Hypnosis & Placebo Therapy
Suggestion & Non-deceptive (“Non-blind”) Placebo Research
Copyright (c) Donald Robertson, 2008
In a sense, the history of hypnosis is all about the discovery of the placebo effect and its relation to verbal suggestion. The Mesmerists believed that they were placing people in a “trance” and influencing them by means of an invisible energy known as “animal magnetism.” Physicians and scientists of the day were naturally sceptical. Mesmerism was, therefore, one of the first major objects, and victims, of early medical placebo research. The overall conclusion of the early scientific committees studying Mesmerism was that its effects were often real but due to “belief” and “imagination” rather than anything resembling animal magnetism.
Ironically, it took several decades before someone, in response to these criticisms, could popularise an alternate system explicitly based upon the assumption that belief and imagination were effective as a technique in their own right. In the early 1840s, James Braid, introduced the term “neuro-hypnotism”, or “hypnotism” for short, to describe a special state of physical relaxation and nervous fatigue. Although Braid did not fully recognise the role of belief and imagination, i.e., suggestion, until later in his career, he did categorically reject the theory of invisible energy proposed by Mesmer.
Some of the areas where research has most strongly established the placebo effect, such as in pain management and the treatment of neurotic disorders, are also areas where hypnosis is proven to be particularly effective. Indeed, until the introduction of chemical anaesthetics around 1845 the dominant use of Mesmerism was in the treatment of pain, hypnotic anaesthesia, and subsequently its primary use became the treatment of “hysteria” or neurotic and psychosomatic symptoms.
In the 1960s, two researchers called Park and Covi published a groundbreaking article entitled simply ‘Nonblind placebo trial: An exploration of neurotic patients’ responses to placebo when its inert content is disclosed’ in The Archives of General Psychiatry (April 1965, vol. 12). They selected 15 neurotic patients from the outpatient dept. of a psychiatric clinic, with a variety of mental and physical ailments. Each patient was seen individually for two sessions only, once for a one-hour assessment and again for a 15-30 minute prescription session. They were each given a bottle of placebo pills, without any active ingredients, to be taken three times per day. Patients were each read the following script at the second appointment,
“Mr. Doe, at the intake conference we discussed your problems and it was decided to consider further the possibility and the need of treatment for you before we make a final recommendation next week. Meanwhile, we have a week between now and our next appointment, and we would like to do something to give you some relief from your symptoms. Many different kinds of tranquilisers and similar pills have been used for conditions such as yours, and many of them have helped. Many people with your kind of condition have also been helped by what are sometimes called “sugar pills,” and we feel that a so-called sugar pill may help you, too. Do you know what a sugar pill is? A sugar pill is a pill with no medicine in it at all. I think this pill will help you as it has helped so many others. Are you willing to try this pill?” (Park & Covi, 1965)
Only one patient expressed reluctance to take part in the experiment. Of the remaining 14 patients, 13 showed signs of significant improvement across a battery of self-report and psychiatrist administered measures. Overall there was a ‘highly significant’ 41% decrease in symptoms reported, on average for each subject, across different measures. The researchers note that this was greater than the improvement found in previous studies of real drugs, using the same measures. Four patients reported, indeed, that the placebo medication did them more good than anything they’d previously been prescribed. By contrast, the one patient who dropped out was subsequently assessed and found to have increased on the same measures of symptom severity.
Some patients were convinced they were receiving placebos, others convinced themselves that the script was a ruse and assumed the “sugar pill” must contain some active ingredient. Notably, however, one patient actually compared the non-blind placebo experiment to a kind of hypnosis,
The patient indicated that she was quite suggestible, and she thought the treatment had been effective through a form of ‘hypnosis’ because she had been told so many times she would improve. (Park & Covi, 1965)
Perhaps she was right; at least her interpretation of the proceedings would accord with Kirsch’s model of hypnosis as a “non-deceptive mega-placebo”, and perhaps even with James Braid’s original perspective on the relationship between hypnotic suggestion and placebo therapy. Indeed, like Braid, the researchers conclude that the use of non-deceptive placebos could have “psychotherapeutic implications”, by using suggestion to heighten expectation in combination with factors which the researchers term “support and autonomy”,
The present placebo treatment could be viewed as having some affinity to psychotherapy not only in a manner similar to the “non-specific form of psychotherapy” which Rosenthal and Frank describe as “produced by the patient’s faith in the efficacy of the therapist and his technique.” Two major characteristics of accepted psychotherapeutic techniques were present: on the one hand, support and reassurance were given, while, on the other hand, the responsibility for improvement was thrown back to the patient by means of the paradoxical statement that he need treatment but that he could improve with a capsule containing no drug. (Park & Covi, 1965)
It is clear to see how this can be related to the role of suggestion and other “non-specific” factors in modern hypnotherapy. The deliberate attempt to construct a psychotherapy approach based upon an understanding of the placebo effect has been undertaken by a number of authors, e.g., Jefferson M. Fish in his Placebo Therapy: A Practical Guide to Social Influence (1973).