In archival training videos, Dr. Kappas was testy about “talk therapy.” A licensed psychotherapist himself, he bemoaned the first-session tradition of taking inventory of all the clients problems, sending them home feeling even worse about themselves than they came in. Traditional talk therapy (Freudian analysis) was characterized as torture – essentially forcing the client to confront their deficiencies until they got bored and decided that they would really rather change.
Perhaps recognizing these defects, talk therapy branched along several lines (Jungian, Rogerian, etc.). Then, as functional imaging (PET and fMRI) brought insight into the workings of the brain, innovations focused on shifting the response from primitive emotional centers of the brain forward into the prefrontal cortex. The prefrontal cortex contains Freud’s superego – that part of the mind that understands the self and seeks to adapt it to achieve success. In large part that is done by suppressing the activity of the more primitive parts of the brain.
These techniques have begun to be collected under the banner of Cognitive Behavioral Therapy (CBT). The psychologists are proud of their accomplishment. In “The Cognitive Behavioral Workbook for Anxiety,” William Knaus touts it as the “gold standard” for treating anxiety. In fact, regarding anxiety as well as depression, CBT appears to be more effective than drug therapy.
So I looked forward to Knaus’ writing with interest. There is a good deal to recommend in it – at least to a sophisticated college graduate. In fact, I would hazard that despite the “Workbook” in the title, not a great many will be able to make full use of the material found here. For example, in explaining why anxious thoughts are hard to control, Knaus lists nine different sources, including such subtle shadings as “loss of perspective” and “faulty expectations.” While perhaps foundational, as each source requires a slightly different technique, this is daunting.
To the sufferer, anxiety is first and foremost an emotional experience. What is the value in these nuanced shadings? Knaus doesn’t provide that motivation.
Given Dr. Kappas’ critique of talk therapy, with some chagrin I must admit that Knaus starts with just such a survey of twenty-one (21!) “indicator statements,” each with cross-references to sections on treatment. Typical is “I’m uncomfortable about making changes,” cross-referenced to chapters 14, 6, 7, 10, and 21.
Each chapter starts with a description of an anxiety trap, with a full description of the pattern of thinking that unfolds when the mind is in its grip. With that pattern defined, the chapter identifies points of intervention that can be used to disrupt the pattern. Assuming a successful intervention, mindful awareness (being in the present moment) defuses tension, allowing the sufferer to take positive, rational action to improve their situation. The whole strategy is summarized as a table or chart that walks them step-by-step toward relief.
Although sometimes it’s not that simple. For example, in Chapter 14 we have a change process with six (6!) phases: approach, awareness, action, accommodation, acceptance, and actualization. Three of the phases have a table or chart.
To simplify digestion, many of the chapters contain “Top Tip” boxes. These are often pithy metaphors for the formal process, culled from the teachings of respected researchers and therapists.
Multiply this by twenty problem-solving chapters, and you’ll understand my concern about accessibility.
If this sounds dry, that’s a fair statement. But that’s part of the method: CBT builds rational control over our thought processes. First we prepare the prefrontal cortex to monitor our thinking while going through an anxiety attack. Then we have to go through the attack without getting wrapped up in what we’re feeling. We need to be dispassionate about it if we’re going to succeed in learning to control those feelings. Indeed, many forms of anxiety (such as “Double Trouble”) involve anxiety about our inability to control our anxiety – a kind of self-reinforcing emotional loop. The only way to shut that off is to turn the focus from feelings to thinking.
To this point, then, I am doing my best to credit the intentions and rationale of the proponents of the CBT approach. But as I slogged through chapter after chapter (before surrendering around chapter 16 to my frustration), I kept on looking for the basics of self-care. This finally comes in the last chapter, “Preventing Anxiety and Fear From Coming Back.” Here we find basic prescriptions: be alert to the emotional warnings that you’re heading into unproductive thinking; exercise; sleep; eat well.
Now as a hypnotherapist, we understand that this isn’t just for recurrence – it’s prevention in the first place. Failing to perform self-care leads to a condition called hypersuggestibility. Hypersuggestibility occurs because the rational part of our mind is an optional function. When deprived of resources through emotional overload, inefficient metabolism, insomnia, or malnourishment, our reason breaks down. Planning goes out the window, and we react to every input when it comes at us – extending to our own thoughts. Already in a state of stress, with every trigger the subconscious mind pushes on the anxiety pedal to produce a strong fight/flight response – a response that is reinforced each time we “survive” our imaginary crisis. Unfortunately, as we become immune to minor anxious thinking, the only way to generate a respectable fight/flight response is to imagine the worst possible scenario. In fact, the mind is constantly searching for the worst possible scenario to ensure that it can summon the fight/flight response.
All this is going on in the subconscious – at the pre-conscious level.
As taught by Dr. Kappas, one of hypnotherapy’s most powerful methods is dehypnotization – to teach the client how to avoid the state of hypersuggestibility. This begins by reminding them how wonderful it can feel to be in homeostasis. It is reinforced by demonstrating how much easier it is to generate constructive thoughts when we are in that state. It is clinched by demonstrating that in homeostasis we are more receptive to information. Everything about life and survival is better served from homeostasis until we encounter unfamiliar and threatening circumstances that require the fight/flight response – and that response will be more effective having preserved resources by staying in homeostasis until survival is threatened.
The formal technique is called “systematic desensitization.”
Hypnotherapy starts where CBT ends. Think about it – if you’re reading the Workbook, you know that your thinking is hurting you. You don’t need someone to teach you how to think. You need to be reminded how to control your emotional state. Yes, CBT will eventually get you there, if only by boring you to tears with your defective thinking.
But in understanding the relationship between the conscious and subconscious minds, Kappasinian hypnotherapy will take you straight to the end of the journey. It will get the two tracks of your mind – reason and emotion – back into convergence.