When we integrate Cognitive Behavior Therapy (or CBT) into hypnotherapy, we also call this approach cognitive-behavioral hypnotherapy.
Cognitive Therapy (CT)
The aim of cognitive therapy is to help patients to replace irrational ways of representing their world with more realistic and rational ways. Some basic procedures in cognitive therapy are:
- Education (about therapy and disorder)
- Identifying salient thoughts
- Challenging the thoughts and beliefs
- Identify distortions
- Cognitive restructuring
- Testing reality
Behavior Therapy (BT)
The basic assumptions of behaviourism are that most behaviour is learned by operant and respondent (or classical) conditioning.
Operant conditioning means that a stimulus positively or negatively reinforces a response. Ivan Pavlov (1849-1936) is famous for his work on classical conditioning through his experiments with dogs: he conditioned an involuntary response (salivation) to a stimulus (sound of a bell) after repeatedly presenting an unconditioned stimulus (food).
Behaviour therapy aims at unlearning or modifying maladaptive (or abnormal) habits and help patients replace them with better habits.
Cognitive Behavior Therapy (CBT) and Cognitive Behavioral Hypnotherapy (CBH)
Cognitive-behavioural therapy combines principles of cognitive and behaviour therapy. Hypnosis is an effective tool in CBT because reduced cognitive processing and heightened suggestibility allow for rapid cognitive changes, such as replacing negative self-suggestions with positive hypnotic suggestions or promoting a self-distance perspective.
Cognitive hypnotherapy (or cognitive-behavioural hypnotherapy) is an integration of CBT and hypnotherapy.
Cognitive Behavioral Hypnotherapy (CBH)
Below are some examples how CBT and hypnotherapy are combined and how CBH is used in clients with anxiety disorders:
For example instructing a patient to breathe slowly and to listen to sounds of the environment in a distressing situation is a verbal instruction. In hypnosis, suggestion is the equivalent of instruction.
Assertiveness and Social Skills
Because anxiety disorders often disturb interpersonal relationships, training of social skills and assertiveness is usually incorporated in CBT, and can be rehearsed using imagery in hypnosis.
By observing the therapist demonstrating a skill, patients can learn desired behaviours, e.g. social skills or – as in the treatment of phobias – handling a feared object while using an anxiety management technique.
Systematic Desensitization, Hypnodesensitization
In imagination the patient is gradually exposed to more anxiety-provoking situations (according to a hierarchy) while relaxing deeply (if using hypnosis, it is called hypnodesensitization). For example, in a patient with fear of flying, the hierarchy of anxiety-provoking situations could be (starting with the least anxiety): 1) Watching a video showing a plane landing; 2) waiting for boarding; 3) waiting for take-off; 4) during take-off; 5) immediately before landing; 6) during landing; 7) experiencing turbulences on the flight. In this case the therapist would start with the least-anxiety provoking situations, induce hypnosis and let the patient imagine the situation as vivid as possible. If the anxiety is reduced to a certain level, the therapist would continue with the next situation until the patient can also imagine the most-anxiety provoking situation with little or no anxiety at all.
Relaxation techniques such as safe place imagery, deep breathing, and muscular relaxation are an important part in the therapy of anxiety disorders, and patients can practice these techniques using self-hypnosis.