Direct verbal suggestibility: Measurement and significance

doi:10.1016/j.concog.2020.103036

Consciousness and Cognition

Volume 89, March 2021, 103036

https://doi.org/10.1016/j.concog.2020.103036 Get rights and content

Abstract

Hypnotic suggestibility is part of the wider psychological trait of direct verbal suggestibility (DVS). Historically, DVS in hypnosis has informed theories of consciousness and of conversion disorder. More recently it has served as a research tool in cognitive science and in cognitive neuroscience in particular. Here we consider DVS as a general trait, its relation to other psychological characteristics and abilities, and to the origin and treatment of clinical conditions. We then outline the distribution of DVS in the population, its measurement, relationship to other forms of suggestibility, placebo responsiveness, personal characteristics, gender, neurological processes and other factors, such as expectancy. There is currently no scale specifically designed to measure DVS outside a hypnotic context. The most commonly used and well-researched of the hypnosis-based scales, the Harvard Group Scale, is described and identified as a basis for a more broadly based measure of DVS for use in psychological research.

Section snippets

Introduction.

Though suggestibility is a broady distributed human propensity, suggestion has received relatively little recent attention in the psychological literature (Halligan & Oakley, 2014). This has not always been the case and many early writers and researchers on psychology such as Binet, 1900, Sidis, 1898, and more recently, McDougall, 1908, Hull, 1929, Hull, 1933, Sherif, 1935, Asch, 1956 placed great emphasis on the importance of ‘normal’ suggestion and suggestibility (see Lundh, 1998 for an

Measuring hypnotic suggestibility using the Harvard Group scale

Presentation of the HGSHS:A testing procedure is traditionally in the form of a pre-recorded audio-file. It commences with a general introduction, establishing rapport, offering reassurance and introducing the participants to the nature of ‘hypnosis’ and ‘suggestion’. This is followed by the hypnosis induction procedure and scripted, standardized test suggestions before hypnosis is terminated.

There are 12 test items in the HGSHS:A, consisting of four ‘Motor’ suggestions (where an involuntary

Suggestibilty and its measurement more generally

A defining feature of the many scales of suggestibility, typically used in hypnotic contexts, is that test items (suggestions) are measures of DVS in that they are directly and verbally presented after a hypnotic induction procedure and are capable of producing a range of behavioural and psychological effects ideally experienced by the participants as involuntary. In relation to the latter, Weitzenhoffer (1974) introduced the term “classical suggestion effect” to identify the non-voluntary

Relevance of DVS for cognitive and clinical psychology

DVS is relevant to views of consciousness in that it exerts a powerful effect on how we as individuals experience the world and how that experience can be influenced by verbal interaction. The phenomena produced by direct verbal suggestion, particularly in the context of hypnosis, have a long history of informing psychological theories of ‘consciousness’ and in particular the role of ‘non-conscious’ processes (Cardeña, 2000, Cardeña, 2014, Ellenberger, 1994, Hebb, 1980, Hilgard, 1977, James,

Direct verbal suggestibility a trait

As noted above, individuals vary in their ability to respond to direct verbal suggestions and DVS as a trait is also a relevant factor in responsiveness to illusions of bodily awareness such as the rubber hand illusion (Walsh, Guilmette, et al., 2015), creativity (Shames & Bowers, 1992), outcomes in somatic medicine (Kekecs & Varga, 2013) and empathy (Wickramasekera & Szlyk, 2003). Individuals scoring highly on scales of direct verbal suggestibility are also more prone to confusing imagined

Characteristics of DVS

Direct verbal suggestibility (DVS) seems to be a distinct capacity and there is good evidence, primarily from the hypnosis literature, that it is not correlated with other forms of suggestibility such as placebo suggestibility and interrogative suggestibility (Kihlstrom, 2008, Tasso and Pérez, 2008, Tasso et al., 2020). Despite almost a century of experimental effort, however, DVS has not been shown to correlate with any of the major personality dimensions, such as extraversion/introversion (

Neuroscientific accounts of DVS

There is an active and growing body of research exploring the role of frontal areas of the brain in direct verbal suggestibility, particularly in hypnotic contexts (Parris, 2017). A number of theories implicate reduced frontal cortical executive function (or ‘hypofrontality’ - Dietrich, 2003), especially in the left hemisphere, in the propensity for suggestibility in general and hypnotic suggestibility in particular (Gruzelier, 1998, Gruzelier, 2006, Kihlstrom, 2013, Woody and Bowers, 1994).

Contextual influences on DVS

Though DVS with and without the addition of a hypnosis induction procedure are considered here as situationally-defined variants of the same trait, it is important to note that context, such as that supplied by a hypnotic induction, may influence the degree of responsiveness shown to direct verbal suggestions. In particular, expectation of outcome is a well-researched situational variable that affects responsiveness to direct verbal suggestions (Silva & Kirsch, 1992) and contributes to the

Measuring direct verbal suggestibility with the HGSHS:A and other scales

Barnier and McConkey (2004) in their review identify 13 ‘hypnotizability scales’ devised since the 1950′s that share the common feature of measuring direct verbal suggestibility. These scales involve between 1 and 12 test items (verbal suggestions) that are preceded in ten of them by a hypnotic induction procedure as standard. The induction procedure is optional in one of the other three scales and not used in the remaining two. Induction typically consists of a set of verbal instructions

Varieties of DVS and their relevance for cognitive science

As noted above, the Harvard Group Scale of Hypnotic Susceptibility: Form A (HGSHS:A) is the most commonly used DVS scale and is commonly considered as the ‘gold standard’(Benham et al., 2002, Council, 1999). It is formed of three subscales, which measure respectively responsiveness to ideomotor, motor challenge and cognitive suggestions (see below and Section 2 above). Aside from practical research considerations these three subscales effectively each measures a different variety of DVS that is

National norms and the structure of the Harvard Group scale

Normative data have been collected for the HGSHS:A since the early 1960s from 18 national, large-sample studies (13 from European countries, and one each from UK, America, Australia, Canada and China). The data overall show that the scores are normally distributed with low numbers of participants falling into the lowest and highest levels of responsiveness and consistency in the relative difficulty of each of the 12 test items. [See Oakley et al. (2020), for an overview and discussion of all 18

Imagination, instruction, suggestion and the ‘classic suggestion effect’

As noted earlier one problem with the HGSHS:A is the potential for confounding ‘imagination’ and the effects of direct suggestion that exists within the traditional wording of suggestions embedded in induction and testing procedures. We are proposing that the experiences and responses produced by DVS are not the same as those that result simply from the instruction to imagine or the spontaneous engagement in imaginative processes. Supporting this view is evidence that reported changes in

Measuring DVS in cognitive science for ‘instrumental’ research

As indicated above, a reliable measure of suggestibility is relevant to cognitive science and cognitive neuroscience research as a means of identifying highly suggestible participants for studies where suggestion can be used as a tool to create phenomena of interest, particularly where the study involves neuroimaging techniques (For overviews of this type of research see Halligan and Oakley, 2013, Oakley and Halligan, 2009, Oakley and Halligan, 2013). A pragmatic first step in this direction

Measuring DVS in cognitive science for ‘intrinsic’ research

One benefit of an increased interest in DVS within cognitive science generally – would be to raise awareness of the extensive relevant hypnosis literature and the various well-established hypnosis journals (e.g. American Journal of Clinical Hypnosis. Australian Journal of Clinical Hypnosis; Contemporary Hypnosis, Contemporary Hypnosis and Integrative Therapy, and the International Journal of Clinical and Experimental Hypnosis). ‘Normalising’ hypnotic suggestibility itself within the DVS

Discussion

Suggestion following a hypnotic induction procedure has begun to make a significant contribution to cognitive science generally, and cognitive neuroscience in particular. It is also the case that an individual’s score on scales involving a hypnotic induction procedure followed by direct verbal suggestions correlates well with their score on the same scales when the hypnotic induction is omitted. On this basis, we have proposed the term Direct Verbal Suggestibilty (DVS) for the trait that is

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Direct verbal suggestibility refers to a unique capacity of individuals to experience pronounced changes in cognition, behaviour, and perception in response to verbal descriptions (suggestions; Oakley et al., 2021).
Direct verbal suggestibility refers to the capacity for an individual to experience perceptual, motor, affective and cognitive changes in response to verbal suggestions. Suggestibility is characterized by pronounced, yet reliable, inter-individual differences. Previous research and theoretical considerations suggest that greater impulsivity and compulsivity is associated to higher suggestibility, but the characteristics and mediating factors of this association are poorly understood. Using established psychometric measures in an online sample, we found positive correlations between the domain comprising impulsivity, compulsivity and behavioural activation, and the domain of suggestibility, dissociation and absorption. We also observed that dissociation and absorption mediated the link between suggestibility and impulsivity, and between suggestibility and behavioural activation, respectively. These results confirm the positive link between suggestibility and the impulsivity/compulsivity domain and shed new light on the characterisation of traits associated with suggestibility.
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Hypnotic suggestibility, as assessed by standardized behavioural scales (Acunzo and Terhune, 2021; Woody and Barnier, 2008), refers to a stable capacity to experience involuntary responses to direct verbal suggestions in the context of hypnosis (e.g., analgesia: “you will not feel anything at all in your arm.” ; (Oakley et al., 2021; Polczyk, 2016)). Responses to suggestions among highly suggestible individuals are characterized by a pronounced reduction in the experience of authorship over one’s actions and experience (Polito et al., 2014; Weitzenhoffer, 1974) and bear close phenomenological resemblance to distortions in the sense of agency in clinical populations (Polito et al., 2015).
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Direct verbal suggestibility: Measurement and significance

Abstract

Section snippets

Introduction.

Measuring hypnotic suggestibility using the Harvard Group scale

Suggestibilty and its measurement more generally

Relevance of DVS for cognitive and clinical psychology

Direct verbal suggestibility a trait

Characteristics of DVS

Neuroscientific accounts of DVS

Contextual influences on DVS

Measuring direct verbal suggestibility with the HGSHS:A and other scales

Varieties of DVS and their relevance for cognitive science

National norms and the structure of the Harvard Group scale

Imagination, instruction, suggestion and the ‘classic suggestion effect’

Measuring DVS in cognitive science for ‘instrumental’ research

Measuring DVS in cognitive science for ‘intrinsic’ research

Discussion

Neuropsychologia

Clinical Psychology Review

Consciousness and Cognition

Cortex

Consciousness and Cognition

Cortex

Cortex

Pain

European Journal of Pain

NeuroImage

Consciousness and Cognition

NeuroImage

Consciousness and Cognition

Seizure

Personality and Individual Differences

Consciousness and Cognition

The Lancet

Cortex

Clinical Psychology Review

Consciousness and Cognition

Consciousness and Cognition

Cortex

Cortex

French norms for the Harvard Group Scale of Hypnotic Susceptibility, Form A

International Journal of Clinical and Experimental Hypnosis

On the mechanism of suggestion and hypnosis

Journal of Abnormal and Social Psychology

Studies of independence and conformity: A minority of one against a unanimous majority

Psychological Monographs

Hypnotic and placebo analgesia: Order effects and the placebo label

Contemporary Hypnosis

Psychoanalytic approaches to clinical hypnosis

The ‘stuff’ of hypnotic performance: A review of psychometric approaches

Psychological Bulletin

Toward a theory of hypnotic behaviour. Effects on suggestibility defining the situation as hypnosis and defining response to suggestions as easy

Journal of Abnormal and Social Psychology

Empirical evidence for a theory of ‘‘hypnotic behaviour: Effects on suggestibility of five variables typically included in hypnotic induction procedures

Journal of Consulting Psychology

Autobiographical remembering and forgetting: What can hypnosis tell us?

International Journal of Clinical and Experimental Hypnosis

Dissociation in hysteria and hypnosis: Evidence from cognitive neuroscience

Journal of Neurology, Neurosurgery and Psychiatry

Hypnotic susceptibility scales: Are the mean scores increasing?

International Journal of Clinical and Experimental Hypnosis

La Suggestibilité

The Waterloo-Stanford Group C (WSGC) scale of hypnotic susceptibility: Normative and comparative data

International Journal of Clinical and Experimental Hypnosis

Understanding reports of non-volition

Behavioral and Brain Sciences

The experience of hypnotic suggestions

International Journal of Clinical and Experimental Hypnosis

Imaginative suggestibility and hypnotizability: An empirical analysis

Journal of Personality and Social Psychology

Eliciting autobiographical pseudomemories: The relevance of hypnosis, hypnotizability and attributions

International Journal of Clinical and Experimental Hypnosis.

Functional blindness: A construction of cognitive and social influences

Cognitive Neuropsychiatry

Hypnosis in the treatment of trauma. A promising, but not fully supported, efficacious treatment

International Journal of Clinical and Experimental Hypnosis.

Hypnos and psyche: How hypnosis has contributed to the study of consciousness

Psychology of Consciousness

Lettre à M. Ampère, sur une classe particulière de mouvements musculaires