Transcript PSYCHOTHERAPY OF PANIC DISORDER AND HYPNOSIS Tahir …

PSYCHOTHERAPY
OF
PANIC DISORDER
AND
HYPNOSIS
Tahir Özakkaş MD.,PhD
Funda Güdücü MD.
Psychotherapy Institute 2008
İstanbul/Turkey
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• Panic disorder (PD) is characterized by
panic attacks that are considered as the
most terrifying symptom in psychiatry, by
many authors.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• Prevalence of PD is 1.5-3 %, whereas,
the prevalence of panic attack (PA) is 3-4
%, because panic attacks can be seen
along the course of other disorders.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• Panic disorder may become accompanied
by agoraphobia that is the fear of being
alone in the public places.
• Agoraphobia can devastate the
functionality of a person severely.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• The diagnostic criteria for panic disorder is
defined in the DSM-IV-TR
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
According to DSM-IV-TR, a panic attack is
characterized by four or more of the following
symptoms
• :
• palpitations, pounding heart, or accelerated
heart rate
• sweating
• trembling or shaking
• sensations of shortness of breath or smothering
• feeling of choking
• chest pain or discomfort
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Psychotherapy Institute
İstanbul/Turkey 2008
• nausea or abdominal distress
• feeling dizzy, unsteady, lightheaded, or faint
• feelings of unreality (derealization) or being
detached from oneself (depersonalization)
• fear of losing control or going crazy
• fear of dying
• numbness or tingling sensations (paresthesias)
• chills or hot flushes
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• The presence of fewer than four of the
above symptoms may be considered a
limited-symptom panic attack.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• Panic attack symptoms overhelm the
patient suddenly and without any apparent
reason. The fear of becoming mad, getting
out of control, and fainting overrun the
patient. Physiological symptoms
accompanying the anxiety persuade the
patient that his/her catastrophic belief is
true.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• This, in turn, catastrophise the symptoms
and thoughts even more. This positive
feed-back, or malign circle so heightens
the anxiety that severe anxiety causes
dissociative symptoms, that is, myriad
forms of somatizations and even
conversions.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• Symptoms, such as profuse sweating,
peculiar sensations in the extremities,
hyperventilation, chest pain, nausea,
paresthesias, dizzyness mostly constitute
an attack. Attacks are generally shortlived. They mostly last less than 10
minutes.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• Panic attack patients have been reported
to be more hypnotizable than the average.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• This shows that the mechanism of the
panic attack is like that of hypnosis. Thus,
the disorder can be handled easily by
hypnotic procedure.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• Spontaneously occurring, panic-filled,
trance-like (dissociative) attacks are a
maladaptive defense against underlying
anxiety.
• To find out the cause of anxiety according
to the several schools of therapy, hypnosis
is a good way to take.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• If a subtle link between a thing and anxiety
had established, hypnosis can shorten the
time to uncover this link.
• Anxiety may be a product of a cognitive
distortion, or a result of dynamic vectors,
or existential causes.
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Psychotherapy Institute
İstanbul/Turkey 2008
• Using psychohypnotherapy,
enlightenment of the patients regarding
underlying pathology can be provided.
• If underlying pathology is considered as a
consequence of behavioral, cognitive,
psychoanalytic, and existential causes at
the same time, not in an eclectical way, we
call it ‘wholistic approach’.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• Hypnosis and self-hypnosis can be used
also in order the patient to be aware of
his/her dissociative capacity that produce
the disorder.
• When (s)he becomes familiar with the
mechanism, (s)he becomes able to control
it easily, reducing the symptoms in a short
time, even stopping them.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• Only the attentive subjects can go into a deep
level of hypnosis, and hypnosis can intensify
one’s attention even more.
• During panic attack there are several ways that
can turn the patient’s attention from bodily
symptoms to imaginations using simple
hypnotherapeutic techniques.
• If one can focus on these imaginations
satisfactorily, the process that leads to panic
attack can be interfered.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• The suggestions of relaxation under
hypnotic trans alleviate panic attack
symptoms.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• Anxiety treatment using hypnosis can be
effective for panic attack patients, because
patients with high-trait anxiety show
stronger respiratory responsivity to
imagined risk of suffocation, which
constitutes a vulnerability factor for the
development of panic disorder. Anxiety
treatment can be improved by hypnosis.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
Behavioral approach:
• Systematıc desensitization, exposure,
aversive training, positive reinforcement
and extinction, relaxation, reconditioning,
supression, support (ego strengthen),
imagination can be applied in combination
of hypnodrama in a more efficacious way
under hypnosis.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
Cognitive approach:
• Hypnotic suggestions are directed toward
the control of cognitions, in this way,
enhancement of self-mastery is helpful in
panic disorder.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
Dynamic approach:1
• Hypnosis facilitates the cooperation of
patients. Many patients can talk about the
things that ashame him/her more easily
under hypnosis than while awake.
• Sometimes it is very easy to access
unconscious conflicts under hypnosis.
Abreaction (catharsis) can even occur
spontaneously in hypnosis.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
Dynamic approach:2
• In addition, some feed-backs can be
obtained in hypnosis, regarding the course
of the therapy. One’s nderstanding his/her
own is realized in shorter time. Hypnosis is
helpful in understanding the internal
dynamics of the disorder. It helps
understand of the patient regarding the
causality of illness.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008
• Alert hypnosis can be used along with
traditional relaxation-based techniques. In
several studies, hypnosis has been found
a valid alternative to drug use. Biofeedback-aided or EMDR aided hypnotherapy
can be used as well.
19.09.2008 Wien
Psychotherapy Institute
İstanbul/Turkey 2008