Is your acid reflux medicine damaging your health?

Hypnotherapy can help

You might have noticed after the excesses of Christmas that you developed a bad case of heartburn.  Left unchecked heartburn can progress and become acid reflux or GERD, illnesses which cause stomach acid to move up into your esophageus. Acid reflux raises the risk of cancer of the throat, tonsils and sinuses in older people, a study has found.  Worryingly, taking remedies for acid reflux may further increase your risk of cancer. Research published last month revealed regularly taking heartburn pills could double your chances of getting stomach tumours.

GERD is thought to affect 10 to 30 percent of the population, more frequently in patients who are obese and elderly. And cancers of the respiratory and upper digestive tracts account for more than 360,000 deaths worldwide each year.  The scientists, from the University College of London and the University of Hong Kong found that using proton pump inhibitors (PPIs) which are freely available over the counter in the UK significantly increases the risk of contracting stomach cancer.

Often, physical conditions are exacerbated by underlying stress or anxiety.  By taking action to relieve the root causes of stress and anxiety in your life you may find that you experience a significant reduction in your acid reflux or GERD symptoms.  Hypnotherapy can be an effective treatment for heartburn and other stomach conditions.  A recent article in Medscape suggests that GERD is form of brain-gut dysregulation and that by working with the mind, researchers were able to reduce abnormal acid secretion under hypnosis.

Also, when you’re in the hypnotic state, a lot of defenses come down, and the brain does open up to the possibility of controlling symptoms better. That’s why we use hypnosis—because it gives that subconscious messaging.

The National Council for Hypnotherapy has a register of qualified practitioners from around the UK who can help.  Find a therapist near you and start to feel better.

 

Not feeling the Christmas spirit?

Gallery

This gallery contains 2 photos.

It’s known as ‘The Most Wonderful Time of the Year’ but for many it’s filled with anxiety and depression. The festive period can intensify feelings of loneliness, increase financial worries and put pressure on people to have the “perfect” Christmas. … Continue reading

Live phobia free with hypnotherapy

Most of us are frightened of something.

Around 2.4% of adults in the United Kingdom have a medically diagnosable phobia, according to a recent NHS survey, that’s around 1.3 million people.

The NHS says: “A phobia is an overwhelming and debilitating fear of an object, place, situation, feeling or animal. Phobias are more pronounced than fears. They develop when a person has an exaggerated or unrealistic sense of danger about a situation or object. If a phobia becomes very severe, a person may organise their life around avoiding the thing that’s causing them anxiety. As well as restricting their day-to-day life, it can also cause a lot of distress.”

Phobias occur when your brain links a specific trigger event to danger.

This could be having a turbulent flight, watching a giant spider on TV, or having a large dog knock you over when you were a child. You might know about many common phobias, such as fear of spiders, heights or flying, but have you come across these phobias before?

According to the National Council for Hypnotherapy, “A phobia is an irrational fear, literally a fear without good reason, or a fear of something that may not happen”. These phobias develop as coping mechanisms to serve a purpose, to keep us safe from a perceived danger, but they become dysfunctional. The mind is designed to generalise, it’s designed to keep you safe, and so whenever you see that thing in future, it says “look out, avoid this”, even if it’s not logical or rational.

Because phobias are rooted in emotional memories, talking therapies which try to rationalise the thought pattern can fall short.  Hypnotherapy can help.  In hypnosis the unconscious is able to process information more effectively without the interference of the conscious critical mind. There are different types of hypnotherapy and skilled hypnotherapists may combine different forms or use hypnosis in conjunction with other treatments depending on the needs of their client.

Often phobias can be treated in just one session, depending on the willingness of the client to embrace the change, says the NCH.  If you have a phobia or a fear which is affecting your life, why not try a session with an NCH hypnotherapist? You can use the NCH directory by clicking here to find a therapist near you.

Hypnotherapy provides effective pain relief

Around 30% of the UK live with daily, chronic pain, that’s around 28 million people according to research carried out in 2016.

For most of these sufferers, opiates are offered as the main treatment for their pain.) In America opiod prescriptions have quadrupled since the turn of the century, but the research shows that the relief offered by opiate medications actually isn’t so great.

The National Council for Hypnotherapy says: “Hypnotherapy is often highly effective in dealing with pain management.

In a study at Stanford University School of Medicine in 2016 scientists scanned the brains of 57 people during guided hypnosis sessions.  They found several changes that occur while the subjects were in hypnosis.  These changes included a greater connectivity between the brain’s executive-control network and the insula, a grape-sized region deeper in the brain that helps us control what’s going on in the body, including processing pain.

Further to this, it is becoming more widely recognised that the mind plays a role in the experience of pain.  Learning skills to change habitual thought patterns around chronic pain can significantly reduce a person’s distress and improve their quality of life.  Negative emotions can amplify the experience of pain, and a positive outlook can ease it.

Self hypnosis can help.  Hypnosis techniques can be taught to clients by an NCH therapist to help them manage chronic pain.  Patients suffering from a range of conditions including fibromyalgia, back disorders and pain from trauma such as car accidents or workplace injuries can learn to control their pain through practicing self-hypnosis.

 “Sleep was totally key,” says Deborah Gray, 53, whose chronic neck pain has disappeared since she began using guided imagery and hypnotherapy to fall asleep. 

When seeing a therapist for chronic pain, it is essential that the pain is checked out by a GP first for a formal diagnosis.  After you’ve had an assessment contact a hypnotherapist near you by using the NCH directory.

 

Reclaiming your life after assault #metoo

If you’ve been on any form of social media in the last few weeks you will undoubtedly have seen a multitude of women coming forward as victims of sexual assault after the hashtag #metoo went viral.

The Twitter thread was started in the wake of The New York Times’ exposé alleging sexual abuse and harassment allegations against Hollywood mogul Harvey Weinstein.

As of Sunday night, #MeToo has been used more than 21 million times on Facebook, giving sense of the magnitude of the problem and serving as a reminder that this is not just a problem for Hollywood and the casting couch, this is an issue which affects all of us at every level of society.

If you have been involved in a sexual assault situation it is possible that you will have long term mental health issues because of the experience.  Post Traumatic Stress Disorder is a condition which develops after someone has been involved in, or witnessed, a serious trauma such as a sexual assault. In some people PTSD develops soon after the trauma; however, in some cases the symptoms first develop several months, or even years, after the trauma, perhaps as a response to the incident being recalled by media attention such as is happening now.

Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt. They may also have problems sleeping and find concentrating difficult. These symptoms are often severe and persistent enough to have a significant impact on the person’s day-to-day life.

Up to 4 in 5 people with PTSD also have other mental health problems; for example, depression, persistent anxiety, panic attacks, phobias, drug or alcohol abuse.

The National Council for Hypnotherapy (NCH) says it is a normal part of the human protection system to experience a fight-or-flight response when there is real and present danger.

Counselling is often mooted as the treatment for PTSD with medication in some adult instances. Hypnotherapy, too, has a success rate in treating this disorder.

“To experience prolonged flight-or-flight creates feelings of anxiety and stress,” says the NCH. “It is often rooted in a previous experience that triggered fear or in a general anxiety and worry about your situation at home or at work.”

While anti-depressant drugs are often prescribed to help sufferers of PTSD, clinical hypnotherapy is one of the therapies recommended to treat the disorder and it has the advantage of being quick and non-invasive.

During a hypnotherapy session, the therapist can help assess the person’s anxiety, identifying the root of stress or anxiety.  Through this process sufferers can come to terms with their trauma and gain a sense of control over their fear. By using a range of techniques, the client can learn to rewire their responses whenever they encounter a trigger.

The National Council for Hypnotherapy has registered members all across the UK who are able to work with you to reduce the symptoms of PTSD.

 

 

 

 

The newest healthy living trend: Sleep

Gallery

This gallery contains 2 photos.

Insomnia is thought to affect one in 3 people in the UK, with sufferers finding it difficult to get to sleep, having interrupted sleep, waking early, and having difficulty concentrating and feeling tired and irritable during the day. With the … Continue reading

Pressure builds for Britain’s youth

 
A recent survey of 2,000 UK school teachers has revealed some frightening news about the mental health of our children and adolescents.  Responding to a survey by the NASUWT union, almost all teachers (98%) said they had come into contact with pupils who are experiencing mental health issues.  In February a survey commissioned by the Varkey Foundation ranked British teenagers and young adults in 19th place out of 20 participating countries when comparing their mental health and levels of stress, anxiety, and depression.

In 2012 the Children’s Society Good Childhood Report found that around 10% of children and young people (aged 5-16 years) have a clinically diagnosable mental problem, yet 70% of children and adolescents who experience mental health problems have not had appropriate interventions at a sufficiently early age.

A single session of self hypnosis instruction has been found to resolve anxiety based abdominal pain symptoms in 3 out of 4 paediatric patients and clinical research has shown that children and adolescents respond extremely well to hypnotherapy for other anxiety related complaints and insomnia.

Dr Marc Bush, chief policy advisor at charity YoungMinds said: “We know from our research that children and young people face a huge range of pressures, including stress at school, body image issues, bullying on and offline, around-the-clock social media and uncertain job prospects.”

Childline, a telephone and internet chat counselling service for children reported that they delivered over 300,000 counselling sessions in the 2015/2016 financial year with the top concerns raised by children being low self-esteem/unhappiness, family relationships, and bullying/online bullying. 1 in 3 Childline counselling sessions related to mental health and wellbeing issues.

Teachers report that “Students generally don’t know how to deal with any stresses in their lives so it tends to present itself through anger and lashing out or crying.”

There are many things that you can do that will help and prevention is always better than cure.  Some of the most important things you can do are to listen and to provide emotional support.  Children learn through modelling, so providing a good example to them of effective communication and problem-solving skills is a very important weapon in helping fight the onset of stress and anxiety childhood mental health issues.

The Mental Health Foundation believes that simple things such as ensuring your child is in good physical health; is eating a balanced diet and getting regular exercise, and is part of a family that’s happy and communicates with each other are effective ways of helping ensure your child remains mentally healthy.  Connections to the community and a sense of belonging, both through schools and outside activities are also important for childhood mental wellbeing.

Limiting media access can also be helpful if your child is showing signs of anxiety.  The NSPCC reported earlier this year that young callers to their Childline service reported being distressed by world events such as Brexit, the US election, and increasingly regular terrorism reports.  Limiting social media access can also help to improve the stress and anxiety levels of your children, allowing them time to switch off and be present in the moment.

However, some children are in need of more formal interventions to support them through their time of crisis.  The National Council for Hypnotherapy, which has over 200 trained and qualified therapists who specialise in working with children on its directory across the UK, says that hypnotherapy can be a fast, effective and drug free treatment for a range of children and adolescent’s mental health issues.

 If caught and treated early, childhood mental health problems can resolve quickly and completely.  Most hypnotherapists are happy to have a no-obligation meeting with you and your child to discuss these problems and make suggestions for intervention.

Visit our database of hypnotherapists to find someone local to you.

 

 

 

Beating the baby blues

Having a child is one of the most life changing things you will ever do, and with major life changes invariably comes stress. 

Chronic, unmanaged stress levels can significantly impact upon quality of life and research has found that both mothers and fathers face an increased risk of depression after the birth of a child, and remain at some increased risk well into a child’s adolescence.  A fifth of fathers and more than a third of mothers experience depression before their child turns 12 years old, with the highest rates in the first year after birth, according to a study from the Medical Research Council (MRC).

The research, which tracked nearly 87,000 families in the United Kingdom between 1993 and 2007, found the highest risk for depression occurred in the first year after a child’s birth.

The National Council for Hypnotherapists(NCH) believes that hypnobirthing can reduce stress and anxiety for you, your partner and your baby, creating a healthy environment for your family.

Overall, 39 percent of mothers and 21 percent of fathers had experienced an episode of depression during the first 12 years of their child’s life. After the first year of parenting, a mother’s risk for depression dropped by half, while second time dads faced only about a quarter of the depression risk compared with new fathers. Although depression risk for both parents dropped considerably in the second year, they remain steady until the child is aged 12 (the survey did not track families beyond the child’s age of 12).

Parents who had an earlier history of depression, who had children at a relatively young age or who had lower incomes were at highest risk for a depressive episode during their parenting years, according to the study.  Although the study wasn’t designed to determine the causes of the higher depression rates among parents, researchers speculated that several potential triggers could occur because of the everyday demands of parenting.  It seems reasonable to suggest that the stress of new fatherhood may put men at risk of depression.

Postnatal depression is a serious issue and can have far reaching consequences.  Babies have been shown to pick up on parental stress, says a Norland trained nanny, “they will cry more if you are overwhelmed. Trying to do too much on your own and not resting enough has become a common trait”.  Children also pick up on stress, depression and anxiety in their parents, with research showing that children with anxiety related stomach conditions are more likely to have anxious or depressed mothers.

Hypnobirthing teaches the mother to deeply relax with specific hypnotic pain control techniques leading to reports of significantly faster births with fewer medical interventions and faster recoveries; this type of birth experience is believed by many to reduce the risk of post-natal depression.  Partners who are involved with the hypnobirthing training also report a significant reduction in stress and anxiety surrounding becoming a parent.

Hypnotherapy can also assist if you are currently struggling with postnatal depression.  During a course of therapy the hypnotherapist will work with their client to help assess and build strategies for dealing with their postnatal depression, including identifying the root causes and establishing post-treatment goals. 

 With the right support, which can include self-help strategies and therapy, most parents make a full recovery.   Search our database of hypnotherapists to find someone local to you.

 

 

Hypnosis & Applied Relaxation (AR) – January Research Snippet

Hypnosis & Applied Relaxation (AR)

January Research Snippet by Donald Robertson, NCH Research Director

(Some of the material for this post is derived from the forthcoming book The Practice of Cognitive-Behavioural HypnotherapyCopyright (c) Donald Robertson, 2011.  All rights reserved.)

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

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,

  1. Assessment, formulation, and self-monitoring, which Öst seems to imply takes 2-3 sessions prior to training
  2. Progressive Muscle Relaxation, lasting 2-3 weeks/sessions
  3. Release-only relaxation, lasting 1-2 weeks/sessions
  4. Cue-controlled relaxation, lasting 1-2 weeks/sessions
  5. Differential relaxation, lasting 1-2 weeks/sessions
  6. Rapid relaxation, lasting 1-2 weeks/sessions
  7. Applied relaxation (application training), lasting 2-3 weeks/sessions
  8. 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.

Hypnotherapy versus CBT: October Research Snippet

Hypnotherapy versus CBT: October Research Snippet

Donald Robertson, NCH Research Director

This month’s research snippet is about a very important treatment outcome study on public-speaking anxiety, a clinical trial comparing an established (evidence-based) CBT protocol for social phobia (social anxiety disorder) against the same protocol augmented by hypnosis, and a third (waiting list) control group.  The study was published in 1997 and has been frequently-cited since as providing evidence of the “additive” value of hypnosis as an adjunct to CBT and potentially other evidence-based treatments.  I’ve decided to summarise it this month because it’s probably one of the most important treatment outcome studies available in relation to hypnotherapy, and so NCH members should be familiar with its findings, and because the study was based on the doctoral dissertation of Nancy Schoenberger, the main author, who was supervised by Prof. Irving Kirsch, one of the speakers at this year’s NCH Extravaganza.  So if you’re lucky you may have the opportunity to ask Prof. Kirsch about this study yourselves!  In a nutshell, the authors conclude: “the addition of hypnosis to cognitive behavioural treatment enhanced the effects of treatment.”

The study involved 62 participants with severe public-speaking anxiety.  They were divided into three groups,

  1. Standard CBT (based on Heimberg’s protocol for social phobia)
  2. CBT+Hypnosis (Cognitive-behavioural hypnotherapy, CBH)
  3. Waiting list control, i.e., a group who received no treatment to control for the effect of spontaneous remission, etc.

The researchers emphasise the established finding that relaxation is not a necessary component of hypnosis (hypnosis is not a “state of relaxation”), although it featured as a treatment component in this study.  (This key misconception is virtually extinct among modern researchers but is still fairly widespread among hypnotherapists.) 

In sum, the hypnotic treatment included all components of the cognitive behavioural treatment.  It differed from the nonhypnotic treatment only in the following ways: (a) relaxation training was termed “hypnosis” and contained reference to entering hypnosis, (b) relaxation practice at home was termed “self-hypnosis”, (c) automatic thoughts were termed self-suggestions, and (d) suggestions for improvement were given following the hypnotic induction.

Participants in both treatment groups received five sessions, two-hours long, of CBT or CBH, based on Heimberg’s established protocol for the generalised subtype of social phobia.  This has already been applied to public-speaking, the most common fear among social phobics, and the authors adapted it to include relaxation skills training and tailored it for application to a specific fear (public speaking).

42 of the 62 participants completed the whole programme of treatment and assessment (= 68% completers).  Essentially, the study found that CBH subjects improved to a greater extent, because of the apparent additive value of hypnosis, across a battery of outcome measures, although the initial credibility rating of both treatments was virtually identical.  The mean effect size across all measures, calculated using a standard formula called Cohen’s d, was 0.80 for CBT, which increased to 1.25 in the group where hypnosis as incorporated.  This shows a substantial increase on average, apparently due to the inclusion of hypnosis in the standard CBT protocol.

The researchers also attempted to identify “moderators” of treatment, i.e., other factors which determined the response to therapy.  They measured hypnotic susceptibility and attitudes toward hypnosis for this purpose.  Suggestibility did not seem to correlate well with outcome measures except for pulse rate (which may have been problematic in this study anyway).  Positive attitudes to hypnosis appear to have moderated the benefits of hypnosis, and correlated with greater reduction in anxious behaviours.

Kirsch’s cognitive “response set” theory holds that the effects of hypnosis are largely mediated by changes in the client’s expectations of improvement.  (It’s generally been found by researchers that treatment expectations correlate with outcome, across the board.)  Although some hypnotists seem to dispute this, it was also central to Braid’s definition of hypnotism that it worked partly by means of expectation.  Statistical analysis in this study showed that hypnosis generated greated expectation for improvement in symptoms of public speaking anxiety than did CBT alone.

In sum, the addition of hypnosis to a cognitive behavioural treatment of anxiety enhances clients’ therapeutic outcome expectancies.  It also appears to promote greater improvement in both expected and experienced anxiety.  Behavioural improvement in hypnotic treatment is associated with positive initial attitudes toward hypnosis, and change in anxiety expectancy appears to be the central unifying characteristic among otherwise uncorrelated measures of change.  These data are consistent with [Kirsch’s] hypothesis that the benefits of adding hypnosis to treatment are mediated by expectancy.

This study followed on from an important meta-analysis by Kirsch and his colleagues which pooled data from different studies comparing different forms of CBT for different problems to the same treatment plus hypnosis and found that for between 70-90% of subjects, on average, hypnosis added to the effects of CBT.  This type of evidence is of particular importance to hypnotherapists as the future of hypnosis and hypnotherapy are likely to be bound up with the integration of hypnosis as a method with other empirically-supported treatments (ESTs).  Dr. Assen Alladin’s recent book Cognitive Hypnotherapy contains numerous integrative protocols which are carefully designed to enhance the effects of established evidence-based treatments for a range of conditions by the incorporation of hypnosis and we should hope that developments like this will continue to add to our understanding of how hypnosis interacts with other nonhypnotic treatments, as this will surely continue to define its role in the future. 

Reference

Schoenberger, N. E., Kirsch, I., Gearan, P., Montgomery, G., & Pastyrnak, S. L. (1997). Hypnotic Enhancement of a Cognitive Behavioral Treatment for Public Speaking Anxiety. Behavior Therapy (28), 127-140.