Age regression: a case study.
|Article Type:||Case study|
Hypnotism (Health aspects)
Phobias (Risk factors)
Phobias (Care and treatment)
Phobias (Case studies)
|Author:||Mackey, Edward F.|
|Publication:||Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2009 American Psychotherapy Association ISSN: 1535-4075|
|Issue:||Date: Winter, 2009 Source Volume: 12 Source Issue: 4|
|Geographic:||Geographic Scope: United States Geographic Code: 1USA United States|
Phobias significantly affect the activities of daily living (ADL) in patients who suffer from them. Age regression therapy in hypnotic trance is a quick method to identify initial sensitizing events (ISEs) and subsequent sensitizing events (SSEs). Detailed here is my experience with a patient who presents with an animal phobia. Since most animal-type specific phobias have their root in early childhood, age regression can move the therapy in that direction and may lead to faster therapeutic interaction. The patient reported that this hypnotherapeutic treatment helped her to regain composure, self control, and to once again enjoy normal ADL.
Age regression is one of the phenomena identified in the hypnotic trance (Crasilneck & Hall, 1985; Watts, 2005). Techniques of age regression usually guide a patient back in memory to reexperience an event either vividly, called hypermnesia, or as if they are reliving the event itself, called revivification (Yapko, 2003). Age regression is perhaps one of the most widely utilized techniques in hypnotic work. At the same time, it is suspect for confabulation and thus remains controversial (Kroger, 1977; Rossi & Cheek, 1988; Yapko, 2003). The use of proper age regression techniques limits confabulation (Cheek, 1994; Ewin & Eimer, 2006).
Despite controversial implications of improperly utilized techniques, age regression is a common event. Each time a memory is spontaneously brought up from the subconscious due to a smell, photo, song, etc., an age regression has taken place. Age regression as a therapeutic technique gives us the opportunity to go backward in time to a significant event and enables the therapist to reframe and help the patient move forward in adaptive fashion. Age regression strategies, such as affect or somatic bridge techniques, (Christensen, Barabasz & Barabasz, 2009; Watkins & Watkins, 1997; Watts, 2005) or more indirect methods of regression therapy, such as theatre-of-the-mind techniques, are methods that quickly identify sensitizing events in the patient's past and allow for reframing and reprocessing to achievemore adaptive behaviors. Affect bridge techniques use feelings and/or emotions that are conjured up within a patient in response to some stimulus (Watkins & Watkins, 1997). These feelings and emotions are brought to the forefront during hypnotic trance and provide an "emotional bridge to the past," which can help to identify causative events, trauma, etc. that are linked to the presenting problem (Christensen, Barabasz & Barabasz, 2009; Watkins & Watkins, 1997; Watkins, 1992). Somatic bridge techniques are similar to the affect bridge technique but utilize somatic or bodily sensations instead of emotional feelings to link to causative events (Watkins & Watkins, 1997). Theater-of-the-mind techniques are a dissociative technique that places a distance between the patient and their particular emotional experience (trauma, etc.). The patient (in trance) is encouraged to imagine sitting in a theater. The patient is then encouraged to float above himself into the projection booth while still seeing himself sitting in the theater below. They are then instructed to imagine the movie on the screen, and they see themselves in whatever troubling situation that caused the current problem. This dissociation helps prevent abreaction and may allow for a smoother, less traumatic regression. This is very similar to the visual-kinesthetic dissociation used in neurolinguistic programming (NLP) for dealing with phobias (Bandler, 2008; Bandler, R., & Grinder, J. 1975; Bandler, R. & Grinder, J., 1976).
A phobia is an intense, persistant fear of a situation, thing, activity, or person. The main symptom of this disorder is the excessive and unreasonable desire to avoid the feared subject. (Comer, R., 2001). Specific phobia is a marked and persistent fear of a particular object or situation and exposure produces an immediate anxiety response. The diagnosis of specific phobia is appropriate only when the avoidance behavior and anxiety interferes significantly with (ADL) and is not better accounted for by another diagnosis (APA, 2000). According to the DSM-IV-TR, several subtypes exist within specific phobia: animal type is usually cued by animals or insects, blood--injection injury type is usually cued by seeing blood or receiving an injection, environment type is cued by storms, heights, or other environmental triggers; and situational phobias are cued by things like bridges, tunnels, etc. and other types (APA, 2000). Specific phobias can develop at any time; animal phobias usually begin sometime in childhood and many last into adult life and require some treatment modality before lessening (APA, 2000; Comer, 2001).
There are several common treatments for specific phobias. In modeling, the therapist confronts the feared object while the patient looks on. Desensitization asks the client to create some type of hierarchical list of fear-producing events and is then subjected to them and subsequently relaxed. Flooding exposes the patient to the fear-producing stimulus repeatedly. These exposure therapies can be done in vivo or in vitro via imaginal techniques (Comer, 2001; Crasilneck & Hall, 1985; Kroger, 1977, Yapko, 2003). There are also hypnotherapeutic techniques such as age regression that can lead the therapist to identify initial sensitizing events and subsequent sensitizing events quickly (Cheek, 1994; Crasilneck & Hall, 1985; Rossi, 1980; Voit & Delaney, 2004; Watkins & Watkins, 1997; Yapko, 2003).
I am presenting this case as one representing the successful use of hypnotic age regression, specifically the "affect bridge" technique. This case shall demonstrate the techniques used to identify the initial and subsequent sensitizing events related to the patients' presenting problem.
The client was a 44-year-old female referred to me for hypnotherapeutic intervention by a colleague who knew of my work in hypnosis and hypnotherapy. L.E. had been troubled for years with a fear of snakes; however she is now a grandmother and finds herself unable to go into the backyard to play with her granddaughter because she fears snakes will attack her (L.E.). This avoidance had become more troubling to L.E. as she also fears that her granddaughter will go out into the backyard without her knowledge and she will not be able to go after her. She had been prescribed anti-anxiety medications by her physician and referred to a psychiatrist for her fears. She had received a diagnosis of specific phobia, animal type by her psychiatrist who prescribed Xanax.
Our purpose during the initial session was to allow L.E. to become familiar with hypnosis, to debunk any misconceptions she had concerning what hypnosis is or is not, and to allow her to ask questions. The first session allowed her to become more relaxed with the office surroundings, my professional interactions, and the hypnotic experience in general. Consent was obtained and appropriate forms were filled out, and a progressive relaxation induction was performed. Post hypnotic suggestion (PHS) was given so in future sessions she would be able to rapidly enter the hypnotic trance state with an arm drop using the right arm, this was reinforced with the suggestion to "imagine, see in your mind, visualize, feel yourself entering hypnosis as I drop your arm only a few inches to the arm rest of the hypnosis chair...." I asked L.E. if it was alright for her to know why she is afraid and if it would be okay to help her "fix it" via finger response. She raised her right index finger to signal "yes." L.E. was emerged and instructed to practice relaxation techniques until the next office visit.
L.E. was anxious to move along with the hypnosis as her granddaughter was coming for a visit in a few weeks and she hoped that "it would work." She presented no new questions or concerns prior to the second hypnotic induction. She sat in the hypnosis chair, and I raised her right arm. After raising it only an inch or two, I dropped it onto the arm rest with the command to "relax deeply and go into a comfortable, safe, relaxing hypnotic rest." L.E. was then instructed to listen to and concentrate on my voice, and that she may hear other sounds or noises, but they would only help her go deeper into hypnosis.
Using an affect and somatic bridge technique (Watkins & Watkins, 1997), I had L.E. imagine a snake. I had her focus on the physical sensations in her body: tachycardia, perspiration, rapid breathing, dry mouth, etc. I had her focus on the thoughts of snakes and what those thoughts caused her to feel in her body and mind. I heightened those responses with suggestions "to feel them becoming stronger," and when she was breathing rapidly, beginning to have beads of perspiration on her forehead, and starting to tremble, I suggested that she follow these feelings back to the first time in her life she felt this way. As I counted from 3 down to 1, I stated firmly:
E: Be there. Inside or outside?
E: Alone or someone there?
E: What is happening?
L: Playing way in the backyard.
E: How old are you playing in the backyard?
L: I ... I'm 7 years old!
E: What happens now?
L: I go where the old buses are beyond the fence. I'm scared; I'm not supposed to be here.
E: Is this the familiar scared feeling you get or something new?
E: What happens now?
L: There is a large dark hairy thing reaching out from under some junk pile.
E: Go on.
L: Voice shaking says, "It looks like a big spider or ..."
E: Or ...
L: A black snake with fingers on the head.
E: Look at it closely now. What do you see?
L: Starts crying and shaking.
L: It's ... it's a hand!
E: What happens now?
L: I'm running back home, I'm afraid Morn will find out I went there.
E: All right, let the scene begin to fade as if moving further away from you. As I count from 1 up to 3, be at the next time in your life that had anything to do with the familiar fear that brings you to my office. Be there now.
E: Inside or outside?
E: Alone or somebody there?
L: I'm at a party with Annie, my friend, in her backyard.
E: How old are you at the party in Annie's backyard?
L: I'm 13.
E: How do you feel at the party?
L: I'm afraid.
E: Is this a new feeling or like one you had before?
L: Like before.
E: What happens now?
L: Something shoots up from the grass and all the kids are screaming and running.
E: The kids are screaming and running ... what happens next?
L: The long black thing is waving back and forth in the air ... spraying and hissing ...
E: What happens now?
L: The other kids are laughing.
L: The kids said the hose "just broke and sprayed us with water."
E: How does it make you feel?
L: I don't know; I guess okay.
E: Let the scene fade away as if moving away from you, farther and farther. As I count from 1 up to 3 let yourself--allow yourself--to move forward in your life to the next time that had anything to do with why you are here in my office, you know, the feelings you get that cause you to feel distress; 1, 2, 3.
E: Inside or out?
E: Alone or with someone?
L: I'm at a picnic in my aunt's backyard with cousins.
E: How old are you at the picnic in your Aunt's backyard?
L: I, I, I'm 15.
E: How do you feel at the picnic in your aunt's backyard?
L: I'm scared.
E: Is this the familiar scared feeling of why you are here in my office or something new?
E: Same as what?
L: Same familiar.
E: What happens now?
L: All the sudden there is a loud popping noise and hissing and ... there's something spraying from all around us ... everyone is running and yelling.
E: How does it make you feel?
L: I'm running into the house with my mom, I feel really scared.
E: What happens now?
L: My uncle is yelling something from around the side of the house.
E: Be there what do you hear him saying?
L: He is cursing. He's yelling that he forgot to turn the timer off on the sprinkler system.
E: How does that make you feel?
L: I'm still scared.
E: Let the scene fade away as if moving farther away from you.
E: Would it be okay for you to come back here to your aunt's backyard again?
L: I guess so.
The regression technique identified the initial sensitizing event in her cascade of fear, that of being in the old busyard where she was not supposed to play, coinciding with an epinephrine-producing event to scribe this as the foundation for her phobia development. Subsequent events were identified using progression techniques from the initial event and identified incidents related to her "familiar feeling" of fear. The first event took place when she was 13 years of age and was a guest at a backyard party where a garden hose burst, whipped around under pressure, and sprayed the children with water. The second event occurred when she was 15 years of age at her aunt's house. This second incident apparently involved a pop-up sprinkler system set on an automatic timer that was not turned off for the backyard event. Both subsequent sensitizing events involved heightened emotion along with an epinephrine-producing event (happiness, joy, and then alarm). I was confident that the event identified as the initial sensitizer was correct as L.E. reported the feeling of "being scared" was "new," and the second and third events were not only chronological but her "fear" was also "familiar" and not something new. The third session was scheduled.
L.E. reported that she was feeling confident that "the hypnosis is working," although she still refused to go into her backyard. We spoke briefly about her week's activity involving the relaxation exercises and how she had been feeling. An arm-drop induction was performed, and L.E. was encouraged to begin to "feel" those familiar feelings of anxiety, fear, and paralysis in response to snakes. As L.E. began to tremble and her breathing had become fast, I encouraged her to follow those feelings back to when she was 15 in her aunt's backyard where we had been the previous session. When she reported that she was there, I encouraged her to progress forward in time to the next event that had anything to do with why she was in my office. As I counted from 3 down to one I said, "Be there!" She reported that she was at the zoo with her young family and was "deathly afraid of going into the reptile house." She would not go in despite prodding from her children, so she waited outside.
L.E. was then progressed to the next event in similar manner and reported that she was now in her present-day kitchen looking outside into the backyard feeling "very afraid." She stated, " I do not even want to look into the backyard; I'm afraid I will see a snake!" After emerging L.E. and discussing the events as they unfolded, I asked her if she would be willing to go back again to the events recalled (in trance) when she was a child and to bring with her the knowledge and confidence she has as an adult, she agreed.
An arm drop was performed and I suggested that as I counted down from 10 to 1, she would go back in time and become younger and smaller to when she was in her backyard playing just prior to going into the busyard. When she affirmed being there in her backyard as a child, I suggested to her adult self that she agreed to be there for her child self. I told her to be with young L.E. and explain to her that whatever happens "I will be there with you" and to move forward with her into the bus yard. At the point where the "large, dark, hairy thing reaches out from under some junk," I suggested to the adult L.E. that she had agreed to be with young L.E. and to help her understand that she would be okay; mom would not find out what she did, and that she had mistaken the hand for a snake or spider. I suggested to the adult L.E. to take the time she needed to explain fully to young L.E. that all is well and that she would be okay, get to grow up, and move on. I suggested to her that when she was done she could signal me by raising her fight index finger which she did after several minutes. I asked young L.E. how she felt and she reported "better."
I did age progression with L.E. to the subsequent events in a similar manner and moved through the therapeutic interaction in similar fashion, using the adult state to inform the child state and to reframe events as needed. After each reframe L.E. appeared more comfortable. Finally, we reached the present-day scene where L.E. was in her kitchen refusing to go or even look into her backyard. I did an age progression with L.E. to a time in the near future when her granddaughter was playing in the backyard and calling for her to come and play. L. E. reported going into the backyard and feeling "good," playing with her granddaughter, and having a "good time being with her." I then oriented L.E. to the hypnosis chair and suggested she search her mind and body to see if there were any of those terrifying feelings that had brought her to my office. With finger signaling she reported there were none. I emerged L.E. and congratulated her on regaining self control and composure. She reported feeling "much lighter."
Within a day of the last session, L.E. reported she was able to move out of her kitchen into the backyard without hesitation. She reported being able to enjoy being with her granddaughter in the backyard "just like in the hypnosis." L.E. reported that she continued to do the relaxation exercises she learned during the first session. She reported that she was no longer "deathly" afraid of snakes and, in fact, was able to go to the reptile house with her granddaughter. It was especially gratifying to receive a note from L.E. several months after her initial visit stating all was well.
This case review provides an example of how regression techniques may be a quick method of identifying sensitizing events (state-dependent memory-influencing behavior) (Rossi & Cheek, 1988). It is important to note that direct age regression techniques, like an affect or somatic bridge, remain controversial with some practitioners and may not always be the most efficacious route to identifying root cause. More indirect methods, such as ideomotor search, may be preferable with less chance for abreaction to occur (Cheek, 1994; Cheek & LeCron, 1968; Ewin & Eimer, 2006). When done properly by those skilled in their use, however, age regression techniques are a safe and effective modality for the therapist who desires an effective method to identify sensitizing events (Barabasz, & Christensen, 2006; Barabasz & Watkins, 2005; Cheek, 1994; Ewin & Eimer, 2006; Watkins, 1992; Watts, 2005). As most specific phobias have the root cause some time in early childhood, direct age regression techniques like the affect bridge can reach back in time and quickly identify causative events (APA, 2000; Barabasz & Watkins, 2005; Cheek, 1994; Comer, 2001; Ewin, & Eimer, 2006; Watkins and Watkins, 1997). In the case of L.E., the use of age regression to identify the cause was beneficial and allowed resolution within a few sessions.
Ideomotor search involves the use of subconscious ideodynamic finger signaling, much like unconscious head shaking to yes or no answers, for analysis and questioning, and it sometimes prevents the emotional abreaction seen when using emotionally (affect) guided techniques (Cheek, 1994; Ewin & Eimer, 2006; LeCron, 1968; Watts, 2005). Ideodynamic or ideomotor signaling methods date back to antiquity; it was rediscovered by Milton Erickson during his early career in hypnotism and then streamlined by Leslie LeCron in the 1950s (Rossi & Cheek, 1988). During periods of shock, stress, trauma, and other emotionally charged events, informational substances are released by the limbic-hypothalmic-adrenal system and subsequently all the internal and external sensory information is encoded in some type of special state or level of consciousness. This "altered state" of psychophysiological shock is sometimes labeled as an hypnoidal state, and memories become imprinted as physiological memory, tissue memory, or muscle memory. In other words, state-dependent encoding of memory by the release of stress-released hormones occurs (Pert, 1997; Rossi & Cheek, 1988). State-dependent memory is often encoded at nonverbal levels during these special life events. Ideodynamic finger signaling is designed to access nonverbal processes, and this allows those statebound memories to be accessed (Ewin, 2002, Ewin & Eimer, 2006, Rossi & Cheek, 1988).
It is important to note that case review and presentation provides detail on a particular person at a particular place in time. Each patient needs to be treated on an individual basis, using therapeutic interventions appropriate for the specific case and therapist's experience. The use of the particular therapeutic technique of age regression during hypnotic trance may not represent what other practitioners would utilize in their respective practice. As mentioned before, hypnotic age regression remains somewhat controversial and needs to be properly done by those experienced in hypnotic age regression. It is important that each therapist practice in areas that they are comfortable with and use techniques with which they are skilled.
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Dr. Ed Mackey has been a practicing CRNA since 1988. He received his diploma in nursing from the Lankenau Hospital School of Nursing in 1983 and his BSN from Eastern University in 1986. He graduated from the Lankenau Hospital School of Nurse Anesthesia in 1988. Dr. Mackey earned a master's degree in nurse anesthesiology from St.Joseph's University in Philadelphia and an MSN in community and public health nursing from West Chester University. He also received a doctorate in psychology from Northcentral University.
Dr. Mackey maintains a long-standing private practice in hypnosis, hypnotherapy, and psychotherapy in Kennett Square, Pennsylvania, and is also an assistant professor in the Department of Nursing at West Chester University of Pennsylvania. In addition, he is an adjunct faculty member for the nurse anesthesiology graduate program at Villanova University, and he retains a private anesthesia practice for outpatient oral and maxillofacial surgery. Dr. Mackey is an Approved Consultant in Clinical Hypnosis for the American Society of Clinical Hypnosis (ASCH) and a Diplomate in the American Psychotherapy Association (DAPA). He also stays active as a member of the American Psychotherapy Association, the Association of Applied Psychophysiology and Biofeedback, the American Association of Nurse Anesthetists, the American Society of Clinical Hypnosis, and the Greater Philadelphia Society of Clinical Hypnosis (GPSCH).
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