Notes on Pavlov & Hypnotic Sleep Therapy

Notes on Pavlov & Hypnotic Sleep Therapy

Copyright (c) Donald Robertson, 2008-2009

The Nobel prize-winning Russian physiologist and psychologist, Ivan P. Pavlov, developed an influential theory of hypnosis based upon his experiments in animal conditioning.  Pavlov’s collection of lectures entitled Conditioned Reflexes (1927) culminates in ‘The experimental results obtained with animals in their application to man’ which summarises two conclusions of his research in relation to hypnotherapy,

  1. That the state of relaxation induced in human hypnosis resembles the physiological phenomenon of “animal hypnosis” and results from intense fatigue or inhibition of specific cells in the cerebral cortex (“cortical inhibition”) irradiating to other parts of the brain.
  2. That hypnotic suggestions function by using words as stimuli to evoke conditioned responses which are intensified in nature because the general inhibition of the cortex leaves individual “rapport zones”, i.e., residual centres of attention and excitation in which conditioned reflex responses to words become greatly enhanced.

In refreshing contrast to the subsequent technical debate stemming from such theories, Pavlov himself opens his discussion of conditioning and hypnotherapy in terms which appeal to common sense observations from daily life.

It is obvious that the different kinds of habits based on training, education and discipline of any sort are nothing but a long chain of conditioned reflexes.  We all know how associations, once established and acquired between definite stimuli and our responses, are persistently and, so to speak, automatically reproduced, sometimes even although we fight against them.  For instance, in the case of games and various acts of skill, it is as difficult to abolish all sorts of superfluous movements as to acquire the necessary movements and it is equally difficult to overcome established negative reflexes, i.e., inhibitions.  Again, experience has taught us that a difficult task should be approached by gradual stages.  We know also how different extra stimuli inhibit and discoordinate a well-established routine of activity, and how a change in a pre-established order dislocates and renders difficult our movements, activities and the whole routine of life.  Again, we know how weak and monotonous stimuli render us languid and drowsy, and very often lead to sleep.  We are also well acquainted with different cases of partial alertness in the case of normal sleep, for example a sleeping mother next to her sick child.  All these [human] phenomena are analogous to those constantly met with in our animals and described in the preceding lectures […] (Pavlov, 1927, Lecture 23).

Regarding the method of inducing hypnosis employed and its relation to conditioning theory, Pavlov observed that a monotonous and weak stimulus, such as the sound of a metronome, or gentle stroking, could progressively induce relaxation and sleep in animals.

The method of inducing hypnosis in man involves conditions entirely analogous to those which produced it in our dogs.  The classical method consisted in the performance of so-called [Mesmeric] “passes” – weak, monotonously repeated tactile and visual stimuli, just as in our experiments upon animals.  At present the more usual method consist in the repetition of some form of words, describing sleep, articulated in a flat and monotonous tone of voice [i.e., direct verbal suggestions of relaxation and sleep].  Such words are, of course, conditioned stimuli which have become associated with the state of sleep.  In this manner any stimulus which has coincided several times with the development of sleep can now by itself initiate sleep or a hypnotic state. […] Most of the procedures producing hypnosis become more and more effective the more frequently they are repeated.  (Pavlov, 1927, Lecture 23)

Braid had emphasised the “law of sympathy and imitation” whereby hypnotic subjects seem to show an enhanced ability to imitate the behaviour of others.  Pavlov pre-empts later social theories of learning by acknowledging the role of this mechanism in hypnotherapy.

Obviously we deal with a certain degree of inhibition of some parts of the cortex – a state in which the more complicated forms of normal activity are excluded and replaced by responsiveness to immediate stimuli.  This partial inhibition allows of or even favours the establishment and reinforcement of the physiological connections between certain stimuli and certain activities, e.g., movements.  In this manner, in hypnosis all activities based on “imitation” are accentuated and we see revealed the long-submerged reflex which in all of us in childhood forms and develops the complicated individual and social behaviour. (Pavlov, 1927, Lecture 23)

Pavlov conceived of hypnotic suggestion as a complex example of a conditioned reflex, fundamental to human nature,

Among the various aspects of the hypnotic state in man attention may be drawn to “suggestion” so-called and its physiological interpretation.  Obviously for man speech provides conditioned stimuli which are just as real as any other stimuli.  At the same time speech provides stimuli which exceed in richness and many-sidedness any of the others, allowing comparison neither qualitatively nor quantitatively with any conditioned stimuli which are possible in animals.  Speech, on account of the whole preceding life of the adult, is connected up with all the internal and external stimuli which can reach the cortex, signalling all of them and replacing all of them, and therefore it can call forth all those reactions of the organism which are normally determined by the actual stimuli themselves.  We can, therefore, regard “suggestion” as the most simple form of a typical conditioned reflex in man.  The command of the hypnotist, in correspondence with the general law, concentrates the excitation in the cortex of the subject (which is in a condition of partial inhibition) in some definite narrow region, at the same time intensifying (by negative induction) the inhibition in the rest of the cortex and so abolishing all competing effects of contemporary stimuli and of traces left by previously received ones.  This accounts for the large and practically insurmountable influence of suggestion as a stimulus during hypnosis as well as shortly after it.  The command retains its effect after the termination of hypnosis, remaining independent of other stimuli, being impermeable to them, since at the time of primary introduction of the stimulus into the cortex it was prevented from establishing any connection with the rest of the cortex.  The great number of stimuli which speech can replace explains the fact that we can suggest to a hypnotized subject so many different activities, and influence and direct the activities of his brain. (Pavlov, 1927, Lecture 23)

Pavlov considers the question as to why hypnotic suggestions should be more effective stimuli than the imagery experienced in dreaming, a point which could be made in comparing hypnosis with ordinary daydreaming or reverie as well.

It could be questioned why does suggestion carry in itself such a commanding influence as compared with dreams, which are usually forgotten and only have a very small vital significance?  But dreams are due to traces, generally of very old stimuli, while suggestion is a powerful and immediate stimulus.  Moreover, hypnosis depends upon a smaller intensity of inhibition than sleep.  Suggestion, therefore, is doubly effective.  Still further, suggestion as a stimulus is brief, isolated and complete, and therefore vigorous, while dreams are generally linked up into chains of various, sometimes inconsistent or antagonistic, traces of stimuli. (Pavlov, 1927, Lecture 23)

Soviet Hypnotherapy (Platonov)

Following Pavlov’s seminal physiological research, which concluded that hypnosis was a form of artificial (conditioned) sleep, Platonov and other Soviet researchers began employing hypnotherapy on a massive scale.  They developed a form of hypnotherapy which employed extended periods of “suggested sleep” in a manner resembling Victorian Mesmerism but based on laboratory research on conditioning.  Indeed, Platonov subtitled his book on hypnotherapy “The Theory and Practice of Psychotherapy according to I.P. Pavlov.” (1959).

            In the Soviet approach, subjects were left to sleep for around an hour following a hypnotic induction without any further suggestions, i.e., in total silence so that they could rest without any disturbance whatsoever.

We have always used long-continued suggested sleep as an auxiliary therapeutic method.  It is usually employed in more or less grave conditions as a concluding method after a course of psychotherapy and serves the purpose of restoring the function of the cortical cells and consolidating the therapeutic effect obtained.

                Even short suggested sleep not infrequently exerts a positive influence on the patient’s nervous system.  This is indicated by very numerous observations of many authors, as well as our own and those of our associates.  In a number of cases even a state of light suggested sleep produces a certain therapeutic effect of itself, without any special suggestions.  Thus, upon awakening from the very first suggested sleep some of our patients frequently report the disappearance of pain or unpleasant sensations.  (Platonov, 1959: 234)

Sleep induced by suggestion often seems considerably more restful and recuperative than normal, nocturnal sleep.  Platonov cites research by Petrova, one of Pavlov’s research team, supporting this observation experimentally (Platonov, 1959: 234).  Platonov applied this method to the prevention of hypertension, treatment of ulcers, and other physical conditions, but also in the treatment of neuroses.   However, Platonov also found physiological evidence that the recuperative function of hypnosis was significantly deepened when explicit suggestions of a “state of absolute rest”, e.g., were used instead of the normal procedure, merely suggesting that the subject was “sleeping deeper”, etc.  (Platonov, 1959: 77-78).

These studies have led us to the recognition of the extraordinarily great importance of a special physiological state of deep rest specially created by verbal suggestion.

                It must be especially emphasised that natural sleep does not always put all the organs and systems of man into a state of complete rest. […]  It is precisely for this reason that it is necessary to exert special influence on the subject’s cerebral cortex by a verbal suggestion that his organism “is in a state of complete rest” during which “all of the experienced emotions have been fully eliminated,” while his brain and all organs and tissues are rapidly regaining their functions.  Thus the first step in the verbal suggestion [“sleep”, “sleep deeper”, etc.] puts the person from his usual waking state into a state of suggested sleep, while the second step in the suggestion [“rest completely”] creates special conditions for deep rest during this suggested sleep.  (Platonov, 1959: 78).

He goes so far as to claim that this special method succeeds by inducing “a maximal activation of the restorative function of the cerebral cortex.” (1959: 235, his italics). 

            In the vast majority of cases, Platonov’s clinic employed short sessions of direct hypnotic suggestion, followed by around an hour of deep hypnotic rest in silence, for about 5-6 sessions.  This approach would be considered unusual today.  However, deep rest of this kind clearly has considerable therapeutic potential.

Experience has shown that one hour of this state, in most cases, provided maximum rest for the entire organism.  This prolonged state of suggested deep rest is extraordinarily beneficial not only to the cortical dynamics and the entire higher nervous activity as a whole, but also to the functional state of all tissues and organs and the entire vegetative and endocrine system.  (Platonov, 1959: 79).

Platonov seemed to believe that any suggestions given during this state might disturb the state of rest, a fact consistent with a number of empirical observations, e.g., Clark L. Hull’s (1933) findings on the phenomenon of initial negative reaction in response to direct suggestion.  He also argued that continued rapport with the hypnotist required the retention of a certain level of awareness, and therefore stimulation of the cerebral cortex.  Whereas, in these periods of silent relaxation, with no disturbing suggestions from outside or need for continued attention, the subject was free to enter an even more profound level of relaxation.  After a while, the subjects receiving “suggested sleep” appear to become unresponsive to suggestion.  Indeed, the subject becomes progressively detached from their whole environment for a while, including the hypnotist as the following report from one of Platonov’s patients illustrates.

“When I am in a state of hypnosis,” writes a woman patient, “I experience different sensations at each session.  Thus during the first session I continued to feel my entire body but was unable to move a single member and though I clearly heard the voice of the hypnotist and was conscious of everything my thoughts were in a sort of muddle.  This was what I should call bodily sleep.  At each successive session my body grew increasingly heavier, I no longer felt it, though I continued to hear all that was going on and it seemed to me it was all happening somewhere far away, I was not quite conscious of it, and it was all absolutely immaterial to me.

                “During the last, fifth, session I no longer felt my body at all, as if I had none.  Nor could I think of anything.  I had no thoughts at all.  I heard various external sounds which did not concern me in the least.  During suggestions I heard everything clearly, but my mind failed to work, and the words of suggestion relating to my former experiences in no way affected me.

                “At the words of awakening, I begin to awaken at first from the head, as it were: thoughts rise in my mind, I begin to think about how to move, to get up; I understand everything that takes place around me, but begin to feel my body somewhat later; as my consciousness clear up, I begin to feel a heaviness throughout my body, which subsequently dissipates upon complete awakening.”  (Platonov, 1959: 73)

At a time when psychoanalysis was struggling to achieve success with roughly two-thirds of patients despite taking many hundreds of sessions, Platonov and his colleagues reported 78% success rates in just 5-6 sessions by using Pavlovian hypnotherapy with tens of thousands of patients presenting with a variety of psychiatric and general medical conditions in Soviet polyclinics and hospitals.

          This approach is obviously impractical for modern clinical practice.  Clients may resent paying for a session in which they are merely left to relax in silence.  However, a similar technique might be used in different settings, e.g., during group workshops or between sessions with the aid of a self-hypnosis CD.

Comments

Notes on Pavlov & Hypnotic Sleep Therapy — 2 Comments

  1. I have had a client and she was bringing a friend from turkey and the friend did not speak german. She was just sitting during the session in the same room when I was working with my client her friend. She was also going into a light trance.

    Next week the client and the friend show up again together and they were telling me that her slleing problems are now over. It was just the state of hypnosis that helps her solving her problem without knowing it.

    It was a big surprice for me. :-)

  2. Recently I saw a client who said she was suffering from insomnia and was using a small dose of temazepan. After her first session of hypnotherapy she reported two successive nights of good sleep. The following night she decided to try to sleep without the temazepan and only obtained a few hours sleep as a result.
    The client came for a second session. I suggested she ensure sleep with half the previous dose of temazepan.
    On follow up she reported that her insomnia had not improved and was proceeding to start treatment with a SSRI.
    In curiosity looked up temazepan and discovered it can have withdrawal effects even after short term use. Anxiety was one of the effects, which could have caused the insomnia again.