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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Dyspnea resolved rapidly with the use of self-hypnosis but without use of AWP in at least 16 of 22 patients in this report, as well as in 13 of 16 patients with normal lung function in a previous report (Anbar, 2001 a). Thus, it appears that gaining a possible insight into the cause of dyspnea is not critical in achieving its resolution in many patients. Self-hypnosis may be very helpful in this setting because of its effectiveness in decreasing anxiety. Thereafter, a calmer response to a situation allows patients to decrease their perceived stress, which is a potential primary cause of the dyspnea.

The improvement of dyspnea in the two patients with asthma emphasizes that the symptoms of some patients with organic respiratory disease can improve with hypnosis (Anbar, 2003). However, dyspnea arising in patients with organic respiratory disease may be attributable to physiologic factors as well as psychological factors of a different nature than in patients without organic disease. Therefore, it is not surprising that in a previous report, use of self-hypnosis achieved resolution of dyspnea in only 2 of 20 patients who had abnormal pulmonary function (Anbar, 2002).

All of the patients in this report indicated an interest in gaining insight into their symptoms. Thus, their observations may not be representative of the psychological causes of dyspnea in patients who are not interested in gaining insight. One of the reasons many patients may have been disinterested in using hypnosis for insight was that their dyspnea had resolved prior to their being given an opportunity to use AWP.

This report examined potential psychological triggers of dyspnea in patients between 11 and 16 years of age. Thus, its findings and methods may be only partially applicable to younger children or an adult population. For example, young children may be unable to develop useful insights, and it might be expected that as children progress through the stages of cognitive development that the nature of their insights will change. Additionally, adolescents may be more adept at using AWP than members of other age groups because of adolescents' high degree of exposure to computers at home and at school.

AWP may promote insight through development of communication with an ego state (Watkins, 1993). Other ways of promoting patient insight include imagining a conversation with an inner adviser (Anbar, 2000; Bresler, 1990), and analytic psychotherapy that helps patients develop insights into the meaning of their symptoms through a long-term interaction with a therapist (Kolb, Cooper, & Fishman, 1995).

In conclusion, dyspnea may provide patients with a way of expressing their reactions to perceived or anticipated stress. Thus, stress reduction interventions may prove very helpful in resolving this symptom. However, in some cases gaining an insight into the potential cause of the dyspnea may increase the effectiveness of therapy.

References

American Psychiatric Association(1994). Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association; 1994.