Accepted Manuscript

NEURAL MECHANISMS OF HYPNOSIS AND MEDITATION

Giuseppe De Benedittis

PII: S0928-4257(15)00019-4
DOI: http://dx.doi.org/10.1016/j.jphysparis.2015.11.001
Reference: PHYSIO 624

To appear in: Journal of Physiology - Paris

Received Date: 7 June 2015

Revised Date: 18 August 2015
Accepted Date: 4 November 2015

Please cite this article as: Benedittis, G.D., NEURAL MECHANISMS OF HYPNOSIS AND MEDITATION,
Journal of Physiology - Paris (2015), doi: http://dx.doi.org/10.1016/j.jphysparis.2015.11.001

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NEURAL MECHANISMS OF HYPNOSIS AND
MEDITATION
Giuseppe De Benedittis

Interdepartmental Pain Center, Dept. of Pathophysiology and Transplants,

University of Milan, Italy.

ABSTRACT
Hypnosis has been an elusive concept for science for a long time. How-
ever, the explosive advances in neuroscience in the last few decades have
provided a bridge of understanding between classical
neurophysiological studies and psychophysiological studies. These
studies have shed new light on the neural basis of the hypnotic
experience. Furthermore, an ambitious new area of research is focusing
on mapping the core processes of psychotherapy and the neurobiology\
underlying them. Hypnosis research offers powerful techniques to isolate
psychological processes in ways that allow their neural bases to be
mapped. The Hypnotic Brain can serve as a way to tap neurocognitive
questions and our cognitive assays can in turn shed new light on the
neural bases of hypnosis. This cross-talk should enhance research and
clinical applications.
An increasing body of evidence provides insight in the neural
mechanisms of the Meditative Brain. Discrete meditative styles are likely
to target different neurodynamic patterns. Recent findings emphasize
increased attentional resources activating the attentional and salience
networks with coherent perception. Cognitive and emotional equanimity
gives rise to an eudaimonic state, made of calm, resilience and stability,
readines to express compassion and empathy, a main goal of Buddhist
practices. Structural changes in gray matter of key areas of the brain
involved in learning processes suggest that these skills can be learned
through practice.
Hypnosis and Meditation represent two important, historical and
influential landmarks of Western and Eastern civilization and culture
respectively. Neuroscience has beginning to provide a better
understanding of the mechanisms of both Hypnotic and Meditative Brain,
outlining similarities but also differences between the two states and
processes.
 2

It is important not to view either the Eastern or the Western system as

superior to the other. Cross-fertilization of the ancient Eastern
meditation techniques presented with Western modern clinical hypnosis
will hopefully result in each enriching the other.

MECHANISMS OH HYPNOSIS

INTRODUCTION

Hypnosis has long been an elusive concept for science due to the lack
of objective neurobiological markers of the state of trance, but the
relentless advances in neuroscience in the last few decades (largely due to
the introduction and refinement of sophisticated electrophysiological and
neuroimaging techniques) have opened up a bridge of knowledge
between the classic neurophysiological studies and psychophysiological
studies of cognitive, emotional, and sensory systems (De Benedittis,
2003). This is the foundation of neurophenomenology (Varela, 1996).
While recent advances in neuroscience have undoubtedly contributed
to unravelling the Veil of Maya of the Hypnotic Brainthat is its neuro-
cognitive structure (De Benedittis, 2006)hypnosis is also increasingly
being recognized by the international scientific community as a valid and
flexible physiological tool to explore the central and peripheral nervous
system. This seems to be a real Copernican revolution in the field (De
Benedittis, 2004).
Current hypnosis research focuses on two major areas (De Benedittis,
2012) (Fig. 1): (a) intrinsic research, that is the research line concerned
with the functional anatomy of hypnosis per se, in the absence of specific
suggestions, the so-called neutral hypnosis or default hypnosis, and
the neurophysiological mechanisms underlying the hypnotic experience
in dynamic conditions, and (b) instrumental research (or extrinsic
studies), the use of hypnosis and suggestion for studying a wide range of
cognitive and emotional processes as well as for creating virtual
analogues of neurological and psychopathological conditions in order to
elucidate their underpinnings and eventually positively change the way
we treat them.

INTRINSIC STUDIES
An important fallout of neuroscience research concerns the precise
status of hypnosis: discrete state of consciousness or process? Reality or
hoax?
 3

For a long time hypnosis has been the subject of a quarrel between the
dominant credulous view (i.e., those claiming hypnosis is an altered
state of consciousness) and the sceptical view (i.e., those challenging
the existence of hypnosis condition, based on the lack of objective
indicators of trance and the reproducibility of hypnotic effects in a wak-
ing state through appropriate motivating suggestions) (Barber, 1969).
This axiological uncertainty has been widely and definitively overcome
by a growing body of convergent neurophysiological researchnamely
electrophysiology and neuroimaging - contributing to significant
advances in our knowledge of hypnotic phenomena, including functional
neuroanatomy of neutral hypnosis. These include electrophysiological
studies (e.g., bispectral analysis), neuroimaging (e.g., single-photon
emission computed tomography (SPECT), functional magnetic resonance
imaging (fMRI), positron emission tomography (PET) ), advanced
neuroimaging (e.g., real-time fMRI and brain-computer interface), and
neurofeedback (De Benedittis, 2012).

EEG Studies
Hypnotic states and hypnotic responding (including hypnotic
analgesia) are associated more often by increase in theta and gamma
activity, with higher levels of theta tending to be associated with higher
hypnotizability and hypnotic responding. ( Ray, 1997 ;Williams and
Gruzelier, 2001; Jensen et al., 2015 ). These findings, particularly
relating to gamma activity, show an overall inconsistency in the research
studies (De Pascalis, 2007).
Neuroscience has not only contributed to validating and defining the
state of trance; it has also enabled us to differentiate between altered
states of consciousness and ordinary states of consciousness. Bispectral
electroencephalographic analysis, a sophisticated and complex evolution
of spectral analysis, has proved to be effective in differentiating between
subjects awake and subjects in trance on the basis of the bispectral (BIS)
index (De Benedittis, 2008).
Bispectral analysis utilizes a composite of multiple advanced
electroencephalography (EEG) signal processing techniques, including
bispectral analysis, power spectral analysis, and time domain analysis. It
is a robust aid in monitoring the hypnotic effect of anaesthetics and has
emerged as an important tool for anaesthesia management. The BIS
index reflects the level of conscious sedation and/or loss of consciousness
in patients undergoing general anaesthesia. The BIS Index is a number
between 0 and 100 that correlates with important endpoints during
administration of anaesthetic agents. BIS values near 100 represent a
fully awake clinical state, while BIS value near 0 represent isoelectric
EEG or cerebral death. When the BIS index value decreases below 80
the probability of explicit recall decreases dramatically. At a BIS index of
 4

less than 60, a patient has a very low probability of consciousness (i.e. ,
anaesthetized subject).
Bispectral analysis and the BIS index can reliably measure and moni-
tor the depth of hypnotic trance, thus distinguishing the hypnotic zone
quantitatively and qualitatively from different levels and states of
consciousness. The Hypnotic Zone BIS index ranges between 77 and
92 (De Benedittis, 2008), with a subject within this BIS index range
likely to be into hypnotic trance.
For the first time the state of trance can be identified by an objective
and reliable (electrophysiological) marker, as compared with the
inadequate phenomenological (experiential) and behavioural
(measurement scales of hypnotic depth) data of the past (De Benedittis,
2008).
In a more recent study (Hinterberger et al., 2011), detectability of
electrophysiological state changes during a hypnotic session as a
correlate to the instructions was reported in one highly susceptible
subject, with significant and congruent state changes occurring
synchronously with specific induction instructions. There was also a
highly significant increase in broadband activity during the stepwise
trance induction that may point to a deep hypnotic state.

Neuroimaging Studies
Several neuroimaging (fMRI, PET) studies (Maquet, 1999;
Faymonville et al., 2000; Rainville et al., 2002; Egner et al., 2005; Cojan
et al., 2009; Del Casale et al., 2012) have contributed to creating a map of
Regions of Interest (ROI) in the brain during neutral or default
hypnosis (i.e., hypnosis in the absence of any specific suggestion),
including the occipital cortex (involved in visualization processing,
which is so important for the induction and the experience of hypnosis),
thalamus, anterior cingulate cortex (ACC), inferior parietal cortex,
precuneus (that normally mediates imagery and self-awareness) (Cojan et
al., 2009), and dorsolateral prefrontal cortex. Perhaps we are not far from
being able to draw a Neurosignature (functional neuroanatomy) of
hypnosis.
Moreover, neuroimaging findings suggest a potential anatomical
(morphological and volumetric) basis for hypnotizability, linking
variations in the rostrum of corpus callosum to differences in attentional
and inhibitory processes (Horton et al., 2004). In a more recent study
(Hoeft et al., 2012), high-compared to low-hypnotizable individuals
showed greater functional connectivity between left dorsolateral
prefrontal cortex (DLPFC), an executive-control region of the brain, and
the salience network composed of the dorsal anterior cingulate cortex
(dACC), anterior insula, amygdala, and ventral striatum, involved in
detecting, integrating, and filtering relevant somatic, autonomic, and
 5

emotional information. These results have provided novel evidence that

altered functional connectivity in DLPFC and dACC may underlie
hypnotizability.
Conclusions
Despite an increasing body of evidence suggesting a rather discrete
Neuromatrix for the hypnotic state and process, hypnosis and hypnotic
responses are probably best explained by more comprehensive models
that take into account factors from biological, psychological, and social
domains (Biopsychosocial Model) (Jensen et al., 2015).
Recent findings provide preliminary evidence regarding the variables
that remain viable as factors that might facilitate hypnotic responses; that
is, structural connectivity, hemisphere asymmetry, higher levels of theta
bandwidth activity, expectancies, trait hypnotizability, motivation,
absorptive capacity, rapport, and context (Jensen et al., 2015). The role
and the interactions of thes variables however remain to be elucidated.

Hypnotic Analgesia
A second fruitful area of intrinsic research has enabled a better
understanding of the multidimensional neural mechanisms underlying
hypnotic processes and responseshypnotic analgesia (Jensen, 2008).
One of the oldest medical applications of hypnosis concerns the control
of pain, whose effectiveness, known for some time, has only recently
found indisputable confirmation at the level of evidence-based medicine
in published meta-analyses of randomized controlled studies in both
acute and chronic pain (see review in De Benedittis, 2003; 2004).
Hypnotic analgesia represents a significant paradigm of how
neurophysiological and neuropsychological research has contributed
decisively to a better understanding of the mechanisms of
multidimensional pain control in trance. Since pain has a
multidimensional structure involving sensory-discriminative,
motivational-affective, and evaluative (attentional) aspects (Melzack and
Casey, 1968), it is likely that hypnotic analgesia involves multiple
mechanisms of pain modulation.

Supraspinal Central Nechanisms

One possible explanation for the increased analgesic efficacy of
 6

hypnosis in highly hypnotizable subjects as compared with the low

hypnotizables is related to greater cognitive flexibility (i.e. , the ability to
adaptively modify cognitive strategies and awareness) (Crawford and
Gruzelier, 1992; Crawford, 1994). In addition, highly hypnotizable
subjects possess stronger attentional filtering capabilities and expression
of fronto-limbic attentional activities. This allows the subject in trance to
be more effective in refocusing their attention and diverting attention
away from nociceptive or undesirable stimuli, as well as ignoring
irrelevant environmental stimuli (Crawford, 1994). Cognitive control
processes are associated with a supervisory attentional system (SAS),
whose activity involves fronto-temporal cortical structures (Shallice,
1988). Neuroimaging techniques have contributed in a decisive way to
revealing the putative mechanisms of cognitive modulation of pain,
including hypnotic analgesia. In a pioneering study using SPECT, De
Benedittis and Longostrevi (1988) reported a significant decrease of the
regional cerebral blood flow (rCBF) in the primary sensorimotor cortex
(S1) during suggestions of hypnotic analgesia in highly hypnotizable
subjects only, possibly associated with a selective neural inhibition.
But the turning point in neuroimaging studies of hypnotic analgesia
was determined by the pivotal studies of a Canadian team headed by
Pierre using PET. In the first of these studies (Rainville et al., 1997), it
was shown that hypnotic manipulation of the degree of negative affective
resonance (unpleasantness) evoked by a nociceptive stimulation in a
group of volunteers concomitantly induced corresponding changes in the
activities of the brain structures (i.e., increased/reduced activation of the
ACC) involved in coding the motivational-affective component of pain.
No change was observed in the activity of the primary sensorimotor
cortex (S1) involved in processing the sensory-discriminative component
of the nociceptive stimulus (Rainville et al., 1999a; 1999b). The
extraordinary selectivity of hypnotic suggestion to manipulate
differentially the two main components of the painful experience was
documented by a striking linear correlation between the intensity of
negative affective resonance, as suggested in hypnosis, and the level of
activation of the ACC.
This pioneering study was followed by others of the same group and
by Belgian researchers (Faymonville et al., 2000; Hofbauer et al., 2001),
which confirmed and extended the results of the aforementioned study,
suggesting that the ability of hypnosis in differentially modulating the
different aspects of pain perception is not rigid, structural, and
unidirectional, but dynamic and dependent upon the structure and
formulation of hypnotic suggestions.
 7

A more recent review of functional neuroimaging studies on pain

perception under hypnosis (Del Casale et al., 2015) indicates that
hypnosis-induced modifications of pain perception are related to
functional changes in several ROIs, including not only the cingulate
(mainly ACC), but also the prefrontal, insular and pregenual cortices, the
thalamus and the striatum. The ACC seems to be the key target in
reducing pain perception, whatever the nociceptive stimulus applied,
emphasizing its critical role in hypnosis-induced modification of sensory,
affective, behavioral and cognitive aspects of nociception. Contrary to
what had been previously believed (De Benedittis et al., 1989; Hilgard
and Hilgard, 1994), it is becoming increasingly clear that hypnosis can
modulate effectively not only the motivational-affective component of
pain but also the sensory-discriminative one (more directly linked to the
intensity of the nociceptive stimulation), albeit to a lesser extent. These
findings confirm the great cognitive-perceptual flexibility mediated by
trance and will certainly exert a significant impact in the clinical context.
Taken together, these data support the notion that cognitive (hypnotic)
modulation of pain alter dramatically the cortical Pain Matrix. The
hypnotic modulation of pain intensity produces changes in pain related
activity mainly in the primary somatosensory cortex (S1), while
modulation of pain unpleasantness induces changes mainly in the
anterior cingulate cortex (ACC), with the anterior (mid)cingulate cortex
possibly modulating both sensory and affect components of pain.
(Faymonville et al., 2000; Peyron et al., 2002).

Spinal Mechanisms
Hypnotic analgesia may also depend on the activation of descending
inhibitory systems that specifically modulate the spinal transmission of
the nociceptive input. The involvement of these systems during hypnotic
suggestions of analgesia has been demonstrated by electrophysiological
studies that have documented that hypnosis significantly reduces the
amplitude of the nociceptive flexion reflex (R-III), believed to be linearly
related to the intensity of perceived pain (Kiernan et al., 1995; Danziger
et al., 1998) and the effect was proportional to the level of hypnotic sug-
gestibility.

Autonomic and Peripheral Mechanisms

 8

In addition to the spinal and supraspinal mechanisms, there is

increasing evidence that hypnosis also modulates the activity of the
autonomic nervous system (ANS) and possibly the peripheral nervous
system (PNS). The sympatho-vagal interaction of ANS during trance was
analysed for the first time with spectral analysis of the heart rate
variability signal (RR interval) by De Benedittis and colleagues (1994).
The study showed that hypnosis modulates the RR interval by shifting
the balance of sympato-vagal interaction towards an increased
parasympathetic output, concomitant with a reduction in the sympathetic
tone. The effect is positively correlated with hypnotic susceptibility.
Though it has been shown (Langlade et al., 2002) that the heat pain
threshold assessed by thermal stimuli is significantly elevated during
hypnosis, suggesting that hypnosis can down-regulate neuronal inflow
from A delta and C fibres stimulation, this finding has been challenged
by a recent study (Kramer et al., 2014) indicating that hypnosis without a
specific analgesic suggestion has no influence on pain thresholds,
independent of the modality that is the source of pain (thermal,
mechanical, etc.). This suggests that hypnosis does not specifically affect
one kind of peripheral afferent nerve fibre but has an impact on central
processing of perception, possibly by distraction and/or modulation of the
affective component of pain.

Conclusions: recent studies on hypnotic analgesia are rather

convergent and strongly support multiple, hierarchical pain control
systems during hypnotic suggestions of analgesia at different levels and
sites within the nervous system. At peripheral level, there is a
controversial evidence that hypnosis may modulate nociceptive input by
down-regulating A delta and C fibers stimulation (Langlade et al., 2002,
Kramer et al., 2014), while it can significantly reduce the sympathetic
arousal (De Benedittis et al., 1994), relevant for inducing and
maintaining some chronic pain states. At spinal level, hypnosis is likely
to activate descending inhibitory systems by reducing the nociceptive R-
III reflex, parallel to self-reported pain reduction (Kiernan et al., 1995;
 9

Danziger et al., 1998). At supraspinal cortical level, neuroimaging and

electrophysiological studies have shown that hypnotic suggestions of
analgesia can modulate directly and selectively both sensory and
affective dimensions of the pain perception (the latter being reduced
significantly more than pain), thus confirming, at least partially, the
neodissociation theory by Hilgard and Hilgard (1994). Moreover, highly
hypnotizable subjects possess stronger attentional filtering abilities than
do low hypnotizable subjects. This greater cognitive flexibility might
result in better focusing and diverting attention from the nociceptive
stimulus as well as better ignoring irrelevant stimuli in the environment.
Cognitive control processes are associated with a supervisory attentional
system, involving the far frontal limbic and temporal cortices (De
Pascalis et al., 1999; Crawford, 2001).
This complex network might represent the Neurosignature of the
hypnotic modulation of pain (De Benedittis, 2003). It is noteworthy that
the structures involved in pain perception are the same as those involved
in its cognitive, hypnotic modulation (Peyron et al., 2002), though the
functional dynamics of these complex patterns remains to be further
elucidated. Fig. 2 shows schematically the putative mechanisms of
hypnotic analgesia.

Neurochemical Correlates of Hypnosis

Several observations indicate that hypnotic analgesia does not depend
on endogenous opioid mechanisms. Different groups of investigators
have failed to demonstrate a reversal of hypnotic analgesia with an
opioids antagonist (naloxone) (Goldstein and Hilgard,1975; Spiegel and
Albert, 1983) or significant changes in beta-endorphin plasma levels
during hypnotic suggestions of analgesia (De Benedittis et al., 1989;
Moret et al., 1991).
On the contrary, the dopamine system, because of its involvement in
attentional tasks, is a particularly likely candidate for hypnosis. Spiegel
and King (1992) demonstrated a robust correlation between measured
hypnotizability and levels of homovanillic acid, a dopamine metabolite,
in the cerebrospinal fluid. The anterior cingulate and right frontal cortex
are rich in dopaminergic neurons.The observed correlation between
hypnotizability and CSF HVA further implicates specific involvement of
the frontal lobes where the majority of dopaminergic pathways exist,
followed by the basal ganglia.
 10

INSTRUMENTAL (EXTRINSIC) STUDIES

In addition to intrinsic research on hypnosis and its mechanisms,
neuroscience research is beginning to consider and use hypnosis as an
attractive, viable, and appropriate physiological tool to explore and
modulate the cognitive and emotional determinants of complex human
experiences. Neuroimaging techniques offer new opportunities to use
hypnosis as a probe into brain mechanisms and as a means of studying
hypnosis itself.

Cognitive Modulation
Hypnosis can be considered as a heuristic paradigm of cognitive
modulation (De Benedittis, 2012). Potential domains of current and
future research include: attentional processes, pain control, manipulation
of mental images and perceptual processes, mnestic processes, ex-
ploration of conscious and unconscious processes, neurocognitive
processes, and genetic determinants of hypnotic responsiveness.
Visual and Auditory Perception
In addition to pain perception, the ability of hypnotic suggestions to
modulate other perceptions has been investigated in several
neuroimaging studies. One study on hypnotic suggestions of auditory
hallucinations (Szechtman et al., 1998) has shown that the brain areas
activated are essentially the same during the actual perception of an
auditory stimulus (albeit with a gradient of less intensity of activation).
Similarly, Kosslyn and colleagues (2000) have shown that visual
illusions under hypnosis activate visual associative areas similar to those
activated when perceiving a real visual stimulus. These studies suggest
that the line between real perception of a stimulus and distorted
perception (i.e., illusion) or absence of a stimulus (i.e., hallucination) is
more elusive than formely believed.
Sensory Hallucinations
Derbyshire and colleagues (2004) have used hypnotically suggested
pain in normal pain-free individuals to create an unequivocal analogue of
functional pain. They found that the hypnotic pain experience was
associated with widespread activation in classic pain areas (thalamus,
anterior cingulate cortex, insula, prefrontal cortex, and parietal cortex),
similar to that seen with a comparable physically induced pain and
proportionate to the level of subjective pain reported. Interestingly, this
activation pattern was not seen when participants were asked to imagine
the same pain experience.
Motor Hallucinations
 11

Motor control hallucinations are common in schizophrenic,

dissociative, and conversion disorders. Blakemore (2003) studied eight
highly hypnotizable subjects using PET. Three experimental conditions
were included in the study: active movement (AM), real-passive (RP),
and hypnotic deluded passive movement (DP). Results showed an
increased activity in the parietal cortex and cerebellum in the DP
condition, with an activation pattern similar to that detected in the AM
condition.

Hypnosis and Attention

Modern cognitive studies have suggested that attention is neither a
property of a single brain area nor that of the entire brain. Attention can
be viewed as involving a system of anatomical areas consisting of three
more specialized networks. These networks carry out the functions of
alerting, orienting, and executive control. Distinct brain areas mediate
different attentional processes (Raz and Shapiro, 2002; De Benedittis,
2003).
Neuroimaging studies suggest that discrete brain areas mediate specific
attentional processes. In a study by Raz et al., (2002) the Stroop
interference test was used to assess interference in cognitive attentional
processes under hypnosis. In more complex tasks, highly hypnotizable
subjects showed significantly shorter reaction times compared to low
hypnotizable subjects, confirming a greater attention skill related to high
hypnotic susceptibility.
Hypnosis and Memory
It is well known that hypnosis is effective in inducing post-hypnotic
amnesia and modulating implicit and explicit mnestic content (Cox and
Bryant, 2008). A neuroimaging study (Mendelsohn et al., 2008) has
shown that the suppression of episodic memories in hypnosis (post-
hypnotic amnesia) is associated with changes in brain areas responsible
for long-term recall (i.e., occipital cortex, temporal cortex, and prefrontal
cortex). These data have been interpreted as evidence of an active
inhibition of the processes of mnemonic recall.
Hypnosis cannot only inhibit processes of mnemonic recall. There is
evidence that high-imagery words can be better recalled when they were
learned under hypnosis (Halsband, 2006). Encoding under hypnosis was
associated with more pronounced bilateral activations in the occipital
cortex and the prefrontal areas as compared to learning in the waking
state.

Experimental Neuropsychopathology and Neurodynamic Correlates

of Therapeutic Techniques
 12

Experimental neuropsychopathology is aimed at elucidating the

neurocognitive processes that contribute, in whole or in part, to the
aetiology, exacerbation, or maintenance of abnormal behaviour
(Zvolensky et al., 2001).
Hypnotic suggestions can serve as an experimental tool for the creation
of hypnotic clinical analogues (virtual patients) (Oakley and Halligan,
2009) of neurological or psychiatric diseases, in order to elucidate
psychophysiopathological mechanisms and eventually being used
appropriately in the therapeutic setting.
The most fascinating and advanced frontier is represented by the use of
hypnosis as a neuropsychobiological investigation tool in psychotherapy
(e.g., assessing psychobiological correlates of experimental unconscious
conflicts with electrophysiological and/or neuroimaging techniques).

Hypnotic analogues of neurological and/or psychiatric conditions

(virtual patients)
An intriguing study by Halligan and colleagues (2000) generated a
hypnotic analogue of conversion hysteria (i.e. limb paralysis) in a healthy
subject and compared his fMRI with those from real patients with
hysteria. The results were striking: in the virtual patient the same key
targets were activated as those observed in real patients.
The psychophysiological and behavioural changes observed during the
recall of memories in patients who have suffered psychological trauma
often resemble the phenomena observed in trance. Activation of identical
brain structures has been observed in studies of strong emotional recall as
well as in studies of neuroimaging in hypnosis: thalamus, hippocampus,
amygdala, medial prefrontal cortex, anterior cingulate cortex (Vermetten
and Bremner, 2004). Therefore, it is not unlikely that the neurodynamic
circuits activated in the recall of traumatic memories in patients with
post-traumatic stress disorder largely overlap with those observed in
trance for the recovery of unconscious memories/conflicts.
Hypnotic modulation of conflicts in the human brain
Increasing evidence suggests that cognitive-emotional conflicts involve
the activity of the ACC. Hypothesizing that such conflict reduction
would be associated with decreased ACC activation, Raz and colleagues
(2005) recently combined neuroimaging methods and studied highly and
less hypnotizable participants both with and without a suggestion to
interpret visual words (i.e. , Stroop interference test) as nonsense strings.
The associated increase in ACC activity in the absence of
compensatory changes in left frontal cortical areas has been interpreted as
evidence that hypnosis acts to decouple the normal relationship between
conflict monitoring and cognitive control.
 13

CONCLUSIONS

Hypnosis is no longer a matter of dispute and controversy in the

international scientific community as it has not only been established as a
viable, valid, and reliable intervention for controlling discrete clinical
syndromes, but it has been eventually recognized as a real
psychobiological state and process. Despite an increasing body of
evidence suggesting a rather discrete Neuromatrix for the Hypnotic
Brain, hypnotic states and processes are probably best explained by more
comprehensive models that stem from biopsychosocial domains (Jensen
et al., 2015). Mostly important, neuroscience research is beginning to
consider and use hypnosis as a physiologically effective tool for studying
the normal human brain and to investigate neurodynamic correlates of
psychotherapy (De Benedittis, 2003; 2012). Also, hypnotic clinical
analogues are increasingly serving as clinical simulations to investigate
specific hypotheses concerning neuropsychopathological disorders.
In conclusion, the most recent clinical-experimental paradigms have
established the role of the Hypnotic Brain as a physiological probe to
explore brain/mind mechanisms, producing, in turn, an important impact
on the advances of our knowledge on the nature of trance. This seems to
be a new callisthenics for the human brain/mind.

MECHANISMS OF MEDITATIVE STATES

INTRODUCTION

The word meditation (from latin meditatio) is used to describe states,

processes and practices that self-regulate the body and mind, thereby
affecting mental and physical events by engaging a specific attentional
set.
From ancient times, people have been fascinated by the wonder of their
own mind and the experience of the surrounding universe. This
pondering, about ones being in reality, may have been the beginning of a
meditative mind, and the origin of various philosophies and religions
(Deshmuck, 2006).
 14

Yoga is a way of adaptive self-integration, being at peace with oneself

and at home in the world. Self-integration results from constant self-
awareness and letting go of irrelevant memories, imaginations and
distractions. Such a person functions with a truly undistracted and serene
mind. When the mind is undirected and assumes its original, unmodified
state, the Self experiences itself. Yoga is a skillful quietening of a
distracted and ruminative mind with a natural resolution of emotional
conflicts, culminating in a truly peaceful and intuitive conscious state.
Three essential steps of Yoga include (a) Dharana: conscious focusing of
attention on an object, an activity, a thought or an ongoing experience;
(b) Dhyana: continued, sustained dwelling of attention on the same
experience; and (c) Samadhi: effortless, self-absorptive, and intuitive
state of understanding and realization of ones true nature or being.
Meditation means awareness to be aware of what you are doing, what
you are thinking, what you are feeling, aware without any choice, to
observe, to learn. Then there is freedom to see things as they actually are,
without distortion (tathata or suchness in Buddhism). The mind becomes
unconfused, clear, and sensitive. There is no actual division between the
organism and the mind. The brain, the nervous system and the mind are
all one, indivisible. Meditation really is also a complete emptying of the
mind.
Meditation is also an art of efficient and adaptive management of
personal resources and energy with total engagement or disengagement.
There is a natural sense of well-being with self-understanding,
spontaneous joy (Ananda), serenity, freedom, and self-fulfillment. It is
where the ultimate pursuit of happiness and search for meaning in life
resolve. One realizes the truth of ones being in harmony with nature and
nature in oneself. This enlightening process is nonlinear and dynamic
(Deshmuck, 2006).
HISTORICAL BACKGROUND OF EASTERN MEDITATIVE
TRADITIONS

Buddhas teachings on mindfulness identified it as a means of

attaining enlightenment, specifically for the overcoming of sorrow and
distress, for the disappearance of pain and sadness (dukkha) (Otani,
2003). That means passing out from this world of suffering (Samsara) to
Nirvana. His teachings later spread to two parts of Asia: one, to
Southeast Asia as the Theravada tradition, and the other to the Far East as
the Mahayana tradition.
 15

Out of the Theravada tradition emerged two primary meditation

techniques known as Samatha or Samadhi (tranquil dwelling) ,
Vipassana (insight achieving), respectively and Ton-Leng (Dalai
Lamas loving kindness meditation)(Bercholz and Kohn, 1993).
Vipassana practices of meditation have been popularized in the U.S
recently under the name of mindfulness meditation (e.g., Hanh, 1999;
Kabat-Zinn, 1995).
In the Mahayana school, Buddhism incorporated Chinese Taoism and
eventually evolved into Chan, or better yet known as Zen in Japan. The
term Zen is a translation of a Sanskrit term, Dhyana, the seventh highest
state of consciousness immediately preceding Samadhi, the final and
non-duality stage described in the eight limbs of Yoga (Bercholz and
Kohn, 1993).

NEUROPHENOMENOLOGY OF MEDITATION

Phenomenological descriptions of changing inner states (first-person

data) can be strengthened by neurophysiological data. In consciousness
studies, this has given rise to a new field called Neurophenomenology
(Varela, 1996). Neurophenomenology integrates subjective experience
and brain dynamics in the Neuroscience of Consciousness.The true
neurophenomenological investigation would simultaneously measure
subjective experience (experiential correlates), phenomenological
correlates and neurophysiological correlates for the same time period or
event.
Now we can begin to define the state by using a combination of self-
report and neurological indicators. The state is suggested by a shift of
brain activity taken together with a shift in phenomenological
experiences in the direction described by people in deep hypnosis or
meditation (Kumar, et al., 1996; Pekala and Kumar, 2000; Cardea,
2005).

EXPERIENTIAL CORRELATES

Eastern and Western meditation seems to have much in common.

Given that regulation of attention is the central commonality across the
many divergent methods (Davidson and Goleman, 1977), meditative
styles can be usefully classified mainly into two types concentrative
and mindfulnessdepending on how the attentional processes are
directed. Most meditative techniques lie somewhere on a continuum
between the poles of these two general methods (Shapiro and Walsh,
1984; Wallace, 1999; Andresen, 2000; Newberg and Iversen, 2003; Cahn
and Polich, 2006).
 16

Concentrative or Ideative Meditation. The first form of meditation is

more common in Western meditation (e.g., Loyolas spiritual excercises
or contempletions, but also in Hindu and Buddhist Theravada and Tantric
Varayana tradition (e.g., Samadhi) .
Concentration, or Samadhi in Pali (a dead language associated with
ancient Buddhist texts), involves focusing attention on a particular
object, such as breathing, a candle light, a face of the Buddha or
symbolic object such as compassion, which may lead to a subjective
experience of absorption with the object of focus (object meditation)
(Newberg and Iversen, 2003; Deshmuck, 2006).
It aims for serenity and leads to altered states of consciousness, called
the Absorptions (Jhanas ), at least one of which resembles deep hypnosis
(Holroyd, 2003). These altered states demonstrate cognitive, emotional,
and motivational changes as they increase in depth (Bucknell, 1993).
Like the attentional focus procedures in hypnosis, this kind of meditation
emphasizes concentration and letting go of thoughts.

Abstract or Non-Ideative Meditation (more common in Eastern

meditation: Vipassana tradition and Mindfulness).
Samadhi meditation is a precursor to Vipassana (Insight) meditation,
which has been referred to as choiceless awareness (Krishnamurti,
1991) or mindfulness (Kabat-Zinn, 2005).
This second form of meditation is one in which the subjects simply
attempt to clear all thought from their sphere of attention and to reach a
subjective state, characterized by a sense of no space, no time, and no
thought (objectless meditation). This state is also fully integrated and
unified, such that there is no sense of a self and other (Newberg and
Iversen, 2003; Deshmuck, 2006).
The practice of insight meditation (Sati) is based upon the Great
Discourse on the Foundations of Mindfulness (Maha Satipatthana Sutta),
which includes the contemplation of the body, the contemplation of the
feelings, the contemplation of the mind, and the contemplation of the
mental objects, through three stages: a) concentration (e.g., visual
stimuli, breathing, mandala ); b) tranquillity ( the sound of silence) and c)
insight (consciousness of consciousness or meta-consciousness: the void
is form and the form is void; reality is impermanent). Fundamental to this
mindfulness training is Anapanasati, which literally means breath
awareness as taught by the Buddha himself.
 17

Mindfulness aims for insight (Vipassana ) through observation of ones

own mental processes and altered states of consciousness.
Vipassana/Mindfulness (VM) meditation trains participants to observe
the rapidly shifting panorama of sensations, thoughts, emotions, etc., and
to describe mental activities and states in great detail and non-
judgmentally (Thoughts are only thoughts!)(Wallace, 1999; Shear and
Jevning, 1999; Holroyd, 2003).
Thus, VM requires becoming aware of all of one's senses and
acknowledging any negative feelings, pain, or blockages in order to
achieve equanimity. Equanimity is defined as not interfering with the
flow of the senses at any level, including the level of preconscious
processing (Young, 1994).
It is noteworthy that meditative states cannot be maintained
uninterruptedly for a long time and between two consecutive attentional
acts there is an inter-attentional awareness, with no attended-attendee
duality (Deshmuck, 2006; De Benedittis, 2015). This results in a
refreshing experience of no experience, which is analogous to waking up
from a sound, non-REM sleep with no dreams. This inter-attentional
awareness can lead to a state of non-alertness or Turiya (Deshmuck,
2006) . During non-alertness conscious mentation exists only in a
potential form.
The enlightening process is nonlinear and dynamic, whereas the
common state of self-consciousness functions within a chaotic attractor
basin (Deshmuck, 2006).
Fig. 3 shows eastern major meditative traditions and their experiential
correlates.

Mindfulness and Clinical Applications. Mindfulness meditation

programs primary goal is to identify and reduce patients' suffering, both
physical and emotional pain, developing detached observation and
awareness of the contents of consciousness. It also has the potential for
transforming the ways in which we respond to life events and for relapse
prevention in affective disorders.
Mindfulness-Based Stress Reduction (MBSR) interventions are being
increasingly used for stress, psychological well being, coping with
chronic illness (such as pain, skin disorders, etc.) as well as adjunctive
treatments for psychiatric disorders (Kabat-Zinn, 2005; Chiesa and
Serretti, 2010; Marchand, 2014). However, given the low-quality designs
of current studies it is difficult to establish whether clinical outcomes are
due to specific or non-specific effects of Mindfulness practice.
 18

Tong-Len. Another form of Buddhist meditation that has been

popularized, particularly by the Dalai Lama (H. H. Dalai Lama and
Cutler, 1998), is Tong-Len. It is a practice designed to cultivate loving-
kindness by means of meditation. This practice resembles significantly
the split-screen technique in hypnosis (Spiegel and Spiegel, 2004). It is
said to be a powerful technique for the monk to develop compassion and
empathy for others.

Mixed forms (Ideative/Non-Ideative). These meditative techniques -

such as Rinzai and Soto tradition (e.g., koan) and Trascendental
Meditation (MT) - lie somewhere on a continuum between the poles of
the above mentioned general methods.

NEURAL CORRELATES

Meditation states and traits are being explored with neuroelectric and
neuroimaging methods. The findings are becoming more cohesive and
directed, even though a comprehensive empirical and theoretical
foundation is still emerging. CNS function is clearly affected by
meditation, but the specific neural changes an differences among
practices are far from clear.

Neuroelectric (EEG & ERP) Studies

Zen Meditation. In a classic study with a group of Soto Zen monks,
Kasamatsu and Hirai (1966) reported distinct EEG changes during
mindful Zen meditation. The experienced monks began to show alpha
EEG in less than a minute after starting to meditate, and this effect lasted
for some time even after the session was over.

Concentrative Meditation. Bispectral electroencephalographic analysis

has proved to be effective in differentiating between subjects awake and
subjects in trance on the basis of the bispectral (BIS) index (De
Benedittis, 2006). The same technique has been used in a most recent
study on three concentrative (Samadhi) lama meditators (De Benedittis,
2015). A significant reduction of the BIS-Index was found, as compared
with waking subjects, but only during the attentional act period (approx.
15).
 19

Concentrative Meditation vs Mindfulness. Electroencephalographic

recordings in 10 Subjects were used to differentiate among two forms of
meditation, concentration and mindfulness, and a normal relaxation
control condition. Significant differences were obtained between
concentration and mindfulness states at all bandwidths. Results suggest
that concentration and mindfulness "meditations" may be unique forms of
consciousness and are not merely degrees of a state of relaxation (Dunn
et al., 1999).

Tong-Len (Loving-Kindness Meditation). In a study using a Tibetan

Buddhist monk highly trained in tong-len visualization, significant
increases in 40Hz gamma activity in the left middle frontal gyrus were
found, suggestive of left-sided anterior activation, a pattern previously
associated with positive affect (emotional happiness), in the meditators
compared with the non-meditators (Davidson et al., 2003).
Lutz and colleagues (2004) studied eight long-term Tibetan Buddhist
meditators who had engaged in contemplative practice for periods of time
ranging from 15 to 40 years, with anywhere from approximately 10,000
to 50,000 hours logged in meditation. A control group consisted of 10
students averaging 20 years of age, each of whom had only ten hours of
training in meditation. All meditators exhibited atypically large
amounts of synchronized gamma activity 5 to 15 seconds after beginning
the meditation, with significant asymmetrical gamma synchrony
appearing in the left midfrontal areas. Analysis revealed that the long-
term meditators showed greater such synchrony than controls, as well as
higher baseline levels of gamma activity.

Comparing different meditative states. Recently, Lehmann et al. (2012)

looked at EEG-patterns in experienced meditators of different traditions
(Tibetan Buddhists, QiGong, Sahaja Yoga, Ananda Marga Yoga
and Zen). When going into and out of meditation, significantly different
connectivities revealed different topographies in the delta frequency band
and in the beta-2 band. EEG-patterns showed lower coherence during
meditation in all five traditions. The globally reduced functional
interdependence between brain regions in meditation suggests that
interaction between the self-process functions is minimized, and that
constraints on the self-process by other processes are minimized, thereby
leading to the subjective experience of non-involvement, detachment and
letting go, as well as of all-oneness and dissolution of ego borders during
meditation.
 20

EEG Studies: Conclusions and Clinical Implications

Electroencephalographic (EEG) studies have revealed a significant
increase in alpha and theta activity during meditation (Chiesa and Serretti,
2010), concomitant with an overall slowing of consciousness processes
(De Benedittis, 2015). Increase in alpha and theta wave activity is
believed to be indicative of states of inner calm and stability (Siegel,
2007). The increased gamma wave synchrony generated during Tibetan
Buddhist loving kindness meditation has been repeatedly observed as
active in attention and perception, and implicated in associative learning.
It has been theorized that gamma wave synchrony may play a significant
role in binding the disparate information conveyed by the central nervous
system into coherent perception (Singer, 2001). If gamma wave
synchrony does in fact play a significant role in perception, this could
explain why long-term practitioners of loving kindness meditation exhibit
a readiness and willingness to compassionately respond to the interior
experience - both positive and negative - of others. In other words,
attentional training with compassionate embrace as its focus seems to
develop the brain's capacity for unifying sensory information into
coherent patterns of perception that support both personal and
interpersonal connection. According to Lutz and co-workers (2004),
attention and affective processes, which gamma-band EEG
synchronization may reflect, are flexible skills that can be trained .This
readiness to readily and practically express compassion has always been
the main objective for such Buddhist practices. Urry and colleagues
(2004) correlated left prefrontal asymmetry, as evidenced in both the
mindfulness and loving kindness forms of meditation, with eudaimonic
well-being, defined by Siegel (2007) as enveloping "the psychological
qualities of autonomy, mastery of the environment, positive relationships,
personal growth, self-acceptance, and meaning and purpose in life" . This
left anterior activity has also been correlated with resilience, the capacity
to rebound after particularly negative experiences (Davidson, et al., 2003).

ERP Meditation Studies. Sensory EP (Evoked Potentials) and cognitive

ERP (Event Related Potentials) meditation assessments have produced a
variety of effects (see review in Cahn and Polich, 2006). The major
difficulties in many studies are a lack of methodological sophistication,
no replication of critical conditions, and inconsistency of task and study
populations. Some intriguing hints of meditation changing early cortical
auditory processing appear reliable, with suggestions that P300 also can
be affected by meditation practice. Simple CNV (Contingent Negative
Variation) tasks yield an increase in amplitude for both state and trait
effects of meditation, such that CNV effects may reflect changes in
attentional resource allocation.
 21

Neuroelectric Studies: General Conclusions . It is difficult to draw

specific inferences from these studies .The current review of meditation
states and traits indicates considerable discrepancy among results, a fact
most likely related to the lack of standardized designs for assessing
meditation effects across studies, the variegated practices assayed, and a
lack of technical expertise applied in some of the early studies. EEG
meditation studies have produced some consistency, with power
increases in theta and alpha bands and overall frequency slowing
generally found. Additional findings of increased power coherence and
gamma band effects with meditation are starting to emerge. ERP
meditation studies are sparse but suggest increased attentional resources
and stimulus processing speed or efficiency.

Neuroimaging Studies
Early studies. Early neuroimaging studies on relaxation practice and
meditation provide the first evidence of functional brain changes using
or C during a relaxation practice and a meditative practice,
respectively. oga idr , literally oga- leep, is a state in the oga
tradition where consciousness of the world and consciousness of action
are meant to be dissociated the mind withdraws from wishing to act
and is not associated with emotions or the power of will. study of
blood flow changes during oga idr practice was carried out by (199
and colleagues (1999). During all meditative phases, overall increases in
bilateral hippocampus, parietal, and occipital sensory and association
regions were found compared to control conditions. This pattern suggests
an increase of activity in areas involved in imagery.
Deactivation was found during meditation in orbitofrontal, dorsolateral
prefrontal, anterior cingulate cortices, temporal and inferior parietal
lobes, caudate, thalamus, pons, and cerebellum. This differential activity
was interpreted as reflecting a tonic activity during normal
consciousness in baseline condition. The areas decreasing during the
meditation state are known to participate in executive function or control
of attention. The AA. interpreted these results as reflecting dissociation
between two complementary aspects of consciousness: the conscious
experience of the sensory world and the fact or illusion of voluntary
control, with self regulation.
 22

Using SPECT, Newberg et al. (2001) measured changes in regional

blow flow (rCBF) while 8 relatively experienced Tibetan Buddhist
practitioners meditated. In constrast to Lou et al. (1999), Newberg and
colleagues reported an increase in orbital frontal cortex, dorsolateral
prefrontal cortex (DLPFC) and thalamus. They also found a negative
correlation between the DLPFC and the superior parietal lobe which was
interpreted as reflecting an altered sense of space experienced during
meditation. The difference in the frontal areas between their finding and
that of Lou et al. (1999), was viewed as reflecting a difference between
an active and a passive form of meditation.

fMRI Studies. Concentrative ( Ideative) Meditation (Samadhi). Lazar

et al. (2000) used functional MRI to identify the ROIs that are
active during a simple form of meditation (Focused Attention
/Mindfulness-Awareness meditation : a form of Kundalini Yoga) and
relaxation response. A significant increase of activity was observed
in the dorsolateral prefrontal and parietal cortices, hippocampus,
temporal lobe, anterior cingulate, striatum, and pre- and postcentral
gyri during meditation. The results indicate that the practice of
meditation activates neural structures involved in attention and
control of the autonomic nervous system.
The comparison of early versus late meditation states showed activity
increase in these regions, but within a greater area and with larger signal
changes later in the practice. Because the pattern of brain activity
increased with meditation time, it may index the gradual changes induced
by meditation.
In eight Tibetan Buddhist monks, voluntary meditation with sustained
attention was initially accompanied by activation in bilateral, but right
more than left, prefrontal cortex and cingulate gyrus (Newberg and
Iversen, 2003). he perception of ones bodily self depends on the
activation of posterior, superior parietal lobules. The hippocampus acts to
modulate cortical arousal and responsiveness via connections with the
prefrontal cortex, amygdala, and hypothalamus. These structures are
involved in generating attention, emotion, and imagery.
 23

Another attention-related study (Brefczynski-Lewis et al., 2004)

studied experienced Buddhist meditators (> 10,000 hours of cumulative
meditation practice) and newly trained control subjects while they
performed a Focused Attention meditation, alternating with a passive
state, while undergoing fMRI. fMRI of concentration meditation in both
the experienced meditators and the controls showed common areas of
activation in the traditional attention network, including areas such as the
intraparietal sulci, thalamus, insula, lateral occipital, and basal ganglia.
However, experienced meditators showed more activation, especially in
the frontal-parietal network. The increased activation in these regions for
experienced practitioners may represent a neural correlate for these
subjects' expertise in sustained attention.

Non-Ideative Vipassana/Mindfulness Meditation. A review of this

literature (Marchand, 2014) revealed compelling evidence that
mindfulness impacts the function of the medial cortex and associated
default mode network as well as insula and amygdala. Additionally,
mindfulness practice appears to activate the prefrontal cortex (PFC) , the
anterior cingulate cortex (ACC) (Chiesa and Serretti, 2010). Structural
imaging studies are consistent with these findings and also indicate
changes in the hippocampus. Long-term meditation practice is associated
with an enhancement of cerebral areas related to attention.

Meditation and Cortical Thickness (Neuroplasticity). Magnetic

resonance imaging was used to assess cortical thickness in 20 participants
with Mindfulness experience (Lazar et al., 2005). Brain regions
associated with attention, interoception and sensory processing (thus
important for sensory, cognitive and emotional processing) were thicker
in meditation participants than matched controls, including the prefrontal
cortex and right anterior insula. Between-group differences in prefrontal
cortical thickness were most pronounced in older participants, suggesting
that meditation might slow age-related cortical thinning. These data
provide the first structural evidence for experience-dependent cortical
plasticity associated with meditation practice.
 24

Mindfulness Therapeutic Interventions and Cortical Thickness

(Neuroplasticity). Therapeutic interventions that incorporate training in
mindfulness meditation have become increasingly popular, but to date
little is known about neural mechanisms associated with these
interventions. In a recent, controlled longitudinal study to investigate pre-
post changes in brain gray matter concentration attributable to
participation in a Mindfulness-Based Stress Reduction (MBSR) program
(Hlzel et al., 2011), anatomical magnetic resonance (MRI) confirmed
increases in gray matter concentration within the left hippocampus.
Whole brain analyses identified increases in the posterior cingulate
cortex, the temporo-parietal junction, and the cerebellum in the MBSR
group compared with the controls. The results suggest that participation
in MBSR is associated with changes in gray matter concentration in brain
regions involved in learning and memory processes, emotion regulation,
self-referential processing, and perspective taking.
Pure compassion and loving-kindness meditation (Ton Leng): the role
of compassion/empathy. Using fMRI, Lutz et al. (2008) assessed brain
activity while novice and long-term practitioners generated a loving-
kindness-compassion meditation, alternating with a resting state. During
the meditative state, a common activation in the striatum, anterior insula,
somato-sensory cortex, anterior cingulate cortex and left-prefontal cortex
was found, concomitant with a deactivation in the right interior parietal.
This pattern was robustly modulated by the degree of expertise, with the
adepts showing considerably more enhanced activation in this network
compared with the novices. These results support the role of the limbic
circuitry in emotion sharing. In addition, data provide evidence that this
altruistic state involved a specific matrix of brain regions that are
commonly linked to feeling states, planning of movements and positive
emotions. Finally, love and compassion require an understanding of the
feelings of others; hence, a common view is that the very regions
subserving ones own feeling states also instantiate ones empathic
experience of others feelings. he key proposal is that the observation
and imagination of another person in a particular emotional state
automatically activates a similar affective state in the observer, with its
associated autonomic and somatic responses, suggesting a sort of
embodied simulation-driven mirror-neurons mechanism (Gallese, 2009).

Neuroimaging Studies: Conclusions. Recent structural and functional

neuroimaging studies are beginning to elucidate neural processes
associated with the practice of meditation. These studies demonstrate
some consistency of localization for meditation practices. Meditation
techniques that target specific underlying processes are thus likely to
engage different neural circuitry.
 25

Although there is considerable potential for advancement in

neuroscience through neuroimaging studies of meditation, the number of
published studies remains sparse and anecdotal, and current results have
to be considered with caution (Chiesa, 2010). Further research is needed
to answer critical questions about replications, self-selection, placebo,
and long-term effects of meditative states.
CONCLUSIONS

An increasing body of evidence provides insight in the neural

mechanisms of the Meditative Brain. Despite over 50years of research in
this field, no clear neurophysiological signatures of discrete meditative
states have been found. Much of this failure can be attributed to the
narrow range of variables examined in most meditation studies, with the
focus being restricted to a search for correlations between
neurophysiological measures and particular practices, without
documenting the content and context of these practices (Thomas and
Cohen, 2014). More meaningful results could be obtained by expanding
the methodological paradigm to include multiple domains such as the
cultural setting (the place), the life situation of the meditator (the
person), details of the particular meditation practice (the practice), and
the state of consciousness of the meditator (the phenomenology).
Discrete meditative styles are likely to target different neurodynamic
patterns. Recent findings emphasize increased attentional resources
activating the attentional and salience networks with coherent perception.
Cognitive and emotional equanimity gives rise to an eudaimonic state,
made of calm, resilience and stability, readines to express compassion
and empathy, a main goal of Buddhist practices. Structural changes in
gray matter of key targets, such as hippocampus, involved in learning
processes, suggest that these skills can be learned through practice.
Functional and structural changes are strongly modulated by the degree
of expertise with long-term meditators showing more activation than
novice meditators in crucial ROIs.

HYPNOSIS vs MEDITATIVE STATES: SIMILARITIES and

DIFFERENCES

SIMILARITIES BETWEEN HYPNOSIS AND MEDITATION

Experiential Correlates
 26

Eastern meditation seems to have much in common with hypnosis. For

example, they both require mental concentration and receptivity on the
part of the practitioner (Brown and Fromm, 1986; Carrington, 1993;
Otani, 2003). Absorption (Tellegen and Atkinson, 1974) also seems to
play a critical role in meditation and hypnosis alike.
Hypnosis and concentrative (object) meditation are similar in the
attentional and concentration practices employed that result in altered
states of consciousness; in the phenomenology of those altered states; and
in the neurophysiology associated with those states. Taken together, from
a neurophenomenological point of view Hypnosis and Samadhi are
closely linked.
These similarities challenge the current belief that hypnosis was
discovered in eighteenth century Europe when Mesmer first introduced
animal magnetism. Rather, it is far more accurate to view hypnosis as
having its roots in Buddhist (and probably other religious) meditation that
predates Mesmerism by at least two millennia (Holroyd, 2003).
Both concentration and mindfulness are familiar and crucial elements
in hypnosis. Brown and Fromm (1986) elucidate that hypnotic trance is
not only characterized by concentrated and focused attention but also
by ego-receptivity.
Current research shows that high hypnotic suggestibility may be a
multifaceted construct, one that needs to account for those who primarily
use focused attention (concentration) as well as those who rely on fantasy
absorption (mindfulness)( Holroyd (2003).

Attentional and Concentration Practices. Both hypnosis and

meditation begin with attempts to relax and concentrate the mind by
focusing attention.
Meditators today most commonly focus on the breath. In hypnosis
focusing and sustaining attention might mean staring at a spot, watching
a swinging pendulum, or focusing on a symbolic object (such as
compassion).
The process used to reach the state has been described in the hypnosis
literature as dis-attending to competing stimuli (Crawford, 1994). In the
meditation literature, it has been described as letting go of thoughts and
perceptions (Khema, 1997).
Focusing and sustaining attention in both hypnosis and meditation
leads to similar changes in mental state. Two experiments give relevant
information. High hypnotizables were studied in one experiment
(Cardea, 2005); Indian Kundalini-Yoga (a mixed, active-passive form of
meditation) meditators in the other (Venkatesh et al., 1997). Both used
the Phenomenology of Consciousness Inventory (PCI) (Pekala, 1991).
 27

Both meditation and deep self-hypnosis were associated with

elevations on PCI scales reflecting alterations in state of awareness, self-
awareness, time sense, perception, and meaning; with changes in imagery
vividness and rationality and both processes were accompanied by
feelings of joy and love. In hypnosis, attention moved from a focus on
imagination at medium levels to free floating in deep self-hypnosis.
Again, meditation showed similar changes.

Neural Correlates of Hypnosis and Meditation: Similarities and

Differences
EEG Studies. Considering hypnosis research first, high band theta is
related to hypnotizability, and theta power often increases as people go
into deep hypnosis. This has been extensively reviewed and summarized
by a number of authors (Crawford and Gruzelier,1992; Ray, 1997;
Crawford, 2001). The increased theta power is found in various cortical
areas, but the far frontal area is well represented.
The far frontal cortex and the anterior cingulate gyrus on the midline
surface of the frontal lobe are areas where theta figures prominently in
meditation studies (Cahn and Polich, 2006).
Halsband et al. (2009) compared EEG changes in brain activity during
hypnosis and Tibetan Buddhist meditation, reporting high amplitudes in
alpha frequency bands most pronounced with meditation at frontal
positions and with hypnosis in central and temporal locations.
Significantly greater activity in theta 2 band was observed only with
hypnosis in both hemispheres.
Neuroimaging Studies. In both the meditation and hypnosis
investigations, areas where theta is prominent (frontal cortex and
especially anterior cingulate cortex) are also perfused with blood, which
means that they are working hard. Two meditation investigations and
four hypnosis investigations show increased regional blood flow to these
areas (see review in Holroyd, 2003).
More recent neuroimaging studies using PET and fMRI (Halsband et
al., 2009) showed differential plasticity changes in brain connectivity in
hypnosis and meditation.
 28

Neurophenomenology of Hypnosis and Meditation: Conclusions. To

summarize, both concentrative meditation and deep hypnosis result in
similar psychological changes, such as diminished thought, emotional
reaction, and body sensations, with consequent equanimity, peacefulness,
and absorption. There is also a sense of unity with all or a sense of
merging. Both hypnosis and meditation altered state experiences are
accompanied by neurophysiological changes, particularly in frontal
areas and anterior cingulate cortex, with slowing and coherence in
cortical areas representing choice and executive control. However, due to
some phenomenological differences between hypnosis and meditation, it
is not surprising to find differential brain plasticity changes (Halsband et
al., 2009).

DIFFERENCES BETWEEN HYPNOSIS AND MEDITATION

The differences between hypnosis and meditation have to do largely

with goals and expectancies, as well as their relative emphasis on
suggestion (hypnosis) or mindfulness (meditation). Also, hypnosis
(usually) calls for two people and meditation is a solo experience.

Differences in Goals and Practices. The treatment principles, goals,

and focuses differ radically between the two paradigms as well. In the
Eastern model, the primary focus of healing is preventive in nature and
the goal is to restore the balance of the mind/body through continuous
care (Holroyd, 2003). Meditators are interested in life-long goals having
to do with serenity, insight, and spiritual liberation or enlightenment.
In the West, however, search for healing can better be explained in
terms of medical system. It often means repair or cure in reaction to
illnesses or injuries. Its main goal is to control both external and internal
environment in order to achieve or restore optimal health. People seeking
hypnosis are generally interested in a specific outcome such as symptom
removal.
As for the duration of treatment, the Western medical system tends to
be pragmatic, often business-oriented, relatively short-term and most
effective in the management of acute illnesses and injuries. The Eastern
model, on the other hand, holds a long-term, if not life-long, perspective.
As such, it is not particularly suited for injuries or infections but may be
more efficacious in the handling of chronic ailments.
Hypnosis patients rarely practice the skill in the long run. On the
contrary, meditators expect to spend years developing their skill. They
practice daily for 20 minutes to an hour, and go away for retreats where
they practice 10 to 15 hours a day for weeks or months.
 29

However recent cross-fertilization of Eastern meditative techniques

presented with Western modern clinical hypnosis has softened these
differences in goals and practice, with an increasing number of subjects
practicing self-hypnosis for long periods of time and meditative
techniques (e.g., Mindfulness-Based Stress Reduction, MBSR)
increasingly used for medical treatment.

Expectancy and Suggestion. Suggestions are generally given in

hypnosis but not in meditation. eople doing meditation dont expect
suggestibility but rather expect that their pure bright awareness will
enable them to see reality without bias of prior conditioning or emotion.

Tab. I shows comparison between hypnosis and meditation.

GENERAL CONCLUSIONS

Hypnosis and Meditation represent two important, historical and

influential landmarks of Western and Eastern civilization and culture
respectively. Neuroscience has beginning to shed a new light on the
mechanisms of the Hypnotic and Meditative Brain, outlining similarities
but also differences between the two states and processes.
It is important not to view either the Eastern or the Western system as
superior to the other (Otani, 2003). The recent introduction and
popularization of meditative techniques (e.g., Mindfulness) in the West
raise some important issues. Since in the West we live in a profoundly
non-monastic and non-contemplative society, to adopt these profound
and esoteric contemplative practices and the monastic way of life without
sufficient context remains highly problematic (Wallace, 2001).
In our Western consumer society, business oriented, the dominant
medical paradigm prioritizes profit, efficiency and short-term therapies.
Can we assume that meditative practices known to be effective in
Eastern cultures and contexts, and transplanted in Europe or America in
the same format and with no adaptation for the West, do still work ? How
can be sure that the Dharma scene in the Buddhist world may be our own
unique staircase to Heaven ?
So simply dropping the teachings into a cultural tabula rasa, is not
reasonable and even desirable. We might expect that degenerating
Buddhism practices run the danger of losing their uniqueness in the West
and being totally assimilated into a naive and regressive New Age culture.
But we also can change the problem in an opportunity. We probably need
to adapt and transform these practices into a idiosyncratic Western way.
One solution is a close, respectful, and open-minded dialog between
Western disciples and Buddhist adepts.
 30

This cross-fertilization of the ancient Eastern meditation techniques

presented with Western modern clinical hypnosis will hopefully result in
each enriching the other.

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FIGURE CAPTIONS

Fig. 1. Potential domains of the Hypnotic Brain. Intrinsic research is the

research line concerned with functional anatomy of hypnosis per se, in
the absence of specific suggestions, the so called neutral hypnosis or
default hypnosis, and the neurophysiological mechanisms underlying
the hypnotic experience in dynamic conditions. Instrumental research
(extrinsic studies) refers to the use of hypnosis and suggestion for
studying a wide range of cognitive and emotional processes as well as for
creating virtual analogues of neurological and psychopathological
conditions in order to elucidate their underpinnings and eventually
positively change the way we treat them.
Legend: A.S.C., altered states of consciousness; O.S.C., ordinary states
of consciousness.

Fig. 2. Putative Mechanisms of Hypnotic Analgesia (De Benedittis,

2003).

Fig. 3. Eastern Major Meditative Traditions and Their Experiential

Determinants.

Tab. I. Comparison between Hypnosis and Meditation: Similarities and

Differences.
 38

Legend: +, positive association; -, negative association; ?, unconclusive,

controversial or no data.
39
40
 41

EASTERN MEDITATIVE TRADITIONS

THERAVADA MAHAYANA

Concentrative
Samadhi Taoism
Object Meditation
Zen

Abstract
Vipassana
Objectless
Mindfulness Meditation

Loving-kindness
Tong-Len
Meditation
Table(s)

HYPNOSIS MEDITATION

EXPERIENTIAL
DETERMINANTS

Altered State of Consciousness + +

Concentration/Focused Attention
Receptivity/Absorption
Hypnotizability
Suggestion
Insight/Mindfullness
+ +
+ +
+ ?
+ -
- +

NEURAL
DETERMINANTS

Brain States
Theta Activity + +
Gamma Activity + +
Neuroimaging ROIs
ACC + +
Frontal + +
Precuneus + ?
Occipital + ?

Functional Connectivity + +
Structural Connectivity - + (Long-Term)

PSYCHOSOCIAL
DETERMINANTS

Expectancies Medically oriented: Healing Pure Bright Awareness (Enlightenment)

Goals Repair Restore
Set Usually call for two A solo
 Rapport
Average Duration Short Long-life