Hypnotic Suggestions: Their Nature and Applicability in Studying Executive Functions

Exekutive Funktionen (EF) sind eine Gruppe von Top-Down-Prozessen, die in neuartigen Situationen eingesetzt werden, um neue Trigger-Response-Assoziationen herzustellen oder vorhandene Handlungsoptionen an neue Situationen anzupassen. Obwohl EF erschöpfend untersucht wurden, bleiben wichtige Fragen offen. Beispiele dafür sind (a) Sind Exekutivfunktionen vollständig trennbar oder beruhen sie auf einem gemeinsamen neurokognitiven System? (b) Was messen verschiedene Versionen der Stroop-Aufgabe, einer der meist-verwendeten Aufgaben zur Prüfung der Inhibitionsfunktion? (c) Muss Inhibition immer Ressourcen-fordernd sein, oder gibt es eine Form der Inhibition, die mühelos implementiert werden kann? Zur Beantwortung dieser Fragen, habe ich neurokognitive Korrelate von EF und ihrer Verbesserung mithilfe posthypnotischer Suggestionen (PHS) und Ereigniskorrelierter Hirnpotentiale (EKP) untersucht. Zusammenfassend ergaben sich folgende Antworten: (a) Psychometrische und EKP-Daten aus den Studien zur Gedächtnisaktualisierung und Inhibition sowie deren Verbesserung anhand PHS zeigten sowohl funktionsspezifische als auch gemeinsame neurokognitive Prozesse der Inhibition und Aktualisierung. (b) Obwohl sowohl die vokale als auch die manuelle Version der Stroop-Aufgabe Inhibitionsfunktionen erfordern, ist die vokale Version Ressourcen-fordernder, da sie mindestens einen zusätzlichen Lokus der Interferenz im Antwort-Produktionsprozess aufweist, der nicht mit PHS beeinflussbar ist und der in der manuellen Version fehlt. (c) Unter Verwendung PHS zur Erhöhung der Präferenzen für kalorienarme Lebensmittel untersuchte ich die Auflösung von Konflikten. Die EKP-Ergebnisse zeigten, dass auch Konflikt-Auflösung, ähnlich wie Inhibition, Ressourcen konsumiert. Insgesamt zeigt dieses Projekt, dass die Verwendung Aufgaben-bezogener PHS in Kombination mit Neuroimaging-Techniken einen fruchtbaren Ansatz für die Untersuchung ungeklärter Fragen über Exekutivfunktionen darstellt.Executive functions (EF) are a group of top-down processes used in novel situations to develop or adapt existing responses to the task at hand. Even though EFs are studied exhaustively, several important questions remain unanswered: (a) Are EFs entirely separated, or do they rely on a common system? (b) What do different versions of the Stroop task measure? (c) Does inhibition always need to be effortful? To address these questions, I investigated neurocognitive correlates of EFs and their enhancements by means of posthypnotic suggestions (PHS) and event-related potentials (ERP). However, before one can use PHSs, it must be elucidated whether and how they affect EFs. Although PHSs are used repeatedly for improving inhibition, it is unclear whether their effects are mediated by bottom-up or top-down processes. By using an updating task, I showed that effects of PHSs can be attributed to top-down processes. Accordingly, a new theory of hypnosis was proposed and empirically tested by modeling hypnotizability scores with structural equation modeling. In short, the simulation-adaption theory suggests that several top-down processes are employed for responding to suggestions. After elucidating the driving mechanism of PHSs is mentally practicing a novel strategy, PHSs were used for addressing the questions regarding EFs. Summarizing (a) the psychometric and ERP results from several studies indicated that different EFs rely on both function-specific and shared neurocognitive processes. (b) Even though different versions of the Stroop task are tapping into inhibition, the vocal compared to the manual version has at least an extra response-production-related locus of interference. (c) Using PHSs for increasing preferences for low-calorie food items, it is shown that resolve is effortful to implement, as indicated by increased P300 amplitudes. Together, this project shows how PHSs, along with neuroimaging techniques, can provide a novel approach for investigating EFs

An integrative cognitive theory of suggestion and hypnosis

On the basis of a critical review of the literature in chapter one, it is concluded that no existing theory of hypnosis is able to provide a satisfactory account of the entire set of behavioural, cognitive, social and physiological evidence pertaining to the phenomenon. In an attempt to rectify this situation, an integrative conceptual framework amalgamating existing theories of hypnosis into a single model on the basis of contemporary cognitive psychological theory is presented in chapters two and three. According to the model, successfully executed suggestions result from the automatic activation of perceptual and behavioural representations following the receipt of triggers by low level attentional systems. By this view, the process involved in hypnotic and non-hypnotic suggestions are essentially the same; however, it is argued that contextual features and state changes associated with the hypnotic situation are responsible for the increased responsivity to suggestions typically displayed therein. In the following chapters, four studies designed to assess predictions from the model are described. In the first two, the related predictions that suggestibility is positively related to a low level processing predisposition and negatively related to a high level processing predisposition were assessed. Both studies provided support for the first hypothesis although no evidence for the second hypothesis was obtained. the third and fourth studies examined the related hypotheses that hypnosis is associated with (i) a low level processing bias; and (ii) a high level processing inhibition. Neither hypothesis received any significant empirical support. In the final chapter, the results of these studies are discussed with reference to the theoretical framework outlined in the introductory chapters. It is concluded that the model provides a fairly good account of suggestion, although certain revisions are required before an adequate account of hypnosis can be offered. Avenues for future research are explored

Adherence to health-related behaviors: effectiveness of implementation intentions and posthypnotic suggestion in college students

Resumo: Com base no conceito de implementação de intenções (Gollwitzer, 1993, 1999) e na teoria do contexto de resposta de Kirsch & Lynn (1997), o presente trabalho testou a eficácia de uma intervenção combinada de implementação de intenções com hipnose e sugestão pós-hipnótica na promoção da adesão a uma tarefa simples (avaliação do humor) e uma tarefa difícil (actividade física). Os participantes são estudantes universitários de uma universidade na Nova Jérsia, (N=124, Estudo 1, EUA) e em Lisboa (N=323, Estudo 2, Portugal). Em ambos os estudos os participantes foram seleccionados a partir de uma amostra mais vasta baseado num escrutínio da sua sugestibilidade hipnótica avaliada por meio da Escala de Grupo de Sugestibilidade Hipnótica de Waterloo-Stanford (WSGC): Forma C. O Estudo 1 usou um desenho factorial do tipo 2x2x3 (tipo de intenção formada x hipnose x nível de sugestionabilidade) e o Estudo 2 usou um desenho factorial do tipo 2 x 2x 2 x 4 (tipo de tarefa x tipo de intenção formada x hipnose x nível de sugestionabilidade). No Estudo 1 foi pedido aos participantes que corressem todos os dias e durante três semanas durante 5 minutos, que medissem a sua pulsação antes e depois da actividade física e que mandassem um e-mail ao experimentador, fornecendo assim uma medida comportamental e uma medida de auto-relato. Aos participantes no grupo de intenções de meta foi apenas pedido que corressem todos os dias. Aos participantes no grupo de implementação de intenções foi pedido que especificasses com exactidão quando e onde iriam correr e enviar o e-mail. Para além disso, cerca de metade dos participantes foram hipnotizados e receberam uma sugestão pós-hipnótica em que lhes foi sugerido que o pensamento de correr todos os dias lhes viria à mente sem esforço no momento apropriado. A outra metade dos participantes não recebeu qualquer sugestão hipnótica. No Estudo 2 foi seguido o mesmo procedimento, mas a cerca de metade dos participantes foi atribuída uma tarefa fácil (enviar um Adherence to health-related behaviors ix SMS com a avaliação diária do seu estado de humor naquele momento) e à outra metade da amostra foi atribuída a tarefa de exercício físico atrás descrita (tarefa difícil). Os resultados do estudo 1 mostraram uma interacção significativa entre o nível de sugestionabilidade dos participantes e a sugestão pós-hipnótica (p<.01) indicando que a administração da sugestão pós-hipnótica aumentou a adesão nos participantes muito sugestionáveis, mas baixou a adesão nos participantes pouco sugestionáveis. Não se encontraram diferenças entre os grupos que formaram intenções de meta e os que formaram implementação de intenções. No Estudo 2 os resultados indicaram que os participantes aderiram significativamente mais à tarefa fácil do que à tarefa difícil (p<.001). Os resultados não revelaram diferenças significativas entre as condições implementações de intenções, hipnose e as duas estratégias combinadas, indicando que a implementação de intenções não foi eficaz no aumento da adesão às duas tarefas propostas e não beneficiou da combinação com as sugestões pós-hipnóticas. A utilização da hipnose com sugestão pós-hipnótica significativamente reduziu a adesão a ambas as tarefas. Dado que não existiam instrumentos em Português destinados a avaliar a sugestionabilidade hipnótica, traduziu-se e adaptou-se para Português Escala de Grupo de sugestibilidade hipnótica de Waterloo-Stanford (WSGC): Forma C. A amostra Portuguesa (N=625) apresentou resultados semelhantes aos encontrados nas amostras de referência em termos do formato da distribuição dos padrões da pontuação e do índice de dificuldade dos itens. Contudo, a proporção de estudantes portugueses encontrada que pontuaram na zona superior de sugestionabilidade foi significativamente inferior à proporção de participantes na mesma zona encontrada nas amostras de referência. No sentido de lançar alguma luz sobre as razões para este resultado, inquiriu-se alguns dos participantes acerca das suas atitudes face à hipnose utilizando uma versão portuguesa da Escala de Valência de Atitudes e Crenças face à Hipnose e comparou-se com a opinião de Adherence to health-related behaviors xAbstract: On the basis of Gollwitzer’s (1993, 1999) implementation intentions’ concept, and Kirsch & Lynn’s (1997) response set theory, this dissertation tested the effectiveness of a combined intervention of implementation intentions with hypnosis with posthypnotic suggestions in enhancing adherence to a simple (mood report) and a difficult (physical activity) health-related task. Participants were enrolled in a university in New Jersey (N=124, Study 1, USA) and in two universities in Lisbon (N=323, Study 2, Portugal). In both studies participants were selected from a broader sample based on their suggestibility scores using the Waterloo-Stanford Group C (WSGC) scale of hypnotic susceptibility and then randomly assigned to the experimental groups. Study 1 used a 2x2x3 factorial design (instruction x hypnosis x level of suggestibility) and Study 2 used a 2 x 2x 2 x 4 factorial design (task x instructions x hypnosis x level of suggestibility). In Study 1 participants were asked to run in place for 5 minutes each day for a three-week period, to take their pulse rate before and after the activity, and to send a daily email report to the experimenter, thus providing both a self-report and a behavioral measure of adherence. Participants in the goal intention condition were simply asked to run in place and send the e-mail once a day. Those in the implementation intention condition were further asked to specify the exact place and time they would perform the physical activity and send the e-mail. In addition, half of the participants were given a post-hypnotic suggestion indicating that the thought of running in place would come to mind without effort at the appropriate moment. The other half did not receive a posthypnotic suggestion. Study 2 followed the same procedure, but additionally half of the participants were instructed to send a mood report by SMS (easy task) and half were assigned to the physical activity task described above (difficult task). Adherence to health-related behaviors vii Study 1 result’s showed a significant interaction between participant’s suggestibility level and posthypnotic suggestion (p<.01) indicating that posthypnotic suggestion enhanced adherence among highly suggestible participants, but lowered it among low suggestible individuals. No differences between the goal intention and the implementation intentions groups were found. In Study 2, participants adhered significantly more (p<.001) to the easy task than to the difficult task. Results did not revealed significant differences between the implementation intentions, hypnosis and the two conditions combined, indicating that implementation intentions was not enhanced by hypnosis with posthypnotic suggestion, neither was effective as single intervention in enhancing adherence to any of the tasks. Hypnosis with posthypnotic suggestion alone significantly reduced adherence to both tasks in comparison with participants that did not receive hypnosis. Since there were no instruments in Portuguese language to asses hypnotic suggestibility, the Waterloo-Stanford Group C (WSGC) scale of hypnotic susceptibility was translated and adapted to Portuguese and was used in the screening of a sample of college students from Lisbon (N=625). Results showed that the Portuguese sample has distribution shapes and difficulty patterns of hypnotic suggestibility scores similar to the reference samples, with the exception of the proportion of Portuguese students scoring in the high range of hypnotic suggestibility, that was found lower than the in reference samples. In order to shed some light on the reasons for this finding participant’s attitudes toward hypnosis were inquired using a Portuguese translation and adaptation of the Escala de Valencia de Actitudes y Creencias Hacia la Hipnosis, Versión Cliente, and compared with participants with no prior hypnosis experience (N=444). Significant differences were found between the two groups with participants without hypnosis experience scoring higher in factors indicating misconceptions and negative attitudes about hypnosis

Positive mental training: efficacy, experience and underlying mechanisms of a health promotion intervention for resilience and wellbeing in the workplace

There is a growing interest in brief, low-cost workplace health promotion interventions for wellbeing, which target increasing resilience, mindfulness and positive appraisal. One such health promotion intervention is Positive Mental Training. Three linked studies set out to investigate the efficacy of Positive Mental Training in the workplace. Study 1 used a double blind, randomised control trial design, with healthy volunteer employees randomised to intervention or control conditions. Validated questionnaires measured wellbeing, resilience, mindfulness, burnout and emotional distress at 4 time intervals, over a 6 month period. Multi-level linear modelling showed significant effects of the intervention on wellbeing and depression. ANCOVA analysis revealed these benefits were not sustained at follow up (26 weeks). Study 2 expanded on study 1, with qualitative interviews of purposefully selected participants of study 1. A grounded theory approach was used to explore individual motivations, benefits and limitations of the programme. Study 3 adopted a component research design to investigate one possible underlying aspect of this multi-component health promotion intervention (positive appraisal suggestion) in a student population and examined whether relaxation increased this effect. Positive appraisal suggestions given with or without relaxation were both able to significantly increase levels of positive affect and self-esteem compared to a control. Positive cognitive bias was found to increase in both the active conditions and the control suggesting differential cognitive and emotional processes, in that an increase in positive CB was not associated with an increase in mood. Overall these studies indicated evidence for the efficacy of Positive Mental Training in workplace health promotion, explored experience of participants undertaking the study and investigated the underlying mechanisms of an active component of Positive Mental Training. Theoretical and clinical implications are discussed