Sunday, 7 May 2017

EXAMPLE ANSWER: Weight Control

(LO 1.5 An ability to determine an ethically and therapeutically appropriate approach for more complex cases where specific training may not be available)

Weight control

from Anna Taylor, with thanks


Student answer
If I was approached by a client who was using laxatives in order to control their weight I would seek to establish more background information. I would find out whether this is an established pattern and if they have or are being treated by a medical professional. If there is no medical intervention I would consider referral or advise them to seek medical advice.
It may be that I also direct them to information such as https://www.nationaleatingdisorders.org/laxative-abuse-some-basic-facts and ensure that they are aware of some of the dangers e.g. electrolyte or mineral imbalance which impacts on colon and heart functioning; severe dehydration and resultant symptoms; prevention of the usual function of the colon and internal organ damage or death. I would ensure that they are equipped with the knowledge that laxatives are not effective for weight loss as they work on the large intestine- by the time food gets there most of the calories have already been absorbed. Laxative abuse causes water loss which will return as the client drinks fluids. I would only consider therapy if I felt I had adequate competence and if this would not be in place of or contraindicate medical treatment. I would make sure that the client agrees to a follow up session as I would not feel that his should be a one off.
If I did decide to progress I would use metaquestioning to establish detail and function. A surface observation of the individual’s body shape may influence a line of question – is the person under, average or overweight? What is their desired outcome of taking the laxatives? Is the underlying focus an issue about body confidence? What have they tried previously? What are the changes they would like to create – healthy eating, exercise- and how would they know that these have been achieved e.g. a certain item of clothing fitting in a certain way. From the responses I would select an intervention. As many issues of body image have an element of control within them and I might use a type of control panel. I would make sure that I was clear as to which way the scale needs to go e.g. your level of confidence is at a 3 and you wish to increase this to a 7. I would then commence with an induction with ideomotor responses combined with a deepener and convincer to ensure that the client is in the therapeutic state. A relaxing place would be established and then I would ask them to imagine themselves on a screen looking and feeling confident and in control. I would ask them to imagine a remote control which has a volume control on it. This volume control can be seen on the screen as they turn it up and down – just like it is on your television. But this volume control is labelled confidence and note where it is at this point (3). I would then ask them to decrease the scale slightly- to level 2 so that they experience the dip and then turn the volume up finding that it moves easily and with little effort. With each press it moves the confidence and they can see the changes that it makes upon the ‘them’ on the screen. Noticing the way in which they show confidence – what it looks like, what it feels like…. This would continue until they are at the point where they are at or as close as 7 as they can be. I would then ask them to remove the batteries on the remote control – making sure that the volume will stay at the level it has been set –a level they have chosen and one which is comfortable to experience. Then I would use future pace to visualise and experience the ‘them’ in the screen in scenarios in which they are confident and happy with their body and the control they have over it –in a positive way. I would then return to the client to full waking awareness and ask how they felt now that their sense of confidence and ease within their body had increased.
I would ensure that they contact me with feedback and book the follow up session that has been agreed.

(LO 1.5 An ability to determine an ethically and therapeutically appropriate approach for more complex cases where specific training may not be available)


EXAMPLE ANSWERS: Pain Control

(LO 1.2 An ability to devise an appropriate psychological intervention for a medical condition.

Pain Control Student answer 

from Anna Taylor, with thanks


When working with pain it is important to establish the current position in terms of treatment – is the client currently under medical supervision or investigation? If so it may be advisable to provide therapy only if they are in a stable situation or are being referred by a GP as therapies could conflict or counteract each other. If they have not seen their GP I would be likely to advise them to do this.

Within the pre-talk of an intervention for pain I would ensure that I explain that pain is the method by which the body provides feedback – a protection mechanism to reduce injury and it is important to explain that it would not be advisable to reduce pain to being totally absent as this may mask any other problems or injuries.

Using metaquestioning I as the therapist can establish what, if anything, makes the pain worse and what, if anything, provides relief. A desired outcome can then be established e.g. reduction in pain to a level where the individual is able to walk, and sleep without the use of pain medication. I would confirm with the client what the intervention was going to be and establish on a scale the where they are now and where they want to be. I would be very clear as to which way the scale needs to go e.g. your level of comfort and ease in relation to your back is at a 2 and you wish to increase this to an 8. I would be specific so that they understand that pain from other areas of injuries will still be experienced if this is necessary for their body to alert them to a need. I would also ask them if they have ever seen a music sound mixing board and assuming that they have I would progress with the hypnotherapy session.

I would then use an induction with ideomotor responses combined with a deepener and convincer to ensure that the client is in the therapeutic state. A relaxing place would be established and then I would ask them to imagine a control panel such as a music mixing board – with slides and toggles that turn volume, bass, treble etc up and down on a sliding scale. I would ask them to realise that each of the toggles is able to move and slide up and down within its track. I would ask them to identify the slide toggle marked ‘back comfort and ease’ and note where it is at this point (2). The client can then be directed to decrease the scale slightly- just a notch to level 1 to experience the change and then without lingering too long I would direct them to slide the slider up the scale, finding that it moves easily and with little effort. With each notch it moves the sense of ease and comfort increases until they are at the point where they are at or as close as 8 as they can be. I would then ask them to notice that the toggle itself can be removed – it can be pulled off so that the slider stays in place. They have control of the toggle and if they ever need to they can put it back on and adjust the scale, but unless they do, it will remain in place, fixed at that point. Next I would use future pace – imagining and experiencing scenarios in which pain was previously experienced and enjoying the comfort and ease they are now experiencing. After repeating several times with different scenarios I would return to the client to full waking awareness and ask how they felt now that their sense of comfort and ease had increased.


(LO 1.2 An ability to devise an appropriate psychological intervention for a medical condition.

HOME QUESTIONS The ADVANCED: Q28

Q28. Locate a piece of hypnotherapy research on pain control. Include statistical evidence and explanation. Explain the scientific methodology used in this research and its advantages. Properly cite your reference sources. Learning outcomes: 5.5
  1. Research methods and application
5.5 A demonstrable ability to locate hypnotherapy research.

Helpful Links:




Example Answer

There have been a number of clinical trials conducted into the use and effectiveness of hypnotherapy for pain control. The following study was completed by Patterson et al. (1992). It is on the subject of pain control in burns victims. ‘30 burn patients undergoing debridement were randomly assigned to three groups: hypnosis, attention/pseudohypnosis (placebo), and no intervention (control). The hypnosis condition included suggestions for relaxation, analgesia, amnesia, and comfort when touched on the shoulder. The placebo condition involved pseudohypnosis (closing your eyes, counting to 20, imagining yourself in a relaxing place), the touch on the shoulder, and instructions to distinguish between sensations of healing and signals of harm. The control condition provided no other procedures to alleviate pain. The results showed that only the group which underwent true hypnosis reported a significant reduction in pain. The true hypnosis group reported a 46% decrease in pain from the baseline, the placebo group reported a 16% decrease, and the control group reported a 14% decrease. Even though the placebo group believed that they underwent hypnosis, those assigned to that group did not report much less pain than those assigned to the control group. Therefore, the results discount the effects of expectancy and reveal that pain reduction due to hypnoanalgesia goes beyond relaxation.

Patterson, D. R., Everett, J. J., Burns, G. L., & Marvin, J. A. (1992). Hypnosis for the treatment of burn pain. Journal of Consulting and Clinical Psychology, 60, 713-7.

Available at http://dujs.dartmouth.edu/1999F/Hypnotism.pdf (accessed on 10/050/2015)

The above study gives statistical information regarding the number of subjects taking part in the study, the three different treatments involved, and the average percentage of pain reduction each group reported. The study took 30 individuals who had been affected by burns and were undergoing the medical removal of dead, infected or damaged tissue in order to aid in the healing of remaining healthy tissue. The subjects were split into three groups, one using full hypnosis involving suggestions for relaxation, analgesia amnesia and comfort, one using a placebo version of hypnosis where only a relaxing place and suggestions of distinguishing between sensations of healing and signals of harm was used and a third group where no intervention was used. The study showed that the group who had undergone full hypnosis reported a 46% decrease in pain, the placebo group reported a 16% decrease in pain and the no intervention group reported a 14% decrease in pain.

This study shows that there was a significant improvement in pain control in those who took part in the full hypnosis with the appropriate suggestions to aid pain control. The advantages of this are that the study took thirty subjects suffering from a specific injury and undergoing the same type of medical procedures in order to achieve an accurate result. The study ensured that all three groups were under the impression that they were undergoing hypnosis, though with only one group receiving a full hypnosis session. Therefore, the results show that regardless of what the subjects were expecting, still only the group experiencing true hypnosis reported a significant reduction in pain. The same can be said for the relaxation element of the study as the other subjects were also in a relaxed state, though didn’t receive the appropriate pain control suggestions that the true hypnosis group did and only reported a 14-16% reduction in pain as opposed to the 46% in the true hypnosis group. Therefore it is fair to say that the relaxation element causing the results can also be discounted.

In conclusion, this study proves that within this group of 30 individuals there was a significant improvement of pain control in those who underwent full and true hypnosis. This is suggestive of hypnosis being an effective aid in helping people with pain control.







HOME QUESTIONS The ADVANCED: Q21

Q21. Investigating related material sources on the internet, discuss how bias can be avoided in scientific research.
Learning outcomes: 5.3
helpful links :

en.wikipedia.org
In experimental science, experimenter's bias, also known as research bias, is a subjective bias towards a result expected by the human experimenter.[1] For example, it occurs when scientists unconsciously affect subjects in experiments.[2]
www.ncbi.nlm.nih.gov
This narrative review provides an overview on the topic of bias as part of Plastic and Reconstructive Surgery's series of articles on evidence-based medicine. Bias can occur in the planning, data collection, analysis, and publication phases of research. ...
explorable.com
Research bias, also called experimenter bias, is a process where the scientists performing the research influence the results, in order to portray a certain outcome.
blog.efpsa.org
Every scientific discipline is determined by the object of measurement and the selection of appropriate methods of data collection and statistical analysis. Faulty methodology can lead to incorrect...



Help on Research Bias


Research bias, also called experimenter bias, is a process where the scientists performing the research influence the results, in order to portray a certain outcome.
Some bias in research arises from experimental error and failure to take into account all of the possible variables.
Other bias arises when researchers select subjects that are more likely to generate the desired results, a reversal of the normal processes governing science.
Bias is the one factor that makes qualitative research much more dependent upon experience and judgment than quantitative research.

Quantitative Research Bias:
Denial of any Bias

Qualitative Research Bias:
Acceptance and Acknowledgment of Bias.
For example, when using social research subjects, it is far easier to become attached to a certain viewpoint, jeopardizing impartiality.
The main point to remember with bias is that, in many disciplines, it is unavoidable. Any experimental designprocess involves understanding the inherent biases and minimizing the effects.
In quantitative research, the researcher tries to eliminate bias completely whereas, in qualitative research, it is all about understanding that it will happen.

Design BiasDesign bias is introduced when the researcher fails to take into account the inherent biases liable in most types of experiment.
Some bias is inevitable, and the researcher must show that they understand this, and have tried their best to lessen the impact, or take it into account in the statistics and analysis.
Another type of design bias occurs after the research is finished and the results analyzed. This is when the original misgivings of the researchers are not included in the publicity, all too common in these days of press releases and politically motivated research.
For example, research into the health benefits of Acai berries may neglect the researcher’s awareness of limitations in the sample group. The group tested may have been all female, or all over a certain age.
Selection/Sampling BiasSampling bias occurs when the process of sampling actually introduces an inherent bias into the study. There are two types of sampling bias, based around those samples that you omit, and those that you include:Omission BiasThis research bias occurs when certain groups are omitted from the sample. An example might be that ethnic minorities are excluded or, conversely, only ethnic minorities are studied.For example, a study into heart disease that used only white males, generally volunteers, cannot be extrapolated to the entire population, which includes women and other ethnic groups.Omission bias is often unavoidable, so the researchers have to incorporate and account for this bias in the experimental design.Inclusive BiasInclusive bias occurs when samples are selected for convenience.
This type of bias is often a result of convenience where, for example, volunteers are the only group available, and they tend to fit a narrow demographic range.
There is no problem with it, as long as the researchers are aware that they cannot extrapolate the results to fit the entire population. Enlisting students outside a bar, for a psychological study, will not give a fully representative group.

Procedural BiasProcedural bias is where an unfair amount of pressure is applied to the subjects, forcing them to complete their responses quickly.
For example, employees asked to fill out a questionnaire during their break period are likely to rush, rather than reading the questions properly.
Using students forced to volunteer for course credit is another type of research bias, and they are more than likely to fill the survey in quickly, leaving plenty of time to visit the bar.
Measurement BiasMeasurement bias arises from an error in the data collection and the process of measuring.
In a quantitative experiment, a faulty scale would cause an instrument bias and invalidate the entire experiment. In qualitative research, the scope for bias is wider and much more subtle, and the researcher must be constantly aware of the problems.
  • Subjects are often extremely reluctant to give socially unacceptable answers, for fear of being judged. For example, a subject may strive to avoid appearing homophobic or racist in an interview.
This can skew the results, and is one reason why researchers often use a combination of interviews, with an anonymous questionnaire, in order to minimize measurement bias.
  • Particularly in participant studies, performing the research will actually have an effect upon the behavior of the sample groups. This is unavoidable, and the researcher must attempt to assess the potential effect.
  • Instrument bias is one of the most common sources of measurement bias in quantitative experiments. This is the reason why instruments should be properly calibrated, and multiple samples taken to eliminate any obviously flawed or aberrantresults.

Interviewer Bias

This is one of the most difficult research biases to avoid in many quantitative experiments when relying upon interviews.
With interviewer bias, the interviewer may subconsciously give subtle clues in with body language, or tone of voice, that subtly influence the subject into giving answers skewed towards the interviewer’s own opinions, prejudices and values.
Any experimental design must factor this into account, or use some form of anonymous process to eliminate the worst effects.
See how to avoid this:Double Blind Experiment


Response Bias

Conversely, response bias is a type of bias where the subject consciously, or subconsciously, gives response that they think that the interviewer wants to hear.
The subject may also believe that they understand the experiment and are aware of the expected findings, so adapt their responses to suit.
Again, this type of bias must be factored into the experiment, or the amount of information given to the subject must be restricted, to prevent them from understanding the full extent of theresearch.


Reporting Bias

Reporting Bias is where an error is made in the way that the results are disseminated in theliterature. With the growth of the internet, this type of bias is becoming a greater source of concern.

The main source of this type of bias arises because positive research tends to be reported much more often than research where the null hypothesis is upheld. Increasingly, research companies bury some research, trying to publicize favorable findings.
Unfortunately, for many types of studies, such as meta-analysis, the negative results are just as important to the statistics.


HOME QUESTIONS The ADVANCED: Q19

Q19. Give the advantages and disadvantages of a hypnotherapy treatment that is not supported by scientific research. Learning outcomes: 3.8
3. Academic thinking and argumentation

3.8 A demonstrable and respectful appreciation of both the advantages and disadvantages of interventions that have, or have not, been scientifically researched.




EXAMPLE ANSWER AND ASSISTANCE


HOME QUESTIONS The ADVANCED: Q10

Q10. By reference to the following article and further research, appraise, in a professional, factual and non-emotive manner, the claim that hypnotherapy could save the NHS money. Learning outcomes: 3.4
3. Academic thinking and argumentation
3.4 An ability to critically appraise, in a professional, factual and non-emotive manner, claims made in the media, including digital media such as websites, or those made by colleagues, supervisors and trainers.



EXAMPLE ANSWER AND ASSISTANCE

Q10
Note the approach required and the learning outcome
Professionally critically appraise article

Example Answer from student, “Founded in July 1948, funded by national insurance contributions, the National Health Service was intended to provide access to health care “Free at the point of delivery”.
The funding of the NHS has been a massive problem to successive governments ever since. As medical practices and techniques have evolved, leading to newer and more expensive equipment for both diagnosis and treatment, whole industries are now geared toward researching, developing and supplying new drugs for each and every malady imaginable.
Against such a background, one might think that a safe and effective alternative would be embraced by most medical professionals, both for the economies involved and the comfort of their patients. Unfortunately, it appears that many doctors choose to ignore the results of the published research into the benefits of hypnosis. Possibly viewed as a “Mystical” or “Eastern” practice, it is shunned by the modern Western medical community in favour of manufactured drugs and surgical solutions.
In at least one field of medicine, published research has proved the efficacy of hypnotherapy. Dr. Roland Valori of Gloucershire Royal Hospital, editor of “Fronline Gastroenterology”, says that symptoms of IBS (Irritable Bowel Syndrome) improved significantly for 9 in 10 of his first 100 patients so treated. He began referring patients as long ago as the 1990s and has found it to be very effective. “It is pretty clear to me that it has an amazing effect” “Of the relaxation therapies available, hypnotherapy is the most powerful” he said.
Despite research showing that hypnosis could help IBS sufferers as early as the 1980s, it is still rarely offered as an option. Current NHS guidelines allow for referral for hypnotherapy or other psychological therapies if medication is unsuccessful or symptoms persist. Doctor Valori thinks that the research may have been overlooked because many doctors find it hard to believe that it could possibly work, and cannot understand how it might work.
Two other areas where hypnotherapy could prove cost effective and beneficial are weight control and smoking cessation. According to a report in August 2013 by the Health & Social Care Information centre (HSCIC);
- Over 2.2 million items were prescribed at a cost of over £58 million to help smoking cessation in England.
- Around 462,900 adult hospital admissions were attributable to smoking
According to a study by Mckinsey Global Institute (MGI) in November 2014, obesity has the second largest health impact after smoking. The UK currently spends £47 billion every year on treatment of obesity, and bringing just 20 percent of overweight individuals back to “normal” weight within 5 to 10 years would save the NHS £766 million every year.
Dr. Alison Tedstone, chief nutritionist at Public Health England (PHE) said that tackling the problem required communication between public and private sectors, and “There is no single ‘silver bullet’ solution. Today 25 percent of the nation is obese and 37 percent is overweight. If we reduce obesity to 1993 levels, where 15 percent of the population were obese, we will avoid 5 million disease cases and save the NHS alone an additional £1.2 billion by 2034,”
As more hypnosis techniques are utilized and further research is conducted and published, still greater results may be obtained across many more areas of treatment, to the point that hypnotherapy and hypnosis could become a mainstream NHS offering.
Surely further education and promotion of these techniques could be of massive benefit to medical staff and the NHS as a whole, not to mention the patients. “
Q10. Correct. I like the way you have, again, really read and understood the elements of the question and answered accordingly, drawing on the given article and also adding to its premise with further research. This is a very interesting and informative answer.


HOME QUESTIONS The ADVANCED: Q9

Q9. State two major theories of hypnosis. Outline and briefly discuss. Using the Harvard citation method detail how you discovered this information. Learning outcomes: 2.1, 3.3
2. Theory and its application
2.1 Knowledge of the various theories on the nature of hypnosis.
3. Academic thinking and argumentation
3.3 An ability to reference other authors' work properly, e.g. in 'Harvard' and 'footnote' formats.




EXAMPLE ANSWER AND ASSISTANCE

Q9
Note length of required answer and learning outcome
State 2 theories, outline & briefly discuss (therefore shorter answer required)
Give appropriate citation reference

Example Answer from student, The “Neodissociation theory” (Hilgard,1974) and the “Socio-cognitive theory” (Spanos, 1986) are two competing theories regarding the phenomena of hypnosis.
Neodissociation is a “State” theory, that is to say that the hypnotized person is thus in an altered state of mind. The hypnotists’ suggestions act upon the dissociated part of the “Executive Control System” which is shielded from the rest of the mind by an “amnesic barrier”. Therefore the subject can be aware of the results of the given suggestions, but remain unaware as to how they were achieved. Hilgards theory arose from his experiments into the “hidden observer” phenomenon whereby a “hidden” part of the mind can be accessed to report on experiences that the subject is not aware of. This concept of conscious and unconscious executive control systems exhibited in hypnosis is controversial. (e.g Heap et al , 2004: Kirsch & Lynn, 1998)
Spanos’ “Socio-cognitive” theory would appear to be the polar opposite of dissociation, in that it is a “Non-state” theory. It argues that subjects actively participate in the process, and that any phenomena of involuntary experience is actually the result of normal psychological processes such as beliefs, expectancies and motivation. (Spanos et al , 1980) That is not to say that the client is deliberately deceiving the hypnotist, or pretending to be affected when they are not. Rather, their acceptance of a phenomena or particular result actually causes said results to be manifested.”

Q9. Correct, You have read the question well and I like the way you compared the two models that you have chosen. You have a good understanding of these models and have presented them clearly and succinctly. The only point to be aware of in future is that of a full stop in certain of the citations, where necessary, the following format applies et al., as in Heap et al., rather than Heap et al , 2004.  


Example Student Answer:  Simplifying the definition of hypnosis into a single sentence: ‘A relaxed state of focussed concentration’ may be enough to appease a nervous client who fears being made to behave like the stereotypical chicken under some kind of magic spell, does not simplify the actual theorists who have done their best to explain the phenomenon of hypnosis.

There are a few camps that one could be a part of in defining hypnosis and I have chosen to concentrate on ‘state’ and ‘non-state’ theories.

Perhaps the grand master of state theories is Hilgard himself, with his ‘Neodissociation theory’ (Hilgard, 1977, 1986, 1994). According to this theory, the human being is existing with ‘multiple cognitive systems or cognitive structures which exist in hierarchical arrangement under some kind of control by an executive ego’ (Steven Jay Lynn , Irving Kirsch, 2005). This controller oversees the various functioning parts of the system and makes decisions, plans and controls the functions of the personality. Therefore, during hypnosis the relevant parts or ‘subsystems’ are temporarily dissociated and relinquish control whilst the hypnotherapist offers suggestions and directly activates these subsystems to behave or think in a different way.

This is explained by Hilgard as the ‘Hidden Observer’, a metaphor that Hilgard explains as a part of the consciousness that absorbs, processes and stores information without the subject being aware of it. Through experimentation with pain and analgesia, Hilgard was able to access this ‘hidden observer’ who could ‘remember’ pain even though the part of the person who was responsible for feeling the pain was ‘switched off’ through hypnosis. In this same way, Hilgard suggested that hypnotic blindness, deafness and hypnotic hallucinations can be penetrated by this hidden observer. Therefore a suggestion of deafness to a certain sound can be activated and the client would not ‘hear’ the sound after the suggestion by the hypnotist, but the hidden observer could be accessed and would be able to hear it. This idea of a controller, or hidden observer is controversial and directly opposed by Spanos et al, who are in favour of the sociocognitive perspective which rejects the idea that the hidden observer simply ‘exists’ in favour of the theory that the hidden observer is dependent on cues and suggestions given by the hypnotist, either implicitly or explicitly, and is therefore no different to any other suggested hypnotic phenomenon which are shaped and created by what the client believes they are ‘supposed’ to be experiencing- demand characteristics: the clients experience being a result of what the client expects to experience in line with what the therapist expects to dictate.

Sarbin and Coe’s theory challenges the typical concept of hypnosis being a special ‘state’, instead suggesting that the client therapist relationship is a series of unvoiced ‘scripts’ (Sarbin, 1997) and a role play between the therapist and the client, acting out what is expected of them in that situation. Within this role play, the client is guided by what they know and learn about what is expected of them and the therapeutic outcome is constructed through dramatization and imaginings dependent on how the client perceives their role in the relationship. Spanos and his colleagues (1986, 1991, Spanos and Chaves 1989) have researched this theory and have expressed the importance of the psychological processes; expectancies, attributions and interpretations of the hypnotist/client relationship (Steven Jay Lynn , Irving Kirsch, 2005). Spanos describes the involuntariness of the reaction to hypnotic suggestion as a “goal directed fantasy” (GDF) or “imagined situations which, if they were to occur would be expected to lead to the involuntary occurrence of the motor response” (Spanos, Rivers and Ross, 1997) for example, the levitation of an arm or closing of eyelids, or movement of finger in response to a question or suggestion.


Both of these theories have their merits and either or both could be accurate. Whilst state theory suggests that the client is not in conscious control and the suggestions of the hypnotist are directly internalised and involuntarily recreated, Spanos et al and their non-state theory are not suggesting that the client is deceiving or misleading the therapist by acting ‘as if’ it were ‘real’, rather that there are certain roles that are undertaken in every situation including that relationship between a client and a hypnotist. Either way the desired outcome can be achieved.

Correct. A comprehensive answer clearly defining the different models, giving proper citations as required, thank you. 


Example Student Answer:  The big debate in the field of hypnosis is ‘state’ vs ‘non-state’. There are many differences in the theories, which make up the debate. State theorists believe that hypnosis is an altered state of consciousness, maybe a mystical state which the hypnotist ‘does’ to the person. On the flip side, non-state theorists believe that normal human psychological processes are capable of responding to suggestion within normal human functions, therefore, the results experienced in hypnosis can be achieved without the ‘hypnotic trance’. (Eason, A. 2009).

Kirsch’s Response Expectancy Theory (Kirsch, 1985) is a non-state theory, based upon the belief that we produce an expected outcome through our behaviour. It can be described as a ‘placebo effect’ where the person believes that the suggestions given to them during hypnosis will bring changes in their behaviour to reach the desired outcome. Kirsch and Lynn (1977) argue that during the hypnosis setting, the person believes in the hypnotist’s suggestions and accepts that they will involuntarily change their behaviours, following the hypnotist’s instructions, as a result, reaching the desired outcome. They believe that as our expectation of experience greatly affects our actual experience, the subjects went on to change their behaviour in ways, which achieved the desired outcome. Although the subjects would experience these as being involuntary, and are likely to believe that the changes were as a result of the hypnosis, Kirsch argues that instead, the changes would have been initiated by the same means as voluntary responses but experienced in a different way.

Hilgard’s Neodissociation Theory (Hilgard, 1979,1986) is a classic state theory. Neodissociation is based upon the belief that the ‘hypnotic trance’ is a result of a dissociation within the executive control system, part of which is said to function normally but an ‘amnesic barrier’ means that it is unable to present itself in conscious awareness, therefore, the subject is experiencing an altered state of mind. According to this theory, the subject has an awareness of their present reality during the hypnosis situation, whilst also believing in the reality of the hypnotic suggestions being offered to them by the hypnotist.

Hilgard’s theory emerged from his experiments with the ‘hidden observer’. He found that during the ‘hypnotic trance’, a hidden part of the mind could be accessed, with information being obtained regarding experiences, which the subject is not consciously aware of.

State theorists will working the way [find a way?] of ensuring that the subject is ‘in an hypnotic’ trance, or state, so they will be checking for formal levels of trance, probably in a traditional setting, such as the client sitting in a chair or lying down.

Non-state theorists may work differently in that they believe that hypnotherapy doesn’t require a specific ‘state’ to be achieved for hypnosis to take place. For example, they may work with a client who is concentrating on something, or in deep thought about something. They will then begin to use suggestions as the client is relaxed, yet focussed.


References: Eason, A. 2009. Adam Eason School of Hypnotherapy and Hypnosis [Online]. Available at: www.adam-eason.com/2009/10/14/the-big-hypnosis-debate-state-or-nonstate/ [Accessed:27th April 2015]



Correct. This is a very clear answer with good comparisons between Kirsch and Hilgard. A comprehensive answer clearly defining the different models, giving proper citations as required, thank you.