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July 6th, 2009

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Cognitive-behavioural therapy (CBT) is therefore a relatively broad church, encompassing a certain amount of diversity in both theory and practice, and there exists some ambiguity over its boundaries, which even experts like Prof. Dobson define loosely.
As we have seen, modern nonstate approaches to hypnotherapy have been widely described as since the early 1970s.  They do, as Dobson requires, place central emphasis upon the mediating role of cognitive factors in determining behavioural (and affective and physiological) responses to stimuli.  These cognitive factors include role-perception (Sarbin Coe), attitudes and beliefs regarding hypnosis (Barber), specific cognitive and mental imagery strategies (Chaves, Spanos, Wagstaff), and expectations about their response to suggestion (Kirsch Lynn).  However, arguably, hypnotherapy has always adopted a cognitive mediation model insofar as its founder, James Braid, specifically attributed the effect of physical interventionsto the dominant, expectant ideas which the subject adopted towards them, either spontaneously or in response to social influences such as imitation or hetero-suggestion.  Many hypnotists have made their slogan: All hypnosis is self-hypnosis following Coue who said All suggestion is autosuggestion.  Self-hypnosis and autosuggestion typically take the form of expectation, imagery, and self-talk.  These cognitive constructs are among the primary mediating factors in cognitive-behavioural hypnotherapy.  They are, and have always been, employed primarily in the service of observable behaviour change. 
It is true that hypnotherapists originally made minimal use of formal outcome assessment.  This is, I think, true of most psychotherapy conducted prior to the Second World War.  However, since the 1950s they have tended to imitate assessment methods employed in other forms of psychotherapy, including CBT.  In addition, hypnotherapists have traditionally drawn upon a number of tests and scales, derived from empirical research, which are designed to assess hypnotic responsiveness, most notably the Stanford Scale of Hypnotic Susceptibility and similar assessment tools which divide hypnotic responses into cognitive (e.g., hallucination, time distortion) and behavioural (e.g., arm heaviness, eye-closure) categories.  Hypnotherapy is normally expected to commence with a full initial consultation and assessment of the clients presenting problem and their suitability for treatment, which typically encompasses affective, behavioural and cognitive factors.  Assessment of outcomes in hypnotherapy most typically mirrors traditional behaviour therapy in that it has long (perhaps since before behaviour therapy) employed SUD (subjective units of disturbance) scales to monitor responses to imaginal (in vitro) or situational (in vivo) exposure, etc. 
It therefore seems that much of modern hypnotherapy would meet the definitional critieria set forward by Prof. Dobson for classification as a form of cognitive-behavioural therapy (CBT) and that this is, of course, especially true of those approaches to hypnotherapy which deliberately adopt cognitive-behavioural theories of hypnosis.  Moreover, in the case of clinicians and researchers who are influenced by Sarbin, Barber, and other major figures in the study of hypnosis, the terminology and concepts they employ will naturally tend to overlap with those used in CBT.  Similar theories and terminology tend to encourage similar practices to some extent or at least to highlight the existing overlap between techniques which were previously described using different terminology.  For example, hypnotic regression therapy was used extensively in the first and second world wars to treat PTSD.  Modern CBT techniques used in PTSD beara striking practical resemblance to certain forms of hypnotic regression to traumatic events except that they use the term imaginal exposure to traumatic events instead.  It is natural therefore, that modern hypnotherapists influenced by empiricalresearchand best practice would adopt a similar terminology and modify their existing techniques accordingly.  These practical modifications are often relatively minor, and may largely entail a shift of emphasis between existing hypnotherapy techniques, e.g., moving away from older theories of emotional catharsis and placing greater emphasis upon cognitive restructuring, formerly referred to by hypnotherapists as rational , etc.  There are, of course, specific concepts and interventions found in modern CBT which do not have any parallels in hypnotherapy.  However, these can easily be imported into hypnotherapy just as hypnotherapy techniques (such as relaxation training, aversion therapy, and desensitisation methods) have previously been assimilated into behaviour therapy and CBT. 
Indeed, as Weitzenhoffer and others have argued, many of the techniques employed in the field of CBT are predated by similar methods used in hypnotherapy.  In some cases CBT techniques seem to have been directly derived from earlier hypnotherapy methods.  It is not surprising, therefore, that a reciprocal inter-action, a mutual borrowing of techniques, has developed whereby the practice of hypnotic desensitisation, for example, which originally inspired behaviour therapy, has assimilated certain influences from subsequent use of related exposure methods in CBT.  For example, in his recent book Cognitive Hypnotherapy (2009), Assen Alladin, one of the leading researchers in the field of clinical hypnosis, provides detailed treatment protocols for a range of common presenting problems which assimilate best practice from CBT with established theories and techniques from within the field of clinical hypnosis.
Hypnotherapy in the UK is considered a different modality from CBT and each tradition has its own regulations, training standards, and professional associations, etc.  It therefore remains somewhat ambiguous whether the use of cognitive-behavioural hypnotherapy should be classified primarily as a form of CBT or hypnotherapy for accreditation purposes.  There is some disagreement on this matter as both the theory and practice of cognitive-behavioural hypnotherapy appear to overlap both professions.  However, the existence of cognitive and behavioural techniques in hypnotherapy, and cognitive-behavioural theories of hypnosis, largely predates the development of CBT as a profession and was historically considered to be part of the study of clinical hypnosis.  My own conclusion, therefore, is that cognitive-behavioural hypnosis is very much an integralpart of the history hypnotherapy and a central sub-modality of modern hypnotherapy, albeit one very closely-related to modern CBT and drawing upon certain elements of its theory, practice, and research.  However, it clearly draws to a far greater extent upon a much longer tradition of theory, practice, and research native to the field of hypnosis.  In focusing upon the historical context, I have not had space to discuss in any detail the various modern variations of cognitive-behavioural theory in hypnosis but these continue to develop, and influence clinical applications independently, to some extent, of the parallel developments in CBT.

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