Anxiety, Phobias, Panic & Trauma: Cognitive Behavior Hypnotherapy

Anxiety is a reaction to danger or the perception of danger. It is called the fight or flight (or freeze) reaction because the effects of anxiety or panic are meant to fight against or flee from the danger. The goal of this reaction is to protect you by warning you.

Anxiety

Human beings are instinctually survivalists. We knowingly or unconsciously scan our environments for warnings of things that may do us harm. This is helpful, for instance, while we are driving, in that our instinct may give us enough forewarning to prevent an automobile accident. It is not helpful when our perception of potential harm prevents us from focusing on the necessarily activities of our day with a clear mind. Distress occurs when we believe we are helpless to avoid feelings of alarm, remembrances of trauma, or are stuck in a cycle of continual dread or hypervigilence for things that may cause us harm.

Like many things in life too much of a good thing is no longer good. Some awareness of our surroundings can help us avoid danger. Some caution about the future can help us with appropriate planning. But when we are hyperaware of everything -- seeking potential danger where minimal danger exists we find ourselves in distress. Or becoming overwhelmed with negative future predictions. It becomes hard to function in the here and now, hard to see beyond the perception of threat.

Panic

A distinct pattern of biochemical changes take place upon cognitive recognition or perception of danger. Joseph Ledoux, neurologist, said about panic that it is as if there were a neuro-highjacking of the prefrontal cortex, that the analysis of danger bypasses the analytical part of the brain and goes right into the limbic system, specifically the amygdala. The amygdala creates autonomic changes in preparation for immediate danger (whether or not the danger is real does not at this point matter, because the body has already begun the preparation for battle, flight, or freezing if that’s what it takes to survive).

Two chemical substances are released adrenaline and noradrenaline. Noradrenaline is the main neurotransmitter of the sympathetic nerves in the cardiovascular system.These neurotransmitters support the ensuing sympathetic nervous system symptoms such as shortness of breath, strong heart beats (these two alone can cause alarm), heart palpitations, chest pain or tightness, muscular tightness, sweating, nausea, tingling in extremities, light-headedness, hyperventilation, and or sensations of choking or smothering.

During a panic attack one cannot take a metaphoric step back and analyze the source of the danger or interpretation of danger. The body has already taken over in preparation for immediate reactive actions to protect the self.

The sequence of events in cases of panic are such that it may be 30 minutes or several hours before the body goes back to the normal resting state. The noradrenaline and adrenaline take time to reabsorb and go back to homeostasis. Because of this, even though the danger or perception of danger has passed, you may still feel shaky or afraid because the chemical substances are still in the body. Typically someone experiencing a panic attack will afterward experience exhaustion.

Post Traumatic Stress

Persons with post traumatic stress oftentimes have pronounced symptoms of re-experiencing their trauma through intrusive memory or flashbacks, and through avoidance of cues that remind them of their trauma. Hypervigilance tries to reorder the world around the trauma—an unrealistic proposition. Not one of us has control to avoid scents, sounds, similar people, similar circumstances, similar surroundings around us that might trigger panic or sudden reminders of trauma. Thus, the hypervigilant person lives in dread of trauma or imminent danger, and attempts to control what they have no control over. In cognitive behavior & hypnosis therapy (CBH) gradual release of control occurs through imaginal exposure. The hypnosis element of CBH helps in a number of ways, through regular self-hypnosis the general state of alarm is reduced in the same manner as in mindfulness mediation. Research has shown that 8 weeks of daily mindfulness meditation reduces the density of the area of the brain associated with anxiety. Additional to enhanced relaxation and calm state, hypnosis helps to reduce or better control anxiety and nightmares.

Hypnosis can provide a safe environment for exposure to one’s trauma. It is well established that exposure therapy reduces the intense emotional reactivity to past trauma. Many traumatized people have become fearful about their ability to cope with cues or exposure to reminders of their trauma. Hypnosis provides a safe way to desensitize the client to exposure. Hypnotic techniques can help to pace and control the exposure, exploration of the meanings and aftermath of trauma, integration, and resolution of traumatic memories.

Treatment for Anxiety Disorders

Psychotherapeutic treatment for anxiety disorders includes:

1. Cognitive Behavior Therapy (CBT)

2. Cognitive Behavior Hypnotherapy (CBH)

3. Psychoeducation: Body’s anxiety reaction—preparation for danger, Addiction, FDA scheduled drugs and medications, benzodiazepine and opioid medications,

4. Exposure treatment for anxiety and panic: Systematic Desensitization, In vivo Exposure, Imaginal Desensitization, Interoceptive exposure

5. Mindfulness meditation. Research has shown that 8 weeks of mindfulness meditation reduces the density in the amydala, the brain’s anxiety center. (Hölzel BK, et. al.. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Res. 2011 Jan 30; 191(1): 36–43.)

6. Hypnosis. “Hypnosis seems to respect the principle of parsimony, one of the most popular principles of clinical psychology, by creating more rapid gains and enhancing the efficacy of CBT interventions. Indeed, clinical psychologists should always try to utilize the least complex and most efficacious mode of treatment first.” Hammond DC. Hypnosis in the treatment of anxiety and stress-related disorders. Expert Review of Neurotherapeutics. 2010;10(2):263-73.