FRANKEL'S HYPOTHESIS OF A RELATION BETWEEN PHOBIC SYMPTOMS
AND HYPNOTIC RESPONSIVENESS: ITS GENERALIZATION
TO AGORAPHOBIA
THESIS
Presented to the Graduate Council of the
North Texas State University in Partial
Fulfillment of the Requirements
For the Degree of
MASTER OF SCIENCE
By
Miles Winnette
Denton, Texas
May, 1987
IMMON .0 offialolwoo, I I -, " . :-Vi" . - - --- loop =-No III go I I
Winnette, Miles, Frankel's Hypothesis of a Relation
Between Phobic Symptoms and Hypnotic Responsiveness: Its
Generalization to Agoraphobia. Master of Science (Clinical
Psychology), May, 1987, 80 pp., 12 tables, references, 48
titles.
The present study was designed to test Frankel and
Orne's hypothesis that persons with a clinically significant
phobia also show high susceptibility to hypnosis. The
hypnotic susceptibility scores of 10 persons who sought
treatment with hypnosis for agoraphobia were compared with
the susceptibility scores of a control group of 20 persons
having comparable motivation to succeed in hypnosis. The
susceptibility measure was the Stanford Hypnotic
Susceptibility Scale: Form C (SHSS:C, Weitzenhoffer &
Hilgard, 1962). The groups were also compared on: a) the
Archaic Involvement Measure (AIM; Nash, 1984); b) the Field
Depth Inventory (FDI; Field, 1965); and c) the Tellegen
Absorption Scale (TAS; Tellegen & Atkinson, 1974).
No significant differences were found between the
groups on the dependent measures. Factors which qualify the
results are discussed.
TABLE OF CONTENTS
Page
LIST OF TABLES iv
FRANKEL'S HYPOTHESIS OF A RELATION BETWEEN PHOBIC SYMPTOMSAND HYPNOTIC RESPONSIVENESS: ITS GENERALIZATIONTO AGORAPHOBIA
Introduction . . . . . . . . .
Method- - a-- - . . .
Results- - - -
Discussion
APPENDICES
REFERENCES
1
22
32
37
46
74
iii
LIST OF TABLES
Table Page
1. Mean, Standard Deviation, and Range for Each Group onthe SHSS:C, the AIM, the TAS, and the FDI . . . . 48
2. Product-Moment Correlations Between Age and Years ofEducation and each of the Four Dependent Measures--TheSHSS:C, the AIM, the TAS, and the FDI . . . . . 49
3. An Analysis of Covariance Comparing the Groupson Hypnotic Susceptibility with Years of Education asthe Covariate . . . . . . . . . . 49
4. Mean, Standard Deviation and Range for Each Group forthe Number of Fears Acknowledged on the FQ at or AboveLevel 4--"Definitely Avoid It", and for the Number ofScored Items on the PSY Scale . . . . . . . . 50
5. Mean, Standard Deviation, and Range for EachGroup for Age and Years of Education . . . . . 50
6. Mean, Standard Deviation, and Range for theOverall Sample for Age and Years of Education . . 51
7. Frequencies and Percentages for Categories basedon Gender, Marital Status, and Experience withHypnosis for Each Group . - . . . . . . . . 51
8. Frequencies and Percentages for Categories basedon Gender, Marital Status, and Experience withHypnosis for the Overall Sample . . . . . . . 52
9. Pearson Product-Moment Correlations Between theDependent Measures--The SHSS:C, the AIM, the TAS,and the FDI - - - - - - - - . . . . . 52
10. An Analysis of Covariance Comparing the Groups onHypnotic Susceptibility with the PSY Scale Scoresas the Covariate . . . . . . . . . . . 53
11. Pearson Product-Moment Correlations Between theDependent Measures--The SHSS:C, the AIM, the TAS,and the FDI for the Control Group . . . . . . 53
iv
List of Tables--Cont.
12. Pearson Product-Moment Correlations Between theDependent Measures--The SHSS:C, the AIM, the TAS,and the FDI for the Experimental Group . . . 43
V
"Aw
Page
FRANKEL'S HYPOTHESIS OF A RELATION BETWEEN PHOBIC
SYMPTOMS AND HYPNOTIC RESPONSIVENESS: ITS
GENERALIZATION TO AGORAPHOBIA
Since the 1960's reliable standardized scales have been
available to measure the behavior and experience considered
typical of hypnotized subjects. Using these scales,
researchers have established that hypnotic susceptibility is
normally distributed in the general population (Hilgard,
1965). Hypnotic susceptibility has also proved consistent
enough to be considered a stable trait (Morgan, Johnson, &
Hilgard, 1974). It is remarkable, therefore, that hypnotic
susceptibility has not been found to be associated with any
particular personality style as measured by such tests as the
Rorschach and the MMPI (Shor, Orne, & O'Connell, 1966). In
view of the failure to find personality correlates to
hypnotic susceptibility, it is surprising that Frankel and
Orne (1976) found a relationship between phobia and hypnotic
susceptibility. The impetus for their study and their
results and conclusions are described below.
Frankel (1976) noted similarities in patients' reports
of the subjective experience of phobia and that of hypnosis.
These similarities include subjective experiences in which
(a) attention narrows to particular thoughts or sensations,
and a larger orientation or awareness of the world (the
1
2
generalized reality orientation) fades (Frankel, 1980),
(b) perceptions of bodily sensations and the environment
are altered and distorted (Frankel, 1978), (c) images and
fantasies become so vivid as to be confused with the world
outside (Frankel, 1976), (d) there is dissociation, or a
split between the observing and experiencing ego, during
which the subject observes herself/himself as if at a
distance, (e) thought and behavior are experienced as
outside one's control, and (f) there is realization of
logical inconsistencies, yet they go unchallenged and the
experience continues (Frankel, 1980).
These similarities suggested to Frankel that there was
an association between phobic symptoms and hypnotizability.
In order to test this hypothesis, Frankel and Orne (1976)
administered either the Stanford Hypnotic Susceptibility
Scale: Form A (SHSS:A, Wietzenhoffer & Hilgard, 1959) or
the Harvard Group Scale of Hypnotic Susceptibility (HGS,
Shor & Orne, 1962) to 24 consecutive phobic patients
applying for treatment with hypnosis. These subjects were
matched with a control group of 24 persons seeking hypnosis
for tobacco addiction. The smokers were not psychiatric
patients and were assumed to have motivation to succeed in
hypnosis similar to that of the phobic group.
On a 13 point scale (0-12) for the SHSS:A and for the
HGS, the mean for phobics was significantly higher than the
mean for smokers (8.08 versus 6.08, respectively).
3
Polyphobics had a significantly higher mean than
monophobics (8.153 versus 7.00, respectively). Frankel and
Orne consider the latter finding to be a further link
between the occurrence of phobic symptoms and
hypnotizability. Scores on the SHSS:A or the HGS were
classified so that 8-12 was considered high susceptible, 5-
7 medium susceptible, and 0-4 low susceptible. Frankel and
Orne found that 57 percent in the phobic group were high
susceptible and 42 percent were medium susceptible. No
phobics scored in the low range of susceptibility. The
corresponding percentages for the control group were 38
percent high susceptible, 33 percent medium susceptible,
and 29 percent low susceptible. A Chi-square analysis
revealed that a significantly greater percent of phobics
scored in the high end of the distribution of hypnotic
susceptibility. These findings support the theory of an
association between phobia and hypnotic responsiveness.
Current research has sought to replicate and extend the
findings of Frankel and Orne. These studies are reviewed
below.
Gerschmann, Burrows, Reade, and Foenander (1979)
studied a sample of the first 40 consecutive persons
receiving hypnotherapy for dental phobia. The Diagnostic
Rating Scale (DRS; Orne & O'Connell, 1957, cited in
Gerschmann et. al.) was used to assess susceptibility. It
was found that 48 percent of the phobics were high
4
susceptible, 35 percent medium susceptible, and 18 percent
low susceptible. The corresponding percentages estimated
for a normative sample were 20 percent high susceptible, 60
percent medium susceptible, and 20 percent low susceptible.
A Chi-square analysis indicated that the percent of high
susceptibles was significantly higher in the phobic group.
However, Frischolz, Spiegel, Spiegel, Balma, and
Markell (1982) note that any conclusions drawn from these
findings are limited by the fact that norms for the DRS
have not been determined. In any case, it is a
questionable strategy in this research to compare a
clinical sample with a normal population as variation due
to subject motivation and experimental context is not
controlled. Also, no indication is given as to when the
phobic sample was assessed for susceptibility--before or
after treatment with hypnosis.
Foenander, Burrows, Gerschmann, and Horne (1980)
carried out a further test of Frankel's hypothesis of the
relation between phobic behavior and hypnotizability. The
subjects were 33 persons consecutively referred by medical
practitioners for treatment of phobic symptoms. Using
Frankel's classification, given above, the phobics'
distribution of susceptibility scores on the HGS was 45.55
percent high susceptible, 48.5 percent medium susceptible,
and 6 percent low susceptible. This distribution was
compared to the expected frequencies for the general
5
population which are 20 percent high susceptible, 60
percent medium susceptible, and 20 percent low susceptible.
Chi-square analysis revealed that the distribution of
susceptibility scores in the phobic group was significantly
different from that expected in the general population.
The direction of the difference was in accord with
Frankel's hypothesis. In contrast to Frankel and Orne,
however, Foenander et al. found that monophobics were
significantly more hypnotizable than polyphobics, and they
found a negative correlation between hypnotizability and
phobic behavior. The authors account for these
contradictions by suggesting that severity and type of
phobia interact to influence susceptibility scores.
The study concludes with a caution that before future
researchers draw definite conclusions regarding the
relation between phobia and hypnotizability, they should
use larger samples and more reliable methods for measuring
the type and severity of phobic behavior. As in the
.Gerschmann et al. study (1979), the internal validity of
this study is reduced because the authors do not control
for variation between groups which may arise from
differences in subject motivation and in the context in
which susceptibility was measured.
Frischolz et al. (1982) also examined the association
between phobias and hypnotic susceptibility. In addition,
they expanded their inquiry in an effort to test Frankel's
6
theory (1976) that phobics, and other high susceptible
subjects, possess a unique type of cognitive functioning
which allows greater responsiveness to stimuli such as
those involved in a hypnotic induction. Frankel and Orne
(1976) have described this functioning as a mental process
in which fantasy becomes so real as to be confused with the
external world. Frischolz et al. noted that the latter
description of this mental process was similar to accounts
of absorption. Tellegen and Atkinson (1974), for example,
described absorption as a personality trait or disposition
for having episodes of total attention that fully engage
one's representational resources. The latter authors
believe that this kind of functioning results -in a
heightened sense of the reality of the attentional object,
imperviousness to distracting events, and an altered sense
of reality in general. To measure absorption, Tellegen
devised the Tellegen Absorption Scale (TAS; Tellegen,
1976), a self-report measure of subjects' trance
experiences outside hypnosis. Frishcholz et al. employed
the TAS in their study. They reasoned that if phobics and
other high susceptible subjects were found to have
significantly more trance experiences outside hypnosis than
controls, then these results would support the idea that
the association between phobia and hypnotic susceptibility
might be the result of a cognitive process unique to highly
susceptible subjects. Frischolz et al. used the Induction
-;-mw
7
(IND) of the Hypnotic Induction Profile (HIP; Spiegel &
Spiegel, 1978) to measure hypnotic susceptibility.
Subjects were 95 phobics (54 polyphobics, 41
monophobics), 226 smokers, and 65 chronic pain patients.
Their scores were compared using a one-way ANCOVA with
symptom category as the independent variable and age as the
covariate. Age was used as a covariate because the mean
age of subjects was close to 45 years and hypnotic
susceptibility is believed to decline after the mid-
thirties. The hypothesis that phobics are high susceptible
and readily experience trance phenomena outside hypnosis
was not confirmed as no significant differences were found
between groups either on the IND or on the TAS. The mean
susceptibility scores for the polyphobics, monophobics and
smokers were 6.65, 6.61, and 6.61, respectively.
Unfortunately the authors did not indicate the range of
susceptibility scores for the IND scale.
It should be noted that there are methodological
problems which cast doubt on the validity of this study's
findings. First, the hypnotist was not blind to the
subject's group. Second, the IND is based on a multiple
scoring of the single test of arm levitation so that much
information about the subjects' hypnotic ability is lost,
and the scores lose predictive value (Hilgard & Hilgard,
1979). More germane to the present discussion,
correlations of the HIP Induction scores with scores from
8
the SHSS:A and the SHSS:C (Stanford Hypnotic Susceptibility
Scale: Form C; Weitzenhoffer & Hilgard, 1962) indicate
that only a small positive relation exists between these
measures. It is unlikely, therefore, that similar traits
are being measured by the HIP and the Stanford Scales
(Hilgard & HIlgard, 1979; Orne, Spiegel, Spiegel, Crawford,
Evans, Orne, & Frischolz, 1979). Finally, John, Hollander,
and Perry (1983) comment that the findings of this study
may be due to a "floor" effect, that is, the mean age for
each subject group exceeded 40 years, and hypnotic
susceptibility has been shown to decline in the mid-
thirties. These authors conclude that perhaps there was
not enough susceptibility left among the subjects to show a
difference.
John et al. attempted to improve on the Frischolz et
al. study by using the Stanford Scales, which allow
comparison with Frankel's results. As an additional means
of evaluating the response of the phobic sample, these
authors made an item analysis comparing the phobic pass
percentage with the item difficulty in a normative sample.
They also limited age effects by using phobics with a mean
age close to 30.
Fifty-four female small-animal phobics participated in
a treatment program designed to alleviate phobics'
symptoms. The first twenty volunteers from this group were
individually tested in small groups of 8-20 women using the
9
same tape-recorded HGS:A. Fifty-five percent of the
phobics were high susceptible, 20 percent were medium
susceptible, and 25 percent scored in the low range of
susceptibility. The corresponding percentages in the
normative sample were 29.4 percent high susceptible, 24.4
pecent medium susceptible, and 46.2 percent low
susceptible. A Chi-square analysis indicated that the
percent of high susceptibles was significantly higher in
the phobic group than in the normative sample. Increases
in item difficulty in the normative sample were accompanied
by increases in pass percentages in the phobic group,
although pass percentages were significantly different only
on items 2 and 10. The authors acknowledge that they did
not control for differences in recruitment method, context,
and samples under consideration. The study also did not
report whether hypnosis was used in the phobics' therapy.
In another study, Kelly (1984) assessed the hypnotic
susceptibility of patients seeking hypnotherapy. Of 134
patients, 22 sought hypnosis for phobias, and 112 sought
hypnosis for a variety of other complaints--most often
obesity, smoking, pain, or anxiety. Subjects' hypnotic
susceptibility was assessed on one of three measures: the
SHSS:A, the HIP, or the Stanford Hypnotic Clinical Scale
(SHCS; Morgan & HIlgard, 1975). Kelly found that 79
percent of the phobics were high susceptible, and 21
percent medium susceptible. No phobics scored in the low
10
range of susceptibility. The corresponding percentages in
the control group were 33 percent high susceptible, 48
percent medium susceptible, and 19 percent low susceptible.
A Chi-square analysis revealed that a significantly greater
percent of phobics than controls scored in the high range
of susceptibility. There are problems with this study,
however. First, subjects' scores were combined across
measures of susceptibility even though correlational
studies indicate that these scales do not measure the same
traits (Hilgard & Hilgard, 1979). Second, patient
evaluations and assessment of susceptibility were carried
out by the author alone. The latter procedure sharply
reduces the external validity of the study.
In summary, although methodological difficulties
cannot be ignored, five of the six studies to date have
indicated that phobic subjects are more susceptible to
hypnosis than controls. The present study will test the
relationship between hypnotic responsiveness and a
specific type of phobia: agoraphobia. Agoraphobia is
characterized by multiple phobias and by avoidance which
greatly reduces the individual's range of activities.
Frankel and Orne propose that the mental functioning which
produces such phobic symptoms is also responsible for
susceptibility to trance experiences. Thus, if Frankel and
Orne are correct, then the number of phobias and their
severity among agoraphobics leads us to expect that
11
agoraphobics will demonstrate considerable capacity for
this kind of mental functioning. Such well-developed
capacities should be apparent in measures of susceptibility
to hypnosis, and in measures of hypnotic depth and trance
experiences outside hypnosis. Therefore, the use of
agoraphobics in this study seems to offer the possibility
of a substantial test of Frankel and Orne's theory through
extending that theory to the complex polyphobic disorder of
agoraphobia
Epidemiology of Agoraphobia
Agoraphobia is the most disabling and distressing of
the phobic disorders, which account for two to three
percent of all psychiatric diagnoses. The distress and
extensive interference with normal activities imposed by
agoraphobia may explain why agoraphobics constitute 8
percent of the phobics at large, but make up 50 percent of
the phobics in treatment (Marks, 1969; Agras, Sylvester, &
Oliveau, 1969). Extrapolating from the incidence in a
Vermont community (6.3/1000), 1.25 million Americans suffer
from this problem (Agras et al.). Surveys indicate that
2/3 or more agoraphobics are women, the majority of whom
are married. Symptoms appear in young adults between ages
18-35, with peak ages of onset at approximately age 20 and
between ages 30-35.
12
Clinical Description
The most consistent symptom of the disorder is a
typical cluster of phobias which appear in varying
combination in any individual case. Thorpe and Burns
(1983) describe the following components: (a) Fear of
environmental situations such as (1) public places (e.g.
streets, shops, crowds), (2) enclosed spaces (e.g.
theatres, churches, elevators), (3) travel on public
transport (e.g. trains, buses, or planes), (4) travel over
bridges or into tunnels, and (5) being home alone; and
(b) fear of confinement or restriction of movement in
situations which seemingly offer no line of escape, such as
sitting in a barber's or a dentist's chair, standing in
line, sitting in a bus, or talking to a neighbor.
Onaet
The distinguishing feature of the onset of agoraphobia
is spontaneous panic attacks, which are followed by
anticipatory anxiety and phobic avoidance (Chambless &
Goldstein, 1980a; Liebowitz & Klein, 1979). The attacks
often have no clear precipitant, though it is not unusual
for agoraphobics to have a history of generalized anxiety
(Snaith, 1968). Symptoms which occur during an attack may
include feelings of unreality, the heart pounding rapidly
and heavily, generalized sweating particularly in the
palms, dryness in the mouth, feeling as if there were a
lump in the throat, stiffness in the back or neck, chest
13
pain or discomfort, trembling or shaking, feeling faint, a
choking or smothering sensation, dizziness, feeling as if
one's surroundings are whirling about, nausea or diarrhea,
and a strong urge to run or scream.
Though unexplained panics occur in social phobias and
other anxiety disorders, agoraphobics may be distinguished
by the specific consequences which they fear will occur if
they panic. These consequences include fear of losing
control, becoming confused, becoming mentally ill, having a
heart attack, being unable to reach a place of safety,
fainting in public, or being surrounded by unsympathetic
onlookers. One can link the clinical description of
agoraphobia to its onset by noting that the situations for
which agoraphobics develop phobias are ones in which it may
be difficult for them to reach a place of safety or trusted
others if a panic attack occurs. These situations often
include the possibility of being surrounded by strangers
who will not understand or accept the agoraphobic should
she/he panic.
.CUra
Following the initial panic attack, agoraphobics are
said to develop a "fear of fear", that is, they become
anxious about feeling anxious. This is because they
believe that the mental and physical symptoms of anxiety
will lead to much worse consequences. In a self-
perpetuating cycle, agoraphobics become hypervigilant to
14
anxiety cues, exaggerate the significance of bodily
sensations, and anticipate the onset of anxiety, all of
which increase the likelihood that they will experience
anxiety. In fact, many agoraphobics experience panic at
times other than on exposure to a circumscribed phobic
stimulus. Chambless (1985) has suggested that agoraphobics
may become phobic of certain physiological sensations
associated with anxiety.
Thus the problem of panic is central to the
understanding of agoraphobia. These attacks are highly
noxious unconditioned stimuli. Places, thoughts, and
feelings associated with panic quickly become anxiety
provoking themselves (Chambless, 1985). Through a process
of generalization from initial panic attacks, the disorder
may ultimately result in a housebound person who is
dependent on others for even the smallest venture outside
home. According to Marks (1969), many cases may be
shortlived, but if the phobia is untreated and persists
over a year, complete remission is unlikely.
In a national survey (Thorpe & Burns, 1983), 89.5
percent of agoraphobics reported that their symptoms
fluctuate from relapse to partial remission on a daily
basis. Also, many agoraphobics can more comfortably enter
a feared situation if they carry a certain object which
reassures them.
4".'
15
Diagnosis
Thorpe and Burns (1983) report it is conventional to
diagnose agoraphobia if the major presenting features are:
fear of leaving home, fear of crowds, confined places, and
public transport, and fear of fear. Liebowitz and Klein
(1979) point out that agoraphobia may be distinguished from
Generalized Anxiety Disorder and Panic Disorder by its
characteristic feature of avoidance of many situations due
to anticipation of panic attacks. Presence of marital
discord, low self-sufficiency, and a tendency to deal with
interpersonal conflict indirectly is said to further
substantiate the diagnosis (Thorpe & Burns, 1983) . In
addition, phobic disorders need to be differentiated from
phobic symptoms which are a minor accompaniment of another
major psychiatric disturbance. DSM III cites the following
diagnostic criteria:
(A) The individual has a marked fear of and thus
avoids being alone or in public places from which
escape might be difficult or help not available
in case of sudden incapacitation, e.g., crowds,
tunnels, bridges, public transportation.
(B) There is increasing constriction of normal
activities until the fears or avoidance behavior
dominate the individual's life.
(C) Not due to a Major Depressive Episode, Obsessive-
Compulsive Disorder, Paranoid Personality
16
Disorder, or Schizophrenia (DSM III, 1980,
p.227).
Other Complaints
Agoraphobia commonly presents in the context of
several additional complaints including depression and
interpersonal problems. For example, Buglass, Clarke,
Henderson, Kreitman, and Presley (1977) found that 93
percent of the 30 agoraphobic housewives they studied
suffered from fears and phobias apart from agoraphobia.
Fear of heights and fear of enclosed spaces were the most
common. Eighty percent of the 30 agoraphobic housewives in
Buglass et al. (1977) typically experienced free-floating
anxiety, regardless of the immediate situation. The
anxiety may be constant or may fluctuate for no apparent
reason. In the 90 phobic cases Shafar (1976) reviewed, 75
percent of the agoraphobics exhibited personality traits
harmful to the subjects' social and marital adjustment.
Nearly 1/3 of agoraphobic housewives were conspicuous for
their high level of neurotic symptoms of all kinds, and a
similar percent of cases exhibited depression (Buglass et
al., 1977).
Fifty-three percent of Buglass' subjects gave
responses indicative of hypochondriasis, though most
recognized that their symptoms were irrational. Harper and
Roth (1962) reported that 37 percent of their subjects
experienced depersonalization, that is, feeling temporarily
17
strange, unreal, dreamlike, or far away from the
environment. Briefly, the agoraphobic can be expected to
present with (a) avoidance of clearly defined situations
which have the characteristic elements of distance from a
safe person or place, crowds, and/or confinement, (b)
several additional phobic disorders, and (c) a wide range
of non-phobic symptoms including free-floating anxiety,
interpersonal conflict, and depression.
Pro lem
In studies of the relationship between hypnotic
susceptibility and phobia, researchers have used samples
composed either of a variety of different types of phobias,
or composed of a single type of simple phobia. Thus, the
question remains whether the relation between hypnotic
susceptibility and phobia can be generalized to polyphobic
disorders. Furthermore, researchers have relied primarily
on behavioral measures when testing for a relationship
between phobia and hypnotic responsiveness. Consequently,
it has not been confirmed that the relationship between
phobia and hypnotic responsiveness is also evident in the
subjective experience of the hypnotic subject. Moreover,
though there is not a consensus in the literature, several
authors (Goldstein & Chambless, 1978; Chambless &
Goldstein, 1980b; Thorpe & Burns, 1983) have described
agoraphobics as very dependent people who perceive
themselves as incapable of functioning without someone to
18
take care of them. It therefore seems likely that
agoraphobics, more than controls, would exhibit a
regressive and dependent mode of relating to the hypnotist.
Finally, Frankel and Orne believe that their findings
lend empirical support to the theory that phobics and high
susceptible subjects share a predisposition for hypnotic-
like experiences. Thus, in addition to responsiveness
during hypnosis, phobics and high susceptible subjects may
share certain traits during the waking state. For example,
Shor (1980) found that individuals with a high or medium
capacity to experience trance in hypnosis also experience
spontaneous trance-like episodes in their daily lives. If
the capacity for these experiences is related to the trait
which produces hypnotic responsiveness, then phobics could
be expected to have such experiences also.
In fact, Frankel and Orne propose that phobic symptoms
originate from spontaneous trance experiences. Phobic
symptoms are said to be generated in the following manner.
Individuals who have a capacity to readily experience
trance attempt to cope with anxiety by spontaneously
entering a trance state. This escape into trance
backfires, however, because the trance produces perceptual
distortions which actually heighten the individual's
anxiety. These cognitive distortions, and the increase in
anxiety that accompanies them, are now both associated with
the stimuli that first led the individual to feel anxious.
19
As a result, these stimuli are now feared and avoided to
such an exaggerated degree that the individual's behavior
in regard to these stimuli would be labelled "phobic" by an
objective observer.
The hypothesis that a capacity for spontaneous trance
experience plays a central role in the development of
phobic symptoms has received little attention in the
research literature however. Frischolz et al. (1982) are
the only authors who have examined phobics' experience of
trance phenomena outside hypnosis. They found no
difference between phobics and controls in the number of
different forms of spontaneous trance experience each
reported having.
Purpose
The purpose of the present study was to replicate and
extend Frankel and Orne's finding that phobics are markedly
responsive to hypnosis. First, the hypnotic
susceptibility of agoraphobics was compared to that of
control subjects seeking treatment with hypnosis for
tobacco addiction or for weight control, to see if the
relationship between hypnotic responsiveness and phobia can
be generalized to this polyphobic disorder. Second, the
trance depth of agoraphobics and controls was compared to
determine if the relationship between hypnotic
responsiveness and phobia was evident in the subjective
experience of the experimental subjects. Third,
20
agoraphobics and controls were compared on the extent to
which regressive or transference needs were projected onto
the hypnotist.
Fourth, agoraphobics and controls were compared to
ascertain if agoraphobics have more types of trance
experiences outside hypnosis. If agoraphobics have
significantly more of these experiences, and they are
highly susceptible to hypnosis, it would support the theory
that they possess a trait which may be related to hypnotic
responsiveness. Last, the present study avoids the
methodological errors of past replications by using a
comparable control group, and a standard measure of
hypnotic susceptibility. The study also controls for the
effects of age, sex, education, previous experience with
hypnosis, level of pathology, and type of phobia.
Research Ouestion
Are agoraphobics more susceptible to hypnosis than a
comparable control group?
Means of Assessment. Subjects were administered the
Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C;
Weitzenhoffer & Hilgard, 1962).
Research Hypothesis. The mean hypnotic susceptibility
score for agoraphobics will be significantly greater than
the mean susceptibility score for controls.
21
Research Question
Do agoraphobics experience greater trance depth in
hypnosis than controls? In other words, do agoraphobics
report having experienced in hypnosis more of the kinds of
subjective experiences which are considered typical of
hypnotized persons?
Means of Assessment. Subjects were administered the
Field Depth Inventory (FDI; Field, 1965) .
Research Hypothesis. The mean FDI score for
agoraphobics will be significantly greater than the mean
FDI score for controls.
Research Ouestion
Do agoraphobics experience more archaic involvement
with the hypnotist during hypnosis? Archaic involvement is
a temporary displacement, or transference, onto the
hypnotist of ". . . core personality emotive attitudes
formed in early life . . ." (Shor, 1962, p.162).
Means of Assessment. Subjects were administered the
Archaic Involvement Measure (AIM; Nash, 1984).
Research Hypothesis. The mean AIM score for
agoraphobics will be greater than the mean AIM score for
controls.
Research Ouestion
Do agoraphobics experience more forms of spontaneous
trance outside hypnosis?
22
Means of Assessment. Subjects were administered the
Tellegen Absorption Scale (TAS; Tellegen, 1976).
Research Hypothesis. The mean TAS score for
agoraphobics will be greater than the mean TAS score for
controls.
Method
Subjects
A total of 30 subjects were used in the study. Ten
were selected from clients seeking treatment with hypnosis
for agoraphobia. The other 20 subjects were selected from
non-phobic clients seeking treatment with hypnosis either
for tobacco addiction (1) , or for weight control (19).
The non-phobic clients were to provide a control group
comparable to the agoraphobic group in demographic features
and in motivation to succeed in hypnosis. Subjects were
recruited from treatment groups within community agencies.
The Psychopathology scale (PSY, Overall & Eiland,
1982) was used to screen all the subjects for severe
psychopathology. The PSY scale consists of 58 items taken
from the first 168 items of the MMPI. These 58 items were
chosen because they showed the greatest difference in
frequency of endorsement between medical school applicants
and psychiatric patients. The cut-off for severe
psychopathology on the PSY scale was a T-score of 70 which
represents the 98th percentile of the 731 medical school
applicants on whom the scale was normed. This means that
23
any control subject who endorsed more than 25 of the 58 PSY
scale items, that is, any control subject with a T-score
above 70, was excluded from the study. However, seven
agoraphobic subjects exceeded the cut-off point by anywhere
from 1 to 8 scored items. These subjects were allowed in
the study if the total number of fears they acknowledged at
or above Level 4 did not exceed twice the number of
agoraphobic fears they acknowledged at or above Level 4 on
the FQ. Thus, agoraphobic fears could be assumed to play a
major part in their symptomatology. The rationale for the
inclusion of these subjects is that it is consistent with
the current literature on this disorder that the majority
of the agoraphobic sample had PSY scale scores indicative
of severe pathology.
An abbreviated form of the Anxiety Disorders Interview
Schedule (ADIS; Dinardo, O'Brien, Barlow, Waddell, &
Blanchard, 1982) was employed to select subjects from the
agoraphobic sample who met DSM III criteria for
agoraphobia. The ADIS provides a detailed examination of
phobic symptoms. The Fear Questionaire (FQ; Marks, 1979)
was also used to test for the specific fears, phobic
avoidance, and extensive interference with everyday life
which characterize agoraphobia.
The FQ includes a list of the 15 most common phobic
stimuli. These 15 stimuli are to be rated on a 9 -point
scale (0-8) for the degree of avoidance associated with
24
each. Ratings on the scale range from 0--"would not avoid
it" to 8 -- "always avoid it." Based on data from factor
analytic studies of fear surveys, Marks (1979) proposed an
Agoraphobia Subscore consisting of 5 of the above 15 phobic
stimuli. These five items are: #5--traveling alone by
bus, #6--walking alone on busy streets, #8--going into
crowded shops, #12 --going alone far from home, and #15--
large open spaces. The items in the Agoraphobia Subscore
were used to further substantiate the diagnosis of
agoraphobia. To be included in the study, agoraphobics had
to acknowledge three or more of these five items at or
above Level 4 --"definitely avoid it" on the avoidance
scale. The final item on the FQ is a Likert-type scale onwhich subjects rate the degree of disturbance or disability
associated with their phobic symptoms. This is a 9 -point
scale (0-8) which lists increasing degrees of severity from
0--"no phobias present," to 8--"very severely
disturbing/disabling." Any agoraphobic subject who rated
the degree of their disturbance or disability less than
Level 4 -- "definitely disturbing/disabling, "was excluded
from the study. Finally, on the demographic questionnaire
agoraphobics had to report that the duration of their
phobic symptoms exceeded one year. If not, they were
excluded from the study.
The FQ was also used to screen the control group for
the presence of phobia. Phobia is defined here as rating
25
the degree of disturbance or disability associated with any
phobic-like symptoms at or above Level 4--"definitely
disturbing/disabling" on the final FQ item. The criteria
for subject selection are summarized in appendices A and B.
Instruments
Demographic Ouestionnaire. Both groups were
administered a questionnaire in order to confirm that they
were comparable on relevant demographic variables.
Information was collected on the following areas: marital
status, age, sex, income, education, duration of present
symptoms, previous experience with hypnosis, and use of
medication
Diagnostic Interview. An advanced graduate student
in psychology conducted a brief, 10 minute interview with
each agoraphobic subject. An abbreviated form of the
Anxiety Disorders Interview Schedule (ADIS; Dinardo et
al., 1982) was used to determine that these subjects met
DSM III criteria for agoraphobia.
Using excerpts from the ADIS, the interviewer obtained
a brief description of the subject's presenting complaint
and checked for the presence of phobic anxiety and panic
attacks. The interviewer asked the subject questions
regarding: any extremely stressful or traumatic event
currently affecting the client, fear or avoidance of
situations because the client might be unable to leave in
case of panic, fear/avoidance of situations in which the
26
client might be humiliated in front of others, recurrent
unreasonable or nonsensical thoughts or images, symptoms of
major depressive episode or mania, and drug abuse. Such
information allowed the interviewer to make a differential
diagnosis between agoraphobia and related anxiety
disorders, such as Social Phobia, Panic Disorder, and
Generalized Anxiety Disorder. In addition, the procedure
allowed the examiner to rule out Major Depression,
Schizophrenia, Organic Brain Syndrome, Substance Abuse,
Obsessive-Compulsive Disorder, Paranoid Personality
Disorder, and other disorders whose symptoms may resemble
those of agoraphobia.
Stanford Hypnotic Susceptibility Scale: Form C., The
Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C;
Weitzenhoffer & Hilgard, 1962) was used to assess hypnotic
susceptibility. It provided an index of subjects' unique
hypnotic abilities and provided a rigorous test of
differences in susceptibility between the agoraphobic and
the control group. It is a 12-item test with possible
scores from 0-12. Subjects' scores are classified so that
scores from 8-12 are considered high susceptible, from 5-7,
medium susceptible; and from 0-4, low susceptible.
Susceptibility is defined by the number of times the
subjects act like a hypnotized person when hypnosis is
induced by a standard procedure, and opportunities to react
are presented in a standard manner. Using the Kuder-
27
Richardson Method (Formula 20), the reliability of the
SHSS:C was estimated at .85 (Weitzenhoffer & Hilgard,
1962).
It is appropriate here to point out how the SHSS:C is
related to the Stanford Scale, the SHSS:A, which Frankel
and Orne (1976) used in their phobia research. Hilgard
(1979) has stated that the Stanford Hypnotic Susceptibility
Scale: Form A (SHSS:A; Weitzenhoffer & Hilgard, 1959) is
a standard against which other scales can be judged due to
its demonstrated reliability and validity. One shortcoming
.of this scale, however, is that it is primarily weighted
with tests of motor functions. Therefore, Weitzenhoffer &
Hilgard (1962) designed the SHSS:C to better represent
cognitive functions. Several items on the SHSS:A were thus
replaced by items which include: age-regression, hypnotic
dreaming, and positive and negative hallucinations in
several sensory areas (vision, audition, taste, and smell).
The SHSS:C is believed to measure the same ability as the
SHSS:A because total scores on the SHSS:C correlate .72
with those of the SHSS:A. In addition, their score
distributions are very similar, though the distribution of
the SHSS:C is positively skewed due to the difficulty of
the SHSS:C items.
Field Depth Inventory. The Field Depth Inventory
(FDI; Field, 1965) was used to measure subjective changes
during hypnosis. The inventory consists of true-false
128
items which are believed to reflect the typical experiences
of hypnotized subjects. From a pool of 300 items, Field
chose those 38 which correlated significantly with the
Harvard Group Scale (HGS; Shore & Orne, 1962). The odd-
even reliability of the 38 items, as corrected by the
Spearman-Brown Prophecy formula, is .915. The Pearson r
concurrent validity coefficient between HGS and the 38
items is .745. In a cross validation by the author, the
retest reliability of the inventory was .87. The validity
coefficient was .43 in the replicaton . The range of
possible scores on the inventory is from 0-38.
Archaic Involvement Measure, The Archaic Involvement
Measure (AIM; Nash, 1984) was used to assess the extent to
which the hypnotic subjects projected "transference-like"
modes of relating onto the hypnotic relationship. Twenty
items were adapted from Shor's (1979, cited in Nash, 1984)
description of subjects' reports of experiences of archaic
involvement. Each of these items is to be rated on a
Likert-type scale allowing one choice from 8 scale points
which range from (1) "I did not feel at all this way,
to (7) "I felt very strongly this way." Possible total
scores range from 20 to 140.
Nash found a Spearman-Brown reliability for the AIM of
.90, and an alpha reliability coefficient of .95. The
measure was found to correlate significantly with the HGS
(r = .41). This correlation is comparable to correlations
'-,OEU " A.;. 1-41* 4f-,MLI . I lwb -
29
between hypnotic susceptibility and ratings of absorption,
and between hypnotic susceptibility and ratings of hypnotic
depth. Using a principle component analysis, with Varimax
rotation, three factors emerged out of data from 299
subjects' scores on the AIM. All three factors correlated
significantly with hypnotic susceptibility.
Tellegen Absorption Scale. The Tellegen Absorption
Scale (TAS; Tellegen & Atkinson, 1974) was also
administered to all subjects. The TAS is an inventory of
37 items describing "hypnotic-like" experiences that occur
in daily life, or tendencies thought to be specifically
related to hypnotic talent. Absorption has shown positive
correlations with indicators of hypnotizability (Tellegen
& Atkinson, 1974). Roberts and Tellegen (1973), for
example, found correlations of .27 and .43 with a modified
version of the Harvard Group Scale. They also found that
the TAS correlated .42 with the Field Depth Inventory.
MMPI-168. As noted above, the present study used the
MMPI-168 to screen subjects for severe psychopathology.
The form was first employed by Overall and Gomez-Mont
(1974) who instructed subjects to complete only the first
168 items of the MMPI Form R test booklet. Overall and
Eiland (1982) subsequently calculated percentile norms for
the MMPI-168 scale scores of 731 medical school applicants.
In addition, they developed percentile norms for the
medical school applicants on the Psychopathology Scale
30
(PSY; Overall et al., 1982). The latter scale consists of
58 items taken from the MMPI-168. Ninety-six percent of
the borderline patients sampled were found to exceed the
90th percentile on this scale, with only 10% of the normal
population exceeding this percentile (Lloyd, Overall, &
Click, 1983). Lloyd et al. (1983) conclude that the
percentile norms for medical school applicants on the MMPI-
168 scales and on the PSY scale are adequate for use in
psychiatric screening, when such screening involves the use
of cut-off points applied to individual scale scores.
Fear Questionnaire, As indicated previously, the FQ
was used as a screening device for agoraphobia, and for
phobias among the control group. The Fear Questionnaire
(FQ; Marks, 1979) is derived from a series of factor
analyses of agoraphobics' responses to fear surveys, and it
has been widely used as an outcome measure in studies of
treatment for agoraphobia. The FQ provides the following
information . The subject lists the main phobia for which
treatment is sought and rates the degree of avoidance
associated with it (1 item, score range 0-8). Next the
subject rates the degree of avoidance (0-8) associated with
each of 15 of the most common phobic stimuli (15 items,
score range 0-120). The avoidance scale for the phobic
stimuli has ratings ranging from 0--"would not avoid it" to
8--"always avoid it." From these 15 items, subscores may
be derived for three common phobic symptom clusters--social
31
phobia, blood-injury, and agoraphobia (5 items per
subscore, score range 0-40 per subscore). The subject also
rates the degree of disturbance (0-8) associated with five
affective symptoms common among phobics (5 items, score
range 0-40). Last, the subject rates the severity of the
disturbance or disability associated with the phobic
symptoms (1 item, score range 0-8). Ratings on the
severity scale range from 0--"no phobias present" to 8--
"very severely disturbing/disabling."
Interrater reliability for the main phobia has been
found to range from .80 to .95 (Marks, 1979). Michelson
and Mavissakalian (1983) administered the FQ to
agoraphobics at 4, 10, and 16 week intervals. They found
that retest reliability within subscales ranged from .58 to
.90. The agoraphobic factor averaged .83 reliability, and
the measure of severity of phobic symptoms had an average
reliability of .83 (Marks, 1979). Marks reports that
reliabilities for individual items and for items versus
subscore correlations were .5 or greater. He also claims
that the FQ is sensitive to clinical improvement in pre-and
post-test mean scores, and that FQ ratings of dysfunction
correspond well with the clinical state of patients, with
relatives' accounts of them, and with other ratings of
their adjustment. Marks does not provide statistical data
to support these claims, however.
w -,*Wwwoq ,
32
Procedure
The 10 experimental subjects were referred by the
Denton Agoraphobia Center, where they had applied for
treatment which included hypnosis. The 20 control subjects
were recruited from community courses offered at North
Texas State University. The courses were advertised as
offering hypnosis for treatment of tobacco addiction or for
weight control. Each subject was scheduled for an
appointment with a hypnotist. The hypnotist was an
advanced graduate student in psychology with more than one
year's experience in hypnosis research. The hypnotist
first had the subject sign a consent form and then
administered the SHSS:C. After the hypnotic procedure, the
hypnotist left, and an assistant asked the subject to
complete the AIM, the FDI, the TAS, the FQ, the MMPI-168,
and a demographic questionnnaire. Administration of the
SHSS:C and the other measures took a total of 90 minutes.
The procedure for the agoraphobic group also included a
brief diagnostic interview. Due to the nature and severity
of the agoraphobics' fears, five of these subjects were
tested at home. The remaining subjects were tested on the
campus of North Texas.
Results
The control group met the screening criteria for the
study and it can therefore be assumed that they did not
experience symptoms of clinical phobia or symptoms of
33
severe psychopathology. The experimental group met the DSM
III criteria for agoraphobia, that is, they reported having
the cluster of fears associated with agoraphobia, and they
reported a pervasive interference with daily activities
which resulted from a fear of panic attacks. Table 4 lists
the mean, standard deviation, and range for each group for
the number of fears they acknowledged at or above Level 4--
"definitely avoid it"--on the FQ, and for the number of
scored items they had on the PSY scale. The mean score on
the PSY scale for the control group was 14.8, or the 40th
percentile for the norm group of bright, young college
graduates (Lloyd, Overall, & Click, 1983). The mean score
for the agoraphobics was 25, representing the 98th
percentile on this scale. An ANCOVA (Table 10) indicated
that differences in the PSY scale scores did not
significantly affect the group comparisons on the SHSS:C.
The following statistical procedures were used to
assess the similarity of the comparison groups.
Differences between the group means on age and education
were analyzed using t-tests for independent samples. Chi-
square tests for independent samples were used to compare
the group distributions of marital status, gender, and
experience with hypnosis. Income was not used in a group
comparison because only 6 of the 20 control subjects, and 6
of the 10 experimental subjects supplied this information.
34
A t-test for independent samples was used to compare
the mean age for the 20 control subjects with the mean age
for the 10 experimental subjects. The latter means are
37.35 and 31.20, respectively. With 28 degrees of
freedom, the resulting !-value (t = 1.26) has a two-tail
probability of .181. Thus, it can be concluded that there
are no significant differences between the groups with
respect to age.
A t-test for independent samples was also used to
compare the mean number of years of education for the
control group with the mean years of education for the
experimental group. The latter means are 13.95 and 12.30,
respectively. With 28 degrees of freedom, the resulting
t-value (t = 2.75) has a two-tail probability of .010. The
results indicate that the comparison groups significantly
differ at the .05 level in the number of years of education
they have undertaken.
A 2 X 2 Chi-square test for independent samples was
used to determine whether the two groups were significantly
different in their number of male and female subjects.
Four of the 10 experimental subjects were male, while one
of the 20 control subjects was a male. The calculated x2
value of 1.76683 has a probability of .1838 with 1 degree
of freedom. The results suggest that the comparison groups
have comparable numbers of male and female subjects.
35
A 2 X 3 Chi-square test for independent samples was
used to determine whether the two groups differed
significantly in their frequency of subjects within three
categories of marital status--l) married, 2) single, and 3)
divorced. The observed frequencies for the control group
were 6 single and 14 married. The corresponding
frequencies for the experimental group were 9 married and 1
divorced. The calculated x2 value of 5.34783 has a
probability of .0690 with two degrees of freedom. The
results indicate that the groups do not have significantly
different frequencies within the marital status categories.
A 2 X 3 Chi-square test for independent samples was
used to determine whether the two groups contained
significantly different numbers of subjects with one of
three levels of experience with hypnosis--l) none, 2), from
1 to 10 hours, and 3) more than 10 hours. The observed
frequencies for the control group were 13 (none), 6 (1-10
hours), and 1 (more than 10 hours). The frequencies for
the experimental group were 3 (none), 6 (1-10 hours), and 1
(more than 10 hours). The calculated x2 value of 3.28125
has a probability of .1939 with two degrees of freedom. It
is reasonable to conclude, therefore, that the two groups
do not significanty differ in their frequency of subjects
within levels of experience with hypnosis.
In summary, the two groups are comparable on the
selected relevant variables except for years of education.
36
An ANCOVA (Table 3) revealed that this difference did not
significantly affect the group comparisons on the SHSS:C.
Table 2 lists correlations obtained between age and each of
the four dependent measures: the SHSS:C, the AIM, the TAS,
and the FDI. The table also lists correlations between
years of education and the dependent measures. Tables 5,
6, 7, and 8 present descriptive statistics for the relevant
variables for each group and for the overall sample.
A t-test for independent samples was used to compare
the mean hypnotic susceptibility score on the SHSS:C for
the 20 control subjects with the mean for the 10
experimental subjects. The latter means are 7.15 and 6.2,
respectively. With 28 degrees of freedom, the resulting t
value (t = 1.26) has a two-tail probability of .218. Thus,
the two samples means are not different enough to conclude
with a high degree of confidence that their population
means differ. These results fail to support the conclusion
that significant differences exist in the two groups'
susceptibility to hypnosis. A median test failed to
support the hypothesis that the groups' scores on the
SHSS:C came from populations with different medians.
A Hotelling's T2 was used to determine whether there
was a significant difference between the two groups on one
or more of the following dependent variables--the AIM, the
TAS, and the FDI. The two-samples T2 statistic had a
value of .20958. The approximate F associated with this t-
37
value is 1.67665, with 3 and 24 degrees of freedom. Under
the hypothesis of equal mean vectors the probability of
exceeding such an F value is approximately .199.
Consequently, it is likely that the two groups have the
same population mean within each dependent variable. It
can, therefore, be concluded that the experimental and
control groups made comparable responses on these three
measures. Table 1 presents the mean, standard deviation,
and range for each group on the dependent variables. Table
9 provides a correlation matrix for these variables.
Discussion
While few personality correlates to hypnotic
susceptibility have been reported, Frankel and Orne (1976)
found a relationship between hypnotic susceptibility and
phobia. Their subjects were taken from a clinical
population of persons seeking treatment with hypnosis
either for phobias or for tobacco addiction. The mean
hypnotic susceptibility score for phobics was significantly
higher than the mean for smokers. The latter means were
8.08 and 6.08, respectively.
Four of five subsequent studies found evidence in
support of Frankel and Orne's (1976) findings. However,
none of the five replications used both a measure of
hypnotic susceptibility comparable to the Stanford scales
and a comparable control group who could be assumed to have
38
motivation to succeed in hypnosis similar to that of the
subjects seeking treatment with hypnosis for phobia.
The purpose of the present study was to replicate
Frankel and Orne's (1976) study using an experimental group
of persons suffering from agoraphobia. Agoraphobia is
characterized by the presence of a number of phobias and by
extensive interference with daily living. Its major
presenting features are: fear of leaving home, fear of
crowds, confined places, and public transport, and fear of
fear. It can be distinguished from other anxiety disorders
by its characteristic feature of avoidance of many
situations due to anticipation of panic attacks. The
hypnotic susceptibility scores of persons who sought
treatment with hypnosis for agoraphobia were compared with
the susceptibility scores of persons who sought treatment
with hypnosis for weight control or for tobacco addiction.
The measure of hypnotic susceptibility was the SHSS:C.
The groups were also compared on three other dependent
measures: 1) the AIM--a measure of subjects'
"transference-like" involvement with the hypnotist, 2) the
FDI--a measure of subjective experiences which are
considered typical of responsive subjects during hypnosis,
and 3) the TAS--a measure of trance experiences outside
hypnosis. Mean susceptibility scores for both groups were
within the medium range of susceptibility. Group
differences on mean susceptibility scores were not
WAR'.
39
statistically significant, and no significant differences
were found between the groups on the other three dependent
measures.
Thus the present findings do not support the
hypothesis that phobics, in general, and agoraphobics, in
particular, are highly susceptible to hypnosis. The
results should be considered in light of several
qualifications however. First, when negative results occur
with a small sample, there is no way to rule out the
possibility that had a larger sample been used there might
have been sufficient power to produce significant results.
In fact, Frankel and Orne (1976) did find significant
differences in hypnotic susceptibility between phobics and
controls using a sample size of 24 for each group.
Consequently, the results of this study are difficult to
interpret, and any conclusions based on the experimental
sample may only be considered exploratory, pending further
investigation with larger samples.
Second, confidence in the external validity of the
study is reduced because the hypnotist was not blind to
group membership due to the distinctive clinical features
of the groups being compared, and due to the fact that five
agoraphobics were tested at home rather than in the
research office at North Texas.
Third, several distinct differences suggest that
agoraphobia may be qualitatively different from other
40
phobias. A study by Arrindell (1983) revealed that
agoraphobia does not appear in a mild form as other phobias
do, that is, agoraphobic fears do not appear in factor
analyses of self-report data for students, adolescents,
"non-phobic" psychiatric patients, or even for
miscellaneous specific phobics. Using a higher-order
factor analysis, Arrindell noted further that the
agoraphobia factor is independent of the phobia factor.
Clinical impressions also suggest distinctions
between agoraphobia and other phobias. Phobias are defined
as unreasonable fears in response to discrete cues. While
agoraphobics respond to specific situations with anxiety,
they also experience panic attacks without exposure to any
circumscribed phobic stimulus. Unlike other phobics,
agoraphobics experience seemingly random, sometimes daily,
fluctuations in their symptoms from partial remission to
relapse, and they can enter a feared situation more
comfortably if they carry a certain object or if they are
accompanied by a trusted friend. In addition, while other
phobias are most successfully treated with desensitization,
agoraphobic anxiety and panic attacks respond best to
direct exposure methods (Thorpe & Burns, 1983). On the
other hand, long-term follow-up studies (Marks, 1969; Munby
& Johnson, 1981) indicate that the central agoraphobic
symptoms of anxiety and avoidance around clearly defined
situations remain stable over many years. While the
41
classification of agoraphobia as a phobia may or may not
change in the future, the fact remains that agoraphobia is
in many ways unlike other phobias. Thus, it is reasonable
to wonder whether agoraphobics' responses to hypnosis may
not also in some way be atypical, and therefore,
unrepresentative of other phobias.
Fourth, it is possible that different perceptions of
the experimental procedure differentially affected each
group. It seemed that agoraphobics more often expressed
reservations about hypnosis. For example, several of them
expressed concern that they might lose control under
hypnosis. As a result, the experimenter often had to give
these subjects lengthy reassurances about the safety of the
procedure. Several agoraphobics expressed doubt that they
would be good subjects because they felt they would not
"let go". In fact, two subjects indicated that they had
resisted the procedure to some extent. There were at least
three occasions when agoraphobic subjects stopped the
procedure in order to postpone it to another day, or to
look around the room, or to go to the bathroom. Two or
three agoraphobic subjects simply left the session and did
not reschedule. The need for lengthy reassurance and
interruptions of the procedure were minimal in the control
group. While these observations are not systematic or
objective, they do suggest that a high level of anxiety and
concerns about hypnosis may have affected agoraphobics'
42
responsiveness to hypnosis to a greater extent than it did
controls.
Finally, the distribution of the SHSS:C is positively
skewed due to the difficulty of its items. It is possible
that this test may reduce some of the variability within
groups, especially toward the higher levels of
susceptibility. Consequently, the instrument may not have
been sensitive enough to detect differences between the
groups in the low range of susceptibility.
It is consistent with the finding of no significant
differences in hypnotic susceptibility on the SHSS:C that
the groups did not differ on measures correlated with the
SHSS:C--the AIM, the TAS, and the FDI. The lack of
differences on the FDI means that subjects reported similar
frequencies of subjective experiences which are considered
typical of hypnotized persons. Thus a behavioral measure
(SHSS:C) and a measure of subjective experiences (FDI)
converge in depicting similar overall responsiveness to
hypnosis between these groups.
The groups did not differ significantly in their AIM
scores, that is, the extent to which they reported a more
regressive, or archaic, relationship with the hypnotist.
Archaic involvement is similar to transference in that
early need and attitudes, which usually developed in
relation to parents, are now projected onto others.
Because some authors have associated agoraphobia with
43
dependency, it was hypothesized that the regressive aspects
of the hypnotic situation might elicit a more pronounced
"transference-like" dependency on the hypnotist among the
agoraphobic sample. The results suggest that agoraphobics
are not more likely to respond in this way during hypnosis
than are controls. Moreover, it is not clear that
subjects' responses to the AIM in any way reflect
dependency needs or regressive tendencies outside hypnosis.
A comparison of TAS scores found no difference between
phobics and controls in the number of different forms of
spontaneous trance experiences each reported. This outcome
supports a similar finding in an earlier study by Frischolz
et al. (1982). Thus, there has been no support in this
study for the contention that phobics and high susceptible
subjects share a predisposition for hypnotic-like
experiences (Frankel and Orne, 1976). Indeed, the phobic
group proved to be neither high susceptible nor unusually
prone to "trance-like" experiences outside hypnosis. The
credibility of these findings is very much in doubt,
however. This is because Tables 11 and 12 show many
negative and non-significant correlations between the
dependent measures for the control and for the experimental
group. Previous research indicates that these correlations
are usually positive and significant. Therefore, the
present findings are highly suspect and may indicate that
extreme variation in experimental procedure occurred among
-c" In A* WwA I - 1 .11
44
the hypnotists. To summarize, the present study found no
evidence to support Frankel and Orne's (1976) contention
that phobics are highly susceptible to hypnosis.
Agoraphobics and controls showed no significant differences
on the SHSS:C, the FDI, the AIM, or the TAS. The overall
mean for the study on the SHSS:C (x = 6.833) is within the
medium range of susceptibility. Factors which may have
affected the outcome were discussed, as well as the limited
credibility of the findings in light of the surprisingly
low correlations among the dependent measures.
Future research in this area should use stringent
criteria for screening the experimental and the control
groups for phobia. It would be well for a set of research
criteria for phobia to be standardized for this purpose.
In order to test Foenander et al.'s assertion that type and
severity of phobia may interact with hypnotic
susceptibility, further studies could compare agoraphobics
with other specified phobics, as well as with a comparable
control group. Also, a comparison could be made to see if
the SHSS:A is in fact more sensitive than the SHSS:C in
discriminating among these groups.
Based on experiences from this study, it seems
important to systematically assess how fearful clients are
of hypnosis (regardless of their motivation to succeed in
treatment), and to ask subjects directly how they think
their attitude toward hypnosis might have affected their
45
hypnotic performance. Furthermore, it is important to use
large samples and a single blind procedure. The latter
procedures seem to be ideal rather than practical, however,
because the nature and severity of agoraphobics' fears
reduce the number of subjects able to participate in
hypnosis research, and because agoraphobics' behavior in
the experimental setting appears likely to distinguish many
of them from the control subjects commonly used in this
research.
This study has implications for the treatment of
agoraphobia in that practitioners who plan to use hypnosis
can be aware that a moderate degree of responsiveness is
possible from many of these clients, in spite of their
fears and anxiety.
46
APPENDIX A
Agoraphobic Subject Selection Criteria
To be included in the agoraphobic sample:
1. The subject must apply for treatment with hypnosis for
agoraphobia.
2. The subject must meet DSM III criteria for agoraphobia
as determined by a 10-minute interview using the ADIS.
3. The subject must not have any elevation above a T-score
of 70, i.e., the 98th percentile, on the PSY scale of
the MMPI-168. This means a subject may not endorse
more than 25 of the 58 PSY scale items to be included
in the study. (Subjects with an actual range from 12-
33 endorsed items were included.)
4. The subject must rate three or more of the five items
on the Agoraphobia subscale of the FQ at or above Level
4--"definitely avoid it." The rating is made on a 9-
point (0-8) avoidance scale. The Agoraphobia subscale
consists of items 5, 6, 8, 12, and 15.
5. The subject must rate the level of disturbance
associated with their phobic symptoms at or above Level
4--"definitely disturbing/disabling," on the 9-point
(0-8) FQ rating of overall severity of symptoms.
6. The subject must report a duration of agoraphobic
symptoms which exceeds one year.
. - ., L , -I, ""Jim" m I I I I,
47
APPENDIX B
Control Group Subject Selection Criteria
To be included in the control group sample:
1. The subject must apply for treatment with hypnosis for
tobacco addiction or for weight control.
2. The subject must not have any elevation above a T-score
of 70, ie., the 98th percentile, on the PSY scale of
the MMPI-168.
3. The subject must report that the degree of disturbance
associated with any fears or "phobic-like" symptoms is
below Level 4--"definitely disturbing/disabling" on the
9 point (0-8) FQ rating of the overall severity of
symptoms.
48
APPENDIX C
Tables
Table 1
Mean, Standard Deviation, and Range for each group on theSHSS:C, the AIM, the TAS, and the FDI
GroupTest Control (n=20) Experimental(n=10)
SHSS:C m = 7.15 m = 6.2S.D. = 1.872 S.D. = 2.09Range = 4-10 Range =4-11
AIM m = 73.421 m = 64.600S.D. = 22.816 S.D. = 30.310Range = 32-115 Range = 33-127
TAS m = 27.526 m = 22.700S.D. = 5.660 S.D. = 7.319Range = 15-35 Range = 11-33
FDI m = 22.550 m = 18.400S.D. = 5.326 S.D. = 5.892Range = 12-33 Range = 6-27
,Q ,- im- --- .. , -1 Imi maluft 0 - -- 1-4mmffQwk%%wh&mWl%"ll'l
Appendix C--Cont. 49
Table 2
Product-moment Correlations between Age and Years ofEducation and Each of the Four DependentMeasures-- the SHSS:C, the AIM,
the TAS, and the FDI
Independent DependentVariables Variables
SHSS:C AIM TAS FDIAge -.2340 -.1606 -.0602 -.1171Education .3785* .0585 .0550 .1882
*significant at the .05 level.
Table 3
An Analysis of Covariance Comparing the Groups onHypnotic Susceptibility with Years of
Education as the Covariate
Source Sums of Degrees of Mean E Sign.Squares Freedom Square of F
Main effects .462 1 .462 .130 .721Explained 16.530 2 8.265 2.333 .116Error 95.637 27 3.542Total 112.167 29 3.868
Appendix C--Cont. 50
Table 4
Mean, Standard Deviation, and Range for each Group forthe Number of Fears Acknowledged on the FQ at orabove Level 4--"Definitely Avoid It", and forthe Number of Scored Items on the PSY scale.
GroupTest Control (n=20) Experimental (n=10)
FQ m = 2.850 m = 5.8S.D. = 1.981 S.D. = 1.476Range = 0-9 Range = 4-8
PSY Scale m = 14.800 m = 25S.D. = 5.227 S.D. = 7.257Range = 6-24 Range = 12-33
Table 5
Mean, Standard Deviation, and Range for Each Groupfor Age and Years of Education.
IndependentVariable Control (n=20) Experimental (n=10)
Age m =37.350 m = 31 20C
Years of Education
S.D. = 13.971Range = 20-80
m = 13.950S.D. = 1.468Range = 12-16
S.D. = 7.843Range = 24-49
m = 12.300S.D. = 1.703
Range = 9-14
Appendix C--Cont. 51
Table 6
Mean, Standard Deviation, and Range for the OverallSample for Age and Years of Education.
Independent Overall SampleVariable (n=30)
Age m = 35.300S.D. = 12.477Range = 20-80
Years of Education m = 13.400S.D. = 1.714Range = 9-16
Table 7
Frequencies and Percentages for Categories based onGender, Marital Status, and Experience with
Hypnosis for each Group.
Independent GroupVariable Control (n=20) Experimental (n=10)
Sex Male = 1 (5)9 M l -)
Female = 19 (95%)
Marital Status
Fa e = 7 (0%)Female= 7 (70%)
Single = 6 (30%) Single = 0 (0%)Married = 14 (70%) Married = 9 (90%)Divorced = 0 (0%) Divorced = 1 (10%)
Hours of Experiencewith Hypnosis
0 = 13 (65%)1-10 = 6 (30%)>10 = 1 (5%)
0 = 3 (30%)1-10 = 6 (60%)>10 = 1 (10%)
I I li 111 .. .
Appendix C--Cont.
Table 8
Frequencies and Percentages for Categories based onGender, Marital Status, and Experience with
Hypnosis for the Overall Sample.
I d d t-=n/% --' 1 JV I
VariableOver iSample
(n=30)
ext, -.
Marital Status
Hours of ExperienceWith Hypnosis
Male = 4 (13.3%)Female = 26 (86.7%)
Single = 6 (20%)Married = 23 (76.7%)Divorced = 1 (3.3%)
0 = 16 (53.3%)1-10 = 12 (40.0%)>10 = 2 (6.7%)
Table 9
Pearson Product-moment Correlations Between theDependent Measures--the SHSS:C, the AIM,
the TAS, and the FDI
SHSS:C AIM TASFDI .2827 .5880** .4984*
-. 2635
-. 2727
.5737**
* p < .01** p < .001
52
TAS
AIM
.qSt-- z
Appendix C--Cont. 53
Table 10
An Analysis of Covariance Comparing the GroupsHypnotic Susceptibility with the PSY Scale
Scores as the Covariate.
on
Source Sums of Degrees of Mean E Sign.Squares Freedom Square of E
Main Effects .842 1 .842 .219 .644Explained 8.279 2 4.139 1.076 .355Error 103.888 27 3.848Total 112.167 29 3.868
Table 11
Pearson Product-moment Correlations between theDependent Measures--the SHSS:C, the AIM, the
TAS, and the FDI for the Control Group.
.3256AIM TAS
.4714 * .4695 *
-.2887 .5917 **
-. 3146
*p < .05**p < .01
FDI
TAS
AIM
Appendix C--Cont. 54
Table 12
Pearson Product-moment Correlations between the DependentMeasures--the SHSS:C, the AIM, the TAS, and the
FDI for the Experimental Group.
SHSS:C AIM TASFDI .0108 .7090 * .3793
TAS -.5602 * .5108
AIM -.3883
* p < .05
55
APPENDIX D
Raw Data
Raw Data for the Weight Control Group
Marital Hyp.SHSS AIM TAS FDI Age Educ. Sex Status Exp. FQ MMPI
1. 6 1002. 8 533. 9 944. 9 665. 9 1156. 9 637. 5 X8. 7 639. 10 34
10. 6 8811. 5 6912. 6 9213. 9 6114. 10 6515. 4 9916. 5 6017. 7 6818. 7 3219. 7 10320. 5 70
30 22 35 1425 21 44 1229 26 21 1317 26 20 1430 33 21 1530 27 32 1530 25 45 1220 18 80 1315 15 40 1526 22 33 1329 28 56 1530 15 36 1629 26 28 1433 27 37 1629 18 38 16X 19 43 13
32 23 48 1620 12 38 1235 28 21 1334 20 31 12
FFFFFFFFFFFFFFFFFFFM
MMSSSSMMMMMMSMMMMMSM
>100
1-101-100
1-10000
1-101-1000000000
1-10
11335014291242234244
1414222476
15189
1819112211151222101512
MMillinhl 1 li 1 -
Appendix D--Cont
Raw Data for the Agoraphobic Group
Marital Hyp.SHSS AIM TAS FDI Age Educ.Sex Status Exp. FQ MMPI
1. 11 65 19 25 28 14 M M 0 6 142. 8 47 23 15 24 12 F M 1-10 4 273. 6 62 14 17 36 14 M M >10 8 274. 4 127 33 27 34 9 F M 0 8 305. 5 56 26 16 25 11 F M 1-10 5 306. 6 33 21 6 24 12 F M 1-10 7 337. 7 58 11 18 25 12 M M 0 5 318. 6 48 19 17 49 14 F M 1-10 5 209. 5 40 30 21 32 14 F M 1-10 6 26
10. 4 110 31 22 35 11 F D 1-10 4 12
56
57
APPENDIX E
Demographic Questionnaire
Name:
Address:
Phone: (home)
(work)
Date of Birth:
Sex:
Education:
Marital Status:
Married
Single
Separated
Divorced
Widowed
Other
Duration of present agoraphobic symptoms:
Less than 1 year
Less than 3 years
More than 3 years
Previous experience with hypnosis:
None
1-10 hours
More than 10 hours
Please list any medication you are currently using:
58
APPENDIX F
Fear Questionnaire
Name Age Sex Date
Choose a number from the scale below to show how much youwould avoid each of these situations listed below because offear or other unpleasant feelings. Then write the number youchoose in the space opposite each situation.
Q - 1-2 3 4 5 6 7 8Would not Slightly Definitely Markedly Alwaysavoid it avoid it avoid it avoid it avoid it
1. Main phobia you want treated (describe in your own words).
2. Injections or minor surgery3. Eating or drinking with other people4. Hospitals5. Traveling alone by bus or coach6. Walking alone in busy streets7. Being watched or stared at8. Going into crowded shops9. Talking to people in authority
10. Sight of blood11. Being criticized12. Going alone far from home13. Thought of injury or illness14. Speaking or acting to an audience15. Large open spaces16. Going to the dentist17. Other situations (describe)
How would you rate the present state of your phobic symptomson the scale below?
0 1 2 3 4 5 6 7 8No phobias Slightly Definitely Markedly Very severelypresent disturbing disturbing/ disturbing/ disturbing/
not really disabling disabling disablingdisabling
Please circle one number between 0 and 8.
59
APPENDIX G
Consent Form
NAME OF SUBJECT:1. I hereby give consent to to perform orsupervise the following investigational procedure ortreatment:
2. I have (seen, heard) a clear explanation and understandthe nature and purpose of the procedure or treatment;possible appropriate alternative procedures that would beadvantageous to me (him, her); and the attendant discomfortsor risks involved and the possibility of complications whichmight arise. I have (seen, heard) a clear explanation andunderstand the benefits to be expected. I understand thatthe procedure or treatment to be performed is investigationaland that I may withdraw my consent for my (his, her) status.With my understanding of this, having received thisinformation and satisfactory answers to the questions I haveasked, I voluntarily consent to the procedure or treatmentdesignated in Paragraph I above.
WitnessSigned:
Signed:
Subjector
Person Responsible
RelatinsqhinInstructions to persons authorized to sign:If the subject is not competent, the person responsible shallbe the legal appointed guardian or legally authorizedrepresentative.If the subject is a minor under 18 years of age, the personresponsible is the mother or father or legally appointedguardian.If the subject is unable to write his name, the following islegally acceptable:John H. (His X Mark) Doe and two (2) witnesses.
Signed:
Signed:
Date
60
Appendix H
SCORING BOOKLET: FORM C
To be used in connection with Weitzenhoffer and Hilgard's Stanford lyp'-notic Susceptibility Scale: Form C, Consulting Psychologists Press , Inc.,Palo Alto, California.
Subject No. . . . . . . . . Date . . . . . . . . Total Score . . . . . . .
Name . . . . . . . . . . - . . - - - - - . . Hypnotist . . . . . . . . . .
Summary of Scores Score
Details on the pages that follow_+0. Eye closure (not counted in total score) ( )
1. Hand Lowering (Right Hand)
2. Moving Hands Apart
3. Mosquito Hallucination
4. Taste Hallucination
5. Arm Rigidity (Right Arm)
6. Dream
7. Age Regression (School)
8. Arm Immobilization (Left Arm)
9. Anosmia to Ammonia
10. Hallucinated Voice
11. Negative Visual Hallucination (Three Boxes)
12. Post-Hypnotic Amnesia
Total (+) score . . . . . . .
Record of Recall in Test for Amnesia
Order of Order ofMention Mention
Hand lowering ....... Age regression ......
Moving hands apart .Arm immobilization .......
Mosquito hallucination Anosrmia to ammonia .......
Taste hallucination Hallucinated voice .......
Arm rigidity . 0.. ..0 Negative visual
Dream .a .. *..hallucination .......
Total number of items recalled *.......
Distributed by Consulting Psychologists Press. Inc.., 577 College Ave.,
Palo Alto, Calif. (c) 1962 Ly the Board of Trustees of Leland Stanford
junior Univers'v.
APPENDIX H--Cont.
1IZIM SCOPZ0. RESPONSE TO INDUCTION
a. (If Eye Closure used)
Eyes :i : : close without forcingdo do not (Not
b. (If other method of induction used) Methodcounted)
Response
l. HAND LOWERING (RIGHT HAND)Remarks:
Score (+) if hand has lowered at least six inches by end of10 seconds.
2. MOVING HANDS APARTRemarks:
Score (+) if hands are six inches or more apart at end of10 seconds.
3. MOSQUITO HALLUCINATIONRemarks:
Score (+) for any grimacing, movement, or acknowledg-ment of effect. (3)
4. TASTE HALLUCINATION
A. Taste of sweet: : : : :none vague weak strong
Overt signs:...yes -no
B. Taste of sour:none vague weak strong
Overt signs:.::yes no
Remarks:
Score (+) i f:o t_ tastes are experzencez and e:ithir onestrong ;r one w.:. ver: "ovements. S(.;)
61
APPENDIX H--Cont.
ITEM
S. ARM RIGIDITY (RIGHT ARM)Remarks:
Score (+) if there is less than 2 inches of arm bending inlC seconds.
6. DREAM(Record dream here, if any;thoughts, fantasies, etc.)
or any report of passing
Score (+) if subject dreams well (i. e., has an experiencecomparable to a dream--not just vague, fleeting experi-ences, or just feelings or thoughts without accompanyingimagery). It is possible to obtain a plus score, eventhough the subject may insist it was not a real dream,provided the hypnotist notes that the imagery and actionare not under volitional control. (6)
I
-M- -. -- wlwwwat Quw *Alm-w-1Wl4M omomwwimi poppowa www*Aw. I
62
APPENDIX H--Cont.
ITM ~~SCORE
7. -AGE REGRESSION (SCHOOL)
a. Verbal evidence: Fifth Grade
How old are you?
Where are you?
What are you doing?
Who is your teacher?
Other information
Rating:No regression Fair Good
b. Verbal evidence: Second Grade
What is your name?
And how old are you?
Where are you?
Who is your teacher?
Other information
Rating:
No regression Fair Good
c. Handwriting evidence
Fifth grade:
no change some change striking change
Second grade:no change some change striking change
Score (+) if clear change in handwriting between the pre-sent and oneof the ;egressed ages (7)
8. ARM IMMOBILIZATION (LEFT ARM)Remarks:
Score (+) ii arm r:ses less than one inch in 10 seconds. (8)
63
APPENDIX H--Cont.
ITEM SCP
9. ANOSMIA TO AMMONIA
Smell of ammonia:.,, ... . ,..:............. :none vague weak strong
Overt signs: :yes no
Remarks:
Score (+) if odor of ammonia denied and overt signsabsent ----
10. HALLUCINATED VOICERecord conversation, if any:
Score (+) if subject answers realistically at least once (10)
11. NEGATIVE VISUAL HALLUCINATION: THRE BOXES
Subject reports 3 boxes:,
Subject reports 2 boxes: Colors and
What is color of third box?
Remarks:
Score (+) if hallucination is present, wnether or not sus-
tained. Sometimes t:ie thiir: zcx is perceived vauely as
a colored spot or shacow. The score is still (+). (ll
64
APPENDIX H--Cont.
ITEM
12. POST-HYPNOTIC AMNESIA
(1) Please tell me now in your own words everything thathas happened from the time that (refer to inductionused). (Mist items in order of mention. If blocked,ask, "Anything else ?" until subject reaches a fur-ther impasse.)
Anything else ?
You have forgotten (all the, many, a few) things which-happened. Can you tell me a little what it feels like ?(If necessary, probe in order to ascertain nature ofamnesia i.e., whether true, verbal inhibition, etc.)
(2) Listen carefully to my. words. Now you can remembereverything. Anything else now? (List in order of men-tion.)
Remind subject of omitted items. Remarks on natureof amnesic experience ("about your in.abiliry to recalla while ago, how real was it -to you ?.")
Score (+) if subject recalls 3 or iewer items before "Nowyou can remember everything."
Y -
65
I srnp-E I
(12).. )i
66
Appendix I
ARCAIC INVOLVEMENT MEASURE
1. Sometimes I felt some very strong bonds to the hypnotist, like an-affection that I usually feel only for parents, special teachers,and special friends.
I did notfeel at allthis way
2 3 4 5 6 festrgly verythis
way
2. For some unknown reason, I really wanted to please the hypnotista whole lot.
I did notfeel at allthi s way
2 3 4 5 6 7 lst
3. Every word or action of the hypnotist seamed to have an effect onmy feelings.
I did notfeel at allthis way
ythisway
2 3 I felt very2 3 5 6 7 stogythis
way
4. I felt like everything the hypnotist did and said deeply mattered.I did notfeel at all Ithis way
I felt very2 36 7 strongly thisway
5. While I was hypnotized, I felt like the hypnotist was almost aperfect person.
I did notfeel at all. 1thi s way
I felIt very2 3 4 5 6 7 stronglythisway
6. The hypnotist felt very powerful to me.
I felt very6 7 strongly this
way
7. It felt like the .hypnotist was very wise.
I did notfeel at all Ithis way
I felIt very2 3 4 5 6 7 strongly thisway
I did notfeel at all Ithis wy
APPENDIX I--Cont.
. I especially admired the hypnotist.
I did notfeel atall 1 2 3 4 5 6this way
9. Inaway, it wasneat to share in thepoweroft
I did not6feel at all 1 2 3 4. 5 6'this may
10. I really wanted the hypnotist to think I was OK.
I did not -feel at all 1 2 3 4 5 6this way
11. In sawe ways, I felt like a child relating to hiithan an adult relating to the hypnotist.
I did notfeel at all 1 2 3 4 5 6this way
12. 1 felt like the hypnotist was a leader and I was
I did notfeel at all 1 2 3 4 5 6this way
13. I wanted the hypnotist to take care of me whileI
I did notfeel at all 1 2 3 4 5 6this way
14. 1 wanted the hypnotist to tell me what to do.
I did notfeel at all 1 2 3 4 5 6this way
15. I wanted the hypnotist's attention.
I did notfeel at all 1 2 3 4 5 6this way
I felt very7 strongly this
way
he hypnotist.
I felt very7 strongly this
way
I felt very7 strongly this
way
S/her parents rather
I felt very7 strongly this
way
a follower.
I felt7 strongly
I was hypnotized.
I felt7 strongly
verythis
way
verythis
way
I felt very7 strongly this
way
I felt very7 strongly this
way
67
APPENDIX I--Cont.
11- Wihan I COuldn't do what the hypnotist said, t mde me feel guilty.
'1 did not I felt veryfeel at all 1 2 3 4 5 6 7 strongly thisthis my way
17. I was worried that the hypnotist wouldn't like me.
I did not I felt very.feel at all 1 2 3 4 5 6 7 strongly thisthi& way way
18. 1 wanted to avoid disappointing the hypnotist.
I did not I felt veryfeel at all 1. 2 3 4 5 6 7 strongly thisthis way way
19. I wanted to avoid the hypnotist becoming angry at me.
I did not I felt veryfeel atall 1 2 3 4 5 6 7 stronly thisthis way way
20. Sometimes I couldn't tell who the hypnotist was.
I did not I felt veryfeel at all 1 2 3 4 5 6 7 strongly thisthis way way
68
69
APPENDIX J
Field Depth Inventory
trite ?TRU or FALSZ in the blank space after each numberafter you give careful thought about your answer to thestatement.
1..Time stood still.
2.....IAy are trembled or shook whes I tried to sove it.
3.... felt dazed.
4....1i felt aware of my body only where it touched thechair.
5......= felt I could have tolerated pain sore easily duringthe esperisent.
6..,.? could have awakened any time I wanted to.
7... was delighted with the experience.
.... The ezperimentorts voice seemed to come from very faraway.
9....I tried to resist, but I could not.
10. Everything happened automatically.
11...Sometimes I did not.know where I was.
12...__It was like the feeliaq I have just before waking up.
13...hen I case out I was surprised at bow such time hadgone by.
14.. I case out of the trance before I was told to.
15. Ouriag the eperiseet I felt I understood thingsbetter or sore deeply.
16...I was able to overcome some or all of thesuggestions.
17. . At times I was deeply hypnotized and at other times Iwas only lightly hypnotized.
18....Durinq the finai "countdowno to vwke me up I becamesore deeply hypnotized for a mosent.
19...._At times I felt completely unavare of being in anexperiment.
20....I did not lose all sense of time.
APPENDIX J--Cont.
31,..t seemed completely different from ordinaryexperience.
22. .xI was is a sodium hypnotic state, but no deeper.
23.. Things seemed unreal.
20 ____Parts of my body soved without my consciousassistance.
25.. .. I felt apart froa everything else.
26. .. It seems as if it happened a long time ago.
27...1 I felt uniahibited.
28.. ..At times I felt as if X had gone to sleepsomnatarily.
29...*.I felt quite conscious of my surroundings all thetime.
30.. .SIverything I did while hypnotized I can also do whileI as not hypnotized.
31.. 1.I could not have stopped doing the things theexperimenter suggested even if I tried.
32.. .bIt was a very strange experience.
33.____I felt asa'zed.
34. ?.N rom time to time I opened my eyes.
31. .M 1 couldn't stop movements after they got started.
36.. .I bad trouble keeping sy head up all during theex perinent.
37...U y mind seemed empty.
38. ____It seemed mysterious.
7 0
71
APPENDIX K
Tellegen Absorption Scale
lameseae: Sex:
?lease read each statement and decide whether it ismostly true or mostly false as applied too you. If youdecide a statement is true or mostly true, circle TRUR. Ifa statement is false or ostly false, as applied to yo,circle FALS?. (There are no right or wrong anwers.)
1. Soeetimes I feel and experience things as I did whes Ivis a child. (a) Tue, (b) False.
2. I cam become deeply involved when reading or hearingabout someone else's experiences. ( s) True. (b) False.3. When I watch a boat on the lake, I can almost feel hatit would be like to be on it. (a) True, (b) False.4. I can be greatly moved by eloquent or poetic language.(a. True, (b) False.
5. While watching a movie, a T.T. how, or a play, I saybecome so involved that I forget about myself and mysurroumdinqs and experience the story as if it were real andas if I were taking part in it. (a) True, (b) False.6. If I stare at a picture and then look away from it, Ican sometimes see& am imaqe of the picture. almost as if Iwere still looking at it. . (a) True, (b) false.
7. Sometimes I feel as if my mind could envelop the wholeworld. (a) True, (b) False.
8. I like to watch cloud shapes change in the sky. (a)True, (b) False.
9. If I wish, I cam imaqlie (or daydream) some things sovividly that they bold my attention is the way a good movieor story does. (a) True, (b) False.
10. I sometimes Ostep outside* my usual self and experiencesa entirely different state of being. (a) True, (b) False.
11. I think I really know what some people sean when theytalk about mystical experiences. (a) True, (b) False.
12. Textures-such as wool, sand, wood-sometimes remind seof colors or music. 4e) True. (b) False.
13. Sometimes I experience things as if they were doublyreal. (a) True, (b) False.
14. When I listen to music, I can qet so caught up in it
_ss,_,_ ' l'' --ri I 'r.II-I i i i i i i F Illis41 r 1 -P"I I'l-2. - MEd't MIMik litet.NIU~fTill 3...-3-1- ilei.lass'i. r-a.ii.rois, --4..=- ... . . .,. ... ,, .asm.memen.sam
APPENDIX K--Cont.
that I doat sotie anything else. (a) True# (b) False.15. If I wish, I can imagine that my body is so heavy thatI could not move it if I wanted to. (a) true. (b) False.16. Often I can somehow sense the presences of anotherperson before I actually see or hear hia(her). (a) true,(b) False.
W. The crackle and flames of a wood fire stimulate myimagination. (a) True* (b) False.
10. It is sometimes possible for se to be completelyimersed in ature or in art and to feel am if my wholestate of conciouseess has somehow bees temporarily altered.(a) True, (b) False.
19. 1 cam sometimes recollect certain past experiences inmy life with such clarity and vividness that it is likelining them agais or almost so. (a) True. (b) False.-
20. I as able to wander off into my own thoughts whiledoiaq a routine task and actually forget that I am doing thetask, and then find a few minutes later that I havecompleted it. (a) True, (b) False.
21. I have attempted to write poetry or fiction. (a) True,(b) False.
22. Different colors have distinctive and special earningsfor me. (a) True, (b).
23. Things that miqht seem meanisless to others often makesese to s. (a) true, (b) False.
25. While acting is a play, I think I could really feel theemotions of the character and become 6 him (her) for thetime being, forgetting both myself and the audience. (a)True, (b) False.
25. By thoughts often don't occur as words but as visualimages. (a) true, (b) False.
26. I often take delight in small things (like the five-pointed star shape that appears when you cut as apple acrossthe core or the colors is soap bubbles). (a) True, (b)False.
27. When listening to organ music or other powerful music,I sometimes feel as if I as being lifted into the air. (a)True, (b) False.
- 'm*a-
72
APPENDIX K--Cont.
26. Sometimes I can chamqe noise into music by the way Ilist to it. (a) True, (b) False.
29. Some of my most vivid memories are called up by scents&ad smells. (a) Tre. (b) False.
30. Certain pieces of music remind me of pictures or soviagpatters of color. (a) True# (b) False.
31. 1 often know what someone Is going to say before he orshe says it. -(a) True, (b) False.
32. 1 often have Ophysical sesoriess; for example, afterI've bees swimming I may still feel like Its is the water.(a) true, (b) aie.
33. The soma4 of a voice can be so fascinating to se that Icas just go @ listening. to it. (a) true. (b) False.
34. It times I somehow feel the presence of someone who issot physically there. (a) True. (b) False.
35. Sometimes thoughts aad images come to se without theslightest effort on my part. (a) True, (b) False.
36. I find that different odors have different colors. (a)True, (b) False.
37. 1 can be deeply moved by a sunset. (a) True, (b)False.
73
74
REFERENCES
Agras, S., Sylvester, D., & Oliveau, D. (1969). Epidemiology
of common fears and phobias. Comprehensive Psychiatry,
i0, 151-156.
American Psychiatric Association. (1980). Diagnostic and
statistical manual of mental disorders. (3rd ed.).
Washington, D.C.: Author.
Arrindell, W.A. (1980). Dimensional structure and
psychopathology correlates of the fear survey schedule
(FSS-III) in a phobic population: A factorial
definition of agoraphobia, Behavior Research and
Therapy, 1_, 229-242.
Buglass, D., Clarke, J., Henderson, A.S., Kreitman, N., &
Presley, A.S. (1977). A study of agoraphobic
housewives. Psychological Medicine, 1, 73-86.
Burns, L.E., & Thorpe, G.L. (1983). The agoraphobic
syndrome: Behavioral approaches to evaluation and
treatment. Sussex: Wiley.
Chambless, D.L. (1985). Agoraphobia. In M. Hersen & A.S.
Bellack (Eds.), Handbook of Clinical Behavior Therapy
with Adults (pp. 49-87). New York: Plenum Press.
Chambless, D.L., & Goldstein, A.J. (1980a). Agoraphobia.
In D.L. Chambless & A.J. Goldstein (Eds.), Handbook of
Behavioral Interventions (pp. 322-416). New York:
Wiley.
75
Chambless, D.L., & Goldstein, A.J. (1980b) . Anxieties:
Agoraphobia and conversion hysteria. In A.M. Brodsky &
R.T. Hare-Mustin (Eds.), Women and Psychotherapy: An
assessment of research and practice
(pp. 113-135). New York: Guilford Press.
Dinardo, P.A., O'Brien, G.T., Barlow, D.H., Waddell, M.T., &
Blanchard, E.B. (1983), The Anxiety Disorders Interview
Schedule (ADIS): Preliminary results. Archives of
General Psychiatry, .4, 1070-1074.
Field, P.B. (1965). An inventory scale of hypnotic depth.
The International Journal of Clinical and Experimental
Hypnosis, 13, 238-249.
Foenander, G., Burrows, G.D., Gershcmann, J., & de L. Horne,
D.J. (1980). Phobic behavior and hypnotic
susceptibility. The Australian Journal of Clinical and
Experimental Hypnosis, _ (1), 41-46.
Frankel, F.H. (1976). Hypnosis: Trance as a coping
mechanism. New York: Plenum Medical Book.
Frankel, F.H. (1978). Hypnosis and related clinical
behavior. American Journal of Psychiatry, 135, 664-667.
Frankel, F.H. (1980). Phobic disorders and hypnosis. In
G.D. Burrows & L. Dennerstein (Eds.), Handbook of
hypnosis and psychosomatic medicine (pp. 170-173).
Amsterdam: Elsevier/North Holland Biomedical Press.
76
Frankel, F.H., & Orne, M.T. (1976). Hypnotizability and
phobic behavior. Archives of General Psychiatry, 31,
261-263.
Frischolz, E.J., Spiegel, D., Speigel, H., Balma, D.L., &
Markell, C.S. (1982). Differential hypnotic
responsivity of smokers, phobics, and chronic-pain
control patients: A failure to confirm. Journal of
Abnormal Psychology, 91 (4), 269-272.
Gerschmann, J., Burrows, G.D., Reade, P., & Foenander, G.,
(1979). Hypnotizability and the treatment of dental
phobic illness. In B.D. Burrows, D.R. Collison, & C.
Dennerstein (Eds.), Hypnosis 1979 (pp.33-39).
Amsterdam: Elsevier/North Holland Biomedical Press.
Goldstein, J.J., & Chambless, D.L. (1978). A reanalysis of
agoraphobia. Behavior Therapy, J, 47-59.
Harper, M., & Roth, M. (1962). Temporal lobe epilepsy and
the phobic anxiety-depersonalization syndrome.
Comprehensive Psychiatry, 31, 129-151.
Hilgard, E.R. (1965). Hypnotic Susceptibility New York:
Harcourt, Brace, & World.
Hilgard, E.R. (1975). The Stanford Hypnotic Susceptibility
Scales as related to other measures of hypnotic
responsiveness. American Journal of Clinical Hypnosis,
21 (3), 68-82.
77
Hilgard, J.R., & Hilgard, E.R. (1979). Assessing hypnotic
responsiveness in a clinical setting: A multi-item
clinical scale and its advantages over single-item
scales. The International Journal of Clinical and
Experimental Hypnosis, 27, 134-150.
John, R., Hollander, B., & Perry, C. (1983).
Hypnotizability and phobic behavior: Further supporting
data. Journal of Abnormal Psychology, 92 (3), 390-392.
Kelly, S.F. (1984). Measured hypnotic response and phobic
behavior: A brief communication. The International
Journal of Clinical and Experimental Hypnosis, 32 (1),
1-5.
Liebowitz, M.R., & Klein, D.F. (1979). Assessment and
treatment of phobic anxiety. Journal of Clinical
Psychiatry, .4, 486-492.
Lloyd, C., Overall, J.E., & Click, M., Jr. (1983).
Screening for Borderline Personality Disorders with the
MMPI-168. Journal of Clinical Psychology, 39 (5), 722-
726.
Marks, I.M. (1969).. Fears and phobias. New York: Academic
Press.
Marks, I.M., & Matthews, A.M. (1979). Brief standard self-
rating for phobic patients. Behavior Research and
Therapy, L7, 263-267.
78
Michelson, L., & Mavissakalian, M. (1983). Temporal
stability of self-report measures in agoraphobia
research. Behavior Research and Therapy, 21 (6), 695-
698.
Morgan, A.H., & Hilgard, J.R. (1975). Stanford Hypnotic
Clinical Scale (SHCS). In E.R. Hilgard & J.R. Hilgard,
Hypnosis in the relief of pain, (pp. 209-221). Los
Altos, CA: William Kaufmann.
Morgan, A.H., Johnson, D.L., & Hilgard, E.R. (1974). The
stability of hypnotic susceptibility: A longitudinal
study. The International Journal of Clinical and
Experimental Hypnosis, 22, 249-257.
Munby, M., & Johnson, D.W. (1980). Agoraphobia: The long-
term follow-up of behavioral treatment, British Journal
of Psychiatry, 137, 418-427.
Nash, M.R. (1984, August). Preliminary findings on a scale
of interpersonal regression during hypnosis: A measure
of archaic involvement. Paper presented at the meeting
of the American Psychological Association, Toronto.
Orne, M.T., Hilgard, E.R., Speigel, H., Speigel, D.,
Crawford, H.J., Evans, F.J., Orne, E.C., & Frischolz,
E.J. (1979). The relation between the Hypnotic
Induction Profile and the Stanford Hypnotic
Susceptibility Scales, Forms A and C. The International
79
Journal of Clinical and Experimental Hypnosis, 27, 85-
102.
Overall, J.E., & Eiland, D.C. (1982). MMPI-168 norms and
profile sheets for bright young college graduates.
Journal of Clinical Psychology, 38, 109-114.
Overall, J.E., & Gomez-Mont, F. (1974). The MMPI-168 for
psychiatric screening. Educational and Psychological
Measurement, 34 (2), 315-319.
Roberts, A.H., & Tellegen, A. (1973). Ratings of "trust"
and hypnotic susceptibility. International Journal of
Clinical and Experimental Hypnosis, 21, 289-297.
Shafer, S. (1976). Aspects of phobic illness: A study of
90 personal cases. British Journal of Medical
Psychology, 4r, 221-236.
Shor, R.E. (1960). The frequency of naturally occurring
"hypnotic-like" experiences in the normal college
population. The International Journal of Clinical And
Experimental Hypnosis, r, 151-163.
Shor, R.E. (1962). Three dimensions of hypnotic depth. The
International Journal of Clinical and Experimental
Hypnosis, 1&, 23-28.
Shor, R.E., & Orne, E.C. (1962). Harvard Group Scale of
Hypnotic Susceptibility. Palo Alto, CA: Consulting
Psychologists Press.
80
Shor, R.E., Orne, M.T., & O'Connell, D.N. (1966).
Psychological correlates of plateau hypnotizability in a
special volunteer sample. Journal of Personality and
Social Psychology, 3, 80-95.
Snaith, R.P. (1968). A clinical investigation of phobias.
British Journal of Psychiatry, 114, 673-698.
Spiegel, H., & Speigel, D. (1978). Trance and Treatment:
Clinical Uses of Hypnosis. New York: Basic Books.
Tellegen, A. (1976). Differential Personality
Questionnaire. Minneapolis: University of Minnesota
Press.
Tellegen, A., & Atkinson, G. (1974). Openness to absorbing
and self-altering experiences ("Absorption"): A trait
related to hypnotic susceptibility. Journal of Abnormal
Psychology, .8 (3), 268-277.
Weitzenhoffer, A.M., & Hilgard, E.R. (1959). Stanford
HypnoticSusceptibilty Scale: -Forms A-and B. Palo
Alto, CA: Consulting Psychologists Press.
Weitzenhoffer, A.M., & Hilgard, E.R. (1962). Stanford
Hypnotic Susceptibility Scale: Form C. Palo Alto,
CA: Consulting Psychologists Press.
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