Stressors Associated with Dyspnea in Childhood: Patients' Insights and a Case Report

American Journal of Clinical Hypnosis,  Oct 2004  by Anbar, Ran D

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Patients who stated they were interested in developing insight into the cause of their dyspnea and liked to type, were offered instruction in automatic word processing (AWP; Anbar, 2001b). This instruction usually took place one or two weeks after the initial hypnosis session. Patients were instructed to begin typing once they "found" their subconscious during hypnosis within imagery of a relaxing place of their choice (Anbar, 2001b). Subconscious was defined as a part of their mind of which they are usually not aware. The patients were instructed that they might be unaware of some of what would be discussed (Anbar, 2001b).

During the interaction that lasted 30 to 90 minutes, the patients and the pulmonologist communicated by typing on individual keyboards connected to a single computer screen. Following the session, patients were allowed to read a copy of the typed interaction if they so desired.

Because this report describes a retrospective chart review without identification of patients, it was exempt from review by the SUNY Upstate Medical University Institutional Review Board. The name of the patient in the case report was changed to protect her privacy.

Results

The dyspnea resolved in 18 of 22 patients (age range, 9-17 years) within 1 month of instruction in self-hypnosis for relaxation and symptom reduction. Eight of these 22 patients wanted to gain insight into the cause of their dyspnea. Among these 8 patients, 2 were diagnosed with asthma, and 2 with vocal cord dysfunction. The remaining patients did not have a diagnosed cause of their dyspnea. Their average duration of dyspnea prior to presentation was 1.8 years (range, 10 days to 4 years). Table 1 lists their additional symptoms. The physical examinations of all but one of the patients showed no abnormalities. The remaining patient manifested persistent stridor, which was documented by laryngoscopy to be attributable to vocal cord dysfunction. Six of the eight patients underwent pulmonary function testing at rest, and all of these were normal. The patient with persistent stridor did not undergo pulmonary function testing.

All 8 patients stated they were unaware of possible psychological triggers of their dyspnea, and chose to use AWP as a tool to gain insight. Their dyspnea resolved after the initial hypnosis instruction, but before AWP for 4 patients; during AWP for one; and a week after AWP for one. The dyspnea did not recur among any of these patients during follow-up of an average 1.6 years (range, 3 months to 3 years). The 2 patients with asthma reported their dyspnea improved before and after AWP, but did not resolve completely.

Only 2 of the 8 patients wanted to see the transcript of their AWP immediately after the session. Three others read their transcripts at a subsequent appointment.

During the hypnotic experience of AWP the patients reported various potential causes of their dyspnea, as summarized in Table 2. Then-year-old who stated his dyspnea protected him from developing worse symptoms, reported that over the previous two years three of his grandparents died, his parents divorced, and a house fire prevented him from living at home for half a year. During that time, his 14-year-old brother became truant from school and began using narcotics.