Hypnosis in psychotherapy, psychosomatics and medicine. A brief overview

Aspects of hypnosis and its application in psychotherapy, psychosomatics and medicine are examined and contextualized in the 250-year history of hypnosis. Imagination as an essential element of hypnotic treatments appeared as early as 1784 as an argument rejecting the theory of animal magnetism of Franz Anton Mesmer. In somnambulism of German romanticism, another proto-form of hypnosis after 1800, concepts of the mind-body problem were dealt with, which still characterize the understanding of unconscious mental processes today. Hypnosis was at the beginning of psychoanalysis, but was not pursued further by Sigmund Freud from 1900 onwards. Nevertheless, there were some hypnoanalytical approaches in the 20th century, as well as attempts to integrate hypnosis into behavior therapy. Techniques of imagination and relaxation combine both; in particular findings from cognitive psychology explain processes of both hypnosis and cognitive behavioral therapy. The influence of social psychology brought a new perspective to the debate about the nature of hypnosis, which continues to this day: is hypnosis to be understood as a special state of consciousness or is it a completely normal, mundane interaction? The experiments that were carried out to support one side or the other were also dependent on the hypnotizability of the subjects involved, as the more difficult hypnotic phenomena such as paralysis, hallucinations or identity delusions can only be demonstrated by highly hypnotizable subjects. The fact that these are not mere compliance reactions has now been proven by many studies using imaging techniques. But even those who are moderately hypnotizable benefit from hypnosis rituals. Variables postulated by socio-cognitive hypnosis researchers, such as motivation and expectation, are relevant, as is a good "hypnotic rapport." Practical application of hypnotherapy today is characterized by the innovative techniques and strategies developed by Milton H. Erickson. Research into the effectiveness of hypnosis in the field of psychotherapy and psychosomatics still leaves much to be done. The situation is different in the field of medical hypnosis, where there are considerably more studies with a satisfactory design and verifiable effects. However, the impact in practical application in everyday medical practice is still low. Newer developments such as virtual reality and artificial intelligence are being looked at with critical interest.

Association of Hypnotizability, Interoception, and Emotion

The present scoping review reports the reciprocal relations between hypnotizability, interoception, and emotion. Brain morpho-functional differences may account for the lower interoceptive accuracy, higher interoceptive sensitivity, and different emotional strategies observed in highly hypnotizable participants with respect to medium-to-low hypnotizables. Since interoception is relevant to both physical and mental health and hypnotizability can predict both interoceptive abilities and the efficacy of interoception-based mental training, this allows for the development of new forms of treatment and rehabilitation.

Studies in patients with temporomandibular disorders pain: Can scales of hypnotic susceptibility predict the outcome on pain relief?

Many medical conditions are claimed to benefit when hypnosis is incorporated into their treatment. For some conditions, the claims are largely anecdotal, but the treatment of pain stands out in two ways. First, there is a strong body of evidence that hypnosis can produce clinically useful analgesic effects. Second, since innocuous pain can be induced in the laboratory, the process can be explored rigorously. This idea assumes that experimentally induced pain and clinical pain behave identically. We describe using experimentally induced pain in patients already suffering from temporomandibular disorders. Scanning results indicate that the pain and its amelioration are the same in the two circumstances. Moreover, the absence of any impact upon a nociceptive trigemino-facial reflex implies that the impact of hypnosis is purely cortical. Finally, we address the observation that clinical success correlates poorly with hypnotic susceptibility scores. It is proposed that a painful experimental situation induces anxiety. This, like hypnosis, has been associated with an emphasis on right hemisphere activity. Thus, clinical anxiety may render a person more responsive to hypnosis than would be indicated by a susceptibility test delivered in stress-free circumstances.

God Locus of Health Control, Paranormal Beliefs, and Hypnotizability

Belief in the paranormal (e.g., spirits, extrasensory perception, fortune telling, extraterrestrials) is common. Extraordinary and magical beliefs have been linked with hypnotizability. A total of 167 undergraduates completed measures of paranormal and magical beliefs, locus of control, absorption, fantasy proneness, expectancy about being hypnotized, and the God Locus of Health Control scale (GLHC) and were hypnotized with the HGSHS:A. High and medium hypnotizable participants more strongly agreed with statements reflecting paranormal and magical beliefs and the assertion that God directly controls their health, relative to those less responsive to hypnosis. Using stepwise regression, we found that expectations about hypnosis along with scores on the GLHC scale accounted for 26% and 30% of the variance in behavioral and subjective scores on the HGSHS:A, respectively. The authors discuss paranormal beliefs and the link between the GLHC and hypnotizability.

Does the Homo Hypnoticus Exist? Personality Styles of People Interested in Hypnosis

It may be that individuals who are interested in hypnosis will volunteer for hypnosis experiments or practice hypnosis. Do these "hypnosis-prone" individuals differ from hypno-neutral, nonhypnosis-prone individuals? If so, could one speak of a personality type, the homo hypnoticus? This study reports on 3 samples of individuals where there was no indication of hypnosis or no interest in hypnosis (NONHYP: N = 1426) and 4 samples of individuals who were interested in hypnosis (HYP: N = 1048). Using the Personality Styles and Disorders Inventory, we calculated contrast analyses for the contextual effect of HYP vs. NONHYP and gender effects. Results suggested there may be a homo hypnoticus personality style with the characteristics of intuitive-schizotypal, rhapsodic-optimistic, and charming-histrionic. These distinctions appear mostly in women.

COMT Genotype and Sensory and Sensorimotor Gating in High and Low Hypnotizable Subjects

We investigated the association between hypnotizability, COMT polymorphism, P50 suppression ratio, and prepulse inhibition of acoustic startle response (ASR) in 21 high (HH) and 19 low (LH) hypnotizable subjects. The frequency of Met/Met carriers of COMT polymorphysm was higher in HH than in LH group (33.3% versus 10.6%, p = .049). Increased ASR amplitude and latency and decreased prepulse inhibition at 120 ms lead interval were found in the HH compared to the LH group. The effect of COMT genotype on prepulse inhibition was observed in LH group only. No between-group differences in P50 measures were found. The obtained results suppose the participation of dopamine system in mechanisms of hypnotizability and different allocation of attentional resources in HH and LH subjects.

Hypnotizability, personality style, and attachment: an exploratory study, part 1-general results

This article is an exploratory study investigating the relationship between hypnotizability, personality style, and attachment. Data were collected from 99 students by means of the Harvard Group Scale of Hypnotic Susceptibility, Form A; Personality Styles and Disorders Inventory; and Relationship Scale Questionnaire. Results suggest that individual personality styles accounted for a significant amount of variance in hypnotizability in: (a) the whole sample, (b) the securely attached, and (c) the insecurely attached. High hypnotizables among both the whole sample and securely attached individuals shared the unselfish/self-sacrificing personality style as a main predictor of hypnotizability and displayed elevated scores for the charming/histrionic and the optimistic/rhapsodic personality style. Furthermore, two groups were identified among the high hypnotizables that differed mainly according to attachment style: one consists of securely attached, charming/histrionic, and optimistic/rhapsodic people, who are best described by socio-cognitive theories. The other is composed of insecurely attached intuitive/schizotypal people, who are better depicted by dissociation theories.

Carriers of the COMT Met/Met allele have higher degrees of hypnotizability, provided that they have good attentional control: a case of gene-trait interaction

Genetic factors may explain part of the interindividual variability in hypnotizability. A new avenue that may provide more comprehensive understanding of the phenotypic effects of genetic variations is the study of gene-trait interaction. In this study, the authors investigate the relationship of the dopamine-related COMT and the serotonin-related 5-HTTLPR polymorphisms to hypnotizability by taking individual differences in executive attention into account. Homozygosity for the COMT Met allele, putatively linked to the capability or proneness to dissociate from reality, was associated with high hypnotizability only if paired with high-attention ability. The finding can be integrated into hypnosis theory and represents a case of gene-trait interaction suggesting that investigating the effects of a gene in the context of relevant psychological traits may further elucidate gene-brain-behavior relationships.

Flexibility in processing visual information: effects of mood and hypnosis

This quasi-experiment using a real/simulator model investigated differences in cognitive flexibility in high and low hypnotizable participants. Using the variables of hypnotizability (low/high), consciousness (nonhypnotized/hypnotized), mood (happy/sad), and visual-information processing (global/local), reaction times and target detection paradigms of the subjects were evaluated during both nonhypnotic and hypnotic states. Flexibility in cognitive processing was operationalized as the ability to overcome the typical global precedence and answer quickly about the nonprevalent local features. It was observed that the low hypnotizable participants were not influenced in their preference for the global or local dimension by any manipulated variable, whereas the high hypnotizables were more flexible.

Dissociative tendencies and individual differences in high hypnotic suggestibility

INTRODUCTION

Inconsistencies in the relationship between dissociation and hypnosis may result from heterogeneity among highly suggestible individuals, in particular the existence of distinct highly suggestible subtypes that are of relevance to models of psychopathology and the consequences of trauma. This study contrasted highly suggestible subtypes high or low in dissociation on measures of hypnotic responding, cognitive functioning, and psychopathology.

METHODS

Twenty-one low suggestible (LS), 19 low dissociative highly suggestible (LDHS), and 11 high dissociative highly suggestible (HDHS) participants were administered hypnotic suggestibility scales and completed measures of free recall, working memory capacity, imagery, fantasy-proneness, psychopathology, and exposure to stressful life events.

RESULTS

HDHS participants were more responsive to positive and negative hallucination suggestions and experienced greater involuntariness during hypnotic responding. They also exhibited impaired working memory capacity, elevated pathological fantasy and dissociative symptomatology, and a greater incidence of exposure to stressful life events. In contrast, LDHS participants displayed superior object visual imagery.

CONCLUSIONS

These results provide further evidence for two highly suggestible subtypes: a dissociative subtype characterised by deficits in executive functioning and a predisposition to psychopathology, and a subtype that exhibits superior imagery and no observable deficits in functioning.

Classes of Multichannel EEG Microstates in Light and Deep Hypnotic Conditions

The study assessed the brain electric mechanisms of light and deep hypnotic conditions in the framework of EEG temporal microstates. Multichannel EEG of healthy volunteers during initial resting, light hypnosis, deep hypnosis, and eventual recovery was analyzed into temporal EEG microstates of four classes. Microstates are defined by the spatial configuration of their potential distribution maps ([Symbol: see text]potential landscapes') on the head surface. Because different potential landscapes must have been generated by different active neural assemblies, it is reasonable to assume that they also incorporate different brain functions. The observed four microstate classes were very similar to the four standard microstate classes A, B, C, D [Koenig, T. et al. Neuroimage, 2002;16: 41-8] and were labeled correspondingly. We expected a progression of microstate characteristics from initial resting to light to deep hypnosis. But, all three microstate parameters (duration, occurrence/second and %time coverage) yielded values for initial resting and final recovery that were between those of the two hypnotic conditions of light and deep hypnosis. Microstates of the classes B and D showed decreased duration, occurrence/second and %time coverage in deep hypnosis compared to light hypnosis; this was contrary to microstates of classes A and C which showed increased values of all three parameters. Reviewing the available information about microstates in other conditions, the changes from resting to light hypnosis in certain respects are reminiscent of changes to meditation states, and changes to deep hypnosis of those in schizophrenic states.

Changes in mismatch negativity across pre-hypnosis, hypnosis and post-hypnosis conditions distinguish high from low hypnotic susceptibility groups

The role of alterations in mismatch negativity (MMN) in hypnosis was examined by recording MMN of the auditory ERP at frontal (F3, Fz, and F4) and mastoid (M1 and M2) placements. Frontal MMN is believed to reflect activity in right anterior cortical generators, whereas MMN at mastoid leads reflects generators located bilaterally in the temporal auditory cortex. MMN recordings were obtained in 11 low and 12 high hypnotically susceptible participants in three successive blocks; pre-hypnosis, hypnosis and post-hypnosis. Frontal (but not temporal) MMN showed a significant quadratic trend across testing conditions. It increased during hypnosis and then dropped post-hypnosis for both susceptibility groups. Linear trends for frontal and temporal MMN showed directly opposite patterns of change in the interaction between hypnotic susceptibility and testing blocks. Frontal MMN built up linearly over the test blocks in high relative to low susceptibility participants. Temporal MMN showed the reverse pattern and increased linearly across test conditions in those with low relative to high hypnotic susceptibility.