International Handbook of Clinical Hypnosis - E-Lib FK UWKS

STRESS AND ANXIETY DISORDERS 121
ii) The effectiveness of coping rehearsal may similarly be aided by the reality
attributions effected through hypnosis. With the increased realism of fantasy
rehearsal, and the uncritical acceptance of the implied message that this will
occur, patients' expectations and motivations to expose themselves to the
anxiety-provoking situation may be heightened. In the absence of selfdefeating
thoughts that maintain anxiety Beck & Emery, 1985) successful
coping may become a viable outcome.
Dissociation fromAnxiety Symptoms and Situations
Patients with anxiety disorders frequently become over-absorbed in their anxiety.
Their anxiety responses result in thoughts concerning the danger posed by the
symptoms and their inability to cope. Dissociation from the symptoms via hypnosis
can provide an adaptive and useful method of reducing this reactivity to the
anxiety-producing situation and to the symptoms that may follow.
Treatment Approaches to Anxiety Disorders
The anxiety disorders have been variously subdivided. One widely accepted
classi®cation, the Diagnostic and Statistical Manual of Mental Disorders 4th
edition) American Psychiatric Association, 1994), subdivides the anxiety disorders
into panic disorders with/without agoraphobia, social phobia, simple phobia,
generalized anxiety disorders, post-traumatic stress disorder and obsessive-compulsive
disorder. Management may include pharmacotherapy and/or a wide variety of
psychological treatments.
Panic Disorders
The cardinal clinical characteristic of panic disorder is the rapid onset of anxiety
symptoms, without apparent or clearly de®ned precipitating events.
With panic disorder the three priorities are ®rstly, the teaching of skills to lower
average or basic anxiety level and to give speci®c control of the acute anxiety
episodes. Often this may involve the relaxation techniques or self-hypnosis.
Additionally, appropriate breathing techniques may be used to control the physiological
signs of the panic disorder. The second component of the treatment of panic
disorder involves realistic patient education and techniques of patient self-talk
about the nature of their symptoms, as signs of the panic disorder rather than signs
of threat to the patient's life, survival or well-being. That is, they are something
unpleasant to be managed rather than something to be panicked about. Fears of
embarrassment are dealt with in the same way that they would be dealt with in
social phobia. The third component of treatment involves therapist-guided graded
exposure to the situation the patient is most afraid of, be that situations that trigger
the panic attacks, social situations where the fear may focus on what others will