Second-order dissociated control theory

Whereas dissociated control theory, as originally proposed by Woody and Bowers (1994), focuses on the functional dissociation of lower subsystems of control from executive control (a weakened path b in Figure 4.2), second-order dissociated control theory, as proposed by Jamieson and his colleagues (Jamieson and Sheehan, 2004; Egner et al., 2005; Jamieson and Woody, 2007), focuses on the functional dissociation of executive con-trol from executive monitoring (a weakened path d). Let’s consider a pure form of this the-ory, in which lower subsystems of control remain integrated with executive control (i.e.

path b is not weakened), but executive control is cut off from executive monitoring. According to this view, the modulation of subsystems of con-trol by executive concon-trol, representing a first level of cognitive control, is intact, whereas the feedback from executive monitoring to execu-tive control, representing a second level of cogni-tive control, is disrupted. The normal function of such feedback is to allow adjustments of execu-tive control by providing information about the effectiveness of the existing control, thereby making control more flexible and sensitive to changing task requirements (Cohen et al., 2004). Accordingly, if the effect of hypnosis is to disrupt this feedback, the hypnotic subject

should be able to modulate behavior at the first level of executive control, based on higher goals and rules, but relatively unable to adjust this control flexibly in the light of executive moni-toring of response conflict, discrepancies, and the like. One implication is that executive con-trol would not be as flexible and complex as it is in nonhypnotic circumstances. Another impli-cation is that the executively monitored effects of suggestions may become quite divergent from the aims of an unchanging control pro-gram that is enacting them, because these effects do not lead to the usual executive adjustments to such a program.

The dissociation of executive monitoring from executive control provides another expla-nation of the phenomenon of hypnotic involun-tariness. In a reformulation of Norman and Shallice’s (1986) dual-control model, Perner (2003, p. 239) noted, ‘Intentional action is defined by the match between what the lower level produces and what the higher level stipu-lates should be done’. Accordingly, if hypnosis interferes with the fine-tuning of executive con-trol by executive monitoring, the mismatches that result should be experienced as nonvoli-tional. Other theorists have also attached great importance to such mismatches. For example, Haggard (2003, p. 126) proposed the following:

‘The efferent binding process could have the dual function of bringing to consciousness mis-matches between intention and action, and of making possible …consciousness of the rela-tions between my intenrela-tions and my acrela-tions’. He argued that these aspects of consciousness are critical to the sense of self-agency, as well as the sense of self more generally. Thus, it stands to reason that if hypnosis increases mismatch due to the functional dissociation of executive control from monitoring, these mismatches would strikingly alter the hypnotic subject’s sense of agency.

A pure version of second-order dissociated control theory has another potentially attractive implication. Because the first level of cognitive control—the governing of lower subsystems of control by executive control—would be intact, it would allow greater novelty in hypnotic responses than the original dissociated control theory, in which the lower subsystems are hypothesized to be relatively independent from

executive control. Recall that a prime function of executive control, as advanced in Norman and Shallice’s (1986) model, is to foster the genera-tion of novel behavior when the circumstances require it. Although some excellent hypnotic subjects do not seem to engage in such novelty generation, others evidently do. For example, the Experiential Analysis Technique (Sheehan and McConkey, 1982; McConkey, 1991; Sheehan, 1991) indicates that some highly hypnotizable subjects are quite cognitively active, devising sometimes fairly complex strategies in the face of the challenges posed by suggestions. To illustrate, McConkey et al. (1989) performed a detailed analysis on two hypnotic virtuosos and found that whereas one reported that the effects sug-gested by the hypnotist just happened passively by themselves, the other reported using a variety of cognitive strategies to respond to suggestions.

Although the passive experience style of hyp-notic responding is more consistent with the original formulation of dissociated control, the cognitively active style is more consistent with second-order dissociated control theory.

Second-order dissociated control theory maps beautifully onto the neuropsychological model of cognitive control developed by Cohen and his colleagues (Cohen et al., 2004). This model distinguishes between the two levels of control in the executive system. The first is implemented by goal representations in the pre-frontal cortex that enable nonroutine responses.

The second is implemented by attentional mon-itoring that enables the adjustment of control based on the detection of interference or con-flict in the processes being influenced by the currently active representations. This conflict-monitoring function is subserved by the ACC (Botvinick et al., 2001; Kerns et al., 2004;

Ridderinkhof et al., 2004), which provides feedback for appropriate control adjustments.

In particular, conflict detection serves as a signal to strengthen further the bias in appro-priate task-relevant subsystems. Such recruit-ment of control resources is subserved by the left dorsolateral prefrontal cortex (Botvinick et al., 2004). Thus, this conflict-monitoring model of cognitive control distinguishes between executive monitoring and executive control, and locates major aspects of these functions anatomically.

MacDonald et al. (2000) developed a method-ology using the Stroop task and functional mag-natic resonance imaging (fMRI) so that they could separately measure the cognitive-control function of the dorsolaternal prefrontal cortex and the conflict-monitoring function of the ACC.

Egner et al. (2005) used this paradigm to exam-ine changes in cognitive control in hypnosis.

Consistent with previous work by MacDonald and colleagues, they identified conflict-related activation in the ACC by contrasting high versus low response conflict conditions (color-naming incongruent trials versus, for example, word-naming congruent trials). Likewise, they identified demand-for-control activation in the left dorsolateral prefrontal cortex by contrasting high versus low control conditions (color-naming trials versus word-(color-naming trials).

For the regions of the ACC most sensitive to response conflict, Egner et al. (2005) found a statistically significant interaction of hypnoti-zability and hypnotic condition. Hypnosis increased conflict-related activation for the high hypnotizable individuals, but not for their low hypnotizable counterparts. The researchers interpreted this finding as showing decreased efficiency of the cognitive control system for the high hypnotizables under hypnosis, strongly consistent with the original version of dissoci-ated control theory. However, they found no dif-ferences between high and low hypnotizable individuals in demand for cognitive control, as indexed by activation in the left dorsolateral prefrontal cortex. Thus, there seemed to be no difference in executive control, which is some-what inconsistent with the original version of dissociated control theory.

The cause of the lack of difference in executive control was elucidated by an EEG component of the study by Egner et al. (2005). They examined coherence, a measure of functional connectivity, between the left frontal and frontal midline recording sites, reflecting electrophysiological activity in the left lateral prefrontal cortex and ACC, respectively. In this way, they were able to assess the degree of integration between exec-utive control and execexec-utive monitoring func-tions. The results indicated that in highly hypnotizable individuals under hypnosis, there is a breakdown in the integration of these functions during ongoing cognitive control.

Key issues and research · 103

This finding strongly supports what we have called second-order dissociated control theory.

Specifically, for highly hypnotizable individuals under hypnosis, the increased conflict-related activation in the ACC indicates mismatch of executive control with task demands, yet this mismatch fails to modulate ongoing demands for cognitive control in the dorsolateral prefrontal cortex.

The neural underpinnings of second-order dissociated control theory crucially involve the ACC. Increased activation in the ACC is the most consistent finding in brain imaging studies of hypnotic suggestions and the hypnotic state (e.g. Rainville et al., 1997, 2002; Crawford et al., 1998; Szechtman et al., 1998; Faymonville et al., 2000; Derbyshire et al., 2004). However, the regions within the ACC that are activated differ somewhat across these studies. Jamieson and Woody (2007) have related these findings to recent research examining the integration of the affective functions of the ACC with its con-flict-monitoring functions. The dorsal regions of the ACC appear to specialize in the detection of conflict, and this information is subsequently evaluated in more rostral regions of the ACC for its relationship to motivationally relevant out-comes. This evaluative monitoring, in turn, may then trigger adaptive changes in cognitive control.

However, any such tidy picture of how the ACC is related to hypnotic responding is com-plicated by the findings of Raz et al. (2005).

They found that a post-hypnotic suggestion to perceive words as nonsense strings led to decreased activity in the ACC during a Stroop task, suggesting superior conflict resolution (see also Sheehan et al., 1988; Raz et al., 2002). Thus, with appropriate hypnotic suggestions, the cognitive control of highly hypnotizable individuals appears to be quite malleable.

In summary, second-order dissociated control theory focuses on breakdown in integra-tion between executive funcintegra-tions within ante-rior regions of the brain, rather than breakdown in integration between anterior and subcortical or posterior regions, as implied by the original version of dissociated control theory. In addi-tion, it paints a rather different picture of the highly hypnotizable person in hypnosis. It sug-gests that, rather than being frontally chal-lenged, as implied by the original dissociated

control theory, highly hypnotizable individuals can set up unusual cognitive control programs and then sustain them in a quasi-perseverative fashion, whereas for low hypnotizables such strategies would be overturned by conflict monitoring.

This idea has broad applicability to hypnotic phenomena. For example, consider the hypnotic suggestion that one’s arm is rigid like a bar of iron and one cannot bend it, despite the effort to do so. Both high and low hypnotizables can imagine and attempt to enact this suggested state of affairs, but for low hypnotizables con-flict monitoring would feed in information indicating that reality, in the form of the state of one’s arm muscles, is inconsistent with this imagined state of affairs. Thus, for them the sug-gestion never becomes more than a tenuous imagining. In contrast, according to second-order dissociated control theory, high hypnotiz-ables are relatively unaffected by such reality testing (i.e. is the state of one’s muscles actually consistent with the attempt to bend one’s arm?).

Therefore the actual state of their arm does not interfere with the phenomenological qualities of the suggested experience. In short, the dissocia-tion of conflict monitoring from cognitive control unhooks the highly hypnotizable subject to some extent from the constraints of reality.

Second-order dissociated control theory, with its emphasis on the isolation of control from executive monitoring, may provide an interest-ing perspective on other empirical findinterest-ings in hypnosis research. To illustrate, Bryant and Wimalaweera (2006) found that during hypno-sis the attempted suppression of an embarrass-ing thought led to its increased accessibility in low hypnotizable participants, but not in highs.

Because such accessibility stems from an under-lying monitoring process (Wenzlaff and Wegner, 2000), these results are consistent with the hypothesis that during hypnosis, monitoring is dissociated from control in highly hypnotizable individuals.

4.5. Conclusion

It remains to be seen whether one of the forego-ing dissociative mechanisms will prevail over the others in future research. An alternative possibility, as originally favored by Hilgard, is

to conceptualize hypnosis in terms of a fluid plurality of dissociative mechanisms.

Understanding hypnosis involves tough issues such as, how does volition work, and what is the nature of awareness? It also touches on philo-sophical problems such as, how does one know what is real, and what is free will? In short, hypno-sis seems to lie at the crossroads of some of the most challenging problems in comprehending the nature of the mind. Thus, although under-standing hypnosis is difficult, it is also potentially rewarding for its promise of illuminating a much broader range of human behavior.

However, the empirical literature on hypnosis is immense, diverse and contradictory. The only hope for welding this mass into something truly enlightening is the development of stronger the-ory. In an interesting discussion of how results in the social sciences are confusing and mislead-ing in the absence of strong theory, Hirsch (2002) quotes the eminent physicist Pauli, who once quipped about a scientific paper, ‘It is not even wrong’. Dissociation theories of hypnosis are at least wrong. And in some ways they may turn out to be right.

Acknowledgments

Preparation of this chapter was supported by a grant from the Natural Sciences and Engineering Research Council of Canada to Erik Woody and a grant from the Social Sciences and Humanities Research Council of Canada to Pamela Sadler.

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