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Cognitive Behavioural Hypnotherapy and Dialectical Behaviour Therapy within therapeutic work

Updated: Apr 12, 2022

I wanted to explain here in my blog a little about DBT, or Dialectical Behaviour Therapy, as the type of hypnotherapy that I practice, cognitive behavioural hypnotherapy, utilises many techniques that have their origins in the same behavioural field as DBT - e.g. the modalities (types of therapy) have similarities, because they're both within the behavioural field. (To credit the appropriate individuals, Marsha Linehan created DBT, and Donald Robertson, and later Mark Davis, developed Hypno CBT®).

DBT is a type of talking therapy based on cognitive behavioural therapy (or CBT), but it's especially focussed on emotional regulation.

The aim of DBT is to help clients -

*Understand and accept difficult feelings

*Learn skills to manage them

*Become able to make positive changes in their life

In case you’re wondering, ‘dialectical’ means to balance two opposite things. So it can be useful if you’re prone to black & white thinking. (Useful for neurodivergent individuals!)

CBT, or Cognitive Behavioural Therapy, focuses on helping you to change unhelpful ways of thinking and behaving, and while DBT does this too, it also focuses additionally on acceptance, as well as mindfulness and relaxation.

Cognitive Behavioural Hypnotherapy (CBH) as a model is geared to how we think about our own attention that is focused on thoughts, expectation and motivation. The modality places a good deal of emphasis on the Now. CBH interventions are cognitive-behavioural – so they include aspects like finding new ways of thinking, finding ways to let go of thoughts, learning how to relax and how to calm down, as well as how to problem solve, amongst others.

So here are two example of how I might use DBT-type behavioural skills in an online hypnotherapy session - please note that this does not represent a typical 'Hypno CBT®' session - because my own interest and CPD in nervous system theories, e.g. nervous system regulation, and the use of safety anchors to help bring us to a point of a more 'safe' place of connection in the autonomic nervous system - is an additional field to the 'core' CBH interventions and theories:

· Time travelling (now, past or present)

· RED tool

The time travelling exercise (are you in the Now, the past or present?) – includes learning distress tolerance skills and 'safety anchors', which in my mind help 'anchor' our nervous system into a 'safer' place. Here, I describe the skill itself:

The next time you are in a distressing situation (e.g. triggered into anger by a partner in an argument), ask yourself the following questions:

Where am I right now? Am I forward projecting into the future, worrying about something that might happen?

Or am I time travelling to the past; using my memories to review mistakes? Or am I in the present, responding based on the Now?

If you're not in the present moment, refocus your attention on what's happening to you now, by using the following steps -

1. Notice what you're thinking about, and recognise if you're forward projecting into the future, or time travelling to the past,

2. Notice how you are breathing - take long, slow breaths to help you refocus on the present. This is a nice tension release breathing exercise: Breathe in. Hold for six counts, or however long is comfortable; and breathe out very slowly. Repeat at least three times.

3. Notice how your body feels and observe any tension. Recognise how your thoughts might be contributing to how you're feeling. Try to be an observer of the thoughts, rather then ‘embedding’ yourself in the ‘story’.

4. Use cue controlled relaxation to release any tension. (Clients: ask Kathy for an audio recording, using this technique.) The cue could be verbal or physical, e.g. touching two fingers together, and is usefully practiced during a hypnotherapy session and by the individual at their leisure.)

5. Notice any difficult emotions you might be feeling as a result of time travelling, and use a distress tolerance skill (also described by Kathy as a tool in an emotional toolbox), to help you relieve any immediate discomfort.

Learn/use distress tolerance skills, based on soothing yourself using one of your five senses:

· For example, touch could be sitting with a weighted or tactile, furry blanket; or you could tap the collar bone or side of the hand, stroke the upper arms/shoulders, etc, while saying something positive (ask Kathy for her list of ‘coping statements’, such as ‘This won’t last forever’ or ‘I can do this’.)

· Taste could be eating or drinking something that feels good, or a particular favourite sweet.

· Hearing could be listening to a relevant playlist suited to the state that you are in, or listening to a podcast or comedy show.

· Using your vision could include doing some kind of art or keeping a photo in your wallet that is meaningful to you.

· Your sense of smell could utilise favourite scented oil on a handkerchief.

Other distress tolerance skills (which are also sometimes described as (or link to) 'safety anchors', as they can 'anchor' the autonomic nervous system to a more 'safe', connected place), could include time with loved ones or pets; time in nature; distraction - for example, counting down from 100; some kind of meaningful task that makes you feel good; mindful meditation; getting something cold on the wrists / temples (see below); using an affirmation (e.g. I am in control of my mind and body); and visualising a safe and positive place.

(The Hypno CBT® model has some beautiful hypnosis exercises that I sometimes do with clients, along these lines).

You could also use your senses to ground you – e.g. name 5 things you can see; 4 you can touch; 3 you can hear, 2 you can smell, and 1 you can taste.

In a hypnotherapy session

In a hypnotherapy session, we could, in hypnosis, visit a particular scenario whereby the client commonly 'time travels' backwards or forwards, using their imagination.

Utilising aspects of the ABC model, created by Dr. Albert Ellis under the umbrella of Rational Emotive Behaviour Therapy (REBT), we might explore the client's 'normal' patterns of relating; e.g. within their scenario, we may look at the 'adversity' or activating event (e.g. they're triggered into anger by a partner in an argument). We'd go onto look at any beliefs (and thoughts) around the event, and also consider the consequences, which may include any behavioural or emotional responses. If the client is time travelling backwards, they may for example be repeating earlier familial patterns concerning how quickly they rise to anger, to defend their emotions. (Defence mechanisms).

And then we may rehearse the optimum way to respond in future, e.g. from the Now; what more rational beliefs could we consider? What associated thoughts? What (more helpful) behavioural or emotional responses could we imagine? This exercise is useful if there's a specific scenario a client is dealing with, as described above, e.g. triggered into anger by a partner.

Or, we may just discuss the above themes and ideas within 'psychoeducation', as opposed to doing an exercise in hypnosis, depending on the client in question.

RED tool (my own tool simplified from the REST acronym, Relax; Evaluate; Set an Intention, and Take Action, from DBT), for when someone’s triggered. (Seeing red?)

I suggest to clients that they practice the ‘R’ and ‘E’ stages of this 'tool' or acronym day to day - e.g. at the traffic lights, or when boiling a kettle! Then when activated / heightened or triggered, they can actively go through the whole process - once practiced, the process of pausing before reacting feels familiar, and the brain/body can access it. It gives you a CHOICE BUBBLE - so you can respond, and not react based on out of control emotions.

(I love Viktor E. Frankl's quote as follows, which reflects this 'choice bubble': “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”)

In the acronym, R is regulate - meaning, relax, and use regulatory breathing techniques. E.g: breathe in. Hold for six counts, or however long is comfortable; and breathe out very slowly. Repeat at least three times.

Evaluate – this is to take a moment to respond, not react – what’s going on? Is my body in danger – what has happened to my autonomic nervous system? Mindfully connect to the surroundings. What can I see etc? Bring the attention back internally to Self.

D is ‘do something’. If you need to stay calm, here is when you use tools from your ‘emotional toolbox’; e.g. the distress tolerance skills above, that can help to soothe yourself using one of your five senses. You could also use something cold on wrists / temples (water from a bottle?), listen to a music track, count backwards from 100, use an affirmation (e.g. I am in control of my mind and body), close the eyes and visualise a safe and positive place, tap the collar bone or side of the hand, stroke the upper arms/shoulders (as in 'Havening'), etc. Alternatively, maybe you do need to respond; e.g. set a boundary; move quickly or remove yourself from a situation; be assertive; express your needs calmly; but you are responding, and not reacting! You are responding from the Now, and not reacting from the past/future.

So, if you remember the RED acronym, you can practice the ‘R’ and ‘E’ stages day to day; for no reason other than to embed the acronym, and practice. It’s useful, as once it is practiced, it is easier to access when triggered, e.g. when the very first signs of ‘being heightened/triggered’ come; e.g. when the conversation with your partner (for example) results in you feeling heightened and triggered.

Other tools I may use from the DBT and Hypno CBT®-inspired toolbox include the use of coping statements and self affirming statements; the exercise 'assessing the feelings and threat balance', whereby we look at the intensity of emotion when distressed, and compare it to the 'actual damage' or danger present, sometimes using 'units of distress' as a measurement tool. (If the figures don't match, coping (distress tolerance) skills may be needed, as described above); as well as mindfulness and meditation skills.

I hope this blog has been useful! A podcast will follow. Do contact me if you'd like to find out more or book a holistic online hypnotherapy session.


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