The circular feedback model of depression (CFMD) takes a multidimensional view of depression. The 12 factors forming the depressive loop are all interrelated, forming a constellation of emotional, cognitive, behavioral, physiological, and nonconscious processes. Focusing on any of the factors allows the patient and the therapist a point of entry into the depressive loop. Which point of entry is selected is determined by the case formulation. Once the patient and the therapist gain access into this set of relationships, they can deploy various techniques as tools to unravel and reorganize this interrelated set. Part III of the book describes various empirical and principle-based intervention strategies. Any of the factors identified by the case formulation can be used as a target for intervention, which can influence simultaneously other processes because of their interrelated nature (Simons, Garfield, & Murphy, 1984). Because depression is a complex disorder involving multiple risk factors and is often comorbid with other conditions, it is unlikely that a single causative factor, either biological or psychological, will be found. Similarly any single intervention is unlikely to provide long-term benefits, although focusing on any of the set of factors may be sufficient to bring on symptomatic relief. The therapist is encouraged to use multiple interventions. Williams (1992), in his comprehensive review of the psychotherapies for depression, concluded that the more techniques that are used, the more effective is the treatment, especially in the prevention of future relapses (Kovacs, et al., 1981). Many studies have demonstrated the superiority of combined treatments (Blackburn, et al., 1981; Taylor & Marshall, 1977; Weissman, et al., 1979, 1981) over single modality therapies. The poorest outcomes tend to result from the strategy that uses the smallest number of techniques. This suggests that the more techniques over which a therapist is allowed to range, the more likely it is that a combination will be found that is maximally suitable for the particular characteristics of her patients.

Cognitive hypnotherapy (CH) provides this multifactorial treatment approach to depression, and allows the therapist to easily combine the most appropriate strategies to suit a particular patient. Although this treatment approach primarily combines cognitive therapy with hypnotherapeutic techniques, it also makes use of behavioral, affective, psychodynamic, and imagery techniques. The therapist should refrain, however, from utilizing random techniques in a shotgun fashion. Instead, the techniques chosen should match the patient’s needs, as determined by the case formulation, and use evidence-based interventions to strengthen
the empirical foundation of CH as a treatment for depression. The clinician can become more effective at reducing a patient’s distress when treatment selection is based on a thorough understanding of the patient’s reality, rather than an imposition of the therapist’s reality (theoretical orientation) on the patient. Because research indicates that depressive pathways can be developed, then, conversely, it should be possible to stimulate and develop antidepressive pathways. Later in this chapter, several hypnotic and imagery techniques are described for developing such pathways.

CH normally consists of 16 weekly sessions (see Alladin, 2006), which can be expanded or modified according to patient’s clinical needs, areas of concern, and presenting symptoms. The stages of CH are listed in Table 5.1, and they are described in detail in Chapters 7, Chapters 8, Chapters 9, Chapters 10, Chapters 11, Chapters 12, Chapters 13

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