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COGNITIVE HYPNOTHERAPY FOR DEPRESSION
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of hypnosis is due to the patient’s positive expectancy. However, the
studies on hypnotically induced analgesia conducted by Goldstein and
Hilgard (1975) and Spiegel and Albert (1983) clearly indicate that hyp-
notic reduction of pain is not due to placebo, stress inoculation, or
changes in the level of endorphins. Moreover, there is a growing litera-
ture providing empirical evidence for the effectiveness of hypnotherapy
with a variety of medical and psychological disorders (see Lynn &
Kirsch, 2006; Lynn, Kirsch, Barabasz, Cardeña, & Patterson, 2000;
Yapko, 2003). Whether hypnosis works via placebo effect or by influenc-
ing behavioral and physiological responses, the sensitive therapist can
create the right atmosphere to capitalize on suggestibility and expecta-
tion effects to enhance therapeutic gains (Erickson & Rossi, 1979).
Ego-strengthening.
Ego-strengthening is an approach whereby positive
suggestions are repeated to oneself with the belief that these suggestions
will become embedded in the unconscious mind and exert automatic
influence on feelings, thoughts, and behavior. Ego-strengthening is incor-
porated into hypnotherapy to enhance a patient’s self-confidence and
self-worth (Heap & Aravind, 2002). Alladin (1992b) has pointed out that
depressives tend to engage in negative self-hypnosis (NSH) and Araoz
(1981) considers NSH to be the common denominator of all psychogenic
problems. More recently, Nolen-Hoeksema and her colleagues (see
Nolen-Hoeksema, 2002, for review) have provided empirical evidence
that individuals who ruminate a great deal in response to their sad or
depressed moods have more negative and distorted memories of the past
and feelings about the present and future. These ruminators or moody
brooders then become increasingly negative and hopeless in their think-
ing, resulting in protracted depressive symptoms.
Ego-strengthening suggestions were offered to counter the NSH.
Alladin and Heap (1991, p. 58) consider ego-strengthening to be “a
way of exploiting the positive experience of hypnosis and the thera-
pist-patient relationship in order to develop feelings of confidence and
optimism and an improved self-image.” As the study did not assess
cognitive distortions or NSH, it is not known to what extent the
depressives from the CH group restructured their cognitive distortions
in response to the ego-strengthening suggestions or to the CBT. Many
patients from the CH group reported that they felt more confident as a
result of the hypnosis and felt “something inside” them reminded
them to “take it easy” when faced with difficulties. None of the
patients from the CBT group made these comments.
Expansion of awareness and positive mood induction.
Hypnosis provides
a powerful tool for expanding awareness and amplifying experience
(Brown & Fromm, 1990) and for intensifying imagery and cognitive
restructuring (Boutin, 1978). Alladin (1994, 2006a) believes such a pro-
cedure, especially with repetition, induces relaxation (feeling good),
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