Treating Depression With Hypnosis

Integrating Cognitive-Behavioral and Strategic Approaches

Michael D. Yapko

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781135896478
• Edition: 1
• Topic: Psychologie
• Subtopic: Conseil en psychothérapie

Depression is a debilitating human condition and a common cause of suffering worldwide. This elicits a sense of urgency for mental health professionals to meet this challenge of the treatment of depression. Hypnosis plays a vital role in that treatment and in the efficacy of psychotherapy.

This book focuses on the structuring and delivering of hypnotic interventions for major depression, with a substantial use of concepts and techniques from cognitive-behavioral and strategic approaches as a foundation. Current research on depression is used in this book to emphasize the still-growing knowledge of depression. Hypnosis has shown itself to be effective in not only reducing symptoms, but in teaching the skills (such as rationale thinking, effective problem-solving and coping strategies, and positive relationship skills) that can even prevent recurrences. Mental health professionals will find the detailed examples of hypnotic strategies invaluable to their own practice and application of hypnosis in the treatment of depression.

CLINICAL APPLICATIONS

Ambiguity and the vulnerability of believing

4

Having studied and practiced clinical hypnosis full-time for over a quarter century, I have come to appreciate some of the paradoxes inherent in doing hypnosis in the clinical context. In applying hypnosis with clients who are striving to change some aspects of their lives, one cannot underestimate how fragile people are and, paradoxically, how powerful they are. Nor can one ignore how utterly vacant someone can be, usually right before, paradoxically, he or she demonstrates a remarkable resourcefulness. People can be mindlessly ritualistic and then, paradoxically, dazzle you with their creativity. These and many other seeming paradoxes of human nature are amplified in hypnosis (Haley, 1973).

My view of human nature has been profoundly influenced by my clinical work with clients. I have certainly learned the importance and power of people’s beliefs. Many years ago, William Kroger, M.D., a pioneer in hypnosis in the 20th Century who frequently taught and eventually cofounded the American Society of Clinical Hypnosis together with Milton H. Erickson, M.D., defined hypnosis for me as “the induction of conviction” (Yapko, 1987, p. 4). I think he was right about that. And, I think it was perceptive on Kroger’s part to frame hypnosis in terms of belief systems.

It is an entirely human phenomenon to have minds that can be so easily manipulated, under the right conditions, by our own innate need to believe. Whether discovered in ancient archaeological digs or pulled out of today’s headlines, the very human need to believe is instantly evident as the force controlling human behavior and even human evolution. How have your beliefs shaped your life? What have they led you to do, and led you to avoid doing? What beliefs have you held that ultimately were proved wrong, and when they were, what did that spark in you? A crisis of faith, an evolutionary leap in consciousness, or nothing at all?

Depression is closely connected to beliefs. So much of what we as clinicians do in treatment is find creative and respectful ways of challenging the depressed client’s worldview, namely, the specific beliefs they hold (e.g., “Life is no damn good”) that can cause or exacerbate depression. And, we challenge the mechanisms by which such beliefs are formed (Kovacs & Beck, 1985).

Focusing on “why” someone would hold an erroneous, self-limiting, even depressing belief is an unnecessary question to ask. The question is as global as this answer: the vulnerabilities associated with the need to believe. Why do we have a need to believe? In large part, to make sense out of randomness and nonsense, and thereby have a sense, however illusory, of having some control over our experience (Seligman, 1993).

Ambiguity

Ambiguity may well be the most powerful and pervasive risk factor for depression of all known risk factors. Ambiguity in this context refers to the lack of clear meaning associated with one’s various life experiences. Events occur, we observe them occur, but what we most often don’t know is what, if anything, they mean. The great majority of events in life do not have a clear and inherent meaning, leaving each of us the task of having to establish for ourselves our own subjective interpretation of what the meaning or significance is of the event. This is the process of “projection”–projecting meaning onto ambiguous stimuli. In response to any life event, however minor or major, the formation of an idiosyncratic meaning represents the heart of a belief system, whether self-reinforced (e.g., “I believe it no matter what others might think”) or culturally reinforced (e.g., “Any true American would believe this”). Beliefs are multidimensional, encompassing feelings, physiology, and behavior, as well as the obvious cognitive components, and all will need to be addressed in a comprehensive intervention.

Like the well-known Rorschach inkblot test requiring respondents to project personal meanings onto ambiguous inkblots, we all do the same throughout life. Thus, life can be described as an “experiential Rorschach,” and what this book is about–and what therapy is about–is dealing with the consequences of the projections one makes. The consequences in terms of mood are the most relevant for this book–the optimism and good feelings that come from an expansive projection that says, “Life is an adventure, a wondrous opportunity to experience all the glories of living,” or the despair and anguish that come from a hurtful projection that says, “Life is a bitch, and then you die” (Peterson, 2000).

Depression is largely (not entirely) about projections that hurt. In the face of ambiguity, the depressed person forms perceptions, attributions, beliefs (pick one) that are painful in some way. Once the person adopts and integrates his or her depressogenic perceptions (attributions, beliefs), a personal conviction has been induced–but in an anti-therapeutic direction. Hypnotic patterns–the induction of conviction–clearly have the potential to harm.

Cognitive therapy (CT) in particular has flourished as the most well-studied and most systematic form of psychotherapy. Aaron T. Beck, M.D. and Albert Ellis, Ph.D., in particular, spawned a revolution in the field of psychotherapy by shifting the focus away from what someone thinks (the content) to how someone thinks (the process). Whether assessing the specific cognitive distortions in the context of Beck’s Cognitive Therapy (1997), or irrational beliefs in the context of Ellis’ (1997) Rational Emotive Behavior Therapy (REBT), the underlying mechanism for the development of depression is in the inability to distinguish inferences (projections) from facts. Why are there cognitive distortions or irrational beliefs to have to correct in CT or REBT? Why can’t people willingly and with self-awareness side-step the vulnerability of their own beliefs?

Let’s consider as an example a so-called cognitive distortion, “jumping to conclusions,” the error of reaching a conclusion despite the lack of supportive evidence. Why jump to conclusions, if not merely to have a conclusion? But the corollary question is, why have the need for a conclusion? What is it about ambiguity that is so compelling in the force it generates to produce an answer, even if it is a wrong or hurtful one? How much human misery could be alleviated by a refined and perceptive means for simply saying, “I don’t know” and leaving it at that? Consider these questions:

Is there a God?

Is there life after death?

Why do innocent babies die of terrible diseases?

Is reincarnation true?

What capacity does the unconscious have for healing sickness?

Is there such a thing as fate?

Why isn’t life fair?

You can answer these and a million more such “cosmic” questions however you might like to, but whatever answer you have settled on is merely your belief. These are and will remain open questions that no amount of analysis, either scientific or philosophical, will definitively answer. Believe what you want, but if these could be answered definitively, they would be answered, and would be in no need of the continuous exploration and re-exploration each question still engenders.

What quality of life, including a quality of mood, does your–or anybody’s–answer create? What would happen if people were able to simply say, “I don’t know” in response to such questions? At the very least, the level of struggle both intrapersonally and interpersonally would be greatly reduced. There would be fewer people feeling the need to kill or hurt other people for their having the “wrong” (i.e., different) politics, religion, skin color, sexual orientation, age, or gender. People would develop a greater tolerance for personal beliefs, arbitrary as they might be, that enhance someone’s sense of personal and social responsibility. People would be more aware of the distinction between fact and inference, and strive to develop more facts when possible, and more acceptance of diversity in projections (“creativity”) when no such facts either do now or will ever exist.

Recognizing and tolerating ambiguity

It is no coincidence that one of the most basic goals in treating therapy clients in general, and depressed clients in particular, is to teach them how to recognize and tolerate ambiguity. It is a therapeutic goal that even precedes identifying specific cognitive distortions or irrational beliefs in the client. Before teaching someone to avoid jumping to conclusions (or personalizing, or thinking dichotomously, for example), that person would have to be comfortable having no conclusions (i.e., a reduced drive to have an answer). Thus, by addressing the issue of ambiguity in therapy, and making it a primary target of a specific hypnotic intervention, the larger goals of therapy such as teaching skills in rational thinking are well facilitated (Sacco & Beck, 1995). For as long as an individual is unable to tolerate uncertainty, he or she will be motivated to continue forming projections onto life experience with little or no insight into the process, and thus suffer the mood consequences when they are accepted as “true.” Simply put, the essence of depression is that people think things, and then mistake their thoughts, beliefs, and perceptions for “truth.” The sophisticated skills of identifying and then self-correcting one’s cognitive distortions are vital skills for any human being, depressed or not, to learn and master if one is to create a better world for oneself (and the rest of us).

Less globally and wishfully, the positive value of cognitive therapy in particular has been well documented in the literature, and is clearly a treatment of choice for depression (Dobson, 1989). Cognitive skills can be learned more easily with hypnosis as a vehicle of experiential learning, and what little efficacy research there is bears that out. Further, cognitive skills can be more easily learned when the basic human need to believe something–anything–can be reduced and, metaphorically, surrounded with warning signs that flash the message, “Warning: Vulnerability to Symptoms Ahead, Proceed With Caution.” People simply have to learn that their beliefs represent, paradoxically, both their potential strengths and weaknesses. Clinicians want their clients to learn how to stay connected to (“associate”) those beliefs that serve them well by enhancing their outlook on life, improving their physical health, increasing their productivity, and enhancing their relationships. Likewise, clinicians want their clients to learn how to disconnect from (“dissociate”) any beliefs that impair functioning on any of those dimensions.

Flexibility

What hurts or helps changes over time, though. The beliefs that help make one strong (e.g., “Never give up!”) can easily become the very beliefs that are the basis for emotional pain and even depression when circumstances change and now make such beliefs unrealistic and self-damaging. Thus, the goal of therapy is not just to teach how to let go of or self-correct specific dysfunctional attitudes or beliefs, but how to recognize the changes in context that now require a modification, coupled with the flexibility to actually achieve the modification. To achieve this, one would have to be relativistic in one’s thinking–the opposite of believing in “absolute” truths, namely, beliefs that do not and will not vary according to context. It is difficult to be relativistic when cultures and families often promote a belief in absolutes: “Trust your intuition”…“All things happen for a reason”…“Keep your feelings to yourself”…“Be fully present in the moment.” Even in the hypnosis culture, the absolutes exist: “Always have the client sign a hypnosis release form”…“Always assess hypnotizability”…“Never tell the client the meaning of the metaphor”…“Hypnosis is all about the skill of the client, not the techniques of the hypnotist”…“Always have the client sit with both feet on the floor before beginning an induction”…“Never use hypnosis with depressed clients.”

Is it any coincidence that the field generates divisive polarities in views and practices of hypnosis? The disdain many traditional practitioners of hypnosis have for “Ericksonian hypnosis” practitioners, and vice-versa, is irrational and unjustifiable. Each approach can work well with some clients but not others. Isn’t that the basis for striving to use what works for an individual rather than striving to remain loyal to one model by devaluing another when either one can be shown to have aspects to it that don’t work universally well for everyone? So how did debates emerge that it’s “better” to be direct than indirect, or vice-versa? Better for who? Certainly not the client, who doesn’t make suggestion structure an issue other than by simply being responsive to one type or another. Some will respond well to direct approaches, some won’t.

Culturally, people get caught up in the same polarized (dichotomous) thinking as clinicians. For example, we tell clients, “Be fully present in the moment,” then complain about how impulsive they are! Why don’t we teach them more relativistic thinking, such as, “Be fully present in the moment sometimes”? But the larger point is that when clients don’t have the ability to adapt their thoughts, feelings, and behaviors context-by-context, the rigid nature of their patterns will sometimes yield distress and symptoms.

Teaching the ability to discriminate

In line with this chapter’s focus on ambiguity and the vulnerability of beliefs, a primary task of the clinician is to teach “discrimination strategies.” A discrimination strategy is an internal strategy the client can use to distinguish when it’s “this” and when it’s “that.” Using the example above of absolutes, if we want to teach someone who is often inappropriately impulsive to “be fully present in the moment sometimes,” we would first have to provide him or her with a means for positively valu...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Dedication
• Contents
• List of Tables
• Foreword
• Introduction
• Acknowledgments
• I. Conceptual Framework
• II. Clinical Applications
• References
• Appendix A Useful information on the Internet
• Appendix B Supplemental materials from Michael D. Yapko, Ph.D.
• Index