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Test – Module 4: States of Consciousness

4.3 Altered States of Consciousness

Learning Objectives

  • Describe how substance abuse disorders are diagnosed
  • Explain how depressants impact nervous system activity
  • Identify stimulants and describe how they affect the brain and body
  • Identify opioids and describe how they impact the brain and behavior
  • Describe hallucinogens and how they affect the brain and behavior
  • Compare and contrast between depressants, stimulants, opioids, and hallucinogens
  • Describe hypnosis and meditation

Introduction to Drugs and Other States of Consciousness

Psychadelic image from Mandelbrot Set.

While we all experience altered states of consciousness in the form of sleep on a regular basis, some people use drugs and other substances that result in altered states of consciousness as well. This section will present information relating to the use of various psychoactive drugs and problems associated with such use. You’ll also learned about other altered states of consciousness like hypnosis and meditation.

Watch It

This CrashCourse video gives an excellent overview of these altered states:

You can view the transcript “Altered States: Crash Course Psychology #10” here (opens in new window).

Psychoactive Drugs and Addiction

Substance Abuse Disorders

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is used by clinicians to diagnose individuals suffering from various psychological disorders. Drug use disorders are addictive disorders, and the criteria for specific substance (drug) use disorders are described in DSM-5. A person who has a substance use disorder often uses more of the substance than they originally intended to and continues to use that substance despite experiencing significant adverse consequences. In individuals diagnosed with a substance use disorder, there is a compulsive pattern of drug use that is often associated with both physical and psychological dependence.

Physical dependence involves changes in normal bodily functions—the user will experience withdrawal from the drug upon cessation of use. In contrast, a person who has psychological dependence has an emotional, rather than physical, need for the drug and may use the drug to relieve psychological distress. Tolerance is linked to physiological dependence, and it occurs when a person requires more and more drug to achieve effects previously experienced at lower doses. Tolerance can cause the user to increase the amount of drug used to a dangerous level—even to the point of overdose and death.

Drug withdrawal includes a variety of negative symptoms experienced when drug use is discontinued. These symptoms usually are opposite of the effects of the drug. For example, withdrawal from sedative drugs often produces unpleasant arousal and agitation. In addition to withdrawal, many individuals who are diagnosed with substance use disorders will also develop tolerance to these substances. Psychological dependence, or drug craving, is a recent addition to the diagnostic criteria for substance use disorder in DSM-5. This is an important factor because we can develop tolerance and experience withdrawal from any number of drugs that we do not abuse. In other words, physical dependence in and of itself is of limited utility in determining whether or not someone has a substance use disorder.

Link to Learning

Read through this fascinating comic created by Stuart McMillen about psychologist’s Bruce Alexander’s Rat Park study on addiction.

For more information on Bruce Alexander’s study and a better understanding of addiction, listen to Johann Hari’s TED Talk, “Everything you think you know about addiction is wrong.”

Drug Categories

The effects of all psychoactive drugs occur through their interactions with our endogenous neurotransmitter systems. Many of these drugs, and their relationships, are shown in Figure 1. As you have learned, drugs can act as agonists or antagonists of a given neurotransmitter system. An agonist facilitates the activity of a neurotransmitter system, and antagonists impede neurotransmitter activity.

The main categories of drugs are depressants, stimulants, and hallucinogens. You’ll learn more about these types drugs in the coming pages.

Four main drug categories are identified by differently colored circles showing overlaps: the four main drug categories are “antipsychotics,” “stimulants,” “depressants,” and “hallucinogens.” The circle titled “Antipsychotics” includes the drug names “Haldol,” “Risperdal,” and “Seroquel.” The circle titled “Stimulants” contains a subcircle titled “Psychmotor stimulants” with the drug names “Amphetamines,” “Khat,” “Ritalin,” and “Cocaine.” The “Stimulants” circle contains another subcircle titled “Methylxanthines” with the drug names “Caffeine,” “Theophylline,” and “Theobromine.” The circle titled “Depressants” contains a subcircle titled “Sedative Hypnotics” with the drug names “Alcohol,” “Barbituates,” “Ether,” and “GHB”; within that circle is a subcircle titled “Minor tranquilizers” with the drug names “Ativan,” “Valium,” and “Xanax.” “Nicotine” falls in the overlap between the “Stimulants” and “Depressants” circles. The circle titled “Depressants” also contains a subcircle titled “Narcotic Analgesics” with the drug names “Opium,” “Codeine,” “Morphine,” “Heroin,” and “DXM.” “DXM” falls in the overlap between the “Depressants” circle and the “Dissociatives” subcircle of the “Hallucinogens” circle. The circle titled “Hallucinogens” contains a subcircle labeled “Dissociatives” including the drug names ”Ketamine,” “PCP,” “Nitrous,” “Amanitas,” and “Salvinorum.” Within that subcircle, “Ketamine,” “PCP,” and “Nitrous” overlap with with the “depressants” circle The circle titled “Hallucinogens” also contains a subcircle titled “Psychadelics” including the drug names “MDMA,” “Mescaline,” “LSD,” “Psilocybin,” “AMT,” “DMT,” and “Ibogaine.” Within that subcircle, “MDMA,” “Mescaline,” “LSD,” “Psilocybin,” and “AMT” fall within the overlap between the “Hallucinogens” and “Stimulants” circles. “Ibogaine” falls within the overlap between the “Psychadelics” and “Dissociatives” subcircles. Outside of all subcircles, “Marijuana” falls within the overlap between the “Stimulants,” “Depressants,” and “Hallucinogens” circles.
Figure 1. This figure illustrates various drug categories and overlap among them. (credit: modification of work by Derrick Snider)

Alcohol and Other Depressants

Ethanol, which we commonly refer to as alcohol, is in a class of psychoactive drugs known as depressants (Figure 1). A depressant is a drug that tends to suppress central nervous system activity. Other depressants include barbiturates and benzodiazepines. These drugs share in common their ability to serve as agonists of the gamma-Aminobutyric acid (GABA) neurotransmitter system. Because GABA has a quieting effect on the brain, GABA agonists also have a quieting effect; these types of drugs are often prescribed to treat both anxiety and insomnia.

An illustration of a GABA-gated chloride channel in a cell membrane shows receptor sites for barbiturate, benzodiazepine, GABA, alcohol, and neurosteroids, as well as three negatively-charged chloride ions passing through the channel. Each drug type has a specific shape, such as triangular, rectangular or square, which corresponds to a similarly shaped receptor spot.
Figure 1. The GABA-gated chloride (Cl-) channel is embedded in the cell membrane of certain neurons. The channel has multiple receptor sites where alcohol, barbiturates, and benzodiazepines bind to exert their effects. The binding of these molecules opens the chloride channel, allowing negatively-charged chloride ions (Cl-) into the neuron’s cell body. Changing its charge in a negative direction pushes the neuron away from firing; thus, activating a GABA neuron has a quieting effect on the brain.

Acute alcohol administration results in a variety of changes to consciousness. Alcohol intoxication is measured for legal and medical uses in terms of Blood Alcohol Content (BAC). A BAC of 0.10 (0.10% or one-tenth of one percent) means that there are 0.10 g of alcohol for every 100 ml of blood. While a BAC of 0.0 is sober, in the United States a BAC of 0.08 is legally intoxicated, and above that is considered very impaired. BAC levels above 0.40 are potentially fatal. At rather low doses, alcohol use is associated with feelings of euphoria. As the dose increases, people report feeling sedated. Generally, alcohol is associated with decreases in reaction time and visual acuity, lowered levels of alertness, and reduction in behavioral control. With excessive alcohol use, a person might experience a complete loss of consciousness and/or difficulty remembering events that occurred during a period of intoxication (McKim & Hancock, 2013). In addition, if a pregnant woman consumes alcohol, her infant may be born with a cluster of birth defects and symptoms collectively called fetal alcohol spectrum disorder (FASD) or fetal alcohol syndrome (FAS).

With repeated use of many central nervous system depressants, such as alcohol, a person becomes physically dependent upon the substance and will exhibit signs of both tolerance and withdrawal. Psychological dependence on these drugs is also possible. Therefore, the abuse potential of central nervous system depressants is relatively high.

Drug withdrawal is usually an aversive experience, and it can be a life-threatening process in individuals who have a long history of very high doses of alcohol and/or barbiturates. This is of such concern that people who are trying to overcome addiction to these substances should only do so under medical supervision.

Stimulants

Stimulants are drugs that tend to increase overall levels of neural activity. Many of these drugs act as agonists of the dopamine neurotransmitter system. Dopamine activity is often associated with reward and craving; therefore, drugs that affect dopamine neurotransmission often have abuse liability. Drugs in this category include cocaine, amphetamines (including methamphetamine), cathinones (i.e., bath salts), MDMA (ecstasy), nicotine, and caffeine.

Cocaine can be taken in multiple ways. While many users snort cocaine, intravenous injection and ingestion are also common. The freebase version of cocaine, known as crack, is a potent, smokable version of the drug. Like many other stimulants, cocaine agonizes the dopamine neurotransmitter system by blocking the reuptake of dopamine in the neuronal synapse.

Dig Deeper: Crack Cocaine

Crack (Figure 1) is often considered to be more addictive than cocaine itself because it is smokable and reaches the brain very quickly. Crack is often less expensive than other forms of cocaine; therefore, it tends to be a more accessible drug for individuals from impoverished segments of society. During the 1980s, many drug laws were rewritten to punish crack users more severely than cocaine users. This led to discriminatory sentencing with low-income, inner-city minority populations receiving the harshest punishments. The wisdom of these laws has recently been called into question, especially given research that suggests crack may not be more addictive than other forms of cocaine, as previously thought (Haasen & Krausz, 2001; Reinerman, 2007).

A photograph shows crack rocks. A ruler indicates that each crack rock is approximately 1–2 inches wide.
Figure 1. Crack rocks like these are smoked to achieve a high. Compared with other routes of administration, smoking a drug allows it to enter the brain more rapidly, which can often enhance the user’s experience. (credit: modification of work by U.S. Department of Justice)

Amphetamines have a mechanism of action quite similar to cocaine in that they block the reuptake of dopamine in addition to stimulating its release (Figure 2). While amphetamines are often abused, they are also commonly prescribed to children diagnosed with attention deficit hyperactivity disorder (ADHD). It may seem counterintuitive that stimulant medications are prescribed to treat a disorder that involves hyperactivity, but the therapeutic effect comes from increases in neurotransmitter activity within certain areas of the brain associated with impulse control.

An illustration of a presynaptic cell and a postsynaptic cell shows these cells’ interactions with cocaine and dopamine molecules. The presynaptic cell contains two cylinder-shaped channels, one on each side near where it faces the postsynaptic cell. The postsynaptic cell contains several receptors, side-by-side across the area that faces the presynaptic cell. In the space between the two cells, there are both cocaine and dopamine molecules. One of the cocaine molecules attaches to one of the presynaptic cell’s channels. This cocaine molecule is labeled “bound cocaine.” An X-shape is shown over the top of the bound cocaine and the channel to indicate that the cocaine does not enter the presynaptic cell. A dopamine molecule is shown inside of the presynaptic cell’s other channel. Arrows connect this dopamine molecule to several others inside of the presynaptic cell. More arrows connect to more dopamine molecules, tracing their paths from the channel into the presynaptic cell, and out into the space between the presynaptic cell and the postsynaptic cell. Arrows extend from two of the dopamine molecules in this in-between space to the postsynaptic cell’s receptors. Only the dopamine molecules are shown binding to the postsynaptic cell’s receptors.
Figure 2. As one of their mechanisms of action, cocaine and amphetamines block the reuptake of dopamine from the synapse into the presynaptic cell.

In recent years, methamphetamine (meth) use has become increasingly widespread. Methamphetamine is a type of amphetamine that can be made from ingredients that are readily available (e.g., medications containing pseudoephedrine, a compound found in many over-the-counter cold and flu remedies). Despite recent changes in laws designed to make obtaining pseudoephedrine more difficult, methamphetamine continues to be an easily accessible and relatively inexpensive drug option (Shukla, Crump, & Chrisco, 2012).

The cocaine, amphetamine, cathinones, and MDMA users seek a euphoric high, feelings of intense elation and pleasure, especially in those users who take the drug via intravenous injection or smoking. Repeated use of these stimulants can have significant adverse consequences. Users can experience physical symptoms that include nausea, elevated blood pressure, and increased heart rate. In addition, these drugs can cause feelings of anxiety, hallucinations, and paranoia (Fiorentini et al., 2011). Normal brain functioning is altered after repeated use of these drugs. For example, repeated use can lead to overall depletion among the monoamine neurotransmitters (dopamine, norepinephrine, and serotonin). People may engage in compulsive use of these stimulant substances in part to try to reestablish normal levels of these neurotransmitters (Jayanthi & Ramamoorthy, 2005; Rothman, Blough, & Baumann, 2007).

Caffeine is another stimulant drug. While it is probably the most commonly used drug in the world, the potency of this particular drug pales in comparison to the other stimulant drugs described in this section. Generally, people use caffeine to maintain increased levels of alertness and arousal. Caffeine is found in many common medicines (such as weight loss drugs), beverages, foods, and even cosmetics (Herman & Herman, 2013). While caffeine may have some indirect effects on dopamine neurotransmission, its primary mechanism of action involves antagonizing adenosine activity (Porkka-Heiskanen, 2011).

While caffeine is generally considered a relatively safe drug, high blood levels of caffeine can result in insomnia, agitation, muscle twitching, nausea, irregular heartbeat, and even death (Reissig, Strain, & Griffiths, 2009; Wolt, Ganetsky, & Babu, 2012). In 2012, Kromann and Nielson reported on a case study of a 40-year-old woman who suffered significant ill effects from her use of caffeine. The woman used caffeine in the past to boost her mood and to provide energy, but over the course of several years, she increased her caffeine consumption to the point that she was consuming three liters of soda each day. Although she had been taking a prescription antidepressant, her symptoms of depression continued to worsen and she began to suffer physically, displaying significant warning signs of cardiovascular disease and diabetes. Upon admission to an outpatient clinic for treatment of mood disorders, she met all of the diagnostic criteria for substance dependence and was advised to dramatically limit her caffeine intake. Once she was able to limit her use to less than 12 ounces of soda a day, both her mental and physical health gradually improved. Despite the prevalence of caffeine use and the large number of people who confess to suffering from caffeine addiction, this was the first published description of soda dependence appearing in scientific literature.

Nicotine is highly addictive, and the use of tobacco products is associated with increased risks of heart disease, stroke, and a variety of cancers. Nicotine exerts its effects through its interaction with acetylcholine receptors. Acetylcholine functions as a neurotransmitter in motor neurons. In the central nervous system, it plays a role in arousal and reward mechanisms. Nicotine is most commonly used in the form of tobacco products like cigarettes or chewing tobacco; therefore, there is a tremendous interest in developing effective smoking cessation techniques. To date, people have used a variety of nicotine replacement therapies in addition to various psychotherapeutic options in an attempt to discontinue their use of tobacco products. In general, smoking cessation programs may be effective in the short term, but it is unclear whether these effects persist (Cropley, Theadom, Pravettoni, & Webb, 2008; Levitt, Shaw, Wong, & Kaczorowski, 2007; Smedslund, Fisher, Boles, & Lichtenstein, 2004).

Link to Learning

To learn more about some of the most commonly abused prescription and street drugs, check out the Commonly Abused Drugs Chart and the Commonly Abused Prescription Drugs Chart from the National Institute on Drug Abuse.

Opioids

An opioid is one of a category of drugs that includes heroin, morphine, methadone, and codeine. Opioids have analgesic properties; that is, they decrease pain. Humans have an endogenous opioid neurotransmitter system—the body makes small quantities of opioid compounds that bind to opioid receptors reducing pain and producing euphoria. Thus, opioid drugs, which mimic this endogenous painkilling mechanism, have an extremely high potential for abuse. Natural opioids, called opiates, are derivatives of opium, which is a naturally occurring compound found in the poppy plant. There are now several synthetic versions of opiate drugs (correctly called opioids) that have very potent painkilling effects, and they are often abused. For example, the National Institutes of Drug Abuse has sponsored research that suggests the misuse and abuse of the prescription pain killers hydrocodone and oxycodone are significant public health concerns (Maxwell, 2006). In 2013, the U.S. Food and Drug Administration recommended tighter controls on their medical use.

Historically, heroin has been a major opioid drug of abuse (Figure 1). Heroin can be snorted, smoked, or injected intravenously. Like the stimulants described earlier, the use of heroin is associated with an initial feeling of euphoria followed by periods of agitation. Because heroin is often administered via intravenous injection, users often bear needle track marks on their arms and, like all abusers of intravenous drugs, have an increased risk for contraction of both tuberculosis and HIV.

Photograph A shows various paraphernalia spread out on a black surface. The items include a tourniquet, three syringes of varying widths, three cotton-balls, a tiny cooking vessel, a condom, a capsule of sterile water, and an alcohol swab. Photograph B shows a hand holding a spoon containing heroin tar above a small candle.
Figure 1. (a) Common paraphernalia for heroin preparation and use are shown here in a needle exchange kit. (b) Heroin is cooked on a spoon over a candle. (credit a: modification of work by Todd Huffman)

Aside from their utility as analgesic drugs, opioid-like compounds are often found in cough suppressants, anti-nausea, and anti-diarrhea medications. Given that withdrawal from a drug often involves an experience opposite to the effect of the drug, it should be no surprise that opioid withdrawal resembles a severe case of the flu. While opioid withdrawal can be extremely unpleasant, it is not life-threatening (Julien, 2005). Still, people experiencing opioid withdrawal may be given methadone to make withdrawal from the drug less difficult. Methadone is a synthetic opioid that is less euphorigenic than heroin and similar drugs. Methadone clinics help people who previously struggled with opioid addiction manage withdrawal symptoms through the use of methadone. Other drugs, including the opioid buprenorphine, have also been used to alleviate symptoms of opiate withdrawal.

Codeine is an opioid with relatively low potency. It is often prescribed for minor pain, and it is available over-the-counter in some other countries. Like all opioids, codeine does have abuse potential. In fact, abuse of prescription opioid medications is becoming a major concern worldwide (Aquina, Marques-Baptista, Bridgeman, & Merlin, 2009; Casati, Sedefov, & Pfeiffer-Gerschel, 2012).

The Opioid Epidemic

The opioid epidemic, or the opioid crisis, refers to the extensive overuse of opioid drugs, both from medical prescriptions and from illegal sources. The epidemic began slowly in the United States, beginning in the late 1990s, and led to a massive increase in opioid use in recent years, contributing to over 70,000 drug overdose deaths in the U.S. in 2018. Fentanyl alone, being 50 times stronger than heroin and 100 times stronger than morphine, was causing about 200 overdose deaths per day in 2017.[1]

Opioids are a diverse class of moderately strong, addictive, inexpensive painkillers prescribed by doctors. In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to opioid pain relievers and healthcare providers began to prescribe them at greater rates. This led to widespread misuse of both prescription and non-prescription opioids before it became clear that these medications could indeed be highly addictive.

Though aggressive opioid prescription practices played the biggest role in creating the epidemic, the popularity of illegal substances such as potent heroin and illicit fentanyl have become an increasingly large factor. It has been suggested that decreased supply of prescription opioids caused by opioid prescribing reforms turned people who were already addicted to opioids towards illegal substances.[2]

In 2015, approximately 50% of drug overdoses were not the result of an opioid product from a prescription, though most abusers’ first exposure had still been by lawful prescription.[3] By 2018, another study suggested that 75% of opioid abusers started their opioid use by taking drugs which had been obtained in a way other than by legitimate prescription.[4]

Those addicted to opioids, both legal and illegal, are increasingly young, white, and female, with 1.2 million women addicted compared to 0.9 million men in 2015. The populations of rural areas of the country have been the hardest hit. Teen abuse of opioids has been noticeably increasing since 2006, using prescription drugs more than any illicit drug except marijuana; more than cocaine, heroin, and methamphetamine combined. The crisis has also changed moral, social, and cultural resistance to street drug alternatives such as heroin.

Hallucinogens

An illustration shows a colorful spiral pattern.
Figure 1. Psychedelic images like this are often associated with hallucinogenic compounds. (credit: modification of work by “new 1lluminati”/Flickr)

A hallucinogen is one of a class of drugs that results in profound alterations in sensory and perceptual experiences (Figure 1). In some cases, users experience vivid visual hallucinations. Common hallucinogens include marijuana, psilocybin (shrooms), mescaline (peyote), and LSD. It is also common for these types of drugs to cause hallucinations of body sensations (e.g., feeling as if you are a giant) and a skewed perception of the passage of time.

As a group, hallucinogens are incredibly varied in terms of the neurotransmitter systems they affect. Mescaline and LSD are serotonin agonists, and PCP (angel dust) and ketamine (an animal anesthetic) act as antagonists of the NMDA glutamate receptor. In general, these drugs are not thought to possess the same sort of abuse potential as other classes of drugs discussed in this section.

Dig Deeper: Medical Marijuana

While the possession and use of marijuana is illegal in much of the United States, since January 2019, it is legal for recreational use in eleven states, and medical marijuana use is now legal in over half of the United States. Medical marijuana is marijuana that is prescribed by a doctor for the treatment of a health condition. For example, people who undergo chemotherapy will often be prescribed marijuana to stimulate their appetites and prevent excessive weight loss resulting from the side effects of chemotherapy treatment. Marijuana may also have some promise in the treatment of a variety of medical conditions (Mather, Rauwendaal, Moxham-Hall, & Wodak, 2013; Robson, 2014; Schicho & Storr, 2014).

A photograph shows a window with a neon sign. The sign includes the word “medical” above the shape of a marijuana leaf.
Figure 2. Medical marijuana shops are becoming more and more common in the United States. (credit: Laurie Avocado)

While medical marijuana laws have been passed on a state-by-state basis, federal laws still classify this as an illicit substance, making conducting research on the potentially beneficial medicinal uses of marijuana problematic. There is quite a bit of controversy within the scientific community as to the extent to which marijuana might have medicinal benefits due to a lack of large-scale, controlled research (Bostwick, 2012). As a result, many scientists have urged the federal government to allow for relaxation of current marijuana laws and classifications in order to facilitate a more widespread study of the drug’s effects (Aggarwal et al., 2009; Bostwick, 2012; Kogan & Mechoulam, 2007).

Until recently, the United States Department of Justice routinely arrested people involved and seized marijuana used in medicinal settings. In the latter part of 2013, however, the United States Department of Justice issued statements indicating that they would not continue to challenge state medical marijuana laws. This shift in policy was likely a response to the scientific community’s recommendations and also a reflection changing public opinion regarding marijuana.

Summary of Psychoactive Drugs

Substance use disorder is defined in DSM-5 as a compulsive pattern of drug use despite negative consequences. Both physical and psychological dependence are important parts of this disorder. Alcohol, barbiturates, and benzodiazepines are central nervous system depressants that affect GABA neurotransmission. Cocaine, amphetamine, cathinones, and MDMA are all central nervous stimulants that agonize dopamine neurotransmission, while nicotine and caffeine affect acetylcholine and adenosine, respectively. Opiate drugs serve as powerful analgesics through their effects on the endogenous opioid neurotransmitter system, and hallucinogenic drugs cause pronounced changes in sensory and perceptual experiences. The hallucinogens are variable with regards to the specific neurotransmitter systems they affect.

Link to Learning

Then visit the Mouse Party website to see a visual example of how drugs alter the chemicals in the brain.

Hypnosis and Meditation

Our states of consciousness change as we move from wakefulness to sleep. We also alter our consciousness through the use of various psychoactive drugs. This final section will consider hypnotic and meditative states as additional examples of altered states of consciousness experienced by some individuals.

Hypnosis

Hypnosis is a state of extreme self-focus and attention in which minimal attention is given to external stimuli. In the therapeutic setting, a clinician often will use relaxation and suggestion in an attempt to alter the thoughts and perceptions of a patient. Hypnosis has also been used to draw out information believed to be buried deeply in someone’s memory. For individuals who are especially open to the power of suggestion, this can prove to be a very effective technique, and brain imaging studies have demonstrated that hypnotic states are associated with global changes in brain functioning (Del Casale et al., 2012; Guldenmund, Vanhaudenhuyse, Boly, Laureys, & Soddu, 2012).

Historically, hypnosis has been viewed with some suspicion because of its portrayal in popular media and entertainment (Figure 1). Therefore, it is important to make a distinction between hypnosis as an empirically based therapeutic approach versus as a form of entertainment. Contrary to popular belief, individuals undergoing hypnosis usually have clear memories of the hypnotic experience and are in control of their own behaviors. While hypnosis may be useful in enhancing memory or a skill, such enhancements are very modest in nature (Raz, 2011).

A poster titled “Barnum the Hypnotist” shows illustrations of a person performing hypnotism.
Figure 1. Popular portrayals of hypnosis have led to some widely-held misconceptions.

How exactly does a hypnotist bring a participant to a state of hypnosis? While there are variations, there are four parts that appear consistent in bringing people into the state of suggestibility associated with hypnosis (National Research Council, 1994). These components include:

The participant is guided to focus on one thing, such as the hypnotist’s words or a ticking watch. The participant is made comfortable and is directed to be relaxed and sleepy. The participant is told to be open to the process of hypnosis, trust the hypnotist and let go. The participant is encouraged to use his or her imagination.

These steps are conducive to being open to the heightened suggestibility of hypnosis.

People vary in terms of their ability to be hypnotized, but a review of available research suggests that most people are at least moderately hypnotizable (Kihlstrom, 2013). Hypnosis in conjunction with other techniques is used for a variety of therapeutic purposes and has shown to be at least somewhat effective for pain management, treatment of depression and anxiety, smoking cessation, and weight loss (Alladin, 2012; Elkins, Johnson, & Fisher, 2012; Golden, 2012; Montgomery, Schnur, & Kravits, 2012).

Some scientists are working to determine whether the power of suggestion can affect cognitive processes such as learning, with a view to using hypnosis in educational settings (Wark, 2011). Furthermore, there is some evidence that hypnosis can alter processes that were once thought to be automatic and outside the purview of voluntary control, such as reading (Lifshitz, Aubert Bonn, Fischer, Kashem, & Raz, 2013; Raz, Shapiro, Fan, & Posner, 2002). However, it should be noted that others have suggested that the automaticity of these processes remains intact (Augustinova & Ferrand, 2012).

How does hypnosis work? Two theories attempt to answer this question: One theory views hypnosis as dissociation and the other theory views it as the performance of a social role. According to the dissociation view, hypnosis is effectively a dissociated state of consciousness, much like our earlier example where you may drive to work, but you are only minimally aware of the process of driving because your attention is focused elsewhere. This theory is supported by Ernest Hilgard’s research into hypnosis and pain. In Hilgard’s experiments, he induced participants into a state of hypnosis, and placed their arms into ice water. Participants were told they would not feel pain, but they could press a button if they did; while they reported not feeling pain, they did, in fact, press the button, suggesting a dissociation of consciousness while in the hypnotic state (Hilgard & Hilgard, 1994).

Taking a different approach to explain hypnosis, the social-cognitive theory of hypnosis sees people in hypnotic states as performing the social role of a hypnotized person. As you will learn when you study social roles, people’s behavior can be shaped by their expectations of how they should act in a given situation. Some view a hypnotized person’s behavior not as an altered or dissociated state of consciousness, but as their fulfillment of the social expectations for that role.

Meditation

Meditation is the act of focusing on a single target (such as the breath or a repeated sound) to increase awareness of the moment. While hypnosis is generally achieved through the interaction of a therapist and the person being treated, an individual can perform meditation alone. Often, however, people wishing to learn to meditate receive some training in techniques to achieve a meditative state. A meditative state, as shown by EEG recordings of newly-practicing meditators, is not an altered state of consciousness per se; however, patterns of brain waves exhibited by expert meditators may represent a unique state of consciousness (Fell, Axmacher, & Haupt, 2010).

Although there are a number of different techniques in use, the central feature of all meditation is clearing the mind in order to achieve a state of relaxed awareness and focus (Chen et al., 2013; Lang et al., 2012). Mindfulness meditation has recently become popular. In the variation of meditation, the meditator’s attention is focused on some internal process or an external object (Zeidan, Grant, Brown, McHaffie, & Coghill, 2012).

Meditative techniques have their roots in religious practices (Figure 2), but their use has grown in popularity among practitioners of alternative medicine. Research indicates that meditation may help reduce blood pressure, and the American Heart Association suggests that meditation might be used in conjunction with more traditional treatments as a way to manage hypertension, although there is not sufficient data for a recommendation to be made (Brook et al., 2013). Like hypnosis, meditation also shows promise in stress management, sleep quality (Caldwell, Harrison, Adams, Quin, & Greeson, 2010), treatment of mood and anxiety disorders (Chen et al., 2013; Freeman et al., 2010; Vøllestad, Nielsen, & Nielsen, 2012), and pain management (Reiner, Tibi, & Lipsitz, 2013).

Photograph A shows a statue of Buddha with eyes closed and legs crisscrossed. Photograph B shows a person in a similar position.
Figure 2. (a) This is a statue of a meditating Buddha, representing one of the many religious traditions of which meditation plays a part. (b) People practicing meditation may experience an alternate state of consciousness. (credit a: modification of work by Jim Epler; credit b: modification of work by Caleb Roenigk)

Link to Learning

Watch this video that describes the results of a brain imaging study in individuals who underwent specific mindfulness-meditative techniques.

Think It Over

  • Under what circumstances would you be willing to consider hypnosis and/or meditation as a treatment option? What kind of information would you need before you made a decision to use these techniques?
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  1. Fentanyl As A Dark Web Profit Center, From Chinese Labs To U.S. Streets", KUAR, NPR Radio News, Sept. 4, 2019 ↵
  2. Prescription Opioid Data". Centers for Disease Control and Prevention (CDC). Retrieved November 2, 2018. ↵
  3. Shipton EA, Shipton EE, Shipton AJ (June 2018). "A Review of the Opioid Epidemic: What Do We Do About It?". Pain and Therapy. 7 (1): 23–36. ↵
  4. Pergolizzi JV, LeQuang JA, Taylor R, Raffa RB (January 2018). "Going beyond prescription pain relievers to understand the opioid epidemic: the role of illicit fentanyl, new psychoactive substances, and street heroin". Postgraduate Medicine. 130 (1): 1–8. ↵
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