A meta-analysis was performed on 18 studies in which a cognitive-behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive-behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments.

Kirsch, I., Montgomery, G., & Sapirstein, G. (1995). Hypnosis as an adjunct to cognitive-behavioral psychotherapy: A meta-analysis. Journal of Consulting & Clinical Psychology, 63, 214-220.

[Reprinted from the Fall, 1997 issue of Psychological Hypnosis (6), 3, pp. 8-12.]

[From your website author: Be sure to note Dr. Barber's use of research published by GPSCH member V. Krishna Kumar and GPSCH Past-President Ron Pekala. Congratulations, Krishna and Ron!]

About the Author

Theodore Xenophon Barber is one of the most influential and creative researchers and theoreticians in the history of hypnosis. In his comprehensive, A History Of Hypnotism, Gauld (1992) does not hesitate to say that "Barber has had a stronger influence on both conceptual and methodological aspects of contemporary hypnotism than any other worker" His contributions include a critique of an unquestioned and facile notion of hypnosis as a "trance," state, methodological and conceptual proposals to further the study of hypnosis, research on "fantasy prone" individuals, and a comparison of hypnosis and other self-control technologies, among others.

Dr. Barber has published four books, more than 180 papers on hypnosis, was President of Division 30 between 1972-73, and was bestowed the Division's 1994 Award for Distinguished Contributions to Scientific Hypnosis. More recently he has directed his iconoclastic and keen mind to the study of animal awareness and mentation, producing the authoritative book The Human Nature of birds. We are fortunate that he has revisited hypnosis in the current paper which, I believe, will turn out to be a "modern classic." Besides his own contributions, he has directly or indirectly spawned the careers of other important figures including the late Nick Spanos, John Chaves and Irving Kirsch.

After seeking the essence of hypnosis for nearly 40 years, I finally synthesized my conclusions in a book chapter (Barber, in press). In this invited statement I'll summarize the basic points of this new hypnosis synthesis.

I understood the essence of hypnosis when I realized there are really three dimensions or kinds of hypnosis, each associated with one of the three types of very good hypnotic subjects. One dimension or type of hypnosis is associated with very good hypnotic subjects who have a secret life-long history of fantasizing "as real as real." A second type of hypnosis is associated with another group of very good subjects who have a surprising tendency to forget events in their life and also have amnesia for hypnosis. A third type of hypnosis is associated with very good subjects who are neither fantasy-prone nor amnesia-prone but, instead, have positive attitudes, motivations, and expectancies toward the hypnotic situation and are thus "positively set" to think with and flow with the suggestions. The three kinds of hypnosis were distinguished gradually by a series of research projects (extending from the late 1950's to the early 1990's) which I summarized in the recent publication (Barber, in press). Here I'll list a few research highlights.

Two large-scale investigations with several thousand hypnotic subjects by Deirdre Barrett (1990, 1996) and by Steven Jay Lynn and Judith Rhue (1986, 1988) confirmed Sheryl Wilson's and T. X. Barber's (1981, 1983) discovery that a small group of people (possibly no more than 2-4% of the adult population) have an astonishing history of realistic fantasizing and are very good hypnotic subjects because they experience externally-guided hypnosis in essentially the same way as their internally-guided "real as real" daily fantasies. Since early childhood these very good hypnotic subjects have spent an incredibly large proportion of their time in fantasy-based activities such as pretend-play, make-believe, vivid daydreaming, "real as real" imaginative recreation of sexual psychophysiological experiences, and interactions with such entities as imaginary companions, guardian angels, and spirits. Now, as adults, they have a closely guarded secret: they still spend much of their time fantasizing and they "see, hear, feel, smell, and experience" what they fantasize.

The second type of very good hypnotic subject was differentiated by Deirdre Barrett (1990, 1996). She discovered that her very good hypnotic subjects included a large proportion of fantasy-prone individuals and an almost equally large proportion of individuals who were not at all fantasy-prone but instead were amnesia-prone, that is, were characterized by amnesic periods in their daily lives, by amnesia for their childhood, and by amnesia following hypnosis. During hypnosis, these amnesia-prone subjects exhibited an extreme loss of muscle tone. When awakened from hypnosis, they seemed confused, struggled to talk, were slow to answer questions, and seemed to have forgotten much or all that occurred. These very good hypnotic subjects also showed much forgetfulness in their lives. Most were amnesic for their life prior to age 5, and 40% could not remember life events prior to ages 6 to 8. (In startling contrast, all of Barrett's fantasy-prone subjects had vivid memories prior to age 3 and most reported memories prior to age 2.) Many and possibly all of Barrett's amnesia-prone subjects (and none of her fantasy-prone) had been beaten, battered, or injured during childhood and had suffered associated psychological abuse and, in many cases, sexual abuse.

Although fantasy-prone and amnesia-prone individuals have played dramatic roles in the history of hypnosis, most individuals rated as very good subjects in modern experiments (typically passing 85% or more of the suggestions on the Barber, Stanford, Harvard, Carleton, and/or Creative Imagination Scales), were neither fantasy-prone nor amnesia-prone. Instead, they were very good hypnotic subjects because they had (a) positive attitudes toward the idea of hypnosis, toward the specific test situation, and toward the particular hypnotist, (b) positive motivations to perform well on the suggested tasks and to experience those things suggested, (c) positive expectancies that they can be hypnotized and can experience the suggested effects, and (d) a positive set to visualize, think with, and not contradict the hypnotist's suggestions. A small number of important investigations in clinical hypnosis, self-hypnosis, and stage hypnosis (summarized by Barber, in press) and numerous investigations in experimental hypnosis (summarized in Baker, 1990; Barber, 1969, 1970; Barber, Spanos, & Chaves, 1974; Sarbin & Coe, 1972; Sheehan & McConkey, 1982; Spanos & Chaves, 1989; Wagstaff, 1981) buttressed this picture of the very good hypnotic subject who is positively set to respond maximally in a particular hypnotic situation.

The research mentioned above, which took nearly 40 years to distinguish the three distinct types of very good hypnotic subjects, was corroborated by a recent statistical investigation in which cluster analyses were performed on the hypnotic experiences reported by several hundred subjects (Pekala, 1991; Pekala, Kumar, & Marcano, 1995). Pekala's cluster analyses yielded the same three types of very good hypnotic subjects: type 1 resemble fantasy-prone persons whose hypnotic experiences are characterized by vivid imagery and fantasy, and mild-to-moderate alterations in consciousness but not by amnesia; type 2 resemble amnesia-prone persons who, during hypnosis, are characterized by automaticity, apparent loss of self awareness, seemingly profound alterations in state of consciousness, and posthypnotic amnesia but not by vivid imagery; type 3, resemble positively-set (or "compliant") "highly hypnotizable subjects who respond behaviorally to all or almost all of the Harvard [Group Scale of Hypnotic Susceptibility] items, and yet do not generate the usual phenomenological response to the Harvard" [that is, do not experience hypnosis in the same way as the fantasy-prone or amnesia-prone].

This new hypnosis paradigm meets the criteria for a useful scientific paradigm (Kuhn, 1962) in that it unifies conflicting ["trance" versus "non- trance"] views, explains the [three-dimensional] nature of hypnosis, explains "baffling" hypnotic phenomena, provides new methods of research to answer entirely new questions, and radically alters the assumptions, conceptualizations, procedures, and aims of hypnosis research.

The new paradigm sees the conflicting schools of hypnosis, both historic and modern (Gauld, 1992), as focusing on different kinds of very good hypnotic subjects and, consequently, as talking about different kinds of hypnosis. One school ("trance," "state," "neodissociation") focused on the hypnosis of the amnesia-prone subject, while the other school ("non-trance," "non-state," "suggestion," "cognitive-behavioral-social-psychological") focused on the positively-set subject, and both schools missed the important fantasy-prone subject. When the three types of hypnosis are clearly distinguished, the conflicting schools disappear into a higher unity, a new paradigm, that harmoniously encompasses the three kinds of hypnosis.

Instead of one undifferentiated, unidimensional hypnosis, we have to now think in terms of three hypnoses: the hypnosis of the fantasy-prone person which involves essentially the same state of consciousness as absorption in realistic fantasy; the hypnosis of the amnesia-prone person which has sleep-like characteristics with apparent automaticity followed by amnesia; and the hypnosis of the positively-set person which involves a not particularly uncommon state of consciousness characterized by "mental relaxation," "letting go," and "going with the flow." Similarly, the new paradigm reconceptualizes autohypnosis in three dimensions: the self-hypnosis of fantasy-prone persons absorbed in their daily fantasies; the self-hypnosis of the amnesia-prone during the "blank" periods in their life; and the self-hypnosis of the positively-set who close their eyes, let go of other concerns, and think-with and imagine self-administered suggestions.

The new paradigm asks new questions and opens new lines of research. What life-experiences produce the three types of very good hypnotic subjects? How are the special "talents" of the different types related to the "classical" hypnotic phenomena and to related phenomena such as the different types of "trance" associated with fantasy-prone and amnesia-prone shamans (Cardena, 1996)? What are the different subtypes of fantasy-prone, amnesia-prone, and positively-set subjects, and how do the different subtypes explain what has not been understood about hypnosis? The preliminary data now available suggest a number of hypotheses related to these questions that can be tested empirically.

Hypothesis 1. There are at least three subtypes of fantasy-prone persons: one subtype developed fantasy talents in association with childhood imaginative activities (such as pretend-play, make-believe, imaginary playmates, and exposure to fantasy-stimulating tales or stories); a second subtype developed fantasy talents in learning to escape mentally from an undesirable early life environment; and a third subtype became proficient in fantasizing "real as real" by engaging in increasingly realistic sexual fantasies based on pleasurable sexual contacts experienced intermittently.

Hypothesis 2. There are at least two subtypes of amnesia-prone subjects: one subtype learned during childhood to escape mentally from abuse by developing an ability to "block out (to separate, isolate, repress, or dissociate) memories and experiences in a separate ego state or alternate personality; and a second subtype learned during childhood to comply with an adult's desires and have amnesia for the events in response to repeatedly experiencing furtive sexual relations with an adult while [the child was] ostensibly sleeping.

Hypothesis 3. There are at least two subtypes of positively-set individuals who are very good hypnotic subjects. One subtype is a highly socialized, empathic, cooperative, friendly person who readily adopts positive attitudes and expectancies in social situations, and is ready to yield to the wishes (or suggestions) of another person. However, most positively-set individuals are very good hypnotic subjects not because they are so highly socialized and so ready to yield to another's wishes but because a proficient hypnotist has removed their misconceptions and fears about hypnosis and maximized their expectations, desires, and readiness to relax mentally, shift into a receptive mode, and cognitively "flow with" (think with, imagine, visualize) those things suggested.

The new hypnosis paradigm is multidimensional. It subsumes the three major dimensions outlined above--the dimensions of fantasy-prone, amnesia-prone, and positively-set subjects--plus three additional dimensions: (a) The dimension of the social psychology of the psychological experiment (Orne, 1962) which includes implicit demand characteristics such as implicit social rules, obligations, and mutual roles and expectations that powerfully affect the behavior of virtually all subjects in all formal experimental situations. (b) The dimension of the hypnotist which includes such variables as the hypnotist's skill, charisma, wisdom and effectiveness in communicating with and profoundly influencing the subject. (c) The dimension of instructions and suggestions including suggestions that especially fit the fantasy-prone subject (suggestions for age-regression, age-progression, past-life regression and the suggestions included in the Creative Imagination Scale), suggestions that especially fit the amnesia-prone subject (suggestions for "blocking out" memories, pain, audition, vision, and other sensations), and suggestions that especially fit the positively-set subject (suggestions for heightened strength and endurance, enhanced learning abilities, and heightened awareness, proficiency, enjoyment, etc.) (Barber, 1985, 1990, 1993).

Baker, R. A. (1990). They call it hypnosis. Buffalo: Prometheus Books.

Barber, T. X. (1969). Hypnosis: A scientific approach. New York: Van Nostrand Reinhold. (Reprinted 1995: Northvale, NJ: Jason Aronson, Inc.)

Barber, T. X. (1970). LSD, marihuana, yoga, and hypnosis. Chicago: Aldine Publishing Co.

Barber, T. X. (1985). Hypnosuggestive procedures as catalysts for all psychotherapies. In S. J. Lynn & J. P. Garske (Eds.), Contemporary psychotherapies: Models and methods (pp. 333-375). Columbus, Ohio: Charles E. Merrill.

Barber, T. X. (1990). Positive suggestions for effective living and philosophical hypnosis. In D. C. Hammond (Ed.), Handbook of hypnotic suggestions and metaphors. New York: Norton.

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Barber, T. X. (in press). A comprehensive three-dimensional theory of hypnosis. In I. Kirsch, A. Capafons, E. Cardeña, & S. Amigo (Eds.), Clinical hypnosis and self-regulation: Cognitive-behavioral perspectives. Washington, DC: American Psychological Association.

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Barrett, D. (1996). Fantasizers and dissociaters: Two types of high hypnotizables, two different imagery styles. In R. C. Kunzendorf, N. P. Spanos, & B. Wallace (Eds.), Hypnosis and imagination (pp.123-I 35). Amityville, NY: Baywood Publishing.

Cardeña, E. (1996). "Just floating in the sky": A comparison of hypnotic and shamanic phenomena. In R. van Quekelberghe & D. Eigner (Eds.), Jahrbuck für transkulturelle medizin und psychotherapie 1994 (Yearbook of cross-cultural medicine and psychotherapy 1994) (pp.85-98). Berlin: WB.

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Pekala, R. J., Kumar, V. K., & Marcano, C. (1995). Hypnotic types: A partial replication concerning phenomenal experience. Contemporary Hypnosis, 12, 194-200.

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Sheehan, P. W., & McConkey, K. M. (1982). Hypnosis and experience: The exploration of phenomena and process. Hillsdale, NJ: Erlbaum.

Spanos. N. P., & Chaves, J. F. (Eds.). (1989). Hypnosis: The cognitive-behavioral perspective. Buffalo, NY: Prometheus Books.

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Wilson, S. C., & Barber, T. X. (1981). Vivid fantasy and hallucinatory abilities in the life histories of excellent hypnotic subjects ("somnambules"): Preliminary report with female subjects. In E. Kunger (Ed.), Imagery: Concepts, results, and applications (pp.133-149). New York: Plenum Press.

Wilson, S. C., & Barber, T. X. (1983). The fantasy-prone personality: Implications for understanding imagery hypnosis, and parapsychological phenomena. In A. A. Sheikh (Ed.), Imagery: Current theory, research and application (pp.340- 387). New York: John Wiley.