A study identifies brain areas altered during hypnotic trance. By scanning the brains of subjects while they were hypnotized, researchers at the School of Medicine were able to see the neural changes associated with hypnosis. Your eyelids are getting heavy, your arms are going limp and you feel like you’re floating through space. The power of hypnosis to alter your mind and body like this is all thanks to changes in a few specific areas of the brain, researchers at the Stanford University School of Medicine have discovered.
The scientists scanned the brains of 57 people during guided hypnosis sessions similar to those that might be used clinically to treat anxiety, pain or trauma. Distinct sections of the brain have altered activity and connectivity while someone is hypnotized, they report in a study published online July 28 in Cerebral Cortex.
“Now that we know which brain regions are involved, we may be able to use this knowledge to alter someone’s capacity to be hypnotized or the effectiveness of hypnosis for problems like pain control,” said the study’s senior author, David Spiegel, MD, professor and associate chair of psychiatry and behavioral sciences.
A serious science
For some people, hypnosis is associated with loss of control or stage tricks. But doctors like Spiegel know it to be a serious science, revealing the brain’s ability to heal medical and psychiatric conditions.
“Hypnosis is the oldest Western form of psychotherapy, but it’s been tarred with the brush of dangling watches and purple capes,” said Spiegel, who holds the Jack, Samuel and Lulu Willson Professorship in Medicine. “In fact, it’s a very powerful means of changing the way we use our minds to control perception and our bodies.”
Despite a growing appreciation of the clinical potential of hypnosis, though, little is known about how it works at a physiological level. While researchers have previously scanned the brains of people undergoing hypnosis, those studies have been designed to pinpoint the effects of hypnosis on pain, vision and other forms of perception, and not the state of hypnosis itself. “There had not been any studies in which the goal was to simply ask what’s going on in the brain when you’re hypnotized,” said Spiegel.
Finding the most susceptible
To study hypnosis itself, researchers first had to find people who could or couldn’t be hypnotized. Only about 10 percent of the population is generally categorized as “highly hypnotizable,” while others are less able to enter the trancelike state of hypnosis.
Spiegel and his colleagues screened 545 healthy participants and found 36 people who consistently scored high on tests of hypnotizability, as well as 21 control subjects who scored on the extreme low end of the scales.
Then, they observed the brains of those 57 participants using functional magnetic resonance imaging, which measures brain activity by detecting changes in blood flow. Each person was scanned under four different conditions — while resting while recalling a memory and during two different hypnosis sessions.
“It was important to have the people who aren’t able to be hypnotized as controls,” said Spiegel. “Otherwise, you might see things happening in the brains of those being hypnotized but you wouldn’t be sure whether it was associated with hypnosis or not.”
Brain activity and connectivity
Spiegel and his colleagues discovered three hallmarks of the brain under hypnosis. Each change was seen only in the highly hypnotizable group and only while they were undergoing hypnosis.
First, they saw a decrease in activity in an area called the dorsal anterior cingulate, part of the brain’s salience network. “In hypnosis, you’re so absorbed that you’re not worrying about anything else,” Spiegel explained.
Secondly, they saw an increase in connections between two other areas of the brain — the dorsolateral prefrontal cortex and the insula. He described this as a brain-body connection that helps the brain process and control what’s going on in the body.
Finally, Spiegel’s team also observed reduced connections between the dorsolateral prefrontal cortex and the default mode network, which includes the medial prefrontal and the posterior cingulate cortex. This decrease in functional connectivity likely represents a disconnect between someone’s actions and their awareness of their actions, Spiegel said.
“When you’re really engaged in something, you don’t really think about doing it — you just do it,” he said. During hypnosis, this kind of disassociation between action and reflection allows the person to engage in activities either suggested by a clinician or self-suggested without devoting mental resources to being self-conscious about the activity.
Treating pain and anxiety without pills
In patients who can be easily hypnotized, hypnosis sessions have been shown to be effective in lessening chronic pain, the pain of childbirth and other medical procedures; treating smoking addiction and post-traumatic stress disorder; and easing anxiety or phobias. The new findings of how hypnosis affects the brain might pave the way toward developing treatments for the rest of the population — those who aren’t naturally as susceptible to hypnosis.
“We’re certainly interested in the idea that you can change people’s ability to be hypnotized by stimulating specific areas of the brain,” said Spiegel. A treatment that combines brain stimulation with hypnosis could improve the known analgesic effects of hypnosis and potentially replace addictive and side-effect-laden painkillers and anti-anxiety drugs, he said. More research, however, is needed before such a therapy could be implemented.
By: Sarah C.P. Williams
Nancy Jordan sat down in my office and lit a cigarette–a deadly habit, given her severe asthma and tobacco allergies. Jonathan Hunter, M.D.–my supervisor, her psychotherapist–was also in the room. He wanted to attend Nancy’s first hypnotherapy session to put the shy college sophomore at ease.
I knew he was also eager to observe hypnosis. “Hunter,” as he was known, was supervising my graduate school psychotherapy program. Although Hunter was no hypnotist, I had taken a hypnosis course and had been practicing on volunteers for a semester. We agreed that he would direct me on general psychological aspects of Nancy’s treatment, my first hypnotherapy case.
I positioned my chair at a 90-degree angle to the recliner in which my young patient sat. I asked Nancy to look up at the ceiling, where four porous tiles intersected in a neat point. (I have yet to encounter a hypnotist who uses a swinging gold pocket watch. Instead, we ask clients to gaze at a steady object to block distracting visual stimuli.)
“Stare at the point on the ceiling and let your breathing become slow and deep. Let your body begin to relax, starting with the muscles of your feet and toes. Let your thighs relax; let all tension flow out of your legs.” I gradually slowed my voice as I spoke to subliminally cue her breathing to slow down. “As you continue to stare at the point on the ceiling, your eyelids become heavier, as if a weight were attached, pulling them gently down. You may notice the point starting to move or change color; that will be a sign that you are beginning to go into hypnosis. Each time you blink, it gets harder to open your eyes. Soon they will close completely, and you will sink into a peaceful, sleeplike state.” Nancy looked drowsy, and her eyes began to droop.
At that point, I glanced over at Hunter to see what he thought of the induction. The worst reaction my insecure imagination could conjure was mild disapproval, but what I saw was infinitely more dismaying: My big, rangy supervisor sat slumped in his chair. His eyes were closed, muscles lax, breathing barely detectable.
I stalled as I wondered what to do next. I could just proceed. But I had no idea how Hunter, a nonsmoker, would respond to my commands about Nancy’s smoking. What if he woke, thinking he did smoke? I decided to bring both Nancy and Hunter out of the trance. She gradually opened her eyes as his popped open. After a moment of confusion, he quickly affected a look of exaggerated nonchalance. I made another appointment with Nancy, and she went on her way.
“You were out cold!” I announced to Hunter the instant the door closed behind her. He looked perplexed again. “I think I dozed off. I remember you saying my eyes would close, I mean, her eyes would close. Maybe I was hypnotized.”
Can you be hypnotized? Most people like to think that they can’t. There is often the suspicion that being hypnotized could label them as being weak-willed, naive or unintelligent. But in fact, modern research shows that hypnotizability is correlated with intelligence, concentration, and focus. Hypnosis is not an all-or-nothing phenomenon, but rather a continuum. Most people can be hypnotized to some degree–the only question is how far.
A hypnotic trance is not therapeutic in and of itself, but specific suggestions and images fed to clients in a trance can profoundly alter their behavior. As they rehearse the new ways they want to think and feel, they lay the groundwork for powerful changes in their future actions. For example, in hypnosis, I often tell people who are trying to quit smoking that they will go hours without even thinking of a cigarette, that if they should light up, the cigarette will taste terrible and they’ll want to put it out immediately.
I’ll talk them through the imagery of being a nonsmoker–some combination of finding themselves breathing easier, having more energy for exercise, enjoying subtle tastes and smells again, having fresh breath and clean-smelling closing, feeling good about their health, even saving money on cigarettes or whatever motivates that person to quit. The deep relaxation of a hypnotic trance is also broadly beneficial as many illnesses, both psychological or physical, are aggravated by anxiety and muscle tension.
Research over the last 40 years shows that such hypnotic techniques are safe and effective. Furthermore, a growing number of studies show that hypnotherapy can treat headaches, ease the pain of childbirth, aid in quitting smoking, improve concentration and study habits, relieve minor phobias, and serve as anesthesia–all without drugs or side effects (see “Hypnosis Heals,” page 62).
We are also learning that both biological and environmental factors predict how deeply a person goes into a trance. Identical twins reared apart often have strikingly similar responses to hypnosis. Furthermore, an “eye roll” test, developed by Herbert Spiegel, M.D., measures how far a person can roll his eyes up beneath slowly lowering lids and is correlated with hypnotizability, implying that hypnosis has neurological underpinnings.
New studies by David Spiegel, M.D. (son of Herbert Spiegel) at Stanford, Helen Crawford, Ph.D., at Virginia Tech and Robert Kunsendorf, Ph.D., at the University of Massachusetts support that idea, example, suggesting anesthesia could blunt cortical activity in areas of the brain associated with pain, while asking hypnotized people to hallucinate an image could produce activity in the visual cortex. Early experiences also play a role. Children who are encouraged to engage in imaginative play and creative activities, for instance, usually grow up to respond strongly to hypnosis.
It is also becoming clear that the skills one needs to respond to hypnosis are similar to those necessary to experience trance-like states in daily life. The best predictors are a propensity to become absorbed in fantasy or imagery and a knack for blocking out the surrounding world.
Research suggests that two groups of people are most easily hypnotized: fantasizers and dissociators. While these groups make up only 5% of the general population, they are so highly hypnotizable that if a person can identify with even a few of their qualities, he or she is probably a good candidate for hypnosis.
Fantasizers
In 1981, Cheryl Wilson, Ph.D., and Ted Barber, Ph.D., of The Medfield Foundation interviewed a group of highly hypnotizable people about their childhoods and current adult experiences. They called these people “fantasizers.” These subjects said their imaginations were every bit as vivid as reality. They fantasized during 90% to 100% of their waking hours, all while carrying out other activities. Wilson and Barber believed fantasizers represented most or all highly hypnotizable people.
I designed a study to test this hypothesis further. After I chose 34 of the most hypnotizable people from the several hundred that I had tested, I observed their responses to a variety of hypnotic suggestions and interviewed them to see why they might be so easily hypnotized. When I looked at people who could enter a trance instantly, I realized that almost two-thirds of them fit the profile of Wilson and Barber’s fantasizers. Here’s what they tend to be like:
The memories that fantasizers have begin unusually early in life. Fantasizers’ recollections are also highly detailed. Of course, we cannot gauge how accurate fantasizers’ memories might be. One subject, for instance, recalled watching glowing alphabet letters popping one by one out of a shower drain. This might be a memory of a childhood dream, but also might well be a complete fantasy–or a drug-induced hallucination.
In childhood, fantasizers had had at least one, but usually many, imaginary companions often drawn from storybook characters, real-life playmates who had moved away, and pets and toys whom they believed could talk. One of my subjects had seen the movie Camelot as a child and, for two years, imagined being the son of Arthur and Guinevere, commanding the King’s court.
Parents of fantasizers encourage imaginative play. Fantasy occupies much of these people’s adult lives, too, getting them through boring chores and free time. Some fantasizers superimpose their daydreams onto their daily tasks. “I’m listening to my boss carefully,” recounted one subject, “but I’m seeing the Saturday Night Live character `Mockman’ next to him, imitating all his gestures.”
o Parents of fantasizers often disciplined their children by reasoning with them instead of laying down hard-and-fast laws, using imagination to evoke empathy. “One time, I’d gotten in a fight in nursery school with another girl because I’d picked up a doll that was her favorite,” one subject recalled.
“She tried to take it away from me and I pushed her down. The teacher told my mother about it. My mother told me I should think about what the girl had felt like when she fell. I actually felt like I was her, hitting the floor, scraping one knee, and crying. I could also feel her desperation and her thought that the doll was really hers, even though it belonged to the school; she had named it and everything. I wouldn’t have done that again.”article continues after advertisement
Although none of the fantasizers in the study reported experiencing severe childhood
abuse, when they were spanked or verbally belittled, they typically used fantasy and imaginary companions to restore their
self-esteem. Powerful aliens came down and kidnapped subjects’ parents and chained them in a dungeon, for example, or were arrested by the police or sent back to grade school.
Not surprisingly, fantasizers become deeply absorbed in stories, movies, and drama, often becoming oblivious to real-world stimuli. They often find it impossible to pry themselves away from a good novel unless someone is shouting at them; they may be surprised to find themselves sitting in a theater seat at the end of a movie. Fantasizers prolong these dreamy states of mind by incorporating them into daily life, dialoguing with a book or film hero for weeks after first reading about them or seeing them onscreen.
Fantasizers have such lively imaginations that visual images can trigger physical sensations. They describe feeling hot and wanting a cool drink, for example, in response to seeing photos of the desert. They also shiver through the snowy scenes in Dr. Zhivago. Half of the female fantasizers in my study had experienced false pregnancy at some point in their lives, complete with physiological changes.
Many fantasizers even reach orgasm through imagination alone. They do so by conjuring up scenarios both vivid and varied, involving partners of both sexes, circus animals, magical beings, and suggestively shaped inanimate objects, for starters. Furthermore, even when having real-life sex with real partners, fantasizers continue to use their imaginations: flesh-and-blood lovers utter imagined comments, dress in hallucinated attire, have movie stars’ faces (and occasionally other body parts) superimposed, and are joined by additional, fantasized partners.
Hypnosis is a natural extension of all these whimsical experiences. Most fantasizers find being in a formal trance more vivid than other imagery in their daily lives, but similar. When I tell fantasizers they will not remember anything about hypnosis after exiting a trance, they sometimes do, anyway. None of them experienced amnesia when I did not explicitly suggest it.
All awakened immediately alert after hypnosis. Not only did fantasizers go into a trance instantly as Barber and Wilson had noted, but they could come out of it instantly–most likely because there was not an extremelydifferent state of consciousness to emerge from. Their most common reaction to hypnosis was a big smile.
Dissociators
When I first read Wilson and Barber’s study, I’d already hypnotized thousands of people in the course of hypnotherapy, research, and the training of several graduate students. Their “fantasizer” described many people I’d known who were highly hypnotizable. But I had also seen others who didn’t fit this model.
Some of the people I’d hypnotized couldn’t remember ever having experienced such vivid imagery. Wilson and Barber used standard measures of response to hypnosis in selecting the most hypnotizable subjects, but they also included the unusual criterion of being able to enter a trance instantly. I wondered if this selected only one particular type of hypnotizable person.
When I interviewed highly hypnotizable people who could not go into trance instantly, I found a completely different subgroup, comprising a third of my subjects. Instead of remembering hypnosis for its vivid imagery, this group tended to have amnesia or to experience separate states of consciousness during hypnosis. I dubbed these people “dissociators.”
They have the following traits in common: Many such subjects reported a history of child abuse. Although some remembered this directly, some had been told by others that they had been battered, and one suspected it was because of multiple childhood bone fractures of dubious origins. Other dissociators who had not been abused had suffered childhood traumas such as prolonged, painful medical conditions and before the age of 10 experienced the deaths of their parents. Some dissociators say that they have developed the ability to “not think about” unpleasant things–a skill that they grow to use more and more frequently and subconsciously. They seem to evolve this adaptive talent for coping to ease the pain and difficulty of their early lives.
While fantasizers have excellent recall for daydreams, movies, and stories that have captured their imagination, dissociators are usually unable to recall them. They are often startled when called on unexpectedly by a teacher or a boss and often state that their mind has been “somewhere else,” though they can’t describe that place. They get intensely absorbed in books and films, losing track of time, but their memory of the stories is vague shortly thereafter.
Somewhat like fantasizers, dissociators report that images in their daily lives can produce physical sensations. Most of these sensations, however, are negative. One subject in my study developed a rash after he was told that a harmless vine was poison ivy. Some dissociators avoid watching the television news because seeing others injured is so painful for them.
Dissociaters do not recall being hypnotized as clearly and cheerfully as fantasizers. For example, when a dissociator in my study was asked whether she’d ever been hypnotized, she answered “maybe” and described watching a police show on television with her boyfriend in which a detective was hypnotizing a witness. He swung his watch and told the witness to go into a deep sleep. The dissociater remembered nothing else of the show until she woke 20 minutes later, during a scene in which the detective was waking his witness.
Dissociaters don’t have the same variety of sexual imagery that their fantasizer counterparts report. In fact, they are often disturbed by even mild sexual fantasies. Dissociaters in my study always had amnesia after hypnosis when I suggested it during their trances. Some lacked recall even when it was not suggested. Dissociaters woke up from hypnosis looking disoriented, asking what had happened. Just as they need a lengthy transition to go into trance, they take a bit of time to emerge from it.
If you recognized yourself as a fantasizer, you’re not alone: Fantasizers are almost twice as common in the general population as dissociators. Still, dissociators are more common in the clinical population, since they’re more likely than fantasizers to have psychological problems.
That’s good news for those who related to the dissociator profile, since not only are you more likely to go into a trance, but you’re more likely to benefit from it, too. Even if neither group seems similar to your own personality, take heart: About 95% of all people are susceptible to hypnosis, to varying degrees. Whether you use it to relieve stress, stop a headache or get over a bad habit, hypnosis is a tool for better health that practically everyone can use–some to dramatic effect. How well it will work depends on you.
BBy: Deirdre Barrett
