**2.1 The techniques and protocols of hypnosis**

The following is a brief synopsis of the techniques and protocols of hypnosis with corroboration of these statements taken from the literature:

*Hypnosis enhances the effectiveness of therapy and creates the belief of self-efficacy* [12]. Evidence from the literature informs us that perceived self-efficacy not only creates a sense of hope but also affects the treatment [13], and that expectation of self-efficacy is central to all forms of therapeutic change [14].

*Hypnosis adds leverage to treatment and shortens treatment time* [15]. When patients are fully relaxed, positive subjective experiences occur replacing negative cognitions, which appear to bring great comfort and relief [16]. Rapid changes are attributed to the brisk and profound behavioural, emotional, cognitive and physiological changes brought about by hypnosis [17].

*Hypnosis breaks resistance when indirect hypnotic suggestions are applied in therapy* [18]. Oppositional statements given by the therapist are used to obtain compliance. An example of this would be 'and the more you try to open your eyes the more they remain tightly shut'. The word 'try' pre-disposes failure, so it is used in therapy whenever the opposite is required [18].

*Hypnosis facilitates rapid transference, which reinforces the suggestions given in therapy*. *During hypnosis, there is greater access to fantasies, memories and emotions, allowing the rapid occurrence of full-blown transference manifestations* [19]. During the hypnotic state, the critical faculty of the mind is bypassed, enabling the processing of thoughts in the unconscious mind, which are then transferred to the conscious in the waking state [4].

*Hypnosis induces deep relaxation, and in this state suggestions can be made that are effective for the reduction of anxiety* [10]. A trance is a special psychological state in which patients can re-associate and reorganise their inner psychological complexities. It is argued that during therapy an inner resynthesis of the patient's behaviour is achieved by the patient [4], and further argued that suggestion and post-hypnotic suggestions during therapy emphasise the innate tendency of the mind to heal itself [20].

*Hypnosis strengthens the ego by enhancing self-confidence and self-worth* [21]. Ego strengthening is a belief that when positive suggestions are repeated sufficiently they become embedded in the unconscious mind to be acted upon in the conscious state [22].

*Hypnosis facilitates divergent thinking, maximising awareness, attentional focus and concentration. It minimises distraction and interference from other sources and stimuli increasing the potential for learning alternatives* [23]. Corroboration from the literature reports that breaking through the limitations of conscious attitudes frees the unconscious potential for problem-solving [4].

*Hypnosis allows engagement of the non-dominant hemisphere in the brain. It provides direct entry into the cognitive processing of the right cerebral hemisphere (in right-handed subjects), which accesses and organises emotional and experiential information. It can be utilised to teach restructuring of cognitive and emotional processes that are influenced by the non-dominant cerebral hemisphere* [22]. Many of the sensoryperceptual languages of the mind (visual, auditory and kinaesthetic information) are encoded like a map over the cerebral cortex of the brain [24, 25].

*Hypnosis facilitates imagery conditioning. In this state, imagery and cognitive restructuring 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 the same right cerebral hemisphere [27].

*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 act upon the suggestions in future experiences [16].

*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 and strengthening hypnotherapy.

*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 treatment* outcome [12].

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 rationale for the integration of CBT with hypnosis.
