Brain areas altered during hypnotic trances identified

Researchers at Stanford University found changes in three areas of the brain that occur when people are hypnotized. By scanning the brains of subjects while they were hypnotized, researchers could see the neural changes associated with hypnosis.

The possibility of a treatment that combines brain stimulation with hypnosis could improve the known analgesic effects of hypnosis and potentially replace addictive and side-effect-laden painkillers and anti-anxiety drugs.

Hypnosis was the first Western form of psychotherapy. It involves highly focused attention, referred to as absorption (Tellegen and Atkinson 1974), coupled with dissociation, the compartmentalization of experience (Elkins et al. 2015), and suggestibility, nonjudgmental behavioral responsiveness to instructions from others (Spiegel H and Spiegel D 2004). Hypnosis is an effective adjunct in the treatment of pain, anxiety, psychosomatic, post-traumatic, and dissociative disorders (Spiegel and Bloom 1983; Colgan et al. 1988; Brom et al. 1989; Lang et al. 2000; Barry and Sanborn 2001; Bhuvaneswar and Spiegel 2013; Spiegel 2013; Tefikow et al. 2013; Adachi et al. 2014; Schaefert et al. 2014).

The scientists at Stanford University Medical Center, scanned the brains of 57 people during guided hypnosis sessions. A study, published online on July 28, 2016 in Cerebral Cortex (1) reported that during hypnosis, distinct sections of the brain showed altered activity and connectivity.

A comment made by the study’s senior author David Spiegel, MD, professor and associate chair of psychiatry and behavioural sciences “now that we know which brain regions are involved, we may be able to use this knowledge to alter someone’s capacity to be hypnotized or the effectiveness of hypnosis for problems like pain control.”

There is a growing interest in the clinical potential of hypnosis, however little is known about how it works at a physiological level. In the past researchers have scanned the brains of people undergoing hypnosis. Those studies were designed
to pinpoint the effects of hypnosis on pain, vision and other forms of perception but not the state of hypnosis itself.

To study hypnosis itself, researchers required people who could or could not be hypnotized. About 10 percent of the population is generally categorized as “highly hypnotizable,” while others are less able to enter the trancelike state of hypnosis. In this study, Spiegel and his colleagues screened 545 healthy participants and found 36 people who consistently scored high on tests of hypnotizability, as well as 21 control subjects who scored on the extreme low end of the scales.

According to Spiegel, “it was important to have the people who are not able to be hypnotized as controls. Otherwise, you might see things happening in the brains of those being hypnotized but you wouldn’t be sure whether it was associated with hypnosis or not.”

Using functional magnetic resonance imaging (fMRI), the brain activity of 57 participants were measured. Each person was scanned under four different conditions – while resting, while recalling a memory and during two different
hypnosis sessions.

Brain activity and connectivity

In this study, Spiegel and his colleagues discovered three hallmarks of the brain under hypnosis. Each change was seen only in the highly hypnotizable group and only while they were undergoing hypnosis.

Firstly, the results showed a decrease in activity in an area called the dorsal anterior cingulate, which is part of the brain’s salience network. According to Spiegel, “in hypnosis, you’re so absorbed that you’re not worrying about anything
else.”

The anterior cingulate cortex (ACC) lies in a unique position in the brain, with connections to both the “emotional” limbic system and the “cognitive” prefrontal cortex [dorsal anterior cingulate]. Cingulate cortex plays a significant role in
mediating cognitive influences on emotion. The salience network is a collection of regions of the brain that select which stimuli are deserving of our attention. The network is critical for detecting behaviourally relevant stimuli and for coordinating
the brain’s neural resources in response to these stimuli.

Secondly, the results showed an increase in connections between two other areas of the brain – the dorsolateral prefrontal cortex and the insula. According to Spiegel, the brain-body connection helps the brain process and control what’s
going on in the body.

The dorsolateral prefrontal cortex (dlPFC) is a region in the frontal lobes toward the top and side; important function of the DLPFC is the executive functions, such as working memory, cognitive flexibility, planning, inhibition, and abstract reasoning. The insula is small region of the cerebral cortex located deep within the lateral sulcus, which is a large fissure that separates the frontal and parietal lobes from the temporal lobe. The insula has increasingly become the focus of attention for its role in body representation and subjective emotional experience. It is believed to be involved in consciousness and play a role in diverse functions usually linked to emotion or the regulation of the body’s homeostasis. These functions include compassion and empathy, perception, motor control, self-awareness, cognitive functioning, and interpersonal experience.

Thirdly, the researchers observed reduced connections between the dorsolateral prefrontal cortex and the default mode network, which includes the medial prefrontal and the posterior cingulate cortex. Spiegel commented that this decrease in functional connectivity is likely to represent a disconnect between someone’s actions and their awareness of their actions. According to Spiegel “when you’re really engaged in something, you don’t really think about doing it – you just do it.” During hypnosis, this kind of disassociation between action and reflection allows the person to engage in activities either suggested by a clinician or self-suggested without devoting mental resources to being self-conscious about the activity.

The default mode network (DMN), is a network of interacting brain regions known to have activity highly correlated with each other and distinct from other networks in the brain. The DMN is most commonly shown to be active when a person is
not focused on the outside world and the brain is at wakeful rest, such as during daydreaming and mind-wandering. But it is also active when the individual is thinking about others, thinking about themselves, remembering the past, and planning. The network activates “by default” when a person is not involved in a task.

Thus, identifying the areas in the brain that hypnosis affects has great potential toward developing treatments for people that are less susceptible to hypnosis. According to Spiegel, a treatment that combines brain stimulation with hypnosis could improve the known analgesic effects of hypnosis and potentially replace addictive and side-effect-laden painkillers and anti-anxiety drugs. However, more research is needed before such a therapy could be implemented.


References:
1. Heidi Jiang, Matthew P. White, Michael D. Greicius, Lynn C. Waelde, and David Spiegel. Brain Activity and Functional Connectivity Associated with Hypnosis. Cerebral Cortex, July 2016 DOI: 10.1093/cercor/bhw220

Tellegen A, Atkinson G. 1974. Openness to absorbing and selfaltering experiences (“absorption”), a trait related to hypnotic susceptibility. J Abnorm Psychol. 83:268–277.

Elkins GR, Barabasz AF, Council JR, Spiegel D. 2015. Advancing research and practice: the revised APA division 30 definition of hypnosis. Int J Clin Exp Hypn. 63:1–9.

Spiegel H, Spiegel D. 2004. Trance and Treatment: Clinical Uses of Hypnosis. Washington, DC: American Psychiatric Publishing.

Spiegel D, Bloom JR. 1983. Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosom Med. 45: 333–339.

Colgan SM, Faragher EB, Whorwell PJ. 1988. Controlled trial of hypnotherapy in relapse prevention of duodenal ulceration. Lancet. 1:1299–1300.

Brom D, Kleber RJ, Defares PB. 1989. Brief psychotherapy for posttraumatic stress disorders. J Consult Clin Psychol. 57:607–612.

Lang EV, Benotsch EG, Fick LJ, Lutgendorf S, Berbaum ML, Berbaum KS, Logan H, Spiegel D. 2000. Adjunctive nonpharmacological analgesia for invasive medical procedures: a randomised trial. Lancet. 355:1486–1490.

Barry JJ, Sanborn K. 2001. Etiology, diagnosis, and treatment of nonepileptic seizures. Curr Neurol Neurosci Rep. 1:381–389.

Bhuvaneswar C, Spiegel D. 2013. An eye for an I: a 35-year-old woman with fluctuating oculomotor deficits and dissociative identity disorder. Int J Clin Exp Hypn. 61:351–370.

Spiegel D. 2013. Tranceformations: hypnosis in brain and body. Depress Anxiety. 30:342–352.

Tefikow S, Barth J, Maichrowitz S, Beelmann A, Strauss B, Rosendahl J. 2013.

Efficacy of hypnosis in adults undergoing surgery or medical procedures: a meta-analysis of randomized controlled trials. Clin Psychol Rev. 33:623–636

Adachi T, Fujino H, Nakae A, Mashimo T, Sasaki J. 2014. A meta-analysis of hypnosis for chronic pain problems: a comparison between hypnosis, standard care, and other psychological interventions. Int J Clin Exp Hypn. 62:1–28.

Schaefert R, Klose P, Moser G, Hauser W. 2014. Efficacy, tolerability, and safety of hypnosis in adult irritable bowel syndrome: systematic review and meta-analysis. Psychosom Med. 76:389–398.

About
Dr. Spiegel, the Jack, Samuel and Lulu Willson Professor of Medicine and associate chair of the Department of Psychiatry and Behavioral Sciences, is internationally known for his work in gauging the effects of the mind on physical health. As director of Stanford’s Center on Stress and Health, he oversees a wide variety of research on how stress and support affect the brain and body. He is also the Medical Director of the Center for Integrative Medicine at Stanford, which provides alternative and complementary services, such as acupuncture, meditation, hypnosis and massage, to help patients cope with cancer and other diseases. Spiegel has authored more than 475 research papers and chapters in scientific journals and ten books.

 

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