In this paper I aim to define what stress and anxiety are and outline the differences between them. These topics form a larger part of the essay as Stress and Anxiety underpin most cases presented to a therapist. I will move onto how phobias and habits are formed. Finally covering off options available to the therapist in order to research all these issues for a given client, understand any hidden agendas, history, treatment strategies and most importantly understand where NOT to treat. Stress ‘a state of mental or emotional strain or tension resulting from adverse or demanding circumstances’ (Oxford English Dictionary)
This definition shows a specific circumstance; the individual involved is experiencing stress due to an event; be it in the past, current or future tense. Whilst stress can have a negative connotation in the English language, in fact most stress is positive. It is there to protect us. The feeling of ‘stress’ is a reaction which ensures we perform appropriately at the right moments. It is a natural reaction to a number of given situations, causing our innate animal instincts to activate and is activated by the hormone Cortizol naturally produced in all mammals.
These are commonly known as Flight, Fight, and the lesser remembered, Freeze responses. As such, our sub-conscious will protect us through releasing chemicals in order that we can perform appropriately to deal with the situation. However distressed a client may be, one thing you can use to help them understand is that it is triggered in order to protect us from a threat. Stress becomes an issue when it is inappropriate to the situation. That is not to say that what the client/patient experiences is not real. It may be that the individual has experienced one or more episodes of stress that may not be representative of the subject at hand.
It may also be that they are experiencing a consistent level of stress, such as workload, a particular home situation or the need to consistently to overachieve in all parts of his/her life in a manner that is unsustainable. Avoiding the stressful situation can also be further damaging as this re-affirms the messaging in the brain around the given situation. Types of stress experienced vary and have many labels depending on how they manifest: Acute StressMost common: immediate threat(s), anticipated demand(s) or pressure(s). Episodic Acute StressRecurring: Overabundance of tasks, tends to become habitual to individual.
Chronic StressPerpetual: Unable to see resolution, due to its constant nature it can go unnoticed by sufferer. HyperstressOverwhelmed: Workload, beyond limits of tasks achievable. HypostressThe ‘Bored’ Stress: Unmotivated, unchallenged. Lacks enthusiasm to innovate, start new challenges. Eustress‘Good’ Stress: Positive events or emotions, motivational, largely ignored. I have separated Traumatic Stress and Post Traumatic Stress as these sit under the title of Anxiety in the next section. Individuals will experience physical responses to a stressful situation or ongoing stress; some common, some more specific to the individual.
These include: sweating, shakes, fast heart rate, dry mouth, upset stomach, acid reflux, releasing of stools, muscles tensing, headaches, other aches, lack of sleep, fatigue, loss of self esteem. Anxiety ‘a feeling of worry, nervousness, or unease about something with an uncertain outcome’ (Oxford English Dictionary) This definition shows that instead of the specific circumstance seen in stress, anxiety is in comparison ill-defined. Sustained stress or specific traumatic event(s) can lead to anxiety. These may be rational or irrational; however, they manifest as very real to the sufferer.
It may even be that the sufferer understands that their anxiety is irrational, but is unable to control it. It is important for a hypnotherapist to understand where they can and cannot treat in relation to Anxiety. The therapist should discuss any anxiety cases with their supervisor, it may be that the case requires GP approval. In certain cases such as PTSD the therapist may need to refer to a multi-disciplinary team (or be part of). One way or another, the key here is caution, ask advice and make sure you are cleared to move on with treatment. There are many types of Anxiety Disorders, here are some:
General AnxietyMost common: Constantly nervous, anxiousness where Disorder (GAD)there is no specific cause is obvious. GP/Supervisor Panic AttacksTriggered with no apparent cause: Response to sustained stress/anxiety. GP/Supervisor PhobiasBroad Subject: From Feathers to Flying, Social, Crowds, Spiders. Can be anything and is very real to the sufferer. Traumatic StressReactive Anxiety, similar to PST. Response to a traumatic event. THIS MUST NOT BE TREATED. GP/MULTI-DISCIPLINARY TEAM. Post Traumatic StressReactive Anxiety Disorder, response to severe traumatic (PTSD)event.
THIS MUST NOT BE TREATED. GP/MULTI-DISCIPLINARY TEAM. Obsessive-CompulsiveObsessive thoughts, released through the compulsion Disorder (OCD)to act on thoughts. Comes in many forms. As with stress there are many physical responses, which include, all those mentioned in the stress section. There are specific symptoms for specific types of anxiety, for example in a Panic Attack, the sufferer truly believes they may die and feel entirely helpless. Anxiety suffers release strong emotions at certain times such as anger or they may cry or want to run from the situation.
Due to the perpetual nature of anxiety issues, nausea, extreme exhaustion, restlessness and obsessive focus on negatives are common. Essentially it shows a loss of control. Treatment of Stress and Anxiety Whilst you may have three clients showing the same symptoms the underlying the reasons will be different for each. It’s key to spend time understanding the background to the issue, to ascertain whether the client remembers the trigger and for the therapist to spend time understanding the reason they are feeling this way, when it occurs, how it occurs and the symptoms.
It may be that the initial reason they believe the stress or anxiety situation occurs is a red herring and perhaps they are unaware of another reason. Regression may be required to fully understand the history, especially if it’s clear that the issue has its roots back in childhood, this may also provide positive imagery that can be re-used in a script. For example, a bad flyer may have roots in childhood experience, but similarly remember a good experience flying that may be re-used during a script.
‘Problematic imagery is reported by clients with almost all anxiety disorders, with the specific content of the images relating to the clients’ main fears that are central to the clinical disorder’ (Hirsh and Holmes 2007: 161). ’ I like the suggestion of asking the client about their dreams as well as using their interests and using this imagery to work through a script appropriate to the situation. There seems to be a lot of evidence to show that there is a direct correlation between how vivid imagery is for an individual and how powerful the feeling is towards the negative situation.
That’s not to say those with different modalities suffer less, but it’s a consideration. So for someone who can easily envisage the worst scenario their stress levels may considerably increase. On the flip side this also means a therapist can use this to their advantage and treat using strong visual tendencies. If the therapist can focus on a positive image from the clients key interests or dream subjects. Outside of the specific script to the given situation, helping the client learn to relax through a relaxation script (and take-home recording) is key to working through stress issues.
I also like the approach of the ego-strengthening scripts for those who are experiencing stress due to self-belief, it’s a good basis to build on during treatment sessions before the therapist can move onto specific reframing or programming of a perception. Having also read a number of ‘rehearsal’ scripts I find these a very positive approach to dealing with stressful situations, although again it would be prudent to ensure you are not trying to ‘fix’ an issue up front without understanding the underlying history and cause.
Also looking to take the negative thoughts, feelings and/or images and find a way of disposing of them in some way using appropriate modality. I think this is a key action to take within a script as those suffering stress or anxiety will primarily focus on the main negative, it will consume thoughts and feelings. In ‘purging’ them, the client can symbolically get rid of those before moving onto a more positive view of their given experience. Anxiety issues require special consideration. OCD for example, requires specific training. PTSD, a specialist team would need to be involved. Key focus areas would be things like GAD and Phobias.
Phobias will be described later in the paper. GAD still requires GP approval to treat using Hypnotherapy. Without wishing to go into too much depth it is key to mention two methods for use with PTSD; Eye Movement Desentisation Reward (EMDR) and Visual Kinesthetic Reward (VKR). Phobias A fear or phobia may root from a number of given sources. It’s possible the client knows when it occurred originally. It’s equally possible that they do not (even if they say they do). So as described above it’s key to discuss the issue and clearly understand the history, the manifestation and perhaps regression may be required.
The phobia may have been caused by several sources. It may also be that whilst the individual may say they are phobic of a particular situation or object, this could be masking the real fear (hidden agenda). So whilst you have a treatment plan, keeping an open mind is key. Reasons for Phobias Occurring: Severe Stress relating to a particular object/event/location. The mind associates that with that. It could be that the object of fear is not the real issue. For example; fear of red doors. Perhaps an individual had to walk through a red door every time they went to the solicitors to meet with the estranged spouse.
This issue is potentially the pain of the divorce, loss of children rather than the door, but the mind’s association is with the door. Specific Experience or Number of Experiences. Fear created through a negative experience that frightened the individual. Perhaps getting stuck in a lift once for a long period would be enough of a severe trauma to create a phobia of lifts or a number of bad experiences in lifts (feeling squashed/delays in the lift moving/jolting action) create a phobia over time. Learned Fear.
Something we associate with animals, demonstrating good stress in practise in a natural environment. It can be learned from a mother or other significant person. So perhaps the mother has a fear of the sea and transmits it to her children. Treatment is similar to the approach for stress. The key is to understanding why/how/history. Its important to look at the root cause and in particular if there are any hidden agendas. Whilst its possible to do things like a rehearsal script and important to build in confidence building/ego-strengthening, these may only temporarily help the situation.
Ultimately, indentifying and tailoring a solution based around the original cause is key to a successful treatment plan. The use of a signal from the client allows them to indicate if the therapy is moving too quickly (given they may be experiencing stressful moments in trance) or they have arrived at a certain point. This allows the therapist to ensure the pacing is correct for the client and that they gain the most from the session. Habits Similar to stress this can appear to have a negative connotation but of course we have many good habits in our lives.
We can all develop bad habits, these may be learnt or absorbed from others. It’s also possible these have occurred over a period of time as a coping strategy for another issue. Again, in this situation its key to understand why the habit is in place and look at a reasonable alternative coping strategy. Two ways to address a habit: Client seeing themselves living without the habit, using their motivations and drivers (such as how they look, feel, etc) Detrimental effects of continuing, so the client will associate the negative affects or perhaps even a negative view (like a cigarette being a charcoal stick)