International Handbook of Clinical Hypnosis - E-Lib FK UWKS

STRESS AND ANXIETY DISORDERS 119
cognitive-behavioral psychotherapies have demonstrated their effectiveness, particularly
in treating anxiety disorders. The principal components of cognitivebehavioral
therapy are applied differently in the different anxiety disorders.
Arousal Management
With appropriate training the majority of patients can learn control of their anxiety
response. This leaves them free to focus on problem-solving, or unlearning the
connection between the anxiety and the anxiety-provoking situation. The anxietymanagement
techniques can have either or both of two purposes, the lowering of
averageÐthat is basalÐanxiety levels, or the control of the acute anxiety response
in the anxiety-provoking situation. Meditation, yoga and the many other forms of
meditation can be of great assistance, particularly in lowering the average or basal
levels of anxiety and arousal. These techniques may be of less use in treating
situational anxieties.
There are numerous other approaches to training patients in the control of
anxiety responses. All require the patient to practise the skill being acquired for a
signi®cant time, in order to have the degree of control over the anxiety necessary to
deal with the anxiety disorder. The use of relaxation techniques to assist patients in
learning to control their anxiety responses has a long history. Jacobson 1929) ®rst
introduced Progressive Relaxation which involved the patient learning discrimination
of the muscle tension and control over it via a process of systematically tensing
and relaxing the muscle groups of the body. An alternative, briefer and effective
approach to training patients in anxiety control was introduced by Benson 1975).
Hypnosis, and in particular self-hypnosis, plays a very useful part in the
treatment of anxiety disorders. Principally hypnosis is used to train the patient in
cued rapid relaxation to be applied in the anxiety-provoking situation, as well as
assisting in changes in perception about the nature of the perceived threat and the
patient's con®dence in their ability to cope with that situation. Adetailed review of
the various uses of hypnosis appears in Stanley, Judd & Burrows 1990), Stanley
1994), and Stanley, Norman & Burrows 1999).
When patients use self-hypnotic arousal reduction and relaxation it adds to their
con®dence in coping and their sense of self-control. They are able to in¯uence what
they previously thought unalterable. This shifts their locus of control beliefs and
increases their sense of self-ef®cacy.
Cognitive-Behavioral Therapy
Cognitive therapy is based on the belief that it is the interpretation of the situation
as threatening that is involved in the maintenance of the anxiety disorder Beck &
Emery, 1985). Athree-stage schema-based information-processing model of anxiety
has been proposed Beck & Clark, 1997). Anxiety may result from the
symptoms of the anxiety being interpreted as threatening, as in panic disorder.