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COGNITIVE HYPNOTHERAPY FOR DEPRESSION
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shape behavior. For example, Clarke and Jackson (1983) regard post-
hypnotic suggestion to be a form of “higher-order conditioning,”
which functions as positive or negative reinforcement to increase or to
decrease the probability of desired or undesired behaviors, respec-
tively. They have successfully utilized posthypnotic suggestions to
enhance the effect of in vivo exposure among agoraphobics. To what
extent the depressives’ maladaptive behaviors and cognitions in the
present were shaped by posthypnotic suggestions is not known.
Hypnotic suggestibility.
Irrespective of treatment modality, the moder-
ate to highly suggestible depressives produced significantly more
improvement than the low suggestible subjects. However, the correlation
between hypnotic suggestibility and clinical improvement was only
moderate; a finding that is consistent with the literature. Lynn et al.
(2000) believe this is due to the fact that most typical hypnotic interven-
tions rely on relatively easy suggestions that require little hypnotic or
imaginative ability to pass. The subjects in the present study received
suggestions to produce relaxation, somatosensory changes (e.g.,
warmth), and expansion of awareness (e.g., remembering good feelings
from the past) that require little hypnotic ability to produce. Neverthe-
less, hypnotic suggestibility is not totally irrelevant to treatment outcome.
The link between suggestions of analgesia and hypnotic suggestibility is
well established (Lynn & Kirsch, 2006), and there is a mixed, but promis-
ing, correlation between hypnotic suggestibility and treatment outcome
for smoking cessation, obesity, warts, anxiety, somatization, conversion
disorders, and asthma (Lynn & Kirsch, 2006; Lynn, Shindler, & Meyer,
2003). In the present study, the strongest correlations were between
hypnotic suggestibility and depression and hopelessness at follow-ups.
Self-hypnosis.
The self-hypnosis component of CH was designed to
create positive affect and counter NSH via ego-strengthening and post-
hypnotic suggestions. The ultimate goal of psychotherapy is to help the
depressed patient establish self-reliance and independence. Alman (2001)
believes patients can achieve self-reliance and personal power by
learning self-hypnosis. Yapko (2003) argues that teaching patients self-
hypnosis and problem-solving strategies allows them to develop a self-
correcting mechanism that gives them control over their lives. All the
patients from the CH group indicated that they derived benefits from
their self-hypnosis tape in the form of time-out, relaxation response, and
getting into the habit of positive self-hypnosis. The results of the study
clearly show that the patients from the CH group continued to progress
at follow-up, and their improvement was significantly larger than the
CBT group, especially with anxiety (see Figure 1). This provides evidence
that the self-hypnosis tape was helpful in the management of depression
after the termination of the treatment and has led Alladin (2006b) to uti-
lize self-hypnosis in the prevention of relapse in depression.
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