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Bridging the Gap: How Clinical Hypnotherapy Can Sit Alongside CBT and EMDR

You can understand your anxiety intellectually. You may recognise your thought patterns, identify situations that trigger you and understand strategies you've learned through therapy - yet sometimes, that understanding doesn't immediately change how you feel physically.

A familiar situation can still bring a racing heart, tense muscles, unsettled breathing or a knot in your stomach, even when you know consciously that you are not in immediate danger.

It can be really frustrating - but experiencing a physical or emotional response despite understanding it intellectually doesn't mean that you have failed at therapy.

Different psychological approaches work in different ways. Understanding those differences can help explain why some people explore complementary approaches such as clinical hypnotherapy alongside established psychological care.

Why understanding something doesn't always change how it feels

Cognitive Behavioural Therapy (CBT) involves examining the relationship between thoughts, feelings and behaviour. Depending on the difficulty being addressed, it can include identifying unhelpful thinking patterns, developing coping strategies, testing beliefs and changing patterns of behaviour.

CBT is recommended by NICE for a range of common mental-health difficulties, including generalised anxiety disorder and panic disorder in specified circumstances; however, our responses to situations are not purely intellectual.

Perceived threat can produce rapid emotional and physiological responses involving interacting brain and autonomic nervous-system processes. These responses can sometimes occur before a person has consciously evaluated what is happening.

This can create a familiar experience:

"I know I'm safe, but I still feel anxious."

The two experiences are not necessarily contradictory. A person can understand intellectually that a situation is safe while still experiencing physical sensations associated with anxiety or heightened arousal. For some people, the useful next step is therefore not simply acquiring more information, but exploring different ways of working with attention, imagery, physical relaxation and learned responses.

Where might clinical hypnotherapy fit?

Hypnosis generally involves focused attention and therapeutic suggestion, although people's responses to hypnosis vary. Research has investigated hypnosis both as an intervention in its own right and as an adjunct to other psychological approaches.

One area that has received particular research attention is the combination of hypnosis with CBT, sometimes described as cognitive-behavioural hypnotherapy (CBH).

An influential 1995 meta-analysis found greater improvement in CBT supplemented by hypnosis compared with CBT alone. More recently, an updated meta-analysis examined 48 post-treatment and 25 follow-up comparisons and found small-to-medium statistically significant advantages for CBT combined with hypnosis at post-treatment, with medium-sized advantages at follow-up. The researchers concluded that the findings supported the adjunctive use of hypnosis with CBT.

This is encouraging evidence for the idea that hypnosis may add another dimension to established cognitive-behavioural techniques.

It is important, however, to understand what this research actually studied. The evidence relates primarily to hypnosis integrated with CBT, rather than demonstrating that every person receiving separate hypnotherapy and CBT will experience additional benefit.

Research has also specifically explored hypnosis in relation to anxiety. A 2019 meta-analysis identified 15 studies incorporating 17 trials and found beneficial effects compared with control conditions. The authors reported that hypnosis appeared particularly promising when combined with other psychological interventions.

Taken together, these findings provide a useful basis for continued research into how focused attention, therapeutic suggestion, imagery and relaxation might complement established psychological approaches. For a client, this doesn't mean choosing hypnotherapy instead of CBT. It means that, where appropriate, hypnotherapy may provide another way of working with experiences such as attention, relaxation and behavioural rehearsal.

Hypnotherapy and EMDR: different approaches, overlapping areas of interest

Eye Movement Desensitisation and Reprocessing (EMDR) is an established psychological therapy used particularly in the treatment of PTSD. NICE recommends EMDR in specified circumstances for adults with PTSD or clinically important PTSD symptoms following trauma. For adults presenting more than three months after a non-combat-related trauma, NICE recommends offering EMDR; between one and three months, EMDR may be considered where the person has a preference for it. NICE also specifies that EMDR should be delivered by trained practitioners with ongoing supervision and according to a validated manual.

Hypnotherapy and EMDR are distinct approaches, with different techniques and evidence bases. There are nevertheless areas of therapeutic interest that overlap. Both can involve focused attention, imagery and attention to a person's subjective emotional experience. EMDR also incorporates preparation and self-calming techniques to help people manage distressing memories and situations during treatment.

Hypnotherapy may similarly incorporate relaxation, imagery and therapeutic suggestion as part of an appropriately structured session. This doesn't mean that the two therapies are interchangeable. Instead, it highlights an important principle: different therapeutic approaches can work with different aspects of a person's experience.

Research into hypnosis alongside CBT is more developed than research specifically examining hypnotherapy alongside EMDR. For someone already receiving trauma-focused treatment, any additional therapy should therefore be considered individually, with the person's existing treatment and clinical needs kept central.

At Asclepieia Hypnotherapy and Wellness in Skipton, hypnotherapy is not presented as a replacement for EMDR, CBT or other established psychological treatments. Instead, the emphasis is on providing a complementary service with clear professional boundaries and an understanding of the importance of existing healthcare.

A simple experiential pause: the anchored breath

When you notice yourself becoming tense or overwhelmed, a short breathing exercise can provide an opportunity to pause and redirect your attention.

Try this for a minute or two:

1. Notice

Pay attention to the physical sensation without trying to force it away.

2. Slow the breath

Breathe comfortably and gently, allowing your exhalation to be slightly longer than your inhalation if that feels natural.

Slow breathing has been associated with changes in autonomic activity, including increases in measures of vagally mediated heart-rate variability.

3. Choose an attention point

Gently press your thumb and index finger together and notice the sensation of contact.

4. Return to the present

Notice one or two things you can see, hear or physically feel around you.

Think of this as a simple wellbeing exercise rather than a treatment for an underlying condition.

If paced breathing makes you uncomfortable or light-headed, stop and return to your normal breathing.

Clinical, evidence-informed practice in Skipton

At Asclepieia Hypnotherapy and Wellness in Skipton, clinical hypnotherapy is delivered by Christopher Hardy, a Registered Mental Health Nurse with 20 years' NHS mental-health nursing experience.

The approach combines appropriate assessment with evidence-informed hypnotherapy techniques, while recognising the importance of professional boundaries and working within the evidence available.

Hypnotherapy is offered as a complementary service rather than a replacement for medical or psychological treatment. It is not intended to replace assessment, diagnosis, medication or psychological therapies where these are clinically indicated.

As a registered nurse, Chris works within the professional standards of the Nursing and Midwifery Council, including requirements relating to competence, evidence-based practice, professional boundaries, communication and safety.

If you are currently receiving treatment from your GP or a mental-health professional, it is sensible to let them know about any additional therapy you are considering. Where appropriate, information can be shared with your consent so that different aspects of your care can be considered together.

The aim is not to replace established psychological therapies, but to provide a carefully considered complementary option for people who may find focused attention, therapeutic suggestion, imagery and relaxation useful.

References

• Kirsch, I., Montgomery, G. and Sapirstein, G. (1995) ‘Hypnosis as an adjunct to cognitive-behavioral psychotherapy: A meta-analysis’, Journal of Consulting and Clinical Psychology, 63(2), pp. 214–220.

• Ramondo, N., Gignac, G.E., Pestell, C. and Byrne, S.M. (2021) ‘Clinical Hypnosis as an Adjunct to Cognitive Behavior Therapy: An Updated Meta-Analysis’, International Journal of Clinical and Experimental Hypnosis, 69(2), pp. 169–202.

• Valentine, K.E., Milling, L.S., Clark, L.J. and Moriarty, C.L. (2019) ‘The efficacy of hypnosis as a treatment for anxiety: A meta-analysis’, International Journal of Clinical and Experimental Hypnosis, 67(3), pp. 336–363.

• National Institute for Health and Care Excellence (NICE) (2018) Post-traumatic stress disorder: NICE guideline NG116.

• National Institute for Health and Care Excellence (NICE) Generalised anxiety disorder and panic disorder in adults: management. CG113.

• Laborde, S. et al. (2022) ‘Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis’, Neuroscience & Biobehavioral Reviews, 138, 104711.

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