Can hypnosis play a role in treating depression?

Michael D. Yapko, Ph.D.
Fallbrook, California

FOR NEARLY THREE DECADES, I have been focused on two primary domains of professional interest: Applying clinical hypnosis in brief psychotherapies, and treating depression in individuals, couples and families. At first glance, these seem to be two unrelated phenomena: The former is a means of multi-dimensional therapeutic intervention that represents the original “positive psychology” in its emphasis on expanding hidden resources, and the latter is a multi-dimensional disorder that embodies a painfully negative orientation towards key areas of life experience.

Upon deeper reflection, however, the overlaps between the separate yet related domains of hypnosis and depression become more evident. I’ll describe just a few of these:

1. Both come about and increase in intensity the more narrow your focus;
2. Both are ultimately social processes, greatly influenced by your relationships with others, whether the other is a clinical authority describing the therapeutic merits of exposing you to an induction procedure, or the other is a parent or spouse describing the flaws in your character;
3. Both are a product of expectancy, whether the expectation is one of getting the benevolent corrective message “into your unconscious” through suggestions received in a dissociated state, or whether the expectation is that no amount of your effort will result in a success, thereby giving rise to the apathy so typical of depression; and,
4. Both involve what hypnosis pioneers Theodore Sarbin and, later, Ernest Hilgard, described when they suggested hypnosis is, in part, a “believed-in imagination,” an experience based on the recognition that people can and do get deeply absorbed in highly subjective beliefs and perceptions that quite literally regulate the quality of their lives. These beliefs and perceptions can be altered and amplified during the experience of hypnosis, illustrating the point well how idiosyncratic each person’s sense of reality really is, especially in response to “mere” suggestions.

The notion of an individual’s personal reality essentially being a “believed-in imagination” preceded the origin and development of cognitive therapy by decades, even centuries, and firmly established the relevance of hypnosis in treatment. Cognitive-behavioral therapy (CBT) is, at this time, probably the most well-researched method of therapeutic intervention. It is founded on the premise that people in general, and depressed people in particular, regularly make identifiable errors in information processing, thinking and genuinely believing in their mistaken notions of what truly – and depressingly -seems like reality to them. This process of becoming absorbed in one’s (depressing) imaginings is, indeed, an instructive parallel to what occurs in hypnosis, where a clinician performs an induction and attempts to absorb the individual in alternative ways of experiencing him or herself.

Using hypnosis procedures, the clinician creates a context where the individual can change the direction and quality of his or her focus. Perhaps the suggested focus is on engaging in some new life enhancing behavior, or perhaps on exciting and motivating glimpses of future possibilities, or possibly on re-writing some of the negative internal dialogue, or somehow altering for the better any of literally scores of depressing focal points (e.g., cognitive styles, coping styles, relational styles). What the clinician suggests during hypnosis may not be any more true in an objective sense than what the person previously believed – it may just feel much better and serve the person better.

The treatment efficacy literature is wonderfully unambiguous in describing how when people learn the key skills for living life well, such as the skills for thinking critically, behaving effectively, and building positive relationships with others, they tend to recover from depression. Hypnosis as a means of teaching people, a vehicle for getting new possibilities for thinking, feeling, behaving, and relating integrated more quickly and deeply is precisely why knowledgeable clinicians do hypnosis in the first place.

Contained in every workshop I present are powerful examples of creative applications of suggestions and hypnosis in the treatment of depression, and all share at least one common denominator: They serve to empower the client. They empower the client to discover new resources, and they empower the client to develop a flexibility in living that encourages shifting directions when a path is temporarily blocked. Contradicting the popular mythology of an imminent loss of control that makes uninformed people wary about hypnosis, my work draws peoples’ attention to the opposite truth: Hypnosis strengthens people, showing people a path of self-discovery and self-growth, providing them a comfortable context for developing the best and most adaptive parts of themselves.
Hypnosis amplifies experience. The first principle one learns in studying hypnosis is that what you focus on, you amplify. Thus, a clinician has to be deliberate about choosing focal points for interventions. Focusing on someone’s cognitions, for example, shouldn’t be a standard procedure as a self-identified cognitive therapist. It should be a choice one makes to focus on the client’s thoughts because there is a powerful depressogenic pattern operating on that dimension. But, for someone else, the focus will need to be on his or her relationships, and for someone else on his or her negative expectations. What a clinician will focus on and amplify with hypnosis will differ according to the profile of each individual client. This is one of the great strengths of being knowledgeable about hypnosis: the ability to make good therapeutic choices based on client need outweighs loyalty to a particular theory of intervention. As you will see, each of the experts emphasizes different focal points in the chapters they have contributed, and each of them represents a choice point for when that particular issue or pattern is evident in a specific client. None of the approaches herein are “one size fits all” formulas.

Hypnosis does many things that are immediately relevant to helping depressed individuals: 1) It helps people focus; 2) facilitates the acquisition of new skills; 3) encourages people to define themselves as more resourceful than previously realized (enhancing their self-image as a result); 4) makes the transfer of information from one context to another easier and more efficient; 5) establishes helpful subjective associations more intensively; 6) provides learning to be more experiential and meaningful; and, 7) defines people as active managers of their internal world. Hypnosis helps sharpen key perceptual distinctions, allow a safe distance from powerful feelings, proceed with new possibilities in a deliberate behavioral sequence, rehearse new responses, develop undeveloped personal resources, and detach from a sense of victimhood. No one gets past depression without achieving all of these things and more.

What does one say to a client to bring such changes about? How does one know when to target what pattern in a client’s depressive phenomenology? These are vitally important questions, and it is my goal in presenting my clinical trainings to provide practical and sensible answers to these and many other such questions. I am grateful that Jack Hirose makes it possible to disseminate this information to interested professionals.

References

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