A presentation on the review of clinical hypnosis used for a client with panic disorder

1. Clinical Hypnosis in the
Management of Panic Disorder
with Cognitive-Behavioral and
Spiritual Strategies
RANDY WILHELM

2. Panic Disorder of “ZACK”
 30yr old man-”ZACK”
 Chinese MBA Student/Restaurant Manager w/Wife and son
 Panic Attacks started after a drowning incident 10 months previously
 Thoughts revolved around:
 Death at sea
 Dying from currently perceived threats
 Fear of his wife, son, and parents having no one to depend on

3. Panic Disorder of “ZACK”
 Panic Attacks lasting 20 minutes with symptoms of:
 Palpitations
 Sweating
 Choking sensations
 Dizziness
 Intense fear of death
 Zack rated 8/10 for distress
 Panic Attack Cognitions Questionnaire (PACQ) 69 (High) during last attack and 40 (Moderate)
after last attack
 Templer Death Anxiety Scale(TDAS) 12 (high)

4. Treatment
 Hypnotic intervention with a cognitive-behavioral framework
 Zack was found suitable for treatment due to his Buddhist meditation, no
signs of psychopathology and after taking the Stanford Hypnotic Clinical
Scale for Adults
 Three main components:
 Cognitive restructuring-”inner adviser” method
 Breathing skills-an imagery of dark blue healing fluid
 Graded exposure with response prevention(Imaginal)-combined with inner adviser
method
 Each method incorporated his religious views

5. Treatment
 Session 1-Zack would repeat “calm” while not pursuing other thoughts
 Session 2-Breathing while visualizing dark blue healing fluid “Medicine
Buddha”
 Session 3-Graded exposure experience with previous coping skills, Inner
Adviser-”True Self” to guide Zack
 Session 4-Mimicking panic attacks rounds
 Session 5-Review and decided no more sessions were needed

6. Treatment Outcome
 After 5 sessions, Zack reported:
 PACQ-During last attack 4 (LOW) After last attack 3(LOW)
 TDAS-2 (LOW)
 No significant episodes for more than 2 months
 Average Duration of 10 minutes
 Indicated 2/10 level of distress

7. Discussion
 It was thought Zack only produced First-Order Change
 First-order change refers to change within a particular frame of
reference or system. You can do things in your dream but nothing causes
you to wake up
 Second-order change refers to a change in the frame of reference or
system itself. You wake up from the dream
 Symptoms could have played dual-roles in Zacks life and were
overlooked
 Family involvement could have been more beneficial for treatment

8. Discussion
 What I liked:
 Integration of faith
 Explanation of goals, treatment, and methods
 Lim Admitted to shortcomings
 What could have been done differently:
 Better definition of terms
 Better explanation of CBT integration
 A follow-up of Zack a year later

9. References
Lim, Kokkwang. (2016). Clinical Hypnosis in the Management of Panic Disorder
with Cognitive-Behavioural and Spiritual Strategies. Australian Journal of
Clinical & Experimental Hypnosis, 41(2), 213–224.
Watzlawick, P., Weakland, J. H., & Fisch, R. (2011). Change: Principles of
problem formation and problem resolution. (pp.12) New York, NY: W.W. Norton
&.