INSHAPE NEWS MIND MATTERS
Peter Walker – Clinical Psychologist
Psychological distress is a complex and costly phenomena. It is awful to experience, plays havoc with relationships and costs individuals and society enormously in reduced productivity. Unfortunately, it also appears to be on the rise.
It has only been in the last hundred years or so that this distress has been categorised and described scientifically, and, then, only the last half century that widely available psycho-social treatments with demonstrated effectiveness have been developed. For those struggling with psychological problems such as addiction, depression or chronic pain, the need for effective and affordable treatments has never been so great. The difficulty for sufferers however, faced with a vast range of treatments making various claims, is determining which treatments are worth their investment.
Hypnosis and its therapeutic application, hypnotherapy, is an often misunderstood phenomena. Most of us will conjure up memories of stage hypnotism that suggests the entertainer having total control over innocent members of the crowd. In reality, hypnotism is not quite this dramatic. Hypnotism is a genuine mental state that is essentially a deep state of relaxation coupled with a focusing of attention that can be initiated through induction by a trained practitioner or self-induced. It is theorised that an individual is more suggestible when hypnotised and carefully stated “suggestions” made when in this state may lead to subsequent changes in behaviour.
So, it is a real mental state, but can it be used to promote mental health? A brief review of claims made by an Australian website promoting hypnotherapy suggest that it can assist in the alleviation of a wide range of problems ( http://www.naturaltherapypages.com.au/cognitive/Hypnotherapy), these are as follows:
- Stop smoking
- Fears and phobias
- Pain relief in pregnancy
- Stress management
- Improved memory
- Gambling addiction
- Sporting performance
- Academic performance
- Exam nerves
- Sexual problems
- Performance anxiety
- Gaining self-confidence
- Improving motivation
- Overcoming grief
- Overcoming insomnia
- Pre-menstrual tension
- Nail biting
- Bed wetting
Yet, we have to ask ourselves, “How do these claims stand in the face of the evidence?”
The assessment of the effectiveness of psychological treatments is complex. For a treatment to be described as evidence-based, rigorous unbiased randomised control trials (RCT’s) are conducted. Because there is variability in the experimental design and outcome of such trials, these trials are collated and assessed in procedures called meta-analyses. Studies that meet the appropriate experimental standards are included, and a mathematical procedure that compares the results allows researchers to firstly determine whether the treatment has demonstrated efficacy and then how large this effect is, which is defined as its effect size.
A review of published meta-analyses in the area of hypnotherapy suggests that, to date, there is no demonstrable efficacy for this treatment (see http://www.cochrane.org/cochrane-reviews a website that publishes meta-analyses). This is not to say it is necessarily ineffective, but rather that to date, there has not been rigorous experimental support for this form of treatment. Therefore, before a conclusion is possible, further well designed research is necessary. As a result of this, I, personally, do not recommend hypnotherapy for the problems defined above. For some of these problems (particularly phobias, fear, gambling and insomnia) there are inexpensive and widely available treatments that demonstrate clear efficacy in meta-analytic reviews. When clients ask for my advice I direct them to these treatments in the first instance.
Peter Walker has over 12 years experience working as a clinical psychologist. He has worked in both public and private practice, having specialised in complex presentations. He established his private practice, Peter Walker & Associates, clinical psychologists, in 2002 as a service to provide psychological treatments for those experiencing difficulties with anxiety, depression and couples in distress. In addition, the practice was relatively unique in that it offered specialised treatments for those experiencing psychotic disorders and bipolar disorder. At the time Peter Walker & Associates was established the development of psychological treatments for these conditions was in its infancy and Peter was considered an innovator in this field. Peter provides clinical supervision for mental health practitioners, is a sought after presenter and has experience providing expert opinion in the media. In recognition of his experience treating mood disorders he has been asked to take on a role at the Black Dog Institute in 2013.
Jay Spence – Clinical Psychologist and PhD Candidate
Hypnotherapy is the practice of inducing a deeply relaxed physical state where the brain’s normal conscious activities of analysing and evaluating are minimized and is therefore more open to suggestion. These suggestions are used to facilitate positive changes for the person under hypnoses, such as helping to decrease anxiety, deal with pain, or to stop smoking. It’s been a controversial practice; however, hypnotic procedures have been researched in hundreds of research trials and the research shows that hypnotherapy is effective for many different types of mental and physical health issues. Although it works well for some issues, there are other issues that it doesn’t appear to work with much at all.
In 2003 a large review of hypnotherapeutic treatments was published. The review looked at how much people improved from hypnotherapy compared with improvement from getting their usual medical treatments or no treatment at all. Reviews like this one use complex statistical methods to come up with a number that allows us to compare trials against each other. This number is called the effect size and the bigger it is, the better the treatment is. The overall effect size for hypnotherapy was 0.57. This might not sound like much but it makes more sense when you compare something like the effect size for Prozac (the popular drug for anxiety and depression), which is 0.26. It’s even more impressive when you look at the average time for the treatment, which was 3.7 weeks. Psychotherapy, which frequently takes longer than 12 weeks to complete has an effect size that is only slightly higher (0.75) than hypnotherapy.
However, it is important to note that the review had some difficulties. This included the number of participants in the study, which in most cases included lots of smaller studies with only 20 or so people in them. Large studies with lots of people tend to produce more accurate findings. When we look at the large studies that have been done for hypnotherapy, the results aren’t quite as good. For example, in a large study on the effects of hypnotherapy on headaches the effect size was only 0.19 and in a large study on smoking the effect size was only 0.31.
Nonetheless, hypnotherapy appears to work pretty well and powerful effects can occur within as little as two sessions. The review suggested that it worked well for health issues like headaches and also for anxiety. Hypnotherapy was moderately effective for stopping smoking and for helping people to cope with cancer treatment (like dealing with nausea and vomiting). However, it wasn’t very effective in helping people to cope with treatment of other medical issues such as burns.
Importantly, the review didn’t examine whether there are any risks associated with using hypnotherapy. As with all treatments, there may be risks. These can be minimized by using a practitioner who is part of a professional body like the Australian Society of Clinical Hypnotherapists (www.asch.com.au).
Jay Spence is a Clinical Psychologist and PhD candidate who specialises in adult and adolescent mental health. He was joint recipient of the Gold Prize at the Australian and New Zealand Mental Health Service Achievement Awards (2010) and of the St Vincent’s Health Australia National Invention and Innovation Award (2010) and was the recipient of the 2011 New South Wales Institute of Psychiatry Fellowship. He has published numerous papers on the treatment of post-traumatic stress, social phobia, and panic, as well as generalized anxiety and transdiagnostic anxiety processes. He held a conjoint lecturer position at the University of New South Wales from 2009 to 2011, lecturing on the treatment of anxiety and depression. He is currently completing a PhD on internet-based interventions for post-traumatic stress disorder (PTSD). He is developing these treatments as part of the Centre for Emotional Health at Macquarie University because PTSD is the most prevalent anxiety disorder in Australia. However, many people do not have access to effective treatments. He sees patients in private practice in Darlinghurst, Sydney.
Phil Owens – Leading Australian Hypnotherapist and NLP Practitioner
Therapeutic approaches utilising hypnosis (often referred to as ‘hypnotherapy’) can be highly effective. With over 3000 clinical studies into the use of hypnosis, it is a proven methodology for assisting clients make rapid change.
Hypnosis can be regarded as the process of assisting the client to become specifically focused, and provides them with an opportunity to engage in experiential learning. Clients who have experienced hypnosis say that it is like mindfulness or meditation.
Hypnosis by itself is neither positive nor negative, it is instead a ‘state’ into which the client voluntarily enters, this, then provides them with a space to think, experience and learn which can significantly assist their change process. Importantly, the process of ‘going into trance’ is an active one – the client remains in control of their experience the whole time. If a client does not want to go into trance, then there is no hypnotist on the planet that can ‘make them’. Similarly, once in a trance, the client is in control of their experience and can make choices about what to do, or what not do, regardless of what the hypnotherapist says or does.
This should now give you an indication of on how ‘stage hypnosis’ works, where an entertainer finds ‘volunteers’ who are happy to accept suggestions to do the crazy things. In fact, consider when these go back to their seat. Many of them will sit down, laugh, and then say, “Look at all the weird things I just did, and I don’t have to take responsibility for doing any of it!”
Hypnosis has been shown in clinical trials to be effective in a range of circumstances, particularly supporting strategic therapeutic approaches to make rapid change. This becomes even more evident when paired with cognitive-behavioural and emotional-somatic approaches, where hypnosis can add significant value, such as speeding up response, increasing the likelihood of long-term change and the opportunity for the client to find creative solutions to long standing problems.
In clinical practice, I use a ‘strategic therapy’ approach supported by the use of hypnosis. This has excellent results. As a scientifically validated and supported method, I am confident that in the correct environment, client hypnosis can be highly effective in relieving depression and anxiety, assisting in weight control and body issues, addictions, fears and phobias, overcoming trauma, smoking cessation and other issues.
As with any profession, there is a range in quality and capability amongst practitioners. I would encourage anyone seeking a hypnotherapist to ask some key questions about the hypnotherapist’s training, experience and their beliefs and approaches to hypnosis. In the end, having a good therapeutic relationship and strong expectations that issues can be change (based upon the quality of the therapist) are key elements in delivering success.
Philip Owens is owner and director of Reflective Resolutions and is a leading Australian hypnotherapist and NLP practitioner based in Melbourne, Australia. Using scientifically validated and pragmatic approaches, Philip is a passionate about creating lasting change in and for his clients.
Working in his clinic with individuals and also with corporate clients, Philip’s international experience, state of the art training and processes have led to successful and happy clients all over the world. Focusing on the issues of modern life, Philip routinely works with clients presenting with anxiety, fears and phobias, addictions, traumas, weight loss, insomnia and smoking cessation’.
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