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Cognitive Column - January 2015

Although I'm writing this before Christmas, I expect you will receive it in the New Year. So, Happy New Year! I hope Christmas went well for you, and also that any of you who had exams in the Autumn were happy with the results.

On the topic of exams, I had messages from a number of DD303 students to say that the exam went well for them and they did better than usual. This they were attributing to hypnosis, because I'd used that to help them with exam nerves. Many of you will know that I have an interest in hypnosis, because I have written about it several times before. I hope you will forgive me if I write a bit more about this fascinating topic. Exactly how hypnosis achieves its effects remains something of a mystery, and we seem to be left with unsatisfactory explanations along the lines, "The brain does what it needs to do to make the suggestion happen." A good example is the removal of the Stroop effect. You will all know about that effect; the fact that, when we are quickly naming the colours of ink used to print words, we get significantly slower if the words themselves are conflicting colour names (e.g. using green ink to write RED). Less well known, there is also a small speeding-up effect when colour and word are congruent (red ink for RED). If people are told in hypnosis that they will just see some meaningless squiggles, like foreign writing, then the Stroop effect goes away, just as they expect it to do. One would assume from this that they really were unable to read the words. However, it turns out that the speedingup effect with congruent stimuli remains, and you can't be speeded by a word you can't read! As I said, the brain is obviously doing something to produce the effect, but it isn't literally what it was instructed to do.

I have recently been using hypnosis with an unfortunate young woman who experienced horrific burns in a fire. Not surprisingly, she was diagnosed as having posttraumatic stress disorder (PTSD) and was sent for CBT. Cognitive Behavioural Therapy is very much "The Thing" at the moment; it is evidenced based (i.e. it works and there are data to prove it) and there are firm theoretical underpinnings. However, its application tends to be formulaic - almost like therapy by numbers. This is handy for an over-stretched NHS, because people can easily be trained to deliver the procedures and the Government can tick the box that says they are dealing with more mental health problems. There is even a move towards providing on-line, semi-automated treatments, so that patients can interact with their computer at home and the NHS doesn't have to recruit so many people. Unfortunately there's a "however". The rather mechanical CBT approach is not right for everyone, and it doesn't seem to have a "human" element that enables it to be tuned to suit the particular needs of the patient. It certainly didn't meet the needs of the burns victim; in fact she said that it was making her worse. In contrast, she speaks highly of hypnosis, and is making great progress. This is rather odd, since many of the incorporated techniques are similar to those of CBT.

Why does hypnosis seem to add a little something extra in so many different therapeutic situations? There is growing evidence that it may have something to do with that especially human quality which CBT tends to lack. Effective hypnosis both fosters and demands a sense of closeness and trust between patient and practitioner. Those sensations are associated with the release of the hormone oxytocin; it is sometimes called the bonding hormone. It modifies brain behaviour via receptor sites which are defined by the oxytocin receptor gene. This gene, like the one for eye colour, comes in two forms, and the presence of one of these versions rather than the other seems to make people more susceptible to hypnosis. Moreover, giving people a little dose of oxytocin before starting hypnosis allows them to be more responsive (Bryant et al. in Psychoneuroendocrinology, 2012). Not only is this theoretically interesting in the context of hypnosis; it also serves as a warning to those who would automate the NHS. If a good warm feeling of closeness is important to recovery (which is no more than we would expect for social animals such as ourselves) then how are we to treat ourselves by logging in to a website? I really don't see the Bill Gates Windows system getting a patient's oxytocin flowing! Now, my trusty Mac . . . well, that's a different matter!

Pets are good for oxytocin; there are schemes in some areas where they are taken to hospitals and care homes, for patients to hold and stroke. Apparently it does them (the patients) the world of good. Dogs have evolved to enjoy human company, so it probably does them good too, since as fellow mammals they also secrete oxytocin. I am looking forward to the time when I am not too busy to own a dog, because truth be told, even the Mac doesn't produce all that much oxytocin. This reminds me of a story I recently heard, perhaps slightly non-PC, but I hope you enjoy it anyway. It does have an educational element, because it very nicely illustrates that correlation need not mean causality. Someone in my position tells his friend that he's at long last planning on getting a dog. "Ah, that's nice. What breed are you thinking of having?" The chap replies that he's always liked Labradors - they seem intelligent and good natured. "Well, that's as may be, but I'd never risk one of those!" The would-be dog owner is surprised by the response and asks what's wrong with Labradors. "Goodness! Haven't you noticed the number of Labrador owners who've gone blind?"

All the very best with your studies in the New Year. No doubt I shall be interrupting them again with more nonsense before 2015 is too far advanced.



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