Various hypnotic induction techniques can be utilized to induce relaxation. I use the relaxation with counting method (see Gibbons, 1979) for inducing and deepening the hypnotic trance. I have chosen this technique because it is easily adapted for self-hypnosis training. One of the important goals of using hypnosis is to induce relaxation. Most depressed patients experience high levels of anxiety either due to comorbid anxiety (Dozois & Westra, 2004) or due to their negative view of the future and their low level of confidence in their abilities to handle life challenges. For these reasons, depressed patients benefit greatly from learning relaxation techniques. As discussed in Chapter 5, the majority of patients treated with CH in our studies (Alladin & Alibhai, 2007; Alladin, 2006, 2006a) indicated that the relaxation experience was empowering. It boosted their confidence to interrupt anxious sequences in their lives. Some of these patients went on to say that for the first time in their life, they were able to relax completely and replace their depressive feeling with good feeling. This is not surprising to hypnotherapists, who routinely observe such changes in their patients. For example, Yapko (2003) states: “I have worked with many people who actually cried tears of joy or relief in a session for having had an opportunity to experience themselves as relaxed, comfortable, and positive when their usual experience of themselves was one of pain and despair” (p. 106). The hypnotherapeutic script in Appendix 9A provides some
examples of the types of hypnotic suggestions that can be utilized to induce a feeling of deep relaxation.

Hypnosis is a powerful therapeutic tool for producing a variety of cognitive, somatic, perceptual, physiological, visceral, and kinesthetic changes under controlled conditions (Alladin, 2006). This process was described as syncretic cognition in Chapter 4. The hypnotic production and modulation of these changes provide depressed patients with dramatic proof that they can change their feeling and experience, thus providing hope that they can alter their depressive affect. In turn, this guides them to reconstruct their negative belief systems, creates a greater sense of self-efficacy and empowerment, redefines their long-held belief that depression is a permanent state, and establishes new confidence in their therapy. DePiano and Salzberg (1981) believe such positive experience in patients is partly related to the rapid and profound behavioral, emotional, cognitive, and physiological changes brought on by the induction of the hypnotic experience.

Eye and body catalepsies, associated with the challenge to open eyes and get up from the chair or couch, are induced to demonstrate the power of the mind over the body. These demonstrations reduce scepticism over hypnosis, instill confidence in depressed patients that they can produce significant emotional and behavioral changes, and foster positive expectancy. In one report, I (Alladin, 2006) describes the case of Bob, a 55-year-old electronics engineer with recurrent major depressive disorder who was successfully treated with CH. Bob was very skeptical of the psychological treatment of depression because he believed his illness was caused by a chemical imbalance. The demonstration of the power of mind over body via eye and body catalepsies, provoked by challenging him to open his eyes and get out of the reclining chair, reduced his scepticism about hypnosis. He became a model patient, and his therapy sessions turned into “fascinating sessions” (Alladin, 2006, p. 180).

Hypnosis provides a powerful vehicle for expanding awareness and amplifying experience. Brown and Fromm (in Hammond, 1990, pp. 322-324) describe a technique called enhancing affective experience and its expression, which can be utilized to expand and intensify positive feelings by (a) bringing underlying emotions into awareness, (b) creating awareness of various feelings, (c) intensifying positive affect, (d) enhancing “discovered” affect, (e) inducing positive moods, and (f) increasing motivation. Such a procedure not only disrupts the depressive cycle but also helps to develop antidepressive pathways. The procedure involves bringing underlying emotions into consciousness, amplifying the experience, and then expressing or communicating the experience. The object of this procedure is to help depressed patients create, amplify, and express a variety of negative and positive feelings and experiences. This technique attempts to further reinforce the view that the depressive affect is not invariant.

To bring an underlying emotion into awareness, the hypnotized patient is told, “When I count from one to five… by the time you hear me say FIVE… you will begin to feel whatever emotion is associated with your [symptom or problem].” Then the patient is helped to amplify the affect by stating, “When I count slowly from one to five… as I count, you will begin to feel [symptom or problem] more and more intensely, so that when I reach the count of FIVE, you will feel it in your body as strongly as you can bear it… dots. Now notice what you feel, and you will be able to describe it to me.” The procedure can be expanded by including past and future projection.

Ego-strengthening suggestions are offered to depressed patients to increase self-esteem and optimize the effects of hypnotherapy. The enhancement of feelings of self-esteem and self-efficacy can provide a powerful tool in working with depressed patients. Bandura (1977) has provided experimental evidence that self-efficacy, the expectation and confidence of being able to cope successfully with various situations, is one of the key elements in the effective treatment of phobic disorders. Individuals with a sense of high self-efficacy tend to perceive themselves as being in control. If depressed patients can be helped to view themselves as self-efficacious, they will perceive the future as being hopeful. The most popular method for increasing self-efficacy within the hypnotherapeutic context is to provide ego-strengthening suggestions. The concept of “ego-strengthening” was coined and popularized by Hartland (1971)

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