Thérapie cognitivo-comportementale brève (TCC) et #hypnothérapie
Cette étude illustre l'efficacité de deux méthodes de traitement intégrées pour faire un meilleur pronostic dans le traitement d'une ménagère pakistanaise déprimée âgée de 25 ans, qui souffrait depuis un an.
Les séances comprenaient l'induction hypnotique, l'enseignement de l'#autohypnose avec des #suggestions positives, la surveillance de l'#humeur, l'utilisation d'images et de techniques de #relaxation ainsi que des stratégies spécifiques de brève TCC. La caractéristique dominante de sa présentation clinique était la #croyance d'être mal aimée et les pensées négatives d'être dévaluées par le mari.
L'hypnothérapie a contribué à réaliser des progrès thérapeutiques remarquables en un temps relativement court. Lors de la présentation initiale, les symptômes dépressifs étaient extrêmement élevés, comme l'ont démontré les tests d'évaluation psychologique et le Beck Depression Inventory (BDI).
Les résultats des tests ultérieurs ont indiqué qu'elle était revenue à un niveau de fonctionnement normal (81-90) tel qu'évalué par le Global Assessment of Functioning Scale (GAFS). Au moment de signaler le cas, elle était en phase de suivi. Le cas met en évidence la valeur de l'hypnose en tant qu'outil d'autonomisation particulièrement important pour réduire la dépression lorsqu'il est utilisé en complément d'une thérapie cognitivo-comportementale.
Lire aussi :
- L’hypnose en réalité virtuelle pour réduire l'anxiété, la fatigue en chirurgie cardiaque
- Protocole d'hypnose pour gérer la douleur chronique
- Hypnose : le stress, déclencheur de céphalée de tension et migraine chez les enfants
- Hypnose, imagerie guidée pour atténuer l'anxiété et la dépression des patients
- Traiter le côlon irritable grâce à l'hypnose
- L'hypnose avant le sommeil nocturne réduit le stress
- Hypnose arrêt du tabac : test de dépendance du fumeur Fagerström et de motivation
Introduction
Cognitive Behaviour Therapy (CBT) is a form of therapy used to treat a wide range of psychological problems. It is based on the assumption that thoughts, feelings, emotions and behaviour are parts of a unified system, and that change in any part can bring about change in the entire system. Hypnotherapy is a combination of hypnosis and therapeutic intervention. The therapist leads the patient to positive change while the patient is deeply relaxed in a state of heightened suggestibility called trance. The degree to which a technique influences the other is known as integration of therapy techniques. When combined with psychotherapy, hypnosis becomes hypnotherapy. Therefore, it is said that hypnosis actually contributes to the effectiveness of CBT. Similarly, CBT is a therapy lacking the power to bring accelerated human changes in the form of belief, perception and behaviour. However, this is achieved when CBT is used in integration with hypnosis.1
Hypnosis can stop playing of automatic negative thoughts in the unconscious through positive suggestions. Hypnosis adds flexibility in perception and behaviour, enabling the client to think in a more adaptive manner. It also helps by detaching the clients from their own thoughts and feelings allowing them to observe their thoughts and feelings as a third person. Instead of making changes at conscious level, which is a very time-consuming process before becoming automatic, hypnosis can be used to bring about changes directly at the unconscious level.2
Hypnosis is most commonly integrated with CBT if the therapist wants the clients to focus on their cognitive distortions (thinking errors). Hypnosis might be used through which correction in thinking pattern can be made in more natural way and the process is actually automatic. Aron. T. Beck, the founder of cognitive therapy, did not deal with the unconscious, but dealt with automatic negative thoughts in the therapy that are embedded in the unconscious. Through hypnosis, these automatic negative thoughts can be eradicated and positive thoughts can be instilled into the subconscious mind.3
Literature Review
Literature suggests that hypnosis works to catalyse different interventions, including CBT. Hypnosis through positive suggestions alleviates symptoms of psychological disorder, including depression, and holds a creative and practical addition to the therapist's practising skills while providing intervention.4 Literature suggests cognitive hypnotherapy as an adjunctive to psychotherapy that enhances the role of hypnosis. As hypnosis lacks empirical evidence regarding therapeutic and behavioural change, it is used as an adjunctive therapy with other psychotherapies to promote its standing therapeutically. It is systematically integrated with a well-established CBT which represents the best integrated psychotherapeutic approach for merging empirical findings.5 The American Psychological Association in 19996 acknowledged hypnosis as an effective adjunct to CBT. Literature clearly suggests the effectiveness of hypnosis for many conditions. Currently, the challenge is to empirically explore the limitation and further the possibilities for hypnotherapy as an effective treatment modality.7 Literature further suggests that hypnotherapy is a beneficial part of some treatment regimes.8 According to a study, hypnotic intervention showed promising results for treating low to moderate level depression,9 and found it to be a successful non-pharmacological treatment to address symptoms of depression.10 Kirsch et al. compared the efficacy of cognitive behaviour hypnotherapy with CBT alone through meta-analysis and concluded that CBT was more effective when integrated with hypnosis compared to CBT alone.11
Case Report
A housewife aged 25 years came to seek therapy who had done her graduation in 2016 and had got married in June, 2017. She had a daughter aged 3 months, and lived in a nuclear family setup in Gujranwala in the Punjab province of Pakistan. She was accompanied by her mother to Transformation Wellness clinics in Lahore throughout the therapy sessions. Her mother reported to be worried for her daughter as her son in law had sent her back, saying he would take her home only after she was mentally stable. At first sight, the client appeared to be sad, was talking in a low tone, and appeared resistant in interacting with the therapist.
Presenting Problems
She reported experiencing low mood throughout the day with crying spells, changes in her appetite, insomnia, lack of energy, loss of interest in routine activities, negative thoughts, poor concentration, and feelings of worthlessness, hopelessness and indecisiveness. Her symptoms had started a year back and had exacerbated in the preceding 6 months. She said she has been disappointed with her husband as he did not give her proper time and attention, and she had a feeling that he did not love her. She expressed her emptiness and hopelessness with her future life. She was having frequent disputes with her husband over her demand to shift his family business to Lahore. She reported to have never liked the environment of the city she was residing in and wanted to come back to her birthplace. She felt suffocated and devastated by her in-laws, her husband's gathering and was having adjustment issues. She demanded a lot of time and attention from her husband which he was unable to provide because of his work routine and socialisation with his friends. She reported having a train of automatic negative thoughts throughout the day, feeling low and hopeless. She had difficulty in falling asleep and usually woke up in the middle of her sleep. She also complained of her weight-gain because of over-eating under stress. She was also having indecisiveness regarding undergoing treatment, staying with her mother or going back to her husband. She believed that if she stayed with her mother, her husband would have no choice to shift his business to Lahore.
Methodology
Assessment for Diagnosis
For the diagnosis of client's symptomatic presentation, psychological assessment was carried out through Human Figure Drawing, Thematic Apperception Test (TAT), Rorschach Inkblot Test and Beck Depression Inventory (BDI)12. Her baseline level of functioning was assessed through Global Assessment of Functioning Scale (GAFS).
Assessment of Suitability for CBT and Hypnotherapy
An initial CBT assessment was carried out to check her appropriateness for the therapy and to decide whether to continue with the brief version of CBT or to switch to some other therapy.
Evaluation Criteria
It included strong motivation to change with knowledge of benefits associated with treatment; clear goals for treatment; willingness to devote the time needed for the weekly sessions; commitment for out-of-session homework; family's support; adequate cognitive functioning and educational level; and mild level of psychopathology.
In order to assess her hypnotisability and level of suggestibility to carry out acceptable primary suggestions, her level of concentration and imagination were tested. In addition, to allay her fears and anxieties, misconceptions about hypnosis and to establish rapport with her, four of the primary suggestibility tests were carried out that included Chevreul's Pendulum Experiment, a permissive test of concentration; Arms Rising and Falling Test, a permissive test of imagination;
a) Hand Clasp Test, an authoritative test of imagination; and the Progressive Muscle Relaxation Test, a permissive test of relaxation.
These tests provided the therapist an opportunity to evaluate her likeliness to be a successful client for clinical hypnosis. The tests also preconditioned her for hypnosis by allaying her fears and provided clues to the therapist in selecting appropriate induction methods based on her response to the tests.
Session Plan
On the basis of evaluation, it was decided to provide her 2 sessions (45 minutes each) in a week. Brief CBT was completed in the period of a month excluding the follow-up sessions. The treatment was carried out in December, 2017, and continued till the end of follow-up sessions in June, 2018. Client's verbal and written consent was taken before using her case for the current study. Throughout the process of assessment, therapy and while reporting her case, confidentiality was maintained at all times.
Specific Interventions