“Describe in detail a specific advanced hypnotherapeutic approach, giving a clear rationale for its application and therapeutic objective.”

Hypnotherapy provides a number of different ways for treating patients suffering from anxiety. This essay seeks to look at some of these methods, aiming to uncover what these methods are, how they specifically target anxiety, what anxiety actually means on a biological and psychological level, and why hypnotherapy can be a good solution for some of the causes of anxiety(Gibb 2007). It is hoped that in the process of answering the question, a better understanding will be reached of the effects of anxiety and hypnotherapy, both in terms of its treatment and efficacy as a means of helping those suffering from anxiety.
Before we can begin to look more closely at hypnotherapy, we must begin by arriving at some working definitions of anxiety. Anxiety stems from neural circuitry in the amygdala and hippocampus, both located in the limbic system within the medial temporal lobes of the brain. Although the hippocampus is more explicitly associated with memory, both combine to produce anxiety in human beings via a complex means of neural communication. Anxiety is not however, a mental illness but instead, a behavioural condition that is a reaction to biological causes. The first of these is an imbalance of neurotransmitters in the brain. If the brain finds itself overloaded with substances such as adrenaline or epinephrine, or lacking in substances such as serotonin, the brain becomes more susceptible to stress (Rossi 1988). Any inbalance in these substances can lead to anxiety. Extended amounts of stress over a long period of time can also cause the brain to become conditioned to anxiety. This works by the brain overproducing adrenaline over an extended period of time to fight anxiety. However, the brain soon becomes accustomed to the extra adrenaline levels, creating ever more, even if there is no stressful situation present. Hormones are another factor that can lead to anxiety. Women tend to be far more vulnerable to this than men as they experience far greater hormonal variation in their bodies than men, for example after giving birth or entering the menopause. In these cases, women’s’ bodies are left without enough progesterone, the hormone needed to control stress, and accordingly, they are more vulnerable to suffer anxiety. However, if levels do not get back to original levels, say after a pregnancy, this can lead to post-partum depression and longer-term anxiety disorder.
On top of this, a person can also feel anxious as a reaction to fear. According to Irving Janis and Terwilliger (1962), the factor trends that can cause anxiety as a result of fear can be classified into three different levels. The first is a low charge anxiety response, which is considered a protective response. The second and more serious charge, the so-called moderate charge, is one in which sympathetic functions become much more marked, and reactions include panic attacks. Usually, people in this group are greatly influenced by the information that is given to them. Information seems to have a positive influence on these people: potential dangers, how dangers are overcome, and protective factors help the patients grasp reality and overcome worry. The third charge, also known as the vaso-vagal syncope, is caused by any example of pathophysiology, ranging from blood loss to extreme stress. Regardless of the trigger, the mechanism of syncope is similar in the various vasovagal syncope syndromes. In it, the nucleus tractus solitarius of the brainstem is activated directly or indirectly by the triggering stimulus, resulting in simultaneous enhancement of parasympathetic nervous system (vagal) tone and withdrawal of sympathetic nervous system tone. This can result in various reactions: a drop in heart rate, a drop in blood pressure, or even a loss of consciousness (Rossi 1988) (Rossi & Cheek 1988).
When we come to look at psychological causes of anxiety, we must return to the amygdala. It works in association with memory pathways to determine the relevance of the stimulus and the gives an emotional reaction. Thus, anxiety can be a product of previous experiences which the amygdala allows the brain to “relive”. This is important when we come to hypnosis as the hypsnosis itself strives to “turn off” the amygdala in an attempt at controlling these emotions caused by unpleasant memories. However, on top of this, anxiety can also be caused by the breaking of rhythms that regulate our lives. These can be broken down into three main ones: the infradian rhythm which refers to rhythms that last longer than a day, the menstrual cycle for example; circadian rhythms which refer to those that take place once every 24 hours such as sleep; and finally, the ultradian rhythm that refers to rhythms that last less then 24 hours, the various cycles involved in sleep for example. While breaking these rhythms can be triggers for anxiety, as we shall see, they can also be used as an effective tool for therapy, (Lloyd, & Rossi, 1992) incorporating rhythms into the actual treatment schedule thereby allowing for greater mind/body communication, and a bolstering of the parasympathetic (Rossi 1988) (Rossi & Cheek 1988).
Having given a brief outline of anxiety and its various causes, let us now turn to the hypnosis itself. When a patient comes to see a hypnotherapist complaining of anxiety, the first task is to come to some form of definition of the problem. This is usually done by using the B.A.S.I.C. I.D. Profile. This form of profiling, developed by Lazarus (1981) looks at seven modalities that can be used to gauge a patient’s anxiety levels. It can be summarised as follows:
The basic framework comprises the following seven modalities:
• Behaviour
• Affect
• Sensation
• Imagery
• Cognition
• Interpersonal
• Drugs/biology
This blueprint is known by the acronym BASIC ID and is used for the basic assessment of clients. During the assessment the different modalities are examined by asking questions similar to the following:
B- What would you like to start doing/stop doing?
A- What makes you angry, sad, etc?
S- What do you like/dislike to hear, taste, etc?
I- What do you picture yourself doing in x weeks, x years?
C- What are your main musts, shoulds, beliefs?
I- How do you get on with others; do you act passively etc?
D- Do you take medication? Do you smoke? How is your health? (adapted from Palmer, 1994)
It is important to realize that the modalities often interact with each other and thus an image of failure could lead to cognition of failure, which in turn could lead to anxiety. Once the cause of the anxiety has been identified, it is the job of the hypnotherapist to begin to help the patient to overcome it.

The treatment of anxiety with hypnosis is not new, and research has shown that it can have favourable results. As Wann der Watt et al (2007) report, ‘Alladin and Alibhai (2008) compared the effectiveness of the combination of hypnosis and CBT, which they termed cognitive hypnotherapy, with that of standard CBT in 84 patients with major depression. Patients were randomly assigned to the two treatment groups, which were run over 16 weeks. The investigators found that treatment outcomes were significantly enhanced when CBT was combined with hypnotherapy. Patients from both groups exhibited significant improvements compared with baseline scores, with greater reductions in depression, anxiety and hopelessness in the cognitive hypnotherapy group than in the CBT group. This improvement was maintained at 6 and 12 months of follow up.’ (p. 163) The aim of hypnotherapy in this case is to get the patient to focus and explore their anxiety. The aim is also to make them look upon both the anxiety and the source of that anxiety in a new light. Thus, it involves a realignment of perspectives. The therapy should begin with the client at a relatively high level of anxiety, as defined by the BASIC ID profile. The reasons for this are various. Firstly it makes it easier to identify the source of the anxiety, both psychologically and at times physically. However, it also presupposes a base level of anxiety from which it is easier to escape. By starting with high anxiety levels, it is possible to decrease them over the course of the therapy so that they can begin to appear surmountable. The process of combating anxiety can be done by a series of reframing techniques. This is broadly separated into three distinct subgroups: memory, bind and sensory. Thus, memories can be reframed (turning negative memories into positive results). Future sources of anxiety can be reframed from something that causes discomfort to an opportunity to excel. Likewise, sensory symptoms of anxiety can be reframed as your body telling you it is ready to achieve rather than to fail.
This process can take a variety of different means, but it is typical to follow a broader pattern of priming/initiation, arousal/accessing, resynthesis/polarity, and finally, internal incubation, all making up the polarity approach. The priming/initiation involves discussing the problem with the patient. It is used to gauge the patient’s severity, but also as a means of engaging verbally with them. It should always be accompanied by positive feedback, aimed at making the patient feel more comfortable. Questions are also key, allowing the patient to fully articulate their problems. Next, the arousal/accessing stage, allows the therapist to begin to look more closely at the source of the anxiety. This can be stressful for the patient as they are forced to confront the source of their anxiety head on, but it is also a key stage as it is when the patient can begin to confront, and overcome their anxieties. Accordingly, this stage needs to be handled with sensitivity, but it can provide a number of breakthroughs as patients begin to reformulate how they view their problems. The resynthesis/polarity stage that follows is more complex. The therapist will ask the patient to invoke an opposite feeling to the one that has originally caused anxiety. This will often be an example for an as yet unknown future. Although the future may in and of itself be a source of anxiety, the therapist will ask the client to focus on a positive aspect of it. Then, they will ask the patient to begin to integrate the positive and negative images in their mind so that they begin to balance the negative with the positive, seeing both as equally capable of overcoming. By doing this, the negativity is visualized as merely a force, much like the positivity, that exists in our lives, that is normal, and that can be dealt with accordingly, and not as something that takes us over, and makes normal bodily function difficult or impossible. Finally, the internal incubation allows all of the previous steps to be internalized, consumed, and digested. Thus, there should be a concentration on breathing, and on visualization of a positive future in which challenging goals have been met and assimilated into normal life. Now, the patients state should be calm, and there should be a new aura of passivity to them, far removed from their initial anxious state. Questions should be focused towards arriving at this point, and should remain positive, asking the patient to make their own mental leaps to arrive at a place of calm, rather than being dragged there by the therapist.

The therapy begins by priming the client by symptom scaling them. Discuss with patient the concept of an imaginary scale of 1 to 10 that could fully express and indicate their own level of feeling at any given time with regards to any situation. If those feelings were at the very highest level and could go no higher the scale would indicate a 10 and if the feelings were at their lowest or even gone the scale would be at zero. The aim here is to get a synthesis of STMLB (state dependent memory learning behaviour). Research in this area supporting the understanding of STMLB (Alladin & Alibhai; 2007; Eich & Metcalfe 1989; Rossi, E., Rossi, K., & Los Osos, 2006). By combining old sources of anxiety with future positive thoughts, the hypnotherapy should provide a resynthesis of the source of the anxiety. This is the followed by a deepening exercise which uses a relaxed count down to allow the client to proceed further with the hypnosis. This is then followed by an awakening, but not before an exercise of ego-strengthening which allows the patient to be more positive, all framed around a series of goals and aims that can be used to turn anxiety into more positive energy.

Throughout this process, the aim is not to negate feelings of anxiety, as they are natural for every human being, but to make them more manageable. Anxiety in and of itself is no bad thing, and can be used in a number of positive ways for meeting goals and so forth. However, when it becomes pathological and hinders everyday living, hypnosis can offer a means of re-assimilating it into normal life via a process of balancing out memories with future hopes and expectations. By recalibrating previous experiences, they can be reformulated and understood as positive steps in a chaotic but fruitful journey.

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Reference list
Alladin A, Alibhai A. (2007). Cognitive hypnotherapy for depression: an empirical investigation. International Journal of Clinical Experimental Hypnosis; 55, 147-166
Eich, E,. & Metcalfe, J. (1989). Mood Dependent Memory for Internal Versus External Events. Journal of Experimental Psychology, 15 (3), 443-455
Gibb, B. (2007). The Rough Guide to The Brain. London: Rough Guides.
Janis, I. L., Terwilliger, R. F. (1962). An experimental study of psychological resistances to fear arousing communications, The Journal of Abnormal and Social Psychology, 65 (6), 403-410.
Lazarus, A. A. (1981). The Practice of Multimodal Therapy. New York: McGraw-Hill.
Lloyd, D. & Rossi, E. (1992). Ultradian rhythms in life processes: An inquiry into fundamental principles of chronobiology and psychobiology. New York: Springer-Verlag.
Palmer, S. (1994). A Multimodal Approach to Stress Management and Counselling, Article based on a paper presented at the International Stress Management Association (UK) 'Cost and Benefit' Conference at the University of York, [online], Retrieved March 18, 2011,from http://members.multimania.co.uk/stress_centre/webpage3.htm
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Rossi, E. (1988). The Psychobiology of Mind-Body Healing. Ontario: Penguin Books.
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