Hypnosis and Agoraphobia


What is Agoraphobia?

Agoraphobia is a very complex phobia usually manifesting itself as a collection of inter-linked conditions.

For example many agoraphobics also fear being left alone (monophobia), dislike being in any situation where they feel trapped (exhibiting claustrophobia type tendencies) and fear travelling away from their ‘safe’ place, usually the home. Some agoraphobics find they can travel more easily if they have a trusted friend or family member accompanying them, however this can quickly lead to dependency on their carer.

The severity of agoraphobia varies enormously between sufferers from those who are housebound, even room-bound, to those who can travel specific distances within a defined boundary. It is not a fear of open spaces as many people think.

Agoraphobia image

See more at: AnxietyUK

As always I am very interested to hear other opinions and experiences around this subject.

Study 1: Case Study of Hypnotherapy for Agoraphobia
Agoraphobia: A case study in hypnotherapy
http://www.tandfonline.com/doi/abs/10.1080/00207147108407147

Results: Based on the described case study, the author advocates a psychodynamically oriented rather than technique-centered approach to hypnotherapy to successfully treat agoraphobia.

Notes: A 58-year-old woman with a 43-year history of agoraphobia was treated with ego-supportive direct suggestion and hypnoanalytic techniques. Literature pertaining to etiological factors and treatment problems is cited. Pertinent details of the patient’s recent and past history are presented. The treatment plan, course of therapy, and outcome are discussed in the context of limited therapeutic goals and anticipated successful results.

International Journal of Clinical and Experimental Hypnosis, Volume 19, Issue 1, 1971
By: Doris Gruenewald, Psychosomatic and Psychiatric Institute for Research and Training Michael Reese Hospital, Chicago

Study 2: Hypnotherapy for Irritable Bowel Syndrome Induced Agoraphobia
Cognitive-Behavioral Hypnotherapy in the Treatment of Irritable-Bowel-Syndrome-Induced Agoraphobia
http://www.tandfonline.com/doi/abs/10.1080/00207140601177889?journalCode=nhyp20

Results: This research paper describes the etiology and treatment of irritable-bowel-syndrome (IBS)-induced agoraphobia. Cognitive, behavioral, and hypnotherapeutic techniques are integrated to provide an effective cognitive-behavioral hypnotherapy (CBH) treatment for IBS-induced agoraphobia. This CBH approach for treating IBS-induced agoraphobia is described and clinical data are reported.

Notes: There are a number of clinical reports and a body of research on the effectiveness of hypnotherapy in the treatment of irritable bowel syndrome (IBS). Likewise, there exists research demonstrating the efficacy of cognitive-behavioral therapy (CBT) in the treatment of IBS. However, until this research paper, little had been written about the integration of CBT and hypnotherapy in the treatment of IBS, and there had been a lack of clinical information about IBS-induced agoraphobia.

International Journal of Clinical and Experimental Hypnosis, Vol. 55, Issue 2, 2007
By: William L. Golden, Private Practice, New York, New York, USA

Study 3: Review of Research on Hypnosis for Agoraphobia and Social Phobia
The Place of Hypnosis in Psychiatry Part 4: Its Application to the Treatment of Agoraphobia and Social Phobia
http://www.londonhypnotherapyuk.com/agoraphobia-social-phobia.asp

Results: This review of world-wide research and literature concludes that hypnosis is a powerful adjunct to therapy for agoraphobia and social phobia. The case studies presented here demonstrate that hypnosis has been highly effective in helping patients (1) to explore feared situations in a safe environment; (2) to reduce anxiety using desensitization; (3) to gain more control using anchoring, fantasy techniques and autogenic training; (4) to enhance coping strategies using ego strengthening and breathing techniques; and (5) to reduce affect using television screen imagery. Age regression (6) was also employed effectively to help a patient to address, and come to terms with, inner conflicts and traumatic events in early childhood. Finally, carefully-designed audio tapes were employed to encourage two patients to practice self hypnosis at home, and this had the effect of enhancing treatment outcome.

Notes: This paper is based on a world-wide search of the literature, and focuses on the use of hypnosis in the treatment of social phobia and agoraphobia. Hypnosis is employed as an adjunct to therapy: it is used to help patients to reduce cognitive and physical symptoms of anxiety, and provides them with more control in every day situations. The author reviews a range of treatment procedures that have been shown to be highly effective in the treatment of both social phobia and agoraphobia. An extensive search of the literature has uncovered seven studies which have used hypnosis in the treatment of agoraphobia: the first two studies (Gruenewald, 1971; Jackson & Elton, 1985) use a hypnoanalytic approach with age regression, the third and fourth studies (Schmidt, 1985; Hobbs, 1982) both use audio tapes, the fifth study (Mellinger, 1992) employs a hypnotically-augmented multidimensional approach, while the sixth study (Roddick, 1992) uses a fantasy technique to encourage cognitive re-structuring. Finally, the seventh paper (Milne, 1988), is useful in that the therapist employs a number of approaches in treatment including group therapy, ego strengthening and the gradual introduction of hypnosis from a process similar to meditation.

The text cited here is a pre-publication version of a paper published in the Australian Journal of Clinical & Experimental Hypnosis.
By: David Kraft, Harley Street, London, UK (PhD) (trained in psychotherapy at the National College of Hypnosis and Psychotherapy, diploma in clinical psychology (Dip.Cl.Psy). In addition, he trained at the BST Foundation in London where he gained both the diploma in Clinical Hypnosis (DCHyp) and the Advanced Certificate in Clinical and Strategic Hypnosis (A.Cert.CSHyp). David is a member of the Hypnosis & Psychosomatic Medicine Section of the Royal Society of Medicine; he is also a member of the British Society of Clinical and Academic Hypnosis (BSCAH))

Study 4: Use of Hypnosis to Counteract Resistance by a Client with Agoraphobia
Counteracting Resistance In Agoraphobia Using Hypnosis
http://www.londonhypnotherapyuk.com/agoraphobia-using-hypnosis.asp

Results: This research paper focuses on the treatment of agoraphobia and, specifically, on how hypnosis is employed in order to counteract resistance, thus reducing negative transference and providing the patient with the coping skills to become independent in the outside world. The author describes one case study in 1992 in which hypnotherapy was gradually introduced and used in stages; after 8 sessions, the client was able to drive herself to sessions and continued to make further progress.

Notes: The author describes how clients are often resistant to treatment for agoraphobia. Resistance takes on many forms. One case study is discussed in detail in which successful treatment consisted of the stages as shown below (Roddick, 1992). Note that the client in this case study had a particular aversion to being driven in a car and that these principles can be adapted to suit the needs of the patient. Stages: 1. Relaxing in the presence of the therapist; case history (approx. 4 sessions); 2. (a) Hypnosis is introduced using progressive muscle relaxation induction; (b) Experiencing special place imagery like a desert island beach; (c) Addressing the unconscious mind focusing on (i) the importance of practicing relaxation, (ii) being able to travel in a car, (iii) being able to eat and drink ‘as well as ever’; 3. (a) Direct suggestions of bringing the three parts together; (b) Ideomotor signalling used to ascertain whether the strategy has worked and was acceptable; (c) Re-integration of unconscious mind and conscious mind on the desert island beach; 4 (a) ‘Throwing out’ of negative thoughts; (b) Direct suggestions that the skills that the patient has learned in the special place can be utilized at any time. After 8 sessions of using this technique, the patient was able to drive herself to sessions and continued to make further progress thereafter.
This is a pre-publication version of the original research paper.
By: David Kraft, Harley Street, London, UK (PhD) (trained in psychotherapy at the National College of Hypnosis and Psychotherapy, diploma in clinical psychology (Dip.Cl.Psy). In addition, trained at the BST Foundation in London where he gained both the diploma in Clinical Hypnosis (DCHyp) and the Advanced Certificate in Clinical and Strategic Hypnosis (A.Cert.CSHyp). Also a member of the Hypnosis & Psychosomatic Medicine Section of the Royal Society of Medicine; he is also a member of the British Society of Clinical and Academic Hypnosis (BSCAH))

Study 5: Hypnotherapy for Panic Attacks
Rational self-directed hypnotherapy: a treatment for panic attacks
http://www.ncbi.nlm.nih.gov/pubmed/2296917

Results: Results showed an increased sense of control, improved self-concept, elimination of pathological symptoms, and cessation of panic attacks.

Notes: A single-subject research design was employed to assess the efficacy of rational self-directed hypnotherapy in the treatment of panic attacks. Presenting symptoms were acute fear, dizziness, constricted throat, upset stomach, loss of appetite, loss of weight, insomnia, fear of doctors, and fear of returning to work. Treatment lasted 13 weeks plus a 2-week baseline and posttherapy period and a 6-month follow-up. Objective measurements (MMPI, TSCS, POMS) and self-report assessments (physiological symptoms and a subjective stress inventory) were implemented. Using hypnosis and guided imagery, the subject reviewed critical incidents identifying self-defeating components within a cognitive paradigm, revising and rehearsing these incidents.

Am J Clin Hypn. 1990 Jan;32(3):160-7
By: Der DF, Lewington P, Dept. of Counseling Psychology, University of British Columbia, USA

Study 6: Direct and Awake-Alert Hypnosis for Panic Disorders
Awake-Alert Hypnosis in the Treatment of Panic Disorder: A Case Study
http://www.asch.net/portals/0/journallibrary/articles/ajch-47/iglesias2.pdf

Results: A case study about an individual with a lifestyle-limiting panic disorder is discussed. At the start of therapy, the client was having panic attacks about three times a week – especially during outings for lunch engagements and dinner parties. Direct suggestions as well as a variant of awake-alert hypnosis were used. (Presumably, awake-alert hypnosis was encouraged to make it easier for the client to self-hypnotize with eyes open in the event she felt a panic attack starting.) After four weeks of three-times-a-week hypnosis, the intensity level of the panic attacks markedly decreased. Then, the client became able to thwart the development of episodes by applying the hypnotic procedure in the early phases of the panic process.

Notes: An eye-fixation induction was used and direct suggestions under hypnosis were first provided that the client would become immediately cognizant of any panic episodes at the earliest onset; it was emphasized in hypnosis that to the degree that she employed hypnosis at the earliest level of a panic episode, she would be successful in aborting the episode. After inducing hypnosis and eye-closure, the client was gradually conditioned to open her eyes while remaining in the hypnotic state. The client was conditioned to engender a disconnected and “woodsy” feeling all over her body. Suggestions were given that the client would feel as if an anesthetic agent had been injected yet it could be active and move about as necessary. The client was instructed that she would be able to induce awake-alert hypnosis over her entire body. The client was asked to imagine she was staring at fine glassware – and that at the slightest hint of discomfort she would immerse herself in the splendor of the glassware; the richness of the glass would offer the perfect sanctuary to feel protected—like an impenetrable fortress. The greater the discomfort, the deeper within the glass the client was told she would retreat. As a result, suggestions were given that her respirations would slow down, her stomach would unwind, etc. until she felt it was acceptable to disengage from the glass.

Am. Jrnl of Clinical Hypnosis, April 2005
By: Alex Iglesias (Palm Beach Gardens, Florida) and Adam Iglesias (Florida Atlantic University)

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