International Handbook of Clinical Hypnosis - E-Lib FK UWKS

116 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
done using the common cognitive-behavioral therapy approaches Beck, 1995).
Inappropriate interpretations are dealt with by the cognitive-behavioral approach of
challenging automatic thoughts. When the process involves problem-solving
strategies which are ineffectual, treatments focus on developing effective problemsolving
strategies and on making them habitual. These approaches involve appropriate
labelling of the problem as a challenge to be overcome, identifying the range
of solutions available, choosing the solution that has the potential most likely to
minimize discomfort and effect a resolution, and evaluating the outcome if the
solution is not as desired. Passivity and problem avoidance must be overcome, and
rather than seeing problems as threats, the patient must be encouraged to see them
as part of the range of life's challenges.
Because personality characteristics such as perfectionism and obsessiveness get
in the way, patients need to be encouraged to be ¯exible in evaluating the situation.
They need to develop the ability to perceive the range of complete or partial
solutions. They need to be assisted to choose between the possible solutions, in the
knowledge that while they may desire to get it right, if they do not they will simply
make another choice or consider it a learning experience. They need to see that
their self-esteem or self-worth is not related to ®nding the perfect solution.
Indecision and passivity are presented as being worse than trying an inadequate
solution that can be changed later if unsuccessful. The realistic recognition that life
is problematic and challenging is encouraged. Some experiences such as the death
of a loved one are to be coped with and survived as part of the vicissitudes of life.
Awillingness to deal with the unsolvable is a necessary part of coping with the
inevitable challenges life throws at us all.
Self-esteem and con®dence in their ability to ®nd and effect solutions need to be
encouraged. Low self-esteem may re¯ect long-standing personal dif®culties that
require more extensive interventions. If necessary, psychotherapy may be recommended
to free the patient from the `ghosts' of the past that continue to colour the
way they deal with their present life and therefore to sensitize them to exhibit stress
responses in the present.
PHASE THREE: AROUSAL MANAGEMENT
The exaggerated physiological response to the particular dif®culties and/or a
habitually increased basal level of arousal may be treated in the initial phase with
appropriate medication.
Longer term it is desirable that the patient can manage the exaggerated phasic
and tonic arousal via other strategies such as relaxation, meditation, self-hypnosis,
biofeedback or exercise programmes. Relaxation/meditation techniques if practised
regularly have been shown to progressively lower the basal physiological
arousal. There are many different approaches to meditation and relaxation Jacobson,
1929; Benson, 1975), but they essentially involve similar principles. The
patient needs to be motivated to persist as it is the alteration of a habitual basal or