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American Journal of Clinical Hypnosis Copyright 2004 by the American Society of Clinical Hypnosis

47:2, October 2004

Enhancing Suggestibility:
The Effects of Compliance vs. Imagery
Steven Jay Lynn
State University of New York at Binghamton

Specific Aims
For more than 30 years, studies based on a social-learning, cognitive skill
model of hypnotic responsiveness have documented appreciable increases on behavioral
and subjective measures of susceptibility following hypnotizability modification training
(Diamond, l972; Gfeller, Lynn, & Pribble, l987; Kinney & Sachs, l974; Sachs & Anderson,
l967; Springer, Sachs, & Morrow, l977). By far the most impressive demonstration of
training-related increments has come from a body of studies conducted by Spanos and
his associates (see Spanos, l986, for a review). In more than fifteen studies (see Gorassini
& Spanos, 1999; Spanos, l991; Spanos, Lush, & Gwynn, l989), Spanos has shown that
between 50% and 80% of initially low-hypnotizable subjects who underwent a multi-
faceted cognitive skill training program (termed herein Carleton Skills Training Program,
CSTP) scored as high hypnotizables at posttesting. The CSTP provides participants
with accurate information about hypnosis, and uses direct instruction and observation
of a videotaped model to teach participants to: (a) physically enact responses, as
opposed to waiting passively for the suggested effects to happen to them (Spanos et
al., 1986), and (b) use a variety of cognitive and imaginal strategies to facilitate responding
to suggestions including goal-directed imagery or fantasies (GDF’s; e.g., imagining a
hand rising in response to a helium balloon attached to the wrist) to experience the
suggestion-related response as involuntary.
What is particularly impressive is that treatment effects have been of large
magnitude, persist for an average of two and a half years after training (Spanos, Cross,
Menary, & Smith, l988), and generalize to novel, demanding test suggestions (e.g., see

Acknowledgment: National Institutes of Health (grant no. 1 RO1 MH67483-01). Request reprints
from:
Steven Jay Lynn, PhD, ABPP
Psychology Department
State University of New York at Binghamton
Binghamton, NY 13902
E-mail: slynn@binghamton.edu

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Spanos, l986). Research in Spain (Cangas & Perez, 1998), Poland (Niedzwienska, 2000),
and England (Fellows & Ragg, 1992) has provided cross-cultural support for the
effectiveness of the CSTP.
The fact that the CSTP substantially enhances hypnotic responsiveness
constitutes support for the sociocognitive model of hypnosis. Sociocognitive theorists
(Barber, 1969; Kirsch, 1991; Lynn & Rhue, 1991; Spanos, 1991) conceptualize hypnotic
responsiveness as the byproduct of a constellation of potentially modifiable attitudes,
beliefs, and expectations, as well as imaginative skills and strategies. Additionally,
participants’ accurate interpretation of hypnotic suggestions is posited to be an
influential determinant of hypnotizability. According to this view, hypnotic
responsiveness is not an immutable trait or propensity locked in at birth. Rather, it can
be substantially modified.
Defenders of the idea that hypnosis is largely a trait-like ability or aptitude
have criticized the CSTP on the grounds that post-training gains do not reflect valid
and enduring enhancements of hypnotizability. More specifically, external demands,
social pressure, and expectancies for compliance with suggestions inherent in the training
procedures are believed to result in trained subjects simply acquiescing to suggestions
in the absence of suggestion-related experiences or genuine modifications in hypnotic
responsivity (see Bates, 1990; Bowers & Davidson, 1991; Hilgard, l989).
Leading hypnosis theorists (Bowers & Davidson, 1991; Gearan, Schoenberger,
& Kirsch, 1995; Hilgard, l989; Spanos, l986) concur that the issue of how the CSTP
works to achieve treatment gains is of paramount importance from a theoretical
perspective. Moreover, empirically supported techniques that augment hypnotic
responsiveness may have considerable utility that extends far beyond the laboratory:
high hypnotizability can confer a wide range of benefits in a variety of treatment contexts
(see Lynn, Kirsch, Barabasz, Cardena, & Patterson, 2000).
Background and Significance
The findings of the CSTP are particularly impressive not only because of the
magnitude of hypnotizability increments obtained, but also because treatment gains
generalize to novel suggestions. The CSTP has documented treatment gains in response
to novel suggestions with the following instruments or test items: the 7-item Carleton
University Responsiveness to Suggestion Scale (CURSS; Spanos, Radtke, Hodgins,
Stam, & Bertrand, l983); a 10- item version of the Stanford Hypnotic Susceptibility
Scale, Form C (SHSS: C; Weitzenhoffer & Hilgard, l962); an “untrained” amnesia item
(Spanos, Cross, Menary, Brett, & deGroh, l987; Spanos, deGroh, & de Groot, l987); and
finally, difficult test suggestions that are considered “cognitive items” (e.g., analgesia,
age-regression, visual hallucination, selective amnesia, and posthypnotic response)
and “trance logic” items (Spanos et al., l989) purported to reflect key aspects of hypnotic
responding (Spanos et al., l988). In these studies, trained subjects’ performance was
indistinguishable from that of “natural,” untrained hypnotizable subjects who received
the generalization measures. Finally, training gains have been shown to persist for an
average of 2.5 years after training (Spanos, et al., l988).
The magnitude of the training-effect reported by researchers at Carleton
University is substantial, and there is a need to determine whether such impressive
findings are robust or are specific to the ecological conditions of that particular

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laboratory. Indeed, a number of other attempts to investigate the CSTP, outside Spanos’s
laboratory: (a) failed to secure impressive and durable treatment effects (Bates, Miller,
Cross, & Brigham, l988); (b) found that treatment gains were achieved on a behavioral
measure of performance but not a measure of subjective experience (Bates & Brigham,
l990); and (c) documented treatment gains that were not as impressive as the gains
obtained in Spanos’s laboratory (Bertrand, Stam, & Radtke, 1993; Gfeller et al., 1987, low
rapport condition; Niedzwienska, 2000). One of the aims of our research is to examine
the degree to which treatment gains are robust, generalize to novel test items, and
persist across diverse situations.
From a clinical perspective, there is much to be gained by developing procedures
to enhance hypnotic responsiveness—thus, effectively turning mediocre subjects into
hypnotic “virtuosos.” Gfeller (1993) has written perceptively about ways in which
exposure to the CSTP might improve clinical outcomes of a variety of psychological
disorders and medical conditions. Moreover, elucidating the effective components of
the CSTP can pave the way for the development of more cost-effective training
procedures that can benefit a broad clientele.
The issue of whether the CSTP can produce valid enhancements of
hypnotizability is important from a theoretical perspective as well, as it bears directly on
the trait-versus-situation controversy in the study of personality (Allport, l966).
Proponents of the idea that hypnotizability is dispositional have generally argued that
hypnotic responsiveness is best construed as a relatively stable, aptitudinal capacity
of the individual (e.g., Hilgard, l975, l982; Perry, l977). In contrast, advocates of the idea
that hypnotizability is modifiable (e.g., Diamond, l972; Spanos, l986) have maintained
that response to hypnotic suggestions is the byproduct of potentially modifiable social-
cognitive skills and attitudes. Yet there is no intrinsic conflict between the contention
that hypnotizability can be enhanced and the notion that certain personal attributes
and abilities related to hypnotizability exist that are stable, enduring, and resistant to
modification (Gfeller et al., l987). An analogy taken from outside the arena of hypnosis
may prove useful: IQ is relatively stable, has high heritability, but also has been shown
capable of massive population-wide changes (Flynn, l984).
Perhaps the crucial issue is whether the CSTP actually changes skills and
aptitudinal capacities that underlie hypnotic responding, or whether the CSTP functions
more like a “coaching program” that engenders compliant performance on specific tests
without altering fundamental skills and abilities on an enduring basis. Indeed, there is
agreement among hypnosis researchers of diverse persuasion (Bates, 1990; Bowers &
Davidson, 1991; Hilgard, l989; Spanos, l986) that the question of whether modifications
of hypnotizability are valid is important to address. With few exceptions, hypnotizability
modification studies have been interpreted as providing support for social-cognitive
models of hypnosis while undercutting opposing viewpoints. For example, Fellows
(l990) notes that, “The overall impact of Spanos’s work has been to severely undermine
the special process view of hypnosis” (p. 83). Despite claims to the contrary, crucial
experiments have not been performed that provide a secure basis for ruling out
compliance-based explanations of the promising CSTP findings.
Preliminary Studies
Preliminary studies relevant to the proposed application have been conducted

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since the inception of my laboratory nearly 25 years ago. In fact, my colleagues and I
(Gfeller, et al., l987) conducted the first independent replication of the work done on the
CSTP at Carleton University. We succeeded in confirming the magnitude of treatment
effects achieved at Carleton when rapport with the trainer was optimized (50% of low
hypnotizables tested as highs after training). However, when the trainer administered
the CSTP in a formal, impersonal way, the success rate was somewhat lower (25% of low
hypnotizables posttested as highs), confirming the direction but not the magnitude of
treatment effects previously reported. We also demonstrated that treatment gains
generalized not only to the Harvard Group Scale of Hypnotic Susceptibility (HGSHS: A;
Shor & Orne, l962), but also to a battery of novel, demanding suggestions that have
been found to differentiate highly hypnotizable subjects from unhypnotizable role-
playing (i.e., simulating) subjects (see Orne, 1979 for a discussion of the simulation
design).
My colleagues and I (Lynn, Weekes, Neufeld, Zivney, Brentar, & Weiss, 1991)
have also shown that low-hypnotizable participants are particularly sensitive to variations
in the hypnotist’s behavior, and that hypnotizability can be substantially enhanced by
the hypnotist’s efforts to optimize rapport. This is not surprising in that other studies
conducted in our laboratory have shown that certain low-hypnotizable participants
appear to be motivated to actively and purposefully assert their independence from the
hypnotist’s influence when no special efforts are made to cultivate rapport (see Lynn,
Rhue, & Weekes, 1990). However, even when we tested low-hypnotizable participants
under optimum interpersonal conditions, they were not as responsive as highly
hypnotizable subjects tested under less than optimum conditions. Accordingly, the
large gains observed following the CSTP are probably not attributable to efforts to
increase rapport with the hypnotist.
An important focus of Study 1 is on the relation between imagination, imagery,
and hypnotizability. We have conducted many studies over the years on fantasy
proneness (see Lynn & Rhue, 1988, for a summary), imagination and goal-directed
fantasies (see Lynn & Sivec, 1992), and the link between expectancies, imaginal
strategies, and hypnotic responsiveness (Lynn, Snodgrass, Rhue, & Hardaway, 1987).
These studies underscore the importance of imagery in hypnotic responding, particularly
when accompanied by the expectation that imagery will lead to the enactment of a
physical response to a suggestion.
A theme that permeates the proposed studies is that demand characteristics
and expectations are powerful determinants of hypnotic responding. Over the years,
my colleagues and I have conducted numerous investigations that have documented
the influential role of expectancies in relation to the following phenomena: the experience
of nonvolition during hypnosis (see Kirsch & Lynn, 1999; Lynn et al., 1990 for a review),
hypnotizability (Lynn, Green, Jacquith, & Gasior, 2003; Lynn, Vanderhoff, Shindler, &
Stafford, 2002), literalism of responding (Green et al., 1990), and hypnotic
pseudomemories (Hirt, Lynn, Payne, Krackow, & McCrae, 1999; Lynn, Lock, Myers, &
Payne, 1997 for reviews).
Two of the measures used in the studies proposed, the Posthypnotic
Experiences Scale (Brentar, Lynn, & Carlson, 1990; Lynn, Brentar, Carlson, Kurzhals, &
Green, 1992) and the Hypnotic Simulation Index (Martin & Lynn, 1996), were developed
in my laboratory. The first scale assesses a broad range of positive and negative

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posthypnotic experiences, and the second scale is the first instrument to reliably
distinguish participants who simulate hypnosis and participants who genuinely attempt
to experience hypnotic suggestions. Previous research in my laboratory has shown
that highly hypnotizable individuals can be distinguished from low-hypnotizable
individuals in terms of measures of nonvolition (Lynn, Nash, Rhue, Frauman, & Sweeney,
1984), “trance logic” (Stanley, Lynn, & Nash, 1986), altered body perceptions (Nash,
Lynn, & Stanley, 1984), literalism of responding (Green et al., 1990), and hidden observer
responses (Mare, Lynn, Kvaal, Segal, & Sivec, 1994). However, many of these measures
do not distinguish a majority of real and simulating persons. Accordingly, it is important
to further evaluate the Hypnotic Simulation Index in the proposed studies. In conclusion,
previous research conducted in my laboratory provides a strong foundation for the
proposed program of research.
Study 1: The Role of Compliance and Imagination
A potentially trenchant criticism of the CSTP is that posttraining gains are
attributable to behavioral compliance. For example, Hilgard (l989) contends that the
CSTP involves a “great deal of authoritarian pressure” (p. 9) and “persuasive
salesmanship” (p. 9), and states, “There can be no question but that demands are made
throughout the training for better performance” (p. 10). He further implies that CSTP-
related gains result in behavioral compliance in the absence of concomitant subjective
experiences.
Bowers and Davidson (1991) note that the crucial question that has not been
addressed regarding the CSTP is: “To what extent does this program genuinely enhance
hypnotic responsiveness, and to what extent does it provoke outward compliance in
the absence of altered experience?” (p. 24). Bates (1990) has observed that CSTP gains
may reflect compliance rather than, or in addition to, enhanced hypnotic ability for two
reasons. First, participants are informed that the goal of training is to increase hypnotic
responsiveness. Second, the procedures themselves indicate that compliance is an
essential part of successful hypnotic responding, as exemplified by the following excerpt
of the training materials:
Arm Raising Suggestion: “Of course, your arm will not really go up by
itself, you must raise it.” Hand Lock Suggestion: “...Do not move
your hands apart...You want it to seem that this is not happening
through any effort on your part.”
In support of Bates’s critique, two studies (Bates & Brigham, l990; Spanos et
al., l986) deleted instructional elements of the CSTP and found that treatment gains
were compromised as a result. Spanos and his colleagues (Spanos et al., l986) tested
subjects in a “partial training” program that encouraged them to become involved in
suggestion-related imagery but did not inform them that suggested responses must be
enacted and do not just happen. None of the subjects who participated in this treatment
scored in the high-hypnotizability range on two posttest measures. However, when
“instructional” information was provided to an independent group of individuals, more
than half of the trained participants tested as high hypnotizables.
In a later study (Spanos et al., 1996), participants administered the full CSTP
exhibited large increases on objective and subjective dimensions of hypnotizability. In

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contrast, participants who received the partial treatment exhibited small but significant
increases in hypnotizability but did not differ in their responsivity from no treatment
controls. The authors noted that their findings demonstrated that the full CSTP leads
to consistently higher scores on behavioral and subjective dimensions of
hypnotizability than does the partial CSTP.
Bates and Brigham (l990) administered three components (information, modeling,
and instructions) of the CSTP to subjects in one of three sequences. Regardless of
whether instructions (i.e., imaginal strategies and instructions to enact responses)
were presented first, second, or third in the training sequence, no significant changes
occurred until the instructional component was provided. Furthermore, the researchers
maintained that because treatment gains were achieved on a behavioral measure of
performance but not on a measure of subjective experience, the effects of the training
were the product of behavioral compliance. Unfortunately, the authors tested only 12
subjects in total; only 4 subjects were tested in each sequence.
To contest Bates and Brigham’s (1990) argument, Spanos and his colleagues
(Spanos et al., 1986) maintained that if compliance were a credible hypothesis, then the
subjects they tested in both the complete and partial (instructional-component deleted)
treatment conditions would have shown comparable and substantial hypnotizability
gains, inasmuch as participants in both groups were exposed to equivalent demands to
comply. That is, both groups were told that the goal of training is to improve hypnotic
performance. However, Bates (1990) argued that Spanos’s explanation ignores the
possibility that the instructional condition contains stronger demands for compliance
than any other treatment component and therefore is most predictive of treatment
outcome.
Like Bates and Brigham (1990), Gearan et al. (1995) contended that the
instructional component consists of instructions to: (a) intentionally enact suggested
behaviors, and (b) become involved in suggestion-related imagery. The researchers
conducted a component analysis in which they tested the full (original) CSTP treatment
versus a treatment in which all references to the need to intentionally enact suggested
behaviors were deleted, but imagery instructions were retained.
Gearan et al. (1995) found that both treatments increased objective and
subjective responses to hypnosis. Additionally, the two treatments were comparable
in terms of response enhancement. However, participants who were exposed to the
original CSTP reported an increase in the extent to which they intentionally enacted
suggestions, whereas participants in the modified training program reported increased
fantasy without voluntary physical enactment. Across conditions, increases in
behavioral and subjective responses to suggestion were correlated with increased use
of fantasy.
Contrary to both Spanos and his colleagues’ (1986) and Bates and Brigham’s
(1990) contention that instructions for physical enactment of responses are needed to
engender increases in hypnotizability scores, Gearan et al. (1995) maintained that the
critical CSTP ingredient is instructions to actively imagine along with the suggested
state of affairs. Instructions for physical enactment increase behavioral compliance,
but do not affect overall hypnotic responsiveness. Whereas Gearan et al. (1995)
contended that imaginal instructions are crucial to producing hypnotic responses, the
findings of a recent component analysis of the CSTP (Niedzwienska, 2000) imply that

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imaginal strategies are not associated with treatment gains. Niedzwienska (2000)
compared the full CSTP with a “partial” training program that deleted information about
imaginal strategies. In this latter condition, participants were “told that the suggested
responses must be enacted but could be made to feel involuntary through relaxation
and absorption in the hypnotist’s words” (p. 409). Niedzwienska (2000) found that
participants who received the original CSTP responded comparably to participants
who received the partial training, suggesting that imaginal strategies do not play a
particularly important role in accounting for hypnotizability enhancement.
Furthermore, unlike Gearan et al. (1995), Niedzwienska (2000) failed to find an
association between goal-directed fantasies or imagery and increases in hypnotizability
following training. Gearan et al. (1995) concluded that imagery strategies were essential
to producing hypnotic response. However, Niedziewska reached a different conclusion.
She argued that training in imagery is not necessary for the CSTP to work and contended
that “...compliance and social pressure would appear to remain prime candidates for
explaining changes in overt and subjective responding following training” (p. 414).
Previous component analyses are difficult to interpret. Both Spanos and his
colleagues’ (Spanos et al., 1986, 1996) and Bates and Brigham’s (1990) partial treatments
eliminated information regarding imaginal strategies along with instructions to enact
physical responses. Indeed, Spanos’s partial treatment excised a great deal of
information related to the use of imagery and imaginal strategies in the process of
eliminating much of the model’s dialogue with the experimenter in the videotape
participants viewed. Whereas Spanos et al. and Bates and Brigham found that the
removal of enactment instructions compromised hypnotizability gains, Gearan et al.
(1995) found that this was not the case. This discrepancy in findings may be attributable
to the fact that Spanos and Bates eliminated imagery instructions in addition to enactment
instructions, whereas Gearan et al. (1995) deleted only imagery instructions.
The disparate conclusions reached by Gearan et al. (1995) and Niedziewska
(2000) may be attributable to the fact that although Niedziewska (2000) eliminated imaginal
strategies from her partial treatment, she did not eliminate instructions to physically
enact responses. Accordingly, the retention of the enactment instructions in both
conditions might have accounted for the equivalence of responsiveness between
subjects who received the full CSTP and those who received the treatment that eliminated
imagery. Additionally, there is no mention in Niedziewska’s (2000) report that she
eliminated imagery from the suggestions presented during training and the suggestions
that participants rehearsed. If she did not eliminate suggestion-related imagery during
the training, it could cue imagery in response to suggestions during the posttest,
thereby minimizing potential differences between the partial (imagery deleted) and the
full CSTP. The failure of researchers to independently manipulate the provision of
enactment instructions and imaginal strategy information has rendered the interpretation
of previous component analyses ambiguous.
Although Niedziewska (2000) found no evidence for a relation between imagery
and increases in hypnotizability in her training program, her measures of imagery were
limited to a single question/suggestion that assessed whether an “appropriate goal-
directed fantasy” was described. Gearan et al. (1995) also used a single measure of
“active imagination” that was included in a more global measure of “interpretive set.”
Unfortunately, the measure of active imagination was not measured independently of

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other interpretive sets (e.g., resistance, passive responding) and could not be entered
into the regression analyses that were conducted.
In summary, previous studies have not independently examined the effects of
providing information regarding: (a) the use of imaginal strategies and (b) the provision
of information that suggested responses must be enacted. Indeed, the fact that we do
not understand precisely how different aspects of the instructional component affect
hypnotic responsiveness is one reason why it is difficult to disentangle a compliance-
based from an ability-based account of training effectiveness (see Bates & Brigham,
l990). Accordingly, Study 1 will independently manipulate the provision of instructions
to enact responses and instructions to implement imaginal strategies and will include a
measure of imagery vividness in addition to the measures of interpretive set.
Study 2: Testing the CSTP in Different Situational Contexts
Bates and his associates (Bates et al., 1988) examined the influence of demand
characteristics on hypnotizability gains. After two screening sessions, a replication
and experimental group received the CSTP program, whereas a control group merely
practiced hypnotic responding. The replication group was informed that training and
testing were part of the same experiment; the experimental group was told that training
and testing were unrelated.
Treatment gains reported by Bates and his associates were not of comparable
magnitude to those reported by Spanos and his colleagues, and they were not maintained
at follow-up. One reason why Bates may have failed to replicate the effects obtained
in Spanos’s laboratory is that subjects failed to master requisite skills. As Bates and
his colleagues (Bates et al., l988) acknowledge, “trainers in this study were discouraged
from cultivating rapport, as we feared that this might confound results” (p. 126). Studies
have shown that poor rapport can dampen training effects (Spanos et al., l988), decrease
the percentage of subjects who retest as high hypnotizable (Gfeller et al., l987), and
diminish receptivity to training procedures (Cross & Spanos, 1988; Spanos, Flynn, &
Niles, 1990). Conducting training under conditions of “low rapport” fails to resemble
the real-world conditions in which hypnotists attempt to cultivate rapport with clients,
and therefore lack ecological validity.
Research is needed that permits rendering firm conclusions about the role of
demand characteristics and the robustness of training effects. As in Bates et al. (1988),
participants in Study 2 will be tested in a separate session in either “same” (High
Demand) or “different” (Low Demand) context conditions. In the latter context,
hypnotizability testing will be conducted as part of an ostensibly separate study in the
Decker Nursing School. Study 2 will ensure that adequate rapport is established with
the trainers and that the manipulation of demand characteristics is effective.
Spanos has claimed that CSTP-related gains cannot be accounted for entirely
in terms of compliance because trained participants and low-hypnotizable participants
instructed to simulate or role-play undergoing the CSTP procedures generally do not
respond comparably (Spanos et al., 1995; Spanos et al., 1996; Spanos & Flynn, 1989;
Spanos et al., 1986). Study 2 includes the following groups: a.) practice-alone controls
who do not receive the training; b.) low-hypnotizable individuals who receive the
training; c.) untrained highly hypnotizable subjects; d.) low-hypnotizable participants
who simulate the performance of subjects who undergo the training procedures; and e.)

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simulators who are only told about the CSTP. Simulating and nonsimulating (trained
low-hypnotizable) individuals will be tested for hypnotizability in either High Demand
or Low Demand conditions. Our studies include a 1-2 month follow-up with the Stanford
Profile Scale (Form II; Weitzenhoffer & Hilgard, 1967) to assess the generalization of
treatment effects to a variety of novel, demanding suggestions. Participants will also
receive measures of response expectancy, posthypnotic experiences, interpretive set,
vividness of imagery, relationship with the hypnotist, and an index of hypnotic
experiences that discriminates simulating and nonsimulating individuals.
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