International Journal of Clinical and Experimental Hypnosis

International Journal of Clinical and Experimental Hypnosis

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International Journal of Clinical
and Experimental Hypnosis
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Cerebral Blood Flow Evaluation
During the Hypnotic State With
Transcranial Doppler Sonography
a
b
b
Turan Uslu , Atilla Ilhan , Osman Ozcan , Dilek
c
b
Turkoglu , Alevtina Ersoy & Emine Celik
c
a
Fatih Sultan Mehmet Training and Research Hospital,
Istanbul, Turkey
b
Fatih University, Ankara, Turkey
c
Middle East Technical University, Ankara, Turkey
Published online: 18 Nov 2011.
To cite this article: Turan Uslu , Atilla Ilhan , Osman Ozcan , Dilek Turkoglu , Alevtina
Ersoy & Emine Celik (2012) Cerebral Blood Flow Evaluation During the Hypnotic State
With Transcranial Doppler Sonography, International Journal of Clinical and Experimental
Hypnosis, 60:1, 81-87, DOI: 10.1080/00207144.2011.622202
To link to this article: http://dx.doi.org/10.1080/00207144.2011.622202
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Intl. Journal of Clinical and Experimental Hypnosis, 60(1): 81–87, 2012
Copyright © International Journal of Clinical and Experimental Hypnosis
ISSN: 0020-7144 print / 1744-5183 online
DOI: 10.1080/00207144.2011.622202
CEREBRAL BLOOD FLOW EVALUATION
DURING THE HYPNOTIC STATE WITH
TRANSCRANIAL DOPPLER SONOGRAPHY
Turan Uslu
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Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
Atilla Ilhan and Osman Ozcan1
Fatih University, Ankara, Turkey
Dilek Turkoglu
Middle East Technical University, Ankara, Turkey
Alevtina Ersoy
Fatih University, Ankara, Turkey
Emine Celik
Middle East Technical University, Ankara, Turkey
Abstract: Cerebral blood flow was measured in normal waking (alert
relaxed mental imagery) and hypnotic states. Mean flow velocity (Vm)
in the middle cerebral artery (MCA) was significantly increased in
hypnosis (Condition II) from Condition I (5 minutes before hypnotic
induction). Vm decreased in Condition III (hypnotic imagination).
After hypnosis, Vm values returned to baseline. Pulsatility index values and resistive index values showed significant variations during
sonographic monitoring between Conditions I and IV (5 minutes after
the completion of hypnosis). Both values were significantly higher
in Condition I than IV. These findings show that hypnotic status can
modulate cerebral blood flow.
A hypnotized person sees, feels, smells and otherwise perceives in
accordance with the hypnotist’s suggestions. Modern research seems
to suggest that hypnosis has a genuine effect on brain functioning.
The neural mechanisms underlying hypnotic states and responses to
Manuscript submitted February 11, 2011; final revision accepted March 3, 2011.
1 Address correspondence to Atilla Ilhan, Medical Faculty, Fatih University, Alparslan
Turkes Caddesi No: 57, 06510 Emek/Ankara, Turkey. E-mail: [email protected]
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TURAN USLU ET AL.
hypnotic suggestions remain largely unknown. Using 133Xe regional
cerebral blood flow (CBF) imaging, differences between low and
high hypnotizable persons were observed during hypnotic conditions
(Crawford, Gur, Skolnick, Gur, & Benson, 1993). Only highly hypnotizable persons showed a significant increase in overall CBF, suggesting
that hypnosis requires cognitive effort.
Transcranial doppler (TCD) measures blood flow velocity and aids
in the diagnosis of emboli, stenosis, vasospasm from a subarachnoid
hemorrhage (bleeding from a ruptured aneurysm), and other problems.
This relatively quick and inexpensive test is growing in popularity
throughout the world. In TCD, the frequency change directly correlates with the speed of the blood, which is then recorded electronically
for later analysis. Because the skull blocks ultrasound transmission,
regions with thinner walls—insonation windows—must be used for
analysis. For this reason, recording is performed in the temporal region
above the cheekbone (zygomatic arch) through the eyes, below the jaw,
and from the back of the head.
To better understand what happens in persons during the hypnotic
state (HS), we decided to determine the cerebral blood flow by using
TCD in healthy volunteers, taken as an index of local neuronal activity.
Method
Subjects
The Ethical Committee of the Faculty of Medicine of the University
of Fatih approved this study. Healthy right-handed subjects were considered for selection after they gave their written informed consent.
Twenty-five healthy adult subjects (13 male, 12 female, mean age 28.8 ±
12.1) participated in this study. Additional exclusion criteria were a history of psychological disorders, trauma, current health problems, and
intake of medications at the time of the experiment.
The TCD measurements were conducted transtemporally using a
traditional 2-MHz transducer (Nicolet EME Companion). The TCD
measurements were routinely performed on the left middle cerebral
artery (MCA). Recordings were documented on a video camera for
later analysis (Sony DCR-SR290). The depth and angle of insonation
giving the highest mean flow velocity (Vm) in MCA was always chosen. Pourcelot’s resistive index (RI) and Gosling’s pulsatility index (PI)
were computed.
Ambient noise was reduced to a minimum, and ambient light
was dimmed. All sessions were preceded by a 10-minute period, not
included in the study, which was used to stabilize autonomic parameters and to let the subjects familiarize themselves with the experimental
setting. Each subject had continuous TCD monitoring in each of the
four conditions.
CEREBRAL BLOOD FLOW AND TRANSCRANIAL DOPPLER SONOGRAPHY
83
Statistical Analyses
Measured values are given as a mean and standard deviation.
Statistical analysis was performed using SPSS for Windows (version
13.0) statistical program (SPSS, Inc., Chicago, IL). The paired samples
t test was used to compare four conditions’ measurements means.
A p value less than .05 was considered significant.
Results
Changes in mean MCA flow velocity, PI, RI, and heart rate are shown
in Figures 1 to 4.
In Condition II, TCD monitoring showed an increase in MCA flow
velocity from Condition I and a decrease in Condition III. At the end of
hypnosis, Vm values returned to baseline values.
PI and RI values showed significant variations during sonographic
monitoring between Conditions I and IV. Both values were significantly
higher in Condition I than Condition IV.
In Condition III, pulse rate significantly decreased compared to
Condition I then increased to the same levels in Condition IV with
baseline.
80
70
60
Vm
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In Condition I (5 minutes before the hypnotic induction), the subjects
were alert and sitting on a comfortable armchair in a silent room.
In Condition II (hypnotic state), the subjects were monitored after
hypnosis was induced. Subjects were considered hypnotized when roving eye movements were observed and if the subject responded by a
hand movement that he or she felt hypnotized.
In Condition III (hypnotic imagination), while under hypnosis,
subjects were invited to imagine pleasant life experiences.
In Condition IV, subjects were monitored 5 minutes after the completion of hypnosis.
*
*
50
40
30
20
10
0
I
II
Groups
III
Figure 1. Changes in MCA mean flow velocity. ∗ p < .05. ∗∗ p < .001.
IV
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TURAN USLU ET AL.
1.4
*
1.2
*
PI
1
0.8
0.6
0.4
0.2
I
II
III
Groups
IV
Figure 2. Changes in pulsatility index. ∗ p < .05. ∗∗ p < .001.
120
*
100
*
**
80
Pulse
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0
60
40
20
0
I
II
III
Groups
IV
Figure 3. Changes in heart rate. ∗ p < .05. ∗∗ p < .001.
RI
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
*
I
*
II
Groups
III
Figure 4. Changes in resistive index. ∗ p < .05. ∗∗ p < .001.
IV
CEREBRAL BLOOD FLOW AND TRANSCRANIAL DOPPLER SONOGRAPHY
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Discussion
In this study, we measured MCA blood flow changes in healthy
volunteers using TCD monitoring during hypnosis. In the literature, there are some single-photon emission computed tomography or
positron emission tomography studies in hypnotized subjects; however, all studies had aimed to evaluate regional cerebral blood flow.
In our study, we directly evaluated arterial blood flow (middle cerebral
artery).
To better understand the comparisons made for hypnosis, we investigated the CBF in four conditions. Our results showed that Vm
significantly changed in Conditions II and III from the other conditions. These velocity changes might be related to mental activity
and concerns during hypnosis. In Condition II, the subject generally had some concern since he or she did not know what would
happen during hypnosis. However, this concern resolved, and the
subject relaxed. So, cerebral blood velocity decreased to minimum
levels.
Maiolo, Porro, and Granone (1969) investigated the CBF, CVR (cerebral vascular resistance) changes, and cerebral metabolic rate (CMR)
of oxygen during hypnosis and compared it to alert subjects. They
found that CBF and CMR of oxygen increased in alert subjects compared to hypnotized ones. During hypnosis, increases in rCBF of
various cerebral regions (right frontal, orbitofrontal, temporal, motor,
and somatosensory areas) were reported in SPECT studies (Crawford
et al., 1993; Diehl, Meyer, Ulrich, & Meinig, 1989; Halama, 1989; Meyer,
Diehl, Ulrich, & Meinig, 1989).
Using PET, it was observed that glucose metabolism decreased in
occipital regions and increased in sensorimotor areas during hypnosis (Grond, Pawlik, Walter, Lesch, & Heiss, 1995). Analysis of PET data
showed that the hypnotic state, compared to normal alertness (i.e., rest
and mental imagery), significantly enhanced the functional modulation
between midcingulate cortex and a large neural network encompassing
bilateral insula, pregenual anterior cingulate cortex, presupplementary motor area, right prefrontal cortex and striatum, thalamus, and
brainstem (Faymonville, Boly, & Laureys, 2006).
In our study, RI and PI values were statistically different only
between Conditions I and IV. Both indices were lower before hypnosis compared to afterward. These differences might have resulted from
hypnotic relaxation at the end of the hypnosis.
Our results provide a new description of the neurovascular basis of
hypnosis, demonstrating specific patterns of cerebral activation associated with the hypnotic state and with the processing of hypnotic
suggestions.
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References
Crawford, H. J., Gur, R. C., Skolnick, B., Gur, R. E., & Benson, D. M. (1993). Effects of
hypnosis on regional cerebral blood flow during ischemic pain with and without
suggested hypnotic analgesia. International Journal of Psychophysiology, 15, 181–195.
Diehl, B. J. M., Meyer, H. K., Ulrich, P., & Meinig, G. (1989). Mean hemispheric blood
perfusion during autogenic training and hypnosis. Psychiatry Research, 29, 317–318.
Faymonville, M. E., Boly, M., & Laureys, S. (2006). Functional neuroanatomy of the
hypnotic state. Journal of Physiology - Paris, 99, 463–469.
Grond, M., Pawlik, G., Walter, H., Lesch, O. M., & Heiss W. D. (1995). Hypnotic catalepsyinduced changes of regional cerebral glucose metabolism. Psychiatry Research, 61,
173–179.
Halama, P. (1989). Die Veranderung des corticalen Durchblutung vor und in Hypnose
[The Statement of Changes of cortical blood flow before and during hypnosis].
Experimentelle und Klinische Hypnose, 5(1), 19–26.
Maiolo, A. T., Porro, G. B., & Granone, F. (1969). Cerebral haemodynamics and
metabolism in hypnosis. British Medical Journal, 1(5639), 314.
Meyer, V. K., Diehl, B. J. M., Ulrich, P. T., & Meinig, G. (1989). Anderungen der regionalen
kortikalen Durchblutung unter Hypnose [Changes in regional cortical blood flow
under hypnosis]. Zeitschrift fur Psychosomatische Medizin und Psychotherapie, 35(1),
48–58.
Untersuchung des Gehirnblutflusses unter Hypnose mit transkraniellem
Dopplerultraschall
Turan Uslu, Atilla Ilhan, Osman Ozcan, Dilek Turkoglu, Alevtina Ersoy und
Emine Celik
Abstrakt: Gehirnblutfluß wurde im normalen Wachzustand (aufmerksame, entspannte, geistige Bilder) und unter Hypnose gemessen.
Strömungsgeschwindigkeiten (Vm) in der mittleren Zerebralarterie (MCA)
waren signifikant höher unter Hypnose (Kondition II) als in Kondition I
(5 Minuten vor der Hypnoseinduktion). Vm sank in Kondition III (hypnotische Vorstellungen). Nach der Hypnose kehrten die Vm-Werte wieder
zur Basislinie zurück. Während der sonographischen Untersuchung zeigten
die Pulsativitätsindex und Resistive Index Werte signifikante Variationen
zwischen Konditionen I und IV (5 Minuten nach Beendigung der Hypnose).
Beide Werte waren signifikant höher in Kondition I als Kondition IV.
Diese Ergebnisse zeigen dass der hypnotische Zustand den Gehirnblutfluß
modulieren kann.
Elvira V. Lang, MD, FSIR, FSCEH
Hypnalgesics, LLC, Brookline, MA, USA
Examen du débit sanguin cérébral durant l’état hypnotique au moyen de
l’échographie Doppler
Turan Uslu, Atilla Ilhan, Osman Ozcan, Dilek Turkoglu, Alevtina Ersoy et
Emine Celik
Résumé: Les auteurs ont mesuré le débit cérébral de sujets en état normal d’éveil (imagerie mentale en état d’éveil calme) et en état d’hypnose.
L’hypnose cause une augmentation significative de la vélocité moyenne du
CEREBRAL BLOOD FLOW AND TRANSCRANIAL DOPPLER SONOGRAPHY
87
débit (Vm) dans l’artère cérébrale moyenne (MCA) en état d’hypnose (État II)
comparativement à l’État I, présent cinq (5) minutes avant l’induction hypnotique. La Vm a diminué dans l’État III (imagination hypnotique). Après la
fin de l’état d’hypnose, les valeurs de la Vm revenaient à la ligne de base. Les
valeurs de l’indice de pulsatilité et de l’indice de résistivité ont indiqué des
variations significatives durant la surveillance échographique entre les États
I et IV (cinq (5) minutes après la fin de l’état d’hypnose). Ces deux valeurs
étaient significativement plus élevées en État I qu’en État IV. Ces résultats
montrent que l’état hypnotique peut moduler le débit sanguin cérébral.
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Johanne Reynault
C. Tr. (STIBC)
Evaluación del flujo sanguíneo cerebral durante un estado hipnótico
mediante una sonografía Doppler transcraneal.
Turan Uslu, Atilla Ilhan, Osman Ozcan, Dilek Turkoglu, Alevtina Ersoy,
y Emine Celik
Resumen: Se midió el flujo sanguíneo cerebral durante el estado normal de
vigilia (imágenes mentales en estado alerta y relajado) y estados hipnóticos. La velocidad media del flujo (Vm) en la arteria cerebral media (MCA)
se incrementó significativamente durante hipnosis (Condición II) en comparación a la Condición I (5 minutos antes de la inducción hipnótica. La Vm
decremento en la Condición III (imaginación hipnótica). Después de la hipnosis, los valores de Vm regresaron a la línea basal. Los valores de los índices
de pulsatilidad y resistencia mostraron variaciones significativas durante el
monitoreo sonográfico entre las Condiciones I y IV (5 minutos después de
completada la hipnosis). Ambos valores fueron significativamente mayores
en la Condición I que en la IV. Estos resultados muestran que el estado
hipnótico puede modular el flujo sanguíneo cerebral.
Omar Sánchez-Armáss Cappello
Autonomous University of San Luis Potosi,
Mexico