36 Sport &Exercise Psychology Review Vol 1 No 1 © The British Psychological Society 2005 GISSN 1745-4980

Case history and initial assessment

T

HE PARTICIPANTwas a female ama-

teur judoka who was ranked within the

top six in Great Britain at the start of the

intervention. The participant trained three

times a week. Preliminary interviews with the

participant revealed that she lacked self-effi-

cacy (self-confidence) for training and com-

petition after having a year out from

competing due to the break-up of a long

standing personal relationship. Although

self-confidence is a term often used by ath-

letes to describe a belief in their ability to be

successful, psychologists typically refer to the

construct of self-efficacy. Self-efficacy is

defined as ‘…a belief in one’s capabilities to

organise and execute the courses of action

required to produce given attainments’

(Bandura, 1997, p.3). The term self-efficacy

reflects situation-specific self-confidence (i.e.

the belief to successfully execute a specific

move in judo) as opposed to global self-con-

fidence (i.e. confidence in your ability as a

judoka) which is more of a personality trait

or disposition (Cox, 2002). Bandura (1986,

1997) proposes that performance accom-

plishments (i.e. experiencing success), vicar-

ious experiences (i.e. viewing a skilled

performer), verbal persuasion (i.e. positive

self-talk) and emotional arousal (i.e. being

emotionally ready and optimally aroused)

are all essential elements that determine an

individual’s level of self-efficacy.

Following a discussion with her coach the

participant had decided to return to training

and competition and to ‘give it one more

go’. Since returning to training the partici-

pant reported that she felt ‘inferior’ and ‘did

not deserve to be on the mat’ as well as expe-

riencing thoughts of failing during training

and competition. This was often the case

when the participant was faced with familiar

opponents. The participant believed that

these thoughts stemmed from a poor run of

form prior to her break from competition.

Because of her low level of self-efficacy the

participant believed that she had become

‘soft’ on the mat, which prevented her hav-

ing the necessary ‘edge’ to compete at a high

level. The participant’s performances were

poorer than past seasons and this was caus-

ing her worry and frustration.

The participant wished to have a greater

belief in her ability prior both to training

and competition. She also wanted to per-

form well in the upcoming National Trials

(which were three months away at the start

of the study) and be more consistent

throughout competitions during the season.

To provide a baseline measure of the type of

Using hypnosis to increase self-efficacy:

A case study in elite judo

Jamie B. Barker & Marc V. Jones

An elite female judoka reported a debilitating level of self-efficacy relative to judo performance. Pre- and

post-intervention data were collected via a specifically designed self-efficacy questionnaire (SEQ) that con-

sisted of seven items relating to good judo performance. An intervention programme consisting of eight hyp-

nosis sessions was conducted. These sessions comprised the delivery of general ego-strengthening,

sport-specific ego-strengthening and self-hypnosis suggestions. A pre-performance routine using self-hypnosis

was developed for use prior to training and competition. Data from the SEQ were inconclusive, as there

was a trend towards higher self-efficacy prior to the intervention. However, the participant reported a pos-

itive perception of hypnosis and believed that the use of hypnosis resulted in increased self-belief during both

training and competition. Although further research is needed the findings of this case study suggest that

hypnosis can be used to enhance self-efficacy in sport performers.

mental strategies employed by the partici-

pant the Test of Performance Strategies

(TOPS; Thomas, Murphy & Hardy, 1999)

was administered. In addition, a specifically

developed Self-Efficacy Questionnaire

(SEQ) was completed within 24 hours of the

training session or competition. The SEQ

consists of seven items relating to good judo

performance based on the micro-analytic

approach to self-efficacy assessment outlined

by Treasure, Monson and Lox (1996). The

seven items consisted of the following:

aggression, gripping, newaza (arm locks/

strangles), upping the pace, attacking first,

positive attacking and focus. The participant

noted how certain she had felt of completing

each move successfully in her last training

session/competition. As such, the question-

naire required the participant to recall the

level of self-belief they felt they had about

successfully completing the identified per-

formance-related items during actual per-

formance. A rating of 100 indicated high

certainty and a rating of 0 indicated no belief

in her ability to complete the tasks. Baseline

data were collected over nine training ses-

sions and competitions.

Problem formulation

The intake interview indicated that the par-

ticipant reported a debilitating level of self-

efficacy prior to performance. In addition,

the participant’s mean score on the SEQ was

46.91 (S.D. = 4.01). The results from the pre-

intervention TOPS revealed that the partici-

pant used relaxation strategies much more

frequently in competition as opposed to

training. In addition, she indicated that the

use of imagery and self-talk in training and

competition was infrequent and that she

engaged in a lot of negative thinking when

performing in competition (see Table 1).

Self-efficacy is regarded as a strong and

consistent predictor of successful individual

athletic performance (Kane, Marks, Zaccaro

& Blair, 1996; Treasure, Monson & Lox, 1996).

Self-efficacy levels are proposed to impact per-

formance by determining levels of motivation

which will be reflected in the challenges indi-

viduals undertake, the effort they expend and

levels of perseverance (Bandura, 1997). Self-

efficacy judgements have also been shown to

influence certain thought patterns (e.g. goal

intentions, worries, causal attributions) and

emotional reactions such as, pride, shame,

happiness, and sadness (Bandura, 1997).

TOPS variable Pre TOPS score Post TOPS score

Activation (Practice) 12 13

Activation (Competition) 14 15

Relaxation (Practice) 4 16

Relaxation (Competition) 9 16

Imagery (Practice) 4 16

Imagery (Competition) 6 15

Goal Setting (Practice) 16 19

Goal Setting (Competition) 16 18

Self Talk (Practice) 5 16

Self Talk (Competition) 4 16

Automaticity (Practice) 12 12

Automaticity (Competition) 11 11

Emotional Control (Practice) 12 12

Emotional Control (Competition) 14 14

Attentional Control (Practice) 11 16

Negative Thinking (Competition) 15 8

Table 1: Pre- and post intervention Test of Performance Strategies (TOPS)scores

38 Sport &Exercise Psychology Review Vol 1 NoThere is a plethora of research docu-

menting the effectiveness of a variety of men-

tal techniques in facilitating self-efficacy

within the sport domain (Zinsser, Bunker &

Williams, 2001). Evidence can be found sup-

porting the use of goal setting (Kane et al.,

1996; Locke & Latham, 1990; Schunk, 1991),

positive feedback (Escarti & Guzman, 1999;

Schunk, 1995), imagery (Feltz & Riessinger,

1990; Jones, Mace, Bray, McRae & Stock-

bridge, 2002) and self-talk (Feltz, 1988;

Wilkes & Summers, 1984).

In the current study hypnosis was used as

an intervention to enhance self-efficacy.

Hypnosis can be defined as ‘…an induced

temporary condition of being in a state that

differs mentally and physiologically from a

person’s normal state of being’ (Weitzenhof-

fer, 2000, p.221). Suggestions are given dur-

ing hypnotic trance to alter perceptions,

thoughts, feelings, sensations which facilitate

a long-term change in behaviour (Unestahl,

1983). Recent research by Pates and col-

leagues has focussed on the effectiveness of

hypnosis in generating an appropriate psy-

chological state for competition (Pates,

Cummings & Maynard, 2002; Pates & May-

nard, 2000; Pates, Maynard & Westbury,

2001; Pates, Oliver & Maynard, 2001). These

researchers have been consistently able to

induce a flow state and demonstrate

enhanced performance across a wide variety

of tasks. Despite these positive findings,

there is a need for further research to evalu-

ate the efficacy of hypnosis on psychological

variables such as self-efficacy, in order for

hypnosis to be considered as a performance

enhancing strategy by the sport science com-

munity (Pates, Cummings &Maynard, 2002;

Taylor, Horevitz & Balague, 1993).

Intervention

Initially, the participant revealed that she was

sceptical about the use of hypnosis as a per-

formance enhancing technique. This was a

result of viewing stage hypnosis which

resulted in the construction of a negative

perception. Therefore, prior to the hypnotic

intervention the participant was presented

with information about hypnosis, the nature

of a trance state, and the procedure that

would be followed when inducing a hypnotic

trance. This was to alleviate any misconcep-

tions about hypnosis, to facilitate rapport

(Heap & Aravind, 2001) and alleviate any

anxiety the participant was experiencing

about the use of hypnosis (Hammond,

1990).The participant was also informed

that an appropriately qualified individual

would deliver the hypnosis sessions (all ses-

sions were delivered by the first author, who

holds a Certificate in Clinical Hypnosis from

the London College of Clinical Hypnosis).

Following this, the participant provided

informed consent to participate in the inter-

vention.

The hypnotic intervention commenced

with three sessions that adopted general ego

strengthening suggestions. The sessions

lasted approximately 70 minutes each and

were consultant led. Each session consisted

of the following phases: induction, deep-

ener, post-hypnotic suggestions (PHS) and

awakening. These sessions introduced the

individual to hypnosis and presented them

with suggestions that would stimulate posi-

tive thoughts and behaviours (Hammond,

1990). Then, three sessions that adopted

judo specific ego strengthening suggestions

were undertaken. Again each session lasted

approximately 70 minutes, were consultant

led, and comprised of an induction, deep-

ener, PHS and awakening. An original script

was developed with the athlete to make it

more personal and specific to judo training

and competition. Here terms and phases

that the participant was familiar with were

used. The post-hypnotic suggestions used are

reported in Figure 1 overleaf. The final part

of the intervention comprised two sessions

(each 80 minutes in length and consultant

led) focussing on developing the partici-

pant’s ability to use self-hypnosis. The self-

hypnosis sessions contained the following

phases; induction, deepener, PHS (focussing

on installing self-hypnosis suggestions) and

awakening. This stage provided the partici-

pant with instructions on how to undertake

self-hypnosis when alone. In addition, sug-

gestions focussing on feelings and sensations

were presented (Liggett, 2000). Following

this session the participant was instructed on

how to induce self-hypnosis and was asked to

practice twice daily and to keep a diary doc-

umenting their experiences as well as the

depth of trance they achieved. Frequency of

practice was measured by the completion of

a practice chart which was collected from the

participant each week. This revealed that she

had adhered to her twice daily practice of

self-hypnosis. From these sessions a pre-per-

formance routine that used self-hypnosis was

developed. The routine comprised using

self-hypnosis two hours prior to each train-

When you practice and compete…you will no longer think nearly so much about yourself…you will

no longer dwell nearly so much upon yourself and your difficulties…and you will become much

less conscious of yourself…much less pre-occupied with yourself…and with your feelings…

Every time you practice and compete…your nerves will become stronger and steadier…more

composed…you will become much less easily worried…much less easily agitated…much less easily

fearful and apprehensive…much less easily upset…you will find it much easier to ‘step up’ on the

mat prior to judo performance…

When standing on the mat prior to judo practice and competition you will be able to think more

clearly…you will be able to concentrate more easily…you will be able to give your whole undivided

attention to whatever you are doing…to the complete exclusion of everything else…and you will

find it easier to ‘step up’…

Every time you practice or compete…youwill become and remain… emotionally much calmer…

much more settled…much less easily disturbed…much more dominant…more assertive…stronger

and powerful…more so than you have felt for a long time…

Every time you practice and compete…youwill become and youwill remain…less tense…both

mentally and physically…

And asyou become…and asyou remain…less tense when standing on the mat prior to and during

practice and competition…you will develop much more confidence in yourself…more confidence in

your abilityto do…not only what you have…to do each day…but more confidence in your ability

to do whatever you oughtto be able to do…without fear of failure…without fear of

consequences…without unnecessary anxiety…without uneasiness…

Because of this…every time you practice or compete… you will feel more and more

independent…more able to stick up for yourself…to stand on your own feet to hold your

own…more assertive and powerful… no matter how difficult or trying things may be…

Every time you practice and compete…you will feel a greater feeling of personal well being…a

greater feeling of personal safety and security…more than you have felt for a long, long time…

And because all these things will begin to happen…exactly as I tell you they will happen…more

and more rapidly…powerfully…and completely…with every treatment I give you…you will feel

more confident when standing on the mat prior to both training and competition…

You will consequently become much more able to rely upon…to depend upon…yourself…your own

efforts…your own judgement…your own opinions…in both practice and competition…

Figure 1: Post-hypnotic sport specific ego strengthening suggestions

ing session for a period of four weeks. The

routine was then adapted for the partici-

pant’s first competition of the season when

the participant would use hypnosis at the fol-

lowing times: the night before competition,

morning of the event and upon arrival at the

venue. Here the participant would find a

place that was quiet and where they could

comfortably position themselves without dis-

tractions, and then they would close their

eyes and focus on deep, slow and controlled

breathing. After approximately five minutes

the participant would present themselves

(internally) with positive suggestions that

focussed on self-belief, success and concen-

tration (similar to those outlined in Figure

1). Then the participant would awaken by

opening their eyes and moving their fingers

and toes. The participant later reported that

she was able to find quiet places to conduct

her routine and that she was able to a attain

a deep level of trance when using self-hyp-

nosis in this situation.

Throughout the intervention regular con-

tact was maintained with the participant,

which comprised telephone calls or meetings.

This was not only to facilitate adherence and

outcome, but also to monitor the participant’s

views and feelings about the use of the mental

skill (i.e. hypnosis) and adapt the intervention

if required (Shambrook & Bull, 1999).

Results

In order to analyse the effectiveness of the

intervention 16 post-intervention data points

(SEQ) were collected. The TOPS was also

completed again and a post-intervention

interview was conducted to assess the partic-

ipant’s perception of the intervention. It is

worth noting that data point 25 in Figure 2

represents participation in the National Judo

Trials. In addition, 10 follow-up measures six

months after the intervention were also col-

lected. Data were analysed via visual analysis

and a comparison of pre and post descriptive

statistics. Visual analytical techniques were

used in order to eliminate small effects and

hence promote large intervention effects

(Baer, 1977).

Figure 2 highlights that self-efficacy

increased (during pre- and post-interven-

tion phases) with each training session that

was completed. However, post intervention

and during the follow-up phase this

increase is more gradual and constant. The

participant indicated that during session

17, her mind was filled with positive

thoughts and images about successful per-

formance for the first time since returning

to training and competition. The data also

indicate that the participant experienced

her highest level of self-efficacy (up to that

point) for the National Trials (data point

Figure 2: Pre- and Post-Intervention and 6-Month Follow-Up Self-Efficacy (SEQ) Scores

25). Visual analysis of the pre- and post-

intervention mean scores indicated a mean-

ingful difference across the SEQ scores

(SEQ pre M = 46.91, SD = 4.01; SEQ post M

= 52.52, SD = 2.88).

The post-intervention TOPS scores

revealed an overall improvement in the indi-

vidual’s use of psychological strategies dur-

ing training and competition. The

improvement centred upon an increase in

the use of imagery and self-talk in training

and competition and a reduction in the use

of negative thinking during competition

(Table 1). For example, the participant

reported visualising successful performance

during training session 17.

A post-intervention interview with the

participant revealed that she now held the

intervention in positive regard. She

reported that the intervention helped her

to have greater belief in her ability (i.e. an

increased frequency of positive thoughts),

to feel more relaxed and focused prior to

training and competition and also that

hypnosis had increased her self-belief in

other life situations (e.g. job interview and

a university presentation). Although the

participant had highlighted that she was

sceptical regarding the use of hypnosis at

the beginning of the intervention, she

indicated that she would now recommend

the technique to other athletes. Further-

more, she reported that there had been a

definite change in the belief she had in

her own ability, stating that the ‘self-belief

is now back’. In short, the hypnosis had

become an integral part of her judo

preparation.

The participant finished sixth in the

National Trials, which was slightly lower than

she had aimed for (her goal was to finish

within the top five). However, she reported

feeling pleased with how she had performed

in the competition and overall she was

pleased with her recent performances and

reported being appreciative of the interest

and enthusiasm shown by the consultant in

aiding her development.

Discussion

The study examined the effects of a hypnotic

intervention on an elite judoka experiencing

low levels of self-efficacy during training and

competition. As the number of training ses-

sions increased so did the participant’s level

of self-efficacy. Accordingly, it seems that

training experiences over the study period,

such as performance accomplishments and

vicarious experiences, have contributed to

this increase (Bandura, 1997). However, evi-

dence from the participant implies that hyp-

nosis encouraged a greater use of positive

self-talk and imagery during training and com-

petition. This supports Bandura’s (1986) pre-

diction that verbal persuasion is a significant

factor impacting upon an individual’s level

of self-efficacy. In addition, the participant

felt the hypnotic intervention had allowed

her to feel more (appropriately) psychologi-

cally prepared for competition. Therefore,

supporting research by Pates and colleagues

who successfully used hypnosis to induce

flow states in participants across a variety of

sport related tasks (e.g. Pates & Maynard,

2000; Pates, Cummings &Maynard, 2002).

The use of educational material relating

to hypnosis and the development of a close

rapport with the participant (via telephone

calls and meetings) was thought to aid the

participant’s adherence to the intervention

protocol. From a practical point the estab-

lishing of rapport and reducing the impact

of negative perceptions towards hypnosis

cannot be underestimated in facilitating a

successful outcome (Hammond, 1990; Heap

& Aravind, 2001).

The participant reported a positive per-

ception towards hypnosis and attributed the

use of hypnosis to her having greater self-

belief in her judo ability both in training and

competition. In addition, she also indicated

that her increase in self-efficacy had trans-

ferred into other life tasks. The participant

also successfully incorporated hypnosis into

her judo preparation and reported it being

an integral part of her training schedule six

months after the study.

One potential limitation of the study is the

inability to state that hypnosis was the contrib-

utory factor in facilitating a change in behav-

iour. It appears that the participant

experienced an increase in self-efficacy as she

began training following her return to compe-

tition. However, the participant did report that

the hypnosis was helpful in enhancing her self-

efficacy. Further research is needed within

sport psychology to consistently document the

effect of hypnosis on self-efficacy and other

psychological variables that impact sport per-

formance, such as anxiety and motivation.

The authors

Jamie B. Barker(j.b.barker@staffs.ac.uk)is a

Lecturer in Sport Psychology at Staffordshire

University. Marc V. Jonesis a Reader in Sport

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References

The hypnotic belay in alpine mountaineering: The use of self-hypnosis for the resolution of sports injuries and for performance enhancement

Auteur(s) / Author(s)

MORTON Priscilla A. ;

Résumé / Abstract

The author, an experienced alpine mountaineer, sustained several traumatic climbing injuries over a two-year period. This article describes her multiple uses of self-hypnosis to deal with several challenges related to herreturning to successful mountain climbing. She used self-hypnosis for physical healing and to enhance her motivation to resume climbing. While training for her next expedition, she successfully utilized self-hypnotic techniques to deal with acute stress and later post-traumatic symptoms that had emerged related to her climbing injuries. She describes her use of hypnotic ego-strengthening, mental rehearsal, age progression, and "Inner Strength" as well as active-alert trance states. Her successful summitting of Ecuador's Cotopaxi at 19,380 feet was facilitated by "The Hypnotic Belay" which permitted her to secure herself by self-hypnosis in addition to the rope used to secure climbers. In 1994, the author returned to the Cascade Mountains where she had been injured three years earlier and reached the summit of Mount Shuksan. This time she was secured by "The Hypnotic Belay".

Revue / Journal Title

The American journal of clinical hypnosis   ISSN 0002-9157

Source / Source

2003, vol. 46, n^o1, pp. 45-51 [7 page(s) (article)]

Langue / Language

Anglais

Editeur / Publisher

American Society of Clinical Hypnosis, Des Plaines, IL, ETATS-UNIS  (1958) (Revue)

Localisation / Location

INIST-CNRS, Cote INIST : 19667, 35400011993442.0040

Nº notice refdoc (ud4) : 149766

Sport Hypnosis

Product Description

Harness the power of your own mind! Hypnosis is now a mainstream, modern training technique used by top professionals; it’s not the submissive state that has been portrayed in movies and misunderstood by the public. It can help you sharpen your mental focus, relax your body, visualize success, stimulate healing, and control your emotions during training or when facing important competitions.

The positive effects are similar to what sport psychologists, coaches, and athletes refer to when they talk about “getting in the zone.” In this state of mental functioning you channel attention and energies fully toward the task at hand. Sport Hypnosis is a guide to that special psychological realm and the higher performance athletes aspire to.

First, Sport Hypnosis presents an overview of mental training and hypnosis. Next, the book provides specific information on how you can use hypnosis to enhance a variety of mental skills. These skills include relaxation, imagery, goal setting, concentration, easing pain, and increasing inner strength. Finally, because athletes rarely focus on one skill at a time, Sport Hypnosis describes in detail how coaches and athletes can apply and combine different hypnotic techniques. Five case studies explain how athletes improved several aspects of their performance through hypnosis. You’ll read how hypnosis helped a soccer player eliminate a long-standing, debilitating hamstring pain and how a basketball player achieved a higher free-throw percentage.

Author Dr. Don Liggett presents the hypnosis techniques that he has applied effectively with athletes in many different sports. You can adopt these techniques readily to your own training and competitions. If you’re looking for a way to improve the mental side of your performance equation, Sport Hypnosis just may be the edge you need to become a champion.

Contents

Part I. Incorporating Hypnosis Into Mental Training Chapter 1. Demystifying Hypnosis Chapter 2. Taking Mental Training to the Next Level

Part II. Developing Specific Mental Training Skills Chapter 3. Easing Out Tension Chapter 4. Imaging Perfect Performance Chapter 5. Mobilizing Energy Chapter 6. Building Motivation With Goals Chapter 7. Optimizing Arousal Levels Chapter 8. Eliminating Distractions Chapter 9. Gaining Inner Strength Chapter 10. Easing Pain Chapter 11. Unleashing Self-Healing

Part III. Learning From Case Studies Chapter 12. David, the Quarterback Chapter 13. Scott, the Soccer Player Chapter 14. Matt, the Kayaker Chapter 15. Jim, the Pole-Vaulter Chapter 16. Beth, the Basketball Player

By Donald Liggett

Psychological preparation for the Olympic Games

Institute for the Study of Youth Sports, Michigan State University, East Lansing, Michigan, USA.

We review research literature on psychological preparation for Olympic Games performance. We address research identifying psychological characteristics associated with Olympic performance success, studies examining how these attributes are developed, stress and coping in Olympians, evaluation studies of the Olympic experience with particular emphasis on factors influencing performance, and the best practice literature on effective Olympic psychological consultations. Key principles are identified as well as gaps in the knowledge base that need to be addressed by investigators. Finally, implications for preparing individual athletes, coaches, and teams are discussed.

Effects of hypnosis on flow states and golf performance

Centre for Sport and Exercise Science, Sheffield Hallam University, South Yorkshire. J.Pate@shu.ac.uk

This study examined the effects of an hypnotic intervention on flow states and golf-chipping performance of 3 participants. The study utilized an ideographic ABA single-subject design combined with a procedure to assess the participants' internal experience (Wollman, 1986). The intervention involved relaxation, imagery, hypnotic induction, hypnotic regression, and trigger control procedures over 5 wk. and 7 trials. Analysis indicated the 3 participants increased their mean golf-chipping performance from the trials in Baseline 1 to intervention, with 2 returning to Baseline 1 performance after the intervention phase at Baseline 2. The intensity of flow experienced by the participants during the performance trials was measured using Jackson and Marsh's 1996 Flow State Scale. Two participants experienced higher flow during the intervention phase and much lower flow during Baselines 1 and 2. Finally, participants indicated the intervention seemed useful in keeping them confident, relaxed, and in control. These results support the hypothesis that an hypnotic intervention can improve golf-chipping performance and increase feelings and cognitions associated with flow.

The Effects of Preliminary Measurement on Psychological Outcomes Associated With Exercise, Hypnosis, and Quiet Rest

The purpose of this study was to evaluate the effects of pre-test sensitization on psychological outcomes following 30-mins of cycling exercise (CE), hypnosis (HY), and quiet rest (QR). A Solomon 6-group design was used and participants were randomly assigned to experimental and control conditions (CE, HY, & QR). The STAI and the POMS were administered to half of the participants (N = 54) before the intervention while the other half (N = 54) did not receive a pre-test. This design allows for the comparison of post-test measurements on participants who have been pre-tested and those who have not. The data were analyzed with a series of repeated measures ANOVA's using the post-test variables as dependent measures. Results indicated that significant state anxiety and mood improvements were measured following each condition (CE, HY, & QR) in those groups that received a pre test. These improvements were not significantly different for the cycling, hypnosis, or quiet rest groups. Additionally pre-test measurement did not appear to effect postûtest outcomes. It is concluded that the common practice of pre-testing of affective variables prior to exercise, hypnosis, or quiet rest does not influence post-test outcomes. ©2001The American College of Sports Medicine University of Wisconsin-Whitewater, WI 53190

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Hypnosis:Interview with Dr. Jack Singer on Core Sports Performance

Recently Dr. Jack was interviewed by Chris Shugart, the editor of T-Nation.

Mind Games

The ball is snapped. The quarterback takes a few steps back and looks downfield. Nothing. Then the defensive line fails and about a 1000 pounds of muscled meanness barrels toward him. A receiver suddenly breaks into the open and the quarterback lifts his arm to throw… Freeze.

At this moment, the amount of weight the quarterback can bench press doesn't matter much. His VO2 max just isn't that important. In fact, his body has become a secondary element in his eventual success or failure. Maybe he'll throw an interception. Maybe he'll choke under the pressure and get clobbered. But not if he has trained with Dr. Jack Singer.

Dr. Jack Singer is an elite level Sports Psychologist. He's the secret weapon of many professional athletes and teams, teaching his clients how to consistently reach states of peak performance. When top level players or even weekend warriors want to get the edge, they go to Dr. Jack.

You've seen him on ESPN, Fox Sports and CNN, now it's time for T-Nation to pick his brain.

T-Nation: Dr. Singer, thanks for chatting with us today. Let's begin by talking about the field of Sports Psychology. Is there a difference between a Sports Psychologist and a shrink who just likes football and consults a few players?

Dr. Jack: That is a wonderful question to ask because there are so many psychologists who don't have formal or ongoing training in Sports Psychology, yet call themselves Sports Psychologists because they happen to work with athletes. I, for example, am a Certified Sports Psychologist and have a Diplomate in Sports Psychology from the National Institute of Sports… a recognition that's only granted to half of 1% of all of the psychologists who apply for such a Diplomate recognition.

T-Nation: What kind of athletes have you worked with over the years? What do they come to you for that needs fixing?

Dr. Jack: I've worked with athletes in virtually every sports endeavor, and with all levels of proficiency, from pros, to college athletes, to nationally ranked juniors, to weekend warriors. They come to me to help them function at peak efficiency, consistently. This may involve anger control, stress and anxiety elimination, mental toughness training, confidence and self-esteem building, rapid injury recovery and staying-in-the-zone training, as examples. I teach every athlete who wants that "unfair advantage" self hypnosis, but there are a multitude of techniques besides hypnosis that we cover.

Incidentally, I also work with teams, teaching them how to communicate with their coaches, how to quickly learn game plans, and how to stay positive regardless of the score.

T-Nation: Reading through some of your work, I see the topic of relaxation and its relationship with peak performance coming up often. When it comes to sports or just lifting weights in the gym, we often think of getting "amped up" or "psyched up." I've seen powerlifters slap each other in the face before a big lift. Where does being relaxed come in?

Dr. Jack: You know, there's a certain amount of getting "amped up" that's necessary for peak performance in all sports. That means that being "too relaxed" is really not the most efficient way to perform your best. The problem is learning the exact point where the "amping" or "psyching" becomes so stressful, that performance actually deteriorates.

So what's the answer? I help each of my athletes determine where that cutoff point is for them and then teach them relaxation routines to use as soon as their "amp level" approaches the point at which continued amping will deteriorate their performance. It’s like a rheostat that they control themselves and keeps their performance sharp and consistent.

T-Nation: Very interesting. We all know when we're in "the zone" and when we're not. But can an athlete or an avid ironhead create the zone?

Dr. Jack: Anyone can be taught to create "the zone." It's a combination of imagery, visualization and hypnotic training. The secret, however, is to learn how to switch it on and stay in the zone, as needed. In short, everyone is capable of creating the zone. Someone once said, "Whatever you conceive, you can believe, and whatever you believe, you can achieve." Conceiving that you want to get in the zone and learn how to stay there is the first step. I can teach you the rest.

T-Nation: I love the field of Sports Psychology because it deals not with beating the opposing team, but conquering one’s own mental barriers and self-limiting thoughts. What are some common ways that people hold themselves back and become their own opponent?

Dr. Jack: Without a doubt, every athlete’s number one opponent is their self-dialogue. You see, the specific messages that you give yourself during practice, just before competing, and during the competition all determine to a large extent your performance.

Self-limiting thoughts are all a result of unfortunate thinking habits and routines that people repeat over and over. As a Sports Psychologist, the very first thing I do is to help my clients recognize these self-limiting thoughts so that they can quickly switch them off and replace them with powerful, proactive, positive, performance enhancing thoughts. It really works!

T-Nation: Interesting. Can you give us an example of a top athlete with a specific problem and how you helped him or her overcome it?

Dr. Jack: Certainly. Of course, I can't relate the actual name or team because of confidentiality issues, but I can certainly share the problem, the treatment and the success.

This is a story about a football quarterback who was an All Star in high school. He was recruited by a major university, and after practicing with the team for two weeks, his coach referred him to me for mental toughness training. From day one, his "internal critic" started to work on him. He thought to himself about all of the other great quarterbacks on the team and how they were probably better than him… better prepared, stronger, etc. Even in practice, he was amazed at how his performance was so poor and then a coach referred him to me.

We set out to discover his internal dialogue and all of the sabotaging comments he was telling himself in his head. Once we discovered his negative thinking patterns, we devised a game plan to recognize and immediately change those thoughts, and his performance rapidly improved. The problem of his mental toughness issues was really a problem of poor self-talk habits, and once these were identified and reversed, his mental toughness and resultant performance skyrocketed! T-Nation: I remember reading about Arnold the Governator using a mental trick in his early years. He didn't like leg training, so he purposefully walked around saying, "I love leg days!" Sure enough, he built a set of powerful legs. Was he on to something?

Dr. Jack: Absolutely! Think about the true case of a 97 pound older woman finding her husband trapped under the wheel of his car. She doesn’t stop to think negatively; she only tells herself that she must lift the car to free her husband… right now! And she accomplishes it!

Your subconscious mind takes all of its directions directly from you and it believes exactly what you tell it, making no judgments. Therefore, if you say to yourself (and therefore to your subconscious mind) "I hate leg training," then it will help you to avoid leg training, because it thinks that's what you want. On the other hand, if you say to yourself, "I love leg training," guess what? Just ask the Governator, or better yet, look at his legs!

T-Nation: On your website you write briefly about a rubber band trick used to counter these self-defeating thoughts. It's a great trick! Tell us about it.

Dr. Jack: Certainly. Get yourself a fat rubber band, like the ones that come in the mail. Once you recognize your negative thinking patterns (for example, saying to yourself "My opponent looks stronger than me"), snap that rubber band one or more times on your wrist to STOP THAT THOUGHT.

Once the thought is stopped in its tracks, take a series of deep breaths through your diaphragm and then replace the negative thought with a positive one, such as, "I have trained hard for this moment and my body is ready to prove to me how really strong it is. Let’s just do it!"

This really works, but like everything else, it gets better with practice.

T-Nation: I'll have to try that when I see those damn pizza commercials. Bad thoughts there! Let's talk about hypnosis. I think most people still visualize a stage show where someone is made to cluck like a chicken. What's the real story of hypnosis?

Dr. Jack: You're right about many folks seeing a stage hypnotist and believing that if they're hypnotized, they'll wind up acting silly or being out of control. Understand that stage hypnotists are entertainers who carefully select volunteers who enjoy being on a stage and making people laugh. Therefore, the folks who wind up clucking like a chicken are actually exhibitionists who enjoy laughing and making others laugh and are completely susceptible to whatever the hypnotist asks.

Clinical Hypnosis is a whole different situation. First of all, no one can be hypnotized against their will or asked to do something which goes against their goals and best interests. It simply won't work. Ultimately, you are in total control in hypnosis, and it's a means of learning control.

Most of us have actually gone into spontaneous hypnosis hundreds of times during our lives. An example is when you're driving to your destination and get there without being aware of passing familiar streets or landmarks along the way…almost like you were driving on automatic pilot. Or, recall a beautiful spring day when you were in school, with your mind focused on something out the window and all of a sudden, your teacher startles you by calling your name. This "daydreaming" was a self-induced altered state of awareness called self-hypnosis.

We know that the mind is intricately connected to the body. There's a ton of research proving that through energy fields and electrical and chemical processes that every thought we have triggers an immediate response in every cell in the body, including, of course, the cells in our muscles. So, if our subconscious mind is filled with negative thoughts during our powerlifting contest, the muscles instantly weaken.

Through hypnosis, I infuse the subconscious minds of my athletes with powerful, positive suggestions, so that as they practice this, their muscles will actually work at peak efficiency during the event. This, of course, is just one of hundreds of examples I could share about the terrific power of hypnosis for athletic performance. I call it the athlete’s "unfair advantage."

T-Nation: What about self-hypnosis? Can you teach us a quick technique?

Dr. Jack: Yes. Prior to a lifting experience, for example, just sit down on a mat and begin to breath slowly and deeply. When you're ready to go into self-hypnosis, make a tight fist with your dominant hand and that will serve as your cue to go into a brief hypnotic trance. Continue breathing slowly and deeply, perhaps visualizing your lungs taking in a full volume of healthy, clean oxygen and exhaling all of the tension out of your body. Breath in through your nose and out through your mouth.

Next, slowly count down from five to one, timing the count down with your exhales and when you get to one, visualize yourself lifting the weight you're about to attempt and lifting it with ease. Just picture in your mind the weights filled with feathers instead of iron, and see yourself lifting the weight easily as you tell yourself, "I know I can do this. I WILL do this."

Do this visualization as long as you wish and then calmly go and do your lift. When you are through, relax and tell yourself that it's time to come out of your self-hypnotic trance. Then, count backwards from five to one. When you get to one, you'll be back to your fully aware and alert stage, feeling wonderful, calm, energized and a new power! Have fun with this, and remember, practice, practice, practice.

T-Nation: Cool. I'll try that. You've written a lot about burnout in athletes, even very young athletes. What about the bodybuilder or average gym member? I don't recall the stats offhand, but the fact is that most people quit training after a while or at least become very inconsistent. Where do we burn out?

Dr. Jack: Burnout is caused by allowing the stresses involved in your sport to become larger than the pleasures. Since all stress is caused by the negative, self-defeating internal dialogue that we engage in, then we can overcome and, in fact, avoid stress by harnessing those negative thoughts in the first place and replacing them with positive affirmations.

Practicing this will ultimately eliminate overwhelming stress and thus eliminate burnout. You all deserve to feel powerful, empowered and proud of yourself. With the proven techniques of Sports Psychology, you can all accomplish this…whether you're a body builder, a powerlifter, a fitness enthusiast or a weekend warrior. These techniques really work! T-Nation: In recreational bodybuilding, I see a lot of people getting discouraged and defeated because they compare themselves to others. The bodybuilding mags are full of genetic gods on steroids, so it's easy for the average guy to get discouraged. Oddly, the same guy doesn't get discouraged when he can't slam dunk like an NBA pro. He still likes shooting hoops. But many quit lifting weights if they don't look like magazine cover models in four weeks. How would a Sports Psychologist tackle this issue?

Dr. Jack: This is another internal dialogue/internal critic issue. So many of us compare ourselves to the best and the brightest celebrities and because we don’t match up in a particular feature or two, we put ourselves down, feel helpless and hopeless, and give up on a goal.

We all need to realize that perfection is never naturally attained, set realistic goals for ourselves and strive to accomplish those goals. Just like we can’t change our nose structure without artificial makeover surgery, we can’t change our physical genetics…but what we can do is absolutely work our bodies, build them, and develop the very best that's possible for our genetically predisposed frames. In addition, new advances in self hypnosis actually dramatically aid muscle development, so that the body limitations you perhaps have always believed about yourself may not really be valid at all!

T-Nation: Now that's interesting! You may have to write us an article on that topic! Thanks for the talk today. Where can T-Nation readers go to find out more about you and your services?

Dr. Jack: This talk has been a real treat for me and I hope to be an ongoing resource for your readers. To learn more about my phone and in-person consultations, please contact me at (949) 481-5660. It will be my pleasure to help you skyrocket your athletic success!

To inquire about me speaking for your company, convention or association, please learn about my professional speaking services by visiting my web site at: www.funspeaker.com or contacting me at the same number as above.

If you're interested in obtaining my Core Sports Performance hypnosis CD’s, please visit www.hypnosisnetwork.com and click on the core sports performance picture. Incidentally, we'll soon have a second CD series on pain control and rapid injury healing available there, and I plan to produce a series for bodybuilding and powerlifting soon.

T-Nation: Cool. Thanks again!

How Effective Is Hypnosis Counseling

A survey of psychotherapy literature by noted psychologist Alfred A. Barrios, Ph.D. revealed the following recovery rates: Psychoanalysis: 38% recovery after 600 sessions. Behavior Therapy: 72% recovery after 22 sessions. Hypnotherapy: 93% recovery after 6 sessions.

Source: American Health Magazine

Christianity and Hypnosis: Answers from an Academic and a Minister

Christianity and Hypnosis: Answers from an Academic and a Minister

In order to help clarify the range of Christian viewpoints on hypnosis, we interviewed two experts about hypnosis and Christianity. Neither one is affiliated in any way with The Hypnosis Network.

Of course, everyone has their own theological perspectives. You may find that neither of these commentators reflects your views. The interviews are provided strictly as information for those who are curious about possible Christian perspectives on hypnosis.

Our interviewees are:

• John Court, Professor of Psychology, University of South Australia Ph.D., Clinical Psychology, University of Adelaide Diploma of Clinical Hypnosis, Australian Society of Hypnosis Certificate in Theology, Sydney
• Paul Durbin, United Methodist minister Chaplain (Brigadier General), United States Army (retired 1989) Director of Pastoral Care & Clinical Hypnotherapy, Methodist Hospital, New Orleans, LA (retired 2001) Director of Clinical Hypnotherapy, MHSF, affiliated with Methodist Hospital (retired June 30, 2005)

Below are their answers to some of the questions we frequently receive.

Some Christians are concerned that by undergoing hypnosis they might be going against their faith. Why is this?

John Court Because they have been told, or have read in Christian books, that hypnosis is condemned in the Bible. Those who love to find a proof text for their beliefs use one word in Deuteronomy 18 (vv 10-11). In English the Hebrew word is usually translated 'charmer,' or 'one who casts spells,' and from other contexts it is clear that the word refers to snake charming. To relate it to hypnosis is quite misleading.

Good exegesis, of course, calls for more than a simple proof text, and this is lacking.

On the other hand, there are two examples in the Acts where it refers to Peter going into a trance (the Greek word is ekstasis from which we get 'ecstasy') and both events are reported as both positive and significant.

Paul Durbin As you well know, there are many misconceptions concerning hypnosis which make some people (religious or non-religious) have some fears of hypnosis.

A few years ago, I read an article in Family Weekly titled "Boom Days For Devil Hypnosis." Hearing that title, what ideas, images, or thoughts come to you? Though the article had what I considered a very negative title, it was a very positive article on hypnosis in the health care field. The only reference to the devil was in the last paragraph, "Some conservative religious groups consider hypnosis to be the work of the devil."

Hypnosis is mistakenly viewed as mind control or demonic by many misinformed people. Let me describe one situation I've experienced:

Recently I received a physician consult to work with a Catholic woman for pain management. As I explained the process of relaxation, imagery, and hypnosis, I could see that she was very responsive. As I concluded my pre-talk, she said, "I am really looking forward to this experience, but I need to tell you that my daughter is a self-proclaimed born-again Christian and she may say something negative to you about this. If so, do not pay any attention to her, for I am the one who is hurting and I want this."

As I completed the induction, the phone rang. I told the patient, "Just allow the ringing of the phone and my answering it to add to your relaxation." I answered the phone, "This is Mrs. Doe's room. As she is in therapy, please call back in 30 minutes," and hung up the phone.

When the procedure was completed, I walked out of the room and there was her daughter standing in front of the door with arms folded over her chest. She said, "What have you been doing to my mother?" I explained that I had taught her mother relaxation, self-hypnosis, and pain reduction. She responded, "I am a born-again Christian." Before she could continue, I raised my hands and said, "Praise the Lord, so am I." She was speechless, so I continued, "I will bring you some information on hypnosis, but regardless of how you feel about hypnosis, your mother has found it very helpful in the reduction of pain."

Some would say that there is no place in religion for hypnosis. I believe that hypnosis and religious faith can work hand in hand to bring about a better life. Jesus said in St. John 10:10, "I am come that you may have life and have it more abundantly."

Christianity includes many different denominations. Which denominations support hypnosis and which do not? Please explain why some traditions do, and some don't.

John Court This is not easy to answer. In general the Catholic tradition has no problem with hypnosis. The Anglican tradition also has no problem. Lutherans have varied: some for, some against. Seventh Day Adventists used to be against it but appear to be changing.

It is mostly the smaller Bible-based and fundamentalist churches, and especially Pentecostals, who have taught against hypnosis. They have largely been teaching from second and third hand writers who have observed some aspect of hypnosis but without personal study of the subject.

Apart from the biblical evidence, the other major issue that has caused this is that some of the less orthodox traditions such as Christian Science have favored hypnosis, and so the orthodox seek to create distance.

Paul Durbin Each one here comes with his/her own history: religiously, personally, and professionally. I come to you as a Christian Minister who looks upon hypnosis as a valuable tool of counseling. Coming from a religious profession and working in a church-related hospital for 30 years, I was often asked, "Why does one of religious faith need hypnosis?" or "How can you use hypnosis? Isn't there a conflict between religious faith and hypnosis?" I believe that these questions can be responded to by referring to the statement of Jesus in John 10:10, "I am come that they may have life and have it more abundantly." Hypnosis is one of the gifts of God which help people experience the "more abundant life."

Hypnosis is neither anti-religious nor pro-religious. It can be used for good or bad, depending on the hypnotist and the subject. Today, most religious groups accept the proper ethical use of hypnosis for helping people.

The Roman Catholic Church has issued statements approving the use of hypnosis. In 1847, a decree from the Sacred Congregation of The Holy Office stated, "Having removed all misconceptions, foretelling of the future, explicit or implicit invocation of the devil, the use hypnosis is indeed merely an act of making use of physical media that are otherwise licit and hence it is not morally forbidden provided it does not tend toward an illicit end or toward anything depraved."

The late Pope Pius give his approval of hypnosis. He stated that the use of hypnosis by health care professionals for diagnosis and treatment is permitted. In 1956, in an address from the Vatican on hypnosis in childbirth, the Pope gave these guidelines:

(1) Hypnotism is a serious matter, and not something to be dabbled in. (2) In its scientific use, the precautions dictated by both science and morality are to be used. (3) Under the aspect of anesthesia, it is governed by the same principles as other forms of anesthesia. This is to say that the rules of good medicine apply to the use of hypnosis.

Except for exceptions noted, no other Protestant or Orthodox Churches have any laws against the proper-ethical use of hypnosis. To the best of my knowledge, there has been no opposition to the use of hypnosis in the Jewish faith when it is used for the benefit of mankind. Many of the Eastern faiths, such as Buddhism, Yoga, Shintoism, Hinduism and others, approve the use of hypnosis and they often use hypnosis in their worship. Islam has no opposition to hypnosis that I have been able to discover.

Hypnosis should not be condemned as anti-religious just because some people misuse it. Some oppose hypnosis because the say it is used by the occult, but do they condemn prayer because prayer is used for occultist purposes? Hypnosis can be a very helpful tool in counseling. Without apology and when appropriate, hypnosis can be used for growth, health and the benefit of people.

Are there any Christian denominations where hypnosis is absolutely forbidden? (We want to make sure that no one purchases our CDs and then subsequently regrets his or her purchase due to this reason.)

John Court There are certainly some strong prohibitions in some Christian books, but the readership is, I think, restricted to fundamentalists.

Paul Durbin Exceptions are Christian Science, Seventh-Day-Adventist and some individuals of various churches.

In recent years, the Seventh-Day-Adventists have lessened their resistance by using relaxation therapy and suggestion therapy. A hypnotist by the name of Phineas Parkhurst Quimby greatly helped Mary Baker Eddy overcome an illness and she used many of his teachings and techniques in developing the Christian Science Church. Though Quimby used hypnosis to help her, she denounced hypnosis while using its techniques.

Though many in various churches opposed to hypnosis are using the principles of hypnosis (relaxation, concentration, suggestion, repetition) in their healing services, they denounce hypnosis. For those who oppose hypnosis on religious grounds, I remind them of the words of Baptist Van Helmont, "Hypnosis is a universal agent . . . and is a paradox only to those who are deposed to ridicule everything and who ascribe to Satan all phenomena which they cannot explain."

Is hypnosis a form of mind control?

John Court It can be, and in stage hypnosis, obviously is.

In clinical work the control is negotiated between therapist and patient so that control is largely with the patient, who is then invited to allow the therapist to work within clearly identified ethical boundaries. There is also self hypnosis, which emphasizes the point that ultimately the control of the mind is with the person in trance (either self-induced or delegated to the therapist). Certainly clinical hypnosis is about enabling the patient to gain greater control of the mind; that is, empowering, not taking control away.

Paul Durbin Hypnosis is no more mind control than watching TV, listening to a political speech, or attending a worship service. It is my belief that a person will not do anything under hypnosis that is against his/her will.

There is a story about Milton Erickson going to his secretary and telling her that he was tired and wanted to rest so anyone called, she was to say that he was out of the office. She agreed to do this for Dr. Erickson. Some days later he put her in a hypnotic state and make the same request. She responded that she could not. He asked her "Why?" and she responded, "Because it would be a lie." She had stronger moral resolve under hypnosis than in the normal waking state.

There is one area where there is a danger, and that is in what I would call "brainwashing," which can be accomplished in or out of hypnosis. It consists of a person being bombarded with suggestion time after time, day after day.

Many therapists of the past 30 years produced false memories for their clients by telling them that they would never get well until they admitted that they were sexually abused as children even though they could not remember it. They would have them imagine what might have happened, and even used guided imagery to help them remember. The results from many were the recovery of false memories which brought havoc to the client and family of the client. I have had several articles published on the subject of "False Memories," and one can find articles on my website by me and others on this subject

Does someone who uses hypnosis for themselves risk punishment in some divine way?

John Court No.

Paul Durbin I certainly do not believe that one risks divine punishment for using hypnosis, or I would not use it in my counseling. Some may risk criticism from their church, but not from God.

You have used hypnosis with many devout Christians. Do you have any examples of people who initially feared hypnosis that ended up benefiting?

John Court Yes, often. My book (Hypnosis, Healing and the Christian [Eugene, OR: Resource Publications, 2002]) contains a number of examples of client experiences, published with their permission.

Paul Durbin While a hospital chaplain and hypnotherapist, I had some people who feared hypnosis either on a personal basis or religious basis. Often a physician would send me a referral to work with a patient who was from a Pentecostal-type church. Many said, "Is it alright for me to call my pastor to see if it is OK?" In each case, their pastor said that it was OK. I had been a chaplain at Methodist Hospital in New Orleans for 6 years before I began practicing hypnotherapy, so the pastors knew me and so did not fear me working with their members.

It has been our position that hypnosis actually gives a person more control as opposed to less control. What are your views on this?

John Court Agreed.

Paul Durbin I totally agree. It gives the person the power to use what he or she already possesses but has not been able to control. People gain control over bad habits, control over fears and phobias, and the list goes on.

I know this is a personal question and just your opinion, but do you see any reason why a person would not try hypnosis only because he or she is a Christian? Please explain.

John Court I know of people who do adopt that position. They have been told Christians must not be hypnotized because that would be to relinquish their free will to another person. If that view can be shown to be false, then it is possible to proceed.

I am saddened at how many Christian people feel unable to accept hypnotic-based interventions, when they could be very helpful in dealing with physical and emotional issues. Christians will also often report with surprise that the experience is spiritually beneficial, as it is possible to incorporate prayer and meditation into the therapeutic process.

Paul Durbin I can see a person who would not use hypnosis because of his/her church position or on their personal understanding.

As an example, I was referred to a lady for pain management who wanted her pain medication long before the required time. I told her that I had been referred by her physician to help her reduce pain with hypnosis and she said "No, I am a Christian." I talked with her about that and even explained some of the common misconceptions about hypnosis. I told her that hypnosis was a normal experience that we pass through many times a day, but she said "No." So she just hurt until her drugs were due.

We have heard that people are concerned that hypnosis can override a person’s "will" and/or create space for evil spirits to enter. What are your thoughts on this?

Paul Durbin The vast majority of research disagrees with the above statement. A person in hypnosis will not do anything against his/her will. They may do things that they would not normally do, but would do if the situation were such as to entice them to do it.

For a physician, it is not unethical to prescribe drugs to stop pain, but it is unethical for a physician to intentionally set up a situation where the patient becomes dependent on that drug so the physician can make more money.

I am a theologically conservative United Methodist Christian and ordained clergyperson of the United Methodist Church. Hypnosis happens all the time: watching television, driving your car, being involved in a worships service, just before going to sleep, and just after waking up. Anything can be used unethically, but that is a problem of the person involved, be he clergy, physician, fireman, policeman, business person, wife, husband, teacher, or hypnotherapist. But don't condemn the profession or the role for the unethical ones among us, or we would have no professions.

People who have been smoking for years, no longer smoke due to hypnotherapy and at a much higher rate than patches, gum or drugs. People are released from fears in a few sessions that have been going to therapy for years. People in pain have had pain reduced or eliminated. Babies have been born to moms who did not have to take any drugs, a positive for both baby and Mom. Cancer patients have been able to take chemo with some of the side effects and have been helped to reduce the pains of cancer and even be healed of cancer. Burn patients have been able to have 3rd degree burns reduced to 2nd and 2nd to 1st when cared for by a hypnotherapist within the first few hours following burns, and to undergo painful procedures following burns with a great reduction of pain. These are blessings from God to be used to help relieve suffering emotionally and spiritually.

For more information about our interviewees

Talking to the Amygdala: Expanding the Science of Hypnosis

In a 9-week study of two weight management groups (one using hypnosis and one not using hypnosis), the hypnosis group continued to get results in the two-year follow-up, while the non-hypnosis group showed no further results (Journal of Clinical Psychology, 1985).

In a study of 60 women separated into hypnosis versus non-hypnosis groups, the groups using hypnosis lost an average of 17 pounds, while the non-hypnosis group lost an average of only .5 pounds (Journal of Consulting and Clinical Psychology, 1986).

In a meta-analysis, comparing the results of adding hypnosis to weight loss treatment across multiple studies showed that adding hypnosis increased weight loss by an average of 97% during treatment, and even more importantly increased the effectiveness POST TREATMENT by over 146%. This shows that hypnosis works even better over time (Journal of Consulting and Clinical Psychology, 1996). Here are some of the studies:

Cochrane, Gordon; Friesen, J. (1986). Hypnotherapy in weight loss treatment.Journal of Consulting and Clinical Psychology, 54, 489-492.

Kirsch, Irving (1996). Hypnotic enhancement of cognitive-behavioral weight loss treatments--Another meta-reanalysis. Journal of Consulting and Clinical Psychology, 64 (3), 517-519.

Allison, David B.; Faith, Myles S. Hypnosis as an adjunct to cognitive-behavioral psychotherapy for obesity: A meta-analytic reappraisal. Journal of Consulting and Clinical Psychology. 1996 Jun Vol 64(3) 513-516

Stradling J, Roberts D, Wilson A, Lovelock F. Controlled trial of hypnotherapy for weight loss in patients with obstructive sleep apnoea. International Journal of Obesity Related Metababolic Disorders. 1998 Mar;22(3):278-81.

Hypnosis for Weight Loss: Does It Work?

In a 9-week study of two weight management groups (one using hypnosis and one not using hypnosis), the hypnosis group continued to get results in the two-year follow-up, while the non-hypnosis group showed no further results (Journal of Clinical Psychology, 1985).

In a study of 60 women separated into hypnosis versus non-hypnosis groups, the groups using hypnosis lost an average of 17 pounds, while the non-hypnosis group lost an average of only .5 pounds (Journal of Consulting and Clinical Psychology, 1986).

In a meta-analysis, comparing the results of adding hypnosis to weight loss treatment across multiple studies showed that adding hypnosis increased weight loss by an average of 97% during treatment, and even more importantly increased the effectiveness POST TREATMENT by over 146%. This shows that hypnosis works even better over time (Journal of Consulting and Clinical Psychology, 1996). Here are some of the studies:

Cochrane, Gordon; Friesen, J. (1986). Hypnotherapy in weight loss treatment.Journal of Consulting and Clinical Psychology, 54, 489-492.

Kirsch, Irving (1996). Hypnotic enhancement of cognitive-behavioral weight loss treatments--Another meta-reanalysis. Journal of Consulting and Clinical Psychology, 64 (3), 517-519.

Allison, David B.; Faith, Myles S. Hypnosis as an adjunct to cognitive-behavioral psychotherapy for obesity: A meta-analytic reappraisal. Journal of Consulting and Clinical Psychology. 1996 Jun Vol 64(3) 513-516

Stradling J, Roberts D, Wilson A, Lovelock F. Controlled trial of hypnotherapy for weight loss in patients with obstructive sleep apnoea. International Journal of Obesity Related Metababolic Disorders. 1998 Mar;22(3):278-81.

Hypnosis and Pain Reduction:The Latest Research

Hypnosis helps healing: Surgical wounds mend faster

By William J. Cromie Harvard University Gazette

Marie McBrown was invited to test whether or not hypnosis would help heal the scars from her breast surgery. Marie (not her real name) and 17 other women underwent surgery to reduce their breast size.

It's a common operation for women whose breasts are large enough to cause back and shoulder strain, interfere with routine tasks, or prompt social and psychological problems. The pain and course of healing from such surgery is well-known, and a team of researchers headed by Carol Ginandes of Harvard Medical School and Patricia Brooks of the Union Institute in Cincinnati wanted to determine if hypnosis could speed wound healing and recovery.

"Hypnosis has been used in Western medicine for more than 150 years to treat everything from anxiety to pain, from easing the nausea of cancer chemotherapy to enhancing sports performance," Ginandes says. A list of applications she provides includes treatment of phobias, panic, low self-esteem, insomnia, sexual dysfunction, stress, smoking, colitis, warts, headaches, and high blood pressure.

"All these functional uses may help a person feel better," Ginandes continues. "I am also interested in using hypnosis to help people get better physically. That means using the mind to make structural changes in the body, to accelerate healing at the tissue level."

Four years ago, Ginandes and Daniel Rosenthal, professor of radiology at the Harvard Medical School, published a report on their study of hypnosis to speed up the mending of broken bones. They recruited 12 people with broken ankles who did not require surgery and who received the usual treatment at Massachusetts General Hospital in Boston. In addition, Ginandes hypnotized half of them once a week for 12 weeks, while the other half received only normal treatment. The same doctor applied the casts and other care, and the same radiologists took regular X-rays to monitor how well they healed. A radiologist who evaluated the X-rays did not know which patients underwent hypnosis.

The result stood out like a sore ankle. Those who were hypnotized healed faster than those who were not. Six weeks after the fracture, those in the hypnosis group showed the equivalent of eight and a half weeks of healing. How to hypnotize

Not everyone is convinced by the results. Some experts claim that the differences can be explained by the extra attention - the increased psychological support - given to the hypnotized patients. So when she was ready to try hypnosis again on 18 breast surgery patients, Ginandes randomly separated them into three groups. All got the same surgical care by the same doctors. Six received standard care only, six also received attention and support and from a psychologist, and six underwent hypnosis before and after their surgery.

Hypnosis sessions occurred once a week for eight weeks. Psychological soothing took place on the same schedule.

Ginandes did not put the patients to sleep by swinging a watch like a pendulum while the patients lay on a couch. "That only happens in the movies," she laughs. "In hypnosis, people don't lose control and go into a zombie-like state where they can be made to do things against their will. They don't have to lie down, you can enter a state of hypnosis standing up, even standing on your head. Patients don't even go to sleep, rather, they enter a state of absorbed awareness, not unlike losing oneself in a good book or favorite piece of music."

While in this state, Ginandes offered suggestions that were custom-tailored to different stages of surgery and healing, Before surgery, the suggestions emphasized lessening pain and anxiety. "You can even suggest to a patient that she can reduce bleeding during surgery by controlling her blood flow," Ginandes notes. Overall, the suggestions focused on things such as expectation of comfort, decreased inflammation, diminished scar tissue, accelerated wound healing, return to normal activities, and adjustments to self-image.

The women received audio tapes of these sessions so they could practice at home.

At one week and seven weeks after surgery, nurses and doctors participating in the study visibly assessed and measured the wounds of all three groups without knowing which group the women were in. They took digital photographs for three physicians to review. Each patient also rated her own healing progress and how much pain she felt on scales of zero to 10.

The result was clear. Marie McBrown and the women who had undergone hypnosis healed significantly faster than the others. Those who received supportive attention came in second.

From hooey to hurrah

The researchers reported these results in the April issue of the American Journal of Clinical Hypnosis. This report, of course, doesn't prove conclusively that hypnosis will accelerate the healing of wounds. The biggest limitation of the study involves the small number of patients, which makes it difficult to generalize the results to other types of wounds. Then there is the possible effect of expectation, the belief of some patients that hypnotism will work. It's the same effect seen when people who take a sugar pill for a backache do as well as people who take medicine. It's going to require more studies involving many more people to get the majority of doctors to shout hurrah instead of hooey.

Ginandes agrees. "Our study underscores the need for further scientific testing of hypnosis," she says. "Subsequent studies might clarify unresolved speculations about the mechanisms by which hypnotic suggestion can trigger the physical and psychological effects that we see."

She and her colleagues suggest future experiments to compare the effects of simple hypnotic relaxation versus "targeted suggestions for tissue healing." They would also like to see more work done using hypnosis for people suffering from other kinds of wounds, such as foot ulcers caused by diabetes.

Nevertheless, Ginandes believes that the study of healing after breast surgery "breaks the ground for studying a broad and exciting range of new adjunctive treatments. Since clinical hypnosis is a noninvasive, nondrug treatment, finding that it can speed healing of wounds and other conditions could lead to fewer visits to doctors' offices and faster return to normal activities. Also, further investigation might confirm our supposition that the mind can influence healing of the body."

Hypnosis and Healing

Hypnosis helps healing: Surgical wounds mend faster

By William J. Cromie Harvard University Gazette

Marie McBrown was invited to test whether or not hypnosis would help heal the scars from her breast surgery. Marie (not her real name) and 17 other women underwent surgery to reduce their breast size.

It's a common operation for women whose breasts are large enough to cause back and shoulder strain, interfere with routine tasks, or prompt social and psychological problems. The pain and course of healing from such surgery is well-known, and a team of researchers headed by Carol Ginandes of Harvard Medical School and Patricia Brooks of the Union Institute in Cincinnati wanted to determine if hypnosis could speed wound healing and recovery.

"Hypnosis has been used in Western medicine for more than 150 years to treat everything from anxiety to pain, from easing the nausea of cancer chemotherapy to enhancing sports performance," Ginandes says. A list of applications she provides includes treatment of phobias, panic, low self-esteem, insomnia, sexual dysfunction, stress, smoking, colitis, warts, headaches, and high blood pressure.

"All these functional uses may help a person feel better," Ginandes continues. "I am also interested in using hypnosis to help people get better physically. That means using the mind to make structural changes in the body, to accelerate healing at the tissue level."

Four years ago, Ginandes and Daniel Rosenthal, professor of radiology at the Harvard Medical School, published a report on their study of hypnosis to speed up the mending of broken bones. They recruited 12 people with broken ankles who did not require surgery and who received the usual treatment at Massachusetts General Hospital in Boston. In addition, Ginandes hypnotized half of them once a week for 12 weeks, while the other half received only normal treatment. The same doctor applied the casts and other care, and the same radiologists took regular X-rays to monitor how well they healed. A radiologist who evaluated the X-rays did not know which patients underwent hypnosis.

The result stood out like a sore ankle. Those who were hypnotized healed faster than those who were not. Six weeks after the fracture, those in the hypnosis group showed the equivalent of eight and a half weeks of healing. How to hypnotize

Not everyone is convinced by the results. Some experts claim that the differences can be explained by the extra attention - the increased psychological support - given to the hypnotized patients. So when she was ready to try hypnosis again on 18 breast surgery patients, Ginandes randomly separated them into three groups. All got the same surgical care by the same doctors. Six received standard care only, six also received attention and support and from a psychologist, and six underwent hypnosis before and after their surgery.

Hypnosis sessions occurred once a week for eight weeks. Psychological soothing took place on the same schedule.

Ginandes did not put the patients to sleep by swinging a watch like a pendulum while the patients lay on a couch. "That only happens in the movies," she laughs. "In hypnosis, people don't lose control and go into a zombie-like state where they can be made to do things against their will. They don't have to lie down, you can enter a state of hypnosis standing up, even standing on your head. Patients don't even go to sleep, rather, they enter a state of absorbed awareness, not unlike losing oneself in a good book or favorite piece of music."

While in this state, Ginandes offered suggestions that were custom-tailored to different stages of surgery and healing, Before surgery, the suggestions emphasized lessening pain and anxiety. "You can even suggest to a patient that she can reduce bleeding during surgery by controlling her blood flow," Ginandes notes. Overall, the suggestions focused on things such as expectation of comfort, decreased inflammation, diminished scar tissue, accelerated wound healing, return to normal activities, and adjustments to self-image.

The women received audio tapes of these sessions so they could practice at home.

At one week and seven weeks after surgery, nurses and doctors participating in the study visibly assessed and measured the wounds of all three groups without knowing which group the women were in. They took digital photographs for three physicians to review. Each patient also rated her own healing progress and how much pain she felt on scales of zero to 10.

The result was clear. Marie McBrown and the women who had undergone hypnosis healed significantly faster than the others. Those who received supportive attention came in second.

From hooey to hurrah

The researchers reported these results in the April issue of the American Journal of Clinical Hypnosis. This report, of course, doesn't prove conclusively that hypnosis will accelerate the healing of wounds. The biggest limitation of the study involves the small number of patients, which makes it difficult to generalize the results to other types of wounds. Then there is the possible effect of expectation, the belief of some patients that hypnotism will work. It's the same effect seen when people who take a sugar pill for a backache do as well as people who take medicine. It's going to require more studies involving many more people to get the majority of doctors to shout hurrah instead of hooey.

Ginandes agrees. "Our study underscores the need for further scientific testing of hypnosis," she says. "Subsequent studies might clarify unresolved speculations about the mechanisms by which hypnotic suggestion can trigger the physical and psychological effects that we see."

She and her colleagues suggest future experiments to compare the effects of simple hypnotic relaxation versus "targeted suggestions for tissue healing." They would also like to see more work done using hypnosis for people suffering from other kinds of wounds, such as foot ulcers caused by diabetes.

Nevertheless, Ginandes believes that the study of healing after breast surgery "breaks the ground for studying a broad and exciting range of new adjunctive treatments. Since clinical hypnosis is a noninvasive, nondrug treatment, finding that it can speed healing of wounds and other conditions could lead to fewer visits to doctors' offices and faster return to normal activities. Also, further investigation might confirm our supposition that the mind can influence healing of the body."

Hypnosis and Headache Pain: The Research

In a study conducted by Anderson (1975), migraine patients treated with hypnosis had a significant reduction in the number of attacks and in their severity compared to a control group who were treated with traditional medications. The difference did not become statistically significant until the second six-month follow-up period. In addition, at the end of one year, the number of patients in the hypnosis group who had experienced no headaches for over three months was significantly higher.

In a controlled trial conducted by Olness (1987), self-hypnosis was shown to be significantly more effective than either propranolol or placebo in reducing the frequency of migraine headaches in children between the ages of six and twelve years of age.

In a research conducted by Schlutter (1980), hypnosis was also found to be effective in dealing with the relief of tension headache.

Alladin (1988) reviewed the literature on hypnosis, identifying fully a dozen different hypnotic techniques that have been used in the treatment of chronic migraine headaches. Of these, hypnotic training emphasizing relaxation, hand warming (which, according to Anderson, 1975) seems the simplest method of establishing increased voluntary control of the sensitive vasomotor system) and direct hypnotic suggestions of symptom removal have all been shown to be effective in reducing the duration, intensity and frequency of migraine attacks during a ten-week treatment course and at thirteen-month follow-up when compared to controls.

A study (Gutfeld, G. and Rao, L., 1992) was conducted on 42 patients suffering from chronic headaches. These patients, all of whom had responded poorly to conventional treatments, were split into two groups. One received hypnotherapy to relieve their daily headaches; the rest acted as a comparison group. The hypnotherapy group experienced reduced frequency and duration of headaches, cutting the intensity by about 30%. "These results are impressive in such a difficult, hard-to-treat group of patients," commented Egilius Spierings, M.D., Ph.D. director of the headache section, division of neurology at Brigham and Women's Hospital.

BIBLIOGRAPHY

Alladin, A. (1988). "Hypnosis in the Treatment of Severe Chronic Migraine. In M. Heap (ed.), Hypnosis: Current clinical, Experimental and Forensic Practices. London: Croom Helm. pp. 159-166.

Anderson, J.A., Basker, M.A. & Dalton, R. (1975). "Migraine and Hypnotherapy."International Journal of Clinical and Experimental Hypnosis, 23, 48-58.

Gutfeld, G. and Rao, L. (1992). "Use of Hypnosis with Patients Suffering from Chronic Headaches, Seriously Resistant to Other Treatment," As reported inPrevention, 44, 24-25.

Olness, K., MacDonald, J.T. & Uden, D.L. (1987). "Comparison of Self-Hypnosis and Propranolol in the Treatment of Juvenile Classic Migraine." Pediatrics, 79, 593- 597.

Schlutter, L.C., Golden, C.J. & Blume, H.G. (1980). "A Comparison of Treatments for Prefrontal Muscle Contraction Headache." British Journal of Medical Psychology, 53, 47-52.

How Effective Is Hypnosis in Relieving Pain

Hypnosis is a state of altered awareness in which we can become absorbed in more relaxing thoughts, ideas, images and feelings, and more easily distracted from negative or painful ones. Many people who benefit from hypnosis respond well to suggestions about feeling less pain, more comfort, increased energy, better sleep, and having rapid healing outcomes. Only about 10-20% of the general population does not receive good results from hypnosis; this group may benefit more from biofeedback and other methods.

There are many published, well-controlled research studies that focus on the use of hypnosis with surgery. In a recent review of 18 of these studies¹, the overall result was that most patients treated with hypnosis have moderate to significantly better surgical outcomes including reports of less pain, use of fewer pain medications, and faster recovery. For example, medical hypnosis for orthopedic hand surgery, which is typically very painful, showed benefits that included significantly less post-surgery pain and anxiety, and fewer complications². In a different study, 339 patients undergoing thyroid and parathyroid neck surgery, were divided into two groups. One group had hypnosis and an intravenous medication that kept them conscious while the other group was given general anesthesia. The hypnosis group had less pain, used fewer pain medications, and had shorter hospital stays³. In a similar study of 241 patients who underwent invasive medical procedures⁴, those who received pre-surgical instruction in self-hypnosis had less pain and anxiety than those who did not receive self-hypnosis instruction. In summary, a year 2000 review of published articles in the field of hypnosis concluded that "the research to date generally substantiates the claim that hypnotic procedures can ameliorate many psychological and medical conditions." ⁵

There has also been evidence that hypnosis may affect the way that pain is processed in the brain. In a recent study, volunteers who plunged their hands into hot water were measured by a PET scan. Later, they were hypnotized and told that the water would not seem as painfully hot. During hypnosis, the PET scan was readministered, showing significantly less activation in the anterior cingulate cortex, the part of the brain that is involved in expanding feelings of emotional distress and can also influence the inhibition of pain. On the other hand, the PET scan data obtained during hypnosis showed no decrease in activation in the somatosensory cortex region which is involved in processing the sensation of pain.⁶ These results suggest that even though the brain may continue to register the sensation of pain, hypnosis seems to help patients shift their experience of pain away from distress and suffering.

Hypnotic intervention has also been used successfully with many types of specific pain. In the treatment of burn patients, hypnosis has been used to reduce the pain associated with debridement (the scrubbing away of burned tissue to give new tissue a chance to grow) and wound cleaning, to modulate anxiety related to burn procedures, and to enhance coping styles such as repression and intellectualizing.⁷ With cancer patients, hypnotic suggestion helps to reduce the suffering related to many painful procedures such as the administration of chemotherapy and treatment-related throat pain and nausea. Hypnosis can also help to reduce the frequency and intensity of migraine headaches, and to relieve tension headaches⁸. In the area of dentistry, hypnosis is used to reduce orofacial pain held in the muscles and jaw, and pain, distress, and anxiety related to specific dental procedures such as root canals and extractions. Other significantly effective applications of hypnosis include reduction of anxiety and physical pain related to invasive medical procedures including endoscopies, intubation, catheter discomfort, and blood transfusions.

References

1 Montgomery, G.H., DuHamel, K.N., and Redd, W.N. (2000). A meta-analysis of hypnotic analgesia: How effective is hypnosis? International Journal of Clinical and Experimental Hypnosis, 48, 138-153.

2 Mauer, M.G., Burnett, K.F., Ouellette, E.A., Ironson, G.H., & Dandes, H.M. Medical hypnosis and orthopedic hand surgery: Pain perception, postoperative recovery, and therapeutic comfort. International Journal of Clinical and Experimental Hypnosis, 47, 144-161.

3 Defechereux, T., Meurisse, M., Hamoir, E., Gollogly, L., Joris, J., & Faymonville, M.E. (1999). Hypnoanesthesia for endocrine cervical surgery: A statement of practice. Journal of Alternative and Complementary Medicine, 5, 509-520.

4 Lang, E.V., Benotsch, E.G., Fick, L.J., Lutgendorf, S., Berbaum, M.L., Berbaum, K.S., Logan, H., & Spiegel, D. (2000). Adjunctive non-pharmacological analgesia for invasive medical procedures: A randomized trial. Lancet, 355, 1486-1490.

5 Montgomery, G.H., David, D., Winkel, G., Silverstein, J.H., and Bovbjerg, D.H. The effectiveness of adjunctive hypnosis with surgical patients: A meta-analysis.Anesthesia and Analgesia, 94, 1639-1645.

6 Rainville, P., Duncan, G.H., Price, D.D., Carrier, B., & Bushnell, M.C. Pain affect encoded in human anterior cingulated but not somatosensory cortex. Science, 277, 968-971.

7 Patterson, David. (1996). Burn pain. In Joseph Barber (Ed.), Hypnosis and Suggestion in the Treatment of Pain, pp. 267-302. New York: Norton.

8 Barber, J. (Ed.). (1996). Headache. In J. Barber (Ed.). Hypnosis and Suggestion in the Treatment of Pain, 158-184. New York: Norton.

A Cross-Correlational review Between Neuroimaging and Hypnosis

FUNCTIONAL BRAIN IMAGING AND THE INDUCTION

OF TRAUMATIC RECALL:

A Cross-Correlational Review Between

Neuroimaging and Hypnosis

ERIC VERMETTEN1,2

University Medical Center and Central Military Hospital, Utrecht, The Netherlands

J. DOUGLAS BREMNER

Emory University and Emory Hospital, Atlanta, Georgia, USA

Abstract: The behavioral and psychophysiological alterations during

recall in patients with trauma disorders often resemble phenomena

that are seen in hypnosis. In studies of emotional recall as well as in

neuroimaging studies of hypnotic processes similar brain structures

are involved: thalamus, hippocampus, amygdala, medical prefrontal

cortex, anterior cingulate cortex. This paper focuses on cross-correla-

tions in traumatic recall and hypnotic responses and reviews correla-

tions between the involvement of brain structures in traumatic recall

and processes that are involved in hypnotic responsiveness. To further

improve uniformity of results of brain imaging specifically for trau-

matic recall studies, attention is needed for standardization of hyp-

notic variables, isolation of the emotional process of interest (state),

and assessment of trait-related differences.

In the last 10 years, there has been a rapid increase in our under-

standing of the brain processes that are involved in processing of

traumatic events (see Stern & Silbersweig, 2001). Much of this research

is related to the processing of stress, memory, and emotion (see reviews

of Armony & LeDoux, 1997; Baddeley et al., 2000; Bremner, Krystal,

Southwick, & Charney, 1995; Bremner & Narayan, 1998; Cahill, 2000;

LeDoux, 1993; McGaugh, Cahill, & Roozendaal, 1996; Nijenhuis,

The International Journal of Clinical

and Experimental Hypnosis

2004, Vol. 52, No. 3, pp. 280–312

Manuscript submitted November 02, 2002; final revision received October 24, 2003.

1

This study was supported NIMH 1R01MH56120-01A1, and a Veterans Administra-

tion Career Development Award to Dr. Bremner.

2

Address correspondence to Eric Vermetten, MD, PhD, Department Psychiatry,

University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 XC

Utrecht, The Netherlands. E-mail: e.vermetten@azu.nl

0020-7144/04/5203-280$16.00 # The International Journal of Clinical and Experimental Hypnosis

280

Van der Hart, & Steele, 2002; Packard & Cahill, 2001; Phillips, Drevets,

Rauch, & Lane, 2003a, 2003b; and the special issues of the International

Journal Clinical and Experimental Hypnosis, April and July 2003). Among

the factors that contributed to this increase are the availability of high-

quality functional brain imaging techniques, cross-fertilization of

different disciplines (e.g., cognitive and developmental psychology,

nuclear medicine, pharmacology, molecular biology, psychiatry), and

the increasing specificity of induction procedures for traumatic recall in

study protocols. (For a description of the characteristics of two of the

main neuroimaging methods, functional magnetic resonance imaging

(fMRI) and positron emission tomography (PET), see the Appendix).

Innovative experimental designs in the field of neuroimaging have

increased our understanding of basic processes of memory storage and

emotion processing, lesion studies have pointed to brain regions that

are critically involved, and clinical studies in a variety of patient

populations have revealed a neural circuitry that is involved in differ-

ent disorders. These developments have also further contributed to our

current understanding of brain processes involved in pain, the phe-

nomenology of consciousness, and emotional processing in general and

have led to an understanding of regional patterns of activation and

deactivation.

Still, little is known about this neural circuitry that underlies (altera-

tion of) perceptual processing in patients with psychopathology in

which emotive processing is challenged in relation to exposure to

traumatic events. This alteration of perceptual processing can be

challenged by using visual, acoustic, or other sensory stimuli, or with

personalized narratives that induce recall of traumatic events. The

pattern of metabolic changes in the brain can be measured and corre-

lated with the subjective emotional response. This emotive process may

be paralleled by a set of involuntary/automatic processes that occur:

effects in heart rate, perceptual and emotional alteration, time distor-

tion, and analgesia (Hull, 2002), upon which patients may be selected

for assessment of their regional blood flow patterns (Lanius et al., 2002).

These studies have started to appear in scientific journals in the last 8

years but are still scarce.

Despite promising study results, the field of hypnosis has not fully

used the momentum that arose from these developments. Several

imaging studies in healthy populations have demonstrated differences

in the neural circuitry that is involved in response patterns across

hypnotic states, e.g., alterations of pain affect and pain modulation

(Faymondville et al., 2003; Rainville, Duncan, Price, Carrier, & Bushnell,

1997), alteration of visual processing (Kosslyn, Thompson, Costantini-

Ferrando, Alpert, & Spiegel, 2000), or hypnotic alteration of acoustic

perception (Szechtman, Woody, Bowers, & Nahmias, 1998). Most of

these studies have used high and low hypnotizable subjects to gain

NEUROIMAGING AND HYPNOSIS 281

insight in the neural mechanisms of perceptual alteration by measur-

ing alteration in regional brain blood flow. From these studies, it

appears that high hypnotizables are capable of modifying their brain

metabolism in response to a specific set of instructions to alter affect,

pain, or other experiences and have pointed out that subjects can

differentially alter (block or stimulate) certain perceptual functions,

e.g., ‘‘taking the color out of a picture’’ that is presented in front of

them. To a considerable extent, high hypnotizables are capable of

modifying the circuitry with which their brains process stimuli. To

date, few of these studies have used the cumulative power of combin-

ing these knowledge-based resources in neuroimaging studies in

patient populations.

It has been a decade since studies by Stutmann and Bliss (1985),

Spiegel, Hunt, and Dondershine (1988), and Frischholz, Lipman, Braun,

and Sachs (1992) empirically confirmed Janet’s early notions (1889) that

there is an overlap between the phenomena that are typically related to

hypnosis and the phenomena occurring in emotional recall in post-

traumatic stress disorder (PTSD). These patients have demonstrated

enhanced susceptibility to ‘‘hypnotic’’ situations, which traumatic re-

call can be considered to be. Hypnotic induction can mobilize a wide

spectrum of responses, varying from increased anxiety to flashbacks

that can occur with or without feelings of detachment to other dis-

sociative experiences, such as numbing or freezing, feelings of in-

voluntariness, and loss of self-agency.’’ Moreover, classic hypnotic

responses such as time distortion, analgesia, and derealization can

occur along with these memories. The content of the emotion is also

widespread and can change rapidly depending on the focus of atten-

tion: e.g., anger, shame, guilt, or disgust. These responses can have

bimodal effects, such as enhanced attention versus lowering of atten-

tion or out of body experiences versus detailed focus on details, and can

also be reflected on the level of psychophysiological alteration, e.g.,

increased versus decreased heart rate. Although these may be related to

hypnotic virtuosity, this has not been studied yet.

Within a general framework of identification, production, and reg-

ulation of emotional recall (see Phillips et al., 2003), hypnotic response

patterns are related to the involvement of different brain correlates

(Lanius et al., 2002). We pose that insight in these hypnotic response

patterns needs to be taken into account when analyzing brain correlates

of traumatic recall in trauma disorders, e.g., in PTSD but also in

dissociative identity disorder (DID) and borderline personality disor-

der (BPD). Moreover, hypnotic paradigms can provide additional

information regarding the involvement of involuntary mechanisms

in traumatic recall. In addition, we feel that by cross-correlating the

phenomenology and neurophysiology of traumatic recall and hypnosis

similarities in parameters, results can be found that improve our

282 ERIC VERMETTEN AND J. DOUGLAS BREMNER

understanding of hypnosis and basic elements of consciousness and

emotion. To explore this relation, we will review the imaging results in

these studies.

TRAUMA AS A HYPNOTIZING AGENT

It is a known fact that traumatic stress can mobilize responses that

have hypnotic features. These can be seen in a variety of situations,

e.g., in the battered and abused child who creates an invisible identity

so as not feel the pain and humiliation (identity alteration, amnesia,

R. Loewenstein, personal communication, November 2000), in jour-

nalists when watching an execution as an eyewitness (dissociation;

Freinkel, Koopman, & Spiegel, 1995), in survivors of the Estonia ferry

disaster who attempted to rescue other survivors (numbing; Ericksson

& Lundin, 1996), in people who witnessed victims jumping from the

World Trade Center on September 11, 2001 (verbal inhibition, Spiegel,

personal communication, 2001), or the responses in orphaned

Rawandan children (stupor). Traumatic experiences can mobilize hyp-

notic responses that resemble the hypnotic state during which intense

absorption in the hypnotic focal experience (Tellegen & Atkinson,

1974) can be achieved by means of a dissociation of experience

(Hilgard, 1977; Spiegel et al., 1988, p. 301). It was Janet who described

the splitting of consciousness that occurrs in response to traumatic

stress and the consequences of trauma on memory and identity. Janet

described a constellation of symptoms that we now categorize as PTSD

or dissociative disorders, including dissociative amnesia and fugue,

with a central assumption that different aspects of the traumatic

experience are not actively available to consciousness, although they

may have an influence on behavior (Loewenstein, 1993; Spiegel &

Carden˜ a, 1991).

The psychological processes that were captured as core components

of the hypnotic experience as described by Spiegel (1997) are: (a)

absorption; (b) dissociation, and (c) automaticity. These three factors have

been postulated because they explain the phenomena best in a hypnotic

situation (Spiegel & Carden˜ a, 1991). Hypnosis has been best defined as

an altered state of consciousness. Recently, a new definition of hypnosis

has been coined in which the use of the word hypnosis as part of the

hypnotic situation is not necessary for the induction nor description of

the state of hypnosis (A. Barabasz, personal communication, September

2003).

Absorption is defined as a narrowing and intensification of attention,

a disposition for having episodes of single total attention that fully

engage one’s representational resources (Tellegen & Atkinson, 1974).

Physiological arousal can produce this narrowing of attention, which is

directed more to central aspects of the traumatic experience than to

NEUROIMAGING AND HYPNOSIS 283

peripheral aspects (Christianson, 1992). Narrowing of attention can be

functional in that all attention can be devoted to essential threat stimuli

and defensive concerns. Dissociation can be described as a kind of

divided or parallel access to awareness where several systems may

have some independence. It refers to a compartmentalization of ex-

perience, which can be considered complementary to absorption. The

term refers both to its origins, i.e., the splitting of consciousness that

may occur during trauma, and to the subsequent process of associating

or assigning experiences, as they occur over and over in time, to specific

states of consciousness, ego centers, or affective states (Crabtree, 1992).

Dissociation can also be part of an autohypnotic process (e.g., ‘‘I am

invisible; I have no feelings’’), which is applied to reduce the perception

of pain and the personal implications of trauma (Van der Kolk &

Van der Hart, 1989). Automaticity may be defined as the tendency to au-

tomatically develop a belief in a suggested reality or the nonvolitional

transformation of a suggested idea to a suggested effect (Van Der Hart

& Van Der Kolk, 1991). Hypnotic automaticity reflects an altered sense

of self-agency consistent with a modification of the property of mineness

of self-generated intentions and voluntary actions. The involuntariness

is captured in this description as well, representing the recognition of

one’s own volition and capacity to act (P. Rainville, personal commu-

nication, September 25, 2002; cf. Krystal, 1988). A diagram illustrating

the shared neurophysiology of hypnosis with the neurophysiology of

traumatic recall situations in highly hypnotizable subjects is illustrated

in Figure 1.

HYPNOTIC SUSCEPTIBILITY IN TRAUMA-RELATED

PSYCHOPATHOLOGY

A central theme in trauma-related psychopathology is that physical,

emotional, or sexual trauma can play a major role in the shift of this

control function manifesting psychological dysfunctions and/or bodily

or somatic problems (Van Der Kolk et al., 1996). This can be viewed as a

Figure 1. Hypothesized similarities between hypnosis and traumatic recall. This diagram

may be especially true for high hypnotizable subjects, which is usually the case in

patients with PTSD. (Adapted from P. Rainville, personal communication, 2002).

284 ERIC VERMETTEN AND J. DOUGLAS BREMNER

disembodied process with an emphasis on the information processing

analysis of attention mechanisms but also as a state of engagement of

the body-self in the interaction with an object of consciousness, with

emphasis on the biological substrate for the representation of self

(Damasio, 1999) and the property of selfhood (Metzinger, 2000). This

disembodiment can also be seen as a disengagement strategy that

serves a natural defensive function (Gilbert, 2000).

Hypnotizability has been described as the fundamental capacity to

experience dissociation in a structured setting. It underlies the ability to

enter trance; it involves the ability to segregate and idiosyncratically

encode experience into separate psychological or psychobiological

processes (Janet, 1898). Like dissociation, hypnotizability can be related

to a lack of agency or control versus loss of control over psychological

and sometimes also physical functions. It is a dispositional term that

points to its manifestation under certain circumstances, e.g., hypnotic

induction. The critical alteration in these processes occurs in what

Damasio called ‘‘feeling of knowing,’’ which is a fundamental aspect of

self-reflective consciousness that can be separated in hypnosis (p. 280,

1999). Self-representation is a derivative of this fundamental function

of consciousness. It is thought that in hypnosis, and also in traumatic

situations, these representations can be disrupted or processed in

separate streams of information. Self-representation is a hierarchically

organized function with activity in some first-order maps in the brain

that are necessary (but not sufficient) for higher-order representation of

self (e.g., autobiographical self), regulation of cognition and behavior,

and other more extended forms of consciousness.

From these notions, hypnotic capacity can be considered to be both

a liability and an asset; from the perspective of a defense strategy, it

serves a protective purpose (e.g., not remembering or not feeling),

however it can also become maladaptive and lead to dysfunctions

(e.g., time gaps, estrangement from inner feelings, flashbacks) and

(psycho)pathology, like PTSD and dissociative or other trauma spec-

trum disorders. The disposition itself does not change but can be

considered ‘‘sensitized.’’ The symptoms of the dissociative and post-

traumatic states have been hypothesized to fit in a diathesis-stress

model that views pathological dissociation as originating from an

interaction between innate hypnotizability and traumatic experience

(Butler, Duran, Jasiukaitis, Koopman, & Spiegel, 1996). If traumatic

experiences involve a hypnotic process or induce a hypnotic state,

then we should expect traumatized patients to show higher hypnotiz-

ability, in particular while still suffering from their trauma-induced

disorder. One would expect that they have higher scores on classical

hypnotizability scales than other psychiatric patient groups and

healthy or trauma controls. Indeed, several studies supported the

hypothesis that trauma-spectrum-disorder patients demonstrate

NEUROIMAGING AND HYPNOSIS 285

higher scores on classic hypnotic susceptibility scales than other psy-

chiatric patient groups and normal control subjects (Frischholz et al.,

1992; Spiegel et al., 1988; Stutman & Bliss, 1985). Their attention and

arousal systems are altered, rendering them prone to entering hyp-

notic states, with a relative decoupling between irrelevant external

events and mental (emotional) states during hypnotic states. It is not

the experience of trauma; it is the psychopathology that accounts for

the difference in hypnotic susceptibility. What happens with their

hypnotic susceptibility after successful treatment is largely unknown.

Although Janet observed that recovered patients became less hypno-

tizable (Janet, 1898), this finding still awaits testing in systematic

research.

RECALL OF TRAUMATIC MEMORIES

The field of trauma spectrum disorders (consisting of PTSD, dis-

sociative disorders, (DD)), and perhaps also borderline personality

disorder (BPD, see Schmahl, McGlashan, & Bremner, 2002) has re-

ceived a great deal of interest in brain imaging studies. The phenom-

enology of theses disorders is at the heart of the interface between

memory and emotion.

Reexperiencing, Traumatic Recall, Flashbacks, and Flashbulb Memories

One of the most intriguing aspects of trauma disorders is the

reexperiencing phenomena. Numerous labels and descriptions have

been applied to this phenomenon (vanOyen Witvliet, 1997). In earlier

days traumatic recall was also described as ‘flashback’, the reliving of

the traumatic event with strong emotional involvement (Frankel, 1994).

Flashback can lead to sleeping problems, irritability, feeling worse with

traumatic reminders, and secondary avoidance. For a long time flash-

backs were assumed to lack a recognizable neurophysiological corre-

late – therefore they were thought to be at least as likely to be the

product of imagination as it is of memory (Frankel, 1994). However, in a

recent study in 62 PTSD patients comparing flashbacks with ordinary

autobiographical memory performance on cognitive tasks demon-

strated that flashback periods were associated with a specific decre-

ment in visuospatial processing, not specific with decrements on a

verbal processing task. Flashback periods were found to be associated

with increases in a wide range of autonomic and motor behaviors

(Hellawell & Brewin, 2002).

Flashbacks share a phenomenology with what has been described

by Brown and Kulik in 1977 as flashbulb memory, to refer to the vivid

recollections that humans may have of events considered to be of

particular significance to the individual. These memories were de-

scribed as having a photographic quality and as being accompanied

286 ERIC VERMETTEN AND J. DOUGLAS BREMNER

by a strong apparel of contextual information (weather, background

music, clothes worn, etc.) pertaining to the time and place where the

event was first known. From a memory point of view we now know

that these memories are not perfectly accurate and are subject to

decay, but what does not necessarily decay is their capacity to evoke

emotions similar to the ones felt upon when first exposed (Conway

et al., 1994). We feel that flashbulb memories are formed by the

activity of evolutionary old brain mechanism evolved to capture

emotional and cognitive information relevant to the survival of the

individual. In the modern neuroimaging era some of the original

assumptions made by Brown and Kulik have since been challenged,

but the phenomenon in question has remained an important area of

research (Davidson & Glisky, 2002; Sierra & Berrios, 1999). The ex-

periences share clinical features such as involuntary paroxysmal

repetition, sensory vividness, and a capacity to trigger emotions like

anxiety, shame, or anger.

We prefer to use the term ‘traumatic recall’. This can be defined as

imaginary (or virtual) re-exposure to a traumatic event in which the

person experienced, witnessed, or was confronted by death or serious

injury to self or others, and responded with intense fear, helplessness,

or horror, in which a re-experience of similar emotional responses

occur. They usually differ from usual/normal (autobiographical) mem-

ories in their emotional involvement (Van Der Kolk & Van Der Hart,

1991). Their nature is that a recall of the helplessness and uncontrol-

lability of the situation at that time, co-occurs with narrowing of the

attention so that ‘it feels like being back there’ (i.e., when and where the

traumatic event occurred). There can be a sense of loss of control or of

self-agency (‘‘That’s not who I am’’ or ‘‘It is not me to whom that

happened’’). There can be an autonomic response (such as tachycardia,

tachypnea, and diaphoresis) that can induce a feeling of panic (‘‘I’m not

going to make it’’). The recall may be activated by a variety of trauma-

related stimuli, thoughts about the trauma, the context, information

about the trauma, and trauma-related images, sounds, or smells, all

factors of which the person does not have to be aware. Veterans can

reveal this effect potently when they are exposed to darkness and

demonstrate augmented startle reflexes (Grillon, Morgan, Southwick,

Davis, & Charney, 1996).

Storage and Retrieval of Traumatic Memories

With long-term storage, memories are shifted from hippocampus

to neocortical areas, where the sensory impressions take place (Kim &

Fanselow, 1992; Phillips & LeDoux, 1992). This shift in the process of

memory storage to the cortex may represent a shift from conscious

representational memory (explicit memory) to unconscious memory

processes (episodic and implicit memory) that indirectly affect

NEUROIMAGING AND HYPNOSIS 287

behavior (Wallenstein, Eichenbaum, & Hasselmo, 1998). The cogni-

tive neuroscience perspective (see Brewin, 2001) favors a dual re-

presentational model of traumatic memories that proposes separate

memory systems underlying vivid reexperiencing versus ordinary

autobiographical memories of trauma. These two can be separated in

hippocampally-dependent and non-hippocampally-dependent forms

of memory, and are differentially affected by extreme stress. Within

this system, the strength of traumatic memories relates, in part, to

the degree to which certain neuromodulatory systems, particularly

catecholamines and glucocorticoids, are activated by the traumatic

experience (Cahill, 1997; Hasselmo, 1995). Both the quantity of re-

lease of these stress hormones, and the functional availability of the

target brain areas (e.g. hippocampus) modulate the encoding of

memories of the stressful event; ineffectiveness of the system may be

responsible for breakdown in the stream of events and changes in

the central and peripheral processing of the events. This can lead to

the wide spectrum of memory symptoms, ranging from hypermne-

sia, amnesia, deficits in declarative memory, delayed recall of abuse,

and other memory alterations or distortions in trauma disorder

patients.

It should be kept in mind that traumatic memories are not fixed or

indelible, but can change over time. Enhanced memory for the gist of

emotional events seems to be a dominant theme. What is encoded

depends on what was perceived, and what is encoded determines

what will be retrieved (Tulving & Thomson, 1973). Neuroimaging

may shed a light on the retrieval aspect of memory and its emotional

involvement by investigating brain processes that are occurring dur-

ing traumatic recall (Baddeley et al., 2000; Bremner, Krystal, Charney,

& Southwick, 1996; Sara, 2000; Zola, 1998). In PTSD patients ‘traumatic

cues’, such as a particular sight or sound reminiscent of the original

traumatic event, typically can induce a cascade of anxiety and fear-

related symptoms, sometimes without conscious recall of the original

traumatic event. This traumatic stimulus may not always be easy to

identify; it may be that through exposure to a movie, a smell, or more

subtle, a gesture or voice, a memory is metaphorically ‘reawakened’ –

traumatic memories can remain indelible for years or decades and

can be recalled by a variety of stimuli and stressors. A model of

extinction to explain this does not seem to qualify in these cases; a

better model seems to be the failure of successful inhibition of

traumatic memories.

Traumatic recall may not always be processed in an integrated mode

of consciousness. This may be a discontinuous experience with amnesic

gaps. Zimbardo, LaBerge, and Butler (1993) compared the emotional,

cognitive, and physiological responses of subjects experiencing induced

physiological arousal with and without awareness of the source of their

288 ERIC VERMETTEN AND J. DOUGLAS BREMNER

arousal. When subjects received posthypnotic suggestions for arousal

(increases in heart and respiration rate) with and without amnesia for

its source only hypnotizable subjects were expected to differ between

conditions. Indeed, for the hypnotizable subjects, unexplained arousal

produced significant and dramatic effects when compared with

explained arousal, including misattributions (Zimbardo et al., 1993).

These experiments demonstrated that ‘discontinuous experiences’ can

contribute to the development of psychopathological symptoms in

normal persons. But recall can also be hypnotically blocked, e.g. by

posthypnotic suggestion. Here a disruption of retrieval like in post-

hypnotic amnesia or posthypnotic suggestion refers to a subjects diffi-

culty in remembering, after hypnosis. This is not a state-dependent

memory, but it does involve a disruption of retrieval processes similar

to the functional amnesias observed in clinical dissociative disorders. In

a situation like this implicit memory, however, is largely spared, and

may underlie subjects’ ability to recognize events that they cannot

recall (Kihlstrom, 1997).

INDUCTION PROCEDURES OF TRAUMATIC RECALL

Recall of traumatic events in imaging studies is usually embedded

in a so-called ‘‘activation paradigm’’ of re-experiencing traumatic

events. In this paradigm, the patient is asked to briefly (for 1 to 2

minutes) recall a memory that is induced by a personal narrative,

smell, picture, or sound with different traumatic load (traumatic vs.

neutral). For the purpose of this paper, we focus on the recall induced

through emotional or cognitive induction. For the purpose of this

paper, we focus on the recall induced through emotional or cognitive

induction.

Traumatic Recall Through Emotional and Cognitive Induction

Typically in a traumatic-script procedure, the patient writes a

narrative of his or her two most traumatic personal events some days

before the scanning. Usually two neutral texts are made at that time for

the no-activation scan. This text is edited for length (30–40 seconds) and

content. The script is audio taped or can be read during the scan

procedure. The script can then be presented in first or second person,

usually present tense. Immediately before each scan the participant is

instructed to ‘‘close your eyes, listen carefully to the audiotape or voice

and imagine the described events as vividly as possible, as if you were

actually participating in the event again’’ (cf. Lanius et al., 2001; Osuch

et al., 2001; Shin et al., 2000). The participant is then usually scanned 6

to 12 times with a 10-minute interval between scans. When the patient

is lying in the scanner, and the radioactive ligand is administered

intravenously, a trauma script (prepared by a participating patient)

NEUROIMAGING AND HYPNOSIS 289

similar to the one below (B. Elzinga, personal communication, July

2000) can be read:

Listen carefully to the script, and try to imagine as vividly as possible

the experience:

My mom is taking a shower. Dave comes up to me in the living room, where I

am standing. He is whispering in my ear, ‘‘I would prefer to kiss your private

part.’’ I think he is saying that as he presses my breast. Soon his hands sweep

down to my private area and he begins to massage it. His touch is not

welcoming; his pressing my breast hurt me and so does his touching my private

area. I am confused and afraid. Mom can come out of the bathroom any minute.

I want to tell him ‘‘stop,’’ but I don’t. It seems as if I can’t find my voice.

Eventually, I make gestures that imply I don’t want any more touching. He

eventually stops, after calling my name a couple of times. I am relieved, and I

seek some quiet corner of the apartment, just as my mom comes out of the

shower.

Now, continue to imagine the experience from the beginning to the end,

until I ask you to stop.

When applying the model of induction of emotional memories in a

trauma population, some points need to be considered:

(1) A prerequisite for successful implementation of a recall paradigm and

completion of the task in neuroimaging research is the ability of

the participating subjects to have reasonable control over their emo-

tional response in recalling traumatic events. In a PET paradigm, they

need to be able to return to a normal state within approximately 10

minutes. Subjects may – even though they are informed and have given

informed consent – become tearful, panicked, and emotionally over-

whelmed during the recall and feel an urge to suppress these responses.

Sometimes this fails and leads to termination of the scan (Osuch et al.,

2001).

(2) Extreme stress, high or low arousal, and fatigue are distinct psycholog-

ical factors that can separately and interactively affect how information

is processed – rendering it especially influential because it is not sub-

mitted to critical reality testing in a calm, relaxed, and rested state. This is

what Bowers described as a situation in which type II unconscious

influences occur. These describe how information is processed outside

normal awareness, initiative, and volition, speaking of dissociated experi-

ence and dissociated control as two complementary aspects of hypnotic

responsiveness (Bowers, 1973). Low-level monitoring of the process

when exposed to traumatic slides and sounds and calling this to a halt

will typically occur in the trauma-control subject; the situation is dif-

ferent in patients with PTSD. Their dissociated experience refers to the

fact that the (induced) state of affairs seems to occur nonvolitionally, –

which means here that the effort involved is not well presented in

conscious experience. These observations contribute to a framework

in which brain correlates of traumatic recall can be understood as

dissociated control. Upon asking subjects to voluntarily start recalling

290 ERIC VERMETTEN AND J. DOUGLAS BREMNER

a situation (‘‘Now continue to imagine the experience from the begin-

ning’’), some will anticipate becoming stressed and voluntarily control

the situation, and some will become upset and may not be able to stop

recalling (involuntary response).

(3) An important aspect in recall inductions is the content of intrusions.

Research studies suggest that they are not random fragments of the

experience. Typically, they represent stimuli that were present shortly

before the moments with the largest emotional impact (Ehlers et al.,

2002). They need not be sensory per se. Reynolds and Brewin de-

scribed elaborations of the original experience as the most intrusive,

linked to preoccupations with appraisals of the trauma and its se-

quelae, rather than presenting trauma memories (Reynolds & Brewin,

1998). This needs to be taken into account when preparing a narrative

script.

(4) Of importance in the induction of traumatic recall for brain imaging

studies is the theme of general versus specific induction of trauma-

related memories. Typically, in a general paradigm a standardized set

of images or words is presented, and the response pattern in the target

population can be calculated by averaging the responses. In a trauma-

specific paradigm, an individual induction is prepared before the brain

imaging procedure. In this paradigm, the surprise effect of the induc-

tions is somewhat diminished since the subject will recognize his or

her specific elements. Ehlers provides examples of the specific (sen-

sory) nature of the traumatic events from which it appears that

traumatic triggers are specific for both nature and content of the

trauma-related stimulus. In designing an experiment using olfaction

as a trauma-related cue in combat-related PTSD, we were to choose a

traumatic smell that could either be specific for each person or a smell

that all veterans reported as a trigger for traumatic memories. All

veterans had been exposed to diesel during their combat experience,

and diesel was present throughout the war. This smell therefore

seemed to qualify as both a generic and specific trauma-related smell

in the population (Vermetten, Schmahl, Southwick, & Bremner, 2003).

The same can be applied to trauma-related words and other types of

sensory stimulation.

(5) Laboratory studies have demonstrated that central cues of a traumatic

event are usually well remembered, whereas memory for peripheral

details is poor (Christianson, 1992). The narrowing of attention is often

used as an explanation for this finding. High anxiety and arousal are

thought to focus the attention on central aspects, such as the weapon

used, and hinder a full processing of the situation. It is thought that

changes in the perfusion of limbic brain structures that coincide with the

high arousal and/or anxiety, such as the amygdala and the hippocam-

pus, can lead to fragmented memories and personality fragmentation

(Spiegel, 1989; Van Der Kolk, Burbridge, & Suzuki, 1997). Narratives

should be written according to these notions.

(6) In all imaging studies in traumatic recall, the patient anticipates the

presentation of trauma (-related) material, and some researchers have

performed a dry run with the patient. Then the subject is not ‘‘cold’’ to

NEUROIMAGING AND HYPNOSIS 291

the trauma cue. It needs to be taken into account that this may dampen

the activation of the brain when exposed to the challenge.

(7) Last, in addition to the first observation of this section, many clinicians

have described a ‘‘dissociative’’ or ‘‘hypnotic’’ blocking of perceptual

aspects as an adaptive response to trauma. Pain in recall can be blocked,

time processing can be distorted, or processing of the perception of

emotions like threat cannot be adequately processed. Patients may

dissociate during the experience and unless this is assessed at each

between-scan interval (to assess whether this is a positive or negative

phenomenon, see Lanius et al., 2002; Nijenhuis et al., 2002) it may

explain a difference in participant responding. In case patients do

dissociate, a systematic procedure needs to be administered to help

reorient them to the common environment and enable them to continue

with the scanning procedure reliably. In PET protocols, this is especially

important since the production of radioactive material is delivered in a

time-wise manner, and typically each interscan interval is set to 10

minutes.

FUNCTIONAL BRAIN IMAGING RESULTS IN TRAUMATIC

RECALL IN TRAUMA DISORDERS

To date, 12 imaging studies that used a symptom provocation

paradigm in PTSD have been published. Seven studies used PET

(Bremner, Narayan, et al., 1999; Bremner, Staib, et al., 1999; Osuch

et al., 2001; Pissiota et al., 2002; Rauch et al., 1996; Shin et al., 1997, 1999),

three used fMRI (Lanius et al., 2001, 2002; Rauch et al., 2000), and two

used SPECT as imaging technique (Liberzon et al., 1999; Zubieta et al.,

1999). The design, patient population, induction method, measure of

recall, psychophysiological coregistration, and changes in brain me-

tabolism are tabulated in Table 1. These studies have used various chal-

lenge models, exposing the subject – at varying levels of complexity –

to perceptual stimulations that range from exposing patients to slides

and sounds, smells of trauma-related experiences, to reading narrative

scripts, to the administration of pharmacologic agents like yohimbine

(see reviews by Bremner, 2002; Hull, 2002). Reexperiencing of traumatic

events typically coincides with heightened attention, lack of awareness

for the surroundings, and loss of perception of time. At the same time,

emotions of fear, shame, disgust, anger, and sadness, may occur and

sometimes coincide with dissociation, freezing, and other psychophy-

siological arousal phenomena (Nijenhuis et al., 1998).

The first PET studies in traumatic recall used combat slides and

sounds and script-driven imagery in PTSD patients. The results sug-

gested that symptoms associated with traumatic recall were mediated

by the limbic and paralimbic systems within the right hemisphere.

Activation of visual cortex corresponded to the visual component of

PTSD reexperiencing phenomena (Rauch et al., 1996). When generating

Note. TC ¼ trauma controls, HC ¼ healthy controls, HR ¼ heart rate, GSR ¼ Galvanic Skin Response, SUDS ¼ Subjective Units of Distress,

PAG ¼ periaquaductal gray, ri ¼ right, le ¼ left, act ¼ n accumbens, VAS ¼ visual analog scale, CADSS ¼ Clinician Administrated Dissociative Symptom

Scale, STAIS ¼ State-Trait Anxiety Inventory Trait Test, MVA ¼ Motor Vehicle Accident, VVIQ ¼ vividness visual imagery questionnaire.

mental images of combat-related pictures, increased regional cerebral

blood flow (rCBF) in the ventral anterior cingulate cortex (ACC) and

right amygdala was seen; when viewing combat pictures, subjects with

PTSD showed decreased rCBF in Broca’s area (Shin et al., 1997). These

first PET studies of traumatic recall in PTSD have since led to a rapid

increase in similar studies modifying the experimental condition and/

or study population.

There is overlap but also considerable diversity in various traumatic

recall studies. The ACC, middle and superior temporal, middle frontal,

right orbitofrontal, occipital, hippocampal, parahippocampal, anterior

temporal, and inferior frontal cortices have all been implicated in

different studies, demonstrating either increases or decreases in perfu-

sion depending on the study conditions and sample population

(Phillips et al., 2003a, 2003b). In general, in comparison to trauma-

control subjects, these studies reveal an exaggerated response activa-

tion in the right (Rauch et al., 1996; Shin et al., 1997) or left (Liberzon

et al., 1999) amygdala, and in the sensorimotor cortex (Bremner,

Narayan, et al., 1999; Shin et al., 1997) and attenuated responses within

the medial prefrontal cortex (mPFC) (Bremner, Narayan, et al., 1999;

Shin et al., 1999) in patients with PTSD. In line with this, imaging

studies of normal autobiographical memory (i.e., no emotional activa-

tion) in healthy subjects compared to memory-control tasks have

pointed to mPFC and (left) hippocampus that are just particularly

responsive to such memories (Conway et al., 1999); other studies point

to right frontal cortices, medial parietal cortex, and cerebellum (Nyberg,

Forkstam, Petersson, Cabeza, & Ingvar, 2002).

Current studies support a model of PTSD in which (a) the amygdala

is hyperresponsive to threat-related stimuli, and (b) interconnected

areas may provide insufficient ‘‘top-down’’ inhibition by mPFC and

ACC of amygdala response. This relative dysfunction of mPFC and

ACC is thought to lower the threshold of amygdala response to fearful

stimuli and is central to symptom mediation (Pitman, Shin, & Rauch,

2001; Villarreal & King, 2001). Thus, dysfunction of the mPFC areas

may provide a neural correlate of a failure of extinction of fearful

stimuli in PTSD.

Recall induction of emotion specifically activated the ACC. This

brain structure is critically involved in cognitive induction of emo-

tional responses and processes attention, executive functions, and

semantic and episodic memory. ACC activation represents a normal

brain response to traumatic stimuli that serves to inhibit feelings of

fearfulness when there is no true threat. Failure of activation in this

area and/or decreased blood flow in the adjacent subcallosal gyrus

(area 25) may lead to increased fearfulness that is not appropriate for

the context, facilitating exaggerated emotional and behavioral re-

sponses (hyperarousal) to conditioned stimuli (Hamner, Lorberbaum,

296 ERIC VERMETTEN AND J. DOUGLAS BREMNER

& George, 1999). Posterior cingulate cortex (PCC) and motor cortex

and anterolateral prefrontal cortex are also known to modulate

emotion and fear responsiveness (Bremner, 2002). PCC plays an

important role in visuospatial processing and is therefore an impor-

tant component in the preparation for coping with a physical threat.

PCC also has functional connections with the hippocampus and

adjacent cortex.

In a meta-analysis of PET and fMRI studies of general emotional

activation reviewing 43 PET and 12 fMRI activation studies spanning

almost a decade of research, Phan, Wager, Taylor, and Liberzon (2002)

describe brain areas that are involved in emotion induction with

cognitive demand, typical paradigms of the recall of autobiographical

elements or visual imagery:

The Mesmerized Mind

THE MESMERIZED MIND

Scientists are unveiling how the brain works when hypnotized

By 

Susan Gaidos

October 10th, 2009; Vol.176 #8

(p. 26)

THE MESMERIZED MINDIllustration by Lou Beach

Mention hypnosis, and the image that springs to mind is a caped magician swinging a pocket watch, seducing otherwise sensible people into barking like dogs.

But hypnosis is more than a stage show act. For years, psychologists have used it to help patients calm preflight jitters, get a good night’s sleep or chuck a cigarette habit. Hypnosis even has uses in mainstream medicine for reducing the side effects of cancer treatments and helping patients cope with pain. Some physicians routinely employ hypnosis as an adjunct to mainstream anesthesia to help block pain during surgery or childbirth.

Most recently, hypnosis has advanced from stage and clinic into the laboratory. It is now used as a research tool to temporarily create hallucinations, compulsions, delusions and certain types of seizures in the lab so that these phenomena can be investigated in detail.

Such studies may lead to more effective treatments for a number of psychiatric and neurological disorders, assert psychologists Peter W. Halligan and David Oakley in the June issue of Trends in Cognitive Sciences.

Other scientists, intrigued by the many practical uses of hypnosis, are striving to figure out how it works. Using the latest neuroimaging tools, these scientists are getting a look at what goes on in the hypnotized brain. The findings are mesmerizing.

When hypnotized people act on a hypnotic suggestion, they really do see, hear and feel differently, such research shows. When they’re told to see colors, for example, the color-processing parts of their brains light up—despite the absence of any real color in view. When they are told to envision color objects in black and white, these color-processing areas are less active. Other imaging studies show that hypnotically induced pain activates the same brain areas as “real” pain.

Still, questions remain, says Halligan, of Cardiff University in Wales, who has studied hypnosis for more than a decade. Scientists have yet to discover how hypnosis produces physiological changes. And some scientists question whether such changes are confined to hypnosis. Perhaps the patterns of brain activity seen during hypnosis can occur during everyday experiences when people are fully absorbed in an activity, some researchers say.

The real question, says Halligan, is whether hypnosis is a specific brain state that differs from any other.

“In other words, is there some sort of neural correlate, or biological marker, within the brain during a hypnotic trance?” he asks.

Enlarge

The answer so far, emerging from studies done during the past few years, is maybe. New research at the University of Geneva suggests that hypnosis alters neural activity by rerouting some of the usual connections between brain regions. Such neurological detours don’t happen when subjects merely imagine a scenario.

Changing your mind

Hypnosis got its start as a “miracle cure” in 1774 when physician Franz Mesmer found a way, using ethereal music played on a glass harmonica, to induce a hypnotic trance in patients suffering from various unexplained medical problems. Though eventually discredited as a healer, Mesmer demonstrated that the mind could be manipulated by suggestion to produce an effect in the body. So powerful is this effect that the practice was resurrected in the 19th century, before the discovery of ether, to block pain during major surgeries.

In this mysterious state of mind, the brain is “quiet,” focused and superattentive. People sometimes report feeling disconnected from their surroundings and lost in thought. During hypnosis, subjects are more open than usual to suggestions and have the ability to focus intensely on a specific thought, feeling or sensation.

Most adults, about two-thirds, are hypnotizable to some degree, though some people experience the effects of hypnosis more intensely than others do, says David Spiegel, a psychiatrist at Stanford University School of Medicine who uses hypnosis in his medical practice. Ten to 15 percent of adults are “highly hypnotizable,” he says, meaning they can experience dramatic changes in perception with hypnosis.

A person’s ability to become hypnotized is unrelated to intelligence, compliancy or gullibility, but may be linked to an ability to become deeply absorbed in activities such as reading, listening to music or daydreaming. People who find themselves engrossed in a best seller even while the television is blaring, or swept away by a movie and losing track of time, are likely to be quite hypnotizable.

During hypnosis, the hypnotherapist tries to direct thoughts, feelings and behavior by instructing a person to concentrate on particular images or ideas. A typical session starts with some sort of induction procedure that helps the subject relax—say, counting down from 20 to one or mentally descending a set of stairs.

To produce a specific behavior or thought, the hypnotherapist will make suggestions targeted toward the goal. To reduce the pain of a medical procedure, for example, a hypnotherapist might invoke an image of pain being turned down like the volume on a radio.

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YOUR BRAIN ON HYPNOSISView larger version | Studies show hypnosis reroutes brain signals. Hypnotized people who are told that their left hand is paralyzed show brain patterns (yellow) that differ from those who aren't hypnotized (red) and from those who aren't hypnotized but are told to pretend their left hand is paralyzed (green).Y. Cojan Et al./Neuron 2009

Over the years, rigorously controlled studies have shown that hypnosis can also control blood pressure and even make warts go away. But because very few studies have attempted to find out how it works, some scientists are still skeptical of its power.

Critics suggest hypnosis is nothing more than playacting, with subjects trying to please the hypnotist. That skepticism has driven some researchers to take a hard look at what happens in the brain during hypnosis. Over the past few years, scientists have begun gathering evidence that hypnosis can indeed measurably change how the brain works.

In 2005, scientists at Weill Medical College of Cornell University in New York City used functional MRI to show how hypnotic suggestions can override “automatic” processes in the brain. When shown the names of colors printed in different colors of ink—for example, the word red printed in blue—subjects were instructed to name the ink color while ignoring the word.

Though this task may sound easy, it’s often difficult for people who can read because the tendency is to automatically read the word instead of naming the color. When told under hypnosis that the words would appear as gibberish, highly hypnotizable subjects were able to perform the task faster, and with fewer errors, than subjects who were less hypnotizable and therefore less likely to respond to suggestion.

The fMRI results were also striking. Highly hypnotizable participants showed less activity in a brain area called the anterior cingulate cortex, which is active when people are trying to sort out conflicting information from different sources, such as contradictory word names and colors. The study was published in theProceedings of the National Academy of Sciences.

Going deeper

Scientists agree that there is a pattern or “orchestra” of brain activity during hypnosis. Halligan and his colleagues are working to figure out what this particular pattern might be, and which—if any—brain region serves as conductor. As part of a collaboration with psychiatrist Quinton Deeley of King’s College London, the researchers are looking at how patterns of brain activity in the induction phase—the countdown—prepare the brain for suggestions.

Preliminary findings suggest that hypnosis boosts activity in the brain’s prefrontal cortex—a region responsible for various executive functions such as decision making and regulating attention—while suppressing activity in other brain regions.

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THE EYE-ROLL TESTSome researchers and hypnotists use a simple eye-roll test to get an idea of how hypnotizable people are. If more white, or sclera, shows when a person looks up (bottom), he or she is more likely to be susceptible to hypnosis.T. Dube, adapted from Powerlines/Istockphoto

Still, researchers are stumped to explain how these changes in brain patterns work to make hypnotized people feel and see things differently. Recent theories, discussed in the article in Trends by Halligan and Oakley, of University College London, propose that hypnotic suggestions may inhibit or disconnect certain mental processes from the brain’s executive control systems.

Until recently, such hypotheses had remained untested. But in the June 25 issue of Neuron, Yann Cojan of the University of Geneva and colleagues report a direct test.

The researchers put 18 subjects in a brain scanner, instructing them to push a button using one hand or the other. Each trial began with a cue indicating which hand to prepare for movement. After a brief interval, an image of a hand would turn green—signaling to press the button—or red, a command to inhibit any motion. Twelve subjects did half of the trials while hypnotized, with the suggestion that their left hand was “paralyzed,” and the other half in a normal, unhypnotized state. Six subjects did trials without hypnosis under instructions to pretend their left hand was paralyzed.

When volunteers used their right hands, the motor cortex linked up with brain regions that control body movement to carry out the task.

But fMRI scans showed changes in several brain areas when hypnotic paralysis prevented subjects from responding to the “go” signal with their left hands. Under hypnosis, neurons in the brain’s motor cortex fired up as usual to prepare for the task. But when instructed to use the left, or “paralyzed” hand, the motor cortex failed to send signals to motor execution regions. Instead, it directed its signals to another brain region, the precuneus.

The precuneus is a sort of center for self-consciousness. If you’ve ever pictured yourself falling flat on your face in the middle of an important event, that’s your precuneus working overtime. Its function is to help retrieve memories and images of yourself from the brain’s archives and help to visualize movements.

By rerouting motor signals to the precuneus, hypnosis appeared to decouple the typical relationship between brain areas that generate the signals for hand movement and the areas that carry out such movements. Subjects who were not hypnotized and were asked to fake paralysis showed no such disconnect between these regions.

Because the precuneus is involved in mental imagery and self-awareness, Cojan says, hypnosis appeared to enhance the brain’s self-monitoring processes to allow images generated by suggestion—“your hand is heavy and cannot move”—to guide behavior.

By linking to the precuneus, “the motor cortex is connected to the idea that it cannot move the left hand,” Cojan says. “So even if you try to move, it will neglect to send signals to the motor execution areas.”

Because the motor cortex fired up as usual to prepare for the task, the findings suggest that mental images created through hypnotic suggestions work by redirecting normal brain functions rather than actively suppressing them, he adds.

Generating piece of mind

Using insights gleaned from the brain scans of subjects paralyzed under hypnosis, Cojan conducted a follow-up study to see whether something like hypnosis happens in the brains of patients during hysterical paralysis. In such instances, patients become paralyzed even though the condition can’t be traced to any physical or neurological brain damage.

An fMRI study of patients with hysterical hand paralysis did not find the heightened precuneus activity that is seen in hypnosis, Cojan’s group reported in the September NeuroImage.

Previously, it had been suggested that hysterical paralysis was “a kind of self-hypnosis,” Cojan says. “Our findings show that’s not the case.”

Halligan points to the recent paralysis studies as examples of how hypnosis can be used to further studies on the nature of hypnosis and to provide insights on a variety of real-life syndromes and disorders.

In 2000, he and Oakley began looking at ways to use hypnosis to simulate psychosomatic conditions, such as hysterical paralysis or hysterical blindness, in the lab. By creating virtual patients through hypnosis, scientists might be able to better understand the basis for such disorders by comparing patients’ brains with hypnotized brains, the researchers reckoned.

Deeley, who treats psychiatric patients at his private practice in London, says using hypnosis also allows him to track brain processes involved in other kinds of disorders that would not ordinarily be possible to study with brain imaging.

In an ongoing series of experiments, he and his colleagues are using hypnosis to study conditions in which patients sense a “lack of control” over their movements or behavior. Such perceptual experiences may be reported by people who experience nonepileptic seizures or who suffer delusions caused by schizophrenia.

By making some targeted suggestions—“Your left hand is now shaking at your side” or “Your right leg is twitching”—the scientists can model a particular symptom in a consistent and controlled way, Deeley says.

“You can’t have somebody having a full-blown seizure within an MRI scanner,” he says. “It’s not safe because they’re moving fast, and you wouldn’t get any useful information. But if you actually restrict an involuntary movement to a particular limb or a hand, it is possible to create a partial model of these involuntary movements.”

Another advantage of hypnosis is that it allows researchers to untangle the many components that make up a complex disorder, such as schizophrenia. In such cases, patients may feel not only that they’re losing control, but also that their actions or behavior are guided by an outside force or agent, such as the CIA.

Scientists then have the problem of sorting out whether a change in brain activity is associated with the physical experience of a movement or whether it is tied to the delusional beliefs behind the movement.

“In such cases, you’ve got two processes going on associated with complex change in brain activity, and you just can’t unpack them in terms of working out what’s associated with what,” Deeley says.

Experimental manipulations using hypnosis could provide a window into a wide range of disorders, he says, and could help explain other types of altered states, such as meditation.

Halligan agrees, noting that hypnosis could be used to simulate various disorders commonly associated with brain injury, such as visual impairment. In a recent study, he used hypnotic suggestions to replicate conditions described by injured soldiers who are still capable of detecting motion in certain visual fields but are unable to make out any distinguishing features of the moving object.

“That’s not to say that the same psychological consequences of pathology seen in patients are somehow replicated in hypnosis,” Halligan says. “But using hypnosis to simulate a specific condition for imaging may tell us which brain systems are involved.” This information may then feed back into the development of new treatments and rehabilitation tools, he says.

Such advancements, however, hinge on learning more about the underlying processes involved in hypnosis itself. Current efforts may help scientists differentiate between the brain structures that play a role in hypnosis and those that are involved in the tasks subjects are asked to perform.

“These are still early days,” Halligan says, noting that it has yet to be seen how well hypnotically simulated disorders will actually match the conditions they’re intended to mimic. Still, he says, hypnosis provides a  way to “test and probe.”

Best of all, no pocket watches are involved.

Susan Gaidos is a freelance science writer based in Maine.

• This is absolute crap. Laboratory research in hypnosis has been going on since the 1940s, at least, and the finding is that there is no "trance," nothing unique about hypnotic responding. "Hypnosis" is the name of a script that the subject knows, he or she is supposed to act as though the "hypnotist" has taken over their mind. Nothing happens in hypnosis that can't happen in a a normal waking state. This kind of fake-science has no place on this web site, I count on you to weed this junk out.

  2. Medium Buddy

  3. Sep. 26, 2009 at 2:31pm

  4. I think the research discussed here is PROVING that there IS something "unique" about hypnotic responding. Did you read the article, or is your comment a knee-jerk reaction to the word "hypnosis"?

  6. ButMadNNW

  7. Sep. 27, 2009 at 2:04pm

  8. MB; People with excessively strong opinions like yourself are known to be easily and deeply hypnotizable. You are feeling veerrry sleepy, and even stupider ...

  10. Brian Hall

  11. Sep. 27, 2009 at 7:33pm

  12. No, hypnosis is not a fake. My husband studied for some time with Kreskin, and learned self-hypnosis. Then one day we went to sit in the audience of one of Kreskin's shows. The place was quite hot, so Kreskin casually mentioned that we would all feel cooler in one minute. We did feel cooler, it seemed, but my husband, who was very susceptible to that particular hypnotist (but very far back in a very big audience) got cold, goosebumps, and the shivers. I had to take him out of the auditorium to get him warm. And he also had all his teeth crowned (10 or 12 of them) without anesthesia, through self hpnosis. If Medium Bud were right, that would be impossible. I am afraid to lose control and be hypnotized, but I stopped perspiring when Kreskin said I should.Kreskin was very famous for what he did, back in the 50's to 70's. I don't know what happened to him after that.I think the technologies being used are extremely interesting, and the results of the scans are tangible evidence of brain activities. Linda J

  14. Linda Johnson

  15. Sep. 27, 2009 at 9:59pm

  16. This article says Critics suggest hypnosis is nothing more than playacting, with subjects trying to please the hypnotist. But "critics" don't say this, this is the mainstream social-psychological view of hypnotic responding, first advanced by Ted Sarbin in the 1950s and elaborated with a very strong research program by the late Nick Spanos, Bill Coe, and others. Spanos' "simulating subject" paradigm demonstrated that there is no difference of any sort between a person who is hypnotized and a person who is faking it. Any amazing feat that can be performed by a hypnotized person is done exactly the same way by a person who is instructed to pretend they are hypnotized. Scientists agree that there is a pattern or “orchestra” of brain activity during hypnosis. --Compared to what? Compared to having unsusceptible subjects fake being hypnotized? I seriously doubt it. Six subjects did trials without hypnosis under instructions to pretend their left hand was paralyzed -- that is not the equivalent condition. The six subjects should have been told to pretend they were hypnotized and should have received the hypnosis induction, after screening to ensure they were not susceptible.The studies described here make a naive assumption about mind and brain, as if brain imagining is more real or accurate than observing behavior. Showing that some area of the brain is active does not say that the individual is "really" in a weird trance, it is entirely likely, and an equally persuasive perspective, that they are enacting a cognitive strategy that happens to activate those neurons.There has been rigorous research into hypnosis for many decades, and a lot of progress has been made. To ignore all that and pretend that the mechanics of brain functioning somehow "explain" things better than a psychological model is regressive and unproductive. You want to believe there is a magical trance state that makes people do things they can't ordinarily do, fine, go ahead and be gullible. The scientific research does not support that viewpoint, and this normally-reliable web site should not, either.

  18. Medium Buddy

  19. Sep. 27, 2009 at 10:25pm

  20. Medium Buddy said, "You want to believe there is a magical trance state that makes people do things they can't ordinarily do, fine, go ahead and be gullible." Firstly, you're the only person who's used the word "magical"; for every study you can point to trying to debunk hypnosis, there's another that supports it. There is now a lot of science supporting the efficacy of hypnosis. And who says trance has to be something "mystical, mysterious, unusual"? The school of thought I and others I know subscribe to says that trance is part of the natural continuum of human consciousness, something we all experience multiple times a day.Secondly, where did anyone in the article or in the comments say that hypnosis makes people do things they can't ordinarily do? It's long been known and proven that hypnosis CAN'T make anyone do anything they can't or wouldn't ordinarily do.I take it, MB, that you haven't heard about any of the recent studies showing that hypnosis is related to the REM stage of sleep (the same eye movement is often seen in hypnotized subjects). For instance, the article talks about paralysis/catalepsy in hypnosis; this same physical phenomenon is experienced when we dream during REM, presumably because it could be quite dangerous to physically act out our dreams.Really, I'm not going to waste my time trying to convince you of anything in a comment chain on a website; you're obviously dead set against believing in the efficacy of hypnosis. Me, I don't "believe" in hypnosis - I *know* that it works. I've experienced the changes it's helped me make in my life, from decreased stress and skill improvement to overcoming a self-harm issue and weight loss. I've seen a friend recover from a lifelong phobia, and my mother decrease her need for pain medication. So many people I know have experienced positive changes in their lives thanks to hypnosis. If that makes us all "gullible," well, at least we're enjoying healthier, less stressed lives in our gullibility. ;-)Hypnosis is one of the most powerful tools we humans have at our disposal to create real change in our lives and behaviors. Deny yourself that if you wish. Be well.

  22. ButMadNNW

  23. Sep. 29, 2009 at 12:46am

  24. Hypnosis is nothing more than a context where one person says he is going to "hypnotize" another and the other believes it will happen. It doesn't work if the second person doesn't know what "hypnosis" is, if they don't know what is expected of them in the role of hypnotized person. You might enjoy thinking that hypnosis "works," that it somehow helps you overcome pain or whatever, but there is nothing in the room but you and the hypnotist -- real, imagined, or implied. No person is changing your brain state, all that happens is that you behave in the way you think a hypnotized person is supposed to behave. You might use a distraction strategy to minimize your awareness of pain, well you could do that without any hypnotic induction, anybody can do that. Anybody can lose weight, anybody can relax, you don't need to claim "hypnosis did it." If you like to think that hypnosis is some special brain-state that gives you unusual powers then go for it, man. Your statement about not believing, but knowing, shows that this is a religious topic for you, and I'm not going to convince you of anything here. Remember Wittgenstein saying, “If there were a verb meaning "to believe falsely," it would not have any significant first person, present indicative.” You must "know" because you can't believe and risk being wrong. But this is a science blog, I understand the articles are popularized for a nonacademic audience but the site editors have some responsibility to present real science, not silly woo asserting that brainwaves prove hypnosis is real and promising to unlock the mysteries of the brain.Social influence is a profound phenomenon. The self is socially constructed and very complex. It should not be a surprise that someone can do surprising things when influenced by a person who has been described to them as having special powers. You don't need a special construct called "hypnosis" to make it interesting, it is already interesting.I keep Science News in my RSS aggregator and often encounter interesting reports here. Occasionally there are lapses. This was one.

  26. Medium Buddy

  27. Sep. 29, 2009 at 9:05am

  28. MB, you're the one who keeps mentioning "special powers." I've said nothing of the sort. We both know neither of us is going to convince the other. I'm not even trying to convince you.Be well.

  30. ButMadNNW

  31. Sep. 30, 2009 at 11:42pm

  32. I am a trained, certified hypnotist and have been presenting and practicing in this field for about 18 years. It not only works, but is profoundly simple to use. I also have a degree in psychology and have been studying cognitive neuroscience as part of my reserarch for the last ten years. There are special techniques to use with people like medium buddy who have doubts. When you turn their logic inward and create a paradox, they collapse and go into trance. I've had university psychology professors leave my presentations and return to apologize as they were on intellectual overload, seeing events demonstrated that were outside their knowlege belief system. They just could not handle that they had been wrong in what they taught for many years. Thomas Kuhns was correct in his paradigm shift theories...!!I've worked with several people who were very intellectual, (some were MDs)and had one or more of their children killed in an accident. The event caused such a loop in their logic that they were in total denial of the reality of the event 10-15 years later, even though they were still able to be fully functional in their work environment. I found similar patterns in studying people with delusional thinking. Hypnosis is an excellent tool to remove the splintering event and heal the wound.The big problem is the model promoted for the brain is totally wrong. Rather than functioning as a computer with memories being stored somewhere in the synapses like a computer hard drive, the brain functions a a radio transmitter and receiver, interacting with fields surrounding the body. This is easy to demonstrate and prove, even in a scientific setting. Karl Pribram at Stanford was correct in his theory of holographic memory storage.Brain scans are like photographing a speaker to see what music is playing. They are very limited in their use to understand psychological processing.If you want to read some excellent research on hypnosis, read about its use with animals. Pavlov used hypnosis in working with dogs during his research in classical condiitioning.

  34. Psi Guy

  35. Oct. 1, 2009 at 9:33am

  36. Buddy said....."This is absolute crap. Laboratory research in hypnosis has been going on since the 1940s, at least, and the finding is that there is no "trance," nothing unique about hypnotic responding. "Hypnosis" is the name of a script that the subject knows, he or she is supposed to act as though the "hypnotist" has taken over their mind. Nothing happens in hypnosis that can't happen in a a normal waking state. This kind of fake-science has no place on this web site, I count on you to weed this junk out." The "shock" one experiences after an auto accident or a soldier sometimes experiences in battle situations is also a form of hypnosis. There are many, many induction techniques, some work better with specific personality traits in the subject. A simple technique which works quite well is to have two people talking to a subject at the same time. This causes logical confusion and induces trance.One thing you are correct on buddy is that hypnosis is a horizontal surrendering of a person's personal control or authority to another person. People like yourself who claim to not be hypnotizable are also usually closed to intimacy in relationships as they are afraid to be vulnerable, a precurser to experiencing the feeling of "Love." When they do enter a relationship, it is usually a control one where they can feel safe and keep their partner in an emotional consciousness state. Opposites do attract!

  37. Psi Guy

  38. Oct. 1, 2009 at 10:02am

  39. Buddy can rail all he or she wants, but hypnosis does work. I teach HypnoBirthing and 70% of the women who take our course are able to birth without anesthesia or analgesia, and most report being pretty comfortable and enjoying the experience.

  40. Kathleen Dolce

  41. Oct. 9, 2009 at 6:47pm

  42. This is an incredible article that has left me pondering about faith. We have all heard about if you have faith, it will happen, you will heal, you will succeed, you will not be afraid. We are constantly filled with self doubt which challenges our faith. Hypnosis seems to relieve you of that self doubt and enables your true ability to be who you want to be. The possiblilities are staggering.

  43. Swany

  44. Nov. 4, 2009 at 3:16pm

Approaching Pain's Layers Through Hypnosis

Under the suggestive power of hypnosis, subjects can be convinced that they're feeling pain when no stimulus is given. Other subjects can be taught to control the amount of pain they feel, as with a dial. Appearing to work well in as many as 15% of people tested, hypnosis can tap into the brain's ability to produce and modulate pain as well as the maddening subjectivity of the experience. Using sophisticated brain imaging techniques in concert with the power of suggestion, scientists are getting closer to parsing the emotional and sensory aspects of pain. "Studies with hypnosis are very elegant," says Northwestern University's Apkar Apkarian, noting that such studies were some of the first to separate different aspects of pain. Stuart Derbyshire, at the University of Pittsburgh, notes hypnosis' parlor-trick reputation: "People think they'll be clucking like a chicken." But serious study can be done under highly controlled circumstances. Hypnosis is about becoming highly focused on one thing and allowing that focus to be controlled externally, he says. In Derbyshire's recent experiment,1 subjects were told that when tapped on the foot once, they would experience 30 seconds of heat pain; two taps to the foot indicated a 30-second period of rest. But some hypnotized subjects reported experiencing pain in absence of the noxious stimulus. Derbyshire considered such pain to be hypnotically induced. This hypnotically induced pain triggered brain activation very similar to that for actual heat pain. In the control case, subjects were asked to imagine pain without any noxious stimulus. Under this imaginary condition, pain was not experienced by most subjects and only fleetingly in two subjects; brain activation was absent in the areas usually associated with such pain. Derbyshire, however, did not have a nonhypnotized control, suggesting that the increase in pain experience might have been due to the expectation of pain. But he still achieved his objectives, he contends--generating a pain experience without a stimulus. "We expected to use hypnosis to bring about that effect, but it really doesn't matter to us that much if it was not actually due to the hypnosis," he says. Where Derbyshire created a pain experience without a stimulus, imaging and pain researcher Pierre Rainville typically employs a methodology that changes the experience of an actual stimulus. As part of an influential 1997 study,2Rainville, an assistant professor of stomatology at the University of Montreal, had hypnotized subjects and told them to imagine a dial that they could turn up or down to affect the sensation of their hand, which was immersed in hot water. Positron emission tomography imaging studies showed that the modulation of the sensory area of the somatosensory cortex was proportional to the subjective modulation that the subjects were reporting. In related experiments, Rainville and colleagues targeted the emotional aspect. They told subjects that they'd feel a burning, pricking sensation in their hand, but through suggestion convinced subjects that they were experiencing various levels of pain intensity. In fact, the sensation was the same in each case; only the external suggestion differed. At the end of each scan, subjects reported what trials were more or less unpleasant. Researchers found the corresponding modulation in the anterior cingulate cortex, the cortical part of the limbic system. It's still unclear, however, whether hypnosis facilitates a widely applicable model for pain exploration. When Derbyshire talks about hypnosis at conferences, he still gets people saying "That's very interesting, but what's it got to do with the real world?" Roughly 15% of the population can be easily hypnotized such that their pain experience is altered. "The onus is on us to prove why that is," says Derbyshire. Rainville downplays the downsides, saying that only another 15% are not responsive, meaning 85% are somewhat to very responsive. Picturing a therapeutically relevant use for such methods, Rainville notes, "It's important to realize that even if someone might not be highly responsive, it doesn't mean they wouldn't get some benefit." References 1. S.W.G. Derbyshire et al., "Cerebral activation during hypnotically induced and imagined pain," Neuroimage, 23:392-401, September 2004. 2. P. Rainville et al., "Pain affect encoded in human anterior cingulate but not somatosensory cortex," Science, 277:968-71, 1997. -

Hypnosis: From Stage Hypnosis to the lab

From the stage to the lab Neuroimaging studies are helping hypnosis shed its 'occult' connotations by finding that its effects on the brain are real. By Lea Winerman Monitor Staff Print version: page Mention hypnosis, and for many people the image that comes to mind is a charlatan with a watch swinging back and forth, seducing otherwise sensible audiences into barking like dogs or clucking like chickens. Today, though, psychologists and others are using hypnosis to help patients stop smoking, lose weight or control pain. But despite this newfound respect for the method, scientists still aren't sure precisely how hypnosis–whether on stage or in a clinician's office–works. For years, they've been trying to determine whether hypnotized people actually feel and see things differently than the nonhypnotized or whether the hypnotized give in to some combination of concentration and social pressure to follow hypnotists' demands. Now, in the past decade or so and with the advent of neuroimaging technology like functional magnetic resonance imaging (fMRI), researchers have begun to get some answers. Recent studies have found that when hypnotized people act on hypnotists' suggestions, their brains really do process information differently. When they're told to see colors, for example, the color-processing parts of their brains light up–despite the absence of any real color in front of them. "This is an exciting time for us," says Columbia University psychologist and hypnosis researcher Amir Raz, PhD. "Neuroimaging technology allows us to really look at what's going on in the brain during hypnotic suggestion." Now, Raz and others are beginning to branch out, to try to figure out why hypnosis works and why some people are more hypnotizable than others. They hope that their research will lead to not only a better understanding of a previously mysterious phenomenon, but also to more effective hypnosis treatments. New findings In one recent study, Raz found that he could use hypnosis to negate the Stroop effect, a task that demonstrates how attention processes can interfere with each other. In the task, participants view the names of colors printed in different colors of ink–for example, the word "red" printed in blue ink–and try to say the name of the ink color while ignoring the words. But people who are literate read the words automatically and so find the task difficult. They often respond slowly and mistakenly read the words rather than identify the ink color. In a recent study, published in the Proceedings of the National Academy of Sciences (Vol. 102, No. 28, pages 9,978–9,983), Raz and his colleagues tested eight highly hypnotizable people and eight who weren't hypnotizable at all. The researchers performed a hypnotic induction, using methods such as guided imagery and visualization. Then, they told the participants that they would later see "meaningless symbols" printed in different colors of ink, and that when they did, they should press a computer key corresponding to the correct ink color. Next, the researchers brought the participants out of hypnosis, put them in an fMRI machine and showed them the Stroop stimuli. But the hypnotizable patients who had been told that they'd see gibberish seemed, in fact, to see gibberish: They performed the task almost 10 percent faster than the nonhypnotized participants, and made fewer mistakes. "It appears that these people were not playing games, and they were not acting," says Raz. "They were genuinely not reading the words." The fMRI results were also striking. The hypnotizable participants showed less activity in an area called the anterior cingulate cortex, which is active when people are trying to resolve conflicting information from different sources–information like conflicting word names and colors. Studies that have examined other types of hypnotic suggestions have found similar evidence. For example, Harvard psychologist Stephen Kosslyn, PhD, found that when he told hypnotized subjects that they would see gray-scale printed, Mondrian-like patterns in color, the participants showed activation in the same area of the brain–the right fusiform gyrus–as when they viewed actual color prints, according to a study published in theAmerican Journal of Psychiatry (Vol. 157, No. 8, pages 1,279–1,284). That area didn't light up, however, when the subjects weren't hypnotized and Kosslyn simply suggested that they visualize the drawings in color. Another experiment found that hypnotically induced pain activated the same brain areas as "real" pain. In this 2004 study, published in Neuroimage (Vol. 23, No. 1, pages 392–401), University College London psychologist David Oakley, PhD, and his colleagues told eight highly hypnotizable participants that they would feel heat-related pain. They found that the same pain-processing areas of the brain–in the thalamus, anterior cingulate cortex and other areas–were active in those subjects as in subjects who actually touched a 120-degree metal probe. Subjects who simply imagined the pain, meanwhile, didn't show the same active brain areas. The interpretation The accumulating evidence suggests that people respond to hypnotic suggestion by actually "feeling" or "seeing" the suggested stimulus, be it pain or color. The question that researchers have yet to answer, Oakley says, is how those changes come about. Scientists are still split on the issue: Some believe that hypnosis puts people into a trance state in which the brain behaves measurably differently than it does in other states. Others, meanwhile, believe that hypnosis is simply an intense form of concentration or focused attention. So far, neuroimaging studies haven't been able to distinguish between the two. To do so, a researcher would need to find a difference in brain activity between a hypnotized and a nonhypnotized person–specifically, a difference unrelated to the effects of any particular suggestion such as seeing color, says University of Plymouth psychology professor Irving Kirsch, PhD. "Nobody has yet disentangled the effect of suggestion from the effect of hypnotic induction," Kirsch says. "That's probably the next step." In fact, he and Raz have begun to address the question with behavioral measures. In one study, published in February in Psychological Science (Vol. 17, No. 2), they repeated the Stroop experiment but this time included a condition in which they simply told the highly hypnotizable participants, who were not hypnotized at that time, that they would see gibberish rather than words. The researchers found that, for these highly suggestible people, the suggestion alone was enough to improve performance on the task. "We now have evidence showing that highly hypnotizable people do not need to be hypnotized in order to benefit from suggestion," Raz says. That indicates that hypnosis may be a normal state of consciousness rather than an altered state–and that some people who are particularly good at experiencing imaginative suggestions are the ones who can be hypnotized, Kirsch explains. Meanwhile, researchers who believe that hypnosis alters the brain's functioning in some fundamental way say that the new findings don't negate that possibility. John Gruzelier, PhD, a psychologist at Imperial College in London, acknowledges that easily hypnotizable people are more suggestible even when not hypnotized. However, he says, the hypnosis itself still makes a difference. "It's my feeling that we wouldn't bother going through the whole rigmarole of hypnosis if it was unnecessary," he says. Raz and Kirsch hope that this and other work will also begin to help explain why some people are more highly hypnotizable than others, and will give researchers insight into who is most likely to benefit from hypnosis.

Brain scans show hypnosis at work

September 9, 2004

Brain scans show hypnosis at work

Trance impairs brain's ability to plan one's own actions.

by Michael Hopkin Nature News

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From the BA Festival of Science, Exeter, UK.

A brain-imaging study has shed light on why some people are more susceptible than others to hypnosis. By hinting at the brain processes involved, the analysis also suggests that hypnosis - both the stage and therapeutic varieties - does have genuine effects on the brain's workings.

“

The evidence really is there; hypnosis is not miraculous

”

Peter Naish

Open University, UK

Those who are easily hypnotized show different activity in a brain region called the anterior cingulate gyrus, which is involved in planning our future actions, reports John Gruzelier of Imperial College London. In a hypnotic trance, the function of this region may be impaired, he says, meaning that subjects are more likely to follow a hypnotist's suggestion: "The hypnotist tells you to go with the flow, and so you don't evaluate what you're doing."This is consistent with the idea that those who are easiest to hypnotize tend to describe themselves as generally letting go of their inhibitions quite easily, Gruzelier told the British Association Festival of Science in Exeter, UK, on Thursday.

Mind games

Some experts have argued that hypnotism is not a real physiological phenomenon at all, but rather the result of hypnotists imposing themselves on their subjects, who may be simply swept along. Stage hypnotists are often accused of intimidating their 'volunteers' into playing along for the sake of the show.

This effect is certainly part of the picture in performance hypnotism, says Gruzelier. "Lots of it is due to personality and persuasiveness, but then that's showbusiness," he told news@nature.com. Such tactics can cause people to ignore the potential of genuine hypnosis to ease painful diseases, he adds: "Unquestionably, stage hypnotists give hypnotism a bad name."

“

Unquestionably, stage hypnotists give hypnotism a bad name

”

John Gruzelier

Imperial College

"Humans like to comply; they don't like to be embarrassed," agrees Peter Naish, who studies hypnosis at the Open University in Milton Keynes, UK. But he insists that underneath the coercion used by charismatic stage acts, a physiological effect is occurring. "The evidence really is there; hypnosis is not miraculous," he adds.

Hardcore trance

Gruzelier studied 24 subjects, half of whom were categorized as succumbing easily to hypnotism, and half of whom were resistant. He scanned the volunteers' brains while they tackled a problem called the Stroop task, a test of mental flexibility that requires subjects to categorize a list of colours presented in a different colour - the word 'green' printed in blue, say - depending either on the name or the actual colour.

“

Lots of it is due to personality and persuasiveness; it's showbusiness after all

”

John Gruzelier

Imperial College

Gruzelier tested the subjects before and after they underwent a standard procedure used by hypnotists to put their subjects into a trance. In resistant subjects, the anterior cingulate gyrus was less strongly activated after the procedure than before, showing that their brains were working less hard as they got better at planning how to complete the task.But in hypnotized volunteers, the anterior cingulate, and the regions that govern it, were more strongly activated when they were in a trance, showing that they were struggling harder to plot their actions, Gruzelier reported. He suspects that this impaired ability to plan for oneself makes people more suggestible.

This process may underlie hypnotists' ability to influence their subjects' behaviour, be it stopping smoking or barking like a dog whenever they hear Elvis Presley. Subjects frequently report that they feel compelled to do something even though they know they don't really want to.

Gruzelier also suspects that hypnotism may interfere with subjects' evaluation of future emotions such as embarrassment. A region in the brain's medio-frontal cortex, close to the anterior cingulate, governs our perception of how we will feel if we take a certain course of action, he says. If connections between the two regions are impaired, stage volunteers might happily act without thinking.

That may well be the final weapon in the showbiz hypnotist's arsenal, says Gruzelier. By not only making volunteers suggestible but also taking away their sense of shame, the possibilities for public ridicule are immense. "The structure that monitors the emotional consequences of future actions becomes disconnected," he suggests. "So you make a fool of yourself."

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