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Among the methods for cognitive control of pain, the suggestions for analgesia-direct or indirect-have been widely and successfully used in experimental and clinical trials. The primary aim of this study was to contribute to the debate about the difference in the effectiveness of indirect and direct suggestions for the management of experimental pain in the ordinary state of consciousness. The secondary aim of the study was to ascertain the role of hypnotizability and expectation of pain relief in the suggestions' effect. A sample of 65 healthy participants with different levels of direct (Harvard Group Scale of Hypnotic Susceptibility: A score) and indirect suggestibility level (Alman-Wexler Indirect Hypnotic Susceptibility Scale score) and different levels of declared expectation of pain relief was submitted to direct and indirect suggestions for analgesia during cold pressure test. The results showed that both direct and indirect suggestions increase the threshold of experimental pain and that the expectation of pain relief is relevant only to the effect of direct suggestions. PERSPECTIVE: Although the reported findings cannot be extended to clinical pain, they suggest that indirect suggestions can be effective independently from the expectation of pain relief, thus evading the possible negative effects of traits such as catastrophism or reactance. Thus, indirect suggestions should be preferred in clinical contexts., (Copyright © 2024. Published by Elsevier Inc.)

Motor imagery (MI) requires the mental representation of the body, obtained by integrating exteroceptive and interoceptive information. This study aimed to investigate the role of interoceptive sensitivity (IS) in MI performed through visual and kinesthetic modalities by participants with low (lows, N = 26; SHSS: A, M + SD : 1.00 + 1.52), medium (mediums, N = 11; SHSS: A, 6.00 + 0.77) and high hypnotizability scores (highs, N = 16; SHSS:A, 9.75 + 1.24), as measured by the Stanford Hypnotic Susceptibility Scale: Form A. The three groups displayed different MI abilities and IS levels. The efficacy of MI was measured using the chronometric index and self-reported experience, while IS was measured using the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire. Alpha and beta power spectrum densities (PSDs) were extracted from the EEG signals acquired during baseline, actual movement and visually and kinesthetically imagined movements. The chronometric indices do not reveal significant differences between groups and imagery modalities. The self-report MI efficacy indicates better kinesthetic imagery in highs and mediums than in lows, and no modality difference among lows. The MAIA dimensions sustain the differences in subjective experience and almost all the EEG differences. The latter are slightly different in highs, mediums and lows. This is the first report of the major role played by IS in MI and strongly supports the theory of embodied cognition.

The hypnotizability-related differences in morpho-functional characteristics of the insula could at least partially account for the differences in interoceptive accuracy (IA) observed between high and low hypnotizable individuals (highs, lows). Our aim was to investigate interoceptive processing in highs, lows, and medium hypnotizable individuals (mediums), who represent most of the population, during a 10-minute open eyes relaxation condition (Part 1) and three repetitions of consecutive 2-minute open eyes, closed eyes, and heartbeat counting conditions, followed by a 2-minute post-counting condition (Part 2). Electrocardiogram and electroencephalogram were recorded in 14 highs, 14 mediums, and 18 lows, classified according to the Stanford Hypnotic Susceptibility Scale: Form A. Heartbeat-evoked cortical potentials (HEP) were extracted throughout the entire session, and IA index was obtained for the heartbeat counting task (HCT). In Part 1, significant hypnotizability-related differences were observed in the right central region in both early and late HEP components, with lows showing positive amplitudes and highs/mediums showing negative amplitudes. In Part 2, the same group differences were limited to the early component. Moreover, in the left frontal regions, only mediums modified their HEP during the counting task with respect to the open/closed eyes conditions, whereas highs displayed HEP differences between counting and post-counting rest. HCT did not show significant group differences. In conclusion, highs and mediums seem to be more similar than mediums and lows regarding HEP, despite the absence of significant differences in HCT. Nonetheless, a negative correlation between hypnotizability scores and HEP amplitudes was observed in the regions showing group differences., (© 2024 Society for Psychophysiological Research.)

Risk is the probability of an adverse event. The proneness to take a risk and the risk taking behavior differ among the general population. Hypnotizability is a stable psychophysiological trait expressing the individual proneness to modify perception, memory and behavior following specific suggestions also in the ordinary state of consciousness. Some hypnotizability-related neurophysiological and behavioral correlates suggest that hypnotizability level, measured by standard scales classifying individuals as low (lows), medium (mediums) and high hypnotizable (highs) subjects, can be related to risk propensity and risk-taking. To study whether hypnotizability modulates risk propensity and behavior, we recruited healthy participants, classified through the Standford Hypnotic Susceptibility scale, form A, and compared lows' (n = 33), mediums' (n = 19) and highs'(n = 15) experiential and behavioral risk perception and propensity variables through the Domain-specific risk-taking scale and the Balloon Analogue Risk Task. MANOVA results indicated that different hypnotizability levels are not associated with different risky behavior and experience, except for higher expected financial benefits from risky behavior in lows. However, hypnotizability-related risk profiles were identified through correlational analyses. In fact, highs exhibited a negative association between risk perception and propensity to risk-taking, whereas mediums and lows displayed a positive association between risk propensity and expected benefit. In conclusion, the highs' profile indicates a more automatic behavior with respect to mediums and lows., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Studies in the field of experimental hypnosis highlighted the role of hypnotizability in the physiological variability of the general population. It is associated, in fact, with a few differences which are observable in the ordinary state of consciousness and in the absence of suggestions. The aim of the present scoping review is summarizing them and indicate their relevance to the neural mechanisms of hypnosis and to the prognosis and treatment of a few medical conditions. Individuals with high, medium and low hypnotizability scores display different cerebral functional differences-i.e., functional equivalence between imagery and perception/action, excitability of the motor cortex, interoceptive accuracy-possibly related to brain structural and functional characteristics, and different control of blood supply at peripheral and cerebral level, likely due to different availability of endothelial nitric oxide. These differences are reviewed to support the idea of their participation in hypnotic behaviour and to indicate their prognostic and therapeutic usefulness in a few medical conditions., Competing Interests: The authors declare no conflict of interest.

Hypnotizability is a psychophysiological trait measured by scales and associated with several differences, including interoceptive accuracy and the morpho-functional characteristics of interoception-related brain regions. The aim of the study was to assess whether the amplitude of the heartbeat evoked cortical potential (HEP), a correlate of interoceptive accuracy, differs in participants with low (lows) and high (highs) hypnotizability scores (assessed by the Stanford Hypnotic Susceptibility Scale, Form A) before and after the induction of hypnosis. ECG and EEG were monitored in 16 highs and 15 lows during an experimental session, including open eyes baseline (B), closed eyes relaxation (R), hypnotic induction (IND), neutral hypnosis (NH), and post session baseline (Post). No significant difference was observed between groups and conditions in autonomic variables. The HEP amplitude was lower in highs than in lows at the right parietal site, likely due to hypnotizability related differences in the functional connection between the right insula and parietal cortex. It increased in highs and decreased in lows across the session, possibly due to the highs' preeminently internally directed attention and to the lows' possible disengagement from the task. Since interoception is involved in several cognitive-emotional functions, its hypnotizability related differences may contribute to the variability of experience and behavior in daily life., (© 2023 The Authors. Psychophysiology published by Wiley Periodicals LLC on behalf of Society for Psychophysiological Research.)

The present scoping review reports the reciprocal relations between hypnotizability, interoception, and emotion. Brain morpho-functional differences may account for the lower interoceptive accuracy, higher interoceptive sensitivity, and different emotional strategies observed in highly hypnotizable participants with respect to medium-to-low hypnotizables. Since interoception is relevant to both physical and mental health and hypnotizability can predict both interoceptive abilities and the efficacy of interoception-based mental training, this allows for the development of new forms of treatment and rehabilitation.

The relevance of formal hypnotic induction to the experience of trance and its neural correlates is not clear, in that hypnotizability, beliefs and expectation of hypnosis may play a major role. The aim of the study was assessing the EEG brain activity of participants with high (highs) or low hypnotizability scores (lows), aware of their hypnotizability level and informed that the session will include simple relaxation, formal hypnotic induction and neutral hypnosis. A total of 16 highs and 15 lows (according to the Stanford Hypnotic Susceptibility Scale, form A) were enrolled. Their EEGs were recorded during consecutive conditions of open/closed-eyes relaxation, hypnotic induction, neutral hypnosis and post hypnosis not interrupted by interviews. The studied variables were theta, alpha and gamma power spectral density (PSD), and the Determinism (DET) and Entropy (ENT) of the EEG signal Multidimensional Recurrence Plot (mRP). Highs reported significantly greater changes in their state of consciousness than lows across the session. The theta, alpha and gamma PSD did not exhibit condition-related changes in both groups. The Alpha PSD was larger in highs than in lows on midline sites, and the different sides/regions' theta and gamma PSD were observed in the two groups independently from conditions. ENT showed no correlation with hypnotizability, while DET positively correlated with hypnotizability during hypnosis. In conclusion, the relevance of formal hypnotic induction to the experience of trance may be scarce in highs, as they are aware of their hypnotizability scores and expecting hypnosis. Cognitive processing varies throughout the session depending on the hypnotizability level.

Hypnotisability is a multidimensional trait predicting the proneness to enter hypnosis and/or accept suggestions and is associated with several psychophysiological correlates. This scoping review reports the differences between individuals with high (highs) and low hypnotizability (lows) in the left cerebellar lobules IV-VI grey matter volume, in the excitability of the right motor cortex and in motor and non-motor functions in which the cerebellum may be involved. A reduced cerebellar inhibition may explain the greater excitability of the highs' right motor cortex. The latter may be involved in their greater proneness to ideomotor behaviour following sensorimotor suggestions. The associated experience of involuntariness and effortlessness could be due to the motor cortex greater excitability as well as to activation of a specific cerebellar-parietal circuit. Looser postural and visuomotor control with no learning across trials and greater attentional stability can be accounted for by a less accurate cerebellar predictive model of information processing. The highs' stronger functional equivalence between imagery and perception/action and greater motor excitability may be involved in the highs' greater proneness to respond to emotional stimuli. Paradoxical pain control may depend on reduced cortical inhibition of the pain matrix by the cerebellum. Cerebellar hypotheses are not alternative to other physiological mechanisms and should be tested in future research., (© 2021. The Author(s).)

Susceptibility to hypnosis is a very pervasive psychophysiological trait characterized by different attentional abilities, information processing, and cardiovascular control. Since near infrared spectroscopy is a good index of neurovascular coupling, we used it during mental computation (MC) and trail making task (TMT) in 13 healthy low-to-medium (med-lows) and 10 healthy medium-to-high (med-highs) hypnotizable participants classified according to the Stanford Hypnotic Susceptibility Scale, form A, and characterized for the level of proneness to be deeply absorbed in related experiences by the Tellegen Absorption Scale. The med-highs reported greater absorption than med-lows. The tissue hemoglobin index (THI) and the tissue oxygenation index (TOI) increased across the tasks only in med-highs who displayed also different time courses of THI and TOI during MC and TMT, which indicates different tasks processing despite the two groups' similar performance. The findings suggest that med-highs' tissue oxygenation is more finely adjusted to metabolic demands than med-lows'., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Hypnotizability is a trait associated with several physiological correlates including cardiovascular control. The present study aimed to investigate the posterior cerebral artery flow velocity (PCAv) in basal closed eyes (B) and during visual stimulation (VS) conditions in med-highs and med-lows. Twenty-four healthy volunteers were submitted to the hypnotic assessment through the Stanford Hypnotic Susceptibility Scale, form A which classified 13 low-to-medium (med-lows) and 10 high-to-medium (med-highs) hypnotizable participants. One subject scoring 6 out of 12 was excluded from the comparisons between groups. Arterial blood pressure, heart rate, and partial pressure of end-tidal CO 2 were monitored during both B and VS conditions. Simultaneously, PCAv was assessed by transcranial Doppler. Cerebrovascular Reactivity (CVR) was computed as a percentage of the PCAv change occurring during VS with respect to B (ΔPCAv). During VS both groups increased their PCAv (mean ± SD: 7.9 ± 5.2 %) significantly with no significant group difference. However, among med-highs, CVR was negatively correlated with hypnotizability scores. Thus, higher hypnotizability may be associated with lower metabolic demand in response to VS only within med-highs hypnotizable participants., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Studies conducted in healthy subjects have clearly shown that different hypnotic susceptibility, which is measured by scales, is associated with different functional equivalence between imagery and perception/action (FE), cortical excitability, and information processing. Of note, physiological differences among individuals with high (highs), medium (mediums), and low hypnotizability scores (lows) have been observed in the ordinary state of consciousness, thus independently from the induction of the hypnotic state, and in the absence of specific suggestions. The potential role of hypnotic assessment and its relevance to neurological diseases have not been fully explored. While current knowledge and therapies allow a better survival rate, there is a constant need to optimize rehabilitation treatments and quality of life. The aim of this paper is to provide an overview of hypnotizability-related features and, specifically, to discuss the hypothesis that the stronger FE, the different mode of information processing, and the greater proneness to control pain and the activity of the immune system observed in individuals with medium-to-high hypnotizability scores have potential applications to neurology. Current evidence of the outcome of treatments based on hypnotic induction and suggestions administration is not consistent, mainly owing to the small sample size in clinical trials and inadequate control groups. We propose that hypnotic assessment may be feasible in clinical routine and give additional cues into the treatment and rehabilitation of neurological diseases., (© 2022. The Author(s).)

Hypnotizability is a cognitive trait associated with differences in the brachial artery flow-mediated dilatation of individuals with high hypnotizability (highs) and low hypnotizability scores (lows). The study investigated possible hypnotizability-related cerebrovascular differences. Among 24 healthy volunteers, the Stanford Hypnotic Susceptibility Scale Form A identified 13 medium-to-lows (med-lows), 11 medium-to-highs (med-highs), and 1 medium hypnotizable. Hypnotizability did not influence the significant changes produced by the trail making task (TMT), mental arithmetic task (MAT), hyperventilation (HVT), and rebreathing (RBT) on heart rate (HR), arterial blood pressure (ABP), and partial pressure of end-tidal CO 2 (P ET CO 2 ), but moderated the correlations between the changes occurring during tasks with respect to basal conditions (Δ) in ABP and P ET CO 2 with middle cerebral artery flow velocity (MCAv). In HVT, med-lows exhibited a significant correlation between ΔMCAv and ΔP ET CO 2 , and med-highs showed a significant correlation between ΔABP and ΔMCAv. Cerebrovascular reactivity (CVR) and conductance (ΔCVCi) were significantly correlated with ΔMCAv only in med-lows during HVT and RBT. For the first time, cerebrovascular reactivity related to hypnotizability was investigated, evidencing different correlations among hemodynamic variables in med-highs and med-lows.

Both hypnotizability and well-being are relevant to health. This study aimed to investigate whether high hypnotizability was positively associated with well-being and whether the latter was related to the activity of the behavioral inhibition/approach system (BIS/BAS). ANOVA revealed significantly higher scores on the General Well-Being Index (PGWBI) in highly hypnotizable (highs, n = 31) compared with low hypnotizable participants (lows, n = 53), with medium hypnotizable participants (mediums, n = 41) exhibiting intermediate values. This finding was discussed in relation to other hypnotizability-related traits, such as morpho-functional brain characteristics, equivalence between imagery and perception, and interoceptive sensitivity. A secondary finding was a nonsignificant gender difference in scores on the PGWBI. The highs' higher well-being could be considered a favorable prognostic factor for physical and mental health.

This study aimed to measure the interoceptive accuracy (IA) of individuals with high (highs ), medium (mediums) , and low hypnotizability (lows) through the heartbeat-counting task during 3 relaxation trials. Participants completed the Multidimensional Assessment of Interoceptive Awareness (MAIA), ECG and skin conductance (SC) were monitored, and the experienced difficulty in counting was reported. Results showed similar counting difficulty and number of actual heartbeats in highs, mediums, and lows. SC decreased in highs during all trials, in mediums and lows only in the third trial. IA measured as [1 - (ǀrecorded heartbeats-counted heartbeatsǀ)/recorded heartbeats] was negatively correlated with hypnotizability and not correlated with interoceptive sensitivity (IS) measured by MAIA scales. Among mediums, IA was higher in males than in females.

Individuals with different hypnotizability display different interoceptive sensitivity/awareness (IS) and accuracy (IA), likely sustained by morphofunctional differences in interoception-related brain regions and, thus, possibly also observable during sleep. We investigated the heartbeat-evoked cortical potential amplitude (HEP) during sleep, its association with IS, and the role of hypnotizability in such association. We performed a retrospective analysis of polysomnographic recordings of 39 healthy volunteers. Participants completed the Multidimensional Assessment of Interoceptive Awareness (MAIA), measuring IS and IA, and underwent hypnotic assessment via the Stanford Hypnotic Susceptibility Scale, form A. The amplitude of the early and late HEP components was computed at EEG frontal and central sites. In both regions, the early HEP component was larger in N3 than in N2 and REM, with no difference between N2 and REM. Greater HEP amplitude at frontal than at central sites was found for the late HEP component. HEP amplitudes were not influenced by the autonomic state assessed by heart rate variability in the frequency and time domains. We report for the first time a positive correlation between the central late HEP component and MAIA dimensions, which became non-significant after removing the effects of hypnotizability. Our findings indicate that hypnotizability sustains the correlation between IS and HEP amplitude during sleep.

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

We propose here an evolutionary interpretation of the presence of highly hypnotizable persons (highs) among the general population. Current experimental evidence suggests the presence of stronger functional equivalence between imagery and perception, non-opioid cognitive control of pain, favorable cardiovascular asset, and greater interoceptive sensitivity in highs. We hypothesize that these characteristics were greatly relevant to our ancestors' survival, and that they may have facilitated the natural selection of individuals who are now named "highs" due to one of their side effects - the proneness to accept suggestions - as part of the reported physiological features. Unfortunately, our theoretical hypothesis cannot be currently experimentally proven. We believe, however, that looking at hypnotizability in a naturalistic, evolutionary perspective may emphasize the importance of its physiological correlates in daily life and in the prediction of the outcome of medical treatments.

This study investigated multisensory integration in 29 medium-to-high (mid-highs) and 24 low-to-medium (mid-lows) hypnotizable individuals, classified according to the Stanford Hypnotic Susceptibility Scale, Form A. Participants completed a simultaneity judgment (SJ) task, where an auditory and a visual stimulus were presented in close proximity to their body in a range of 11 stimulus onset asynchronies. Results show that mid-highs were prone to judge audiovisual stimuli as simultaneous over a wider range of time intervals between sensory stimuli, as expressed by a broader temporal binding window, when the visual stimulus precedes the auditory one. No significant difference was observed for response times. Findings indicate a role of hypnotizability in multisensory integration likely due to the highs' cerebellar peculiarities and/or sensory modality preference.

Higher arousal and cortical excitability have been observed in high hypnotizable individuals (highs) with respect to low hypnotizables (lows), which may be due to differences in the activation of ascending activating systems. The present study investigated the possible hypnotizability-related difference in the cortical noradrenergic tone sustained by the activity of the Locus Coeruleus which is strongly related to pupil size. This was measured during relaxation in three groups of participants-highs (N = 15), lows (N = 15) and medium hypnotizable individuals (mediums, N = 11)-in the time and frequency domains and through the Recurrence Quantification Analysis. ECG and Skin Conductace (SC) were monitored to extract autonomic indices of relaxation (heart interbeats intervals, parasympathetic component of heart rate variability (RMSSD) and tonic SC (MeanTonicSC). Most variables indicated that participants relaxed throughout the session. Pupil features did not show significant differences between highs, mediums and lows, except for the spectral Band Median Frequency which was higher in mediums than in lows and highs at the beginning, but not at the end of the session.Thus, the present findings of pupil size cannot account for the differences in arousal and motor cortex excitability observed between highs and lows in resting conditions.

The aim of the study was to investigate the effects of pleasant and unpleasant interoceptive imagery on postural control in participants with different hypnotizability, interoceptive sensibility and ability of imagery. Forty-one healthy individuals classified as high (highs), medium (mediums) and low hypnotizables (lows) according to the Stanford Hypnotic Susceptibility Scale, form A (SHSS, A) were characterized for Interoceptive Sensitivity (IS) through the Multisensory Assessment of Interoceptive Awareness (MAIA) and for organic mental imagery (ORG) through Betts' questionnaire. The experimental session included baseline closed eyes conditions preceding tasks of pleasant (P) and unpleasant imagery (U) and a neutral cognitive task (NT) while standing on a stabilometric platform. Subjective reports of vividness and pleasantness/unpleasantness of mental images were collected. Postural variables, ECG and pneumogram were acquired. Highs exhibited greater vividness of imagery than mediums/lows and larger Area of the Centre of Pressure (CoP), while mediums and lows decreased it during all tasks with respect to baseline conditions. Significant differences moderated by IS and ORG were found between highs and lows in the CoP Area. In all groups significant task related differences in the CoP Area were moderated only by IS. Cardiovascular variables were similar in the three groups, but differed among tasks and were influenced by IS and ORG. Our findings extend earlier observations on the role of hypnotisability in the postural correlates of sensorimotor imagery to interoceptive imagery, support the hypothesis that interoceptive sensibility moderates postural control and cardiorespiratory variables during interoceptive imagery, and confirm earlier reports of the absence of hypnotisability-related modulation of cardiorespiratory variables during emotional tasks., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The aim of the study was to investigate the possible association of hypnotizability and deep sleep (N3) duration, and whether the interoceptive sensibility influences this association. This was motivated by the proneness of highly hypnotizable individuals to easily change their psychophysiological state, i.e., from wakefulness to hypnosis and sleep, and by the positive association observed between hypnotizability and interoceptive sensibility. Forty-seven healthy participants previously enrolled in a polysomnographic night sleep study completed the questionnaire for Multidimensional Assessment of Interoceptive Awareness (MAIA) and underwent hypnotic assessment through the Stanford Hypnotic Susceptibility Scale, form A (SHSS,A). Results showed that N3 duration is not linearly correlated with hypnotizability. Controlling for a few MAIA scales did not modify the relation between hypnotizability and deep sleep. A polynomial relation indicates that N3 duration and N3 percentage of the total sleep time increase with hypnotizability in the low-to-medium range of hypnotizability and decrease in the medium-to-high range. In conclusion, hypnotic assessment predicts N3 duration and their association is not modified by interoceptive awareness/sensitivity.

This study examined hypnotizability-related modulation of the cortical network following expected and nonexpected nociceptive stimulation. The electroencephalogram (EEG) was recorded in 9 high ( highs ) and 8 low ( lows ) hypnotizable participants receiving nociceptive stimulation with (W1) and without (noW) a visual warning preceding the stimulation by 1 second. W1 and noW were compared to baseline conditions to assess the presence of any later effect and between each other to assess the effects of expectation. The studied EEG variables measured local and global features of the cortical connectivity. With respect to lows, highs exhibited scarce differences between experimental conditions. The hypnotizability-related differences in the later processing of nociceptive information could be relevant to the development of pain-related individual traits. Present findings suggest a lower impact of nociceptive stimulation in highs than in lows.

Hypnotizability is a psychophysiological trait associated with morphofunctional brain peculiarities and with several cognitive, sensorimotor and cardiovascular correlates. Behavioral and EEG studies indicate stronger functional equivalence (FE) between motor imagery and action in the individuals with high hypnotizability scores (Highs). We hypothesized that stronger FE leading to greater proneness to ideomotor behavior could be due to greater cortical excitability of the motor cortex. The aim of the study was to evaluate the motor cortical excitability through measurements of the muscle potentials (MEPs) evoked in the left abductor pollicis brevis by transcranial magnetic stimulation (TMS) of the right motor cortex in 10 Highs, 10 medium (Mediums) and 10 low hypnotizable individuals (Lows) classified according to the Stanford Hypnotic Susceptibility Scale, form A (SHSS). They were studied in basal conditions (B) and during motor imagery (MI). Results showed significant, negative correlations (i) between hypnotizability and MEPs Resting Motor Threshold (RMT) in basal conditions, and (ii) between hypnotizability and both MEPs RMT and suprathreshold (I 1mv ) stimulation intensities during MI. ANOVA revealed significantly lower stimulation intensities in Highs than in Lows, with Mediums exhibiting intermediate values. Thus, the Highs' greater cortical excitability could sustain their greater FE and proneness to ideomotor behavior. In cognitive neuroscience these findings are relevant to the physiological interpretation of the response to sensorimotor suggestions by participants in the ordinary state of consciousness. In the clinical field they can predict the efficacy of mental training based on motor imagery and, possibly, the degree of imagery-induced cortical plasticity., (Copyright © 2020 IBRO. Published by Elsevier Ltd. All rights reserved.)

Fatty acid amide hydrolase (FAAH) degrades the endogenous endocannabinoid (eCB) anandamide and might be involved in the response to suggestions of analgesia in subjects with high hypnotizability scores ( highs ). Since the A allele of the FAAH C385A polymorphism (rs324420) is associated with lower FAAH activity, it was studied in 21 highs, 66 low hypnotizable individuals ( lows ), and 172 individuals not selected for hypnotizability ( controls ) representing the general population. No significant difference was observed among groups, but the A allele frequency showed a significant trend to increase from lows to controls and from controls to highs. Since eCB small differences can be amplified by eCB interactions with other neurotransmitters, a contribution of the FAAH polymorphism to the highs' analgesia should not be excluded.

Emotions are influenced by several individual factors. Hypnotizability - a psychophysiological trait associated with morpho-functional cerebral and cerebellar variations able to sustain differences in interoception and emotion - could be one of them. The aims of the study were to find out possible differences in Interoceptive Awareness (IA) and in the emotional traits sustained by the Behavioral Inhibition/Activation System (BIS/BAS) in participants with high (highs), medium (mediums) and low (lows) hypnotizability and to investigate the association of interoceptive awareness and BIS/BAS related emotional traits as a function of hypnotizability. Thus, IA and BIS/BAS were studied in 284 subjects of both genders by the Multidimensional Assessment of Interoceptive Awareness (MAIA) and by BIS/BAS scales, respectively. Significantly lower BIS scores (lower inhibitory control/conflict monitoring) in highs and lows with respect to mediums and significantly higher IA (proneness to notice and interpret interoceptive information) in highs with respect to mediums and lows were found. In addition, different correlations between MAIA and BIS/BAS scales were observed in the three groups, indicating different hypnotizability-related associations.The hypnotizability-related relation between interoceptive awareness and emotional traits could be accounted for by different models and their knowledge may be relevant to the science of emotion and to clinical applications.

Motor imagery is influenced by individual and contextual factors. We investigated whether the psychophysiological trait of hypnotisability modulates its subjective experience and cortical correlates similarly to what was previously shown for head postures mental images. EEG was acquired in 18 high (highs) and 15 low (lows) hypnotizable subjects (Stanford Hypnotic Susceptibility Scale, A). The experimental conditions were: baseline, a complex arm/hand movement, visual (1st person) and kinesthetic imagery of the movement. After each imagery condition, participants scored the vividness and easeness of their performance and their ability to mantain the requested modality of imagery. Subjective reports, chronometric visual/kinesthetic indices, absolute beta and fronto-central midline alpha powers were analyzed. Findings confirmed earlier reports of better kinestetic imagery ability in highs than in lows and better visual than kinesthetic imagery in lows, as well as smaller restructuring of the cortical activity in highs than in lows, during all tasks. Also, they show that hypnotisability accounts for most of the correlations between brain regions for both alpha and beta changes. Thus, imagined and actual movements were less demanding processes in highs at subjective and cortical levels. Finally, hypnotic assessment assists to plan personalized mental training for neuro-rehabilitation and sports and predict their efficacy., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The functional equivalence (FE) between imagery and perception or motion has been proposed on the basis of neuroimaging evidence of large spatially overlapping activations between real and imagined sensori-motor conditions. However, similar local activation patterns do not imply the same mesoscopic integration of brain regions, which can be described by tools from Topological Data Analysis (TDA). On the basis of behavioral findings, stronger FE has been hypothesized in the individuals with high scores of hypnotizability scores (highs) with respect to low hypnotizable participants (lows) who differ between each other in the proneness to modify memory, perception and behavior according to specific imaginative suggestions. Here we present the first EEG evidence of stronger FE in highs. In fact, persistent homology shows that the highs EEG topological asset during real and imagined sensory conditions is significantly more similar than the lows. As a corollary finding, persistent homology shows lower restructuring of the EEG asset in highs than in lows during both sensory and imagery tasks with respect to basal conditions. Present findings support the view that greater embodiment of mental images may be responsible for the highs greater proneness to respond to sensori-motor suggestions and to report involuntariness in action. In addition, findings indicate hypnotizability-related sensory and cognitive information processing and suggest that the psycho-physiological trait of hypnotizability may modulate more than one aspect of the everyday life., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The reduced cerebellar gray matter (GM) volume observed in highly hypnotizable individuals (highs) is likely due to the excessive release of endothelial nitric oxide in the brain and could account for their behavioral (postural and visuomotor control) and physiological (paradoxical pain control after cerebellar anodal stimulation) characteristics. Reduced cerebellar GM can induce low inhibition of the cerebral cortex, thus stronger functional equivalence (FE) between imagery and perception and greater proneness to respond to sensorimotor suggestions. In fact, stronger FE suggested in highs by behavioral studies has been confirmed by topological data analysis of EEG signals recorded during sensorimotor and imagery tasks. The authors' hypothesis cannot be applied to obstructive suggestions likely sustained by mechanisms related to socio-cognitive factors, i.e., oxytocin availability.

Introduction: The aim of this exploratory study was to assess the EEG correlates of head positions (which have never been studied in humans) in participants with different psychophysiological characteristics, as encoded by their hypnotizability scores. This choice is motivated by earlier studies suggesting different processing of vestibular/neck proprioceptive information in subjects with high (highs) and low (lows) hypnotizability scores maintaining their head rotated toward one side (RH)., Methods: We analyzed EEG signals recorded in 20 highs and 19 lows in basal conditions (head forward) and during RH using spectral analysis, which captures changes localized to specific recording sites, and topological data analysis (TDA), which instead describes large-scale differences in processing and representing sensorimotor information., Results: Spectral analysis revealed significant differences related to head position for alpha 1, beta 2, beta 3, and gamma bands, but not to hypnotizability. TDA instead revealed global hypnotizability-related differences in the strengths of the correlations among recording sites during RH. Significant changes were observed in lows on the left parieto-occipital side and in highs in right frontoparietal region. Significant differences between the two groups were found in the occipital region, where changes were larger in lows than in highs., Conclusions: This study reports finding of the EEG correlates of changes in the head posture for the first time, indicating that hypnotizability is related to the head posture representation/processing on large-scale networks and that spectral and topological data analyses provide complementary results., (© 2019 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.)

Purpose: A positive association between resting state vagal tone and performance of a few cognitive functions has been proposed. Aim of this study was to investigate the possible association between vagal tone and motor imagery (MI), as MI is based on high-level cognitive processes such as attention, working memory and inhibitory control., Methods: The experiment consisted of the execution of a motor sequence and of the MI of the same action in the kinesthetic and internal visual modality. Participants with high (High, N=15) and low (Low, N=16) vagal tone at rest, were characterized for imagery and executive functions abilities through the Motor imagery questionnaire and standard cognitive tests (Trail Making test A and B, Digit span and Corsi test). We studied as indices of vagal tone a few variables estimated from heart rate variability: the sroot mean square of successive heart-beat-intervals differences (RMSSD), the high frequency band (HF), the standard deviation 1 of Poincaré plot (SD1). As indices of MI ability we measured the isochrony between real and imagined movements and the reported vividness of imagery., Results: A significantly greater isochrony was observed in Highs than in Lows only for the kinesthetic modality of imagery. Isochrony was not predicted by trait imagery abilities and did not correlate with vividness reports. Also, a reduction of the vagal control, which is the typical autonomic correlate of MI, was observed during both imagery tasks only in Highs., Conclusions: These findings indicate a cross-talk between the cardiovascular control and the proprioceptive representation of movement and reinforce the theory of bi-directional communication between heart and brain.

Hypnotizability is a psychophysiological trait associated with morpho-functional brain differences. Since also cerebellar peculiarities have been reported in individuals with different hypnotizability levels and the cerebellar function is relevant to spatial imagery, the present study was aimed at investigating possible hypnotizability-related differences in the ability of spatial imagery. Highly (highs, N = 31), low (lows, N = 17) and medium (mediums, N = 16) hypnotizable participants (classified by Stanford Hypnotic Susceptibility Scale, form A) of both genders were submitted to a test of mental rotation, which requires the integrity of both executive and cerebellar structures. In order to disentangle the role of the cerebellum from that of executive circuits as much as possible, visuospatial and verbal working memory tests, which mainly reflect executive processes, were also performed. Healthy highs exhibited higher scores of mental rotation ability compared to mediums in the absence of significant differences in visual-spatial and verbal working memory. Lows reported intermediate scores not significantly different from both highs' and mediums'. Different cognitive strategies were observed in the three groups as the correlations between mental rotation, visuospatial and verbal working memory were different in highs, mediums and lows. In conclusion, present findings represent the first report of hypnotizability-related differences in a mental rotation task, which is relevant to several cognitive functions., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The study investigated whether the cardiac activity and cognitive-emotional traits sustained by the behavioral inhibition/activation system (BIS/BAS) may contribute to hypnotizability-related pain modulation. Nociceptive stimulation (cold-pressor test) was administered to healthy participants with high (highs) and low (lows) hypnotizability in the presence and absence of suggestions for analgesia. Results showed that heart rate increased abruptly at the beginning of nociceptive stimulation in all participants. Then, only in highs heart rate decreased for the entire duration of hand immersion. During stimulation with suggestions of analgesia, pain threshold negatively correlated with heart rate. BIS/BAS activity partially accounted for the observed hypnotizability-related differences in the relation between cardiac interoception and pain experience.

The study investigates the cortical representation of the visual and kinesthetic image of a rotated position of the head in highly (highs) and low hypnotizable individuals (lows) of both gender. Participants were invited to imagine maintaining their head rotated toward one side by seeing their chin aligned with their right shoulder (V, visual imagery), and in a different condition, by feeling tension in their neck muscles (K, kinaesthetic imagery). Vividness of imagery and cognitive effort were reported after each task. Alpha and beta band absolute power was studied. Highs reported higher vividness than lows only for the kinaesthetic modality of imagery. The cortical desyncronization observed during visual and kinaesthetic imagery were different in high females (HM), low females (LF), high males (HM) and low males (LM). In fact, only HF and LM exhibited significant power changes during the kinaesthetic task, whereas visual imagery was associated with cortical desynchronization in all subgroups except HM. The study supports earlier findings of an advantage of highs in kinesthetic imagery, shows an intriguing interaction of hypnotizability and gender, and indicates topographical difference in the four subgroups of participants suggesting differences in underlying generators., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The possible cooperation between hypnotizability-related and placebo mechanisms in pain modulation has not been consistently assessed. Here, we investigate possible genetic bases for such cooperation. The OPRM1 gene, which encodes the μ1 opioid receptor-the primary site of action for endogenous and exogenous opioids-is polymorphic in the general population for the missense mutation Asn40Asp (A118G, rs1799971). The minor allele 118G results in decreased levels of OPRM1 mRNA and protein. As a consequence, G carriers are less responsive to opioids. The aim of the study was to investigate whether hypnotizability is associated with the presence of the OPRM1 polymorphism. Forty-three high and 60 low hypnotizable individuals, as well as 162 controls, were genotyped for the A118G polymorphism of OPRM1. The frequency of the G allele was significantly higher in highs compared to both lows and controls. Findings suggest that an inefficient opioid system may be a distinctive characteristic of highs and that hypnotic assessment may predict lower responsiveness to opioids.

High hypnotizability is associated with left-sided cerebral asymmetry, which could influence measurement of the Peripersonal Space (PPS). Right-handed participants with high (highs, n = 20), medium (mediums, n = 9), and low hypnotizability scores (lows, n = 20) performed the line bisection test on a computer screen automatically displaced at distances of 30, 60, and 90 cm from the subjects' eyes. Highs' results showed rightward bias of the bisection (Relative Error, RE) for all presentation distances. In contrast, in lows RE was displaced leftward at 30 cm and exhibited a progressive rightward shift at 60 and 90 cm, as occurs in the general population. Mediums' RE values were intermediate between highs' and lows' values. Bisection Times (BT) were significantly longer in highs/mediums than in lows. Findings indicate that the highs' bisection identifies PPS as if it was extrapersonal, but further studies should assess its functional characteristics. The highs/mediums longer BT suggest less efficient sensorimotor performance.

The aim of the present study was to compare the effects of explicit suggestions of analgesia and of the activation of the Diffuse Noxious Inhibitory Control (DNIC) by cold pressor test on pain perception and heart rate in healthy participants with high (highs, N=18), low (lows, N=18) and intermediate scores of hypnotizability (mediums, N=15) out of hypnosis. Pain reports and the stimulus-locked heart rate changes induced by electrical nociceptive stimulation of the left hand were studied in the absence of concomitant stimuli (Control), during suggestions of analgesia (SUGG, glove analgesia) and during cold pressor test used as a conditioning stimulus to the right hand (DNIC, water temperature=10-12°C) in the REAL session. Participants were submitted also to a SHAM session in which the DNIC water temperature was 30°C and the suggestions for analgesia were substituted with weather forecast information. Both suggestions and DNIC reduced pain significantly in all subjects; however, the percentage of reduction was significantly larger in highs (pain intensity=55% of the control condition) than in mediums (70%) and lows (80%) independently of the REAL/SHAM session and of the specific pain manipulation. Heart rate was not modulated consistently with pain experience. Findings indicate that both suggestions and DNIC influence pain experience as a function of hypnotizability and suggest that both sensory and cognitive mechanisms co-operate in DNIC induced analgesia., (Copyright © 2017 Elsevier Inc. All rights reserved.)

In the general population, transcranial anodal direct current stimulation of the cerebellum (ctDCS) reduces pain intensity and the amplitude of nociceptive laser evoked potentials (LEPs), whereas cathodal ctDCS elicits opposite effects. Since behavioral findings suggest that the cerebellar activity of highly hypnotizable individuals (highs) differs from the general population, we investigated whether hypnotizability-related differences occur in the modulation of pain by ctDCS. Sixteen healthy highs (according to the Stanford Hypnotic Susceptibility Scale, form A) and 16 participants not selected according to hypnotizability (controls) volunteered to undergo laser nociceptive stimulation of the dorsum of the left hand before and after anodal or cathodal ctDCS. LEPs amplitudes and latencies and the subjective pain experience (Numerical Rating Scale) were analyzed. Smaller LEP amplitudes and longer latencies were observed in highs with respect to controls independently of stimulation. After anodal and cathodal cerebellar stimulation, controls reported lower and higher pain than before it, respectively. In contrast, highs did not report significant changes in the perceived pain after both stimulations. They increased significantly their N2/P2 amplitude after anodal ctDCS and did not exhibit any significant change after cathodal tDCS, whereas controls decreased the N1 and N2P2 amplitude and increased their latency after anodal cerebellar stimulation and did the opposite after cathodal ctDCS. In conclusion, the study showed impaired cerebellar pain modulation and suggested altered cerebral cortical representation of pain in subjects with high hypnotizability scores.

This article summarizes key advances in hypnosis research during the past two decades, including (i) clinical research supporting the efficacy of hypnosis for managing a number of clinical symptoms and conditions, (ii) research supporting the role of various divisions in the anterior cingulate and prefrontal cortices in hypnotic responding, and (iii) an emerging finding that high hypnotic suggestibility is associated with atypical brain connectivity profiles. Key recommendations for a research agenda for the next decade include the recommendations that (i) laboratory hypnosis researchers should strongly consider how they assess hypnotic suggestibility in their studies, (ii) inclusion of study participants who score in the middle range of hypnotic suggestibility, and (iii) use of expanding research designs that more clearly delineate the roles of inductions and specific suggestions. Finally, we make two specific suggestions for helping to move the field forward including (i) the use of data sharing and (ii) redirecting resources away from contrasting state and nonstate positions toward studying (a) the efficacy of hypnotic treatments for clinical conditions influenced by central nervous system processes and (b) the neurophysiological underpinnings of hypnotic phenomena. As we learn more about the neurophysiological mechanisms underlying hypnosis and suggestion, we will strengthen our knowledge of both basic brain functions and a host of different psychological functions., Competing Interests: Conflict of interest statement. None declared.

Hypnotizability is associated with attentional characteristics whose neurophysiological bases are still under debate. Aim of the study was the assessment of possible hypnotizability-related differences in blink reflex (BR) which has a nociceptive component, is sensitive to attentional-emotional traits and states and is modulated by the brain dopamine content. In 10 high (highs) and 10 low hypnotizable participants (lows) BR was induced by electrical nociceptive stimulation of the right supraorbital nerve in the absence (noW) and in the presence of a visual cue preceding the electrical stimulation by 0.1ms (W01) and by 1ms (W1). The studied variables were: the amplitude of BR components (R1, R2, R3), the amplitude of the quick change (TO) of heart rate ("turbulence") induced by stimulation and its recovery slope (TS), the role of the Behavioral Inhibition/Activation System (BIS/BAS) in the variability BR and cardiac turbulence. Repeated measures ANOVA did not show any significant difference between highs and lows in blink reflex. TO indicated stimulation related HR increase in highs and decrease in lows, TS was larger in highs. BIS and BAS accounted for the warning effects on the BR amplitude and modulated the hypnotizability and warning effects on TO and TS. Findings do not support dopamine based hypnotizability-related attentional abilities. In contrast, they indicate that hypnotizability modulates the short-lasting cardiac response to electrical nociceptive stimulation., (Copyright © 2016 Elsevier Inc. All rights reserved.)

The aim of this article is to complement the recently revised American Psychological Association (APA) definition of hypnotizability. It (a) lists a few differences in sensorimotor integration between subjects with high (highs) and low (lows) hypnotizability scores in the ordinary state of consciousness and in the absence of suggestions, (b) proposes that hypnotizability-related cerebellar peculiarities may account for them,, ((c) suggests that the cerebellum could also be involved in cognitive aspects of hypnotizability and (d) explains why the information derived from studies of sensorimotor and cardiovascular aspects of hypnotizability may be relevant to its definition and useful in orienting further experimental research in the field of hypnosis.)

Earlier studies have shown hypnotizability-related postural effects of visual suppression and of leg and neck proprioceptive alteration. This study completes this investigation by demonstrating the postural effects of asymmetric tactile foot stimulation in standing participants with different hypnotizability scores. During this stimulation, body sway changed in medium-to-high more than in low-to-medium hypnotizable participants. Findings support the view that high hypnotizability is associated with higher vulnerability of posture to sensory alteration; together with earlier results, they suggest a role of the cerebellum in the observed hypnotizability-related differences and prompt investigation of cerebral structures and factors potentially responsible for both the cognitive and physiological aspects of hypnotizability.

The susceptibility to hypnosis, which can be measured by scales, is not merely a cognitive trait. In fact, it is associated with a number of physiological correlates in the ordinary state of consciousness and in the absence of suggestions. The hypnotizability-related differences observed in sensorimotor integration suggested a major role of the cerebellum in the peculiar performance of healthy subjects with high scores of hypnotic susceptibility (highs). In order to provide behavioral evidence of this hypothesis, we submitted 20 highs and 21 low hypnotizable participants (lows) to the classical cerebellar Prism Adaptation Test (PAT). We found that the highs' performance was significantly less accurate and more variable than the lows' one, even though the two groups shared the same characteristics of adaptation to prismatic lenses. Although further studies are required to interpret these findings, they could account for earlier reports of hypnotizability-related differences in postural control and blink rate, as they indicate that hypnotizability influences the cerebellar control of sensorimotor integration.

We report novel findings concerning the role of hypnotizability, suggestions of analgesia and the activity of the Behavioral Inhibition/Activation System (BIS/BAS) in the modulation of the subjective experience of pain and of the associated EEG dynamics. The EEG of high (highs) and low hypnotizable participants (lows) who completed the BIS/BAS questionnaire was recorded during basal conditions, tonic nociceptive stimulation without (PAIN) and with suggestions for analgesia (AN). Participants scored the perceived pain intensity at the end of PAIN and AN. The EEG midline dynamics was characterized by indices indicating the signal predictability (Determinism) and complexity (Entropy) obtained through the Recurrence Quantification Analysis. The reduced pain intensity reported by highs during AN was partially accounted for by the activity of the Behavioral Activation System. The decreased midline cortical Determinism observed during nociceptive stimulation in both groups independently of suggestions remained significantly reduced only in lows after controlling for the activity of the Behavioral Activation System. Finally, controlling for the activity of the Behavioral Inhibition System abolished stimulation, suggestions and hypnotizability-related differences. Results indicate that the BIS/BAS activity may be more important than hypnotizability itself in pain modulation and in the associated EEG dynamics., (Copyright © 2015. Published by Elsevier Inc.)

We  investigated whether healthy subjects with high (highs) and low (lows) hypnotizability scores differ in the ability to report the position of their right hand in the horizontal plane at the end of passive and active arm movements directed to lateral, intermediate and medial targets of the right hemispace under correct or incorrect visual feedback. Results showed that incorrect visual feedback increased the error in both groups. In lows, the error was similar after active and passive movements; in highs, it was lower for active than passive movements toward the medial position, but lower for passive than for active movements for the lateral one. The highs' error was significantly lower than the lows' one only for the active movements directed toward the medial hand position. Hypnotizability-related differences may be due to different role of efferent copies in highs and lows.