Giuseppe De Benedittis
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DOI: http://dx.doi.org/10.1016/j.jphysparis.2015.11.001
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NEURAL MECHANISMS OF HYPNOSIS AND
MEDITATION
Giuseppe De Benedittis
ABSTRACT
Hypnosis has been an elusive concept for science for a long time. How-
ever, the explosive advances in neuroscience in the last few decades have
provided a bridge of understanding between classical
neurophysiological studies and psychophysiological studies. These
studies have shed new light on the neural basis of the hypnotic
experience. Furthermore, an ambitious new area of research is focusing
on mapping the core processes of psychotherapy and the neurobiology\
underlying them. Hypnosis research offers powerful techniques to isolate
psychological processes in ways that allow their neural bases to be
mapped. The Hypnotic Brain can serve as a way to tap neurocognitive
questions and our cognitive assays can in turn shed new light on the
neural bases of hypnosis. This cross-talk should enhance research and
clinical applications.
An increasing body of evidence provides insight in the neural
mechanisms of the Meditative Brain. Discrete meditative styles are likely
to target different neurodynamic patterns. Recent findings emphasize
increased attentional resources activating the attentional and salience
networks with coherent perception. Cognitive and emotional equanimity
gives rise to an eudaimonic state, made of calm, resilience and stability,
readines to express compassion and empathy, a main goal of Buddhist
practices. Structural changes in gray matter of key areas of the brain
involved in learning processes suggest that these skills can be learned
through practice.
Hypnosis and Meditation represent two important, historical and
influential landmarks of Western and Eastern civilization and culture
respectively. Neuroscience has beginning to provide a better
understanding of the mechanisms of both Hypnotic and Meditative Brain,
outlining similarities but also differences between the two states and
processes.
2
MECHANISMS OH HYPNOSIS
INTRODUCTION
Hypnosis has long been an elusive concept for science due to the lack
of objective neurobiological markers of the state of trance, but the
relentless advances in neuroscience in the last few decades (largely due to
the introduction and refinement of sophisticated electrophysiological and
neuroimaging techniques) have opened up a bridge of knowledge
between the classic neurophysiological studies and psychophysiological
studies of cognitive, emotional, and sensory systems (De Benedittis,
2003). This is the foundation of neurophenomenology (Varela, 1996).
While recent advances in neuroscience have undoubtedly contributed
to unravelling the Veil of Maya of the Hypnotic Brainthat is its neuro-
cognitive structure (De Benedittis, 2006)hypnosis is also increasingly
being recognized by the international scientific community as a valid and
flexible physiological tool to explore the central and peripheral nervous
system. This seems to be a real Copernican revolution in the field (De
Benedittis, 2004).
Current hypnosis research focuses on two major areas (De Benedittis,
2012) (Fig. 1): (a) intrinsic research, that is the research line concerned
with the functional anatomy of hypnosis per se, in the absence of specific
suggestions, the so-called neutral hypnosis or default hypnosis, and
the neurophysiological mechanisms underlying the hypnotic experience
in dynamic conditions, and (b) instrumental research (or extrinsic
studies), the use of hypnosis and suggestion for studying a wide range of
cognitive and emotional processes as well as for creating virtual
analogues of neurological and psychopathological conditions in order to
elucidate their underpinnings and eventually positively change the way
we treat them.
INTRINSIC STUDIES
An important fallout of neuroscience research concerns the precise
status of hypnosis: discrete state of consciousness or process? Reality or
hoax?
3
For a long time hypnosis has been the subject of a quarrel between the
dominant credulous view (i.e., those claiming hypnosis is an altered
state of consciousness) and the sceptical view (i.e., those challenging
the existence of hypnosis condition, based on the lack of objective
indicators of trance and the reproducibility of hypnotic effects in a wak-
ing state through appropriate motivating suggestions) (Barber, 1969).
This axiological uncertainty has been widely and definitively overcome
by a growing body of convergent neurophysiological researchnamely
electrophysiology and neuroimaging - contributing to significant
advances in our knowledge of hypnotic phenomena, including functional
neuroanatomy of neutral hypnosis. These include electrophysiological
studies (e.g., bispectral analysis), neuroimaging (e.g., single-photon
emission computed tomography (SPECT), functional magnetic resonance
imaging (fMRI), positron emission tomography (PET) ), advanced
neuroimaging (e.g., real-time fMRI and brain-computer interface), and
neurofeedback (De Benedittis, 2012).
EEG Studies
Hypnotic states and hypnotic responding (including hypnotic
analgesia) are associated more often by increase in theta and gamma
activity, with higher levels of theta tending to be associated with higher
hypnotizability and hypnotic responding. ( Ray, 1997 ;Williams and
Gruzelier, 2001; Jensen et al., 2015 ). These findings, particularly
relating to gamma activity, show an overall inconsistency in the research
studies (De Pascalis, 2007).
Neuroscience has not only contributed to validating and defining the
state of trance; it has also enabled us to differentiate between altered
states of consciousness and ordinary states of consciousness. Bispectral
electroencephalographic analysis, a sophisticated and complex evolution
of spectral analysis, has proved to be effective in differentiating between
subjects awake and subjects in trance on the basis of the bispectral (BIS)
index (De Benedittis, 2008).
Bispectral analysis utilizes a composite of multiple advanced
electroencephalography (EEG) signal processing techniques, including
bispectral analysis, power spectral analysis, and time domain analysis. It
is a robust aid in monitoring the hypnotic effect of anaesthetics and has
emerged as an important tool for anaesthesia management. The BIS
index reflects the level of conscious sedation and/or loss of consciousness
in patients undergoing general anaesthesia. The BIS Index is a number
between 0 and 100 that correlates with important endpoints during
administration of anaesthetic agents. BIS values near 100 represent a
fully awake clinical state, while BIS value near 0 represent isoelectric
EEG or cerebral death. When the BIS index value decreases below 80
the probability of explicit recall decreases dramatically. At a BIS index of
4
less than 60, a patient has a very low probability of consciousness (i.e. ,
anaesthetized subject).
Bispectral analysis and the BIS index can reliably measure and moni-
tor the depth of hypnotic trance, thus distinguishing the hypnotic zone
quantitatively and qualitatively from different levels and states of
consciousness. The Hypnotic Zone BIS index ranges between 77 and
92 (De Benedittis, 2008), with a subject within this BIS index range
likely to be into hypnotic trance.
For the first time the state of trance can be identified by an objective
and reliable (electrophysiological) marker, as compared with the
inadequate phenomenological (experiential) and behavioural
(measurement scales of hypnotic depth) data of the past (De Benedittis,
2008).
In a more recent study (Hinterberger et al., 2011), detectability of
electrophysiological state changes during a hypnotic session as a
correlate to the instructions was reported in one highly susceptible
subject, with significant and congruent state changes occurring
synchronously with specific induction instructions. There was also a
highly significant increase in broadband activity during the stepwise
trance induction that may point to a deep hypnotic state.
Neuroimaging Studies
Several neuroimaging (fMRI, PET) studies (Maquet, 1999;
Faymonville et al., 2000; Rainville et al., 2002; Egner et al., 2005; Cojan
et al., 2009; Del Casale et al., 2012) have contributed to creating a map of
Regions of Interest (ROI) in the brain during neutral or default
hypnosis (i.e., hypnosis in the absence of any specific suggestion),
including the occipital cortex (involved in visualization processing,
which is so important for the induction and the experience of hypnosis),
thalamus, anterior cingulate cortex (ACC), inferior parietal cortex,
precuneus (that normally mediates imagery and self-awareness) (Cojan et
al., 2009), and dorsolateral prefrontal cortex. Perhaps we are not far from
being able to draw a Neurosignature (functional neuroanatomy) of
hypnosis.
Moreover, neuroimaging findings suggest a potential anatomical
(morphological and volumetric) basis for hypnotizability, linking
variations in the rostrum of corpus callosum to differences in attentional
and inhibitory processes (Horton et al., 2004). In a more recent study
(Hoeft et al., 2012), high-compared to low-hypnotizable individuals
showed greater functional connectivity between left dorsolateral
prefrontal cortex (DLPFC), an executive-control region of the brain, and
the salience network composed of the dorsal anterior cingulate cortex
(dACC), anterior insula, amygdala, and ventral striatum, involved in
detecting, integrating, and filtering relevant somatic, autonomic, and
5
Hypnotic Analgesia
A second fruitful area of intrinsic research has enabled a better
understanding of the multidimensional neural mechanisms underlying
hypnotic processes and responseshypnotic analgesia (Jensen, 2008).
One of the oldest medical applications of hypnosis concerns the control
of pain, whose effectiveness, known for some time, has only recently
found indisputable confirmation at the level of evidence-based medicine
in published meta-analyses of randomized controlled studies in both
acute and chronic pain (see review in De Benedittis, 2003; 2004).
Hypnotic analgesia represents a significant paradigm of how
neurophysiological and neuropsychological research has contributed
decisively to a better understanding of the mechanisms of
multidimensional pain control in trance. Since pain has a
multidimensional structure involving sensory-discriminative,
motivational-affective, and evaluative (attentional) aspects (Melzack and
Casey, 1968), it is likely that hypnotic analgesia involves multiple
mechanisms of pain modulation.
Spinal Mechanisms
Hypnotic analgesia may also depend on the activation of descending
inhibitory systems that specifically modulate the spinal transmission of
the nociceptive input. The involvement of these systems during hypnotic
suggestions of analgesia has been demonstrated by electrophysiological
studies that have documented that hypnosis significantly reduces the
amplitude of the nociceptive flexion reflex (R-III), believed to be linearly
related to the intensity of perceived pain (Kiernan et al., 1995; Danziger
et al., 1998) and the effect was proportional to the level of hypnotic sug-
gestibility.
Cognitive Modulation
Hypnosis can be considered as a heuristic paradigm of cognitive
modulation (De Benedittis, 2012). Potential domains of current and
future research include: attentional processes, pain control, manipulation
of mental images and perceptual processes, mnestic processes, ex-
ploration of conscious and unconscious processes, neurocognitive
processes, and genetic determinants of hypnotic responsiveness.
Visual and Auditory Perception
In addition to pain perception, the ability of hypnotic suggestions to
modulate other perceptions has been investigated in several
neuroimaging studies. One study on hypnotic suggestions of auditory
hallucinations (Szechtman et al., 1998) has shown that the brain areas
activated are essentially the same during the actual perception of an
auditory stimulus (albeit with a gradient of less intensity of activation).
Similarly, Kosslyn and colleagues (2000) have shown that visual
illusions under hypnosis activate visual associative areas similar to those
activated when perceiving a real visual stimulus. These studies suggest
that the line between real perception of a stimulus and distorted
perception (i.e., illusion) or absence of a stimulus (i.e., hallucination) is
more elusive than formely believed.
Sensory Hallucinations
Derbyshire and colleagues (2004) have used hypnotically suggested
pain in normal pain-free individuals to create an unequivocal analogue of
functional pain. They found that the hypnotic pain experience was
associated with widespread activation in classic pain areas (thalamus,
anterior cingulate cortex, insula, prefrontal cortex, and parietal cortex),
similar to that seen with a comparable physically induced pain and
proportionate to the level of subjective pain reported. Interestingly, this
activation pattern was not seen when participants were asked to imagine
the same pain experience.
Motor Hallucinations
11
CONCLUSIONS
INTRODUCTION
NEUROPHENOMENOLOGY OF MEDITATION
EXPERIENTIAL CORRELATES
NEURAL CORRELATES
Meditation states and traits are being explored with neuroelectric and
neuroimaging methods. The findings are becoming more cohesive and
directed, even though a comprehensive empirical and theoretical
foundation is still emerging. CNS function is clearly affected by
meditation, but the specific neural changes an differences among
practices are far from clear.
Neuroimaging Studies
Early studies. Early neuroimaging studies on relaxation practice and
meditation provide the first evidence of functional brain changes using
or C during a relaxation practice and a meditative practice,
respectively. oga idr , literally oga- leep, is a state in the oga
tradition where consciousness of the world and consciousness of action
are meant to be dissociated the mind withdraws from wishing to act
and is not associated with emotions or the power of will. study of
blood flow changes during oga idr practice was carried out by (199
and colleagues (1999). During all meditative phases, overall increases in
bilateral hippocampus, parietal, and occipital sensory and association
regions were found compared to control conditions. This pattern suggests
an increase of activity in areas involved in imagery.
Deactivation was found during meditation in orbitofrontal, dorsolateral
prefrontal, anterior cingulate cortices, temporal and inferior parietal
lobes, caudate, thalamus, pons, and cerebellum. This differential activity
was interpreted as reflecting a tonic activity during normal
consciousness in baseline condition. The areas decreasing during the
meditation state are known to participate in executive function or control
of attention. The AA. interpreted these results as reflecting dissociation
between two complementary aspects of consciousness: the conscious
experience of the sensory world and the fact or illusion of voluntary
control, with self regulation.
22
Experiential Correlates
26
GENERAL CONCLUSIONS
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FIGURE CAPTIONS
THERAVADA MAHAYANA
Concentrative
Samadhi Taoism
Object Meditation
Zen
Abstract
Vipassana
Objectless
Mindfulness Meditation
Loving-kindness
Tong-Len
Meditation
Table(s)
HYPNOSIS MEDITATION
EXPERIENTIAL
DETERMINANTS
NEURAL
DETERMINANTS
Brain States
Theta Activity + +
Gamma Activity + +
Neuroimaging ROIs
ACC + +
Frontal + +
Precuneus + ?
Occipital + ?
Functional Connectivity + +
Structural Connectivity - + (Long-Term)
PSYCHOSOCIAL
DETERMINANTS