**3.2 Behavioural therapy**

*Hypnotherapy and Hypnosis*

the same right cerebral hemisphere [27].

and strengthening hypnotherapy.

*the treatment* outcome [12].

**3. The background of CBT**

**3.1 Cognitive therapy**

act upon the suggestions in future experiences [16].

rationale for the integration of CBT with hypnosis.

*Hypnosis facilitates imagery conditioning. In this state, imagery and cognitive restruc-*

*Hypnosis uses post-hypnotic suggestions and is an important part of therapy and is used to shape desired future behaviour; it can be powerful in altering problem behaviours, dysfunctional cognitions and negative emotions* [28]. It is reported that posthypnotic suggestions function as positive ideas for desired future behaviour, and are regarded as a necessary part of the therapeutic process, enabling the patient to

*Hypnosis enhances training in positive self-hypnosis, which provides a strategy for counteracting negative cognitions* [29]. It is argued that negative thinking can lead to negative affect, biased thoughts, impaired motivation, concentration and cognition [30]. Positive techniques can be practised during self-hypnosis, thus reinforcing

*Hypnotic techniques are easily exported and can be easily assimilated with many forms of therapy. When hypnosis is used as an adjunct to a particular form of therapy whether behavioural, cognitive or cognitive behavioural therapy, the effects can enhance* 

The above techniques and protocols suggest that by adopting hypnosis as an adjunct to therapy addressing the unconscious mind, change can be implemented quickly, is more profound and therapy outcome is enhanced. By adopting this therapeutic procedure, it follows that therapy outcome should be more effective than CBT alone. An overview of the background of CBT is now given together with the

Cognitive therapy is organised around the idea that behaviour is based on schemas and that these are shaped by early experiences. Schematic thoughts consist of memories, attitudes, core beliefs and assumptions and are factors that, when occurring in certain circumstances, can result in individuals spiralling into negativity and consequential psychological problems [31]. Implicit memories (memories no longer consciously perceived) and explicit negative memories of past experiences can trigger latent patterns of thoughts, emotions and behaviour, resulting in a vicious cycle that maintains and exacerbates the non-helpful behaviour. It is argued that implicit memory is the unconscious remembering of thoughts that accompanied specific events. If negative thoughts have been encoded, implicit feelings are brought into conscious awareness causing both physiological and psychological symptoms [32]. It has been concluded that interventions should focus on problematic over-activation of safety behaviours [33]. This research was extended when the common elements in different anxiety disorders (dysfunctional thinking, physiological reactions, and behavioural responses based on the 'fight or flight syndrome', the body's reaction to unpleasant experiences) were reviewed, and a process map of treatment formulated enabling therapists to adhere to a treatment

*turing are intensified. The use of the word 'hypnosis' and the application of various hypnotic techniques appear to augment the power of the suggestion* [26]*.* Evidence from the literature suggests that when the patient is hypnotised, the power of imagination is increased and that possibly hypnosis, imagery and affect are all mediated by

**106**

plan [34].

Behavioural therapy, in contrast to cognitive therapy, is based on the premise that undesirable behaviours are learned and as such can be 'unlearned' through a process of systematic desensitisation. It is argued that desired behaviours can be taught and reinforced and unwanted behaviours eliminated [35]. Behavioural therapy was expanded when the theory of shaping behaviour by a system of rewards and punishment was first postulated [36]. Behavioural theorists consider that specific phobias and anxiety conditions are acquired through a process of classical conditioning, and that all learned responses derive from innate behavioural patterns, the stimulus/response paradigm [37]. The basis of behavioural therapy encouraged therapists to use techniques aimed at changing the negative affect, introducing positive cognitions through the use of language [38].

While behavioural therapy is based primarily on learning theory and cognitive therapy is rooted more in cognitive theory, the two systems have much in common [39]. Both behavioural and cognitive therapy focus on changing dysfunctional behaviour that occurs in feared situations and both concentrate on positive visual imagery of the environment and situation in which the maladaptive behaviour occurs. Other commonalities are management of physiological and somatic symptoms of anxiety and verbalassisted coping strategies. However, there are differences in the techniques used in each therapy: the behaviourists concentrate on systematic desensitisation and sequencing of negative images [40], whereas cognitive therapists target the patient's unhelpful reported thoughts [39]. However, the methodologies of behavioural therapists were integrated with cognitive therapies, resulting in a heterogeneous set of techniques and procedures that distinguished between conscious beliefs and unconscious representations in memory [41]. This was a new concept developed from behavioural therapy and became known as cognitive behavioural therapy, resulting in specific cognitive behavioural treatments being developed for a variety of psychological problems [42].
