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The Relationship Between the Hypnotic Induction Profile and the Stanford Hypnotic Susceptibility Scale, Form C: Revisited a
b
a
Edward J. Frischholz , Warren W. Tryon , Herbert Spiegel & Stanley Fisher a
a
Columbia University
b
Fordham University Published online: 06 Nov 2014.
Click for updates To cite this article: Edward J. Frischholz, Warren W. Tryon, Herbert Spiegel & Stanley Fisher (2015) The Relationship Between the Hypnotic Induction Profile and the Stanford Hypnotic Susceptibility Scale, Form C: Revisited, American Journal of Clinical Hypnosis, 57:2, 129-136, DOI: 10.1080/00029157.2015.967069 To link to this article: http://dx.doi.org/10.1080/00029157.2015.967069
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American Journal of Clinical Hypnosis, 57: 129–136, 2014 Copyright © American Society of Clinical Hypnosis ISSN: 0002-9157 print / 2160-0562 online DOI: 10.1080/00029157.2015.967069
The Relationship Between the Hypnotic Induction Profile and the Stanford Hypnotic Susceptibility Scale, Form C: Revisited Edward J. Frischholz Downloaded by [University of Otago] at 02:54 12 March 2015
Columbia University
Warren W. Tryon Fordham University
Herbert Spiegel and Stanley Fisher Columbia University
Hilgard’s comment raises some important issues, although many of these have little to do with the primary purpose of the study under discussion. This purpose was to objectively examine the relationship between three conceptually and operationally different procedures for measuring hypnotic responsivity. Hilgard’s concern over the magnitude of the correlation between the HIP and SHSS:C is unfounded. A cross-validated correlation of .66 was found between the HIP and SHSS:C in a new sample of 44 student volunteers. This demonstrates that the HIP correlates about the same with SHSS:C as the Harvard Group Scale of Hypnotic Susceptibility. Hilgard’s conception of the Eye-Roll (ER) hypothesis is clarified. Evidence which utilizes all cases in the correlational analysis is presented in support of the ER hypothesis. Happily, we all agree on a new methodology which will be definitive in testing the validity of the ER hypothesis.
Hilgard (1981) has criticized a recent collaborative study carried out at Fordham and Columbia Universities (Frischholz, Tyron, Vellios, Fisher, Maruffi, & Spiegel, 1980) regarding the relationship between scores on the Hypnotic Induction Profile (HIP; Spiegel & Spiegel, 1978) and scores on the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C; Weitzenhoffer & Hilgard, 1962). This study found a significantly higher relationship between the HIP and SHSS:C than was previously reported (Orne, Spiegel, Spiegel, Crawford, Evans, Orne & Frischholz, 1979). Instead of attempting to interpret the Fordham findings in conjunction with other available data, the thrust of Hilgard’s This article was originally published in the American Journal of Clinical Hypnosis, Vol. 24, No. 2, 1981, pp. 98–105. DOI: 10.1080/00029157.1981.10403296
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criticism is directed at trivializing these findings and downplaying the usefulness of the HIP. We feel that Hilgard’s criticism has raised some important issues although most of these have little to do with the primary purpose of the Fordham-Columbia study. This purpose was to objectively examine the relationship between three conceptually and operationally different procedures for measuring hypnotic responsivity while methodologically controlling for experimental biases which existed in previous studies. Instead, the majority of Hilgard’s discussion is concerned with his interpretation of the theory which underlies the HIP. Thus Hilgard has tangentially transformed a concurrent validation study into a construct validation study. Such a transformation obfuscates the main issue at hand. The time has now come to clarify the issues Hilgard (1979, 1981; and Hilgard, 1979) raises regarding the HIP and its relationship to other methods of measuring hypnotic responsivity. An attempt will be made to examine all available data in the hope of distinguishing what is established fact from theoretical speculation. Previous Findings Regarding the Relationship Between the HIP and SHSS:C Before the collaborative study under discussion was carried out, three previous attempts were made to estimate the relationship between the HIP and SHSS:C. One study carried out at the University of Pennsylvania (Orne et al., 1979) reported a correlation of .45 (p < .001) between these two measures. Unfortunately, in this study the HIP and SHSS:C were administered years apart. A second study, carried out at Stanford University (Orne et al., 1979) reported a correlation of .19 (p > .05) between the HIP and SHSS:C. However, in this study the reliability coefficient between the two forms of SHSS (r = .65) was well below that expected for two alternate forms of the same test. Such reliability coefficients typically fall in the .80’s or .90’s (cf. Anastasi, 1976). Thus, if there was lowered intra-method consistency, then one would expect the inter-method consistency to be even lower yet. While carrying out a study on the relationship between hypnotic responsivity and the ability to learn thermal biofeedback, Frischholz and Tryon (1980) reported a correlation of .601 (p < .001) between the HIP and SHSS:C. Unfortunately, the same examiner administered both measures. No significant association was found between either measure of hypnotic responsivity and the ability to learn thermal biofeedback illustrating the situational convergence of these methods in drawing similar conclusions. A detailed discussion of these previous studies regarding the relationship between the HIP and SHSS:C can be found in Frischholz, Spiegel, Tryon, and Fisher (1981). It was due to the possible biases operating in these previous studies that the collaborative study under discussion (Frischholz et al., 1980) was carried out. The HIP and the SHSS:C were administered in a counter-balanced order by two qualified examiners who were unaware of a subject’s score on a previously given measure. In addition, after the administration of each measure, each subject was asked to rate how hypnotized
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he/she felt on an 11-point scale. A correlation of .63 (p < .001) was reported between the HIP and SHSS:C. Collectively, an average correlation of .66 was reported for the inter-relationships between the HIP, SHSS:C, and the subject’s self-ratings of hypnotic responsivity. A central point of Hilgard’s (1981) criticism of the above study concerns the magnitude of the correlation between the HIP and SHSS:C. Hilgard concludes that the value of .45 found at the University of Pennsylvania was probably the most accurate estimate of this relationship. Such a contention is based on his observation that the value reported in the Stanford study was probably an underestimate and the values reported from the Fordham-Columbia studies were probably an overestimate of this relationship. It is interesting in this regard that Orne2 had at one point reported a correlation of .55 between the HIP and SHSS:C for the University of Pennsylvania sample. Before this, Orne3 had originally reported a correlation of .64. Three requests have been made over a two-year period for the original data so that an independent calculation of the correlations could be made. The data have yet to be received! In order to clarify the issue concerning the magnitude of the relationship between the HIP and SHSS:C, a second study was carried out at Fordham and Columbia Universities (Frischholz et al., 1981). In this study, 44 new subjects were administered the HIP, SHSS:C, and two self-ratings of hypnotic responsivity under the same conditions described by Frischholz et al. (1980). The prediction weights for the Induction Score (IND) of the HIP derived in the Frischholz et al. (1980) study were then applied in this new sample. The prediction weights derived in the Frischholz et al. (1981) sample were also used to predict scores in the Frischholz et al. (1980) sample. The average cross-validated correlation between the HIP and SHSS:C was found to be .66 (p < .001). The average cross-validated correlations between all measures of hypnotic responsivity utilized in the study were found to be .69. In summary, the preponderance of studies now appears to suggest that the true correlation between the HIP and SHSS:C is in the mid .60’s. The impressiveness of this result is illustrated by two points. First, the alternate form reliability of the SHSS:C is .72 (Hilgard, 1965). Second, is the fact that different measures of the same construct, intercorrelate less than the reliability coefficients of the measures themselves. For example, the correlation between the Harvard Group Scale of Hypnotic Susceptibility and SHSS:C has been reported to be .59 (Evans & Schmeidler, 1966). We, therefore, conclude that the HIP is measuring most of what SHSS:C is measuring. The HIP certainly answers the clinically relevant questions of how hypnotically responsive a particular patient is. Indiction Score: Structure and Psychometric Properties Hilgard (1979, 1981; and J. Hilgard, 1979) has consistently and incorrectly characterized the HIP as a “single item” test, choosing to focus on the second arm levitation as the only “measure of hypnotic responsivity.” In fact, the HIP is a multi-item test. The five items consist of: a subjective experience of dissociation; posthypnotic arm
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levitation, a subjective experience of nonvoluntarism, cut-off to a posthypnotic signal, and a subjective sense of floating. The items of the HIP are continuously scored. Thus, it is not informative to speak of simply “passing an item” (cf. Hilgard, 1979). Rather it is more informative to know to what degree a particular item was passed. A summary score, known as the Induction score (IND) is obtained by summing across these five items. We have already demonstrated that the IND score is substantially correlated with SHSS:C and subject’s self-ratings of hypnotic responsivity. Some investigators have questioned the psychometric properties of the HIP (e.g., Bowers, Reference Note 1; Hilgard, 1981; Hilgard & Hilgard, 1979). However, several psychometric papers (DeBetz & Stern, 1980; Spiegel, Aronson, Fleiss & Haber, 1976; Spiegel & Spiegel, 1978; Stern, Spiegel & Nee, 1979) have clearly demonstrated that the distribution of HIP scores is stable within different psychiatric populations. In addition, the scores are internally consistent (standardized item alpha = .81), temporally stable after a three year interval (r = .76), and that the items of the IND score load substantially on a single factor. Self-Rating of Hypnotic Responsivity and the Experience of Non-Voluntarism Hilgard (1981) notes that subject’s self-ratings of hypnotic responsivity following the SHSS:C are significantly higher than their self-ratings following the HIP. This finding was replicated by Frischholz et al. (1981) and is not at all surprising. Naive subjects exposed to a 15-minute hypnotic induction ceremony in which they are repeatedly told to go into a “deep, deep, sleep” followed by a 40-minute exposure to a standardized set of hypnotic instructions, should be expected to rate their experience higher than a 5-minute procedure. However, the highly significant correlation between the SHSS/C self-ratings and HIP self-ratings (r = .78) clearly indicates the high consistency between the two procedures. Hilgard (1981) interprets the above finding as providing evidence that the SHSS:C taps the phenomenon of nonvoluntarism associated with hypnotic responses. We do not understand why Hilgard equates self-ratings of hypnotic responsivity with nonvoluntarism. Weitzenhoffer (1980), the senior author of the Stanford scales, has provided compelling evidence that observed responses to hypnotic instructions can be much different than the subjective experience of nonvoluntarism associated with these responses. Weitzenhoffer (1980) also notes that this subjective experience of nonvoluntarism is more congruent with traditional definitions of the domain of hypnosis. Clearly, Hilgard’s interpretation lacks substance. Other Advantages of the HIP The HIP has other advantages than its brevity, clinical appropriateness, and substantial overlap with SHSS/C. The first advantage is that clinical norms are available based
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upon thousands of psychiatric outpatients (DeBetz & Stern, 1980; Spiegel, Aronson, Fleiss & Haber, 1976; Spiegel & Spiegel, 1978; Stern, Speigel & Nee, 1979). A new HIP manual (Spiegel, Spiegel & Frischholz, Reference Note 2) will present normative data on psychiatric outpatients, psychiatric inpatients, VA in and out-patients, medical outpatients, and college students. The wealth of standardization information on the HIP make it an especially useful measure in the clinical sphere. The second advantage of the HIP concerns its proven effectiveness in predicting treatment outcome (Katz, Kao, Spiegel, Katz, 1974; D. Spiegel, Frischholz & Fleiss, Reference Note 3; D. Spiegel, Frischholz, Maruffi & Spiegel, in press; H. Spiegel & D. Spiegel, 1978), personality (Frischholz, D. Spiegel, H. Spiegel & Balma, Reference Note 4) and severity of psychopathology (D. Spiegel, Detrick & Frischholz, in press; Spiegel, Fleiss, Bridger & Aronson, 1975). These studies clearly confirm the clinical utility of the HIP. The Eye-Roll Sign and Profile Grade of the HIP Hilgard takes issue with the validity of the Eye-Roll hypothesis (Spiegel, 1972; Spiegel & Spiegel, 1978) and the logic underlying the Profile Grade of the HIP. In fact, Hilgard states that “the Eye-Roll is no longer used in determining the Profile Grades.” This is completely untrue. It should be noted at this point, that Hilgard is not taking issue with the clinical utility of the Eye-Roll Sign (ERS). His acknowledgement of its predictive utility is illustrated in his book on “Hypnosis in the Relief of Pain” (Hilgard & Hilgard, 1975), in which he reports a correlation of .50 (which he computed) between Eye-Roll Grades and successful treatment of acupuncture. Hilgard interprets this finding as “suggesting parallels between hypnosis and acupuncture in pain reduction (Hilgard & Hilgard, 1975, p. 198).” It should also be noted that Hilgard (1981) does not take issue with the fact that the Profile Grade of the HIP discriminates between low and high hypnotic responders as indexed by SHSS. In all published studies to date, the Profile Grade has been found to be significantly associated with scores on SHSS. Rather, Hilgard does take issue with the interpretability of the ERS as an indicator of “manifest hypnotic responsivity.” He then cites several correlational studies which show that the ERS correlates poorly with measures of manifest hypnotic responsivity. A brief explanation of the Eye-Roll hypothesis may clarify this issue. The ERS is hypothesized to be a presumptive biological sign of hypnotic capacity. However, Spiegel (1972) also observed that the ERS is a false positive indicator of hypnotic responsivity approximately 25% of the time. In other words, a subject may have the necessary “biological wiring” to experience hypnosis, but something may be blocking this person’s ability to express this capacity. This is what is meant by the intact/nonintact profile grade categories. For example, a positive ERS and a manifest responsivity to hypnosis indicates that a person has the necessary biological potential for hypnosis and is capable of expressing it. A non-intact profile score (i.e., a positive ERS and no manifest
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responsivity to hypnosis) indicates that a person has the necessary biological potential, but that something is blocking the expression of this hypnotic capacity. H. Spiegel and his colleagues (Spiegel et al., 1975) have demonstrated that one potential block4 of hypnotic capacity is the presence of psychopathology. In this study, a significant association was found between a non-intact HIP Profile Grade and severe psychopathology as indexed by a comprehensive battery of psychological tests. The ramification of this finding is that the ERS should correlate significantly with manifest hypnotic responsivity within those subjects who earn intact profiles. The majority of evidence provides support for this contention. Unfortunately, as Hilgard and the present authors note, such a procedure may also produce a statistical artifact. This happens because if one computes a correlation between the ERS and manifest hypnotic responsivity only within intact profiles, many discrepant cases are eliminated from the correlational analysis. Obviously, this methodology is not appropriate for testing the validity of the Eye-Roll hypothesis. In order to clarify this issue, a new methodology was employed (Spiegel & Spiegel, 1978) which utilized all subjects in the correlational analysis. A group of psychiatric patients was administered the HIP and then sent to a psychologist for diagnostic testing. The psychologist, who was unaware of the patient’s ERS or HIP scores, administered a comprehensive battery of psychological tests. On the basis of their performance on the psychological battery, the psychologist screened out those patients who were severely disturbed (n = 49) from those who were not (n = 56). Separate correlations were then computed between the ERS and manifest hypnotic responsivity within the two patient groups. The correlation within the healthy patient group (r = .52) was significantly higher (z = 2.3, p < .05) than the correlation in the severely disturbed patient group (r = .15). The above study supports the validity of the ER hypothesis. Hilgard (1981) does not report the correlation of .52 between the ERS and IND scale within the healthy group of patients because he maintains that it was obtained under unusual circumstances. The present authors see nothing unusual with the above methodology. In fact, it highlights what is known in psychometrics as a “moderator variable” (cf. Anastasi, 1976; Saunders, 1956). That is, the validity of the ER hypothesis is moderated by the presence or absence of psychopathology. We also recognize that correlational data alone are insufficient to resolve the issue of potential hypnotic responsivity. In fact, data where one patient status is associated with one test score is always insufficient to resolve issues of potential anything. What is needed are data that associate two clinical statuses with two scores within the same person pre and post the removal of or diminuation of the hypothesized block. That is, patients need to be given the HIP before and after treatment that was effective in reducing hypothesized hypnotic blocks. The desired outcome would be that the manifest IND score would increase in direct proportion to the extent to which the hypnotic block is removed.
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Hilgard (1981) appears to accept the above methodology for clarifying whether the Eye-Roll sign is truly a measure of hypnotic potential when he wrote “the answer would be clear if the deficits could be overcome and hypnotic responsiveness increased.” It is agreed that data of the two status-two test score variety will be definitive in connection with the Eye-Roll sign of potential hypnotic responsivity. We, therefore, encourage the scientific community with access to mental health populations undergoing treatment to conduct studies along these lines.
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Funding Preparation of this manuscript and the studies described within was made possible by grants from the Charles E. Merrill Trust and the Merlin Foundation. Notes 1. Two subjects who were administered the HIP and SHSS:C in this study were unable to complete the biofeedback phase of the experiment due to academic commitments. If these two subjects’ scores were included in computing the correlation between the HIP and SHSS:C, the correlation would be 4(26) = .63, p < .001. 2. Orne personally transmitted this value to H. Spiegel over the telephone. The value was published with Orne’s approval in the International Journal of Clinical and Experimental Hypnosis (of which Orne is the editor). The exact reference is: Spiegel, H., Aronson, M., Fleiss, J. L. & Haber, J. Pyschometric Analysis of the Hypnotic Induction Profile. International Journal of Clinical and Experimental Hypnosis, 1976, 24, 300–315. 3. Martin T. Orne, written personal communication dated November 2, 1973. 4. Undoubtedly, there are many potential blocks of manifest hypnotic responsivity. For example, unpublished data from our laboratory suggest that neurological impairments also moderate the expression of responsivity to hypnosis.
Reference Notes 1. Bowers, K. Has the sun set on the Stanford Scales: No, not really. Paper presented at the annual meeting of the American Psychological Association, Montreal, September, 1980. 2. Spiegel, H., Spiegel, D., & Frischholz, E. J. Assessing Hypnotic Responsivity in Clinical Contexts. In preparation. 3. Spiegel, D., Frischholz, E. J., & Fleiss, J. L. Characteristics of successful smoking abstainers at six months. Manuscript submitted for publication, 1981. 4. Frischholz, E. J., Spiegel, D., Spiegel, H., & Balma, D. The relationship between hypnotic responsivity, absorption, and spatial awareness in a psychiatric outpatient population: Cross-validation and validity extension. Manuscript submitted for publication, 1981.
References Anastasi, A. (1976). Psychological testing. New York: Macmillan Co. DeBetz, B., & Stern, D. B. (1979). Factor analysis and score distributions of the HIP-replication by a second examiner. American Journal of Clinical Hypnosis, 22, 95–102.
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Evans, F. J., & Schmediler, D. (1966). Relationship between the Harvard Group Scale of Hypnotic Susceptibility and the Stanford Hypnotic Susceptibility Scale, Form C. International Journal of Clinical & Experimental Hypnosis, 14, 333–343. Frischholz, E. J., & Tryon, W. W. (1980). Hypnotizability in relation to the ability to learn thermal biofeedback. American Journal of Clinical Hypnosis, 23, 53–56. Frischholz, E. J., Tryon, W. W., Vellios, A. T., Fisher, S., Maruffi, B. L., & Spiegel, H. (1980). The relationship between the Hypnotic Induction Profile and the Stanford Hypnotic Susceptibility Scale, Form C: A replication. American Journal of Clinical Hypnosis, 22, 185–196. Frischholz, E. J., Spiegel, H., Tryon, W. W., & Fisher, S. (1981). The relationship between the Hypnotic Induction Profile and the Stanford Hypnotic Susceptibility Scale Form C: Cross-Validation and Validity Extension, American Journal of Clinical Hypnosis, in press. Hilgard, E. R. (1965). Hypnotic susceptibility. New York: Harcourt Brace & World. Hilgard, E. R. (1979). The Stanford Hypnotic Susceptibility Scales as related to other measures of hypnotic responsiveness. American Journal of Clinical Hypnosis, 21, 68–83. Hilgard, E. R. (1981). The Eye-Roll Sign and other scores of the Hypnotic Induction Profile (HIP) as related to the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C): A critical discussion of a study by Frischholz and others. American Journal of Clinical Hypnosis. Hilgard, E. R., & Hilgard, J. J. (1975). Hypnosis in the relief of pain. Chicago: William Kaufman. Hilgard, J. R., & Hilgard, E. R. (1979). Assessing hypnotic reponsiveness in a clinical setting: A multiitem clinical scale and its advantages over single-item scales. International Journal of Clinical & Experimental Hypnosis, 27, 134–150. Katz, R. L., Kao, C. Y., Spiegel, H., & Katz, G. J. (1974). Pain, acupuncture, hypnosis. In J. Bonica (ed.) Advances in Neurology, Vol. 4. New York: Raven Press. Orne, M. T., Hilgard, E. R., Spiegel, H., Spiegel, D., Crawford, H. J., Evans, F. J., Orne, E. C., & Frischholz, E. J. (1979). The relation between the Hypnotic Induction Profile and the Stanford Hypnotic Susceptibility Scales, Forms A and C. International Journal of Clinical & Experimental Hypnosis, 27, 85–102. Saunders, D. R. (1956). Moderator variables in prediction. Education and Psychological Measurement, 16, 209–222. Spiegel, D., Detrick, D., & Frischholz, E. J. (in press). Hypnotizability and psychotherapy. American Journal of Psychiatry. Spiegel, D., Frischholz, E. J., Maruffi, B. L., & Spiegel, H. (1981). Hypnotic responsivity and the treatment of flying phobia. American Journal of Clinical Hypnosis, 23, 239–247. Spiegel, H. (1972). An Eye-Roll test for hypnotizability. American Journal of Clinical Hypnosis, 15, 25–28. Spiegel, H., Aronson, M., Fleiss, J. L., & Haber, J. (1976). Psychometric analysis of the Hypnotic Induction Profile. International Journal of Clinical & Experimental Hypnosis, 24, 300–315. Spiegel, H., Fleiss, J. L., Bridger, A. A., & Aronson, M. (1975). Hypnotizability and Mental Health. In S. Arieti (Ed.), New dimensions of world psychiatry: A world view. New York: John Wiley & Sons. Spiegel, H., & Spiegel, D. (1978). Trance and treatment: Clinical uses of hypnosis. New York: Basic Books. Stern, D. B., Spiegel, H., & Nee, J. C. M. (1979). The Hypnotic Induction Profile: Normative observations, reliability and validity. American Journal of Clinical Hypnosis, 21, 109–132. Weitzenhoffer, A. M. (1980). Hypnotic susceptibility revisited. American Journal of Clinical Hypnosis, 22, 130–146. Weitzenhoffer, A. M., & Hilgard, E. R. (1962). Stanford Hypnotic Susceptibility Scale Form C. Palo Alto: Consulting Psychologists Press.
American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
The Relationship Between the Hypnotic Induction Profile and the Stanford Hypnotic Susceptibility Scale, Form C: Revisited a
b
a
Edward J. Frischholz , Warren W. Tryon , Herbert Spiegel & Stanley Fisher a
a
Columbia University
b
Fordham University Published online: 06 Nov 2014.
Click for updates To cite this article: Edward J. Frischholz, Warren W. Tryon, Herbert Spiegel & Stanley Fisher (2015) The Relationship Between the Hypnotic Induction Profile and the Stanford Hypnotic Susceptibility Scale, Form C: Revisited, American Journal of Clinical Hypnosis, 57:2, 129-136, DOI: 10.1080/00029157.2015.967069 To link to this article: http://dx.doi.org/10.1080/00029157.2015.967069
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [University of Otago] at 02:54 12 March 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
American Journal of Clinical Hypnosis, 57: 129–136, 2014 Copyright © American Society of Clinical Hypnosis ISSN: 0002-9157 print / 2160-0562 online DOI: 10.1080/00029157.2015.967069
The Relationship Between the Hypnotic Induction Profile and the Stanford Hypnotic Susceptibility Scale, Form C: Revisited Edward J. Frischholz Downloaded by [University of Otago] at 02:54 12 March 2015
Columbia University
Warren W. Tryon Fordham University
Herbert Spiegel and Stanley Fisher Columbia University
Hilgard’s comment raises some important issues, although many of these have little to do with the primary purpose of the study under discussion. This purpose was to objectively examine the relationship between three conceptually and operationally different procedures for measuring hypnotic responsivity. Hilgard’s concern over the magnitude of the correlation between the HIP and SHSS:C is unfounded. A cross-validated correlation of .66 was found between the HIP and SHSS:C in a new sample of 44 student volunteers. This demonstrates that the HIP correlates about the same with SHSS:C as the Harvard Group Scale of Hypnotic Susceptibility. Hilgard’s conception of the Eye-Roll (ER) hypothesis is clarified. Evidence which utilizes all cases in the correlational analysis is presented in support of the ER hypothesis. Happily, we all agree on a new methodology which will be definitive in testing the validity of the ER hypothesis.
Hilgard (1981) has criticized a recent collaborative study carried out at Fordham and Columbia Universities (Frischholz, Tyron, Vellios, Fisher, Maruffi, & Spiegel, 1980) regarding the relationship between scores on the Hypnotic Induction Profile (HIP; Spiegel & Spiegel, 1978) and scores on the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C; Weitzenhoffer & Hilgard, 1962). This study found a significantly higher relationship between the HIP and SHSS:C than was previously reported (Orne, Spiegel, Spiegel, Crawford, Evans, Orne & Frischholz, 1979). Instead of attempting to interpret the Fordham findings in conjunction with other available data, the thrust of Hilgard’s This article was originally published in the American Journal of Clinical Hypnosis, Vol. 24, No. 2, 1981, pp. 98–105. DOI: 10.1080/00029157.1981.10403296
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criticism is directed at trivializing these findings and downplaying the usefulness of the HIP. We feel that Hilgard’s criticism has raised some important issues although most of these have little to do with the primary purpose of the Fordham-Columbia study. This purpose was to objectively examine the relationship between three conceptually and operationally different procedures for measuring hypnotic responsivity while methodologically controlling for experimental biases which existed in previous studies. Instead, the majority of Hilgard’s discussion is concerned with his interpretation of the theory which underlies the HIP. Thus Hilgard has tangentially transformed a concurrent validation study into a construct validation study. Such a transformation obfuscates the main issue at hand. The time has now come to clarify the issues Hilgard (1979, 1981; and Hilgard, 1979) raises regarding the HIP and its relationship to other methods of measuring hypnotic responsivity. An attempt will be made to examine all available data in the hope of distinguishing what is established fact from theoretical speculation. Previous Findings Regarding the Relationship Between the HIP and SHSS:C Before the collaborative study under discussion was carried out, three previous attempts were made to estimate the relationship between the HIP and SHSS:C. One study carried out at the University of Pennsylvania (Orne et al., 1979) reported a correlation of .45 (p < .001) between these two measures. Unfortunately, in this study the HIP and SHSS:C were administered years apart. A second study, carried out at Stanford University (Orne et al., 1979) reported a correlation of .19 (p > .05) between the HIP and SHSS:C. However, in this study the reliability coefficient between the two forms of SHSS (r = .65) was well below that expected for two alternate forms of the same test. Such reliability coefficients typically fall in the .80’s or .90’s (cf. Anastasi, 1976). Thus, if there was lowered intra-method consistency, then one would expect the inter-method consistency to be even lower yet. While carrying out a study on the relationship between hypnotic responsivity and the ability to learn thermal biofeedback, Frischholz and Tryon (1980) reported a correlation of .601 (p < .001) between the HIP and SHSS:C. Unfortunately, the same examiner administered both measures. No significant association was found between either measure of hypnotic responsivity and the ability to learn thermal biofeedback illustrating the situational convergence of these methods in drawing similar conclusions. A detailed discussion of these previous studies regarding the relationship between the HIP and SHSS:C can be found in Frischholz, Spiegel, Tryon, and Fisher (1981). It was due to the possible biases operating in these previous studies that the collaborative study under discussion (Frischholz et al., 1980) was carried out. The HIP and the SHSS:C were administered in a counter-balanced order by two qualified examiners who were unaware of a subject’s score on a previously given measure. In addition, after the administration of each measure, each subject was asked to rate how hypnotized
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he/she felt on an 11-point scale. A correlation of .63 (p < .001) was reported between the HIP and SHSS:C. Collectively, an average correlation of .66 was reported for the inter-relationships between the HIP, SHSS:C, and the subject’s self-ratings of hypnotic responsivity. A central point of Hilgard’s (1981) criticism of the above study concerns the magnitude of the correlation between the HIP and SHSS:C. Hilgard concludes that the value of .45 found at the University of Pennsylvania was probably the most accurate estimate of this relationship. Such a contention is based on his observation that the value reported in the Stanford study was probably an underestimate and the values reported from the Fordham-Columbia studies were probably an overestimate of this relationship. It is interesting in this regard that Orne2 had at one point reported a correlation of .55 between the HIP and SHSS:C for the University of Pennsylvania sample. Before this, Orne3 had originally reported a correlation of .64. Three requests have been made over a two-year period for the original data so that an independent calculation of the correlations could be made. The data have yet to be received! In order to clarify the issue concerning the magnitude of the relationship between the HIP and SHSS:C, a second study was carried out at Fordham and Columbia Universities (Frischholz et al., 1981). In this study, 44 new subjects were administered the HIP, SHSS:C, and two self-ratings of hypnotic responsivity under the same conditions described by Frischholz et al. (1980). The prediction weights for the Induction Score (IND) of the HIP derived in the Frischholz et al. (1980) study were then applied in this new sample. The prediction weights derived in the Frischholz et al. (1981) sample were also used to predict scores in the Frischholz et al. (1980) sample. The average cross-validated correlation between the HIP and SHSS:C was found to be .66 (p < .001). The average cross-validated correlations between all measures of hypnotic responsivity utilized in the study were found to be .69. In summary, the preponderance of studies now appears to suggest that the true correlation between the HIP and SHSS:C is in the mid .60’s. The impressiveness of this result is illustrated by two points. First, the alternate form reliability of the SHSS:C is .72 (Hilgard, 1965). Second, is the fact that different measures of the same construct, intercorrelate less than the reliability coefficients of the measures themselves. For example, the correlation between the Harvard Group Scale of Hypnotic Susceptibility and SHSS:C has been reported to be .59 (Evans & Schmeidler, 1966). We, therefore, conclude that the HIP is measuring most of what SHSS:C is measuring. The HIP certainly answers the clinically relevant questions of how hypnotically responsive a particular patient is. Indiction Score: Structure and Psychometric Properties Hilgard (1979, 1981; and J. Hilgard, 1979) has consistently and incorrectly characterized the HIP as a “single item” test, choosing to focus on the second arm levitation as the only “measure of hypnotic responsivity.” In fact, the HIP is a multi-item test. The five items consist of: a subjective experience of dissociation; posthypnotic arm
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levitation, a subjective experience of nonvoluntarism, cut-off to a posthypnotic signal, and a subjective sense of floating. The items of the HIP are continuously scored. Thus, it is not informative to speak of simply “passing an item” (cf. Hilgard, 1979). Rather it is more informative to know to what degree a particular item was passed. A summary score, known as the Induction score (IND) is obtained by summing across these five items. We have already demonstrated that the IND score is substantially correlated with SHSS:C and subject’s self-ratings of hypnotic responsivity. Some investigators have questioned the psychometric properties of the HIP (e.g., Bowers, Reference Note 1; Hilgard, 1981; Hilgard & Hilgard, 1979). However, several psychometric papers (DeBetz & Stern, 1980; Spiegel, Aronson, Fleiss & Haber, 1976; Spiegel & Spiegel, 1978; Stern, Spiegel & Nee, 1979) have clearly demonstrated that the distribution of HIP scores is stable within different psychiatric populations. In addition, the scores are internally consistent (standardized item alpha = .81), temporally stable after a three year interval (r = .76), and that the items of the IND score load substantially on a single factor. Self-Rating of Hypnotic Responsivity and the Experience of Non-Voluntarism Hilgard (1981) notes that subject’s self-ratings of hypnotic responsivity following the SHSS:C are significantly higher than their self-ratings following the HIP. This finding was replicated by Frischholz et al. (1981) and is not at all surprising. Naive subjects exposed to a 15-minute hypnotic induction ceremony in which they are repeatedly told to go into a “deep, deep, sleep” followed by a 40-minute exposure to a standardized set of hypnotic instructions, should be expected to rate their experience higher than a 5-minute procedure. However, the highly significant correlation between the SHSS/C self-ratings and HIP self-ratings (r = .78) clearly indicates the high consistency between the two procedures. Hilgard (1981) interprets the above finding as providing evidence that the SHSS:C taps the phenomenon of nonvoluntarism associated with hypnotic responses. We do not understand why Hilgard equates self-ratings of hypnotic responsivity with nonvoluntarism. Weitzenhoffer (1980), the senior author of the Stanford scales, has provided compelling evidence that observed responses to hypnotic instructions can be much different than the subjective experience of nonvoluntarism associated with these responses. Weitzenhoffer (1980) also notes that this subjective experience of nonvoluntarism is more congruent with traditional definitions of the domain of hypnosis. Clearly, Hilgard’s interpretation lacks substance. Other Advantages of the HIP The HIP has other advantages than its brevity, clinical appropriateness, and substantial overlap with SHSS/C. The first advantage is that clinical norms are available based
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upon thousands of psychiatric outpatients (DeBetz & Stern, 1980; Spiegel, Aronson, Fleiss & Haber, 1976; Spiegel & Spiegel, 1978; Stern, Speigel & Nee, 1979). A new HIP manual (Spiegel, Spiegel & Frischholz, Reference Note 2) will present normative data on psychiatric outpatients, psychiatric inpatients, VA in and out-patients, medical outpatients, and college students. The wealth of standardization information on the HIP make it an especially useful measure in the clinical sphere. The second advantage of the HIP concerns its proven effectiveness in predicting treatment outcome (Katz, Kao, Spiegel, Katz, 1974; D. Spiegel, Frischholz & Fleiss, Reference Note 3; D. Spiegel, Frischholz, Maruffi & Spiegel, in press; H. Spiegel & D. Spiegel, 1978), personality (Frischholz, D. Spiegel, H. Spiegel & Balma, Reference Note 4) and severity of psychopathology (D. Spiegel, Detrick & Frischholz, in press; Spiegel, Fleiss, Bridger & Aronson, 1975). These studies clearly confirm the clinical utility of the HIP. The Eye-Roll Sign and Profile Grade of the HIP Hilgard takes issue with the validity of the Eye-Roll hypothesis (Spiegel, 1972; Spiegel & Spiegel, 1978) and the logic underlying the Profile Grade of the HIP. In fact, Hilgard states that “the Eye-Roll is no longer used in determining the Profile Grades.” This is completely untrue. It should be noted at this point, that Hilgard is not taking issue with the clinical utility of the Eye-Roll Sign (ERS). His acknowledgement of its predictive utility is illustrated in his book on “Hypnosis in the Relief of Pain” (Hilgard & Hilgard, 1975), in which he reports a correlation of .50 (which he computed) between Eye-Roll Grades and successful treatment of acupuncture. Hilgard interprets this finding as “suggesting parallels between hypnosis and acupuncture in pain reduction (Hilgard & Hilgard, 1975, p. 198).” It should also be noted that Hilgard (1981) does not take issue with the fact that the Profile Grade of the HIP discriminates between low and high hypnotic responders as indexed by SHSS. In all published studies to date, the Profile Grade has been found to be significantly associated with scores on SHSS. Rather, Hilgard does take issue with the interpretability of the ERS as an indicator of “manifest hypnotic responsivity.” He then cites several correlational studies which show that the ERS correlates poorly with measures of manifest hypnotic responsivity. A brief explanation of the Eye-Roll hypothesis may clarify this issue. The ERS is hypothesized to be a presumptive biological sign of hypnotic capacity. However, Spiegel (1972) also observed that the ERS is a false positive indicator of hypnotic responsivity approximately 25% of the time. In other words, a subject may have the necessary “biological wiring” to experience hypnosis, but something may be blocking this person’s ability to express this capacity. This is what is meant by the intact/nonintact profile grade categories. For example, a positive ERS and a manifest responsivity to hypnosis indicates that a person has the necessary biological potential for hypnosis and is capable of expressing it. A non-intact profile score (i.e., a positive ERS and no manifest
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responsivity to hypnosis) indicates that a person has the necessary biological potential, but that something is blocking the expression of this hypnotic capacity. H. Spiegel and his colleagues (Spiegel et al., 1975) have demonstrated that one potential block4 of hypnotic capacity is the presence of psychopathology. In this study, a significant association was found between a non-intact HIP Profile Grade and severe psychopathology as indexed by a comprehensive battery of psychological tests. The ramification of this finding is that the ERS should correlate significantly with manifest hypnotic responsivity within those subjects who earn intact profiles. The majority of evidence provides support for this contention. Unfortunately, as Hilgard and the present authors note, such a procedure may also produce a statistical artifact. This happens because if one computes a correlation between the ERS and manifest hypnotic responsivity only within intact profiles, many discrepant cases are eliminated from the correlational analysis. Obviously, this methodology is not appropriate for testing the validity of the Eye-Roll hypothesis. In order to clarify this issue, a new methodology was employed (Spiegel & Spiegel, 1978) which utilized all subjects in the correlational analysis. A group of psychiatric patients was administered the HIP and then sent to a psychologist for diagnostic testing. The psychologist, who was unaware of the patient’s ERS or HIP scores, administered a comprehensive battery of psychological tests. On the basis of their performance on the psychological battery, the psychologist screened out those patients who were severely disturbed (n = 49) from those who were not (n = 56). Separate correlations were then computed between the ERS and manifest hypnotic responsivity within the two patient groups. The correlation within the healthy patient group (r = .52) was significantly higher (z = 2.3, p < .05) than the correlation in the severely disturbed patient group (r = .15). The above study supports the validity of the ER hypothesis. Hilgard (1981) does not report the correlation of .52 between the ERS and IND scale within the healthy group of patients because he maintains that it was obtained under unusual circumstances. The present authors see nothing unusual with the above methodology. In fact, it highlights what is known in psychometrics as a “moderator variable” (cf. Anastasi, 1976; Saunders, 1956). That is, the validity of the ER hypothesis is moderated by the presence or absence of psychopathology. We also recognize that correlational data alone are insufficient to resolve the issue of potential hypnotic responsivity. In fact, data where one patient status is associated with one test score is always insufficient to resolve issues of potential anything. What is needed are data that associate two clinical statuses with two scores within the same person pre and post the removal of or diminuation of the hypothesized block. That is, patients need to be given the HIP before and after treatment that was effective in reducing hypothesized hypnotic blocks. The desired outcome would be that the manifest IND score would increase in direct proportion to the extent to which the hypnotic block is removed.
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Hilgard (1981) appears to accept the above methodology for clarifying whether the Eye-Roll sign is truly a measure of hypnotic potential when he wrote “the answer would be clear if the deficits could be overcome and hypnotic responsiveness increased.” It is agreed that data of the two status-two test score variety will be definitive in connection with the Eye-Roll sign of potential hypnotic responsivity. We, therefore, encourage the scientific community with access to mental health populations undergoing treatment to conduct studies along these lines.
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Funding Preparation of this manuscript and the studies described within was made possible by grants from the Charles E. Merrill Trust and the Merlin Foundation. Notes 1. Two subjects who were administered the HIP and SHSS:C in this study were unable to complete the biofeedback phase of the experiment due to academic commitments. If these two subjects’ scores were included in computing the correlation between the HIP and SHSS:C, the correlation would be 4(26) = .63, p < .001. 2. Orne personally transmitted this value to H. Spiegel over the telephone. The value was published with Orne’s approval in the International Journal of Clinical and Experimental Hypnosis (of which Orne is the editor). The exact reference is: Spiegel, H., Aronson, M., Fleiss, J. L. & Haber, J. Pyschometric Analysis of the Hypnotic Induction Profile. International Journal of Clinical and Experimental Hypnosis, 1976, 24, 300–315. 3. Martin T. Orne, written personal communication dated November 2, 1973. 4. Undoubtedly, there are many potential blocks of manifest hypnotic responsivity. For example, unpublished data from our laboratory suggest that neurological impairments also moderate the expression of responsivity to hypnosis.
Reference Notes 1. Bowers, K. Has the sun set on the Stanford Scales: No, not really. Paper presented at the annual meeting of the American Psychological Association, Montreal, September, 1980. 2. Spiegel, H., Spiegel, D., & Frischholz, E. J. Assessing Hypnotic Responsivity in Clinical Contexts. In preparation. 3. Spiegel, D., Frischholz, E. J., & Fleiss, J. L. Characteristics of successful smoking abstainers at six months. Manuscript submitted for publication, 1981. 4. Frischholz, E. J., Spiegel, D., Spiegel, H., & Balma, D. The relationship between hypnotic responsivity, absorption, and spatial awareness in a psychiatric outpatient population: Cross-validation and validity extension. Manuscript submitted for publication, 1981.
References Anastasi, A. (1976). Psychological testing. New York: Macmillan Co. DeBetz, B., & Stern, D. B. (1979). Factor analysis and score distributions of the HIP-replication by a second examiner. American Journal of Clinical Hypnosis, 22, 95–102.
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Evans, F. J., & Schmediler, D. (1966). Relationship between the Harvard Group Scale of Hypnotic Susceptibility and the Stanford Hypnotic Susceptibility Scale, Form C. International Journal of Clinical & Experimental Hypnosis, 14, 333–343. Frischholz, E. J., & Tryon, W. W. (1980). Hypnotizability in relation to the ability to learn thermal biofeedback. American Journal of Clinical Hypnosis, 23, 53–56. Frischholz, E. J., Tryon, W. W., Vellios, A. T., Fisher, S., Maruffi, B. L., & Spiegel, H. (1980). The relationship between the Hypnotic Induction Profile and the Stanford Hypnotic Susceptibility Scale, Form C: A replication. American Journal of Clinical Hypnosis, 22, 185–196. Frischholz, E. J., Spiegel, H., Tryon, W. W., & Fisher, S. (1981). The relationship between the Hypnotic Induction Profile and the Stanford Hypnotic Susceptibility Scale Form C: Cross-Validation and Validity Extension, American Journal of Clinical Hypnosis, in press. Hilgard, E. R. (1965). Hypnotic susceptibility. New York: Harcourt Brace & World. Hilgard, E. R. (1979). The Stanford Hypnotic Susceptibility Scales as related to other measures of hypnotic responsiveness. American Journal of Clinical Hypnosis, 21, 68–83. Hilgard, E. R. (1981). The Eye-Roll Sign and other scores of the Hypnotic Induction Profile (HIP) as related to the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C): A critical discussion of a study by Frischholz and others. American Journal of Clinical Hypnosis. Hilgard, E. R., & Hilgard, J. J. (1975). Hypnosis in the relief of pain. Chicago: William Kaufman. Hilgard, J. R., & Hilgard, E. R. (1979). Assessing hypnotic reponsiveness in a clinical setting: A multiitem clinical scale and its advantages over single-item scales. International Journal of Clinical & Experimental Hypnosis, 27, 134–150. Katz, R. L., Kao, C. Y., Spiegel, H., & Katz, G. J. (1974). Pain, acupuncture, hypnosis. In J. Bonica (ed.) Advances in Neurology, Vol. 4. New York: Raven Press. Orne, M. T., Hilgard, E. R., Spiegel, H., Spiegel, D., Crawford, H. J., Evans, F. J., Orne, E. C., & Frischholz, E. J. (1979). The relation between the Hypnotic Induction Profile and the Stanford Hypnotic Susceptibility Scales, Forms A and C. International Journal of Clinical & Experimental Hypnosis, 27, 85–102. Saunders, D. R. (1956). Moderator variables in prediction. Education and Psychological Measurement, 16, 209–222. Spiegel, D., Detrick, D., & Frischholz, E. J. (in press). Hypnotizability and psychotherapy. American Journal of Psychiatry. Spiegel, D., Frischholz, E. J., Maruffi, B. L., & Spiegel, H. (1981). Hypnotic responsivity and the treatment of flying phobia. American Journal of Clinical Hypnosis, 23, 239–247. Spiegel, H. (1972). An Eye-Roll test for hypnotizability. American Journal of Clinical Hypnosis, 15, 25–28. Spiegel, H., Aronson, M., Fleiss, J. L., & Haber, J. (1976). Psychometric analysis of the Hypnotic Induction Profile. International Journal of Clinical & Experimental Hypnosis, 24, 300–315. Spiegel, H., Fleiss, J. L., Bridger, A. A., & Aronson, M. (1975). Hypnotizability and Mental Health. In S. Arieti (Ed.), New dimensions of world psychiatry: A world view. New York: John Wiley & Sons. Spiegel, H., & Spiegel, D. (1978). Trance and treatment: Clinical uses of hypnosis. New York: Basic Books. Stern, D. B., Spiegel, H., & Nee, J. C. M. (1979). The Hypnotic Induction Profile: Normative observations, reliability and validity. American Journal of Clinical Hypnosis, 21, 109–132. Weitzenhoffer, A. M. (1980). Hypnotic susceptibility revisited. American Journal of Clinical Hypnosis, 22, 130–146. Weitzenhoffer, A. M., & Hilgard, E. R. (1962). Stanford Hypnotic Susceptibility Scale Form C. Palo Alto: Consulting Psychologists Press.
