**3. Complementary therapies currently adopted for the treatment of cognitive anxiety**

A variety of treatment therapies are presently adopted for the reduction of stress and cognitive anxiety, however the main interventions adopted are listed below and fall into several categories:


In discussing the above interventions positive effects have been reported in the literature in the cognitive therapies; however a large number of sessions are required [3, 22]. Further to this, core problems are insufficiently focused upon and the relapse rate for individuals who have undergone symptom-based CBT is cause

*Cognitive Hypnotherapy and EMDR: Two Effective Psychodynamic Therapies for the Rapid… DOI: http://dx.doi.org/10.5772/intechopen.101770*

for concern [23]. The physiological and physically-based therapies and assertiveness training demonstrate little beneficial effect; however more promising results have been found in the reduction of cognitive anxiety in meditation and yoga [23]. It has been found however that it takes time to acquire these skills and as with the cognitive therapies the drawback is the length of time taken to effect positive change [3, 23]. More details of the above interventions can be found in the author's doctorate [3].

This chapter now reviews CH and EMDR, two psychodynamic therapies that target implicit processes, thoughts and actions no longer in conscious awareness, for the alleviation of cognitive anxiety. The rationale is that by focusing on the role that these processes exert on anxiety both therapies have the potential to reduce cognitive anxiety quickly and effectively.

## **4. Cognitive Hypnotherapy**

CH is the integration of two disciplines, hypnosis and CBT; therefore to enable the reader to understand the genesis of CH this section of the chapter first reviews hypnosis. This is followed by a brief synopsis of the background of CBT including the protocols and procedures adopted in this therapy. The rationale is given and discussed for the assimilation of these two disciplines before documenting the roots, development and theory of CH. This section concludes with the findings from research in various domains where CH has been adopted for the reduction of cognitive anxiety.

#### **4.1 Hypnosis**

Hypnosis dates back over 220 years as an area of scientific research and clinical practice and has been adopted to bring about positive change in diverse psychological conditions [24]. However there are different approaches to hypnosis. Traditional hypnosis, which is believed to be the earliest form of hypnosis, is more authoritative, using direct commands and orders to bring about positive changes, and has been shown to be less effective than the modern hypnosis [25]. Modern hypnosis was developed by the psychologist Dr. Milton Erikson in the 1930s and was known as Eriksonian Hypnosis. Eriksonian philosophy revolutionised the process of hypnotherapy by recognising that individuals are able to access their own inner resources to improve their quality of life. It adopts a holistic approach to each client, understanding their needs and their individual situation and is the form of hypnosis used by the author when conducting cognitive hypnotherapy. This approach uses metaphors by comparing and contrasting experiences and situations, rather than commands and suggestions. Working in this way it enables the brain to think more creatively, and the suggestions become more acceptable to the unconscious mind [26]. It has been suggested that during hypnosis the memory and meaning of negative experiences and the effect of fear can be changed through emotional processing [27, 28]. It is further suggested that when hypnosis is added to therapy such as cognitive behavioural therapy (CBT) the hypnotic relationship enhances the efficacy of the treatment effects [29].

#### **4.2 Cognitive behavioural therapy**

CBT, which has been adopted for anxiety and diverse disparate conditions since the 1980s, uses a combination of behavioural and cognitive interventions aimed at changing dysfunctional thoughts and memories. Individuals are helped in the pursuit of goals, and emotional problems by directing cognitions towards memories,

images, thoughts and attention [30]. Through its development over the last 40 years CBT has adopted treatments for diverse anxiety conditions and emotional disorders [31]. There are a number of protocols and procedures adopted in CBT which allow clients to re-access early negative experiences and enable more understanding of how the negative thoughts, emotions and behaviours have been generated. However for the purpose of this review the formulation by Persons is illustrated as this is most usually associated with CBT [32].

### **Persons' Formulation 1989**

*Early Experience*: Negative experience either from teacher, parents or peers.

↓

*Schemas*: Become maladjusted and lead to mistrust. Mistrusts ability to do things.

*Core Beliefs*: Negative cognitions result in anxiety leading to behavioural and physiological problems.

**↓** *Assumptions*: I know I will feel anxious because it always happens and then I will ............ (becomes a self-fulfilling prophecy).

> ↓ *Trigger*: Thought of an impending event.

**↓** *Vicious Cycle*: *Negative Automatic Thought (NAT)*: Negative thoughts of dread, apprehension, failure. **↑↓** *Consequence*: The conceptualised belief regarding the event is realised. *Feeling*: Hopelessness, worthlessness, depression, shame, withdrawal.

**↑↓**

*Behaviour*: Decision not to (put themselves in that situation again).

By following the guidelines of the above model CBT helps to redress negative cognitions, and encourages the association of positive thoughts, changing the negativity into positive outcomes. In fact it is argued that suppositions are reiterated with corrected thoughts, enabling positive visualisation of present and past experiences, giving the client confidence in their ability to handle situations so that a positive outcome can be achieved [33].

However, the literature reports that no theory/therapeutic action is without flaws, and a number of issues have been identified with the CBT approach: the effective role that cognition plays on physiological symptoms in the body; the failure to recognise the role of the unconscious mind in overt behaviour; and the failure to recognise that human thought and action are socially embedded [34]. Further to this, evidence from the literature indicates that one of the main drawbacks with CBT is the number of sessions required to effect positive change (10 or more sessions in the majority of cases) [3]. New cognitive models are being developed considering the role of cognitions and emotions in generating anxiety, including a meta-cognitive model (MCM) [35], and an emotion dysregulation model (EDM) [36]. However neither of these models takes into account the role of the unconscious mind in the way that anxiety develops.

#### **4.3 The rationale for the integration of hypnosis with CBT**

It has been proposed that hypnosis is based on the affect theory of human emotion and that cognitions locked to unpleasant emotions can become disturbingly *Cognitive Hypnotherapy and EMDR: Two Effective Psychodynamic Therapies for the Rapid… DOI: http://dx.doi.org/10.5772/intechopen.101770*

resistant to change until hypnosis alters the affective perceptions of the individual [37]. Intransigent symptoms of dysfunctional cognitions and emotions can be approached and treated through a sequence of interactions as thoughts previously locked to negative affect are processed and changed positively [37]. Indeed It is argued that as a result of incorporating techniques from two disciplines the core ideas of each are integrated changing both and resulting in a new assimilative model [38]. The rationale for the integration of the two disciplines is well documented in the literature. It has been suggested that by combining the treatment of two disciplines gives a quicker resolution of the dysfunctional condition [39]. Further to this it is argued that hypnosis combined with CBT offers a powerful form of treatment approach with rapid effects and has been shown that this treatment approach offers a template for the guidance of treatment strategies for cognitive and emotional conditions [40].

CH uses a model first adopted in the 1990s, not dissimilar to cognitive behavioural therapy (CBT). However the fusion of hypnotic techniques with CBT first proposed in 1994 strengthens the therapeutic outcome, offering an addition to therapy by facilitating the resolution of resistant symptoms [41]. By focusing on the unconscious mind cognitive hypnotherapy targets implicit memories and cognitions no longer in conscious awareness. The impact and added strength of integrating two disciplines maximise therapeutic effect [39].

#### **4.4 Protocols and procedures of CH**

CH uses an integrative and holistic approach in the treatment of disparate conditions and focuses on both explicit and implicit processes. Case formulation is guided by case history and the therapist's interpretation of this and a treatment plan is then outlined to the patient. An explanation of hypnosis is given making sure that the patient feels comfortable with this. Whilst in trance the therapist attempts to address the unconscious mind, as during this state the critical part of the mind is bypassed allowing the establishment of positive thoughts, substituting former judgemental cognitions with helpful ones [33]. During the process of hypnotherapy implicit processes which appear to be causing negative cognitions, emotions and behaviours are targeted whist the patient is in a state of deep relaxation or a trancelike state. In this state the unconscious mind is receptive to positive ideas and behaviours, hypnotic relaxation, positive mood induction, ego strengthening and post-hypnotic suggestions [33].

#### **4.5 Findings from research using cognitive CH as an intervention**

The research documented below gives evidence for the effectiveness of CH in various domains and documents the beneficial effects of integration. In fact a metaanalysis was conducted looking at comparative studies of CBT and CH and gave evidence that patients receiving CH as opposed to CBT showed a 70% improvement in their mean scores in comparison with the CBT group [42].

Significant benefits have been found for the following conditions using CH: Anxiety disorders [43], general anxiety disorder [44], anxiety in cancer patients [45], PTSD [46], cognitive anxiety/trauma [47], pain relief [48], sleep disorders [49], diabetes [50], anxiety in public speaking [51], music performance anxiety [5, 52]. For more information on these studies see Brooker [3].

The above research testifies to the effectiveness of CH for the above conditions. Eye movement desensitisation and reprocessing (EMDR), another psychodynamic therapy used widely for anxiety conditions, is now reviewed.
