1. Case Study: Discussing Hyphotherapy Methods in Panic Disorder Patient
TAHIR OZAKKAS, M.D., Ph.D.
PSYCHOTHERAPY INSTITUTE
SEPI XXXIII ANNUAL MEETING DENVER, COLORADO, USA • MAY , 2017

2. Panic Disorder
Panic attack, also known as panic disorder, is included in the symptomatology of anxiety disorders.
In our country and in the world, the cluster of anxiety disorders holds a critical place among psychiatric disorders, and panic attack presents as a serious medical and social problem.

3. Psychiatrists apply medical treatment for anxiety disorders such as social phobia, specific phobia, agoraphobia that may accompany panic attacks to control the symptoms with medication.
However, in addition to biological causes, the psychological roots and dynamic origins of the disorder have been found to suggest that psychotherapeutic approaches would be suitable for this disorder.

4. The medical treatment of alprazolam, i. e
The medical treatment of alprazolam, i.e. Xanax, has almost changed the name of panic disorder as alprazolam-deficit disorder.
Those who suffer from panic attacks feel good without any fear of panic attack when they carry alprazolam with them, but when they remember having left the alprazolam medicine at home, they may have panic attacks on the street, on the bus, train, subway, or plane.

5. Treatment
There are various psychotherapeutic techniques applied for panic attack for years.
A wide range of behavioral, cognitive, dynamic insight-oriented, and existentialist techniques are applied in the treatment of panic attack.
One of these options is hypnotherapy
The etiological factors underlying panic attack are quite diverse. Therefore, diverse treatment options should be offered to panic attack patients, depending on the underlying etiology of the disorder. One of these options is hypnotherapy.

6. Hypnosis
Hypnosis can be quite useful by directly suppressing or altering the symptom, or uncovering the unconscious causality so as to allow an analysis of the symptom.
In the two cases to be presented, the apparent causality and the information obtained under hypnotic trance will allow us to discuss the use of hypnosis in panic attack.
Hypnosis is an altered state of consciousness achieved through suggestions, which leads to changes in thoughts, emotions, behaviors, and sometimes in physiological aspects. It is neither a state of sleep nor wakefulness. Hypnosis bears similarities with several clinical pictures. Hypnosis can be easily induced in those individuals with dissociative tendencies, while it is known to be more difficult with those having obsessive-compulsive traits. There have been many studies on the relationship between hypnosis and trauma, hypnosis and dissociative personality.

7. First Case
In the first case, the patient is a 32-year-old married man.
He is afraid of darkness, being alone, narrow places, elevators, heights, seeing dead people, prayer halls, and funerals.
When forced to do such things, he has panic attacks.
The clinical picture is thus consisting of multiple phobia and panic attack.
Under hypnosis, it was possible to desensitize and strengthen the patient regarding the stimuli that triggered his panic attack. However, his history revealed that childhood traumas were underlying each phobia. These traumas were symbolized in various ways and externalized, transformed into places and phenomena, which allowed him to be free of internal distresses by avoiding those things. When he was only five years old, his friend playing next to him was killed in the village by a truck coming downhill unable to stop due to brake failure. All rituals conducted in the religious ceremony of his dead friend appeared later in the form of phobia. In his adolescent years, he was sexually harassed by a woman from the village who entered into his room. As these behaviors continued in a chronic way, his anxiety and fear of getting caught turned into panic attack. At sight of police officers, the anxiety of being reported and investigated became expressed in the form of panic attack.
Under hypnotic attack, all these pieces of information dissociated from the memory were re-integrated into memory, emotional catharsis was enabled regarding this information, the patient re-positioned himself with regard to these experiences, and this re-framing allowed the patient to achieve control over these experiences as the unconscious materials became conscious. Under hypnotic trance, he was desensitized against the events, places and situations that he had been avoiding. He was encouraged to confront them through homework. The whole process led to disappearance of panic attack and related symptoms. Long years of panic attack symptoms were eliminated in 10 sessions conducted over 10 days, which suggests that we have a strong therapeutic tool for this group of patients.

8. Second Case
In the second case, the patient again presented with panic attack and multiple phobias.
The phobias included the sight of blood, hospitals, sick people, traffic accidents, death-related news reports, even the sight of a collapsed wall.
The extent of disturbance and panic attack reaction to such phenomena made his life unbearable. It was discovered under hypnotic trance that the story underlying the panic attacks dated back to long years ago. He was 35 years old, married with two children. He was repairing radios for a living. Panic attacks had started a few years ago when he saw the criminal enactment of a murder case on TV. Until that incident, the patient was quite the hero, very brave, the first to intervene in any illness, injury, or death, the first to help if he saw a traffic accident. In the TV show, there was a man who was killed by his wife; the wife cut his throat with a knife when he was asleep at night and drank his blood. The patient felt very helpless and defenseless after watching this enactment on TV. Having watched murder news and rushed to intervene in accidents avidly for over thirty years as a reaction formation, the patient became so terrified after watching the TV program that he could hardly leave the house. During the anamnesis journey under hypnotic trance, it was revealed that when he was 3-4 years old, he witnessed his parents being killed by his cousin in the village, and that he was sent to an orphanage after that incident. In order to deal with the trauma of living in fear of being the next victim of this blood feud for over thirty years, he had formed a reaction formation defense mechanism that drove him to confront danger as a lifestyle. However, watching the TV enactment of the unexpected killing of an unsuspecting husband when he was vulnerable asleep at night collapsed his thirty years of defense mechanism, reactivating the childhood trauma of being vulnerable to death, which presented as panic attack. Along with the trauma expressed in the form of panic attack, the patient also had unresolved mourning reaction due to the loss of his parents. Hypnotic trance allowed access to the patient’s unconscious materials and reintegration of these materials with his conscious memory, making his inner world whole again. The unresolved grief reaction was also resolved as the patient was helped through his mourning for his lost parents.

9. Result
As indicated in these two cases, underlying multiple phobias and panic attacks, there are certain traumatic incidents in the past or in the childhood that are permanently dissociated from the memory and later externalized through various symptoms in an attempt to control them.
Direct application of behavioral or cognitive interventions does not seem to be useful.
Hypnosis and hypnotherapy, on the other hand, prove to be a significant tool to recover and integrate unconscious conflicts and dissociated pieces of memory.
Hypnotherapy may be promising in certain cases of chronic and persistent panic attack.

10. Thank you for your attention…