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American Journal of Clinical Hypnosis
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Cognitive Hypnotherapy: A New Vision
and Strategy for Research and Practice
Assen Alladin a
a University of Calgary , Calgary , Alberta , Canada
Published online: 26 Mar 2012.
To cite this article: Assen Alladin (2012) Cognitive Hypnotherapy: A New Vision and Strategy
for Research and Practice, American Journal of Clinical Hypnosis, 54:4, 249-262, DOI:
10.1080/00029157.2012.654528
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American Journal of Clinical Hypnosis, 54: 249–262, 2012
Copyright © American Society of Clinical Hypnosis
ISSN: 0002-9157 print / 2160-0562 online
DOI: 10.1080/00029157.2012.654528
Cognitive Hypnotherapy: A New Vision and Strategy
for Research and Practice
Assen Alladin
University of Calgary, Calgary, Alberta, Canada
This article describes cognitive hypnotherapy (CH), a visionary model of adjunctive hypnotherapy
that advances the role of clinical hypnosis to a recognized integrative model of psychotherapy.
As hypnosis lacks a coherent theory of psychotherapy and behavior change, hypnotherapy has
embodied a mixed bag of techniques and thus hindered from transfiguring into a mainstream school
of psychotherapy. One way of promoting the therapeutic standing of hypnotherapy as an adjunc-
tive therapy is to systematically integrate it with a well-established psychotherapy. By blending
hypnotherapy with cognitive behavior therapy, CH offers a unified version of clinical practice
that fits the assimilative model of integrated psychotherapy, which represents the best integrative
psychotherapy approach for merging both theory and empirical findings.
Keywords: cognitive-behavioral therapy, hypnotherapy, integrative psychotherapy
As an adjunctive therapy, hypnotherapy has been traditionally combined with other
psychotherapies. However, the assimilation has not always been driven by a coherent
theory of integration. The blending of hypnotic techniques with other therapies has
vacillated from being very systematic to idiosyncratic (Alladin & Amundson, 2011).
In this article cognitive hypnotherapy (CH) is described as an assimilative model of
integrative psychotherapy. The purpose of this article is not to discuss the cognitive-
behavioral theories of hypnosis as explicated by, for example, Sarbin and Coe (1972) and
recently revisited by Lynn and Green (2011). The present focus is on the assimilation of
hypnotherapeutic techniques with other psychotherapies within the context of a coherent
model of psychotherapy integration. It is thus fitting to briefly review the psychotherapy
integration movement before providing an overview and clinical implications of CH.
Psychotherapy Integration Movement
Due to xenophobic fear and reflexive dismissal, for decades the field of psychotherapy
had been marked by deep division and segregation of theories and methods (Gold &
Address correspondence to Assen Alladin, University of Calgary, Psychiatry, 1403 29 Street NW, Calgary, Alberta
T2N 2T9, Canada. E-mail: Assen.Alladin@albertahealthservices.ca
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250 ALLADIN
Stricker, 2006). Fortunately, some clinicians and writers such as French (1933), Dollard
and Miller (1950), and Watchel (1977, 1997) were able to step out of this furrow
and incorporate forbidden schools of psychotherapy, namely behavior therapy and
psychodynamic psychotherapy, in their clinical work. Their pioneering work sparked
the psychotherapy integration movement, which culminated in the formation of the
Society for the Exploration of Psychotherapy Integration, the founding of the Journal
of Psychotherapy Integration in 1991, and the publication of two influential handbooks
on psychotherapy integration (Norcross & Goldfried, 1992; Stricker & Gold, 1993) dur-
ing the last decade of the 20th century. Psychotherapy integration can be defined as
the “search for, and study of, the ways in which the various schools or models of psy-
chotherapy can inform, enrich, and ultimately be combined” (Gold & Stricker, 2006,
p. 8) to reduce distress and suffering. From the current psychotherapy integration lit-
erature, four models of integrations can be identified, including technical eclecticism,
common factors approach, theoretical integration, and assimilative integration.
The assimilative model of psychotherapy is considered to be the most recent model
of psychotherapy integration, drawing from both theoretical integration and technical
eclecticism (Gold & Stricker, 2006). In this mode of psychotherapy integration the ther-
apist maintains a central theoretical position but incorporates or assimilates techniques
from other schools of psychotherapy. This approach to integration is well illustrated
by the psychodynamically-based integrative therapy developed and described by Gold
and Stricker (2001, 2006). Within this framework, “therapy proceeds according to stan-
dard psychodynamic guidelines, but methods from other therapies are used when called
for, and they may indirectly advance certain psychodynamic goals as well as address
the target concern effectively” (Gold & Stricker, 2006, p. 12). Lampropoulos (2001)
and Messer (Lazarus & Messer, 1991; Messer, 1989, 1992) claim that when techniques
from different theories are incorporated into one’s preferred theoretical orientation both
the host theory and the imported technique interact with each other to produce a new
assimilative model. Assimilative integration thus represents the best model for integrat-
ing both theory and empirical findings to achieve maximum flexibility and effectiveness
under a guiding theoretical framework.
Cognitive Hypnotherapy
Integration within the field of hypnotherapy had been somewhat cursory and arbi-
trary, and the approaches to assimilation had ranged from being idiosyncratic to very
systematic, rather than driven by a coherent integrated theory. Moreover, the practice of
hypnosis had traditionally embraced psychoanalytic framework and like other schools
of therapy, “classical” hypnotherapists had been resistant to diluting hypnotherapy with
other schools of therapy (e.g., Nash, 2008). Nonetheless some clinicians went on to
incorporate hypnosis with behavior therapy (e.g., Clarke & Jackson, 1983; Lazarus,
1973, 1992, 1999, 2002; Kroger & Fezler, 1976; Wolpe & Lazarus, 1966) and with CBT
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COGNITIVE HYPNOTHERAPY: NEW VISION 251
(e.g., Alladin, 1994, 2006, 2007a; Alladin & Alibhai, 2007; Chapman, 2006; Ellis, 1986,
1993, 1996; Golden, 1986, 1994, 2006; Golden, Dowd, & Friedberg, 1987; Kirsch, 1993;
Lynn & Kirsch, 2006; Tosi & Baisden, 1984; Yapko, 2001). However with the exception
of Alladin (2007a, 2008; Alladin & Amundson, 2011), none of the writers endeavored
to combine hypnosis with CBT within any of the four current psychotherapy integra-
tion models mentioned before. Moreover, Alladin (1992, 1994, 2006, 2007a; Alladin &
Heap, 1991) developed a working model of nonendogenous depression, dubbed the cog-
nitive dissociative model of depression, which provides the theoretical framework for
combining cognitive and hypnotic techniques with depression.
More recently Alladin (2007a) revised the model and called it the circular feed-
back model of depression (CFMD), which accentuates the biopsychosocial nature of
depression and underlines the role of multiple factors in the causation and mainte-
nance of depressive affect. The model is not a new theory of depression or an attempt
to explain the causes of depression. It is an extension of Beck’s (1967) circular feed-
back model of depression, which was later elaborated on by Schultz (1978, 1984,
2003) and expanded by Alladin (1994, 2007a). In combining the cognitive and hypnotic
paradigms, the CFMD incorporates ideas and concepts from information processing,
selective attention (negative rumination), brain functioning, adverse life experiences, and
the neodissociation theory of hypnosis (Hilgard, 1977).
The initial model was referred to as the cognitive dissociative model of depres-
sion because it encompassed the dissociative theory of hypnosis and it proposed that
nonendogenous depression is analogous to a form of dissociation produced by negative
cognitive rumination, which can be regarded as a form of negative self-hypnosis (NSH).
CFMD consists of 12 interrelated components (e.g., negative rumination, negative affect,
dissociation, kindling, symbolic transformation, etc.) that form into a circular feedback
loop that may influence the course and outcome of depression (see Alladin, 2007a).
Any of these factors, for example, negative affect, can trigger, exacerbate, or maintain
depressive symptoms. The conceptualization of the model underscores how hypnosis can
be used as a useful construct to study and understand certain aspects of the depressive
phenomenology.
Utilizing the hypnosis construct to study psychopathologies is not a new concept.
Historically the observation of the parallels between hypnosis and hysteria had played
an important role in the discovery of the unconscious mental processes, the development
of psychogenic theories of psychopathology, and the rise of psychotherapy (Ellenberger,
1970). In regard to experimental studies, Kihlstrom (1979) proposed that hypnotic anes-
thesia and analgesia, amnesia, and posthypnotic suggestions may serve as laboratory
models of dissociative phenomena seen in the clinical settings. He also suggested that
hypnosis may be useful in the exploration of processes involved in emotional response
and the formation of hallucinations and delusions.
The circular feedback model can be easily applied to other emotional disorders
beyond depression. Alladin (2008) stated three pragmatic reasons for combining cogni-
tive and hypnotic paradigms in the treatment and understanding of emotional disorders.
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252 ALLADIN
First, since hypnosis can produce cognitive, somatic, perceptual, physiological, and
kinesthetic changes under controlled conditions, the combination of the two paradigms
serves a conceptual framework for studying the psychological processes by which cog-
nitive distortions (negative rumination) produce concomitant psychobiological changes
underlying various emotional disorders. Secondly, hypnosis offers insight into the
phenomenology of emotional disorders (Yapko, 1992). Like hypnosis, emotional dis-
orders are highly subjective experiences. Hypnosis allows remarkable insights into
the subjective realm of human experience and thus provides a very useful paradigm
for understanding how experience, normal or abnormal, is generated and structured.
Thirdly, after reviewing the strengths and limitations of CBT and hypnotherapy with
emotional disorders, Alladin (1989, 2007) found each treatment approach lacking in
several ways. For example, CBT does not focus on unconscious cognitive restructuring;
instead, it concentrates on cognitive restructuring via conscious reasoning and Socratic
dialogue. Hypnotherapy, on the other hand, has traditionally been concerned with insight
and unconscious reframing, with less focus on systematic conscious restructuring of
dysfunctional cognitions.
Alladin (1989, 2007a) suggested the integration of the two treatment modalities to
compensate for the shortcomings of each single treatment. Similarly, Schoenberger
(2000) asserted that since many CBT procedures are easily conducted with hypnosis
or simply relabelled as hypnosis, CBT-oriented clinicians with experience in hypnosis
could easily establish a hypnotic context “as a simple, cost-effective means of enhancing
treatment efficacy” (p. 244). Furthermore, Golden (2006) indicated that integration of the
two approaches seems natural as CBT and hypnosis share a number of commonalities
such as imagery and relaxation.
CH uses CBT as the base theory for integration as the latter provides a unifying theory
of psychotherapy and psychopathology and it effectively integrates theory and clinical
practice. Absence of a good theory can be problematic as it is likely to lack concep-
tual coherence (Bergin & Garfield, 1994). Another distinctive characteristic of CBT is
that it is technically eclectic, that is, although most of the techniques utilized in CBT are
“behavioral” or “cognitive,” they routinely combine techniques from various psychother-
apies. Alford and Beck (1997) emphasized that “any clinical technique that is found to be
useful in facilitating the empirical investigation of patients’ maladaptive interpretations
and conclusions may be incorporated into the clinical practice of cognitive therapy”
(p. 90). However, in CBT the techniques are not chosen haphazardly or arbitrarily.
They are selected in the context of cognitive case formulation that is used to guide the
practice of CBT for each individual case (Needleman, 2003; Persons, 1989; Persons &
Davidson, 2001; Persons, Davidson, & Tompkins, 2001). Beutler, Clarkin, and Bongar
(2000) have provided evidence that matching of treatment to particular patient charac-
teristics increases outcome. As CBT adopts multiple approaches to case formulation and
treatment, it offers an excellent framework for integrating hypnotic and cognitive strate-
gies with a variety of syndromes. Alladin (2007a, 2008; Alladin & Amundson, 2011)
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COGNITIVE HYPNOTHERAPY: NEW VISION 253
conceptualized CH, a multimodal approach, mainly consisting of CBT and hypnotic
techniques, for treating emotional disorders, as an assimilative model of psychotherapy.
The CH approach to integration is similar to the psychodynamically-based integrative
therapy developed and described by Gold and Stricker (2001, 2006). Gold and Stricker’s
assimilative model of psychotherapy integrates standard psychodynamic methods with
other therapies “when called for” in order to “address the target concern effectively”
(Gold & Stricker, 2006, p. 12).
However, for a therapy to be designated as an assimilative integrative model of psy-
chotherapy, it should meet the six criteria laid down by Lampropoulos (2001), which
include (a) empirical validation of host theory; (b) evidence-based imported techniques;
(c) empirically based assimilation; (d) sensitivity around assimilation; (e) coherent
assimilation; and (f) empirical validation of assimilated therapy. CH meets all of the six
criteria listed above (Alladin & Amundson, 2011) and as such it promotes the adjunctive
role of hypnotherapy to a recognized integrative model of psychotherapy. As Alladin
and Amundson (2011) had reviewed the six criteria proposed by Lampropoulos (2001)
in great detail elsewhere, they will not be covered here, except for a discussion about the
empirical validation of CH as an assimilative model of psychotherapy.
Empirical Validation of CH
Without empirical validation it is not possible to establish whether the importation of
hypnotic techniques into CBT positively impact therapy, especially when the techniques
are decontextualized and placed in a new framework. It is only through empirical valida-
tion that ineffective and idiosyncratic assimilation can be avoided. Moreover, empirical
validation is important for the reevaluation of the assimilative model itself. Some empir-
ical evidence for combining hypnosis with CBT already exists. Clinical trials (Alladin &
Alibhai, 2007; Bryant, Moulds, Gutherie, & Nixon, 2005; Dobbin, Maxwell, & Elton,
2009; Schoenberger, Kirsch, Gearan, Montgomery, & Pastyrnak, 1997), meta-analysis
(Kirsch, Montgomery, & Sapirstein, 1995), and detailed reviews (Moore & Tasso, 2008;
Schoenberger, 2000) have substantiated the additive value of hypnotic interventions
when combined with CBT for various emotional disorders.
As CH is based on latest empirical evidence, the treatment protocol provides an addi-
tive design for studying the summative effect of hypnosis. An additive design involves
a strategy in which the treatment to be tested is added to another treatment to deter-
mine whether the treatment added produces an incremental improvement over the first
treatment (Allen, Woolfolk, Escobar, Gara, & Hamer, 2006). For example, Kirsch,
Montgomery, and Sapirstein (1995), from their meta-analysis of 18 studies in which
CBT was compared with the same therapy supplemented or facilitated by hypnosis,
found that the addition of hypnosis substantially enhanced therapy outcome. The average
patient receiving cognitive-behavioral hypnotherapy demonstrated greater improvement
than at least 70% of patients who received nonhypnotic treatment. The effects seemed
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254 ALLADIN
particularly pronounced in the treatment of obesity, especially at long-term follow-up.
Unlike nonhypnotic treatment, when treatment was facilitated with hypnosis, patients
continued to lose weight after treatment was concluded. The findings were considered
particularly striking because there were so few procedural differences between hypnotic
and nonhypnotic treatments. In the one study of anxiety there was a high effect size of
1.4 standard deviations, indicating that the addition of hypnosis significantly enhanced
the efficacy of cognitive-behavioral therapy (Sullivan, Johnson, & Bratkovitch, 1974).
In CH, in an effort to empirically validate the therapeutic techniques and examine the
additive effect of the combined intervention, the treatment protocols are clearly delin-
eated and described. Alladin (2007a, 2008) has described the application of CH with a
range of emotional and medical disorders. His comprehensive description provides clear
guidelines of how to incorporate various hypnotic techniques within the CBT context
to amplify the therapeutic experience and enhance the treatment effect. Similarly this
special issue offers several well-structured assimilative treatment protocols that can be
easily validated.
Fortunately, several assimilative hypnotherapy protocols with such conditions as acute
stress disorder (Bryant et al., 2005), depression (Alladin & Alibhai, 2007), pain (Elkins,
Jensen, & Patterson, 2007; Elkins, Johnson, & Fisher, this issue), and somatoform dis-
order (Moene et al., 2003) have already been validated. However, these studies need
to be replicated and subjected to second generation studies, which involve disman-
tling designs to evaluate the relative effectiveness of each imported technique to the
base therapy (Alladin, 2008). For example, Alladin and Alibhai (2007) in their CH
protocol for depression imported several hypnotic techniques into CBT, including hyp-
notic relaxation, ego-strengthening, expansion of awareness, positive mood induction,
posthypnotic suggestions, and self-hypnosis. Without further studies (second generation
studies), there is no way of knowing which techniques were effective and which were
superfluous. The assimilative protocols that have not been subjected to empirical valida-
tion yet, are deemed suitable for first generation studies. First generation studies involve
either assessing the additive effect of imported techniques via the additive design, or
comparing a single-modality hypnotherapy with another well established therapy, for
example, ego-strengthening can be compared with exposure therapy (evidence-based
CBT technique) in the treatment of post-traumatic stress disorder.
Clinical and Research Implications
Although the conceptualization of CH as an assimilative model of psychotherapy may
advance the adjunctive role of hypnotherapy from the fringes of therapeutic activities to
a more prominent position in the realm of psychotherapy integration movement, much
work remains to be done. Future progress will depend a great deal on what the hypnosis
community chooses to do. The attempt to formally conceptualize CH as a recognized
form of integrative psychotherapy is only the first step to hypnotherapy gaining greater
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COGNITIVE HYPNOTHERAPY: NEW VISION 255
recognition as an empirically valid clinical intervention. For the field of clinical hypnosis
to flourish and achieve the empirically supported status of treatment enhancer with var-
ious disorders, clinical practitioners and researchers are encouraged to endorse, adopt,
and validate the assimilative model of hypnotherapy. Alladin and Amundson (2011) sug-
gest seven strategies for advancing the clinical and empirical status of hypnotherapy as
an assimilative model of integrative psychotherapy.
(1) Clinicians and researchers are encouraged to take greater interest in integrative
approaches to therapy rather than firmly holding on to a sectarian version of
psychotherapy that were created generations ago.
(2) Clinical assessment and treatment are based on a more assimilative model of
hypnotherapy. Clinicians use other base theories, beside CBT, such as psycho-
dynamic psychotherapy, Ericksonian psychotherapy (Lankton, 2008), or gestalt
therapy, to develop new assimilative models of hypnotherapy. The CH model
provides a template for developing new models of integrative therapy. However,
when generating new assimilative models it will be advisable to develop them
within the framework proposed by Lampropoulos (2001).
(3) A case formulation approach is used for clinical assessment.
(4) Treatment strategies are based on individual case formulation and evidence-based
best clinical practice.
(5) Baseline and outcome measures are routinely used.
(6) Assimilative treatment protocols that have not been subjected to empirical
validation are subjected to first generation studies (see below).
(7) Assimilative hypnotherapy protocols that have already been validated are repli-
cated and subjected to second generation studies (see below).
(8) To these suggestions, publication can be added. CH clinicians and investigators
are encouraged to publish their work in other journals, beside hypnosis journals,
such as Journal of Integrative Psychotherapy,Psychological Review,etc.
Limitations of the Assimilative Model
The CH model described in this article is not seen as a finished product, but an evolv-
ing process. Although it is important to empirically evaluate and validate assimilative,
integrative therapies, it is important to bear in mind that creativity and clinical advances
often occur in the consulting room of individual therapists that cannot be opera-
tionalized or subjected to large-scale research investigations. Gold and Stricker (2006)
write:
Future progress in psychotherapy integration may be stalled or even be made impossible by overly
strict demands for rigor and regularity in psychotherapy that emphasize conformity to manuals and
guidelines at the expense of clinical experimentation and innovation. (p. 13)
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256 ALLADIN
Therefore clinicians should be encouraged to continue to experiment with new
integrative ideas, but within a single-case design framework, and in parallel with
innovative clinical practice, theoreticians and investigators should continue to explore
psychotherapy integration in its complex and sophisticated form, moving beyond clin-
ical derivations. Moreover, beyond techniques blending, clinicians should attempt to
integrate patient’s insight and feedback into their assimilative therapies.
Future Directions
Although many writers and clinicians advocate that hypnotherapy is very effective in the
treatment of a wide range of disorders, limited research exists to support this claim. The
current empirical state and the future of hypnotherapy can be summarized by quoting
Graci and Hardie’s (2007) observation in the context of the empirical status of insomnia:
There is a plethora of research suggesting that combining cognitive behavioral therapy with hypno-
sis is therapeutic for a variety of psychological, behavioral, and medical disorders. Yet, very little
empirical research exists pertaining to the use of hypnotherapy as either a single or multi-treatment
modality for the management of sleep disorders. The existing literature is limited to a very small sub-
set of “non-biologic” sleep disorders, specifically the insomnia disorders .... There is an immediate
need for more research evaluating the efficacy of hypnotherapy as both a single treatment and multi-
treatment modality for managing sleep disturbance. Once this efficacy is established, it will increase
the utilization of hypnotherapy and a demand for its services as a treatment of non-biologic sleep
disorders. (p. 288)
Fortunately the empirical evidence for the effectiveness of hypnosis with other con-
ditions is better than with insomnia, particularly when hypnosis is combined with
CBT. For example, the adjunctive effectiveness of hypnosis has been empirically val-
idated with chronic pain (Elkins et al., 2007, this issue; Montgomery, David, Winkel,
Silverstain, & Bovbjerg, 2002; Montgomery, DuHamel, & Redd, 2000; Patterson &
Jensen, 2003), chronic headache and migraine (Alladin, 2008; Hammond, 2007), irri-
table bowel syndrome (Tan & Hammond, 2005), dermatology (Alladin, 2008; Spanos,
Williams, & Gwynn, 1990), psychosomatic disorders (Flammer & Alladin, 2007;
Tausk & Whitemore, 1999), somatization disorders (Moene et al., 2003), acute stress
disorder (Bryant et al., 2005), depression (Alladin & Alibhai, 2007), various emo-
tional disorders (Kirsch, Montgomery, & Sapirstein, 1995), public speaking anxiety
(Schoenberger et al., 1997), and a wide range of medical conditions (Pinnel & Covino,
2000). For the latest empirical status of clinical hypnosis with various medical and
psychiatric disorders see Lynn, Kirsch, Barabasz, Cardeña, and Patterson (2000), Moore
and Tasso (2008), and the special issues on evidence-based practice in clinical hypno-
sis in the International Journal of Clinical and Experimental Hypnosis (Alladin, 2007b,
2007c). Albeit these empirical advances, research in clinical hypnosis is in its infancy.
Considering modern hypnosis has been around for over a quarter of a century, the relative
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COGNITIVE HYPNOTHERAPY: NEW VISION 257
empirical foundation of clinical hypnosis is not very solid and hypnotherapy is far from
being recognized as mainstream psychotherapy. On the other hand, while it is easy to
criticize the relative lack of empirical research in hypnotherapy, it is enlightening to
learn that the scientific basis of the practice of other health care, for example, medicine,
is not as evidence-based as one would like to think. In a major article in the Journal
of the American Medical Association, Tricoci, Allen, Kramer, Califf, and Smith (2009)
reported that only 11% of 2,711 cardiac medical treatment recommendations are based
on multiple randomized controlled studies, and only 41% are based on evidence from
a single randomized trial or non-randomized studies, while 48% are simply based on
“expert opinion” or only on case studies. Nevertheless, the authors recommend that
practice guidelines should be evidence-based and not based on “lower levels of evidence
or expert opinion” (p. 831). Similarly, Graci and Hardie (2007) have indicated that in
order to increase credibility and utilization of clinical hypnosis, the empirical basis of
hypnotherapy needs to be widely established. The following contributions from the prac-
tice of CH may represent an attempt to solidify the empirical status and credibility of
hypnotherapy:
(1) The assimilative model of hypnotherapy describes, disseminates, and encourages
evidence-based clinical practice and research in hypnotherapy.
(2) CH provides clinicians some guidance on how to assimilate hypnosis as an
adjunct with CBT in the management of various emotional disorders.
(3) CH lays down a solid theoretical foundation for combining hypnosis with CBT in
the management of various emotional disorders.
(4) The conceptualization of CH as an assimilative model of psychotherapy advances
the adjunctive role of hypnotherapy to a more prominent position in the realm
of psychotherapy integration movement. To keep this momentum going, CH
research and findings should be published in other reputable journals besides
those pertaining to hypnosis.
(5) CH provides a case formulation approach to clinical practice. Such a model of
practice allows the assimilation of techniques based on empirical findings rather
than using techniques haphazardly in a hit or miss fashion. This approach, apart
from individualizing therapy, also allows innovation and creativity.
(6) CH offers detailed step-by-step treatment protocol, which facilitates replication
and validation.
(7) CH provides a template for developing other integrative hypnotherapies.
(8) By virtue of being a multimodal treatment approach, CH acknowledges the
complexity of psychological disorders, paying particular attention to recent
progress in aetiology, existing empirical treatments, and comorbid disorders. This
approach is more likely to be effective with complex disorders such as depres-
sion and somatoform disorders than single technique such as ego-strengthening,
regression, or abreaction.
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258 ALLADIN
Summary
This article provided an overview of CH as an assimilative model of integrative psy-
chotherapy. It is hoped that the application of the model with various clinical disorders
will inform and guide clinicians how to select treatment strategies, not haphazardly,
but based on case formulation of each individual case. It is also hoped that the further
developments of CH will contribute to solidify the empirical status of hypnotherapy and
increase the clinical credibility of the integrative approach. Although it is important to
empirically evaluate and validate assimilative integrative therapies, it is important to bear
in mind that creativity, originality, and many advances occur in the consulting room of
individual therapists who cannot submit their work to large-scale research investigations.
Therefore vis-à-vis the exploration of complex and sophisticated integrative hypnother-
apies, creativity and innovations should be encouraged. Moreover, beyond techniques
blending, clinicians should also attempt to integrate patient’s insight and feedback into
their assimilative therapies.
References
Alford, B. A., & Beck, A. T. (1997). The integrative power of cognitive therapy. New York, NY: Guilford.
Alladin, A. (1989). Cognitive-hypnotherapy for depression. In D. Waxman, D. Pederson, I. Wilkie, & P.
Mellett (Eds.), Hypnosis: The 4th European Congress at Oxford (pp. 175–182). London, UK: Whurr
Publishers.
Alladin, A. (1992). Depression as a dissociative state. Hypnos: Swedish Journal of Hypnosis in
Psychotherapy and Psychosomatic Medicine,19, 243–253.
Alladin, A. (1994). Cognitive hypnotherapy with depression. Journal of Cognitive Psychotherapy: An
International Quarterly,8, 275–288.
Alladin, A. (2006). Cognitive hypnotherapy for treating depression. In R. Chapman (Ed.), The clinical use
of hypnosis with cognitive behavior therapy: A practitioner’s casebook (pp. 139–187). New York, NY:
Springer Publishing Company.
Alladin, A. (2007a). Handbook of cognitive hypnotherapy for depression: An evidence-based approach.
Philadelphia, PA: Lippincott Williams & Wilkins.
Alladin, A. (Guest Editor) (2007b). Special issue: Evidence-based practice in clinical hypnosis—Part I.
International Journal of Experimental and Clinical Hypnosis,55: 115–249.
Alladin, A. (Guest Editor) (2007c). Special issue: Evidence-based practice in clinical hypnosis—Part II.
International Journal of Experimental and Clinical Hypnosis,55: 251–371.
Alladin, A. (2008). Cognitive hypnotherapy: An integrated approach to treatment of emotional disorders.
Chichester, West Sussex: John Wiley & Sons.
Alladin, A., & Alibhai, A. (2007). Cognitive-hypnotherapy for depression: An empirical investigation.
International Journal of Clinical and Experimental Hypnosis,55,147–166.
Alladin, A., & Amundson, J. (2011). Cognitive hypnotherapy as an assimilative model of therapy.
Contemporary Hypnosis & Integrative Therapy,28, 17–45.
Alladin, A., & Heap, M. (1991). Hypnosis and depression. In M. Heap & W. Dryden (Eds.), Hypnotherapy:
A handbook (pp. 49–67). Milton Keynes, UK: Open University Press.
Allen, L. A., Woolfolk, R. L., Escobar, J. I., Gara, M. A., & Hamer, R. M. (2006). Cognitive-behavioral
therapy for somatization: A randomized controlled trial. Archives of Internal Medicine,166, 1512–1518.
Downloaded by [184.64.123.170] at 08:01 22 April 2015
COGNITIVE HYPNOTHERAPY: NEW VISION 259
Beck, A. T. (1967). Depression: Clinical, experimental and theoretical aspects. New York, NY: Hoeber.
Bergin, A. E., & Garfield, S. L. (1994). Overview, trends, and future issues. In A. E. Bergin & S. L.
Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 821–830). New York, NY:
Wiley.
Beutler, L. E., Clarkin, J. F., & Bongar, B. (2000). Guidelines for the systematic treatment of the depressed
patient. New York, NY: Oxford University Press.
Bryant, R., Moulds, M., Gutherie, R., & Nixon, R. (2005). The additive benefit of hypnosis and cognitive-
behavioral therapy in treating acute stress disorder. Journal of Consulting and Clinical Psychology,73,
334–340.
Chapman, R. A. (2006). Introduction to cognitive behavior therapy and hypnosis. In R. A. Chapman (Ed.),
The clinical use of hypnosis with cognitive behavior therapy: A practitioner’s casebook (pp. 3–24). New
York, NY: Springer Publishing Company.
Clarke, J. C., & Jackson, J. A. (1983). Hypnosis and behavior therapy: The treatment of anxiety and phobias.
New York, NY: Springer.
Dobbin, A., Maxwell, M., & Elton, R. (2009). A benchmarked feasibility study of a self-hypnosis treat-
ment for depression in primary care. International Journal of Clinical and Experimental Hypnosis, 57,
293–318.
Dollard, J., & Miller, N. E. (1950). Personality and psychotherapy. New York, NY: McGraw-Hill.
Elkins, G., Jensen, M. P., & Patterson, D. R. (2007). Hypnotherapy for the management of chronic pain.
International Journal of Clinical and Experimental Hypnosis,55, 275–287.
Elkins, G., Johnson, A., & Fisher, W. (this issue). Cognitive hypnotherapy for pain management. American
Journal of Clinical Hypnosis,54(4), 294–310.
Ellenberger, H. F. (1970). The discovery of the unconscious: The history and evolution of dynamic
psychiatry. New York, NY: Basic Books.
Ellis, A. (1986). Anxiety about anxiety: The use of hypnosis with rational-emotive therapy. In E. T. Dowd
&J.M.Haley(Eds.),Case studies in hypnotherapy (pp. 3–11). New York, NY: Guilford Press.
Ellis, A. (1993). Rational-emotive therapy and hypnosis. In J. W. Rhue, S. J. Lynn, & I. Kirsch (Eds.),
Handbook of clinical hypnosis (pp. 173–186). Washington, DC: American Psychological Association.
Ellis, A. (1996). Using hypnosis in rational-emotive behaviour therapy in the case of Ellen. In S. J. Lynn, I.
Kirsch, & J. W. Rhue (Eds.), Casebook of clinical hypnosis (pp. 335–347). Washington, DC: American
Psychological Association.
Flammer, E., & Alladin, A. (2007). The efficacy of hypnotherapy in the treatment of psychosomatic dis-
orders: Meta-analytical evidence. International Journal of Clinical and Experimental Hypnosis,55,
251–274.
French, T. M. (1933). Interrelations between psychoanalysis and the experimental work of Pavlov. American
Journal of Psychiatry,89, 1165–1203.
Gold, J. R., & Stricker, G. (2001). Relational psychoanalysis as a foundation for assimilative integration.
Journal of Psychotherapy Integration,11, 47–63.
Gold, J. R., & Stricker, G. (2006). Introduction: An overview of psychotherapy integration. In G. Stricker
& J. Gold (Eds.), A casebook of psychotherapy integration (pp. 3–16). Washington, DC: American
Psychological Association.
Golden, W. L. (1986). An integration of Ericksonian and cognitive-behavioral hypnotherapy in the treatment
of anxiety disorders. In E. T. Dowd & J. M. Haley (Eds.), Case studies in hypnotherapy (pp. 3–11). New
York, NY: Guilford Press.
Golden, W. L. (1994). Cognitive-behavioral hypnotherapy for anxiety disorders. Journal of Cognitive
Hypnotherapy: An International Quarterly,8, 265–274.
Golden, W. L. (2006). Hypnotherapy for anxiety, phobias and psychophysiological disorders. In R.Chapman
(Ed.), The clinical use of hypnosis with cognitive behavior therapy: A practitioner’s casebook (pp.
101–137). New York, NY: Springer Publishing.
Downloaded by [184.64.123.170] at 08:01 22 April 2015
260 ALLADIN
Golden, W. L., Dowd, E. T., & Friedberg, F. (1987). Hypnotherapy: A modern approach.NewYork,NY:
Pergamon Press.
Graci, G. M., & Hardie, J. C. (2007). Evidenced-based hypnotherapy for the management of sleep disorders.
International Journal of Clinical and Experimental Hypnosis,55, 288–302.
Hammond, D. C. (2007). Review of the efficacy of clinical hypnosis with headaches and migraines.
International Journal of Clinical & Experimental Hypnosis,55(2), 207–209.
Hilgard, E. R. (1977). Divided consciousness: Multiple controls in human thought and action.NewYork,
NY: John Wiley & Sons.
Kihlstrom, J. F. (1979). Hypnosis and psychopathology: Retrospect and prospect. Journal of Abnormal
Psychology,88, 459–473.
Kirsch, I. (1993). Cognitive-behavioral hypnotherapy. In J. W. Rhue, S. J. Lynn, & I. Kirsch (Eds.),
Handbook of clinical hypnosis (pp. 151–171). Washington, DC: American Psychological Association.
Kirsch, I., Montgomery, G., & Sapirstein, G. (1995). Hypnosis as an adjunct to cognitive-behavioral
psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology,63, 214–220.
Kroger, W. S., & Fezler, W. D. (1976). Hypnosis and behavior modification: Imagery conditioning.
Philadelphia, PA: J. B. Lippincott Company.
Lampropoulos, G. K. (2001). Bridging technical eclecticism and theoretical integration: Assimilative
integration. Journal of Psychotherapy Integration,11, 5–19.
Lankton, S. (2008). An Ericksonian approach to clinical hypnosis. In M. R. Nash & A. J. Barnier (Eds.), The
Oxford handbook of hypnosis: Theory, research and practice (pp. 467–485). Oxford: Oxford University
Press.
Lazarus, A. A. (1973). “Hypnosis” as a facilitator in behaviour therapy. International Journal of Clinical
and Experimental Hypnosis,6, 83–89.
Lazarus, A. A. (1992). Multimodal therapy: Technical eclecticism with minimal integration. In J. C.
Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 231–263). New York,
NY: Basic Books.
Lazarus, A. A. (1999). A multimodal framework for clinical hypnosis. In I. Kirsch, A. Capafons, E.
Cardena–Buelna, & S. Amigo (Eds.), Clinical hypnosis and self-regulation (pp. 181–210). Washington,
DC: American Psychological Association.
Lazarus, A. A. (2002). The multimodal assessment treatment method. In F. W. Kaslow (Ed. In Chief) & J.
Lebow (Vol. Ed.), Comprehensive handbook of psychotherapy:Vol. 4.Integrative/eclectic (pp. 241–254).
New York, NY: Wiley.
Lazarus, A. A., & Messer, S. B. (1991). Does chaos prevail? An exchange on technical eclecticism and
assimilative integration. Journal of Psychotherapy Integration,1, 143–158.
Lynn, S. J., & Green, J. P. (2011). The sociocognitive and dissociation theories of hypnosis: Toward a
rapprochement. International Journal of Clinical and Experimental Hypnosis,59, 277–293.
Lynn, S. J., & Kirsch, I. (2006). Essentials of clinical hypnosis: An evidence-based approach. Washington,
DC: American Psychological Association.
Lynn, S. J., Kirsch, I., Barabasz, A., Cardeña, E., & Patterson, D. (2000). Hypnosis as an empirically sup-
ported clinical intervention: The state of the evidence and a look to the future. International Journal of
Clinical and Experimental Hypnosis,48, 239–258.
Messer, S. (1989). Integrationism and eclecticism in counseling and psychotherapy: Cautionary notes.
British Journal of Guidance and Counselling,19, 275–285.
Messer, S. (1992). A critical examination of belief structures in integrative and eclectic psychotherapy. In
J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 130–168). New
York, NY: Basic Books.
Moene, F. C., Spinhoven, P., Hoogduin, & Van Dyck, R. (2003). A randomized controlled clinical trial of
a hypnosis-based treatment for patients with conversion disorder, motor type. International Journal of
Experimental and Clinical Hypnosis,51, 29–50.
Downloaded by [184.64.123.170] at 08:01 22 April 2015
COGNITIVE HYPNOTHERAPY: NEW VISION 261
Montgomery, G. H., David, D., Winkel, G., Silverstain, J. H., & Bovbjerg, D. H. (2002). The effec-
tiveness of adjunctive hypnosis with surgical patients: A meta-analysis. Anesthesia & Analgesia,94,
1639–1645.
Montgomery, G. H., DuHamel, K. N., & Redd, W. H. (2000). A meta-analysis of hypnotically induced
analgesia: How effective is hypnosis? International Journal of Clinical & Experimental Hypnosis,48,
138–153.
Moore, M., & Tasso, A. F. (2008). Clinical hypnosis: The empirical evidence. In M. R. Nash & A. J. Barnier
(Eds.), The Oxford handbook of hypnosis: Theory, research and practice (pp. 697–725). Oxford, UK:
Oxford University Press.
Nash, M. R. (2008). A psychoanalytic theory of hypnosis: A clinically informed approach. In M.R. Nash &
A. J. Barnier (Eds.), The Oxford handbook of hypnosis: Theory, Research and practice (pp. 201–222).
Oxford, UK: Oxford University Press.
Needleman, L. D. (2003). Case conceptualization in preventing and responding to therapeutic difficul-
ties.InR.L.Leahy(Ed.),Roadblocks in cognitive-behavioral therapy: Transforming challenges into
opportunities for change (pp. 3–23). New York, NY: Guilford Press.
Norcross, J. C., & Goldfried, M. R. (Eds.). (1992). Handbook of psychotherapy integration. New York, NY:
Basic Books.
Patterson, D. R., & Jensen, M. P. (2003). Hypnosis and clinical pain. Psychological Bulletin,129,
495–521.
Persons, J. B. (1989). Cognitive therapy in practice: A case formulation approach. New York, NY: Norton.
Persons, J. B., & Davidson, J. (2001). Cognitive-behavioral case formulation. In K. Dobson (Ed.), Handbook
of cognitive-behavioral therapies (pp. 86–110). New York, NY: Guilford Press.
Persons, J. B., Davidson, J., & Tompkins, M. A. (2001). Essential components of cognitive-behavior therapy
for depression. Washington, DC: American Psychological Association.
Pinnell, C. A., & Covino, N. A. (2000). Empirical findings on the use of hypnosis in medicine: A critical
review. International Journal of Clinical and Experimental Hypnosis,48, 170–194.
Sarbin, T. R., & Coe, W. C. (1972). Hypnosis: A social psychological analysis of influence communication.
New York, NY: Holt, Rinehart & Winston.
Schoenberger, N. E. (2000). Research on hypnosis as an adjunct to cognitive-behavioral psychotherapy.
International Journal of Clinical and Experimental Hypnosis,48, 154–169.
Schoenberger, N. E., Kirsch, I., Gearan, P., Montgomery, G., & Pastyrnak, S. L. (1997). Hypnotic
enhancement of a cognitive-behavioral treatment for public speaking anxiety. Behavior Therapy,28,
127–140.
Schultz, K. D. (1978). Imagery and the control of depression. In J. L. Singer & K. S. Pope (Eds.), The power
of human imagination: New methods in psychotherapy (pp. 281–307). New York, NY: Plenum Press.
Schultz, K. D. (1984). The use of imagery in alleviating depression. In A. A. Sheik (Ed.), Imagination and
healing (pp. 129–158). New York, NY: Baywood Publishing Company.
Schultz, K. D. (2003). The use of imagery in alleviating depression. In A. A. Sheikh (Ed.), Healing images:
The role of imagination in health (pp. 343–380). New York, NY: Baywood Publishing Company.
Spanos, N. P., Williams, V., & Gwynn, M. I. (1990). Effects of hypnotic, placebo, and salicylic acid
treatments on wart regression. Psychosomatic Medicine,52, 109–114.
Stricker, G., & Gold, J. R. (Eds.). (1993). Comprehensive handbook of psychotherapy integration.New
York, NY: Plenum Press.
Sullivan, D. S., Johnson, A., & Bratkovitch, J. (1974). Reduction of behavioral deficit in organic brain
damage by use of hypnosis. Journal of Clinical Psychology,30, 96–98.
Tan, G., & Hammond, D. C. (2005). Hypnosis and irritable bowel syndrome: A review of efficacy and
mechanism of action. American Journal of Clinical Hypnosis,47, 161–178.
Tausk, F., & Whitmore, S. E. (1999). A pilot study of hypnosis in the treatment of patients with psoriasis.
Psychotherapy & Psychosomatics,68, 221–225
Downloaded by [184.64.123.170] at 08:01 22 April 2015
262 ALLADIN
Tosi, D. J. & Baisden, B.S. (1984). Cognitive-experiential therapy and hypnosis. In W. C. Wester & A.
H. Smith (Eds.), Clinical hypnosis: A multidisciplinary approach (pp. 155–178). Philadelphia, PA: J.B.
Lippincott Co.
Tricoci, P., Allen, J. M., Kramer, J. M., Califf, R. M., & Smith, S. C. (2009). Scientific evidence underlying
the ACC/AHA clinical practice guidelines. Journal of the American Medical Association,301, 831–841.
Wachtel, P. L. (1977). Psychoanalysis and behavior therapy: Toward an integration. New York, NY: Basic
Books.
Wachtel, P. L. (1997). Psychoanalysis, behavior therapy, and the representational world. Washington, DC:
American Psychological Association.
Wolpe, J., & Lazarus, A. A. (1966). Behavior therapy techniques. Oxford, England: Pergamon.
Yapko, M. D. (1992). Hypnosis and the treatment of depressions: Strategies for change.NewYork,NY:
Brunner/Mazel.
Yapko, M. D. (2001). Treating depression with hypnosis: Integrating cognitive-behavioral and strategic
approaches. New York, NY: Brunner/Routledge.
Downloaded by [184.64.123.170] at 08:01 22 April 2015
