*The Integrative Theory of Hypnosis in the Light of Clinical Hypnotherapy DOI: http://dx.doi.org/10.5772/intechopen.92761*

and panic attacks (PA) to take part in a clinical study of psychotherapeutic treatment of anxiety disorders. Psychotherapeutic treatment was offered for free. Inclusion criteria were that patients: (1) be between 18 and 60 years and (2) fulfill diagnostic criteria for either PD or GAD. Exclusion criteria were: (1) suicidality, (2) other psychiatric disorders as a primary diagnosis (schizophrenia spectrum disorders, affective disorders, personality disorders), (3) severe somatic diseases in the decompensation stage, and (4) parallel participation in other psychotherapeutic programs.

These criteria allowed for the presence of isolated comorbid depressive and phobic symptoms, provided that patients had AD as a primary diagnosis. Patients with initial pharmacological treatment (antidepressants, anxiolytics, tranquilizers) were also included in the study. The possibility of termination of pharmacological treatment as their state improves during the therapy was discussed with such patients. The pharmacological treatment was terminated at all patients after 5–6 psychotherapeutic sessions. **Figure 5** illustrates the patient flow in the study.

**Figure 5.** *Research design.*

to continue with modeling positive states is emphasized along with enhancing the

are liberation from symptom, normalization of functioning, and relaxation.

behavior and provide suggestions for sleep normalization.

suggestions with the proper speech intonation.

hypnotized person.

**disorders**

tion of mindfulness effect.

**4.1 Method**

**56**

*4.1.1 Participants*

dence, calmness, and freedom; they also focus on distancing from stressogenic experiences and on resolution of negative states or disorders, with the development of positive behavioral models that would offer an alternative for pathological

So, the first and the third parts in the composition of the UH session focus on body projective working, using breathing techniques and inducement of pleasant feelings of warmth and coolness; it also emphasizes a personal activity and a personal responsibility to continue the work in the same manner. The goals of body projective work

The second and third parts of the session actualize the feelings—states of confi-

The therapeutic influence on the client is achieved by providing a meaningful sensory stimulation through three channels (verbal, visual, and proprioceptive): active positive modeling of problem situations; repeating semantically significant components of the script which may be presented in the archaic folk song style —couplet-refrain—with induction of blue color as being the refrain; and presenting

UH has an integrated and focused content of the suggestions that support each other; as a result, regardless of whether a single individual component of therapy is effective, the whole therapeutic structure remains considerably efficient. UH creates a system of multilevel impacts stimulating a patient to assimilate actively his or her primary ideas, mental states, and experiences; its positive cognitive-behavioral models could be later implemented in real life, in order to eliminate psychopathology and to promote effective problem-solving. The application of UH creates a positive therapeutic semantic field and a goal-oriented therapeutic process.

At the end of the hypnotic session, the patient is informed about the upcoming dehypnotization according to a feedback scheme: a spontaneous return movement of a previously lowered hand is suggested, and when the hand returns to its initial position, the session is finished. The rate of dehypnotization is determined by the

**4. Universal hypnotherapy in the controlled therapy of anxiety**

The last two decades have become a time of significant increase in AD. In the 2000s, the author applied UH for the treatment of panic disorder (PD) and GAD, adding a psycho-educational component to the therapy complex determined initially as a cognitive-oriented psychotherapy, later named by author positive-dialogue psychotherapy (PDP) for anxiety disorders. PDP has demonstrated sufficient clinical efficacy in the treatment of anxiety disorders (PD, GAD). In 2010, the author with the co-worker [35] conducted a controlled study of the effectiveness of PDP for anxiety disorders. Assuming a partial similarity of UH to mindfulness-based CBT methods, the study used additional psychometric estima-

Patients were recruited through an Internet advertisement on the site of Moscow Research Institute of Psychiatry soliciting for individuals with anxiety symptoms

positive dynamic and motivation for recovery.

*Hypnotherapy and Hypnosis*

#### *4.1.2 Procedures*

After a preliminary telephone screening, eligible participants (N = 63) were invited for a structural clinical interview based on the criteria of the research version of ICD-10 [10]. Participants also completed a number of self-reported questionnaires for baseline assessment.

(1–4). (6) Creation in hypnotherapy a positive vector semantic space for patient's

The symptomatic questionnaire SCL-90-R is a Russian adaptation of N. Tarabarina [55]. In our research the following scales were used: DEP, depression; ANX, anxiety; and GSI, general severity index, a measure of the overall psychological distress. The Spielberger State-Trait Anxiety Inventory (STAI) is a Russian adaptation of Hanin [56]. The following tools were also used: Beck's depression inventory (BDI) [57]; Sheehan Clinical Anxiety Rating Scale (ShARS) [58]; and Five-Factor Mindfulness Questionnaire (FFMQ) [59], its short version. The FFMQ was adapted for Russian-speaking population by the authors. The Mindful Attention Awareness Scale (MAAS) [60] was adapted to Russian-speaking population by

The statistical analysis was made with the use of the program "Statistica 10." The following data were compared, using this program: (1) Initial data of the therapeutic group and the waiting-list control (WLC) group. (2) Initial data of the WLC group and the data of the WLC group at the beginning of the therapy. (3) Initial data of the primary therapeutic group and the WLC group at the point of the beginning of the therapy. (4) Initial and final data of the combined therapeutic group and the data from the WLC group (initial and at the point of the beginning of the therapy). (5) Initial and final data of the subgroup of monopsychotherapy (MPT) and the subgroup of psychotherapy with gradual discontinuation of psychopharmacotherapy (PT + PPT). (6) Initial and final data of the subgroup of

Gender and demographic and psychometric characteristics were used in the statistical analysis. The methods of descriptive statistics (M, SD) and nonparametric statistics (Wilcoxon's test, Mann–Whitney test) were used. To evaluate the effect size, Cohen's unbiased d-index was used [61, 62] (d ≤ 0.20, small effect size; d ≤ 0.50, moderate effect size; d ≤ 0. 80, large effect size). The effect size was calculated using a pooled standard deviation. χ<sup>2</sup> was used to compare the degree of

Patients' gender and demographic and diagnostic characteristics are presented in

Twenty-nine participants (55.8%) were diagnosed with PD (11 of them were taking psychopharmacological medications at the beginning of the therapy); 23 participants (44.2%) had GAD as the main diagnosis (9 of them were taking

**Tables 2** and **3**. Apart from the type of anxiety disorder, the presence of the accompanying psychopharmacotherapy at the beginning of the treatment was

from 8 to 15 (till the stable improvement of patient's state).

*The Integrative Theory of Hypnosis in the Light of Clinical Hypnotherapy*

The UH, done in the second part of a 1-h session of PDP, lasts for 40 min. The frequency of PDP sessions is three times a week; the total number of sessions varies

active therapeutic changes.

*DOI: http://dx.doi.org/10.5772/intechopen.92761*

*4.3.1 Psychometric instruments*

**4.3 Instruments**

the authors.

*4.3.2 Statistical instruments*

PD and the subgroup of GAD.

improvement between groups.

taken into consideration.

*4.4.1 Baseline characteristics of the main and control groups*

**4.4 Results**

**59**

#### *4.1.3 Design*

After diagnostic evaluation and completion of all questionnaires, patients were randomly assigned to a treatment group or a waiting-list group. In the treatment group, patients went in therapy immediately and completed the self-report questionnaires at the end of the therapeutic process. Patients on a control waiting-list group were informed about a certain order for the beginning of the therapy and that they had to complete the questionnaires two times (the second time was 3 weeks after the first). The evaluation of psychometric data of this group was carried out 3 weeks before the treatment, just before the start of treatment and at the end of treatment. The control waiting-list group was a control group for itself and for the first group.

#### **4.2 Treatment**

PDP is based on the protocol developed by the author [14, 15]. The therapeutic intervention consists of three main components: (1) psycho-educational; (2) causal cognitive-orientated; and (3) hypnotherapeutic.

The psycho-education component includes a didactic material covering the following information about: (1) anxiety as a normal reaction of mobilization, needed to cope or avoid a dangerous situation; (2) anxiety disorder and the phases of its development for PD and GAD, because of the "swinging" of anxiety reaction by a combination of social, biological, and psychogenic factors; and (3) possibilities of psychotherapeutic treatment of AD based on (a) the resolution of current psychogenic issues, (b) the excluding intoxicating mechanisms (if there are any), (c) the coping with phobic component (if it's present), (d) the general increase of adaptive resources of the organism (through lifestyle rationalization), and (e) the normalization of vegetative regulation by psychotherapy or combination of psychotherapy with pharmacotherapy. The psycho-educational component of PDP is realized during the first therapy session, in an individual or group format.

The causal cognitive-orientated component of PDP has the following objectives: (1) Individual assimilation of the psycho-educational component. (2) Normalization of patient's traumatic experiences during a PA (if there are any). (3) Stimulation of patient's coping of anxiety triggers, restrictive behaviors, and phobias. (4) Stimulation of a healthy lifestyle with normalization of vegetative regulation. (5) Development of patient's autonomous understanding and coping with problem situations. (6) Development of skills of positive thinking and attitude.

The causal cognitive-orientated component of PDP is used during 2–7 sessions for about 20 min.

The hypnotherapeutic component of PDP uses the method of UH [10, 11, 29, 30, 36, 37, 39–41] which contains the following therapeutic interventions: (1) Increase of self-identity and self-integrity. (2) Transformation of patient's projections of his/ her psychogenic and somatic-sensorial content. (3) Use of sedative and detachment influences of reproduced colors. (4) Stimulation of detachment of stress experience and completion of negative states and experiences based on modeling and realization of positive correct behavior. (5) Repeat of the interventions mentioned above

*The Integrative Theory of Hypnosis in the Light of Clinical Hypnotherapy DOI: http://dx.doi.org/10.5772/intechopen.92761*

(1–4). (6) Creation in hypnotherapy a positive vector semantic space for patient's active therapeutic changes.

The UH, done in the second part of a 1-h session of PDP, lasts for 40 min. The frequency of PDP sessions is three times a week; the total number of sessions varies from 8 to 15 (till the stable improvement of patient's state).

### **4.3 Instruments**

*4.1.2 Procedures*

*Hypnotherapy and Hypnosis*

*4.1.3 Design*

first group.

**4.2 Treatment**

for about 20 min.

**58**

questionnaires for baseline assessment.

cognitive-orientated; and (3) hypnotherapeutic.

ing the first therapy session, in an individual or group format.

situations. (6) Development of skills of positive thinking and attitude.

After a preliminary telephone screening, eligible participants (N = 63) were invited for a structural clinical interview based on the criteria of the research version of ICD-10 [10]. Participants also completed a number of self-reported

After diagnostic evaluation and completion of all questionnaires, patients were randomly assigned to a treatment group or a waiting-list group. In the treatment group, patients went in therapy immediately and completed the self-report questionnaires at the end of the therapeutic process. Patients on a control waiting-list group were informed about a certain order for the beginning of the therapy and that they had to complete the questionnaires two times (the second time was 3 weeks after the first). The evaluation of psychometric data of this group was carried out 3 weeks before the treatment, just before the start of treatment and at the end of treatment. The control waiting-list group was a control group for itself and for the

PDP is based on the protocol developed by the author [14, 15]. The therapeutic intervention consists of three main components: (1) psycho-educational; (2) causal

The psycho-education component includes a didactic material covering the following information about: (1) anxiety as a normal reaction of mobilization, needed to cope or avoid a dangerous situation; (2) anxiety disorder and the phases of its development for PD and GAD, because of the "swinging" of anxiety reaction by a combination of social, biological, and psychogenic factors; and (3) possibilities of psychotherapeutic treatment of AD based on (a) the resolution of current psychogenic issues, (b) the excluding intoxicating mechanisms (if there are any), (c) the coping with phobic component (if it's present), (d) the general increase of adaptive resources of the organism (through lifestyle rationalization), and (e) the normalization of vegetative regulation by psychotherapy or combination of psychotherapy with pharmacotherapy. The psycho-educational component of PDP is realized dur-

The causal cognitive-orientated component of PDP has the following objectives: (1) Individual assimilation of the psycho-educational component. (2) Normalization of patient's traumatic experiences during a PA (if there are any). (3) Stimulation of patient's coping of anxiety triggers, restrictive behaviors, and phobias. (4) Stimulation of a healthy lifestyle with normalization of vegetative regulation. (5) Development of patient's autonomous understanding and coping with problem

The causal cognitive-orientated component of PDP is used during 2–7 sessions

The hypnotherapeutic component of PDP uses the method of UH [10, 11, 29, 30, 36, 37, 39–41] which contains the following therapeutic interventions: (1) Increase of self-identity and self-integrity. (2) Transformation of patient's projections of his/ her psychogenic and somatic-sensorial content. (3) Use of sedative and detachment influences of reproduced colors. (4) Stimulation of detachment of stress experience and completion of negative states and experiences based on modeling and realization of positive correct behavior. (5) Repeat of the interventions mentioned above
