Paradoxical Intention and Hypnosis for Anxiety Disorders: Cautious Promise and Considerations from a CBT Perspective

Abstract

This commentary discusses the case studies of "Fran" and "Emily," treated by Sam Hamburg (2026) with Paradoxical Intention (PI) combined with hypnosis to address panic disorder and agoraphobia in Fran and aviophobia in Emily, with both patients showing a rapid positive response. Hamburg (2026) presents a compelling and novel approach to treating anxiety disorders in just three sessions, a notable departure from traditional CBT protocols that typically require 6–20 sessions to see clinically meaningful change. Drawing on our expertise in third-wave CBT frameworks, including Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT), we highlight strengths of Hamburg’s approach while identifying areas that warrant further clarification. We then propose an alternative mechanism of action in Hamburg’s treatment with "Fran" and "Emily," with particular emphasis on the inhibitory learning model as a process underlying PI combined with hypnosis. Finally, we underscore the importance of approaching techniques such as PI and hypnosis with both openness and caution in the treatment of anxiety disorders given the limited empirical evidence.