Mind-Matters Podcast #2: Tamsin Astor


This week started with an interview for my Mind-Matters Podcast and in this second epsiode I talk to Tamsin Astor PhD who talks about dealing with her youngest son being diagnosed at the age of just 2 with Burkitt’s Lymphoma, whihc is a cancer of the lymphatic system.

She talks about the struggle to get her concerns heard and recognised by the doctors, hearing the diagnisis and dealing with the whole treatment process and being strong for her son, her family and herself.

She talks later about her divorce and how now, ten years on her son is clear and healthy and how they are planning a ten year celebration of him being clear.

It’s a highly emotive story, hugely inspirational and I hope you get as much from it as I have.

You can find out more about Tamsin by going to her website www.tamsinastor.com

Click on the link below to go to the Podcast and click on episode 2 to hear the interview with Tamsin.

Enjoy

Mind-Matters Podcast

Changes In Treatment Approaches For PTSD


Below is an article taken from the APA website that I find extremely interesting and reassuring that the military is not restricting themselves to CBT and EMDR in treating serving personnel struggling with PTSD.

A psychodynamic treatment for PTSD shows promise for soldiers
March 2012, Vol 43, No. 3
Print version: page 11

PTSD
While cognitive-behavioral therapy remains the most well-researched treatment for post-traumatic stress disorder, it doesn’t help all patients. That’s especially true for service members who have been perpetrators as well as victims of violence, says Russell B. Carr, MD, an Army psychiatrist.
“It’s a much more complicated experience, and they often feel a lot of shame in addition to the usual PTSD symptoms,” he says.

For the past six years, Carr has been working with soldiers who haven’t responded to cognitive-behavioral therapy, and he’s developed a new treatment rooted in intersubjective systems theory. This modern take on psychoanalysis pioneered by Robert Stolorow, PhD, posits that the heart of trauma is shame and isolation.
Carr’s therapy, described in the October 2011 issue of Psychoanalytic Psychology, has shown promise helping soldiers who haven’t responded to CBT by addressing the existential dread dredged up by trauma, and the feeling that their entire world has lost meaning. Though Carr’s goals are ambitious, his intervention is relatively short—requiring twice-weekly sessions for up to three months. As a result, the therapist must clearly define goals, keep conversations on track and quickly establish rapport with clients, Carr found.

Short-term therapy—which is typical of CBT, but less common with psychoanalytic approaches—is often the only option in military settings, he says.
“In the military, there is frequently the situation where a patient or therapist is leaving soon,” says Carr. “It’s a transient population, and it limits the length of time we have to work together.”

A key part of intersubjective therapy is helping clients put their feelings around traumatic experiences into words. These feelings aren’t always negative. One patient described in the article found he enjoyed the smell of burning human flesh, and was later horrified and ashamed of his initial reaction. By expressing empathy and not rejecting the soldier, Carr helped the soldier process the experience and reconnect with the civilian world.

Convincing soldiers that a therapist—as well as friends and family—can understand a little of what they are going through lessens their PTSD symptoms, Carr found. In some cases, soldiers even learn from the experience, he says. “Recognizing the fragility of life, you can refocus on what’s important to you, and not waste time on things that aren’t.”
—S. Dingfelder

Hypnosis and Childbirth


The following studies were conducted and highlight ways that hypnosis can be used and the clinical and scientific outcomes.


Study 1: Hypnosis Allows for Less Medication and Less Labor Pains
Hypnosis for Pain Relief in Labor And Childbirth: A Systematic Review.
http://bja.oxfordjournals.org/content/93/4/505.full.pdf

Results: Women who used hypnosis required significantly less pain medication. This study also found that women who used hypnosis reported having less severe labor pains.

Notes: This study reviewed a number of studies where hypnosis was used during pregnancy and childbirth.

British Journal of Anesthesia. 2004 Oct;93(4):505-11. Epub 2004 Jul 26
By: A. M. Cyna, G. L. McAuliffe, M. I. Andrew
Author Affiliations: 1 Department of Women’s Anesthesia, Women’s and Children’s Hospital, Adelaide, South Australia 5006, Australia. 2 Department of Anesthesia, Lyell McEwin Hospital, Adelaide, South Australia, Australia


Study 2: Hypnosis – To Shorten Labor, Reduce medication to control pain or to lengthen pregnancy if expectant mother goes into labor too early
Evidence-Based Clinical Hypnosis in Obstetrics, Labor and Delivery, and Preterm Labor.
http://www.ncbi.nlm.nih.gov/pubmed/17558723

Results: The authors report that the use of hypnosis has been proven to shorten Stage 1 and 2 of labour, while also leading to a significant reduction in the use of medication to control the pain. The authors also note that hypnosis has been used to significantly prolong the length of pregnancy when an expectant mother goes into labour too early.

Notes: This paper reviews various academic studies conducted on the use of hypnosis in labour and delivery.

Int Journal of Clinical and Experimental Hypnosis, Vol. 55, No. 3, July 2007
By: D. Brown, D. C. Hammond, Private Practice, Halifax, Nova Scotia, Canada


Study 3: Hypnosis – Infertility
Infertility and Pregnancy Loss: Hypnotic Interventions for Reproductive Challenges. Healing from within: The use of hypnosis in women’s health care (pp. 191-212)2000.
http://psycnet.apa.org/books/10377/009

Notes: This study reports on the use of hypnosis and imagery-based techniques to help women feel more empowered when dealing with miscarriages and infertility. Based on 15 years of experience in this field, the author concludes that hypnosis can really help at three points in the infertility process. First, it can bring a greater acceptance of the diagnosis. Second, it can help the patient cope more easily with infertility treatments. And third, it can help them to deal with any miscarriages.

By: Susan G. Mikesell


Study 4: Hypnosis – To Help Embryo Transfer at Fertility Clinic
Impact of Hypnosis During Embryo Transfer on the Outcome of In Vitro Fertilization-Embryo Transfer: A Case-Control Study.
http://www.nwmedicalhypnosis.com/documents/Impact%20of%20hypnosis%20during%20embryo%20transfer.pdf

Results: Those who received hypnosis had a 30.2% implantation rate compared with only 14.4% in the control group. This study concluded that not only did hypnosis help to double the rate of embryonic implantation, but it also helped to improve the subject’s attitude towards fertility treatment.

Notes: This study compared two groups of women undergoing embryo transfer (ET) at an Israeli fertility clinic. Ninety-eight women used hypnosis to help them during this process and 96 acted as the control group and followed the normal procedures. During the pre-hypnosis session, every patient was requested to choose a very pleasant life experience to relive. The hypnotic state was induced by the same hypnosis therapist using eye fixation, relaxation, and permissive and indirect suggestions. It was suggested that the patient compare the procedure of ET with the reception of long-awaited and very welcome guests. Only when the patient was thought to be at an adequate trance level (approx.. 10 minutes) was the ET procedure initiated. After ET, and previous to dehypnotization, the patient was given posthypnotic suggestions to produce calm, relaxation, and optimism for the future.

Fertility and Sterility. 2006 May
E. Levitas, A. Parmet, E. Lunenfeld, Y. Bentov, E. Burstein, M. Friger, G. Potashnik
Author Affiliations: a Fertility and IVF Unit, b Department of Obstetrics and Gynecology, Soroka University Medical Center, and c Department of Epidemiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel


Study 5: Self-Hypnosis for Labor and Childbirth
Antenatal self-hypnosis for labour and childbirth: A pilot study
http://digital.library.adelaide.edu.au/dspace/handle/2440/23183

Results: Seventy-seven antenatal women consecutively taught self-hypnosis in preparation for childbirth were compared with 3,249 parity and gestational age matched controls. Of the women taught antenatal self-hypnosis, nulliparous parturients used fewer epidurals: 36% (18/50) compared with 53% (765/1436) of controls (RR 0.68 [95% CI 0.47-0.98]); and required less augmentation: 18% (9/50) vs 36% (523/1436) (RR 0.48 [95%CI 0.27-0.90]). Conclusions: Our clinical findings are consistent with recent meta-analyses showing beneficial outcomes associated with the use of hypnosis in childbirth.

Notes: The institute where this study took place had used antenatal training in self-hypnosis for over three years as a tool to provide relaxation, anxiolysis and analgesia for women in labor. To assess the effects of hypnotherapy, they prospectively collected data related to the use of hypnosis in preparation for childbirth, and compared the birth outcomes of women experiencing antenatal hypnosis with parity and gestational age matched controls. Methods: Prospective data about women taught self-hypnosis in preparation for childbirth were collected between August 2002 and August 2004. Birth outcome data of women using hypnosis were compared with routinely collected retrospective data from parity and gestational age matched women delivering after 37 weeks gestation during 2003.

Anaesthesia and Intensive Care, 2006; 34 (4):464-469
By: Allan Michael Cyna, Marion I. Andrew, Georgina L. McAuliffe


Study 6: Effect of Hypnosis on Labor and Birth Outcomes (focuses on pregnant adolescents)
The Effects of Hypnosis on the Labor Processes and Birth Outcomes of Pregnant Adolescents
http://www.fourseas.co.uk/chipreg/researchpregnancy.html
Submitted, revised, February 13, 2001. Journal of Family Practice
By: Alice A. Martin, PhD; Paul G. Schauble, PhD; Surekha H. Rai, PhD; R. Whit Curry Jr, MD, Gainesville, Florida

Results: When labor and delivery outcome measures were compared in the 2 groups, significant differences favoring the hypnosis intervention group were found in the number of complicated deliveries, surgical procedures, and length of hospital stay. Only one patient in the hypnosis group had a hospital stay of more than 2 days compared with 8 patients in the control group (P=.008). None of the 22 patients in the hypnosis group experienced surgical intervention compared with 12 of the 20 patients in the control group (P=.000). Twelve patients in the hypnosis group experienced complications compared with 17 in the control group (P=.047). Although consistently fewer patients in the hypnosis group used anesthesia (10 vs 14), Pitocin (2 vs 6), or postpartum medication (7 vs 11), and fewer had infants admitted to the NICU (1 vs 5), statistical analysis was non-significant. This study provides support for the use of hypnosis to aid in preparation of obstetric patients for labor and delivery. The reduction of complications, surgery, and hospital stay show direct medical benefit to mother and child and suggest the potential for a corresponding cost-saving benefit.

Notes: This study evaluated how childbirth preparation incorporating hypnotic techniques affected the labor processes and birth outcomes of pregnant adolescents. The study included 42 teenaged patients receiving prenatal treatment at a county public health department before their 24th week of pregnancy. They were randomly assigned to either a treatment group receiving a childbirth preparation protocol under hypnosis or a control group receiving supportive counseling. The hypnosis focused on the educational preparation of the patient while in hypnosis to create the expectation of a normal labor and delivery, develop a conditioned response of comfort and confidence, and facilitate an increased sense of control in achieving a healthy delivery. The subjects in the treatment group received a 4-session sequence of standard hypnotic interventions incorporating childbirth preparation information (in which they were instructed in the methods and benefits of focused relaxation and imagery to increase the likelihood of a safe and relatively pain-free delivery.) The sessions provided an opportunity to experience and practice hypnotic induction and deep relaxation. The suggestions directed toward the expectant mothers during the hypnotic state focused on the conceptualization of pregnancy and childbirth as a healthy natural process. Suggestions were also given to help the patient respond to possible complications, in the event they might occur. These suggestions were designed to increase the patient’s sense of trust in her physician and her confidence in her own ability to manage anxiety and discomfort. Hypnotic inductions also included ego-strengthening techniques and suggestions for a relatively discomfort-free delivery and suggestions for the application of the hypnotic techniques to other stressful periods in their lives. In each session the patients were given the opportunity to ask any questions of concern regarding the method or the pregnancy.


Study 7: Hypnosis to Help Achieve Uncomplicated Birth
Hypnosis to Facilitate Uncomplicated Birth
http://www.tandfonline.com/doi/abs/10.1080/00029157.2004.10403614#preview

Results: Women receiving prenatal hypnosis had significantly better outcomes than women who did not. Further assessment suggested that hypnosis worked by preventing negative emotional factors from leading to a complicated birth outcome. Attention only was associated with minimal differences in outcome over the no-contact group. Concludes that the routine prenatal use of hypnosis could improve obstetric outcome.

Notes: The purpose of this study was to determine if prenatal hypnosis could facilitate uncomplicated birth. Following a psychosocial assessment, 520 pregnant women in their first or second trimester of pregnancy were randomized to receiving prenatal hypnosis or attention-only groups. The goal of the hypnosis was to reduce fear of birth and parenthood; to reduce anxiety; to reduce stress; to identify specific fears that might complicate the labor process (addressing them whenever possible); and to prepare women for the experience of labor. The attention-only group was matched to a no-contact comparison group.

American Journal of Clinical Hypnosis, Volume 46, Issue 4, 2004, pages 299-312
By: Lewis E. Mehl-Madrona MD, PhDa, University of Arizona College of Medicine


Study 8: Self-Hypnosis for Pain Relief During Labor
The Effect of Hypnosis on Pain Relief During Labor and Childbirth in Iranian Pregnant Women

http://www.tandfonline.com/doi/abs/10.1080/00207140802665435#preview

Results: Women described their feelings about hypnosis during labor as: a sense of relief and consolation, self-confidence, satisfaction, lack of suffering labor pain, changing the feeling of pain into one of pressure, a decrease in fear of natural childbirth, lack of tiredness, and lack of anxiety. They expressed increased concentration on the uterus and cervical muscle, awareness of all the stages of labor, and having “positive thoughts.” Births were perceived as being very satisfactory compared to their previous experiences.

Notes: This study describes the effect of hypnosis on pain relief during labor and childbirth. Using a qualitative approach, 6 pregnant women were trained to use self-hypnosis for labor. Outcomes were analyzed using Colaizzi’s procedure.

International Journal of Clinical and Experimental Hypnosis, Volume 57, Issue 2, 2009 pages 174-183
By: Marzieh Abbasia, Fery Ghazia, Ann Barlow-Harrison, Middelsex University, Lond, United Kingdom
Mehrdad Sheikhvatanb, Medical Sciences/Univeristy of Tehran, Tehran, Iran
Fatemeh Mohammadyaric, Islamic Azad University, Tehran, Iran

I hope you found this article interesting and useful and please feel free to share.

Simon Maryan

 

Hypnosis and Fear of Dentists


stay-connectd

Unsurprisingly for many of you, a fear of dentists and dental treatment is a very common phobia in the UK and elsewhere around the world.

  • Almost half of UK adults have a fear of the dentist.
  • 12% of these suffers from an extreme dental anxiety.
  • Women are more likely to suffer from extreme dental anxiety than men.
  • Visiting the Dentist is ranked number one (22%) for making people nervous, even more popular than heights (19%).

Direct experience is the most common way people develop dental fears. Most people report that their dental fear began after a traumatic, difficult, and/or painful dental experience. However, painful or traumatic, dental experiences alone do not explain why people develop dental phobia. The perceived manner of the dentist is an important variable. Dentists who were considered “impersonal”, “uncaring”, “uninterested” or “cold” may develop high dental fear in patients, even in the absence of painful experiences, whereas some patients who had had painful experiences failed to develop dental fear if they perceived their dentist as caring and warm.

Indirect experiences

  • Vicarious learning
  • Dental fear may develop as people hear about others’ traumatic experiences or negative views of dentistry (vicarious learning).
  • Mass media

The negative portrayal of dentistry in mass media and cartoons may also contribute to the development of dental fear. This negative portrayal may come from such films as the 1932 comedy film The Dentist, the unrelated horror film The Dentist, its sequel, the 1933 cartoon The Merry Old Soul, and Marathon Man (the antagonist, Dr. Christian Szell, is a Nazi war criminal who tortures with dental equipment).

Stimulus Generalisation

Dental fear may develop as a result of a previous traumatic experience in a non-dental context. For example, bad experiences with doctors or hospital environments may lead people to fear white coats and antiseptic smells, which is one reason why dentists nowadays often choose to wear less “threatening” apparel. People who have been sexually, physically or emotionally abused may also find the dental situation threatening.

Helplessness and Perceived Lack of Control

If a person believes that they have no means of influencing a negative event, they will experience the feeling of helplessness. Research has shown that a perception of lack of control leads to fear. The opposite belief, that one does have control, can lead to lessened fear. For example, the belief that the dentist will stop when the patient gives a stop signal lessens fear. Helplessness and lack of control may also result from direct experiences, for example an incident where a dentist wouldn’t stop even when the person was in obvious pain.

Diagnosis of Phobia
Phobia of dental care is sometimes diagnosed using a fear measurement instrument like Corah’s Dental Anxiety Scale or the Modified Dental Anxiety Scale

It would be very interesting to read your experiences of dentists and how you feel about your 6 monthly appointment. In the meantime here are some case studies and also additional references at the end.

 

Study 1: Hypnosis in Pediatric Dental Treatment Using elements of hypnosis prior to or during pediatric dental treatment.

http://www.ncbi.nlm.nih.gov/pubmed/23635894

Results: A review of the relevant research and literature shows that the advantages of using hypnotic elements and hypnosis in pediatric dentistry are evident.

Notes: Most dental practitioners are familiar with pediatric patients expressing dental fear or anxiety. Occasionally, the dentist may encounter a situation where all behavioral techniques fail, while, for some reason, premedication or general anesthesia are contraindicated or rejected by the patient or his/her parents and a different approach is required. Hypnosis may solve the problem in some cases. The purpose of this study was to review the literature about techniques that use elements of hypnosis and hypnotic techniques prior to or during pediatric dental treatment. There is a limited amount of literature regarding the use of hypnosis and hypnotic elements in pediatric dentistry. Induction techniques, reframing, distraction, imagery suggestions, and hypnosis are identified, although mostly anecdotally.

Pediatr Dent. 2013 Jan-Feb;35(1):33-6
By: B. Peretz, R. Bercovich, S. Blumer, Department of Pediatric Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel

Study 2: Hypnosis for Dental Procedure Pain
Effects of Hypnosis as an Adjunct to Intravenous Sedation for Third Molar Extraction: A Randomized, Blind, Controlled Study
http://www.tandfonline.com/doi/abs/10.1080/00207140903310782?journalCode=nhyp20#preview

Results: Intraoperative Propofol administration, patient postoperative pain ratings, and postoperative prescription pain reliever consumption were all significantly reduced in the hypnosis treatment group compared to the control group.

Notes: This study aimed to evaluate the use of hypnosis/therapeutic suggestion as an adjunct to intravenous (IV) sedation in patients having 3rd molar removal in an outpatient setting. The patients were randomly assigned to a treatment (n = 46) or control (n = 54) group. The treatment group listened to a rapid conversational induction and therapeutic suggestions via headphones throughout the entire surgical procedure along with a standard sedation dose of intravenous anesthetic. The control group listened to only music without any hypnotic intervention. Intraoperative Propofol administration, patient postoperative pain ratings, and postoperative prescription pain reliever consumption were all significantly reduced in the treatment compared to the control group. Implications of these results are discussed.

International Journal of Clinical and Experimental Hypnosis, Volume 58, Issue 1, 2009
By: Edward F. Mackey, West Chester University of Pennsylvania, West Chester, Pennsylvania, USA

Study 3: Use of Imagery to Make Easier Injection of Anesthesia for Dental Work
The use of imagery suggestions during administration of local anesthetic in pediatric dental patients.
http://www.ncbi.nlm.nih.gov/pubmed/10997242

Results: The authors of this study conclude that imaging/imagery techniques may be successfully utilized in the administration of local anesthesia to young children (from three years of age) in an effort to mitigate untoward, pain-related stress.

Notes: The aim of this study was to evaluate the effects of suggestion before and during the administration of local anesthesia to children. Eighty children between the ages of three and sixteen years and who required at least one injection of local anesthesia were monitored. Retrospective examinations of their dental records provided the information regarding the behavior and dental treatment histories of the patients. All other data were provided through observation during the dental treatment phase. During the first treatment session, before the injection, each child was asked to select a favorite, pleasant memory or image. Where children had difficulty in identifying an image, one was proposed by the dentist. After an image had been chosen, the patients were asked to concentrate on the image and to visualize it during the procedure. The majority of children had chosen their own images, and significantly visualized the same images throughout the injection procedures. Image selection and visualization had no association with gender, age, the parent’s assessment of the child’s behavior, previous dental experience, behavior (both past and present) or, management techniques (both past and present).

ASDC J Dent Child. 2000 Jul-Aug;67(4):263-7, 231
By: B. Peretz, E. Bimstein, Department of Pediatric Dentistry, Hebrew University, Hadassah School of Dental Medicine, Jerusalem, Israel

References

  1. Bracha HS, Vega EM, Vega CB (2006). “Posttraumatic dental-care anxiety (PTDA): Is “dental phobia” a misnomer?” (PDF). Hawaii Dent J. 37 (5): 17–9. PMID 17152624.
  2. Milgrom P, Weinstein P, Getz T (1995). Treating Fearful Dental Patients: A Patient Management Handbook (2nd ed.). Seattle, Wash.: University of Washington, Continuing Dental Education. doi:10.1111/j.1600-0528.1996.tb00893.x. ISBN 1-880291-01-0.
  3. Erten H, Akarslan ZZ, Bodrumlu E (April 2006). “Dental fear and anxiety levels of patients attending a dental clinic”. Quintessence Int. 37 (4): 304–10. PMID 16594362.
  4. Stabholz A, Peretz B (April 1999). “Dental anxiety among patients prior to different dental treatments”. Int Dent J. 49 (2): 90–4. doi:10.1111/j.1875-595x.1999.tb00514.x. PMID 10858738
  5. Locker D, Shapiro D, Liddell A (June 1996). “Negative dental experiences and their relationship to dental anxiety”. Community Dent Health. 13 (2): 86–92. PMID 8763138
  6. Bernstein DA, Kleinknecht RA, Alexander LD (1979). “Antecedents of dental fear”. J Public Health Dent. 39 (2): 113–24. doi:10.1111/j.1752-7325.1979.tb02932.x. PMID 287803
  7. Hilton IV, Stephen S, Barker JC, Weintraub JA (December 2007). “Cultural factors and children’s oral health care: a qualitative study of carers of young children”. Community Dent Oral Epidemiol. 35 (6): 429–38. doi:10.1111/j.1600-0528.2006.00356.x. PMID 18039284
  8. http://www.dentalfearcentral.org/abuse_survivors.html
  9. Lundgren J, Carlsson SG, Berggren U (May 2006). “Relaxation versus cognitive therapies for dental fear—a psychophysiological approach”. Health Psychol. 25 (3): 267–73. doi:10.1037/0278-6133.25.3.267. PMID 16719597

Why We Are The Way We Are. The good and the bad of conditioned response.


It’s 4am and I’m awake again at the sound of the car door closing outside the window. My instincts are kicking in with my body and mind ready to respond in the blink of an eye and as I look around the room I realise I’m not in Baghdad or Kabul, Portharcourt or Baiji or anywhere else that is a threat, I’m on my own sofa in the living room of my own house.
My heart is racing as I struggle between two realities not completely sure which one to chose and not always knowing which one I prefer. It’s hard to step away from the chaos, fear and excitement that comes with combat, as crazy as it sounds it can feel more reassuring for a while than the quiet of a so called normal life with a host of new uncertainties that are alien and in their own way just as scary at times.

We were trained for years to respond to threats with a highly calculated, swift and utterly devastating level of aggression and violence on the battlefield, and to be able to turn that aggression down like a dimmer switch. It’s a hard skill to learn and one of many that never leaves you, and like so many it gets confused in the civilian life that we all end up in at some point.

When your brain is so used to high speed threat assessment it is easy for mistakes to be made in the civvy world because we feel constantly under threat as we navigate our new environment and unsure of the new rules of engagement. Sometimes we’re not sure who the enemy is and ironically, particularly in the early days, we are our own enemy. Our mind is struggling to cope, half knowing we can’t respond the way we do but not knowing any other way yet, until we learn what’s acceptable in this new world. And this takes time. Not something given up lightly in a frantically fast and ruthless world that we live in because time is a commodity, it’s precious and people and business hold onto it like it was a newborn child at times, protecting it with every ounce of strength they have.

Being conditioned into who we are has many advantages in both worlds. We are fiercely loyal, we have a work ethic that is second to none, we are extremely adaptable, learn fast and want to learn, we are highly disciplined, fantastic team players and very capable of getting the job done on our own when need be. We make great leaders because we have been trained and led by great men and when the shit hits the fan, there is no one else you would rather have by your side.

So when you meet or know someone who is struggling with their own mind as they work to come to terms with physical and/or psychological injuries from their time in the military, please share some of that precious time, allow them a little more of it and some space to come to terms with their new world.

And for you my brothers, when there is no need to brace yourself as the tailgate lowers and there are no more doors to kick in, no more need to try and squeeze yourself into the tiniest rut in the ground as the dirt kicks up all around you, when there are no more explosions that vibrate every organ in your body leaving you deaf, nauseous and disoriented and there is nothing left but deafening silence.

Remember that when the faces come rushing at you in those quiet moments, when you least expect them, with your heart racing as you check your exits and for people who are a threat, it is just your mind and the way you’ve been conditioned to be. Remember the simple things, remember to breathe, and as you breathe in clench your fists and as you breathe out open your hands and flex your fingers till they strain and imaging that you push those faces further away with every breath out. Keep doing this until those faces drift and fade into the distance and when they’re gone relax your hands at your sides and let that complete relaxation in your hands and forearms to flow all the way up to your shoulders, up your neck and into your head and face, then let that relaxation flow all the way down your upper body, through your hips, down your legs into your feet and all the way down to the ends of your toes. Remembering to breathe slowly as you do this.

You may well find this takes a bit of practice, as crazy as this sounds, but we all do it from time to time, we forget to breathe when we are stressed, under pressure and we tense up. So when you catch yourself tensing up like this, even if there are no faces to push away, just practice it like any other skill you’ve learned and create a new conditioned response when you feel stressed and threatened on any way.

Just as in the military and on operations we have each others back, well I have your back now. If you need to speak to clear your mind and get things off your chest then get in touch with me either on Facebook or my email, simon@simonmaryan.com and we can arrange a time to chat. We need to look out for each other just as much in this civvy world as we did in the military and sometimes more so. Despite retiring from that old world we will always be that band of brothers and that loyalty does not need to fade because we are not side by side physically anymore, technology has seen to that and made the world a much smaller place. So let’s take advantage of that and keep each other safe.

On that note ladies and gentlemen spoofers, I believe I am done.
Simon Maryan

Per Mare Per Terram

Mind-Body Health and Your Vagus Nerve


For me, being a therapist, counsellor or coach is just like being a good host at a dinner party, because a client is a guest in my practice and they have come because they need something from me that I can give them so I invite them in.

If my guest is thirsty, I give them a drink. If they’re belly is rumbling with hunger, I give them food. This is a basic duty of being the host with the most. And in my mind, the same principle applies to a client suffering from stress (and almost every client I see is).

When treating a negatively emotionally aroused client, the first thing I need to do is calm them down.

Don’t get me wrong, calm empathic listening can take the wind out of the sail of rising cortisol. But sometimes clients need immediate help. Their level of stress has become an emergency, and until you apply therapeutic psychological first aid, other diagnostics and treatments have to wait.

It’s equally useless to try to get someone who is dying of thirst to think about their long-term finances, you won’t get anywhere by attempting to help a stressed person until you address their need for relaxation and calm.

But why do people suffer stress in the first place?

People become stressed when they are not meeting their needs, or fear their needs will stop being met. (What if he/she leaves me? What if I lose my job?) A great visual for our needs is this image below which is an adapted version of Maslow’s Hierarchy of Needs. When these needs, starting from the bottom up, are not met we begin to suffer psychologically and then physically.

Maslow's Hierarchy of Needs

Emotional stress is a signal that needs are not being met adequately, just as thirst is a physical stress signal that the body is dehydrated. Knowing how to deeply relax stressed clients – offering ‘psychological & physical first aid’ – is a prerequisite skill to make any other therapy or coaching remotely possible.

Quench That Thirst 

Using talk therapy or getting all analytical when someone is crippled by stress is like giving salted food to a dehydrated guest. Quench their urgent thirst first, then work out how you can help them in the long term.

Stress is the one thing almost all psychological conditions have in common. Depressed people always have more of the stress hormone cortisol in their bloodstreams (1). Addicted people are stressed because they aren’t meeting their needs, and they try to relieve that stress through the escapism of addiction (2). People develop panic attacks when they’re generally stressed. Emotional problems are caused by stress, but in turn cause more stress.

So, to me, it seems almost unforgivable for any therapist not to be exquisitely skilled in the art and science of relaxation. And this is why I believe all people helpers should be able to heal through calm – and why I have always trained coaches and therapists to do this.

Here are three reasons why it’s not just ethical but essential to know how to relax your clients deeply.

1. You can’t help your client until they’re relaxed and ready

sp_image_role_of_vagus_nerve

Pete was clearly on the brink of either exploding or imploding, I wasn’t quite sure which one at first. His facial muscles were rigid, and the deeply etched creases in his face indicated long term tension and stress. Sitting in front of me his breath was shallow, fast and heavy, just like he’d run to my practice – yet he looked frozen in place. It was blatantly obvious that he needed help and right now.

Crucially, as I began engaging in conversation I found that he couldn’t think. Every time I asked a question I could see his mind wander off somewhere else. He did say one very important thing though.

When I asked what it was that he wanted, he looked straight at me and said “Not to feel like I’m dying inside!”

“I can’t relax, ever”, he said. Yet relaxation was precisely what he needed. Natural, mind-clarifying relaxation, that is, not the alcohol and sleeping tablet induced semi-coma that he’d become accustomed to.

We know that depressed brains are stressed brains. Pete was depressed because his needs weren’t being met. And the double bind was that in order to help meet his needs, he needed to become less stressed.

Long-term stress inhibits the function of the left prefrontal lobe, which generates feelings of enjoyment and satisfaction (3) and facilitates calm cognition (4). To put it simply, stress inhibits cognitive function. We can’t think or learn when we’re highly stressed.

Without wanting to overcook the analogy, you can’t teach someone calculus when they are desperate for water. And good luck trying to do cognitive therapy with someone whose thinking brain is crippled by anxiety.

I gave Pete what he needed in that first session, which was deep rest and relaxation. He was a different person at the end of that first session: clear, calm and hopeful. I didn’t just tell him he could feel different. I showed him how to feel different. Pete now had some clear space in his mind to really think about what else he wanted from therapy, beyond the relaxation.

Constant stress and failure to relax makes people feel hopeless, disassociated from their personal resources, and therefore helpless. From there it’s not far to go to reach crisis point.

Of course, we can’t disentangle body from mind – it’s a false dichotomy. Helping your clients relax will also greatly help their physical wellbeing.

2. You can’t heal the body without healing the mind

vagus nerve

For me, a good therapist, counsellor or coach should be able to improve the physical health of their clients by quickly improving their emotional health.

High levels of stress are correlated with increased risk of obesity and diabetes (5), and can damage immunity (6) and working memory (7). Prolonged stress (ongoing activation of the sympathetic nervous system or ‘fight or flight’ response) also increases inflammation in the body (8), which can adversely affect digestion (9).

Stress-induced inflammation is also implicated in the onset of some cancers (10), heart disease (11), and the physical manifestations of depression (12). This is hardly surprising, as depression is essentially a sense of nervous exhaustion from the stress of unresolved worry and rumination (13).

On the other hand, good immune function, clear thought, and feelings of wellbeing can all be promoted through an amazing mechanism that is closely tied to the relaxation response. Let me explain.

The Vagus Nerve and Your Mind-Body Health

As a therapist or coach, your job is to help people feel better, to give them the calm and confidence to pursue their goals. When the mind is troubled, the body is troubled – and vice versa. Fortunately for us, there’s something we can use to dramatically improve mental and physical health and reduce inflammation throughout the entire body. It’s called the vagus nerve.

The vagus nerve is an incredible meandering bundle of nerve fibres that extends from the brainstem, through the neck and thorax, and finally to the abdomen, where it supplies the gut. This is the widest nerve distribution of any nerve in the body.

The function of the vagus nerve is closely tied to your health, both mental and physical. It interfaces with your parasympathetic nervous system (relaxation response) and controls the healthy functioning of the heart, digestive tract and lungs.

Low ‘vagal tone’ has been linked to higher levels of inflammation in the brain and body (14). Conversely, when the vagus nerve is stimulated and strengthened, inflammation is lowered throughout the entire body.

Social connections (15) and healthy diet (16) both stimulate the vagus nerve, but perhaps the most important and practical way of stimulating the vagus nerve is by practising deep relaxation. In fact, just the simple act of breathing slowly in and out (the exhalation needs to be longer than the inhalation) activates the vagus nerve (17).

Relaxation helps our clients feel healthier, not ‘just’ physically but mentally too. Relaxing distressed clients is not just dealing with the symptom – it’s also helping alleviate the cause. When people improve their vagal tone they become more able to make emotional, cognitive and behavioural changes.

But as well as all the benefits of relaxation in and of itself, the relaxed state offers a perfect medium for psychological change. It’s during relaxation that we can best help our clients by treating the cause of long-term distress – and here’s how.

3. Relaxation primes your client for inner work

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I remember a client coming to see me who used to have CBT. He recounted how the ‘therapy’ would make him feel so stressed (with all the health implications that entailed) because the practitioner would ask him to replay in the sessions by focusing on all that was and had ever been bad in his life.

He learned to schedule the sessions on Fridays because he’d tried other days but found he had to take up to three days off work to recover from the ‘therapy’. So his weekends were ruined which added more stress from frustration.

This is absolutely insane. Our clients should feel better after every session.

Pete found that after months of building stress, the simple act of relaxing was incredibly therapeutic in itself. But we needed to deal with the reasons for the stress to prevent it from happening again in future.

All coaching and counselling uses inner work and what I mean by that is that even if you just ask a client what they want or ask them to think about the past, you are inviting them to go inside their minds to find the answer, to forget the room for a little while and enter a kind of light trance.

As a therapist, counsellor or coach, you are using a kind of trance focus whether you know it or not. Relaxed trance (and note that not all trance is relaxing) is the gentle medium through which change work can be done more powerfully and quickly. The relaxation part of any session is also the perfect time for a client to psychologically process earlier work.

People make intuitive leaps when they are relaxed and the unconscious mind has a chance to form new possibilities and solutions. Sometimes a reframe won’t take when a person is too stressed, but can be offered and digested in the mind during a state of deep calm and rest. It’s during deep relaxation that we can encourage real insight by having the client calmly use their dissociated, ‘Observing Self’.

You can help your client inwardly rehearse new positive behaviours by talking to them gently while they are deeply calm, resting with their eyes closed. This kind of rehearsal makes it more likely a client will actually carry out the behaviours required to help them toward their goals. And there’s more.

Relaxation is also the medium through which severe PTSD and phobias are lifted. The brain works through association but sometimes, as with phobias, addictions or low self-esteem, those associations can be harmful. We can use relaxed trance states as a way to unhook damaging pattern matches.

To put it another way, relaxation isn’t just the part of the medicine that makes it ‘taste good’. This natural and wonderful mind/body medicine also packs a real ‘nutritional’ punch.

Pete learned to relax himself once I’d helped him do it a couple of times. We used deeply relaxed hypnosis to not only help his vagus nerve adjust to a new, more generally relaxed Pete, but also to de-traumatise an old memory so that his flashbacks stopped and his nightmares faded away fast.

It was during deep relaxation that I helped Pete rehearse new, healthy behaviours to help him meet his needs better in future. What he said as he left the final session was brilliant:

“I never knew therapy was so enjoyable – I actually had fun!”

This is why I strongly believe that every therapist, counsellor and coach must to know how to deeply, quickly, easily and conversationally relax their clients.

Never let a client leave a session in need in any way, ever.

References:

1 http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.2007.164.4.617
2 https://www.youtube.com/watch?v=ao8L-0nSYzg
3 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907136/
4 http://www.sciencedirect.com/science/article/pii/S0896627301003592
5 http://www.sciencedirect.com/science/article/pii/S0889159103000485
6 http://www.nature.com/nri/journal/v5/n3/abs/nri1571.html
7 http://www.tandfonline.com/doi/abs/10.1080/10253890600678004
8http://www.huffingtonpost.com/2013/11/07/chronic-stress-health-inflammation-genes_n_4226420.htm and http://www.nature.com/nri/journal/v5/n3/abs/nri1571.html
9 https://dl.sciencesocieties.org/publications/jas/abstracts/87/14_suppl/0870101
10 http://www.sciencedirect.com/science/article/pii/S0889159112001833
11 http://www.sciencedirect.com/science/article/pii/S0022399901003026
12 http://www.sciencedirect.com/science/article/pii/S0006322308015321
13 http://www.bbc.co.uk/news/magazine-24444431
14 http://www.ncbi.nlm.nih.gov/pubmed/17192580
15 https://genomebiology.biomedcentral.com/articles/10.1186/gb-2007-8-9-r189
16 http://www.ncbi.nlm.nih.gov/pubmed/17192580
17 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3216041/

Life Design


For a long time I thought I was happy with my job, I was doing what I’d set to do in joining the Royal Marines. I worked with like-minded people, got paid to stay exceptionally fit, got fed four times a day and was provided with a roof over my head. The trade-off was that I was expected to do what I was told do whether I liked it or not and, some of the things I was asked to do I really didn’t like. However I was still happy living my dream.

Or so I thought.

Continue reading Life Design

Hypnosis and Erectile Dysfunction


causes-and-symptoms-of-erectile-dysfunction

Erectile dysfunction is a very common condition, particularly in older men. It is estimated that half of all men between the ages of 40 and 70 will have it to some degree.

Why does erectile dysfunction happen?
Erectile dysfunction can have a range of causes, both physical and psychological. Physical causes include: Continue reading Hypnosis and Erectile Dysfunction

Hypnosis and the Brain – Body Connection


I found this article on research at Stanford University School of Medicine that has identified three specific areas of the brain that are altered by hypnosis. It goes on to explain how effective hypnosis can be in using our minds to control our perception and our bodies and also, that there is a brain-body connection that helps the brain process and control what’s going on in the body.

So many benefits to using hypnosis to your advantage.

http://med.stanford.edu/news/all-news/2016/07/study-identifies-brain-areas-altered-during-hypnotic-trances.html

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A Day In the Life of a Dad With Combat Related PTSD


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I have spoken to and worked with many serving military personnel and veterans with PTSD and have heard some horrific stories that match some of my own. I never ask for any content of stories and just allow them to tell me what they need to say out loud, in their own way.

There are surprisingly innocuous triggers for flash backs, which is one of the many frustrating aspects of PTSD. Those who suffer with it find themselves getting lost in a flash back from minor little daily events that have no apparent connection to anything they have experienced. This recollection is from someone with PTSD and will hopefully go someway to help you understand what PTSD sufferers can be going through on a daily basis.

Continue reading A Day In the Life of a Dad With Combat Related PTSD