Volume 17 (2022) - Ericksonian Hypnotherapy

Volume 17 (2022) - Ericksonian Hypnotherapy

Issue 1+2, October 2022, 224 pages

of the journal Hypnose – Zeitschrift für Hypnose und Hypnotherapie (Hypnose-ZHH)

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Table of Contents and Abstracts

Dan N. Short

What is Ericksonian therapy: The use of core competencies to operationally define a non-standardized approach to psychotherapy

Hypnose-ZHH  2022, 17(1+2), 7-33

Ericksonian therapy (ET) is a treatment modality practiced internationally by medical and mental health providers who wish to utilize experiential techniques and practical problem-solving as an integral part of general therapeutic protocol. As a non-standardized approach to psychotherapy, which places high value on creativity and differentiated treatment, ET has been notoriously difficult to operationalize in terms precise enough for rigorous outcome study. Building a foundation for ongoing research, this article provides an operational definition of ET using six core competencies that have been observed and measured. This conceptual frame is set within an historical context and delineated using principles discovered during a qualitative analysis of data from the field’s leading authorities as well as extensive scholarly research.

Keywords: brief therapy, core competencies, hypnosis

Kristina Fuhr, Cornelie Schweizer, Christoph Meisner und Anil Batra

Hypnotherapy in the treatment of depression – Content and efficacy according to the WIKI depression study

Hypnose-ZHH  2022, 17(1+2), 35-52

Background: The aims of this article are, on the one hand, to present the hypnotherapeutic treatment manual in more detail and, on the other hand, to present the results of the depression study that was financially supported by the Milton Erickson Society. The aim of this study was to investigate whether Hypnotherapy (HT) was not inferior to Cognitive Behavioral Therapy (CBT) in the percentage reduction of depressive symptoms in the treatment of mild to moderate Major Depression (MD).

Methods: In a monocentric two-armed randomized-controlled rater-blind trial a total of 152 patients with MD were randomized to either HT or CBT receiving individual outpatient psychotherapy with 16 to 20 sessions over six months. The primary outcome was the mean percentage improvement in depressive symptoms that were assessed with the Montgomery-Asberg Depression Rating Scale (MADRS) before and after treatment. The manualized treatment with HT will be described in more detail.

Results: Concerning the pre-specified non-inferiority margin, the results confirm the noninferiority of HT to CBT. The results for the follow-ups six and twelve months after the end of the treatment also support the non-inferiority.

Limitations: For ethical reasons the study design did not include a control group without treatment. Therefore, it can be only indirectly concluded that both treatment conditions were effective.

Keywords: efficacy; hypnotherapy, behavioural therapy, major depression

Ernil Hansen

Hypnose-ZHH  2022, 17(1+2), 53-68

Placebo and Nocebo Effects

Placebo effects are based on conditioning, expectation, or observational learning. They are not to be regarded as being only a disruptive factor of approval studies, but as an effective component of every medical therapy. For without announcement and induction of expectation, every medical measure remains limited to one to two thirds of its effectiveness, while with it the therapist comes into focus. On the other hand, negative expectation can make a treatment ineffective and produce side effects. In order to understand positive and negative effects of suggestions, it is essential to place a trance/suggestion model alongside the placebo/nocebo model in order to include important elements such as altered state of consciousness and therapeutic relationship. The effect of suggestions can not only be felt subjectively and described with subjective scores, but can also be objectively quantified and compared with measurement possibilities of physiology, e. g. dynamometry. Thus, alternative formulations can be developed and tested, whereby therapeutic communication can be improved in an evidence-based way. Even if hypnosis cannot be explained solely as a placebo effect, more attention should be paid to its significance and that of nocebo effects in hypnotherapy.

Keywords: placebo, nocebo, negative suggestions, risk disclosure, informed consent, therapeutic communication

Björn Rasch

Psychosomatic and Sleep: How do our thoughts and imaginations influence sleep?

Hypnose-ZHH  2022, 17(1+2), 69-80

Sleep, particularly slow-wave sleep (SWS), is critical for our health and cognitive functioning. Sleep disturbances are highly frequent in our society and strongly influenced by cognitive factors, e.g. rumination, expectations and thoughts. However, the mechanism of how cognition influences sleep architecture is not yet understood. To explain how cognition influences sleep, I propose the “Memories-of-Sleep” (MemoSleep)-Hypothesis. The hypothesis proposes that the influence of thoughts on later sleep relies on a repeated reactivation of the thought content and its associated embodied representation during sleep. In this review, I will explain the rational of the MemoSleep-Hypothesis, and present and discuss recent experimental findings.

Keywords: Sleep, Cognition, Reavtivation, Embodiement, Hypnosis

Barbara Schmidt

Hypnose-ZHH  2022, 17(1+2), 81-88

How fear becomes safety: Neuroscientific evidence for the effectiveness of hypnosis in anxiety and stress

The suggestion of a safe place is one of the basic techniques in hypnotherapy. In my research, I demonstrate the efficacy of this safety suggestion. In several studies, I showed that participants felt significantly safer with safety suggestion than in a control condition. In this context, suggestions under hypnosis had a stronger effect than post-hypnotic suggestions. The effect of post-hypnotic safety suggestions lasted for several weeks. When participants felt safe, they showed lower EEG brain activity to monetary rewards and devalued future rewards less compared to immediate rewards. These are indications of less impulsivity and more self-control and indicate a satisfied motivational state. I also used the safe place suggestion in the ICU with non-invasively ventilated patients and show that it helped them accept ventilation very well. The effect sizes of the safe place technique are very large across all studies. With my research, I contribute to an even wider use of this technique, so that anxiety can become safety.

Keywords: anxiety, safety-suggestion, efficacy, post-hypnotic suggestion, EEG-brain activity, intensive care, non-invasive ventilation, effect size

Maria Hagl

Hypnose-ZHH  2022, 17(1+2), 89-108

Efficacy and effectiveness research in the field of clinical hypnosis in 2021

On behalf of the Milton Erickson Society of Clinical Hypnosis in Germany, an annual review of randomized controlled trials (RCTs) and meta-analyses on the efficacy and effectiveness of clinical hypnosis and hypnotherapy is conducted. In the systematic literature search for 2021, 17 RCTs that evaluated clinical hypnosis or hypnotherapy in comparison to a control group were identified, one of them having already been published online in 2020. Most of the RCTs targeted chronic physical complaints, the others predominately evaluated the use of hypnosis before or during medical procedures. Also, one of the meta-analyses published in 2021 found strong evidence for the benefits of the use of hypnosis in adults undergoing surgical procedures. Only one RCT addressed the treatment of a mental disorder, namely the treatment of mild to moderate depression in a larger-scale non-inferiority design. Searching the trial registries for newly registered RCTs showed that more RCTs addressing mental disorders are to be expected, although mostly with smaller samples. Overall, however, the published RCTs show a clear trend towards better methodological quality regarding design and procedure than in earlier years, and towards improved presentation that follows current reporting standards.

Keywords: Hypnosis, hypnotherapy, efficacy, effectiveness, psychotherapy research, randomized controlled trials, RCT, meta-analysis, review

Hansjörg Ebell

Hypnose-ZHH  2022, 17(1+2), 109-125

„When it hurts so badly!“ Therapeutic Communication und Resonance in the Treatment of Pain

The experience of pain (i.e. being ill) and the scientific explanation of pain as a symptom (i.e. illness) are two major perspectives eminently relevant to both patients and therapists as respective protagonists. There is an inherent bond between an objectively determinable source of pain and its subjective experience as suffering. Here two perspectives refer both to the very same thing. The classification of pain as a dysfunction, injury or illness in terms of acute, chronic or objective suffering requires its recognition according to the defined criteria of scientific research or clinical experience. A hypno-systemic approach proves useful when trying to comprehend and/or overcome difficulties that frequently arise within the therapist-patient relationship. Here complaints are often qualified as psycho-somatic, somatoform (psychogenic) or as functional disorders. Intersubjective resonance, however, supports the notion of efficient communication in order to identify and achieve the desired goals of treatment and the treated.

Keywords: acute and chronic pain, functional physical disorders, therapeutic communication, hypnosis, behavioral inhibition system (BIS), behavioral activation system (BAS), intersubjective resonance

Winfried Häuser

Hypnose-ZHH  2022, 17(1+2), 127-140

Importance of medical hypnosis in somatic medicine

The importance of medical hypnosis in somatic medicine was assessed as follows: Existence of systematic reviews with meta-analysis of randomised controlled trials published in journals of somatic medicine; recommendations in German guidelines; availability of audio files. There is highest level of evidence for the efficacy of hypnosis in surgery (general and local anaesthesia), obstetrics, oncology (reduction of pain, vomiting, psychological distress), gastroenterology (irritable bowel syndrome) and pain medicine (fibromyalgia syndrome). Hypnosis is recommended in the German guidelines on vaginal childbirth, irritable bowel and fibromyalgia syndrome. Audio files are available for arterial hypertension, promotion of healing after surgery, irritable bowel and fibromyalgia syndrome. A digital health application which includes gut-directed hypnosis is available for irritable bowel syndrome. The availability of hypnosis in somatic medicine can be increased by the development of audio files for defined clinical conditions and the integration of hypnosis into the curricula of psychooncology and pain psychotherapy of psychotherapists.

Key words: Medical hypnosis; systematic reviews; guidelines; digital health application

Justin Böhmerund Barbara Schmidt

Hypnose-ZHH  2022, 17(1+2), 141-165

Safety on demand: Post-hypnotic suggestions of safety reduce neural signals of reward sensitivity with longterm beneficial effects

Increased reward sensitivity has been proposed as an important transdiagnostic feature for a series of disorders, including addictive behaviors. Earlier studies on positive affect indicate that experiencing the feeling of safety could reduce reward sensitivity. Feeling safe could thus pose as a protective factor for individuals at risk. A promising technique to establish a feeling of safety on demand is to utilize post-hypnotic suggestions. We hypothesize that the feeling of safety elicited by post-hypnotic suggestions makes participants feel safe and reduces their neural signals of reward sensitivity. To test our predictions, we hypnotized 24 highly suggestible participants, suggested them to feel safe using the mental image of a safe place and coupled this feeling of safety to a post-hypnotic trigger that reactivates the feeling of safety outside the hypnotic state. Participants then played a risk game in which they could win monetary rewards. Simultaneously, we recorded their EEG. Participants reported significantly higher ratings of safety when using the post-hypnotic safety trigger as compared to using a neutral trigger. This effect persisted for several weeks after the experiment. Moreover, the Reward Positivity (RewP), a component of the event-related potential in the EEG that has been proposed as a psychophysiological marker for reward sensitivity, was significantly reduced when using the post-hypnotic safety trigger. We show that post-hypnotic suggestions sustainably activate the feeling of safety on demand and thereby reduce an individual’s reward sensitivity. Our study reveals new trajectories for the treatment of disorders associated with increased reward sensitivity such as substance use disorders.

Keywords: reward sensitivity, positive affect, safety, hypnosis, post-hypnotic suggestion, EEG, Reward Positivity (RewP)

Thomas Fritzsche

Hypnose-ZHH  2022, 17(1+2), 167-176

"Time Line" at a young man with erythrophobia. Case example

A 23-year-old man seeks therapy. He is so afraid of blushing that it hinders him professionally and privately. Although we do not define as a mandate that he no longer blushes, but that it no longer bothers him, the first conversations, cognitively, go in circles. During the subsequent "Time Line" intervention, he achieves a qualitative change: instead of thinking about the problem, he experiences the (minor) importance of the problem from a future/solution perspective and feels immediately liberated by this change of perspective or dimension.

Keywords: erythrophobia, time line, change of perspective

Dorothea Thomaßen

Hypnose-ZHH  2022, 17(1+2), 177-195

Anna finds her peace. State-dependent learning and remembering as the key to successful treatment of a dog phobia. Case example

Hypnotherapeutic treatment of a young woman with a specific phobia of dogs in a single session

Keywords: State dependent learning and memory, U-Assessment-and-Therapeutic-Protocol (UATP), idiolect, in sensu-exposition, anchor technique, posthypnotic seedings