Hypnosis and Treating Depression: Applications in Clinical Practice

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The meta-analysis clearly indicates hypnotherapy is highly effective in treatment of psychosomatic disorders Results of scientific studies demonstrate that hypnosis is an effective and efficient means of developing the resources of people suffering from severe chronic illness 14 , 17 , 26 , 28 - After an average of few hypnotherapy sessions in severe chronic diseases, patients are able to locate previously unexploited resources within themselves and are able to become autonomous in the use of self-hypnosis.

The major benefits reported concerned the reduction in pain, anxiety and distressing symptoms 4 , 14 - 18 , 20 - 23 , Clinical hypnosis in palliative care is indicated for all the patients with any serious illness and who have physical, psychological, social, or spiritual distress 4 , 15 - 17 , 26 - We perceive pain and suffering as separate entities. The physical, anatomic, and neurochemical expression of pain is treated by medicines, antidepressants, benzodiazepines, opioids, anesthesiological nerve blocks, electric stimulators, surgery and physical therapy.

The multiple physical and psychological symptoms, the dramatic alteration in support needs and in personal relationships, all may constitute pathways to psychological distress in this population.

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These emotions and the pain are quite responsive to a good hypnotherapy as adjuvant to the other therapies. Each patient must be treated with the knowledge that physical, psychological, social and spiritual suffering, cannot be treated in separation. When suffering is removed, pain tends to become tolerable or may even disappear 17 , 18 , 27 , 28 , 31 , 33 - The goals of clinical hypnosis, as an adjuvant therapy, in palliative care for the severe chronic diseases, are the same focused on the guidelines for palliative care of WHO 1.

Several reviews and systematic research studies confirm that psychological interventions and clinical hypnosis are effective in the treatment of acute and chronic pain 15 - 18 , 33 - 36 in disability, cancer-related pain, and in severe chronic diseases 17 , 28 - 31 , 37 - For both chronic and acute pain conditions:.

The brain imaging studies are demonstrating the neurophysiological changes that can and do occur because of hypnotic analgesia treatment. Studies using fMRI and PET scan technology have revealed that a number of brain structures involved in the perception of pain e.

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A method for the assessment of symptoms in patients and their relief with hypnosis , admitted to pain therapy and palliative care, is the Edmonton Symptoms Assessment Scale ESAS , in which there are eight visual analog scales VAS. VAS from 0 to 10, indicating the levels of pain, activity, nausea, depression, anxiety, drowsiness, appetite and sensation of well-being 46 , sometimes with the addition of shortness of breath On the scales, 0 means that the symptom is absent and 10 that it is of worst possible severity 46 , Suffering from uncontrolled pain and symptoms, is a significant fear of those with severe chronic illnesses 9 , 10 , 17 , 28 - 30 , The analgesic ladder was designed by the WHO 49 to assist the healthcare prescriber in the recommendation of analgesic drugs by suggesting a logical strategy for managing pain in a multitude of pain situations.

We can consider clinical hypnosis as a non-pharmacological and noninvasive adjuvant in pain therapy and related symptoms, in severe chronic diseases and in palliative care 15 - 18 , 22 , 28 - 32 , 34 - 38 , 41 , Clinical hypnosis is efficacious for managing chronic pain and symptoms, and hypnosis interventions consistently produce significant decreases in pain associated with a variety of chronic-pain problems. In addition, hypnosis is generally found to be more effective than non-hypnotic interventions such as attention, physical therapy, and education 17 , 18 , 41 , 42 , 50 - The hypnotic intervention for pain and anxiety relief typically begins with an induction and suggestions for deepening the trance state.

These are followed by various suggestions for reduced pain, anxiety and other distressing symptoms. The existing literature suggests that although benzodiazepines effectively reduce anxiety symptoms in the short term, at this time, there is not sufficient evidence to determine the long-term benefits of these medications.

Hypnosis and self-hypnosis training represents a rapid, cost-effective, and safe adjuvant or alternative to medication for the treatment of anxiety-related conditions 17 , 20 , 28 - 31 , 34 - 36 , 54 , Cognitive hypnotherapy CH is applied to the treatment of anxiety disorders 17 , 20 , 34 , 35 , 38 , Rapid and sustained relief of severe anxiety is necessary to achieve comfort at the end of life: skilled additions of psychological therapies as clinical hypnosis with breathing exercises, and combined pharmacotherapy, led to control of anxiety 17 , Depressed people feel sad, anxious, empty, hopeless, worried, helpless, worthless, guilty, irritable, hurt, or restless.

They may lose interest in activities that once were pleasurable, experience loss of appetite or overeating, have problems concentrating, remembering details, or making decisions, and may contemplate, attempt, or commit suicide. Insomnia, excessive sleeping, fatigue, loss of energy, or aches, pains, or digestive problems that are resistant to treatment may also be present 30 , 58 , Screening for depression in terminally ill patients can optimize their physical comfort at the end of life The core issue regarding antidepressants for many clinicians is whether they perform significantly better than placebos.

However, the enhanced effects of psychotherapy utilizing hypnosis offer a means of avoiding most, if not all, of the problems associated with the use of antidepressants as a primary form of treatment 17 , 30 , 61 - Alladin A. They studied 84 patients with depression: they were randomly assigned to 16 weeks of treatment of either CH or CBT alone.

At the end of treatment, patients from both groups significantly improved compared to baseline scores. The effect size was maintained at 6-month and month follow-ups. This study represents the first controlled comparison of hypnotherapy with a well-established psychotherapy for depression Evidence-based strategies, including hypnosis, are studied in the context of CH for depression, to illustrate how expectancy effect can be maximized in psychotherapy and clinical hypnosis 30 , 64 , During the final months and days of the life, pain, anxiety, depression, fatigue, loss of appetite, dependency and feeling, unwell are the most prevalent symptoms.

Physical symptoms are more often treated than psychosocial symptoms 17 , 30 , 64 , Nausea and vomiting are portrayed in the specialist palliative care literature as common and distressing symptoms affecting the majority of the patients. Nausea is a non-specific symptom, which means that it has many possible causes. Some common causes of nausea are motion sickness, dizziness, headache, fainting, gastroenteritis stomach infection , or the side effects of many medications including cancer chemotherapy.

Nausea may also be caused by anxiety, and depression. Typically, it is controlled using antihistamine drugs or anti-emetics. In addition to nausea and vomiting following chemotherapy treatment, cancer patients can experience these side effects prior to a treatment session, the so-called anticipatory nausea and vomiting. Richardson, Smith, McCall, Richardson, Pilkington, and Kirsch 67 , systematically reviewed the research evidence on the effectiveness of hypnosis for cancer chemotherapy-induced nausea and vomiting CINV. Specialist complementary and alternative medicine databases were searched and efforts were made to identify unpublished and ongoing research.

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Randomized controlled trials RCTs were appraised and meta-analysis undertaken. Clinical commentaries were obtained.

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In five of these studies the participants were children. Studies report positive results including statistically significant reductions in anticipatory and CINV. Meta-analysis revealed a large effect size of hypnotic treatment when compared with treatment as usual, and the effect was at least as large as that of CBT 67 , The scientific experience highlights the potential value of hypnosis in the management of anticipatory nausea and vomiting in chemotherapy and in severe chronic diseases 17 , 27 - 31 , 38 , They recognized reasonable quality of nonpharmacologic strategies for managing common chemotherapy adverse effects, as cognitive distraction, exercise, hypnosis, relaxation, and systematic desensitization to reduce symptoms in cancer 35 , 37 - 39 , 66 - Dyspnea is frequently encountered in the palliative care setting.

Dyspnea is treated with or without invasive or noninvasive mechanical ventilation by optimizing the underlying etiological condition, patient positioning and, sometimes, supplemental oxygen. Systematized improvement efforts addressing symptom management and assessment, as clinical hypnosis, can be implemented 17 , 18 , Hypnotherapy in severe chronic diseases can be useful in the management of anxiety, discomfort, physical and psychosomatic symptoms, all of which may contribute to a complaint of dyspnea 17 , 18 , 26 - 31 , 35 , 37 - 39 , The focus of the hypnotherapy in severe chronic diseases is to ameliorate not only the effects of pain, anxiety, but also other distressing symptoms as dyspnea, to restore a level of psychological and physical wellbeing 17 , 18 , When a state of a lighter or deeper relaxation is achieved, through different techniques of hypnotical induction, the patient is trained to interpret the feeling of chronic pain, or tremor, or rigidity, coming from a specific place in the body, and to transform it, slowly from an unpleasant feeling, to a sensation of different nature.

For example, he can feel pleasant slight, moderate pressure, beneficial warmth or cold sensation of anesthetizing nature. After achieving relatively strong analgesia in a certain part of the body with the techniques described above, you aim to mentally transfer the analgesia to another part of the body for instance from the hands to the abdomen or to the back obtaining this way a gradual and progressive reduction of the global suffering.

This method can be very useful for chronic pain by training the patient to move his attention to those parts of the body, which are not affected by pain. Using gratifying visualizations, you train the patient to move his attention to other pleasant sensation of his body, which are past or present. This method is also useful in chronic pains, which are not too strong and the patient must participate actively to the visualizations. With this exercise, you will be under hypnosis for different lengths of time measured in minutes or seconds:.

Think that by counting down also your pain decreases progressively. This is one of the most efficient techniques and is carried out in three phases of suggestions during a light physical relaxation or a medium hypnosis:. Anytime during the day or evening, if you feel overwhelmed, anxious or stressed in any way, it would be extremely beneficial to just stop for a moment, and take very slowly, five to ten deep, relaxing breaths. We all started out our life doing deep breathing but as we got older, some, because of certain factors, in their life switch over to shallow breathing. So, if you want to look at it as relearning the type of breathing you did when first born, then do so, because as an unknowledgeable newborn baby, at the subconscious level or soul level, you came into this world knowing what was best for your survival in it.

If you have difficulty in doing your inner slow breathing, try it while lying down in a relaxed and comfortable position. The more slowly you do it, the more it will become automatic and the need to consciously think about it will eventually be gone. This kind of memory is fixed on groups of cortical and sub-cortical neurons or some programs active in our brain since the first 2 or 3 years of life. When something distracts us, a thought, a sound, a voice far away, without effort… naturally we return our attention on our slowly breathing. We are very afraid consciously and unconsciously of death, because we do not know what death is.

Hypnosis and Treating Depression Applications in Clinical Practice

We have learnt to be afraid of death. During our life span, we have a lot to learn, for instance how to feel, how to love, how to respect the others, and ourselves how to be compassionate towards others, how to understand the awakening of our consciousness and the most important thing to know, the fact that we will leave our body here on this world.

Hypnotherapy : Holistic Treatment for Severe Depression

Death is the event that changes us most, but it is also the event, which is less important in our lives obsessed by time. Dying is something that happens to everyone. It is very important to be able to die with serenity and awareness. The more advanced a severe chronic illness has become, the more hospital staff should focus on holistic treatment, as hypnosis, encompassing body, mind and soul of the patient.

Clinical hypnosis is a treatment that activates available resources; it is not only an effective way of alleviating pain, but it also can ease psychological problems at the same time 17 , 20 , 28 - 31 , 34 - 36 , 54 , 55 , When we allow death and awareness of life to occupy their natural position in our life, we are presented with many opportunities to open ourselves to the beauty of life, and we will never fear the unexpected, but gain the strength, love and compassion when we understand that all this is a natural part of our life. Hypnosis and self-hypnosis, affirms life, regards dying as a normal process and helps 17 , 20 , 27 - 31 , 34 - 36 , 38 , 54 , 55 , 61 - 65 , 68 :.

When the patient is always in state of relaxation or in medium hypnosis state, you can introduce particular visualizations that will origin, after a certain time, major handsome feeling visualizations that are capable to modify the stressful information in the central nervous system, and therefore reduce pain and the total suffering to the patient 17 , Clinical hypnosis respects life and death.

Clinical hypnosis can be useful for patients at the end of life, not only for pain and suffering relief, but also to relief psychological and spiritual suffering, with the activation of spiritual consciousness, like a near-death experience NDE Clinical hypnosis at the end of life represents the optimism of the human spirit, or maybe it ensures that the experience is subject to recall and recounting.

A NDE refers to personal experiences associated with impending death, encompassing multiple possible sensations including detachment from the body, feelings of levitation, total serenity, security, warmth, the experience of absolute dissolution, and the presence of a light. Indeed, hypnosis confers only a slight advantage 1—1. These very same procedures can be used in clinical contexts to maximize hypnotic responsiveness.

Practitioners with allegiance to virtually every major school of psychotherapy have incorporated hypnotic methods into the broader skein of their therapy of choice. Such expectancies may be so unrealistic, however, that therapists may feel the need to temper them, so as not to leave patients feeling defeated in the event the intervention fails.

Freud — used hypnosis in his early work with patients. However, his later rejection of hypnosis as an unreliable method relegated hypnosis to the fringes of medicine and psychology for much of the first half of the twentieth century. The evidence for this theory is mixed. Although hypnosis can increase fantasy, imagination, and primary process material, it may be the case that these shifts in consciousness are associated with relaxation and eye closure, and are not specific to hypnosis. The effects of adding hypnosis to psychodynamic approaches have not been studied systematically.

Hypnosis and treating depression : Applications in clinical practice. - Version details - Trove

After a long hiatus in interest in dissociation, E. The theory posits that during hypnosis, executive monitoring of behaviors is dissociated from subsystems of control, which can be directly accessed by suggestion. An amnesic barrier is theorized to separate these subsystems of control from normal executive functions, so people are unaware of how their behavior is controlled and respond automatically to suggestions.

More specifically, they suggest that therapists can access and have conversations with different ego states i. Another version of dissociation theory has been termed dissociative control theory. This rejects the idea of an amnesic barrier like the one Hilgard hypothesized. There is considerable evidence that much behavior, hypnotic or otherwise, is executed on an automatic basis with little or no conscious control, and that hypnosis may further automatize mental processes and behaviors. The sociocognitive approach holds that hypnotic behavior is not the product of a special altered state of consciousness but is instead the product of a convergence of variables, including what people believe about hypnosis, their attitudes, expectancies, imaginings, knowledge about what is expected of them, and their motivation and ability to experience imaginative suggestions.

This perspective has its origins in the writings of Sarbin, T. Barber, Coe, Spanos, Chaves, Lynn, Kirsch, and Wagstaff, who have vigorously challenged the existence of a special hypnotic state or trance. This view of hypnosis finds support in research showing that expectances, attitudes, beliefs, and imaginings account for significant variability in hypnotic suggestibility. Milton H. Erickson eschewed the traditional, authoritarian approach to hypnosis and devised clever hypnotic approaches that he integrated into brief therapies that used paradox, metaphors, analogies, indirect and permissive suggestions, and teaching stories to modify behaviors.

Some of his contentions, such as that the hypnotic state is marked by a curious literal response to suggestions, and that indirect and permissive suggestions are superior to more direct approaches, have not withstood experimental scrutiny, but many of his methods have remained popular among clinicians and promulgated in writings by Zeig, Yapko, and Lankton. The effectiveness of hypnosis has been evaluated in treating medical and psychological conditions.

In terms of habits and psychological conditions, hypnosis appears to provide better outcomes than no treatment for smoking but it does not appear to be superior to rapid smoking or other psychological treatments. Researchers have also found that hypnosis contributes to therapeutic outcomes when added to CBT for depression, public speaking anxiety, and acute stress disorder.

Some uses of hypnosis are contraindicated by research. These pseudoscientific applications include the use of hypnosis to recover repressed memories, for memory enhancement generally, and for past life regression. In fact, hypnotherapist certification has been obtained for a pet cat under the name Dr. Zoe D.