Hypnosis & Applied Relaxation (AR) – January Research Snippet

Posted on 16th January, 2011 by Donald Robertson

Hypnosis & Applied Relaxation (AR)

January Research Snippet by Donald Robertson, NCH Research Director

This month’s snippet is a bit of a change again: a slightly longer article providing the whole outline of a modern evidence-based behaviour therapy for anxiety, which is well-suited to be assimilated into hypnotherapy. People often ask “Why isn’t there more research on hypnosis?” In fact, the people who ask this, in my experience, never seem to have read (or even heard of) the main research journals in the field of hypnosis (IJCEH, AJCH, and Contemporary Hypnosis) and are unaware that there’s actually an awful lot of research on hypnosis, arguably more than on any other psychological therapy, apart from cognitive-behavioural therapy (CBT). However, one of the problems facing hypnosis researchers is that methods of hypnotherapy are too messy, eclectic and complex to be well-suited to good research design. It helps build an evidence base if a treatment is “manualised” and can be described in a guide so that other researchers can replicate it in independent studies. Hypnotherapists tend to do lots of strange things with clients, making it difficult to isolate which “bits” are effective and which bits are redundant. Modern research on psychological therapies is constantly evolving and improving in quality. Protocols for therapies tend to have become simpler in order to facilitate the process of research.

A well-known example is the “Applied Relaxation” protocol developed in Sweden by the psychologist Lars-Goran Öst, currently a professor at the University of Stockholm, and his colleagues (Applied Relaxation: Description of a Coping Technique and Review of Controlled Studies, 1987). It developed out of Edmund Jacobson’s Progressive Muscle Relaxation, Wolpe’s Systematic Desensitisation, and a variety of “coping skills” approaches to anxiety management that evolved in the 1970s. The following account is based on Öst’s original protocol and the self-help version published by Davis et al. (Davis, et al., 1995 pp. 65-74; Applied Relaxation: Description of a Coping Technique and Review of Controlled Studies, 1987). Although essentially a form of modern behaviour therapy, Applied Relaxation has also been used in combination with cognitive restructuring as part of a cognitive-behavioural therapy (CBT) approach.

Applied Relaxation is of interest to hypnotherapists because it consists of a very simple treatment protocol employing relaxation coping skills, which has been adapted for use with a range of problems, and supported by a number of well-designed research studies. It has met critical appraisal criteria for being classed as an Empirically-Supported Treatment (EST) for panic disorder and research has also supported its efficacy in the treatment of generalised anxiety disorder (GAD) and, to some extent, for specific phobias, headache, pain, epilepsy, tinnitus, and other conditions. It’s also been recommended for general management of worry and stress, i.e., for subclinical problems.

I think this protocol would be of interest to hypnotherapists because the method closely resembles “hypnotic desensitisation” (Wolberg, 1948; Wolpe, 1958) and it provides a good example of how a simplified hypnotherapy treatment protocol could be developed for use in treatment outcome research. When reading the description below, just consider replacing the Jacobson tension-release relaxation method with self-hypnosis training in suggested relaxation and (I hope) it should be easy for hypnotherapists to see how this coping skills framework can be directly modified and transformed into a simple behavioural hypnotherapy method for anxiety.

Overview of the Applied Relaxation (AR) Protocol

The full text of a journal original article by Prof. Öst describing the method in detail is currently available online at this link.

Components of Applied Relaxation

In brief, Applied Relaxation begins with training in Progressive Muscle Relaxation, which is gradually developed into a cue-controlled relaxation coping skill, and systematically applied during in vivo exposure to feared situations. The original protocol takes about 10-12 sessions, following assessment, and the specific stages of treatment are as follows,

Assessment, formulation, and self-monitoring, which Öst seems to imply takes 2-3 sessions prior to training
Progressive Muscle Relaxation, lasting 2-3 weeks/sessions
Release-only relaxation, lasting 1-2 weeks/sessions
Cue-controlled relaxation, lasting 1-2 weeks/sessions
Differential relaxation, lasting 1-2 weeks/sessions
Rapid relaxation, lasting 1-2 weeks/sessions
Applied relaxation (application training), lasting 2-3 weeks/sessions
Maintenance

1. Assessment & Formulation Phase

The full protocol begins with behavioural analysis and self-monitoring, usually carried out over three weeks. Clients are asked to begin during the first week by recording their experiences on a very simple self-monitoring form that contains the following three headings: Date, Situation, and Intensity (rated 0-10). In the second week, a column is added headed “Reaction (What did you feel?)”, and finally, in the third week, a column is included headed “Action (What did you do?”). The final self-monitoring form, therefore contains headings as follows,

Tension Self-Monitoring Record

Date/Time

Situation

Reaction

(What did you feel?

Focus on the earliest signs.)

Intensity

(0-100%)

Action

(What did you do?)

Öst introduces clients to a three-system conceptualisation model of anxiety (or stress) that distinguishes between physiological sensations, behaviour, and cognitive (subjective) responses. The emphasis of assessment and conceptualisation is on helping the client spot the signs of stress, especially the earliest stages of the response developing. This tends to particularly involve identifying common physiological sensations, such as muscles tensing or heart rate increasing, and environmental antecedents such as typical events or situations that are associated with elevated stress. Öst recommends presenting the treatment rationale to clients as follows,

One good way of breaking this development [of anxiety] is to focus on the physiological reactions and learn not to react so strongly. The method we are going to use to achieve this is called applied relaxation. The aim of this technique is to learn a skill of relaxation, which can be applied very rapidly and in practically any situation. This skill can be compared to any other skill, e.g. learning to swim, ride a bike, or drive a car, in that it takes time and practice to learn, but once you have mastered it you can use it anywhere. You are not restricted to the calm and non-stressful situation in my office or your own home. The goal is to be able to relax in 20-30 sec and to use this skill to counteract, and eventually get rid of, the physiological reactions you usually experience in phobic situations. To achieve this we are going through a gradual process starting with tensing and relaxing different muscle groups. This takes about 15 min, and you are to practice it twice a day. Then we start to reduce it by taking the tension part away, just relaxing, which takes 5-7 min. The next step teaches you to connect the self-instruction “Relax” to the bodily state of relaxation. Then we teach you to do different things while still being relaxed in the rest of your body, and also relaxing while standing and walking. After that it is time for the rapid relaxation, which you practice many times a day in non-stressful situations. Finally, you reach the stage of applying the skill in phobic situations, and I will take you to different anxiety arousing situations coaching you how to apply the relaxation at the first signs of anxiety in these situations. Applied relaxation is thus a skill that most people can acquire with the right instructions and a lot of practice. It is a “portable” skill that can be used in almost any situation and is not restricted to phobias, but can be used in other situations, e.g. when having problems in falling asleep. (Applied Relaxation: Description of a Coping Technique and Review of Controlled Studies, 1987)

2. Coping Skills Training Phase

2.1 Progressive Muscle Relaxation

The first phase of actual Applied Relaxation training consists of Jacobson’s Progressive Muscle Relaxation technique, which Öst derives directly from the abbreviated approach introduced by Wolpe and Lazarus as part of Systematic Desensitisation (Wolpe, et al., 1966; Jacobson, 1938). This training is divided across the first 2-3 sessions, the first of which focuses on relaxing the head and arms (hands, arms, face, neck, and shoulders), to which are added, in the second session, relaxation of the torso and lower body (back, chest, stomach, breathing, hips, legs, and feet). In Öst’s version, each muscle group is tensed for only five seconds, much abbreviated from Jacobson’s original method, followed by 10-15 seconds of relaxation. In Jacobson’s original approach, the aim is to learn to keep relaxing the rest of the body while tensing individual muscle groups, i.e., to only tense the muscles you’re deliberately using, which helps create a bridge to the “differential relaxation” stage (Jacobson, 1938). At the end of the procedure, the client rates their level of tension on scale (0-100%), similar to a traditional SUD scale, where zero means absolute relaxation and 100% means maximum tension – the same self-rating scale used during homework. Although people do normally find it easier to relax when lying down, training begins in a seated upright position, as the purpose is to develop a coping skill that will generalise to situations where the client is physically active. The same relaxation routine is to be practised twice daily for homework, sessions typically lasting about 15-20 minutes, with each recorded on a homework form for review during sessions.

Relaxation Homework Record
Date/Time	Component(Technique)	Tension Before(0-100%)	Tension After(0-100%)	Duration(Minutes)	Comments(Any difficulties?)

2.2 Release-only Relaxation

The next phase of Applied Relaxation, like the original Progressive Muscle Relaxation approach, focuses on “release-only relaxation” training for an additional 1-2 weeks. In this phase, the initial tensing of muscles is omitted, some basic skill having been acquired in closely studying the contrasting sensations of tension and relaxation. This also means a reduction in the time taken to induce relaxation from 15-20 minutes to 5-7 minutes. The therapist verbally prompts the client to “Breathe with calm, regular breaths and feel how you relax more and more for every breath… Just let go… Relax your forehead… eyebrows… eyelids… jaws… tongue and throat… lips… your entire face…”, etc. (Applied Relaxation: Description of a Coping Technique and Review of Controlled Studies, 1987). The client then scans their body for any remaining tension and tries to relax completely. However, if the client does find tension creeping back into a muscle group during release-only relaxation they are to revert to the original tension-release technique, for that part of the body alone.

2.3 Cue-controlled Relaxation

The next phase, cue-controlled relaxation, involves training in a “verbal cue” or “self-instruction” to induce relaxation more quickly, usually in around 2-3 minutes, by using the word “RELAX”, which is practised for another 1-2 weeks. This is apparently conceptualised by Öst as a process of conditioning the relaxation response to the verbal stimulus (“RELAX”). During the session the client relaxes as deeply as possible using the release-only approach, signalling when they have done so by raising a finger. The client then focuses on their breathing, while the therapist repeatedly says the words “INHALE”, just before each inhalation, and “EXHALE”, before each exhalation, five times in a row. The therapist then fades this verbal prompt and the client takes over using her own self-instruction by saying “INHALE” and “RELAX” internally (covertly), in a similar manner. After about a minute, the therapist begins repeating the words again, about five times, and the client takes over again, repeating the process above, and once more after a break of about fifteen minutes. The therapist should ask the client to estimate how long it took them to relax completely, and feedback the correct answer, because, as Öst points out, clients typically over-estimate the duration. This routine should also be practised about twice per day, to help condition an association between the verbal cue “RELAX” and rapid release-only relaxation.

2.4 Differential Relaxation

The next phase involves “differential relaxation, again derived from Jacobson’s approach, which consists of learning to relax while using some muscles. The client is asked to induce cue-controlled relaxation while seated in a hard chair or standing, and to remain relaxed while moving their head or arms, or legs, etc., and finally while walking. Emphasis is placed on further reducing the time taken to induce relaxation, which typically comes down to 60-90 seconds, according to Öst.

2.5. Rapid Relaxation

This is followed by a “rapid relaxation” training phase, which aims to help the client relax in vivo, in naturally stressful situations, while further reducing the time taken for relaxation to 20-30 seconds. The client is asked to relax 15-20 times each day for homework. Obviously, this means the technique is used very frequently throughout the day, and so cues are identified to act as reminders, such as each time the client checks the time on a watch or clock, or opens a door, etc. Sticky notes or other reminders can be used in the work or home environment to act as additional reminders. The rapid form of cue-controlled relaxation consists in taking three deep breaths, saying “RELAX” internally after each one, before exhaling slowly. The body is then scanned for any remaining tension, and the client tries to maintain maximum relaxation in the real-world situation.

3. Application & Maintanence Phase

3.1 Application

The “application” phase usually begins after roughly 8-10 sessions of preceding training, and involves brief exposure to a wide variety of anxiety-provoking stimuli and situations. The client is encouraged to use their cue-controlled relaxation coping skill immediately prior to exposure, and to continue to use the technique during exposure, in response to any initial signs of escalating tension. Exposure using Applied Relaxation typically takes 10-15 minutes, much briefer than normal prolonged exposure sessions, which can last 1-2 hours. However, the aim is not to extinguish anxiety completely but rather to learn to cope with it by using cue-controlled relaxation as a coping strategy. The client may be exposed in vivo to feared objects or events, or through interoceptive exposure to panic sensations, or using imaginal exposure, especially for feared catastrophes in worry and GAD.

3.2 Maintanence

Training is followed by a “maintenance” programme to help ensure that the coping skill further generalises to different situations in the future and is not simply forgotten. To help maintain the skill, clients are asked to scan their body at least once each day and use their rapid relaxation method to dispel any tension identified, and to practice either differential or rapid relaxation at least twice per week. The client may also keep the therapist updated by posting them records of their progress, e.g., for a period of six months after treatment.

Hypnosis & Applied Relaxation

Very little in Öst’s original protocol needs to be changed in order, I think, to legitimately transform it into a hypnotherapy technique. As cognitive-behavioural approaches to hypnotherapy typically conceptualise hypnosis mainly as a form of self-hypnosis, and emphasise specific evidence-based skills training procedures (such as Nicholas Spanos‘ CSTP), cognitive-behavioural hypnotherapy in particular lends itself well to a “coping skills” approach, like Öst’s Applied Relaxation. There’s not much reason to believe that the tension-release (Jacobson) method has significant advantages in relation to treating common problems over suggestive methods like Autogenic Training, which can easily be used instead as part of a hypnotic version of Applied Relaxation.

Christmas Research Snippet: Hypnotism & Babies

Posted on 3rd December, 2010 by Donald Robertson

Christmas Research Snippet: Hypnotism & Babies

Donald Robertson, NCH Research Director

For personal reasons, I’ve been delving into the research relating to hypnotism and childbirth recently, an area that, I confess, I’ve largely overlooked before. Throughout its entire history, hypnotherapy has been used in relation to childbirth. Even James Braid, the founder of hypnotherapy, reports a case where hypnotic suggestion was used to induce childbirth early for medical reasons. However, the largest and most systematic use of hypnosis for issues relating to childbirth occurred in the Soviet Union at the start of the 20th century, based on the Pavlovian approach to hypnosis and psychotherapy. Tens of thousands of women received hypnosis and a surprising amount of data was collected on its use. In order to make it accessible to a wider audience, by being conducted in a group setting, the hypnotic method was replaced by a psycho-educational method termed “psychoprophylaxis”, meaning “psychological prevention” of pain and anxiety during childbirth. The French obstetrician Dr. Fernand Lamaze visited Moscow in the 1940s to study the Pavlovian psychoprophylactic method from which he developed the well-known Lamaze method of natural childbirth that continues in popularity today. The Pavlovian hypnotic approach, psychoprophylaxis and the Lamaze methods competed with Dr. Grantly Dick-Read’s “Childbirth without Fear” approach, and all of these co-existed alongside numerous other uses of hypnosis in obstetrics, e.g., in the work of William S. Kroger, one of the best-known authors in clinical hypnosis, who wrote Psychosomatic Gynecology (1951) and the self-help book Childbirth with Hypnosis (1961).

Perhaps the most important recent review in this area was published by Donald C. Brown and D. Corydon Hammond in 2007 in a Special Issue of The International Journal for Clinical & Experimental Hypnosis dedicated to reviewing evidence-based practice in clinical hypnosis. Professor Hammond is a clinical psychologist at the University of Utah School of Medicine and former president of the American Society of Clinical Hypnosis. He’s well-known in the field of hypnosis for his many publications and as the editor of The Handbook of Hypnotic Suggestions & Metaphors (1990), a resource most experienced hypnotherapists possess and will be familiar with.

Brown & Hammond reviewed the evidence concerning the benefits of hypnosis in obstetrics, labor, and delivery, in relation to a range of issues, including,

Reduction in use of analgesics and anaesthetics, i.e., reducing pain in labor
Increasing enjoyment of labor
Reducing the duration of labor
Preventing preterm labor (PTL)

The review is quite wide-ranging and takes in many other benefits and applications of hypnosis, with reference to studies of varying age and quality.

The authors begin by reporting a previous review by Hoffman & Kipenhaur (1969) that found studies reported that hypnosis eliminated or substantially reduced the pain of childbirth for 50% (median) of women, with individual studies reporting success rates ranging from 35% to 90% of cases. That suggests that the chances of having a painless childbirth with hypnosis varies enormously, depending upon the specific characteristics of the study, i.e., the way hypnotherapy is conducted and the characteristics of the women participating, including their level of motivation, expectations, etc. Roughly half the women typically experienced substantial freedom from pain in these old studies. There’s no mention of control comparisons, so it’s impossible to tell what percentage of these women would have reported painless childbirth without the use of hypnosis, i.e., their attitude and motivation to give birth naturally may explain their success to some extent.

This ambiguity is addressed to some extent by a recent meta-analysis, identified by Brown and Hammond as the most comprehensive study to date on hypnosis for analgesia in childbirth. The meta-analysis identified three randomised controlled trials (RCTs) where hypnotised and non-hypnotised women were compared (Cyana et al., 2004). Across three studies, involving 142 women in total, they found that the hypnotised group were about half as likely to require pharmaceutical pain relief (analgesia) during childbirth compared to women giving birth without hypnosis. More specifically, 62% of hypnotised women (mean) did not require analgesia compared to only 26% of non-hypnotised women (see chart). This suggests, again, that more than half the women having hypnosis had relatively painless childbirths, although a large part of their success must be attributed to non-hypnotic factors. (This is not a surprising finding and broadly consistent with research on other uses of hypnotherapy, and indeed psychological therapies in general.)

Although use of chemical analgesics, etc., is a more objective measurement, it does not necessarily reflect an accurate picture of the amount of subjective pain reported. This has seldom been adequately reported in the literature, however, Brown and Hammond report a study by Mairs (1995) in which 28 hypnotised women subjectively rated their pain and anxiety levels, before (expected level) and after childbirth (actual level) , which were compared to ratings from 27 women in a non-hypnotised (control) group. No differences were found between the hypnotised and non-hypnotised women in their anticipated levels of pain or anxiety before childbirth, however, after the birth the hypnotised women rated their pain as 5.41 on average compared to 7.58 in the non-hypnotised group, excluding those (n=7) who required caesarean sections. By my calculations, that suggests that the women giving birth without hypnosis reported their feelings of pain as being about 40% higher during labour, on average, than the hypnotised group did.

In addition to these data, Brown & Hammond focus at length on the limited evidence regarding the potential of hypnosis in the prevention of preterm labour. I’d suggest that anyone interested in the whole area of evidence-based practice in relation to hypnosis for obstetrics and childbirth, etc., consult this article for the wealth of information and useful references it contains. Indeed, over fifty books and articles specifically relating to the use of hypnosis in childbirth were referenced by the authors.

Graph of Childbirth without Chemical Analgesia

Reference

Brown, DC; Hammond, DC (2007). ‘Evidence-based clinical hypnosis for obstetrics, labor and delivery, and preterm labour’, IJCEH, 55(3), pp. 355-371

Cyna, A.M.;McAuliffe, G.L.;Andrew, M.I. (2004). ‘Hypnosis for pain relief in labour and childbirth’, British Journal of Anaesthesia, 93(4), 505-511.

Blood & Tension: November Research Snippet

Posted on 23rd October, 2010 by Donald Robertson

Blood & Tension

Applied Tension in Treating Blood Phobia

Donald Robertson, NCH Research Director

This month’s research snippet deviates once again from the usual format. This is an issue I’ve been talking to some hypnotherapists about recently and it’s of interest because it highlights the possible limitations of relaxation-based therapies in treating certain common anxieties.

Virtually all contemporary researchers have rejected the idea that hypnosis can be equated with any form of relaxation, or that relaxation is a necessary component of hypnotherapy. However, the notion that hypnosis involves mental or physical relaxation is still very popular, even among many hypnotherapists. It is also widely-assumed that relaxation serves well as a method of managing anxiety, including in most phobias. However, the value of relaxation in treating certain forms of anxiety has been questioned over recent decades for a number of reasons.

In particular, the treatment of choice for blood-injection-injury (BII) type phobias is currently the “Applied Tension” method developed by Lars-Göran Öst and his colleagues at the University of Uppsala in Sweden. Basically, Öst has produced a series of research studies which provide evidence that training in a special tension “coping skill” combined with exposure to feared situations or events appears to be more effective than exposure alone or accompanied by relaxation training (termed “Applied Relaxation”). The rationale for Applied Tension is that BII phobia, unlike most other forms of anxiety, is often accompanied by actual fainting or feelings of faintness caused by the vasovagal response. The response to blood among phobics has been found to be unusual in that it consists of a ”biphasic” reaction during which blood pressure and heart rate first rise (as in normal anxiety) and then rapidly drop, leading to fainting.

The tension coping skill learned in Applied Tension involves tensing one’s arms, chest, and legs until a feeling of warmth occurs in the face, usually taking about 10-20 seconds. This is repeated five times in a row, with 20-30 second pauses between. Relaxation more than normal is deliberately avoided. Doing so has been found to increase blood pressure and, in particular, cerebral blood flow, and to do so sufficiently to prevent the drop in blood pressure associated with fainting and the associated sensations of faintness. This coping skill is then repeated for sessions of five repetitions, five times per day, over the space of five weeks. It is combined with systematic exposure to the feared situations, which in the research conducted by Öst, includes a visit to the blood donor clinic, where the phobic provides a blood sample, and ultimately to an operating theatre to observe thoracic surgery taking place in person. 90% of blood phobics have been found to have improved to a clinically-significant degree following this brief intensive treatment, compared to only 60% of those trained in relaxation methods.

Most of the (highly-regarded) research on Applied Tension for blood phobia comes from the same research group and has, unfortunately, tended to employ relatively small sample sizes. Recently, the findings have been questioned somewhat by one team of reviewers (Ayala, Meuret & Ritz, 2009). On the other hand, a recent large-scale study of 614 blood donors found that those who expressed fears of fainting were more likely to continue donating blood if trained in Applied Tension (Ditto, France & Holly, 2010).

So if tension may be more beneficial than relaxation in the treatment of blood phobia, how can this be incorporated into hypnotherapy? Well hypnotherapy certainly doesn’t seem to require relaxation and so “active alert” approaches to hypnotic induction might be better indicated for this client group. James Braid, the founder of hypnotherapy, definitely used to induce either tense (“cataleptic”) or relaxed states depending on the individual needs of his clients. Modern active-alert hypnotic procedures can be combined with suggestions for confidence-building (or ego-strength) which seems important with this client group, and used in conjunction with Applied Tension training. Let us know what you think, though, by posting your comments below.

References

Öst, Fellenius & Sterner (1991). ‘Applied tension, exposure in vivo, and tension-only in the treatment of blood phobia’, Behav. Res. Ther., vol. 29, no. 6, pp. 561-574.

Öst, Sterner & Fellenius (1989). ‘Applied tension, appplied relaxation, and the combination in the treatment of blood phobia’, Behav. Res. Ther., 27, 109-121.

Öst & Sterner (1986). ‘A specific behavioral method for treatment of blood phobia’, Behav. Res. Ther., vol. 25, no. 1, pp. 25-29.

Ditto B.; France CR.; Holly C. (2010). ‘Applied tension may help retain donors who are ambivalent about needles’, Vox Sanguinis. 98(3 Pt 1):e225-30

Ayala ES.; Meuret AE.; Ritz T. (2009). ‘Treatments for blood-injury-injection phobia: a critical review of current evidence’, Journal of Psychiatric Research. 43(15):1235-42

Voting results for Motions at AGM

Posted on 21st October, 2010 by Martin Armstrong-Prior

The results of the voting at the AGM in respect of the 2 Motions to ratify change to elements of the Bye Laws are:
1) Motion 1 – the change of Bye Law 1 to the CNHC format – Votes for = 474, against = 32, abstained = 18.
2) Motion 2 – the change of Bye Law 2 in respect of the Grievance Process – Votes for = 512, against = 16, abstained = 6.
Both motions were therefore passed and the changes to the Bye Laws ratified.

Election Results

Posted on 8th October, 2010 by Martin Armstrong-Prior

Following the election held at the AGM on Saturday 2nd October at the Royal Society for Medicine, 2 candidates required a recount of the Votes.

The original Returns were: Paul Howard 118, Rob Woodgate 2, Trevor Silvester 224, Donald Robertson 72, Sophie Fletcher 50, Chris Gelder 2, Neil Foster 14, Andrew Hill 5, Mo Ferrington 1, Gina Davy 4, Lorah Townes 0.

The Voting papers were recounted by myself and Annie Dee Hughes at 7 pm Thursday 7/10/10, witnessed by Jo-Anne Kellehar the Standards Officer.

The result of this count was that the following are declared elected with their final vote counts: Paul Howard 114, Trevor Silvester 225, Donald Robertson 73, Sophie Fletcher 50, Neil Foster 14, Andrew Hill 33.

Those declared as elected are now directors of the NCH.

Important Voluntary Self Regulation Announcement

Posted on 23rd September, 2010 by Paul White

There has been a lot of talk about Voluntary Self Regulation recently, now I’d like to share with you what this will really mean in the next couple of months (hopefully) – exclusively for NCH members.

“The Department of Health (DoH) recommends that when seeking a Hypnotherapist you always consult with someone who is CNHC registered.”

We have independently reached an informal agreement with the Complementary and Natural Healthcare Council (CNHC) that the NCH will be a pilot for their Hypnotherapy register.

This means that over the next couple of months, Martin Armstrong-Prior and I will be working hand in hand with the CNHC to have the programme up and running by the New Year.

You will then be able to take full advantage of the above DoH endorsement.

This is one of the key reasons why we wish to change our Codes of Ethics at the AGM to mirror the CNHC code drawn up by the DoH. So we still need your attendance or proxy vote at the AGM if you cannot attend the meeting.

Something to note: CNHC membership is not obligatory; you only need to register if you want to.

Finally, there are still some places at the Extravaganza if you would like to come on this exciting day. You’ll get world-class speakers, lunch with the NCH, a meet up with lots of friends and a lively AGM – all for only £60+VAT.

Of course the AGM is free for any member to attend if they wish. Please notify your attendance or register your proxy online here:

http://www.hypnotherapists.org.uk/agm/

Kind regards,

Paul

Paul White, Chairman

National Council for Hypnotherapy

http://www.hypnotherapists.org.uk

Important: Your AGM Vote Counts

Posted on 18th September, 2010 by Donald Robertson

Special Notice for NCH Members

The 2010 Annual General Meeting (AGM) of the NCH will take place at the Royal Society of Medicine at 2pm on Saturday 2nd October 2010.

If you’re a voting member of NCH, which you probably are, then visit the secure link below to read more and indicate your voting intentions online. If you’re not able to attend the AGM in person then you should consider allocating your vote to someone else (a proxy) to vote on your behalf.

Link to the AGM page with voting options for NCH members:

http://www.hypnotherapists.org.uk/agm/

Link to election addresses and AGM notices can be found in the members area here.

http://www.hypnotherapists.org.uk/1596/agm-2010-notices-motions-and-election-candidates/

If you need more advice please email NCH for information.

AGM 2010 – Notices, Motions & Election Candidates

Posted on 16th September, 2010 by Martin Armstrong-Prior

The 2010 Annual General Meeting of the NCH will take place at the Royal Society of Medicine at 2pm on Saturday 2nd October 2010 and all currently active full members are entitled to a vote.

Please confirm attendance or nominate a proxy using this form
NB: Form closes 5pm on Thursday 30th September 2010.

Draft Agenda

10th AGM of the National Council for Hypnotherapy;
2pm on 2nd October 2010

Open meeting & welcome to members,
Apologies and statement of proxy vote numbers, plus those present to give quorum, (if not quorate adjourn meeting in accordance with M&A.)
Minutes of previous AGM (2008),
Matters arising,
Chair’s report,
Secretary’s report,
Election of Directors,
A.o.B.
Close meeting.

Election Statements

The following Directors are standing for re-election this year:

Sophie Fletcher – Exec Director
Paul Howard – PR & Marketing
Trevor Silvester – Supervision
Donald Robertson – Research
Rob Woodgate – IT

The following members have put themselves forward for election:

Chris Gelder
Neil Foster
Andrew Hill
Mo Ferrington
Gina Davy
Lorah Towns

Election statements for all candidates can be found here: Election Addresses

Motions to Amend Byelaws

Two motions are proposed by the Executive Committee. There are no member motions.

Motion 1 – The NCH adopts the Revised Bye Law 1

It has become clear that the NCH Code of Ethics, whilst excellent, will be redundant or superflous as UKCHO move towards Voluntary Self Regulation and the Complementary and Natural Healthcare Council (CNHC). The NCH Executive proposes that the NCH Code of Ethics, enshrined in Bye Law 1, be brought into line with the CNHC Code, which is sanctioned by the Department of Health.

Document: Proposed New Bye Law 1

Motion 2 – The NCH adopts the Revised Bye Law 2

During the past year, problems with way the Grievance and Complaints procedure could be triggered were highlighted and in resolving these, necessary changes to the Bye Law were identified. The Executive Committee proposes changes to the Grievance and Public Protection Procedures, enshrined in Bye Law 2, to allow a complainant’s right to confidentiality to be waived in cases where the best interests of the NCH as an organisation are compromised.

Document: Proposed Bye Law 2

Directors Reports

Secretary’s report 2010
Chairman’s Report (To Follow)
Draft Accounts 2010

NB: 2009 Accounts may be found in the Winter 09 Journal.

Mindfulness, Metacognition and Hypnosis: August Research Snippet

Posted on 26th July, 2010 by Donald Robertson

Mindfulness, Metacognition and Hypnosis

August Research Snippet

Donald Robertson, NCH Research Director

Apologies for the absence of a July Snippet but here’s August’s a bit early as compensation. Following our previous snippets on meta-analyses, finding research online, and treatment outcome studies, etc., we’ve recently looked at attempts to combine mindfulness research and hypnosis in the treatment of depression. This is a popular area so I thought I’d continue in the same theme by looking at, arguably, the most important recent article on this subject. In 2006, Steven Jay Lynn collaborated with the Buddhist teacher Lama Surya Das, and two other researchers, in an attempt to explore the possibility of combining elements of Buddhist mindfulness meditation practice, cognitive therapy, and hypnosis, drawing on recent research in cognitive psychology.

Mindfulness versus Thought Suppression

Over the past couple of decades, enthusiasm for mindfulness meditation techniques derived from Buddhism has flourished among cognitive-behavioural therapists, inspired by the early success of Jon Kabat-Zinn’s meditation programme for stress management. Meditation and acceptance strategies have been used to counteract the tendency of many clients to try to suppress, control, or “fight” distressing thoughts. Lynn et al. refer to the recent study by Wegner and his colleagues, which found that when people tried to deliberately suppress a thought there was evidence of a “rebound effect” in which they subsequently experienced more intrusions of the thought than a control group who were simply asked to think freely about the same thing. Other studies have found evidence that emotional suppression can inhibit memory and problem-solving and increase physiological signs of nervous arousal. Lynn and his colleagues report that of nearly a hundred subjects who were asked to keep their minds blank while listening to hypnotic suggestions, only one reported any success.

Where thought-control strategies backfire, mindfulness and acceptance have been seen as offering an alternative way of responding to distressing experiences. Lynn et al. follow other contemporary cognitive-behavioural therapists in contrasting non-judgemental mindfulness and acceptance with the unhealthy suppression of thoughts and feelings. (However, they fail to mention that experimental studies on this “rebound” effect in thought suppression have produced some mixed results – q.v. Clark & Beck, 2010, for a more detailed review.) Lynn et al. also cite a 2003 meta-analysis of mindfulness-based cognitive therapy and stress reduction approaches by Baer, which found a mean effect size of 0.59 (a medium-sized treatment effect) for this approach across various emotional problems and medical conditions. In other words, it probably works, but the effects are comparable to those of other therapies and not dramatically superior to them.

Mindfulness & Metacognition

Lynn et al. appeal to a cognitive model combining elements of Adrian Wells’ influential metacognitive theory and Lynn and Kirsch’s own “response set” theory to explain the mechanism underlying mindfulness meditation and its relationship with hypnosis. Contrary to Beck’s earlier cognitive therapy model, Wells introduced a focus on the notion of “metacognition”, thinking about thinking, or beliefs about beliefs. According to this model, negative automatic thoughts aren’t particularly unhealthy in themselves, but rather they become so because of our attitude toward them. In plain English, whereas Beck’s original cognitive therapy assumed that negative thoughts play a central role in the development of emotional disturbance, Wells points to the fact that many people experience lots of negative thoughts without becoming upset by them, whereas patients with severe emotional disorders appear to be unusually disturbed by individual negative thoughts and worries. Mindfulness meditation, likewise, can be seen as an attempt to adopt a more detached attitude toward our stream of consciousness, and thereby to modify our thinking about thinking, i.e., to see automatic (spontaneous) thoughts as relatively transient and harmless, rather than important and dangerous. Indeed, Beck has recently assimilated many aspects of Wells’ metacognitive approach into his revised cognitive therapy for anxiety (Clark & Beck, 2010).

Curiously, Lynn et al. don’t mention the fact that Wells’ metacognitive model raises serious problems for hypnotherapy because it suggests that the assumptions often made by hypnotherapists about the “power of thought” risk reinforcing maladaptive (metacognitive) assumptions held by many clients, i.e., the assumption that thoughts (including suggestions) are inherently powerful, whereas Wells teaches his clients that ideas are only as powerful as we believe them to be and we can learn to dismiss them as “mere thoughts”, lacking any real power or significance. Likewise, Lynn et al. cite the recent research by Twohig (2004), which found that by repeating a negative thought to oneself one hundred times, like a mantra or autosuggestion, subjects made it seem less believable rather than more so, as some hypnotists might assume. To borrow Wells’ terminology, hypnotism itself can be seen as a set of metacognitive beliefs rather than an altered state of consciousness or “hypnotic trance”. The belief that autosuggestions are powerful when phrased in certain ways and the strategy of attending to their meaning for a prolonged period, to the exclusion of distractions, are ways of “thinking about thinking” (metacognition), which it’s the aim of most “hypnotic inductions” to instantiate. In a sense, mindfulness meditation can be seen as a kind of “de-hypnosis” or “counter-hypnosis”, which aims to develop a metacognitive mind-set that weakens the hold of certain thoughts or suggestions, e.g., “Imagine that you are transparent, and disturbing thoughts and emotions cannot penetrate you or have any power to control your actions” (Lynn et al.), which contrasts sharply with typical preliminary hypnotic suggestions to experience certain ideas (suggestions) as powerful, controlling, and deeply penetrating into the mind, etc.

Combining Hypnosis & Meditation

Lynn et al. summarise the relevance of hypnosis to mindfulness training as follows,

Suggestions can be used to motivate clients to persevere with meditation practice on a regular basis.
Suggestions can be used to generate a patient mind-set, so that when the attention naturally wanders this is seen as normal and accepted.
Suggestions can be given about acceptance of things that cannot be changed.
Hypnosis can be used to help people avoid identification with thoughts and feelings.
Hypnosis can help clients to become more tolerant of unpleasant feelings.
Clients can be hypnotised to perceive negative thoughts as transient and unimportant.

They specifically recommend the use of the following hypnotherapy techniques in conjunction with mindfulness meditation, which generally involves exposure to aversive feelings and events in CBT,

Mental (“covert behavioural”) rehearsal of previously avoided situations.
Cue-controlled relaxation to help facilitate exposure to feared situations.
The use of hypnotic desensitisation to facilitate mental (“imaginal”) exposure .
The use of hypnotic regression or reliving as a form of imaginal exposure to traumatic memories (as in PTSD treatment).
The use of suggestion to help clients tolerate the discomfort and repetition of exposure therapy.

They add that the most basic use of hypnosis in combination with mindfulness-based CBT would be in the use of suggestion to directly develop an ongoing state of mindfulness. As Lynn et al. emphasise, virtually all modern researchers now take it for granted (following several well-known studies) that hypnosis does not necessarily entail any form of relaxation, although it is frequently accompanied by it. The same applies to meditation and Lynn et al. refer to a recent EEG brain imaging study in which subjects trained in relaxation showed markedly different brain activity from those trained in mindfulness meditation.

Negative Reactions

As an aside, Lynn et al. also note that a considerable body of research demonstrates the existence of transient, relatively superficial, negative reactions following standard hypnosis, i.e., things like headaches, feelings of nausea, anxiety, etc., in up to 29% of subjects. This is comparable to the rates of negative responses reported by control groups who are simply asked to sit with their eyes shut, without being hypnotised, for the same amount of time. However, similar negative reactions are also reported following meditation training, and may even be more frequent, being reported in up to 63% of subjects. Hence, we might say that although negative reactions can occur following hypnosis it may be as harmless (generally speaking) as common meditation or relaxation techniques.

References

Lynn, Steven Jay; Das, Lama Surya; Hallquist, Michael N.; Williams John C. (2006). Mindfulness, acceptance and hypnosis: cognitive and clinical perspectives. IJCEH, 54(2), 143-166.

Clark, David A.; Beck, Aaron T. (2010). Cognitive Therapy of Anxiety Disorders: Science and Practice.

Phone Scam Warning

Posted on 17th June, 2010 by nch

It has come to our attention today that Hypnotherapists are being cold called by a salesman who claims his company is working in partnership with the NCH and Google.

We can only assume this is a scam operation, as the NCH has no such partnership with any such company or Google.

We advise members to always check the members area in case of doubt, as details of approved NCH member benefits will always be posted there first.

Kind regards,
Rob

Rob Woodgate
Technology Director
National Council for Hypnotherapy