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Klinische Hypnose

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Abstract

Hypnose wurde seit alters her als ein Verfahren und als ein daraus resultierender Zustand veränderten Bewusstseins (Trance) beschrieben, in dem die Menschen (bisweilen auch Tiere) anders als gewöhnlich reagieren. Die Folklore schreibt diesem Zustand Willenlosigkeit, verbesserte kognitive Fähigkeiten (z. B. Erinnerungsvermögen), ungewöhnliche körperliche Leistungen (z. B. kataleptische Brücke), Schmerzlosigkeit und bestimmte psychosomatische Phänomene (z. B. suggerierte Brandblasen) zu. Hypnose hat eine gespaltene Tradition: eine mystische und eine medizinische. Sie lebt einerseits in magischen Formen der Geistheilung, des spirituellen Wachstums weiter und hat etwa die Theosophische Gesellschaft oder Christian Science in ihren Riten beeinflusst. Andererseits hat sie eine Vielzahl wissenschaftlicher Untersuchungen im klinischen und im experimentellen Bereich hervorgebracht und ist als therapeutische Methode bei unterschiedlichsten somatischen und psychischen Störungen wissenschaftlich anerkannt und erfolgreich eingesetzt worden. Fragen, die sich mit dem Thema Hypnose verbinden, sind u. a.: Hat der Mensch in diesem Zustand besondere physische oder mentale Fähigkeiten? Kann man gegen seinen Willen hypnotisiert werden? Ist jeder hypnotisierbar? Sind Erinnerungen unter Hypnose verlässlich? Wegen der Publikumswirksamkeit einiger dieser Fragen wird Hypnose oft als Schaustellung verunglimpft. In der Hauptsache ist sie jedoch eine vielseitige und effektive Therapiemethode.

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Nach einem Überblick zur Wirksamkeit von Hypnose und Hypnotherapie mit Schwerpunkt auf psychischen Störungen anhand aktueller Meta-Analysen und Reviews wird die Interventionsforschung der letzten drei Jahre dargestellt. Der Fokus liegt auf randomisierten kontrollierten Studien, zu denen im Auftrag der Milton Erickson Gesellschaft für Klinische Hypnose eine systematische Literatursuche erfolgte. Für die Jahre 2010 bis 2012 wurden 20 randomisierte oder quasi-randomisierte Studien gefunden, die Hypnose allein oder als Adjunkt evaluierten. Wie schon in den Jahren davor überwogen Studien aus dem medizinischen und zahnmedizinischen Bereich. Die Relevanz der Ergebnisse war zum Teil aufgrund der unzureichenden Darstellung der Methodik schwer zu beurteilen. Nach heutigen Standards ist die Wirksamkeit von Hypnose zur Schmerzreduktion und Unterstützung bei medizinischen Eingriffen ausreichend belegt, nicht aber in der Behandlung von psychischen Störungen. Abschließend werden methodische Probleme bei der kontrollierten Forschung mit Bezug auf die Evaluation von Hypnose diskutiert, ferner werden Ansätze zur Verbesserung der Berichterstattung sowie methodische Alternativen erörtert.
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Book
This important volume applies hypnotic principles to the specific challenges of behavioral medicine. Drawing from extensive clinical evidence and experience, the authors describe how hypnobehavioral techniques can help in the treatment of psychophysiological disorders. © 1987 by Lawrence Erlbaum Associates, Inc. All rights reserved.
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Book
The Handbook of Clinical Hypnosis is divided into sections that cover general clinical considerations, hypnosis theoretical models, hypnotic techniques, specific clinical applications, and contemporary issues. The book is intended for anyone who wishes to learn about clinical hypnosis. It introduces the novice hypnotherapist to the basics of hypnotherapy and the many potential uses of hypnosis. It is thus suited for use as a textbook for graduate and postgraduate courses and workshops. For the trained hypnotherapist, and even the seasoned clinician, the "Handbook" can be used as a reference volume that contains many suggestions for applying techniques and strategies relevant to the day-to-day work of the practitioner. Hypnosis researchers and theoreticians will also find value in this book. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Article
Contents include: What Is Hypnosis?; Role of Hypnotic Induction; Aftereffects of Hypnosis; Hypnotic Susceptibility and Its Assessment; Facilitation and Inhibition of Muscular Response; Analgesia and Hallucinations; Hypnotic Dreams; Hyperamnesia and Age-Regression; Posthypnotic Amnesia and Other Posthypnotic Responses; Distortions of Meaning, Affect, and the Image of Self; General-Purpose Scale: SHSS, Forms A and B; Graded Difficulty Scale: SHSS, Form C; Scales Yielding Profiles of Hypnotic Ability: Stanford Profile Scales of Hypnotic Susceptibility (SPS), Forms I and II; Descriptive Characteristics: Age, Sex, Neuropsychiatric Diagnosis; Hypnoticlike Experiences Outside Hypnosis; Attitudes Toward Hypnosis and Self-Predictions; Personality Inventories, Projective Tests, and Behavioral Tests; Personality and Hypnotizability: Inferences from Case Studies; Developmental-Interactive Theory of Hypnotic Susceptibility. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Used knowledge from the basic sciences and clinical research in psychology, cross-cultural psychiatry, psychodynamics, hypnosis, and behavior therapy to develop a multimodal form of therapy. It is argued (a) that the integration of techniques from behavior modification and hypnosis can expedite therapy for specific disorders and (b) that hypnosis intensifies the perceptual and cognitive factors involved in "visual voyages" or hypnagogic experiences, evocation of fantasies, feeling states, and "altered states of consciousness" to bring about behavioral changes. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Increased numbers of unexpected complications (ranging from severe, life threatening emergencies and personality changes to mild, unpleasant thoughts or feelings) point to the need for effective risk management in the use of hypnosis. This book focuses on these problems, and provides practical information on standards of care and preventive practices to avoid potentially dangerous situations. Discussions cover: risk evaluation; classification of complications; itemized risk factors for subjects, hypnotists and environment (visual, auditory, tactile, smell and taste); malpractice; and risk management, including crisis intervention. Appendices include data sheets and checklists for medical-social problems, informed consent/treatment contracts, induction data sheet, treatment summary, and a complications report form. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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As its title implies, the focus of the work is on what one does in practicing hypnotism, but I also feel that any professional who works with hypnotism ought to know what is fact and what is fiction about hypnosis, one needs to have a thorough knowledge of the phenomena that can be produced and how they are brought about, irrespective of particular applications. . . . For this reason, I have not limited myself to mere description of methods and techniques but have presented them within a framework of what has been scientifically established about hypnotism, delving at some length into the phenomenology of hypnotism. Volume 1 follows closely the original plan of G.T. [General Techniques of Hypnotism] describing in detail context-free techniques, that is, that area of general applicability. Much of Volume 2 describes the traditional, and especially the semi-traditional, approach to clinical hypnotism. This work will probably have a varied readership. It is addressed to a professionally trained audience that I have assumed will have a certain amount of technical knowledge. Last, as with G.T., this work has been written to be used for self-study and training. It should also serve well as a textbook to supplement courses and workshops in hypnotism. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Investigated depth of trance and the components of susceptibility (the Harvard Group Scale of Hypnotic Susceptibility—Form A) as outcome variables in 47 female patients in a weight-reduction program involving hypnosis and in 46 program dropouts. Significant reductions were found in measures of anthropometry following treatment. A significant depth of trance effect was found between patients and dropouts and significantly more weight was lost by high- than low-susceptible Ss. Significant correlations were found between weight loss and general ideomotor and challenge susceptibility. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
An integration between neurobiological and sociocognitive perspectives is advocated to advance and overhaul the concept of hypnosis and its humanistic applications. The thesis is presented that hypnosis is an altered state of brain functional organization involving interrelations between brain regions initiated by the intervention of the hypnotist – that is, an atypical alteration of brain systems through an interpersonal and cultural context. Experimental evidence shows that the hypnotic process produces a brain state that is different from everyday neurophysiology, as shown by evidence of differential effects of attention and relaxation, and by evidence of cognitive and neurophysiological dissociation, which are central features of hypnosis. The hypnotic induction has a neurophysiological logic involving a temporal process that becomes conditioned to facilitate future induction and self-hypnosis. Our integrative perspective of brain systems in a social context includes a neuropsychological translation of the hypnotic induction and draws out the implications of orbital-frontal suppression for subjects being oblivious to embarrassment and being able to endure stage hypnosis. Wasteful pursuits in the field of hypnosis include the search for a single marker, premature closure of neurophysiological investigation, attributions and inferences such as ‘suggestion’ and goal-directed striving without validation and without consideration of process and mechanism, and the use of dichotomies such as ‘waking’ versus ‘sleeping’. Recommendations include considerations of multidimensionality regarding trance and levels of susceptibility; the modifiability of susceptibility; formal assessment of social conceptions about hypnosis; concurrent validation of susceptibility during experimental procedures; consideration of both objective and subjective measures of susceptibility together with cross-checking for inconsistencies; the feasibility of control conditions; assessment of processes underpinning suggestibility; distinguishing the social impact of experimental, clinical and stage hypnosis; and assessment of after-effects. Copyright © 2000 British Society of Experimental and Clinical Hypnosis
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Seit 1985 hat sich innerhalb der tiefenpsychologischen und analytischen Psychotherapie in Praxis und Theorie sowie beginnend in der Forschung die psychodynamisch-imaginative Traumatherapie (PITT) als ein Verfahren herausgebildet, das heute im deutschsprachigen Raum vielfach bei Patienten mit komplexen posttraumatischen Störungsbildern (▸ Abschn. 2.2.3) eingesetzt wird. PITT entwickelte sich aus den Bedürfnissen der Praxis und erfüllt die Forderung nach einer traumaadaptierten Handhabung psychotherapeutischer Verfahren (Flatten et al., 1998).
Chapter
Die Hypnotherapie, als komplexe Kommunikationsform, beschäftigt sich mit den vielschichtigen Ebenen menschlicher Informationsverarbeitung. Die dabei auftretenden Trancephänomene sind vom Alltagsbewusstsein abgekoppelt. Sie dienen kognitiver und physiologischer sowie psychosomatischer Veränderungen. Zur Erklärung von Trancephänomenen werden veränderte Wirkweisen neurobiologischer und sozialpsychologischer Mechanismen angenommen, die empirisch nachweisbar sind. Die Vorgehensweise der Hypnotherapie passt sie an die Möglichkeiten der Patienten an und sieht das Symptom als veränderungsbedürftigen Lösungsversuch. Dazu werden Ressourcen in einer Art und Weise aktiviert, die dem Alltagsdenken nicht unbedingt zugänglich ist. Hypnotische Trance kann in unterschiedliche Therapieformen integriert werden und bildet eine Brücke zwischen Psychologie und Medizin.
Article
This functional Magnetic Resonance Imaging (fMRI) study investigated high and low suggestible people responding to two visual hallucination suggestions with and without a hypnotic induction. Participants in the study were asked to see color while looking at a grey image, and to see shades of grey while looking at a color image. High suggestible participants reported successful alterations in color perception in both tasks, both in and out of hypnosis, and showed a small benefit if hypnosis was induced. Low suggestible people could not perform the tasks successfully with or without the hypnotic induction. The fMRI results supported the self report data, and changes in brain activity were found in a number of visual areas. The results indicate that a hypnotic induction, although having the potential to enhance the ability of high suggestible people, is not necessary for the effective alteration of color perception by suggestion.
Article
The science of large-scale brain networks offers a powerful paradigm for investigating cognitive and affective dysfunction in psychiatric and neurological disorders. This review examines recent conceptual and methodological developments which are contributing to a paradigm shift in the study of psychopathology. I summarize methods for characterizing aberrant brain networks and demonstrate how network analysis provides novel insights into dysfunctional brain architecture. Deficits in access, engagement and disengagement of large-scale neurocognitive networks are shown to play a prominent role in several disorders including schizophrenia, depression, anxiety, dementia and autism. Synthesizing recent research, I propose a triple network model of aberrant saliency mapping and cognitive dysfunction in psychopathology, emphasizing the surprising parallels that are beginning to emerge across psychiatric and neurological disorders.
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Hypnotic paralysis has been used since the times of Charcot to study altered states of consciousness; however, the underlying neurobiological correlates are poorly understood. We investigated human brain function during hypnotic paralysis using resting-state functional magnetic resonance imaging (fMRI), focussing on two core regions of the default mode network and the representation of the paralysed hand in the primary motor cortex. Hypnotic suggestion induced an observable left-hand paralysis in 19 participants. Resting-state fMRI at 3T was performed in pseudo-randomised order awake and in the hypnotic condition. Functional connectivity analyses revealed increased connectivity of the precuneus with the right dorsolateral prefrontal cortex, angular gyrus, and a dorsal part of the precuneus. Functional connectivity of the medial frontal cortex and the primary motor cortex remained unchanged. Our results reveal that the precuneus plays a pivotal role during maintenance of an altered state of consciousness. The increased coupling of selective cortical areas with the precuneus supports the concept that hypnotic paralysis may be mediated by a modified representation of the self which impacts motor abilities.
Article
The 'default mode' network refers to cortical areas that are active in the absence of goal-directed activity. In previous studies, decreased activity in the 'default mode' has always been associated with increased activation in task-relevant areas. We show that the induction of hypnosis can reduce anterior default mode activity during rest without increasing activity in other cortical regions. We assessed brain activation patterns of high and low suggestible people while resting in the fMRI scanner and while engaged in visual tasks, in and out of hypnosis. High suggestible participants in hypnosis showed decreased brain activity in the anterior parts of the default mode circuit. In low suggestible people, hypnotic induction produced no detectable changes in these regions, but instead deactivated areas involved in alertness. The findings indicate that hypnotic induction creates a distinctive and unique pattern of brain activation in highly suggestible subjects.
Article
Brain mechanisms of hypnosis are poorly known. Cognitive accounts proposed that executive attentional systems may cause selective inhibition or disconnection of some mental operations. To assess motor and inhibitory brain circuits during hypnotic paralysis, we designed a go-no-go task while volunteers underwent functional magnetic resonance imaging (fMRI) in three conditions: normal state, hypnotic left-hand paralysis, and feigned paralysis. Preparatory activation arose in right motor cortex despite left hypnotic paralysis, indicating preserved motor intentions, but with concomitant increases in precuneus regions that normally mediate imagery and self-awareness. Precuneus also showed enhanced functional connectivity with right motor cortex. Right frontal areas subserving inhibition were activated by no-go trials in normal state and by feigned paralysis, but irrespective of motor blockade or execution during hypnosis. These results suggest that hypnosis may enhance self-monitoring processes to allow internal representations generated by the suggestion to guide behavior but does not act through direct motor inhibition.
Article
It was suggested to 22 subjects that their warts would disappear if they imagined them tingling for a few minutes each day. Half the subjects received the suggestion after they had been exposed to a formal hypnotic induction procedure and the remaining half (controls) received the same suggestion after they were told simply that they were to be treated by a method called “focused contemplation.” Three of the 11 hypnotic subjects and none of the 11 “focused contemplation” subjects lost their warts during the experimental period. It is suggested that the relatively greater effectiveness of the hypnotic treatment may have been due to its believed-in efficacy; that is, subjects who lost their warts strongly believed that warts could be cured by hypnosis whereas the “focused contemplation” subjects did not believe that their treatment was especially effective in curing warts.
Article
Describes the testing of an active-alert induction procedure which sufficiently controlled conditions to permit a comparison between the alterations produced by that procedure and those produced by the traditional relaxation induction technique. Ss were 50 university students. In the active-alert induction the S rode a bicycle ergometer under load, keeping eyes open while exercising and receiving suggestions of alertness. The alternate form, used in random alternation with the same Ss, consisted of the standard eye-fixation and relaxation induction of the Stanford Hypnotic Susceptibility Scale, Form B (SHSS-B). Within each session on 2 days during which each S served, the induction procedure was followed by 8 tests of responses to suggestion, from the SHSS-A and SHSS-B. The mean measured hypnotic responsiveness was independent of the type of induction. The active-alert condition was characterized by an acceleration of the rate of pedaling for the more responsive Ss. Although the subjective alterations differed between the 2 kinds of induction, the highly susceptible reported that in both cases altered states were achieved. (23 ref)
Article
Case histories show that hypnosis can control massive bleeding and pain, and it can remove warts, probably by stopping blood flow to them. We propose that blood flow to cancerous tumors can likewise be controlled, which could destroy them outright, or which control could be a useful adjunct to chemo- or radiotherapy.
Article
This study investigated the effects of hypnotic susceptibility and of suggestion of direction on 4 measures of autokinetic movement: the mean number of changes in direction reported per trial, the latency of reported movement, the estimated direction, and the reported magnitude of movement. Subjects high in hypnotic susceptibility had significantly lower latencies and reported significantly more changes; estimated direction and reported magnitude did not differ as a function of hypnotic susceptibility. Suggestion of direction seemed to attenuate magnitude.
Article
A beacon quickened on the eastern bank, Glistening out its last light at the dawn. The soft trees undulated overhead Like restless children racing toward the shore. Their silhouettes grew fundamental parts, The great pines laced with limbs became alive, Like dark green giants rising from the sand, And marsh grass rustled, whistled with the wind. A mile to east the mighty breakers rolled, Rising with the tide upon the jetty rocks, And breaking up the coral on the beach. The solemn sun rose orange on the sea, In momentary coolness like the moon, And turned the once grey waters flaming red. * The experimentation leading to this paper and its preparation have been aided by research grant MH-3859 from the National Institute of Mental Health. 1. I am ignoring the preconscious in Freud's earlier formulation because it consists largely of available memories not now in consciousness; hence, for purposes of this discussion it may be viewed as part of the conscious control mechanism. This is, to be sure, an oversimplification of Freud's theory. 2. It is amusing to note the source of the name of the ouija board: oui ("yes" in French); ja ("yes" in German).
Article
Raynaud's Disease is a painful vasospastic disorder of the fingers and toes precipitated by cold or emotional stimuli. Treatment has usually included protection from cold stimuli and vasodilators. Biofeedback, imagery, relaxation, and hypnosis have also been used. The relationship between response to treatment and hypnotizability has been inconclusive. A case of Raynaud's Disease was treated using hypnosis. The patient was highly hypnotizable and responded rapidly to direct suggestion with a fourfold increase in her blood volume. The implications of this rapid response and its relationship to hypnotizability are discussed with suggestions for further studies.
Article
Reviews recent experimental evidence on the hypnotic treatment of obesity, cigarette smoking, alcoholism, clinical pain, warts, and asthma. It is concluded that although hypnosis may be effective with addictive behavior, the therapeutic success is attributable to nonhypnotic factors. In contrast, hypnosis appears to be of unique value in the treatment of clinical pain, warts, and asthma. Differential effectiveness may be attributable to the nature of the disorders or to the manner in which hypnosis is used in treating them. The relevance of hypnotizability to treatment is discussed, as is the need to distinguish between genuine and placebo-based hypnotic effects. It is concluded that future research must be more attentive to the (a) nature of the disorders and patient populations, (b) adequate implementation of therapeutic techniques, (c) context in which treatment is delivered, and (d) influence of hypnotic susceptibility and other S factors on outcome. (41/2 p ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).
Article
In order to investigate the question of whether or not Ss experiencing a phenomenon during trance which would be very unlikely to occur outside of trance improves the efficacy of hypnotic treatment for obesity, a S pool of obese women was divided into 3 groups: a non-hypnotic behavior modification group, a hypnosis group without any special phenomenon structured into it, and a hypnosis group with such a phenomenon (hand levitation). Weight-loss data were collected 4 weeks and 6 months after the start of treatment. All treatments resulted in at least moderate weight loss. Statistically significant differences were found between the hypnosis-with-hand-levitation treatment effect and the other treatment effects. Possible reasons for the treatment effects and the differences obtained are discussed.
Article
A meta-analysis was performed on 18 studies in which a cognitive-behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive-behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments.
Article
There is a growing body of research evaluating the use of hypnosis with cognitive-behavioral techniques in the treatment of psychological disorders. The central question for research is whether the addition of hypnosis enhances the efficacy of cognitive-behavioral treatments. Overall, studies demonstrate a substantial benefit from the addition of hypnosis; however, the number of published studies is relatively small, and many of them have methodological limitations. For cognitive-behavioral hypnotherapies to be recognized as empirically supported treatments, a number of well-designed, randomized clinical trials are necessary. Currently, the efficacy of hypnosis as an adjunctive treatment remains unresolved.
Article
The neural mechanisms underlying the modulation of pain perception by hypnosis remain obscure. In this study, we used positron emission tomography in 11 healthy volunteers to identify the brain areas in which hypnosis modulates cerebral responses to a noxious stimulus. The protocol used a factorial design with two factors: state (hypnotic state, resting state, mental imagery) and stimulation (warm non-noxious vs. hot noxious stimuli applied to right thenar eminence). Two cerebral blood flow scans were obtained with the 15O-water technique during each condition. After each scan, the subject was asked to rate pain sensation and unpleasantness. Statistical parametric mapping was used to determine the main effects of noxious stimulation and hypnotic state as well as state-by-stimulation interactions (i.e., brain areas that would be more or less activated in hypnosis than in control conditions, under noxious stimulation). Hypnosis decreased both pain sensation and the unpleasantness of noxious stimuli. Noxious stimulation caused an increase in regional cerebral blood flow in the thalamic nuclei and anterior cingulate and insular cortices. The hypnotic state induced a significant activation of a right-sided extrastriate area and the anterior cingulate cortex. The interaction analysis showed that the activity in the anterior (mid-)cingulate cortex was related to pain perception and unpleasantness differently in the hypnotic state than in control situations. Both intensity and unpleasantness of the noxious stimuli are reduced during the hypnotic state. In addition, hypnotic modulation of pain is mediated by the anterior cingulate cortex.
Article
Delusions of alien control, or passivity experiences, are symptoms associated with schizophrenia in which patients misattribute self-generated actions to an external source. In this study hypnosis was used to induce a similar misattribution of self-generated movement in normal, healthy individuals. Positron Emission Tomography (PET) was employed to investigate the neural correlates of active movements correctly attributed to the self, compared with identical active movements misattributed to an external source. Active movements attributed to an external source resulted in significantly higher activations in the parietal cortex and cerebellum than identical active movements correctly attributed to the self. We suggest that, as a result of hypnotic suggestion, the functioning of this cerebellar-parietal network is altered so that self-produced actions are experienced as being external. These results have implications for the brain mechanisms underlying delusions of control, which may be associated with overactivation of the cerebellar-parietal network.
Article
Many studies have suggested that conflict monitoring involves the anterior cingulate cortex (ACC). We previously showed that a specific hypnotic suggestion reduces involuntary conflict and alters information processing in highly hypnotizable individuals. Hypothesizing that such conflict reduction would be associated with decreased ACC activation, we combined neuroimaging methods to provide high temporal and spatial resolution and studied highly and less-hypnotizable participants both with and without a suggestion to interpret visual words as nonsense strings. Functional MRI data revealed that under posthypnotic suggestion, both ACC and visual areas presented reduced activity in highly hypnotizable persons compared with either no-suggestion or less-hypnotizable controls. Scalp electrode recordings in highly hypnotizable subjects also showed reductions in posterior activation under suggestion, indicating visual system alterations. Our findings illuminate how suggestion affects cognitive control by modulating activity in specific brain areas, including early visual modules, and provide a more scientific account relating the neural effects of suggestion to placebo. • anterior cingulate cortex • attention • hypnosis • neuroimaging • Stroop effect
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  • M R Nash
Hypnose: Ein ökosystemischer Ansatz
  • D P Fourie
Hypnosis and sleep Hypnosis: Developments in research and new directives
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Clinical hypnosis: Principles and applications
  • H B Crasilneck
  • J A Hall
On the simulating subject as a quasi-control group in hypnosis research
  • M Orne