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Hypnotic suggestion: opportunities for cognitive neuroscience

Key Points

  • For well over a century, hypnotic suggestion has been used to successfully treat a wide range of clinical conditions, including chronic and acute pain, irritable bowel syndrome, post-traumatic stress disorder, phobias and eating disorders.

  • Hypnosis uses the powerful effects of attention and suggestion to produce, modify and enhance a broad range of subjectively compelling experiences and behaviours.

  • Participants typically describe these perceptual and behavioural changes as 'real', not imaginary and beyond voluntary control.

  • Hypnotic suggestibility is normally distributed in human populations and remains a stable individual trait. None of the major personality variables, however, correlate with hypnotic suggestibility.

  • Many of the striking effects produced by targeted suggestions in hypnosis can be generated without prior hypnotic induction in a substantial number of people.

  • The availability of functional imaging techniques and growing acceptance of the 'cognitive unconscious' in shaping experience and behaviour has provided opportunities for cognitive neuroscientists to explore the neurocognitive correlates of hypnosis and suggestion.

  • Improvements in experimental design have made it possible to make inroads into the functional anatomy of hypnosis itself (intrinsic research). The induction of hypnosis is associated with reduced brain activity in anterior parts of the default-mode system and increased activity in prefrontal attentional systems.

  • Several recent studies using hypnotic suggestion have modified established examples of 'automaticity' in cognitive processing (such as the Flanker, Stroop and McGurk effects), demonstrating the potential that hypnotic suggestion has for probing theories of cognitive functioning in the laboratory.

  • Recent studies using hypnotic suggestion as an experimental tool for neuroscience research (instrumental research) show how manipulating subjective awareness in the laboratory can provide theoretical insights into normal brain mechanisms involved in attention, motor control, pain perception, beliefs and volition.

  • This instrumental approach allows researchers to uncover the putative cognitive origins of clinical symptoms, such as medically unexplained paralysis seen in conversion disorder (hysteria), hallucinations, delusions and alterations in control over thought and action seen in schizophrenia.

Abstract

Hypnosis uses the powerful effects of attention and suggestion to produce, modify and enhance a broad range of subjectively compelling experiences and behaviours. For more than a century, hypnotic suggestion has been used successfully as an adjunctive procedure to treat a wide range of clinical conditions. More recently, hypnosis has attracted a growing interest from a cognitive neuroscience perspective. Recent studies using hypnotic suggestion show how manipulating subjective awareness in the laboratory can provide insights into brain mechanisms involved in attention, motor control, pain perception, beliefs and volition. Moreover, they indicate that hypnotic suggestion can create informative analogues of clinical conditions that may be useful for understanding these conditions and their treatments.

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Figure 1: Modulating the default-mode and attentional networks using hypnosis.
Figure 2: Using hypnotic suggestion to abolish the Stroop effect.
Figure 3: fMRI images of hypnotic pain and physical pain.

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Acknowledgements

We are grateful to J. Kihlstrom and I. Kirsch for their encouraging and helpful comments on an earlier version of this review.

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Correspondence to David A. Oakley or Peter W. Halligan.

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Glossary

Interrogative suggestibility

The tendency, during cross-examination, to yield to leading questions and to shift replies once interpersonal pressure has been applied.

Placebo suggestibility

An expectancy-based tendency to experience a positive outcome after the administration of an inert substance or ineffective treatment.

Chevreul pendulum effect

A pendulum held by an individual is experienced as moving 'all by itself' in response to expectation or suggestion (see 'ideomotor movement').

Hypnotic analogues

Reversible simulations of clinical conditions produced by tailored hypnotic suggestions informed by clinical phenomenology.

Ideomotor movements

Apparently involuntary or spontaneous movements of the body or held objects corresponding to an individual's thoughts or beliefs but produced by unconscious motor activity.

Psychosomatic interactions

When an individual's erroneous belief (for example, “I touched a poisonous leaf”) results in a bodily reaction (for example, inflammation of the skin).

Choice blindness

The failure to notice that the consequences of a previous freely made choice have changed.

Postural sway

The tendency of the body to sway from side to side or front to back when standing still.

Alexia

An acquired inability to read.

Gender change

The creation (for example, by hypnotic suggestion) of a subjectively compelling belief in an individual that their sexual identity has been reassigned.

Intermetamorphosis

The belief that one has physically and psychologically become another person.

Somatoparaphrenia

A delusional belief that one's own limb belongs to someone else.

Mirrored-self-misidentification

The belief that one's reflection in the mirror is a stranger.

Associative prosopagnosia

The loss, or significant impairment, of the ability to recognize familiar people by their face.

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Oakley, D., Halligan, P. Hypnotic suggestion: opportunities for cognitive neuroscience. Nat Rev Neurosci 14, 565–576 (2013). https://doi.org/10.1038/nrn3538

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