Each time I see a client with an anxiety disorder, I witness the stronghold that anxiety has on them.
Anxiety is like a dark invisible beast: little by little, day by day, week by week it grabs you and takes hold of you until one day, you realise that it has completely possessed you; that you can no longer handle your racing thoughts, chaotic emotions and overwhelming body responses.
A few numbers
Moreover, it is important to note that these figures are dated before 2019, and therefore pre-pandemic.
Various studies show that the number of people reporting high levels of anxiety in the U.K. significantly increased during the coronavirus pandemic (e.g. between March and May 20, then Oct20 to Feb 21) and, as per the Office for Health, Improvement and Disparities (OHID), whilst these deteriorations partly recovered post-pandemic, psychological distress and disorders remain higher than pre-pandemic.
What is anxiety?
The American Psychological Association defines anxiety as ‘an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure (…)’.
Although if it is widely recognised that thoughts and emotions all contribute to maintain the vicious cycle of anxiety, unpleasant body responses that these provoke are what generally bring people to therapy.
Anxiety responses are multiple. The most common physiological ones include sweating, palpitations, muscular tension, breathlessness, headaches, nausea, butterflies or diarrhoea. Psychological symptoms include distress, irritability, poor concentration, memory difficulties, feeling unreal and losing control. The list is not exhaustive.
These symptoms are in themselves not dangerous when experienced sporadically for a short period of time, and it is important to remember that everyone at some point in their life will experience some form of anxiety since it is a natural response (for example, before an important exam or interview). However, if these occur for a prolonged period of time and become chronic, if your fears and worries become disproportionate to the situation, if you avoid going somewhere for fear of experiencing these overwhelming symptoms or losing complete control, then, the beast has taken over and it is time to do something about it.
Types of anxieties
Anxiety wears many masks and disorders include generalised anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, body dysmorphic disorder (BDD), post-traumatic stress disorder (PTSD), social anxiety disorder (previously called social phobia), phobias and separation anxiety disorder.
Whilst these all share some features and symptoms and carry the notion of anticipating a future threat, they also have very distinct differences and it’s these differentiations that are going to guide your doctor through to a sound diagnosis so relevant treatment can be established.
Similarly when visiting a hypnotherapist. It is important to give your hypnotherapist as many details as possible. Not only this will give her/him a good understanding of what exactly needs to be addressed, but also because some hypnotherapists work with some specific types of anxieties and not others. Different types of anxiety require different types of techniques, methods and your hypnotherapist should always be honest and open about whether she/he has the required knowledge and expertise to help you with that particular type of anxiety disorder.
Is hypnotherapy effective against anxiety disorders?
Hypnosis has been mentioned in many studies proving that yes, it can deal very effectively with anxiety.
I cannot mention every single one of them for this would take me far too long however, here are a few major ones.
Perhaps starting with one of the most recent ones. A meta-analysis (i.e. review of various studies on hypnosis for treating anxiety) conducted in 2019 by Valentine et al. quantified the effectiveness of hypnosis as a treatment for anxiety. The meta-analysis reviewed 15 studies incorporating 17 controlled trials of hypnosis used as a treatment for anxiety. Anxieties included dental anxiety, surgery and medical anxiety, general anxiety and test and performance anxiety. The meta-analysis concluded that ‘hypnosis is a highly effective intervention for anxiety’, that ‘it may be as effective, or possibly more effective than other common interventions for anxiety’ and that ‘hypnosis was more effective in reducing anxiety symptoms when combined with other psychological interventions for this problem (e.g., cognitive-behavioral therapy) than when used as a stand-alone treatment’.
In his thorough review ‘Hypnosis in the treatment of anxiety and stress-related disorders’, Hammond (2010) lists a multitude of experimental literature on hypnosis and self-hypnosis for the treatment of anxiety. Conclusive study samples in this review are multiple and all confirm the efficacy of hypnosis on anxiety-related disorders. For example, another meta-analysis made on no less than 18 studies by Kirsh et al. and where cognitive behavioural therapy (CBT) was compared with cognitive behavioural hypnotherapy (CBH) on conditions such as public speaking anxiety, phobia, or even insomnia, concluded that ‘the average patient receiving cognitive-behaviorally oriented hypnosis demonstrated greater improvement than at least 70% of patients who received nonhypnotic treatments’.
An investigation made by Sapp (1990) to measure the effects of hypnosis against a Hawthorne control group on 40 students, demonstrated the effectiveness of hypnosis in reducing test anxiety; this was maintained after 6 weeks.
A Van Dyck et al study (1994) showed that self-hypnosis training was as effective in reducing anxiety and tension headaches as autogenic training (a relaxation technique). And from the multiple conclusive research demonstrating success rates of no less than 95% on patients suffering from irritable bowel syndrome (assumed to be anxiety-mediated) to other ones showing the very positive impact of hypnosis on medical, surgical or dental-related procedure anxieties (e.g. Zelter and LeBaron1982; Pekala and Forbes 1988; Melis et al. 1991; Lang et al. 1996; Schupp et al. 2005; Slack et al.2009...etc), little is left to scepticism about whether or not it can help.
How does it work?
Every therapist works differently according to the school of thoughts and therapies they are influenced by.
I am personally influenced by cognitive behavioural therapy and my sessions will always reflect this. However, no matter what your therapist’s influences are, you will be taught relaxation techniques. Hypnosis is in itself very relaxing and as such very appropriate to the practice of relaxation. Other techniques such as breathing or imageries are very efficient too. Mindfulness can be very successfully incorporated into your hypnosis sessions and you can be, for example, taught how to accept your feelings for what they are without however being so engrossed in them.
Importantly, any technique can and should be practised again at home through self-hypnosis. In most of the studies mentioned above, patients used self-hypnosis to reinforce what they had learned in the practice with their therapists. The more you practise these methods, the better the outcome.
Dealing with anxiety is about learning new more appropriate and adaptive responses. Your brain was trained for years to respond in some sort of maladaptive way to certain triggers. Teaching it to respond in a different, more appropriate way takes effort and patience.
But the good news is, all that can be reversed - and hypnosis is here to help!
Anxiety UK: Key facts and figures, 2019. https://www.gov.uk/government/publications/covid-19-mental-health-and-wellbeing-surveillance-report/2-important-findings-so-far. Depression and other common mental disorders – Global health estimates – 2017, World Health Organisation. Keara E. Valentine, Leonard S. Milling, Lauren J. Clark & Caitlin L. Moriarty (2019) THE EFFICACY OF HYPNOSIS AS A TREATMENT FOR ANXIETY: A META ANALYSIS, International Journal of Clinical and Experimental Hypnosis, 67:3, 336-363. D. Hammond, Hypnosis in the treatment of anxiety and stress-related disorders, Expert Rev. Neurother. 10(2), 263–273 (2010).