Under Pressure

johntepe
Apr 30
12 min read

How Cognitive Behavioural Hypnotherapy

Manages Stress and Builds Resilience

Introduction: The Hidden Cost of Holding It All Together

High performers often present a composed, confident exterior. But behind the accolades and accomplishments lies another reality—one marked by persistent overthinking, emotional reactivity, and a pressure to be flawless. If you're outwardly successful but inwardly wired for stress, you're not alone. And more importantly, you're not beyond help.

Stress isn't a sign of weakness. It's the body and mind doing their job—sometimes too well. The challenge isn't learning how to "cope" better. It's learning how to rewire the system altogether. This is where science-based hypnotherapy, and specifically cognitive-behavioural hypnotherapy (CBH), offers something uniquely powerful. When grounded in the principles of psychology, CBT, and neuroscience, hypnotherapy becomes a tool not just for calming down, but for transforming how you respond under pressure.

In this article, I share how CBH helps high-functioning professionals build stress resilience, break free from perfectionism, and develop emotional regulation that actually sticks.

Why High Achievers Struggle with Stress—Even When They're Winning

Stress in high performers often isn’t caused by external chaos—it’s driven by internal demands: be impressive, never fail, keep it together. These aren't goals; they’re survival rules. Judson Brewer, in Unwinding Anxiety, describes how stress and anxiety become habitual loops tied not just to our environment but to how we process uncertainty. When uncertainty hits, the brain seeks control. For perfectionists, this often means over-efforting, over-preparing, or never slowing down.

At the neurological level, these behaviours form through habit loops:

trigger → behaviour → reward

For example, stress (trigger) may lead to over-preparing (behaviour), which generates a sense of temporary control (reward). Over time, this loop becomes automated—even when the behaviour no longer serves you. These loops are reinforced through the brain’s dopaminergic pathways, creating learned associations between certain stress-relieving behaviours and the chemical sense of control or reward.

CBH helps rewire these patterns by targeting both the habit and the reward system. In trance, clients are guided to identify cues, uncouple them from maladaptive behaviours, and associate them with healthier, emotionally regulated responses. In doing so, the brain’s reward networks are subtly updated to reinforce ease, clarity, and flexible control.

From a biological standpoint, this involves modulating the hypothalamic-pituitary-adrenal (HPA) axis—the body’s central stress response system. Chronic perfectionistic thinking keeps this axis chronically activated, increasing circulating cortisol and reducing hippocampal volume over time. CBH, particularly when integrated with breathing techniques and mindfulness protocols, supports parasympathetic activation and restores regulatory control to the prefrontal cortex. In addition, recent neuroimaging studies have shown that hypnotic states can increase connectivity between the dorsolateral prefrontal cortex and the insula, supporting interoceptive awareness and emotional regulation.

But there's an emotional root beneath that cognitive loop. Brené Brown, in Daring Greatly, names perfectionism for what it often is: "a defence mechanism against shame." It’s not about striving for excellence—it’s about avoiding the deep, quiet fear that "I'm not enough." That fear drives a physiological stress response that can become chronic and identity-bound.

This mechanism directly links to burnout—a theme I’ve explored in detail in other blogs on workplace anxiety and performance fatigue. Perfectionism, sustained over time, depletes emotional resources and pushes the nervous system into a chronic state of threat detection. The result? Burnout, disengagement, and a loss of intrinsic motivation.

The Neuroscience of Stress and Memory

Why Your Body Remembers What Your Mind Tries to Forget

Modern neuroscience confirms what ancient traditions always knew: stress lives in the body and in the predictive circuits of the brain. As Charan Ranganath explains in Why We Remember, the brain is not a passive storage system. It constantly uses memory to predict the future. And if your past memories are saturated with anxiety, failure, or over-control, your body prepares to re-experience them—even when the danger isn’t real.

This involves highly reactive memory networks—particularly in the hippocampus and amygdala—being triggered by cues associated with past emotional pain. These networks feed into the predictive coding systems of the brain, shaping your interpretation of current events. In short, you don’t just remember the past; you relive it when under stress. The plasticity of these networks means they are not fixed—they can be rewired with precision through targeted repetition under relaxed, focused states of awareness.

CBH addresses this loop at the neurocognitive level. Through trance-based rehearsal and hypnotic suggestion, the brain is guided to recode past experiences and develop more flexible, grounded predictions for the future. This isn’t just cognitive reframing—it’s embodied rewiring. This allows for what Robertson (2013) describes as "consolidation of therapeutic learning under conditions of heightened suggestibility and lowered threat arousal."

What Is Cognitive Behavioural Hypnotherapy?

Cognitive Behavioural Hypnotherapy (CBH) is a psychotherapeutic approach that integrates the structured, evidence-based techniques of cognitive-behavioural therapy (CBT) with the focused, suggestion-based interventions of hypnosis. While often misunderstood or mystified in popular culture, CBH rests on solid scientific foundations and aligns closely with contemporary psychological models of behaviour change, cognition, and emotional regulation.

Rooted in the empirical legacy of James Braid—who first defined hypnotism as a process of focused mental abstraction—and expanded through 20th-century cognitive and behavioural research, CBH offers a way of working with the mind that is both imaginative and methodical.

Rather than treating hypnosis as an “altered state,” CBH follows a cognitive-behavioural reconceptualisation: it views hypnosis as a natural extension of normal psychological processes like attention, imagination, belief, and expectation. Hypnotic responses, from this view, are best understood not as exotic phenomena, but as amplified examples of how suggestion influences behaviour and perception—much like automatic thoughts, rumination, or worry function in cognitive models of anxiety and depression.

A Cognitive-Behavioural Theory of Hypnosis

CBH is not just about using hypnosis in therapy—it involves adopting a CBT-informed model of what hypnosis is and how it works. This theoretical shift moves away from outdated notions of “trance” or “deep states,” focusing instead on:

Expectation and belief: Hypnotic responses are largely determined by what the client expects will happen.
Imagination and attention: Suggestive experiences are most effective when the client is able to actively imagine the experience and focus attention upon it.
Active participation: Hypnotic responses emerge from the client’s intentional involvement—not from passive submission.

This orientation is described as a nonstate theory of hypnosis, championed by researchers such as T.X. Barber and Nicholas Spanos, and consistent with the socio-cognitive model developed in the 20th century. Their research demonstrated that hypnotic phenomena are not exclusive to a “special state” but are the result of normal cognitive, behavioural, and social processes operating in a structured way.

Hypnosis harnesses everyone’s shared ability to use their brain to expect positive change, imagine what the change looks and feels like, and actively participate in imagining that change with the support of hypnotic suggestions.

If you want to change, expect yourself to change, and are willing to participate fully in the processes that will bring about that change, then CBH will work for you.

The Five-Part Cognitive Set in Hypnosis

Donald Robertson, adapting earlier models, proposes a five-factor model of the “hypnotic cognitive set”—the mindset that facilitates any person's effective hypnotic responding:

1. Recognition – Understanding that hypnotic suggestions are cues for active mental involvement.

2. Attribution – Recognising that responses are due to imagination and expectation, not outside control.

3. Appraisal – Viewing the experience as safe, beneficial, and goal-relevant.

4. Control – Holding a sense of self-efficacy over the process.

5. Commitment – Willingness to invest sustained attention and mental energy into responding.

This schema transforms hypnosis from a mysterious technique into a trainable skill, one that aligns with CBT’s emphasis on psychoeducation and skill development. As part of the CBH model, I provide my clients with detailed education on the biological and psychological framework for hypnosis, how hypnosis will work for them.

Clinical Evidence for CBH

CBH is one of the few integrative therapies with a strong empirical base. Meta-analyses suggest that hypnosis significantly enhances the effectiveness of CBT across a wide range of conditions, particularly:

· Anxiety and phobias

· PTSD and trauma recovery

· Chronic pain management

· Functional disorders

· Depression

In a meta-analysis by Kirsch et al. (1995), cognitive-behavioural therapy enhanced with hypnosis was more effective than CBT alone in 70% of studies—demonstrating a reliable additive effect. Clients often report faster progress, deeper emotional engagement, and greater confidence in their ability to change .

From Negative Autosuggestion to Therapeutic Change

CBH practitioners often frame negative automatic thoughts (as in anxiety or depression) as a form of negative self-hypnosis. This concept traces back to 19th-century thinkers like Émile Coué, who emphasised the power of suggestion in shaping mental and physical health.

In this light, worry, catastrophising, or intrusive thoughts become distorted “self-suggestions,” and the goal of therapy becomes twofold:

Interrupt negative self-hypnosis through awareness and distancing strategies (such as mindfulness or metacognitive distancing)
Introduce positive, goal-aligned suggestions that support behavioural change and emotional resilience

Robertson aligns this with modern cognitive restructuring, where beliefs are identified, challenged, and replaced—not only rationally but experientially, using mental imagery, future pacing, and rehearsal under hypnosis .

Why High Performers Choose CBH

Professionals operating under high pressure often develop sophisticated coping strategies—but coping alone is not the same as transformation. Many of my clients arrive having already tried coaching, self-help frameworks, or traditional talk therapy. What they’re seeking isn’t more advice. It’s a change that begins at the level of identity and belief.

CBH is designed for this depth of work. It enables clients to develop deep-level behavioural change anchored in nervous system regulation and cognitive-emotional integration. It offers structured pathways to rewire belief systems that are subconsciously linked to stress, success, and self-worth.

When cognitive behavioural therapy is combined with hypnosis, the result is more than a method—it’s a mindset recalibration. Clients report feeling calmer, more confident, and no longer driven by the fear-based narratives that once dominated their inner world.

This is why my approach blends CBH with high-performance mindset coaching and neuroscience. It doesn’t ask you to do more—it helps you become more attuned to who you are beneath the pressure. The goal isn’t just to cope with stress. It’s to no longer be defined by it. High-performance coaching for professionals often stops at behaviour. Talk therapy sometimes stops at insight. CBH bridges both, offering deep-level behavioural change anchored in nervous system regulation.

When you integrate CBT, hypnosis, and neuroscience, you get more than a method—you get a mindset upgrade that lasts. And when your identity shifts from reactive overachiever to calm, focused leader, everything changes.

This is why my approach blends high-performance coaching, neuroscience, and CBH techniques. It isn’t about doing more. It’s about becoming more of who you are—without the constant pressure to prove it.

This is particularly important in professional cultures that confuse output with identity. In my workplace-focused blogs, I highlight how burnout and chronic performance anxiety are symptoms of systemic overidentification. CBH works because it doesn’t just target surface behaviour—it reaches the level of identity and emotional narrative. It retrains how the self is held in mind, both neurologically and socially.

Rewiring Perfectionism: From Performance to Presence

Perfectionism isn’t about high standards. It’s about rigid self-worth. CBH treats perfectionism as a belief system—one that can be challenged, updated, and transformed through both cognition and trance.

Using hypnosis, clients learn to:

Challenge black-and-white thinking
De-couple self-worth from performance
Rehearse new identity-based narratives: I can be human and still succeed

Brown writes, "Perfectionism is not the path to excellence. It is the path to self-destruction." In CBH, perfectionism is treated as an emotionally charged belief pattern rooted in shame, which can be softened through exposure, self-compassion, and mental rehearsal under trance.

Brewer’s work shows that the prefrontal cortex—our decision-making centre—goes offline under stress. Hypnosis, however, has been shown to increase top-down control, helping re-engage the prefrontal cortex even when stress arises. The result: clearer decisions, more grounded emotional responses, and less reactive perfectionism.

From a sociological lens, perfectionism also functions as a culturally reinforced adaptation to scarcity-based values. As Brown notes, "We get scarcity because we live it." In a society that constantly reinforces "never good enough" narratives through comparison and performance metrics, perfectionism becomes a means of protection. This is especially true in high-status professional contexts, where identity and output are tightly linked. My clinical approach recognises this and integrates work on shame resilience, emotional vocabulary development, and values-based identity restructuring—three core processes that support more authentic and sustainable self-expression.

Stress Inoculation Isn't Just for First Responders

In traditional CBT, Stress Inoculation Training (SIT) helps people prepare for future stressors by breaking them down into manageable steps: conceptualisation, skill acquisition, and rehearsal. CBH enhances this with hypnotic rehearsal, allowing clients to experience the future calmly before it happens. It's mental time travel, scientifically applied.

You rehearse the speech before the board meeting, the feedback session with your team, or the conversation you’ve been dreading. Not just cognitively—emotionally and physiologically.

This method strengthens emotional resilience and increases self-efficacy. It inoculates you against reactivity by updating the brain’s predictions. As one client put it, "It was like my nervous system already knew what to do when the moment came."

The Biology of Burnout: Why Over-Performance Backfires

Chronic stress isn't just a psychological state—it's a physiological one. In high-achieving individuals, overperformance and overthinking often activate the hypothalamic-pituitary-adrenal (HPA) axis repeatedly, leading to elevated cortisol and eventual dysregulation of the autonomic nervous system. According to Everly and Lating in A Clinical Guide to the Treatment of the Human Stress Response, this prolonged activation diminishes the body’s ability to return to homeostasis, resulting in fatigue, cognitive fog, and increased emotional volatility.

Neuroscientifically, burnout impairs the function of the prefrontal cortex—critical for decision-making and perspective-taking—while hyperactivating the amygdala, the brain’s threat detection centre. This neurobiological shift makes it harder to regulate emotions, tolerate uncertainty, or maintain flexible thinking. It’s not “all in your head”—it’s embedded in your brain-body feedback loops.

Clients I work with often arrive reporting symptoms like insomnia, digestive upset, loss of joy, and a relentless inner critic. When we explore these clinically, what we find is a nervous system shaped by performance-based fear conditioning. CBH helps interrupt this by accessing trance states that calm the sympathetic nervous system, promote vagal tone, and allow the body to experience safety without earning it through achievement.

This biological reset is often the first domino in a cascade of change—clients begin sleeping better, thinking more clearly, and no longer associating rest with guilt. The nervous system, once calmed, becomes fertile ground for belief change.

Social Scripts and Identity Loops:

The Sociology of Self-Pressure

While biology wires us to survive, society scripts us to perform. One of the most under-acknowledged drivers of stress in ambitious professionals is the internalised expectation that worth must be proven through productivity. From school rankings to corporate KPIs, we are conditioned to link doing with being.

Sociologists call this performative individualism: the idea that the self must be visible, curated, and measured to matter. Brené Brown explores this in Daring Greatly, observing how modern cultures of shame are structured around scarcity: not thin enough, smart enough, successful enough. These messages infiltrate family systems, educational environments, and professional cultures. As Brown puts it, “We get scarcity because we live it.”

In the therapeutic space, these social messages become evident in language patterns: “I should already be further along,” “I can’t slow down,” or “If I stop, I’ll fall behind.” These aren’t personal flaws—they are reflections of a broader cultural script that equates rest with laziness and vulnerability with risk.

In my practice, we bring these assumptions to light and actively restructure them. CBH allows clients to observe, challenge, and rewire these identity-level narratives through guided trancework. When you mentally rehearse being respected without overworking—or loved without earning it—you begin to loosen your dependency on external validation.

The goal isn’t to drop out of society. It’s to stop outsourcing your self-worth to it.

High-Performance Professionals Need More Than Coping Skills

Coaching alone often stops at behaviour. Talk therapy sometimes stops at insight. CBH bridges both, offering deep-level behavioural change anchored in nervous system regulation.

Professional cultures often confuse output with identity. In my workplace-focused blogs, I highlight how burnout and chronic performance anxiety are symptoms of systemic over-identification. CBH works because it doesn’t just target surface behaviour—it reaches the level of identity, purpose and emotional narrative. It retrains how the self is held in mind, both neurologically and socially.

Conclusion: Train Your Mind

Gain Clarity. Gain Control.

Stress resilience is not a personality trait. It’s a trained response. And perfectionism isn’t a flaw—it’s a signal that your inner system is wired for safety, not ease.

Cognitive Behavioural Hypnotherapy offers a way to rewire that system. Not with mantras or willpower, but with tested methods that teach your body and brain how to thrive under pressure. By engaging the HPA axis, the memory networks, the dopaminergic reward system, and the deeply embedded social beliefs that link self-worth to performance, CBH provides a multidimensional framework for transformation.

At the heart of this approach is the principle that hypnosis is a skill anyone can learn. Hypnotic responsiveness is not a fixed trait—it’s trainable. As Donald Robertson outlines, hypnotic ability is shaped by mindset, expectation, and cognitive flexibility. Through structured hypnotic skills training, clients learn how to direct their attention, amplify goal-aligned imagery, and use suggestion intentionally to influence their own emotional and behavioural responses.

This means you don’t have to be “suggestible” in any traditional sense to benefit. You simply need a willingness to learn. Hypnosis, in this model, becomes a tool for self-leadership—a learnable process that strengthens psychological flexibility, emotional control, and identity alignment.

This is not just therapy—it is a structured, evidence-based method that empowers clients to take control of their mental and emotional processes. At its core, CBH is a scientifically grounded framework that supports anyone with the willingness to learn and apply the tools of focused attention, guided imagery, and self-directed change.

You’re Ready to Change. Now Expect It.

CBH is built on the principle that when you expect change, and actively participate in making it happen, real transformation follows. Hypnosis isn’t something done to you—it’s something you learn to use. When guided correctly, your imagination, focus, and commitment become tools for rewiring your stress responses, perfectionist patterns, and self-narrative at their roots.

If you’re ready to engage in that process—to take ownership of your mindset and work with a structured, science-based approach—book a high-performance strategy call.