The Hypnotic Induction in the Broad Scheme of Hypnosis: A Sociocognitive Perspective

The Effectiveness of Hypnoanalgesia Using Conventional and Placebo Hypnosis Induction

The effectiveness of hypnosis-based pain management is well-established. However, mechanisms of action and specific effective components are not well understood. The sociocognitive theory of hypnosis proposes that the effectiveness of hypnosis for pain management is determined by the nonspecific features of response expectancy and context. We tested this claim by contrasting the effectiveness of 2 hypnoanalgesia procedures in a within subjects design using the cold pressor task. The 2 procedures were identical, including analgesic suggestions, except for the hypnosis induction used. One condition involved a well-established hypnosis induction, including suggestions for focused attention, relaxation, and deepening. The other condition included a sham induction procedure using only white noise. In our confirmatory analysis (N = 46), we found that pain tolerance increased compared to baseline equivalently in the conventional and sham induction conditions (mean increase 13.7 and 12.4 seconds respectively, average within subject difference -1.27 seconds, 90% confidence interval [CI] = -8.46, 5.90). This finding supports the claim of the sociocognitive theory considering that response expectancy for pain reduction was also equivalent between the conditions (average difference 2.30, 90% CI = -2.23, 6.84). However, self-reported hypnosis depth was greater in the conventional induction condition (average difference -.78, 90% CI: -1.36, -.07), which contradicts sociocognitive predictions. Our findings indicate that conventional procedural elements of hypnosis inductions, such as suggestions for focused attention, relaxation, and deepening, may not be necessary to achieve acute pain reduction in an experimental setting when the hypnosis intervention includes analgesic suggestions. PERSPECTIVE: This study assessed the necessary effective components of hypnosis-based analgesia interventions. Our findings suggest that procedural features such as suggestions for focused attention, relaxation, and deepening may not be necessary for hypnoanalgesia as long as pain relief suggestions are present, and the hypnosis context and response expectancy are established. TRIAL REGISTRATION: This trial was registered on Open Science Framework with the registry number e96xk, available at https://osf.io/e96xk.

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.

Redefining hypnosis: A narrative review of theories to move towards an integrative model

Hypnosis is an ancient mind-body intervention that has regained interest with the surge of research in the last decade documenting its clinical validity. Yet, theoretical controversies and misconceptions prevail among theorists, clinicians, and the general public, impeding the understanding, acceptance, replication, and use of hypnosis. Providing adequate information, which dispels misconceptions and promotes more balanced views, is warranted to facilitate the implementation and adoption of hypnosis in clinical and research settings. This review re-examines the conceptualisation of hypnosis throughout history and the theoretical controversies surrounding it while highlighting their meeting points and clinical implications. Despite dichotomies, a broad agreement appears across theoretical approaches regarding hypnotic analgesia effects, key components, and vocabulary. Further, theories highlight key factors of hypnotic responding. For instance, social theories highlight social and contextual variables, whereas state theories highlight biopsychosocial mechanisms and individual factors. Based on theories, the terms hypnotherapy or clinical hypnosis are recommended to refer to the therapeutic use of hypnosis in psychotherapeutic and medical contexts, respectively. This review concludes with a model that integrates various theories and evidence and presents hypnosis as a complex multifaceted intervention encompassing multiple procedures, phenomena, and influencing factors. This review intends to deepen our understanding of hypnosis, and promote its more rapid adoption and adequate implementation in research and clinical contexts, in addition to steering research towards evidence-based hypnotic practice. The review can have important research and clinical implications by contributing to advancing knowledge regarding hypnotic procedures, phenomena, and influencing factors.

The response set theory of hypnosis reconsidered: toward an integrative model

Irving Kirsch is a leading figure in the field of psychological science who has advanced our understanding of hypnosis in key respects that have withstood the tests of time and replication. We honor his prodigious contributions over his distinguished career and extend his response expectancy theory in an integrative model that encompasses predictive coding. We review the construct of expectancies that he articulated and championed for decades and extended in response set theory. We propose novel hypotheses to align his innovative contributions with the most current findings in psychological science and to acknowledge the heuristic value of his work. We especially focus on (I) how the response set theory can be conceptualized in terms of the predictive coding model and (II) psycho-social constructs that need to be considered to better understand the effects of expectancies on hypnotic phenomena in an open and evidence-based integrative model of hypnosis.

Effectiveness of Hypnosis for the Prevention of Anxiety During Coronary Angiography (HYPCOR study): a prospective randomized study

BACKGROUND

Coronary angiography is the gold standard for the diagnosis of coronary artery disease. This intervention is nevertheless a source of anxiety for the patient both by its discomfort and by the consequences linked to the discovery of potential diseases.

OBJECTIVES

The aim of this study was to determine the effectiveness of hypnosis in reducing anxiety in patients undergoing coronary angiography.

METHODS

One hundred sixty-nine patients with planned coronary angiography and no history of coronary angiography were randomized to a hypnosis or control group. Patients in the hypnosis group underwent a hypnosis session with self-hypnosis posthypnotic suggestions, while those in the control group had a conversational interview with the hypnotherapist. The primary endpoint was pre-exam anxiety level assessed by the Spielberger State-Trait Anxiety Inventory (STAI-Y A).

RESULTS

Performing a hypnosis session did not result in a significant decrease in anxiety before the intervention. Age, high trait anxiety, high state anxiety the day before, and belief that hypnosis works in general were associated with increased anxiety before the procedure. No adverse events were reported after hypnosis. There was no statistically significant difference between the 2 groups for the occurrence of complications of the intervention.

CONCLUSION

In this study, performing a hypnosis session before coronary angiography did not reduce the state of anxiety measured just before the intervention. In all cases, the hypnotic experience appears to be positive for the patient, encouraging further research efforts.

TRIAL REGISTRATION

The research protocol has been registered on the ClinicalTrials.gov registry (NCT02818101; 29/06/2016) and with the ANSM (IDRCB 2016-A00205-46; 02/02/2016).

Development and validation of audio-based guided imagery and progressive muscle relaxation tools for functional bloating

Mind-body techniques, including Guided Imagery (GI) or Progressive Muscle Relaxation (PMR), may effectively manage bloating. The current study aimed to develop and validate (psychometric and psychological responses) audio-based GI and PMR techniques for bloating. Audio scripts were first developed from literature reviews and in-depth interviews of participants with bloating diagnosed based on the Rome IV criteria. Scripts were validated using psychometric (content & face validity index) and physiological approaches (brain event-related potentials & heart rate variability). 45/63 participants completed the in-depth interview, and ‘balloon’ emerged as the synonymous imagery description for bloating, of which inflation correlated with a painful sensation. The final tools consisted of narrated audio scripts in the background of a validated choice of music. Overall, the content and face validity index for PMR and GI ranged from 0.92 to 1.00. For ERP and HRV, 17/20 participants were analyzed. For ERP, there was a significant difference between GI and PMR for alpha waves (p = 0.029), delta waves (p = 0.029), and between PMR and control for delta waves (p = 0.014). For HRV, GI and PMR exhibited similar autonomic responses over controls (overall p<0.05). The newly developed GI and PMR audio-based tools have been validated using psychometric and physiological approaches.

In medio stat virtus: The importance of studying mediums in hypnosis research

Most of the experimental investigations on hypnosis used to compare small samples of individuals with low or high responsiveness to hypnosis by systematically excluding medium responders. The present article underlines the limitations of this methodological approach that may have partially weakened the scientific impact of hypnosis research. In fact, the mediums-neglecting bias might be one of the reasons why some investigations suffer from low replicability and generalizability. Themes such as hypnotizability scales, suggestibility, statistical power, and research design are critically reviewed with the aim of proposing a more rigorous approach that boost up impact and reliability of hypnosis research. In particular, the recruitment of medium hypnotizables and the adoption of a within-instead of a between-subjects design currently seem to be some of the best recommendations for strengthening hypnosis research, as well as to renew the dialogue between clinical and experimental hypnosis.

Beyond words: Conceptual framework for the study and practice of hypnotherapeutic imagery

This paper provides a conceptual framework for the study and clinical application of hypnotherapeutic imagery (HTI). Using the grounded theory method of conceptual analysis, a unified theoretical framework is constructed from a multidisciplinary review of literature (i.e., this new theory is based on the collection and analysis of independently sourced data). The aim is to enumerate the chorographical features of HTI simulations within the mental landscape, rather than seeking to predict them. This is achieved using a combination of ontological, epistemological, and methodological inquires. Because mental simulation is both symptomatic of mental disorders and a psychotherapeutic agent, used across various treatment modalities, an attempt is made to isolate those variables that differentiate HTI from other instances of mental simulation. Lastly, applied principles from multiple disciplines are used to formulate HTI methodology designed to effectively enhance intuitive understanding and unconscious problem-solving.

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.

The neural mechanisms of immediate and follow-up of the treatment effect of hypnosis on smoking craving

Hypnosis has a therapeutic effect on substance dependence. However, its neural basis remains unclear, which impedes its further clinical applications. This study investigated the mechanisms of smoking treatment based on hypnosis from two perspectives: immediate and follow-up effects. Twenty-four smokers screened from 132 volunteers underwent hypnosis suggestion and performed a smoking-related cue task twice during functional magnetic resonance imaging (fMRI) scanning (in normal and hypnotic states). The number of cigarettes smoked per day was recorded at follow-up visits. The smokers reported decreased craving after hypnosis. The activations in the right dorsal lateral prefrontal cortex (rDLPFC), the left insula and the right middle frontal gyrus (rMFG), and the functional connectivity between the rDLPFC and the left insula were increased in the hypnotic state. The reduced craving was related to the DLPFC-insula network, which reflected the immediate mechanism of hypnosis on smoking. The number of cigarette use at the 1-week and 1 month follow-up was correlated with the rMFG activation which reflecting hypnotic depth, suggesting the follow-up effect of hypnosis on smoking depended on the trait of smokers. We identified two different mechanisms of hypnosis effect on smoking, which have important implications for design and optimization of hypnotic treatments on mental disorders.

Hypnotic Enhancement of Virtual Reality Distraction Analgesia during Thermal Pain: A Randomized Trial

Excessive pain during medical procedures is a pervasive health challenge. This study tested the (additive) analgesic efficacy of combining hypnotic analgesia and virtual reality (VR) pain distraction. A single blind, randomized, and controlled trial was used to study 205 undergraduate volunteers aged 18 to 20. The individual and combined effects of hypnotic analgesia (H) and VR distraction on experimentally induced acute thermal pain were examined using a 2 X 2, between-groups parallel design (4 groups total). Participants in groups that received hypnosis remained hypnotized during the test phase pain stimulus. The main outcome measure was "worst pain" ratings. Hypnosis reduced acute pain even for people who scored low on hypnotizability. As predicted, H+ VR was significantly more effective than VR distraction alone. However, H+ VR was not significantly more effective than hypnotic analgesia alone. Being hypnotized during thermal pain enhanced VR distraction analgesia.

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.

Effects of Prehypnotic Instructions on Hypnotizability and Relationships Between Hypnotizability, Absorption, and Empathy

Although hypnotizability exhibits high across-time and across-test consistencies, it is not clear (a) how different preambles to a hypnotic procedure (metasuggestions) influence responsiveness to suggestions and the strength of the association between two hypnotizability scales and (b) how hypnotizability relates to absorption and empathy. In Experiment 1, nonclinical participants (N = 152 women) were administered the Modified Tellegen Absorption Scale (MODTAS), Interpersonal Reactivity Index (IRI), Hypnotic Induction Profile (HIP), and Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C). In Experiment 2, nonclinical participants (N = 188; 105 women and 83 men) were administered the MODTAS, IRI, and Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A). The induction scores of the HIP (HIP-IND) and the SHSS:C scores showed a significantly stronger correlation when the HIP was introduced to the participants after hypnosis metasuggestion (HIP-H-IND) than after imagination metasuggestion (HIP-I-IND). Metasuggestion was a moderator of the association between HIP-IND and SHSS:C scores. Participants with low and medium, but not with high, hypnotizability levels on the SHSS:C showed significantly higher scores on the HIP-I-IND than on the HIP-H-IND. The strong correlations between the SHSS:C, HIP-H-IND, and HIP eye-roll (HIP-ER) scores indicate that both the HIP-H-IND and HIP-ER are robust measures of hypnotizability. Absorption and empathy were not significantly associated with hypnotizability. Women were more hypnotizable than men, as assessed by the HGSHS:A. The clinical relevance of metasuggestions, intended to increase responsiveness to suggestions, is discussed as a strategy to improve treatment outcomes.

RESPONDING TO SENSORIMOTOR SUGGESTIONS: From Endothelial Nitric Oxide to the Functional Equivalence Between Imagery and Perception

The reduced cerebellar gray matter (GM) volume observed in highly hypnotizable individuals (highs) is likely due to the excessive release of endothelial nitric oxide in the brain and could account for their behavioral (postural and visuomotor control) and physiological (paradoxical pain control after cerebellar anodal stimulation) characteristics. Reduced cerebellar GM can induce low inhibition of the cerebral cortex, thus stronger functional equivalence (FE) between imagery and perception and greater proneness to respond to sensorimotor suggestions. In fact, stronger FE suggested in highs by behavioral studies has been confirmed by topological data analysis of EEG signals recorded during sensorimotor and imagery tasks. The authors' hypothesis cannot be applied to obstructive suggestions likely sustained by mechanisms related to socio-cognitive factors, i.e., oxytocin availability.

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.

HYPNOTIC AUTOMATICITY IN THE BRAIN AT REST: An Arterial Spin Labelling Study

The feeling of automaticity reported by individuals undergoing a hypnotic procedure is an essential dimension of hypnosis phenomenology. In the present study, healthy participants rated their subjective experience of automaticity and resting-state arterial spin labelling (ASL) scans were acquired before and after a standard hypnotic induction (i.e., "neutral hypnosis"). The increase in perceived automaticity was positively associated with activity in the parietal operculum (PO) and seed-based coactivation analysis revealed additional associations in the anterior part of the supracallosal cingulate cortex (aMCC). This is consistent with the role of these regions in perceived self-agency and volition and demonstrates that these effects can be evidenced at rest, in the absence of overt motor challenges. Future studies should further examine if/how these changes in brain activity associated with automaticity might facilitate the responses to suggestions and contribute to clinical benefits of hypnosis.

HYPNOSIS, HYPNOTIC PHENOMENA, AND HYPNOTIC RESPONSIVENESS: Clinical and Research Foundations-A 40-Year Perspective

The authors summarize research findings, their clinical implications, and directions for future research derived from 40 years of study of hypnosis, hypnotic phenomena, and hypnotic responsiveness at Steven Jay Lynn's Laboratory of Consciousness, Cognition, and Psychopathology and Joseph P. Green's Laboratory of Hypnosis. We discuss (a) the accumulating body of evidence that hypnosis can be used to advantage in psychotherapy; (b) the fact that hypnosis can facilitate a broad array of subjective experiences and suggestions; (c) the failure to find a reliable marker of a trance or radically altered state of consciousness and reservations about conceptualizing hypnosis in such terms; (d) determinants of hypnotic responsiveness, including attitudes and beliefs, personality traits, expectancies, motivation, and rapport; (e) efforts to modify hypnotic suggestibility; and (f) the need to further examine attentional abilities and the role of adopting a readiness response set that the authors argue is key in maximizing hypnotic responsiveness.

Conversational Hypnosis: Conceptual and Technical Differences Relative to Traditional Hypnosis

This article provides an overview of conversational hypnosis (CH) as distinct from traditional forms. The article includes a history of Ericksonian hypnosis followed by a conceptual model and operational definitions for CH. The analysis is built on three levels of comparison and contrast. Three concepts commonly used in the general hypnosis literature-focusing, engaging, and inciting-structure a comprehensive definition of CH. The article concludes with recommendations for future research.

The Sussex-Waterloo Scale of Hypnotizability (SWASH): measuring capacity for altering conscious experience

The ability to respond to hypnotic suggestibility (hypnotizability) is a stable trait which can be measured in a standardized procedure consisting of a hypnotic induction and a series of hypnotic suggestions. The SWASH is a 10-item adaptation of an established scale, the Waterloo-Stanford Group C Scale of Hypnotic Suggestibility (WSGC). Development of the SWASH was motivated by three distinct aims: to reduce required screening time, to provide an induction which more accurately reflects current theoretical understanding and to supplement the objective scoring with experiential scoring. Screening time was reduced by shortening the induction, removing two suggestions which may cause distress (dream and age regression) and by modifications which allow administration in lecture theatres, so that more participants can be screened simultaneously. Theoretical issues were addressed by removing references to sleep, absorption and eye fixation and closure. Data from 418 participants at the University of Sussex and the Lancaster University are presented, along with data from 66 participants who completed a retest screening. The subjective and objective scales were highly correlated. The subjective scale showed good reliability and objective scale reliability was comparable to the WSGC. The addition of subjective scale responses to the post-hypnotic suggestion (PHS) item suggested a high probability that responses to PHS are inflated in WSGC screening. The SWASH is an effective measure of hypnotizability, which reflects changes in conscious experience and presents practical and theoretical advantages over existing scales.

A Multifaceted Hypnosis Smoking-Cessation Program: Enhancing Motivation and Goal Attainment

Smoking cessation remains a major health priority. Despite public campaigns against smoking and widespread availability of smoking-cessation treatments, many people continue to smoke. The authors argue that the "problem of motivation," that is, suboptimal or fluctuating motivation to resist smoking urges and to comply with the demands of treatment, commonly undermines treatment seeking and adherence, appreciably reducing the success rates of smoking-cessation programs. The authors describe the history of the Winning Edge smoking-cessation program and discuss ways to enhance motivation before, during, and after formal treatment. They illustrate how hypnotic suggestions, administered in the context of their program, can promote cognitive, behavioral, and emotional commitment to treatment and enhance motivation to live a smoke-free life.