two case studies involving the hypno-desensitisation approach to the treatment of simple phobias
by Karen Campbell, M.A. (Hons), D.Hyp. MBSCH
In this article Karen Campbell, Clinical Hypnotherapist with a solid grounding in psychology, demonstrates some of the main advantages hypnotherapy affords over conventional treatments of phobias by way of two case studies involving a claustrophobic and a spider phobic
What is a phobia?
Originating in ancient Greece, the word ‘phobia' derives from Phobos - the god of fear. Possibly the most comprehensive definition of a phobia is provided by Marks (1):
A phobia is a special form of fear which is (1) out of proportion to demands of the situation, (2) cannot be explained or reasoned away, (3) is beyond voluntary control and (4) leads to avoidance of the feared situation.
The DSM-IV (Diagnostic and statistical manual of Mental Disorders 4 th edition) divides phobic disorders into three categories – simple phobias, social phobias and agoraphobia. In simple phobias the anxiety is provoked by a specific event, subject or situation, whereas social phobias are evoked by a social situation and agoraphobia is fear of being alone or in a public place where escape might be difficult or impossible. What is common to all phobias is that the fear experienced is most certainly real as the sufferer usually feels ‘out of control' in a particular situation. Phobias therefore can have very debilitating effects on that person's quality of life as they go out of their way to avoid anything that might trigger it.
Harland (1989) notes that the symptoms associated with the phobic reaction are so common that they their description is in everyday usage: sweating with fear, panting with fear, paralysed with fear, butterflies in the stomach, thumping in the chest, and so on. While we all experience one or more of these symptoms at some time when these become a ‘learned habit of reaction', when they occur repeatedly in specific situations, when they are maladaptive and unacceptable to the person experiencing them then they have become pathological and must be treated.
Where do phobias come from?
Hadley and Staudacher (1996) suggest phobias that may be the product of:
a series of stressful or negative experiences
a fear of fear
transmission from someone else (e.g. a parent or sibling)
The aim of therapy is never to completely eradicate the fear since a certain amount of fear is usually adaptive since it allows the client to take sensible precautions to avoid danger. Rather the aim is to help the client to manage their fear. This is where hypnotherapy comes in.
What can hypnotherapy offer over and above other approaches?
There are many different techniques now available to the phobic to help them to manage their fear: conventional psychological therapy; exposure treatment; gestalt therapy; transactional analysis; psycho synthesis; NLP; counselling; time line therapy and EMDR to name but a few. Conventional therapy is very time-consuming though as it can take several sessions simply to teach relaxation techniques before the phobia is ever tackled. Hypnotherapy affords the client the following:
• the opportunity to achieve a deep state of relaxation very quickly
• imagery is enhanced in hypnosis
However, the main advantage hypnotherapy provides over the above approaches lies in its potential to access and communicate with the unconscious mind, from where the irrational thoughts emerge.
While it is incumbent on the therapist to explore the origins of any phobia, often the case history reveals that the client has no awareness of any specific traumatic event which has lead to the build up of a phobia, as Barbara notes in her testimony (below). Desensitisation is therefore recognised as the treatment of choice with most phobic clients (Hartland, 1989). Its roots in the behavioural-therapy method of the treatment of phobias, systematic desensitisation involves developing a scale of fearful stimuli through which the therapist takes the client in the mind while the client is relaxed, calm and in control. The client is thus presented with gradually more fearful scenarios in-vitro to an agreed point on the scale creating new conditioned responses of calmness, confidence and relaxation as the hierarchy is worked through. There must be a target, usually negotiated at the first session and the target must be realistic and achievable. A ‘contract for action' may be agreed whereupon the client agrees to face his or her fear in vivo, in terms of one of the scenarios on the scale, by the end of session four, for example, with milestones built into the treatment plan along the way. Hypno-desensitisation affords the possibility of gradually confronting one's fears using imagination thus avoiding the potentially traumatic consequences of exposure therapy.
Hypnotherapy has other beneficial applications in the treatment of phobias including:
self-hypnosis can be taught to address anxiety and to repeat the therapeutic suggestions post session
increasing self-confidence and self-esteem
post hypnotic suggestions and anchoring help the client to control their breathing, slow their heart, and achieve a relaxed state of mind when faced with the phobic stimulus
dissociation may be employed in order either to provide a safe place of relaxation or to negotiate with the ‘part' responsible for the phobic reaction
ideo motor responses can be invoked in order to receive permission for change, to create dissociation and to establish change without conscious interference
age regression can guide the client back in time and help the client re-examine the event that initially triggered the fear from an objective point of view thus re-establishing control; it can also be employed to access positive feelings such a s self-confidence, calmness and assertiveness
pseudo orientation in time can be employed so that the client can visualise themselves coping effectively in the future when faced with the phobic stimulus
Case study 1: Claustrophobia
How long does it take you to get to work? In my case it depended on how many people were already occupying the front carriage of the train. Too many, too hot, no open windows and I'd panic, the doors would close and I'd still be standing on the platform. Claustrophobia is frustrating as well as frightening and can undermine both your confidence and your ability to function normally.
I approached Karen for some help, and help she duly provided through hypnotherapy. Ina deeply relaxed but always conscious state, Karen used visualisation to help me picture myself sitting in control in a busy train, then a hot train, then a hot busy train and so on and eventually in my most feared situation: in a busy hot train going nowhere, stuck due to some unknown reason. In my mind's eye I was calm, safe and in control and able to just relax and do some reading fro work. Back in my real life I can bring this picture to the fore when I commute daily. Knowing that I can overcome my fear my fear even if from a mental picture re-assures me that I am capable of doing this in real life as well as through relaxation and positive thinking. I now know that, in my mind, I have all the space I ever need.
After two sessions I am not 100% ‘cured' as this was never the aim. But the panic has gone and the physical symptoms have been effectively numbed to a point where I can accept, acknowledge and work with these to maintain self-control. I no longer spend my entire working day wasting nervous energy worrying about my journey home and last week I even managed to board a busy train which I knew was going to be held up by the train in front which had broken down.
Karen does not perform magic – rather she uses professionally recognised skills and techniques in a friendly and confident manner through hypnotherapy to facilitate positive personal change.
So am I late for work now as a result of a busy train? Only if I've got a hangover!
I always thought of myself as a fairly rational person - quite calm, not easily stressed, able to cope with most of the ups and downs that life threw at me but, for almost as long as I can remember, the one thing that was absolutely guaranteed to transform me into a quivering wreck was an encounter with a spider.
The sight of a spider scuttling across the floor would throw me into a state of panic. My heart rate would increase, I would hyperventilate and I would often be reduced to tears. I really did not want my children seeing me in such a state and I was acutely aware of the fact that I was probably passing on my phobia to them.
I began to realise that even if I didn't see a spider, I was looking for one. When I entered a room, I found that I was quickly scanning it for spiders - particularly the ceiling. I reasoned that obviously if there was a spider on the ceiling, it would fall on my head! I had other irrational rituals as well. For example, I would always throw back the bed clothes before I got into bed, just to check I wasn't going to snuggle up with a spider. I always checked my shoes before I put them on, again to make sure there wasn't a spider lurking in there.
I didn't really want to become best friends with the arachnid population. I didn't want a tarantula for a pet. I just wanted to be able to be desensitised to the extent that I could cohabit with a spider who was minding its own business in its own web in the corner of my kitchen getting rid of the flies for me. I also wanted to be able to eject those large black ones who like to scurry about my house with apparently no other purpose than to terrify me.
I had thought about hypnotherapy but, in all honesty, had been a bit nervous about what I perceived would be a loss of control. However, one day, when I went upstairs to change my baby's nappy, I found a large spider sitting right in the middle of the changing table and was therefore unable even to grab a clean nappy from the very edge of the table. I decided then that enough was enough. Far from worrying about losing control, I needed to take control of this part of my life. My spider phobia had encroached on my ability to look after my baby daughter properly. It couldn't go on.
My first meeting with Karen was quite an eye opener for me. She asked me to rate my fear of all things spidery on a scale of 1-100 and then we could decide what level on the scale I felt I would be comfortable aiming fro for within each session and by the end of my treatment. 100 for me was having lots of large spiders on me then further down the scale would be lots of large spiders near me then one spider on me and so on. This process actually made me realise just how seriously phobic I was about spiders and confirmed fro me that I was definitely doing the right thing by seeking some help. I discovered for example that even looking at pictures of spiders could give me mild feelings of panic. I wasn't even particularly keen to look at the friendly spiders in the books I'd bought for my young children to try to prevent them picking up my phobia. After discussion with Karen, I decided that dealing successfully with one large spider would be the highest level I wanted to achieve. This came out at 70 on the scale.
At the first hypnotherapy session, I felt slightly nervous, but Karen has such a calm manner and is clearly such a sensible and sensitive person, that I began to feel more relaxed. To allay my fears about being out of control, Karen fully explained to me that I would not be asleep or in some sort of deep trance but rather I would be in the trance-like state that we all reach just before drifting off to sleep at night. In other words, the state we are in when we are fully relaxed. Once I had achieved this state, she would then give my subconscious mind positive suggestions about how I could tackle my phobia. She explained that my subconscious mind would not accept any negative suggestions or any suggestions which would be harmful to me.
Karen is extremely professional and had obviously given my problem serious thought. She had found out about a spider catcher that she thought would enable me to deal with spiders in an efficient way for me. I felt relieved that she didn't expect me to pick them up in my hand and remove them but rather I was going to aim to be able to use the 'bug buster' to get rid of the little blighters. The 'bug buster' turned out to be a mini hoover which was ideal because it could be used to catch spiders in awkward places and, let's face it, they are very often in awkward places.
On the night following my third session I walked into the bathroom and there was a medium to large spider lying in wait for me just beside the door. I waited for the panic to rise but nothing. No hyperventilating or thumping heart either. I even managed to pass the spider again (a manoeuvre which would previously have been impossible) on my way out the door to get the bug buster. I didn't call for my husband I just calmly sucked it up and then, holding my bug buster containing the captured spider (admittedly at arm's length), I set off to find the rest of the family to allow them to thoroughly congratulate me. They did, and I basked in the glory of my small personal triumph.
Now, a few weeks on from that first capture, I am using my 'bug buster' to great effect. I no longer bother with the small to medium sized spiders having adopted a live and let live policy towards them. I still prefer to remove the big ones and I am doing this with greater and greater confidence.
What hypnotherapy did was to help me to have the ability to regain control when panic would previously have set in. Of course this ability can then be used in other areas of life we find challenging.
I still don't love spiders but I don't think I could have overcome my utter terror of them without Karen's help. She, for her part, will no doubt tell me that I have done it myself and it's all about me being able to access my own subconscious and give me the positive thoughts that I need. This, of course, makes me feel very proud of myself and makes me feel that I have taken control of my life although I still couldn't have done it without Karen. Barbara Ross, Solicitor, Bridge of Weir.
Marks, I.M., 1969. Fears and Phobias. Heinemann, London.
Waxman, D. (Ed.), 1989. Hartland's Medical and Dental Hypnosis, Third Edition, Bailliere Tindall. London.
Hadley, J. & Staucher, C., 1996. Hypnosis for change. Third edition, New Harbinger Publications, Oakland, CA.