Internal and external distraction in the control of cold-pressor pain as a function of hypnotizability

The effectiveness of different pain-distraction tasks was compared as a function of level of hypnotizability, using the cold-pressor pain-testing procedure. Selected high, medium, or low hypnotizable participants first underwent a 1-minute baseline immersion of a hand in ice water, with periodic pain ratings. Independent groups were then given 4-minute test immersions under one of five conditions. Analgesia suggestion and guided imagery were conceived to be internal distractors, whereas word memory and pursuit-rotor tasks were external distractors. Placebo-control groups were given permission to let their minds wander. All four experimental treatments reduced pain significantly for highly hypnotizable participants, compared to the control group, whereas none of the experimental treatments were effective for low hypnotizables. The different treatment instructions did not produce different preimmersion anxiety state ratings, so the treatment effects on pain ratings could not be explained in terms of their effects on anxiety. It appears that high hypnotizables are more effective than low hypnotizables at diverting attention to control pain, regardless of whether internal or external distractor tasks are used. Treatment effects on pain ratings did not change between 1 and 4 minutes of test immersion.