Clinical Use of Hypnosis in CBT by Robin A. Chapman

Author:Robin A. Chapman
Format: epub
Published: 2014-07-23T04:00:00+00:00

CASE STUDIES

Case 1: Janet

Janet, a 45-year-old housewife and mother of two teenage children, was referred by a psychiatrist to the author for CBT. Janet had been depressed on and off for over 12 years. She had been under the care of a psychiatrist for 4 years. She had trials of various antidepressants but showed no significant improvement. Because Janet felt “very negative about everything,” her psychiatrist strongly recommended CBT.

Janet met the DSM-IV criteria for a recurrent moderate major depressive disorder and generalized social phobia. She scored in the severe range on the BDI-II and the BAI, and her score on the BHS was in the moderate range. She expressed low self-esteem and lack of confidence, and presented extensive cognitive distortions (see Session 1: Clinical Assessments). Moreover, she felt guilty for not being a good mother to her children. Her score on the BSS was in the highly susceptible range.

From the information available, it was concluded that her symptoms of depression and social anxiety were to a large extent maintained by her negative cognitions. Based on the history and assessment, the following sequential course of treatment was planned for Janet.

• Continue follow-ups with her psychiatrist as she was still on an antidepressant

• CBT for restructuring her negative cognitions

• Hypnotherapy for ego-strengthening

• Hypnotherapy for expansion of experience

• Hypnotherapy for demonstration of self-control

• Hypnotherapy for positive mood induction

• Hypnotherapy for anxiety management

• Hypnotherapy to overcome guilt

• Thought stopping and attention switching for countering negative ruminations

• Hypnotherapy for developing anti-depressive pathways

• Behavioral rehearsal under hypnosis (forward projection)

Janet had 16 sessions of cognitive hypnotherapy over a period of 6 months in the sequential stages described below. The treatment was very effective according to her psychiatrist, who decided to wean her from her medications. After the 16 sessions, the author did not follow up Janet as she was followed-up by her psychiatrist. A year after discharge, the author received a discharge letter from the psychiatrist stating that Janet was significantly improved and weaned from medication.

Session 1: First Session Devoted to History Taking and Assessments (See Above)

Sessions 2-6: CBT

It was decided to start Janet on CBT first and later introduce hypnotherapy for affect regulation and anxiety management. She had four sessions of CBT as described under Sessions 3-6: Cognitive Behavior therapy (CBT).

Sessions 7-14: Hypnotherapy

Janet had eight sessions of hypnotherapy spread over a period of 2 months. Although she understood the rationale for CBT and carried out her homework diligently, she still complained of symptoms of anxiety and depression, indicating that she still “felt empty inside her.” The hypnotherapy sessions were therefore structured to provide as much of an experiential focus as possible (expansion and amplification of positive affect). The six reasons for using hypnosis

with depression, as articulated by Yapko (1992), were fully utilized with Janet (see Hypnosis as a Treatment for Depression). The hypnotherapy sessions consisted of:

• Ego-strengthening: The ego-strengthening suggestions were tailored to counter Janet’s rumination with NSH (negative self-hypnosis). The Enhancing Positive Affective Experience technique of Brown and Fromm (1990) (see Hypnotherapy for Expansion of Experience) was used to amplify and expand Janet’s range of positive experiences.

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