1. Using Integrative Hypnotherapy for Patient with Social Phobia
Reyhan Ozakkas & Tahir Ozakkas

2. A CASE OF SOCIAL ANXIETY DISORDER Introduction:
Social anxiety disorder is characterized by introversion, shyness, isolation from social relationships, and difficulty entering into and talking in social settings.
From a descriptive perspective, it is diagnosed according to the clinical picture of social phobia. However, there may be other factors related to the etiopathogenesis of social anxiety disorder.
These factors may be grouped as social phobia related to behavioral modelling and learning, social phobia resulting from cognitive distortions, and social phobia resulting from dynamic causality.
This case is an example of dynamic causality where the underlying etiopathogenesis is related to the narcissistic personality organization. The patient was desensitized against situations that triggered social anxiety symptoms with the aid of hypnosis.

3. Patient History
Presenting complaints were social anxiety disorder behaviors and attitudes and self-isolation from social life.
He was 23 years old, single, university student, living with his parents.
Especially after he started the university, he developed intense shyness, could not have social relationships, talk to girls, enter into social settings like cafés or parties, or attend his classes.
He was at risk of being expelled from the school due to absenteeism.
After the diagnosis of social anxiety disorder, the patient was recommended a treatment aimed at personality restructuring together with attack therapy.

4. Attack therapy is an intensive integrative psychotherapy of forty sessions conducted over fifteen days in four stages, namely history taking, psycho-education, explaining and implementing treatment techniques, and termination.
During attack therapy, the patient appeared to have narcissistic personality patterns underlying social anxiety disorder.
Certain sub-types of narcissistic personality disorder are known to present with defensive withdrawal from social relationships due to high vulnerability to injury.
The patient is thought to present a similar clinical picture, and the treatment was planned to address the underlying narcissistic personality disorder, with the aid of hypnosis.

5. Narcissistic personality disorder is often described as grandiose, egocentric, self-entitled, non-empathic, and seeking omnipotent control.
In the dynamic literature, this type of narcissistic personality disorder is called thick-skinned or grandiose narcissist by Kernberg, a prominent figure in contemporary object relations, and by Masterson, the founder of abandonment depression theory uniquely focused on separation-individuation processes.
Another type of narcissistic disorder is described from an object relations perspective as thin-skinned or closet narcissist, characterized by isolation and withdrawal, resembling the clinical picture of social anxiety, and satisfying grandiose needs only in fantasy.
The patient appeared to fit in the second diagnosis.

6. Treatment
The most urgent step of the treatment program was to ensure his attendance to school and graduation. Therefore, the treatment aimed at improving his capacity to tolerate vulnerability in environments where he felt afraid or that he avoided.
The strategies in the third stage of attack therapy involve behavioral treatment principles. (? Should we eloborate)

7. Exposure and response prevention through hypnodramas in hypnotic trance resulted in significant progress.
In the early hypnodramas, patient went to the school, walked around the school comfortably, entered the social places and school cafeteria, and had a meal in the cafeteria.
In one desensitization work, the aim was for him to achieve enough capacity to tolerate a situation where he dropped his tray and everyone turned around to look at him.

8. Conclusion
Through such hypnodramas, his capacity to tolerate vulnerability in social environments expanded, avoidance behavior decreased, and he could enter social environments.
In further stages of treatment, hypnodramas helped him socialize, have girlfriends, and even meet with the university rector as a student representative.
It is understood that hypnosis can be a very useful instrument in the treatment of social phobia in closet narcissistic disorder.
Hypnodrama, desensitization, theatre stage technique, and ego strengthening techniques helped the patient decrease his vulnerability, increase assertiveness, and adapt to the real world rather than living in a fantasy world.

9. With this perspective, it is seen that the underlying causality of some social anxiety disorders may be related to closet or thin-skinned narcissistic organization, and that this structure can be treated gradually with the use of hypnodrama to increase vulnerability toleration, decrease avoidance, improve ego capacities, and adapt to reality.
Further studies on this subject are needed to develop ways to treat this clinical picture in briefer periods of time.
Thank You…