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The pronounced interindividual differences in hypnotic suggestibility have been known ever since the formal inception of hypnosis in the 19th century Laurence et al. The development of reliable measures of hypnotic suggestibility helped to usher in a nascent era of rigorous research on hypnosis in the 20th century Hilgard and are widely seen as an integral feature of experimental hypnosis research Woody and Barnier Nevertheless, disagreement regarding when and how to include hypnotic suggestibility measures in experimental studies persists.

In addition, as the study of hypnosis has continued within the broader domains of clinical and cognitive neuroscience, questions regarding the efficacy of standardized measures of hypnotic suggestibility Weitzenhoffer ; Bowers ; Sadler and Woody ; Woody and Barnier ; Terhune are re-emerging.


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A lingering question that is of considerable importance for the neuroscience of hypnosis is whether the assessment of hypnotic suggestibility is a requisite for hypnosis research. Disagreement in the answer to this question typically falls along clinician-practitioner lines. For example, a meta-analysis of clinical trials revealed only a weak, albeit statistically significant, association between measures of hypnotic suggestibility and treatment outcome Montgomery et al. These results arguably question the practical necessity of including such measures in clinical settings, especially for use to screen patients for exclusion from treatment with hypnosis.

However, the low predictive efficacy of hypnotic suggestibility appears to be restricted to the clinical context; in experimental contexts, hypnotic suggestibility is more strongly and more consistently predictive of responsiveness to suggestion Oakley and Halligan ; Woody et al. In addition, clinical treatments often include multiple sessions that are provided over many weeks, which may increase the opportunity for treatment-related factors that are not specific to hypnosis to impact outcome. Moreover, multiple hypnosis sessions — especially if they are accompanied by daily home practice of self-hypnosis — provide the individual with increased exposure to suggestions.

Hearing suggestions repeatedly could potentially then translate to beneficial outcomes even among individuals with low levels of hypnotic suggestibility. Although the clinical use of hypnosis should undoubtedly aim to maximize treatment outcome for patients, in an experimental context aiming to identify the neural substrates of hypnotic responding, there was consensus in our symposium that it is necessary to isolate the factors that contribute to response to specific suggestions as precisely as possible.

A positive response to a hypnotic suggestion may occur through a multitude of channels; but if that response is related to a measure of hypnotic suggestibility there can be some corroboration that the outcome was caused, at least in part, by a hypnotic suggestion. Thus, although we accept the justification for omitting hypnotic suggestibility scales in clinical outcome studies because of their poor predictive validity in clinical contexts Patterson and Jensen , we strongly recommend that laboratory experiments aiming to identify the neurocognitive substrates of hypnotic responding include measures of hypnotic suggestibility so as to maximize identification of suggestion-specific responses and thereby strengthen the internal validity of the study.

Although we view hypnotic suggestibility as an essential feature of experiments aiming to delineate the characteristics and mechanisms of hypnotic responding, there remain questions regarding the validity of established measures. Hypnotic suggestibility scales are typically used in two complementary ways: as instruments for i screening participants and ii identifying individuals of varying levels of hypnotic suggestibility for measuring trait hypnotic suggestibility as a dependent or predictor variable. Although both uses assume the construct validity of standardized measures of hypnotic suggestibility, the second more clearly necessitates it.

That is, there is an assumption that even though no measure is perfectly reliable and valid, a measure of hypnotic suggestibility will still be able to reasonably identify highly suggestible individuals i. However, the introduction of noise into a measure, such as by conflating involuntary and compliant responses in a single score Bowers et al.

Hypnosis researchers continue to use measures of hypnotic suggestibility that were developed more than five decades ago Shor and Orne ; Weitzenhoffer and Hilgard , and this raises questions regarding whether the rigor of hypnotic suggestibility measurement properly matches the rigor of contemporary behavioral and neuroimaging paradigms.

Although traditional scales can be considered the gold standard for the time period in which they were developed, there is growing evidence that they may be suboptimal for contemporary research purposes. For example, there is evidence that group measures, which are more widely used as stand-alone measures for the assessment of hypnotic suggestibility Barnier and McConkey , are inferior to individual measures in the prediction of response to suggestion Moran et al.

The pool of items in such measures is also poorly-suited to probing individual differences in hypnotic suggestibility Woody and Barnier ; Terhune An additional substantial limitation is that these measures do not reliably distinguish between voluntary and involuntary responding Weitzenhoffer ; Bowers et al.

Future measures will need to more optimally integrate behavioral and experiential measures, rather than focusing solely on the former Bowers et al. We maintain that the expansion of standard measures of hypnotic suggestibility to incorporate broader phenomenological changes, such as distortions in body image, time perception Pekala and Kumar , and sensorimotor integration Santarcangelo and Scattina , will be particularly valuable.

Further concerns with existing measures are that i they do not distinguish between direct e. The development of future measures of hypnotic suggestibility will benefit from a more thorough consideration of such issues. Most but not all hypnosis research designs select participants on the basis of hypnotic suggestibility, usually to assess the impact of hypnotic suggestibility on responses to some specific suggestion or to ensure a sufficient level of susceptibility to produce the phenomena under investigation.

From about to , studies conducted at the major centers of hypnosis research routinely included highs, mediums, and lows in their research designs. Consistent with the idea that hypnotic suggestibility represents a continuum and not discrete categories of responding , research often produced intermediate results for mediums [e.

Sheehan et al. As a result, and given the resources required to both screen and test mediums, researchers determined that those resources would be better placed in expanding the sample sizes of highs and lows. In addition, for intrinsic hypnosis research that focused only on specific hypnotic hallucination suggestions — a response that requires very high levels of hypnotic suggestibility — there was no perceived value in including a further comparison group composed of lows who would be unable to respond to these suggestions. However, it remains possible that mediums may differ in important qualitative ways from both highs and lows.

For example, differences between highs and mediums have been found in EEG patterns in response to a simple hypnotic induction Crawford et al. Without a group of medium responders, the evaluation of these differences is not possible. In addition, extreme lows and highs are atypical; most people are mediums Lynn et al. As a result, in studies comparing lows and highs [e.

Horton et al. If neurophysiological differences are observed between mediums and highs, it is a reasonable inference that the latter are the atypical group. As neuroscience research on hypnosis continues to investigate the neurophysiological correlates and markers of high hypnotic suggestibility we hope that greater attention is afforded to such nuances. It is ironic then that some recent research designs in the neuroscience of hypnosis have dropped even the low suggestible comparison group, using instead only high suggestible subjects acting as their own controls Oakley and Halliagan There are several reasons for this.

First, in neuroimaging studies scanner time is simply too expensive to include participants who do not show the phenomenon under investigation. Second, based on the experience of many of the authors, it is becoming progressively more difficult in the modern university environments to recruit, screen and run the numbers of participants required for study designs with multiple levels of hypnotic suggestibility. Third, the blanket rejection by many journals of perceived low powered studies leads researchers to perform experimental manipulations on a single high susceptible group rather that split this difficult to obtain group into those who do and do not show the phenomenon in question, as was done in earlier neuroimaging studies Szechtman et al.

Whereas few researchers have the luxury to ignore these pressures, it must be recognized that none of these design trends would have been considered acceptable in the previous era of behaviorally dominated research.

Variability in the pattern of hypnotic responses among individuals with the same overall level of suggestibility has long been recognized. The Stanford Profile Scales Weitzenhoffer and Hilgard , were designed to address this feature among highs although they have been little used in practice.

Shor and Sheehan and McConkey developed first-person interview methods to further assess these differences. Whereas these methods focused on individual heterogeneity in responses, later researchers sought to identify meaningful groupings of individuals and responses within these patterns of variability Pekala and Kumar , including among mediums Winkel et al. Although many would agree with Kihlstrom that definitive findings will require the compilation of larger datasets than currently available, these and other research findings support the idea that distinct patterns of hypnotic responding seem to exist within high, medium, and low suggestible groups.

This fruitful program of contemporary hypnosis research has no counterpart in the neuroscience of hypnosis. One way to advance this program is to carefully select and compare low, medium, and high suggestible individuals chosen not simply for their global hypnotic suggestibility scores but rather for specific patterns of responsiveness to different types of hypnotic suggestions or other characteristics.

While the recruitment of subjects with a variety of hypnotic abilities is important for understanding the nature of hypnosis in general i. For example, researchers wanting to study psychiatric conditions or symptoms that can be modeled with hypnosis may require mostly or even only highs. A large number of neuroimaging studies of hypnosis [for reviews see Mazzoni et al. That is, many experiments contrast data from some condition of interest e.

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Stroop task, pain stimulation in individuals who are administered both components of hypnosis with usually the same individuals who are administered neither. It is important to consider the types of questions such a study design can answer. This design is acceptable if one wants to determine whether hypnotic suggestions i. Indeed, studies using this design have shown how hypnosis can produce specific changes in brain activation due to hypnotic suggestions [e. Halligan et al. However, one cannot determine from studies using this design that the effects are due to the induction alone, the suggestion alone, or as is usually supposed their interaction.

To the extent that a hypnotic induction is viewed as a necessary component of hypnosis then, if we want to conclude that the effects observed in response to these suggestions are indeed due to hypnosis — i. In other words, to examine the effects of hypnosis on response to suggestion in neuroimaging research, one needs to use experimental designs that disentangle the effects of induction of hypnosis on response to suggestions from the effects of the same suggestions given without the induction Hull ; Maquet et al. This decoupling is achieved by using designs in which the same suggestion is given with and without an induction, thus requiring the inclusion of a suggestion-only condition Oakley and Halliagan Oakley and Halligan and Mazzoni et al.

Moreover, as stressed by Oakley and Halligan , in this design it is essential that the wording of the suggestion be identical in all groups. However, researchers occasionally have used subsets of this design that meet the minimal criterion for evaluating the effects of inductions e. For example, brain activation following versus not following an induction has been compared using both simple pre-post induction [e.

Rainville et al. Egner et al. These studies have identified potential brain markers related to hypnotic inductions, but, as in the Egner et al. The Crawford et al. The importance of including mediums in hypnosis research has already been discussed in this article, and including mediums in the extended design would represent an important addition to achieve a complete design that examines the brain activation linked to all three crucial variables in hypnosis: the effect of the individual level of suggestibility, of the specific suggestion, and of the hypnotic induction used.

Research in other fields has benefited substantially from data-sharing initiatives. A relevant example is evident in genomics research, in which data pooling has, e. Lambert et al. Data-sharing is also likely to lead to knowledge enhancement in the areas of hypnosis and suggestibility research. If data from multiple labs are accessible, researchers could assess them using additional analytic methods that may offer further insights that would otherwise be missed.

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Replicability checks and comparisons could also be undertaken more easily. Given the absence of a data-sharing framework that is specific to research on hypnosis and suggestibility, a preexisting data-sharing option could be adopted. This initiative offers suitable flexibility for sharing various types of data e. Experimental procedures, paradigms, and software can also be shared.

Any file format is accepted and uploads receive a Digital Object Identifier for citation purposes. For very large sets of data, additional links could be provided, e. There are a number of different data-sharing models that could be adopted. For example, i data-sharing initiatives such as that outlined above can simply enable the exchange of data from different studies, whereas ii others would require a standard set of measures to be collected routinely across studies. The first option is the easiest to implement, the second option would require consensus within the field about what measures would be most useful at least for an initial phase of data collection and sharing.

If a selection of uniform measures were to be collected across studies in addition to study specific measures , an advantage of data-sharing is that the data might be pooled more easily, increasing statistical power and thereby potentially enabling subtle and previously undetectable findings to be identified. This may benefit studies in particular that focus on neuroimaging, which are costly and tend to have small sample sizes Button et al. Behavioral data are not precluded from the benefits of having uniform data-sets, however. To ensure methodological rigor, studies require not only uniform measures but uniform procedures e.

To provide for standardization, here we propose a set of basic variables which we recommend hypnosis researchers assess. A clear statement regarding the hypnotic suggestibility scale that was administered, and the specific responses provided to each item on the scale, in addition to the summary score. If the same hypnotic induction and suggestions were used for each participant, it would be beneficial to provide a verbatim script. If elements are included that have not been covered in this list, these should also be detailed.

Generally, the more detailed the provision of data, the more useful it will be. In the case of neuroimaging or electrophysiological studies, relevant meta-data should also be shared e. A further barrier is that data-sharing needs to be considered in the project planning stage and the intention to share data should be detailed within ethics applications, participant information sheets, and consent forms.

Reflecting on the progress in other research fields, we are hopeful that in the area of hypnosis and suggestibility, if scientists begin to share data, we too can rapidly extend the knowledge that is currently available. As early as the French Royal Commission in the 18th century, chaired by Benjamin Franklin, investigators of hypnosis have been divided between those who view hypnosis in terms of psychological processes encountered in everyday life and those who view hypnosis as a rare or unusual processes outside the range of ordinary psychological functioning Gauld Since the late 20th century this division has often been characterized as a debate between those who believe that responses to hypnotic suggestions at least for highly susceptible individuals involve or are facilitated by the individual being in an Altered State of Consciousness ASC Kihlstrom and those that who explain hypnotic responses entirely in terms of more mundane, ubiquitous social, and cognitive processes that are not unique to hypnosis imagery, focused attention, goal-directed cognitive strategies, response expectancies, etc.

Lynn et al. This division among experimenters is perhaps viewed as less of a divisive issue by clinicians, many of whom view hypnosis from both perspectives. For example, many experiments evaluated or directly contrasted hypotheses derived from modern dissociation theories Woody and Sadler or response expectancy theories Lynn et al. This is not to dismiss the importance of conceptual debates in scientific progress, but only to recognize that some debates are fruitful and lead to a resolution of the issues, whereas engaging in unresolvable debates consumes intellectual resources that for the researcher might be better spent in other pursuits.

Moreover, once the scope of explanation is extended to include the emerging concepts and discoveries of human neuroscience, the distinction between state and nonstate explanations becomes difficult to sustain. For example, response expectancies a putative nonstate mechanism of suggestion are plausibly instantiated through predictive coding models of cortical functions. However, when implemented in such models, response expectancies engage with regulatory mechanisms that may result in the emergence of functionally distinct patterns of cortical dynamics Jamieson Suppose this mechanism is shown to be involved in responses to hypnotic suggestions.

Is this finding an example of a state or nonstate explanation? This will ultimately hinge on how an ASC is defined and consensus on such a definition remains elusive Mazzoni et al.

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Alternatively, suppose that functional connectivity the exchange of information or coordination of activity between the nodes of some cortical network e. This might be considered to instantiate dissociation, a putative ASC mechanism operating in hypnosis. However, selective cortical inhibition [topographically specific modulation of alpha band activity Siegel et al. Therefore, this mechanism is ubiquitous in ordinary cognitive processes and might be considered a nonstate mechanism. In short, it is possible, even likely, that future discoveries regarding the neurophysiological basis of hypnosis can be interpreted in ways consistent with both models, as have virtually all of the discoveries made to date.

A more productive path forward may be to focus on the integration of these seemingly competing accounts and the new lines of research suggested by such integration Lynn and Green The full range of differences on such interpretations was present in the Paris conference discussions. Some of us contend that the state debate may still prove to be theoretically valuable once other fundamental conceptual and theoretical issues are resolved.

On the other hand, some of us maintain that continuation of this debate has been an unproductive distraction that hinges on superficial disagreements that lack theoretical substance and whose resolution will not yield a substantive advance in our understanding of hypnosis. In the absence of any means to reach consensus, it was agreed that continued insistence on the priority of the state versus nonstate issue would likely divert researchers from the common effort needed to resolve the important solvable questions now within technological reach, such as the neurophysiological correlates of hypnotic suggestibility, and the neural mechanisms that support responses to hypnotic suggestions.

For example, how are individual differences in these effects expressed at the level of genetics, neurochemistry, structural organization, and propensity for specific forms of neural dynamics? Consensus on the resolution of these fundamental questions is within the reach of current paradigms in the human neurosciences. Success in addressing these questions will be enhanced by collaborative efforts across laboratories that prioritize this research. Such a program is unlikely to proceed in a context dominated by individual research agendas committed to waging a divisive state versus nonstate conflict.

Indeed, it is only once consensus has been achieved, on the core questions identified here, that a meaningful resolution of the state versus nonstate debate may become possible. This article summarized the discussions held at a meeting of contemporary hypnosis researchers in the fall of The consensus view was that despite some barriers to hypnosis research, a great deal has been learned regarding the neurophysiological underpinnings of hypnosis in the past two decades.

Highlights include clinical research supporting the efficacy of hypnosis for managing a number of clinical problems and symptoms, research supporting the role of various divisions in the anterior cingulate and prefrontal cortices in hypnotic responding and that high hypnotic suggestibility is characterized by an atypical brain connectivity profile. Five key recommendations for moving the field of hypnosis research forward were identified during the meeting Table 1.

First, there was consensus that while the assessment of hypnotic suggestibility may not be needed in clinical settings, and perhaps when conducting some clinical research, laboratory researchers should strongly consider the assessment of hypnotic suggestibility in their studies, to help ensure that they are indeed studying hypnotic phenomenon. Researchers should strongly consider including participants who score in the middle range of hypnotic suggestibility in their studies, given evidence that these individuals may differ in important qualitative ways from both highs and lows.

Hypnosis researchers should also give thought to expanding their designs, when indicated and appropriate, to more properly dissociate the roles of inductions and specific suggestions. Finally, two specific suggestions for helping to move the field forward include i the use of data sharing, and ii redirecting resources away from contrasting state and nonstate positions toward research examining the neurophysiological underpinnings of hypnotic phenomena.

Table 1 Primary consensus recommendations for hypnosis research. Laboratory researchers should strongly consider how they assess hypnotic suggestibility in their studies, to help ensure that they are indeed studying hypnotic phenomena. Researchers should strongly consider including participants who score in the middle range of hypnotic suggestibility in their studies.

Hypnosis researchers should also give thought to expanding the research designs used, when indicated and appropriate, to more properly dissociate the roles of inductions and specific suggestions. The field would benefit from greater use of data-sharing, perhaps through the use of data registries. The field would benefit from redirecting resources away from defending and attacking state or nonstate positions and toward research examining the neurophysiological underpinnings of hypnotic phenomena.

Findings from research on hypnosis have a great deal to offer the clinical and scientific community. As more is learned about the clinical applications of hypnosis treatments, the more individuals suffering from those conditions can be helped with hypnotic treatments — including most certainly chronic pain, irritable bowel syndrome, and PTSD, but also likely other conditions as well — can be helped. At the same time, as we learn more about the neurophysiological mechanisms underlying hypnosis and hypnotic phenomena, we will also learn more about basic brain functions and the responses influenced by hypnosis, such as amnesia, hallucinations, and delusions.

We hope that this review article both inspires researchers to consider incorporating hypnosis into their research programs and also provides some guidance for the future direction of hypnosis research. Support for this article was provided in part by grants to M. Oxford University Press is a department of the University of Oxford.

It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Recent Advances in Hypnosis Research. Current Challenges in Hypnosis Research. Addressing the Challenges of Contemporary Hypnosis Research. Strategies for Moving the Field Forward. Summary and Conclusions. New directions in hypnosis research: strategies for advancing the cognitive and clinical neuroscience of hypnosis Mark P Jensen.

Oxford Academic. Google Scholar. Graham A Jamieson. Antoine Lutz. Giuliana Mazzoni. William J McGeown. Enrica L Santarcangelo.

Athena Demertzi. Vilfredo De Pascalis. Christian Rominger. Patrik Vuilleumier. Marie-Elisabeth Faymonville. Devin B Terhune. William J. Cite Citation. Permissions Icon Permissions. Abstract 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.

Table 1. Mindfulness-based hypnosis: blending science, beliefs, and wisdoms to catalyze healing. Search ADS. Google Preview. Evidence for ventricular enlargement is weaker in affective disorders than in schizophrenia, and a considerable number of studies found no difference between patients and controls. Elderly patients with depression have so far been the only group were a sizeable majority of studies have reported enlarged lateral ventricles Beyer and Krishnan, , and most studies in BD converge to suggest enlarged third ventricles.

Strasser et al. Volume losses in medial thalamic or hypothalamic areas that form the walls of the third ventricle have been suggested to underlie this enlargement. A possible implication of the hypothalamus would be of particular interest because of the prominent somatic and autonomic symptoms, for example the disturbed circadian clock, present during both depressed and manic episodes. However, the recent study by McDonald et al. The heterogeneity of the findings across studies and the effect of age suggest that ventricle size, if altered in affective disorders at all, would be a state rather than a trait marker.

This view would be supported by the observation that relatives of patients with familial schizophrenia, but not those of patients with familial BD, also showed increased ventricles McDonald et al. Similar findings of lack of genetic association in BD have recently been reported for corpus callosum size Walterfang et al.

Findings are also inconsistent across studies for most cortical areas. Yet, some confined areas have been suggested by several studies to be reduced. The medial temporal lobe, particularly the hippocampus and the amygdala, has been specifically targeted by several volumetric studies because of the link between their presumed function in emotion regulation and associative memory formation and the clinical symptoms of depression.

Furthermore, an attractive aetiological model, largely based on animal studies, has implicated hippocampal damage due to stress in the brain processes of depression. However, findings from structural imaging are inconsistent, with volume reductions, increases and no changes all being reported Beyer and Krishnan, A recent report also suggests that hippocampi are smaller already during adolescence in never medicated patients with early onset familial depression MacMaster et al.

Yet, small hippocampi have also been observed in traumatised individuals without depressive symptoms Karl et al. In the basal ganglia, several studies reported a reduction of the volume of the striatum caudate nucleus and putamen mainly in elderly depressed patients. Research in the s suggested that a subgroup of patients with depression is suffering from increased secretion of cortisol and other signs of dysregulation of the hypothalamic-pituitary-adrenal HPA axis.

This line of research has recently attracted renewed interested because of the HPA-stress model of depression, which will be discussed below. Structural imaging lent some support to changes in the HPA in depression. Both the adrenal gland and the pituitary were found to be enlarged in patients with depression, but it is as yet unknown whether this would normalise again after successful treatment or remission. In any case, as with most changes in the HPA axis, it will be difficult if not impossible to determine whether they are aetiological factors of depression or correlates of the stress resulting from depression, unless they are found in subjects with genetic risk but no clinical symptoms.

Although the best outcome measures of a psychiatric or psychological intervention will always be at the level of the clinical phenotype — for example, improvement of mood in a case of depression — these are sometimes difficult to define or obtain, especially for not primarily symptom-focussed techniques. This difficulty and the unreliability of self-report measures have triggered a quest for biological or physiological markers of treatment responses.

Such markers could be obtained by psychophysiology e. The attraction of functional neuroimaging is that it provides a means of assessing metabolism or activation of individual brain regions, which confers an advantage compared to more global biochemical or psychophysiological measures where treatment effects are expected to operate through modifications of specific pathophysiological nodes.

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For example, if spider phobia is indeed caused by hyperactivation of the limbic system Dilger et al. Treatment monitoring with functional neuroimaging has had particularly fascinating applications in the field of psychological interventions. One interesting aspect of this approach was that it had to overcome longstanding mutual reservations on the part of psychotherapists and neuroscientists.

We can now safely say that there has been a paradigm shift over the past 10 years to an integrated view of psychological and neurobiological models of mental illness and its treatment. We have recently reviewed the neuroimaging studies that investigated psychotherapy effects or compared psycho- and pharmacotherapy effects for anxiety disorders and depression elsewhere Linden, , b. Several studies of cognitive behavioural therapy for specific or social phobia indeed found decreased activity in limbic structures Furmark et al. The relationship between psycho- and pharmacotherapy can be studied best in disorders where both approaches are equally potent and commonly used.

For example, in the study of social phobia a similar reduction in medial temporal lobe activity during preparation of a public speech was observed in the CBT and antidepressant treated groups Furmark et al. What contribution can functional neuroimaging then make to the treatment of mental disorders? We suggest three lines of investigation and potentially practical implementation Linden, c :.

It may ultimately become possible to identify likely responders to different types of therapy by their baseline patterns of neural activation, allowing for an individualized therapy. A word of caution is needed here because this aim has not been fulfilled in over a decade of functional imaging of pharmacotherapy, and refined psychopathological criteria may be at least as promising.

Functional imaging results have influenced or even motivated various physical treatment approaches. The finding of auditory cortex activity during hallucinations has already led to partly successful attempts at attenuating hallucinations with TMS over the temporal lobe Hoffman et al. In affective disorders, attention has focused on the subgenual area of the medial frontal lobe, where both volume and metabolism were found to be reduced Drevets et al.

However, when metabolic activity was corrected for the partial volume effect, it appears to be higher in depressed patients compared to controls and revert to normal after effective treatment. This area has been the target of a recent DBS study with treatment refractory depressed patients Lozano et al. The recent finding of contradictory treatment effects in the same brain area Kennedy et al. Another interesting development driven by the advances of fMRI is the self-regulation of brain activity through neurofeedback.

This technique consists in training participants to influence the neural signal from a target area while they receive online information about the amplitude of this signal Weiskopf et al. The rationale for its therapeutic application can perhaps be based on the analogy with hypnosis. It should therefore be possible in principle for participants to produce similar changes themselves, for example by specific imagery strategies.

FMRI-neurofeedback, targeting the anterior cingulated cortex, has indeed shown some preliminary success in chronic pain deCharms et al. However, any application in complex psychiatric disorders probably would have to integrate neurofeedback in a comprehensive biopsychosocial intervention package, as one would with classical biofeedback or relaxation techniques.

Functional and structural neuroimaging are key techniques of modern brain research and play a major role in the quest for biological markers of mental disorders. Although they have already contributed greatly to our understanding of the pathophysiology of mental disorders and their associated symptoms, clinical applications in diagnosis or treatment monitoring are still sparse. However, they may become more widespread once more information about the reliability and diagnostic specificity of neuroimaging changes becomes available. Neuroimaging is also likely to assume increasing importance as a tool to monitor and compare the brain effects of different psychiatric and psychological treatments, and eventually aid in the development of new interventions.

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