Discuss the relationship between stress, anxiety, habits and phobias and describe how you would treat these issues with hypnotherapy. Stress Stress can result from many factors and can be a short term or long term problem. Some level of stress is normal and should not be confused with levels of that become debilitating and affect ones everyday functioning. In fact some stress is necessary in order to ensure that we are operating at optimum. Frustration, anger or feelings of anxiety can cause stress. Whilst it is common for stress to be caused by outside factors such as unmanagable workload or demanding children it can be a learned behavior picked up from our parents. We see how the inﬂuential adults deal with situations and we assume that this is appropriate, thus we ﬁnd ourselves stressed by the same things and unable to ﬁnd a way of reducing the impact without help. There are six different types of stress which increase in seriousness from Hypostress which is effectively having insufﬁcient to do or lack of stimulation resulting in boredom, Eustress which is a positive form of stress brought about by having a deadline to meet or something to complete causing the body and mind to “ramp up” activity in order to succeed.
Acute stress is where heightened levels of stress begin to have physical impact, Episodic Acute stress is longer term and can have serious physical impact such as heart attack and stroke. It can be treated but will often take some months to see signiﬁcant beneﬁt. Chronic stress is a very serious state and is linked to cancer and other life threatening disease. Whilst it can be treated, due to its seriousness it can take years to treat successfully. Finally there is Traumatic stress which will usually have been brought about by a seriously stressful event or situation and will need a multi-disciplinary team to treat.
When the levels of stress begin to become destructive a sufferer will begin to ﬁnd difﬁculty concentrating, planning and time management begin to deteriorate, sleep can become disturbed and sex drive can also decrease. Stress can be triggered by a speciﬁc event such as a visit to the dentist or the necessity to deliver a speech or presentation to a group of people, or it can be something which is constantly in evidence which would point to there being issues around self-esteem or inadequacy. Anxiety There is a clear link between stress and anxiety and there has been much debate about the precise deﬁnition of anxiety. In their book “Hypnotherapy – A Handbook” Heap & Dryden describe anxiety as “a learned and anticipatory response” in contrast to fear which usually has a clear identiﬁable reason such as a ﬁre alarm going off or someone threatening you with a knife. Anxiety is much more ambiguous and is driven by an unidentiﬁed sense of foreboding that something will happen and it won’t be good, although there is often no evidence or indeed justiﬁcation for these feelings.
The establishing of underlying reasons for anxiety is absolutely imperative for the ethical hypnotherapist because many of the symptoms manifest in anxiety can be caused by psychosis or speciﬁc medical conditions rather than neurosis and therefore should not be routinely treated with hypnotherapy. Schizophrenia, Bipolar, Alzheimer’s, Parkinson’s can all present symptoms of anxiety so the initial consultation is critical in ensuring that it is neurosis that is being treated. Anxiety can sometimes result from long term stress that has not been adequately dealt with. Anxiety in the appropriate situation is actually very positive, for example if we are attacked we should most deﬁnitely feel anxious in order for our in-built “ﬁght or ﬂight” mechanism to work properly. Anxiety can be triggered by our belief system tricking us into thinking that a situation is potentially dangerous when in fact it is perfectly harmless.
Our belief system is inﬂuenced by the experiences we have and the way that they impacted us at the time. For example if someone who was previously perfectly happy to ﬂy experiences a bad ﬂight, the belief system will possibly present that image the next time the person is due to ﬂy, thus causing anxiety and failing to access the many previous times that a ﬂight had been taken without problems. If this anxiety is not treated it can lead to a phobia. Like too much stress a problem with anxiety will effect our whole life and our ability to function effectively and productively because it will lead us to avoid situations which we believe to be potentially dangerous but which would be very innocuous and often healthy and beneﬁcial. As we avoid the things which make us anxious we feed the negative thoughts and belief system and the more we convince ourselves that we are right to be concerned, and so our anxiety is perpetuated. There are many physical symptoms of anxiety such as tense muscles, stomach discomfort, headache, backache, palpitations, numbness and sweating.
Once again, because these symptoms can also be present in any number of potentially serious physical illnesses the ethical therapist will ensure that he undertakes a thorough and forensic initial consultation. So, we have established that avoiding situations that cause anxiety usually only serves to fuel the ﬁre of anxiety which in the end can lead to a phobia being developed. The subconscious mind sees things in black and white, and so it is important to identify the event or situation that originally caused the anxiety. This is known as the ISE or “Initial Sensitising Event”. If it is not identiﬁed and treated the therapy is likely to fail and the anxiety could develop into a phobia. Often the ISE can date back to a patient’s childhood and then it is necessary to deal with the child’s perception rather than that of the adult self possibly through regression. Phobia John Broadhus Watson developed his theory of conditioning which sought to prove that you can teach people to be afraid of things. It is also clear that some fear is learned and some innate. We are all born with a fear of loud noise and monkeys appear to have an inbuilt fear of snakes so it seems some fears are inherent and some appear to be learned.
Fears will respond to hypnosis but in the same way as it is important to understand the root cause of anxiety and stress it is necessary to ﬁnd the root cause of the phobia no matter how strange it appears. Ethically it is very important for the therapist not to show any level of amusement. Whilst it may seem very odd and whimsical a true phobia is, like stress and anxiety, likely to be hugely debilitating for the sufferer. There are three distinct types of phobia. Simple phobias associated with climbing ladders and being is small spaces. Complex phobias which have a range of related factors such as ﬂying when you may fear crashing, losing control, explosion. Social phobias are associated with being in the company of others and the way that you react physically or emotionally. Panic attacks and Agoraphobia are in their own category of social phobia and sufferers must always be referred to their doctor for full medical examination. They can be triggered by life crisis and may need different course of treatment. Habits A habit is something which we do unconsciously. It is important to recognise that even the most apparently damaging or unpleasant habits at some point were designed to serve a useful purpose. It is as if the mind realised that intervention was required but selected a course of action that was in the long term damaging in a different way.
Too much chocolate may have been to provide comfort, smoking may have been a way of reducing stress. Habits are created by the brain as a way of dealing with avoidance, creating comfort or generating a feeling of joy. The challenge is once again to ﬁnd the underlying need that is being served by the habit and then to ﬁnd a more constructive and useful way of serving the need. In relation to stress the forming of a habit can be seen as the brain “self-medicating” in an inappropriate manner to reduce the impact of unwanted stress. Treatment Strategies Something is common across all of these conditions when considering treatment and that is the necessity to understand the underlying reasons. Without a complete appreciation of the root causes it is hard to imagine a successful outcome. The ethical therapist will take seriously even the most apparently simple and shallow issues to ensure that there is not a more signiﬁcant deep rooted underlying problem or, as discussed earlier, that the symptoms are not indicative of psychosis or serious physical health problem.
When dealing with phobias the cause can be something recent which has caused anxiety, not dealt with and which has turned into a phobia. It can also be something from way back in earlier life. The identiﬁcation of the ISE is imperative for effective treatment. It is also worth pointing out that a phobia can be learned and may not result from a personal direct experience but similarly this needs to be uncovered to allow for effective treatment. Once the underlying cause is established the script will need to confront the situation and deal with it. In the case of all these conditions, particularly stress, anxiety and phobias, the patient will often ﬁnd himself in an agitated state, therefore the relaxation aspect of hypnotherapy is very conducive to successful intervention. Wolpe (1958) was an exponent of the technique of “reciprocal inhibition” which states that anxiety and tension cannot exist in parallel with relaxation and peace of mind thereby illustrating the power of hypnotherapy and relaxtion in dealing with these conditions. The suspension of rational thought is very helpful in dealing with conditions which are, in effect, manifestations of destructive irrational thought.
However, as pointed out in an earlier essay the importance of treating a patient as an individual is critical as no two examples of stress or anxiety or any of these conditions can be considered the same. A personalised script is always necessary taking into account relevant modalities, styles and sympathetic imagery but the aspect of relaxation is critical so effective PMR’s and deepeners are also necessary parts of treatment. Interestingly when developing a course of treatment for a patient the earlier sessions will focus on the calming of the anxiety, stress, phobia or identifying the unnecessary nature of the habit, but in later sessions it may well be important to begin exposing the patient to some of the stress, anxiety or subject of the phobia that he came to cure in order to ascertain the level of success. This is not true of habits. Once stopped there should be no encouragement to begin again. It is worth noting that in dealing with the changes necessary to eradicate stress there can come signiﬁcant difﬁculty and pain and this in itself can lead to anxiety.
The use of metaphor can be very helpful in reducing stress and anxiety. For example in “Hypnotherapy – A Practical Handbook” Karle & Boys use the writing of things that upset of worry a patient on pieces of paper and then throwing them into a stream and seeing them drift away. This type of metaphoric imagery will usually need to be repeated numerous times to take effect but is very useful because it enables the patient to confront the fears and causes of the issue in a more detached and gentle fashion . In the case of habits it is often useful to bring what is essentially an unconscious action into the conscious and to help the patient recognise what the “triggers” are for indulging in the habit. Nail biting for example is often an unconscious action and so a patient may be instructed to bite their nails by the therapist just to bring the activity to the surface and create awareness. Smokers should be asked to identify the situations in which they are most likely to smoke, once again to create some sort of picture around the stimulants and trigger.
For example, if a smoker generally smokes in order to relax in situations of high stress the challenge is to ﬁnd another more productive and less harmful way to bring about that state of relaxation. Sometimes a habit may have formed as an attempt to establish the patient’s independence and boosting self-esteem. In these circumstances it is very important to identify a way of maintaining these positive desires in a more appropriate manner. In summary all of these conditions require a thorough investigative analysis prior to treatment and the initial consultation and subsequent discussions with the patient will be critical success factors. There is a close relationship between all the conditions and indeed the same event can develop into any one of them thus again illustrating the need to identify what happened and what impact it is having on the patient.