International Handbook of Clinical Hypnosis - E-Lib FK UWKS

122 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
think, but more commonly the anxiety symptoms themselves. Exposure to the
symptoms may be brought about through the patient hyperventilating on instruction,
and then managing the symptoms by means of the relaxation technique or
breathing techniques previously taught to them.
Suggested strategies for dealing with the frequently present agoraphobic symptoms
are detailed below. With suf®cient practice, self-hypnosis techniques may
assist in reducing the panic state and gaining control over symptoms. Rapid
reduction in anxiety, and dissociation from fears of the panic state, may be used to
truncate the secondary anxiety response anticipatory anxiety) about having a panic
attack.
Additionally hypnosis may be used with panic disorder patients to reinforce their
belief that they can deal with intense anxiety states. Such improved self-ef®cacy
Frankel, 1974) and a shift to an internal locus of control may come about via
hypnotic demonstrations of control behavioral control) or through attitudinal shifts
toward con®dence in coping cognitive control) encouraged by persuasive communications
of exploring the precipitants of panic states, should any exist.
Agoraphobia
As avoidance and escape from anxiety are the key features of agoraphobia, whether
with panic disorder or without, the priority is therapist-guided graded exposure to
the situation the patient is anxious about. The patient, in a step-by-step way,
approaches the situations that trigger anxiety and which they have been avoiding.
Exposure to the anxiety symptoms themselves is also of importance, especially
where panic disorder is involved with the agoraphobia. The acquisition of anxietymanagement
skills, while not essential, is helpful in facilitating the graded
exposure and making treatment less threatening, by establishing speci®c control
over acute anxiety. The anxiety-management skills may involve the patient in
regular practice of either relaxation techniques or self-hypnosis, with or without
imagery-based rehearsal of exposure to the anxiety-producing situations. Alternatively,
breathing techniques may be taught to assist in the control of the physiological
signs, if the agoraphobia is a secondary development of panic disorder. The
third component of the treatment of agoraphobia involves the patient in realistic
self-talk about the nature of their anxiety, the absence of real threat, and their
acceptance of the anxiety symptoms as unpleasant experiences to be faced and
coped with, not run away from.
Hypnotic interventions may assist the treatment of agoraphobia by re-establishing
a sense of security and coping through a supportive therapist relationship,
enhanced by hypnosis, establishing a sense of `control' over physical symptoms
and cognitive anxiety, thereby permitting exposure and changing self-ef®cacy
perceptions, imaginal rehearsal of coping as a prelude to in vivo exposure,
enhancing motivation and determination through the exploration of what freedom
from the symptoms means to lifestyle `Doing what they have always wanted to