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56 Neurobiol Persp Hypn PDF
56 Neurobiol Persp Hypn PDF
Título: La hipnosis desde una perspectiva neurobiológica: Abstract: Neuropsychophysiological evidence is re-
Una revisión de la evidencia y aplicaciones a la mejora de la viewed testing a three-stage, top down working model
función inmune. of the traditional hypnotic relaxation induction involv-
Resumen: Se revisa la evidencia neuropsicofisiológica que sir- ing: 1) a thalamocortical attentional network engaging a
ve de prueba a un modelo de trabajo, en tres etapas, de la in- left frontolimbic focussed attention control system un-
ducción hipnótica tradicional por relajación, y que incluye: 1)
derpinning sensory fixation and concentration on the
una red atencional talamocortical que implica al sistema fronto-
induction; 2) instatement of frontolimbic inhibitory sys-
límbico de control de la atención focalizada del hemisferio iz-
quierdo que sostiene la fijación sensorial y la concentración en tems through suggestions of tiredness at fixation and
la inducción; 2) toma del control por parte de los sistemas in- relaxation whereby anterior executive functions are sus-
hibitorios frontolímbicos, mediante las sugestiones de cansan- pended and directed by the induction; 3) engagement of
cio y relajación, con lo que las funciones ejecutivas anteriores right-sided temporoposterior functions through passive
quedan en suspenso y pasan a ser dirigidas por la inducción; 3) imagery and dreaming. A selectivity of action in high
implicación de las funciones temporoposteriores propias del susceptibles was a hallmark of the studies. Increased
hemisferio derecho a través de la imaginación pasiva y el sue- Stroop interference coincided with maintenance of er-
ño. Una marca característica de los estudios fue la selectividad ror detection and abolition of error evaluation poten-
de acción en los sujetos muy susceptibles. Un incremento en la
tials, interpreted as dissociation of cognitive and affec-
interferencia Stroop coincidió con el mantenimiento de la de-
tección de errores y la supresión de los potenciales de evalua-
tive executive systems of the anterior cingulate. Verbal,
ción del error, lo que se interpreta como una disociación de los category and design fluency tasks were dissociated with
sistemas ejecutivos afectivo y cognitivo del cingulado anterior. hypnosis centring on left anterior processes as seen in
Se observó una disociación entre las tareas de fluidez verbal, left lateral and medial reduced EEG connectivity. Lim-
categórica y de diseños, con un efecto específico de la hipnosis bic modulated electrodermal orienting responses and
sobre los procesos propios de la región anterior izquierda, refle- frontal modulated mismatch negativity waves were in-
jado también en la reducción, medida con EEG, de la conecti- hibited. Asymmetries in electrodermal and electrocorti-
vidad entre la zonas medial y lateral izquierda. Se inhibieron las cal responses to tones shifted to favour the right hemi-
respuestas electrodérmicas de orientación, moduladas por el sphere, an asymmetry also seen in visual sensitivity.
sistema límbico, y la Missmatch Negativity (MMN) modulada
Haptic processing and visual sensitivity disclosed more
por la región frontal. Las asimetrías en las respuestas electro-
dérmicas y electrocorticales a los tonos cambiaron a favor del
distributed changes in medium susceptibles, while low
hemisferio derecho, asimetría también observada en la sensibi- susceptibles were characterised by poorer attentional
lidad visual. El procesamiento háptico y la sensibilidad visual functions at baseline and improvements through the in-
revelaron cambios más distribuidos en los sujetos con un nivel duction.
medio de susceptibilidad, mientras que los no susceptibles se Key words: Neurophysiology of hypnosis, inmune re-
caracterizaron por unas funciones atencionales más pobres en sponse
la línea base, que mejoraron con la inducción.
Palabras clave: Neurofisiología de la hipnosis, respuesta inmune.
* Abridged with permission, and extended to include psychoneuroimmunological results, from article published in Contempo-
rary Hypnosis.
** *Dirección para correspondencia /Address for correspondence: Professor John Gruzelier, Department of Behavioural
& Cognitive Sciences, Imperial College School of Medicine, St Dunstans Road, London W6 8RF.
E-mail: j.gruzelier@ic.ac.uk
- 111 -
112 J. Gruzelier
hemisphere specific tasks, there were also neu- message may also facilitate right hemispheric
ropsychophysiological measures which took processing as does emphasising past experi-
into account brain anatomy such as EEG, di- ence and emotion. In contrast the low suscep-
chotic listening and conjugate lateral eye tible fails to show engagement of left frontal
movements (Crawford and Gruzelier, 1992). attentional control mechanisms, or if there is
Experimental evidence was, however, con- focal attentional engagement the low suscepti-
flictual, but the methodology of many studies ble fails to undergo the inhibitory, letting go
were questionable (Gruzelier, 1988). Methods process. This working model will serve to
of inducing hypnosis were various and often structure the review of findings.
poorly described. Often there was a failure to
distinguish between high and low susceptibles Thalamo-frontal-limbic attentional
or to attribute changes in low susceptibles that processes.
were absent in high susceptibles to the hyp-
notic process. Seldom was evidence cited of Electrodermal Orienting, Habituation,
test-retest reliability, or of replication, or of Sensitisation and Tonic Reactivity.
validation of hypnotic level during the experi-
mental procedure. We first investigated the basic attentional
In integrating the results of a decade ago a processes of orienting, which represents
three stage working model of the induction focussing of attention, and of habituation with
process was proposed (Gruzelier, 1988, 1990). stimulus repetition, which allows attention to
Stage I: The initial instructions of fixating on a be redirected, and which together involve
small object and listening to the hypnostist’s modulation by the limbic system, in particular
voice was posited to involve an attentional the amygdala and hippocampus (e.g., Pribram
network including thalamocortical systems and and McGuinness, 1975; Gray, 1982). The
parietofrontal connections with engagement of electrodermal response was chosen because
a left anterior focussed attention control sys- among physiological measures it has the ad-
tem. This underpins the focussed, selective at- vantage of indexing sympathetic nervous sys-
tention inherent in fixation and listening to the tem activity unconfounded by competing para-
hypnotist’s voice, processes which together re- sympathetic influences. Using a standardised
quire left hemispheric frontotemporal process- tone orienting and habituation paradigm (Gru-
ing. Stage II: This first stage is then replaced zelier and Venables, 1972) we monitored in
by eye closure, suggestions of fatigue at con- normal and patient volunteers the effects of
tinued fixation, and tiredness together with hypnosis on orienting responses to tones that
deep relaxation. This sets in motion frontolim- were interspersed with the hypnotic induction
bic inhibitory processes underpinning the sus- (Gruzelier and Brow, 1985). Subjects took part
pension of reality testing and critical evalua- in three sessions separated by four weeks to
tion, and the handing over of executive and avoid carryover effects on habituation. They
planning functions to the hypnotist; the “let- were first monitored to provide a baseline
ting go” component of the hypnotic induction. measure and to equate groups for individual
Stage III: The third stage involves instructions differences in rate of habituation. Then with
of relaxed, passive imagery leading to a redis- session order counterbalanced they experien-
tribution of functional activity and an augmen- ced a hypnosis session and one of two control
tation of posterior cortical activity, particularly conditions. The control conditions consisted
of the right hemisphere in high susceptibles. of either a story read by the hypnotist, or
Simplifying the verbal content of the induction relaxing listening to a story for a period
anales de psicología, 1999, 15(1)
114 J. Gruzelier
equivalent in length to the hypnotic induction habituation, the hypnosis condition was
prior to the introduction of the tones which distinguished from the three control
were presented without any accompanying conditions through a higher incidence of both
verbal message. Hypnotic susceptibility was nonresponding and non-habituation, a bimodal
monitored throughout the experimental distribution. It was the high susceptibles who
session showed a reduction in orienting and/or faster
The outcome was clear and depended on habituation with hypnosis, whereas low
level of susceptibility. As shown in Figure 1, in susceptibles showed retarded habituation with
the group distributions of orienting and rate of hypnosis, as can be seen in Figure 2.
Figure 1: Electrodermal orienting response habituation in baseline (tones alone), hypnosis, relaxation after listening to a
story, and story conditions.
Figure 2: Subjects categorised according to increase, decrease or no change in habituation from baseline to hypnosis as a
function of induction susceptibility score.
Comparisons with other features of At the same time some components of arousal
electrodermal activity shed light on arousal reduction were associated with hypnosis. This
and attentional processes. For the group as a was shown by fewer non-specific responses
whole, in hypnosis there was an absence of during hypnosis both in the first half and
sensitisation to a test tone presented towards second half of the hypnotic induction as well
the end of the session while throughout the as by reductions in tonic levels of skin
induction there was an increase in electro- conductance. However, one high susceptible
dermal non-specific responses. It is important had levels of skin conductance two standard
to note that both these effects were shared deviations above the control group mean,
with the control story condition and did not indicating that a reduction in tonic arousal is
vary with hypnotic susceptibility. From this we not a necessary part of the hypnotic process as
can infer that listening to the story and to the will be confirmed later in an experiment with
hypnotic induction produced a similar degree the active-alert induction procedure.
of autonomic arousability and attentional The facilitation of habituation with hypno-
engagement and these did not vary with sus- sis was replicated in an experiment designed to
ceptibility. Turning to the relaxation condition, compare hypnosis with simulating hypnosis in
this was insufficient to change either habitua- medium/high hypnotisables (Gruzelier, Alli-
tion (see also Teasdale, 1972) or sensitisation, son & Conway, 1988). Subjects were examined
so that the facilitation of habituation could not first in a baseline session and then assigned on
be explained away as a function of relaxation. the basis of the Barber Suggestibility Scale
(Barber, 1969) to the simulator or hypnosis ged in opposite directions from baseline to
groups matched for electrodermal reactivity, hypnosis for high and low susceptibles (Gruze-
sex and suggestibility. Hypnotic susceptibility lier, 1996). Cortical evoked potentials were
was monitored throughout the second session measured to infrequent tones mixed with
as in the former experiment. Levels of frequent tones in a standard P300 paradigm
susceptibility all fell within the moderate to with particular interest in a negative going
high range. As before rate of habituation was (N2a) attentional component The difference
faster with hypnosis in the susceptible subjects between the wave to the infrequent target or
while in simulators habituation was slower. deviant when subtracted from the frequent
Simulators were more aroused during the non-target or standard belongs to the class of
induction prior to presentation of the tones phenomena termed MisMatch Negativity
(p<0.005) but subsequently there was no (MMN). This is thought to involve a
difference in the number of nonspecific preattentive sensory specific process generated
electrodermal responses. Support was found in auditory cortex (superior temporal gyrus).
for reports that simulators are characterised by Aside from bilateral temporal maxima it has a
exaggerated compliance (Williamsen , Johnson predominant single maximum over the frontal
& Eriksen, 1965; Hilgard, McDonald, Morgan cortex suggestive of frontal involvement
& Johnson, 1978), for in compliance with (Naatanen, 1992).
instruction by the hypnotist to forget about the Before the topographical EEG recording
tones, all but one simulating subject claimed at session subjects were assigned with the
the end of the session not to have heard the Harvard Group scale (Shor and Orne, 1962) to
tones, whereas all but one in the hypnosis high (9-12) and low (0-4) susceptibility groups.
group admitted to hearing the tones. Baseline measures were first recorded and
Neuroanatomically the influence on elec- these were repeated following the hypnotic
trodermal orienting and habituation was com- induction as in the electrodermal studies, and
patible with the evidence of De Benedittis and repeated a second time following an extended
Sironi (1988) arising from recordings of intra- induction. Susceptibility was recorded throug-
cranial electrical activity. They found that hyp- hout the session as in previous studies. As can
nosis involved functional inhibition of the be seen in Figure 3 high susceptibles showed a
amygdala and activation of the hippocampus. large magnitude difference wave at baseline
The amygdala has been shown to exert mainly and a progressive reduction in MMN with
excitatory influences on orienting activity each stage of the induction and in keeping
whereas the inhibitory action of the hippo- with frontal inhibition. By the later stage of the
campus facilitates the habituation of the induction MMN was negligible in both the
orienting response with stimulus repetition lateral frontal placements. Importantly opposi-
(Gruzelier &Venables, 1972; Pribram & te changes were manifested by the low suscep-
McGuinness, 1975). tible group. Whereas at baseline their differen-
ce wave was absent, there was a progressive
Electrocortical Event-Related Attentional increase in MMN through the experiment,
Components and Frontal Inhibition. until in the last condition the magnitude of the
difference wave was on a par with the results
Electrocortical procedures have also de- in high susceptibles at baseline, suggesting an
monstrated alterations in attentional processing increasing enhancement of attentional pro-
with the induction of hypnosis, and like cessing.
electrodermal rates of habituation these chan-
Figure 3: Nd wave scores in baseline (B), induction (H1) and extended induction (H2) in high and low susceptible groups.
showed a reduction in errors and RT variance Hand order was counterbalanced and there
(Kallai, Revonsuo, Hamalainen, Markela & was control for movement time. The task was
Gruzelier,1998). Together these studies show done prior to hypnosis and again after the
that whereas susceptible subjects evinced hypnotic induction, with susceptibility
inhibitory influences on attention with monitored through the experiment. As shown
hypnosis, unsusceptible subjects improved in Figure 4 high susceptibles showed an in-
attentional performance as the induction pro- crease in right hand processing times with
gressed. hypnosis while there was no change in their
Anterior inhibitory processes left hand times, nor were there bilateral chan-
ges in low susceptibles. The increase in the
Left Anterior Inhibition. processing times of the right hand (indexing
the left hemisphere) correlated positively with
Evidence of frontal inhibition was first dis- the hypnotic susceptibility score. Some evi-
closed by measuring right and left hemisphere dence has suggested that the anterior inhibi-
processing times in dextral subjects with a tion may be laterally asymmetrical and biased
haptic object sorting task comparing left and towards the left hemisphere. We replicated the
right hands (Gruzelier, Brow, Perry, Rhonder slowing of left hemispheric processing with
& Thomas, 1984). This was an extremely hypnosis in high susceptibles in contrast to low
simple task involving the discrimination of susceptibles in a follow-up experiment with
letters and numbers. This was planned initially middle aged subjects, which was performed
to validate asymmetries disclosed by the away from the laboratory and which included a
bilateral monitoring of electrodermal orienting non-hypnosis control group, (Gruzelier, Brow,
and habituation processes described in the Perry, Rhonder &Thomas, 1984). The
next section; in the haptic task which required combining of both experiment samples also
“active” as distinct from “passive” touch, the disclosed evidence of a left hemispheric prefe-
mediation of hemispheric influences is rence in high susceptibles at baseline as had
unambiguously contralateral. Subjects sorted been shown in the electrodermal study outli-
objects by class with each hand separately ned in the next section.
while blindfolded.
Figure 4: Haptic processing times for right and left hands for prehypnosis baseline and with hypnosis in high (left figure)
and low (right figure) susceptibles.
between word fluency and both design fluency Anterior disconnection with hypnosis in
and category fluency, but not between design susceptible subjects was recently disclosed by
and category fluency. This could be interpre- Kaiser in an unpublished experiment involving
ted as showing that an underlying process such EEG topographical mapping with a 32 elec-
as distributed inhibition was most at work with trode array in which we examined regional
word fluency, and while centring on left connectivity with EEG coherence. EEG co-
anterior processes was also having some herence, a putative measure of connectivity,
impact on design and category fluency which was examined between bipolar pairs of elec-
involved right anterior and left temporal trodes. This disclosed a significant hypnosis x
processing respectively. Correlations also group x condition interaction in high alpha ac-
showed that the significant relation between tivity, as shown in Figure 6. In high suscepti-
left and right hand finger tapping dexterity bles with hypnosis there was a reduction in
before hypnosis was reduced with hypnosis in connectivity within the left prefrontal region -
keeping with a tendency towards lateral specifically between left lateral (FP1 and F7)
dissociation. and medial (F3 and FTC1) placements -
whereas the opposite effect, namely an in-
crease in connectivity was found in low sus-
ceptibles. In baseline there was also a highly
significant difference between susceptibility
groups in the direction of greater left anterior
connectivity in high than low susceptibles.
Importantly the coherence result did not
generalise to all bands but was restricted to
high alpha activity. This represents an EEG
band which relates to cognitive as distinct
from connative processing, variously described
as indexing high workload, sustained motor
control and long term memory (Mecklinger &
Bosel, 1989; Sterman, Mann, Kaiser & Suye-
nobu, 1994; Klimesche, 1996; Burgess &
Gruzelier, 1998). The importance of selectivity
in narrow band EEG power has also been
demonstrated by our differentiating hypnosis
from relaxation with high theta versus low al-
pha band power (Williams & Gruzelier, 1998).
Figure 6: Left anterior EEG coherence in baseline and hypnosis for medium/high and low susceptibles (high short dis-
tance coherence represents low connectivity and vice versa).
Fronto-Limbic Supervisory Attentional tion to the green arrow condition red arrows
System. were randomly presented, in which case the
button must be pressed in the opposite
We went on to examine evidence of frontal direction to the arrow (incongruent condition).
inhibition in the context of contemporary Electrophysiological evidence has shown that
models of anterior functions which focus on following an erroneous response in a reaction
attentional control systems (Posner & Peter- time task there is a large negative going wave
son, 1990; Shallice & Burgess, 1991). A super- at about 100msecs, referred to as error-related
visory attentional system which involves the negativity and termed an error detection wave,
frontal lobes and limbic system monitors which is not elicited following correct
ongoing activity and modulates behaviour in responses (Falkenstein, Hohnbein, Hoorman
response to novelty, as in orienting, and when & Blank, 1990; Gehring, Goss, Coles, Meyer
environmental stimuli convey conflicting & Donchin, 1993). This negative wave is
information. We tested this with a behavioural followed by a positive wave which varies with
and electrophysiological paradigm which re- a range of task-related factors and may
quires the monitoring of errors in performance represent context updating, error evaluation
(Kaiser, Barker, Haenschel, Baldeweg & Gru- and adjustment of response strategies, an error
zelier, 1997). We utilised a Stroop-like task evaluation wave (Falkenstein, Hohnsbein &
involving a simple 2-choice reaction time task Hoorman, 1995).
in which a button was pressed according to the With hypnosis the medium/high suscep-
side in which a green arrow was pointing tibility group showed an increase in errors on
(congruent condition). This was contrasted incongruent trials –the stroop interference
with a complex 4-choice task where in addi- effect– but no change in errors on congruent
Figure 7: Error detection and error evaluation waves in medium/high susceptibles in hypnosis and pre-hypnosis baseline.
The error detection wave has been loca- The anterior cingulate performs executive
lised to a midline anterior cingulate generator functions which have been subdivided into
(Dehaene, Posner &Tucker, 1994), a promi- affective and cognitive components (Devinsky,
sing candidate for involvement in hypnosis. Morrell & Vogt, 1995). The cognitive
Figure 8: The amplitude of bilateral electrodermal orienting responses showing reversal of asymmetry from baseline
(tones) to hypnosis in high susceptibles and no consistent changes in low susceptibles.
An enhancement of right posterior func- the divided visual field presentation of flashes
tions was found in an experiment involving requiring brightness judgements. The experi-
ment involved three sessions in the order showed that judgements were more conser-
baseline, hypnosis, baseline. It was conducted vative for the right hemisphere than the left
with eyes open with sufficient trials to perform for the group as a whole (p<0.05. However,
signal detection analysis to give estimates of there was no effect of group, providing no
perceptual sensitivity independent of cognitive evidence for the possibility that the influence
bias (McCormack and Gruzelier, 1993). Blocks of hypnosis may be due to a shift in attitude
of trials were interspersed with a live hypnotic such as an adoption of a lax response criterion
induction. Susceptibility was monitored leaving perceptual sensitivity unaffected
throughout the experiment with subjects (Naish,1985). The demonstrable changes in
divided into medium and high susceptibles. perceptual sensitivity with hypnosis were
Results are shown in Figure 9. Perceptual consistent with other reports (Segal & Fusella,
sensitivity was found to be enhanced in the 1970; Miller & Leibowitz, 1976; Farthing,
hypnosis condition compared with the control Brown & Venturio, 1982). Thus the results
conditions. Comparison of the susceptibility which disclosed an enhancement of right
groups indicated a bilateral increase in per- posterior processing with hypnosis, showed
ceptual sensitivity in medium susceptibles that only in high susceptibles was this strictly
whereas in high susceptibles there was no lateralised. It was more widely distributed in
change in susceptibility in the left hemisphere medium susceptibles to include a bilateral
(right visual field) in contrast to a focal right processing enhancement and was of lesser
hemispheric enhancement (left visual field). magnitude. A similar conclusion was reached
An improvement in perceptual sensitivity is in a haptic sorting task experiment above
according to signal detection theory indicative (Cikurel and Gruzelier, 1989).
of an increase in signal to noise ratio as will
occur with a reduction in central levels of
arousal. Analysis of the cognitive bias variable
Figure 9: Visual sensitivity in baseline control conditions and hypnosis in high and medium susceptibles for left and right
hemispheres.
measured with the personality syndrome ques- range of lymphocytes assayed (p<0.04-
tionnaire (PSQ, Gruzelier et al, 2000a) with ac- p<0.008).
tive, withdrawn and unreality syndromes. In a subsequent, as yet unpublished study
Withdrawal has been associated with immune (Gruzelier, Levy, Henderson), with a similar
compromise and there is little formal docu- study design we compared a passive (N = 11)
mentation relating to positive attributes of per- versus active induction (N = 11) and control
sonality in relation to immune function. We condition (N = 6). The “active” induction was
hypothesised that the active personality would similar to before, having immune-related im-
be associated with immune up-regulation. agery and ego strengthening suggestions,
Life-style changes at exam time were moni- whereas the “passive” induction involved only
tored with a questionnaire and mood was the typical relaxation induction as used in our
measured with the Speilberger and Thayer laboratory studies. Here the passive imagery
scales. group showed a marked decline (p<0.008) in
NK cell counts and CD8 counts were CD4 counts at exam time, whereas the decline
found to decline in controls, but this decline was not significant in the active imagery group
did not occur in the hypnosis group (p<0.002; (p<0.27). Regarding the relevance of the CD4
p<0.07) (Gruzelier et al, 2000b). Self-hypnosis marker to the health of students at exam time,
was accompanied by a paradoxical increase in eight students reported illnesses around the
cortisol. These changes were significantly cor- exam period. When comparing them with the
related suggesting an integrated pattern and remainder, the illness group had a significant
underlying process. The effects were inde- decline in CD4 counts (p<0.016) whereas the
pendent of life–style changes. Furthermore decline was not significant in the well group
exam NK cell counts correlated positively with (p<0.15). In other words the beneficial influ-
energy for the group as a whole and negatively ences of hypnosis were relevant not only to
with anxiety. well being, but also to health. We went on to
Additional benefits associated with hypno- explore these relations in a clinical study.
sis included higher energy ratings at exam time
than in the control group (p<0.01), while in- Recurrent and chronic genital herpes
creased calmness after hypnosis training corre-
lated positively with increased CD4 counts The first association between psychological
(p<0.01). In controls cortisol correlated posi- distress and reduced resistance to HSV was
tively with tiredness and with an increase in reported by Lycke et al (1974) in the form of
anxiety (p<0.035, p<0.009). These congruent increased antibodies to the latent herpes vi-
relations between cortisol and negative mood ruses HSV, Epstein-Barr virus and Cytomega-
were not found in the hypnosis group suggest- lovirus in depressed patients. Subsequent in-
ing that along side the paradoxical increase in vestigators confirmed this association in medi-
cortisol in the hypnosis group, hypnosis results cal students at exam time and in spouses about
in a dissociation of the negative effects of cor- to divorce, in whom in addition there was a
tisol (Gruzelier et al, 2000c). reduction in Natural Killer (NK) cell activity,
Compelling relations were found between CD4 lymphocyte counts and lymphocyte pro-
the personality syndromes of the group as a liferative responses (see Sheridan et al, 1994).
whole and the T and B-lymphocyte changes. NK cells, macrophages, CD4 and CD8 lym-
The syndrome we predicted to be associated phocytes, interferon alpha and gamma, inter-
with immune up-regulation, namely the active leukin 2 (IL-2) and leucocyte migration inhibi-
syndrome, correlated positively with the full tory factor are all significant in protecting
against HSV (Rinaldo and Torpey, 1993). ber scale and the dependent variables. Sug-
20 patients with frequently recurrent geni- gestibility correlated positively with an increase
tal herpes (HSV-2) attending a department of in NK cell counts (p<0.03), CD3 counts
genito-urinary medicine at Chelsea and West- (p<0.01) and CD 8 counts (p<0.02).
minster Hospital were examined at baseline The patients were also examined on the
and after a six week course of self hypnosis Hospital Anxiety and Depression Scale (HAD)
(Fox et al, 1999).All were due to discontinue at the beginning and end of the study. Im-
prophylactic antiviral medication for a trial pe- provers showed a reduction in both depression
riod or were reluctant to take the medication. and anxiety when compared with Nonim-
Patients had experienced a median of 12 or provers (p<0.05). In support of our student
more episodes a year study an action- orientated personality, meas-
Overall the number of recurrences fell fol- ured with the PSQ was associated with im-
lowing hypnosis training (p<0.048). The me- provement (p<0.04) while a withdrawn per-
dian number in the six weeks before was 2 sonality was associated with nonimprovement
(range 0 – 6) and in the six weeks of self hyp- (p<0.04).
nosis 1 (range 0 – 3). The patients were subdi- In the year following the study some pa-
vided into Improver (N = 13, 65%) and tients have remained off medication and have
Nonimprover (N = 7, 35%) groups on the ba- experienced very little recurrence of HSV.
sis of clinical outcome. There was no differ- This pilot study requires confirmation in a
ence in Barber suggestibility scores between controlled clinical trial, but confirms that re-
the groups; the mean score was 4.8, and the laxation can improve nonspecific NK cell
pre-intervention number of recurrences was function, and as shown by others can reduce
higher in those who improved (2.5 versus antibody titres to HSV (Kiecolt-Glaser et al,
1.35), but not significantly so. The number of 1985; Zachariae et al, 1990). Hypnosis, how-
recurrences fell in the Improver group to 0.84 ever, is more than relaxation (e.g., Gruzelier
(p<0.001), and increased in the Nonimprovers and Brow, 1985; Williams and Gruzelier,
(p<0.03). The number of symptomatic days 2000). This clinical study has demonstrated for
fell in Improvers and rose in Nonimprovers the first time that hypnotherapy may bring
(p<0.002). about an improvement in a chronic medical
Following hypnosis Natural Killer cell condition.
counts increased only in Improvers (p<0.02),
as did functional NK activity with regard to Conclusion
HSV specific Lymphokine Activated Killer
(LAK) following activation by interleukin-2, This series of experiments has shown a num-
which more than doubled (p<0.007).The rise ber of reproducible changes in brain function
in percentage of NK cells as a proportion of which distinguished medium to high suscepti-
the total lymphocyte count (p<0.015) was bles after instructions of hypnosis both from
matched by a fall in CD4 lymphocytes their baseline state and from low susceptibles.
(p<0.03). CD3 and CD8 lymphocytes in- The attempts were modest in scope and must
creased for the group as a whole (both be confined to the traditional hypnotic relaxa-
p<0.02), suggesting a nonspecific influence of tion induction. Continuing support was pro-
hypnosis independent of HSV. Cortisol re- vided for associations between hypnosis and:
mained unchanged, as did HSV specific NK 1) activation of anterior fronto-limbic inhibi-
and Antigen Dependent Cellular Cytotoxicity. tory processes, 2) anterior inhibition or dis-
Correlations were obtained between the Bar- connection, either lateralised to left hemi-
spheric regions or bilateral depending on the content of experience, and the nonspecific di-
processes examined, 3) involvement of right ffuse thalamic projection system which provi-
temporoposterior processing, 4) evidence of des the context and alertness. In this regard
superior attentional abilities in high suscepti- the anterior and posterior cingulate appear of
bles, 5) evidence of poor attentional abilities in particular promise in the top down control of
unsusceptible subjects with progressive im- thalamic activity relevant to hypnosis.
provement through the induction, and 6) no Devinsky, Morrell & Vogt (1995) have remar-
evidence of right hemisphericity in the base- ked “One of the unique features of anterior
line state in susceptible subjects. cingulate cortex circuitry is its diverse thalamic
As the studies unfolded a selectivity of afferents and consequent ability to sample
central action increasingly became a hall- inputs from more thalamic nuclei than any
mark of hypnosis providing undeniable evi- other cortical region. The ability to sample
dence of neurophysiological changes in sus- from a wide range of thalamic inputs may be
ceptible subjects which distinguished them crucial for its contributions to motor response
from unsusceptible subjects. Across elec- selection functions. p 280” The same could be
trodermal, electrocortical and behavioural said for connative functions and the limbic
domains susceptible subjects evinced inhibi- thalamus (Bentivoglio, Kultas-Ilinsky & Ilins-
tory influences on attention with hypnosis ky, 1993). Hypnosis research would benefit
whereas unsusceptible subjects improved at- from examining the interplay between cortical
tentional performance as the induction pro- and thalamo-cortical systems, for which the
gressed. Evidence was also found for bilat- methodology of fast frequency EEG transients
eral alterations of function in medium sus- holds much promise.
ceptibles in situations where changes in high In Llinas’s model dreaming is regarded as a
susceptibles were lateralised, suggesting state of hyperattentiveness to intrinsic activity
more diffuse or distributed changes in me- without the registration of sensory input, a
dium susceptibles and more focal changes in state with an obvious affinity with hypnosis.
high susceptibles. Together these results in- This serves to acknowledge that the dream
dicate the importance of stratifying groups analogy remains appealing for aspects of the
into low, medium and high susceptibles. hypnotic experience. Consider Fuster’s (1995)
In our neuropsychological translation of description of cognitive features of dreaming
the traditional hypnotic induction, hypnosis which include the altered sense of time and
was initiated by engaging anterior executive absence of temporality, the lack of guiding
control systems. Aside from alterations in reality and critical judgement, the anchoring in
cortical functions along anterior-posterior and personal experience, affective colouring, disso-
lateral axes, these will orchestrate top down ciation from sensory input and context. “ The
changes influencing thalamic and brain stem fragmented networks activated in the dream
mechanisms. Currently there is renewed inte- seem to lack the associative links to a time
rest in the electrophysiology of thalamocortical frame, anchored as they are in the present,
mechanisms in perceptual binding, conscious without time tags and references.” This could
perception and altered states of awareness equally be a description of the hypnotic state
(Llinas & Pare, 1991; Singer, 1993). Llinas, as high susceptibles experience it.
Joliot & Wang (1994) have proposed that Self–hypnosis with guided imagery di-
consciousness is a noncontinuous event deter- rected to both healthy immune function and
mined by simultaneity of activity in specific towards mobilising resources, in three studies
thalmocortical nuclei which provide the was found to be effective in buffering negative
influences of stress on the immune system, promoting health in the population at large.
which in one was combined with a chronic In conclusion, as Schopenhauer remarked
medical condition. The 10 session programme “All truth passes through three stages. First it
was successful in overcoming initial differ- is ridiculed. Second it is violently opposed.
ences in susceptibility. It was of relatively Third it is accepted as being self-evident”. Ap-
short duration, was inexpensive and through plication of the rapid advances in cognitive
home practice was saving of clinical time. neuroscience to hypnosis research may make
Guidance for individual differences in patient the reality of the third stage ever more likely.
response and compliance may follow the pre-
dictive ability of the personality trait. Given Acknowledgements: The research was suppported by the
Saugstad Fund, the Institut fur Grenzgebiete der Psycholo-
the influence of hypnosis in buffering the de-
gie und Psychohygiene and studentships from the Medical
cline or raising the natural killer cell popula- Research Council and the Wellcome Trust.
tion, which has antiviral and anti tumor func-
tions, this relatively simple and inexpensive
psychological intervention has applications
both to a range of immune disorders and for
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