Cognitive Hypnotherapy

Hypnosis added to cognitive behavioral therapy

The idea of combining hypnosis with cognitive behavioral therapy (CBT) was assessed formally in a 1995 meta-analysis by Kirsch, Montgomery and Sapirstein. The authors compared CBT with the same therapy supplemented by hypnosis and reported that adding hypnosis substantially enhanced outcomes, with effects that seemed larger for obesity treatment, particularly at long-term follow-up.

A 2007 randomized study by Alladin and Alibhai used the term cognitive hypnotherapy for hypnosis combined with CBT. Eighty-four people with depression were assigned to 16 weeks of either that combined treatment or CBT alone, and the authors described it as the first controlled comparison of hypnotherapy with a well-established psychotherapy for depression.

A branded approach from the Quest Institute

A separate use of the name comes from the Quest Institute, a UK training organization. An article by its founder, adapted from a book on language in hypnotherapy, says the term Cognitive Hypnotherapy was chosen so that students could recognize what its course offered that other courses did not, because the approach borrows principles from cognitive theory, neuroscience and evolutionary psychology.

The same article describes the approach as built on a different idea of trance from traditional clinical hypnosis. The sources reviewed do not give a founding date for the approach, and an association of Quest-trained therapists describes the method as a way of thinking about therapy rather than one fixed model.

Three uses of the name

The sources reviewed show at least three uses. In the research literature, cognitive hypnotherapy or cognitive behavioral hypnotherapy refers to hypnosis added to a CBT protocol. Alladin and Alibhai define it as hypnosis combined with CBT. Quest Cognitive Hypnotherapy (QCH) is a named, trained approach with its own stated principles. In everyday use, the words may also describe any hypnotherapy that includes cognitive techniques.

The Quest founder notes that the term clinical hypnotherapy is used by many courses that teach very different syllabuses. The sources reviewed did not identify a shared or independent definition of cognitive hypnotherapy that covers both the research usage and the branded usage.

Trance and related terms

The Quest approach states that trance is an everyday phenomenon present in every problem, and its founder writes that it does not treat trance as a special state created by the hypnotist or regard depth of trance as significant. These are positions of the approach itself. The sources reviewed do not test them, and they are not presented here as consensus views in hypnosis research.

The founder also draws on modeling concepts credited to Bandler and Grinder, linking the approach to ideas also discussed on the Neuro Linguistic Programming page. Machipedia pages on Clinical Hypnosis and Hypnotherapy describe hypnosis more broadly, and the Psychotherapy page covers the wider family of talking therapies in which CBT sits.

Hypnosis within a CBT program

In the one randomized study reviewed that uses the name, cognitive hypnotherapy was hypnosis combined with CBT, delivered over 16 weeks and compared with CBT alone in adults with depression. The abstract does not describe the content of sessions, so the sources reviewed do not allow a more detailed account of how hypnosis was integrated.

Meta-analyses of hypnosis as an adjunct to CBT compare a CBT treatment with the same treatment plus hypnosis. A 2021 update pooled 48 treatments assessed after therapy and 25 assessed at follow-up, which indicates that the studies varied in problem treated and in the way hypnosis was added.

Quest Cognitive Hypnotherapy

According to the Quest founder, the therapist's role is to ask guiding questions rather than supply answers. The approach aims to identify what the client believes is causing the problem, described as the problem pattern, to change it with a range of techniques, and then to link the change to a desired outcome using a language method the institute calls Wordweaving. Only these general features are described here.

The practitioners' association states six guiding principles, including working from the client's model of the world, the view that all behavior has a positive purpose, and the view that people have what they need to solve their issues. Members may use any technique they are qualified in if it fits these principles, so the content of a session may differ between therapists.

Uses claimed for the branded approach

The Quest organization and its practitioners' association present the approach mainly as a brief therapy for anxiety and depression, citing a published pilot study. The founder's article also links a range of difficulties, including phobias, eating and weight problems, low self-esteem and social anxiety, to what it describes as faults in the mind's information processing that the approach aims to change.

Uses examined for hypnosis added to CBT

Research on hypnosis added to CBT has examined obesity, depressed mood and pain, among other problems. The 1995 meta-analysis highlighted weight loss, and the 2021 update reported advantages at the end of treatment specifically for depressed mood and pain, and at follow-up for obesity. The 2007 trial studied depression. These are the uses examined in the studies, not recommendations.

Meta-analyses of hypnosis added to CBT

The 1995 meta-analysis of 18 studies concluded that the average client receiving CBT with hypnosis improved more than at least 70 percent of clients receiving CBT without hypnosis, with the largest differences in obesity. A reanalysis the next year focused on six weight-loss studies, corrected transcription and computational errors, and reported a mean effect size of .26 instead of 1.96. With one questionable study removed, the mean was .21 and no longer statistically significant.

A 2021 update, motivated by the lack of full replication and by new studies, meta-analyzed 48 post-treatment comparisons (1,928 participants) and 25 follow-up comparisons (1,165 participants). It reported small to medium advantages for CBT with hypnosis after treatment, with values between .25 and .41, and medium advantages at follow-up, between .54 and .59.

A randomized trial in depression

In the 2007 trial, both groups improved on the Beck Depression Inventory, Beck Anxiety Inventory and Beck Hopelessness Scale. The combined hypnosis and CBT group showed larger changes, described as 6, 5 and 8 percent greater reductions in depression, anxiety and hopelessness, and the difference was reported to persist at 6- and 12-month follow-up. The authors judged it met American Psychological Association criteria for a probably efficacious treatment.

This is a single study of 84 participants, and the abstract does not report details such as blinding or who delivered the treatments. It supports a statement about hypnosis combined with CBT in depression, not about other conditions or other versions of hypnotherapy.

Evidence on Quest Cognitive Hypnotherapy

The published study of the branded approach is a 2015 pilot in the Mental Health Review Journal. Adult clients of Quest-trained therapists completed anxiety (GAD-7) and depression (PHQ-9) measures before and after therapy. Of 106 clients above a clinical cut-off at the start, post-treatment scores were available for 83, and 59 had moved to recovery: 71 percent of those with post scores and 56 percent of the 106. The authors compared the results with published national program data for 2012 to 2013.

The authors state that the study was exploratory, involved clients paying privately, and had no randomized control group or evaluation of specific components. Quest materials summarize the comparison as 71 percent recovery against 42 percent in other talking therapies. That figure compares different populations and settings, so it does not show that the approach outperforms them. PubMed searches for cognitive hypnotherapy combined with Quest or the founder's name found no randomized trial of the approach.

Why the evidence does not automatically carry over

The meta-analyses and the 2007 trial test hypnosis added to a CBT protocol. The Quest approach describes itself as drawing on cognitive theory and as using a different concept of trance, and its practitioners may use many techniques. The sources reviewed contain no study comparing the two, so findings about hypnosis added to CBT cannot be assumed to describe Quest Cognitive Hypnotherapy, or the reverse.

Reanalysis and heterogeneity

The reanalysis of the weight-loss studies concluded that adding hypnosis to CBT results in, at most, a small enhancement of outcome, a sharply lower estimate than the original. The 2021 update describes the original as lacking full replication. The counts of included studies are described differently across the sources: the 1995 abstract reports 18 studies, while the 2021 abstract describes the original analysis as covering 20.

Branding, self-reported evidence and untested premises

Evidence for the branded approach comes from a small uncontrolled pilot, and the association of Quest-trained therapists restricts use of its research data to members and asks them to market in a unified way. That arrangement is an organizational choice, but it means promotional summaries and the peer-reviewed abstract should be read separately. The premises about trance and the mind's modular structure stated by the founder are theoretical claims that the sources reviewed do not test.

What the sources report about harms

The abstracts of the meta-analyses, the 2007 trial and the 2015 pilot reviewed here do not report harms. A Cochrane review of psychosocial interventions for conversion and dissociative disorders, which included hypnosis comparisons graded very low quality, found that none of the included studies reported adverse effects. A systematic review of hypnotherapy for sleep called for future studies to report adverse events.

Absence of reported harms in these sources reflects limited reporting and should not be read as evidence that none occur. The sources reviewed do not quantify negative effects of cognitive hypnotherapy, and this page does not provide guidance for any individual. It is not a substitute for assessment or care from a qualified health professional.

Care boundaries in professional codes

The code of the National Council for Hypnotherapy, a UK professional body, states that members must not attempt to dissuade clients from seeking or continuing treatment by their registered medical practitioner. It also requires written informed consent before therapy, requires members to act within the limits of their knowledge, skills and experience, and says they must advise clients about further support when needs fall beyond their scope.

Training and professional registers

For Quest Cognitive Hypnotherapy, the practitioners' association states that members must hold the institute's Diploma in Cognitive Hypnotherapy and belong to either the Complementary and Natural Healthcare Council (CNHC) or the National Council for Hypnotherapy. The association states that members with under three years of experience must be in contracted supervision with an approved supervisor and should hold public liability insurance.

These are requirements of private professional and training bodies in the United Kingdom, and the sources reviewed do not describe a statutory training standard for the title. Anyone considering a practitioner can check the register of the relevant body and ask what training the person completed and which approach their sessions follow.