Hypno-CBT® – The Cognitive Behavioural Approach to Hypnotherapy
Hypno-CBT® is a legally registered trademark of the UK College of Hypnosis & Hypnotherapy.
It designates a proprietary system of cognitive-behavioural hypnotherapy.
[Note: “Cognitive Behavioural Hypnotherapy is synonymous with term “Cognitive Hypnotherapy” – but should not to be confused with term “cognitive hypnotherapy” as used in the United Kingdom by some NLP based training organisations. Please see this article for the origins of “Cognitive Hypnotherapy” and the actual meaning of the term before it was appropriated by those involved with Neurolinguistic Programming (NLP).]
What is Hypno-CBT® (HCBT)?
Hypno-CBT® (HCBT) is one among several current systems of cognitive-behavioural hypnotherapy. It is not simply “hypnotherapy plus CBT”, however. As opposed to “theoretical eclecticism”, H-CBT is a tight integration of social, cognitive and behavioural psychology with modern evidence-based (non-trance) hypnosis. It is based upon various established models of theory and practice which pre-date the development of modern cognitive-behavioural therapy (CBT). Nevertheless, HCBT embraces the principle of evidence-based “technical eclecticism” (Lazarus) which encourages clinicians to seek proven methods from different modalities of psychological therapy and attempt to incorporate them within a consistent theoretical model.
Modern research on hypnotherapy is increasingly focused upon the integration of hypnotherapy and CBT since the publication in a mainstream peer-reviewed psychology journal of an influential meta-analysis carried out in 1995 by Irvine Kirsch et al. Kirsch’s research team pooled data from 18 separate controlled studies, including 577 participants, comparing the efficacy of cognitive-behavioural hypnotherapy to CBT alone. They showed that for between 70-90% of clients, cognitive and behavioural therapies were more effective when integrated with hypnosis, i.e., that for the vast majority of clients cognitive-behavioural hypnotherapy is superior to CBT alone.
A meta-analysis was performed on 18 studies in which a cognitive-behavioural therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive-behavioural hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. […] These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments. (Kirsch et al., 1996)
This finding led to the inclusion of cognitive-behavioural hypnotherapy for obesity on the list of empirically supported treatments (ESTs) compiled by the American Psychological Association. The only other therapies to have proven their efficacy sufficiently to meet these stringent research criteria are almost exclusively cognitive-behavioural.
Since 25 years had passed since the publication of Kirsch's widely cited meta-analysis in 2021 Ramondo et al (University of Western Australia) published an updated search and meta-analysis on Clinical Hypnosis as an Adjunct to Cognitive Behaviour Therapy, they pooled the results form 48 controlled studies, including 1,928 participants. Each study was a randomised control trial of CBT vs CBT+Hypnosis. The results broadly supported the earlier Kirsch meta-analysis:
This investigation suggests that the adjunctive use of clinical hypnosis can help make CBT a more efficacious and enduring treatment, with 66% of participants at posttreatment, and 72% at follow-up, experiencing better outcomes than their CBT counterparts. (Ramondo et al, 2021)
This is a significant finding. CBT has garnered an enormous amount of research to support it's effectiveness across a wide range of conditions. If the addition of hypnosis can improve outcomes for 72% of patients (at followup) then any evidence-based practitioner should be considering adding hypnosis to their CBT treatments.
Ramondo et al particularly noted that certain studies “integrated” the hypnosis with the CBT more thoroughly, and they conduced a subsidiary analysis on to see if this “integrative CBH” was more effective.
Additionally, we found that Integ, how hypnosis was integrated with CBT, was a significant moderator for pain-related treatments…. To our knowledge, significant effects from the integration of core CBT principles with hypnosis (rather than offering generalized suggestions) has not been previously reported in the hypnosis literature on pain management.
(Ramondo et al. 2021)
This is encouraging evidence that level of integration of hypnosis with core CBT principles moderates outcome.
To be clear, our Hypno-CBT® is a highly integrative model where hypnosis is seamlessly integrated with core CBT principles – using suggestions and imagery to target the specific process changes of CBT – individualised to each client. (Hypnosis supporting Process-Based CBT).
However, this recent view on the integration of hypnosis with CBT is not new.
Throughout the history of CBT, since the 1960s, expert clinicians’ reports and individual studies have converged on a similar conclusion,
We believe on the basis of our clinical experience that when behaviour therapy and hypnosis are used together, a synergistic effect results. (Kroger & Fezler, 1976: 74).
Indeed hypnosis and behaviour therapy were used together right at the very outset of behaviour therapy – with the work of Andrew Salter, Joseph Wolpe and later Arnold Lazarus. When cognitive therapy arrived Albert Ellis himself was using hypnosis to reinforce the cognitive changes he was targeting.
Thus there has been a strong historical association of hypnosis and CBT.
There has long been a consensus among certain clinicians that hypnosis enhances cognitive and behavioural interventions, specifically, by raising “response expectancy”, facilitating autonomic relaxation, and improving the client’s degree of “imaginal absorption”, etc.
The UK College of Hypnosis & Hypnotherapy have been teaching cognitive-behavioural approaches to hypnotherapy since our first courses and workshops in 2003, long before other training schools. We are well-known as pioneers and specialists in this area and in evidence-based approaches to hypnotherapy in general.
See the article What is Cognitive-Behavioural Hypnotherapy? for more detailed information and the article Strategies and Application of Cognitive Behavioural Hypnotherapy (Hypno-CBT®)