Academic journal article Journal of Cognitive Psychotherapy

Cognitive Hypnotherapy with Depression

Academic journal article Journal of Cognitive Psychotherapy

Cognitive Hypnotherapy with Depression

Article excerpt

A cognitive dissociative model of nonendogenous unipolar depression (CDMD) is described. The model offers a framework for extending Beck's cognitive theory of depression and it provides the grounding for combining cognitive and hypnotic techniques in the management of depression. An integrated approach to treatment, referred to as cognitive hypnotherapy, based on the model is described in detail.

After reviewing the strengths and limitations of cognitive therapy and hypnotherapy, Alladin (1989) argued the case for integrating hypnotic and cognitive techniques in the management of clinical depression. Tosi and Baisden (1984), and Golden, Dowd and Friedberg (1987) have also described treatment approaches combining cognitive therapy with hypnotherapy. Moreover, Williams (1984), concluded from his comprehensive review of the psychological therapies for depression that the more techniques that are used, the greater the treatment effects. However, none of these writers has provided a scientific rationale for integrating various treatment modalities with depression. More recently, Alladin (1992; Alladin & Heap, 1991) described a cognitive dissociative working model of depression, providing the grounding for combining hypnotic and cognitive techniques. The aim of this paper is to briefly describe this theoretical model and then to detail a multimodal approach to treatment, referred as cognitive hypnotherapy, based on the model.

Cognitive Dissociative Model of Depression (CDMD)

The CDMD utilizes cognitive and hypnotic paradigms to explain the psychological processes that may be involved in the genesis and maintenance of nonendogenous unipolar depression. Although Beck (1967, 1976) has provided the most comprehensive and useful psychological theory of depression, his cognitive theory does not satisfactorily explain the complex processes by which cognitive distortions lead to psychobiological changes. Since hypnosis can produce cognitive, somatic, perceptual, physiological, and kinesthetic changes under controlled conditions, the combination of the cognitive and the hypnotic paradigms may provide a window for investigating and understanding the psychobiological processes by which transient mild dysphoric states develop into severe and persistent depressive episodes. The CDMD is an extension of Beck's (1967) circular feedback model of depression, later elaborated by Schultz (1978). The CDMD incorporates ideas and concepts from information processing, selective attention, brain functioning, cerebral lateralization, and the neodissociation theory of hypnosis. It is referred as the cognitive dissociative model of depression because (1) it encompasses the dissociative theory of hypnosis and (2) it proposes that nonendogenous unipolar depression is a form of dissociation produced by negative self-hypnosis. It consists of 12 interrelated components (see Figure 1), forming a circular feedback loop. The components are briefly described below.

Negative Affect and Negative Cognition

The relationship between dysfunctional cognitions and depressive affect is very well documented in the literature (e.g., Beck, Rush, Shaw, & Emery, 1979). The CDMD, however, does not give precedence to either affect or cognition. Both are regarded as being interactive and in line with the concept of the "bicameral brain" proposed by Jaynes (1976), affect or cognition, each can independently start the chain process of the feedback loop (Figure 1). Furthermore, the model considers imagery to be an important aspect of cognition in determining, maintaining, and alleviating depression. Many writers (e.g., Ley & Freeman, 1984) claim that images have a greater capacity than language for attracting and retrieving emotionally-loaded associations.

Rehearsal of Negative Cognitions

Individuals predisposed to depression tend to focus on negative thoughts and images. Schultz (1976), Starker and Singer (1975), and Traynor (1974) have provided evidence that with increasing levels of depression, depressives tend to change the contents of their imagination to negative fantasies, and they are consequently unable to redirect their thinking and imagery from their current problems and negative life-concerns. …

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