Mind-Body Medicine

02/03/2014

Dr. David Spiegel Speaks from Paris and Addresses SCEH Berkeley Meeting

Dr. David Spiegel Addresses SCEH from Paris
Dr. David Spiegel Addresses SCEH from Paris

 

David Spiegel, MD, Associate Chair of Psychiatry and Medical Director, Stanford Center for Integrative Medicine, addressed the SCEH conference in October, 2013, from Paris where he was spending a three month sabbatical.  Hypnosis has a venerable tradition in France and in Paris, specifically. Once Anton Mesmer gained some recognition, for his work in animal magnetism, he moved from Vienna to Paris.   

Spiegel emphasized that hypnosis is the oldest Western model for psychotherapy.  Over 100 years before Freud, Mesmer established the principle that an interpersonal interaction with a patient can be therapeutic.  Freud himself began his professional work by studying hypnosis with Charcot in Paris. Only after he was frightened by a female patient expressing affection for him, did he abandon hypnosis as his therapeutic approach.  Ironically, at the end of his career, after his move to London, Freud placed a photograph of Charcot on the wall above his analytic couch.

Spiegel is now pursuing neuro-imaging studies, and identified the anterior cingulate cortex as central to understanding hypnosis, and the subgenual cingulate as mediating affective and cognitive experiences.

Spiegel cited a study he conducted ten years ago, triggering pain by applying electric shock to the subjects wrists, and then studying the difference in brain process, for those hypnotized and those not hypnotized.  A later study used PET imaging, and hypnotized subjects to add color perception for a black and white grid, and also to subtract color from a colored grid.  When the subjects altered their perception hypnotically, it mimicked the brain activity in perceiving an actual colored or black and white grid.

Hypnosis for pain can modify pain in one of two ways :  by reducing the sensation of pain via the somatosensory cortex, or reducing the suffering related to pain, via changes in the anterior cingulate cortex.  In the former case, the individual experienced a lessened or eliminated sensation of pain.  In the latter case, the individual noted the pain, but did not suffer affectively with it.  Several studies have now shown that hypnosis modifies activity in the anterior cingulate cortex, when it modifies attention and executive control.

Spiegel and colleagues have also studied the neural bases of hypnotizability.  Piccione, Hilgard, and Zimbardo showed extraordinary stability of hypnotizability; over a 25 year period the test re-test correlation was 0.7.  In fMRI studies, Spiegel and his team looked at the Salience network (anxiety related activity), the Default mode network (the brain idling), and the Executive control network (cognitive attention and control tasks).  The team used fMRI to map these three networks, by mapping fMRI activation areas during these three types of activities. The mapping showed significant differentiation between low and high hypnotizable subjects.  High hypnotizables showed more Salience network connectivity in the anterior cingulate cortex than did lows.  When highly absorbed in something, the highs are not worried about taking care of something else.

Functional connectivity is much higher between the Anterior cingulate and the Dorsolateral prefrontal cortex in highly hypnotizables than in lows. The highs recruit activity for executive control, in the dorsal left prefrontal cortex.

Take home conclusion:  Brain research in hypnosis is enhancing the credibility of hypnosis in medicine.

Posted at 04:36 PM

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