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APPLICATIONS OF HYPNOSIS: ANXIETY© Maureen F. Turner, LCMHC,RN-BC,LCSW Hypnovations: Intermediate Clinical Hypnosis Workshop April 9-11, 2010 Anxiety Anxiety is the most common presenting issue in Clinical Hypnosis. Anxiety is also the most easily reduced and many times, eliminated by the application of hypnosis and hypnotic techniques. Anxiety from a specific situation or fear can cause some or many anxiety symptoms for a short time. When the situation passes, the symptoms subside. Many people, including children and adolescents, develop anxiety disorders in which there is “no identifiable cause.” Anxiety Does Have Causes! According to Mark Schucket, M.D., of the UCSD School of Medicine, Generalized Anxiety can consistently be traced to one of three causes: 1. A reaction to an ingested substance (including prescriptive medications) 2. A reaction to some physical ailment that has not been recognized, or 3. A reaction to psychological issues. While our focus will be the psychological issues - Non-psychological Causes of Anxiety are important to screen out! For Example: – Anxiety signs & symptoms can be caused by sleep deprivation, apnea, excess caffeine (8 cups a day), prescribed stimulants, anti-depressant enhancers, nicotine (cigarettes, chew, patches, lozenges), vasodialators in sprays and inhalers, anti-histamines in cold and allergy medication, and over-prescribing of thyroid replacement. (All of the above were mitigating factors with individuals requesting treatment for Anxiety in Maureen Turner’s Adult-Child Clinical Hypnosis practice within the first 3 mos. of 2010) “No Identifiable Cause” It is a fair statement and better than educated guessing or dismissing all anxiety to the psychological realm. “No Identifiable Cause” of symptoms may be akin to the Chaos Theory in field of Physics – much of what had been dismissed as random molecular activity – is now being found to be actually not random but “predictable” and the assumption of random appears to be a pseudoname for “we don’t know the formula yet!” (Turner, M. 2010) Phobias and Panic Disorders Phobias and panic disorders are two common anxiety-related disorders. Phobias are irrational, involuntary fears of common places, objects, or situations, i.e., the “cause” is thought to be known! Panic disorder is characterized by distinct periods of intense fear and anxiety that occur when there is no clear cause or danger. Hypnosis provides access to cause and treatment. Clinical Hypnosis – Changes in Paradigms l Clinical Hypnotherapist as Diagnostician – no longer just treating symptoms. l Patient/Client as colleague on the team l Clinician and Patient/Client attaining an appropriate “Working understanding” of: – the new Brain research on Mind/Body – Unconscious and Conscious Minds – Belief Change = Behavior Change Anxiety – Mind/Body View Anxiety – a mind/body fear response to a perception of danger. This response becomes the “default (or ‘automatic’ or ‘unconscious’) response” to the danger stimuli - until and when - new information is sufficient to change the response. First Mind/Body 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 BloodInjection-Injury Type Specific phobia (BIITS phobia/ “Vaso-vagal Episode”) which may have a genetic base. (Bracha et all, 2004; Bracha, 2003) THE CIRCUITS OF THE BODY'S ALARM SYSTEM Amygdala: Trojan Mouse of Motivation The Amygdala is part of the limbic system located in the Mid-brain, which coordinates survival responses and is responsible for emotional arousal and memory. The amygdala has been described as “the Trojan mouse of motivation: Upon this small site, all else depends. It plays a powerful part in labeling or tagging an experience as significant. Once an experience has been tagged, we respond thereafter in very different ways (Smith, 2004). The amygdala is very small, the size of a thumbnail, almond shaped, and composed of a dozen or so of neural clusters. Each of these clusters links with different structures elsewhere in the brain and utilizes different chemical messengers to facilitate connections. The amygdala is involved in regulation of arousal, sleep, immune responses, movement, reproduction, and memory (Smith, 2004). The neuroscientists find that the amygdala seems particularly involved in aggression, fear, anxiety, and worry. The amygdala is closely connected to the frontal lobes which manage impulsivity, long-term planning, discrimination and fine judgment, and goal setting. There are more connections from the limbic system up into the cortex than in the reverse direction, and there are more connections from the frontal lobes into the amygdala than from any other part of the brain. (Smith, 2004). Trauma =Trigger – Trauma event memory is stored in the lateral nucleus – therefore, all information from the outside world is screened for trauma event triggers before it even gets to the amygdala – If the lateral nucleus is “triggered” – this is communicated to the amygdala which then interprets what level of fear (anxiety reaction) to effect. THE CIRCUITS OF THE BODY'S ALARM SYSTEM Imprinting the Fear Response in the Mind/Body Prefrontal Brain – perceives the environment Amygdala in Midbrain – links perceptions to emotions – it is now considered center of the fear process if deemed dangerousthe event is “encoded” by the amygdala Beliefs Control Biology (Lipton, B., 2008) A trauma is “encoded” through a process of neuropeptide activity that encases the event in total with all of its senses including immediate prior trauma events that are now associated as the cause. ( Lipton, B., 2008) The “prior trauma events” can be up to 15 minutes prior to the trauma happening - this can include laughing and having fun, snow falling, a cold temperature –just prior to the dog bite, accident, or news of death, etc.- the prior events can, and often do, become “triggers” to the mind/body fear responses. (Turner,M., 2010) “There is only one way to change beliefs- with new information! The “encoded trauma” is then stored in the lateral nucleus periaqueductal gray region (seat of immobility) of the midbrain. There is only one way in to change the belief(s) of the encoded trauma (ex. All black and white dogs are dangerous!) and that is with new information – Only New Information can be transmitted to the Lateral Nucleus Only new information is able to penetrate the encoded fortress of the Lateral Nucleus which is protecting the traumatic event and that part of the ego state that is trapped in there. Any subsequent event that reminds the lateral nucleus of the original “encoded” event is stored in the same or near-by file. Intelligent Cells Mind and body become one as neuropeptides chemically communicate emotions, thought, and beliefs to cells. The “mobile brain” translates intelligent information from one system to another – profoundly influencing how we respond to and experience our world. (Pert,C.,1997) Intelligent Systems Mind and body become one as neuropeptides chemically communicate emotions, thought, and beliefs to cells. The “mobile brain” translates intelligent information from one system to another – profoundly influencing how we respond to and experience our world. (Pert,C.,1997) Intelligent Systems (cont.) It is now become more and more accepted by neuroscientists that emotions are “the result of multiple brain and body systems that are distributed over the whole person” and that “we cannot separate emotion from cognition or cognition from the body” (Ratey,J. 2001) Ex.: Triggering Unresolved Grief For example, it is common for an individual to go to a funeral of someone they hardly know or know not at all – but is a relative of a friend, colleague, classmate, etc. and attendance is out of respect and support of them. It is also common for this same individual to find themselves tearing, crying, and even sobbing in sympathy (because it triggered a memory of personal loss(es) that are still traumatic. Hypnosis: Beliefs,Emotions,Behavior Change Most basic beliefs are established by the time a child is 5 years old. Basic beliefs (positive and negative) are “cause-effect” in outcome. The Making of a Fear Response Imprint Since most imprints occur in childhood – the child is dependent upon the adult or older child to define the danger and response. Children believe what they are told, and in danger – do what they are told. Beliefs make sense Beliefs provide for protection and mastery over one’s environment. The belief dictates the behavior accordingly – “if this, then that.” Once beliefs are encoded, so is the habitual response (physical and emotional response). Hypnosis and Belief Change Hypnosis – provides access to the unconscious mind where these beliefs are stored. The analytic conscious mind is relaxed so that its “gate-keeping” functions are no longer fending off new information from gaining access to the amygdala’s encoding function. De-Coding, Un-coding, then Changing Beliefs By providing new information to the encoded belief – enables change is to the belief system and change the response. Imagined/ or real new information such as: – using teaching metaphors that match, – future progression (imagining when a negative behavior is no longer a problem), and/or – giving direct suggestions which address the belief (s), emotion, and behavior (s). – utilizing Solomon Asch Conformity Research and establish a duality connection between the traumatic part and the present healthy parts of the patient/client in a “Rescue Mission” ( Turner, M. 2004) Applying Hypnosis to Belief Change Pre-requisites: Establish RAPPORT, Trust, and empathy As clinicians using Clinical Hypnosis, we are treating people with words. What we say, what we omit, and how we say it matters very much. The dictionary and thesaurus are our pharmacopoeias. (Ewin,D., 2008) All Hypnosis is Self-Hypnosis In non-emergency situations, Teach Self-Hypnosis and establish and anchor* a “Safe Room” in their mind – before beginning belief change work. * An Anchoring Script is included in Handout for this presentation – M. Turner. Anchoring – as a Powerful Hypnotic Technique Anchoring is the Process of Labeling a Positive Mind/Body State of Mind that can be utilized as an antidote or counter-balance to Negative Mind/Body States. It is a NLP (NeuroLinguisticProgramming) technique that is even more effective when induced in a hypnotic state. Anchors are a great resource (s) to helping one – “right one’s own ship!” (Turner, M., 2004) Anchoring – a “bookmark” for the Unconscious Mind – A Safe Harbor Establish safe and self-soothing anchors of comforting and empowering mind states. Follow the patient/client lead whenever possible provided there are no contra-indications. Let them know that the states they anchor need to be positive and not associated with negative consequences – such as a beach in Hawaii that was also the site for a major argument later on in the day/vacation. Anchoring Resources – “to have and to hold.” Establishing anchors for positive empowering mind states allows for re-harvesting these empowering experiences and using them as a value-added resource , such as – re-capturing proud moments of the past, feelings of “I’ve got what it takes!”. Positive empowering beliefs can be further enhanced: “If there is a will, there is a way!” The trance states respond to happy feelings being anchored – such as at a good birthday party memory or a reunion of friends – to be anchored to enhance self-esteem and reduce social anxiety. Anchoring for Emerging In trance, suggest prior to emerging patient/client that they decide “how they would like to feel when they emerge and ask them to tell you what that state of mind is so you can help them anchor it (and evaluate whether it is in their best interest to do so). In Trauma - is In Trance An emergency can be highly anxietyproducing. Be calm and directive i.e., “The worst is over! You are safe now.” Prompt their imagination as needed. to relax and distract. (Anchor safety) Teach them self-hypnosis. Keep them current with what is happening as necessary, i.e., the ambulance is on its way. Hypnosis and Emergency Anxiety Hypnosis not only can reduce anxiety in an emergency situation, but it can effect positively all systems. Bleeding, swelling, pain, heart beats, breathing, and blood pressure can be directed to respond in efforts to life - and limbsave. Hypnosis healing enhancement qualities have been proven to save days in post-op hospital stays due to accelerated healing. And, Remember the victim is in a trance state and also highly susceptible to negative suggestions. And that, hearing is the last sense to be retained in life. Words can be life-saversl References Lipton, Bruce (2008). The Biology of Belief: Unleashing the Power of Consciousness, Matter, and Miracles. New York, Hay House. 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. 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 – Anxiety. Vermont, Motivation Hypnosis Publication. Turner,M. (1995-2010). Private Clinical Hypnosis Practice, Case Presentations. (Unpublished). Anchoring or Labeling Positive Mind/body States Script© (Turner, M. 2009) Anchoring or Labeling Positive Mind/body States Script© (Turner, M. 2009) Allow yourself to find a place that you enjoy going to and that you would like to visit again and have as a resource to calm yourself down. Vividly go there – see what you would see if you were there now, notice the colors of what you see close up and far away. Anchoring Script Page 2 Hear what you would hear if you were there. Notice the subtle sounds too. Feel your body and mind – notice how you feel when you are there, notice the air and whether there is any wind. Smell any smells that make you know you are there. Any tastes that you connect with this comforting place. Anchoring Script Page 3. And when you feel just as you wish – allow yourself to anchor – like a book-mark for your unconscious mind – You can just talk to your unconscious when you are ready and give this feeling a name that is easy for you to remember – it can be the actual name of this place that you are in or something else that you want to name it. Be sure to label it something easy to remember and store it in a place in your mind/body that is easy to find. Anchoring Script Page 4. When you have your name label for it – ask your unconscious mind, if you wish, to come to this place in your mind whenever it is safe to do so and you say the name to yourself and give yourself a “thumbsup!” That can be your signal to yourself to come here – safely, easily – for a moment or longer depending on the safety of doing so. Anchor it or label it if you wish with the instructions I just gave you. Anchoring Script Page 5. And then, raise your finger to let me know you are ready to move on. Turner,2009)