Psychology of Consciousness: Theory, Research, and Practice 2015 American Psychological Association

2016, Vol. 3, No. 1, 45 60 2326-5523/16/$12.00 http://dx.doi.org/10.1037/cns0000055

Enhancing Sports Performance With Hypnosis: An Ode

for Tiger Woods

Leonard S. Milling and Elizabeth S. Randazzo

University of Hartford

We present a comprehensive methodological review of controlled and single-case

design studies of the effectiveness of hypnosis for enhancing sports performance. To be
included in the review, controlled studies were required to use a between-subjects or
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

mixed model design in which hypnosis was compared with a control condition or
This document is copyrighted by the American Psychological Association or one of its allied publishers.

alternative intervention to improve sports performance. Single case-design studies were

required to incorporate baseline and intervention phases, with multiple assessment
points during the baseline phase to establish a stable trend for the target behavior. An
exhaustive search of the PsycINFO database identified 17 studies satisfying these
criteria. Hypnosis was shown to be effective for improving performance in a variety of
sports, with the strongest support for enhancement of basketball, golf, soccer, and
badminton skills. Common methodological limitations in the reviewed studies included
a failure to fully specify the demographic characteristics of samples, to utilize a
treatment manual, and to assess relations between hypnotic suggestibility and outcome.
Two hypnotic interventions met criteria as possibly efficacious empirically supported
therapies, thereby indicating that hypnosis can be a way of engaging in evidence-based
practice in sports psychology. Practitioners who work with athletes may wish to
consider the potential of hypnosis for enhancing sports performance.

Keywords: hypnosis, sports performance, effectiveness, methodology, empirically

supported therapies

Competitive sports are played mainly on a five-and-a-
half-inch court-the space between your ears.
Bobby Jones, Co-Founder of the Masters
Tournament
Since becoming a professional golfer in
1996, Tiger Woods has won 105 tournaments
including four Masters Tournaments, four PGA
Championships, three U.S. Open Champion-
ships, and three British Open Championships,
thereby cementing his legacy as one of the
greatest golfers in the history of the game and
earning him prize money of more than $132
million worldwide (http://www.tigerwoods.com/
about-tiger). According to Forbes magazine, in
This article was published Online First May 25, 2015.
Leonard S. Milling and Elizabeth S. Randazzo, Depart-
ment of Psychology, University of Hartford.
We thank Taryn Brandt and Dawn Neese for their helpful
suggestions in carrying out this project.
Correspondence concerning this article should be ad-
dressed to Leonard S. Milling, Department of Psychology,
University of Hartford, 200 Bloomfield Avenue, West Hart-
ford, CT 06117. E-mail: milling@hartford.edu
45
2010 2011, the average annual salaries of pro-
fessional athletes were $1.9 million in the Na-
tional Football League, $2.4 million in the Na-
tional Hockey League, $3.2 million in Major
League Baseball, and $5.15 million in the Na-
tional Basketball Association (http://www
.forbes.com). However, the excitement and
challenge of competition are frequently men-
tioned as the primary motivations for youth,
high school, collegiate, and even elite profes-
sional athletes. For example, Lionel Messi, soc-
cer forward for FC Barcelona and captain of the
Argentina National Team, has said, my moti-
vation comes from playing the game I love. If I
was not paid to be a professional footballer, I
would willingly play for nothing (Duda &
Treasure, 2015, p. 66). Clearly, the intrinsic and
extrinsic rewards for success as an athlete can
be substantial.
The pressure on athletes to gain even a small
advantage over competitors is often enormous.
In the major U.S. sports (e.g., basketball, foot-
ball, baseball, hockey, soccer), only about 6%
of high school athletes go on to play in college,
 46 MILLING AND RANDAZZO
and less than 2% of NCAA student-athletes
later compete at the professional level (http://
www.ncaa.org). The boundary between success
and failure is sometimes quite narrow. For ex-
ample, at the 2008 Summer Olympics, U.S.
swimmer Michael Phelps won an unprece-
dented eight gold medals. Across the eight
events, his average margin of victory relative to
each of the 4th place finishers (who did not
receive a medal of any kind) was a mere 3.84 s.
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Indeed, in the 100 m butterfly, the margin of
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victory over the 4th place finisher was a razor-
thin .55 s. In view of the tremendous incentives
for success and the fierce level of competition, it
should come as no surprise that athletes often
seek out every possible way of maximizing their
abilities and performance.
Psychological Skills Training and
Sports Performance
A variety of psychological interventions
are commonly used to enhance sports perfor-
mance, including visualization, self-talk,
arousal regulation, and goal setting (Whelan,
Mahoney, & Meyers, 1991). Visualization is
sometimes referred to as imagery or mental
rehearsal. It involves cognitively creating a
new experience or recreating a past experi-
ence to either practice a specific sport skill or
to prepare immediately before competition
(Vealey & Forlenza, 2015). Self-talk, or self-
instructional training, is concerned with mod-
ifying the ongoing thoughts and internal con-
versations that athletes experience during
preparation and competition, thereby reduc-
ing negative cognitions and increasing confi-
dence (Williams, Zinsser, & Bunker, 2015).
Arousal regulation is a used to produce the
optimal level of arousal, which might include
arousal energizing techniques to increase
arousal levels, as well as relaxation tech-
niques to decrease arousal and anxiety (Gould
& Udry, 1994). Finally, goal setting involves
helping the athlete to establish specific, mea-
surable, and realistic performance goals of
moderate difficulty that result in improved
performance (Gould, 2015). Evidence of the
effectiveness of these interventions is mixed,
but generally supportive (Gardner & Moore,
2006).
Hypnotic Enhancement of
Sports Performance
Another psychological intervention that has
been used to enhance sports performance is
hypnosis. There are many definitions of hypno-
sis, but we prefer the following one because of
its clarity: Hypnosis is a procedure during
which a health professional or researcher sug-
gests that a client, patient, or subject experience
changes in sensations, perceptions, thoughts, or
behavior (Kirsch, 1994, p. 143). Another at-
tractive feature of this definition is its neutrality
with regard to long-standing, unresolved theo-
retical controversies, such as whether people
enter an altered state of consciousness when
they are hypnotized (Kirsch & Lynn, 1995).
According to Hilgard (1965), every hypnotic
procedure consists of a hypnotic induction and a
suggestion. The induction customarily consists
of instructions for relaxation, along with state-
ments that the person is becoming hypnotized.
Thereafter, a suggestion or suggestions invite
the person to experience some imaginary state
of affairs (e.g., you are feeling calm, confident,
and powerful as you imagine yourself approach-
ing the ball to take the penalty kick). When a
suggestion is delivered without a hypnotic in-
duction beforehand, it is referred to as a non-
hypnotic or imaginative suggestion (Kirsch,
1997a).
There are numerous anecdotal reports of
well-known athletes using hypnosis to enhance
sports performance. Undoubtedly, some of
these reports involved the use of visualization,
which was then inaccurately labeled as hypnosis
in the popular media. Although hypnosis and
visualization share some common elements,
they are not the same. For example, visualiza-
tion is not preceded by a hypnotic induction.
Thus, visualization would be more similar to
use of imaginative suggestions. However, there
do appear to be some instances in which well-
known athletes used hypnosis to enhance per-
formance (e.g., Tiger Woods, Nolan Ryan). For
example, in his biography of Tiger Woods, Lon-
dino (2010) describes how a sports psychologist
worked with Tiger Woods when he was a teen-
ager, using hypnosis to sharpen his ability to
focus in the moment on the golf course.
Empirical research has shown that hypnosis
is a very effective intervention for a variety of
problems and symptoms, including pain (Mont-
 HYPNOSIS AND SPORTS PERFORMANCE
gomery, DuHamel, & Redd, 2000; Patterson &
Jensen, 2003), chemotherapy-related nausea
and vomiting (Richardson et al., 2007), smok-
ing cessation (Green, 2010; Green & Lynn,
2000), weight loss (Kirsch, 1996), and psycho-
somatic disorders (Flammer & Alladin, 2007).
In this article, we present a comprehensive
methodological review of research on the hyp-
notic enhancement of sports performance. More
specifically, our first goal is to describe the
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results of all controlled and single-case design
This document is copyrighted by the American Psychological Association or one of its allied publishers.
studies of the effectiveness of hypnosis for im-
proving sports performance. Our second goal is
to weigh the methodological strengths and lim-
itations of this body of research. Finally, our
third goal is to appraise these studies using the
criteria for empirically supported therapies ad-
vanced by Chambless and Hollon (1998). Over
the last 15 years, there have been a number of
selective reviews of the use of hypnosis in sport
and exercise (Barker, Jones, & Greenlees, 2013;
Morgan, 1996; Stegner & Morgan, 2010). How-
ever, ours is the first article to comprehensively
review all controlled and single-case design out-
come studies, to critique the methodology of
this literature, and to identify investigations sat-
isfying the criteria for empirically supported
therapies (Chambless & Hollon, 1998).
Method of Review
To be included in this review, controlled
studies were required to use a between-
subjects or mixed model design in which a
hypnosis intervention was compared with at
least one alternative intervention, or a pla-
cebo, attention, standard intervention, or no-
treatment control condition to enhance sports
performance. Single-case design studies were
required to incorporate baseline and interven-
tion phases, with multiple assessment points
during the baseline phase to establish a stable
trend for the target behavior. No studies were
included that failed to use a performance
measure as an outcome variable (e.g., DeVos,
Potgieter, & Blaauw, 1999). Finally, studies
were required to be published in an English-
language journal.
PsycINFO was searched for abstracts meet-
ing the stated inclusion criteria through the mid-
dle of April, 2015. Search terms were hypnosis
in combination with either sports or sports psy-
chology. This yielded a total of 142 records. An
47
additional six records were identified through
other sources (e.g., references of relevant re-
view articles). This produced a total of 148
records to be screened relative to the inclusion
criteria. Of these, 121 records were excluded,
leaving 27 records to be examined in greater
detail. These 27 articles were read in full and 10
were excluded based on the inclusion criteria.
This left a total of 17 articles (i.e., six controlled
and 11 single-case design studies) to be in-
cluded in the review. Figure 1 details the
screening and selection process.
Table 1 summarizes the major characteristics
of the controlled studies, including sample size
and type of sport, intervention conditions, and
key findings. Table 2 summarizes the major
characteristics of the single-case design studies.
The 17 studies can be grouped based on type of
sport into the following seven categories: (a)
basketball, (b) golf, (c) soccer, (d) racquet
sports, (e) endurance and strength sports, (f)
precision sports, and (g) other sports.
Summary of Controlled and Single-Case
Design Studies
Basketball
Three studies examined the effects of hypno-
sis on basketball shooting. In a controlled study,
Schreiber (1991) evaluated the effectiveness of
hypnotic suggestions for increased confidence,
concentration, and that the basket would appear
twice as large as its normal size to improve
shooting performance during college basketball
games. Athletes in the hypnosis condition
achieved higher cumulative scores four weeks
into the basketball season than the control con-
dition, although inferential statistics for this
comparison were not reported.
In a series of single-case design studies,
Pates, Maynard, and colleagues utilized a hyp-
notic intervention featuring suggestions to re-
call a multisensory experience of a best basket-
ball performance to successfully improve the
jump- and set-shooting (Pates, Maynard, &
Westbury, 2001), as well as three-point shoot-
ing (Pates, Cummings, & Maynard, 2002) of
college players. The findings of these studies
suggest hypnosis is an effective intervention for
enhancing basketball shooting.
 48 MILLING AND RANDAZZO

142 records 6 additional records

Identification
identified through identified through
database searching other sources

148 records after duplicates removed

148 records screened

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121 records excluded:

Screening

Review (n=14)
Case study or practice materials (n=18)
Book (n=14)
Commentary or book review (n=5)
Dissertation abstract (n=7)
Not controlled or single-case design
outcome study (n=4)
Not English-language (n=11)
Not relevant to topic (n=48)

27 full-text articles
assessed for
Eligibility

eligibility

10 full-text articles excluded:

Case study or practice materials (n=1)
Sports performance not an outcome
(n=6)
Not controlled or single-case design
outcome study (n=3)
Included

17 studies included
in review

Figure 1. PRISMA flow chart.

Golf the effectiveness of this intervention for enhanc-

In three single-case design studies, Pates,
Maynard, and colleagues examined the effects
of hypnosis on golf performance. A hypnotic
intervention was used to help golfers evoke a
multisensory experience of their best competi-
tive golf match in order to successfully improve
putting accuracy (Pates, Oliver, & Maynard,
2001), chipping accuracy (Pates & Maynard,
2000), and average stroke performance (Pates,
2013). Results from these three studies support
ing golf skills.
Soccer
Two studies by Barker and colleagues exam-
ined the effects of hypnosis on soccer ability.
Both studies used a hypnotic intervention that
included ego-strengthening suggestions to fos-
ter feelings of confidence and composure. In a
single-case design study, Barker and Jones
(2008) utilized this intervention with a profes-
 HYPNOSIS AND SPORTS PERFORMANCE 49

Table 1
Characteristics of Controlled Studies of Hypnosis for Enhancing Sports Performance
Sample size
Study (sport) Intervention conditions Summary of key findings
Barker, Jones, & 59 (soccer) Hyp suggestions for confidence Hyp improved soccer wall-volley
Greenlees (2010) and composure performance more than C
C video attention control
Greer & Engs (1986) 90 (tennis) Hyp suggestions to visualize Hyp no different from PR and C on
forehand and backhand drives tennis-rally test
PR Progressive relaxation
C standard instruction
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Howard & Reardon 32 (weight CHI Cognitive hypnotic CHI improved bench press
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(1986) lifting) imagery performance, as well as arm and

Hyp Hypnosis only
CR Cognitive restructuring
C no-treatment control
Jalene & Wulf 22 (throwing) Hyp suggestions for throwing
(2014) accuracy
C no-treatment control
Schreiber (1991) 24 (basketball) Hyp suggestions for confidence
and concentration
C no-treatment control
Wojcikiewicz & 33 (fencing) Hyp posthypnotic suggestions
Orlick (1987) for confidence and relaxation
R Relaxation
C no-treatment control
chest size more than Hyp, CR,
and C
Hyp reduced throwing errors more
than C
Hyp may have increased cumulative
points scored more than C
Hyp no different from R and C in
fencing performance

sional soccer player. After receiving the inter-
vention, the player self-reported improvements
in passing, tackling, heading, ball control, and
decision-making. However, the lack of an ob-
jective performance measure makes it impossi-
ble to know whether there were actual improve-
ments in play.
In a controlled study, Barker, Jones, and
Greenlees (2010) utilized the hypnosis interven-
tion described above to increase accuracy on a
wall-volley task in which a soccer ball was
repeatedly kicked at a target. Collegiate soccer
players who received the hypnosis intervention
performed significantly better than those in the
attention-control group. These investigations
suggest that hypnosis may be an effective inter-
vention for improving soccer performance.
Racquet Sports
In a controlled study, Greer and Engs (1986)
assigned beginning tennis players to hypnosis,
progressive relaxation, or standard instruction
conditions. Players in the hypnosis condition
experienced suggestions to visualize forehand
and backhand drives. There was no difference
between conditions on a tennis-rally test. In
contrast, in a single-case design study, Pates and
Palmi (2002) used a hypnotic intervention that
included suggestions to evoke a multisensory
experience of a best badminton performance to
successfully improve the serve accuracy of uni-
versity badminton players.
Endurance and Strength Sports
In a single-case design study, Heyman (1987)
was unable to show that a hypnotic suggestion
to silence crowd noise was able to improve the
in-fight performance of an amateur boxer. Sim-
ilarly, Lindsay, Maynard, and Thomas (2005)
used a single-case design to evaluate the effect
of hypnosis on the race performance of three
elite cyclists. During hypnosis, athletes were
asked to recall a multisensory experience of an
optimal cycling performance. The intervention
was highly similar to the one successfully uti-
lized in the studies of basketball (Pates et al.,
2002; Pates, Maynard, & Westbury, 2001), golf
(Pates, 2013; Pates & Maynard, 2000; Pates,
Oliver, & Maynard, 2001), and badminton
(Pates & Palmi, 2002) described above. Race
performance was positively affected in one cy-
clist, sporadically affected in a second cyclist,
and not affected in a third cyclist. These results
fail to provide clear support for the effective-
 50 MILLING AND RANDAZZO

Table 2
Characteristics of Single-Case Design Studies of Hypnosis for Enhancing Sports Performance
Sample size
Study (sport) Hypnosis intervention Summary of key findings
Barker & Jones (2006) 1 (cricket) Hyp suggestions for confidence Hyp improved cricket
and composure performance
Barker & Jones (2008) 1 (soccer) Hyp suggestions for confidence Hyp improved self-reported
and composure soccer performance
Heyman (1987) 1 (boxing) Hyp suggestions to silence Hyp did not improve in-fight
crowd noise performance
Lindsay, Maynard, & 3 (cycling) Hyp suggestions for Hyp improved race performance
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Thomas (2005) multisensory experience of best of 1 out of 3 cyclists

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performance
Pates (2013) 1 (golf) Hyp suggestions for Hyp improved golf stroke
multisensory experience of best average
performance
Pates, Cummings, & 5 (basketball) Hyp suggestions for Hyp improved three-point
Maynard (2002) multisensory experience of best shooting accuracy
performance
Pates & Maynard (2000) 3 (golf) Hyp suggestions for Hyp improved golf chipping
multisensory experience of best accuracy
performance
Pates, Maynard, & 3 (basketball) Hyp suggestions for Hyp improved jump- and set-
Westbury (2001) multisensory experience of best shooting accuracy
performance
Pates, Oliver, & Maynard 5 (golf) Hyp suggestions for Hyp improved golf putting
(2001) multisensory experience of best accuracy
performance
Pates & Palmi (2002) 4 (badminton) Hyp suggestions for Hyp improved short serve
multisensory experience of best accuracy
performance
Robazza & Bortoli 1 (archery) Hyp suggestions for body Hyp improved shooting
(1995) awareness, focus, and flow accuracy

ness of this intervention to enhance cycling
performance.
However, in a controlled study, Howard and
Reardon (1986) randomly assigned weight lift-
ers to cognitive-hypnotic imagery, hypnosis
only, cognitive restructuring or control condi-
tions. Weight lifters assigned to the cognitive-
hypnotic imagery group received suggestions
for imagery designed to increase muscular
growth and improved bench press performance.
Lifters in the hypnosis only group received sug-
gestions for relaxation and visualization of a
pleasant scene. The cognitive-hypnotic imagery
condition produced significantly greater im-
provements than the other three conditions in
arm and chest size, as well as on bench press
performance.
Precision Sports
In a single-case design study, Robazza and
Bortoli (1995) utilized a hypnotic intervention
consisting of suggestions to improve body aware-
ness during stance, focus during draw and aim,
and natural flow of movement to successfully
improve the shooting accuracy of an expert archer.
Likewise, in a controlled study of throwing accu-
racy, Jalene and Wulf (2014) assigned undergrad-
uate participants to either hypnosis or control con-
ditions. The hypnosis intervention consisted of
direct suggestions for throwing accuracy. The
hypnosis group demonstrated fewer throwing er-
rors than the control group.
Other Sports
In a controlled study, Wojcikiewicz and Or-
lick (1987) randomly assigned fencers to hyp-
nosis, relaxation, or control conditions. Partici-
pants assigned to the hypnosis group were given
posthypnotic suggestions for relaxation and
confidence. No difference was observed be-
tween the three conditions on fencing perfor-
mance measures in national-level fencing com-
 HYPNOSIS AND SPORTS PERFORMANCE 51

petition. However, in a single-case design
study, Barker and Jones (2006) employed ego-
strengthening suggestions to increase feelings
of confidence and composure to successfully
improve the bowling average, strike rate, and
number of wickets taken of a semiprofessional
cricket player. The intervention was highly sim-
ilar to the one successfully used to enhance
soccer wall-volley performance described ear-
lier (Barker et al., 2010).
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controlled and single-case design studies, re-
spectively. Table 3 evaluates the 17 studies rel-
ative to the other five methodological criteria.
Studies are designated by a Yes when a par-
ticular criterion was satisfied and by a No
when not satisfied.
Sample Size
According to Chambless and Hollon (1998),

for a single-case design study to be designated

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Methodological Considerations as empirically supported, there must be at least

The 17 studies included in this review were
appraised relative to six methodological crite-
ria: (a) sample size, (b) specification of sample,
(c) use of a treatment manual, (d) direct statis-
tical comparison of experimental conditions, (e)
stable baseline, and (f) assessment of hypnotic
suggestibility. Some criteria were selected be-
cause they are mentioned in the Chambless and
Hollon (1998) framework for empirically sup-
ported therapies and others because they reflect
general methodological rigor. Only single-case
design studies were evaluated according to
whether they established a stable baseline
across three or more assessment periods. Also,
only controlled studies were evaluated as to
whether they included a direct statistical com-
parison of the experimental conditions. Tables 1
and 2 show the sample size for each of the
three participants. Six of the 11 single-case de-
sign studies included at least three participants
(Lindsay et al., 2005; Pates et al., 2002; Pates &
Maynard, 2000; Pates, Maynard, & Westbury,
2001; Pates, Oliver, & Maynard, 2001; Pates &
Palmi, 2002). In a controlled study, there must
be a sufficient number of participants per ex-
perimental condition to provide adequate statis-
tical power. As a rule of thumb, we consider 15
participants per condition to represent the min-
imum, although it seems likely that many more
participants might be necessary to detect an
effect of small to moderate size. Of the six
controlled studies, four incorporated fewer than
15 participants per condition (Howard & Rear-
don, 1986; Jalene & Wulf, 2014; Schreiber,
1991; Wojcikiewicz & Orlick, 1987). In con-
trast, only two controlled studies utilized rela-
tively large samples, with more than 25 partic-

Table 3
Methodological Criteria
Specification Treatment Statistical comparison Stable Hypnotic
Study of sample manual of conditions baseline suggestibility
Barker et al. (2010) No Yes Yes No
Greer & Engs (1986) No No Yes No
Howard & Reardon (1986) No No Yes No
Jalene & Wulf (2014) No No Yes No
Schreiber (1991) No No No No
Wojcikiewicz & Orlick (1987) No No Yes No
Barker & Jones (2006) No Yes No No
Barker & Jones (2008) No Yes Yes No
Heyman (1987) No No No Yes
Lindsay et al. (2005) No Yes Yes No
Pates (2013) No Yes Yes No
Pates et al. (2002) No Yes Yes No
Pates & Maynard (2000) No Yes Yes No
Pates, Maynard, & Westbury (2001) No Yes Yes No
Pates, Oliver, & Maynard (2001) No Yes Yes No
Pates & Palmi (2002) No Yes Yes No
Robazza & Bortoli (1995) No No No No
 52 MILLING AND RANDAZZO
ipants per condition (Barker et al., 2010; Greer
& Engs, 1986).
Specification of Sample
To be able to determine the population to
which the results of a study generalize, it is
important to specify the age, sex, and race of
participants. Of the 17 reviewed studies, all but
two indicated the sex and age of study partici-
pants (Greer & Engs, 1986; Wojcikiewicz &
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Orlick, 1987). In contrast, none of the 17 studies
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identified the race of study participants. Be-
cause race was not specified in any of the stud-
ies, it is difficult to estimate how well the find-
ings of this literature generalize to the
population of all athletes.
Use of a Treatment Manual
A treatment manual makes it more likely that
a treatment or intervention will be delivered
consistently within a single research team, or
across different research teams. Indeed, to iden-
tify a treatment or intervention as empirically
supported, a study must utilize a manual, unless
the treatment is simple and adequately de-
scribed in the journal article (Chambless & Hol-
lon, 1998). Ten of the 17 reviewed studies uti-
lized the equivalent of a manual (Barker &
Jones, 2006; Barker & Jones, 2008; Barker et
al., 2010; Lindsay et al., 2005; Pates, 2013;
Pates et al., 2002; Pates & Maynard, 2000;
Pates, Maynard, & Westbury, 2001; Pates, Ol-
iver, & Maynard, 2001; Pates & Palmi, 2002). It
is worth noting that these 10 studies were car-
ried out by just two research groups.
Statistical Comparison of
Experimental Conditions
In a controlled study, the effect of a treatment
should be established using a direct statistical
test of differences between the treatment and
control conditions. Regrettably, one of the six
controlled studies did not report inferential sta-
tistics (Schreiber, 1991). Another unfortunate
statistical practice noted in this literature should
be mentioned here. This practice involves cal-
culating simple pre/post change scores and then
performing multiple within-condition statistical
tests to ascertain whether there were differences
between conditions (e.g., DeVos et al., 1999).
This approach is vulnerable to a regression to
the mean effect and increases alpha beyond .05
by a multiple of the number of tests performed.
Appropriate inferential statistical tests such as
repeated measures analysis of variance or anal-
ysis of covariance should be utilized in a con-
trolled study and alpha can be regulated using a
Bonferroni correction.
Stable Baseline
According to the Chambless and Hollon
(1998) framework for empirically supported
therapies, a single-case design study must es-
tablish a stable baseline for the behavior of
interest across at least three assessment periods.
Because the baseline period serves as the equiv-
alent of a control condition, a stable or deteri-
orating baseline enables a researcher to control
for the passage of time and the effects of as-
sessment. Only three of the 11 single-case de-
sign studies failed to establish a stable baseline
across three or more assessment periods.
Hypnotic Suggestibility
In the hypnosis literature, the terms hyp-
notic suggestibility, hypnotic susceptibility,
hypnotic responsiveness, and hypnotizability
are used interchangeably. Hypnotic suggest-
ibility is a traitlike individual difference vari-
able indicating a persons general tendency to
respond to hypnosis and hypnosis suggestions
(Gur, 1978). Hypnotic suggestibility can be
assessed with standardized scales consisting
of a hypnotic induction and a series of test
suggestions. Research with these scales
shows there are large individual differences in
suggestibility (Gwynn & Spanos, 1996). For
example, on the Stanford Hypnotic Suscepti-
bility Scale, Form C, widely regarded as the
gold standard of suggestibility measures,
about 25% of the normative sample scored in
the high range of hypnotic suggestibility,
about 30% scored in the medium range, and
about 45% in the low range (Hilgard, 1965).
Lynn and Shindler (2002) recommend as-
sessing hypnotic suggestibility when investigat-
ing the effects of hypnosis as a treatment or
intervention. In a controlled study, assessing
hypnotic suggestibility makes it possible to test
whether there is a statistical interaction between
suggestibility and treatment outcome. This has
to the potential to show that the effects of a
hypnotic intervention vary for athletes scoring
 HYPNOSIS AND SPORTS PERFORMANCE
at different suggestibility levels. In a single-case
design study, assessing hypnotic suggestibility
seems especially crucial because of the very
small number of participants. The representa-
tion of hypnotic suggestibility in a small sample
of one to five athletes could easily be skewed,
which might account for a large treatment ef-
fect or none at all. Unfortunately, hypnotic
suggestibility was assessed in only one of the 17
reviewed studies (Heyman, 1987).
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This document is copyrighted by the American Psychological Association or one of its allied publishers.
Empirically Supported Therapies
According to the American Psychological
Association (APA), an empirically supported
therapy is a psychological intervention that has
been identified through research as likely to be
helpful for a particular problem and population.
In 1995, the APA Division 12 Task Force on
Promotion and Dissemination of Psychological
Procedures introduced a framework for evalu-
ating the results of outcome studies to identify a
treatment as empirically supported (Task Force
on Promotion and Dissemination of Psycholog-
ical Procedures, 1995), which was later refined
by Chambless and Hollon (1998).
This framework maintains that to classify a
treatment as possibly efficacious, there must be
at least one study using a between-groups de-
sign showing that the intervention is superior to
no treatment, a placebo, or an alternative inter-
vention, or the equivalent of an intervention
previously identified as possibly efficacious
(Chambless & Hollon, 1998). To classify a
treatment as efficacious, there must be at least
two studies using a between-groups design sat-
isfying these criteria carried out by two separate
investigative groups. Finally, to classify a treat-
ment as efficacious and specific, there must be
studies carried out by two separate investigative
groups showing the intervention is superior to a
placebo or intervention previously identified as
efficacious in research controlling for nonspe-
cific factors. Such studies must use a treatment
manual or its equivalent, clearly describe the
sample under investigation, and adhere to the
principles of sound research methodology.
According to these criteria, the hypnotic in-
tervention utilized by Barker and colleagues
(Barker et al., 2010) can be classified as a pos-
sibly efficacious therapy for improving soccer
wall-volley performance. This intervention was
designed to increase efficacy expectations and
53
consisted of three 45-min small group sessions.
Each session was comprised of three phases.
The first phase was a question and answer pe-
riod about hypnosis intended to facilitate rap-
port. The second phase consisted of a hand-
clasp suggestion designed to acclimatize
participants to hypnosis. The third phase incor-
porated progressive relaxation procedures and
ego-strengthening suggestions specific to the
wall-volley task, emphasizing feelings of con-
fidence and composure.
This intervention was more effective than an
attention-control condition in improving wall-
volley performance immediately after the third
intervention session, as well as at follow-up
four weeks later. In the attention-control condi-
tion, participants watched videos of profes-
sional soccer games edited to eliminate the
modeling of behaviors that could have en-
hanced self-efficacy. The wall-volley task re-
quired the athletes to kick a soccer ball at a
target 2.7 m wide from a distance of 7.6 m
continuously for 90 s, with accuracy of the shots
serving as the outcome measure. In a volley, a
soccer player kicks a ball in flight without first
controlling it using a trap or dribble. The re-
searchers utilized a relatively large sample of 59
participants, the equivalent of a treatment man-
ual, and clearly described the gender and age
characteristics of their sample. Although the
racial breakdown of the sample was not re-
ported, it was later determined that 92% of
participants were White and 8% of participants
were Black (J. Barker, personal communication,
January 26, 2015).
According to Chambless and Hollon (1998),
studies using a single-case design may be used
to classify a treatment as empirically supported.
To do so, an investigator must establish a stable
baseline by showing the behavior targeted for
change is stable or demonstrates a pattern of
decline for at least three assessment points prior
to carrying out the intervention. Acceptable sin-
gle-case study designs include (but are not lim-
ited to) the ABAB design, in which A is a
baseline period and B is an intervention period,
as well as the multiple baseline design, in which
an intervention is carried out across multiple
participants, settings, or behaviors.
In a single-case study design, to classify a
treatment as possibly efficacious, an interven-
tion must be shown to be effective with at least
three participants in research carried out by a
 54 MILLING AND RANDAZZO
single investigative group. To classify a treat-
ment as efficacious, an intervention must be
shown to be useful in at least three studies, with
at least three participants each, carried out by at
least two separate investigative groups. Finally,
to classify a treatment as efficacious and spe-
cific, there must be comparable studies showing
that the intervention is superior to an alternative
treatment controlling for expectancy and atten-
tion, as well as assessment effects.
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According to these criteria, the hypnosis in-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
tervention utilized by Pates, Maynard, and col-
leagues can be classified as a possibly effica-
cious intervention for enhancing performance in
golf (Pates & Maynard, 2000; Pates, Oliver, &
Maynard, 2001) and basketball (Pates et al.,
2002; Pates, Maynard, & Westbury, 2001). The
hypnosis intervention used in these studies was
designed to increase flow and consisted of four
phases: relaxation, hypnotic induction, hypnotic
regression, and trigger control.
During the first phase, participants were in-
structed to engage in deep breathing and pro-
gressive muscle relaxation. During the second
phase, participants experienced a staircase in-
duction in which they were asked to imagine
descending a flight of 20 stairs, opening a door
to a room containing a comfortable chair, sitting
in the chair, and viewing relaxing scenes on a
cinema screen. In the third phase, participants
were asked to recall a multisensory (i.e., visual,
auditory, tactile, olfactory, and gustatory) expe-
rience of a best performance in their sport. In
the fourth phase, participants recall of a best
performance was conditioned to be released by
a trigger. Suggestions were given so that the
trigger could be used to access associations with
the best performance at some point in the future.
Triggers included gripping the golf putter
(Pates, Oliver, & Maynard, 2001), the basket-
ball (Pates et al., 2002), music (Pates & May-
nard, 2000), and a word (Pates, Maynard, &
Westbury, 2001).
In a series of rigorous single-case design
studies each with at least three participants,
Pates, Maynard, and colleagues established a
stable baseline across at least three assessment
periods, utilized the equivalent of a treatment
manual, and described the sex and age charac-
teristics of their participants. The researchers
did not report the racial composition of their
samples. However, it was later determined that
all three basketball players were White in Pates,
Maynard, & Westbury (2001), whereas four
basketball players were White and one player
was Black in Pates et al. (2002). In Pates and
Maynard (2000), all three golfers were White,
whereas in Pates, Oliver, & Maynard (2001),
four golfers were White and one golfer was
Asian (I. Maynard, personal communication,
January 30, 2015). Notably, this intervention
could have been designated as a possibly effi-
cacious therapy for improving performance in
badminton had it been possible to determine the
racial composition of the sample in Pates and
Palmi (2002).
Discussion
Our review of 17 single-case design and con-
trolled studies suggests that hypnosis is an ef-
fective intervention for enhancing performance
in basketball (Pates et al., 2002; Pates, May-
nard, & Westbury, 2001; Schreiber, 1991) and
golf (Pates, 2013; Pates & Maynard, 2000;
Pates, Oliver, & Maynard, 2001). Hypnosis also
appears to show great promise as an interven-
tion for improving soccer (Barker et al., 2010)
and badminton skills (Pates & Palmi, 2002).
Finally, there is preliminary evidence that hyp-
nosis may be useful for enhancing performance
in cricket (Barker & Jones, 2006), weight-
lifting (Howard & Reardon, 1986), as well as
precision sports activities like archery (Robazza
& Bortoli, 1995) and throwing accuracy (Jalene
& Wulf, 2014).
Generally, the methodological rigor of the
single-case design studies included in this re-
view exceeded that of the controlled studies. Six
of the 11 single-case design studies had rela-
tively robust samples of at least three partici-
pants. Furthermore, approximately three-
quarters of these studies established a stable
baseline for the target behavior of at least three
assessment periods and utilized a treatment
manual or its equivalent. In contrast, five of the
six controlled studies did not use a treatment
manual and one of these studies also failed to
perform a direct statistical test of differences
between the treatment and control conditions.
Moreover, the majority of the controlled studies
could be characterized as possessing limited
statistical power, with four of the six studies
incorporating 15 or fewer participants per ex-
perimental condition. Of note, none of the 17
 HYPNOSIS AND SPORTS PERFORMANCE
reviewed studies specified the race of partici-
pants.
Another methodological limitation evident
throughout this literature involved a failure to
assess hypnotic suggestibility. As previously
mentioned, assessing hypnotic suggestibility is
necessary to establish the representativeness of
the small samples characteristic of single-case
design studies. In controlled studies, measuring
hypnotic suggestibility makes it possible to test
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whether there is a statistical interaction between
This document is copyrighted by the American Psychological Association or one of its allied publishers.
suggestibility and treatment outcome. Unfortu-
nately, hypnotic suggestibility was assessed in
only one of the 17 studies included in this
review. Although hypnotic depth (i.e., the de-
gree to which the person believes he or she was
hypnotized) was measured in a few studies, this
construct is distinct from hypnotic suggestibil-
ity.
The importance of assessing hypnotic sug-
gestibility is highlighted by outcome studies
carried out both in the laboratory (Milling,
Reardon, & Carosella, 2006) and in clinical
settings (see Montgomery, Schnur, & David,
2011 for a meta-analysis) showing that suggest-
ibility moderates the treatment effects of hyp-
nosis. Indeed, the Montgomery et al. meta-
analysis reported that the effect size for the
association between suggestibility and hypnotic
outcomes for a variety of clinical problems fell
in the small to medium range. The relationship
between suggestibility and treatment outcome is
perhaps clearest in studies of pain. A meta-
analysis of the effectiveness of hypnotic pain
interventions found that the average effect size
for participants scoring in the high range of
suggestibility was D ! 1.16, which is consid-
ered a large effect, and nearly zero for those
scoring in the low suggestibility range (Mont-
gomery et al., 2000). In view of its potency as a
moderator variable, future studies of the use of
hypnosis for enhancing sports performance are
encouraged to assess hypnotic suggestibility us-
ing a standardized scale and to assess its relation
to treatment outcome in controlled research us-
ing the analytic strategy of Baron and Kenny
(1986).
Two hypnotic interventions included in this
review satisfied criteria for empirically sup-
ported therapies. Specifically, the hypnotic in-
tervention developed by Barker et al. (2010)
met criteria as a possibly efficacious therapy for
improving soccer skills. Likewise, the hypnotic
55
intervention advanced by Pates, Maynard, and
colleagues met criteria as a possibly efficacious
therapy for enhancing performance in golf
(Pates & Maynard, 2000; Pates, Oliver, & May-
nard, 2001) and basketball (Pates et al., 2002;
Pates, Maynard, & Westbury, 2001). It is a
propitious development that two hypnotic inter-
ventions for enhancing sports performance can
be classified as possibly efficacious therapies.
Over the last 10 years, there has been a grow-
ing emphasis in psychology on evidence-based
practice (APA Presidential Task Force on Evi-
dence-Based Practice, 2006), including in
sports psychology (McArdle & Moore, 2012;
Moore, 2007). Identifying an intervention as
empirically supported is one way of engaging in
evidence-based practice. However, empirically
supported therapies and evidence-based prac-
tice are not synonymous (Westen, Novotny, &
Thompson-Brenner, 2005). According to the
APA Presidential Task Force on Evidence-
Based Practice, 2006, evidence-based practice
in psychology (EBPP) is the integration of the
best available research with clinical expertise in
the context of patient characteristics, culture,
and preferences (p. 273). In turn, empirically
supported therapies represent some of the best
available research evidence that can be utilized
in the clinical decision making process (Spring,
2007). Although the interventions used in ap-
plied sports psychology are not therapies per se
and athletes are not patients, the principles of
evidence-based practice are nevertheless ger-
mane.
Mechanisms of Empirically
Supported Interventions
More research is needed on the mechanisms
that could help to explain how the hypnotic
interventions developed by Barker, as well as
Pates and Maynard work. According to Pates &
Maynard (2000), their hypnosis intervention
functions by increasing flow (Csikszentmihalyi,
1975), in which the person becomes completely
immersed in a challenging activity, loses their
sense of self-awareness, and successfully per-
forms the activity with a sense of automaticity.
An athlete might describe this experience as
being in the zone. In their rigorous series of
single-case design studies, Pates, Maynard, and
colleagues consistently showed that this inter-
vention produced both higher self-reported flow
 56 MILLING AND RANDAZZO
states and better performance in golf (Pates,
2013; Pates & Maynard, 2000; Pates, Oliver, &
Maynard, 2001), basketball (Pates et al., 2002),
and badminton (Pates & Palmi, 2002). How-
ever, as these researchers acknowledge, changes
in flow scores did not always mirror changes in
performance. Also, because flow was always
measured after performance in each of these
studies, it becomes difficult to say that changes
in flow produced improvements in performance.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Barker (e.g., Barker et al., 2010) contends
This document is copyrighted by the American Psychological Association or one of its allied publishers.
that his hypnosis intervention works by increas-
ing efficacy expectations, or the persons belief
that he or she can successfully execute a specific
behavior necessary to bring about a particular
outcome (Bandura, 1997). In several rigorous
single-case design studies, Barker and Jones
demonstrated that this hypnosis intervention
produced increases in efficacy expectations in a
cricket player (Barker & Jones, 2006) and a
professional soccer player (Barker & Jones,
2008). However, the extent to which changes in
efficacy expectations played a causal role in
producing performance gains is unclear.
Later, in a controlled study, Barker et al.
(2010) demonstrated that collegiate soccer play-
ers who received this intervention achieved
larger increases in self-efficacy and performed
better on a wall-volley task than those in a
control group. Unfortunately, changes in self-
efficacy failed to mediate the effect of hypnosis
on wall-volley performance. However, because
of the size of the sample in this study (n ! 59),
the regressions required to test mediation may
have lacked sufficient statistical power to detect
an effect. Now that the effectiveness of the
hypnosis interventions developed by Barker, as
well as Pates and Maynard have been demon-
strated, large scale controlled studies utilizing
Baron and Kennys (1986) method of testing
mediation would seem desirable to examine
whether changes in flow and efficacy expecta-
tions are mechanisms of these interventions.
Targeting Specific Sports
The findings of our review suggest the pos-
sibility that the hypnosis interventions evalu-
ated in this literature may be of greater benefit
to sports for which dexterity and coordination
are crucial attributes and of less benefit to sports
that depend primarily on strength or endurance.
For example, the very same intervention that
improved performance in basketball (Pates et
al., 2002; Pates, Maynard, & Westbury, 2001),
golf (Pates, 2013; Pates & Maynard, 2000;
Pates, Oliver, & Maynard, 2001), and badmin-
ton (Pates & Palmi, 2002) did not benefit cy-
cling (Lindsay et al., 2005). Notably, many of
the effective hypnosis interventions in this lit-
erature utilized suggestions for increased confi-
dence (Barker & Jones, 2008; Schreiber, 1991)
or recall of an optimal performance (Pates &
Maynard, 2000), which could serve as a buffer
against sports performance anxiety.
Sports performance anxiety is conceptualized
as a tendency to respond with anxiety to com-
petitive sports situations in which the adequacy
of the athletes performance is evaluated (Smith
& Smoll, 1990). Sports performance anxiety
can be operationalized along three dimensions:
somatic, worry, and concentration disruption
(Smith, Smoll, Cumming, & Grossbard, 2006).
The Yerkes-Dodson law states there is an in-
verted-U relation between arousal and perfor-
mance, and that increases in arousal beyond the
optimal level results in a deterioration of per-
formance (Yerkes & Dodson, 1908). According
to Smith (1996), the more complex the task,
the lower is the optimal level of arousal for
performing it. Thus, motor tasks that require
delicate movements and high demands for tim-
ing and coordination such as complex gymnas-
tics routines or hitting a golf ball, are more
likely to be disrupted by high levels of arousal
than are simple tasks such as running or lifting
a weight (p. 270). Indeed, empirical research
suggests that performance anxiety is more dis-
ruptive to sports emphasizing coordination and
fine motors skills than to those depending pri-
marily on gross motor skills (Mellalieu, Hanton,
& Fletcher, 2006; Smith & Smoll, 1990).
Consequently, by reducing high levels of
arousal (i.e., anxiety), hypnosis interventions in-
corporating suggestions that increase confidence
may be most beneficial to sports for which dex-
terity and coordination are key attributes. This
position is consistent with the findings of a recent
meta-analysis of the effectiveness of self-talk for
enhancing sports performance. Specifically,
Hatzigeorgiadis, Zourbanos, Galanis, and The-
odorakis (2011) reported that self-talk was signif-
icantly more effective in improving perfor-
mance in sports involving fine motor skills,
dexterity, eye-hand coordination, precision, and
accuracy (e.g., basketball, golf, dart throwing)
 HYPNOSIS AND SPORTS PERFORMANCE
than those emphasizing endurance, strength,
and power (e.g., cycling, long-distance running,
shot-put). Of course, it would be premature to
conclude that specific kinds of hypnosis inter-
ventions are more effective for enhancing per-
formance in some sports versus others based on
a literature consisting of only 17 studies. More
research on this issue would seem warranted.
Implications for Practice
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This document is copyrighted by the American Psychological Association or one of its allied publishers.
The findings of our review may have useful
implications for practice. Psychologists who work
with athletes may wish to consider utilizing hyp-
nosis and, specifically, the hypnotic interventions
developed by Pates and Maynard (Pates & May-
nard, 2000) and Barker (Barker & Jones, 2008) as
tools for enhancing sports performance. Classi-
cally, hypnosis involves direct suggestions for al-
terations in sensations, perceptions, thoughts, feel-
ings, and behaviors (Hilgard & Hilgard, 1994).
Lately, however, some practitioners have de-
emphasized the role of direct suggestions and are
more likely to provide established cognitive
behavioral techniques in a hypnotic context
(Kirsch, Montgomery, & Sapirstein, 1995). From
this perspective, interventions such as visualiza-
tion and self-talk could be preceded by a hypnotic
induction and relabeled as hypnotic visualization
and hypnotic self-talk.
It is important to recognize there are large in-
dividual differences in hypnotic responding (Gw-
ynn & Spanos, 1996). Consequently, hypnosis is
unlikely to be an appropriate intervention for ev-
ery athlete. On the contrary, there is some evi-
dence showing that athletes, as a group, may be
more responsive to hypnosis than nonathletes
(Dunlap, 2005). Attitudes (Kirsch, Silva, Comey,
& Reed, 1995) and expectancies (Kirsch, 1997b)
have been shown to be important predictors of
hypnotic responding. An athlete who has a posi-
tive attitude and expectancies regarding hypnosis
may be a good candidate for hypnotic interven-
tion. If an athlete has negative beliefs about hyp-
nosis, it may make more sense to use nonhypnotic
interventions, such as visualization or self-talk.
There are many misconceptions about hypnosis
(Kirsch & Lynn, 1995), which, if corrected, could
help to foster a more positive attitude. At the same
time, it is important for athletes to be realistic
about the limits of hypnosis. For example, hyp-
notic suggestions could not somehow impart an
average high school tennis player with the skills of
57
Serena Williams. Finally, practitioners who pro-
vide hypnosis to athletes should have some train-
ing and experience in the use of this technique.
Conclusions
Support for the use of hypnosis as a tool for
enhancing sports performance once consisted
primarily of anecdotal reports (e.g., Tiger
Woods) and case histories. However, the evi-
dence base has strengthened in recent years,
thanks in part to the proliferation of rigorous
single-case design studies. Our review of 17
single-case design and controlled studies indi-
cates there is very solid evidence of the effec-
tiveness of hypnosis for improving sports per-
formance, particularly in basketball, golf,
soccer, and badminton. Indeed, two hypnosis
interventions were classified as possibly effica-
cious according to the criteria for empirically
supported therapies. To move research to the
next level, additional controlled studies, empha-
sizing the use of treatment manuals, specifica-
tion of study samples, assessment of hypnotic
suggestibility, and evaluation of hypothesized
mechanisms, are needed. Practitioners who
work with athletes may wish to consider hyp-
nosis as a useful tool for improving sports per-
formance and as a way of engaging in evidence-
based practice in sports psychology.
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Received February 1, 2015
Revision received April 23, 2015
Accepted April 27, 2015 !

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