Hypnosis and CBT – A perfect combination

 

Over the past few weeks, we’ve looked at some of the extensive research behind hypnosis.

We’ve looked at evidence showing what it is – and how it works.

We have discussed a number of studies into the range of conditions that hypnosis can help.

Today let’s look at another fascinating piece of research.

What happens when you combine hypnotherapy with another very powerful, evidence-based treatment – one which is extremely popular in its own right.

I’m talking about CBT, or Cognitive Behavioural Therapy.

When used together, do they improve patient results?

Or…. Does something else happen?

Cognitive Behavioural Therapy (CBT)

Before we start, let’s just briefly review what CBT is.

Originally developed by Albert Ellis and Dr. Aaron Beck in the 1960’s, CBT is a short-term therapy designed to manage stress, difficult relationships, grief, Post-Traumatic Stress and other challenges.

Previously, Behaviour Therapy focused on simply changing the client’s behaviour as the key to therapy.  CBT built on that by adding the client’s thoughts, beliefs, judgements and assumptions as targets that could be changed through therapy.

Even more than hypnosis, it has been subject to an enormous amount of research, so it is extremely well-evidenced.

In 2006, the Clinical Psychology Review published one of the most cited studies of CBT – a review of 16 “methodologically rigorous” meta-analyses of the practice.  Altogether it covered 9,995 subjects across 332 studies.

The researchers conclude there is strong evidence to support CBT as effective in treating depression, anxiety, certain phobias and panic disorders, and post-traumatic stress.

CBT is currently a required part of the curriculum in all clinical psychology training programmes and in nearly every psychiatric residency training programme.

The National Institute for Health and Clinical Excellence (NICE) recommends its use for a variety of psychiatric conditions.

Indeed it is the psychotherapy approach that is used most consistently in the NHS, across a wide range of mental health conditions and to aid with stress and anxiety from medical conditions.


Astounding results for CBT+Hypnosis vs CBT alone!

And in 1995, the Journal of Consulting and Clinical Psychology published a groundbreaking meta-analysis, comparing CBT treatment without hypnosis to identical treatment with hypnosis…

…With astounding results.

The evidence was compiled from 18 case studies covering therapy issues ranging from obesity and hypertension to insomnia and public speaking anxiety.

It showed that “the average client receiving cognitive behavioural hypnotherapy benefited more than at least 70% of clients receiving the same treatment without hypnosis.”

Ten years later, the same journal published a study of combined CBT-hypnosis in treating acute stress disorder.

Again, it found that “CBT-hypnosis resulted in greater reduction in re-experiencing symptoms at post-treatment than CBT [alone].”

The researchers concluded that “hypnosis may have use in facilitating the treatment effects of CBT for post-traumatic stress.”

 

How to use hypnotherapy and CBT together

Why do the two treatments work so well together?

Because they are complementary.

The goal of CBT is to help people understand how their thoughts and feelings come together to produce unwanted behaviours or responses.

In CBT, people explore their thoughts, to figure out whether they are rational or helpful.

For example, a client struggling with social anxiety and lack of confidence might look at situations where they typically feel anxious, and consider whether there is any evidence to support the negative way they perceive themselves, or their worries about what might happen.

They will then try to find more helpful, balanced and reasonable ways of considering the situation, and responding to their unhelpful thoughts.

Hypnotherapy takes this process further in interesting ways.

Firstly, when you add hypnosis, most people expect their treatment to have even more impact, and raise their expectations. So that’s an immediate placebo-effect “add-on” to their CBT!

Secondly, clients can quickly experience rapid shifts in the way they feel and think under hypnosis. (“Wow! I was SO relaxed. That was amazing!”)

These shifts create hope and new possibilities in the client’s mind. It changes their belief in the treatment, in the therapist and even about themselves. (“I wonder what else I could experience or achieve?”)

And then thirdly, while in hypnosis, patients rehearse more positive ways of thinking or behaving in situations which challenge them.  They imagine the thoughts, feelings and behaviour they’d like to be experiencing in those challenging situations, as if they were real.

(Actually there are a LOT more reasons why adding hypnosis to CBT improves outcomes over CBT – and especially the “non-state” (non-trance) model of hypnosis that we teach. But let’s keep those in-depth reasons for another article).

 

Practice before going into a stressful situation > new “positive-response-set”

So perhaps our client grappling with social anxiety has a goal of starting a new evening class.

Working together, you would explore more positive ways of thinking and behaving when he attends class.

Then, using hypnosis, you might help him explore what it’s like to fully accept and believe those more positive, helpful ways of thinking.

You might also explore what it would be like for him to behave in a really calm, relaxed, confident way…

…How he can calmly walk into the class, and how a really calm and confident version of himself would greet the other students.
With this method, the client engages in both explicit and “implicit learning.”

He knows intellectually what’s the most effective way to feel, think and behave in that challenging situation.

But he is also given the opportunity to practice the feeling or behavioural change he wants to experience before he’s placed in the stressful situation.

It’s like the difference between a set of instructions on how to ride a bike and the feeling-knowledge-skill of how to ride a bike.
It is an extremely powerful combination.


And more… the power of SWITCHING!

And even more than that… the client can learn how to “switch” from the unhelpful-negative chain of automatic thoughts onto a positive-helpful sequence of thoughts.

While in hypnosis they are guided to experience the negative thoughts and negative response set and then switch to the positive-response-set.

And they can practice this switching again and again under hypnosis.

Until the negative thoughts become the CUE to switch easily to positive helpful thoughts (and the consequent feelings and automatic behaviour that goes with those thoughts… approach behaviours like going up and shaking people’s hands rather than avoiding eye contact – for example)!

So there are some of the reasons why our hypnotherapy diploma teaches you how to use both, together – indeed, how to integrate them nearly seamlessly.

 

Now learn to combine hypnotherapy and CBT yourself

It is the only course I know of, anywhere in the world to focus on Cognitive Behavioural Hypnotherapy – this seamless integration of CBT and hypnosis.

(Which is why you’ll find psychologists from around the world attending this course.)

And it means that graduates of our diploma are not only equipped to deliver the best possible outcomes for patients…..

By being able to combine both these well-known, evidence-based therapies, they also stand out from other hypnotherapists.

That makes them more attractive to potential clients – and also to doctors, dentists, pychiatrists or other health professionals that could refer clients to you.

It’s win-win.

Want to join them?

Our next diploma starts in April.

Discover the details here

Reserve your place now!

Warm regards,

Mark

 

Sources:

 

The empirical status of cognitive-behavioral therapy: a review of meta-analyses.
Butler AC, Chapman JE, Forman EM, Beck AT.
Clinical Psychology Review  – 2006
https://www.ncbi.nlm.nih.gov/pubmed/16199119

Hypnosis as an adjunct to cognitive-behavioral psychotherapy: A meta-analysis. 
Kirsch, I., Montgomery, G., & Sapirstein, G. (1995).
Journal of Consulting and Clinical Psychology, 63(2), 214-220.
https://psycnet.apa.org/record/1995-26166-001

The Additive Benefit of Hypnosis and Cognitive-Behavioral Therapy in Treating Acute Stress Disorder. 
Bryant, R. A., Moulds, M. L., Guthrie, R. M., & Nixon, R. D. V. (2005).
Journal of Consulting and Clinical Psychology, 73(2), 334-340.
https://psycnet.apa.org/record/2005-02854-017

“Why Does Cognitive Behavioral Therapy Work?”
https://www.psychologytoday.com/us/blog/think-act-be/201501/why-does-cognitive-behavioral-therapy-work

“What is Cognitive Behavior Therapy?”
https://beckinstitute.org/get-informed/what-is-cognitive-therapy/

“How Does Cognitive Behavioral Therapy Work?”
https://www.medicalnewstoday.com/articles/296579.php

About the author

Principal and Director of The UK College of Hypnosis and Hypnotherapy. Cognitive Behavioural Hypnotherapist - with practices in Central and North London. Personal website at www.inspiredhypnosis.co.uk

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  • This is mind blowing evidence but I’m at a loss as to why CB hypnosis isn’t used as an evidence based treatment in the NHS? Why has it not been adopted more widely?

  • Hi Sarah, good question.

    Firstly NICE, who puts together the recommendations for NHS, have very high standards in terms of the design of the clinical trials. And most of the studies do not have sufficient rigour to pass that test.
    It should be noted that the hypnotherapy for chronic IBS is recommended by NICE – and should be available under the NHS.
    – And in the United States CBT+hypnosis is (was?) on the list of empirically validated treatments for obesity with the American Psychological Association (APA Division 12).

    For example there was a good study done by Dr Assen Alladin on CBT vs CBH for Depression. With better outcomes for CBH. However there needs to be TWO studies done (Randomised Control Trials) for CBH to really make the list and get attention.

    Basically we need more high quality research with good size samples (not 12 people in study but 120!)

    Secondly, training for hypnotherapy has been poorly standardised and regulated. Where to send someone to get trained? Moreover serious researchers can’t even agree what is hypnosis. Which creates even more fractures in the field.
    The profession is simply not very together. Which prompts caution from the NHS.

    That being said the NHS does regularly fund psychologists to take the Diploma we offer. Every year we have probably 3-4 NHS psychs take the training. Usually not mainstream Clinical Psychologists but those working in Neuropsychology or pain management or, for example, supporting children during difficult clinical procedures.