"I would love to be 'discredited' like this more often": An interview with Irving Kirsch.

This interview with Professor Irving Kirsch took place in late August, 2022. He recently turned 80 years old and agreed to focus his interview on topics and areas that illustrate his influence on the field of hypnosis. Professor Kirsch discusses the influences that shaped him as a person and scientist; what unites his theoretical and research work on hypnosis, placebo, and antidepressants. He also addresses the importance of response expectancies, why clinicians should learn hypnosis and what he considers the source of his greatest personal and professional fulfillments.

Irving Kirsch: a life beyond expectations.

This paper provides an overview of the life of the eminent psychologist and hypnosis researcher and theoretician Irving Kirsch. It describes the strenuous lives and legacy of his immigrant parents, his lesser know activities as a satirical editor of a tape that was nominated for a Grammy, and as a violin player. The trajectory of his professional life evidences his courage to question conventional ideas and psychotherapeutic and pharmaceutical practices. He has also been consistently a supportive and warm friend and colleague to many in the hypnosis and other fields.

"Everything has been done at some time or another..." An Interview with Ernest Hilgard.

Ernest R. Hilgard is not only one of the most important hypnosis theoreticians and researchers in history, but one the most eminent psychologists of the 20th century. This paper starts with a brief summary of his contributions to hypnosis, emphasizing his dissociation theory, and placing it within previous and later dissociation theories of hypnosis. I then transcribe an interview with him circa 1989, which I recorded with his authorization for later use, emphasizing dissociation in hypnosis. He also reminisced about historical figures in psychology.

Dispositional Self-Consciousness and Hypnotizability.

The abeyance of self-consciousness (SC) during hypnosis has been discussed as a central aspect of hypnosis, yet dispositional SC has been very rarely evaluated as a correlate of hypnotizability. In this study (N = 328), the authors administered the Harvard Group Scale of Hypnotic Susceptibility (HGSHS), the Inventory Scale of Hypnotic Depth (ISHD), and the Self-Consciousness Scale-Revised (SCS-R). Women tended to score higher than men on the HGSHS, besides experiencing greater ISHD automaticity. The Discontinuity (with everyday experiences) subscale of the ISHD correlated with the Public Self-Consciousness scale of the SCS-R and with the Private Self-Consciousness subscale (using simple, quadratic, and cubic regressions). Being concerned about the perception of others related to experiencing hypnosis as discontinuous with everyday life, which also related to being more introspective and interested in subjectivity at the middle range of scores. The article concludes with suggestions on how to pursue the implications of these results, including testing for nonlinear relations.

Anomalous experiences are more prevalent among highly suggestible individuals who are also highly dissociative.

Introduction: Predictive coding models propose that high hypnotic suggestibility confers a predisposition to hallucinate due to an elevated propensity to weight perceptual beliefs (priors) over sensory evidence. Multiple lines of research corroborate this prediction and demonstrate a link between hypnotic suggestibility and proneness to anomalous perceptual states. However, such effects might be moderated by dissociative tendencies, which seem to account for heterogeneity in high hypnotic suggestibility. We tested the prediction that the prevalence of anomalous experiences would be greater among highly suggestible individuals who are also highly dissociative.Methods: We compared high and low dissociative highly suggestible participants and low suggestible controls on multiple psychometric measures of anomalous experiences.Results: High dissociative highly suggestible participants reliably reported greater anomalous experiences than low dissociative highly suggestible participants and low suggestible controls, who did not significantly differ from each other.Conclusions: These results suggest a greater predisposition to experience anomalous perceptual states among high dissociative highly suggestible individuals.

THE ROLES OF RESPONSE EXPECTANCIES, BASELINE EXPERIENCES, AND HYPNOTIZABILITY IN SPONTANEOUS HYPNOTIC EXPERIENCES.

This study evaluated factors underlying individual differences in spontaneous (unsuggested) experiences during hypnosis. Participants varying in hypnotizability (low, medium, and high) completed a questionnaire about various dimensions of consciousness they would expect to experience at the "deepest level of hypnosis" (expectancy), an eyes-closed resting condition (baseline), and their actual experiences during "neutral hypnosis" (hypnosis). Responses during hypnosis were characterized by higher scores in dimensions related to alterations in conscious experience, affect, and imagery, and lower scores in rationality and agency. Only highs and mediums evinced increases in altered experience and body image. Across conditions, highs reported greater alterations in time experience and lower self-awareness than other groups. Participants overall tended to overestimate the changes they would experience in hypnosis. Baseline and hypnosis correlated in various dimensions, including affect, arousal, and internal dialogue. After controlling for baseline scores and hypnotizability, expectancies correlated with some dimensions having to do with alterations in consciousness. In sum, spontaneous experiences during hypnosis are driven by response expectancies, hypnotizability, and baseline experiences, which show differential effects.

Some needed psychological clarifications on the experience(s) of shamanism.

The target article's use of core concepts is confused and excessively broad. Two main types of experiences have been described in relation to shamanism: magical flight and mediumship/possession. The first refers to visual and remembered experiences of events in other realms, the second to embodied experiences of ceding mental control and personality to a preternatural entity. These experiences grossly correspond to two main experience modalities exhibited by highly hypnotizable individuals in a secular setting.

The "hypnotic state" and eye movements: Less there than meets the eye?

Responsiveness to hypnotic procedures has been related to unusual eye behaviors for centuries. Kallio and collaborators claimed recently that they had found a reliable index for "the hypnotic state" through eye-tracking methods. Whether or not hypnotic responding involves a special state of consciousness has been part of a contentious debate in the field, so the potential validity of their claim would constitute a landmark. However, their conclusion was based on 1 highly hypnotizable individual compared with 14 controls who were not measured on hypnotizability. We sought to replicate their results with a sample screened for High (n = 16) or Low (n = 13) hypnotizability. We used a factorial 2 (high vs. low hypnotizability) x 2 (hypnosis vs. resting conditions) counterbalanced order design with these eye-tracking tasks: Fixation, Saccade, Optokinetic nystagmus (OKN), Smooth pursuit, and Antisaccade (the first three tasks has been used in Kallio et al.'s experiment). Highs reported being more deeply in hypnosis than Lows but only in the hypnotic condition, as expected. There were no significant main or interaction effects for the Fixation, OKN, or Smooth pursuit tasks. For the Saccade task both Highs and Lows had smaller saccades during hypnosis, and in the Antisaccade task both groups had slower Antisaccades during hypnosis. Although a couple of results suggest that a hypnotic condition may produce reduced eye motility, the lack of significant interactions (e.g., showing only Highs expressing a particular eye behavior during hypnosis) does not support the claim that eye behaviors (at least as measured with the techniques used) are an indicator of a "hypnotic state." Our results do not preclude the possibility that in a more spontaneous or different setting the experience of being hypnotized might relate to specific eye behaviors.

Nuances and Uncertainties Regarding Hypnotic Inductions: Toward a Theoretically Informed Praxis.

Although most definitions of hypnosis consider inductions as the initial stage in a hypnosis protocol, knowledge of inductions remains poor and uninformed by recent developments in theory and research. It is frequently argued that inductions play a critical role in hypnotic responding or, by contrast, are largely interchangeable and unimportant. Drawing on the literature on suggestibility, spontaneous phenomenology, neurophysiology, and cognition, this article argues that the value of inductions, as well as the potential value of inductions, is more nuanced and uncertain. Certain components of standard inductions appear to be efficacious in enhancing suggestibility, whereas others do not have any clear benefits. The impact of inductions on suggestibility seems to vary across suggestions and modes of assessment with the sources of this variability being unknown. Considering these effects, and the broader impact of inductions on spontaneous conscious states and cognition, through the lens of heterogeneity in high hypnotic suggestibility and componential models of hypnotic suggestibility may offer novel research avenues in this area. The article concludes by arguing for the practical and theory-driven optimization of inductions.

Hypnotic tape intervention ameliorates stress: a randomized, control study.

This study (N = 35) used a randomized control design, and participants were collected from a variety of groups. After evaluating their degree of stress and burnout, coping styles, general well-being, and hypnotizability, participants were matched by stress level and randomly assigned to an intervention or wait-list group. The intervention comprised an audio recording of a hypnotic induction accompanied by suggestions for progressive relaxation, imagery, and anchoring to be used for 2 weeks. The results show that, as compared with baseline and wait-list conditions, the hypnotic intervention had a medium-to-large beneficial effect on participants' experience of stress, burnout, and well-being. Some participants also decreased their use of the coping strategy escape-avoidance postintervention. Hypnotizability correlated significantly or marginally with some outcomes of the intervention, but only for 1 group.

The neurophenomenology of neutral hypnosis.

INTRODUCTION: After a hypnotic induction, medium and highly hypnotizable individuals often report spontaneous alterations in various dimensions of consciousness. Few studies investigating these experiences have controlled for the inherent demands of specific hypnotic suggestions and fewer still have considered their dynamic properties and neural correlates. METHODS: We adopted a neurophenomenological approach to investigate neutral hypnosis, which involves no specific suggestion other than to go into hypnosis, with 37 individuals of high, medium, and low hypnotizability (Highs, Mediums, and Lows). Their reports of depth and spontaneous experience at baseline, following a hypnotic induction, and then after multiple rest periods were analyzed and related to EEG frequency band power and global functional connectivity. RESULTS: Hypnotizability was marginally associated with lower global functional connectivity during hypnosis. Perceived hypnotic depth increased substantially after the induction especially among Highs and then Mediums, but remained almost unchanged among Lows. In the sample as a whole, depth correlated moderately to strongly with power and/or power heterogeneity for the fast EEG frequencies of beta2, beta3, and gamma, but independently only among Highs. The spontaneous phenomenology of Lows referred primarily to the ongoing experiment and everyday concerns, those of Mediums to vestibular and other bodily experiences, and those of Highs to imagery and positive affect/exceptional experiences. The latter two phenomena were associated with lower global functional connectivity during hypnosis. Imagery correlated positively with gamma power heterogeneity and negatively with alpha1 power heterogeneity. Generally, the pattern of correlations for the Highs was the opposite of that for the Lows. CONCLUSIONS: Experienced hypnotic depth and spontaneous phenomena following a neutral hypnotic induction vary as a function of hypnotizability and are related to global functional connectivity and EEG band wave activity.

Individual differences and state effects on mind-wandering: hypnotizability, dissociation, and sensory homogenization.

Consciousness alterations can be experienced during unstructured, monotonous stimuli. These effects have not been linked to particular cognitive operations; individual differences in response to such stimulation remain poorly understood. We examined the role of hypnotizability and dissociative tendencies in mind-wandering (MW) during a sensory homogenization procedure (ganzfeld). We expected that the influence of ganzfeld on MW would be more pronounced among highly hypnotizable individuals (highs), particularly those high in dissociative tendencies. High and low hypnotizables, also stratified by dissociation, completed the sustained attention to response task during ganzfeld and control conditions. High dissociative highs made more commission errors during ganzfeld, suggesting increased MW, whereas the other groups displayed the opposite pattern. Increases in commission errors from the control condition to ganzfeld were associated with more alterations in consciousness and negative affect, but only among highs. Sensory homogenization had opposite effects on MW depending on the interaction of hypnotizability and dissociation.

Evaluation of the evidence for the trauma and fantasy models of dissociation.

The relationship between a reported history of trauma and dissociative symptoms has been explained in 2 conflicting ways. Pathological dissociation has been conceptualized as a response to antecedent traumatic stress and/or severe psychological adversity. Others have proposed that dissociation makes individuals prone to fantasy, thereby engendering confabulated memories of trauma. We examine data related to a series of 8 contrasting predictions based on the trauma model and the fantasy model of dissociation. In keeping with the trauma model, the relationship between trauma and dissociation was consistent and moderate in strength, and remained significant when objective measures of trauma were used. Dissociation was temporally related to trauma and trauma treatment, and was predictive of trauma history when fantasy proneness was controlled. Dissociation was not reliably associated with suggestibility, nor was there evidence for the fantasy model prediction of greater inaccuracy of recovered memory. Instead, dissociation was positively related to a history of trauma memory recovery and negatively related to the more general measures of narrative cohesion. Research also supports the trauma theory of dissociation as a regulatory response to fear or other extreme emotion with measurable biological correlates. We conclude, on the basis of evidence related to these 8 predictions, that there is strong empirical support for the hypothesis that trauma causes dissociation, and that dissociation remains related to trauma history when fantasy proneness is controlled. We find little support for the hypothesis that the dissociation-trauma relationship is due to fantasy proneness or confabulated memories of trauma.

EEG sLORETA functional imaging during hypnotic arm levitation and voluntary arm lifting.

This study (N = 37 with high, medium, and low hypnotizables) evaluated depth reports and EEG activity during both voluntary and hypnotically induced left-arm lifting with sLORETA functional neuroimaging. The hypnotic condition was associated with higher activity in fast EEG frequencies in anterior regions and slow EEG frequencies in central-parietal regions, all left-sided. The voluntary condition was associated with fast frequency activity in right-hemisphere central-parietal regions and slow frequency activity in left anterior regions. Hypnotizability did not have a significant effect on EEG activity, but hypnotic depth correlated with left hemisphere increased anterior slow EEG and decreased central fast EEG activity. Hypnosis had a minimal effect on depth reports among lows, a moderate one among mediums, and a large one among highs. Because only left-arm data were available, the full role of the hemispheres remains to be clarified.

Differential diagnosis between non-pathological psychotic and spiritual experiences and mental disorders: a contribution from Latin American studies to the ICD-11.

OBJECTIVE: To review research articles in psychiatry and psychology involving Latin American populations and/or produced by Latin American scholars to investigate the differential diagnosis between spiritual/anomalous experiences and mental disorders in order to contribute to the validity of the International Classification of Diseases towards its 11th edition in this area. METHOD: We searched electronic databases (PubMed, PsycINFO, Scopus, and SciELO) using relevant keywords (possession, trance, religious experience, spiritual experience, latin, Brazil) for articles with original psychiatric and psychological data on spiritual experiences. We also analyzed the references of the articles found and contacted authors for additional references and data. RESULTS: There is strong evidence that psychotic and anomalous experiences are frequent in the general population and that most of them are not related to psychotic disorders. Often, spiritual experiences involve non-pathological dissociative and psychotic experiences. Although spiritual experiences are not usually related to mental disorders, they may cause transient distress and are commonly reported by psychotic patients. CONCLUSION: We propose some features that suggest the non-pathological nature of a spiritual experience: lack of suffering, lack of social or functional impairment, compatibility with the patient's cultural background and recognition by others, absence of psychiatric comorbidities, control over the experience, and personal growth over time.

Diagnóstico diferencial entre experiências espirituais e psicóticas não patológicas e transtornos mentais: uma contribuição de estudos latino-americanos para o CID-11 / Differential diagnosis between non-pathological psychotic and spiritual experiences and mental disorders: a contribution from Latin American studies to the ICD-11

OBJETIVO: Contribuir para a validade da Classificação Internacional de Doenças-11ª edição no diagnóstico diferencial entre experiências espirituais/anômalas e transtornos mentais revisando artigos de pesquisa sobre o tema em psiquiatria e psicologia envolvendo populações latino-americanas e/ou produzidos por pesquisadores latino-americanos. MÉTODO: Pesquisa em bases de dados (PubMed, PsycINFO, Scopus, and SciELO) por meio de palavras-chave (possessão, transe, experiência religiosa, experiência espiritual, Latin, Brazil) em busca de artigos com dados psicológicos e psiquiátricos originais em experiências espirituais. Também foram analisadas as referências dos artigos selecionados e autores na área foram contactados em busca de dados e referências adicionais. RESULTADOS: Há evidências consistentes que experiências psicóticas e anômalas são frequentes na população geral e que em sua maioria não estão relacionadas a transtornos psicóticos. Frequentemente, experiências espirituais envolvem experiências dissociativas e psicóticas de caráter não patológico. Embora as experiências espirituais não estejam habitualmente relacionadas a transtornos mentais, elas podem causar sofrimento transitório e são frequentemente relatadas por pacientes psicóticos. CONCLUSÃO: Propomos algumas características que sugerem a natureza não patológica de uma dada experiência espiritual: ausência de sofrimento, de prejuízo funcional ou ocupacional, compatibilidade com o contexto cultural do paciente, aceitação da experiência por outros, ausência de comorbidades psiquiátricas, controle sobre a experiência e crescimento pessoal ao longo do tempo.

OBJECTIVE: To review research articles in psychiatry and psychology involving Latin American populations and/or produced by Latin American scholars to investigate the differential diagnosis between spiritual/anomalous experiences and mental disorders in order to contribute to the validity of the International Classification of Diseases towards its 11th edition in this area. METHOD: We searched electronic databases (PubMed, PsycINFO, Scopus, and SciELO) using relevant keywords (possession, trance, religious experience, spiritual experience, latin, Brazil) for articles with original psychiatric and psychological data on spiritual experiences. We also analyzed the references of the articles found and contacted authors for additional references and data. RESULTS: There is strong evidence that psychotic and anomalous experiences are frequent in the general population and that most of them are not related to psychotic disorders. Often, spiritual experiences involve non-pathological dissociative and psychotic experiences. Although spiritual experiences are not usually related to mental disorders, they may cause transient distress and are commonly reported by psychotic patients. CONCLUSION: We propose some features that suggest the non-pathological nature of a spiritual experience: lack of suffering, lack of social or functional impairment, compatibility with the patient's cultural background and recognition by others, absence of psychiatric comorbidities, control over the experience, and personal growth over time.

Differential frontal-parietal phase synchrony during hypnosis as a function of hypnotic suggestibility.

Spontaneous dissociative alterations in awareness and perception among highly suggestible individuals following a hypnotic induction may result from disruptions in the functional coordination of the frontal-parietal network. We recorded EEG and self-reported state dissociation in control and hypnosis conditions in two sessions with low and highly suggestible participants. Highly suggestible participants reliably experienced greater state dissociation and exhibited lower frontal-parietal phase synchrony in the alpha2 frequency band during hypnosis than low suggestible participants. These findings suggest that highly suggestible individuals exhibit a disruption of the frontal-parietal network that is only observable following a hypnotic induction.

Dissociative tendencies and individual differences in high hypnotic suggestibility.

INTRODUCTION: Inconsistencies in the relationship between dissociation and hypnosis may result from heterogeneity among highly suggestible individuals, in particular the existence of distinct highly suggestible subtypes that are of relevance to models of psychopathology and the consequences of trauma. This study contrasted highly suggestible subtypes high or low in dissociation on measures of hypnotic responding, cognitive functioning, and psychopathology. METHODS: Twenty-one low suggestible (LS), 19 low dissociative highly suggestible (LDHS), and 11 high dissociative highly suggestible (HDHS) participants were administered hypnotic suggestibility scales and completed measures of free recall, working memory capacity, imagery, fantasy-proneness, psychopathology, and exposure to stressful life events. RESULTS: HDHS participants were more responsive to positive and negative hallucination suggestions and experienced greater involuntariness during hypnotic responding. They also exhibited impaired working memory capacity, elevated pathological fantasy and dissociative symptomatology, and a greater incidence of exposure to stressful life events. In contrast, LDHS participants displayed superior object visual imagery. CONCLUSIONS: These results provide further evidence for two highly suggestible subtypes: a dissociative subtype characterised by deficits in executive functioning and a predisposition to psychopathology, and a subtype that exhibits superior imagery and no observable deficits in functioning.