Hypnotherapy Needs Exposure Therapy?
Do you have a phobia that you are considering treating with hypnotherapy alone without exposure therapy? Read further to learn why this is not only a bad idea but also a complete waste of money. Additionally, avoiding exposure therapy will actually make your phobia worse!
Phobias can be debilitating, trapping individuals in a cycle of fear that limits their daily activities. While various treatments are available, the effectiveness of hypnotherapy without immersive exposure therapy remains a contentious topic. This article delves into the scientific reasons why hypnotherapy alone is insufficient for curing phobias and highlights the necessity of combining exposure therapy for lasting change.
Clinical vs. Stage Hypnotherapy
Just to be clear about what I mean about hypnotherapy, it is clinical hypnotherapy that is relevant. Clinical hypnotherapy differs significantly from stage hypnotherapy, which is purely for entertainment and often misleads people into believing they lose control when hypnotised. In reality, during clinical hypnotherapy, individuals remain in complete control. Stage hypnosis is actually not real hypnosis at all and is entirely performative.
Clinical hypnotherapy involves entering a highly relaxed state, facilitating inner absorption and focused attention. It is a state where we can make changes more easily within the subconscious mind. I like to call it ‘consciously going into the subconscious.’ The person being hypnotised can get up at any time they want, they do not lose ability to connect with reality. They are simply in a deeply relaxed state. Many people might not realise the difference so I wanted to establish this at the beginning for clarity’s sake.
Definition of Immersive Exposure Therapy
Immersive exposure therapy is when someone will face the actual fear trigger, thus immersing and exposing oneself to that fear. The goal is to train the brain that the trigger of the phobia is not actually a threat. This process involves gradually and repeatedly exposing individuals to their phobic triggers in a controlled environment. Hypnotherapy can be supportive of exposure therapy but, as we will prove, will not work on its own to cure a phobia. We will explore scientifically how exposure therapy is the only way for the survival part of our brains to learn and make lasting changes around fear.
Misleading Claims That Can Make Your Phobia Worse
Many people are tricked into buying hypnotherapy treatment for phobias that claim no “nasty” exposure therapy is needed. This notion appeals as it promises an easy way out without the discomfort of facing your fear. However, taking action and facing one’s fears are essential for overcoming phobias permanently (APA, 2017).
Though facing your fears is difficult, emotional, and challenging, so is the way for most things worth accomplishing. Taking the easy way out by avoidance actually only reinforces the fear. This is why doing hypnotherapy alone and avoiding exposure therapy can actually make your phobia worse!
The Role of Avoidance in Reinforcing Fear
Avoidance is a common reaction to fear. It is a natural response of the brain’s survival mechanism, aimed at protecting us from perceived threats. However, avoidance can paradoxically reinforce and deepen our fears. This is incredibly inconvenient when this happens around ‘threats’ that are not actually threats. Understanding the role avoidance plays is crucial for overcoming phobias and anxiety disorders. To understand this, let’s first look at the basics of how fear operates within the relevant parts of our brains.
The Survival Brain and Fear Responses
The amygdala, or the ‘survival brain’ is a part of our brain’s limbic system that plays a critical role in our fear response. It assesses threats from memories of past experiences and then triggers the fight-or-flight reaction. This ancient survival mechanism is designed to protect us from danger. However, when the amygdala records a non-threatening stimulus as dangerous, it leads to irrational fears or phobias. Unfortunately, it is often inaccurate about real danger!
Inconveniently, the amygdala doesn’t realise that thousands of years have gone by and that we are no longer cavemen living in the bushes. We have evolved too quickly for it to have adapted to our current living conditions. Back then, everything could kill us, so we needed an heighten sense of danger and precaution. Obviously, this is no longer the case in our modern age. The risks to our lives are significantly lower. Now, more than ever, humans are living longer and healthier with the aid of modern medicine and science.
A Disconnection from Rational and Logic
Unfortunately, the amygdala is unable to communicate with our pre-frontal cortex. This is the more rational side of our brains that can make better judgement calls and rationalise about how dangerous something actually is. Where the prefrontal cortex can understand grey, the amygdala only sees things in black or white, all or nothing (Hartley & Phelps, 2010).
Our survival brain would much rather sacrifice new experiences and growth for the ‘better be safe than sorry’ approach. The amygdala is not willing to take any risks. Your happiness and mental wellbeing are not a priority for the amygdala. Just keeping you safe and alive is all that matters, even if that means you are scared and stressed out all of the time. This is why the amygdala’s reaction is disproportionate to the actual threat posed, explaining how phobias often seem irrational.
Frustratingly, because these two sides of our brains are not communicating, we cannot simply talk ourselves out of a phobia. We can only teach the amygdala through taking action and creating new positive memories around the trigger. So, avoiding facing your fears with an easy way out with hypnotherapy alone is only going to train your brain to be even more afraid. Let’s take a closer look about why this is.
How Avoidance Strengthens Fear
Avoidance prevents the brain from learning that the feared trigger is not harmful. As mentioned, it actually makes the fear worse. When you avoid you are confirming your amygdala’s threat assessment of the trigger as being valid as accurately dangerous. This then reinforces the idea that the fear and anxiety experienced over the trigger is justified and necessary for survival. This means your amygdala will make you feel even more fear the next time you encounter the trigger. This is why phobias get worse over time. (Craske et al., 2014).
The Cycle of The Avoidance Habit
- Encountering the Fear: When faced with a phobic trigger, the amygdala signals fear and creates uncomfortable feelings both physically and mentally.
- Avoidance Behaviour: To avoid this discomfort, the individual then avoids the trigger.
- Reinforcement of Fear: Avoidance provides a reward of temporary relief but strengthens the fear response over time, creating long term suffering as anxiety is increased more and more.
Just like you train a dog with positive reinforcement such as with a treat or affection, you wrongfully reward and train your amygdala with avoidance. To overcome fear, it is essential to break the avoidance cycle. When you keep living in the avoidance cycle, it means that your primitive survival instinct is in the driving seat, making your choices for you. These choices made from fear are usually limiting, irrational and often isolating. When your survival instinct is calling the shots, you will not grow as a human being and live in constant anxiety.
I will explain scientifically how exposure therapy plays a key role in breaking this cycle. Understanding how phobias form and operate in the mind helps to illuminate the importance of why exposure therapy is so necessary.
Understanding Phobias
Phobias are intense, irrational fears of specific objects or situations, usually formed in childhood from learned behaviour or a frightening memory. Memory plays a crucial role in phobia development. When a person encounters a fear-inducing stimulus, the amygdala records this experience, creating a memory link between the stimulus and fear. This link persists and is strengthened each time the person encounters the trigger and reacts with avoidance. This then causes the person to experience intense fear whenever they encounter the stimulus again.
The amygdala then stores these fear memories and learned behaviours. When faced with a phobic trigger, the amygdala sends a distress signal, prompting a fight-or-flight response.
The amygdala quickly assesses potential threats and triggers a physiological reaction. This reaction, however, is based on stored memories rather than rational analysis which happens in the pre frontal cortex. And because these two part of the brains are not able to communicate, rational thinking fails to stop the fear response. Though the brain is trying to ‘protect’ us, it’s over the top threat assessments usually are just getting in the way of living life.
The Limits of Hypnotherapy in Phobia Treatment
Hypnotherapy involves inducing a trance-like state to explore thoughts and feelings in the conscious and subconscious mind. While it can offer temporary relief and insight, it lacks the essential component of actual real-world experience to create new memories. As mentioned, creating memories are the only way the amygdala can learn and change.
In short, you need to have a memory of facing the fear, pushing through the fear and coming out the other side unharmed. This is the only way for our survival brain to let go of its need to protect us from the trigger and its perceived threat. It NEEDS to know that the trigger is safe. This is why immersive exposure is so necessary for reconditioning the amygdala’s response to fear triggers.
Habituation and Extinction
Exposure therapy is grounded in the principles of habituation and extinction. By confronting their fears in a safe setting, individuals can desensitise their amygdala’s response over time.
Habituation is a form of non-associative learning in which a non-reinforced response to a trigger decreases after repeated or prolonged presentations of that trigger. Extinction refers to the fading away and eventual elimination of undesirable behaviours. Habituation occurs when the brain becomes accustomed to a trigger after repeated exposure, leading to a decrease in fear response. Extinction involves the gradual weakening of the conditioned fear response. Together, these processes help recondition the brain to perceive the phobic trigger as non-threatening (Myers & Davis, 2007).
The Process of Change
- Initial Exposure: The individual is exposed to the fear-inducing trigger in a controlled and safe manner.
- Repeated Exposure: Through multiple experiences, the brain learns to associate the trigger with safety rather than danger.
- New Memory Formation: The amygdala forms new memories, recognising the trigger as harmless.
The Importance of Multiple Exposures in Forming New Habits
One-time exposure is insufficient for lasting change. To have lasting results, multiple experiences of safely experiencing the trigger are needed to rewire the brain. These experiences then become new habits. Habits are automatic behaviours triggered by specific cues or triggers. Phobias can be seen as maladaptive habits where the cue (phobic trigger) leads to an automatic fear response. The reward in a phobia habit loop is from the temporary relief avoidance gives. Changing this negative fearful habit requires altering the brain’s response to the cue to form a new positive conditioned habit.
This process is akin to building any new habit – it requires repetition and consistency. To replace the old fear memory that causes the phobic reaction, the brain requires consistent and repeated exposure to solidify new, non-fearful memories. This then can allow the brain to relax to form a new positive habit of how to react to the trigger. Remember, they amygdala does not want to take any risks, it wants to be 100% sure things are safe. Repeated exposure helps the amygdala to re-evaluate the threat and learn that it is not harmful.
The Science is Proven
Research supports the necessity of multiple exposures for effective phobia treatment. Studies have shown that repeated exposure sessions lead to significant reductions in fear and avoidance behaviours. I can also contribute and bolster this research with my own experience of nearly a decade of treating animal phobias.
For example, on my Spider Courage Experience workshop, most of my clients will feel completely over their fear of spiders in just one session. But because I understand the neuroscience, I will often send my clients home with a house spider to practice with. This is done willingly because they feel so comfortable with spiders by the end of the day.
Even though they feel they are completely over the fear, I remind them it must become a new conditioned habit. Otherwise, the phobia can come back. Sod’s Law, they don’t see a spider for weeks or even months after treatment. So, they take home the spider and interact with it every day for around two weeks. This solidifies a new habit of how the person reacts around spiders. The survival brain learns that the spider is definitely not a threat and lasting freedom is achieved.
Unfortunately, most hypnotherapist and even other exposure therapists don’t mention this or help their clients to get the consistent exposure that they need.
Debunking the Hypnotherapy-Only Myth:
A Scientific Consensus
Hopefully this has so far explained a bit more about the basics of how the human brain processes and learns fear. Promoters of hypnotherapy-only solutions either misunderstand or misrepresent the science of phobia treatment. Without immersive exposure, the amygdala cannot form new, non-fearful memories. Thus, hypnotherapy alone cannot provide a complete cure for phobias. Exposure therapy helps create new neural pathways, allowing the brain to respond differently to the phobic trigger. Over time, the new response becomes the default, replacing the old fear habit. The brain’s plasticity allows it to adapt and change.
The consensus in psychological research is clear: exposure therapy is essential for effectively treating phobias. Hypnotherapy can aid the process but cannot replace the need for real-world exposure. However, the proof of the success of combined hypnotherapy and exposure approach is backed by neuro-science.
A Combined Approach Works Best
While hypnotherapy alone is insufficient, it can complement exposure therapy and help it be more successful and effective. Hypnotherapy can prepare individuals for exposure by reducing anxiety and increasing their willingness to confront their fears.
Hypnotherapy’s Role in Exposure Therapy
Hypnotherapy works by placing individuals in a state of deep relaxation and heightened suggestibility, making them more open to new ways of thinking and less resistant to confronting their fears. This state allows for the effective implementation of exposure therapy techniques, as clients are more likely to engage with and process the feared stimuli in a constructive manner (Psychology Today) (PositivePsychology.com).
For example, one of the ways the survival brain makes us uncomfortable when facing our fears is by causing an overload of adrenaline. When this happens, it feels so intense that it makes it feel like facing the fear is impossible and not within our control. However, this adrenaline rush usually only lasts for about 20 minutes. Once the initial rush subsides, individuals can begin to calm down and face their fear in a more rational state.
Using different therapeutic techniques such as hypnotherapy can help prepare people to push through this initial discomfort of adrenaline overload to make exposure therapy more effective. These techniques can even help a person to avoid the adrenaline overload all together by making it easier to take action before the fear can fully take over. A person’s resolve and coping skills are further strengthened by the rewiring of the subconscious through hypnotherapy.
When combined with hypnotherapy, the exposure can occur in a highly suggestive state, making the therapy more potent and less distressing for the client. This is why the combined approach is so effective and is better than either hypnotherapy or exposure therapy used just on its own. (Verywell Mind) (Mind Phobias).
The Synergy of Combined Therapy
- Preparation: Hypnotherapy can help individuals manage anxiety and build confidence.
- Exposure: Gradual exposure to the phobic trigger reconditions the brain’s response.
- Reinforcement: Hypnotherapy can reinforce the progress made during exposure sessions.
Case Studies and Evidence
Case studies have demonstrated the effectiveness of combining hypnotherapy with exposure therapy. Individuals who undergo both treatments often experience greater reductions in fear and more sustainable outcomes.
For instance, a study published in the American Journal of Clinical Hypnosis demonstrated that combining hypnotherapy with exposure therapy can result in more rapid and sustainable improvements in patients with specific phobias (Psychology Today).
Overcoming Animal Phobias Using Hypnotherapy and Exposure Therapy
A notable case study demonstrates how combining hypnotherapy with exposure therapy can effectively treat animal phobias. This case deals with specifically cynophobia (the fear of dogs). In this study, this combined approach has shown to be more successful than hypnotherapy alone, offering a comprehensive treatment that addresses both the cognitive and emotional aspects of the phobia.
Case Study: Young Boy Overcomes His Dog Phobia
A young boy exhibited severe cynophobia, experiencing intense anxiety and avoidance behaviours whenever he saw or thought about dogs. Initial attempts to treat his phobia using hypnotherapy alone provided limited relief. The treatment was then modified to include exposure therapy, aiming to provide a more holistic approach.
Results and Effectiveness
The combination of hypnotherapy and exposure therapy proved highly effective. The boy’s anxiety significantly decreased, and his ability to approach and interact with dogs improved markedly. Follow-up assessments showed sustained improvements, with the boy reporting a significant reduction in his fear of dogs and an increased ability to manage his anxiety when encountering dogs in daily life. He even expressed a desire to have a pet dog, indicating a complete turnaround in his attitude and behaviour towards dogs.
This case highlights how the integrated approach of hypnotherapy and exposure therapy can offer more substantial and lasting results compared to hypnotherapy alone. By addressing both the psychological and behavioural components of the phobia, this combined method facilitates a more comprehensive and effective treatment (Cambridge University Press & Assessment) (After Hours Hypnotherapy) (Psychology Today).
Evidence of Effectiveness: Research Findings
The effectiveness of combining hypnotherapy with exposure therapy is supported by empirical research. A meta-analysis found that integrating these therapies can significantly reduce anxiety symptoms compared to when hypnotherapy is used alone (PositivePsychology.com). Exposure therapy, particularly when augmented by the suggestibility state of hypnosis, helps individuals confront their fears in a controlled and safe environment, leading to reduced phobic responses (Home).
I can also vouch for this in my work of treating animal phobias with my business Creature Courage. Several of my past clients had wasted a lot of time and money on expensive hypnotherapy treatments before coming to me. They either did not have much success at all or quickly developed their phobias again after treatment. They finally achieved the freedom they were seeking with Creature Courage. I use both hypnotherapy and exposure therapy alongside a plethora of other proven phobia fighting techniques. This muti-technique approach gives the treatment the highest chance of success.
The Long-Term Benefits of Facing Your Fear
For a phobia to be truly overcome, the brain must experience and re-evaluate the feared stimulus in a safe environment. Hypnotherapy alone does not offer this necessary exposure, making it an incomplete solution. The integration of hypnotherapy and exposure therapy, backed by scientific evidence, provides a more effective approach. By understanding the brain’s mechanisms and the importance of habituation and extinction, individuals can achieve lasting freedom from their fears.
Confronting fears, rather than avoiding them, leads to long-term benefits. The brain learns to handle the feared stimulus without triggering a severe fear response. This process builds resilience and reduces anxiety over time.
Exposure therapy not only diminishes fear but also builds confidence. Each successful encounter with the trigger reinforces the brain’s understanding that it can handle the situation. This newfound resilience can translate to other areas of life, promoting overall mental well-being. Once you learn how to handle one trigger of anxiety with courage, you can then learn to start handling all anxiety triggers with courage.
Understanding how avoidance reinforces fear is crucial for addressing and overcoming phobias. By embracing exposure therapy, individuals can break the cycle of avoidance, retrain their brain, and achieve lasting freedom from fear.
Creature Courage: Harnessing Neuroscience for Effective Phobia Treatment
Creature Courage understands the science behind phobia treatment and leverages the power of neuroscience by combining hypnotherapy and exposure therapy. This dual approach ensures the most effective treatment for animal phobias. Don’t be fooled by those who claim hypnotherapy alone can work. Either they do not understand neuroscience or are deliberately scamming people.
Additionally, Creature Courage allows our clients to prove that our approach works on the same day of treatment! Our clients are comfortably interacting with the trigger animal in just a few hours. When doing hypnotherapy, you leave without having any proof that it has worked. By the time you encounter the trigger animal again and realise that you are still terrified, it is too late. Don’t waste your money. Embrace a scientifically validated method that addresses the root cause of the fear and leads to lasting change.
Find out how you can get over your phobia in as little as one day with Creature Courage! Get in touch today to book your free consultation call.
References and Further Reading
- Understanding the Role of the Amygdala in Fear and Phobias
- The Efficacy of Exposure Therapy in Treating Phobias
- Habit Formation and the Brain: A Neuroscientific Perspective
- Breaking the Cycle of Avoidance in Anxiety Disorders
- Valentine, KE, Milling, LS, Clark, LJ & Moriarty, CL (2019) The Efficacy of Hypnosis as a Treatment for Anxiety: A Meta-Analysis, International Journal of Clinical and Experimental Hypnosis,67:3, 336-363, DOI: 10.1080/00207144.2019.1613863
- Hirsch JA. (2018) Integrating Hypnosis with Other Therapies for Treating Specific Phobias: A Case Series. Am J Clin Hypn. Apr;60(4):367-377. doi: 10.1080/00029157.2017.1326372. PMID: 29485374.
- Jiang, H, White, MP, Greicius, MD, et al. (2017) Brain Activity and Functional Connectivity Associated with Hypnosis, Cerebral Cortex, 27 (8): 4083–4093, https://doi.org/10.1093/cercor/bhw220