Awake-Alert Hypnosis in the Treatment of Panic Disorder: A Case Report

American Journal of Clinical Hypnosis,  Apr 2005  by Iglesias, Alex,  Iglesias, Adam

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An individual developed a lifestyle-limiting case of Panic Disorder that threatened to interfere with her raison d'etre: To participate in the exclusive lifestyle of her community. The panic episodes started to cripple her social calendar and as the "season" came into full swing her coveted role of chairwoman of various philanthropic functions came into peril. A variant of awake-alert hypnosis had to be created for this case. Hypnosis consisting of eye closure with relaxation was out of the question. The authors created an induction technique and specific suggestions based on the Waterford glassware, as focal point, with the purpose of not only inducing awake-alert hypnosis but also of executing a series of specific strategies, tailored to abort the incipient panic episodes.

Keywords: Awake-alert hypnosis, panic disorder

Panic Disorder has been described as perhaps the most terrifying of all psychiatric symptoms (Maxmen, 1986). Suddenly and devoid of any logical reason, panic attacks inundate the unsuspecting victim with overwhelming ominous thoughts. Moreover, these episodes are accompanied by a constellation of horrific sensations that create fears of going mad or of actively dying. Complicating the picture is the slippage of controls that the individual has always taken for granted. The loss of control at times escalates into a sense that one is losing consciousness (Beck & Emery, 1985). The striking characteristic of a panic attack is the overwhelming and paralyzing experience of being engulfed by anxiety (Barlow, 1993). The individual's reasoning powers are categorically suppressed by the anxiety and the accompanying cognitive ideations of doom, destruction, and imminent death (Burns & Beck, 1978). A host of physiological correlates are present during an episode and they conspire to convince the victim that he must fight for his own life. Profuse sweating, peculiar sensations in the extremities, hyperventilation, chest pains, nausea, paresthesias, chills or hot flashes, and feeling dizzy or faint constitute the constellation of physiological symptomatology that make panic attacks such a devastating experience (American Psychiatric Association, 1994). Most episodes have duration of 3 to 10 minutes and rarely more than 30 minutes.

Panic attacks can present in a host of Anxiety Disorders including Panic Disorder, Social Phobia, Simple Phobia, and Posttraumatic Stress Disorder. The DSM IV (American Psychiatric Association, 1994) further classified Panic Disorder to be with or without Agoraphobia and adds that for Agoraphobia to be present, the individual has to report anxiety in places or situations from which escape might be difficult or in which help may not be available in the event of having unexpected panic attack symptoms (American Psychiatric Association, 1994).

Hypnotherapy of Anxiety Disorders

Because hypnosis exploits the intimate connection between mind and body (Rossi & Cheek, 1988) and provides relief through improved self-regulation (Kirsch, Capafons, Cardena, & Amigo, 1999), it holds utility in the treatment of the anxiety disorders. Moreover, as it beneficially affects the control of cognitions (Zarren & Eimer, 2001) and enhances the experience of self-mastery (Dowd, 2002), hypnosis has been deemed an efficacious treatment for the management of Anxiety Disorders (Smith, 1990).

Hypnosis has been employed in the treatment of Panic Disorder in different ways, depending on the theoretical orientation of the hypnotherapist. The combination of hypnosis and behavioristic principles and strategies was documented in a study of the efficacy of biofeedback-aided hypnotherapy for intractable phobic anxiety (Somer, 1995). McNeal (2001) reported on the role of hypnosis aided with EMDR in the efficacious treatment of phobias. A dynamically oriented hypnotic approach for the therapy of anxiety reactions was developed by Spiegel and Spiegel (1978). Their approach stressed the importance of helping the patient understand the historical origin of the anxiety condition.

Hypnosis is recognized as a potent anti-anxiety intervention, which can be incorporated into a variety of theoretical systems and models of therapy. Its efficacy and role in enhancing the successful treatment of anxiety disorders has been endorsed for a variety of orientations including the psychodynamic, interpersonal, cognitive, or behavioral (Gilbertson & Kemp, 1992; Miller, 1986). Additionally, the role of hypnosis in treating anxiety conditions from a co-morbid pharmacological/hypnosis perspective was investigated in a study of the efficacy of alprazolam (Xanax) and hypnosis with a college-aged population (Nishith.Barabasz, Barabasz, & Warner, 1999). Their findings supported the use of hypnosis as a substitute for sedative drug use.

Awake-Alert Hypnosis

Despite the fact that relaxation-oriented inductions hold the greatest popularity and are the most widely used form of trance induction, hypnosis is not equivalent to relaxation nor is relaxation a required characteristic (Alarcon, Capafons, Bayot, & Cardeña, 1999). The notion that a relaxation-based induction could be counterproductive in conditions where cognitive alertness was desirable was suggested by Oeting (1964). Gibbons (1974) created an approach that emphasized suggestions of alertness which he coined "hyperempiria" and which he described as a "new altered state of consciousness." The evidence which clearly demonstrated that relaxation-based techniques are not essential to hypnosis is summarized by Cardeña, Alarcón, Capafons, and Bayot (1998) and by Wark (1998).