Hypno-psychotherapy and Evidence-based Best Practice

Psychotherapy has been defined (see for example UKCP, 2009) as a process ”to help Clients gain insight into their difficulties or distress, establish a greater understanding of their motivation, and enable them to find more appropriate ways of coping or bringing about changes in their thinking and behaviour. Psychotherapy involves exploring feelings, beliefs, thoughts and relevant events, sometimes from childhood and personal history, in a structured way”.

Hypno-psychotherapy is defined as a core modality of psychotherapy in which Hypnotic language and processes are used as an adjunct to evidence-based psychotherapies. The use of Hypnosis in conjunction with psychotherapy normally results in greater treatment effectiveness.

Hypno-psychotherapy can be used to treat a large array of Client issues including mood disorders, difficult thoughts and feelings, habit disorders, social disorders, phobias, anxieties and depression as well as panic attacks and serious stress disorders such as ASD and PTSD. It is also widely used to enhance sports performance, creativity, memory and concentration. It finds wide application also in chronic pain management and pre/post-operative surgical procedures, and also in support of stress-related psycho-somatic disorders such as IBS, skin disorders and headaches/migraines. See REFERENCES.

Therapeutic Hypnosis has an established track record when employed as an adjunct to Counselling and sometimes to Psychotherapy. Much of the material is however of an anecdotal nature and lacks a solid research base with replicable structured approaches and adequate appropriate trials. As neuro-imaging studies reveal what is going on in the brain during “Talk” therapy the “trance” state, achieved typically in Hypnosis and Meditation, has also become a research tool, in modern Neuro-science.

Thus over the last few years significant advances in Neuroscience and in particular the use of imagery (fMRI, SPECT and PET principally) have been made by using verbal suggestions with a subject in the induced trance state (effected in Hypnosis and Meditation typically). A range of mental phenomena have been studied including thought suppression, perception, pain, memory, “blindness”, assessment of color, literary and numerical tasks, the production of “hallucinatory” material and voluntary control of various body systems. The induced trance state has also been manipulated to develop hypnotic emulations of various psycho-pathological conditions (for example synaesthesia). Modern functional MRI imaging and PET techniques in particular have made it possible to observe the relevant highlighted areas of brain activity associated with particular verbal suggestions.

It is becoming apparent that the effects observed in the trance state relate to disturbances in the normal communications connectivity between particular brain areas. In particular in this state there seems to be a de-coupling between cognitive control and conflict monitoring in the frontal lobes of the brain. Maintaining an induced delusional belief about self, even when presented with conflicting evidence, seems to be a direct example of the latter de-coupling. The common trance experience of “timelessness” and sometimes detachment from “self” are typical examples of such disturbances. Post trance state memory loss, as a result of a direct suggestion in trance to display amnesia for the suggestion, also appears to be a viable emulation of actual functional amnesia.

In addition to the relatively common Clinical use of trance techniques to manage pain there are now beginning to appear studies relating to some of the other serious issues presenting themselves in Clinic. For example post traumatic stress-related memory processes with “flashbacks” and other symptoms of PTSD are now beginning to be suppressed by a process of trance-induced emotional “numbing” which, with suitable suggestions, can be induced without affecting the ability to cognitively recall the memories themselves. It is proving possible to re-script the trauma using the creative imagination of the “right brain”.

There is also now increasing evidence via imaging that the trance experience of an activity seems to create brain states closer to the actual experience of the activity than simply imagining it. This implies that trance experience in the Clinic during behavioural rehearsal of new beliefs and behaviour is more effective than live therapeutic procedures. This may be because of the degree of focused attention involved. This provides clear support for a vast body of anecdotal Clinical hypnotic experience relating to successful behavioural rehearsal.

Both hypnotic and meditative trance states (particularly the practice of mindfulness) heighten awareness and the ability to focus attention, enhance learning-related discrimination, reduce attention to external stimuli and tend to suppress spontaneous interfering thought.

Verbal suggestions therefore lay an efficient basis for cognitive, affective and behavioural re-education and in so doing offer a pathway towards Clinical Psychotherapy. Increasing interaction between neuroscience and Psychotherapy reveals the fact that learning plays a vital role both in the early development of brain structure and in its development throughout life through the process referred to as neuro-plasticity by which re-education can result in the laying down of new neuronal pathways at any point in the lifetime.

As the understanding of Hypnosis expands it is clear that Hypnosis used as an adjunct to evidence-based psychotherapy (such as CBT and Psychodynamic therapies) opens up a rich collection of tactics and strategies involving the deeper mind (the seat of auto-biographical memory). These are not generally available to talk therapy restricted largely to the conscious mind as, for the most part, in classical CBT for example.

This being so it is inevitable that Professional Associations, Government and the Insurance Industry will, within the discipline of Therapeutic Hypnosis, push for the adoption of evidence-based practice as the only acceptable “best practice” for the consumer. It is this overall understanding which has led to the establishment in Europe of the discipline of Hypno-psychotherapy.

The international register of evidence-based Hypno-psychotherapists (IREBH) provides a route for Professional Accreditation in the use of Hypnosis in evidence-based best practice as distinct from complementary (CMT) practice[1]; such a route is necessary if Hypnosis is to be successfully promoted as a core modality of evidence-based Psychotherapy.

[1] CMT is the acronym that has been adopted for Complementary Medical Practices in general.