Transcript Applications of Hypnosis-Phobias

Applications of HypnosisPhobias ©
Presented by:
Maureen Finnerty Turner, RNBC, LCMHC, LCSW
Co-Director, Hypnovations: Clinical Hypnosis
Education & Training Programs
President, Motivation Hypnosis
April, 2010
300.29 Specific Phobia (formerly Simple
Phobia) Definition (DSM-IV-TR):
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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).
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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.)
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C. The person recognizes that the fear is
excessive or unreasonable. (In children, this
feature may be absent.)
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D. The phobic situation(s) is avoided or else is
endured with intense anxiety or distress.
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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.)
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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
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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 comorbid symptoms such as agoraphobia or
panic disorders, ex. Driving phobia masking
agoraphobia – no exit on the highway.
Individuals Prone to Phobias
Infants and Children
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Most phobias are caused in childhood.
Children are normally and naturally more
vulnerable to fear responses (the younger, the
more vulnerable) due to:
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Being dependent on care-givers for basic
survival
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Normally being in and out of trance
during daily activities including play.
Individuals Prone to Phobias
Infants and Children
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(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 Phobias
Infants and Children
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(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.)
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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.)
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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.)
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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 comorbid 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
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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 Reviewing
Fear Responses
Phobic Response is a
Fear Response
First Response to Fear
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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
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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
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Faint – Feeling faint and fainting.
Most associated with the BloodInjection-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
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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
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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 phobiarelated 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.
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Go to the Dr.’s office with her husband and get
her blood tested.
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Allow her husband to administer prescribed
fertility injections in my (Daitch’s) office.
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Allow her husband to administer injections at
home.
Total Treatment Visits: 12 weekly visits
Ten months later – she was pregnant with twins.
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Age –Regression and
Insight-oriented hypnotic procedures
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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.
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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.)
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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
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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.)
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Turner, M. (2009). The Unconscious Mind and the
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Motivation Hypnosis Publication.
Turner, M. (2010). Applications of Hypnosis –
Phobias. Vermont, Motivation Hypnosis
Publication.
Conscious Mind: How They Co-habitate, Cooperate, and Differentiate –Whose is Whose and
What is What! (a working draft). Vermont: