Archives Italiennes de Biologie, 146: 21-33, 2008.

Manipulation of attention in highly

and low hypnotizable individuals:
a study on verbal priming

E. Castellani and L. Sebastiani

Dept. of Human Physiology, University of Pisa, Italy

abs t rac t

This study investigated the effects of manipulation of attention on verbal priming in

highly (Highs) and low (Lows) hypnotizable individuals. Priming was evaluated via the
word-stem completion task (WSCT). The experimental paradigm consisted of one con-
dition in full-attention and in two conditions with colored words in which attention was
directed, respectively, only to the color and to both color and word. No significant dif-
ferences between Highs and Lows were found in none of the three attentional conditions.
However, during encoding in full-attention, Highs showed shorter reaction times (RTs) than
Lows. This is in accord with previous evidence of faster simple and choice RTs in Highs
than in Lows, and suggests hypnotizability-related differences in arousal, likely driven by
a different cognitive control activity. Also, Highs’ self-report of interference of color-nam-
ing on word-reading suggests possible differences between Highs and Lows in cognitive
activity related to mental effort.

I N T R O D U C TI O N

For many years the hypnotic phenomenon has been the object of controversies concerning
its basic nature and the underlying neural mechanisms (6, 11, 31, 35, 43, 51, 59, 64, 65).
According to the Altered State Theory of Hypnosis (42), hypnotic behaviour consists of
two distinct elements: a state of hypnosis, characterized by profound alterations of sensa-
tion, perception and cognition, and hypnotic suggestibility. This refers to an individual trait,
confined only to about 10-15% of healthy alert individuals that make them able to accept
suggestions and modify their conscious experience accordingly.
Research focusing on the correlates of the hypnotic trait has long since associated sus-
ceptibility to attention; namely, differences in hypnosis would rely on a different frontal
executive attentional control (5, 16, 23, 32, 38, 56, 67, 70).
One of the most acknowledged views (15, 16, 30) proposes that highly hypnotizable
individuals would be extraordinarily skillful at focusing attention. This would allow them to

Corresponding Author: Laura Sebastiani, Department of Human Physiology, University of Pisa, via S. Zeno 31,
56127 Pisa, Italy - Tel.: ±39 050 2213483 - Fax: ±39 050 2213527 - E-mail: lauseba@dfb.unipi.it
22 E. Castellani and L. Sebastiani

be engaged in the first stage of hypnotic induction by easily concentrating their attention on
hypnotist’s voice/instruction, and ignoring distracting stimuli. However, when hypnotized,
their attention control would likely be compromised due to a decoupling between conflict
monitoring and cognitive control processes of the frontal lobe (23, 39).
While there is a large body of neurophysiological, neuroimaging and behavioral evidence
that supports the alteration of attention functioning in hypnotized highly susceptible individ-
uals (Highs) (9, 23, 24, 32, 33, 34, 39, 40, 41, 50, 53, 54, 62), it is still controversial whether,
out of hypnosis, Highs’ executive attentional processing is different from that of low hyp-
notizable individuals (Lows) (1, 17, 21, 22, 24, 32, 36, 41, 58). In a previous study in which
we investigated the relationship between hypnotizability and spatial attention by means of
a modified version of the Attention Network Task, we failed to demonstrate differences
between Highs and Lows in the executive control component of spatial attention (13).
The present study was designed to further investigate the relationship between hypnotic
susceptibility and executive functions. We studied whether individuals with different sus-
ceptibility to hypnosis displayed a different sensibility to manipulation of attention during
verbal priming. Priming, a type of implicit memory, has been defined as “unintentional
retrieval of previously acquired information on tests that do not require conscious or explic-
it recollection of specific previous experiences” (60). Verbal priming is usually assessed
with word-stem or word-fragment completion tasks, in which a part of the word is given,
and the influence of previously seen words during a study phase on the subject’s comple-
tion behavior is evaluated (61). Studies on amnesic patients with selective impairment of
either explicit or implicit memory indicated that priming can be dissociated from explicit
memory (25, 26, 29, 37, 63).
The choice of verbal priming was motivated by three main reasons. First, there is experi-
mental evidence indicating that manipulation of attention affects implicit memory (55).
In particular, division of attention during a color-naming Stroop task is known to reduce
the magnitude of perceptual priming in implicit word fragment and word stem completion
tasks. This effect has been ascribed to the requirement to deselect the word as the target
response and suggests that intact perceptual priming is a function of both processing word
identity and selectively attending to the word as the appropriate response.
Second, previous findings have shown differences between Highs and Lows only with
memory tasks specifically sensitive to frontal lobe functioning (i.e. free recall) (24). Third,
it has been recently demonstrated that, with conscious voluntary retrieval, implicit retrieval
during word stem completion task is not associated with any frontal activations (4).
Thus, since word stem completion task cannot be considered a frontal task, basal differ-
ences in implicit memory between Highs and Lows are not expected. On the other hand,
any difference accompanying manipulation of attention could be likely attributed to hypno-
tizability-related differences in executive attention functioning.
Three experimental conditions were designed, each addressing a specific issue. In a con-
trol condition we investigated possible difference between Highs and Lows by measuring
their perceptual priming in a full-attention word stem completion task (WSCT). In the sec-
ond and third condition that consist of WSCTs with colored words, we evaluated the effects
of diverted attention, that is naming the color and ignoring the word, and dual attention, that
is naming both color and word, on the perceptual priming of Highs and Lows.
 Manipulation of attention in highly and low hypnotizable individuals 23

METHODS

Subjects
Participants were forty volunteers recruited from a pool of students at the University of Pisa,
who decided to participate in the experiment to obtain an extra credit for a Physiology Lab (age 24
± 1.93; mean ± SD). Subjects had earlier been individually screened for hypnotizability by a medi-
cal psychologist using the Italian version of the Stanford Hypnotic Susceptibility Scale, Form C
(SHSS:C) (68), that is one of the currently used standard scales to measure hypnotic susceptibility.
Twenty individuals scored in the higher range of the hypnotizability scale (Highs, score 9-12, 10
females) and twenty scored in the lower range (Lows, score 0-3, 10 females). All subjects reported
normal or corrected-to-normal vision.
Written informed consent was obtained from all participants.
The general hypnotic-related attentional characteristics of subjects were preliminarily evaluated
through the four major subscales of the Differential Attentional Processing Inventory (DAPI) (17),
and the Tellegen Absorption Scale (TAS) (66, 67).

Stimuli and Procedure

The test was carried out by one of the author (E.C.) in a neurophysiology laboratory at least one
month after hypnotizability assessment. Volunteers were not informed that there were any relation-
ships between the attentional task and hypnotizability.
Testing was completed in two sessions, on different days. In the first session subjects performed
the full-attention task and in the second one the diverted- and dual-attention tests.
Experiments were run on a FreeBSD PC system (Imago program, feanor.sssup.it/∼pv/).
Participants viewed the screen from a distance of 57 cm, and responses were collected via key-
stroke (full-attention condition) or via microphone (diverted- and dual-attention). To reduce head
movements and to maintain the distance from the screen fixed, subjects positioned their head on
a suitable support.
A set of 90 words was selected to serve as stimuli according to the following criteria: all the
words were nouns, were 6-9 letters in length and were of low to medium frequency (20, 44).
For each attentional condition, 12 words were designed as the critical stimuli and 12 were used
to create filler stems in the test list. Six words served as buffer stems at the beginning of the list
in order to discourage the participants from using explicit retrieval strategies. Test stems, obtained
by retaining the first three letters from each test word, were created with the constraint that only 1
word from the set of 90 words used in this experiment could serve as the completion (although each
stem had multiple solutions with reference to all the words in the Italian language).
The experimental procedure consisted of three phases: study, distractor, and test. In both study
and test phase the words (or word stem) were presented one at a time.
During the study phase of each session words were presented for encoding (display time 50
ms) in one of the 3 attentional conditions. In the full-attention condition, the participants were
instructed to read each word presented on the monitor and to press the key as quickly as possible
when they had completed reading, thus allowing measuring of reaction times (RTs). All words
were presented in dark gray on a white screen.
In the diverted- and dual-attention tasks the 12 studied words were presented in each of four
colors (yellow, blue, red, green) and subjects were asked to name the color as quickly as possible.
In the diverted condition subjects were required to direct attention away from the word while in
the dual condition to pay attention to both color and word. Vocal reaction times were recorded
throughout both sessions.
The study phase was followed by a “distraction” period (5 minutes) during which participants
performed an unrelated task –i.e. naming the chief towns of Italian regions.
During test, 24 word-stem (12 from the study list and 12 non studied) were presented in black on
a light gray screen for 3 seconds. The critical stems were presented in a random order with respect
to the study condition, the 6 buffer stems were presented at the beginning of the list, and the filler
stems (from nonstudied words) were distributed randomly throughout the test list. Participants
were instructed to complete each stem with the first Italian word that came to mind and not to use
24 E. Castellani and L. Sebastiani

proper names. The instructions emphasized the need to provide the first solution because of the
limited time available. The instructions for all three conditions were provided before the start of
the study phase. No mention of the test phase, or the nature of the test, was made until the start of
the test phase.
Even though stem-completion tasks reflect involuntary retrieval and are usually uncontaminated
by voluntary recall strategies (7, 25), possible explicit memory occurrence was evaluated by asking
subjects, at the end of the WSC test, to do a voluntary recall of the studied words. Priming effects
were calculated only on items that participants did not show voluntary retrieval for. The entire
procedure took approximately 15 min for the first session and 40 min for the second one.
At the end of each experimental condition subjects were asked to evaluate the degree of interfer-
ence due to manipulation of attention by rating how difficult had been word-reading (rating range
between 1, easy, and 5, extremely difficult) and, limited to the diverted- and dual-attention, how
easy had been color-naming (rating range between 1, easy, and 5, extremely difficult).
A schematic drawing of the experimental procedure is shown in Fig 1.

Fig. 1. - Word Stem Completion Task in full-attention: Study and Test phases.

a) Samples of studied and unstudied word lists and of word-stems. An example of primed and casual
completion is given. b) Flow chart of the experimental paradigm.
Words translation: Rubrica-address book, arbusto-shrub, miraggio-mirage, vignetta-sketch, frazione-
fraction, ottava-octave, velista-yachtsman, corallo-coral.
 Manipulation of attention in highly and low hypnotizable individuals 25

Priming Effect and Priming Score Computation

The magnitude of Implicit Memory was measured by calculating the Priming Effect and Priming
Score indices. The Priming Effect is referred to a facilitation effect, e.g., processing or identifica-
tion of stimuli is improved as an effect of the stimuli presentation in conditions that do not require
explicit (voluntary) remembering. Priming Effect occurs when the number of completed stems
on studied words-list is higher than words completions occurring by chance on the unstudied list
(control list). The Priming Score, that measures the extent of implicit memory, corresponds to the
rate of correct completions on the studied list relative to casual completions on the control list.

Data Analysis
Priming effect data were analysed by means of Repeated Measures ANOVA, with Hypnotizability
(Highs and Lows) and Gender (Males, Females) as Between Subject factors, and Task (Control
list, Studied list) and Condition (full-attention, diverted-attention, dual-attention), as Within
Subjects factors. Priming scores data were analysed by means of repeated measures ANOVA, with
Hypnotizability (Highs and Lows) and Gender (Males, Females) as Between Subject factors and
Condition (full-attention, diverted-attention, dual-attention) as Within Subjects factor.
All analysis were performed on arcsin-square root transformed data.
For RTs evaluation the attentional sessions were subdivided in 4 successive blocks of 12 words
and mean keystroke/vocal RTs of each block were analysed by means of a separate repeated meas-
ures ANOVA, with Hypnotizability (Highs and Lows) and Gender (Males, Females) as Between
Subject factors and Block (RT1-RT4) as Within Subjects factor.

RESULTS

Neuropsychological Charachterization
Highs’ scores on absorption (TAS) were generally higher than those of Lows (Highs vs.
Lows, 23.00 ± 1.11 vs. 19.95 ± 1.40; mean ± SE). On DAPI, Highs obtained higher scores
than Lows on the whole scale (Highs vs. Lows, 186.32 ± 6.76 vs. 162.25 ± 5.91; mean ±
SE) even though separate analysis of the four subscales revealed that Highs differed signifi-
cantly from Lows only on the extremely focused attention items (Highs vs. Lows, 82.47 ±
4.00 vs. 69.25 ± 3.15; F(1,34) = 6.95, p = 0.013).

Priming Data
Implicit memory performance was not influenced by either Hypnotizability or Sex.
Indeed, repeated measures ANOVAs did not show any significant Hypnotizability and
Gender effects. As concern Within-subjects effects, analysis of priming effects yielded
significant Task (Fig. 2, Studied list > Control list, mean ± SE, 28.86 ± 1.22 > 10.65 ±
0.90; F(1,36) = 143.18, p < 0.0001) and Condition effects (F(2,72) = 61.23, p < 0.0001)
with the scores in the full-attention condition (30.48 ± 1.34, mean ± SE) higher than those
obtained during both diverted-attention (14.29 ± 1.25; F(1,36) = 75.90, p < 0.0001) and
dual-attention (14.49 ± 1.09; F(1,36)=92.88, p < 0.0001) conditions. Task X Condition
interaction (F(2,72)=6.29, p < 0.003) was also found significant, due to the fact that scores
on the studied words-list was higher than scores on the control list in all the 3 attentional
conditions (full-attention, F(1,39) = 116.94, p < 0.0001; diverted-attention, F(1,39) = 23.77,
p < 0.0001; dual-attention, F(1,39) = 14.19, p < 0.001). Analysis of Priming Scores showed
similar findings. In fact, it yielded a significant Condition effect with full-attention scores
(0.37 ± 0.03, mean ± standard error) higher than those during both diverted-attention (0.12
26 E. Castellani and L. Sebastiani

Fig. 2. - Priming effect.

Mean percentage of primed

and casual completions in
Highs and Lows.

± 0.03; F(1,36) = 27.37, p < 0.0001) and dual-attention (0.14 ± 0.03; F(1,36) = 26.22, p <
0.0001) conditions (Fig. 3).

RT’s Data
Analysis of RTs did not yield any significant hypnotizability or Sex effects. As concern
Within subjects results, analysis indicated that, in the 3 attentional conditions, performance
tended to get faster along the session. Indeed, significant Block effects were found for full-
(F(3,114) = 8.00, p < 0.0001), diverted- (F(3,114) = 25.33, p < 0.0001), and dual-attention
conditions (F(3,114) = 7.67, p < 0.001).
Despite the lack of any significant hypnotizability effect, in the full-attention condition
Highs were generally faster than Lows, especially in the second half of the session. Indeed,
comparisons between Highs and Lows by means of separate univariate ANOVAs yielded a
significant difference between Highs and Lows at RT3 (F(1,34) = 4.98, p < 0.05) and RT4
(F(1,34) = 5.86, p < 0.05) (Fig. 4).
Self-rating Data
Self-ratings of difficulty on word reading during the 3 attentional conditions reveled that
for all subjects reading in full-attention was very easy (Highs, 1.3 ± 0.5; Lows, 1.4 ± 0.4;
mean ± SD). Fifteen out of 20 Highs reported that color-naming made the word reading
quite difficult (diverted-attention, 3.7 ± 1.5; dual-attention, 3.6 ± 1.4); in contrast, Lows
assigned low ratings to both conditions (diverted-attention, 1.7 ± 0.8; dual-attention, 1.5 ±
0.8). As concern self-rating of difficulty on color-naming both groups reported that they
had been able to direct their attention away from the words very easily (Highs, 1.2 ± 0.3;
Lows, 1.4 ± 0.3).

DI S C U S S I O N

This research was designed to study the relationship between hypnotic susceptibility and
frontal attention functioning by investigating whether manipulations of attention differen-
tially affect perceptual implicit memory in highly and low hypnotizable subjects.
WSCT in full-attention, that is the condition without competing tasks, yielded similar
scores independently of the hypnotizability level of subjects. The similar behavior of Highs
 Manipulation of attention in highly and low hypnotizable individuals 27

Fig. 3. - Priming scores.

Priming scores (means ± stand-

ard errors) of Highs and Lows
in the three attentional condi-
tions: diverted-, dual- and full-
attention.

and Lows was not surprising. In fact, on the basis of previous evidence, hypnotizability-
related differences were expected only with explicit memory tasks that are specifically
sensitive to frontal lobe functioning (24). This finding, however, contrasts with the results
of preliminary experiments carried out in our laboratory that show better performances of
Highs than Lows on a word-stem completion task in which both words and word stem were
presented through the auditory channel (14). This difference could depend on the sensory
modality involved and suggests that the exceptionally efficient focused attention abilities
postulated for Highs could be specifically related to the auditory domain. Actually, most
of the hypnotic induction scales require the focusing of attention on hypnotist voice and
suggestions are administered through the auditory channel.
In spite of similar implicit memory scores, analysis of RTs showed that at encoding (study
phase) Highs were faster than Lows. This effect could be ascribed to the capability of Highs
to process words more automatically than Lows, as suggested by Dixon et al. (21, 22) on the
basis of the greater discrepancies between congruent and incongruent trials in Highs than

Fig. 4. - Reaction times.

Reaction times (ms) of Highs

and Lows during the study
phase in full attention. RT (1-
4) refers to the mean reaction
time (± standard errors) calcu-
lated in each of 4 successive
blocks of 12 words.
28 E. Castellani and L. Sebastiani

in Lows, during Stroop color-naming tasks. On the other hand, shorter RTs in Highs than
in Lows is the frequent finding of studies concerning simple and choice reaction times (12,
13, 18). Thus, the ability of Highs of responding at faster speed than Lows could represent a
generalized skill of Highs attributable to a particularly high efficiency in the locus coeruleus-
mediated arousal component of attention (13). Indeed, evidence from animal neurophysi-
ological studies indicates a key role of locus coeruleus-noradrenergic system in facilitating
rapid neural responses in tasks requiring focused attention (2, 3, 8, 10). The synchronized
LC activation mode that is considered responsible for the increased responsiveness of tar-
get neurons in cortical projections areas is likely driven by cognitive control activity in the
anterior cingulated (ACC) and orbito-frontal cortices. Indeed, despite the limitation due to
the scarce temporal resolution of neuroimaging techniques, a negative correlation between
ACC activity and RTs has been reported in PET and fMRI studies (49, 69). This negative
correlation has also been the frequent finding in simple and choice RTs tasks, as assessed by
event-related potentials studies (27, 45, 46, 48). Specifically, during choice reaction tasks,
volunteers with faster RTs also showed higher N1 peak amplitudes and higher ACC activity
during the N1 timeframe (LORETA, equivalent dipole source). Since ACC is considered one
of the generator of N1 (28, 47), these findings suggest that shorter RTs might be the outcome
of increased ACC cognitive control activity (19, 52). On these bases, a higher activity in
performance monitoring in Highs than in Lows could be then suggested.
During the diverted-attention task, both groups reported that they had been able to direct
their attention away from the words easily; this subjective evaluation is consistent with
their implicit memory scores that were significantly lower than those in the full-attention
condition. In addition, no significant differences between Highs and Lows were found
either in priming or in vocal reaction times, as Highs resulted as fast as Lows in color-
naming. Actually, on the assumption that focusing attention selectively to the color should
have been particularly easy for Highs (DAPI scores), and on the basis of their self-report
of interference of color-naming on word-reading, we expected a worse implicit memory
performance in Highs than in Lows. Since this was not the case, we cannot exclude that
Highs could have possibly counterbalanced their disadvantage due to their more marked
automatism in verbal processing with respect to Lows (21, 22, 57).
In condition of dual-attention, both groups exhibited similar priming scores that were
significantly reduced relative to the full-attention score. Thus, apparently, hypnotic trait
does not modulate the effects of division of attention on implicit memory. This finding is
in accord with DAPI neuropsychological characterization of Highs and Lows (13, 17), as it
indicated similar scores of Highs and Lows on the specific subscale for dual attention.
Again, Highs reported an interference effect of color-naming on word-reading. Even
though the task required paying attention to both color and word, subjects had to name only
the color and this could have added an element of conflict to the performance. In a recent
study (23), a higher conflict-related activity in the dorsal anterior cingulated cortex (ACC)
of Highs with respect to Lows has been found during a Stroop task. More specifically,
ACC activity increased significantly from baseline to hypnosis only in Highs, suggesting
more conflict-related activation in Highs than in Lows after hypnotic induction. Moreover,
recent studies on the functions of ACC (48) revealed a close relationship between dorsal
ACC activity and conscious mental effort, as shown by the positive correlation between
 Manipulation of attention in highly and low hypnotizable individuals 29

activity in the dorsal ACC and the subjectively evaluated increase in mental effort; this sug-
gests that self-ratings are reliable indices of the conscious effort expended. Thus, in spite
of the lack of any differences between the performances of Highs and Lows, the difficulty
claimed by Highs to perform successful word-reading during manipulation of attention
could be as well reflect a higher ACC activity related to conscious monitoring in Highs
than in Lows (48).
In conclusion, although manipulation of attention similarly affects verbal priming of
Highs and Lows, our findings on reaction times and self-reports offer evidence in support
of hypnotizability-related differences in cognitive executive functions.

Acknowledgements – This work was funded by the Italian Ministry of University, Scientific
Research and Technology. We gratefully acknowledge Dr. E.L. Santarcangelo for hypnotic
assessment of volunteers and Prof. B. Ghelarducci and Dr. A. Gemignani for their helpful com-
ments.

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