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The Use of Hypnosis in Boosting the Effect of Cognitive Behavioural Therapy in the Treatment of Chronic Fatigue

The Use of Hypnosis in Boosting the Effect of Cognitive Behavioural Therapy in the Treatment of Chronic Fatigue

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european
journal oi ciinical hypnosis - volume five
-
issue three
Q
Clinical Articles
THE USE OF HYPNOSIS INBOOSTING THE EFFECT OFCOGNITIVE BEHAVIOURALTHERAPY IN THE TREATMENTOF CHRONIC FATIGUE
Author:Jeff Wailes
This study looks
at the
possible increase
in the
efficacy
of
Cognitive Behavioural Therapy (CBT)
in the
amelioration
of
the symptoms
of
Chronic Fatigue Syndrome (CFS)
by
the inclusion
of
hypnosis. Undertakenby a practising psychotherapist, the study Vi/as carried out in
a
clinic environment.The study took the form
of
quasi-experimental, pre-test/post-test design with two groups undergoing therapyand
a
third "control" group providing reports but not undergoing therapy. Of those undergoing therapy one
of
the two groups experienced hypnosis within
the
duration
of
the therapy. The study extended over twelveweeks. In addition all participants completed two Lifestyle Questionnaires. One completed prior to the onset oftherapy and the other
at
the end of the twelve-week period.Comparison
of
qualitative and quantitative data gathered, during the study, suggests possible theories as
to
the links between fatigue and stress. The effects
of
stress on the potential exhaustion
of
physical resourcesessential to the efficient working of the endocrine and nervous systems leads on to an analysis of material fromprevious studies relating
to the
possible connection between dysfunction
in the
interplay between
the
Hypothalamus, Pituitary and Adrenal glands (the HPA axis) and CFS.The resulting data illustrates that those participating
in
therapy reported increased energy levels followingtreatment. Those within the control group showed little
or
no improvement. However, there was only marginaldifference in increased energy level between those receiving hypnosis within their therapy and those that didnot.
 
10
european journal ot clinical hypnosis - volume five - issue three
BACKGROUND
The National Task Force on Chronic FatigueSyndrome (1994) states that fatigue is, now,recognised by the medical authorities as one of themajor health issues of our time, yet there is littleknown of its cause or effective treatment. The debateas to whether Chronic Fatigue Syndrome is purelyphysical, purely psychological or psychophysiologicalin nature will no doubt rage for years. In themeantime sufferers find little real help in minimisingthe effects of this illness.This study looks at some of the theories regardingfatigue and describes a qualitative researchprogramme assessing the effectiveness of a Hypno/Cognitive Therapy. It should be noted that thisresearch programme is seen as a developmentalprocess and. therefore, ongoing It was alwaysthought, therefore, that it was likely that any numberof additional questions could be raised as the studyunfolded. As important as the answer to the mainquestion is an underlying need to continually improveknowledge and information that may guide thepractitioner to improved levels of effectiveness.Over a period of three years, commencing in 1996, anumber of clients at Tyringham Naturopathic Clinicsuffering chronic fatigue were referred forpsychotherapy. The majority had been diagnosed bytheir GP as suffering from CFS others describedthemselves as having absolutely no energy.The therapy offered usually consisted of 2 one-hoursessions of Cognitive Behavioural Therapy andHypnosis. Initial results from the treatment sessionssuggested that these sessions offered at least someshort-term relief. Even more encouraging werereports from clients that long-term improvements inmood and energy seemed to be taking place. Thereare many questions raised by the reportedsuccesses. Firstly, we have to acknowledge that theclients went through a variety of therapies whilst atTyringham.In addition to the psychotherapy, other therapiesoffered to clients would include a detoxification dietregime, relaxation through visualisation techniques,osteopathy and graded exercise. There are claimsfrom a variety of sources that some of thesetechniques may have a positive effect in thetreatment of fatigue. For instance relaxation andgraded exercise are both cited as being helpful forCFS sufferers (Fulcher, 1997).We are. therefore, left with a number of questionsregarding the Tyringham experience. Was it thecombination of the various therapies experienced bypatients that was at the root of the improvements?What value can be attached to the contribution of thepsychotherapy toward the overall healthimprovement of these clients?The influence of hypnosis in a variety of psycho-physiological disorders is well documented,especially those linked to stress and depression(Yapko, 2001).The question posed in this study was, therefore,designed to expand on the existing research into theeffectiveness of CBT by introducing the potentiallybeneficial effects of hypnosis. When one considersthe difficulties in presenting CBT to severely fatiguedindividuals with limited attention span, delivering suchtherapy in a deep relaxation mode might be seen asa logical step in helping those suffering with CFS.
AETIOLOGY
The cause of CFS is still a mystery, indeed there areconcerns that the CFS umbrella is far too large indefinition to be useful. New diagnosis criteria wereset down in what is now termed the Oxford Criteria(Sharpe et al, 1996). These new criteria attempt toseparate CFS and Post Viral Fatigue Syndrome thelatter having a recognised causality link to earlier viralinfection such as glandular fever.The symptoms of CFS are many and overlap withother illnesses including depression, chronic stress,hormone dysfunction to name but a few. The NationalTask Force on CFS (1994) suggested the followingcriteria in diagnosing CFS:Persistent (excess of 6 months) debilitating fatiguenot resolved with bed rest. The fatigue must besevere enough to impair daily activity to below 50% ofthe patient's pre-illness level.The National CFS Task Force produced a reportdetailing many aspects of CFS research (NTF report,1994) and included the following statement:-
"Chronic fatigue appears not to fit neatly into theconventional view that disease is either physical orpsychological. Instead, the holistic concept ofdisease as a disorder of the whole person,
body,
mind and spirit, provides a better model for thechronic fatigue syndromes."
The report goes on to suggest that the boundaries ofphysical and psychological disease are becomingblurred as understanding of the interplay betweenendocrine and neurological systems becomeapparent. The physical effects of depression andchronic stress are prime examples of the interplay
 
european journal of clinical hypnosis - volume five - issue three
11
between mind and body (Rossi, 1993). Indeed
the
correlation between chronic stress leading
to
HPAdysfunction
and the
onset
of
chronic fatigue
is
becoming
a
major focus
for
research (Demitrack,1991) (Kavelaars et al, 1998).
It
seems also possiblethat stress caused
by
unhelpful thinking may
be
alleviated
by
cognitive therapy, relaxation throughvisualisation and exercise (McNammara,1997).From these concepts
it
seems appropriate
to
consider realignment
of
thinking and core beliefsthrough the use
of
CBT
as
potentially beneficial
to
those with CFS. Previous research (Sharpe 1996)points
to
the effectiveness
of
CBT
in
treating CFS.Adding hypnosis
to
the treatment regime may
be
beneficial
in
increasing the learning taken from suchCBT sessions.For the purposes of this study the state of hypnosis isone
in
which
the
individual experiences deeprelaxation and an altered state of consciousness. Theinduction
of
the hypnotic state initiated through
the
use
of
imagination and visualisation, suggested
as
effective in unlocking the power of the mind (Hilgard,1977).
As
hypnosis utilizes
the
client's
own
imagination
it may be
suggested that this
may
increase
the
effectiveness
of the
treatment,
an
important concept utilised
in
Eriksonian hypnosis(Erickson 1964).There
is a
body
of
research suggesting
a
strong linkbetween changes
in
behaviour, thinking style andsuggestion delivered within
a
state
of
hypnosis(Hilgard, 1977).Full explanation of the therapy content is given in thetext of the full research report.
METHODOLOGY
A randomised, pre/post therapy energy levelquestionnaire approach was the chosen researchstrategy. This
was
supplemented with LifestyleQuestionnaires taken before commencement
of
andat the end of the study. In addition to these, researchtools data was gathered
in
the form
of
notes takenduring
the
therapy sessions. The duration
of the
study was twelve weeks. This allowed three weeks ofdata collected prior
to
the intervention leaving
six
weeks available for data collection post therapy.The study took place
in
the natural environment
of
each
of
the participants and within each therapysession with the therapist.Participants reported their energy levels on
a
twicedaily basis, using
a
proforma provided. The energydiaries provided
an
indication
of
the participants'ability to cope with daily activities before, during andafter the therapy sessions; in this way giving
a
guideto their fatigue status throughout
the
study.
To
monitor any changes
in
self-esteem and ongoingstress levels all participants completed the LifestyleQuestionnaire
on two
separate occasions,
on
commencement of the study and at the end of weektwelve. The objective of this was
to
identify changesin
the
participants' feelings
of
self-worth
and
susceptibility to stress. Kreger (1995) suggests linksbetween stress, perception
of
control
of
life's eventsand levels of self
worth.
It was therefore felt importantthat these issues be monitored.
Participants were randomly allocated
to
threeseparate groups:"A"
receiving CBT and hypnosis, which we shall callHypno-Cognitive Therapy.
'B'
received CBT only.
"C"
purely completed the documentation.CBT consisted
of
three, sixty-minute sessions.Qbjectives
of
the sessions were
the
progressivereduction
of
the overall psychological stress
and
developing
a
rational acceptance of the prognosis ofthe illness. Underlying, unhelpful belief patterns(Yankora & Dryden, 1990) identified prior to or duringtherapy were also addressed during the sessions.Homework
in the
classic CBT tradition (Dryden,1996) was given and self-help exercises provided
as
necessary.In
the
hypno-cognitive sessions
30
minutes wereconfined
to the
delivery
of
suggestion underhypnosis.The classical hypnosis method, fullydescribed in Hartland's Medical and Dental Hypnosis(Waxman, 1998), was used throughout.
Results
Percentage change
in
mean energy levels withingroups:Group
ABCn554
Lowest8.8700.720-1.860Highest42.38040.3304.710Range33.5139.6106.570Mean22.69622.4041.610
The figures shown represent the mean of the energy levelsreported in each group collected from the participant's diarysheets.
The numerical data shows only marginal difference inpercentage energy improvement between group
'B'
(22.404%) and group
'A'
(22.696%). The change
in
energy levels within the control group was negligibleat
1.610%.

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