Brain Oscillations, Hypnosis, and Hypnotizability

An interhemispheric frontoparietal network supports hypnotic states

Understanding the neural substrate of altered conscious states is an important cultural, scientific, and clinical endeavour. Although hypnosis causes strong shifts in conscious perception and cognition, it remains largely unclear how hypnosis affects information processing in cortical networks. Here we manipulated the depth of hypnotic states to study information processing between cortical regions involved in attention and awareness. We used high-density Electroencephalography (EEG) to record resting-state cortical activity from 30 hypnosis experts during two hypnotic states with different depth. Each participant entered a light and a deep hypnotic state as well as two well-matched control states. Bridging top-down and lateralisation models of hypnosis, we found that interhemispheric frontoparietal connectivity distinguished hypnosis and control conditions, while no difference was found between the two hypnotic states. Using a graph-theoretic measure, we revealed that the amount of information passing through individual nodes (measured via betweenness centrality) is reduced during hypnosis relative to control states. Finally, we found that theta power was enhanced during hypnosis. Our result contributes to the current discussion around a role for theta power in bringing about hypnotic states, as well as other altered conscious states. Overall, our findings support the notion that altered top-down control in frontoparietal regions facilitates hypnosis by integrating information between cortical hemispheres.

"Close your eyes and relax": the role of hypnosis in reducing anxiety, and its implications for the prevention of cardiovascular diseases

Anxiety is the most common form of mental health disorder, affecting millions of people worldwide. Psychosocial interventions such as mindfulness and cognitive behavioral therapy (CBT) have been suggested as an effective treatment in the management of general anxiety and anxiety disorders, with emerging evidence also suggesting the effectiveness of hypnosis. Moreover, anxiety has shown to be linked to the onset and development of several cardiovascular diseases (CVD), which are the leading cause of global death. In this paper, we review the current literature to examine the role that anxiety has on the onset and development of CVD and summarize the current knowledge on the role that hypnosis and hypnotherapy have in reducing anxiety, also explaining how this can impact the cardiovascular system and the prevention of CVD. Review of the evidence suggests that hypnosis and hypnotherapy are effective in treating anxiety and may positively affect the heart and the cardiovascular system, reducing sympathetic activation and increasing parasympathetic tone, potentially preventing the onset of CVD related to increased sympathetic activation. However, further studies are required to further understand how hypnosis and hypnotherapy affect the cardiovascular system through investigation of the neurophysiological components of the hypnotic state and of the mind-body relationship. Healthcare systems should embed mental health screening in patients at risk of developing CVD as part of the clinical pathway and consider the role that hypnosis and hypnotherapy may play in the management of CVD.

EEG Correlates of Suggestion-Induced Stroop Interference Reduction in High-Suggestible Individuals: A Systematic Review and Meta-Analysis

Studies have explored the impact of suggestion on the Stroop effect, aiming to understand how effective suggestion is in modulating this phenomenon. The suggestion effect has been replicated in multiple studies, supporting its robustness, but lacks systematic evaluation. We conducted a systematic review and meta-analysis of relevant English-language studies from PubMed, Web of Science, PsycINFO, Scopus, and ScienceDirect since databases inception until January 2023. Quality of included studies was evaluated using the Joanna Briggs Institute (JBI) appraisal checklist, and potential publication biases were assessed. Subgroup analyses were also performed, and effect sizes were estimated using Hedges' g and analyzed using random effects model. The systematic review was comprised of 19 studies. For the meta-analysis, 14 studies examined the suggestion effect on Stroop interference effect (SIE), while six studies investigated suggestion effects on accuracy. Results have revealed significant overall effects of suggestion on Stroop performance in participants, as evidenced by SIE and accuracy. Subgroup analysis based on types of suggestion demonstrated a significant effect on SIE. Six EEG/ERP studies have also been discussed in the context of the review.

Symphonic resonance: optimizing hypnotic suggestions with music to harmonize depression and rumination

Depression is a complex, multi-dimensional disorder that is recognized as a leading cause of human suffering and disability. A wide variety of treatments, both physical and psychological, have been developed to lessen the burden on depressed individuals and those they may affect. Hypnosis has been shown to be an effective vehicle for delivering psychological treatments for alleviating depression in a number of studies, but it is always a challenge to increase the effectiveness of suggestions given in hypnosis. The addition of music to enhance hypnotic approaches has been studied and received substantial support for its potential effectiveness. This article explores the merits of incorporating music into the delivery of hypnosis sessions and offers specific recommendations for the use of rhythmic methods as a means of deepening hypnosis and increasing the impact of one's suggestions for reducing depressive ruminations. Five case examples are provided to illustrate the successful use of this integrative approach to treatment.

The Role of Electroencephalogram-Assessed Bandwidth Power in Response to Hypnotic Analgesia

Research supports the efficacy of therapeutic hypnosis for reducing acute and chronic pain. However, little is known about the mechanisms underlying these effects. This paper provides a review of the evidence regarding the role that electroencephalogram-assessed bandwidth power has in identifying who might benefit the most from hypnotic analgesia and how these effects occur. Findings are discussed in terms of the slow wave hypothesis, which posits that brain activity in slower bandwidths (e.g., theta and alpha) can facilitate hypnosis responsivity. Although the extant research is limited by small sample sizes, the findings from this research are generally consistent with the slow wave hypothesis. More research, including and especially studies with larger sample sizes, is needed to confirm these preliminary positive findings.

Hypnosis for Symptom Management in Adult Cancer Patients: What is the Evidence?

OPINION STATEMENT

As a palliative care specialist and a hypnotherapist, I use therapeutic communication and conversational hypnosis daily in my patient - doctor relationship. Formal hypnotherapy sessions are integrated in my practice whenever patients are open or wish for such an approach in relation to a specific symptom, for better overall management of their disease burden and/or enhanced well-being. Although hypnosis has been used for centuries in medical practice and for thousands of years in healing practices in ancient cultures all over the world, the evidence remains scarce. Nevertheless, in the last 10 years several randomised controlled trials have been conducted, building up an evidence base. In contrast to most oncological treatments, hypnotherapy is far from being considered evidence-based "standard care". It is however, if practiced by a trained health care professional, almost free of side effects and therefore potentially has a very favourable benefit-to-harm ratio. The question arises whether hypnotherapy will ever become a standard of care intervention? This seems unlikely since its efficacy may be influenced by the patient's belief in hypnosis and compliance to therapy. Furthermore, a fundamental necessity is a personalised approach that moves hypnotherapy more into the category of individual-centred care rather than standard care.

Brain Functional Correlates of Resting Hypnosis and Hypnotizability: A Review

This comprehensive review delves into the cognitive neuroscience of hypnosis and variations in hypnotizability by examining research employing functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and electroencephalography (EEG) methods. Key focus areas include functional brain imaging correlations in hypnosis, EEG band oscillations as indicators of hypnotic states, alterations in EEG functional connectivity during hypnosis and wakefulness, drawing critical conclusions, and suggesting future research directions. The reviewed functional connectivity findings support the notion that disruptions in the available integration between different components of the executive control network during hypnosis may correspond to altered subjective appraisals of the agency during the hypnotic response, as per dissociated and cold control theories of hypnosis. A promising exploration avenue involves investigating how frontal lobes' neurochemical and aperiodic components of the EEG activity at waking-rest are linked to individual differences in hypnotizability. Future studies investigating the effects of hypnosis on brain function should prioritize examining distinctive activation patterns across various neural networks.

Hypnosis measured with monitors of anesthetic depth - EEG changes during the test for Harvard Group Scale of Hypnotic Susceptibility

Introduction

Hypnotic trance can be defined as a non-ordinary state of consciousness that is accompanied by a number of neurophysiological changes, including brain electrophysiology. In addition to subjective measures, corresponding objective parameters are needed in experimental and clinical hypnosis research but are complex, impractical, or unspecific. A similar challenge exists for the measurement and monitoring of drug-induced hypnosis, namely general anesthesia. The observation of changes in EEG induced by narcotics has led to the development of monitors for the depth of anesthesia based on EEG parameters. We investigated whether two such monitors react to the induction and maintenance of hypnosis during a highly standardized procedure.

Methods

A total of 56 volunteers were monitored for the bispectral index (BIS) and cerebral state index (CSI) (range 0-100, >95 considered "awake") during the Harvard Group Scale of Hypnotic Susceptibility test. For this test, trance is induced by a taped text and followed by 12 tasks performed under hypnosis. In contrast to random forms of hypnosis, this represents a standardized, worldwide-established condition. According to the resulting score, participants were classified into suggestibility groups in order to evaluate whether the electrophysiological measurements of BIS and CIS indices differ between high and low suggestible persons. Furthermore, participants were asked to rate their hypnotic depth (HD, 1-10) at every task of the test.

Results

Scores dropped significantly from a mean of 97.7 to 86.4 for BIS and from 94.6 to 77.7 for CSI with the induction of hypnosis to stay throughout hypnosis at levels of approximately 88.6 or 82.9, respectively. Results did not differ between high- and low-suggestible participants. The means of the subjective score of hypnotic depth and of the electrophysiological measurements showed a similar course. However, no correlation was found between BIS or CSI values and scores of hypnotic depths.

Conclusion

Monitors for depth of anesthesia respond to changes in consciousness, including trance states of hypnosis. However, specificity is unclear. Practically, in hypnosis research with the exclusion of drug effects or sleep, these monitors might be helpful to test and compare the efficacy of induction texts and to detect disturbances of trance state.

Who Benefits the Most From Different Psychological Chronic Pain Treatments? An Exploratory Analysis of Treatment Moderators

Different psychological chronic pain treatments benefit some individuals more than others. Understanding the factors that are associated with treatment response-especially when those factors differ between treatments-may inform more effective patient-treatment matching. This study aimed to identify variables that moderate treatment response to 4 psychological pain interventions in a sample of adults with low back pain or chronic pain associated with multiple sclerosis, spinal cord injury, acquired amputation, or muscular dystrophy (N = 173). The current study presents the results from secondary exploratory analyses using data from a randomized controlled clinical trial which compared the effects of 4 sessions of cognitive therapy (CT), hypnosis focused on pain reduction (HYP), hypnosis focused on changing pain-related cognitions and beliefs (HYP-CT), and a pain education control condition (ED). The analyses tested the effects of 7 potential treatment moderators. Measures of primary (pain intensity) and secondary (pain interference, depression severity) outcome domains were administered before and after the pain treatments, and potential moderators (catastrophizing, hypnotizability, and electroencephalogram (EEG)-assessed oscillation power across five bandwidths) were assessed at pre-treatment. Moderator effects were tested fitting regression analyses to pre- to post-treatment changes in the three outcome variables. The study findings, while preliminary, support the premise that pre-treatment measures of hypnotizability and EEG brain activity predict who is more (or less) likely to respond to different psychological pain treatments. If additional research replicates the findings, it may be possible to better match patients to their more individually suitable treatment, ultimately improving pain treatment outcomes. PERSPECTIVE: Pre-treatment measures of hypnotizability and EEG-assessed brain activity predicted who was more (or less) likely to respond to different psychological pain treatments. If these findings are replicated in future studies, they could inform the development of patient-treatment matching algorithms.

Real-time assessment of hypnotic depth, using an EEG-based brain-computer interface: a preliminary study

OBJECTIVE

Hypnosis can be an effective treatment for many conditions, and there have been attempts to develop instrumental approaches to continuously monitor hypnotic state level ("depth"). However, there is no method that addresses the individual variability of electrophysiological hypnotic correlates. We explore the possibility of using an EEG-based passive brain-computer interface (pBCI) for real-time, individualised estimation of the hypnosis deepening process.

RESULTS

The wakefulness and deep hypnosis intervals were manually defined and labelled in 27 electroencephalographic (EEG) recordings obtained from eight outpatients after hypnosis sessions. Spectral analysis showed that EEG correlates of deep hypnosis were relatively stable in each patient throughout the treatment but varied between patients. Data from each first session was used to train classification models to continuously assess deep hypnosis probability in subsequent sessions. Models trained using four frequency bands (1.5-45, 1.5-8, 1.5-14, and 4-15 Hz) showed accuracy mostly exceeding 85% in a 10-fold cross-validation. Real-time classification accuracy was also acceptable, so at least one of the four bands yielded results exceeding 74% in any session. The best results averaged across all sessions were obtained using 1.5-14 and 4-15 Hz, with an accuracy of 82%. The revealed issues are also discussed.

Awake or Sleeping? Maybe Both… A Review of Sleep-Related Dissociative States

Recent studies have begun to understand sleep not only as a whole-brain process but also as a complex local phenomenon controlled by specific neurotransmitters that act in different neural networks, which is called "local sleep". Moreover, the basic states of human consciousness-wakefulness, sleep onset (N1), light sleep (N2), deep sleep (N3), and rapid eye movement (REM) sleep-can concurrently appear, which may result in different sleep-related dissociative states. In this article, we classify these sleep-related dissociative states into physiological, pathological, and altered states of consciousness. Physiological states are daydreaming, lucid dreaming, and false awakenings. Pathological states include sleep paralysis, sleepwalking, and REM sleep behavior disorder. Altered states are hypnosis, anesthesia, and psychedelics. We review the neurophysiology and phenomenology of these sleep-related dissociative states of consciousness and update them with recent studies. We conclude that these sleep-related dissociative states have a significant basic and clinical impact since their study contributes to the understanding of consciousness and the proper treatment of neuropsychiatric diseases.

Is Hypnotic Induction Necessary to Experience Hypnosis and Responsible for Changes in Brain Activity?

The relevance of formal hypnotic induction to the experience of trance and its neural correlates is not clear, in that hypnotizability, beliefs and expectation of hypnosis may play a major role. The aim of the study was assessing the EEG brain activity of participants with high (highs) or low hypnotizability scores (lows), aware of their hypnotizability level and informed that the session will include simple relaxation, formal hypnotic induction and neutral hypnosis. A total of 16 highs and 15 lows (according to the Stanford Hypnotic Susceptibility Scale, form A) were enrolled. Their EEGs were recorded during consecutive conditions of open/closed-eyes relaxation, hypnotic induction, neutral hypnosis and post hypnosis not interrupted by interviews. The studied variables were theta, alpha and gamma power spectral density (PSD), and the Determinism (DET) and Entropy (ENT) of the EEG signal Multidimensional Recurrence Plot (mRP). Highs reported significantly greater changes in their state of consciousness than lows across the session. The theta, alpha and gamma PSD did not exhibit condition-related changes in both groups. The Alpha PSD was larger in highs than in lows on midline sites, and the different sides/regions' theta and gamma PSD were observed in the two groups independently from conditions. ENT showed no correlation with hypnotizability, while DET positively correlated with hypnotizability during hypnosis. In conclusion, the relevance of formal hypnotic induction to the experience of trance may be scarce in highs, as they are aware of their hypnotizability scores and expecting hypnosis. Cognitive processing varies throughout the session depending on the hypnotizability level.

What happens in the brain when we die? Deciphering the neurophysiology of the final moments in life

When do we die and what happens in the brain when we die? The mystery around these questions has engaged mankind for centuries. Despite the challenges to obtain recordings of the dying brain, recent studies have contributed to better understand the processes occurring during the last moments of life. In this review, we summarize the literature on neurophysiological changes around the time of death. Perhaps the only subjective description of death stems from survivors of near-death experiences (NDEs). Hallmarks of NDEs include memory recall, out-of-body experiences, dreaming, and meditative states. We survey the evidence investigating neurophysiological changes of these experiences in healthy subjects and attempt to incorporate this knowledge into the existing literature investigating the dying brain to provide valuations for the neurophysiological footprint and timeline of death. We aim to identify reasons explaining the variations of data between studies investigating this field and provide suggestions to standardize research and reduce data variability.

Suggestions in Hypnosis to Aid Pain Education (SHAPE) in People with Chronic Low-Back Pain: A Pilot Feasibility Randomized, Controlled Trial

Chronic low back pain (CLBP) is a debilitating and burdensome condition, and new treatment strategies are needed. This study aimed to evaluate (1) the feasibility of undertaking a controlled clinical trial investigating a novel intervention for people with CLBP: hypnotically reinforced pain science education, and (2) the acceptability of the intervention as rated by participants. A priori feasibility and intervention acceptability criteria were set. Twenty participants with CLBP were recruited and randomized to receive: (1) hypnotically delivered pain science education that utilizes hypnotic suggestions to enhance uptake of pain science concepts; or (2) pain science education with progressive muscle relaxation as an attention control. Twenty participants were recruited, however, not solely from the hospital waitlist as intended; community sampling was required (13 hospital, 7 community). Most criteria were met in the community sample but not the hospital sample. Protocol modifications are needed before progressing to a full scale randomized controlled trial for hypnotically reinforced pain science education. Improvements in relevant secondary outcomes paired with moderate-high treatment acceptability ratings are promising.

Hypnotherapy for persons with Irritable Bowel Syndrome: A three-arm randomized controlled trial

The current study sought to (1) compare the efficacies of Ericksonian hypnotherapy, traditional hypnotherapy, and educational talk in treating irritable bowel syndrome (IBS), and to (2) evaluate the impacts of hypnotic susceptibility on participants' responses to hypnotherapy. The study adopted a three-arm randomized controlled trial design and achieved an effective sample size of 144. Self-reported psychological questionnaires were used to assess participants' IBS symptom severity, health-related quality of life, and coping patterns at baseline, immediately post-intervention, and 3 months after intervention. The evaluation focused primarily on IBS symptom severity and health-related quality of life, as well as on the illness coping patterns of symptom catastrophizing and symptoms-related social hypervigilance.The findings showed that significant improvements in IBS symptom severity occurred in all three types of study groups immediately after completion of the intervention (p < .05, η_ρ² = .20). However, only the traditional hypnotherapy groups and the Ericksonian hypnotherapy groups still had a notably significant decrease in symptoms 3 months after the intervention, whereas the educational talk groups had dropped back to pre-treatment symptom levels at the 3-month follow-up. The amplitude of change of symptom catastrophizing in the traditional hypnotherapy groups was stronger than that in the Ericksonian hypnotherapy groups after completion of the intervention, and the two types of hypnotherapy groups were significantly lower in symptom catastrophizing both immediately after the intervention and also 3 months post-intervention (p < .001, η_ρ² = .17). The other coping mechanism studied, symptoms-related social hypervigilance, showed a significant decline only in the Ericksonian hypnotherapy groups (ps < .001, η_ρ² = .45). Interestingly, in the traditional hypnotherapy groups, persons with higher hypnotic susceptibility showed significant improvement in symptom severity, health-related quality of life, and coping patterns following treatment. Notably, the effects from Ericksonian hypnotherapy for IBS diverged from the effects from traditional hypnotherapy. Finally, both Ericksonian hypnotherapy and traditional hypnotherapy appeared to have greater positive effects than educational talk did, but at different levels.

Functional Changes in Brain Activity Using Hypnosis: A Systematic Review

Hypnosis has proven a powerful method in indications such as pain control and anxiety reduction. As recently discussed, it has been yielding increased attention from medical/dental perspectives. This systematic review (PROSPERO-registration-ID-CRD42021259187) aimed to critically evaluate and discuss functional changes in brain activity using hypnosis by means of different imaging techniques. Randomized controlled trials, cohort, comparative, cross-sectional, evaluation and validation studies from three databases—Cochrane, Embase and Medline via PubMed from January 1979 to August 2021—were reviewed using an ad hoc prepared search string and following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. A total of 10,404 articles were identified, 1194 duplicates were removed and 9190 papers were discarded after consulting article titles/abstracts. Ultimately, 20 papers were assessed for eligibility, and 20 papers were included after a hand search (n^total = 40). Despite a broad heterogenicity of included studies, evidence of functional changes in brain activity using hypnosis was identified. Electromyography (EMG) startle amplitudes result in greater activity in the frontal brain area; amplitudes using Somatosensory Event-Related Potentials (SERPs) showed similar results. Electroencephalography (EEG) oscillations of θ activity are positively associated with response to hypnosis. EEG results showed greater amplitudes for highly hypnotizable subjects over the left hemisphere. Less activity during hypnosis was observed in the insula and anterior cingulate cortex (ACC).

Neural dynamics of mindfulness meditation and hypnosis explored with intracranial EEG: A feasibility study

PURPOSE

Intracranial electroencephalography (iEEG) offers a unique window on brain dynamics with excellent temporal and spatial resolution and is less prone to recording artefacts than surface EEG. This study used a within-subject design to explore the feasibility to compare iEEG data during mind wandering, mindfulness meditation and hypnosis.

RESULTS

Three patients who had iEEG for clinical monitoring and who were new to mindfulness meditation and hypnosis were able to enter these states. We found non-specific and wide-spread amplitude modulations. Data-driven connectivity analysis revealed widespread connectivity patterns that were common across the three conditions. These were predominant in the low frequencies (delta, theta and alpha) and characterised by positively correlated activity. Connectivity patterns that were unique to the three conditions predominated in the gamma band, one third of the correlations in these patterns were negative.

CONCLUSIONS

This study is the first to support the feasibility of a direct comparison of the neural correlates of mindfulness meditation and hypnosis using iEEG. These modulations may reflect the complex interplay between different known brain networks, and warrant further functional investigations in particular in the gamma band.

Implications on hypnotherapy: Neuroplasticity, epigenetics and pain

We provide a brief review about the significance of hypnosis with respect to applications and physiological processes in hypnotherapy. Our review concludes that hypnosis is a promising method to manage acute and chronic pain. In addition, we discuss indications pointing toward the view that hypnosis can induce changes in neuroplasticity possibly involving epigenetic mechanisms.

Leaving hypnosis behind?

Our consciousness and our practice of hypnosis co-evolve. From earliest civilizations to the present, we can think of the source of our abilities and knowledge, along with our self-awareness, as progressing from external and imperative to internal and autonomous. This perspective aligns with Jaynes' thesis on the origin of consciousness and its trajectory from a bicameral mind, to increasing self-efficacy, and on toward higher consciousness. With the ongoing emergence of our subjective and narrative consciousness comes shifting and multiplying resources for rational, shared, compassionate, and creative self-determination. However, the formal practice of therapeutic hypnosis - especially within reductive and diagnosis-based biomedical and psychological models - has lagged behind the evolution of consciousness. Most of the history of hypnosis has adhered to the bicameral paradigm. We have reserved a place for the authority of an externalized, revered entity whom we credit nonconsciously with our innate and extraordinary abilities. The creative applications of hypnosis by Erickson and the expansion of that work by Rossi signaled a fundamental emergence from that paradigm that encourages self-authorization and moves hypnosis practice toward a more evocative, systematic, and numinous horizon.

Pain-related beliefs, cognitive processes, and electroencephalography band power as predictors and mediators of the effects of psychological chronic pain interventions

ABSTRACT

The current study used data from a clinical trial to identify variables that are associated with and/or mediate the beneficial effects of 4 psychological chronic pain treatments: one teaching patients self-hypnosis to reduce pain intensity (HYP), one teaching self-hypnosis to change thoughts about pain (hypnotic cognitive therapy [HYP-CT]), one teaching cognitive restructuring skills to change thoughts about pain (cognitive therapy [CT]), and one providing education about pain (ED; included as an active control condition). Of 17 possible mechanism variables examined, and with alpha not corrected for multiple comparisons, significant between-group differences were observed for 3. Two of these (changes in beliefs about control over pain and number of days of skill practice) were supported as mediators of the beneficial effects of HYP, CT, or HYP-CT, relative to ED. Six mechanism variables evidenced significant pretreatment to post-treatment changes in the sample as a whole, without showing significant between-group differences. Pretreatment to post-treatment changes in all 6 were associated with improvements in pain interference, pain intensity, or both. In addition, participant ratings of therapeutic alliance at post-treatment were associated significantly with improvements in both pain intensity and pain interference in the sample as a whole. Thus, of the 17 possible mediators examined, there were relatively few that served as mediators for the beneficial effects of specific treatments; a larger number of variables predicted treatment outcome overall. The extent to which these variables are treatment mediators (ie, are responsible for, rather than merely associated with, treatment-related improvements) will require further research.

Neural Mechanisms of Hypnosis and Meditation-Induced Analgesia: A Narrative Review

Meditation and hypnosis have both been found to attenuate pain; however, little is known about similarities and differences in the cognitive modulation of pain. Hypnotic and meditative states (e.g., mindfulness) reduce pain by sharing and overlapping multiple neuro-cognitive mechanisms, but they differ in many respects. While there are overlapping brain networks involved, the nature of these effects seems different. Both phenomena involve frontal modulation of pain-related areas. The role of the dorsolateral prefrontal cortex appears to depend, in hypnosis, on the type of suggestion given and, in meditation, on the level of practice. Whereas the anterior cingulate cortex seems to be a key node in both hypnosis and meditation, the dorsolateral prefrontal cortex appears to engage in hypnosis as a function of suggestion and, in meditation, as a function of proficiency.

No evidence for theta power as a marker of hypnotic state in highly hypnotizable subjects

EEG spectral-power density was analyzed in a group of nine highly hypnotizable subjects via ten frontal, central, parietal, and occipital electrodes under four conditions: 1) wake state, 2) neutral hypnosis, 3) hypnotic suggestion for altering perception of tones, and 4) post-hypnosis. Results indicate no theta-power changes between conditions, challenging previous findings that increased theta power is a marker of hypnosis. A decrease in gamma power under hypnotic suggestion and an almost significant decrease under neutral hypnosis were observed, compared to post-hypnosis. Anteroposterior power distribution remained stable over all conditions. The results are discussed and compared to earlier studies, which report heterogenous findings.

Quantum and Electromagnetic Fields in Our Universe and Brain: A New Perspective to Comprehend Brain Function

The concept of wholeness or oneness refers to not only humans, but also all of creation. Similarly, consciousness may not wholly exist inside the human brain. One consciousness could permeate the whole universe as limitless energy; thus, human consciousness can be regarded as limited or partial in character. According to the limited consciousness concept, humans perceive projected waves or wave-vortices as a waveless item. Therefore, human limited consciousness collapses the wave function or energy of particles; accordingly, we are only able to perceive them as particles. With this “limited concept”, the wave-vortex or wave movement comes into review, which also seems to have a limited concept, i.e., the limited projected wave concept. Notably, this wave-vortex seems to embrace photonic light, as well as electricity and anything in between them, which gives a sense of dimension to our brain. These elements of limited projected wave-vortex and limitless energy (consciousness) may coexist inside our brain as electric (directional pilot wave) and quantum (diffused oneness of waves) brainwaves, respectively, with both of them giving rise to one brain field. Abnormality in either the electrical or the quantum field or their fusion may lead to abnormal brain function.

Towards a multi-brain framework for hypnosis: a review of quantitative methods

Most real-world applications of hypnosis involve a pair of actors: a hypnotist and a subject. Accordingly, most current models of hypnosis acknowledge the relevance of social factors in the development of the hypnotic response. Yet, psychophysiological research on hypnosis has been mostly restricted to techniques that are studying one individual, neglecting the complexity of hypnosis as a social phenomenon. In this paper, we review evidence suggesting that a multi-brain approach to studying the psychophysiology of hypnosis could lead to a breakthrough in our understanding of the neural correlates of hypnosis. In particular, we aim to highlight how this approach which relies on the information conveyed by complex verbal stimuli can be utilized to deal with the multifaceted nature of hypnosis. Furthermore, we present analytical approaches to assessing brain-to-brain coupling developed in the field of social cognitive neuroscience in the past decade, to aid the design of similar multi-brain studies in hypnosis research.

Current neuroscientific research database findings of brain activity changes after hypnosis

Using multi-modal brain imaging techniques we found pronounced changes in neuronal activity after hypnotic trance induction whereby state changes seem to occur synchronously with the specific induction instructions. In clinical patients, hypnosis proved to be a powerful method in inhibiting the reaction of the fear circuitry structures. The aim of the present paper is to critically discuss the limitations of the current neuroscientific research database in the light of a debate in defining relevant hypnotic constructs and to suggest ideas for future research projects. We discuss the role of hypnotic suggestibility (HS), the impact of hypnotic inductions and the importance of the depth of hypnotic trance. We argue that future research on brain imaging studies on the effects of hypnosis and hypnotherapy should focus on the analysis of individual cross-network activation patterns. A most promising approach is to simultaneously include physiological parameters linked to cognitive, somatic, and behavioral effects.

Physiological Monitoring to Enhance Clinical Hypnosis and Psychotherapy

Physiological monitoring provides a useful access into the patient's affective state during hypnotically assisted therapeutic sessions. Physiological monitoring identifies autonomic dysregulation and can also display the process of restoring autonomic regulation via hypnosis and other quieting strategies. Commonly used modalities for physiological monitoring are identified, and clinical illustrations of how psychophysiological monitoring can be used in hypnosis and hypnotically assisted psychotherapy are provided. Clinicians may benefit from including psychophysiological knowledge in hypnosis education. Physiological monitoring may enhance hypnosis interventions for some disorders; however, more research is needed for evaluation of efficacy.

Neurofeedback for Pain Management: A Systematic Review

Background: Chronic pain is a significant global health issue. For most individuals with chronic pain, biomedical treatments do not provide adequate relief. Given the evidence that neurophysiological abnormalities are associated with pain, it is reasonable to consider treatments that target these factors, such as neurofeedback (NF). The primary objectives of this review were to summarize the current state of knowledge regarding: (1) the different types of NF and NF protocols that have been evaluated for pain management; (2) the evidence supporting each NF type and protocol; (3) if targeted brain activity changes occur with NF training; and (4) if such brain activity change is associated with improvements on treatment outcomes. Methods: Inclusion criteria were intentionally broad to encompass every empirical study using NF in relation to pain. We considered all kinds of NF, including both electroencephalogram- (EEG-) and functional magnetic resonance imagining- (fMRI-) based. We searched the following databases from inception through September 2019: Pubmed, Ovid, Embase, Web of Science, PsycINFO. The search strategy consisted of a combination of key terms referring to all NF types and pain conditions (e.g., neurofeedback, rt-fMRI-NF, BOLD, pain, migraine). Results: A total of 6,552 citations were retrieved; 24 of these that were included in the review. Most of the studies were of moderate quality, included a control condition and but did not include a follow-up. They focused on studying pain intensity (83%), pain frequency, and other variables (fatigue, sleep, depression) in samples of adults (n = 7-71) with headaches, fibromyalgia and other pain conditions. Most studies (79%) used EEG-based NF. A wide variety of NF types and protocols have been used for pain management aiming to either increase, decrease or regulate brain activity in certain areas theoretically associated with pain. Conclusions: Given the generally positive results in the studies reviewed, the findings indicate that NF procedures have the potential for reducing pain and improving other related outcomes in individuals with chronic pain. However, the current evidence does not provide definitive conclusions or allow for reliable recommendations on which protocols or methods of administration may be the most effective. These findings support the need for continued - but higher quality - research in this area.

Potential Effect of Repetitive Hypnotic Inductions on Subjectively Rated Hypnotizability: A Brief Report

This study aimed to describe the potential influence of repetitive hypnotic inductions on hypnotizability, presentation of change dynamics, and comparison of 2 types of assessment. Six subjects underwent 5 subsequent hypnotic procedures. Ratings of response to hypnotic suggestions included self ratings by subjects and ratings by observers. The suggestion effects were evaluated using a 0-to-3 rating scale. Five out of 6 subjects were susceptible to suggestions; 1 was not responsive. Increase or stability, not decrease, were observed within subsequent procedures. The hypnotizability ratings increased significantly in subjects' assessment. However, there was an insignificant change in observers' assessment. Repetitive hypnotic inductions may modulate subjectively rated hypnotizability. Behavioral responses do not precisely reflect subjective experiences in the state of hypnosis.

Hypnotizability-Related Asymmetries: A Review

Hypnotizability is a dispositional trait reflecting the individual ability to modify perception, memory and behavior according to imaginative suggestions. It is measured by validated scales that classify the general population in high (highs), medium (mediums) and low (lows) hypnotizable persons, predicts the individual proneness to respond to suggestions, and is particularly popular in the field of the cognitive control of pain and anxiety. Different hypnotizability levels, however, have been associated with specific brain morpho-functional characteristics and with peculiarities in the cognitive, sensorimotor and cardiovascular domains also in the ordinary state of consciousness and in the absence of specific suggestions. The present scoping review was undertaken to summarize the asymmetries observed in the phenomenology and physiological correlates of hypnosis and hypnotizability as possible indices of related hemispheric prevalence. It presents the findings of 137 papers published between 1974 and 2019. In summary, in the ordinary state of consciousness, behavioral, neurophysiological and neuroimaging investigations have revealed hypnotizability related asymmetries mainly consisting of pre-eminent left hemisphere information processing/activation in highs, and no asymmetries or opposite directions of them in lows. The described asymmetries are discussed in relation to the current theories of hypnotizability and hypnosis.

The chronic pain skills study: Protocol for a randomized controlled trial comparing hypnosis, mindfulness meditation and pain education in Veterans

OBJECTIVES

To describe the protocol of a randomized controlled trial to evaluate the effectiveness and mechanisms of three behavioral interventions.

METHODS

Participants will include up to 343 Veterans with chronic pain due to a broad range of etiologies, randomly assigned to one of three 8-week manualized in-person group treatments: (1) Hypnosis (HYP), (2) Mindfulness Meditation (MM), or (3) Education Control (EDU).

PROJECTED OUTCOMES

The primary aim of the study is to compare the effectiveness of HYP and MM to EDU on average pain intensity measured pre- and post-treatment. Additional study aims will explore the effectiveness of HYP and MM compared to EDU on secondary outcomes (i.e., pain interference, sleep, depression, anxiety and PTSD), and the maintenance of effects at 3- and 6-months post-treatment. Participants will have electroencephalogram (EEG) assessments at pre- and post-treatment to determine if the power of specific brain oscillations moderate the effectiveness of HYP and MM (Study Aim 2) and examine brain oscillations as possible mediators of treatment effects (exploratory aim). Additional planned exploratory analyses will be performed to identify possible treatment mediators (i.e., pain acceptance, catastrophizing, mindfulness) and moderators (e.g., hypnotizability, treatment expectations, pain type, cognitive function).

SETTING

The study treatments will be administered at a large Veterans Affairs Medical Center in the northwest United States. The treatments will be integrated within clinical infrastructure and delivered by licensed and credentialed health care professionals.

FUNCTIONAL CHANGES IN BRAIN ACTIVITY AFTER HYPNOSIS: Neurobiological Mechanisms and Application to Patients with a Specific Phobia-Limitations and Future Directions

Studies of brain-plasticity changes in hypnosis using functional magnetic resonance imaging (fMRI), positron-emission-tomography (PET) and electroencephalography (EEG) were reviewed. The authors found evidence in those studies that hypnosis is a powerful and successful method for inhibiting the reaction of the fear circuitry structures. Limitations of the studies were critically discussed, and implications for future research were made. The authors are currently using a portable fNIRS apparatus to integrate the scanning device into real life situations in medical practice. Their aim is to disentangle the neuronal mechanisms and physiological correlates in patients with severe fear of medical treatments when directly confronted with anxiety-provoking stimuli and to assess the effects of a brief hypnosis. Drawing on evidence from several technological modalities, neuroimaging and physiological studies pave the road to a better scientific understanding of neural mechanisms of hypnosis.

THE EFFECTS OF HYPNOSIS AND HYPNOTIC SUGGESTIONS ON THE MISMATCH NEGATIVITY IN HIGHLY HYPNOTIZABLE SUBJECTS

The neural mechanisms associated with hypnosis were investigated in a group of 9 high hypnotizable subjects by measuring the mismatch negativity (MMN) component of the auditory event-related potential (ERP). ERPs were recorded using a passive oddball paradigm to sinusoidal standard and deviant tone stimuli of 500 and 520 Hz, respectively, in four conditions: prehypnosis, neutral hypnosis, hypnotic suggestion for altering the tone perception, and posthypnotic conditions. Earlier studies have indicated that hypnosis and hypnotic suggestions might have an effect on MMN, but the results of our study contradict these results: No statistically significant differences were found between the conditions in the MMN amplitudes.

Investigation on the Neural Mechanism of Hypnosis-Based Respiratory Control Using Functional MRI

Respiratory control is essential for treatment effect of radiotherapy due to the high dose, especially for thoracic-abdomen tumor, such as lung and liver tumors. As a noninvasive and comfortable way of respiratory control, hypnosis has been proven effective as a psychological technology in clinical therapy. In this study, the neural control mechanism of hypnosis for respiration was investigated by using functional magnetic resonance imaging (fMRI). Altered spontaneous brain activity as well as neural correlation of respiratory motion was detected for eight healthy subjects in normal state (NS) and hypnosis state (HS) guided by a hypnotist. Reduced respiratory amplitude was observed in HS (mean ± SD: 14.23 ± 3.40 mm in NS, 12.79 ± 2.49 mm in HS, p=0.0350), with mean amplitude deduction of 9.2%. Interstate difference of neural activity showed activations in the visual cortex and cerebellum, while deactivations in the prefrontal cortex and precuneus/posterior cingulate cortex (PCu/PCC) in HS. Within these regions, negative correlations of neural activity and respiratory motion were observed in visual cortex in HS. Moreover, in HS, voxel-wise neural correlations of respiratory amplitude demonstrated positive correlations in cerebellum anterior lobe and insula, while negative correlations were shown in the prefrontal cortex and sensorimotor area. These findings reveal the involvement of cognitive, executive control, and sensorimotor processing in the control mechanisms of hypnosis for respiration, and shed new light on hypnosis performance in interaction of psychology, physiology, and cognitive neuroscience.

The Association Between Mindfulness and Hypnotizability: Clinical and Theoretical Implications

Mindfulness-based interventions and hypnosis are efficacious treatments for addressing a large number of psychological and physical conditions, including chronic pain. However, there continues to be debate surrounding the relative uniqueness of the theorized mechanisms of these treatments-reflected by measures of mindfulness facets and hypnotizability-with some concern that there may be so much overlap as to make the mechanism constructs (and, therefore, the respective interventions) redundant. Given these considerations, the primary aim of the current study was to examine the degree of unique versus shared variance between two common measures of mindfulness facets and hypnotizability: the Five Facet Mindfulness Questionnaire and the Stanford Hypnotic Clinical Scale. A cross-sectional survey was conducted with a sample of (N = 154) veterans with heterogeneous chronic pain conditions. Bivariate Pearson correlations were used to examine the associations between the target scales. Results showed that the correlations between the Five Facet Mindfulness Questionnaire scales and Stanford Hypnotic Clinical Scale total score were uniformly weak, although significant negative correlations were found between mindfulness facets of observe and nonreact with hypnotizability (ps < 0.05). Thus, not only are the mindfulness and hypnotizability constructs unique, but when significantly associated, hypnotic suggestibility corresponds with a tendency to be less mindful. These findings have important implications for future research aimed toward matching patients to the treatment most likely to be of benefit, and suggest that matching patients on the basis of these theoretically derived "unique" moderators may hold potential.

USE OF NEUROFEEDBACK AND MINDFULNESS TO ENHANCE RESPONSE TO HYPNOSIS TREATMENT IN INDIVIDUALS WITH MULTIPLE SCLEROSIS: Results From a Pilot Randomized Clinical Trial

This pilot study evaluated the possibility that 2 interventions hypothesized to increase slower brain oscillations (e.g., theta) may enhance the efficacy of hypnosis treatment, given evidence that hypnotic responding is associated with slower brain oscillations. Thirty-two individuals with multiple sclerosis and chronic pain, fatigue, or both, were randomly assigned to 1 of 2 interventions thought to increase slow wave activity (mindfulness meditation or neurofeedback training) or no enhancing intervention, and then given 5 sessions of self-hypnosis training targeting their presenting symptoms. The findings supported the potential for both neurofeedback and mindfulness to enhance response to hypnosis treatment. Research using larger sample sizes to determine the generalizability of these findings is warranted.

REVISITING THE SAFE PLACE:Method and Regulatory Aspects in Psychotherapy when Easing Allostatic Overload in Traumatized Patients

Safe-place inductions are considered important altered states of consciousness (ASC) to be (re)installed during trauma-informed psychotherapy. Coregulation aimed at changing implicit relational knowing and increasing integration and coherence through relational work and hypnotic techniques is crucial, as clients' abilities to self-soothe and regulate have become seriously impaired. Thus, resource-oriented metaphors as inner strength imagery is advocated. Also, methods such as creative-arts therapy and neurofeedback will induce ASCs, as most methods used with complex traumatized clients, due to their high hypnotizability. When positive or soothing imagery or relationally held suggestions for changed attentional focus are added to both psychodynamic psychotherapy and CBT, a hetero-hypnosis will be induced-a prerequisite for phase-specific trauma therapy aimed at changing inner schemas and scripts.

New directions in hypnosis research: strategies for advancing the cognitive and clinical neuroscience of hypnosis

This article summarizes key advances in hypnosis research during the past two decades, including (i) clinical research supporting the efficacy of hypnosis for managing a number of clinical symptoms and conditions, (ii) research supporting the role of various divisions in the anterior cingulate and prefrontal cortices in hypnotic responding, and (iii) an emerging finding that high hypnotic suggestibility is associated with atypical brain connectivity profiles. Key recommendations for a research agenda for the next decade include the recommendations that (i) laboratory hypnosis researchers should strongly consider how they assess hypnotic suggestibility in their studies, (ii) inclusion of study participants who score in the middle range of hypnotic suggestibility, and (iii) use of expanding research designs that more clearly delineate the roles of inductions and specific suggestions. Finally, we make two specific suggestions for helping to move the field forward including (i) the use of data sharing and (ii) redirecting resources away from contrasting state and nonstate positions toward studying (a) the efficacy of hypnotic treatments for clinical conditions influenced by central nervous system processes and (b) the neurophysiological underpinnings of hypnotic phenomena. As we learn more about the neurophysiological mechanisms underlying hypnosis and suggestion, we will strengthen our knowledge of both basic brain functions and a host of different psychological functions.

Brain Oscillations and Diurnal Variations in Hypnotic Responsiveness--A Commentary on "Diurnal Variations in Hypnotic Responsiveness: Is There an Optimal Time to be Hypnotized?"

A recent study published in the International Journal of Clinical and Experimental Hypnosis reported an interesting diurnal pattern of hypnotic responsivity; specifically, the authors found higher hypnotic responsiveness in a large sample of undergraduates in the morning and early evening. However, they did not have an explanation for this pattern of findings. This pattern is consistent, however, with the theta hypothesis of hypnotic responsivity. Further examination of the associations between brain oscillations and response to hypnosis is needed to determine if specific oscillations such as theta (a) actually facilitate response to some hypnotic suggestions, (b) merely reflect hypnotic responding, or (c) reflect another factor that itself plays a causal role in response to hypnosis.