Treating Depression

171

onstrate that CH is equally, or even more, effective than CBT in the management of chronic depressives. From the results of this study, one can conclude that adding hypnosis to CBT increases the effect size of the treatment. The study meets the criteria for probably efficacious treatment but not for well-established treatment since the study was conducted at a single site. Arrangements are underway to have the study replicated at two independent sites.

CASE STUDIES

Case 1: Janet
Janet, a 45-year-old housewife and mother of two teenage children, was referred by a psychiatrist to the author for CBT. Janet had been depressed on and off for over 12 years. She had been under the care of a psychiatrist for 4 years. She had trials of various antidepressants but showed no significant improvement. Because Janet felt very negative about everything, her psychiatrist strongly recommended CBT. Janet met the DSM-IV criteria for a recurrent moderate major depressive disorder and generalized social phobia. She scored in the severe range on the BDI-II and the BAI, and her score on the BHS was in the moderate range. She expressed low self-esteem and lack of confidence, and presented extensive cognitive distortions (see Session 1: Clinical Assessments). Moreover, she felt guilty for not being a good mother to her children. Her score on the BSS was in the highly susceptible range. From the information available, it was concluded that her symptoms of depression and social anxiety were to a large extent maintained by her negative cognitions. Based on the history and assessment, the following sequential course of treatment was planned for Janet. Continue follow-ups with her psychiatrist as she was still on an antidepressant CBT for restructuring her negative cognitions Hypnotherapy for ego-strengthening Hypnotherapy for expansion of experience