According to a standard manual for mental health clinicians, the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revised (also known as the DSM-IV-TR ), the following disorders are considered anxiety disorders:
- Panic disorder without agoraphobia - A person with this disorder suffers from recurrent panic attacks and worries about experiencing more attacks, but agoraphobia is not present. Panic attacks are sudden attacks of intense fear or apprehension during which the sufferer may experience shortness of breath, increased heart rate, choking, and/or a fear of losing control. Agoraphobia is anxiety about places or situations from which escape might be difficult, or in which help might not be available.
- Panic disorder with agoraphobia - A person with this disorder also experiences recurrent panic attacks but also has agoraphobia. The anxiety about certain places or situations may lead to avoidance of those places or situations.
- Agoraphobia without history of panic disorder - The person with this disorder suffers from agoraphobia and experiences panic-like symptoms but does not experience recurring panic attacks.
- Specific phobias - A person diagnosed with a specific phobia suffers from extreme anxiety when he or she is exposed to a particular object or situation. The feared stimuli may include: particular animals (dogs, spiders, snakes, etc.), situations (crossing bridges, driving through tunnels), storms, heights, and many others.
- Social phobia - A person with social phobia fears social situations or situations in which the individual is expected to perform. These situations may include eating in public or speaking in public, for example.
- Obsessive-compulsive disorder - A person with this disorder feels anxiety in the presence of a certain stimulus or situation, and feels compelled to perform an act (a compulsion) to neutralize the anxiety. For example, upon touching a doorknob, a person may feel compelled to wash his or her hands four times, or more.
- Post-traumatic stress disorder —This disorder may be diagnosed after a person has experienced a traumatic event, and long after the event, the person still mentally re-experiences the event along with the same feelings of anxiety that the original event produced.
- Acute stress disorder — Disorder with similar symptoms to post-traumatic stress disorder, but is experienced immediately after the traumatic event. If this disorder persists longer than one month, the diagnosis may be changed to post-traumatic stress disorder.
- Generalized anxiety disorder —A person who has experienced six months or more of persistent and excessive worry and anxiety may receive this diagnosis.
- Anxiety due to a general medical condition—Anxiety that the clinician deems is caused by a medical condition.
- Substance-induced anxiety disorder—Symptoms of anxiety that are caused by a drug, a medication, or a toxin.
- Anxiety disorder not otherwise specified - This diagnosis may be given when a patient's symptoms do not meet the exact criteria for each of the above disorders as specified by DSM-IV-TR.
Anxiety disorders and panic attacks can make it difficult for an individual to hold down a job or conduct normal daily activities. Hypnosis for anxiety treatment works to replace the conscious and subconscious thoughts of the patient that are creating an anxious state with more calm and positive feelings and thoughts to relieve the anxiety.
Anxiety and anxiety-related conditions are the most common psychological afflictions on man and account for a major percentage of initial complaints to psychiatrists as well as to general practitioners. Although it is estimated that some 5% of the population may suffer from acute or chronic anxiety, with women outnumbering men two to one (Cohen and White, 1950), the numbers are probably significantly higher.#
Hypnosis finds its most common clinical utilization in the treatment of anxiety and its related states, not only because of anxiety's prevalence, but because hypnosis has such a clear role as a potent anti-anxiety agent.
NOTES: Goal of treatment is to (1) reduce respiratory rate, and (2) cognitive reattribution of physical symptoms to hyperventilation instead of other more catastrophic causes. Reviews a number of studies, mostly small sample, including panic disorder studies, and concludes that the majority point to a therapeutic effect of breathing retraining and cognitive reattribution of physical symptoms to hyperventilation for patients suffering HVS and the closely related panic disorder with or without agoraphobia. However, the _specificity_ of these techniques for HVS is questionable. Vlaander-van der Giessen (1986) found relaxation training just as effective as breathing retraining; and Hibbert & Chan (1989) found breathing retraining equally effective as a placebo treatment, and not more effective with patients who had recognized symptoms at a hyperventilation provocation test than with those who had not.
Two cases of simple phobia demonstrate the inadequacies of both behavioral and psychodynamic theories. These cases and their treatment outcomes provide support for the state-dependent memory and learning theory. Hypnosis and ideomotor signaling proved to be not only effective treatments but also useful means of illuminating the role and nature of symptom function. Issues of symptom removal and substitution are also discussed in relation to these cases
The following unpleasant side effects have been observed: "unpleasant sensations of heaviness, warmth, perspiration, tingling, numbness, dizziness, floating, coolness; paradoxical increases in tension; rapid heart rate; feelings of physical and psychological vulnerability; depression; fear of losing control; depersonalization; dissociation; myoclonic jerks; spasms; headache; akathesia; negative auditory, gustatory, and olfactory reactions; intrusive images and thoughts; anxiety; irritability; guilt; regressive urges; hallucinations; and panic" (p. 261).
620, Belicki & Bowers, 1982 ABSTRACT: Investigated the role of demand characteristics in dream change by comparing dream report change following pre- and postsleep administrations of instructions to pay attention to specific dream content. This design was based on the assumption that if presleep instructions merely distort dream reports rather than influence actual dreams, report change should be observable following a postsleep instruction. 42 undergraduates were prescreened with the Harvard Group Scale of Hypnotic Susceptibility (Form A), which allowed experimenters to examine the role of hypnotizability in dream change. Significant differences were observed only following the presleep instructions. It is concluded that report distortion as a result of paying attention to a dimension of dream content was insufficient to account for dream report change following presleep instructions. Hypnotic ability correlated significantly with the amount of dream change.
"Previous investigations have demonstrated the effectiveness of rational emotive therapy in reducing public speaking anxiety and the increased benefit derived by combining rational emotive procedures with hypnosis. The present study examined the effectiveness of rational emotive imagery and rational emotive imagery plus hypnosis in reducing public speaking anxiety in subjects with high and low levels of imaginative ability. The dependent measures employed included self report, behavioral and physiological measures of anxiety. "47 undergraduate students who reported anxiety while speaking in public served as subjects in the study. The subjects were divided into high and low levels of imaginative ability and randomly assigned to one of three experimental groups as follows: rational emotive imagery, rational emotive imagery plus hypnosis, and an instructional control group. It was hypothesized that subjects in the rational emotive imagery plus hypnosis group would evidence significantly less anxiety than subjects in the rational emotive imagery and instructional control group, and that subjects with high pre-treatment levels of imaginative ability would evidence significantly less anxiety than subjects with low pre- treatment levels of imaginative ability. "The results of this study provided some support for the efficacy of combining rational emotive imagery with hypnosis. Subjects in the rational emotive imagery plus hypnosis group evidenced significantly less anxiety than subjects in the rational emotive imagery and instructional control group on the two self-report measures. There were no significant differences as between subjects in the rational emotive imagery group and instructional control group or between subjects with high and low imaginative ability on post-treatment assessments. Subjects tended to have their highest pulse rates at the start of the speeches, their lowest pulse rate just after the speeches, and moderate pulse rates just before and during the speeches. "Factors contributing to these results and interpretations of the data were discussed. Suggestions regarding the direction of future research were offered" (p. 633- 634).
Complex moving visual stimuli are used to induce states of relaxation, hypnosis and revery. To test the efficacy of using aquarium contemplation to induce relaxation, 42 patients were randomly assigned to one of five treatments prior to elective oral surgery: 1) contemplation of an aquarium, 2) contemplation of a poster, 3) poster contemplation with hypnotic induction, 4) aquarium contemplation with hypnosis, and 5) a non intervention control. Blood pressure, heart rate, and subjective and objective measures of anxiety were used as dependent measures. Pretreatment with aquarium contemplation and hypnosis, either alone or in combination, produced significantly greater degrees of relaxation during surgery than poster contemplation or the control procedure. Two-way ANOVA demonstrated that a formal hypnotic induction did not augment the relaxation produced by aquarium contemplation.
Subjects in the Meditation condition received 1 hour of group instruction-- a lecture which discussed physiological benefits, guidelines for practice, and possible side-effects. "The technique consisted of the passive, subvocal repetition of a mantra, '
TM reportedly diminishes Trait Anxiety (
Compared the effectiveness of relaxation, hypnosis, and a control condition in reducing in dental phobics the reaction to pressure-algometer stimulation and the injection of anesthesia. For subjects with high baseline skin-conductance levels, relaxation was most effective in reducing stress reactions. Hypnosis did not differ from the control condition. For subjects with a medium or low skin-conductance baseline, relaxation was not effective. The hypnosis group rated their treatment as most effective, and the controls rated their treatment as least effective. Five-month follow-up indicated that all subjects in the hypnosis group returned for dental treatment and that 5 of
I began by describing the Jacobson-Wolpe position on the use of deep muscular relaxation as an anxiety-inhibitor: these writers assume that the considerable reduction in proprioceptive feedback from muscles which are in a relaxed state is incompatible with a state of anxiety. Then I mentioned the evidence that at least modern neuromuscular blocking-agents operate solely at the myoneural junction, with no direct central effects. I went on to discuss the various studies which have used paralytic drugs, primarily d- tubocurarine chloride, to show the learning of fear-responses under complete striate muscle paralysis: the fact that these animals are able to acquire classically-conditioned fear-responses under curare was taken as evidence inconsistent with the views of Jacobson and Wolpe. Several studies were then reviewed which purport to furnish confirmatory evidence for the Jacobson position: these studies showed considerable central depression during curare paralysis.
This is a description of one dentist's office practice employing hypnosis: 197 hypnodontic subjects experienced 776 hypnodontic sessions (about 4 sessions per patient). Appointments included: 107 surgical (exodontics), 527 operative, 15 prosthetic, 46 periodontic surgery, 14 endodontics, and 67 "for suggestive conditioning only." The average depth of trance estimated from the first "conditioning" appointment was: 4 refused all instruction following introduction of the subject; 4 were refractory -- did not enter a trance or relaxed mood; 43 reached hypnoidal stage; 41 reached light trance; 65 reached medium trance; 40 reached somnambule stage. The author concludes, "we might also remind ourselves that all patients do not survive surgical or anesthesia intervention. The hypnodontist or hypnotherapist has a 100% clean record for the survival of his patient or even of any deleterious side effects of his treatment. No other specialty of medical-dental therapy is so fortunate" (p. 119).