June’s Enhanced Research Snippet

Hypnosis, Meditation, Problem-Solving, & Depression

Donald Robertson, NCH Research Director

For a bit of a change, this snippet is about a proposed protocol for treatment of clinical depression, based on existing evidence-based interventions.  I reckoned the subject needed a bit of background explanation so apologies if it’s a bit longer than usual!  It’s difficult to avoid jargon when talking about state-of-the-art stuff but I’ve tried to explain briefly what some of it means.  Email me with any questions, though.

research@hypnotherapists.org.uk

There’s been growing interest recently in the relationship between cutting-edge, “third wave”, approaches to cognitive-behavioural therapy (CBT) and hypnotism.  Some of these new approaches place particular emphasis on cultivating particular states or attitudes of mind, such as acceptance or mindfulness, rather than the disputation emphasised in early cognitive therapy.  There’s also increasing emphasis on the role of attention in psychopathology and psychotherapy.  These are both, obviously, factors which can be related to hypnotherapy, which specialises in inducing particular states of mind and shifting the allocation of attention.

A June 2010 special edition of the International Journal for Clinical and Experimental Hypnosis (IJCEH) was dedicated to the subject of clinical depression, edited by Michael Yapko, who is well-known as a specialist in this particular area.  This follows on the success of Assen Alladin’s recent randomised controlled trial (RCT), which provided evidence that cognitive hypnotherapy could compete with standard cognitive therapy in the treatment of depression, and may be superior on some measures.  (The treatment of clinical depression by ordinary hypnotherapists is considered inappropriate by many experts but this research can probably be applied, to some extent, to the treatment of subclinical symptoms of depression of the sort more commonly encountered in hypnotherapy.)  The article by Lynn et al. (see below) was of particular interest because it outlined proposals for a third-wave cognitive-behavioural approach to hypnotherapy for depression, with scripted examples. 

Lynn et al. focus in particular on the central role now ascribed to morbid “rumination” in the maintenance of depressive symptoms.  They provide proposals for combining thee specialised treatments with modern hypnotherapy.

1. Rumination-Focused Cognitive-Behavioural Therapy (RFCBT)
2. Cognitive Control Training (CCT)
3. Mindfulness-Based Cognitive Therapy (MBCT)

Full details of the hybrid protocol can be found in the article referenced below.  However, to illustrate their approach, I’d like to elaborate briefly on one small aspect of this multi-component treatment approach.

Lynn et al. refer briefly to the use of problem-solving methods which are near-universal in CBT.  However, they could have also mentioned the fact that Problem-Solving Therapy (PST), an approach originating in the 1970s, has received growing support recently from treatment outcome studies as a stand-alone intervention for clinical depression.  (This is an area of special interest to me at present.)  Now, as far back as the 1940s, Lewis Wolberg had discussed the use of problem-solving methods within hypnotherapy, from a cognitive-behavioural perspective.  Wolberg, an eclectic psychotherapist, combined elements of behavioural psychology with rational persuasion psychotherapy, an early precursor of cognitive therapy, in his Medical Hypnotism, one of the best-known clinical hypnosis textbooks of the period. 

Problem-Solving Therapy (PST), in its modern form, has the merit of being a very brief and simple approach, with a well-rounded evidence-base.  It’s simple enough to combine well with hypnotherapy to form a brief hybrid treatment.  Lynn et al. go for a more complex mixture, as mentioned above, but their modified problem-solving plus hypnosis, might be viable as another stand-alone intervention.  I’d strongly recommend that you check out the third edition of the core text, Problem-Solving Therapy: A Positive Approach to Clinical Intervention, by D’Zurilla and Nezu, for a thorough description of PST methodology.  Problem-Solving methodology is derived from experimental studies on problem-solving, decision-making, and related skills, and focuses on helping clients to become more skilled and confident at identifying and solving their own problems of living, of whatever kind.  It’s based on the observation that clients, especially depressed clients, tend to complain of feeling overwhelmed by various problems of living and helpeless to start tackling them.  Essentially, the method is divided into five basic components,

1. Problem Orientation.  The client is trained to adopt and maintain a positive attitude toward solving their problems, and the key components of this mind-set are explored with them.
2. Problem Definition.  The client is trained to identify relevant problems and define them objectively with reference to appropriate goals and key obstacles.
3. Brainstorming Alternatives.  Osborn’s principles of brainstorming are employed to systematically develop a wide variety of alternative solutions.
4. Decision Making.  Cost-benefit analysis and other methods are used to evaluate proposed solutions and rank them in order of suitability.
5. Solution Implementation.  An action plan is developed and tested out in practice, followed by systematic reflection on the observed consequences, and possibly re-iteration of the process above.

That’s it in a nutshell, but read the manual above for a proper description.  PST seems to benefit a wide range of clients but it’s been especially linked to the treatment of clinical depression where there is clear evidence of a correlation between depression and problem-solving deficits, in the first place, and evidence from treatment outcome studies that PST can be broadly equivalent to standard cognitive therapy or antidepressants, although delivered in a very brief format, over about six 30-minute sessions. 

Anyway, Lynn et al., propose the following ways in which problem-solving can be facilitated by hypnosis, and I would suggest that these can be integrated with standard problem-solving methodology to form brief hypno-PST for depression, or related issues,

1. Age regression is used to regress subjects to times in the past when problem-solving was done better and prevented morbid rumination happening.
2. Suggestions can be given for increased perception of the key features of problems to be solved.
3. Imaginal rehearsal in hypnosis can be used to test out different proposed solutions and evaluate their consequences.
4. Imaginal rehearsal can also be used to develop skill and confidence in implementing the chosen solution.
5. Self-talk (autosuggestions such as “I can do this!”) can be rehearsed during hypnosis, to enhance coping skills in relation to solution implementation.
6. Hypnotic age progression can be used to have clients envision a future time when they have already solved their problems and to retrospectively identify steps they might have taken to do so.

They also mention that brooding can be overcome by use of direct suggestions (which could be recorded on a CD) to develop a positive problem-orientation or problem-solving mind-set.  I would observe that there’s some reason to believe that problem-orientation is the most important part of the whole methodology and that hypnotic suggestion could serve well as a simple way of helping clients to feel more positive and confident about tackling their problems of living, and to see them more objectively, from a realistic perspective, rather than being threatened or overwhelmed by problems.

Lynn et al., as I have done, are merely commenting on existing evidence-based methods and speculating about protocols which could combine them within a hypnotherapy framework but we can probably look forward to other treatment outcome studies, like Assen Alladin’s, which attempt to provide direct evidence for the efficacy of such multi-component hypnotic approaches. 

Reference

Lynn, S., Barnes, S., Deming, A. & Accardi, M. (2010). Hypnosis, Rumination, and Depression: Catalyzing Attention and Mindfulness-Based Treatments. International Journal of Clinical and Experimental Hypnosis, 58(2), 202-221.