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Hypnosis and anxiety: Early interventions
Abstract
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.
... 16 Additionally, Hypnosis has been used for several psychological disorders, like stress, anxiety and depression, with proven effective results. 17 Based on the evidence available for CBT and Hypnosis regarding their efficacy and suitability for integration, CBH is used. 18 The CBH is utilised following the Manual for Intervention. ...
Objective: To identify the effect of cognitive behaviour hypnotherapy on nonsuicidal self-injury condition.
Methods: The quasi-experimental study was conducted from May 2019 to April 2020 in Islamabad and Rawalpindi,
Pakistan, and comprised students aged 18-25 years at various universities and colleges in the twin cities. The
participants were screened using deliberate self-harm inventory for >2 events without suicidal intention in line with
the Diagnostic and Statistical Manual of Mental Disorders 5th edition. They were then divided into two intervention
and control groups. Over the following three months, the intervention group received cognitive behaviour
hypnotherapy, while the control group did not receive any treatment. The groups were assessed post-intervention.
The final phase comprised follow-up assessment of the condition. Data was analysed using SPSS 25.
Results: Of the 60 subjects, there were 30(50%) in each of the two groups. Overall, there were 41(68%) males and
19(32%) females. The majority of the subjects were aged 21-23 years 29(48%). More than 5 self-harm incidents were
reported by 48(80%) subjects, while suicidal ideation was detected in 6(10%) students. The effect size of the study
was good in terms of pre- and post-intervention values (d=4.90), the post-intervention and follow-up assessment
values (d=0.32) and the pre-intervention and follow-up values (d=5.42). The comparison between treatment and no
treatment groups indicated the effectiveness of treatment over no-treatment, F (1, 58) = 53.16, p < .001.
Conclusion: Cognitive behaviour hypnotherapy was found to be effective in treating the nonsuicidal self-injury
condition.
Keywords: Nonsuicidal self-injury, Deliberate self-harm, Hypnotherapy, Cognitive therapy, Intervention study.
(JPMA 72: 275; 2022) DOI: https://doi.org/10.47391/JPMA.1752
... One of the most important predictors of a psychotherapy outcome is a positive therapeutic relationship (Cozolino, 2010, p.336). The experience of hypnosis promotes many of the most important aspects of therapeutic relationships--warmth, trust, comfort, security--and lowers defenses with the therapist (Barber, 2012), which indicates that hypnosis can be used in a variety of ways in psychotherapy (Barabasz & Watkins, 2005;Bryant, 2012;Covino & Pinnell, 2010;Elkins & Perfect, 2008;Steven Jay Lynn, Kirsch, Barabasz, Cardena, & Patterson, 2000;Nash, 2012;Peebles, 2012;Scott, Lagges, LaClave, Nash, & Barnier, 2012). The specific approach taken within the hypnoanalytic framework is based on historic origins of symptoms that are rooted in implicit memory of traumas that occurred before the symptom appeared (A. ...
Neuroscience is providing growing evidence that psychopathology is related to neural integration and amygdala-based implicit memories. Understanding the brain provides psychotherapists a guide for treatment, and neuroscience points to hypnosis as a potent treatment tool. Hypnosis affects functional areas of the brain, including the amygdaloid memory system and neural integration. Hypnosis in itself is not curative. Neuroscience, more recent psychotherapy models, and modern understandings of hypnoanalysis appear to confirm Freud's early observations of hypnosis effectiveness and, for his objection that hypnosis works well for some clients but not for others, explain why. Neuroscience's understanding of the development of psychopathology and psychotherapy models give us tools and models Freud did not have. Using age regression (abreaction) in hypnosis in the context of psychotherapy appear to provide direct access to amygdala-based implicit memories during which the content of implicit memories can be explored for the unconscious meaning and for the responses conditioned during traumatic events. With the skilled use of psychotherapy treatment models while a client is in hypnosis, new patterns can be created through neurologically vividly experiences. These vivid experiences create new, reconditioned patterns that appear to reflect direct changes in the amygdala-based implicit memories and neural integration, evidenced by clients' new, automatic responses in previously difficult circumstances. Two case studies illustrate the use of Ego Psychology, Self Psychology, Attachment and Narrative psychotherapy models during hypnotic age regressions to disconnect stimulus-response patterns in a phobia client and provide vivid experiences of attachment and guidance for a borderline client.
... There is abundant evidence that hypnosis is an effective and useful intervention in a wide variety of clinical situations and disorders. Recent reviews indicate that hypnosis is an effective adjunctive procedure in the treatment of psychiatric disorders, among them posttraumatic stress disorder (Lynn & Cardeña, 2007), dissociative disorders (Maldonado, Butler, & Spiegel, 2002), and anxiety disorders (Bryant, 2008 ). In the area of behavioral medicine, it has been found that persons that receive a hypnotic procedure report a significant drop in pain perceptions (Askay, Patterson, Jensen, & Sharar, 2007; Elkins, Jensen, & Patterson, 2007; Hammond, 2007), reduce risk factors in the area of obstetrics (Brown & Hammond, 2007 ) and produce substantial benefits in the area of psychosomatic disorders (Flammer & Alladin, 2007). ...
The only hypnotizability scale that has been translated and validated for the Puerto Rican population is the Barber Suggestibility Scale (BSS). In this article, the Stanford Hypnotic Clinical Scale (SHCS) was translated and validated for this population. The translated SHCS ("Escala Stanford de Hipnosis Clinica" [ESHC]) was administered individually to 100 Puerto Rican college students. There were no significant differences found between the norms of the original SHCS samples and the Spanish version of the SHCS. Both samples showed similar distributions. The Spanish version's internal reliability as well as the item discrimination index were adequate. The authors conclude that the ESHC is an adequate instrument to measure hypnotizability in the Puerto Rican population.
The present study examines the therapy of an individual diagnosed with generalized anxiety disorder, two situation type specific phobias, and nicotine dependence. Treatment consisted of psychodynamic psychotherapy with adjunctive hypnosis. Client's symptoms were tracked using daily, self-report measures over the 6-month treatment period. The simulation modeling approach for time-series was used to assess the phase change from baseline to treatment. Tracked symptoms included generalized anxiety, worry associated with specific phobias, phobic avoidance, number of cigarettes smoked daily, and nicotine craving intensity. All symptoms decreased significantly over the course of treatment. Utility of an ideographic and also quantified research methodology for treatment outcome studies are discussed.
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.
From 444 studies published un til 2002 that investigated the efficacy of hypnosis, 57 randomised clinical studies were selected that compared patients treated exclusively by hypnosis to an un treated control group (or to a group of patients treated b y conventional medical procedures). The 57 studies were integrated into a meta-analysis that yielded a weighted average post-treatment effect size of d = 0.56 (medium effect size). For hypnotic treatment of ICD-10 codable disorders (32 studies) the ca lculation of the weighted mean effect size resulted in d = 0.63. These estimates are conservative since all variables of a given study were used. Most of the studies employed methods of the classic approach to hypnosis. In o rder to ob tain an estimate to which extent non-clinical factors (design-quality, way of comparison of dependent variables) have a n influence on the effect sizes, effect sizes were computed for all studies of the original 444 studies that reported the necessary statistical information (N = 133). For those studies with an average e ffect size of d = 1.07 a massive influence of non-clinical factors was demonstrated with a range from d = 0.56 for randomised studies with group comparisons to d = 2.29 for non-randomised studies using pre-post- comparisons. Out of the 57 randomised studies, only 6 studies reported numerical values for the c orrelation between h ypnotic suggestibility and treatment outcome with a mean correlation of r = .44.
Describes pertinent issues in hypnosis research and discusses the nature of research on dissociation. The literature is reviewed to examine the relationship between hypnotizability and dissociation independent of hypnosis. J. R. Hilgard's (1968) theory of 2 developmental pathways to hypnotizability is considered. Findings support the notion of 2 distinct pathways to hypnotizability. These pathways may produce a dichotomy in which an individual's experience of hypnosis varies according to the influences and interplay of the 2 pathways. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The authors compared the hypnotizability of 65 Vietnam veteran patients with posttraumatic stress disorder (PTSD) to that of a normal control group and four patient samples using the Hypnotic Induction Profile. The patients with PTSD had significantly higher hypnotizability scores than patients with diagnoses of schizophrenia (N = 23); major depression, bipolar disorder--depressed, and dysthymic disorder (N = 56); and generalized anxiety disorder (N = 18) and the control sample (N = 83). This finding supports the hypothesis that dissociative phenomena are mobilized as defenses both during and after traumatic experiences. The literature suggests that spontaneous dissociation, imagery, and hypnotizability are important components of PTSD symptoms.
Although there is converging evidence that posttraumatic stress disorder (PTSD) is associated with higher levels of hypnotizability, there are no studies concerning the stability of hypnotizability levels following trauma. Acutely traumatized participants with acute stress disorder (N = 45) were administered the Stanford Hypnotic Clinical Scale (SHCS) within 4 weeks of their trauma. Participants were subsequently administered a brief cognitive-behavior therapy program. Six months after treatment, participants were re-assessed with the SHCS. Although SHCS scores were generally stable (r = .47), two thirds of participants responded differently across the 2 assessments. Increased SHCS scores at the second assessment were correlated with elevated PTSD avoidance scores. This finding suggests that elevated hypnotizability in PTSD populations may not be entirely stable and may be associated with specific PTSD responses.
From both theoretical and therapeutic perspectives, there is a need to expand and integrate current lines of research into the phenomenon of self-hypnosis and its clinical application. Some issues and research implications are outlined that concern the need to (a) delineate the phenomenon, (b) convergently assess it through behavioral and phenomenological techniques, and (c) investigate the consequences of its private use. Behavioral, experiential, and consequential measures of self-hypnosis are seen as methodologically distinct ways of convergently assessing the phenomenon. The adoption of multiple strategies of inquiry into the nature and function of self-hypnosis may allow a better understanding of it from the respective viewpoints of those who seek to understand, to teach, and to use the technique.
We examined posthypnotic suggestion away from the laboratory. In Experiment 1, high-hypnotizable subjects were given a posthypnotic suggestion (of limited or unlimited duration) or a social request (of unlimited duration) to mail one postcard every day to the experimenter. Subjects given a social request rather than a posthypnotic suggestion sent more postcards, and those given a limited-duration suggestion responded differently from those given an unlimited-duration suggestion. In Experiment 2, real, hypnotized and simulating, unhypnotized subjects were given a posthypnotic suggestion, and nonhypnotic control subjects were given a social request, to mail one postcard every day; the suggestion or request was of either limited or unlimited duration. Real, hypnotized subjects sent more postcards than simulators; control subjects sent as many postcards as real, hypnotized subjects; and subjects given a suggestion or request of limited duration sent more than those given one of unlimited duration. The findings highlight the interaction of individual differences and the social context of the suggestion or request. They underscore important aspects of experience and behavior associated with posthypnotic responding away from the hypnotic setting.
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.
This study indexed the relationship between intrusive thoughts and hypnotizability. After screening on the Harvard Group Scale of Hypnotic Susceptibility, Form A and the Stanford Hypnotic Susceptibility Scale, Form C, high-, medium- and low-hypnotizable participants (n=55) were given an intrusive thoughts questionnaire that indexed frequency, pleasantness, involvement and vividness of intrusive thoughts. High-hypnotizable participants reported more intrusive thoughts than low-hypnotizable participants. Although vividness of intrusions and involvement in the intrusions were correlated, these were not associated with hypnotizability. These findings are discussed in terms of the role of hypnotizability, absorption and fantasy-proneness in the experience of intrusive thoughts. Copyright © 2001 British Society of Experimental and Clinical Hypnosis
Thirty-three female college students who scored in the upper 15% on the Dissociative Experiences Scale (DES) were compared with 33 female students who scored below the mean on the DES on measures of psychopathology (Symptom Checklist-90), college adjustment (Student Adaptation to College Questionnaire), and child and adolescent maltreatment. Compared with controls, high-DES subjects reported more psychopathology, poorer college adjustment, and a greater extent of psychological, physical, and sexual maltreatment. On the basis of the Dissociative Disorders Interview Schedule, 2 high-DES subjects but none of the control subjects met criteria for a dissociative disorder (i.e., multiple personality and psychogenic amnesia). Despite the sensitivity of the DES, 8 subjects who scored in the upper 2% of the population on the DES failed to meet criteria for a dissociative disorder.
We report the analyses of daily journal descriptions of 790 self-defined panic attacks from 59 patients meeting DSM-III criteria for panic disorder or agoraphobia with panic attacks. The DSM-III-R specified symptoms occurred with frequencies ranging from choking (17% of attacks) to palpitations (63% of attacks). The mean weekly panic attack severity correlated significantly with the number of symptoms per attack, but not their weekly frequency. Within a given person, situational and spontaneous panic attacks did not significantly differ over a number of characteristics, including severity, duration, frequency per week, diurnal distribution, and the number of symptoms per attack. Limited symptom attacks were less severe, but were otherwise similar to panic attacks. Also, panic attacks during sleep were less frequent than panic attacks in the awake state, but did not significantly differ on other descriptive characteristics. These data support the validity of the symptoms specified for panic attacks by DSM-III-R. They also suggest that within an individual, panic attacks of various subtypes may be descriptively similar, despite the differing contexts in which they arise. In addition, these data question the diagnostic significance of the limited symptom attack-panic attack distinction.
The first part of this paper examines the concept of dissociation in the context of hypnosis. In particular, the neodissociative and social psychological models of hypnosis are compared. It is argued that the social psychological model, in describing hypnotic enactments as purposeful, does not adequately distinguish between behavior that is enacted "on purpose" and behavior that serves or achieves a purpose. 2 recent dissertations (Hughes, 1988; Miller, 1986) from the University of Waterloo are summarized, each of which supports the neodissociative view that hypnotic behavior can be purposeful (in the sense that the suggested state of affairs is achieved) and nonvolitional (in the sense that the suggested state of affairs is not achieved by high level executive initiative and ongoing effort). The second part of the paper employs a neodissociative view of hypnosis to help understand the current epidemic of multiple personality disorder (MPD). In particular, it is argued that many symptoms of MPD are implicitly suggested effects--particularly prone to occur in persons who have a lifelong tendency to use dissociative type defenses. The present author believes that this account is easier to sustain conceptually and empirically than the current view, which states that a secondary (tertiary, etc.) personality accounts for the striking phenomenological discontinuities experienced by MPD patients.
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.
Compared 3 methods for reducing fear of snakes using approach behavior and self-report anxiety measures of 36 adult female snake phobics. The methods, all involving hypnosis, were: (a) relaxation while recalling fearful snake-related events, (b) fear arousal during similar recall, and (c) posthypnotic suggestion about the disappearance of the snake phobia. All methods led to a significant decrease in fear as measured by overt behavior and self-report instruments, while notreatment controls showed little change. Because fear arousal within treatment had no advantage over methods, some doubt it cast on abreaction as essential to therapy of fears. Hypnotizability was positively related to degree of final approach behavior, and S's self-report of depth of hypnosis was positively related to degree of improvement. No S had ever experienced a harmful contact with snakes; the role of cognitive elaborations in the development of persistent fears is noted. (36 ref.)
This article examines multiple or dissociative personality syndrome as a multiple post-traumatic stress disorder, discussing these patient's developmental histories, their high hypnotizability, and their profound capacity to dissociate spontaneously to protect themselves from emotional and physical pain.
Reviews recent experimental evidence on the hypnotic treatment of obesity, cigarette smoking, alcoholism, clinical pain, warts, and asthma. It is concluded that although hypnosis may be effective with addictive behavior, the therapeutic success is attributable to nonhypnotic factors. In contrast, hypnosis appears to be of unique value in the treatment of clinical pain, warts, and asthma. Differential effectiveness may be attributable to the nature of the disorders or to the manner in which hypnosis is used in treating them. The relevance of hypnotizability to treatment is discussed, as is the need to distinguish between genuine and placebo-based hypnotic effects. It is concluded that future research must be more attentive to the (a) nature of the disorders and patient populations, (b) adequate implementation of therapeutic techniques, (c) context in which treatment is delivered, and (d) influence of hypnotic susceptibility and other S factors on outcome. (41/2 p ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).
This study examined the levels of hypnotizability and dissociation in an outpatient sample of 17 normal-weight bulimic women and 20 healthy controls. Bulimic patients were significantly more hypnotizable than controls (p < .003) and scored higher on a self-report scale of dissociative experiences (p < .02). The results of measures of hypnotizability and dissociation showed a significant positive correlation in the combined subject group. These results are consistent with previous reports on hospitalized patients and college students and suggest that psychological factors associated with hypnotizability might play a role in the etiology and treatment of bulimia nervosa.
There is evidence that preference for a given therapy may influence results. Literature also suggests that hypnotizability may be elevated in agoraphobic patients, making hypnosis a potentially powerful method for treatment. Agoraphobic patients (N = 64) were treated with either exposure in vivo or exposure combined with hypnosis in a crossover design. Half of the patients started with the treatment they preferred and the other half received the other treatment first. Although patients' preference clearly shifted in favor of the combined therapy in the course of the study, no effect of preference on outcome was evident. Although hypnotizability clearly correlated to outcome in the combined therapy, no difference in effect between the two therapies was found on behavioral, self-report, and observer measures. No additional effect of hypnosis could be shown and preference was not found to be a powerful mediator of effect.
Attempted suppression of traumatic memories was investigated in survivors of motor vehicle accidents with acute stress disorder (ASD; n = 24) and without ASD (n = 24). Participants monitored their trauma-related thoughts for three 5-minute periods. In Period 1, participants were instructed to think about anything. For Period 2, participants were administered suppression or non-suppression instructions relating to thoughts of the trauma. In Period 3, participants were again instructed to think about anything. ASD participants reported higher ratings of anxiety, frequency of trauma-related thoughts, and attempted suppression of trauma-related thoughts than non-ASD participants. Participants who were given suppression instructions demonstrated a delayed increase in trauma-related thoughts in the period subsequent to suppression.
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.
Social cognition research has indicated that attempts to suppress thoughts can lead to a paradoxical increase in the frequency of that thought. This phenomenon has been a central component of cognitive-behavioural models of obsessive-compulsive disorder (OCD); however, research has yet to demonstrate deficient thought suppression ability in OCD patients. We examined whether individuals with OCD (OCs) exhibit a deficit in the ability to suppress thoughts. In Experiment 1, attempted thought suppression led to a paradoxical increase in self-reported thoughts for OCs, but not for nonanxious controls (NACs) or anxious controls (ACs). In order to rule out self-report biases, in Experiment 2 we utilized a lexical decision paradigm that measured priming strength of a target word under thought suppression conditions. Results paralleled those of Experiment 1: OCs showed decreased lexical decision latency of the 'suppressed' thought (thought to reflect either increased priming strength or disrupted processing of nonsuppressed thoughts), thus exhibiting a paradoxical effect of thought suppression. This effect was not seen in NACs or ACs. These findings suggest that deficits in cognitive inhibitory processes may underlie the intrusive, repetitive nature of clinical obsessions.
Much research indicates that attempts to suppress thoughts lead to increased accessibility of those thoughts, especially when additional cognitive load is present. On the premise that hypnosis may permit more effective management of cognitive load, it was hypothesized that hypnosis may enhance more effective thought suppression. The present research examined whether the obstacle of cognitive load could be bypassed using hypnosis to facilitate successful thought suppression. Thirty-nine high and 40 low hypnotizable participants were hypnotized and received either a suppression instruction or no instruction for a memory of an embarrassing experience and subsequently completed a sentence-unscrambling task that indexed accessibility of embarrassing thoughts. Whereas lows instructed to suppress displayed a delayed increase in suppressed thoughts, highs did not. These findings support the proposition that hypnosis facilitates thought suppression.