What is Cognitive-Behavioural Hypnotherapy?

What is Cognitive-Behavioural Hypnotherapy?

This article attempts to briefly outline the historical context and origin of cognitive-behavioural hypnotherapy, a major sub-modality of modern hypnotherapy.  It proceeds to examine the relationship between hypnotherapy and cognitive-behavioural therapy (CBT) from this perspective.  Parallels are drawn between modern cognitive-behavioural theories of hypnosis and the original “ideo-motor” or “psycho-physiological” theory developed in the early 1840s by James Braid, the founder of hypnotherapy.

Origin of the Cognitive-Behavioural Theory of Hypnosis

Andre Weitzenhoffer, one of the best-known and most influential scientific researchers in the field of hypnosis, and a prominent critic of the cognitive-behavioural approach to hypnosis, briefly outlines its history in The Practice of Hypnotism,

Most members of these groups directly and indirectly credit Robert W. White for giving impetus to this school of thought.  However, it was Theodore Sarbin, first, and later Theodore X. Barber (and from then on their students and collaborators) who were most responsible for the development of the cognitive-behavioural position.  (Weitzenhoffer, 2000: 112).

Adding,

The written output of the cognitive-behaviourists has been considerable.  They have touched upon just about every aspect of hypnotic behaviour. (Weitzenhoffer, 2000: 114)

However, Weitzenhoffer contends that in essence the cognitive-behavioural theory of hypnosis has remained relatively faithful to the the psychologist Robert White’s seminal 1941 article ‘A preface to the theory of hypnotism’, and this is generally cited as the beginning of the cognitive-behavioural tradition in hypnosis.  White argued that research on hypnosis consistently suggested that its effects were primarily due to the conscious attitudes and voluntary efforts of the hypnotic subject.  In an oft-quoted passage, he defined hypnotic responses as a peculiar kinds of socially-determined behaviour.

Hypnotic behaviour is meaningful, goal-directed striving, its most general goal being to behave like a hypnotised person as this is continuously defined by the operator and understood by the client.  (White, 1941)

A concise summary of modern social and cognitive-behavioural theories of hypnosis was given by Steven Jay Lynn and Sean O’Hagan in a recent journal article.  Several theories are typically grouped under this heading, attributable to different hypnosis researchers who various place emphasise upon the following factors,

(a) enactment ofthe social role of a hypnotised person (William Coe, Theodore Sarbin);

(b) attitudes and beliefs about hypnosis, fantasy involvements and motivated engagement with imaginative suggestions (T.X. Barber);

(c) cognitive strategies, goal-directed activities and interpretation of suggestions (John Chaves, Nicholas Spanos, Graham Wagstaff);

and (d) expectancies, response sets and automatic responses in everyday actions (Irving Kirsch, Steven Jay Lynn).  (‘The Sociocognitive and Conditioning and Inhibition Theories of Hypnosis’, Contemporary Hypnosis, 26(2): 121-125, 2009)

Nonstate theorists such as these, who reject the concept of hypnosis as a “special state” or “hypnotic trance”, and are therefore sometimes described as skeptics, are often misinterpreted as rejecting the practical value of hypnotherapy.  This is not the case as hypnotherapy is interpreted as a psychological therapy which functions by increasing expectation, focusing attention, guiding mental imagery, modifying beliefs, etc., rather than by inducing a mysterious altered state of consciousness called “trance”.

Only the uncritical practitionerwill remain satisfied with a declaration that the causal condition for behaviour change is the “trance”. […] The effectiveness of hypnotism as a therapeutic procedure or as a means of relieving suffering is not at issue.  One consequence of our efforts to clarify the events traditionally labeled hypnotism would be a an increase in therapeutic effectiveness following from more precise knowledge. (Sarbin & Coe, 1972: 247)

Indeed, replacing the concept of “trance” with specific cognitive and behavioural strategies permits an interpretation of hypnotherapy which makes it appear similar in many respects to other psychological therapies, especially, as the name indicates, certain forms of cognitive-behavioural therapy (CBT).

Barber’s Cognitive-Behavioural Theory

Although White’s article is often cited, by proponents and critics alike, as the theoretical genesis of various “cognitive-behavioural” and “social-cognitive” theories of hypnosis, he did not use this terminology.  The first major textbook on hypnosis to refer to a “cognitive-behavioural” theory of hypnosis was published in the early 1970s.

In 1974 one of the best-known and most widely-referenced texts in the history of hypnosis research was published by Theodore X. Barber, Nicholas P. Spanos, and John F. Chaves.  Hypnotism: Imagination & Human Potentialities, though a small book, contains a detailed review of research on hypnosis supporting the view that hypnotism functions by means of ordinary psychological factors and rejecting the concept of “hypnotic trance” and attempts to describe hypnosis as an altered state of consciousness.  T.X. Barber opens the book with a clear statement of position,

This orientation, which we shall label the “hypnotic trance” viewpoint, has been widely accepted.  In fact, most people take it for granted that subjects who have been exposed to a hypnotic induction procedure manifest a “hypnotic” appearance, are responsive to test suggestions, report changes in body feelings and report that they are hypnotised because they are in a special state – “hypnotic trance”.

An alternative point of view, which is elaborated in the present text, might be labeled the cognitive-behavioural viewpoint.  This approach proceedstoaccountfor so-called “hypnotic” experiences and behaviours without postulating that the subjects are in a special state of “hypnotic trance”. […] From the cognitive-behavioural viewpoint, subjects carry out so-called “hypnotic” behaviours when they have positive attitudes, motivations, and expectations toward the test situation which lead to a willingness to thing and imagine with the themes that are suggested. (Barber, Spanos & Chaves, 1974: 5, authors’ italics)

Cognitive-behavioural hypnotherapy, as we interpret it, is hypnotherapy based upon the cognitive-behavioural theory of hypnosis developed by Barber and his colleagues.

Although this book was mainly focused upon reviewing experimental research and the formulation of a general theory of hypnosis, Barber and his colleagues used their cognitive-behavioural model to compare the processes involved in hypnotherapy and behaviour therapy at a practical level.  They chose to focus their discussion upon the cardinal behaviour therapy technique of “systematic desensitisation” developed by Joseph Wolpe in the late 1950s.  Wolpe had originally referred to his technique as “hypnotic desensitisation” because in order to induce relaxation, he had employed the hypnotic eye-fixation and arm-levitation inductions described by Lewis Wolberg in one of the best-known textbooks of clinical hypnotherapy, Medical Hypnosis(1948).  However, Wolpe fails to mention that Wolberg’s book, published a decade before his own, also contains a clear account of a hypnotherapy technique, based on behavioural theories of conditioning, called “hypnotic desensitisation” which greatly resembled the behaviour therapy technique, both involving repeated pairings of physical relaxation with a series of anxiety-provoking mental images.

Another means of treating phobias is by desensitisation.  Under hypnosis the patient is given suggestions to expose himself gradually to the terrifying situation.  The aim in desensitisation is to get the patient to master his fears by actually facing them.  It is essential for the individual to force himself again and again into the phobic situation, in order that he may finally learn to control it. […] The hope is that the conquering of graduated dosesof his fear will desensitise him to its influence.  (Wolberg, Medical Hypnosis, 1948: 235)

Wolberg describes several variations of hypnotic desensitisation and reconditioning and provides two brief case studies describing the use of the method in the treatment of socialanxietyand a simple phobia.  The fact that systematic desensitisation and many other techniques of behaviour therapy, especially those involving mental imagery, appear to have been pre-empted by hypnotherapy, and possibly even derived from hypnotherapy, was specifically confronted by one of the leading researchers in the field of hypnosis, Andre Weitzenhoffer, in his 1976 article ‘Behaviour Therapeutic Techniques & Hypnotherapeutic Methods.’  Weitzenhoffer noted that, in particular, the use of systematic desensitisation and aversive mental imagery in behaviour therapy were pre-empted by very similar techniques, also based on behavioural “learning theory”, in the field of hypnotherapy.

The literature on behaviour therapy suggests that the use of hypnosis in connection with the application of learning principles is essentially limited to systematic desensitisation.  On the other hand, perusal of the hypnotherapeutic literature indicates that hypnotic techniques are being successfully used in conjunction with learning principles in a great many ways which clearly qualify as recognised behaviour therapeutic techniques.  Recognition of this fact by behaviour therapists and hypnotherapists could be of considerable benefit to both groups if followed through.  (Weitzenhoffer, in Dengrove, 1976: 288).

Weitzenhoffer and others argued that a great many hypnotherapy techniques already in existence, some traceable as far back as the late Victorian era, could quite legitimately be described as constituting a “behavioural hypnotherapy.”  Although this sub-modality of hypnotherapy preceded “behaviour therapy” by at least a decade, it also clearly benefits from the assimilation of theory and practice developed subsequently by behaviour therapists and there has therefore been some degree of reciprocal influence between hypnotherapy and behaviour therapy.

Following the “cognitive revolution” in psychology, cognitive (thinking) factors were increasingly emphasised as mediating the effect of physical stimuli, and therefore modifying the theories of behavioural psychology derivedfrom animal experiments.  Barber and his colleagues were among the first researchers, in this period, to observe that the integration of cognitive and behavioural factors in mainstream psychology could be applied to the scientific study of hypnosis.  Hypnosis researchers were therefore among those in the late 1960s and 1970s who argued that the effects of systematic desensitisation could not be understood purely in terms of behaviourallearningtheories, such as Pavlovian conditioning, but required analysis in terms of the central role of cognitive factors such as the expectations, attitudes, self-talk, and mental imagery experienced by the client during the treatment.

Barber argued that when the pseudoscientific concept of “hypnotic trance” is removed, and hypnotherapy is understood in terms of more common psychological concepts and theories, the considerable overlap between techniques such as “hypnotic desensitisation” and “systematic desensitisation” becomes quite apparent.

Our purpose has not been to show that hypnotism and desensitisation are “the same thing” or that the only variables that produce therapeutic change in desensitisation are also found in hypnotic situations.  Instead, we have tried to show that (a) these situations contain a number of commonalities that are important in understanding the behaviour change seen in each situation, (b) these commonalities have not been fully appreciated because the “hypnotic trance” notion tends to preclude looking for the kinds of similarities between hypnotism and other research areas that deal with “normal” phenomena, and (c) a free flow of information between these research areas, unencumbered by the “hypnotic trance” notion, will lead to a mutual theoretical enhancement. (Barber et al., 1974: 143-144)

In addition to abandoning the concept of “hypnotic trance”, however, Barber’s “cognitive-behavioural” theory of hypnosis was one of many converging factors in the 1960s and 1970s supporting the increasing re-interpretation of behaviour therapy in terms of cognitive factors and the development of theory and practice which evolved into modern cognitive-behavioural therapy (CBT).

In terms of both theory and practice, however, hypnotherapists have some claim to historicalpriority.  Hypnotherapy, which originated in 1841, is by far the oldest psychological therapy, preceding psychoanalysis by half a century.  Most of the practical techniques and strategies which hypnotherapy shares with cognitive-behavioural therapy originated many decades before either CBT or behaviour therapy.  The application of cognitive and behavioural theories to hypnosis and hypnotherapy led to Barber’s self-professed “cognitive-behavioural” theory of hypnosis in the early 1970s but was the natural result of many decades of prior inter-action between researchers in the field of hypnosis and the emerging theories of behavioural and social psychology.

Sarbin’s Social-Cognitive Theory

Barber actually began developing this position in the late 1960s, following on from the previous work of Theodore Sarbin.  Sarbin, another well-known researcher in the field of hypnosis, had developed an influential social psychological theory of hypnosis based on “role-taking” theory in his seminal article ‘Contributions to role-taking theory: I. Hypnotic behaviour’ published in 1950.  (He had already briefly introduced the theory in talks and articles during the 1940s.)  Though he did not use the term “cognitive-behavioural”, Sarbin had also rejected the concept of hypnotic trance as a “special state” (altered state of consciousness) and developed an explanation of hypnotism in terms of ordinary social, cognitive, and behavioural factors, modelled on explanations used in other branches of psychology.  In 1972, Sarbin, along with his colleague William C. Coe, published a summary of their role-taking theory of hypnosis in the seminal Hypnosis: A Social Psychological Analysis of Influence Communication.  This book presents a “cognitive theory of action” which combines elements of behaviourism with cognitive factors discussed in social psychology.

Role theory may be classified among those theories that recognise the utility of cognitive concepts but at the same time place high value on naturalistic-empirical constraints.  (Sarbin & Coe, 1972: 63)

In particular, Sarbindecribes his role-taking theory of hypnosis as being based upon a “cognitive theory of action” in which the effects of external stimuli upon behaviour are mediated by intervening cognitive factors, especially the subject’s identification with socially-constructed roles and their associated expectations.

Early Behavioural Theories of Hypnosis (Pavlov & Hull)

The famous Russian physiologist and psychologist Ivan P. Pavlov (1849-1936) was one of the major contributors to the field of experimental hypnosis research and, indirectly, to clinical hypnotherapy.  Pavlov argued that the states of profound relaxation induced in human hypnotism physiologically resembled the phenomenon of “animal hypnosis” or catalepsy, and were due to a progressively irradiated inhibition of cells in the cortex of the brain (“cortical inhibition”).  To this physiological theory of hypnotic relaxation or “sleep”, Pavlov added a theory of hypnotic suggestion which identified hypnotic suggestion responses with “conditioned reflex” responses to words.  In the Soviet Union, Freudian psychoanalysis was considered deeply pseudoscientific and bourgeois.  Pavlov’s theory of hypnosis therefore became the basis of subsequent Soviet psychotherapeutic methods which assimilated the social psychology of Bekhterev’s hypnosis, the rational persuasion methods of Paul Dubois, and elements of Bernheim’shypnotic psychotherapy.  Soviet psychotherapy was therefore a combination of rational persuasion and physiological conditioning, using hypnosis, which can be seen as an indirect precursor of modern cognitive-behavioural hypnotherapy.  Indeed, although Pavlov firmly identified hypnosis with a special state (“cortical inhibition”) accounts of Soviet hypnotherapy which reached the English-speaking world directly influenced early behavioural hypnotherapists such as Andrew Salter in the 1940s and 1950s.

Closely following the development of Soviet rational hypnotherapy, starting in the 1920s, the eminent American psychologist Clark L. Hull, one  of the pioneers of behaviourism, carried out an extensive programme of laboratory research on hypnosis which culminated in the publication of the first major textbook reviewing scientific research in the field of hypnosis, Hypnosis & Suggestibility (1933).  On the basis of many experimental studies, Hull concluded that hypnosis was not a sleep-like state and could only be characterised in terms of suggestion and heightened suggestibility.  Hull’s behavioural theory of hypnosis, and the work of Pavlovian hypnotherapists in the Soviet Union, were part of the inspiration for early behaviour therapists seeking a radical alternative to the “Freudian Empire” which dominated Western psychotherapy until the 1960s.  Andrew Salter drew upon both of these traditions in developing his own “conditioning” approach to hypnotherapy, which employed behavioural shaping methods as a vehicle for skills training in self-hypnosis.  Salter was one of the founders of Western behaviour therapy which he termed, in his book of the same name, Conditioned Reflex Therapy (1949).

The Original Ideo-Motor Theory of Hypnosis (Braid & Carpenter)

Hull’s influential behavioural research and Sarbin’s social “cognitive” theory of behaviour constituted two major precursors of Barber’s “cognitive-behavioural” theory of hypnosis and subsequent “nonstate” perspectives.  However, there are many other important precursors of cognitive-behavioural theory and practice in hypnotherapy and elements of both can be traced all the way back to the writings of James Braid, the Scottish surgeon who coined the term “hypnotism” and founded hypnotherapy in the 1840s.

Braid initially emphasised the concept of hypnosis as a “peculiar” sleep-like state, although he explained that 90% of his patients remained fully conscious.  He therefore appears to have meant that hypnotic subjects typically appeared externally relaxed or asleep, although their mind remained conscious and focused.  His basic method consisted of fixating the subject’s attention upon a monotonous stimulus or idea in order to induce progressively deeper states of relaxation and fatigue.

However, Braid soon revised his theory of hypnosis, responding, in part, to the research of his ally Prof. William B. Carpenter of the RoyalInstitution, an eminent English scientist who is sometimes regarded as a precursor of American behaviourism.  Carpenter developed the concept of “Mental Physiology”, an early attempt to study the relationship between the physical functioning of the nervous system and the realm of human psychology.  Carpenter coined the term “ideo-motor reflex” in 1852 to describe the basic psychological mechanism underlying various involuntary or unconscious behaviouralresponses to ideas.  Braid adopted Carpenter’s theory as the basic explanation of hypnotic suggestion and argued that hypnotic therapy worked by increasing mental focus or concentration upon “dominant ideas” in order to increase the ideo-motor reflex response, or response to suggestion.

Braid himself concluded that the term “hypnotism” (meaning sleep), which he introduced, tended to confused his patients into believing that they should be unconscious rather than focusing their conscious attention upon certain images and ideas.  He therefore considered restricting the term “hypnotism” to 10% of his patients who did exhibit a sleep-like level of relaxation accompanied by fatigue.

I am well aware that, in correct phraseology, the term hypnotism ought to be restricted to the phenomena manifested in patients who actually pass into a state of sleep, and who remember nothing on awakening of what transpired during their sleep.  All short of this is mere reverie, or dreaming, however provoked, and it, therefore, seems highly desirable to fix upon a terminology capable of accurately characterising these latter modifications which result from hypnotic processes.  This is the more requisite from the fact that, of those who may be relieved and cured by hypnotic processes of diseases which obstinately resist ordinary medical treatment, perhaps not more than one in ten ever passes into the state of oblivious sleep, during the processes which they are subjected to.  The term hypnotism, therefore, is apt to confuse them, and lead them to suspect that, at all events, they cannot be benefited by processes which fail to produce the most obvious indication which the name imports.  (Braid, The Physiology of Fascination, 1853)

Braid comments, “This term [hypnotism] has met with most favourable consideration from many able writers on the subject; still it is liable to this grave objection – that it has been used to comprise not a single state, but rather a series of stages or conditions, varying in every conceivable degree.”  From this much it is clear that he did not think hypnotherapy functioned by means of inducing a single altered state of consciousness, and it certainly did not typically employ any type of state he would be happy referring to as a “hypnotic trance.”

Braid proposed instead to refer to the other 90% of his patients as being in a state of “monoideism” or focus upon a single dominant, expectant idea or image, in a manner designed to evoke the ideo-motor reflex response.  Far from being a state of sleep, unconsciousness, amnesia, or trance, Braid defined what he had previously referred to as “hypnotic therapy” as that therapy which employs focused conscious attention upon a single idea or image accompanied by a sense of confidence and expectation.

I became satisfied that the hypnotic state was essentially a state of mental concentration, during which the faculties of the mind of the patient were so engrossed with a single idea or train of thought as, for the nonce, to render it dead or indifferent to all other considerations and influences. (Braid, 1853)

He wrote, “I feel satisfied that the mental and physical phenomena which flow from said processes [of hypnotism] result entirely from the mental impressions, or dominant ideas, excited thereby in the minds of the subjects, changing or modifying the previously existing physical action, and the peculiar physical action thus superinduced re-acting on their minds.”   Adding, “monoideism will indicate the condition resulting from the mind being possessed by a dominant idea.”  This terminology, however, did not catch on, and to this day hypnotherapists still use “hypnosis” and its cognate terms to refer to the full range of responses found among their clients.  Indeed, Braid himself continued to use the loose terminology of “hypnotism” to refer to his psycho-physiological therapy in general, as in the title of his final manuscript on the subject On Hypnotism (1860).  Though technically incorrect, insofar as it means “sleep”, hypnotism remained a generic label for the technique of focusing attention upon suggested ideas and imagery.

Braid also repeatedly observed that the effect of certain physicalstimuli could be influenced by the mental attitude or expectation of the subject.  Braid therefore coined the term “psychophysiology” to describe the reciprocal inter-action between the mind and body in hypnotic therapy.  Braid’s emphasis upon the role of expectation in shaping responses to physical sensations can be seen as a precursor of the modern notion of “cognitive mediation”.  Moreover, Braid’s inter-active “psychophysiological” method of hypnotherapy involved the use of both “dominant, expectant ideas” and “muscular suggestion.”  By fixating attention upon a dominant idea, Braid helped the client to induce physical responses in their body.  By contrast, in a reversalof this apparent causal sequence, by modifying the client’s facial expression, posture, and gestures during hypnotic therapy, Braid induced corresponding subjective changes in attitudes and emotions.  In the terminology of modern cognitive-behavioural hypnotherapy, these interacting psychophysiological methods would be referred to as “cognitive” and “behavioural” strategies respectively.  They constitute two complementary channels of suggestion or autosuggestion in hypnotherapy.

It is an interesting coincidence that the terms “ideo-motor” and “psycho-physiology” bear a striking resemblance to the modern expression “cognitive-behavioural.”  Indeed, Braid’s mature theory of hypnosis emphasised very similar factors to the modern “cognitive-behavioural” theory developed by Barber and his colleagues.  Braid, the founder of hypnotism, never used the expression “trance” to describe the state of mind responsible for the effects of suggestion.  (He reserved the word “trance” to describe a tiny percentage of exceptional subjects who could be induced into a state of extremely profound relaxation, a death-like state superficially resembling a coma.)  Like Barber, and subsequent cognitive-behavioural theorists in the field of hypnosis research, Braid emphasised the role of ordinary social, cognitive, behavioural and physiological factors in accounting for the effects of hypnotism.

Cognitive-Behavioural Hypnotherapy & CBT

 In the Handbook of Cognitive-Behavioural Therapies, Keith Dobson explains the ambiguity of the terminology as follows,

One of the basic questions raised in the first edition of this volume [thirteen years earlier] was that of what constitutes a “cognitive-behaviouraltherapy”.  This question is still valid today, and when I speak with others, it is not at all unusual to have someone ask about the difference among behaviour therapy, cognitive therapy, and cognitive-behavioural therapy.  Indeed, with the development of approaches such as schema-focused cognitive therapy and constructivist therapy, I continue to question myself on the conceptual limits of the field.  Broadly speaking, my perception is that in order for a treatment to be accurately labelled a cognitive-behavioural therapy, it must be based on the mediational model.  A therapist using this model is presumed to make the assumption that cognitive change will mediate or lead to behavioural change.  Furthermore, cognitive-behavioural therapy rests on a pragmatic concern on the therapist’s part about the client’s adaptive (i.e., behavioural) functioning.  Cognitive-behavioural therapists therefore use treatment methods to effect cognitive change in the service of behavioural change; furthermore, in order to assess their outcomes, both cognitive and behavioural (and in most instances emotional) assessment is required. (Dobson, 2001: xii)

Cognitive-behavioural therapy (CBT) is therefore a relatively broad church, encompassing a certain amount of diversity in both theory and practice, and there exists some ambiguity over its boundaries, which even experts like Prof. Dobson define loosely.

As we have seen, modern nonstate approaches to hypnotherapy have been widely described as “cognitive-behavioural” since the early 1970s.  They do, as Dobson requires, place central emphasis upon the mediating role of cognitive factors in determining behavioural (and affective and physiological) responses to stimuli.  These cognitive factors include role-perception (Sarbin & Coe), attitudes and beliefs regarding hypnosis (Barber), specific cognitive and mental imagery strategies (Chaves, Spanos, Wagstaff), and expectations about their response to suggestion (Kirsch & Lynn).  However, arguably, hypnotherapy has always adopted a cognitive mediation model insofar as its founder, James Braid, specifically attributed the effect of physical interventionsto the “dominant, expectant ideas” which the subject adopted towards them, either spontaneously or in response to social influences such as imitation or hetero-suggestion.  Many hypnotists have made their slogan: “All hypnosis is self-hypnosis” following Coue who said “All suggestion is autosuggestion.”  Self-hypnosis and autosuggestion typically take the form of expectation, imagery, and self-talk.  These cognitive constructs are among the primary mediating factors in cognitive-behavioural hypnotherapy.  They are, and have always been, employed primarily in the service of observable behaviour change.

It is true that hypnotherapists originally made minimal use of formal outcome assessment.  This is, I think, true of most psychotherapy conducted prior to the Second World War.  However, since the 1950s they have tended to imitate assessment methods employed in other forms of psychotherapy, including CBT.  In addition, hypnotherapists have traditionally drawn upon a number of tests and scales, derived from empirical research, which are designed to assess hypnotic responsiveness, most notably the Stanford Scale of Hypnotic Susceptibility and similar assessment tools which divide hypnotic responses into cognitive (e.g., hallucination, time distortion) and behavioural (e.g., arm heaviness, eye-closure) categories.  Hypnotherapy is normally expected to commence with a full initial consultation and assessment of the client’s presenting problem and their suitability for treatment, which typically encompasses affective, behavioural and cognitive factors.  Assessment of outcomes in hypnotherapy most typically mirrors traditional behaviour therapy in that it has long (perhaps since before behaviour therapy) employed SUD (subjective units of disturbance) scales to monitor responses to imaginal (in vitro) or situational (in vivo) exposure, etc.

It therefore seems that much of modern hypnotherapy would meet the definitional critieria set forward by Prof. Dobson for classification as a form of cognitive-behavioural therapy (CBT) and that this is, of course, especially true of those approaches to hypnotherapy which deliberately adopt cognitive-behavioural theories of hypnosis.  Moreover, in the case of clinicians and researchers who are influenced by Sarbin, Barber, and other major figures in the study of hypnosis, the terminology and concepts they employ will naturally tend to overlap with those used in CBT.  Similar theories and terminology tend to encourage similar practices to some extent or at least to highlight the existing overlap between techniques which were previously described using different terminology.  For example, hypnotic “regression therapy” was used extensively in the first and second world wars to treat PTSD.  Modern CBT techniques used in PTSD beara striking practical resemblance to certain forms of “hypnotic regression to traumatic events” except that they use the term “imaginal exposure to traumatic events” instead.  It is natural therefore, that modern hypnotherapists influenced by empiricalresearchand best practice would adopt a similar terminology and modify their existing techniques accordingly.  These practical modifications are often relatively minor, and may largely entail a shift of emphasis between existing hypnotherapy techniques, e.g., moving away from older theories of emotional catharsis and placing greater emphasis upon “cognitive restructuring”, formerly referred to by hypnotherapists as rational “re-education”, etc.  There are, of course, specific concepts and interventions found in modern CBT which do not have any parallels in hypnotherapy.  However, these can easily be imported into hypnotherapy just as hypnotherapy techniques (such as relaxation training, aversion therapy, and desensitisation methods) have previously been assimilated into behaviour therapy and CBT.

Indeed, as Weitzenhoffer and others have argued, many of the techniques employed in the field of CBT are predated by similar methods used in hypnotherapy.  In some cases CBT techniques seem to have been directly derived from earlier hypnotherapy methods.  It is not surprising, therefore, that a reciprocal inter-action, a mutual borrowing of techniques, has developed whereby the practice of hypnotic desensitisation, for example, which originally inspired behaviour therapy, has assimilated certain influences from subsequent use of related exposure methods in CBT.  For example, in his recent book Cognitive Hypnotherapy (2009), Assen Alladin, one of the leading researchers in the field of clinical hypnosis, provides detailed treatment protocols for a range of common presenting problems which assimilate best practice from CBT with established theories and techniques from within the field of clinical hypnosis.

Hypnotherapy in the UK is considered a different modality from CBT and each tradition has its own regulations, training standards, and professional associations, etc.  It therefore remains somewhat ambiguous whether the use of cognitive-behavioural hypnotherapy should be classified primarily as a form of CBT or hypnotherapy for accreditation purposes.  There is some disagreement on this matter as both the theory and practice of cognitive-behavioural hypnotherapy appear to overlap both professions.  However, the existence of cognitive and behavioural techniques in hypnotherapy, and cognitive-behavioural theories of hypnosis, largely predates the development of CBT as a profession and was historically considered to be part of the study of clinical hypnosis.  My own conclusion, therefore, is that cognitive-behavioural hypnosis is very much an integralpart of the history hypnotherapy and a central sub-modality of modern hypnotherapy, albeit one very closely-related to modern CBT and drawing upon certain elements of its theory, practice, and research.  However, it clearly draws to a far greater extent upon a much longer tradition of theory, practice, and research native to the field of hypnosis.  In focusing upon the historical context, I have not had space to discuss in any detail the various modern variations of cognitive-behavioural theory in hypnosis but these continue to develop, and influence clinical applications independently, to some extent, of the parallel developments in CBT.

About the author

Donald is a writer and trainer, with over twenty years’ experience. He’s a specialist in teaching evidence-based psychological skills, and known as an expert on the relationship between modern cognitive-behavioural therapy (CBT) and and classical Greek and Roman philosophy. Donald is the original founder of The UK College of Hypnosis & Hypnotherapy, setting up in 2003 under the name Hypnosynthesis. Donald developed the evidence-based hypnotherapy approach taught in the College. He also has been instrumental in the further integration of hypnosis with CBT - both via the training courses of the College and his publication: The Practice of Cognitive Behavioural Hypnotherapy. He passed the College along to Mark Davis in 2013. He now lives in Canada

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