What follows is a brief précis of the evidence firstly for hypnosis, next for CBT, before looking at why the two disciplines marry so well. I will finish by discussing why not all hypnotherapy is evidence-based.
The Evidence for Hypnosis
The phenomenon of hypnosis and its therapeutic potential has not been in doubt since 1892, when the British Medical Association published a report which stated conclusively that:
‘The Committee, having completed such investigation of hypnotism as time permitted, have to report that they have satisfied themselves of the genuineness of the hypnotic state … are of opinion that as a therapeutic agent hypnotism is frequently effective in relieving pain, procuring sleep, and alleviating many functional ailments.’
Over the intervening years, right up until the present day, there have been plenty of subsequent reports by the British Medical Journal, the American Medical Association and the British Psychological Society which have looked at all the best available evidence and published their findings. Below are some of the key conclusions from a 2001 report commissioned by the British Psychological Society:
‘There is convincing evidence that hypnotic procedures are effective in the management and relief of both acute and chronic pain and in assisting in the alleviation of pain, discomfort and distress due to medical and dental procedures and childbirth.
Hypnosis and the practice of self-hypnosis may significantly reduce general anxiety, tension and stress in a manner similar to other relaxation and self-regulation procedures.
Likewise, hypnotic treatment may assist in insomnia in the same way as other relaxation methods.
There is encouraging evidence demonstrating the beneficial effects of hypnotherapeutic procedures in alleviating the symptoms of a range of complaints that fall under the heading ‘psychosomatic illness’. These include tension headaches and migraine; asthma; gastro-intestinal complaints such as irritable bowel syndrome; warts; and possibly other skin complaints such as eczema, psoriasis and urticaria.
There is evidence from several studies that its inclusion in a weight reduction program may significantly enhance outcome.’
The Evidence for CBT
CBT has become hugely popular because of it pragmatic approach to giving people the skills they need in order to improve their lives. It looks at problematic thoughts and behaviours, examining how they interact with emotions and deeply held beliefs, and asking if there might be a more helpful way of engaging with the world.
It’s a highly practical model that uses a lot of techniques such as visualisation, Socratic questioning and mindfulness – all of which can be viewed as extensions of ‘common sense’ thinking. Often the ideas underpinning the therapy may seem obvious, but really that’s as it should be – it’s only really our own distortions and hang-ups that make life so much more complicated than it actually is.
The papers listed below are meta-analytic reviews of CBT – articles that take the results of multiple studies and look at the findings.
Butler, A.C., Chapman, J.E., Forman, E.M., & Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17-31.
Chambless, D.L., & Ollendick, T. H. (2001). Empirically Supported Psychological Interventions: Controversies and Evidence. Annu. Rev. Psychol, 52, 685-716.
Tolin, D.F., Is cognitive-behavioral therapy more effective
than other therapies? meta-analytic review, Clinical Psychology Review (2010).
The Perfect Match
CBT places great emphasis on challenging unhelpful thoughts and beliefs. These are essentially maladaptive suggestions we repeatedly make to ourselves, which is nothing if not negative self-hypnosis. It makes perfect sense, then, to use positive suggestion to combat negative auto-suggestion.
Moreover, one of most utilised techniques in the CBT toolbox is visualisation. It’s used to help people imagine themselves in challenging situations so they can put their newly acquired coping skills to the test. Because hypnosis promotes focused attention, it makes this technique more effective. Because of this, it can speed up the treatment time, reducing the number of sessions required.
A meta-analysis of 18 separate studies investigating the use of hypnosis alongside CBT techniques made the following findings:
‘The results of this meta-analysis indicate a fairly substantial effect as a result of adding hypnosis to cognitive-behahvioural psychotherapies.’
‘Hypnosis enhances the effects of cognitive behavioural psychotherapy across a broad range of problems.’
‘[It is estimated] the average client receiving cognitive-behavioural hypnotherapy benefitted more than at least 70% of clients receiving the same treatment without hypnosis.’
‘Hypnosis enhances the efficacy of both psychodynamic and cognitive-behavioural psychotherapy, and this effect is especially strong in long-term outcome of treatment for obesity.’
‘The effect of adding hypnosis to the treatment of obesity was even greater. Across studies, teh mean weight loss was 6.03 pounds [for CBT] without hypnosis and 14.88 pounds with hypnosis … Most important, correlational analyses indicated that the benefits of hypnosis in the treatment of obesity increased substantially over time.’
‘These data justify the recommendation that hypnosis be adopted as a standard component of therapeutic interventions.’
Kirsch, I.; Montgomery, G.; Sapperstein, G. (April 1995). “Hypnosis as an adjunct to cognitive-behavioral psychotherapy: A meta analysis”. Journal of Consulting and Clinical Psychology 63 (2): 214–220.
If there is evidence for hypnosis, isn’t all hypnotherapy evidence-based?
The technique of inducing hypnosis, the physiological and psychological effects it produces, is beyond doubt. However, an evidence-based practice will look at how this technique can be applied to be of proven benefit to its recipient.
For example, there are many hypnotherapists who practise past-life regression. Under the conditions of hypnosis, people recount all sorts of extraordinary stories about events supposedly from their former lives. While all of this may be very colourful and sometimes fascinating, there are no solid, peer-reviewed studies that suggest that this is rooted in anything beyond the subject’s imagination.
It doesn’t just refer to past-life regression either. False Memory Syndrome, whose name rather speaks for itself, is highly prevalent in these kinds of therapies, and some studies suggest that memories uncovered under hypnosis are in fact less reliable than those from non-hypnotic recall.