Sound, Suggestibility and Hypnotisability: Can an artificial auditory environment utilising music and sound enhance the process of hypno-psychotherapy?
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ABSTRACT: Music and Hypnosis have many similar qualities and properties. This paper aims to investigate the methods by w...
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Sound, Suggestibility and Hypnotisability: Can an artificial auditory environment utilising music and sound enhance the process of hypno-psychotherapy?
By Peter Bryant
Sound, Suggestibility and Hypnotisability
Peter Bryant
Table of Contents Introduction ............................................................................................................................................ 4 Section 1: Terminology, Definitions and Assumptions. .......................................................................... 6 Suggestion and Suggestibility. ............................................................................................................ 6 Clarification of Terms: Suggestion and Suggestibility ..................................................................... 6 Suggestion ....................................................................................................................................... 6 Suggestibility ................................................................................................................................... 8 General Characteristics ................................................................................................................. 10 Suggestion ..................................................................................................................................... 10 Suggestibility ................................................................................................................................. 10 Hypnotic Susceptibility and Hypnotisability. .................................................................................... 11 Clarification of Terms: Hypnotisability.......................................................................................... 12 General Characteristics of Hypnotisability.................................................................................... 12 Trance ............................................................................................................................................... 13 Clarification of Terms: Trance ....................................................................................................... 13 General Characteristics: Trance .................................................................................................... 13 Absorption & Dissociation ................................................................................................................ 14 Clarification of Terms: Absorption and Dissociation .................................................................... 14 Absorption .................................................................................................................................... 14 General Characteristics: Absorption and Dissociation.................................................................. 14 Absorption .................................................................................................................................... 14 Dissociation ................................................................................................................................... 14 General Characteristics: Dissociation ........................................................................................... 15 Assumptions...................................................................................................................................... 15 Section 2: Music and the Mind. ............................................................................................................ 16 Therapeutic Properties of Music....................................................................................................... 16 Music, Mind and Brain ...................................................................................................................... 18 A Socio-cultural History of Music and Hypnosis ............................................................................... 21 The History of Therapeutic Music and Sound ................................................................................... 27 Sound and Brainwave Manipulation ............................................................................................. 27 Music Therapy ............................................................................................................................... 28 Section Three: Music and Hypnosis Research. ..................................................................................... 32 Procedure.......................................................................................................................................... 32 Scopus ........................................................................................................................................... 32 Web of Science.............................................................................................................................. 33
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PubMed ......................................................................................................................................... 33 PsycINFO ....................................................................................................................................... 33 Other Publications ........................................................................................................................ 33 Section 4: General Overview of the Literature. .................................................................................... 35 H1. Can sound manipulate an individual’s level of suggestibility? .................................................... 35 H2. Can sound manipulate an individual’s hypnotic susceptibility? ................................................. 38 H3. Are these manipulations temporal or permanent? .................................................................... 40 H4. Which characteristics of sound are most likely to alter a listener’s hypnotisability? ................. 41 H5. Could music or sound enhance the process of hypno-psychotherapy and if so, how?.............. 42 H6. How may these findings be best utilised by therapy practitioners? ........................................... 43 H7. Does being musically sophisticated increase a person’s hypnotisability? .................................. 43 Section 5: Conclusion and considerations for further research. .......................................................... 44 Bibliography .......................................................................................................................................... 45
ABSTRACT: Music and Hypnosis have many similar qualities and properties. This paper aims to investigate the methods by which music could aid the process of hypno-psychotherapy. A systematic literature review of the topic is conducted. Eighty-four relevant papers are discussed and analysed in order to establish an empirical research base for the topic. It is found that the psychological properties of absorption, dissociation, empathy, expectancy and rapport development are common to both fields and can be used to assist clients with the psychotherapeutic process in multiple ways, as discussed. Recommendations for further research are provided alongside guidance and support for therapists wishing to utilise music within their hypnotherapy and psychotherapy practices.
Main text word count = 11,990.
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Introduction The psychological state which has been labelled ‘hypnosis’ by scholars, practitioners and researchers for most of its modern existence, is usually, and most effectively instigated via the use of sound (American Psychological Association, 2014). This sound has traditionally been the words of a therapist or a qualified professional who has delivered suggestions to the listener within the context of a therapeutic intervention, to manage and assist with and alleviate unpleasant symptoms of a particular mental disorder, health condition or habitual issue. Throughout the history of hypnosis, there have been a number of questions raised by scholars as to the ability of music to produce hypnotic phenomena and specifically music’s capabilities to compliment and enhance a talkingtherapy session (Kennaway, 2011). This may be thanks to hypnosis and music enjoying a complex and interconnected relationship due to their broadly similar psychological features such as absorption, dissociation and expectancy (Rouget, 1985). In many cultures around the world, the idea of utilising music for the benefit of health is relatively commonplace and is now gaining acceptance in the western world (Saarikallio, 2012; Campbell & Doman, 2011). With the rise in modern audio technology, it is now a common occurrence for talkingtherapists to utilise music regularly within their practices, both within the actual sessions themselves and within their therapeutic recordings for client distribution (Brookhouse, 2013). Just how widespread the utilisation of music within a therapeutic context is, does not currently seem to be known, however, the majority of practitioners who utilise music within their sessions qualify it to drown out extraneous noise or to fill the otherwise empty silence for the reassurance of their subjects (and perhaps, if they are completely honest, also themselves) (Brookhouse, 2013). This is one way of using music to benefit the process of therapy, however, I plan to argue that the use of music can be exploited further as a tool to aid talking-therapists by heightening a client’s suggestibility and willingness to engage within the therapeutic process. This strategy, it is
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hoped, would thereby improve the efficacy of psychotherapeutic procedures in a cost effective manner, and without the negative side-effects of other solutions. This paper will present a systematic literature review of the current and historical thinking on this topic with the intention that these investigations promote future primary research within this area. I have a number of hypotheses that I wish to investigate during this literature review which are as follows: 1) Does music or sound allow individuals to become more suggestible? 2) Can music or sound manipulate a person’s level of hypnotisability? 3) If H1 and/or H2 are correct then are these alterations temporal or permanent? 4) If H2 is true then, which characteristics of sound are most likely to alter the listener’s hypnotisability and why might these musical characteristics adapt client hypnotisability? 5) How could these findings enhance the process of hypno-psychotherapy? 6) How best may these findings be utilised by practitioners in their psychotherapy practices in order to achieve greater results with clients? 7) Does being musically sophisticated increase a person’s ability to be hypnotised?
At the close of this paper, I shall recommend additional areas of research in order to elaborate upon these initial hypotheses in order to improve the perspective on this topic for future researchers. This paper is an overview of how sound and music can affect the mind. How music can improve client-therapist relationships and sound can improve hypnotic and psychotherapeutic interventions for the benefit of clients. I believe that music is a vitally important, cost-effective, sideeffect free, largely untapped source of potential for improving the lives of many people.
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Section 1: Terminology, Definitions and Assumptions. Writing on topics such as Music, Mental Health, Medicine, Psychology, Hypnosis and Suggestion unavoidably requires the use of jargon. Unfortunately, there is a disparity on the use of some terminology throughout the literature, particularly with regard to hypnosis, which has suffered many problems with the definition of its terms over the course of its history (Waterfield, 2004). I have, therefore, dedicated this section to providing my working definitions of several terms that I shall use throughout this paper in favour of ensuring that my meaning and use of each term is clear.
Suggestion and Suggestibility. Suggestion and suggestibility have become largely synonymous within popular culture thanks to the topic of hypnosis being prevalent in mainstream popular culture1 (Tasso & Perez, 2008). This is an issue for researchers and academics as there are several important distinctions between the two definitions and their related phenomena which are relevant to hypnosis and their associated mental processes.
Clarification of Terms: Suggestion and Suggestibility Suggestion ‘Suggestion’ has seven definitions, according to the Oxford English Dictionary, only one of which is within the remit of hypnosis: ‘The insinuation of a belief or impulse into the mind of a subject by words, gestures, or the like; the impulse or idea thus suggested’. The six accompanying definitions are more common everyday definitions or niche uses of the word (Oxford English Dictionary, 2014). The phenomenon of suggestion is pervasive in everyday life; a young child injures himself, picks himself up and dusts himself down. Only then does he
1
See ‘A Socio-cultural History of Music and Hypnosis’ on page 21.
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witness his mother’s expression of panic which prompts him to cry. It has therefore been suggested to him that he is expected to react emotionally to this situation by his anxious mother (Gass & Seiter, 1999; Gwynn & Spanos, 1996; Tasso & Perez, 2008). The above scenario is an example of everyday or non-hypnotic suggestion. Suggestion is not a purely hypnotic phenomenon as some individuals believe; it is not a requirement for suggestion to be within a therapeutic or even a so-called hypnotic context in order for it to be effective in communicating ideas and beliefs. Thus ‘slow down’ is a suggestion along with a whole plethora of everyday statements that we regularly encounter in our lives within normal communication. The lack of distinction between these different types of suggestion has caused some confusion within academic texts which, as a result, now make a deliberate effort to explicitly categorise suggestions as nonhypnotic suggestion (‘hurry up’) and hypnotic suggestion. The only difference between these two types of suggestion is that hypnotic suggestions are non-hypnotic suggestions conducted in a socalled trance state, or - at least - within the context of hypnosis (which may in itself, be a suggestion) (Tasso & Perez, 2008). Accordingly, modern authors have argued that there are an almost limitless number of types of suggestion depending on their context, whilst others have been more reserved and stated that the ability to respond to both hypnotic and non-hypnotic suggestions is a global and universal trait with similar properties to intelligence which has multiple facets and qualities (Tasso & Perez, 2008, p. 284; Gardner, 2006). It is generally agreed that there are three distinct components of suggestion (Bernheim, 1889): 1. The introduction of an idea (to the individual). 2. The acceptance of that idea (by the individual). 3. The realisation of that idea (by the behaviour, performance or attitude of the individual). These three properties are vital for any suggestion to be effective. Everyday suggestion has a pivotal role for our communicative abilities, which arguably, make us human. There is strong 7
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evidence that our innate capacity for suggestion has directly contributed to our evolutionary success as a species (Brown, 1991; Waterfield, 2004). It has been found that everyone of normal cognitive ability is born with the psychological mechanisms and traits which enable them to be capable of accepting suggestions. Despite its importance, the literature on the topic of suggestibility (particularly non-hypnotic suggestibility) is still poor, due to it being side-lined in favour of research on hypnosis and hypnotic susceptibility which is arguably easier to objectify and empirically measure (Tasso & Perez, 2008).
Suggestibility Suggestibility is characterised as to how readily an individual will accept statements and ideas (suggestions2) from others and subsequently act upon them. There is no requirement for the presence of a hypnotic context which is a similar property for the use of the term suggestion. However, in recent popular culture, hypnosis and suggestibility have become fused in the public consciousness (along with hypnotic susceptibility or hypnotisability3). It is for this reason that the term suggestibility is commonly used to refer to the psychological state of hypnosis, as suggestion is arguably a central and vital facet and requirement of effective hypnosis (Kihlstrom, 2008, p. 26). However, the literature posits that suggestibility and hypnotisability are separate psychological constructs and should be treated as separate, mutually exclusive entities (Hilgard, 1973; 1991; Bowers, 1983; De Pascalis, 1989; Edmonston, 1989; Evans, 1989; De Pascalis, et al., 1998; Tasso & Perez, 2008). After all, suggestions form a pivotal role in hypnotic procedures in order to inspire positive change. The only qualifier that they are hypnotic is that these suggestions are delivered to the client during a so-called state or psychological framework of trance. However, in this paper, I shall not use the term suggestibility to refer to an individual's capacity to enter a so-called psychological state of hypnosis. Instead, I shall regard it as a term to describe how effectively both 2 3
See page 6-8 for a definition. See page 11 for a definition.
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hypnotic and non-hypnotic suggestions enact on the behaviour and attitude of the listener. Unfortunately, for the purposes of clarity, highly suggestible individuals are usually ascribed to be very competent hypnotic subjects. Highly hypnotisible individuals are seen to have an improved ability to comply with verbal suggestions and thus, the efficacy of the therapeutic procedure is enhanced4. This trend has lead to a confusion of the terms suggestibility and hypnotic susceptibility or hypnotisability5. These pseudo-interchangeable terms even appear in dictionaries as the word ‘suggestibility’, according to the Oxford English Dictionary, is synonymous with hypnotisability6: ‘Susceptibility to (hypnotic or other) suggestion’ (Oxford English Dictionary, 2014). These definitions are somewhat unhelpful as the research literature has, correctly, begun to separate the psychological train of suggestibility from that of hypnotisability. An individual’s level of suggestibility dictates how successful the second and third components are from the three facets of suggestion7 and thus how readily a new idea is accepted by that individual and to what extent it affects their life. This is where hypnosis (along with other mechanisms) can be used as a tool in order to increase both hypnotisability and suggestibility using a hypnotic and psychological environment. Research has indicated that suggestibility can be modestly increased using a wide variety of factors from hypnosis to pharmacological products and other psychological tools (Faymonville, et al., 2000). However, the ability of music or sound to enhance suggestibility (with or without the use of hypnosis) is conspicuous only by its absence from the majority of empirical research literature. For the purposes of this paper, I shall work according to the definition that suggestibility is the degree to which an individual can accept non-hypnotic suggestions. This is important, as it can be argued that music is a form of non-hypnotic suggestion
4
See the list of assumptions on page 15 for more on this. For the sake of argument (and my word count) I shall use the term hypnotisability to mean hypnotic susceptibility for the remainder of this paper. 6 Hypnotisability itself is not referenced within the OED. This is surprising as ‘hypnotisability’ does feature heavily within the literature. For example Lynn & Snodgrass ‘Hypnotizability and music involvement’ (1986), or ‘Hypnotizability and blink rate…’ by (Lichtenberg, et al., 2008) among others. 7 See the three distinct components of suggestion (Bernheim, 1889), summarised on page 7 of this paper. 5
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which may be more effective when combined with the context and psychological attributes of hypnosis. Music can be seen a parallel to linguistic suggestion; an idea can be communicated to an individual either explicitly and consciously with language or unconsciously with sound and music.
General Characteristics Suggestion The general characteristics of suggestion are a deliberate instruction, idea or theme communicated to an individual with the intent to alter their perspectives, beliefs, or attitudes in order to invoke a paradigm shift. Thus, all forms of communication could be labelled as ‘suggestive’. This includes written and verbal language, music, literature and art. Suggestion is capable of permeating all of the senses including visual, olfactory, auditory, proprioceptive (Kinaesthetic), somatosensory and gustatory perception. Suggestion is a facet of everyday life; we encounter it on an almost continual basis in everyone we communicate with (Tasso & Perez, 2008).
Suggestibility Suggestibility is the degree to which we accept these ubiquitous suggestions. Evidence has suggested that a person’s general level of suggestibility decreases with their age (Hilgard, 1965). This may be due to a number of psychological biases which generally increase in power with our cumulative life experience. However, there are as yet no general tests of suggestibility8. It has been argued that there are three distinct types of suggestibility; Emotional suggestibility9, Physical suggestibility and Intellectual suggestibility, but there may be as many types of suggestibility as there
8
‘Suggestibility tests’ of which there are eighteen common varieties, which were developed during the mid-toth late 20 century such as the Stanford Hypnotic Susceptibly Scales (SHSS) (Weitzenhoffer & Hilgard, 1959), actually measure hypnotisability factors such as hypnotic quality and hypnotic depth (Laurence, et al., 2008; Waterfield, 2004). For more information on these scales, including their potential in clinical practice see (Weitzenhoffer, 2000, pp. 250-306) 9 This type may be particularly suitable for musical hypnosis thanks to music being a very effective mechanism for conveying and manipulating emotional states (Juslin & Sloboda, 2001).
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are types of suggestion with each type having its own factor (and measure) of suggestibility (Edmonston, 1989).
Hypnotic Susceptibility and Hypnotisability. Hypnotisability10 is a measure of an individual’s capacity to complete a hypnotic experience in terms of depth and performance (Kihlstrom, 2008). It can be defined as an individual’s readiness to enter a ‘state’ of hypnosis – whatever that may be - and subsequently the amount (and quality) of hypnotic phenomena which can seemingly be achieved by the individual when experiencing suggestions when under the psychological influence of hypnosis (Tasso & Perez, 2008). As we have already witnessed, hypnotisability is commonly confused with suggestibility. In academic environments, there are important requirements for clear distinctions between the two psychological traits (Tasso & Perez, 2008). Hypnotisability has had a reasonably large interest from academics throughout the 20th century. Clarke Hull made a pioneering attempt at quantifying the quality of a hypnotic state with the use of scales, in order to assess an individual’s ability to enter a trance state (Hull, 1933). Subsequent development by other scholars and academics has enabled a wealth of psychometric tests to be implemented in order to assess the quality of an individual’s hypnotic experience11 (Woody & Barnier, 2008). Researchers can now utilise a wide variety of tools to assess the quality of an individual’s hypnotic experience, but further work is needed from a research perspective in specific areas. For example, the majority of scales designed to assess hypnotisability aim to assess the ‘depth’ of a trance, however, the existence of this ‘depth’ and its clinical methodology is contested by some researchers and practitioners in modern literature (Kihlstrom, 2008).
10 11
‘Hypnotizability’ in American English. See footnote 8 on page 10 for more information.
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Clarification of Terms: Hypnotisability Hypnotisability can be subjectively measured using psychometric tests12. When an individual reaches a point where they can no longer manifest a subsequent phenomenon that the researcher or therapist is requesting, they are said to have reached their current level of hypnotic susceptibility. Tests of hypnotic susceptibility tend to be used primarily in research environments rather than as an aid to therapeutic intervention as most therapists deem them to be an unnecessary hindrance to the therapeutic process with the exception of the most sceptical of clients (Brookhouse, 2013).
General Characteristics of Hypnotisability Unlike suggestibility, hypnotisability has been shown to remain relatively constant throughout an individual’s life (Piccione, et al., 1989). Research has suggested that there are individual differences in hypnotisability with around 5-10% of the population finding a hypnotic state easy to engage with and 5-10% finding hypnosis extremely difficult to achieve with a broad spectrum in-between these two extremes. This spectrum (generally considered to be identical to many other personality and psychological trait) is represented as a Gaussian bell curve. However, hypnotisability can be affected by personality traits such as an individual’s capacity for absorption13 and certain types of intelligence (Geiger, et al., 2014; Chamorro-Premuzic & Furnham, 2007). Other research has demonstrated that small alterations and enhancements in hypnotisability can be made depending upon the individual’s environment, personal experiences and genetic makeup (Gorassini, 2004). Strong correlates which do appear to be related to measures of hypnotisability are absorption (Tellegen & Atkinson, 1974; de Groh, 1989), fantasy proneness (Lynn & Rhue, 1988), empathy (Wickramasekera & Szlyk, 2003) and self-directedness14 (Laidlaw, et al., 2005). It has been noted that children have higher hypnotic susceptibility scores than adults, possibly due to their innate capacity for imaginative exercises. There are no physiological traits or identifiers of hypnotisability.
12
See page 9, footnote 7 ‘Suggestibility tests’. See definition on page 14. 14 Individuals with an internal locus of control had lower hypnotisability scores than individuals with an external locus of control. 13
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Furthermore, an individual’s hypnotisability can be modestly adjusted with drugs, abnormal circumstances or environments and with repeat exposure to hypnosis (Hilgard, 1965).
Trance A trance is an altered state of consciousness from normal consciousness (Wier, 2007, p. 58). The debate on whether hypnosis is a trance state has been a point of contention for the majority of the 20th century (Waterfield, 2004). However, for the purposes of this paper, the distinction is unimportant. Few scholars would argue that the act of hypnosis causes no psychological change for any individual. In this essay, I choose to call this state a ‘trance’. Whether it be caused by social pressure to conform or by a different set of brainwave patterns on an EEG machine is not a crucial distinction for my argument to stand. The term ‘trance’ has been used throughout the majority of music literature to reference rituals of demonic possession, absorption, dissociation and other psychological constructs. I shall refer to them all as a state of trance and explicitly state which type I am discussing at the relevant time.
Clarification of Terms: Trance As discussed above, throughout this essay, I shall use the term trace to indicate the state of hypnosis. I am defining the state of trance according to Becker’s definition as: ‘A cognitive, emotional, and behavioural state characterized by the loss of sense of self, the cessation of inner languaging [sic], and an extraordinary ability to withstand fatigue or pain’ (Becker, 2004). I will utilise the assumption that hypnosis (both hetero and solo) results in a successful state of trance throughout this paper.
General Characteristics: Trance The characteristics of trance have been widely documented and have been subject to exaggeration. Unlike hypnotic susceptibility, there are physiological and behavioural patterns to the
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trance state; however, these cannot indicate for certain that an individual is in trance and should be used with caution (Barber, 1961).
Absorption & Dissociation The interrelated psychological traits of absorption and dissociation have provided a possible psychological mechanism for trance, hypnosis and other phenomena associated with an altered state of consciousness involving music to occur (Herbert, 2011).
Clarification of Terms: Absorption and Dissociation Absorption Absorption is defined as “…an effortless, non-volitional quality of deep involvement with the objects of consciousness” (Jamieson, 2005). This is in contrast to ‘goal-directed attention’, which is effortful, rational and progress directed (Herbert, 2011, p. 5).
General Characteristics: Absorption and Dissociation Absorption Absorption has been identified as a contributing factor to strong or peak musical experiences (Lowis, 1998).
Dissociation The treatment of dissociation will be purely non-pathological for the entirety of this paper. Non-pathological dissociation is defined as: “…an altered state of consciousness that is not organically induced, and that involves the temporary alteration or separation of normally integrated mental processes in conscious awareness” (Butler & Palesh, 2004).
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General Characteristics: Dissociation Dissociation involves a temporary detachment from immediate surroundings and reality. It is commonly displayed on a continuum from everyday experiences such as daydreaming to severe pathological breakdowns (Dell & O'Neil, 2009, p. 18). It is worth noting, that, despite its similarities with hypnosis (indeed, dissociation is considered to be the hallmark psychological quality of the hypnotic experience15), several studies have shown that it does not appear to predict hypnotic susceptibility or hypnotic responsiveness (Faith & Ray, 1994; Silva & Kirsch, 1992). Although, it has also been found that individuals diagnosed with dissociative identity disorder have the highest hypnotisability scores of any clinical group (Spiegel, et al., 2011).
Assumptions Throughout this paper, I adhere to several assumptions (for the sake of argument) which are not yet ready to be clarified by the research literature. None of these assumptions are controversial, and although general acceptance is no proof of the statement being correct, all my assumptions are commonly held beliefs among the majority of empirically minded hypnotherapists and scholars. 1. Better ‘quality’ hypnotic experiences lead to higher efficacy of effective interventions. 2. The higher a person’s hypnotisability, the more likely they are to have a higher quality hypnotic experience.
15
See (Orne, 1959; 1966; Bowers, 1983; Frankel, 1976; Hilgard, 1986; Hilgard & Hilgard, 1994) for more on this.
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Section 2: Music and the Mind. Therapeutic Properties of Music Music is inherently suggestive, although its ability to explicitly communicate or express anything with a similar quality to language is highly lacking (Patel, 2008, p. 301). In modern times, there have been many debates between scholars as to music’s ability to communicate concepts, ideas and objects in a similar way to language (Levitin, 2006; Patel, 2008). These debates are still ongoing, but aside from a strong argument as to the development of language itself (Mithen, 2007), music seems to be essentially redundant in modern communicative processes (Pinker, 1997). Music scholars and composers have debated music’s ability to communicate messages throughout the 20th century. Ivor Stravinsky stated his controversial opinion in 1936 in his autobiography that: ‘…music is, by its very nature, essentially powerless to express anything at all… If, as is nearly always the case, music appears to express something, this is only an illusion and not a reality. It is simply an additional attribute which, by tacit and inveterate agreement, we have lent it, thrust upon it, as a label, a convention – in short, an aspect which, unconsciously or by force of habit, we have come to confuse with its essential being’ (Stravinsky, 1936, pp. 53-54). Having said this, this ‘additional attribute’ is extremely powerful in television, films and in our lives. Anecdotal evidence of the power of music to stimulate memory, improve performance at cognitive tasks (such as creativity and athletic ability) and to contribute to emotional and mood management are beginning to be supported by a large amount of empirical evidence (Whaley, et al., 2009)16. The academic study of music and its potential to alter the mind has been small compared with the references from popular culture. Rumours of music’s alleged ability to ‘brainwash’ the mind have been relatively commonplace throughout history; over one thousand years ago, music’s ability 16
For more on the topic of music, healing and its power to accelerate and improve cognitive development see (Campbell & Doman, 2011).
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to control the emotive state of listeners deemed it an unattractive addition to church services as religious leaders feared that music had the capacity ‘to influence the ethos of listeners, for good or for ill’ and feared its power over the human psyche (Burkholer, et al., 2010, p. 25). There have even been specific composers whose music has been associated with hypnosis and hypnotic phenomena the most prolific of which is Richard Wagner whose music has been perceived to induce hypnotic like properties in its listeners, primarily through the use of highly emotive passages (Warthin, 1894)17. The understanding of music as a psychological tool to aid our comprehension of the mind has increased in recent times thanks to a greater recognition of the power of our own psychological processes and new technology. Unfortunately, this technological development has fed a wave of reports of music’s alleged contribution to so-called suggestion based suicides, murders and other similar incidents (Kennaway, 2012). On the other side of the spectrum, there is the rapidly expanding field of music therapy which is increasingly becoming a highly popular therapy modality18. All these findings can assist other therapists in how to use music constructively and responsibly with their own clients in order to improve their therapeutic results.
17
There is an extremely recent experiment (currently in press), where eight volunteers were asked to listen to the entirety of Wagner’s Ring Cycle whilst their heart rate, sweat level and micro-movements were monitored. Preliminary results suggest that individual psychological responses can be prompted by musical techniques such as the use of leitmotifs in order to manipulate the audience’s reaction (Goldsmiths, University of London, 2014). 18 See page 28 for more information.
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Music, Mind and Brain Music’s ability to influence the mind has been shown in a wide variety of domains throughout history. Examples include playing tempo-calibrated music in supermarkets and restaurants in order to manipulate how long individuals spend within these establishments. Sonic techniques have been promoted to businesses as a potential method of increasing turnover by controlling how much money individuals spend within these respective environments (Gueguen, et al., 2007). Music has been used in commercial settings, media and by individuals themselves to suggest everything from moods, ideas and products throughout history. Research into this area has uncovered a wealth of surprising findings which have influenced business practices. For example, supermarkets can suggest to customers which wines to purchase using music from different (stereotypical) nationalities and different associated musical instruments. The presence of French music in a wine isle (as indicated with the traditional French instrument; the accordion) can lead to an increase in sales of French wine by a factor of five. A similar result has been found with the use of the Germanic ‘oompah’ band music increasing German wine sales by a factor of two (North, et al., 1997). The music was acting (perhaps unconsciously) as a suggestion as to the nationality of the wine to be chosen by the customers. It is this type of musical suggestion that I am aiming to investigate and whether it can be applied for more than purely commercial means. One of the most obvious and powerful mechanisms of the capacity of sound to manipulate the mind is called Pavlovian conditioning. The work of Ivan Pavlov (1849 – 1936) successfully demonstrates that concepts and ideas can be associated with external objects such as dogs associating food with the sound of a tuning fork, bell or metronome (Pavlov, 1927). This conditioned response could then, with repeated exposure and training, be instigated even when there was no food present. Since these studies, it has been shown that conditioning affects humans on many
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levels and can be extremely powerful as a therapeutic tool19. There have been a number of cases where musical instruments have been used in order to aid hypnotherapy interventions, in particular the use of a gong is favoured by some practitioners as an exotic and dramatic instrument to aid therapeutic change (Livnay, 2014). Is that all there is to music as a tool for therapeutic and cognitive change? Can there be a mechanism for aiding the process of hypnosis using music besides standard Pavlovian conditioning? Further examples of the power of music include noise and sound control in the world of gambling and in other entertainment media such as television shows and films where we are provided with an auditory accompaniment which enables the viewer to gain a better understanding of the context of the visual information being presented. One only has to watch a horror film or a comedy with the sound turned off to appreciate the value of a soundtrack, score or canned laughter track. Sound and music convey highly-emotive messages in an extremely effective and efficient manner. Architects have long exploited the auditory properties of the environments which they create, particularly within the entertainment industry. Greek amphitheatres are renowned for their spectacular auditory properties. This is mainly due to their circular, tiered design and the specific properties of the type of limestone that went into their construction. These considerations helped to dampen unwanted lowfrequency crowd noise and boosted the actor’s voices at higher frequencies (Declercq & Dekeyser, 2007). Modern examples include casino design where hard, sonically reflective surfaces are maximised in order to allow a higher degree of sound reflection and reverberation. These reflections allow the casino to sound and seem busier than using soft surfaces. Busy casinos promote and motivate gamblers to bet more money, more frequently and increase impulsivity due to the psychology of social proof and social conformity (Friedman, 2000, pp. 135-137). Another example, from modern warfare, features the playlists of soldiers stationed in territories overseas, which contain an extremely high amount of heavy metal and other violent music. Soldiers readily admit to
19
This school of thought is broadly referred to as ‘Behaviourism’.
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using music in order to alter their mindset in order to allow them to become ‘monsters’ and commit what they commonly refer to as ‘inhumane acts’ in the name of war (Gilman, 2010). The benefit of music has not gone unnoticed in a variety of domains related to psychology and performance improvement. For example, the use of music during cardio-vascular exercise can improve performance by as much as 15% (Edworthy & Waring, 2006). Other transference effects have been noted, for example, an enhanced capability to complete spatial tasks (Rauscher, et al., 1993), increased work productivity and enhanced reading comprehension, among other psychological improvements (Music Works, 2014)20. Music has been isolated as a key factor in rapidly transforming our sense of self via an altered state of consciousness known as a trance. Music is used throughout the world in order to enhance trance or ecstatic rituals (Becker & Penman, 2009). However, the relationship between music and trance is complex and there is, as yet, no evidence that music alone can place a listener in a state of trance without the correct context and the listener’s implied consent (Heap, 2013). The effects demonstrated with trance states and music require both language and music working in situ in order to have their full transformative effect. However, there is not currently enough research to rule out whether instrumental music alone could, in the right circumstances, have a comparable effect purely of its own merit (Patel, 2008, pp. 324-325).
20
For more on this please see Victoria Williamson’s excellent book ‘You are the Music’ (2014). Also see the fascinating Music Works project (www.musicworksforyou.com).
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A Socio-cultural History of Music and Hypnosis Among the scattered and disparate literature on the topic of music and hypnosis are a number of key articles which attempt to address basic questions about the links and contrasts between the two fields. An understanding of the historical and current attitudes towards music and hypnosis in popular culture is important, as personal expectation, which depends and is influenced by the attitudes of popular culture, is a trait shared by both music and hypnosis (Lynn, et al., 2008, p. 122; Stevens & Byron, 2011). Presently, the most prominent of these articles is by James Kennaway who discusses the history of music, hypnosis and trance states from their earliest beginnings to the present day (Kennaway, 2011). Kennaway begins by tracing the history of music and trance back to the late eighteenth century where the early development of hypnosis – then referred to as ‘animal magnetism’ occurred (Waterfield, 2004). Music had obviously existed long before these hypnotic effects were popularised by Franz Mesmer. Mesmer not only utilised music and sound to therapeutic effect, (referred to by him as ‘sympathetic vibration’) but also developed a theory that auditory phenomena could be used to communicate, propagate and reinforce what came to be understood as modern-day hypnotic suggestion (Mesmer, 1779, p. 78; Goldschmidt, 1983; Kennaway, 2010). Indeed, it has been heavily speculated that pianos, violins and harps – in particular the glass armonica – which Mesmer frequently used in his ‘treatments’ are directly responsible for the successes and triumphs of his bogus therapy of magnetically aligning human ‘universal fluid’ (Polter, 1934, p. 15; Franklin, 1785, p. 23; Gallo & Finger, 2000; Hadlock, 2000; Hyatt King, 1945). This hypothesis gains more validity when we consider that many of Mesmer’s clients had very strong musical experiences throughout their lives, such as auditory hallucinations, cures achieved with the aid of music and stories of tone-deaf patients suddenly developing musical talent whilst in a ‘magnetized sleep’ (Wirth, 1836, p. 180; Kretschmar, 1824, pp. 41-42; Spiritus, 1819, pp. 83-4; Baehr & Kohlschütter, 1843, p. ix). Today, music has a longstanding relationship with healthcare thanks to
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the development of Music Therapy21 – an intervention which is specifically designed around the modality of music and its capacity to improve the mind (The American Music Therapy Association, 2014). Unfortunately, the public opinion of hypnosis has not progressed as much as the opinion of music
therapy
within
western
culture22.
Other practitioners of hypnosis began to see the benefits of using sound and music within their ‘performances’. The beginnings of hypnosis were usually displays of women reaching a ‘crisis’ seemingly caused by the techniques of a male hypnotist. The sexualised nature of this practice has been discussed at length23 (Braid, 1843; Kaplan, 1974). Of particular note are Jean-Martin Charcot’s use of gongs, tuning forks and other percussive instruments in order to provoke cataleptic fits or ‘hysterical hypnosis’ (Regnard, 1887). Other individuals such as Paul Regnard, Paul Richer, Alfred Binet and Charles Féré also used percussive instruments in addition to simple melodies and children’s lullabies with similar results to Charcot (Regnard, 1887, pp. 261-2; Richer, 1881, pp. 599600; Binet & Féré, 1887, pp. 88-89, 93). From the perspective of clients, it may have seemed as if the sound itself was contributing something to these performances by allowing them to be more outlandish and incredible than performances without the aid of music. Moving into the 19th century, musical hypnosis became of interest to mainstream composers, in particular, Wagner. I have already discussed that he was suspected of using hypnotic techniques to aid his compositions and, as a direct result of his new compositional style, was labelled a ‘mesmerist’ and ‘a master of hypnosis’. These terms were intended to be highly derogatory implying that he could control and manipulate his audience without their prior consent (Nietzsche, 1888, pp. 104, 99). Wagner’s personal notes are full of references to the current thinking on the topic of musical hypnosis, and he was quite obviously fascinated by the concept (von Herrmann, 21
See page 28. Today, music therapy is effectively a chartered profession whilst hypnotherapy and even psychotherapy is still largely unregulated. 23 It is interesting that music was chosen as a means of enhancing hypnotic technique as music performance th was a predominantly female pastime during the 18 century (Burkholer, et al., 2010). The use of music in therapeutic sessions may have enhanced the rapport between Mesmer and his female clients thereby improving the alleged performance of animal magnetism. 22
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2007). At the time, popular culture contained frequent references to hypnosis, indeed a novel entitled Trilby was published in 1894 where musical hypnosis features as a major plot mechanism. The novels antagonist Svengali hypnotises the protagonist (a young, innocent and naïve teenage girl called Trilby) into performing hypnosis around Europe before marrying her (du Maurier, 1985). If anyone suspected that the anxieties surrounding music and hypnosis would abate during the 20th century - when the frequently wild claims could be examined according to the scrutiny of the scientific method, rather than supported by anecdotal evidence - they were to be disappointed. Alongside the huge technological advances promoted by the first and second world wars came new fears about music and its ability to influence the mind, in particular, its use as a tool for brainwashing. Music could now be recorded, manipulated and then distributed in processes that would have been unimaginable to composers and performers during the 18th century (Rouget, 1985, p. 121). Once again, popular culture was ahead of academic interest as anxieties about the Cold War fed into mainstream media including manipulation by music. Cinema (once itself considered to be a form of hypnotism (Andriopoulos, 2008)) contributed to this by publicising films such as The Manchurian Candidate and A Clockwork Orange which depicted the ‘Ludovico Technique’ a fictitious form of aversion therapy which involved watching atrocious images of violence whilst listening to music (Burgess, 1966). Academic interest in using auditory cues in order to influence the mind took a revolutionary step when Ivan Pavlov started conducting experiments with dogs (Pavlov, 1928)24. This, now famous research, sparked the academic debate into whether humans could be primed to behave in a similar fashion to the dogs in Pavlov’s experiments; namely, to respond to auditory stimuli completely unconsciously – auditory hypnosis (Thomas, 1994). The development of popular music brought with it further anxieties about control. Genres such as rock and heavy metal (potentially a straw man approach by lawyers thanks to its general reliance on satanic themes and evil iconography) drawing strong criticism from governments for
24
To save me repeating myself, please see my previous discussion of Pavlovian conditioning on page 18.
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their themes of rebellion, evil and death (Kennaway, 2011). This criticism was initially centred at the sheer popularity of the music; for example, right-wing Christian David Noebel has argued that rock music is literally a communist plot orchestrated by Russian researchers in order to take control of America’s youth. He cites that the widespread popularity of the Beatles during the 1970’s and 80’s as proof of his argument (Ostendorf, 1997; Noebel, 1974; Noebel, 1982). It is not just the music which has come under attack but also the lyrics. There have been a number of violent incidents and suicides allegedly caused by music that the perpetrators were listening to prior to the incidents taking place. Concern arose about the phenomenon of ‘subliminal messages’ encoded into the lyrics of tracks which, it was argued, could instruct people to become violent, impulsive or act more impulsively. The first alleged instance of subliminal messaging was not in auditory form but in film. In 1957, James Vicary claimed to have developed a new way of marketing confectionary to cinema audiences using subliminal messages such as ‘drink coke’ and ‘eat popcorn’ at extremely short durations whilst the film was being performed (Packard, 1957). Subsequent research has shown that this technique is not as profitable or as reliable as Vicary claimed in his research, in fact, he had made the whole thing up in an effort to revive his consulting business (Moore, 1992; Pratkanis, 1992). Despite this, the auditory equivalent of subliminal messaging called ‘backmasking’ gained even more public attention than its visual (likely fictitious) analogy. A popular claim was that bands such as Judas Priest were deliberately inserting barely audible, reversed, satanic messages into recordings, which, it was argued, could affect the unconscious minds of listeners. It was claimed that these messages could unconsciously alter the behaviour, beliefs and attitudes of the listeners without conscious awareness, resulting in increased suicidal tendencies and other violent behaviours (Lilienfeld, et al., 2010). ‘Experts’ have often disagreed about precisely what is being said in these messages as they are, by definition, almost impossible to understand (Kennaway, 2011). Nevertheless, this has not held back high profile litigation as artists such as Ozzie Osborne who was (unsuccessfully, as the case was thrown out on the grounds of free speech) sued in 1985 based on the accusation that his song ‘suicide solution’ had 24
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caused a listener to attempt suicide. This suicide, it was argued, had been instigated via the process of musical brainwashing. Another case, again in 1985, saw two teenagers shoot themselves. Their parents blamed the heavy metal band Judas Priest, claiming that ‘satanic incantations are revealed when the music is played backwards’ (Wright, 2000). Further examples of the harm of alleged musical brainwashing can be found in the 1990’s after Richard Kuntz committed suicide whilst listening to Marilyn Manson and media reports blamed Manson for the Columbine school massacre in 1999 (Wright, 2000). In all of these cases, individuals have testified in court that it was the music that was the primary culprit of these atrocities. The arguments for the method of use is remarkably similar to one of the theories regarding how hypnosis may operate (i.e. the critical factor theory25) in that if someone were to hear the phrase ‘God is Satan’, the brain would reject it straight away. However, if someone were to hear the phrase “dog si natas” or “Satan is God” backwards then it would be decoded by the right (or creative) part of the brain and stored as a fact (Aranza, 1983). The academic interest in this area is continuing but does not currently support the idea that musical brainwashing is a large contributing factor in teenage suicides (Scheel & Westefeld, 1999; Rosenbaum & Prinsky, 1991). Although the idea of music and hypnosis has had an influential and notorious history, the idea of musical hypnosis for brainwashing has significant weaknesses. Firstly, there is scant evidence to suggest that people can be hypnotised against their will or without their knowledge – an almost essential requirement for any hypnotic procedure (Heap & Aravind, 2001). Furthermore, the quasihypnotic states which have been associated with the history of this topic may be more accurately described as a ‘voluntary, self-controlled, learned change of self-consciousness’ (Erlmann, 1982). This is important, as these findings do not rule out that music can contribute to a trance experience when an individual is adequately informed about what is taking place and consents to it. Furthermore, the effects of music upon any trance state are, at best, minimal from a brainwashing
25
This theory states that suggestions in hypnotised individuals do not undergo the same level of critical analysis as suggestions in non-hypnotised individuals see (Zarren & Eimer, 2002, pp. 6-7).
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perspective, although they may a much more significant benefit for psychotherapeutic outcomes and interventions (Fachner, 2006; Schipkowensky, 1977). An ethical therapist then may be able to use music in order to enhance therapy and accomplish greater therapeutic achievements than with standard ‘silent’ therapy alone. That being said, it has been found that music may only have a limited effect in the practice of hypnosis, and it has been shown that the participants have to be in some way complicit with the way in which the music is being used (Critchley & Henson, 1977). This is not a problem for therapists and other professions who would be glad of any method which can be seen to improve the lives and therapeutic results of their clients. I would argue that the therapeutic use of hypnosis, which has so far been pushed to the sidelines of research and implementation due to the fears and anxieties of brainwashing deserves to be investigated to the fullest extent. In the next section, I aim to amass all the available primary research literature on the therapeutic use of musical hypnosis.
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The History of Therapeutic Music and Sound Sound and Brainwave Manipulation One of the first academic papers to address the topic of direct musical manipulation of the mind was written by Heinrich Wilhelm Dove, a physicist and meteorologist who discovered the phenomenon of binaural beats in the beginning of the 19th century (Dove, 1839; Oster, 1973). Ever since the invention of the Electroencephalogram (EEG) it has been claimed that sound may be able to alter brainwave patterns. Indeed, this is the most popular hypothesis of musical manipulation of the mind. Binaural beats have become the central mechanism for these claims which posit that they are able to adjust conscious awareness by altering the firing rates of neurones by a process called entrainment. Binaural beats are constructed by the superposition of two different tones. The degree to which these tones differ in frequency is directly related to the frequency of the binaural beat. For example, if I performed two tones, one with a frequency of four-hundred and forty hertz to your left ear and one with a frequency of four-hundred and sixty hertz to your right ear via headphones, then you would perceive a binaural beat of twenty hertz. It is claimed, that a binaural beat of twenty hertz (that is, the difference between the left and right ears) is capable of manipulating your neurones to fire at this rate (i.e. twenty times per second) and thus affect conscious experience. It is generally agreed that ‘normal’ consciousness has a neuron frequency of ten to fourteen hertz whereas an individual who is asleep (or in a state of trance) would display brainwave activity around four to five hertz or lower. However, evidence behind this theory has been lacking and has proven difficult to validate. A theory of brainwave entrainment was first postulated as a supporting theory for evidence for a similar effect to binaural beats in the visual domain (Herrmann, 2001; Budzynski, 2006). This theory was extrapolated into the auditory domain and applied to the phenomena of binaural beats (Foster, 1990). Modern studies on binaural beats were conducted in the latter half of the 20th century, possibly due to their demand for synthetic audio technology (the phenomena, owing to the
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use of pure sinusoidal tones, do not normally exist in the natural environment (Oster, 1973). The results of these studies have been mixed. Some show effects in the application of binaural beat technology for stress management, pain reduction, and behavioural improvement (Huang & Charyton, 2008) along with affect vigilance (attention) and improvement of mood (Lane, et al., 1998). Other research has demonstrated no or very little effect, for example, with pain perception (Wahbeh, et al., 2007; Stevens, et al., 2003). However, this murky research landscape on the topic has not stopped claims by practitioners of being able to induce alterations in listener consciousness, along with a large amount of other desirable (and marketable) mental effects. Binaural beats have even been marketed and used as a form of ‘auditory drug’ (gethightnow.com, 2013). This is anecdotally regarded as being a feature of brainwave entrainment, although the supporting evidence and research for brainwave entrainment, contrary to popular opinion, is severely lacking (Turow & Lane, 2011). Sadly, the empirical research literature on binaural beats has proven to be a lot less exciting than the claims made by the retailers of binaural beat audio products with very little evidence of their efficacy in treating psychological conditions such as stress, anxiety or pain perception (Bryant, 2012). This is not to say that music itself may be ineffective in assisting with psychological ailments as binaural beats are unusually harsh, unnatural sounds and the mechanism by which they are claimed to work is dubious, at best. Other types of music, along with other auditory interventions, have shown a lot more potential to be therapeutically viable and effective.
Music Therapy Despite the lack of evidence for sound directly altering brain states via binaural beats and entrainment, to claim that music has no place in altering the mind or provide a therapeutic influence would be highly incorrect. The therapeutic properties of music have demonstrated highly positive results under empirical examination. Inherent musical properties such as the social, communicative
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and cognitive aspects of musical performance and improvisation play a vital role in music therapy which is: “An evidence-based clinical intervention utilising music and sound to address physical, emotional, cognitive and social needs of individuals” (American Music Therapy Association, 2014). There is a huge amount of research demonstrating the positive effects of performing, listening to and improvising music for a wide variety of medical and psychological conditions including depression (Maratos, et al., 2008), assisting individuals with Autism and other learning disabilities (Geretsegger, et al., 2014), mental health disorders such as Schizophrenia or Schizophrenia-like disorders (Mossler, et al., 2013), and acquired brain injury (Bradt, et al., 2010). This research landscape has tended to focus on music as an interactive and social activity rather than directly on the psychological qualities of music (such as the type and genre of the music and what it means for the listener). However, some important findings can be taken from the research literature of music therapy and applied to other therapies (such as hypnotherapy and psychotherapy) in order to improve client care. A number of scholars have drawn parallels between the techniques of hypnosis and those used in music therapy. For example, music can capture the attention of a listener in much the same way that a hypnotic suggestion by seeming to attract the conscious awareness of the listener wholly and fully (Vas, 2013). Furthermore, argues the Hungarian scholar József Vas: “Hypnosis can be seen as an inductive method expressing its effect from outside to inside the client or participant, however, music can be used as a deductive therapeutic tool, effecting from inside to outside” (Vas, 2013). Other scholars have also noted similarities between hypnosis procedures and music. Rhythmic practices which lead to: “phase locking… when two or more objects are pulsing at nearly the same time tend to lock in and begin pulsing at the same rate...the rhythm can bring the two (therapist and client) together
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on a level which is distinct from verbal communication...even more basic and significant." (Moreno, 1988, p. 271) This is not just an apt description of a musical style and technique, but also the hypnotic practice of pacing and leading which is an inherent aspect of modern hypno-psychotherapeutic practice (Livnay, 2014). Hypnosis has also been a highly effective tool in studying auditory hallucinations. Hypnosis has been used in several studies to create auditory hallucinations which could be studied in a PET scanner. Highly hypnotisable participants were not able to differentiate between a recording of a voice and their own auditory hallucination of a voice in their head allowing researchers to gain a valuable insight into the neuroscience of psychosis (Szechtman, et al., 1998). Clearly the overlap between music therapy and other modalities is only just beginning to be investigated. The use of music within psychotherapy in general has demonstrated several important properties which can assist in the therapy intervention such as: increasing levels of arousal (Berlyne, 1971; Madsen, et al., 1975), evoking curiosity (Berlyne & Borsa, 1968), improving the ability to focus and diverting attention away from other potentially distracting senses (Hernandez-Peon, 1961; Marteniuk, 1976), providing a positive emotional experience (Berlyne, 1971), and enticing an emotive response (Juslin & Sloboda, 2001). However, both hypnotic and musical interventions have their uses in facilitating an improved performance in the psychotherapy process, for example, listening to music has been shown to decrease levels of arousal due to stress (Pelletier, 2004); increase client self-disclosure during highly emotive procedures (Jensen, 2001); assist therapist with client resistance by allowing the client to seemingly control the session utilising music (Stanton, 1980); and assist with relaxation techniques (including, crucially, progressive muscle relaxation) (Robb, 2000). Music can even assist and improve induction procedures (Morris, 1986); alongside client support strategies such as self-hypnosis (Walker, 1990); and assist with therapeutic deepening techniques (Walker & Diment, 1979) alongside other factors which assist therapy clients by
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contributing directly to the therapeutic process (Granone, 1973). Furthermore, music can benefit from hypnotic procedures (for example, by combating performance anxiety) in order to produce enhanced performances (as judged by experimentally blinded music critics) (Mellgren, 1979). Music can also be used as an adjunct to hypno-psychotherapy in the care of cancer patients, by focusing the mind, and by allowing emotions to be triggered and controlled. These powerful strategies, alongside other therapeutic techniques such as anchoring, assisting with hypnotic imagery and enabling a greater sense of focus enable hypnosis and music to be powerful allies in combating complex mental health and other psychological issues (Esser, 2007).
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Section Three: Music and Hypnosis Research. Procedure This paper shall use the following research databases in order to provide a systematic literature review of the topic of Music, Suggestion and Hypnosis. To perform this review, several databases will be used to assess the range of literature that currently exists. Multiple databases are used in order to gain a complete overview of the present research landscape. These databases will include Scopus26, Web of Science27, PubMed28, PsycINFO29, and Google Scholar30. Articles that were unavailable online were sourced from the British Library or via International Inter-Library Loan. All articles will be assessed for their quality during the search process by their relevance to this papers hypotheses. Primary research findings and data will not be collated in this paper as there are too many research variables and not enough studies to perform a fair and comprehensive meta-analysis at this time. All searches were performed on the 29th of September 2014 using the search terms ‘Hypnosis’, ‘Music’, ‘Suggestibility’, and ‘Hypnotizability’ (the ‘z/s’ spelling is automatically redundant in all databases). Searches were conducted by ‘Music’ followed by either ‘Hypnosis’, ‘Suggestibility’ or ‘Hypnotisability’. Furthermore, there was no time specification provided for the search resulting in a complete publication history for these search terms. The methodology of the search process is broken down only in the Scorpus search in order to save words, but is identical for all the included databases.
Scopus Scorpus is the largest up-to-date collection of global, unbiased and expertly sourced research data in the world (Elsevier, 2014). ‘Music’ and ‘Hypnosis’ yielded five results (based on title 26
http://www.scopus.com/ (Requires university login). www.webofknowledge.com (Requires university login). 28 http://www.ncbi.nlm.nih.gov/pubmed 29 http://www.apa.org/pubs/databases/psycinfo/ 30 http://scholar.google.co.uk/ 27
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only – a ‘strict’ search) with 289 results when the search included the article title, abstract and keywords (a ‘loose’ search). Of these 289 results, only 38 were relevant to this paper ranging from 1956 to 2014. ‘Music’ and ‘Hypnotisability’ yielded 10 results in the loose search; it was, therefore, not deemed necessary to include the results of a strict search (1 result, present in loose search). ‘Music’ and ‘Suggestibility’ yielded 6 results for a strict search. A further search of ‘Music’ and ‘Suggestion’ produced 654 results of which only 8 were relevant for this paper. Upon collating the results of this database search and removing, duplicate papers, a total of 51 papers were extracted from the Scorpus search for inclusion in this paper.
Web of Science The total number of articles from this database, after elimination of repeated papers, is 13 resulting in a cumulative total of 64 papers.
PubMed This search produced 7 unique papers. A total of 71 papers had now been discovered.
PsycINFO A total of 15 new articles were discovered in this database resulting in a total of 84 papers for inclusion in this paper.
Other Publications Included within this literature review will be a number of other publications which do not form part of a research database. These include books, magazine articles, newspaper clippings and other sources which will be documented in the bibliography at the end of this paper alongside the 33
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articles I have sourced from the research databases above. The online academic research tool Questia31 was used in order to discover the majority of these publications with others sourced from the bibliographies of papers which have been included in this document.
31
https://www.questia.com/
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Section 4: General Overview of the Literature. The topic of Music and Hypnosis, much like the topic of hypnosis itself, has waxed and waned in interest for its entire existence (Kennaway, 2011). The research literature has reflected this fact. Whilst the literature is not as sensational as the popular culture narrative32, it is still extremely interesting. In this section, my aim is collate the disparate research literature from a number of sources and provide an overview of the topic so far and attempt to answer the eight hypotheses set out in my introduction. There have been remarkably few studies conducted in this field when compared to other interventions33 and the studies which have been conducted are of limited quality. I do believe that the research which has been conducted demonstrates a highly positive outlook for the application of music and hypnosis research. Ideally, this paper would be a meta-analysis of the field, but the research literature, as it currently stands, is nowhere near this ideal. A meta-analysis of music and hypnosis cannot yet be conducted. It is my hope that this paper will inspire more research in this area in order for a meta-analysis to be completed in the near future. I will conclude this section with recommendations for further research in order to implement this.
H1. Can sound manipulate an individual’s level of suggestibility? We have already witnessed the power of music in commercial and business settings34. Purchasing decisions can be influenced by sound, for example, it has been found that individuals purchase more expensive wine when classical music is played rather than ‘top 40’ popular music due to the inherent suggestions and stereotypes of sophistication and affluence associated with classical music (Areni & Kim, 1993). Further research has indicated that even the taste of wine can be influenced by the music being played at the time of consumption (North, 2011). Research on whether repeated exposure to these auditory cues can increase the likelihood of a favourable response for the initiator is scarce. However, research from other domains has generally shown that 32
See ‘A Socio-cultural History of Music and Hypnosis’ on page 21. For example, Hypnosis compared against Cognitive Behavioural Therapy. 34 See page 18. 33
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repeated exposure to suggestions increases their power and effectiveness and can even, in extreme circumstances, lead to the creation of false memories (Zaragoza & Mitchell, 1996). Using music and sound is a highly indirect mechanism to influence individuals and can, therefore, have powerful ramifications when used to increase everyday non-hypnotic suggestibility. However, for whatever reason, the mechanisms behind these impressive observations are not usually discussed by the researchers. A notable exception can be found in research which has shown that music combined with suggestion is a highly prevalent way of decreasing driver stress and anger. Drivers who were tested within an education class performed significantly better after instrumental music preceded by a verbal suggestion (intended to relax the driver) was presented to them, rather than silence in subsequent driving tests on a simulator (Groene & Barrett, 2012). Music can also be used to aid suggestive and associative memory recall. Techniques have been developed where music can assist learning a foreign language. Learners are instructed to listen to the music and allow rhythmically stated foreign words to ‘wash over them’ in a remarkably similar way to some hypnotic procedures. This procedure has proven remarkably successful and supports the idea that the unconscious mind can absorb and retain information presented whilst the conscious mind is distracted with a different, unrelated task (Stanton, 1984). Further examples of how music can affect or influence our choices are highly prolific. There have been a number of studies which have examined the use of music on telephone call centre waiting times. It has been found that customer expectations, along with familiar music, are highly effective in keeping people waiting on the telephone (Sherwin, 2013). There has even been an entire company – Muzak Holdings - established in order to produce music to influence customers in order to make them calmer on the telephone, increase impulsivity with regard to purchasing decisions or to make them more receptive to advertising. This practice appears to be in high demand and worth a considerable amount of money and investment as the company Mood Media purchased Muzak holdings in 2011 for £215 million (National Post, 2011).
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The suggestion-based effects of music have also been felt in the education sector with background music boosting the behaviour and mathematical performance of school children with emotional and behavioural difficulties (Hallam & Price, 1998). Music can also be used to dramatically increase the atmosphere in social spaces such as banks. Classical music performed in a banking hall caused a two hundred and thirty-three percent increase in a customers’ perception of the bank as ‘inspiring’ against the same environment having only ambient noise (North, et al., 2000). Further to this, the type of music, volume of music and time of day all had significant interactions on customer’s estimates of the maximum sum they would spend for products on sale at a bar (North, et al., 2000). It has been suggested that low-frequency sound called infrasound, and strong vibrations are a key contributor to alleged ghost and other supernatural sightings. The psychological effects of infrasound have been investigated (anecdotally) perhaps most notably by Vic Tandy who developed a reputation for debunking paranormal myths in the late 20th century when he experienced a ‘ghostly’ apparition whilst working in a research laboratory for a medical manufacturing firm. Tandy then experienced a ghostly apparition in his peripheral vision which promptly vanished when he turned to observe it properly. The experience was later attributed to imperceptible low frequency noise emanating from a recently installed extractor fan that activated the physiological ‘fight or flight’ response, this generated tension, unease and caused Vic’s eyes to vibrate in their sockets leading to him seeing the ‘ghostly’ apparition (Lyster, 2001). These infrasound vibrations have also provided an explanation for reports of the London underground being haunted with extremely high levels around areas that are frequently reported bizarre experiences (Ghosts of the Underground, 2006). All this research literature, alongside anecdotal support from films, songs and other media demonstrate that sound, music and noise can have a high influence over our thoughts, feelings and emotions and can successfully persuade and suggest concepts, ideas and behaviours to individuals at
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an unconscious level. Music and sound is a very powerful and highly effective method of delivering suggestions. Despite this, there is as yet, no studies on whether music can increase a person’s general level of suggestibility. This may be due to the fact that there are no objective measures of suggestibility itself, let alone studies which examine the correlates to this psychological trait. I am therefore not in a position to answer my hypothesis in full, but can state that music is a highly effective method of delivering suggestion and the more it is utilised, the more effective it seems to become (from an anecdotal perspective).
H2. Can sound manipulate an individual’s hypnotic susceptibility? The limited research literature on this topic makes it difficult to reach a direct conclusion. Researchers have found that listening to ten minutes of music produced a slight increase in hypnotic responsiveness, but ten music of listening to silence failed to generate any increase at all (Talone, et al., 1975). Indeed, sensory deprivation seems to be a highly effective method of increasing hypnotic susceptibility alongside drugs and other methods which have extreme psychological and physiological side effects which have no place in a modern therapy practice. In contrast to this, it has been found that listening to highly rhythmical music for fifteen minutes prior to a hypnotic induction significantly increases the effectiveness of the induction procedure (Maurer Sr, et al., 1997). Furthermore, highly hypnotisable participants in this study, were more likely to subjectively report relaxed feelings and shamanic-type experiences. Research has found that individuals who have high hypnotisability scores show more absorption in classical music than individuals with low hypnotisability scores (Snodgrass & Lynn, 1989). Music may also be able to assist the client’s willingness to enter a hypnotic state by allowing the client the control of the progress of the intervention by adjusting music via a volume control or other device. There have been a number of cases where this approach has assisted clients who were initially reluctant to utilise hypnotic
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techniques (Stanton, 1980). Furthermore, music has been demonstrated to be effective with increasing hypnotic depth (Walker, 1992) and with induction procedures (Morris, 1986). It is interesting to note that musicians are usually highly hypnotisable subjects. Research has shown that musicians (as measured by the psychometric test, GoldMSI35) tend to have a higher pain tolerance, as a group, than non-musicians when participating in a cold pressor pain task (Bryant, 2012). It has been shown that the psychological traits of absorption, imagination and dissociation are a common feature shared by both music and hypnosis (Herbert, 2011; Tellegen & Atkinson, 1974; Snodgrass & Lynn, 1989). Musical absorption, in particular, is highly correlated with hypnotic susceptibility (Snodgrass & Lynn, 1989). It has been shown that there are links between musical enjoyment and absorption indicating that it may be worthwhile allowing clients to select their own music for their therapeutic intervention in the same way they would select the modality of therapy they wish to use (Rhodes, et al., 1988). Physiologically, it has been found that music can produce similar bodily responses to that of hypnosis, not just in terms of relaxation but also that individuals who are attending to music produce fewer eye movements, probably ‘as a result of an inwardly directed shift of attention’. Once again this research uncovered that absorption ratings were much higher in the participant group who provided their own music against unknown music or no music while viewing a visual stimulus (Schäfer & Fachner, 2014). In more recent research it has been demonstrated that individuals who have a high degree of musical involvement, so a strong emotional response to music (as measured by a Musical Involvement Scale (MIS)36) are more likely to experience trance states (Nagy, 2003). Further research has shown that hypnotic susceptibility shows a moderate correlation with musical involvement and that hypnotic induction is effective for improving the musical experience of low musical involvers.
35
This is the Goldsmiths Musical Sophistication Index (Müllensiefen, 2012). It provides a quantitative measure of an individual’s level of musical sophistication via a psychometric assessment. See more at http://www.gold.ac.uk/music-mind-brain/gold-msi/. 36 For more information please see Dixon (1980).
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This same piece of research found that ‘music serves as a hypnotic induction for high involvers, but not for low involvers’ (Nagy & Szabó, 2006). The research literature indicates that hypnotic susceptibility and music are linked, perhaps not directly, but via the cognitive and psychological processes which are common to each domain namely absorption, dissociation, emotion and trance.
H3. Are these manipulations temporal or permanent? Very little research has been conducted on this area. Musical traits, thanks to their training via a method of repetition and neural plasticity seem to be permanent in the majority of cases (for example, perfect or absolute pitch or the technical ability of playing an instrument). Furthermore, music and memory are highly interlinked with a number of studies showing the impressive ability of music in rehabilitating patients with dementia and other neurocognitive disorders (Vink, et al., 2004). Research has suggested that the effects of any hypnotic intervention are temporary, provided no post-hypnotic suggestion was delivered. However, music therapy interventions (alongside other psychotherapeutic interventions) are more permanent. From the research literature I have presented; it is apparent that any alteration in hypnotic susceptibility or suggestibility via the medium of sound is temporary and is only in effect during the presentation of the stimulus. This is by no means an issue for therapists, who are used to interventions (such as hypnosis) only lasting for the length of the session, but the results permeating into the lives and personalities of their clients. A permanent residue of the mechanism of intervention is not a requirement for a therapeutic intervention to be effective.
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H4. Which characteristics of sound are most likely to alter a listener’s hypnotisability? Across all studies, it has been the element of rhythm which has been emphasised as being a very important aspect of music trance. This is clearly apparent when looking at trance from a wider cultural context than therapeutic interventions. However, it may not be musical qualities which are the most important factors in determining the success of a hypnotic intervention. As we have seen, the emotional response to music, the level of absorption, dissociation, expectation and empathy generated by the music are far more important than any of the pure musical characteristics such as instrumentation, orchestration or genre. Allowing the participant to choose their own music appears to be vitally important for a successful therapy intervention as it heightens the chances of the participant engaging with the music (Walker, 1990). It is in this respect that the genre of music and other ‘taste’ qualities are important. However, I would advise that music without lyrics is prioritised in order not to distort the talking therapy aspect of the intervention (Waterfield, 2004). Having said this, there are a number of individuals who place a great deal of stress on which instruments are used in order to ensure a quality trance. These include the use of a gong, the sound of which is said to possess the essential qualities of rhythm (a beating effect, similar to binaural beats), resonance (the resulting overtones coalesce to produce a ‘hypnotic’ effect), arousing and then relaxing when the sound fades into nothing (Livnay, 2014). There has been also speculation that the use of musical instruments in order to administer and guide trance allows the participant to enter a deeper (and presumably more effective) trance state, but there have been no conclusive empirical studies conducted on this hypothesis (Livnay, 2014).
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H5. Could music or sound enhance the process of hypno-psychotherapy and if so, how? There have been a number of clinical studies investigating the use of music with the delivery of suggestions. A study in 1973 found that hospitalised chronic schizophrenic patients, on a fourweek treatment plan showed more improvement when music was performed alongside relaxing suggestions than music alone or music accompanying encouraging suggestions. All these interventions were provided on audio tape, with both the patients and nurses blinded to the experimental nature of the intervention (Ihalainen & Rosberg, 1976). Classical music has been shown to increase and influence client self-disclosure in therapeutic circumstances. In a study of eighty-five undergraduates who were asked to reveal ‘the most significant event of experience of their lives’, participants who listened to classical music in the background whilst completing the self-disclosure task, chose more emotive memories, demonstrated more expression and increased their liking of musical enjoyment. Consequently, the amount and validity of information revealed was significantly improved in the music group than in the group who completed the exercise in silence (Jensen, 2001). Music and hypnosis has also been used successfully in a number of other therapeutic case studies; as an aid to the induction procedures (Morris, 1986); in self-hypnosis (Walker, 1990); as a deepening technique (Walker & Diment, 1979); and as an tool for assisting with client compliance and combatting resistance, allowing the patient to lead the therapy via the use of sound (Walker, 1992). Music has been shown to increase the performance of hypno-psychotherapy in cancer patients via several mechanisms previously mentioned37. Critically, music can increase the level of endorphins and lower cortisol levels (which, when elevated for an extended period of stress can inhibit immune response) which is a property unique to music (Bartlett, et al., 1993).
37
See the music therapy section in this paper on page 28.
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Overall then, it is clear that music can enhance the process of hypnosis and psychotherapy far more than being used purely to drown out extraneous noise. It can be considered an intervention in its own right and assist and compliment the practice of hypno-psychotherapy to make it more effective.
H6. How may these findings be best utilised by therapy practitioners? Music, in general, can assist a practitioner in a wide variety of procedures. At the very basic level, the use of music could improve the relationship between a client and a therapist which has been shown to be one of the most important aspects of the therapy process (Rogers, 1959). At a higher level, the therapist can utilise the knowledge of music in planning, or pacing their therapeutic intervention appropriately on a client-by-client basis. For example, if a client is having issues with self-disclosure, a session aided by classical music may enable them to disclose more information than a standard session of hypno-psychotherapy. By asking the client to bring their own music to a subsequent session, we can help to engage the client further with the therapeutic process and inturn boost the rapport between the practitioner and the client.
H7. Does being musically sophisticated increase a person’s hypnotisability? Based on the available research literature, this certainly seems to be the case. Being musically sophisticated either by listening to music or being involved in music-related tasks increases the participant’s capacity for absorptive experiences and thus their hypnotisability. Musical activities usually involve a high degree of empathy, social cohesion, improvement in reaction times, alongside imagination and fantasy proneness. All of these traits correlate with hypnotic susceptibility and can therefore to be seen to be contributory towards an individual’s capability to produce a high-quality hypnotic and therapeutic experience (Barnier & McConkey, 2004).
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Section 5: Conclusion and considerations for further research. Further research is needed in order to enhance and clarify several issues with the research landscape of Music and Hypnosis. The field as a whole does show some highly useful implementations for music in aiding suggestion for a variety of purposes. But there are still large gaps in our knowledge regarding the effective use of music and hypnosis in aiding psychological difficulties. For example, the ability of music to alter our level of non-hypnotic suggestibility (and the field of suggestibility in general) is lacking in quality research literature. Another prosperous avenue of research would be to conduct a clinical trial where hypnosis and music in combination were assessed against hypnosis and music therapy on an individual basis for a variety of psychological issues. This would be an ideal situation. A lot of the literature in this document is over twenty years old and therefore out of date. It would be highly beneficial if some of the research identified within this paper were to be replicated in the 21st century in order to ensure validity of the arguments that are presented in modern times. The literature identifies that hypnosis and music share common factors such as Absorption, Dissociation, Trance, Expectancy and establishing rapport between a therapist and their clients. Music does not have the popular culture stigmatism of hypnosis and may, therefore, be a powerful tool in aiding a difficult or challenging hypno-psychotherapeutic process. All in all, the research landscape looks to be positive regarding the use of music to aid hypnosis and psychotherapeutic procedures, provided that the therapist is mindful of the use of music within each therapeutic session and the client is prepared to suggest suitable music and consent for its use within the therapeutic context.
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