Hypnosis reshapes multilevel stress response and enhances executive performance in stressed medical students

Stress and anxiety impair executive function and degrade performance, yet rapid and scalable interventions remain limited. This controlled study tested whether a single personalized hypnosis session could enhance stress regulation and cognitive performance during negative memory recall in medical students. Forty-nine final-year students were assigned to hypnosis or a breath-focused attention condition (control arm) (ClinicalTrials.gov: NCT06778109). Executive function (Tower of London Revised), perceived stress and anxiety (VASs, VASa, PSS-10), were assessed before and after a repeated personal negative memory recall, while autonomic reactivity (heart rate, heart rate variability, electrodermal activity, skin conductance responses and percentage of time in sympathetic activation) before, during and after the repeated personal negative memory recall. Hypnosis yielded significantly greater improvements in executive functions (ANCOVA, p < 0.05, d = 0.62), reduced stress and anxiety, whereas stress increased in controls. Physiologically, hypnosis increased parasympathetic recovery (HRV), tonic sympathetic activity (EDA), while suppressing excessive phasic sympathetic surges (SCR/min) and reducing time spent in stress response. Bayesian analyses provided extreme evidence (Jeffreys' scale) for psychophysiological effects. Network analysis identified electrodermal activity as a central hub linking stress responses and executive functions. A logistic model accurately classified group membership. In leave-one-out cross-validation (LOOCV), the model retained strong performance (Accuracy = 90%, AUC = 0.91, Brier score = 0.0796). These findings are consistent with a hypnosis-related shift toward an adaptive challenge-like autonomic profile, suggesting improved cognitive resilience and flexibility in high-pressure contexts.