Hypnosis Techniques for PTSD
In Part 1 of this three part series, we looked at the history of hypnosis in the treatment of Post Traumatic Stress Disorder (PTSD), starting with the work of Pierre Janet in the late nineteenth century and his work with dissociation. The article also looked at how our understanding of PTSD has changed during the last hundred years, especially through the major wars.
In the second article, the focus was on what we understand PTSD to be, including the newest definitions that included that of Complex PTSD (CPTSD). The article examined the risk factors, causes and symptoms of the disorder in more detail.
In this, the final in the series of articles on this topic, the focus shifts to the ways in which PTSD is treated, with attention to the different hypnotherapy techniques that research has shown to be effective.
Psychotherapy Treatments of PTSD
Even though hypnosis was the first choice in treating people suffering from what was first known as hysteria, and later defined as shell shock and war fatigue, conditions that we now understand to be related to PTSD, it has not become the preferred method of treatment. Instead, psychotherapy has taken the lead. There are three types of talk therapy that make up this first choice of treatment.
Cognitive Behaviour Therapy (CBT)
CBT has been the therapy that has been most used and has consistently been shown to be the most effective psychotherapy treatment for people suffering from PTSD. This type of treatment focuses on the trauma itself, which involves identifying the type of trauma and understanding all its components.
A therapist will help the patient to confront their trauma by having them think about the traumatic event in all its details. The therapist helps by providing coping mechanisms so that the patient can deal with their distress.
The treatment works by changing thinking patterns and making behavioural changes. The patient is actively involved in the treatment that usually takes the form of weekly sessions. During the sessions they learn the necessary skills that they then apply to their symptoms. The treatment usually lasts for between twelve to sixteen weeks.
Eye Movement Desensitisation and Reprocessing (EMDR)
This new type of treatment has been found to reduce symptoms associated with PTSD. The patient is required to follow the therapist’s finger with their eyes as it is moved from side to side. While moving the eyes from side to side they recall their traumatic incident. The treatment may also involve tapping or playing a musical tone. There is still some mystery as to why this kind of treatment works, but it does help the patient change the negative associations attached to their trauma.
Cognitive Processing Therapy (CPT)
This is a type of CBT that deals with the perception of the trauma and the coping mechanism associated with the emotional and mental aspects of it. By collaborating with the therapist, the patient processes the trauma and works through what is known as “stuck points”. These are certain thoughts relating to the traumatic event that are preventing the patient from recovering. CPT can be done individually or in groups.
Exposure Therapy
This is a kind of behavioral therapy where the patient faces the frightening situations and memories in a safe way and by doing so, find effective ways of coping. Exposure therapy can be especially helpful in reducing the occurrence of flashbacks and nightmares. Sometimes virtual reality (VR) is used so that the patient can re-enter the setting in which the trauma was experienced.
Prolonged Exposure Therapy (PE)
PE helps a patient to confront the things that remind them of the traumatic event. The therapist will teach the patient techniques that will help ease their anxiety when they think about the traumatic incident. The patient will be required to list all the things they have been avoiding and will systematically learn how to face each one. They may also be required to recount their traumatic ordeal and take home a recording of the session, which they will listen to at home.
Stress Inoculation Training (SIT)
SIT is a kind of CBT that can be done individually or in groups. In this type of therapy the patient is not required to go into the details of their trauma, instead they are taught how to manage their stress. This may include breathing exercises, massage and other techniques, which they will learn over a three-month period.
Medication
There are three types of medication that can be prescribed by a healthcare professional for the treatment of PTSD. These include:
Antidepressants
Antidepressants can help relieve the symptoms of both depression and anxiety. They can help a patient to sleep and concentrate better.
Anti-anxiety medications
These types of medication are prescribed to relieve severe stress and related problems. They are usually only prescribed for short periods because they have the potential to be abused.
Prazosin
There is conflicting research results abut the effectiveness of this type of medication that is prescribed to reduce or suppress nightmares. Placebos have been shown to produce the same results as the medication itself.
It is important to note that only a doctor, psychologist, or psychiatrist can administer the above treatments.
Complementary and Alternative Therapies
Trauma-Sensitive Yoga
Due to its many benefits, including stress relief, yoga has been shown to benefit people suffering from PTSD. David Emerson and Bessel van der Kolk developed trauma-sensitive yoga. Their research found that focusing on gentle yoga postures brings the greatest relief, avoiding hands-on adjustments as far as possible.
Acupuncture
This Chinese medicine energy practice has been shown to significantly reduce feelings of stress and anxiety.
New Treatments
Virtual Reality Exposure (VR)
This treatment method been mentioned earlier and is worth mentioning again. VR works through desensitising a patient to the impact of their experience. The technology is used to gradually expose the patient to their traumatic experience while working with a clinician. Through repeated use, the patient experiences a reduction in the emotional impact caused by the trauma. Repetition eventually breeds boredom, which then leads to a failure to elicit an emotional reaction from the patient.
Ketamine Infusion
The Food and Drug Administration (FDA) originally approved ketamine as an anesthetic. It can be used in situations where the patient has proven to be resistant to other forms of treatment. It is administered intravenously at a very low dose and just one infusion over a forty-minute period can lead to a rapid reduction in the symptoms of PTSD. It must be administered by a trained medical professional and the treatment will be repeated a few times over the period of a few weeks.
MDMA-Assisted Therapy
MDMA is the name of the recreational drug known as ecstasy. Research has shown that MDMA works by reducing the threatening level of the memories associated with PTSD. The memories and emotions are accessed without the feeling of imminent threat or fear, making them easier to process. Research about this type of treatment is ongoing.
Do not attempt any of the new therapies on your own. Always consult your health care practitioner about the best treatment for you.
Hypnotherapy
Hypnosis has been used as an effective treatment for PTSD for more than a hundred years. Ongoing research is consistently showing that this is a safe and effective method for bringing lasting relief for those suffering from PTSD. New techniques have recently been developed that are deserving of more attention.
There are several advantages that hypnosis can provide when working with people who suffer from PTSD. Hypnosis can produce a dissociative state, as proven by Janet all those years ago. It can be tailored to the specific symptoms of the PTSD sufferer and be used to reframe their dissociation. Hypnosis can assist in helping with non-dissociative symptoms too, including anxiety, stress and emotional withdrawal. Hypnosis can easily be used in combination with other treatment methods. And, as Janet proved, people who suffer from PTSD are highly hypnotisable, which makes his kind of therapy very suited for producing successful outcomes.
Hypnotic Regression Therapy
This technique poses the danger of retraumatising a person suffering from PTSD if not done by a trained professional. During a session, the person suffering from PTSD is guided into hypnosis and identifies a feeling they do not like, then uses that feeling to travel back in time to the original event that caused that feeling. In the case of PTSD it would be the original traumatic event. They are then disassociated from the event by for instance looking at it from an outsider’s perspective. Usually an abreaction occurs which is a release of the cropped up emotions and feeling, after which they will receive suggestions o increase their self-confidence and reduce their stress.
Parts Therapy with Abreaction
Also known as Ego State Therapy, Parts Therapy has been proven to be an extremely effective and durable method for resolving PTSD. During one session lasting five to six hours, and consists of five phases. During the session different ego states, or parts, are called forward to resolve inner conflicts by hypnotic abreaction. This involves regressing the part that is holding on to the trauma back to the original event and facilitating an abreaction. “The abreactions are repeated three or four times during the session so that each subsequent abreaction reveal[s] a progressive dissipation of the emotional expressions” (Barabasz et al, 2013).
“They are then skillfully guided to release the feelings that belong to the time of the trauma but that have no relevance in the present. The session ends with reassurances and a re-interpretation of the events, which leaves the patient with a feeling of great relief that is lasting.”
“The ego state harbouring the trauma can then learn something new, which is constructive, and empowering. The ego state that was formed to cope with trauma learns that it no longer needs to be fearful, guilty, or that it is no longer a victim. These changes provide the bases for […] what [is] essentially a permanently reconstructed personality.”
Hypnotherapists who want to learn more about this technique can access the research, which includes an explanation of the process, here.
Rewind Technique
The rewind technique is a Neuro Linguistic Programming (NLP) technique most often used for the treatment of phobias. Research has shown it to be an effective tool in the treatment of PTSD. After inducing the hypnotic state, suggestions are made which take the patient to an imaginary movie theatre. They are dissociated by watching themselves sitting in the theatre from the vantage point of the projection booth, with a double dissociation occurring as they watch the trauma play off on the screen, as if it is a movie.
The hypnosis practitioner will establish a safe place before and after the movie. The movie is then played repeatedly, and every time rewound. The client starts and ends in their safe space. There are a number of ways in which the movie can be played, for instance as a cartoon, at fast speed, in black and white, very small and so on.
It is highly recommended to use the rewind technique in conjunction with CBT and not as a wonder-cure-all on its own.
Hypnotic Olfactory Conditioning (HOC)
It is clinically well known that “olfactory intrusions in PTSD can be a disabling phenomena due to the involuntary recall of odor memories. Odorants can trigger involuntary recall of emotional memories as well have the potential to help diminishing emotional arousal as grounding stimuli” (Daniels & Vermetten, 2016).
This new technique was developed in Israel and helps people suffering from PTSD to “develop new olfactory associations to overcome anxieties and dissociative states.” Using a positive olfactory association as an anchor, the patient can regain control over their symptoms, specifically when they are triggered by olfactory stimuli. It has been found that there are connections between emotions and smells. This is because the olfactory bulb, which is the only part of the brain in direct contact with the physical environment, “sends output fibres to limbic and neocortical areas involved in storing memories and processing emotions. The amygdala, in particular, plays a role in the long-term, unconscious storage of memories of fear, as well as in the emotional processing of olfactory stimuli.”
“The ability of olfactory stimuli to evoke vivid flashbacks of trauma scenes in individuals suffering from combat-related PTSD has been noted. Combat veterans with PTSD revealed an activation in the amygdala, insula, medial prefrontal, and anterior cingulate cortical areas upon re-exposure to olfactory elements of the traumatic memories.”
The suggestion has been made that “the intense emotional response to olfactory stimuli might be exploited for therapeutic purposes.”
“HOC the patient develops mastery over anxiety symptoms by being conditioned to associate a pleasant odour with a state of calm.” Using olfactory cues, the patient “then learns how to cultivate a ‘safe place’ where one can learn to manage one’s anxiety and to gain a sense of mastery over fear and stress. In the next phase, the patient is finally able to withstand imaginal exposure to the traumatic memory itself. Finally, the patient, who has learned the role of scent in producing one’s symptoms, is able to replace the traumatic olfactory cues with pleasant ones.”
This technique is used during six sessions and three different pleasing odours are introduced. Through posthypnotic suggestion, the patient is “taught to use the vial of pleasant-smelling oil to re-enter the safe place in situations that trigger anxiety or panic attacks. It is understood that the patient will continue to carry this vial with him or her, as a tool for combating anxiety and hopefully as a substitute for benzodiazepines, which one may have been consuming in stressful situations.” (Abramowitz & Lichtenberg, 2010).
HOC incorporates elements of CBT.
Hypnotherapists who want to learn more about this technique can access the research, which includes an explanation of the process, here.
No matter which method you choose, it is important that you consult an expert. Do not do any of these methods on your own. You will need help and support in order to overcome your PTSD.
If you do choose hypnosis, make sure the practitioner you choose has the expertise and experience to deal with trauma.
References
Abramowitz, E. G., & Lichtenberg, P. (2010). A new hypnotic technique for treating combat-related posttraumatic stress disorder: a prospective open study. The International Journal of Clinical and Experimental Hypnosis, 58(3), 316–328. https://doi.org/10.1080/00207141003760926
Barabasz, A., Barabasz, M., Christensen, C., French, B., & Watkins, J. G. (2013). Efficacy of Single-Session Abreactive Ego State Therapy for Combat Stress Injury, PTSD, and ASD. International Journal of Clinical and Experimental Hypnosis, 61(1), 1–19. https://doi.org/10.1080/00207144.2013.729377
Bhandari, S. (2017). What Are the Treatments for PTSD? WebMD; WebMD. https://www.webmd.com/mental-health/what-are-treatments-for-posttraumatic-stress-disorder
Daniels, J. K., & Vermetten, E. (2016). Odor-induced recall of emotional memories in PTSD–Review and new paradigm for research. Experimental Neurology, 284(Pt B), 168–180. https://doi.org/10.1016/j.expneurol.2016.08.001
Ganz, S. (2019). Is There a Cure for PTSD? Verywell Mind. https://www.verywellmind.com/ptsd-treatment-2797659
Muss, D. C. (1991). A new technique for treating post-traumatic stress disorder. British Journal of Clinical Psychology, 30(1), 91–92. https://doi.org/10.1111/j.2044-8260.1991.tb00924.x
NHS Choices. (2019). Treatment – Post-traumatic stress disorder (PTSD). NHS. https://www.nhs.uk/conditions/post-traumatic-stress-disorder-ptsd/treatment/
Post-traumatic stress disorder (PTSD) – Diagnosis and treatment – Mayo Clinic. (2018). Mayoclinic.org; https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/diagnosis-treatment/drc-20355973
Rewind Technique. (2021). Psychology Tools. https://www.psychologytools.com/resource/rewind-technique/
Slater, P. M. (2015). Post-traumatic stress disorder managed successfully with hypnosis and the rewind technique: two cases in obstetric patients. International Journal of Obstetric Anesthesia, 24(3), 272–275. https://doi.org/10.1016/j.ijoa.2015.03.003
Spiegel, D., & Cardena, E. (1990). New uses of hypnosis in the treatment of posttraumatic stress disorder. The Journal of Clinical Psychiatry, 51 Suppl(51), 39–43; discussion 44-46. https://pubmed.ncbi.nlm.nih.gov/2211565/
Treatment & Facts – Anxiety and Depression Association of America, ADAA. (2021). Adaa.org. https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/treatment-facts
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