The Psychosocial Genomics of Therapeutic Hypnosis and Psychotherapy€¦ · nosis, psychotherapy,...

26 Sleep and Hypnosis, 4:1, 2002

INTRODUCTION

Classical Mendelian genetics focuses ongenes as the units of biological heredity

that are transmitted from one generation toanother through some form of reproduction.Today we know, in addition, that many classesof these genes are expressed (activated, turnedon or off), from moment to moment in every-day life, to carry out the important functions ofhomeostasis, adaptation, learning, and healing.Psychosocial genomics is a newly emergingfield that studies how psychological and social

signals can evoke gene expression in the normaladaptive processes of everyday life as well ascreative dynamics in the cultural arts, sciences,and psychotherapeutic practices (1). The infi-nite variety of human experiencing in creative-ly oriented therapeutic hypnosis, psychothera-py, and the healing arts will always defy simplesummary. In this paper, however, we offer apractical outline to help therapists conceptual-ize the deep psychobiology of therapeutic hyp-nosis on all levels from gene expression andneurogenesis to the psychosocial dynamics ofproblem solving and healing.

Stage One: Preparation: Immediate-EarlyGene Expression in Hypnotic Induction

Theory and Research. Many psychobiologi-

The Psychosocial Genomics ofTherapeutic Hypnosis and Psychotherapy

Ernest Lawrence Rossi, Ph.D.

Psychosocial genomics is the newly emerging study of how our psychological andsocial environment interacts with gene expression in everyday life as well as the cre-ative dynamics of human experience in the cultural arts, sciences, and healing. Thetheory, research, and clinical applications of psychosocial genomics to therapeutic hyp-nosis, psychotherapy, and the holistic healing arts are outlined. The key concept of psy-chosocial genomics is that many forms of psychobiological arousal during waking,sleeping, and dreaming can evoke immediate-early genes (IEGs), behavioral state-relat-ed gene expression (BSGE), and activity-dependent gene expression (ADGE) to opti-mize the synthesis of proteins to facilitate neurogenesis, problem solving, and healingin the 4-stage creative cycle. A summary of the 4-stage creative cycle replaying natu-ral Darwinian variation and conscious selection for problem solving and symptom res-olution is illustrated with a videotape of a demonstration of therapeutic hypnosis.(Sleep and Hypnosis 2002;4(1):26-38)

Key words: psychosocial genomics, therapeutic hypnosis, psychotherapy, immedi-ate-early genes, behavior state-related genes, activity-dependent genes, replay, cre-ative cycle

ORIGINAL ARTICLES

From Baylor University, Waco, Texas, USA

Address reprint requests to: 560 Baywood Way Los Osos, CA, 93402USA.

E-mail: [email protected]

Accepted 12 November, 2001

cal states of arousal in everyday life as illustrat-ed in Figure 1 are associated with the initiationof immediate-early gene expression (1,2). Themost fundamental experimental evidence thatimmediate-early gene (IEG) expression is asso-ciated with behavioral states of arousal, waking,sleeping, and dreaming (REM sleep) in theultradian time frames (90-20 minutes) comesfrom the observation of limbic-hypothalamic-pituitary oscillations during the normal circadi-an replay of the sleep-wake cycle (3,4). Figure1 emphasizes how many processes of psychobi-ological arousal—such as pain, stress, novelty,the basic rest-activity cycle (BRAC), dreaming(REM sleep), and creative moments—can initi-ate (1) immediate-early gene expression (IEGs)that, in turn, lead to (2) the expression of spe-cific target genes which (3) code for new pro-tein synthesis that is the molecular basis of (4)state-dependent memory, learning and behavior(SDMLB). As reviewed previously (5,6), thereare many immediate-early genes such as c-fosand c-jun that are turned on within a minute ortwo by any strong psychobiological stimulus toactivate target genes associated with the sleep-wake cycle (6-8). These include target genesassociated with maternal behavior (9), the con-struction and reconstruction of memory andlearning (10), stress and emotions (11), sleepand dreams (12,13), pain and reward (14), psy-chosomatic disorders (15), addictions (16),psychosis (17), and many of the target geneswhose transcription and translation into pro-teins generate the neurotransmitters and mes-senger molecules (eg. hormones, cytokines) ofmindbody regulation and healing (1,18,19).

Therapeutic Practice. The author has pro-posed how immediate-early gene expressionbegins with the varying degrees of emotionalarousal that usually takes place in the typicalhistory taking at the beginning of any psy-chotherapeutic process (19). More than merewords and talk are involved in any form of ther-apeutic hypnosis or psychotherapy from thedeep perspective of psychosocial genomics. Thetypical tears and distress in an initial interview,

for example, indicate that patients are alreadyaccessing and replaying state-dependent mem-ory and the emotional dynamics that signalshow they are embarking on a potentially heal-ing adventure. The patient’s task in this initialstage is to simply receive with courage andcompassion the state-dependent memories,emotions, and experiences associated with theirproblems. The therapist’s task at this point is torecognize and facilitate the natural ultradiancreative cycle of gene expression, neurogenesis,and healing has already begun. Implicit pro-cessing heuristics (that is, open ended thera-peutic suggestions that enable patients to createtheir own response rather than authoritariansuggestion that attempts to direct the patient inan exact manner as in programming a comput-er) may be employed to optimize the entire psy-chogenomic process (1). The psychotherapeu-

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Sleep and Hypnosis, 4:1, 2002

Figure 1. A psychogenomic view of the essential dynamics oftherapeutic hypnosis, psychotherapy, and the holistic healingarts. Mindbody communication via psychobiological arousalcan initiate (1) immediate-early gene expression (IEGs) that,in turn, leads to (2) the expression of specific target genes,which (3) code for new protein synthesis that is the molecu-lar basis of (4) state-dependent memory, learning, behavior(SDMLB) that is replayed on conscious and unconscious levelsin the creation and recreation of human consciousness andexperience.

Psychological ArousalPain, Stress, Novelty,

BRAC, REM Sleep,Creative Moments

IEGs

State DependentMood, Memory &

Learning

Target GeneTranscription

NewProtein

Synthesis

1

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3

tic process may begin with a symptom scalingof the patient’s currently experienced symptom,emotions, or attitudes. A subjective scale fromone to ten scale (where ten being the worst theproblem was ever experienced, five about aver-age, and zero a completely satisfactory state)may be used to assess the patient’s experientialstate before, during, and after psychotherapeu-tic process to assess and validate it.

Figure 2 illustrates the first stage of the cre-ative cycle in a demonstration of therapeutichypnosis at an Ericksonian Congress (20) witha young woman volunteer who has severerheumatoid arthritis in her hands. The therapistmodels a delicately balanced and symmetricalhand position a few inches above the lap to ini-tiate an activity-dependent approach to theinduction of therapeutic hypnosis and the cre-ative cycle (1,2). The thought bubble notes thepsychogenomic concerns of the therapist dur-ing this first stage. The therapist is interested inknowing what stage of the basic rest activitycycle (BRAC) the patient may be experiencinginitially in order to facilitate further progress inwhatever direction is appropriate (21). Hewonders whether CYP17—the "social gene"associated with the synthesis of arousal and sex-ual hormones—is becoming engaged as a natu-ral manifestation of the psychotherapeutictransference. The psychosocial genomics ofCYP17 gene expression is well described byRidley (22):

“The brain, the body and the genome arelocked, all three, in a dance. The genome is asmuch under the control of the other two as theyare controlled by it. That is partly why geneticdeterminism is a myth. The switching on andoff of human genes can be influenced by con-scious or unconscious external action [p.148]... genes need to be switched on, and externalevents—or free-willed behavior—can switch ongenes [p.153]…Social influences upon behav-ior work through the switching on and off ofgenes [p.172]…The psychological precedes thephysical. The mind drives the body, whichdrives the genome” [p.157].

The therapist wonders to what extent imme-diate-early genes (IEGs) such as c-fos and c-jun—associated with a creative state of psy-chobiological arousal, problem solving, andhealing—will become engaged to evoke the tar-get genes that will be essential to optimize pro-tein synthesis and therapeutic transformationsin state dependent memory, learning, andbehavior that will be reviewed and replayed instage 2.

Stage Two: Incubation: Behavior State-Related Gene Expression in Hypnosis.

Theory and Research. Important advances inresearch on gene expression and the molecular

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The Psychosocial Genomics of Therapeutic Hypnosis and Psychotherapy


Figure 2. Stage One: The therapist models a delicately bal-anced and symmetrical hand position a few inches above thelap to initiate a hand levitation approach to the induction oftherapeutic hypnosis. The therapist wonders what stage ofthe basic rest-activity cycle (BRAC) the patient may be experi-encing, whether CYP17 — the social gene — is becomingengaged as a natural manifestation of the psychotherapeutictransference, and to what extent immediate-early genes(IEGs) such as c-fos and c-jun — associated with a creativestate of psychobiological arousal, problem solving, and heal-ing — are becoming engaged.

biology of waking, sleeping, and dreaming haveprofound implications for a new view of thedeep psychobiological dynamics of therapeutichypnosis (5,6). Behavioral state-related geneexpression (BSGE) refers to research document-ing how a wide range of behavioral states, suchas sleeping, rest, dreaming, consciousness, vig-ilance, stress, emotional arousal, and depres-sion is associated with different patterns of geneexpression (7,23,24). This wide range of statesassociated with behavioral state-related geneexpression resolves one of the apparent myster-ies of historical hypnosis: How can the so-called"miraculous healing" of therapeutic hypnosiscan be facilitated with apparently oppositestates such as rest and relaxation versus activityand excitation (25-27)? Our answer is thatbehavioral state-related gene expression modu-lates the entire range of psychobiological statesranging from rest to high activity (4,28). Thisleads us to predict that behavioral state-relatedgene expression will be important in futureexperimental research defining the psychosocialgenomics of the "hypnotic state" (1,6,8).Behavioral state-related gene expression is afundamental link between psychology and biol-ogy and it is of essence in the relationshipsbetween unconsciousness and consciousness.

Therapeutic Practice. Figure 3 illustrateshow the patient experiences a mild state of con-fusion in stage two of the creative cycle as thetherapist points out evidence of psychobiologi-cal arousal and (by implication, behavioralstate-related gene expression) in the very finevibration she begins to experience involuntarilyin her hands and fingers. She is surprised bythese movements and she spontaneously com-ments that her "right hand is doing some stuff"(unusual sensations and involuntary move-ments that were not suggested by the therapist).Unexpectedly her hands also become hot.These are typical manifestations of psychobio-logical arousal in stage two of the creative cyclethat we hope to channel into a therapeuticprocess of salient self-engagement and healing(18,19).

The therapist now wonders about how toengage the psychogenomic dynamics ofimmunological variables such as interleukin-1& 2 that are messenger molecules of theimmune system that could facilitate healing. Healso wonders about the activity of IL-1ß that isassociated with Cox2, which has been implicat-ed in rheumatoid arthritis (the patient’s pre-senting symptom). While there are clinical testsfor gene expression leading to the formation ofthese molecules that would be important tomeasure in any real therapeutics at the molecu-lar level, they are not yet available to cliniciansengaged in therapeutic hypnosis (8). This isunfortunate, indeed! It means that at the pres-ent time therapists and patients are, for themost part, blind to the results of their thera-

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Figure 3. Stage Two: The patient experiences psychobiologi-cal arousal (associated with behavioral state-related geneexpression (BSGE). She evidences surprise and confusionabout her unusual sensations and involuntary movementsthat were not suggested by the therapist. The therapist won-ders how to facilitate the psychogenomics of immunologicalvariables such as interleukin-1, 2, and IL-1ß associated withCox2 that has been implicated in rheumatoid arthritis whichis the patient’s presenting symptom.

peutic work on the genomic level as it is takingplace in real time. Until we develop practicalapproaches to assessing gene expression, pro-tein synthesis, neurogenesis, and healing dur-ing the hypnotherapeutic process, we willremain limited to the phenotypic level of obser-vations on cognitive-behavioral levels some-what as follows.

The second stage of the creative cycle may beexperienced on the phenotypic level by patientsas periods of incubation, meditation, or innersearch for the source of their problem. Theytypically encounter depression, anger, tears,and the valley of shadow and doubt ("the darknight of the soul," "the storm before the light")that is portrayed in poetry, song, and dance inthe rituals of all cultures during important psy-chosocial transitions. These rituals—includingthose of therapeutic hypnosis, psychotherapy,and virtually all the healing arts—initiatebehavioral state-related gene expression, neuro-genesis, and the possibility of problem solvingand healing. As patients review the origin andhistory of their problems the natural dynamicsof Darwinian variation are experienced on deeppsychobiological levels: as they attempt to recallthe details of their traumatic experiences theyare, without quite realizing it, replaying theirpast with new Darwinian variations. AsHeraclitus said, "you cannot step into the sameriver twice." The patient’s main task in this sec-ond stage is to simply receive and appreciatewhat come up spontaneously regarding theirproblems in the manner of Freud’s technique offree association. The therapist's tasks duringthis second stage are (1) to offer open-endedtherapeutic questions that may function asimplicit processing heuristics (that is, socraticquestions) to access and replay the state-dependent memory and behavior encoding thepatient’s symptoms and (2) to support thepatient through the sometimes painful arousalof their natural ultradian cycle of creativity asthey make a courageous effort to recall theproblems of the past. Less is often more at thisstage of respectful listening rather than giving

advice.What is actually happening on the level of

gene expression during the recall and replay ofproblematic past experience during this secondstage of the creative cycle? Recent research byNader et al. (29,30) illustrates how recall andthe reconstructive aspect of memory can engagethe dynamics of psychosocial genomics in amanner that supports the growth paradigm ofpsychotherapy (1,6,8,31,32,33). Nader et al.demonstrated how fear memories that arestored in the amygdala of the brain could bedisrupted and made to disappear when they arereactivated under special experimental condi-tions. Their research illustrates how consoli-dated fear memories return to a liable state dur-ing recall so that gene expression and proteinsynthesis cycle are reactivated to resynthesizethe memory in a new way! When the rat brainis infused with anisomycin (an inhibitor of pro-tein synthesis) shortly after the reactivation of along consolidated memory (from one to 14days after conditioning), the memory is extin-guished. The same treatment of the brain withanisomycin but without reactivating the consol-idated memory leaves the memory intact. Thismeans that the gene expression and proteinsynthesis cycle is reactivated when importantemotional memories are recalled and replayed.Nader et al. (29) describe their research in thisway. "Our data show that consolidated fearmemories, when reactivated, return to a liablestate that requires de novo protein synthesis[via gene expression] for reconsolidation.These findings are not predicted by traditionaltheories of memory consolidation." (pp.723).While Nader et al.’s research is conducted on ananimal model at the present time, it does implythat similar molecular mechanisms of creativityand the transformation of consciousness takeplace in humans (that psychotherapists attemptto describe when they say, "every recall is areframe.") That is, every recall of a memoryautomatically replays, re-synthesizes, andchanges it in some way.

Further support for this recall-replay-resyn-

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thesize principle comes from more recentresearch on the molecular-genetic dynamics ofnovel learning and memory versus relearningwith familiar cues. Berman & Dudai describetheir research in this way (34).

Experimental extinction is the decline in the fre-quency or intensity of a conditioned response fol-lowing the withdrawal of reinforcement. It does notreflect forgetting due to the obliteration of the orig-inal engram, but rather "relearning," in which thenew association of the conditioned stimulus with theabsence of the original reinforcer comes to controlbehavior . . . This is in accordance with the sugges-tion that the cortex contains molecular "novelty"switches, which are turned on only on the first high-ly salient [numinous] encounter with the stimulus .. . This means, among other things, that the cortexhonors at the molecular level the distinctionbetween learning anew and learning the new. (pp.2417–2419, italics added).

We propose that the research of Nader et al.(29,30) and Berman & Dudai (34) describesessential mechanisms of psychosocial genomicsin therapeutic hypnosis, the cognitive-behav-ioral psychotherapies, and the holistic healingarts in general: The recall and replaying of trau-matic and problematic memories opens thepossibility of reconstructing and resynthesizingthem on the levels of gene expression, proteinsynthesis, neurogenesis, and healing (1,35).

The skeptic could well challenge this viewby asking: Why don’t patients with post-trau-matic stress syndromes cure themselves whenthey involuntarily replay their traumatic andpainful memories in everyday life? Aye, this is afundamental tragedy of the human condition.Most people do not know how to utilize therecall and replay of traumatic memories duringstage two of the creative cycle to move on tostage three wherein they can experience newinsights and a satisfactory resolution of theirproblems. Rather, when they experience thespontaneous recall of traumatic memories dur-ing the normal states of arousal in everyday life,they quickly try to suppress their painful mem-ories. This self-suppression blocks their incipi-

ent creative process; patients now feel stuck anddo not know how to help themselves. Theybelieve they have a problem they do not knowhow to deal with. They do not realize that theapparently autonomous upwelling of traumaticmemories actually means they are alreadyengaged in stage two of the creative cycle. That’sprecisely why they need a psychotherapist tosupport them going through their "dark nightof the soul." The therapist encourages thepatient’s spontaneous anamnesis by encourag-ing them to have the courage to allow thepainful memories to continue for "just a littlewhile longer" in the safety of the therapeutic sit-uation. This replay of memory continues untilthe entirely natural process of Darwinian varia-tion iterates new possibilities that move thepatient’s implicate associative dynamics closerand closer to appropriate options for problemsolving and healing. Healing finally takes placewhen patient’s consciousness discovers interest-ing options and possibilites that reframe theirpast with new insights that generate the thera-peutic reconstruction of memory, meaning, andpersonal identity in stage 3 of the creative cycle.

Stage Three: Illumination: Activity-depend-ent Gene Expression and ConsciousSelection of the Novel and Numinous.

Theory and Research. The basic workingassumption of neuroscience is that the psycho-logical experiences of mind, memory, emotions,learning, and behavior are encoded in the neu-ral networks of the brain (36-38). A generationof research by the Nobel Laureate Eric Kandel(39), and others, has found that messengermolecules can facilitate the molecular-geneticbasis of memory, learning, and behavior withinneurons of the brain. Laboratory researchersidentified three factors relating psychologicalexperience to neurogenesis and brain growth:1. novelty (10,40); 2. environmental enrich-ment (38,41); 3. physical exercise (37). It hasbeen found, for example, that activity-depend-ent gene expression in response to novelty and

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exercise can double the number of neurons andconnections between them generated in thehippocampus leading to the construction ofnew memory, learning, and behavior (36). In aseries of remarkable drawings Lüscher et al.(42) have shown how the number of synapsescan double during the growth process over aperiod of 60 minutes as illustrations in Figure4. This is precisely the time frame of therapeu-tic hypnosis and most forms of psychotherapy.

In a series of pioneering papers, Kandel(39,43-45) proposed how these molecular-genetic mechanisms could account for many ofthe classical phenomena of memory and learn-ing as well as clinical phenomena of psy-chopathology such as chronic anxiety, neurosis,and schizophrenia. Kandel's theoretical andexperimental work is the clearest expression ofthe possibilities of activity-dependent geneexpression as the molecular basis of psychoso-matic medicine, psychotherapy, and the healingarts. The role of activity-dependent geneexpression and neurogenesis in the way weexpress ourselves with language (using meas-ures of "idea density" and grammatical com-

plexity) from an early age is evident in the qual-ity of human experience as well as organic braindysfunctions such as Alzheimer’s disease. Amajor finding of Snowdon’s (46) research in hisstudy of nuns suffering from Alzheimer’s dis-ease is that exercising whatever mental capacityone has with positively stimulating intellectualactivities and emotions offers some protectionagainst age-related mental decline.

Therapeutic Practice. At its best, the patient’sexperience in stage 3 may described as thefamous cry of "Ah-ha" or "Eureka" that is cele-brated in ancient and modern literature whenthe creative process is described in the arts andsciences (47-49). People are usually surprisedwhen they receive a creative intuition. Manypeople automatically dismiss their own origi-nality as worthless since it has never been rein-forced in their early life experience. Thepatient’s task is to consciously recognize thepotential value of the new that appears in stage3. Likewise, the therapist’s task in is to help thepatient recognize and appreciate the value ofthe novel and the numinous that usuallyemerges spontaneously and unheralded after

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Figure 4. The ultradian (time) dynamics of activity-dependent memory, learning, and behavior change as proposed by Lüscheret al., (42). Within the first 10 minutes there are measurable changes in gene expression and the activation (phosphorylation)and growth of receptors that are involved in synaptic communication via neurotransmitters. Within 30 minutes the size of thesynaptic spine increases and receptors move to the postsynaptic membrane; this leads to an increase in the size of the postsy-napse. Within an hour, some postsynapses divide in two. This leads, in turn, to further growth in presynaptic multiplication andremodeling that eventually create new neural networks encoding memory, learning, and behavior change that is of essence forpsychotherapy and many activity-dependent processes of gene expression, protein synthesis, and neurogenesis during creativehuman experiences in the arts and sciences.

o 10 min 30 min 60 min later

Receptor PhosphorylationReceptor Insertion

PSD perforation Multi-Spine Synapses Presynaptic RemodellingnSynapse Multiplication

High-frequencyStimulation

the period of inner struggle in stage 2. Often thepatient may have already thought of the optionsthat come up for problem solving at this stagebut dismissed them since they were never vali-dated. Figure 5 illustrates just such a creativemoment between patient and therapist in stage3 of the creative cycle. After the patientreviewed the history of her rheumatoid arthritisin stage 2 she gained new insights during stage3 regarding the emotional dynamics of her sup-pressive life experiences with her employer andboyfriend. The reactive anger she experiencedwas channeled into playful shadow boxing thatwas supported by the therapist. This playfulshadow boxing could be interpreted as an activ-ity-dependent exercise that could generateactivity-dependent gene expression, proteinsynthesis, and healing. During this playfulshadow boxing of stage 3 the patient experi-

enced a creative breakout of her typicallyrestrained hand and finger movements associat-ed with her rheumatoid arthritis. She did reportsome pain associated with her newly flexiblehand and finger movement, but she was obvi-ously exhilarated that she now could movethem well enough to make a clenched fist.

The therapist wonders at this high point ifactivity-dependent gene expression (ADGE)—via the CREB complex associated with newmemory and learning—as well as the ODCgene (associated with physical growth) and theBDNF (brain derived neurotropic factor) geneassociated with neurogenesis and physicalgrowth are actually being engaged (1,9).Further research assessing the moleculardynamics of the gene expression-protein syn-thesis cycle during therapeutic hypnosis andpsychotherapy as described by the methodolo-gy of genomic neuroscience will be needed toknow for sure (50).

Stage Four: Verification: ConsolidatingTarget Gene Expression, Neurogenesis,Problem Solving, and Healing

Theory and Research. The recall of a memo-ry in everyday life invariably involves a min-gling of the old representations of the past withthe new perceptions of the present. This min-gling of past and present in everyday recallresults in new associations that lead to a naturalDarwinian process of variation and consciousselection in the change and transformations ofmemory over time. Current research docu-ments how the classical process of Pavlovianstimulus-response conditioning requires theactivation of a conditioned response before itcan be extinguished (51). As note above, thisprocess of reactivating a memory in order toextinguish, reframe, or resynthesize it has pro-foundly important implications for the practiceof psychotherapy and, by extension, many ofthe therapeutic arts.

The problem in stage 4 of the creative cycle,however, is that the new therapeutic insights

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Figure 5. Stage 3 of the creative cycle wherein the patientexperiences the playful activity-dependent exercise of shad-ow boxing as a creative breakout of her typically restrainedhand and finger movements associated with her rheumatoidarthritis. Future research will be needed to determine if activ-ity-dependent gene expression (ADGE) — such as the CREBgenes associated with new memory and learning — as wellas the ODC and BDNF genes associated with physical growthand neurogenesis are actually being engaged during such cre-ative moments.

and symptom resolutions experienced in stage3 are themselves fragile. Sometimes they are ini-tially experienced only momentarily in the ther-apeutic situation and are immediately lost whenpatients walk out the door and move back intotheir usual everyday life situations that tend tore-evoke their old traumas, symptoms, andproblems. How do we consolidate the nascenttherapeutic process so that it is not immediate-ly lost?

Erickson dealt with this problem by usingposthypnotic suggestions to support therapeu-tic advances (52) and posthypnotic amnesia toprotect the fragile new memory reconstructionsfrom the negativity of the patient’s own psycho-dynamics as well as that of their psychosocialmilieu (53). Current neuroscience researchindicates how the consolidation process can befacilitated with multiple rounds of recall andreplay of past life experiences for the recon-struction of memory.

Research by Shimizu et al. (54), for example,clarifies how a particular region of the hip-pocampus called "CA1" is crucial for convertingnew memories into long-term memories. Thispsychobiological process may continue forweeks after the initial learning and memoryevent. They found that multiple rounds of recalland replay of past life experiences are requiredfor the reconstruction, resynthesis, and recon-solidation of memory.

Our results indicate that memory consolidationmay require multiple rounds of site-specific synap-tic modifications, possibly to reinforce plasticchanges initiated during learning, thereby makingmemory traces stronger and more stable. Recentstudies report that the learning-induced correlationstates among CA1 neurons are reactivated sponta-neously in a post-learning period. Such a co-activa-tion of these neurons might suggest the existence ofthe natural condition within the hippocampus bywhich recurrent synaptic strengthening can occurduring memory consolidation. We hypothesize thatsuch a synaptic re-entry reinforcement (SRR)process can also be applied to explain how the hip-pocampus transfers newly created memories to the

cortex for permanent storage. As the hippocampusundergoes reactivation during consolidation, it mayalso act as a coincidence regenerator for activatingneurons in the cortical area such as the associationcortex. This would allow cortical neurons previous-ly corresponding to the different sensory modalitiesto be reactivated together, leading to the strengthen-ing of the connections between them through SRR.Indeed, such a coordinated reactivation of hip-pocampal-cortical neurons after learning has beenobserved recently . . . Once these cortical connec-tions are fully consolidated and stabilized, the hip-pocampus itself becomes dispensable for theretrieval of the ‘old memory’ . . .Therefore, we pos-tulate that the hippocampus, by serving as a coinci-dence regenerator, may induce the reinforcement ofsynaptic connection within the cortex during mem-ory consolidation as the cellular means to convertshort-term memories into long-term memories. (pp.1172-1173, italics added)

This outlines a neuroscience approach todealing with many of the mysteries of how toconsolidate the new insight, problem solving,and symptom resolution that are usually expe-rienced as taking place spontaneously in stage 3of the creative process.

Therapeutic Practice. As indicated, the maintask of patient and therapist in stage 4 is to con-solidate the therapeutic work of stage 3. Thefirst step in this consolidation process can befacilitated by the therapist offering a posthyp-notic suggestion when it is apparent thatpatients have navigated stage 3 well and arebeginning to make spontaneous shifts inbreathing, facial gestures, body position, andminimal movements that indicate they arealready experiencing a natural ending to theirtherapeutic trance. A posthypnotic suggestionthat supports the patient’s behavior at this pointtogether with a continuation and consolidationof the therapeutic work during their naturalultradian rhythms of homeostasis and adapta-tion in everyday life runs somewhat as follows. "When your unconscious mind knows it can contin-ue this healing work all by itself [pause] wheneverit’s entirely appropriate [pause], and when your

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conscious mind knows it can cooperate by helpingyou recognize those moments throughout the daywhen it is right to take a rest [pause], will you findyourself awakening feeling refreshed, alert, and asaware as you need to be of the meaning of yourexperience here today?"

With this implicit processing heuristic in theform of an open ended question, awakeningfrom therapeutic trance is made contingent onthe healing process continuing on an inner,implicate, unconscious level. Simultaneously,the conscious mind is focused on cooperatingby learning recognizing those ultradian mind-body cues that can be used to break the stresscycle to facilitate our natural "ultradian healingresponse" (1,2,13). The dynamics of many vari-ations of this type of posthypnotic implicit pro-cessing heuristic with a variety of problems andsymptoms in clinical practice have been

described in detail (1,55,56). From our currentperspective of psychosocial genomics, itbecomes apparent how accessing and utilizingthe patient’s natural ultradian rhythms of adap-tation and healing in everyday life in this man-ner may be facilitating the molecular mecha-nisms of activity-dependent and behavior state-related gene expression, protein synthesis, neu-rogenesis, and healing.

After the patient has awakened, the processof consolidating therapeutic progress can befacilitated by reviewing and discussing insightsand symptom resolution with a sense of wonderand appreciation—a positive reinforcement ofthe new! Sometimes the patient will affirm thetherapeutic change by considering how theynow can voluntarily change their thinking, feel-ing, and behavior to maintain their progress ineveryday life. If not, the therapist can facilitatethe process of consolidation by offering implic-it processing heuristics such as these.

"Having had this wonderful experience heretoday – how will your behavior change in every-day life?

What do you suppose you can do differentlynow to support the progress you have madetoday?

What will you be saying to yourself and oth-ers in your everyday life to continue this thera-peutic work you have begun here today?"

In constructing a response to such questionsthe patient will, in effect, give themselves a cog-nitive-behavioral prescription whereby theyutilize their own resources in their own way tosynthesize a psychosocial genomic bridgebetween their new therapeutic progress and thereal everyday circumstances of their presentand future life. As illustrated in Figure 6 thepatient experiences a satisfying self-empower-ment with the support of a standing ovationfrom the therapeutic community in the audi-ence. The therapist hopes this encounter withthe experiential theater of demonstration thera-

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Figure 6. Stage 4 of the creative cycle when the patientreceived a standing ovation from the audience. The therapistspeculates that the zif-268 gene will certainly be expressed inher REM dream states tonight to encode her new therapeuticexperiences with this unusually strong show of psychosocialsupport.

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py will be sufficiently numinous to activate zif-268 gene expression in her REM dreamingtonight to optimize the therapeutic reorganiza-tion and reconstruction of her mind and mem-ories in keeping with the psychobiologicaldynamics of current neuroscience research.Recent research (12) has documented how aday rich in memorable experiences leads to cre-ative replays of gene expression, protein syn-thesis, and neurogenesis (literally brain growth)during dreaming (REM sleep).

Most people are not aware of how they needto facilitate and consolidate gene expression,neurogenesis, problem solving, and healing ineveryday life as well as psychotherapy. Thisfourth stage of the creative process requirescooperation between the implicit, unconsciousdynamics of target gene expression (the specif-ic genes engaged in memory, learning, and heal-ing) and the explicit, conscious dynamics ofratifying the reality of the new. Patients partici-pate in this cooperative process but they do notdirect it. This is the greatest source of misun-derstanding made about the creative process byboth patients and therapists: patients and ther-apists are co-creators, not directors of the natu-ral dynamics of gene expression, neurogenesis,and healing. The patient’s co-creative task is torecognize and value the new that arises in stage3 and then plan in stage 4 how the new can bepracticed in real life. The therapist’s co-creativetask in stage 4 is to (1) facilitate the patient’screative experiences to validate the value of

their psychotherapeutic process and (2) helpreframe and resynthesize symptoms into signalsand psychological problems into innerresources (1,2,18). Symptom scaling may beused to validate the therapeutic experience andwhat may need to be done in future sessions.

SUMMARY

The leading edge of neuroscience is tracing thepathways of mindbody communication, neuro-genesis, and healing on all levels from the psy-chosocial to the cellular-genetic in a mannerthat makes a genuine science and practice oftherapeutic hypnosis, psychotherapy, and thehealing arts possible. Many of the problems andparadoxes of historical hypnosis can beresolved by a deeper understanding of the newpsychobiological parameters of mindbody com-munication and healing in the emerging field ofpsychosocial genomics. We propose that thepsychosocial genomics of therapeutic hypnosisand psychotherapy can be modeled as a 4-stagecreative cycle that facilitates the replay andresynthesis of problematic memory, learning,and behavior in an adaptive manner. Whilemost current research on the genomic neuro-science of memory and learning is still beingconducted with animal models in the laborato-ry, it is likely that new methods of assessinggene expression, neurogenesis, and healing onthe molecular level will become available toguide clinical practice in the future.

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