The Role of Interoceptive Sensitivity and Hypnotizability in Motor Imagery.

Motor imagery (MI) requires the mental representation of the body, obtained by integrating exteroceptive and interoceptive information. This study aimed to investigate the role of interoceptive sensitivity (IS) in MI performed through visual and kinesthetic modalities by participants with low (lows, N = 26; SHSS: A, M + SD: 1.00 + 1.52), medium (mediums, N = 11; SHSS: A, 6.00 + 0.77) and high hypnotizability scores (highs, N = 16; SHSS:A, 9.75 + 1.24), as measured by the Stanford Hypnotic Susceptibility Scale: Form A. The three groups displayed different MI abilities and IS levels. The efficacy of MI was measured using the chronometric index and self-reported experience, while IS was measured using the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire. Alpha and beta power spectrum densities (PSDs) were extracted from the EEG signals acquired during baseline, actual movement and visually and kinesthetically imagined movements. The chronometric indices do not reveal significant differences between groups and imagery modalities. The self-report MI efficacy indicates better kinesthetic imagery in highs and mediums than in lows, and no modality difference among lows. The MAIA dimensions sustain the differences in subjective experience and almost all the EEG differences. The latter are slightly different in highs, mediums and lows. This is the first report of the major role played by IS in MI and strongly supports the theory of embodied cognition.

Is Hypnotic Induction Necessary to Experience Hypnosis and Responsible for Changes in Brain Activity?

The relevance of formal hypnotic induction to the experience of trance and its neural correlates is not clear, in that hypnotizability, beliefs and expectation of hypnosis may play a major role. The aim of the study was assessing the EEG brain activity of participants with high (highs) or low hypnotizability scores (lows), aware of their hypnotizability level and informed that the session will include simple relaxation, formal hypnotic induction and neutral hypnosis. A total of 16 highs and 15 lows (according to the Stanford Hypnotic Susceptibility Scale, form A) were enrolled. Their EEGs were recorded during consecutive conditions of open/closed-eyes relaxation, hypnotic induction, neutral hypnosis and post hypnosis not interrupted by interviews. The studied variables were theta, alpha and gamma power spectral density (PSD), and the Determinism (DET) and Entropy (ENT) of the EEG signal Multidimensional Recurrence Plot (mRP). Highs reported significantly greater changes in their state of consciousness than lows across the session. The theta, alpha and gamma PSD did not exhibit condition-related changes in both groups. The Alpha PSD was larger in highs than in lows on midline sites, and the different sides/regions' theta and gamma PSD were observed in the two groups independently from conditions. ENT showed no correlation with hypnotizability, while DET positively correlated with hypnotizability during hypnosis. In conclusion, the relevance of formal hypnotic induction to the experience of trance may be scarce in highs, as they are aware of their hypnotizability scores and expecting hypnosis. Cognitive processing varies throughout the session depending on the hypnotizability level.

Association of Hypnotizability, Interoception, and Emotion.

The present scoping review reports the reciprocal relations between hypnotizability, interoception, and emotion. Brain morpho-functional differences may account for the lower interoceptive accuracy, higher interoceptive sensitivity, and different emotional strategies observed in highly hypnotizable participants with respect to medium-to-low hypnotizables. Since interoception is relevant to both physical and mental health and hypnotizability can predict both interoceptive abilities and the efficacy of interoception-based mental training, this allows for the development of new forms of treatment and rehabilitation.

Cerebrovascular reactivity during visual stimulation: Does hypnotizability matter?

Hypnotizability is a trait associated with several physiological correlates including cardiovascular control. The present study aimed to investigate the posterior cerebral artery flow velocity (PCAv) in basal closed eyes (B) and during visual stimulation (VS) conditions in med-highs and med-lows. Twenty-four healthy volunteers were submitted to the hypnotic assessment through the Stanford Hypnotic Susceptibility Scale, form A which classified 13 low-to-medium (med-lows) and 10 high-to-medium (med-highs) hypnotizable participants. One subject scoring 6 out of 12 was excluded from the comparisons between groups. Arterial blood pressure, heart rate, and partial pressure of end-tidal CO2 were monitored during both B and VS conditions. Simultaneously, PCAv was assessed by transcranial Doppler. Cerebrovascular Reactivity (CVR) was computed as a percentage of the PCAv change occurring during VS with respect to B (ΔPCAv). During VS both groups increased their PCAv (mean ± SD: 7.9 ± 5.2 %) significantly with no significant group difference. However, among med-highs, CVR was negatively correlated with hypnotizability scores. Thus, higher hypnotizability may be associated with lower metabolic demand in response to VS only within med-highs hypnotizable participants.

Does hypnotizability affect neurovascular coupling during cognitive tasks?

Susceptibility to hypnosis is a very pervasive psychophysiological trait characterized by different attentional abilities, information processing, and cardiovascular control. Since near infrared spectroscopy is a good index of neurovascular coupling, we used it during mental computation (MC) and trail making task (TMT) in 13 healthy low-to-medium (med-lows) and 10 healthy medium-to-high (med-highs) hypnotizable participants classified according to the Stanford Hypnotic Susceptibility Scale, form A, and characterized for the level of proneness to be deeply absorbed in related experiences by the Tellegen Absorption Scale. The med-highs reported greater absorption than med-lows. The tissue hemoglobin index (THI) and the tissue oxygenation index (TOI) increased across the tasks only in med-highs who displayed also different time courses of THI and TOI during MC and TMT, which indicates different tasks processing despite the two groups' similar performance. The findings suggest that med-highs' tissue oxygenation is more finely adjusted to metabolic demands than med-lows'.

Cerebral Blood Flow in Healthy Subjects with Different Hypnotizability Scores.

Hypnotizability is a cognitive trait associated with differences in the brachial artery flow-mediated dilatation of individuals with high hypnotizability (highs) and low hypnotizability scores (lows). The study investigated possible hypnotizability-related cerebrovascular differences. Among 24 healthy volunteers, the Stanford Hypnotic Susceptibility Scale Form A identified 13 medium-to-lows (med-lows), 11 medium-to-highs (med-highs), and 1 medium hypnotizable. Hypnotizability did not influence the significant changes produced by the trail making task (TMT), mental arithmetic task (MAT), hyperventilation (HVT), and rebreathing (RBT) on heart rate (HR), arterial blood pressure (ABP), and partial pressure of end-tidal CO2 (PETCO2), but moderated the correlations between the changes occurring during tasks with respect to basal conditions (Δ) in ABP and PETCO2 with middle cerebral artery flow velocity (MCAv). In HVT, med-lows exhibited a significant correlation between ΔMCAv and ΔPETCO2, and med-highs showed a significant correlation between ΔABP and ΔMCAv. Cerebrovascular reactivity (CVR) and conductance (ΔCVCi) were significantly correlated with ΔMCAv only in med-lows during HVT and RBT. For the first time, cerebrovascular reactivity related to hypnotizability was investigated, evidencing different correlations among hemodynamic variables in med-highs and med-lows.

Hypnotisability and the Cerebellum: Hypotheses and Perspectives.

Hypnotisability is a multidimensional trait predicting the proneness to enter hypnosis and/or accept suggestions and is associated with several psychophysiological correlates. This scoping review reports the differences between individuals with high (highs) and low hypnotizability (lows) in the left cerebellar lobules IV-VI grey matter volume, in the excitability of the right motor cortex and in motor and non-motor functions in which the cerebellum may be involved. A reduced cerebellar inhibition may explain the greater excitability of the highs' right motor cortex. The latter may be involved in their greater proneness to ideomotor behaviour following sensorimotor suggestions. The associated experience of involuntariness and effortlessness could be due to the motor cortex greater excitability as well as to activation of a specific cerebellar-parietal circuit. Looser postural and visuomotor control with no learning across trials and greater attentional stability can be accounted for by a less accurate cerebellar predictive model of information processing. The highs' stronger functional equivalence between imagery and perception/action and greater motor excitability may be involved in the highs' greater proneness to respond to emotional stimuli. Paradoxical pain control may depend on reduced cortical inhibition of the pain matrix by the cerebellum. Cerebellar hypotheses are not alternative to other physiological mechanisms and should be tested in future research.

Hypnotizability and the position sense: proprioceptive localization of the hand.

We  investigated whether healthy subjects with high (highs) and low (lows) hypnotizability scores differ in the ability to report the position of their right hand in the horizontal plane at the end of passive and active arm movements directed to lateral, intermediate and medial targets of the right hemispace under correct or incorrect visual feedback. Results showed that incorrect visual feedback increased the error in both groups. In lows, the error was similar after active and passive movements; in highs, it was lower for active than passive movements toward the medial position, but lower for passive than for active movements for the lateral one. The highs' error was significantly lower than the lows' one only for the active movements directed toward the medial hand position. Hypnotizability-related differences may be due to different role of efferent copies in highs and lows.

Pain perception and EEG dynamics: does hypnotizability account for the efficacy of the suggestions of analgesia?

We report novel findings concerning the role of hypnotizability, suggestions of analgesia and the activity of the Behavioral Inhibition/Activation System (BIS/BAS) in the modulation of the subjective experience of pain and of the associated EEG dynamics. The EEG of high (highs) and low hypnotizable participants (lows) who completed the BIS/BAS questionnaire was recorded during basal conditions, tonic nociceptive stimulation without (PAIN) and with suggestions for analgesia (AN). Participants scored the perceived pain intensity at the end of PAIN and AN. The EEG midline dynamics was characterized by indices indicating the signal predictability (Determinism) and complexity (Entropy) obtained through the Recurrence Quantification Analysis. The reduced pain intensity reported by highs during AN was partially accounted for by the activity of the Behavioral Activation System. The decreased midline cortical Determinism observed during nociceptive stimulation in both groups independently of suggestions remained significantly reduced only in lows after controlling for the activity of the Behavioral Activation System. Finally, controlling for the activity of the Behavioral Inhibition System abolished stimulation, suggestions and hypnotizability-related differences. Results indicate that the BIS/BAS activity may be more important than hypnotizability itself in pain modulation and in the associated EEG dynamics.

Pain Symptoms in Fibromyalgia Patients with and without Provoked Vulvodynia.

Objective. The aim of the study was to compare the pain symptoms of fibromyalgia patients exhibiting (FMS+PVD) and not exhibiting (FMS) comorbidity with provoked vulvodynia. Study Design. The case control study was performed in 39 patients who had been diagnosed with FMS and accepted to undergo gynaecological examination and in 36 healthy women (C). All patients completed standardized questionnaires for pain intensity, pain area, and psychological functioning. The gynaecological examination included vulvar pain pressure reactivity (Q-tip), pelvic tone assessment (Kegel manoeuver), and a semistructured interview collecting detailed information about pelvic symptoms and sexual function. Results. FMS+PVD patients displayed a higher number of associated symptoms than FMS patients. The vulvar excitability was significantly higher in FMS+PVD than in FMS and in both groups than in Controls. Half of FMS+PVD patients were positive to Kegel manoeuver and displayed higher scores in widespread pain intensity, STAI-Y2, and CESD levels than Kegel negative patients. Conclusions. The study reveals that increased vulvar pain excitability may occur in FMS patients independently of the presence of coital pain. Results suggest that coital pain develops in patients with higher FMS symptoms severity due to the cooperative effects of peripheral and central sensitization mechanisms.

Body sway modulation by hypnotizability and gender during low and high demanding postural conditions.

The cognitive trait of hypnotizability, associated with the proneness to accept suggestions, exhibits several physiological correlates including the modulation of sensorimotor integration and, in particular, of postural control. In this respect, we have shown that, at eyes closure, healthy subjects with high hypnotizability scores (highs) having their feet 2 cm apart show larger and faster body sway with respect to low hypnotizable individuals (lows). The aim of the present study was to investigate whether hypnotizability modulates body sway during slightly more demanding and very difficult postural conditions such as feet together bipedal posture and one legged stance, respectively. The Center of Pressure (CoP) Area, mean Velocity, the CoP mean position (Xmean, Ymean) and its variability (SDx, SDy) in the frontal and sagittal planes were acquired in 18 highs (9 females) and 18 lows (9 females). Results showed that the previously observed lows' smaller and slower body sway was not present any longer. Nonetheless, hypnotizability interacted with gender in the modulation of the variability of the CoP movement in the frontal plane during both the bipedal feet together posture and one legged stance, as significant gender differences were observed only among lows. In conclusion, results confirm a role of hypnotizability in sensorimotor integration and support the relevance of hypnotic assessment in clinical settings, as hypnotizability may be responsible for part of the postural variability.

Visual identification of haptically explored objects in high and low hypnotizable subjects.

Hypnotizability is associated with peculiar characteristics of sensorimotor integration, imaginal abilities, and preferences in the sensory modality of imagery. The visual recognition of haptically explored objects involves an interaction among these processes and is a proper tool to investigate their possible hypnotizability-related modulation. Sixteen high hypnotizables and 16 lows participated in the study. Higher frequencies of correct recognition (RF) were observed in highs. RF improved across both groups. As an effect of learning, shorter recognition times were found in males among highs and in females among lows. The findings are consistent with the literature suggesting that hypnotizability levels may be associated with specific modes of sensory integration and/or imagery.

Hypnotizability-related effects of vestibular impairment on posture and locomotion.

Body sway and locomotion are differentially modulated in high (highs) and low (lows) hypnotizable subjects undergoing alteration of visual and neck/leg proprioceptive inputs. The study's aim was to investigate whether partial impairment of vestibular information due to backward head extension affects postural (Study 1) and locomotor behavior (Study 2) differentially in highs and lows. Results showed that, at variance with the visual and proprioceptive modalities, vestibular inactivation did not induce major differences between the 2 groups, with the exception of improvement in walking straight across consecutive trials, which was observed only in highs. The article presents an overview of the structures and mechanisms possibly involved in the observed hypnotizability-related differences in motor control and suggests that hypnotic susceptibility might be a relevant factor in neuro-rehabilitative treatments because it accounts for part of the variability in the sensorimotor self.

Modulation of the postural effects of cognitive load by hypnotizability.

Aim of the experiment was to study whether cognitive load affects postural control more in low (Lows) than in highly hypnotizable (Highs) subjects due to the latter's greater attentional abilities. Standing Highs and Lows underwent an experimental session (closed eyes) consisting of a basal condition and of mental computation in an easy (stable support) and a difficult (unstable support) postural condition. Variability [standard deviation (SD)] and complexity [sample entropy (SampEn)] of the movement of the centre of pressure (CoP), its mean velocity (Velocity), the area swept by the CoP (Area) and the ratio between the CoP trajectory length and area [length for surface (LFS)] were measured. Few hypnotizability-related differences were detected (reduction in the Highs' SD and increases in the Lows' LFS in the difficult postural condition). Thus, the hypnotizability-related postural differences observed in previous studies during sensory alteration could not be accounted mainly by attentional abilities.

Hypnotizability-dependent modulation of postural control: effects of alteration of the visual and leg proprioceptive inputs.

The aim of the experiment was to investigate whether the peculiar attentional/imagery abilities associated with susceptibility to hypnosis might make postural control in highly hypnotizable subjects (Highs) that are less vulnerable to sensory alteration than in individuals with low hypnotic susceptibility (Lows). The movement of the centre of pression (CoP) was monitored in Highs and Lows during alteration of the visual and leg proprioceptive input. The two groups responded differently to eyes closure and to an unstable support and the CoP movement was generally larger and faster in Highs. The stabilogram diffusion analysis indicated a different set point in Highs and Lows and suggested that the former are more independent of specific sensory information than the latter, likely due to different abilities in sensory re-weighting and/or peculiar internal models of postural control. The results are discussed within the general perspective of high pervasiveness of the hypnotizability trait, which modulates cognitive, autonomic and somatic functions.

Frequency of occurrence of the F wave in distal flexor muscles as a function of hypnotic susceptibility and hypnosis.

The aim of the experiment was to assess whether the membrane excitability of flexor cervical and/or lumbar motoneurons is related to hypnotic susceptibility (measured with the Stanford Hypnotic Susceptibility Scale, Form A) and hypnosis. During the experimental sessions, hypnotized subjects were given only suggestions of relaxation (neutral hypnosis) while awake subjects were given instructions to be quiet and relaxed (simple relaxation). F waves were recorded from the abductor digiti minimi and abductor hallucis of both sides after electrical stimulation of the ulnar or tibial nerve, respectively, and were used as an index of motoneuron membrane excitability in three groups of subjects: highly susceptible under neutral hypnosis, highly susceptible and non-susceptible during simple relaxation sessions. In lower limbs, there was no difference among the groups in the frequency of occurrence of F waves. In upper limbs, hypnosis selectively reduced F frequency of occurrence in flexor motoneurons on the right side. This reduction persisted after the end of hypnosis and also occurred during the last period of relaxation in highly susceptible non-hypnotized subjects. Results support the idea that hypnotic phenomena develop along a continuum in which some trait differences can be more easily revealed by the induction of hypnosis.