HYPNOSIS AND

HYPNOTHERAPY
A Practical Experience
and Odyssey
YOUR INSTRUCTOR
 History of Hypnosis
• “Laying on of hands by priests and rulers (the Royal Touch).
• The woman who was healed by touching Jesus’ cloak.
• Paracelsus was able to heal by astral bodies.
• Fr. Maximilian Hell , SJ, obtained cures by applying steel
plates to the naked body.
• Franz Anton Mesmer systematized “animal magnetism” as
a treatment, in large tubs. He was able to obtain somatic
symptom relief and induce convulsions and hallucinations.
He was eventually exposed by a French commission in
1784 which concluded his results were based on the power
of suggestion.
• The Marquis de Puysegur first noted the similarity between
hypnosis and sleep and associated it with clairvoyance.
• James Braid coined the word “hypnosis” and associated it
with the power of suggestion.
 History (Continued)
• Hypnosis has been associated with Vampirism.
• Josef Breuer found that symptoms were lessened
when traumatic memories were recovered under
hypnosis. Not all patients responded well to
suggestions for direct symptom removal.
• Sigmund Freud initially used hypnosis but
considered it unwise to remove symptoms that still
had meaning for the patient. He also sensed a
sexual connotation. He discovered that not all
patients could achieve a good hypnotic state.
Eventually he thought it interfered with the
transference and gave it up.
• Milton Erickson gave hypnosis new vigour in the
1930s and beyond, with his method of indirect
suggestion.
 Theories of Hypnosis
• State theories – Hypnosis is an altered
and special state of consciousness on
which people differ significantly and
which is relatively unchangeable over
time and in different conditions. Studies
do show that hypnotic susceptibility (or
trance ability/capacity) is relative
invariant and follows a normal
distribution. It is correlated with almost
nothing else.
 Theories (continued)
• Socio-cognitive theory (non-state) –
Hypnotic responsiveness is dependent
on social psychological phenomena,
such as expectancies, attitudes,
demand characteristics, imagining and
beliefs, as well as one’s interpretation of
suggestions. Education about hypnosis
is critical as is role-related behaviours.
 Models of Hypnotherapy
Psychodynamic Model
• 1. Hypnosis is erotic in nature.
• 2. Uncovering repressed material via
hypnosis.
• 3. Primary (imagery) and secondary
(language-based).
• 4. “Double consciousness” between
observing and participating ego.
• 5. Transference and dependence.
 Ericksonian Model
• 1. The unconscious need not be
made conscious.
• 2. Mental phenomena are to be
utilized rather than analyzed.
• 3. Hypnotic suggestions are indirect
rather than direct.
• 4. Most hypnotic work can be done in
a light trance.
 Cognitive-Behavioural Model
• 1. The hypnotic situation is explicitly
defined as “hypnosis.”
• 2. Suggestions are made that phenomena
will be experienced non-volitionally or
involuntarily. This has been a definition of
hypnosis.
• 3. Most psychological disturbance is
caused by a negative form of self-hypnosis
in which negative thoughts are accepted
uncritically and without awareness.
Cognitive-Developmental Model
• 1. Hypnosis may be especially useful in
directly accessing and modifying core
cognitions of personal identity, self-
concept and dysfunctional tacit rules.
• 2. Hypnotic imagery and related emotional
processing may be useful in changing tacit
knowledge structures which are often
preverbal and nonverbal.
• 3. Bypass conscious resistance.
• 4. Two major tasks: Identify core cognitive
structures and changing those structures.
 Myths of Hypnosis
• 1. Hypnosis is caused and controlled by the
hypnotist and is done TO the subject.
• 2. Hypnosis can make people do things against their
will and reveal secrets.
• 3. Hypnosis is a form of sleep.
• 4. Hypnosis occurs only when a formal induction is
used.
• 5. Hypnosis occurs only when one is relaxed.
• 6. Hypnosis is a therapy.
• 7. Only some people can be hypnotized.
• 8. Hypnosis can be used to help people accurately
recall what has happened in the past.
 Myths (Continued)
• 9. Hypnosis is dangerous!
• 10. Hypnosis works only with gullible or weak-
minded people
• 11. Women are more hypnotizable than men
• 12. Hypnotized people may not be able to be
dehypnotized
• 13.Hypnotized people “lose consciousness”
• 14. The hypnotist must be charismatic or “weird”
 Levels of Hypnosis
•
Indications for hypnosis success
• 1. Treatment of pain
• 2. Smoking cessation
• 3. Anxiety disorders
• 4. Stress-related physical disorders and
medical conditions (e.g. hypertension,
ulcers, bruxism)
• 5. Dermatological conditions
• 6. Asthma
• 7. Obesity and eating disorders
 Contraindications
• 1. OCD clients are less hypnotizable
• 2. Psychotic decompensation
• 3. Paranoid level of resistance or control
• 4. Borderline personality
• 5. Clients’ experiences with authority
figures, sexual transference, cultural
history
• 6. Dissociative disorders
General Hypnosis Assessment
 Hypnotic Induction
Preparation
• 1. Dispel myths
• 2. Assess reasons and motivation
• 3. Assess prior experience with
hypnosis
• 4. Assess one’s own motivation
• 5. Develop therapeutic rationale
 Assessment of hypnotic
susceptibility/trance capacity
• 1. Eyelid fluttering
• 2. Head nodding
• 3. Deeper breathing
• 4. Client posture
• 5. Trance literalness
• 6. Subsequent memory
• 7. Weight/balloon technique
 Hypnotic Induction Techniques
• 1. Eye fixation and closure
• 2. Relaxation-based techniques
• 3. Arms rising and falling
• 4. Arm levitation
• 5. Confusion technique
• 6. Counting technique
• 7. Self-induction
 Deepening Techniques
• 1. Staircase, elevator or diving
• 2. Repeating the induction
• 3. Challenges (e.g. eye closure, hand
clasp, arm catalepsy)
• 4. Deeper breathing technique
• 5. Suggesting greater “depth”
• 6. Arm rotation
• 7. Counting backwards by odd numbers
 Hypnosis in Cognitive Therapy
Cognitive Contents
The words and sentences we use; what are called
automatic thoughts (A.T. Beck), irrational thoughts (Ellis)
or the internal dialogue (Meichenbaum).

Ex: “This audience won’t like what I’m saying” or “I’m doing
a terrible job!’ Daniel Araoz refers to this as “negative
self-hypnosis.”

Use the two-column technique to generate positive self-

statements to offset the negative self-statements. The
hypnotist can often use direct hypnotic suggestions.
 Cognitive Processes
(J.S. Beck, 1995)
1. All-or-nothing (dichotomous) thinking
2. Catastrophizing
3. Discounting the positive
4. Emotional reasoning
5. Labeling
6. Magnification/Minimization
 Cognitive Processes
(Continued)
7. Mental filter
8. Mind reading
9. Overgeneralization
10. Personalization
11. Using imperative statements
12. Tunnel vision
 A. Ellis’s Irrational Beliefs
1.Demandingness (DEM) – absolutist
requirements: “Shoulds,” “Musts.”
The rational response is
preferences.
2. Awfulizing/catastrophizing (AWF) –
An extreme evaluation of a negative
event. The rational response is a
more moderate evaluation of
“badness.”
3. Low frustration tolerance (LFT) – a belief
that one cannot stand certain
circumstances; someone or some thing is
in your way! The rational response is that
it may be difficult but not intolerable. LFT
can lead to anger.
4. Global evaluation/Self downing (SD) – a
global and negative self evaluation to
oneself, others and the world. The rational
response is an unconditional acceptance;
rather Buddhist in nature.
 Cognitive Structures
(Young, Klosko, & Weishaar, 2003)

Domain 1: Disconnection and Rejection

1. Abandonment/Instability.
2. Mistrust/Abuse
3. Emotional Deprivation
a. Deprivation of Nurturance
b. Deprivation of Empathy
c. Deprivation of Protection
4. Defectiveness/Shame
5. Social Isolation/Alienation
Domain 2: Impaired Autonomy and
Performance
6. Dependence/Incompetence
7. Vulnerability to Harm or Illness
8. Enmeshment/Undeveloped Self
9. Failure
Domain 3: Impaired Limits
10. Entitlement/Grandiosity
11. Insufficient Self-Control/ Self-Discipline
 Domain 4: Other Directedness
12. Subjugation
a. Subjugation of needs
b. Subjugation of emotions
13. Self-Sacrifice
14. Approval-seeking/Recognition-
Seeking
 Domain 5: Overvigilence and
Inhibition
15. Negativity/Pessimism
16. Emotional Inhibition
17. Unrelenting
Standards/Hypercriticalness
18. Punitiveness
 Memory Processes
Encoding
1. Under encoding – Not enough information is
used.
2. Over encoding – Too much information is used.
3. Conceptually-driven processing – Encoding
processes initiated by people; generalizing,
elaborating, organizing, reconstructing.
4. Data-driven processing – information presented
without a context; difficult to distinguish
memory from imagination.
 Memory Processes
Encoding (Continued)
1. Explicit memory/learning – Derives from
conceptually-driven processing. Involves
ordinary, conscious, effortful learning.
2. Implicit memory/learning – Derives from data-
driven processing. Involves tacit associations
of concepts and rules that form our knowledge
of the world. Solidified by repeated processing
so that memory may become more firmly held
but less accurate.
 Memory Changes
Daniel Schacter et al.
1. Context. Memory for an event improves when
one is in a similar context in which the
memory was originally learned. For example,
sad or angry clients often spontaneously
remember past events when they felt the
same emotion. Mood congruence effect.
2. Attention. People learn differently in focused
versus divided attention situations. Information
learned in divided attention cannot be recalled
as easily but can still be used or recognized.
Divided attention reduces cognitive censoring.
 Memory Changes

3. The number of times an event is recalled.

Repeated recall of events results in less
accuracy but more confidence. Memories
change over time, generally in self-serving
directions. Memories also begin to lose
their power if repeatedly recalled.
Therapist techniques can shape a
memory.
 Memory Changes
Misattribution
1. People remember accurately but attribute
it to the wrong source.
2. People remember without knowing they
are remembering; attribute it to
imagination. Crypnomnesia, “false fame
effect.”
3. People recall or recognize events that
never happened. They “fill in the blanks.”
 Memory changes
Suggestibility
1. People can incorporate information
provided by others, e.g. misleading
questions. Suggestions made at the time
of retrieval can lead to (partly) false
autobiographical memories.
2. The tendency to report false memories is
positively correlated (.48) with the
Dissociative Experiences Scale.
Hypnotic suggestibility has been
correlated with success in therapy
(Kenneth Bowers).
 Memory Changes
Bias
1. Memories can be changed or distorted
by current knowledge, beliefs and
expectations as well as mood. People
exaggerate the consistency between
their current and past attitudes, beliefs
and feelings.
2. When people believe they have changed
they may overestimate differences over
time.
 Memory Changes
Persistence
1. It involves remembering events or facts
one would prefer to forget.
2. Current feelings can increase the
accessibility of affectively congruent
memories.
3. Excessive ruminations can increase the
salience of those memories and enhance
them.
Attributes of Tacit/Implicit Learning
Arthur Reber et al.
1. Implicit knowledge is acquired faster than
explicit knowledge. It is especially
important in emotion-based knowledge
and is more inflexible and resistant to
change.
2. Implicit learning is more effective that
explicit learning, especially in complex
tasks. One immerses oneself in the
situation.
 Attributes (Continued)
3. Implicit learning occurs through the tacit
detection of co-variation. In the process
tacit (unconscious) rules are formed.
People may detect co-variations where
none actually exist.
4. The rules and associations created by
implicit learning are nonverbal (often
preverbal) and therefore cannot be
discussed. Therefore they are especially
resistant to change.
 Attributes (Continued)
5. Implicit knowledge is very
conservative and not easily changed,
especially if protecting core meaning
structures of personal meaning and
self-identity.
6. Implicit learning happens very rapidly
with few repetitions needed. This is
especially true in emotionally-based
learning.
 Attributes (Continued)
7. Cultural assumptions and one’s
native language are examples of
implicit learning.
8. Implicit knowledge is demonstrated
when people say, “But that’s just
reality!” Everyone knows that!”
9. Freud’s “unconscious” and Beck’s
“core cognitive constructs” are
examples of this Implicit/tacit
knowledge.
 Self-perpetuating encoding
algorithms
Pavel Lewicki et al.
1. All incoming stimuli must be encoded
using some classification if they are to be
meaning and therefore used.
2. The algorithms (inferential rules) are
responsible for filtering stimuli so that
those that support the inferential rules
are allowed access and those that do not
support them are denied access.
3. Over time these algorithms (or rules)
become self-perpetuating because the
inferential rules become more elaborated
and stronger because they are repeatedly
confirmed. This tendency is especially
pronounced in ambiguous situations
where multiple interpretations are
possible. When faced with ambiguous
situations, people impose their pre-existing
rules on the new situation. Therefore, “We
find/see what we expect to find/see” and
“Believing is seeing.” This is also known
as “confirmatory bias.”
 Hasty Encoding
4. The individual uses very little supporting
information before imposing a particular
rule (interpretation) on an event even if the
co-variations which result in the
interpretation to not match well. Essentially
he “jumps to conclusions.” These people
are less likely to use outside information in
interpreting new events. They use a more
internal encoding style (intuition).
 Hypnosis in everyday life
1. “Highway hypnosis.”
2. The deliberate inclusion of trance and
meditative states.
3. “Let your mind lay flat.”
4. Focusing on one particular aspect of a
situation. Reduce the effect of the
“monkey mind.”
5. “Lean into your problem.” Learning to
overcome problems by embracing it.
Contributions of Milton Erickson
1. The utilization approach. Accept the
client’s manifest behaviour, their
resistance, negative affect, symptoms
and work within their personal frame of
reference. Use these in hypnosis.
2. Indirect suggestion. It is useful for
exploring potentialities and facilitating
natural response tendencies. Tends to
bypass conscious resistance. Indirection
is a continuum.
3. Truisms. It is a simple statement of fact
that cannot be denied. It can lead to
acceptance of more difficult acts, much
like the “foot in the door” technique.
4. Open ended suggestions. They tend to
encourage the exploration of new
possibilities and reduce or eliminate old
views and solutions.
5. Suggestions covering all response
possibilities. Tends to validate and ratify
trance behaviour.
6. Not knowing, not doing. Tends to discourage
the client from “working on” immediate
solutions and to create the suggestion of
allowing things to happen. May also validate
and ratify trance behaviour.
7. The “yes-set.” Tends to reduce resistance
and leads the client by proposing increasingly
difficult questions to which the client answers,
“Yes.” Acts like an encourager to continue
and a “foot in the door” technique.
8. Binds. Providing a client with a few
comparable choices only. Tacitly accepts a
situation with only a few choices to attain it.
9. Double bind. Offers possibilities of
behaviour that may be outside the client’s
usual range of responses. May suggest
that clients will go into a trance no matter
what they do.
10. Meta-communication; communication on
more than one level. Binds and double
binds tend to meta-communicate because
there are hidden meanings. (E.g. “How
would you like to go into a trance?” “As
you begin to think about changing,
perhaps you can begin to think about all
the exciting possibilities of changing – and
even more than you know and think”).
11. Early learning set. Using a common
early experience to facilitate trance and
foster change.
12. The use of metaphor and analogy. Using
a common situation to suggest another,
e.g. change.
13. Story-telling. Telling a client a story
about a particular person’s journey without
the client realize it is about him. Similar to
parables.
14. Reframing a situation as positive rather
than negative (not unique to Erickson).
 Cognitive Resistance
Resistance is a natural human tendency.
The human cognitive system wisely protects
itself from excessively rapid changes in its
tacit core concepts of human meaning and
personal identity. They have been
repeatedly rehearsed and are therefore
very resistant to change. They shape the
assimilation and perception of incoming
stimuli.
 Psychological Reactance
J.W. & S.S. Brehm
Defined as the motivational force to restore
lost or threatened freedoms. Attempts to
restore these freedoms may not always
occur; it is a potential. There are several
ways to restore these freedoms:
1. Directly reassert the free behaviour
through oppositional behaviour.
2. Observe others perform the threatened
behaviour.
 Reactance (Con’t)
3. Engage in a related behaviour.
4. Respond to threatened freedom by
aggressing against the threatening agent.
5. Exhibiting a greater liking for the
threatened free behaviour (the “forbidden
fruit”).
6. Leave the situation entirely.
 Individual Difference in
Psychological Reactance
1.It is both a state variable and a trait variable.
2. It is distributed along a normal distribution.
3. The mean score on the TRS normative
group was 66.68; the median was 66.50;
the SD was 6.59.
4. One cross cultural study showed that
Germans were significantly more reactant
than Americans.
5. Some studies have shown men to be more
reactant than women.
 Motivational Components of
Psychological reactance
Reactant individuals tend to be aggressive,
dominant, defensive, quick to take offense
and autonomous/individualistic. They tend
not to affiliate with others and neither seek
support from others nor support them.
They neither describe themselves in
favourable terms nor present a favourable
picture of themselves to others. They are
somewhat dissatisfied with themselves but
have a positive self-image. But they may
be strong and effective leaders.
 Personality Components of
Psychological Reactance
Reactant individuals are less concerned with
making a good impression (Impression
Management) on others, are less likely to
follow social norms and rules and may be
careless about fulfilling duties and
obligations. They are less likely to be
tolerant of others’ beliefs and values, may
express strong feelings and emotions and
may be concerned about problems and
the future. They tend to be independent.
 Personality Disorders and
Psychological Reactance
One study found that personality disorders were
ordered in the following manner on psychological
reactance, from low to high; passive-aggressive,
dependent, personality disorder NOS, no diagnosis
(about the scale average), obsessive-compulsive,
and borderline. Another, using Millon’s personality
system, found that the Sadistic, Paranoid, and
Borderline patterns were associated with high
reactance while the Dependent, Histrionic, and
Avoidant patterns were associated with low
reactance.
 Developmental Correlates of
Psychological Reactance
1. Reactant individuals were less trusting
(Erik Erikson’s stage 1), less intimate
(stage 6), more autonomous (stage 2),
stronger sense of identity (stage 5), and
tentatively more despairing (stage 8).
Autonomy and identity are elevated over
trust and intimacy.
2. Verbal reactance tended to be associated
with more healthy psychosocial
development; behavioural reactance with
less healthy development.
 Personality Disorders and
Psychological Reactance
One study found that personality disorders were
ordered in the following manner on psychological
reactance, from low to high; passive-aggressive,
dependent, personality disorder NOS, no diagnosis
(about the scale average), obsessive-compulsive,
and borderline. Another, using Millon’s personality
system, found that the Sadistic, Paranoid, and
Borderline patterns were associated with high
reactance while the Dependent, Histrionic, and
Avoidant patterns were associated with low
reactance.
 Psychological Reactance and
Cognitive Hypnotherapy
Resistance and reactance are constant
aspects of psychological change,
regardless of the type of therapy.
Ericksonian indirect hypnotherapy has
shown some promise in bypassing
conscious resistance. But use of the TRS
may help identify those clients who may
be especially suited for indirect methods or
more direct methods.
Cognitive Hypnotherapy in Treating
Various Psychological Disorders
1. Anxiety disorders
2. Depression
3. Anger treatment
4. Pain Management
5. Smoking Cessation
6. Bruxism
7. Reconstruction of memories
8. Enhancing life
 What Causes Anxiety?
1. Catastrophic thinking – Exaggerating the
negativity.
2. Anxiety expectancy – The self-confirming
expectancy of having a phobic or stress
reaction. Exacerbated by “Spectatoring.”
3. Avoidance – It is reinforced by the
reduction of anxiety.
 Relaxation in Treating Anxiety
A simple way to elicit the relaxation response:
Basic meditation is a very simple way to elicit this
response. Ideally it is done once or twice daily for 10 to
20 minutes.
* Sit in a relaxed position
* Close your eyes
* Repeat a word or sound as you breathe.
If your thoughts stray, which is normal, shift your
attention back to the word/sound repetition. An essential
component of producing the relaxation response is to
interrupt the everyday train of thought. On rare
occasions, the relaxation response can produce
disturbing thoughts or fear of losing control, especially in
people with serious psychiatric conditions, but for most
it's well tolerated.
Guided Imagery in Treating Anxiety
In addition to the simple meditation technique
described above, there are formal methods,
including "mindfulness meditation" and
"transcendental meditation" or TM. Classes in
these techniques are often available in hospitals,
health clubs and community centers.
* Guided imagery
With this approach, a person learns to create
visual images that have relaxing effects. Books
and audiotapes are available for instruction.
Progressive Muscle Relaxation
“I’d like you to start at the top of your head
and let it relax, feeing the tension move
down your body, relaxing as it goes…Your
facial muscles; your jaw and tongue; your
next; your shoulders, arms and hands;
your chest; your thighs; your upper legs;
your lower legs; your feet…allowing all the
tension to gradually leave your body, only
peace and relaxation left…
 Desensitisation in Treating Anxiety
Desensitisation[8] consists of muscle relaxation, reduction of anxiety
and construction of a graded hierarchy of aversive stimuli from
information provided by the patient. For example, such a hierarchy
for a flying phobia would consist of arrival at the airport, proceeding
to the departure lounge, walking onto the plane, experiencing takeoff
and landing. The hierarchy can be presented to the patient, either in
imagery or in reality. Tape recordings can also be used effectively in
desensitisation.

Desensitisation works well with social and specific phobias. The

disadvantage is that this process is time-consuming and often
requires many sessions. Desensitisation can, however, be carried
out in hypnosis, often in one or two patient encounters and with
minimal therapist contact. In such a case hypnosis is used to
prepare the client for receiving suggestions. Occasionally with high
hypnotisable subjects, hypnosis may be used in reality.
 Flooding in Treating Anxiety
Another technique, called “flooding” or implosion, can he
used. If desensitisation is like wading slowly into a
swimming pool at the shallow end, flooding is equivalent
to jumping in at the deep end. Exposure is usually
initiated by flooding in fantasy, with people imagining
themselves in the frightening situation for one to two
hours. The basic principle is to encourage the patient to
face rather than to avoid fears so that it is important they
stay with the scene.

Modified flooding, using a single session, can be used

effectively with hypnosis and is useful when time
constraints prevail. It can work well with specific phobias
such as flying, when the client presents a day or so
before anticipated travel.
Hypnosis in Treating Anxiety
Focused attention and concentration
is used to produce a trancelike or
hypnotic state in which the individual
is vulnerable to suggestion, for
example, to relax. Hypnosis is
generally induced by a trained
hypnotherapist, but individuals can
also learn self hypnosis.
Treating Performance Anxiety
 Jay’s Work Anxiety
EMSs of: Unrelenting standards
(similar to a core belief of “I’m
Incompetent”) at work
EMSs of Defectiveness/Shame and
possibly Emotional Deprivation
(deprivation of nurturance) in
relationships
 Major Issues in Depression
1. Sense of Loss
2. Negative View of the Self
3. Negative View of the
Future
4. Negative View of the Word
 Negative Self-Hypnosis
1. Daniel Araoz argued that depression is
caused by a form of negative self-
hypnosis, in which negative automatic
thoughts (spontaneous self-suggestions)
are repeated constantly. Cure is to be
found by developing more positive self-
statements as antidotes.
2. Can use the “empty chair” technique to
foster these. Hypnosis can provide
emphatic repetition.
Building Positive Expectations
Michael Yapko has developed a treatment
program for depression, involving
interrupting negative expectations and
building positive expectancies and
providing hope. The key to expectancy
building is age progression, in which the
patient is “encouraged to experience
positive future consequences now that
arise from implementing new changes and
decisions.”
 Energizing Hypnosis
1. Depression often involves lethargy. An
energizing hypnotic routine can foster
more energy and a sense of aliveness.
2. Alert hypnosis can help, in which the
hypnotist speaks in an energizing tone of
voice and develops a very pleasant and
involving scene.
3. Ask the client to focus on a highly
involving and pleasant scene from the
past.
 Jan’s Depression
Cognitive processing distortions:
1. Overgeneralization
2. Using selective abstraction
Possible EMSs of:
1. Defectiveness/Shame
2. Self-Sacrifice
 Major Issues In Anger
Sense of Being Disrespected or Denigrated
– Similar to Resentment but stronger
1. Righteous Anger (seen as positive)
2. Constructive Anger (seen as
Empowering)
3. Malevolent Anger (Seen as Harmful)
4. Selfish Anger (Seen as Aggrandizing)
5. Behind Anger is Often Hurt
 Anger Cognitions
1.”How dare he do that to me!”
2. “She had no right to…”
3. “He’s a complete jerk who
should be punished!”
4. “She always does that to me!”
5. “He has no right to be that rude!”
 Anger Processing and Structures
Cognitive Processes
1. Faulty Primary and Secondary Appraisal Errors
2. Dichotomous Thinking
3. Overgeneralization
4. Imperative Statements
5. Labeling

Cognitive Structures
1. Rejection
2. Punitiveness
 Treatment of Anger
A Buddhist Perspective
1. Take responsibility for your anger. Not
easy because angry individuals tend to
be externalizers
2. Become aware that anger is a result of
our frustrated desires
3. Understand the dynamics of anger – it
reduces our sense of danger,
helplessness and humiliation.
 Treatment (Continued)
4. Ask the client to reflect on his anger as it
arises
1. “What did I want that I wasn’t getting?
2. “What was I getting that I didn’t want?
5. Client decision – The commitment not to
act out anger, not to repress it, but to
become aware of it and reflect upon it.
6. The client gradually turns his mind to
alternatives to anger
 Pain Management
Pain is a complex, multifaceted
phenomenon. High hypnotizables tend to
benefit more.
1. Physical factors. The specificity approach
proposes that pain sensations result from
the stimulation of pain receptors. But this
cannot account for variations in pain
perception. Melzack and Wall’s Gate
Control Theory suggests that neural
mechanisms in the spinal cord increases
or decreases the flow of nerve impulses.
 Pain Management
2. Attention paid to pain sensations tends to
increase pain. Attention diverted from
pain tends to decrease pain sensations.
This can be increased for people who
have little to do.
3. Cognitive factors. People with pain tend to
catastrophize. They can engage in
imagery that is incompatible with the
experience of pain. They can think about
pain in a more detached way. They may
dissociate.
 Pain Management
4. Emotional factors. People become very
anxious while in pain, especially when it
cannot be predicted. It can lead to
“anxious anticipation.” People tense which
increases the experience of pain. It is
difficult to know which comes first; anxiety
or pain. Anxiety can generalize to pain-
associated phenomena (e.g. physicians).
 Pain Management
5. Behavioural factors. People exhibit “pain
behaviours” when in pain. They begin as
expressions of pain but can become cues
for pain and can increase the perception of
the pain itself; a vicious cycle.
6. Interpersonal factors. The experience of
pain can become socially reinforcing;
secondary gain. Sometimes monetary gain
occurs as long as one is in pain. They may
end up with Socially Legitimized
Dependency.
 Types of Pain
1. Acute pain. It declines by itself and
usually relaxation and anxiety reduction
are sufficient.
2. Chronic pain. Recurrent, intense and
intermittent pain. Direct suggestions for
pain reduction or relaxation can help.
3. Chronic, intractable, benign pain. Usually
present, varies in intensity. Psychological
factors and secondary gain are
important. Example is lower back pain.
 Types of Pain
4. Chronic, progressive pain. A primary
example is cancer. Anxiety is a prominent
feature. It is difficult to treat because the
constant attempts are exhausting and only
partially helpful. Psychological factors and
secondary gain are usually not present.
Distraction, relaxation, positive imagery all
may help.
 Hypnotherapeutic Treatment of
Pain
1. Hypnotic relaxation. It can reduce the
anxiety and tension and provides a
coping strategy and hope.
2. Direct suggestions for pain reduction. It
may work for highly motivated clients
with moderate to high hypnotizability. But
it may not work if the pain intensity is
great and it does not provide coping
strategies. One should do a “medical
rule-out” first.
3. Indirect suggestions. It does not challenge
the client to resist. It does not use the
word “pain;” rather words like comfortable,
relaxed, letting go, and peaceful.
4. Transformation of pain. There are two
kinds: A. the pain is actually moved to
another part of the body less central to the
client’s activities. It may work in cases of
chronic, intractable, benign pain. B. pain
can be transformed into other sensations,
such as itching, tingling.
Hypnotic Analgesia and Anesthesia
1. Analgesia is a dulling of sensation and is
produced by suggestions of numbness –
can be achieved by most people.
2. Anesthesia is a loss of sensation –
achievable only by high hypnotizables.
3. It can be used for chronic pain; intractable
and progressive as well as psychogenic
pain. Clients can keep only as much pain
as they wish.
 Dissociative Techniques
1. Instructing clients in a trance to detach
and dissociate from their bodies; look at
themselves from the outside.
2. The “Telescope technique” asks clients to
see their pain through the wrong end of a
telescope.
3. The “bag of pain” approach asks clients to
imagine their pain wrapped up in a bag.
 Distraction Techniques
1. The client is asked to visualize a
pleasant or happy scene and then
concentrate on it and the pleasant
feelings. It can be used for acute and
chronic pain and teaching the client a
coping strategy.
2. The client is asked to focus on another
part of his body.
 Cognitive Restructuring
1. Reduce negative catastrophic thoughts.
2. Reduce hopeless thoughts.
3. Reduce angry thoughts.
4. Increase self-coping statements.
 Smoking Cessation
The research evident indicates that
hypnosis is at least as, if not more,
effective than alternative treatments. But it
can be difficult to untangle the effects of
hypnosis from the behavioural and
educational interventions. It can be a brief
package.
 Treatment Components
1. Hypnosis as self-hypnosis. Requires that
clients actively participate in their
treatment.
2. Cognitive and behavioural skills. Uses
techniques such as minimizing negative
self-talk, increasing self-reward.
3. Education component. Describes smoking
as a learned behaviour response. Ask
clients to generate positive reasons to be
a non-smoker.
4. Assessing and enhancing motivation. “Do
you want to quit or want to want to?”
Includes positive suggestions for
increased control and mastery, keeping
healthy and alive.
5. Helping clients to define themselves as a
nonsmoker. “I am a nonsmoker!” This is
predictive of success.
6. Relapse prevention. Identify triggers for
smoking. Develop coping responses.
Avoid high risk situations.
 Bruxism
• Physicians don't completely understand
the causes of bruxism. Possible physical
or psychological causes may include:
• Anxiety, stress or tension
• Suppressed anger or frustration
• Aggressive, competitive or hyperactive
personality type
• Abnormal alignment of upper and lower
teeth (malocclusion)
• Changes that occur during sleep cycles
• Response to pain from an earache or
teething (in children)
• Growth and development of the jaws
and teeth (for children)
• Complication resulting from a disorder,
such as Huntington's disease or
Parkinson's disease
• An uncommon side effect of some
psychiatric medications, including
certain antidepressants.
 The Case of S.C.
1. S.C. was 33 years of age and was self-
referred for a 20 year history of teeth-
grinding in her sleep. The problem had
remained constant. She wore a mouth
guard which she had to replace every six
months or so.
2. She had oral surgery on one joint. She
exercises regularly She kept a diary to
attempt to determine if life events were
causing this. Her home life (husband and
two children) was happy.
 Psychological Profile
1. S.C. was above average intelligence. She
had a good self-concept. She was trustful
and optimistic. She had one younger
brother.
2. S.C. was not experiencing psychological
turmoil. There was a tendency for her to
deal with stress and anger in an indirect or
passive way to avoid upsetting others.
There may be a hidden hostility in her.
 First Session
1. I conducted a “medical rule-out.” Her
dentist had prescribed a mouth guard
and she wore out several.
2. She had jaw surgery several years earlier
which had had a slight effect. She could
open her mouth wider. The problem had
existed about 20 years.
3. Her physician ruled out physical causes.
4. Her pain was only on the left side of her
jaw.
 First Session
5. Her relationship with her husband was
good.
6. She reported she had no anger in her life.
Eventually she said she sometimes felt a
little anger but preferred to call it
frustration.
7. She reported no aggression but when
things don’t go well she feels “deflated”
(drained).
8. I asked her to reflect upon what happened
20 years ago for next session.
 Second Session
1. In response to my assignment she talked
about her volatile parents. She reported
she was always the family peacemaker.
2. She wanted hypnosis and I conducted a
session around themes of allowing
herself to let go and learn new things
about herself.
3. In the subsequent discussion she became
quite emotional and said she has always
wanted to let go. She has devoted much
of her life to “having it all together” and
therefore not being vulnerable.
 Second Session
4. Being vulnerable is scary. She has
somaticised her “holding it all together”
into her jaw, next and head.
5. We discussed the paradoxical nature of
trying to let go versus allowing it to
happen.
6. We identified a theme in her life; always
being in control to avoid anxiety.
 Third Session
1. She reported “something worked!” She
had not woken up with a sore jaw and
she was sleeping better.
2. She had a revelation; she no longer
wanted to be the peacemaker.
3. I discussed the nature of transformational
versus conservational changes.
4. I conducted a hypnotic routine around
themes of shedding old roles and
discomforts (pain).
 Third Session
5. She wished to practice shedding old roles
with her mother, second with her brother.
6. Her mother’s reactive and volatile nature
is a major stressor for her. She reported
(emotionally) being afraid she would act
like her mother towards her daughter. In
the area of emotional reactivity S.C. has
been trying to be the opposite of her
mother.
 Fourth Session
1. S.C. was excited because she slept 10
hours!
2. She has learned: a. therapy is going really
fast, b. she stood up to her mother on an
issue and her mother backed off, c. she
only had jaw pain on two mornings, d. a
co-worker told her she “put up walls,” e.
she was able to let go of a small piece of
control. She felt tension escaping.
 Fourth Session
3. I asked what the walls were protecting her
from. She replied, “Afraid of being hurt?,
afraid of other seeing who she really is,
afraid of receiving?”
4. I conducted a hypnotic routine around
themes of making new connections among
her thoughts, feelings and actions as she
grows and develops. These connections
will go under, over and through her walls,
gradually crumbling them.
5. We discussed her “spectatoring.”
 Fifth Session
1. She reported that her mother is backing
off more as she is more assertive.
2. She has noticed she “spectators” when
she thinks she will be judged by others.
3. Her jaw pain was noticeable only three
mornings.
4. I interpreted the MMPI for her. I reminded
her that she had denied being angry but
the results showed she was. After a
moment, she said, “I really AM angry!”
 Fifth Session
1. Who hurt S.C.” And when and how?
2. Before the next session I asked her to:
a. do something different for herself
(something she had not done), and b.
meditate each day upon her anger.
 Sixth Session
1. This session lasted about 1 ½ hours.
2. S.C. combined both assignments and had
constructed a double-sided drawing. On
one side were all the things she felt
typified her; good and bad. On the other
side were all the things that made her
angry.
3. Some friends she had earlier in her life
had hurt her.
 Sixth Session
1. In her exploration, several things stood out: a.
her lack of assertion in relationships, b. she
doesn’t know who she is, c. her difficulty
expressing strong emotions, d. the fear that
governs her life.
2. Her jaw pain has mostly disappeared and she
can now eat nuts.
3. The hypnotic routine was around themes of
“letting go;” connecting letting go of her fear
with letting go of her jaw pain.
 Seventh Session
1. What had she learned?
A. How much anger she has at herself (mostly) and
others.
B. How to let go of her anger.
C. The connection between her emotional state and
her jaw pain.
D. The anger directed at her by an old acquaintance
was hers, not S.C.,s.
2. Her church’s sermon was about the need to forgive
and let go of grievances and she was able to relate it
to herself.
3. Her husband has described her as more playful.
 Follow Up
1. After a year I talked to S.C. She reported
her jaw pain had disappeared and stayed
gone.
2. Her relationship with her husband had
improved.
3. She was doing things she had not done
before (and about which we had not
talked), such as returning to school.
 Reconstruction of Memories
The Case of Arnold
1. Arnold had few childhood memories,
describing it as a “barren wasteland.”
2. He said he didn’t really “begin to live” until
after High School graduation; everything
before was a “dead loss.”
3. He saw himself as a “loner” and his
memories may have been developed
and elaborated to reflect this self-image.
 Enhancing Optimism:
Sherry’s failed marriage
1. It is my fault that my marriage failed
a. I should have made my husband happy
b. It is my fault he was unhappy and left
c. I wasn’t a good wife; I’ll never be
d. I will never have a successful marriage
e. I will be alone for the rest of my life
2. I am a failure with all men
a. Men will always leave because I can’t make
them happy
b. No man will ever love me
c. I can’t believe or trust any man
 Sherry (Continued)
3. I’m not good enough; there is something
wrong with me
a. I’m not attractive enough
b. I’m not smart; I’m stupid
c. I’m not interesting; I’m boring
4. Cognitive Distortions: Personalization,
catastrophizing, emotional reasoning,
overgeneralization
 Sherry (Continued)
5. Early Maladaptive Schemas:
Disconnection and rejection
a. Abandonment/Instability
b. Emotional Deprivation
c. Defectiveness/Shame
 Addressing Defectiveness
You feel abandoned, alone, deprived, don’t you [speaks to
EMS]? You feel somehow deficient, don’t you? But let’s
look at who is really alone…you or your ex-husband?
Who’s really defective – deficient? You or him? …after all,
he couldn’t love you. Perhaps he’s the one who is
deprived…will he ever find a woman who can love him?
Didn’t you love, cherish him? Isn’t that good? Can’t you use
that knowledge of how to truly care, truly care, for a man –
to develop new relationships? Perhaps you now know that
because something happens once doesn’t mean it will
happen again…It all depends…
 Increasing Goal-Directed
Behaviour: Ed’s stagnation
Ed’s beliefs about himself:
1. I should have snapped out of it by now.
2. I can’t do anything else.
3. I have lost everything.
4. I can’t cope/I will never be able to cope.
5. Things will never get any better.
6. Why did this happen to me?
7. My life is over.