Evaluate the role that behaviour therapy theories have to play in clinical hypnosis

The quest to understand human behaviour, emotion and thinking has led to the emergence of behavioural psychology as a discipline. Interest in behaviour stemmed up during the early part of the twentieth century where it was believed that new behaviour was learned by observation and from the environment (Gross, 2005; Sardar et al, 2002). These behavioural theories have since been implemented by psychotherapists and researchers and have formed the foundation for new methods in clinical hypnosis. The main objective of this article is to critically evaluate the relevance and impact of different behavioural theories such as classical and operant conditioning, extinction, desensitisation, reciprocal inhibition, learning theory on hypnotherapeutic methods such as hypnodesensitisation, flooding, mass practice, aversion therapy and assertiveness training and to discuss the strengths and weaknesses of the different hypnotherapy methods.
The selection of different hypnotherapy methods depends on the requirement and the choice is usually made by the therapist who customises the approach for each unique situation (Kaplan & Sadock, 1997; Rogers, 2004). Systematic hypnodesensitisation is a method which is extensively used by hypnotherapists to treat phobias (Jemmer, 2005). The method is based on classical conditioning theory proposed initially by Ivan Pavlov and then subsequently modified by Wolpe and also operant conditioning. The difference between systematic desensitisation and classical conditioning lies in the fact that the stimulus is gradually increased in intensity until it reaches a maximum where it is maintained until the phobia is gone and the process requires that the patient practices relaxation techniques. This method is considered less directive, superior and more ethical compared to other hypnotherapy methods like flooding and implosion therapy because it allows the patient to control the progression from one step to another only after reaching adequate relaxation at a particular level. There is, however, much debate among practitioners who suggest that relaxation is less important than the hierarchy of increase in the stimulus which is the biggest contributing factor for the favourable response. The downside of this method is that patients experience extreme discomfort and trauma during the treatment process (McGlynn et al, 2004). This problem is addressed by therapists by suggesting to their patients to imagine the stimulus which reduces the discomfort to some extent. The systematic desensitization method combined with hypnosis is called hypnodesensitisation which is very safe and helps the patient to achieve their goals faster. However, this method is time consuming, does not have a hundred percent success rate in all cases because of residual disability left in patients, involves relapses and requires that the patient does not terminate facing his/her anxiety.
Another method that is used to treat phobias and obsessive compulsive is flooding (Johnstone et al, 1998). This method and its variant called Implosion therapy are totally different compared to systematic desensitisation because it involves exposing the patient continuously to the anxiety stimulus until the phobia is gone. It is also based on the classical conditioning theories. The process is administered such that there is no escape route for the patient, which can lead to extreme trauma in some cases and permanent impairment. The benefit of this method is that it prevents the patient from disregarding or terminating the stimulus because they have no control over it. This method has the advantage of being rapid compared to systematic desensitization procedures and does not involve complex multiple hierarchical steps. The patients realise and become comfortable with their anxiety stimulus within a very short period of time. Studies have shown that this method is better than systematic desensitization as far as consistency and temporal pattern of recovery is concerned. This technique is faster and economical but has the disadvantage of being not ethically sound because it causes intense suffering and may also result in withdrawal from therapy, which can have an adverse effect by worsening the phobia (Kroger, 1997). This issue is addressed similar to systematic desensitization by performing the steps invitro and making the patient imagine instead of physically recreating the fear. Another disadvantage of this method is that there is no relaxation involved which puts patients in a constant fear and anxiety until they overcome it. The major weakness of these methods is that if the treatment is prematurely terminated, it can worsen the phobia and adversely affect the outcome in addition to the extreme emotional cost involved.
Hypnotherapists utilize a procedure called massed or negative practice to treat addiction which is also based on classical conditioning theories like other methods (Halgin & Whitbourne, 2003). This method is useful because it helps to break a bad habit by consciously repeating it a number of times to the point of exhaustion. This method is advantageous over flooding and implosion therapy because it affords more control to the patient. The downside is that this method can only be used to cure habits that do not cause injury to self or others in the process of repetition. This issue can be rectified by performing the procedure in vitro. This also has the disadvantage that prolonged repetition of the adverse habit may lead to physically performing the act unconsciously in public and could lead to potential and lethal problems if it is a dangerous habit (Redd, 2004). This could lead to worsening of habit rather than curing it. The benefit of this method is that it can be associated with an ideo-motor response such as moving a finger in response to breaking down of the habit thus improving the outcome (Chaves, 2006). This may sometime have a negative effect because the therapist can themselves get hypnotized as a result of observing the finger. Another complication associated with this method is that prolonged repetition of the habit may lead to worsening of symptom in a patient with obsessive compulsive disorder.
Depending on the extent of addiction, hypnotherapists may choose to administer aversion therapy instead of massed practice (Goodwin, 1999). The therapy uses operant conditioning methods and is useful because the undesired habit or stimulus can be paired with a noxious or bad stimulus, usually a drug that causes nausea or discomfort on a continuous basis. This leads to aversion and results in the patient losing the urge to perform the undesired act. This is a very powerful method compared to massed practice. Studies have shown that aversion therapy is equally controversial and has been the cause of relapse in several cases (Marshall & Laws, 2003; Marshall et al, 1991). The process of extinction, discovered by Pavlov, also comes in play here because even after treatment, it depends on the will power of the patient to abstain from the habit causing addiction. This abstinence is usually lost over time after a second exposure after treatment. The other weakness includes emotional trauma to the patient because of the noxious stimulus. This method also offers the advantage of ideo-motor response pairing like massed practice but shares similar disadvantage as mentioned above.
Assertiveness training is a relatively new procedure used by hypnotherapists, which uses the counter conditioning behavioural theory (Clarke & Jackson, 1983). This method is helpful to the patients because it allows them to display contrasting assertive emotions in the face of an unwanted stimulus. This reduces the impact of the original unwanted stimulus thereby curing the patient. Many hypnotherapists follow this method because it has a number of advantages (Benson, 1999). The strengths of this procedure are that it helps the patient to handle their fear in the mature and adult way; makes them more confident, responsive and expressive; and promotes self esteem through positive suggestions. There are very few weaknesses for this method; the only major problem is that this method is ineffective in situations where the patient has problems with communication. A modification of this method called the cognitive behavioural therapy has been shown to have the best effect in treating a majority of psychological problems.
In most classical behavioural approaches, the patient is exposed physically to their phobia or addiction, which may cause more harm than benefit. In contrast to this, the hypnobehavioural approach lets the patient imagine the fear in vitro in a comfortable and safe therapeutic setting (Ashton, 1997; Flammer & Bongartz, 2003). Hypnobehavioural approach is safe for all types of phobias and is very cost effective. Many of the hypnobehavioural methods are effective especially hypnodesensitization. During this process, the patients, in their effort to maintain the score corresponding to their anxiety, realise that the fear is absurd and there is no rationale for it. This aids in treatment rather than exposing them to the actual fear. Hypnotherapy is also very useful in breaking up bad, unwanted and dangerous habits without injuring the patients. In the overall sense hypnobehavioural therapy is far superior compared to classical behavioural methods because the level of stimulus can be changed more easily by the therapist who can control the imagination and emotions of the subject. This advantage along with cost effectiveness, relaxation techniques, and safety makes hypnobehavioural approach a far better choice compared to classical behavioural methods.