CBT vs. Cognitive-Behavioral Hypnotherapy for Cognitive Avoidance, Perceived Stress, and Thought–Action Fusion in Adults with GAD Symptoms

Objective: To compare cognitive-behavioral therapy (CBT) and cognitive-behavioral hypnotherapy (CBH) in reducing cognitive avoidance, perceived stress, and thought–action fusion among adults presenting with generalized anxiety symptoms.

Methods and Materials: This quasi-experimental study used a controlled pretest–posttest design with two intervention arms (CBT, CBH) and a no-treatment control group. Participants were recruited purposively from licensed counseling/psychotherapy/psychiatric centers in Isfahan (Q4 2024). After screening with the GAD-7 (cutoff ≥11) and applying eligibility criteria, 60 adults (20–40 years) were selected and randomly allocated to CBT (n=20), CBH (n=20), or control (n=20). Interventions followed Rezaeian et al.’s CBT protocol (2014) and Hammond’s CBH protocol (2013), delivered in eight 60-minute sessions (two sessions/week). Outcomes were assessed using the Cognitive Avoidance Questionnaire (Sexton & Dugas, 2008), Perceived Stress Scale (Cohen et al., 1983), and Thought–Action Fusion Questionnaire (Shafran et al., 1996). Data were analyzed in SPSS (v23) using MANCOVA/ANCOVA with post hoc comparisons.

Findings: Both CBT and CBH reduced perceived stress and thought–action fusion versus control, with no significant difference between the two treatments on these outcomes. CBH produced greater reductions than CBT in several cognitive avoidance components (behavioral avoidance, postponement, distraction/suppression, and denial/repression).

Conclusion: CBH may offer added benefit over CBT for targeting cognitive avoidance in adults with generalized anxiety symptoms, while both approaches appear similarly beneficial for perceived stress and thought–action fusion. Follow-up assessments and larger samples are recommended to test durability and generalizability.