Helping clients to get back in charge of their lives, with the confidence, calmness & self-sufficiency to flourish.

Anxiety UK therapy outcomes for 2016

Anxiety UK have published figures for therapy outcomes in 2016, measured using the IAPT method for calculating recovery, reliable improvement and reliable recovery.

Out of 221 planned completions, 67% of clients recovered, 87% reliably improved and 67% reliably recovered.
This compares very favourably to the national IAPT outcomes for 2015/16 which were 46.3% recovered, 62.2% reliably improved and 44% reliable recovery.
Just to be clear, these figures relate to all forms of therapy provided through Anxiety UK's approved therapist schemes, working with CBT or hypnotherapy. I think they show the quality of the service and support that Anxiety UK are able to offer their members through the scheme.

For any one who is curious, the IAPT method for calculating recovery, reliable improvement and reliable recovery is as follows:

A referral is classed as ‘recovered’ if the client has finished a course of treatment and moved from caseness* to not being at caseness by the end of the referral.

A referral is deemed to have shown reliable improvement if it shows a decrease in one or both assessment scores that surpass the measurement error, (for GAD7 assessment this is 4, for PHQ9 it is 6).

Reliable improvement and recovery can be combined to create an overall measure of reliable recovery where both a change from caseness to not caseness during the course of the referral and which show reliable improvement.

*Caseness is the term used to describe a referral that scores highly enough on measures of depression and anxiety to be classed as a clinical case.

More information on the use of IAPT services can be found in this report.

Some thoughts on why stopping smoking can be challenging.

Many people successfully stop smoking in October, thanks to the Stoptober campaign, but unfortunately some find themselves struggling in the following months. To help anyone in this position, I’m offering a 20% reduction in the ‘Single Session’ protocol I provide, and this will be available to anyone until the end of 2016.

So this seems like a good time to share a few thoughts on why stopping smoking can seem so difficult:

We often use phrases like 'being in two minds' about something, or having 'mixed feelings' when we're struggling to take action in some way. These phrases are really useful in describing the situation people find themselves in when they're experiencing difficulty in stopping smoking. One part of them wants to smoke, (otherwise they simply wouldn’t be smoking), whilst another part of them clearly wants to stop. We could call one part the ‘smoker’s mind’ and let’s call the other part the ‘smoke-free mind’. It’s between these ‘two minds’ that the struggle starts; an internal struggle between two seemingly different parts of our mind. 

This is never a comfortable place to be, and the stress and anxiety that can be felt at such times will often cause a smoker to crave a cigarette, but this craving is mostly a craving to reduce anxiety, rather than a physical craving for a drug. Of course it is possible to reduce anxiety or stress in a number of ways, but if we haven't correctly identified what we’re feeling, we may just misinterpret it as a craving for nicotine and thus a sign of the 'addictive power' of nicotine. This will then be followed by another thought from the ‘smoker’s mind’, along the lines of how ‘impossible’ it is to fight such a powerful ‘addiction’, leading to more stress and anxiety, which fuels further cravings... it’s no wonder stopping can be so difficult for many people. 

Part of the problem is that we tend to identify our thoughts - our internal dialogue - as ourselves, and also as factual. The discovery that ‘we are not our thoughts’ is a powerful and liberating lesson, whether it comes from mindfulness meditation, cognitive behavioural therapy, or anywhere else. Equally, learning that our thoughts are not necessarily facts, but opinions, can transform our experience of them, and of our lives. Finally, and equally empowering, is an awareness that thoughts and cravings are transient, and will pass out of our consciousness just as easily as they came into it.

Without this knowledge, it’s all too easy to listen to the ‘smoker’s mind’, without identifying it as such, just accepting it, and following what it is saying. For example, the ‘smoke-free mind’ may be congratulating you on how well you’ve done by not smoking all morning - and how easy it seemed to be. But then the ‘smoker’s mind’ continues, in the same voice, telling you how much you deserve a reward for that achievement... how it’s OK to have one cigarette at lunchtime... how it’ll be much easier to quit completely in a week or two, after cutting down a little… Now the craving has been lit, and before too long the anxiety is rising, and perhaps another attempt to quit will soon become an attempt to cut down. And unfortunately that will bring a sense of failure, and the ‘smoker’s mind’ will soon be telling the story of how impossible it is to quit, which becomes a justification for continuing to smoke. It can seem as if the ‘smoker’s mind’ is always looking for an excuse to fail, as proof that it can’t be ignored.

So how does hypnotherapy help? Well, there are several different ways of describing this, but in essence it strengthens the part of the mind that wants to stop, making it easier to keep on top of the part that wants to smoke. Considered in this way, its obviously best to use hypnosis as an aid to stopping, when you’re really wanting to stop - that is, when the part of you that wants to stop is big enough to have a chance.

Another way of understanding this is to consider a simplified model of what is happening in the brain during hypnosis: There is a shift towards more activity in the brain's right hemisphere, which is more closely involved in emotion, intuition, imagery, metaphor and 'the big picture' - as opposed to the logical, rational, and detail-focussed left hemisphere. Whilst logical, rational conscious processes are important, they do not easily modify emotions, and this is rarely more obvious than in the case of the drive to smoke. We can think rationally and logically about how harmful, expensive and unacceptable smoking is, but it doesn’t seem to help much in many cases. What really needs to be ‘re-educated’ is the emotional drive, the right hemisphere, not the logical thinking left. And this is where hypnosis has the potential to help. It certainly doesn’t help by ‘controlling your mind’ and ‘forcing’ you to stop! 

False Memories…. when story and history get confused.

Many people still believe memories to be like video recordings, or filing cabinets containing perfect, detailed records laid down as events occur, and hopefully ready to be recalled at any time. Sure, we sometimes forget, or have hazy memory, but we believe that all those clear memories we have represent ‘perfect’ recordings of historical fact. However, research tells a very different story, which starts with the way we perceive the world: We take in a limited amount of information, which is then expanded and interpreted, based on our past experiences and cognitive biases, and becomes something we experience as an objective reality. The question of perception itself is a big subject, but it’s just the error-prone starting point for memories.

Our brains only record a small amount of our moment-by-moment experience in long-term memory, yet we tend not to experience memories as partial. In fact we ‘reconstruct’ memories when we recall them, and this process can easily cause memories to change over time, in a way that is imperceptible to us. A detail gets changed or added, extracts from other memories become combined, the chronology changes, and we may even add details that other people have told us about. But when we access that memory, it’s as if this was exactly how it was originally created. It feels completely true and accurate. These factors become particularly important when someone is being asked to recall a memory: If they are allowed to report what they remember, the result will be more accurate than if they keep being asked about details, which may lead to erroneous elements being added to the memory.

Psychologist Elizabeth Loftus studies false memories, and has been involved in conducting some of the most well known research in this field. One piece of research illustrated the hazards of leading questions in criminal prosecutions: People were shown a simulated accident and subsequently asked either the speed the cars were going when they ‘hit’ each other, or the speed they were going when they ‘smashed’ into each other. When the word ‘hit’ was used, witnesses considered the car’s speed to be 34 mph on average, but when the word ‘smashed’ was used, they recalled a higher speed of 41 mph. Furthermore, when the word ‘smashed’ was used, 32% of the people said they remembered seeing broken glass, against 14% who claimed to have seen broken glass when the word ‘hit’ was used. There was no broken glass.

The ways in which memories can be altered or contaminated by leading questions, or even conversations between witnesses, obviously raises may issues in criminal investigations and prosecutions, and it’s in this field that people became very interested in using hypnosis to ‘improve’ access to memories. The Los Angeles Police Department trained detectives to use hypnosis with both suspects and witnesses, and the officers became known as the ’Svengali Squads’. Perhaps the most dramatic success came in 1976 with the ‘Chowchilla’ kidnapping: Twenty-six children and a school bus driver were kidnapped by three men, but managed to escape after spending some time partially buried in a quarry. Under hypnosis the bus driver remembered the licence plate of one of the vehicles involved in the abduction, which led the police to detain the men responsible. However, the use of hypnosis did not prove to be a turning point in the fight against crime, and there were equally noteworthy failures. What was particularly significant on this occasion was that the driver had attempted to memorise the licence plate at the time of the abduction; the information had been encoded in memory.

Although there is still some debate on the subject, it seems there is little evidence that hypnosis makes memories more reliable as such, and although it can seemingly enhance memory access, it can also enhance all the errors that naturally occur in our memory; those ‘added details’, distortions and confusions. It’s like turning up a signal and getting more noise too. As a result, the pendulum has swung the other way in many places, including the UK where Home Office guidelines warn that evidence obtained under hypnosis is likely to be inadmissible in court.

Of course, this also raises questions about the use of memories in psychotherapy, and also the use of hypnosis to access memories in therapy. In fact, this was the subject of some pretty fierce fighting in the 80s and 90s, sometimes referred to as the ‘memory wars’. Elizabeth Loftus was on the receiving end of some of the hostility, for speaking out on the subject of false memories in therapy, something she discusses in her TED Talk linked below. Michael Yapko, clinical psychologist and author on the subject of clinical hypnosis, has written about this episode on a number of occasions, explaining that therapists used a range of techniques (including hypnosis) to ‘uncover’ repressed memories of childhood abuse. Unfortunately many of the therapists had no idea that digging deeply for memories of abuse could result in the creation of false memories. Inevitably, the results were disastrous for individuals, with families being torn apart, and on occasions innocent people stood accused in courtrooms.

Thankfully, the issues around false memories are better understood today, and psychotherapists can be expected to work with memories in ways that are not directive and do not involve suggestion. They should ensure their clients understand that memories would need to be independently corroborated, before they can be considered to have any historical accuracy, no matter how real they feel. But most often in therapy, unlike forensics, it’s the narrative truth that really matters. It’s the story we carry with us that influences how we think, feel and act, not the historical truth. Imagine a parent telling a child that they’ll get a great reward if they do well at school: The historical truth may be that the parent simply wanted their child to have the best opportunities in life, but if the child heard ‘I’ll only love you if you’re clever’, they may be left with a feeling of rejection, rather than unconditional love, and that is the story they will carry.

So, ultimately, memory is pretty unreliable when it comes to providing any historical truth, regardless of the fact that it feels so convincingly true. But, despite it’s inherent inaccuracy it forms the basis of our story, and fuels our thoughts, feelings and actions. Thus it can directly influence our present and our future.


See the TED Talk by Elizabeth Loftus here.

Supporting Anxiety UK

Anxiety UK

I am now an Anxiety UK Approved Therapist, providing therapeutic support to the charity’s members and partner beneficiaries in my work as a hypnotherapist. I am subject to Anxiety UK’s regular monitoring of my professional qualifications, supervision, continual professional development, insurance and professional body membership in addition to complying with the ethical framework and professional standards set down by my registered governing body, the National Society of Hypnosis, Psychotherapy and Mindfulness.

Full details of the Anxiety UK Approved Therapist scheme can be found here: www.anxietyuk.org.uk/getinvolved/therapists-at-anxiety-uk.

Details about becoming a member of Anxiety UK to be able to access therapy via the charity can be found here www.anxietyuk.org.uk/membership.

Anyone who becomes a member of Anxiety UK can gain a number of benefits, one if which is access to reduced-rate therapy services. These must initially be booked through Anxiety UK (see the membership link above).

Alternatively, non-members can access therapy through the charity’s FAST referral service, the details are here: www.anxietyuk.org.uk/our-services/fast

Of course, my services are still available to be booked directly.

Anxiety UK Approved Therapist logo

Hypnosis and Pain

I decided to post this video in my blog as I've often suggested it to people who are unsure about whether or not hypnosis 'works'. It's a TV documentary from More4 in the UK, dating from 2006. It includes live footage of a patient undergoing a hernia operation without the use of a general anaesthetic, or any anaesthetics for that matter. Pain is managed by hypnosis. The program also includes discussion and debate about hypnosis and it's use in healthcare, with other examples of it's use in the operating theatre, along with it's benefits in terms of healing and the speed of recovery. All in all it's very enlightening to anyone who is unsure about the validity of hypnosis, especially if they’ve been seeing too much of it's use in entertainment.



A few decades ago the argument over whether or not hypnosis was an altered state of consciousness was at its peak. Some very sound research work seemed to suggest that hypnosis was mostly evidence of 'social compliance', rather than an altered state of consciousness: When hypnotised people were simply behaving as they thought they should, and complying with the instructions of the hypnotist. Whilst this made sense in terms of the research studies, it made little sense to people working with hypnosis in a clinical setting, who regularly worked with people who had misconceptions about hypnosis being like sleep, or unconsciousness, a state where they would have no control. Yet, when hypnotised they did not behave in any of these ways, as they had expected to. Instead, they behaved as people normally do when hypnotised. And of course, as this program shows so wonderfully, it would be very difficult to undergo major surgery without an anaesthetic, and to be free of pain or discomfort through social compliance alone. It's not that such research and theories were 'wrong', they actually were very helpful in developing understanding, but they were incomplete, and seemingly disconnected from hypnosis in a clinical environment.

The debate about an altered state of consciousness has largely subsided in recent years, no doubt in part because we still don't really know quite what a 'normal' state of consciousness is. Unfortunately the disconnection between research into hypnosis and it's clinical application is often still there. There are some practical reasons for this: Researchers need to be able to measure and repeat many aspects of their work. This means working with hypnosis in a standardised way, rather than adapting it to suit the individual, as a clinician would. It means focusing on the depth of hypnosis, which is more likely to be unhelpful in a clinical setting, unless working with pain. It also means working with highly hypnotisable subjects, something that would be impractical in healthcare settings. This last factor is particularly significant, as it may cause some research results to be inappropriate in the context of hypnosis used in the general population. Ultimately, research into hypnosis is a fascinating subject, but we do need to be careful when considering how findings relate to the use of hypnosis within a healthcare setting.