Hypnotherapy vs CBT, EMDR, and Talk Therapy: How They Compare and Work Together

Author: Andreas Balasis, LCSW-QS, CHP

Reviewer:  Dr. Mary Perleoni, LMHC ✓

All therapeutic modalities, if they are truly therapeutic, enhance a sense of understanding and a sense of agency, a belief that one is capable of improving, and a belief that the work it's going to take in order to do so is worth doing.

They're similar in the sense of improving understanding and changing patterns. They differ in the points of focus, the potential speed, and the mechanics that are utilized.

How Does Hypnotherapy Compare to CBT, EMDR, and Talk Therapy?

There are different schools of what therapy itself even is. That's problem number one. The way I see it, for something to be therapeutic, it's going to elicit a change in perception of self or a deeper understanding of self and behavior. With understanding, ideally, we're able to change in ways that we want.

Whether we use Socratic questioning and understanding underlying reason and faulty logic with cognitive behavioral therapy (CBT) procedures, or whether we implement particular skills in particular contexts, be it emotional regulation or distress tolerance or mindfulness or effective communication, like in dialectical behavior therapy (DBT), whether it be bilateral stimulation in eye movement desensitization and reprocessing (EMDR), so we can change the way our body relates to traumatic memories. The idea is we are creating different associations that are more functional than the ones the person initially presented with before they walked in the door.

So underlying mechanics are helping people understand what is actually taking place, because there are so many variables that we just can't see. We won't see unless there's someone who's trained to observe them and point them out or add clarification, patch up inconsistencies, create alignment with thoughts and feelings.

I don't believe there's a magic bullet. It's really hard to take something that's been built over years and completely rebuild it. The roots are really deep in there. A huge oak is going to be a lot harder to take out of the ground than a small plant. That's human nature. That's how we think, that's how we feel, that's how we relate to other things.

What Can Hypnotherapy Do That Talk Therapy Can't?

The sales answer would be a more direct engagement with the subconscious mind.

I think a more responsible and intellectually defensible answer starts with why I really like ACT, acceptance and commitment therapy. I understand how it functions from the standpoint of relational frame theory, this idea that we experience the world by nature of comparison and connection.

So we only know what up is because we have a concept of what down is. We only have a concept of day because we have a concept of night. We engage with things based on their opposites or their equivalents.

You could say dog is a word. You might picture a dog, you might picture a dog that you've had. You might think of a stray dog. You might hear the sound of barking. You could picture the word D-O-G. If you're multilingual, you might think of dog in other languages. So there are many associations with one origin.

The hypnotic component is being able to have that awareness that this is a theory of learning, this is a theory of cognition, and it applies behaviorally as well, because we create associations with these different concepts.

And hypnosis, in a way, it's like gene editing technology, where they can go in and cut out parts of the gene, implant certain parts. It functions kind of like that, where you can get really granular with the word, the image, the environment, the concept, the label, the identity. And you can look at these things very particularly, like you would under a microscope. And you could change the physiological response, you could change the expectancy.

Can Hypnotherapy Be Combined With Other Therapies?

I would actually encourage that hypnotherapy is not a standalone practice where someone comes in and I strictly do hypnotic inductions. This is part of my assessment, this is part of my intake. I want to understand how things connect. I want to understand areas of psychological rigidity.

And that's why I really lean towards ACT, because it is transdiagnostic. It's meant to look at areas where it might be really hard for us to take different perspectives or to disengage from unhelpful patterns of thought and reaction. So that's the lens that I look at it through.

Third wave cognitive behavioral therapies, the idea of understanding that thoughts, behaviors, and emotions, they influence one another. Nothing happens in isolation. If I change one part of the system, invariably the other parts of the system are going to have to adapt.

So with that understanding, you can use CBT Socratic questioning. Well, if that happens, then what happens? And just keep going down the line.

How Does ACT Work With Hypnotherapy?

Defusion: Seeing Thoughts as Thoughts

I want to know what are the thoughts that are hardest to disengage from. In ACT, that would be defusion. What thoughts do we get most easily fused with? I'm terrible. I can never achieve this. I'm not supposed to be here. My life sucks. I'm never going to win the tour championship. I'll never play varsity ball.

All these doubtful thoughts, when we hear them, and that's that anterior cingulate cortex with threat appraisal, when we hear those things, it pulls our attention even deeper into it. Just like if there's a tiger in the room, I don't want to take my eyes off the thing. I need to know where it's at.

There's a poisonous spider in the corner. I'm not going to look away, and now I look back and it's gone. No, it's going to command my attention. So those thoughts, they function very similarly to what a real physical threat would be. So the skill set from ACT to be able to see those thoughts as something that is outside of the mind, as opposed to something that is indicative of identity, is crucial.

Acceptance: Noticing Without Giving Up

Certain things cannot be changed. And that's a fundamental dialectic, acceptance versus change. Acceptance is not being resigned to it, like, yeah, my life just sucks. I suck. I'm terrible at everything. No, acceptance is the ability to say, I'm noticing a lot of discomfort right now. I'm noticing that my mind is pulling me into this place. I'm noticing that maybe I'm actually not happy with the decisions that have led me to this point.

Being able to confront that, to engage with that, as opposed to experiential avoidance, pretending like that's not true, which can lead to compensations in other areas. That's the primary problem, experiential avoidance. Because the more we avoid it, the more it builds up.

I remember vividly as a kid, backyard pool, one of those little boogie boards, skim boards. The further down you try to push it underwater, what happens? The more force it's going to explode up with. If you don't have that awareness, like, I pushed it down this far, maybe you miss time, you get cracked in the chin.

Present Moment Awareness

Present moment awareness, again, one of the six pillars in ACT. You can't stop a storm. I don't control the weather. But the further out I could see a storm cloud coming from, the more time and opportunity I have to prepare for that storm, whether that be to seek shelter, construct shelter. If I know I've got to be outside, all right, what represents my umbrella? What represents my raincoat?

Self as Context

Self as context, which is another pillar. We come to believe that our stories are an indication of who we are. That could be really detrimental, because that would tell us that the story's already been written and there's nothing left to write. That's not a good story. If you're alive, there's more story to be written.

People argue in their own minds, and a lot of people aren't taught to understand what that is, this idea of thinking about our own thinking. So we have a constant tug of war going on in our heads.

We're not each side of the tug of war. We're the one that's able to conceive of the fact that we have a tug of war going on in our heads. We're not opposing chess pieces on a board. I didn't make the right decision. I didn't make the wrong decision. I'm not smart. I'm not stupid. I'm the board itself.

My awareness that I can conceive of the fact that there are opposing sides of my own mind is my awareness. That's more me than the story I've come to believe about myself, my name, my status in my family, my status amongst my friends, my occupation, the degrees that are hanging on my wall. Those are ancillary details. We are more than the sum of our parts. That's self as context.

Meet Andreas Balasis

My name is Andreas Balasis. I'm a licensed clinical social worker in the state of Florida, and also a qualified supervisor. I have a positive psychology certification through UPenn's Coursera course, and I've been intensively trained in dialectical behavior therapy through the School of Social Policy and Practice at Penn.

If you're already in therapy and wondering whether hypnotherapy could add to that work, reach out to IBWHC to set up a conversation with Andreas.