12
Role of hypnosis and self-hypnosis in cognitive-behavioral interventions The interest on hypnosis as an area of re- search, has burgeoned in the last decades at a level only comparable to that at the end of the last Century. Only lack of specific knowledge can bring about the rejection of a series of procedures that are proving to be of considerable importance as adjuncts to psychological treatments, particularly cog- nitive-behavioral ones (Lazarus, 1973; Kirsch, Montgomery, & Sapirstein, 1995). The tendency to include hypnosis within psychological treatments is prevalent in the other advanced countries (Capafons, 1995a). The rejection of hypnosis among some psychotherapists can only be explai- ned by myths and wrong beliefs (Capafons, 1998). It is also true, nonetheless, that a change in this attitude is exemplified by the prominent manuals of behavior modifica- tion published recently in Spain (e.g., Caba- llo, 1991; Labrador, Cruzado & Muñoz, 1993; Vallejo & Ruiz, 1993). They include chapters on hypnosis although, paradoxi- cally, only one is written from a cognitive- behavioral perspective, in contrast with the main approach of such manuals. Hypnosis is a very efficient way to use suggestion, but not the only one (Amigó, Psicothema, 1998. Vol. 10, nº 3, pp. 571-581 ISSN 0214 - 9915 CODEN PSOTEG Copyright © 1998 Psicothema 571 RAPID SELF-HYPNOSIS: A SUGGESTION METHOD FOR SELF-CONTROL Antonio Capafons Universitat de Valencia Auto-hipnosis rápida: un método de sugestión para el auto-control. Se describe un método estructurado de auto-hipnosis “despierta” -auto-hipnosis rápida-, creado desde una vertiente cognitivo-comportamental y validado empíricamente. Se detallan algunas de sus aplicaciones clínicas desde una perspectiva de habilidades generales de afronta- miento y auto-control. En ellas se enfatiza la utilización de las sugestiones en la vida co- tidiana, mientras la persona realiza su actividad, con los ojos abiertos y estando activo. Se evitan referencias a estados alterados de conciencia, trance o aspectos esotéricos de la hipnosis. A structured self-hypnosis method -rapid self-hypnosis- is described. This met- hod has been created from a cognitive-behavioral perspective, and has received empiri- cal validation. Some clinical applications of rapid self-hypnosis are shown from a coping skills and self-control orientation. From this perspective, the use of the method in every- day activities are emphasized. Clients can use suggestions while keeping their eyes open and being active. Mention to altered states of consciousness, trance o esoteric ideas is absolutely avoided. Correspondencia: Antonio Capafons Facultat de Psicologia Blasco Ibáñez, 21 46010 Valencia (Spain) E-mail: [email protected]

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Page 1: Hypnosis

Role of hypnosis and self-hypnosisin cognitive-behavioral interventions

The interest on hypnosis as an area of re-search, has burgeoned in the last decades ata level only comparable to that at the end ofthe last Century. Only lack of specificknowledge can bring about the rejection ofa series of procedures that are proving to beof considerable importance as adjuncts topsychological treatments, particularly cog-nitive-behavioral ones (Lazarus, 1973;Kirsch, Montgomery, & Sapirstein, 1995).

The tendency to include hypnosis withinpsychological treatments is prevalent in theother advanced countries (Capafons,1995a). The rejection of hypnosis amongsome psychotherapists can only be explai-ned by myths and wrong beliefs (Capafons,1998). It is also true, nonetheless, that achange in this attitude is exemplified by theprominent manuals of behavior modifica-tion published recently in Spain (e.g., Caba-llo, 1991; Labrador, Cruzado & Muñoz,1993; Vallejo & Ruiz, 1993). They includechapters on hypnosis although, paradoxi-cally, only one is written from a cognitive-behavioral perspective, in contrast with themain approach of such manuals.

Hypnosis is a very efficient way to usesuggestion, but not the only one (Amigó,

Psicothema, 1998. Vol. 10, nº 3, pp. 571-581ISSN 0214 - 9915 CODEN PSOTEGCopyright © 1998 Psicothema

571

RAPID SELF-HYPNOSIS: A SUGGESTIONMETHOD FOR SELF-CONTROL

Antonio CapafonsUniversitat de Valencia

Auto-hipnosis rápida: un método de sugestión para el auto-control. Se describe unmétodo estructurado de auto-hipnosis “despierta” -auto-hipnosis rápida-, creado desdeuna vertiente cognitivo-comportamental y validado empíricamente. Se detallan algunasde sus aplicaciones clínicas desde una perspectiva de habilidades generales de afronta-miento y auto-control. En ellas se enfatiza la utilización de las sugestiones en la vida co-tidiana, mientras la persona realiza su actividad, con los ojos abiertos y estando activo.Se evitan referencias a estados alterados de conciencia, trance o aspectos esotéricos dela hipnosis.

A structured self-hypnosis method -rapid self-hypnosis- is described. This met-hod has been created from a cognitive-behavioral perspective, and has received empiri-cal validation. Some clinical applications of rapid self-hypnosis are shown from a copingskills and self-control orientation. From this perspective, the use of the method in every-day activities are emphasized. Clients can use suggestions while keeping their eyes openand being active. Mention to altered states of consciousness, trance o esoteric ideas isabsolutely avoided.

Correspondencia: Antonio CapafonsFacultat de PsicologiaBlasco Ibáñez, 2146010 Valencia (Spain)E-mail: [email protected]

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1992; Capafons & Amigó, 1993a, 1993b).As with other forms of suggestion deploy-ment, it reduces the effort and time neces-sary to bring about behavioral change (Ca-pafons, 1994; Capafons & Amigó, 1995).The media, stage shows and literature haveportrayed hypnosis as a method to erase thesubject’s will. Although this «robotic por-trait» is inaccurate, patients typically ask forthis type of methods, because they are una-ware of the other types. The seminal workof Lazarus (1973) showed that fulfilling theclients’ demands and choices with regard tohypnosis enhances therapeutic results.Thus, it is advisable to apply «hypnosis»when the patient requests it, after clarifyingits possibilities, so as to avoid undesirablereactions among the clients (Capafons,1998).

Hypnosis can, however, bring about dif-ficulties when dealing with some problems.Such difficulties are mostly centered on theissues of asking patients to close their eyes,to relax, and to adopt postures conducive tosleepiness, heaviness and muscle flaccidity.The therapist often needs to have a rapidcommunication with the patient, to evaluatethe effect of suggestions and to apply somespecific therapeutic procedures (e.g., in vi-vo exposure). This kind of problemsbrought about the development of Emotio-nal Self-Regulation Therapy (Amigó, 1992;Amigó & Capafons, 1996; Capafons, 1994,1995 b; Capafons & Amigó, 1993a, 1993b).This procedures uses «waking» sugges-tions, while patients have their eyes open,are alert, and have an ongoing dialog withthe therapist.

It is clear that there are other ways to «in-duce» hypnosis, such as expanding aware-ness («hyperempiria,» Gibbons, 1979) oractive-alert methods (Bányai, Zseni, & Tú-ri, 1993l; Capafons, 1998). These methods,but particularly Bányai’s, emphasize physi-cal and mental alertness. She encouragesmuscular activity to «hypnotize» the pa-

tients, mainly using an ergonomic bicycle inwhich the patients keep on pedaling to acti-vate the body. To the extent that the patientcan open the eyes, claim Bányai et al., thepotentials of hypnosis can be best utilized.Indeed, being able to create a situation inwhich the client is open to «hypnotic» sug-gestions, without having to close the eyes orget «sleepy», extends the range of possiblesuggestions, increases the client’s motility(for role playing, in vivo exposures, etc)and, above anything else, fosters the activeparticipation of the client in effecting beha-vioral changes.

Nonetheless, the Bányai methods (Gib-bons’ hyperempiria does not solve the issueof closed eyes enough) have their difficul-ties. For instance, the requirements of an er-gonomic bicycle or a large room in whichthe patients may walk can be difficult orawkward (Capafons, 1998). In fact it wasfound that about a 30% of experimental par-ticipants drop out from the bike method(Cardeña, Alarcón, Capafons, & Bayot,1998). In addition, pedaling may be dange-rous for some patients suffering from heartillnesses. Pedaling or walking fast can pro-duce sweating or fatigue, and are difficult togeneralize to everyday life as self-hypnosismethods.

Although another method is proposed asan alternative for solving many of these pro-blems («awake-alert hypnosis», Capafons,1998), it is not thought as a self-hypnosismethod. Self-hypnosis is necessary whenthe therapist needs to generate a sense ofself-determination in the patient (as oppo-sed to be dependent on the therapist) and/orwhen additional practice in hypnosis is ne-cessary.

For all of these reasons it was proposed aprocedure that would link hypnosis to self-regulation therapy, in its sense of «wakinghypnosis». This procedure would satisfythose patients who want to be hypnotized,allowing them to be «activated» so as to fo-

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llow suggestions quickly, certainly and in aconcealed way. The purpose is to includehypnosis as one of the procedures for theactive management of stress (Denney,1983), particularly in the frame of the tea-ching of applied relaxation of Hutching,Denney, Basgall and Houston (1980). Ac-cording to the logic of these procedures, thepatient learns how to relax, usually as a va-riation of Jacobson’s (1938) progressivemuscular relaxation, so that later on the pa-tient can relax quickly in order to handlestress. The approach of Hutchings et al. al-so emphasizes the use of relaxation in thepatient’s everyday life by adapting the exer-cises to the needs of the clients so that theycan do them without anybody else noticing.In this way, the person can relax «in situ»(whenever there is a problem), which allowsfor in vivo shaping of the relaxation. Theperson will also perceive this as an activetechnique to reduce stress.

Thus, the self-hypnosis method had tofulfill the following requirements: 1) Userapid «self-hypnotizing» so as to allow it tobe maximally used in the everyday activi-ties of the clients. 2) Alongside with the pre-vious point, the exercises should be done ina «concealed» way, also keeping the eyesopen, so that they would not be noticed byothers. 3) Finally, the exercises should opti-mize the likelihood that people would havecertain experiences than could be easilythough of as «hypnotic» (Capafons, 1998;Capafons & Amigó, 1993b), while interfe-ring minimally with everyday tasks. For thisreason, the use of «goal-directed fantasy»(Spanos, 1971) should be minimized becau-se not everyone can imagine vividly and in-tensely, and vividness of imagery is nothighly correlated with the ability to respondto hypnosis.

Much of the literature on self-hypnosisis, and has been, concerned with the processof self-hypnosis, not with induction met-hods. Some examples include the work of

Ruch (1975), Fromm (Fromm & Kahn,1990), Johnson (Johnson, 1979), Brown,Forte, Rich and Epstein (1982-83), and Or-ne and McConkey (1981).

Paradoxically, self-hypnosis is systemati-cally used either as an adjunct to «hete-rohypnosis» treatments, or as the basic pro-cedure of other «hypnotic» procedures for agreat variety of alterations and problems(Ganer, 1984; Martínez-Tendero, 1995;Sanders, 1993). Nonetheless, as mentionedthere are very few structured self-hypnosisinduction methods, specially awake self-hypnotic methods. Only those of Wollman(1978) and H. Spiegel & D. Spiegel (1978)have a very detailed and structured format.The majority of these self-hypnosis induc-tion methods, including that of Spiegel &Spiegel, are variations of heterohypnoticmethods, which makes them similar. Thissimilarity carries the limitations we havementioned: closed eyes, have to practice athome in a particular context, intense use ofimagery and meditation, etc. In addition, so-me forms of self-hypnosis are just post-hyp-notic suggestions in which the client is gi-ven a cue that needs to be activated to again«enter» into the «hypnotic state.»

Only the method by H. Spiegel and D.Spiegel (1978) attempts to adapt self-hypno-sis exercises to the needs of the patient. Des-pite this, the client must keep the eyes clo-sed. Other problem are the requirements ofasking the client to roll the eyes upwards,which is difficult or bothersome for manypeople, and requesting arm levitation, whichmany people find difficult because whenthey are relaxed they feel their arms to be he-avy rather than light. Last, empirical rese-arch (Martínez-Tendero, 1995) shows that60% of the people who used the Spiegels’method needed to use their imagination toexperience a floating sensation after closingthe eyes and exhaling, and 76.6% of partici-pants were really able to have that sensation.Only 26.6% of participants were able to sen-

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se a floating sensation at the end of the pro-cedure. By the same token, it was found outthat 76.6% needed to use imagery to expe-rience arm levitation; thus, people with littleimagination have an additional burden. Furt-hermore, 74.4% of the participants did notexperience flotation, necessary, according tothe Spiegels’, to produce relaxation, and63.4% did not really show arm levitation,one important response to persuade clientsthat they are «hypnotized». Some of the par-ticipants complained about having to roll theeyes upward, as they experienced dizziness,tremor, pain in the eyes when lifting themand even headaches. Finally, 13% had diffi-culties in keeping the eyes rolled upwardswhile they lowered the eyelids.

Considering the dearth of structured self-hypnosis methods that are applicable toevery day circumstances in an unobtrusiveway, and the need to link hypnosis to self-regulation therapy, I decided to create a newprocedure that we called rapid self-hypnosis(RSH), which is now described.

The rapid self-hypnosis method (RSH)

The rapid self-hypnosis method has threevery structured steps. All of them, but parti-cularly the first two, are designed to instiga-te sensations of relaxation, heaviness andimmobility. The behaviors suggested in thismethod are ways to obtain these reactions,so that the client will not only not «doubt»that they are «tricks» but, on the contrary,will have the certainty that the exercises areindeed muscular «tricks» to get the reac-tions suggested by the therapist. This frame-works seeks to ensure the collaboration ofthe clients to promote responses to sugges-tions. The therapist must indicate that theexercises seek to obtain natural reactionsand that the clients are our allies in makingthe therapeutic suggestions work.

The Method to train self-hypnosis is ba-sed on Applied Functional Behavior Analy-

sis. It consists in shaping a behavior throughsuccessive approximations to a goal, verbalexplanations, modeling, and the chaining ofbehaviors. The various steps are taught inisolation and then they are linked, with theassumption that reinforcements are social(provided by the therapist), proprioceptive(the successful experiencing of reactions fo-llowing therapeutic suggestions) and self-administered (clients’ self-efficacy). Theability to respond is then generalized to newtherapeutic suggestions, without the needfor further shaping exercises.

The whole procedure is akin to a processof stimulus fading and generalization. Thetherapist’s instructions, the instigating exer-cises and the sensations of heaviness are fa-ded, although the last two can still be usedto maintain the habit and optimize overlear-ning, or when relaxation is needed.

Steps of rapid self-hypnosis

Before learning the steps, the therapistmust explain the logic of the method moreor less as follows: « There are many ways toinduce hypnosis very rapidly, in a matter ofseconds. We are going to use two of them. Ihave chosen them because they are very po-werful and can be used in such a way thatthey will go unnoticed in everyday life. Wewill use hand-shaking and falling back-wards (assuming that the client’s susceptibi-lity to hypnosis has been ascertained th-rough the exercises of falling backwardsand fingers-interlacing; see Capafons &Amigó, 1993a, 1993b). When I measureyour hypnotic susceptibility, we did an exer-cise in which I suggested that you wouldfall backwards, and another one in which Iasked you to interlace your fingers and no-tice a sensation of paralysis, that you couldnot separate them. Do you remember them?Well, these two exercises can be modifiedinto fast methods to induce hypnosis. Andthat is what we will do next, only now as a

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form of self-hypnosis. Don’t worry, theexercises we will practice are designed sothat you won’t fall to the floor and get hurt.»

Hand-clasping

After explaining the steps, the therapistclasps his or her hands without interlacingthe fingers and without pressing themagainst each other. The client is told that«This way is useful so that I won’t get hurtif I wear rings or jewelery. It is also helpfulwith individuals who suffer from rheuma-tism, arthritis, etc.»

Next, the therapist takes a deep breathand during the exhalation lightly presseseach hand against the other. At that mo-ment, the patient is told «Pay attention. It isvery important to just exert a light pressureas you very slowly exhale. It is not appro-priate to exhale abruptly or to use muchpressure. It is not a matter of using a lot ofpressure, but only enough to notice later onthe sensation of heaviness in the arms. Ma-king them feel tired in this exercise, it willbe easier later on to notice their heaviness aswe do an exercise of arm immobility. Slowbreathing will help us notice general sensa-tions of heaviness and relaxation. Remem-ber that we will use anything that will helpus experience those sensations. Now, I amgoing to repeat the exercise twice, withoutrelaxing the hands as I inhale (the therapistdemonstrates). You must now do the exerci-se. (the client does the exercise, as the the-rapist helps and corrects as necessary).»

It may be useful to be very clear with thepatients that with each exhalation they mustvery lightly press each hand against theother, so that by the third exhalation there isa level of pressure that is mild but strongenough to notice heaviness in the arms andhands when they are suddenly dropped onthe legs.

On the other hand, some people exhaletoo rapidly or abruptly. If the client finds it

difficult to exhale slowly, the therapist canask him/her to imagine a candle 25 cms.away from the mouth. As the client exhales,the flame must move but not go out. That ishow softly the exhalation must be. If the pa-tient cannot imagine that, or cannot exhaleslowly, the therapist can use a real candle sothat the patient will learn to move the flamewithout turning the candle out. Once thishas been achieved, it is time to continue togo to the next exercise, after verbally rein-forcing the patient: «Very good, you are le-arning very fast. This is a good sign that youcan use this method successfully. Now weare proceeding to the next step, falling back-wards.»

Falling backwards

Here the therapist models the exerciseand says the following: « I am now recli-ning into the sofa so that I will be comforta-ble. This is the position that I will be inwhen I let myself fall backwards. Next Iwill lean forward, separating my back fromthe back of the sofa some 10 cms., and thenI will let myself fall backwards, in a similarway as what I would do if I were sittingupright and I wanted to be more comforta-ble. (The therapist lets him/herself fall back-wards twice of thrice). When I do this, I no-tice a sense of muscle relaxation (by beingmore comfortable) and of momentary pa-ralysis. This light paralysis is a natural reac-tion. This is not a «hypnotic» reaction but abiological response that will help us evoke alater response, which is very important toactivate our mind and enter self-hypnosis.Now you should repeat this exercise. Youwill see that it is not difficult or uncomfor-table, but you must practice so that you canend up in a comfortable position and in sucha subtle way that no one will notice anyt-hing. (The client repeats the exercise a num-ber of times). All right, now we are going tolink both steps. Afterwards, I will give you

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some suggestions so that you can focus onsensations of heaviness and paralysis.

You know that if you do not interfere youwill notice the reactions that I will proposeto you. You will also know that if you do notlike them, you can interrupt them any timeand without difficulty, so I will ask you tocollaborate as much as possible.»

Chaining of the two steps

As with the other two, the therapist mo-dels this exercise, separating from the backof chair, shaking the hands and inhaling. Atthe moment of exhalation, the therapistlightly will press the hands against eachother and will exhale slowly. Next he or shedoes it again twice, without relieving thepressure on the hands with each inhalation,as we mentioned above. When the therapisthas finished shaking the hands with the lastexhalation, he or she abruptly lets the handsfall on the legs and the back on the back ofthe chair, while explaining to the client whatis happening.

Next, the therapist asks the client to dothe same, assisting and correcting the clientin a kind and encouraging way, while ex-plaining what reactions should be occu-rring. «As you may have seen, the hands arevery heavy, actually all of your body is hea-vier and you notice that you are lightly rela-xed. (Some people get very relaxed at thisstage; if this occurs, the therapist shouldshow surprise and indicate that this is a go-od signal of what is to come). This allow usto stimulate the reactions of the followingstep (i.e., the sensation of relaxation instiga-tes a sensation of immobility).»

If the clients indicate that they do not ex-perience anything of what we have descri-bed, we should suspect that they are interfe-ring, since the exercises are designed to letanybody experience heaviness and relaxa-tion. Martínez-Tendero has shown experi-mentally that 90% of the people that used

rapid self-hypnosis felt great heaviness, ofwhich only 43% also had to use imagery toachieve heaviness. Hence, if the patientsstate that they do not feel heaviness, the the-rapist must interrupt the session and find outwhat the problem is. It could be fear of hyp-nosis, disbelief about what the person is ex-periencing, fear of being hurt, or disap-pointment that the method is not powerfulor «esoteric» enough. Until those fears anddoubts are eliminated, the therapist shouldnot proceed to the following step (cf. Capa-fons, 1998). If the client does not succeedevent after exploring fears and inhibitions,another procedure such as emotional self-regulation or non-suggestive therapies maybe applied.

Once the client dominates the previoussequence, the therapist goes to the followingstage: body immobility.

Body immobility

«Now - says the therapist- you will re-peat the sequence you just learnt, and whenyou have “fallen backwards”, I will giveyou suggestions to feel your hands moreand more glued to your legs. When it beco-mes very difficult to separate the handsfrom the legs, or you feel so heavy and rela-xed that you feel too lazy to try to separatethem, you will have activated your mindand your brain, and you will be able to pro-duce some enriching and useful responsesto your problem. Remember that at anypoint you can interrupt those reactions.What matters here is that you may be able touse them so that you can self-administer thetherapeutic suggestions in a very efficientway, and wherever and whenever you want.Is that all right?»

Once the client has again practiced sha-king the hands and falling backwards, thetherapist begins the suggestions: «Now, clo-se the eyes, if you wish, and focus on yourhands. One or both of them will feel heavier

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and heavier, glued to the legs ... (in a slowand rhythmic voice), heavier and heavier,glued, heavier and glued, as if they were fu-sed to the legs. To help you achieve that,and if you so wish, you can use images of asoft rope that binds your hands to your legs,or of a very powerful glue that glues yourhands to your legs, or of a very heavy objectthat does not allow you to lift the hands. Ifyou notice these reactions, you will noticethat in a moment it will be very difficult tolift the hands, and they feel even more gluedto the legs. You know that, if you wish, youcan lift your hands at any point, but if youput your mind in action, if you let your brainbe sufficiently activated, you will noticethat you cannot separate your hands fromthe legs. Furthermore, the more you try toseparate them, the more difficult it will be tolift them and the more they will feel gluedto the legs. Try it and you will notice howdifficult it is to detach the hands from thelegs (the client tries to do it and »cannot«).

Very well, excellent, I notice that you areable to control your mind so that it can fo-llow your instructions. Now, focus on yourhands. They will feel lighter and lighter, andwill recover their usual sensation .. that’sright, you could separate them now. Theyare lighter and lighter . .. That’s it. I willnow count to three and you will «come out»of self-hypnosis, you will open the eyes (ifthe patient closed them) and your mind willbe active, clear, with a desire to work on theproblem, calm and relaxed. All right, 1...,2... and 3 How are you feeling?»

The percentage of people who feel thehands heavy and glued is very high: 93%were able to do it, and only 54.4% neededimagery to do it (Martínez-Tendero, 1995).This shows that the method really instigatesthe reactions and may increase suggestibi-lity, although this last point needs experi-mental corroboration.

On the other hand, some patients, afterour own experience, particularly hypotensi-

ve ones (i.e., low blood pressure) show hea-viness and sleepiness even after the «hyp-notic» situation is over. These responsesshould be attributed to the individuals’ ta-lent to use the method. Next, they aresimply asked to close their eyes and countto three. If they still have some difficulties,they should practice imagining, for instan-ce, running to catch a bus, a train, or to geta sip of water when they are very thirsty ona Summer day.

Once this motor task challenge is over,clients should be interviewed to find outtheir reactions (Capafons, 1998). This infor-mation will allow us to adapt the exercisesin future sessions to the characteristics andpreferences of the client. We have mentio-ned that a very high percentage of peoplehas the awareness of this challenge itemeven without using imagery; if such aware-ness is not present in our patients, we shouldsuspect interference or we must do otherexercises based on sensory recall to impro-ve the response to suggestions (Bayot, Ca-pafons, & Amigó, 1995).

On the other hand, clients will be toldthat it is important to repeat the method th-ree times in a row during the morning, af-ternoon and at night. Clients are also advi-sed to practice in various places, in accordwith the principle of stimulus generaliza-tion.

Finally, our research shows that our par-ticipants deem rapid self-hypnosis as so-mewhat noticeable by others. Participantsgave an average score of 4.2, in a scale from0 to 10, to the item «it is not noticed by ot-hers.» The Spiegels’ method got a score of4.1 in this same scale (Martínez-Tendero,Capafons, & Cardeña, 1996). So the partici-pants did not think that either method wascovert enough to go unnoticed by others.For that reason I added a variation in whichpatients are told that the goal is to eliminatethe steps learnt when they need to use self-hypnosis and self-administer suggestions,

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so as to decrease how noticeable the stepsare. We should remember that the goal ofrapid self-hypnosis is to give the patient amethod of self-control, to increase the senseof mastery and responsibility to self-regula-te. From this perspective, to implement apost-hypnotic signal that will increase sug-gestibility through hetero-hypnosis is notthe best solution. On the contrary, the pur-pose is to have the client use a self-adminis-tered procedure that will «enable» him/herto direct the use of hypnosis. So, the clientis told to generate a response that will workas a «signal» to initiate the suggestive abili-ties. The client is introduced to the conceptof sensory recall (Kroger & Fezler, 1976) inapproximately these terms: «When you ha-ve mastered the steps you have learnt, youwill be able to self-hypnotize in public in anever faster and unobtrusive way, becauseyou will not need to shake the hands or fallbackwards. You must only focus on one ofthe arms (the one whose hand achieved thegreatest paralysis) and you will start noti-cing how it becomes increasingly heavierand glued to the body. You are activatingyour sensory recall at that time, that is, youare turning on your capacity to reproducemany emotions, sensations, feelings and be-haviors that you have ever experienced andthat are stored in your brain (notice thatwhen one hears a song that was associatedto some event a long time ago, even if youhad not heard it for a long time, one expe-riences feelings and sensations that wereonce associated to the song even though onehad believed that those experiences had be-en forgotten). Nonetheless, our memory isnot like a tape recorder. Although memoryis not a faithful and exact recording of whathas happened, it can nonetheless preservethe important and necessary parts of our re-actions or of what occurs in the environ-ment. Sometimes, however, we store infor-mation in an involuntary way, without ourhaving any special interest in keeping speci-

fic images, feelings or emotions. Eventhough time may go by, when we listen to orsmell certain stimuli, we automatically evo-ke the reactions we associated to them. The-se reactions are not an exact copy of whatwe experienced, but they are a similar andparticularly valuable copy nonetheless. Ifthe activated or evoked reactions are distas-teful, we tend to avoid those stimuli; if theyare pleasant, we will not avoid those stimu-li but will likely try to preserve them. To ta-ke advantage of our sensory recall, we musttrain and control our mind so that it can evo-ke or reproduce (although not as a «carboncopy») the reactions (behaviors, images,sensations, emotions, etc.) that we experien-ced beforehand and that we are interested inreproducing at a particular time. To achievethis, you will not need to repeat all the stepsI have taught you. You need only focus onyour arm, and when the sensory recall of he-aviness and immobility are activated, yourarm will become heavy and immobile. Youknow that you can stop these sensations atany point. What matters is that when youfind moving it to be very difficult, you willhave activated your mind enough to start gi-ving yourself suggestions. You will be ableto keep the eyes open and hold a conversa-tion, while simultaneously being able to re-lax, become active, anesthetized, or whate-ver you need. Do you understand what I amsaying?»

Even though we are now beginning a re-search on the efficacy of these instructions,our clinical experience suggests that almostanybody can achieve that response. Whenyou have obtained arm immobility, you cando other exercises that will let the patientexperience various experiences that wewant to effect through hypnosis (e.g., rela-xation, alertness, anesthesia, changingbody temperature) so that they will be con-vinced that they are «self-hypnotized». Be-sides, by using this last chain (arm disso-ciation), we are chaining hypnosis to self-

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regulation therapy (Amigó, 1992; Capafons& Amigó, 1995). That is, we can use «hyp-notic» suggestions, without a traditionalformal «hypnotic» induction. All of this hasthe great advantage of generalizing toeveryday life what has been achieved intherapy. This really allows us to use the lo-gic of the training in applied relaxation asproposed by Hutchings et al. (1980), butwith the advantage that hypnosis increasesthe effect of cognitive-behavioral treat-ments, as found by Kirsch, Montgomeryand Sapirstein (1995).

Finally, we can use an additional proce-dure to increase the patient’s understandingof the role and usefulness of hypnosis, spe-cifically self-hypnosis. Parting from the lo-gic of training in anxiety management(Suinn, 1990) a metaphor can be designedfor helping the patients understand howthey can use self-hypnosis. Suinn reportsthat when patients are confronted with mo-derate or high stress situations that might ormight not be related to their specific fear,the patients noticeably improved throughguided practice. The patients needed tothink of relaxation as an active way to hand-le stress, and they also needed to interpretthe signs of anxiety as a discriminative sti-mulus to activate their abilities to handle thesituation. Therefore, the metaphor shouldinclude stressful scenes, so that clients canactivate their anxiety responses, and recog-nize them as cues for activating the self-hypnosis skills. Besides, the metaphor

should talk about some object that is appa-rently dangerous, but when used in a properway can help to clients to cope with pro-blems in everyday life. This object can be-come in a cue for activating these copingskills, and clients should understand thatself-hypnosis is a tool for enhance the ef-fects of effort and perseverance on the re-duction of their problems.

Conclusions

Rapid self-hypnosis is a new method thatlinks experimental research on hypnosis,made from a cognitive-behavioral perspec-tive, to clinical practice. Its aim is to impro-ve the efficiency of self-hypnosis methods,allowing to clients to activate suggestiveprocesses almost in every situation and cir-cumstance. From this point of view, rapidself-hypnosis tries to reduce the clients’ de-pendence, encouraging them to conceptuali-ze hypnosis as a general coping skill. Rapidself-hypnosis is an adjunt to psychologicalintervention that, like hypnosis, tries to en-hance their effectiveness.

Acknowledgements

The author thanks Etzel Cardeña his transla-tion of the manuscript into English and his help-ful comments in the preparation of this article.The author thanks, also, Irving Kirsch and Ste-ven J. Lynn for their comments and clarifica-tions.

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Aceptado el 24 de noviembre de 1997

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