The article “Hypnosis in Treating Symptoms of Major Depression” by Michael Yapko was recently republished in the Australian Journal of Clinical Hypnotherapy & Hypnosis after having appeared in the American Journal of Clinical Hypnosis. The article outlines some of the current treatments available for depression and evaluates the use of Hypnosis both in conjunction with other treatments and Hypnotherapy on its own.
Depression (i.e. Major Depressive Disorder) is one of most common disorders existing in the Western World today and the rate of increase is on the rise in every age group. Currently there are more than 20,000,000 Americans known to be suffering this disorder. A similar proportion of the Australian population falls into the same category.
Many factors contribute to Major depression and there is no single cause. The contributing factors are biological, psychological and social. Therefore a new term has been coined, the “biopsychosocial model”.
Depression can be a risk factor for other serious illnesses and these, as well as are other psychological conditions are often found to co-exist with depression. For example cancer, heart disease, anxiety disorders and substance abuse disorders. Therefore sharp differential diagnosis and a multifaceted treatment approach are required.
Depression can be successfully managed with medication and psychotherapy together or individually. Some psychotherapies have been shown to outperform others in the management of depression. Medication on the other hand has the advantage of providing a generally faster rate of symptom remission and greater effectiveness in treating the vegetative symptoms such as sleep and appetite disturbances.
The disadvantages of medication lie in the area of dosage, effectiveness and potentially negative side effects. The drug may also lead to habituation. “Poop-out” is another risk. This term is used when the medication eventually stops working. Higher initial rates of relapse can also occur when medication alone is used.
Practitioners prescribing the drug often rely on information provided by the pharmaceutical companies and it is difficult to determine the effectiveness of each of the medications. Reliable comparative studies are difficult to find and each company will usually state their product is the most effective.
The advantages and disadvantages of psychotherapy treatment, in turn, need to be evaluated. Cognitive, behavioural and interpersonal approaches have the greatest empirical support. The advantages include therapy’s focus on skill-building and the associated reduced relapsed rate, the value of the therapeutic relationship, the greater degree of personal empowerment, and the potential to not just perform a “mop-up” of the pre-existing problems but to instead teach the skills of prevention. The disadvantages of psychotherapy are that there is greater reliance on the competency of the clinician, a longer time lag between the beginning of treatment and remission of symptoms compared to medication and lesser effect in reducing the vegetative symptoms.
Although genes play an important role in specific disorders, they operate in association with environmental variables that may increase or decrease their likelihood of expression. In the case of unipolar major depression both the genetic contribution environmental factors are significant. In contrast, the genetic component in bipolar disorder has been shown to be a strong one. With bipolar disorder there is a two-way relationship between neurochemistry and experience. This means that environmental triggers influence neurochemistry at least as much as neurochemistry influences experience. There is some evidence to suggest that psychotherapy may be a means for affecting neurotransmitters in the brain, perhaps in a similar way to medication.
The three psychotherapies that have most empirical support are the cognitive, behavioural and interpersonal psychotherapy. The guidelines for those therapies stress a symptom-based approach rather than an approach based on the therapist’s preference. It is also emphasised that a historically based approach is unnecessary. Focus should be given to developing solutions to problems and applying coping skills to managing symptoms.
Hypnosis is especially amenable to each of these psychotherapeutic applications because it is an active and directive means of intervention. Furthermore treatment with hypnosis follows the same guidelines as with psychotherapy.
There is a growing body of evidence showing that hypnosis can contribute directly and indirectly in the treatment of depression. This is especially so with the use of hypnosis as a tool for empowerment. Various reports attest to the reduction of depression when treating pain, anxiety and other physical and psychological symptoms.
It has been hard to find research on the use of hypnosis specifically for the treatment of depression. There are two main reasons for this. Firstly practitioners of hypnosis are generally not researchers, the second concerns the very nature of depression itself. The Diagnostic and Statistical Manual of Mental Disorder 4th Edition (DSMIV) lists several symptoms, which include: as depressed mood, loss of appetite, loss of interest in pleasure, insomnia, fatigue, agitation or retardation. Sometimes clients seek Hypnotherapy for some of those symptoms. When those symptoms are treated, depression can lift, even though the client didn’t particularly seek therapy for depression. In other words, the client may have been depressed without being aware of it but sought treatment for particular symptoms that resulted in lifting the depression. We can rely on the strong clinical evidence that indicates when hypnosis is integrated with other therapies it can be helpful in resolving many of the patterns and risk factors of depression.
Doctor Yapko also point out that treatments involving Hypnosis, where depression was an associated factor, did result in improvement of depression. The improvements, like the ones mentioned in the previous paragraph did not feature in any statistics for cure of depression because the depression itself wasn’t particularly being addressed. Overall it therefore seems that therapies involving Hypnosis can help in the treatment of depression.
Alfred Bellanti is a published author, Clinical Hypnotist and webmaster for www.mindbody.biz. He runs a successul practice in Waverley, NSW, Australia.