Contemporary Hypnosis (2005)
Vol. 22, No. 2, 2005 pp. 77-83
SUGGESTIBILITY OF THE CHINESE AS REVEALED BY THE
CREATIVE IMAGINATION SCALE
Calvin Kai-ching Yu
Department of Counselling and Psychology, Hong Kong Shue Yan College, Hong
Kong
Abstract
The current aim of the study is to provide a preliminary view of the suggestibility of
Chinese people. Direet hypnotie experience was examined by giving a widely used
suggestibility measure, the 'Creative Imagination Seale', to 90 volutiteer subjects who
were randomly drawn from a college in Hong Kong. The Creative Imagination Scale is
thought to be a clinically useful assessment, which may reveal some implications for the
applications of hypnosis in the Chinese culture. The eurrent results indicated that the
distribution of the suggestibility scores of the current Chinese sample tended to be more
centralized than the Western counterpart, and that there were some cultural differences in
the psychometric features and preferred modalities. By and large, the prospect of using
hypnosis in the Chinese population is positive in view of their relatively good susceptibility to hypnotic suggestions.
Key words: Chinese, CIS, creative imagination, hypnotizability, suggestibility,
susceptibility
Introduction
In 1978 Barber and Wilson constructed the Creative Imagination Scale (CIS) to measure
responsiveness to waking hypnotic suggestions so as to meet the need for a non-authoritarian scale, which informs subjects to produce the phenomena themselves and can be
delivered with or without a trance induction. The scale includes ten items (test suggestions) that ask subjects to think and imagine, for instance, that an arm is heavy, that they
are eating a delicious orange, and that they are re-experiencing themselves back in
childhood. American norms were developed, and the scale has satisfactory test-retest
reliability (Wilson, 1976), split-half reliability (Kiddoo, 1977), and factorial validity
(Wilson, 1976; McConkey, Sheehan, Law and White, 1977). Later, Barber, Wilson and
Scott (1980) demonstrated that a traditional trance induction is useful to raise responsiveness with the Barber Suggestibility Scale, a hypnotist-centred test prior to the CIS,
but not with the CIS, a subject-centred scale.
The CIS has been correlated with another widely-used standardized test, the Harvard
Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A). Sapp and Evanow's study
(1998) indicated that the CIS and the HGSHS:A were significantly correlated.
McConkey, Sheehan and White (1979) found that performance on the CIS was associated
positively with success on the HGSHS:A, though as pointed out by the researchers, the
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two measures are independent in their underlying dimensions. According to McConkey,
Sheehan and White (1979), the CIS appears to tap primarily the processes of imagery and
imagination that are only in part related to performance on the more complex scales that
measure hypnosis as generally conceptualized. Similar findings were also documented by
Laidlaw and Large (1997), where although the CIS and HGSHS:A results were correlated, factor analysis on the two tests showed loadings on separate factors suggesting that
these tests are measuring two related, but separate, abilities found in conjunction with
each other (viz., imagining and hypnotizability perhaps).
The CIS is a practically valuable and reliable instrument that correlates well with
other cognitive variables, especially vividness of imagery, and it presents itself as a useful
instrument for measuring subjects' potential for mental absorption (e.g. Tellegen
Absorption Scale; Sheehan, McConkey and Law, 1978). The CIS was shown to be
positively related to the revised art scale (RAS) scores (Kornfeld, 1984), scores on other
imagining tests such as the Betts Test of Mental Imagery and the Gordon Test of Imagery
Control (Richardson, 1969), dissociation and absorption as measured by the Dissociative
Experiences Scale (DES), General Dissociation Scale (GDS), and Tellegen Absorption
Scale (TAS) (Sapp and Hitchcock, 2003), and even one's ability to disengage from reality
monitoring and false memories (Hyman and Billings, 1998). Similarly, Sigman, Phillips
and Clifford (1985) found significant correlations between CIS scores and absorbed and
directed attention, with high hypnotizable subjects showing greater attentional capacity.
As regards the clinical aspect, the CIS appear to be associated with both the pathological tendency and the therapeutic efficacy. There is evidence that CIS suggestibility
correlates significantly with dietary restraint as assessed by the Three-Factor Eating
Questionnaire and the Revised Restraint Scale, and restrained eaters demonstrated
generally elevated susceptibility to body image modification compared with unrestrained
eaters (Frasquilho, Oakley and Ross-Anderson, 1998). In contrast, CIS suggestibility is
significantly correlated with the efficacy of hypnotherapeutic suggestions in the
treatment of nail biting (Wagstaff and Royce, 1994) and the potency of hypnotic analgesia
(Stewart and Marks, 1990).
Johnson, Walker and Heys (1996) evaluated the psychological and immunological
effects of three weeks' relaxation practice to investigate the effects of relaxation training
and hypnosis on the modulation of the immune response to an experimental stressor and
to relate changes to the CIS suggestibility. Relaxation training improved effects on a
number of measures of mental state and a reduction in lymphocyte responsiveness and
interleukin-1 secretion. The extent to which immunoglobulin A increased as a result of
relaxation therapy for three weeks was positively correlated with the CIS scores.
The CIS has been translated into other languages such as Spanish (de Alvarez, 1977)
and Hungarian (Varga, 1992). The comparison of the normative data revealed that the
Hungarian version of the scale was not significantly different from most important
psychometric features of the original scale (Varga, 1992). Likewise, Siuta (1987)
compared the CIS psychometric characteristics of a Polish sample with those from
American (Wilson and Barber, 1978) and Australian (Sheehan, McConkey and Law,
1978) normative studies, and with reference to this study cultural differences did not
influence the major pattern of findings obtained with the CIS.
Notwithstanding the highly consistent findings in Western cultures, Sapp and
Hitchcock (2003) found that the African American sample had a significantly lower
mean CIS score than the European American sample obtained by Barber and Wilson
(1978) and Wilson and Barber (1978). In a similar vein, the native Malaysian students
scored lower than the Malaysian students and native students in the US in the CIS
Suggestibility ofthe Chinese
79
measures (Jaequith, Rhue and Lynn, 1996). Baba (1985) administered a Japanese revision
ofthe CIS to undergraduates. Compared with American and Australian students,
Japanese subjects tended to have less active and less relaxed imaginative activity, and
were less efficient in controlling images autonomously. Culture-based expectancies
therefore seem to play a role in mediating the relationship between suggestibility and
measures associated with suggestibility (Jacquith, Rhue and Lynn, 1996).
Due to its fiindamental importance, suggestibility has been investigated extensively in
many Western countries. In contrast, there have been very few parallel studies in Asian
countries. The present study strives to provide a preliminary view of suggestibility in
Chinese culture by administering the widely used non-authoritarian measure CIS in
college students.
Method
Subjects
A total of 90 undergraduates, aged 20-46 (M = 21.64, SD = 2.76), were drawn randomly
from an entire population of 198 psychology major students in a college in Hong Kong.
Participation was completely voluntary, and written consents were obtained. There were
significantly more males than females (male N = 24, 26.7%; female N = 66, 77.3%;
binomial test, p > 0.001). Over 60% reported no religious affiliation. None had experienced hypnosis. Participants were administered the CIS in a laboratory setting in two
groups (N = 45). Seven participants were removed from analyses (six dozed off and/or
could not remember having some or all CIS episodes, 1 fell asleep), leaving 83 participants.
Measures
The original CIS (Barber and Wilson, 1978),which assesses subjective responses to ten
test-suggestions was translated into Chinese. The ten suggestions provide descriptions
that guide subjects to use their own thinking and creative imagining in order to
experience the suggested effects. Following administration of the CIS, the participants
were asked to rate their experiences for each ofthe ten test-suggestions, by indicating the
extent to which each imagined experience matched the corresponding real experience on
a five-point scale ranging from: 'Not at all the same' as the real thing (score of 0) to
'Almost exactly the same' as the real thing (score of 4). Thus scores on each ofthe ten
test-suggestions can range from 0 to 4, and total scale scores on the CIS can range from 0
to 40.
Results
The CIS mean was 20.41 (SD = 6.24, median = 20, range = 3-34), and is similar to
Barber and Wilson's mean (M = 20.8, SD = 8.6). There are no significant gender differences for the CIS total mean (males: M = 20.23, females: M = 20.48) or for the individual
10 CIS ratings (Mann-Whitney U, p > 0.1). Although not perfectly normally distributed,
the CIS distribution is reasonably symmetrical and bell-shaped (Kurtosis = 0.055;
skewness = -0.17) and the CIS distribution does not violate the normality assumption
(Shapiro-Wilk = 0.989, p = 0.694). Both the alpha reliability coefficient and the Guttman
split-half coefficient for the 10 test components are 0.71.
A predominant number of subjects consider themselves as moderately hypnotizable
(see Table 1). The total CIS mean scores ofthe three levels of self-perceived hypnotiz-
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ability are close to each other (Table 1), and the total CIS does not vary significantly with
the self-perceived hypnotizahility (Kruskal-Wallis test: %2 = 0.63; df = 2; p = 0.73). The
total CIS scores ofthe current Chinese sample tend to he more centralized than those of
Barber and Wilson's Western sample, with both fewer cases of high and low CIS susceptibility (see Table 2). Specifically, 84.4% of Chinese subjects, as opposed to 69% in
Barber and Wilson's Western sample, fall within the medium group.
The greatest discrepancies in the mean scores between the Western and Chinese
samples among the ten episodes are the arm heaviness and the finger anesthesia (mean
differences = 0.6; see Table 3). As compared with Barber and Wilson's study, the subjects
in the current sample tend to have higher mean scores in the first three components about
the hand imageries, whereas they have in general relatively lower means for the olfactorygustatory 'hallucination', the music 'hallucination' and the mind-body relaxation.
The mean total CIS score for the Christian respondents is 18.9, and that ofthe respondents without religion is 20.7. There are no significant variations between the Christian
respondents and the respondents without religion in both the total CIS and the individual
10 CIS ratings, except age regression (Mann-Whitney U = 370; p < 0.05), in which the
respondents without religion have significantly higher mean scores (2.57) than the
Christian respondents (1.74).
Discussion
Many Western studies have found gender differences in hypnotizability (e.g. Bramwell,
1903; Hull, 1933; WeitzenhofFer, 1953; Bowers, 1971) though there are many others who
have rejected this stereotyping assertion (see Hilgard, 1965; Gibson, 1977). Hollerbach
(1996) reported that the CIS revealed a significant gender difference, with the total mean
score being higher for the females than males. According to Laidlaw and Large (1997),
however, suggestibility scores on the CIS were predicted by neither age nor sex. The
Table 1. Mean CIS scores of stratified self-perceived hypnotizability
Self-perceived hypnotizability
Frequency
%
Mean CIS
High
Medium
Low
Missing
Total
8
70
9
3
90
8.9
77.8
10.0
3.3
100
21.4
20.1
21.3
-
Table 2. Distribution of stratified CIS levels
CIS Level
Raw score
No. of subjects
Valid %
% (Barber's study)
High
Medium high
Medium low
Low
Total
29^0
21-28
11-20
0-10
-
7
33
37
6
83
8.4
39.8
44.6
7.2
100
18
34
35
13
100
Note: Valid percentages do not take the missing cases into account.
Suggestibility ofthe Chinese
81
Table 3. Mean scores of 10 CIS suggestions
Test-suggestion
Mean
(Barber)
SD
(Barber)
Mean
(Current)
SD
(Current)
Mode
(Current)
1, Arm heaviness
2, Hand levitation
3, Finger anesthesia
4, Water 'hallucination'
5, Olfactory-gustatory 'hallucination'
6, Music 'hallucination'
7, Temperature 'hallucination'
8, Time distortion
9, Age regression
10, Mind-body relaxation
Average:
2,2
1,5
1,5
2,0
2,2
2,7
1,7
1.9
2,3
2,7
2.08
1,1
1,2
1.2
1.3
1.3
1,3
1.2
1.4
1.3
1,2
-
2.8
1,8
2.1
2,0
1,7
2.1
1,7
1,7
2,4
2,2
2,05
0,9
1.0
1,3
1,1
1,3
1,3
I.I
1.2
1.3
1.2
-
3
1
2
2
1
3
1
2
3
3
-
Note: Barber = Barber and Wilson's study (1978); Current = current sample; all scales range from 0 to 4.
current Chinese study does not support a sex difference with regard to the CIS susceptibility.
McConkey (1980) studied the suggestion that instructed subjects to imagine that they
were 'amnesic' for the events ofthe CIS testing. Subjects who indicated a high, as
compared with a low, degree of subjective 'amnesia', tended to recall fewer items during
the suggestion to reverse their 'amnesia' more, and to display more temporal disorganization of recall. It is worth noting that in the current Chinese study the seven subjects who
either experienced a certain degree of natural amnesia or drowsiness without receiving
any hypnotic inductions or corresponding suggestions of amnesia and sleepiness may
actually be highly susceptible. Natural amnesia or dozing off during susceptibility testing
(not hypnotic therapy) has rarely been reported in the literature, if at all.
Although the data ofthe Chinese sample is generally similar to the original norms, the
current study revealed some cultural differences between Chinese and English speaking
populations with regards to the CIS suggestibility. There is a potential association
between the two language speaking groups and the stratified CIS suggestibility levels
(Pearson chi-square = 7.59, df = 3, p = 0.055). Specifically, relatively few Chinese
subjects ofthe current sample (7.2%) were classified as low susceptibility, as opposed to
13% ofthe Western subjects in Barber and Wilson's study.
As disclosed by the differential psychometric features of the distributions of mean
scores of the Western and Chinese samples, there may be fundamental cultural-specific
preferences or orientations ofthe modalities for receiving hypnotic suggestions. It is
interesting to note that, for instance, Chinese subjects in the current sample, resembling
Japanese subjects (Baba, 1985), tended to be less responsive than American and
Australian counterparts in the mind-body relaxation imagery, which is nevertheless
almost routinely included in hypnotic procedures. Besides the possibility of culturalspecific preferences ofthe modalities, there are also other possible explanations for this,
such as the laboratory setting (a potentially stressful environment) in which the current
research was administered, different living pressures and styles between Chinese and
Western cultures, and imprecision ofthe Chinese vocabulary of emotional terms.
Although the number ofthe subjects with total CIS scores of 20 or below is slightly more
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than that of the subjects with total CIS scores of 21 or above, almost half (48.2%) of the
subjects indicated medium high or high susceptibility. In any event, the current results by
and large seem to indicate that Chinese people are potentially responsive to hypnotic
suggestions without sex differences, and that the prospective applications of hypnosis for
the Chinese population are positive.
Acknowledgement
The author gratefully acknowledges the support of the administrative members of the
Hong Kong Shue Yan College. The author also thanks Helen Crawford for her very
detailed and thoughtful review on this paper.
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Address for correspondence:
Calvin Kai-ching Yu
Department of Counselling and Psychology
Hong Kong Shue Yan College
10 Wai Tsui Crescent
Braemar Hill Road
North Point
Hong Kong
Email: [email protected]