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Hypnotizability and Opinions About Hypnosis in a Clinical Trial for the

Hypnotic Control of Pain and Anxiety During Pregnancy Termination
Alexandra Dufresne a; Pierre Rainville b; Sylvie Dodin a; Patrick Barré a; Benoît Masse c; René Verreault
a
; Isabelle Marc a
a
Laval University, Québec City, Canada b University of Montréal, Montréal, Canada c Fred Hutchinson
Cancer Research Center, Seattle, Washington, USA

Online publication date: 03 December 2009

To cite this Article Dufresne, Alexandra, Rainville, Pierre, Dodin, Sylvie, Barré, Patrick, Masse, Benoît, Verreault, René
and Marc, Isabelle(2010) 'Hypnotizability and Opinions About Hypnosis in a Clinical Trial for the Hypnotic Control of
Pain and Anxiety During Pregnancy Termination', International Journal of Clinical and Experimental Hypnosis, 58: 1, 82
— 101
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 Intl. Journal of Clinical and Experimental Hypnosis, 58(1): 82–101, 2010
Copyright © International Journal of Clinical and Experimental Hypnosis
ISSN: 0020-7144 print / 1744-5183 online
DOI: 10.1080/00207140903310865

HYPNOTIZABILITY AND OPINIONS ABOUT

1744-5183
0020-7144
NHYP
Intl. Journal of Clinical and Experimental Hypnosis,
Hypnosis Vol. 58, No. 1, September 2009: pp. 0–0

HYPNOSIS IN A CLINICAL TRIAL FOR

THE HYPNOTIC CONTROL OF PAIN AND
ANXIETY DURING PREGNANCY
TERMINATION1,2
ALEXANDRA DUFRESNE
HypnotizabilityDUFRESNE
ALEXANDRA and opinions
ETabout
AL. hypnosis

Laval University, Québec City, Canada

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PIERRE RAINVILLE
University of Montréal, Montréal, Canada

SYLVIE DODIN AND PATRICK BARRÉ

Laval University, Québec City, Canada

BENOÎT MASSE
Fred Hutchinson Cancer Research Center, Seattle, Washington, USA

RENÉ VERREAULT AND ISABELLE MARC3

Laval University, Québec City, Canada

Abstract: This descriptive study evaluates the hypnoanalgesic

experience’s effect on participants’ hypnotizability and opinions
about hypnosis and identifies factors associated with hypnotizability.
Hypnotizability was assessed using the Stanford Hypnotic Suscepti-
bility Scale: Form A in 290 women 1 month after their participation in
a randomized clinical trial evaluating hypnotic intervention for pain/
anxiety versus standard care during pregnancy termination. Opin-
ions were collected before and after the intervention. The regression
model describing hypnotizability (F = 13.55; p < .0001; R2 = 0.20)

Manuscript submitted November 21, 2008; final revision accepted April 10, 2009.
1
This study was supported by Canadian Institutes of Health Research (CHIR) grant
MCT-68538, and I. Marc has a researcher award from the Fonds de Recherche en Santé
du Québec #11920.
2
We would like to thank Lucie Vaillancourt, MD, and the medical care staff and
research staff of the family-planning service for their contributions to the study, as well
as Monique de Longpré for recruiting the patients.
3
Address correspondence to Isabelle Marc, Centre Mère-Enfant, Centre hospitalier de
l’Université Laval (CHUQ), Département de pédiatrie, 2705 boul. Laurier, Local R1742,
Québec, G1V 4G2, Canada. E-mail: isabelle.marc@crsfa.ulaval.ca

82
 HYPNOTIZABILITY AND OPINIONS ABOUT HYPNOSIS 83

retained 5 variables but not the intervention group. The variable

explaining most of total variance (62.9%) was the level of perceived
automaticity/involuntariness. Opinions about hypnosis were modi-
fied by the hypnotic experience compared to standard care but were
not associated with hypnotizability. Exposure to hypnoanalgesia did
not influence hypnotizability but modifies significantly the opinions
about hypnosis. Consistent with previous findings, perceived
automaticity appears to best predict hypnotizability.

The role of a latent cognitive ability underlying the differences in

people’s hypnotic performance has been examined in many studies
(Barabasz & Perez, 2007; Benham, Woody, Wilson, & Nash, 2006;
Montgomery, DuHamel, & Redd, 2000). Findings suggest that this abil-
ity is a trait that predicts hypnotic responsiveness (Milling, Reardon, &
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Carosella, 2006). Several experimental studies pointed out that a higher

score on a hypnotizability scale (i.e., following a hypnotic induction)
results in lower pain perception following hypnotic suggestions for
pain reduction. However, many of the latest published randomized
clinical trials (RCT; Patterson & Jensen, 2003) evaluating hypnoanalge-
sia to reduce pain and anxiety during painful procedures were con-
ducted using samples without formal measurement of hypnotizability.
For example, recent RCTs reported an effect of hypnoanalgesia on pain
and anxiety for medical procedures without screening for hypnotiz-
ability prior to the procedure (Jones, Cooper, Miller, Brooks, &
Whorwell, 2006; Lang et al., 2000; Marc, Rainville, Masse, et al., 2008;
Montgomery et al., 2007; Vlieger, Menko-Frankenhuis, Wolfkamp,
Tromp, & Benninga, 2007).
The stability of hypnotizability over time is generally well acknowl-
edged. In the absence of intervention aimed at altering it, the test-retest
reliability of hypnotizability is very high and remains so over periods
as long as 25 years (Piccione, Hilgard, & Zimbardo, 1989). Sociocogni-
tive theorists explain this by the relative stability of motivations,
expectations, beliefs, attitudes, and imaginative capacity (Barber,
Spanos, & Chaves, 1974; Diamond, 1977; Kirsch, 2001). According to
this theory, some studies succeeded in increasing the level of hypnotiz-
ability moderately by modifying these sociocognitive factors
(Gorassini & Spanos, 1986). However, no study has directly examined
if an experience of clinical hypnosis may positively affect performance
in subsequent hypnotic susceptibility tests.
From January 2005 to September 2006 in an open RCT (Marc,
Rainville, Masse, et al., 2008), a total of 350 women attending a first-
trimester pregnancy termination at the family planning clinic of a large
hospital in Quebec City were randomized to receive either 20 minutes
presurgery hypnotic analgesia intervention or standard care. The trial
aimed to determine whether a hypnotic intervention is beneficial in the
 84 ALEXANDRA DUFRESNE ET AL.

management of pain and anxiety during surgical first-trimester preg-

nancy termination. Main RCT results showed that a hypnoanalgesia
intervention before and during the surgical gynecologic procedure
decreased the frequency of request for intravenous medication by more
than 22% while maintaining clinically equivalent levels of self-reported
pain and anxiety during the procedure, compared with standard care.
In clinical settings, sums of specific and less specific effects of the
hypnotic intervention interact together to achieve hypnotic response.
As part of the prior RCT, we prospectively and systematically assessed
hypnotizability 1 month after their participation in the trial. In this
descriptive study, we explore (a) the influence of the hypnotic experi-
ence on hypnotic susceptibility and (b) the influence of the hypnotic
experience on the women’s opinions about hypnosis. Secondarily, we
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examined whether hypnotic susceptibility scores varied according to

the participant’s characteristics (sociodemographic, obstetrical, and
psychological).

METHOD

Participants
The details of eligibility and intervention have been published else-
where (Marc, Rainville, Masse, et al., 2008). Participants were women
18 years old or older undergoing elective first-trimester abortion (at
gestational age of at least 6 and less than 14 weeks) having no known
psychiatric condition, taking no antidepressant therapy, having
consumed no illegal drugs the day of the surgery, or having no
contraindications to “on request” conscious sedation at recruitment in
the trial.

Procedure
Women participating in this study were randomly assigned to
either the standard-care or hypnoanalgesia group. The interventions
were standardized (Marc, Rainville, & Dodin, 2008). Women in the
hypnosis group were accompanied by a hypnotherapist and received a
hypnotic intervention 20 minutes before and during all procedures to
decrease anxiety and pain during the pregnancy termination. In the
standard group, each woman was accompanied by a nurse during the
abortion procedure. The nurse provided the usual attention and sup-
port to the patient, talking and listening, giving positive reinforcement,
reassurance, and instructions for relaxation and deep breathing but no
specific instructions for imagery or suggestions directed at decreasing
pain or anxiety. During the procedure, women of both groups had
access, on their request, to intravenous sedation. The surgical preg-
nancy termination procedure was standardized and has been
described elsewhere too (Marc et al., 2007).
 HYPNOTIZABILITY AND OPINIONS ABOUT HYPNOSIS 85

Follow-Up
As usual with pregnancy termination, approximately 1 month after
the surgery women came back to the family planning clinic for a
follow-up appointment with their physician (N = 290). On the same
day, a research assistant, trained in hypnosis and masked to the inter-
vention group, met the women to perform hypnotizability testing.

Measures
Beliefs. Before randomization and 30 minutes after the medical pro-
cedure, women filled out the Opinion About Hypnosis Scale (OAH). The
questionnaire consisted of 21 items intended to assess patients’ beliefs
about hypnosis on a 7-point Likert-type scale (Green, 2003; McConkey,
1986). According to Green, 15 of the 21 items describe hypnosis as an
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altered state of consciousness where suggestions are perceived in an

automatic and involuntary way, whereas the six remaining items (2, 3,
4, 7, 10, 20) describe hypnosis as a normal state of consciousness where
participants use their imagination in a controlled and voluntary man-
ner to create a subjective experience. Thus, to calculate a total score, the
six items noted above were reverse scored. Total score was then
obtained by summing the scores of individual items; higher total
scores meaning stronger agreement with the fact that hypnosis is an
altered state of consciousness in which participants’ experiences are
automatic and involuntary, and lower scores meaning stronger agree-
ment to the fact that hypnosis is a normal state of consciousness where
experiences are controlled and voluntary. Subgroups of items assessed
whether patients believed that (a) hypnosis is a special state of con-
sciousness (Beliefs 1–3), (b) hypnosis is dependent upon individual
ability or on the hypnotist’s ability (Beliefs 4–5), and (c) the partici-
pant’s experience is involuntary/automatic (Beliefs 6–15) and reflects
the power of the suggestions (Beliefs 16–21). For each item, partici-
pants indicated the degree to which they agreed (1 = completely disagree
and 7 = completely agree). A mean score was given for every subgroup
of items evaluated before the randomization (pre) and after the inter-
vention (post). Subsequently, the differences of these mean scores
(postintervention mean score – prerandomization mean score) was
used for further analysis.
Finally, a supplementary question, “I think I am very susceptible to
hypnosis,” was added after the 21st item and assessed on a similar
scale.
Hypnotizability. Hypnotizability was assessed at follow-up using
the Stanford Hypnotic Susceptibility Scale, Form A (SHSS:A), which
allows discrimination of the patients based on their ability to respond to
hypnotic suggestions following a hypnotic induction (Weitzenhoffer &
Hilgard, 1959). The SHSS:A is a 12-item test individually administered
 86 ALEXANDRA DUFRESNE ET AL.

according to a standardized procedure (Hilgard, 1965). Each item of

the SHSS:A is scored “pass” (= 1) or “fail” (= 0) and total score is
obtained by summing every item. Due to several motor items, the
Form A allows less discrimination for very hypnotizable persons, but
it is well correlated with Form C (r = .72) (Gay, 2007). A satisfactory
reliability of .83 has been found for the SHSS:A (Weitzenhoffer &
Hilgard, 1962).
If a participant was unable to achieve the conditions of concentra-
tion requested for the hypnotic susceptibility test, the therapist first
proposed to attempt reinducing the hypnotic state. The test was defin-
itively stopped (n = 20) if the patient did not agree to continue the test
and/or failed to respond to three consecutive items. Final scores
reflected the total number of items to which patients produced overt
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behavioral responses consistent with the suggestions.

Further, the test was briefly interrupted following Item 3 (left hand
lowering) to assess the perceived automaticity/involuntariness of the
response. The therapist asked the participant to verbally evaluate the
automaticity of her response on a scale from 0 to 10 (0 = completely
voluntary, 10 = completely automatic).

Statistical Analysis
Analysis of the beliefs. To determine if the hypnotic experience modi-
fied beliefs about hypnosis, we first examined the raw scores of each of
the 21 items of the OAH questionnaire assessed before and after the
surgical procedure. Then, we created a new variable called “the score
difference,” which represented the difference between the postinter-
vention score minus the prerandomization score of an individual for
every item. The significance of this score difference within each group
was given by the confidence interval (difference was considered not
significant if the interval comprised the value of 0). Finally, the differ-
ence between groups was assessed using a student t test comparing
the means of this score difference, applying a Bonferroni correction for
21 tests (for alpha = .05, corrected p threshold = .0024).
Subsequently, a mean score was given for every dimension of items
evaluated before the randomization (pre) and after the intervention
(post) according to the classification described in the measure section.
The differences of these mean scores (postintervention mean score –
prerandomization mean score) was used to examine whether hypnotic
susceptibility scores varied according to the participant’s changes in
beliefs.
Analysis of the hypnotizability score. The analysis of the hypnotizabil-
ity scores verified the assumption of the scores distribution by the
Shapiro-Wilks test (i.e., normality when W > .94) and a factor analysis
of the SHSS:A. Next, a univariate analysis was performed on the
continuous quantitative hypnotizability scores (Y) using generalized
 HYPNOTIZABILITY AND OPINIONS ABOUT HYPNOSIS 87

linear models with every independent variables (X) to retain only

variables associated at p < .20 to the hypnotizability scores. All socio-
demographic characteristics, measures of emotions before randomiza-
tion and during installation, measures of pain and anxiety’s
expectancies, and the mean score’s difference of the four OAH
subgroups were considered for analysis. Some modalities were
dichotomized or clustered.
Finally, a linear regression model was computed using the
backward selection method where the less significant terms were
sequentially deleted from the descriptive model of hypnotizability,
stopping at the first term that reached significance (p < .05). The
assumptions of normality, independence, and homoscedasticity were
evaluated and found to be acceptable in the regression analysis
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proposed here. Noncollinearity was examined by the variance infla-

tion factor (>10), the condition index (>30), and proportion of variance
(>.90 for at least two regression coefficients) and was not found
between variables.

RESULTS

Patients’ Characteristics
A total of 290 (83%) of the 350 women returned for the follow-up
appointment. Their characteristics were similar to those of the whole
group (N = 350) (see Table 1) (Marc et al., 2009; Marc, Rainville, Masse,
et al., 2008).

Analysis of Beliefs
Opinions about hypnosis were successfully (n = 344/347)
assessed in both groups before randomization and after the surgical
procedure as summarized in Tables 2 and 3. Several subgroups of
items showed significant changes following the intervention in the
hypnosis group while responses were highly stable in the control
group (Table 4).
The mean score difference at Question 22, “I think I am very suscep-
tible to hypnosis,” was different according to the group (hypnosis
group: 0.4, SD = 1.7; control group: 0.1, SD = 0.9; Student t p > .0379).

Analysis of the Hypnotizability Score

Hypnotizability. A total of 288 participants out of 290 (99.3%)
returned for follow-up (hypnosis group: n = 151; control group: n = 137).
Two declined to take the SHSS:A due to lack of time. The mean score
of hypnotizability in the entire sample was 7.0 (SD = 2.9) on the 0 to
12 scale (n = 288). Distribution and scores are presented in Figure 1.
The distribution of the hypnotizability scores is normal (Shapiro-
Wilks, W = .97; p < .0001).
 88 ALEXANDRA DUFRESNE ET AL.

Table 1
Patient’s Characteristics of the Whole Population (N = 347) and the Population at
Follow-Up (N = 290)

Characteristics Whole Population

Population at Follow-Up
( N = 347) (N = 290)

Age (in years)a 25.2 ± 5.8 25.2 ± 5.9

Body mass indexa 23.4 ± 4.1 23.5 ± 4.1
Ethnicity (Caucasian) 327 (94%) 274 (94%)
Marital status
Married or living with a partner 150 (43%) 118 (41%)
Living with parent 66 (19%) 59 (20%)
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Living alone 131 (38%) 113 (39%)

Years of schooling >13 228 (66%) 196 (68%)
Student† 132 (38%) 116 (40%)
Employee† 274 (79%) 230 (79%)
Emotional support is always available† 270 (77%) 226 (78%)
Illegal drug use in the past 3 months† 152 (44%) 129 (45%)
Gestational age at abortion (weeks)a 8.5 ± 1.7 8.4 ± 1.6
Woman’s own decision for abortion† 70 (20%) 58 (20%)
Feeling of pressure for abortion† 23 (7%) 21 (7%)
Self-reported verbal or physical aggression 53 (15%) 39 (14%)
in the previous 3 months†
Accompanied by a relative the day of the 305 (88%) 255 (88%)
procedure†
Gravid
1 137 (39%) 121 (42%)
2 82 (24%) 68 (23%)
≥3 128 (37%) 101 (35%)
Former abortion† 170 (50%) 134 (46%)
Hypnosis group 172 (50%) 152 (52%)
Anxiety at the beginning of surgerya 41.2 ± 29.4 39.6 ± 28.9
Pain during pregnancy termination 40.9 ± 26.7 39.5 ± 26.5
procedurea (at uterus content aspiration)
Anxiety during procedurea (at uterus 33.7 ± 27.5 32.1 ± 26.7
content aspiration)

Note. Values are numbers of patients (percentages) unless stated otherwise.

a
Mean ± SD.
†
Dichotomic variable (yes/no).

No significant difference (p > .05) was observed between the two

groups (hypnosis group: 6.8, SD = 3.1; control group: 7.1, SD = 2.8;
Student t p > .4162).
Factor analysis of the SHSS:A. The factor analysis extracted three fac-
tors (Table 5), which were the same ones extracted in a previous factor
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Table 2
Raw Scores of the 21 Items of the Opinions About Hypnosis Questionnaire Assessed Before the Randomization (Pre) and After the Intervention (Post)
(N = 347)

Belief Hypnosis (n = 172) Control (n = 175)

Prescore Postscore Prescore Postscore

1. “Hypnosis is an altered state of consciousness, quite different 4.7 ± 1.5 4.3 ± 2.1 4.5 ± 1.4 4.4 ± 1.4
from normal waking consciousness.”
2. “Hypnosis is a normal state of consciousness that simply involves 3.0 ± 1.5 2.4 ± 1.5 3.1 ± 1.3 3.3 ± 1.3
the focusing of attention.Ӡ
3. “Hypnosis only involves thinking along with and imagining the 2.8 ± 1.5 2.0 ± 1.4 2.8 ± 1.4 2.9 ± 1.3
suggestions given by the hypnotist.Ӡ
4. “The experience of hypnosis depends on the ability of the subject, 3.7 ± 1.6 3.9 ± 1.7 4.0 ± 1.5 4.0 ± 1.7
not on the ability of the hypnotist.Ӡ
5. “The experience of hypnosis depends on the ability of the hypno- 4.0 ± 1.5 4.2 ± 1.8 4.0 ± 1.4 4.0 ± 1.6
tist, not on the ability of the subject.”
6. “During hypnosis, responsive subjects experience the effects 4.6 ± 1.2 4.9 ± 1.6 4.7 ± 1.2 4.6 ± 1.1
without having to consciously try to make them happen.”
7. “During hypnosis, responsive subjects can experience the effects 3.8 ± 1.2 3.5 ± 1.6 3.8 ± 1.3 4.0 ± 1.1
only if they consciously think in a way to facilitate them.Ӡ
8. “During hypnosis, responsive subjects experience the suggested 3.9 ± 1.3 4.1 ± 1.7 4.0 ± 1.3 4.0 ± 1.3
effects as happening involuntarily.”
9. “During hypnosis, responsive subjects are aware only of what the 3.5 ± 1.6 3.1 ± 1.9 3.2 ± 1.6 3.3 ± 1.7
hypnotist is suggesting and are not aware of anything else.”
HYPNOTIZABILITY AND OPINIONS ABOUT HYPNOSIS

10. “During hypnosis, responsive subjects have a sort of double 3.5 ± 1.3 3.1 ± 1.5 3.6 ± 1.3 3.5 ± 1.2
awareness where they experience what is suggested, but also
know things that are in contradiction to the suggestion.Ӡ
(Continued)
89
 Downloaded By: [Universidad de Valencia] At: 15:54 16 March 2010

90

Table 2
(Continued)

Belief Hypnosis (n = 172) Control (n = 175)

Prescore Postscore Prescore Postscore

11. “During hypnosis, responsive subjects seem to understand 4.0 ± 1.2 4.2 ± 1.6 4.0 ± 1.3 4.1 ± 1.2
everything better.”
12. “During hypnosis, responsive subjects feel that everything 4.1 ± 1.1 4.2 ± 1.6 4.0 ± 1.2 4.1 ± 1.2
happens automatically.”
13. “During hypnosis, responsive subjects feel that time stands still.” 4.4 ± 1.3 4.9 ± 1.8 4.4 ± 1.1 4.3 ± 1.2
14. “During hypnosis, responsive subjects seem to be more than one 3.9 ± 1.3 4.2 ± 1.9 4.1 ± 1.1 3.9 ± 1.3
person, with one part experiencing things and the other part
observing them.”
15. “During hypnosis, responsive subjects are not conscious of their 3.5 ± 1.6 3.1 ± 1.8 3.3 ± 1.5 3.3 ± 1.6
surroundings.”
16. “Suggestions given during hypnosis can make subjects insensitive 4.4 ± 1.4 4.5 ± 1.8 4.5 ± 1.3 4.6 ± 1.3
to pain.”
17. “Suggestions given during hypnosis can make subjects remember 4.5 ± 1.4 3.9 ± 1.7 4.7 ± 1.5 4.5 ± 1.5
ALEXANDRA DUFRESNE ET AL.

things that they could not normally remember.”

18. “Suggestions given during hypnosis can make subjects tell the 3.8 ± 1.7 3.0 ± 1.7 3.7 ± 1.8 3.7 ± 1.7
truth about things that they would normally lie about.”
19. “Suggestions given during hypnosis can make subjects do things 3.3 ± 1.8 2.7 ± 1.8 3.4 ± 1.8 3.4 ± 1.7
that they would not normally do.”
20. “Suggestions given during hypnosis will only work if the subjects 3.1 ± 1.5 2.6 ± 1.6 2.9 ± 1.5 2.9 ± 1.3
want them to work.Ӡ
21. “Suggestions given during hypnosis cannot be resisted by 3.6 ± 1.3 3.4 ± 1.7 3.6 ± 1.4 3.7 ± 1.4
Subjects.”
†
Reverse scored.
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Table 3
Student t Test Comparisons Between the Two Groups of the Mean Score Differences (Post-Pre) (N = 347)

Belief Mean score Difference t Test p Value

(95% CI) Between Groups*
Hypnosis Control
(n = 172) (n = 175)

1. “Hypnosis is an altered state of consciousness, quite different from normal −0.37 –0.13 p = .2318
waking consciousness.” [−0.71;−0.02] [–0.32;0.06]
2. “Hypnosis is a normal state of consciousness that simply involves the −0.65 0.12 p < .0001
focusing of attention.”† [−0.90;−0.40] [–0.06;0.29]
3. “Hypnosis only involves thinking along with and imagining the sugges- −0.83 0.11 p < .0001
tions given by the hypnotist.” [–1.10;–0.56] [–0.13;0.34]
4. “The experience of hypnosis depends on the ability of the subject, not on 0.17 0.07 p = .5907
the ability of the hypnotist.”† [–0.13;0.46] [–0.14;0.28]
5. “The experience of hypnosis depends on the ability of the hypnotist, not on 0.25 0.06 p = .3187
the ability of the subject.” [–0.05;0.55] [–0.14;0.27]
6. “During hypnosis, responsive subjects experience the effects without hav- 0.36 –0.06 p = .0193
ing to consciously try to make them happen.” [0.07;0.65] [–0.28;0.15]
7. “During hypnosis, responsive subjects can experience the effects only if –0.30 –0.22 p = .6469
they consciously think in a way to facilitate them.”† [–0.57;–0.02] [–0.43;0.00]
8. “During hypnosis, responsive subjects experience the suggested effects as 0.22 0.04 p = .2934
happening involuntarily.” [–0.05;0.48] [–0.18;0.25]
9. “During hypnosis, responsive subjects are aware only of what the hypno- –0.40 0.04 p = .0434
HYPNOTIZABILITY AND OPINIONS ABOUT HYPNOSIS

tist is suggesting and are not aware of anything else.” [–0.75;–0.05] [–0.21;0.28]
10. “During hypnosis, responsive subjects have a sort of double-awareness –0.45 –0.13 p = .0595
where they experience what is suggested but also know things that are in [–0.73;–0.18] [–0.33;0.07]
contradiction to the suggestion.Ӡ
91

(Continued)
 Downloaded By: [Universidad de Valencia] At: 15:54 16 March 2010

Table 3
(Continued)
92

Belief Mean score Difference t Test p Value

(95% CI) Between Groups*

Hypnosis Control
(n = 172) (n = 175)

11. “During hypnosis, responsive subjects seem to understand everything bet- 0.24 0.10 p = .3418
ter.” [0.02;0.47] [–0.10;0.30]
12. “During hypnosis, responsive subjects feel that everything happens 0.10 0.07 p = .8306
automatically.” [–0.15;0.35] [–0.13;0.27]
13. “During hypnosis, responsive subjects feel that time stands still.” 0.44 –0.11 p = .0004
[0.18;0.70] [–0.26;0.05]
14. “During hypnosis, responsive subjects seem to be more than one person, 0.27 –0.22 p = .0070
with one part experiencing things and the other part observing them.” [–0.04;0.57] [–0.40;–0.04]
15. “During hypnosis, responsive subjects are not conscious of their surround- –0.37 –0.05 p = .0897
ings.” [–0.68;–0.06] [–0.26;0.17]
16. “Suggestions given during hypnosis can make subjects insensitive to 0.06 0.08 p = .9371
pain.” [–0.25;0.37] [–0.12;0.27]
17. “Suggestions given during hypnosis can make subjects remember things –0.60 –0.17 p = .0155
ALEXANDRA DUFRESNE ET AL.

that they could not normally remember.” [–0.88;–0.32] [–0.37;0.04]

18. “Suggestions given during hypnosis can make subjects tell the truth about –0.85 –0.02 p < .0001
things that they would normally lie about.” [–1.12;–0.58] [–0.21;0.17]
19. “Suggestions given during hypnosis can make subjects do things that they –0.60 –0.02 p = .0016
would not normally do.” [–0.88;–0.33] [–0.25;0.21]
20. “Suggestions given during hypnosis will only work if the subjects want –0.55 0.03 p = .0022
them to work.”† [–0.84;–0.26] [–0.20;0.26]
21. “Suggestions given during hypnosis cannot be resisted by subjects.” –0.23 0.13 p = .0576
[–0.51;0.05] [–0.11;0.38]

*Bonferroni correction of 0.0024.

†
Reverse scored.
 HYPNOTIZABILITY AND OPINIONS ABOUT HYPNOSIS 93

Table 4
Mean Scores of Every Belief Dimensions (N = 290)

Belief Hypnosis (n = 172) Control (n = 175)

Prescore Postscore Prescore Postscore

Total score* 80.2 ± 11.0 76.0 ± 14.2 80.2 ± 10.8 80.0 ± 11.5
Subgroup
Altered state (items 1–3)** 10.5 ± 2.0 8.6 ± 3.1 10.4 ± 2.6 10.5 ± 2.4
Ability (items 4–5) 7.7 ± 2.6 8.1 ± 2.5 7.9 ± 2.3 8.0 ± 2.5
Experience (items 6–15) 39.2 ± 6.1 39.3 ± 9.0 39.1 ± 5.7 38.6 ± 6.3
Suggestions (items 16–21)** 22.8 ± 5.2 20.0 ± 6.0 22.7 ± 5.3 22.8 ± 5.4

*p < .01. Student t test comparing the mean score differences between groups.
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**p < .0001. Student t test comparing the mean score differences between groups.

Figure 1. Hypnotic susceptibility distribution by group as measured by the Stanford

Hypnotic Susceptibility Scale, Form A (SHSS:A) (N = 288).

analysis performed on the SHSS:A (Weitzenhoffer & Hilgard, 1959)

(ideomotor inhibition items, challenge items, and cognitive items). For
instance, items associated with a direct action suggestion, such as “fall
behind,” “eye closure,” “hand lowering,” and “hands moving together”
gathered in the same cluster. Internal consistency was a = .76. The three
 94 ALEXANDRA DUFRESNE ET AL.

Table 5
Factor Analysis of the Stanford Hypnotic Susceptibility Scale: Form A (SHSS:A)
(N = 288)

Factor Item Theoretical Cronbach

Dimension a (Raw)

1 1 “Fall Behind”
2 “Eye Closure”
3 “Hand Lowering (left)”
7 “Hands Moving Together” Challenge 0.58
items
2 4 “Immobilization (right arm)”
5 “Finger Lock”
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6 “Arm Rigidity (left arm)”

8 “Verbal Inhibition (name)”
10 “Eye catalepsy” Ideomotor 0.81
inhibition
items
3 9 “Hallucination (fly)”
11 “Post-hypnotic (changes chairs)”
12 “Amnesia” Cognitive 0.45
items

factors explained 51.9% of the total variance of the model generated by

the analysis of the 12 items. Thus, the underlying factor structure of the
SHSS:A in our study population is quite similar to the general popula-
tion studied in the Stanford University samples (Weitzenhoffer &
Hilgard, 1959).
Descriptive factors. The univariate analysis retained several factors
associated with the hypnotizability scores (Table 6). The group was not
retained in the univariate analysis (p = .4161). Also, there were no asso-
ciations between the hypnotizability score and any of the four
subgroups of belief items: Subgroup 1 – A special state of consciousness
(p = .5987), Subgroup 2 – A phenomenon depending of ability (p = .9619),
Subgroup 3 – An involuntary and automatic experience (p = .7125), Sub-
group 4 – A reflection of the power of suggestions (p = .4167).
The multiple linear regression model (Table 7) selected five vari-
ables associated together with the hypnotizability score. The strongest
association was a significant positive relationship between the
hypnotic susceptibility score and automaticity (p < .0001), which
accounted for 63% to the total variance explained by the model. The
determination coefficient of the final model was 0.20, which signified
that 20% of the total variance of the susceptibility score was explained
by our five retained variables.
 HYPNOTIZABILITY AND OPINIONS ABOUT HYPNOSIS 95

Table 6
Retained Variables at p < .20 in Univariate Analysis with Hypnotic Susceptibility
Score (N = 288)

Characteristics b p value

Age in years 0.07 p = .0226

Was a student in the previous year (no/yes) −0.62 p = .0788
Body Mass Index 0.06 p = .1468
Illegal use of drugs in the last 3 months (no/yes) −0.73 p = .0363
Regular medication (analgesics, beta-blocker) −0.91 p = .1504
(no/yes)
Woman’s own decision for abortion (partner did 1.42 p = .0009
not agree/not informed/indifferent) (no/yes)
−1.21
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Perceived pressure for abortion (no/yes) p = .0751

Self-reported verbal, physical, or psychological 1.21 p = .0168
aggression in the last 3 months (no/yes)
Have already consulted for a psychological or 0.63 p = .0833
emotional problem (no/yes)
Anxiety at the beginning of the surgery in the −0.01 p = .0913
operating room
Expectations of pain during intervention using 0.02 p = .0835
medication alone
Expectations of anxiety during intervention using 0.01 p = .1586
medication alone
PCS score −0.02 p = .2032
Score difference of the question “I think I am very 0.38 p = .0032
susceptible to hypnosis” (post vs pre)
Emotions at baseline
Frustration (no/yes) 0.79 p = .0233
Anger (no/yes) 0.78 p = .0290
Fear (no/yes) −1.06 p = .1012
Shame (no/yes) 0.61 p = .0772
Sadness (no/yes) 0.56 p = .1956
Automaticity rated following Item 3 0.51 p < .0001

Note. PCS = Pain Catastrophizing Scale.

DISCUSSION

Following an RCT evaluating hypnoanalgesia compared to standard

care in a study of 350 women, we assessed the opinions about hypno-
sis of both groups, as well as their susceptibility scores 1 month later.
Our results suggest that (a) opinions on hypnosis were modified by
the hypnotic experience during procedure but were not associated
with the susceptibility score, and (b) the previous experience with or
without hypnosis during the surgical procedure was not associated
1 month later to the level of susceptibility. Thus, in our data, the
 96 ALEXANDRA DUFRESNE ET AL.

Table 7
Descriptive Model of the Hypnotic Susceptibility Score (N = 277)

Variables b 95% CI p Value % Added

Variance

Intercept 3.45 [2.09; 4.82] p < .0001 –

Automaticity rated following 0.48 [0.34; 0.63] p < .0001 62.9
Item 3
Illegal use of drugs −0.68 [−1.30; −0.07] p = .0295 7.1
Woman’s own decision for 1.02 [0.25; 1.80] p = .0099 10.0
abortion
Anxiety at the beginning of −0.01 [−0.02; −0.00] p = .0255 7.5
the surgery in the operating
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room
Sadness at baseline 0.88 [0.11; 1.64] p = .0253 7.5

F = 13.55. p < .0001. R2 = .2000.

susceptibility score could be used eventually as a potential predictive

factor for the success of the intervention, and (c), among variables
retained in the model to explain hypnotizability, automaticity accounts
for 63% of total variance in the model.
Our results suggest that a hypnotic experience in a clinical setting
may change women’s beliefs about hypnosis, which is congruent with
the experimental study of Green (2003). In an experimental context,
Green’s study administered the OAH twice, 1 month apart, to 276
American undergraduate students. Hypnotizability was assessed 2
weeks after the first OAH testing using the Harvard Group Scale of
Hypnotic Susceptibility, Form A (Shor & Orne, 1962). Green’s results
showed that exposure to hypnosis influenced a change in every sub-
group of items in the experimental group across the two testing ses-
sions, contrary to the control group, where the mean scores remained
stable. Our results were similar, except for Subgroups 2 (ability) and 3
(experience), which remained stable across the two testing sessions in
the experimental group as well. Moreover, in contrast to Green’s uni-
versity-student sample, our findings with a patient sample showed no
association of the four subgroups of items with the hypnotizability
score in univariate analysis; therefore none of them was retained in the
final model. These subgroups evaluate how patients experienced hyp-
nosis: a special state of consciousness, a phenomenon depending on
the individual ability or the hypnotist’s ability, an involuntary and
automatic experience, and a reflection of the power of the suggestions.
Besides, we cannot exclude the possibility that assessing the
patients’ expectations about hypnosis may have introduced perfor-
mance biases and changes in opinions about hypnosis. However,
 HYPNOTIZABILITY AND OPINIONS ABOUT HYPNOSIS 97

changes in opinions were observed on only a subset of items suggest-

ing at least some specificity in the effect of the hypnotic intervention
rather than a nonspecific effect of prehypnotic expectations. Further-
more, the delay of 1 month between the questionnaire assessment and
the hypnotic susceptibility test would be expected to limit a potential
performance bias in the SHSS:A assessment.
We identified factors that describe hypnotizability in this popula-
tion of exclusively young women seeking pregnancy termination, and
the variable “intervention group” was not retained in the final model.
This suggests that having been exposed or not to a hypnotic experience
in our clinical setting does not influence women’s hypnotizability
assessed 1 month later. This is consistent with previous experimental
research showing hypnotizability to be a stable trait over time (Milling,
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2008; Piccione et al., 1989). However, these findings differ from those
of some previous studies that succeeded in increasing moderately the
level of hypnotizability by modifying sociocognitive factors (Gorassini
& Spanos, 1986). Furthermore, our standard care was very supportive,
but our results did not show that this control intervention decreased
hypnotizability as suggested by previous observations in a similar con-
text of a clinical trial (Koch et al., 2003). The delay of 1 month after the
surgical procedure and interventions in our study may account for the
lack of long-term effect of the interventions on the susceptibility score.
Finally, considering the determination coefficient of our model (.20),
we suppose that some valuable variables were not assessed during the
trial. The most contributive variable in the model to explain suscepti-
bility score was the self-reported measure of automaticity of the
response following Item 3 of the susceptibility scale (left hand lower-
ing). It is difficult to infer an entirely causal relationship between auto-
maticity and hypnotizability. Nonetheless, consistent with what is
suggested in the literature, automaticity or hypnotic involuntariness
was reported to truly characterize all direct responses to hypnotic
suggestion (Zamansky & Ruehle, 1995) and is considered to be a core
feature of hypnotic experiences (Price & Barrell, 1990; Weitzenhoffer,
1980).
In our clinical context, the specific and less specific effects of hypno-
sis were combined to achieve therapeutic effects in participants. The
hypnotic intervention was proposed to women independently of their
hypnotizability level, which was assessed only at follow-up. Our study
sample was representative of a normal distribution of hypnotizability
scores and consistent with several previous studies (Barabasz &
Watkins, 2005; Lang et al., 2000; Montgomery et al., 2000; Patterson &
Jensen, 2003), and hypnosis was effective in controlling acute pain and
anxiety. However, results of our trial are also consistent with the use of
hypnotherapy for pain and anxiety management in various clinical set-
tings, whatever a participant’s hypnotizability levels. The present
 98 ALEXANDRA DUFRESNE ET AL.

study further demonstrates that the exposure to clinical hypnosis did

not affect hypnotic susceptibility assessed 1 month later and reinforces
the notion that hypnotic susceptibility tests and clinical hypnosis may
rely on separate mechanisms. Finally, based on the results of this explor-
atory study, it would be of interest to further investigate the predictive
role of hypnotizability and automaticity. Future studies should also
assess further the potential factors predicting hypnosis efficacy on clini-
cal outcomes such as medication requests, pain perception, and anxiety.

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Hypnotisierbarkeit und Annahmen bezüglich Hypnose im Rahmen einer

klinischen Studie zur hypnotischen Schmerzkontrolle und zu Angst bei
Schwangerschaftsabbruch

Alexandra Dufresne, Pierre Rainville, Sylvie Dodin, Patrick Barré,

Benoît Masse, René Verreault und Isabelle Marc
Zusammenfassung: Diese deskriptive Untersuchung evaluiert die
Auswirkungen hypnoanalgetischer Erfahrungen auf die Hypnotisierbarkeit
von Teilnehmern sowie ihre Meinung über Hypnose. Außerdem werden
Faktoren, die mit der Hypnotisierbarkeit einhergehen, untersucht. Mithilfe
der Stanford Hypnotic Susceptibility Scale: Form A wurde die
Hypnotisierbarkeit von 290 Frauen gemessen, einen Monat nach der
 100 ALEXANDRA DUFRESNE ET AL.

Teilnahme an einer randomisierten klinischen Untersuchung, die die

Effekte eine Hypnoseintervention vs. Standardbehandlung bei Angst-/
Schmerzsymptomatik im Zusammenhang mit Schwangerschaftsabbruch
evaluierte. Das Regressionsmodell für die Hypnosefähigkeit (F = 13.55; p < .0001;
R2 = 0.20) lieferte 5 Variablen, darunter allerdings nicht der Gruppenfaktor
“Intervention”. Die Variable mit dem höchsten Anteil erklärter Varianz
(62.9%) war die Menge erlebter Automatizität/Unwillkürlichkeit.
Meinungen bezüglich Hypnose änderten sich durch die Erfahrung von
Hypnose im Vergleich mit der Standardbehandlung, die Veränderung hing
aber nicht vom Ausmaß der Hypnotisierbarkeit ab. Hypnoanalgesie
beeinflusste zwar nicht die Hypnosefähigkeit, wohl aber die Meinungen
über Hypnose. Im Einklang mit vorangehenden Befunden scheint das
Ausmaß erlebter Automatizität am besten die Hypnosefähigkeit zu
erklären.
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RALF SCHMAELZLE
University of Konstanz, Konstanz, Germany

Hypnotisabilité et opinions sur l’hypnose dans un essai clinique sur le

soulagement par hypnose de l’anxiété et de la douleur durant une
intervention volontaire de grossesse (IVG)

Alexandra Dufresne, Pierre Rainville, Sylvie Dodin, Patrick Barré,

Benoît Masse, René Verreault et Isabelle Marc
Résumé: Cette étude descriptive a permis d’évaluer l’effet de l’expérience
hypnoanalgésique sur l’hypnotisabilité des participantes et sur leur opinion
au sujet de l’hypnose, et de cerner des facteurs associés à l’hypnotisabilité.
L’hypnotisabilité des sujets a été évaluée à l’aide de l’échelle de
susceptibilité hypnotique de Stanford, formulaire A, auprès de 290 femmes,
un mois après leur participation à un essai clinique randomisé, comparant
l’intervention hypnotique avec les soins habituels dans le soulagement de la
douleur ou de l’anxiété durant une IVG. Les opinions ont été recueillies
avant et après l’intervention. Le modèle de régression décrivant
l’hypnotisabilité (F = 13,55; p < 0,0001; R2 = 0,20) a retenu 5 variables; celui du
groupe d’intervention, aucune. La variable expliquant la majorité de la
variance totale (62,9%) était le niveau perçu d’automaticité ou du caractère
involontaire de l’expérience. Les opinions en matière de comparaison de
l’expérience hypnotique avec les soins standards ont été modifiées par
l’expérience hypnotique, mais elles n’ont pas été associées à
l’hypnotisabilité. L’exposition à l’hypnoanalgésie n’a pas influencé
l’hypnotisabilité, mais elle a modifié de façon significative les opinions au
sujet de l’hypnose. L’automaticité perçue semble le mieux prédire
l’hypnotisabilité, et ces résultats correspondent à ceux de publications
précédentes.
JOHANNE REYNAULT
C. Tr. (STIBC)
 HYPNOTIZABILITY AND OPINIONS ABOUT HYPNOSIS 101

Hipnotizabilidad y opiniones acerca de la hipnosis en un estudio clínico

para el control hipnótico del dolor y la ansiedad durante
el término del embarazo

Alexandra Dufresne, Pierre Rainville, Sylvie Dodin, Patrick Barré,

Benoît Masse, René Verreault, y Isabelle Marc
Resumen: Este estudio descriptivo evalúa el efecto de la experiencia
hipnoanalgésica en la hipnotizabilidad y las opiniones acerca de la hipnosis
de los participantes y se identifican los factores asociados con
hipnotizabilidad. Evaluamos con la Escala de Susceptibilidad Hipnótica de
Stanford: Forma A la hipnotizabilidad de 290 mujeres 1 mes después de su
participación en un estudio clínico aleatorizado para evaluar la intervención
hipnótica para el dolor/ansiedad frente a la atención estándar durante la
terminación del embarazo. Recogimos las opiniones antes y después de
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la intervención. El modelo de regresión que describe a la hipnotizabilidad

(F = 13.55; p < .0001; R2 = 0.20) retuvo 5 variables, pero no el grupo de
intervención. La variable que explicó la mayor parte de la varianza total
(62.9%) fue el nivel de percibido de automaticidad/involuntariedad. Las
opiniones acerca de la hipnosis cambiaron con la experiencia hipnótica en
comparación con el cuidado estándar, pero no se asociaron con la
hipnotizabilidad. La experiencia de la hipnoanalgesia no modificó
significativamente a la hipnotizabilidad pero sí las opiniones acerca de la
hipnosis. En consonancia con resultados previos, la percepción de la
automaticidad parece predecir mejor la hipnotizabilidad.
ETZEL CARDEÑA
Lund University, Lund, Sweden