Stress / Anxiety / Panic attacks.

Related symptoms – blurred vision,  headaches,  salivation,  increased heart rate,  shaking,  blushing,  aches and pains,  feeling clammy,  IBS, sugar cravings,  sleep problems,  tightening of chest , tension across scalp,  knot in the stomach,  fear of heart attack or stroke, dizziness.

I have said several times throughout my website that I very much like reading,  telling and writing stories which is one of the reasons why I became and remain fascinated by hypnotherapy.  Most people of any age enjoy stories and the line ‘ Once upon a time…….’ captures most people’s attention – whether they stay to listen is up to the Story teller.

I am going to present for you here a fictitious case study and if any part of it is of interest to you please give me a call.  It is a way of illustrating how I work and is only a single example – not all of it may work for you however I hope it gives some insight into my operating style. Should you wish to come and see me we will discuss what we both feel will work for you – every session is different because every individual is unique.

I hope you find it useful or at least an interesting read.

Tom.

Initial conversation –

Tom called me mid-morning and said that his GP had given him my number and asked if he could book an appointment to come and see me.  I said that there would be no problem at all however was he able to spare about 10-15minutes now to give me some background information ( I have a pad and pen on my desk at all times so was able to take notes relating to specific information,  presenting condition,  Tom’s primary modality,  does he predominantly process information by seeing – visual / hearing – auditory / feeling – kinaesthetic / smell – olfactory / taste – gustatory,  his tone,  pace,  mood and if it changed and why and anything else I thought may be relevant for planning therapy sessions should Tom book them ).  I assured Tom that anything he said would be treated confidentially and at the end of the conversation if he chose to book an appointment that would be fine however there was no obligation at all.

He said he was happy to do that and I asked who his GP was ( professional information for myself ) and why they had recommended my services ( if Tom booked a session I may then ask his permission to contact his GP for background information should Tom be happy for me to do so).  Tom said that he had been at work in a meeting a few weeks ago which he was finding particularly stressful and

‘ his heart started beating like crazy, he felt dizzy and he thought he was having a heart attack.’ 

He was taken to hospital by a colleague and the hospital ran tests which showed that he had not had a heart attack,  everything was completely normal and they referred him to his GP.  Tom’s GP said he was suffering from anxiety and the ‘heart attack’ sensation was a panic attack.  His GP had been happy to prescribe medication however his choices were limited due to the fact that Tom drove trains for a living and anyway Tom said ‘ I did not want to take anything that may affect my job.’  The GP had suggested that Tom contact me to discuss further options.

I needed to establish if Tom actually wanted to come and see me for himself or if he was calling because the Doctor had told him to so.  I asked him what his expectations were and if he had ever sought help from a hypnotherapist before.  Tom said that he didn’t want to go and see a ‘psychiatrist’ as he was not crazy but believing he was having a heart attack had really frightened him ( his dad had died suddenly four months ago of a heart attack ).  He didn’t want to take tablets if at all possible because of his job but clearly there was something very wrong and he wanted to ‘ fix it ( kinaesthetic ).’ [ I utilized this later in the session as Tom had written on his client intake registration form as one of his hobbies and interests – DIY.  I found it very positive language that ‘ he ( Tom ) wanted to fix it ( his panic attacks ).’ He said he didn’t know anything about hypnotherapy except that he had been to see a hypnotist stage show with friends – when the GP suggested me initially Tom had been quite sceptical for this reason however the GP explained that

stage hypnotism must not be confused with clinical hypnotherapy. 

I asked if Tom had any questions he wanted to ask me with regards to hypnotherapy and he asked ‘ what are you going to do to me ?’ I reassured him that I/ hypnosis will not do anything to him.  I can’t and will not make him do anything he does not want to do.  I hoped that the fact that his GP had referred him to me gave him reassurance and said that professionally -

I believed the success of hypnotherapy was based on establishing a meaningful and focussed interaction between myself and the client.  I listen carefully to and am responsive to whatever the  individual clients needs are and tailor my approach to those unique needs and it is only in this way that a client will respond to the possibilities for change that I make available to them.  I consider that the relationship between the client and myself is one on mutual interdependence where each party ‘leads’ and the necessary ‘work / change’ is done together.  It is a partnership – the client and myself do the work together.  Hypnosis is not a magic wand. I added that I believed hypnosis to be a state of intense internal focus where deep reflection and understanding could occur without the constant distractions of the external world we live in. 

I said that I used relaxation exercises,  story telling,  visualisations and guided imagery in the sessions combined with widely accepted,  proven techniques like Neuro Linguistic Programming ( NLP ) and Cognitive Behavioural Therapy ( CBT ) all uniquely tailored to the individual client’s needs – no session was ever the same.  I asked if that had answered his question and if he was happy to proceed which he was.  I asked if he could tell me how he had been since his trip to hospital.  Tom said that he had not felt like he was having a heart attack again however he still got dizzy feelings,  his heart did beat loudly and it was usually in meetings at work.  He said that he was fine whilst driving the train and suggested it may be because he feels relaxed ‘ looking at the scenery ’ whereas in meetings he felt under pressure.

I asked if Tom would mind telling me a bit about driving a train since I knew nothing about it.  Tom spoke freely about which routes he drove and the systems in the office and then I asked him to describe the consoles / equipment in the driver’s compartment and how the train was started / stopped / any gears / neutral settings etc.  He went into a lot of detail which I noted down and it became apparent that his primary modality was kinaesthetic ( feeling / touch ) ‘ you grip it and turn it and it makes contact / the mechanisms work hand in hand with each other / it took a while but eventually I got to grips with it ’ and so on however he was visual as well – he described the console sufficiently well that I could see it in my mind.

I thanked him for the information and we discussed how many sessions I usually anticipated to be of benefit recommending in this first instance that we book 3 one and a half hour sessions to start with and then more if required.  We discussed fees and I said that I needed to send him my information pack which contained information about myself and my practise,  my terms of business,  my commitments and guarantees as well as a client intake registration form and consent form that required completion prior to the first session so that I could review any relevant information.  Tom was not on email so I promised to put it in the post to him.  I reassured him of my confidentiality policy and we booked three appointments the first two for the following week a few days apart and the last one a week after that. I said we could record the sessions if he liked.  I detected during the conversation that confidentiality was of big importance to him as he did not want his boss to find out he was seeing a hypnotherapist.

I asked him one final question – that I ask all new clients – if he really wanted change in his life and if there was anything stopping him achieving it to which he responded that he very much wanted to fix the ‘heart attack’ thing and was fine to do whatever was necessary to achieve that.  I congratulated him on his decision to call me today,  confirmed the information pack would be in the post to him and that I looked forward very much to meeting him next week.

Session one of three -

Preparation :

Tom had returned his registration forms in the post together with his signed consent form.  I would run through his answers with him in the session.  I wanted to try and establish the causes of Tom’s anxiety so had downloaded the Holmes and Rahe Stress Inventory for use in the session so that we could look at it in more detail in order to understand more clearly his presenting symptoms – anxiety / panic attacks. Once Tom understood his symptom better we could work on alleviating it more effectively.  I also wanted to share the physiology of stress / a panic attack with Tom so that he understood exactly what was happening,  anchor him a safe place so that he was better prepared to handle them when he left my office than when he entered it and to give him some self hypnosis and relaxation exercises to practise at home ( not at work whilst driving the train or operating machinery ). I had anticipated giving him a thought record chart to complete as homework however when I received his forms back his writing was not very good,  he had several spelling mistakes and it seemed as if he had written as little as possible on the intake form. I did not want to damage the therapy/ rapport with a request for him to complete another more detailed form – that he may be resistant to – that required seven columns to be filled in to track a thought. However if it turned out that he felt he would like to do it then that would be fine – I would keep it as an option once I had met Tom in person.

I made sure that my tone at all times was to be calm and relaxed and confident given that Tom’s presenting symptom was anxiety.

Session One of Three.

Tom arrived on time and was smartly dressed in a shirt and trousers with clean black polished shoes. He immediately made an excuse that he had come straight from work and seemed quite embarrassed and shy.  I welcomed him in and we sat down. 

Tom is 45,  single and a train driver.  Under issues that he would like to resolve he had written ‘stop panic attacks at work – ok when I’m driving the train’ and under what outcome was he looking for he had written ‘same.’  Under what stops you achieving this on your own he had written ‘ I don’t know what to do -  I thought I was having a heart attack but Doctor said it’s anxiety.’ He had ticked that he truly desired change in his life.

Tom was not taking any medication and had written that he felt anxious,  was having problems sleeping and that he did not feel confident at times in his new job.  He was an only child and did not wear contact lenses or glasses ( something I needed to know if I was going to ask him to close his eyes for hypnosis ).  His interests included walking his dog,  DIY and travel. We discussed his answers and I discovered that he had recently had a promotion at work which he was proud of and he enjoyed the new responsibility however his shift pattern had changed and he was having problems sleeping.  He also had to attend management meetings which he did not enjoy that he had not had to attend previously and worrying about them was affecting his sleep. He said that his father had died suddenly four months ago of a heart attack which had also affected him – his mother was still alive.

I explained that one of the reasons for the client intake form was to try and understand what had brought Tom to my office today ie.  the causes of his concern as opposed to the symptom itself.  We agreed that the loss of his father suddenly at around the same time as he became aware of his anxiety could certainly be an influencing cause as could his new promotion which also happened at around the same time.  I wanted to focus Tom’s attention ‘into’ my office as opposed to any ‘outside’ thoughts ( shopping list etc etc ) so added that it may be interesting to complete a simple form that may further decipher causes of his symptom which Tom  was happy to do – I said he didn’t have to do anything just answer 30 questions yes or no,  which again he was happy to do. 

I read out the Holmes and Rahe stress inventory questions and made sure that he could see clearly what I was reading from and the marks that I was making on the page. 

Tom answered yes to

death of a close family member, 

change in financial status, 

change in responsibilities in job,

 outstanding personal achievement, 

trouble with boss, 

change in work hours or conditions, 

change in sleeping habits, 

change in eating habits and

Christmas which gave him a total score of 243. 

We discussed his answers which provided me with additional information – he had received a pay rise as a result of his promotion,  he was now the driver of the train and responsible for it ( which he was very proud of and enjoyed ),  he felt that he had reached outstanding personal achievement as he had ‘worked up from the bottom having left school at 16’,  he was experiencing problems with his boss because whilst Tom  was an excellent practical man he did not like filling in forms and found meetings very difficult. 

The change in shift pattern had affected his sleep and his routine of walking his dog every lunchtime ( his mother now walked the dog when he was at work ),  his eating habits had changed because of his shifts and sometimes he missed meals and Christmas had been almost impossible because of the loss of his father.

I explained that someone with a similar score to Tom could be expected to be showing signs of moderate stress in their lives and there would be a 50% chance of illness or a change in health so the fact that Tom had himself had a change in health was not surprising.  He admitted that he knew he was not as well as he had been in the past as he had had colds and coughs recently that he could not ‘shake off.’  He never usually suffered from colds or coughs.  I clicked on my computer to show a picture of the brain and said that the oldest part of the brain was where the problem lay : 

It is linked to and controls miles and miles of highly sensitive nerves that are protected by running deep within our bodies to all our internal organs – it keeps us alive and it generates our emotions and our feelings.  It is responsible for releasing stress hormones eg adrenalin and also the release of endorphins that mop up any excess adrenalin. It keeps us safe by responding in a very primitive way – the flight or fight response - which is very useful if a train is coming towards you on a level crossing however it can be compared to the mentality of an 8 year old child.  So often it takes you from perceived danger to perceived safety ( from the point of view of a child ). 

It is also important to remember that it is operating using information that you provide it with.  For example if you are in a car and someone cuts in front of you but you happen to be listening to some nice music and not in any hurry then you may think to yourself casually ‘ they must be in a hurry’ and not be affected by it at all.  However if they cut in front of you and you shout out of the window and shake your fist then the old part of your brain inside has no idea what is going on,  hears the tone of your voice and it’s knee jerk reaction is to produce adrenalin ready for the ‘fight or flight ’ that it perceives is to follow.  Your heart starts to beat faster to increase the blood flow to muscles and vital organs in preparation for the flight / flight and then nothing happens because you have neither had to run nor fight. 

And if the old part of your brain keeps receiving signals from you and reacting over time it gets tired and cries out for a rest so that it can recharge.  And when it calls out for a rest and if you ignore it often it finds your weakest point and attacks it to get your attention.  For example someone gets a new job that means a lot of travel which is causing them stress and anxiety - eventually the old part of their brain finds their weak spot ( not enjoying the travel ) and it may be that they have a panic attack on the motorway.  The old part of the brain believes that if it can stop the travelling then the person will finally listen to it,  stop for a while,  and rest and recharge themselves.

Tom interrupted and said that his panic attacks had only started now he had to attend meetings and we agreed that perhaps this was his weak point ( his fuse ) that his old brain had pinpointed.  Tom was actually quite full up with dealing with the stress of losing his father,  shift changes,  not sleeping or eating properly and saw it’s best opportunity (Tom’s weakest link ) to stop Tom in his tracks by sabotaging his meetings. 

Tom looked quite relieved by the simplicity of the explanation and grasped it effectively however he was concerned that he could not avoid the meetings – he was already having trouble with his boss about his contribution in them.  I shared with Tom the idea of a locus of control in that some people have a more external locus of control and others a more internal one.  I hoped he would find the concept of control easy to understand and connect with since he had a lot of control when he was driving his train.

We discussed that people with an external locus of control tended to rely on others for their opinions,  believe things are out of their control,  believe in fate and that other people play a big part in how their life unfolds.  These people tend to be much more vulnerable to anxiety,  poor health etc whereas people with an internal locus of control believe they are responsible for their own lives and any consequences of their actions – these people are often calmer,  more positive,  bounce back after difficult events in their lives etc…….. I suggested that if we could find a way to make sure that Tom’s ‘ old part of his brain ’ started to feel less stressed and began to recharge then not only would it stop attacking him in meetings but it would be more able to help him help himself ( internal locus ) as necessary in his daily life in a more healthy way as opposed to looking outwards and relying on others opinions ( external locus ). 

Tom added that recently he had started to feel stressed at the thought of going to the local supermarket so had opted for the smaller local shop although it had not felt like a panic attack.  We discussed that maybe his ‘ old brain ’ had noticed another weak link – in the same way that Tom did not like the way he felt his new colleagues in the meetings at work were looking at him,  he may now be associating all strangers with looking at him – so he was now choosing the easier,  safer and more familiar option of the local shop.  We discussed that panic attacks took on many different formats and as such it was important to notice the symptoms and understand the causes to reassure Tom what was happening,  that it would subside and that moreover he would be learning a way of controlling them. 

I shared with Tom that release of adrenalin as a direct response to perceived danger causes muscles to tense however if the body then tenses up as a response to the ‘felt’ tension then more adrenaline will be released/ controlled by the ‘old brain ’ which feels the secondary warning and this causes more tension – so tensing up because we have tensed up makes things much worse.  The key is to not tense up or at least to understand what is going on and stop the cycle / to relax and let the tension subside.  When adrenaline is released into the bloodstream it is in response to one of our most primitive instincts – the fight or flight response.  The adrenaline immediately affects the muscles of our heart getting it to pump faster to get blood to the parts of the body that will help us ‘ fight or flight.’ 

The fast beating of your heart / hearing it sometimes in your ear makes people fear a stroke or heart attack,  which in turn  releases more adrenaline.

Sometimes the chest muscles tighten and breathing is constricted because of the adrenaline – which causes more fear which releases more adrenalin.  During an anxious episode people breathe very quickly and more oxygen enters the body and too much carbon-dioxide leaves which upsets the delicate balance required to facilitate efficient gaseous exchange ( which is why breathing into a paper bag works as carbon-dioxide gets re-circulated into the bloodstream ).

Dizziness is caused by the effects of gravity and sudden channelling of the blood to major large muscle groups in preparation for flight or fight. 

Tension across the scalp or a stress headache is also caused by adrenaline as it constricts the many muscles in the scalp – the longer or more intense the anxiety the greater chance of the muscles beginning to ache. 

Some people experience blurred vision because adrenaline causes the tiny delicate muscles at the back of the eyes used for focussing to repeatedly contract and relax. 

The unconscious nervous system has many feeder lines that run to your stomach and these gently release adrenalin during times of anxiety onto the structure of the stomach causing continuous and random contractions that feel like your stomach is churning.  As anxiety grows the drops become a flow and the muscles stay contracted hence the ‘knot in my stomach’ sensation.  The stomach ache that follows when the attack has passed is a result of aching and tired muscles. 

The unconscious nervous system is also attached to your saliva glands and when adrenalin is released digestion is put on hold ( since it is not required in the flight or fight process ) so your mouth feels dry. 

Our bowels can also be subjected to the same agitation caused by adrenalin and this can cause bloating,  wind and diarrhoea.  The bladder may also feel as though it needs emptying when in fact it is only half full – this is because the body is trying to ‘off load’ excess fluid for flight or fight. 

The adrenalin also causes shaking as the muscles are continually contracted and relaxed and any adrenalin left for example at the end of the day tends to get deposited around the neck area – hence tension in the neck. Endorphins released mop up any excess adrenaline which is why exercise is so important.

Sweating and clammy hands is a result of the body trying to pre-cool before the ‘flight/fight’. 

Blushing is caused by blood vessels in your neck and face expanding again to release heat in preparation for flight/fight.

Tiredness – emotional tiredness is very different from physical tiredness and eventhough you may feel physically tired it is your emotional energy banks that are low.

 ( Symptoms and definitions taken from John Glanvill Therapy and Self Awareness – Work Book 2 Anxiety 2011  www.johnglanvill.com Anxiety Hypnotherapy Specialist )

 The body also releases Noradrenaline which stimulates the liver to release fats and sugars as energy ready for the ‘flight or fight’ which is why we often crave sugary products after stressful situations.

The body releases Cortizol which thickens the blood ‘ in anticipation that we may be injured in the flight or fight ’ so that it will clot more easily however whilst this is undoubtably useful if we are indeed injured it may not be useful if we are not – blood clotting can lead to Strokes and Heart Attacks.

If we can stop and think in a situation as opposed to reacting instinctively many of the above symptoms can be alleviated.

Tom recognised many of these symptoms and realised that his anxiety had been affecting him for much longer than he had thought ‘ but at least he knew he wasn’t dying now.’ I shared with him one of my favourite quotes that we consider ourselves as ‘ thinking creatures that feel,  whereas infact we are actually feeling creatures that think’ ( Jill Bolte-Taylor – My Stroke of Insight ) and once we understand this we realise that we cannot trust our instinctive response ( not all the time anyway ).  If we can just pause and think rationally for a few seconds at least then we could slow down or even prevent the sudden release of adrenalin and all the unnecessary chaos it causes. Jill Bolte-Taylor also adds that ‘ responsibility ’ should be written ‘ response-ability ’ in that as humans we can begin to realise that we have a choice/ ability to respond ( or not ) to situations. Tom added that he enjoyed the responsibility of driving the train.

 So in summary anxiety and stress is not something we want too much of.

The good news for Tom was that he now understood what was causing his symptoms namely ‘ adrenaline in the hands of a very ‘young’ old brain ’ – Tom was amused by this.

I was aware of time and that we had actually done a lot of work so said to Tom that he had two options – we could relax now and provide him with a technique that would help him if he felt any hint of anxiety coming on in the future however this technique meant he may experience some of the symptoms to a level he would be completely in control of turning them up and down at his will,  or we could work specifically on confidence building for meetings.  Tom said that now he knew he was not dying he would like to try the control technique.  I reassured him he could open his eyes at any time.

I asked if he was happy to proceed and if he had any questions which he didn’t.  I said that I was going to talk him through a very simple process,  he did not have to say anything just sit back and relax and I asked him which hand he wrote with ( right ).

I knew Tom was a little apprehensive so decided to avoid the traditional induction and start conversationally first then move into the more conventional methods once he was relaxed and focussed. I said he was welcome to close his eyes if it made him feel more comfortable and that I was simply going to talk through the technique and help him relax.

I reassured Tom that he was welcome to open his eyes at any time if he so wished.

I utilized personal information unique to Tom in the hypnosis - the fact that Tom enjoyed driving his train and that he knew his hands were important to him and the element of control they gave him and also the fact that he enjoyed the control and responsibility ( most of the time ) of his new job.  I gave him/ taught him an anchoring technique that he could use at any time in the future when he may feel anxious or stressed in any way.

I have given a few extracts from the script below :

‘ ……..Tom I am going to talk you through a technique that you can use whenever you need to that has helped many of my clients who have suffered with anxiety in the past……anxiety and stress often occur when you feel that the resources you have are being overwhelmed by the demands that are being made upon them…..’

‘……..and I know because you have told me that you are the driver of a train……….and your hands are so important to you………..to turn levers and dials……….to grasp firmly …….to pull…..and to give signals…..a wave maybe…..to punch in numbers and settings so that everything is just right………’

‘………a safe place where you can relax……and go deeper……….and whilst you are resting here I would like your unconscious mind to search through your memories and find a time when you felt calm and happy……..confident…….accepted and strong…….just allow your inner mind to find a time when you felt calm and confident,  no matter how brief that time may have been or how long ago……’

‘………….and now as you feel these feelings I’d like you to close your right hand into a tight fist and as you do so those positive feelings become even stronger…..that’s right….just close your right hand into a tight fist as a sign and symbol of confidence and determination……hands are such important things…..you know that……’

‘………….Your unconscious mind has memorized these feelings, these experiences and they will remain just beneath the surface as inner resources.  ………..And because of this they will be readily available whenever you need them….all that you’ll need to do is clench your right hand into a fist as these memories and positive feelings wash back over you…..’

‘……..you may not always be able to keep unpleasant feelings from appearing in your mind or body but you’ll be able to transfer them into your left fist where you can control them……..and when it feels as though all those unpleasant feelings are collected in that fist …..….’

‘……….and as you sit there resting listening to my voice you don’t need to try and remember everything that I have said to you whilst you are relaxing or whilst we have been  talking because your mind is a wonderful and powerful thing…..a wonderful resource……it’s like shaking up one of those snowstorm ornaments you may have seen as a child…..some of the things we have discussed today will connect with you immediately…..some will drift down later ….and some in a week or so……so trust your mind……everything is there………….and I’d like you to spend a few moments with those good feelings……..confidence and an easy calm…………’

[ Extracts of the script only ]

Tom re-orientated well and I noticed that his right hand was still clenched tightly closed which embarrassed and amused him – he immediately stretched out his fingers. 

He said that he had very much enjoyed the anchoring exercise and felt much more reassured.  He was amused by the fact that some of the most important hormones in his body were in the control of a very young ‘ old’ brain which was trying to help him in the best way it could but was relying on basic instinctive information.  This had the potential to cause a certain amount of internal chaos and it was up to him as the adult to calm things down a bit,  take control of the situation and bring about order. 

Task Setting and Homework –

I suggested that Tom continue using the clenched fist anchoring technique between now and our next session not only because it was a new ‘ tool ’ ( Tom listed DIY as one of his interests on his intake form ) that he could chose to learn more about and practise using but also because the technique benefitted from ‘re-charging ’ – it became more powerful with use – and to sit down if necessary if he felt he was becoming anxious for any reason until he felt his body start to soften and rest.

I also suggested that as endorphins mop up left over adrenalin and given that exercise releases endorphins Tom walk a little more quickly with his dog or took longer walks – which Tom very much liked the idea of. I gave him a copy of the cd that I give all clients which included support material and asked that he take a few moments to listen to it in the week. We had covered a lot of material in the session and I said he was welcome to call me at any time if he had any queries.

Session two of three.

Friday 2.30-4pm

Preparation-

I wanted to work with Tom’s self-esteem and self-confidence today and continue to bring his locus of control from predominantly external to a more helpful internal position.  In that way he would hopefully become more confident within himself in meetings as well as social situations generally and be less affected by what others may be thinking / what he perceives they ‘mean’ by comments etc.  I wanted to look at the structure of beliefs and show Tom that they can be shaken up and updated or even replaced for his benefit.  I also wanted to introduce him to the voices in his mind,  that were not him ! I intended to use Neuro Linguistic Programming ( NLP ) to look at the strategies Tom’s brain uses to store information and Cognitive Behavioural Therapy ( CBT ) to look at Tom’s thoughts and ways to generate thoughts that were more helpful to him.  I wanted to continue the theme of hands since he liked DIY and used his hands to control a train at work and his primary modality was kinaesthetic so had printed off an exercise to do. I was conscious that any conclusions / changes made Tom made ‘by himself’ rather than me ‘ telling ’ him what to do etc. I could only nudge him in a direction that I thought professionally he may find of interest – it was all about Tom’s journey through Tom

The Session –

Tom arrived on time smartly dressed in his work clothes again but did not apologise this time.  He was much less awkward with himself and confidently informed me that he had been using the ‘fist thing and I was right – it got better as he did it more often.’  He had had a few anxious moments however after a few times of using the clenched fist technique he had become aware that when he got anxious the next time his right hand tingled – which he found quite amusing and a bit bizarre however ‘ it worked – clever stuff this hypnosis thing.’ 

He said he still did not like meetings particularly but he had made himself go to the supermarket and told the ‘ oldest part of his brain with the young mentality ’ ( which clearly also amused him ) that if he got worried just to ‘ tell him ( Tom ) to clench his fist and everything would be fine.’ I said he had done exceptionally well and added that when he was ‘ talking’ it could be useful to be aware that the brain is very ‘ keyed in ’ to the tone he uses,  a bit like Tom’s dog.  I said that there was a therapist who I particularly liked call Jonathan Altfeld who is fascinated with tone of voice and the effect that it has – for example he talks about ‘ command tone down ’ which basically means when you are giving a command drop your voice down at the end of the command – ‘ sit down ’.  If you raise it up at the end of the command then it sounds to the listener like a question and the result is confusion.  So it’s very important to talk to yourself in a way which will easily be understood and also by using the correct tone.  I asked Tom if he ever had to do emergency practice drill on the train and asked him to tell me about it which resulted in Tom saying that it was important to keep himself calm ( his voice etc ) so that the passengers and staff did exactly as they were told to ensure a safe evacuation procedure.

Tom grasped immediately the link between the importance of his tone and mood etc in an emergency at work to his tone and voice when ‘ talking ’ to himself when feelings of anxiety started to grow inside him.

I said that today we were going to work with Tom’s self-esteem and confidence which would help him in meetings and in his daily life in general and also to look at his beliefs and see if some of them needed a bit of updating so that they could be a bit more helpful for him.  I said we were going to find out about how he thought and then I’d tell him a relaxing story to finish.  I would be using proven techniques of Neuro Linguistic Programming ( NLP ) and Cognitive Behavioural Therapy  ( CBT ) and asked if Tom was happy to proceed with the session on this basis and he was fine.

I said to Tom that we would go back to Monday’s session for a moment to when we had talked about tension.  I said that whilst tension is caused by the release of adrenalin and may lead to anxiety ( if we let it ) a little bit of tension can be used in a positive way.  We then proceeded with an eyes open exercise which illustrated how tension can be used in a positive way and combined it with 7/11 breathing techniques.

After the exercise we talked about accepting tension ( accept symptoms of anxiety ) in the body and utilizing it as a positive reminder to do this exercise – having the control to draw in clean air,  energy,  power and push out tension leaving Tom alert and refreshed for the day / situation at hand.

I then suggested that we swop chairs as Tom was going to do the work now which he was happy to do.  I wrote A +  B = C on a pad and reassured Tom that he would more than likely enjoy this exercise as I knew he liked taking things apart and fixing them ( he had said he enjoyed DIY and he had already ‘ connected ’ with the concept of being able to ‘fix’ himself ).  I said that as a child from 0-7 we imprint from our environment but from 7-14 we model ie.  we may take on the characteristics of an idol etc and we can often detect those characteristics in ourselves as adults.  In the same way we develop a belief system which we rely on because we think it keeps us safe however as we mature into adulthood sometimes our belief system gets left behind and we end up relying on an out of date system.

‘  I’m sure your train is not driven in the same way as it was 40 years ago,  maybe even a year ago – the systems are always being improved and updated to make them more efficient ’

So it is important to understand the structure of a belief system so that we can then take it apart if we want to,  redesign it,  and put it back together to make it more efficient.  I explained that A was an activating event,  B was a belief and that C was consequences. 

For example,  A could be that a meeting at work had been scheduled / B could the self-belief that Tom was not good in meetings and C may be that Tom believed he would not perform well in the meeting and he may lose his job.

We discussed that in the same way Tom could control ( I very much wanted control to be a dominating theme in Tom’s therapy since he was very happy with the control he had as a train driver and the responsibility – response-ability – that brought with it ) his anxious thoughts from escalating by clenching his fist he could begin to notice when a belief had hooked his attention and stop for a moment and break it down.  I said that this process may seem hard initially as Tom was not used to doing it however with practise it would become automatic. Tom would progress from :

unconscious incompetence – not being aware of what you need to know

to conscious incompetence  – being aware that you don’t know it

to conscious competence – being aware of what you know

and finally unconscious competence – do those things without thinking eg. driving a car / riding a bike etc

If Tom asked himself questions at each point of A + B = C then as a result of his answers he could update and change the belief if he chose to so that it became more helpful.  We did the exercise together asking things like what is it about Tom in meetings that makes you think you are not good in them ? How do you think you could improve that ? When would you like to be able to do this ? Why do you think it is so ? etc.  We talked about How/ What / Why Tom saw the consequences of the meeting and How/ What / Why those consequences would change if he adjusted his belief even in a small way. 

We noticed that even tiny changes to his belief had greater effects on the consequences for example we altered his belief that everyone was looking at him in the meetings ( what – always ? everyone ? ) to the fact that some people looked at him and some did not but they also looked at other people because that is what people do in meetings and in life – people like to connect – it did not mean that they were waiting for him to say something.  Reframing the situation took the heat out of the situation.

If they wanted him to say something they could ask him and then he would know that they required him to speak however until that point he was welcome to listen and enjoy a new part of his job.  And even when they did require him to speak they did so because they were looking to him for advice or for his opinion  – he has been promoted and his boss promoted him because he is good enough. And if he does not know the answer then that does not matter because he is new to the job – say he will find out the answer before coming back to them.  In the same way that he would not drive the train out of the station without knowing what he needed to know to drive it safely – don’t drive the train / don’t answer questions until you have the necessary information.

It’s ok to say I don’t know but I will find out – be imperfectly perfect.

We repeated this exercise with several beliefs until Tom grasped it – in a nutshell,  stop when you are aware a belief has hooked you,  break it down by asking questions – take all the time you need – and then reform it / update it so that it serves you more healthily.

Tom enjoyed the analogy of breaking something apart and putting it back together and we agreed that there was never a wrong answer. The process was important and if Tom dismantled a belief and then put it back together and it then became something completely different then that was fine.  If it stayed the same – then it had stood up to the test !

I was aware that we had worked very hard indeed and suggested I give Tom something to take home that he would enjoy.  I gave him a worksheet that focussed beautifully simply on using your hands to remind you about the fundamental basics of breaking down a belief and how the process could be used to truly decipher meaning ( NLP exercise ).  I very much wanted to focus on Tom’s hands as a theme in his therapy because they meant a lot to him – DIY / driving the train / keeping his dog safe on a lead when required and so on.

Tom liked the exercise – we discussed that eventually with practise he may not need the reminder sheet anymore and would instead simply look at his hands for assistance. If nothing else,  just pausing to look at his hands before reacting to something / someone was healthy – response-ability !

I was aware that we had worked hard and suggested that we now sit back and relax which Tom was happy to do. 

I reminded Tom that he was always welcome to open his eyes at any time should he so wish. I knew Tom liked to travel as he had written it on his client intake form and asked if he had ever been to Egypt and if he was ok with flying ( just in case I had to modify my script ) and caves and boats.  He said that he had not been toEgypthowever it was on his list and he was fine with flying, caves and boats. 

‘ ………Ok……close your eyes……let’s go to Egypt…’ I knew that Tom did not need the conventional induction and that he was actually more comfortable with a ‘story’ to focus his attention. I proceeded with a tension / breathing relaxation script combined with ego-strengthening and confidence building utilizing the theme of hands and control.

Some extracts of the script follow :

‘………and whilst you are resting there…….comfortable and calm……I would like to tell you a story……….because everyone likes stories…………and when someone reads you a story it shows you that they have made time for you……..your time………..just you and them………….and if you read yourself a story……..or a book…..a novel…….it is because you have made time for yourself………..nobody wanting anything……….nobody needing anything………..and do you remember how do stories start ? Well ……when we were young and stories were truly magical they usually started ‘ once up on a time ’……..so let’s try that shall we………..Once upon a time there was a man……and he was a good man and an honest man…..and when he was a young boy he had for as long as he could remember enjoyed playing with his toys……….especially the ones that came apart and needed to be put back together again and sometimes it took him a long time to put those toys back together …… and he would look at the pieces and turn them around in his hands……because hands are wonderful things……you can turn things over with them……….feel …..touch….. mend…….fix…and this young boy would look at the parts of the toy in his hands and work out the way to put them all back together until the job was done…….’

 ‘……  and the young man was calm and confident and enjoyed his work immensely and did very well …..quietly…..and then one day the big boss offered him a promotion and the young man was so proud…….so very proud……and he took the position and his heart swelled………however the new job…..the perfect job…….brought with it many changes………and some of the changes the young man found hard to manage……..he began to feel that his internal resources were just not enough to cope with the demands of his perfect job….. ……..and one day he felt as if there was someone inside him crying out for him to just stop……and rest…….but he could not hear clearly the words of the voice inside him and he was confused…………..for this had not happened to him before……’

‘……..the voice that was crying out inside him……….because the voice was part of him all along and it was only trying to help him…….’

‘……and he took a flight to Cairo and took the old train line down from Cairo through the desert to Luxor…..The Valley of The Kings…………and he enjoyed the feeling of the train as it rocked and clinked along the track and the incredible scenery ………. and he noticed that he was no longer bothered by other people on the train……..’

‘……..he was part of their scenery ……….a smile maybe……. a connection…….because people need connection……. but nothing more…….nobody wanting anything…..that’s right……….and when he arrived at Luxor he left his luggage at the hotel and caught the river boat across the Nile……….and it was a beautiful evening………peaceful……..and he followed others deep into the Valley of The Kings………great statues stood tall into the evening sky and tombs sunk deep into the ancient ground and there was easy calm……..and as he walked into the valley he felt the presence of …………..’

‘……..he feels a sense of security and confidence as he follows the passageway as it takes him deeper and deeper into the heart of the tomb…..at the very end of the passage is a vast storeroom filled with treasures of all descriptions…..’

‘…..  all of this treasure is rightfully yours for it was stolen from you through force of circumstance.  However unless you carry it back into the world outside to enjoy and share with others it will eventually be sealed up within the room and lost forever…………’

‘………and breaks into a thousand pieces……’

‘………..step outside into the warm sunshine…………’

[ Extracts only ]

Task Setting and Homework –

Tom re-orientated well and stretched.  He said that he had very much enjoyed the journey and now wanted to go to Egypteven more ! We discussed the relaxation for a short while – I did not want to over analyse it as I wanted Tom to make it his own.  I encouraged Tom to continue using the clenched fist technique – re-charge it – and to listen to my recordings and suggested he used the tension exercise to help him sleep ( self hypnosis ) and stressed with all these ‘ tools’ they needed to be used and practised to best effect.  I encouraged him to play and have some fun with the hands exercise to help him loosen a grip on out of date beliefs.

One week later

Preparation –

Now that we had addressed the old part of the brain that was very immature/ young I wanted to introduce Tom to the voices in his head.  Both exercises would reset his locus of control to a more healthy internal position where he could begin to rely and trust himself as opposed to an external one that relied on external influences that he had little or no control over for support.

I also wanted to help Tom’s confidence regarding group participation in both meetings and social environments in general.

The Session –

Tom arrived for the session in smart casual clothes for a change and was much more relaxed.  He said he had had a good week and had actually booked himself a holiday to Egypt– it was nice for the first time to be able to book himself into a nice hotel because his promotion had meant he now earned more money.  He was pleased to say that he was still using the clenched fist technique and often found himself squeezing his hand several times to ‘ re-charge ’ the positive feelings in his right hand.  He was sleeping better and was enjoying using self-hypnosis.  Tom was finding time to walk his dog again ( his mum had been helping out whilst he got himself settled in his new job and shift patterns ) and the walks were getting longer as he liked the feeling that he was using endorphins to mop up any excess adrenalin.

We began the session by introducing Tom to the idea that any voices he heard in his mind may be categorised into individual ‘characters’ and we talked about whether Tom could find them in his mind,  what their various attributes and characteristics were,  what they said to eachother and how they said it ( we placed them in several situations eg.  a meeting at work / a shopping trip to buy clothes / a drive to a friends that proves difficult as Tom gets delayed in traffic etc etc ) until Tom became proficient at spotting all their ‘faces’ and hearing their ‘voices.’  We gave them names for example The Prince who believes he is entitled to that car parking space because ‘he saw it first’ and The Saboteur who sounds like a friend however he is really trying to hold you back.

Tom grasped this concept well and quickly accepted that the voices in his mind were simply that – voices in his mind.  They had their own opinions and characteristics however he did not have to listen to them or take their advice – thanks,  but no thanks. 

We discussed being able to distance Tom from the voices in his mind and even better if he could question them ( using his new questioning resources / skills – what always ?  never ?  should ? shouldn’t ? how do you come to that conclusion  etc ) He was able to distance himself from them / dissociate from them and not be affected so much by them – Tom is not the voices in his mind.

We spent a considerable amount of time on this exercise as Tom enjoyed it and it also linked in very nicely with the work we had done on loosening his grip on and updating his beliefs.  He could appreciate that in a meeting he may hear a voice in his head telling him that he was nervous and should not speak ( Victim and Saboteur ) however he could thank them for their contribution and instead take strength from the Prince who assured him he was quite entitled to speak at the meeting and as such if he wanted to,  he could.

I then asked if he would like to relax and he said yes and I worked with a script focussing on control of emotions and confidence. 

I told him he was welcome to close his eyes whenever he wished.’

Extracts of the script follow :

‘……..and you know exactly where you are going……….to that place you found a long time ago………….you walk to the corner of the room where there just could not possibly be anything …..else…… there……….. and you see it again as if for the first time…………a small control panel…..you take a deep breath in……..and as you breathe out you place your hand firmly onto the panel and the door slides open as it always has done………’

‘……….and everything is exactly as you remember it………..as you enter the room soft lighting flickers on………not too much…….just right………and you see the screen in front of you…….like a private cinema screen……..with a few rows of seats……..and the control panel……a mixing desk……..just like the ones technicians use for music concerts and shows……..and you know what you are going to watch today………….’

‘………. and you can come here whenever you like…….you take a disc out of your pocket and slide it gently into the machine and the screen comes to life………..and it plays a film of you……….you have come so far………’

‘………you are in control now……..how fascinated you are with the changes you have made in such a short time………how proud…..and you stop the film and take out the disc and put it somewhere safe so that you can always refer to it………’

‘……….experiences….and these applications give rise to still more questions resulting in your even greater desire to know………..because learning is finding out what you already know………..doing is demonstrating that you know it……..this is your time………..now……….’

[ Extracts only ]

Tom re-orientated well and we discussed the relaxation and his feedback on the control room which he liked.  I encouraged him now to ‘live’ what he has learned over the past three sessions for a while.  I said that ‘ therapy is a bit like one of those children’s snow storms – some ideas connect immediately and some later and some drift down in a week or so ( David Holmes 2011).’

I suggested he continued to practice the self hypnosis he had learned and the anchoring technique ( and re-charging it ) and continued to listen to and question the voices of the characters in his mind and deciphering meaning using the hand exercise/ questioning patterns we had shared.  I congratulated Tom on all his hard work,  said he was welcome to call whenever he liked and wished him a lovely holiday.

 END

I hope that you have enjoyed reading Tom’s story and if anything is of interest to you or you think any part of it will work for you please give me a call and we can discuss it.  Therapy is different for everyone.  I use the personal information that you chose to share with me to tailor make a treatment programme that is unique to you.

Fiona : 07968 106113

 

We will work together to find out where you are today and take you to where you want to be.