The functional anatomy and connectivity of thought insertion and alien control of movement

How hypnotic suggestions work - A systematic review of prominent theories of hypnosis

In recent decades, hypnosis has increasingly moved into the mainstream of scientific inquiry. Hypnotic suggestions are frequently implemented in behavioral, neurocognitive, and clinical investigations and interventions. Despite abundant reports about the effectiveness of suggestions in altering behavior, perception, cognition, and agency, no consensus exists regarding the mechanisms driving these changes. This article reviews competing theoretical accounts that address the genesis of subjective, behavioral, and neurophysiological responses to hypnotic suggestions. We systematically analyze the broad landscape of hypnosis theories that best represent our estimation of the current status and future avenues of scientific thinking. We start with procedural descriptions of hypnosis, suggestions, and hypnotizability, followed by a comparative analysis of systematically selected theories. Considering that prominent theoretical perspectives emphasize different aspects of hypnosis, our review reveals that each perspective possesses salient strengths, limitations, and heuristic values. We highlight the necessity of revisiting extant theories and formulating novel evidence-based accounts of hypnosis.

Theories of consciousness and psychiatric disorders - A comparative analysis

Disorders of consciousness represent an efficient way to test theories of consciousness' (ToCs) predictions. So far, ToCs have mostly focused on disorders of quantitative awareness such as coma, vegetative state, spatial neglect and hemianopia. Psychiatric disorders, by contrast, have received little attention, leaving their contribution to consciousness research almost unexplored. Therefore, this paper aims to assess the relation between ToCs and psychiatric disorders - that is, the extent to which current ToCs can account for psychiatric symptomatology. First, I review direct and indirect evidence linking each ToC to psychiatry disorders. Next, I differentiate ToCs based on their theoretical and methodological ground, highlighting how they distinctively address neural, cognitive, and phenomenological aspects of conscious experience and, in turn, psychiatric symptoms. Finally, I refer to one specific symptom to directly compare ToCs' explanatory power. Overall, Temporospatial Theory of Consciousness (TTC) appears to provide a more comprehensive account of psychiatric disorders, suggesting that a novel dimension of consciousness (i.e., form of consciousness) may be needed to address more qualitative alterations in conscious experience.

A neurophenomenological fMRI study of a spontaneous automatic writer and a hypnotic cohort

PURPOSE

To evaluate the neurophenomenology of automatic writing (AW) in a spontaneous automatic writer (NN) and four high hypnotizables (HH).

METHODS

During fMRI, NN and the HH were cued to perform spontaneous (NN) or induced (HH) AW, and a comparison task of copying complex symbols, and to rate their experience of control and agency.

RESULTS

Compared to copying, for all participants AW was associated with less sense of control and agency and decreased BOLD signal responses in brain regions implicated in the sense of agency (left premotor cortex and insula, right premotor cortex, and supplemental motor area), and increased BOLD signal responses in the left and right temporoparietal junctions and the occipital lobes. During AW, the HH differed from NN in widespread BOLD decreases across the brain and increases in frontal and parietal regions.

CONCLUSIONS

Spontaneous and induced AW had similar effects on agency, but only partly overlapping effects on cortical activity.

Genetic variations in DOCK4 contribute to schizophrenia susceptibility in a Chinese cohort: A genetic neuroimaging study

BACKGROUND

Emerging evidence suggests that the DOCK4 gene increases susceptibility to schizophrenia. However, no study has hitherto repeated this association in Chinese, and further investigated the relationship between DOCK4 and clinical symptoms in schizophrenic patients using clinical scales and functional magnetic resonance imaging (fMRI).

METHODS

In this study, we genotyped three single nucleotide polymorphisms (SNPs) (rs2074127, rs2217262, and rs2074130) within the DOCK4 gene using a case-control design (including 1289 healthy controls and 1351 patients with schizophrenia). 55 first-episode schizophrenia (FES) patients and 59 healthy participants were divided by the genotypes of rs2074130 into CC and CT+TT groups. We further investigated the association with clinical symptoms and neural characteristics (brain activation/connectivity and nodal network metrics).

RESULTS

Our results showed significant associations between all selected SNPs and schizophrenia (all P < 0.05). In patients, letter fluency and motor speed scores of T allele carriers were significantly higher than the CC group (all P < 0.05). Interestingly, greater brain activity, functional connectivity, and betweenness centrality (BC) in language processing and motor coordination were also observed in the corresponding brain zones in patients with the T allele based on a two-way ANCOVA model. Moreover, a potential positive correlation was found between brain activity/connectivity of these brain regions and verbal fluency and motor speed.

CONCLUSION

Our findings suggest that the DOCK4 gene may contribute to the onset of schizophrenia and lead to language processing and motor coordination dysfunction in this patient population from China.

A neurophenomenological approach to non-ordinary states of consciousness: hypnosis, meditation, and psychedelics

No contemporary unifying framework has been provided for the study of non-ordinary states of consciousness (NSCs) despite increased interest in hypnosis, meditation, and psychedelics. NSCs induce shifts in experiential contents (what appears to the experiencer) and/or structure (how it appears). This can allow the investigation of the plastic and dynamic nature of experience from a multiscale perspective that includes mind, brain, body, and context. We propose a neurophenomenological (NP) approach to the study of NSCs which highlights their role as catalysts of transformation in clinical practice by refining our understanding of the relationships between experiential (subjective) and neural dynamics. We outline the ethical implications of the NP approach for standard conceptions of health and pathology as well as the crucial role of experience-based know-how in NSC-related research and application.

Interactions between the cortical midline structures and sensorimotor network track maladaptive self-beliefs in clinical high risk for psychosis

Individuals at clinical high risk for psychosis (CHR) report a maladaptive self-concept—with more negative and less positive self-beliefs—linked to clinical symptoms and functional impairment. Alterations have also been reported in brain networks associated with intrinsic (cortical midline structures, CMS) and extrinsic (sensorimotor network, SMN) self-processing. Theoretical accounts of multiple levels of self-experience in schizophrenia suggest that interactions between these networks would be relevant for self-beliefs. This study tested whether self-beliefs related to resting-state functional connectivity within and between the CMS and SMN. Participants were 56 individuals meeting CHR criteria and 59 matched healthy community participants (HC). Pearson correlations examined potential mediators and outcomes. The CHR group reported more negative and less positive self-beliefs. Greater resting-state functional connectivity between the posterior CMS (posterior cingulate cortex) and the SMN was associated with less positive self-beliefs in CHR, but more positive self-beliefs in HC. Attenuated negative symptoms and poorer social functioning were associated with CMS-SMN connectivity (trend level after FDR-correction) and self-beliefs. Reduced connectivity between the left and right PCC was associated with lower positive self-beliefs in CHR, although this effect was specific to very low levels of positive self-beliefs. Left-right PCC connectivity did not correlate with outcomes. Dynamic interactions between intrinsic and extrinsic self-processing supported positive self-beliefs in typically developing youth while undermining positive self-beliefs in CHR youth. Implications are discussed for basic self-fragmentation, narrative self-related metacognition, and global belief updating. Interventions for self-processing may be beneficial in the CHR syndrome.

Editing reality in the brain

Recent information technologies such as virtual reality (VR) and augmented reality (AR) allow the creation of simulated sensory worlds with which we can interact. Using programming language, digital details can be overlaid onto displays of our environment, confounding what is real and what has been artificially engineered. Natural language, particularly the use of direct verbal suggestion (DVS) in everyday and hypnotic contexts, can also manipulate the meaning and significance of objects and events in ourselves and others. In this review, we focus on how socially rewarding language can construct and influence reality. Language is symbolic, automatic and flexible and can be used to augment bodily sensations e.g. feelings of heaviness in a limb or suggest a colour that is not there. We introduce the term 'suggested reality' (SR) to refer to the important role that language, specifically DVS, plays in constructing, maintaining and manipulating our shared reality. We also propose the term edited reality to encompass the wider influence of information technology and linguistic techniques that results in altered subjective experience and review its use in clinical settings, while acknowledging its limitations. We develop a cognitive model indicating how the brain's central executive structures use our personal and linguistic-based narrative in subjective awareness, arguing for a central role for language in DVS. A better understanding of the characteristics of VR, AR and SR and their applications in everyday life, research and clinical settings can help us to better understand our own reality and how it can be edited.

The Thought From the Machine: Neural Basis of Thoughts With a Coherent and Diminished Sense of Authorship

Patients with schizophrenia who experience inserted thoughts report a diminished sense of thought authorship. Based on its elusive neural basis, this functional neuroimaging study used a novel setup to convince healthy participants that a technical device triggers thoughts in their stream of consciousness. Self-reports indicate that participants experienced their thoughts as self-generated when they believed the (fake) device was deactivated, and attributed their thoughts externally when they believed the device was activated-an experience usually only reported by patients diagnosed with schizophrenia. Distinct activations in the medial prefrontal cortex (mPFC) were observed: ventral mPFC activation was linked to a sense of thought authorship and dorsal mPFC activation to a diminished sense of thought authorship. This functional differentiation corresponds to research on self- and other-oriented reflection processes and on patients with schizophrenia who show abnormal mPFC activation. Results thus support the notion that the mPFC might be involved in thought authorship as well as anomalous self-experiences.

Hypnosis

Clinical hypnosis is an important therapeutic tool with an increasingly understood cognitive and neurobiological basis, and evidence for efficacy. Hypnosis involves controlled modulation of components of cognition-such as awareness, volition, perception and belief-by an external agent (the hypnotist) or by oneself (self-hypnosis) employing suggestion. In this article, we describe what hypnosis is, how it can be used in clinical settings, and how it is done.

Thought consciousness and source monitoring depend on robotically controlled sensorimotor conflicts and illusory states

Thought insertion (TI) is characterized by the experience that certain thoughts, occurring in one's mind, are not one's own, but the thoughts of somebody else and suggestive of a psychotic disorder. We report a robotics-based method able to investigate the behavioral and subjective mechanisms of TI in healthy participants. We used a robotic device to alter body perception by providing online sensorimotor stimulation, while participants performed cognitive tasks implying source monitoring of mental states attributed to either oneself or another person. Across several experiments, conflicting sensorimotor stimulation reduced the distinction between self- and other-generated thoughts and was, moreover, associated with the experimentally generated feeling of being in the presence of an alien agent and subjective aspects of TI. Introducing a new robotics-based approach that enables the experimental study of the brain mechanisms of TI, these results link TI to predictable self-other shifts in source monitoring and specific sensorimotor processes.

Super Placebos: A Feasibility Study Combining Contextual Factors to Promote Placebo Effects

Background: Ample evidence demonstrates that placebo effects are modulated by contextual factors. Few interventions, however, attempt to combine a broad range of these factors. Here, we explore the therapeutic power of placebos by leveraging factors including social proof, positive suggestion, and social learning. This study aimed to test the feasibility of an elaborate "super placebo" intervention to reduce symptoms of various disorders in a pediatric population. Methods: In a single-arm qualitative study, participants entered an inactive MRI scanner which they were told could help their brain heal itself through the power of suggestion. The sample included 11 children (6-13 years old) diagnosed with disorders known to be receptive to placebos and suggestion (Attention Deficit Hyperactivity Disorder, Tourette Syndrome, chronic skin picking, and migraines). The children were given positive suggestions during 2-4 placebo machine sessions over the span of approximately 1 month. We assessed open-ended treatment outcomes via recorded interviews and home visits. Results: The procedure was feasible and no adverse events occurred. Ten of the 11 parents reported improvements in their children after the intervention, ranging from minor transient changes to long-term reductions in subjective and objective symptoms (e.g., migraines and skin lesions). Discussion: These preliminary findings demonstrate the feasibility and promise of combining a broad range of contextual factors in placebo studies. Future research is needed to assess the causal effects of such interventions.

Hypnotised by Your Phone? Smartphone Addiction Correlates With Hypnotisability

Hypnosis and heavy smartphone use are both characterised by absorbed states in which one loses track of time and responds automatically to stimuli. In this pre-registered study, we tested whether there was a relationship between smartphone addiction and hypnotisability: one's tendency to follow suggestions under hypnosis. Over 11 public lectures, we hypnotised 641 student-aged participants; after the hypnosis session, participants completed the Smartphone Addiction Scale (Short Version). There was a positive correlation between hypnotisability and smartphone addiction (r = .17, 95% CI [.09, .24], p < .001) with a magnitude similar to standard predictors of hypnotisability. This correlation was small but unlikely spurious: it was positive in 10 of the 11 samples (including two from psychology courses) and persisted in a follow-up several months later. The addiction scores in this Canadian sample were unexpectedly high (M = 31.41) compared to other countries. We hypothesise that targeting the absorbed, time-distorted, and automatic use of smartphones may promote healthier phone habits.

The rubber hand illusion in hypnosis provides new insights into the sense of body ownership

Body ownership can be experimentally investigated with the rubber hand illusion (RHI), in which watching a rubber hand stroked synchronously with one’s own hidden hand induces a feeling of ownership over the rubber hand. The aim of this study was to investigate response to the RHI in high (N = 21) and low (N = 19) hypnotizable individuals in normal waking state and in hypnosis. Response to the RHI was measured via a question on the illusory feeling of ownership and with proprioceptive drift. The Highs expressed an overall feeling of more ownership over the rubber hand in both the normal waking state and hypnosis, although both groups gave higher ownership scores after synchronous than after asynchronous stroking and the difference between conditions was similar across groups. Conversely, the proprioceptive drift appeared to be differentially modulated by hypnosis and hypnotic suggestibility: it was increased in the Highs and decreased in the Lows after hypnosis induction. These findings hint at an interplay between hypnotic suggestibility and hypnosis in modulating response to the RHI. The selective breakdown of proprioceptive drift among the Lows suggests resistance to recalibrate one’s own limb in hypnosis.

UNITED KINGDOM NORMS FOR THE HARVARD GROUP SCALE OF HYPNOTIC SUSCEPTIBILITY, FORM A

The Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A), is widely used as a measure of suggestibility to screen participants for research purposes. To date, there have been a number of normative studies of the HGSHS:A, the majority of which originate from Western countries. The outcomes of these Western studies are summarized, and variations in methodologies are described and discussed. Also reported are the psychometric properties of the HGSHS:A in a large contemporary United Kingdom (UK) sample. Overall, these UK results are consistent with the earlier Western norms studies in terms of response distribution and item difficulty, with only minor differences. The continued use of HGSHS:A as a screening procedure is supported, particularly if corrected for response subjectivity/involuntariness and with revised amnesia scoring. The HGSHS:A is also important as a potential measure of the broader trait of direct verbal suggestibility.

Effectiveness of Cerebellar Circuitry Modulation in Schizophrenia: A Systematic Review

Structural and functional abnormalities of the cerebellum have been observed in schizophrenia since the first neuroimaging studies. More recently, the functions of the cerebellum have been extended beyond sensorimotor control to include participation in higher-level cognition and affective regulation. Consistently, the "cognitive dysmetria" theory posits that dysfunctions of cortical-subcortical-cerebellar circuitry may be crucial for the pathogenesis of different clinical features of schizophrenia. This conceptual framework offers a set of testable hypotheses, now that various tools to exert direct modulation of cerebellar activity are available. We conducted a systematic review of studies examining the effects of cerebellar modulation in schizophrenia. Two independent authors conducted a search within PubMed for articles published up to April 2019 and identified 10 studies (three randomized controlled trials, two open-label studies, two case reports, one preclinical study) describing the effects of cerebellar circuitry modulation in patients with schizophrenia or animal models. The majority of interventions were uncontrolled and used stimulation of the cerebellar vermis, using transcranial magnetic stimulation or transcranial direct-current stimulation. Most studies detected improvements after cerebellar modulation. Clinical changes mostly pertained the domains of negative symptoms, depressive symptoms and cognitive functions. In conclusion, few studies examined the effects of cerebellar modulation in schizophrenia but yielded promising results. This approach may hold therapeutic potential, pending further methodologically robust replication.

Brain mechanisms for loss of awareness of thought and movement

Loss or reduction of awareness is common in neuropsychiatric disorders and culturally influenced dissociative phenomena but the underlying brain mechanisms are poorly understood. fMRI was combined with suggestions for automatic writing in 18 healthy highly hypnotically suggestible individuals in a within-subjects design to determine whether clinical alterations in awareness of thought and movement can be experimentally modelled and studied independently of illness. Subjective ratings of control, ownership, and awareness of thought and movement, and fMRI data were collected following suggestions for thought insertion and alien control of writing movement, with and without loss of awareness. Subjective ratings confirmed that suggestions were effective. At the neural level, our main findings indicated that loss of awareness for both thought and movement during automatic writing was associated with reduced activation in a predominantly left-sided posterior cortical network including BA 7 (superior parietal lobule and precuneus), and posterior cingulate cortex, involved in self-related processing and awareness of the body in space. Reduced activity in posterior parietal cortices may underlie specific clinical and cultural alterations in awareness of thought and movement. Clinically, these findings may assist development of imaging assessments for loss of awareness of psychological origin, and interventions such as neurofeedback.

Chasing the Rainbow: The Non-conscious Nature of Being

Despite the compelling subjective experience of executive self-control, we argue that “consciousness” contains no top-down control processes and that “consciousness” involves no executive, causal, or controlling relationship with any of the familiar psychological processes conventionally attributed to it. In our view, psychological processing and psychological products are not under the control of consciousness. In particular, we argue that all “contents of consciousness” are generated by and within non-conscious brain systems in the form of a continuous self-referential personal narrative that is not directed or influenced in any way by the “experience of consciousness.” This continuously updated personal narrative arises from selective “internal broadcasting” of outputs from non-conscious executive systems that have access to all forms of cognitive processing, sensory information, and motor control. The personal narrative provides information for storage in autobiographical memory and is underpinned by constructs of self and agency, also created in non-conscious systems. The experience of consciousness is a passive accompaniment to the non-conscious processes of internal broadcasting and the creation of the personal narrative. In this sense, personal awareness is analogous to the rainbow which accompanies physical processes in the atmosphere but exerts no influence over them. Though it is an end-product created by non-conscious executive systems, the personal narrative serves the powerful evolutionary function of enabling individuals to communicate (externally broadcast) the contents of internal broadcasting. This in turn allows recipients to generate potentially adaptive strategies, such as predicting the behavior of others and underlies the development of social and cultural structures, that promote species survival. Consequently, it is the capacity to communicate to others the contents of the personal narrative that confers an evolutionary advantage—not the experience of consciousness (personal awareness) itself.

The fragmented self: imbalance between intrinsic and extrinsic self-networks in psychotic disorders

Self-disturbances are among the core features of schizophrenia and related psychotic disorders. The basic structure of the self could depend on the balance between intrinsic and extrinsic self-processing. We discuss studies on self-related processing in psychotic disorders that provide converging evidence for disrupted communication between neural networks subserving the so-called intrinsic self and extrinsic self. This disruption might be mainly caused by impaired integrity of key brain hubs. The intrinsic self has been associated with cortical midline structures involved in self-referential processing, autobiographical memory, and emotional evaluation. Additionally, we highlight central aspects of the extrinsic self in its interaction with the environment using sensorimotor networks, including self-experience in sensation and actions. A deficient relationship between these self-aspects because of disrupted between-network interactions offers a framework to explain core clinical features of psychotic disorders. In particular, we show how relative isolation and reduced modularity of networks subserving intrinsic and extrinsic self-processing might trigger the emergence of hallucinations and delusions, and why patients with psychosis typically have difficulties with self-other relationships and do not recognise mental problems.

Hypnosis as a model of functional neurologic disorders

In the 19th century it was recognized that neurologic symptoms could be caused by "morbid ideation" as well as organic lesions. The subsequent observation that hysteric (now called "functional") symptoms could be produced and removed by hypnotic suggestion led Charcot to hypothesize that suggestion mediated the effects of ideas on hysteric symptoms through as yet unknown effects on brain activity. The advent of neuroimaging 100 years later revealed strikingly similar neural correlates in experiments matching functional symptoms with clinical analogs created by suggestion. Integrative models of suggested and functional symptoms regard these alterations in brain function as the endpoint of a broader set of changes in information processing due to suggestion. These accounts consider that suggestions alter experience by mobilizing representations from memory systems, and altering causal attributions, during preconscious processing which alters the content of what is provided to our highly edited subjective version of the world. Hypnosis as a model for functional symptoms draws attention to how radical alterations in experience and behavior can conform to the content of mental representations through effects on cognition and brain function. Experimental study of functional symptoms and their suggested counterparts in hypnosis reveals the distinct and shared processes through which this can occur.

Are You Suggesting That's My Hand? The Relation Between Hypnotic Suggestibility and the Rubber Hand Illusion

Hypnotic suggestibility (HS) is the ability to respond automatically to suggestions and to experience alterations in perception and behavior. Hypnotically suggestible participants are also better able to focus and sustain their attention on an experimental stimulus. The present study explores the relation between HS and susceptibility to the rubber hand illusion (RHI). Based on previous research with visual illusions, it was predicted that higher HS would lead to a stronger RHI. Two behavioral output measures of the RHI, an implicit (proprioceptive drift) and an explicit (RHI questionnaire) measure, were correlated against HS scores. Hypnotic suggestibility correlated positively with the implicit RHI measure contributing to 30% of the variation. However, there was no relation between HS and the explicit RHI questionnaire measure, or with compliance control items. High hypnotic suggestibility may facilitate, via attentional mechanisms, the multisensory integration of visuoproprioceptive inputs that leads to greater perceptual mislocalization of a participant's hand. These results may provide insight into the multisensory brain mechanisms involved in our sense of embodiment.