International Handbook of Clinical Hypnosis - E-Lib FK UWKS

STRESS AND ANXIETY DISORDERS 125
reoccurring when they intrude into consciousness. As well there is often a
continuous level of anxiety associated with the impending intrusion into consciousness
of the affects and memories. Hypnotic techniques and eye movement
desensitization are used in dealing with this dissociative partial coping, with
cognitive restructuring of the thoughts of the trauma being a primary goal Spiegel,
Hunt & Dondershine, 1988; Shapiro, 1989).
Secondly, the avoidance of stimuli associated with the traumatic events needs to
be dealt with as a form of phobic avoidance with progressive exposure. Systematic
desensitization, in vivo or in imagination, remains an important part of treatment.
Treatment by exposure in reality is more effective than imagery-based treatment,
but imagery-based treatments are of considerable importance where the traumatic
associations cannot easily be produced. The therapist guides and encourages the
patient through the graded exposure to the traumatic stimuli or situation. The
acquisition of anxiety-management skills based on either relaxation techniques or
self-hypnosis, and with or without imagery-based rehearsal of exposure to the
anxiety-producing situations, while not essential, may facilitate the in vivo graded
exposure.
Brett & Ostroff 1985) have argued that images play a central role in the
maintenance of post-traumatic stress disorder. Stutman & Bliss 1985) noted that,
amongst Vietnam veterans, victims of this disorder demonstrated higher hypnotic
susceptibility and imagery vividness than those without the disorder. Kingsbury
1988) detailed the application of hypnosis to the treatment of post-traumatic stress
disorder, including cognitive reframing of events, dissociation to distance the
sufferer from the event and alterations of memories of the events. Similar applications
of hypnosis to achieve both abreactive reactions and cognitive restructuring
are often the treatment of choice MacHovec, 1985).
The psychoanalytically oriented use of hypnosis in post-traumatic stress disorder
has been described Peebles, 1989). The use of age-regression and abreactive
techniques permits therapeutic changes to occur.
Generalized Anxiety
With generalized anxiety disorder there are two speci®c goals of treatment; ®rstly
the lowering of the average level of anxiety and secondly the changes in thoughts,
perceptions and attitudes that reactivate the anxiety response. With appropriate
training the majority of patients can learn to control their basal level of anxiety.
There are numerous 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 suf®cient 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. Apart from the relaxation
techniques commonly used Jacobson, 1929; Benson, 1975), hypnosis and in