“Discuss the relationship between stress, anxiety, habits and describe how you would treat these issues with hypnotherapy”. Introduction Common requests for hypnotherapy treatment are those related to stress, anxiety, habits and phobias. An understanding of the relationship between these disorders, examining the similarities and the differences between each, provides the therapist with information useful in deciding how and if to treat these disorders.
It could also be argued that the uniqueness of each client and each set of symptoms demands the therapist to review each case on a one to one basis and not to blur the boundaries between each of these types of disorders, which may in turn result in a less effective form of treatment being provided. Each of these disorders is discussed below, along with mention of any similarities and differences, as well as the considerations that need to be made in the treatment of these disorders. Understanding Stress The term stress was first employed in a biological context by the endocrinologist Hans Selye in the 1930s.
In his usage stress refers to a condition and stressor to the stimulus causing it. Selye researched the effects of stress on rats and other animals by exposing them to unpleasant or harmful stimuli. He found that all animals display a similar sequence of reactions, manifesting in three distinct stages, Alarm, Resistance and Exhaustion. He labeled this universal response to stressors the general adaptation syndrome or GAS. When a threat or stressor is identified or realised, the body’s stress response is a state of alarm.
During this stage adrenaline will be produced in order to bring about the fight-or-flight response. As Dr David Beales, a specialist in the field of stress, commented recently, “There is not enough oxygen in the brain to solve a problem or make s good decision,” This problem occurs because the blood has been diverted from the thinking brain to the emotional brain, which diverts energy to the muscles to provide the fight or flight response. (Whitten, 2009). Resistance is the second stage. If the stressor persists, it becomes necessary to attempt some means of coping with the stress.
Although the body begins to try to adapt to the strains or demands of the environment, the body cannot keep this up indefinitely, so its resources are gradually depleted. Exhaustion is the third and final stage in the GAS model. At this point, all of the body’s resources are eventually depleted and the body is unable to maintain normal function. The result can manifest itself in obvious illnesses such as ulcers, depression, diabetes, trouble with the digestive system or even cardiovascular problems, along with other mental illnesses.
Richard Lazarus and Susan Folkman suggested in 1984 that stress can be thought of as resulting from an “imbalance between demands and resources” or as occurring when “pressure exceeds one’s perceived ability to cope”. Stress management was developed and premised on the idea that stress is not a direct response to a stressor but rather one’s resources and ability to cope mediate the stress response and are amenable to change, thus allowing stress to be controllable.
Treating Stress with Hypnotherapy Based on the work of Lazarus and Folkman, in order to develop an effective stress management programme it is first necessary to identify the factors that are central to a person controlling his/her stress, and to identify the intervention methods which effectively target these factors. Lazarus and Folkman’s interpretation of stress focuses on the transaction between people and their external environment (known as the Transactional Model).
The model proposes that stress can be reduced by helping stressed people change their perceptions of stressors, providing them with strategies to help them cope and improving their confidence in their ability to do so. Hadley and Staudacher support this view in their book Hypnosis for Change (Hadley ; Staudacher, 1996) in which they state that any hypnotherapy treatment provided to help a client manage stress must be tailored to meet the individual needs of that client. They go on to say that these needs are determined by pinpointing the individuals stress stimuli and their accompanying responses.
Successful hypnotherapy treatment will include asking the client to examine the exact stimuli that contribute to their stress and their physical and emotional responses to each stimulus. This will then be followed by using suggestions within hypnotherapy to embed new responses to each of these stress stimulus. Understanding Anxiety One of the negative effects induced by stress is anxiety. Whereas stress is caused by an existing stress-causing factor or stressor, anxiety is stress that continues after that stressor is gone.
Anxiety is a feeling of apprehension, where often the source of this uneasiness is not always known or recognized, which can add to the distress felt by the client. According to Hadley and Staudacher, anxiety does not arise directly out of painful or dangerous situations. Instead, it’s the thought of potential danger, not the actual danger, which produces the symptoms of anxiety. This is similar to the work done by Lazarus and Folkman’s on their interpretation of stress.
This process is referred to as the ABC model of anxiety, the situation – A, gives rise to the thought – B, which in turn causes the anxiety – C. Anxiety is sometimes considered to be a normal reaction to stress. It may help a person to deal with a difficult situation, however when anxiety becomes excessive, it may fall under the classification of an anxiety disorder. The physical effects of anxiety may be similar to those experienced by someone suffering from stress, such as heart palpitations, muscle weakness and tension, fatigue, nausea, chest pain, shortness of breath, stomach aches, or headaches.
When the body prepares to deal with a threat blood pressure and heart rate are increased, sweating is increased, bloodflow to the major muscle groups is increased, and immune and digestive system functions are inhibited, engaging the fight or flight syndrome as also sometimes experienced by those suffering from stress. Treating Anxiety with Hypnotherapy Hypnotherapy can help with the treatment of anxiety in a number of ways. Firstly, the treatment can help clients to manage the symptoms of their anxiety.
For example, Hadley and Staudacher recommend the use of ‘coping statements’ within the hypnotherapy to increase the client’s ability to compose and recover themselves in situations in which they find themselves suffering from anxiety. Similarly, clients suffering from anxiety should also be provided with the knowledge and skills needed for self-hypnosis so that they can continue the work of the therapist between sessions but also in situations in which they face a level of anxiety.
Research provided by the British Society of Experimental and Clinical Hypnosis support this. The outcome and process of treating subclinical anxiety with self-hypnosis and relaxation were compared. Twenty individuals who presented for treatment for stress, anxiety, and worry were assessed, exposed to a 28-day treatment programme (which involved daily measures of outcome and process variables), and re-assessed (for anxiety). It was found that both self-hypnosis and relaxation alleviated anxiety pre- to post-treatment.
Although there was no difference in the outcome data, throughout treatment self-hypnosis rather than relaxation was associated with a greater sense of treatment efficacy and expectation and with a greater sense of cognitive and physical change. (British Society of Experimental and Clinical Hypnosis, 1999) Wolfe (1958) supports this in his work on ‘reciprocal inhibition’, which argues that anxiety and tension co-exist with relaxation and peace of mind.
Hypnotherapy can be used to this affect by creating a trigger for the client, for example, a word that has been selected, to act as a conditioned stimulus. If, for example, the conditioned stimulus is associated with relaxation, then it will trigger off that reaction no matter how sense the client may be feeling at that point. It is however suggested that anxiety treatment provided purely at a symptomatic level is rarely adequate as the anxiety is often a manifestation of underlying disturbance.
Most writers therefore advise that ‘uncovering’ techniques should be employed in such conditions (Karle & Boys, 1987). For example, the ‘affect bridge’ technique described by Watkins (1971) enables the hypnotherapist to explore the circumstances, both past and present, that are associated with the client’s experience of anxiety. Understanding Phobias A phobia is said to be an intense and persistent fear of certain situations, activities, things, animals, or people. The main symptom of this disorder is the excessive and unreasonable desire to avoid the feared stimulus.
When the fear is beyond one’s control, and if the fear is interfering with daily life, then a diagnosis under one of the anxiety disorders can be made. Like anxiety, a phobia centres on our natural reaction to fear. The symptoms suffered with phobia’s are also similar to those suffered by clients suffering from stress or anxiety, such as increased heart rate, dizziness, sickness and a shortness of breath, sweating and trembling, dry mouth, confusion and full of dread.
Also like stress and anxiety, phobias are more often than not linked to the amygdala, which secretes hormones that control fear and aggression. When the fear or aggression response is initiated, the amygdala releases hormones into the body to put the human body into an “alert” state, in which they are ready to move, run or fight i. e. the same fight or flight syndrome as previously discussed. Treating Phobias with Hypnotherapy Again, as with the treatment of stress and anxiety, there are a number of ways in which hypnotherapy is reported to aid the treatment and management of phobias.
One such suggested method is hypno-desensitization, which is adapted from the same behavioural therapy technique developed by Wolpe for the treatment of anxiety, as discussed above. Researchers discovered that phobias, as with anxieties, are learned, maladaptive responses, therefore new more appropriate responses could replace them by counter conditioning. The technique known as systematic desensitization gradually exposed subjects to the stimulus whilst in a relaxed state, maintaining their exposure to the stimulus until any initial anxiety subsided.
It is important for the therapist to take gather a full case-history, including understanding the triggers and associations the Patient has created relating to the phobia. The therapist can work with the client to create an ‘Anxiety Hierarchy’, a scale usually from 0-100, marking out increments of increased anxiety. This scale is used by the therapist to present the imagined scenes to the client starting at zero and working up through the hierarchy.
So long as the client is very relaxed and the increments are equally spaced, momentum is gained as the client learns it is possible to cope with each scene. Because of the similarities between the nature of phobias and anxiety, the recommended hypnotherapy treatments are often also similar. Therefore, techniques such as embedding a trigger to a relaxed state within the treatment, as discussed above for the treatment of anxiety, are also effective for the treatment of phobias.
Understanding Habits A commonly used definition of a habit is that it is something that we do without thinking about it. It is said that when we learn something, the brain makes connections that create pathways for neurological activity. When we then routinely perform the same actions, the brain learns this pattern of behaviour and sets up a pathway. This pathway is a more efficient way for the brain to process the routine, as opposed to a new series of discreet tasks. This then becomes a habit.
Common requests for treatment include the extinction of patterns of behaviour that have become habitual to the point of compulsion such as smoking, hair-pulling, nail-biting etc. or for the re-establishment of lost habitual behaviours such as sleeping. Treating Habits with Hypnotherapy One way in which hypnotherapy is said to be able to aid the treatment of habits is through the use of ‘ego-strengtheners’ associated with the extinction of the targeted behaviour. Emphasis is put on the anticipated benefits of no longer having a particular habit.
Indeed, such a technique can also be a useful part of any hypnotherapy implemented for the treatment of stress, anxiety and phobias, which all involve the client working towards something that they would like to achieve. However, as suggested by Karle and Boys, “While such suggestions are a useful component in any programme and should be included, our experience is that a more powerful approach is one that explicitly tackles the behaviour itself and at the same time provides some relief and compensation for the sense of deprivation involved in ‘giving up’ and for any underlying anxieties”.
For example, this may include time spent embedding new behaviour and thought patterns with the client to replace those associated with the previous habit. Ethical Considerations in the Treatment of Stress, Anxiety, Phobias ; Habits Hadley and Staudacher point out that clients which are showing signs of one of these disorders may also benefit from counselling, in addition to hypnotherapy, particularly if the symptoms are long term. Similarly, clients reporting physical symptoms may be suffering from physical problems which may or may not be related to their condition.
Taking the above into account, as with all forms of hypnotherapy treatment whether for stress, phobias, habits or otherwise, therapists treating anxiety should only proceed when they are confident that hypnotherapy provides a valid form of treatment, and that an alternative method is not actually more suitable. Conclusion There are several similarities in the nature and therefore effective treatment of disorders such as stress, anxiety, phobias and habits.
An understanding of these similarities, and differences, provide the therapist with information useful in the diagnosis and treatment of these disorders. However, as presented above, each client and each experience of the these disorders is different and therefore an ethical and effective hypnotherapist will take time to understand each client and gather sufficient information before diagnosing or undertaking any form of hypnotherapy treatment.