applications of hypnosis- phobias © presented by: maureen finnerty turner, rnbc, lcmhc, lcsw...

Applications of Hypnosis-Phobias ©

Presented by:Maureen Finnerty Turner, RNBC, LCMHC, LCSWCo-Director, Hypnovations: Clinical Hypnosis Education & Training ProgramsPresident, Motivation HypnosisApril, 2010

300.29 Specific Phobia (formerly Simple Phobia) Definition (DSM-IV-TR): A. Marked and persistent fear that is

excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).

B. Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or predisposed Panic Attack. Note: In children, it may be by crying, tantrums, freezing, or clinging.

Specific Phobia – Definition (cont.)

C. The person recognizes that the fear is excessive or unreasonable. (In children, this feature may be absent.)

D. The phobic situation(s) is avoided or else is endured with intense anxiety or distress.

E. The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person’s normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

Specific Phobia – Definition (cont.)

F. In individuals under age 18 years, the duration is at least 6 months.

G. The anxiety, Panic Attacks, or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder, such as Obsessive-Compulsive Disorder (e.g., fear of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), Separation Anxiety Disorder (e.g., avoidance of school),

Specific Phobia – Definition (cont.)

Social phobia (e.g. avoidance of social situation because of fear of embarrassment), Panic Disorder With Agoraphobia, or Agoraphobia Without History of Panic Disorder.

Individuals Prone to Phobias People who develop phobias are particularly

imaginative and hypnotically responsive by nature.

Three studies have indicated that those who develop phobias tend to be highly susceptible to being hypnotized (Fromm & Nash, 1992).

Daitch (2007) makes the point that what may be presented as a specific phobia by the patient/client can sometimes occur with co-morbid symptoms such as agoraphobia or panic disorders, ex. Driving phobia masking agoraphobia – no exit on the highway.

Individuals Prone to PhobiasInfants and Children

Most phobias are caused in childhood. Children are normally and naturally more

vulnerable to fear responses (the younger, the more vulnerable) due to:

Being dependent on care-givers for basic survival

Normally being in and out of trance during daily activities including play.

Individuals Prone to PhobiasInfants and Children (Cont.)

Having Cause-Effect heightened awareness: “if this, then that – ” which can trigger the imprint of a belief (most beliefs are formed by age 5)

Being concrete and literal thinkers – believing

what they are told: “The monster lives in your closet!” (Abstract thought begins age 14-18)

Having heightened awareness so that a warning can become a Post-Hypnotic Suggestion: “Don’t let the spider bite you!”

Individuals Prone to PhobiasInfants and Children (Cont.)

Usually. the younger the child having a traumatic experience and the more severe the trauma - the more “generalized” the phobia (e.g., if a young child was bitten by a black & white dog – the phobia may be - just black & white dogs, all dogs, all black & white four-legged animals including cows and horses.

How the trauma is treated has a profound effect on whether a phobic reaction occurs and whether the trauma is anchored with a secondary gain due to extreme avoidance or attention/rewards.

(Turner, 2004)

Types of Specific Phobia

Specific Type: Animal Type: If the fear is cued by animals or insects. This

subtype generally has a childhood onset. Example: Black & White Dog Bites Child, the younger the

onset, the more likely to be generalized, ie. fear of all black and white animals from guinea pigs to cows and horses

Example of insects: An infected mosquito bite could be the trigger to an imprinting belief that all mosquitoes or even flying insects such as flies and moths are to be feared.

Specific Phobia – Definition (cont.)

Natural Environment Type: If the fear is cued by objects in the natural environment, such as storms, heights, or water. This subtype generally has a childhood onset. Examples: Storms – Grandmother’s fear when it storms Heights – Mother abandoned 9 month-old

daughter - left in her crib with sides down Dark – Ghost stories, movies, sexual abuse Water – Near drowning, boat accidents, bullied

in water play, “Don’t let ‘Jaws’ bite you!”

Specific Phobia – Definition (cont.)

Situational Type: If the fear is cued by a specific situation such as public transportation, tunnels, bridges, elevators, flying, driving, or enclosed places. This subtype has a bimodal age-at-onset distribution, with one peak in childhood and another peak in the mid-20s. This subtype appears to be similar to Panic Disorder With Agoraphobia in its characteristic sex ratios, familial aggregation pattern, and age at onset.

Specific Phobia – Definition (cont.)

Blood-Injection-Injury Type: If the fear is cued by seeing blood or an injury or by receiving an injection or other invasive medical procedure. This subtype is highly familial and is often characterized by a strong vasovagal response. Example: Pediatrician hated giving needles when nurse on vacation.

Specific Phobia – Definition (cont.)

Other type: If the fear is cued by other stimuli. These stimuli might include the fear of choking, vomiting, or contracting an illness; “space” phobia (i.e., the individual is afraid of falling down if away from walls or other means of physical support); elevators and children’s fears of loud sounds or costumed characters.

Specific phobias with co-morbid symptoms

Often the Specific Phobia occur with co-morbid symptoms such as Agoraphobia and/or Panic Disorder and have many underlying layers of related trauma and are more complicated and complex than originally presented.

Case Examples: Fear of driving – Agoraphobia - PTSD Fear of Vomiting – Panic Disorder – PTSD (Turner, 2010)

A Phobic Reaction is a Fear Response

To a Stimuli believed to be Dangerous, potentially Dangerous, or a signal of Danger approaching ( ie., thunder and lightening in the distance heralding an approaching storm)

“The “Response” will depend on the severity

and specificity of the causal event, numbers of times and circumstances the phobia has been “triggered,” age/development of the patient/client and emotional resources.

(Turner, 2010)

Briefly ReviewingFear Responses

Phobic Response is a

Fear Response

First Response to Fear

Normal Freeze – stop, turn toward the source of threat, assess if in danger or safe – within .10 seconds (Amygdala) and decides to Fight, Flight, or Fright (Abnormal Freeze) within an average of .25 seconds

Fight = Anxiety Reaction Flight = Anxiety Reaction Fright = Panic/Phobic Reaction

Fright/Freeze Response

Fright (Abnormal Freeze/Dissociation) – inhibition of action (tonic immobility) meaning resigned acceptance of this new, unpleasant situation. This may enhance survival and is therefore adaptive when there is no perceived possibility of escaping/ winning a fight.

Freeze, Fight, Flight, Fright, Faint

Faint – Feeling faint and fainting. Most associated with the Blood-Injection-Injury Type Specific phobia (BIITS phobia/ “Vaso-vagal Episode”) which may have a genetic base.

(Bracha et all, 2004; Bracha, 2003)

Treatment Choice for Client/Patient

Treating the symptoms of phobic reactions depend upon:

the severity, specificity, the age/development of the

patient/client, emotional and socio-economic

resources.

Applying Hypnotic Techniques to Phobic Reactions for Adults and Adolescents

Hypnotic Direct Suggestions & Metaphor Techniques alone or in conjunction with:

Hypnotic Age Regression/Insight-oriented* approach alone or/and

In conjunction with CBT (Cognitive Behavioral Therapy) and/or EMDR (Eye Movement Desensitization Reprocessing)*

*Techniques chosen to utilize must depend on the needs of the client, nature of License to practice (ie., interventions in keeping with License), experience, and training of the clinician

Applications of Hypnosis to Phobia (April 11,2010):

The two most common hypnotic interventions: 1. Hypnotic Direct Suggestions & Metaphor

Techniques alone or in conjunction with:2. Hypnotic Age Regression/Insight-oriented

approach alone or in conjunction with Direct Suggestions (can start with either technique)*

*Most clinicians use Direct Suggestion first and if symptoms continue, may use Age Regression.

Using Direct Suggestion Hypnosis to Treat Symptoms of Phobia

Psycho-Education (Positive hypnotizability and phobic (Crawford & Barabasz. 1993)

Induce Hypnosis Teach Self-Hypnosis Visualization – Self-Soothing Safe Place

Imagery De-Sensitization Hierarchy Combined with

Sandwich Technique (Daitch,C. 2007)

Systematic Desensitization (Wolpe, 1958), (Rimm & Masters, 1974)

Four Steps:

1. Relaxation

2. Exposure to mildly provoking aspects of the feared event from least frightening to most frightening

3. Great detailing of the fear-induced scenario

4. Rehearsal of behavioral exposure in the office and then finally practice in real life.

Sandwich Technique

Goals: Build an imaginary “sandwich” that alternates

between exposure to soothing images and phobia-related images.

Gain mastery of using a safe place for affect regulation.

Increase tolerance of uncomfortable affective states Diminish intensity of fearful or avoidant responses to

phobia or images of phobia (Daitch, 2007)

Case Example: Desensitization Hierarchy Combined with Sandwich Technique for Needle Phobia (Daitch, Affect Tool Box, 2007)

After Vaso-Vagal Reaction education: Look at picture of a syringe with a needle. Look at a picture of a nurse giving someone

a shot. Look at a real syringe. Visit an acupuncturist with me to observe

acupuncture treatment. Watch a diabetic friend give herself an

injection.

Case Example (Continued)

Visit the Red Cross with her husband and watch him give blood.

Go to the Dr.’s office with her husband and get her blood tested.

Allow her husband to administer prescribed fertility injections in my (Daitch’s) office.

Allow her husband to administer injections at home.

Total Treatment Visits: 12 weekly visitsTen months later – she was pregnant with twins.

Age –Regression and Insight-oriented hypnotic procedures

Review conscious history and recall of events re. the specific trauma – in attempt to identify cause(s)

Teach Rescue Mission Technique – and prepare patient/client for their role in the “rescue”

Induce Age Regression utilizing Somatic Bridge (Body sensations and Affect Bridge)

Using Rescue Mission Techniques - Lift the Imprint, all events related to Specific Phobia and any layered related traumas until symptoms are relieved and phobia is eliminated. Anchor Ego-Strengthening with Direct suggestion (Turner, 2004)

Advanced Training Recommended before using Age Regression

Specific Stimulus as Trigger to the “Cause – Effect” Belief which triggers the “symptoms.”

When utilizing the Somatic/Affect Bridge to identify the causal imprint to the phobic reaction, Turner has found in the treatment of over 100 Phobias that the Imprinting event is similar to a classic trauma event and the treatment is similar to addressing PTSD. (Turner, 2010)

Case Examples: (1) Dental Phobia Needles and Procedures; (2) Snake phobia

Applying Hypnotic Techniques to Phobic Reactions for Children

1. Containment of Phobia - educating parents, who need to know that:

Children are in and out of trance naturally during the day Children are naturally concrete thinkers – the younger, the

more literal “Suzie is always so afraid of snakes!” is a Post-Hypnotic suggestion!

Establishing a secondary gain can be avoided via reducing attention/rewards

Re-introducing exposure before clinically ready can also re-enforce the phobia.

Applying Hypnotic Techniques to Phobic Reactions for Children (Cont.)

Technique options depending on Clinician Environment (Medical or Psychiatric): Hypnotic Language, Direct Suggestion,

Metaphors, Imagination, De-sensitization and Visualization with and without Play Therapies.

Applications of Hypnosis – Phobias References

American Psychiatric Assoc.(2002). DSM-IV-TR, Washington,D.C.: American Psyciatric Association.

Daitch, C. (2007). Afffect Regulation Toolbox. New York: W.W. Norton &Co.

Olness, K. and Daniel, P.(1996). Hypnosis and Hypnotherapy with Children. New York: The Guilford Press.

Thomson, L.(2005).Harry the Hypno-potamus, Vols.1-2., CT.: Crown House Publishing Limited.

Turner, M. (2004). “Using Ego Therapy and Solomon Asch’s Social Decision-Making Theory to Treat Cognitive Errors (Opinions, Beliefs, and Judgments) in Trauma Patients” Presented at Crasilneck Session Presentations, Society for Clinical and Experimental Hypnosis, 58th Annual Workshops and Scientific Program.

Applications of Hypnosis – Phobias References (Cont.)

Turner, M. (2009). The Unconscious Mind and the Conscious Mind: How They Co-habitate, Co-operate, and Differentiate –Whose is Whose and What is What! (a working draft). Vermont: Motivation Hypnosis Publication.

Turner, M. (2010). Applications of Hypnosis – Phobias. Vermont, Motivation Hypnosis Publication.