International Handbook of Clinical Hypnosis - E-Lib FK UWKS

114 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
are key factors, making it more logical to de®ne stress by the process resulting in
the response, rather than the problematic situation. Thus overall the `stress'
response will depend on individual characteristics, life experiences; other problematic
or challenging situations; the availability of suitable coping strategies to
resolve problematic situations; the patient's con®dence in putting these into effect
and their ability to tolerate partial solutions to challenging situations.
Stress is implicated as a factor in precipitating a wide range of psychiatric and
psychological disturbances. For some, the repeated or chronic perception of threat
or inability to cope leads to anxiety, while for others it leads to a sense of
helplessness and depression. It is probable, given the similarities between the
anxiety and stress responses, that the same vulnerabilities to stress show up as
vulnerabilities to anxiety disorders. Similarly in depression, psychologically confronting
demanding and problematic situations repeatedly, or in the perceived
absence of coping strategies, may lead to a sense of helplessness and contribute to
a depressive response. The same neurotransmitter processes of the hypothalamicpituitary
axis and serotonergic and adrenergic mechanisms are implicated in both
depressive disorders and stress vulnerabilities. To deal with chronic or severe acute
stress patients self-medicate. The use of alcohol is a common strategy to reduce
stress responses. Psychological dependence on this as the solution to chronic stress
leads often to alcohol abuse with all its associated problems. The same problem
occurs with marijuana and other illicitly obtained drugs that have some sedative
effect. Benzodiazepine abuse and dependence in dealing with stress is common.
Similarly other drug use such as nicotine can have an element of self-medication to
dampen the physiological components of stress.
THE MANAGEMENT OF CHRONIC STRESS
The treatment of stress is divided into three phases Stanley, Norman & Burrows,
1999). Firstly, the medical, psychiatric and psychological conditions that are the
outcome of the stress experience are treated in their own right. Anxiety, depression
or the effects of attempts to manage their psychological distress by alcohol or drug
use require appropriate clinical management ®rst. Secondly, the chronic hyperarousal
is treated, and this `arousal management' contributes to controlling the
secondary psychological distresses. In the third phase, the patient is assisted with
stress prevention by developing more effective strategies for dealing with life
stressors as well as changing attitudes, habitual thought processes and learned
behavioral patterns.
Hypnosis as a therapeutic approach contributes to all three of these components
of stress management. The part hypnosis may play in cognitive/attitudinal change,
arousal management and in the treatment of the psychological and physical
consequences of stress, will be reviewed and the management of anxiety disorders
that may result from chronic stress will be outlined.