Stoic Philosophy as Rational and Cognitive Psychotherapy

Donald Robertson

Publisher: Karnac Books (Aug 2010)
ISBN-10: 1855757567 / ISBN-13: 978-1855757561

The Philosophy of CBT

The Philosophy of Cognitive-Behavioural Therapy: Stoic Philosophy as Rational and Cognitive Psychotherapy, published by Karnac and available for pre-order online now.

You can also now order The Philosophy of Cognitive-Behavioural Therapy from Amazon, where you may preview a sample of the contents online free of charge. See Donald’s author page on Amazon UK for additional publications.

You can now browse sample chapters from The Philosophy of CBT on Google Books free-of-charge.

Synopsis:

Why should modern psychotherapists be interested in philosophy, especially ancient philosophy? Why should philosophers be interested in psychotherapy? There is a sense of mutual attraction between what are today two thoroughly distinct disciplines. However, arguably it was not always the case that they were distinct.

Donald Robertson takes the view that by reconsidering the generally received wisdom concerning the history of these closely-related subjects, we can learn a great deal about both philosophy and psychotherapy, under which heading he includes potentially solitary pursuits such as “self-help” and “personal development”.

Testimonials:

Here are a selection of comments about The Philosophy of CBT from other therapy and philosophy authors:

[F]or many of us something is missing from most of the [CBT] literature. What has been needed is a book that covers the underlying philosophy of the cognitive behavioural therapies in much greater depth. This book on the Philosophy of Cognitive-Behavioural Therapy by Donald Robertson provides us with the missing link between the theory and the philosophy. [...] It is a fascinating read. The Philosophy of Cognitive-Behavioural Therapy could be considered as either a prequel or a sequel to the standard textbook read by a trainee or experienced cognitive behavioural or rational emotive practitioner who wants to understand these approaches to therapy within an historical framework.
— From the Foreword by Professor Stephen Palmer PhD FAREBT FBACP, Director of the Centre for Stress Management, London, UK

This book is a fascinating interweaving of Stoic philosophy and contemporary cognitive-behavioural therapy (CBT). Robertson rightly reminds us of how much CBT owes its philosophical origins to the Stoics but, sadly, how often this debt is insufficiently acknowledged. He urges us to redirect our attention to the past to see how modern CBT still has much to learn from its ancient precursors. Highly recommended.
— Michael Neenan, Co-Director of the CBT Programme, Centre for Stress Management, Bromley, Kent, UK

The author has uncovered a wealth of connections between modern cognitive-behavioural therapies and ancient Stoic philosophy. It should be read by anyone interested in understanding the historical roots of CBT or in learning about how ancient psychotherapeutic methods can add to the modern therapist’s toolkit.
— Tim LeBon, UKCP registered psychotherapist and author of Wise Therapy

Donald Robertson is blazing a trail to discover the sources of cognitive-behavioural therapy, and Stoic philosophy is prime among these. A fascinating work that should be compulsory reading for all practitioners in the field and interested lay people, providing insights into how ancient philosophy can give us the coping and life success strategies we are all looking for, both as professionals and in private life. A great read!
— Tom Butler-Bowdon, author of 50 Self-Help Classics and 50 Psychology Classics

Ancient Ethics in Hypnotherapy & Psychotherapy

Hippocrates of Kos

Copyright (c) Donald Robertson, 2010.  All rights reserved.

The Hippocratic Oath is an oath traditionally taken by doctors, and believed to have been written in the 4th century BC by Hippocrates, widely regarded as the father of Western medicine.  This is a traditional translation of the oath,

I swear by Apollo the Physician and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art –if they desire to learn it– without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken the oath according to medical law, but to no one else.

I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep myself holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honoured with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

The oath has frequently been modified and modernised throughout recent centuries.  This is my proposal for a modern version adapted for hypnotherapy and psychotherapy,

I pledge a moral oath before my peers and colleagues, making them my witnesses, that I will fulfil to the best of my ability and judgement this covenant and undertaking,

I will respect the clinicians and researchers in my field, study their work diligently, critically, and with care, and extend their contributions by my own efforts to advance the therapeutic art and science.

I will apply therapeutic methods for the benefit of others according to my ability and judgement; I will keep them free from distress and respect their human rights.

I will never offer treatment or advice which might needlessly harm a client.

I will only offer treatment or advice within my sphere of professional competence, and will respect the judgement and actions of other professionals within their own.

I will act with honesty and integrity, and in particular I will avoid any potential exploitation of clients.

What I see or hear in the course of the treatment or even outside of the treatment, in regard to the life of my clients, which falls within the bounds of professional confidentiality, I will keep private, as far as it is legal, reasonable and practicable to do so.

I will fulfil this pledge and refrain from violating it; If I break it and swear falsely, may my colleagues hold me to account for doing so.

Although its wording clearly needs to be modernised, the basic principles of the Hippocratic Oath have stood the test of time, and it seems to me to apply as well, if not better, to the psychological therapies as to traditional medicine.  I therefore hope that my adapted version, or some similar version, might be found useful by professional organisations, as a guide for modern therapists.

We have a wide range of new short courses and workshops running this October, some for complete beginners and some for more experienced therapists.
 
See below for course titles and dates, and click through for further information and to book your place.
 
Special Offer: Book a place on three or more of the workshops below by the 3rd September and get a 10% discount.
 
If you have any questions or to book your place, call us free on 0800 195 9809 or simply reply to this email. 

• Taster Workshop – Introduction to Hypnotherapy – Sunday 3rd October
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Special Offer: Book a place on three or more of the above workshops by the 3rd September and receive a 10% discount. 
 
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Dr. J.J.G. Wilkinson’s Account of James Braid’s Hypnotism

Dr. James John Garth Wilkinson

Excerpts from The Discovery of Hypnosis: The Complete Writings of James Braid, edited by Donald Robertson.   www.James-Braid.com

In his book, The Human Body (1851), Dr. James John Garth Wilkinson gives an account of hypnosis, quoted favourably by James Braid, the founder of hypnotherapy.  Wilkinson was a succesful contemporary writer, who used much more “purple prose” than Braid.  Wilkinson had been hypnotised by Braid, observed him work several times, and appears to have made use of the hypnotic method with his own patients.  Braid writes,

Regarding Mr. Wilkinson, however, I may observe that he possesses a mind of the very highest order, and was, therefore, peculiarly fitted for dealing successfully with the psychological part of the question.  Another circumstance which gives so much greater value to his opinions is his practical experience of hypnotism in his own person as well as in others.  Mr. W. not only carefully watched many cases when operated upon by me, and has continued ever since to practise the art when suitable, but he also submitted himself to me several times to be hypnotised; and, as he is one of those who remember when awake all which occurs during the condition, he was enabled to describe, with the greater accuracy, not only what he saw but also what he felt.

Wilkinson writes of Braid’s hypnotism,

We presume it is evident to the reader what a power Mr. Braid has methodised and called into play for the treatment of disease.  As a curative agent, hypnotism contains two elements, each valuable in its kind:–

1. Where it produces trance, it has the benefits of the Mesmeric sleep, or furnishes so strong a dose of rest, that many cases are cured by that alone. 

2. The suggestion of ideas of health, tone, duty, hope, which produce dreams influential upon the organisation, enables the operator by this means to fulfil the indication of directly ministering to that mind diseased, which always accompanies and aggravates physical disorders. 

We have a direct proof of the continuation of the mind through the body, in the way in which suggestions, directed to the mind, respecting the organs, operate upon the latter.  In the hypnotic state, the operator can play upon the emotions by a variety of suggestive means, and in this way give power to impotent parts, and hand them over to the will.  Mr. Braid’s devices for these ends stamp him as a man of inventive genius; and we are surprised that such a piece of combined intellectual and scientific sagacity as hypnotism has not placed him, long ago, in the first rank of metropolitan physicians.  The virtue of hypnotism, where it succeeds, is just this, that for the moment it unweeds the human soil so completely, that whatever faith is impressed can work and grow. 

Wilkinson describes Braid’s hypnotism as follows, based on his own experience as subject, observer, and practitioner,

The atom of sleep is diffusion; the mind and body are dissolved in unconsciousness; they go off into nothing, through the fine powder of infinite variety, and die of no attention; common sleep is impersonal.  The unit of hypnotism is intense attention, abstraction – the personal ego pushed to nonentity.  The unit of Mesmerism is the common state of the patient, caught as he stands, and subjected to the radiant ideas of another person; it is mediate – or both personal and impersonal.  Patients can produce the hypnotic state upon themselves, without a second party; although a second will often strengthen the result by his acts or presence, just as one who stood by and told you that you were to succeed in a certain work would nerve your arm with fresh confidence.

Adding, 

The preliminary state is that of abstraction, and this abstraction is the logical premise of what follows.  Abstraction tends to become more and more abstract, narrower and narrower, it tends to unity, and afterwards nullity.  There, then, the patient is, at the summit of attention, with no object left – a mere statue of attention – a listening, expectant life – a perfectly undistracted faculty, dreaming of a lessening and lessening mathematical point, the end of his mind sharpened away to nothing.  What happens?  Any sensation that appeals is met by this brilliant attention, and receives its diamond glare, being perceived by force of leisure, of which our distracted life only affords the rudiments.  External influences are sensated, sympathised with, to an extraordinary degree; harmonious music sways the body into graces the most affecting; discords jar it as though they would tear it limb from limb; cold and heat are perceived with equal exaltations, so smells and touches.  In short, the whole man appears to be given to each perception; the body trembles like down with wafts of the atmosphere; the world plays upon it as upon a spiritual instrument finely attuned.  This is the natural hypnotic state, but it may be modified artificially.  

He proceeds to describe the influence of the hypnotist’s tone of voice on the hypnotic subject as follows,

The power of suggestions over the patient is excessive.  If you say, ‘What animal is it?’ the patient will tell you it is a lamb, a rabbit, or any other.  ‘Does he see it?’  ‘Yes.’  ‘What animal is it now?’ putting depth and gloom into the tone of now, and thereby suggesting a difference.  ‘Oh,’ with a shudder, ‘it is a wolf.’  ‘What colour is it?’ still glooming the phrase.  ‘Black.’  ‘What colour is it now?’ giving the now a cheerful air.  ‘Oh, a beautiful blue,’ spoken with utmost delight.  And so you lead the subject through any dreams you please, by variation of questions, and of inflections of voice; and he sees and feels all as real.  

Of Braid’s experiments in “muscular suggestion” during hypnosis, he observes,

Another curious study is the influence of the patient’s postures on his mind in this state.  Double his fist, and put up his arm, if you dare, for you will have the strength of your ribs rudely tested.  Put him on his knees, and clasp his hands, and the saints and devotees of the artists will pale before the trueness of his devout actings.  Raise his head while in prayer, and his lips pour forth exulting glorifications, as he sees heaven opened, and the majesty of God raising him to his place; then, in a moment, depress the head, and he is dust and ashes, an unworthy sinner, with the pit of hell yawning at his feet; or compress the forehead so as to wrinkle it vertically, and this little attitude of gloom glooms the whole mind, and thorny-toothed clouds contract in from the very horizon; and what is remarkable, the smallest pinch and wrinkle, such as will lie between your nipping nails, is sufficient nucleus to crystallise the man into that shape, and to make him all foreboding; as again the smallest expansion, in a moment, brings the opposite state, with a full breathing of delight. […] In this state, whatever posture of any passion is induced, the passion comes into it at once, and dramatises the body accordingly.  Moreover, the patient’s mind directed to his own body does physical marvels.  He can do in a manner what he thinks he can.  Tell him that a tumour on his body is about to disappear, and his mind will often realise your prophecy. […] A patient in the full state obeys all motives in the most natural direction.  If the arm is placed up, there it will stay; but a waft of air will cause it to fall.  Why?  Because it is already up, and the new motive changes the direction.  If the arm be down, another waft will raise it.  If down, and prevented from moving up, the impression will send it sideways.  When the frame is erect, a touch behind the bend of the knees will send it into genuflexion, which will at once suggest prayer, as noticed before. 

Wilkinson’s comments are of value as Braid quotes them enthusiastically, and clearly finds them agreeable, although Wilkinson writes more from the perspective of the subject, having been hypnotised by Braid himself, and in a much more colourful and expressive style, adding to our comprehension of the subjective side of hypnotism.

From James Esdaile to James Braid

Excerpt from The Discovery of Hypnosis: The Complete Writings of James Braid.

[Braid introduces the letter, saying "After acknowledging the receipt of some of my publications on hypnotic phenomena, and thanking me for them, Dr. Esdaile says:"]

I shall find much in the books to interest and instruct me, as I did in your first work on Hypnotism; but I shall not wait to read them before replying to your communication.

I have not seen any of the papers you allude to in the journals; but am glad to hear that the doctors are, at last, condescending to turn their attention to one of the most interesting and important subjects ever submitted to the consideration of the physiologist, the metaphysician, and natural philosopher. […] Regarding the reality and cause of the Mesmeric phenomena, if I venture to differ from you even, who are so much better prepared to investigate the subject (than certain individuals to whom the Doctor had referred), it is for reasons which I hope you will consider worthy of your attention.  I am fully aware that there are various modes of inducing the Mesmeric symptoms, to a certain extent, without the probability, or even possibility, of any vital force proceeding from the operator being concerned in the matter.  But I have never (except for experiment) produced the Mesmeric state of the system by the exhaustion of any organ, such as the eye, (here the Doctor has overlooked the important part which the mental act of fixed attention plays in this matter, vide page 53-7) or by acting strongly on the imagination, or by any means that could favour self-Mesmerisation, as you will perceive from the following resumé of my practice:–

During the last six years I have performed upwards of 300 capital operations of every description, and many of them of the most terrible nature, without inflicting pain on the patients; and, in every instance, the insensibility was produced in this fashion.

All knowledge of our intentions was, if possible, concealed from the patients, and if they had never heard of Mesmerism and painless operations, so much the better.  They were taken into a darkened room, and desired to lie down and shut their eyes.  A young Hindoo or Musulman [i.e., Hindu or Muslim] then seated himself at the head of the bed, and made passes, without contact, from the head to the epigastrium [around the navel area], breathing on the head and eyes all the time, and occasionally resting his hands for a minute on the pit of the stomach.  This often induced the coma deep enough for the severest surgical operation in a few minutes; but the routine was for me to examine the patient at the end of an hour, and if he was not ready, the process was repeated daily.  Taking the average, the operation, of whatever description, was usually performed on the fourth or fifth day.

Probably as many more cases were subjected to the trance for medical purposes, and were usually treated in the same way, for its convenience to both parties.

The enclosed remarkable case of clairvoyance, with transference of the senses to the epigastrium [i.e., the Mesmerised subject “seeing with” their own belly], will show that the Mesmeric control of the system may be obtained, when the patient is not only asleep, but in a state of intense natural coma.

I have also entranced a blind man, and made him so sensitive, that I could entrance him however employed, (eating his dinner, for instance,) by merely making him the object of my attention for ten minutes.  He would gradually cease to eat, remain stationary a few moments, and then plunge, head foremost, among his rice and curry.

Numbers of madmen have been entranced in the lunatic asylum of Calcutta, and I performed a Mesmeric operation on one man who had cut his throat.

I frequently desired the visitors of my hospitals to pretend to take the portraits of patients, and to engage their attention as much as possible, by conversing with them.  I then retired to another room, and reduced them to statues, without the possibility of their suspecting my intentions.

How such phenomena can be accounted for, without presuming the existence of a physical power transmitted from the operator to the subject, passes my comprehension, that the Mesmeric virtue can be communicated to inanimate matter, is a physical fact, of which I am as well convinced as of my own existence.  It was my common hospital practice to entrance patients for the purpose of having their sores burned with Nitric Acid, by giving them Mesmerised water to drink.

Community of taste, and thought-reading, are among the most common of the higher Mesmeric phenomena, and how they are to be explained, except by the transmission of the operator’s sensations, through his thought-stamped, nervous fluid, sent to the brain of the subject, I cannot conjecture.

“Important, if true,” you will probably say.  I can only say that healthy senses, a natural power of seeing things as they really are, and an earnest desire to know the truth, whatever it may be, are perfectly useless for the acquisition of knowledge, if all I have related is not perfectly true.

Till such facts are known to medical men and natural philosophers, it is surely premature to dogmatise about the only source of the Mesmeric phenomena.

It happened curiously enough, that the sleeping Fakir of Lahore had attracted my attention about the very time your interesting account of him appeared, and I had actually written to Sir Henry Lawrence [an influential British statesman and soldier in India], begging him to procure us information on the subject; but my departure from India, shortly after, prevented my prosecution of the subject.

Excerpt from The Discovery of Hypnosis: The Complete Writings of James Braid

www.James-Braid.com

I shall now cite from a paper [the middle section of “Magic, Hypnotism, Mesmerism, etc., considered historically and physiologically”] actually published by me in The Medical Times for December 28^th 1844, a few of the wonders recorded in Ward’s “History of the Hindoos”, which they represent as facts and as special gifts imparted to them in token of the great superiority of their religious system, of inducing a state of self-hypnotism, or ecstatic trance.  They produce this condition by certain postures or modes of sitting – the minds of the devotees being engaged in acts of fixed attention, by looking at some parts of their own bodies, or at inanimate or ideal [i.e., imaginary] objects; at the same time holding their breath, i.e., suppressing their respiration.  My modes of explaining these alleged marvels are given within parentheses.  I may premise, however, that whatever idea occupies the mind of the subject before he passes into the condition, or whatever may have occurred to it accidentally or through the suggestion of others subsequently, will ever after be realised, under similar combination of circumstances, in consequence of the power of suggestion and double-conscious [dissociated] memory, as manifested in some patients even in the sub-hypnotic or waking condition, when what have been called the vigilant or waking phenomena are producible; and still more certainly during the full, active, double-conscious condition.  These principles alone, and the vivid state of the imagination, explain most of the marvels; but, with the parenthetic explanations, I trust to make them sufficiently obvious to any candid and intelligent person.

The Yogee [i.e., master of yogic meditation] who has perfected himself in the three parts of sungyamu [yogic “self-mastery”] obtains a knowledge of the past and of the future (quickened memory and excited imagination); if he apply sungyamu to sounds, to their meaning and to the consequent results, he will possess, from mere sound, universal knowledge (hypnotic patients imitate, with the utmost precision and with the greatest facility, the vocal enunciation of any language, but do not understand the meaning of the words which they utter).  He who applies sungyamu to discover the thoughts of others will know the thoughts of all.  (He will believe and talk as if he did so.)  He who does the same to his own form, and to the sight of those whose eyes are fixed upon him, will be able to render his body invisible, and to dim the sight of the observers. (Through the force of imagination, or fixed attention, or suggestion.)  He who, according to these rules, meditates on his own actions, in order that he may discover how he may most speedily reap the fruits of them, will become acquainted with the time, cause, and place of his own death.  He who, according to these rules, meditates on the strength of the powerful, so as to identify his strength with theirs, will acquire the same.  (Through concentrated attention and conviction of their physical energy, there is a most amazing manifestation of increased muscular power.)  He who meditates, in the same manner, on the sun as perfect light, will become acquainted with the state of things in every place.  (He will believe and speak as if he really did.)  By similar application of sungyamu to the cup at the bottom of the throat, he will overcome hunger and thirst; by meditation on the basilar suture, he will be capacitated to see and converse with deified persons, who range through the aerial regions; by meditation on extraordinary presence of mind, he will obtain a knowledge of all visible objects; by meditating on the seat of the mind, or on the faculty of reason, he will become acquainted with his own thoughts and those of others, past, present, and future; by meditation on the state of the Yogee who has nearly lost all consciousness of separate existence, he will recognise spirit as unassociated and perfect existence.  (Belief and vivid imagination.)  After this he will hear celestial sounds – the songs and conversations of the celestial choirs; he will have the perception of their touch in their passage through the air, his taste will become refined, and he will enjoy the constant fragrance of sweet scents.  (All this I can easily cause hypnotic patients to realise, through suggestion and their fervid imagination.)  When the Yogee, by the power of Samadhi [meditation], has destroyed the power of those works which retained the spirit in captivity, he becomes possessed of certain and unhesitating knowledge; he is enabled to trace the progress of intellect through the senses, and the path of the animal spirit through the nerves.  After this he is able to enter into any dead or living body, by the path of the senses – all the senses accompanying him, as the swarm of bees follows the queen bee; and, in this body, to act as though it were his own.  (Now, all this extravagance I can easily make hypnotic patients imagine themselves accomplishing – but, of course, it is only imaginary, just as such feats are accomplished in dreams.)

The collected power of all the senses is called the animal soul, which is distinguished by five operations connected with the vital air, or air collected in the body.  The body of the Yogee who, according to the rules of Dharanu, Dhyanu, and Sumadhee [concentration, meditation, and mystic union], meditates on the air proceeding from (…) to the head, will become light as wood, and will be able to walk on the fluid element.  He who, in the same manner, meditates on the ear and its vacuum, will hear the softest and most distant sounds, as well as those uttered in the celestial regions, etc.  (This accords with my proposition, that calling attention to any organ or function will exalt the activity of the function positively, as well as excite ideas con­nected with such organ or function.)  He who meditates on vacuum will be able to ascend in the air.  (Imaginary ascent.)  He who meditates, by the rules of sungyamu, and in a perfect manner, on the subtle elements, will overcome and be transformed into those elements; he will be capacitated to become as rarefied and atomic as he may wish, and proceed to the greatest distance; in short, he will be enabled to realise in himself the power of Deity, to subdue all his passions, to render his body invulnerable, to prevent the possibility of his abstraction being destroyed, so as to subject himself again to the effects of actions.

“By applying sungyamu to the division of the four last minutes of time, he who perfects himself in this will obtain complete knowledge of the separate elements, atoms, etc., which admit not of division of species, appearance, and place.  This knowledge brings before the Yogee all visible objects at once, so that he does not wait for the tedious process of the senses.  (Imagination, lively faith, and fixed attention, until ideas became too vivid to be corrected by an appeal to the senses and sober reason.)

The following paragraph is from the “Dabistan” [Dabistān-i Mazāhib, a 17^th century Persian religious text of a syncretistic nature]:–

The Sipasian [an ancient Zoroastrian sect] and the historians relate that, whoever carries this process to perfection rises above death; as long as he remains in the body, he can put it off and be again reunited to it; he never suffers from sickness, and is fit for all business.

So much for the lively fancy and fervid faith of these religious enthusiasts, during their dreams, in the state of self-induced hypnotism, through fixing their thoughts or sight upon some part of their own bodies, or on some ideal [i.e., imaginary] or inanimate objects, and holding their breath, or suppressing their respiration.  By an appeal, therefore, to the feats of the Hindoos, I might claim for hypnotism, or self-induced trance, quite as high pretensions for its capability of inducing clairvoyant marvels as anything adduced by the animal magnetists or Mesmerists, with all the exoteric or alleged aid which they profess to communicate or impart to their subjects, by whatever name they may call it – whether magnetic, Mesmeric, odylic, nervous, or vital force transferred from the operators into the bodies of their subjects.

Hypnotherapy and Rational Psychotherapy as Psychoprophylaxis

Copyright (c) Donald Robertson, 2010.  All rights reserved.

Following the large-scale use of Pavlovian hypnotherapy at the start of the 20th century, as a means of reducing pain and anxiety during childbirth and dealing with associated complications, Soviet clinicians began to employ rational psychotherapy in a group setting as a preventative (prophylactic) against pain during childbirth.  These techniques were generally influenced by Pavlovian conditioning theory.  Today we would probably refer to what the Soviet therapists called “psychoprophylaxis” as “psycho-education”.

In a collection of papers by experts in this field, Shugom provides a brief review of Soviet statistical data on the results of psychoprophylaxis of labour pain.  His first observation is that the duration of labour among women who have attended group rational psychotherapy seminars in preparation for childbirth is reduced by an average of two hours, compared to childbirth under anaesthetic, or 3-4 hours compared to labour without anaesthesia.  Shugom provides a table illustrating this conclusion by reference to data from fifteen studies by different authors.  Eight of these were studies specifically on psychoprophylaxis, which report average duration of labour to be between 5hrs 40 min. and 16hrs.  The seven other studies, on duration of labour without psychoprophylaxis, found labour duration to range from 11hrs to 24hrs.

Soviet Rational Psychotherapy for Prophylaxis of Pain during Childbirth

Shugom reports the following mean figures collated from many thousands of cases, measured on a standard five-point clinical scale,

Summing up the results of pain prevention by the psychoprophylactic method on the basis of the reports of 20 authors, including 9 foreign authors, using the materials of more than 15,000 childbirths, A. Nikolayev reported at the Tenth All-Union Congress of Obstetrics and Gynaecology the following data on the effectiveness of rendering childbirth painless by the psychoprophylactic method:

Complete effect of preparation (5): 45-50%
Considerable partial effect (4): 30%
Insignificant (3): 15%
No effect (2): 4-5%

In old studies of this kind, complete or significant partial improvement are often pooled to provide a success rate figure, which in this case would be 75-80%, based on Nikolayev’s data from 15,000 women undergoing childbirth following psychoprophylaxis by the Soviet method. 

Shugom also provides a table of data, summarised in the chart above, which (excluding one site where the number of participants was unknown) shows that among a total sample of 5,610 pregnant women at seven different sites in the Soviet Union, psychoprophylaxis resulted in complete or significant reduction of pain during 83% of childbirths, on average.  Comparison of the figures across sites shows that they are fairly consistent, lending some additional credibility to the finding.

In a direct comparison between the psychoprophylactic method and suggestion hypnotherapy for labour pain, another Soviet author, Velvovsky, reported data from exactly 1,000 childbirths.  In this study, 641 women had preventative rational psychotherapy (psychoprophylaxis) whose reported level of pain during labour was compared directly against a sample of 113 women who received hypnotherapy.  See my article on Velvovsky’s comparison between psychoprophylaxis and hypnotherapy for a more detailed discussion.  The graph below places the data on psychoprophylaxis from Nikolayev’s study alongside the figures from Velvovsky’s direct comparison,

Combined data from Velvovsky and Nikolayev's Studies

These figures need to be treated with caution because little information is provided on the studies and any comparison the two sets of data can only be very tentative indeed.  However, they may provide some inspiration for further research in this area using modern research design methods.  There certainly seems to be an indication, from large numbers of women treated with these methods in the Soviet Union, that psychological methods can reduce the pain of labour to varying degrees, and that the inclusion of Pavlovian-style relaxation hypnosis may substantially improve the effect of psycho-education and suggestion, although non-hypnotic relaxation techniques may be found to have similar properties.

References
Velvovsky, I.; Platonov, K.; Ploticher, V.; Shugom, E.   (1960).  Painless Childbirth through Psychoprophylaxis.
Zdravomyslov, V.I.   (1956).  ‘The Significance of Psychotherapy in Obstetrics and Gynecology’ in Psychotherapy in the Soviet Union, Ralph B. Winn (ed.).  Grove Press: New York.

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Copyright (c) Donald Robertson, 2010.  All rights reserved.

These data were reported by I.A. Zhukov in a paper presented at, apparently, the last conference on psychotherapy in the Soviet Union, held in 1956.  Although this is an old study, and doesn’t provide enough information to meet modern research design criteria, it has the benefit of a control group and the figures come from a reasonably large sample of 580 patients.  Participants were treated for different skin conditions in spa resorts at Sochi, Matsesta and the Caucausus, where hypnotherapy was combined with recuperation, sulphur mineral baths and sunbathing.  The patients were mainly (about 92%) women, apparently aged between 20-60, their skin conditions were of one to twenty-five years in duration, and Zhukov says their case histories contained “in all instances some psychological traumata.”  He provides separate data on those patients presenting with eczema, neuro-dermatitis, and psoriasis, which he says in most cases “was quite extensive and affected the head, the trunk, and the legs and feet.”

Comparison of Hypnotherapy and Spa Treatment

Half of the patients constituted a control group who received spa treatment as usual, whereas the other half, the experimental treatment group, received the same spa treatment plus hypnotherapy.  Treatment consisted of seventeen sessions of direct suggestion hypnotherapy based on a Pavlovian conditioning model.  This approach usually involved prolonged periods of deep hypnotic relaxation combined with suggestions of symptom remission and general well-being.  Zheltakov, who presented to the same conference, observed that many of these dermatological patients also suffered from neurotic anxiety and problems sleeping, which might now be described as more “stress-related” or psychosomatic cases.  Zhukov describes his technique as a form of Braidism,

All our hypnotic treatments were conducted by means of the so-called fascination technique (involving staring at some bright object), the spoken word conveying the required suggestion.  Evening hours were chosen for the hypnotic sessions, insofar as this time was most compatible with the resort regimen and permitted us to extend the patients’ sleep to ten or twelve hours.  the sessions were conducted in the patients’ own words.

On average, the control group, who received spa treatment only, reported marked or complete improvement in 23% of cases.  By contrast, those who received hypnotherapy in addition to treatment as usual were marked or completely improved in 63% of cases.  These figures were broadly similar for different conditions, although neuro-dermatitis patients exhibited most improvement with 70% of the hypnotherapy group showing at least marked improvement, compared to 27% of the treatment as usual control group.

There was a follow-up of this study of eczema, neuro-dermatitis, and psoriasis.  Practically all the patients of the experimental group and many patients of the control group were contacted by means of a questionnaire, and 229 answers were received [i.e., a 39% response rate].  The answers overwhelmingly testified to the permanent nature of the improvements.

According to these data, the vast majority of patients, 85% in the treatment as usual group and 98% in the hypnotherapy group, reported at least slight improvement.  However, whereas only 10% of patients in the spa treatment control group were classed as “completely recovered”, three times as many, 31% of the hypnotherapy patients met criteria for full recovery. 

References
Zheltakov, M.M.  (1961).  ‘The use of hypnosis and conditioned-reflex therapy in dermatology’, in Winn, Ralph B. (ed.), Psychotherapy in the Soviet Union.
Zhukov, I.A.  (1961).  ‘Hypnotherapy of dermatoses in resort treatment’, in Winn, Ralph B. (ed.), Psychotherapy in the Soviet Union.

We are very excited this month to announce a brand new course format for 2011.

The new modular format will open up a huge range of short courses for complete beginners as well as qualified counsellors, psychotherapists, psychologists and hypnotherapists. In the meantime, we have opened up most of the days on our October Stage 1 course. See below for details.

If you have any questions please feel free to contact us on 0800 195 9809 or simply reply to this email.

Certificate in Evidence-Based Hypnotherapy – 3rd – 9th October

Book by the 3rd September for a 10% early booking discount.

We still have places left available on our next certificate course which will take place in Croydon, South London. Croydon is really easy to get to from most of the main London train stations, and all over the Southeast. It’s also only 15 minutes by train from Gatwick Airport. Click here for more information on travel to Croydon.

As you are probably aware, our training focuses on evidence-based, cognitive-behavioural approaches to hypnotherapy. But what exactly is cognitive-behavioural hypnotherapy? How is it different from CBT? College Principal, Donald Robertson has recently written an article that will answer these questions for you. Click here to read it. If you are interested in attending this course, just give us a call on 0800 195 9809, or click here for more details and to book your place.

Brand New Modular Course Format

From next year, we will be offering our Diploma in Cognitive-Behavioural Hypnotherapy in a new modular format. There will still be one more opportunity to attend in the current seven-day format in February (stage 1), March (stage 2) and April (stage 3). These courses will be comprised of one and two day modules, which can be taken as standalone workshops. After this, all modules will take place at weekends. Click here for details. In the meantime, we are opening up the following days of our October Stage 1 Certificate course:

• Introduction to Hypnotherapy (Open to all) – 3rd October
• Self-Hypnosis and Hypnotic Skills Training – 4th October
• Hypnotic Inductions, Deepeners, and Tests (Open to all) – 5th – 6th October
• Suggestion and Script Writing (Open to Hypnotherapists) – 7th October
• Assessment and Conceptualisation (Open to all Therapists) – 8th October

Click on the name of each course for further information, prices and to book you place. Want to know about this new format and why we are doing it? Click here to read our FAQs.

Best wishes,

Mandy Robertson
Training Administrator