Cognitive Hypnotherapy as part of CBT

Cognitive Behavioural Therapy is an umbrella term that covers a number of different therapies that share common elements, such as Cognitive Therapy, Rational Emotive Behaviour Therapy and Motivational Enhancement Therapy. Cognitive Hypnotherapy is another approach that fits under this umbrella, which is pleasing having heard the news that the Government is going to spend £170 million on making this approach more available to the public. At the same time our approach has several things that differentiate it from most other forms of CBT, which we think offer useful alternatives. Let’s begin with the similarities:

CBT approaches assume an interaction between how we think (cognition), how we feel (emotion) and how we act (behaviour).
Our thoughts can influence our feelings and behaviour – if you’re thinking about something pleasant your overall mood improves and you’re more likely to engage in productive behaviours.
Our emotions can influence our thoughts and behaviour – if someone upsets you at work those feelings are likely to impact on your thinking about other things going on in your life, and how you behave ‘in the moment’. Our emotions act like lenses that colour everything we experience.
Our behaviour can influence our thoughts and emotions. Research has shown that changing our physiology can change our emotional state and the quality of our thoughts. If you’re nervous, but stand as you would if you were feeling confident, you will feel better and be able to think more clearly.

This inter-relationship suggests that change in one area is likely to bring change in the others.

Most CBT approaches emphasise the primacy of our thoughts in creating our problems, an example of which is their utilisation of a model developed by one of the founders of this approach, Albert Ellis. The ABC model, as it’s called, suggests that an Activating Event (a situation you find yourself in) triggers a Belief you have about that situation (in therapeutic situations usually negative and limiting beliefs about yourself, the world, or the future) which leads to the Consequence – the disturbed feelings or dysfunctional behaviours that arise as a result of this cognitive process.

Beliefs are thoughts we have about situations, and CBT makes a distinction between conscious thoughts, and automatic thoughts. The latter are thoughts we have no control over. Most CBT approaches work to bring these automatic thoughts to light (i.e. make them conscious) in order to contest their usefulness, often by keeping a journal and using questioning techniques to logically deconstruct the negative thoughts. This ‘contesting’ of beliefs is often accompanied by behavioural tasks; in the case of someone with a fear of germs and infection, for example, they might be made to wash their hair in the toilet (as seen on the programme The House of OCD).

Where Cognitive Hypnotherapy differs is in its emphasis on two things; the existence of an adaptive unconscious, and the presence of trance states in our life generally, and in our problems, specifically.

The Adaptive Unconscious

Nowadays we use ‘the unconscious’ as a figure of speech without giving it a thought, and largely accept its presence, again without giving it much thought. However, neuroscience and other scientific fields are finding more and more evidence to suggest that it plays a huge role in our daily functioning, and is capable of acting independently of the conscious – that part of us that believes it chose to read this article. We use the term adaptive to make the point that the unconscious is purposeful, its actions aren’t random or baseless. Every thought and action the unconscious generates has a reason. Which is why Cognitive Hypnotherapy completely accepts that we have conscious thoughts and that we have what were termed earlier, automatic thoughts – but we pay much more attention to the unconscious processes that create the latter. Professor Timothy Wilson suggests that we all have two personalities, our conscious self and our adaptive unconscious. Both meet Allport’s definition of a personality. Both have distinctive, characteristic ways of interpreting the social environment, and stable motives that guide people’s behaviours. We believe that change needs to occur through the unconscious, because that’s where the mental miscalculations we call our problems are created and manifested, and why logically understanding your problem does little to change it. The unconscious does not use the rules of logic to make its decisions.

We also contend that emotions are the ‘language’ of the unconscious, and precede consciousness. The emotional centres (the limbic system) in the brain have twice as many connections leading to the cortex (our ‘thinking’ area) as the cortex has leading to the limbic system. This isn’t surprising because the limbic system evolved long before the cortex and explains why, in situations assessed by the brain as negative, threatening or unpleasant, we tend to get emotionally hijacked and feel as if we’ve lost control of our actions until the situation changes. From this comes one of our key presuppositions – all behaviour has a purpose. Our unconscious has a purpose behind the behaviour it generates, and that purpose is a positive intention. Our personal problems often feel as if they’re designed to make us miserable, but, when you think of it, why would that have any evolutionary benefit?

We believe that such problems are ‘programming blunders’, errors made using normal rules of thumb the brain has used over millions of years to help us survive. An example would be the child who is shouted at by a teacher for getting a sum wrong. Children are primed to avoid the withdrawal of approval (in the cave it could lead to death), so in some children this situation could trigger the rule of thumb designed to protect them from this situation – they’ll try to work out how to go about avoiding this consequence. One child might withdraw from situations that could lead to a similar consequence and become an underachiever who avoids anything they could fail at. Another child might over-compensate by never being satisfied with anything less than perfection. Both are likely to grow up unhappy as a result of a calculation designed to keep them safe. A third child’s brain might not connect the teacher’s behaviour to this rule – it isn’t seen as a threat, and so doesn’t develop any compensatory behaviour. But at lunchtime the dinner lady tells her she’s a ‘fat little pig’ for taking a second desert…

Unfortunately, as I mentioned earlier, our brains don’t use logic to come to conclusions anywhere as much as we’d like to think they do. 90% of our actions each day are generated by the unconscious, and research by people such as Gerd Gigerenzer is showing that these actions are arrived at by the ‘rules of thumb’ I mentioned earlier, algorithms the unconscious uses to make decisions. Essentially they’re the calculations that lead to what we tend to call our intuition. By understanding how these rules of thumb can lead to errors – usually as a result of our immature brains taking a limited understanding from an experience – we can use them to help people change the programming that generates the issue, and by using trance we can actually make the change in the root of the problem – the memory.

It’s all trance, Dude.

This is where hypnotherapy comes in. Most CBT approaches don’t use trance in their work, or recognise it in the client’s problem. We do. We think that trance is an everyday experience for us all – think about daydreaming or losing yourself when driving, or playing with your baby. Also think about when you ‘lose it’ with someone, when you see a spider and can’t help yourself running away from it, when you realise you’ve eaten a whole packet of biscuits watching television after watching what you eat all day long, when your mind goes blank when asked to speak in front of a group of people, or when you miss the putt that the match rested on. We think these are all examples of trance, so people are actually in an altered state (which could be termed hypnosis) whenever they are doing their problem, and we think this is the way the unconscious wrests control from us in order to carry out its ‘rule of thumb’ action, itself driven by something that probably started many years before. Our job as therapists becomes one of helping client’s ‘de-hypnotise’ themselves; in other words, enable them to remain in control of their actions in a situation where in the past they weren’t able to.

Why you might choose Cognitive Hypnotherapy if you’re looking for CBT?

Because trance is a component of a problem, it’s also a route in to their solution. The reason why people can logically know that their problem is stupid, but can’t stop it, is because (we would argue), the logical centre of the brain isn’t where the problem pattern is stored – emotion trumps thought in these situations, so it’s that part of the brain that needs addressing. Trance appears to enable the mind to access these algorithms – the strings of memory that lead to negative beliefs, fears, anxieties etc – and re-tune the brain, to undo examples of bad programming and create better ones. The brain is constantly changing, and has been shown to be plastic in its learning, so anything can be re-learned or reinterpreted. Techniques from approaches such as Neuro Lingustic Programming give us great ways to change unpleasant or unhelpful thoughts and images very quickly, and with much less stress on the client than tends to be the case with the CBT practitioners so beloved by reality television.

Unfortunately many people who could benefit from CBT are driven from it by the terror of having to confront their fears – remember the toilet hair-washing? Research has demonstrated that imagining change can have the same effect as experiencing it, so in Cognitive Hypnotherapy we can use trance to assist the client in incrementally addressing their fears in their own minds until they get to the point (usually quite quickly) where the change is such that their fear is no longer present in their reality, and with no drama (it’s why you haven’t seen us on those kinds of programmes, our clients get better too easily).

Finally, in Cognitive Hypnotherapy, we aim to be extremely sensitive to the differences in the way people think – because everyone is unique in that regard – and tailor our therapy to use these differences, instead of seeing them as obstacles or resistance. Some client will respond better to emotional techniques, while for others its thinking or behavioural interventions that create the change. For some the evidence that they’re improving needs to be the realisation that the way they feel about their past is different, for others it’s the way they think about their future, some need to be able to influence their present. And so the differences stack up. That’s what makes therapy fascinating – finding what works with each person – and why we are dedicated to evolving our model to include everything that is found that helps, wherever it comes from.

This is an exciting time. There is excellent evidence that shows the effectiveness of utilising trance in therapy. The biggest ever meta-analysis of therapeutic approaches showed cognitive approaches to be the most effective, followed closely by hypnotherapy. I hope you agree that a synthesis of these two approaches could lead to even more powerful means of helping people.

To end, let me return to one of the attitudes we share within CBT. This is the view that a client’s issues stem from the way they create an awareness of their situation – echoed by the philosopher Epictetus who stated that “Men are disturbed not by things, but by the views which they take of them”.

By understanding the way we each create the meaning of what happens in our life we can learn the means to influence this act of creation in order to live the most fulfilled, productive and happy life possible.

References:

Channel Four: The House of Obsessive Compulsives
The User Illusion by Tor Norretranders
Gut Feelings by Gerd Gigerenzer
Strangers to Ourselves by Timothy Wilson