Mindful hypnotherapy

1. Introduction

Version followed: the eight-session, individual Mindful Hypnotherapy (MH) protocol of Gary Elkins and Nicholas Olendzki (Baylor University Mind-Body Medicine Research Laboratory), as set out in their book Mindful Hypnotherapy: The Basics for Clinical Practice (Springer Publishing; publisher's contents page only) and in Elkins's ASCH continuing-education workshop handout (CE cycle 2024–2027), which gives the session themes and the 10-step induction structure. Where the handout and the book's chapter titles name sessions 4 and 8 differently, both names are given. The book's year appears as 2018 on the publisher page, and other pages cite it as 2019 or 2020 [uncertain]. The brief two-session variant (Slonena & Elkins, 2021) is described separately in 4.15.

• What it is. Elkins defines MH as an intervention that deliberately uses hypnosis (a hypnotic induction plus suggestions) to bring mindfulness into therapy and self-practice. Its main aim is to give clients mindfulness skills they keep using. It was developed and tested for stress and anxiety and for well-being in non-clinical and mildly distressed adults, mostly students. [source: ASCH handout; ISH masterclass page; Springer page]
• How change is thought to happen. Hypnosis is the delivery vehicle for mindfulness. The hypnotic experience (focused attention, less peripheral awareness, relaxation, imagery, and responsiveness to suggestion) is meant to make present-moment, nonjudgmental awareness easier to reach and easier to understand than effortful meditation training. MH also joins mindfulness's acceptance stance to hypnotherapy's change stance, using suggestions tailored to the person. Elkins credits the gains to greater receptivity to positive ideas in hypnosis, together with mindfulness and emotional relaxation. Daily self-hypnosis carries the skills into everyday life. [source: ASCH handout; Baylor 2020 press release; Yoga Journal interview with Elkins]
• Why brief. Elkins presents MH as a shorter, less demanding alternative to MBSR-style programmes: 8 weekly one-hour individual sessions, with no 2-hour classes or retreat day. Hypnotic responding is described as experiential and effortless rather than effortful. [source: Olendzki 2016 thesis record; Baptist News 2020]
• Relation to tab 090. Mindfulness-based cognitive-behavioural hypnotherapy (tab 090) also combines mindfulness with hypnosis but sits inside a CBT case formulation. MH is a stand-alone, theme-sequenced mindfulness programme delivered through hypnosis. Use 090 when cognitive restructuring of a specific disorder is the main task, and MH when the goal is general stress reduction and mindful self-regulation [synthesis].
• Scope of this guide. This guide covers clinical hypnosis only, used by licensed health professionals within their competence. MH is not a trauma-memory method and not a medical treatment. All example wording below is illustrative paraphrase, not Elkins's transcripts.

2. Framework

Format. One-to-one sessions of about one hour, weekly, for 8 weeks. Each session includes an in-session mindful hypnosis experience. Between sessions the client listens daily to a self-hypnosis audio recording of about 20–25 minutes that contains an induction, relaxation, and mindfulness suggestions, and logs the practice (the book's Appendix B is a daily practice log). In the 2020 trial most participants practised almost daily and rated satisfaction 8.9/10. [source: Olendzki 2016 thesis record; Baylor 2020 press release; Yoga Journal; Springer page]

Phase 0 – Assessment and preparation (before or within session 1). Goals: rapport, case conceptualisation, clarifying the client's goals, correcting myths about hypnosis, informed consent, screening, and optionally measuring hypnotizability with the Elkins Hypnotizability Scale (EHS, about 20 minutes) to plan and individualise suggestions. [source: ASCH handout; Springer page (Ch. 6, Appendix A); screening is synthesis, see 4.1]

The eight sessions [source: ASCH handout; chapter titles from Springer page; Baylor 2020 press release]:

Typical session flow (only partly specified in sources). Review the past week's practice and log (stated for session 2 onward) → introduce the theme and rationale → in-session mindful hypnosis built on the 10-step induction with theme-specific suggestions → re-alerting → debrief → give or update the audio and the home-practice plan [source: ASCH handout for practice review and the induction; the rest of the sequence is synthesis].

Criteria for moving on. The sources describe a fixed weekly sequence, not mastery criteria [uncertain]. Practical criteria [synthesis]: move on when the client (a) is practising most days, (b) can describe the session's skill in their own words, and (c) shows no unresolved adverse reaction. Before session 4, check that the client can reliably re-alert themselves. Before session 5, check that self-directed warmth is not likely to set off trauma material (see 4.9). Spend part of session 7 on any theme that has not taken hold.

Brief variant. Two audio-delivered mindful hypnosis sessions about a week apart, with a daily home recording, for stress reactivity (see 4.15). [source: Slonena & Elkins 2021 record]

3. Guiding principles

[source: ASCH handout unless tagged otherwise]

• Hypnosis serves mindfulness. Every induction and suggestion is built around a mindfulness goal. Practically: ask of each suggestion whether it builds present-moment, nonjudgmental awareness.
• Integrate acceptance and change. Mindfulness accepts, and hypnotherapy suggests change. Practically: pair acceptance wording (allowing, noticing) with change wording tied to the client's goals (calmer, steadier).
• Individualise. Unlike standard mindfulness practice, suggestions are tailored to symptoms, goals and hypnotizability. Practically: use the EHS profile and the client's own imagery and words.
• Empower the client. Self-hypnosis is a skill the client owns, and building self-efficacy in self-hypnosis is a named target [source: ISH article]. Practically: by session 4 the client runs their own induction.
• Daily practice so the benefit shows itself. Practically: do not argue for the method; set up daily practice and let the client notice the effects.
• Expect difficulty and normalise it. Practically: tell clients early that minds wander and practice gets easier.
• Use Buddhist ideas secularly, without dogma. The Four Noble Truths, the Middle Path, concentration and mindfulness training, and teaching stories are used as secular ideas, and the approach is not dogmatic about either hypnosis or mindfulness. Practically: offer the concepts as optional lenses and drop the religious framing.
• The client stays in charge. Elkins says MH is "not a form of mind control" and can fit any faith or value system [source: Baptist News 2020]. Practically: explain that the client can stop, adjust or open their eyes at any time.
• Effortless rather than effortful. Hypnotic responding is described as experiencing rather than trying [source: Baptist News 2020]. Practically: invite rather than instruct, and drop any language about doing it right.
• Trauma-aware pacing. Bring in compassion gradually and watch for trauma that shapes how it is received. Practically: check in before and after compassion work and offer gentler versions.
• Relationship and evidence base. Practice is evidence-based and rests on a strong therapeutic bond. Therapist qualities: authentic, empathic, compassionate, calm, nonjudgmental, attuned to goals, humble, grateful, open to learning. Practically: model nonjudgment in how you respond to the client's practice reports.
• The therapist practises. Needed skills: clinical hypnosis, metaphor, mindfulness, and a personal mindful self-hypnosis practice. Training routes: SCEH, ASCH, ISH (hypnosis); Center for Mindfulness and Center for Mindful Self-Compassion (mindfulness). Practically: do not deliver MH without formal hypnosis training and your own practice.

4. Intervention inventory

The sources give session themes, the 10-step induction, and named exercises. They do not give Elkins's transcripts (those are in the book, which is not drawn on here). Step detail beyond what is cited is marked [synthesis]. All example language is illustrative paraphrase.

4.1 Orientation, informed consent and screening

• Purpose / when: Phase 0 and the start of session 1. Correct myths, set expectations, get consent, screen for suitability, and build rapport (rapport-building is named for session 1). In the trials, sessions began by introducing the concept of hypnosis. [source: ASCH handout; Yoga Journal]
• Steps:
  1. Explain hypnosis as focused attention with reduced peripheral awareness and more responsiveness to suggestion, and mindfulness as nonjudgmental present-moment attention. Explain that MH uses the first to train the second [source: ASCH handout; Baptist News].
  2. Separate clinical hypnosis from stage hypnosis: the client keeps control, cannot be made to act against their will, can hear and respond, and can end the session at any time [source: Baptist News for "not mind control"; rest synthesis].
  3. Describe the 8-session plan, the daily 20–25-minute audio practice, and the log.
  4. Screen [synthesis; the sources list no exclusion criteria or contraindications, and the handout only asks for awareness of trauma]: active psychosis or mania; severe dissociative disorder; current suicidal intent (assess risk with standard practice first and treat it as the priority); untreated PTSD with intrusive re-experiencing (stabilise first, and do not use MH to explore memories); current substance intoxication; marked cognitive impairment; and unexplained physical symptoms (refer for medical assessment, because MH is an adjunct and never replaces medical care). Severe depression or anxiety disorders need a full treatment plan, with MH as an adjunct at most.
  5. Get and document informed consent to hypnosis and to recordings, including permission to record the in-session work if you make personalised audio.
• Example language (illustrative): "In hypnosis you stay aware and in charge. It's more like being absorbed in a good book than being asleep. I'll offer suggestions, and you're free to take them up, change them, or ignore them. If you want to stop at any point, just open your eyes and we'll talk."
• Watch for: fears about losing control or about religious conflict (see 5.6); expectations of a cure from one session; any history of frightening hypnosis experiences.

4.2 Hypnotizability assessment (Elkins Hypnotizability Scale)

• Purpose / when: Optional, in Phase 0. Used for planning, individualising suggestions and encouraging the client; it is not a gate to treatment. The full EHS takes about 20 minutes and is described as pleasant and clinically practical. [source: ASCH handout; EHS PDF via SCEH]
• Steps (structure only; items not reproduced): Seat the client upright with head support. Give a standardised induction (gaze on a point, eye closure, progressive relaxation, deepening count paced with the breath). Then give six scored suggestion items: arm heaviness, arm lightness/levitation, garden imagery with an inquiry about dissociation, a rose-scent item, an amnesia item, and a positive-perception item with eyes open. Re-alert with an upward count, then do a structured post-session inquiry. The full scale scores 0–12 (bands: low, middle, high, very high). A clinical form (EHS-CF, 0–9) leaves out the amnesia and positive-hallucination items. [source: EHS PDF; ASCH handout] Use the published administration text with appropriate permission; it is copyrighted by Springer Publishing. The book's Appendix A contains the clinical form.
• Example language (illustrative), for framing: "This isn't a pass/fail test. It shows which kinds of suggestions come easily to you, so I can shape the recordings to suit you."
• Watch for: low scorers feeling they have failed. Reframe the result as information and lean on suggestions about relaxation, attention and acceptance rather than involuntary motor or sensory items [synthesis]. Elkins proposes hypnotizability as a possible moderator; how much it predicts MH outcome is not established [uncertain].

4.3 The 10-step mindful hypnotic induction (core procedure)

• Purpose / when: The template for every in-session experience and every audio recording. The theme-specific suggestions for sessions 1–8 go into steps 7–9. [source: ASCH handout for the 10 steps; pacing and wording are synthesis]
• Steps:
  1. Focus of attention: invite the gaze to rest on one point or on something in the room. Elkins describes attention starting on an external object and then shifting inward [source: Yoga Journal].
  2. Eyelid closure: suggest that the eyelids grow heavy and close when ready.
  3. Awareness of breathing: observe the natural breath without controlling it.
  4. Relaxation suggestions: release tension progressively through the body.
  5. Deepening: for example, a slow count paced with out-breaths, or descending imagery.
  6. Safe-place imagery: a peaceful place, often in nature (nature imagery was used in the trial sessions [source: Yoga Journal]). Let the client choose it and explore it through all the senses.
  7. Suggestions for awareness of experience: sensations, sounds and the felt sense of the body, as they are.
  8. Suggestions for awareness of the mind: thoughts and feelings noticed as passing events.
  9. Nonjudgmental awareness of the moment: resting in open, accepting awareness; add goal-directed suggestions and a post-hypnotic suggestion linking the state to daily life.
  10. Return to alertness: an upward count with suggestions of feeling refreshed and clear-headed; check orientation and then debrief.
• Example language (illustrative): step 1, "Let your eyes settle on one spot, just resting there…"; step 5, "With each breath out, I'll count down from ten, and you can drift a little deeper…"; step 9, "Notice that you don't need to change anything right now, just noticing this moment, as it is…"; step 10, "As I count up from one to five, you'll come back fully alert, refreshed, bringing this calm with you."
• Watch for: facial relaxation, slower breathing, stillness and delayed responses (signs of absorption); after re-alerting, full orientation (time, place) and no lingering heaviness. Debrief by asking what the client noticed, what helped, and what got in the way.

4.4 Session 1 – Relaxation and present-moment awareness

• Purpose: Give a first experience of mindful hypnosis and bring in nonjudgmental present-moment awareness through suggestion. Build rapport and start daily practice. [source: ASCH handout]
• Steps: orientation and consent (4.1) → brief psychoeducation on present-moment awareness and the mind's habit of drifting into past and future [synthesis] → the 10-step induction, emphasising steps 3–6 and 9 → re-alert and debrief → give the session-1 audio and the practice log, and agree a daily time and place.
• Example language (illustrative): "Each time you notice your mind has wandered, that noticing is the practice. You gently come back to this breath, this moment."
• Watch for: whether the client can describe one moment of present-focused calm; a realistic daily practice plan.

4.5 Session 2 – Nonjudgmental acceptance of sensations

• Purpose: Practise staying with sensations, through each of the five senses and within the body, and noticing how they change, flow and feel, without trying to change them [source: ASCH handout; Baylor 2020 press release].
• Steps: review the week's practice, expect difficulty, and reassure the client that it gets easier [source: ASCH handout] → induction → in steps 7–9, guide attention through sounds, touch and pressure, temperature, smell and taste, and inner body sensations in turn, suggesting curious, label-free noticing of each quality and of how it shifts → debrief → updated audio. The Yoga Journal article lists "tracking the senses" and mantras among MH components; how mantras are used was not found [uncertain].
• Example language (illustrative): "Notice a sensation in your hands, maybe warmth, tingling, or pressure. See if you can simply be curious about it, letting it be just as it is, watching it change by itself."
• Watch for: uncomfortable sensations (pain, tension). The task is to allow and observe, not to remove them. If discomfort rises sharply, widen attention to the whole body or move to a neutral anchor [synthesis]. Signs it is working: the client reports that sensations shifted on their own when they were not fought.

4.6 Session 3 – Nonjudgmental acceptance of thoughts and feelings

• Purpose: Show that letting go of the need to escape or alter inner experience brings greater peace, and build self-soothing through acceptance [source: ASCH handout].
• Steps: practice review → brief teaching on craving and aversion as sources of suffering, offered as a secular idea from Buddhist concepts [source: ASCH handout] → induction → in steps 8–9, suggest observing thoughts and emotions as passing events, with metaphor (for example clouds crossing the sky or leaves on a stream; the specific metaphors are synthesis) and permission to name them gently and let them be → debrief → audio.
• Example language (illustrative): "A thought comes… you notice it… and you let it pass, like a cloud moving across a wide sky. The sky doesn't need to chase the cloud away."
• Watch for: the client using acceptance as a way to get rid of feelings (a subtle form of avoidance). Gently point out the difference [synthesis]. Strong emotion surfacing: see 5.3.

4.7 Session 4 – Self-hypnosis training (empowerment and self-guided sessions)

• Purpose: Turn the work into a skill the client owns, carrying the earlier mindfulness aims forward through a guided self-induction that walks through the 10 steps [source: ASCH handout; Springer page Ch. 11].
• Steps: review → teach the 10 steps explicitly (a written list or card helps [synthesis]) → guided self-induction: the therapist talks the client through giving themselves each step silently → the client practises a short self-induction in session with minimal prompting, including self-re-alerting → agree a mix of audio-guided and self-guided practice. Sessions can be long or brief depending on goals [source: ASCH handout].
• Example language (illustrative): "This time you'll guide yourself. I'll just name each step, and you give yourself that suggestion in your own words… Now, when you're ready, count yourself up and open your eyes."
• Watch for: the client being able to re-alert themselves fully and reliably (essential before unsupervised practice); a short version (for example 3–5 minutes) for daily stress moments [synthesis].

4.8 Daily mindful self-hypnosis practice (audio and log)

• Purpose: The between-session engine of MH. Daily audio-guided self-hypnosis of about 20–25 minutes, with an induction, relaxation and mindfulness suggestions matched to the current theme, recorded in a daily practice log [source: Baylor 2020 press release; Yoga Journal; Springer page Appendix B].
• Steps: give a recording for each theme (the lab's own or one personalised in session) → agree when, where and how (seated, undisturbed; not while driving or operating machinery [synthesis]) → the client logs date, duration, and brief notes on the experience → review the log at the start of each session.
• Example language (illustrative): "Once a day, find a quiet spot where you won't be disturbed for about 20 minutes and play the recording. Afterwards jot down a line or two: how long, and what you noticed."
• Watch for: frequency, and also quality (falling asleep, rushing). Adherence problems: see 5.4.

4.9 Session 5 – Compassion for self and others

• Purpose: Bring in self-compassion and compassion for others as part of mindful practice. The handout frames compassion through the metaphor of a gift that meets needs, shows care, does no harm and lets one thrive. It loosens anger's apparent power and recasts compassion as real strength. Introduce it gradually, staying alert to trauma that shapes how compassion lands. [source: ASCH handout; Baylor 2020 press release]
• Steps: review → brief discussion of what compassion means to the client and any discomfort with self-kindness [synthesis] → induction → in steps 7–9, offer the compassion-as-gift metaphor, first towards someone easy to care for, then towards oneself, then more widely (the order is synthesis, so adjust it to the client) → suggestions that anger can be noticed without being obeyed, and that compassion is a strength → debrief → audio.
• Example language (illustrative): "Imagine compassion as a gift, something that meets a real need, that cares and does no harm. Notice who you might offer it to… and whether you could offer some of it to yourself, just as you are."
• Watch for: grief, shame or a sense of threat when self-kindness is invited (common after neglect or abuse [synthesis]). Pause, return to safe-place imagery or an external anchor, and offer a gentler dose such as compassion towards a pet or a child first [synthesis]. Signs of benefit: softer self-talk in practice logs.

4.10 Session 6 – Values and meaning

• Purpose: Help the client identify meaningful experiences and the values beneath them, for greater purpose and authenticity. Two named exercises. [source: ASCH handout; Springer page Ch. 13; Baylor 2020 press release]
• Exercise A – Process of elimination:
  1. Out of hypnosis, the client lists their attributes, roles and identities (job, relationships, appearance, achievements and so on).
  2. In the hypnotic state, invite them to set these aside one at a time and notice what remains, until they reach a core sense of self [source: ASCH handout for the exercise; doing step 2 in hypnosis is synthesis].
  3. Debrief: what remained, and which values that core points to.
• Exercise B – Existential bravery: the client considers what they would do if there were no fear of failure. In hypnosis, this can be imagined as a scene of living that way [synthesis]. Debrief to name the values revealed and one small step that fits them.
• Example language (illustrative): "Gently set aside your job title… notice you're still here. Now set aside how others see you… still here. What remains when the labels are put down?"; "Imagine for a moment that failure isn't possible. What do you find yourself doing?"
• Watch for: existential anxiety or emptiness when roles are set aside. Pace this, and let the client keep any attribute they do not wish to set aside [synthesis]. In people prone to depersonalisation, use only Exercise B or do Exercise A outside hypnosis [synthesis].

4.11 Session 7 – Deepening and integration

• Purpose: Confirm understanding and progress towards goals. Refine the plan and strategies, correct technique, and work on the barriers the client has noticed. Deeper practice may bring up new topics. [source: ASCH handout; Springer page Ch. 14]
• Steps: review the whole log → ask the client to teach back each theme in their own words [synthesis] → identify which skills come easily and which do not → a longer, deeper induction that weaves the themes together (present moment, senses, thoughts and feelings, compassion, values) and gives extra time to the weakest theme → problem-solve barriers → note new topics, which may need separate therapy.
• Example language (illustrative): "Let's look back over these weeks. Which parts have become yours, and where do you still get stuck?"
• Watch for: new clinical material (for example relationship or trauma themes). Contract for further work rather than expanding MH into memory processing.

4.12 Session 8 – Seeing progress, renewing goals, long-term practice

• Purpose: Help the client recognise their gains, encourage curiosity and self-set goals, plan ongoing mindful self-hypnosis, acknowledge the therapeutic bond and the meaning of the work, and handle the ending [source: ASCH handout; Springer page Ch. 15].
• Steps: compare current stress and mindfulness with baseline (for example re-administer the outcome measures you used, such as a perceived-stress and a mindfulness questionnaire, without reproducing items) [synthesis; these constructs were the trial outcomes per the Olendzki 2016 thesis record] → the client names their gains → write a long-term practice plan (frequency, which recordings, a brief version for stressful moments, a cue to restart after lapses) [synthesis] → a closing induction with suggestions for continued curiosity and practice → acknowledge the relationship and the ending, and offer booster contact if your service allows.
• Example language (illustrative): "What do you notice is different now, compared with when we started? … What would you like your practice to look like over the next few months?"
• Watch for: relapse planning, and dependence on the therapist's voice. Encourage self-guided sessions.

4.13 Suggestion and metaphor formulation

• Purpose: Build the theme-specific content of steps 7–9. The handout describes goal-directed suggestions tailored to symptoms and goals, delivered mainly through stories, metaphors and reframing of thoughts, individualised by hypnotizability and worded with acceptance. It does not name permissive wording as a rule. [source: ASCH handout; Springer page Ch. 5]
• Steps [synthesis built on the handout's elements]: take the client's goal and preferred imagery → write one acceptance suggestion (allowing what is) and one change suggestion (the goal state) → pick a metaphor from the client's world → add a post-hypnotic suggestion linking the state to a daily cue (for example a doorway, the first sip of a drink) → for high scorers, more vivid sensory imagery; for low scorers, simpler attention and relaxation suggestions.
• Example language (illustrative): acceptance: "You can let this feeling be here, without needing to push it away…"; change: "…and as you let it be, you may notice a steadier calm growing underneath"; post-hypnotic: "Each time you pause at a doorway today, you can take one easy breath and notice this moment."
• Watch for: suggestions that quietly push the client to not feel something, which conflicts with the mindfulness aim.

4.14 Secular teaching from Buddhist concepts

• Purpose: Give a conceptual frame for acceptance: suffering is recognised; its origin lies in craving (clinging and aversion); relief is possible; and the Middle Path and Eightfold Path are a lifestyle that supports acceptance. Concentration and mindfulness training means seeing experience without elaborating on it or judging it. Stories and metaphors are used as teaching tools. All of this is used secularly. [source: ASCH handout; Springer page Ch. 3]
• Steps: introduce briefly, usually in sessions 2–3, in plain language and only if it helps the client; offer a short teaching story outside or inside hypnosis; link it to the client's own experience of struggling against discomfort [synthesis for timing].
• Example language (illustrative): "Much of the extra distress we feel comes from fighting what's already here, or grasping for what isn't. Today we'll practise loosening that grip."
• Watch for: religious objections or unease. Keep it optional and secular (see 5.6).

4.15 Brief mindful hypnosis variant (two sessions)

• Purpose: A short protocol for stress reactivity, tested in 55 adults with elevated perceived stress against an active control: two audio-delivered mindful hypnosis sessions about one week apart, plus a daily home recording [source: Slonena & Elkins 2021 record].
• Steps: session 1, consent and orientation (4.1), then the mindful induction (4.3) with present-moment and acceptance suggestions; give the home recording → a week of daily practice → session 2, repeat or extend, and review practice. The details of the scripts were not found [uncertain].
• Example language: as in 4.3–4.6 (illustrative).
• Watch for: use it as an entry point or booster, not as a substitute for the full eight sessions when broader change is the aim [synthesis].

5. Handling problems

Source-based guidance is limited to the ASCH handout (items 5.1 and 5.2, and the trauma caution in 5.3). Everything else is [synthesis].

• 5.1 "It's hard / I'm not getting much from it" (stuck client). Source: clients may struggle to integrate awareness or report little benefit; review their practice and reassure them that the skill develops with time [source: ASCH handout]. Also [synthesis]: check the log for how they practise (rushing, practising while distracted, using it to get rid of feelings); shorten or simplify the induction; switch the anchor (sound instead of breath); use the client's own imagery; re-check goals; for low hypnotizability, emphasise relaxation and attention suggestions and drop imagery-heavy ones.
• 5.2 "Mindfulness is just a trick" / scepticism. Source: some clients see mindfulness as a trick rather than a meaningful practice, and compassion work should be introduced gradually so as not to overload them [source: ASCH handout]. Also [synthesis]: do not argue; invite a two-week experiment with the log as evidence; link each theme to the client's own stated goal.
• 5.3 Overwhelm, abreaction or trauma material during inward focus [synthesis, apart from the handout's call for trauma awareness]. MH is not a memory-processing method. If distressing memories, flashbacks or intense emotion arise: (1) stop deepening and shift to an external, present-moment anchor (sounds in the room, feet on the floor); (2) offer the safe-place image only if it is experienced as safe; (3) re-alert gently with a count, eyes open, and check orientation; (4) ground (name objects in the room, feel the chair); (5) debrief, validating the client's experience without exploring or interpreting the memory, and never suggest that hypnosis has revealed what happened; (6) review suitability, and refer for or provide trauma-focused treatment with stabilisation first before going on with MH. Treat any memory content as the client's experience, not as historical fact, and never use MH to recover memories.
• 5.4 Dissociation or difficulty re-alerting [synthesis]. Signs: blank or glazed stare after the count, delayed answers, feeling unreal or far away. Respond with an eyes-open, slower re-alerting count; clear suggestions of full alertness; orientation questions; sensory grounding; movement. Do not let the client leave or drive until they are fully oriented. For clients prone to depersonalisation, keep sessions shorter, use eyes-open or light-trance versions, avoid self-dissolving imagery (adapt Exercise A in 4.10), and consider whether MH fits at all.
• 5.5 Non-adherence to daily practice [synthesis]. Explore the barriers (time, privacy, boredom, sleepiness, forgetting); agree a fixed time and an implementation intention; offer a shorter version; let the client choose seated rather than lying down if they fall asleep; review the log without judgement, modelling the nonjudgmental stance; if practice keeps failing, reconsider fit or the timing.
• 5.6 Fears about control, or religious and cultural objections. Source: Elkins frames MH as not mind control and as compatible with any faith or values, and compares inward hypnotic absorption to deep prayer [source: Baptist News 2020]. Also [synthesis]: explain the client's control again; present Buddhist ideas as optional and secular, or leave them out; let the client choose imagery and wording consistent with their beliefs.
• 5.7 Panic or discomfort with breath focus or eye closure [synthesis]. Some anxious or traumatised clients find breath attention or eye closure threatening. Offer eyes open with a softened gaze, an external anchor (sounds, hands), and permission to move; frame noticing anxiety as a valid mindful object rather than a failure.
• 5.8 Compassion work provokes shame or grief (session 5) [synthesis building on the handout's trauma caution]. Slow down, and start compassion with an easier target; normalise resistance to self-kindness; return to grounding if needed; consider extra sessions before moving on.
• 5.9 Ruptures [synthesis]. Common triggers: the client feels the method is being pushed, feels they failed the hypnotizability test or the practice, or feels a suggestion did not fit. Name the strain openly, take responsibility for the mismatch, ask what would fit better, and adjust the wording. The handout's emphasis on a nonjudgmental, humble, attuned therapist applies here [source: ASCH handout for the qualities].
• 5.10 Clinical deterioration, risk or new disorder emerging [synthesis]. MH was studied for stress and distress, not as a stand-alone treatment for major psychiatric disorders. If suicidality, severe depression, psychosis or substance problems emerge, pause MH, assess risk with standard practice, and move to appropriate treatment. Physical symptoms need medical assessment, because MH is a stress-management adjunct and never a treatment for physical disease.
• 5.11 Over-reliance on the therapist's voice or recordings [synthesis]. From session 4, phase in self-guided inductions; in session 8, agree a plan that does not depend on the therapist.
• 5.12 Choosing between MH and tab 090 or other approaches [synthesis]. If the problem calls for disorder-specific cognitive work (for example depressive rumination with distorted beliefs), see tab 090 (mindfulness-based cognitive-behavioural hypnotherapy) or standard CBT; MH is for general stress, anxiety symptoms and well-being.

Sources

Sources

• Mindful Hypnotherapy: The Basics for Clinical Practice – Springer Publishing (publisher page, contents)
• Elkins, G. Mindful Hypnotherapy, Workshop 1 handout (ASCH-ERF)
• Olendzki, N. A. (2016). An investigation of the feasibility of Mindfulness-Based Hypnotherapy for stress and anxiety (PsyD thesis record, Baylor IR)
• Effects of a brief mindful hypnosis intervention on stress reactivity (Baylor IR record)
• Mindfulness Combined with Hypnotherapy Aids Highly Stressed People – Baylor University news, 2020
• Elkins Hypnotizability Scale (SCEH resource PDF)
• ISH Monthly Masterclass: Mindful Hypnotherapy, Gary Elkins
• ISH article on mindful hypnotherapy
• Baylor Mind-Body Medicine Research Laboratory – Publications
• Mindful hypnotherapy cited as way to reduce stress and boost compassion – Baptist News Global
• Beat stress and anxiety with mindful hypnotherapy – Yoga Journal (only Elkins's own description used; the home routine in that article is by another hypnotherapist and is not used here)
• Mindful Hypnosis: How to Stress Less and Live More Mindfully – TCSPP CE (Slonena, 2023) (lists the 8-session model and an experiential induction; no content details)

Further reading (not drawn on; cited for orientation only) [uncertain]

• Padilla et al. Effect of mindful hypnotherapy on psychological distress: a systematic review and meta-analysis (PMC12837898). Access was refused, so it was not used.

Books and papers cited

• Elkins, G., & Olendzki, N. (2018/2019). Mindful Hypnotherapy: The Basics for Clinical Practice. Springer Publishing. Contents page only; the transcripts are not drawn on.
• Elkins, G. (2014). Hypnotic Relaxation Therapy: Principles and Applications. Springer Publishing. Source of the EHS administration text reproduced by SCEH with permission.
• Olendzki, N., Elkins, G., Slonena, E., Hung, J., & Rhodes, J. (2020). Mindful hypnotherapy to reduce stress and increase mindfulness: a randomized controlled trial. International Journal of Clinical and Experimental Hypnosis, 68(2), 151–166. doi:10.1080/00207144.2020.1722028. Known through the press release and thesis record; full text not drawn on.
• Slonena, E., & Elkins, G. (2021). Effects of a brief mindful hypnosis intervention on stress reactivity: a randomized active control study. IJCEH, 69(4), 453–467. doi:10.1080/00207144.2021.1952845.
• Elkins, G. (2020). Contemplative practices and hypnosis: emerging perspectives and future directions. IJCEH, 68(2), 139–143. Not drawn on.