Hypnotherapy for Anxiety Disorders

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Anxiety & Panic Attacks, Cambridge - The Hypnosis Clinic

Anxiety can be a dead weight just hanging over you all the time. Present from the moment you wake, its exhausting, anxiety drains you physical and emotionally, meaning you wake up exhausted and you go about your work or social life in a permanently tired state.

Anxiety can be brought about by specific (work, colleagues, presentations, fear of illness), or non specific issues, just a feeling of impending pressure.

For a confidential discussion phone 0779 210 82 72 or e-mail Anxiety in Cambridge

Hypnotherapy can alleviate anxiety by direct suggestion and by behavioural training both in trance and using self hypnosis can alleviate anxiety and help break mind loops of anxiety.

Hypnotherapy can remove anxiety triggers and be used to dissociate you from these anxiety causing problems.   Helping you regain motivation and move forward to a higher quality of life.

Extreme Anxiety can cause panic attacks, (For hypnotherapy treatment of Panic attacks, visit panic attacks ),  blushing, profuse sweating, trembling, and other symptoms of anxiety, including difficulty talking and nausea, and over all feeling of dread or other stomach discomfort, irregular heartbeat.

Work related stress  Hypnosis can elevate the stress concerning,  performance, targets, a person or people at work who just demotivate you, or just change totally that journey to work which is currently wasted time. more information

The experience of anxiety can range from mild uneasiness and worry to severe panic. At a reasonable level, short bursts of anxiety can motivate us and enhance our performance. If anxiety becomes too severe or chronic, however, it can become debilitating.

Anxiety typically involves an emotional component (e.g. fear, nervousness), a physical component (e.g. trembling, dry mouth, heart racing, stomach churning) and a cognitive component (frightening thoughts, e.g. I'm going to fail/make a fool of myself/loose control). These can then affect our behaviour, for example by putting off or stopping work, avoiding people, not sleeping, or drinking too much.

• leaving home
• coping with work and exams
• dealing with relationships or the lack of relationships
• sexuality issues
• preparing to leave university.
• new job
• moving to new area

But sometimes it is specific situations that are anxiety provoking

• apprehension about going into new or social situations
• having to deal with people in authority
• worrying about whether you have chosen the right course or job
• panic about preparing for and facing exams or making a presentation
• fears about health.

The experience of anxiety can range from mild uneasiness and worry to severe panic. At a reasonable level, short bursts of anxiety can motivate us and enhance our performance. If anxiety becomes too severe or chronic, however, it can become debilitating.

Most theories of anxiety begin with the autonomic nervous system, which connects the central nervous system to the other organs of the body and helps to regulate their functions, like breathing, heartbeat, perspiration, blood pressure. The ANS is divided into two parts, the sympathetic system and the parasympathetic system. When we appraise a situation as fear-producing the sympathetic nervous system raises heartbeat and respiration rate - the fight or flight response. The parasympathetic nervous system on the other hand is involved in returning our heartbeat and other functions to resting level.

People differ in how the respond when anxious - some  may sweat, others may suffer a pounding heart and so forth, the exact profile of anxiety reactions will differ for different people.

People may also differ in terms of their readiness to become anxious. Anxiety may be a personality trait (Spielberger, 1966; 1972; 1985) which might originate in  constitutional differences or be developed through early experiences. Anxiety may also be a temporary state. Again, people  differ in their tendency to see situations as threatening. Walking through a forest may be threatening for one but enjoyable for another. Changes through life course may occur too. E.g. children are afraid of the dark but this wears off in adulthood.

Appraisal: In order for these responses to be activated we undertake some sort of appraisal of the situation - a primary appraisal - if we appraise it as threatening we may then go on to a secondary appraisal where we assess whether we have the resources to deal with it (Lazarus and Folkman, 1984)

In the US anxiety disorders are relatively widespread, affecting 15-17% of the adult population in any given year (Kessler et al, 1994; Regier et al, 1993; Eaton et al, 1991; Blazer et al, 1991; Davidson et al, 1991). Rovner (1993) estimated that the cost to the US economy was $46.6 billion in 1990.

Anxiety involves feelings of uncertainty, helplessness and physiological arousal. Sometimes referred to as part of the group 'neuroses' - characterised by anxiety, personal dissatisfaction and inappropriate but not psychotic behaviour DSM IV groups them as 'anxiety disorders'.

Explanations for anxiety disorders

1) Cultural, social and environmental

People in threatening situations are more likely to suffer mental health problems, chief among them anxiety with exaggerated startle reactions, sleep disturbance and specific fears and avoidance behaviour (Baum and Fleming, 1993; Melick et al, 1993).  In the aftermath of the Three Mile Island nuclear accident researchers studied the psychological impact on people living nearby and discovered that mothers of pre-school children in the neighbourhood displayed five times the rate of anxiety and depression disorders compared to mothers of comparable age in comparable families outside the area. Although some of the symptoms subsided the three mile island mothers were still showing elevated rates of anxiety and depression a year later.

Anxiety might be related to social change. The US population seems to be showing increased rates of anxiety problems, e.g. Weissman et al (1978) discovered rates of 1.4% for phobias and 2.5% for generalised anxiety. By the 1990s these had increased to 11% and 3.8% respectively (Regier et al, 1993; Blazer et al, 1991; Eaton et al, 1991). There are higher rates of anxiety disorder in urbanised countries (Compton et al, 1991; Hwu et al, 1989). With technological changes come some new kinds of fears e.g. in a survey reported by Swingle, 1993) 55% of Americans said they were afraid of using video recorders, answering machines or walkmans and 32% said they were intimidated by computers and were afraid of damaging the machine.

Poverty is linked with anxiety disorders. Blazer et al (1993) discovered that  for those with incomes below $10,000 a year the rate of anxiety disorders is twice what it is for those with higher incomes. In the US this has also been tied to race. E.g. according to Belle (1990) and Bennett (1987) African Americans have the highest rate for generalised anxiety disorder (6% compared to 3.5% for whites). African American women have much higher phobia rates (20%, as opposed to 9% for whites) in any given year.

2) Psychodynamic explanations

According to Freud (e.g. 1917; 1933) we experience realistic anxiety when we are confronted with a genuine external danger, whereas we experience neurotic anxiety if we are prevented from expressing our id impulses. Moral anxiety arises from our being threatened or punished for expressing our id impulses, as a result of which these impulses themselves come to be perceived as threatening. Specific fears result from overuse of the defense mechanisms of repression, where people push the feared object deeper and deeper into unconsciousness, and displacement, where they attach the fear to otherwise neutral objects. Generalised fear results from a breakdown of defense mechanisms, perhaps where they have not been sufficiently developed in childhood.  More recently, object relations theory suggests that children with strict or punitive parents come to fear being attacked by 'bad objects' or losing 'good objects' (Cirese, 1993; Zerbe, 1990). Alternatively, if parents do not treat children in a confident relaxed and supportive manner the self will not develop appropriately and the child may develop disintegration anxiety where the self is perceived as lacking support and develop defensive processes to safeguard their damaged self (Zerbe, 1990). These individuals may be overwhelmed by the stress of adulthood and suffer from self fragmentation (Diamond, 1987).

In support of these psychodynamic positions, experimenters have manipulated people's anxiety. For example Rosenzweig (1933; 1943) arranged for subjects to fail half the problems on a test they believed was important. They remembered less about the questions on which they failed. Luborsky (1973) looked at transcripts of therapy sessions and showed that people reacted to topics that they were anxious about by changing the subject, forgetting what they were talking about and denying negative feelings. In cultures where children are punished more, adults seem to have more fears and anxieties (Whiting et al, 1966). Where parents are overprotective, children seem to be more anxious (Jenkins, 1968; Eisenberg, 1958). Some other studies have been less supportive, for example Raskin et al (1982) looked at people presenting with anxiety disorders and did not find a history of harsh discipline or disturbed childhood behavior.

4) Humanistic and existential explanations

These propose that people become anxious when they have difficulty in accepting themselves honestly and when their defensive postures stop them looking at themselves with acceptance. When children fail to receive unconditional positive regard from others they may become overly critical of themselves and set themselves overly high self standards. These conditions of worth mean that anxiety provoking self judgements break through. Therapists then try to surround the person in unconditional positive regard and create the conditions whereby people can come to believe in themselves and stop evaluating themselves unfavourably. This idea has received some support (Chodorkoff, 1954), but there has been little independent verification of humanistic theories. By nature, humanistic therapists are sceptical of scientific evaluations of their work.

According to existentialists, people are governed by an existential anxiety, a fear of the limits and responsibilities of human existence (Tillich, 1952). Existential analysts have suggested that people, in modern technological competitive societies deny their fears and freedom of choice and lead inauthentic lives, where they are overly concerned with conforming to the standards of society (May, 1965; Bugenthal, 1965). Again, little systematic research has been conducted on this perspective because of the belief of many such therapists that their subject matter is not adequately captured by scientific research.

5) Behavioural explanations - learning to fear.

In 1922 Bagby described a case where a child acquired a phobia (of running water) as a result of an aversive experience. This appeared to reflect the recently discovered principles of conditioning. This was part of a search to find other ways in which fear could be learned. Watson and Rayner (1920) and Little Albert acquiring a fear of rats and Jones (1924) and Little Peter being conditioned out of his fear of rabbits. With the development of social learning theory in the 1960s Bandura and Rosenthal (1966) argued that fear may be learned from watching others being fearful.  Once we have acquired the fear we will tend to avoid  the fear-producing object and thus will experience a reduction in anxiety. Hence, we learn to avoid the feared object.

Some authors have detected specific instances where fears seem to arise from unpleasant events (Ost, 1991; Merckelbach et al, 1991). Others have not found this relationship (Marks, 1987; Keuthen, 1980), This theory has been extended to include the idea of preparedness - that evolution prepares us to be more afraid of certain objects, like animals, darkness, heights etc. (e.g. Marks, 1977; Seligman, 1971).

6) Cognitive explanations

Assume that anxiety is caused by maladaptive assumptions. E.g. Ellis (1977; 1984) suggests that people are inclined to seek approval from everyone, to despair if things are not the way they want them, and keep dwelling on the possibility of fearsome events occurring. Hence people are inclined to overreact and experience fear when confronted with new life events. In a related theory, Beck describes how some people constantly make assumptions that imply they are in immanent danger (Beck & Greenberg, 1988). Experimental evidence has supported some of the features of these models of anxiety. When people are told to repeat to themselves anxiety provoking statements they show more respiratory changes and emotional arousal (Rimm & Littvak, 1969). Beck et al (1974) found that people suffering from free floating anxiety reported negative assumptions and automatic thoughts about physical injury, Illness or death; mental illness; psychological impairment or loss of control, failure or inability to cope; and rejection, depreciation and domination.

Cognitive theorists believe that people whose lives have been punctuated by unpredictable negative events are more likely to be vigilant in trying to predict what may go wrong in the world around them and be inclined to interpret ambiguous stimuli as threats (Pekrun, 1982). People in laboratory studies  respond more fearfully to unpredictable or un-warned negative events compared to predictable ones or those which they are warned about (Weinberg and Levine, 1980).

7) Biological explanations

These have concentrated on the kinds of neurotransmitters and subsystems of the brain involved in anxiety states. Like many other 'mental disorders', important clues emerged through observation of the action of drugs. Benzodiazepines (Valium, Xanax and Librium) were observed to reduce anxiety in the 1950s and the development of brain scanning techniques in the 1970s helped researchers to pinpoint that these drugs seemed to be most active in the hypothalamus and limbic system, in binding to receptor sites (remember what we did about neurotransmitters and their receptors a few weeks ago?) (e.g. Gray, 1987; Costa, 1985; Hollister, 1982).

The benzodiazepines bind to receptors which are designed to receive the neurotransmitter GABA (gamma amino butyric acid). GABA is an inhibitory neurotransmitter - it makes the neurone receiving it less likely to 'fire'. The elevated rate of neural firing in fear reactions is believed to be brought back to resting level by the GABA producing neurones which inhibit the cells which receive them from firing.

Perhaps people with anxiety disorders do not have a working GABA feedback system, e.g. by not secreting enough GABA, by secreting other chemicals which interfere with the action of GABA or having GABA receptors which do not readily bind to the  neurotransmitter. Benzodiazepines act on GABA receptors and increase their ability to bind GABA (Leonard, 1992; Costa and Guidotti, 1979)

This explanation is not complete, as it is known that a number of chemicals, not just GABA, can bind to GABA receptors (Bunney and Garland, 1981). GABA is used very widely in the brain - about 40% of neurones can secrete GABA, so which ones are responsible?

  Aniety information Paper 2

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