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Chapter
The Integrative Theory of
Hypnosis in the Light of Clinical
Hypnotherapy
Rashit Tukaev
Abstract
The chapter describes the author’s integrative theory of hypnosis and hypno-
therapy (ITHH) and the universal hypnotherapy (UH) method. The ITHH contains
neurophysiological, biological, and communicative components. (1) Hypnosis is
triggered by symbolical hypnogenic situations of inability of decision-making
and/or its behavioral realization. Hypnosis development results in qualitative
reorganization of the brain activation system functioning from distribution to
generation of activity. Hypnosis deepening is based on the increase of brain
activation. Hypnosis development in right-handers is associated with a regressive
reorganization of the left hemisphere to the right hemisphere functioning mode,
with whole brain functioning on right hemispheric principle. (2) Hypnotization
generates hypnogenic stress. Hypnotherapy activates a readaptation process,
including neurohormonal, neurotransmitter secretions; activation of the immuno-
logical and biochemical responses; and spontaneous change of pain sensation.
(3) Hypnotic communication styles (directive, non-directive) are (i) changing due
to historical evolution of social communication styles and (ii) indirectly using the
representations about hypnosis. The UH utilizes the ITHH, being close to the
positive and mindfulness psychotherapeutic approaches. The complex of UH and
psycho-education formed positive-dialogue psychotherapy (PDP) for the treatment
of anxiety disorders. The randomized clinical trial of PDP efficiency in the therapy
of panic and generalized anxiety disorders confirmed high clinical efficiency and
the mindfulness effect of UH.
Keywords: hypnosis, theory, secondary-phenomenological approach,
neurophysiology, hypnogenic situation, brain activation system, biology,
communication, universal hypnotherapy, positive-dialogue psychotherapy,
panic disorder, generalized anxiety disorder, randomized clinical trial,
efficiency of psychotherapy, mindfulness effect
1. Introduction
The author’s long-term work in the fields of hypnology and hypnotherapy
revealed restrictions associated with the lacks of consistency and interdisciplinarity
of the research and practice.
1
The phenomenon of animal hypnosis, identified in all higher vertebrates and,
therefore, genetically determined [1, 2], as a rule, is not evaluated by modern
hypnologists as a homolog of human hypnosis. The belonging of humans to mam-
mals gives no chance for selective “loss”of basic, genetically determined protective
mechanisms of hypnosis. If the ability of hypnotization in humans is genetically
determined, how one can be fundamentally non-hypnable? In this logic, situational
hypnability/non-hypnability is the result of the interaction of cultural and personal
representations about hypnosis with the perception of actual hypnotization, per-
sonal request for hypnotization, but not the implementation of some primary,
essential level of hypnability. What is the point of populational and longitudinal
studies of hypnability and creation of great amount of appropriate psychometric
tools for its estimation? What is measured in reality, hypnability or suggestibility?
Where is the analysis of the results of clinical practice in which the vast majority of
hypnotherapist’s patients are hypnable?
It should be noted that the general trend for searching of interrelations between
genetic factors and brain activities, especially in cases of mental disorders [3, 4],
is accepted by modern hypnology [5, 6]. In the logic of the cognitive hypnosis
paradigm, the relationship of the dopamine-related catechol-O-methyltransferase
(COMT) [5] and the serotonin-related 5-HTTLPR polymorphisms to measuring
hypnotizability was studied [6]. The study of connections between genotype and the
hypnotizability, determined both by questionnaires, outside hypnosis, and in
combination with real hypnosis [7] concretizes interrelations of dopaminergic and
serotonergic genotypes and the subjective different experiences in hypnosis. From
the standpoint of clinical hypnotherapy, which demonstrates efficiency in the
treatment of anxiety and affective disorders [8], the fact of cross-association of the
Val158Met catechol-O-methyltransferase genetic polymorphism simultaneously with
(1) anxiety disorders (ADs) [9] and (2) hypnotizability [6] becomes significant.
The long-term process of accumulation of genetic data associated with the
phenomenon of human hypnosis in the future can lead to a comparison of human
and animal hypnosis. The search for the genetic basis of universal protective
hypnosis reaction in humans and animals has not yet been realized.
The brain of all higher vertebrates operates in the fundamental circadian cycle of
the steady states (modes) of sleep and wakefulness. The phenomenon of animal
hypnosis represents a protective adaptation to the behavioral situations of an
insoluble impasse [10, 11], which includes a holistic systemic pattern associated
with immobilization (catalepsy); decrease or cessation of pain sensitivity; and
situationally determined duration. Sleep and wakefulness form a category of
circadian-conditioned, fundamental, stable states, whereas the phenomenon of
hypnosis belongs a qualitatively different category of behaviorally situationally
developing state that ends when the situation is resolved successfully. Such a logic
allows us to distinguish between two basic genetically determined categories or
classes of states in the activity of the brain: (1) circadian-conditioned sleep and
wakefulness and (2) situationally determined (animal) hypnosis.
Russian neurophysiologists Bogdanov and Galashina [1, 2, 12] in the study of
animal hypnosis in rabbits had revealed that the single case of animal hypnosis has
long-term (1 month) neurobiological action; is followed by functional regress of
neuronal activity in the networks, with reorganizational transduction of pathways
of coded information, and restoration of neuronal activity after hypnosis; and
stimulates and optimizes the learning in a previously actualized area of the behav-
ior. So, experimental data indicate a powerful neurobiological effect of animal
hypnosis, and increasing the effectiveness of learning in a previously actualized area
acquires a fundamental therapeutic value in human hypnosis [12].
Being a homolog of animal hypnosis, human hypnosis extensively and variably
implements a genetically defined neurophysiological pattern of adaptive response
2
Hypnotherapy and Hypnosis
to behavioral impasse, complementing the range of triggers by symbolic impasses,
due to thinking, culture. Moreover, traditional culture, and then therapy, channel-
ing the use of the given neurophysiological pattern-state in various ways creates
different types of its utilization and nominalization, defining it as hypnosis, trance,
meditation, relaxation, etc.
The extreme adaptive and regressive nature of animal hypnosis (to overcome
the behavioral impasse) determines the presence in this phenomenon of explicit
systemic neurobiological and general biological adaptive mechanisms, which are
inevitably realized in human hypnosis. Thus, the acceptance of conclusion about the
fundamental unity of animal and human hypnosis not only stimulates the theoret-
ical analysis of this phenomenon and development of related therapeutic practices
but also targets the areas of research and outlines potential results.
2. The integrative theory of hypnosis
2.1 History of development and components
In the 1970s to 1980s, the author conducted an extensive research on the char-
acteristics of reproduction and the impact of hypnosis-induced colors and images in
the interest of their utilization in hypnotherapy of anxiety disorders [10, 11].
In the 1970s, Russian hypnology was based on Pavlov’s theory of hypnosis, and
the phenomenology of hypnosis was completely studied [10]. In an attempt to use
color suggestion for additional directed (sedative, activating, based on the psychol-
ogy of color) effects, the author began to use regular suggestion of blue color for the
therapy of anxiety disorders. Like the Western colleagues, the author believed in
the direct implementation of the “correct”hypnotic suggestion and expected that in
deep hypnosis, patients would directly realize the suggestion of concrete blue color.
Results of the suggestion, “To see the blue color, to see it constantly,”turned out to
be much more complicated (see Figures 1–4): (1) “vision”of color occurred not
only in deep but also in medium hypnosis, i.e., in most patients; and (2) in addition
to blue, other chromatic and achromatic colors and visual images were realized.
Since the identified phenomenology of realization of color suggestion was not
previously known, the author began its independent study, which lasted 10 years.
Four voluminous studies were conducted:
1.The study of patterns of reproduction of hypnotically inducted colors and images,
depending on the hypnosis depth (healthy subjects, 62; neurotic patients, 131)
2.The study of the phenomenon of chromatic and achromatic transformations of
the blue color (healthy teenagers, 44; healthy adults, 63; neurotic patients, 158;
patients with organic disorders, 156)
3.The study of spontaneous structures in the reproduction of hypnotically
inducted colors (105 patients)
4.The study of the psychophysiological effects of hypnotically inducted color
sensations and images (totally 85 healthy individuals, 90 patients)
For each study, special questionnaires were developed. Results obtained in the
1970s and 1980s were published in two author’s monographs, given in the refer-
ence; therefore, this chapter contains only the main, valid results.
The experience obtained in the study of the hypnotic reproduction of color
sensations and images is probably unique in its focus on the identification, fixation,
3
The Integrative Theory of Hypnosis in the Light of Clinical Hypnotherapy
DOI: http://dx.doi.org/10.5772/intechopen.92761
and detailed analysis of the spontaneous variability of the hypnotized response to
suggestions in hypnosis. The study is focused not on assessing the effective
achievement of a particular suggested result but on spontaneous responses to
Figure 1.
The post-hypnotic drawings of hypnotized subjects, reflecting the reproduction of induced blue color: “To see, to
represent, to feel the blue color.”Illustrations from the author’s monograph.
Figure 2.
The phenomenon of the chromatic transformation of hypnotically induced color. Posthypnotic drawings of
subjects.
4
Hypnotherapy and Hypnosis
“banal”suggestion or spontaneous trance characteristics during hypnotherapy.
Therefore, the phenomena described by the author fall out of sight of modern
researchers of color suggestions in hypnosis [13, 14].
As a result of our research, a new systematization of the reproduction of
suggested colors was obtained. It included (1) patterns of reproduction of the
induced color and image in different depths of hypnosis; (2) the description and
interpretation of a phenomenon of chromatic transformation of the induced color;
and (3) the description and interpretation of a phenomenon of achromatic trans-
formation of the induced color.
We described the spatial and temporal differences in the reproduction of color
and image in medium and deep hypnosis. In medium hypnosis induced colors and
images are reproduced two-dimensionally (flat) and wavelike damped. In deep
hypnosis induced colors and images are reproduced three-dimensionally and stable
over time. The hypnosis maximum depth is characterized by “effect of presence,”
when hypnotized find himself “in the reality of image”—the image becomes sen-
sory multimodal.
The phenomenon of chromatic transformation of the induced color manifested
in the reproduction of another color instead induced (e.g., red, yellow, green—on
induction of blue). The study pointed to the connection of this phenomenon with
infantilism—as personality characteristics of a hypnotized subject: (1) age-related
(adolescents) and (2) disorder-related (dissociative disorders).
Figure 4.
Patterns of reproduction of color and image in dependence of hypnosis depth. Posthypnotic drawings of subjects.
Note: picture’s systematization was based on independent estimation of hypnosis depth during hypnosis session.
Figure 3.
The phenomenon of the achromatic transformation of induced blue color. Posthypnotic drawings of subjects.
5
The Integrative Theory of Hypnosis in the Light of Clinical Hypnotherapy
DOI: http://dx.doi.org/10.5772/intechopen.92761
The phenomenon of achromatic transformation of the induced color manifests
in decolorization of induced colors (into black, gray). According to our findings, the
phenomenon of achromatic transformation of reproduced colors in hypnosis
intensely increased in cases of brain organic disorders, which lead to the idea of its
connection with low level of brain activation. The experimental verification con-
firmed the hypothesis. We received a change in the initial reproduction of blue
color by psychopharmacological increase (imipramine) and decrease (chlorproma-
zine) of the level of activity of the reticular formation of the brain. A single use of
imipramine (25 mg 1 h before a hypnotic session) validly improved color reproduc-
tion, and a single use of chlorpromazine (25 mg 1 h before a hypnotic session)
caused a total achromatic transformation in all subjects.
The obtained results allowed us in the 1980s to 1990s to develop the secondary-
phenomenological approach of the study of hypnosis [10, 11]. It is based on the
following: (1) Identification of patterns of reproduction of induced colors and
images depending on the hypnosis depth, age, healthy subjects, and anxiety and
organic disorders. (2) Comparison of hypnotic visual phenomenological patterns
with neurophysiological models of brain activation system, visual afterimages, age
dynamics of hemispheric asymmetry, and construction of the neurophysiological
model of hypnosis. (3) Comparison of modern data of hypnosis neurophysiology.
The secondary-phenomenological approach allowed us to move from the sys-
temic phenomenological description of visual hypnosis to its neurophysiological
modeling.
The secondary-phenomenological approach to the study of hypnosis is funda-
mentally close and presents the precursor of the methodology of studying neuronal
correlates of consciousness developed in modern psychology of consciousness [15],
in which the implementation of consciousness patterns is related to the neurophys-
iological activity of the brain that provides them.
In the 1980s to 1990s, we have investigated the biological mechanisms of
hypnotherapy and hypnosis phenomenon of spontaneous nociception [10, 11].
The study of the biological mechanisms of hypnotherapy was based on results of
systemic clinical research of blood system in dynamics of hypnotherapy of anxiety
and organic disorders.
The study was based on a fourfold analysis of 29 blood components (clinical,
biochemical, immunological): (1) at the beginning of therapy, before and after a
hypnotherapy session and (2) at the end of therapy, before and after a hypnother-
apy session. The groups of the study include 113 patients with anxiety disorders
of neurotic (78 subjects) and organic (35 subjects) genesis. The description of the
biological mechanisms of hypnotherapy was based on the valid data of statistical
analyzes (parametric, nonparametric, factorial).
The last 30 years, we have conducted research on therapy and hypnotherapy
communication mechanisms. These studies formed the basis for the description of
the communicative component of hypnotherapy [14].
Studies have allowed us to develop the integrative theory of hypnosis,
represented by neurophysiological, biological, and communicative components
[10, 11, 16].
2.2 Neurophysiological component
The development of hypnosis is achieved through the creation of primary (for
man and animal) or secondary (symbolical) hypnogenic situations which restricts
the ability to make decisions and/or its behavioral expressions. Hypnosis develop-
ment results in a qualitative reorganization of the brain activation system function-
ing from distribution to generation of activity. The functions of distribution and
6
Hypnotherapy and Hypnosis
generation of activity are realized by morphologically different structures within
the activating system of the brain.
Deepening of hypnosis from wakefulness to somnambulism is based on the
growth of opportunities for brain activation; deep hypnosis opportunities for brain
activation are comparable to the waking state.
Hypnosis development in right-handers is associated with a regressive transfer
of the left hemisphere regulatory activity to the right hemispheric functioning
mode. In comparison with the ontogenetic shift of hemispheric specialization, this
is a reversed process of the whole brain function reorganization to right hemi-
spheric principle. This conclusion was published in 1996 [10]. A year later, in 1997,
the authoritative American hypnotist published a review with the characteristic title
[17]: “Relateralizing hypnosis: or, have we been barking up the wrong hemisphere?”
Subsequent functional magnetic resonance imaging (fMRI) research showed
[18, 19] high levels of activity in areas responsible for visualizing scenes (the
occipital lobes) and for analyzing verbally presented scenarios (the left temporal
lobe), a heightened activity in the prefrontal cortex, and a higher connectivity
between different brain regions in highly hypnotizable people. In hypnosis, a per-
ception of color, real or hallucinated, led to the activation of the fusiform area with
more clear effects in the left cerebral hemisphere than the right.
Functional regression of thinking processes promotes prevalence of figurative
thinking and activates attributive projectivity of thinking. Hypnotic reproduction of
sensations and images involves attributive projectivity and reflects entirely personal
traits and states and body functioning; this opens a way for projective transforma-
tions of problems and symptoms of psychogenic and somatic disorders. In the
waking state, phenomenal models of the world and the self, stored in the subject’s
memory, are superimposed on the current perception of the external world and the
perception of self. In hypnosis subject’s phenomenal models of the world and the
self are superimposed, projected on the limited self-perception, which leads to the
formation of limited (intra-perceptual) hypnotic reality and expanded
(intra-/extra-perceptual) hypnotic reality. All the phenomenal content of con-
sciousness of the subject in hypnosis deeply and fully reflected his current psycho-
logical and bodily condition.
2.3 Biological component
Hypnotization generates hypnogenic stress. Hypnotherapy activates the sys-
temic readaptation processes that are reflected in changes in neurohormonal and
neurotransmitter secretions; activities of the immunological system; activation of
protein, bilirubin, and cholesterol exchange; etc.
Hypnotherapy activates protein metabolism and activity of several enzyme sys-
tems of the organism. Hypnotherapy has a positive influence on the metabolism of
bilirubin. The activation of cholesterol metabolism, characterized by a significant
reduction of its concentration in the blood, has a significant clinical importance. The
observed decrease of cholesterol concentration in blood, normalizing its metabolism
in the process of hypnotherapy, means the restoration of activity of cell mem-
branes, cells, organs, and tissues, slowing down their aging.
The stressful nature of hypnosis limits its therapeutic application, in that exces-
sive intensity of hypnogenic stress may result in the maladaptation. Prolonged
hypnotherapy may actually decrease and exhaust adaptable resources of an
organism.
Hypnosis in clinical situations enables the possibility of a spontaneous (without
specific suggestions) change of pain sensations.
7
The Integrative Theory of Hypnosis in the Light of Clinical Hypnotherapy
DOI: http://dx.doi.org/10.5772/intechopen.92761
In the 1980s during the course of group hypnotherapy in a therapeutic clinic,
based on the universal hypnotherapy (UH) technique [10, 11, 17], which has no
analgesic suggestions (see below), the author was faced with cases of spontaneous
relief of acute (traumatic) pain after the session and opposite cases of the causeless
appearance and amplification of patients’bodily pain during a hypnotherapeutic
session, with its subsequent reduction in chronic disorders. Repeated cases of spon-
taneous modulation in hypnosis of pain in cases of acute and chronic pathological
processes required explanation; therefore, using a special questionnaire, all such
cases were studied. Over the 5 years of observation, the hypnotherapeutic dynamics
of pain in acute traumas (15 patients) and in chronic pathological processes (mainly
neurointoxications—167 patients) was studied. This study was clinical-
phenomenological; the dynamics of the severity of pain were correlated with the
results of other objectivizing methods of clinical research and the conclusions of
relevant specialists. Data ware obtained on patients who received accidental injuries
or dental care (bone fractures, sprains, tooth extraction) during an intensive short-
term hypnotherapy of anxiety disorders (10–12 1-h sessions 3–5 times a week). The
phenomenon of spontaneous hypnotic nociception became an unexpected, but
regularly repeated, finding. Therefore, the question is not in the existence of the
phenomenon of spontaneous hypnotic nociception but in the scientific understand-
ing of its mechanisms.
The author’s explanation of the phenomenon of spontaneous hypnotic
nociception was based on the model of the structure and function of the nociceptive
and vegetative regulation systems [20], according to which the pain impulse on the
way from the pathological zone to the cerebral cortex can be damped by the
damping system of the brain at three levels (spinal cord, thalamus, cerebral cortex),
with the parallel activation of the hierarchical system of vegetative regulation of the
pathological zone; this model satisfactorily explains the phenomenon of spontane-
ous hypnotic nociception [10, 11].
Western hypnology in the last 70 years in its development has paid a considerable
attention to the research and practice of suggestive hypnotic analgesia. Researchers in
experiment and practice have always been interested in only directed hypno-
suggestive analgesia and its mechanisms, which essentially brought the phenomenon
of spontaneous hypnotic nociception beyond the scope of any analysis.
It should be noted that studies of hypnotic analgesia have become the corner-
stone in the development of modern hypnology, since after a long discussion they
have led to the recognition that hypnosis is an altered state of consciousness [22–27].
Brain mechanisms underlying the modulation of pain perception under hypnotic
conditions involve cortical as well as subcortical areas including anterior cingulate
and prefrontal cortices, basal ganglia, and thalami [22]. It is demonstrated that
hypnotic analgesia is characterized by a loss of coherence between the brain areas,
reflecting “an alteration or even a breakdown of communication between the sub-
units of the brain”[20, 24, 25, 27]. Recently, in addition to experimental neuro-
physiological studies of the differences in the brain mechanisms of pain perception
by high and low hypnotizable [28], analogous genetic studies have appeared [30].
Due to these studies, it became known that hypnotic assessment may predict lower
responsiveness to opioids, and inefficient opioid system may be a distinctive char-
acteristic of highs [29], and modulation of hypnotic pain responses is connected
with differential recruitment of right prefrontal regions, which are involved in
selective attention and inhibitory control [28].
Returning to the phenomenology of spontaneous nociceptive sensations in hyp-
notherapy, we need to note that it is characterized by the following features.
Acute pathological processes are characterized by one-step regressive dynamics
of hypnotic nociception.
8
Hypnotherapy and Hypnosis
Chronic pathological processes are characterized by two-stage dynamics,
including consistently associated progressive and regressive stages. The progressive
stage of the dynamics of nociceptive sensations is observed at the beginning of
hypnotherapy. At this stage, the strengthening or the appearance of nociceptive
sensations in the area of localization of chronic pathological process occurs. On the
regressive stage, the weakening or disappearance of nociceptive sensations caused
by a chronic pathological process occurs.
The dynamics of the hypnotic nociception in acute and chronic pathological
processes turns on spontaneously and has a positive therapeutic vector, being
determined by the hypnogenic mechanism of readaptation. It can be strengthened
by specific hypnotic suggestions.
2.4 Communicative component
Hypnotization and hypnotherapy can be considered as a goal-oriented commu-
nication—the communicative process. The hypnotic communicative process
includes two basic components: cultural and interpersonal. The cultural component
determines the varying boundaries, volumes, dynamics, and potential effectiveness
of hypnotherapy while the interpersonal its specific implementation. The cultural
and interpersonal components of hypnotherapy interact typologically, since culture
defines historically determined patterns—communication styles that actualize the
style sets of cultural and interpersonal components. Communicative styles, formed
in the space of everyday communication, are then transferred to hypnotherapy,
acquiring specialized features. The historical evolution of cultural communicative
styles will generate the evolution of communicative styles of hypnotherapy. How-
ever, “within”hypnotherapy, a change in communicative styles will be perceived as
an independent, personified process. The evolution of hypno-communication
develops from classical and directive to non-directive hypnosis. In Russia, the style
of universal hypnotherapy [21, 29] further appeared.
Directive hypnosis is a product of the European nineteenth century, with its
class-hierarchical communicative style. Therefore, its communicative, being domi-
nantly authoritarian, is based on the idea of direct “guiding”of “hypnable”patient
by the hypnotherapist to a positive therapeutic result.
Non-directive hypnosis appeared in the 1970s, during the cultural heyday of
individual rights and freedoms, with a manipulative management style in society.
Its communicative style (Erickson’s model) is based on the verbal, non-directive,
and manipulative management of the patient, taking into account his or her non-
verbal reactions, which uses non-directive adjustment and management, and on the
idea of finding an adequate use of the resources of the wise unconscious, which uses
thematic metaphors and descriptions, as tools for accessing resources.
The communicative style of universal hypnotherapy is built on a biopsychosocial
paradigm; takes into account and rebuilds relevant cultural representations about
hypnosis in the interests of therapy; uses primary positive cognitive-behavioral
models and biological mechanisms of hypnotherapy; actively applies the non-verbal
component of communicative interaction during hypnotherapy; attracts and
potentiates the patient’s recovery activity during the session and the entire course of
hypnotherapy; and contributes to the formation of semantic therapeutic, aimed at
active recovery and improvement.
A real hypno-communication is inevitably wider and deeper than the prescribed
methodological frameworks. But the communicative style forms a therapeutic
“core”that determines the initial selectivity, process, and the results of hypnother-
apy. Table 1 compares the communicative styles of directive, non-directive hypno-
sis and universal hypnotherapy.
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The Integrative Theory of Hypnosis in the Light of Clinical Hypnotherapy
DOI: http://dx.doi.org/10.5772/intechopen.92761
2.5 Outcomes of the integrative theory of hypnosis and hypnotherapy
Thus, hypnotherapy should be considered as a systemic therapeutic space,
which includes four components: a culture-dependent communicative, defining
the communicative style of hypnosis and hypnotherapy, which, as a rule, is
attributed to the nature of hypnosis; the methodological component; the biological
component of hypnosis, with neurobiological, analgesic, and general adaptive
effects; and the component of the patient’s personal response to the disorder and
its therapy.
Feature Directive hypnosis Non-directive hypnosis Universal hypnotherapy
The conscious
use of cultural
representations
about hypnosis
No No Yes
The use of
cultural beliefs
about hypnosis
Yes Yes No
Therapeutic
transformation
of cultural
beliefs about
hypnosis
No No Yes
Features of
verbal
communication
Spelling out prescriptive
text
Algorithm of non-directive
adjustment, management
taking into account the
trance microdynamics
Stimulation of positive
directed activity of the
patient using feedbacks
Non-verbal
communication
Spontaneous use to
support directive
management
Mirroring and management
reflecting the trance
microdynamics
Active semantically
directed use of non-verbal
feedback channel
The ratio of
activity of the
therapist and
patient
The dominant activity
of the therapist
Reliance on the client’s
internal activity to utilize
the resources of the
unconscious with the dual
activity of a therapist in
realization of a client’s and
his own trance
Stimulation of the patient’s
increasing motivational
activity during therapy with
the creation of a semantic
therapeutic space
Using of
feedbacks
Intuitive, for the
regulation of directive
management
Conscious feedback in the
form of adjusting and
maintaining tracking mimic
reactions, breathing, muscle
tone, body postures, with
reduced ideomotor
feedback
Hypnotization,
dehypnotization, body-
oriented work is completely
built on the feedback of
verbal and non-verbal levels
Goal setting Local restrictions
overcoming by
suggestion of
alternative positive
states, positive
conditioning
Patient’s access to the wise
unconscious, its unlimited
resources for problems
solving + partial use of the
principles of the “classical”
approach
Stimulation of the patient’s
active assimilation of the
basic positive mechanisms
of healthy mental
homeostasis
Therapy
limitations
Non-hypnability,
hypomania
Hypnosis resistance Therapy cessation
Table 1.
Communicative styles of directive, non-directive hypnosis and universal hypnotherapy.
10
Hypnotherapy and Hypnosis
The regressive rearrangement of brain functioning to a prepubertal level, caused
by hypnosis, sharply increases the subject’s learning ability and the assimilation of
suggestive therapeutically significant information.
The biological effects of hypnotherapy provide broader prospects for its clinical
application. The therapeutic effectiveness of hypnotherapy is restricted by the pres-
ence and volume of stress-readaptive resources of the subject’s organism and psyche.
Technically, “correctness”of hypnotherapy is important, but it is not the only condi-
tion for treatment success. The absence or reduction of the hypnotherapy biological
effect should be expected in patients undergoing a long-term treatment with adrenal
hormonal medications and cases when the medication blocks or reduces the hypno-
therapy biological readaptation effect (antidepressants, tranquilizers).
The integrative theory of hypnosis and hypnotherapy focuses on the basic sys-
temic mechanisms of hypnosis and hypnotherapy, available for verification and
concretization. Therefore, the constant accumulation of hypnosis research data
(e.g., 3–9, 13, 14) will rather complement and expand its basic positions.
Thus, the default mode network—a large neural structure connecting different
parts of the brain—was recently described [30–32]; its function is to provide a high
level of activity even when the person is not engaged in a focused mental work.
Recent experiments have described an increase in activity and an increase in the
volume of the default mode network when practicing mindfulness meditation [33]
and yoga [34].
According to the integrative theory of hypnosis and hypnotherapy, hypnosis
development results in the reorganization of the brain activation system function-
ing from distribution to generation of activity. It was supposed that the functions of
distribution and generation of activity need to be realized by morphologically dif-
ferent structures of the brain. So, the proposed system of activation generation of
the brain activation system now is determined as a default mode network.
3. The method of universal hypnotherapy
More than three decades ago, the author developed a new method called uni-
versal hypnotherapy, so named because of its efficacy in both individual and group
forms of therapy for a wide range of anxiety disorders [10, 11, 16, 21, 24, 35–37, 40,
41]. UH is rooted in the traditions of the Russian school of hypnotherapy, which
shares its basic principles with positive approach (concept of resilience and
resourcefulness) [21, 29] and mindfulness-based psychotherapeutic methods.
The author understands mental health and mental stability as an active adaptive
state and process, which are spontaneously and actively maintained [16], whereas
anxiety disorders break down the psyche’s natural homeostasis. On the basis of
research of therapy outcomes, we had described a model of the Personal System of
Psychological Adaptation (PSPA) [11, 16, 21, 29, 38]. PSPA is a spontaneously
activated homeostatic dynamic structure which forms during ontogenesis and cre-
ates a hierarchy of adaptive mechanisms from the earliest, most simple types to
mature, complex, individualized, and personal ones which can be used as coping
mechanisms. The hierarchic PSPA can be represented as a spherical multilayered
model involving the following components: (1) a concentric structure of layers-
levels of the hierarchic organization of adaptation mechanisms that form an
expanding sphere around a “center”or the “self,”the self who decides which outer
layers will be predominantly activated; (2) a system of connections between each of
layers-levels of the sphere; and (3) the highest mature level of the hierarchy of
multilayer level mechanisms of psychological adaptation that has the capability of
transforming the interactions between the underlying levels.
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PSPA dynamics may express themselves in regressive, reactivating, or progres-
sive (forming) transformations. In the case of regressive dynamics, the underlying
levels, ontogenetically antecedent to it, become primarily active and assume the role
of regulatory functions overriding more advanced functions; this results in the
reorganization of the system of radial and spherical connections and development
of new clusters not present at the previous stages of PSPA ontogenesis. Reactivation
dynamics involves the reconstruction of the function initially of the top layer level
of psychological adaptations and of PSPA “normal functioning”which has been
disturbed by its previous regressive dynamics. The formation of PSPA dynamics is
possible through the development of a higher layer level which would overcome the
insufficiency and defectiveness of previous psychological adaptations of underlying
levels. In cases of anxious maladaptation, weakening in the higher level of adaptive
mechanisms causes the lower level of adaptive mechanisms to acquire greater
behavioral significance. According to our model [11, 16, 21, 29, 38], psychothera-
peutic interventions are especially suitable for cases of anxiety disorders in which
there is a regressive activation of early ontogenic adaptation mechanisms.
Our empirical research on hypnotherapy outcomes [10, 11, 16, 29] has revealed
that the dynamics in cases of efficient hypnotherapy with complete improvement in
anxiety disorders is consistent with the mechanism of reactivation and, for organic
disorders, with the mechanism of PSPA formation; in cases of partial improvement,
the psychological dynamics for anxious disorders corresponds to PSPA incomplete
reactivation, and for organic disorders it corresponds to PSPA incomplete
formation.
3.1 Basic principles of universal hypnotherapy
UH method is based [10, 11, 16, 21, 29, 35–39, 41] on the activation of hypno-
therapy biological healing potential leading to readaptation and to physiological and
psychological self-regulation; more specifically, this includes stimulation of positive
personal states and values and further depends on an individual’s holistic positive
engagement in recovery and in future steady adaptation. This process should lead to
the creation of a positive goal-oriented semantic field enabling clients to act on
hypnotic suggestions which should shape positive behaviors and therapeutic trans-
formations.
UH is built on positive stimulation of patient’s self-holistic activity all over
hypnosis session: from hypnosis induction to therapy and final dehypnotization.
The specific techniques include distancing from stressogenic experiences and
negative states, along with utilizing projective transformations and visualization of
color. One of the most important hypnotherapeutic goals refers to the stimulation of
a holistic personal positive activity that would promote recovery and future steady
adaptation. In this respect, the strength of a patient’s motivation to recover and to
improve his or her state has a direct impact on the outcome. That is why stimulation
of positive therapeutic motivation (PTM) to improve one’s condition and to recover
is considered, in universal hypnotherapy, to be its main therapeutic objective. Work
with a patient’s PTM starts on the first diagnostic session and becomes the founda-
tion of the therapeutic contract; such motivation is maintained during the course of
therapy and is acknowledged when the course is finished.
During the diagnostic session, after discussing the clinical diagnosis and possible
prognosis of therapy and establishing a confidential relationship, a patient’s moti-
vation and wish to recover and/or to actively achieve the desired psychotherapeutic
outcome are reviewed. Motivation for improvement, or for recovery, is directly or
indirectly stimulated and maintained during the course of subsequent therapy, both
within and outside of the hypnotherapy format. Indirect stimulation of the PTM is
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Hypnotherapy and Hypnosis
maintained by continuous encouragement of the patient’s activity within the course
of therapy, but also directly during the sessions of UH at all its stages.
Positive dynamics, commencing with the hypnotic induction, can be enhanced
by showing the patient changes in symptoms, from session to session, based on a
self-evaluation utilizing a graphic linear scale (ranging from the most negative to
the most positive state); this allows for a comparison of results between sessions and
identification of interim and general dynamics. Any increase in a patient’s motiva-
tion for recovery and its behavioral manifestations is acknowledged and empha-
sized, during and at the end of therapy, as his or her tangible achievement in the
process of positive adaptation. Furthermore, hypnosis is used to facilitate change.
Our understanding of hypnosis is that it leads to functionally regressive stages in
brain functioning that trigger prepubertal imaginative thinking [10, 11, 21, 29] and
promotes the reverse transformation in a regulatory hierarchy in which the mean-
ing of words dominates over feelings, mental states, and perceptual experiences.
Such a reorganization makes it possible in hypnosis to elicit actual feelings and
mental states which could be utilized for positive transformation (i.e., confidence,
calmness, freedom, self-efficiency and self-sufficiency, etc.) enabling the patient to
experience positive personal states and values.
One of the most effective technique in dealing with specific symptoms includes
somatic projective catharsis which requires awareness of personal control and lim-
itations, along with the recognition of positive change in a person’s condition, even
though it may not be consciously known how it was achieved. The highest level of
conscious differentiation occurs in the visual domain; it is less in the auditory and
even less in the proprioceptive modalities [10, 11, 40, 41].
From a practical clinical perspective, catharsis is achieved after a client is
informed that the perception of any event in one domain may also be reflected in
another perceptual domain. Subsequently, it is proposed to the patient to become
aware of anything unpleasant, negative, and painful that is a result from past
experiences—memories, feelings, and also any feelings in his or her breast (i.e.,
heaviness or tension which occurs when a person is offended or derogated); if a
person begins experiencing such a feeling, it is suggested to him or her to breathe it
out. When after some attempts, the unpleasant feeling is diminished and each
subsequent inhaling becomes easier, it is suggested that also the remaining part of
the feeling can be breathed out. Breathing out the unpleasant sensation (i.e., heavi-
ness or tension) is assigned to a client as a task to be carried out independently and
to be continued until the maximum liberation from this unpleasant feeling is
obtained, which is typically associated with a sense of peace.
Yet another technique utilizes visualization. The author’s research [10, 11, 39]
into the impact of color sensations and images induced in hypnosis was a stimulus
for its integration with hypnotherapy for anxiety disorders. We have experimen-
tally shown [10, 11, 37] that for the purposes of relaxation, the imaging of a blue
color is the most suitable approach. That is why repeated blue color induction (with
an interval of 1–2 minutes) is used during hypnotherapy sessions for the creation of
a color-relaxing background to accompany the verbal suggestions.
Experimental data has shown that in mild and deep hypnosis, color inductions
have a direct psycho-vegetative and emotional impact on a human being, and this
impact is different from the one in the waking state because of the intensification of
the activating potential of colors and the reduction of their sedative effect. The
visualization of colors, induced in hypnosis, is accompanied by three phenomena of
a neurophysiologic and psychological nature. The first one is achromatic transfor-
mation, when following hypnotic suggestion, chromatic colors (blue, green, yellow,
red) are seen as achromatic (i.e., gray, black, brown). According to our experimen-
tal and clinical investigations, achromatic transformation phenomenon is the
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manifestation of a low level of activity of the reticular formation which is the brain
activating system [10, 11, 39]. We should note that achromatic transformation is
clinically significant; specifically, induced color visualization is restored as the
patient’s condition clinically improves [10, 11, 39]. The third phenomenon—chro-
matic transformation of colors induced in hypnosis—manifests as the recognition of
another color, not the one which was suggested to the patient to be imagined.
According to our data, the phenomenon of chromatic transformation of visualized
color is conditional on an individual’s personal characteristics associated with per-
sonal maturity. Therefore, the phenomenon of induced color chromatic transfor-
mation which is typically observed in children is reduced in healthy adults, but is
increased in dissociative and somatoform disorders.
The phenomenology of induced color characterizes the depth of hypnosis; in
mild hypnosis, visualized color is flat (two-dimensional) and changes sinusoidally;
in deep hypnosis, it becomes three-dimensional and remains stable (in both healthy
and emotionally disordered people).
The mind’s ability to dissociate can be utilized for distancing from stressogenic
experiences. It has been shown in psychological research [36, 42] that people’s
normal experiences proceed through subjective separation or distancing from the
events, without cognitive distortion of their essence. Pathological attempts at psy-
chological adaptation lead to events of the past events being confounded by cogni-
tive deformations and distortions of events. Already more than 30 years ago, we
noted that hypnotherapy allows for the normal experiencing of events and for
subjective distancing while eliminating pathological adaptation mechanisms that
distort the experience [3, 4]. To normalize the process of experiencing, we have
elaborated a method of two-stage distancing with respect to current and past
events; the first step serves for distancing from the current personally stressogenic
events, and the second step is designed for distancing and resolving past
stressogenic, negative, and traumatic experiences.
The mechanism of normal experiencing of current events presents the basic
mechanism for the stable functioning of a healthy psyche; therefore, the author
considers the sustainable inclusion of this mechanism in anxiety disorders as a key
point in successful therapy. During UH the patient gains the ability to stably dis-
tance himself both from the current experiences and their projections into the
future and from the past experiences.
Since the 1980s cognitive-behavioral therapy (CBT) has developed techniques
based on modifications of ancient Vipassana meditation [43–48]: mindfulness-
based stress reduction (MBSR) [49, 50] and mindfulness-based cognitive therapy
(MBCT) [51, 52]. These techniques, producing “the third wave”of CBT evolution,
have expanded the range of therapeutic efficacy for anxiety disorders, including
generalized anxiety disorder (GAD) [53, 54].
Since these techniques also use the principle of distance experiencing, the author
with the co-worker performed a comparative analysis of UH and CBT mindfulness-
based techniques [36, 37], which revealed a significant similarity, consisting of (1)
the formation of distancing, metaposition, and positive perception and (2) stimula-
tion of personal integration and self-identity and working with body control and
breathing control. UH and mindfulness-based techniques differ in parameter of
experiences without judgment, duration of therapy, the need for meditation, and
self-hypnosis after the end of therapy. UH explores only the principle of distancing,
out of religious-philosophical connotations, it is the most short-term (10–15, rarely
up to 20 sessions), and it does not require the continuation of self-hypnosis.
Yet another technique uses an individual’s abilities to generate bodily sensations.
Indirect suggestions of feelings of warmth (mostly) and coolness (in some areas of
the body) are used for projective body work in universal hypnotherapy. Areas
chosen for suggestion of warmth are the parieto-occipital zone with projection
14
Hypnotherapy and Hypnosis
“inside head,”posterior surface of the neck, shoulders, area of the left half of the
breast (from the front), precostal space, and epigastria; suggestion of coolness while
inhaling is directed to the nose, temples, and the zones, where it is needed. These
suggestions establish experiences of warmth and coolness in the body which replace
other less pleasant feelings.
The process of normalization requires restoration of restful sleep. That is why
increasing the quality of sleep is one of the objectives of UH in which suggestion
refers to the positive phenomenological model of restful sleep (falling asleep in the
evening and in the morning waking up without remembering sleeping itself).
Before finishing the session of universal hypnotherapy, the therapist needs to
seed suggestions about positive feelings taking place in the following order: body
comfort, lucidity of thinking, and a good mood state.
3.2 Structure of session
A session of UH lasts for about 35–40 min, which includes (1) hypnosis induc-
tion and four (2–5) therapeutic parts.
3.3 Hypnosis induction in universal hypnotherapy
Hypnosis induction in UH is completely based on the realization of motivational
activity of the hypnotized person, in the algorithm of bodily feedback with himself
and implements the scheme: the hypnotized person is focusing on the desire to
enter into hypnosis, mentally saying the phrase: “I want to enter into hypnosis,”
being ready (if the phrase dominates the person’s mind for 20–30 s), giving the
signal by raising any hand. The therapist touches the brush, suggesting that if the
hand is spontaneously lowered, there happens a transition to hypnosis; the comple-
tion of the movement means the completion of the hypnotization. The therapist in
immediate feedback briefly describes the characteristics of the movement of the
hand and the behavior of the hypnotized, who perceives this as therapist’s control of
the induced movement.
The given method of hypnosis induction is contrary to cultural beliefs about
hypnosis. Therefore, before the first induction, the therapist implements a special
connecting script, which transforms the cultural model of hypnosis and allows the
hypnotized person to accept fully the proposed method. It is effective in the vast
majority of therapy-motivated patients (more than 99%), which allows patients in
single and group format to enter hypnotic trance quickly and deeply.
The first part of UH therapeutic session is focused on somatic projective cathar-
sis, whereas the second part of UH session consists of the following steps:
1.The induction of blue color, which is then repeated periodically with an
interval of 1–2 min during the whole session
2.The enhancement of positive mental states and values
3.A two-step procedure of distancing from stressogenic experiences and
resolving negative states or disorders and developing hypnotic self-suggestions
that would shape positive behavior
4.The suggestion of sleep normalization
The third part of the session is represented by body projective work with a
periodic induction of blue color. The fourth part of the session basically corresponds
to its first part (but does not use projective “breathing”), and additionally the need
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to continue with modeling positive states is emphasized along with enhancing the
positive dynamic and motivation for recovery.
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 respon-
sibility to continue the work in the same manner. The goals of body projective work
are liberation from symptom, normalization of functioning, and relaxation.
The second and third parts of the session actualize the feelings—states of confi-
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
behavior and provide suggestions for sleep normalization.
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
suggestions with the proper speech intonation.
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 cre-
ates 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 psychopathol-
ogy 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
hypnotized person.
4. Universal hypnotherapy in the controlled therapy of anxiety
disorders
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 deter-
mined initially as a cognitive-oriented psychotherapy, later named by author
positive-dialogue psychotherapy (PDP) for anxiety disorders. PDP has demon-
strated 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-
tion of mindfulness effect.
4.1 Method
4.1.1 Participants
Patients were recruited through an Internet advertisement on the site of Moscow
Research Institute of Psychiatry soliciting for individuals with anxiety symptoms
16
Hypnotherapy and Hypnosis
and panic attacks (PA) to take part in a clinical study of psychotherapeutic treat-
ment of anxiety disorders. Psychotherapeutic treatment was offered for free. Inclu-
sion 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 disor-
ders, 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.
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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.
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 ques-
tionnaires 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 fol-
lowing 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 psycho-
genic 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 normali-
zation of vegetative regulation by psychotherapy or combination of psychotherapy
with pharmacotherapy. The psycho-educational component of PDP is realized dur-
ing 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) Normaliza-
tion of patient’s traumatic experiences during a PA (if there are any). (3) Stimula-
tion 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, 21, 29,
36–41] 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 realiza-
tion of positive correct behavior. (5) Repeat of the interventions mentioned above
18
Hypnotherapy and Hypnosis
(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
4.3.1 Psychometric instruments
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 psycho-
logical 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 Atten-
tion Awareness Scale (MAAS) [60] was adapted to Russian-speaking population by
the authors.
4.3.2 Statistical instruments
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 therapeu-
tic 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
PD and the subgroup of GAD.
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
2
was used to compare the degree of
improvement between groups.
4.4 Results
4.4.1 Baseline characteristics of the main and control groups
Patients’gender and demographic and diagnostic characteristics are presented in
Tables 2 and 3. Apart from the type of anxiety disorder, the presence of the
accompanying psychopharmacotherapy at the beginning of the treatment was
taken into consideration.
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
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psychopharmacological medications at the beginning of the therapy). The basic
clinical, demographic, and clinical-psychometric criteria of the main and control
groups were compared using the Mann–Whitney test and χ
2
test for independent
samples. The two groups did not show significant differences in all the parameters,
but STAI-S score (which was significantly different in the groups of MPT and
PT + PPT (p = 0.01)) and SCL-90 ANX (p = 0.03) and ShARS (p = 0.007) scores
were significantly different in the PD and GAD groups (Tables 1 and 2). That fact
witnesses a general success of the randomization.
The duration of the illness till the moment of the beginning of the treatment was
also significantly different in the groups of MPT and PT + PPT (18.1 months and
112.8 months, accordingly; p <0.0001). The mean duration of psychopharma-
cotherapy before the treatment in the group PT + PPT was 37.6 months. In all these
cases (except 2) during this period the patients received more than two different
psychopharmacological courses. These data allow us to call the PT + PPT group a
therapy-resistant group.
4.4.2 Patients in the therapy: dropped out patients and patients who finished the therapy
Eleven out of 63 patients (17%) dropped out before the end of the treatment.
Four patients could not visit sessions due to time limitations, 7 patients dropped out
without any explanation, and 52 patients finished the therapy. The mean duration
of the therapeutic course for these patients was 13.5 sessions of PDP. However, in
the MPT group, the mean number of sessions was 11.5, and in the PT + PPT group,
this number was significantly higher—16.7 sessions (p = 0.0005).
Total
(n= 52)
Primary therapeutic group
(n= 27)
WLC group
(n= 25)
n%n%n%
Gender (female) 35 67.3 20 74.1 15 60.0
Age (M, SD) 31.6 10.4 30.9 9 32.5 12.1
Education
High 41 78.8 20 74.1 21 84.0
Student 6 11.5 2 7.4 4 16.0
Vocational school 4 7.7 4 14.8
Secondary school 1 1.9 1 3.7
Marital status
Married/partner 23 44.2 12 44.4 11 44.0
Single 27 51.9 15 55.6 12 48.0
Divorced 2 3.8 2 8.0
Diagnosis
PD 29 55.8 16 59.3 13 52.0
GAD 23 44.2 11 40.7 12 48.0
Months science onset (M, SD) 54.5 77.4 51.5 53.7 58.4 100.8
PPT 20 38.5 12 44.4 8 32.0
Primary therapeutic group—group that began therapy right after the screening; WLC group—waiting list control
group; PPT—number of subjects with psychopharmacotherapy.
Table 2.
Patient characteristics.
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Hypnotherapy and Hypnosis
Scale Total (n=
52)
Primary therapeutic
group (n= 27)
WLC group at screening
point (n= 25)
WLC group right before the
therapy (n= 25)
MPT group
(n= 32)
PT + PPT group (n
= 20)
PD group
(n= 29)
GAD group
(n= 23)
MSD MSD МSD MSD MSD MSD MSD MSD
SCL-90 DEP 1.66 0.82 1.58 0.75 1.59 0.81 1.74 0.90 1.56 0.64 1.81 1.06 1.68 0.77 1.62 0.91
SCL-90 ANX 1.85 0.93 1.75 0.87 1.75 0.89 1.96 1.00 1.76 0.80 2.01 1.11 2.09 0.81 1.54
2
1.00
SCL-90 GSI 1.29 0.62 1.23 0.66 1.33 0.58 1.35 0.58 1.21 0.41 1.42 0.86 1.40 0.62 1.14 0.61
STAI-S 37.35 11.11 38.59 10.25 36.16 11.12 36.00 12.04 34.25 6.66 42.30
1
14.74 36.80 10.83 38.09 11.71
STAI-T 55.08 9.79 54.63 9.86 53.72 6.71 55.56 9.90 52.69 8.10 58.90 11.19 55.53 10.12 54.45 9.52
BDI 19.54 10.24 19.96 10.74 19.80 10.20 19.08 9.87 18.44 8.92 21.30 12.09 19.93 10.89 19.00 9.49
ShARS 48.77 25.47 49.11 21.75 51.76 22.10 48.40 29.43 45.38 24.95 54.20 25.99 56.67 25.03 38.00
3
22.37
FFMQ-SF 71.54 9.28 72.60 8.62 71.68 8.95 70.40 9.99 71.70 7.34 71.28 11.95 72.46 9.02 70.28 9.68
MAAS 3.90 0.72 3.97 0.76 3.87 0.70 3.82 0.68 3.85 0.75 3.97 0.67 3.97 0.82 3.79 0.55
SCL-90 DEP, ANX, GSI—depression, anxiety, and global severity index of symptom checklist 90; STAI-S—Spielberger Anxiety Inventory, state anxiety; STAI-T—Spielberger Anxiety Inventory, trait
anxiety; BDI—Beck Depression Inventory; ShARS—Sheehan Clinical Anxiety Rating Scale; FFMQ-SF—Five-Factor Mindfulness Questionnaire, short version, total score; MAAS—Mindfulness Attention
Awareness Scale; MPT group—monopsychotherapy group; PT + PPT group—psychotherapy + psychopharmacotherapy group with later psychopharmacotherapy withdrawal.
1
p<0.01 (comparing to MPT group).
2
p<0.03 (comparing to PD group).
3
p<0.007 (comparing to PD group).
Table 3.
Means and standard deviations at screening point and right before the therapy.
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The Integrative Theory of Hypnosis in the Light of Clinical Hypnotherapy
DOI: http://dx.doi.org/10.5772/intechopen.92761
4.4.3 Psychotherapy results according to psychometric data
Psychotherapy results according to psychometric data are shown in Tables 4–6.
The combined psychotherapy results are presented in Table 4. Comparing
before and after data in the main group and analyzing these data in comparison
with WLC group data, we can observe a significant decrease of all clinical scales’
scores in the main group (SCL-90 DEP, SCL-90 ANX, SCL-90 GSI, STAI-S, STAI-T,
BDI, ShARS) practically to the level of the nonclinical norm.
For the STAI-T scale, the effect size is moderate (0.73); for the other six clinical
scales, the effect size is large (from 0.87 to 1.28). The mindfulness scores (FFMQ-
SF, MAAS) increased significantly with large (FFMQ-SF = 0.98) and moderate
(MAAS = 0.71) effect sizes. There were no such changes in the WLC group during
3 weeks of waiting period.
Psychotherapy results in the PD and GAD groups are shown in Table 5. Signif-
icant changes of all clinical scales’scores are observed in both groups. There were no
statistically significant differences between the groups at the end of the therapy.
The effect size for clinical scales (SCL-90 DEP, SCL-90 ANX, SCL-90 GSI, STAI-S,
STAI-T, BDI, ShARS) was bigger in the PD group, in which for all the scales it was
large (from 0.99 to 1.75), but moderate for STAI-T (0.69). In the GAD group, the
effect size was moderate (from 0.53 to 0.74) for five scales (SCL-90 DEP, SCL-90
ANX, SCL-90 GSI, STAI-T, ShARS) and large (from 1.06 to 1.20) for two scales
(STAI-S, BDI). Changes in mindfulness scores in the PD group were moderate
(FFMQ-SF, 0.78; MAAS, 0.62); in the GAD group, the effect size was large for
FFMQ-SF (1.20) and moderate for MAAS (0.61).
Results for the groups of MPT and psychotherapy with gradual withdrawal of
psychopharmacotherapy (PT + PPT) are presented in Table 6. It is important to
notice significant differences between MPT and PT + PPT groups at the end of the
therapy according to six scales of 9 (SCL-90 DEP, SCL-90 ANX, ACL-90 GSI, STAI-
S, STAI-T, ShARS), which is confirmed by a larger effect for the MPT group.
Comparing before and after the scores in the MPT group, there is a significant
decrease of all scales’scores to the level of the nonclinical norm (SCL-90 DEP, SCL-
90 ANX, SCL-90 GSI, STAI-S, STAI-T, BDI, ShARS). For all seven scales, the effect
size is large (from 1.13 to 1.91). Mindfulness scores increased significantly with
large (FFMQ-SF = 1.17) and moderate (MAAS = 0.64) effect sizes.
Comparing before and after the data in the PT + PPT group, a moderate signif-
icant decrease was observed for six clinical scales’scores (SCL-90 ANX, SCL-90
GSI, STAI-S, STAI-T, BDI, ShARS). There were no significant changes in SCL-90
DEP scores. The effect sizes are large for three scales (STAI-S, 0.94; BDI, 0.84;
ShARS, 1.11), moderate for one scale (SCL-90 ANX, 0.56), and weak for two scales
(SCL-90 GSI, 0.39; STAI-T, 0.46). Mindfulness scores significantly increased with a
moderate effect size (FFMQ-SF, 0.75; MAAS, 0.57).
Results of this controlled study show high effectiveness of PDP for PD and GAD,
which is confirmed by mainly high or moderate size effects in psychometric data.
The correctness of distinction of the groups of MPT and PT + PPT is confirmed
by statistical analysis of psychometric data. The effectiveness of MPT is signifi-
cantly higher than the combination of PT + PPT, while the duration of MPT is
significantly lower.
The use of instruments in this research for mindfulness evaluation (FFMQ-SF,
MAAS) was justified, because for the first time the significant increase of these
parameters (with moderate effect size) was shown for the UH (PDP). Additionally,
the effectiveness of the PDP was compared with MBCT [53] and MBSR [54]
methods for several psychometric clinical scales and mindfulness scales
22
Hypnotherapy and Hypnosis
(see Table 7), which demonstrated comparable effect sizes for the three methods.
The received data expand the representation about mindfulness phenomenon, tak-
ing it beyond the boundaries of traditional meditation and bringing closer to the
basic mechanisms of UH activation of the psychological process of normal coping
by means of distancing.
Scale Therapy group (n= 52) Waiting list control group (n= 25)
MSD d (before-
after)
MSD d (before-
after)
d (between the
groups)
SCL-90 DEP
At baseline 1.66 0.82 1.59 0.81
At the end of treatment 0.94
1
0.83 0.87 1.74
2
0.90 0.18 0.92
SCL-90 ANX
At baseline 1.85 0.93 1.75 0.89
At the end of treatment 0.93
1
0.84 1.04 1.96
2
1.00 0.22 1.12
SCL-90 GSI
At baseline 1.29 0.62 1.33 0.58
At the end of treatment 0.74
1
0.59 0.89 1.35
2
0.58 0.03 1.04
STAI-S
At baseline 37.35 11.11 36.16 11.12
At the end of treatment 24.81
1
10.11 1.18 36.00
2
12.04 0.01 1.01
STAI-T
At baseline 55.08 9.79 53.72 6.71
At the end of treatment 48.12
1
9.27 0.73 55.56
3
9.90 0.22 0.78
BDI
At baseline 19.54 10.24 19.80 10.20
At the end of treatment 9.65
1
7.41 1.11 19.08
2
9.87 0.07 1.08
ShARS
At baseline 48.77 25.47 51.76 22.10
At the end of treatment 22.04
1
14.99 1.28 48.40
2
29.43 0.13 1.13
FFMQ-SF
At baseline 71.54 9.28 71.68 8.95
At the end of treatment 80.12
1
8.06 0.98 70.40
2
9.99 0.13 1.07
MAAS
At baseline 3.90 0.72 3.87 0.70
At the end of treatment 4.35
1
0.71 0.63 3.82
4
0.68 0.07 0.76
SCL-90 DEP, ANX, GSI—depression, anxiety and global severity index of symptom checklist 90; STAI-S—Spielberger Anxiety
Inventory, state anxiety; STAI-T—Spielberger Anxiety Inventory, trait anxiety; BDI—Beck Depression Inventory; ShARS—
Sheehan Clinical Anxiety Rating Scale; FFMQ-SF—Five-Factor Mindfulness Questionnaire, short version, total score; MAAS—
Mindfulness Attention Awareness Scale; MPT group—monopsychotherapy group; PT + PPT group—psychotherapy +
psychopharmacotherapy group with later psychopharmacotherapy withdrawal.
1
p<0.0001 (comparing to the baseline figures).
2
p≤0.0001 (comparing to therapy group).
3
p<0.001 (comparing to therapy group).
4
p<0.002 (comparing to therapy group).
Table 4.
Treatment effect.
23
The Integrative Theory of Hypnosis in the Light of Clinical Hypnotherapy
DOI: http://dx.doi.org/10.5772/intechopen.92761
4.4.4 Conclusion
1.PDP is clinically effective for the treatment of PD and GAD, comparing with
the WLC group.
2.PDP is more effective in the MPT format than in PT + PPT format.
Scale PD group (n= 29) GAD group (n= 23)
MSD d (before-
after)
MSD d (before-
after)
d (between the
groups)
SCL-90 DEP
At baseline 1.68 0.77 1.62 0.91
At the end of treatment 0.82
1
0.83 1.05 1.09
4
0.83 0.59 0.33
SCL-90 ANX
At baseline 2.09 0.81 1.54 1.00
At the end of treatment 0.89
1
0.72 1.52 0.98
3
1.00 0.53 0.10
SCL-90 GSI
At baseline 1.40 0.62 1.14 0.61
At the end of treatment 0.72
1
0.60 1.08 0.78
2
0.59 0.57 0.10
STAI-S
At baseline 36.80 10.83 38.09 11.71
At the end of treatment 24.13
1
9.77 1.20 25.72
3
10.73 1.06 0.15
STAI-T
At baseline 55.53 10.12 54.45 9.52
At the end of treatment 48.20
1
10.66 0.69 48.00
2
7.20 0.74 0.02
BDI
At baseline 19.93 10.89 19.00 9.49
At the end of treatment 10.13
1
8.29 0.99 9.00
2
6.16 1.20 0.15
ShARS
At baseline 56.67 25.03 38.00 22.37
At the end of treatment 20.40
1
13.78 1.75 24.27
3
16.56 0.67 0.25
FFMQ-SF
At baseline 72.46 9.02 70.28 9.68
At the end of treatment 79.18
1
8.17 0.78 81.32
3
7.95 1.20 0.27
MAAS
At baseline 3.97 0.82 3.79 0.55
At the end of treatment 4.45
1
0.70 0.62 4.20
3
0.71 0.61 0.35
SCL-90 DEP, ANX, GSI—depression, anxiety and global severity index of symptom checklist 90; STAI-S—Spielberger Anxiety
Inventory, state anxiety; STAI-T—Spielberger Anxiety Inventory, trait anxiety; BDI—Beck Depression Inventory; ShARS—
Sheehan Clinical Anxiety Rating Scale; FFMQ-SF—Five-Factor Mindfulness Questionnaire, short version, total score; MAAS—
Mindfulness Attention Awareness Scale; MPT group—monopsychotherapy group; PT + PPT group—psychotherapy +
psychopharmacotherapy group with later psychopharmacotherapy withdrawal.
1
p<0.0001 (comparing to baseline figures).
2
p<0.001 (comparing to baseline figures).
3
p<0.005 (comparing to baseline figures).
4
p<0.02 (comparing to baseline figures).
Table 5.
Treatment results in PD and GAD groups.
24
Hypnotherapy and Hypnosis
3.PDP is effective in the PT + PPT format, so it can be used for a successful
therapy on patients recurrent and resistant to PPT.
4.UH produces a distinct mindfulness effect comparable to that for mindfulness-
based CBT.
Scale MPT group (n= 32) PT + PPT group (n= 20)
M SD d (before-
after)
M SD d (before-
after)
d (between the
groups)
SCL-90 DEP
At baseline 1.56 0.64 1.81 1.06
At the end of treatment 0.62
1
0.45 1.67 1.45
6
1.05 0.34 1.03
SCL-90 ANX
At baseline 1.76 0.80 2.01 1.11
At the end of treatment 0.66
1
0.46 1.64 1.37
3,7
1.11 0.56 0.84
SCL-90 GSI
At baseline 1.21 0.41 1.42 0.86
At the end of treatment 0.53
1
0.25 1.91 1.08
4,7
0.80 0.39 0.92
STAI-S
At baseline 34.25 6.66 42.30 14.74
At the end of treatment 22.00
1
7.85 1.64 29.30
2,6
11.81 0.94 0.73
STAI-T
At baseline 52.69 8.10 58.90 11.19
At the end of treatment 44.75
1
5.32 1.13 53.50
3,5
11.61 0.46 0.97
BDI
At baseline 18.44 8.92 21.30 12.09
At the end of treatment 8.44
1
4.99 1.35 11.60
3
10.02 0.84 0.40
ShARS
At baseline 45.38 24.95 54.20 25.99
At the end of treatment 18.38
1
10.38 1.38 27.90
3,6
19.19 1.11 0.62
FFMQ-SF
At baseline 71.70 7.34 71.28 11.95
At the end of treatment 80.60
1
7.76 1.17 79.40
4
8.65 0.75 0.15
MAAS
At baseline 3.85 0.75 3.97 0.67
At the end of treatment 4.31
1
0.65 0.64 4.40
2
0.80 0.57 0.12
SCL-90 DEP, ANX, GSI—depression, anxiety and global severity index of symptom checklist 90; STAI-S—Spielberger Anxiety
Inventory, state anxiety; STAI-T—Spielberger Anxiety Inventory, trait anxiety; BDI—Beck Depression Inventory; ShARS—Sheehan
Clinical Anxiety Rating Scale; FFMQ-SF—Five-Factor Mindfulness Questionnaire, short version, total score; MAAS—Mindfulness
Attention Awareness Scale; MPT group—monopsychotherapy group. PT + PPT group—psychotherapy + psychopharmacotherapy group
with later psychopharmacotherapy withdrawal.
1
p<0.0001 (comparing to baseline figures).
2
p<0.001 (comparing to baseline figures).
3
p<0.005 (comparing to baseline figures).
4
p<0.01 (comparing to baseline figures).
5
p<0.001 (between the groups).
6
p<0.01 (between the groups).
7
p<0.05 (between the groups).
Table 6.
Treatment results in MPT and PT + PPT groups.
25
The Integrative Theory of Hypnosis in the Light of Clinical Hypnotherapy
DOI: http://dx.doi.org/10.5772/intechopen.92761
5. Chapter conclusion
In this chapter, the author attempted to describe briefly and systematically some
of the results of his experimental, theoretical, and clinical studies in the field of
hypnosis and hypnotherapy.
The integrative theory of hypnosis allows us to consistently explain a number of
features of the hypnosis phenomenon related to hypnotization and analgesia,
improving learning ability (suggestibility) and biological effects and providing a
wide range of therapeutic applications and the evolution of the communicative style
of hypnotherapy. The universal hypnotherapy presents the practical embodiment of
the developed theoretical understanding of hypnosis, which in the controlled study
has showed a high efficacy in the treatment of anxiety disorders.
The fact that UH, developed independently in the 1970s to 1980s of the twenti-
eth century, was later assigned to the category of methods of positive psychology
and psychotherapy, the author considers natural, associated with the fundamental
prevailing of positive susceptibility of hypnotic (functional child) psyche. The
therapeutically valuable feature of this technique is its pronounced mindfulness
effect, which we explain as reactivated by therapy homeostatically significant
mechanism of normal experiencing.
Authors Diagnosis Intervention No of
subjects
Scales M1 S1 M2 S2 D-unbiased
Evans and
co-authors
GAD MBCT 11 BDI 13.8 7.9 8.82 8.5 0.56
MAAS 3.68 0.66 4.2 0.58 0.78
Vollestad
and co-
authors
AD MBSR 31 BDI 17.3 9.3 8.5 9.1 0.93
SCL-90
GSI
1.3 0.6 0.7 0.7 0.9
FFMQ 113.8 21.6 128.2 22.3 0.64
Tukaev and
Kuznetsov
GAD and
PD
PDP (UH) 52 BDI 19.54 10.24 9.65 7.41 1.11
SCL-90
ANX
1.85 0.93 0.93 0.84 1.04
SCL-90
GSI
1.29 0.62 0.74 0.59 0.89
SCL-90
DEP
1.66 0.82 0.94 0.83 0.87
FFMQ 71.54 9.28 80.12 8.88 0.99
MAAS 3.9 0.72 4.35 0.71 0.63
Table 7.
The comparison of PDP (UH) MBCT, MBSR efficiency, and mindfulness effect in therapy of anxiety disorders.
26
Hypnotherapy and Hypnosis
Author details
Rashit Tukaev
Department of Psychotherapy and Sexology, Russian Medical Academy of
Continuous Professional Education, Ministry of Healthcare of the Russian
Federation, Moscow, Russia
*Address all correspondence to: tukaevrd@gmail.com
© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms
of the Creative Commons Attribution License (http://creativecommons.org/licenses/
by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
27
The Integrative Theory of Hypnosis in the Light of Clinical Hypnotherapy
DOI: http://dx.doi.org/10.5772/intechopen.92761
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