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Multidisciplinary Approach to Hypnosis: Psychiatric Basis, Neuroimaging and Genetic Findings

Year 2024, , 451 - 465, 30.09.2024
https://doi.org/10.18863/pgy.1321465

Abstract

Hypnosis, a practice often misunderstood and surrounded by misconceptions, has a rich historical lineage dating back to ancient civilizations. Our review explores the relationship between neuroanatomy, genetics, and hypnotic susceptibility, investigating organic factors influencing an individual's responsiveness to hypnosis. This review highlights the importance of hypnosis as a high-level cognitive activity, especially in pain and anxiety management, and emphasizes the potential benefits of integrating hypnosis into healthcare practices. Recent advancements in neuroimaging have provided insights into the neurological mechanisms of hypnosis, while genetic research has expanded its applications. However, persistent misconceptions hinder its acceptance. This article offers a multidisciplinary basic exploration of hypnosis, focusing on its origins, historical development related to psychiatry, the basic neuroimaging findings mainly affecting the limbic system responsible for emotion, and genetic underpinnings. We aim to inspire clinicians, social scientists, and healthcare professionals to effectively integrate the scientific basics of hypnosis into therapeutic practice, contributing to a better understanding of its role in augmenting outcomes.

References

  • Alladin A (2012) Cognitive hypnotherapy: A new vision and strategy for research and practice. Am J Clin Hypn, 54:249-262.
  • Alladin A, Alibhai A (2007) Cognitive hypnotherapy for depression: An empirical investigation. Int J Clin Exp Hypn, 55:147-166.
  • Andrews-Hanna JR, Reidler JS, Sepulcre J, Poulin R, Buckner RL (2010) Functional-anatomic fractionation of the brain's default network. Neuron, 65:550-562.
  • Baclig MO, Predicala RZ, Mapua CA, Lozano-Kühne JP, Daroy ML, Natividad FF et al. (2012) Allelic and genotype frequencies of catechol-O-methyltransferase (Val158Met) and CYP2D6*10 (Pro34Ser) single nucleotide polymorphisms in the Philippines. Int J Mol Epidemiol Genet, 3:115-121.
  • Barnier AJ, Cox RE, McConkey KM (2014) The province of “highs”: The high hypnotizable person in the science of hypnosis and in psychological science. Psychol Conscious (Wash D C), 1:168-183.
  • Benjamin J, Li L, Patterson C, Greenberg BD, Murphy DL, Hamer DH (1996) Population and familial association between the D4 dopamine receptor gene and measures of novelty seeking. Nat Genet, 12:81-84.
  • Bernheim H (1980) Bernheim's New Studies in Hypnotism. New York, International Universities Press.
  • Blasi G, Goldberg TE, Weickert T, Das S, Kohn P, Zoltick B, et al. (2006) Brain regions underlying response inhibition and interference monitoring and suppression. Eur J Neurosci, 23:1658-1664.
  • Blasi G, Mattay VS, Bertolino A, Elvevåg B, Callicott JH, Das S et al. (2005) Effect of catechol-O-methyltransferase val158met genotype on attentional control. J Neurosci, 25:5038-5045.
  • Braid J (1843) Neurypnology: Or the Rationale of Nervous Sleep, Considered in Relation with Animal Magnetism. London, John Churchill.
  • Bush G, Frazier JA, Rauch SL, Seidman LJ, Whalen PJ, Jenike MA et al. (1999) Anterior cingulate cortex dysfunction in attention-deficit/hyperactivity disorder revealed by fMRI and the counting Stroop. Biol Psychiatry, 45:1542-1552.
  • Bush G, Spencer TJ, Holmes J, Shin LM, Valera EM, Seidman LJ et al. (2008) Functional magnetic resonance imaging of methylphenidate and placebo in attention-deficit/hyperactivity disorder during the multi-source interference task. Arch Gen Psychiatry, 65:102-114.
  • Cabeza R, Nyberg L (2000) Imaging cognition II: An empirical review of 275 PET and fMRI studies. J Cogn Neurosci, 12:1-47.
  • Casiglia E, Finatti F, Gasparotti F, Stabile MR, Mitolo M, Albertini F et al. (2018) Functional magnetic resonance imaging demonstrates that hypnosis is conscious and voluntary. Psychology, 9:1571-1581.
  • Caspi A, Sugden K, Moffitt T E, Taylor A, Craig I W, Harrington H, et al. (2003) Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science, 301:386-389.
  • Chan N, Zhang Z, Yin G, Li Z, Ho R (2023) Update on hypnotherapy for psychiatrists. BJPsych Advances, 29:381-387.
  • Chen JE, Glover GH, Greicius MD, Chang C (2017) Dissociated patterns of anti-correlations with dorsal and ventral default-mode networks at rest. Hum Brain Mapp, 38:2454-2465.
  • Cojan Y, Piguet C, Vuilleumier P (2015) What makes your brain suggestible? Hypnotizability is associated with differential brain activity during attention outside hypnosis. NeuroImage, 117:367-374.
  • Császár N, Scholkmann F, Bókkon I (2021) Implications on hypnotherapy: Neuroplasticity, epigenetics and pain. Neurosci Biobehav Rev, 131:755-764.
  • Dang LC, O'Neil JP, Jagust WJ (2012) Dopamine supports coupling of attention-related networks. J Neurosci, 32:9582-9587.
  • De Benedittis G (2021) Neural mechanisms of hypnosis and meditation-induced analgesia: A narrative review. Int J Clin Exp Hypn, 69:363-382.
  • De Pascalis V, Cacace I, Massicolle F (2008) Focused analgesia in waking and hypnosis: Effects on pain, memory, and somatosensory event-related potentials. Pain, 134:197-208.
  • De Pascalis V, Russo P, Marucci FS (2000) Italian norms for the Harvard group scale of hypnotic susceptibility, form a. Int J Clin Exp Hypn, 48:44-55.
  • Deeley Q, Oakley DA, Toone B, Giampietro V, Brammer MJ, Williams SCR et al. (2012) Modulating the default mode network using hypnosis. Int J Clin Exp Hypn, 60:206-228.
  • Diamond A (2013) Executive functions. Annu Rev Psychol, 64:135-168.
  • Edwards TJ, Sherr EH, Barkovich AJ, Richards LJ (2014) Clinical, genetic and imaging findings identify new causes for corpus callosum development syndromes. Brain, 137:1579-1613.
  • Egner T, Hirsch J (2005) Cognitive control mechanisms resolve conflict through cortical amplification of task-relevant information. Nat Neurosci, 8:1784-1790.
  • Ellenberger HF (1970) The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry. New York, Basic Books.
  • Farrell SM, Tunbridge EM, Braeutigam S, Harrison PJ (2012) COMT Val(158)Met genotype determines the direction of cognitive effects produced by catechol-O-methyltransferase inhibition. Biol Psychiatry, 71:538-544.
  • Fornito A, Yücel M, Pantelis C (2009) Reconciling neuroimaging and neuropathological findings in schizophrenia and bipolar disorder. Curr Opin Psychiatry, 22:312-319.
  • Fromm E, Nash MR (1997) Psychoanalysis and Hypnosis. Madison, CT, International Universities Press.
  • Glatt SJ, Faraone SV, Tsuang MT (2003) Meta-analysis identifies an association between the dopamine D2 receptor gene and schizophrenia. Mol Psychiatry, 8:911-915.
  • Goldberg TE, Egan MF, Gscheidle T, Coppola R, Weickert T, Kolachana BS et al. (2003) Executive subprocesses in working memory: relationship to catechol-O-methyltransferase Val158Met genotype and schizophrenia. Arch Gen Psychiatry, 60:889-896.
  • Goldfried MR, Davison GC (1976) Clinical Behavior Therapy. New York, NY, Holt, Rinehart & Winston.
  • Green JP (2003) Beliefs about hypnosis: Popular beliefs, misconceptions, and the importance of experience. Int J Clin Exp Hypn, 51:369-381.
  • Green JP, Laurence JR, Lynn SJ (2014) Hypnosis and psychotherapy: From Mesmer to mindfulness. Psychol Conscious (Wash D C), 1:199-212.
  • Green JP, Page RA, Rasekhy R, Johnson LK, Bernhardt SE (2006) Cultural views and attitudes about hypnosis: A survey of college students scross four countries. Int J Clin Exp Hypn, 54:263-280.
  • Greicius MD, Srivastava G, Reiss AL, Menon V (2004) Default-mode network activity distinguishes alzheimer's disease from healthy aging: evidence from functional MRI. Proc Natl Acad Sci U S A, 101:4637-4642.
  • Halsband U, Wolf TG (2021) Current neuroscientific research database findings of brain activity changes after hypnosis. Am J Clin Hypn, 63:372-388.
  • Hertrich I, Dietrich S, Blum C, Ackermann H (2021) The role of the dorsolateral prefrontal cortex for speech and language processing. Front Hum Neurosci, 15:645209.
  • Hoeft F, Gabrieli JDE, Whitfield-Gabrieli S, Haas BW, Bammer R, Menon V et al. (2012) Functional brain basis of hypnotizability. Arch Gen Psychiatry, 69:1064-1072.
  • Horton JE, Crawford HJ, Harrington G, Downs JH III (2004) Increased anterior corpus callosum size associated positively with hypnotizability and the ability to control pain. Brain, 127:1741-1747.
  • Das JM, Geetha R (2023) Corpus callosum agenesis. In StatPearls. Treasure Island (FL), StatPearls Publishing.
  • Kanfer FH, Goldstein AP (1986) Helping People Change: A Textbook of Methods. New York, Pergamon Press.
  • Kapur S (2003) Psychosis as a state of aberrant salience: A framework linking biology, phenomenology, and pharmacology in schizophrenia. Am J Psychiatry, 160:13-23.
  • Katonai ER, Szekely A, Vereczkei A, Sasvari-Szekely M, Bányai ÉI, Varga K (2017) Dopaminergic and serotonergic genotypes and the subjective experiences of hypnosis. Int J Clin Exp Hypn, 65:379-397.
  • Kayhan H (2021) Behavioral genetics and predisposition to aggressive behavior. The Research and Reviews on Healthcare: Open Access Journal, 6(5): doi:: 10.32474/RRHOAJ.2021.06.000250.
  • Kirsch I, Low CB (2013) Suggestion in the treatment of depression. Am J Clin Hypn, 55:221-229.
  • Kirsch I, Lynn SJ (1999) Automaticity in clinical psychology. Am Psychol, 54:504-515.
  • Klein KB, Spiegel D (1989) Modulation of gastric acid secretion by hypnosis. Gastroenterology, 96:1383-1387.
  • Klin A, Jones W, Schultz R, Volkmar F (2003) The enactive mind, or from actions to cognition: lessons from autism. Philos Trans R Soc Lond B Biol Sci, 358:345-360.
  • Kocabaş NA, Sardaş S, Cholerton S, Daly AK, Karakaya AE (2002) Cytochrome P450 CYP1B1 and catechol O-methyltransferase (COMT) genetic polymorphisms and breast cancer susceptibility in a Turkish population. Arch Toxicol, 76:643-649.
  • Landry M, Raz A (2015) Hypnosis and imaging of the living human brain. Am J Clin Hypn, 57:285-313.
  • Laurence JR, Perry C (2015) Hypnosis, Will, and Memory: A Psycho-Legal History. New York, Guilford Press.
  • Lechun L, Yu S, Pengling H, Changqi H (2013) The COMT Val158Met polymorphism as an associated risk factor for Parkinson's disease in Asian rather than Caucasian populations. Neurol India, 61:12-16.
  • Lesch KP, Bengel D, Heils A, Sabol SZ, Greenberg BD, Petri S et al. (1996) Association of anxiety-related traits with a polymorphism in the serotonin transporter gene regulatory region. Science, 274:1527-1531.
  • Lichtenberg P, Bachner-Melman R, Ebstein RP, Crawford HJ (2004) Hypnotic susceptibility: multidimensional relationships with Cloninger's tridimensional personality questionnaire, COMT polymorphisms, absorption, and attentional characteristics. Int J Clin Exp Hypn, 52:47-72.
  • Lichtenberg P, Bachner-Melman R, Gritsenko I, Ebstein R (2000) Exploratory association study between catechol-O-methyltransferase (COMT) high/low enzyme activity polymorphism and hypnotizability. Am J Med Genet, 96:771-774.
  • Lifshitz M, Cusumano EP, Raz A (2013) Hypnosis as neurophenomenology. Front Hum Neurosci, 7:469.
  • Lifshitz M, Raz A (2015) Hypnotic ability and baseline attention: fMRI findings from Stroop interference. Psychol Conscious (Wash D C), 2:134-143.
  • Lynn SJ, Kirsch I (2006) Essentials of Clinical Hypnosis: An Evidence-Based Approach. Washington, D.C, American Psychological Association.
  • Lynn SJ, Malakataris A, Condon L, Maxwell R, Cleere C (2012) Post-traumatic stress disorder: cognitive hypnotherapy, mindfulness, and acceptance-based treatment approaches. Am J Clin Hypn, 54:311-330.
  • Mac Hovec FJ (1975) Hypnosis before Mesmer. Am J Clin Hypn, 17:215-220.
  • Maletic V, Robinson M, Oakes T, Iyengar S, Ball SG, Russell J (2007) Neurobiology of depression: an integrated view of key findings. Int J Clin Pract, 61:2030-2040.
  • Männistö P T, Kaakkola S (1999) Catechol-O-methyltransferase (COMT): biochemistry, molecular biology, pharmacology, and clinical efficacy of the new selective COMT inhibitors. Pharmacol Rev, 51:593-628.
  • Maquet P, Faymonville ME, Degueldre C, Delfiore G, Franck G, Luxen A et al. (1999) Functional neuroanatomy of hypnotic state. Biol Psychiatry, 45:327-333.
  • McConkey KM (1986) Opinions about hypnosis and self-hypnosis before and after hypnotic testing. Int J Clin Exp Hypn, 34:311-319.
  • McGeown W J, Mazzoni G, Venneri A, Kirsch I (2009) Hypnotic induction decreases anterior default mode activity. Conscious Cogn, 18:848-855.
  • Mészáros I, Szabó C (1999) Correlation of EEG asymmetry and hypnotic susceptibility. Acta Physiol Hung, 86:259-263.
  • Meyer-Lindenberg A, Weinberger DR (2006) Intermediate phenotypes and genetic mechanisms of psychiatric disorders. Nat Rev Neurosci, 7:818-827.
  • Mier D, Kirsch P, Meyer-Lindenberg A (2010) Neural substrates of pleiotropic action of genetic variation in COMT: a meta-analysis. Mol Psychiatry, 15:918-927.
  • Mikail H, Mamman M (2020) Hypnosis and hypnotherapy: the role of traditional versus alternative approach. In Hypnotherapy and Hypnosis (C Mordeniz). London, UK, InTech Open.
  • Montag C, Kirsch P, Sauer C, Markett S, Reuter M (2012) The role of the CHRNA4 gene in internet addiction: a case-control study. J Addict Med, 6:191-195.
  • Montgomery G H, DuHamel KN, Redd WH (2000) A meta-analysis of hypnotically induced analgesia: how effective is hypnosis? Int J Clin Exp Hypn, 48:138-153.
  • Morgan AH, Hilgard JR (1978) The Stanford hypnotic clinical scale for adults. Am J Clin Hypn, 21:134-147.
  • Moseley RL, Ypma R J, Holt RJ, Floris D, Chura LR, Spencer MD et al. (2015) Whole-brain functional hypoconnectivity as an endophenotype of autism in adolescents. Neuroimage Clin, 9:140-152.
  • Nadon R, Laurence JR, Perry C (1987) Multiple predictors of hypnotic susceptibility. J Pers Soc Psychol, 53:948-960.
  • Nash MR (2001) The truth and the hype of hypnosis. Sci Am, 285:46-49, 52-45.
  • Nash MR (2008) A psychoanalytic theory of hypnosis: a clinically informed approach. In Oxford Handbook of Hypnosis (Eds M Nash, A Barnier):201-224. New York, Oxford University Press.
  • Nordby H, Hugdahl K, Jasiukaitis P, Spiegel D (1999) Effects of hypnotizability on performance of a Stroop task and event-related potentials. Percept Mot Skills, 88:819-830.
  • Ozsunar Y, Kayhan H (2021) Hipnozun organik temelleri: beyin görüntüleme ve genetik. In Hipnozda Nörobilimsel ve Klinik Yaklaşımlar (Eds D Ozcengiz, Y Ozsunar): 1-20. Ankara, Akademisyen Kitabevi.
  • Page RA, Green J P (2007) An update on age, hypnotic suggestibility, and gender: a brief report. Am J Clin Hypn, 49:283-287.
  • Paul LK, Brown WS, Adolphs R, Tyszka JM, Richards LJ, Mukherjee P et al. (2007) Agenesis of the corpus callosum: genetic, developmental and functional aspects of connectivity. Nat Rev Neurosci, 8:287-299.
  • Peter B (2005) Gassner's exorcism--not Mesmer's magnetism--is the real predecessor of modern hypnosis. Int J Clin Exp Hypn, 53:1-12.
  • Pintar L (2008) Hypnosis: A Brief History. New York, Wiley.
  • Ponniah K, Hollon SD (2009) Empirically supported psychological treatments for adult acute stress disorder and posttraumatic stress disorder: a review. Depress Anxiety, 26:1086-1109.
  • Presciuttini S, Gialluisi A, Barbuti S, Curcio M, Scatena F, Carli G et al. (2014) Hypnotizability and Catechol-O-Methyltransferase (COMT) polymorphysms in Italians. Front Hum Neurosci, 7:929.
  • Pugnaghi M, Meletti S, Castana L, Francione S, Nobili L, Mai R et al. (2011) Features of somatosensory manifestations induced by intracranial electrical stimulations of the human insula. Clin Neurophysiol, 122:2049-2058.
  • Rainville P, Hofbauer RK, Paus T, Duncan GH, Bushnell MC, Price DD (1999) Cerebral mechanisms of hypnotic induction and suggestion. J Cogn Neurosci, 11:110-125.
  • Raz A (2005) Attention and hypnosis: neural substrates and genetic associations of two converging processes. Int J Clin Exp Hypn, 53:237-258.
  • Raz A (2008) Genetics and neuroimaging of attention and hypnotizability may elucidate placebo. Int J Clin Exp Hypn, 56:99-116.
  • Raz A, Fan J, Posner MI (2006) Neuroimaging and genetic associations of attentional and hypnotic processes. J Physiol Paris, 99:483-491.
  • Raz N, Lindenberger U, Rodrigue KM, Kennedy KM, Head D, Williamson A et al. (2005) Regional brain changes in aging healthy adults: General trends, individual differences and modifiers. Cereb Cortex, 15:1676-1689.
  • Rominger C, Weiss EM, Nagl S, Niederstätter H, Parson W, Papousek I (2014) Carriers of the COMT Met/Met allele have higher degrees of hypnotizability, provided that they have good attentional control: a case of gene-trait interaction. Int J Clin Exp Hypn, 62:455-482.
  • Roussos P, Giakoumaki SG, Pavlakis S, Bitsios P (2008) Planning, decision-making and the COMT rs4818 polymorphism in healthy males. Neuropsychologia, 46:757-763.
  • Rujescu D, Giegling I, Gietl A, Hartmann AM, Möller HJ (2003) A functional single nucleotide polymorphism (V158M) in the COMT gene is associated with aggressive personality traits. Biol Psychiatry, 54:34-39.
  • Santarcangelo EL, Consoli S (2018) Complex role of hypnotizability in the cognitive control of pain. Front Psychol, 9.
  • Seeley WW, Menon V, Schatzberg AF, Keller J, Glover GH, Kenna H et al. (2007) Dissociable intrinsic connectivity networks for salience processing and executive control. J Neurosci, 27:2349-2356.
  • Seeley WW, Zhou J, Kim EJ (2012) Frontotemporal dementia: What can the behavioral variant teach us about human brain organization? Neuroscientist, 18:373-385.
  • Shih M, Yang Y H, Koo M (2009) A meta-analysis of hypnosis in the treatment of depressive symptoms: a brief communication. Int J Clin Exp Hypn, 57:431-442.
  • Spiegel D, Hunt T, Dondershine HE (1988) Dissociation and hypnotizability in posttraumatic stress disorder. Am J Psychiatry, 145:301-305.
  • Stoelb B, Molton I, Jensen M, Patterson D (2009) The efficacy of hypnotic analgesia in adults: A review of the literature. Contemp Hypn, 26:24-39.
  • Storozheva ZI, Kirenskaya AV, Gordeev MN, Kovaleva ME, Novototsky-Vlasov VY (2018) COMT genotype and sensory and sensorimotor gating in high and low hypnotizable subjects. Int J Clin Exp Hypn, 66:83-105.
  • Szechtman H, Woody E, Bowers KS, Nahmias C (1998) Where the imaginal appears real: a positron emission tomography study of auditory hallucinations. Proc Natl Acad Sci U S A, 95:1956-1960.
  • Szekely A, Kovacs-Nagy R, Bányai EI, Gosi-Greguss AC, Varga K, Halmai Z et al. (2010) Association between hypnotizability and the catechol-O-methyltransferase (COMT) polymorphism. Int J Clin Exp Hypn, 58:301-315.
  • Trochu T (2008) L’Amérique de. Pierre Janet : William James & Co. Ann Med Psychol (Paris), 166:199-205.
  • Tunbridge EM, Lane TA, Harrison PJ (2007) Expression of multiple catechol-o-methyltransferase (COMT) mRNA variants in human brain. Am J Med Genet B Neuropsychiatr Genet, 144b:834-839.
  • Uddin LQ (2015) Salience processing and insular cortical function and dysfunction. Nat Rev Neurosci, 16:55-61.
  • Uddin LQ, Nomi JS, Hébert-Seropian B, Ghaziri J, Boucher O (2017) Structure and function of the human insula. J Clin Neurophysiol, 34:300-306.
  • Varma GS, Karadağ F, Erdal ME, Ay Öİ, Levent N, Tekkanat Ç et al. (2011) Katekol-O-metiltransferaz geni Val158Met polimorfizminin şizofreni hastalarındaki bilişsel işlevlere etkileri. Klin Psikofarmakol Bulteni, 21:24-32.
  • Vigliocco G, Kousta ST, Della Rosa PA, Vinson DP, Tettamanti M, Devlin JT et al. (2013) The neural representation of abstract words: The role of emotion. Cereb Cortex, 24:1767-1777.
  • Vogt BA, Hof PR, Zilles K, Vogt LJ, Herold C, Palomero-Gallagher N (2013) Cingulate area 32 homologies in mouse, rat, macaque and human: cytoarchitecture and receptor architecture. J Comp Neurol, 521:4189-4204.
  • Wang Y, Tang W, Fan X, Zhang J, Geng D, Jiang K et al. (2017) Resting-state functional connectivity changes within the default mode network and the salience network after antipsychotic treatment in early-phase schizophrenia. Neuropsychiatr Dis Treat, 13:397-406.
  • Wolberg L R (1948) Medical Hypnosis. New York, Grune & Stratton.
  • Wolf T G, Faerber KA, Rummel C, Halsband U, Campus G (2022) Functional changes in brain activity using hypnosis: A systematic review. Brain Sci, 12:108.
  • Yapko M D (2010) Hypnotically catalyzing experiential learning across treatments for depression: Actions can speak louder than moods. Int J Clin Exp Hypn, 58:186-201.
  • Yücel M, Wood SJ, Fornito A, Riffkin J, Velakoulis D, Pantelis C (2003) Anterior cingulate dysfunction: implications for psychiatric disorders? J Psychiatry Neurosci, 28:350-354.
  • Zammit S, Spurlock G, Williams H, Norton N, Williams N, O'Donovan MC et al. (2007) Genotype effects of CHRNA7, CNR1 and COMT in schizophrenia: interactions with tobacco and cannabis use. Br J Psychiatry, 191:402-407.
  • Zhang R, Volkow N D (2019) Brain default-mode network dysfunction in addiction. NeuroImage, 200:313-331.

Hipnoza Multidisipliner Yaklaşım: Psikiyatrik Temeli, Nörogörüntüleme ve Genetik Bulgular

Year 2024, , 451 - 465, 30.09.2024
https://doi.org/10.18863/pgy.1321465

Abstract

Hipnoz, sıklıkla yanlış anlaşılan ve çeşitli yanılgılarla çevrili bir uygulama olup, antik uygarlıklara kadar uzanan köklü bir tarihi geçmişe sahiptir. Bu derleme, bireyin hipnoza yanıt verme yeteneğini etkileyen organik faktörleri inceleyerek, nöroanatomi, genetik ve hipnotik duyarlılık arasındaki ilişkiyi keşfetmektedir. Bu derleme, özellikle ağrı ve kaygı yönetiminde, hipnozun yüksek düzeyde bilişsel bir aktivite olarak önemini vurgulamakta ve hipnozun sağlık uygulamalarına entegre edilmesinin potansiyel faydalarını belirtmektedir. Son zamanlarda nörogörüntüleme alanındaki ilerlemeler, hipnozun nörolojik mekanizmalarına dair içgörüler sunarken, genetik araştırmalar uygulama alanlarını genişletmiştir. Ancak, süregelen yanılgılar kabulünü engellemektedir. Bu makale, hipnozun kökenleri, psikiyatriyle ilgili tarihsel gelişimi, esas olarak duygulardan sorumlu limbik sistemi etkileyen temel nörogörüntüleme bulguları ve genetik alt yapısına odaklanarak, hipnozu multidisipliner bir şekilde keşfetmeyi amaçlamaktadır. Amacımız, klinisyenleri, sosyal bilimcileri ve sağlık profesyonellerini hipnozun bilimsel temellerini terapötik uygulamalara etkili bir şekilde entegre etmeye teşvik ederek, sonuçları iyileştirmedeki rolünü daha kapsamlı şekilde anlamalarına katkıda bulunmaktır.

References

  • Alladin A (2012) Cognitive hypnotherapy: A new vision and strategy for research and practice. Am J Clin Hypn, 54:249-262.
  • Alladin A, Alibhai A (2007) Cognitive hypnotherapy for depression: An empirical investigation. Int J Clin Exp Hypn, 55:147-166.
  • Andrews-Hanna JR, Reidler JS, Sepulcre J, Poulin R, Buckner RL (2010) Functional-anatomic fractionation of the brain's default network. Neuron, 65:550-562.
  • Baclig MO, Predicala RZ, Mapua CA, Lozano-Kühne JP, Daroy ML, Natividad FF et al. (2012) Allelic and genotype frequencies of catechol-O-methyltransferase (Val158Met) and CYP2D6*10 (Pro34Ser) single nucleotide polymorphisms in the Philippines. Int J Mol Epidemiol Genet, 3:115-121.
  • Barnier AJ, Cox RE, McConkey KM (2014) The province of “highs”: The high hypnotizable person in the science of hypnosis and in psychological science. Psychol Conscious (Wash D C), 1:168-183.
  • Benjamin J, Li L, Patterson C, Greenberg BD, Murphy DL, Hamer DH (1996) Population and familial association between the D4 dopamine receptor gene and measures of novelty seeking. Nat Genet, 12:81-84.
  • Bernheim H (1980) Bernheim's New Studies in Hypnotism. New York, International Universities Press.
  • Blasi G, Goldberg TE, Weickert T, Das S, Kohn P, Zoltick B, et al. (2006) Brain regions underlying response inhibition and interference monitoring and suppression. Eur J Neurosci, 23:1658-1664.
  • Blasi G, Mattay VS, Bertolino A, Elvevåg B, Callicott JH, Das S et al. (2005) Effect of catechol-O-methyltransferase val158met genotype on attentional control. J Neurosci, 25:5038-5045.
  • Braid J (1843) Neurypnology: Or the Rationale of Nervous Sleep, Considered in Relation with Animal Magnetism. London, John Churchill.
  • Bush G, Frazier JA, Rauch SL, Seidman LJ, Whalen PJ, Jenike MA et al. (1999) Anterior cingulate cortex dysfunction in attention-deficit/hyperactivity disorder revealed by fMRI and the counting Stroop. Biol Psychiatry, 45:1542-1552.
  • Bush G, Spencer TJ, Holmes J, Shin LM, Valera EM, Seidman LJ et al. (2008) Functional magnetic resonance imaging of methylphenidate and placebo in attention-deficit/hyperactivity disorder during the multi-source interference task. Arch Gen Psychiatry, 65:102-114.
  • Cabeza R, Nyberg L (2000) Imaging cognition II: An empirical review of 275 PET and fMRI studies. J Cogn Neurosci, 12:1-47.
  • Casiglia E, Finatti F, Gasparotti F, Stabile MR, Mitolo M, Albertini F et al. (2018) Functional magnetic resonance imaging demonstrates that hypnosis is conscious and voluntary. Psychology, 9:1571-1581.
  • Caspi A, Sugden K, Moffitt T E, Taylor A, Craig I W, Harrington H, et al. (2003) Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science, 301:386-389.
  • Chan N, Zhang Z, Yin G, Li Z, Ho R (2023) Update on hypnotherapy for psychiatrists. BJPsych Advances, 29:381-387.
  • Chen JE, Glover GH, Greicius MD, Chang C (2017) Dissociated patterns of anti-correlations with dorsal and ventral default-mode networks at rest. Hum Brain Mapp, 38:2454-2465.
  • Cojan Y, Piguet C, Vuilleumier P (2015) What makes your brain suggestible? Hypnotizability is associated with differential brain activity during attention outside hypnosis. NeuroImage, 117:367-374.
  • Császár N, Scholkmann F, Bókkon I (2021) Implications on hypnotherapy: Neuroplasticity, epigenetics and pain. Neurosci Biobehav Rev, 131:755-764.
  • Dang LC, O'Neil JP, Jagust WJ (2012) Dopamine supports coupling of attention-related networks. J Neurosci, 32:9582-9587.
  • De Benedittis G (2021) Neural mechanisms of hypnosis and meditation-induced analgesia: A narrative review. Int J Clin Exp Hypn, 69:363-382.
  • De Pascalis V, Cacace I, Massicolle F (2008) Focused analgesia in waking and hypnosis: Effects on pain, memory, and somatosensory event-related potentials. Pain, 134:197-208.
  • De Pascalis V, Russo P, Marucci FS (2000) Italian norms for the Harvard group scale of hypnotic susceptibility, form a. Int J Clin Exp Hypn, 48:44-55.
  • Deeley Q, Oakley DA, Toone B, Giampietro V, Brammer MJ, Williams SCR et al. (2012) Modulating the default mode network using hypnosis. Int J Clin Exp Hypn, 60:206-228.
  • Diamond A (2013) Executive functions. Annu Rev Psychol, 64:135-168.
  • Edwards TJ, Sherr EH, Barkovich AJ, Richards LJ (2014) Clinical, genetic and imaging findings identify new causes for corpus callosum development syndromes. Brain, 137:1579-1613.
  • Egner T, Hirsch J (2005) Cognitive control mechanisms resolve conflict through cortical amplification of task-relevant information. Nat Neurosci, 8:1784-1790.
  • Ellenberger HF (1970) The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry. New York, Basic Books.
  • Farrell SM, Tunbridge EM, Braeutigam S, Harrison PJ (2012) COMT Val(158)Met genotype determines the direction of cognitive effects produced by catechol-O-methyltransferase inhibition. Biol Psychiatry, 71:538-544.
  • Fornito A, Yücel M, Pantelis C (2009) Reconciling neuroimaging and neuropathological findings in schizophrenia and bipolar disorder. Curr Opin Psychiatry, 22:312-319.
  • Fromm E, Nash MR (1997) Psychoanalysis and Hypnosis. Madison, CT, International Universities Press.
  • Glatt SJ, Faraone SV, Tsuang MT (2003) Meta-analysis identifies an association between the dopamine D2 receptor gene and schizophrenia. Mol Psychiatry, 8:911-915.
  • Goldberg TE, Egan MF, Gscheidle T, Coppola R, Weickert T, Kolachana BS et al. (2003) Executive subprocesses in working memory: relationship to catechol-O-methyltransferase Val158Met genotype and schizophrenia. Arch Gen Psychiatry, 60:889-896.
  • Goldfried MR, Davison GC (1976) Clinical Behavior Therapy. New York, NY, Holt, Rinehart & Winston.
  • Green JP (2003) Beliefs about hypnosis: Popular beliefs, misconceptions, and the importance of experience. Int J Clin Exp Hypn, 51:369-381.
  • Green JP, Laurence JR, Lynn SJ (2014) Hypnosis and psychotherapy: From Mesmer to mindfulness. Psychol Conscious (Wash D C), 1:199-212.
  • Green JP, Page RA, Rasekhy R, Johnson LK, Bernhardt SE (2006) Cultural views and attitudes about hypnosis: A survey of college students scross four countries. Int J Clin Exp Hypn, 54:263-280.
  • Greicius MD, Srivastava G, Reiss AL, Menon V (2004) Default-mode network activity distinguishes alzheimer's disease from healthy aging: evidence from functional MRI. Proc Natl Acad Sci U S A, 101:4637-4642.
  • Halsband U, Wolf TG (2021) Current neuroscientific research database findings of brain activity changes after hypnosis. Am J Clin Hypn, 63:372-388.
  • Hertrich I, Dietrich S, Blum C, Ackermann H (2021) The role of the dorsolateral prefrontal cortex for speech and language processing. Front Hum Neurosci, 15:645209.
  • Hoeft F, Gabrieli JDE, Whitfield-Gabrieli S, Haas BW, Bammer R, Menon V et al. (2012) Functional brain basis of hypnotizability. Arch Gen Psychiatry, 69:1064-1072.
  • Horton JE, Crawford HJ, Harrington G, Downs JH III (2004) Increased anterior corpus callosum size associated positively with hypnotizability and the ability to control pain. Brain, 127:1741-1747.
  • Das JM, Geetha R (2023) Corpus callosum agenesis. In StatPearls. Treasure Island (FL), StatPearls Publishing.
  • Kanfer FH, Goldstein AP (1986) Helping People Change: A Textbook of Methods. New York, Pergamon Press.
  • Kapur S (2003) Psychosis as a state of aberrant salience: A framework linking biology, phenomenology, and pharmacology in schizophrenia. Am J Psychiatry, 160:13-23.
  • Katonai ER, Szekely A, Vereczkei A, Sasvari-Szekely M, Bányai ÉI, Varga K (2017) Dopaminergic and serotonergic genotypes and the subjective experiences of hypnosis. Int J Clin Exp Hypn, 65:379-397.
  • Kayhan H (2021) Behavioral genetics and predisposition to aggressive behavior. The Research and Reviews on Healthcare: Open Access Journal, 6(5): doi:: 10.32474/RRHOAJ.2021.06.000250.
  • Kirsch I, Low CB (2013) Suggestion in the treatment of depression. Am J Clin Hypn, 55:221-229.
  • Kirsch I, Lynn SJ (1999) Automaticity in clinical psychology. Am Psychol, 54:504-515.
  • Klein KB, Spiegel D (1989) Modulation of gastric acid secretion by hypnosis. Gastroenterology, 96:1383-1387.
  • Klin A, Jones W, Schultz R, Volkmar F (2003) The enactive mind, or from actions to cognition: lessons from autism. Philos Trans R Soc Lond B Biol Sci, 358:345-360.
  • Kocabaş NA, Sardaş S, Cholerton S, Daly AK, Karakaya AE (2002) Cytochrome P450 CYP1B1 and catechol O-methyltransferase (COMT) genetic polymorphisms and breast cancer susceptibility in a Turkish population. Arch Toxicol, 76:643-649.
  • Landry M, Raz A (2015) Hypnosis and imaging of the living human brain. Am J Clin Hypn, 57:285-313.
  • Laurence JR, Perry C (2015) Hypnosis, Will, and Memory: A Psycho-Legal History. New York, Guilford Press.
  • Lechun L, Yu S, Pengling H, Changqi H (2013) The COMT Val158Met polymorphism as an associated risk factor for Parkinson's disease in Asian rather than Caucasian populations. Neurol India, 61:12-16.
  • Lesch KP, Bengel D, Heils A, Sabol SZ, Greenberg BD, Petri S et al. (1996) Association of anxiety-related traits with a polymorphism in the serotonin transporter gene regulatory region. Science, 274:1527-1531.
  • Lichtenberg P, Bachner-Melman R, Ebstein RP, Crawford HJ (2004) Hypnotic susceptibility: multidimensional relationships with Cloninger's tridimensional personality questionnaire, COMT polymorphisms, absorption, and attentional characteristics. Int J Clin Exp Hypn, 52:47-72.
  • Lichtenberg P, Bachner-Melman R, Gritsenko I, Ebstein R (2000) Exploratory association study between catechol-O-methyltransferase (COMT) high/low enzyme activity polymorphism and hypnotizability. Am J Med Genet, 96:771-774.
  • Lifshitz M, Cusumano EP, Raz A (2013) Hypnosis as neurophenomenology. Front Hum Neurosci, 7:469.
  • Lifshitz M, Raz A (2015) Hypnotic ability and baseline attention: fMRI findings from Stroop interference. Psychol Conscious (Wash D C), 2:134-143.
  • Lynn SJ, Kirsch I (2006) Essentials of Clinical Hypnosis: An Evidence-Based Approach. Washington, D.C, American Psychological Association.
  • Lynn SJ, Malakataris A, Condon L, Maxwell R, Cleere C (2012) Post-traumatic stress disorder: cognitive hypnotherapy, mindfulness, and acceptance-based treatment approaches. Am J Clin Hypn, 54:311-330.
  • Mac Hovec FJ (1975) Hypnosis before Mesmer. Am J Clin Hypn, 17:215-220.
  • Maletic V, Robinson M, Oakes T, Iyengar S, Ball SG, Russell J (2007) Neurobiology of depression: an integrated view of key findings. Int J Clin Pract, 61:2030-2040.
  • Männistö P T, Kaakkola S (1999) Catechol-O-methyltransferase (COMT): biochemistry, molecular biology, pharmacology, and clinical efficacy of the new selective COMT inhibitors. Pharmacol Rev, 51:593-628.
  • Maquet P, Faymonville ME, Degueldre C, Delfiore G, Franck G, Luxen A et al. (1999) Functional neuroanatomy of hypnotic state. Biol Psychiatry, 45:327-333.
  • McConkey KM (1986) Opinions about hypnosis and self-hypnosis before and after hypnotic testing. Int J Clin Exp Hypn, 34:311-319.
  • McGeown W J, Mazzoni G, Venneri A, Kirsch I (2009) Hypnotic induction decreases anterior default mode activity. Conscious Cogn, 18:848-855.
  • Mészáros I, Szabó C (1999) Correlation of EEG asymmetry and hypnotic susceptibility. Acta Physiol Hung, 86:259-263.
  • Meyer-Lindenberg A, Weinberger DR (2006) Intermediate phenotypes and genetic mechanisms of psychiatric disorders. Nat Rev Neurosci, 7:818-827.
  • Mier D, Kirsch P, Meyer-Lindenberg A (2010) Neural substrates of pleiotropic action of genetic variation in COMT: a meta-analysis. Mol Psychiatry, 15:918-927.
  • Mikail H, Mamman M (2020) Hypnosis and hypnotherapy: the role of traditional versus alternative approach. In Hypnotherapy and Hypnosis (C Mordeniz). London, UK, InTech Open.
  • Montag C, Kirsch P, Sauer C, Markett S, Reuter M (2012) The role of the CHRNA4 gene in internet addiction: a case-control study. J Addict Med, 6:191-195.
  • Montgomery G H, DuHamel KN, Redd WH (2000) A meta-analysis of hypnotically induced analgesia: how effective is hypnosis? Int J Clin Exp Hypn, 48:138-153.
  • Morgan AH, Hilgard JR (1978) The Stanford hypnotic clinical scale for adults. Am J Clin Hypn, 21:134-147.
  • Moseley RL, Ypma R J, Holt RJ, Floris D, Chura LR, Spencer MD et al. (2015) Whole-brain functional hypoconnectivity as an endophenotype of autism in adolescents. Neuroimage Clin, 9:140-152.
  • Nadon R, Laurence JR, Perry C (1987) Multiple predictors of hypnotic susceptibility. J Pers Soc Psychol, 53:948-960.
  • Nash MR (2001) The truth and the hype of hypnosis. Sci Am, 285:46-49, 52-45.
  • Nash MR (2008) A psychoanalytic theory of hypnosis: a clinically informed approach. In Oxford Handbook of Hypnosis (Eds M Nash, A Barnier):201-224. New York, Oxford University Press.
  • Nordby H, Hugdahl K, Jasiukaitis P, Spiegel D (1999) Effects of hypnotizability on performance of a Stroop task and event-related potentials. Percept Mot Skills, 88:819-830.
  • Ozsunar Y, Kayhan H (2021) Hipnozun organik temelleri: beyin görüntüleme ve genetik. In Hipnozda Nörobilimsel ve Klinik Yaklaşımlar (Eds D Ozcengiz, Y Ozsunar): 1-20. Ankara, Akademisyen Kitabevi.
  • Page RA, Green J P (2007) An update on age, hypnotic suggestibility, and gender: a brief report. Am J Clin Hypn, 49:283-287.
  • Paul LK, Brown WS, Adolphs R, Tyszka JM, Richards LJ, Mukherjee P et al. (2007) Agenesis of the corpus callosum: genetic, developmental and functional aspects of connectivity. Nat Rev Neurosci, 8:287-299.
  • Peter B (2005) Gassner's exorcism--not Mesmer's magnetism--is the real predecessor of modern hypnosis. Int J Clin Exp Hypn, 53:1-12.
  • Pintar L (2008) Hypnosis: A Brief History. New York, Wiley.
  • Ponniah K, Hollon SD (2009) Empirically supported psychological treatments for adult acute stress disorder and posttraumatic stress disorder: a review. Depress Anxiety, 26:1086-1109.
  • Presciuttini S, Gialluisi A, Barbuti S, Curcio M, Scatena F, Carli G et al. (2014) Hypnotizability and Catechol-O-Methyltransferase (COMT) polymorphysms in Italians. Front Hum Neurosci, 7:929.
  • Pugnaghi M, Meletti S, Castana L, Francione S, Nobili L, Mai R et al. (2011) Features of somatosensory manifestations induced by intracranial electrical stimulations of the human insula. Clin Neurophysiol, 122:2049-2058.
  • Rainville P, Hofbauer RK, Paus T, Duncan GH, Bushnell MC, Price DD (1999) Cerebral mechanisms of hypnotic induction and suggestion. J Cogn Neurosci, 11:110-125.
  • Raz A (2005) Attention and hypnosis: neural substrates and genetic associations of two converging processes. Int J Clin Exp Hypn, 53:237-258.
  • Raz A (2008) Genetics and neuroimaging of attention and hypnotizability may elucidate placebo. Int J Clin Exp Hypn, 56:99-116.
  • Raz A, Fan J, Posner MI (2006) Neuroimaging and genetic associations of attentional and hypnotic processes. J Physiol Paris, 99:483-491.
  • Raz N, Lindenberger U, Rodrigue KM, Kennedy KM, Head D, Williamson A et al. (2005) Regional brain changes in aging healthy adults: General trends, individual differences and modifiers. Cereb Cortex, 15:1676-1689.
  • Rominger C, Weiss EM, Nagl S, Niederstätter H, Parson W, Papousek I (2014) Carriers of the COMT Met/Met allele have higher degrees of hypnotizability, provided that they have good attentional control: a case of gene-trait interaction. Int J Clin Exp Hypn, 62:455-482.
  • Roussos P, Giakoumaki SG, Pavlakis S, Bitsios P (2008) Planning, decision-making and the COMT rs4818 polymorphism in healthy males. Neuropsychologia, 46:757-763.
  • Rujescu D, Giegling I, Gietl A, Hartmann AM, Möller HJ (2003) A functional single nucleotide polymorphism (V158M) in the COMT gene is associated with aggressive personality traits. Biol Psychiatry, 54:34-39.
  • Santarcangelo EL, Consoli S (2018) Complex role of hypnotizability in the cognitive control of pain. Front Psychol, 9.
  • Seeley WW, Menon V, Schatzberg AF, Keller J, Glover GH, Kenna H et al. (2007) Dissociable intrinsic connectivity networks for salience processing and executive control. J Neurosci, 27:2349-2356.
  • Seeley WW, Zhou J, Kim EJ (2012) Frontotemporal dementia: What can the behavioral variant teach us about human brain organization? Neuroscientist, 18:373-385.
  • Shih M, Yang Y H, Koo M (2009) A meta-analysis of hypnosis in the treatment of depressive symptoms: a brief communication. Int J Clin Exp Hypn, 57:431-442.
  • Spiegel D, Hunt T, Dondershine HE (1988) Dissociation and hypnotizability in posttraumatic stress disorder. Am J Psychiatry, 145:301-305.
  • Stoelb B, Molton I, Jensen M, Patterson D (2009) The efficacy of hypnotic analgesia in adults: A review of the literature. Contemp Hypn, 26:24-39.
  • Storozheva ZI, Kirenskaya AV, Gordeev MN, Kovaleva ME, Novototsky-Vlasov VY (2018) COMT genotype and sensory and sensorimotor gating in high and low hypnotizable subjects. Int J Clin Exp Hypn, 66:83-105.
  • Szechtman H, Woody E, Bowers KS, Nahmias C (1998) Where the imaginal appears real: a positron emission tomography study of auditory hallucinations. Proc Natl Acad Sci U S A, 95:1956-1960.
  • Szekely A, Kovacs-Nagy R, Bányai EI, Gosi-Greguss AC, Varga K, Halmai Z et al. (2010) Association between hypnotizability and the catechol-O-methyltransferase (COMT) polymorphism. Int J Clin Exp Hypn, 58:301-315.
  • Trochu T (2008) L’Amérique de. Pierre Janet : William James & Co. Ann Med Psychol (Paris), 166:199-205.
  • Tunbridge EM, Lane TA, Harrison PJ (2007) Expression of multiple catechol-o-methyltransferase (COMT) mRNA variants in human brain. Am J Med Genet B Neuropsychiatr Genet, 144b:834-839.
  • Uddin LQ (2015) Salience processing and insular cortical function and dysfunction. Nat Rev Neurosci, 16:55-61.
  • Uddin LQ, Nomi JS, Hébert-Seropian B, Ghaziri J, Boucher O (2017) Structure and function of the human insula. J Clin Neurophysiol, 34:300-306.
  • Varma GS, Karadağ F, Erdal ME, Ay Öİ, Levent N, Tekkanat Ç et al. (2011) Katekol-O-metiltransferaz geni Val158Met polimorfizminin şizofreni hastalarındaki bilişsel işlevlere etkileri. Klin Psikofarmakol Bulteni, 21:24-32.
  • Vigliocco G, Kousta ST, Della Rosa PA, Vinson DP, Tettamanti M, Devlin JT et al. (2013) The neural representation of abstract words: The role of emotion. Cereb Cortex, 24:1767-1777.
  • Vogt BA, Hof PR, Zilles K, Vogt LJ, Herold C, Palomero-Gallagher N (2013) Cingulate area 32 homologies in mouse, rat, macaque and human: cytoarchitecture and receptor architecture. J Comp Neurol, 521:4189-4204.
  • Wang Y, Tang W, Fan X, Zhang J, Geng D, Jiang K et al. (2017) Resting-state functional connectivity changes within the default mode network and the salience network after antipsychotic treatment in early-phase schizophrenia. Neuropsychiatr Dis Treat, 13:397-406.
  • Wolberg L R (1948) Medical Hypnosis. New York, Grune & Stratton.
  • Wolf T G, Faerber KA, Rummel C, Halsband U, Campus G (2022) Functional changes in brain activity using hypnosis: A systematic review. Brain Sci, 12:108.
  • Yapko M D (2010) Hypnotically catalyzing experiential learning across treatments for depression: Actions can speak louder than moods. Int J Clin Exp Hypn, 58:186-201.
  • Yücel M, Wood SJ, Fornito A, Riffkin J, Velakoulis D, Pantelis C (2003) Anterior cingulate dysfunction: implications for psychiatric disorders? J Psychiatry Neurosci, 28:350-354.
  • Zammit S, Spurlock G, Williams H, Norton N, Williams N, O'Donovan MC et al. (2007) Genotype effects of CHRNA7, CNR1 and COMT in schizophrenia: interactions with tobacco and cannabis use. Br J Psychiatry, 191:402-407.
  • Zhang R, Volkow N D (2019) Brain default-mode network dysfunction in addiction. NeuroImage, 200:313-331.
There are 119 citations in total.

Details

Primary Language English
Subjects Psychiatry, Genetics-Environment Interaction, Clinical Neuropsychology, Psychotherapy Practise and Research
Journal Section Review
Authors

Yelda Özsunar 0000-0003-2642-5464

Handan Kayhan 0000-0003-4967-2740

Lara Utku Ince 0000-0003-3440-8824

Publication Date September 30, 2024
Acceptance Date December 1, 2023
Published in Issue Year 2024

Cite

AMA Özsunar Y, Kayhan H, Utku Ince L. Multidisciplinary Approach to Hypnosis: Psychiatric Basis, Neuroimaging and Genetic Findings. Psikiyatride Güncel Yaklaşımlar. September 2024;16(3):451-465. doi:10.18863/pgy.1321465

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