Exploring the Role of Conscious and Unconscious Processes in Hypnosis: A Theoretical Review.

This review provided a comprehensive examination of various theories that attempt to explain hypnosis, focusing on the interplay between conscious and unconscious processes. We conducted a thorough analysis of key theories, from historical origins to recent models centered on cognition, social factors, and attributions. A central theme emerged: the critical role of the unconscious as a "gatekeeper" that modulates and guides the hypnotic experience. This notion appears in various forms across many theories, with the unconscious actively shaping and regulating the flow of information between conscious and unconscious realms during hypnosis. Understanding this dynamic interplay is crucial for comprehending the complex nature of hypnosis. The synthesized view of the unconscious as a "gatekeeper" offers a framework for integrating insights from diverse perspectives and highlights the centrality of unconscious processes in shaping hypnotic phenomena. Future research should further investigate the mechanisms of this unconscious "gatekeeper" role and its impact on hypnosis.

Conscious intelligence is overrated: The normative unconscious and hypnosis.

Hypnosis has been mysterious and controversial for hundreds of years. The legacy of this history is still with us. The philosophy of Ryle and of Dennett argue that the usual emphasis placed on states of consciousness and privileged access is misplaced. Cognitive neuroscience supports this by showing that unconscious processes explain much of our functioning and that what we call consciousness and privileged access is illusory. Attribution theory can largely account for the subjective states that have been seen as characteristic of and unique to hypnosis. Current models of hypnosis are reviewed and shown to have maintained classic and outdated views of dissociation and/or disconnected executive systems. Normative unconscious processes can account for much of hypnotic phenomena thereby showing hypnosis to be a normative phenomenon. An unconscious need to be absorbed into or become part of something beyond the self may underlie some of the individual differences in hypnotizability.

Reactive Chlorine Species Reversibly Inhibit DnaB Protein Splicing in Mycobacteria.

Intervening proteins, or inteins, are mobile genetic elements that are translated within host polypeptides and removed at the protein level by splicing. In protein splicing, a self-mediated reaction removes the intein, leaving a peptide bond in place. While protein splicing can proceed in the absence of external cofactors, several examples of conditional protein splicing (CPS) have emerged. In CPS, the rate and accuracy of splicing are highly dependent on environmental conditions. Because the activity of the intein-containing host protein is compromised prior to splicing and inteins are highly abundant in the microbial world, CPS represents an emerging form of posttranslational regulation that is potentially widespread in microbes. Reactive chlorine species (RCS) are highly potent oxidants encountered by bacteria in a variety of natural environments, including within cells of the mammalian innate immune system. Here, we demonstrate that two naturally occurring RCS, namely, hypochlorous acid (the active compound in bleach) and N-chlorotaurine, can reversibly block splicing of DnaB inteins from Mycobacterium leprae and Mycobacterium smegmatis in vitro. Further, using a reporter that monitors DnaB intein activity within M. smegmatis, we show that DnaB protein splicing is inhibited by RCS in the native host. DnaB, an essential replicative helicase, is the most common intein-housing protein in bacteria. These results add to the growing list of environmental conditions that are relevant to the survival of the intein-containing host and influence protein splicing, as well as suggesting a novel mycobacterial response to RCS. We propose a model in which DnaB splicing, and therefore replication, is paused when these mycobacteria encounter RCS. IMPORTANCE Inteins are both widespread and abundant in microbes, including within several bacterial and fungal pathogens. Inteins are domains translated within host proteins and removed at the protein level by splicing. Traditionally considered molecular parasites, some inteins have emerged in recent years as adaptive posttranslational regulatory elements. Several studies have demonstrated CPS, in which the rate and accuracy of protein splicing, and thus host protein functions, are responsive to environmental conditions relevant to the intein-containing organism. In this work, we demonstrate that two naturally occurring RCS, including the active compound in household bleach, reversibly inhibit protein splicing of Mycobacterium leprae and Mycobacterium smegmatis DnaB inteins. In addition to describing a new physiologically relevant condition that can temporarily inhibit protein splicing, this study suggests a novel stress response in Mycobacterium, a bacterial genus of tremendous importance to humans.

Psychotherapy Technique Related to Changes in Anxiety Symptoms With a Transdiagnostic Sample.

The current study examined how techniques in a psychodynamic model of therapy (Blagys and Hilsenroth, Clin Psychol Sci Pract. 7, 167-188, 2000) were related to changes in anxiety symptoms across early treatment process among a transdiagnostic sample of patients with primary anxiety disorder, subclinical anxiety disorder, and no anxiety disorder. Secondary analyses examined the use of specific psychodynamic techniques in relation to symptom change. Results revealed that therapists' use of psychodynamic-interpersonal (PI) techniques were significantly and directly related to changes in anxiety symptoms, in line with previous findings (Pitman, Slavin-Mulford, and Hilsenroth, J Nerv Ment Dis. 202, 391-396, 2014). In addition, patients with co-occurring axis I and II disorders demonstrated positive changes in anxiety symptoms regardless of level of PI technique used, whereas patients without co-occurring disorders experienced greater improvement with more PI. Implications for transdiagnostic treatment protocols for anxiety, notably Leichsenring and Salzer's (Psychotherapy 51, 224, 2104) Unified Psychodynamic Protocol for Anxiety Disorders, are discussed in relation to the current findings.

Common factors are not so common and specific factors are not so specified: toward an inclusive integration of psychotherapy research.

The dichotomy between what has been termed empirically supported treatments (EST) and common factors (CF) is false and counterproductive. Neither has a monopoly on empirical truth. The term nonspecific is unproductive and misleading. Specified versus nonspecified is more empirically correct. Assumptions of the EST and CF approaches are questionable. Common factors (both currently specified and not so specified) are reviewed. These include the therapeutic relationship, expectancies, attributions for therapeutic success, exposure, and mastery. Far from maximizing therapeutic success, the CF EST dichotomy and its resulting theoretical squabbles result in weaker outcomes than would be the case if empirical results were taken seriously, and factors shown to be effective (both specified and nonspecified) were systematically investigated and integrated so as to create maximally effective treatments.

Environmental concentrations of the selective serotonin reuptake inhibitor fluoxetine impact specific behaviors involved in reproduction, feeding and predator avoidance in the fish Pimephales promelas (fathead minnow).

Pharmaceuticals and personal care products (PPCPs) have been found in surface waters worldwide, but little is understood of their effects on the wildlife that inhabit these waters. Fluoxetine (Prozac; Eli Lilly), a highly prescribed selective serotonin reuptake inhibitor (SSRI), is a commonly found PPCP in surface water. The purpose of this project was to determine if environmentally relevant concentrations of fluoxetine impact behavior that is important for population survival in native fish species, including reproduction, feeding and predator avoidance. Chronic 4-week exposures were conducted with doses ranging from 100 ng/L to 100 µg/L to cover a range of environmentally relevant concentrations up to higher concentrations comparable to other published studies with the same drug that have documented various physiological impacts. Pimephales promelas (fathead minnow), a species native to North America, was used as it conducts a range of specific mating behaviors and therefore serves as an excellent model of specific impacts on brain function. Fluoxetine concentrations as low as 1 µg/L, a concentration that has been found in many freshwater environments, were found to significantly impact mating behavior, specifically nest building and defending in male fish. Males were also found to display aggression, isolation, and repetitive behaviors at higher concentrations. Female mating behavior was largely unaffected. In addition, predator avoidance behaviors in males and females were also impacted at 1 µg/L. Feeding was impacted at 10 µg/L and in the highest exposure (100 µg/L), egg production was limited by deaths of females due to significant male aggressive behaviors in the first two weeks of exposure. Specific behavioral changes occurred at each concentration (most noticeably 1 µg/L and 100 µg/L) indicating a dose dependent effect that triggered different responses at lower exposures versus higher exposures or differential impacts of dose depending on brain region. Length of exposure also had an impact on aggressive behavior. Changes in hormone levels, indicating significant neuroendocrine changes, suggested as a mechanism of response in higher dose and acute studies, were not linked to changes in behaviors at the doses used in this study. This research provides detailed data on how exposures to fluoxetine impact specific fish behaviors and reproduction and that the effects are dose dependent.

The effect of D-cycloserine on subliminal cue exposure in spider fearful individuals.

Research on D-cycloserine (DCS) has demonstrated a significant effect on symptom reduction in human studies that utilized conventional exposure-based approaches. Recent studies have offered promising results for targeting fears through subliminal paradigms. In this double-blind, randomized placebo-controlled study, 45 spider fearful individuals received DCS or placebo pills prior to completing a subliminal cue exposure task to images of spiders. Participants completed self-report questionnaires and a behavioral approach task to a live caged tarantula. After repeated exposure to subliminal spider cues, participants in the DCS group reported a greater reduction in disgust than individuals in the placebo group. No difference was observed in fear ratings. These findings suggest that DCS augments the reduction in disgust in spider fearful subjects after subliminal exposure to spider cues.

Less is more: the effects of very brief versus clearly visible exposure.

This study compared the effects of exposure to masked and unmasked phobic stimuli on phobic behavior. Participants were identified as spider-phobic with a questionnaire and a Behavioral Avoidance Test (BAT) with a live tarantula (N = 101). One week later, they were administered one of three types of exposure: very brief (25 ms) or clearly visible (120 ms) images of spiders, or very brief images of flowers. They reported ratings of subjective distress just before and after these exposures, and engaged in the BAT again thereafter. Two weeks later, 57 participants returned for a follow-up BAT. The results indicated a double dissociation between the effects of very brief and clearly visible exposure: the former reduced avoidance of the tarantula and did not affect distress, whereas the latter increased distress but did not affect avoidance. The behavioral effect lasted for two weeks. These findings suggest that avoidance of a feared object can be reduced without full conscious awareness. The theoretical implications are discussed.

Investigating merger: subliminal psychodynamic activation and oneness motivation research.

Two programs of empirical research have endeavored to explicate some of the unconscious processes involved in adult phenomena of merger, symbiosis, or oneness. Starting in the 1960s under the leadership of Lloyd Silverman (see, e.g., Silverman, Lachmann, and Milich 1982), subliminal psychodynamic activation (SPA) has used subliminal methods to prime and manipulate these processes. Later research into what was termed oneness motivation (OM) posited the existence of a chronic personality variable and explored it independently of priming (see, e.g., Siegel and Weinberger 1998). These lines of research have established links between unconscious processes of oneness and a range of clinical and nonclinical outcomes.

Therapeutic interventions related to outcome in psychodynamic psychotherapy for anxiety disorder patients.

This is the first study with acceptable inter-rater reliability to examine specific therapeutic techniques related to change in anxiety disorder patients during short-term psychodynamic psychotherapy. The study first examined the effectiveness of short-term psychodynamic psychotherapy and results showed significant and positive pre-/post-treatment changes on both patient and independent clinical ratings for anxiety, global symptomatology, relational, social, and occupational functioning. Likewise, the majority of patients (76%) reported anxiety symptoms within a normal distribution at termination. Importantly, psychodynamic interventions rated early in treatment (third/fourth session) were positively related to changes in anxiety symptoms. Further, results showed that several individual psychodynamic techniques were meaningfully related to outcome including (1) focusing on wishes, fantasies, dreams, and early memories; (2) linking current feelings or perceptions to the past; (3) highlighting patients' typical relational patterns; and (4) helping patients to understand their experiences in new ways. Clinical applications are discussed.

What you cannot see can help you: the effect of exposure to unreportable stimuli on approach behavior.

We examined effects of exposure to unreportable images of spiders on approach towards a tarantula. Pretests revealed awareness of the stimuli was at chance. Participants high or low (top and bottom 15%) on fear of spiders were randomly assigned to receive computer-generated exposure to unreportable pictures of spiders or outdoor scenes. They then engaged in a Behavioral Approach Task (BAT) with a live tarantula. Non-fearful participants completed more BAT items than spider-fearful individuals. Additionally, as predicted, a significant interaction (F(1,48)=5.12, p<.03) between fear of spiders and stimulus demonstrated that spider-fearful participants exposed to spiders completed more BAT items than spider-fearful participants exposed to control stimuli (but not as many as non-fearful participants). The findings support the hypothesis that exposure to unreportable feared stimuli promotes approach towards the feared object. Future research and clinical implications were discussed.

Very brief exposure: the effects of unreportable stimuli on fearful behavior.

A series of experiments tested the hypothesis that very brief exposure to feared stimuli can have positive effects on avoidance of the corresponding feared object. Participants identified themselves as fearful of spiders through a widely used questionnaire. A preliminary experiment showed that they were unable to identify the stimuli used in the main experiments. Experiment 2 (N=65) compared the effects of exposure to masked feared stimuli at short and long stimulus onset asynchronies (SOA). Participants were individually administered one of three continuous series of backwards masked or non-masked stimuli: unreportable images of spiders (25-ms SOA), clearly visible images of spiders (500-ms SOA), or unreportable images of trees (25-ms SOA). Immediately thereafter, they engaged in a Behavioral Avoidance Test (BAT) with a live, caged tarantula. Exposure to unreportable images of spiders resulted in greater approach towards the tarantula than unreportable neutral images. A post-hoc comparison with clearly visible exposure to these same images approached significance. These effects were maintained at a 1-week follow-up (N=57). In Experiment 3 (N=26), participants engaged in the BAT 1 week prior to the exposure manipulation in order to provide a baseline measurement of their avoidant behavior, and again immediately after the exposure manipulation. Exposure to unreportable images of spiders reduced avoidance of the tarantula. Similar exposure to trees did not. Implications for the non-conscious basis of fear are discussed.

A primer on meta-analysis of correlation coefficients: the relationship between patient-reported therapeutic alliance and adult attachment style as an illustration.

The aim of this article is twofold: to offer an introduction to meta-analysis using correlation coefficients to facilitate greater understanding of meta-analytic findings and to guide those interested in conducting meta-analyses. The authors review calculations for a weighted average effect size, the statistical significance of this effect, a test of homogeneity, confidence intervals, and file drawer analysis. They provide a running example of the relationship between patient-reported therapeutic alliance and adult attachment style. Results (k = 12, N = 581.17, weighted average r = .17, p < .0001, 95% confidence interval=.13-.21) indicated a positive, statistically significant relationship, suggesting that greater attachment security is associated with stronger therapeutic alliances, whereas greater attachment insecurity is associated with weaker therapeutic alliances. File drawer results suggested that some caution is warranted in terms of the size of the effect.

Therapist affect focus and patient outcomes in psychodynamic psychotherapy: a meta-analysis.

OBJECTIVE: The authors systematically examined the relationship between therapist facilitation of patient emotional experience/expression and outcome in psychodynamic psychotherapy. METHOD: Computer and manual searches were conducted for relevant publications, and 10 independent samples of short-term dynamic psychotherapy were included in a meta-analysis. Data analysis included calculation of an overall effect size of the relationship between therapist affect focus and outcome, statistical significance, and test for homogeneity. In addition, moderator analyses were conducted to examine the potential impact of type of outcome construct used and the methodological quality of individual studies. RESULTS: The overall average weighted effect size across all outcome types was statistically significant (r=0.30), and the homogeneity statistic was nonsignificant. Moderator analyses indicated a statistically significant relationship between therapist facilitation of patient emotional experience/expression and outcome when more than one outcome construct was included but not when either a single or an unclear outcome construct was used. There were no significant relationships between methodological quality and the size of the effects, although use of audio- or videotaping for supervision demonstrated a moderate effect. CONCLUSIONS: These data indicate that therapist facilitation of patient affective experience/expression is associated with patient improvement over the course of psychodynamic psychotherapy. Although the size of this relationship was not significantly related to methodological quality, results suggest the importance of close supervision of actual techniques through the use of audio- or videotapes. Additionally, results highlight the importance of defining outcome in a multidimensional way to properly assess theoretically relevant effects.

In praise of clinical judgment: Meehl's forgotten legacy.

Although Paul E. Meehl demonstrated the limits of informal aggregation of data and prognostication by presumed experts, he remained convinced that clinical experience confers expertise of some kind. The authors explore this forgotten side of Meehl's legacy by reconsidering the validity of clinical judgment in its natural context, everyday clinical work. Three domains central to clinical practice are examined: diagnosis, interpretation of meaning, and intervention. It is argued that a more sanguine picture of clinical expertise emerges when the focus shifts from prediction at high levels of inference to (a) judgments at a moderate level of inference, (b) contexts for which clinical training and experience are likely to confer expertise, and (c) conditions that optimize the expression of that expertise (e.g., use of instruments designed for expert observers). The authors conclude by examining domains in which clinical judgment could prove useful in knowledge generation (e.g., hypothesis generation, identification of falsifying instances, item development).

When clinical description becomes statistical prediction.

This article reconsiders the issue of clinical versus statistical prediction. The term clinical is widely used to denote 1 pole of 2 independent axes: the observer whose data are being aggregated (clinician/expert vs. lay) and the method of aggregating those data (impressionistic vs. statistical). Fifty years of research suggests that when formulas are available, statistical aggregation outperforms informal, subjective aggregation much of the time. However, these data have little bearing on the question of whether, or under what conditions, clinicians can make reliable and valid observations and inferences at a level of generality relevant to practice or useful as data to be aggregated statistically. An emerging body of research suggests that clinical observations, just like lay observations, can be quantified using standard psychometric procedures, so that clinical description becomes statistical prediction.

Where's the text? The problem of validation in psychoanalysis.

Whatever their differences, the various schools of psychoanalysis all subscribe to the case study, based on clinical vignette and anecdote, as the "text" of psychoanalysis. Because the typical case study presents not the actual analytic dialogue but a reconstruction based on the analyst's selective memory, the use of such a text renders problematic the validation of an analyst's case formulation, and has traditionally diminished the epistemological status of psychoanalysis. Pristine clinical data, as would be provided by verbatim transcripts of audio-recorded analytic sessions, are rarely created and even more rarely made public. Study of the psychoanalytic process is thereby made impossible, whether by clinical exegesis, qualitative analysis, or quantitative statistical analysis. Yet the analytic community, highly resistant to this public documentation, continues to marshal five common arguments against it. These arguments are reviewed and responded to in the belief that such documentation would enhance the field's intellectual status by allowing the problem of clinical validation to be addressed in ways that move beyond appeals to the authority of private clinical experience.