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ASSEN ALLADIN AND ALISHA ALIBHAI
and 56 treatments that meet the criteria for probably efficacious
treatments (Chambless et al., 1998). The most common treatments listed
were cognitive-behavioral and behavioral. Hypnotherapy for depres-
sion was not included in the list.
In fact, hypnosis has not been widely used in the management of
depression, possibly due to the prevailing erroneous belief that hypnosis
can exacerbate suicidal behaviors in depressives (Alladin, 2006a). Recently
many clinicians have questioned this belief and argued that hypnosis,
especially when forming part of a multimodal treatment approach, is not
contraindicated with either inpatient or outpatient depressives (e.g.,
Alladin & Heap, 1991; Yapko, 1992, 2001). Nevertheless, the bulk of the
published literature on the application of hypnosis in the management of
depression consists of case reports. Although they describe a variety of
techniques, from these reports it is not clear what therapists do with hyp-
nosis in the treatment of depression (Burrows & Boughton, 2001).
Another trend has been for many clinicians (Golden, Dowd, &
Friedberg, 1987; Tosi & Baisden, 1984; Yapko, 2001; Zarren & Eimer,
2001) to integrate cognitive-behavioral therapy (CBT) with hypnosis in
the management of depression. There is some empirical evidence for
combining hypnosis with CBT. Kirsch, Montgomery, and Sapirstein
(1995) carried out a meta-analysis of 18 studies (1974 to 1993) compar-
ing CBT with the same treatment supplemented by hypnosis to exam-
ine the additive effect of hypnosis in the management of various
psychological disorders. Their review found the mean effect size was
significantly larger for the treatment combined with hypnosis than the
nonhypnotic treatment. Similarly, Schoenberger (2000), in a more
detailed review, substantiated the additive value of hypnotic interven-
tions when combined with CBT for various emotional disorders.
Schoenberger pointed out that although promising treatment gains
have been observed in relation to obesity, anxiety disorders, and pain
management, no hypnotically augmented CBT has as yet met the APA
criteria for well-established treatment.
With the exception of Alladin (1992a, 1992b, 1994, 2006a; Alladin &
Heap, 1991), none of the writers have provided a scientific rationale or
a theoretical model for combining CBT with hypnosis in the treatment
of clinical depression. After reviewing the strengths and limitations of
CBT and hypnotherapy with depression, Alladin (1989) concluded that
each treatment approach was lacking in several ways. For example,
CBT does not permit access to unconscious cognitive restructuring; its
main focus is on cognitive restructuring via reasoning and Socratic dia-
logue. Hypnotherapy, on the other hand, has traditionally focused on
unconscious restructuring or reframing, paying less attention to sys-
tematic conscious cognitive restructuring. Alladin (1989) argued that
the shortcomings of each single treatment could be compensated for
by integrating the techniques from the two treatment approaches.
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