Psychedelics and hypnosis: Commonalities and therapeutic implications

The review (2018) examines the similarities between psychedelics and hypnosis with respect to their neurophenomenological features and therapeutic applications and highlights the potential for harnessing the power of suggestion to influence the phenomenological response to psychedelics in the context of therapy.

Abstract

Background: Recent research on psychedelics and hypnosis demonstrates the value of both methods in the treatment of a range of psychopathologies with overlapping applications and neurophenomenological features. The potential of harnessing the power of suggestion to influence the phenomenological response to psychedelics toward more therapeutic action has remained unexplored in recent research and thereby warrants empirical attention.

Aims: Here we aim to elucidate the phenomenological and neurophysiological similarities and dissimilarities between psychedelic states and hypnosis in order to revisit how contemporary knowledge may inform their conjunct usage in psychotherapy.

Methods: We review recent advances in phenomenological and neurophysiological research on psychedelics and hypnosis, and we summarize early investigations on the coupling of psychedelics and hypnosis in scientific and therapeutic contexts.

Results: We highlight commonalities and differences between psychedelics and hypnosis that point to the potential efficacy of combining the two in psychotherapy. We propose multiple research paths for coupling these two phenomena at different stages in the preparation, acute phase and follow-up of psychedelic-assisted psychotherapy in order to prepare, guide and integrate the psychedelic experience with the aim of enhancing therapeutic outcomes.

Conclusions: Harnessing the power of suggestion to modulate response to psychedelics could enhance their therapeutic efficacy by helping to increase the likelihood of positive responses, including mystical-type experiences.

Authors: Devin B. Terhune & Clément E Lemercier

Summary

Introduction

Psychedelics have been used in therapeutic processes from ancient shamanism to contemporary psychotherapy. Research has shown that psychedelics can induce profound changes in perception, thought, affect and self-awareness, which can have sustained beneficial effects on personality and psychological well-being.

Hypnosis is a mind-body intervention that involves verbal suggestions for alterations in affect, cognition and perception. Recent studies have shown that hypnosis can be used to model and experimentally modulate conscious states that are otherwise challenging to control, such as pathological symptoms or anomalous experiences.

Recent research suggests that hypnosis and psychedelics are useful in the treatment of a range of psychopathologies. It is worth exploring how suggestion can influence the phenomenological response to psychedelics.

Despite multiple phenomenological parallels, recent research on psychedelics and hypnosis has occurred largely in isolation. Previous research highlighted overlapping characteristics between these phenomena and the potential for joint use in psychotherapy.

Psychedelics

Psychedelics, such as LSD, mescaline, psilocybin, and DMT, exert their hallucinatory effects primarily through activation of serotonin 2A receptors (5-HT2A). Their effects depend on the user’s psychological profile, current mood state, pre-drug history, response expectancies, and social and environmental context.

Neurophysiology

Psychedelic experiences are characterized by changes in the dynamics and connectivity patterns of resting state networks, including the default mode network (DMN). Several brain regions involved in self-awareness, perception, affect processing, and executive and higher cognitive functions are affected.

Therapeutic potential

Psychedelic-assisted psychotherapy involves ingesting a predetermined dose of a psychedelic drug in a supportive environment, and the therapist provides generally non-directive support for the subsequent experience of the individual. The individual may experience a range of psychological effects including extreme positive and negative emotions.

Hypnosis

Hypnosis is a method in which a therapist or experimenter uses verbal suggestion to modulate the conscious states of a patient or participant. A session typically consists of three phases: an induction, a suggestion phase, and a de-induction.

Evidence indicates that hypnosis is not necessary for responsiveness to suggestions, and that suggestibility can be induced without hypnosis. However, the relationship between hypnosis and placebo is potentially complex and moderated by multiple factors.

As measured by standard, and well-validated, behavioural scales, hypnotic suggestibility is normally distributed with approximately 10 – 15% of the population displaying low and high suggestibility and the remainder exhibiting moderate responsiveness. Hypnotic suggestibility has few known personality correlates, including heightened automaticity, poor working and short-term memory, and selectively impaired metacognition.

Neurophysiology

Researchers have utilized neuroimaging techniques to study the neurophysiological correlates of response to hypnotic inductions and suggestions and individual differences in hypnotic suggestibility.

Research has shown that highly suggestible individuals have a reduction in self-related or metacognitive processing, coupled with atypical connectivity of the executive control network, which may reflect cognitive control with reduced awareness. Imaging studies indicate that hypnotic suggestions for altered perception engage neural systems that overlap with those of the genuine experience.

Therapeutic potential

Hypnosis is a clinical tool that involves the administration of verbal suggestions and metaphors to guide individuals into dynamic, multimodal experiences with the aim of promoting emotional catharsis and desirable changes in perceptual experiences, self-image, behaviours, habits and general health.

Hypnosis and suggestion-based interventions are safe and efficacious for treating a range of psychopathological and somatic symptoms, including chronic pain, post-menopausal hot flashes, irritable bowel syndrome, enhancement of immunological functions, depression, anxiety, nicotine addiction, symptoms inherent to neurodegenerative disorders, and dermatological problems.

Psychedelics and hypnosis

Several studies have explored the potential benefits of combining psychedelics and hypnosis in psychotherapy, and have reported on the use of hypnosis to recreate psychedelic-like experiences or to control, guide and deepen LSD-induced psychedelic experiences.

Hypnodelic treatment technique

Ludwig and Levine hypothesised that hypnosis could be used in conjunction with LSD to enhance therapeutic outcome. They conducted a randomized controlled trial in which 70 participants received LSD + hypnosis + psychotherapy.

Research has shown that patients who received hypnodelic treatment for alcoholism showed greater improvement than those in the other conditions, and that this improvement was due to the mental calmness arising from hypnosis, as well as to the patients’ enhanced acceptance of and control over the psychedelic experiences.

Phenomenology

LSD and hypnotic experiences share overlapping phenomenology, and participants in neutral hypnosis report experiencing similar alterations in perception, body image, imagery, self-awareness, affect, time perception and meaning. The same way that absorption predicts mystical-type experience with psychedelics, hypnotic suggestibility correlates with the propensity to experience hypnotically suggested mystical-type experiences. However, it has not yet been determined whether and to what extent hypnotically induced mystical-type experiences exert long-term beneficial effects on individuals.

LSD, mescaline and psilocybin enhance suggestibility to a similar extent as hypnosis, but the mechanisms underlying this augmentation remain unknown. Nonpharmacological factors such as expectation, preparation, intention and physical and social environment all influence response to both phenomena.

Neurophysiology

Neuroimaging studies have shown that psychedelics and hypnosis affect the activity of several brain areas and networks, and that the spontaneous phenomenological effects shared by the two phenomena seem to be associated with converse global functional connectivity patterns. Similarities in spontaneous experiential response to psychedelics and hypnosis may be explained in part by the modulation of the DMN and global functional connectivity.

Individual differences in hypnotic suggestibility and responsiveness to psychedelics may relate to the psychedelic enhancement of suggestibility. This suggests that hypnotic suggestion may be used to reproduce psychedelics-occasioned mystical-type experiences.

Future directions

Recent research on psychedelics and hypnosis allows for revisiting their combined use in psychotherapy. Harnessing the power of suggestion may enhance the therapeutic efficacy of psychedelics.

Hypnosis-based training for participant preparation

Hypnotic suggestibility could be used as a preliminary training regimen to familiarize naive participants with the experiential effects of psychedelics in a controlled setting, and could potentially reduce pre- and post-treatment anxiety, and participant attrition.

Hypnodelic treatment technique: Using suggestion to guide psychedelic states

Hypnosis and psychedelics may enhance the therapeutic efficacy of psychedelics by enhancing the likelihood of positive responses, promoting mystical-type experiences, and avoiding unwanted experiences. Moreover, posthypnotic suggestions may further aid integration of the experience and carry over to everyday life.

Hypnosis and mild dosages of psychedelics: Transversal applications

Drug dosage reduction for equivalent treatment outcome is an important goal in psychopharmacology. However, little is known about the neurophenomenological effects of psychedelics at low dosages, and the dose level required to enhance suggestibility is unknown.

Hypnosis for drug-free re-experiencing of psychedelic states

Hypnosis has been shown to induce mystical-type experiences, and combining psychedelics with hypnosis may allow patients to re-experience these experiences with greater control over the post-administration response to psychedelic-assisted therapy.

Conclusion

Recent research on psychedelic-assisted psychotherapy and hypnosis demonstrates the value of both methods in the treatment of a range of conditions, and the potential of harnessing the power of suggestion to influence the phenomenological response to psychedelics.

Study details

Topics studied
Neuroscience

Study characteristics
Literature Review

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