Neurobiological correlates of hypnosis

The rapid expansion and sophistication of neuroimaging techniques since the late 1990s has identified specific changes in brain function during hypnosis and in response to suggestion.19,  ۲۰,  ۲۱,  ۲۲,  ۲۳ In particular, pain perception under hypnotic conditions involves cortical and subcortical areas, primarily the anterior cingulate.3,5,24 Neuroimaging also shows that hypnotic depth and hypnotisability are not synonymous and that hypnosis correlates with activation of the lingual gyrus, where higher order visual processing and mental imagery are processed.25 Enhanced hypnotic suggestibility has been associated with lower EEG signal variability, particularly in the theta frequency band.3,24 The neurobiology behind the altered sense of agency experienced during hypnosis and the non-volitional nature of responses to suggestion, are examined in detail elsewhere.

Language structures

The LAURS acronym (listening; acceptance; utilisation; reframing; suggestion) provides a framework that deconstructs the elements of intuitive communication. It builds patient rapport and provides structure through which specific clinical hypnosis techniques can be embedded within a therapeutic interaction.39 Hypnosis techniques can empower patients to modify their distress and allow cooperation in ways that facilitate the conduct of a procedure that would otherwise be prolonged or even thwarted (Figs 2 and 3 online videos). This approach has the added advantage of allowing anaesthetists to reach the coffee room in both a timely, and more relaxed, manner!

Conclusions

It is timely that anaesthetists are re-evaluating the unique advantages of hypnosis in potentially avoiding or limiting the risks of invasive interventions or adverse effects from drugs.43 Indeed, if hypnosis were a drug, it would have been standard practice decades ago.9 The use of hypnosis in anaesthetic practice appears too valuable a tool to be left outside the anaesthetist’s armamentarium any longer.