Functional neuroanatomy of the hypnotic state

The neural mechanisms underlying hypnosis and especially the modulation of pain perception by hypnosis remain obscure. Using PET we first described the distribution of regional cerebral blood flow during the hypnotic state. Hypnosis relied on revivification of pleasant autobiographical memories and was compared to imaging autobiographical material in "normal alertness". The hypnotic state was related to the activation of a widespread set of cortical areas involving occipital, parietal, precentral, premotor, and ventrolateral prefrontal and anterior cingulate cortices. This pattern of activation shares some similarities with mental imagery, from which it mainly differs by the relative deactivation of precuneus. Second, we looked at the anti-nociceptive effects of hypnosis. Compared to the resting state, hypnosis reduced pain perception by approximately 50%. The hypnosis-induced reduction of affective and sensory responses to noxious thermal stimulation were modulated by the activity in the midcingulate cortex (area 24a'). Finally, we assessed changes in cerebral functional connectivity related to hypnosis. Compared to normal alertness (i.e., rest and mental imagery), the hypnotic state, significantly enhanced the functional modulation between midcingulate cortex and a large neural network involved in sensory, affective, cognitive and behavioral aspects of nociception. These findings show that not only pharmacological but also psychological strategies for pain control can modulate the cerebral network involved in noxious perception.     

Hypnosis for Asthma—a Controlled Trial: A Report to the Research Committee of the British Tuberculosis Association*

An investigation of hypnosis in asthma was made among patients aged 10 to 60 years with paroxysmal attacks of wheezing or tight chest capable of relief by bronchodilators. One group of patients was given hypnosis monthly and used autohypnosis daily for one year. Comparisons were made with a control group prescribed a specially devised set of breathing exercises aimed at progressive relaxation. Treatment was randomly allocated and patients were treated by physicians in nine centres. Results were assessed by daily diary recordings of wheezing and the use of bronchodilators, and by monthly recordings of F.E.V.₁ and vital capacity. At the end of the year independent clinical assessments were made by physicians unaware of the patients'' treatment.There were 252 patients (127 hypnosis and 125 controls) accepted for analysis, but a number of them did not continue the prescribed treatment for the whole year: 28 hypnosis and 22 control patients failed to co-operate, left the district, or had family problems; one hypnosis and one control patient died. Seven hypnosis and 17 control patients were withdrawn as treatment failures, the difference between the two groups being statistically significant.As judged by analyses based on the daily “score” of wheezing recorded in patients'' diaries, by the number of times bronchodilators were used, and by independent clinical assessors, both treatment groups showed some improvement Among men the assessments of wheezing score and use of bronchodilators showed similar improvement in the two treatment groups; among women, however, those treated by hypnosis showed improvement similar to that observed in the men, but those given breathing exercises made much less progress, the difference between the two treatment groups reaching statistical significance. Changes in F.E.V.₁ and V.C. between the control and hypnosis groups were closely similar.Independent clinical assessors considered the asthma to be “much better” in 59% of the hypnosis group and in 43% of the control group, the difference being significant There was little difference between the sexes. Physicians with previous experience of hypnosis obtained significantly better results than did those without such experience.     

Possibilities of hypnosis and hypnosuggestive methods in oncology

Fear of death, pain, or the recurrence of the illness of tumor patients can narrow their attention to a point where a spontaneous altered state of consciousness occurs. In these cases hypnosis either in formal psychotherapy or embedded into the everyday communication with the physician can effectively complement other already known medical and psychological techniques. Although numerous studies have reported the beneficial physical and mental changes induced by hypnosis, for a long time there were not enough research to affect evidence-based medicine. New studies meeting the most rigorous methodological standards, new reviews and the characteristics of hypnosis shown by neuroimaging techniques support the acceptance of this method. Hypnosis is used and studied with adult and child tumor patients alike mostly in the areas of anxiety, pain, nausea, vomiting, quality of life, mood amelioration, immune system and hot flushes. Most of the assays describe hypnosis as an empirically validated treatment technique that in most cases surpass attention diversion, coping trainings, cognitive behavior and relaxation techniques and other regular treatments. In this paper we review these observations.     

JM-1232(−) and propofol,a new combination of hypnotics with short-acting and non-cumulative preferable properties

Drug interactions are significant in anesthesiology because drug combinations can potentially possess novel properties. The pharmacological advantages of a new combination of the benzodiazepine receptor agonist JM-1232(−) and propofol were investigated in mice. Male adult mice were administered JM-1232(−) or propofol or combinations of the two drugs intravenously. Loss of the righting reflex was evaluated as achieving hypnosis, and the time until recovery of the reflex was measured as hypnosis time. After determining the ED₅₀, doses double and triple the ED₅₀ of propofol were injected with JM-1232(−) to compare hypnosis time. The injections were repeated four times, and the hypnosis times were compared. Flumazenil was administered separately immediately after the last dose was injected. The ED₅₀ values ([95% confidence interval]) for hypnosis were 3.76 [3.36–4.10] for JM-1232(−) and 9.88 [8.03–11.58] mg kg⁻¹ for propofol. Co-administration of 0.5 and 1 mg kg⁻¹ JM-1232(−) reduced the ED₅₀ values of propofol to 1.76 [1.21–2.51] and 1.00 [0.46–1.86] mg kg⁻¹, respectively. The drug combination for hypnosis produced a supra-additive interaction. Hypnosis time was significantly shorter in the groups given the mixtures compared to each hypnotic administered alone. After repeated injections, hypnosis time with the mixtures showed smaller prolongation than that with the hypnotic alone. Flumazenil completely restored the recovery time after anesthesia. The combination of JM-1232(−) and propofol showed a supra-additive interaction, and the reduced hypnotic dose contributed to a faster recovery even after multiple injections.     

Motor polarization dominance and "animal hypnosis"

Two kinds of dominanta were simultaneously formed under conditions of chronic experiments in rabbits. The motor polarization dominanta was formed under exposure of the right sensorimotor cortex of an animal to direct anodic current, and the state of "animal hypnosis" (the second dominanta) was induced. Animal behavior and electrophysiological characteristics were recorded. It was shown that the "animal hypnosis" induced at the optimum of the right motor polarization dominanta inhibited the motor reaction of the "dominant" extremity to testing stimuli. After the "animal hypnosis session, exposure of the right sensorimotor cortex to anodic current produced the latent excitation focus, which did not reach the level of summation. Two days later, exposure to testing stimuli developed the latent foci at first in the right cortex and then in subcortical structures. In the course of recovery of the motor polarization dominanta and its further change for the state characteristic of the "animal hypnosis", the patterns of cortical EEG coherence in the delta range typical of each kind of dominanta alternated in parallel with the time course of state changes.     

Dietary selenium supplementation prolongs pentobarbital induced hypnosis

The present studies characterized the influence of dietary selenium (Na2SeO3) on the duration of pentobarbital (PB) induced hypnosis (sleep) in the rat. Rats were fed semipurified diets varying from 0.01 to 2.0 mg Se/kg for up to 4 weeks. Consumption of diets containing 1.0 and 2.0 mg Se/kg significantly prolonged PB induced hypnosis. Hepatic selenium, but not hepatic glutathione peroxidase activity, correlated with the length of PB induced hypnosis. The prolongation of hypnosis caused by diets containing 1.0 mg Se/kg was substantially reduced or eliminated by repeated exposure to PB. Although single exposure to increasing quantities of PB (60-100 mg/kg body weight) led to a progressive increase in sleep duration, the proportional increase caused by supplemental selenium (2.0 vs 0.1 microg Se/g) remained relatively constant (approximately 25%). Increasing maturity was inversely related to the duration of PB induced hypnosis, regardless of dietary selenium provided. Consumption of the 2.0 mg Se/kg diet prolonged PB induced hypnosis to a greater degree in immature than in mature rats (P < 0.05). Consumption of the selenium enriched diet (2 microg Se/g) resulted in an increase in cytochrome 2B, but had no effect on cytochrome 1A compared to controls (0.1 microg Se/g). Pretreatment of rats with P450 enzymes activators (i.e., PB, Aroclor 1254, or 3-methylcholanthrene) shortened the duration of PB induced sleep and masked the effects of dietary selenium. The current studies document that dietary selenium can influence the response to pentobarbital induced hypnosis and likely relates to changes in drug detoxification enzymes.     

Breathing patterns peculiarities as the index of the "animal hypnosis" state in the rabbit

Breathing patterns were recorded during "animal hypnosis" in seven Chinchilla rabbits. The state of "animal hypnosis" was evoked by the hand pressure on the thorax and the waist of a rabbit. Breathing pattern was recorded by means of an elastic coal-powder element that was set round the rabbit's thorax. Distortions of the breathing patterns in the active state and in the course of hypnosis development were marked by numbers 0, 1, 2. In all rabbits, modifications of the breathing patterns depended on the features of the animal state: quiet state, tension, and "animal hypnosis".     

Improvement in bronchial hyper-responsiveness in patients with moderate asthma after treatment with a hypnotic technique: a randomised controlled trial.

A prospective, randomised, single blind, and controlled trial of a hypnotic technique was undertaken in 39 adults with mild to moderate asthma graded for low and high susceptibility to hypnosis. After a six week course of hypnotherapy 12 patients with a high susceptibility score showed a 74.9% improvement (p less than 0.01) in the degree of bronchial hyper-responsiveness to a standardised methacholine challenge test. Daily home recordings of symptoms improved by 41% (p less than 0.01), peak expiratory flow rates improved by 5.5% (p less than 0.01), and use of bronchodilators decreased by 26.2% (p less than 0.05). The improvement in bronchial hyper-reactivity occurred without a change in subjective appreciation of the degree of bronchoconstriction. A control group 17 patients and 10 patients undergoing treatment with low susceptibility to hypnosis had no change in either bronchial hyper-responsiveness or any of the symptoms recorded at home. This study shows the efficacy of a hypnotic technique in adult asthmatics who are moderately to highly susceptible to hypnosis.     

The interhemispheric brain asymmetry of the rabbit in a state of "animal hypnosis"]

By the method of forced immobilization the rabbits were brought into the state of "animal hypnosis" (immobilization reflex), and their ECoG was recorded, which was further processed on the computer. It was found that during hypnosis a functional interhemispheric brain asymmetry was developed in rabbits with activity predominance in the right hemisphere. The "animal hypnosis" is a phasic process: in the ECoG of the rabbit under hypnosis a regular alternation of delta and theta activity takes place. Electrophysiological reconstructions in the rabbit brain during the change of its functional state correlate with the brain thermal reactions, revealed earlier.     

Learning in trance: Functional brain imaging studies and neuropsychology

This study examined the fundamental question, whether verbal memory processing in hypnosis and in the waking state is mediated by a common neural system or by distinct cortical areas. Seven right-handed volunteers (25.4 years, sd 3.1) with high-hypnotic susceptibility scores were PET-scanned while encoding/retrieving word associations either in hypnosis or in the waking state. Word-pairs were visually presented and highly imaginable, but not semantically related (e.g. monkey-street). The presentation of pseudo-words served as a reference condition. An emission scan was recorded after each intravenous administration of O-15 water. Encoding under hypnosis was associated with more pronounced bilateral activations in the occipital cortex and the prefrontal areas as compared to learning in the waking state. During memory retrieval of word-pairs which had been previously learned under hypnosis, activations were found in the occipital lobe and the cerebellum. Under both experimental conditions precuneus and prefrontal cortex showed a consistent bilateral activation which was most distinct when the learning had taken place under hypnosis. In order to further analyze the effect of hypnosis on imagery-mediated learning, we administered sets of high-imagery word-pairs and sets of abstract words. In the first experimental condition word-pair associations were presented visually. In the second condition it was found that highly hypnotisable persons recalled significantly more high-imagery words under hypnosis as compared to low-hypnotisables both in the visual and auditory modality. Furthermore, high-imagery words were also better recalled by the highly hypnotisable subjects during the non-hypnotic condition. The memory effect was consistently present under both, immediate and delayed recall conditions. Taken together, the findings advance our understanding of the neural representation that underlies hypnosis and the neuropsychological correlates of hypnotic susceptibility.     

Sensitivity and Specificity of Hypnosis Effects on Gastric Myoelectrical Activity

Objectives

The effects of hypnosis on physiological (gastrointestinal) functions are incompletely understood, and it is unknown whether they are hypnosis-specific and gut-specific, or simply unspecific effects of relaxation.

Design

Sixty-two healthy female volunteers were randomly assigned to either a single session of hypnotic suggestion of ingesting an appetizing meal and an unappetizing meal, or to relax and concentrate on having an appetizing or unappetizing meal, while the electrogastrogram (EGG) was recorded. At the end of the session, participants drank water until they felt full, in order to detect EGG-signal changes after ingestion of a true gastric load. During both conditions participants reported their subjective well-being, hunger and disgust at several time points.

Results

Imagining eating food induced subjective feelings of hunger and disgust as well as changes in the EGG similar to, but more pronounced than those seen with a real gastric water load during both hypnosis and relaxation conditions. These effects were more pronounced when imagining an appetizing meal than with an unappetizing meal. There was no significant difference between the hypnosis and relaxation conditions.

Conclusion

Imagination with and without hypnosis exhibits similar changes in subjective and objective measures in response to imagining an appetizing and an unappetizing food, indicating high sensitivity but low specificity.     

The Effects of Hypnotherapy on Homosexuality

Fifteen homosexuals were treated with hypnosis. The patients were selected from a general psychiatric practice and had a long history of confirmed homosexual behaviour and showed no evidence of organic or psychotic illness. The type of hypnotic induction attempted in all cases is described. In those where a satisfactory depth of hypnotic trance was achieved a change in sexual orientation was suggested to the patient.Before therapy, each patient was assessed using the Kinsey scale. Results were evaluated in terms of the patient''s subsequent behaviour and his subjective feelings. Of the 15 patients, three showed no improvement, four showed a mild improvement and eight showed a marked improvement. There was a significant correlation between the depth of hypnosis achieved and the therapeutic outcome. Those patients who reached a deep level of hypnotic trance were most likely to show a marked improvement. There were no significant correlations with other factors such as degree of homosexuality as measured on the Kinsey scale and the patient''s marital status.Treatment of homosexuals with hypnosis may produce more satisfactory results than those obtainable by other means. The best results are likely to be achieved in patients who are good hypnotic subjects.     

La spécificité de l’auto-analyse freudienne: un expérimentalisme sans laboratoire

WithThe Interpretation of Dreams, Freud introduced his readers into the psychoanalytic technique. Freud’s strategy was a reaction to the difficulties produced by the establishment of laboratories of hypnosis, difficulties due to the resistance of patients and to the large diffusion of suggestion in everyday life. The possibility of resistance enables subjects to take an active role. This led to a change of the former configuration of experimental hypnotism where the subjects had to be deceived. In contrast to the doctors of the hypnosis movement, Freud abandoned the project of constructing a laboratory of hypnosis and elaborated reading and writing practices instead. Early psychoanalysis thus develops in the form of an “experimentalism without a laboratory”, a specific articulation of dreaming, reading and writing.     

The Use of Hypnosis in the Treatment of Exhibitionism

The use of hypnosis in the treatment of exhibitionism is described in three patients in whom the condition had been present for more than five years. In each patient there was no subsequent recurrence of the exhibitionism once therapeutic suggestions had been made in a deep hypnotic trance, the follow-up period being respectively five years, four and a half years, and one year.The method of treatment and the results are discussed in terms of the concepts of behaviour therapy.It is concluded that with certain patients suffering from exhibitionism the use of hypnosis may well be one of the best methods of treatment, but considerable care should be exercised to exclude those patients with an underlying psychosis, mental defect or psychopathic condition. It is also noted that the efficacy of the treatment would appear to depend on achieving a satisfactory depth of hypnotic trance. If this is not reached, the results are less likely to be successful.     

The Impact of Hypnotic Suggestions on Reaction Times in Continuous Performance Test in Adults with ADHD and Healthy Controls

Attention is one of the key factors in both hypnotic processes and patients with ADHD. In addition, the brain areas associated with hypnosis and ADHD overlap in many respects. However, the use of hypnosis in ADHD patients has still received only minor attention in research. The main purpose of the present work was to investigate whether hypnosis and hypnotic suggestions influence the performance of adult ADHD (n = 27) and control participants (n = 31) in the continuous performance test (CPT). The hypnotic susceptibility of the participants was measured by the Harvard Group Scale of Hypnotic Susceptibility (HGSHS:A) and the attentional task was a three minute long auditory version of the CPT. The CPT task was administered four times: before hypnosis (CPT1), after a hypnotic induction (CPT2), after suggestions about speed and accuracy (CPT3), and after the termination of hypnosis (CPT4). The susceptibility of the groups measured by HGSHS:A did not differ. There was a statistically significant decrease in reaction times in both ADHD and control groups between CPT2 and CPT3. The differences between CPT1 and CPT2, even though non-significant, were different in the two groups: in the ADHD group reaction times decreased whereas in the control group they increased. Both groups made very few errors in the short CPT. This study indicates that hypnotic suggestions have an effect on reaction times in the sustained attention task both in adult ADHD patients and control subjects. The theoretical and clinical implications are discussed.     

Possible role of adenosine in the CNS effects of ethanol

The ability of adenosine to modify the CNS effects of acute and chronic ethanol was studied by using theophylline, an adenosine antagonist, and dipyridamole, a blocker of adenosine reuptake. We also studied the binding characteristics of adenosine using crude membranes of whole brain. Theophylline pretreatment prior to acute ethanol administration markedly reduced the duration of ethanol-induced sleep and similarly decreased the intensity and duration of motor incoordination. In chronic ethanol treated mice the effect of theophylline on ethanol-induced hypnosis and motor incoordination was similar to the acute experiment. Dipyridamole markedly prolonged the duration of ethanol-induced hypnosis and potentiated the motor incoordination produced by acute ethanol. However, in chronic ethanol treated mice dipyridamole was not able to potentiate the motor incoordinating effect of ethanol although it was able to prolong ethanol hypnosis similar to the results obtained in the acute ethanol study. Neither drug had any effect on ethanol-induced hypothermia, in either the acute or chronic studies.After 10 days of ethanol ingestion the adenosine dissociation constant was unchanged whereas the number of brain adenosine receptors was increased 28% although the increase did not reach statistical significance. The number of the adenosine receoptors was reduced 40% at 24 and 48 h after withdrawal and returned to prewithdrawal levels at 72 h. The dissociation constant was reduced at 24 and 48 h but by 72 h had returned to prewithdrawal levels. The marked changes in adenosine binding characteristics as well as the modification of some CNS effect of ethanol by drugs which influence either adenosine binding to its receptor or the availability of adenosine suggest that adenosine may be involved in the expression of some of the CNS effects of ethanol.     

The existence of a hypnotic state revealed by eye movements

Hypnosis has had a long and controversial history in psychology, psychiatry and neurology, but the basic nature of hypnotic phenomena still remains unclear. Different theoretical approaches disagree as to whether or not hypnosis may involve an altered mental state. So far, a hypnotic state has never been convincingly demonstrated, if the criteria for the state are that it involves some objectively measurable and replicable behavioural or physiological phenomena that cannot be faked or simulated by non-hypnotized control subjects. We present a detailed case study of a highly hypnotizable subject who reliably shows a range of changes in both automatic and volitional eye movements when given a hypnotic induction. These changes correspond well with the phenomenon referred to as the "trance stare" in the hypnosis literature. Our results show that this 'trance stare' is associated with large and objective changes in the optokinetic reflex, the pupillary reflex and programming a saccade to a single target. Control subjects could not imitate these changes voluntarily. For the majority of people, hypnotic induction brings about states resembling normal focused attention or mental imagery. Our data nevertheless highlight that in some cases hypnosis may involve a special state, which qualitatively differs from the normal state of consciousness.     

Hypnotherapy for incontinence caused by the unstable detrusor.

Fifty incontinent women with proved detrusor instability completed 12 sessions of hypnosis (symptom removal by direct suggestion and "ego strengthening") over one month. This was continued at home with a prerecorded cassette, and all patients were followed up for at least six months. At the end of the 12 sessions 29 patients were entirely symptom free, 14 improved, and seven unchanged. Three months later cystometry in 44 of the patients showed conversion of the cystometrogram to stability in 22 and a significant improvement in a further 16; only six showed no objective improvement. Seven patients relapsed (three after bereavement). Further treatment was given and five out of six patients were rendered symptom free again. Patients with detrusor instability were not found to have a noticeably increased susceptibility to hypnosis. It is concluded that psychological factors are very important in "idiopathic" detrusor instability and that hypnotherapy is effective for incontinence due to this disorder.     

Hypnosis,memory and amnesia.

Hypnotized subjects respond to suggestions from the hypnotist for imaginative experiences involving alterations in perception and memory. Individual differences in hypnotizability are only weakly related to other forms of suggestibility. Neuropsychological speculations about hypnosis focus on the right hemisphere and/or the frontal lobes. Posthypnotic amnesia refers to subjects'' difficulty in remembering, after hypnosis, the events and experiences that transpired while they were hypnotized. Posthypnotic amnesia is not an instance of state-dependent memory, but it does seem to involve a disruption of retrieval processes similar to the functional amnesias observed in clinical dissociative disorders. Implicit memory, however, is largely spared, and may underlie subjects'' ability to recognize events that they cannot recall. Hypnotic hypermnesia refers to improved memory for past events. However, such improvements are illusory: hypermnesia suggestions increase false recollection, as well as subjects'' confidence in both true and false memories. Hypnotic age regression can be subjectively compelling, but does not involve the ablation of adult memory, or the reinstatement of childlike modes of mental functioning, or the revivification of memory. The clinical and forensic use of hypermnesia and age regression to enhance memory in patients, victims and witnesses (e.g. recovered memory therapy for child sexual abuse) should be discouraged.