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I thought I’d examine the question as to how different self-hypnosis and hetero-hypnosis actually are and what research says about this question.

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According to an evidence-based sociocognitive explanation of self-hypnosis, the hypnotised individual does not respond mechanically to suggestions given, but rather in an active and goal-directed manner (Lynn and Sivec, 1992). Similarly, cognitive-behavioural therapists have defined hypnosis as a coping strategy that individuals can learn to apply across a variety of problematic situations (Golden, Dowd and Freidberg, 1987, p. xi). There would not seem to be a great deal of difference between these statements and self-hypnosis or hetero-hypnosis explanations.

Despite increasing use and awareness of self-hypnosis, there has been little research to explore whether (and potentially how) self-hypnosis differs from hetero-hypnosis, if at all.

Following on from the first real definition of hypnosis that they created, an executive committee of the American Psychological Association altered the APA definition of hypnosis to include the much used clinical technique of self-hypnosis, which they describe as “the act of administering hypnotic procedures on one’s own.” (Green et al., 2005).

Numerous major hypnosis researchers have (Barber, 1985; Orne and McConkey, 1981; Sanders, 1991) stated that the vast majority of hypnotic procedures can be accurately defined as self- hypnosis. Michael Yapko (1995) suggested that whatever power a hypnotherapist has, is acquired from the individual being hypnotised and of course, can be terminated by the client. Lynn, Rhue and Weekes (1990) showed that subjects retain the ability to control their behaviour during hypnosis, to refuse to respond to suggestions, and even to oppose suggestions. If the individual is ultimately in control of how suggestions affect and influence, is there any difference between hetero-hypnosis and self-hypnosis?

On one hand, we see that the role of the hypnotist is actually relatively minor, as compared with an individual’s hypnotic aptitude, and all hypnosis can be conceived as self-hypnosis. On the other hand, a lot of self-hypnosis is actually taught in the context of a two-way relationship with the hypnotist or therapist, and so it can also rightly be argued that self-hypnosis is actually a variant of hetero-hypnosis (e.g. Weitzenhoffer, 1957) or the re-accessing of previous hetero-hypnosis experiences.

Gould (1953) highlights the importance of and problems with patient/therapist relationship as well as the significance of “prestige” and “authority” of a therapist when it comes to examining the differences between self-hypnosis and hetero-hypnosis. As shown in this review, all of the studies whereby self-hypnosis outperformed an active control, the self-hypnosis skills development and training were preceded by hetero-hypnosis sessions.

Other authors (Fromm & Khan, 1990) suggest that they (self-hypnosis and hetero-hypnosis) are both entirely separate entities to be treated as such, and though they correlate, the existence of one is not dependent on the other. Comparisons of self-hypnosis with more widely known hetero-hypnosis show that they absolutely do have an important relationship that cannot be ignored, and a number of studies have gone in to exploring that relationship (Shor and Easton, 1973; Orne and McConkey, 1981) and show the two to be correlated.

Shor and Easton (1973) created an Inventory of Self-Hypnosis (ISH) which is a self-hypnosis version of the hetero-hypnosis Harvard Group Scale for measuring responsiveness. The two were used to draw comparisons between self-hypnosis and hetero-hypnosis. they could find virtually no differences between behavioural responses to suggestions in a preliminary study included within their paper. They point out that initial responsiveness using self-hypnosis could be affected by motivation and whereby people responding to hetero-hypnosis instructions can sit back and follow instructions, the self-hypnosis subjects have to read instructions and be motivated to apply the skills. However, they state that while self-hypnosis may be more difficult to learn initially, “their eventual level of proficiency may be even higher, since the subjects must learn how to develop their own internal resources more fully.” (p.44)

Orne and McConkey (1981) state that self-hypnosis contrasts with hetero-hypnosis in that it (self-hypnosis) allows the individual to gain control over an issue such as pain or anxiety.

Is all Hypnosis Self-Hypnosis?

Many of the social cognitive theorists have adopted the view, as did James Braid, that hetero-hypnosis is essentially guided self- hypnosis. (Golden, Dowd and Freidberg, 1987, p. 119). A number of researchers, and many clinicians, have found that simply asking subjects to “put yourself into hypnosis” is generally about as effective as performing the standard eye-fixation induction, or probably any other induction technique used by hypnotists (Barber, Spanos and Chaves, 1974).

Berreman and Hilgard (1936) in one of the earliest comparisons of self-hypnosis with heteo-hypnosis, examined differences in suggestions given by hetero-hypnosis, verbalised in self-hypnosis, or by use of the imagination only and how they effected postural movements. No real differences were found in responses of 30 university students within the study between the ways the suggestions were delivered, but did find that practice increased responsiveness.

Hilgard (1977) believed that all hypnosis is really self-hypnosis and that heterohypnosis is “merely aided self-hypnosis” (p. 229). A student of Hilgard’s, Ruch (1975) published a paper in which self-hypnosis in the presence of a hypnotist was compared with hetero-hypnosis. All subjects in the study subjects had a single session experience of hetero-hypnosis and a single session of self-hypnosis on consecutive days. Ruch’s study showed that untrained subjects were as effective in self-hypnosis as in hetero-hypnosis. That is, they achieved the same scores on the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A) and Form C of the SHSS (SHSS:C), regardless of whether the experimenter hypnotised them or they administered hypnosis to themselves in the presence of the experimenter). The study also showed results that when hetero-hypnosis was experienced on the first day, self-hypnosis skills were inhibited on the second day. The opposite was also true; those who engaged in self-hypnosis first were better subjects when they engaged in hetero-hypnosis on the second day. Ruch then concluded that self-hypnosis is the primary phenomenon; hetero-hypnosis is “in effect a form of guided self-hypnosis” (Ruch, 1975, p. 296).

In another study comparing self-hypnosis with heterohypnosis, Johnson and Weight (1976) showed that when the subjects were measured as not being highly hypnotisable and were inexperienced with hypnosis, the reported subjective experiences of self-hypnosis and hetero-hypnosis are virtually the same. This concurs with Fromm’s (1975) research showing this to be true for subjects measured as low and medium hypnotisables, but not necessarily for those considered highly hypnotisable. Johnson and Weight (1976) concluded that self-hypnosis and heterohypnosis are similar in most behavioural and phenomenological aspects. However, they did find that hetero-hypnosis evoked more feelings of unawareness, passivity, and loss of control in their subjects, whereas self-hypnosis evoked more feelings of activity, awareness, and being in control of ones feelings. Johnson (1979) later confirmed Ruch’s finding that inexperienced subjects are as capable of hypnotising themselves as they are of being hypnotised by a hypnotist.

In a study of experiential and behavioural differences between self-hypnosis and hetero-hypnosis, Johnson and Lynn (1976) had similar results to Johnson (1979), Johson and Weight (1976) and Fromm (1975). Johnson and Lynn (1976) concluded that self-hypnosis and hetero-hypnosis are indeed similar in most behavioral and phenomenological effects. Additionally, the authors added that hetero-hypnosis evoked more feelings of unawareness, passivity, and loss of control. Self-hypnosis elicited more feelings of time distortion, disorientation, active direction and trance variability.

Fromm (1981) in her capacity as clinical editor of a special issue of the International Journal of Clinical and Experimental Hypnosis (July issue, 1981) invited a number of researchers to write articles on self-hypnosis or on the similarities and differences between self-hypnosis and other altered states of consciousness. In one of the articles in that issue, Singer and Pope (1981) highlighted several features that self-hypnosis and reverie have in common. Primarily, they highlighted the capacity for intense absorption and the capacity for experiencing vivid imagery. Within the paper, they subsequently suggest that daydreaming and imagery skills are predisposing factors for effective use of self-hypnosis.

In another of the articles, and contrary to Ruch (1975), Sacerdote (1981) disagrees that self-hypnosis is the primary phenomenon, and wrote about his experiencing of teaching his patients self-hypnosis during or after hetero-hypnosis using posthypnotic suggestions. Within these studies of the 1970s comparing heter-hypnosis and self-hypnosis, Ruch (1975), Johnson (1979) and Johnson and Weight (1976) all had the hypnotist present and each subject was instructed on what to say to himself. In her research Fromm explored the subjective experiences of those hypnotising themselves and examined personality traits to see if there was a correlation with being a good self-hypnotic subject. Throughout Fromm’s studies, the subject was alone and had no presence of a hypnotist.

In the first article of the 1981 edition of the International Journal of Clinical and Experimental Hypnosis, Fromm and her students (Fromm, Brown, Hurt, Oberlander, Boxer, & Pfeifer, 1981) shared their findings into the phenomenology and characteristics of self-hypnosis.

While indications from studies that in both self-hypnosis and hetero-hypnosis, individuals experience a high level of absorption, as well as a lessening in their connection to reality (Ruch, 1975; Johnson and Weight, 1976), Fromm and colleagues (1981) showed that individuals seem to experience more vivid imagery when using self-hypnosis. Additionally, Johnson (1981) showed that individuals stated they are more cognitively active and self-controlling when using self-hypnosis. Ruch (1975) also confirmed the hypothesis that more visual imagery and idiosyncratic fantasy arise in self-hypnosis than in hetero-hypnosis and this had been proposed earlier by Fromm, Litchman, and Brown (1973) in a paper read at the annual convention of the Society for Clinical and Experimental Hypnosis.

These authors concluded that although the overall behavioural responses and experiences of subjects using self- hypnosis and hetero-hypnosis are indeed correlated, some individuals do respond in different ways to self-hypnosis than they do to hetero-hypnosis (Fromm et al., 1981; Johnson, 1979, 1981).

More recently, Hammond, Haskins-Bartsch, Grant, and McGhee (1988) compared self-directed and tape-assisted self-hypnosis in 48 inexperienced subjects. They found that the tape-assisted experiences were more gratifying to the subjects and convinced them more fully that they had been in an altered state. However, the authors state that over time subjects usually moved from tape-assisted self-hypnosis to self-induced self-hypnosis (i.e., from training to mastery). Is it essential for individuals to be convinced that they have been in an altered state though? I don’t think so.

Hannigan (2000) posed the question “is self-hypnosis essentially the same as hetero-hypnosis?” and concluded that the existing research was unable to demonstrate that there was any real difference between self-hypnosis and hetero-hypnosis.

In a study comparing self-hypnosis and hetero-hypnosis in 48 participants, Bibby, McConkey and Lim (2001) gave subjects a dial to indicate the strength of their experience while experiencing hypnosis induced arm levitation and age regression. In contrast to earlier findings, with the ideomotor activity of arm levitation, 83% of the subjects described hetero-hypnosis as being more real and more involuntary, and 65% of the subjects reported that self-hypnosis involved more active thought. With the cognitive activity of age regression, 57% of the subjects rated hetero-hypnosis as being more real, and again 65% of the subjects rated hetero-hypnosis as being more involuntary with self-hypnosis also perceived as involving more active thought by 87% of the subjects. Consistent with other studies (Shor and Easton, 1973; Ruch, 1975; Hammond, Haskins-Bartsch, Grant and McGhee, 1988) the authors showed that subjects were equally likely to pass each item during self-hypnosis as they were during hetero-hypnosis. Similar to Johnson and Weight (1976) and McConkey (1986) they also concluded that subjects retrospectively reported the experience of hetero-hypnosis as being more real and involuntary, and the experience of self-hypnosis as involving more active thought.

In a related and different matter, Unestahl (1973) found self-hypnosis using taped material as effective as hetero-hypnosis in a study exploring hypnosis and posthypnotic suggestions. Many studies included in this review have used audio recordings and deemed them to be self-hypnosis yet these studies may not always include developing specific self-hypnosis skills for the subject to use in a self-directed fashion and can thusly be debated as to whether this truly constitutes self-hypnosis. For example, Laidlaw and Willett (2002) used self-hypnosis tapes with anxious cancer patients and compared progressive relaxation with a breathing technique, both delivered within a recorded hypnosis session. Participants in the study demonstrated improvements in acute anxiety episode and emotional states, with the breathing group showing improvements in all of the measures. Although the authors hypothesised that the use of the tapes would raise levels of personal control, only audio tapes were used and no training given to use the skill of self-hypnosis without the audio aid, though after repetition, the author of this review assumes the recipients could have attempted to use the strategies learned without the audio as an active coping skill.

Hammond and colleagues (1988) compared self-directed and tape-assisted self-hypnosis with hetero-hypnosis. No differences were discovered between hetero-hypnosis and either of the self-hypnosis groups in terms of responses to behavioural suggestions. However, the experiential ratings of the subjects consistently suggested hetero-hypnosis was favoured over each of the self-hypnosis methods. Audio recordings were evaluated as superior to self-directed techniques in terms of subjects being convinced that they had been in ‘an altered state.’ The only differences cited by this study are subjective responses to the quality of certain aspects of their experiences deemed by the researchers to be evidence of ‘trance.’ Kirsch and Lynn (1995) suggest that referring to hypnosis as a ‘trance’ is misleading and potentially a harmful misconception about hypnosis. Self-efficacy, ability to transport a skill set to a wide variety of aspects of life for example, were not measured in this Hammond (1988) study.

In comparing hetero-hypnosis and self-hypnosis, some may argue that being hypnotised renders the subject so relaxed and sleepy that the subject requires a facilitator. Hypnosis is not a sleep-like state (Banyai, 1991, 1993) and requires the subject to be engaged and focused. Hypnosis is also not the same as relaxation, far from it, self-hypnosis outperforms relaxation skills in many of the studies featured in this review. Banyai (1991) writes about and builds upon her earlier work from the 1970s with Ernest Hilgard (1976), whereby she showed that by having a subject exercise vigorously for a period of time prior to a hypnosis session, the subject could still be hypnotised, but would not be at all relaxed. In fact, they would be alert and focused and have a heart rate and pulse that was very active.

A client undergoing relaxation training in any form of psychotherapy would not gain the benefits of the relaxation in the same way, making the two quite different. Banyai and Hilgard (1976) and Wark (2006) additionally showed that a wide variety of hypnotic inductions can also be effective. Inductions that emphasise alertness can be just as effective as inductions that promote physical relaxation.

Phenomenological Differences Between Self-Hypnosis and Hetero-Hypnosis:

The experience of imagery in hetero-hypnosis has been explored (Hilgard, 1970) and has been correlated to hypnotisability (Bowers, 1978) whereas, a nonlinear correlation has also been reported (Perry, 1973; Sutcliffe, Perry and Sheehan, 1970). Lombard, Kahn and Fromm, E. (1990) examined the role of imagery in self-hypnosis and found that as with hetero-hypnosis, female subjects produced greater imagery than male subjects. In an earlier work by Fromm and colleagues (1981) the authors reported that imagery in self-hypnosis is richer and fuller.

Fromm and colleagues (1981) stated that whereby both hetero-hypnosis and self-hypnosis involve a lessening of orientation with reality whereby the individual is absorbed in the experience, the perceived ‘depth’ of the hypnotic experience varied much more during self-hypnosis than hetero-hypnosis sessions. The authors explain that this may be due to differences in arousal levels that are not as interfering when the session is structured by instructions from a hypnotist. The authors also point out minor differences between hetero-hypnosis and self-hypnosis. In hetero-hypnosis the subject can concentrate attention fully and expansively on their own stream of consciousness in a way that cannot happen while self-direction of tasks occurs in self-hypnosis sessions that requires concentration elsewhere. Likewise, memories and bodily sensations occurred spontaneously in self-hypnosis which distracted in a way that did not occur when able to be guided by and absorbed in instructions of a hypnotist during hetero-hypnosis.

Unlike Fromm and colleagues (1981) who suggested that those who liked ritualised and structured experiences are more hypnotisable using self-hypnosis, Schwartz and Burdsal (1977) found that those who liked structure, ritual and procedure actually were more hypnotisable using hetero-hypnosis. Moss and Magaro (1989) explored personality types in relation to hypnotisability with heterohypnosis compared to self-hypnosis and found that a compulsive type personality orientation is associated to greater hypnotisability using self-hypnosis and a hysteric personality type was more hypnotisable with hetero-hypnosis.

Phenomenologically, authors have also likened the dissociative experience of therapeutic art and doodling (Cohen and Cox, 2001) to that of self-hypnosis and long distance running (Callen, 1983) as being a similar experience to that described by Fromm and colleagues (1981). Balson and colleagues (1984) suggest that auto-hypnosis occurs naturally when individuals are exposed to coercive persuasion whereby those individuals automatically engage in dissociation, active fantasy and positive hallucinations, for example. Further relating self-hypnosis to ordinary, usual social and cognitive experiences that can and do occur without the presence of a hypnotist. Upon presentation of a complex case study, Miller (1984) even suggests that self-hypnosis can be used as a defence mechanism against therapy, and in this case (not dissimilar to Araoz’s negative self-hypnosis theory) self-hypnosis was used by the patient to maintain multiple personalities.

Tamura and colleagues (2001) examined the effects of the cognitive style of subjects in relation to suggestive experiences and found that those asked to visualise suggestions were able to increase skin temperature and prolong concentration better than those who verbalised the suggestions in self-hypnosis sessions. The group visualising and using mental imagery suggestions also engaged in the tasks more actively.

Overall, the studies focusing phenomenologically on self-hypnosis suggest that self-hypnosis is qualitatively different from hetero-hypnosis, especially for those considered to be highly hypnotisable. Hannigan (2000) notes that the extensive studies of Fromm and colleagues worked with subjects that were highly motivated, trained, and highly hypnotisable and that the procedures within the studies were “geared to maximise differences between self-hypnosis and hetero-hypnosis” (Hannigan, 2000, p. 142). Johnson (1981) stated that a true picture is not reflected in these studies as instructions to the subjects included being asked to try new things in self-hypnosis and to advance upon previous hetero-hypnotic experiences which created differences.

Zeig (2008), writing about the Ericksonian approach to hypnosis, suggests that the very concept of self-hypnosis is a misnomer as it is a different entity to hypnosis as he defines it. “Self-hypnosis is more similar to active imagination, meditation, relaxation, mindfulness, and biofeedback states, none of which rely on interpersonal responsiveness – a characteristic that I am requiring as a central definition of hypnosis.” (Zeig, 2008, p. 112) This seems slightly at odds with Erickson, Rossi and Rossi (1976) who focused upon the experience and capabilities of the individual and stated that the hypnotists provides support for the patient’s capacity to experience hypnosis. The results of the studies included in my own PhD literature review comparing self-hypnosis to meditation, relaxation, mindfulness and biofeedback would suggest that self-hypnosis is more distinct from these modalities.

Barber (1957) offers up an interesting case study whereby a hypnotic subject is no longer responsive due to his beliefs of the hypnotist being changed greatly. Barber (1957) states “Although he is not a good subject in the interpersonal hypnotic relationship he can induce authohypnosis in himself whenever he desires and he uses autohypnosis in his personal life for studying, going to sleep, and changing his moods and feelings.” (Barber, 1957, p. 304) This would offer another benefit for self-hypnosis; that it can be useful in the absence of a good quality working alliance with a professional hypnotherapist and this hypothesis is given strength by the studies included in this review.

Technological developments have led to the study of the brain in relation to hypnosis. There have been some fascinating findings, but to date, as well as there being no unique or defining EEG base signature for a state of hypnosis (DePascalis, 1999), there is also no research that has differentiated the electrocortical correlates of hetero-hypnosis and self-hypnosis.

Brown (1992) offered a specificity theory of hypnotisability which suggests that within the general area of hypnotic responsiveness, certain sub-talents exist. Therefore, hypnotic phenomena such as ideomotor responses (e.g. arm levitation, catalepsy) or cognitive processes (e.g. age regression) or mental imagery ability are considered as such sub-talents and an individual may be better at some than others. In line with this, the ability to engage in self-hypnosis or hetero-hypnosis effectively could also be considered a sub-talent of a general hypnosis skill. Evans (1991) suggests that being able to experience hypnosis is part of a larger dimension of cognitive functioning including an individual’s ability to access, regulate and alter states. In line with this, perhaps a larger cognitive process is closer to the primary phenomenon and self-hypnosis, along with hetero-hypnosis are talents which lead to what we call hypnosis.

Despite the studies included here spanning back decades, we can still not say with any certainty that hetero-hypnosis and self-hypnosis are really all that different. Does anyone dare me to say “they are basically the same thing”? They are correlated and the studies included within my own PhD literature review suggest that successful outcomes are common when self-hypnosis skills are preceded by hetero-hypnosis.

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