Dissertation approved as a partial requirement for obtaining a Master's degree in Psychology in the Postgraduate Program in Psychology at the Federal University of Santa Catarina.____________________________________________________________
ABSTRACT
Hypnosis has been studied in various areas of health, such as medicine, dentistry and sports. This research aimed to investigate the perception of the visualization characteristics of the Ironman race and its psychophysiological components during the hypnotic trance in triathlon athletes. Seven male athletes were studied in six hypnosis sessions. After each session, a semi-structured interview was conducted and a questionnaire was administered. Heart rate (HR) was monitored during the trance in all sessions. The results point to relaxation and concentration as the main characteristics of the hypnotic trance with triathletes. The athletes felt body relaxation throughout and after the trance, which was confirmed by the behavior of the heart rate. Heart rate decreased significantly at the start of the trance (p = 0.000) and remained low until the end of the trance, when it increased significantly (p = 0.000), with the group average being 60 bpm. The athletes reported being focused throughout the trance, especially on the therapist's voice. Focal attention was more intense during visualization. Participants tended to feel from normal to warm and lighter. Participants perceived entering and exiting the trance naturally and gradually.
The hypnotic phenomena of hypermnesia, catalepsy and anesthesia were present less frequently. While viewing the Ironman race, the athletes answered in the questionnaires that they were in an internal perspective (inside the image) or alternating between internal and external. In the interviews, this perception was well distributed between being inside, outside or in between. The athletes perceived images in general with good quality (medium focus, medium light, medium size, colorful and with normal movement), indicating a proximity to the images seen in the awake state. Participants perceived that they were breathing slowly and deeply, which is in line with HR behavior and the feeling of relaxation. It can be concluded that hypnosis applied to triathlon athletes during the visualization of the Ironman race produces behaviors typical of hypnosis, and that the characteristics of concentration, relaxation, anesthesia and hypermnesia can be put to even better use in the sports environment. Hypnosis is a useful tool for training triathlon athletes and has the potential to be explored in other sports.
KEYWORDS: Hypnosis. Triathlon. Visualization
1 INTRODUCTION
1.1 PROBLEM
Hypnosis was associated for centuries with the loss of consciousness and voluntary control of actions, a state where the hypnotist could manipulate the hypnotized person into doing whatever he wanted, including revealing the deepest secrets. Surrounded by mysticism, for a long time it was the target of criticism and admiration. Public presentations helped to spread the technique as something magical and mysterious. Hypnosis, however, has existed for many centuries, and it is believed that the ancient "healing by the laying on of hands" or the work of "faith healers" were already hypnotic in nature. Centuries have passed and hypnosis has evolved. The term, which originally came from the Greek root hypnos, meaning sleep, no longer has this meaning. Hypnosis has become a technique that is studied and respected in different areas, enabling it to be used in a broader and more beneficial way.
Authors such as Caballo, Elman, Rossi and Erickson bring a new look to this ancient technique, and in the same vein, researchers around the world are trying to unravel the functional mechanisms of hypnosis and its effects in various areas of health. Hypnosis has gained respect in medicine, mainly for its effects on analgesia (DIETRICH, 2003). This approach has been used for millennia to treat medical and dermatological problems. Dermatological disorders can be improved or cured with the use of hypnosis as a complementary or alternative therapy (SHENEFELT, 2003).The positive results brought about by hypnosis for pain relief have also been studied in clinical trials. Many controlled clinical trials have been conducted using hypnosis to control pain (GAY; PHILIPPOT; LUMINET, 2002). Clinical studies in dentistry (STAM; MCGRATH; BROOKE, 1984; ENQVIST; FISHER, 1997), burn treatments (PATTERRSON; PTACEK, 1997; OHRBACH et al., 1998), surgery (LAMBERT, 1996; MAUER et al., 1999) and radiology (LANG; ROSEN, 2002) have indicated that this technique brings results in the treatment of both acute and chronic pain, showing a 50% reduction in the pain caused by osteoarthritis after four weeks of training (GAY; PHILIPPOT; LUMINET, 2002).Looking at the number of studies carried out in the health area, one wonders about the contributions of this type of therapeutic technique in other areas such as sports.
The use of hypnosis in the sports context has been studied in countries such as the United States, Italy and Germany. Research includes aspects such as the state of fluency (MASTERS, 1992; PATES; MAYNARD, 2000), visualization (LIGGETT; HAMADA, 1993), the use of hypnosis to improve the performance of archers (ROBAZZA; BORTOLI, 1995), in the treatment of anxiety (MORGAN, 1995), among others. Due to the physical and mental demands that sports make on athletes, especially high-performance athletes, new alternatives are being sought to improve performance and enhance the well-being of these individuals. Alternative therapies such as acupuncture, massage, yoga, meditation, among others, are some of the alternatives sought by athletes to promote well-being.
Hypnosis, both for performance and health, can be an alternative when working with athletes. In the context of high-performance sports, triathlon is considered an endurance activity, made up of three disciplines practiced consecutively: swimming, cycling and running (O'TOOLE; DOUGLAS; HILLER, 1998). There are several triathlon competitions with very different distances. Of these, the Ironman is the longest. Triathletes prepare for approximately five months specifically for this race, following a daily training schedule with an average of 20 hours of training per week. As well as being a test of physical endurance, this event requires mental strength simply to complete the race (O'TOOLE, 1999 apud SCHOFIELD et al., 2002).
The intensive training prior to the race can cause emotional states such as anxiety, stress, irritability and low self-esteem. During the race, it is important for the athlete to be able to control their anxiety, maintain concentration and adjust their emotional balance as physical symptoms such as cramps, stomach pains and tiredness arise (SZENÉSZI, 2002). Considering the literature reviewed, the possibilities of working with athletes using hypnosis, and the desire to understand more deeply how athletes experience hypnosis, we came up with the following guiding research question for this study: What are the characteristics of the visualization of the Ironman race and its psychophysiological components in the perception of triathlon athletes during the hypnotic trance?
1.2 GENERAL OBJECTIVE
To investigate the characteristics of the visualization of the Ironman race and its psychophysiological components during the hypnotic trance, in the perception of triathlon athletes.
1.3 SPECIFIC OBJECTIVES
a). To identify the triathlon athlete's sensory perceptions during the hypnotic trance; b). To identify the characteristics of the visualization of the Ironman race during the hypnotic trance, in the perception of triathlon athletes; c). Analyze the heart rate behavior of triathlon athletes during the hypnotic trance.
1.4 JUSTIFICATION
From the perspective of the physical and psychophysical demands (cognitive and emotional aspects) that sports such as triathlon make, there is a need for new work alternatives to promote the well-being of athletes. For this to be possible, there is a need to study and understand them in order to better target them in the sporting context. There is a significant lack of national publications on the subject, both in the health and sports fields. As a country in the process of growing sports development, Brazil needs research to improve performance and promote the well-being of these athletes. In this sense, the most well-known hypnotic phenomena, such as anesthesia and relaxation, could, for example, help treat injuries in athletes and reduce pre-competition anxiety. Other phenomena, such as hypermnesia, could help to perfect wrong moves during matches, and even repeat well-done moves exactly.
Hypnosis can thus be an alternative way of working and promoting sports development in the country. Given the recent results of the use of Ericksonian hypnosis, and the lack of studies describing the experience of individuals in relation to this approach (STAM; MCGRATH; BROOKE, 1984; ENQVIST; FISHER, 1997; PATTERRSON;PTACEK, 1997; OHRBACH et al, 1998; LAMBERT, 1996; MAUER et al., 1999; GAY; PHILIPPOT; LUMINET, 2002; SHENEFELT, 2003; DIETRICH, 2003), the aim of this study is to better understand the characteristics of athletes' experiences with hypnosis. This research could contribute to a better understanding of hypnosis and open up new possibilities for its use with athletes.
1.5 DELIMITATION OF THE STUDY
This study is limited to an exploratory field study carried out with a triathlon team taking part in the Ironman race. The research is qualitative and quantitative-descriptive, with the heart rate stage characterized as a quasi-experimental study. The study investigates the perceptions of triathletes about the characteristics of the visualization of the race and the hypnotic trance, as well as the behavior of the heart rate during hypnosis.
1.6 DEFINITION OF TERMS
Hypnosis: a state of relaxation in which the individual increases their attention and receptivity to ideas, with the effect of altering sensory and motor capacities to initiate appropriate behavior (ERICKSON; HERSHMAN; SECTER, 1994).Hypnotic trance: a period during which the participant is in a state of hypnosis. Hypnotic phenomena: symptoms or functions of perception that are affected by a process of differentiation of the figure from the background inserted in the phenomenological field occurring within the hypnotic experience, either by suggestion or spontaneously (WOODARD, 1996).Psychophysical characteristics: characteristics that attend to the correlation between aspects of physical stimuli and the sensations they provoke (KANDEL; SCHWARTZ; JESSEL, 1991).Sensation: immediate result of the activity of sensory receptors (BRANDÃO, 2001). Sensory systems receive information from the environment and transmit it to the central nervous system, where it is used for three main purposes: sensation, movement control and maintenance of stimulation.
In addition to the information received from the environment, we also receive information from our own bodies, such as muscle actions, for example (KANDEL; SCHWARTZ; JESSEL, 1991).Perception: the final stage in the process of activating sensory receptors, where recognition and identification take place (BRANDÃO, 2001). Perceptions are not direct records of the external world, but are partially constructed internally, according to our innate rules or our pre-knowledge (KANDEL; SCHWARTZ; JESSEL, 1991).Sensory Perception: perception of stimuli internal or external to the body, initiated by the reception of information through sensory receptors and interpreted by the person later .Mental Images: images that arise in the mind spontaneously and voluntarily in the physical absence of the object. Mental images are associated with meanings and concepts, and recruit memory mechanisms, not requiring the physical presence of the object (BRANDÃO, 2001).Consciousness: instantaneous self-knowledge of psychic activity (BAUER, 1998).Conscious or Conscious Mind: set of psychic processes and facts during which we are aware (BAUER, 1998).Unconscious or Unconscious Mind: activities and psychic procedures of the individual, of which they are not aware (BAUER, 1998).Visualization: seeing mental images (O'CONNOR, 2001).Mentalization: a form of simulation, similar to the real experience of seeing, hearing and feeling, but taking place only in the mind (WEINBERG; GOULD, 2001). The exercise of only mentally seeing images created or memories of situations experienced, using as many sensory stimuli as possible: auditory, olfactory, gustatory, tactile and visual. Mind: a range of functions carried out by the brain (KANDEL;SCHWARTZ; JESSEL, 1991). Functions that allow the individual to think, imagine, mentalize and visualize anything at any time.
1.7 LIMITATIONS OF THE STUDY
The initial sample of 10 athletes was reduced to 7 according to the availability of the participants. All the participants had activities parallel to their training (work and/or study), which made it impossible to standardize their schedules for the research. In addition, as the researcher was part of the team of professionals working with the team, she had previous contact with some of the participants, which may have influenced the athletes' experience. It is worth noting that this contact did not involve hypnotic induction.
2 LITERATURE REVIEW
2.1 DEFINITIONS OF HYPNOSIS
Krasner (1990/1991) highlights Hilgard and Weitzenholffer's definition of hypnosis as the willingness to be receptive to ideas, allowing these ideas to act without interference. These ideas can be called suggestions. Ansari (1991) complements the definition by saying that hypnosis is an altered state in which the individual can be suggestible. This state occurs through the combined use of relaxation, fixation of attention and suggestion. Milton Erickson provides definitions throughout his literature on what hypnosis is. Krasner (1990/1991) describes one of Erickson's definitions as hypnosis being a state in which the individual has their attention and receptivity to ideas increased, and can be seen as an increased susceptibility to suggestion. In this state, the individual has the effect of altering sensory and motor capacities to initiate appropriate behavior (ERICKSON; HERSHMAN; SECTER,1994).The American Psychological Association defines hypnosis as follows:
"Hypnosis typically involves an introduction to the procedure during which the participant is told that suggestions for imaginative experiences will be presented. The hypnotic induction is an initial suggestion extended to use the person's imagination, and may contain further elaborations of the introduction. The hypnotic procedure is used to encourage and evaluate responses to the suggestions. When using hypnosis, the person (the participant) is guided by another (the hypnotist) to respond to suggestions for changes in subjective experiences, alterations in sensations, perceptions, thoughts or behaviors...Procedures traditionally involve suggestions for relaxation, although relaxation is not necessary for hypnosis and a wide variety of suggestions can be used including those for becoming more alert.1" (APA, 2005).
2.2 THE HISTORY OF HYPNOSIS
Erickson, Hershman and Secter (1994) give a brief history of hypnosis. According to the authors, modern hypnosis began with Franz Mesmer in 1773. Mesmer used magnets to treat cases of hysteria. The Jesuit priest and astronomer Maximilian Hell, for whom Mesmer worked, believed that healing was brought about by the physical properties of the magnet. He even attributed healing to the redistribution of some kind of fluid which he called animal magnetism.Erickson, Hershman and Secter (1994) state that later, in 1975, a priest called Grasner cured people by the laying on of hands.Mesmer believed that Grasner was using animal magnetism without his knowledge.
Mesmerism evolved until a commission formed by Benjamin Franklin, the chemist Lavoisier, Dr. Guillotin and others, discovered that the effects of Mesmer's work came from the imagination of the patients and not from magnetic fluids. According to the authors, in 1841, an English doctor called James Braid took an interest in the subject, declaring that animal magnetism was not involved in the cures, but rather suggestion. He created a visual fixation technique to induce relaxation. Initially, because he thought it was a state similar to sleep, he called it hypnosis from the Greek word hypnos = sleep. He later tried to change it to monodeism, which means concentration on an idea, but to no avail.
Hypnosis persisted, despite not directly corresponding to the phenomenon, maintaining the idea that it is a state related to sleep. Erickson, Hershman and Secter (1994) describe what happened between 1845 and 1956. In 1845, James Esdaille, a surgeon working in the jungles of India, performed hundreds of small surgeries on natives using mesmeric anesthesia, recording 250 of these operations in the book "Mesmerism in India" published in 1950. In this book, Esdaile describes in detail the surgeries and many hypnotic phenomena as we know them today. At the same time, in France, the physician Ambroise-Auguste Liébaut and the neurologist Hippolyte Bernheim worked together treating around 10,000 patients using hypnosis. The first scientific treatise on hypnosis was then written by Bernheim in 1886, called Suggestive Therapeutics (ERICKSON; HERSHMAN; SECTER, 1994).Later, in 1890, Freud approached hypnosis together with Breuer, with the interest of helping people with emotional disorders.
However, for his own purposes, Freud felt that hypnosis cured too superficially, which led him to abandon the method. Freud did, however, believe that hypnosis was a powerful tool for recovering submerged memories. It was also at the beginning of his contact with hypnosis that Freud had his most profound insights into human behavior and mind (ERICKSON; HERSHMAN; SECTER, 1994).The First World War brought an incidence of traumatic shocks, which led German psychoanalyst Ernst Simel to use hypnosis to treat patients.
During the Second World War, hypnosis was also used to treat fatigue and other neuroses (ERICKSON; HERSHMAN; SECTER, 1994).As a result of World War I and II, there was a significant merging of hypnosis and psychoanalysis. At Yale, in the United States, a psychology professor called Hull became interested in the experimental aspects of hypnosis, publishing the book Hypnosis and Suggestionability. Other books have been published since then and hypnosis has also been taught at universities such as California University, Long Island University, Roosevelt University, Tufts University, among others (ERICKSON; HERSHMAN; SECTER, 1994).A committee of the American Medical Association met in 1956 to discuss how hypnosis could be integrated into medical teaching, reporting its results in the September 13, 1958 journal in the article Medical use of Hypnosis.
Erickson, Hershman and Secter (1994) cite the existence of several journals dedicated to the scientific study of hypnosis and its applications, such as the American Journal of Clinical Hypnosis, the British Journal of Medical Hypnosis and The Journal of Clinical and Experimental Hypnosis. In Brazil, in 2000, the Federal Council of Psychology, through Resolution 013/2000, approved and regulated the use of hypnosis as an auxiliary resource in the work of psychologists (ANNEX 1).
2.3 MYTHS ABOUT HYPNOSIS
Krasner (1990/1991) and Ansari (1991) point out some of the most common myths about hypnosis. According to the authors, it is important to demystify hypnosis before starting the inductive process. The first myth pointed out by Ansari (1991) is that hypnosis is sleep. Although apparently the hypnotic state is similar to sleep - the individual closes their eyes, breathes calmly and has some alterations in their consciousness - the two states are different in both physiological and psychological aspects. During sleep, only the unconscious mind is activated, whereas in hypnosis both the conscious and unconscious minds are functioning and work together. Thus, unlike sleep, in the hypnotic state the individual hears sounds and responds to vocal instructions. During sleep, the patellar reflex is significantly diminished, which does not occur in hypnosis.
In the sleep state, the limbs are flaccid due to lack of activity. In the hypnotic state they can become rigid and firm. The heartbeat and respiratory rate during hypnotic trance are closer to alertness than sleep. The fact that only people with a weak "mind" can be hypnotized is another myth pointed out by Ansari (1991). The ability to concentrate is necessary, but not a sufficient condition in itself. Bernhardt and Martin(1977 apud ANSARI, 1991) state that the best participants tend to be those with average or slightly above average intelligence, with strong motivation and the ability to concentrate. Krasner (1990/1991) adds that those with an active and vivid imagination are also the best participants for hypnosis. The fact that the hypnotist has a dominant personality is also a myth.
The patient's motivation and receptiveness are more important than the therapist's personality traits. Rapport also plays a fundamental role in the trance process (ANSARI, 1991). A common myth is that there is a danger of the participant not being brought out of the hypnotic trance. Ansari (1991) explains that therapists rarely encounter difficulties in waking participants from the hypnotic trance.
Bauer (1998) adds that hypnosis is a state between being awake and asleep. If the participant remains in the trance for too long, they end up falling asleep. And if they fall asleep, at some point they wake up. Loss of control, revealing secrets, and acting in an antisocial way are other existing myths. Ansari (1991) explains that, during the hypnotic trance, the participant is not under the control of the therapist's will, but in total control of him/herself, completely aware of the environment and fully capable of making decisions on his/her own at all times. In this way, the participant will not engage in any behavior that might go against their values. Krasner (1990/1991) adds that the hypnotized participant will not accept any suggestion. The participant is in control of the situation, as they are able to come out of the trance if they wish, or not accept suggestions given by the therapist.
Ansari (1991) clarifies the myth that hypnosis is harmful. According to him, hypnosis is a valid scientific phenomenon that can help people overcome problems. Hypnosis has been used with thousands of people, without the slightest sign of harm to their physical or psychological integrity. Elman (1970) reinforces the point that hypnosis is in no way harmful. The author states that there is no recorded case of any individual being induced to commit a crime, to hurt themselves or others. According to him, when a hypnotized individual receives an inappropriate suggestion, one of two things happens: either the individual does not respond to the suggestion, or the trance state ends immediately. Elman (1970) highlights three basic requirements for hypnosis: 1) the consent of the participant; 2) communication between the operator and the participant, and 3) being free from fear or reluctance on the part of the participant to trust the operator (p. XII).
2.4 THEORIES ON HYPNOSIS
Erickson, Hershman and Secter (1994) describe some theories of hypnosis. Pavlov, in his work on conditioned reflexes, states that words and ideas acquire a conditioned meaning for the participant. But conditioning is only one part of hypnosis. The psychoanalyst Ferenczi proposed a theory that hypnosis was a kind of regression to childhood, in a kind of dependent relationship between the child and the parents. This theory fell apart. Robert White, in 1941 (GILLIGAN, 1987), believed that the participant in a hypnotic state acts as he believes a hypnotized person should act.
For the induction of trance, this can be supported, but in the case of a child who has no knowledge of hypnosis and shows signs of trance, this theory fails. Gilligan (1987) explains some more theories about hypnosis. At the end of the 19th century (ANSARI, 1991), neurologist Jean Martin Charcott concluded in his studies on hypnosis that the trance state was a pathological state, very similar to hysteria, theorizing about three levels of trance: catalepsy, lethargy and somnambulism. Around 1864, the French doctor Auguste Lébeault, founder of the Nancy school, likened trance to sleep, but through suggestions. He also tried to explain why the patient in the trance state remained in rapport with the therapist. The theory of Pierre Janet, who was Charcot's pupil and Freud's assistant, stated at the beginning of the 20th century (ANSARI, 1991), around 1910 (GILLIGAN, 1987), that hypnotic trance was a state in which the patient's unconscious mind performed cognitive functions, outside of conscious perception. With regard to more recent theories, Gilligan (1987) points to the concept of partial regression in the service of the ego, developed by Kris in 1952. Similarly, Gill and Brenman (1959 apud GILLIGAN, 1987) presented the hypnotic trance as a regression to a primitive state.
In this regression, the patient gives in to their impulses and develops a transference relationship with the therapist. Both were based on Freudian or neo-Freudian theories. Gilligan (1987) also presents other theories such as those of Hull, Hilgard, Barber, Sarbin and Erickson. Around 1933, Clark Hull presented the theory of trance as acquired learning. In it, Hull proposed that hypnotic phenomena were acquired responses, like other habits, and emphasized the experience of trance as natural and that it could become easier with practice. Ernest Hilgard, around 1976, improved on Janet's theory of dissociation, creating the theory of neo-dissociation. Hilgard used concepts from contemporary cognitive psychology, describing the hypnotic experience as a momentary disconnection from the functions of planning and monitoring, reducing criticism and enabling the development of dissociative experiences such as amnesia, hypnotic deafness, pain control and automatic writing (GILLIGAN, 1987).Barber, in 1969, developed a cognitive-behavioral idea.
In it, he states that trance experiences are the result of positive attitudes, motivations and expectations in relation to the test situation, which leads to a willingness to think and create images according to the suggested themes. As White's successor, Sarbin, around 1956, stated that a skilled and motivated person could become strongly immersed in the hypnotic role, even having experiences of dramatic qualitative changes in subjective reality (GILLIGAN,1987).Milton Erickson in the 1950s developed a naturalistic theory of hypnosis. For him, trance processes are naturally employed, without the need for
without the need for a specific trance ritual.
For Erickson, the trance experience allows the patient to function properly and directly on an unconscious level of perception, without the interference of the conscious mind. The participant's limitations are temporarily altered so that the individual becomes receptive to the patterns, associations and ways of functioning of the mind that lead to problem-solving (GILLIGAN, 1987).
2.5 TRADITIONAL APPROACH VERSUS NATURALISTIC OR ERICKSONIAN APPROACH
There are reports in the literature of hypnosis being used to treat clinical cases, such as Jean-Martin Charcot, Josef Breuer and Sigmund Freud. After the 1970s, there was a resurgence of hypnosis, mainly through authors such as Spiegel and Kroger, but fundamentally influenced by the work of Milton Erickson (CABALLO, 1996).The so-called traditional hypnosis approach differs in some respects from the Ericksonian or naturalistic approach. Traditional hypnosis is generally characterized by the use of predictable words or words that can be attributed to someone. The attributions can be about feelings, thoughts or behaviors, predicting what the person will feel, see or what will happen (O'HANLON; MARTIN, 1995).
These are called direct suggestions where the hypnotist tells their client what they are going to do or feel, and they accept it and act on it. This approach works on approximately 25% of people, who are considered suggestible. About 50% of people are more or less suggestible, and may or may not respond to traditional stimuli. Therefore, only the first 25% of people respond well to this type of approach (O'HANLON; MARTIN, 1995).This type of hypnosis is the one traditionally seen in stage performances, and surrounded by mysticism. The hypnotist looks like a magician and the hypnotized person looks like a zombie. In the Ericksonian approach, the therapist-patient relationship occurs differently.
Whereas in the traditional approach, hypnotic suggestions are direct and not very flexible, in Ericksonian hypnosis the hypnotist allows the patient to make choices. O'Hanlon and Martin (1995) state that according to Erickson, anyone can be induced into trance. The use of permission words helps people not to feel obliged to act in a way set by the therapist. Instead of telling the person what to do or feel, in the Ericksonian approach the therapist uses everything that the person already brings with them. For this reason, it is also called the Utilization Approach. Thus, the therapist uses the client's own characteristics to induce the trance and gives permissive suggestions, where the client has the choice of doing or not doing, feeling or not feeling. Because he used "natural" elements of the client, Erickson called his hypnosis techniques "naturalistic".
Erickson believed that people have within themselves the aptitudes necessary to overcome difficulties, solve problems, go into trance and experience all the phenomena of trance. His approach consisted of bringing these abilities to the surface (O'HANLON, 1994, p. 19). According to Zeig (1985), at the very beginning of therapy, Erickson considered patients to be complete individuals who possessed all the resources necessary for therapy. The task then became to guide the patient to discover their own potential to make changes. Erickson understood that communication takes place on multiple levels, including verbal content, non-verbal behavior and the implications of each individual.
He used all levels in the therapeutic process, starting from the resources brought by the patient himself. According to Zeig (1985), the so-called "utilization" technique means using what the patient brings with him, and not what the therapist thinks would be best to give the patient. It is preferable to use the patient's own clothes, adapting them to a helping relationship, rather than trying to dress them in imposed and sometimes inappropriate clothes. This means adapting the therapy to each patient and creating a more consistent rapport. Gilligan (1987) states that in the utilization principle, the patient's patterns of self-expression form the basis for the development of the therapeutic trance. This requires adaptable rather than standardized instructions.
Phillips (1993) utilized the post-traumatic symptoms of people who had suffered childhood sexual abuse, transforming them into positive resources for rapid and successful change. He concluded that the utilization approach created by Milton Erickson is very effective in treating this type of symptomatology, managing to address one of the most persistent post-traumatic symptom patterns related to childhood sexual abuse. Another point that stands out in the Ericksonian approach is the attitude of thinking about the future. Setting strategic goals is part of the therapy, respecting the client's changing conditions. We observe how far the individual can go, and as they make changes, new goals are set (ZEIG, 1985).
According to Zeig (1985), despite all the flexibility of the Ericksonian approach to utilization, some points are crucial in the therapeutic process: 1) Identification of the patient's latent resources; 2) Diagnosis of the patient's values (what they like and what they don't like); 3) Development of resources using the patient's own values; 4) Linking the resource to the problem in a direct or indirect way; 5) Establishment of rapport, motivation and control of receptivity throughout the process; 6) Acceptance and use of any behavior, manifestation or resistance presented by the patient; 7) Use of drama to improve receptivity to directives; 8). Sowing ideas in advance generates receptive behavior; 9). Acting at the right time is fundamental. The therapeutic process involves monitoring, disorganizing the mental model and creating new response patterns;10) The therapist must have an attitude of expectation;11) Monitoring the results to verify the effectiveness of the intervention.
You can have the patient practice the new behavior together with the therapist during the session, or make reinforcement appointments, or even suggest that the patient imagine themselves practicing the new behavior (ZEIG, 1985, p. 84, 85 and 87).
One aspect considered by Gilligan (1987) to be extremely important in the Ericksonian approach is integrity. According to him, integrity refers to the degree of self-awareness and the interdependent support of the various parts of a system. In hypnotherapy, integrity is the degree to which the therapist's intentions and expressions go hand in hand with the patient's needs. In this way, the hypnotherapist must support the patient at all times in their quest for transformation, must put aside their prejudices and personal needs and completely accept the patient's experience, and must also avoid giving solutions or applying personal beliefs to the patient. For the process to be therapeutically successful, a context of integrity is essential, so that the hypnotherapist can guarantee rapport with the patient.
The Ericksonian approach has been studied by various authors in different areas of human behavior and health. Gilmore (1987), for example, describes how the methods of the Ericksonian approach can alleviate sexual problems, describing cases of effective treatment of sexual dysfunctions using this approach. Gay, Philippot and Luminet (2002) investigated the effectiveness of Ericksonian hypnosis in the treatment of pain caused by osteoarthritis compared to Jackobson's Progressive Relaxation technique.
2.6 PHENOMENOLOGICAL CHARACTERISTICS OF TRANCE
Authors such as Elman (1970), Gilligan (1987) and Ansari (1991) mention some phenomenological characteristics of the hypnotic trance. Some of these are highlighted below: Concentration of attention: during the trance, the patient can develop a concentration of attention for an extended period, being able to completely immerse themselves in a specific experiential state.
Voluntary expressions: the trance experience seems to happen without the patient having any plans in advance. It just happens. In this way, the patient's unconscious processes can express themselves autonomously in the hypnotherapeutic context. During the trance, the patient can express these unconscious processes through images, changes in physical characteristics (flushing of the face, increase in body temperature, breathing patterns or pupil dilation), relaxation, tearing, trembling of the eyelids or levitation of the hands.
Involvement in the experience without conceptualization: patients who go into trance generally concentrate on the experience without worrying about logical understanding. They experience the trance as it is, without trying to conceptualize the experience.
Flexibility in the relationship between time and space: during the trance, which takes place within time and space, the patient can experience a different relationship with these two factors. There can be a dissociation from the present, moving into the past in an age regression, or into the future in an age progression. Distorting the notion of time by expanding (a minute seems to be an hour) or condensing.
Autonomous thinking, balanced tone (catalepsy), change in voice quality, comfort, relaxation, economy of movement, closing of the eyes, feeling of distance, slower pulse, slower breathing, lack of body movements, lack of alarm responses, slowing of reflexes (swallowing and blinking), changes in the pupil, spontaneous hypnotic phenomena (amnesia, regression, anesthesia, catalepsy, distortion of time, etc.), pleasant feelings after the trance, among others.
2.7 THE ORGANIZATION OF TRANCE EVENTS
Gilligan (1987) proposes dividing trance states into four phases: 1) preparation; 2) induction; 3) utilization; 4) consolidation of learnings.In the preparation phase, the main objectives are to gather information about the patient and establish rapport. During this phase, the therapist identifies the patient's main beliefs, occupations, level of education, preferences, skills, etc., as well as the changes desired by the patient.In the induction phase, the therapist induces the trance using the information acquired in the previous phase.
The patient's characteristics become fundamental as they promote a more natural induction for the patient. In the utilization phase, the therapist uses trance to elicit and organize the patient's latent resources for problem-solving. Rather than adding or taking away anything, the aim in this phase is to get the patient to realize and reorganize the resources they already have. In the last phase, the consolidation of learnings, the therapist takes the patient out of the trance and generalizes the learnings. The patient is gently brought out of the trance, after which the therapist can talk to the patient for a few minutes in order to apply the learnings to other areas of their life, or even to future events. This can be done through conversation or with the patient imagining future events related to the previous problem.
2.7.1 Accompanying the Current Experience and Deepening the Hypnotic Trance
According to Bandler and Grinder (1982), one of the ways Milton Erickson modeled for inducing the hypnotic trance is by accompanying the current experience.
This accompaniment takes place by shifting the focus of attention from the external experience to the internal experience. The therapist begins by describing external sensory experiences that are actually present at that moment, things that the participant may be seeing, hearing and feeling, alternating with internal experiences described in an ambiguous way, so that the participant creates an internal focus of attention, looking for proof of the therapist's description. You could, for example, say to the participant: while you're looking in this direction, and you're hearing my voice... and you're hearing the sound coming from the air conditioning, you may notice your thoughts going in a certain direction and your body becoming more and more ready to relax...
There is a gradual decrease in the number of descriptions of external experiences, as the number of induced internal experiences increases. The deepening of the hypnotic trance is a continuation of the induction process (ANSARI, 1991). By deepening the trance, the participant tends to become more relaxed and live the experience more intensely. Some of the techniques for deepening the hypnotic trance are: going up or down flights of stairs, progressive or regressive counting, the confusion technique, among others (ELMAN, 1970; ANSARI, 1991; ERICKSON;HERSHMAN; SECTER, 1994).
2.8 STUDIES ON HYPNOSIS
Theories and techniques of hypnosis have been explored in scientific circles. Authors such as Perry (1992) and Perry and McConkey (2002) have analyzed theories of hypnosis. Otani (1989) studied the technique of mental confusion, while other authors have studied different ways of using hypnosis (KAHN et al., 1989; VAN DER DOES et al., 1989; PAGE; HANDLEY; RUDIN, 2001) or hypnosis compared to other therapies (VICKERS, 1999; GAY; PHILIPPOT; LUMINET, 2002).Gay, Philippot and Luminet (2002) report different scientific studies involving the use of hypnosis for pain control. These authors verified the effectiveness of Ericksonian hypnosis compared to Jacobson's relaxation technique in reducing the pain caused by osteoarthritis.
Studies involving pain control and analgesia of chronic pain (CRAWFORD et al., 1998), tension headaches (VAN DYCK et al., 1991) and clinical pain (KIERNAN et al., 1995; PATTERSON; JENSEN, 2003) have been found. Hypnosis has also been used in the treatment of drug addiction (MCGARTY, 1985), sexual problems and dysfunctions (GILMORE, 1987) (GILMORE, 1987; PHILLIPS, 1993) and dermatological problems (FRENAY et al., 2001; SHENEFELT, 2002, 2003).Studies on brain function and physiological responses, when eliciting different emotional states during the hypnotic trance, have been carried out to verify different responses of the organism. Maquet et al. (1999), in order to better understand what happens to patients in a hypnotic state during surgery, decided to study the brain mechanisms during the hypnotic state of healthy participants using PET (Positron Emission Tomography) and statistical parametric mapping.
Sebastiani et al. (2003) evaluated heart rate, respiratory rate, muscle tone and different electroencephalographic rhythms. The use of EEG (Electroencephalogram) has been quite frequent in studies of human responses to hypnotic states (ISOTANI et al., 2001; MUNTE et al., 2003; RAY; DE PASCALIS,2003).
2.9 HEART RATE AND CIRCULATORY SYSTEM
The circulatory system of human beings is a closed circuit that carries blood to all the body's tissues. Blood is pumped by the heart, creating the "hydrostatic pressure" needed to move blood through the system. Blood leaves the heart through the arteries and returns to it through the veins (POWERS; HOWLEY, 2000). The cardiac cycle refers to the standardized repetition between contraction (systole) and relaxation (diastole). At rest, the contraction of the ventricles during systole ejects two thirds of the blood contained in them, keeping one third in the ventricular cavities.
The ventricles then fill with blood in the following diastole. The increase in heart rate (HR) implies a greater reduction in diastole time, with systole being less affected (POWERS; HOWLEY, 2000).The regulation of heart rate is influenced more strongly by the parasympathetic and sympathetic nervous systems. The parasympathetic fibers innervate the heart, releasing acetylcholine and decreasing the heart rate. The cardiovascular control center receives information from various parts of the circulatory system regarding important parameters such as oxygen tension and blood pressure, for example, and sends motor impulses to the heart in response to a change in cardiovascular needs (POWERS; HOWLEY, 2000).The heart rate can be measured by palpating the radial or carotid artery, using a stethoscope or surface electrodes that transmit the signal to an oscilloscope, electrocardiograph or a monitor that directly displays the heart rate.
The frequency count over ten seconds is multiplied by six to express the HR in beats per minute (bpm) (POWERS;HOWLEY, 2000).Specific literature relating to heart rate and resting activity has generally been found on meditative states and hypnosis. Peng et al. (1999) studied HR oscillations in two meditation techniques. The authors found extremely sharp oscillations during both types of meditation. De Pascalis (1998), studying heart rate during the recall of emotional memories in hypnosis, found that there was an increase in HR in the recall of negative memories, when compared to positive memories during hypnosis.These results are in line with those of Sebastiani et al. (2003), who noticed an increase in HR and respiratory rate during the visualization of negative stimuli during hypnosis, typical of states of arousal. These increases did not occur with neutral stimuli viewed by the participants.
2.10 VISUALIZATION
Weinberg and Gould (2001) conceptualize visualization or mentalization as the mental creation or recreation of an experience. It is a recreation of sensory experience (seeing, feeling and hearing), but only in the mind. Visualization can also create images of situations that have not yet been experienced. Although imagination is based heavily on memory, it is possible to construct images from different parts of the memory. The authors also state that mentalization, even when it is called visualization, should include as many senses as possible (kinaesthetic, tactile, auditory, olfactory, for example).
Murphy, in 1994 (apud WEINBERG; GOULD, 2001), pointed to good mentalization skills as factors that differentiate elite and non-elite or successful and less successful athletes. According to the authors, good mentalizing ability has been defined by the sharpness and ability to control images. Weinberg and Gould (2001) divide mentalization into internal mentalization (the individual visualizes the execution of the action from their point of view, i.e. experiencing the situation) and external mentalization (the individual sees themselves from the point of view of an external observer, as if it were a film).
According to the authors, the fact that an individual practices internal or external mentalization seems to be less important than having a comfortable style, which brings up clear and controllable images.The use of hypnosis associated with visualization is reported by some authors.Bryant and Mallard (2003) researched the degree of reality and vividness attributed to images visualized during hypnosis. According to the authors, the results of this research indicate that the ability of participants to partially confuse reality and suggestion indicates evidence against the proposition that hypnotic reports are simply images "as if" the suggested event were occurring. Furthermore, these results indicate that the means by which hypnotized individuals evaluate reality are distinct from situations without hypnosis.
Hypnotized participants can attribute reality to experiences even when the experience is characterized by mechanisms that are incongruent with "normal" perceptions of reality.Liggett and Hamada (1993) did a study with gymnasts where hypnosis was used to get them to perform for the first time some very complex exercises that they had been training for over a year. The gymnasts were able to eliminate timing errors, increase flexibility, and possibly concentrate strength. Liggett (2000) studied 14 athletes doing visualizations with and without hypnosis.
The participants reported that visualization under hypnosis was more intense in different situations (practicing alone, practicing in front of others, watching a teammate and competing) and different dimensions (visual, auditory, kinesthetic and affective). Thus, the author concludes that hypnosis increases the intensity of images as well as the effectiveness of visualization.
2.11 HYPNOSIS IN SPORTS
Feijó (1998) presents Ericksonian hypnosis as a simple and efficient tool. According to the author, it boosts the natural capacity for relaxation, power and concentration and quickly leads to psychomotor readiness. The author also states that hypnosis can be applied individually or in groups, always bringing good results in increasing the athlete's productivity and performance.Mendo (2001) gives a brief history of hypnosis and, citing some techniques, presents hypnosis as a scientific strategy for intervention in sports psychology.Patês and Maynard (2000) studied the effects of hypnosis on the state of fluidity of golf players.
The intervention consisted of relaxation, visualization, hypnotic induction, hypnotic regression and trigger control procedures over 5 weeks and 7 sessions. The participants indicated that the intervention seems to have been useful in keeping them confident, relaxed and under control. The authors concluded that hypnosis may have improved the performance of golfers by increasing sensations and cognitions associated with fluidity. A similar study by Pates, Cummings and Maynard (2002) looked at the effects of hypnosis on fluidity states in basketball players' performance on three-point shots.
The authors researched 5 athletes from a university basketball team in England, initially observing their baseline performance, and a treatment phase for each of the participants, with the size of the baseline increased for each successful player used in the analysis. The intervention was introduced when the baseline had stabilized or when there was a trend in the opposite direction of the anticipated change. The intervention (hypnosis) was applied until everyone had received the intervention. The authors found that the hypnosis intervention increased accuracy in three-point shooting performance. They also observed an increase in fluency state scores in each of the 5 participants.
Pates, Cummings and Maynard (2002) then conclude that hypnosis increases both the accuracy and fluency of basketball athletes' three-point shooting performance.Masters (1992) describes some characteristics of marathon runners in relation to hypnosis. According to the author, marathon runners who use dissociation as a running strategy during the marathon have been shown to have a direct relationship with susceptibility to the hypnotic trance, i.e. the more dissociation, the more susceptibility to the trance. Those who used dissociation as a strategy during training were more susceptible to the hypnotic trance than other runners.
In a comparison between Ericksonian hypnosis and the psychophysiological state of the Japanese martial art Aikido, Windle and Samko (1992) found some similarities. The authors describe, for example, the use of the opponent's resistance in Aikido as similar to the use of resistance to induce hypnotic trance. Shared trance is also comparable to the psychophysiological state of centering. The application of hypnosis through an isomorphic model is suggested by the authors Robazza and Bortoli (1994). The authors suggest that alert-active hypnosis is induced before and during sports practice, while traditional hypnosis is induced after sports practice, in order to establish a connection between the two.
The model is based on the idea that hypnosis and motor performance share abilities that can be modified through training. The model also considers the similarity between hypnosis and peak performance.Robazza and Bartoli (1995) also studied the case of improved sports performance with the use of hypnosis. According to the authors, in a case study using the isomorphic model, there was an improvement in the performance of an archery athlete after 20 sessions of mental training.
Crews (1992) studied the relationship between psychological states and running economy. The author states that the simulation induced by hypnosis and visualization was effective in changing the response to exercise, such as performance and heart rate. Perception altered by the use of hypnosis and personality characteristics did not change the physiological response to exercise, probably because of the passive role of the exerciser in these situations. Cognitive strategies such as biofeedback, coping and mental strategies elicited changes in physiological and behavioral responses to exercise. The author concludes that the psychological state can influence the physiological and behavioral response to exercise, and suggests using the multidisciplinary method to examine the interactional effects of physiology, biomechanics, psychology and neurology to adequately delineate the mechanisms of changes in running economy.
3.1 CHARACTERIZATION OF THE RESEARCH
The research is characterized as qualitative, quantitative-descriptive, quasi-experimental, as it aims to investigate the subjective experience of triathlon athletes in relation to the hypnotic trance through the analysis of the semi-structured interview (APPENDIX 1) and the questionnaire (APPENDIX 2).
According to Biasoli-Alves (1998, p. 147), in the Quantitative - Descriptive System, "... the researcher explores the responses or behaviors as they were presented by the participant. This type of analysis covers the function of providing objective information, and in the case of applying statistical tests, if deemed necessary describing actions, characteristic patterns or even establishing correlations between variables. "Quantitative - descriptive analysis consists of checking the simple frequency of occurrence of each alternative in the closed questions, followed by calculating percentages. The final step is the construction of tables, graphs and profiles for the subsequent description and discussion of the results (BIASOLI-ALVES, 1998).
The Qualitative System, according to Biasoli-Alves (1998), has the characteristic of seeking to apprehend meanings in the speeches or other observed behaviors of the participant. These meanings, integrated into the context in which they are inserted and delimited by the researcher's conceptual approach, constitute in the writing a systematization based on quality, with no ambition to reach the frontier of representativeness.
According to Andrade (2001), qualitative research can be considered a method that allows for a deeper understanding of social and subjective reality, through a careful, patient and exhaustive look at the information obtained, the context in which it is inserted and the historical and more subtle aspects of reality (ANDRADE, 2001, p. 109). Considering that the heart rate was analyzed at the beginning and end of each session, even though there was no control group, the classification of a quasi-experimental study with a pre- and post-test group design is appropriate for this study (THOMAS; NELSON, 1990).
3.2 RESEARCH PARTICIPANTS
Seven male triathlon athletes with an average age of 33.57 years (± 5.653) took part in the study. The athletes were part of a sports team and were at a similar level of sporting performance, with an average of 7 years (± 3.651) of triathlon practice. The prerequisite for participation in the study, in addition to good health, was the experience of having completed at least one Ironman race. Experience with the race is more important than time spent practicing triathlon, as the visualization was based on this race. All the athletes met this requirement.
The athletes had close training conditions and medical, nutritional, physiotherapeutic and psychological support. An initial interview was conducted with each athlete to obtain information about their health conditions, medication used, supplementation used, chronic or temporary injuries, training time, time spent practicing triathlon, as well as the reasons why they practice triathlon. This data is important as the athlete must be in good health to take part in the study, not be taking medication that interferes with their cognitive perception and also for a better characterization of the sample.
3.3 CHARACTERIZATION OF TRIATHLON AND THE IRONMAN RACE
Triathlon is an endurance activity made up of three disciplines practiced consecutively: swimming, cycling and running (O'TOOLE;DOUGLAS; HILLER, 1998). The Ironman race consists of 3.8 km of swimming, 180 km of cycling and 42.2 km of running (SCHOFIELD et al., 2002).
3.4 SITE CHARACTERIZATION
The location for the research was a psychological care room, measuring approximately 12 square meters. The room had good lighting and ventilation. The participants were seated in a reclining armchair, with the possibility of adjusting the position to suit the comfort of each participant. The quiet and comfortable environment provided favorable conditions for data collection.
3.5 CHARACTERISTICS AND VARIABLES STUDIED
The semi-structured interview script (APPENDIX 1) consisted of three parts, which were transformed into themes during analysis: Within each proposed theme, categories were created according to the information presented by the participants, combined with the literature studied. This categorization of information, based on Andrade's model(2201), made it possible to gather coinciding reports from the participants, giving an overview of their experience during the trance.
Some categories generated diverse responses, which made it possible to create subcategories to further specify the information reported. Thus, the theme of Initial Trance was divided into the following categories and subcategories:- Relaxation: Sensory perception / Increased sensitivity / Perception of heartbeat / Sensation of tingling or numbness / Perception of weight of limbs / Perception of temperature of limbs;- Beginning of Trance: Sensation of beginning gradually / Sensation of beginning quickly;- Concentration: Concentrated/Unconcentrated;- Auditory Perception: Attention to the sound of the voice and/or music - Not hearing the voice and/or the sound of the music;- Anesthesia;- Catalepsy;- Sensation of drowsiness;- Dissociation;- Consciousness;The theme Visualization was divided into the following categories and subcategories:- Concentration/ Concentrated/Unconcentrated;
Self-perception in the Image: Inside the Image/Outside the Image/Intercalating;- Intensity of Visualization: Strong/Moderate/Weak- Sensation of Relaxation;- Anesthesia;- Quality of Images: Good Quality/Bad Quality/No Images- Association of Sensations of the Test;- Auditory Perception: Hearing sounds/Not hearing sounds/Sometimes hearing, sometimes not/ Confusion in relation to sounds- Dissociation;- Perceptions During the Trance: Sensory (temperature, weight, involuntary contractions)/Sensation of tranquility, peace/ Sensation of having a dream or sleeping/ Sensation of agitation;- Amnesia;- Hypermnesia;- Consciousness: Being conscious/ Not being conscious;- Control of the Image: With control/ Without control;- Catalepsy;- Increased sensitivity;- Hallucination;- Regression. The theme Return from Trance was divided into the following categories and subcategories:- Sensation of leaving the trance: Tranquil, natural, easy or normal/Sensation of wanting to stay in the trance/ Gradual return/ Sudden return;- Sensations after the trance: Quiet, relaxed, lazy or rested/ As if awake, sleepy/Apprehensive;- Speed of Return: Fast or automatic/ Slow, slow or with resistance;- Sensations of Pleasure;- Control: With control/ Without control;- Psychophysical Perception;- External Perception;- Consciousness;- Amnesia;- Catalepsy;- Concentration.
The questionnaire (APPENDIX 2) answered by the participants was divided into three parts: Kinesthetic/Physical Perception, Auditory Perception and Visual Perception. The first part of the questionnaire investigated sensory aspects related to the following parts of the body: hands, arms, feet, legs, torso, neck and head. Questions related to breathing, intensity of visualization and perceived trance time were also included in this part of the questionnaire.The second part of the questionnaire contained questions related to the participants' auditory perception of the following aspects: external sounds, the therapist's voice, the sound of music and the visualization of the Ironman race.The third and final part of the questionnaire contained questions investigating the following visual aspects: colors, sharpness, luminosity, size, details, movement and visualized perspective.Heart rate was the direct physiological variable investigated.
3.6 DATA COLLECTION INSTRUMENTS
The following instruments were used in this study: a semi-structured interview script (APPENDIX 1), a questionnaire (APPENDIX 2) and a frequency meter, described in detail below.The interview used in the study was a semi-structured interview (APPENDIX 1).The semi-structured interview is characterized by having flexible questions, with the sequence and thoroughness depending on the discourse of the participants and the dynamics that occur naturally (BIASOLI-ALVES, 1998). The questions in this case are open-ended and should "evoke" or "elicit" a verbalization that expresses people's way of thinking or acting in relation to the topics focused on; they often concern an evaluation of beliefs, feelings, values, attitudes, reasons and motives accompanied by facts and behaviors" (BIASOLI-ALVES, 1998, p. 145).
The interview was divided into three parts: questions about Initial Trance, questions about Visualization and questions about Coming Out of Trance. The questionnaire (APPENDIX 2), drawn up especially for this research, contains 16 closed questions and one open question (question 10). According to Cervoe Bervian (1983), the questionnaire has a set of questions, all logically related to a central problem (p. 159).
The HR was measured using a heart rate monitor consisting of a sensor that records heartbeats at 5-second intervals. This sensor is attached to the participant's chest using an elastic band and transmits information to a device similar to a wristwatch. The information is stored in this device and then transferred to the computer via a direct interface suitable for this function.
After this procedure, the data is processed using specific software. The heart rate monitor is a Polar® VantageNS model, and its data is processed using Polar Precision Performance software.
2.1.3.7 PILOT STUDY
The pilot study was carried out with three triathlon athletes who had already taken part in the Ironman at least once. These participants only took part in the pilot study. Eight sessions were held with the athletes, the first of which consisted of an initial conversation, where the research procedures were explained, any doubts were answered, the Informed Consent Form was signed and the first acclimatization session was held. This was followed by two more acclimatization sessions, 5 hypnosis sessions followed by the interview (APPENDIX 1) and the application of the questionnaire (APPENDIX 2). During all the sessions, the athlete was asked to wear a heart rate monitor. The pilot study aimed to improve the method used in the research.
The suitability of the guiding questions for the interview was checked and it was adapted for the main study. The questions in the questionnaire (appendix 2) were also checked and modifications made to facilitate analysis. The appropriate number of setting and hypnosis sessions was modified after the pilot study. The report and analysis of the pilot study can be found in APPENDIX 4.
3.8 DATA COLLECTION PROCEDURES
Data was collected during eight sessions, the duration of which varied according to the length of the test viewing. It was not possible to standardize the time of each session exactly, but the average was calculated and is described in Chapter 4. It was also not possible to standardize the collection time due to each athlete's training and private activities. The minimum interval between each session was one week. During the first session, the research and its procedures were explained. All participants signed the Free and Informed Consent Form (APPENDIX 3).
After signing the Informed Consent Form, the participant was asked to put on the heart rate monitor and sit comfortably in the armchair, where they stayed for a few minutes to get used to the place. The research participant was explained the importance of this setting for the success of the research. In the session that followed, the athlete was asked to put on the heart rate monitor and just relax in the armchair (setting) as follows:- (athlete's name) please put on the Polar, and sit down in the armchair.Find a comfortable position. Just relax your body, trying to make it as comfortable as possible.
You remain relaxed for a few minutes. The following six sessions constitute the sessions in which hypnosis is applied. Here is a description of the sessions:1) Greeting: hello (athlete's name), how are you? Today we are going to do the first (or one more) hypnosis session.2) Putting on the Polar: (participant's name), please put on the Polar and sit comfortably in the armchair;3) Body relaxation instruction: find a position that will help you relax and enjoy the experience. Check if there is any part of your body that could relax even more. Sometimes a small movement can make you feel even more comfortable and relaxed;4) Hypnosis induction (the induction was done according to Erickson's model (ERICKSON; HERSHMAN; SECTER, 1994), with the Current Experience Accompaniment technique): while you see what you see in front of you...and hear the sound of my voice...and hear the sound of the music...and notice your arms leaning against the armchair...and notice your feet resting on the floor, you can notice how your mind prepares to relax more deeply now. This model used 5 external experiences (EE) and 1 internal experience (EI), then 4 EE and 2 EI, then 3 EE and 3 EI, then 2 EE and 4 EI, then 1 EE and 5 EI.
From this moment on, only internal experiences will be used, starting the deepening of the trance. External experiences are situations that are happening at the moment of the induction and that are external to the participant (music playing, air temperature, etc.). Internal experiences are sensations that the participant may be experiencing during relaxation (muscle sensations, thoughts, etc.). This transition from external experiences to internal experiences allowed the research participant to gradually disconnect from the external environment and get in touch with their internal sensations, both physical and psychological. The countdown technique (10 to 1) was used to deepen the trance. 5) Visualization of the Ironman race: ...I would now like you to allow yourself to visualize the Ironman race. You can start with the start of the race... look at everything you've seen, listen to the sounds you've heard, and feel what it's like to be in this race right now.
And so on with each part of the race, following the sequence: start, swim, transition, cycling, transition, run and finish.6) Bringing back: the way the participant was brought back was progressive counting. In this counting, the therapist counted from 1 to 10, giving the athlete time to reorient himself. Thus, with each number, suggestions for reorientation were made (1, and you can start to hear the sound of the music more clearly, 2 you can notice your breathing, and so on).7). After returning from the trance, the elastic band was removed from the heart rate monitor, the interview was conducted (APPENDIX 1) and the questionnaire was applied (APPENDIX 2).
3.9 DATA ANALYSIS
3.9.1 Analysis of information from the interviews
The interviews were recorded and transcribed verbatim. The interviews were analyzed according to Bardin's technique (1977 apud ANDRADE, 2001) combined with the mirror technique (ANDRADE, 2001). "The 'mirror technique' means placing the most important contents of the statements 'side-by-side', in the form of 'micro discourses' obtained in the interviews" (p. 127). The purpose of this technique is to allow for comparisons and more in-depth qualitative analyses of the reality being investigated. The interviews were analyzed using stages which made it possible to organize the content of the interviews in a coherent way. This organization made it possible to gain an easier view of the experience lived by the group during the hypnosis sessions.
A matrix was created showing the most relevant parts of the interviews grouped according to the categories and subcategories of analysis. The codes A, B, C, D, E, F and G were given to the participants and the numbers 1, 2, 3, 4, 5 and 6 corresponded to the hypnosis sessions. The letters corresponding to the participants were chosen at random. Thus, participant D in the interview for hypnosis session 4 will be represented by D4. Participant G in the interview for hypnosis session 5 will be represented by G5, and so on.
The data from the interviews was first analyzed by carefully reading the transcribed interviews, highlighting the most relevant parts of the speeches. These parts of the speeches were then removed from the text and "glued" into a matrix within the respective themes. In this matrix, the parts of speech were organized according to the possible categories initially proposed by prior knowledge of the literature. Those parts of the discourse that were considered relevant, and which might generate new categories in addition to those initially proposed, were categorized according to the behavior described by the participants. Since it was possible to see the categories and the parts of the discourse they contained, it was necessary to create subcategories within some categories to give greater specificity to the perception reported by the participant.
Thus, in the Speed of Return category, for example, there were speeches such as F3's "It was sudden" and D3's "It took a little longer", which required sub-categories differentiated into fast or automatic and slow, slow or with resistance.
3.9.2 Treatment of questionnaire data
The participants' answers obtained through the questionnaire were first transposed into SPSS software, version 11.0, where a database was compiled. This data was analyzed using descriptive statistics, and percentage tables were drawn up for all the items, except for the variable perceived transe time (item 10), where the mean and standard deviation were calculated. The chi-square test was used to test for correlations between the answers given by the survey participants. In the first part of the questionnaire, called Physical Perception, correlations were tested between the perception of weight and temperature; trunk relaxation and neck relaxation; rhythm and intensity of breathing.
Correlations between perceptions of sounds were tested for the variables volume and distance of external sounds; volume and distance of the therapist's voice; volume of music and volume of external sounds. In the last part of the questionnaire, where the perceptions of the characteristics of the visualization images were investigated, the correlations between colors and focus; clarity and focus; size and movement; colors and clarity; colors and details, size and details; details and movement and self-perception of the image and intensity of the visualization were tested. The significance level considered was p < 0.05.
3.9.3 Treatment of heart rate data
Heart rate (HR) was recorded throughout the hypnotic trance, considering the beginning of the trance, the moment the participant closed their eyes, and the end of the trance (the moment the participant opened their eyes). Means and standard deviations were calculated with the heart rate data and a student's t-test was used to check for statistical significance. The significance level was p< 0.05.
3.10 ETHICAL ASPECTS
At the first meeting with the athlete, the research objectives and procedures were explained in detail. After this clarification, the athlete signed the Free and Informed Consent Form (APPENDIX 3). This research was evaluated and approved by the UDESC Ethics Committee under reference number 103/05. 4 RESULTS The results are presented in this chapter in the following order: description of the content of the interviews, presentation of the questionnaire data and analysis of heart rate behavior.
4.1 DESCRIPTION OF THE CONTENT OF THE INTERVIEWS
The interviews (n = 42 participants) provided a more in-depth understanding of the participants' experiences during the hypnosis sessions. The speeches of the research participants, when inserted into the themes, categories and subcategories described above, can be clearly visualized and organized in this chapter.
4.1.1 Initial trance process
In the Initial Trance Process (Table 1), the majority of triathletes felt relaxed (n = 35), as seen in A4's speech "...I felt relaxed" and D2's "...I was totally relaxed... very relaxed". very relaxed". The feeling of constant relaxation at the beginning of the hypnotic trance indicates that this is an important characteristic in this phase of the trance. Also during this phase, sensory perceptions were frequently reported by the athletes (n = 34). Some of the research participants noticed their body sensitivity increasing (n = 8), especially the sensitivity of the touch of clothing or attention to their own body, as shown in the speech of F2 "the sensation of the body, I also felt it, for example the tendon, this shoe has laces...".
Some athletes felt parts of their body tingling or numb (n = 7) as can be seen in E1's statement, "but my hand and foot started to tingle". The sensation of a change in body weight was perceived less often by the athletes at the start of the hypnotic trance (n = 6). Research participant G1 perceived his body to be lighter, as shown in his speech "...it's the lightest weight in the body". The athletes noticed their body temperature changing (n = 6), generally feeling their whole body or parts of it warming up. This sensation can be seen in D2's statement "...so pre-warmed, the hand warmed, the whole body well warmed".
At times the athletes felt their hearts beating (n = 5). This perception indicates an increase in the athletes' sensitivity not only to the external environment, as seen in the increase in body sensitivity, but also to their own body's behavior and reactions. Athlete A4 is a good example: "I notice my heart beating a lot". It can be said that the athletes noticed typical signs of the hypnotic trance at this early stage. The athletes perceived the start of the trance in two different ways. Some athletes felt that they were entering the trance gradually (n = 12), as C1 points out: "you get into the mood for preparation, more still, more quiet, and then when you close your eyes it seems to come, everything starts to come stronger". Less often, the athletes perceived this transition quickly (n = 6), as was the case with F3: "I relaxed quickly. Suddenly I braked. From one hour to the next". The gradual transition into trance shows how the athletes were disconnecting from the outside world and becoming more inward, coming into more direct contact with themselves, their sensations, their feelings and their deepest thoughts.
In this initial phase of the trance, the athletes concentrated on different levels. More often than not, the athletes were at a high level of concentration (n = 11) "very focused, without thinking about anything else" (B5). However, other athletes reported not being concentrated during the hypnotic trance (n = 6), as G2 put it "...I didn't concentrate as much as the other time". It can be said that at the start of the trance, participants tend to have a high level of concentration. With regard to sounds, the athletes were more attentive to the sound of the therapist's voice and the sound of music (n = 12). D1's speech clearly points out this characteristic: "I only heard your voice and the music in the background".
Few times did the athletes not hear the therapist's voice and/or the sound of music (n = 4). This shows that the participants at this stage are partially focused on the outside world. Some of the participants perceived their bodies to be somewhat anaesthetized at the start of the trance (n = 12). D2's speech shows us how he lost body sensitivity during this phase of the trance: "There were moments when I didn't feel myself at all... I didn't perceive the body anymore... I couldn't feel the body anymore...". Some didn't move their bodies at the beginning of the hypnotic trance (n = 10). This phenomenon is known in the literature as catalepsy. This was the case with D2: "at the same time I felt like I was in the chair, trapped, that I couldn't get out of here". Some athletes felt drowsy during the beginning of the trance (n = 9), "I thought I was asleep, but it was only at the beginning..." (E5). The perception of these phenomena by the research participants proves that they entered the hypnotic trance and tells us the first characteristics of the hypnotic trance in triathletes. Few times in the interviews did the athletes mention perceiving their state of consciousness (n = 4) or perceiving themselves as dissociated from their body (n = 3) at the start of the trance.
An overview of the participants' perception of the Trance Entry Process can be seen in Table 1 below, which describes the categories and subcategories relating to this phase of the hypnotic trance. The categories have been positioned from the highest frequency of perception to the lowest frequency of perception. Table 1 - Perceptions of Triathlon Athletes during the Initial Trance Process Categories N Relaxation 35 (83.3%)** Psychophysical Perception Increased sensitivity Sensation of tingling or numbness Perception of limb weight Perception of limb temperature Heart Perception Salivation 34 (80, 9%)** 8 (23.5%) § 7 (20.6%) § 6 (17.6%) § 6 (17.6%) § 5 (14.7%) § 2 (6%) § Entry into trance Feeling of entering gradually Feeling of entering quickly 18 (42, 8%)** 12 (66.6%) § 6 (33.33%) § Concentration Concentrated No concentration 17 (40.5%)** 11 (64.7%) § 6 (35.3%) § Auditory perception Attention to the sound of the voice and/or the sound of the music Don't hear the voice and/or the sound of the music 16 (38, 1%)** 12 (75%) § 4 (25%) § Anesthesia 12 (28.6%)** Catalepsy 10 (23.8%)** Sensation of drowsiness 9 (21.4%)** Dissociation 4 (9.5%)** Consciousness 3 (7.1%)** Number of interviews in which the reports appeared
Percentage relative to the total number of interviews (42) § Percentage relative to category 4.1.2 Visualization The second part of the interview investigated the athletes' perception of aspects related to the experience of Visualizing (Table 2) the Ironman race. These aspects may be related to the athlete's physical or psychological state, as well as to the perceived images themselves. The athletes reported being concentrated during the visualization phase (n = 24). Concentration clearly appears, as in B4 "I was able to switch off from the outside and concentrate on the race...", D1 "...I feel that I am well concentrated. " and F1 "I think I was 100% focused".
The fact that the athletes were more concentrated than (not concentrated n = 9) tells us that hypnosis can help with concentration during visualization. The perspective from which the athlete perceived themselves when viewing the race is indicated in the Self-Perception in the Image category. The athletes varied in three different perspectives: in 14 cases the participants reported that they were in and out of the race; 12 times they were in the race and 11 times they saw themselves outside the race.
Athlete G1 alternated between being inside and outside the race: "there were moments when I felt like I was pedaling... at times I saw myself". Experiencing the race inside the image is reported by D2 "I was experiencing it, I was inside...". Seeing oneself outside the race, in other words, watching oneself do the race, is evidenced in A2's account: "I was visualizing myself from the outside". These data indicate that triathletes vary in the perspective from which they view the Ironman race and, therefore, there is no clear trend as to which perspective they perceive themselves in this race.
The intensity with which the participants experienced the race shows how easy it was for them to visualize and feel like they were actually doing the race. Some athletes experienced the race intensely (n = 14), like D4, for example "I managed to live it well, it was very intense". Others experienced the race with less intensity (n = 10), as E1 says "...I'd rate it between 1 and 10, 2 to 2.5". Due to the proximity of the number of reports between the different levels of intensity, it was not possible to conclude in what sense hypnosis influences the intensity of visualization in triathletes.
The sensation of having the body or part of it anaesthetized was often perceived by athletes during visualization (n = 19). The reports of B3, D3 and D6 are examples of how they perceived anesthesia: B3 "I wasn't feeling the body...", D3 "...I don't feel it in the armchair" and D6 "I didn't feel the body again". This means that the hypnotic phenomenon of anesthesia also continued during the test viewing phase. During this phase of the hypnotic trance, the athletes felt relaxed (n = 18), with some athletes feeling their bodies deeply relaxed, such as D1 "...I was totally relaxed" and F1 "my body was totally relaxed". This shows that even during the visualization of the race, the participants maintained the state of relaxation provided by hypnosis. Some athletes felt sensations during the display (n = 17), which proves that hypnosis can bring out sensations of an event that is only being imagined. This sensation can be seen in the reports by C1 "I really felt like I was in a competition situation" and G1 "there were moments when I felt like I was pedaling, what gear I was in...".
The quality of the images viewed by the research participants was good (n = 10), i.e. the athletes were able to mentally see images with good color quality and sharpness, for example. G3's speech shows this ability to visualize good quality images: "for the first time I was able to see something with my eyes closed... and I had more clarity at the beginning... I visualized a lot more today... it was clear". Less often did the participants not see good quality images (n = 4). In this way, hypnosis facilitates the visualization of clear and colorful images. During the hypnotic trance, the athletes experienced sensations other than those presented above.
The so-called sensory perceptions (sensations of temperature; heaviness and muscle contractions) were reported a few times during the viewing of the test (n = 6), as shown by G4's report "I felt my hand a little warmer". Feelings of tranquillity and peace also occurred a few times during this phase of the trance (n=4). A6's speech points to this perception: "a feeling of peace like that...". Few athletes had the sensation of having slept or had a dream (n = 3). Only one athlete felt more agitated during the hypnotic trance, but without specifying how this happened. The athletes perceived auditory stimuli in different ways. Sometimes they heard sounds (n = 6), especially the therapist's voice, as shown in D3's speech "while I was asleep, I could hear your voice". Other times, but less frequently, they didn't hear any sounds (n = 4), as shown by A2 "many times I didn't even hear your voice anymore". A few times the participants switched between hearing and not hearing (n = 2) or felt confused about the sounds (n = 1).
This shows that the therapist's voice also plays an important role in visualizing the race during the hypnotic trance. Some athletes reported feeling their body "separate from their mind", a phenomenon referred to in the literature as Dissociation (n = 13). D1's account clearly points to this phenomenon: "I wasn't here in my body... I was outside, funny, outside myself...". The appearance of dissociation during the visualization phase confirms the hypnotic state the athletes were in during this phase, pointing to another characteristic of the hypnotic trance with athletes. Some athletes forgot parts of the visualization and the trance experience, characterizing amnesia (n = 10).
This phenomenon can be seen in the speech of D1 "funny, I don't remember some of the things I thought...". On the other hand, remembering particular details of previous experiences, known as hypermnesia, was experienced by fewer athletes (n = 8). The phenomenon of hypermnesia appears clearly in the words of G3 "the sand was still cold, the sun, walking barefoot, right? So it's incredible how we can remember so many details...". These two phenomena characteristic of hypnosis during visualization give us more precise indications that the hypnotic state was maintained throughout the experience.
Table 2 - Perceptions of Triathlon Athletes during the Visualization of the Ironman Race Categories N Self-perception in the images Interspersing (inside and outside) Inside the image Outside the image 37 (88.1%)* 14 (37.8%)§ 12 (32.4%)§ 11 (29.7%)§ Concentration Concentrated No Concentration 33 (78.6%)** 24 (72.7%)§ 9 (27. 2%)§ Intensity of the visualization 2%)§ Intensity of visualization Strong Weak Moderate 28 (66.6%)** 14 (50%)§ 10 (35.7%)§ 4 (14.3%)§ Anesthesia 19 (45.2%)** Sensation of relaxation 18 (42.8%)** Quality of images Good quality Poor quality No images 16 (38.2%)** 10 (62.5%)§ 4 (25%)§ 2 (12.5%)§ Sensations during trance Physical (temperature, weight, involuntary contractions) Tranquility, Peacefulness Sensation of dreaming or sleeping Agitation 14 (33.3%)** 6 (42.8%)§ 4 (28.6%)§ 3 (21.5%)§ 1 (7.1%)§ Dissociation 13 (30.9%)** Auditory perception Listening Not listening Sometimes listening, sometimes not listening Confusion in relation to sounds 13 (30.9%)** 6 (46.1%)§ 4 (30.8%)§ 2 (15.4%)§ 1 (7.7%)§ Amnesia 10 (23, 8%)** Hypermnesia 8 (19%)** Consciousness Being conscious Not being conscious 7 (16.6%)** 6 (85.7%)§ 1 (14.3%)§ Image control With control Without control 7 (16.6%)** 6 (85.7%)§ 1 (14.3%)§ Catalepsy 3 (7.1%)** Increased sensitivity 2 (4.7%)** Hallucination (positive or negative) 1 (2.4%)** Regression 1 (2.4%)** Number of interviews in which the reports appeared
Percentage relative to the total number of interviews (42) § Percentage relative to category Some athletes were generally conscious during the trance (n = 6), as D4 says "this one I managed to stay very conscious, conscious like this, very centered". Only a few times did participants report being unconscious (n = 1). The athletes reported that they were controlling the visualization images (n = 6). G4's speech shows this control: "I try to find my visualization... today I visualized an ideal type of race". Perceptions of catalepsy, increased sensitivity, hallucination and regression were not significantly mentioned during the interviews, as shown in Table 2.
2. 4.1.3 Return from trance
The research participants' perceptions related to the Return from Trance (Table 3) were investigated in the last part of the interview. The return from trance was considered from the moment the Ironman viewing ends until the moment the participants open their eyes and return to a state of alertness. The feeling of coming out of the trance occurred in different ways among the participants in the study. The athletes came out of the trance in a calm, natural, easy or normal way (n = 20), as can be seen in the reports of B1: "Very calm, very calm..." and D2 "it was very natural, very calm...". Some athletes returned gradually (n = 13), "...the foot, the hand, the head, we return, parallel, my body by the established count..." (G1).
The sensation of returning gradually and calmly or in a natural way indicates that the athletes had a smooth process of return, a reorientation to the external world that occurred little by little, disconnecting from internal contact and gradually turning to external stimuli. Some athletes said they wanted to be in a trance (n = 7), suggesting that this was a pleasant experience for the research participants. D1's speech shows how this feeling was present at the end of the trance: D1 "didn't want to leave... deep down, deep down, I didn't want to...". Only one athlete experienced a sudden return from the trance. After returning from the trance, most of the athletes felt good, calm, relaxed, lazy or rested (n = 30), as shown by the reports of B3 "more calm, lazy, you know, softer, lazier..." and E3 "good, rested...".
Other athletes felt as if they had woken up or felt sleepy after the trance (n = 8). C2's statement illustrates this feeling well: "...as if I had woken up from a deep sleep. Only one athlete felt apprehensive after returning. The physical and psychological state the participants were in after the trance indicates that the experience of hypnosis was congruent throughout the process. From the beginning to the end of the trance, the participants had perceptions indicating physical and mental relaxation. It can therefore be said that hypnosis produces this effect in athletes, and that in general it is a relaxing process as a whole. The speed with which the athletes came out of the trance was fast or automatic (n = 10), for example, F3 "...you say now open your eye and that's it, then I opened it and that was it. It was as if you, it was almost as if you had said: wake up!".
A smaller number of athletes took longer to come back from the trance (n = 4), as can be seen in D5's statement "...a little slowly...". The way or speed at which the participant comes back from the trance is a particular and non-standardized characteristic. The reports show that each participant may perceive the return differently in each trance, depending on the depth of the trance and even the physical and mental state of the participant on the day of the session. Positive sensations were felt by the athletes during the trance and these sensations were reported in the final moments of the research (n = 6), "...it was so good... it was positive" (D3).
In certain interviews, participants reported feeling in control during the return to alertness. A2, for example, reports feeling in control during reorientation: "I have a good grip on it... if I wanted to I could have woken up by now". The research participants reported having Sensory Perceptions (n = 3), External Perceptions (n = 2), a state of Consciousness (n = 2), Amnesia (n = 2), Catalepsy (n = 1) and Concentration (n = 1). This indicates that at this stage of the trance these perceptions are not significant. Table 3 below shows the perceptions of triathlon athletes during the return from the trance, starting with the most present perceptions in their speeches, to the least present ones indicated by N.
Table 3 - Perceptions of Triathlon Athletes during the Return from the Hypnotic Trance Category N Sensation of coming out of the trance Smooth, natural, easy Gradual return Sensation of wanting to stay Sudden return 47 21 (44.7%)§ 15 (31.9%)§ 8 (17%)§ 3 (6, 4%)§ Feelings after the trance Well, calm, relaxed, lazy, rested As if you'd just woken up, sleepy Apprehensive 42 (100%)** 31 (73.8%)§ 10 (23.8%)§ 1 (2.4%)§ Exit speed Fast or automatic Slow, slow or with resistance 17 (40, 5%)** 12 (70.6%)§ 5 (29.4%)§ Sensations of pleasure 9 (21.4%)** Control With control Without control 6 (14.3%)** 5 (83.3%)§ 1 (16.6%)§ Physical perception 3 (7.1%)** External perception 2 (4.7%)** Consciousness 2 (4.7%)** Amnesia 2 (4.7%)** Catalepsy 1 (2, 4%)** Concentration 1 (2.4%)** Number of interviews in which the reports appeared * Percentage relative to total N of interviews (42) § Percentage relative to category _ Category that may have speeches by a participant in a given session in more than one subcategory
4.2 QUESTIONNAIRE DATA
The questionnaire was administered at the end of each hypnosis session and aimed to quantify the triathletes' experience of the trance. The total number of questionnaires administered was 42. The triathletes' sensory perception of body temperature during the hypnotic trance is shown in Table 4: Table 4 - Sensory Perception of Triathletes in relation to Body Temperature during the Hypnotic Trance* Sensory Perception Parts of the body much colder colder(s) no change in temperature warmer(s) much warmer(s) did not answer hands 0% 16.7% 47, 6% 23.8% 11.9% 0% arms 16.7% 59.5% 9.5% 11.9% 2.4% feet 2.4% 19% 45.2% 14.3% 11.9% 7.1% legs 0% 7.1% 66.7% 7.1% 11.9% 7.1% head 2.4% 9.5% 64.3% 7.1% 9.5% 7.1% N = 42 questionnaires Table 4 shows that there was no change in body temperature during the hypnotic trance. However, there was a tendency to perceive the body as warmer during the trance.
This means that the hypnotic trance in triathletes can cause body heating. The sensory perception of body weight can be seen in Table 5. The athletes did not feel a change in body weight, or felt their bodies were lighter during the hypnotic trance. The perception of body lightness was accompanied by an increase in body temperature during the hypnotic trance (Tables 4 and 5).
Table 5 - Triathletes' Sensory Perception of Body Weight during the Hypnotic Trance much lighter (s) lighter (s) no change in weight heavier heavier (s) much heavier (s) no Answer= hands 23.8% 35.7% 28.6% 0% 11.9% arms 19% 35.7% 33.3% 0% 0% 11.9% feet 19% 31% 38, 1% 9.5% 0% 2.4% legs 21.4% 31% 33.3% 11.9% 0% 2.4%head 14.3% 33.3% 42.9% 4.8% 0% 4.8% torso 16.7% 38.1% 38.1% 0% 7.1% N = 42 questionnaires To confirm the correlation between temperature and weight, a chi-squared test was carried out relating each of the body parts investigated. There was a significant correlation between weight and temperature in the hands (p = 0.000), arms (p = 0.000), feet (p = 0.002), legs (p = 0.001) and head (p = 0.001). This means that there is a congruence of bodily sensations during trance, and that in hypnosis, perceptions of weight and temperature have a direct and harmonious relationship. Tingling, numbness and immobility were not frequently felt by the athletes during the hypnotic trance.
Sensitivity was maintained during the trance: Table 6 - Triathletes' Sensory Perception of Tingling, Numbness, Immobility and Body Sensitivity during the Hypnotic Trance Tingling Numbness Immobile Sensitivity Yes No Yes No Yes No Yes No Hands 14.3% 85.7% 4.8% 95.2% 23.8% 76.2% 88.1% 11.9% Arms 4.8% 95.2% 2.4% 97.6% 31% 69% 90.5% 9.5% Feet 14.3% 85.7% 7.1% 92.9% 28.6% 71, 4% 90.5% 9.5% Legs 7.1% 92.9% 2.4% 97.6% 26.2% 73.8% 81% 19% Torso 78.6% 21.4% Neck 83.3% 13.7% Head 90.5% 9.5% N = 42 questionnaires The athletes had no sensations of tingling, numbness or immobility of parts of the body during the hypnotic trance, and maintained body sensitivity, indicating that normal states of body perception were maintained. The athletes' perception of relaxation and tension in the trunk and neck during the hypnotic trance are shown in Table 7.
Table 7 - Triathletes' Sensory Perception of Relaxation and Tension during the Hypnotic Trance Very tense Normal relaxation Relaxed very relaxed no answer Trunk 0% 0% 47.6% 35.7% 14.3% 2.4% Neck 0% 9.5% 40.5% 35.7% 11.9% 2.4% N = 42 questionnaires The athletes had a relaxed trunk and neck during the hypnotic trance, tending towards deeper relaxation. It can be seen that the relaxation of the torso goes hand in hand with the relaxation of the neck (significant correlation p = 0.000), so hypnosis is an experience that generally promotes muscle relaxation. The perception related to the triathletes' breathing behavior during the hypnotic trance is shown in Table 8.
Table 8 - Sensory perception of triathletes' breathing during the hypnotic trance. Very fast Normal rhythm Slow, very slow No answer Breathing rhythm 0% 9.5% 26.2% 50% 11.9% 2.4% Very shallow Normal Deep Very deep No answer Breathing intensity 0% 11.9% 33.3% 26.2% 4.8% 23.8% N = 42 questionnaires It can be seen that the athletes were breathing normally or slowly and deeply. There is a tendency for respiratory movements to decrease during the trance, which can be seen in the synchrony between the rhythm and intensity of breathing (significant correlation p = 0.000). This breathing behavior reaffirms the evidence that hypnotic trance promotes relaxation. Different levels of visualization intensity were perceived by the athletes during the hypnotic trance.
Table 9 below shows this data: Table 9 - Triathletes' Perception of the Intensity of Visualization of the Ironman Race during the Hypnotic Trance Very superficial Intens. Medium Deep Very deep No answer Visualization Intensity 9.4% 23.8% 35.7% 23.8% 7.1% 0% N = 42 questionnaires Some athletes reported greater difficulty (weak intensity) in visualizing the Ironman race. Others reported that it was easier (strong intensity) to visualize the race. In general, the majority said they could visualize the Ironman race normally during the hypnotic trance. This indicates that hypnosis does not seem to affect the visualization of the Ironman race, and that it is possible to relate the intensity of visualization to personal characteristics of the athlete and of each individual trance. The duration of the hypnotic trance perceived by the athletes is shown in Table 10:
Table 10 - Triathletes' perception of the duration of the Hypnotic Trance Maximum Minimum Mean Perceived time Standard deviation of trance 60' 10' 24.29' ±11.721 N = 42 questionnaires The athletes perceived the total duration of the hypnotic trance at an average of 24 minutes and 29 seconds (±11.72 minutes). In this case, the phenomenon of time distortion did not occur during the hypnotic trance with the athletes, as the perceived time was close to the real time (25' 18"± 1.97 minutes). The athletes' auditory perception during the trance was also investigated. Table 11 shows the participants' perception of external sounds during the hypnotic trance.
Table 11 - Triathletes' Psychophysical Perception of External Sounds during the Hypnotic Trance Didn't hear low Medium volume Heard high Extremely Didn't answer External sounds Volume 47.6% 19.5% 26.2% 2.4% 2.4% 2.4% Very far Medium distance Close very close Didn't answer External sounds distance 11.9% 9.5% 31% 4.8% 0% 42.9% N = 42 questionnaires A large proportion of the participants didn't hear the eternal sounds and consequently didn't perceive the distance of the external sounds. Not hearing external sounds may be a reflection of the attention focused on the participants' internal state, their physical and mental sensations provoked by the hypnotic trance. The perception of the therapist's voice during the trance was investigated in relation to volume and distance, data presented in Table 12.
Table 12 - Triathletes' Psychophysical Perception of the Therapist's Voice during the Hypnotic Trance. Didn't hear low Medium volume Heard high extremely Didn't answer Therapist's voice volume 0% 23.8% 52.4% 11.9% 0% 11.9% Far away Distance Medium Close Very close didn't answer Therapist's voice distance 0% 5% 31% 19% 16.7% 21.4% N = 42 questionnaires The athletes heard the therapist's voice normally and tended to hear it at a low volume. Some athletes didn't answer the question about the distance of the therapist's voice, which may correspond to those who heard it at a low volume. By listening to the therapist's voice normally, the athletes show a congruent perception of reality, pointing to the importance of the therapist's guidance throughout the process. Attention to the therapist's voice was always present during the trance, which shows the concentration of attention typical of hypnosis. Another aspect investigated in this research was the participants' perception of the sound of music during the hypnotic trance, shown in Table 13.
Table 13 - Triathletes' Psychophysical Perception of the Sound of Music during the Hypnotic Trance Didn't hear low Medium volume Heard high extremely Didn't answer Sound of music volume 21.4% 20% 16.7% 2.4% 0% 11.9% Very far Medium distance Close Very close didn't answer Sound of music distance 7.1% 13% 23.8% 7.1% 0% 31% N = 42 questionnaires While some athletes didn't hear the sound of music, others heard it at low or medium volume, reflecting the lack of answers to the question relating to the distance of the sound of music. The athletes congruently perceived the volume and distance of the external sounds (p = 0.000) and the sound of the music (p = 0.000), which was not the case with the therapist's voice. The athletes heard the external sounds and the sound of the music in a similar way (p =0.000), indicating that the participants' attention to external stimuli was focused exclusively on the therapist's voice, which provided guidance on the trance experience. This indicates a selectivity of external attention during the trance. The athletes' perception of the sounds of the race during the visualization is shown in Table 14.
Table 14 - Triathletes' Perception of the Sounds of the Ironman Race Visualization Nothing, a few things, a lot of things, Almost everything, In detail, Did not answer; Visualization sounds 42.9% 47.6% 7.1% 2.4% 0% 0% N = 42 questionnaires Table 14 shows that the athletes did not perceive any sounds in the visualization or heard very few things. This may have been due to the fact that triathlon is an individual sport and there is little interaction between athletes, so there is little auditory stimulation from the environment. The survey participants' perception of aspects related to the visualization images of the Ironman race is shown in Table 15 below. Table 15 - Triathletes' perception of aspects related to the visualization of the race Black and white. Some colors, Colorful, very colorful, very strong colors, no answer Colors 9.5% 33.3% 50% 4.8% 0% 2.4% Very blurry, Blurry, Medium focus, sharp, very sharp No answer Focus of images 4.8% 23.8% 42.9% 23.8% 2.4% Very dark, Dark, Medium light, light, very light, no answer Clarity of images 2.4% 28.6% 33.3% 28.6% 2.4% 4.8% Small, Medium, Large, no answer; Size of images 9.5% 64.3% 4.8% 21.4% No details, detailed, with many details, no answer; Details of images 38.1% 54.8% 4.8% 2.4% No movement, Normal movement, very moved, no answer; Movement of images 7.1% 81% 0% 11.9% Outside the image, sometimes outside, sometimes inside, inside the image No answer; Self-perception 11.9% 33.3% 42.9% 11.9% *N = 42 questionnaires
The athletes saw colorful images with medium focus (significant correlation between colors and focus with p = 0.046). Other characteristics of the images ranged from dark, with medium light, to light, medium size, detailed and with normal movement, showing good image quality. There was a statistically significant correlation between clarity and focus (p = 0.000), size and movement (p = 0.014). These data indicate that in hypnosis the visualization of the race reproduces the reality perceived by the athlete. Thus, the hypnotic trance does not compromise the mental experience of the sport, in this case triathlon. During this visualization, the athletes could perceive themselves inside the images, outside the images or alternating between these two positions. The athletes were most often inside the image (42.9%) or alternating between outside and inside the image (33.3%). It is worth noting that there was no significant correlation between self-perception and viewing intensity, indicating that there is no relationship between the self-image perspective and the intensity of the race experience.
4.3 HEART RATE BEHAVIOR
During the 42 hypnosis sessions, the individuals' heart rates (HR) were analyzed during the trance, using a heart rate monitor described in the Method. Table 16 shows the averages, maximum and minimum measurements, as well as the standard deviation of the heart rates recorded during the hypnosis sessions. Table 16 - Minimum, Maximum and Average Heart Rate of Triathletes during the Hypnotic Trance Minimum Maximum Average Standard Deviation Initial 44 84 65.43 10.616 FCInt1 40 78 60 10.062 Median 44 80 59.93 9.503 FCInt2 42 87 59.74 9.546 FCFinal 45 83 64.69 9.782 The participants' heart rate decreased at the start of the trance. The significant difference between the initial and final heart rates (p = 0.00) is indicative of deepening relaxation. However, the difference between the initial and final heart rates was not significant (p = 0.537).
The state of relaxation demonstrated by the heart rate was maintained at the beginning, middle and end of the hypnotic trance. The final increase in HR (p = 0.000) proves that when participants opened their eyes, they were in a state of alertness very close to their initial state. Table 17 below shows the maximum, average and minimum values for mean HR, maximum HR and minimum HR during the hypnotic trance in the 42 sessions. Table 17 - Maximum, Average and Minimum Heart Rate Values of Triathletes during the Hypnotic Trance Minimum HRMaximum HRM Average HRM Standard Deviation Average HRM 44 75 60 8.764 Maximum HRM 48 93 72.55 10.682 Minimum HRM 38 70 53.95 8.500 The average values of the average HRM show that in general the participants had a low heart rate, indicative of a state of relaxation (below 60 bpm). It can also be seen that the average values of the Minimum HR are characteristic of relaxation, and the average values of the Maximum HR are below 73bpm.
5 DISCUSSION OF RESULTS, CONCLUSIONS AND SUGGESTIONS
Based on the testimonies described in the interviews, the answers to the questionnaires and the heart rate analysis, the discussion of the results aims to present the main information on triathletes' perceptions of the characteristics of viewing the Ironman race and their psychophysiological behavior during the trance. We analyze the qualitative and quantitative data from the interviews and questionnaires in relation to the literature, also discussing the behavior of the participants' heart rate during the hypnotic trance. The conclusions answer the questions posed at the beginning of the research.
5.1 DISCUSSION OF RESULTS
5.1.1 Relaxation and other sensory changes
The first characteristic of the hypnotic trance with triathletes is relaxation. Felt throughout the trance, relaxation appears to be a fundamental component of hypnosis. At the beginning of the hypnotic process, the athletes related the transition from alertness to trance with feelings of relaxation. Body and mental relaxation led the athletes to an internal focus, which they maintained throughout the trance and after it had ended. During the visualization (Table 2), the relaxation remained very deep, as reported by D1 and F1. The athletes perceived the relaxation in different parts of the body, such as the neck and torso (Table 7) in a congruent way, and felt no tension during the trance. After returning from the trance, the athletes continued to feel relaxed (Table 3), indicating that relaxation is a very significant characteristic of the hypnotic trance, and that this sensation is maintained after the trance.
This state of relaxation characteristic of the trance is in line with what Hermes et al. (2005) say. The authors present complete bodily relaxation as one of the objective symptoms of the beginning of the trance experience and mental relaxation as a subjective experience characteristic of this same phase of the trance. In their study of patients undergoing maxillofacial surgery in a hypnotic trance, they report that after the surgery the patients felt relaxed, distanced from the surgery and slightly sedated. Rainville and Price (2003) analyzed the current literature on the phenomenology of hypnosis and the neurobiology of consciousness. Congruent with the data from this research, they point to two studies that found mental relaxation to be one of the necessary or sufficient elements to produce the sensation of being hypnotized. Rainville and Price (2003) also state that the experience of being hypnotized begins with the sensation of mental and (usually) physical relaxation, in combination with the absorption of focus on an object or objects of attention.
This evidence shows that relaxation is a crucial element, and was present as a feature during the hypnotic trance in triathletes. In addition to relaxation, Erickson, Hershman and Secter (1994) say that there can be various forms of sensory alteration during the hypnotic trance. During the interviews, some athletes described the sensation of their bodies warming up (Tables 1 and 2), and there is a tendency for athletes to feel their bodies go from normal to warm during the trance (Table 4). Accompanying the changes in body temperature, the athletes also noticed changes in body weight. Table 5 shows that the participants tended to feel their bodies were normal to lighter. These perceptions could be due to the state of relaxation the participants were in.
The literature points out that the sensations of a change in temperature and weight are part of the symptoms of hypnosis, but there is no specification of how this change occurs (BAUER, 1998). Cardeña (2005), however, in a study on the phenomenology of hypnotic trance, points out that the sensation of lightness was reported by the research participants as being characteristic of a light to medium trance. Thornton et al. (2001), in their research on the monitoring of cardiorespiratory variables during trance associated with the visualization of two different levels of effort in physical activity (downhill cycling and uphill cycling) and the suggestion of hyperventilation, point out that in spontaneous reports the perception of intense relaxation and altered self-perception, for example of warming up, was evident.
It is acceptable to conclude, therefore, that triathletes during hypnotic trance can feel a warming of the body together with a sensation of lightness in the body and, according to the literature, these can be typical signs of a light or medium trance. Increased bodily sensitivity during the hypnotic trance is a manifestation of the phenomenon of hyperesthesia or hypersensitivity. Ansari (1991) points out that hypersensitivity is related to the increased sensitivity of the sensory systems of participants in a hypnotic trance. It is the opposite of anesthesia. In anesthesia we inhibit the senses, but in hypersensitivity we make them super sensitive. The athletes felt increased sensation both on the skin (in relation to clothing, F2) but also in relation to internal sensations, such as heartbeats. Hypersensitivity is therefore a characteristic during the hypnotic trance with athletes.
A relevant point in the initial phase of the hypnotic trance is the way in which the participants perceived their entry into the trance. Generally, the athletes felt this transition gradually, which shows that the participants were gentle and maintained their integrity. Gradually starting the trance also shows how the athletes gradually detached themselves from the external environment and turned to internal contact, their own feelings and sensations. This transition to internal contact is fundamental in hypnosis, so that deeper levels of consciousness can be reached in the trance state. The rapid perception of entering the trance may be related to the automaticity described by Rainville and Price (2003), i.e. the sensation of having automatic responses, without effort or deliberation.
So, as the athletes entered the trance state, the deepening process flowed automatically, continuing throughout the trance, the visualization and even the exit from the trance. During this characteristic passage at the beginning of the trance, and also during the deepest trance, the athletes perceived the auditory stimuli in a very peculiar way. At the beginning of the trance, the athletes gradually disconnected from external sounds (such as music or any sounds that might appear during the trance - telephone, passing car, barking dog, etc.), while remaining focused on the sound of the therapist's voice (Table 2 and Tables 8, 9 and 10). The attention on the therapist's voice shows the state of concentration that was being established, and the focus of attention characteristic of hypnosis. Thus, the athletes entered a state called mental absorption. In mental absorption, the participant feels the engagement of themselves towards objects of consciousness. This is a phenomenological property belonging to the interaction of the self with objects, or being modified by them (RAINVILLE; PRICE, 2003), in this case the therapist's voice.
These results show that the therapist's voice plays a fundamental role in the hypnotic trance, leading the focus of attention into the trance, and that external sounds don't seem to interfere with hypnosis. The sounds of the visualization don't seem to be relevant, as the athletes generally heard little or nothing during the Ironman visualization (Table 14). The athletes' concentration at the start lasted throughout the trance (Table 2). In fact, this was the most striking feature of the visualization phase (Table 2). The reports from B4, D1 and F1 clearly show how the athletes felt disconnected from the external environment and concentrated on the race they were mentalizing. During the visualization, B4 felt isolated from the external environment and turned completely to the visualization.
These results are in line with Thornton et al. (2001) who used hypnosis precisely to isolate participants from the external environment, to achieve a greater focus of attention on mentalization, and consequently have a greater chance of corresponding cardiorespiratory responses. Cardeña's research (2005) shows that deep hypnosis is associated with states of greater focal attention. The fact that hypnosis produces this state of concentration tells us that it can be a tool for developing or maintaining concentration in athletes. With the continuous use of hypnosis in the athlete's daily practice, it is possible for this state of focal attention to become more automatic and natural for the athlete, transposing this mental state to training and competition situations.
In more superficial hypnotic states (light trance), it is possible for the athlete to maintain the trance and consequently concentration during sports practice. In this way, taking advantage of this characteristic of hypnosis enables athletes to improve their ability to concentrate and their sporting performance. The anesthesia felt at the beginning of the trance and during the visualization of the race is an important characteristic of the hypnotic trance in triathletes. Although not very frequent during the research (see body sensitivity in Table 6), this phenomenon was experienced by the athletes at times and could be useful, if better explored, in pain treatments, for example. The phenomenon of anesthesia has been used frequently in different areas of medicine and has brought important results (GAY; PHILIPPOT; LUMINET, 2002; KESSLER; PATTERSON; JOSEPH, 2003; LIOSSI; HATIRA, 2003; PATTERSON; JENSEN, 2003; ASTIN, 2004; WILD; ESPIE, 2004; HERMES et al., 2005).
In the study by Hermes et al. (2005) 94.3% of patients had greater tolerance to the invasive processes of surgery, and in the post-operative period they hardly asked for more painkillers. Despite these results, the authors conclude that hypnosis cannot serve as a serious substitute for sedation or general anesthesia, and that its therapeutic use should be limited to patients who are mentally healthy and cooperative, and who are at least open to the procedure. Kessler, Patterson and Joseph (2003), analyzing various studies of hypnosis and relaxation in the treatment of pain, found hypnosis to be more effective in treating patients with chronic pain than attention or standard forms of pain control. From this point of view, the anesthesia felt by athletes during the hypnotic trance could be very useful for athletes with chronic pain, for example.
It is worth emphasizing that the use of hypnosis to treat pain must be done ethically and safely, thus avoiding further complications to the athlete's health. Another phenomenon perceived by the athletes was the sensation of little mobility, known as catalepsy, characterized by body rigidity involving the impossibility of moving a hand or arm, which also produces inhibition of fatigue (WOODARD, 1996). This phenomenon was infrequent, but some athletes (Table 6) show that catalepsy can be a characteristic phenomenon of hypnotic trance. Erickson, Rossi and Rossi (1992) point to economy of movement as an indication of the development of trance. Erickson, Hershman and Secter (1994) indicate that in addition to the economy of movement, there may be a loss of mobility, reflexes and a lack of swallowing, as well as a reduction in involuntary reflexes.
In the hypnotic trance in triathletes, catalepsy was present and could, like anesthesia, be better studied and explored in the sports field. At times, the participants felt drowsy. This sensation, which appeared at the beginning of the trance, is probably due to the state of relaxation produced during the initial phase of the trance. 5.1.2 Visualization characteristics The perspective from which the athletes saw themselves during visualization varied. In visualization, individuals can see themselves from an external perspective, i.e. the way the movement is seen in a video recording, or from an internal perspective, as the environment and movement are experienced by the individual when the action is physically performed (SCHMIDT; WRISBERG, 2001).
In the questionnaires, most of the athletes said they perceived themselves to be inside the image or in between (Table 45), and in the interviews the athletes showed that they had the three perspectives well distributed (inside the race, outside the race and in between inside and outside the race, Table 2). Even with this difference, the results are in line with the literature. Weinberg and Gould (2001) state that the perspective experienced depends on the athlete and the situation. According to the authors, many people alternate between external and internal mentalizations. One of the important aspects of the perceived perspective is the possible relationship with the intensity of the experience of the race during this phase of the trance. In this study, self-perception in the images and the intensity of the experience were not correlated, which is not in line with the results of Wang and Morgan (1992, apud CALABRESE et al., 2004).
According to these authors, the internal perspective results in increased ventilation and the perception of responses that are more related to the actual exercise than the external perspective. In other words, internal mentalization makes the images more vivid, because the participant is living the situation and not watching it. The athletes showed different perceptions of the intensity of the race experience in the interviews and questionnaires. The interviews show that the athletes tended to view the Ironman race intensely (Table 2), which does not correspond to the questionnaires (Table 9). Even though the answers related directly to the intensity of visualization do not show an explicit tendency, the characteristics of the images visualized by the participants (Table 45) show that hypnosis promotes the visualization of images with normal characteristics, suggesting a good quality of images, i.e. hypnosis can facilitate the visualization of mental images. Liggett (2000), for example, points to evidence that mentalization associated with hypnosis increases the intensity and efficiency of images in athletes.
The intensity of the visualization perceived may also be related to the association of the sensations of the race. Some athletes felt deeply into the race, like C1 and G1, feeling the sensation of the competition or the movements performed during the exercise. The association of visualization sensations can be very useful in preparing athletes for competitions and in acquiring and perfecting new skills. Mental practice, the procedure of cognitively repeating aspects of a motor skill without practicing its corresponding physical movements (MAGILL, 1993; SCHMIDT; WRISBERG, 2001) and imagination or visualization, seeing and feeling oneself actually performing the skill, whether already known or new, are part of the mental training explored in Motor Learning (SCHMIDT; WRISBERG, 2001).
Magill (1993) points out that mental practice is better than no practice at all, and that in the right proportion, it can be just as effective in combination with physical practice as physical practice alone. Weinberg and Gould (2001) point to control and sharpness as important variables. We discussed the possibility of creating more efficient mental images, high-quality visualizations, evolving the concept and practice of mental training, with more concrete answers about the effects of this resource in the area of motor development and learning. And, in addition, to look for its effects on athletes' emotional states and, consequently, on their behavioral responses. Jackson et al. (2003) examined via PET the functional changes associated with learning a sequence of foot movements through mental practice of the motor movement. Mental practice over a few days led to a modest but significant improvement in performance.
Healthy participants showed an increase in activity restricted to the medial aspect of the orbitofrontal cortex (OFC) and a decrease in the cerebellum. These results, according to the authors, show that learning a sequential motor task through mental practice produces functional brain changes similar to those observed after physical practice of the same task. Thus, these results are in line with the hypothesis that mental practice of the motor image improves performance, at least initially, by acting on the preparation and anticipation of movements rather than on the execution itself. Hypnosis can be a resource for motor learning as well as a technique that represents an evolution in the processes of "mental practice" orientation. The findings of this research in relation to the quality of the images seen by the athletes in the visualization are in line with the literature.
In the speeches, such as that of G3, and in the questionnaires (Table 45), the evidence points to an image quality similar to the athletes' real perception. The athletes saw colorful images, with focus; medium light and size, detailed and with normal movement, reinforcing Liggett's (2000) assumption that mentalized images during hypnosis are more efficient. Cardeña (2005), researching the phenomenology of hypnosis at rest and during physical activity, concluded that hypnosis typically involves physical sensations and more intense visualizations, with more vividness and focal attention on the images. In his study, the author reports that the participants referred to various aspects related to the visualization of images, such as "increased reality", "increased quality", "sustainable sequences", "spontaneous images" and imagination unrelated to any sensory modality.
The correlation between some visual submodalities during hypnosis tells us that these characteristics change harmoniously, proving the reproduction of real images. Further studies could clarify how this association occurs and whether there is a direct relationship between the submodalities. In addition to the visual perceptions of the images during the visualization period, the research participants had other perceptions during the trance. In addition to the sensory perceptions of temperature, weight and muscle contraction mentioned above, there were also sensations of peace, dreaming and agitation. The depth that the athletes reached in the trance can be estimated from the answers given, which generally indicated a medium to deep trance. According to Thornton et al. (2001), there is still no satisfactory direct measure to assess the depth of the hypnotic trance. In their study, there was no evidence that the depth of the trance could have altered the results, despite the participants apparently showing different levels of hypnotic trance depth.
The study by Cardeña (2005) shows that in very deep trances there is a change from cognitively controlled thoughts to free, more elaborate and vivid images. Sebastiani et al. (2003) point out that there is a pattern of autonomic and electroencephalographic (EEG) changes in the visualization of an unpleasant situation, involving various sensory modalities, guided by hypnosis. These changes are different from the pattern of change that occurs in visualization done through cognitive stimulation of any type of emotion. In visualization with hypnosis, there is an increase in heart and respiratory rate as well as in gamma and beta activity and an increase in theta power, indicating a high level of internal reality in the visualization of the unpleasant situation. Rainville et al. (1999) studied the effects of hypnosis and suggestion on changes in pain perception using PET, EEG and rCBF.
The authors investigated unpleasant sensations of pain during rest, hypnotic relaxation and hypnosis with suggestion, where each participant's left hand could be immersed in room temperature or very hot water. Hypnosis was accompanied by a significant increase in occipital rCBF and delta EEG activity, with a high correlation between them (p < 0.0001). Rainville et al. (1999) conclude that this increase in occipital rCBF and delta EEG activity reflects the alteration in consciousness associated with decreased stimulation and possible facilitation of mental visualization. We return to the discussion on the possibilities of hypnosis as a resource for visualizing images in motor learning.
The data on the images and sensations experienced by the athletes during the visualization of the Ironman in the hypnotic trance, together with the data in the literature, tell us about the real possibilities of using this tool in a more present and active way in day-to-day physical activity. It is clear from this discussion that there is a significant component of internal reality when images are visualized during hypnosis, as well as the establishment of an internal state of relaxation. Hypnosis cannot be restricted to a population with dramatic needs, such as recovering patients, but should be better explored in its usefulness for the development of sporting skills and even in the search for the emotional balance needed to improve sporting performance. 5.1.3 Hypnotic phenomena Among the hypnotic phenomena experienced by athletes during the research, the phenomenon of dissociation was reported in 30.9% of cases. According to Ansari (1991), dissociation is characterized by a segregation of the participant from their immediate environment, excluding all environmental awareness as a source of stimulation, except the therapist.
In this case, this dissociation from the external environment also appeared at the moment when the athletes didn't hear any external sounds, focusing only on the therapist's voice. The phenomenon of dissociation was also found in the studies by Thornton et al. (2001) when participants reported feeling like they were nowhere, as well as in the study by Hermes et al. (2005), where maxillofacial surgery patients reported feeling distant from the surgery and in the research by Cardeña (2005) where participants in deep hypnosis reported feeling like they were "floating", "flying" or "the mind leaving the body". The dissociation of body and mind during the hypnotic trance leads us to question the usefulness of this phenomenon in the sporting environment. It may be that dissociation is useful in cases of pain or exhaustion, for example, although there are no specific studies on this.
Research focused specifically on this phenomenon is needed in order to reach a conclusion about its usefulness in sport. In this study, it can be considered that dissociation is one of the characteristics of the hypnotic trance with triathlon athletes. Other phenomena experienced by the participants were amnesia and hypermnesia. It is important to understand how these two apparently opposite phenomena can appear in the hypnotic trance process. According to Woodard (1996), the expansion or narrowing of the phenomenal field allows clear differentiations about what is being focused on. This can occur when past experiences are recalled, either spontaneously or through images or feelings of past situations. During hypnosis, the field changes or reorganizes itself temporarily.
Amnesia for such events can occur or reoccur as soon as the field of attention changes from an expanded field to a narrowed field from the experience of hypnosis. In hypermnesia, the phenomenological field is altered to the moment in time when the past experience occurred, while other aspects of the field of attention (physiological, environmental and psychological) disappear. As in amnesia, the level of attention changes from the hypnotic experience. According to Woodard (1996), remembering or forgetting occurs as a function of perception and the need for adequacy. Hypnosis can then enhance this process by providing a reorganization of the phenomenal field, creating a new experience, bringing new meanings to the being and resulting in a change in perceptions. Hudetz, Hudetz and Reddy (2004), studying the effects of relaxation on memory performance, found significant psychological and psychophysiological results (in EEG studies) using short-term guided visualization to produce relaxation and memory retrieval.
In the literature, studies were found in which amnesia was reported more often than hypermnesia (THORNTON et al., 2001; HERMES et al., 2005). In this study, the athletes experienced both amnesia (23.8%) and hypermnesia (19%). Athlete G3 described his memories in detail, including the sensations of the sand and the sun. Hypermnesia being a characteristic of the hypnotic trance with triathletes can bring up memories of successful moments, increasing the athlete's motivation and even seeking successful strategies to be repeated in future competitions. 5.1.4 Return from trance The athletes went through the reorientation process (return from trance to alertness) calmly, gradually and automatically, i.e. without the need for effort (Table 3). This shows how, in general, hypnotic trance is a process that maintains the integrity and rhythm of the participant from start to finish.
The athletes came out of deep contact with themselves and turned their attention to the outside world, in the opposite way to when they entered the trance. The old idea that hypnotized people slept and woke up suddenly fell apart, proving to be a smooth and pleasant process. As well as some athletes expressing a desire to stay in the trance, the reports of positive sensations, such as D3's, show the pleasurable nature of the hypnotic trance. This characteristic remained after the trance too. After returning from the hypnotic trance, most of the athletes had positive feelings, which reinforces the idea that the hypnotic trance is a pleasant experience. These results are in line with Cardeña (2005) who concludes that emotions at a deep level of hypnosis are generally positive.
The pleasant experience is also confirmed in the research by Hermes et al. (2005), where patients after surgery report having had a positive trance experience, and would consent to having another operation under hypnosis. These data provide consistent evidence that hypnosis is a positive experience, and that participants who undergo it benefit from the sensations it provides. The perception of the duration of the trance (Table 40) shows that on average the participants matched the actual trance time. These results are not in line with the literature that points to time distortion as a typical hypnotic phenomenon (WOODARD, 1996; HERMES et al., 2005). It is clear here that in this study time distortion was not present in the hypnotic trance, but it is not possible to state why this phenomenon did not occur. 5.1.5 The behavior of breathing and heart rate during the trance
The athletes breathed at a slow pace with normal or deep intensity. Slow, deep breathing is more indicative of relaxation. The literature analyzed does not present data on the perception of the rhythm of breathing, but it does provide data on the ventilation of participants during hypnosis. Thornton et al. (2001) found that imagining physical exercise (uphill cycling) during hypnotic trance causes an increase in ventilation corresponding to 30% of the increase in real exercise. Respiratory rate and ventilation have been verified in studies with visualization of physical exercise, but without hypnosis. Calabrese et al. (2004) measured HR, respiratory rate and ventilation in four different groups (professional rowers, athletes from other sports, sedentary young people and sedentary seniors) at rest, watching a video of a rowing race and mentalizing the rowing race. Their results indicate a greater increase in ventilation, respiratory rate and heart rate in all groups during the mentalization of the race than watching the video when compared to rest.
In this study, we limited ourselves to investigating the perception of breathing and did not measure direct data on its behavior. This also limits our conclusions about breathing behavior during hypnosis and visualization of the Ironman race. The decrease in the athletes' heart rate during the trance (Table 46) proves the state of relaxation they were in. The significant decrease in heart rate at the start of the trance shows that in a hypnotic trance the athletes reduce their internal agitation, relaxing and maintaining this state throughout the trance. The average minimum HR of 53.95 bpm, ± 8.5bpm (Table 47), is comparable to the results found by Sacknoff et al. (1994), who studied the effect of training on heart rate variability. According to the authors, the HR of trained athletes at rest was lower than that of untrained individuals (49.5 ± 1.6 vs. 64.1 ± 3.6 bpm).
The HR of the athletes investigated decreased during the hypnotic trance, returning to the initial rate after returning to the alert state. These results are partially in line with Williamson et al. (2004). These authors compared groups of highly hypnotizable and poorly hypnotizable individuals mentalizing the motor task of "catching" with and without hypnosis. They concluded that there was no significant increase in HR in either group. However, Thornton et al. (2001) state that during hypnosis, the mentalization of a heavy exercise previously performed results in an increase in HR in athletes. It can be considered that the heart rate of triathletes in hypnosis visualizing the Ironman race showed a decrease at the beginning of the trance, maintaining low levels until the return, when it returned to the pre-hypnosis heart rate. The behavior of the triathletes' HR during the hypnotic trance accompanied their perceptions throughout the process, indicating relaxation and concentration.
5.2 CONCLUSIONS AND SUGGESTIONS
Considering the objectives proposed in this study, the literature reviewed, the information collected in the interviews, the analysis of the questionnaire data and the analysis of heart rate, in the hypnotic trance experience with triathlon athletes: - Triathlon athletes feel relaxed during the hypnotic trance. Bodily and mental relaxation is present throughout the trance, even after returning to a state of alertness, when the athletes continue to feel relaxed. - The triathletes in this study tended to feel warmer and lighter during the trance. In addition to these sensory perceptions, the athletes felt an increase in the sensitivity of touch and the perception of their own body. - Both entering and exiting the trance was gradual. At first, the athletes felt relaxed and "gave in" to the trance automatically.
When they returned, the athletes gradually became aware of external stimuli and naturally returned to a state of alertness. - During the hypnotic trance, the athletes isolated themselves from the external environment in a very expressive way, especially with regard to sounds. The only sound present for the athletes during the trance was the therapist's voice. Music and other sounds were not perceived, nor did they interfere with the hypnotic trance. Attention to the therapist's voice is part of the trance, manifesting the focus of attention typical of hypnosis. The athletes' attention to both the therapist's voice and the visualization of the race led them to the phenomenon of mental absorption. This phenomenon, characterized by concentration on a task, can be very useful in the mental preparation of athletes and deserves to be further explored in future research. - Other hypnotic phenomena were experienced by the athletes during the trance.
Anesthesia was felt a few times, as well as catalepsy and dissociation. These phenomena can be more intense when there is a suggestion that they happen, which was not the case in this study. These phenomena could be better explored when working with athletes, so that they can be used more specifically in sport. - The phenomenon of time distortion was not experienced by the athletes. - The triathletes were generally very focused when they viewed the Ironman race.
This is the most striking feature of the visualization of the race, confirming that hypnosis can increase the ability to concentrate, and make visualization better. A greater understanding of how the process of concentration takes place during hypnotic trance can be useful in the psychological preparation of athletes, extending to everyday situations of training and competition - The athletes visualized images that were very close to normal, generally colorful, with medium focus, light and size, with details and normal movement. This shows that during hypnosis, there is no distortion of images and that it is possible to visualize a long race like the Ironman while maintaining good image quality. This maintained quality may have contributed to the intensity with which the athletes perceived the visualization of the race. In general, the participants found it easy to visualize the Ironman and at times they felt like they were doing the race, having sensations of cycling or other sensations related to the race.
The intensity, however, was not related to the perspective in which the athletes perceived themselves in the visualization, as this varied greatly and there was no obvious trend. - It is therefore possible to establish a dialog with motor learning and development, using hypnosis to seek an evolution in mental practice. It is possible to increase the participants' ability to concentrate, improve the quality of the images and even bring about positive sensations linked to the execution of the motor activity. Different possibilities are created, ranging from a simple movement such as the "grip" motor activity to a sequence of movements such as a rehearsed move or a rhythmic gymnastics routine. - The athletes also noticed that their breathing was slower and deeper.
This breathing behavior is indicative of relaxation and is congruent with heart rate behavior. - The behaviour of the heart rate was characterized by a decrease in the heart rate at the beginning of the trance, and it remained at this rate throughout, rising when the athlete returned to a state of alertness. This behavior is congruent with the entire description of the athletes' sensations during the trance, showing evidence that hypnosis has significant effects on the athletes' physiological responses. - After the trance, the athletes had generally positive feelings, indicating that hypnosis is a pleasant experience for triathlon athletes.
It is concluded that the triathletes felt relaxed and concentrated during the hypnotic trance, and that there were also typical hypnotic phenomena and other sensory perceptions. The hypnotic trance with triathlon athletes was medium to deep, with corresponding characteristics of these levels. Isolation from the external environment was evident, which kept the athletes focused both on visualizing the race and on their sensations during the trance. The athletes generally visualized the Ironman race with ease and with mental images that were close to the real thing. The behaviour of the heart rate showed the entry into the trance, through a decrease in the heart rate, and the return to the alert state, characterized by an increase in the heart rate at the end of the trance.
Understanding hypnotic phenomena in all their complexity is limited in this research. The cognitive processes involved in hypnosis, as well as its functions, require a greater understanding of these processes during the trance. With this understanding, it will be easier to use the full potential of this technique and better target its application in sports.
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Dra. Andréa Zanella – Coordenadora do programaBanca Examinadora:Orientador:Prof. Dr. Emílio Takase
Universidade Federal de Santa CatarinaCo-orientador:Prof. Dr. Alexandro Andrade
Universidade do Estado de Santa CatarinaMembro:Prof. Dr. Roberto CruzUniversidade Federal de Santa CatarinaSuplente:Prof. Dr. José Carlos ZanelliUniversidade Federal de Santa Catarina
Florianópolis, julho de 2005.
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