International Handbook of Clinical Hypnosis - E-Lib FK UWKS

120 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
Threat may be attributed to an animal, germs or blood, as in a speci®c phobia and
some obsessive-compulsive disorders. The perceived threat may result from some
aspect of a particular situation, as in social phobia, agoraphobia, or from reminders
of past traumatic events, as in post-traumatic stress disorders. The cognitive
approach has the patient challenge the beliefs about threat through helping the
patient to examine the irrational thought processes and self-statements.
As a form of persuasive communication, hypnotically based treatments offer a
powerful addition to the cognitive-behavioral strategies. The suspension of critical
thinking in the hypnotic state may make the patient more susceptible to accepting
the persuasive communications of cognitive-behavioral therapy.
Clients, who typically make critical and negative comments towards therapeutic
communications, are essentially required by the hypnotic context to listen to persuasive
messages from the therapist, in a way that they may not ordinarily do so; this
process of attending and listening, without commenting, may make the clients more
accessible to the content of the therapist's message. McConkey, 1984, p. 80)
Additionally, alterations in cognitive processes may help patients accept alternative
interpretations of events, their signi®cance, their own coping abilities, and the
expected outcome.
Exposure Based Unlearning
When anxiety is situation-speci®c, exposure-based treatments take a prominent role
in cognitive-behavioral treatment. While the patient manages the anxiety by
techniques detailed above, therapist-guided, or more commonly patient-guided
stepwise exposure to the situation, is the basis of unlearning of the anxiety
response. While there is no evidence that the exposure-based treatments need to be
carried out in stepwise fashion, the gradual exposure of the stepwise approach
maintains patients in treatment and prevents the therapy experience itself becoming
traumatic.
Many psychotherapies use imagery and fantasy to facilitate the process of
change. For some patients hypnotically assisted therapies may result in them being
able to respond to imagery and fantasy as reality. Speci®cally, hypnosis may
enhance a variety of interventions applied to the treatment of anxiety.
i) Systematic desensitization remains one of the most common treatments for
speci®c phobic disorders. Lang 1979) showed that patients who bene®t from
systematic desensitization have a greater ability to generate emotional
responses to the imagined items from a hierarchy. The more realistic the
experience of the imagined situation, the more likely are such responses to be
generated. Hypnosis offers an adjunct to desensitization that is potentially
extremely powerful, since the attribution of realism to imagined events is a
characteristic of the hypnotic state.