Psychotherapy Institute İstanbul/Turkey 2008 PSYCHOTHERAPY OF PANIC DISORDER AND HYPNOSIS Tahir Özakkaş MD.,PhD Funda Güdücü MD. Psychotherapy Institute 2008 İstanbul/Turkey 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 Panic disorder (PD) is characterized by panic attacks that are considered as the most terrifying symptom in psychiatry, by many authors. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 Prevalence of PD is 1.5-3 %, whereas, the prevalence of panic attack (PA) is 3-4 %, because panic attacks can be seen along the course of other disorders. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 Panic disorder may become accompanied by agoraphobia that is the fear of being alone in the public places. Agoraphobia can devastate the functionality of a person severely. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 The diagnostic criteria for panic disorder is defined in the DSM-IV-TR 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 According to DSM-IV-TR, a panic attack is characterized by four or more of the following symptoms : palpitations, pounding heart, or accelerated heart rate sweating trembling or shaking sensations of shortness of breath or smothering feeling of choking chest pain or discomfort 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 nausea or abdominal distress feeling dizzy, unsteady, lightheaded, or faint feelings of unreality (derealization) or being detached from oneself (depersonalization) fear of losing control or going crazy fear of dying numbness or tingling sensations (paresthesias) chills or hot flushes 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 The presence of fewer than four of the above symptoms may be considered a limited-symptom panic attack. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 Panic attack symptoms overhelm the patient suddenly and without any apparent reason. The fear of becoming mad, getting out of control, and fainting overrun the patient. Physiological symptoms accompanying the anxiety persuade the patient that his/her catastrophic belief is true. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 This, in turn, catastrophise the symptoms and thoughts even more. This positive feed-back, or malign circle so heightens the anxiety that severe anxiety causes dissociative symptoms, that is, myriad forms of somatizations and even conversions. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 Symptoms, such as profuse sweating, peculiar sensations in the extremities, hyperventilation, chest pain, nausea, paresthesias, dizzyness mostly constitute an attack. Attacks are generally short-lived. They mostly last less than 10 minutes. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 Panic attack patients have been reported to be more hypnotizable than the average. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 This shows that the mechanism of the panic attack is like that of hypnosis. Thus, the disorder can be handled easily by hypnotic procedure. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 Spontaneously occurring, panic-filled, trance-like (dissociative) attacks are a maladaptive defense against underlying anxiety. To find out the cause of anxiety according to the several schools of therapy, hypnosis is a good way to take. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 If a subtle link between a thing and anxiety had established, hypnosis can shorten the time to uncover this link. Anxiety may be a product of a cognitive distortion, or a result of dynamic vectors, or existential causes. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 Using psychohypnotherapy, enlightenment of the patients regarding underlying pathology can be provided. If underlying pathology is considered as a consequence of behavioral, cognitive, psychoanalytic, and existential causes at the same time, not in an eclectical way, we call it ‘wholistic approach’. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 Hypnosis and self-hypnosis can be used also in order the patient to be aware of his/her dissociative capacity that produce the disorder. When (s)he becomes familiar with the mechanism, (s)he becomes able to control it easily, reducing the symptoms in a short time, even stopping them. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 Only the attentive subjects can go into a deep level of hypnosis, and hypnosis can intensify one’s attention even more. During panic attack there are several ways that can turn the patient’s attention from bodily symptoms to imaginations using simple hypnotherapeutic techniques. If one can focus on these imaginations satisfactorily, the process that leads to panic attack can be interfered. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 The suggestions of relaxation under hypnotic trans alleviate panic attack symptoms. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 Anxiety treatment using hypnosis can be effective for panic attack patients, because patients with high-trait anxiety show stronger respiratory responsivity to imagined risk of suffocation, which constitutes a vulnerability factor for the development of panic disorder. Anxiety treatment can be improved by hypnosis. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 Behavioral approach: Systematıc desensitization, exposure, aversive training, positive reinforcement and extinction, relaxation, reconditioning, supression, support (ego strengthen), imagination can be applied in combination of hypnodrama in a more efficacious way under hypnosis. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 Cognitive approach: Hypnotic suggestions are directed toward the control of cognitions, in this way, enhancement of self-mastery is helpful in panic disorder. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 Dynamic approach:1 Hypnosis facilitates the cooperation of patients. Many patients can talk about the things that ashame him/her more easily under hypnosis than while awake. Sometimes it is very easy to access unconscious conflicts under hypnosis. Abreaction (catharsis) can even occur spontaneously in hypnosis. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 Dynamic approach:2 In addition, some feed-backs can be obtained in hypnosis, regarding the course of the therapy. One’s nderstanding his/her own is realized in shorter time. Hypnosis is helpful in understanding the internal dynamics of the disorder. It helps understand of the patient regarding the causality of illness. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008

Psychotherapy Institute İstanbul/Turkey 2008 Alert hypnosis can be used along with traditional relaxation-based techniques. In several studies, hypnosis has been found a valid alternative to drug use. Biofeed-back-aided or EMDR aided hypnotherapy can be used as well. 19.09.2008 Wien Psychotherapy Institute İstanbul/Turkey 2008