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MARK P. JENSEN ET AL.
addition to pain intensity. Findings with these other measures suggest
that the hypnotic-analgesia protocol used in the study had no system-
atic impact on pain interference or depressive symptoms, although it
did decrease pain unpleasantness and did increase perceived control
over pain in some patients.
One explanation for the negative results on pain interference and
depression is that the hypnotic suggestions in this study focused on
increasing perceived comfort and relaxation and decreasing perceived
pain; no suggestions were included for mood or day-to-day functioning.
An increasing body of research supports the conclusion that partici-
pants can be quite literal about responding to specific suggestions. For
example, suggestions for reductions in pain intensity, but not pain
unpleasantness, have a greater impact on the former than the latter
and also show a different pattern of effects on brain function as
assessed by PET scans compared to suggestions that target pain
unpleasantness but not pain intensity (Rainville, Carrier, Hofbauer,
Bushnell, & Duncan, 1999). The current findings support the impor-
tance of ensuring that the suggestions target the outcome domains of
greatest interest to ensure maximum benefit from hypnotic treatment
(Patterson & Jensen, 2003).
Predictors of Treatment Outcome
Only one of the potential predictors of treatment outcome included
in the study (treatment-outcome expectancy assessed after the first ses-
sion) demonstrated a statistically significant association with treat-
ment outcome, and this association was only moderate. This finding
suggests that, at least at this point, patients with a disability and
chronic pain should not necessarily be excluded from treatment
involving hypnotic analgesia on the basis of low scores on measures of
general hypnotizability or treatment-outcome expectancies, their diag-
nosis, or their early (e.g., first session) response to hypnotic-analgesia
suggestions. The findings also suggest that standardized (i.e., script-
driven) treatment provided over a short period of time (i.e., daily) is
not necessarily more effective than treatment provided over a longer
period of time (e.g., weekly).
The lack of a statistically significant association between hypnotizabil-
ity scores and treatment outcome in the current study is inconsistent with
previous research that examined this association in other samples of
patients with chronic pain (Patterson & Jensen, 2003). There are a num-
ber of possible explanations of this negative finding. First, they may be
related to the content of the suggestions used in the treatment protocol.
Although some of the suggestions might be expected to require greater
hypnotic ability (e.g., symptom substitution, hypnotic analgesia), others
are relatively easy to respond to for most patients, even those with lim-
ited hypnotic skill (e.g., relaxation). The suggestion for decreased