Many hypnotherapists will use versions of what is called inner child work. There are several formal definitions of the Inner child. Few hypnotherapists use these definitions rigidly. Within the context of hypnotherapy, the inner child is most often represented as:

A part of the mind which has been traumatised. As a traumatised part it has broken off and become separate.

This is sometimes called a wounded inner child. This traumatised part is often represented as a child because it was created by childhood psychological trauma.

• Note – There are joyful and playful variants of the inner child. These are less commonly engaged with in hypnotherapy.

The creation of an inner child through trauma.

An inner child may be created by a single trauma, or several lesser traumas. Children do the best they can with what they have got. What they have to work with is often restricted by society and their lack of life experience. As a result, they tend to adopt strategies which are imperfect. The child will have found a way to protect themselves emotionally from the trauma by separating (dissociating) themselves from the emotional pain. In the process they will have developed an inner child.

How inner child behaviours manifest.

There are two things tend to result from the presences of a wounded inner child:

1. From time to time the Inner child takes over – Frequently this takes the form of meltdowns, tantrums and behaving in a way which matches or mirrors the origin trauma.
2. Coping strategies are adopted – These are often behaviours which allow for the person to move out of their mental pain such as: drug use, excessive eating, self-harm, arguing and fighting. Alternatively, they may be externalised behaviours such as arguing, fighting or vandalism.

How would a hypnotherapist work with an Inner child

There are several likely steps to this process:

• Initial work will be done to ensure the patient is in a strong mental potion for the subsequent work.
• They will access the inner child through the imagination in a hypnotic state. This may be done by eliciting the inner child’s voice or by imagining them them. In this way communication between the patient and the Inner child can be initiated.
• Communication is conducted between patient and the inner child. This may be done to understand the development of the inner child and what it is doing, or reassure it that it is accepted and safe.
• Reintergration will be sought. This may be after a single session or several encounters. The aim of the reintegration is to bring the experience which the inner child developed to help with back into the whole. This allows for the development of a new way of being informed by the wider adult understanding and opportunities.

Does it work?

With the right patient, at the right time, Inner child work can produce powerful shifts which can appear to be almost miraculous. However, with most patients it opens them up to change which will require behaviour change techniques to capitalise upon. Following Inner child work such techniques as…

• Direct hypnotic suggestion.
• Desensitisation.
• Goal setting.
• EMDR.

…may be used to help the patient create lasting change.

Dr Matt Krouwel PhD is a Birmingham based hypnotherapist with over 25 years experience. He has taught hypnotherapy around the world at private institutions and medical schools. He is a member of both the BSCH and the NCH.

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• In life regression – This is where a person revisits an earlier point in their life.
• Esoteric or past life regression – This is when someone visits an earlier life. As only a small percentage of people believe in past lives this form of regression is more controversial than in-life regression.

It is important to clarify which you mean when discussing these as they are often confused.

Characteristics of a regression

A regression is a specific state and as this state matters therapeutically it can be helpful to understand it. There are couple of things which a regression is not.

1. Regression is not remembering – Remembering is the act of being in the present time and calling up memories of the past. The key feature being that you are grounded in the present. Hypnosis is associated with increased recall (hypermnesia) but this is used in different ways to regression.
2. Regression is not reliving – Reliving is when you are so deeply in the past that you act and recall as if back then. Say you had returned to the age of seven you would respond as a seven-year-old and possess no memories beyond the age of seven. When someone mentally returns to the past this full it is referred to as revivification. Such states have value

So, what is regression?

Regression is…

… returning to the past with a degree of awareness of everything which has happened since. You go back to the age of seven and are experiencing much of it as if it were happening now but maintain an awareness that you are older.

This has potentially great therapeutic value as you may be seeing and experiencing things with more experienced eyes.

Why conduct a hypnotic regression?

Regressions are done for one of several reasons, such as:

• To help remember the origin of a problem – By gaining insight into the origin of a problem a client will feel more in control. This approach would be used when the origin is unknown but it runs the risk of creating a false memory if not handled skilfully.
• To release trapped emotional energy at the start of a problem – This is sometimes known as catharsis. Catharsis is frequently powerful, often to a level that can resolve a problem. However, most commonly catharsis is a release of energy which opens the door for change, but other approaches are required to make that change permanent. Catharsis is so powerful that there is the potential for re-traumatisation. As such many therapists will avoid it wherever possible and only allow it under highly supported circumstances.
• To alter problem behaviour by changing the perception of the initial experience – By returning to a known event and experiencing it with an older (wiser) perception the mind can recontextualise it within that mature understanding. What was devastating as a child, is something that you have survived as an adult.
• Other reasons – Sometimes a hypnotherapist will be asked to conduct regressions to help recover lost information. They may also be asked to help someone in their philosophical or spiritual journey.

Dangers and limitations of hypnotic regression

Anyone can regress spontaneously, but a hypnotic regression should be carefully managed by a professional to reduce the risk of problems arising. The two most important factors are

• Appropriate psychological preparedness – A hypnotherapist should ensure that their client is in a strong psychological state prior to any regression. This is done by using psychological control exercise and ego strengthening suggestions. Typically, a hypnotherapist will not conduct a regression on the first session.
• Careful questioning – By using open questions and avoiding leading questions the therapist reduces the chance of a false memory being created.

Dr Matt Krouwel PhD is a hypnotherapist based in Birmingham (UK) with over 25 years experience. He has taught hypnotherapy around the world at private institutions and medical schools. He is a member of both the BSCH and the NCH

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Understanding relationships

It is worth noting that there are two distinct stages of break up. We shall call these recent and long term.

• Recent – This is when the breakup is still recent and fresh. The person is still dealing with the shock of it. At this stage they are often full of unresolved questions and may even be conflicted about whether the relationship has really ended.
• Long-term – This is when the relationship has been over for a while and the person finds that they are still unable to move on from it. There will tend to be less confusion and doubt as to what the problem is here. For example, it is likely to be apparent that the relationship is genuinely over. Equally, it is likely that there will be only one or two unresolved questions about the relationship.
• Healthy resolution – This is when a person has come to terms with the breakup. They are probably able to see the problems with the relationship and can take balanced learnings from this. This is the point at which they will be able to comfortably consider a new relationship.

Although they are defined by time, there is no specific point at which a person moves from one to another. A person may move to the long-term stage quite rapidly or be stuck in the recent stage for months. Equally, the long-term stage can be very short lived as a person moves rapidly to healthy resolution.

How can hypnotherapy help with a relationship breakup?

The hypnotherapist is likely to take several different approaches to dealing with a relationship breakup. The choice of approach will vary with the individual needs of the person. The goal of therapy is to help move the person closer to healthy resolution. Techniques employed may include

• Counselling and listening – Especially in the early stage of a breakup there may be considerable value in saying aloud what you are thinking. Saying things to another person helps to externalise the thoughts. Externalising thoughts separates them from the emotional context in which they are being had. This allows many of them to be processed in the mind.
• EMDR – This is used when there are traumatic elements to a relationship breakup. A common example of which could be the discovery of infidelity. However, there are far more causes of trauma than infidelity alone and these will be investigated and work on where appropriate. Equally, EMDR can be used to help process the strong feelings which a breakup produces and work through triggers for rumination upon it.
• Systematic desensitisation – In breakups there are usually numerous triggers for rumination upon the relationship. These can be things like places you used to hang out together, music you both listened to, other media you consumed, events you went to and so on. Desensitisation can be used to work through these triggers to reduce their impact.
• Psychodynamic work – Various approaches like regression to childhood, inner child work and parts therapy can be used to help address underlying trends
• Mental organisation and clear out exercises – There work to help provide the foundations of reprocessing which the mind needs to move on from a relationship.
• Acceptance and commitment therapy – Techniques from this school of therapy help provide the framework to establish healthier future relationships.

The next step in get hypnotherapy for my breakup

If you would like to know more please contact Dr Matt Krouwel to discuss or arrange a free consultation. Dr Matt is a long standing member of both the BSCH and the NCH. 

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Hypnotherapy for public toilet anxiety

I can never speak for all hypnotherapists, but I can tell you what I would do with hypnotherapy for public toilet anxiety. Usually, the first thing will be to take a case history. A case history is where I find out about you and your problem. What it primarily does is tell the me what approaches are going to suit you best.

Assessing the causes of public toilet anxiety.

From the case history I will look for both the cause of the public toilet anxiety and the factors which maintain it. Typically, a public toilet anxiety is based on one of three things:

1. Social anxiety.
2. Contamination anxiety.
3. Traumatic experience.

Having identified the primary cause, I will decide if that needs to be treated first or if I can move directly to symptom change. If I need to work with the initial cause I can help with approaches like EMDR, systematic desensitisation, parts therapy or a combination of these. This could be sufficient to solve the issue, but more likely some work changing the habitual and behavioural elements of the problem will be required.

Changing habits and behaviours.

Whatever the cause, public toilet anxiety tends to be associated with certain habits of thought and behaviour. Typically, these include:

• Anticipation of negative outcomes from using a public toilet. – This can be anything from being criticised for the sound or smell of bowel movements to experiencing violence. A therapist would look to change such thoughts, by processing old thoughts and introducing new ones.
• Lack of privacy. – Both bowel and balder are tremendously private organs and the awareness of being in public can inhibit their actions. Through a combination of suggestion, visualization and relaxation a hypnotherapist would look to decrease self-consciousness and help relax them into the toilet.

If you would like to begin addressing your public toilet anxiety please get in touch to book a free consultation.

The author

Dr Matt is a hypnotherapist who decades of experience who has a specialism in functional disorders and anxiety issues. He is a member of the BSCH and NCH

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Gut-directed hypnotherapy (GDH)

There are a distinct set of features to GDH, which include:

• Imagery – This is used primarily to encourage regularity in the digestion, and to encourage the awareness of healing within the digestive system.
• Direct suggestion – Suggestions are used to encourage digestive calmness, regularity and enhance the perception of the strength and durability of the digestive track.
• Physical sensation counter conditioning – This is used to moderate the experience of digestive discomfort and pain.
• Systematic desensitisation – This is used to help reduce anxiety around agreed upon some foods.
• Multiple treatment sessions – Typically 6-12
• Sessions should be as close to one per week as possible.
• Hypnotic recordings – These are used to support deeper hypnotic learnings and as ongoing support after formal therapy has concluded.

Hypnotherapy for IBS – Does it work?

Yes! Hypnotherapy for IBS is one of the most well researched areas of hypnotherapy which allows us to say conclusively that it does work, for most people. So, who does it work for:

• People who have received a diagnosis of IBS by either their GP or from a specialist.
• Studies suggest approximately 75-80% of those people with a diagnosis of IBS will benefit from hypnotherapy.
• People who benefit from hypnotherapy for IBS tend to notice changes after 3-5 sessions.
• People who do 8-12 sessions tend to experience the most benefit.
• Benefits tend to grow over time, even after therapy has finished. Research has found that benefits can continue to grow over several years.

Why does it work?

Several ways in which hypnotherapy for IBS may create the changes it does have been proposed, the main two currently are:

• Perceptual changes – Hypnotherapy creates changes in the levels of discomfort and pain experienced the person with IBS. Less pain and discomfort for many is benefit enough, but there is a secondary positive impact. With a reduced burden of pain/discomfort the person with IBS can be less tense. This means that their digestion is now less disrupted by stress and adrenaline. This results over time in a general calming and balancing of the digestion.
• Re-reregulation of the gut-brain – Reduced stress both in life and specifically around symptoms and food triggers reduces disruption of digestion through by the physical constriction. With the digestion less disrupted it has the chance to re-regulate.

Most likely both contribute to beneficial change.

For a more detailed and academic exploration if these topics see chapter 1 of thesis.

The Author

Dr Matt Krouwel is a hypnotherapist and health scientist with PhD in hypnotherapy for IBS. He is a member of both the BSCH and NCH.

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Why is confidentiality important in hypnotherapy

The main reason that confidentiality is important is that it allows a person to speak freely about personal matters.Confidentiality means being safe in the knowledge that their private information will not be shared or treated casually.

We use peoples personal data and stories with care because the world is more connected than we think it is. My patients and clients often recommend each other to me, and it is my job to ensure that even when i know that they are friends and connected, that i respect the confidentiality of their information. Equally, My family and I live in this community were there are many overlaps with people who know my patients. Further, in my career I have seen enough examples of unlikely connections; patients who live abroad but share online work environments with other patients. I such I know the need to respect confidentiality no matter how unlikely it seems that a breach will occur.  However, hypnotherapists often have to share case notes and histories for a number of reasons,

When will a hypnotherapist share case notes and case histories?

There are many legitimate times when a hypnotherapist will discuss cases. When discussing cases these will be anonymised to protect privacy.

What is anonymisation of identifiable details?

There are many ways in which details will be anonymised, such as;

• Names – These can be shortened to; initials only, to a single name, a new name can assigned, or, my preference, which is to exclude the name entirely.
• Jobs and professions – A subtle shift in profession, for example from geography teach to history teacher can effectively disguise someone. Generalisation of work can also help i.e. just saying “ secondary school teacher”. This allows relevant work issues to be discussed without giving away the details of a specific person.
• Geographical location – Subtle changes in town, for example switching Sandwell to Tipton. Alternatively,  a generalisation, such as the  “industrial West midlands” can allow this context to be present in a shared case history whilst not endangering privacy.

Times when a hypnotherapist will legitimately share anonymised case details.

• Teaching; a lot of hypnotherapists teach hypnotherapy. When teaching a hypnotherapist will often use case examples to illustrate a point. Equally, hypnotherapists often share instructive cases as peers in less formal circumstances to enhance everyone’s knowledge.
• Discussion with clinical experts; it is not uncommon for a hypnotherapist to consult with a colleague who has a specialism in a particular field or an expert from outside of hypnotherapy. In these situations a broad idea of the case history is needed to give context to any subsequent expert advise given.
• As part of clinical supervision; Many hypnotherapists will have clinical supervision. Clinical supervision is a place where therapists can explore cases for technical advice, but also to explore their own reactions to cases and any limitations to themselves as therapist. In this supervision some details of cases need to be disclosed for the supervisor to understand.
• In therapy; hypnotherapists frequently use examples of former patients to illustrate points and to help explain techniques to patients.

Non-anonymised sharing of information.

There are circumstances under which a hypnotherapist may share identifiable details of a patient. Some of these circumstances are legitimate; for example;

• Sharing with health care services or relevant governmental bodies; for various reasons such as accessing benefits or seeking a diagnosis, a client may need a letter from a hypnotherapist. Such letters must be written only with the clients explicit consent and it is wise to give the client the opportunity to look over the letter before it is sent to ensure they do not dispute anything which is being written about them.*¹

There are however a small number of circumstance under which a hypnotherapist may disclose a patients details without their consent.

Confidentiality in hypnotherapy – When is it permissible to disclose information

When the client or public are endangered by the clients behaviour the hypnotherapist may have a duty to disclose. The requirement to do so may be moral/ethical or legal. A hypnotherapist will discuss a potential disclosure with a member of their professional body before doing anything. If they go forward, it is likely to be due to one of these situations;

• Disclosure of ongoing abuse of a minor or vulnerable adult. Here, the therapist may need to make a safeguarding disclosure to social services or police.
• Disclosure of life threatening criminal behaviour such as; involvement in terrorism, trafficking in dangerous narcotics, potentially life threatening health and safety violations.
• If the therapist believes there to be a serious and impending risk of the client committing suicide.
• If the therapist believes there is a serious and impending risk of the client committing a serious violent offense.

With the last two examples; the hypnotherapists has to distinguish between the very common reality of discussing violence against the self or other, which is a common topic in therapy, and the possibility that they will actually engage in these behaviors in the immediate future.

Confidentiality

Hopefully this helps to explain what confidentiality in hypnotherapy is, what it is for, and what its limits are. Related issues which may be worth reading about are;

• Taking and storing notes.
• Therapeutic contract.

The author

Dr Matt Krouwel PhD is a hypnotherapist based in Birmingham (UK)  with over 25 years experience as a therapist. He has experienced the practical applications of confidentiality in multiple environments including clinical and academic environments. Further, he has taught the practicalities of confidentiality to hundreds of trainee hypnotherapists. Like all good hypnotherapists he is a member of a professional body. Professional bodies provide a place to discuss professional matters and set minimum behaviour standards for confidentiality. .

Footnotes

*¹ Please note: clients should not be allowed to influence the content of letters overly, the hypnotherapist has to feel that everything they write is true and accurate. Being true and accurate often means that the therapist will have to give a very limited amount of information and opinion which they can evidence.

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Pornography and pornography addiction

Pornography is a normal part of life for huge number of people, with one yougov.co.uk report finding that 76% of men and 53% of women had viewed pornography. Only a small number of people would be considered heavy users with only 13% of men and less than 1% of women accessing porn weekly. However, for some pornography use can become problematic or even addictive.

Are you a pornography addict ?

There is no single widely agreed upon definition of pornography addiction. Attempts to define it have generally focused upon frequency of pornography use. However, many authorities reject frequency of use as too simplistic preferring to let the person themselves decide if they have a problem based on the impact pornography use has on their life. Commonly, people who identify as having a pornography addition will highlighting the;

• Damage to relationships.
• Impact on their real sex life.
• Amount of time they spend viewing pornography each day.

However it is defined, it is clear that for some people there is a problem. So how can hypnotherapy help?

Hypnotherapy for pornography addiction

Hypnotherapy is the use of hypnosis to create beneficial change, either as a direct tool of to enhance or support the use of another therapy approach. It has been accepted as a therapeutic tool since the eighteen hundreds and has proven adaptable to the most modern of problems. There are a number of ways in which hypnotherapy can provide help to someone experiencing pornography addiction;

• Hypnotherapy may help pinpoint and reduce the triggers for pornography use. Triggers could be obvious, such as feeling sexually aroused after seeing a sexy picture whilst generally online. Or, they might be less obvious, such as feeling sad or bored. A hypnotherapist will help find these triggers and then give help to reducing their impact.
• They may help you to adjust thoughts and beliefs regarding desires. This would typically look to change the belief that a desire has to be acted upon to something which encourages coping with it and letting it pass.
• A hypnotherapist may develop, in collaboration with their client, ways of redirecting energy towards healthier outcomes. This could be paying more attention to a partner or filling life with more meaningful activities. They would then support these changes with hypnotherapeutic suggestions.
• They may help to reduce craving directly through the use of suggestion and systematic desensitisation.
• They may help identity and address underlying life problems which the pornography has been used to compensate for, such as problems in sex life, or unhappiness more generally.
• They may discuss life changes which support reduced pornography use, such as; leaving devices in public areas, dating or doing exercise. Where appropriate they may then support these changes with formal hypnosis work.

As can be seen there are many approaches in hypnotherapy to helping with pornography addiction.

The ACT approach to hypnotherapy for pornography addiction

As a hypnotherapist I tend to start out using an acceptance and commitment therapy model (ACT) approach. I use ACT as it was developed as an approach with addiction problems in mind, and evidence for its effectiveness(1).  ACT encourages;

• living in line with your values.
• Mindfulness in your life.
• Treating thoughts and feelings as pieces of information rather than imperative to be acted upon immediately.

Further, large elements of ACT adapt well to the hypnotherapy way of working.

Confidentiality in hypnotherapy for pornography addiction.

With such a sensitive subject for many people confidentiality is often a concern. Hypnotherapists, just like all psychological therapists, maintain confidentiality for their clients and patients information. This confidentiality is guided by the legal requirements of the region they work in such as the UK general data protection regulations (GDPR). Further, most therapist will adopt the spirit of confidentiality as much as the legal letter of it.

The limits of confidentiality.

Although this is irrelevant to the vast majority of pornography addicts it is important to flag up the limits of confidentiality. There are times when UK law not only allows, but requires, that confidentiality be broken. One of these areas is with the abuse of children. Any therapist receiving information about abusive and exploitative images of the under aged is obligated by law to report this and they will.

Hypnotherapy for pornography addiction – practical issues

Making substantial change in life can be hard work, even with the help of hypnotherapy, here are some of things to be aware of in advance.

• Think in terms of a minimum 6 sessions.
• Sessions can be either in-person or online.
• Look for a therapist who has experience and expertise in pornography addiction.
• Take a free consultation, this will allow you to find out if you are relaxed enough to do this kind of personal work with them.

Hopefully this has provided you with enough information to get you started, but if you have any questions please get in touch.

The author

Dr Matt Krouwel PhD is a hypnotherapist with over 25 years experience of working with addictions, anxiety and related conditions. he is a member of the both the BSCH and the NCH

1. Ghazanfarpour M, Babakhanian M, Keshtkar A, Kiani M. A systematic review and meta-analysis of three clinical trials with Acceptance and Commitment Therapy for problematic pornography use. Alcoholism and Drug Addiction/Alkoholizm i Narkomania. 2020;33(3):275-82.

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Systematic desensitisation – Key features and terms

Trigger.

In this context, a trigger is anything which initiates an emotional or state change. The trigger could be;

• External, like seeing or hearing something,
• Internal, such as imagining or remembering something.

The change induced by the trigger is perceived as swift and automatic.

Relaxation.

In systematic desensitisation relaxation is a deliberately created state. It is common for a therapist to teach relaxing exercises or use a guided relaxation technique to produce relaxation. This kind of relaxation allows the patient to retain a sense of  control and personal agency.

Reciprocal inhibition.

Reciprocal inhibition is the idea that a person can only really experience a single emotional/physical state at one time. This means that if you are anxious you will experience things as anxious. eventually you will come to associate everything experienced with anxiety. Conversely, if you experience something in a relaxed state you will begin to associate that with being  relaxed. So, if relaxation is induced by a therapist and then the anxiety inducing trigger experienced, a new relaxed response will be learnt. This new response will override (inhibit) the previous one.

Graded exposure.

Also called graduated exposure, graded exposure is a process of gentle exposure to trigger stimuli. The triggers are organised in a progressively more challenging way. Normally to achieve this a hierarchy of disturbance is created which is then worked through.

Hierarchy of disturbance.

This is a list of all the elements of a trigger which a person can identify. These are organised from leash difficult to most challenging. An example for a spider phobic might look like this;

1. Knowing there is a small spider in an adjacent room. (least difficult for this hypothetical patient).
2. Seeing a small spider on the far wall (staying still).
3. Seeing a small spider on the far wall (moving slowly).
4. Seeing a medium sized spider on the far wall (staying still).
5. Seeing a medium sized spider on the far wall (moving slowly).
6. Seeing a large spider on the far  wall (staying still).
7. Seeing a large spider on the far wall (moving slowly).
8. A large spider on the floor about 1.5 metres away (staying still).
9. A large spider on the floor about 1.5 metres away (moving slowly).
10. A large spider on the floor about 1 metre away (moving slowly).
11. A large spider on the floor about half a metre away (moving slowly).
12. Touching a spider whilst wearing a thick gardening glove.
13. Touching a spider whilst wearing a plastic glove.
14. Touching a spider. (Most challenging for this hypothetical patient) .

The job of the therapist is then to help create a list of situations of progressively more intense triggers to be worked through.

In life / In the imagination.

The exposure to triggers which is required for systematic desensitisation to work can be done in two ways;

• In real life with the trigger stimulant being either; present in the therapist office or by going out into the world to encounter it.
• In the imagination of the patient.

Both methods have their strengths and limitations. Desensitization in real life is almost certainly the best way but the resources to do it are expensive, time consuming, often specific and difficult to manage. The imagination by contrast is usually very good at conjuring up the required resources but at some point this will have to be consolidated into real life with some real world practice.

Systematic desensitization – uses and limitations.

Systematic desensitization is frequently used by therapists for anxiety responses where the trigger is specific and the reaction is disproportionate to the level of threat. A typical example of this would be a phobia or anxiety induced response like psychological erectile dysfunction or vaginisimus  like . However, frequently the anxiety trigger will have a reason to have come into existence, which may limit progress with systematic desensitization alone. Typical reasons for this are;

• The fear is secondary to another fear. For example a fear of insects can sometimes be a fear of contamination or a fear of heights will often be the result of having the wooziness caused by  vertigo.
• The fear is related to post traumatic stress disorder (PTSD). At some point a powerful experience resulted in an anxiety, it may be that the originating experience needs to be treated before the anxiety can be desensitised.
• Neurological sensitivity to the trigger. Not every bodies sensory experience is the same, substantial numbers of people have a visual or auditory sensitivity which results in apparently normal situations being uncomfortable. Over time the effect of this, combined with other people’s lack of awareness or comprehension of the problem, result in a build-up of tension around it. Overall this means that at best systematic desensitisation will help deal with the build up of tension.

The Author

Dr Matt Krouwel PhD is a hypnotherapist in Birmingham (UK) with over 25 years experience of working with anxieties, panic and related disorders. He is a a member of the BSCH and NCH.

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The ABC model of Cognitive Behavioural Therapy (CBT)

The ABC model is used to understand how thoughts, feelings, and behaviours are interconnected. It helps individuals identify and change negative patterns by examining these components.

Here’s a breakdown:

• A (Activating event): The activating event or trigger is what initiates the chain. This is commonly an external event but can also be a thought (such as suicidal thoughts) or a feeling.
• B (Beliefs): The thoughts or beliefs about the event. This is how we interpret the A (Activating event). We may be aware of these at the time (Thoughts) or they may be deeper ingrained and automatic (beliefs).
• C (Consequence): The emotional or behavioural response resulting from the beliefs about the event.

I describe the relationship between these elements mathematically;

A x B = C

To give an example; Bob has to give a presentation at work (A), Bob believes his colleagues will negatively judge him (B). which makes him very nervous (C).

If Bob held a different belief (B) about the presentation (A), such as ‘I’m great at presentations and everyone is going to think I’m amazing’, he is more likely to feel excitement (C).

By identifying and analysing the beliefs (B) that link the event (A) to the emotional or behavioural consequences (C), individuals can work to challenge and modify unhelpful beliefs, leading to healthier emotional responses and behaviours. However, changing a belief (B) is rarely as simple as just telling yourself a different story, you have to believe in that new belief, so how do we create this change?

Cognitive Behavioural Therapy (CBT) changing beliefs through actions

Unfortunately,  a lot of thoughts and beliefs appear to happen automatically and simply trying to think differently can seem naïve to people who have been attempting to do that most of their life. As such, CBT has adopted and developed a number of tools and approaches to aid in this change.

Realistic new belief

Most unhelpful beliefs don’t come from nowhere, if we find something difficult its often because, for us at least, it is hard, but probably not as hard as we believe. To put it another way, Bob, from the earlier example, probably isn’t one of life’s natural presenters and if he just believes he’s brilliant at presenting he probably won’t suddenly become brilliant. However, probably can, when calm, present to a sufficient degree. So we formulate the belief accordingly, ‘I don’t enjoy presenting, but I can do it, and it’s generally fine’.

Alternatively, we might emphasis coping and survival as part of the new belief formulation. This is based on the idea that we often tell ourselves that something is terrible or a disaster, when in fact the consequences fall a long way short of this. In this instance Bob’s proposed new belief might be, “I prefer to give good presentations, and when I don’t it is disappointing, but it’s not the end of the world and I can cope with not always being perfect”.

The emphasis is upon making the belief realistic, which makes it easier to accept.

Another way to address this is to take practical measures which raise your ability, so Bob might learn more about how to give a good presentation. By learning this his ability to accept that the presentation will be good increases.

Behavioural experiments

It can be hard to change an automatic reaction, but less hard to deliberately enter a situation with a pre-planned belief that you are rehearsing as you enter that situation. By doing this the person disrupts the old belief, giving the new one some chance to embed. Simultaneously, they are learning that the consequence is not what they believed it would be. By repeating this multiple times they may embed the new belief and become more comfortable in those situations.

The aforementioned Bob could volunteer for presentations and in gently reminding himself of his new belief would find overtime that the new realistic belief is indeed true.

Systematic desensitization

Systematic desensitisation is a process in which a patient is moved through a progressively more challenging series of anxiety provoking situations (A’s) whilst in a relaxed state. The move into a relaxed state fundamentally alters the patients experience of the situation allowing them to lay down new beliefs in relation to the trigger (A).

Bob, could be guided into a physically relaxed state and then be taken through the build up to the presentation, and the presentation itself, in his imagination whilst relaxed. At each stage the guiding therapist would endeavor to help Bob obtain a state of relaxation and calm before moving onto the next stage. Subsequently, Bob may be taught to relax himself so that he can enter a relaxed state more effectively himself and reinforce this as he approaches and gives the presentation.

These are mainstream CBT approaches, but how does hypnotherapy help?

Cognitive Behavioural Therapy (CBT) and hypnotherapy

So how do hypnotherapy and CBT interact? There are a number of ways

• Hypnotic relaxation and questioning can make identifying the and problematic beliefs more easily.
• Hypnosis can be used to help integrate new beliefs. Traditional hypnosis can be used to give direct suggestions for the agreed new beliefs. EMDR can be particularly useful at helping with this change.
• Enabling deeper relaxation to aid with processes like systematic desensitisation

What is Cognitive Behavioural Therapy (CBT) helpful with?

In theory CBT can help with any psychological problem, or physical problem with psychological impact. Specifically, CBT is most well researched for anxiety(1), depression(2), PTSD(3) substance abuse(4) anorexia nervosa (5) and coping with cancer(6).  However, there are a wealth of other problems for which it has been successfully applied and has probably the most substantial body of evidence for its effectiveness of any psychotherapeutic intervention.

Cognitive Behavioural Therapy (CBT)

Hopefully this brief overview has helped you get an understanding of what Cognitive Behavioural Therapy (CBT) is and how it could be of use.

A note of caution and final thought

Despite the mass of evidence for its beneficial effects this does not mean that it works equally well for everyone with every condition. Further, the enthusiasm with which CBT has been deployed in health services around the world, often in short interventions, may mean that many people have encountered it do so in less favorable circumstances, leaving them with a poor perception of it. CBT is a therapeutic tool which fits well into the kit of a generalist, but as with any tool it is not right for ever job and an integrative therapist will use it as and when it appears appropriate.

References

1. Bhattacharya S, Goicoechea C, Heshmati S, Carpenter JK, Hofmann SG. Efficacy of cognitive behavioral therapy for anxiety-related disorders: A meta-analysis of recent literature. Current psychiatry reports. 2023;25(1):19-30.
2. Werson AD, Meiser-Stedman R, Laidlaw K. A meta-analysis of CBT efficacy for depression comparing adults and older adults. Journal of affective disorders. 2022;319:189-201.
3. Zainal NH, Soh CP, Van Doren N, Benjet C. Do the effects of internet-delivered cognitive-behavioral therapy (i-CBT) last after a year and beyond? A meta-analysis of 154 randomized controlled trials (RCTs). Clinical psychology review. 2024;114:102518.
4. Boness CL, Votaw VR, Schwebel FJ, Moniz-Lewis DI, McHugh RK, Witkiewitz K. An evaluation of cognitive behavioral therapy for substance use disorders: A systematic review and application of the society of clinical psychology criteria for empirically supported treatments. Clinical Psychology: Science and Practice. 2023;30(2):129.
5. Duggan HC, Hardy G, Waller G. Cognitive-behavioural therapy (CBT) for outpatients with anorexia nervosa: a systematic review and meta-analysis of clinical effectiveness. Cognitive behaviour therapy. 2025:1-46.
6. Xiang L, Wan H, Zhu Y. Effects of cognitive behavioral therapy on resilience among adult cancer patients: a systematic review and meta-analysis. BMC psychiatry. 2025;25(1):204.

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Penis size anxiety can present as anything from a concern that it isn’t big enough to impress, which may contribute to performance anxiety in sex and erectile disorder, to a form of body dysmorphia characterised by an obsession with the organ and frequent checking and measuring of it (Veale, Miles, Read, Troglia, Wylie & Muir 2015). Either way, for some men it’s enough of an issue that they may seek help from a therapist.

Small penis anxiety – What sort of therapeutic interventions might help?

As a hypnotherapist I take an integrated approach to addressing issues like small penis anxiety which involves selecting therapeutic techniques that suit the specific needs of the person I’m working with. Certain elements occur more frequently than other.

Treating small penis anxiety – Trauma

Although rare, a man may have lived experience of their penis size being criticized or mocked. Typically this is traumatizing if the person mocking them has reason to know their penis size, for example if a sexual comments or if they are teased by people whom they have shared a locker room. This can take what might otherwise be an amorphous dissatisfaction with their penis size and turn it into a specific trauma which creates an anxiety. If the person hasn’t processed this it is likely to be an active component powering their anxiety, as such techniques like EMDR can be employed to process the trauma.

Treating small penis anxiety Cognition and undermining inner voice

The patient may have developed beliefs which undermine his confidence. Typical examples might be “I’m too small”, “with my small cock I can’t please a women” or “she’ll laugh at me when she sees my small cock”. These beliefs are examined with the patient to assess how realistic they are, and often a new, more acceptable, belief will be agreed.

Identified beliefs can then be addressed in hypnosis by replacement with new ones. To do this a hypnotherapist may use suggestion or visualizations, which combine amnesia for the old idea and acceptance of the new one. Alternatively, EMDR may be used to remove the emotional power from the old belief, and to install a new one.

When a belief is in the form of an inner voice, be that the patients own or someone else’s, it can be disrupted with various visualizations or through the use of parts therapy. New voices can be introduced which replace the old voice with more helpful material, for example if an ex partner has complemented their penis in the past, then reminding them of that experience can be quite beneficial.

Treating small penis anxiety – Systematic desensitization

Systematic desensitization is based on relaxation which makes it especially helpful with sexual problems as sexual response is mediated by the parasympathetic nervous system, the bodies relaxation system, so being relaxed tends to make everything sexual work better.

The therapist helps the patient to create a structured group of situations which may involve a degree of penis size anxiety. These are organised  into the least anxiety provoking (for example, wearing baggy trunks at the beach) to the most anxiety provoking (such as getting naked in front of a new sexual partner). The therapist then takes the patient through these situations, one at a time, whilst giving suggestions for relaxation. With each situation the body and mind are learning to be relaxed about the situation. When a person is relaxed, they feel safe, which allows them to transfer this feeling of relaxation into their life.

Treating small penis anxiety with hypnotherapy

It can be seen that between reducing trauma, challenging unhelpful beliefs and retraining the bodily response to anxiety that much can be done to help the man whose penis size anxiety has become problematic. However, we have detailed only a few of the most common approaches that a hypnotherapist may take to help someone with small penis anxiety to become more relaxed and confident about themselves.

Always remember that the therapist is an expert on therapy, and the patient is an expert on themselves, and that choice of techniques used should involve both sets of expertise.

References

Veale, D., Miles, S., Read, J., Troglia, A., Wylie, K., & Muir, G. (2015). Sexual functioning and behavior of men with body dysmorphic disorder concerning penis size compared with men anxious about penis size and with controls: a cohort study. Sexual Medicine, 3(3), 147-155.e

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