This article by Erzana Szwertak explores conversational hypnosis and the systemic approach to treating fears. It details how these methods help understand and overcome anxiety disorders, offering unique insight into managing phobias and improving mental health.
Are we right to be afraid?
For Aristotle, “courage is a virtue that we can acquire by accustoming ourselves to despising danger and standing up to it. We become courageous, and once we have become courageous, then we will be most able to face danger” (Aristotle, 1104b).
Therapeutic work consists of acting on the perception-reaction system and bringing about changes in the way of thinking about oneself, of telling oneself, of abandoning attempts at dysfunctional solutions, of constructing a new functioning and learning the techniques of self-hypnosis to better manage emotions.
The customer is the expert on their problem and its solution. The therapist is the expert on the strategy and framework that allows the client to change safely in a living relationship.
Definition of anxiety disorders
History of anxiety disorders
When faced with danger or stress, our physiological functioning changes: the heart beats faster, breathing changes, body temperature increases, digestion stops then, when the danger is over, the body returns to its usual functioning. .
Sometimes these changes take hold, persist, become chronic and invasive, creating a feeling of unease and insecurity. We then enter the vicious circle, into the world of anxiety disorders.
Anxiety disorders are defined by the presence of physical or psychological symptoms of anxiety, without any organic brain disease. At the end of the 19th century, the French psychiatrist Bénédict Morel was the first to identify these disorders. Freud worked on the origin of anxiety and proposed several models including his psychoanalytic model of neuroses, the reference in the field of psychopathology.
From the second half of the 20th century the diagnosis of anxiety disorders was identified under the name neuroses. At the end of the 20th century, research, neuroscience, technology and pharmacology allowed the development of new psychological systems such as cognitivism, behaviorism, attachment theory, constructivism and, then, the term "disorders". anxious” has become more relevant and better adapted.
Do anxiety disorders have a genetic origin?
Genetically, although there are no “anxiety genes,” some are involved in the risk of anxiety. This is the case for the serotonin 5-HT1A receptor gene.
List of anxiety disorders
Anxiety disorders include several other disorders such as generalized anxiety, panic disorder, specific phobias, agoraphobia, social anxiety disorder, and separation anxiety disorder. Anxiety symptoms can be varied and affect different areas of life.
Nosography of anxiety disorders
The World Health Organization (WHO) defines anxiety as “the feeling of undetermined imminent danger accompanied by a state of unease, agitation, helplessness, or even annihilation”. Anxiety is not a pathology except in the nosographic sphere of anxiety disorders, when (unrelated to a dangerous situation) anxiety has disruptive consequences in usual functioning.
The “Diagnostic and Statistical Manual of Mental Disorders” (DSM 5) of 2013, differentiates anxiety disorders including panic disorder with or without agoraphobia, specific phobias, social anxiety disorder (social phobia) and generalized anxiety disorder, from obsessive-compulsive and post-traumatic stress disorder.
Prevalence of anxiety disorders
Anxiety disorders in figures
According to the Haute Autorité de Santé (INSERM figures, 2021), “15% of adults aged 18 to 65 present with severe anxiety disorders in a given year, and 21% will present them during their lifetime”.
Who is affected by anxiety disorders?
Women are almost twice as likely to be affected by these disorders as men. Anxiety disorders are usually chronic, with a decline in quality of life. They continue to increase steadily and are marked by great distress. These disorders may be aggravated by comorbidity with other disorders. In young children, anxiety disorders are difficult to diagnose and can take years.
Monophobias or specific phobias
In The Aeneid, Virgil pleads for courage:
“Come on, courage, noble child, this is how we rise to the stars” (Virgil, Canto IX, line 641).
Like Proteus, the Greek god endowed with the power to transform, take all forms and metamorphose infinitely, specific phobias can have countless facets and faces.
The first systematic medical description dates from the 18th century. At the beginning of the 19th century, phobias were part of monomania.
Astute readers of Nietzsche, the philosophers W. Benjamin and S. Kracauer analyze that our experiences of pathological fear are also our instruments of perception and our resources for perfecting the gaze and considering critical reversals (Breton, Maestragg, 2016).
When do you become phobic?
“The dividing line is clear, we become phobic from the moment we are afraid of being afraid” (Perrot, 2021, p. 211).
How does the phobia manifest?
Often the phobia starts with a panic attack which is impressive and often traumatic. It leaves traces, anxiety comes at the idea of reliving it. Panic panics and the phobia begins.
The DSM 5- the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association in 2013 determines the criteria for a specific phobia.
Phobia is an intense and irrational fear, facing a feared object or situation or just facing the same imagined, anticipated situations. The object or situation is well defined and anxiety is present as long as the exposure lasts and panic attacks can occur. This creates a source of insecurity. The person begins to flee feared situations, isolates himself, his life changes, ties with others begin to break...
What are phobic syndromes?
Clinically, three phobic syndromes are defined:
- Specific phobias
- Social phobias
- Agoraphobia
We can note comorbidity links between anxiety and depression and anxiety and addictions. The list of stimuli causing specific phobias is not exhaustive: fear of animals (snakes, dogs, pigeons), fear of natural elements (water, storms, fear of heights, etc.), fear the plane, the sight of blood, the darkness, closed spaces, fear of speaking in public...
Example of a specific phobia with amaxophobia
Etymologically, amaxophobia comes from the ancient Greek, “amaxo” designating tank, vehicle and “phobia”, dread, the disabling fear of driving. It is an unreasonable fright caused during usual driving circumstances that turns into a stressful activity. Some people stop driving altogether.
What is amaxophobia?
Symptoms of amaxophobia are anxiety, sweating, shivering and panic attack. Clinically, amaxophobia is classified in the DSM-5 (American Psychiatric Association, 2015) and ICD-10 (World Health Organization, 2011) as a specific phobia of the situational subtype.
What are the origins of amaxophobia?
The origin of amaxophobia is multifactorial: genetic, psychological and developmental.
Fear of driving can appear following a traumatic event, such as after being in an accident or after losing a loved one in these circumstances.
Very often a lack of confidence and under-esteem are additional factors that promote vulnerability.
According to a study proposed by the “Centro Studi e Documentazione Direct Line”, an online car insurance company, 68% of Italian drivers admitted to being afraid of driving in particular situations. The factors that aggravate amaxophobia are situations where there is a lack of control over events and environments (bad weather, rain, snow), highways, bridges, tunnels, rapid descents and also loneliness while driving.
How does amaxophobia manifest?
This exaggerated fear can manifest itself:
- Physiologically (malaise, confusion, tension, tachycardia, panic attack, fear of dying or losing control of one's body)
- Emotionally (fear of anticipation)
- Behavioral (avoidance)
- At the cognitive level (catastrophic scenarios)
The idea that danger is everywhere takes hold and gradually grows, for example “other drivers are dangerous, they lack skills, they don't pay attention”. Going out by car is then risky, the avoidance solution increases and amaxophobia can thus evolve into agoraphobia.
Giorgio Nardone's model
In his books, in his courses and his conferences, Giorgio Nardone and his team share the support protocols that they have developed and tested, with theoretical support, clinical examples, transcriptions of detailed interviews and we have been able to benefit from this chance to learn and work thanks to its recorded sessions.
How is fear treated in G. Nardone's strategic systemic approach?
G. Nardone's intervention model is centered on stopping attempts at a solution. The symptom is the result of attempts to find a solution to a difficulty. In anxiety disorders, fear is the basic sensation and it is precisely by wanting to avoid fear that the person enters the net of the phobia. She begins to feel helpless and begins to avoid what she fears, or asks for help. His attempts at solutions bring immediate relief, but increase fear. The person becomes truly incapable and dependent.
According to G Nardone the natural reaction is to avoid the situation and the object of fear. The more there is avoidance, the more the feeling of fear grows. With time and repetition, this becomes an ineffective and counterproductive solution.
Another typical and ineffective solution is “ask for help” because it seems logical but ultimately reinforces the disorder.
The attempted solution that doesn't work anymore is "socialization of the problem." The disorder invades one's existence and becomes the favorite subject with those around them, family, friends, spouse... As if those around them condone the increase in the disorder.
The proliferation of these ineffective strategies makes the situation worse. It is observed that the possibility of falling into a trap depends mainly on the attitude one adopts towards an idea - that of abandoning one's beliefs and habitual thoughts (Watzlawick, 1988).
Strategic intervention strategies to treat fear
The intervention logic is centered on stopping the most frequent solution attempts (avoidance and asking for help) to deconstruct the phobia trap.
The therapist implements therapeutic maneuvers, with task prescriptions, to break dysfunctional solution attempts, to expand and experiment with new functional strategies and to confront fears.
In this approach, anxiety disorders are not an illness. They are the consequence of attempts at dysfunctional and redundant solutions in a circular interaction.
Anxiety disorders, according to systemic therapy, are the result of a vicious cycle of fear avoidance and help-seeking. A quote attributed to Einstein posits that “ignorance is doing the same thing over and over and expecting a different result.”
Neurobiology of anxiety disorders
We can think of anxiety as a progressive phenomenon, part of which we can only consider in abstraction. On the one hand, moderate anxiety can be useful and motivating and on the other hand, intense anxiety with “fight or flight” responses enables survival in the face of danger. Paradoxically, it becomes dangerous when it exceeds a threshold of what is appropriate or when it rises to an excessive degree.
The neural circuits of fear
Advances in neuroscience explain the neuroanatomical circuits involved in fear and anxiety in humans (the conditioning, acquisition, consolidation, reconsolidation and extinction of fear). The response to danger passes through the limbic system, with the amygdala being essential in emotional processing and connected to a sophisticated system with the hippocampus, cortical areas, prefrontal cortex, thalamus and hypothalamus.
Danger stimuli affect the thalamus and can then be treated:
1) Either by the short route (thalamus -amygdala activating immediate responses with the aim of preparing survival behavior" (secretion of stress hormones, adrenaline, acceleration of the heart rate raising blood pressure, endocrine responses (cortisol), behavioral responses (avoidance, bewilderment) and motivational responses (dopamine and pleasant feelings).
During a traumatic experience, the amygdala can disconnect from the hippocampus (the peri-traumatic dissociative state).
2) Either by the long route (thalamus - the cortical system - amygdala) with analytical and decision-making processing, (Salmona, 2020)
Short pathway responses (neuroanatomical, behavioral and neuroendocrine) during manifestations of anxiety disorders in panic disorder, specific and social phobias, post-traumatic stress disorder and generalized anxiety disorder resemble manifestations in animals exposed to fear. Specific phobias could be explained by a dysfunction of (conditioned) fear circuits.
Where to train in the systemic and strategic approach & hypnosis training
Read also:
- Hypnosis training and systemic therapy with Giorgio Nardone
- Hypnosis training: the basics
- online ericksonian hypnosis training
- Overcome fear and anxiety through hypnosis and self-hypnosis. Michele Ritterman.
- Hypnosis training: A hypnosis lesson with Milton Erickson
- Hypnosis training: the foundations of Ericksonian hypnosis, Interview with Michele Ritterman and Ph.D.By Michael Hoyt, Ph.D.
- Ritterman: human wickedness
Also read about anxiety disorders:
- A clinical view of anxiety disorders
- Brief and effective treatment for anxiety disorders and phobias
- Anxiety disorders: In the beginning, how to identify anxiety disorders?
- Anxiety disorders: Can we see both avoidance and control strategies in a patient?
- Anxiety disorders: Obsession, how to analyze it in relational terms in the notion of control?
- Anxiety disorders: Is paranoia part of the category of psychosis?
- Anxiety disorders: Does the anxiety disorder make it easier to stay in the exhaustion of the stress mechanism?
- Anxiety disorders: Faced with pathological doubt, how can you help a person?
- Anxiety disorders: the interval of therapeutic sessions from the first session
- GENERAL - Stress, anxiety and anxiety disorders - By Claude de SCORRAILLE
