International Handbook of Clinical Hypnosis - E-Lib FK UWKS

HYPNOSIS AND DEPRESSION 135
tions are a core component of depression and rather than being seen as a risk factor,
they need to be addressed in treatment using hypnosis.
The conclusion from this literature is that relief of anxiety without associated
improvement in depression and unmet treatment expectations are potential predictors
of suicide risk. In fact, prediction of suicide risk has been well researched
and there appears to be good agreement about the primary factors involved. Beck
and coworkers Beck, Rush et al., 1979; Beck, Brown et al., 1990), reporting two
large-scale prospective studies of suicide, found that hopelessness, as measured by
the Beck Hopelessness Scale 1988), was a powerful predictor of eventual suicide.
Fawcett, Schefter, Clark et al. 1987), again utilizing a predictive design, also found
that hopelessness was a signi®cant predictor, as was loss of pleasure or interest and
`mood cycling during the index episode'. Fawcett et al. 1987) also refer to the
predictive value of a variable they describe as `depressive turmoil'. It is not clear
whether this is related to anxiety but certainly the ®ndings are in the opposite
direction to that suggested in the clinical literature, that is, increased turmoil was
associated with increased suicidal risk while the clinical hypothesis predicts that
decreased anxiety is associated with increased risk.
Given our understanding that hopelessness is the best predictor of suicide risk,
the decision for the clinician becomes whether to avoid the use of hypnosis with
patients high on this variable, or to utilize hypnosis as a tool for the modi®cation of
hopelessness. The cognitive-behavioural literature provides some data relevant to
the ®eld of hypnosis. For example, a study by Rush, Beck, Kovacs et al. 1982),
showed that depressed patients treated with cognitive therapy showed a more rapid
reduction in hopelessness scores than a comparison group of depressed patients
treated with an antidepressant drug.
SEVERELY DEPRESSED INDIVIDUALS LACK THE CAPACITY TO
UTILIZE HYPNOSIS
There is a range of variations to this hypothesis that either individuals with
depression are less able to attend or are less hypnotizable.
Spiegel & Spiegel 1978) suggest that: `Those with serious depressions may be
so narcissistically withdrawn and devoid of energy that they cannot attend to the
input signals' pp. 148±149). Others point to the dif®culties in concentration and
attention associated with severe depression, suggesting that these individuals are
unable to focus on the induction process. Yapko 1992) talks about the way in
which depression impairs the client's ability to focus. Rather than seeing this
phenomenon as a contraindication for therapy, Yapko 1992) spends some sessions
`providing some general relaxation and focusing techniques to help build an
attention span adequate to utilize in therapy'. He advocates the repeated use of
session tapes as ongoing practice increases ability to focus meaningfully p. 47).
Studies which compare various clinical populations in terms of level of hypnotizability
provide evidence on the question of whether depressed individuals are less