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Using hypnosis to disrupt face processing: Mirrored-self misidentification delusion and different visual media

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Mirrored-self misidentification delusion is the belief that one's reflection in the mirror is not oneself. This experiment used hypnotic suggestion to impair normal face processing in healthy participants and recreate key aspects of the delusion in the laboratory. From a pool of 439 participants, 22 high hypnotisable participants ("highs") and 20 low hypnotisable participants were selected on the basis of their extreme scores on two separately administered measures of hypnotisability. These participants received a hypnotic induction and a suggestion for either impaired (i) self-face recognition or (ii) impaired recognition of all faces. Participants were tested on their ability to recognize themselves in a mirror and other visual media - including a photograph, live video, and handheld mirror - and their ability to recognize other people, including the experimenter and famous faces. Both suggestions produced impaired self-face recognition and recreated key aspects of the delusion in highs. However, only the suggestion for impaired other-face recognition disrupted recognition of other faces, albeit in a minority of highs. The findings confirm that hypnotic suggestion can disrupt face processing and recreate features of mirrored-self misidentification. The variability seen in participants' responses also corresponds to the heterogeneity seen in clinical patients. An important direction for future research will be to examine sources of this variability within both clinical patients and the hypnotic model.
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ORIGINAL RESEARCH ARTICLE
published: 18 June 2014
doi: 10.3389/fnhum.2014.00361
Using hypnosis to disrupt face processing: mirrored-self
misidentification delusion and different visual media
Michael H. Connors1,2,3 *, Amanda J. Barnier1, 2 , Max Coltheart 1,2 , Robyn Langdon 1,2 , Rochelle E. Cox1, 2 ,
Davide Rivolta 4,5,6 and PeterW. Halligan1, 7
1ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
2Department of Cognitive Science, Macquarie University, Sydney, NSW, Australia
3Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
4School of Psychology, University of East London, London, UK
5Department of Neurophysiology, Max Planck Institute for Brain Research, Frankfurt am Main, Germany
6Ernst Strüngmann Institute for Neuroscience in Cooperation with Max Planck Society, Frankfurt am Main, Germany
7School of Psychology, Cardiff University, Cardiff, UK
Edited by:
Aina Puce, Indiana University, USA
Reviewed by:
Aina Puce, Indiana University, USA
Devin Terhune, University of Oxford,
UK
*Correspondence:
Michael H. Connors, Dementia
Collaborative Research Centre, School
of Psychiatry, Level 3, Australian
Graduate School of Management
Building (G27), University of New
South Wales, Sydney, NSW 2052,
Australia
e-mail: michael.connors@mq.edu.au
Mirrored-self misidentification delusion is the belief that one’s reflection in the mirror is
not oneself.This experiment used hypnotic suggestion to impair normal face processing in
healthy participants and recreate key aspects of the delusion in the laboratory. From a pool
of 439 participants, 22 high hypnotisable participants (“highs”) and 20 low hypnotisable
participants were selected on the basis of their extreme scores on two separately
administered measures of hypnotisability.These participants received a hypnotic induction
and a suggestion for either impaired (i) self-face recognition or (ii) impaired recognition of all
faces. Participants were tested on their ability to recognize themselves in a mirror and other
visual media – including a photograph, live video, and handheld mirror – and their ability to
recognize other people, including the experimenter and famous faces. Both suggestions
produced impaired self-face recognition and recreated key aspects of the delusion in highs.
However, only the suggestion for impaired other-face recognition disrupted recognition of
other faces, albeit in a minority of highs. The findings confirm that hypnotic suggestion
can disrupt face processing and recreate features of mirrored-self misidentification. The
variability seen in participants’ responses also corresponds to the heterogeneity seen in
clinical patients. An important direction for future research will be to examine sources of
this variability within both clinical patients and the hypnotic model.
Keywords: delusion, face perception, hypnosis, instrumental hypnosis, mirror sign, mirrored-self misidentification,
self-recognition, visual self-recognition
INTRODUCTION
Hypnotic suggestions can temporarily disrupt or alter many cog-
nitive processes (Hilgard, 1965;Kihlstrom, 1985,2007;Oakley
and Halligan, 2009,2013). In visual perception, for example, spe-
cific hypnotic suggestions can cause participants to hallucinate
(Szechtman et al., 1998), become blind (Bryant and McConkey,
1999), or selectively ignore particular areas of their visual field
(Oakley and Halligan, 2009;Priftis et al., 2011). These experi-
ences can be very compelling – to the point that many participants
have difficulty distinguishing the hypnotically suggested alter-
ations from reality (Woody and Szechtman, 2000,2011;Bryant
and Mallard, 2003) – yet are completely reversible (Hilgard, 1965;
Kihlstrom, 1985,2007). In some cases, these alterations may
even reflect changes to otherwise automatic cognitive processes
(Lifshitz et al., 2013). Hypnotic suggestion is thus a powerful
tool to manipulate and study cognition (Oakley and Halligan,
2009,2013). One such application is in the study of clinical
disorders (Kihlstrom, 1979). In previous work, we used hyp-
notic suggestion to disrupt self-recognition and “model” the
neuropsychiatric mirrored-self misidentification delusion, the
belief that one’s reflection in the mirror is a stranger (e.g.,
Connors et al., 2012a). The current experiment extends this work
by using hypnotic suggestion to disrupt face processing while test-
ing both self-recognition and face recognition across different
visual media.
MODELLING MIRRORED-SELF MISIDENTIFICATION DELUSION
Mirrored-self misidentification delusion commonly occurs in
dementia. Approximately 2–7% of patients with Alzheimer’s dis-
ease misidentify their own reflection in the mirror (see Connors
and Coltheart, 2011;Connors et al., in press-b). The delusion can
also occur in schizophrenia (Gluckman, 1968) and after stroke
(Villarejo et al., 2011). Patients vary in their reactions to the
“stranger.” Some patients treat their reflection as a companion
(Phillips et al., 1996). Other patients remain indifferent (Breen
et al., 2001) or are deeply suspicious of the stranger (Gluckman,
1968). The delusion can occur despite intact semantic knowl-
edge of mirrors (e.g., being able to define their properties and
function; Breen et al., 2001). The delusion can also occur despite
an ability to accurately recognize other people’s reflections in the
mirror (Spangenberg et al., 1998;Breen et al., 2001;Villarejo et al.,
2011).
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Connors et al. Hypnotic mirrored-self misidentification
The influential two-factor theory of clinical delusions provided
by Langdon and Coltheart, 2000 (see also Coltheart et al., 2011)
proposes that two separate factors are necessary for a delusion. The
first factor (Factor 1) explains the content of a delusion and typi-
cally involves some type of perceptual and/or emotional anomaly.
In the case of mirrored-self misidentification, either impaired face
processing (which leads to a difficulty in recognizing one’s own
face in the mirror) or mirror agnosia (an inability to use mir-
ror knowledge when interacting with mirrors) can lead to the
idea that there is a stranger in the mirror (Breen et al., 2001).
The second factor (Factor 2) explains why the delusion is main-
tained and involves a deficit in belief evaluation. This second factor
accounts for why some patients with impaired face processing
or mirror agnosia develop a delusion and others do not (for a
description of patients with these deficits without the delusion,
see Ellis and Florence, 1990;Connors and Coltheart, 2011). The
second factor may result from damage to the prefrontal cortex.
This damage may be specific to the right dorsolateral prefrontal
cortex (Coltheart, 2010), though it might also involve other areas,
such as the ventromedial prefrontal cortex (Gilboa, 2010;Tur ner
and Coltheart, 2010) or right inferior frontal gyrus (Sharot et al.,
2011).
Delusions are difficult to study because of co-occurring symp-
toms and impairments. Mirrored-self misidentification delusion,
in particular, is difficult to study because of the cognitive and
neurological deterioration associated with dementia. Hypnotic
suggestion allows researchers to recreate critical aspects of the
delusion while avoiding some of these challenges (Kihlstrom,
1979;Kihlstrom and Hoyt, 1988;Cox and Barnier, 2010;Con-
nors, 2012). Hypnotic suggestion is able to recreate many of
the “surface features” of mirrored-self misidentification. The
majority of high hypnotisable participants (“highs”), for exam-
ple, who are hypnotized and given a suggestion to see a
stranger in a mirror, report this experience and show fea-
tures strikingly similar to clinical patients (Barnier et al., 2008,
2011). Participants, for example, maintain this belief when chal-
lenged and interact with their reflection as if it were another
person.
Hypnosis may also be able to model the underlying neuropsy-
chological processes of mirrored-self misidentification delusion
as specified by the two-factor theory. Whereas a suggestion for
impaired face processing or mirror agnosia may produce the
content of the delusion (Factor 1), hypnosis by itself may dis-
rupt belief evaluation (Factor 2; Connors et al., 2012a,b,2013).
People tend to accept ideas during hypnosis that they would
normally reject in an ordinary, everyday state of consciousness
(Shor, 1959). In support of this, previous research has shown
that a hypnotic induction by itself reduces the ability of highs to
distinguish between suggested and real events (Bryant and Mal-
lard, 2003); encourages more holistic, rather than detail-oriented,
processing of visual memory (Crawford and Allen, 1983); and
affects brain areas, such as the upper pons, thalamus, rostral
areas of the right anterior cingulate cortex, prefrontal cortex,
and right inferior parietal lobule, that are involved in atten-
tion, absorption, and critical thinking (Rainville et al., 2002;
Oakley, 2008;Deeley et al., 2012). Our previous research has
compared participants given suggestions either with or without
hypnosis to manipulate Factor 2 and demonstrated that hypno-
sis is necessary for most participants to experience the delusion
(Connors et al., 2012a,2013). Specific suggestions within hypno-
sis may thus allow researchers to create a laboratory model of
mirrored-self misidentification and hence the unique opportu-
nity to investigate selective cognitive influences in a controlled
manner.
RESPONSES TO DIFFERENT VISUAL MEDIA
Given the apparent success of the hypnotic modeling paradigm
so far, the current experiment aimed to better define some of the
parameters of hypnotic mirrored-self misidentification. In par-
ticular, we focused on the impaired face processing (Factor 1)
thought to be responsible for the delusion’s content and sought
to extend previous research in three ways. First, we examined
whether hypnotic disruptions to self-face recognition generalized
to include other visual media. This is directly relevant to the clin-
ical disorder. Some patients with mirrored-self misidentification,
for example, remain able to recognize themselves in photographs
(Phillips et al., 1996;Breen et al., 2001) and small, handheld mir-
rors (Kumakura, 1982;Feinberg, 2001). Other patients, however,
fail to recognize themselves in photographs (Biringer et al., 1991)
orinanytypeofmirrororreectivesurface(Gluckman, 1968;
Spangenberg et al., 1998). In healthy participants, there is also
evidence that self-face recognition in photographs involves dif-
ferent neural mechanisms to mirror images (Butler et al., 2012;
Suddendorf and Butler, 2013).
Second, we examined whether the hypnotic mediated disrup-
tions to face processing affected recognition of other people’s faces.
In the clinical condition, patients with mirrored-self misidentifi-
cation vary to the extent that they can recognize images of other
people. Whereas some patients recognize people other than them-
selves in the mirror (e.g., Spangenberg et al., 1998;Breen et al.,
2001;Van den Stock et al., 2012), other patients report that all
people in the mirror are strangers (Phillips et al., 1996;Breen et al.,
2001). Some patients are also impaired in recognizing famous faces
(Breen et al., 2001). The current experiment therefore examined
whether participants recognized the hypnotist in the mirror,a pho-
tograph of person familiar to them (their lecturer), and a series of
famous faces.
Finally, we attempted to create a more general deficit in face
processing and examined whether the type of impairment spec-
ified in the hypnotic suggestion affected participants’ responses.
This is theoretically important because there are different views
on the type of face processing deficit responsible for mirrored-
self misidentification. The account by Phillips et al. (1996) implies
that a deficit specific to self-face recognition is responsible for the
content of the delusion and explains why some patients can recog-
nize other people in the mirror but not themselves. An alternative
account by Breen et al. (2001; see also Langdon, 2011), however,
suggests that a more general face processing deficit is responsible
for the content of the delusion and is evident in neuropsychological
tests of face processing in some patients. Against this background,
this experiment compared two suggestions to help disambiguate
different types of face processing deficit. The first suggestion was
the Factor 1 suggestion for impaired face processing used in previ-
ous work (Connors et al., 2012a,2013,in press-a). This suggestion
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Connors et al. Hypnotic mirrored-self misidentification
indirectly implied that participants would only fail to recognize
their own face in the mirror, so is referred to here as the sug-
gestion for impaired self-face recognition. The second suggestion
was a new suggestion designed to impair recognition of all faces.
Itisreferredtohereasthesuggestion for impaired general-face
recognition.
OVERVIEW OF THE CURRENT EXPERIMENT
A hypnotist provided high and low hypnotisable participants
with a hypnotic induction and either a suggestion for impaired
self-face recognition or a suggestion for impaired general-face
recognition. The experimenter then asked participants to iden-
tify who they saw in a mirror and in a series of photographs that
included participants’ own photograph and a photograph of a
high profile lecturer from their psychology course. The experi-
menter then tested participants’ ability to recognize famous faces
in a forced-choice familiarity test (see Young and De Haan, 1988;
Rivolta et al., 2010,2012). After this, the experimenter tested
whether participants could identify themselves in a live video
image and then a handheld mirror. Next, to assess participants’
understanding of mirrors, the experimenter asked them to define
mirrors and to touch a ball that was only visible by its reflec-
tion in the mirror on the wall (see Connors and Coltheart, 2011).
Finally, the experimenter tested participants’ ability to recognize
the hypnotist in the mirror when the hypnotist stood next to
them.
This order of tests was not counterbalanced as previous work
suggested that some challenges were more likely to break down
the delusion than others (Barnier et al., 2011;Connors et al.,
2012a). As a result, the tests were presented in a fixed order,
starting with those considered to be least confronting and ending
with the most confronting. It was expected that both sugges-
tions would generate mirrored-self misidentification in highs, but
not lows. In particular, it was expected that whereas highs given
the suggestion for impaired self-face recognition would be able
to recognize themselves in the other visual media and recognize
other faces, highs given the suggestion for impaired general-face
recognition would not recognize themselves or other faces in any
media.
MATERIALS AND METHODS
PARTICIPANTS AND DESIGN
Participants were selected from a pool of 439 students (101 males,
318 females, 20 not disclosed) of mean age 22.06 years (SD =6.25)
on the basis of a 10-item modified version of the Harvard Group
Scale of Hypnotic Susceptibility, Form A (HGSHS:A; Shor and Orne,
1962). High scorers (participants who scored 7 or greater) and
low scorers (participants who scored 3 or less) were invited to
participate in the current experiment, which also included an 11-
item modified version of the Stanford Hypnotic Susceptibility Scale,
Form C (SHSS:C; Weitzenhoffer and Hilgard, 1962)1in the same
session. Participants received payment ($20 for 1.5 h) for their
1The 10-item modified HGSHS:A included: head falling, eye closure, hand lower-
ing, finger lock, moving hands together,communication inhibition, experiencing of
fly, eye catalepsy, posthypnotic suggestion, and posthypnotic amnesia; arm rigidity
and arm immobilization items were removed to ensure that the procedure could
be conducted within the time limits of a1hclass. The 11-item tailored SHSS:C
involvement. A total of 51 participants (16 males, 35 females)
of mean age 21.92 years (SD =6.10) completed this session.
Only participants who scored in the range 7–11 (highs)or03
(lows) on both the HGSHS:A and SHSS:C were included in the
analyses.
The final sample consisted of 22 highs (8 males, 14 females)
of mean age 21.32 years (SD =3.85), and 20 lows (7 males, 13
females) of mean age 21.15 years (SD =5.28). Highs had a mean
score of 8.05 (SD =0.90) on the HGSHS:A and 8.91 (SD =1.23)
on the SHSS:C. Lows had a mean score of 1.60 (SD =1.19) on
the HGSHS:A and 1.55 (SD =1.19) on the SHSS:C. Participants
weretestedina2(hypnotisability: high vs. low) ×2 (suggestion:
impaired self-face recognition vs. impaired general-face recog-
nition) between-subjects design. Participants were asked not to
participate if they had any ongoing psychological condition, prob-
lems with substance abuse, or if they had ever suffered a serious
head injury or neurological illness. All participants provided writ-
ten informed consent. Research was approved by the Macquarie
University Human Research Ethics Committee.
MATERIALS AND PROCEDURE
The hypnotist tested participants individually in a 90 mins ses-
sion. This session consisted of an experimental session and a
postexperimental inquiry. Both the experimental session and the
postexperimental inquiry were recorded using a video camera.
Experimental session
Before the experiment, the hypnotist briefly explained the exper-
iment and obtained participants’ informed consent. Next, the
hypnotist took participants’ photograph using a digital camera.
The hypnotist then printed the photograph, unbeknownst to par-
ticipants, who were occupied completing payment forms. To do
this, the hypnotist used a Canon Selphy CP780 compact photo
printer to produce a standard 14.8 cm ×10.0 cm color photo-
graph. Once printed, the photograph was placed in a photo album
containing nine other photographs of faces that were produced
using the same camera and printer.
The hypnotist then administered a standard hypnotic induction
(10 min, from the SHSS:C; Weitzenhoffer and Hilgard, 1962).
The hypnotist administered the first 10 items from the SHSS:C
and scored participants’ responses.
Suggestion. After these items, the hypnotist uncovered a mirror
(40 cm ×50 cm) that was mounted on a wall next to the partic-
ipants’ chair. The mirror was positioned so that participants could
look directly into it by turning their head to the left and leaning
slightly forward (see Figure 1). The hypnotist gave participants
one of two suggestions for a deficit in face processing. Partici-
pants were randomly assigned to receive either the suggestion for
impaired self-face recognition (11 highs, 10 lows) or the sugges-
tion for impaired general-face recognition (11 highs, 10 lows). The
suggestion for impaired self-face recognition was:
included: hand lowering, moving hands apart, mosquito hallucination, taste hallu-
cination, arm rigidity, dream, age regression, arm immobilization, anosmia, negative
visual hallucination, and posthypnotic amnesia; the auditory hallucination item was
removed to ensure that the procedure could be conducted within the time limits of
a 1 h individual session.
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Connors et al. Hypnotic mirrored-self misidentification
FIGURE 1 |Topographical view of materials in the experiment. The mirror was covered with a screen when the participant entered the room. The computer
was positioned at 45from the participant’s chair, though the participant could rotate their chair to face the screen directly.
When you look to your left,there will be a mir rorthere, and you will see
a person in it. When you see this person in the mirror, you will not be
able to recognize this person. When you open your eyes and turn your
head to your left, whilst remaining as deeply relaxed and comfortably
hypnotized as you feel now, you will see a face in the mirror that you
will not be able to identify, as if you have never seen this face before.
The suggestion for impaired general-face recognition was:
When you look to your left, there will be a mirror there, and you will
see a person in it. When you see this person in the mirror, you will
not be able to recognize this person. In fact, when you open your eyes
and look around, you will not be able to recognize any person you see.
That’s right, whenever you see a face, it will seem unfamiliar to you and
you will not be able to recognize who it is. When you open your eyes
whilst remaining as deeply relaxed and comfortably hypnotized as you
feel now, all faces will seem unfamiliar to you and you will not be able
to recognize them.
The hypnotist checked that participants understood the sugges-
tion. The hypnotist then asked participants to slowly open their
eyes, turn their head to the left, and look into the mirror.
Test 1: mirror 1. The hypnotist asked participants to identify who
they saw in the mirror and to briefly describe them. If participants
reported seeing someone other than themselves, the hypnotist
asked participants if they had ever seen this person before.
Test 2: photograph. The hypnotist handed participants a photo
album that contained the participants’ photograph and nine other
photos (eight of unfamiliar faces, one of their lecturer’s face) in one
of four fixed randomized orders. The hypnotist asked participants
to look at each photo one at a time and to indicate whether the
face was familiar or unfamiliar. If participants reported that a face
was familiar, the hypnotist asked participants who the person was.
When this was completed, the hypnotist took the photo album
from participants and asked participants to close their eyes.
Test 3: Famous faces. The hypnotist placed a keyboard on partici-
pants’ lap and started the forced choice familiarity task of famous
faces on the computer (see Rivolta et al., 2012, for more detail). As
shown in Figure 1, the computer was positioned in the room
approximately 45to the participants’ right; participants were
asked to swivel their chair to face the screen directly. The hyp-
notist explained to participants that two faces would appear on
the computer screen at the same time. One face would belong to
someone famous; the other face would belong to someone who
was not famous. Participants had to indicate using the keyboard
which face was the famous face – that is, whether they thought the
famous face was on the left or on the right. The task had 30 trials
and involved 30 sets of faces: 30 famous faces (actors, politicians,
and musicians who were well known to Australian participants)
and 30 unfamiliar faces matched as closely as possible for age, sex,
and attractiveness. The famous faces included Jennifer Aniston,
Tony Blair, Sandra Bullock, George Bush, Nicholas Cage, Prince
Charles, Bill Clinton, George Clooney, Kevin Costner, Tom Cruise,
Robert De Niro, Johnny Depp, Cameron Diaz, Leonardo DiCaprio,
Clint Eastwood, Queen Elizabeth II, Mel Gibson, Hugh Grant,
Tom Hanks, Paris Hilton, Dustin Hoffman, John Howard, Nicole
Kidman, Madonna, Kylie Minogue, Brad Pitt, Julia Roberts, John
Travolta, Robin Williams, and Catherine Zeta-Jones. The faces
were presented as black and white photographs, approximately
10 cm high, on a 51 cm ×32 cm (24 ) Macintosh computer
screen. The order and positioning (left vs. right) of the famous
faces were randomized. Participants were approximately 50 cm
from the computer screen and gave their responses by pressing rel-
evant keys on the keyboard. There was no time limit on responses;
once a response was selected, the next set of faces appeared. The
hypnotist told participants they should try to be as accurate as
they could and that if they were unsure they should guess (there
was no emphasis on speed). After these instructions, the hypnotist
Frontiers in Human Neuroscience www.frontiersin.org June 2014 |Volume 8 |Article 361 |4
Connors et al. Hypnotic mirrored-self misidentification
asked participants to open their eyes and begin the task. When
the task was completed, the hypnotist took the keyboard from
participants.
Test 4: mirror 2. The hypnotist asked participants to look again
at the mirror on their left and to identify who they saw. This was
done to see whether participants maintained their delusion after
the famous faces task.
Test 5: video. The hypnotist activated a live video feed of the
participants’ face and shoulders on the computer screen. This
required a second video camera, focused on participants, which
was concealed above the computer screen. The hypnotist asked
participants to look at the computer screen and identify who they
saw. The hypnotist then turned off the computer screen.
Test 6: handheld mirror. The hypnotist gave participants a hand-
held mirror to hold and asked them to identify who they saw in it.
The hypnotist then took the handheld mirror from participants.
Test 7: mirror agnosia. The hypnotist first asked participants to
define what mirrors are. The hypnotist then held a plastic ball,
slightly larger than a tennis ball, above participants’ shoulder
and asked them to touch the ball. The hypnotist looked to see
whether participants reached towards the ball or towards the ball’s
reflection in the mirror (as in mirror agnosia; see Connors and
Coltheart, 2011).
Test 8: mirror 3 and hypnotist’s reflection. The hypnotist asked
participants to once again look at the mirror on the wall to
their left. The hypnotist then moved position so that participants
could see the hypnotist’s reflection in the mirror. The hypnotist
asked participants who they saw. If participants reported seeing
the hypnotist but not themselves, the hypnotist asked them to
explain how they could see the hypnotist but not themselves.
The hypnotist then touched participants on the shoulder while
they were looking in the mirror and asked participants what
happened.
Cancellation and deinduction. The hypnotist canceled the sug-
gestion by telling participants that everything was back to normal
and that they were able to recognize themselvesand other faces, just
as they always had been able to. The hypnotist asked participants
to look in the mirror once more and checked that they could rec-
ognize themselves. Next, the hypnotist gave participants the final
SHSS:C suggestion for posthypnotic amnesia and administered the
SHSS:C deinduction, which involved gradually awakening partic-
ipants as the hypnotist counted from 20 to 1. The hypnotist then
tested and canceled participants’ posthypnotic amnesia.
Postexperimental inquiry
For all media (mirror, photograph, video, handheld mirror), the
hypnotist asked participants to describe their experience of look-
ing at it and to rate the extent to which they believed that they
were looking at a stranger (1 =notatall,7=completely). The
hypnotist also asked participants to repeat the famous faces task to
assess whether participants showed different responses when not
affected by hypnosis or suggestion. Finally, the hypnotist debriefed
participants and thanked them for their time.
Coding of responses
After testing all participants, the hypnotist and a rater (who was
unaware of the aims of the experiment and the conditions in which
participants were tested) independently examined the videotape
records of the experiment. The two raters scored whether or not
participants recognized themselves in each of the different visual
media. The raters also scored whether or not participants rec-
ognized their lecturer in a photograph and the hypnotist in the
mirror. Interrater reliability was 100%.
RESULTS
EXPERIENCING THE DELUSION
Participants were scored as passing the suggestion if they identified
their reflection in the mirror as someone other than themselves.
Overall, 9 (82%) highs given the suggestion for impaired self-face
recognition and 5 (46%) highs given the suggestion for impaired
general-face recognition passed the suggestion. Fisher’s exact test
showed that this difference did not reach statistical significance,
p=0.18. No lows passed the suggestion. The 14 highs who
reported seeing a stranger were asked if they had ever seen this
person before. Of these, 10 (71%; 8 impaired self-face recogni-
tion, 2 impaired general-face recognition) said they had never
seen the person before, 2 (14%; 2 impaired general-face recog-
nition) said they had seen the person before, and 2 (14%; 2
impaired self-face recognition) were unsure. Consistent with pre-
vious research (Connors et al., 2013,2014), a post hoc analysis
revealed that highs who passed the suggestion had higher SHSS:C
scores than highs who failed the suggestion, F(1,18) =4.56,
p=0.05, η2
p=0.20, but did not differ on HGSHS:A scores,
F(1,18) =0.24, p=0.63, η2
p=0.01. The remainder of the results
focus on the highs who passed the suggestion unless otherwise
specified.
RESPONSE TO THE DIFFERENT MEDIA
The responses of participants to the different visual media are
shown in Table 1. Participants were scored as being impaired on
these tests if they failed to identify themselves. Statistical com-
parisons using Fisher’s exact test revealed that more highs given
the impaired self-face recognition suggestion failed to recognize
themselves in the photograph (p=0.02) and in the mirror the sec-
ond time it was presented (p=0.02) than highs who received the
impaired general-face recognition suggestion. There was, however,
no differences between suggestions in terms of highs’ responses to
the video (p=0.15), handheld mirror (p=0.59), or the mirror
on its third presentation (p=1.00).
Overall, three highs (27%) given the impaired self-face recogni-
tion suggestion and one high (9%) given the impaired general-face
recognition suggestion failed to recognize themselves in all visual
media – these four highs maintained the suggested experience
across all tests. In contrast, two highs (18%) given the impaired
self-face recognition suggestion and six highs (55%) given the
impaired general-face recognition suggestion recognized them-
selves in all visual media – these eight highs failed the suggested
experience. The remaining six highs (55%) given the impaired
self-face recognition suggestion and four highs (36%) given
the impaired general-face recognition suggestion showed mixed
responses – these ten highs recognized themselves in some media
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Connors et al. Hypnotic mirrored-self misidentification
Table 1 |The number and percentage of participants who failed the visual tests.
Highs Lows
Impaired
self-face
(n =11)
Impaired
general-face
(n =11)
Impaired
self-face
(n =10)
Impaired
general-face
(n =10)
1. Mirror 1 9 (82%) 5 (45%) 0 (0%) 0 (0%)
2. Photograph 7 (64%) 1 (9%) 0 (0%) 0 (0%)
Lecturer’s photograph 3 (27%) 5 (45%) 2 (20%) 2 (20%)
3. Famous Faces 0 (0%) 2 (18%) 0 (0%) 0 (0%)
4. Mirror 2 7 (64%) 1 (9%) 0 (0%) 0 (0%)
5. Video 5 (45%) 1 (9%) 0 (0%) 0 (0%)
6. Handheld mirror 3 (27%) 1 (9%) 0 (0%) 0 (0%)
7. Mirror agnosia* 0 (0%) 0 (0%) 0 (0%) 0 (0%)
8. Mirror 3 3 (27%) 1 (9%) 0 (0%) 0 (0%)
Hypnotist in mirror 0 (0%) 1 (9%) 0 (0%) 0 (0%)
Tests in italics involved recognition of other people; *test does not involve self or other recognition.
but not others. Some of these highs initially failed to recognize
themselves in the mirror but breached the suggested experience
during the course of the experiment. In the case of the impaired
self-face recognition suggestion, two of the nine highs (22%) who
initially passed the suggestion reported recognizing themselves
in the mirror the second time it was presented. In the case of
the impaired general-face recognition suggestion, four of the five
highs (80%) who initially passed the suggestion reported recog-
nizing themselves in the mirror the second time it was presented.
This left only one high given the impaired general-face recogni-
tion suggestion who failed to recognize themselves across different
visual media. These findings implied that the experience of the
impaired general-face recognition suggestion broke down more
quickly than the experience of the impaired self-face recognition
suggestion.
Despite this, highs given the impaired general-face recogni-
tion suggestion were more likely to not recognize other people
than highs given the impaired self-face recognition suggestion. A
greater proportion of highs who passed the impaired general-face
recognition suggestion failed to recognize their lecturer’s photo-
graph or the hypnotist in the mirror than highs who passed the
impaired self-face suggestion (Tabl e 1 ). This difference between
suggestions was also evident in the famous faces task. Partici-
pants were scored as being impaired on the famous faces task
if their scores were at chance during the experiment, but sig-
nificantly above it once the suggestion was canceled. As shown
in Table 1, two highs (18%) given the suggestion for impaired
general-face recognition met this criterion: They scored 10/30 and
14/30 during the experiment, but were unimpaired when they
repeated the task in the postexperimental inquiry and scored 30/30
and 28/30, respectively. In contrast, no highs given the impaired
self-face suggestion and no lows had difficulty completing the
famous faces task (for highs, M=26.68, SD =5.08; for lows,
M=27.35, SD =2.23). A repeated-measures ANOVA, however,
revealed no group differences between highs and lows or between
the two suggestions, most likely due to the small number of par-
ticipants experiencing these effects (all Fs<3.22, all ps>0.08, all
η2
ps<0.08).
All participants’ ratings of belief in the postexperimental
inquiry are shown in Ta ble 2. Ratings across the different media
were compared using a mixed ANOVA with between-subject fac-
tors of hypnotisability (high vs. low) and suggestion (impaired
self-face recognition vs. impaired general-face recognition) and a
within-subject factor of visual media (mirror, photograph, video,
handheld mirror). In all media, highs rated their belief that they
were looking at a stranger higher than lows, F(1,38) =33.77,
p<0.01, η2
p=0.47. There was also a significant difference
between visual media, F(3,38) =11.25, p<0.01, η2
p=0.23,
and a significant interaction between hypnotisability and visual
media, F(3,38) =8.60, p<0.01, η2
p=0.19. Whereas highs overall
reported moderate ratings for the mirror and gave declining rat-
ings thereafter,lows reported consistently low ratings for all visual
media. There was no difference between suggestions and no inter-
actions between hypnotisability and suggestion (all Fs<3.63,
all ps>0.07, all η2
ps<0.09). Overall, this indicates that the
effects were limited to highs, effects declined somewhat over the
visual media, and there were no clear differences between the two
suggestions.
During the postexperimental inquiry, highs who passed the
suggestion described a compelling experience. When asked about
their experience of looking in the mirror, highs given the sugges-
tion for impaired self-face recognition made comments like, “It
just wasn’t me. I thought that if I looked in the mirror, I would
see me, but it didn’t look or feel like me.” Another high given
this suggestion said, “It was a bit bewildering actually ... I was
looking at someone in there but I couldn’t register who it was. I
was confused. I thought, ‘Who is this person?”’ Highs given the
suggestion for impaired general-face recognition reported similar
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Connors et al. Hypnotic mirrored-self misidentification
Table 2 |The postexperimental ratings of all participants regarding the extent to which they believed they were looking at a stranger in each of
the visual media.
Highs Lows
Impaired self-face Impaired general-face Impaired self-face Impaired general-face
Mirror 4.73 (1.49) 3.45 (2.02) 1.10 (0.32) 1.10 (0.32)
Photograph 3.73 (1.85) 2.55 (1.86) 1.10 (0.32) 1.70 (0.95)
Video 3.27 (1.49) 2.00 (1.84) 1.00 (0.00) 1.10 (0.32)
Handheld Mirror 2.36 (1.43) 1.91 (1.76) 1.00 (0.00) 1.00 (0.00)
Ratings were made on a scale of 1-7 (1 =not at all, 7 =completely). Standard deviations are in parentheses.
experiences. One high given this suggestion, for example, said,“It
was weird. I know when you look in the mirror, it’s meant to be
you, but it was just unfamiliar. I just didn’t recognize it was me.”
Another high given this suggestion said, “I actually felt like there
was actually another person in the mirror. That another person
was looking back at me. They felt familiar, but I didn’t know who
they were.”
When asked about the other visual media, many highs reported
similar experiences as when looking in the mirror. When describ-
ing the experience of looking at his photo, one high given the
suggestion for impaired self-face recognition said, “I remember
looking at it and being confused, like I was in the mirror. I felt
as if I should know who it was, but I didn’t.” Another high given
this suggestion described looking at her photo in a similar way: “I
eventually came to the conclusion that I had never seen this person
before. It was a similar experience to when I was looking in the
mirror.”When asked about the live video, highs said,“It felt weird,
very similar to the feeling I had when I looked in the mirror. It
just felt like I should be seeing me but it wasn’t me. Sort of famil-
iar, like feeling familiar with it, but also very unfamiliar.” Other
highs made comments like, “He looked very familiar. It looked
like the guy in the mirror” and “I didn’t think it looked like me.
It just felt like someone really foreign, someone I wasn’t familiar
with.”
When asked about the handheld mirror during the postexper-
imental inquiry, one high said he saw, “The same thing [as the
mirror]. Just familiar but unfamiliar. Not what I would normally
expect to see and feel.” The one high who received the suggestion
for impaired general-face recognition and maintained the delu-
sion reported that she did not remember her experiences looking
in the mirror. Such unsuggested posthypnotic amnesia is rare (Hil-
gard and Cooper, 1965;Hilgard, 1966;Cooper, 1979), but was also
present in a participant in a previous experiment (Connors et al.,
2012b). The other high given this suggestion who was impaired on
the famous faces task described his experience as very compelling:
“I found it extremely difficult. They both just looked famous, I
could not really tell. Sometimes I could tell them apart after a
while but sometimes I just had no clue who it was.” However,
these highs were in the minority; the majority of highs reported
recognizing the famous faces and recognizing themselves in the
handheld mirror.
A number of highs who did not show the delusion reported
that they had some difficulty recognizing themselves. Three highs
who received the suggestion for impaired general-face recognition
said that they were initially unsure who they were looking at. Two
of these highs said that they concluded it was them when they
noticed the person in the mirror was wearing the same clothes as
them, and the third said he recognized it was him when he saw
the person move at the same time as he did. Likewise, four highs
who displayed the delusion and failed to recognize themselves
in the mirror (two impaired self-face recognition, two impaired
general-face recognition) reported some initial difficulty recogniz-
ing themselves in the live video. These highs said they concluded
it was themselves because they recognized the room they were
in. A further three highs who experienced the delusion after the
suggestion for impaired self-face recognition said that they had
difficulty recognizing themselves in the handheld mirror but that
the fact that they were holding and controlling it led them to
believe it was themselves. Finally, one high (given the suggestion
for impaired self-face recognition) breached her delusion after the
hypnotist appeared next to her. This participant described hav-
ing difficulty reconciling her subjective experience with what she
knew to be true: “When you moved behind me, I realized it had
to be me in the mirror. I still had some doubts though. My expe-
rience was that I still didn’t think it was me, but logically it had to
be me.”
DISCUSSION
OVERVIEW
Both hypnotic suggestions disrupted the ability of highs to recog-
nize themselves in the mirror. Highs, however, showed a different
pattern of responses to the other visual media depending on the
nature of the suggestion received. When tested on their ability to
recognize themselves in other visual media, a proportion of highs
given the suggestion for impaired self-face recognition failed also
to recognize themselves in a photograph, in a live video, and in
a handheld mirror. In contrast, only one high who received the
suggestion for impaired general-face recognition failed to recog-
nize herself in other visual media. When tested on their ability to
recognize other faces using the famous faces task, no highs given
the suggestion for impaired self-face recognition were impaired,
whereas two highs given the suggestion for impaired general-face
recognition were impaired. Although these findings are obviously
limited by the small numbers of highs passing and maintaining the
delusion, the findings show the potential for these two suggestions
to model different aspects of mirrored-self misidentification.
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Connors et al. Hypnotic mirrored-self misidentification
SELF-FACE RECOGNITION IN DIFFERENT VISUAL MEDIA
As in previous work (Connors et al., 2012a), a hypnotic suggestion
for impaired self-face recognition was able to recreate the surface
features of the mirrored-self misidentification delusion. In partic-
ular, participants reported that their reflection was not themselves
and maintained this belief over time. The current experiment
extended previous findings by examining how participants with
the hypnotic delusion responded to different visual media. The
findings show that this suggestion affected the ability of some
highs to recognize themselves in other visual media, despite not
directly specifying this in the suggestion. As expected, however,
the suggestion for impaired self-face recognition did not impair
the ability of highs to recognize other people. Highs given this
suggestion correctly identified their lecturer’s photograph, iden-
tified the hypnotist in the mirror, and were not impaired in the
famous faces task. These highs also showed an intact procedu-
ral understanding of mirrors. These findings indicate hypnotic
suggestion might be able to selectively impair self-face recogni-
tion in some participants. Nevertheless, this pattern of responses
differs from some clinical patients with mirrored-self misidentifi-
cation who often show more general deficits in face processing
(Phillips et al., 1996;Breen et al., 2001;Van den Stock et al.,
2012).
Thisexperimentusedanewsuggestion–asuggestionfor
impaired general-face recognition. This suggestion for impaired
general-face recognition, however, did not seem to be as successful
at generating mirrored-self misidentification as the original sug-
gestion. Fewer participants receiving this suggestion reported the
delusion than those receiving the original suggestion, although
this difference did not reach statistical significance. The resulting
delusion also broke down quickly, leaving only one participant
who maintained the delusion through all the tests. This partic-
ipant failed to recognize herself or other people in any of the
different visual tests, yet showed an intact procedural understand-
ing of mirrors. Although limited by the single participant, this
high demonstrates that it is possible to generate a general face
processing deficit using hypnotic suggestion. Importantly, two
highs given the suggestion for impaired general-face processing
were impaired on the famous faces task. These participants per-
formed at a level very similar to patients with prosopagnosia, a
condition in which participants have difficulty recognizing faces
(Behrmann and Avidan, 2005;Rivolta et al., 2013) and show
impairments in recognizing famous faces in forced choice tasks
(Young and De Haan, 1988;Rivolta et al., 2012). Unlike patients,
however, these two participants showed no sign of impairment
once the suggestion was canceled. These findings indicate that
hypnotic suggestion can create a general face processing deficit
that can be measured on a formal neuropsychological test. The
findings are consistent with Oakley and Halligan (2013),who
used hypnotic suggestion to model prosopagnosia in a single par-
ticipant. The current experiment replicated these finding using
a more stringent, forced-choice measure, though only in two
participants. Together, these findings indicate that hypnotic sug-
gestion may be able to disrupt face processing in certain high
hypnotisable participants. However, the fact that only 18% of
highs given this suggestion showed this deficit reveals the diffi-
culty of this type of hypnotic suggestion (as a comparison, 23%
of highs in this experiment passed the suggestion for negative
visual hallucination – to not see a specific object – in the SHSS:C;
this suggestion is known to be difficult even for highs; Hilgard,
1965).
Other factors may have also prevented some participants from
responding to the suggestion for impaired general-face recogni-
tion. Three participants reported in the postexperimental inquiry
that they felt anxious when they heard this suggestion and were
worried about what it would be like to not recognize faces. None
of these participants experienced the delusion and it is possible
that their anxiety interfered with their response to the suggestion.
A fourth participant reported in the postexperimental inquiry that
she had difficulty imagining what it would be like to not recog-
nize faces. This participant likewise did not develop the delusion
and it is possible that her difficulty anticipating the effects of the
suggestion prevented her from responding. Overall, these findings
highlight a limitation of using hypnosis to model clinical condi-
tions. Responses are affected by factors such as the participants’
expectations and interpretations, as well as the relative difficulty
of the suggestion. It is thus not the verbatim suggestion, but the
participants’ interpretation of the suggestion and ability to expe-
rience it that shapes their response (McConkey, 1991,2008). It
is important to consider these factors when designing a hypnotic
analog (see Connors et al., 2012b).
For both suggestions, a proportion of highs breached the hyp-
notic delusion during the visual tests. The visual tests, although
not designed to challenge participants’ hypnotic experiences, pro-
vided accumulating evidence against the hypnotic delusion and
this may have led some highs to breach their delusion. As
a result, it is difficult to compare the different tests because
they were given in a single order that was designed to mini-
mize breaching. However, the fact that some highs breached the
delusion is consistent with previous research, which found that
directly challenging the hypnotic delusion with confronting evi-
dence led some participants to breach the delusion and report
seeing themselves in the mirror (Connors et al., 2012a). The
finding is also consistent with research that has found that a pro-
portion of highs experiencing a hypnotic delusion (Noble and
McConkey, 1995;Cox and Barnier, 2009) or posthypnotic amne-
sia (Kihlstrom et al., 1980;McConkey and Sheehan, 1981;Coe,
1989;Coe and Sluis, 1989) breach their experience in response
to challenges. Hypnotic effects require participants to resolve the
conflict between objective reality and the suggested experience
(McConkey, 1983;Mallard and Bryant, 2006). Challenges both
draw attention to and increase this conflict, leading some partic-
ipants to breach the suggested effect. Nevertheless, a proportion
of highs maintain their hypnotic responses in the face of con-
fronting evidence and an important question for future research
is whether particular individual differences predict whether par-
ticipants maintain or breach their hypnotic experience (Connors
et al., 2014).
HETEROGENEITY IN RESPONSES
As in previous work (Connors et al., 2012a), hypnotized par-
ticipants displayed considerable variation in their responses to
hypnotic suggestions and this variation corresponds to hetero-
geneity seen in clinical reports. Both hypnotized participants and
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Connors et al. Hypnotic mirrored-self misidentification
clinical patients, for example, vary in the extent to which they rec-
ognized themselves in photographs, video, and handheld mirrors
(Biringer et al., 1991;Breen et al., 2001;Connors and Coltheart,
2011). For both hypnotized participants and clinical patients, it is
likely that the specific properties of the different visual media influ-
ence self-recognition. These properties may, in part, explain why
some participants (and patients) recognize themselves in some
visual media but not in others. Mirrors, for example, offer move-
ment and depth cues that are not present in photographs. As a
result, mirrors provide a highly realistic image that could be con-
fused with a real person, whereas photographs provide a static,
two-dimensional image that is unlikely to be confused in the same
way (see also Butler et al., 2012;Suddendorf and Butler, 2013). In
a similar way, a handheld mirror shows just the face in its narrow
field of vision and is accompanied with greater physical control of
the visual image than a larger mirror on the wall. All these cues
could lead some participants and patients to identify themselves in
a handheld mirror, despite being unable to identify themselves in a
larger mirror on the wall and a clear understanding of how mirrors
operate.
A large part of the variability, however, may also originate
from the participants and patients themselves. Within the hyp-
notic model, for example, there are a number of sources of
variation. Highs might interpret the same verbal suggestion in
different ways to each other (see McConkey, 1991,2008) and/or
differ in their ability to experience specific types of hypnotic effects
(see Woody et al., 2005). As a result, they may have different
responses to the visual media. Highs also could use different cog-
nitive strategies to experience the suggestion and this could lead
to different responses (McConkey, 1991,2008;McConkey and
Barnier, 2004). Previous research, for example, has shown that
highs using a constructive strategy (in which they actively use
cognitive strategies to experience the hypnotic suggestion) were
more likely to pass a suggestion for hypnotic blindness than par-
ticipants using a concentrative strategy (in which they focused
on the hypnotist’s words; Bryant and McConkey, 1990). In addi-
tion, highs could vary in terms of how completely they respond
to the suggestion (see Spanos, 1986). Cognitive-delusory sugges-
tions tend to be more difficult to experience, even for highs, and
highs could vary in their ability to generate a compelling and vivid
experience.
In the clinical delusion, there are a number of other sources
of variation. The variability, for example, could be due to the
specific aspects of face processing that are impaired (see Lang-
don, 2011). The influential model of face processing by Bruce and
Young (1986) holds that face processing involves a sequence of
stages. These stages include encoding the structural properties of
a face, experiencing a sense of familiarity if the face is known,
accessing semantic information about the person, and naming the
person. Patients who only have impairment at a late stage of face
processing (such as in accessing semantic information or nam-
ing) may still experience a sense of familiarity when looking at
images of themselves in some media. This sense of familiarity
could provide the basis of self-face recognition in these instances
(see Mandler, 1980). In contrast, patients who have more pervasive
impairments or impairment at an earlier stage of face processing
(such as in encoding the structural properties of faces) may fail to
experience even this sense of familiarity when looking at images of
themselves. As a result, these patients may fail to recognize them-
selves in all media. Future research couldinvestigate this possibility
by directly testing clinical patients and potentially also by using
hypnotic models.
IMPLICATIONS AND FUTURE DIRECTIONS
The current study has a number of limitations that could be
addressed in future work. Given the significant variability evi-
dent among participants, larger sample sizes will be required to
fully define the nature of the face-perception deficits and exam-
ine the role of individual differences. Future research could also
formally test for both familiarity and recognition, use other
types of face processing tests, and use larger numbers of tri-
als to detect smaller effects. In addition, future research could
examine the specific visual cues that participants use to recog-
nize themselves in different media. Research, for example, could
vary the size of the image in each media, use time delayed
video footage to remove contingency cues, and disguise the video
monitor as a mirror by placing a frame around it to alter expec-
tations associated with the medium. As mirrors present images
in a different orientation to photographs, reversing the axis of
left and right, future research could also examine the role of
this visual transformation by presenting photographs of par-
ticipants and famous faces in this orientation. Finally, given
that several participants suggested that their anxiety might have
prevented them from experiencing the impaired general-face
recognition suggestion, future research could consider revising
the wording of this particular suggestion to make it appear
more benign. This could be done, for example, by emphasiz-
ing that the effect would only be temporary and by suggesting
that participants might find the experience both pleasant and
interesting.
In addition to these issues, we acknowledge a number of impor-
tant differences between clinical delusions and hypnotic models.
Clinical delusions are functionally disruptive, and typically endure
for long periods of time and across different contexts. In con-
trast, hypnotic delusions are short-lived, highly contextualized,
and limited to the laboratory (see Barnier et al., 2008;Cox and
Barnier, 2010). These differences between clinical and hypnoti-
cally suggested delusions obviously limit the ability to generalize
experimental findings to clinical patients. For example, the longer
duration of clinical delusions may lead to more extensive elab-
oration of the delusion, compared to the shorter exposure in
otherwise healthy controls and where delusions are observed
at their inception. Indeed, clinical patients with mirrored-self
misidentification can often seem accustomed, even indifferent,
to the stranger and attribute names and details to them (Breen
et al., 2001). In contrast, many hypnotized participants appear
surprised or shocked to see a stranger in the mirror and report
not having seen the person before or knowing who they are. This
difference in timeframe may be useful to simulate the experiences
of patients when their delusion first forms, which is usually not
possible to study directly in clinical patients. It is also impor-
tant to note, though, that some aspects of the delusion may
not be captured in the hypnotic model as they may require
the persistence of the experience over long periods of time and
Frontiers in Human Neuroscience www.frontiersin.org June 2014 |Volume 8 |Article 361 |9
Connors et al. Hypnotic mirrored-self misidentification
across different contexts. It is also important to recognize that,
despite our focus on a monothematic delusion, many patients
reporting this belief may experience other clinically related symp-
toms as a result of their overall condition (see Brodaty et al.,
2013a,b).
Despite these differences, specific hypnotic suggestions could
be used to test theoretical accounts of other clinical delusions.
Other delusions, such as Capgras (the belief that a loved one is
replaced by a visually similar impostor) and Frégoli (the belief
that familiar people are following one around in disguise), may
be due, in part, to disorders in face processing (Ellis and Young,
1990; see also Coltheart et al., 2011;Langdon, 2011). In Capgras
delusion, loss of autonomic responsiveness to faces may lead to
the idea that a known person has been replaced by an impos-
tor. In Frégoli delusion, heightened autonomic responsiveness
to faces may lead to the idea that strangers are known people
in disguise. Future research could use hypnotic suggestion to
manipulate face processing and model these other clinical delu-
sions. According to Langdon and Coltheart’s (2000) two-factor
theory, a deficit in belief evaluation is also necessary for a delu-
sion to form. In other research we have conducted (Connors
et al., 2012a,2013), we have found that a hypnotic induction
can model this Factor 2 and specifically disrupt belief evalua-
tion. It remains possible, however, that some individuals may not
need to have a deficit in belief evaluation hypnotically induced
in order to accept a suggestion for a delusional belief (Connors
et al., 2013). In particular, pre-existing differences in the belief
evaluation process could themselves act as Factor 2 and predis-
pose certain individuals to delusions. Within hypnosis, there is
also some evidence of variability in how highs rate their subjec-
tive experiences of a hypnotic induction (Terhune and Cardeña,
2010) and in how they objectively respond to suggestions follow-
ing different types of hypnotic inductions (Brown et al., 2001). An
important direction for future research, therefore, is to character-
ize the nature of Factor 2 in both clinical patients and hypnotic
analog.
Hypnotic suggestions can also be used to investigate face pro-
cessing independently of delusional belief. Specific suggestions
can be designed to selectively impair specific stages of face pro-
cessing within cognitive models. Adopting Bruce and Young’s
(1986) influential account, for example, a suggestion to not be
able to discriminate features in faces could disrupt the struc-
tural encoding of faces, a suggestion to not recognize familiar
faces could disrupt face recognition units that represent pre-
viously seen faces, and a suggestion to not be able to recall
personal information about faces could disrupt the person iden-
tity nodes that link recognized faces to knowledge about the
people. The ability to produce these effects on demand makes
hypnotic suggestion particularly suited to neuroimaging (Oak-
ley and Halligan, 2009,2013;Woody and Szechtman, 2011).
Future research could examine the underlying functional neu-
roanatomy and altered functional connectivity associated with
hypnotic disruptions to face processing. Such investigations have
the potential to inform neural models of face processing (see
Gobbini and Haxby, 2007;Haxby and Gobbini, 2011;Kanwisher
and Barton, 2011). While it is important to carefully screen
participants both on their hypnotisability and their ability to
experience these specific suggestions in order to carry out such
research, hypnotic suggestion provides a unique means of exam-
ining how higher-order cognitive processes influence different
stages of face perception. As such, hypnosis offers considerable
promise as a methodology to study both face perception and its
pathologies.
ACKNOWLEDGMENTS
We are grateful to Graham Jamieson, John Kihlstrom, and
Andrew Young for helpful comments on an earlier version of this
manuscript. We are also grateful to Jocelyn Elliott and Talia Morris
for their research assistance. This research was supported by the
Australian Research CouncilCentre of Excellence in Cognition and
its Disorders (CE110001021). Davide Rivolta was supported by the
LOWE grant Neuronale Koordination Forschungsschwerpunkt
Frankfurt (NeFF).
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Conflict of Interest Statement: The authors declare that the research was conducted
in the absence of any commercial or financial relationships that could be construed
as a potential conflict of interest.
Received: 09 October 2013; accepted: 11 May 2014; published online: 18 June 2014.
Citation: Connors MH, Barnier AJ, Coltheart M, Langdon R, Cox RE, Rivolta D and
Halligan PW (2014) Using hypnosis to disrupt face processing: mirrored-self misiden-
tification delusion and different visual media. Front. Hum. Neurosci. 8:361. doi:
10.3389/fnhum.2014.00361
This article was submitted to the journal Frontiers in Human Neuroscience.
Copyright © 2014 Connors, Barnier, Coltheart, Langdon, Cox, Rivolta and Halligan.
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... The term "hypnotic suggestion" denotes here all types of verbal recommendations addressed by a hypnotist to someone else about what this person might perceive, feel, think, memorize, or do while hypnotized. For example, well hypnotized individuals commonly report significant changes of the gestalt of objects [1][2][3], modulations of colour [4][5][6], hue [4] and other physical properties of visual stimuli [7]. Further studies have reported deafness or modulated loudness [8], and changes of the smell of olfactory stimuli [9]. ...
... We argue that highly suggestible participants generally complied better with task instructions, and showed better counting accuracy in CON but were significantly hampered by the hypnotic suggestion when counting during HYP. This hypnosis-related impairment of visual perception confirms earlier studies, e.g., on visual gestalts [1][2][3], colour [4][5][6], and hue [4]. ...
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Several theories of hypnosis assume that responses to hypnotic suggestions are implemented through top-down modulations via a frontoparietal network that is involved in monitoring and cognitive control. The current study addressed this issue re-analyzing previously published event-related-potentials (ERP) (N1, P2, and P3b amplitudes) and combined it with source reconstruction and connectivity analysis methods. ERP data were obtained from participants engaged in a visual oddball paradigm composed of target, standard, and distractor stimuli during a hypnosis (HYP) and a control (CON) condition. In both conditions, participants were asked to count the rare targets presented on a video screen. During HYP participants received suggestions that a wooden board in front of their eyes would obstruct their view of the screen. The results showed that participants’ counting accuracy was significantly impaired during HYP compared to CON. ERP components in the N1 and P2 window revealed no amplitude differences between CON and HYP at sensor-level. In contrast, P3b amplitudes in response to target stimuli were significantly reduced during HYP compared to CON. Source analysis of the P3b amplitudes in response to targets indicated that HYP was associated with reduced source activities in occipital and parietal brain areas related to stimulus categorization and attention. We further explored how these brain sources interacted by computing time-frequency effective connectivity between electrodes that best represented frontal, parietal, and occipital sources. This analysis revealed reduced directed information flow from parietal attentional to frontal executive sources during processing of target stimuli. These results provide preliminary evidence that hypnotic suggestions of a visual blockade are associated with a disruption of the coupling within the frontoparietal network implicated in top-down control.
... Literature has evidence for defects in spatial orientation of reflected images in patients with http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193155/?report=printable 6/8 neglects due to focal brain insult due to cerebrovascular accidents and neurodegenerative diseases such as dementias resulting in defective mirrored self identification. Connors et al. (2014) also managed to recreate mirrored self misidentification delusion in healthy participants by disrupting face processing or mirror knowledge as well as belief evaluation, using hypnotic suggestion. [20] Our patients showed defective reflected self image processing in the absence of focal brain insults in the form of neglects or any evidence of other forms of face processing defects except in one patient. ...
... Connors et al. (2014) also managed to recreate mirrored self misidentification delusion in healthy participants by disrupting face processing or mirror knowledge as well as belief evaluation, using hypnotic suggestion. [20] Our patients showed defective reflected self image processing in the absence of focal brain insults in the form of neglects or any evidence of other forms of face processing defects except in one patient. Neuropsychological tests as well as neuroimaging showed consistent abnormality in the nondominant parietal lobe. ...
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