Hypnosis for anxiety/depression

[Iwillheal]

We only do CBT and a bit of ACT. But a psychiatrist who is not my supervisor but does work with the program, told me to consider learning hypnosis, after I asked him how he deals with very anxious and also Cluster B patients. My psychologist supervisor doesn't believe hypnosis helps much. Regardless, this is a personal project and something that I've had an interest in, for a long time. I never pursued it because it looked more like a magic trick, a placebo effect, than something genuine and scientifically defensible. Anyhow, I want to learn more about hypnosis, in particular for anxiety/depression. I've read Elman's classic book and Erickson's (that one, long ago) and I'm in process of reading Spiegel's I'm okay/decent on theory now I think, and I need a few books on actual practice of hypnosis, perhaps with scripts and explanation of the process and how to handle client reactions and tailor the process accordingly, and also perhaps a less jargon filled book on self hypnosis to recommend to the motivated patient.

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[billypilgrim37]

American Society for Clinical Hypnosis is a great place to start. Their trainings are supposed to be wonderful, and I'm going to try to get to one next year sometime. I have friends who have done it and thought highly of it. Nitemagi is our local hypnosis expert, so wait to see what he has to say before you go registering for any classes.

 

[F0nzie]

I think it would be neat to learn more about hypnosis. Unfortunately, I have not learned a single thing about it during my first 3 years of Psychiatry residency. The one thing that comes to the forefront of my mind is liability, and I wish it were not so. We hear all these stories of people getting hypnotized and publicly humiliated ie. instructed to act like a chicken in front of an audience without even realizing it. In an intrusive/obssessive kind of way, I start to think of catastrophic scenarios of being alone with a patient ie, the pt who may be considered by the public eye to have lacked capacity during the time of hypnosis who fabricated a story about being touched inappropriately. Not to mention having a lawyer ask me "where does it say in your medical treatment guidelines that hypnosis is a standard of care treatment for anxiety?". As physicians we're held to high standards and use of alternative, potentially life saving methods for treatment resistant depression would be placed under a critical eye even among those in our own profession. A savvy forensic psychiatrist destroying my reputation on the stand would not be my cup of tea. However, I do coach some patients through progressive muscle relaxation exercises which may operate by similar principles and patients have found it to be extremely helpful. Until I know more about hypnosis I would be reluctant to even try it or call it hypnosis simply because of the added stigma attached to it. The modern era of defensive medicine does not help my unease.

 

[splik]

You really need to do a course with the ASCH (as mentioned), the Society of Clinical and Experimental Hypnosis or Division 30 of the American Psychological Association (at the annual convention). The Milton Erickson Foundation also runs courses but these are longer and you are less likely to have time to do them.

You might also consider going to the International Society of Hypnosis Congress, which this year is in Bremen and you will meet the leaders in the field from all over the world. In particular they have a whole program on depression from different perspectives. In North American Michael Yapko and Assen Alladin have written the most on hypnosis and depression, and the latter wrote a book on cognitive hypnotherapy with a small study showing superiority to cognitive therapy alone for depression.

It's great you've done some reading but really you need to get proper training if you want to use hypnosis effectively in your work. I find it useful and it is a joy to have patients who are very hypnotizable!

 

[splik]

I think it would be neat to learn more about hypnosis. Unfortunately, I have not learned a single thing about it during my first 3 years of Psychiatry residency. The one thing that comes to the forefront of my mind is liability, and I wish it were not so. We hear all these stories of people getting hypnotized and publicly humiliated ie. instructed to act like a chicken in front of an audience without even realizing it. In an intrusive/obssessive kind of way, I start to think of catastrophic scenarios of being alone with a patient ie, the pt who may be considered by the public eye to have lacked capacity during the time of hypnosis who fabricated a story about being touched inappropriately. Not to mention having a lawyer ask me "where does it say in your medical treatment guidelines that hypnosis is a standard of care treatment for anxiety?". As physicians we're held to high standards and use of alternative, potentially life saving methods for treatment resistant depression would be placed under a critical eye even among those in our own profession. A savvy forensic psychiatrist destroying my reputation on the stand would not be my cup of tea. However, I do coach some patients through progressive muscle relaxation exercises which may operate by similar principles and patients have found it to be extremely helpful. Until I know more about hypnosis I would be reluctant to even try it or call it hypnosis simply because of the added stigma attached to it. The modern era of defensive medicine does not help my unease.

Where is in the standard of care is psychodynamic psychotherapy for depression or anxiety disorders? This is still used. What about existential psychotherapy, or gestalt therapy, or integrative therapy? The point is there are any different approaches that are used, some of which do not have a robust evidence-base. The question is, as a clinician are you using your judgement and expertise to select an approach that you believe is indicated, that is not contra-indicated, that has a clear rationale. Hypnosis is not a form of therapy itself, it is used with other therapeutic approaches, e.g. analytic, behavioral, cognitive etc to improve outcomes. There is an evidence-base in some cases. Cognitive-behavioral approaches increasingly use techniques from the hypnotic toolkit like stories, metaphors, imagery, relaxation, imaginal exposure whether they admit it or not.

There is the risk of being accused of a patient of being inappropriate during any psychotherapy. Is the risk greater when using hypnosis? Possibly. That is why it is important, as always to recognize that there are some patients who are liable to make such allegations and proceed with caution. Sometimes recording the sessions, or the presence of a chaperone may be necessary. This is especially true when working with children or adolescents. There may be the possibility of touch with hypnosis (I often will use touch) - it must be made clear and is usually acceptable.

 

[F0nzie]

Where is in the standard of care is psychodynamic psychotherapy for depression or anxiety disorders?

I suppose since it's still under the umbrella of psychotherapy, the nuances do not bother me as much. While I have learned several distinct styles of psychotherapy in my 3rd year, I do not practice them exclusively. I simply pick and choose different styles that I believe would be most helpful to the patient. I do not really care for a single psychotherapy type unless I feel the patient would benefit from a very structured method.

Sometimes recording the sessions, or the presence of a chaperone may be necessary.

Interesting concept. That would pretty much cover most of the concerns I have.

 

[Iwillheal]

Thanks for the comments thus far.

 

[nitemagi]

Hypnosis is a broad term. What you're mostly interested in is hypnotherapy. Reading some books is useful, but it's similar to reading a book on psychotherapy. You need practice.

The books you cite are good --
Elman has some good basics. Spiegel & Spiegel (Trance and Treatment) is very good (written by 2 psychiatrists). Erickson isn't going to be summed up in a book. Everyone has a different take on what he did (check out books by Jay Haley, Sidney Rosen, Bandler and Grinder, and by Erickson himself). Then watch videos.

The ASCH courses are useful for the basics and they usually involve small group practice, which is where the money is. I've been doing hypnosis work since I was 20 years old, starting as a layman and then learning it professionally. ASCH hours also qualifies you for the American Board of Medical Hypnosis (really more like a certficate than a real board certification, if that makes sense).

My best suggestion is to use it in at least small pieces with all your patients. Try it out. It's not just about induction. Inducing someone is the easy part. There's many levels beyond that that really gets at the meat of the trait vs. state debate, the idea of communicating with the unconscious without trance, and the nature of psychotherapy in its various forms. And most importantly, get a good supervisor (and like any therapy supervisor recognize they will likely come from a school of hypnosis/hypnotherapy training, so get another supervisor later).

As for the title of the thread, applying hypnosis to depression and anxiety, anxiety is easy because the nature of trance involves relaxation (relaxation, concentration, dissociation). Teaching self-hypnosis is then a useful strategy as well. Depression varies. Some approaches can involve visualization exercises, use of suggestion, metaphor to guide through the struggle they're going through, or use of regression and their heightened state of concentration to do work that might take longer in a normal waking state. Imaginal exposure for example could be used as well in a systematic desensitization. Lot of options, for those interested.

As others have said, go with the reputable sources -- ASCH (has local branches around the country), SCEH. There's also Erickson Institutes and a foundation with trainings.

As for your psychologist supervisor, my experience is that like in all of medicine, people carry the biases they were passed on from their teachers, usually without exploring it much on their own. I doubt that supervisor has much experience using it, or has reviewed much of the literature on it.

 

[Iwillheal]

Thank you Nitemagi, appreciate the comprehensive and helpful reply.

 

[aphenomenon]

Somewhat relevant, I was reading through my own personal insurance benefits and they specifically listed hypnosis as one of ~10 things that won't be covered.