Monthly Webinar -'Ego-strengthening, Self-efficacy and Hypnosis'

Members have free access to this event and will be sent the zoom link via the mailing list.
This monthly webinar takes place between 6 and 7.30pm.

We are very happy to have Prof. Leslie Walker sharing his thoughts, experience and insights on ego-strengthening, self-efficacy, and hypnosis.

Aim: The aim of the presentation is to consider a conceptual framework which participants can use to understand more clearly some of the processes involved in what is often known as ‘ego-strengthening’, thereby enabling them to optimise its effectiveness in clinical practice.

Learning outcomes:
1. to understand the basics of Bandura’s conceptual model of self-efficacy (Bandura, 1977; Bandura 1997, Bandura and Cervone, 2023)
2. to explore some of the ways in which mastery experiences, vicarious experiences, verbal persuasion and emotional states can be used to enhance self-efficacy by means of clinical hypnotherapy

About this webinar:
When I was introduced to the uses of hypnosis by the British Society of Medical and Dental Hypnosis in the late 1970s, ‘ego strengthening’ was strongly advocated as a routine component of hypnotherapy.   The method recommended was that used by the late John Hartland (Hartland, 1966; Yeates, 2014) which involves a series of suggestions designed to enhance self-reliance. 

Although the aim was entirely laudable, I felt uncomfortable with the authoritarian phraseology and, in my view, the lack of a credible conceptual framework or theoretical rationale.    The assumption was that because the patient was hypnotised, these suggestions would be absorbed uncritically into the ‘unconscious mind’ and would automatically produce the desired effects.

In the 1970s, based on the dual principles of reciprocal inhibition and classical conditioning, systematic desensitisation had been proven to be effective in the treatment of various phobias.  However, it was a long and generally tedious procedure for patients and therapists.  To expedite matters, and to help patients with generalised anxiety, studies were carried out to evaluate the effects of applying muscular relaxation in vivo to alleviate or at least manage fear and anxiety (e.g., Suinn and Richardson, 1971; Öst et al, 1981).  Instead of being told whilst hypnotised that they would become more self-reliant, these relaxation methods provided patients with coping skills that enabled them to control distress for themselves.  

In the 1970s, I used these methods with some success in patients who had anxiety disorders (Ashcroft, Walker and Lyle, 1993) and, in 1980, went on to incorporate them into a hypnotherapeutic intervention to help patients with cancer to cope with chemotherapy side effects (Walker, 1984; Walker et al., 1988).  I called this ‘nausea management training’ in view of its similarities to anxiety management training and applied relaxation training.

A key component of this approach was to train patients to use cue-controlled relaxation (CCR) so that they could ‘switch on’ the relaxation response and apply it when and where they wished.  As in traditional progressive muscular relaxation training (Jacobsen, 1938), patients would be asked to tense and then relax the main muscles in the body in a systematic order, but with one important difference:  as they let go the tension and began to relax a muscle, they would be invited to say out loud with the therapist the key words “one-two-three relax!  They would then be asked to tense their muscles and think the key words as they let go the tension.   The idea was that, with repetition, they would associate the key words to the onset and deepening of the relaxation response, thereby achieving a degree of self-control over how relaxed they felt moment by moment.   Thinking the key words would become a conditioned stimulus for the elicitation of the relaxation response.   They were also taught diaphragmatic breathing and how to relax by focussing their attention without the necessity for muscular tension.  Training was carried out in live sessions, with or without a hypnotic induction, and with recordings for home practice.

I felt more comfortable with this ‘self-control’ approach, both in terms of the therapeutic alliance and the underlying theoretical framework.   The latter was greatly advanced by Albert Bandura in his classical paper on self-efficacy (Bandura, 1977).  This paper, based on the findings of many experimental studies, described a unifying theory which strongly suggested that different psychological interventions work by altering perceived self-efficacy.  The key mechanisms that affect self-efficacy are mastery experiences (the most powerful), vicarious experiences, social persuasion, and the effects of emotional and physiological states (Bandura, 1977; Bandura 1994; Bandura 1997, Bandura and Cervone, 2023).

In this webinar, I shall develop the self-efficacy model with particular reference to how it can inform and guide hypnotherapeutic interventions.  

Examples from my own casebook will be used as clinical illustrations.

Ashcroft G W, Walker L G and Lyle A (1993). A psychobiological model of panic: implications for behavioural and pharmacological therapies. In: S A Montgomery (ed.), The Psychopharmacology of Panic Disorder, (Ch 11, pp 131-143): Oxford, Oxford University Press. ISBN 0-19-262087-8.
Bandura, A, (1977).  Self-efficacy: towards a unifying theory of behavioral change.  Psychological Review, 84, 191-215.
Bandura, A. (1994). Self-efficacy. In V. S. Ramachaudran (Ed.), Encyclopedia of human behavior (Vol. 4, pp. 71-81). New York: Academic Press. (Reprinted in H. Friedman [Ed.], Encyclopedia of mental health. San Diego: Academic Press, 1998).
Bandura A (1997). Self-efficacy: the Exercise of Self-control.  W H Freeman & Co., New York.
Bandura A and Cervone D (2023) Social Cognitive Theory: An Agentic Perspective on Human Nature. John Wiley & Sons Inc, New York, United States
Hartland, J. (1966). Medical and Dental Hypnosis and Its Clinical Applications. London: Baillière, Tindall & Cassell.
Jacobson, E. (1938). Progressive Relaxation: A Physiological and Clinical Investigation of Muscular States and Their Significance in Psychology and Medical Practice (1st ed.). Chicago, IL: University of Chicago Press.
Öst L G, Jerremalma A, Johansson J (1981) Individual response patterns and the effects of different behavioral methods in the treatment of social phobia. Behavior Research and Therapy, 19. 1-16.
Walker L G (1985).  Aversions to chemotherapy in patients with lymphoid tumours.  Proceedings, First Annual Conference, British Society for Experimental and Clinical Hypnosis (pp 86-91).  London: BSECH Publications
Walker L G, Dawson A A, Pollet S M, Ratcliffe M A and Hamilton L (1988). Hypnotherapy for chemotherapy side effects.  British Journal of Experimental and Clinical Hypnosis, 5, 79-82
Yeates, L.B. (2014). Hartland’s Legacy (I): The Ego-Strengthening Procedure. Australian Journal of Clinical Hypnotherapy & Hypnosis, 36, pp.19-36.

Leslie G Walker is Emeritus Professor of Cancer Rehabilitation at the University of Hull, UK.  Until 2009 when he retired from the NHS and the University of Hull, he held the Foundation Chair of Cancer Rehabilitation and was the Clinical Lead for the Division of Cancer in the Postgraduate Medical Institute. He was also Director of the Oncology Health Service, and a founding member of the Faculty of the Hull York Medical School (HYMS).

Since the 1970s, he has used hypnosis to treat a range of clinical problems, and he has carried out five randomised clinical trials to evaluate the effects of hypnotherapy, primarily in cancer-related distress.  He is a former Member of the Council of the British Society of Experimental and Clinical Hypnosis and External Examiner for the hypnosis courses at Sheffield University and University College London.  In 2015, he was made an Honorary Life Member of the British Society for Clinical and Academic Hypnosis “in recognition of his contribution to hypnosis and the Society”. 

Recent research interests include the psychoneuroimmunology of breast, brain, lung, and colorectal cancers; psychosocial aspects of cancer screening; psychosocial interventions to prevent psychological distress and psychiatric morbidity in people with cancer, and Li Fraumeni syndrome.

Professor Walker has given numerous Invited Lectures and Keynote Addresses throughout the world, and he has over 300 publications to his name.  He is a Fellow of the British Psychological Society, and a former Fellow of the Royal Statistical Society, the Royal Society of Medicine, and the Society of Biology.  

Further details: www.lgwalker.com.