LCCH No: 12380 UWL No: 21174286 London

PG Cert Clinical Hypnosis

Essay 1
Evaluate the role that behaviour therapy
theories have to play in clinical hypnosis


Date of Submission: 19 Sept 2012



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No of words excluding title and bibliography and including references in text: 1637 Words
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LCCH No 12380 UWL No 21174286 PGCert Clinical Hypnosis 2004 London

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Hypnosis has many birthdays. (Nash 2008 p55) ranging from the ancient temples of Aesculapius
through Gassner, Mesmer and Baird to the present day. The development of an observable
scientific approach was the dominant slant of the 20
th
Century and especially the 21st Century with
major advances in neuroimaging.

This paper will outline the development of behaviour therapy, its connection with hypnotism and
some practical applications of this relationship.

Given that such scientific investigation was not easily accessible to the non-academic, it is not
surprising that the field has been largely shaped by the research labs of big universities, mainly in the
USA. The individuals who played a large part in advancing our knowledge of hypnosis during the last
few generations include Prince, Young, Murray and White at Harvard University, Estabrooke at
Colgate University, Erikson at Worcester State Hospital and Hull at the University of Wisconsin.
These led to the big five (ibid) laboratories.
Despite the great endeavours of the Big Five, the foundations of this scientific approach was based
on the work carried out by the behaviourists: Watson, Pavlov, Skinner & Wolfe. Prior to this,
introspection was the main method for the investigation of mental process (Gross 2012 p12). This
was challenged by Watson in 1913 who focussed on observable behaviour.
However, the bridge from theory to practice is never an easy one and so was the growth from
hypnosis to hypnotherapy. There are over 400 types of psychotherapy (Kroger 2007:xxxiv), some of
them almost diametrically opposed to each other on both a practice and philosophical level. What
they generally have in common is a the idea of mind and body. Hypnotherapy is the joining of the
skills of hypnotism with other psychological therapies. It is an eclectic if not an integrative form of
therapy. Most modern therapies coexist and even integrate, albeit somewhat uneasily in some
cases. But not all do.
McLeod (1993, p97) cites arguments against integrationism. One of these viewpoints is that it can be
seen as muddled and confused. He quotes the Eysench who vividly stated that theoretical
integration would lead us to nothing but a mish-mash of theories, a huggermugger of procedures, a
gallimaufry of therapies, a charivaria of activities having no proper rationale, and incapable of being
tested or evaluated. What is needed in science and in medicine are clear-cut theories leading to
specific procedures applicable to specific types of patients.(Ibid) In Eysenchs opinion, only behaviour
therapies could provide this.
Some suggest that another realm or dimension is present. This is called the consciousness-based
approach or non-local mind. Boyer (2012 p27 ) proposes that consciousness is more than the ability
to be aware of an object of experience. He cites major progress in quantum physics stating that
matter doesnt have a material basis.
Nevertheless, behaviourism is an important aspect of the historical development of hypnosis from
being something bordering on heresy or even magic to being a respectable feature of current
medicine and psychotherapy.
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Gross (2012 p38) wrote that the essence of Behaviourism is S-R where S stands for Stimulus and R
for Response. He further emphasises the role of environmental factors as the main influence of
behaviour. He excludes innate or inherited factors.
Learning Theory covers both classical and operant conditioning and is called Learning Theory as
opposed to theories of learning (Gross p38). Skinner (ibid p338) explored the distinction between
classical and operant conditioning. The essence of this difference is that classical or respondent
conditioning (Pavlov) is automatically triggered by an environmental stimulus and is automatic while
operant or instrumental conditioning is voluntary (Skinner).



Figure 1 Major figures in the behaviourist (learning theory) tradition (ibid 337)

The underlying principle operant conditioning or learning is that behaviour is learned and that
maladaptive behaviour can be relearned or conditioned. This process began with Pavlov and his
conditioned reflex theory. This was expanded and developed by Watson and others and
incorporated into psychological theory (Kroger 167). A well-known example of classical conditioning
is Pavlovs dog while one of operant conditioning is a Skinner Box

Hypnobehavioural therapy is where hypnotic procedures are used as augmentations to a behaviour
therapy course of treatment. (Heap & Aravind, 2002, p255). The following are examples of such
procedures.
Operant Conditioning is a stimulus-response psychology and was mainly developed by Skinner and
his followers. The main concepts in hypnosis are:

1. Positive reinforcement
2. Negative reinforcement
3. Punishment
4. Aversion

The various reinforcement procedures have both overt and covert forms. Examples of overt
reinforcements are (Kroger 1977, p171)
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o Ill give you (a reward) if you stop (behaviour)
o If you (behaviour), Ill (punishment)
o If you (behaviour); Ill withdraw (an entitlement)
o You can (removal of punishment) if you promise not to (behaviour)

Heap & Aravind (2002, p268) state that the effectiveness of these behavioural techniques, along
with others, can be increased when hypnotic procedures are introduced.

Aversion therapy is also called sensitisation therapy. The Roman writer, Pliny the Elder, suggested
that secretly slipping the body of a large putrid spider in the bottom of a wineglass of an
overindulgent drinker would cause a revulsion in the imbiber and a consequent reduction in
drinking. Aversion therapy is widely used as a Hypnobehavioural method to help people stop
smoking. Nash & Bernier (2008 p711) summarise the research on the efficacy of hypnosis in smoking
cessation. Earlier (ibid p570) they express surprise at the mixed results found in clinical trials varying
from 14% to over 80%.

There are covert and overt forms of this procedure. Overt aversion would be the association of an
electric shock or induced nausea with the maladaptive or unwanted behaviour, for example smoking
or drinking alcohol. This procedure is more effective if applied when the client is under hypnosis
(Kroger 1977, P170). This is because external distraction is eliminated and conditioning is more
rapid.

Covert aversion techniques use imagery; a mental representation of an actual object (ibid p171).
Cautela (1966, p33 & 1967, p459) was the first to describe clinical trials where covert sensitisation or
aversion therapy was used where a client was asked to use imagery or imagined scenes to help
eliminate unwanted behaviour. Later (Cautela 1970, p20) he describes how covert sensitisation is
used in the treatment of smoking.

Desensitisation is the one procedure most often associated with behaviour modification and was
first used to treat phobias and is now used to treat a wider range of complaints. It consists of both
exposing the client to the feared situation or object gradually while at the same time presenting a
response that is not compatible with fear such as hunger, thirst, sexual arousal or relaxation. A
hierarchy of fear responses is constructed where an easily managed task is first completed followed
by increasingly difficult or anxiety provoking ones until the fear is eliminated. These steps are
calibrated by an experienced therapist. Relaxation is the most approachable of these and is very
amenable to hypnotism.

Redd et al (2001 p810-823) state the this process of systematic desensitisation is effective in
reducing anticipatory nausea and vomiting (ANV) in a population of cancer patients. Zeltzer (1991)
tested hypnosis and produced the greatest reduction in symptoms

Flooding is where a client is exposed continuously to an anxiety inducing situation with no escape or
without the benefit of relaxation until anxiety levels lessen or diminish to an acceptable level. There
are two types: in vitro or covert and in vivo or overt. Covert flooding is where the client imagines a
dreaded object or situation at its most intense with no escape. The theory states that anxiety is
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extinguished when no more adverse consequences are felt. This approach, however, is controversial
as the phobic response can be increased instead of being minimised. The role of hypnosis is to
increase the feelings of anxiety or reaction upon which the procedure is based.

Burrows & Dennerstein (1980 P514) states that overt behavioural techniques such as flooding are
enhanced during hypnosis. They state (p178) that prolonged exposure to flooding is especially
effective. Pitman et al (1991) highlight under-recognised complications during therapy for PTSD and
states that flooding techniques used in anxiety management is contraindicated. They suggest more
cognitive forms of therapy as being effective. Moulds & Nixon (2005) study the evidence supporting
the efficacy of flooding techniques used in anxiety and highlights the scantiness of studies relating to
its use in PTSD cases.

Powell et al (2008, p196) express the concern that medical complications may occur from using this
form of therapy and cautions its use with clients who have psychiatric disorders as symptoms might
be exacerbated. They are quite vigorous in stating that it should only be used with great care on
clients with PTSD. (ibid p197)

Other forms of hypnobehavioural techniques include extinction and reciprocal inhibition. Powell et
al (2008 p198) states that the basic behavioural approaches now have several variations which
combine various aspects of each procedure and also add new processes such as observational
learning. They state that such hybrid approaches are now considered to be the treatment of choice
for phobic disorders.

In conclusion. Behavioural therapy came about as a response to the introspective nature of
psychoanalysis and methods of understanding human behaviour. It took a scientific approach and
concentrated on observable, measureable and replicable facts. There are also many other forms of
therapy combining or integrating some of the aspects of both but also some new approaches.
Hypnobehavioural therapy is the application of hypnotic techniques to behavioural therapies and is
found to be effective in such areas as smoking cessation and phobias. The application of hypnosis to
such techniques as flooding and desensitisation increases the intensity of feelings such as anxiety or
relaxation thereby making the treatment more effective. It is chiefly used in covert forms of these
therapies. Some of the research points to uncertainty in the efficacy of hypnobehavioural processes
and suggest further clinical trials.



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