Article

The Use of Hypnosis for Airplane Phobia With an Obsessive Character: A Case Study

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Abstract

This is a single-case study of a middle-aged woman with specific phobia and panic symptoms associated with airplanes. Treatment was brief and supportive in nature, using hypnosis for both exposure purposes and as a self-regulatory tool for anxiety management. The patient’s identified target symptom (readiness to fly) was tracked using daily subjective, self-report measures over the 12-session treatment. Simulation modeling analysis for time-series was used to evaluate the level change across baseline, treatment, and follow-up phases. The patient’s self-assessed readiness to fly increased significantly over the course of treatment, and she successfully engaged in a “practice flight” toward the end of her treatment. However, this patient required a drastic shift in treatment modality, after which progress was made. Theoretical rationale for this shift and ultimate success is discussed.

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... His results showed that patients in the hypnosis group enjoyed greater anxiety reduction than the other group. Finally, case studies also corroborated the effectiveness of CBH for driving phobia[72], animal phobia[73], and airplane phobia[74]. This evidence tends to support the use of CBH as an effective therapy for different types of phobias. ...
... Mixed results[21][69]CBH and HOC as an effective treatment[71][72][73][74]Significance was reached in the Llobet study[21]but not in the Stanton study[69]CBH provided better results than CBT alone[71]HOC allowed patient to face the phobic situation with success[122]Panic disorder with or without agoraphobia ...
... Flying phobia Milne (1988) Systematic desensitization; bonding with baby Flying phobia Brann (2012) Special place imagery; retrograde desensitization; calmness anchoring Flying phobia (aeroplane phobia) Volpe and Nash (2012) Supportive psychotherapy; exposure therapy in hypnosis; anxiety management Exam phobia (severe test anxiety) Spies (1979) Systematic desensitization. Biofeedback vs hypnosis vs no treatment Fear of public speaking Schoenberger (1996) Hypnosis with cognitive behavioural work Fear of eating Spiegel (1960) Hypnoanalysis; an uncovering of the symbolic nature of the phobia Fear of eating Culbert, Kajander, and Reaney (1996) Hypnosis and self-management techniques Penetration phobia Frutiger (1981) Dilation exercises; psychotherapy and systematic desensitization; masturbation leading to coitus Hospital phobia Waxman (1978) Age regression; systematic desensitization in vitro; self-hypnosis Driving phobia Morgan (2001) Systematic desensitization; psychodynamic psychotherapy; special place imagery Driving phobia Kraft and Kraft (2004) Systematic desensitization in vitro and in vivo; psychodynamic psychotherapy Driving phobia Williamson (2004) Special place imagery; unconscious search; self-hypnosis; use of metaphor; covert conditioning; cinema technique Driving phobia Hill and Bannon-Ryder (2005) In vivo dessensitization; visualization; special place imagery Bus driving phobia Kraft and Burnfield (1967) Systematic desensitization in vitro and in vivo; social support Traffic phobia Kraft & Al-Issa (1965) Systematic desensitization especially to noise Wedding phobia Kraft (1970) Systematic desensitization in vitro using emotional imagery ...
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Part 5 of this series concentrates on the practical use of hypnosis as an adjunct to therapy in the treatment of specific phobias, focusing on animal and situational subtypes. The author evaluates the effectiveness of a range of interventions which have been shown to have been valuable in treatment. The report shows how hypnosis may be employed effectively in conjunction with behavioural approaches, including cognitive restructuring and systematic desensitization, psychodynamic psychotherapy, and dental treatment. There are a surprisingly large number of advertisements in the media which claim that phobias can be treated quickly using behavioural therapy; however, although in vitro desensitization and imaginal exposure have been employed successfully by clinicians, when the source of the phobic anxiety is in early childhood further psychological investigation is often required. This study discusses the implications of using a number of hypnotic techniques which have been employed in clinical practice.
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This book collects the contributions of a number of clinical psychiatrists all over the world, interested in developing basic research about anxiety and in applying it in clinical contexts. It is divided into four sections, covering general issues about anxiety (ethological and developmental ones), basic research issues on specific aspects of anxiety (bioanatomical ones, correlation with personality structure and so on), and new clinical and therapeutical proposals and hypothesis. Each author summarized the clinical importance of his work, underlining the clinical pitfalls of this publication.
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This is a case study of a 55-year-old married woman who had a severe driving phobia with a concomitant reduction in her mobility. She had been involved in an accident on the motorway but did not develop phobic symptoms until after the second incident – a near collision. The treatment consisted of a systematic desensitization of driving scenarios in hypnosis: after sixteen treatment sessions, the patient made a complete recovery and was able to drive on all public roads. Following each session, the patient was encouraged to practise her driving in the presence of her husband who was a skilled driver. In hypnosis, the patient was able to create a world of vivid imagery using all sensory modalities; and it was this verisimilitude, akin to ‘virtual reality exposure therapy’ (VRET), that contributed significantly to her complete recovery. Copyright © 2004 British Society of Experimental and Clinical Hypnosis
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The 12-member National Institute of Health Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia (1996) reviewed outcome studies on hypnosis with cancer pain and concluded that research evidence was strong and that other evidence suggested hypnosis may be effective with some chronic pain, including tension headaches. This paper provides an updated review of the literature on the effectiveness of hypnosis in the treatment of headaches and migraines, concluding that it meets the clinical psychology research criteria for being a well-established and efficacious treatment and is virtually free of the side effects, risks of adverse reactions, and ongoing expense associated with medication treatments.
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It was natural enough that hypnosis came to be the all-purpose foil for psychoanalysis because when psychoanalysis was born, hypnosis dominated the landscape of clinical and experimental psychiatry. If psychoanalysis was to have its own identity, hypnosis as technique had to be jettisoned. This article discusses the ways in which hypnosis can be used in psychoanalytically informed therapies across a range of therapeutic aims and patient diagnoses. The most current psychoanalytic models of hypnosis rely on two aspects of psychoanalytic metapsychology: early analytic constructs rooted in drive theory, conflict and insight; and later developmental principles grounded in attachment, identity, and the therapeutic relationship. This article further takes on the significances of clinical usages of hypnosis stating that for patients in the normal to neurotic spectrum, hypnosis can be used supportively to strengthen already intact defenses, in service of managing pain, anxiety, stress, and some somatic symptoms.
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The integrity of professional service in psychology depends upon its scientific foundation. Continual strengthening of that foundation is therefore essential. The complexities of many conditions that engage practitioners, however, limit the extent to which practice can be based exclusively on scientific knowledge and still provide maximum benefit to the public. Resolution of this dilemma can be advanced by adopting a strong definition of science but acknowledging that some problems confronting practitioners are inaccessible to rigorous scientific inquiry and require alternative, primarily humanistic approaches. Three levels of pragmatically acceptable scientistic confidence are defined, the advantages of constructive dialogue across these levels are discussed, and the view of psychology as a pluralistic rather than monistic discipline is advocated.
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This case demonstrates the use of CBT and hypnosis in managing the symptoms of anxiety experienced by a retired registered nurse. Her symptoms included panic attacks and heightened blood pressure when she visited medical specialists. Therapy was time limited to five sessions under the Enhanced Primary Care program. A research question was posed about the possibility of achieving success in this time frame, using CBT enhanced by hypnosis for exposure to both the symptoms of panic and situational anxiety. On completion of the sessions, there was a marked decrease in anxiety symptoms, and the patient was able to visit her doctors without undue elevation of blood pressure.
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This article is aimed at those who are unfamiliar with the technical aspects of clinical hypnosis and its procedures. In introducing the practitioner to the techniques of hypnotic induction and clinical hypnosis in general, it must be emphasized that the pre-eminent factor determining how fully patient experiences hypnosis has almost nothing to do with therapist technique or any other therapist-related factor for that matter. One becomes a better clinical hypnotist by sharpening and refining ones clinical skills in general, and applying those general clinical skills to the environment of hypnosis. There are certain parameters and techniques specific to hypnosis and suggestion that constitute a helpful body of knowledge for clinicians wishing to employ hypnosis. This article describes the prehypnosis interview. Apart from explaining in detail the six phases of hypnotic procedure, it also gives an example of how to instruct patients in self-hypnosis.
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Anxiety can be defined as a fear that persists even when a salient threat is not present. The most common anxiety disorders, as defined by the 'Diagnostic and Statistical Manual of Mental Disorder' (American Psychiatric Association, 1994), are specific phobia, social phobia, generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder (PTSD), acute stress disorder, and separation anxiety disorder. There is convergent evidence that people with anxiety disorders are characterized by increased levels of hypnotizability. This article takes on the possible connection between the anxiety level and the hypnotizability. It states that hypnosis is not a therapy; it is a tool that can be used as an adjunct to established therapy techniques that have proven efficacy in reducing anxiety. It explains different hypnotic strategies for reducing anxiety such as muscle relaxation, imagery, thought control, motivational enhancement, post-hypnotic suggestions, and self-hypnosis.
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Clinicians typically possess considerable interest about what interventions work and do not work; however, they often dismiss the notion that they can make viable contributions to the scientific literature. This state of affairs derives in part from an unfortunate assumption that the only true experiment is a between-groups experiment. This article describes how clinicians working with hypnosis can carry out researches like the single-case time-series design, which is particularly compatible with real-world clinical practice. This article shows how robust time-series studies can be carried out by fulltime clinicians. It first describes and reviews some available time-series designs and then discusses issues related to dependent measures and data collection in time-series studies. Furthermore it reviews some available time-series data analytic techniques and describes a new data analytic technique. This chapter also describes the rationale of single-case time-series studies and how these studies might be crafted by those interested in hypnosis.
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This report describes the successful hypnotic intervention with a battered woman who has post-traumatic stress disorder (PTSD). The treatment basically consists of three phases: The first is stabilisation by reducing stress and building up personal resources, the second is re-exposing the client to the trauma by graded approximation, and the last is consolidation of the therapeutic gains. Data obtained by the client's verbal reports, the therapist's observations, and objective measures at one month and three month post-treatment follow-ups provides evidence of maintenance and continued improvement in symptoms. This suggests that hypnosis may be an effective adjunct to therapy for battered women with PTSD.
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There are several possible strategies for documenting the stable individual differences in processing the history of hypnosis. However, an approach characteristic of science is to devise a scale that assigns different numbers to the varying manifestations of the phenomenon under study. This article declares that the first such hypnosis scale was developed in the late 1800s by Bernheim (1886/1964) and Liébeault (1889). Since then, there have been several developments in that direction. However, as this article explains, it was the scale construction work of Weitzenhoffer and Hilgard in the late 1950s that completely transformed the scientific study of hypnosis. Modifying the hypnosis scale of Friedlander and Sarbin (1938), they introduced a simplified pass/fail scoring scheme for the response to each test suggestion, and they added additional relatively easy test suggestions, yielding two alternate forms: the Stanford Hypnotic Susceptibility Scales, Forms A and B (SHSS: A and SHSS: B; Weitzenhoffer and Hilgard, 1959).
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We describe how to conduct case-based time-series studies in a practice setting. First we offer a sampler of clinical research questions that can be addressed by case-based studies. Second we construct a hypothetical case that illustrates the structure of a time-series project now being conducted in a university-based outpatient psychotherapy clinic. This case also familiarizes the reader with the data array of a time-series study. Third, we present two actual case studies, each carried out in a different outpatient setting. Fourth, we move to the logistics of how a time-series study is efficiently conducted in an applied setting. Finally we provide a step-by-step description of Simulation Modeling Analysis (SMA) for time-series data and how the practitioner can use freely-available software to analyze his or her real-world clinical practice data (i.e., relatively short streams of time-series data).
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Over the last 10 years, evidence-based practice in psychology has become synonymous with a particular operationalization of it aimed at developing a list of empirically supported therapies. Although much has been learned since the emergence of the empirically supported therapies movement, its restrictive definition of evidence (excluding, for example, basic science as a source of evidence to be used by clinicians) is problematic, and the assumptions inherent in its nearly exclusive focus on brief, focal treatments for specific disorders are themselves not generally supported by the available data. Recent meta-analytic data support a more nuanced view of treatment efficacy than one that makes dichotomous judgments of empirically supported or unsupported, suggesting the need for a more refined concept of evidence-based practice in psychology.
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Self-hypnosis and hetero-hypnosis were compared, and selfhypnosis was studied longitudinally. Results indicated that absorption and the fading of the general reality orientation are characteristics of both hetero-hypnosis and self-hypnosis. The differentiating characteristics lie in the areas of attention and ego receptivity. Expansive, freefloating attention and ego receptivity to stimuli coming from within are state-specific for self-hypnosis, while concentrative attention and receptivity to stimuli coming from one outside source—the hypnotist on whom the subject concentrates his attention-are state-specific for laboratory defined hetero-hypnosis. Attempts to produce age regression and positive or negative hallucinations are markedly more successful in hetero-hypnosis. Imagery is much richer in self-hypnosis than in hetero-hypnosis. Self-hypnosis requires adaptation to the state: in the beginning of self-hypnosis there is a good deal of anxiety and self-doubt. As the subject feels more comfortable in the self-hypnotic state, he spends less time worrying about failures in self-suggestion, his ability to enter trance quickly and easily increases, as does the fading of the general reality orientation, trance depth, and absorption. An attempt was also made in the present study to find personality characteristics related to the ability to experience self-hypnosis.
Article
A meta-analysis was performed on 18 studies in which a cognitive-behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive-behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments.
Article
This is a single case study of a college aged woman with generalized anxiety disorder. Treatment consisted of psychodynamic psychotherapy, with an emphasis on facilitating separation and individuation, using hypnosis as a supportive, self-regulation skill for anxiety management. The patient’s symptoms were tracked using daily subjective, self-report measures over the 13-month treatment period. The simulation modeling approach for time-series (SMATS) was used to assess the phase change from baseline to treatment. Symptoms tracked included anxiety peaks, preoccupation with time, interpersonal closeness, and self-sacrificing of self for others. The patient’s worries about time decreased significantly over the course of treatment. There was also a trend of both less interference of anxiety in the patient’s daily tasks and less self-sacrificing behaviors in her interpersonal relationships. Utility of an idiographic and also quantified research methodology for treatment outcome studies is discussed.
Article
The client was a 37-year-old married woman with two young daughters working as a community psychiatric nurse who requested assistance with driving difficulties following a number of accidents, and maintained by avoidance behaviour. Assessment indicated that she was currently avoiding driving on any unfamiliar routes and avoiding motorway travel altogether. This avoidance was affecting her professional and personal life and she was keen to see whether the use of hypnotic procedures in conjunction with a behavioural driving programme could help her. Four sessions were undertaken and, although she retained some anxiety, sufficient progress was established for her to make a long distance trip that she has been avoiding for a number of years. Reviewing progress a year later, she reported that residual anxiety had diminished and that progress had continued. Copyright © 2005 British Society of Experimental and Clinical Hypnosis
Article
The outcome and process of treating subclinical anxiety with self-hypnosis and relaxation were compared. Twenty individuals who presented for treatment for ‘stress, anxiety, and worry’ were assessed (for anxiety and self-hypnotizability), exposed to a 28-day treatment programme (which involved daily measures of outcome and process variables), and re-assessed (for anxiety). It was found that both self-hypnosis and relaxation alleviated anxiety pre- to post-treatment. Although there was no difference in the outcome data, throughout treatment self-hypnosis rather than relaxation was associated with a greater sense of treatment efficacy and expectation and with a greater sense of cognitive and physical change. The findings are discussed in terms of the expectational and experiential aspects of self-hypnosis, and their potential role in the perception, progress and impact of using self-hypnosis in therapy. Copyright © 1999 British Society of Experimental and Clinical Hypnosis
Article
In this article, we present a cognitive-behavioral model and treatment of generalized anxiety disorder (GAD). In the first section, we review a model of GAD that includes four main components: intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance. Next we present the GAD assessment tools used at our clinic, which include standardized interviews and self-report questionnaires of GAD symptoms and underlying cognitive-behavioral processes. We then provide a step-by-step description of a treatment that is based on the aforementioned model of GAD, and that has six core components: presentation of treatment rationale (learning to cope with uncertainty); worry awareness training; reevaluation of the usefulness of worrying; problem-solving training; cognitive exposure; and relapse prevention. Following the treatment description, we summarize the efficacy data from our completed randomized clinical trials, and present some preliminary findings from our ongoing trial comparing our treatment to applied relaxation and wait-list control. In the final section, we present an in-depth discussion of future directions for the study and treatment of GAD, with a focus on the approach-avoidance nature of GAD. Given the movement in the field favoring the expansion of cognitive-behavioral treatments, we also comment on the possible implications of the newest integrative therapies for our existing treatment.
Book
This book is essentially clinical in nature. But it is a clinical book with a research base. The clinical strategies and techniques that are presented are ones that the authors have used in their practice and that they have taught their graduate students to use. They are procedures with an evidential base. Many of the specific techniques they describe have been validated in clinical trials and outcome studies, and their approach to most strategic issues has been shaped by their understanding of the research literature in hypnosis, psychotherapy, and psychopathology. If there is a fundamental difference between this book and the many other guides that have been published on clinical applications of hypnosis, it is the degree to which the principles and practices the authors describe are evidence-based. Hence, the subtitle of this book. The authors aim to bring their enthusiasm for integrating hypnosis with empirically supported methods to a wide readership and to move hypnosis more securely into the mainstream of established clinical practice. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Purpose/Objective: There have been few randomized controlled studies on the effectiveness of clinical hypnotic analgesia. The authors' goal was to improve on previous methodologies and gain a better understanding of the effects of hypnosis on different components of pain in a clinical setting. Research Method/Design: This study used a randomized controlled design in which the nurses and data collectors were unaware of treatment condition to compare hypnotic analgesia with an attention-only placebo for burn pain during wound debridements. Data were analyzed on a total of 46 adult participants. Results: The authors found that the group receiving hypnosis had a significant drop in pain compared with the control group when measured by the McGill Pain Questionnaire but not when measured by other pain rating scales. Conclusion: The McGill Pain Questionnaire total score reflects multiple pain components, such as its affective component and various qualitative components, and is not merely a measure of pain intensity. Thus, the findings suggest that hypnosis affects multiple pain domains and that measures that assess these multiple domains may be more sensitive to the effects of hypnotic analgesia treatments. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
A woman with a 50-year history of intense handwriting anxiety was treated wwith an in-vivo desensitization procedure. The technique was an adaptation of a method described by Janet in 1925. After only six sessions the subject was able to write in front of strangers without anxiety. Treatment effects were maintained at six month follow-up.
Article
This single-case study examines the efficacy of hypnosis as an anxiety management and confidence strengthening technique in the specific area of a social communication disorder of long duration and which had proved resistant to other therapeutic approaches. The anxiety of a 15-year-old student with a social communication disorder and inability to enter a classroom was measured before and after intervention, in addition to progress on personal targets and the effect of his difficulties on life at home. In hypnosis the student was taught anxiety management and self-hypnosis techniques and, with his mother, approaches to increase assertiveness. Anxiety decreased, and self-confidence, social communication and school attendance increased during and following the hypnosis intervention. Four sessions, including hypnosis and self-hypnosis, were delivered. Follow-up monitoring visits at one, three and six months provided evidence of maintenance or continued improvement in the post-intervention measures. In addition to the marked positive gains from pre- to post-intervention measures, both the client and his mother reported improvements in his emotional well-being and social inclusion. The significance of the results for the use of hypnosis as an adjunct to educational psychology is discussed. Copyright © 2002 British Society of Experimental and Clinical Hypnosis
Article
The integrity of professional service in psychology depends upon its scientific foundation. Continual strengthening of that foundation is therefore essential. The complexities of many conditions that engage practitioners, however, limit the extent to which practice can be based exclusively on scientific knowledge and still provide maximum benefit to the public. Resolution of this dilemma can be advanced by adopting a strong definition of science but acknowledging that some problems confronting practitioners are inaccessible to rigorous scientific inquiry and require alternative, primarily humanistic approaches. Three levels of pragmatically acceptable scientistic confidence are defined, the advantages of constructive dialogue across these levels are discussed, and the view of psychology as a pluralistic rather than monistic discipline is advocated.
Article
The authors review the existing models for understanding agoraphobia and suggest a more complex behavioral model which includes a combination of necessary and sufficient factors for its formation. This model is presented as a framework allowing classification of agoraphobic-like symptoms with implications for treatment planning and research efforts.
Article
In two randomly selected groups of subjects phobic hierarchies were constructed, and from each hierarchy five evenly separated items were selected than spanned the range from least disturbing to most disturbing. One group was trained in relaxation and the other not. The five selected items from each subject's own hierarchy were presented to him, five times each in ascending order, during each of four sessions. The same schedule of scene presentations was administered to both groups. The galvanic skin response (percentage change) was recorded in respect of every presented stimulus. A consistent decreasing trend in magnitude of response was found for each of the 5 scenes across sessions for the relaxed group, and no trend for the non-relaxed group.
Article
The effectiveness of a multidimensional cognitive behavioral treatment for public speaking anxiety was compared with that of the same treatment supplemented by hypnosis. The hypnotic treatment included all components of the cognitive behavioral treatment. It differed from the nonhypnotic treatment only in that relaxation training was presented as a hypnotic induction, automatic thoughts were referred to as self-suggestions, and explicit hypnotic suggestions for improvement were added. Participants in both treatment conditions improved more than those in a wait-list control group. Moreover, labeling the treatment “hypnotic” appeared to enhance treatment effectiveness. The hypnotic treatment generated expectancies for greater change among participants than did the nonhypnotic treatment, and these expectancies were correlated with treatment outcome. Implications for the use of hypnosis in treatment are discussed.
Article
A 55-yr-old man with a severe driving phobia was treated by in vivo desensitization. A radio transceiver was used to provide the anxiety-inhibiting effects of voice contact during exposure to phobic driving experiences. Treatment effects were maintained at 6-month follow-up.
Article
The authors describe two studies of special interest to clinicians and clinical researchers. Both are randomized controlled studies, exclusively focused on female patients. The first study tests whether a year-long weekly group intervention including hypnosis can reduce cancer pain among women with metastatic breast cancer. Findings suggest the intervention slowed the increase in reported pain over a 12-month period relative to controls. The second study examines the effect of hypnosis in women suffering from temporomandibular disorder (TMD), with a special focus on function as well as pain. Hypnosis reduced TMD pain as measured by a numerical-rating scale.
Article
This randomized clinical trial compared cognitive-behavioral therapy (CBT), applied relaxation (AR), and wait-list control (WL) in a sample of 65 adults with a primary diagnosis of generalized anxiety disorder (GAD). The CBT condition was based on the intolerance of uncertainty model of GAD, whereas the AR condition was based on general theories of anxiety. Both manualized treatments were administered over 12 weekly 1-hour sessions. Standardized clinician ratings and self-report questionnaires were used to assess GAD and related symptoms at pretest, posttest, and at 6-, 12-, and 24-month follow-ups. At posttest, CBT was clearly superior to WL, AR was marginally superior to WL, and CBT was marginally superior to AR. Over follow-up, CBT and AR were equivalent, but only CBT led to continued improvement. Thus, direct comparisons of CBT and AR indicated that the treatments were comparable; however, comparisons of each treatment with another point of reference (either waiting list or no change over follow-up) provided greater support for the efficacy of CBT than AR.
Article
This meta-analysis evaluates the effect of hypnosis in reducing emotional distress associated with medical procedures. PsycINFO and PubMed were searched from their inception through February 2008. Randomized controlled trials of hypnosis interventions, administered in the context of clinical medical procedures, with a distress outcome, were included in the meta-analysis (26 of 61 papers initially reviewed). Information on sample size, study methodology, participant age and outcomes were abstracted independently by 2 authors using a standardized form. Disagreements were resolved by consensus. Effects from the 26 trials were based on 2342 participants. Results indicated an overall large effect size (ES) of 0.88 (95% CI = 0.57-1.19) in favour of hypnosis. Effect sizes differed significantly (p < 0.01) according to age (children benefitted to a greater extent than adults) and method of hypnosis delivery, but did not differ based on the control condition used (standard care vs. attention control).
Article
Breast cancer radiotherapy can be an emotionally difficult experience. Despite this, few studies have examined the effectiveness of psychological interventions to reduce negative affect, and none to date have explicitly examined interventions to improve positive affect among breast cancer radiotherapy patients. The present study examined the effectiveness of a multimodal psychotherapeutic approach, combining cognitive-behavioral therapy and hypnosis (CBTH), to reduce negative affect and increase positive affect in 40 women undergoing breast cancer radiotherapy. Participants were randomly assigned to receive either CBTH or standard care. Participants completed weekly self-report measures of positive and negative affect. Repeated and univariate analyses of variance revealed that the CBTH approach reduced levels of negative affect [F(1, 38)=13.49; p=.0007, omega(2)=.56], and increased levels of positive affect [F(1, 38)=9.67; p=.0035, omega(2)=.48], during the course of radiotherapy. Additionally, relative to the control group, the CBTH group demonstrated significantly more intense positive affect [F(1, 38)=7.09; p=.0113, d=.71] and significantly less intense negative affect [F(1, 38)=10.30; p=.0027, d=.90] during radiotherapy. The CBTH group also had a significantly higher frequency of days where positive affect was greater than negative affect (85% of days assessed for the CBTH group versus 43% of the Control group) [F(1, 38)=18.16; p=.0001, d=1.16]. Therefore, the CBTH intervention has the potential to improve the affective experience of women undergoing breast cancer radiotherapy.
Article
Systematic desensitization is indicated for phobias, obsessions, compulsions, and anxiety reactions that are maintained by anxiety reducing defense mechanisms. The technique involves instruction in deep muscle relaxation, construction of an anxiety hierarchy, and stepwise pairing of relaxation with imagined anxiety provoking scenes. The basic principle is that relaxation is incompatible with anxiety. Relaxation can be induced by direct instruction, drugs, carbon dioxide, hypnosis, positive imagery, and a metronome conditioned method. More than 100 outcome studies indicate that systematic desensitization produces significantly better results than a variety of comparison therapies.
Article
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.
Article
A meta-analysis was performed on 18 studies in which a cognitive-behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive-behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments.
Article
A scheme is proposed for determining when a psychological treatment for a specific problem or disorder may be considered to be established in efficacy or to be possibly efficacious. The importance of independent replication before a treatment is established in efficacy is emphasized, and a number of factors are elaborated that should be weighed in evaluating whether studies supporting a treatment's efficacy are sound. It is suggested that, in evaluating the benefits of a given treatment, the greatest weight should be given to efficacy trials but that these trials should be followed by research on effectiveness in clinical settings and with various populations and by cost-effectiveness research.
Article
Although much is now known about the neural basis of fear acquisition, the mechanisms of fear inhibition or suppression remain largely obscure. Fear inhibition is studied in the laboratory through the use of an extinction procedure, in which an animal (typically a rat) is exposed to nonreinforced presentations of a conditioned stimulus (CS; e.g., a light or tone) that had previously been paired with a fear-inducing unconditioned stimulus (US; e.g., a mild footshock). Over the course of such training, the conditioned fear response exhibited by the rat in the presence of the CS is reduced in amplitude and frequency. This procedure is analogous to those employed in the treatment of fear dysregulation in humans, which typically involve exposure to the feared object in the absence of any overt danger. Recent work on the neural basis of extinction indicates that the neurotransmitters gamma-aminobutyric acid (GABA) and glutamate are critically involved. Gamma-aminobutyric acid may act to inhibit brain areas involved in fear learning (e.g., the amygdala), and glutamate, acting at N-methyl-D-aspartate receptors, may play a role in the neural plasticity that permits this GABA-mediated inhibition to be exerted appropriately. These insights have significant implications for the conduct of extinction-based clinical interventions for fear disorders.
Article
Since it had been noted that in the desensitization treatment of phobias the number of presentations of a scene required to bring the anxiety level down to zero is not uniform but tends to increase or decrease on the way up a hierarchy, an attempt was made to establish quantitative relations by a study of those phobias that vary along a physical dimension. It was found that in claustrophobias and phobias in which anxiety rises with increasing proximity to a feared object the number of scene presentations to zero anxiety is low at a distance and increases with proximity, the cumulative curve corresponding to a positively accelerating function. In agoraphobias as in phobias increasing with number of objects the number of presentations needed is initially high and progressively falls as distance grows, the cumulative curve corresponding to a negatively accelerating function. In both cases the number of prestations to advance a segment of given size varies inversely with the distance of that segment from the central "safe zone" (as in agoraphobia) or "danger zone" (as in claustrophobia) in accordance with a simple power function such as has been constantly found to be the functional relation between stimulus magnitude and psychological magnitude.
Article
This is a comprehensive review of treatment studies in specific phobia. Acute and long-term efficacy studies of in vivo exposure, virtual reality, cognitive therapy and other treatments from 1960 to 2005 were retrieved from computer search engines. Although specific phobia is a chronic illness and animal extinction studies suggest that relapse is a common phenomenon, little is known about long-term outcome. Treatment gains are generally maintained for one year, but longer follow-up studies are needed to better understand and prevent relapse. Acutely, the treatments are not equally effective among the phobia subtypes. Most phobias respond robustly to in vivo exposure, but it is associated with high dropout rates and low treatment acceptance. Response to systematic desensitization is more moderate. A few studies suggest that virtual reality may be effective in flying and height phobia, but this needs to be substantiated by more controlled trials. Cognitive therapy is most helpful in claustrophobia, and blood-injury phobia is uniquely responsive to applied tension. The limited data on medication have not been promising with the exception of adjunctive D-clycoserine. Despite the acute benefits of in vivo exposure, greater attention should be paid to improve treatment acceptance and retention, and additional controlled studies of more acceptable treatments are needed.
Article
This article reviews controlled prospective trials of hypnosis for the treatment of chronic pain. Thirteen studies, excluding studies of headaches, were identified that compared outcomes from hypnosis for the treatment of chronic pain to either baseline data or a control condition. The findings indicate that hypnosis interventions consistently produce significant decreases in pain associated with a variety of chronic-pain problems. Also, hypnosis was generally found to be more effective than nonhypnotic interventions such as attention, physical therapy, and education. Most of the hypnosis interventions for chronic pain include instructions in self-hypnosis. However, there is a lack of standardization of the hypnotic interventions examined in clinical trials, and the number of patients enrolled in the studies has tended to be low and lacking long-term follow-up. Implications of the findings for future clinical research and applications are discussed.