its aftermath remains as a reflex. Often hypnosis can break up the chronic pain pattern by reversing or interrupting what we call a conditioned reflex.”
TECHNIC FOR GROUP HYPNOSIS
The direct technic is the best for group hypnotherapy. The levitation technic is impractical because varied responses occur with each patient. Furthermore, one might have to wait 35 or 45 minutes for the arm to levitate.
VERBALIZATION FOR GROUP AUTOHYPNOSIS
“If you all are interested in going into a nice, deep state of relaxation, get as comfortable as you can.
“Now I want you all to listen to me because I am going to show you how hypnosis can be readily induced in all who wish to follow my suggestions. (The author's progressive relaxation technic for autohypnosis, described on pages 96 and 97, is employed.)
“Now, what is the purpose of going into this state of relaxation or meditation, self-reflection, contemplation, or absorption? It is to give yourself positive, healthy, constructive suggestions in order to neutralize negative, harmful, and destructive suggestions.
“In the case of the young lady who wishes to have a delivery under hypnosis, she can imagine, ‘I'm going to look forward to having my baby with a feeling of joy and happiness. I will not have the slightest dread or fearful anticipation. It's going to be a wonderful, wonderful experience and I need not have any more discomfort than I am willing to bear. Pain-killing drugs, too, will be available if I should need them. I will not hesitate to ask my doctor for these drugs. I am not going to feel guilty in asking for them. If the hypnosis does not work, I may have to have drugs. However, I will relax and, the more I relax, the less tension I will have. And the less tension I will have, the less discomfort I will have.’ And really, childbirth is not a terrifying procedure unless you make it that way in your imagination. You can look forward to its being a beautiful experience in your imagination. It's as simple as that.
“And all of you can give yourselves positive suggestions for your own benefit. Now one more thing. While you are in this state of relaxation, it's remarkable with how much clarity and with how much precision you can think. It's almost like praying in church. It's almost like concentrating on your studying before an examination in a sound-proof room. As a result of this ‘retreat into yourselves’ right now, whatever you are thinking about is going to stick. And since you are planting ideas in your mind, you can rest assured that these eventually will become positive and constructive suggestions.
“Now, how are you going to bring yourself out of this? It's very simple. All you have to do is to count to 3. At number 1, you will say to yourself, ‘I am going to go deeper the next time that I try this.’ Number 2, ‘I am going to try to the best of my ability to follow all suggestions.’ Now in this state of introspection, reflection, meditation or contemplation (it doesn't make a bit of difference what you call it), these suggestions really stick. This is more effective than when suggestions are given while there is noise and distraction around you. When you are concentrating, tell yourself, ‘I'm going to follow suggestions to the best of my ability.’ And the third thing that you will think is, ‘I will open my eyes and feel perfectly wonderful, free from all tensions, completely relaxed.’
“There are also two other suggestions you might like to follow. And that is, when your doctor wishes to rehypnotize you, he will touch you on the right shoulder—and this will happen only with your permission—it will be your cue for re-entering hypnosis. Remember, you are always in charge. When he touches you on the right shoulder, that will be a cue for you to drop into a deep stage of relaxation. At first you will close your eyes, then let your eyeballs roll up into the back of your head, and then you will feel a real, deep state of relaxation coming over you. Not sleep, but deep relaxation or hypnosis. A touch on the left shoulder will be the signal to open your eyes. So now you have two ways to enter into hypnosis; one in which the doctor can induce it and the other in which you do it yourself. That is all there is to it.”
The author's methods of handling large groups for prenatal training are described in Chapter 36. Invariably, one-third of those who are observing the volunteers being hypnotized will be hypnotized in varying degrees themselves. They will all dehypnotize themselves when the signal is given.
Group hypnosis has been employed effectively for stutterers, alcoholics, and those afflicted with headaches. However, group hypnosis reaches its greatest potential in relieving pain in obstetric patients and in the therapy of obesity. There is no reason why it could not be utilized in dermatology and anesthesiology, especially if conducted in a hospital setting.
Autogenic training was developed some 50 years ago in Berlin by Johannes Schultz.6 He trained patients to go into self-induced hypnotic-like states. Autogenic training consists of a graduated series of mental exercises designed to produce a general psychobiologic reorganization. The resultant changes improve the individual's capacity for introspection and purposeful activity, which help to modify maladaptive behavior processes.
Schultz, as does Vogt, uses definitive bodily sensations reported by the subject during induction. Most subjects, for instance, develop an abnormally heavy sensation of the limbs and/or the body, or a warmth that diffuses through the organism, and lightness of the extremities. He suggests that the subject correlate the sensation of heaviness with muscular relaxation. Thus, the development of self-relaxation invariably produces a hypnoidal state similar to that described by Meares.4 As a prerequisite, subjects must be motivated, cooperative and capable of a certain amount of self-direction and self-control. Introspection on ideomotor and ideosensory activities is enhanced while the subject is in a relaxed position. Distracting stimuli are reduced to a minimum, and monotonic auditory stimuli are used to facilitate self-concentration; as a result, psycho-physiologic changes occur.
The posture is similar to that used for hypnotic induction. The subject leans backward in an armchair with his arms held limply at his sides or resting on his thighs; or he can slump forward or lie on his back. The eyes are closed at the start and the subject emphasizes at the very beginning, “I am very relaxed.” Then it is suggested that the subject can relax still more if he associates the thought of deep relaxation with memories of when he was actually relaxed, as, for example, the experience of dozing while sunbathing. In this way, mere words such as “relaxed” become fused into meaningful experiences. This is identical to hypnotic sensory-imagery conditioning.
After the subject attains relaxation readily, he is taught, through suggested ideosensory and ideomotor activities, to concentrate on making one arm very, very heavy. Here, too, stroking the arm facilitates a feeling of heaviness, which automatically spreads by generalization to the other arm, the lower limbs and the rest of the body. The right arm is chosen because most people are righthanded.
Schultz advises that at first this should be performed for only 10, 20, or 30 seconds at a time. Subjects described their feelings as “sleepy,” “detached,” and “dizzy.”
He terminates this relaxed state by having the subject take a deep breath, and flex and extend his arms several times in quick succession. The subject breathes deeply several times more, and then opens his eyes. The importance attached to posture, concentration, an expectant attitude, a favorable mind-set and the use of a ritualistic procedure shows that all are modifications of hypnotic technics. Systematic practice of the exercises invariably results in a graduated mastery of bodily functioning.
Autogenic training is a kind of mental gymnastics; its principles are similar to progressive relaxation,6 Yoga, Buddhist and transcendental meditation, and other ritualized practices. Benson and his co-workers use the term “the relaxation response”1,2 (see Chap. 24). The mental exercises are practiced two or three times a day. The relaxation spreads whether or not patients were informed that it would happen. Schultz's technics are rather elaborate, and the reader can study his excellent book, Autogenic Training, for the specific steps involved.6
The importance of autogenic training is that hypnotic phenomena are not a mere matter of heterosuggestion, that is, of one person suggesting certain things to another. As used clinically, hypnosis is structured around autosuggestion and heterosuggestion. Thus, when a person is in hypnosis, something happens to enable him to do a great many things which often are not suggested. One may not know what to suggest for a specific purpose. Yet some patients develop the capacity to meet their somatic needs in an autonomous fashion. With autogenic training, some people learn to develop complete anesthesia automatically without its being specifically suggested. One must remember, however, that 5 per cent or more of the population can develop some degree of anesthesia without autogenic or hypnotic training.
Schultz also demonstrated that many individuals could induce self-relaxation without the instructor's presence. As they learned to relax deeply, many became interested in sensory changes such as feelings of heaviness, coldness or warmth of the extremities. He cites data to prove that, if warmth was produced in the right arm, a rise of 1°C. occurred, as measured by a thermocouple. The other arm was unaffected. Eventually, he had subjects learn as many hypnotic phenomena as possible. When subjects were merely hypnotized, peripheral skin temperature responses to hot and cold did not vary. However, when given “method acting” instructions in another experimental session, peripheral temperature of the hand increased.5
The clinical applications of autogenic training have not been explored in this country. Schultz's method has proved to be a rational and practical psychotherapeutic modality in Europe. The method has been employed primarily as an adjunctive procedure for relief of a wide variety of psychosomatic conditions such as asthma, hypertension, ulcers, female disturbances, and numerous others. He does not claim that he can cure asthmatics simply by autogenic training. However, in conjunction with other therapeutic measures, it is indispensable in their cure.
Autogenic training is very useful in that it teaches the patient to be self-reliant and enables him to feel that he is now doing something helpful. This undoubtedly builds up the patient's self-esteem. As happens when autohypnosis is utilized, the dependency situation is minimized.
The author has been able to duplicate Schultz's results. Autogenic training has given some individuals the feeling that they have learned something with which they can externalize their tensions. It can be used not only for relaxation, but for rather involved and complicated psychotherapeutic procedures, such as relief of impotency, or as in surgery or acupunctural analgesia (see Chap. 35). Autogenic training indicates that hypnosis is more than mere suggestion. It also beautifully illustrates that hypnotic behavior is primarily a subjective experience based on the inner conviction and the expectant attitude induced by the hypnotic state. This capacity resides within every person.
Autogenic training is a rather interesting aspect of hypnotherapy, and Schultz's work is timely and provocative. For many years the author of this book had been using similar technics for autohypnosis without being aware that they were a modification of Schultz's methods. Many therapists, unfamiliar with autohypnotic technics, fail to realize that psychotherapeutic results often can be attained almost wholly as the result of the patient's own efforts. Sellers corroborated Schultz's findings, noting that the technic was useful with a wide variety of situations.7
Edmund Jacobson's3 progressive relaxation is similar to Schultz's autogenic training, and Schultz points out the similarity. Even though the “misdirection” for these methodologies is different, sensory-imagery conditioning and motivational strivings are the principal features responsible for the recoveries. Yoga employed similar technics centuries ago. The relaxation, meditation, and self-absorption produce some degree of dissociation, and the resultant cortical inhibition, similar to that which occurs in prayer, narrows the attention span to the imaginative processes. The more one responds to his own healthy mental pictures, the more likely his healthy fantasies will become healthy realities!
REFERENCES
1. Benson, H.: The Relaxation Response. New York, Morrow, 1975.
2. Benson, H., et al.: The relaxation response. Psychiatry, 37:37, 1974.
3. Jacobson, E.: Progressive Relaxation. Chicago, University of Chicago Press, 1938.
4. Meares, A.: A System of Medical Hypnosis. New York, Julian Press, 1960.
5. Peters, J.E., et al.: Peripheral skin temperature responses to hot and cold suggestions. Int. J. Clin. Exp. Hypn., 21:205, 1973.
6. Schultz, J.H., and Luthe, W.: Autogenic Training. New York, Grune & Stratton, 1959.
7. Sellers, D.J.: Teaching self-initiated control technique to individuals and a group in college. Int. J. Clin. Exp. Hypn., 22:39, 1974.