Depression is one of the most common problems in UK today.  The longer you feel depressed the more difficult it can be to change. CBT and cognitive hypnotherapy offer effective strategies to improve your quality of life.

Depression is characterized by:

• feelings of sadness,
• lack of interest in formerly enjoyable pursuits,
• sleep and appetite disturbance, feelings of worthlessness
• and, sometimes, thoughts of death and dying.

All forms of depression can be extremely disabling, affecting your view of yourself, your relationships and your quality of life.

Medication vs psychotherapy

Although anti-depressant medication is very effective in many cases, recent studies have suggested that it is less useful than was originally believed. And inevitably for some there are risks of side-effects especially when taken over an extended period. The government advisory body, NICE (National Institute for Clinical Excellence), now recommends psychotherapy and particularly CBT as the best treatment for depression, alone or combined with anti-depressant medication.

Of course relying on drug therapy alone has never made sense. A low level of serotonin in your brain could possibly be a factor in feeling listless or weepy, but it can’t produce thoughts such as “I’m so unattractive”, “No one really cares about me”, “I never do anything right” or “It’s all my fault.” When we are depressed these are the sorts of things we tell ourselves repeatedly, leading to a never-ending cycle of hopelessness and self-recrimination. Taking Prozac doesn’t do anything to change habitual negative thoughts - it simply pumps up your serotonin levels and hopes that you will magically decide to be different. Some people have suggested you can get the same endomorphin lift from a bar of chocolate – but we all know that a Cadbury’s Flake every hour isn’t the answer! Just as the only way to lose weight is to change your eating habits (regrettably!) so the only real cure for many depressive symptoms is to change your thinking habits. And like dieting it can be difficult and hard work.

Even when anti-depressant medication works well, it obviously does not alter the problems that might have caused the depression in the first place. A failing marriage, unhappy work situation or family conflict cannot be fixed by pills. Therefore, many depressed people benefit from psychotherapy designed to help them cope with the difficult life circumstances or personality vulnerabilities that put them at risk for depression.

CBT

Cognitive behaviour therapy (CBT), which is the currently recommended treatment for depression, has been studied in over 80 controlled trials. It has been demonstrated to reduce symptoms of depression and also reduce the chance of relapse. It’s underlying assumption is that if you can recognise and reassess your negative beliefs and the way you make judgements about the world, then it is possible to see experiences in less negative terms and cope more effectively with life's challenges.

The CBT approach combines education with therapy, helping you notice your habitual ways of responding and then find alternatives. The aim is to provide you with confidence and problem-solving skills that you can take away and use independently. Therapy is a collaborative process based on exploration, examination and experimentation.

Research shows that the best results are achieved in between 16-20 one hour sessions. Until recently, counselling in primary care has often been limited to 6 sessions. If you have felt depressed for some time, six sessions will initially make you feel better but usually there has not been sufficient time to really change what may be the habits of a lifetime. With the new IAPT programme the number of sessions may increase, but in order to get access to a fully trained cognitive therapist you are likely to first be asked to try "bibliotherapy" (reading self-help books!), a new online computer-based CBT self-help programme, or a low-intensity support group.

A proportion of people who have tried CBT for depression find that it does not work effectively for them. No therapy is a magical solution and CBT certainly expects that you practice the techniques and do the homework for changes to take place. The emphasis on being more aware of thoughts can sometimes make people feel as though emotions are being neglected. And where the central problem is "negative rumination" - depressive thoughts going round and round in your mind without you being able to get rid of them - different approaches such as attention switching and mindfulness training tend to be more helpful. Quite a number of people who have found CBT only partially successful tend to turn to hypno-psychotherapy, which uses additional techniques to reach the thoughts or memories which give rise to depression.

Hypno-psychotherapy and cognitive hypnotherapy for depression

Until recently, hypnosis was not widely used to treat clinical depression. However with the surge of interest in CBT there is growing evidence that hypnosis combines successfully with cognitive techniques and often tends to make them more effective.

Cognitive hypnotherapy uses the natural trance states of clients to unlock unconscious thoughts and memory patterns that generate and sustain problems. The Canadian psychologist Assen Alladin has developed a new approach called the Circular Feedback Model of Depression which moves from CBT to hypnosis over the course of 10-16 sessions, with considerable success.

Hypnosis centres on the skill of focused attention, which in itself is helpful in training the mind to move away from negative thoughts towards a calmer and more objective view of situations. In this it is akin to Mindfulness techniques which have been demonstrated to prevent relapse into depression. From its earliest days (over 200 years ago!) hypnotherapy has used guided imagery, which has proved to be very effective in lifting the mood of depressed patients - but should only be used in the safety of an interaction with a therapist.

Negative rumination can be effectively tackled using attention switching training whilst in trance, or with guided imagery. Submerged memories and core beliefs which may be at the root of depressive feelings can also be accessed and explored, often more rapidly than with conventional therapy. However it should be stressed that before delving into painful emotions it is essential that you find a fully trained, qualified and experienced hypno-psychotherapist as emotions can be accessed more rapidly and powerfully in hypnosis so you need to know that you are in capable hands.

If you are considering hypno-psychotherapy for depression the first step is always to consult your GP.

Links:

5 self-help strategies for depression

Cognitive hypnotherapy for depression - evidence and research