Mental Imagery Vs. Hypnosis

PHENOMENOLOGY AND THERAPEUTIC APPLICATION

Over the past thirty years, both hypnosis and mental imagery—once recognized as powerful tools in the healing arts and later repudiated for centuries—have been making their way back into modern health practices. Although these two modalities share certain similarities, they are fundamentally different. They differ phenomenologically and in their psychotherapeutic significance. A practitioner’s ability to recognize the unique qualities of hypnosis and mental imagery can significantly influence the therapeutic process.

Phenomenology of Hypnosis and Mental Imagery

Studies using electroencephalograph recordings reveal that hypnotized subjects exhibit random alpha waves (indicating mental and physical relaxation) with more prominent beta waves (suggesting arousal to external stimuli) (Hirai, 1974). In contrast, during mental imagery, there is a predominance of theta brain activity, characterized by low-frequency brain waves, which indicates minimal arousal to external stimuli. According to Brown, during mental imagery, a person is "...more likely than in hypnosis and meditation to lose the sense that they are actually creating the experience" (Brown, Forte, Rich, Epstein, 1982). In other words, during imagery, the individual becomes inactive regarding the outside world but hyper-active and hyper-attentive to their internal experience.

Thus, we observe two quite different phenomena. Hypnosis is marked by inner passivity and heightened receptiveness to external reality, while imagery involves outer passivity and heightened receptiveness to internal reality. These phenomenological differences give rise to their distinct therapeutic applications.

 Hypnosis

Milton Erickson, one of the pioneers of modern hypnosis, described it as "a state of intensified attention and receptiveness and an increased responsiveness to an idea or set of ideas" (Erickson, 1958). Hypnosis has also been characterized as a "state of selective hypersuggestibility" (Weitzenhoffer, 1957). In this altered state of consciousness, a person responds to their own suggestions or those of others. Suggestions—defined as ideas offered for uncritical acceptance—bypass the patient’s conscious critical judgment and enter the subconscious mind, the part of the mind believed to drive thoughts, feelings, and behavior.

For instance, in cases of substance abuse, a patient may associate substance use with pleasure or confidence, accompanied by ideas such as "I can’t live without it" or "Life is boring without it." The therapist might use suggestions to counter these associations by emphasizing the negative effects of substance use and the positive outcomes of abstaining. For example, a suggestion like "Any time you feel the desire, take a deep breath and say to yourself ‘freedom’ is reinforced in the therapist's office while the patient is relaxed and committed to recovery. Over time, these suggestions are intended to replace the old conditioning (substance = pleasure) with new conditioning (abstinence = freedom, self-respect).

 Mental Imagery

Mental imagery is the process of directing the sense organs—typically used to explore outer reality—toward the inner world. It is described as "a flow of thoughts we can see, hear, feel, smell, or taste" (Rossman, 1987). Unlike spoken words, which can fragment or distort reality, spontaneous mental images reflect an unbroken portrayal of one's internal experience. "Images may have a greater capacity than the linguistic mode for attracting and focusing emotionally loaded associations in concentrated forms: verbal logic is linear, whereas imagery is a simultaneous representation" (Sheikh, Panagiotou, 1975). In this imaginal state, individuals detach from the external world, silence their critical judgment, and fully experience their inner reality.

Imagination is often described as the "enzyme of the mind" (Epstein, 1994), speeding up internal transformation by revealing insights and offering direction. Patients, by exploring the images that arise during guided journeys, can uncover belief systems and reframe adverse experiences. For example, a woman who experienced childhood abuse may use imagination to "stand up" to her perpetrator in the imaginal realm. Although her factual memory remains unchanged, the emotional memory of helplessness transforms into one of self-reliance, courage, and confidence.

 Psychotherapeutic Application: Hypnosis vs. Mental Imagery

Consider a patient who is overweight. Using hypnosis, the therapist implants suggestions into the patient’s subconscious mind about eating less, choosing healthier foods, or exercising more. These suggestions, when reinforced, are expected to alter the patient’s behavior. While this approach works for some, in many cases, it only produces temporary results.

People with undesirable habits often describe themselves as having "addictive personalities." Hypnotic suggestions may target a specific habit, but they often fail to address the underlying belief system. For example, a person with anorexia nervosa might strongly believe "I am fat," even when reality contradicts this belief. Suggestions alone cannot change such deeply rooted beliefs because they do not engage the inner perception that drives behavior. Only by accessing this internal world through imagination can these belief systems be identified and altered.

 Case Illustrations

Case A:
A., age 37, had been overweight since junior high school and struggled with compulsive shopping and short, unsatisfactory relationships. Despite years of psychotherapy, A. remained stuck in the same patterns. After a brief introduction to mental imagery, A. imagined herself descending into her body, where she discovered an emaciated man begging for food. A. was able to break the cage and free the man. She helped him to climb out of the cave and they surfaced in the field of flowers. With the first blow of the wind the man was lifted in the air and became a cloud. As the cloud burst into a rain, A. felt all her suffering and all her fat being washed away. She danced in the rain. She felt light, free, and happy. The "journey" was over. The whole experience lasted eight minutes.

A. was instructed to do a 30-40 seconds imagery exercise of dancing in the rain every morning for twenty one days. Shortly after the session A. started effortlessly losing weight. She decided to take time off from dating so she could "get to know herself.”  A. came for five additional sessions three weeks apart for the purpose of "cleaning up" other issues and "developing the muscle of voluntary will."

Two years later A. was at her desired weight, was no longer shoping compulsively and, was involved in a loving and stable relationship.

 Case B:
B., age 41, experienced severe headaches for three years, with limited success from biofeedback and self-hypnosis. After a short introduction to mental imagery, B. was asked to go inside of her head to meet and befriend the Ache, which appeared to her as a "big sad blob." B. invited the Ache to go to the bank of a river (B.’s identified most favorite place)— and there, the Ache told B. that it hated her mother-in-law. It hated when the mother-in-law called almost every day telling B. how to raise her child. It hated when on holidays her mother-in-law controlled "every breath of everyone present." B. was instructed to thank the Ache for coming and sharing this with her. Then, B. said good-bye to the ache as it sailed away down the river. 

After the imagery exercise, B. made a commitment to being aware of and being accepting of her hateful feelings toward her mother-in-law, and to learning to stand up for herself when she felt intruded upon. B. was assigned to meet her Ache daily for three weeks through mental imagery. During the imagery exercise, her new friend “the Ache” shared a lot of valuable information with her, and B.'s headaches subsided. At the end of the three week period her "Ache" did not show up. B. has been headache free for one year at follow up.

The Issue of Personal Autonomy

One major distinction between hypnosis and mental imagery concerns personal autonomy. Hypnosis often increases suggestibility, which may conflict with the goal of strengthening a person’s self-mastery. While hypnotic suggestions can successfully address certain behaviors, they can also heighten vulnerability to future external suggestions—whether from others or the media. Mental imagery, by contrast, is an active, self-directed process that promotes personal responsibility and autonomy.

Conclusion

Both hypnosis and mental imagery are useful tools in psychotherapeutic intervention. Their similarity begins and ends with the reality that both are: a) altered states of consciousness, b) capable to effect one's psychological and physiological states, and c) can elicit images. However, they are different in their phenomenology and their psychotherapeutic merit.

Hypnosis is a valuable technique in working with people who have difficulties focusing or using their will to conduct their own imaginary journey.  A woman in labor, for example, might have difficulties using imagery for pain management because of experiencing fear and/or pain. In this case preliminary hypnotic suggestions can establish a conditioned relaxation response. 

There are also people whose habitual behavior is so ingrained and overwhelming that they do not believe that they can effectively produce changes on their own. In this situation, which is often seen in cases involving substance abuse, hypnotic suggestion can be a helpful jolt, a jolt that can be reinforced later on by a person's own imagery and willful behavior.

Mental imagery offers a more autonomous, inner-directed path toward self-awareness and change. It can be successfully utilized to discover, and if necessary, correct one's inner conflicts and/or limiting beliefs. It is a method in which the therapist can be a guide and an educator without intruding on a patient's personal freedom and personal responsibility for his/her own healing.

Bibliography

Brown, D., Forte, M., Rich, P., Epstein, G. (1982). Phenomenological differences among self-hypnosis, mindfulness meditation, and imagination. Imagination, Cognition and Personality, 2(4), 291-308.
Epstein, G. (1992). Waking Dream Therapy. ACMI Press, New York.
Erickson, M. (1958). Hypnosis in painful terminal illness. American Journal of Clinical Hypnosis, 1, 1-117.
Hirai, T. (1974). Psychophysiology of Zen. Igaku Shion, Tokyo.
Kroger, W., & Fezler, W. (1976). Hypnosis and Behavioral Modification: Imagery Conditioning. J.B. Lippincott Company, Philadelphia.
Rossman, M. (1987). Healing Yourself. Pocket Books, New York.
Sheikh, A., & Panagiotou, N. (1975). Use of mental imagery in psychotherapy: A clinical review. Perceptual and Motor Skills, 41, New York.
Weitzenhoffer, A. (1957). General Techniques of Hypnotism. Grune & Stratton, New York.