How Expectations Shape Success: Insights from a Hypnotherapy Study on Smoking Cessation and Broader Implications for Therapy
When we think about factors that influence the success of therapy, the therapist's skill, the chosen technique, and the patient's commitment often come to mind. However, a new study comparing hypnotherapy and cognitive-behavioral therapy (CBT) for smoking cessation has brought another powerful factor to the forefront: expectations. The study, published in Frontiers in Psychology (Batra et al., 2024), investigated whether expectations of success could influence actual outcomes in quitting smoking. The implications go far beyond smoking cessation, offering valuable insights for all therapists about how our clients’ beliefs can shape their journey and success.
The Study: Hypnotherapy vs. CBT for Smoking Cessation
In this randomised controlled trial, smokers were split into two groups: one receiving hypnotherapy (HT) and the other CBT. Each group attended six weekly sessions, aiming for sustained abstinence over the next 12 months. Surprisingly, both therapies led to similar long-term abstinence rates (around 15%), challenging assumptions that one approach might be significantly more effective than the other.
Yet, a fascinating factor emerged that influenced success rates: participants’ expectations of therapy’s efficacy. Participants who had a higher expectation that their chosen therapy would work were more likely to stay abstinent. This suggests that simply believing in the therapy’s potential might enhance its effects, underscoring the power of expectations in shaping real-world outcomes. But why do expectations matter so much in therapy, and how can therapists use this insight to improve results for clients?
The Power of Expectations in Therapy
Expectations can serve as a form of “mental priming,” creating a framework that affects how clients respond to therapy. When clients believe that a therapy will be effective, they’re more engaged and motivated, and they often perceive themselves as more capable of reaching their goals—a phenomenon known as self-efficacy.
Placebo Effect and Expectancy in Therapy
In medicine, the placebo effect demonstrates that when patients expect a positive outcome, they’re more likely to experience one, even if they’re receiving a non-active treatment. This concept applies to psychological therapies as well. Studies across various modalities, including psychotherapy, counseling, and physical rehabilitation, show that patients’ beliefs about the treatment’s effectiveness often correlate with better outcomes. Expectations create a framework for clients, influencing how they perceive progress and respond to interventions.
For example, in hypnotherapy, which relies on relaxation, suggestion, and visualisation, positive expectations can help clients enter a receptive state, enabling them to engage more deeply with the process. This connection between expectancy and therapeutic depth is something therapists across fields can leverage.
Self-Efficacy and Client Empowerment
Expectations also relate closely to self-efficacy, or clients’ beliefs in their own ability to make changes. Research has shown that clients who believe they are capable of achieving their therapy goals tend to have better outcomes. When a therapist can build this sense of self-efficacy, clients are more likely to make lasting changes, as they see themselves as active agents in their recovery or personal growth.
For hypnotherapy, expectations that the treatment will "work" can encourage clients to adopt new behaviours and internalise therapeutic suggestions more fully. When working with hypnotherapy clients, therapists can promote self-efficacy by emphasising the client’s role in change, making it clear that their engagement and belief in the process contribute significantly to the outcomes.
Implications for Therapists: Leveraging Expectations for Better Outcomes
So, how can therapists in all fields use the findings from this study to help clients make the most of therapy? Here are a few practical strategies:
Build Positive, Realistic Expectations Early
Therapists can foster positive expectations from the start by educating clients about the process and benefits of therapy. For hypnotherapy, I always explain how suggestion and relaxation can influence the mind, and share success stories or data (when relevant) to reinforce credibility. This type of psychoeducation not only informs but also builds the belief that change is possible.
Highlight Self-Efficacy and Client Agency
Regardless of the modality, therapists should underscore the client’s role in their progress. By framing therapy as a collaborative effort, where the client’s belief and engagement are crucial, we can empower clients to take an active role in their healing journey. As an example, in my hypnotherapy practice I encouraging clients to practice self-hypnosis between sessions and visualise positive outcomes. This hands-on involvement builds confidence and reminds clients that they are capable of achieving their goals. The idea of client agency is, I think, particularly important in hypnotherapy where stage hypnotism may have introduced to the client the idea that hypnotherapy is something which is “done to them” and robs them of control, rather than “done with them” giving them tools which they use freely.
Set Clear, Achievable Goals and Milestones
Break down the overall therapy goal into manageable steps, celebrating each small achievement. Hypnotherapists might focus on initial milestones like reducing the frequency of cravings in smoking cessation. Each success reinforces the client’s belief that therapy is working, which further boosts their commitment and expectations for future success.
Expectations as a Powerful Tool in Therapy
The smoking cessation study offers more than just insights into hypnotherapy; it reveals how expectations can shape therapeutic outcomes across different modalities. When therapists pay attention to their clients’ beliefs and actively foster a positive, collaborative environment, they set the stage for a more effective therapeutic experience. This study reminds us that therapy isn’t just about the techniques we use but also about the mindsets we help our clients adopt.
In short, expectations are powerful allies in the journey of change. By harnessing this force, therapists can support clients in creating lasting, meaningful transformations. Whether you're working with hypnotherapy, CBT, or another approach, focusing on your clients’ expectations can help turn hope into genuine, tangible results.
Batra, A., Eck S., Riegal, B., Freideich, S., Fuhr, K., Torchella, I & Tönnies, S. (2024) Hypnotherapy compared to cognitive-behavioral therapy for smoking cessation in a randomized controlled trial. Frontiers in Psychology, 15, p.1330362. Available at: https://doi.org/10.3389/fpsyg.2024.1330362