International Journal of Clinical and Experimental Hypnosis
Transkript
International Journal of Clinical and Experimental Hypnosis
This article was downloaded by: [Harvard College] On: 15 September 2013, At: 13:05 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK International Journal of Clinical and Experimental Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/nhyp20 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 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. 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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 Downloaded by [Harvard College] at 13:05 15 September 2013 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: ailhan@fatih.edu.tr 81 Downloaded by [Harvard College] at 13:05 15 September 2013 82 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 Downloaded by [Harvard College] at 13:05 15 September 2013 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 84 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 Downloaded by [Harvard College] at 13:05 15 September 2013 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 85 Downloaded by [Harvard College] at 13:05 15 September 2013 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. 86 TURAN USLU ET AL. Downloaded by [Harvard College] at 13:05 15 September 2013 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. Downloaded by [Harvard College] at 13:05 15 September 2013 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