Tranceformation: Hypnosis, Dissociation and Trauma

Abstract
Hypnosis was the first Western form of psychotherapy, yet it remains underutilized in part because of insufficient understanding of its neural basis. Hypnosis involves highly focused attention, coupled with dissociation of aspects of awareness, an increase in cognitive flexibility, and an enhanced ability to modulate perception. Considerable evidence has emerged regarding this regarding underlying brain mechanisms, including studies employing event-related potentials, PET and fMRI. Our recent resting state fMRI data demonstrate functional connectivity between the executive control and salience networks among high but not low hypnotizable individuals. The hypnotic state involves reduced activity in the dorsal anterior cingulate cortex (key region in the salience network), heightened functional connectivity between the left dorsolateral prefrontal cortex (executive control network) and the insula, and inverse functional connectivity between the left DLPFC and the posterior cingulate cortex, part of the default mode network. Neuroimaging of those with PTSD has demonstrated similarities between the hypnotic state and responses to trauma, in particular dissociative reactions to trauma and its aftermath. The introduction of the Dissociative Subtype of PTSD into the DSM-5 and DSM-5-TR, involving depersonalization and/or derealization in addition to the exposure, intrusion, avoidance, demoralization and hyperarousal symptoms, has underscored the importance of dissociation as a treatable response to trauma, accessible through the controlled dissociation of the hypnotic state.

Despite this progress in understanding the neural basis of hypnosis and its salience to trauma and PTSD, it remains underutilized. Hypnotic techniques for addressing and treating PTSD and other trauma-related disorders will be presented. Research on modifications of exposure-based psychotherapies to assist with dissociative responses, in particular teaching the use of dissociation to separate physiological from psychological responses to trauma exposure and the use of hypnosis to help with restructuring of trauma-related memories will be presented.