1. Hypnosis can enhance psychotherapy through building rapport and eliciting trance states, which activate inner healing resources. 2. Milton Erickson's approach to hypnosis and psychotherapy was pioneering and implicitly based on an evolutionary perspective, optimizing trance induction skills. 3. Hypnotic psychotherapy is a blend of hypnosis in psychotherapy and hypnosis as psychotherapy, based on rapport, trance, and conscious activation of theory of mind within a supportive clinical setting.

1. HYPNOSIS IN PSYCHOTHERAPY AND HYPNOSIS AS PSICOTHERAPY:THE ERICKSONIAN APPROACH FROM AN EVOLUTIONARY POINT OF VIEW Ambrogio Pennati *, MD, psychiatrist, private practice, Milano, Italy pennati.ambrogio.md@fastwebnet.it Giampiero Mosconi §, MD, psychologist, private practice, Milano, Italy giampieromosconi@virgilio.it Italian Medical Association for the Study of Hypnosis (AMISI, www.amisi.it), §President and * Member of Board of Directors

2. EvolutionaryPsychology and Psychotherapy Evolutionarypsychologyseemstobe a euristically fertile approachto life sciences, suchas medicine, psychology, economics, sociology. Althoughthereisnot (and wehopethatwillneverbe) anevolutionarypsychotherapy, suchpointofviewcouldoffernewperspectives in psychotherapy, as some experiences in jungian and freudianpsychoanalisys, cognitive-behaviortherapy, systemictherapysuggest.

3. EvolutionaryPsychology and Hypnosis As a matteroffact, onlypioneristic, short and merely speculative papersabout the relationshipbetweenevolutionarypsychology and hypnosis are available. Wethinkthatadopting the evolutionaryperspective in the studyofhypnoticphenomenacould generate newresearch and newconceptualizations in ourfield. Wethinkthat at the coreofEricksonian work thereisanimplicitevolutionary way ofthinking, notfullyblossomedbecauseof the zeitgeist in whichheoperated.

4. A paradigmaticshift Evolutionarypsycvhologysuggeststhat a shiftfrom the Standard Social Science Model (and itscorollaryofhuman mind asblankslate) to the NaturalisticModelcouldbeuseful in bypassingmostof the conceptualconundrumsofpsychotherapy. In our case thisshiftcould bypass the “state or process” issueofhypnosis. The evolutionaryapproachidentify the abilitytodevelop trance experienceasoneof the mostimportantadaptativemodule in the in the brainfor the individual, the group and the specie.

5. Definitionof Trance Weoperativelydefine the trance asanAltered State ofConsciousness (ASoC) in which the followingphenomena can consensuallyoccur in a statisticallysignificantpercentages: Dissociationbetween executive and monitoringfunctionof the Self High frequencyofideodinamicbehaviors Verbal and/or motor inhibition Extremefocusingofattention, internal or external Facilitationofautoreferentialthinking Mnesicalterations Changes in quality and quantityof the timeexperience Changes in quality and quantityofperceptualexperience

6. The AdaptativeValueof Trance Social value: increasedgroupidentity, dischargeamong the groupofpeersofotherwiseunacceptablefeelings, self-trascendence, facilitationofmeme-relatedcomplexes, facilitationofmimeticlearning Individualvalue: self trascendence, modulationofpain, modulationof immune system, modulationofautonomicresponse, increasedefficiencyoffight or flight response, increasedefficiencyofmatingstrategies, increased chance ofactivationofinternalhealingmodules (seebelow) Biologicalvalue: increasedprobabilityofselectionof the fittest gene or memebyreshufflingofgenetic and memetic pool (ritual and/or orgiastic trance)

7. The EvolutionaryValueofRapport The mirrorneuronssystemsseemsto play a determinantrole in the abilitytodevelopempathicrelationshipsamonghumans. Suchrelationships are essentialfor the survivalstruggle and reproductive success of the individual and the group, gene (kin) or memerelated. Empathiclearningmaybeactivatedwithoutawareness (procedural), and thereforeitcouldbe more efficient and resilientthan the declarativelearning, whichreliesuponlinguistic and eideticstructuresof information. WecoulddefineAlteredStatesofConsciousness (AsoC) inductors the multifacetedproceduresthat homo sapiens utilizedtoachieve trance states. Suchinductorsrelyupon the empathicrapport.

8. Trance, Rapport, Hypnosis Fromanhistoricpointofviewhypnosiscouldbedefinedas the processof the complex, bidirectional, fluctuactinginteractionsbetween ASoCinductorsrecognizedby the western scientificcomunityasempiricallyvalidated and useful in medicine and psychology , accordingto the scientificparadigmof the zeitgeist, and The trance statesobtainedfollowingsuchinductionprocedures

9. Trance, Rapport, Hypnosis

10. Hypnosis and Psychotherapy Psychotherapycouldbeoperationallydefinedaseverymodalityofhelping people in copingwith stress, emotionalproblems, relationalproblems, or problematichabits; suchmodalities share the factofbeingall treatment based on talkingotanother people and doingsomethingtogether” (RCPychiatrists). Hypnosiscouldbetherapeuticbecauseboth the induction procedure in sé (modeling, emotionaltuning, procedurallearning, based on rapport, ofnewbehavioral or cognitive adaptativestrategies) and hypnotic trance (emotionalreleaseofotherwiseunacceptablefeelings, activation on internalhealingmodules, self-trascendence).

11. Hypnosisassynergicisticempowermentofinnerhealingresources Hypnosiscouldbeinterpretedas the potentiallymostpowerfuldevicetoactivateinnerhealingresourcesthanksto Interpersonal powerofrapport Intrapersonalpowerof trance thatsynergicallyactivatedinternalhealermodules.

12. Hypnosis and EthiopatogeneticalModelsofIllnesses The majorityofpsychotherapeuticapproachestriedtodevelopetiopathogeneticalmodelsofdisorderscoherentwiththeirpostulates, butallthesemodelslackofstatistical and scientificvalidation. Hypnosistoosearchedfor a coherentmodel (neodissociative theory), butalso in this case empiricalvalidationisinsufficient or absent. Metaanalysises show thatthereis no evidence (ie, directlylinkedto the model) of the superiorityof a theoreticalmodelamong the others, and thataspecificvariables are the key factors in the efficacyofpsychotherapies. Therefore, everytheoreticalapproachtopsychotherapyseemstobemerely speculative.

13. Recentempirical data Data fromclinicalfieldsuggestthatempatethicalsharingofmemes (beliefs, values, social rituals, ideasabout the cause of the illness) with the clients can enhance the responsetodifferenttreatments. Sincethere are no evidencesofsuperiorityof a modelofpsychotherapyamong the otherswe can suppose that building a memeticrapportempatheticallybasedis the best operative option in psychotherapy.

14. The Ericksonian way Nowadayswe can think at Milton Erickson’s work as a pionieristic, revolutionary way ofthinking and workingbased on implicit, intuitive evolutionaryapproachtoclinicalactivity. Suchapproachisrooted in shamanictraditions and overtlyproposedby ME in his look and style. ME optimizedhisskillswithanthropological and psychiatricstudies, lookingfor social and biologicalbasisof trance induction and trance states.

15. Whichparadigm? The linear, cause-effect, newtonian, thre-dimensionsparadigmseems obsolete to help ustounderstandhypnoticclinicalphenomena The holistic way ofthinking, based on the complexitytheory, seems more useful in explaining the fuzzy nature of life sciences

16. Hypnosis in Psychotherapy and HypnosisasPsychotherapy

17. Hypnosis in Psychotherapy and HypnosisasPsychotherapy Hypnosis in psychotherapycouldenhance the effectivenessofdifferentapproachesthroughelicitationofrapportmodules; itisbased on empathiccommunicationskills Hypnosisaspsychotherapycouldenhanceself-trascendence and innerhealermodulesthroughactivationof trance states

18. Hypnosis and Theoryof Mind Recentneurophysiological data suggestthat the abilitytomakeinference on the mental state of the others and toempathizewiththemislinkedto a decrease in activityof the cortexofanteriorcingulus; hypnoticinductionseemsto generate the sameeffect. We can thereforeaffirmthatHypnosisdoesn’t need a theoryof mind, sinceitisTheoryof Mind in Action.

19. Placebo, Hypnosis, InternalHealer As “internalhealer” we can identify the biochemical and neurophysiologicalmodulesof placebo: increasedopioid and dopaminergicactivity reduction in anteriorcingulatecortexactivity modulationof immune system modulationof social neuroendocrine pathways

20. HypnoticPsychotherapy Hypnoticpsychotherapy can bedefinedas the structuralblendbetweenhypnosis in psychotherapy and hypnosisaspsychotherapy. Itisbased on Rapport Trance Theoryof Mind consciousactivation In the contextof the aspecificfactorsthatconstitute the goodclinicalsetting.

21. Suggestionsfor future work Integrationofclinical and theoreticalresearchwith the recentbiochemical and neuropshysiological (EEG, PET, f-NMR) data Integrationofbehavioral and emotive hypnoticpatterns in anevolutionary interpretative frame Integrationofclinicalpracticelanguagewith the traditional western and easternhealingapproachestoreconciliatedifferenttherapeuticexperiences Assumptionof a newholisticparadigmofhealth