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

2. 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.
Wien
Psychotherapy Institute İstanbul/Turkey 2008

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

4. 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.
Wien
Psychotherapy Institute İstanbul/Turkey 2008

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

6. 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
Wien
Psychotherapy Institute İstanbul/Turkey 2008

7. 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
Wien
Psychotherapy Institute İstanbul/Turkey 2008

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

9. 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.
Wien
Psychotherapy Institute İstanbul/Turkey 2008

10. 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.
Wien
Psychotherapy Institute İstanbul/Turkey 2008

11. 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.
Wien
Psychotherapy Institute İstanbul/Turkey 2008

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

13. 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.
Wien
Psychotherapy Institute İstanbul/Turkey 2008

14. 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.
Wien
Psychotherapy Institute İstanbul/Turkey 2008

15. 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.
Wien
Psychotherapy Institute İstanbul/Turkey 2008

16. 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’.
Wien
Psychotherapy Institute İstanbul/Turkey 2008

17. 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.
Wien
Psychotherapy Institute İstanbul/Turkey 2008

18. 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.
Wien
Psychotherapy Institute İstanbul/Turkey 2008

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

20. 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.
Wien
Psychotherapy Institute İstanbul/Turkey 2008

21. 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.
Wien
Psychotherapy Institute İstanbul/Turkey 2008

22. 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.
Wien
Psychotherapy Institute İstanbul/Turkey 2008

23. 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.
Wien
Psychotherapy Institute İstanbul/Turkey 2008

24. 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.
Wien
Psychotherapy Institute İstanbul/Turkey 2008

25. 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.
Wien
Psychotherapy Institute İstanbul/Turkey 2008