1 Psychology and human development1.2 Awareness, sleep and consciousness
1.2 States and levels of awareness
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Written by Resident Doctor Committee · Published
Levels of consciousness
Consciousness has a level (wakefulness and responsiveness) and content (accessible perceptions, thoughts, feelings and memories).
Level | Responsiveness |
|---|---|
Alert wakefulness | Attentive, orientated, normally responsive |
Drowsiness | Easily roused; drifts off without stimulation |
Clouding | Fluctuating attention and comprehension; suggests an organic cause |
Stupor (organic) | Briefly roused by vigorous stimulation |
Coma | No arousal or purposeful response |
Psychiatric stupor is akinesis and mutism with preserved consciousness, as in catatonia, and the person may later recall events in detail.
Delirium gives a fluctuating level with disturbed content, whereas schizophrenia gives a normal level with disordered content.
Arousal and attention
Arousal is physiological activation driven by the reticular activating system.
Attention is selective processing, and it can fail while arousal is high, as in mania.
The Yerkes-Dodson relationship is an inverted U, and complex tasks need lower arousal than practised ones.
Sleep stages
Stage | EEG | Features |
|---|---|---|
N1 | Theta 4 to 7 Hz; alpha disappears | Hypnic jerks, hypnagogic imagery |
N2 | Spindles and K complexes | 45% of sleep |
N3 | High-amplitude delta below 4 Hz | Sleepwalking and sleep terrors, early in the night |
REM | Desynchronised, sawtooth waves | Atonia, vivid dreams, nightmares late in the night |
Hypnosis
Hypnosis focuses attention and increases responsiveness to suggestion; relaxation is optional.
James Braid introduced the term in the early 1840s, from the Greek word for sleep; Mesmer's animal magnetism came before it.
Hypnotisability is a stable trait measured by the Stanford and Harvard scales.
High hypnotic suggestibility is linked to reduced metacognition of agency, meaning weaker insight into one's own sense of agency, so responses feel involuntary.
High scorers show absorption and imagination, not gullibility, while low openness and poor imagery go with low suggestibility.
Dissociation is only weakly related to hypnotic suggestibility.
Account | Claim |
|---|---|
State theories | Dissociated agency; Hilgard's hidden observer |
Social cognitive theories | Expectancy and role adoption |
Hypnosis should not be used to recover memories, because confidence rises without greater accuracy.
Suggestibility
Suggestibility is accepting expectations that alter perception, memory, belief or behaviour.
Compliance is public agreement without private belief change, and it usually ends when pressure stops.
The Gudjonsson Suggestibility Scale measures interrogative suggestibility and is used in forensic assessment of vulnerable suspects.
Score | What it counts | Related to |
|---|---|---|
Yield 1 | Leading questions accepted (15 of 20, asked after narrative recall) | Poor memory, lower intelligence, anxiety |
Shift | Answers changed after negative feedback | Interpersonal pressure, low assertiveness |
Total suggestibility = Yield 1 + Shift.
Trance
Trance is absorption with narrowed attention and reduced awareness and volition. Culturally sanctioned trance ends without distress, whereas dissociative trance disorder is unwanted and impairing; the former can be mistaken for psychosis.