Anxiety and Depression: Condition Overview

Depression is a common mental health disorder characterized by a persistent low mood, loss of interest or pleasure in normally enjoyable activities, fatigue, and cognitive impairments. Anxiety refers to a group of disorders (such as Generalized Anxiety Disorder, or GAD) defined by excessive, uncontrollable worry, heightened physiological arousal, and avoidance behaviors. These two conditions are highly comorbid, meaning they frequently occur together, which has driven research into therapeutic approaches that can address both simultaneously.

Therapies with RCT Evidence of Effectiveness

1. Cognitive Behavioural Therapy (CBT)

• Description: CBT is a structured, time-limited intervention that helps patients identify and restructure maladaptive thought patterns and beliefs. It involves behavioral activation, exposure techniques, and cognitive restructuring to change the self-reinforcing cycles of negative thoughts and anxious behaviors.
• Evidence: Extensive meta-analyses of randomized controlled trials (RCTs) confirm that multi-modal CBT is highly effective at reducing both anxiety and depressive symptoms. It has proven efficacy not only in specialized psychiatric settings but also in primary care environments (Twomey et al., 2014) and adapted online formats for individuals dealing with chronic health distress (White et al., 2020).

2. Transdiagnostic Psychological Treatments

• Description: Rather than using separate manuals for distinct disorders, transdiagnostic therapies target shared underlying psychological mechanisms—such as emotional dysregulation or neuroticism—that fuel both anxiety and depression.
• Evidence: Systematic reviews and meta-analyses of RCTs have demonstrated that transdiagnostic treatments, including those delivered via the internet, produce moderate added clinical effects for patients suffering from depression, anxiety, or both simultaneously (Kolaas et al., 2024).

3. General Psychotherapy Targeted at Depression

• Description: Broad psychotherapeutic interventions designed primarily to alleviate primary depressive symptoms through interpersonal exploration, emotional processing, and problem-solving.
• Evidence: Evidence from RCTs reveals a "spillover" effect: engaging in psychotherapy specifically targeted at treating clinical depression also significantly reduces comorbid anxiety symptoms compared to control conditions (Weitz et al., 2018).

4. Mindfulness-Based Interventions (MBIs / MBCT / MBSR)

• Description: MBIs, such as Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR), combine meditative practices with cognitive therapy principles. They teach patients to observe their thoughts and feelings without judgment, reducing rumination and preventing the escalation of depressive and anxious states.
• Evidence: Meta-analyses of RCTs confirm that MBIs effectively reduce symptom severity for individuals currently experiencing a depressive or anxiety disorder, particularly showing strong benefits for depressive symptoms and acting as a robust relapse prevention strategy.

5. Compassion-Focused Therapy (CFT)

• Description: Originally developed by Dr. Paul Gilbert, CFT integrates cognitive behavioral techniques with evolutionary psychology and neuroscience to address deep-seated shame and self-criticism. It utilizes techniques like compassionate imagery and self-talk to help clients soothe their nervous systems and cultivate self-kindness.
• Evidence: Meta-analyses and recent RCTs demonstrate that CFT significantly reduces self-criticism and shame, correlating with moderate to significant improvements in both depressive and anxiety symptoms, particularly in populations where low self-worth is a core driver of their distress.

6. Acceptance and Commitment Therapy (ACT)

• Description: ACT is a "third-wave" behavioral therapy that focuses on psychological flexibility. Rather than trying to eliminate or restructure difficult emotions and thoughts, ACT teaches patients to accept them mindfuly while committing to behaviors that align with their personal values.
• Evidence: Meta-analytic reviews of RCTs have found ACT to be significantly more effective than waitlist or psychological placebo control conditions across several mental health disorders, including offering a viable and effective approach for reducing the symptoms of both depression and anxiety.

7. Dialectical Behavior Therapy (DBT)

• Description: Originally designed for Borderline Personality Disorder, DBT has been adapted for broader mood and anxiety disorders. It balances acceptance and change strategies, focusing on four core modules: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.
• Evidence: RCTs investigating DBT in various populations, including medical students and the elderly, have shown that DBT group therapy and standardized 12-week DBT interventions yield significant reductions in depression and anxiety scores with moderate to large effect sizes when compared to control groups.

References

Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183. https://doi.org/10.1037/a0018555

Kirby, J. N., Tellegen, C. L., & Steindl, S. R. (2017). A Meta-Analysis of Compassion-Based Interventions: Current State of Knowledge and Future Directions. Behavior Therapy, 48(6), 778–792. https://doi.org/10.1016/j.beth.2017.06.003

Kolaas, K., Berman, A. H., Hedman-Lagerlöf, E., et al. (2024). Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both: a systematic review with meta-analysis of randomised controlled trials. BMJ Open, 14, e075796. https://doi.org/10.1136/bmjopen-2023-075796

Powers, M. B., Zum Vörde Sive Vörding, M. B., & Emmelkamp, P. M. G. (2009). Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and Psychosomatics, 78(2), 73–80. https://doi.org/10.1159/000190790

Strauss, C., Cavanagh, K., Oliver, A., & Pettman, D. (2014). Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: a meta-analysis of randomised controlled trials. PloS one, 9(4), e96110. https://doi.org/10.1371/journal.pone.0096110

Twomey, C., O’Reilly, G., & Byrne, M. (2014). Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: a meta-analysis. Family Practice, 32, 3–15. https://doi.org/10.1093/fampra/cmu060

Weitz, E., Kleiboer, A., van Straten, A., & Cuijpers, P. (2018). The effects of psychotherapy for depression on anxiety symptoms: a meta-analysis. Psychological Medicine, 48, 2140–2152. https://doi.org/10.1017/s0033291717003622

White, V., Linardon, J., Stone, J. E., et al. (2020). Online psychological interventions to reduce symptoms of depression, anxiety, and general distress in those with chronic health conditions: a systematic review and meta-analysis of randomized controlled trials. Psychological Medicine, 52, 548–573. https://doi.org/10.1017/s0033291720002251

Stuart was initially trained in the integrative approach of analytic psychotherapy, stress management (traumatic and occupational), counselling and clinical hypnotherapy. As a regulated hypnotherapist his use of other therapies is also monitored by the regulator for public safety.

Hypnotherapists as a matter of course use counselling, analysis and other psychotherapy methods, and Stuart was trained in all of these in an integrative fashion. Many methods like mindfulness, CBT and compassion based therapies are used in BOTH psychotherapy and hypnotherapy. In addition to this overlap there is also evidence of hypnosis itself being effective in mental health support.

Based on current meta-analyses of randomized controlled trials (RCTs), there is robust evidence that hypnosis is highly effective for reducing anxiety, but the evidence for its effectiveness as a stand-alone treatment for clinical depression is mixed and generally considered insufficient.

Efficacy for Anxiety

Meta-analyses show that hypnosis is an effective intervention for anxiety. A comprehensive meta-analysis of 17 RCTs found that, at the end of active treatment, individuals who received hypnosis showed greater reductions in anxiety than 79% of participants in control groups (Valentine et al., 2019). Furthermore, the long-term benefits are substantial; at follow-ups, participants treated with hypnosis fared better than 84% of control participants (Valentine et al., 2019). The evidence also indicates that hypnosis is most effective for anxiety when it is combined with other evidence-based psychological interventions (such as Cognitive Behavioral Therapy) rather than being used as a completely stand-alone treatment (Valentine et al., 2019).

Efficacy for Depression

The evidence regarding depression is less definitive. While earlier meta-analyses found some positive effects for hypnotic interventions in treating depression symptoms (Milling et al., 2019), the most recent and rigorous systematic reviews conclude that there is currently not enough high-quality evidence to recommend hypnosis as a primary treatment for clinical depression (Souza et al., 2024). Researchers emphasize that the lack of efficacy data precludes clinical recommendation for depression until more robust trials are conducted, though it remains a useful adjunctive tool for somatic symptoms and anxiety (Rosendahl et al., 2024; Souza et al., 2024).

It should be noted however that Cognitive Behavioural Hypnotherapy is a blend of CBT and hypnosis, mindfulness based hypnotherapy is likewise a blend and so on, so in many cases the highly evidenced therapies mentioned further up this page have been provided in a range of overall models including relaxed states, as used primarily by hypnotherapists. Indeed it is a matter of concern to many therapists that providers untrained in hypnosis or other trance states so regularly use mindfulness relaxation routines with very little knowledge of the risks and contra indications. (Whereas such issues are core parts of hypnosis skills and ethics training).

References

Milling, L. S., Valentine, K. E., McCarley, H. S., & LoStimolo, L. M. (2019). A meta-analysis of hypnotic interventions for depression symptoms: High hopes for hypnosis? American Journal of Clinical Hypnosis, 61(3), 227–243. https://doi.org/10.1080/00029157.2018.1489777

Cited by: 109

Rosendahl, J., Alldredge, C. T., & Haddenhorst, A. (2024). Meta-analytic evidence on the efficacy of hypnosis for mental and somatic health issues: a 20-year perspective. Frontiers in Psychology, 14. https://doi.org/10.3389/fpsyg.2023.1330238

Cited by: 126

Souza, F. L., Moura, M. S., Vieira Almeida Silva, J., & Elkins, G. (2024). Hypnosis for depression: Systematic review of randomized clinical trials with meta-analysis. Complementary Therapies in Clinical Practice, 57, 101913. https://doi.org/10.1016/j.ctcp.2024.101913

Cited by: 24

Valentine, K. E., Milling, L. S., Clark, L. J., & Moriarty, C. L. (2019). The efficacy of hypnosis as a treatment for anxiety: A meta-analysis. International Journal of Clinical and Experimental Hypnosis, 67(3), 336–363. https://doi.org/10.1080/00207144.2019.1613863