My Personal Experience Of Pain:
The pain I experienced was not wholly physical or wholly mental but something in between. This is perhaps not surprising as both physical and mental pain are processed by the same brain regions, so emotional and physical pain are closely interrelated.
Maddeningly, such pain is extremely difficult to articulate. So, for want of a more precise term, let’s call it excruciating mental anguish. This went on for years without respite. I would have given anything for just 5 minutes release from this ineffable suffering. I could not even sit back in a chair or lie down during the day as I was too agitated to do so. I didn’t wash or brush my teeth and rarely shaved. I could not leave the flat to go shopping and, instead, lived off takeaways. I continually suffered from muscle spasms in my arms and legs and developed a nervous tic under my right eye.
My only wish in life was to be free of this intolerable anguish. Nothing else mattered. In fact, and I do not say this lightly if someone had said that they could take away the pain by amputating my legs, I would have accepted without a second thought. I willingly submitted myself multiple sessions of ECT over a number of years which did no good. I even asked doctors if it would be possible to have brain surgery to alleviate my condition (they told me it would not be).
Only thoughts that I could kill myself, paradoxically, kept me alive. In fact, I obsessively turned over the idea of suicide in my mind and how I might do it. It was a way of self-soothing as it represented a potential permanent escape from my suffering. And I did I make suicide attempts, one of which left me in a coma in intensive care for five days.
My other methods of self-soothing included alcohol, nicotine, and food. There was hardly a second of my waking day when I was not indulging in at least one of these dysfunctional coping strategies (and, not infrequently, all three at once).
And at night? Extremely fitful and shallow sleeping. At its very worst, I would wake every five minutes. Only waking up, say, ten times in the night represented, for me, a good night’s sleep. But there was no respite even when I was asleep. I had perpetual and repetitive nightmares of being tortured in the most horrible and gruesome ways imaginable, would flail about knocking things off my bedside table, and, occasionally, due to tossing and turning so violently, fall out of bed.
In short, I came to believe, unequivocally, unambiguously, and without the merest hint of reservation that the pain I was experiencing must be due to brain damage caused by childhood trauma and that its intensity would never diminish, and that my torturous mental state was permanent and irreversible.
Unfortunately, it is often very difficult to talk to doctors about our mental pain as it can induce feelings of shame (and shame is a major contributor to mental pain) and we might worry that by trying to explain the full extent of our suffering we might be perceived as being melodramatic, exaggerating or even malingering. Or we may fear being classified as a ‘difficult’ patient resulting in what has been termed ‘malignant alienation.’ Indeed, research suggests that doctors do not take mental pain as seriously as physical pain.
Complex PTSD And Mental Pain
Severe, protracted, and repetitive interpersonal childhood trauma may lead to complex PTSD, a condition that can involve a living hell of fear, anxiety, a rock-bottom self-concept, feelings of pervasive helplessness, and outbursts of extreme anger and aggression. All of these feelings and emotions feed into the experience of mental pain.
Other symptoms of complex PTSD include overproduction of adrenaline and a resultant overactive nervous system and feelings of not being in control. Indeed, Freud was of the view that flashbacks and nightmares occur due to a ‘compulsion to repeat’ our traumatic experiences in an (unconscious) attempt to gain control or mastery over them. Modern neuroscience supports this idea. Learning to regulate our nervous system and regaining feelings of control can both very significantly reduce the intensity of the mental pain we feel.
Cognitive hypnotherapy can be an effective tool to address these emotional and psychological factors relating to mental pain and it is especially helpful that those suffering from complex PTSD are, in general, more easily hypnotized than the average person.
Psychological Factors That Can Exacerbate Or Reduce Our Feelings Of Pain
Two different people could have very different pain responses to the same negative stimuli. Indeed, one person may experience pain caused by the same negative stimuli on two different occasions due to various psychological factors such as the context within which the pain is experienced.
For example, in the case of physical pain (though remember that physical and mental pain are closely intertwined and cannot be neatly separated into two different categories) its intensity has been found to diminish if inflicted in war by what has been termed ‘battle enthusiasm.’ Similarly, it has been found to be reduced due to a similar phenomenon known as ‘work enthusiasm.’ Likewise, in the context of endurance sports, the physical pain endured can be reduced by a sense of pride in what one is achieving.
Also, pain will be processed and experienced very differently if it caused childbirth compared to if it was deliberately inflicted by a torturer. Also, if we catastrophize pain (as I did for a very long time – see ‘My Experience Of Mental Pain’ above) such as by telling ourselves it will last forever and that absolutely nothing can ameliorate it, our experience of our pain will be exacerbated. Another thing I did was obsessively monitor my inner mental state so that my focus was never on anything else. This, too, severely intensifies how we process and perceive pain (accordingly, anything that helps to distract us from focusing on our pain will reduce it). Cognitive hypnotherapy can very effectively address psychological factors such as these that may be significantly contributing to our internal sense of anguish.
Direct Evidence Of How Hypnosis Affects How We Perceive Pain
There have been several studies conducted on the role of hypnosis in pain reduction and it has been found that people can keep their hand submerged in freezing water if given pain-reducing post-hypnotic suggestions than those who are not given these post-hypnotic suggestions.
Furthermore, it has been shown that some people will develop a rash if they are hypnotized into believing their hand has been rubbed with poison ivy even when the substance rubbed over their hands was, in fact, entirely harmless. (This, of course, shows the negative effect that psychological factors can have on our perception of pain.)
Finally, it has been found that people respond differently to exactly the same pills they are told are for the treatment of their pain depending upon the color of the pills.
Combining Hypnosis with Cognitive Behavioral Therapy:
Cognitive-behavioral therapy, or CBT, is, essentially, a therapy that seeks to alter the way we think and behave in order to improve how we feel. CBT can be COMBINED with hypnotherapy in order to make it more effective. it is thought to make it more effective as it causes the individual being treated to become more receptive to the therapist’s suggestions, and, also, it enhances his/her ability to utilize imagery. Hypnosis can also help the individual being treated become more insightful into the causes of his/her psychological symptoms.
Below, I provide some examples of areas of CBT in which hypnosis can help it become more effective in treating the patient:
1) THE USE OF POST HYPNOTIC SUGGESTION: For example, the individual being treated may be given the post-hypnotic suggestion (this is a suggestion made by the therapist to the effect that the individual will behave in a particular way once the hypnosis is over. An example of a post-hypnotic suggestion is: ‘whenever you have a negative thought you will challenge it and try to replace it with a more positive one.’ For example, post-hypnotic suggestions may be used for ‘EGO-STRENGHTHENING’ which is a process that improves an individual’s sense of self-worth, inner strength, and confidence.
2) REFRAMING: Another area where it can be useful to combine hypnotherapy with CBT is by improving the ability of the individual being treated to develop the skill of REFRAMING. Reframing refers to the skill, taught in CBT, of looking at a negative experience or situation and trying, with conscious effort, to interpret it in a more positive way.
3) INTRUSIVE THOUGHTS: Furthermore, it can help the individual under treatment identify INTRUSIVE THOUGHTS and more effectively control their emotional responses to such thoughts.
These are just some of the ways that hypnosis can be combined with CBT to both accelerate and augment its effectiveness. It is thought to do this by helping the individual under treatment FOCUS on the experience of therapy. It may, too, improve the therapeutic relationship between the therapist and the individual being treated, because, for example, the hypnotic experience tends to be comforting, and, also, promote trust between the therapist and patient. Additionally, it can give the individual being treated a greater sense of security which often leads to greater compliance with the therapist’s suggestions.
If we have suffered severe childhood trauma, otherwise neutral stimuli that have become associated with our traumatic experiences can trigger the fight/flight/freeze response and panic attacks up to and including a kind of speechless terror and fears of imminent death or descent into irreversible madness. For example, if an individual was severely physically abused by his/her father, his/her fight/flight/freeze response may be triggered by criticisms made by an authority figure (such as his/her boss) or those with by those with a similar physical appearance.
In a relaxed state induced by hypnosis in which the individual (crucially) feels safe s/he is often able to identify triggers of which s/he was previously unaware. Also, in such a state of feeling safe and relaxed, s/he can be encouraged to imagine experiencing such triggering stimuli whilst rehearsing calmer, more rational, and objective reactions. This can lead to a gradual reduction in stress-related reactions to the stimuli until it no longer triggers the fight/flight/fight reaction, panic attacks, or similar unwanted responses.
Studies On Effectiveness Of Hypnosis As A Treatment For PTSD:
A metanalysis of previous studies carried out by Rotaru et al. (2016) found that hypnosis was an effective treatment of PTSD.
Another study that compared the effectiveness of hypnosis with the effectiveness of psychodynamic psychotherapy for treating PTSD found that hypnotherapy was just as successful at reducing symptoms of PTSD and sometimes even more so (Roberts et al., 2019).
A third study cognitive hypnotherapy (hypnotherapy used in combination with cognitive-behavioral therapy) was just as successful as CBT alone in ameliorating symptoms of PTSD and that these benefits were still apparent twenty-four months after the initial treatment (Nisenoff et al., 2008).
Hypnosis And Stress:
Sometimes, if the stress experienced is very severe, such as in the case of suffering protracted childhood trauma, the condition of post-traumatic stress disorder (PTSD) can develop. For example, research carried out by Donovan et al., (1996) found that childhood physical punishment was strongly associated with the later development of PTSD.
Indeed, childhood trauma in general (be it sexual, emotional, physical, or a combination of these) very significantly increases the probability of developing PTSD later in life – one of the reasons for this is that such adverse early experience can greatly lower our later ability to cope with stress. Thus, as well as being badly affected by stress in childhood, we are also, as a consequence, then far more vulnerable to the effects of stress in adulthood.
Siegel (1996) identified three specific categories of symptoms of PTSD; these are :
A) INTRUSIVE SYMPTOMS (e.g flashbacks, preoccupation with trauma-related thoughts which are extremely hard to dispel from the mind)
B) EMOTIONAL NUMBING (e.g the inability to experience feelings of pleasure – this is formally referred to as ANHEDONIA)
C) HYPERAROUSAL (extreme and uncontrollable responses – for example, the startle response – to trauma-related stimuli)
REASONS WHY HYPNOTHERAPY MAY BE OF PARTICULAR BENEFIT TO SUFFERERS OF PTSD :
Hypnotherapy may be particularly beneficial for those who suffer from PTSD due to the fact that there is an analogy between the above three types of symptoms and the three major components of hypnosis. The three components of hypnosis which are analogous to A, B, and C above are :
Let’s look at why the analogy exists in relation to A, B, and C :
A) Because those with PTSD have deeply absorbed their traumatic experiences, it is likely, too, that they will be able to effectively absorb the information provided to them whilst in hypnosis
B) Emotional numbing is a form of dissociation (you can read my article on dissociation by clicking here). As hypnotic trance is also a form of dissociation, it is likely that PTSD sufferers will be easily able to enter into the hypnotic trance state
C) Hyperarousal involves heightened responsiveness. This suggests that those who suffer from PTSD will be highly responsive to therapeutic hypnotic suggestions.
HOW ELSE CAN HYPNOTHERAPY HELP THOSE WHO SUFFER FROM PTSD?
Hypnotherapy can help the individual with PTSD to DISTANCE THEMSELVES and DECENTRE from the immediacy of their traumatic experiences.
Also, hypnotic suggestions can be given that help the individual restructure and modify the memory of the trauma in a way that makes it less distressing
Furthermore, it can reduce, or eliminate, any feelings of self-blame the individual may have in connection with their trauma.
THE TELESCOPE TECHNIQUE :
The telescope technique is sometimes used to help individuals recover from PTSD: under hypnosis, the client is instructed to imagine ‘viewing’ his/her trauma through the wrong end of a telescope – using this mental image, the client is told s/he can increase the length of the telescope to make the trauma ‘look’ yet more distant and tiny. The client practices this technique, and variations of it, throughout several hypnotherapy sessions. Eventually, s/he will be able to apply the technique at will without the assistance of the hypnotherapist. Whilst the technique may sound a little facile, many have found such a technique, or techniques similar to it, can be highly effective at reducing feelings of anxiety and distress connected to the trauma.
HYPNOTHERAPY AND COGNITIVE HYPNOTHERAPY FOR ANXIETY CAUSED BY CHILDHOOD TRAUMA:
In cases where medication does not work or is inappropriate, hypnotherapy can be an effective treatment for anxiety. The relaxation that hypnosis induces can significantly reduce both emotional arousal and the physiological arousal which invariably accompanies it.
Well-controlled research studies (e.g. Weldon et. al.) have demonstrated that the more hypnotizable an individual is, the better their outcome when being treated for anxiety. Anxiety is related to PERSISTENT NEGATIVE THOUGHTS, in particular, the constant anticipation that the worst is likely to happen.
Such thoughts are often of the ‘what if…’ type, leading to the imagination conjuring up all kinds of dire predictions (the anxious individual will almost invariably vastly overestimate the chances of the worst happening AND underestimate his/her ability to cope should the worst occur. However, I know from my own experience that the fear such thinking creates is very real and can lead to severe distress).
Examples of the kinds of thoughts the anxious individual may experience are :
– ‘ what if my partner leaves me? – I’ll die lonely and unhappy.’
– ‘ what if I lose my job? – I’ll be on the streets and have to obtain my meals from garbage cans.’
– ‘ what if this new mole on my hand is skin cancer? – I’ll be dead within a month and die horribly, or else my hand will be amputated and my juggling career will be severely hampered.’
The term for this kind of thinking, you will not be surprised to discover, is CATASTROPHIZING. Such thought processes are often deeply ingrained in those who suffer anxiety; indeed, such catastrophizing can become intrusive and obsessive causing, as I have said, considerable anguish. My own anxiety required that I was sometimes hospitalized.
THE ROLE OF HYPNOSIS.
When we are anxious, a vicious circle can develop: our negative, even paranoid, thinking causes us to experience adverse physiological symptoms (e.g. sweating, dizziness, tremors, dry mouth, stomach upsets, physical tension, restlessness, etc), and these symptoms, in turn, intensify our negative thinking. In this way, the mental and physiological symptoms feed off one another in a king of anti-symbiotic relationships.
Hypnosis can address both of these categories of symptoms in a two-pronged attack – it can reduce negative thinking and encourage their replacement with more realistic, positive thoughts by utilizing a technique, based upon the psychologist, Beck’s, cognitive behavioral therapy model (click here to read my article on this) AND training the individual to use powerful, physical relaxation techniques.
However, acquiring the new skills requires several hypnotherapy sessions, which is why a good hypnotherapist will provide the client with a recording of the session so that s/he (the client) can repeatedly listen to it at home, thus making it more likely the new skills will take permanent root in his/her mind.
COGNITIVE BEHAVIORAL HYPNOSIS AND COGNITIVE DISTORTIONS THAT UNDERPIN ANXIETY :
The psychologist Beck (1985), identified certain faulty-thinking styles, or cognitive (thinking) distortions, which underpin the pathological anxious response. These include :
– CATASTROPHIZATION: always expecting the worst possible outcome
– HYPERVIGILANCE: constantly feeling in great danger, and, therefore, always being on ‘red alert’, making relaxation impossible (I myself was in such a state for at least three years without respite and I can therefore attest to the excruciating mental agony such a state can entail)
– SELECTIVE ABSTRACTION: this refers to when we exclusively focus on just the negative side of the situation we find ourselves in
– IRRATIONALITY/LOSS OF PERSPECTIVE: this can involve greatly overestimating the odds of what we fear actually happening. Again, I was in such a state for a long period of time which I think must have extended, at times, into the realms of clinical paranoia. Absolutely horrible.
– DICHOTOMOUS THINKING: this refers to seeing things in extremes and is sometimes referred to ‘black and white’ thinking, so things are viewed as ‘all good’ or ‘all bad’ which leads to the exaggeration, in our minds, of negative events, circumstances and situations.
Hypnosis can help by positively modifying these kinds of faulty-thinking styles and also be inducing relaxation. Some specific techniques employed by cognitive hypnotherapy are outlined below :
1) AGE PROGRESSION: this involves getting the client, in the hypnotic state, to visualize him/herself in a future situation which s/he currently fears and then imagine him/herself coping well with it
2) RESTRUCTURING COGNITIVE CORE BELIEFS: Beck and Emery (1985) identified a number of unhelpful fundamental or core beliefs that the individual prone to pathological anxiety was likely to hold (such a maladaptive belief system almost invariably stems from adverse childhood experiences). Examples of such anxiety-inducing core beliefs (and for many such core beliefs will be acting on an unconscious level) include :
a) ‘I should regard any strange situation I find myself in as dangerous’
b) ‘ I should always expect the worst will happen
c) ‘I am constantly in serious danger’
The psychologist Leahy (1996) expands upon this and puts forward the view that underlying anxiety is a sense of :
b) Imminent loss or failure
c) Imminent, or current, loss of control over one’s own life
Dowd (1997) outlines ways in which hypnosis can help us to cognitively restructure our unhealthy core beliefs :
REPLACEMENT AND COPING IMAGERY: Once the individual is in the hypnotic trance state it is suggested to them that they imagine themselves in a feared situation, such as being reprimanded by a superior at work. It is then suggested to them that any anxiety this induces will quickly dissolve and be replaced by feelings of competence and of being in control, together with an acceptance that no one is perfect so there is no need to feel one’s confidence has been significantly undermined.
HYPNOTIC COGNITIVE REHEARSAL: This involves repeatedly imagining, under hypnosis, performing well in a feared situation, such as an upcoming social event ( a similar technique is used in sports psychology, whereby, for example, a tennis player will have been trained to vividly imagine a successful serve – exactly where to place the ball, etc – before executing the shot).
David Hosier BSc Hons; MSc; PGDE(FAHE).
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David Hosier BSc Hons; MSc; PGDE(FAHE)