International Handbook of Clinical Hypnosis - E-Lib FK UWKS

STRESS AND ANXIETY DISORDERS 123
do'), changing general self-image, and enhancing dissociation from the anxiety and
self- or symptoms focus a healthy dissociative mechanism).
Social Phobias
Social phobias present in a variety of forms with different aetiological implications:
fears of public speaking, fainting, losing control of bladder or bowels, vomiting, or
embarrassing oneself by inappropriate action or speech. Jackson & Stanley 1987)
noted the variety of aetiological explanations which have been offered to account
for social phobias, ranging from inadequately developed social skills to fears of
incurring the displeasure or rejection of others and catastrophic assumptions
concerning the outcome of such displeasure, and even to a general intolerance of
discomfort. In addition, some cases of social phobia may occur as a secondary
complication of panic disorder Liebowitz, 1987).
With social phobias the main feature to be addressed is the patient's fear of the
evaluation of others in the social situation. Their cognitive processes result in them
turning embarrassments into disasters and their normal preference for the approval
of others into almost a requirement for their survival. Cognitive therapy actively
encourages them to explore and challenge their beliefs that the situation is any
more than embarrassing. The three-stage schema-based cognitive model of anxiety
proposed by Beck & Clark 1997) is a useful starting point for conceptualizing
social phobias. The cognitive approach has the patient challenge the beliefs about
threat through helping the patient to examine the irrational thought processes and
self-statements, particularly in the social situation. Homework-based exposure to
the feared social situations is mandatory in the treatment of the socially phobic.
Exaggerated confronting of social anxiety by `shame-attacking exercises' may also
greatly assist the socially phobic patient if they can be encouraged to do them.
Apart from general anxiety reduction, hypnotic techniques may be applied to
establish a sense of self-worth and self-esteem. For example, cognitive restructuring
within the hypnotic state may sensitize patients to their positive characteristics and
successes, while emphasizing that projected disasters do not occur, and that those
problems which do can be coped with. Additionally, through the use of rapidly
induced self-hypnosis, patients may develop control over bodily processes where
they fear loss of control Jackson & Stanley, 1987). Dissociation into a tranquil and
relaxed state on a cue speci®c to social situations may be achieved, as may realistic
coping through fantasy rehearsal.
Speci®c Phobias
With speci®c phobias, systematic desensitization, in vivo or in imagination,
remains the mainstay of treatment. Treatment by exposure in reality is more
effective than imagery-based treatment, but imagery-based treatments are of considerable
importance where the situation of which the patient is fearful cannot