Hypnosis in treating depression: Applying multidimensional perspectives

The extraordinary events of recent years have given the topic of depression a greater urgency than ever before. The disasters that have occurred in the US and around the world, both natural and human made, have been the cause of suffering in ways and numbers that are staggering. The sharp spike in the number of people suffering depression during these most trying of times makes it especially clear how much world conditions affect our individual and collective outlook.

In 2017 the World Health Organization (WHO) declared depression to be the number one cause of human suffering and disability on earth, a mental health problem still on the rise in every age group (World Health Organization [WHO], 2017). Then, seemingly overnight, the COVID-19 pandemic made the world a terribly unfortunate “living laboratory,” providing us a new window through which to see depression much more clearly. WHO claimed that the rate of depression more than doubled during the pandemic; some studies suggested the rate nearly tripled during this time (Cenat et al., 2022; Daly & Robinson, 2022; Ettman et al., 2022). Recently, the Centers for Disease Control released an especially troubling report describing the dramatic rise of depression and suicidal ideation in our young people, especially teen girls (Centers for Disease Control [CDC], 2022).

What do these findings say about the vulnerabilities of people to depression when their circumstances change so suddenly and dramatically? They highlight the risk factors for depression that receive too little attention in the literature. Instead of depression seeming to just strike “out of the blue,” in fact there are numerous risk factors we can identify that can predispose us to depression. Some of these are internal to an individual, such as one’s cognitive style, coping style, degree of social skills, decision-making and problem-solving skills. Other risks arise from external factors, such as social isolation and loneliness, overreliance on and reactivity to social media, disruptions to work and school schedules, toxic social conditions, financial hardships, bullying, grief, and loss.

The pandemic may be winding down at this time and get reclassified as an endemic, but the lessons learned from it related to depression should stay with us, especially the key lesson: this debilitating disorder is generally much more about your circumstances – and how you manage them – than your biology alone.

Surveys of the public reveal the medicalization of depression has led to the widespread belief that depression is a consequence of a “biochemical imbalance” in the brain, namely too low a concentration of the neurotransmitter serotonin (Harrington, 2020; Moncrieff, 2007). This provides a seemingly plausible biological rationale for the common routine of prescribing SSRIs (and other antidepressant drugs aimed at other presumed neurochemical culprits) whenever depression is detected and, too often, even when it isn’t.

The framing of depression as a “brain disease” has dominated the treatment literature, giving rise to the use of antidepressant medications as the most common form of treatment. However, the rumblings among many depression experts, including me, have grown louder and more forceful in not only questioning but directly contradicting the ubiquitous one-dimensional view of depression as a “medical illness.”

One of the most explosive events of 2022 in the depression literature was the widely disseminated publication of an “umbrella study” that comprehensively researched the relationship between serotonin and depression in a variety of ways (Moncrieff et al., 2022). Psychiatrist and lead researcher Joanna Moncrieff and her colleagues found no evidence to support the presumed relationship between depression and serotonin, a finding generating a great deal of controversy, as you might imagine. Psychologist and placebo researcher Irving Kirsch had previously analyzed data that led to the approval of the newer generation of antidepressants and found them to be only minimally more effective than placebos (Kirsch, 2010). More recently, in a study sponsored by the Food and Drug Administration questioning Kirsch’s conclusions, the researchers collectively reaffirmed Kirsch’s original findings stating that antidepressants have only about a 15% extra benefit beyond placebos in clinical trials (Stone et al., 2022). Given their side-effects and the difficulties in stopping their use, it is a legitimate question as to how we should view the merits of antidepressants. Additional blows to the medical model and the presumed merits of antidepressant medications came from other studies that indicated when people are given medical/biological interpretations of their depression, they subsequently do significantly less well in psychotherapy (Lebowitz et al., 2021; Loughman & Haslam, 2018; Schroder et al., 2020). This finding shouldn’t be much of a surprise since it’s not unreasonable for people to think that if their problem is entirely biological, then merely talking about it isn’t likely to help very much.

Now, as I write this, another explosion has taken place, namely the already widespread and still growing interest in the use of psychedelics such as the “magic mushroom” psilocybin, MDMA (commonly referred to as “ecstasy”), LSD, and ketamine in treating depression (Peters et al., 2022). Given the hallucinogenic and dissociative qualities of all the psychedelics, the potential concerns about their use seem readily apparent. Conservatively, one could reasonably ask whether the enthusiasm for the psychedelics is outpacing the science, especially when made readily available for at-home, unsupervised treatment from online “clinics” (Gilbert, 2022; Horowitz & Moncrieff, 2021).

When social forces are so clearly a major factor in the onset and course of depression, it is equally clear that no biological perspective or medical treatment alone can be a total solution. It does not mean that biology plays no role in the onset and course of depression, but its role has been overstated in the great majority of cases. It may sound extreme to some, but I stand by this statement: There will not be a total biological solution to the problem of depression any more than there will be biological solutions to other social problems such as loneliness, racism, or poverty.

Acknowledging the challenges we face, the cynics among us have even proclaimed, “If you’re NOT depressed, it’s because you’re not paying attention.” That is an exaggerated and unhelpful statement, of course, but it highlights two major themes that run through this special issue of the journal: 1) Depression is likely to be more a product of our circumstances than our biology, and 2) psychotherapy utilizing hypnosis can help people cope with and ultimately better manage their moods with new skills and perspectives. The thoughtful and practical articles in this special double issue written by distinguished contributors all support these points and reinforce the salient message: We need to expand the use of hypnosis in treating depression. At the risk of sounding cliché, the world desperately needs skilled hypnosis professionals now more than ever.

There are many reasons why this special double issue of the journal is especially important. The evidence is unambiguous, both from clinical studies of therapeutic effectiveness as well as studies of depression prevention strategies, that effective therapy involves teaching skills and providing meaningful perspectives to people who suffer when the challenges they face in their lives overwhelm them. The psychotherapies that have the highest treatment success rates each emphasize the importance of depressed individuals evolving specific self-regulation skills, whether the skills of thinking rationally as in cognitive-behavioral therapy (CBT), the social skills taught in interpersonal therapy (IPT), or the effective behavioral skills of behavioral activation (BA) approaches.

As I think most hypnosis experts would readily agree, hypnosis isn’t the therapy. Rather, it’s a vehicle for delivering therapy, whatever forms that therapy might take. Hypnosis offers many specific advantages as a treatment tool that can be especially helpful in addressing depression. Hypnosis helps people focus, learn new skills experientially, redefine themselves as more resourceful than previously thought, more flexibly adapt perspectives in more helpful directions, define themselves as active managers of their subjective experience, and evolve a greater automaticity for more effective responses to life’s challenges.

Since depression affects individuals in different ways and in differing degrees of severity, hypnosis can be effectively aimed at any or all relevant targets: 1) physiology (e.g., encouraging physical activity and better nutrition, sleep, and physical self-care); 2) cognition (e.g., generating positive “automatic thoughts,” revised cognitive schema, and making better discriminations and decisions); 3) affect (inducing specific affective experiences such as self-compassion or feelings of gratitude); and, 4) behavior (e.g., increasing engagement in pleasant activities and taking proactive steps in the direction of desired and realistic goals). Hypnosis by its very nature is an active treatment, done with a collaborative client, not done to a passive patient, helping to empower them in the process.

The articles contained herein reflect this type of multi-dimensional consideration of depression and its active treatment with hypnosis. The range of topics receiving consideration is broad, highlighting the point that there are many different pathways into depression and, fortunately, there are also many different pathways that can lead one out of depression. Each of the authors speak directly to the pivotal role hypnosis can play in addressing the many facets of depression and each has a perceptive and important focal point to be considered in a treatment plan involving hypnosis. Each contributor also provides illuminating examples of what a meaningful and potentially helpful hypnosis session might offer.

The first article in this issue is authored by Douglas Flemons who insightfully promotes a broader and deeper perspective of depression as more than just an individual’s problem. Flemons provides strong encouragement for seeing the interpersonal and contextual factors that make simply “getting rid of it” an unrealistic goal. Shawn Criswell’s illuminating and practical article is next, focusing on the well-known relationship between perfectionism and depression. Perfectionism creates a toxic internal environment that is highly correlated with depression and Criswell gives sharply focused attention to this topic that receives too little attention in the hypnosis literature. Her insights into ways to reduce perfectionism’s impact are invaluable. The next article is my own and speaks to the relationship between a global, over-general cognitive style and depression. It highlights the importance of using hypnosis as a vehicle of teaching depressed clients more specific ways of addressing problems since specific problems are unlikely to be resolved with nonspecific solutions. The article by George Burns is next. Burns is a master storyteller, and his article acknowledges the role of metaphor in the treatment process. As he describes, good stories can inspire hope, encourage flexibility, and change self-limiting perspectives. Next is the excellent article by Stephen Lankton, the journal’s editor. It focuses on the relationship between a limiting self-image and depression. Lankton provides an insightful and structured approach to enhancing self-efficacy and reducing depression called Self-Image Thinking (SIT), and then clearly illustrates its merits in treatment. The final article in this first of the two special issues on hypnosis and depression theme is contributed by Lynn Lyons. Lyons’ expertise in treating children and adolescents shines through in her superb article brimming with insights about factors contributing to depression in young people. She offers practical advice we can all incorporate into our work with children and adolescents.

Until now, the hypnosis community has been all too quiet about the merits of using hypnosis to empower some of the most disempowered people there are, namely depressed individuals who generally feel both hopeless and helpless. This may be because in years past hypnosis was viewed as contraindicated in treating depression. The belief of respected experts suggested that depression would impair the person’s ability to focus and therefore would respond poorly to hypnosis. Other experts promoted the unfounded fear hypnosis would strip depressed individuals’ defenses and make them more vulnerable to suicide or psychosis (Yapko, 1992, 2006, 2010). Fortunately, as the field advanced, new research and new understandings of both hypnosis and depression have rendered these older perspectives obsolete. I hope that these new additions to the too sparse hypnosis literature will provide both inspiration as well as practical value to readers.

I want to thank the journal’s Editor-in-Chief, Stephen Lankton, for inviting me to serve as Guest Editor for this special issue as well as the one forthcoming. Steve has served this journal exceptionally well over the years and he has an excellent grasp of what to bring into our collective awareness as practitioners of clinical hypnosis. I deeply appreciate this opportunity. I also want to thank each of the authors who generously agreed to contribute their knowledge and wisdom to this effort. It’s a significant investment of their time and energy to make their contributions, and I am deeply grateful to each of you.

Disclosure statement

No potential conflict of interest was reported by the author(s).