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.
No other single topic within the domain of emotions has perceived as much attention or argument during the past century... Anxiety has only been considered as a negative emotion par excellence in the theoretical writings of psychological theorists but, even apart from its prototypical status as a negative emotion, it became generally the central emotional concept of many theoretical treatments in psychology. (Mandler, G. 'Mind and Emotions' New York: Wiley 1975)
I would like you to consider anxiety in a general way before embarking on the psychoanalytical course. The majority of clients consulting you as a hypnotherapist will be suffering from some form of anxiety. Therefore, an understanding of the symptoms and physical effects of anxiety is necessary for treating these clients. The more knowledge of the subject you have the easier it will be for you to put the client at ease and even explain the forces they have to contend with. In this chapter suggestions are given as well and body mind interplay of anxiety. These examples are given mainly to clarify anxiety as the majority of clients will require analysis to be freed from their symptoms. However, other clients may decide on a different course such as suggestion therapy and hopefully these 'tools' may be beneficial in easing the anxiety subject.
Anxiety can, for convenience, be divided theoretically into three forms of expression; Anxiety hysteria, anxiety repression and worry. Although no such division is possible in reality since anxiety is a condition of the psyche with various qualities and characteristics of expression according to the particular person and his problem.
Anxiety Repression:
Anxiety repression has many similarities with hysteria, both in causation and characteristics. It brings a general sense of discomfort, extreme irritability and kindred negative conditions. For example, the case of a client, a nurse, who was haunted by the fear that her work was not satisfactory and she feared administering the wrong drugs and care for her patients. Under analysis it was discovered that she was having an affair with a doctor and was toying with the idea of leaving her husband. By the mental mechanism of displacement she displaced this thought in her mind by associating it with her work going wrong. The root cause of her problem was the feared marriage separation.
Symptoms of anxiety repression may also arise when the individual is afraid of a situation event or experience. A woman who was shortly to undergo her fourth driving test lived in such a continual state of nerves and tension. At the last driving test she broke down and cried uncontrollably when the instructor failed her. The last incident threw her into a state of panic, her whole life was going wrong, she felt something terrible was going to happen. She was really projecting her inner dread and uncertainty into the environment.
Worry:
Worry is usually the most common expression of anxiety and is usually expressed in the following ways:
1. An unconscious fear of disaster, physical, social or economical.
2. An unconscious repression of the libido or life urge.
3. An unconscious sense of guilt.
Anxiety Hysteria:
Anxiety caused by a psychological conflict is converted into a physical symptom usually an anxiety attack. This is the main form of anxiety hysteria (symptoms described in the fight or flight response chapter). It has been established that anxiety conditions are mainly caused by some form of injurious sex life (of which there are so many) erotic excitement, rigid abstinence, frustration, etc., other factors are a loveless marriage, disgust, and repugnance to the partner or a repressed perversion. I will always remember in my first year as a practising hypnotherapist, a retired priest of 70 years consulted with anxiety symptoms. During the introductory talk he admitted to having sexual relations with boys in his teenage years and was haunted by these sexual thoughts all his life. He also said he had only masturbated three times in 50 years but was admitted to various mental institutions with severe anxiety symptoms on five different occasions. This story was an eye opener for me and a confirmation that when the sexual instincts becomes frustrated or perverted in development and expression it can destroy both mental and physical well-being.
Freud has laid down as an axiom where marriage is impossible for whatever reason an endeavour should be made to sublimate the instinctive desires by devotion to social welfare, religious work and intellectual occupations, or the pursuit of a creative hobby that engages all the interests of the individual. In this way the surplus of nervous energy which is the by-product of life on its animal side is sublimated, transformed and released.
Of course there are many other causes of anxiety such as apprehension, guilt complexes etc.
Anxiety, in a psycho-somatic context can take many forms, the most common being phobias, post-traumatic stress disorders, obsessive compulsive disorders, social anxiety and panic attacks, to name but a few. The goal of hypnotherapy is to change the negative fixed ideas that fuel anxiety by replacing them with positive, realistic coping thoughts that are imprinted into the subconscious mind.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.
The following compilation of Research into Hypnotherapeutic Interventions for Anxiety & Phobias with specific examples of working with patients at each level of illness, and gives statistical analysis of Hypno-psychotherapeutic interventions which were used in the treatment of these clients. If you have comments on the following research, or simply ideas, approaches, techniques or opinions, please feel free to post below, or on our discussions page on Facebook at http://www.facebook.com/group.php?gid=142527652458782
Please visit our website www.hypnosiseire.com for more details or email ichphq@gmail.com
ANXIETY
1997
Ashton C Jr. Whitworth GC. Seldomridge JA. Shapiro PA. Weinberg AD.Michler RE. Smith CR. Rose EA. Fisher S. Oz MC. Self-hypnosis reduces anxiety following coronary artery bypass surgery. A prospective, randomized trial. Journal of Cardiovascular Surgery 1997;38(1):69-75
OBJECTIVE: The role of complementary medicine techniques has generated increasing interest in today's society. The purpose of our study was to evaluate the effects of one technique, self-hypnosis, and its role in coronary artery bypass surgery. We hypotesize that self-hypnosis relaxation techniques will have a positive effect on the patient's mental and physical condition following coronary artery bypass surgery.
EXPERIMENTAL DESIGN: A prospective, randomized trial was conducted. Patients were followed beginning one day prior to surgery until the time of discharge from the hospital.
SETTING: The study was conducted at Columbia Presbyterian Medical Center
PATIENTS: All patients undergoing first-time elective coronary artery bypass surgery were eligible. A total of 32 patients were randomized into two groups.
INTERVENTIONS: The study group was taught self-hypnosis relaxation techniques preoperatively, with no therapy in the control group.
MEASURES: Outcome variables studied included anesthetic requirements, operative parameters, postoperative pain medication requirements, quality of life, hospital stay, major morbidity and mortality.
RESULTS: Patients who were taught self-hypnosis relaxation techniques were significantly more relaxed postoperatively compared to the control group (p=0.032). Pain medication requirements were also significantly less in patients practising the self-hypnosis relaxation techniques that those who were noncompliant (p=0.046). No differences were noted in intraoperative parameters, morbidity or mortality.
CONCLUSION: This study demonstrates the beneficial effects self-hypnosis relaxation techniques on patients undergoing coronary artery bypass surgery. It also provides a framework to study complementary techniques and the limitations encountered.
1988
Goldmann L. Ogg TW. Levey AB. Hypnosis and daycase anaesthesia. A study to reduce pre-operative anxiety and intra-operative anaesthetic requirements. Anaesthesia 1988;43(6):466-9 Fifty-two female patients who underwent gynaecological operations as day cases received either a short pre-operative hypnotic induction or a brief discussion of equal duration. Hypnotized patients who underwent vaginal termination of pregnancy required significantly less methohexitone for induction of anaesthesia. They were also significantly more relaxed as judged by their visual analogue scores for anxiety. Less than half of the patients were satisfied with their knowledge about the operative procedure even after discussions with the surgeon and anaesthetist. A significant correlation was found between anxiety and perceived knowledge of procedures. The results suggest that pre-operative hypnosis can provide a quick and effective way to reduce pre-operative patient anxiety and anaesthetic requirements for gynaecological daycase surgery.
1984
Katcher A. Segal H. Beck A. Comparison of contemplation and hypnosis for the reduction of anxiety and discomfort during dental surgery. American Journal of Clinical Hypnosis 1984;27(1):14-21 Used complex moving visual stimuli to induce states of relaxation, hypnosis, and revery in 42 dental patients (aged 21-60 yrs). To test the efficacy of using aquarium contemplation to induce relaxation, Subjects were randomly assigned to 1 of 5 treatments prior to elective oral surgery: contemplation of an aquarium, contemplation of a poster, poster contemplation with hypnotic induction, aquarium contemplation with hypnosis, and a nonintervention control. Subjects were administered 5 tests of susceptibility adapted from the Stanford Hypnotic Susceptibility Scale; blood pressure, heart rate, and subjective and objective measures of anxiety were also taken. It was found that 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. Findings suggest that aquarium contemplation can alter patients' subjective experiences and overt behavior during oral surgery. Other clinical applications of the contemplation procedure are discussed.
1983
Boutin GE. Tosi DJ. Modification of irrational ideas and test anxiety through rational stage directed hypnotherapy RSDH. Journal of Clinical Psychology 1983;39(3):382-91 Examined the effects of four treatment conditions on the modification of Irrational Ideas and test anxiety in female nursing students. The treatments were Rational Stage Directed Hypnotherapy, a cognitive behavioral approach that utilized hypnosis and vivid-emotive-imagery, a hypnosis-only treatment, a placebo condition, and a no-treatment control. The 48 Ss were assigned randomly to one of these treatment groups, which met for 1 hour per week for 6 consecutive weeks with in-vivo homework assignments also utilized. Statistically significant treatment effects on cognitive, affective, behavioral, and physiological measures were noted for both the RSDH and hypnosis group at the posttest and at a 2-month follow-up. Post-hoc analyses revealed the RSDH treatment group to be significantly more effective than the hypnosis only group on both the post- and follow-up tests. The placebo and control groups showed no significant effects either at post-treatment or at follow-up.
1980
Hurley JD. Differential effects of hypnosis, biofeedback training, and trophotropic responses on anxiety, ego strength, and locus of control. Journal of Clinical Psychology 1980;36(2):503-7 Pretested 60 college students on three scales: The IPAT Anxiety Scale, the Barron Ego-strength scale, and the Rotter I-E scale. The Ss then were assigned randomly to one of four treatment groups designated: Hypnotic treatment, biofeedback treatment, trophotropic treatment, and control. Three of these groups met separetely for 60 minutes once a week for 8 weeks. The control group did not meet during this time. During the sessions, each group was trained in a different technique for self-regulation. At the end of the 8-week period the scales were readministered to all groups. A series of covariance analyses indicated that hypnosis was a more effective self-regulatory technique for lowering anxiety levels when compared to biofeedback or trophotropic response procedures. With regard to increasing ego strength, both the hypnotic training group and the biofeedback training group proved to be significant. No significant difference was found between the experimental and control gorups on the I-E scores.
1978
Benson H. Frankel FH. Apfel R. Daniels MD. Schniewind HE. Nemiah JC. Sifneos PE Greenwood
Thus, 4 treatment groups were studied: moderate-high responsively MT; low responsively MT; moderate-high responsively HT; and low responsively HT. The low responsively HT group, by definition largely incapable of achieving the altered perceptions essential to hypnosis, was designed as the control group. Patients were instructed to practice the assigned technique daily for 8 weeks. Change in anxiety was determined by three types of evaluation: psychiatric assessment; physiologic testing; and self-assessment.
There was essentially no difference between the two techniques in therapeutic efficacy according to these evaluations. Psychiatric assessment revealed overall improvement in 34% of the patients and the self-rating assessment indicated improvement in 63% of the population. Patients who had moderate-high hypnotic responsivity, independent of the technique used, significantly improved on psychiatric assessment (p = 0.05) and decreased average systolic blood pressure from 126.1 to 122.5 mm Hg over the 8-week period (p = 0.048).
The responsivity scores at the higher end of the hypnotic responsivity spectrum were proportionately correlated to greater decreases in systolic blood pressure (p = 0.075) and to improvement by psychiatric assessment (p = 0.003). There was, however, no consistent relation between hypnotic responsivity and the other assessments made, such as diastolic blood pressure, oxygen consumption, heart rate and the self-rating questionnaires. The meditational and self-hypnosis techniques employed in this investigation are simple to use and effective in the therapy of anxiety.
1976
Melnick J. Russell RW. Hypnosis versus systematic desensitization in the treatment of test anxiety. Journal of Counseling Psychology 1976;23(4):291-295. Assessed the comparative effectiveness of systematic desensitization (SD) and the directed experience hypnotic technique (HT) in reducing self-reported test anxiety and increasing the academic performance of 36 test-anxious undergraduates. Subjects were assigned randomly to either the HT or SD conditions or to 1 of 2 control groups. All Subjects had previously scored above the 50th percentile on Sarason's Test Anxiety Questionnaire (TAQ) and below the 85th percentile on a midterm exam. Results indicate that only the SD treatment significantly reduced TAQ scores. No significant improvement in academic performance was observed for either treatment. An additional analysis of high- vs moderate-anxious subgroups failed to show differential treatment effects on either dependent measure.
Podolnick EE. Field PB. Emotional involvement, oral anxiety, and hypnosis. International Journal of Clinical & Experimental Hypnosis 1970;18(3):194-210. 48 undergraduates were randomly assigned to either a high or low emotional arousal manipulation and then underwent a tape-recorded hypnotic induction and test of depth. The high-arousal group was exposed to infantile oral objects and were led to believe that they would have to suck on them as part of a physiological psychology experiment in which the cutaneous sensitivity of the human mouth was being mapped. The low-arousal group believed they only had to blow on whistles or pipes. While both groups were anticipating these experiences, hypnosis was induced. Subjects in the high-arousal group were significantly more hypnotizable (p < .001) than their counterparts in the low-arousal group. Subjects in the high-arousal group were significantly less anxious after hypnosis than they were before hypnosis, while the low-arousal Subjects did not show a reduction in anxiety. The groups did not differ on several background personality tests given as checks on the randomization. (Spanish & German summaries)
1993
Rankin EJ. Gilner FH. Gfeller JD. Katz BM. Efficacy of progressive muscle relaxation for reducing state anxiety among elderly adults on memory tasks. Perceptual & Motor Skills 1993;77(3 Pt 2):1395-402 Cognitively intact anxious elderly subjects were randomly assigned to either a progressive muscle relaxation-training condition or control condition (ns = 15) and then completed selected subtests from the Wechsler Memory Scale--Revised. Despite significant reductions in state anxiety in the relaxation group, no significant differences were detected between the two groups on memory measures. These results are discussed within the context of previous research, and suggestions for further research are made
Brown, Gail W.; Riddell, Rodney; Summers, David; Coffman, Brent (1994, August). Use of hypnosis by practitioners in the school setting. [Paper] Presented at the annual meeting of the American Psychological Association, Los Angeles
NOTES
Hypnosis is a therapeutic procedure that is appropriate for some school-age clients. Through the use of hypnosis that utilizes metaphors and imagery, children can be empowered to find unique solutions to their problems. Children enjoy the feeling of power and mastery that they have when able to perform hypnotic phenomena. They like to play magic and can be told that a finger or other body part will become numb. Because a major goal of hypnotherapy is to teach a child to be an active participant in his or her own behalf, the focus is on creating solutions and mastering the situation rather than enduring the problems. Four case studies demonstrate the utility of hypnosis in the treatment of phantom pain and nausea, sleep terror disorder, school phobia, and spider phobia. In each case, treatment goals were realized. Because the solutions were self- generated, the behavioral changes maintained over time and situation.
Case #1: Hypnosis was used to help alleviate phantom limb pain and nausea during chemotherapy following amputation of the right leg at the knee due to cancer in a thirteen- year-old male. The client had indicated that he loved nature and enjoyed the mountains. The metaphor described a young tree that has just begun to grow small silvery leaves. The spring floods tear the limbs and branches from the stump. The deep roots and stump of the tree are all that remain. The tree is not the same as before the flood. Its roots are stronger, its base more sturdy compared to the branches and limbs. The young tree has withstood the catastrophe of the torrent of waters and is even stronger than before. To counter the nausea and vomiting associated with chemotherapy a switch mechanism metaphor was used. The client was adroit with computers and had no difficulty picturing a switch located in his brain which could "turn off" the nausea from chemotherapy. A room contained all the unpleasant feelings that were being experienced. In this room is a light of a particular color that represents all the unpleasant sensations. Press the key on the computer that controls the switch to turn off the colored light in that room. Suggestions for healing were also given. Your body has known for years how to heal. Visualize the battle between good and bad cells and the victory of the good cells.
Case #2: Hypnosis was used to alleviate sleep terror disorder in a ten-year-old female. The onset of the subject's parasomnic symptomatology appeared to coincide with her starting kindergarten and her family's relocation shortly before. The initial treatment consisted of progressive relaxation, deep breathing, and the visual image of her "secret safe place." An induction utilizing a variety of images was presented. Hiking barefoot on a cool moss covered mountain trial, sitting in a an alpine meadow on a warm summer afternoon, and flying proved most effective in facilitating trance. The participant was told to "Visualize all your anxiety and tension as hard grey rocks. Pick up these rocks and place them in your pockets. Go to the front porch of your "secret safe place and on the porch is a "magic hefty bag." Place your hard grey rocks that contain all your anxiety and tension in the magic bag. Once in the bag, the rocks will no longer weight you down, you will be free of any feelings of stress or tension. Your bed is magic; it is covered with a special glue which will keep you in a reclining position until you are fully rested and ready to awaken."
Case #3: Hypnosis was used in the treatment of school phobia in a nine-year-old male. The student experienced intense anxiety whenever separation from the primary caretaker occurred. The teacher stated that this boy experienced frequent absences and crying spells that were only relieved by phone calls to his mother or the presence of his mother next to him in class. In preparation for the intervention, the student was asked to draw a picture of how he felt inside during a panic attack. He drew a fire. He also said that only his mother could put that fire out. This information was utilized in creating a metaphor that described a house in a small town. "The mother had left, and a young boy was left alone. While at home, the boy looked out the window and saw several boys trying to burn a neighbor's yard! Acting quickly, he called the fire department, grabbed the fire extinguisher and unraveled the garden hose. He was able to extinguish the fire. The neighbors and friends were very happy and praised the boy's performance. When his mother heard the good news, she quickly returned home and held a celebration in his honor." Following the metaphor, hypnotherapy continued with suggestions about fire extinguishers that the subject could use to put out emotional fires.
Case #4: Hypnosis was used in the treatment of spider phobia. Diagnosis of phobia was made in this eleven-year-old female when the fear or avoidance behavior was distressing. The child's strained facial expressions occurred even at the thought of seeing what she described as "a creepy, crawly creature with 8 legs." Preparatory to her first induction the participant was read the story of Charlotte Charlotte Charlotte Charlotte
1992
Bindler, Paul (1992, October). Hypnosis and Psychotherapy: The clinical utility of altered states of consciousness. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington, VA.
NOTES
Author assesses state, especially attentional changes, with Multidimensional Consciousness Scale (receptivity, arousal, .... etc.)
Clinical management of anxiety is goal. Cites Nash as characterizing anxiety disorders with cognitive/affective characteristics similar to hypnotized state. Wickramasekera's model has people high in neuroticism and high in hypnotizable being hypersensitive to stress, with physiological hyperarousal. Lows have alexithymia, may be unresponsive to symbolic events but very responsive to concrete events; poor verbalization of alexithymics leads to somatization.
Author focuses on relaxation and anxiety reduction. Suggests that Crawford's attention model (highs better able to shift cognitive and attentional strategies) is useful.
Instructions facilitate focusing attention inward so external stimuli become irrelevant. Therapist helps patient focus attention on the link between cognitions and tension.
Garssen, Bert; de Ruiter, Corine; Van Dyck, Richard (1992). Breathing retraining: A rational placebo?. Clinical Psychology Review, 12, 141-153
Breathing retraining of patients with Hyperventilation Syndrome (HVS) and/or panic disorder is discussed to evaluate its clinical effectiveness and to examine the mechanism that mediates its effect. In relation to this theoretical question, the validity of HVS as a scientific model is discussed an is deemed insufficient. It is concluded that breathing retraining and related procedures are therapeutically effective, but probably due to principles other than originally proposed, namely decreasing the tendency to hyperventilate. An alternative principle is the induction of a relaxation response, presenting a credible explanation for the threatening symptoms, giving a distracting task to practice when panic may occur, and promoting a feeling of control.
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.
Levitan, Alexander A. (1992). The use of hypnosis with cancer patients. Psychiatric Medicine, 10, 119-131.
Hypnosis has proven to be extremely valuable in the treatment of cancer patients. Specific applications include: establishing rapport between the patient and members of the medical health team; control of pain with self-regulation of pain perception through the use of glove anesthesia, time distortion, amnesia, transference of pain to a different body part, or dissociation of the painful part form the rest of the body; controlling symptoms, such as, nausea, anticipatory emesis, learned food aversions, etc.; psychotherapy for anxiety, depression, guilt, anger, hostility, frustration, isolation, and a diminished sense of self-esteem; visualization for health improvement; and, dealing with death anxiety and other related issues.
Hypnosis has unique advantages for patients including improvement of self-esteem, involvement in self-care, return of locus of control, lack of unpleasant side effects, and continued efficacy despite continued use.
Morse, Donald R.; Martin, John; Moshonov, Joshua (1992). Stress induced sudden cardiac death: Can it be prevented?. Stress Medicine, 8, 35-46.
Previously, psychosomatically induced death relative to stress, hypnosis, mind control, and voodoo was discussed. In this article, emphasis is on one aspect of that - stress induced sudden cardiac death (SCD). A brief review is presented of the sympathetic aspects of the acute stress response and stress induced SCD. Findings from previous studies are presented to highlight sympathetic aspects of the acute stress response. This is followed by a presentation of various strategies to prevent of decrease the possibilities for stress induced SCD. These include long-term measures (e.g. diet control, smoking control, hypertension control, stress management strategies) and immediate measures (e.g. calm, controlled approach, elicitation of the relaxation response, selected use of drugs, and heart rate variability monitoring). Relative to prevention strategies, findings are presented both from previous studies and new investigations.
1991
Bodden, Jack L. (1991). Accessing state-bound memories in the treatment of phobias: Two case studies. American Journal of Clinical Hypnosis, 34, 24-28.
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
NOTES: The authors state that Rossi and Cheek (1988) summarize a number of experimental studies on animal memory that demonstrate that different information substances are involved in different learning situations. For example, ACTH and cortisol are involved in avoidance learning while angiotensin is involved in operant conditioning. In hypnosis, state dependent memory seems to be implicated. "Hilgard (1977) interpreted the state-dependent memory studies by Overton and others as entirely consistent with and supportive of his theory of hypnosis. Milton Erickson (1948) has also strongly suggested that it is the altered levels of arousal and affect that are responsible for the encoding and recall of stress-related problems with hypnosis" (p. 26).
"Affective experiences are apparently stored independently from their intellectual counterparts, or the emotional unit form one set may attach itself to a constellation of cues that make up a totally different cognitive set. Hypnosis may facilitate recall by providing relevant cues during an altered state of consciousness" (p. 27).
"In commenting upon [one of Erickson's cases], Rossi (1986) states that Erickson was effective because he helped the patient access state-bound memories by reviewing the context and sensory-perceptual cues that surrounded their original acquisition" (p. 27).
"When traditional behavior therapy fails it may be because the original fear stimulus is state bound or unconscious. What is conscious to the patient are those stimuli that are similar in some important respect to the original phobic stimulus and are acquired by stimulus generalization. Desensitization may reduce the patient's reactivity to the associated or acquired stimuli but cannot desensitize the original stimulus until it can be accessed consciously" (p. 27).
"The two main psychological explanations of phobic behavior are psychodynamic and behavioral. The psychodynamic approach is built upon the early writings of Freud (1956) on the traumatic basis of neurosis. Freud speculated that the intense anxiety (psychic pain) associated with the emotional trauma lead to dissociation, repression, and amnesia. Symptoms represented a dissociated or symbolic vestige of the repressed ('forgotten') trauma.
"Behavioral explanations (e.g., Rimm & Masters, 1974) are built upon classical and operant conditioning models of learning. Classical conditioning explains how a neutral stimulus (e.g., a bridge) can acquire reactivity and elicit a fear response. Avoidant behavior, which preserves the phobia, is acquired and maintained by operant conditioning. Treatment apparently involves gradual extinction of the fear response.
"These two divergent explanations have spawned quite different therapeutic approaches, with the behavioral approach (systematic desensitization) demonstrating greater empirical support for its effectiveness (Kaplan & Sadock, 1986). The problem is made complex theoretically by the fact that desensitization doesn't always work, even when applied in a competent fashion" (p. 25).
"Freud's early work on the traumatic basis of neurosis pointed to but offered an incorrect explanation of phobias whose origins were unconscious or state bound (i.e., not available to recall during the normal conscious state)" (p. 25).
Cochrane, Gordon J. (1991). Client-therapist collaboration in the preparation of hypnosis interventions: Case illustrations. American Journal of Clinical Hypnosis, 33, 254-262.
Therapists can use hypnosis in a variety of situations to help clients utilize their own resources effectively. In both heterohypnosis and tape-assisted self-hypnosis, the respectful collaboration of therapist and client in the development of specific intervention strategies can be effective. I have described four cases to illustrate the collaborative aspect of heterohypnosis in a surgical setting and tape-assisted self-hypnosis for anxiety, tinnitus, and situational depression. In each case the clients were willing and able participants.
NOTES:
"Hypnotic interventions as adjunctive therapeutic modalities for a variety of surgical procedures have been well documented (Frankel, 1987; Gravitz, 1988; Nathan, Morris, Goebel, & Blass, 1987). The availability, relative safety, dependability, and ease of use have made chemical agents the anesthetic of choice in the majority of surgical situations, but hypnosis, either alone or in conjunction with chemical agents, can have a number of advantages for some patients (Udolf, 1987, p. 248).
Some patients who have extreme preoperative pain and anxiety can learn to use self-hypnosis (Frankel, 1987); others may use hypnosis when experiencing postoperative nausea and other uncomfortable side effects of chemical anesthetics. Some may fear death under general anesthesia or react to a previous trauma arising from general anesthesia and the operating room procedures in general (Udolf, 1987, p. 250) and therefore choose hypnotic strategies. In the following case illustration the patient feared general anesthesia because of a previous negative postoperative experience" (p. 255).
While collaboratively planned hypnosis often empowers the patient, contributing to a sense of personal control and well being, some patients are not able to participate in that manner. Cochrane cites patients who are severely depressed or "who struggle with narcissism and other severe pathologies" (p. 260). He notes that audiotapes are useful for supplementing in-session therapy, contributing to skill development, attitude change, and a sense of self-worth. He cites Eisen and Fromm (1983) as indicating that self hypnosis is also useful for clients "who struggle with issues of control and intimacy" (p. 260).
Mauer, D. R. (1991, October). A comparison of cognitive-behavioral and hypnotic techniques in the management of electromyography pain (Dissertation, University of Iowa
"Compared a cognitive behavioral technique that included providing specific sensory and procedural information combined with relaxation with a hypnotic technique (relaxation with guided imagery) and a control group for management of acute EMG pain and anxiety. Pain and anxiety ratings were gathered from 45 EMG patients and observers for both nerve conduction and needle electrode components of the EMG exam. It was found that only the hypnosis group significantly reduced pain and anxiety during the needle electrode portion of the procedure. Patients with unexplained or functional symptoms reported more EMG pain and anxiety than patients who had an organically based disease. Because having had a prior EMG seemed to have an effect on the efficacy of treatment, the data were reexamined. Results determined that inexperienced EMG patients who were treated had less pain and anxiety than patients who experienced EMG before, but inexperienced control patients had an increase in pain and anxiety over experienced patients" (p. 1070).
1990-1991
Avants, S. Kelly; Margolin, Arthur; Salovey, Peter (1990-91). Stress management techniques: Anxiety reduction, appeal, and individual differences. Imagination, Cognition and Personality, 10, 3-23.
NOTES
Four stress management techniques were evaluated for their general appeal, their immediate benefits, and the subjective experiences they evoke. One hundred undergraduates were randomly assigned to one of five treatment groups: (1) progressive muscle relaxation (PMR); (2) distraction imagery; (3) focused imagery; (4) listening to music; (5) sitting quietly (control). Distraction imagery and listening to music were the only techniques found to reduce anxiety to a greater extent than simply sitting quietly. The techniques differed in the way they made subjects feel, but not in their general appeal. Individuals with a 'blunting' coping style were more likely to find all five techniques appealing.
Tests used included the Miller Behavioral Style Scale, Cognitive-Somatic Anxiety Questionnaire of Schwartz, Davidson & Golman, Life Orientation Test of Scheier & Carver, Somatic Perception Questionnaire of Landy and Stern, Body Consciousness Questionnaire of L. C. Miller, Murphy, & Buss, Betts' Questionnaire Upon Mental Imagery, Shortened Form, State-Trait Anxiety Inventory, and Technique Evaluation Questionnaire of the authors.
Progressive muscle relaxation was according to Bernstein & Borkovec. Distraction imagery involved successively imagining a walk along a beach, a stroll across a flower filled meadow, sitting by a stream, a walk into the woods, sitting in a cabin in the woods listening to the rain against the windowpane, all including images in a variety of sense modalities. Focused imagery involved creating an image of a stressor, then through symbolic imagery experiences Ss were guided through a typical day's events that might lead up to the stressor, reinterpreting cues associated with the stressor as signals that they are in control, visualizing encountering the stressor feeling strong and determined, and any physical sensations reinterpreted as 'energy' that would help them to cope, visualizing enjoying their success (from Crits-Cristoph & Singer. Music was a 20-min tape (10 min of music used in the distraction imagery tape--Natural Light by Steve Halpern & David Smith) and 10 min of music used in background of the focused imagery tape (Structures of Silence by Michael Lanz). A 5th group, Control, was instructed to sit quietly with eyes closed.
This data can be used in support of imagery-suggestion types of hypnosis (as in surgery study) reducing anxiety. It shows particularly strong effects for people high in cognitive anxiety or low in optimism, pre-treatment.
Discussion: "... we feel confident that our distraction techniques were more effective for the immediate relief of anxiety than was PMR. This conclusion is consistent with the Suls and Fletcher meta-analysis (29) that suggested that 'avoidance' is an effective short-term coping strategy. That distraction (positive) imagery may be a more useful clinical technique than focused (active involvement) imagery was concluded in a study comparing these two techniques in the treatment of phobias (24)" (p. 19. [Ref #24 is Crits-Cristoph & Singer (1983) in Imagination, Cognition, and Personality.]
"Pessimism and cognitive anxiety emerged as the only individual difference variables to influence anxiety reduction. Pessimism as measured by the LOT is cognitive in nature, with most of the items relating to expectations of negative outcomes; similarly, cognitive anxiety is characterized by worry and an inability to control negative thoughts and images. That individuals who perceive their world somewhat negatively should have entered the study more anxious than individuals who do not is hardly surprising. What is surprising is that despite an inverse relation between cognitive anxiety and the ability to relax, these individuals were able to benefit from whatever technique they performed to a greater extent than were individuals with a more positive outlook. In fact, after performing the technique, pessimists had reduced their anxiety to the level of optimists" (p. 19).
"The stress management techniques used in the current study did not differ in their appeal" (p. 20). "Our finding that PMR produced more somatic effects than did focused imagery and less cognitive effects than did distraction imagery, listening to music, or sitting quietly is consistent with the model of anxiety proposed by Davidson and Schwartz (17). Our findings are also generally consistent with a conclusion reached by Woolfolk and Lehrer (4): that although various techniques are generally stress reducing, they seem to have highly specific effects. However, we found no support for the hypothesis that individuals who express anxiety cognitively (or somatically) prefer and benefit most from techniques that produce cognitive (or somatic) effects. In fact, the extremely high correlation found between the cognitive and somatic anxiety subscales of the Schwartz et al. measure (5) casts some doubt on the usefulness of a cognitive-somatic distinction, as does the corr between the experience of physical symptoms under stress (the Somatic Perception Questionnaire) with the cognitive, as well as the somatic, anxiety subscale.
"The finding that blunters experiences more 'somatic effects' regardless of the technique they were assigned may have been the result of a single response--'how much did mind-wandering interfere with performing the technique'--which was the only Factor 2 item that was highly inversely) related to blunting. Since blunters are more likely to perceive mind wandering as the essence of stress management rather than as 'interference,' we do not view this main effect as particularly illuminating" (p. 20). "However, our finding that blunters experienced all techniques as appealing is consistent with the results of Martelli et al. (1) who found that individuals with low information-preference benefitted from what the authors labeled an 'emotion-focused' intervention, but which, in fact, included many of the quite diverse stress management techniques that we compared in the current study.
That 'avoiders' failed to benefit from any intervention in the Scott and Clum study (11) may be due to the nature of the stressor [postsurgical pain]. Our undergraduates may have been more like the Martelli dental patients in terms of their level of distress than were the Scott and Clum subjects who were patients undergoing major surgery (hysterectomy or cholecystectomy). Future research needs to examine possible three-way, technique by patient by stressor-type, interactions (cf. 19)" pp 20-21.
Lazarus, A. A.; Mayne, T. J. (1990). Relaxation: Some limitations, side effects, and proposed solutions. Psychotherapy, 27, 261-266
Deep-muscle relaxation has been widely regarded as anxiety inhibiting, and the relaxation response an antidote to tension and stress. However, some relaxation techniques have been shown to have negative effects. These include relaxation-induced anxiety and panic, paradoxical increases in tension, and parasympathetic rebound. Specific indications and contraindications are discussed.
NOTES 1:
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).
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).
People have been observed to have "negative or untoward reactions to meditation ([Lazarus, 1976]; French, Schmid & Ingalls, 1975; Kennedy, 1976), relaxation (Borkovec & Grayson, 1980; Carrington, 1977; Edinger & Jacobsen, 1982), and biofeedback (Miller & Dworkin, 1977). In his doctoral dissertation Heide (1981) found that more than half of his subjects under focused relaxation reported increased tension due to the relaxation session. Recently, the concept of RIA--relaxation-induced anxiety--has appeared in the literature (Heide & Borkovec, 1983; 1984). Clients suffering from generalized anxiety appear to be especially prone to RIA" (pp. 261-262).
Others have suggested that relaxation may be counterindicated for asthmatics, because the small airways dilate with sympathetic nervous system arousal. The specific instructions of autogenic training may be counterindicated for patients with gastrointestinal disease because focusing on a sense of warmth in the abdomen tends to produce more peristalsis, increased blood flow in the gastric mucosa, and acidity in the gastric juice (Luthe & Schultz, 1979). Even the standard relaxation therapy for tension headache (as well as other pain problems) is being replaced with cognitive behavioral therapy, which may have relaxation as only one component. "The point again is that relaxation is not a panacea, and that an informed selection and administration of treatments is mandated, even in disorders where relaxation has traditionally been held second only to medication" (p. 264).
Interviews suggest people with relaxation induced anxiety (RIA) fear losing control. "Some are afraid of heightened arousal; others refer to helplessness, depression, some unidentified internal or external danger, a fear of going crazy, a negative association with anesthetics, a fear of falling from heights, plus any number of catastrophic expectations (Chambless & Goldstein, 1980)" (p. 264). Lazarus recommends that if someone displays RIA, the therapist may try alternative techniques, which might include for example tensing-relaxing muscles, passive receptivity, positive or pleasant imagery, focus on breathing, subvocal monotonous chant or mantra, or the Vipassana meditation practice of achieving awareness of spontaneous sensations and thoughts. The relationship with the therapist, differences in room illumination, amount of time per session, and sitting or reclining may be important.
"If a therapist deduces that a client is likely to derive benefit from relaxation training, three obvious questions arise: (1) Which of the many types of relaxation training programs is this particular client likely to respond to? (2) How frequently, and for what length of time, should the client practice the selected relaxation sequence? (3) Will treatment adherence be augmented or attenuated by the supplementary use of cassettes for home use?" (P. 262).
The authors describe their Structural Profile Inventory (SPI; Lazarus, 1989), a 35- item questionnaire, which may be used to predict the preferred sequences and forms of relaxation to employ with individual clients. "A predominantly imagery/sensory reactor, for example, may do well with visualization and autogenic training, whereas a highly active/cognitive client might be better advised first to engage in strenuous exercise followed by calming self-statements (Zilbergeld & Lazarus, 1988)" (p. 265). They suggest that for those patients who are perfectionistic and simply can't "just let go," they might simply fill a bathtub with warm water and sit in it for 10-20 minutes and rest with a magazine (rather than "relax") once or twice a day.
McNally, Richard J. (1990). Psychological approaches to panic disorder: A review. Psychological Bulletin, 108 (3), 403-419.
Panic disorder has been the subject of considerable research and controversy. Though biological conceptualizations have been predominant, psychological theorists have recently advanced conditioning, personality, and cognitive hypotheses to explain the etiology of panic disorder. The purpose of this article is to provide an empirical and conceptual analysis of these psychological hypotheses. This review covers variants of the "fear-of-fear" construal of panic disorder (i.e., Pavlovian interoceptive conditioning, catastrophic misinterpretation of bodily sensations, anxiety sensitivity), research on predictability (i.e., expectancies) and controllability, and research on information-processing biases believed to underlie the phenomenology of panic. Suggestions for future research are made.
1986
Belicki, Kathryn; Belicki, Denis (1986). Predisposition for nightmares: A study of hypnotic ability, vividness of imagery, and absorption. Journal of Clinical Psychology, 42 (5), 714-718.
The relationships of nightmare frequency to hypnotic ability, vividness of visual imagery, and the tendency to become absorbed in fantasy-like experiences were examined. Subjects were 841 undergraduate university students who participated in group tests of hypnotic ability, after which they estimated the number of nightmares that they had experienced in the prior year. In addition, 406 of the subjects completed Marks' Vividness of Visual Imagery Questionnaire, and Rotenberg and Bowers' Absorption scale. Of the subjects, 76% reported experiencing at least one nightmare in the prior year; 8.3% indicated one or more per month. Individuals with frequent nightmares scored higher on hypnotizability, vividness of visual imagery, and absorption.
NOTES 1:
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.
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.
1984
Billotti, Thomas J. (1984, August). The effects of rational emotive imagery and rational emotive imagery plus hypnosis in reduced public speaking anxiety (Dissertation). Dissertation Abstracts International, 46 (2), 633-634-B.
"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).
Katcher, Aaron; Segal, Herman; Beck, Alan (1984). Comparison of contemplation and hypnosis for the reduction of anxiety and discomfort during dental surgery. American Journal of Clinical Hypnosis, 27, 14-21.
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.
NOTES
1:The consent form was designed to reduce anxiety about hypnosis by stating that if hypnosis was used, it would be used only to induce relaxation. Patients were then randomly assigned to one of the 5 pretreatment groups, with 8 in each of the four contemplation groups and 10 in the nonintervention control.
1. Aquarium contemplation. Ss contemplated it for 40 minutes; during the 1st 25 min, 5 tests of suggestibility were administered (from the Stanford) which eliminated all tests the authors considered anxiety-provoking such as suggested hallucination. Also, the terms hypnotically relaxed or hypnotic relaxation replaced the term hypnosis throughout the protocol.
2. Poster contemplation was the same, using a color photo of a mountain waterfall.
3. Poster contemplation with hypnosis used a protocol derived from Stanford, with visual fixation on poster, then the 5 tests, then Ss contemplated the poster for 10 minutes under hypnosis and were given post hypnotic suggestion that they could reenter hypnosis during the dental procedure by closing their eyes and visualizing the poster
4. Aquarium contemplation with hypnosis was like #3 except that Ss were asked to look at "either one fish or a portion of the aquarium" during induction and were told to reenter hypnosis during treatment by closing their eyes and visualizing the aquarium
5. Nonintervention control Ss were given no tests of suggestibility; they were seated in a chair and told to "relax."
During surgery, an observer recorded overt signs of anxiety or agitation on a check list, making entries at five-minute intervals.
The surgeries took variable lengths of time (5-90 minutes) and variable kinds of procedures (multiple injections, removal of bone, etc.) Surgeons varied in management-- gentleness, etc.
Blood pressure fell significantly during all 5 pretreatments without any significant differences between groups. Analysis of interaction effects, significant at the 0.1 level for all 3 dependent variables, indicated that hypnosis had a major effect on relaxation only when the S was contemplating a poster. Hypnosis had no significant influence on the levels of relaxation obtained by contemplation of the aquarium.
There were no significant differences between groups in the number of suggestions accepted.
1983
Boutin, Gerald E.; Tosi, Donald J. (1983). Modification of irrational ideas and test anxiety through rational stage directed hypnotherapy (RSDH). Journal of Clinical Psychology, 39 (3), 382-391.
Examined the effects of four treatment conditions on the modification of Irrational Ideas and test anxiety in female nursing students. The treatments were Rational Stage Directed Hypnotherapy, a cognitive behavioral approach that utilized hypnosis, and vivid emotive imagery, a hypnosis-only treatment, a placebo condition, and a no-treatment control. The 48 Ss were assigned randomly to one of these treatment groups, which met for 1 hour per week for 6 consecutive weeks with in-vivo homework assignments also utilized. Statistically, significant treatment effects on cognitive, affective, behavioral, and physiological measures were noted for both the RSDH and hypnosis group at the posttest and at a 2-month follow-up. Post-hoc analyses revealed the RSDH treatment group to be significantly more effective than the hypnosis only group on both the post- and follow-up tests. The placebo and control groups showed no significant effects either at posttreatment or at follow-up.
Harris, Gina M.; Johnson, Suzanne Bennett (1983). Coping imagery and relaxation instructions in a covert modeling treatment for test anxiety. Behavior Therapy, 14, 144-157.
The present study compared the efficacy of instructing test anxious subjects to use personalized coping imagery based on nonacademic experiences of competence with coping imagery based on academic experiences of competence. The effect of relaxation was also examined and the relationship of imagery elaborateness and content to treatment effectiveness was assessed. Sixty-three subjects were randomly assigned to one of four treatments or a waiting list control group. Test anxiety as measured by a self-report instrument significantly decreased in all treatment groups. Improvement in grade point average occurred for all treatment groups except for academic coping imagery without relaxation which was also the least efficient treatment. The waiting list control group significantly deteriorated in academic performance. Relaxation training did not appear to enhance treatment effectiveness or influence the elaborateness or content of the imagery used. Test anxiety scenes elicited highly response- oriented images by all subjects. However, the stimulus/response content of the subjects' images was not influenced by treatment outcome. In contrast, successful treatment was primarily associated with reduction in negative coping imagery descriptions, although an increase in positive coping statements cured as well.
Heide, F. J.; Borkovec, T. D. (1983). Relaxation-induced anxiety: Paradoxical anxiety enhancement due to relaxation training. Journal of Consulting and Clinical Psychology, 51, 171-182.
The present study was designed to document the occurrence of relaxation- induced anxiety. Fourteen subjects (7 male, 7 female) suffering from general tension and significant levels of anxiety were given one session of training in each of two relaxation methods, progressive relaxation and mantra meditation; order of presentation was counterbalanced. Four of the subjects plus one other who terminated prematurely displayed clinical evidence of an anxiety reaction during a preliminary practice period, while 30.8% of the total group under progressive relaxation and 53.8% under focused relaxation reported increased tension due to the relaxation session. Progressive relaxation produced greater reductions in subjective and physiological outcome measures and less evidence of relaxation-induced anxiety, and the phenomenon was not clearly evident from physiological measures and from subjective ratings even in this clinical population.
1982
Hilgard, Josephine R.; LeBaron, Samuel (1982). Relief of anxiety and pain in children and adolescents with cancer: Quantitative measures and clinical observations. International Journal of Clinical and Experimental Hypnosis, 30, 417-442.
Children and adolescents with cancer, chiefly forms of leukemia, aged 6 to 19 years, underwent medical treatments which required repeated bone marrow aspirations, normally a painful and anxiety-provoking experience. Data were obtained in baseline bone marrow observations on 63 patients, who were then offered the opportunity to volunteer for hypnotic help in pain control. Of the 24 patients who accepted hypnosis, 9 were highly hypnotizable. 10 of the 19 reduced self-reported pain substantially by the first hypnotic treatment (the prompt pain reducers) and 5 more reduced self-reported pain by the second treatment (the delayed pain reducers) while none of the 5 less hypnotizable patients accomplished this. The latter benefitted by reducing anxiety. Short case reports illustrate the variety of experiences.
Analysis of baseline observations before any therapeutic intervention revealed age and sex differences. The difference between self-reported and observed pain was not statistically significant for patients under age 10 but was significant for the patients age 10 and older (p<.001). There were minor but significant sex differences both in observed pain (p<.01) and in self-reported pain (p<.05), with the females reporting more pain.
1981
Fling, Sheila; Thomas, Anne; Gallaher, Michael (1981). Participant characteristics and the effects of two types of meditation vs. quiet sitting. Journal of Clinical Psychology, 37 (4), 784-790.
Randomly assigned 61 undergraduate volunteers to Clinically Standardized Meditation (CSM), quiet sitting (SIT), or wait list1 and 19 others to Open Focus (OF) or wait list2. Ss were tested before training and again 8 weeks later. All groups but wait list2 decreased significantly on Spielberger's trait anxiety. All groups became nonsignificantly more internal on Rotter's locus of control. On the Myers-Briggs Type Indicator, meditation volunteers were more introverted than extraverted, intuitive than sensing, feeling than thinking, and perceiving than judging. All groups became more intuitive, approaching significance for CSM only. OF became significantly more extraverted than both CSM and SIT, and CSM significantly more so than wait list1. Practice time correlated with anxiety reduction for the combined treatment groups. More evidence was found for correlations of practice time and outcome with growth motivation than with either new experience motivation or expectancy of benefit.
1980
Heide, Frederick J.; Wadlington, W. L.; Lundy, Richard M. (1980). Hypnotic responsivity as a predictor of outcome in meditation. International Journal of Clinical and Experimental Hypnosis, 28 (4), 358-385.
This study tested the hypothesis that measures of hypnotic responsivity would predict outcome from brief meditation training. 58 Ss were matched on hypnotic responsivity and randomly assigned to meditation and control conditions. The Ss in the meditation group displayed significantly greater decreases in trait anxiety than control Ss following a 1-week treatment period. The Ss highest in hypnotic responsivity showed the most substantial decrements in anxiety. It is concluded that hypnotic responsivity is moderately predictive of outcome in meditation. Findings were also consistent with reports that hypnotic responsivity is not increased by practice in meditation.
NOTES 1:
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, 'Om ,' for a period of 20 minutes. It was emphasized that the mantra should be allowed to 'repeat itself' in a gentle, effortless fashion. The Ss were told that when they found themselves distracted by thoughts, they should not try to block them out but should simply return to repeating the mantra" (p. 360). Ss practiced the technique for 20 minutes and were asked to meditate twice daily for 7 days, keeping a log for that period.
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, '
Hurley, John D. (1980). Differential effects of hypnosis, biofeedback training, and trophotropic responses on anxiety, ego strength, and locus of control. Journal of Clinical Psychology, 36 (2), 503-507.
Pre-tested 60 college students on three scales: the IPAT Anxiety Scale, the Barron Ego-strength scale, and the Rotter I-E scale. The Ss then were assigned randomly to one of four treatment groups designated: hypnotic treatment, biofeedback treatment, trophotropic treatment, and control. Three of these groups met separately for 60 minutes once a week for 8 weeks. The control group did not meet during this time. During the sessions, each group was trained in a different technique for self-regulation. At the end of the 8-week period the scales were re-administered to all groups. A series of covariance analyses indicated that hypnosis was a more effective self-regulatory technique for lowering anxiety levels when compared to biofeedback or trophotropic response procedures. With regard to increasing ego strength, both the hypnotic training group and the biofeedback training group proved to be significant. No significant difference was found between the experimental and control groups on the I-E scores.
Lamb, Douglas H.; Strand , Kenneth H. (1980). The effect of a brief relaxation treatment for dental anxiety on measures of state and trait anxiety. Journal of Clinical Psychology, 36 (1), 270-274.
Used a brief deep muscle relaxation procedure to reduce patient (N = 39) anxiety during a dental appointment. State anxiety decreased significantly for a relaxed (treated) group from the waiting room period to the actual contact with the dentist. This reduction in state anxiety was maintained for the duration of the dental visit. There were no changes in trait anxiety. Implications for the reduction of state and trait anxiety in an in vivo situation were discussed.
Lundy, Richard M.; Heide, Frederick J.; Wadlington, W. L. (1980). Hypnotic responsivity as a predictor of outcome in meditation. International Journal of Clinical and Experimental Hypnosis, 28 (4), 358-366.
NOTES 1:
TM reportedly diminishes Trait Anxiety (not State
TM reportedly diminishes Trait Anxiety (
Used Control and Experimental groups pretested on a scale of hypnotizability (Harvard Scale?): Lows = 1-4; Mediums = 5-7; Highs = 8-12.
Subjects were given instructions for modified TM, including a lecture on physiological benefits. "Let the sound 'OM ' repeat itself; let that sound pass through and return to the mantra." Subjects logged practice on their 20 minute meditation twice a day, for 7 days. They were given pre- and posthypnotic tests of State and Trait anxiety.
RESULTS. Meditators decreased Trait anxiety but not State
CONCLUSIONS. This provides more evidence that the skill of hypnotizability has more utility than we had thought, in therapy. Spanos, et al. also found that improvement in meditation was correlated with hypnotizability (in terms of number of intrusions) and Benson, Frankel, et al., found Lows benefit less in blood pressure change with either meditation or hypnosis.
1978
Benson, Herbert; Frankel, Fred H.; Apfel, Roberta; Daniels, Michael D.; Schniewind, Henry E.; Nemiah, John C.; Sifneos, Peter E.; Crassweller, Karen D.; Greenwood, Martha M.; Kotch, Jamie B.; Arns, Patricia A.; Rosner, Bernard (1978). Treatment of anxiety: A comparison of the usefulness of self-hypnosis and a meditational relaxation technique. Psychotherapy and Psychosomatics, 30, 229-242.
We have investigated prospectively the efficacy of two nonpharmacologic relaxation techniques in the therapy of anxiety. A simple, meditational relaxation technique (MT) that elicits the changes of decreased sympathetic nervous system activity was compared to a self-hypnosis technique (HT) in which relaxation, with or without altered perceptions, was suggested. 32 patients with anxiety neurosis were divided into 2 groups on the basis of their responsivity to hypnosis: moderate-high and low responsivity. The NIT or HT was then randomly assigned separately to each member of the two responsivity groups. Thus, 4 treatment groups were studied: moderate-high responsivity MT; low responsivity MT; moderate-high responsivity HT; and low responsivity HT. The low responsivity HT group, by definition largely incapable of achieving the altered perceptions essential to hypnosis, was designed as the control group. Patients were instructed to practice the assigned technique daily for 8 weeks.
Change in anxiety was determined by three types of evaluation: psychiatric assessment; physiologic testing; and self-assessment. There was essentially no difference between the two techniques in therapeutic efficacy according to these evaluations. Psychiatric assessment revealed overall improvement in 34% of the patients and the self-rating assessment indicated improvement in 63% of the population. Patients who had moderate- high hypnotic responsivity, independent of the technique used, significantly improved on psychiatric assessment (p = 0.05) and decreased average systolic blood pressure from 126.1 to 122.5 mm Hg over the 8-week period (p = 0.048). The responsivity scores at the higher end of the hypnotic responsivity spectrum were proportionately correlated to greater decreases in systolic blood pressure (p = 0.075) and to improvement by psychiatric assessment (p = 0.003). There was, however, no consistent relation between hypnotic responsivity and the other assessments made, such as diastolic blood pressure, oxygen consumption, heart rate and the self-rating questionnaires. The meditational and self- hypnosis techniques employed in this investigation are simple to use and effective in the therapy of anxiety.
Counts, D. Kenneth; Hollandsworth, James G., Jr.; Alcorn, John D. (1978). Use of electromyographic biofeedback and cue-controlled relaxation in the treatment of test anxiety. Journal of Consulting and Clinical Psychology, 46 (5), 990-996.
The effect of using electromyographic (EMG) biofeedback to increase the efficacy of cue-controlled relaxation training in the treatment of test anxiety was studied. Forty college undergraduates scoring in the upper third on a self-report measure of test anxiety were randomly assigned to one of four treatment conditions - EMG-assisted cue- controlled relaxation, cue-controlled relaxation alone, attention-placebo relaxation, and no-treatment control. Pre-post self-report measures of test anxiety, state anxiety, and trait anxiety were obtained. In addition, a performance measure in the form of a mental abilities test was administered. Subjects from the three relaxation groups received six 45- minute individual sessions over a period of 2 weeks. All treatments were conducted using audiotape recordings. The results indicate that cue-controlled relaxation is effective in increasing test performance for test anxious subjects, that EMG biofeedback does not contribute to the effectiveness of this procedure, and that self-report measures of anxiety are susceptible to a placebo effect.
Lehrer, Paul M. (1978). Psychophysiological effects of progressive relaxation in anxiety neurotic patients and of progressive relaxation and alpha feedback in nonpatients. Journal of Consulting and Clinical Psychology, 46 (3), 389-404.
Gave 10 anxiety neurotic patients 4 sessions of individual instruction in progressive relaxation; 10 patients served as waiting list controls. 10 nonpatients were assigned to each of the same conditions, and an additional 10 nonpatients were given 4 sessions of alpha feedback. Nonpatients showed more psychophysiological habituation over sessions than patients in response to hearing 5 very loud tones and to a reaction time task. Patients, however, showed greater physiological response to relaxation than did nonpatients. After relaxation, the autonomic responses of the patients resembled those of the nonpatients. The effects of relaxation were more pronounced in measures of physiological reactivity than in measures of physiological activity. Defensive reflexes yielded to orienting reflexes more readily in nonpatients than in patients. There was also a tendency for progressive relaxation to generalize to autonomic functions more than alpha feedback.
1977
Dillbeck, Michael C. (1977). The effect of the transcendental meditation technique on anxiety level. Journal of Clinical Psychology, 33 (4), 1076-1078.
Two weeks of twice-daily practice of the Transcendental Meditation (Transcendental meditation) technique was compared with 2 weeks of twice-daily practice of passive relaxation as a means of reduction of anxiety, as measured by the Trait scale of the State-Trait Anxiety Inventory. Thirty-three graduate and undergraduate students were assigned randomly to a relaxation group and a Transcendental meditation group. After a 2-week experimental interval, the relaxation Ss began Transcendental meditation. As hypothesized, in the comparison between the relaxation and meditation Ss, as well as between conditions of the relaxation-meditation group, Transcendental meditation was significantly more effective in reducing anxiety level. Thus, the anxiety-reducing effect of the practice of Transcendental meditation cannot be attributed merely to sitting quietly twice daily, although additional research must determine the extent to which S expectations for change contributed to this effect.
Gatchel, Robert J.; Hatch, John P.; Watson, Paur J.; Smith, Dan; Gaas, Elizabeth (1977). Comparative effectiveness of voluntary heart rate control and muscular relaxation as active coping skills for reducing speech anxiety. Journal of Consulting and Clinical Psychology, 1093-1100.
The present study investigated whether heart rate biofeedback training is as effective as muscular relaxation training in reducing speech anxiety. Also, a combined muscle relaxation/biofeedback treatment group was included in this study. All treatment groups were compared to a false-biofeedback placebo control group. This investigation also assessed whether the degree of autonomic nervous system awareness significantly influences the treatment process. Ten speech-anxious subjects, half of whom scored high on the Autonomic Perception Questionnaire (APQ) and half of whom scored low on the APQ, were assigned to each group. Results indicated that all four groups demonstrated a decrease in self-reported anxiety. Assessment of physiological measures (heart rate and skin conductance) indicated that the three treatment groups were associated with less physiological responding during the posttreatment assessment of anxiety, relative to the false-biofeedback group. Moreover, among the three treatment groups, the combined relaxation/biofeedback group demonstrated the lowest level of responding. The degree of autonomic awareness was not found to be related to therapeutic improvement
Lick, John R.; Heffler, David (1977). Relaxation training and attention placebo in the treatment of severe insomnia. Journal of Consulting and Clinical Psychology, 45 (2), 153-161.
This study compared the effectiveness of progressive relaxation training with and without a supplementary relaxation recording, which the subjects played at home, and an attention placebo manipulation in the modification of severe insomnia in adult volunteers. The results indicated that the relaxation training procedures were significantly more effective than placebo and no-treatment controls in modifying several parameters of sleeping behavior, in reducing consumption of sleep-inducing medication, and in influencing a self-report anxiety measure. The supplementary relaxation tape did not increase the effectiveness of relaxation training conducted in the clinic, and there was no difference in the efficacy of the placebo and no-treatment conditions. Physiological data gathered during the last treatment session indicated few significant correlations between reductions in arousal associated with relaxation training and treatment outcome.
1976
Gatchel, Robert J.; Proctor, Janet D. (1976). Effectiveness of voluntary heart rate control in reducing speech anxiety. Journal of Consulting and Clinical Psychology, 381-389.
The effects of learned control of heart rate deceleration and therapeutic expectancy set in reducing speech anxiety were investigated in a factorial design employing 36 speech-anxious subjects. Heart rate control training and no heart rate control training were each paired with high-therapeutic-expectancy and neutral- expectancy instructions, in order to assess the individual and combined effects of the two factors. Results demonstrated that learning to control heart rate deceleration led to a significant reduction in self-report, physiological (heart rate and skin conductance level), and overt signs of anxiety, relative to the no-heart-rate control condition. High- therapeutic-expectancy instructions also contributed to a reduction in self-reported anxiety. These results demonstrate that learned heart rate control is an effective therapeutic technique for reducing anxiety.
Hemme, Robert; Boor, Myron (1976). Role of expectancy set in the systematic desensitization of speech anxiety: An extension of prior research. Journal of Clinical Psychology, 32 (2), 398-404.
SUMMARY
The influence of expectancy set with regard to therapy outcome on the effectiveness of systematic desensitization (SD) for reducing public speaking anxiety was investigated. The 7 Ss given a high expectancy set for favorable therapy outcome were informed about psychological research that indicates that SD is effective to reduce public speaking fears. SD was administered with the standard instructions to the 11 Ss given a neutral expectancy set. This expectancy manipulation did not require deception and perhaps could be used with actual SD therapy clients. As in previous research by Woy and Efran, the expectancy set manipulation significantly modified Ss' self-report of subjective perceptions of anxiety from pretratment to posttreatment speeches, but did not affect overt behavioral or physiological indices of anxiety. Since subjective perceptions of anxiety responses are psychologically significant behaviors, these data suggest the importance of conveying a high expectation of improvement to SD and perhaps also to other types of therapy clients. SD sessions administered to small groups of clients on consecutive days, as in this study, appeared to be as effective to reduce speech anxiety as SD sessions administered to each client individually at 1-week intervals, as in the Woy and Efran study" (pp. 403-404).
Lawlor, E. D. (1976). Hypnotic intervention with 'school phobic' children. International Journal of Clinical and Experimental Hypnosis, 24, 74-86.
Case studies are used to illustrate the use of hypnosis in working with children who exhibit symptoms of "school phobia." Responses obtained during and after hypnosis are utilized to uncover underlying conflicts and fears.
The literature (Ansbacher, 1956; Friedman, 1959; Johnson, 1957; Johnson, Falstein, Szurek, & Svendsen, 1941: Kessler, 1966; Waldfogel & Gardner, 1961) confirms the findings that a child through his symptoms has fears which he is unable to bring to consciousness and talk about. Typical are fears of abandonment by parents; fears of disaster befalling parents, especially the mother; fears based on destructive wishes toward siblings due to severe rivalry for the mother's love and attention; fears that exhibiting angry feelings will be punished by the parents; and fears of annihilation and starvation.
Hypnosis has aided in restoring these children to a school environment more quickly than more traditional methods. One case is reported with excerpts from a session. The perceptions uncovered through the use of hypnosis can be utilized with children in various school settings
1973
McReynolds, William T.; Barnes, AllanR.; Brooks, Samuel; Rehagen, Nicholas (1973). The role of attention-placebo influences in the efficacy of systematic desensitization. Journal of Consulting and Clinical Psychology, 41 (1), 86-92.
Systematic desensitization was compared with two attention- placebo control treatments - one taken from Paul and one currently devised as an elaborate, highly impressive "therapeutic" experience - and no treatment. It was hypothesized that (a) fear reductions following desensitization would be no greater than those associated with an equally compelling placebo treatment and (b) fear and control measure changes following the previously used attention-placebo treatment would be less than those following desensitization and the present placebo control manipulations. Both hypotheses were supported, although support for the first was more consistent than for the second.
1971
McAmmond, D. M.; Davidson, P. O.; Kovitz, D. M. (1971). A comparison of the effects of hypnosis and relaxation training on stress reactions in a dental situation. American Journal of Clinical Hypnosis, 13, 233-242.
NOTES 1:
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 of10 in the control group and only 1 of the relaxation group returned for care.
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
1970
Davis, Daniel; McLemore, Clinton W.; London
NOTES
Summary: a measure of visual imagery ability was obtained for 33 females who and participated in desensitization therapy for snake phobia. Visual imagery was positively related to pretherapy performance (closeness of approach to a live snake), but not to improvement. On the basis of these results and the results of two other studies, it was hypothesized that the fear of good imagers tends to be based on imagination while that of poor imagers tends to be based on sensory experience.
Most psychologists now recognize behavior therapy as effective in alleviating a wide variety of fears, but the nature of the processes underlying the various methods remains an open issue. Imagery has been of particular interest as a possible common denominator among various desensitization techniques. Lazarus (1961), for example, asserts that a "prerequisite for effective application of desensitization is the ability to conjure up reasonably vivid images," and Wolpe (1961) claims, "it is essential for visualizing to be at least moderately clear." London suggests that theoretically opposed treatments such as reciprocal inhibition (Wolpe, 1958) and implosion (Stampfl and Levis, 1967) may both be facilitated by repeated imagery which "produces a discrimination set such that the patient learns to distinguish between the imaginative, cognitive, affective aspects of experience, and the sensory and overt muscular aspects" (1964, p. 130). However, no systematic studies linking visual imagery to desensitization have been reported. This study examined the relationship between visual imagery and success in desensitization therapy.
1965
Davison, Gerald C. (1965, June). Anxiety under total curarization: Implications for the role of muscular relaxation in the desensitization of neurotic fears. [Paper] Presented at the annual meeting of the Western Psychological Association, Honolulu
NOTES 1:
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.
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.
I re-interpreted these studies in the light of the over-riding importance of exteroceptive stimulation, stressing that the animals in the curare learning experiments were likewise deprived of proprioceptive feedback and yet were hardly non- anxious: the important difference was that the animals in the conditioning experiments were stimulated frequently from the environment while curarized, this stimulation maintaining an alert, often anxious state. Finally, two hypotheses were put forward as to why training in muscular relaxation does, in fact, inhibit anxiety: the one suggested that relaxing one's muscles generates strong positive affect states, which in turn inhibit anxiety; the other hypothesis called attention to the fact that the states of muscular relaxation under curare versus under self-induced relaxation differ in the important respect that only with self-induced relaxation is there a reduction in efferent activity--perhaps this elimination of efferents, rather than afferents, inhibits anxiety.
1955
Jacoby, James D. (1955). A statistical report on the practical use of hypnosis in dentistry. Journal of Clinical and Experimental Hypnosis, 3 (2), 117-119.
NOTES 1:
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).
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).
Food allergies or food intolerances affect nearly everyone at some point. People often have an unpleasant reaction to something they ate and wonder if they have a food allergy.
ReplyDeleteIt is critical to clarify the diagnosis and to make certain that no treatable physical conditions have been ignored. The moment this has been clarified, ideal generalised anxiety disorder treatment can be determined.
ReplyDeleteAnxiety Treatments Offered by Sydney Clinical Psychologist Centre