Wednesday, January 30, 2008

Hypnosis for Depression?

Hypnosis may be a useful adjunct to the treatment of depression.
For example, some people are both de-energized and chronically
tense over extended periods of depression, particularly when
waiting for their medication to "kick in" or the right prescription
and therapeutic dosage. They also report feeling very "stuck",
unable to make headway with their cognitive therapy while their
minds continue to spin with negative thoughts. Particularly
frustrating are the thoughts that "this will never stop" and a
sense that they are not getting any help.

When hypnosis is considered as an adjunct to their treatment
several things can happen. First, if a combined relaxation/self-
hypnosis training is accomplished, the individual can experience
periods of relaxation and calming that they have not experienced
in many months or longer. This can instill a sense of greater
efficacy and control, combating the sense of helplessness and
hopelessness. In addition, some people may apply the technique
to insomnia and night time waking to aid in their sleep. Second,
the individual may experience a degree of variability, even if only
slightly, that contrasts with the ongoing drone of their depressed
mood.

Another utility of hypnosis is combining the procedure for
relaxation and focusing with the cognitive-behavioral exercise
of challenging negative thoughts. It can be very difficult to focus
and do the cognitive exercises. Hypnosis is a relaxed state of
focused attention. Utilizing this state may help the individual
develop some focus to do the cognitive work.

As can be seen from the above, hypnosis is not a treatment that
necessarily removes depression by suggestion. Rather, it can be
a tool the individual uses to strengthen their resources to cope and
to accomplish their treatment program. Many hypno-therapists
complain that it is very difficult or "impossible" to get their clients
into a "relaxed and safe inner space". The challenge can be lessened
by understanding that one should not send some people directly to
an inner experience since this may simply lead them to focus where
they already unhappily are. They may need to transition through
a number of progressive mental states to get to or create a "positive
relaxing place".

For example, before doing any hypnosis at all and especially with
younger clients, its sometimes useful to discuss the things they like to
do, see, listen to, feel, in short what sensory experiences give them
relief. For other people, it is their pets that accomplish the beginning
shift out of sameness. Then a therapist can help the client creatively
utilize their experience as a resource to build a state of mind that
varies from depression. Working first with eyes open helps too. So,
first you help the client gather their internal and external
resources. Then they build an experience. Then, having constructed
something durable and comfortable, they may open the door, go
inside that space, and perhaps even invite you along.

When I feel really stuck with a patient in training self-hypnosis I
want to know everything about their environment in terms of who
and what is stressful. Working with this who and what may be
necessary before any hypnosis training is possible. Finally if the
clinician hasn't assessed hypnotizability in some fashion, he or she
may be leading themselves and their client down the path of
frustration and disappointment. I like informal methods of
assessment ("arm-drop","eye roll", etc.) to begin with as they
may be less draining in terms of time and energy for the client
while standard scales and techniques (HIP, Harvard, etc.) may
be added.

There are some new cognitive techniques (C-BASP) for depression
coming along and I have corresponded with one of the researchers
about combining a new technique with hypnosis and visualization.
I have had preliminary anecdotal success by adding this on to
existing techniques, by self-report from clients. The point is, don't
give up either as a patient or clinician. Be creative while building on
to what works rather than discarding the foundation of
cognitive therapy and medical intervention.

Resources: Books and articles by Dr. Michael Yapko on Hypnosis
and Depression, The American Society of Clinical Hypnosis (lists
specialists in hypnosis and their certification).

Thursday, January 10, 2008

Slideways Into 2008

My metaphor for the new year occurred during a snow tubing
adventure at White Tail in Pennsylvania. The awareness that
there is no real control as you slide sideways, backwards, and
head first down the slope was freeing. Nothing to do but laugh
all the way to the bottom over and over again. And so we go
slideways into the future, the only control being how we want
to be about the direction it takes us...fighting the flow or "digging"
the snow. I am reminded that in sports and life we control
what we choose to do and how we react to what else is beyond
our control. On a tube there is no preparation, no goal, no plan,
just the ride. The more you let go, the better the ride.
Happy New Year!

Geoff Michaelson, Ph.D.