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Another Example of Confusion in Trance Induction  Milton H. Erickson

Estimated reading time: 2 minutes, 22 seconds.

As told to the Ernest L. Rossi in 1976.

On one occasion Erickson was lecturing to a group of doctors about hypnosis. He was interrupted when another doctor brought in two women volunteers who were interested in experiencing hypnosis and introduced them to Erickson. In the following he describes the situation as he understood it.

Erickson: I began by telling them that they really didn’t know anything about me but I had at least an average education; I’d gone to grade school; I’d lectured to doctors; I had learned to count, I could count to twenty easily; I could count to twenty by one, by twos, fours, fives, or tens; I could write my name. I told them a sheer bunch of nonsense along with that important statement about counting to twenty in different ways. And then I said, “Now, of course, whenever I count to twenty, you can go into a hypnotic trance.” They just looked at me and I continued with my nonsensical discussion of irrelevant facts about myself. I liked corned beef, I liked golden-eyed trout, etc. Then I looked at them significantly and said, “I had four boys and four girls- that makes eight. They really come cheaper by the dozen, you know.” With that they both went into a trance. Eight and twelve is twenty. The women came in expecting to go into a trance. They just didn’t know what a trance induction was, so I started the nonsense discussion in which I talked about my education and counting to twenty; telling them that when I came to twenty they would go into a trance- then slipping in the statement, four boys, four girls-they come cheaper by the dozen; four plus four plus twelve equal twenty. I had earlier said that I could count to twenty in any fashion, and when I come to twenty you go into a trance. They went into a trance just that quickly. All that nonsense was not really nonsense; it was a confusion procedure. While they tried desperately to make sense out of all of that nonsense I was telling them (because it is nonsensical for somebody lecturing to a group of doctors to talk in that fashion), they probably asked themselves, “Why is he talking in that fashion? Why is he saying that? Why is he telling that to us?” They tried desperately to make some meaning out of it, and the first possible meaning to it was four plus four plus twelve, and as soon as they put that meaning on it, they went into a trance. Nice demonstration of confusion technique and of subjects struggling to put a meaning upon what you say and your awareness that the subjects are going to put a meaning upon what you say. Give them plenty and let them select.

Hypnotherapy with a Psychotic Milton H. Erickson and Ernest L. Rossi

Estimated reading time: 7 minutes, 43 seconds. 

Unpublished manuscript, circa 1940s, edited by E. L. Rossi

Laskarri had been diagnosed on the psychiatric ward as suffering from schizophrenia of the mixed catatonic-hebephrenic type. He was moderately disturbed in his behavior; several times a day he would shout gibberish apparently at hallucinatory figures and race back and forth and around and about the dormitory beds or scramble frantically under and over them. Or in the dayroom comparable behavior might be manifested in relation to the chairs and tables. Otherwise, he merely mumbled and muttered when questioned, despite the fact that he had a college education. Another item of great interest was his alert, intelligent gaze when not disturbed emotionally. He seemed to be intently studying his fellow patients and the interpersonal relationships between patients and the nursing and medical personnel. Yet when approached directly, his interest seemed to vanish and his gaze became veiled.

INDIRECT TRANCE INDUCTION

 Made curious by “this” Laskarri’s behavior, the writer approached a passively obedient, rather stuporous patient and maneuvered him into a chair nearby so that Laskarri would have a full view of him. The writer then took a chair slightly to one side so that his primary view was of the stuporous patient but his secondary, somewhat sidelong glance permitted an adequate view of Laskarri. In effecting this seating arrangement the writer spoke earnestly and intensely to the unresponsive stuporous patient, but was well aware of Laskarri’s intent observations. The writer then gave the stuporous patient a series of suggestions to induce attentiveness, relaxation, a state of restfulness, a state of attentive sleep, restful sleep during which one might hear, understand, wish to respond, to communicate, to tell things of interest, to need to tell one’s thoughts and feelings, to express one’s need to ask for help, to do so comfortably even while asleep and without fear.

Previous experimentation with the mildly stuporous patient, who tended to stand about immobile with a vacuous expression in his eyes, had disclosed that he would, if seated in a chair, loll comfortably and seemingly go to sleep. No interpersonal contact had yet been made with him, but he could be used as a suggestive example for Laskarri.

Peripheral vision and sidelong glances soon disclosed that Laskarri, as is common among normal people, was responding to the suggestions he apparently thought were addressed to the subject. Shortly Laskarri gave every appearance of being in a trance, and he manifested catalepsy upon being tested. Slowly the tempo of the hypnotic “sleep” suggestions was decreased, and there was a gradual replacement of them by increasingly urgent suggestions that sometime, somewhere, somehow, courage be found to tell a little, just a little about what happens when you run, you twist, you turn, you crawl over, crawl under, run, twist, shout, sometime soon, somehow, must some way … will … must … can … must … tell what happens when crawl, run, rush, shout, go over, go under.

These suggestions were repeated many times-softly, gently, insistently, urgently-and they were followed with cautious slowness, “… and head will   nod, nod, nod, yes … yes … yes … yes … slowly nod yes … slowly … will do … will do soon.”

Shortly Laskarri’s head nodded “yes” gently, perseveratively, and further suggestion was offered that he sleep restfully for a while, since he might want to say something that afternoon. The afternoon of that same day the writer slowly made ward rounds, finally seating himself in a chair beside Laskarri and waited patiently. Within 20 minutes Laskarri leaned over slightly and murmured, “Big Joe-you-put Joe asleep-put him asleep-different way.”

What Laskarri meant was readily recognized. Some 10 days previously Big Joe, six feet five inches tall and 275 pounds, had become increasingly restless and had announced finally, in the writer’s presence, his intention of “singing and yelling for about an hour” and then “smashing the ward and everybody in it.” There had been previous such experience with him. Immediately the writer secured a syringe with 15 grains of sterile intravenous solution of sodium amytal and took a seat in front of Big Joe’s chair. Suspiciously Big Joe inquired if an intravenous injection was planned. He was told that none was planned, but that if he were to sing and yell for about an hour, his mouth would get dry, but the writer could squeeze a small stream into his mouth without interrupting his singing and yelling and his mouth would not get dry and sore. Big Joe nodded his head agreeably, tipped his head back, and began his bellowing. Little by little the sodium amytal was squirted into Joe’s mouth. He swallowed it as he sang and soon lapsed into sleep.

Having thus oriented the writer to his needs, Laskarri’s requests now became more personally meaningful. The writer moved his chair closer and Laskarri said, “Sleep-I dream awful dreams-you help.” Suggestions of hypnotic sleep were offered, and soon Laskarri was in a trance. He replied to questions of what he should do by answering, “Just let me sleep here in chair-awful dream-hurt-hurt.” Taking a chance, I told him, “Sit here in chair, don’t move, don’t wake up, just don’t hurt-just dream awful dream and then tell me.”

He seized my wrist, shuddered, perspired, and kept on shuddering and moaning. After some 15 minutes he aroused, stating, “My dream-I had it-I    got to keep dreaming until I find out.” What it was he had to find out he could not tell. But the next day he could tell the content of the dream, and he begged for further help because he must dream until he found an answer. The content of the dream was that he was being forced, shoved, pulled, yanked, twisted, and thrown through an endless, lightless corridor crowded and filled with bramble bushes, thorny bushes, crucifixion thorns, barbed wire, jagged spikes, long, penetrating slivers of glass, swords, daggers, all manner of painful lacerating, cutting things-a journey that would come to a sudden end with the knowledge that again he would have to traverse that painful way until he “found it.” Though approached many times, Laskarri never had revealed anything verbally to any of the hospital personnel. [MHA’s original manuscript was left in an incomplete form at this point. Questioning by Ernest Rossi completed the case history in 1978]

Rossi: What was the next step of your therapy with Laskarri?

Erickson: The next dream was of a similar character. I then told him to dream the same dream again with a different set of characters. In his next dream, instead of bramble bushes, he found himself dealing with a net full of fishhooks.

Rossi: This variation of the dream indicated that his unconscious was receiving your suggestions and that he had enough control within his inner processes to actually modify them in accordance with your suggestions.

Erickson: He repeated that dream with a number of people in it. He did not know who they were or even their sex, but they were fishing. Somehow or other they would snag him in that net full of fishhooks. In the next dream it was the same situation with another cast of characters on a grassy bank of a river with four people there all fishing. Three of them (two women and a man) kept catching him with their fishhooks. The fourth person, a man, caught a fish. He then fried this fish, and it smelled good.

The final dream was of an older brother of his who protected him; he was the one who caught and fried the fish that smelled so good in the previous dream. The other three people who caught Laskarri were his mother, father, and sister. These three were the hurtful people in his earlier life.

Rossi: Did you interpret that dream to him?

Erickson: No, he interpreted it to me! He said he could never get along with his father, mother, or sister, but he could get along with his brother, who always did good things for him. Then we discussed what he ought to do when he left the hospital.

Rossi: Most of his personality was intact; he just needed this insight. The bad dreams of the dark corridor with sharp cutting things were symbolic of the hurt arising from his early family situation. Do you agree that insight was the curative factor in this case? This was a case where the unconscious did have to be made conscious, as Freud believed.

Erickson: Yes. Familiarity breeds contempt. When you go through a painful situation again and again in a dream, changing it a bit each time, it becomes less painful.

Rossi: Yes, that is the desensitization technique of behavior therapy.

Erickson: I got into a lot of trouble over that case. The staff said I had no right to engage in the “unethical and unprofessional act” of sedating Big Joe that way while he was singing.

Rossi: But that act not only protected the ward, it also helped Laskarri gain a positive transference to you as that protective older brother.

Erickson: When he saw the difficulty I got into with the nurses and doctors over my undignified way of sedating Big Joe, that also helped him sympathize and establish rapport with me. The hospital staff did not realize I was actually carrying out Laskarri’s first request to put Big Joe asleep in a “different way.”

Ericksonian Brief Psychotherapy in the New Millennium: Immediate-Early Genes in the Deep Psychobiology of Psychotherapy Ernest Lawrence Rossi

Estimated reading time: 24 minutes, 48 seconds.

The traditional psychotherapies, ranging from classical psychoanalysis to current cognitive-behavioral schools, usually conceptualize communication in terms of verbal interactions between the therapist and patient. The brain and body in the early behaviorist school, for example, were labeled a “black box” that need not be taken into account in describing human behavior. In contrast to this traditional approach, Milton H. Erickson (1948/1980) emphasized that it was the experiential “reassociation,” “reorganization,” and “resynthesis” of one’s internal life that led to problem solving and healing as follows:

The induction and maintenance of a trance serves to provide a special psychological state in which the patient can reassociate and reorganize his inner psychological complexities and utilize his own capacities in a manner in accord with his own experiential life … Therapy results from an inner resynthesis of the patient’s behavior achieved by the patient himself. It’s true that direct suggestion can effect an alteration in the patient’s behavior and result in a symptomatic cure, at least temporarily. However such a “cure” is simply a response to suggestion and does not entail that reassociation and reorganization of ideas, understandings, and memories so essential for actual cure. It is the experience of reassociating and reorganizing his own experiential life that eventuates in a cure, not the manifestation of responsive behavior which can, at best, satisfy only the observer. (p. 38, italics added)

How are we to understand Erickson’s view of the reassocation and re­synthesis of experiential life? Is it simply a process of change that takes place in a kind of subjective phenomenological space of cognitions, fantasies, and dreams, or does it involve transformations in the organic structure and functioning of the brain and body, as well? This chapter proposes that the current information revolution in psychology and medicine on the cellular-genomic level is creating a new foundation for the understanding of Erickson’s view of “reassociation” and “resynthesis” as the essence of healing leading to lasting impressions in psychotherapy. Prominent researchers, for example, now regard immediate-early response genes (IEGs) as rapidly acting mediators between nature and nurture at the cellular-genomic level. The IEGs act as transducers, allowing brief signals from the external environment to regulate the expression of genes within the nucleus of life itself. It is now known that IEGs can transduce strong but brief signals of pain, trauma, stress, and novelty from the environment into enduring changes in the physical structure of the brain, as well as memory, learning, and behavior. This chapter explores how currently emerging understanding of the pathways of communication between mind and gene may become the psychobiological basis of Ericksonian brief therapy for creating lasting impressions.

IEGs AS THE FIRST RESPONSE TO EMOTIONAL AROUSAL

A generation ago, it was believed that genes were simply the units of physical heredity that were transmitted from one generation to another through sexual reproduction. Today, we know that different classes of genes have a number of other adaptive functions throughout the life cycle. A major class of genes, sometimes called immediate-early genes (or primary response genes or third messengers), that are actively  turned on and off every second of our lives in response to physical and psychosocial stimuli, are important in the continual process of adaptation to our changing environment. Everything from physical trauma and toxins to temperature, psychosocial stress, food, and sexual stimuli in the environment  can be signaled to neurons in the brain, where IEGs are turned on as the first step in the arousal of a creative response system at the molecular-genomic level, as illustrated in Figure 1.

{ADD FIGURE 1}

In step 1, IEGs initiate a series of molecular-genomic transformations that can transduce relatively brief signals from the environment into lasting impressions in the physical structure of the developing nervous system throughout life. When neurons of the brain transmit electrochemical signals to each other, IEGs are activated immediately as the first step in an adaptive response at the cellular-genomic level (Dragunow, 1995; Tolle, Schadrack, & Zieglgansberger, 1995).

Cfos, for example, is an IEG that is stimulated into activity by arousing or stressful environmental stimuli within neurons of the brain, where it leads to the production of a protein called “fos.” Fos can then act as a transcription factor that turns on “target genes.” That is, fos can bind on to the DNA molecule, where it can turn on target genes as illustrated in step 2 of Figure 1. These target genes are transcribed so that the information they contain can be sent to the cell in the form of messenger ribonucleic acid (mRNA). This mRNA then serves as a kind of blueprint for manufacturing the proteins in step 3 that are the bottom line for most processes of adaptation and healing on the material, energetic, and informational levels of life in response to psychosocial, as well as physical, stress and trauma (Rossi, 1986/1993, 1996, 1997a, 2002).

Many researchers now believe that memories, along with new experiences, are encoded in the central nervous system (CNS) by changes in the structure and formation of new proteins within neurons. IEGs function as transcription factors regulating downstream target genes that make the proteins within the neurons. Much current research is concerned with a number of families of IEGs involved with memory and learning, such as the egr family (also know as the zif 268 family, or krox -24 family). More than 100 IEGs have been reported so far. Although many of their functions still remain unknown, neuroscientists are exploring the complex range of interrelated biological and psychological functions that IEGs are already known to serve. It is precisely this simultaneous mediation of both the biological and psychological levels – the psychobiological – that recommends a central role for IEGs in understanding the foundations of mind-body medicine and psychotherapy, as illustrated in Figure 2.

{ADD FIGURE 2}

In the neurons of the CNS, the IEGs are now recognized as general or universal transducers responding to many classes of noxious environmental stimuli by inducing adaptive changes in gene transcription to facilitate the healing of stress and trauma caused by mechanical or physical injury, severed neurons, epilepticus, spreading cortical depression, viral and bacterial infections, drug intoxication, and the like (Merchant, 1996). Studies of the role of cfos are currently changing the face of pain research, for example, in both acute and chronic pain, in phantom limb pain, and in hyperalgesia and allodynia. (Tolle, Schadrack, & Zieglgansberger, 1995). Drugs dealing with pain, as well as related addictive drugs, such as cocaine, amphetamine, and the opiates, are also mediated by IEGs.  The implication is that IEGs are central in the  expression  of  the emotions,  moods, and behavioral addictions that are of prime interest in psychotherapy.

Most arousing environmental stimuli that have been studied can in­duce IEGs within minutes; their concentrations typically peak within 15 to 20 minutes and their effects are usually over within an hour or two (Rossi, 2002; Schlingensiepen, 1995). These rapid changes in gene transcription and new protein formation, however, can lead to enduring transformations in the CNS by converting short-term memory to long­ lasting learning by the process of long term potentiation (Bailey, Bartsch, & Kandel, 1996; Dragunow, 1995; Tully, 1996). Immediate-early genes are now also used as markers or indicators of changes in neuronal activity in psychopathological conditions, such as schizophrenia. Antipsychotic drugs are being designed to modulate the effects of IEGs on pathways leading to the production and utilization of neurotransmitters, such as dopamine, serotonin, and noradrenaline, that are implicated in the “dopamine hypo­thesis” of schizophrenia.

There is as yet no research relating to hypnosis or psychotherapy to the IEG-protein cascade in healing. Recent research on the relation of the IEG c-fos and nerve growth factor-induced A (NGFI-A) in the wake-sleep cycle, however, suggests how they may be related to patterns of arousal and relaxation in hypnotherapy. It has been found “that the expression of c-fos during waking is strictly dependent on the level of activity of the noradrenergic system: “high levels of c-fos during forced and spontaneous waking and low levels during sleep” (Cirelli, Pompeiano, & Tononi, 1998, p. 46). It is tempting to speculate that such stimulation of the noradrenergic system and IEG expression may be the molecular-genetic basis of healing in hypnosis. This leads us to propose that a truly deep psychobiological model of how psychotherapy works at the cellular level to facilitate the lasting impressions of mindbody healing on a physical level as well as on the emotional and mental levels, must involve these moleculargenetic levels.

PATHWAYS OF MIND-GENE COMMUNICATION IN ANXIETY AND DEPRESSION

Much of conventional counseling and psychotherapy consists of talk at an ordinary level of attention and emotional arousal. Genuinely transforming psychological experiences of therapy, however, usually involves some­thing more. Typically, the patient becomes emotionally aroused with highly focused attention when deeply significant psychological experiences are touched upon. Dramatic shifts in posture, mood, and emotional expressions, and tears, flushing, and breathing changes are all common accompaniments of the creative moments of psychological insight that can lead to lasting impressions and transformations of a patient’s life (Rossi & Cheek, 1988, 1990). Such emotional arousal, illustrated as step 1 in Figure 1, has been described in great detail, with varying emphasis and interpretation, in the classical literature of hypnosis and depth psychotherapy as abreaction, catharsis, reliving and reframing of posttraumatic experiences, creative moments of transformation, and so on (Rossi, 1973a, 1973b, 1996, 2002).

The first step in mind-gene communication in such emotionally arousing processes of psychotherapy takes place in the limbic-hypothalamic­ pituitary system, which is currently recognized as a major information transducer between the brain and the body. The pioneering physiologist Papez (1937) first traced the anatomical pathways by which emotional experiences of the brain were transduced into the physiological responses of the body in that system. The Scharrers (1940) and Harris (1948) then illustrated how the secretory cells within the hypothalamus could mediate molecular information transduction between brain and body. Cells within the hypothalamus transform the essentially electrochemical neural impulses of the neurons of the cerebral cortex that apparently encoded the phenomenological experience of “mind” and emotions into the hormonal messenger molecules of the endocrine system that are communicated to the body through the bloodstream in a cybernetic loop of information transduction, as described previously (Rossi, 1986/1993, 1996, 2002).

One of the first hormonal messenger molecules to be expressed in the hypothalamus in response to physical, as well as psychosocial, stress is corticotrophin-releasing factor (CRF). Within a minute, CRF signals the pituitary to release ACTH into the bloodstream as a primary messenger molecule, where it travels to the adrenals and signals them to release the next messenger, cortisol, into the bloodstream, where it can turn on cells throughout the entire body to activate their special functions to cope adaptively with stress. This major pathway from mind to molecules in response to stress has been called the hypothalamic-pituitary-adrenal (HPA) axis. During the emergence of stress, cortisol signals muscle cells to absorb fuel to facilitate the “fight or flight response,” while CRF de­ presses appetite and sexuality and sharpens alertness to cope with the environmental stressor.

Several decades of neurobiological research have documented that when there is a chronic stressor, activating the HPA axis to the point where the organism no longer can cope, the conditions are being set for depression. It has been shown that the pituitary and the adrenal gland are actually enlarged because of the hyperactivation of the HPA axis in depressed patients. Microscopic examination of the brain tissues of these patients reveals that there has been a proliferation of CRF-producing neurons in the hypothalamus and an overexpression of the CRF gene, leading to an elevation of CRF in the cerebrospinal fluid and the typical behavior of depression in humans, such as insomnia, decreased appetite and libido, anxiety, and negative cognition.

Although this excessive production of CRF can be reduced by antidepressants and electroconvulsive treatments, there are unwanted side effects. This has led some psychobiologically oriented workers to call for brain-imaging studies with positron emission tomography (PET) to deter­mine whether or not the activity of CRF-producing neurons and the expression of the CRF gene might not be  modified  by  psychotherapy  as well (Nemeroff, 1998). While such workers do not state it as explicitly as here, the direct implication of this research would be that appropriately focused mental activity in psychotherapy could modulate gene expression, as well as the anatomical structure of neurons in the hypothalamus of the human brain. This would clearly document how the mind can modulate molecules as well as how molecules can modulate the mind (Rossi, 1986/ 1993). This mutual modulation between mind and molecules is the essence of what has been called state-dependent memory, learning, and behavior (Rossi, 1990, 1996). This breakthrough in the Cartesian dichotomy between  mind and  body is well  expressed  by Andreasen  (1997, p. 1592) as follows.

A key point … is that the anatomy of melancholy can be modified by both psychological and chemical/ molecular experiences. The depressed state can often be reversed through treatment with drugs that affect the biogenic amine systems of the brain, but it can also be treated with cognitive therapies that attempt to reverse “negative sets,” and combination therapies are perhaps the most effective of all. Depression may be a consequence of the plastic response of mind/brain to experience, and it may also remit because of either pharmacological or psychotherapeutic manipulations of brain plasticity.

The concept of gene-protein dynamics as the final common path to healing integrates traditional physical medicine with mind-body models and becomes an important criterion for evaluating all forms of therapeutic communication and healing – biofeedback, body work, meditation, imagery, active imagination, hypnosis, prayer, ritual, yoga, or whatever – with a common yardstick. Whatever the therapeutic method, we can test whether it has really facilitated healing with relatively simple assays that determine whether appropriate genes are expressed in the form of mRNAs (step 2 of Figure 1) that serve as “blueprints” for the synthesis of proteins. A dramatic example is provided by Schanberg (Pauk, Kuhn, Field, & Schanberg, 1986; Schanberg, personal communication, 1998), who found that “isolated very premature human babies showed marked gains in weight, development and sympathoadrenal maturation” when they were massaged. He reports that in an animal model (pre-weaning rat pups), “The absence of nurturing touch suppresses ODC [ornithine decarboxylase] gene transcription by interfering with a cell’s ability to transduce the hormone receptor-activated signal. This is accomplished by the down regulation of specific immediate early genes essential to the synthesis of this growth regulating enzyme.” Such research literature implies that both touch and verbal suggestion can initiate gene-protein cascades to facilitate growth and healing at the cellular level. Further research may afford a new methodology for differentiating the relative merits of the many approaches to hypnosis and their therapeutic applications.

PSYCHOIMMUNOLOGY, STRESS, CANCER, ANDIEGs

The most comprehensive demonstration of how psychosocial stress can modulate gene transcription was demonstrated by Ronald Glaser (Glaser, et al., 1990; Glaser, Lafuse, Bonneau, Atkinson, & Kiecolt-Glaser, 1993). His research helps us trace the effects of psychological stress (experienced by medical students during academic examinations) on the transcription of the interleukin-2 receptor gene and interleukin-2 production. These re­ searchers, in essence documented the same path of information transduction illustrated in Figure 1 where (1) stress-activated IEGs in the limbic­hypothalamic-pituitary system lead to the release of hormones (primary messengers) that trigger (2) cell receptors to initiate a cascade of secondary messengers (cAMP) that mediate gene transcription of the interleukin-2 Skinnerian, imprinting, sensitization, etc.) involve the four-step cascade of Figure 1. Insofar as these classical forms of learning are initiated with IEGs leading to the formation of messenger molecules, they ipso facto have a “state-dependent component” (Rossi, 1986/1993; Rossi & Cheek, 1988, 1990; Rossi, 1996, 2002).

This four step cascade of information transduction between arousal and stress, immediate-early genes, messenger molecules, and the state-dependent encoding of mind body problems suggest a new research frontier for the psychobiological investigation of many classical psychoanalytic concepts, such as repression, dissociation, and emotional complexes. A new paradigm for such research has been provided by Cahill and associates (Cahill, Prins, Weber, & McGaugh, 1994), who compared the effects of the beta-adrenergic receptor antagonist propranolol hydrochloride on the long-term memory for an emotion-arousing and an emotionally neutral short story. Their results support the neuroscience paradigm of how enhanced memory associated with emotional experiences involves activation of the messenger molecules of the beta-adrenergic system. It would require only a simple extension of their method to document how the arousal phase of a psychobiologically oriented psychotherapy is mediated by the activation of similar messenger molecule-receptor systems.

A NEW PSYCHOBIOLOGICAL APPROACH TO PSYCHOTHERAPY

How long does it take to process one complete cycle of communication between mind and gene in Figure 1? Detailed research on the genetic, neuroendocrinal, and psychosocial levels suggests that the 90-120-minute ultradian rhythm (Lloyd & Rossi, 1992, 1993), originally described as the “basic rest-activity cycle” by K.leitman, is a more fundamental “work cycle of life” than the circadian cycle (the 24-hour rhythm). Ultradian in this context means any rhythm faster than the 24-hour circadian cycle; in this chapter, we focus on the major 90-120-minute ultradian rhythms on the genetic, endocrine, and cognitive-behavioral levels during sleeping and waking that have important implications for a new understanding of how all the systems of traditional psychophysiology are actually coordinated in time.

When the 90-120-minute ultradian cycle of mindbody communication of Figure 1 is unfolded over time we get graphs of the alternating ultradian rhythms of activity and rest on the genetic, endocrine and cognitive behavioral, as illustrated on the lower part of Figure 3 (Rossi, 1996). This coordination of the diverse systems of traditional psychophysiology via their time parameters has been called the “Unification Hypothesis of Chronobiology” (Lloyd & Rossi, 1992; Rossi & Lippincott, 1992; Rossi, 1986/1993). This new understanding of the chronobiology of our natural psychophysiology from the molecular-genetic to the cognitive-behavioral levels may be taken as a new database for understanding the dynamics of mind-body communication and healing in psychotherapy.

The lower part of Figure 3 summarizes the alternating 90-120-minute ultradian rhythms of the awake and sleep states of an entire day in a simplified schematic manner. The ascending peaks of rapid eye movement (REM) sleep characteristic of nightly dreams every 90-120 minutes or so are illustrated along with the more variable ultradian rhythms of activity, adaptation, and rest in the daytime. Figure 3 also illustrates how many hormonal messenger molecules of the endocrine system such as growth hormone, the activating and stress hormone cortisol, and the sexual hormone testosterone have a typical circadian peak at different times of the 24-hour cycle. Because the nonlinear chronobiological release of many of these hormones (Rossi, 1988) is recognized as having profound state­dependent effects on memory, learning, emotions, and behavior through­out the day, it is important to consider their relevance for new models of psychotherapy.

{INSERT FIGURE 3}

The upper part of Figure 3 illustrates my conjecture (Rossi, 1996) that the natural unit of psychobiologically oriented psychotherapy may be a utilization of one 90-120-minute ultradian cycle of activity and rest. In support of this idea, we may cite much research of the type illustrated by Iranmanesh, Lizarralde, Johnson, and Veldhuis (1989), for example, who documented how the ultradian peaks of cortisol secretion that lead to psychophysiological states of arousal every 90-120 minutes or so throughout the day (that I label as “Ultradian Performance Peaks” in Figure 3) are typically followed after about 20 minutes by ultradian peaks of beta endorphin that lead to rest and relaxation that I label as “Ultradian Healing Responses” (Rossi, 1996; Rossi & Nimmons, 1991). It appears as if nature has built in a natural but flexible and highly adaptive ultradian rhythm of activity, rest, and healing, the “work cycle of life” mentioned above, every 90-120 minutes.

What, exactly, is the “work” that is done in each 90-120-minute ultradian cycle? I propose that the essence of such work is the formation of new proteins for a creative response to changing environmental conditions, stress and healing as described above particularly in the research of Todorov (1990). Twenty-five years ago (Rossi, 1972/1985/2002), I formulated “The Dream-Protein Hypothesis: Recent studies of learning and memory indicate that new experience is encoded by means of protein synthesis in brain tissue … dreaming is a process of psychophysiological growth that involves the synthesis or modification of protein structures in the brain that serve as the organic basis for new developments in the personality” (Rossi, 1973a, p. 1094). While recent research has documented that new proteins are synthesized in some brain structures associated with REM dream sleep, such as the nucleus raphe dorsalis and the locus ceruleus (Sokolova, Taranova, & Kudriavtseva, 1992; Smith, Tenn, & An­nett, 1991), the significance of such protein synthesis for humans during dreaming remains controversial (Flanagan, 1996). As a seminal hypothesis for Ericksonian approaches in the future, however, I would generalize the dream-protein hypothesis to include all states of creativity associated with the peak periods of arousal and insight generation in psychobiologically oriented psychotherapy as illustrated with clinical case histories elsewhere (Rossi, 1996, 2002). It will require extensive cooperation between psycho­therapists and researchers to document this new psychobiological vision of the essence of Erickson’s (1948/1980) synthetic approach as quoted above.

SUMMARY

To summarize, then, this chapter outlines an evolving view of how Milton Erickson’s brief approaches to facilitating lasting impressions in the experience of reassociating, reorganizing, and resynthesizing emotional life “eventuates in a cure” on the molecular-genomic level. Current research on IEGs is providing a new database for understanding the fundamentals of the effects of novelty, pain, and stress on addictions, mood, depression, psychoimmunology, and a variety of issues of central concern to the psychotherapist. The pathways of mind-gene communication and healing that may lead to a new era of psychobiological healing whereby the mind could modulate the transcription and expression of certain classes of genes as the “bottom line” of healing are discussed. A psychobiological approach to hypnosis that is consistent with much of the classical theories of psychoanalysis and psychosomatic medicine, as well as the modern neuroscience of memory and learning at the cellular-genomic level, is proposed. This new integration of theory and research leads to a psychobiological model of how we may utilize the creative process in a manner that may seem visionary to some. Such a visionary ideal, however, may be what we need to develop truly new and inspired approaches to healing in the new millennium.

Note Added in Proof

Castes et al. (1999) reported that a 6-month program of relaxation, guided imagery, and self-esteem workshops with asthmatic children reduced the number of illness episodes and medication. The children had a significant increase in natural killer’s cells and other immune system factors associated with a reduction of psychosocial stress. These children had an increase in gene expression of the T-cell receptor for interleukin-2 as hypothesized (on page 376 of this chapter to text the mind-gene pathway of healing in psychotherapy). Eric Kandel (1998), who received the Noble Prize for Medicine in 2000, describes mind-gene concepts in this way.

Insofar as psychotherapy or counseling is effective and produces long-term changes in behavior, it presumably does so through learning, by producing changes in Gene Expression that alter the strength of synaptic connections and structural changes that alter the anatomical pattern of interconnections between nerve cells  of the brain the regulation of gene expression by social factors makes all bodily functions, including functions of the brain, susceptible to social influences. These social influences will be biologically incorporated in the altered expressions of specific genes in specific nerve cells of specific regions of the brain. (p. 460)

References

Andreasen, N. (1997). Linking mind and brain in the study of mental  illness:  A project for a scientific psychopathology. Science, 275, 1586-1593.

Bailey C.H., Bansch, D., & Kandel, E. R. (1996). Toward a molecular definition of long-term memory storage. Proceedings of the National Academy of Science. USA, 93, 13445-13452.

Brey, D. (1995). Protein molecules as computational elements in living cells. Nature, 376, 307-312.

Cahill, L., Prins, B., Weber, M., & McGaugh, J. (1994). /3-Adrenergic activation and memory for emotional events. Nature, 371(10), 702-704.

Castes, M., Hagel, I., Palenque, M., Canelones, P., Corano, A., & Lynch, N. (1999). Immunological changes associated with clinical improvements of asthmatic chil­ dren subjected to psychosocial intervention. Brain & Behavioral Immunology, 13(1), 1-13.

Cirelli, C., Pompeiano, M., & Tononi, G. (1998). Immediate early genes as a tool to understand the regulation of the sleep-wake cycle: In situ hybridization, and anti­ sense approaches. In R. Lydic (Ed.), Molecular regulation of arousal states. New York: CRC Press.

Davson, H., & Segal, M. (1996). P/rysiology of the CFS and blood-brain barriers. Boca Raton, FL: CRC Press.

Dragunow,  M. (1995). Differential  expression  of immediate-early genes during  syn­aptic plasticity, seizures and brain injury suggests specific functions for these mol­ecules  in  brain  neurons.  In  T.  R. Tolle, J. Schadrack,  and  W. Zieglgansberger {Eds.), Immediate early genes in the CNS. New York: Springer-Verlag.

Erickson, M. (1948/1980). Hypnotic psychotherapy. In E. Rossi (Ed.), 1be collected papers of Milton H. Erickson on /rypnosis. Vol. 4. Innovative lrypnotherapy (pp. 35- 48). New York: Irvington.

Flanagan, 0. (1996). Deconstructing dreams: The spandrels of sleep. In S. Hameroff, Kaszniak, & A. Scott (Eds.), Toward a science of consciousness: The first Tucson discussions and debates (pp. 67-88). Cambridge, MA: MIT Press.

Glaser, R., Kennedy, S., Lafuse, W., Bonneau, R., Speicher, C., Hillhouse, J. & Kiecolt-Glaser, J. (1990}. Psychological stress-induced modulation  of interleukin 2 receptor gene expression and interleukin 2 production in peripheral blood leu­kocytes. Archives of General Psychiatry, 47, 707-712.

Glaser, R., Lafuse, W., Bonneau, R., Atkinson, C., & Kiecolt-Glaser, J. (1993}. Stress­ associated modulation of proto-oncogene expression in human peripheral blood leukocytes. Behavioral Neuroscience, 107, 525-529.

Hadamard, J. (1954}. 7be psychology of invention in the mathematical field. New York: Dover.

Harris, G. (1948). Neural control of the pituitary gland. Physiological Review, 28, 139-179.

Iranmanesh, A., Lizarralde, G., Johnson, M., & Veldhuis, J. (1989}. Circadian, ultradian, and episodic release of /j-endorphin in men, and its temporal coupling with cortisol. Journal of Clinical Endocrinology and Metabolism, 68, 1019-1026.

Kandel, E. (1998). A new intellectual framework for psychiatry? 7be American Jour­nal of Psychiatry, 155, 457-469.

Kraus, M., & Wolf, B. (1996). Structured biological modeling: A new approach to bio­ physical cell biology. Boca Raton, FL: CRC Press.

Lloyd, 0., & Rossi, E. (1992). Ultradian rhythms in life processes: A fundamental in­quiry into chronobiology and psychobiology. New York: Springer-Verlag.

Lloyd, D., & Rossi, E. (1993}. Biological rhythms as organization and information. Biological Reviews, 68, 563-577.

Merchant, K. (Ed.). (1996). Pharmacological regulation of gene expression in the CNS. Boca Raton, FL: CRC Press.

Nemeroff, C. (1998). The neurobiology of depression. Scientific American, 278, 42-49. Papez, J. (1937). A proposed mechanism of emotion. Archives of Neurology and Psy­chiatry, 38, 725-744.

Pauk, J., Kuhn, C., Field, T., & Schanberg, S. (1986}. Positive effects of tactile versus kinesthetic or vistibular stimulation on neuroendocrine and ODC activity in maternally-deprived rat pups. Life Sciences, 39, 2081-2087.

Rosenberg, S., & Barry, J. (1992). 7be transformed cell: Unlocking the mysteries of can­cer. New York: Putnam/Chapmans.

Rossi, E. (1972/1985/2000). Dreams, consciousness, spirit (3rd edition of Dreams and the growth of personality). Phoenix: Zeig, Tucker, & Theisen.

Rossi, E. (1973a). The dream-protein hypothesis. American Journal of Psychiatry, 130, 1094-1097.

Rossi, E. (1973b}. Psychological shocks and creative moments in psychotherapy. American Journal of Clinical Hypnosis, 16, 9-22.

Rossi, E. (1986/1993). 7be psychobiology of mind-body healing (rev. ed.) New York: Norton.

Rossi, E. (1990). From mind to molecule: More than a metaphor. In J. Zeig & S. Gilligan (Eds.), Brief therapy: Myths, methods and metaphors (pp. 445-472). New York: Brunner/Maze!.

Rossi, E. (1996). 7be symptom path to enlightenment: 1be new dynamics of self organization in hypnotherapeutic work. Pacific Palisades, CA: Palisades Gateway Publishing.

Rossi, E- (1997a). The symptom path to enlightenment: The psychobiology of Jung’s constructive method. Psychological Perspectives, 36, 68-84.

Rossi, E. (1997b). The Feigenbaum scenario in a unified science of life and mind. World Futures, 49, 3-4; part II, 50, 1-4.

Rossi, E. (1998). The Feigenbaum as a model of the limits of conscious information processing. BioSystems, 40, 1-10.

Rossi, E. (2002). 7be psychobiology of gene expression: Neuroscience and neurogenesis in hypnosis and the healing arts. New York: Norton.

Rossi, E., & Cheek, D. (1988). Mind-body therapy: Jdeodynamic healing in hypnosis. New York: Norton.

Rossi, E., & Cheek, D. (1990}. Ideomotor healing of burn injuries. In E. C. Ham­ mond (Ed.), Handbook of hypnotic suggestions and metaphors. New York: Norton.

Rossi, E., & Lippincort, B. (1992). The wave nature of being: Ultradian rhythms and mind-body communication. In D. Lloyd & E. Rossi (Eds.), Ultradian rhythms in life processes: A fundamental inquiry into chronobiology and psychobiology (pp. 371-402). New York: Springer-Verlag.

Rossi, E., & Nimmons, D. (1991). 7be twenty minute break: Using the new science of ultradian rhythms. Phoenix: Zeig, Tucker, & Theisen.

Schacter, D. (1996). Searching for memory: 1be brain, the mind and the past. New York: Basic Books.

Schanberg, S. (1998). Early life experiences and the developing brain: consequences on mind and body. Presented at the Sedona Conference on the Science and Prac­tice of Mindbody Interactions.

Scharrer, E., & Scharrer, B. (1940). Secretory cells within the hypothalamus. In re­search publications of the Association of Nervous and Mental Diseases. New York: Hafner.

Schlingensiepen, K., Kunst, M., Gerdes, W., & Brysch, W. (1995). Complementary expression patterns of c-jun and jun B in rat brain and analysis of their function with antisense oligonucleotides. In T. Tolle, J. Schadrack, W. Zieglgansberger (Eds.), Immediate early genes in the CNS. New York: Springer-Verlag.

Smith, C., Tenn, C., & Annett, R. (1991). Some biochemical and behavioral aspects of the paradoxical sleep window. Canadian Journal of Psychology, 45(2), 115-124. Sokolova, N., Taranova, N., & Kudriavtseva, I. (1992). The normalizing pattern of some behavioral and neurochemical parameters after paradoxical sleep depriva­tion in rats. Fiziologicheskii Zhumal SSSR im L M. Sechenova, 78(5), 9-16.

Todorov, I. (1990). How cells maintain stability. Scientific American, 263, 66-75.

Tolle, T., Schadrack J., & Zieglgansberger, W. (Eds.) (1995). Immediate early genes in the CNS. New York: Springer-Verlag.

Tully, T. (1996). Discovery of genes involved with learning and memory: An experi­mental synthesis of Hirschian and Benzerian perspectives. Proceedings of the Na­tional Academy of Science. USA, 93, 13460-13467.