Cognitive Hypnotherapy For Depression – How Effective Is It?
In my last blog I wrote all about the evidence for the anti-depressant effect of exercise on those with clinical depression (you can read that here: Depression: Does aerobic exercise have anti-depressant effects?). The overall conclusions suggest that, with depression, it makes sense to include some active exercise components in your treatment plan.
In this post I’m going to be looking at the effectiveness of cognitive hypnotherapy to help reduce symptoms of depression. Hypnotherapy can help in many ways with the psychological aspects of depression, including motivation and tackling rumination, anxiety and worry.
We are going to be looking at a study that compared the effects of cognitive behavioural therapy (a well established treatment for depression) with clinical hypnotherapy to empirically investigate the additive effect of hypnosis in the management of chronic depression.
But before we get onto that, if you needed any more evidence on top of my previous post (about exercise and depression) that exercise lifts the mood and makes you feel better then look no further that this recent photo of me at bootcamp!!! Say cheese!
(I haven’t found anything in the research that putting a cheesy grin on your face enhances the positive benefits but hey, it works for me!)
Cognitive Hypnotherapy For Depression
As mentioned above, the research by Alladin & Alibhai (2007, full reference below), set out to investigate the effectiveness of cognitive hypnotherapy combined with cognitive behavioural therapy on depression.
If the concept of combining hypnosis with cognitive behavioural therapy seems familiar, it may be because I’ve written about it a number of times before. In previous articles I’ve mentioned the analysis carried out by Kirsch et al. (1995) that found a significantly larger effect when cognitive behavioural therapy was combined with hypnosis (when compared to the same treatment without hypnosis). Here, we are looking at comparing the effects of cognitive behavioural therapy with cognitive hypnotherapy to empirically investigate the additive effect of hypnosis in the management of chronic depression.
The outcome measures consisted of the Beck Depression Inventory which is a self-reported questionnaire used to evaluate your depression. It covers aspects such as whether you feel sad, hopeless about the future or a failure as a person (you can easily find a full copy of the depression inventory online).
Ninety eight chronic outpatient depressives were randomly assigned to either cognitive behavioural therapy with hypnosis or the same treatment without hypnosis.
Amongst the aspects of the hypnosis used in this research was something called the ‘positive mood induction’ and I mention it here because it can be a useful little process that I think anyone can benefit from, whether or not they carry it out within hypnosis. It’s a way of switching from negative thoughts, worry and rumination and switching instead to more pleasant and positive thoughts.
As the authors describe it, this “involved making a list of 10 to 15 pleasant life experiences, and to “practice holding each experience in your mind for about 30 seconds.” The patient was encouraged to practice with the list four or five times a day and to get into the habit of switching off from ruminative negative thoughts or experience and to “replace them with one of the pleasant items from your list.” This procedure provided a technique for weakening depressive pathways and strengthening “happy pathways.” In other words, the patients learned to substitute negative cognitions...”
So rather than habitually focusing on negative thoughts and strengthening those mental pathways, here you interrupt that flow of thinking and redirect it to more positive, beneficial thoughts. And in the same way the unwanted thoughts become habitual through repetition, so the more helpful thinking can become more habitual in the same way through deliberate practice.
Effective Depression Treatment
Of course, what we really want to know are the results of this research that compared cognitive hypnotherapy with cognitive behavioural therapy.
Alladin and Alibhai found that both treatments of clinical depression produced “a significant reduction in depressive symptoms at the termination of treatment and during follow-ups.” However, the results also demonstrated that adding hypnosis to cognitive behavioural therapy has an additive effect. The effect size for cognitive hypnotherapy was “significantly larger both at the end of the intervention and during 6- and 12-month follow-ups.”
Or in other words, cognitive behavioural therapy is effective for the treatment of depression but cognitive hypnotherapy produces even better results in reducing the symptoms of depression.
There are many possible reasons for the greater clinical improvements from cognitive hypnotherapy for depression.
As many people with depression also experience anxiety, elements of the hypnotherapy that included relaxation could have helped reduce that anxiety. Indeed, in my experience, reducing the stress and worry elements of depression can make it much easier to tackle the other elements of depression. Sometimes with purely cognitive approaches the difficulty becomes that the fear, anxiety, stress and worry are so great that it is difficult to think clearly or to learn new ways of dealing with things. By learning how to become more mentally calm and physically relaxed, someone with depression will find it much easier to change thinking patterns and introduce more beneficial ways of thinking, feeling, acting and reacting.
The researchers also point out that there may also be a placebo effect, in that someone utilising hypnosis may have created a positive expectancy. In the context of therapy, anything that creates such a positive expectancy of beneficial change is a great thing.
And as mentioned above, techniques that tackle ruminating are a key part of reducing the experience of depression. “Individuals who ruminate a great deal in response to their sad or depressed moods have more negative and distorted memories of the past and feelings about the present or future. These ruminators or moody brooders then become increasingly negative and hopeless in their thinking, resulting in protracted depressive symptoms.”
Techniques that focus on more positive aspects, whether in the way described above or by focusing on expressing gratitude (something I’ve written about and described in previous articles and that has a very strong evidence base), counters that ruminating and helps develop different thinking pathways the more it is practiced. If nothing else, it reduces the time and energy available for worry and ruminating, and that can only be a helpful thing.
There are many other facets of cognitive hypnotherapy that can help alleviate the symptoms of depression (as well as other factors like utilising exercise). “Hypnosis provides a broad range of short-term techniques, which can be easily integrated with CBT to enhance treatment outcome.”
This study I am referring to here clearly demonstrates the superiority of cognitive hypnotherapy over cognitive behavioural therapy in the management of clinical depression. “The study clearly shows that the addition of hypnotherapy – an extra component to CBT, which largely focuses on changing behaviours and automatic thoughts – enhances treatment outcome.”
Given the often debilitating nature of clinical depression and the ever increasingly levels of people who are affected, it makes sense to make use of the most effective treatment available. This research clearly demonstrates the additive effect of clinical hypnotherapy in achieving those depression treatment outcomes. Certainly I’ve found that cognitive hypnotherapy can transform the experience of my own clients.
Depression doesn’t only impact on the individual; it affects their family, friends, colleagues and the ripples can spread throughout all spheres of their lives. Some people are able to function and even keep their inner turmoil secret from those around them; others simply withdraw and struggle to even get out of bed each day. The evidence really shows that depression symptoms can be reduced and I really hope that more and more people will find that they are able to access the treatment they need that allows them to feel better and to take back control over their thoughts and feelings.
To your success,
Hypnotherapy in Ely & Newmarket
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Alladin, Assen, and Alisha Alibhai. “Cognitive hypnotherapy for depression: An empirical investigation.” Intl. Journal of Clinical and Experimental Hypnosis 55, no. 2 (2007): 147-166.
Kirsch, Irving, Guy Montgomery, and Guy Sapirstein. “Hypnosis as an adjunct to cognitive-behavioral psychotherapy: A meta-analysis.” Journal of consulting and clinical psychology 63, no. 2 (1995): 214.