Tuyệt vọng có thể cần phải được giải quyết trước khi một cá nhân trải qua trầm cảm nặng có thể tham gia vào bất kỳ khía cạnh khác của điều trị. Một sự hiểu biết tuyệt vọng là một signi ® không thể tính năng của phương pháp nhận thức hành vi trầm cảm. | 138 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS and formal rating scales such as the Hamilton Depression Rating Scale the Beck Depression Inventory and the Beck Hopelessness Scale is required so that an individualized treatment approach can be developed. It is highly likely that the severity of depression will be a significant factor in deciding the focus of treatment. 2 Hopelessness may need to be addressed before an individual experiencing major depression is able to engage in any other aspect of therapy. An understanding of hopelessness is a significant feature of cognitive-behavioural approaches to depression. The learned helplessness model of depression Abramson Seligman Teasdale 1978 emphasizes depressive attributional style whilst Beck s 1979 theory of depression included a negative view of the future as one aspect of his depressive triad. Yapko 1992 describes several strategies to address hopelessness. Appendix A contains a description of a possible approach to the modification of hopelessness using a hypnotic process. 3 Ego strengthening techniques hold considerable promise for the modification of depression on theoretical grounds. A negative view of the self is one of the primary components of Beck s 1979 cognitive triad. Hartland 1971 popularized the concept of ego-strengthening and utilized it in much of his therapy to reinforce self-reliance and a positive self-image see Hammond 1990 for a useful discussion and a range of hypnotic approaches to ego-strengthening . 4 The process of cognitive restructuring may be facilitated by the use of hypnotic techniques. Alladin 1994 describes a process of cognitive restructuring under hypnosis. Trance is established and the client imagines a situation that normally causes distress. The client is then instructed to focus on the dysfunctional cognitions and associated emotions physiological and behavioural responses. Encouragement is given to identify or freeze frame by frame like a movie the faulty cognitions in .
