Hypnotherapy for Anxiety Disorders 2

Second part of anxiety disorders

Some of the more noteworthy instances are:

1) Generalised or free floating anxiety. Diffuse vague unpleasant feeling of fear and apprehension. Worries about unknown dangers or risks inherent in everyday events. Symptoms may include rapid heart rate, loss of breath, loss of appetite, sweating, fainting, diarrhoea, nausea, frequent urination, tremors. With f-f anxiety, there's no obvious cause of the worry, nor is it easily attributed to recent life experience. The symptoms are i) Motor tension  muscle tension, shakiness, inability to relax, strained facial expression, easily startled ii) Autonomic reactivity sympathetic and parasympathetic activity contributing to the physical symptoms, heart, stomach respiration, sweating. iii) Apprehensive feelings about the future. iv) Hypervigilance scan the environment for dangers. Related to the hyperaroused state.

Generalised anxiety is defined as a disorder that does not involve a lack of contact with reality.

2) Panic disorder Like anxiety but intense and sudden. Periods of intense anxiety interspersed with normal functioning. symptoms similar to anxiety but may also include chest pains and palpitations. Some psycho sensory symptoms - distortion of light intensity, sound intensity, strange feeling in stomach, sensations of floating, turning, moving, feelings of unreality or loss of self identity. Attacks may be several seconds, a few hours or even days long. People with panic attacks may develop anxiety that they're about to suffer an attack, particularly in embarrassing situations, in public.

3) Phobias - Phobos Greek god of fear. Specific fear or anxiety, about a particular object or situation. Fears may not be linked to likelihood of happening e.g. more traffic accident fatalities than violent crime victims but more people worry about crime than car accidents (Sarason and Sarason, 1989). Fear may occur even if the phobic person imagines the object or situation. Phobias may develop gradually without there being a specific event or situation which sets it off. Some e.g. fear of cats, cars, staircases are part of everyday life to most of us; others e.g. fear of snakes, heights, pain are felt to some degree by most people. Torgensen (1979) typology of phobias from study of phobic patients:

i) separation fears - crowds, travelling alone, being alone at night.

ii) Animal fears - mice, rats, insects, spiders

iii) Mutilation fears - open wounds, operations, blood or bleeding.

iv) Social fears - speaking in public, being watched.

v) Nature fears - heights, mountains, cliffs, the sea.

Sometimes people develop cumbersome ways of dealing with phobias, subway woman etc. avoiding phobia object. Most common phobias are about things that could really be dangerous (McNally, 1987). Maybe evolutionary e.g. fear of snakes more common than fear of electricity. Tend to be grouped into three categories, namely

i) Simple phobias - fear of a specific object like spiders or claustrophobia. Therapy might involve promoting associations between fear arousing stimuli and non anxiety responses.

ii) Social phobias fear and embarrassment in dealing with others. People may fear that the signs of their embarrassment may show to others, trembling, stuttering, blushing. May involve fear of asserting oneself, fear of making a mistake and fear of public speaking. May involve people feeling inadequate and having social and interpersonal inadequacies. Marks (1987) some techniques for dealing with social phobia. i) Respond to anxiety symptoms by approach rather than withdrawal. ii) Greet people properly with eye contact. iii) Listen carefully to people and make a mental list of possible topics of conversation. iv) Show that you want to speak, initiate conversation asking questions etc. v) Speak up without mumbling. vi) Tolerate some silences vii) Wait for cues from others in deciding where to sit, when to pick up a drink and what to talk about viii) Learn to tolerate criticism by introducing controversy deliberately at an appropriate point.

4) Agoraphobia. Literally fear of the market place. More generally fear of entering unfamiliar situations. May involve fear of leaving home or secure setting. May deteriorate or improve and object of fear may change. Agoraphobics can be divided into those who suffer panic attacks and those who don't. Agoraphobia can develop from panic attacks, because patients associate the panic with the situation in which it occurs. Ag. is sometimes associated with clinging dependent personality (Gittelman and Klein, 1984) and separation anxiety in childhood.

5) Obsessive compulsive disorders Obsessive people are unable to get an idea out of their minds. Compulsive people feel compelled to perform a particular act over and over. E.g. Lady Mac Beth and hand washing. Obsessions may involve doubt, hesitation fear of contamination or fear of one's own aggression. Compulsive behavior may involve counting, ordering, washing etc. Sometimes purely cognitive, e.g. to prevent bad things happening recite series of words to self. Some people have obsessive thoughts but do not act on them, others have obsessive thoughts which lead to compulsive behavior and a very few have compulsive behavior without related obsessive thoughts. Obsessive compulsive people can be very cautious. O-C problems usually characterised by i) The obsession or compulsion intrudes insistently and persistently into the individual's awareness ii) A feeling of anxious dread intrudes if the thought or act is prevented for some reason. iii) The obsession or compulsion is experienced as foreign to oneself as a psychological being. iv) The individual recognises the obsession as absurd or irrational but can't do anything about it. v) Individual feels a need to resist it. O-C people may be very indecisive. O-C rituals may involve i) checking e.g. taps, locks ii) Cleaning or cleanliness iii) Slowness iv) Doubting own competence and conscientiousness. These tendencies increase during periods of stress. Obsessional thoughts can occur in psychotic behavior, but in the latter cases people are more detached from reality. O-C problems are like phobias in that both involve anxiety. Sometimes associated with interpersonal problems.

6) Hysteria. Originally treated by Charcot in C19th. Organic complaints for which no organic cause had been found. Complaints of e.g. loss of sensation in the skin, pains, blindness, paralysis, tics, muscular contractions and seizures. Often accompanied by what Charcot called 'la belle indifference' - Patients did not seem to be concerned about their condition. Also, hysterical patients had their on theories about bodily functioning and the symptoms were compatible with these theories. Charcot used hypnosis an suggested to patients while they were in the trance that their symptoms would disappear - considerable success. Influenced Freud and Pinel. Pinel extended Charcot's work and believed that the onset of the hysterical symptoms was related to an upsetting event and that if patients expressed these feelings the symptoms could be relieved. In US now called somatoform disorder. Somatoform disorder includes i) Psychogenic pain disorder - pain without or in excess of what would be expected from organic symptoms. May be to do with trying to get attention from others or associated with actual or threatened interpersonal loss. ii) Hypochondriasis - where people show unrealistic fear of disease despite reassurance that his or her social or occupational functioning is not impaired. May include obsessive preoccupation with bodily organs and worry about health. Tend to misunderstand the nature of physiological activity and exaggerate symptoms when they occur (Kellner, 1987). iii) Somatization disorder involves multiple somatic complaints, often chronic, sometimes called Briquet's syndrome. Headaches, fainting, nausea, vomiting, abdominal pains, bowel trouble, menstrual and sexual problems, allergies. May induce doctors to perform operations. Woodruff et al (1974) compared 50 somatizing patients and 50 normal controls and found that three times as much body tissue had been removed from somatizing patients. S-D's usually accompanied by difficulties in social relationships, exaggerated displays of emotion and self-centred attitude. iv) Conversion disorders involve complaints by patients that they have lost all or part of some bodily function. Does not seem to be under voluntary control. Symptoms often follow stressful event. Psychoanalysis suggests that the symptom represents an underlying conflict. Sometimes symptoms conflict with medical knowledge, e.g. glove anaesthesia, where patients claim to have lost sensation in their hands, very unlikely neurologically. (But carpal tunnel syndrome??) Episodes may follow upsetting or challenging events. Symptoms may allow person to escape the aversive stimuli or get sympathy. Group hysteria also possible where people who live and work together may suffer similar symptoms.

Changing the subject a bit we have Stress Inoculation training. Based on the work of Ellis (1973) - Rational Emotive Therapy - people have problems because they feel it is necessary always to be totally competent, that they have no control over their feelings, that they must rely on others who are stronger, or that they cannot overcome their past misfortunes. As a result suffer self hatred, hostility, sense of worthlessness and inadequacy. RET tries to replace these beliefs with more positive methods of self evaluation. SIT gets client/patient to talk to him/herself differently about the problem. Several phases i) educational phase in which patient is encouraged to analyse problem rather than just panic. Told that fear involves a) physiological arousal and b) anxiety engendering thoughts, images and self statements. Get client to re-label the physical sensations as e.g. eagerness to demonstrate competence. Result is a change to a sense of learned resourcefulness instead of learned helplessness. The shift in cognitions may in itself lead to a shift in autonomic functions. Client is instructed in the application of specific phrases and skills. Practice and rehearsal. Instruction in muscle relaxation too. Example: Mucous colitis (Youell & McCullough, 1975). Client keep a record of the attacks and note the events that occurred prior to each attack. Majority of patients attacks seemed to occur after negative interpersonal encounter. Instructed to approach individuals who created these negative feelings and ask them if this is how they intended her to understand the transaction. Later in the therapy the client was asked to do concurrent hypothesis testing. Attacks declined over a 50 week period.

References

Bakal, D. (1979) 'Psychology and medicine' London: Tavistock.

Ellis, A. (1973) 'Humanistic Psychotherapy' New York: Julian Press.

Gittelman, R. & Klein, D.F. (1984) 'Relationships between separation anxiety and panic and agoraphobic disorders' Psychopathology (Supplement) vol. 17 ps 65-65.

Marks, I.M. (1987) 'Fears Phobias and rituals: Panic, anxiety and their disorders' New York: Oxford University Press.

McNally, R.J. (1987) 'Preparedness and Phobias: A review' Psychological Bulletin  vol. 101 ps283-303.

Meichenbaum, D, (1976) 'Towards a cognitive theory of self control' In Schwartz, G.E. & Shapiro, D. (Eds) 'Consciousness and self regulation: Advances in research' vol. 1 New York: Plenum.

Sarason, I.G. & Sarason, B.R. (1989) 'Abnormal Psychology' Englewood Cliffs N.J.: Prentice Hall

Torgersen, S. (1979) 'The nature and origin of common phobic fears' British Journal of Psychiatry, vol. 134 ps 343-351.

Woodruff ,R.A. Jr, Godwin, D.W. & Gruze, S.B. (1974) 'Psychiatric Diagnosis' New York: Oxford University Press.

Youell, K.J. & McCullough, J.P. (1975) 'Behavioural treatment of mucous colitis' Journal of consulting and clinical psychology vol. 43 ps 740-745.