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HYPNOSIS IN PSYCHOTHERAPY AND HYPNOSIS AS PSICOTHERAPY: THE ERICKSONIAN APPROACH FROM AN EVOLUTIONARY POINT OF VIEW Ambrogio Pennati *, MD, psychiatrist, private practice, Milano, Italy [email protected] Giampiero Mosconi §, MD, psychologist, private practice, Milano, Italy [email protected] Italian Medical Association for the Study of Hypnosis (AMISI, www.amisi.it ), §President and * Member of Board of Directors

Hypnosis in psychotherapy and hypnosis as psicotherapy

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Page 1: Hypnosis in psychotherapy and hypnosis as psicotherapy

HYPNOSIS IN PSYCHOTHERAPY AND HYPNOSIS AS PSICOTHERAPY:

THE ERICKSONIAN APPROACH FROM AN EVOLUTIONARY POINT OF VIEW

Ambrogio Pennati *, MD, psychiatrist, private practice, Milano, Italy [email protected]

Giampiero Mosconi §, MD, psychologist, private practice, Milano, Italy [email protected]

Italian Medical Association for the Study of Hypnosis (AMISI, www.amisi.it),

§President and * Member of Board of Directors

Page 2: Hypnosis in psychotherapy and hypnosis as psicotherapy

Evolutionary Psychology and Psychotherapy

Evolutionary psychology seems to be a euristically fertile approach to life sciences, such as medicine, psychology, economics, sociology. Although there is not (and we hope that will never be) an evolutionary psychotherapy, such point of view could offer new perspectives in psychotherapy, as some experiences in jungian and freudian psychoanalisys, cognitive-behavior therapy, systemic therapy suggest.

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Evolutionary Psychology and Hypnosis

As a matter of fact, only pioneristic, short and merely speculative papers about the relationship between evolutionary psychology and hypnosis are available. We think that adopting the evolutionary perspective in the study of hypnotic phenomena could generate new research and new conceptualizations in our field. We think that at the core of Ericksonian work there is an implicit evolutionary way of thinking, not fully blossomed because of the zeitgeist in which he operated.

Page 4: Hypnosis in psychotherapy and hypnosis as psicotherapy

A paradigmatic shift

Evolutionary psycvhology suggests that a shift from the Standard Social Science Model (and its corollary of human mind as blank slate) to the Naturalistic Model could be useful in bypassing most of the conceptual conundrums of psychotherapy.

In our case this shift could bypass the “state or process” issue of hypnosis.

The evolutionary approach identify the ability to develop trance experience as one of the most important adaptative module in the in the brain for the individual, the group and the specie.

Page 5: Hypnosis in psychotherapy and hypnosis as psicotherapy

Definition of Trance

We operatively define the trance as an Altered State of Consciousness (ASoC) in which the following phenomena can consensually occur in a statistically significant percentages:

Dissociation between executive and monitoring function of the Self

High frequency of ideodinamic behaviors Verbal and/or motor inhibition Extreme focusing of attention, internal or external Facilitation of autoreferential thinking Mnesic alterations Changes in quality and quantity of the time experience Changes in quality and quantity of perceptual experience

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The Adaptative Value of Trance

Social value: increased group identity, discharge among the group of peers of otherwise unacceptable feelings, self-trascendence, facilitation of meme-related complexes, facilitation of mimetic learning

Individual value: self trascendence, modulation of pain, modulation of immune system, modulation of autonomic response, increased efficiency of fight or flight response, increased efficiency of mating strategies, increased chance of activation of internal healing modules (see below)

Biological value: increased probability of selection of the fittest gene or meme by reshuffling of genetic and memetic pool (ritual and/or orgiastic trance)

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The Evolutionary Value of Rapport

The mirror neurons systems seems to play a determinant role in the ability to develop empathic relationships among humans. Such relationships are essential for the survival struggle and reproductive success of the individual and the group, gene (kin) or meme related. Empathic learning may be activated without awareness (procedural), and therefore it could be more efficient and resilient than the declarative learning, which relies upon linguistic and eidetic structures of information.

We could define Altered States of Consciousness (AsoC) inductors the multifaceted procedures that homo sapiens utilized to achieve trance states. Such inductors rely upon the empathic rapport.

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Trance, Rapport, Hypnosis

From an historic point of view hypnosis could be defined as the process of the complex, bidirectional, fluctuacting interactions between

ASoC inductors recognized by the western scientific comunity as empirically validated and useful in medicine and psychology , according to the scientific paradigm of the zeitgeist, and

The trance states obtained following such induction procedures

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Trance, Rapport, Hypnosis

Hypnosis

TranceRapport

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Hypnosis and Psychotherapy

Psychotherapy could be operationally defined as every modality of helping people in coping with stress, emotional problems, relational problems, or problematic habits; such modalities share the fact of being all treatment based on talking ot another people and doing something together” (RCPychiatrists).

Hypnosis could be therapeutic because both the induction procedure in sé (modeling, emotional tuning, procedural learning, based on rapport, of new behavioral or cognitive adaptative strategies) and hypnotic trance (emotional release of otherwise unacceptable feelings, activation on internal healing modules, self-trascendence).

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Hypnosis as synergicistic empowerment of inner healing resources

Hypnosis could be interpreted as the potentially most powerful device to activate inner healing resources thanks to

Interpersonal power of rapport Intrapersonal power of trancethat synergically activated internal healer

modules.

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Hypnosis and Ethiopatogenetical Models of Illnesses

The majority of psychotherapeutic approaches tried to develop etiopathogenetical models of disorders coherent with their postulates, but all these models lack of statistical and scientific validation. Hypnosis too searched for a coherent model (neodissociative theory), but also in this case empirical validation is insufficient or absent.

Metaanalysises show that there is no evidence (ie, directly linked to the model) of the superiority of a theoretical model among the others, and that aspecific variables are the key factors in the efficacy of psychotherapies.

Therefore, every theoretical approach to psychotherapy seems to be merely speculative.

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Recent empirical data

Data from clinical field suggest that empatethical sharing of memes (beliefs, values, social rituals, ideas about the cause of the illness) with the clients can enhance the response to different treatments.

Since there are no evidences of superiority of a model of psychotherapy among the others we can suppose that building a memetic rapport empathetically based is the best operative option in psychotherapy.

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The Ericksonian way

Nowadays we can think at Milton Erickson’s work as a pionieristic, revolutionary way of thinking and working based on implicit, intuitive evolutionary approach to clinical activity. Such approach is rooted in shamanic traditions and overtly proposed by ME in his look and style. ME optimized his skills with anthropological and psychiatric studies, looking for social and biological basis of trance induction and trance states.

Page 15: Hypnosis in psychotherapy and hypnosis as psicotherapy

Which paradigm?

The linear, cause-effect, newtonian, thre-dimensions paradigm seems obsolete to help us to understand hypnotic clinical phenomena

The holistic way of thinking, based on the complexity theory, seems more useful in explaining the fuzzy nature of life sciences

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Hypnosis in Psychotherapy and Hypnosis as Psychotherapy

rapport

• Hypnosis in psychotherapy (mainly linguistic,

linear/newtonian paradigm)

trance• Hypnosis as psychotherapy

(mainly somatic, complexity/holistic paradigm)

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Hypnosis in Psychotherapy and Hypnosis as Psychotherapy

Hypnosis in psychotherapy could enhance the effectiveness of different approaches through elicitation of rapport modules; it is based on empathic communication skills

Hypnosis as psychotherapy could enhance self-trascendence and inner healer modules through activation of trance states

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Hypnosis and Theory of Mind

Recent neurophysiological data suggest that the ability to make inference on the mental state of the others and to empathize with them is linked to a decrease in activity of the cortex of anterior cingulus; hypnotic induction seems to generate the same effect. We can therefore affirm that Hypnosis doesn’t need a theory of mind, since it is Theory of Mind in Action.

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Placebo, Hypnosis, Internal Healer

As “internal healer” we can identify the biochemical and neurophysiological modules of placebo:

increased opioid and dopaminergic activity

reduction in anterior cingulate cortex activity

modulation of immune system modulation of social neuroendocrine

pathways

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Hypnotic Psychotherapy

Hypnotic psychotherapy can be defined as the structural blend between hypnosis in psychotherapy and hypnosis as psychotherapy. It is based on

Rapport Trance Theory of Mind conscious activationIn the context of the aspecific factors that

constitute the good clinical setting.

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Suggestions for future work

Integration of clinical and theoretical research with the recent biochemical and neuropshysiological (EEG, PET, f-NMR) data

Integration of behavioral and emotive hypnotic patterns in an evolutionary interpretative frame

Integration of clinical practice language with the traditional western and eastern healing approaches to reconciliate different therapeutic experiences

Assumption of a new holistic paradigm of health