Every professional hypnotherapist, counselor, psychologist and physician knows about post traumatic stress disorder (PTSD), although not everyone knows how to treat it safely and effectively. The Mayo Clinic defines PTSD as follows:
Post-traumatic stress disorder (PTSD) is a mental health condition that’s triggered by a terrifying event. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event. (www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246)
By clicking on “Symptoms” one reads that symptoms of PTSD include: flashbacks (for minutes or even days at a time), upsetting dreams, emotional numbness, avoiding activities previously enjoyed, hopelessness, problems with memory and concentration, and difficulty maintaining close relationships. Additional symptoms may include irritability or anger, overwhelming guilt or shame, self-destructive habits (drinking, etc.), insomnia, being startled or frightened easily, and/or hearing or seeing things that are not there.
Unfortunately, given all of the terror in the world, PTSD is a common disorder. While only about 1% of the general population suffers from PTSD (Kinchin, 2011), about 20% of veterans are impacted by the condition (Schimelpfening, 2008). The Pentagon reports that in 2007, the number of troops suffering from post traumatic stress disorder was up 50% (Jelenik, 2008). The article by Pauline Jelenik also states that many more veterans might be keeping their illness a secret. In light of this, perhaps the true percentage of the total population suffering from this condition might be higher than 1%; but even if the original estimate is correct, including veterans there would still be over three million people in the United States alone who need help overcoming the emotional devastation of PTSD.
You may wonder what the difference is between PTSD and a “normal response” to trauma (which competent hypnotherapists can clear with HRT). The Harvard Medical School help guide (www.helpguide.org) contains an article by Melinda Smith and Jeanne Segal that describes the difference:
After a traumatic experience, the mind and the body are in shock. But as you make sense of what happened and process your emotions, you come out of it. With post-traumatic stress disorder (PTSD), however, you remain in psychological shock. Your memory of what happened and your feelings about it are disconnected. In order to move on, it’s important to face and feel your memories and emotions. (Smith & Segal, 2011)
They also state that the traumatic events that lead to PTSD are usually so overwhelming and frightening that they would upset anyone.
As a clinical psychologist, I (Eimer) have treated many people over the years who suffered with PTSD. It has been my experience that if people suffering an acute reaction to stress (i.e., soon after an extraordinary life threatening event that has been experienced either first hand or vicariously) receive early and appropriate intervention (e.g., critical incident stress counseling), they can often be saved years of severe distress and dysfunction. Unfortunately, in most cases, people who have experienced critical incidents do not received appropriate early interventions and their acute post traumatic stress is often compounded by stressors emanating from supervisors, administrators, company policies, community and societal responses, the news media, relatives, neighbors, friends and so on (condemnation, negative publicity and judgments, shaming, shunning, gossip, rejection, unreasonable administrative demands from superiors at work that either prescribe unhealthy changes or prohibit healthy changes, etc.). These stressors raise the PTSD survivor’s anxiety levels and anxiety related symptoms such as hyper-vigilance, guilt, intrusive thoughts and images including flashbacks, nightmares, affective blunting, social withdrawal, activity avoidance and dissociation. These clusters of symptoms unabated can eventually lead to severe depression.
Over time (typically months), a normal acute stress reaction evolves into an acute case of PTSD. At this point, it is still amenable to efficacious treatment. However, if not treated within this window, the PTSD reaction symptoms begin to spread and generalize to greater and greater aspects of the survivor’s life, and a full blown chronic PTSD syndrome develops.
Although technically classified as an anxiety disorder by the American Psychiatric Association’s DSM-IV (APA, 1994) (anxiety is a prime component of the disorder), PTSD is essentially a dissociative condition. As Smith and Segal (2011) observe, the mind, in response to the enduring shock of a terrifying event, disconnects the survivor’s memory of what happened from his/her feelings about it. In order to heal psychologically and emotionally, the survivor must face and feel his/her memories and emotions, and in the process integrate them. Thus, effective psychotherapy for PTSD entails confronting, reviewing and reliving—mentally and emotionally—the traumatic memories, and then reframing them.
As discussed in detail by Spiegel and Spiegel (2004), people who are highly hypnotizable also score high on measures of dissociation; and people with PTSD score high on measures of hypnotizability and dissociation. Hypnosis is essentially a controlled state of dissociation and, as such, it is especially effective as a treatment tool in doing psychotherapy with people suffering from PTSD.
The hypnosis tool is invaluable in helping the client lift repression and denial through the following processes: condensing the essence of the traumatic experience; uncovering and confessing one’s feelings about the experience and one’s role in it (these feelings often include shame, guilt and anger); normalizing those feelings; and putting the memories and feelings into a new more adaptive and functional perspective (i.e., reframing) (Spiegel & Spiegel, 2004).
The essence of a generic treatment plan that incorporates hypnosis in the treatment of PTSD is to use HRT to regress the client back to the traumatic incident (TI) which is identified as the ISE. Then, following the principles of HRT delineated above, the TI is relived, the emotions are released and the client’s interpretation of the significance of the TI in terms of what it says about the client’s self is reframed. Then, appropriate suggestions and imagery are delivered to seal, or fix in place, the client’s new learning in his/her subconscious and conscious mind.
The Mayo Clinic website (cited above) states that anyone can develop PTSD after going through (or vicariously learning about) an event that causes intense fear, helplessness or horror. Not everyone responds to an event in the same way, so doctors are not sure why some people get it while others do not. By clicking on “Causes” in the Mayo definition, it states that a complex mix of the following factors can make a person more vulnerable to developing PTSD:
Typical treatments recommended by numerous sources include medication, psychotherapy, hypnosis and EMDR. The U.S. Department of Veterans Affairs states that, at the current time, cognitive-behavioral therapy appears to be the most effective type of counseling for PTSD (United States, Department of Veterans Affairs, 2007). Hypnosis is a tool that makes CBT more powerful by harnessing the power of the subconscious and integrating the client’s emotions and imagination. As such, hypnosis reduces the time it takes to do CBT with clients suffering from PTSD (Zarren & Eimer, 2002).
Additionally, because a client cannot be in a truly relaxed state at the same time that he/she is in an uncomfortable emotional state, the hypnosis tool is invaluable for its power to induce relaxation states (Zarren & Eimer, 2002). Pairing relaxation with the anxiety triggered by traumatic memories is the essence of pioneering psychiatrist Joseph Wolpe’s technique of systematic desensitization (Wolpe, 1973).
Hypnosis is also a focusing technique and excels in helping PTSD clients focus and concentrate on memories, thoughts and images they have been avoiding, so that this material can be reprocessed.
In the first half of the 20th century, PTSD was common among veterans of war, and was called battle fatigue, combat stress reaction or shell shock. After both the First and Second World Wars, hypnosis was often used to help combat veterans because of its more rapid results. We may verify this fact through a number of sources. An excellent manual and casebook on the use of hypnosis to treat Second World War soldiers suffering from “war neurosis”, “combat stress reaction” or combat PTSD is Hypnotherapy of War Neuroses (1949) by the late John Watkins, who was also the co-author of Ego States: Theory and Therapy (Watkins & Watkins, 1997).
Hypnotic techniques for the treatment of post traumatic conditions were frequently employed by the clinical pioneers of the end of the 19th century and by military therapists treating soldiers during the wars of the 20th century (Spiegel & Spiegel, 2004). In the past 30 years, hypnosis has been effectively employed with survivors of sexual assault, accidents and other traumas. Hypnosis as a treatment tool can be effectively integrated into psychotherapy with traumatized clients. The work of Spiegel and Spiegel (2004) indicates that individuals with PTSD frequently demonstrate high hypnotizability, which is not surprising since PTSD is essentially a dissociative condition, even though it is classified as an anxiety disorder by the American Psychiatric Association’s diagnostic bible, the DSM-IV.
Hypnosis has proven to be an effective treatment tool for both authors in addressing and ameliorating the symptoms associated with PTSD. Eimer has found that hypnosis and HRT have been effective for helping clients with PTSD modulate and integrate their memories and other intrusive symptoms of trauma (e.g., flashbacks, intrusive thoughts and images, nightmares), for reducing anxiety and hyper-vigilance, and helping clients gain control over their dissociative symptoms.
Eimer has been using hypnosis and HRT for helping people recover from PTSD for over 20 years. HRT provides a vehicle for accomplishing safe reliving, abreaction, emotional reframing and ultimately desensitization. HRT does not require full exposure if the client cannot tolerate a full abreaction or an implosive experience—we can titrate the intensity of the client’s exposure to the material. In any case, we can safely take the willing and collaborative client forward onto the pathway to health by helping the client reframe his/her experiences so that he/she can feel safe in the present and become more functional again.
On one level the symptoms of PTSD are caused by an associational learning of emotions which is a classical or respondent conditioning paradigm (Hall, 1976). Essentially, the initial and subsequent sensitizing events cause “one-trial learning,” and stimulus cues associated with these sensitizing events, over time, generalize to more and more aspects of the PTSD survivor’s life (Zarren and Eimer, 2002). This is similar to the concept of “state dependent learning” discussed by Rossi (1993) and Rossi and Cheek (1994).
While HRT can certainly help a motivated client suffering from post traumatic stress disorder, the authors recommend that any therapist who is not trained in the specifics of PTSD either refer the client to a therapist who is, or get additional training and education in the unique aspects of PTSD and its treatment. That being said, the authors also believe that anyone already trained in treating people who suffer from PTSD would be doing both themselves and their clients a favor by becoming trained in hypnotherapy and hypnotic regression therapy.