Brief Cognitive Hypnosis Facilitating the Change of Dysfunctional Behavior Jordan I. Zarren, MSW., DAHB is a licensed clinical so- cial worker and a board-certified diplomate in clinical hyp- nosis with the American Hypnosis Board for Clinical Social Work, and in clinical social work with the National Associ- ation of Social Workers. He is a founding member of the American Hypnosis Board for Clinical Social Work and a fellow of the American Society of Clinical Hypnosis, the Society for Clinical and Experimental Hypnosis, and the Florida Society of Clinical Hypnosis. He is a Past President of the Florida Society of Clinical Hypnosis and the current Presi- dent-Elect of the American Society of Clinical Hypnosis. He has over 40 years of experience as a psychotherapist. Bruce N. Elmer, PhD, ABPP is a licensed clinical psycholo- gist and a board-certified diplomate in behavioral psychol- ogy with the American Board of Professional Psychology and in pain management with the American Academy of Pain Management. He is a member of the American Psychologi- cal Association and a fellow of the Society for Psychological Hypnosis, Division 30, of the American Psychological Association. He is also a member of the American Society of Clinical Hypnosis, the Society for Clin- ical and Experimental Hypnosis, and the Greater Philadelphia Society of Clin- ical Hypnosis. He has over 20 years of experience as a psychologist and psychotherapist. Both authors are also certified consultants in clinical hypnosis with the American Society of Clinical Hypnosis. Brief Cognitive Hypnosis Facilitating the Change of Dysfunctional Behavior Jordan I. Zarren, MSW, DAHB Bruce N. Elmer, PhD, ABPP SPRINGER PUBLISHING COMPANY Copyright © 2002 by Springer Publishing Company, Inc. All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or other- wise, without the prior permission of Springer Publishing Company, Inc. Acquisitions Editor: Sheri W. Sussman Production Editor: Janice Stangel Cover design by Susan Hauley 3rd printing 05 06 07 / 5 4 3 Library of Congress Cataloging-in-Publication-Data Zarren, Jordan I. Brief cognitive hypnosis: facilitating the change of dysfunctional behavior / Jordan I. Zarren, Bruce N. Eimer. p. cm. Includes bibliographical references and index. ISBN 0-8261-1484-9 1. Hypnotism—Therapeutic use. 2. Cognitive therapy. 3. Brief psychotherapy. I. Eimer, Bruce N., 1953- II. Title. RC497.Z37 2001 616.89'162--dc21 2001040010 Printed in the United States of America I dedicate this book to my wife of forty-nine years, Lillian. Her patience, unwavering support and wise counsel made it all possi- ble. Also, my daughter Marcia Schneider and her husband Marc, my son Robert and his wife Susie and their children Ella and newborn Nathaniel. Their presence has kept me young. —Jordan I. Zarren I dedicate this book to my loving wife Andrea and to my daugh- ters, Marisa and Allison who make my life whole. Also, to my mother Cecile, and my father Joe, who taught me the meaning of love. —Bruce N. Eimer This page intentionally left blank CONTENTS Foreword ix Preface xiii An Important Note xvii Acknowledgments xix PART ONE FUNDAMENTAL CONCEPTS AND ESSENTIAL TOOLS Introduction: Brief Cognitive Hypnosis—A Powerful Tool for Brief Psychotherapy 3 1. Establishing the Therapeutic and Hypnotic Relationship 13 2. The Waking State Reframing Model 30 3. Change Language: General, Waking, Trance, and Posttrance State Reframing 42 4. Trance Induction: Design, Choice, and Administration 58 5. Self-Hypnosis for Continued Problem Resolution 78 6. Common Factors in Dysfunctional Behavior and the Creation of Double Binds 90 7. Dysfunctional and Therapeutic Rituals 106 PART TWO CLINICAL APPLICATIONS 8. Irritating Habits as Dysfunctional, Outdated Coping Skills 121 9. More Complex Habits as Ways of Dealing with Anxiety and Stress 147 10. Panic Disorders and Other Complex Anxiety-based Behaviors 169 v»' viii CONTENTS 11. Medical Problems Including Pain, Preparing for Medical Procedures, Self-Healing, and Coping with Treatment Side Effects 212 PART THREE SMOKING CESSATION AND KEYS TO CHANGE 12. A Single-Session Smoking Cessation Program 241 13. Review: Keys to Change 264 References 279 Index 288 Foreword WILLIAM C. WESTER II In 1961,1 took my first graduate school course in psychopathology. The course was taught by George W. Kisker, author of The Disorganized Personality (Kisker, 1972). Dr. Kisker became my major adviser and later supervisor when I com- pleted my clinical internship. My first exposure to hypnosis was watching Dr. Kisker use hypnosis with a hospitalized population. He became my mentor and teacher of hypnosis because there was no graduate course in hypnosis at the time. The rest is history in terms of my career in the field of hypnosis. I ended up teaching the first hypnosis course at the University of Cincinnati to graduate/ medical students. Hypnosis has been used for as long as records have been kept and originally was influenced by beliefs in the stars, magnetic fields and exorcism. The term hypnosis was coined in 1841 by an English physician, James Braid. Hypnosis became more scientific and accepted and officially recognized by the American Medical Association (AMA) in 1958 as a legitimate treatment method. The last 40 years has been a tremendous growth period for hypnosis, and books too numerous to mention have been published on the subject. Clinicians graduated from a variety of training programs, and their particular theoretical backgrounds influenced how they began to use hypnosis. Much of this early training, including my own and that of Jordan Zarren, was very psychoanalytic in nature. Clinicians took continuing education courses, and we began to see a shift to behavioral and cognitive treatment approaches. Hypnosis just seemed to fit in better within cognitive-behavioral models because of the shorter term treatment approaches that they espoused. Training programs began to change, and the advent of managed care pushed for even shorter and briefer models of treatment. IX jc FOREWORD Many other health care groups have continued to recognize hypnosis, as the AM A did in 1958, as an effective therapeutic treatment modality. This has led to the need for specialized training of more licensed health care clinicians and a greater need for published material on hypnosis geared to brief treatment skills. Books on hypnosis have continued to be published. The majority of them have been general texts, covering the whole field of hypnosis, or very specific texts, such as those addressing the use of hypnosis for pain control. Even though the cognitive treatment model has been recognized as most effective in producing change in patient behavior, there has been little written on combining cognitive techniques with hypnosis, within a brief therapeutic model—until now. Brief Cognitive Hypnosis: Facilitating the Change of Dysfunctional Behav- ior is a magical addition to the field of clinical hypnosis. Two distinguished board-certified clinicians with over 60 years of combined clinical experience have provided a delightful and practical resource book for all clinicians using hypnosis as a tool in their clinical work. The authors state that their book is for clinicians experienced in the use of hypnosis. However, after 40 years in the field myself, and having taught hun- dreds of graduate students and licensed professionals, it is my opinion that this book not only will add to the experienced clinician's skills but also will provide a straightforward and practical approach for the neophyte in hypnosis. This book is a practical, well-documented, clinical volume based on solid psychological concepts and principles. As the title implies, Brief Cognitive Hypnosis is also consistent with the managed care model, which emphasizes brief therapy and structured treatment. Like cognitive therapy in general, the authors come from a positive frame of reference in which the patient assumes a degree of responsibility for his or her treatment. In addition to the material presented, related issues in hypnosis, such as sensory representational language, waking state refraining, and the importance of semantics, are skillfully interwo- ven into the framework of this book. This book becomes even stronger with the addition of excellent case studies, brief inductions and numerous examples of specific wording to facilitate ther- apeutic change. Jordan Zarren even uses distraction as he mentions the appro- priate use of sleight-of-hand magic in the treatment process. The thirteen chapters are broken into three well-organized sections: Part One—Fundamental Concepts and Essential Tools, Part Two—Clinical Applica- tions, and Part Three—Smoking Cessation and Keys to Change. In Part One, chapters 1 through 7, the brief cognitive hypnosis model is clearly introduced and the fundamental concepts and essential tools for doing this type of therapy are logically presented. These chapters are packed full of new and alternative ideas for the experienced clinician, while providing the basics to beginners in the field who want to follow a cognitive model. FOREWORD xi In Part Two, chapters 8 through 11, the authors get down to the specific treatment of many clinical problems, such as anxiety, dysfunctional habits, pain, and a variety of medical problems, which can all benefit from using this approach. Part Three, chapter 12, provides a detailed single-session smoking cessation program. I learned a great deal that I can now incorporate into the single- session smoking cessation treatment approach that I have used for over 38 years. Chapter 13, "Review: Keys to Change", pulls it all together, leaving the reader with a strong feeling of excitement for having read this excellent book. More than adequate references are given at the end of the book that support and document the brief cognitive hypnosis model. William C. Wester, II, Ed.D., ABPP, ABPH, CEO, Behavioral Science Center, Inc., Cincinnati, Ohio. Past-President: American Society of Clinical Hyponsis.