Ernest Rossi - 20 Min Break Prologue

The
Milton H. Erickson Founda6on

presents
Trea%ng Depression Hypno%cally and Strategically:
The Power of Experien%al Learning in Teaching
Mood Regula%on Skills
with
Michael D. Yapko, Ph.D.
December 14, 2014
www.yapko.com
A World Health Organiza6on (WHO)
Predic6on
•  Depression is currently the FOURTH most significant
cause of suffering and disability worldwide (behind
heart disease, cancer and traffic accidents)

and, sadly,
•  It was predicted to become the SECOND most
debilita6ng human condi6on by the year 2020, but
that terrible mark was already hit in late 2013

www.yapko.com
Devia6ng From the Official
Recommenda6ons for Combined Treatment
Many people are prescribed drugs as the sole
form of interven6on, despite experts’
recommenda6ons for so-‐called combined
treatments of medica6on and psychotherapy
(Thase, May 23, 2012). In fact, nearly 80% of
an6depressant prescrip6ons are wri[en by
physicians who are not psychiatrists, and only about
20% of pa/ents on an/depressants also received
psychotherapy (Mark, Levit & Buck, 2009; Olfson & Marcus, 2009).
www.yapko.com
Strands of Evidence Depression is About Much
More than Biology Run Amok
•  Gene6cs and Epigene6cs

•  Neuroscience
•  Affec6ve Neuroscience
•  Epidemiology
•  Individual Psychology
•  Social Forces (e.g., culture, a[achment)

www.yapko.com
No Amount of Medica6on
Can Teach Your Client:
•  More effec6ve coping skills
•  More realis6c explanatory styles
•  Healthier rela6onship styles
•  More flexible and discrimina6ve cogni6ve skills
•  Sophis6cated problem-‐solving skills
•  More effec6ve decision-‐making strategies
•  How to build and maintain a support network
•  How to transcend an adverse personal history
•  How to build a realis6c and mo6va6ng future
www.yapko.com
Helping people develop key skills in
these areas in order to empower them
to live effec6vely is what therapists
can do that medica6ons can’t

www.yapko.com
My focus in this address is on the
strategic use of hypnosis in
treatment…
… un6l recently a terribly overlooked

treatment approach despite the fact that
clinicians have always pointed out that
hypnosis fosters greater self-‐control
www.yapko.com
Consider Recent Research Regarding Brain
Differences in Responsiveness
•  The researchers looked at the activity of 3
different brain networks in HH vs. LH subjects: the
default-‐mode, used when one’s brain is idle; the
executive control network, involved in decision-‐
making; and the salience network, involved in
deciding something is more important than
something else.

www.yapko.com
Consider Recent Research Regarding
Brain Differences in Responsiveness
•  General findings: “Our results provide novel
evidence that altered func6onal connec6vity in the
dorsolateral prefrontal cortex and dorsal anterior
cingulate cortex may underlie hypno6zability.”
•  “…the work confirms that hypno%zability is less
about personality variables and more about
cogni/ve style.” Co-‐author David Spiegel

Hoef, F., Gabrieli, J., Whihield-‐Gabrieli, S., et al. (October, 2012), Func6onal brain
basis of hypno6zability. Archives of General Psychiatry, 69, 10, 1064-‐1072.
www.yapko.com
Cogni6ve style can be defined as the
interface between enduring, reflexive
habit pa@erns of thinking, context-‐
based quali6es of pa@erns of
a@enBon, and situaBonal responses
that reflect the personal and
interpersonal consequences of these
pa[erns
www.yapko.com
Cogni6ve Style Pa[erns That
Directly Affect Mental Health
•  A[ribu6onal Style (internal/external, stable/
unstable, global/specific)
•  Expectancy
•  “Believed-‐in imagina6on” (Sarbin, Hilgard)
•  Tolerance for ambiguity
•  Abstract vs. concrete thinking
•  Cogni6ve flexibility vs. rigidity
•  Global vs. linear cogni6on
www.yapko.com
Virtually all of my professional life
has been spent studying major
depressive disorder, a condi6on
heavily regulated by cogni6ve style:
Internal, stable and global a[ribu6ons, nega6ve

expectancy, low tolerance for ambiguity,
cogni6ve rigidity, and global thinking
www.yapko.com
Let’s Focus on Global (Over-
general) Thinking and its
Relationship to Depression

www.yapko.com
Global Cognitive
Style is a Key Factor
When you can’t see the

trees for the forest…

www.yapko.com
“Overgenerality Bias” and the Global
Cognitive Style in Depression
“Depressed individuals suffer from an overgenerality

bias in retrieving personal memories of past emotional
experiences as well as in imagining possible future
experiences. For instance, when asked to recall
experiences of anger, depressed individuals tend to
report overgeneral events (e.g., “When I am with my
girlfriend”) rather than a specific event (e.g., “last
Sunday, I had an argument with my neighbor whose dog
was endlessly barking”).” (p. 560)
Philippot, P., Baeyens, C., & Douilliez, C. (Nov., 2006). Specifying emotional
information: Regulation of emotional intensity via executive processes.
Emotion, Vol. 6, No. 4, 560-571.

www.yapko.com
Overgeneral Memory
Bias and PTSD
Findings suggest that “people with PTSD may have
an overgeneral memory bias (OGM) similar to people
with depression. When asked to retrieve a specific
memory from their lives in response to a cue word
(e.g., “happy”) in an Autobiographical Memory Test
(AMT), people with OGM will reply with descriptions
that summarize several different events (“always
when I visit my friend”) instead of retrieving a single,
circumscribed event (e.g., “going to my friend’s place
last Saturday afternoon”).” (p. 461)
Schönfeld & Ehlers, Emotion, www.yapko.com
November, 2006, Vol. 6, No. 4, 611-621.
Examples of Global Style in Client
Self-Reports
•  “I just want to be happy”

•  “I just want to feel normal”
•  “I am my depression” (anxiety, history, or
diagnosis)
•  “I’m just so overwhelmed”
•  “I get so bad I just can’t think”
•  “The symptom just happens to me”
www.yapko.com
Examples of Global
Therapeutic Truisms
•  “Trust your guts” (inner sage, unconscious)
•  “Life is what happens to you when you had
other plans”
•  “Just let go…no need to try to control it”
•  “Be fully present in the moment”
•  “It’s a disease…it’s not your fault”
•  “Everyone is entitled to good self-esteem”
www.yapko.com

Lily Tomlin

www.yapko.com
Someone may be global in one area –
certainly the symptom context – yet
be fully capable of detailed or linear
cogni6on in other areas

www.yapko.com
Global Thinking vs. Compartmentaliza6on
Across Common Treatment Issues
If you can’t compartmentalize, how can you:

•  Have and maintain good personal boundaries
•  Contain anxiety and “do it anyways”
•  Accept a limitation in one’s self or others
•  Forgive a transgression in one’s self or others
•  Develop frustration tolerance
•  Exercise impulse control
•  Focus and experience hypnosis
www.yapko.com

Cogni6ve Style and Hypnosis


www.yapko.com
So ofen, the founda6on of peoples’
problems is found in their focusing
on aspects of experience that work
against them

www.yapko.com
Hypnosis and Re-‐direc6ng Focus
•  Focusing globally on what’s wrong, not
no6cing what’s right
•  Focusing globally on past hurts, not specific
future possibili6es
•  Focusing globally on helpless feelings, not
specific proac6ve solu6ons
•  Focusing globally on the subjec6ve, missing
specific chances to reality-‐test
www.yapko.com
It amplifies and/or de-‐amplifies specific
elements of experience.
It generates associations and dissociations.

www.yapko.com
The primary purpose of hypnosis and
related approaches such as mindfulness is
to absorb the person in a frame of mind
that is consistent with the therapeu6c
objec6ves
Using experien6al approaches to teach
empowering emo6onal self-‐regula6on (ESR)
strategies is a core part of that process

www.yapko.com
www.yapko.com
The Salient Ques6ons
You Can Be Curious About
•  How does paying a[en6on – focusing – translate into non-‐
voli6onal yet meaningful responses?
•  Why do some people respond so drama6cally to
experien6al processes such as hypnosis, finding them
“transforma6ve”?
•  What general factors determine one’s capacity to
respond?
•  What role do specific factors such as expectancy,
sugges6bility, and dissocia6on play in client response?
•  Can an individual’s quality of responsiveness be increased?
www.yapko.com
Why Hypnosis for Depression? Because it
Empowers People
Hypnosis:
•  Helps people focus
•  Facilitates the acquisi6on of new skills
•  Encourages people to define themselves as
resourceful
•  Eases the transfer of informa6on across contexts
•  Intensifies useful subjec6ve associa6ons
•  Provides experien6al learning
•  Defines people as ac6ve managers of themselves
www.yapko.com
The ability to detach from your
own thoughts and other aspects
of your internal experience is
essen6al to transforming it
What role does dissocia6on play in this process?
How might this be amplified hypno6cally?
www.yapko.com
Clearly, people differ greatly in
their dissocia6ve capaci6es
Global cogni6on as a determinant
of hypno6c responsiveness?

www.yapko.com
Powerful: Creating new “realities”
(e.g., “The inner child”)
Powerless: Overlooking everyday insights


www.yapko.com
Concreteness in
Interven6ons is Vitally Important
¨ “Manipulating the mode of self-focused

rumination in depressed patients differentially
influenced social problem solving, such that
concrete ruminative self-focus significantly
improved problem-solving relative to abstract
ruminative self-focus…increased concreteness
of thinking will produce better problem
solving compared with less concrete, more
abstract, thinking” (p. 326)
Watkins & Moulds, Emotion, September, 2005, 5(3), 319-328

www.yapko.com
Key Point:
Hypnosis can be used especially well
to help people make key dis6nc6ons
and lead them through specific
effecBve sequences of thought,
feeling and behavior for applying
these sequences skillfully

www.yapko.com
Depressed and Anxious
Individuals Tend to Underes6mate
Their Personal Power…
Thus, either passivity or impulsive
reac6ons can seem like
reasonable (though ineffec6ve)
responses

www.yapko.com
Strategic Methods of Interven6on

www.yapko.com
We all seem to know that
homework is important to assign…
But not all homework assignments are of
equal value in achieving their objec6ves

www.yapko.com
Remember the “African Violet Lady of
Milwaukee?” This was a case Erickson
reported in A Teaching Seminar with
Milton Erickson, (Jeff Zeig, 1980)
Erickson treated a 52 year old spinster who lived
alone in a big house. She was deeply depressed and
terribly isolated. Her nephew, a physician who knew
Erickson, asked him to see her on an upcoming trip to
town…
www.yapko.com
Erickson encouraged her to ac/vely
engage on a variety of levels:
•  Behavioral ac%va%on: Grow African violets in
large enough quan66es to share generously
•  Cogni%ve ac%va%on: Pay a[en6on to others’
celebra6ons and iden6fy their significance
•  Social ac%va%on: Engage with others and
selflessly contribute to their lives
•  Emo%onal ac%va%on: Focus on and amplify the
feelings of warmth, compassion and generosity
www.yapko.com
I encouraged David to acBvely engage
on a variety of levels:
•  Behavioral ac%va%on: Go to the mall and carry out
a behavioral experiment
•  Cogni%ve ac%va%on: Compartmentalize anxiety;
Pay a[en6on to others’ responses and consider
their significance and contradic6on to his views
•  Social ac%va%on: Engage with others and evolve
skills in asking ques6ons, listening and contribu6ng
•  Emo%onal ac%va%on: Focus on and amplify the
feelings of curiosity, acceptance and enjoyment
www.yapko.com
Communicating the need for
action is critical in treating
depression well
How do you communicate your expectation
that the client will be active in treatment?

www.yapko.com
The Art of Behavioral Ac6va6on:
Defining the rela6onship

Modeling
Follow-‐up
www.yapko.com
Two Factors Are Especially Powerful
in Shaping Proac6ve Behavior:
Expectancy and Rumina%ve Coping

www.yapko.com
An ideal use of hypnosis is to introduce an
idea and then “seed” forthcoming
homework that amplifies the salient
learning

www.yapko.com
The use of strategic
homework assignments
Dozens of task assignments are detailed in my
books, Breaking the PaAerns of Depression and
Depression is Contagious

www.yapko.com
Rigidity is the target
Rigidity is the lack of variability in response

across a variety of contexts

www.yapko.com
Types of Rigidity
•  Cogni6ve rigidity
•  Behavioral rigidity
•  Emo6onal rigidity
•  Perceptual rigidity
•  Iden6ty rigidity
•  Rela6onal rigidity
•  Situa6onal rigidity

www.yapko.com
Examples of Strategic Methods for
Treating Depression
q Target: Ignorance. Method: Psychoeducation

(“Depression is a complex, multi-dimensional disorder”)
q Target: Self-Blame. Method: Reframing
(“It isn’t that you’re sick, it’s the way you go about it”)
q Target: Global cognition. Method: Linear sequencing
(“A flow of steps…create a flow chart for the action”)
q Target: Negative focus. Method: Gratitude journal
q Target: Rigid interpretations. Method: Re-attributing
events (“How else might that be explained?”)
www.yapko.com
Skill-‐building in treatment
and preven6on

www.yapko.com
The Founda6on of Preven6on is the
Ability to Think Ahead
Emphasize the Skill of Foresight

www.yapko.com
www.yapko.com
Preven6on Opportuni6es

•  Expanding diagnos6c opportuni6es
•  Addressing sleep
•  Encouraging exercise
•  Working with couples and families
•  Screening for postpartum depression
•  Iden6fying children at risk
•  Teaching social and problem solving skills
•  Prac6cing foresight
www.yapko.com
A Major Resource on
Preven6on of Depression
•  The 2009 Ins6tute of Medicine Report, PrevenBng
Mental, EmoBonal, and Behavioral Disorders
Among Young People: Progress and PossibiliBes,
listed several randomized trials in which the
propor6on of new cases of major depressive was
significantly reduced in par6cipants randomly
assigned to a preven6ve interven6on compared to
a control group.
Na6onal Research Council & Ins6tute of Medicine (2009). PrevenBng Mental,
EmoBonal, and Behavioral Disorders Among Young People: Progress and
PossibiliBes. O’Connell, M., Boat, T., & Warner, K. (Eds.). Washington, D.C.:
Na6onal Academies Press. Michael D. Yapko, Ph.D.
www.yapko.com
An Excellent Review of the Current
Depression Preven6on Literature
•  See “Major Depression Can be
Prevented” by Ricardo Muñoz, William
Beardslee, and Yan Leykin in the May-‐June,
2012, issue of American Psychologist (Vol.
67, No. 4, 285-‐295).
•  Meta-‐analyses suggest that 22-‐38% of major
depressive episodes could be prevented
with currently available methods.
www.yapko.com
Please visit my website
(www.yapko.com) to join my
electronic mail list in order to
receive my monthly newsle[er
Also, you’ll find ar6cles posted there as well as
informa6ve videos

www.yapko.com
e-mail: michael@yapko.com
website: www.yapko.com
P. O. Box 487
Fallbrook, CA. 92088-0487
USA

www.yapko.com

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The

Milton H. Erickson Founda6on

Michael D. Yapko, Ph.D.

• Gene6cs and Epigene6cs

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

… un6l recently a terribly overlooked

Michael D. Yapko, Ph.D.

Internal, stable and global a[ribu6ons, nega6ve

Michael D. Yapko, Ph.D.

When you can’t see the

Michael D. Yapko, Ph.D.

“Depressed individuals suffer from an overgenerality

Michael D. Yapko, Ph.D.

• “I just want to be happy”

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

If you can’t compartmentalize, how can you:

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

¨ “Manipulating the mode of self-focused

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

Deﬁning the rela6onship

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

Rigidity is the lack of variability in response

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

q Target: Ignorance. Method: Psychoeducation

Michael D. Yapko, Ph.D.

Emphasize the Skill of Foresight

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

Michael D. Yapko, Ph.D.

Das könnte Ihnen auch gefallen

•  Gene6cs and Epigene6cs

•  “I just want to be happy”

¨ “Manipulating the mode of self-focused

q Target: Ignorance. Method: Psychoeducation