Hypnotic suggestibility in dissociative and related disorders: A meta-analysis, 2022, Wieder et al

[Andy]

Highlights

• Patients characterized by severe dissociative psychopathology display elevated hypnotic suggestibility.
• Elevated hypnotic suggestibility was most pronounced in the dissociative disorders.
• There was considerable heterogeneity across patient subgroups.
• Effect sizes were not reliably related to methodological features of studies.
• These results have implications for the mechanisms, risk factors, and treatment of dissociation.

Abstract
Elevated responsiveness to verbal suggestions is hypothesized to represent a predisposing factor for dissociative disorders (DDs) and related conditions. However, the magnitude of this effect has not been estimated in these populations nor has the potential moderating influence of methodological limitations on effect size variability across studies. This study assessed whether patients with DDs, trauma- and stressor-related disorders (TSDs), and functional neurological disorder (FND) display elevated hypnotic suggestibility. A systematic literature search identified 20 datasets. A random-effects meta-analysis revealed that patients displayed greater hypnotic suggestibility than controls, Hedges’s g=0.92 [0.66, 1.18]. This effect was observed in all subgroups but was most pronounced in the DDs. Although there was some evidence for publication bias, a bias-corrected estimate of the group effect remained significant, g=0.57 [0.30, 0.85]. Moderation analyses did not yield evidence for a link between effect sizes and methodological limitations. These results demonstrate that DDs and related conditions are characterized by elevated hypnotic suggestibility and have implications for the mechanisms, risk factors, and treatment of dissociative psychopathology.

Open access, https://www.sciencedirect.com/science/article/pii/S0149763422002408

 

[Andy]

Despite these convergent results, considering elevated suggestibility in these conditions under the broad umbrella of dissociative psychopathology neglects heterogeneity within and between these conditions and variability in the constellation of dissociative symptoms more broadly (Brown, 2006, Holmes et al., 2005). Indeed, although these disorders are often treated uniformly in discussions of the association between hypnotic suggestibility and dissociative psychopathology (e.g., Dell, 2019), patient subgroup comparisons revealed that the magnitude of elevated hypnotic suggestibility relative to controls was significantly greater in DD (lower bound prediction interval:.91) relative to FND patients (lower bound prediction interval:.15) and, after the removal of a borderline outlier, TSD patients, with the latter two groups not reliably differing. One interpretation of these group differences is that elevated hypnotic suggestibility covaries with the severity of dissociative psychopathology, yielding the most pronounced level of hypnotic suggestibility in DID. Evidence in favour of this severity hypothesis comes from research showing that hypnotic suggestibility in FND and PTSD correlates with the severity of functional or dissociative symptomatology (Bryant et al., 2001, Kuyk et al., 1995, Roelofs et al., 2002) and that hypnotic suggestibility in DDs is associated with greater self-harming behaviours (Ebrinc et al., 2008), with similar findings in chronic fatigue syndrome (Constant et al., 2011) and eating disorders (Vanderlinden et al., 1995).

...

In contrast with both models, multiple researchers have proposed that high hypnotic suggestibility confers risk for TSDs and DDs in response to trauma (L. D. Butler et al., 1996; Dell, 2019) (see also Keynejad et al., 2019). In support of this view, hypnotic suggestibility has been repeatedly shown to be positively associated with posttraumatic stress symptoms (Bryant et al., 2001, Bryant et al., 2003, DuHamel et al., 2002, Keuroghlian et al., 2010, Yard et al., 2008). By contrast, relatively little attention has been afforded to the converse mechanism that elevated suggestibility is a sequela of the DDs (see also Hilgard, 1979). A sequela model nicely explains the findings that hypnotic suggestibility varies with length of illness in chronic fatigue syndrome (Constant et al., 2011) and may help to account for the observation that patients with schizophrenia are responsive to hallucination suggestions (Young et al., 1987) despite not displaying elevated hypnotic suggestibility (Frischholz et al., 1992). Longitudinal studies are required to more robustly discriminate between these competing accounts.

 

[Hutan]

So, it seems people with CFS are too suggestible (or at least some subset of people with severe symptomology, or long lasting illness, or self-harming behaviours or well, it's not really clear, but it's all sort of in there).

And yet, we are also not suggestible enough, because CBT doesn't fix us, and we insist on telling the BPS people that their ideas are wrong.

Yet another characteristic for the pile of 'simultaneously-held 180-degree opposite flaws*' that serve to make us 'the other' and deserving of our illness.

(* e.g. Too ambitious/Type A personalities but also too lazy; booming and busting but not trying hard enough; too perfectionist and yet not following the instructions for the therapies well enough; too emotional but also having repressed emotions....)

I'm sure if we poked into these studies, we'd find that there is a lot of nasty rubbish and things that don't hang together. I'm not quite sure if and how "hypnotic suggestibility" differs from "elevated responsiveness to verbal suggestions"; it doesn't seem to matter to these authors.

I mean sure, I can believe people with "severe dissociative psychopathology" who are struggling to keep hold of reality might be able to be easily convinced of things - but the various researchers seem to have taken that kernel of truth and blasted it around willy-nilly at whatever innocent bystanders they didn't much like.

Ugh, I don't have a lot of patience for stupidity and bigoted thinking today.

 

[Trish]

This idea of pwCFS being prone to hypnotic suggestibility reminds me of the patients' accounts of LP, where at least one described something that sounded very like patients were being hypnotised, and another referred to the method as self hypnosis. What this dubious practice achieved was hugely detrimental to patients who kept on pushing through PEM and ended up much sicker. A lot of the accounts showed some pushed on for years before realising it was the process that was harming them. My interpretation being that they were awakening from hypnosis.

 

[Hutan]

I don't really know what to think about hypnosis. I'm not sure if it is a thing. I've read some views that it is just suggestion - that the volunteers who take part on the stage shows for example know, at some level, that they are putting on a show and are chosen back stage for their demonstrated willingness to do silly things when told to. And, for things like stopping smoking, maybe it is just a placebo?

A well-meaning friend and trained hypnotist (she used it in her counselling work) hypnotised someone I know with the aim of reducing pain from a broken ankle. It made no difference.

 

[Trish]

I tried being hynotised once by a professional hypnotist who used it for things like smoking cessation. I can't remember what it was intended for in my case, maybe i had a headache or something. He was a colleague, so I wasn't paying for it. It had no effect on me. I don't think I'm suggestible.

It may well be just suggestibility combined with a strategy to get people to focus their attention only on the suggestion and get them in a relaxed state to be receptive to what is suggested. It's supposed to only work if the subject is given a suggestion of something they want to do anyway, in the case of LP, to trust that the process that gives them set words and movements becomes associated with believing the words and acting accordingly. They are screened for suggestibility before they are allowed to do LP.

 

[NelliePledge]

I’ve done hypnotherapy in the past with a few different people. it’s pretty much like a guided meditation with a bit of counselling thrown in. I found that it did make me go to a deep relaxation verging on sleep which felt pretty good during the session and afterwards. The suggestion side of it didn’t make much impact possibly a bit but not long term.

 

[Mithriel]

I checked the reference for CFS. Couldn't access the whole paper but these are the highlights. It doesn't match what is being claimed here.

E.L. Constant, S. Adam, B. Gillain, M. Lambert, E. Masquelier, X. Seron
Cognitive deficits in patients with chronic fatigue syndrome compared to those with major depressive disorder and healthy controls
Clinical Neurology and Neurosurgery, 113 (4) (2011), pp. 295-302, 10.1016/j.clineuro.2010.12.002

Twenty-five patients with CFS, 25 patients with major depressive disorder (MDD), and 25 healthy control subjects were given standardized tests of attention, working memory, and verbal and visual episodic memory, and were also tested for effects related to lack of effort/simulation, suggestibility, and fatigue.

Results
Patients with CFS had slower phasic alertness, and also had impaired working, visual and verbal episodic memory compared to controls. They were, however, no more sensitive than the other groups to suggestibility or to fatigue induced during the cognitive session.

Conclusions
This study confirms the presence of an objective impairment in attention and memory in patients with CFS but with good mobilization of effort and without exaggerated suggestibility.

 

[Snow Leopard]

So, it seems people with CFS are too suggestible (or at least some subset of people with severe symptomology, or long lasting illness, or self-harming behaviours or well, it's not really clear, but it's all sort of in there).

Yeah nah, it's just a mis-quote.

I checked the reference for CFS. Couldn't access the whole paper but these are the highlights. It doesn't match what is being claimed here.

Exactly. The study found no evidence of "suggestibility", so this is a classic example of authors claiming the exact opposite of a studies finding, as well as a failure of peer review to actually check the claims being made in the manuscript.

 

[Trish]

Is it worth writing to the authors telling them they have misused a reference to claim the opposite of what that reference showed? And ro ask them to get the paper amended?

 

[Snow Leopard]

Is it worth writing to the authors telling them they have misused a reference to claim the opposite of what that reference showed? And ro ask them to get the paper amended?

I doubt they'd care. Unless the researchers have a close relationship with a patient community, they're unlikely to care and may have misquoted it deliberately because they're so convinced of their hypothesis.