Cognitive-Behavioural Hypnotherapy (WIP)
Donald J. Robertson
Unlike CBT, hypnosis is seen as an adjunct to therapy, not a therapy itself.
Acronyms
- CBT - Cognitive Behavioral Therapy
- CBH - Cognitive-Behavioral Hypnotherapy
- NSH - Negative Self Hypnosis (worry, rumination)
Part 1 - The Cognitive-Behavioural Approach to Hypnosis
Chapter 1 - Introduction to cognitive-behavioural hypnotherapy
- CBH is not just integrating CBT with hypnosis, but rethinking hypnosis through a CBT lens.
- Behavior therapy, the precursor to modern CBT, was developed by Joseph Wolf - originally called ‘hypnotic desensitization.’ There were others, but they were thought of as hypnotic interventions minus the hypnosis label.
Of course, hypnotism is essentially a cognitive procedure: hypnotic suggestions are intended to evoke ideas (cognitions) that lead to certain desired hypnotic responses.
Personal thought - a comedian is to comedy as a hypnotist is to hypnotic trance and hypnosis. There’s no ‘comedy’ state, but comedy is real.
Their Hypnotic Mindset model is based on the cognitive-set described by Barber.
- Recognition. Induction as a cue to act favorably towards hypnosis (selective attention, implementing suggestions.)
- Attribution. Accurately attributing responses to imagination and expectations, rather than just voluntary compliance.
- Appraisal. See hypnosis as an opportunity, not a threat. (Uninhibited.)
- Control. Confidence in fulfilling the suggestions, as well as confidence in automatic response given the right mindset. Self-efficacy and response expectancy.
- Commitment. Accurately estimating effort - not ‘trying to hard’ or ‘just waiting.’
Roles (Sarbin) may give ‘schema’ (Beck) to responses.
CBH should have…
- Psychopathology. A cognitive-behavioral understanding of the problem.
- Treatment rationale. A CB solution approach.
- Hypnosis. A CB reconceptualization of hypnosis and procedures.
Albert Ellis, founder of rational-emotive behavioral therapy (REBT,) suggested that if we engage in harmful rumination and it causes unwanted effects, we can use the same tools of rumination to negate those effects. (Regarding auto-suggestion.)
In a study - CBH was 70% more effective than CBT alone.
Interesting…
They “rearrange themselves” to get into the right mind-set and orientation, and shift their focus of attention on to the most relevant cues, probably the voice of the hypnotist and the location of the sensations being suggested. They adopt the appropriate mind-set in order to be able to pass the first test, that is, to respond to the hypnotic induction technique. It’s important to realise that means hypnotic subjects enter hypnosis, at least to an initial extent, just before the hypnotic induction rather than after it; that is, in preparation rather than as a consequence.
(There’s a solid smackdown interesting take on Ericksonian approaches in therapy around p19 worth a read.)
Hypnosis has advantages over just CBT…
- Response expectancy because of that hypnotist swag vs just therapy.
- Relaxation is a cool bonus.
- Learning benign dissociative skills.
- “Dehypnosis” strategies - which can be applied in hypnosis… Then applied in an anxiety loop.
- Hypnosis enhances imaginative intensity.
- Hypnosis supports experiencing emotional states.
- Hypnosis expands your toolkit.
- Training autosuggestion is a good tool to have.
- Hypnotherapy is a “creative melting pot.”
- Hypnotherapists have skills for making therapeutic recordings.
There are more specific enhancements in imagination in CBH.
- Maladaptive behavior is more clearly identified.
- The client is exposed to a range of situational cues.
- Greater engagement, including emotional.
- Imagery may allow the client to become aware of behavioral and cognitive patterns.
- Imagery behavior, with practice, allows selective attention.
Meditation as ‘dehypnosis’ (exiting a maladaptive cognitive loop) is also a benefit. Seeing your own thoughts as a “movie,” or uh - learning to ignore your hypnotist as you would discard a suggestion, has benefits.
- Hypnosis is behaving ‘as if.’
- Dehypnosis is behaving ‘as if not.’ Simply being aware like a movie, not getting lost in the story.
Including these tables to show how a CBT approach sees this.
- Suggestions can encourage compliance with a meditation practice.
- Suggestions can encourage a patient (healing) mindset, where healing is natural.
- Suggestions can be given for acceptance.
- Hypnosis can avoid identification with thoughts and feelings.
- Hypnosis can increase acceptance of thoughts and feelings.
- Suggestions can improve the perception that negative thoughts are transient and unimportant.
Can combo hypnosis with mindfulness meditation to…
- Do exposure therapy (covert behavioral rehearsal.)
- Cue relaxation.
- Desensitization.
- Regression, such as in PTSD treatment.
- Suggestion to help clients tolerate the discomfort and repetition in exposure therapy.
“Imagine that you are transparent, and disturbing thoughts and emotions cannot penetrate you or have any power to control your actions.” Suggestions can be used to weaken (negative) suggestions, hypnosis to nullify (negative) self-hypnosis.
The book will cover four main traditions of CBT as CBH.
- Stress inoculation training (SIT.) Training hypnotherapy, mindfulness, and ‘dehypnosis.’
- Exposure and response prevention (ERP,) for more severe cases.
- Problem solving therapy (PST.)
- Cognitive therapy. Examining faulty threat appraisals, distortions, using distancing and dehypnosis.
Chapter 2 - James Braid and the original hypnotherapy
When we understand Braid’s position on hypnosis, it’s relationship to CBT becomes obvious. They saw hypnosis as focusing on a single idea, expecting a response, and the effects of mind over body.
Braid facts:
- They never referred to the conscious mind - hypnosis was a form of focus and imagination.
- He did not believe trance was involved in hypnosis.
- He thought of suggestion as “dominant ideas.”
- He thought hypnosis had more in common with yogic meditation than Mesmerism.
- He regretted introducing the term “hypnotism,” as hypnosis is unrelated to sleep.
- Hypnosis could only be done consensually - people reject what is objectionable.
- His positive definition had to do with focusing on an idea and expecting an outcome.
The book suggests a ‘return to Braid’ in hypnotherapy because…
- The confusion surrounding hypnosis comes from Mesmerism, not hypnosis.
- Braid embraced hypnosis as a “common sense” approach to therapy.
- Their approach is simple and largely compatible with CBT.
- Braid saw psychopathologies such as negative ‘automatic thoughts’ and hysteria as hypnotic in nature.
Braid worked with William Carpenter and based his ideas on his ideo-motor theory. This is similar to cognitive-behavioral concepts, where ideo-motor responses are motor responses to ideas.
Franz Mesmer and Victorian nostrum remedies
According to the author, hypnotism did not originate from Franz Mesmer, who believed he could control the magnetic forces in others with his body and mind. Animal magnetism and mineral magnetism were to separate ideas - and Braid suggested mesmeric responses were due to expectation and suggestion. Marquis de Puysegur, following in Mesmer’s footsteps, developed a more relaxed term of “artificial somnambulism” and tried to create it’s effects. The unfortunate downside of this is hypnotism has since been seen as related to sleep.
The scientific community was (rightfully) skeptic of Mesmer’s claims, and included some of the earliest placebo-like control trials. Faithful followers of Mesmer believed the control was in the hands of the Mesmerist/operator, and their model did not have space for ‘self-magnetism.‘
James Braid, the father of hypnotherapy
Braid, while initially outwardly combative and skeptical against the idea of Mesmerism, tempered his point of view after seeing a demonstration where he himself slid a pin between a subject’s nail and their finger, remaining mesmerized. He made the motto of his first book…
“Unlimited scepticism is equally the child of imbecility as implicit credulity.” -Professor Dugald Stewart
At this point, Braid asked the mesmerists to take a more scientific approach in their studies. Stewart saw that mesmeric response could be a byproduct of focused attention, from observing Mesmer’s techniques of fixation. Braid’s initial attempts at inducing this included eye strain, but he later found it to be unnecessary. With Braid’s new techniques, he was able to create similar effects faster than mesmerists - to the point where some of them suggested he was naturally a Mesmerist himself. (Braid disproved this by training others in his technique, getting similar results.)
Hypnotism may have been introduced in concept by braid as neurological inhibition (‘nervous sleep’) created by prolonged selective focus.
The battle with Mesmerism
Originally, Braid coined hypnotism to differentiate himself from the esoteric beliefs of Mesmerism. The Mesmerists, instead of accepting Braid’s position, hypothesized Braid had found a ‘new agency,’ and both mechanisms existed.
Braid and yogic meditation
Braid found yogic meditation similar to his idea of hypnotism, but unlike mesmerism, and used this as evidence against mesmerism.
William B. Carpenter and the ideo-motor reflex
Braid worked with Professor William Benjamin Carpenter, working together to scientifically examine (dismantle) mesmerism. Carpenter came up with the idea of the “ideo-motor reflex,” which Braid assimilated into his work. Ironically, the two of them were seen as a ‘threat’ to mesmerism.
Who discovered hypnotism?
Abbe de Faria and Alexandre Bertrand seemed to also reject magnetism, despite being mesmerists, but did not appear to follow Braid’s scientific approach.