How to Integrate Hypnosis Into a CBT Session

Hypnosis can help clients escape well-trodden linguistic pathways and explore the hinterlands of possibility.

“Change will lead to insight far more often than insight will lead to change.” – Milton H. Erickson

Cognitive behaviour therapy (CBT) is a highly valuable therapy. It can be vital in helping clients uncover hidden assumptions and biases as to what they are like and the nature of their reality. But sometimes more is needed.

Sally, a CBT practitioner I know, told me, “I love working with the way that people think, but I can do so much more when I integrate my hypnosis training.”

I’ve trained many CBT practitioners in the use of clinical hypnosis, and they have invariably felt that this training has freed them up to work more directly with the emotional components of problems. They are also relieved to know that hypnosis has a huge pedigree of research to back it up.

One CBT trainer told me she couldn’t believe she’d ever worked without using hypnosis. So I was intrigued but not at all surprised to see a recent meta-analysis showing that CBT work can be greatly enhanced by adding hypnosis.

CBT is 70% more effective when you add in hypnosis

A large meta-analysis of 18 studies shows that cognitive behavioral therapy is a whopping 70% more effective when used in combination with hypnosis than when used alone.¹

I think this is partly because the main premise of classical CBT is mistaken, or at least doesn’t give the whole picture.²

Thoughts can produce feelings, but more often it is feelings that produce thoughts. Pattern matching – that is, a response pattern triggered in your mind and body by an environmental pattern – happens quicker than the speed of thought.

Thoughts, if they come at all, come after the emotion. For example, the traumatized war veteran who suddenly jumps in fright at hearing fireworks and has an immediate flashback isn’t thinking to himself, “Oh, this is a bit like the sounds I heard during battle in Iraq!” then deciding he should feel afraid. The fear comes first, because fear needs to come first for survival.

Sometimes if you try to do cognitive therapy with a client who feels really strong emotions, they will tell you they don’t know what they think in such times. This may be because strong emotion tends to disable thought. Asking someone what they think just before or while they are panicking, for example, may elicit little response if the emotion is overwhelming.

We can certainly treat people’s limiting beliefs and help them change their behaviours so as to improve their wellbeing, but we need to work with all the different parts of a client’s mind. We are not simply thinking animals, nor are all emotional problems caused by faulty thinking.

In fact, you could make the case that many emotional problems are actually more to do with trance than with thought.

Emotional trances versus thought disorders

When some trigger in the environment produces a pattern match to some past trauma, what happens? The person spontaneously regresses back to that original trauma.

This is not a cognitive process; it is a hypnotic one. I’ve worked with traumatized clients who, during a flashback, genuinely feel as if it is thirty years ago.

A client who had been raped repeatedly by a car mechanic found that, even decades later, the mere smell of engine oil would act as a kind of post-hypnotic trigger. She told me, “Before I know it I’m back there again. I can see him, I smell his breath and the engine oil, and it’s happening all over again!”

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This is an experience more akin to a nightmare or a ‘bad trip’ than a thought. During hypnotic trance people tend to disassociate from their surroundings, and the imagination becomes activated – sometimes to the point where they feel almost as though they are dreaming. When we use this therapeutically, it can be a wonderful experience. But when it happens spontaneously, through emotional conditioning, it can cause serious problems.

Anger, depression, obsession, addiction, and jealousy all narrow our focus of attention, just as any hypnotic induction does. These are hypnotic phenomena, no doubt about it.

Addicts and OCD clients talk about losing track of time and forgetting everything else. Angry clients talk about losing their sense of self-consciousness to the point where they only realize what they’ve done later on, when they calm down. And depressives can sit still for hours on end with a fixed stare, ruminating about the past or creating imaginary scenarios of hopelessness about the future.

So if people’s emotional problems are in themselves hypnotic, it makes sense to work on the level of the problem by using hypnosis.

So how can we begin to incorporate hypnosis into CBT practice?

Tip one: Ask the client to access the feeling that goes along with a thought

We might examine the kinds of thoughts a client typically has around some issue. For example, for a bulimic client we might examine the thoughts they tend to have just before they start bingeing.

The client might say, “I just think to myself, ‘Oh, what’s the point! I might as well just eat the tub of ice cream!'”

Here, incorporating hypnosis can be as simple as saying, “And it’s really the feeling rather than the thought that’s been inducing you to binge… Just close your eyes for a moment and get a flavour of that feeling…”

All we are doing here is asking the client to access the part of the mind that doesn’t just think, but experiences – and this is the cornerstone of hypnosis.

From here, we can use hypnosis to help them master that feeling. We could, for example, ask them about times when they feel least likely to binge, and simply invite them to access those resourceful feelings. We could help them bring those resourceful feelings into contexts where they previously might have thought (and felt) “Oh, what’s the point!”

So we can extend a cognitive technique by adding hypnosis. For example, when working with a depressed client you could start by asking a Socratic question, that is, the kind of question that pushes the client to challenge their assumptions purely through the way it is framed. You might ask:

“Can a person who is generally ‘a success’ still fail at some things?”

The way this question is framed already offers the opportunity to loosen up the client’s thinking biases. But here’s where you can take it a step further by engaging the unconscious mind.

Now you can invite the client to close their eyes, go inwards, and take a few moments to simply “notice what ideas come to mind in relation to that question.”Noticing what comes to mind appeals to the unconscious mind (not the cognitive mind) to come up with some images or ideas around that question.

As they do this, you can make suggestions for them to relax more fully, to really let their unconscious mind take over the reins. In this way, we can naturally and conversationally incorporate hypnosis.

This is a great approach to use whenever you are discussing a client’s limiting beliefs – simply ask them to relax deeply and notice what other ways of thinking about that issue come to mind.

We always need to be mindful of which part of a client we are appealing to – the thinking part, or the experiential (hypnotic) part.

Tip two: Know when to use ‘thinking’ versus ‘feeling’ with clients

Many, many years ago I did some work for a charity, calling supporters and asking them to make a regular donation. I remember being specifically instructed not to ask what people thought about giving £15 of their hard-earned income to the charity every month, only what they felt about it.

This raises an interesting question.

Does it make a difference whether what you say is couched in ‘thinking’ or ‘feeling’ terms?

Does the language of thought affect the brain in a different way to the language of feeling?

The answer, it seems, is yes. A study published in the Personality and Social Psychology Bulletin back in 2010 found that this seemingly unimportant distinction – whether you couch your message in feeling or thinking terms – can significantly influence the power of your persuasive message.³

Psychologists Nicole Mayer and Zakary Tormala started by establishing which of the 65 participants tended to describe their experiences with reference to feelings – unpleasant or pleasant, scary or comforting, and so forth – and which were more inclined to make reference to thoughts, perhaps categorizing things as useful or useless, harmful or beneficial, and so on. In this way, they made judgements as to the natural tendencies of participants to think either cognitively or emotively.

The subjects were then asked to read a persuasive message about donating blood. Two versions of this message were used, identical in argument but different in language: one version used the word think to present the arguments, while the other used feel. Each participant was then asked how likely it was that they would donate blood in future.

Those who tended to process experience in cognitive terms were more persuaded to give blood when the message was framed using think, while those who responded to their experience with emotions were more persuaded when the word feel was used.

These findings suggest that if you want to persuade someone, it’s useful to know whether they are a ‘thinker’ or a ‘feeler’, and target your message accordingly.

The easiest way to find out which category someone falls into is simply to listen to how they describe the world – cognitively, or emotionally. Of course, everyone does both to some extent, but when you start paying attention you’ll find that a surprising number of people generally swing more one way than the other.

And of course, we can – and should – apply this to therapy.

How does that make you think?

When we work hypnotically with a client, we are asking them to access enveloped experience rather than detached thought. Conversely, when we want to calm someone we can, bit by bit, use more ‘thinking’ terms to help them detach from their emotions. (Of course, that’s not to say it isn’t also helpful to talk in terms of positive feelings.)

Asking a really distressed person the therapeutic cliché “How does that make you feel?” is essentially asking them to place even more focus on their already distressing feelings, which may lead them to genuinely feel more distress.

You could ask the distressed person to think about a favourite resourceful time or place, but this may cause them to detach from the resourceful feelings, right when they need them most.

Instead, we might ask the client to:

“Notice the feelings in your body and mind as you get a sense of that wonderful beach… the feelings of joy and comfort, calm and tranquility…“

In this way, we revivify those resourceful feelings so the client can actually get a sense of experiencing them.

So when seeking to blend hypnosis with CBT, we can help shape the way a client responds to our input – that is, hypnotically or cognitively – by being mindful of whether we are using feeling or thinking terms with them. We can also help a client begin to envisage a brighter future by helping them feel the possibility of that better future rather than just think about it.

Tip three: Use hypnosis for calmer, more flexible thought

CBT is a solution-focused therapy. What that means is that it’s a way of helping clients live better and meet their emotional needs more sustainably in the future.

When we help clients examine their thoughts and challenge limiting beliefs, we can begin the process of helping them live more flexibly and cast off old habits of mind that don’t serve them well. And the creation of hope is integral to this process.

Expectations are extremely powerful. The placebo response – measurable, observable, or perceived improvement in health and behavior that cannot be attributed to medication or other medical intervention – is, in most cases, the result of an expectation of relief from illness or pain. For some people, this can huge impacts on their wellness (or otherwise).⁴

Funnily enough, it appears that CBT itself may owe a large part of its historical success to the placebo response.

A 2015 meta-analysis suggests that CBT is only half as effective for treating depression as it used to be.⁵ That may be because in the early days of CBT, depression sufferers would have likely had high hopes for its effectiveness. But as the novelty of CBT has worn off and reports have emerged questioning its effectiveness, the positive expectations (placebo effect) may have fallen away a bit.

Expectations play a massive role in human experience, so we need to be harnessing it as a part of our therapy. And hypnosis, when used well, can do just that.

It’s astonishing how accessing resourceful states during therapy, such as deep rest and calm, enthusiasm, or wonder can help someone widen their perspective.

I once hypnotised a woman and had her envisage flying like a bird and “seeing the world from new and wider perspectives”. I then asked her to notice how she could “think in new ways” about an old problem. When she came out of trance she told me that her “old thinking” had seemed small and distant as she gained all kinds of new perspectives.

The cognitive therapy, the challenging of old thoughts, came after we had accessed that resourceful hypnotic state. But there was more hypnotic work yet to be done!

Next, I asked her to travel into the future inwardly and experience feeling calmer and thinking differently about all kinds of things. She also hypnotically rehearsed being more flexible in her future.

We had already discussed her thinking and assumptions and beliefs, and I had worked hard to respectfully reframe those beliefs where I could. But hypnosis added an extra level by helping her to actually generate new insights, guided by her own intuition.

And finally…

We are all hypnotic beings

We are thinking creatures, but we are also hypnotic creatures. And for therapy to be effective, it must take that into account. Thankfully, many CBT practitioners are now recognizing this central tenet of psychotherapy and incorporating mindfulness and other hypnotic techniques into their work.

When you calm a client and connect them to resourceful feelings, the thoughts change to fit the new and better feelings. This can be a much easier and more natural way of working than trying to change the thoughts and hoping the strong feelings will change with them.

People often know their thoughts are unreasonable, but can’t help feeling the way they do. We bypass this problem when we use hypnosis alongside CBT.

Skilled hypnotherapists should never assume they are less effective or able to help people in distress than any other practitioner.

How to integrate hypnosis with your practice

If you’d like to add the most powerful psychotherapeutic tool to your repertoire, learn conversational, indirect hypnosis with our online course Uncommon Hypnotherapy. Read more here.

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About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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