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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The following case demonstrates how development of insight appeared to be helpful for the patient who was uncomfortable because of her stepfather. The excerpt of the AWP session is presented verbatim (with typographical errors corrected).

Case Report

Jane, a 13-year-old, was in good health until she developed a sore throat associated with dyspnea, inspiratory stridor, coughing, and chest tightness. Also, she reported intermittent dizziness, headaches, and numbness and tingling of her extremities. Despite therapy with systemic steroids and nebulized bronchodilators, her symptoms persisted for ten days. A diagnosis of vocal cord dysfunction was confirmed by a laryngoscopic examination of her upper airway.

Her symptoms persisted despite employment of hypnotic imagery for general relaxation, as well as specific imagery to relax her vocal cords. She was encouraged to practice her hypnosis on a nightly basis, and told that with time her symptoms would improve. She was offered a referral for speech therapy, which is a widely used treatment for vocal cord dysfunction (Anbar & Hehir, 2000). However, she preferred to work with hypnosis.

A week later, because of persistent symptoms, a cranial magnetic resonance imaging (MRI) study was performed to exclude a brain abnormality. This study was normal.

On the same day as the MRI, she described a dream from the previous night during which she saw that her stepfather's eyes were blood shot. She said she did not know what this dream meant, and that in "real life" his eyes often were blood shot, for an unknown reason. She agreed to learn how to use AWP to gain an understanding of her dream and whether there was a psychological reason for her breathing difficulties. (In this transcript excerpt, her stepfather was referred to as her "father".)

Doctor: Jane wanted me to ask you about the meaning of the dream about her father with the blood shot eyes...

Jane: Her dad has a bad habit.

Doctor: Do you want to tell me about it?

Jane: If you promise not to tell her or her MOM.

Doctor: I absolutely promise that.

Jane: Ok.

Doctor: So tell me what needs to be told

Jane: He smokes pot.

Doctor: What do you think about that?

Jane: I'm afraid to tell Jane because she might get scared for him.

Doctor: Would that be bad, for her to get scared for him?

Jane: Yes.

Doctor: Why?

Jane: Because then she might get too scared, then tell her mom. And her mom and dad fight already.

Doctor: So it would make matters worse?

Jane: Yes, much.

Doctor: And what does the breathing problem have to do with all of this?

Jane: I can't let her talk about it.

Doctor: About what?

Jane: The stuff I just told you.

Doctor: Are you willing/able to let up on her breathing if she promises not to talk about what she's not supposed to talk about?

Jane: Yes.

Doctor: Does that feel safe enough for you?

Jane: Yes.

Doctor: Have you fixed her breathing?

Jane: Yup.

When Jane typed "Yup," her stridor resolved. At the conclusion of the AWP session, she stated that she did not recall what she had typed, and that she did not want to see a transcript of what had been discussed.