Re-thinking the treatment of depression: have we been misinformed about antidepressants? A webinar discussion with Irving Kirsch, Ph.D. and Michael D. Yapko, Ph.D.

This article provides an edited transcript of a moderated discussion between depression experts Irving Kirsch and Michael Yapko regarding the role of antidepressants in the treatment of major depression. It includes references to the role of expectancy and the merits of hypnosis in treatment. This presentation was sponsored by MindsetHealth, an Australian-based digital therapeutics company (mindsethealth.com) and took place online on March 28, 2023. As a webinar offered at no cost, it was open to anyone with an interest in the subject. Dr. Kirsch described his landmark research on the placebo effect and its curious relationship to the presumed merits of antidepressant medications. Dr. Yapko discussed the limitations of drug treatment based on the substantial evidence indicating that depression is much more a social problem than a medical one. The moderator for this discussion is Claire Davidson, who serves as the Research Lead at MindsetHealth. Drs. Kirsch and Yapko both serve on the MindsetHealth Scientific Advisory Board.

Addressing global cognition and ineffective depressogenic discrimination strategies with clinical hypnosis.

It is a fundamental truth in living that the quality of your decisions shapes the quality of your life. One's cognitive style determines whether one is more likely to be detailed and linear in thinking or more general and impressionistic, obvious influences on the way experiences are interpreted and reactions formed. Global thinking, also referred to as over-general thinking, has been linked to depression for several reasons. These include the lack of detail in making important discriminations that would reduce or eliminate the kind of self-injurious and depressogenic decisions described in the "stress generation" model of depression. The importance of having meaningful strategies for making effective decisions on a situation-by-situation basis cannot be overstated. Cognitive psychologists and cognitive neuroscientists use the term "discrimination" to describe the process of making distinctions between different situations that give rise to one's reactions. In this article, hypnosis is described as a vehicle for teaching global thinkers to be more skilled in making important discriminations. A sample hypnosis script is provided to illustrate the process.

The "Whack-a-Mole" Challenge of Hypnosis Research: A Commentary Regarding "Guidelines for the Assessment of Efficacy of Clinical Hypnosis Applications".

In this short commentary, the author acknowledges the merits of trying to establish treatment guidelines for the use of hypnosis in treatment and applauds the efforts and intentions of the Task Force for Establishing Efficacy Standards for Clinical Hypnosis. He identifies a few of the complex issues in trying to promote guidelines for conducting research and clinical practice in the domain of hypnosis; these include the difficulties in defining hypnosis and hypnotically-based interventions, the divergent ways hypnosis is applied in actual practice by clinicians who rely on their own understandings and biases in designing and delivering hypnosis, and the inevitable variations in skill level across practitioners. To their credit, the Task Force has considered these and other practical issues in their approach to formulating guidelines.

Encouraging hindsight in advance: Age progression in therapy - and life.

Each person forms a relationship to the dimension of time, called a "temporal orientation." How that relationship is defined and prioritized, whether consciously or non-consciously, plays a huge role in the way people go about living their lives. In psychotherapy, the quality of one's expectations plays a pivotal role in virtually every phase of treatment. As a class of hypnotic interventions, age progression treatment strategies are intricately connected to expectancy since they typically involve guiding the client experientially, i.e., subjectively, into the future. While absorbed in this suggested projection, clients may have the opportunity to imagine and experience the consequences of current or new choices, integrate suggestions at deeper levels for eventual activation, rehearse new patterns of thought, feeling or behavior, and, in general, obtain a greater overview of his or her life than a narrower focus on day-to-day living typically affords. To paraphrase Milton Erickson, one can think of it as encouraging hindsight while it is still foresight.

Contemplating the Obvious: What you Focus On, you Amplify.

Mindfulness has been transformed over recent years from a spiritual practice to a method of clinical intervention. This is a new evolutionary step in applying mindfulness in ways that move it much, much closer to the related domain of hypnosis. Both approaches now share a goal-oriented, purposeful clinical pragmatism. This contribution is an "op-ed" piece regarding the author's view of the distant relationship between mindfulness and hypnosis practitioners. Understanding of the similar and differential aspects of mindfulness and hypnosis can be enhanced by recognizing that "what is focused upon is amplified." Similarities between hypnosis and mindfulness should be more widely recognized. Differences between hypnosis and mindfulness exist but not because of innately different structures. Rather, differences exist because of what each general approach is likely to focus upon in regard to goals and content.

The spirit of hypnosis: doing hypnosis versus being hypnotic.

The spirit of hypnosis is reflected in the belief that people are more resourceful than they realize and through hypnosis can create meaningful possibilities. Thus, it is puzzling why hypnosis isn't better regarded. Do we present as too internally conflicted to inspire others' confidence? Do we overstate the dangers of hypnosis and scare people away? Do we define hypnosis as such a unique approach that others don't see its relevance for their work? Self-exploration is important if we want to ensure we are not unwittingly adding to our image problems as a field. Beyond these considerations, the novel and spirited application of hypnosis in the context of captive elephant breeding is discussed, as is a personal acknowledgment of some of the pioneers who manifested the spirit of hypnosis.

Treating depression with antidepressants: drug-placebo efficacy debates limit broader considerations.

The core issue regarding antidepressants for many clinicians is whether they perform significantly better than placebos. However, this article suggests eight additional concerns beyond drug efficacy alone to consider regarding antidepressants including: (1) formulating only a one-dimensional, biological view of depression; (2) defining the client's role as passive in treatment; (3) economic corruption of the research and reporting; (4) false or misleading consumer advertising; (5) conflicting data that confuse practitioners and consumers alike; (6) over- and under-prescription of medications; (7) drug side-effects; and (8) harm to the environment. The enhanced effects of psychotherapy utilizing hypnosis offer a means of avoiding most, if not all, of the problems associated with the use of antidepressants as a primary form of treatment.

Hypnotically catalyzing experiential learning across treatments for depression: actions can speak louder than moods.

A number of psychotherapeutic approaches for the treatment of major depression have received empirical support in the literature, most notably cognitive-behavioral and interpersonal therapies. Recent studies have shown the therapeutic value of the behavioral activation component of such interventions. Depressed individuals actively learning and applying new skills on their own behalf is widely considered a critical component of recovery. This article describes the use of hypnosis to catalyze experiential learning and to encourage behavioral activation in the depressed client by directly addressing and transforming cognitive and perceptual patterns that can impede such behavioral activation, especially global thinking and ruminative coping styles.