Italian norms for the Stanford Hypnotic Susceptibility Scale, Form C

Effects of Direct and Indirect Suggestions for Analgesia: The Role of Hypnotizability and Expectation of Pain Relief

Among the methods for cognitive control of pain, the suggestions for analgesia-direct or indirect-have been widely and successfully used in experimental and clinical trials. The primary aim of this study was to contribute to the debate about the difference in the effectiveness of indirect and direct suggestions for the management of experimental pain in the ordinary state of consciousness. The secondary aim of the study was to ascertain the role of hypnotizability and expectation of pain relief in the suggestions' effect. A sample of 65 healthy participants with different levels of direct (Harvard Group Scale of Hypnotic Susceptibility: A score) and indirect suggestibility level (Alman-Wexler Indirect Hypnotic Susceptibility Scale score) and different levels of declared expectation of pain relief was submitted to direct and indirect suggestions for analgesia during cold pressure test. The results showed that both direct and indirect suggestions increase the threshold of experimental pain and that the expectation of pain relief is relevant only to the effect of direct suggestions. PERSPECTIVE: Although the reported findings cannot be extended to clinical pain, they suggest that indirect suggestions can be effective independently from the expectation of pain relief, thus evading the possible negative effects of traits such as catastrophism or reactance. Thus, indirect suggestions should be preferred in clinical contexts.

The Role of Interoceptive Sensitivity and Hypnotizability in Motor Imagery

Motor imagery (MI) requires the mental representation of the body, obtained by integrating exteroceptive and interoceptive information. This study aimed to investigate the role of interoceptive sensitivity (IS) in MI performed through visual and kinesthetic modalities by participants with low (lows, N = 26; SHSS: A, M + SD: 1.00 + 1.52), medium (mediums, N = 11; SHSS: A, 6.00 + 0.77) and high hypnotizability scores (highs, N = 16; SHSS:A, 9.75 + 1.24), as measured by the Stanford Hypnotic Susceptibility Scale: Form A. The three groups displayed different MI abilities and IS levels. The efficacy of MI was measured using the chronometric index and self-reported experience, while IS was measured using the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire. Alpha and beta power spectrum densities (PSDs) were extracted from the EEG signals acquired during baseline, actual movement and visually and kinesthetically imagined movements. The chronometric indices do not reveal significant differences between groups and imagery modalities. The self-report MI efficacy indicates better kinesthetic imagery in highs and mediums than in lows, and no modality difference among lows. The MAIA dimensions sustain the differences in subjective experience and almost all the EEG differences. The latter are slightly different in highs, mediums and lows. This is the first report of the major role played by IS in MI and strongly supports the theory of embodied cognition.

Interoception as a function of hypnotizability during rest and a heartbeat counting task

The hypnotizability-related differences in morpho-functional characteristics of the insula could at least partially account for the differences in interoceptive accuracy (IA) observed between high and low hypnotizable individuals (highs, lows). Our aim was to investigate interoceptive processing in highs, lows, and medium hypnotizable individuals (mediums), who represent most of the population, during a 10-minute open eyes relaxation condition (Part 1) and three repetitions of consecutive 2-minute open eyes, closed eyes, and heartbeat counting conditions, followed by a 2-minute post-counting condition (Part 2). Electrocardiogram and electroencephalogram were recorded in 14 highs, 14 mediums, and 18 lows, classified according to the Stanford Hypnotic Susceptibility Scale: Form A. Heartbeat-evoked cortical potentials (HEP) were extracted throughout the entire session, and IA index was obtained for the heartbeat counting task (HCT). In Part 1, significant hypnotizability-related differences were observed in the right central region in both early and late HEP components, with lows showing positive amplitudes and highs/mediums showing negative amplitudes. In Part 2, the same group differences were limited to the early component. Moreover, in the left frontal regions, only mediums modified their HEP during the counting task with respect to the open/closed eyes conditions, whereas highs displayed HEP differences between counting and post-counting rest. HCT did not show significant group differences. In conclusion, highs and mediums seem to be more similar than mediums and lows regarding HEP, despite the absence of significant differences in HCT. Nonetheless, a negative correlation between hypnotizability scores and HEP amplitudes was observed in the regions showing group differences.

Modulation of the heartbeat evoked cortical potential by hypnotizability and hypnosis

Hypnotizability is a psychophysiological trait measured by scales and associated with several differences, including interoceptive accuracy and the morpho-functional characteristics of interoception-related brain regions. The aim of the study was to assess whether the amplitude of the heartbeat evoked cortical potential (HEP), a correlate of interoceptive accuracy, differs in participants with low (lows) and high (highs) hypnotizability scores (assessed by the Stanford Hypnotic Susceptibility Scale, Form A) before and after the induction of hypnosis. ECG and EEG were monitored in 16 highs and 15 lows during an experimental session, including open eyes baseline (B), closed eyes relaxation (R), hypnotic induction (IND), neutral hypnosis (NH), and post session baseline (Post). No significant difference was observed between groups and conditions in autonomic variables. The HEP amplitude was lower in highs than in lows at the right parietal site, likely due to hypnotizability related differences in the functional connection between the right insula and parietal cortex. It increased in highs and decreased in lows across the session, possibly due to the highs' preeminently internally directed attention and to the lows' possible disengagement from the task. Since interoception is involved in several cognitive-emotional functions, its hypnotizability related differences may contribute to the variability of experience and behavior in daily life.

Is hypnotic assessment relevant to neurology?

Studies conducted in healthy subjects have clearly shown that different hypnotic susceptibility, which is measured by scales, is associated with different functional equivalence between imagery and perception/action (FE), cortical excitability, and information processing. Of note, physiological differences among individuals with high (highs), medium (mediums), and low hypnotizability scores (lows) have been observed in the ordinary state of consciousness, thus independently from the induction of the hypnotic state, and in the absence of specific suggestions. The potential role of hypnotic assessment and its relevance to neurological diseases have not been fully explored. While current knowledge and therapies allow a better survival rate, there is a constant need to optimize rehabilitation treatments and quality of life. The aim of this paper is to provide an overview of hypnotizability-related features and, specifically, to discuss the hypothesis that the stronger FE, the different mode of information processing, and the greater proneness to control pain and the activity of the immune system observed in individuals with medium-to-high hypnotizability scores have potential applications to neurology. Current evidence of the outcome of treatments based on hypnotic induction and suggestions administration is not consistent, mainly owing to the small sample size in clinical trials and inadequate control groups. We propose that hypnotic assessment may be feasible in clinical routine and give additional cues into the treatment and rehabilitation of neurological diseases.

Does Hypnotizability Affect Neurovascular Coupling During Cognitive Tasks?

The susceptibility to hypnosis is a very pervasive psychophysiological trait characterized by different attentional abilities, information processing, and cardiovascular control. Since near infrared spectroscopy (NIRS) is a good index of neurovascular coupling, we used it during mental computation (MC) and trail making task (TMT) in 13 healthy low-to-medium (med-lows) and 10 healthy medium-to-high hypnotizable (med-highs) participants classified according to the Stanford Hypnotic Susceptibility Scale (SHSS), form A, and characterized for the level of proneness to be deeply absorbed in cognitive tasks by the Tellegen Absorption Scale (TAS). Med-highs reported greater absorption than med-lows. The tissue hemoglobin index (THI) and the tissue oxygenation index (TOI) increased across the tasks only in med-highs who displayed also different time courses of THI and TOI during MC and TMT, which indicates different tasks processing despite the two groups' similar performance. The findings suggest that the med-highs' tissue oxygenation is more finely adjusted to metabolic demands than med-lows'.

Cerebral Blood Flow in Healthy Subjects with Different Hypnotizability Scores

Hypnotizability is a cognitive trait associated with differences in the brachial artery flow-mediated dilatation of individuals with high hypnotizability (highs) and low hypnotizability scores (lows). The study investigated possible hypnotizability-related cerebrovascular differences. Among 24 healthy volunteers, the Stanford Hypnotic Susceptibility Scale Form A identified 13 medium-to-lows (med-lows), 11 medium-to-highs (med-highs), and 1 medium hypnotizable. Hypnotizability did not influence the significant changes produced by the trail making task (TMT), mental arithmetic task (MAT), hyperventilation (HVT), and rebreathing (RBT) on heart rate (HR), arterial blood pressure (ABP), and partial pressure of end-tidal CO₂ (P_ETCO₂), but moderated the correlations between the changes occurring during tasks with respect to basal conditions (Δ) in ABP and P_ETCO₂ with middle cerebral artery flow velocity (MCAv). In HVT, med-lows exhibited a significant correlation between ΔMCAv and ΔP_ETCO₂, and med-highs showed a significant correlation between ΔABP and ΔMCAv. Cerebrovascular reactivity (CVR) and conductance (ΔCVCi) were significantly correlated with ΔMCAv only in med-lows during HVT and RBT. For the first time, cerebrovascular reactivity related to hypnotizability was investigated, evidencing different correlations among hemodynamic variables in med-highs and med-lows.

Well-Being in Highly Hypnotizable Persons

Both hypnotizability and well-being are relevant to health. This study aimed to investigate whether high hypnotizability was positively associated with well-being and whether the latter was related to the activity of the behavioral inhibition/approach system (BIS/BAS). ANOVA revealed significantly higher scores on the General Well-Being Index (PGWBI) in highly hypnotizable (highs, n = 31) compared with low hypnotizable participants (lows, n = 53), with medium hypnotizable participants (mediums, n = 41) exhibiting intermediate values. This finding was discussed in relation to other hypnotizability-related traits, such as morpho-functional brain characteristics, equivalence between imagery and perception, and interoceptive sensitivity. A secondary finding was a nonsignificant gender difference in scores on the PGWBI. The highs' higher well-being could be considered a favorable prognostic factor for physical and mental health.

Hypnotizability Norms may not be Representative of the General Population: Potential Sample and Self-Selection Bias Considerations

The analysis of the methods sections of 66 normalization tests of hypnotizability scales reveals that out of 33,338 subjects, 58.57% were college and university students, and the majority of these were students of psychology. Of all subjects, 7.45% were younger school children, 27.63% were patients treated with hypnosis, and out of these, 85.26% were patients of 1 single therapist. Only 0.51% were trainees of dental or nursing schools, 0.13% were prisoners, and 5.71% were other adults. These figures suggest a sample-selection bias. As 83.08% of these subjects were told beforehand that they were to undergo a hypnosis study, a self-selection bias is also implied in the data. It can be presumed that those interested in hypnosis participated, whereas others who had no interest in hypnosis may have refrained. It is concluded that some of the published norms of hypnotizability tests may not be adequately representative of the general population. Many hypnosis studies, whether clinical or experimental, which are based on hypnotizability, may be afflicted by these biases.

Interoceptive Accuracy as a Function of Hypnotizability

This study aimed to measure the interoceptive accuracy (IA) of individuals with high (highs), medium (mediums), and low hypnotizability (lows) through the heartbeat-counting task during 3 relaxation trials. Participants completed the Multidimensional Assessment of Interoceptive Awareness (MAIA), ECG and skin conductance (SC) were monitored, and the experienced difficulty in counting was reported. Results showed similar counting difficulty and number of actual heartbeats in highs, mediums, and lows. SC decreased in highs during all trials, in mediums and lows only in the third trial. IA measured as [1 - (ǀrecorded heartbeats-counted heartbeatsǀ)/recorded heartbeats] was negatively correlated with hypnotizability and not correlated with interoceptive sensitivity (IS) measured by MAIA scales. Among mediums, IA was higher in males than in females.

Heartbeat-Evoked Cortical Potential during Sleep and Interoceptive Sensitivity: A Matter of Hypnotizability

Individuals with different hypnotizability display different interoceptive sensitivity/awareness (IS) and accuracy (IA), likely sustained by morphofunctional differences in interoception-related brain regions and, thus, possibly also observable during sleep. We investigated the heartbeat-evoked cortical potential amplitude (HEP) during sleep, its association with IS, and the role of hypnotizability in such association. We performed a retrospective analysis of polysomnographic recordings of 39 healthy volunteers. Participants completed the Multidimensional Assessment of Interoceptive Awareness (MAIA), measuring IS and IA, and underwent hypnotic assessment via the Stanford Hypnotic Susceptibility Scale, form A. The amplitude of the early and late HEP components was computed at EEG frontal and central sites. In both regions, the early HEP component was larger in N3 than in N2 and REM, with no difference between N2 and REM. Greater HEP amplitude at frontal than at central sites was found for the late HEP component. HEP amplitudes were not influenced by the autonomic state assessed by heart rate variability in the frequency and time domains. We report for the first time a positive correlation between the central late HEP component and MAIA dimensions, which became non-significant after removing the effects of hypnotizability. Our findings indicate that hypnotizability sustains the correlation between IS and HEP amplitude during sleep.

Linear and Nonlinear Quantitative EEG Analysis during Neutral Hypnosis following an Opened/Closed Eye Paradigm

Hypnotic susceptibility is a major factor influencing the study of the neural correlates of hypnosis using EEG. In this context, while its effects on the response to hypnotic suggestions are undisputed, less attention has been paid to “neutral hypnosis” (i.e., the hypnotic condition in absence of suggestions). Furthermore, although an influence of opened and closed eye condition onto hypnotizability has been reported, a systematic investigation is still missing. Here, we analyzed EEG signals from 34 healthy subjects with low (LS), medium (MS), and (HS) hypnotic susceptibility using power spectral measures (i.e., TPSD, PSD) and Lempel-Ziv-Complexity (i.e., LZC, fLZC). Indeed, LZC was found to be more suitable than other complexity measures for EEG analysis, while it has been never used in the study of hypnosis. Accordingly, for each measure, we investigated within-group differences between rest and neutral hypnosis, and between opened-eye/closed-eye conditions under both rest and neutral hypnosis. Then, we evaluated between-group differences for each experimental condition. We observed that, while power estimates did not reveal notable differences between groups, LZC and fLZC were able to distinguish between HS, MS, and LS. In particular, we found a left frontal difference between HS and LS during closed-eye rest. Moreover, we observed a symmetric pattern distinguishing HS and LS during closed-eye hypnosis. Our results suggest that LZC is better capable of discriminating subjects with different hypnotic susceptibility, as compared to standard power analysis.

Persian Norms for The Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C)

The Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C), is the most commonly used measure of hypnotizability. In Persian (Farsi), there was a lack of a valid test for hypnotizability. The norms for different language versions of the SHSS:C are important for evaluating the cross-language validity of the measure and determining the ability to compare research findings using the SHSS:C samples of different languages. In this study, a Persian translation of SHSS:C was administered to 321 Farsi-speaking individuals from the cities Tehran and Mashhad. Then, different parameters of the measure, including the distribution, normality, internal consistency, difficulty, and comparison with other SHSS:C norms, have been evaluated and presented. The results indicated that the Persian SHSS:C has good reliability, which is in line with the other language versions of the scale, and the scores from the Persian SHSS:C are comparable to those of the other language versions.

Linear and non linear measures of pupil size as a function of hypnotizability

Higher arousal and cortical excitability have been observed in high hypnotizable individuals (highs) with respect to low hypnotizables (lows), which may be due to differences in the activation of ascending activating systems. The present study investigated the possible hypnotizability-related difference in the cortical noradrenergic tone sustained by the activity of the Locus Coeruleus which is strongly related to pupil size. This was measured during relaxation in three groups of participants—highs (N = 15), lows (N = 15) and medium hypnotizable individuals (mediums, N = 11)—in the time and frequency domains and through the Recurrence Quantification Analysis. ECG and Skin Conductace (SC) were monitored to extract autonomic indices of relaxation (heart interbeats intervals, parasympathetic component of heart rate variability (RMSSD) and tonic SC (MeanTonicSC). Most variables indicated that participants relaxed throughout the session. Pupil features did not show significant differences between highs, mediums and lows, except for the spectral Band Median Frequency which was higher in mediums than in lows and highs at the beginning, but not at the end of the session.Thus, the present findings of pupil size cannot account for the differences in arousal and motor cortex excitability observed between highs and lows in resting conditions.

Now You See One Letter, Now You See Meaningless Symbols: Perceptual and Semantic Hypnotic Suggestions Reduce Stroop Errors Through Different Neurocognitive Mechanisms

Compelling literature has suggested the possibility of adopting hypnotic suggestions to override the Stroop interference effect. However, most of these studies mainly reported behavioral data and were conducted on highly hypnotizable individuals. Thus, the question of the neural locus of the effects and their generalizability remains open. In the present study, we used the Stroop task in a within-subject design to test the neurocognitive effects of two hypnotic suggestions: the perceptual request to focus only on the central letter of the words and the semantic request to observe meaningless symbols. Behavioral results indicated that the two types of suggestions did not alter response time (RT), but both favored more accurate performance compared to the control condition. Both types of suggestions increased sensory awareness and reduced discriminative visual attention, but the perceptual request selectively engaged more executive control of the prefrontal cortex (PFC), and the semantic request selectively suppressed the temporal cortex activity devoted to graphemic analysis of the words. The present findings demonstrated that the perceptual and the semantic hypnotic suggestions reduced Stroop errors through common and specific top-down modulations of different neurocognitive processes but left the semantic activation unaltered. Finally, as we also recruited participants with a medium level of hypnotizability, the present data might be considered potentially representative of the majority of the population.

Hypnotizability-Related Effects of Pain Expectation on the Later Modulation of Cortical Connectivity

This study examined hypnotizability-related modulation of the cortical network following expected and nonexpected nociceptive stimulation. The electroencephalogram (EEG) was recorded in 9 high (highs) and 8 low (lows) hypnotizable participants receiving nociceptive stimulation with (W1) and without (noW) a visual warning preceding the stimulation by 1 second. W1 and noW were compared to baseline conditions to assess the presence of any later effect and between each other to assess the effects of expectation. The studied EEG variables measured local and global features of the cortical connectivity. With respect to lows, highs exhibited scarce differences between experimental conditions. The hypnotizability-related differences in the later processing of nociceptive information could be relevant to the development of pain-related individual traits. Present findings suggest a lower impact of nociceptive stimulation in highs than in lows.

Association of hypnotizability and deep sleep: any role for interoceptive sensibility?

The aim of the study was to investigate the possible association of hypnotizability and deep sleep (N3) duration, and whether the interoceptive sensibility influences this association. This was motivated by the proneness of highly hypnotizable individuals to easily change their psychophysiological state, i.e., from wakefulness to hypnosis and sleep, and by the positive association observed between hypnotizability and interoceptive sensibility. Forty-seven healthy participants previously enrolled in a polysomnographic night sleep study completed the questionnaire for Multidimensional Assessment of Interoceptive Awareness (MAIA) and underwent hypnotic assessment through the Stanford Hypnotic Susceptibility Scale, form A (SHSS,A). Results showed that N3 duration is not linearly correlated with hypnotizability. Controlling for a few MAIA scales did not modify the relation between hypnotizability and deep sleep. A polynomial relation indicates that N3 duration and N3 percentage of the total sleep time increase with hypnotizability in the low-to-medium range of hypnotizability and decrease in the medium-to-high range. In conclusion, hypnotic assessment predicts N3 duration and their association is not modified by interoceptive awareness/sensitivity.

High Motor Cortex Excitability in Highly Hypnotizable Individuals: A Favourable Factor for Neuroplasticity?

Hypnotizability is a psychophysiological trait associated with morphofunctional brain peculiarities and with several cognitive, sensorimotor and cardiovascular correlates. Behavioral and EEG studies indicate stronger functional equivalence (FE) between motor imagery and action in the individuals with high hypnotizability scores (Highs). We hypothesized that stronger FE leading to greater proneness to ideomotor behavior could be due to greater cortical excitability of the motor cortex. The aim of the study was to evaluate the motor cortical excitability through measurements of the muscle potentials (MEPs) evoked in the left abductor pollicis brevis by transcranial magnetic stimulation (TMS) of the right motor cortex in 10 Highs, 10 medium (Mediums) and 10 low hypnotizable individuals (Lows) classified according to the Stanford Hypnotic Susceptibility Scale, form A (SHSS). They were studied in basal conditions (B) and during motor imagery (MI). Results showed significant, negative correlations (i) between hypnotizability and MEPs Resting Motor Threshold (RMT) in basal conditions, and (ii) between hypnotizability and both MEPs RMT and suprathreshold (I_1mv) stimulation intensities during MI. ANOVA revealed significantly lower stimulation intensities in Highs than in Lows, with Mediums exhibiting intermediate values. Thus, the Highs' greater cortical excitability could sustain their greater FE and proneness to ideomotor behavior. In cognitive neuroscience these findings are relevant to the physiological interpretation of the response to sensorimotor suggestions by participants in the ordinary state of consciousness. In the clinical field they can predict the efficacy of mental training based on motor imagery and, possibly, the degree of imagery-induced cortical plasticity.

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.

HYPNOTIZABILITY-RELATED FAAH C385A POLYMORPHISM: POSSIBLE ENDOCANNABINOID CONTRIBUTION TO SUGGESTION-INDUCED ANALGESIA

Fatty acid amide hydrolase (FAAH) degrades the endogenous endocannabinoid (eCB) anandamide and might be involved in the response to suggestions of analgesia in subjects with high hypnotizability scores (highs). Since the A allele of the FAAH C385A polymorphism (rs324420) is associated with lower FAAH activity, it was studied in 21 highs, 66 low hypnotizable individuals (lows), and 172 individuals not selected for hypnotizability (controls) representing the general population. No significant difference was observed among groups, but the A allele frequency showed a significant trend to increase from lows to controls and from controls to highs. Since eCB small differences can be amplified by eCB interactions with other neurotransmitters, a contribution of the FAAH polymorphism to the highs' analgesia should not be excluded.

Hypnosis and learning: Pilot study on a group of students

Background Milton Erickson was the first to introduce hypnosis as a form of therapy during the post-war period. Numerous studies have evaluated the effects of hypnosis on memory, focusing principally on post-hypnotic amnesia, post-hypnotic hypermnesia, faux memories and learning growth. The aim of the present study was to determine if hypnosis can influence visual-spatial memory by increasing its performance and learning; to do this, we chose to utilise the Corsi Test (backward and forward). Methods Three hundred second-year students enrolled in the psychology faculty at the University of Catania were informed of the research and its modalities, and an e-mail was sent to inquire if they wanted to participate in the experiment. Seventy female students took part in the research; 10 were excluded because they presented a high risk of being influenced under hypnosis. The 60 subjects in the research sample were randomly divided into two groups: the Experimental Group and Control Group. The protocol prescribed administration of the Corsi Test at Time 0 (start) followed by a resting phase of 30 min. The hypnotic state was subsequently introduced, and the Corsi Test was administered again. Results The results of the Corsi Test for the Experimental Group showed statistically significant results (p<0.0004 and p<0.0001), while the results obtained in the Control Group did not show any significance. Conclusions These results led us to believe that hypnosis has the capacity to induce a nervous plasticity that supports learning of visual-spatial memory.

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.

Does hypnotic assessment predict the functional equivalence between motor imagery and action?

Motor imagery is influenced by individual and contextual factors. We investigated whether the psychophysiological trait of hypnotisability modulates its subjective experience and cortical correlates similarly to what was previously shown for head postures mental images. EEG was acquired in 18 high (highs) and 15 low (lows) hypnotizable subjects (Stanford Hypnotic Susceptibility Scale, A). The experimental conditions were: baseline, a complex arm/hand movement, visual (1st person) and kinesthetic imagery of the movement. After each imagery condition, participants scored the vividness and easeness of their performance and their ability to mantain the requested modality of imagery. Subjective reports, chronometric visual/kinesthetic indices, absolute beta and fronto-central midline alpha powers were analyzed. Findings confirmed earlier reports of better kinestetic imagery ability in highs than in lows and better visual than kinesthetic imagery in lows, as well as smaller restructuring of the cortical activity in highs than in lows, during all tasks. Also, they show that hypnotisability accounts for most of the correlations between brain regions for both alpha and beta changes. Thus, imagined and actual movements were less demanding processes in highs at subjective and cortical levels. Finally, hypnotic assessment assists to plan personalized mental training for neuro-rehabilitation and sports and predict their efficacy.

The interoception and imagination loop in hypnotic phenomena

We tested a working hypothesis that the ideomotor and motor-control suggestions measured by current hypnotizability scales depend on the activation of an interoception-imagination processing loop. In three experiments, participants were exposed to an induction phase, Items 3 (mosquito hallucination) and 8 (arm immobilization) of the Stanford Hypnotic Susceptibility Scale, Form C, and a new version of Item 8 involving the additional activation of imaginative and interoception processes. We found that this modified version of Item 8 elicited greater responsiveness to suggestion, irrespective of its position in the sequence of hypnotic items. We argue that this interoception-imagination loop hypothesis provides a useful information processing analysis for understanding several hypnotic phenomena.

Spectral and topological analyses of the cortical representation of the head position: Does hypnotizability matter?

INTRODUCTION

The aim of this exploratory study was to assess the EEG correlates of head positions (which have never been studied in humans) in participants with different psychophysiological characteristics, as encoded by their hypnotizability scores. This choice is motivated by earlier studies suggesting different processing of vestibular/neck proprioceptive information in subjects with high (highs) and low (lows) hypnotizability scores maintaining their head rotated toward one side (RH).

METHODS

We analyzed EEG signals recorded in 20 highs and 19 lows in basal conditions (head forward) and during RH using spectral analysis, which captures changes localized to specific recording sites, and topological data analysis (TDA), which instead describes large-scale differences in processing and representing sensorimotor information.

RESULTS

Spectral analysis revealed significant differences related to head position for alpha 1, beta 2, beta 3, and gamma bands, but not to hypnotizability. TDA instead revealed global hypnotizability-related differences in the strengths of the correlations among recording sites during RH. Significant changes were observed in lows on the left parieto-occipital side and in highs in right frontoparietal region. Significant differences between the two groups were found in the occipital region, where changes were larger in lows than in highs.

CONCLUSIONS

This study reports finding of the EEG correlates of changes in the head posture for the first time, indicating that hypnotizability is related to the head posture representation/processing on large-scale networks and that spectral and topological data analyses provide complementary results.

Cerebellar Structural Variations in Subjects with Different Hypnotizability

Hypnotizability-the proneness to accept suggestions and behave accordingly-has a number of physiological and behavioral correlates (postural, visuomotor, and pain control) which suggest a possible involvement of cerebellar function and/or structure. The present study was aimed at investigating the association between cerebellar macro- or micro-structural variations (analyzed through a voxel-based morphometry and a diffusion tensor imaging approach) and hypnotic susceptibility. We also estimated morphometric variations of cerebral gray matter structures, to support current evidence of hypnotizability-related differences in some cerebral areas. High (highs, N = 12), and low (lows, N = 37) hypnotizable healthy participants (according to the Stanford Hypnotic Susceptibility Scale, form A) were submitted to a high field (3 T) magnetic resonance imaging protocol. In comparison to lows, highs showed smaller gray matter volumes in left cerebellar lobules IV/V and VI at uncorrected level, with the results in left lobule IV/V maintained also at corrected level. Highs showed also gray matter volumes smaller than lows in right inferior temporal gyrus, middle and superior orbitofrontal cortex, parahippocampal gyrus, and supramarginal parietal gyrus, as well as in left gyrus rectus, insula, and middle temporal cortex at uncorrected level. Results of right inferior temporal gyrus survived also at corrected level. Analyses on micro-structural data failed to reveal any significant association. The here found morphological variations allow to extend the traditional cortico-centric view of hypnotizability to the cerebellar regions, suggesting that cerebellar peculiarities may sustain hypnotizability-related differences in sensorimotor integration and emotional control.

Polymorphism of Opioid Receptors μ1 in Highly Hypnotizable Subjects

The possible cooperation between hypnotizability-related and placebo mechanisms in pain modulation has not been consistently assessed. Here, we investigate possible genetic bases for such cooperation. The OPRM1 gene, which encodes the μ1 opioid receptor-the primary site of action for endogenous and exogenous opioids-is polymorphic in the general population for the missense mutation Asn40Asp (A118G, rs1799971). The minor allele 118G results in decreased levels of OPRM1 mRNA and protein. As a consequence, G carriers are less responsive to opioids. The aim of the study was to investigate whether hypnotizability is associated with the presence of the OPRM1 polymorphism. Forty-three high and 60 low hypnotizable individuals, as well as 162 controls, were genotyped for the A118G polymorphism of OPRM1. The frequency of the G allele was significantly higher in highs compared to both lows and controls. Findings suggest that an inefficient opioid system may be a distinctive characteristic of highs and that hypnotic assessment may predict lower responsiveness to opioids.

Hypnotizability and Performance on a Prism Adaptation Test

The susceptibility to hypnosis, which can be measured by scales, is not merely a cognitive trait. In fact, it is associated with a number of physiological correlates in the ordinary state of consciousness and in the absence of suggestions. The hypnotizability-related differences observed in sensorimotor integration suggested a major role of the cerebellum in the peculiar performance of healthy subjects with high scores of hypnotic susceptibility (highs). In order to provide behavioral evidence of this hypothesis, we submitted 20 highs and 21 low hypnotizable participants (lows) to the classical cerebellar Prism Adaptation Test (PAT). We found that the highs' performance was significantly less accurate and more variable than the lows' one, even though the two groups shared the same characteristics of adaptation to prismatic lenses. Although further studies are required to interpret these findings, they could account for earlier reports of hypnotizability-related differences in postural control and blink rate, as they indicate that hypnotizability influences the cerebellar control of sensorimotor integration.

Complementing the Latest APA Definition of Hypnosis: Sensory-Motor and Vascular Peculiarities Involved in Hypnotizability

The aim of this article is to complement the recently revised American Psychological Association (APA) definition of hypnotizability. It (a) lists a few differences in sensorimotor integration between subjects with high (highs) and low (lows) hypnotizability scores in the ordinary state of consciousness and in the absence of suggestions, (b) proposes that hypnotizability-related cerebellar peculiarities may account for them,

Transcultural Factors in Hypnotizability Scales: Limits and Prospects

Hypnotic suggestibility--loosely termed hypnotizability--is difficult to assess across cultures. Investigators often use translated research instruments to guide their inquiry in disparate geographic locations. Present-day hypnosis researchers rely heavily on two primary scales that are more than half a century old: the Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C) (Weitzenhoffer & Hilgard, 1959) and the Harvard Group Scale of Hypnotic Susceptibility: Form A (HGSHS:A) (Shor & Orne, 1962). Scholars typically translate these scales to measure hypnotizability transculturally. This approach, however, operates under the specious assumption that the concept of hypnotizability is largely monolithic or universal across cultures. Whereas translations likely conserve the linguistic content, they may arguably imply different cultural meanings and historical subtexts. Whereas social scientists acknowledge the importance of qualitative and phenomenological accounts in the study of altered consciousness, including suggestibility, researchers interested in hypnotizability consider the impact of findings from anthropology and ethnography too little. Clinicians and scholars of hypnosis would stand to benefit from incorporating the insights afforded by transcultural research in the overarching investigation of a concept as nuanced as hypnotizability.

Cross-evidence for hypnotic susceptibility through nonlinear measures on EEGs of non-hypnotized subjects

Assessment of hypnotic susceptibility is usually obtained through the application of psychological instruments. A satisfying classification obtained through quantitative measures is still missing, although it would be very useful for both diagnostic and clinical purposes. Aiming at investigating the relationship between the cortical brain activity and the hypnotic susceptibility level, we propose the combined use of two methodologies - Recurrence Quantification Analysis and Detrended Fluctuation Analysis - both inherited from nonlinear dynamics. Indicators obtained through the application of these techniques to EEG signals of individuals in their ordinary state of consciousness allowed us to obtain a clear discrimination between subjects with high and low susceptibility to hypnosis. Finally a neural network approach was used to perform classification analysis.

Structural and functional cerebral correlates of hypnotic suggestibility

Little is known about the neural bases of hypnotic suggestibility, a cognitive trait referring to the tendency to respond to hypnotic suggestions. In the present magnetic resonance imaging study, we performed regression analyses to assess hypnotic suggestibility-related differences in local gray matter volume, using voxel-based morphometry, and in waking resting state functional connectivity of 10 resting state networks, in 37 healthy women. Hypnotic suggestibility was positively correlated with gray matter volume in portions of the left superior and medial frontal gyri, roughly overlapping with the supplementary and pre-supplementary motor area, and negatively correlated with gray matter volume in the left superior temporal gyrus and insula. In the functional connectivity analysis, hypnotic suggestibility was positively correlated with functional connectivity between medial posterior areas, including bilateral posterior cingulate cortex and precuneus, and both the lateral visual network and the left fronto-parietal network; a positive correlation was also found with functional connectivity between the executive-control network and a right postcentral/parietal area. In contrast, hypnotic suggestibility was negatively correlated with functional connectivity between the right fronto-parietal network and the right lateral thalamus. These findings demonstrate for the first time a correlation between hypnotic suggestibility, the structural features of specific cortical regions, and the functional connectivity during the normal resting state of brain structures involved in imagery and self-monitoring activity.

Stabilizing posture through imagery

Abstract In the general population, suppression of vision modulates body sway by increasing the center of pressure (CoP) velocity, while a light fingertip touch reduces the area of the CoP displacement in blindfolded subjects. This study assessed whether imagined fixation and fingertip touch differentially stabilize posture in subjects with high (highs) and low (lows) hypnotizability. Visual and tactile imageries were ineffective in lows. In highs, the effects of visual imagery could not be evaluated because the real information was ineffective; real tactile stimulation was effective only on velocity, but the imagery effects could not be definitely assessed owing to low effect size. The highs' larger variability could account for this and represents the most important finding.

Hypnotizability, hypnosis and prepulse inhibition of the startle reflex in healthy women: an ERP analysis

A working model of the neurophysiology of hypnosis suggests that highly hypnotizable individuals (HHs) have more effective frontal attentional systems implementing control, monitoring performance, and inhibiting unwanted stimuli from conscious awareness, than low hypnotizable individuals (LHs). Recent studies, using prepulse inhibition (PPI) of the auditory startle reflex (ASR), suggest that HHs, in the waking condition, may show reduced sensory gating although they may selectively attend and disattend different stimuli. Using a within subject design and a strict subject selection procedure, in waking and hypnosis conditions we tested whether HHs compared to LHs showed a significantly lower inhibition of the ASR and startle-related brain activity in both time and intracerebral source localization domains. HHs, as compared to LH participants, exhibited (a) longer latency of the eyeblink startle reflex, (b) reduced N100 responses to startle stimuli, and (c) higher PPI of eyeblink startle and of the P200 and P300 waves. Hypnosis yielded smaller N100 waves to startle stimuli and greater PPI of this component than in the waking condition. sLORETA analysis revealed that, for the N100 (107 msec) elicited during startle trials, HHs had a smaller activation in the left parietal lobe (BA2/40) than LHs. Auditory pulses of pulse-with prepulse trials in HHs yielded less activity of the P300 (280 msec) wave than LHs, in the cingulate and posterior cingulate gyrus (BA23/31). The present results, on the whole, are in the opposite direction to PPI findings on hypnotizability previously reported in the literature. These results provide support to the neuropsychophysiological model that HHs have more effective sensory integration and gating (or filtering) of irrelevant stimuli than LHs.

Hypnotic susceptibility modulates brain activity related to experimental placebo analgesia

Identifying personality traits and neural signatures that predict placebo responsiveness is important, both on theoretical and practical grounds. In the present functional magnetic resonance imaging (fMRI) study, we performed multiple-regression interaction analysis to investigate whether hypnotic susceptibility (HS), a cognitive trait referring to the responsiveness to suggestions, explains interindividual differences in the neural mechanisms related to conditioned placebo analgesia in healthy volunteers. HS was not related to the overall strength of placebo analgesia. However, we found several HS-related differences in the patterns of fMRI activity and seed-based functional connectivity that accompanied placebo analgesia. Specifically, in subjects with higher HS, the placebo response was related to increased anticipatory activity in a right dorsolateral prefrontal cortex focus, and to reduced functional connectivity of that focus with brain regions related to emotional and evaluative pain processing (anterior mid-cingulate cortex/medial prefrontal cortex); an opposite pattern of fMRI activity and functional connectivity was found in subjects with lower HS. During pain perception, activity in the regions reflecting attention/arousal (bilateral anterior thalamus/left caudate) and self-related processing (left precuneus and bilateral posterior temporal foci) was negatively related to the strength of the analgesic placebo response in subjects with higher HS, but not in subjects with lower HS. These findings highlight HS influences on brain circuits related to the placebo analgesic effects. More generally, they demonstrate that different neural mechanisms can be involved in placebo responsiveness, depending on individual cognitive traits.

Hypnotizability modulates the cardiovascular correlates of subjective relaxation

Mean values and the spectral variability of heart rate (HRV), blood pressure, and skin blood flow were studied in high and low hypnotizable subjects during simple relaxation. Similar subjective relaxation was reported by highs and lows. A parasympathetic prevalence (indicated by a higher High-Frequency component of HRV and a lower High/Low-Frequency ratio) and lower renin-angiotensin activity (indicated by a lower Very-Low-Frequency component of HRV) could be attributed to highs with respect to lows. Hypnotizability did not affect blood pressure and its variability and modulated the skin blood flow across the session only in lows. The findings confirm that relaxation cannot be defined solely on cardiovascular parameters and also indicate that hypnotizability modulates cardiovascular activity during simple relaxation and suggest it may have a protective role against cardiovascular disease.

An investigation of Taiwanese norms for the Stanford Hypnotic Susceptibility Scale: Form C (Mandarin Chinese Translation)

This study establishes normative data for the Mandarin Chinese Translation of the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C-MCT). Fourteen administrators gave the SHSS:C-MCT as well as demographic and meditation questionnaires to 322 participants of Taiwanese nationality. Score distributions, normality, internal consistency, item difficulty, and comparisons with other SHSS:C samples are presented. Scores on the SHSS:C-MCT were compared to both demographic and meditation practice data. The psychometric properties of the SHSS:C-MCT were found to be similar to those of other samples, and the Taiwanese mean score was found to be higher than most other samples, providing support for continued and expanded use of hypnosis in relative treatment applications in Taiwan.

Belgian norms for the Waterloo-Stanford Group C (WSGC) Scale of Hypnotic Susceptibility

Belgian norms of the Waterloo-Stanford Group C Scale of Hypnotic Susceptibility (WSGC) are presented. A French translation of the WSGC was administered to 150 Belgium college students between October and December 2009. Belgium has 2 main linguistic groups, Dutch and French speakers. The present translation was conceived for all French-speaking populations. Score distribution, item analysis, and reliability of the WSGC are presented and compared to the normative sample of the WSGC. The results were also compared with 2 North American norms (University of Connecticut and Seton Hall University) and a Portuguese (translated) norm. The findings show that normative data from the French (Belgium) sample are in line with the reference samples. The only significant difference was the lower proportion of participants scoring within the high range of hypnotic suggestibility on the WSGC.

Efficacy of hypnosis in the treatment of human papillomavirus (HPV) in women: rural and urban samples

This article investigates the effect of hypnosis on immunity and whether this is the key mechanism in the hypnotic treatment of the genital infection caused by human papillomavirus (HPV). HPV is the most common sexually transmitted disease and can lead to cervical and other cancers. Current medical treatments are aimed at tissue assault (acids, freezing, surgery). Medical wart clearance rates are only 30% to 70% and recurrence is common. Our research contrasted hypnosis-only with medical-only therapies, using both urban hospital and rural community samples. Both hypnosis and medical therapy resulted in a statistically significant (p < .04) reduction in areas and numbers of lesions. Yet, at the 12-week follow-up, complete clearance rates were 5 to 1 in favor of hypnosis.

Israeli norms for the Stanford hypnotic susceptibility scale, Form C

A Hebrew version of the 12-item Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C) was administered to 169 subjects in Israel. The authors compared the results with those obtained for the English original administered in the USA and with an additional group of 38 English-speaking subjects in Israel, as well as with versions translated into Spanish (2 versions, for Spain and for Mexico), Italian, German, and Dutch. Mean scores and pair-wise rank-order correlations between item pass rates were comparable across the different samples. Item reliability was somewhat lower in the Hebrew version; however, if testing was discontinued after failure to comply with 3 consecutive items, reliability was similar to that obtained for the other samples. We conclude that the Hebrew version of the SHSS:C can be used for the assessment of hypnotizability and recommend that the discontinuation criterion be applied.

Modulation of the postural effects of cognitive load by hypnotizability

Aim of the experiment was to study whether cognitive load affects postural control more in low (Lows) than in highly hypnotizable (Highs) subjects due to the latter's greater attentional abilities. Standing Highs and Lows underwent an experimental session (closed eyes) consisting of a basal condition and of mental computation in an easy (stable support) and a difficult (unstable support) postural condition. Variability [standard deviation (SD)] and complexity [sample entropy (SampEn)] of the movement of the centre of pressure (CoP), its mean velocity (Velocity), the area swept by the CoP (Area) and the ratio between the CoP trajectory length and area [length for surface (LFS)] were measured. Few hypnotizability-related differences were detected (reduction in the Highs' SD and increases in the Lows' LFS in the difficult postural condition). Thus, the hypnotizability-related postural differences observed in previous studies during sensory alteration could not be accounted mainly by attentional abilities.

Portuguese norms for the Waterloo-Stanford Group C (WSGC) scale of hypnotic susceptibility

Portuguese norms for the Waterloo-Stanford Group C (WSGC) scale of hypnotic susceptibility are presented. A Portuguese translation of this scale was given to 625 Portuguese college students. Score distribution, item analysis, and reliability of the WSGC are presented and compared to three North American samples. The findings show that normative data from the Portuguese sample are congruent with the reference samples. The only significant difference obtained was a lower proportion of participants scoring within the high range of hypnotic suggestibility on the WSGC.

Mexican norms for the Stanford Hypnotic Susceptibility Scale, Form C

Normative data for the Mexican adaptation of the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C) are presented. Twenty-seven raters administered the scale to 513 Mexican volunteers. Score distribution, item analysis, and reliability of the SHSS:C are presented and compared to other international norming studies. The findings show that the Mexican adaptation of the SHSS:C has psychometric properties essentially comparable to those of the Dutch, German, Italian, and United States reference samples. However, the elevated sample mean suggests Mexicans may have an elevated ability to engage in hypnotic behavior, thus they would likely be especially good candidates for hypnotherapeutic interventions that would better the health options currently available.