BUILDING BRIDGES OF UNDERSTANDING
CLINICAL RELEVANCE OF RESEARCH FINDINGS
In each section of the NL we introduce you to a summary of recent research with short and easy explanations of some research concepts. Scientific reports are more and more complex and complicated; only a small portion of hypnosis experts enjoy them. For the majority of professionals it can even be frightening or boring. The aim of these letters is to bring researchers and clinicians closer together, to highlight the clinical relevance of research findings of hypnosis in a very simple user-friendly way. Clinicians are also encouraged to propose questions to be studied, clinically relevant phenomena to analyze, and hypnotic processes to be understood. Let’s build the bridges of understanding together…
By Putri Sibron and Methavee Chaloeyjitr
Psychological interventions have been posited to aid in the recovery of physical ailments for quite some time, dating as far back to 1930 and even before that, although it was not labelled as psychoneuroimmunology until relatively recently (Hall, 1983). One of these interventions is hypnosis, which has been studied somewhat extensively given its potential to directly influence the immune system and its cellular by-products.
The immune system is the body’s first and foremost bastion against diseases. It destroys foreign substances, commonly called pathogens, by producing cells that locate and fight against them. Primarily, the cells in the immune system are white blood cells of several varieties which work alongside antibodies that could be for general or specific diseases. Research has shown that the immune system has ties to the brain via the sympathetic nervous system, implying that it can be therefore controlled to an extent (Hudacek, 2007).
This potential for manipulation forms the basis for hypnosis’ interactions with the immune system. A psychological treatment that has a long history, hypnosis is most often described as a method of altering awareness through techniques such as relaxation or imagery (Evans, 1990). Though there has been much research proposed on hypnosis’ ability to moderate immune system functioning, it is not yet proven to what extent the effect is: either a general relaxation response or hypnosis-specific effect (Hannigan, 1999). Some sources (Evans, 1990) suggest that hypnosis’ effects are purely placebo, although more recent research states otherwise. Though at first glance hypnosis might not look like it directly affects anything, it is an intervention that works on the brain to incite changes within the body, so it is understandable that any physical (and therefore visible) outcomes are not immediately apparent.
Hypnosis has been used to assist with inducing relaxation and imagery training, thus hypnotic susceptibility (a.k.a. hypnotisability) has been measured as an individual difference that may predispose individuals to a more successful outcome. This is a factor that has been discussed since the start of hypnosis research (Hall, 1983) and is now widely operationally measured using scales such as the Stanford Hypnosis Scale Form C (Hudacek, 2007).
It has been shown that self-hypnosis training and practice led to observable physiological results, such as heart rate improvements, and has the potential to enhance immune function as it can reduce physical or mental responses to stress (Hammond, 2010). Barling and Raine (2005) state that stress, regardless of source, is an important factor in the complex system of interactivity that connects the central nervous system to immunity. Their data highlights that even something as temporary and subjective as academic stress from exams can regulate a wide range of immunological activities.
Hypnosis also possesses comparable effects with well-established treatments, like progressive relaxation. Considerable evidence exists that training in self-hypnosis not only reduces generalized stress but is additionally effective in reducing anxiety related to public speaking, test-taking, and coping after being diagnosed with cancer. It also reduces anxiety experienced by burn patients and those who undergo childbirth (Hammond, 2010).
Johnson et al. (1996) conducted a study to investigate the effects of relaxation training and hypnosis on the modulation of the immune response to an experimental stressor. Relaxation training and hypnotic suggestion led to increased lymphocyte responsiveness to phytohaemagglutinin (PHA), and only experimental subjects showed a significant increase in interleukin 1B (IL-1B) immediately after stressing and 24–48 hours later. Furthermore, stress-induced changes in interleukin 1 (IL-1) have been related to hypnotisability. These findings indicate that hypnotisability, as assessed by the Creative Imagination Scale (CIS), may be an important moderator of the psychoneuroimmunological response to relaxation training and exposure to an acute stressor.
Following the results of hypnosis on stress, Hudacek (2007) wanted to see if hypnosis could affect more serious diseases, such as breast cancer, by examining prior case studies. As a key component in the escalation of cancer, stress can trigger the release of the tumour growth hormones glucocortisol and cortisol. The hypothalamic-pituitary-adrenal pathway is where these hormones can originate from, and as hypnosis has been
shown to reduce stress, it can possibly regulate this pathway, thereby slowing down cancerous growth.
The results were not significant enough to be conclusive. There were only some temporary increases in natural killer cells (NKC) in two of the examined studies. Interestingly, when the difference in technique (either more relaxed or more meditative/imagery-based) was factored in, it was found that those in the autogenic (meditative) group with more vivid imagery ability had a definite increase in NKC count. This result ties to the cognitive activation hypothesis of Gruzelier et al.’s (2002) work, discussed further below, wherein a more active approach seems to stimulate positive results.
As self-hypnosis seems to be a common methodology, we present Darby and Fannon (1995), who measured immune response lymphocytes in students and suggested that hypnosis may be an effective technique to stabilize the immune system during stressful life events. Students who received self-hypnosis training differed from the control group in counts of Tlymphocytes, helper T cells, NKC, and non-helper T-lymphocytes. RuzylaSmith et al. (1995) similarly focused on immune responses related to cell counts between the treatment group (hypnosis) and relaxation group, who underwent Restricted Environmental Stimulation Therapy (REST). Those high in hypnotisability exposed to hypnosis showed significant immunomodulation as measured by greater counts of B-cells, helper T-cells, and suppressor T-cells in contrast to those high in hypnotisability exposed to REST relaxation.
Hypnosis has been shown to have a significant impact on herpes (HSV; herpes simplex virus). In Gruzelier et al.’s (2002) study, frequency of selfhypnosis practice (the methodology of which involved instructions of cognitive alertness, immune imagery, and ego strengthening) was correlated positively with a general immune up-regulation response and specific NKC efficacy (cytotoxicity) towards HSV alongside increases in flat NKC numbers and CD8+ (lymphocyte) cells. The trait of cognitive activation, mentioned above, was also found to be quite important in regulating the results and had high predictive quality on herpes recurrence.
It is within this cognitive activation framework that Gruzelier et al. explains the intricacies of hypnosis’ effects on the immune system. First of all, there is evidence to suggest that immune system functionality is lateralised within the brain, specifically to the left hemisphere. This stems from trans-magnetic stimulation studies of salivary IgA (immunoglobin-A) and free cortisol concentration, animal studies, and EEG studies on those with HIV (Clow et al., 2002; Gruzelier, 1989; Gruzelier et al., 1996). As cognitive activation also involves thinking and speaking quickly, activities that are well-established to be lateralised in the left hemisphere, it can be surmised that cognitive activation has a left hemispherical preference. Therefore, the active component of hypnosis, which involves directed and generative imagery, may influence the immune system by triggering cognitive activation, located primarily in the left hemisphere, which in turn is connected to the efficacy of the immune system.
Although we have described hypnosis as a strategy for controlling specific responses to stress, this can be slightly misleading. The flexibility of hypnosis makes it hard to categorize as a therapeutic modality, and this may be one reason why its use has not been widely touted. While there is hardly a dearth of scientific evidence, results have usually been either mixed or specific to certain afflictions. Nevertheless, those familiar with the literature on therapeutic hypnosis may conclude that it can be effective for some persons and disorders, and this in itself makes the area worth further study.
Putri Sibron is a graduate student in Computational and Cognitive Neuroscience at Eötvös Loránd University, Hungary. She has completed her bachelor’s degree in Psychology at International Islamic University Malaysia (IIUM), Malaysia.
She has had experience as a school psychologist intern at SMK Wangsa Melawati in Malaysia. She has also been active in volunteer work such as with homeless people in Kuala Lumpur, Old Folks Home at AlFikrah, Malaysia, among others.
Her research interests lie in the area of the cognitive and neural basis of perception, memory and aging.
MSc Computational and Cognitive Neuroscience
Methavee Chaloeyjitr is currently a student at Eötvös Loránd University (ELTE) in Budapest, Hungary, studying MSc Computational and Cognitive Neuroscience. She is a graduate from the University of Sussex, United Kingdom (MSc Marketing and Consumer Psychology) and also holds a BSc Psychology from Bangor University, United Kingdom.
She was a research assistant for Chulalongkorn University in Thailand in the summer of 2019, working on a project about subjective well-being and wellness in collaboration with Stanford University in the United States.
Her Masters’ thesis was on the emotional valence of virtual emojis and she wishes to pursue research into virtual/augmented reality environments and their effects on neuropsychology and cognition.
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