Hypnotherapy as Treatment for Depression: A Scoping Review

ABSTRACT

This scoping review aims to provide a comprehensive overview of studies that explore the use of hypnotherapy as a treatment for depression, adhering to the PRISMA-ScR guidelines. A total of 232 articles were identified through systematic search strategies in four databases. Following rigorous screening, 14 studies, varying from case studies to randomized controlled trials, were included in the final review. The age range of participants spanned from 18 to 70 years, and the number of female participants generally exceeded that of males in these studies. Hypnotherapy was found to be frequently used as an adjunct treatment alongside various types of psychotherapy such as cognitive behavioral therapy and often included techniques like hypnotic induction, ego strengthening, and self-hypnosis. The treatment duration varied from 3 sessions to as long as 20 weekly sessions. Most importantly, the majority of the studies found hypnotherapy to be effective in reducing symptoms of depression, with some studies suggesting it has superior effects to antidepressant treatment in areas such as overall health and vitality. This review highlights the potential of hypnotherapy as a viable treatment option for depression and highlights the need for further controlled studies to establish its efficacy.

Hypnotherapie als Behandlung von Depressionen: Eine Übersichtsarbeit

JOLENE WAN VUN PANG, Ponnusamy Subramaniam, Noh Amit, Suzaily Wahab, und Ahmed A. Moustafa

Zusammenfssung: Ziel dieser Übersichtsarbeit ist es, einen umfassenden Überblick über Studien zu geben, die den Einsatz von Hypnotherapie zur Behandlung von Depressionen unter Einhaltung der PRISMA-ScR-Richtlinien untersuchen. Insgesamt wurden 232 Artikel durch systematische Suchstrategien in vier Datenbanken identifiziert. Nach einem strengen Screening wurden 14 Studien, die von Fallstudien bis hin zu randomisierten kontrollierten Studien reichten, in die endgültige Untersuchung aufgenommen. Die Altersspanne der Teilnehmer reichte von 18 bis 70 Jahren, und die Zahl der weiblichen Teilnehmer überstieg in diesen Studien im Allgemeinen die der männlichen. Es wurde festgestellt, dass Hypnotherapie häufig als Zusatzbehandlung zu verschiedenen Psychotherapien wie der kognitiven Verhaltenstherapie eingesetzt wird und häufig Techniken wie hypnotische Induktion, Ich-Stärkung und Selbsthypnose umfasst. Die Behandlungsdauer reichte von 3 Sitzungen bis zu 20 wöchentlichen Sitzungen. Vor allem aber erwies sich die Hypnotherapie in den meisten Studien als wirksam bei der Verringerung der Depressionssymptome, und einige Studien deuten darauf hin, dass sie einer antidepressiven Behandlung in Bereichen wie allgemeine Gesundheit und Vitalität überlegen ist. Diese Übersichtsarbeit unterstreicht das Potenzial der Hypnotherapie als praktikable Behandlungsoption für Depressionen und macht deutlich, dass weitere kontrollierte Studien erforderlich sind, um ihre Wirksamkeit zu belegen.

L’hypnothérapie comme traitement de la dépression: Une revue de l’étendue des connaissances

JOLENE WAN VUN PANG, Ponnusamy Subramaniam, Noh Amit, Suzaily Wahab, et Ahmed A. Moustafa

Résumé: Cette revue de la littérature a pour but de fournir une vue d’ensemble des études qui explorent l’utilization de l’hypnothérapie comme traitement de la dépression, en adhérant aux directives PRISMA-ScR. Au total, 232 articles ont été identifiés grâce à des stratégies de recherche systématique dans quatre bases de données. Après une sélection rigoureuse, 14 études, allant d’études de cas à des essais contrôlés randomisés, ont été incluses dans l’examen final. Les participants étaient âgés de 18 à 70 ans et le nombre de femmes était généralement supérieur à celui des hommes dans ces études. L’hypnothérapie a été fréquemment utilisée comme traitement complémentaire à divers types de psychothérapie, comme la thérapie cognitivo-comportementale, et comprenait souvent des techniques telles que l’induction hypnotique, le renforcement de l’ego et l’auto-hypnose. La durée du traitement variait de 3 séances à 20 séances hebdomadaires. Plus important encore, la majorité des études ont montré que l’hypnothérapie était efficace pour réduire les symptômes de la dépression, certaines études suggérant qu’elle avait des effets supérieurs aux traitements antidépresseurs dans des domaines tels que la santé et la vitalité en général. Cette revue met en évidence le potentiel de l’hypnothérapie en tant qu’option thérapeutique viable pour la dépression et souligne la nécessité de mener d’autres études contrôlées pour en établir l’efficacité.

La Hipnoterapia Como Tratamiento de la Depresión: Una Revisión Exhaustiva

JOLENE WAN VUN PANG, Ponnusamy Subramaniam, Noh Amit, Suzaily Wahab, y Ahmed A. Moustafa

Resumen: Esta revisión exhaustiva tiene como objetivo proporcionar una visión global de los estudios que exploran el uso de la hipnoterapia como tratamiento para la depresión, adhiriéndose a las directrices PRISMA-ScR. Se identificaron 232 artículos mediante estrategias de búsqueda sistemática en cuatro bases de datos. Tras un riguroso cribado, se incluyeron en la revisión final 14 estudios, desde estudios de casos hasta ensayos controlados aleatorizados. El rango de edad de los participantes oscilaba entre los 18 y los 70 años, y el número de mujeres participantes generalmente superaba al de hombres en estos estudios. Se observó que la hipnoterapia se utilizaba con frecuencia como tratamiento complementario junto con diversos tipos de psicoterapia, como la terapia cognitivo-conductual, y a menudo incluía técnicas como la inducción hipnótica, el fortalecimiento del ego y la autohipnosis. La duración del tratamiento variaba desde 3 sesiones hasta 20 sesiones semanales. Lo más importante es que la mayoría de los estudios hallaron que la hipnoterapia es eficaz para reducir los síntomas de la depresión, y algunos estudios sugieren que tiene efectos superiores al tratamiento antidepresivo en áreas como la salud general y la vitalidad. Esta revisión destaca el potencial de la hipnoterapia como una opción de tratamiento viable para la depresión y resalta la necesidad de realizar más estudios controlados para establecer su eficacia.

Translation acknowledgements: The Spanish, French, and German translations were conducted using DeepL Translator (www.deepl.com/translator).

KEYWORDS:

• Depression
• depressive symptoms
• emotional disorder
• hypnosis
• hypnotherapy
• treatment for depression

Introduction

Depressive disorder, commonly referred to as depression, is characterized by a persistent period of depressed mood, loss of pleasure or interest in activities, and various accompanying symptoms. These symptoms may include disturbances in sleep patterns, changes in weight, psychomotor agitation or retardation, fatigue, feelings of worthlessness, and difficulties in thinking or concentrating (APA, 2022). According to the World Health Organization, depressive disorder is projected to become the primary contributor to the global disease burden by 2030 (WHO, 2011). Globally, it is estimated that approximately 5% of adults experience depression, with a prevalence of 4% among men and 6% among women. Among adults aged 60 years and older, the estimated prevalence is 5.7%. These figures suggest that there are approximately 280 million individuals worldwide who are affected by depression (WHO, 2023).

According to the American Psychological Association’s (APA) Clinical Practice Guideline, at least seven types of interventions are recommended for depression, including behavioral therapy, cognitive therapy, cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), mindfulness-based cognitive therapy (MBCT), supportive therapy, and medication (APA, 2019). Despite the availability of these well-established treatments, a significant percentage of patients do not respond well to these and remain at high risk of relapse (Buckman et al., 2018; Gaynes et al., 2009; Rush et al., 2006).

Recently, increased attention has focused on the potential of hypnotherapy as an adjunct to traditional treatments. Studies have found hypnotherapy to be as effective as other psychological treatments (Jensen, 2009; Schlarb et al., 2018; Schoenberger, 2000), suggesting hypnotherapy could be a valuable addition to current therapeutic strategies.

Alladin (2016) reported that hypnotherapy may offer supplementary benefits when used alongside other evidence-based approaches. This viewpoint is further substantiated by meta-analyses. For example, Ramondo et al. (2021) noted a slight yet statistically significant benefit of cognitive behavioral therapy with hypnosis (CBTH) over traditional CBT, underscoring its supplemental value. Similarly, Milling et al. (2019) found hypnotherapy to be as effective as other psychological interventions, affirming its efficacy in treating depression. Furthermore, Shih et al. (2009) provided evidence supporting hypnotherapy as a viable intervention for depressive symptoms, highlighting its effectiveness in comparison to placebo treatments. Together, these studies reinforce the potential of hypnotherapy as a valuable tool in a clinician’s arsenal for treating depression, either as a standalone treatment or in conjunction with other therapeutic approaches.

Despite the empirical support from various scholars (Alladin, 2012, 2018; Alladin & Alibhai, 2007; Alladin & Amundson, 2016; Deltito & Baer, 1986; Elyasi et al., 2021; Frischholz, 2013; Gould & Krynicki, 1989; Holdevici, 2014; Lynn et al., 2010; Milling et al., 2019; Sado et al., 2012; M. D. Yapko, 2013), hypnotherapy remains underutilized in treating depression in clinical settings.

Depression and Hypnotherapy

M. D. Yapko (1992) pointed out six primary reasons to consider hypnotherapy as a therapeutic method for treating depression. He proposed that hypnotherapy could enhance personal experiences, breaking the recurring cycles of depressive symptoms, encourage experiential learning, create a bridge between responses and their contexts, offer flexible perception models, and establish an ability for focused attention. These points underline the unique ability of hypnotherapy to tackle the multifaceted nature of depression. Furthermore, in 2001, Yapko (2001) emphasized that the effectiveness of hypnotherapy heavily relies on various factors, among which patient expectations play a crucial role. Drawing on cognitive theory, he noted that depression is often characterized by negative self-perceptions, pessimistic expectations, and a tendency to interpret events unfavorably (Beck et al., 1979 as cited in M. D. Yapko, 2001). This suggests that hypnotherapy, with its potential to modify these harmful cognitive patterns, could be a significant tool in alleviating depression symptoms.

According to research findings by Dozois and Westra (2004 as cited in Alladin, 2009), a significant number of individuals with depression also experience elevated levels of anxiety. In light of this association, hypnotherapy has been recognized as a valuable tool for relaxation training, providing patients with the confidence and skills necessary to effectively manage anxiety and navigate stressful events in their lives (Alladin, 2009). The randomized controlled trial by Chiu et al. (2018) provides empirical evidence supporting the use of hypnotherapy in reducing anxiety and depressive symptoms. This highlights the potential benefits of incorporating hypnotherapy techniques into therapeutic interventions for individuals with depression. In the partially randomized preference trial (PRPT) study by Dobbin et al. (2009), the advantage of hypnotherapy over antidepressant treatment for depression was observed. This suggests that hypnotherapy may offer distinct advantages in terms of effectiveness when compared to traditional medication-based approaches.

Alladin and Alibhai (2007) focused on the integration of hypnotherapy with CBT, which is a widely recognized and evidence-based treatment for depression. Their study demonstrated that cognitive hypnotherapy, an evidence-based approach in addressing clinical depression, showed superior outcomes compared to CBT alone in managing Major Depressive Disorder (MDD). Furthermore, they found that the combination of hypnotherapy with CBT had additive effects in the treatment of chronic depression. These findings align with the criteria set by the American Psychological Association Task Force (Chambless & Hollon, 1998) for probably efficacious treatments for depression, further validating the integration of hypnotherapy techniques into CBT for MDD. These studies highlight the potential of hypnotherapy as an effective adjunct to traditional treatment approaches for depression. The evidence suggests that integrating hypnotherapy techniques into psychotherapy can lead to improved outcomes in terms of symptom reduction and overall well-being.

Objective

The current body of research on the application of hypnotherapy in the management of depression remains limited. According to Alladin (2010), prevailing beliefs suggest that depression impairs hypnotic responsiveness and that hypnotherapy may potentially exacerbate suicidal behavior in affected individuals. However, these beliefs have been challenged by M. D. Yapko (1992, 2001), who argues that hypnotherapy is not contraindicated for both inpatient and outpatient individuals with depression. In fact, Yapko suggests that hypnotherapy can enhance treatment outcomes in such cases.

Despite the proven effectiveness of CBT, IPT, and antidepressant medication in the treatment of depression, there is a significant subset of patients who do not respond positively to these interventions (Alladin, 2010). Additionally, even among those who experience symptom reduction, a substantial percentage, ranging from 50% to 90%, remain at high risk of relapse (Kessing et al., 2004). Consequently, there is a critical need to explore alternative short-term treatment approaches for depression to address this persistent challenge.

To date, several noteworthy studies have examined the efficacy of hypnotherapy in treating depression, including the meta-analysis by Milling et al. (2019). However, these studies, while valuable, primarily focus on the overall effectiveness of hypnotherapy, neglecting to explore the variety and nuance of different hypnotherapy approaches and techniques utilized in the field. Milling et al. (2019) offered crucial insights into the effectiveness of hypnotherapy but concentrated predominantly on its efficacy rather than investigating the spectrum of treatment modalities and techniques available. Similarly, Shih et al. (2009) provided evidence supporting the effectiveness of hypnotherapy over placebos but did not delve into the specificities of treatment approaches, techniques, or moderating factors such as individual suggestibility and expectancy levels. Therefore, there is a clear and pressing need for a review that not only explores hypnotherapy’s efficacy but also sheds light on the diversity of its applications and methodologies in treating depression.

The primary aim of this scoping review is to map out the evidence derived from existing studies and relevant literature on how hypnotherapy can contribute to the treatment of clients with depression. To achieve this, the specific objectives of the review are as follows:

1. Summarize the current body of research pertaining to the application of hypnotherapy in the treatment of depression.

2. Report on the various approaches and techniques of hypnotherapy utilized in the treatment of depression.

3. Examine and report on the therapeutic effects and outcomes of hypnotherapy in the context of treating depression.

Methods

This scoping review adheres to the PRISMA-ScR reporting guidelines (Tricco et al., 2018) to deliver a comprehensive overview of current studies investigating the utilization of hypnotherapy as a treatment approach for depression. The methodology for this scoping review was informed by the five-stage framework proposed by Arksey and O’Malley (2005). Following this framework, the research question was formulated, relevant articles were identified, a selection of studies was made, data was extracted, and finally, the data was summarized and reported (as shown in Figure 1). This review was registered in the Open Science Framework (https://osf.io/49qn7) on July 17, 2023.

Figure 1. Flowchart of Study Selection

Inclusion Criteria

The inclusion criteria for this scoping review are as follows: 1) participants included in the selected studies must have depression; 2) the studies must involve the use of hypnosis as part of the intervention, including self-hypnosis and/or hetero-hypnosis techniques; and 3) the review will focus on original studies published in English. The exclusion criteria for this scoping review are as follows: 1) review, guideline, protocol papers, will be excluded to maintain a primary focus on original studies; and 2) studies involving participants with comorbidities will be excluded to maintain a specific focus on depression as the primary condition under investigation.

Literature Search Strategy

A systematic and comprehensive search strategy was devised to identify relevant literature for this scoping review. Databases including PubMed, Scopus, World of Science (WOS), and ScienceDirect were thoroughly searched to locate pertinent papers. Additionally, a manual search of the reference lists of identified articles was conducted to ensure comprehensive inclusion of relevant studies. To supplement the search, we also explored gray literature sources, which include research materials not typically found within conventional academic publishing avenues. These sources included reference lists from evidence-based books authored by renowned researchers in the field, such as Yapko and Alladin, as well as websites of local, national, and international organizations and related scientific or medical institutions. This rigorous search approach was employed to ensure that all relevant and pertinent materials were considered for this scoping review.

To develop a robust search strategy aligned with the research questions outlined earlier, the literature searches focused on the PCC framework: Population (patients with depression), concept (hypnotherapy), and content (global scope without geographic restrictions). The research team generated search terms by incorporating keywords, subject headings, and synonyms related to hypnotherapy, treatment, and depression. These terms were compiled into a keyword list, as depicted in Table 1. The search strings were formulated using appropriate Boolean operators, such as “AND” and “OR” to maximize the retrieval of potential resources from the selected databases. The search strings generated are presented in Table 2. All search results were meticulously documented, and the selected articles were exported to a dedicated folder using Endnote 20 reference management software.

Table 1. List of Keywords and Synonyms Generated as Search Terms

Hypnotherapy	Treatment	Depression
Hypnosis	Intervention	Major depressive disorder
Hypnotic	Therapy	Depressive symptoms
Suggestion	Remedy	Sadness
	Therapeutic	Distress
		Dysthymia
		Hopelessness
		Emotional disorder

Table 2. List of Search Strings

Search String

“Hypnotherapy” OR “Hypnosis” OR “Hypnotic” OR “Suggestion” AND “Treatment” OR “Intervention” OR “Therapy” OR “Remedy” OR “Therapeutic” AND “Depression” OR “Major Depressive Disorder” OR “Depressive Symptoms” OR “Sadness” OR “Distress” OR “Dysthymia”“OR “Hopelessness” OR “Emotional Disorder”

Data Extraction and Charting

The screening process involved a rigorous evaluation of articles that successfully passed the initial selection based on the predefined inclusion criteria. These articles were considered suitable for further analysis and underwent a thorough assessment by reading their titles and abstracts. Only the articles that met the inclusion criteria were subjected to a comprehensive full-text analysis. For each selected study, relevant information was extracted, including the first author’s name, year of publication, title, population characteristics, study design, sample size, age and gender distribution, and outcome measures.

To maintain accuracy and consistency, two reviewers independently performed the data extraction from the selected articles. During this process, discrepancies or disagreements occasionally surfaced between the reviewers. These disagreements mainly stemmed from differing interpretations of the study methodologies, outcome measures, or how well specific studies fit the scope of our review.

To address and resolve these issues, a structured resolution process was employed. This included open discussions where each reviewer could express their perspective on the contested points, always aiming to reach a consensus based on the scoping review’s overall objectives and inclusion criteria. When consensus could not be achieved through discussion alone, a third reviewer was consulted to offer an additional perspective and help resolve the disagreement. This rigorous approach ensured an unbiased and comprehensive survey of the literature for our scoping review.

Collecting, Summarizing, and Reporting the Results

Following data extraction, we amassed a comprehensive array of findings that were then systematically summarized and reported. We started by bringing together data related to the study characteristics, including aspects like the study design, sample size, age range and gender of participants, duration and type of treatment, methods and measures used, as well as the therapeutic effect. After that, we synthesized the findings in a narrative manner to identify recurring themes, any variations, and areas that might be worth investigating in future research. Finally, in reporting the results, we utilized a mix of descriptive text and informative tables to provide a thorough overview of the evidence we gathered on the potential benefits of applying hypnotherapy in depression treatment.

Results

Study Characteristic

A comprehensive search of the four selected databases yielded a total of 232 articles. These articles underwent the screening process to determine their suitability for inclusion in this review. After meticulous evaluation, 14 articles were identified as meeting the predefined criteria and were thus included in this review. Among the studies included in the analysis, there were 4 case studies, 3 randomized controlled trials, 3 empirical investigations, 2 quasi-experimental designs, 1 randomized pilot study, and 1 partially randomized preference study. The common objective across these studies was to investigate the effectiveness of hypnotherapy in reducing depressive symptoms among patients with depression. In all the studies, the proportion of female participants exceeded that of male participants. The age range of the respondents spanned from 18 to 70 years (Table 3).

Table 3. Characteristics of the Included Studies

No.	Author	Title	Population characteristic	Study design	Sample	Age, gender	Treatment duration	Modality	Measure
1	Alladin et al. (2007)	Cognitive hypnotherapy for depression: An empirical investigation	Inclusion Criteria: Diagnosis of chronic major depressive disorder based on DSM-IV-TR (APA, 2000). Attainment of a minimum objective score of three on the Barber Suggestibility Scale. Being under the care of a general practitioner (GP) or psychiatrist and receiving antidepressant treatment for at least 6 months. Exclusion Criteria: Presence of comorbid conditions such as schizophrenia, schizoaffective disorder, current substance abuse, eating disorder, bipolar disorder, obsessive-compulsive disorder, organic mental disorder, pervasive developmental delay, or personality disorder.	Empirical investigation	84	36 males, 48 females; mean age range 33.67–36.50	16-week	CBT or cognitive hypnotherapy (Hetero and self-hypnosis)	BDI, BAI, BHS
2	Beevi et al. (2019)	The effectiveness of hypnosis intervention in alleviating postpartum psychological symptoms	Pregnant women in their second trimester	Quasi-experimental design	28	All female, age range 23–36	4 hetero-hypnosis sessions during weeks 16, 20, 28 and 36 of pregnancy; engaged in self-hypnosis as an at home practice task during the pre and postnatal phase.	Hetero and self-hypnosis	DASS-21, EPDS
3	Butler et al.(2008)	Meditation with yoga, group therapy with hypnosis, and psychoeducation for long-term depressed mood: A randomized pilot trial	Inclusion criteria: Diagnosis of depressive disorder based on DSM-IV (APA, 1994), with the additional requirement that depressive symptoms had persisted for a minimum of 2 years without a remission of 2 months or more. Age 18 years and above. Sufficient proficiency in English. Ability to attend weekly meetings at Stanford University. Exclusion criteria: Comorbid conditions such as bipolar or depressive disorder with psychotic features. Current or past psychosis. Current primary diagnosis of panic disorder, generalized anxiety disorder, or posttraumatic stress disorder. Current drug or alcohol dependence. Active suicidal ideation. Significant medical condition that could interfere with participation in meditation or yoga. Current participation in individual or group psychotherapy or a meditation group. Initiation of prescribed antidepressant medication or St. John’s Wort within the previous 3 months.	Randomised pilot study	46	26% are male,74% are female; age range 20–80	Meditation group: 8 weekly group sessions and additional 40-min booster session in week 12. Group therapy with hypnosis intervention: 10 weekly sessions and additional 2-hour booster session in week 12.	Group meditation or group hypnosis (hetero and self-hypnosis)	SCID, HRSD, CDRS-SR
4	Chen et al. (2017)	Hypnosis in the treatment of major depression: An analysis of heart rate variability	Inclusion Criteria: Diagnosis of major depression based on DSM-IV. Absence of a history of myocardial infarction, diabetes, arrhythmia, alcohol abuse, head injury, epilepsy, or other psychiatric illnesses. No previous use of antidepressant drugs. Subjects had not consumed caffeinated drinks within 24 hours prior to the study procedure.	Empirical investigation	25	6 males, 19 females, age range 22–45	3 sessions	Hetero hypnosis	HRV
5	Dobbin et al. (2009)	A benchmarked feasibility study of a self-hypnosis treatment for depression in primary care	Inclusion criteria: Individuals with a recent episode of depression, whether a first attack or a recurrence. Patients for whom the general practitioners (GPs) intended to prescribe antidepressant medication. Exclusion Criteria: Presence of comorbid conditions such as bipolar depression or psychoses. Current alcohol and drug use. Experience of a depressive episode within the previous 6 months. Active suicidal ideation.	Partially randomised preference trial (PRPT)	58	Self-hypnosis preference: 20% male, 80% female; Antidepressant preference: 25% male, 75% female; Bedi counselling randomized: 31% male, 69% female; Bedi antidepressant randomized: 16% male, 84% female; Ward CBT randomized: 21% male, 79% female; Ward counseling randomized: 22% male, 78% female; Ward treatment as usual randomized: 25% male, 75% female; Proudfoot Computerized CBT and treatment as usual: 27% male, 73% female; Proudfoot treatment as usual: 25% male, 75% female. Age range: 18–65 years	12-Week	Medicine or self-hypnosis	BDI-II, BSI, SF-36
6	Fuhr et al. (2023)	Long-term outcomes of depression treatment with hypnotherapy or cognitive behavioural therapy	Inclusion criteria: Current mild to moderate major depressive episode (MDE) according to DSM-5 (APA, 2013). Confirmation of MDE: Structured Clinical Interview for DSM-IV Axis I (SCID-I; First et al., 1997). Medication allowance: Stable course of antidepressant medication for at least 2 months. Exclusion criteria: Lifetime diagnoses of bipolar disorders, psychotic disorders, chronic depression, high suicidality, active alcohol or drug dependence, posttraumatic stress disorder, or anorexia nervosa. Patients who had received outpatient psychotherapy within the last 12 months.	RCT	136	Gender not specified; age range 18–70	20 weekly sessions	CBT or hypnotherapy (hetero and self-hypnosis)	PHQ, LIFE
7	Fuhr et al. (2021)	Efficacy of hypnotherapy compared to cognitive behavioural therapy for mild to moderate depression - Results of a randomized controlled rater-blind clinical trial	Inclusion Criteria: Diagnosis of major depression based on DSM-V. MADRS (Montgomery-Åsberg Depression Rating Scale) baseline scores < 35. Age between 18 and 70 years. Patients who are currently on antidepressant medication should have been on the medication for a minimum of 3 months without planned changes during the duration of therapy. Exclusion Criteria: Patients with a lifetime diagnosis of bipolar disorder or psychotic disorder. Chronic major depression with a duration of 2 years or longer. Current severe major depressive episode, as determined by SCID-I (Structured Clinical Interview for DSM Disorders) or MADRS scores above 34. Acute suicidality. Patients who have been in remission from the current depressive episode for four weeks or longer. Patients with other severe primary mental disorders, such as severe personality disorder of the borderline type with self-injury. Active alcohol or drug dependence. Current diagnosis of posttraumatic stress disorder or anorexia nervosa. Patients who have attended another outpatient psychotherapy within the last twelve months.	RCT	152	52 males, 100 females; age range 18–70	16–20 sessions	CBT or hypnotherapy (hetero-hypnosis)	MADRS
8	González-Ramírez et al. (2017)	Effectiveness of hypnosis therapy and Gestalt therapy as depression treatments	Inclusion Criteria: Diagnosis of slight to moderate depression. A score ranging from 10 to 29 on the Beck Anxiety Inventory (BAI).	Quasi-experimental design	30	9 males, 21 females; age range 23–35	6 sessions	Hypnosis or Gestalt hypnosis (hetero-hypnosis)	BAI
9	Greene (1973)	Combining rational emotive and hypnotic techniques: Treating depression	Inclusion criteria: Acute depression	Case study	1	Female, 28-year old	4-months	Rational emotive and hypnosis (hetero-hypnosis)	Not specified
10	Khazraee et al. (2023)	The effectiveness of mindful hypnotherapy on depression, self-compassion, and psychological inflexibility in females with major depressive disorder: A single-blind, randomized clinical trial	Inclusion Criteria: Score above 28 on the Beck Depression Inventory-II (BDI-II). Diagnosis of major depressive disorder (MDD) according to DSM-V. Age range between 18 to 50 years. Education level of at least a high school/secondary school diploma. If receiving psychiatric medication, the dosage and type of medication should have remained stable in the last 3 months before the start of the study and remain stable during the study period. Available for 8 weekly sessions. Exclusion Criteria: Individuals who are unwilling to continue treatment. Presence of serious suicidal thoughts and a plan to attempt suicide. Individuals receiving psychological interventions at the same time or within the last 6 months. Recent substance abuse. Diagnostic indicators or a history of borderline personality disorder (BPD), bipolar disorder, psychosis, or schizophrenia due to contraindication with hypnosis.	RCT	31	Female only, age range 18–50	8 sessions	Mindful hypnotherapy (hetero and self-hypnosis)	BDI-II, SCS-SF,AAQ-II
11	Matheson (1979)	Modification of depressive symptoms through posthypnotic suggestion	Depressive symptoms	Case study	1	Female, 39-year old	Not specified	Hetero-hypnosis	Not specified
12	Shakil (2020)	Integration of hypnotherapy with brief cognitive behaviour therapy (CBT) for treatment of depression	Diagnosis of depression, with the symptoms of low mood throughout the day with crying spells, changes in appetite, insomnia, lack of energy, loss of interest in routine activities negative thoughts, poor concentration, and feelings of worthlessness, hopelessness and indecisiveness.	Case study	1	Female, 25-year old	8 sessions (2 sessions per week)	CBT with hypnotherapy (hetero and self-hypnosis)	BDI, GAFS
13	Shi et al. (2022)	Study on the improvement of sleep quality and emotional status of patients with depression by hypnosis and cognitive behavioral therapy	Inclusion criteria: Meeting diagnostic criteria for depression based on the International Classification of Diseases, 10th Revision (ICD-10).	Empirical investigation	70	Not specified	Not specified	Medicine or CBT with hypnosis (hetero-hypnosis)	PSQI, SDS, WHOQOL
14	Yexley (2007)	Treating postpartum depression with hypnosis: Addressing specific symptoms presented by the client	Postpartum depression	Case study	1	Female, 27-year old	2-session	Hetero-hypnosis	Not specified

CBT is cognitive behavioral therapy; HRV is heart rate variability; BDI is the Beck Depression Inventory; BDI-II is the Beck Depression Inventory (revised version); BAI is the Beck Anxiety Inventory; BHS is the Beck Hopelessness Scale; DASS-21 is the Depression, Anxiety and Stress Scale-21; EPDS is the Edinburgh Postnatal Depression Scale; BSI is the Brief Symptoms Inventory; PSQI is the Pittsburgh Sleep Quality Index; SF-36 is the Short Form Quality of Life Questionnaire; SCID is the Structured Clinical Interview for DSM Disorders; HRSD is the Hamilton Rating Scale for Depression; CDRS-SR is the Cornell Dysthymia Rating Scale-Self Report; PHQ is the Patient Health Questionnaire; LIFE is the Longitudinal Interview Follow-Up Evaluation; SCS-SF is the Self-Compassion Scale-Short Form; AAQ-II is the Acceptance and Action Questionnaire-II; GAFS is the Global Assessment of Functioning Scale; SDS is the Self-Rating Depression Scale; WHOQOL is the World Health Organization Quality of Life.

Most studies implemented exclusion criteria to ensure the absence of comorbid conditions among participants, such as bipolar disorder, psychotic disorder, drug or alcohol dependence, and personality disorder (Alladin & Alibhai, 2007; Butler et al., 2008; Dobbin et al., 2009; Fuhr et al., 2021; Khazraee et al., 2023). Participants with active suicidal ideation or self-injury tendencies were also excluded in several studies (Butler et al., 2008; Dobbin et al., 2009; Fuhr et al., 2021; Khazraee et al., 2023). Additional exclusion criteria encompassed individuals with eating disorders, obsessive-compulsive disorder, organic mental disorders, and pervasive developmental delays (Alladin & Alibhai, 2007). Moreover, participants who had recently experienced remission from depressive episodes or had engaged in other forms of outpatient psychotherapy within the preceding months were excluded from participation (Butler et al., 2008; Fuhr et al., 2021; Khazraee et al., 2023).

The Beck Depression Inventory (BDI) and its revised version, BDI-II, were commonly used measures in several studies (Alladin & Alibhai, 2007; Dobbin et al., 2009; Khazraee et al., 2023; Shakil, 2020). BDI-II replaced four items from the original BDI and introduced four new items to assess different aspects of depression. The Beck Anxiety Inventory (BAI) was also employed in multiple studies (Alladin & Alibhai, 2007; González-Ramírez et al., 2017). Other measures included the Beck Hopelessness Scale (BHS; Alladin & Alibhai, 2007), the Depression, Anxiety, and Stress Scale-21 (DASS-21) and the Edinburgh Postnatal Depression Scale (EPDS; Beevi et al., 2019), the Structured Clinical Interview for DSM Disorders (SCID), the Hamilton Rating Scale for Depression (HRSD), and the Cornell Dysthymia Rating Scale-Self Report (CDRS-SR; Butler et al., 2008; Dobbin et al., 2009). Heart rate variability (HRV), the Brief Symptom Inventory (BSI), and the Short-Form Quality of Life Questionnaire (SF-36) were also utilized (Dobbin et al., 2009). Other studies employed measures such as the Patient Health Questionnaire (PHQ) and the Longitudinal Interval Follow-Up Evaluation (LIFE; Fuhr et al., 2023), the Montgomery-Åsberg Depression Rating Scale (MADRS; Fuhr et al., 2021), the Self-Compassion Scale-Short Form (SCS-SF) and the Acceptance and Action Questionnaire-II (AAQ-II; Khazraee et al., 2023), the Global Assessment of Functioning Scale (GAFS; Shakil, 2020), and the Pittsburgh Sleep Quality Index (PSQI), the Self-Rating Depression Scale (SDS), and the World Health Organization Quality of Life-BREF (WHOQOL; Shi et al., 2022). The specific measurement instruments were not specified in case studies conducted by Greene (1973), Matheson (1979), and Yexley (2007).

Duration of Treatment

The selected studies on hypnotherapy for depression encompass a range of treatment durations, reflecting the varying approaches and interventions employed. The treatment durations observed in the studies ranged from as short as 3 sessions (Chen et al., 2017) to as long as 20 weekly sessions (Fuhr et al., 2023). Some studies followed a structured timeframe, such as the 16-week duration in the empirical investigation by Alladin and Alibhai (2007) and the 12-week feasibility study by Dobbin et al. (2009). Others incorporated booster or additional sessions to enhance the treatment, as seen in the study by Beevi et al. (2019) and Butler et al. (2008).

Types of Hypnotherapy Approaches

Hypnotherapy is commonly utilized as an adjunct treatment alongside various types of psychotherapy (Table 4). It is frequently combined with Cognitive Behavioral Therapy (CBT) in studies (Alladin & Alibhai, 2007; Shakil, 2020; Shi et al., 2022). Additionally, there are studies that incorporate hypnotherapy with group psychotherapy (Butler et al., 2008), gestalt therapy (González-Ramírez et al., 2017), rational-emotive approach (Greene, 1973), and mindfulness approach (Khazraee et al., 2023); studies also included hypnotherapy as a standalone treatment (Beevi et al., 2019; Chen et al., 2017; Dobbin et al., 2009; Fuhr et al., 2021, 2023; González-Ramírez et al., 2017; Yexley, 2007). In the majority of studies, participants were instructed to engage in self-hypnosis practice outside of their hypnotherapy sessions (Alladin & Alibhai, 2007; Beevi et al., 2019; Butler et al., 2008; Dobbin et al., 2009; Fuhr et al., 2021, 2023; Khazraee et al., 2023).

Table 4. Various Approaches and the Therapeutic Outcomes of Hypnotherapy

No.	Author	Approach and technique	Therapeutic effect and outcome
1	Alladin and Alibhai (2007)	Group 1: CBT based on the manual by Beck et al. (1979). Group 2: Cognitive hypnotherapy, which included CBT supplemented by hypnotic procedures such as hypnotic induction, ego-strengthening, expansion of awareness, positive mood induction (developing anti-depressive pathways), posthypnotic suggestions, and self-hypnosis.	Specifically, the cognitive hypnotherapy group experienced larger improvements in depression scores (BDI-IIa; p < .05), anxiety scores (BAIb; p < .01), and hopelessness scores (BHSc; p < .05) from pre-treatment to post-treatment. These improvements were sustained at 6-month and 12-month follow-ups for anxiety scores (p < .05) and hopelessness scores (p < .05). The effect size calculations (Cohen’s d) revealed medium to large effects for the cognitive hypnotherapy group in these metrics compared to the CBT group both at the termination of treatment and the 12-month follow-up. Participants in the cognitive hypnotherapy group reported continued use of self-hypnosis tapes post-treatment, citing benefits in relaxation and morale. These findings suggest that cognitive hypnotherapy may offer more sustained and effective outcomes in treating depression, anxiety, and hopelessness compared to CBT, though the study was limited by its focus on mild to moderate cases of depression.
2	Beevi et al. (2019)	Group 1: Experimental group; hypnotherapy intervention focused on alleviating psychological symptoms such as anxiety and stress, as well as physical symptoms like nausea and vomiting. It included hypnotic induction, progressive muscle relaxation under hypnosis, ego-strengthening, positive suggestion, and self-hypnosis. Group 2: Control group.	Statistical analysis using the DASS-21d scale showed no significant differences between the experimental and control groups in the overall comparison (t (25) = .927, p = .363, d = .36). Despite this, a closer examination of specific mental health outcomes revealed key distinctions. The experimental group displayed lower levels of anxiety symptoms, with scores averaging 28 ± 3.01, compared to the control group’s average of 38.36 ± 58.81. This difference was statistically significant (t(25) = −2.431, p = .023, d = .85, 95% CI = −65.550 to − 5.428). Depressive symptoms also differed significantly between the groups: the experimental group averaged 1.25 ± 2.41 compared to 6.73 ± 5.68 in the control group (t (25) = −3.457, p = .002, d = 1.26, 95% CI = −8.741 to − 2.214). Regarding postpartum depression, assessed using the EPDSe, the experimental group had a much lower prevalence rate of 3.6% as opposed to 32.1% in the control group. Further, none of the participants in the experimental group reported suicidal ideation, as assessed by item 10 on the EPDS. In contrast, five participants in the control group selected “hardly ever” (rating of 1), and one participant chose “sometimes” (rating of 2) for the same item.
3	Butler et al. (2008)	Group 1: Meditation and yoga exercise (inner resources program, hatha yoga, breathing techniques, guided breathing imagery, and mantra repetition). Group 2: Group therapy with formal hypnotic inductions (positive affect, increasing the modulation of affect, generating alternative responses, exploring life themes, and significant life events related to participants’ current mood, self-hypnosis, relaxation and affect regulation, “here-and-now” group therapy, and supportive-expressive psychotherapy). Group 3: Control group.	A chi-square test of independence revealed a statistically significant difference in the rate of remission between the meditation cohort and the control group (χ^2(1, N = 27) = 4.64, p = .031, Cramer’s V = .41). However, the hypnosis cohort did not manifest a statistically significant differential when juxtaposed with the control group in terms of remission. Concurrent treatment modalities were also scrutinized. Among participants who achieved the clinical threshold for remission, 39% were engaged in auxiliary psychotherapy and/or pharmacotherapy. This percentage was 41% for those who failed to meet remission criteria. The distribution across the cohorts was as follows: 5 participants in the meditation cohort, 1 in the hypnosis cohort, and 3 in the control group were undergoing auxiliary treatment and achieved remission. In terms of the proportion of participants achieving remission, data indicate a 77% remission rate in the meditation cohort, 62% in the hypnosis cohort, and 36% in the control group. Intriguingly, incident major depressive episodes were exclusively reported in the control cohort, thereby suggesting potential prophylactic benefits of the interventions under investigation. However, no statistically significant group differences were discerned in the longitudinal decline of symptomatology. These empirical findings contribute to the growing body of literature affirming the potential utility of meditation and hypnosis as adjunctive therapies in the management of chronic depressive disorders. Noteworthy are the superior remission rates and absence of emergent major depressive episodes in the intervention cohorts.
4	Chen et al. (2017)	Three conditions were implemented as follows: Pre-hypnotic condition: Subjects were instructed to breathe normally with their eyes closed and remain still without any movement. Imagination of a pleasant and peaceful scene: Participants were guided to engage their subconscious and tap into positive energy. The aim was to modify their perception, sensation, emotion, thought, or behavior through the power of imagination and suggestion. Post-hypnotic condition: Subjects were asked to continue breathing normally with their eyes closed and maintain a still position without any movement.	Statistical analysis revealed a significant modulation in HRVf parameters across the hypnotic and posthypnotic phases. Specifically, during the hypnotic condition, patients manifested elevated values in key HRV indices including mean RR intervals (MEAN), standard deviation of all RR intervals (SDNN), root mean square of the successive differences (RMSSD), the standard deviation of the points perpendicular to the line-of-identity (SD1), the standard deviation of the points along the line-of-identity (SD2), and high-frequency power (HF). The posthypnotic phase was marked by a similar uptick in various HRV parameters such as MEAN, SDNN, RMSSD, the percentage of RR intervals that are more than 50 ms different from the previous interval (PNN50), SD1, SD2, low-frequency power (LF), and HF. Additionally, the low-frequency to high-frequency ratio (LF/HF), an index often utilized to gauge sympathetic-vagal balance, was observed to increase more significantly in the posthypnotic state. These results collectively indicate that hypnosis exerts a modulatory influence on the autonomic nervous system of major depressive patients, as evidenced by changes in HRV measures.
5	Dobbin et al. (2009)	Three options were available for participants: Self-help, self-hypnosis therapy: Participants had the choice to receive self-help therapy utilizing self-hypnosis techniques. (Psychoeducation, relaxation, mindfulness, setting of conditioned triggers, visualization of mental room, a safe place, self-hypnosis, increase self-confidence, desensitization, hypnotic skill training, associate with past positive experiences and bring those to present, distancing and reframing of past events from a safe place, increase self-esteem, problem-solving, vision for the future). Antidepressant medication: Participants could opt to take antidepressants as prescribed by their general practitioner. Randomization to treatment groups: Participants had the possibility of being randomly assigned to either of the treatment groups.	At a 12-week follow-up, the study found notable differences between the two groups. Those who underwent hypnosis had better scores on the BSIg and BDIh, indicating a more significant reduction in depressive symptoms compared to those on antidepressant medication (p = .012 for BSI and p = .004for BDI). Furthermore, when it came to general health and vitality, as measured by the SF-36i, the hypnosis group also showed significant improvements. For general health, the significance level was p = .012, with a confidence interval ranging from 5.1 to 37.9 for the effect size. For vitality, the significance was even stronger with a p-value of .003 and a confidence interval of 1.3 to 46.6 for the effect size. In summary, this study suggests that hypnosis may be more effective than antidepressant medication in not only reducing depressive symptoms but also in improving general health and vitality.
6	Fuhr et al. (2023)	Group 1: Received hypnotherapy based on the manual by Wilhelm-Goessling et al. (2020). The hypnotherapy techniques included self-hypnosis, time progression, relapse prevention, and ego structure. Group 2: Received CBT based on the German version of Beck’s CBT manual (Beck, 1979; Hautzinger, 2013). This CBT intervention consisted of two modules that addressed relapse prevention, specifically targeting early warning symptoms and risk situations.	Regarding full remission rates, a majority of patients (72.8%) achieved full remission for at least 8 weeks. In terms of achieving full remission, the majority of all patients—72.8% to be exact – reached this threshold. While the CBT group had a slightly higher remission rate at 77.9%, compared to 67.6% in the hypnotherapy group, this difference was not statistically significant, meaning it could have occurred by chance. The study also looked at the time it took for patients to reach full remission. On average, it took 37 weeks for the hypnotherapy group and 27 weeks for the CBT group. Again, this difference was not statistically significant. In summary, both hypnotherapy and CBT appear to be equally effective in achieving full remission from depressive symptoms over time, based on this study. Neither the rates of remission nor the time it took to achieve it showed any significant differences between the two treatment approaches.
7	Fuhr et al. (2021)	Group 1: Hypnotherapy based on the manual by Wilhelm-Goessling et al. (2020), incorporating techniques to promote emotional activation and reinforce personal resources. This includes utilizing emotionally positive and negative experiences from the individual’s biography, developing positive solution imagery, formal trance induction, utilization techniques, various types of metaphor, and ego structure. Group 2: CBT based on the manual by Hautzinger (2013), employing techniques such as psychoeducation, behavioral activation, cognitive restructuring techniques, problem-solving skills, and interpersonal skills.	Researchers used two different types of samples to conduct this analysis. The first, known as the Intention-to-treat sample, included all 134 participants, regardless of whether they completed the treatment. The second, called the Per Protocol sample, also had 134 participants but focused only on those who adhered to the treatment guidelines. In the Intention-to-treat sample, the average percentage of symptom reduction was only 2.8% different between the hypnotherapy and CBT groups. The 95% CI for this difference ranged from − 9.85 to 15.44. In the Per Protocol sample, the difference was slightly higher at 4.0%, with a 95% CI of − 9.27 to 17.27. Importantly, these differences fall within a pre-specified range that researchers use to say whether one treatment is “non-inferior” to the other. In this case, the data suggests that hypnotherapy is at least as effective as CBT for reducing symptoms. Even better, follow-up assessments at six and twelve months after the treatments ended support these findings. This suggests that both hypnotherapy and CBT have long-lasting benefits. In summary, the study indicates that hypnotherapy is comparable to CBT in its effectiveness for treating depression, both in the short-term and over an extended period.
8	González-Ramírez et al. (2017)	Group 1: Therapeutic hypnosis (specific techniques not specified). Group 2: Gestalt Hypnosis Therapy (specific techniques not specified). Group 3: Control group (passive listening).	In statistical terms, the control group demonstrated no significant modulation in their depressive symptomatology, as evidenced by an F(1, 18) value of .00 and an associated p-value of 1.00. In contrast, both intervention groups – hypnosis and Gestalt hypnosis – exhibited statistically significant improvements in their posttest scores when compared to their respective baseline measures. For the hypnosis group, the F(1, 18) value was calculated to be 12.19 with an associated p-value of .003, while the Gestalt hypnosis group yielded an F(1, 18) value of 15.65 with a corresponding p-value of .001. Subsequent comparative analyses of post-intervention scores revealed significant between-group differences. Specifically, the hypnosis cohort demonstrated statistically significant improvements compared to both the control group and the Gestalt hypnosis group, as substantiated by an F(2, 27) value of 11.82 and a p-value of less than .000. In contrast, no such statistical difference was discerned between the Gestalt hypnosis cohort and the control group. In summation, while both hypnosis and Gestalt hypnosis evidenced therapeutic efficacy in reducing depressive symptomatology, the empirical data suggests a superior treatment effect associated with hypnosis.
9	Greene (1973)	The Rational-Emotive approach focuses on teaching clients how their thoughts influence their emotions and assists them in recognizing and modifying irrational thought patterns. Hypnosis techniques utilized in this approach include visual fixation, relaxation procedures, traditional hypnotic tests, and posthypnotic suggestions for self-relaxation.	The effectiveness of the treatment was assessed through self-reported measures and clinical observation. Post-intervention evaluation revealed significant improvements in the patient’s emotional well-being. Specifically, the patient no longer experienced the intense feelings of guilt and depression that were initially observed. In terms of behavior, the patient reported improved sleep quality, corroborated by her decision to discontinue physician-prescribed sedative medication. In summary, the therapeutic intervention appeared to be highly effective in improving both emotional and behavioral symptoms.
10	Khazraee et al. (2023)	Group 1: Mindful hypnotherapy (includes techniques such as present-moment awareness, non-judgmental awareness of bodily sensations, non-judgmental awareness of thoughts and feelings, self-hypnosis, cultivating compassion for self and others, awareness of personal values and meaning in life, integrated mindfulness, termination/transition to long-term practice). Group 2: Waitlist control group.	Statistical analysis revealed robust effects in favor of the intervention. Specifically, significant reductions in depressive symptoms were observed both immediately post-intervention and at the 2-month follow-up (p < .001) for the intervention group. Longitudinal analysis corroborated these findings, showing a significant temporal effect on depressive symptoms within the intervention group. Between-subjects analysis yielded a highly significant main effect for time across both groups (F = 53.86, p < .001, effect size = .65). This result was further substantiated by an analysis of covariance, confirming significant distinctions between the mindful hypnotherapy group and the waitlist control group at both assessment points (p < .001). In addition to improvements in depression, the intervention group demonstrated clinically significant gains in self-compassion (F = 33.18, p < .001, effect size = .53) and reductions in psychological inflexibility (F = 26.84, p < .001, effect size = .48). In summary, the empirical data strongly supports the efficacy of mindful hypnotherapy in significantly reducing depressive symptoms while concurrently enhancing self-compassion and reducing psychological inflexibility.
11	Matheson (1979)	Psychotherapy with hypnosis includes various techniques aimed at addressing depressive dynamics, reducing guilt, enhancing self-esteem, providing relaxation training, inducing positive mood, and utilizing age-regressive techniques.	The assessment was conducted post-therapy and extended to a one-year follow-up. Significant improvements in mood and behavior were observed shortly after the initiation of therapy, specifically targeting the fourth behavioral objective. These therapeutic gains facilitated the patient’s discharge from the hospital within a few weeks following the commencement of treatment. During a one-year follow-up, the patient reported only a single brief episode of suicidal ideation occurring six months post-therapy, which they interpretatively described as a “cleaning out” process. No additional incidents were reported. The patient also noted substantial improvements in their coping mechanisms, community engagement, and familial relationships. These self-reported outcomes were further verified by the patient’s spouse, adding an external dimension of validation to the findings. In summary, the data suggests a robust and enduring therapeutic effect, highlighted by the patient’s discharge from the hospital and sustained improvements in mood, behavior, and quality of life.
12	Shakil (2020)	Hypnotherapy with brief CBT (psychoeducation, identification of the connection between thoughts and feelings, cognitive disputation, hypnotic induction, ego strengthening, journaling, generate alternative thoughts, self-hypnosis, problem-solving, anchoring, imagery relaxation, positive imagination, relapse prevention).	Within a limited timeframe of 3–4 sessions, the client exhibited marked improvements in multiple domains. Specifically, her ability to control negative thought patterns and generate positive cognitive alternatives improved. Quantitatively, her depression rating on the BDI demonstrated a significant decrease, plummeting from an “extremely high” category (90%) to a “normal” range (40%). Additionally, the client reported enhanced attention and concentration, increased energy levels, and renewed engagement in daily activities and social interactions. Self-hypnosis was identified as a key therapeutic element contributing to these positive outcomes. Follow-up sessions indicated sustained benefits while also revealing minor residual anxieties and insecurities. These were targeted through further therapeutic interventions, thereby refining the treatment approach. In summary, this case provides robust evidence for the effectiveness of short-term therapeutic intervention, inclusive of self-hypnosis, in substantially reducing depressive symptoms and enhancing overall well-being.
13	Shi et al. (2022)	Group 1: Received a combination of CBT and hypnotherapy alongside medication. The specific strategies employed were not specified. Group 2: Served as the control group and received medication only.	Initially, there were no statistically significant differences in PSQIj scores, SDSk scores, or quality-of-life metrics between the observation and control groups. Post-treatment assessments, however, revealed distinct improvements for both cohorts compared to their baseline measures. Importantly, these improvements were more pronounced in the observation group across all evaluated domains, reaching statistical significance in comparison to the control group. In essence, the data indicate that the intervention delivered to the observation group led to meaningful and statistically significant improvements in sleep quality, depressive symptomatology, and overall quality of life, outperforming the control group. These outcomes highlight the therapeutic efficacy of the treatment, warranting further investigation in larger, more diverse samples.
14	Yexley (2007)	In the first hypnotherapy session, the following key objectives were addressed: 1) Retrieval of positive affect associated with feelings of safety, connectedness, and confidence; 2) Exploration of past experiences to identify emotions that parallel the client’s response to infant distress; 3) Suggestions for self-parenting to promote resolution and the development of alternative responses; 4) Transference of these altered responses to future experiences. During the second hypnotherapy session, the focus shifted to unresolved grief. Three metaphors of grief were utilized to achieve the following objectives: 1) Facilitating a stage-based normalized grief process; 2) providing adaptive ways of honoring deceased loved ones; and 3) alleviating guilt experienced by surviving loved ones.	After only two hypnotherapy sessions, the patient self-reported cessation of symptoms and consequently canceled the appointment for the third session. Notably, she reported no longer experiencing any thoughts of harm toward her infants. Additionally, assessment of her grief-related symptoms indicated successful emotional processing and resolution; she was neither avoiding nor obsessively focusing on her past losses. A five-month follow-up, conducted via a telephone interview, corroborated the sustainability of these therapeutic gains. The patient-maintained symptom-free status, and normal maternal-infant interactions were reported. In summary, this case study provides preliminary evidence supporting the potential efficacy of hypnotherapy in rapidly resolving severe postpartum symptoms and facilitating emotional well-being. The sustained benefits, confirmed at a five-month follow-up, further suggest the long-term utility of this approach.

CBT is cognitive behavioral therapy. CI is confidence interval.

^aBDI-II is the Beck Depression Inventory (revised version). ^bBAI is the Beck Anxiety Inventory. ^cBHS is the Beck Hopelessness Scale. ^dDASS-21 is the Depression, Anxiety, and Stress Scale-21. ^eEPDS is the Edinburgh Postnatal Depression Scale. ^fHRV is heart rate variability. ^gBSI is the Brief Symptom Inventory. ^hBDI is the Beck Depression Inventory. ⁱSF-36 is the Short Form Quality of Life Questionnaire. ^jPSQI is the Pittsburgh Sleep Quality Index. ^kSDS is the Self-Rating Depression Scale.

The most commonly used techniques in hypnotherapy include hypnotic induction, ego strengthening, positive mood induction, self-hypnosis, and relaxation training (Alladin & Alibhai, 2007; Beevi et al., 2019; Butler et al., 2008; Chen et al., 2017; Shakil, 2020). Other techniques utilized in hypnotherapy include psychoeducation, expansion of awareness (bringing underlying emotions to consciousness, creating awareness of various feelings, intensifying positive affect, enhancing newly discovered emotions, inducing positive moods, and increasing motivation), posthypnotic suggestion (a verbal or nonverbal instruction given during hypnotherapy that influences an individual’s thoughts, behaviors, or experiences after they have emerged from the hypnotherapy), positive suggestion (affirmative statements or instructions are given to encourage positive thinking, behavior, or outcomes) or anchoring (associating a specific sensory stimulus (such as a touch, sound, or image with a particular state of mind or emotion), exploration of life themes or significant events related to the participant’s mood, setting up a safe space, desensitization, problem-solving, utilization of metaphor, and mindfulness (Butler et al., 2008; Dobbin et al., 2009; Fuhr et al., 2021; Khazraee et al., 2023; Yexley, 2007).

Therapeutic Effects and Outcome

Alladin and Alibhai (2007) found that cognitive hypnotherapy yielded superior results in lessening depression, anxiety, and feelings of hopelessness in comparison to CBT. An analogous outcome was depicted in the work of Beevi et al. (2019), where the group exposed to an experimental intervention demonstrated lower levels of anxiety and depressive symptoms, with a lower incidence of postpartum depression as compared to the control group.

The effectiveness of meditation and hypnotherapy in managing persistent depressive moods was noted by Butler et al. (2008), who reported higher remission rates than those recorded in the control group. Additionally, Chen et al. (2017) provided empirical evidence indicating a positive impact of hypnotherapy on the balance of the autonomic nervous system in patients with major depression, as reflected in the enhancement of heart rate variability.

Furthermore, hypnotherapy was found to surpass antidepressant treatment in terms of symptom relief, especially in areas pertaining to overall health and vitality, according to Dobbin et al. (2009). The work of Fuhr et al. (2023, 2021) suggested that the efficacy of hypnotherapy was on par with CBT, indicating that both treatments have similar effects on symptom reduction.

González-Ramírez et al. (2017) and Greene (1973) reaffirmed the beneficial effects of therapeutic hypnosis in mitigating depression levels. Khazraee et al. (2023) depicted significant reductions in depression levels in an intervention group both immediately after the intervention and during the 2-month follow-up. Shi et al. (2022) documented an enhancement in sleep quality, depression symptoms, and overall quality of life following treatment.

Case studies such as those presented by Matheson (1979) and Shakil (2020) elucidated the substantial improvement in mood, behavior, attention, concentration, and daily activity engagement following therapy. Yexley (2007) reported a patient achieving complete symptom remission after just two sessions of hypnotherapy, and successfully navigating the grief process, as confirmed by a five-month follow-up.

Discussion

A total of 14 studies were identified to explore on the role of hypnotherapy in the treatment of depression, focusing on the existing body of research, various hypnotherapy approaches and techniques, and their therapeutic effects and outcomes.

Type and Diversity of Studies

The diversity in the types of studies – including case studies, randomized controlled trials, empirical investigations, quasi-experimental designs, partially randomized preference studies, and randomized pilot studies – indicates the broad interest in the field. It also underscores the need for a more standardized approach to investigate the effectiveness of hypnotherapy in depression treatment. Additionally, the predominance of female participants in the included studies suggests a potential gender bias that future research should address by seeking a more balanced representation.

Measurement Tools

The use of numerous screening instruments, such as BDI, BAI, BHS, DASS-21, and others, shows the comprehensive efforts in measuring depression and related symptoms. However, this heterogeneity in measurement tools may cause difficulties in comparing the outcomes of different studies, highlighting the need for more standardized assessment tools in future research.

Hypnotherapy Techniques and Duration

A wide range of hypnotherapy techniques was reported across the studies. These techniques include hypnotic induction, ego strengthening, positive mood induction, self-hypnosis, relaxation training, providing psychoeducation, expansion of awareness, posthypnotic suggestion, and others. This diversity reflects the flexibility of hypnotherapy, but it also suggests a need for further research to identify which techniques are most effective for depression treatment.

In terms of treatment duration, a wide range was observed, from as short as 3 sessions to as long as 20 weekly sessions. This reflects the adaptability of hypnotherapy to individual patient needs but also underlines the need for further research on the optimal duration and frequency of treatment sessions for the best outcomes.

Therapeutic Effects and Outcomes

The findings of the studies included in this review indicate that hypnotherapy can effectively reduce depressive symptoms, often outperforming or matching the efficacy of established treatments such as CBT and antidepressant treatment. Some studies even reported improved outcomes in areas such as overall health, vitality, sleep quality, and heart rate variability. These promising findings suggest that hypnotherapy can contribute substantially to depression treatment, either as a standalone intervention or as an adjunct to other therapeutic approaches.

Self-Hypnosis

Self-hypnosis is a self-directed process where an individual uses cognitive techniques and suggestions to alter their perception, behavior, sensations, thoughts, or emotions. This process does not involve any perceived loss of control; rather, it is an active, voluntary, and empowering skill (Kirsch, 1999). Several studies included in the review have emphasized the benefits of this technique.

In the study by Alladin and Alibhai (2007), patients undergoing cognitive hypnotherapy were taught self-hypnosis as part of their treatment protocol. They were encouraged to practice the technique independently to foster self-efficacy and mastery over their depressive symptoms. Beevi et al. (2019) also found that incorporating self-hypnosis into their treatment approach was associated with reduced anxiety and depressive symptoms among postpartum women. Participants were guided through a standardized self-hypnosis process and instructed to practice at home. The practice of self-hypnosis was found to be instrumental in the maintenance of therapeutic gains post-treatment.

In the studies conducted by Butler et al. (2008), Dobbin et al. (2009), Fuhr et al. (2021), Fuhr et al. (2023), and Khazraee et al. (2023), self-hypnosis was included as a part of the treatment protocol. These studies highlighted the utility of self-hypnosis as a tool for managing emotional distress and negative thought patterns outside of therapy sessions. By regularly practicing self-hypnosis, patients reportedly experienced reductions in depressive symptoms and improvements in mood and overall well-being.

Research Gaps and Implication for Future Research

Our scoping review of hypnotherapy for depression has revealed promising results, with multiple studies reporting positive outcomes. However, several important gaps in the existing literature and potential limitations should be noted.

Variability in Hypnotherapy Techniques and Approaches

Studies in our review employed a wide array of hypnotherapy techniques and approaches. Given this diversity, determining the most effective techniques and approaches for specific patient populations remains a challenge. Future research should seek to identify which techniques or combinations thereof yield the best results for distinct demographic and clinical subgroups of patients with depression.

Potential Publication Bias

We must also acknowledge the potential presence of publication bias. The predominance of positive outcomes in our review could reflect a systemic bias in the field toward publishing studies with significant positive findings over non-significant or negative ones. Future reviews should consider conducting a formal assessment for publication bias.

Need for Longitudinal Studies

The long-term effects of hypnotherapy on depression remain relatively unexplored. A notable exception is the study by Fuhr et al. (2023), which provided a 12-month follow-up on the effects of hypnotherapy versus CBT. However, more longitudinal research is needed to further investigate the sustainability of treatment effects, rates of remission, and time to remission following hypnotherapy.

Despite these limitations and gaps in the literature, the current body of evidence highlights the potential of hypnotherapy as a therapeutic intervention for depression. Hypnotherapy, either as a standalone treatment or as an adjunct to other forms of psychotherapy, shows promise in the field of depression treatment, and it should be a focus for future research.

Conclusion

In conclusion, this review highlights the potential of hypnotherapy as a treatment for depression, with various studies demonstrating its positive impact on depressive symptoms. Despite the promising findings, more research is needed to identify the most effective hypnotherapy techniques, optimal treatment durations, and the impact of gender and other demographic variables on treatment outcomes.

Throughout this review, we have delved into the thematic therapeutic effects and outcomes of hypnotherapy, shedding light on its versatility and potential as a valuable intervention for depression. Yet, our methodological critique also points toward areas for improvement, such as addressing variability in hypnotherapy techniques, potential publication bias, and the need for more longitudinal studies.

Therefore, we strongly advocate for hypnotherapy to gain wider recognition and to be subjected to more rigorous research as an integral part of depression treatment strategies. The expanding body of evidence indeed sets a solid foundation for further studies that will continue to enhance the quality of the methodology and thereby the robustness of the findings in this realm.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Data Availability Statement

The raw data supporting the conclusion of this article will be made available by the authors, without undue reservation.

Additional information

Funding

This study was supported by Universiti Kebangsaan Malaysia.