Treating anxiety disorders with hypnosis

This case study is very interesting for understanding and treating anxiety disorders with the systemic approach and hypnosis.

He believes that to be a good father you have to feel safe to be able to reassure your child and his family when he himself does not feel safe, despite a rational internal discourse. This insecurity emerges like a storm as soon as he is behind the wheel. He needs to be reassured, to be helped by his wife, which reinforces the contradiction. I start from this double bind as a clinical hypothesis with the aim of working on it to eradicate his phobia.

There is a contradiction between his desire for relational autonomy with the issue of parenthood and his incapacity because he is dependent on his wife. We highlight that his initial request is not so much on the outside, afraid to drive on the highway, but that it resides in his deep interior, with a desire for a relational change that touches him intimately.  

The trap of the double injunction

As if he were trapped in a double injunction: on the one hand he has the extreme desire to become a worthy father and on the other he is under pressure from this role which he apprehends to the point of losing his means. In this ambivalence, driving, leading his life, becomes a dubious and impossible mission that frightens him, and the highway with the reigning speed, where he has to come to terms with others, threatens him even more. He feels helpless. He is in the logic of avoidance and wishes to find a solution in order to show himself capable.

During this session I was attentive to his body (very rigid at the beginning), his posture (he was neither grounded nor focused), his verbal and paraverbal language and I paid close attention to the words he used and to metaphors (which I used regularly).

Analyze the perception–reaction system

At the end of this session, here are the main elements of his perception-reaction system:

Worldview: To live and survive you have to be brave. Fears and anxieties weaken. The world can be dangerous and currently there is such a feeling of insecurity in this world; the current context is worrying. A parent must reassure their child in all circumstances. A good father must reassure his family.

Problem: He has been suffering from panic attacks for several months. He experienced several while driving. He begins to feel very hot, his body weakens, his breathing quickens. At such times, he is afraid of losing control of his body. Now he anticipates, he is afraid of a new crisis; increasingly avoids driving, going out.

With whom: With himself

Where: When driving (especially on the highway), but also in closed rooms.

When: For 1 year

Position in relation to the problem: I have a problem and I must solve it. I have to do everything to succeed. I will be a dad soon and I want my child to be proud of me.

The attempted solutions he has put in place: He is very controlling and when he can't, he avoids (driving, delegates to others). Asks for help, readily accepts someone else driving.

Socialization (talks with his wife and with all his friends)

Relevant system: His wife

No exceptions

Sensation, dominant emotion: fear of losing control and sadness

The relationship with his wife is complementary, he is in a “one-down” position and he needs help from his wife (even though she is pregnant). She is always available to take the wheel, sending the subtle message “I help you because you are unable to drive”.

 In the 2016 book “A Logic of Mental Disorders” G. Nardone and JJ Wittezaele develop a model to illustrate how the fear of a panic attack always triggers the same response that maintained the problem (Nardone, Wittezaele 2016 p.110) . It is a logic of avoidance which makes it possible to understand how the problem functions in the present and how it persists.

avoidance behavior

The interactional scheme inspired by my numerous courses at LACT ( generalist systemic training with the University of Paris 8 ) and by the book “When work hurts” is the result of questioning during the session. : “The practitioner devotes time to investigating the functioning of the problem and his instrument to achieve this is his mode of questioning” (De Scorraille, Brosseau, Vitry, 2017, p.80). This diagram is a proposal of the interactional diagram of the request for help with the relational dynamics and the consequences, emotional and behavioral.

Requirements

In the rest of the accompaniment, he always respected the prescriptions and quickly felt different. He managed to stop dodging, even though it was quite a feat. He drove several times. His wife was surprised and proud of him. The anticipatory fears persisted and they accompanied him whenever he had to drive. He no longer discussed his fears with those around him and forced me to think carefully before asking for help. He felt more confident and realizes he is capable. I valued and encouraged changes that went in the right direction. He noted a few "small" attacks, all managed without panic attack, with an intensity of maximum 4 (scale of 1 to 10).

As he had obtained the expected changes, he was instructed to continue the initial prescriptions and, this time, I offered him the task par excellence, the paradoxical ritual of the “worst-case fantasy”: 30 minutes a day with a double objective, to he must first stop avoiding and then he will face his fears, he will seek them out, choose them in order to no longer suffer them. He left by committing to 300%.

I kept as common thread that his avoidances are the consequence of a problem of relational autonomy (vision of hypnosis). He is afraid of having a panic attack again, of feeling the same symptoms, with the same inability to act. As if he was "dissolving", as if he were no longer in control of his life. This fear was not connected with lived experiences, it was connected with his representations of lived experiences, such as images, thoughts and behaviors.

The questioning was inspired by the lessons of Eric Bardot:

When you tell me “I think our work is helping me, changing me”, could you explain to me what makes you feel confident here and now?

We are working on security, in the present. He sought to identify the elements that connect him with security, with serenity. In my particular way of questioning him, I go further, to push his imagination and activate a more unconscious work:

When you explain to me "I'm afraid of losing control of my body" are you afraid of losing control of your body or are you imagining what could happen and are you afraid of your imagination?

During the questions, I let the silences settle down so that the imagination can operate and the scene can appear. We then work so that the externalization process can take shape and we establish "shared imagination" where both of us visualize a situation (from the past) where he is driving on the highway, carefree, confident and content, knowing that at the end of the night his wife is waiting for him.

During the following sessions, I took the experience further and we talked about its representations of the family and its relationships, the shared roles, the relationships and its necessary criteria. He spoke of his childhood, of missing his father, of the stories he had invented to justify his absence and to lessen his suffering. A situation emerged (he thought he had forgotten it): at school, to play football, an opposing team had been formed with the fathers and he remembered his injury and his loneliness.

Slowly, I suggested to him:

“In a moment, I will ask for your attention and focus on all the details”

I then invited him to bring back this whole scene which was hurting his mind and to imagine it in my hand and to observe it as if it were a screen (dissociation). I suggest that he retouch the scene, using the “mental Photoshop” technique, and modify it so that it is pleasant and acceptable to him (Megglé, 2021). He gets involved, he applies himself and transforms the mental film. He is appeased, the new scene was pleasant. He felt it all over his body and especially in his chest.

I accompanied him:

“You have all the time you need to live this new experience, while your eyes naturally close and this pleasant feeling settles more and more. I stay with you and my voice accompanies you.

… “And while you are having this experience now and when you are attentive to the details, you can observe people who are closely or remotely connected to this experience and with you”

He was amazed, his grandfather was present and was able to play football with the adults. He scored two goals and, thanks to him, they had celebrated the victory. And, as our memory evolves with our experiences, he “injected” a new memory during the time of the session.

In the therapeutic follow-up, and at each session, I took the time to question the prescriptions and what was put in place. Since my client was in a complementary relationship, he perfectly implemented the requested tasks. He wanted to change.

He told me that during his daily meetings with the worst of his fantasies, he was not comfortable but that, day after day, he was able to manage. Once he fell asleep during exercise. He thought he had conquered his fears.

A few weeks later he had an important meeting with his wife at the midwife's. He drove and had a major seizure with strong and bothersome symptoms, but this time he continued driving without stopping. He lived this experience as a failure.

I validated her ability to not give up and “integrated” relapse into the process. It was part of the job and was predictable. As a logical continuation and to unlock the system that maintained fear. The next task was “5 minutes of the worst 5 times a day”.

During the following sessions, the therapeutic work progressed well. We had a solid and trusting alliance and the results were convincing. We have established a safe and comfortable distance for him.

We then worked on its values ​​and their incarnations: freedom, respect, protection. He learned to welcome his sensory feelings which were linked to his fear. This time we made connections with experiences related to his values ​​and he was able to reconnect with his fears. He saw his grandfather again and they were able to talk, because they share the same values.

He had "attachment disorders" according to the work of John Bowlby, this vital need for a secure attachment bond interrupted in early childhood. It is important to work on it. He was locked in this world of insecurity and oscillated between the abandoned world and the world of abuse.

He seeks to build a secure relationship with his wife with whom he shares the same values ​​and who is always there for him. He recalled the first time he took the initiative to enroll in a dance class knowing that she loved to dance.

Read also: 

Treatment of anxiety disorders with the systemic and strategic approach
Effective treatment of anxiety disorders

 To relive this beautiful experience again, he closed his eyes, he reconnected with this experience and was proud to have taken this initiative and saw the joy in his wife's eyes again. His shoulders, his head, are very straight, he has a broad smile. He was connected with his body, the sensations are pleasant. He feels better and more confident. He had the impression that something had just been released physically. From that moment, he no longer had any seizures. He drives on the highway several times with a total sense of security.  

 Everything was ready for her baby and he was impatient. Her father came and they reconciled. The relationship was still fragile, they needed time. He wanted his child to be surrounded, to have a grandfather. He felt close to this old man. To strengthen his autonomy he learned the self-hypnosis known as "Sensory Spiral" from Betty Erickson. I prescribed it to him daily to act on the physiology, to calm his nervous system.

 To consolidate the results obtained, in a continuum, he had the prescription "the fantasy of the worst 5 minutes" 

• Either when he feels the symptoms coming                
• Either in anticipation of a stressful situation

 The return continued to be satisfactory, the tasks were like a pledge of his commitment and he respected everything. There was no crisis. He felt happy. Towards the end of the intervention, I asked him with the intention of verifying:

 This time we set up a recent experience, where his mother objected when he decided to change jobs. The relationship with his wife was in place and she supported him. Being autonomous and in a secure relationship, he was able to overcome his fears and his phobia.

 “What is your assessment of the path traveled today? from 0 to 10? 0 was when you first came and at 10 you could say: Thank you, I solved my problem”.

 After following all the instructions, the changes seemed to be well established. Since he looked the “ghost” in the eye, he disappeared and so did his seizures.

 On the 0 to 10 rating scale, he is now at 10 (ORS).

 We keep the latest prescription to stabilize the latest changes. Two months after the last interview, DP became a father, he is in the clouds. He experienced an internal transformation, he thinks, acts and feels the courage to grow. He took parental leave, wants to take care of his daughter, wants to be the protective father capable of dispelling all fears. I asked an unusual question that comes from problem-oriented therapies: "How to make it worse." During this last session, he explains that the relationship with his wife was more balanced.

 “If you really wanted to be certain to make it worse and if you deliberately wanted to complicate your situation so that your fear of driving was present again, what could you deliberately do or not do, think or not think? , to say or not to say, so that your situation worsens?…

 What are the strategies and solutions that you can apply if you want to be certain of going wrong again? Of course, you don't have to set them up."

 He no longer needed her driving him. This couple of young parents was doing very well, their little girl is happy and he takes good care of her. He changed his way of being, he was on leave, more relaxed. He was confident, managed to manage his family life, happily assumed his role as father, husband, and he observed that in his social life he was more open and his relationships became more balanced because he felt that he was loved. .

 The cross-questions of systemic therapy, hypnosis and narrative therapy had made it possible to obtain spectacular changes in a short time (7 sessions). Fatherhood was perhaps a positive factor that contributed to the change. He changed his perception-reaction system and his dominant sensations evolved. As if at the beginning of the therapy, there was only one light on, like in the theatre, that of fear. He succeeded in “thinking outside the box” in which he had locked himself and he opened up new perspectives. As Robin Williams in the film "The Dead Poets Society" explains to his students: "I stand on my desk so as not to forget that we must constantly force ourselves to look at everything from a different angle".

We human beings have this wonderful ability to time travel, we can relive our experiences from the past. We can rediscover and relive the best emotions and sensations through our thoughts. Our brain is also programmed to anticipate the future, to protect us, to avoid dangers, to receive rewards. With technological progress, we have learned to compact time and space, everything is fast and in real time. Very quickly we became fond of this concomitant information (sms, e-mails, tweets) and social networks (FB, Instagram, Snapchat, Twitter). We have become hyper connected and paradoxically we have become disconnected from ourselves, dissociated. Our most sophisticated brain, the neocortex, the one that thinks, analyzes and deduces has developed on the old brain, the one that is governed by the laws of survival, reproduction, attachment.

 How did we go from a skill to foresee the future to a pathology of anticipation such as a phobia? Where is the border between a healthy and useful fear and that which handicaps? Is it this ability to anticipate the future and the danger that creates the conditions for a phobia or is it to avoid falling into the traps of an uncertainty that we try to anticipate, to foresee, to calculate, increasing the likelihood of falling back into our own trap?

Modern life, with its multiple threats, wars, pandemics, global warming, droughts, floods, terrorist attacks, economic problems, pesticides on our plates, are the favorite subjects that impose themselves in our exchanges.

 How to resist this anxiety that surrounds us, how to take a step back? How can we tame our fears and live well with them?

 An effective therapy is initially flexible and requires a range of varied therapeutic techniques to be able to adapt to each particularity. Systemic and strategic therapy provides a precise framework, its questioning leads to quickly understand how the problem works now. This information allows the therapist to construct the best problem-solving strategies.

 The contribution of hypnosis is to allow the client to work in a secure space, in a living relationship. The goal of an accompaniment is to guide the client towards new, more functional perspectives, towards a lasting change, using suggestions, evocative language, metaphors, aphorisms, so that he can live a corrective emotional experience, in order to to feel differently before understanding.   

Generalist systemic training with the University of Paris 8
DU in Relationship Clinic with the University of Paris 8
Clinical Masters with specialization in psychopathology with the CTS of Prof. Nardone
Systemic Coach Training with the University of Paris 8
Systemic Training in relationship management with University of Grenoble
Ericksonian Hypnosis Training Online