Hypnosis and cognitive behavioral therapy

It is important to emphasize that hypnosis is above all a catalyst for the strategies and techniques that can be applied in the context of cognitive-behavioral therapy to a specific patient with a particular problem. Hypnosis is not a therapy, so its use will always be subject to functional analysis of the specific case that required intervention with cognitive-behavioral techniques that seemed appropriate.

Psychology has provided interesting samples by applying suggestion and hypnosis. The use of hypnosis has led to the development of theories and techniques that are now commonly used by cognitive-behavioral psychologists. Without going into further detail, Wolpe used hypnosis as a mean to obtain the incompatible response to anxiety in the implementation of systematic desensitization. Schultz' autogenic training is based on the author's previous experience in the field of hypnosis and suggestion. Definitely, the consideration for the study of hypnosis as a technique of behavioral modification is raised by Krasner and Ullman (1965). Hypnosis has been closely associated with the study of systematic desensitization during the sixties (Wolpe and Lazarus used it extensively in their research). Stealth and Ellis have also used hypnosis in their respective therapeutic developments.

The following are some of the behavioral therapy techniques that can be used as a hypno-suggestive catalyst:

• Relaxation training
• Imagination training
• Systematic desensitization imagination
• Imagination saturation
• Covert hypnosis: it has been used preferentially as covert sentimentalization, also as modeling or extinction techniques and positive reinforcements.
• Self-control techniques
• The use of images
• Successive approximations (in person and by imagination)
• Self-instructions and coping strategies: using hypnosis to remember that we have strategies to address problems or facilitate the development of self-instruction programs.
• Training in problem solving and other cognitive processes (stop thinking f.e.)
• Cognitive re-constructing: introduction of self-statements and management of cognitive distortions.
• Rational-emotional therapy from Ellis: Rational-Emotional Hypnosis replacing the inappropriate emotions with appropriate other ones.
• Time projection (Lazarus)
• Habit inversion
• Response prevention

Special to mention are cognitive re-constructing procedures in hypnosis which has received little attention from clinicians in most relevant professional field. More in specific, Araoz (1985) has argued that the "negative hypnosis" or uncritical acceptance and repetition of negative thoughts and images, can be overcome by replacing them with more positive images and adaptive thoughts.

A cognitive re-constructing procedure is similar to hypnosis we all know: detection of distorted and/or irrational thoughts and ideas and self-criticism (as an alternative to how it's done in the usual clinical procedures: suggest under hypnosis that the patient can imagine a problem situation and derive the distorted thinking of it, or more traditionally through self-registration), construction of alternative thoughts and expressions to replace the negative (suggested by the psychologist or by the patient, not just about looking for cognition or allegations but also mental images or scenes that bring a positive change can be useful), implementation of such expressions and alternative constructions and link positive images to the patient's own experience, initially by testing strategies in imagination. All of this can be supported with new suggestions that reinforce the "positive role." It is also suggestive for the patient to establish relations between automatic negative images and positive images or positive reciting.

Ordi González and Miguel Tobal (1993) conducted a review of the aspects that contribute to the use and empowerment of hypnosis techniques as an added value to other techniques used within the framework of cognitive behavioral therapy:

The use of suggestion

Virtually all of the phenomena described in hypnosis are related to some form of direct or indirect suggestion. Most hypnotic suggestibility scales are based on the implementation of standardized hypnotic induction techniques and administration of various tests using the suggestion, a concept that has been used in two ways: as a variable of the procedure (hypnotic instructions) and as subject variables (suggestibility). This interesting pairing is of great interest not only to better understand the so-called hypnotic process, but could also make a valuable contribution to the design of cognitive-behavioral programs in various clinical areas mainly in two ways: (1) consider the degree or level of suggestibility as a moderator variable, including the effects of various techniques of behavior therapy and (2) use the degree or level of suggestibility as a criteria for choosing one or other intervention strategy. (González Ordi and Miguel Tobal, 1993).

Focus on the imagination

Tellegen (1978/1979) considers the ability to be hypnotized and the ability to respond imaginatively on participatory situations or states suggested as if the experience were real.

The use of relaxation instructions

Much of the techniques handled by cognitive-behavioral psychologists involve the use of relaxation strategies (f.e., systematic desensitization, covert conditioning, stress inoculation, etc.).. Any relaxation technique can be facilitated by hypnosis. Although most authors agree that there is no difference in effectiveness between relaxation procedures applied in isolation and under hypnosis, relaxation in the use of hypnosis seem to have more advantages: a) the speed with which the results are satisfactory, especially when post-hypnotic suggestions is used (in a session) and b) it does not imply the need for a patient to already have previous training (Fernández-Abascal, 1979). Techniques such as autogenic training from Schultz (1959) are a variation on these hypnotic procedures.

The modification of attitude, expectations and motivation towards the task.

The belief in hypnosis leads to hypnosis (Kroger, 1963). Any therapeutic intervention strategy must manage and handle certain expectations and attitudes towards "behavioral change", this management of expectations and positive attitude of the patient is often reinforced by using hypnotic strategies. Many researchers have focused their clinical and experimental research on the management of patient expectations (Barber, Dalal and Carverley, 1968; Wedemeyer and Coe, 1981; González Ordi and Miguel Tobal, 1992; Lazarus, 1973 and others).

Ordi González and Miguel Tobal (1993) support a harmonic relationship between the techniques of hypnosis and behavioral therapy, especially at these application levels of the techniques:

• To apply techniques for the modification or determination of behavior: psycho-physiological responses, psychosomatic disorders, direct suggestions, etc.
• To encourage self-control techniques and change in expectations and attitude towards problem-situations: post-hypnotic suggestions, training skills, increase self-efficacy and self-esteem, cognitive strategies.
• To apply other technical and cognitive-behavioral techniques: undercover conditioning, systematic desensitization, relaxation, etc.