International Handbook of Clinical Hypnosis - E-Lib FK UWKS

130 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
Jackson 1983) adopt a similar viewpoint, suggesting that the notion that
hypnosis has no place in the treatment of depression is a `bit of clinical
folklore'. Miller 1984) produces a chapter on the application of hypnosis to the
treatment of depression without questioning the appropriateness of this approach.
Crasilneck & Hall 1985) advocate a more conservative view, listing some
contraindications but concluding that `while hypnosis can be used in treating
depression, we strongly advise that such use be only by therapists adequately
grounded in psychodynamics; even then it should be used with caution and care'
p. 324).
Given that signi®cant differences exist between respected authors in the area,
what accounts for this variation?
THE NATURE OF DEPRESSION
In terms of DSM-IV criteria, a diagnosis of Major Depression requires evidence of
at least one primary symptom and at least four associated symptoms lasting nearly
every day for at least two weeks. Depressed mood and a distinct loss of interest or
pleasure in most or all activities anhedonia) count as primary symptoms. The
secondary symptoms are: a) appetite disturbance or weight change; b) sleep
disturbance; c) psychomotor agitation or retardation; d) fatigue or loss of energy;
e) feelings of worthlessness or guilt; f) diminished concentration or decisionmaking
ability, g) thoughts of death or suicide.
DSM-IV distinguishes between Major Depression and a range of other
mood disorders including Dysthymic Disorder and Bipolar I Disorder. This
range of classi®cations attempts to encompass the variety of presentations of
signi®cant depressive mood. Current thinking e.g. Parker, 1996) emphasizes
that the notion of depression includes a range of disorders: `As ``depression''
encompasses heterogeneous conditions, single answers should not be sought'.
Parker 1996) distinguishes between melancholic and non-melancholic depression
in his challenge to current thinking about responsiveness to antidepressant
medication and other treatments for depression. He argues that: `Any
study which amalgamates separate depressive subgroups, rapid and slow
remitters, will give limited information as the ``group'' trajectory subsumes a
set of potentially distinctly different trajectories'. Such thinking warns us
against responding to depression as if it were a unitary construct and against
too readily attempting to make generalizations about individuals struggling
with depression.
Very little useful comparison can be made between treatment accounts unless
some objective measure of depression has been utilized. Whilst the Hamilton
Depression Rating Scale HDRS) and the Beck Depression Inventory BDI) are
extensively used in research studies, they are only rarely utilized in the body of
case accounts that form the data base in this area.