New views of hypnotizability

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.

Postural effects of interoceptive imagery as a function of hypnotizability

The aim of the study was to investigate the effects of pleasant and unpleasant interoceptive imagery on postural control in participants with different hypnotizability, interoceptive sensibility and ability of imagery. Forty-one healthy individuals classified as high (highs), medium (mediums) and low hypnotizables (lows) according to the Stanford Hypnotic Susceptibility Scale, form A (SHSS, A) were characterized for Interoceptive Sensitivity (IS) through the Multisensory Assessment of Interoceptive Awareness (MAIA) and for organic mental imagery (ORG) through Betts' questionnaire. The experimental session included baseline closed eyes conditions preceding tasks of pleasant (P) and unpleasant imagery (U) and a neutral cognitive task (NT) while standing on a stabilometric platform. Subjective reports of vividness and pleasantness/unpleasantness of mental images were collected. Postural variables, ECG and pneumogram were acquired. Highs exhibited greater vividness of imagery than mediums/lows and larger Area of the Centre of Pressure (CoP), while mediums and lows decreased it during all tasks with respect to baseline conditions. Significant differences moderated by IS and ORG were found between highs and lows in the CoP Area. In all groups significant task related differences in the CoP Area were moderated only by IS. Cardiovascular variables were similar in the three groups, but differed among tasks and were influenced by IS and ORG. Our findings extend earlier observations on the role of hypnotisability in the postural correlates of sensorimotor imagery to interoceptive imagery, support the hypothesis that interoceptive sensibility moderates postural control and cardiorespiratory variables during interoceptive imagery, and confirm earlier reports of the absence of hypnotisability-related modulation of cardiorespiratory variables during emotional tasks.

Hypnosis-induced modulation of corticospinal excitability during motor imagery

Hypnosis can be considered an altered state of consciousness in which individuals produce movements under suggestion without apparent voluntary control. Despite its application in contexts implying motor control, evidence for the neurophysiological mechanisms underlying hypnosis is scarce. Inter-individual differences in hypnotic susceptibility suggest that sensorimotor strategies may manifest in a hypnotic state. We tested by means of transcranial magnetic stimulation applied over the primary motor cortex whether motor system activation during a motor imagery task differs in the awake and in the hypnotic state. To capture individual differences, 30 healthy volunteers were classified as high or low hypnotizable (Highs and Lows) according to ad-hoc validated scales measuring hypnotic susceptibility and personality questionnaires. Corticospinal activation during motor imagery in the hypnotic state was greater in the Highs than the Lows. Intrinsic motivation in task performance and level of persuasion modulated corticospinal activation in the Highs. Corticospinal system activation under hypnosis may have practical implications that merit research in areas where hypnosis can be applied to improve motor performance, such as loss of motor abilities and sports.

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.

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.

Comparison of Hypnotic Suggestion and Transcranial Direct-Current Stimulation Effects on Pain Perception and the Descending Pain Modulating System: A Crossover Randomized Clinical Trial

Objectives: This paper aims to determine if hypnotic analgesia suggestion and transcranial direct-current stimulation (tDCS) have a differential effect on pain perception. We hypothesized that transcranial direct-current stimulation would be more effective than hypnotic analgesia suggestion at changing the descending pain modulating system, whereas the hypnotic suggestion would have a greater effect in quantitative sensory testing.

Design: This is a randomized, double blind and crossover trial.

Settings: All stages of this clinical trial were performed at the Laboratory of Pain and Neuromodulation of the Hospital de Clínicas de Porto Alegre.

Subjects: Were included 24 healthy females aged from 18 to 45 years old, with a high susceptibility to hypnosis, according to the Waterloo-Stanford Group Scale of Hypnotic Susceptibility, Form C (15).

Methods: The subjects received a random and crossover transcranial direct-current stimulation over the dorsolateral prefrontal cortex (2 mA for 20 min) and hypnotic analgesia (20 min).

Results: Only hypnotic suggestion produced changes that are statistically significant from pre- to post-intervention in the following outcomes measures: heat pain threshold, heat pain tolerance, cold pressure test, and serum brain-derivate-neurotrophic-factor. The analysis showed a significant main effect for treatment (F = 4.32; P = 0.04) when we compared the delta-(Δ) of conditioned pain modulation task between the transcranial direct-current stimulation and hypnotic suggestion groups. Also, the change in the brain-derivate-neurotrophic-factor was positively correlated with the conditioned pain modulation task.

Conclusion: The results confirm a differential effect between hypnotic suggestion and transcranial direct-current stimulation on the pain measures. They suggest that the impact of the interventions has differential neural mechanisms, since the hypnotic suggestion improved pain perception, whereas the transcranial direct-current stimulation increased inhibition of the descending pain modulating system.

Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03744897.

Perspective: These findings highlight the effect of hypnotic suggestion on contra-regulating mechanisms involved in pain perception, while the transcranial direct-current stimulation increased inhibition of the descending pain modulating system. They could help clinicians comprehend the mechanisms involved in hypnotic analgesia and transcranial direct-current stimulation and thus may contribute to pain and disability management.

Visuospatial imagery in healthy individuals with different hypnotizability levels

Hypnotizability is a psychophysiological trait associated with morpho-functional brain differences. Since also cerebellar peculiarities have been reported in individuals with different hypnotizability levels and the cerebellar function is relevant to spatial imagery, the present study was aimed at investigating possible hypnotizability-related differences in the ability of spatial imagery. Highly (highs, N = 31), low (lows, N = 17) and medium (mediums, N = 16) hypnotizable participants (classified by Stanford Hypnotic Susceptibility Scale, form A) of both genders were submitted to a test of mental rotation, which requires the integrity of both executive and cerebellar structures. In order to disentangle the role of the cerebellum from that of executive circuits as much as possible, visuospatial and verbal working memory tests, which mainly reflect executive processes, were also performed. Healthy highs exhibited higher scores of mental rotation ability compared to mediums in the absence of significant differences in visual-spatial and verbal working memory. Lows reported intermediate scores not significantly different from both highs' and mediums'. Different cognitive strategies were observed in the three groups as the correlations between mental rotation, visuospatial and verbal working memory were different in highs, mediums and lows. In conclusion, present findings represent the first report of hypnotizability-related differences in a mental rotation task, which is relevant to several cognitive functions.

HYPNOTIZABILITY AND PAIN MODULATION: A Body-Mind Perspective

The study investigated whether the cardiac activity and cognitive-emotional traits sustained by the behavioral inhibition/activation system (BIS/BAS) may contribute to hypnotizability-related pain modulation. Nociceptive stimulation (cold-pressor test) was administered to healthy participants with high (highs) and low (lows) hypnotizability in the presence and absence of suggestions for analgesia. Results showed that heart rate increased abruptly at the beginning of nociceptive stimulation in all participants. Then, only in highs heart rate decreased for the entire duration of hand immersion. During stimulation with suggestions of analgesia, pain threshold negatively correlated with heart rate. BIS/BAS activity partially accounted for the observed hypnotizability-related differences in the relation between cardiac interoception and pain experience.

Hypnotizability influences the cortical representation of visually and kinaesthetically imagined head position

The study investigates the cortical representation of the visual and kinesthetic image of a rotated position of the head in highly (highs) and low hypnotizable individuals (lows) of both gender. Participants were invited to imagine maintaining their head rotated toward one side by seeing their chin aligned with their right shoulder (V, visual imagery), and in a different condition, by feeling tension in their neck muscles (K, kinaesthetic imagery). Vividness of imagery and cognitive effort were reported after each task. Alpha and beta band absolute power was studied. Highs reported higher vividness than lows only for the kinaesthetic modality of imagery. The cortical desyncronization observed during visual and kinaesthetic imagery were different in high females (HM), low females (LF), high males (HM) and low males (LM). In fact, only HF and LM exhibited significant power changes during the kinaesthetic task, whereas visual imagery was associated with cortical desynchronization in all subgroups except HM. The study supports earlier findings of an advantage of highs in kinesthetic imagery, shows an intriguing interaction of hypnotizability and gender, and indicates topographical difference in the four subgroups of participants suggesting differences in underlying generators.

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,

Asymmetric Tactile Foot Stimulation: How Postural Studies May Suggest New Views of Hypnotizability

Earlier studies have shown hypnotizability-related postural effects of visual suppression and of leg and neck proprioceptive alteration. This study completes this investigation by demonstrating the postural effects of asymmetric tactile foot stimulation in standing participants with different hypnotizability scores. During this stimulation, body sway changed in medium-to-high more than in low-to-medium hypnotizable participants. Findings support the view that high hypnotizability is associated with higher vulnerability of posture to sensory alteration; together with earlier results, they suggest a role of the cerebellum in the observed hypnotizability-related differences and prompt investigation of cerebral structures and factors potentially responsible for both the cognitive and physiological aspects of hypnotizability.

Pain perception and EEG dynamics: does hypnotizability account for the efficacy of the suggestions of analgesia?

We report novel findings concerning the role of hypnotizability, suggestions of analgesia and the activity of the Behavioral Inhibition/Activation System (BIS/BAS) in the modulation of the subjective experience of pain and of the associated EEG dynamics. The EEG of high (highs) and low hypnotizable participants (lows) who completed the BIS/BAS questionnaire was recorded during basal conditions, tonic nociceptive stimulation without (PAIN) and with suggestions for analgesia (AN). Participants scored the perceived pain intensity at the end of PAIN and AN. The EEG midline dynamics was characterized by indices indicating the signal predictability (Determinism) and complexity (Entropy) obtained through the Recurrence Quantification Analysis. The reduced pain intensity reported by highs during AN was partially accounted for by the activity of the Behavioral Activation System. The decreased midline cortical Determinism observed during nociceptive stimulation in both groups independently of suggestions remained significantly reduced only in lows after controlling for the activity of the Behavioral Activation System. Finally, controlling for the activity of the Behavioral Inhibition System abolished stimulation, suggestions and hypnotizability-related differences. Results indicate that the BIS/BAS activity may be more important than hypnotizability itself in pain modulation and in the associated EEG dynamics.