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Hypnotherapy as a Tool to Treat Phobias

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Discuss the relationship between stress, anxiety and phobias and describe how you would treat these issues with hypnotherapy

NHS (2013) purport that stress is associated with too much pressure, either from an external (workload, financial worries or relationship problems) or internal (low self-esteem and self-efficacy) source. Regardless of the cause of stress and the various definitions which surround it, biologically, stress is a response to a stressor, or something which is outside of the body’s control and disrupts the homeostasis of an individual biologically from the increased adrenal response of a person and also in their head (Coote, 2005: 247-248). Although stress is stereotypically deemed to have negative connotations, in reality there may be some benefits, according to eminent theories of performance and motivation. Yerkes and Dodson (1908: 459) outlined the following model which depicts the relationship between stress and performance:

This is known as the Yerkes- Dodson Law and suggests that a moderate degree of stress may actually be beneficial in enhancing the performance of an individual, so they can enter a ‘flow’ like state (at the zenith of the curve) where they are engaged and do not have any intrusive thoughts (Csikszentmihalyi, 1990) and is totally engaged within an activity or the daily events of their life. However, as the model illustrates, too much stress can result in anxiety, which can result in a vast amount of physical and psychological problems for the person experiencing stress. On a neurological level, if a person is exposed to constant and significant stress (chronic) for a sustained period of time, this has been proven to ‘rewire’ the brain into negative thought patterns, which naturally lead a person to become more susceptible to anxiety and also result in the suppression and eradication of positive memories, which will naturally decrease the level of a person’s wellbeing, if they cannot recall times when they were happy (Kalat, 2013). Stress can affect someone’s mood on a longitudinal and short-term basis and not allow them to be able to regulate their emotions, which can lead them to be susceptible to anxiety as they may feel lost about their condition and inability to experience positive emotions, possibly even resulting in depression, particularly if the decrease in mood was caused by adverse life events and circumstances (Hammen, 2005). On a side note, stress may also cause a person to put on weight (particularly if they turn to comfort food as a distraction from their problems), which could contribute to their stress still further if they become frustrated with their body image and decrease their self-esteem, which is yet another risk factor and characteristic of anxiety, although this relationship has not been definitively proved in psychological studies (Sowislo and Orth, 2013).

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Although there is an inevitable connection between stress and anxiety, there are seemingly several degrees of how a person can be affected. Normal, everyday stress may result in momentary bursts of anxiety whereas stress on a long-term basis can alter the make-up of the brain and leave a person vulnerable to mood disorders and anxiety and not feeling like themselves. A recent study conducted by the University of California (2013) discovered that prolonged periods of stress affected the hippocampus of the brain in that it developed a stronger connection with the area of the brain associated with the well-known ‘fight or flight’ response connected with stress and weakened relations with the medial cortex, which regulates these emotions and moods. A conclusion could be drawn from this point that people who suffer from stress are more likely to be erratic in their moods and hence more susceptible for suffering from anxiety and distorted thinking. However, another research conducted at the same establishment by Kaufer and Kirby (2013) again referenced the positive features of stress, surmising that it could lead to increased performance as long as an individual’s stress levels are not overloaded.

Stress is known to lead to disturbing and intrusive thoughts which can lead a person to feel a decrease in their mood and possibly experience anxiety due to the distress which these moods can cause a person. Indeed the natures of these thoughts are often obsessional and lead a person to feel frustrated and bereft that they cannot eradicate such thoughts, which naturally increases anxiety (APA, 2009). Consequently, an individual may try to mitigate such thoughts and regulate them, although this may actually do more harm than good, particularly if the scale of the thoughts is exacerbated. This could be related to characteristics of Obsessive Compulsive Disorder, where a person carries out their compulsion in order to bring some immediate relief from the anxiety although this may be detrimental to their behaviour in the long run (Pittenger et al., 2011:315). However, care should be taken by readers not to believe that OCD and anxiety are synonymous with each other, as although they may share a miscellany of characteristics, they are still separate entities.

If a person experiences a plethora of negative of negative thoughts from stress then this can lead to the intensity and prevalence of those thoughts increasing, which could lead them to become ubiquitous in the sufferer’s mind. This is known as rumination, where negative thoughts become automatic and the person is repeatedly thinking the same negative thoughts, which may increase with severity as the individual may have a distorted perception of them, particularly if their mind is addled by anxiety (Smith and Alloy, 2009: 117). This has the propensity also to cause someone to become depressed by what is happening to them and feel a sense of helplessness if they do not foresee an escape route out of their negative feelings.

Interestingly, there seems to be two responses to the issue to stress from people, although it is questionable whether the reaction to stress can be dichotomised in such a manner. A recent study by Green et al. (2012) examined the effects of stress on mice by monitoring some neurons in the medial prefrontal cortex of the brain. They found that such neurons were active in people who ruminated on their thoughts which led to phobias and wishing the negative thoughts would desist. Conversely, the neurons were less active in the mice which were more resilient and dealt with stress better. This seems to infer that there is a biological component to stress and anxiety and that some people are more genetically pre-disposed to be stressed and anxious than others due to their genetic makeup. Synthesising all of the information available in the essay, there does seem to be evidence of a circular relationship between stress, anxiety and phobias.

Hypnotherapy is commonly used as an antidote to conditions where the patient has ingrained thoughts and is susceptible to anxiety from them. It can help with smoking cessation, alcoholism, as well as a whole host of other addictions and cravings, potentially increasing the self-esteem of the client and reducing impulsive behaviours and propagating more rational ones (APA, 2004:284), which seems to indicate the multi-faceted nature of hypnotherapy in that it has some strong applications in curing a myriad of afflictions and problems which a patient may be experiencing. It places the subject under hypnosis in a state of deep relaxation and attempts to change the subconscious thought patterns which a patient may be suffering from which causes anxiety and correct them with more calming ones which may alleviate the stress that they are suffering from (Heap, 2012). This can lead to changed behaviour patterns in the patient and allow them to sample a better quality of life which was not previously available to them.

There are various definitions of it which exist but the most common one which is used is that hypnotherapy is a state of heightened consciousness where someone is more suggestive and responsive to the prompts and probes of a hypnotherapist and exists in a state of heightened awareness which allows them to take on the suggestions which a hypnotherapist may put forward (APA, 2014). The Encyclopaedia Britannica (2004) recognises that hypnosis is an altered state and one which exists in the mind for the person by interacting with their subconscious and changing any thought patterns which may exist within it (such as ingrained and intrusive thoughts), allowing them to access new ways of thinking which will enable them to reduce any stress and anxiety that they may be feeling, which could impact on several areas of their life. Significantly, hypnosis will not work for all people, which is affected by how motivated one is to become hypnotised as this will discern the barriers which the mind puts up to stop the hypnotherapist from entering the patient’s sub-conscious mind. A supposition could be made that the person needs to be intrinsically motivated to want to become hypnotised so that they can be responsive to what the psychiatrist suggests and change their behaviour, which may have a greater impact than if the person needed to be extrinsically motivated to change their behaviour (Deci and Ryan, 1985). This seems a fairly valid point to make, although other variables could influence the success of hypnotherapy, such as the proficiency, skill and expertise of the hypnotherapist.

However, hypnotherapy may not work with all people, with certain individuals being influenced more than others. Hypnosis works by regulating the activity in the brain in the region which directs how much a person concentrates. A study commissioned by Stamford University School of Medicine (2012) investigated the brain activity of patients and came to the conclusion that it was their cognitive style (specifically the high co-ordination and connectivity between areas of the brain related to concentration and paying attention), rather than their personality traits, which influenced their degree of suggestibility, i.e. how much they were affected by hypnotherapy. This actually disagrees with the point made in the earlier paragraph that a person’s type of motivation is more imperative in determining how much hypnotherapy affects them, although their level of motivation is surely likely to be influenced by the chemistry and composition of their brain.

This fascinating development does bring some insight into how people become hypnotised and how open and amenable they are to hypnotherapy practices, which could in turn influence how hypnotherapists actually practice their work and result in greater outcomes for the patient and an alteration in their behaviour. However, it could be conjectured that the relationship a patient has with their hypnotherapist is equally applicable in determining the success of the hypnosis, a point which could be applied to any field where there is an interaction between a professional and client, such as education, health and business. Gilligan (1999) makes the sweeping statement that rapport is the most essential aspect of hypnosis as the relationship between the hypnotherapist and the patient is crucial in quantifying how far the hypnotherapist can probe into the patient’s mind and consequently change their thought and behaviour patterns. The patient may become more ‘suggestable’ if they have established a firm bond between themselves and the hypnotherapist. How a hypnotherapist establishes rapport with the patient seems to be a matter of ethics which needs to be closely be adhered, as in any sensitive and intimate relationship in healthcare. The General Hypnotherapy Register Code of Ethics (2014) expects a hypnotherapist to pay attention to their work with high standards of due care and diligence, taking care to build and sustain a rapport with the client whilst also ensuring that they do implant any false memories within them. This suggests the delicate nature of hypnotherapy as the mind is a fragile and complex being which needs gradually to be changed, so that the benefits can be felt over a long period of time, which is why the code advocates taking the time to build a relationship with clients, and progressively, rather than radically altering their mind for optimal effect.

In essence, hypnotherapy can really allow someone to become free of their phobias and fears, but only if certain conditions exist for them to do this. Firstly, they have to be highly suggestable and open to experience, whilst establishing a good rapport with the hypnotherapist and they also have to be able to remove blockades from their mind which hinder them from accessing the benefits of hypnotherapy.

Screed (script) for assisting someone with nail biting habit

Progressive Muscle Relaxation (PMR)

I want you to get yourself as comfortable as you possibly can be and just relax. Take a moment to calm and compose yourself and just let your whole body relax and release your tensions as you find your whole body relaxing and the tension draining out of you, like you have no care in the world. Feel the relaxation just course up through your body and enter your toes, now, feel it on your toes and the gentle pool of relaxation cascading through your body so that you feel it gently lapping on your toes with no other place for the relaxation to go to, other than inside you.

Next feel it rising up through your legs as all the pain and tension is relieved and you feel much better with nothing troubling you, nothing at all. All is well with the world and so are you and you feel so calm, confident and collected. Next feel the nice wave of relaxation come to your knees so that you feel even more calm, contented and relaxed (extra emphasis on the word relaxed here, i.e. elongate the vowel sounds within it, but not too long). Your knees and legs slacken as you feel great, like you have not a care in the world and everything is well and all will be fine. You have no more worries.

The relaxation starts to spread up through your body now, it comes to your chest and all the anxiety is draining out of you and you feel so much better. Cool, calm and collected, with not a care in the world. You feel no more anxiety, you are in the present moment, with nothing here to bother you and nothing left to worry you anymore. Your arms start to enter the relaxation and you feel even better, with all the positive emotions flooding through you. You don’t need to be anywhere else or think about anything in the future, all that matters is here and the present moment and what you are doing right now, which is entering into a state of deep relaxation, with no more problems or worries or anything left which can hurt or torment you. You feel great, there are no battles to be won, nothing that you have to fight against, only a great feeling of deep relaxation which spreads through your veins into every area of your body now. You feel like you are entering a state of deep sleep, where nothing can bother you anymore and all is well. The relaxation is now there in every area of your body and you know that it is great to be in the present moment right now and nothing else matters at all.

Deepener

You are feeling calm and relaxed as you listen to me speak and nothing else seems to matter anymore, you just feel so relaxed, with no tenseness nothing at all which bothers you, only a sense of deep relaxation, which makes you feel totally at ease with the world and like nothing else matters. Embrace this now as you go still further into this level of relaxation and let it affect all areas of your body. Now it starts to enter your mind and you feel yourself becoming further ingrained in it as you become even more relaxed and you feel any barriers which you have put in your mind, just going, dropping away as if they were never there in the first place and you feel so light and happy.

Special Place

Now I want you to think about a place where you are happy, a relaxing place, perhaps full of sunset, or in nature or any setting which you feel comfortable and relaxed in, a place where you can really become yourself and no-one else can penetrate: it is your own special place. It may be in this very room right now as you feel so relaxed and like nothing else can affect you. You may feel a little drowsy but a deep sense of contentment rises up through you as you feel like nothing else matters and you can stay in this special place for as long as you want and no-one or nothing can take you away from this and it makes you feel sunny and happy.

Linger in this special place for a little while longer and feel the relaxation rising up through you. Notice how this place is just the right temperature and that your fears no longer exist. You feel absolutely brilliant and calm, confident and relaxed, things are the best they have been for a long time. Nothing else matters right now and you know that life is brilliant and that all your worries and fears are not going to affect you anymore and that you have nothing to be scared of anymore, and so much to look forward to in the future. You feel great, serene, content and relaxed and there is an inner peace there.

Suggestion

You are entering a deep phase of relaxation in your life where you will always feel for a very long time, with nothing that will bother, worry or upset you ever again. You will feel joy and happiness which people cannot take away from you and a sense of calm which will envelope you at all times and that no-one else can affect and it will make you feel brilliant and happy, with no more worries, fears and apprehensions. Life is great and you know that now and you can feel all the worry disappearing from you, with none left behind and no traces of it.

Now I want you to think about your nail biting habit. You don’t need to bite your nails, there is no benefit to it, you will only feel unhappy and destitute by doing so. The need to bite your nails is now gone as you feel a sense of calm which cannot be taken away from you, it is something which you feel all throughout your body and there is nothing left which can hurt you, only things which can stimulate you and bring you even more happiness, which was previously not available to you.

Now you are so calm and relaxed, things feel great as you enter a sense of serenity and well-being. You don’t need to have any bad habits and you can just feel great, like nothing else matters. Indeed, nothing else does matter anymore and you realise that now as you enter that enhanced state of relaxation which you have been craving for so long. You feel calm, collected and relaxed. You only need to be here right now. No other place. Just here and then you will feel so much better and happy and all your fears and anxieties just drain away. There is no need to bite your nails, there is no need to do anything at all, the only thing you need to do is be here in this present moment right now, with no other distractions, just here and nowhere else. That is all you need to think about.

Reorientation

Now you are going to gradually return back to the present and I am going to count down from five and when I reach one you will open your eyes and you will feel great, like you have not a care in the world and everything is right with no more fears, worries and anxieties. Five, your body is still relaxed, you are starting to return to the present moment. Four, you feel even better now and things are going to change. Three, slowly coming back now, two and one, now open your eyes…..

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