Hypnotic Cognitive Therapy

Transcription

1 Hypnotic Cognitive Therapy Mark P. Jensen, Ph.D. University of Washington, Seattle, WA, USA Workshop facilitated at the 6 th Congrés International, Hypnose & Douleur St. Malo, France, 5 May, 2016

2 Workshop Goals - Provide a neurophysiological model of hypnotic cognitive therapy that can be used to guide assessment and treatment, - Learn three specific strategies based on this model

3 Overview - The behavioral activation and inhibition systems (BIS and BAS) - Model and practice three BAS-focused interventions

4 Facilitate a shift from this My pain is horrible manageable

5 To this My pain is horrible manageable

6 And Sensations horrible safe are

7 From this My life is horrible meaningfull

8 To this My life is horrible meaningfull

9 Sensations are My life is horrible safe horrible meaningfull

10 Two systems

11 Two systems BIS BAS

12 BIS and BAS BIS BAS Behavior (e.g., Approach, Goal-Directed)

13 BIS and BAS BIS BAS Behavior (e.g., Withdraw, Stop, look, & Listen ) Behavior (e.g., Approach, Goal-Directed)

14 BIS and BAS BIS BAS Cognitive Content (e.g., Hurt Harm, Anticipate reward) Behavior (e.g., Withdraw, Stop, look, & Listen ) Behavior (e.g., Approach, Goal-Directed)

15 BIS and BAS BIS BAS Cognitive Content (e.g., Hurt Harm, Anticipate reward) Emotion and affect (e.g., Excitement) Behavior (e.g., Withdraw, Stop, look, & Listen ) Behavior (e.g., Approach, Goal-Directed)

16 BIS and BAS BIS BAS Cognitive Content (e.g., Hurt Harm, Anticipate reward) Emotion and affect (e.g., Excitement) Behavior (e.g., Withdraw, Stop, look, & Listen ) Behavior (e.g., Approach, Goal-Directed) Cognitive processes (e.g., Acceptance, Cognitive flexibility)

17 BIS and BAS BIS Cognitive Content (e.g., Pain = Danger, Anticipate punishment) Emotion and affect (e.g., Anxiety) Behavior (e.g., Withdraw, Stop, look, & Listen ) Cognitive processes (e.g., Rumination, Hypervigilance) BAS Cognitive Content (e.g., Hurt Harm, Anticipate reward) Emotion and affect (e.g., Excitement) Behavior (e.g., Approach, Goal-Directed) Cognitive processes (e.g., Acceptance, Cognitive flexibility)

18 Key features Automaticity

19 Key features Automaticity via associative learning, not logic

20 Automaticity BIS and BAS reponses are automatic you cannot easily stop them.

21 Example 1

22 Example 1 VOMI (VOMIT)

23 Example 1 We all had emotional, behavioral, and cognitive responses.

24 Example 1 We all had emotional, behavioral, and cognitive responses. That were automatic

25 Which system? BIS BAS

26 Which system? BIS Emotion and affect

27 Which system? BIS Emotion and affect Behavior

28 Which system? BIS Cognitive Content Emotion and affect Behavior

29 Which system? BIS Cognitive Content Emotion and affect Behavior Cognitive processes

30 Example 2

31 Example 2 Read the following

32 Example 2 Read the following

33 Example 2 Now read the following

34 Example 2

35 Example 2

36 Example 2 Context (cues) influence our responses

37 Example 2 Context (cues) influence the response Their influence is automatic

38 Example 3

39 Example 3 What is the color of fresh fallen snow?

40 Example 3 What is the color of fluffy (not rain) clouds?

41 Example 3 What is the color of a fresh sheet of standard Xerox paper?

42 Example 3 What do cows drink?

43 Example 3 Context (cues) influence our responses

44 Example 3 Context (cues) influence our responses Their influence is automatic

45 Example 4 How many of each species?

46 Example 4 How many of each species did Moses put on the ark?

47 Example 4 Context (cues) influence our responses

48 Example 4 Context (cues) influence our responses Their influence is automatic

49 The characteristics of automaticity and mutual activation among networks may explain the effects of seeding

50 The characteristics of automaticity and mutual activation among networks may also explain the very large impact of HYP-CT on pain intensity

51 BIS and BAS BIS Cognitive Content (e.g., Pain = Danger, Anticipate punishment) Emotion and affect (e.g., Anxiety) Behavior (e.g., Withdraw, Stop, look, & Listen ) Cognitive processes (e.g., Rumination, Hypervigilance) (-) BAS Cognitive Content (e.g., Hurt Harm, Anticipate reward) Emotion and affect (e.g., Excitement) Behavior (e.g., Approach, Goal-Directed) Cognitive processes (e.g., Acceptance, Cognitive flexibility)

52 BIS and BAS BIS Cognitive Content (e.g., Pain = Danger, Anticipate punishment) Emotion and affect (e.g., Anxiety) Behavior (e.g., Withdraw, Stop, look, & Listen ) Cognitive processes (e.g., Rumination, Hypervigilance) (+) (-) Pain Perception BAS Cognitive Content (e.g., Hurt Harm, Anticipate reward) Emotion and affect (e.g., Excitement) Behavior (e.g., Approach, Goal-Directed) Cognitive processes (e.g., Acceptance, Cognitive flexibility)

53 BIS and BAS BIS Cognitive Content (e.g., Pain = Danger, Anticipate punishment) Emotion and affect (e.g., Anxiety) Behavior (e.g., Withdraw, Stop, look, & Listen ) Cognitive processes (e.g., Rumination, Hypervigilance) (+) (-) (-) Pain Perception BAS Cognitive Content (e.g., Hurt Harm, Anticipate reward) Emotion and affect (e.g., Excitement) Behavior (e.g., Approach, Goal-Directed) Cognitive processes (e.g., Acceptance, Cognitive flexibility)

54 Hypnosis enhances CT

55 Hypnosis enhances CT Average Pain Intensity *.56 *.97 * Pre Post

56 Hypnosis enhances CT Pain Interference *.46 Pre Post

57 Hypnosis enhances CT Catastrophizing * Pre.61 Post

58 What s wrong w/ HYP à Pain reduction?

59 What s wrong w/ HYP à Pain reduction? It focuses on.

60 What s wrong with pain-focused HYP? It focuses on.pain

61 What s wrong with pain-focused HYP? It focuses on.pain Image courtesy of FreeDigitalPhotos.net

62 What s wrong with pain-focused HYP? It focuses on.pain Image courtesy of FreeDigitalPhotos.net

63 What s wrong with pain-focused HYP? It focuses on.pain Image courtesy of FreeDigitalPhotos.net

64 What s wrong with pain-focused HYP? It focuses on.pain Image courtesy of FreeDigitalPhotos.net

65 Which system does pain activate? BIS Cognitive Content (e.g., Pain = Danger, Anticipate punishment) Emotion and affect (e.g., Anxiety) Behavior (e.g., Withdraw, Stop, look, & Listen ) Cognitive processes (e.g., Rumination, Hypervigilance) (+) (-) (-) Pain Perception BAS Cognitive Content (e.g., Hurt Harm, Anticipate reward) Emotion and affect (e.g., Excitement) Behavior (e.g., Approach, Goal-Directed) Cognitive processes (e.g., Acceptance, Cognitive flexibility)

66 Which system does pain activate? Which system does pain inhibit? BIS Cognitive Content (e.g., Pain = Danger, Anticipate punishment) Emotion and affect (e.g., Anxiety) Behavior (e.g., Withdraw, Stop, look, & Listen ) Cognitive processes (e.g., Rumination, Hypervigilance) (+) (-) (-) Pain Perception BAS Cognitive Content (e.g., Hurt Harm, Anticipate reward) Emotion and affect (e.g., Excitement) Behavior (e.g., Approach, Goal-Directed) Cognitive processes (e.g., Acceptance, Cognitive flexibility)

67 What s right with HYP-CT? It focuses on.

68 What s right with HYP-CT? It focuses on.life Images courtesy of FreeDigitalPhotos.net

69 What s right with HYP-CT? It focuses on.life Images courtesy of FreeDigitalPhotos.net

70 What s right with HYP-CT? It focuses on.life Images courtesy of FreeDigitalPhotos.net

71 What s right with HYP-CT? It focuses on.life Images courtesy of FreeDigitalPhotos.net

72 What s right with HYP-CT? It focuses on.life Images courtesy of FreeDigitalPhotos.net

73 Which system does joy activate? BIS Cognitive Content (e.g., Pain = Danger, Anticipate punishment) Emotion and affect (e.g., Anxiety) Behavior (e.g., Withdraw, Stop, look, & Listen ) Cognitive processes (e.g., Rumination, Hypervigilance) (+) (-) (-) Pain Perception BAS Cognitive Content (e.g., Hurt Harm, Anticipate reward) Emotion and affect (e.g., Excitement) Behavior (e.g., Approach, Goal-Directed) Cognitive processes (e.g., Acceptance, Cognitive flexibility)

74 Which system does pain activate? Which system does joy inhibit? BIS Cognitive Content (e.g., Pain = Danger, Anticipate punishment) Emotion and affect (e.g., Anxiety) Behavior (e.g., Withdraw, Stop, look, & Listen ) Cognitive processes (e.g., Rumination, Hypervigilance) (+) (-) (-) Pain Perception BAS Cognitive Content (e.g., Hurt Harm, Anticipate reward) Emotion and affect (e.g., Excitement) Behavior (e.g., Approach, Goal-Directed) Cognitive processes (e.g., Acceptance, Cognitive flexibility)

75 A treatment that does this Images courtesy of FreeDigitalPhotos.net

76 Results in this BIS Cognitive Content (e.g., Pain = Danger, Anticipate punishment) Emotion and affect (e.g., Anxiety) Behavior (e.g., Withdraw, Stop, look, & Listen ) Cognitive processes (e.g., Rumination, Hypervigilance) (-) BAS Cognitive Content (e.g., Hurt Harm, Anticipate reward) Emotion and affect (e.g., Excitement) Behavior (e.g., Approach, Goal-Directed) (+) (-) Cognitive processes (e.g., Acceptance, Cognitive flexibility) Pain Perception

77 Remember BIS and BAS reponses are automatic you cannot easily stop them.

78 So Changing activity within the BIS-BAS systems will have automatic effects on pain

79 Hypnosis - Changes what is activated and inhibited within the automatic response (BIS-BAS) systems - Can make changes quickly - Can create responses that are automatic (seem effortless)

80 Hypnotic Cognitive Therapy Classic cognitive therapy Hypnotic Cognitive Therapy: Using hypnotic suggestions to nurture adaptive thoughts. HCT: Techniques and procedures (incorporating MI)

81 Cognitive Therapy Cognitive therapy (cognitive restructuring) Automatic thoughts Emotions (depression) Event: Dramatic increase in pain. Thought: I m never going to get better. Emotions: Feelings of sadness and anxiety.

82 Cognitive Therapy Thought: I can t stand this any more! Emotions: Feelings of hopelessness. Thought: That!%(*#@ guy who hit me! Emotions: Anger and frustration

83 Cognitive Therapy Thought: I can handle this. Emotions: Perhaps somewhat distressed, but less hopeless.

84 Cognitive Therapy With CT, you teach clients to: 1. Identify, 2. Stop, and 3. Replace negative thoughts. Pain may be higher now, but it will decrease. I can manage until then.

85 Cognitive Therapy Uses logic; the reflective mind

86 Hypnotic Cognitive Therapy Is different: 1. Identify, 2. Develop, 3. Automatize adaptive thoughts

87 Cognitive Therapy It s horrible, and will never get better I have no control over my life I m weak and stupid Maybe someday I might feel a little better

88 Cognitive Therapy

89 Cognitive Therapy

90 Cognitive Therapy

91 Cognitive Therapy

92 Cognitive Therapy

93 Cognitive Therapy

94 Cognitive Therapy

95 Cognitive Therapy

96 Hypnotic Cognitive Therapy

97 Impact of thought change Changing thoughts - Has been shown to reduce depression in individuals who are depressed (Jakobsen et al., 2011; Rupke et al., 2006) - Has been shown to reduce pain intensity in individuals with chronic pain (Ehde & Jensen, 2004; Jensen et al., 2011))

98 Adaptive Thoughts (often, BAS) Self-efficacy (I can ) Importance (I would like ) Affirmations (I am ) Optimism/Hope (It will ) Flexibility (Either way ) Intent (I will.)

99 Adaptive Thoughts/Suggestions Thoughts indicating that the client plans to

100 Adaptive Thoughts/Suggestions Thoughts indicating that the client plans to do something different that is adaptive,

101 Adaptive Thoughts/Suggestions Thoughts indicating that the client plans to do something different that is adaptive, that he or she will be able to make this change,

102 Adaptive Thoughts/Suggestions Thoughts indicating that the client plans to do something different that is adaptive, that he or she will be able to make this change, and that this will lead to positive consequences.

103 Adaptive Thoughts/Suggestions I am willing to give this a try. I think I can do this. If I get stronger, I will feel better. I think I can get my life back. I can feel better, I will feel better.

104 Using Open Qs and Reflections Open questions to elicit adaptive thoughts (aka, effective hypnotic suggestions) Reflective listening to provide/ repeat the suggestions

105 Open Questions Open questions are ones that cannot be answered with a yes or no Open questions do not elicit specific answers like name or date. Open questions get the client talking, hopefully about change Using open questions you can demonstrate empathy and acceptance, and elicit ATs (potential suggestions)

106 Converting Closed to Open Questions Did you exercise much last week? Do you do get to the gym three days a week? Are you feeling better? Are you willing to improve your diet? Did you call the trainer I recommended?

107 Reflective Listening Reflective listening involves being interested in what the person has to say and respect for the person s inner wisdom. Key element is hypothesis testing. A reflective statement tests a hypothesis: Is this what you mean?

108 Reflective Listening Importantly - Reflections can be used to nurture connections that already exist. - Can use reflections as to plant seeds for new connections. - Reflections can be viewed as suggestions; self-, non-hypnotic, and a source for formal hypnotic suggestions.

109 What types of ideas should be nurtured (via reflection)? BIS Cognitive Content (e.g., Pain = Danger, Anticipate punishment) Emotion and affect (e.g., Anxiety) Behavior (e.g., Withdraw, Stop, look, & Listen ) Cognitive processes (e.g., Rumination, Hypervigilance) (+) (-) (-) Pain Perception BAS Cognitive Content (e.g., Hurt Harm, Anticipate reward) Emotion and affect (e.g., Excitement) Behavior (e.g., Approach, Goal-Directed) Cognitive processes (e.g., Acceptance, Cognitive flexibility)

110 Forming Simple Reflections An effective reflective listening response is a statement, not a question. With questions inflection goes up at the end. With statements, inflection stays down at the end. Example: - You re angry about what I said? - You re angry about what I said. What is the effect of questions versus statements?

111 Tips on reflective listening Guess at what they mean Make a statement not a question So, you think Your are wondering if It sounds like Repeat an element Paraphrase with synonyms Reflect the content or reflect a feeling

112 Reflections-Batting Practice I will throw out some statements Simply reflect the content of the statement Don t worry about not being perfect, just get some wood on the ball.

113 Practicing Reflections 1. Client not following exercise program: Those exercises are not improving my pain. 2. Client with sleeping problems offerred information on sleep hygiene: Can t you just give me a pill? 3. Obese person on a diet: I ordered grilled chicken rather than fettuccini Alfredo last night for dinner. 4. Person with chronic pain referred for pain management: The pain is not in my head.

114 Forming reflections Types of reflective listening: 1. Repeating (repeat an element). 2. Rephrasing (repeat with synonyms). 3. Paraphrase (repeat best guess at meaning; like saying the next sentence instead of repeating the last one). 4. Reflection of feeling (paraphrase that emphasizes the emotional dimension). à Reflections are truisms as far as the client is concerned. They build rapport and a yes set, and yield useful suggestion content.

115 Reflective listening: Tips Reflective listening (positive suggestion) stems: So, you think Your are wondering if It sounds like It must feel Non-reflections: Advice Questioning Warning

116 Hypnotic Cognitive Therapy Demonstration(s) (look for and note ideas for hypnotic suggestions/ adaptive thoughts)

117 Age progression (from Moshe Torem) - Open questions and reflection (to elicit network and identify suggestions and goals) - Induction (often favorite place). - See and then experience future self. - Bring back the new experience and connections to the present - Post-hypnotic suggestions (to strengthen new connections)

118 Summary - Two systems (BIS and BAS) - Hypnosis influences whether and how much each system is activated - Can use hypnosis to nurture BIS and BAS emotional, cognitive, & behavioral responses - Can use open questions to identify existing connections and suggestions to nurture - Can use age progression to strengthen responses consistent with patient goals

119 Thank you! Images courtesy of stockimages at FreeDigitalPhotos.net