Multicultural Personality and Posttraumatic Stress inU.S. Se.docx

Multicultural Personality and Posttraumatic Stress in
U.S. Service Members
Catherine J. Herrera1 and Gina P. Owens2
1JFK Special Warfare Center and School
2University of Tennessee
Objective: Modern military missions place numerous demands
on service members, including
tactical, personal, and cultural challenges. The purpose of this
study was to explore how domains of
multicultural personality (cultural empathy, open-mindedness,
social initiative, emotional stability, and
flexibility) and combat exposure relate to posttraumatic stress
disorder (PTSD) in service members.
Method: Participants (N = 163) completed the Multicultural
Personality Questionnaire, Combat Ex-
posure Scale, and PTSD Checklist–Military as part of an online
survey. The majority of participants were
Caucasian (87%), mean age was 33 years, and all were deployed
at least once to Iraq or Afghanistan
Results: Regression results indicated that higher levels of
combat exposure and open-mindedness
and lower levels of flexibility and emotional stability were
significant predictors of higher PTSD severity.
The interactions between combat exposure and flexibility and
combat exposure and openness were
also significant. Conclusion: Higher levels of flexibility and
emotional stability seem particularly im-
portant in their association with lower PTSD severity for
service members. C© 2014 Wiley Periodicals,

Inc. J. Clin. Psychol. 71:323–333, 2015.
Keywords: military; posttraumatic stress disorder; multicultural
personality characteristics; Iraq and
Afghanistan
In well over a decade of war, spanning fronts in Iraq and
Afghanistan, U.S. military personnel
have faced unique, complex, and continuous challenges. The
surge in operational tempo to
meet the demands of both theaters placed consistent strain on
service members’ personal health
and relationships, the effects of which can continue for years.
Growing research has begun
to paint a clearer picture of the mental health effects associated
with these wars, with early
reports estimating that roughly 16%–17% of veterans of the Iraq
war met screening criteria for
posttraumatic stress disorder (PTSD), depression, or anxiety
(Hoge et al., 2004). Similarly, more
recent work found that approximately 22% of Iraq and
Afghanistan veterans were diagnosed
with PTSD in the U.S. Department of Veterans Affairs (VA)
system between 2002 and 2008
(Seal et al., 2009). Reducing PTSD severity is of the utmost
importance given its significant
effect on social and occupational functioning. In a cross-
sectional study including active and
National Guard Operation Iraqi Freedom (OIF) veterans,
prevalence rates of those who met
criteria for depression or PTSD with some functional
impairment ranged between 23% and
31%, and even when using a stricter case definition with severe
functional impairment, rates still
ranged between 9% and 14% (Thomas et al., 2010).

Underscoring the mental health effect of combat experiences in
Iraq and Afghanistan, an
analysis of data from the mandated Post-Deployment Health
Assessment, showed that roughly
one third of veterans returning from Iraq accessed mental health
services within the first year
after deployment (Hoge, Auchterlonie, & Milliken, 2006).
Results also showed combat duty in
Iraq was related to attrition from military service, raising
mental health as well as operational
concerns. These findings signal a need for greater understanding
of the psychological risks of
deployment.
Please address correspondence to: Gina P. Owens, Department
of Psychology, University of Tennessee, 1404
Circle Dr., Knoxville, TN 37996-0900; E-mail:
[email protected]
JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 71(4), 323–333
(2015) C© 2014 Wiley Periodicals, Inc.
Published online in Wiley Online Library
(wileyonlinelibrary.com/journal/jclp). DOI: 10.1002/jclp.22138
324 Journal of Clinical Psychology, April 2015
Military Cultural Stress
Modern warfare demands that service members not only
navigate unfamiliar geographical ter-
rain but also negotiate an immensely diverse human landscape.
In a context in which a cultural
misstep can be dangerous, military personnel must frequently
interact with, influence, and work
alongside foreign community members and other international

forces to be successful. Moni-
toring sociocultural understanding while simultaneously striving
to maintain security creates a
higher cognitive demand and greater challenge for the unit and
individual. Bartone (2005) iden-
tified a lack of cultural understanding as potentially adding to
feelings of isolation, ambiguity,
and powerlessness in deployed soldiers. As prior research has
investigated in the civilian business
sector (e.g., Aycan, 1997; Shaffer, Harrison, Gregersen, Black,
& Ferzandi, 2006), examining
associations between such factors as multicultural effectiveness
and psychological adjustment
in the military population may provide important directions for
not only military mental health
but also selection and training. Although immersion in and
reentry from a foreign culture is an
explicit aspect of modern military deployments, military
cultural stress and adaptation remain
relatively unexplored domains (Azari, Dandeker, & Greenberg,
2010).
Military cultural stress, with its ongoing nature and relation to
other forms of combat stress,
presents a unique area of study with increasingly relevant
human and operational implications
(Azari et al., 2010). More research is needed to identify
characteristics that may help mitigate
the effect of cultural stress on service members and aid in
adjustment. Multicultural personality
is one construct that may help in this effort.
Multicultural Personality
The construct of multicultural personality, which encompasses
aspects of multicultural adapt-

ability and intercultural effectiveness (Ponterotto et al., 2007),
has become an important focus
in expatriate research as modern globalization has spurred a
growing interest in cultural com-
petence within the psychology field. Despite considerable
research dedicated to the assessment
and identification of multiculturally effective civilian
expatriates who may adapt well or even
thrive in foreign cultures (Aycan, 1997; Shaffer et al., 2006),
little to no research has empirically
examined these factors in the military. Multicultural personality
provides one avenue from which
to begin.
Van der Zee and Van Oudenhoven (2000, 2001) defined
multicultural personality as compris-
ing five distinct domains: cultural empathy, open-mindedness,
emotional stability, social initia-
tive, and flexibility. Cultural empathy describes a person’s
ability to empathize with the thoughts,
feelings, and behaviors of those from varying cultural
backgrounds. Open-mindedness indicates
an individual’s tendency to hold an open, unprejudiced mindset
toward different groups, values,
and cultural norms. Social initiative describes a tendency to
actively approach social situations
and take initiative. Emotional stability depicts the propensity to
maintain calm as opposed
to exhibiting strong emotional reactions during high stress
situations. Finally, flexibility is the
propensity to adjust to new, unknown situations and view them
as challenges (Van der Zee &
Van Oudenhoven, 2001).
Research with international civilian samples has found
relationships between multicul-

tural personality factors and psychological well-being, physical
health, and life satisfaction
(Ponterotto, 2008). Multicultural personality dimensions have
also been predictive of levels of
personal, social, and professional adjustment among expatriate
workers (Van Oudenhoven, Mol,
& Van der Zee, 2003). Another study investigating multicultural
personality domains conducted
with Dutch college students found that those with higher scores
on the Multicultural Personality
Questionnaire appraised potentially threatening intercultural
scenarios more positively and had
fewer negative reactions than those with lower scores, a finding
that highlights the relevance of
this construct for military personnel, who may face a range of
threatening intercultural experi-
ences overlaid with varying levels of combat exposure (Van der
Zee, Van Oudenhoven, & Grijs,
2004). Although deployment is a unique type of expatriation in
which the cultural demands
placed on service members are coupled with the potential for
life threat, extant research suggests
Multicultural Personality 325
that multicultural personality characteristics may be beneficial
for buffering stressors such as
those that may be experienced during combat exposure.
As the wars in Iraq and Afghanistan called for the military to
meet new operational demands,
the resulting mental health effects have challenged
psychologists to identify ways to better treat
prevalent diagnoses and bolster resilience in a force whose

working environment spans the globe.
Research applying the multicultural personality framework to a
military population may provide
needed information about how this construct fits within a
military context, how multicultural
personality dimensions may buffer the potentially negative
effects of combat exposure, and,
thus, how they relate to psychological distress levels. In
addition, it may help inform innovative
efforts of prevention and intervention.
Purpose of Study
Given the relevance of multicultural stress to a military career
and research that suggests that
certain personality factors may help buffer the effects of this
stress, it is surprising that limited
research has examined multicultural personality characteristics
among military personnel. To
address this gap in the literature, the purpose of the present
study is to investigate the relationships
between multicultural personality characteristics and PTSD
severity in service members who
have been deployed. Based on the available research literature,
we hypothesized that dimensions
of multicultural personality (cultural empathy, open-
mindedness, social initiative, emotional
stability, and flexibility) would be negatively related to PTSD
severity. We also expected that
greater combat exposure would be positively related to PTSD
severity. Further, we aimed to
investigate whether multicultural personality variables would
moderate the effects of combat
exposure on PTSD severity. Because no prior literature has
examined these relationships, our
moderator analyses were exploratory in nature.

Method
Participants
A total of 163 service members who had deployed at least once
to Iraq or Afghanistan since
2001 completed the online survey. Respondents’ ages ranged
from 21 to 57 years, with a mean
age of 33 (standard deviation [SD] = 7.90). Regarding race and
ethnicity, the majority of
the participants self-identified as White (87%; n = 140),
followed by 6% (n = 10) Hispanic
or Latino, 3% (n = 5) Asian, 4% (n = 6) African American,
about 2% (n = 3) American
Indian or Alaska Native, .6% (n = 1) Native Hawaiian or Other
Pacific Islander, and 1% (n = 2)
identified as other. Participants could indicate more than one
category for race or ethnicity. As the
original concept for this study was to examine only combat arms
branches for which respondent
gender would have been all male, gender was inadvertently left
out of the survey initially and
was added after many respondents had already participated.
Thus, percentages of males and
females completing the survey could only be partially
determined. Of those with gender recorded
(n = 46), 87% (n = 40) were male.
The sample was made up of about 66% (n = 106) officers and
34% (n = 55) enlisted personnel.
Participants ranged in number of previous deployments, with
41% (n = 66) having deployed
once, 30% (n = 48) having deployed twice, 19% (n = 30) having
deployed three times, and 11%
(n = 17) having deployed more than three times. A large

majority of respondents were members
of the Army (90%, n = 145), followed by the Navy (4%, n = 6),
Marine Corps (3%, n = 5), and
Air Force (3%, n = 4). In terms of duty status, most service
members were Active Duty (65%, n
= 104), followed by Reserve (19%, n = 30), National Guard
(13%, n = 21), and Active Guard
(2%, n = 3). Regarding participants’ levels of cultural or
language training prior to deployment,
16% (n = 26) of respondents indicated receiving more than 40
hours of cultural or language
training, 29% (n = 47) had 10–40 hours, 45% (n = 72) had less
than 10 hours, and 10% (n = 16)
reported no such training.
Regarding the depth of respondents’ interactions with foreign
personnel during deploy-
ment, 49% (n = 79) indicated having “extensive” interactions
(i.e., communication with foreign
personnel was a primary part of role), 21% (n = 34)
“significant” interactions (i.e., several sig-
nificant interpersonal interactions with foreign personnel which
required lengthy or repeated
communications), 16% (n = 26) “somewhat significant”
interactions (i.e., some interpersonal in-
teractions with foreign personnel which required
communication), and 14% (n = 22) “minimal”
interactions (i.e., had few interactions with foreign personnel or
interactions were very brief or
not in-depth).

Measures
Multicultural Personality Questionnaire (MPQ; Van der Zee &
Van Oudenhoven,
2001). The MPQ is a 78-item Likert-type scale designed to
measure multicultural effective-
ness. The scale assesses five dimensions: Cultural Empathy,
Open-Mindedness, Social Initiative,
Emotional Stability, and Flexibility. Respondents were asked to
rate the extent to which each
statement applied to him or her on a 5-point scale, ranging from
1 (not at all applicable) to
5 (totally applicable). Example items include: “Tries to
understand other people’s behaviors”
(Cultural Empathy); “Is intrigued by differences” (Open-
Mindedness); “Makes contacts easily”
(Social Initiative); “Considers problems solvable” (Emotional
Stability); and “Changes easily
from one activity to another” (Flexibility). Internal consistency
for scales on the MPQ ranged
from .74 (Flexibility) to .91 (Emotional Stability; Van der Zee
& Van Oudenhoven, 2001).
Construct validity has been demonstrated through expected
correlations between dimensions
of the MPQ and the Big Five personality traits (Leone, Van der
Zee, Van Oudenhoven, Perugini,
& Ercolani, 2005). Specifically, correlations were highest
between Cultural Empathy (r = .39)
and Open-Mindedness (r = .50) with Openness to Experience,
Social Initiative and Extraversion
(r = .76), Emotional Stability and Neuroticism (r = −.73), and
Flexibility and Conscientiousness
(r = −.46). Internal consistency coefficients for scales in the
current study were .86 (Cultural
Empathy), .88 (Open Mindedness), .87 (Social Initiative), .84

(Emotional Stability), and .70
(Flexibility).
Combat Exposure Scale (CES; Keane et al., 1989). The Combat
Exposure Scale
is a seven-item measure designed to evaluate respondents’
exposure to a variety of combat
experiences. Responses are rated on a 5-point scale with item-
specific anchors. Total scores
indicate the severity of combat exposure, with higher scores
signifying higher rates of exposure.
Example items include: “Did you ever go on combat patrols or
have other dangerous duty?”
and “How often did you see someone hit by incoming or
outgoing rounds?” Adequate internal
consistency reliability (coefficient alpha = .85) and test-retest
reliability over a 1-week time
span (r = .97) have been reported (Keane et al., 1989). Keane et
al. (1989) found support for
the construct validity of the CES with principal components
factor analysis indicating a single
construct that accounted for 58% of the variance. Internal
consistency reliability for the current
study was .81.
PTSD Checklist-Military Version. (PCL-M; Weathers, Litz,
Herman, Huska, &
Keane, 1993). The PCL-M is a 17-item measure of PTSD
symptomatology based on the
Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition, Text Revision (DSM-
IV-TR) criteria (American Psychiatric Association, 2000), the
standard for assessing PTSD at
the time of this study. Respondents indicated on a 5-point scale,
ranging from 1 (not at all) to
5 (extremely), how much they have been troubled by a

particular problem in the past month.
Total scores range from 17 to 85, with higher scores indicating
greater PTSD symptom severity.
Example items include: “Repeated, disturbing memories,
thoughts, or images about the stressful
experience” and “Avoiding thinking or talking about the
stressful experience.” Blanchard, Jones-
Alexander, Buckley, and Forneris (1996) found support for the
construct validity of the PCL
through a high correlation between the PCL and the Clinician-
Administered PTSD Scale (r =
.93, p < .0001; Blake et al., 1990). Prior research with military
samples supports the internal
consistency and test-retest reliability of the measure with
coefficients of .94 and .96 respectively
(Blanchard et al., 1996; Weathers et al., 1993). Internal
consistency reliability for the current
study was .95.
Procedure
An Internet survey was used to collect data for the current
study. Participants were recruited
via e-mail announcements sent through Army Knowledge Online
(the primary Intranet system
for the Army), veteran listserves and interest groups, and
personal contacts of the first author.
Participants used a hypertext link to connect to the survey
website, where an informed consent
with further information about the study was provided. Potential
participants were informed
that the purpose of this study was “to obtain information

regarding attitudes and characteristics
related to resilience and mental health.” Participants indicated
their consent by moving forward
to the survey items. Data were collected and stored through a
secure server.
Data Analysis
Available case analysis (AIA; Parent, 2013) was used to deal
with item-level missingness among
the completed surveys received. With AIA, mean scale scores
are calculated without the need for
imputation of values. Parent (2013) found this procedure
produced similar results to both mean
substitution and multiple imputation methods. No patterns of
missingness in item responses
were observed in the current dataset. Means for all scales were
calculated when at least 80%
complete data were available for that particular scale. Thus, any
cases that had one or more
scales on which a participant did not answer more than 20% of
the questions were excluded
(Schlomer, Bauman, & Card, 2010). This method resulted in the
exclusion of two participants.
Thus, the final sample comprised 161 participants.
Means, standard deviations, internal consistency reliability
estimates, and inter-correlations
among all continuous variables were computed. Prior to
regression analyses, independent vari-
ables were checked for their appropriateness for multivariate
analyses. Skewness, kurtosis, and
multicollinearity were in acceptable ranges. To investigate our
hypotheses, correlational analyses
among multicultural personality factors, combat exposure, and
PTSD severity were conducted.

Next, a hierarchical linear regression was performed to
determine which variables were signifi-
cantly associated with PTSD. Because MPQ factors have not
been examined previously among
U.S. service members, we included all five subscales in our
PTSD model to explore significant
relationships.
Step 1 of the model included combat exposure and step 2
included the moderating variables
(MPQ scales). To investigate our exploratory hypothesis about
the possible moderating effect of
multicultural personality factors on combat exposure, the
following interactions were entered as
step 3 in the model: combat exposure x openness, combat
exposure x flexibility, combat exposure
x cultural empathy, combat exposure x social initiative, and
combat exposure x emotional stabil-
ity. Scores for all variables included in the interactions were
first mean-centered, and the centered
values were then multiplied to obtain the interaction terms
(Aiken & West, 1991). Plots of low
and high levels of multicultural personality factors and combat
exposure corresponding to one
standard deviation above and below the mean were constructed
to illustrate their relationships
with PTSD severity (Aiken & West, 1991).
Results
Means, standard deviations, and correlations among variables
using mean scores are shown in
Table 1. The mean score on the CES (mean [M] = 2.61; SD =
1.33) indicated a moderate level
of combat exposure for this sample (Keane et al., 1989). The
mean for PTSD symptom severity

on the PCL-M was 1.94 (SD = .86), slightly below the middle
range for this measure. Mean
scores for scales of the MPQ were slightly above middle range
(all means at least 3.2 or higher).
Correlational analyses indicated significant negative
relationships between three MPQ scales
and PTSD severity: Social Initiative (r = −.30, p < .001),
Emotional Stability (r = −.45, p <
.001), and Flexibility (r = −.36, p < .001). Combat exposure was
significantly positively related
to PTSD (r = .29, p < .001). Open-Mindedness (r = −.00, p =
.96) and Cultural Empathy (r =
−.15, p = .05) were not significantly related to PTSD severity.
Table 1
Means, Standard Deviations, and Correlations for Study
Variables (N = 163)
Variable M SD 1 2 3 4 5 6 7
1. PTSD Severity 1.94 .86 –
2. Combat Exposure 2.61 1.33 .29* –
3. Cultural Empathy 3.61 .56 −.15 .02 –
4. Open-Mindedness 3.59 .62 −.00 .04 .60* –
5. Social Initiative 3.73 .53 −.30* .06 .56* .58* –
6. Emotional Stability 3.34 .49 −.45* .12 .29* .28* .56* –
7. Flexibility 3.20 .49 −.36* .02 .17 .36* .47* .45* –
Note. M = mean; SD = standard deviation; PTSD =
posttraumatic stress disorder. A Bonferroni correction
was applied.
*p < .008.

Table 2
Hierarchical Multiple Regression Analyses Predicting PTSD
Severity
Predictor R2 �R2 B SE β
Step 1 .09 .09***
Combat Exposurea .19 .05 .29***
Step 2 .40 .32***
Cultural Empathy −.22 .13 −.14
Open-Mindednessa .44 .12 .31***
Social Initiative −.17 .15 −.11
Emotional Stability −.65 .14 −.37***
Flexibilitya −.42 .13 −.24**
Step 3b .45 .05**
Cultural Empathy −.25 .13 −.16
Open-Mindednessa .42 .11 .30***
Social Initiative −.12 .15 −.08
Emotional Stability −.68 .13 −.39***
Flexibilitya −.44 .13 −.25**
Combat Exposure x Open-Mindedness .17 .07 .17*
Combat Exposure x Flexibility −.26 .08 −.21**
Note. SE = standard error; PTSD = posttraumatic stress

disorder. N = 161, R2 = .45.
aCentered values were used for variables included in the
interaction term.
bThe interactions between combat exposure x cultural empathy,
combat exposure x social initiative, and
combat exposure x emotional stability were not significant and
were dropped from the final model.
*p < .05. **p < .01. ***p < .001.
The overall hierarchical regression model predicting PTSD
severity was significant, F(8, 152)
= 15.41, p < .001, R2 = .45. Combat exposure (β = .31, p <
.001), flexibility (β = −.25,
p < .01), open-mindedness (β = .30, p < .001), emotional
stability (β = −.39, p < .001), the
combat exposure x flexibility interaction (β = −.21, p < .01),
and the combat exposure x open-
mindedness interaction (β = .17, p < .05) emerged as significant
predictors (see Table 2 for all
steps in the model). Cultural empathy almost reached statistical
significance (β = −.16, p =
.053). Because these two interactions were the only ones that
reached significance, the remaining
three interactions were dropped from the final model. The
interaction plot for combat exposure
x flexibility (Figure 1) indicated that at moderate and high
levels of combat exposure, higher
levels of flexibility were associated with lower levels of PTSD
severity. However, at low levels of
combat exposure, this effect of flexibility was not apparent.
Figure 1. Interaction between combat exposure and flexibility

with PTSD severity as dependent variable.
Note. For both variables, low = one standard deviation below
the mean and high = one standard deviation
above the mean.
Figure 2. Interaction between combat exposure and open-
mindedness with PTSD severity as dependent
variable.
Note. For both variables, low = one standard deviation below
the mean and high = one standard deviation
above the mean.
Similarly, in terms of the combat exposure x openness
interaction (Figure 2), at low levels of
combat exposure, there was little impact of degree of openness
on PTSD severity. At moderate
and high levels of combat exposure, lower levels of openness
were associated with lower levels of
PTSD severity. Further, Open-mindedness functioned as a
suppressor variable in the regression
model (Cramer, 2003). Open-mindedness was negatively related
to PTSD severity in correlational
analyses (r = −.00, p = .96), but was a significant positive
predictor of PTSD severity (β = .30,
p < .001) in regression analyses when included in the model
with all predictors included due to
the suppression of extraneous variance.
Discussion
The current study examined multicultural personality
characteristics in relation to PTSD severity

in service members who had been deployed to Iraq or
Afghanistan. Although a current dearth
of research on multicultural personality characteristics within a
military context prevents an
extensive analysis of our findings compared to other military
research, our results appear largely
consistent with research suggesting links between MPQ factors
and aspects of well-being and
adjustment in civilian populations (Ponterotto et al., 2007;
Ponterotto, 2008; Van Oudenhoven
et al., 2003).
Our results suggest the relevance of certain multicultural
personality characteristics for service
member mental health, partially supporting our hypotheses. Our
findings that higher emotional
stability and flexibility were associated with lower PTSD
severity suggest that these constructs
may serve as protective factors for current service members
against PTSD. Emotional stability,
or the tendency to maintain calm during high stress situations,
has previously been shown to be
the most significant predictor of psychological adjustment of all
MPQ scales (Van Oudenhoven
et al., 2003). Van Oudenhoven and Van der Zee (2002) have
suggested that emotional stability
may be the most salient factor upon one’s initial entrance into a
foreign culture, while the
remaining factors may become increasingly important for
adjustment after the initial culture
shock has decreased.
Similarly, results regarding flexibility, or a tendency to adapt to
new situations and appraise
them as challenges, also appear consistent with existing civilian
literature. Prior work with civilian

populations found that the cognitive appraisals of stressors may
act as a moderating variable
in PTSD (Agaibi & Wilson, 2005). In our sample, higher levels
of flexibility were particularly
protective in the face of high combat exposure, and appeared to
buffer the effects of combat
exposure on PTSD severity. It may be that higher levels of
combat exposure demand a more
complex cognitive approach for successful coping. Flexibility
may have implications for how one
appraises stressors including cultural differences (e.g., more or
less threatening). It may influence
the meaning one assigns to different culture-related stressful
events and interpersonal challenges,
and may affect the likelihood of approaching versus avoiding
unfamiliar yet potentially helpful
coping resources in a new culture.
Thus, our findings related to emotional stability and flexibility
may have implications for
more focused military resilience training and selection. In
addition, these findings suggest a
possible mental health benefit of current operational goals to
increase multicultural competence
military-wide (Abbe, Gulick, & Herman, 2007; Abbe & Halpin,
2010).
Our finding that the Open-Mindedness subscale was a
significant positive predictor of PTSD
was surprising, although further exploration revealed its role as
a suppressor variable in the
presence of all other predictors in the model. Open-mindedness
also served as a moderator of
the combat exposure-PTSD severity relationship, with low
open-mindedness buffering the effects
of high combat exposure on PTSD. Thus, it may be that one’s

openness to a new culture can
also potentially operate as a risk factor during deployment,
especially at higher levels of combat
exposure. For example, perhaps an initial openness to a culture
leaves one more vulnerable
to stress related to destruction within the culture or
disappointed expectations related to their
intercultural experiences. As with all of our findings, further
research, possibly investigating
multicultural personality traits longitudinally, is needed to
better illuminate the nature of this
relationship.
Several other findings were contrary to our predictions.
Although Cultural Empathy did
not reach statistical significance in analyses (p = .05), further
exploration of this variable is
warranted given that it is the subscale most specifically related
to culture and given the statistical
trend found in the current study. Prior research with other
expatriate populations (Ponterotto
et al., 2007; Van Oudenhoven & Van der Zee, 2002) has
suggested that one’s ability to empathize
with the thoughts, feelings, and behaviors of those from varying
cultural backgrounds may
aid adjustment. Social initiative also was not a significant
predictor of PTSD severity with this
sample. Thus, it seems that actively approaching social
situations had no added benefit in the face
of other, more important multicultural personality
characteristics in terms of PTSD severity.

Literature on resilience to trauma suggests it is a multifaceted
process that likely involves
various factors such as one’s cognitive appraisals of the
stressor(s), activation of particular
personality variables, and capacity for affect regulation (Agaibi
& Wilson, 2005). Our findings
indicate several potential implications for military mental health
and multicultural personality
factors. Because aspects of multicultural personality may be
trainable (Abbe et al., 2007), military
training incorporating knowledge, skills, and abilities
specifically related to emotional stability,
flexibility, and open-mindedness may help bolster resilience
and mitigate the effects of compound
stress during deployment to a combat zone. For example, in
describing the need for more cultural
competency training in the Army, Abbe and Halpin (2010)
discussed how existing training and
education can be leveraged to incorporate cultural competency
skills because of the significant
overlaps between these competencies and generalized leadership
concepts that are already a part
of Army training and culture.
In this same spirit, perhaps such a merging of initiatives could
exist between military opera-
tional goals and mental health needs. Ideally, while service
members learn to be more culturally
adept and effective, their skills could serve to bolster their
cultural as well as overall resilience
in a more holistic approach to fitness. This strategy is
consistent with the Army’s Comprehen-
sive Soldier Fitness Program, which emphasizes prevention and
risk management and positive
psychology interventions to improve mental health (Cornum,
Matthews, & Seligman, 2011).

Limitations and Directions for Further Research
The current findings should be considered in light of several
limitations of this study. Be-
cause this is correlational research, causation cannot be
determined. Our sample comprised a
high percentage of Caucasian participants (87%) and therefore
may not fully represent other
races/ethnicities. In addition, officers were overrepresented in
our sample (66%) and therefore
results may not be representative of enlisted personnel. Future
research should further examine
multicultural personality with more diverse and representative
military samples.
We also did not assess for military occupational specialty or
differentiate between combat
arms versus combat support or service and support. Although
the modern battlefield is much
less linear than in previous eras, assessing for service members’
specific role during deployment
may be important for understanding how these traits may be
differentially valuable depending
upon one’s role. For example, specialized elements charged
with training or supporting foreign
populations require more cultural savvy than personnel whose
role may be solely managed
within their operating base.
Another important limitation of this study is that we did not
assess how long it had been since
service members had returned from deployment, which may
have influenced distress measures
and recall. Future research may benefit from examining specific
units at isolated times, before

and after deployment or, if possible, at different times during
deployment. In this way, the relative
importance of different MPQ factors over time could be
assessed.
Conclusion
Although there is growing recognition of the relevance of the
expatriation experience and multi-
cultural competence within a military population (Abbe &
Halpin, 2010), to date little empirical
research exists within this context. Abbe and Halpin (2010)
discuss the “cultural imperative” of
modern military training for its operational value and other
authors have illustrated the impor-
tant mental health implications of cultural stress (Azari et al.,
2010). The present study has begun
to connect these paradigms by illuminating how aspects of
intercultural effectiveness, theorized
to predict success in foreign environments, are associated with
mental health outcomes such as
PTSD in service members who have deployed to Iraq or
Afghanistan. Specifically, multicultural
personality factors were associated in generally expected
directions with PTSD symptomatol-
ogy. Emotional stability, open-mindedness, and flexibility
appear to have particularly significant
implications for service member mental health. This research
sheds light on concepts that may
simultaneously influence service member effectiveness and
resilience and inform initiatives in
prevention, training, and selection.

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Reading Questions
IET 123—Pages 634-640
1. What are the two metal strips in the Daniell’s cell?
2. What is used to connect the two containers of the Daniell’s
cell?
3. What crosses over the salt bridge?
4. What is the voltage of a fresh Daniell’s cell?
5. What happens to the voltage of the Daniell’s cell over time?
6. What is in the solution of a lead-acid battery?
7. What is the natural voltage of a lead-acid cell?
8. How many cells make-up an automobile battery?
9. Why does an automobile battery last so long?
10. What allows a lead-acid battery to deliver the enormous
currents needed to start a car?
Reading Questions
IET 123—Pages 600-612
1. What is the most important atom in petroleum and organic
chemistry?
2. What geometric shape fits the way hydrogen bonds to the
carbon atom?
3. What group of hydrocarbons has double bonds?
4. Ring-like structures belong to what group of hydrocarbons?
5. What element is common in “sour crude?”
6. What molecule is present in gasoline to allow engines to start
when they are cold?
7. What are the two molecules used to create the octane
number?
8. What are the two octane numbers used to calculate the octane
numbers found at the punp?
9. The largest molecules found at the refinery are found in
what?
10. What two contaminants have to be removed from crude oil

before it can be refined?
11. What are the five products produced by the distillation
tower?
American Journal of Clinical Hypnosis, 57: 330–348, 2015
Copyright © American Society of Clinical Hypnosis
ISSN: 0002-9157 print / 2160-0562 online
DOI: 10.1080/00029157.2014.978495
Mysteries of Hypnosis and the Self Are Revealed
by the Psychology and Neuroscience of Empathy
Ian E. Wickramasekera II
University of the Rockies, Denver, Colorado, USA
This article reviews a growing body of research and theory in
hypnosis and neuroscience that sup-
ports the empathic involvement theory (EIT) of hypnosis
(Wickramasekera II, 2001; Wickramasekera
II & Szlyk, 2003; Wickramasekera II, 2007c). The EIT is a
unified transpersonal theory of hypnosis
and the self, which weaves together empathic elements of
Dzogchen, neodissociative, neuroscience,
psychoanalytic, sociocognitive, and other theories by proposing
that hypnotic phenomena are inher-
ently characterized by their deep involvement with processes of
empathy and the self. The EIT
proposes that the experience of hypnosis is embodied in a
system of neural networks in the brain
that utilizes empathy-related processes, adaptive resonance
between perceptual input and top-down
expectancies, and connectionist learning algorithms to (a)

empathically enact the affect, cognition,
body language, response expectancies, social roles, sensations,
etc. that are presented to them during
hypnosis in accordance with socio-cognitive theories of
hypnosis; (b) engage in a convergent psy-
chophysiological relationship with another person in accordance
with psychoanalytic, Ericksonian,
and polyvagal/social engagement system theories; (c) alter the
empathic self/other (theory of
mind) coding of phenomenological experiences during hypnosis
in accordance with aspects of the
neo-dissociative and socio-cognitive traditions; and (d) develop
an experiential understanding of the
illusion of self that may lead, in some people, to its
transcendence in accordance with Bon-Buddhist,
Dzogchen, and transpersonal scholars. A unified definition of
hypnosis is proposed based on find-
ings in the empathic neuroscience of hypnosis as well as a
working model of the neuromatrix of
the self.
Keywords: consciousness, Dzogchen, empathy, hypnosis,
neuroscience, self
Introduction: The Mysteries of Hypnosis and the Self
Researchers around the world have struggled for over 200 years
to resolve a seemingly
intractable debate about whether the nature of hypnosis
(Forrest, 1999; Kirsch & Lynn,
1995; Pekala & Kumar, 2005) is primarily a social
psychological related phenomenon
or rather a special state of consciousness based on advanced
mind/body and/or neu-
ropsychological talents. This debate started from the earliest of
times in the history of

hypnosis (Bernheim, 1891; Faria, 1819) and has been
particularly vexing to resolve
Address correspondence to Ian E. Wickramasekera II,
University of the Rockies, School of Professional Psychology,
1201 16th Street, Suite 200, Denver, CO 80202, USA. E-mail:
[email protected]
mailto:[email protected]
MYSTERIES OF HYPNOSIS AND THE SELF 331
due to the impressive amount of evidence that each theoretical
camp has produced.
For instance, there are a number of impressive studies that seem
to indicate that the
effects of the hypnotic state can be reliably measured
phenomenologically (Pekala &
Kumar, 2000, 2005; Sheehan, 1992) and even indexed
psychophysiologically (Barabasz
& Barabasz, 2008; McGeown, Mazzoni, Venneri, & Kirsch,
2009). Meanwhile, a sep-
arate tradition of research has produced an equally impressive
amount of evidence that
indicates how expectation, context, and other social
psychological factors influence hyp-
notic subjects to genuinely enact the role of being hypnotized as
a kind of believed-in
imagining (Kirsch & Lynn, 1995; Kirsch, Mazzoni, &
Montgomery, 2007; Sarbin, 1950,
1998). Any theory of hypnosis that wishes to resolve its central
mysteries must at least
account for and integrate these two strong traditions of hypnosis
in some way (Pekala &
Kumar, 2005).

Meanwhile, questions regarding the true nature of the self that
human beings seem to
inherently experience has been debated in folklore, philosophy,
religion, science, and
various traditions of wisdom for millennia (Wickramasekera II,
2014). There is evi-
dence from the earliest times in civilization that our ancestors
struggled with questions
about whether the sense of identity or self that we experience
was singular or plural
in nature, eternal or transitory, or perhaps a mere illusion or a
distortion of our true
nature (Wickramasekera II, 2014). For example, many mystical
traditions that practice
techniques of meditation, such as mindfulness and Dzogchen,
have asserted that the self
is very illusory in nature (Wangyal, 2011) and that techniques
of meditation can help
one to experience the true nature of our mind. Questions about
whether the nature of
human identity was singular or plural were also immediately
present in the early history
of hypnosis when researchers discovered that some of their
hypnotic subjects appeared
to evidence other parts of themselves or ego states that could be
contacted during hyp-
notic experiments and psychotherapy (Faria, 1819; Hilgard,
1977; Watkins & Watkins,
1997). More recently, participants in studies conducted by
Amanda Barnier and her col-
leagues (Barnier, Cox, Connors, Langdon, & Coltheart, 2010;
Cox & Barnier, 2010,
2013) have shown that people experiencing hypnosis can even
have the ability to con-
vincingly transform their identity into that of another person to

such a degree that they
no longer demonstrate signs of self-recognition when shown the
image of their face in a
mirror.
I wish to explore a theory in this article in which I assert that
these mysteries of
hypnosis and the self can be explained by a close examination
of how empathy and
its embodiment in the mind and brain influence them both.
Overall, I have termed
my theory the empathic involvement theory (EIT:
Wickramasekera II & Szlyk, 2003;
Wickramasekera II, 2007b, 2007c) for its characterization of the
ubiquitous way in
which empathy is involved with hypnotic phenomena and the
creation and mainte-
nance of the self. The EIT defines hypnosis as an experience of
enhanced empathy
and phenomenological alteration with the self in which a
hypnotic subject utilizes
332 WICKRAMASEKERA II
perspective taking, empathic concern, and empathic aspects of
theory of mind (TOM)
to experience alterations in affect, behavior, consciousness,
sensation, thoughts, and
mind/body relationship that are suggested to him/her by a
hypnotist and/or through
his/her own creative and imaginative directions. This definition
of hypnosis asserts that
hypnosis is a consequence of the empathic nature of human
beings and the processes of

self/other that underlie how we experience the world. This
article will examine the evi-
dence and theory behind the EIT beginning with the life
experiences that first led me to
develop this theory, and will commence with an examination of
how the EIT can bridge
the gap between the social cognitive and special state theories
of hypnosis by grounding
them both in the psychology and neuroscience of empathy.
Along the way, the theoreti-
cal implications of the EIT will also be discussed for other
theories of hypnosis, finishing
with some glimpses at what might lie beyond the self.
Empathy and Hypnosis: Original Observations
I first developed the ideas in the Empathic Involvement
Hypothesis about 15 years ago
after my own chance observation that many people gifted with
high hypnotic ability
seemed to be very empathic (Wickramasekera II, 2001;
Wickramasekera II & Szlyk,
2003). I have had the good fortune to be able to work with
hundreds of high hyp-
notizables in clinical and experimental settings and have often
been struck with how
empathic they were in and outside of hypnosis. I was also
fascinated with quite a num-
ber of experiences that I have had in psychotherapy in which
hypnotic-like (Krippner,
2005) experiences of trance seemed to spontaneously emerge
while I was utilizing tech-
niques of therapeutic empathy through following the traditions
of humanistic psychology
(Rogers, 1957). I often find that it is possible for me to become
so empathically entranced

in a client’s inner world that we both lose track of time in the
session. Somehow the flow
of time seems to have been altered and slowed in these moments
by the empathic bond
that we share. This experience of time alteration in deep
empathic moments seems very
related to experiences of time distortion that I have experienced
in hypnosis (Cooper &
Erickson, 2002; Pekala & Kumar, 2000).
These early experiences collectively suggested that there was
something about empa-
thy that was powerful enough to alter the experience of
consciousness, as if empathy
could create spontaneous hypnotic-like experiences by itself. It
was at this time that
I initially developed the EIT, which proposes the idea that
hypnosis is an inherently
empathy-laden experience and that high hypnotizables use their
empathic talents to
adapt to the perspective, expectations, imagery, emotions, and
body language that their
hypnotist presents to them using hypnotic induction procedures
and hypnotic sugges-
tions (Wickramasekera II, 2001). I later discovered that a
number of theorists had
previously proposed empathy-related ideas about hypnosis,
which will now be briefly
reviewed.
Empathy and Hypnosis: Socio-Cognitive Perspectives

Theodore Sarbin (1911–2005), who was one of the great
founders of the socio-cognitive
tradition of hypnosis, developed a theory that hypnotic
phenomena were produced by the
hypnotic subject’s adoption of what he/she thought the role of a
hypnotic subject should
be (Sarbin, 1950). Sarbin’s theory has sometimes been
misinterpreted by some to mean
that hypnosis is a faked behavior, while in actuality, Sarbin’s
intention was to describe
the genuineness of the hypnotic role as a believed-in imagining
(Sarbin, 1998). Sarbin
(1956) touched upon the value of empathy in his theory when he
noted that some peo-
ple seemed to have greater accuracy in their role-taking aptitude
than others, which also
allowed them to experience hypnosis with greater intensity.
Role-taking ability has been
identified in social psychological research as one of the most
important individual dif-
ferences between people in their capacity for empathy and is
more generally referred to
as perspective-taking in the modern literature of social
psychology (Davis, 1983, 1994).
I have previously hypothesized that processes of empathy may
account for how hyp-
nosis is affected by various social psychological interventions
(Wickramasekera II, 2001,
2003, 2007c) designed to define the role of a hypnotic subject
(Sarbin, 1950; Spanos,
1996) and/or the response expectancies of the person
experiencing hypnosis (Kirsch &
Council, 1989). For instance, a number of experiments have
demonstrated that a person’s
prior expectation that he/she will be able to experience hypnotic

phenomena is moder-
ately to highly correlated with his/her subsequently measured
hypnotic ability (Council,
1999). Another classic experiment by Glass and Barber (1961)
demonstrated that it was
even possible to induce an experience of hypnosis in subjects by
merely administering a
placebo pill to a person who had been previously led to expect
that the pill could induce
a hypnotic trance. In general, there is excellent evidence for the
socio-cognitive assertion
that people’s roles, expectations, and attitudes tend to mediate
the experiences that they
have in hypnosis (Council, 1999).
However, other than Sarbin’s (1956) discussion of role-taking
ability, there has been
very little theoretical development within the socio-cognitive
tradition of an account
for how these kinds of social roles and response expectancies
are actually ascertained
and adopted by hypnotic subjects. After all, there must be some
psychological mech-
anism that allows hypnotic subjects to adopt these attitudes,
cognitions, expectancies,
and roles, or else they simply would not have any effect on
people even on an uncon-
scious, implicit, or automatic basis (Kirsch & Lynn, 1999).
Furthermore, it has been
similarly difficult to research how response expectancies and
roles are adopted by the
brain since there has been no real accounting of a hypothesized
process that could
explain how roles and expectancies are psychologically
absorbed into human beings.
Empathy may therefore be the missing link in explaining how

socio-cognitive processes
are mediated within a person. Processes of empathy may be
required for participants
to empathically enact and embody the expectations, roles,
perspectives, imagery, emo-
tions, somatic symptoms, and/or body language suggested to
them through hypnotic
inductions, psycho-educational interventions prior to
experiencing hypnosis, and a myr-
iad of potential manipulations of the social psychological
context in which the hypnotic
relationship takes place (Wickramasekera II & Szlyk, 2003).
This study now turns to an
examination of the psychological research and findings in
neuroscience that implicate
empathy as a process that is deeply involved with hypnosis.
Psychological Research on Empathy and Hypnosis
There have been two studies that have examined the relationship
between hypnotic abil-
ity and empathy directly (Wickramasekera II & Szlyk, 2003;
Wickramasekera II & Ran,
2008). Both studies have essentially found modest significant
correlations between hyp-
notic ability and empathy consistent with the predictions of the
EIT. There have also
been six studies of the relationship between absorption, a
personality correlate of hyp-
notic ability, and empathy, which all demonstrate a moderate
relationship between the

tendency to enter into focused states of awareness (absorption)
and to engage in empathic
experiences (Rivers, Wickramasekera II, & Pekala, 2006;
Wickramasekera II, 2007a;
Wickramasekera II & Szlyk, 2003; Wickramasekera II & Ran,
2008). A related study by
Cardeña, Terhune, Lööf, and Buratti (2008) also found a
relationship between automatic
and implicit aspects of empathy (emotional contagion) and
hypnosis. A recent study by
Peter et al. (2015) found that high hypnotizables are more likely
to report having an
unselfish and self-sacrificing style, which the authors concluded
is consistent with the
EIT. Furthermore, a previous study conducted by Lynn et al.
(1991) found that varying
the amount of rapport (an empathy-like experience) that a
hypnotist utilized had a pos-
itive effect on encouraging hypnotic behaviors and experiences.
Overall, these studies
collectively do seem to indicate that empathy is a trait that can
be reliably found in high
hypnotizables and that empathy is important for initiating a
hypnotic relationship as pre-
dicted by the EIT. However, only a few of these studies
controlled for context effects
(Council, Kirsch, & Hafner, 1986), and many utilized a subject
self-selection design that
has demonstrated some potential confounds in previous
hypnosis research (Barabasz &
Barabasz, 1992). Meanwhile, a number of studies in medicine
and neuroscience have
been published that also seem to implicate that empathy and
hypnosis are related.
The Empathic Neuroscience of Hypnosis

A number of experiments conducted by Elvira Lang and her
colleagues (Lang et al.,
2000, 2008) have demonstrated that utilizing empathy by itself
(as well as with hypno-
sis) can help patients significantly reduce their experience of
pain and suffering during
invasive medical procedures. These findings seem to again raise
the possibility that
there is something entrancing about empathy that is capable of
providing some anal-
gesia and anxiolysis during an invasive medical procedure just
through having a medical
professional engage in an empathic intervention with them.
However, the hypnosis group
in these experiments benefitted more in terms of analgesia,
anxiolysis, and the rate of
adverse effects than the empathic attention group. The
additional benefit may be due
to the specific hypnotic suggestions that they received in
addition to the hypnotic-like
relationship of therapeutic empathy.
There have been a number of studies linking the autonomic
psychophysiology of
empathy with hypnosis as well. Eve Banyai (1998)
demonstrated that there is a ten-
dency for participants in hypnotic relationships (i.e., the
hypnotist and the hypnotic
subject) to mirror each other’s body language and autonomic
psychophysiology as the

hypnotic experience deepens. This kind of mirroring is evident
in the overt body move-
ments that each person makes, the body postures that they hold,
and the synchrony
between measures of their psychophysiology, such as
respiration and electromyography
(muscle tension). These studies essentially provided the first
direct psychophysiologi-
cal evidence of an automatic and implicit empathy-related
process operating within the
hypnotic relationship.
However, the idea that mirroring and imitation might
contagiously spread from one
person to another is something discussed in both the
psychoanalytic understanding of
transference and countertransference (Tansey & Burke, 1989)
and the Ericksonian tra-
ditions of hypnosis (Rossi & Rossi, 2006). Freud (1922)
speculated that the experience
of countertransference might emerge as a genuine empathic
experience from an ana-
lyst’s attempt to formulate how his/her countertransference
experience embodies the
projective identification of his/her patient (Tansey & Burke,
1989). Freud’s theory was
essentially that we pick up on the projections of others through
imitation and can then
form an empathic model of their mind through mirroring them.
Wickramasekera II and
Ran (2008) were able to partially validate this idea by
demonstrating that the strength
of a person’s transference response in hypnosis is moderately
related to both their trait
empathy and hypnotic ability. In this sense, the trance of
transference may be due to the

trance-inducing nature of strong empathic experiences, such as
hypnosis and projective
identification.
More recently, Stephen Porges (2011) independently proposed
that this kind of uncon-
scious tendency for people to come into a state of
psychophysiological convergence with
one another is a sign that the social engagement system of their
body is empathically
responding to the other person. The social engagement system
of the body is described
as an unconscious and automatic system that evaluates the
emotions of others (empa-
thy) and also engages in affective bonding and mirroring
responses with them. Porges
discovered that much of this response occurs in the body via the
vagus nerve (Porges,
2011) and that cardiac vagal tone (heart rate variability) is a
good index of the employ-
ment of this kind of unconscious engagement and
psychophysiological synchrony with
other people. Harris, Porges, Clemenson, and Vincenz (1993)
were the first to discover
that cardiac vagal tone is a reliable predictor of hypnotic
ability. Subsequent research
by Diamond, Davis, and Howe (2008) has even shown that
cardiac vagal tone can be a
good predictor of the depth of the state of hypnosis as well as a
predictor of hypnotic
ability. Previous research also implicates the neurohormone

oxytocin to both hypnosis
and the social engagement system (Bryant, Hung, Guastella, &
Mitchell, 2012; Porges,
2011), and oxytocin appears to play a similar role in calming
and attuning the autonomic
nervous system in both experiences. Collectively, these lines of
research seem to demon-
strate that the autonomic psychophysiology of empathically
attuning to people is similar
to the experience of hypnosis and is also predictive of being
able to experience hypnosis.
The psychophysiogical convergence between the hypnotist and
the hypnotic subject
discussed in Eve Banyai’s (1998) research demonstrates the
kind of emotional conta-
gion effect that Cardeña and colleagues (2008) were able to
correlate with hypnotic
ability. The idea that emotional contagion, imitation, or the
chameleon effect (Chartrand
& Bargh, 1999) are related to hypnosis has long been discussed
and written about, going
back to Benjamin Franklin’s observations of the séances of
mesmerism (Forrest, 1999).
Sigmund Freud (1922) and Clark Hull (1933) both remarked
upon the nature of imitation
in hypnosis, and Hull even attempted to invent a device to
measure it. More recently, a
number of researchers and theorists have speculated that the
network of mirror neurons
in the brain may underlie this relationship (Rossi & Rossi,
2006; Wickramasekera II,
2007b). Mirror neurons are a subtype of neurons that are
hardwired to fire in response
to the body language and emotion-related movements of others
(Gallese, 2009). Mirror

neurons appear to offer our brains a bottom-up oriented way of
understanding other peo-
ple’s emotions through imitating/mirroring the neural firing
patterns in our own brain
networks that we observe in others. It is important to note that
these neurons fire max-
imally in relationship to the movements of others and not in
relationship to the body
movements in which we ourselves are engaged. The mirror
neuron network is thought
to help us to implicitly and automatically understand how
another person is feeling
through forming a neural representation or simulation about
what the observable body
movements of others might mean physically and emotionally.
For example, witnessing
a person who is shivering, stamping their feet, and rubbing their
hands might generally
signal to us that they are cold and quite probably unhappy.
Empathy theorists have suggested that the brain might be
running simulations all the
time about the probable meaning of various body postures,
facial expressions, etc. that
we observe in others whether we realize it or not (Gallese,
2009). These simulations
are thought to be run and stored for future reference in case we
might encounter the
same scenario again when interacting with other people. The
learning, interpretation, and
storage of these emotional simulations are thought to be
accomplished by networks of
our brain that are utilizing connectionist algorithms and neural
network-like architecture
(Grossberg, 2013). The mirror neurons form a bottom-up
representation or simulation

in the brain of what we are experiencing in another person. The
simulation represents
what we think another person is experiencing, and this input is
then compared with
previously stored simulations of emotions that we have
encountered before with the
same and other people (Gallese, 2009; Otti et al., 2010). This
comparison process occurs
automatically and unconsciously in milliseconds so that we do
not typically consciously
experience it.
This process of matching bottom-up simulations from mirror
neurons with previous
representations and/or simulations of emotion are thought to be
effectively learned and
stored in a network of brain regions called the default-mode
network (DMN; Buckner,
Andrews-Hanna, & Schacter, 2008; Otti et al., 2010). The DMN
is thought to be a critical
network of the brain that helps embody empathy, although it
more generally is thought
to be involved with the inward experience of self, mentation,
and day-dreaming. The two
simulations receive an increasing amount of neurochemical
resonance (Grossberg, 2013)
between them when the DMN arrives at a good match between
what the mirror neurons
have encoded and a previously stored simulation of another
person’s emotional experi-
ence. A conscious experience of the other person’s emotional

state may then emerge as a
result of this increasing neurochemical resonance between the
bottom processing activ-
ity of the mirror neurons and the activated top-down simulation
activity of the DMN.
A critical level of resonance between the target simulation and
the stored input is needed
to trigger conscious empathic awareness of the other person’s
emotional and physical
experience, and this appears to be a basic principle of
perceptual processes (Grossberg,
2013).
A number of studies have tied activity in the DMN to the
experience of hypnosis,
which is consistent with the predictions of the EIT due to the
empathic nature of the
tasks that the DMN performs (Demertzi et al., 2011; McGeown
et al., 2009). There are
a number of brain areas involved in the DMN, including the
cingulate cortex, medial
temporal lobe, medial prefrontal cortex, and the hippocampus
(Buckner et al., 2008).
The DMN is thought to be the brain network that is most
associated with internal and/or
self-oriented neural processes. Activity in the DMN is anti-
correlated with the activ-
ity of another brain network called the extrinsic system, which
mediates the conscious
experience of the external world and is involved in task-
oriented activities (Demertzi
et al., 2011; Vincent, Kahn, Snyder, Raichle, & Buckner, 2008).
The activity of both the
intrinsic (DMN) and extrinsic brain networks systems is thought
to be regulated by the
frontoparietal control system (FPCS), which may integrate the

activity in both networks
(Vincent et al., 2008). The task of the FPCS is to integrate the
right balance of extrinsic
and intrinsic processing needed at the moment for the
individual. For example, most of
us would drift into a period of heavy DMN activation if we were
instructed to rest with
our eyes closed as we naturally attended to our internal
mentation and phenomenology.
Meanwhile, the extrinsic system is engaged and the DMN
diminished by the FPCS if we
are asked to engage in a visual recognition task.
The anterior cingulate (AC) is a critical structure in the FPCS
and DMN that has
previously been shown to be active during many different types
of hypnotic phenomena
(Spiegel, White, & Waelde, 2010) that involve an integration of
extrinsic and intrinsic
brain processes, such as hypnotic analgesia. It may be that
hypnosis utilizes the DMN
to empathically enact the hypnotic suggestions presented to
subjects while also utilizing
the FPCS to modulate the specific balance needed between the
intrinsic and extrinsic
brain systems. This may help explain why some studies have
found a decrease in the
DMN when hypnosis was utilized with eyes open and increases
in DMN when hypnosis
was employed with eyes closed (Demertzi et al., 2011;
McGeown et al., 2009).

In summary, knowledge about the precise phenomenology of the
embodiment of
empathy and hypnosis can still be said to be at an early stage.
However, it is relatively
safe to say that the embodiment of hypnosis seems to involve a
lot of psychophysio-
logical processes that implicate empathy in the autonomic
nervous system, brain, and
neurohormone networks. I propose that the experience of
hypnosis is accomplished
through an empathic neural network that utilizes the DMN and
mirror neurons to help
hypnotic subjects embody the roles, response expectancies,
sensations, emotions, and
body language that their hypnotist suggests to them or that they
present to themselves
in self-hypnosis. This hypothesis is remarkably consistent with
the socio-cognitive tra-
dition of hypnosis since it emphasizes the social psychological
aspects of how a person
could come to hear a hypnotic suggestion and utilize their
empathy to embody the expe-
rience that has been suggested to them. This hypothesis might
also explain the difficulty
in defining hypnosis since it can be argued that many empathic
experiences seem to
create trance-like experiences, such as love at first site,
becoming deeply involved with
the characters in a book, having a powerful empathic experience
with a client in psy-
chotherapy, and/or long term meditation on one’s own
phenomenological experience.
The experience of trance in these seemingly non-hypnotic
contexts might simply be a
sign that we have utilized our empathy in a powerful way that

has altered our sense of
self. This leads to the next topic regarding the powerful ways
that empathy can alter our
experience of the self and the concept called theory of mind.
Empathy, Hypnosis, and the Neuromatrix of the Self
Researchers have known for many years that hypnosis seems to
have a special effect
on the self (Faria, 1819; Forrest, 1999; Hilgard, 1977;
Kihlstrom, 1987). An example
of this phenomena includes recent research that has shown the
remarkably flexible self-
structure of high hypnotizables who can experience a
completely new sense of self in
response to hypnotic suggestions to alter their identity (Barnier
et al., 2010; Cox &
Barnier, 2010, 2013). These subjects not only experienced
profound alterations of self
in response to hypnosis but also displayed greatly diminished
signs of self-recognition
when challenged to interact with a mirror or to talk with a close
friend who knows
them from real life. Another example is the tradition of neo-
dissociation (Hilgard, 1977),
which has demonstrated that many people can experience the
sense of contacting other
parts of themselves in hypnosis as if they had a family of ego
states (Watkins & Watkins,
1997) operating within them at all times. The neo-dissociative
tradition has hypothesized
that there is an executive ego that integrates these aspects of
self (ego states) and under

ordinary conditions keeps one’s phenomenological experience
of self as being unitary
and stable when in reality it might be polypsychic (Frederick,
2005).
Another interesting aspect of neo-dissociative research is that it
has demonstrated
that ordinary people can experience their own actions and
cognitions during hypnosis
as if they were involuntary (Kihlstrom, 1992). A person can
experience a suggestion to
imagine that their head is “becoming very heavy and falling
forward” as if their behav-
ioral response to do so was involuntary and not volitional.
Socio-cognitive theorists have
tended to be skeptical of neo-dissociative and polypsychic
theories of identity and have
emphasized that these alterations of self might just be
temporary roles that they are act-
ing out (Spanos, 1996). However, even this position accepts the
notion that hypnosis can
alter the self temporarily and that ultimately our identity as
human beings is merely a
believed-in imagining, which is “constructed, role governed,
and performed” as if it was
real (Sarbin, 1998, p. 137). It is safe to say that no matter how
you look at this issue,
there is much evidence that processes of hypnosis can alter our
experience of self and
agency. It will be seen later that the ideas of self that have been
proposed by the Bon-
Buddhist schools of Dzogchen meditation (Wangyal, 2005,
2011) are consistent with
both the socio-cognitive concept of the self as being a believed-

in imagining as well as
the neo-dissociative idea that there is a kind of executive ego
actively constructing our
experience of self.
People often attribute the sense of involuntariness and the
alteration of their sense of
self to the magical power of the hypnotist. However, I would
like to propose that the
real magic may come from the way their empathic perceptions
of the world are based in
a neural process called theory of mind (TOM). TOM (Gallese,
2009; Mahy, Moses, &
Pfeifer, 2014) can be understood to be the neural process by
which we attribute agency
and a sense of self to our own actions and the actions of others.
It is a deeply empathic
process in that it represents a process that is fundamental to
empathy, such as how we
attribute a sense of self or a sense of other to actions,
experiences, mentation, and objects
in the world, including our body. TOM is also thought to be
embodied by the activity
of brain regions in the DMN, such as the cingulate cortex
(Gallese, 2009; Mahy et al.,
2014). Our experience of the self is therefore an emergent
property (Varela, Thompson,
& Rosch, 1991) from the neuromatrix (Melzack, 1999) of
empathy and TOM-related
processing embodied in our DMN. Our experience of self is
derived in a neuromatrix
as in other experiences, such as the somatosensory cortex,
which underlies our con-
scious experience of the body (Melzack, 1999). In a sense then,
it is in fact a believed-in
imagining consistent with socio-cognitive tradition of hypnosis

as well as the Dzogchen
tradition of meditation. It is therefore not that surprising that
research in hypnosis has
been so successful in altering the self (Barnier et al., 2010; Cox
& Barnier, 2010, 2013;
Hilgard, 1977) since its creation depends critically on empathy-
related processes.
Previously I have hypothesized that the experience of
alterations in our experience
of identity (self/other) and agency (voluntary/involuntary) may
be due to the empathic
processes involved in TOM (Wickramasekera II, 2007b).
Specifically, I propose that
empathic processes involving TOM that are embodied by the
DMN can alter the sense
of agency and identity that we readily experience in hypnosis as
predicted by both neo-
dissociative and socio-cognitive theories. The executive ego, of
which neo-dissociation
speaks, may in fact be embodied in the empathy-related
processes of the DMN. Thus
our experience in hypnosis that a magnetic force is “acting on
our hands and moving
them together” is due to an alteration in our sense of agency by
TOM-related processing
in the DMN in which we dissociate away our attribution that we
are moving our hands
together in accordance with neo-dissociative theory. However,
the effect is also mediated
by our ability to empathically experience the hypnotic roles and

expectancies that we
have embodied using the DMN in accordance with socio-
cognitive theory.
The empathic nature of this alteration in identity and agency
can also of course be
observed in deeply empathic settings outside of hypnosis, such
as when we feel at one
with our friends, lovers, family, and our communities in the
right social psychological
contexts. I hypothesize that just as empathy can create an
experience of trance outside
of hypnosis, so too can empathy alter our sense of identity and
agency without any hyp-
notic induction at all. A strong empathic experience is all that is
needed is to create
hypnotic-like phenomena. This may help explain why the
hypnosis community has had
such difficulty in defining what hypnosis is since its empathic
nature makes these phe-
nomena appear in a myriad of other empathy-related situations,
such as falling in love,
receiving and practicing meditation instructions, and even
empathically following a yoga
teacher in class.
What Lies Beyond the Self?
Practitioners of mystical traditions around the world have
frequently questioned whether
the self we experience is illusory in nature for at least several
thousands of years
(Wickramasekera II, 2014). This is very consistent with the
socio-cognitive view of the
self as a believed-in imagining. In this section I wish to relate
some of the transpersonally

oriented ideas within the EIT to ideas that have been developed
by the Bon-Buddhist tra-
dition of Dzogchen meditation (Wangyal, 2005, 2011;
Wickramasekera II, 2004a, 2007d,
2010). In particular, I wish to examine the similarity of the
Dzogchen model of identity
to the neo-dissociative and socio-cognitive traditions of
hypnosis.
The Dzogchen tradition of meditation can be found in both the
Bon and Buddhist reli-
gions of Tibet as well as other Himalayan countries (Reynolds,
2005). The tradition of
Dzogchen states that the self that we generally experience is an
illusion constructed by
a deep structure in our mind called the kunzhi-namshe. The self
that Dzogchen medita-
tors describe could very much be described as a believe-in-
imagining consistent with the
socio-cognitive theory of hypnosis and dissociative phenomena.
The nature of the self is
formless in both traditions, and the self is said to rely on the
empathy and TOM of the
person to discern its own structure and character. A simple way
of thinking about this
is to reflect on how much we often rely on feedback from other
people to discern who
we think we are. Theoretically, this probably means that the
nature of self could have
a variety of characteristics, appearing to be unitary at times and
polypsychic at others

depending on the context of the experience of self.
However, some aspects of Dzogchen also support directly some
ideas proposed by
neo-dissociative theorists of hypnosis. For instance, the kunzhi-
namshe is said to oper-
ate very much like the executive ego described in neo-
dissociative theory in that it is
constantly dividing the seamless flow of experience into
dualistic categorizations, such
as self/other, good/bad, and happy/sad, which further divide and
define the illusion of
self. Over time, these divisions are said to create parts of the
illusory self that are expe-
rienced under certain conditions and contexts. So, for example,
when we do something
in the world, we label our self and our actions as good or bad in
that instance. These cat-
egorizations further define and refine the illusion of selfhood
through creating the good
“me” and the bad “me.” In this way, the kunzhi-namhse works
just like the executive ego
in that it is integrating and defining the nature of the self-states
within a person. Just as
the executive ego of neo-dissociation theory, I hypothesize that
the kunzhi-namshe may
well be embodied in the empathy and TOM-related processes of
the DMN.
Dzogchen meditators practice a number of meditation- and
yoga-related disciplines
that are aimed at helping them to gain experience with the true
nature of the mind
called “the natural state,” which is normally covered over by the
illusory experience
of self and other dualistic obscurations of consciousness.

Several of the practices of
Dzogchen are familiar to most readers since they are equivalent
to mindfulness med-
itation. Mindfulness meditation is thought to be a foundation
practice for developing
the powers of mental introspection necessary to make progress
in finding and staying
within the natural state (Reynolds, 2005; Wangyal, 2005). It is
said that through practic-
ing Dzogchen one can come to experience and embody the true
nature of the mind that
one has been born with but previously not been able to
appreciate. Freedom from the
illusion of self that is created by the activity of the kunzhi-
namshe is said to be neces-
sary to properly experience the natural state in a stable way.
Losing one’s sense of self
as being separate from others is said to free up vast amounts of
a sense of freedom and
also a limitless capacity for compassion, empathy, and love. It
is even said that the flow
of thoughts and chatter throughout the mind might stop at this
point. However, some
Dzogchen scholars assert that a person’s thoughts might
continue although the practi-
tioner no longer relates to them dualistically (Vyner, 2007).
Dzogchen meditators aim
to gain increasing awareness of the natural state to transcend
the illusion of self, which
allows the practitioner to realize higher states of wisdom and
compassion.
Recent research regarding the neurophysiology of mindfulness
meditation seems to
support some aspects of the Dzogchen model of how experience
with the natural state

can relieve our suffering while developing our wisdom and
compassion. For instance,
studies of the benefits of mindfulness meditation (a foundation
practice in Dzogchen)
have demonstrated that mindfulness meditation does tend to
reliably reduce peoples’
experience of anxiety, depression, pain, and stress while
increasing their experience
of compassion, happiness, and well-being (Shapiro & Walsh,
2003). Mindfulness is
a practice that in essence asks one to completely and
empathically attend to one’s
own phenomenological experience and to stay with it. Like self-
hypnosis, mindfulness
meditation requires a disciplined form of empathic
concentration to one’s own phe-
nomenological experience. Thus it is not too surprising to find
that its neural correlates
are very similar to hypnosis in that the AC has been implicated
in many different stud-
ies (Spiegel et al., 2010). A recent study of long-term
meditators using mindfulness
found that the activity of their DMN was greatly reduced
compared to novice meditators
(Brewer et al., 2011). The DMN has been linked to mind-
wandering and day-dreaming
in previous research (Buckner et al., 2008). It is thought that
long-term meditators might
then actually have diminished DMN activity due to their ability
to experience a greater
sense of the stillness of their mind with reduced thoughts and

distractions. Novice medi-
tators frequently complain of distractions when first starting
mindfulness mediation, but
this difficulty usually diminishes in intensity as one gains more
experience with attending
to one’s own phenomenology in meditation practice.
Dzogchen scholars refer to this “stillness of the mind” as one
aspect of the natural
state. It is interesting to learn that long-term meditators do in
fact show psychophysiog-
ical evidence of reduced thoughts (reduced DMN activity)
during meditation, just as the
Dzogchen tradition asserts that thoughts do diminish with
increasing experience of the
natural state. This leads to the examination of the question of
whether the practice of
hypnosis or self-hypnosis could also be utilized toward
transcending the illusion of self.
A related question might be stated as “Are Dzogchen and
mindfulness meditation forms
of hypnosis anyway?” Meditation and hypnosis certainly do
share many similarities
(Holroyd, 2003; Spiegel et al., 2010) besides the empathic
nature of their phenomenol-
ogy and their shared embodiment in terms of neurophysiology,
previously examined
involving the DMN and the AC. However, there are many
differences surrounding the
communities, histories, and traditions that have respectively
produced these techniques
of meditation and hypnosis. It is probably best to describe
meditation as a hypnotic-like
experience (Krippner, 2005) and leave this question open for
now. Someday it may be
possible to integrate hypnotic techniques with the teachings of

Dzogchen, since the two
traditions are very similar in terms of their phenomenology and
their ideas about the
nature of self. Until that day, it is best satisfy this question
through practicing each tra-
dition separately and authentically on its own terms while
gaining personal insights into
the nature of self-transcendence (Wangyal, 2005).
Summary and Implications for the Future
The main point of this article has been to review the evidence
backing the EIT of hyp-
nosis and its implications for an embodied understanding of the
self. The EIT defines
hypnosis as an experience of enhanced empathy in which a
hypnotic subject utilizes
perspective taking, empathic concern, and empathic aspects of
TOM to experience alter-
ations in affect, behavior, sensation, thoughts, and his/her
mind/body relationship that
are suggested by a hypnotist or through his/her own creative
and imaginative processes.
The EIT attempts to unify many different theoretical and
research traditions of hypno-
sis by demonstrating their common underpinnings in the
psychological processes and
neuroscience of empathy. The EIT proposes that the experience
of hypnosis is embodied
in a system of neural networks in the brain that utilize empathy
to (a) empathically enact

the affect, cognition, body language, response expectancies,
social roles, sensations, etc.
that are presented to them during hypnosis in accordance with
socio-cognitive theories of
hypnosis; (b) engage in a convergent psychophysiological
relationship with another per-
son in accordance with psychoanalytic, Ericksonian, and
polyvagal/social engagement
system theories; (c) alter the empathic self/other (TOM) coding
of their phenomenolog-
ical experiences during hypnosis in accordance with aspects of
the neo-dissociative and
socio-cognitive traditions; and, (d) develop an experiential
understanding of the illusion
of self, which may lead in some people to its transcendence in
accordance with Bon-
Buddhist, Dzogchen, and transpersonal scholars. The EIT also
proposes that the self is
a believed-in imagining that is created in a neuromatrix that
utilizes empathic processes
to give it a sense of definition and solidity.
There are many implications for future research involving the
EIT. First, it would be
good to revisit some of the initial research that examined the
relationship between hyp-
notic ability and empathy while controlling for context effects
(Council et al., 1986).
It would also be good for these studies to employ the Stanford
Form C (Weitzenhoffer
& Hilgard, 1962) as a measure of hypnotic ability due to its
superior psychometric
properties and perhaps also a performance-based measure of
empathy so that empathic
accuracy could be assessed as well as empathic disposition.
Many questions have been

left open regarding the psychophysiology of the DMN, AC, and
other brain regions as
to whether they are truly the areas involved with the
embodiment of empathy, TOM,
and the trance states experienced with hypnosis and other strong
empathic phenomena,
such as falling in love, psychotherapy, and sexual intimacy.
More precise studies of the
specific neurophenomenology (Lutz & Thompson, 2003) of
hypnosis and strong expe-
riences of empathy are needed, and these studies will certainly
need to employ a more
thorough focus on the precise phenomenology of the
participants though employing such
measures as the Phenomenology of Consciousness Inventory
(Pekala & Kumar, 2000),
heuristic analysis (Moustakas, 1990), and the Experiential
Analysis Technique (Sheehan,
1992). These same research techniques could also be utilized to
examine my predic-
tion that strong empathic experiences are all that is necessary to
induce hypnotic-like
phenomenology.
Finally, there are many implications for clinical practice
involving the EIT, such
as a general directive for clinicians to become more acutely
aware of the underly-
ing grounding of hypnosis in a strongly empathic experience.
Any strong empathic
experience can become trance-inducing, and knowledge of these
phenomena may be

useful for therapists in encouraging therapeutic transference
(Gill & Brenman, 1961),
understanding countertransference as an potential empathic
device (Tansey & Burke,
1989), building a strong therapeutic alliance with convergent
psychophysiogical mirror-
ing (Banyai, 1998; Rossi & Rossi, 2006), and helping therapists
time their interventions
with patients’ cognitions toward moments when their self-
structure might be more open
for feedback/interpretation. I hope that this article might serve
as an encouragement
for therapists to consider that empathy is perhaps a much more
powerful clinical tool
than they ever realized and that strong empathic experiences are
very naturally hypnotic.
Furthermore, all therapists should be encouraged to practice
mindfulness meditation to
further develop their capacity to kindle and enact their patients
psychophysiology and to
activate their social engagement system (Porges, 2011; Tansey
& Burke, 1989). Finally,
it is hoped that many practitioners of hypnosis will become
interested in the psychol-
ogy of mindfulness, Dzogchen, and other forms of meditation
that have been associated
with the transcendence of self. It is hoped that more writings
such as these will appear
in the literature of psychotherapy to build a mutually beneficial
bridge of understanding
(Wickramasekera II, 2004b) between the Bon-
Buddhist/Dzogchen schools of medita-
tion and the hypnosis community that will allow us to help ever-
increasing numbers of
people to further develop their wisdom and compassion.

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