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How Hypnosis Boosts CBT

Updated: Oct 9, 2023



Cognitive behavioural hypnotherapy (as the name suggests) is an integration of CBT and evidence-based hypnosis. The idea of integrating these two techniques is not new. Let me show you how much these two therapeutic traditions have in common and how they can be the perfect fit when dealing with a wide variety of mental health issues.


The CBT Approach


Many of us probably know of someone who has received Cognitive Behavioural Therapy (or CBT). This is now the most commonly used talking therapy for treating issues from insomnia to anxiety and depression. CBT’s no-nonsense, practical approach to dealing with mental health has led it to being fully embraced by the psychological and psychiatric establishment.


CBT explores the way that one’s thoughts (or ‘cognitions’) and emotions can intertwine and lead us into behaviours that are not always beneficial. After a client has outlined their problem, the therapist will devise a ‘formulation’ with them. This is a conceptualization of how the client is trapped in a vicious cycle that perpetuates their problem. To give an example, let’s say the client complains of social anxiety which is triggered whenever they attend a social gathering such as a party. In this situation, certain thoughts may be prevalent such as ‘Everyone is looking at me and they think I look foolish’. These thoughts often lead to a chain of uncomfortable emotions (fear, panic) and bodily sensations (breathlessness, sweating, heart-racing). The discomfort of all of this then leads the individual to certain behaviours, such as leaving the party early and perhaps avoiding all party invitations in the future. The problem now is that they become fearful of social situations for the future and become ‘stuck’ in this pattern.


In order to treat this condition, the CBT therapist may begin by asking a client to keep a record of situations that trigger anxiety and ask them to write down their thoughts, feelings and behaviours. Once the client becomes mindful of these patterns, the therapist can help the client change by either focusing on:


Thoughts – i.e. helping them to challenge their thinking patterns or by learning to accept these thoughts by becoming de-fused from them.


Behaviours – i.e. helping them to change the behaviour that is continuing to maintain the problem (so, in the example, by actually ensuring that the client goes to social situations but learns to manage their anxiety using techniques to lower their stress response) – and thus learning to understand that they are able to overcome their discomfort.


Plus Hypnosis...

Hypnosis is plagued by popular misconceptions. Many people are unsure that it actually exists at all, associating it with the tricks of a stage magician, or associating it with other ‘flakey’ unscientific ideas. However, hypnosis has a long history of being accepted by the scientific and medical establishment, since the days of pioneer, James Braid in the 19th Century. It has been regarded as a valid and useful therapeutic technique by the British Medical Association for over a hundred years ago and it is fully accepted by the British Psychological Society as part of normal human psychological phenomenon. There have been literally thousands of experimental and clinical research studies on hypnosis published by highly respected universities over decades. There is now an abundance of evidence that hypnosis can be very effective in conquering negative habits, improving performance, minimising anxiety, reducing pain, improving sleep and relieving a wide variety of psychosomatic or stress-related illnesses.


There is more than one interpretation of hypnosis. Some hypnotherapy training schools like to use the word ‘trance’ and explain that a hypnotised person is in a special ‘state’ where the therapist talks to the ‘unconscious mind’. Other schools favour a more sceptical, evidence-based and scientifically-minded approach and tend to choose their words more carefully, defining hypnosis as little more than the use of the human imagination for therapeutic benefit. In short it can be seen as simply focusing one’s attention and willingly allowing oneself to become suggestible. The beauty of this idea is that it is totally compatible with cognitive therapies. Some hypnotherapists suggest that the term imagination therapy would be much more helpful to understand how it works. Human imagination is something that we often take for granted. Yet it often exerts its strange power upon us when we least expect it, particularly with regards to negative emotion. Who hasn’t experienced the physical sensations of anxiety when a loved one fails to return home at an agreed time, and the imagination runs wild with tragic scenarios? Or what about the intense visceral fear prompted by the misinterpretation of information from the senses: a strange-shaped shadow seen when walking home late alone or an unexplained noise from downstairs in the middle of the night?


This negative power of imagination can have long-term consequences. Many people’s early experiences of over-critical adults can lead to lives defined by stories about themselves that hinder personal growth - a kind of ‘negative self-hypnosis’ imposed in childhood, a time of high-suggestibility. But what if we could make a conscious effort to loosen the grip of such stories and tell ourselves ideas that are more positive and useful, allowing us to build a better life. Can we imagine what it would be like to imagine an existence not crippled by negative self-belief, fear of spiders or terror of social situations?


Another way to perhaps understand hypnosis is a harnessing of the placebo effect. Most of us have only heard of this term when used deceptively, such as when a doctor prescribes sugar pills in order to make use of the power of the patient’s mind in improving health. But what if this potential for self-healing could be utilized deliberately and without deception. Hypnosis is really nothing more than this.


Approximately 5% of people are naturally highly-suggestible. (They are the ones that the stage hypnotists are so skilful at selecting.). But most of us benefit from some kind of skills-training exercises to get the hypnotic ball rolling, so to speak. These exercises are referred to as ‘convincers’ and are often fascinating and fun exercises. Examples include being given repeated suggestions that one’s arm will start moving about as if all by itself or that one’s eyelids are glued shut. By using such exercises, a hypnotherapist helps a client learn to experience suggestibility and therefore rapidly increase the client’s suggestibility in the future, thus creating a positive feedback loop.


Hypnosis can be hugely useful therapeutically when creating ‘imaginal rehearsal’ – a kind of virtual reality of the imagination – one where a hypnotized client can mentally rehearse changes before trying them out in the real world. When combined with relaxation techniques, this can be a powerful way to allow a client to become desensitized to a previously anxiety-inducing situation and create new associations of behaviour and emotion. Let’s think back to our client with social anxiety. The CBT therapist wants them to make changes to thoughts and behaviour. Here hypnosis is the perfect tool for the job. Suggestions can be made to modify thoughts and ‘imaginal rehearsal’ can be used to help them rehearse new helpful patterns of behaviour and make positive associations i.e. being comfortable, confident and relaxed in social situations, rather than anxious.


Conclusions

So, there is a powerful argument that CBH can be more effective than CBT. Albert Ellis, the psychologist credited as the godfather of cognitive therapy was known to use hypnosis with his clients in order to improve the therapy’s effectiveness. But what if a solid body or research studies also supports this? In fact, every time there has been a comparison of the effectiveness of CBT versus CBT combined with hypnotherapy, the latter has proven to be more effective and this has been the case with a wide variety of issues from tackling depression and anxiety to obesity. To give just one example, a 1988 review of 109 different studies on pain management found that CBT combined with hypnotherapy was three and a half times more effective that CBT alone.


I hope that you found this informative. If you believe you could benefit from CBH for anxiety-related issues, please contact neil@focusedattention or just click on the button below.


References

BMA (1955). ‘Medical use of Hypnotism: Report of a Subcommittee appointed by the Psychological Medicine Group Committee of the British Medical Association’, Supplement to the BMJ April 23, 1955: 190-193, Appendix X.


BPS. (2001). The Nature of Hypnosis. Leicester: BPS.


Flammer, E., & Bongartz, W. (2003). On the efficacy of hypnosis: A meta-analytic study.

Contemporary Hypnosis, 20 (4), 179-197.


Kirsch, I.; Montgomery, Guy; Sapirstein, Guy (1995). 'Hypnosis as an adjunct to cognitive behavioural psychotherapy: A meta-analysis.' Journal of Consulting and Clinical Psychology, 63 (2), 214-220.


Malone, M.; Strube, M. (1988). 'Meta-analysis of non-medical treatment for chronic pain.' Pain, 34, 231-234.





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