On Use of Hypnosis for Treatment of PTSD

Reprint of my article published at HealthWorksCollective.com on June 10, 2013


Post Traumatic Stress Disorder (PTSD) affects around 10% of the population and can strike anyone after a traumatic event.  A traumatic event is defined differently for everyone. For one person a traumatic event could be getting a divorce while for someone else it may be fighting in a war. The perception of the event from the viewpoint of the person with PTSD is what determines the severity of the symptoms and duration of the disorder. Acute PTSD lasts no more than 3 months while chronic PTSD lasts much longer. No matter the trauma, a person with PTSD lives with flashbacks of the event, avoidance behaviors, hypervigilance, and often physical symptoms such as headaches and gastrointestinal concerns. These symptoms can often be debilitating and life-altering, and can be very difficult to treat.

Treatment can include medication, Cognitive Behavioral Therapy, Eye Movement Desensitization and Reprocessing, and/or Hypnosis.  A multimodal approach has been found to be most effective in the treatment of PTSD. Medication can ease some symptoms and make life bearable but it is often necessary to have some form of therapy in order to reach full remission.  Although hypnosis is not a true form of therapy on its own, it is a technique that can be used to increase the chances of recovery from this disorder when paired with therapeutic intervention. Most people are not familiar with the therapeutic effects of hypnosis and may see it as something of a party trick. However, it can be a very useful tool to aid therapy. The origin of hypnosis as magical or metaphysical contributes to the skepticism of those who question its use in the mental health field. Hypnosis emerged in the 1800s from a new awareness of meditation techniques. It was reported that self-hypnosis, or meditation, was showing positive results in the East but how it worked was not truly known. There have been many metaphysical, medical, and psychological hypotheses about how hypnosis works to induce change in the mind and body. There has been equal skepticism about whether it works at all. The uses for hypnosis are plentiful and diverse. It has been used to cure ailments, addictions, pain, mental health, and a host of other concerns. Recently, hypnosis has been studied scientifically to show that it is effective in helping patients deal with all the symptoms involved in PTSD including dissociations, flashbacks, and hypervigilant fear responses.

Hypnosis is in essence an intensely focused state in which the mind ignores outside stimuli and the person becomes  tuned in and in control of their thoughts. During this time, the counselor is able to help the patient traverse his thoughts and fears in a safe environment, allowing him to become aware of his dysfunctional behaviors and reactions. Hypnosis allows the patient to minimize the effect of the traumatic  event on their daily life and to learn how to relax when the fear reaction is triggered.  The most important factors in the use of hypnotism in therapy are the patient’s ability and willingness to be hypnotized and the therapist’s training and expertise in the use of this technique. Going into a hypnotic state makes the patient extremely vulnerable because he is disconnected from his environment and highly suggestible. It is important that the relationship with the counselor is a trusting one so that the patient is able to process feelings and progress appropriately. It is equally important that the counselor be able to effectively lead the patient through hypnosis in a way that is clinically helpful.

Hypnosis is used with treatment in a stair stepped approach. It is first used to allow the patient to learn to relax and regain control in situations outside of therapy. Specific suggestions are instilled in the patient to allow them to quickly call on these coping strategies when neeeded. Next, it is used to find resolution in the trauma. During this time, the patient will be able to use reframing and integration techniques to see the trauma in a new light. This step in hypnosis can also allow the patient to dissolve self-blame and restructure the event in a way that allows for closure and a decrease in exaggerated recreations during flashbacks. In the final step of hypnosis, the patient is able to learn to maintain stability and solidify coping and relaxation mechanisms in daily life. They will be able to distract their thoughts from the trauma and regain control over their daily life. If used correctly, hypnosis along with therapy can alleviate the daily retraumatizing symptoms that a patient must endure. When used shortly after the trauma has occurred, the effects of hypnosis can be seen in very few sessions.

PTSD is a fairly new diagnosis and studies are continually being done to determine the most effective combination of interventions. Although hypnosis is an effective technique in the therapeutic treatment of PTSD, it must be tailored to the needs of the patient and adjusted as those needs change.

image: flickr-photos-42269094@N05-4707772587 

Link to original publication: http://healthworkscollective.com/talishenfield/107161/use-hypnosis-treatment-ptsd

Dealing with Anger and Aggression in Children

Reprint of my article published at MedHelp.org on June 25, 2013

 Every parent wants to protect their children, teach them to protect themselves, and help them redirect their own outbursts before they become dangerous and aggressive. We want to know that when our children become angry, we can discipline them appropriately and effectively and that we can help them resolve their conflicts constructively. It is important to identify children who may need professional help or may be at risk for future problems related to anger and aggression. 

If your child is being victimized and does not have a way to ward off a bully, he needs immediate help. You can spot the warning signs by noticing if your child is getting hurt or bruised, appears scared, has nightmares and doesn’t want to go to school. Your child is may be a victim of bullying if he or she speaks negatively of him or herself, appears to be socially isolated, or talks of being put down physically and/or verbally at school. You can help by instructing your child to stand up for himself, by teaching him to say ‘Stop hurting me/hitting me/pushing me’, or a simple and firm ‘NO!’ if he is preverbal. Teach him to speak firmly, stand tall and walk away from his bully. It is a good idea to inform a teacher at school so that he can be supervised when you are not around. 

Sometimes, children who are being victimized turn to aggression as a means to express themselves. Many young children also lash out because of low self-esteem, isolation, and a sense of failure and anxiety. Sadness and depression is often linked with anger in young children. Young children also tend to act out of angry defiance to assert independence when they feel unimportant and lacking control over their lives. It is important not to dismiss their transgressions, because childhood-onset anger and aggression is correlated with serious problems later in life. In fact, parents who choose not to react might be ignoring symptoms of potential childhood psychiatric disorders such as Oppositional Defiant Disorder and Conduct Disorder. The problem may become more persistent and “can be part of a developmental trajectory leading to adolescent delinquency” (Barry and Lochman, 2004). 

I assume that you are reading this blog because you know you need to be involved in shaping your child’s social behavior. So what should you do and which reactions should you avoid? It is absolutely necessary to remind your child what kinds of behaviors are unacceptable and to teach them the ramifications of breaking the rules. With both younger and older children, it is important to understand that anger is not ‘bad’. It is not the child that is bad, but the behavior. As mentioned above, it is crucial that you do not ignore their outburst. Help them communicate how they feel. Do not act out of impulse and verbally berate your child or become physical. Not only are these strategies ineffective, they teach your child deplorable ways of coping with problems. You want to model proper behavior and teach him or her that every problem has a solution that can be arrived at with a calm and clear mind. Reasoning works better with older children, whereas younger children who act aggressively out of anger need a time out so that they do not hurt themselves or others.  You can help both younger and older children to cool down by acknowledging how they feel and instructing them in techniques such as deep breathing and relaxation. With young children, it is usually beneficial just to stand nearby, watch them when you expect them to get stirred up and talk to them about how they feel before they escalate. An unexpected warm touch might remind the child that they have you at their side. It is helpful to remind both younger and older children of the strengths they possess and strategies at their disposal to help them work through their problems. By doing so, you are building up the child’s self-esteem and encouraging him to resolve his own conflicts in ways that are not hurtful.

If your child appears to have problems managing his emotions on a regular basis, this might be a good time to consider professional help. There are intensive programs which help older children and adolescents, in groups and one-on-one. These programs encourage a child to identify and express how he or she is feeling, to take another’s perspective and to practice role playing in order to learn techniques to scale down violent outbursts. They usually include components on problem-solving, negotiation and resisting peer pressure. There are also professional-led workshops and classes for parents. They teach you how to talk to your child, what to look out for and how to behave in the moment so that you don’t have to lose your cool. It is important not to underestimate your influence and the role you have in preventing your child from going down the trajectory that leads him or her to potential academic failure, delinquency, substance abuse and other deleterious behaviors. 

If your child's anger manifests through intense screaming, kicking, hitting, or biting, he or she may have so called "anger overload". To learn how to deal with anger overload you can read my article "Does your child suffer from Anger Overload" at http://www.psy-ed.com/blog/anger-Apr2013.php 

Link to original publication: http://www.medhelp.org/user_journals/show/803752/Dealing-with-Anger-and-Aggression-in-Children

The Mystery of Memory

Reprint of my article published at yourbrainatwork.org on June 24, 2013

Have you ever read and enjoyed a book, only to discover that you can't remember it years later? Things start to come back when you pick it up and reread it, yet that reread is mostly a new experience that is only modified by the original reading. The same sort of thing occurs with the names of people we knew in the past. How many of us can accurately list the names and faces of the people we knew in the seventh grade?

Memory is a strange thing. There is a transience about it that is both unique and mysterious. The day-to-day details get lost amid the constant updates. How many of us remember what we had for breakfast two weeks ago last Sunday, let alone twenty years ago? The transience of memory may have something to do with the emotional impact of the memory. We may remember our first kiss, but not the face of our math teacher, unless we either really loved or really hated math.

Transience affects both short and long-term memory. A short-term memory (also called working memory ) is formed when the mind relays what is happening now to what happened only a short time ago. A good example of short term memory is writing a long sentence. You wouldn't be able to string the words together in any meaningful way unless you could remember the words that you wrote a few seconds before. Short term memory gets displaced quickly. It gets knocked out of position by the next thing the mind focuses its attention on. In one experiment, test subjects were given a three letter sequence to memorize and then were asked to count backward in sets of threes, such as 100, 97, 94 etc. It took only eighteen seconds of backward counting to displace the three letter set.

By contrast, long term memory seems to be a matter of slowly forgetting. We move to a new neighborhood and we slowly forget the faces of the people and the names of the streets where we once lived. Of course, when we revisit that place, the memories start coming back. This is evidence that we, perhaps, never really forget anything . The information is just downgraded, because we aren't using it, until it gets filed in some remote cubbyhole of the mind, until circumstance cause us to pull it out and dust it off. There is no real evidence that the human mind actually ever really forgets anything. The problem is that the further back you go, the more debatable the memory becomes. There are vivid memories from childhood that can be triggered by a cue, such as a particular smell or sound or even the return of a person that we knew as a child. Memories can sometimes be recalled under hypnosis, but the veracity of such memories depends to a great extent on the hypnotist. This is especially true of memories of events that took place long ago. People under hypnosis are very suggestible and it is easy for a hypnotist who doesn't know what he's doing or is looking for a memory he believes is there to accidentally "implant" a memory of something that never actually occurred.

We are only beginning to scratch the surface of the human mind. The more we study, the more its complexity, diversity and adaptability amaze us. Will there come a time when we truly understand every nuance of our minds and all the hidden corners are revealed? 

Link to original publication: http://yourbrainatwork.org/the-mystery-of-memory-how-memory-works/ 

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Persistent Memories and PTSD

Reprint of my article published at yourbrainatwork.org on June 1, 2013

Memory doesn't always fade away. It can persist, even to our detriment. Those afflicted by post traumatic stress disorder are often haunted by memories and images of traumatic events to a point where it becomes unbearable. The ordeal they underwent keeps resurfacing over and over again.

The persistence of memory, especially the persistence of traumatic memory is likely a survival mechanism that developed in the distant past when human beings were constantly on the move. It was a way of remembering the bad things that happened and driving us away from similar circumstances. In our modern lives, traumatic circumstances may not be all that common. Still, we're stuck with the memories, even when they are no longer useful.

Direct forgetting, that is just telling yourself, or being told by someone to forget, doesn't seem to work. A traumatic experience causes our minds to be hyper-sensitive to certain concepts, words and surroundings. In one study, a group of women who had been sexually abused as children were given words that described traumatic experiences and then told to forget them. Very few could. While, on the other hand, the control group made up of women who had not been abused could easily forget. It appeared that traumatic experiences actually suppress the ability to forget. So, it seems that, in treating post traumatic stress disorder, we are actually up against a built-in mental mechanism designed to keep traumatic memories and things associated with them at the forefront of the mind.

This mechanism can have often be linked to depression. It can create a vicious cycle where thinking about traumatic past events can lead to depression and depression can lead to more thinking about traumatic past events.

Studies have shown that when people are encouraged to be introspective, they often tend to recall negative thoughts, while people whose attention is extroverted tend to recall more positive thoughts. Does this mean that the cure for depression is to be an outgoing extrovert?

Well, not really.

The persistence of memory and the tendency of traumatic experiences to persist is part of a memory system that has evolved for the purpose of survival. Our ability to remember consequences keeps us from making the same mistakes twice.

The number of life threatening, traumatic situations that the average person encounters has been greatly diminished in our modern world. Because of this, a mechanism that once kept us alive is now more often a hindrance than a help.

Will the day come when we evolve out of this little trap? Maybe, if things keep going as they are. However, if our descendants don't have the cushy lives that we have, the persistence of memory might once more be a valuable survival tool.

 

Link to original publication: http://yourbrainatwork.org/persistent-memories-and-ptsd/