Anxiety Attacked - A therapist explores the domino effect

Brookside Center for Counseling and Hypnotherapy

Anxiety Attacked: A Therapist Explores the Domino Effect

by Maurice Kouguell, Ph.D., BCETS.

Question: Is it possible to cure more than one phobia at a time?
M.K: I prefer not to “overload” the client. However, in the following case I succeeded in “curing” two phobias at one time.
Question: What do you mean by curing?
M.K: I think that after one symptom-free year that the case can be considered closed.

INTRODUCTION
This 55-year-old woman entered my office with a pronounced limp, yet I had observed her coming up the walk to my office limp-free. Briefly, as a child the only time she could get her mother's attention was to make herself sick enough to require hospitalization.

PANIC ATTACKS
The following is a partial transcript of the second session with patient C. The third session was a report by C of her panic-free experience with M.R.I. procedures at the hospital (scanning).

The initial session revealed that this 55 year old woman has lived since childhood in a constant state of fear and free-floating anxiety. In her formative years, her mother acknowledged her presence and existence only when she pretended to be sick or really was sick.

Please note how this session brought her to master two phobias: claustrophobia and fear of water. The follow-up session indicated that she overcame both of these; however, she has retained her need to let everyone know how "unfortunate and sick she is."

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MK: Now, what I'm going to do, I'm going to take you from your house to wherever you're going, to the hospital...to the lab.

C: Hospital.

MK: To the hospital. Play my stress reduction tape once a day at least, before Wednesday, at least once a day. The purpose is for you to get into that complete environment. Being in your comfortable chair at home. If you can see yourself doing the whole experience, you are going to be fine. I have a patient of mine who was so prepared she went through the tunnel (scanner) completely and when she finished, she remembered what I told her and what I told her was "Isn't it too bad it's over, it was such a nice experience to just relax?" This was her statement, "I was sorry it was over. It was so nice and relaxing. I didn't have to do anything."

C: I have to think of pleasant things. What they're doing to me doesn't bother me--it's not hurting me--it's just the fear I have of not being able to breathe.

MK: What I’ll do for you...You'll breathe okay...

C: ...My nostrils too, up in the air.

MK: That's right; as long as you know that there is air--as long as I can guarantee that you will have enough air. Can I guarantee you that you will have enough air?

C: I don't know, we'll see.

MK: I think I can guarantee that. I can call the hospital and ask them to guarantee there is enough air.

C: I want me to feel the air, I know that if I feel the air...

MK: Before you start, ask the technician, who is going to be hovering around you anyway, ask him not to have garlic or onion and to blow on your face once in a while so that you know you have enough air.

C: My face will already be in...my face is underneath the machinery, the rest of my body is out.

MK: So if you smell onion or garlic, you'll know someone is checking on you. Okay. So make yourself comfortable. You can hear me well enough?

C: Yes.

MK: Okay. You can hear me, so maybe your hearing is improving.

C: No, maybe I have my hearing aid turned up a little higher.

MK: You can see me too.

C: Yes.

MK: Now that you can see me too, you can take one breath and close your eyes because you know I'm here. And now, I'm going to relax you first. Then I'm going to take you through your day,Wednesday.

C: Could you sit here? Because when I close my eyes, I lose some sense of the hearing.

MK: You hear better with your eyes open. That makes sense, I cannot hear with my glasses on.

C: When I close my eyes, I'm more relaxed. The tendency is for my mind to drift off and then I don't hear the voice.

MK: Now I'm going to ask you to take a comfortable breath and let go and close your eyes and now, with each breath you take, relax and be comfortable, feel the rising and falling of your back, and as you do so, just let yourself go. Bring your attention to your eye-lids. Begin to feel the heaviness in your eyelids and let this feeling of heaviness be in your eyelids and let this feeling of heaviness go down to your cheeks, your chin, all the way down to your legs, to your shoulders, your arms, your fore-arms, all the way down to the very tip of your toes. Allow yourself to feel relaxation and happiness. And at this point, you are just beginning to relax and with your permission, what I'd like to do today is to take you to a point, starting one hour or so before your appointment at the hospital for the test, getting you ready already as you are ready to leave your house, on the way to the hospital, and to the waiting room, on the way to your test.
Now, that morning, at the suggestion of your physician as you have mentioned before we started, he recommended that you may want to take some tranquilizers. As long as you take the tranquilizer, it will begin working. Follow his instruction and take the tranquilizer. Tranquilizer has, at this point, two very important factors. One, physiologically it will work on your system, it will work on your brain, it will relax you. And two, since you know it will work, it will work. So take your tranquilizer and also a good hour or so before you leave your house, begin to work and to do some relaxation exercises.

You may wish to just lie down and give yourself five to ten minutes. Close your eyes after you have taken three to four breaths. And begin to count backwards from fifty to one. 49, 48, 47, 46, 45, going all the way down, when you are down to 1, you will count up to 5, and at the count of 5, you will open your eyes and you feel relaxed and calm. Feeling real good. So this already will predispose you to feeling calm.

Your mind will direct you to feeling calm and relaxed. So now, you have about an hour or so left before you leave the house. You have done the relaxation exercises. You proceed with any arrangements you need to do. And again, this time you will sit in a chair, you will have in the waiting room.You will sit in that room and you simply breathe in and out. With each breath you will say to yourself, calm, relaxed. Calm and relaxed. You will enjoy doing this as long as you like. This will already pre-condition you to do the same thing when you are in the waiting room. Thus, your mind will already be programmed for you to feel calm and relaxed as you are in the waiting room.

Now, I'm going to relax you and take you deeper and afterwards I'm going to take you deeper into hypnosis and we'll deal specifically with your experience during the scan.

Again, take a deep breath and let go. Another breath, inhale and let go. And as you do so program yourself, give yourself permission to go into hypnosis either by counting backwards or by simply saying to yourself, calm and relaxed. Calm and relaxed. Allowing yourself to go deeper and deeper. You may wish at this point to picture your nose as allowing your breathing to be smooth and relaxed, smooth and relaxed. And knowing that you are in complete control. Completely relaxed.

And now, with your eyes closed, imagine a warm summer day and that you are just floating around in a rubber raft, perfectly safe, perfectly comfortable. You are pretty close to the shore. Just picture yourself resting there in the soft, rubber raft with the water gently rolling you back and forth, back and forth as you continue to enjoy the sun and the ocean coolness. It is so calm and so peaceful out there, with the sound of the waves, all you want to do is to just be there breathing, calm, into a deep calm.

Picture the scene as I described it, while I count slowly from one to ten. By the time I get to the count of ten, you will be resting comfortably in a deep, deep, sound sleep.

One. You can feel yourself relaxing, relaxing so very deeply as you continue floating on and on, the water gently rocking you.
Two. You feel so relaxed. As you continue to listen to my voice.
Three. Relaxing more and more deeply. Really feeling relaxation, relaxing deeper and deeper as you just drift.
Four. You feel relaxed and stronger and stronger.
Five. Every word I say is putting you into a deep, sound sleep as I continue to count. Allow yourself to drift faster and faster into a deep sound sleep, relax.
Six. Just listen to the sound of my voice and by the time we get to ten, you will be resting comfortably in a deep sound sleep.
Seven. You are drifting faster and faster and you are comfortable.
Eight. Every word that I utter is putting you faster and faster into a deep, deep sound relaxing sleep.
Nine. Into a deep, deep sound sleep, deep, sound sleep.
Ten. Very deeply drifting in a deep, sound sleep.

Continue to drift deeper with each passing second...drifting deeper and deeper down...drifting and drifting. And now, you are now transporting yourself in your mind's eye to the waiting room. You are sitting in the waiting room; you are given some papers to fill out, so you do, so to save time you will go into relaxation. You have several methods. You will go into relaxation. You will go into relaxation as you are waiting in the waiting room. You will continue your deep breathing as you go...one...two...until the test will begin. And as you are getting made comfortable by the technician, you will begin to go into hypnosis by taking four deep breaths and the fifth one which you will hold for just a few seconds, two or three seconds and you will start counting backwards once again, very slowly. Allowing yourself to go sleep, and in the process of going to sleep, your mind and your memory will find a place which will make you so happy, make you so happy...

Transport yourself to the place with colors and shapes and sounds and smells, and taste the feeling, transport yourself a place where you are completely tuned in, mentally tuned in, and begin to feel the time, time, making little sense. Minutes will just drift away. Seconds melt, time just drifts away. You'll get so involved with yourself that you feel only calmness and relaxation. Allow yourself to just let go of yourself...completely relaxed.

You will remember some of your favorite sessions that you've had here. Allow yourself to just be calm and relaxed, let go and relax. And should you wish, sleep. Sleep. Sleep. Each moment that goes by, feel relaxed. Sleep. Sleep. Sleep. Now you are comfortable in the hospital. You will feel that time has gone by, feel relaxed. Sleep. Sleep. Sleep. Now you are comfortable in the hospital. You will feel that time has gone by so fast that you won't believe the test is over. You will feel proud of yourself that you have accomplished this experience. You will feel good and this test will show you once again that you have indeed allowed yourself to take charge of your life. You have allowed yourself to take charge of yourself.

Now, I'm going to count. On the count of five you will reopen your eyes feeling totally conscious and aware of your presence, feeling absolutely wonderfully relaxed and so good. One. Two, beginning to wake up. Three, letting go and waking up. Four, feeling so good and so relaxed and five, feeling so good and so relaxed.

C: It took me back to one of my other fears. I can't believe it.

MK: Floating on the raft?

C: Yes.

MK: And you handled it.

C: ...myself in the water: I'm petrified of it. I tried to overcome it a few years ago and I did temporarily and still when I see myself in the water I'm either drowning or under the water...and again I can't breathe. The whole thing...and I found myself in all places, I've been in Hawaii, but, I had myself between going back to Hawaii and the commercial I see on TV with this guy on a raft and all of a sudden these girls come to him...to rinse his mouth or something and I saw these girls with their Hawaiian costumes and I'm running out of the water instead of in...I'm sitting in the raft, but for some reason the raft was not on top of the water, it was below the water and the water was up to here, which normally I would be going out of my mind. And the water felt cool and I felt the breezes, trying to get the breezes to go on my face, into my nose, and somehow I managed to get out of the water, I don't know where the raft went to, but I was coming out of the water.

Also, you know I'm petrified of the water and when you started with the raft, I kept thinking I'm going into my other problem area, between the heights and the water you got me coming and going. But I managed to not let it conquer me, I was slightly apprehensive in the beginning, I said to myself, well, I’ll see how long I can stay here.

MK: You know that I'm aware that you are scared on the water. I know that.

C: I had mentioned that.

MK: I am also aware you are scared of that machine.

C: Yes.

MK: What do you think I accomplished with you? I put you through an experience about a week ago going up in air you enjoyed that for awhile, right?

C: Normally I would feel an enclosed feeling, because whenever I'm up in the air I see high mountains around me, and I'm in the valley and I'm going to plummet but, going up in the balloon I was up in the air before you got me there and I also felt these breezes on me.

MK: And today I put you in the water which was your other phobia.

C: Yes. Definitely.

MK: I never said that I wasn't tricky but you survived and you enjoyed it.

C: I was fairly calm about it. Because of knowing how my emotion can be aroused by this fear of being in the water, drowning, learning how to swim, which I never really did. I tried it about six year ago and oddly it came about when my husband decided to tell me this was it. It was the day I supposedly conquered my fear of being in the water.

MK: So we did it?

C: We did it, yes.

MK: Two fears without you even knowing it.

C: How about that.

MK: Behind your back.

C: Yes. Sneaky, sneaky.

MK: Some of us have no ethics. Right?

C: Right.

[Please note how this session brought her to surmount two phobias: claustrophobia and fear of water. The follow-up session indicated that she overcame both of these.]