Hypnosis and cognitive behavioral therapy are both proven, effective treatment methods for a wide range of situations. But did you know they can be combined for even better client outcomes?
Let's explore the uses of cognitive behavioral therapy, hypnosis, and how they can be used together.
What Is Cognitive Behavioral Therapy?
Cognitive behavioral therapy (CBT) is a type of psychotherapy that helps patients work with the thoughts and feelings that influence their behaviors.
It's commonly used to treat a wide range of disorders including phobias, addictions, depressive symptoms, and anxiety.
CBT can also be used in medical interventions to help manage chronic physical symptoms such as chronic pain or irritable bowel syndrome.
Is CBT a talking therapy? Yes.
CBT is based on the idea that it's not events themselves that upset us, but the meanings we give them. Cognitive behavioral therapy can reduce symptoms of mental health problems as well as run-of-the-mill daily problems by helping people to change their thinking about a situation.
This in turn changes the way they feel, and consequently behave.
What's The Difference Between Behavioral Therapy, Cognitive Therapy And Cognitive Behavioral Therapy?
Cognitive behavioral therapy focuses on our thoughts and their effect on our emotions and behaviors. Whereas cognitive therapy emphasizes decreasing psychological distress, cognitive behavioral therapy works to improve behavior as well as distress.
There's also behavioral therapy, which focuses on (you guessed it), changing behavior. Behavioral therapy may help a client change how they feel by changing how they act.
In this article, we're focusing on cognitive behavioral therapy, and how it works with hypnosis.
Cognitive Behavioral Therapy:
Example Of Meaning Affecting Thoughts, Which Affect Feelings, Which affect Behaviors
A person with a fear of flying is on an airplane and they hear a clunking noise while on the tarmac, before the flight. They interpret the noise as something being wrong with the plane, and that the plane may crash (this is the meaning they give the noise). Their thoughts may consist of disaster scenarios of the plane crashing and everyone dying. This causes fear and panic and they demand to leave the airplane.
Another person may want to stop smoking. They try, but soon experience a craving and have a cigarette. They then have internal dialog that goes, "These things are addictive. I'll never be able to quit." In this case, the meaning is that one slip-up means that they are addicted and can not stop smoking. They then feel unmotivated and give up.
Cognitive behavioral therapy helps us to become conscious of our thoughts and how they affect us. We can, with effort and practice, replace the thoughts that are causing problems, with thoughts that leave us feeling more resourceful. This cognitive restructuring can help us generate more effective behavioral choices.
What Is Hypnotherapy?
Hypnotherapy focuses on the subconscious, or unconscious mind.
One way to understand this concept is to think about how we learn a new skill (or behavior).
When we learn a new skill, we practice it consciously. We are aware of each step of the process we are learning, and we are intentional about carrying out the elements.
After some time and replication, we have learned the skill. We then begin to "just do it". In other words, after we become skilled, the behavior becomes automatic and the details may drop out of consciousness.
The subconscious handles automatic, learned behaviors.
This includes not only skills, but emotions, habits, and the large percentage of our thoughts that exist below the level of consciousness, like the submerged part of an iceberg.
Hypnotherapy works with the subconscious mind with the aim of changing habitual patterns, including emotional and behavioral responses, for the good of the client. In this way, hypnosis can be used as a main or adjunct treatment for depressive symptoms, performance anxiety, negative thoughts, anxiety disorders, stress disorders, and more.
Medical hypnosis can also be used for direct symptom relief, as well as distress caused by various chronic health conditions and diseases involving chronic pain or other symptoms.
Hypnosis may be able to help with pain control and pain management, irritable bowel syndrome (and other gastrointestinal disorders), functional dyspepsia, symptom relief for cancer patients, fibromyalgia sufferers, and lots more.
Cognitive Behavioral Therapy As An Evidence-Based Approach
In the US healthcare system, there are financial pressures on insurance companies and managed healthcare systems. It's a terrible and expensive system, but one positive outcome has been the focus on evidence-based therapies.
These organizations are unwilling to pay for therapy that doesn't work. So there has been plenty of science over the years showing that cognitive behavioral therapy techniques work.
Hypnosis And CBT For Mental Health Issues
Efficacy of Hypnosis on Dental Anxiety and Phobia: A Systematic Review and Meta-Analysis
Here are a couple of quotes from the pubmed abstract.
"the results of the systematic review are promising in that hypnosis can also be regarded as powerful and successful method for anxiety reduction."
"CBT delivered in a variety of formats, including one-session treatment, showed the most evidence for the efficacy of reducing anxiety."
Medical Hypnosis And CBT
Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis.
A quote from the Pubmed abstract.
"After completion of therapy, among trials recruiting only patients with refractory symptoms, group CBT and gut-directed hypnotherapy were more efficacious than either education and/or support or routine care . . ."
"CBT-based interventions and gut-directed hypnotherapy had the largest evidence base and were the most efficacious long term."
Psychological interventions for needle-related procedural pain and distress in children and adolescents.
From the author's conclusion from the Pubmed abstract.
"We identified evidence supporting the efficacy of distraction, hypnosis, combined CBT, and breathing interventions for reducing children's needle-related pain or distress . . ."
Note that this analysis contains some low-quality data, a situation the study acknowledges.
The Additive Benefit of Hypnosis and Cognitive-Behavioral Therapy in Treating Acute Stress Disorder.
I found this study on APA Psyc.net (The American Psychological Association) via Google Scholar. It states:
" fewer participants in the CBT and CBT-hypnosis groups met criteria for posttraumatic stress disorder at posttreatment and 6-month follow-up than those in the SC group. CBT-hypnosis resulted in greater reduction in reexperiencing symptoms at posttreatment than CBT."
In other words, CBT + hypnosis resulted in less PTSD, and fewer symptoms after the treatment, as compared to cognitive behavioral therapy alone.
Complementary treatment comparison for chronic pain management: A randomized longitudinal study
"In chronic pain, it seems that the effect of cognitive-behavioral therapy (CBT) is boosted when it is combined with hypnosis."
Randomized controlled trial of the Valencia model of waking hypnosis plus CBT for pain, fatigue, and sleep management in patients with cancer and cancer survivors
"They (cancer patients and cancer survivors) reported significantly greater improvement after receiving the active treatment relative to the control condition in all the outcome measures."
For cancer patients and survivors, treatment gains remained stable.
Cognitive-behavioral therapy plus hypnosis to reduce emotional distress associated with radiotherapy for breast cancer: A randomized trial
"Results revealed significant benefits of CBTH on emotional distress at the midpoint (d=0.54), the conclusion (d=0.64), and four weeks following the conclusion (d=0.65) of radiotherapy (all ps < .05)"
CBTH stands for cognitive behavioral therapy plus hypnosis. Cancer patients undergoing CBTH experienced lower levels of emotional distress at all phases of the study.
According to the American Psychological Association, there's evidence that hypnosis works. Referencing a study published in the journal Gut ( a monthly peer-reviewed medical journal on gastroenterology and hepatology), regarding irritable bowel syndrome, they say . . .
"Fifty-eight percent of the men and 75 percent of the women reported significant symptom relief immediately after finishing treatment."
How Long Does A CBT Treatment Course Last?
CBT is a short-term therapy that usually involves ten to twenty sessions. Each session is usually an hour, although they can range from 30 to 90 minutes, depending on the therapist.
The therapy is highly structured, and the therapist often assigns homework for the patient to complete between sessions.
Overall, CBT is a highly effective treatment for a variety of mental health issues, and its efficacy is backed by substantial clinical research.
CBT involves the following steps:
- Identifying troubling situations, thoughts, feelings, and behaviors: In the initial sessions, the therapist may start by asking you what you want to work on. The therapist will help you identify the issues that cause distress and figure out your goals for therapy.
- Gaining awareness of your thoughts, emotions, and beliefs about these problems: Once you've identified your problems, the therapist will encourage you to share your thoughts about them. This may include what you tell yourself about an experience (your "automatic thoughts"), your beliefs about yourself and the world, and your "rules" for living.
- Identifying negative or inaccurate thinking: To help you recognize patterns of thinking and behavior that may be contributing to your problem, your therapist may ask you to pay attention to your physical, emotional, and behavioral responses in different situations.
- Reshaping negative or inaccurate thinking: Once you recognize your problematic thinking, the therapist will help you question this thinking. This step involves asking you to challenge your own thoughts, which can help you change the pattern of negative thinking to more positive and accurate thoughts.
Cognitive Behavioral Play Therapy Techniques
CBT can be used with children. The play techniques below are not limited to children but are often used with them.
Cognitive Behavioral Play Therapy (CBPT) techniques include:Reinforcement: Rewards promote desired behaviors.
- Role-playing: Children rehearse responses to difficult situations.
- Storytelling: Enables indirect expression of thoughts and feelings.
- Art therapy: Children express complex emotions through art.
- Board games: Used to teach skills like impulse control and patience.
- Sand tray therapy: Child's play provides insight into their emotions.
- Modeling: Therapist shows appropriate behavior.
- Relaxation and Imagery: Techniques to manage anxiety and stress.
These methods help children recognize and manage their feelings and thoughts.
The Challenge With CBT
From a hypnotherapist's viewpoint, there's a challenge to benefitting with cognitive behavioural therapy. CBT is focused on conscious thought and behavior.
As hypnotherapists, we know that people are often not aware of their thought patterns and beliefs.
Therefore, many of the blocks and challenges we face as human beings tend to exist at deeper levels than conscious thought. A therapy that focuses only on the conscious mind may not reach the root of a problem.
In CBT, beliefs and patterns are brought to our conscious attention and then we consciously make efforts to change them. Hopefully, after some repetition, the new patterns and thoughts become second nature. In other words, they become automatic, subconscious thoughts.
We can use the analogy of wanting to make changes in the way a hotel operates. We can tell the desk clerk what the problem is. If we bother the desk clerk enough, they may tell the manager, and the manager might do something about it.
Well, why not talk directly to the manager?
The unconscious mind, or subconscious mind, is where these automatic thoughts, habits and emotions reside and are maintained. Talking to the conscious mind is one way to get to them, but not the most direct way. Hypnosis works at the level at which the problems exist.
And that's one reason a hypnosis/CBT hybrid can be effective.
In addition, both CBT and hypnosis techniques can help change the meaning of an experience, thus reducing pain, stress and depressive symptoms. In addition, medical hypnosis for pain control can provide actual decreased levels of pain signals reaching the brain.
Clinical hypnosis modulates functional magnetic resonance imaging signal intensities and pain perception in a thermal stimulation paradigm
"Our observations indicate that clinical hypnosis may prevent nociceptive inputs from reaching the higher cortical structures responsible for pain perception."
Using Hypnosis And CBT Together (Cognitive Hypnotherapy, Or Cognitive Behavioral Hypnotherapy)
The Journal of Consulting and Clinical Psychology published a meta-analysis (a systematic review and analysis of multiple other studies), comparing CBT treatment with and without hypnosis.
They looked at 18 studies covering various therapeutic issues including, public fear of public speaking, weight issues, high blood-pressure and sleep issues.
The meta analysis showed that at least 70% of the clients receiving both hypnosis and cognitive behavioral therapy benefited more than the clients receiving only CBT. This is strong evidence that clients getting both clinical hypnosis and cognitive behavioral therapy do better.
We might call this combination of therapeutic methods cognitive behavioral hypnotherapy (or cognitive behavioural hypnotherapy, as the Brits spell it), cognitive hypnosis, or hypnosis CBT. Since it's a grab-bag of studies, various hypnotic techniques were used -- some being more effective than others.
It's important to note that meta analyses analyze multiple studies. The studies may contain different methods and gather data in different ways. Some may have a control group and randomized controlled methods and controlled trials, and some not. The best meta analyses eliminate studies with dubious methods.
Cognitive Behavioral Hypnotherapy
One way to use hypnosis and CBT together is to use CBT to track, change and manage conscious thought patterns that are getting in the way in a particular context.
Then use hypnosis to step the client into the same context in their imagination, and give them an experience of thinking and feeling differently.
Let's suppose a client is exhibiting depressive symptoms and engages in a common depressive thinking pattern of 'mind reading'. In this pattern the client may imagine that they know what other people are thinking. They may believe that other people don't like them, or are thinking bad things about them in some way.
With cognitive behavioral therapy, we may combat this by calling these thoughts to the attention of the client and considering their accuracy. We may give the client exercises that challenge and change these thought patterns.
With hypnosis, we might take the client to a time when they were neutrally observant, and another time when they felt peaceful and connected to the world, or people around them. Hypnotically, we can have them watch, from a distance, a previous time when they felt people were judging them.
We can suggest they watch the event with the neutral state, and report what they notice. Their thoughts and interpretations will shift. Then we can step them into their own body in the past experience, and have them see it with from this changed perception. We can also suggest they feel peaceful and connected to the world as they do so.
Challenging negative thoughts is often just the beginning of the process.
It's worth noting that the brain is more fully re-wired by a more full, emotionally intense experience. Hypnosis gives the client something pretty close to the real experience but with different emotions and responses than previously. This, combined with practicing new thoughts, is a powerful road to change.
Taking a client repeatedly through similar scenarios while in hypnosis, with the new emotional resources and perspectives, will strengthen the new programming.
We can also use the hypnosis session to reinforce the CBT exercises, in what we might call cognitive behavioral hypnosis, or cognitive behavioral therapy hypnosis. While the subject is in hypnosis, the hypnotherapist might suggest,
"You can easily notice the thought patterns that were causing the old problems, and quickly challenge them with more accurate thinking."
The Uses Of Hypnosis And Cognitive-Behavioral Therapy
- depression and depressive symptoms
- performance anxiety
- negative thoughts
- anxiety disorders
- stress disorders
- direct symptom relief for medical symptoms
- relief of distress cause by various chronic health conditions and diseases involving chronic pain or other symptoms
- pain control
- pain management
- irritable bowel syndrome (and other gastrointestinal disorders),
- functional dyspepsia
- pain management and symptom relief for cancer patients (both symptoms from the disease and from various treatments)
- acute stress disorder asd
- PTSD (post-traumatic stress disorder)
Final Thoughts On Hypnosis And CBT
CBT and hypnosis can be effectively paired as a one-two punch against many mental health and medical issues. Science and anecdotal evidence both support the conclusion that using CBT and hypnosis together can be more effective than CBT alone.
Bottom line: By working with both the conscious and subconscious levels of the mind, we can more thoroughly help folks.