Institute of Clinical Hypnotherapy-Psychotherapy: FEARS & PHOBIAS - Treating phobias with Clinical Hypno-psychotherapy

A phobia is group of anxiety-related disorders, in which an excessive fear is perceived in the absent of real danger. The DSM-IV (Diagnostic and statistical manual of Mental Disorders 4th edition) divides phobic disorders into three categories - simple phobias, social phobias and agoraphobia. In simple phobias the anxiety is provoked by a specific event, subject or situation, whereas social phobias are evoked by a social situation. There are many kinds of social phobias, but a common theme is uncontrollable fear or incompetence in social contexts. Agoraphobia is fear of being alone or in a public place when escape might be difficult or impossible. Essentially, it is a fear from having a panic attack.

A phobia is any persistent fear of a specific stimulus object or situation. Phobia is from the Greek meaning to fear or dread. It is more than a simple fear, or being afraid. It is to be totally terrified of the stimulus. The subconscious mind can often set up a kind of false instinct, whereby any sign of the stimulus, or even something resembling it, or associated with it, may cause a phobic reaction, and then the body's flight or fight response will kick in and the individual may begin to panic - a panic attack.

A client can present with a fear/phobia, of flying for example. However, the skilled therapist, on exploring this fear/phobia with the client, may find the fear/phobia is actually about being enclosed, or locked in. Perhaps it might be a fear/phobia of dying, not being able to breath on an aircraft, or something else connected with the aircraft or leaving their own area/country etc, but not actually the flying itself.

Hypnotherapy makes a person who suffers from fear, depression, anxiety or any illnesses, relax by bringing him to a trance-like state. This therapy is proven to be very successful in a lot of cases. The person with a phobia will need to be helped to find and review the trigger situation, to see it with an adult maturity and understanding, and to then see the cause in a different way and with a different and better understanding. The mind can be reprogrammed to see things in a different way and to accept situations as normal that would previously have been viewed as threatening.

Hypnosis helps by;

Desensitising the client to the stimulus i.e. spiders, the flying experience.
Learning a new, more relaxed response and helping you to become much calmer in situations where you are likely to encounter the stimulus.
Uncovering the source of the phobia although this is not generally necessary.
Teaching you how to feel more in control so you can be free of your fears and start to go where you want and do what you want.
NLP techniques are also particularly useful with phobias and fears.

A phobia is a persistent irrational fear of and wish to avoid a specific object, activity, or situation. The fear is irrational in the sense that it is out of proportion to the real danger and also that the person himself recognises that it is exaggerated. The person finds it difficult to control his fear and often tries to avoid the feared object or situation if he possibly can. The objects that provoked the fear may be living creatures such as a dog, snake, or spider, or a natural phenomenon such as darkness or thunder. Fear-provoking situations include high places, crowds, and open spaces. Phobic clients feel anxious not only in the presence of the object or situation but also when thinking about them (anticipatory anxiety).

When repressed fear is transferred to a particular object or situation, the resulting fear is called a phobia. It has been estimated that one out of every ten persons is beset by a special fear of one kind or another. The original word for phobias comes from the Greek word 'phobio' meaning fear.

The distinction between normal fear, anxiety and the phobias may be briefly stated thus. A normal fear is around when some external object or situation threatens the existence of the individual. The emotion of fear on these occasions is perfectly natural, as by its awareness preparation is made for either flight or defence; thereby the individual preserves his own life and that of the race.

Anxiety, and its various expressions, is aroused when there is no external object or situation to justify any kind of negative feeling or disturbance. It is rather a persistent subjective sense of emotional discomfort and apprehension.

A phobia, on the other hand, has its origination and stimulating cause in the environment but the object or person which is the cause of the fear to the neurotic is usually treated by the normal as quite harmless or of no consequence.

A classic case study by Sigmund Freud in 1909 on five year old Hans will help to illustrate the above. Hans would not go out into the street because of his intense fear that a horse might bite him. According to Freud this fear of horses had been converted from a fear that his father would cut off his penis (castration anxiety) caused by a combination of factors: feelings of hostility and jealousy towards his father, who the boy wished would die so that he could marry his mother (the Oedipus complex) together with threats made when he was found masturbating, and the sight of a penisless girl playmate. This fear and consequently the fear of horses, was later overcome when Hans was encouraged to imagine his father robbing him of his little penis and replacing it with a bigger one (the Oedipus complex is, in psychoanalytic theory, supposed to be largely unconscious and to exist in one form or another in every family. It is the unresolved desire of a child for sexual gratification through the parent of the opposite sex. The female equivalent is known as the Electra complex).

Treatment of phobias for hypnotherapists involves finding the cause of the problems and resolving the fears and using future pacing, i.e. asking the client to imagine themselves face to face with their fears etc.

50% of your work as a therapist will probably involve clients with phobias and this will be explained more fully in the analytical section of this course.

Phobias of Ideas:

Phobias of ideas are very common and many people are haunted with the fear that they are going insane. Such phobias are usually displaced expression of guilty feelings, thoughts and desires, which surge within the unconscious mind but become transformed by the censorship of the conscious mind. This mental mechanism follows the well known mental law that a person who has no hesitation in robbing another man is suspicious that every other man is bent on the same unethical conduct. His own attitude to life colours his interpretation of another man's attitude.

Phobias of the body are very common among clients. Though the client is assured by his doctor that there is nothing organically wrong with him, he still persists in believing that he has a cancerous growth, heart trouble, stomach trouble, etc. In many cases the subconscious mind creates the symptoms in response to the fear, so that these "conversion" pains are looked upon as infallible indications that something very serious is the matter.

Compulsions:

Akin to and arising from obsessive fears we have compulsions. The difference between an obsession and a compulsion is that an obsession is felt while a compulsion is acted out.

In an obsession the fear is private and inward, in a compulsion the fear (or desire that is taboo) is given a symbol that arouses the feeling of fear, in a compulsion the individual creates his own symbol.

Compulsion like obsessions cover every conceivable subject, object or situation. The travelling compulsive must sit in a certain seat in a certain way in a certain carriage. The fadistic compulsive must eat certain food in a certain way at a certain time. The erotic compulsive must have sex in a certain way according to an established ritual.

The repetitive compulsive performs a particular act over an over again. He must touch every lamp-post on his way home, count his money over and over again, etc. Any failure in the established order his unconscious mind has built up throws him into panic. The sadistic compulsive must hurt someone in a certain way, and the methodical compulsive must do his homework or his office work by a certain routine from which there is no deviation.

Both the obsessions and the compulsions are substitutes for something desired, or imagined, that does not harmonise with the personality ego.

The desired thing or hurtful thought has been repressed into the unconscious mind, but because it is so strongly desired or has not been adequately dealt with by the conscious mind, it keeps fermenting in the depth of the psyche and endeavouring to find fulfilment and expression in these phobias.

The fear associated with every phobia is really the condemnation by the super-ego or conscience of the ego for harbouring such unethical wishes. The fear may also be a fear of detection.

Phobias are big obstacles in every person’s lives. It is important that this disorder be treated so that those with phobias can go on living their lives and treating their past experiences with this condition like a bad dream. Science has given an answer or cure for this condition – hypnotherapy, and it has some unique benefits compared to other procedures like:

1. A quick feeling of relief – because hypnotherapy is based on neuro linguistic programming, a patient can be assured of a quick feeling of relief. The process of hypnosis brings immediate effects that the patient can feel even after the first session.

2. Hypnotherapy also helps patients to bring out their real problem aside from what they are showing outside. This makes the procedure different from others. Other methods of treating phobia focuses on the treatment of the symptoms that the patient shows them. With hypnotherapy, the treatment starts from deep inside the mind of the patient, draws out the real problem and eradicates it.

3. Hypnotherapy also cures almost every phobia in the book, including social interactions, animals, places, insects, death and height. This means, whatever phobia the patient is suffering from, hypnotherapy is the answer.

4. Hypnotherapy makes use of a procedure to eradicate the feeling of fear from a person effectively. And once this fear has been overcome by the patient, they are unlikely to feel this profound fear again.

Cognitive Behavioural Therapy for Phobias

Behavioural therapy for phobia is based extensively on the work of Wolpe (1958;1961) on systematic de-sensitisation. He proposed that a phobia was a learned maladaptive response which could be unlearned.

The technique of ‘graded exposure’ obliges the subject to come in contact with the objects or situations he fears, so he cannot escape, and so learns that, as nothing bad happens him, that the object is something he need no longer fear; e.g. the common idea among many people that if you have a bad experience in a car/with a dog, you need to start driving again/patting dogs as soon as possible afterward.

With the phobic person, the process of exposure is done in a much more systemised way, via a hierarchy of difficulty being constructed by the client and therapist, and the client is then exposed to the phobic situation or object, working his way up the hierarchy.

Before treatment is started, a thorough assessment is undertaken, featuring such aspects of the client’s experience as:

Severity:

Ø How much does it affect the client in everyday life?

Ø What situations does he avoid?

Ø How would his life be better if he were no longer phobic

Maintaining factors:

Ø What beliefs does the client have which stop him getting better?

Ø Does he have other symptoms such as anxiety and depression?

Ø Secondary gains – what does the phobia allow him to do or not do, that he would have to give up if he were cured?

Existing Coping Skills:

Ø What does he do now?

Ø On whom does he rely?

Ø Any ‘false friends’ e.g. alcohol, tobacco etc?

EXAMPLE OF A PHOBIA – FEAR OF FLYING
A fear of flying is a fear of being on an airplane (aeroplane), or other flying vehicle, such as a helicopter, while in flight. It is also sometimes referred to as aerophobia, aviatophobia, aviophobia or pteromechanophobia.

Overview

Fear of flying may be a distinct phobia in itself, or it may be an indirect combination of one or more other phobias related to flying, such as claustrophobia (a fear of enclosed spaces) or acrophobia (a fear of heights). It may have other causes as well, such as agoraphobia (especially the type that has to do with fear of open spaces). It is a symptom rather than a disease, and different causes may bring it about in different individuals.
The fear receives more attention than most other phobias because air travel is often difficult for people to avoid—especially in professional contexts—and because the fear is widespread, affecting a significant minority of the population. A fear of flying may prevent a person from going on vacations or visiting family and friends, and it can cripple the career of a businessperson by preventing them from traveling on work-related business.
Commercial air travel continues to cause a significant proportion of the public and some members of the aircrewto feel anxiety. When this anxiety reaches a level that significantly interferes with a person's ability to travel by air, it becomes a fear of flying.

Symptoms

A fear of flying is a level of anxiety so great that it prevents a person from travelling by air, or causes great distress to a person when he or she is compelled to travel by air. The most extreme manifestations can include panic attacks or vomiting at the mere sight or mention of an aircraft or air travel.

Causes

The fear of flying may be created by various other phobias and fears:

a fear of closed in spaces (claustrophobia), such as that of an aircraft cabin
a fear of heights (acrophobia)
a feeling of not being in control
fear of vomiting, motion sickness can make the person vomit, thus making flying hard.
fear of having panic attacks in certain places, where escape would be difficult and/or embarrassing (agoraphobia)
fear of hijacking or terrorism
fear of turbulence
fear of flying over water or night flying
the result of hormone release during pregnancy
the result of difficulty with the regulation of emotion when not in control due to developmental issues
fear of crashing resulting in injury or death

A previous traumatizing experience with air travel or somehow connected to flying can also trigger a fear of flying. For example, the experience of flying to a meeting only to be told that one has been fired might be traumatic enough to subsequently create an association between any air travel and bad or unpleasant events.
Some suggest that the media are a major factor behind fear of flying, and claim that the media sensationalize airline crashes (and the high casualty rate per incident), in comparison to the perceived scant attention given the massive number of isolated automobile crashes. As the total number of flights in the world rises, the absolute number of crashes rises as well, even though the overall safety of air travel continues to improve. If only the crashes are reported by the media (with no reference to the number of flights that do not end in a crash), the overall (and incorrect) impression created may be that air travel is becoming increasingly dangerous, which is untrue. In a way, the media coverage is forcing confirmation bias on viewers.
Misunderstandings of the principles of aviation can fuel an unjustified fear of flying. For example, many people incorrectly believe that the engines of a jet airliner support it in the air, and from this false premise they also incorrectly reason that a failure of the engines will cause the aircraft to plummet to earth. In reality, all aircraft glide naturally, and the engines serve only to maintain altitude during the flight. A big cause of fear of flying is that it’s difficult to imagine how planes stay in the air, thus a person's understanding of the science behind flying can affect the person's fear about flying.

Treatment

Non-pharmacologic

In some cases, educating people with a fear of flying about the realities of air travel can considerably diminish concern about physical safety. Learning how aircraft fly, how airliners are flown in practice, and other aspects of aviation can assist people with a fear of flying in overcoming its irrational nature. Many people have overcome their fear of flying by learning to fly or skydive, and effectively removing their fear of the unknown. Some people with a fear of flying educate themselves; others attend courses (for people with the phobia or for people interested in aviation) to achieve the same result. Some airline and travel companies run courses to help people get over the fear of flying.
Education plays a very important role in overcoming the fear of flying. Understanding what a certain sound is or that an encounter with turbulence will not destroy the aircraft is beneficial to easing the fear of the unknown. Nevertheless, when airborne and experiencing turbulence, the person can be terrified despite having every reason to know logically that the plane is not in danger. In such cases, therapy — in addition to education — is needed to gain relief.
Behavioral therapies such as systematic desensitization developed by Joseph Wolpe and cognitive behavior therapy developed by Aaron Beck rest on the theory that an initial sensitizing event (ISE) has created the phobia. The gradually increased exposure needed for systematic desensitization is difficult to produce in actual flight. Desensitization using virtual flight has been disappointing. Clients report that simulated flight using computer-generated images does not desensitized them to risk because throughout the virtual flight they were aware they were in an office. Research shows Virtual Reality Exposure Therapy (VRET) to be no more effective than sitting on a parked airplane.
Cognitive therapy may be useful when there is no history of panic. But since in-flight panic develops rapidly, often through processes which the person has no awareness of, conscious measures may neither connect with - nor match the speed of - the unconscious processes that cause panic.
Hypnotherapy generally involves regression to the ISE, uncovering the event, the emotions around the event, and helping the client understand the source of their fear. It is sometimes the case that the ISE has nothing to do with flying at all.
Neurological research by Allan Schore and others using EEG-fMRI neuroimaging suggests that though it may first be manifest following a turbulent flight, fear of flying is not the result of a sensitizing event. The underlying problem is inadequate development of ability to regulate emotion when facing uncertainty, except through feeling in control or able to escape. According to Schore, the ability to adequately regulate emotion fails to develop when relationship with caregivers is not characterized by attunement and empathy. Chronic stress and emotional dysregulation during the first two years of life inhibits development of the right prefrontal orbito cortex, and hinders the integration of the emotional control system. This renders the right prefrontal orbito cortex incapable of carrying out its executive role in the regulation of emotion.
When emotional regulation is not adequately built inside, anxiety develops when not personally in control or unable to physically escape. Since flight affords the passenger neither control nor physical escape, anxious fliers may attempt to escape psychologically by dissociating from the flight and focusing awareness elsewhere. Turbulence, because it is physically intrusive, defeats this strategy. When awareness of the flight is restored, being far from the ground with neither control nor escape may throw the person into panic. A specialized treatment to provide control of emotion during flight was developed by therapist-airline captain Tom Bunn based on Schore's research, attachment theory and object relations theory.

Pharmacologic

Fear of flying may be treated by anti-anxiety medications such as benzodiazepines or other relaxant/depressant drugs. A double blind, controlled, crossover clinical study found that alprazolam (Zanax) "acutely reduces self-reported anxiety, tension, desire to leave, and symptom number and score in flight phobics to a clinically and statistically significant degree, although these measures were still well above levels experienced by non-anxious controls." However users of alprazolam that then were switched to placebo had higher anxiety and sharply increased incidence of in-flight panic. This study reveals that alternatives to drug therapy such as exposure therapy are incompatible. A patient who is treated with benzodiazapienes one time should be treated similarly the next.
Typical pharmacologic therapy is 0.5 or 1.0 mg of alprazolam about an hour before every flight, with an additional 0.5-1.0 mg if anxiety remains high during the flight. The alternative is to advise patients not to take medication, but encourage them to fly without it, instructing them in the principles of self-exposure.

The following compilation of Research into Hypnotherapeutic Interventions for Fears & 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

RESEARCH

Phobia

2002

Ginandes, Carol (2002). Extended, strategic therapy for recalcitrant mind/body healing: An integrative model.. American Journal of Clinical Hypnosis, 45 (2), 91-102.

The development of the power therapies, behavioral medicine, and short term interventions have reported such success even with trauma cases that it is relevant to question the justification for lengthy psychotherapy. Yet some patients with complex mind/body conditions impervious to medical treatment/hypnosis may require extended, multi-modal, integrative therapy. This paper details a single complex case of paruresis as a prototype for illustrating a holographic treatment model for recalcitrant conditions: Component features of the proposed model presented include: 1) the sequential utilization of hypnobehavioral and analytic approaches; 2) uncovering work providing access to the somatic ego state associated with the illness condition; 3) the extended treatment time frame required for deep psycho-physiological change; and 4) the stages of counter-transference expectably evoked by such patients (e.g. urgency, exuberant optimism, frustration, discouragement), and the transformation of such reactions to achieve maximum therapeutic efficacy.

NOTES 1:
Paruresis is a social phobia involving urinary retention and "thought to affect some 17 million or 7% of the American population" (p. 92). Also known as "bashful bladder."

1997

Van Dyck, R.; Spinhoven, P. (1997). Depersonalization and derealization during panic and hypnosis in low and highly hypnotizable agoraphobics. International Journal of Clinical and Experimental Hypnosis, 45 (1), 41-54.

The primary aim of the present study was to investigate the association between spontaneous experiences of depersonalization or derealization (D-D) during panic states and hypnosis in low and highly hypnotizable phobic individuals. Secondarily, the association among level of hypnotizability, capacity for imaginative involvement, and severity of phobic complaints was also assessed. Sixty-four patients with panic disorder with agoraphobia according to the DSM-III-R (American Psychiatric Association, 1987) criteria participated in the study. Proneness to experience D-D during hypnosis was positively related to hypnotizability, but only for agoraphobic patients who had already experienced these perceptual distortions during panic episodes. Correlations of level of hypnotizability and capacity for imaginative involvement with severity of agoraphobic complaints were not significant. These findings suggest that hypnotizability may be a mediating variable between two different, although phenotypically similar, perceptual distortions experienced during panic states and hypnosis. Implications for both theory and clinical practice are discussed. -- Journal Abstract

1995

Holroyd, Jean (1995). Handbook of clinical hypnosis, by Judith W. Rhue, Steven Jay Lynn, & Irving Kirsch (Eds.) [Review]. International Journal of Clinical and Experimental Hypnosis, 43 (4), 401-403.

NOTES 1:
"This is a book for the thinking clinician" (p. 401). "The editors are to be congratulated for making this volume much more coherent than most edited books" (p. 402). "My impression is that the book is best suited for an intermediate or advanced course on hypnotherapy, or for people who are already using hypnosis in treatment. Although there is some material on the basics of hypnotic inductions and a few introductory sample scripts for inductions, a beginners'' course should probably use a different book, or this book could be accompanied by an inductions manual. ... I recommend it very highly" (p. 403).

1994

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.

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 #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's Web (White, 1980) to facilitate the imagery for future hypnotic work. In the following session systematic desensitization was accomplished using characters from the story of Charlotte's Web. During the third session the subject was age regressed to the first time she remembered seeing a spider. She recalled playing in the woods outside her family home on an island and seeing a large web stretched between two trees with a very large spider in the center of its web. She was then asked to remain at that place to look closely at that spider as it was most likely Charlotte or one of Charlotte's family. Upon closer investigation she saw not only Charlotte but "teeny-tiny babies." The event was reconstructed as a happy experience. The imagery provided by Charlotte's Web permitted the subject to fantasize her previous frightful experience and reframe spiders as cute little "teeny-tiny" babies with admirable human qualities.

Culbert, Timothy P.; Reany, Judson B.; Kohen, Daniel P. (1994). Cyberphysiologic strategies for children: The clinical hypnosis/biofeedback interface. International Journal of Clinical and Experimental Hypnosis, 42 (2), 97-117

This article presents an in-depth discussion of the integrated use of self-hypnosis and biofeedback in the treatment of pediatric biobehavioral disorders. The rationale for integrating these techniques and their similarities and differences are discussed. The concepts of children's imaginative abilities, mastery, and self-regulation are examined as they pertain to these therapeutic strategies. Three case studies are presented that illustrate the integrated use of self-hypnosis and biofeedback in the treatment of children with psychophysiologic disorders. The authors speculate on the specific aspects of these self-regulation or "cyberphysiologic" techniques that appear particularly relevant to positive therapeutic outcomes.

Stanton, Harry E. (1994). Self-hypnosis: One path to reduced test anxiety. Contemporary Hypnosis, 11, 14-18.

Describes a self-hypnosis technique and its efficacy in reducing test anxiety. Forty high school students were matched on sex and anxiety scores and randomly allocated to an experimental group (receiving two 50-minute sessions, a week apart, to learn the self-hypnosis technique), and a control group (receiving two 50-minute sessions focused on ways of reducing test anxiety). Students were retested after the two sessions, and 6 months later. Results showed a significant reduction in anxiety scores only for the hypnosis group, which was maintained at 6-month follow-up.

Wormnes, Bjorn (1994, October). Hypnosis in integrated treatment of dental fear. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, San Francisco.

Research reports from different countries estimate the proportion of adult dental phobic patients to be between 5% to 10%. It represents a large health problem. Helping patients to continue regular treatment by their local dentist and experience it as tolerable is the main treatment goal in our program. The main treatment method is a flexible and integrated exposure training. The psychotherapist works in cotherapy with the dentist. Using hypnosis in the dental chair is of great help, and patients are normally found to be very susceptible and easily hypnotized. Hypnosis helps the patient to experience increased tolerance of treatment and also to perform better than expected in the treatment situation.

1993

LaGrone, Randy G. (1993). Hypnobehavioral therapy to reduce gag and emesis with a 10-year-old pill swallower. American Journal of Clinical Hypnosis, 36, 132-136.

A 10-year-old child experienced severe nausea and psychogenic vomiting that resulted in refusal to take oral medication in pill form. The youngster was treated with hypnobehavioral therapy consisting of mental imagery, relaxation, direct suggestion, adaptive self-talk, self-monitoring, and self-reinforcement. The child's parents were instructed to reinforce approximations of successful pill swallowing while withdrawing attention for avoidance, whining, gagging, and vomiting. A one-year follow-up revealed successful pill swallowing without significant distress.

Distress.

1992

Somerville, Wayne R.; Jupp, James J. (1992). Experimental evaluation of a brief 'ideodynamic' hypnotherapy applied to phobias. Contemporary Hypnosis, 9, 85-96.

This study used a test-retest design to investigate the effectiveness of a brief 'ideodynamic' hypnotherapy which notionally located and reformulated memories in the treatment of simple phobia disorder. Subjects were 19 phobics randomly assigned to treatment (n = 10) and waiting control groups (n = 9). Rapid, significant, and sustained relief from phobic fear and avoidance was reported by 50% of treatment subjects. A number of symptoms and therapy process variables were correlated with treatment outcome. These included a negative association with hypnotizability and a positive association with hypnotic depth estimates. The ramifications of these and other associations are discussed and it is concluded that the 'ideodynamic approach' investigated may have contributed a therapeutic effect beyond the operation of treatment non-specific factors.

NOTES

Treatment consisted of: 1. Hypnotic induction. 2. Establishment of ideomotor signals described to clients as a means of communicating with the 'inner unconscious mind'. 3. Beyond the first therapy session, a review of work done in previous sessions. 4. Gaining signaled permission from clients to work on their problem and for the 'inner mind' to review relevant memories. 5. Location of the 'earliest critical event' by the 'inner mind'. 6. Review of the located memory by the 'inner mind'. 7. Establishing age at the occurrence of the 'critical' event. 8. Ideomotor signaling indicating suitability of a visual imagoic processing of the event.

If visual processing was chosen, the dissociated viewing procedure (step 9A) was used next, otherwise the ego-state procedure (step 9B) was employed.

The authors describe each treatment step in detail. Each subject received at least two sessions of therapy, or a maximum of three sessions if signaling indicated the presence of further unresolved memories after two sessions.

They present a case illustrating that the approach is possible with minimally hypnotizable subjects, in the apparent absence of imagoic experience, 'desensitization', catharsis, unpleasant affect, talking through or 'insight'.

"There was a positive correlation between changes in phobic fear and capacity for mental imagery which suggests that this may be one relevant variable in predicting response to memory reformulating therapy.

"There was a negative correlation between changes in fear and hypnotic responsiveness. So, successful therapeutic outcome was obviously not limited to highly hypnotizable subjects. Hypnotizability was assessed in a careful and standardized manner but testing was conducted 10 weeks following therapy. This meant that subjects had a substantial experience in hypnotherapy at assessment. Furthermore, at the time of assessment subjects were aware of the outcome of therapy and of the kinds of memories located during therapy. it has been suggested that an association between level of hypnotizedness achieved during treatment and outcome rather than an association between degree of hypnotizability possible during therapy and outcome, taps an hypnotic effect (Spiegel & Spiegel, 1978).

"All therapy sessions were of equal duration and, as the inductions were standardized, all subjects had an approximately equal opportunity to engage in memory reformulation. However, there were individual differences in the number of memories located and a strong significant association was found between reduced fear and the number of these critical memories that were dealt with. This result suggests that the therapeutic effect may have derived either from factors specific to the therapy cycle or from differing levels of motivation among subjects to undertake the necessary 'work'.

"Maximum discomfort experienced during session two of treatment was negatively correlated with relief from phobic fears. This relationship may again reflect the influence of unresolved problematic memories on subjects who had not achieved relief by that time. It is clearly consistent with relief not being associated with painful abreaction.

"The therapy permitted a pervading privacy through the options of non- imaginative processing of recalled material (which was used by a substantial minority of subjects) and conscious withholding of the content of memories from the therapist (which was employed to a large extent by all subjects). Their reports indicated that this 'privacy' was seen as attractive by both successfully and unsuccessfully treated subjects. Taken with other results mentioned above these process findings suggest that the treatment studied stood up quite well against other brief but highly stressful exposure treatments for phobia currently in use (e.g. Ost, 1989).

"Further research needs to address the complex question as to what are the necessary and sufficient features of this procedure in producing therapeutic change. Unsolicited comments by subjects about their experience during treatment suggested that some of them were surprised by the 'involuntary' nature of their ideomotor signaling while others said that signaling was under their voluntary control. Some expressed surprise at the nature of the memories that came to them 'suddenly' during therapy. Some memories were of traumatic childhood experiences that were unexpected and considered to have 'nothing to do with my phobia'" (pp 93-94).

Stanton, Harry E. (1992). Brief therapy and the diagnostic trance: Three case studies. Contemporary Hypnosis, 9, 130-135.

NOTES

He reviews very brief hypnotherapy, then writes, "A systematic way of encouraging people in the use of their inner resources to solve problems, the 'diagnostic trance', has been outlined by Havens and Walters (1989). People sit quietly, eyes closed, physically relaxed, concentrating upon the unpleasant sensations or feelings associated with their problem. By turning inward in order to focus upon these internal events, they tend to drift into a trance state.

"While mentally observing these unpleasant sensations, they describe, in a somewhat detached manner, the thoughts and images which are present in their minds. They make no effort to control these in any way, simply allowing associated memories to surface quite spontaneously. Usually they reveal a pattern of thinking, a series of images, or even a specific memory which is creating the problem. Sometimes these are in the form of visual images of previously forgotten incidents, usually of a traumatic nature. On other occasions thy may take the form of a voice repeating a particular negative statement.

"Once people have been able to identify the source or sources of their unpleasant feelings, they attempt to find a thought or image which is sufficiently powerful to remove or displace the negative material. On many occasions, people find that they have the inner resources needed to solve their problem but, until given the opportunity provided by the diagnostic trance, they were unaware that they possessed these resources. However, the diagnostic trance procedure appears to encourage the spontaneous emergence of creative solutions" (p. 131).

Of the 103 patients with whom he used the procedure, "approximately 70% reported that it had helped them resolve the specific problem for which they had sought therapeutic assistance. ... In addition to being effective, the diagnostic trance is enjoyable, even when used to process past experience of an unpleasant nature. In its simplicity lies its strength. Patients find it easy to learn and, once they have gained confidence in its value as a problem-solving tool, often teach it to family members and friends" (p. 134).

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).

Migaly, Peter, M. D. (1991). Hypnotic pain control and patient management in dentistry. Hypnos, 18 (3), 127-32.

NOTES

The value of brief psychological and hypnotic techniques in dentistry is discussed from the point of view of an anesthesiologist. The paper deals with three important areas in general and pediatric dentistry, namely the hypnotic pain control, the management of dental anxiety and phobia and the use of hypnosis as adjunct to chemoanesthesia. Two cases are also presented.

1990

Clark, Duncan B.; Agras, W. Stewart (1990). The assessment and treatment of performance anxiety in musicians. American Journal of Psychiatry, 148 (5), 598-605.

94 adults with a performance anxiety problem were recruited by mass media announcements and were seen in a university-based outpatient psychiatric clinic. Assessments were questionnaires for all 94 ss, diagnostic interview of 50 ss, and laboratory performance of 34 ss. Treatment conditions were 6 weeks of buspirone, 6 weeks of placebo, a five-session group cognitive-behavior therapy program (CBTP) with buspirone, or the CBTP with placebo. All Ss fulfilled criteria for Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) social phobia. Of the 15 full-time professional musicians, 10 had tried propranolol and 3 had stopped performing. Most Ss had substantial anxiety and heart rate increases during lab speech and musical performances. CBTP resulted in significant reductions in subjective anxiety, improved quality of musical performance, and improved performance confidence.

1989

Abelson, James L.; Curtis, George C. (1989). Cardiac and neuroendocrine responses to exposure therapy in height phobics: Desynchrony within the 'physiological response system'. Behaviour Research and Therapy, 27 (5), 561-567.

Monitored subjective, behavioral, cardiovascular and neuroendocrine responses in 2 men (aged 19 and 34 yrs) with height phobias over a full course of exposure therapy and at 6 and 8 month follow-up. Both Ss showed rising cortisol responses and stable, nonextinguishing norepinephrine responses to height exposure over the course of treatment, while improvement occurred in subjective and behavioral response systems. They had differing heart rate responses. Despite desynchrony among anxiety response systems and within the physiological system at treatment conclusion, Ss had successful outcomes with general measures of change (phobia rating scales, the Fear Survey Schedule, and the SCL-90) showing substantial improvement for both Ss. These outcomes were preserved at follow-up.

Owens, Mark E.; Bliss, Eugene L.; Koester, Peri; Jeppsen, E. Alan (1989). Phobias and hypnotizability: A reexamination. International Journal of Clinical and Experimental Hypnosis, 37 (3), 207-216.

25 phobic Ss were administered the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C) of Weitzenhoffer and E. R. Hilgard (1962). The mean SHSS:C score was 3.5 (S.D. = 2.6), which was lower than that obtained by comparison groups. The results are in direct opposition to previous results and the predictions of Frankel (1974; Frankel & M. T. Orne, 1976). Potential explanations for the discrepancy in results are discussed, including the possibility that previous studies used unrepresentative samples of phobics. It is suggested that hypnosis may sometimes play a role in the production of phobic symptoms but that other processes must be considered as well.

1986

LeBoeuf, Alan (1986). Relaxation-induced anxiety in an agoraphobic population. Perceptual and Motor Skills, 62, 910.

Two groups of 14 agoraphobic patients with anxiety attacks were randomly assigned to suggestion-imagery (like hypnosis) and progressive relaxation (with muscle tensing and release). The progressive relaxation group showed greater drop in subjective anxiety, but there was no different between groups with regard to heart rate. Following the experience, the suggestion-imagery group had more negative responses to : Did you experience anxiety? Did you ever fear losing control? Did you experience any strange sensations during the session? Was the session aversive?

1985

Domangue, Barbara B. (1985). Hypnotic regression and reframing in the treatment of insect phobias. American Journal of Psychotherapy, 39 (2), 206-214.

Presents the case histories of 2 women (aged 30 and 38 yrs) with insect phobias, who were treated with therapies that combined constructs and strategies from psychodynamic, cognitive, and behavioral approaches with hypnotic interventions. In one case, hypnotic regression to the original trauma resulted in reframing. In the other case, hypnotic regression was indirectly introduced through a childish story.

1984

Kelly, S. F. (1984). Measured hypnotic response and phobic behavior: A brief communication. International Journal of Clinical and Experimental Hypnosis, 32 (1), 1-5.

A prospective replication of Frankel and M. T. Orne's (1976) finding that phobic patients scored higher on measures of hypnotic response than did patients wishing to use hypnosis to control smoking was carried out. 112 patients with a variety of complaints were compared to 22 phobics. The latter scored significantly higher on hypnotizability.

Nugent, William R.; Carden, Nick A.; Montgomery, Daniel J. (1984). Utilizing the creative unconscious in the treatment of hypodermic phobias and sleep disturbance. American Journal of Clinical Hypnosis, 26 (3), 201-205.

An Ericksonian hypnotherapeutic procedure is designed to access and direct creative unconscious processes toward the creation and implementation of satisfactory solutions to recurrent problem behaviors. The use of the procedure is described in 3 cases. Two of the cases involve treatment of severe hypodermic needle phobias. The third case involves use of the procedure in treatment of a somnambulistic sleep disturbance. Possible curative forces tapped by the procedure, suggestions for its continued use, and suggestions for further investigation of the procedure are also discussed.

NOTES

The procedure involved: 1. Pretrance discussion of unconscious mental processes 2. Hypnosis, followed by "Now your unconscious mind can do what is necessary, in a manner fully meeting all your needs as a person, to insure that [desired therapeutic outcome], and as soon as your unconscious knows that you will [desired therapeutic outcome] it can signal by [appropriate ideomotor signal]" 3. Post-ratification.

Example: "'Now your unconscious mind can do what is necessary, in a manner fully meeting all your needs as a person, to insure that you remain comfortably awake and alert anytime you receive an injection in the future, and as soon as your unconscious knows you will remain comfortably awake and alert when receiving an injection it can signal by lifting your right hand into the air off the chair.' This suggestion was [their] communicative effort to access and direct unconscious processes to the creation and implementation of altered behavioral responses to injections. Three minutes after the suggestion, B's right hand lifted jerkily into the air. She was then awakened and experienced a complete amnesia for the trance period" (p. 203).

"[They] then carried out a procedure to ratify the therapeutic change. This process presumably further develops expectancy of change, confirms change at the unconscious level, and puts doubt into any conscious beliefs contrary to positive change. This step is standardly carried out as was done with B. [They] had B sit with her hands resting on the arms of the chair. [They] told her they would ask her unconscious mind a question that only it would know the answer to. It could answer 'yes' to the question by lifting her left hand, 'no' by lifting her right hand, and 'I don't know' or 'I don't want to answer' by lifting both hands. Then the question was asked, 'In the future, will B remain comfortably awake and alert anytime she receives an injection or a blood test?' After a few minutes her left hand jerked momentarily into the air. After some discussion about the ideomotor response and her trance experience they dismissed her with the prescription to 'await the surprising results'" (p. 203).

The authors cite as a source for their work two books: Erickson, Rossi, and Rossi, Hypnotic Realities, 1976, pp. 226-230; also Erickson & Rossi, Hypnotherapy, 1979.

1983

Baker, S. R; Boaz, D. (1983). The partial reformulation of a traumatic memory of a dental phobia during trance: A case study. International Journal of Clinical and Experimental Hypnosis, 31 (1), 14-18.

A dental patient undertook hypnosis for the modification of a dental phobia. While she was in trance, the disturbing memory was replaced by a nontraumatic memory. After 2 sessions, the dental phobia was significantly reduced.

Flatt, Jennifer R. (1983). What makes therapy work? Thoughts provoked by a case study. Australian Journal of Clinical and Experimental Hypnosis, 11 (2), 63-72.

The case described is offered as illustrating the doubt common to introspective therapists: what _did_ cure the patient? "Francesca's" presenting problem and the object of the short-term psychological intervention described here, was a fairly circumscribed set of fears related to enclosed spaces. The therapeutic approach adopted was primarily hypnobehavioural, with hypnotically-assisted systematic desensitization and "in vivo" exposure being the main components of the planned programme. However, at the client's suggestion, one hypnotic session with content planned by the therapist as age regression produced rather dramatic and unexpected results claimed by the patient to effect complete cure.

NOTES 1:
The therapist suggested that "her mind would take her back to a time that was important in understanding her fears and that she would be able to stay calm and relaxed while this past event was revealed to her" (p. 69. She subsequently imagined being in a cave, peaceful and calm. "On being roused from hypnosis, Francesca eagerly described her cave image. She was enthusiastic about the significance of this experience, claiming that it was evidence that in a _previous life_ she had died from being locked into a cave as some sort of punishment and that this pexperience made her fear of enclosed places rational and comprehensible to her" (p. 69).

John, Rodney; Hollander, Barbara; Perry, Campbell (1983). Hypnotizability and phobic behavior: Further supporting data. Journal of Abnormal Psychology, 92 (3), 390-392.

Twenty women who were phobic to snakes, spiders, or rats were individually evaluated for hypnotic susceptibility using the standard audiotaped version of the Harvard Group Scale of Hypnotic Susceptibility, Form A. Consistent with the findings of three earlier studies using the Hypnotic Induction Profile (HIP), 55% of the present sample was found to be highly responsive to hypnosis. An item analysis comparing item pass percentages for the phobic subjects with item difficulties obtained from a normative sample of 357 female college students indicated that the two samples were significantly correlated. The discrepancy between the findings of studies using standard measures of hypnotizability and studies using HIP is discussed.

1981

Epstein, S. J.; Deyoub, P. L. (1981). Hypnotherapy for fear of choking: Treatment implications of a case report. International Journal of Clinical and Experimental Hypnosis, 29 (2), 117-127.

An eclectic hypnotherapeutic approach consistent with Sacerdote's treatment model was utilized for overcoming the swallowing difficulty of an adult male. Traumatic onset followed an active fellatio experience. Cognitive restructuring preceded symptomatic improvement, and the client was nearly asymptomatic after 56 sessions. Further improvement was evidenced posttherapy on a 3-year follow-up study. The process of change is emphasized, highlighting the broader case management implications of this single case study. Clinical observations are supplemented with psychological test data, providing a richer framework for understanding client and therapy process.

Frutiger, A. Dewane (1981). Treatment of penetration phobia through the combined use of systematic desensitization and hypnosis: A case study. American Journal of Clinical Hypnosis, 23, 269-273.

Systematic desensitization and hypnosis were used in a client with long- standing penetration phobia. Glass test tubes were used in dilation exercises and masturbation instead of more expensive metal catheters. The client was able to have intercourse and adequate sexual adjustment.

Gustavson, John L.; Weight, David G. (1981). Hypnotherapy for a phobia of slugs. American Journal of Clinical Hypnosis, 23, 258-262.

Hypnotic procedures for treating phobias are reviewed. A case of a 21-year- old female with a long-standing phobia of slugs involved hypnotic techniques of dream elicitation, age regression, and directed imagery in therapy. The patient successfully overcame her fear of slugs as well as related problems.

O'Brien, Richard M.; Cooley, Lewis E.; Ciotti, Joseph; Henninger, Kathleen M. (1981). Augmentation of systematic desensitization of snake phobia through posthypnotic dream suggestion. American Journal of Clinical Hypnosis, 23, 231-238.

Nine snake phobics who had scored above eight on the SHSS (Form A) were given four desensitization sessions and five sessions in which a pleasant posthypnotic dream of the phobic object was suggested. These subjects were significantly superior to a desensitization-only control group on a behavioral avoidance test. Seven of the nine hypnosis subjects were able to touch a real snake. The two subjects who did not touch the snake reported dreams in which the snake was either absent or threatening. Although conclusions are limited by differential attention and susceptibility, the technique seems promising.

Scrignar, C. B. (1981). Rapid treatment of contamination phobia with hand-washing compulsion by flooding with hypnosis. American Journal of Clinical Hypnosis, 23, 252-257.

Two obsessive-compulsive patients with contamination phobias and hand-washing compulsions are presented. Psychoanalytic psychotherapy had resulted in little change. Behavior therapy techniques of thought-stopping, systematic desensitization, progressive muscle relaxation, cognitive restructuring and self-imposed response prevention were first used, resulting in some subjective improvement, but no change in the hand-washing rate. Hypnosis, emphasizing relaxation, positive suggestion and corrective information provided further temporary subjective improvement but little change in compulsive rituals. Hypnosis, combined with the behavioral technique of flooding, produced rapid improvement. The patients maintained improvement at seven years and two years. Flooding under hypnosis may afford obsessive-compulsive patients a rapid and economical therapeutic procedure

Spiegel, David; Frischholz, Edward J.; Maruffi, Brian; Spiegel, Herbert (1981). Hypnotic responsivity and the treatment of flying phobia. American Journal of Clinical Hypnosis, 23, 239-247.

Systematic follow-up data are reported for 178 consecutive flying phobia patients treated with a single 45-minute session involving hypnosis and a problem restructuring strategy. One hundred fifty-eight (89%) of the patients completed follow-up questionnaires between six months and ten and one half years after treatment. Results showed that hypnotizable patients were over two and one half times more likely to report some positive treatment impact than those who were found to be nonhypnotizable on the Hypnotic Induction Profile. In addition, the patients' previous experiences with psychotherapy were found to be significantly associated with treatment outcome. The clinical implications of these findings are discussed.

1980

Kelly, S. F. (1980). Hypnotizability and the inadvertent experience of pain: A brief communication. International Journal of Clinical and Experimental Hypnosis, 28 (3), 189-191.

A clinical case of dental phobia similar to that reported by Frankel (1974, 1975) is presented that suggests a relationship between high hypnotizability and the genesis of phobic behavior. Further, the experience of pain despite anesthesia is speculatively linked to hypnosis and the mechanism for the development of the phobia.

1978

Dyckman, John M.; Cowan, Philip A. (1978). Imaging vividness and the outcome of in vivo and imagined scene desensitization. Journal of Consulting and Clinical Psychology, 46 (5), 1155-1156.

This study reexamined the role of imaging vividness in desensitization success. Scores on the Betts Questionnaire on Mental Imagery were used to divide 48 snake-phobic subjects into high, medium, and low vivid groups, who were assigned to imagined scene or in vivo desensitization treatments. Imaging vividness was assessed at scheduled points during therapy. Significant decreases in behavioral and self-reported fear were observed after both treatments, though in vivo desensitization produced significantly greater fear reduction. In therapy imaging vividness scores were significantly correlated with therapeutic success and were superior to pretherapy ratings as predictors of outcome.

Slutsky, Jeffrey; Allen, George J. (1978). Influence of contextual cues on the efficacy of desensitization and a credible placebo in alleviating public speaking anxiety. Journal of Consulting and Clinical Psychology, 46 (1), 119-125.

This investigation was designed to determine the extent to which contextual cues mediated the effectiveness of systematic desensitization and a plausible placebo in alleviating public speaking anxiety. After participating in a public speaking situation that allowed the collection of self-report, physiological, and behavioral manifestations of anxiety, 67 subjects were randomly assigned to receive five sessions of either desensitization, "T scope" therapy, or no treatment. Each of these conditions was conducted in a context that either stressed the clinical relevance of the procedure or presented the procedure as a laboratory investigation of fear without therapeutic implications. Analysis of changes both between groups and within individuals indicated that desensitization reduced public speaking anxiety in both contexts, whereas the placebo was effective only in the therapeutic setting. The superiority of desensitization was most pronounced on the physiological variables. The results are interpreted as indicating support for a counterconditioning, rather than an expectancy, interpretation of desensitization.

Weerts, Theodore C.; Lang, Peter J. (1978). Psychophysiology of fear imagery: Differences between focal phobia and social performance anxiety. Journal of Consulting and Clinical Psychology, 46 (5), 1157-1159.

Spider phobics and speech anxious subjects imaged fear scenes with spider and public-speaking content and a series of standard scenes that were constructed to vary in degree of emotional arousal and movement. Heart rate, skin conductance, and ocular activity were recorded. Spider phobics rated all imagery contents as more vivid and reported more scene movement than speech anxious subjects. Both groups responded to their own fear scenes with higher ratings of emotion and a greater physiological response than to the other group's fear scenes. The arousal response of spider phobics to relevant fear scenes was greater than that of speech anxious subjects. The data suggest that the outcome of imagery-based therapies may be partly determined by type of fear.

1976

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.

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.

1975

Lick, John R. (1975). Expectancy, false galvanic skin response feedback, and systematic desensitization in the modification of phobic behavior. Journal of Consulting and Clinical Psychology, 43 (4), 557-567.

This study compared systematic desensitization and two pseudotherapy manipulations with and without false galvanic skin response feedback after every session suggesting improvement in the modification of intense snake and spider fear. The results indicated no consistent differences between the three treatment groups, although all treatments were significantly more effective than no treatment in modifying physiological, behavioral, and self-report measures of fear. A 4-month follow-up showed stability in fear reduction on self-report measures for the three treatment groups. Overall, the results of this experiment were interpreted as contradicting a traditional conditioning explanation of systematic desensitization. An alternate explanation for the operation of systematic desensitization emphasizing the motivational as opposed to conditioning aspects of the procedure is discussed.

1973

Tori, Christopher; Worell, Leonard (1973). Reduction of human avoidant behavior: A comparison of counterconditioning, expectancy, and cognitive information approaches. Journal of Consulting and Clinical Psychology, 41 (2), 269-278.

This study was designed to compare the fear-reducing efficacy of procedures based on three major theories that have been proposed to account for the success of systematic desensitization therapy: (a) cognitive information storage and retrieval, (b) cognitive expectancy, and (c) counterconditioning. Predictions were confirmed in that the outcome measures of the high-expectancy placebo group and the two cognitive-coping groups were significantly superior to those of the counterconditioning and no-treatment groups. Thus, this experiment supports the supposition that changes in human avoidant behavior may be attributed to demand and expectancy variables rather than the conditioning of "antagonistic responses" as has been previously suggested.

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

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 10 in the control group and only 1 of the relaxation group returned for care.

month follow-up indicated that all subjects in the hypnosis group returned for dental treatment and that 5 of 10 in the control group and only 1 of the relaxation group returned for care.

1970

Davis, Daniel; McLemore, Clinton W.; London, Perry (1970). The role of visual imagery in desensitization. Behaviour Research and Therapy, 8 (1), 11-13.

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.

Owens, Herbert E. (1970). Hypnosis and psychotherapy in dentistry: Five case histories. International Journal of Clinical and Experimental Hypnosis, 18, 181-193. (Abstracted in Current Contents, 2, 35, 21)

Used hypnosis to facilitate dental psychotherapy in resolving problems specific to the dental situation. Case histories illustrate the use of hypnosis in alleviating dentophobia and in the care and control of allergic responses. Formal induction procedures are not always necessary in achieving the desired result. Through the appropriate use of hypnosis, observable benefits can accrue to some dental patients in their ability to approach the dental situation and receive proper care. (Spanish & German summaries) (PsycINFO Database Record (c) 2003 APA, all rights reserved)

1969

Marcia, James E.; Rubin, Barry M. (1969). Systematic desensitization: Expectancy change or counterconditioning?. Journal of Abnormal Psychology, 74 (3), 382-387.

Forty-four snake and spider phobic Ss, selected from a large pool of undergraduates were exposed to either (a) a form of systematic desensitization treatment, (b) a technique, called T-scope therapy, which embodies most of the expectancy-manipulating features of desensitization, but does not contain the technical elements of the procedure (i.e., relaxation, visualization, and the construction of an anxiety hierarchy), (c) T-scope therapy, presented as an "incomplete" and probably ineffective form of treatment, or (d) no treatment. There were no significant differences (on self-rating, runway, or interview measures) between the effects of the systematic desensitization procedure and T-scope therapy, although Ss receiving either of these treatments improved significantly more than those who received no treatment or T-scope therapy administered under the "low-expectancy" condition.

1969

Marmer, Milton J. (1969). Unusual applications of hypnosis in anesthesiology. International Journal of Clinical and Experimental Hypnosis, 17 (4), 199-208.

Describes 6 cases which illustrate the successful application and use of hypnosis in treating malignant anxiety, preparing "patient substitution" for surgery, maintaining a nasogastric tube, treating narcotic addiction and aiding in surgical diagnosis, caring for a patient with intense claustrophobia, and anesthetizing a former narcotic addict for surgery. (Spanish & German summaries) (PsycINFO Database Record (c) 2002 APA, all rights reserved

1967

Schubot, Errol David (1967). The influence of hypnotic and muscular relaxation in systematic desensitization of phobias (Dissertation). Dissertation Abstracts, 27 (n10-B), 3681-3682.

"15 snake phobic subjects had desensitization treatment and 15 matched subjects had desensitization treatment with a hypnotic and muscular relaxation induction. Rate of moving through the fear hierarchy was based on three variables fear report, report of body tension, and time of signaling anxiety. Analysis of results took into consideration initial approach (to snake) level of subjects. Both treatments were effective. However, hypnotic relaxation was significantly important in desensitization for the most phobic subjects (those who couldn't approach closer than 5 feet, initially) though not for less fearful subjects. In fact, the most fearful subjects did not show improved approach behavior if they did not get the hypnosis relaxation treatment, though bodily tension and fear were reported as less while working on early items in the hierarchy. The Waking group, compared to the Relaxation hypnosis group, manifested significantly less improvement in approach and slower progress in desensitization. Hypnotizability was significantly correlated with improvement for the Relaxation subjects, as was vividness of imagery. In summary, hypnosis (a relaxation induction) facilitated desensitization treatment of highly anxiety snake-phobic subjects with the hypnotic relaxation induction, treatment outcome was related both to hypnotizability and to imagery vividness" (p. 3681- 3682).

1966

Schneck, Jerome M. (1966). Hypnoanalytic elucidation of a childhood germ phobia. International Journal of Clinical and Experimental Hypnosis, 14, 305-307.

A PATIENT IN HYPNOANALYSIS WAS ABLE TO BECOME AWARE OF THE RELATIONSHIP BETWEEN HER CHILDHOOD GERM PHOBIA AND HER EARLIER FEAR AND FANTASY OF PREGNANCY. THIS REPORT TOUCHES ON THE ROLE OF HYPNOSIS IN FACILITATING THE CONNECTION OF ISOLATED MEMORIES. (SPANISH + FRENCH SUMMARIES) (PsycINFO Database Record (c) 2002 APA, all rights reserved)

1961

Levendula, Dezso (1961). Two case presentations: Treatment of central pain with reconstruction of the body-image -- hypnoanalysis of a travel phobia. International Journal of Clinical and Experimental Hypnosis, 9, 283-289.

NOTES

Uses analogy of phantom limb (hallucinated pain which is a central pain) with a multiple sclerosis patient who had ''excruciating'' pain between her thighs despite paralysis from waist down due to multiple sclerosis. She valued her sex life though she couldn''t feel sexual response, and felt that she ''didn''t have any legs'' and her husband ''had to carry her.''

In giving her history the patient noted an increasing numbness and weakness in her legs five years earlier. At that time she also entered menopause and developed severe vaginitis. She became depressed when she became increasingly unable control her excretory functions. As the pain in the genital region increased, her ability to feel pleasant vaginal sensations diminished. Ultimately the pain was continually present.

The therapist attributed her problem to a faulty body image because she "denied the existence of her legs which were actually physically present, although, she could neither feel, nor see, nor move them" (p. 285). Secondly, it was most necessary for her to hold on to the myth [sic], that her vagina existed, because it made her feel wanted and needed by her husband. She was unconsciously afraid that by giving up her vagina she would lose the most important bond between herself and her husband" (p. 285).

The therapist speculated that "the pain, which was the last sensation perceived before the total sensory loss occurred, was fixated centrally. This ''pain-image'' served to maintain the pretense, unconsciously of course, that there was still feeling in the vagina even though it was only pain and not pleasure. The pain permitted her to avoid facing reality, just as in the case of an amputee who develops the fantasy of a phantom limb, because he cannot readjust his pre-existing body-image to the acceptance of mutilation" (p. 285). He offered the patient "the rather simple explanation... that because she really did not feel where her lower body ended or began, the pain served her need to know where the body halves were separated. If she could learn to imagine and to accept herself as a full, whole person, the pain probably would leave her. This theory seemed very logical and acceptable to the patient" (p. 285).

"Hypnosis was extensively utilized in the following sessions to regress the patient toward her youth. She went again for long walks with her boyfriend, now her husband. It was fun to re-experience the feeling of walking in her father''s apple orchard and stretch up for a red apple. Autohypnosis was taught and [he] told her to exercise ''walking'' while hypnotized twice daily" (p. 285-286). He also tapped on the soles of her feet repeatedly, until she could localize the vibrations. "She finally learned that she did have legs and also that other sensations besides pain could originate below the waist.... Gradually with the acceptance of her ''wholeness and tallness'' the pain became less and less. She was able to ''forget'' the pain for a longer period of time. ... Occasionally she does call. She tells [the therapist] that in a stressful situation, such as moving into a new house and not knowing where things are, the pain comes back temporarily, but it is much less and after [they] talk an hour she is relieved" (p. 287). The patient had a total of 20 visits.

The author describes a second case, which is not described in these notes.

1960

Moss, C. Scott (1960). Brief successful psychotherapy of a chronic phobic reaction. Journal of Abnormal and Social Psychology, 60, 266-270. (Abstracted in Psychological Abstracts, 60: 7901)

A report demonstrating the use of hypnosis in the therapy of a phobic reaction. Hypnotic and posthypnotic suggestions were used to help uncover the affectively-laden but forgotten experiences which elucidated the meaning of the phobia, as well as to help the patient relive, work through, and accept the insights gleaned therefrom, both during the therapeutic hour, between therapeutic hours, and after termination. It was felt the use of hypnosis in this case helped shorten the duration of the therapy. (PsycINFO Database Record (c) 2002 APA, all rights reserved)

1959

Platonov, K. I. (1959). The word as a physiological and therapeutic factor: The theory and practice of psychotherapy according to I. P. Pavlov. ( 2nd). Moscow: Foreign Languages Publishing House.

NOTES

On pp. 75-76 the author discusses conditioning in hypnosis. Most of the theoretical material is in the first part of the book; the rest consists of case studies. He presents the position that the activity of the cortex and subcortex are different during states of waking and suggested sleep.

Note: Much of the Russian research done during "suggested sleep" involves subjects who are hypnotized for a long period of time--sometimes hours. Routinely, in treatment, they would give corrective suggestions and then tell the person to "sleep" and would leave them in the "sleep" for an hour or longer.

"Thus, it appears from the foregoing that the basic peculiarities of the activity of the cerebral cortex manifesting themselves in the state of suggested sleep are as follows: 1. In addition to the division of the cerebral hemispheres into sections of sleep and wakefulness typical of the hypnotic sleep of an animal, there is also a functional dissociation of the two signal systems and within the second signal system. 2. The activity of the second signal system under these conditions is not only confined to the narrow framework of the rapport zone, but is also frequently of a passive nature being directly dependent on the verbal influences of the hypnotist. Outside these influences there is no (or hardly any) activity. 3. A considerable increase in the coupling function with respect to the stimuli of the second signal system is noted at the same time in the rapport zone. This especially favours the formation of new cortical dynamic structures under the verbal influences of the hypnotist, these structures representing the physiological basis for effectuating the suggested actions and states.

"The foregoing peculiarities manifest themselves in the fact that the entire external second signal activity of the subject is reduced only to direct answers to the questions of the hypnotist with no independent reactions to any influences, including verbal, coming from other people (so-called isolated rapport). This is understandable, since the activity of the second signal system lying outside the rapport zone is inhibited" (pp. 73-74).

"As to the problem of the peculiarities of the conditioned reflex activity during suggested sleep, it will be noted that this problem has not been very extensively studied as yet. Nevertheless, the data of various authors are of indubitable interest, since they have revealed a number of specific peculiarities in the state of the higher nervous activity under these conditions.

"According to these data the conditioned reflex activity in suggested sleep undergoes certain changes. Thus, S. Levin observed in his early studies (1931) that in children under conditions of suggested sleep the motor and secretory conditioned reflexes elaborated earlier in the waking state grew very much weaker and that there was a dissociation both between the motor and secretory conditioned reflexes and between the unconditioned reflexes of salivation and mastication; he also observed the transitional (phasic) states--paradoxical, ultraparadoxical and inhibitory phases, all the way to the onset of complete sleep" (pp. 74-75).

Platonov indicates that conditioned reflexes may disappear during suggested sleep (Povorinsky & Traugott, 1936). Arousal from suggested sleep results in gradual restoration of the reflexes, with speech reactions inhibited first and restored last. Pen & Jigarov (1936) also showed that there is a weakening of conditioned reflexes, with increased latency, in suggested sleep. These authors showed that it is impossible to form new conditioned reflexes in deep states of suggested sleep, and the conditioning is difficult in lighter states.

"Y. Povorinsky's data (1937) indicate that the conditioned reflexes elaborated in the waking state have a longer latent period during suggested sleep and in some subjects they are completely absent. Under these circumstances, the reactions to the verbal influences of the hypnotist are retained even during the deepest suggested sleep. The more complex and ontogenetically later conditioned bonds of the speech-motor analyzer are inhibited first as the subject lapses into a state of suggested sleep and are disinhibited the last as the subject awakens from this state" (p. 75).

"B. Pavlov and Y. Povorinsky observe (1953) that the conditioned bonds reinforced by the words of the hypnotist are formed during suggested sleep faster than in the waking state. In this case, during the somnambulistic phase of suggested sleep verbal reinforcements, as a rule, provoke a stronger and longer reaction with a shorter latent period than a direct first signal stimulus" (p. 76). The conditioning that occurs during suggested sleep does not manifest during waking periods unless suggestions are given during the sleep to react after wakening. The author takes this to be evidence that conditioned reflex activity can be modified by verbal suggestions.

During the somnambulistic stage of suggested sleep, subjects are less adept at performing addition. This indicates that inhibition has spread to the second signal system. However, inhibition of different sensory systems seems to vary from person to person. Krasnogorsky (1951) reported one subject did not react to light, but hearing seemed to be more sensitive than in the waking state.

"All of the above testifies to the considerable changes in the character of cortical activity regularly occurring during suggested sleep and determining, on the whole, the specific nature of higher nervous activity, the systematic study of which should be the object of further research" (p. 77).

1954

Schneck, Jerome M. (1954). Hypnotherapy in a case of claustrophobia and its implications for psychotherapy in general. Journal of Clinical and Experimental Hypnosis, 2 (4), 251-260. (Abstracted in Psychological Abstracts, 55: 6064)

NOTES
"Summary. This report presents the hypnotherapy of a patient with claustrophobia. The crucial event responsible for symptom formation occurred in military service when the patient was trapped in a trench by a tank which stopped over the patient before proceeding, and at which time the sides of the trench began to cave in. Subsequent traumatic events served as reenforcement. It is likely that a low threshold for the development of anxiety predisposed this patient to the development of the claustrophobia, although the major trauma sustained was undoubtedly of tremendous impact and a distinct threat to life. Emotional experiences were sealed and free expression was permitted through hypnotic revivification. The dynamics, further elaborated in the report, suggest that similar occurrences not necessarily in military settings may be approached therapeutically in this way. Aside from the reliving technique, recall stimulation through a dream induction approach was employed. Other hypnotic methods were described and further implications for psychotherapy in general were elaborated. Hypnotherapeutic and hypnoanalytic approaches to phobic reactions have been described at length elsewhere" (p. 260).

Institute of Clinical Hypnotherapy-Psychotherapy

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Wednesday, January 26, 2011

FEARS & PHOBIAS - Treating phobias with Clinical Hypno-psychotherapy

Overview

Symptoms

Causes

Treatment

Non-pharmacologic

Pharmacologic

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