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WORKSHOP ON “DESENSITIZATION1”

BRUCE BONNETT I. Dr. John Kappas2

“The symptomatic approach simply means working directly with the symptoms of a particular problem, and not with the . . . causes. It is the first and easiest approach to take. No harm to the subject can possibly come from it . . . Only a small number of cases . . . require an identification of the cause because the majority of problems can be alleviated symptomatically. In fact, many symptoms have been known to disappear simply because of imagination, medical placebos, or a change of environment.

The most basic symptomatic approach involves systematic

desensitization. With this method you simply place the client in hypnosis3 and suggest that the symptom distressing him will soon disappear. Then have him imagine feeling comfortable in a given situation that usually causes his symptomatic discomfort. Many times, people

1 If you are looking for information on this topic, look for “desensitization” as well as “systematic desensitization.” 2 “The Professional Hypnotism Manual”, p. 116. 3 Interestingly, in the past it appears that hypnosis and systematic desensitization were viewed as competing approaches. The following study by psychiatrists in London in 1968 tried to ascertain whether hypnosis or systematic desensitization was a superior approach to treat phobias: “Hypnosis and Desensitization for Phobias: A Controlled Prospective Trial”, I. M. MARKS, M. G. GELDER, GRIFFITH EDWARDSThe British Journal of Psychiatry Oct 1968, 114 (515) 1263-1274; DOI: 10.1192/bjp.114.515.1263 http://bjp.rcpsych.org/content/114/515/1263 . Fortunately for us, someone realized the two could be combined!

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will have anticipatory dread of an event, and this dread will cause misery during the event. The discomfort experienced will increase the anticipatory dread, and a vicious circle, operating on the Law of Association, begins.

In therapy this is corrected by having the client

imagine an association of the negative situation with feelings of comfort and ease. Since feelings of comfort and discomfort cannot coexist, the negative stimulus will lose its potency and the symptomatic discomfort will disappear.” (emphasis added). II. George Kappas “Dr. Kappas suggested we treat fears (reality based traumatic incidents) [that the client remembers] differently that phobias.4

4“While fears and phobias are very similar, a fear is when you get panic attack symptoms that are triggered by something realistic while a phobia is when the panic attack is triggered by irrational and sometimes unknown factors. . . . Phobias are usually created when someone experiences feeling panicked, terrified, physical pain, or the fear of impending danger and then associates it with something around them, whether or not what they’ve associated the feeling with caused or played a part in creating the negative feeling. Very often the trigger is only marginally related to the original emotion. . . You may have been scared by something other than the spider, saw a spider, and “pinned” the blame on it. Maybe someone bullied you with a toy spider and you became scared of the toy and not the person.

However, phobias that develop in adulthood are quite often due not to something psychological, but physiological, i. e., due to hypoglycemia or a lack of sugar in one’s system. This mimics a panic attack and the person associates that shakiness and panicky feeling with something around them. People skip breakfast or eat poorly, get that panicky feeling later, and suddenly they begin to develop a phobia around whatever they were doing or where they were when the feeling hit them — driving, eating a specific food, or taking tests (when a person is already pretty nervous to begin with).” https://franzblauhypnosis.wordpress.com/tag/systematic-desensitization/

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He suggested with fears you use what he called "circle therapy5". Circle therapy is you have the client relive the traumatic reality based incident usually from the past, in small increments, "feel it" "pass it" "feel it" "pass it" until you have diminished their ability to feel it as strongly as before. Once this is accomplished then you have then imagine future incident while remaining in the calm state, therefore associating the future incident to the relaxed state. With Phobia [which are not based on some real past event or situation] you do not have to experience the anxiety because he did not want to reinforce the phobic association. Instead he systematically exposes them to the phobic anxiety producing stimuli in such small increments that they always are able to maintain their relaxed state, therefore changing the association of the stimuli to the relaxed state.”6 [***NOTE FROM BRUCE: Because the client does not know or remember the specific event/cause for a phobia, if you had a client “relive” under hypnosis the time when the phobia started, it seems like you would also risk: (a) the possibility of planting a false memory; and/or (b) making the client possibly relive an event or situation that the client’s mind has repressed to protect the client because it was so traumatic.]

5 According to Cheryl O’Neil, Dr. Kappas towards the end of his life told her he hardly ever did circle therapy anymore. 6 Communication with Bruce Bonnett.

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III. CHERYL O’NEIL [In contrast to circle therapy, with desensitization,] the client is NOT taken back into the fear/trauma itself.

[Bruce’s example: bad feeling from sugar high & low --- leads to bad feeling/panic feeling --- and you just happen to be at airport or getting on a flight --leads to fear of flying]

. . . [The client] while in hypnosis is taught to associate the negative stimulus

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with a new positive response of relaxation.

This is based on the conditioning process of the Law of Association, ‘you cannot have two opposing feelings at the same time, and from now on any time you feel stress or negative anxiety the

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mind and body will immediately trigger a relaxed feeling of well being and safety.”7 IV. 201 Workbook “Desensitization is one of the preferred ways to work with fears as well as phobias. Desensitization: once in hypnosis, the client is asked to bring up the fear response elicited by the fear stimulus. In hypnosis, the client is taught to associate the fear stimulus with a new a positive response – such as the calmness and relaxation of being in hypnosis. Use of imagery personally calming to the client is also helpful such as the sound and waves of the surf. This is different form circle therapy because the client is NOT taken back to the original trauma (to “connect” with original situation when the fear was formed; note: do not use “circle therapy” for phobias because the original cause/situation is unknown). Systematic Desensitization: phobic stimuli are ranked on a distress scale. They are then presented and worked on in a progressive manner.”

7 Text provided by Cheryl O’Neil to Bruce Bonnett. Emphasis and crazy cartoon images added by Bruce Bonnett.

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V. CREATIVE SCRIPTS FOR HYPNOTHERAPY by Marlene Hunter, M.D., page 117. “Utilizing the hypnotic state as a safe place to go through a desensitization procedure can be useful in some cases. One could invite the person to find a tiny picture of the phobic object in an imaginary book, for instance; then find bigger pictures; then image the object itself behind glass, etc.” VI. HANDBOOK OF SUGGESTIONS AND METAPHORS, Edited by D. Corydon Hammon, P.hD. (“the big red book”). “With repetition and reliving under hypnotic trance, the ‘alien’ quality dissipates, the episode begins to

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assume manageable proportions, and a better psychological perspective about the memory evolves.” (page 542) “Prior to inducing hypnosis, the patient develops a hierarchy of situations gradually approaching the actual phobic situation, such that the first situation is the least anxiety-provoking [in the case of fear of flying, for example] (such as reading a travel magazine), to a bit more anxiety (thinking of taking an airplane [trip]) and then more anxiety-provoking (making a reservation). Gradually, his visualizations then take him onto the plane itself, and then into the air. These form the basis of images. You can repeat the patient’s own words during hypnosis. As scenes are imagined, the patient should be told to stop imagining the scene and to imagine a neutral stimulus. The anxiety response diminishes as you have the person take himself/herself deeper into trance before imagining the anxiety-provoking scene again. As you reintroduce the troubling scene, the anxiety response recurs but hopefully lessens.” (page 179)

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VII. HUMOR A. "Using Humor In Systematic Desensitization To Reduce Fear" published by a psychology professor at the College of William & Mary in 2001 http://web.csulb.edu/~jmiles/psy100/ventis.pdf [***Note—laughter relieves physical symptoms of fear Plus—if we can enjoy the process of hypnotherapy to achieve our goals, why not!?!?] Example from above article: Instead of merely associating relaxation for someone with a fear of spiders, the person is asked to consider/imagine the previously feared situation from a more humorous perspective; for example: "Imagine the spider did nothing unusual when you touched it with a pointer or when you put your gloved hand into the cage. Now, imagine you put your gloved hand into the cage and touch the spider's leg-- but consider this from the spider's perspective: 'So

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who told these clowns they could touch my leg?!?! Would they be so patient if I were feeling their legs? You bet your sweet life they wouldn't! They would have a cop here in an instant telling me to lean against the wall and spread all of my legs for frisking!!!'" B. Example from Bruce: “Kidnapped by K-mart” https://www.youtube.com/watch?v=kYHFlcM6IUo C. Grammar Bully/Grammar Nazi example (desensitizing someone who gets irritated by a friend’s poor grammar—but who does not want the poor grammar to bother her)

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VIII. 301 Workbook “For smoking, have client list the times they smoke (taking a break, with coffee, after lunch, etc.). Then, have the client prioritize them in order of discomfort if he/she does not have a cigarette. Then desensitize to each.” “Tardiness/Being Late. Desensitize time to fun or productive. Phys: Can socialize if early, can use the restroom to freshen up and look great, be more prepared to engage in the moment Emo: Can be productive or efficient; check e-mails, read, prepare for something, do brain games or mind engaging activities.” “Exam anxiety: Teach self hypnosis to associate good feeling with exam study, etc. Imagine feeling calm in exam room and during exam. Imagine recalling all necessary information for exam with no discomfort. Visualize smiling leaving exam room happy (for emo., infer happiness by visualizing smiling about something specific – maybe part of exam that went well) If possible, create “knowns” regarding the exam: maybe physically actually drive to exam site, plan what he/she will bring.” “Weight Loss: Desensitize to triggers, fears, emotions, stumbling blocks that contribute to weight problem” [***Bruce’s note: Stanford baseball player and volleyball player examples -- really desensitizing to pressure/nervous situation—video of home run] https://www.youtube.com/watch?v=oCDUO3LM5FE

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IX. Hypnosis and Systematic Desensitization – Does It Work? July 28, 2014 by Joshua Houghton http://www.whatsonmybrain.com/hypnosis-systematic-desensitization/ “The problem is that the more the person avoids the thing they fear, the more firmly established the fear becomes. They are not getting the chance to overlay their fear with different memories or experiences. Systematic desensitization redresses the balance, by making the person gradually get closer to the thing they fear, so that they steadily build up a bank of experiences where they have allowed the object of their fears to come closer, with nothing bad happening. . . . So where does hypnosis come into it? Well, for one thing, not all objects of fear are easy to come by. Nor are they necessarily predictable in their behavior. If a psychotherapist specializes in helping people with phobias, where are they going to get the bees to help person 1, the spider(s) for person 2, the lightning storm for person 3, the clown mask for person 4, a variety of dogs for person 5…. You get the idea. And even if the therapist does somehow manage to source the necessary objects, how can they be sure that those things will behave in the way they need them to? You’ve probably heard me say this many times before, but one of the greatest gifts to a hypnotist is the fact that the unconscious mind can’t tell the difference between a real experience and one we have vividly imagined. Suddenly systematic desensitization becomes something we can completely control. Through hypnosis, we can create a situation where the client comes into contact with the object of their fears in exactly the way they need to.

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In imagination they can approach or experience the thing they fear, while maintaining a calm and relaxed state of mind. They don’t have to wait until they happen to encounter the thing they’re trying to overcome.” X. Another Description https://www.naturalhypnosis.com/blog/systematic-desensitization-a-hypnosis-technique-to-deal-with-your-problems 1. Relaxation. . . . hypnotic relaxation techniques are first employed to enable the subject to produce an accepting, receptive and relaxed state of mind. 2. Hypnotic suggestions. Then he or she may get hypnotic suggestions - imagining an image of a spider. The whole idea of this kind of therapy is to gradually convince the subject that no harm will come to them. The next stage may be to "watch" a spider at some distance, possibly with the spider in a glass box on – so that the spider is visible, but obviously incapable of approaching the subject. 3. Increased Exposure. The exposure to the spider is gradually ramped up in the mind - until eventually, there is little problem with holding a spider or allowing it to be on the subject’s clothes. The relaxation techniques may be repeated in between various stages. In fact the exact technique used is often called ‘progressive’ relaxation in which there is alternative tightening and relaxation, so that the subject can perceive the contrast between tension and release. . . .”

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XI. IRONY: BRUCE’S APPROACH -relaxation, laughter/humor, whimsical, stories, fun XII. SOME QUOTES & CARTOONS ABOUT DESENSITIZATION “You have mixed feelings when you hear a hurricane is coming because they keep telling you to leave and then nothing happens, ... Sometimes you hear the sirens, and you just roll over and go back to sleep. You get desensitized to it. “ ~ Ian Williamson “I had a blood-and-guts period when I was a kid, but I just think that whole splatter movie thing kinda got out of control, and too many people became too desensitized to other people being brutally murdered, you know?” ~ Rick Baker http://www.quotesea.com/quotes/with/desensitized

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XIII. List of just some fears and phobias8

For practice, pick one—then you and a partner figure out how you would use desensitization/circle therapy to help a client with that fear or phobia. “Agoraphobia (fear of open areas, crowds, etc.) Claustrophobia (fear of confined spaces) Disposaphobia (fear of getting rid of things) Fear of Abandonment Fear of Air Turbulence Fear of Anaesthesia Fear of Authority Fear of Balloons Fear of Bees or Wasps Fear of Being Alone Fear of Birds Fear of Blood . . . Fear of Blood Tests Fear of Bodily Functions Fear of Bodily Hair Fear of Bowel Movements for Younger Children Fear of Buttons Fear of Cancer Fear of Cats Fear of Choking for Adults Fear of Clowns Fear of Commitment Fear of Conflict Fear of Confrontations Fear of Contracting HIV Fear of Criticism 8 This list is from www. HypnoticWorld.com – a fee-based subscription service that allows members access to over 1,000 hypnosis scripts.

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Fear of Crowds Fear of Death Fear of Dental Treatment Fear of Doctors and Dentists Fear of Dogs Fear of Driving Fear of Dwarfs Fear of Eating Fear of Elevators Fear of Escalators Fear of Eye Drops Fear of Failure Fear of Fainting Fear of Falling Asleep While Driving Fear of Falling Over Fear of Fear Fear of Finance Fear of Fish Fear of Flying . . . Fear of Flying Everyday Fear of Frogs Fear of Furry Animals Fear of Germs Fear of Ghosts Fear of Growing Old Fear of Heights Fear of Bridges Fear of Hospitals Fear of Ice Fear of Injections Fear of Insects Fear of Inserting Contact Lenses Fear of Internal Examinations Fear of Intimacy Fear of Living Alone Fear of Lizards

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Fear of Long Flights Fear of Loud Noises Fear of MRI Scans Fear of Meeting People Fear of Monsters (for Children) Fear of Moths Fear of Motorway Driving Fear of Mountainous Driving Fear of Needles Fear of Pain Fear of Panic Attacks Fear of Passenger Driving Fear of Passenger Travel Fear of Passing Wind Fear of Poverty Fear of Pregnancy Fear of Public Toilets Fear of Rats and Mice Fear of Rejection Fear of Shopping Centres (Malls) Fear of Snakes Fear of Soiling Fear of Spiders Fear of Spiders for Children Fear of Spiders' Webs Fear of Staying Awake Fear of Success Fear of Surgery Fear of Talking on the Telephone Fear of Technology Fear of Thunderstorms Fear of Travel Fear of Travelling by Underground/Subway/Metro Fear of Trying New Food Fear of Viral Contamination Fear of Vomiting

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Fear of Warmth on Skin Fear of Water. . .

Fear of the Dark Fear of the Dark for Children Fear of the Unknown Fear of the Wind. . . Homophobia . . . Social Phobia Spider Phobia” XIV. ONE MORE EXAMPLE: REAL LIFE CASE STUDY—FEAR OF DENTIST/DENTAL INJECTIONS https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515441/ “Desensitization Using Meditation-Hypnosis To Control ‘Needle’ Phobia [i.e., dental injections] In Two Dental Patients”, by a Professor & the Research Director at the Temple University School of Dentistry & a Psychology Professor from West Chester State College. Anesth Prog. 1983 May-Jun; 30(3): 83–85. The underlying concept involved is that fear and relaxation cannot occur simultaneously. . . . the feared object is introduced to the subject in gradually increasing steps while the individual is deeply relaxed.” [Two case studies are presented where the “relaxant” used is meditation-hypnosis.] The first patient feared dental injections, the drill, the saliva ejector and even the thought of the dentist. Growing up, she was taken to a dental clinic where she had to wait for a long time and she heard patients crying, saw them bleeding, etc. The patient was taught how to do meditation-hypnosis and get into a relaxed state within 5 minutes.

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The authors of the study prepared a dental anxiety hierarchy with 10 items – which were arranged from least-anxiety-producing to most-anxiety-producing (based on the patient’s evaluation of them). All would be presented to the patient while she was in the dental chair—ranging from just sitting in the dental chair all the way up to injection of anesthetic. After the first item, she said “I am afraid”—but then she used meditation-hypnosis to relax. While she was in meditation-hypnosis relaxation, she was also presented with and tolerated well the following: placement of the dental towel, turning on the overhead light, inclining the dental chair back, holding her mouth open 30 seconds, insertion of the author’s index finger into her mouth, insertion of saliva ejector into mouth, placement of topical anesthetic. The patient did so well, the following visit they added more items: running the high speed drill near the tooth for 15 seconds, releasing water spray into the mouth, etc. The patient was able to go to subsequent dental visits without fear. The second patient had similar success. XV. WHAT IF THE CLIENT FREAKS OUT? http://www.hypnotherapy-directory.org.uk/hypnotherapist-articles/how-to-overcome-fears-and-phobias “How to overcome fears and phobias”, 18th October, 2011. “With phobias, the person overestimates the danger so the fear is much greater than is really justified. Like being terrified by a non-poisonous spider or a tiny mouse. Example: For example in the case of fear of flying step1 least feared might be booking the flight and most feared boarding the plane. In between would be steps that cause the client increasing degrees of

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anxiety for example arriving at the airport, proceeding through security. No two phobias are exactly alike although many concern the same objects and situations. when the client is deeply relaxed in hypnosis he/she is asked to mentally picture the first step on the hierarchy. So in the case of fear of flying mentioned above this could be booking the flight. A non verbal signal is set up so that the therapist will know if the client is becoming too distressed by what he/she is picturing. This very rarely occurs whilst dealing with the first step on the hierarchy. If it does the therapist will direct the client away from the distressing image and give suggestions of calmness, relaxedness and confidence. If a client finds a particular step too distressing to visualize this is returned to at the next session with the therapist giving further confidence boosting suggestions. Most clients are able to proceed smoothly through the desensitization process with no hold ups. Once this is complete the client should be able to deal with the previously feared object or situation calmly and comfortably.”

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DESENSITIZATION (fear – known original cause) Or (phobia – unknown/unrelated cause) Original Real Situation (when negative feeling originally occurred)

Fear Stimuli (what causes panic now)

Can be unrelated to original trigger (get phone call that your mother died while driving on freeway --- fear of freeway) Fear Response/Emotion (too much or too little sugar at breakfast—bad feeling – while at airport – fear of flying)

Original trigger may be forgotten, unknown, repressed, etc.

STEPS Do not try to bring up the anxiety; if anxiety comes up, immediately move away from it Tell client that 2 opposite feelings cannot co-exist at same time Visualize/Imagine yourself in same situation—but feeling calm, relaxed this time. Hypnosis = safe place Can ask client to let left finger rise once relaxed; teach relaxation in hypnosis In hypnosis, give suggestion that uncomfortable symptom will disappear A non-verbal signal is set up so that the hypnotherapist will know if the client is becoming too distressed by what he/she is picturing In hypnosis, imagine feeling comfortable in the previously uncomfortable situation. In hypnosis, expose to anxiety producing stimuli in small increments – while remaining calm (or smiling if you use humor instead of relaxation) Use imagery that is personally relaxing to client (sound of waves, feel of sunshine, etc.) Use a “distress/anxiety” scale/hierarchy – take clients through steps from least anxiety producing to most anxiety producing Eliminates “alien”, “uniqueness” of fear stimuli as exposed more and more Can suggest client will go deeper in hypnosis at each step Can use “progressive relaxation” of tensing and then relaxing various muscles at each step

CIRCLE THERAPY (fear only – known original cause) Original Real Situation

Memory of Real Situation – Or similar new situation

Fear Response/Emotion

STEPS Warn client that he/she will be bringing up the anxiety but not to worry because will pass it Relive original traumatic incident -- in small increments Feel anxiety, then let it pass Replace anxiety with a smile or positive emotion Then, imagine future similar incident while remaining calm, smiling Do this until client cannot bring up the anxiety any more Give suggestion that the anxiety is weakening From this time forward, the harder you try to feel the anxiety, the more difficult that will be

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Create “knowns” (like drive to exam site, practice packing what you will take to test…) Actually experience the real type of incident (such as actually drive on freeway, or fly on an airplane) If you feel any anxiety, allow right finger to rise; the more anxiety, the higher the right finger rises Each and every time you do this, you gain more control over your anxiety The harder you try to feel anxious, the more relaxed you become Note: if this does not work, perhaps client is incapable of believing he/she can let go of the anxiety – or perhaps some 2ndary gain exists

*** IF client freaks out

during desensitization or circle therapy: a non-verbal signal is set up so that the hypnotherapist will know if the client is becoming too distressed by what he/she is picturing; direct the client away from the distressing image and give suggestions of calmness, relaxedness and confidence. If a client finds a particular step too distressing to visualize this is returned to at the next session with the hypnotherapist giving further confidence boosting suggestions.

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A FEW EXAMPLES: 1 Imagine tiny picture of object in a book 2 Imagine a bigger picture of the object in a book 3 Imagine the object behind a gass wall 4 … Etc. 1 Imagine reading a travel magazine 2 Just think about taking a plane trip 3 Imagine making a reservation and buying a plane ticket 4 Imagine being on the plane on the ground 5 Imagine being on the plane up in the air 1 Think about a spider 2 Look at photo of spider 3 Look at real spider in a closed glass box 4 Hold the glass box with the spider 5 Let the spider crawl on your desk 6 Let the spider crawl on your shoe 7 Let the spider crawl on your pants leg 8 Let the spider crawl on your sleeve 9 Let the spider crawl on your bare arm OR USE HUMOR: SPIDER: “Who told you that you could touch my leg?!? How rude!” 1 Not smoking after coffee 2 Not smoking at a bar when having a drink 3 Not smoking during work break with co-workers who smoke 4 Not smoking when talk to my ex-husband 5 Not smoking when facing a big work deadline 6 Not smoking when my triplets kept me awake all night 1 Sitting in dental chair 2 Placement of dental towel 3 Turning on overhead dental light 4 Inclining the dental seat back 5 Mouth held open for 30 seconds 6 Insertion of finger into mouth 7 Insertion of saliva ejector into mouth 8 Placement of topical anesthetic 9 Injection shot of anesthetic 10 Running of high speed dental drill

VIDEO DEMONSTRATIONS AHA Members can watch demonstration on video: Circle Therapy: American Hypnosis Association Live Hypnotherapy Sessions Hypnotherapy Live - Marc Gravelle/Kristine - Fear of Flying - 1 of 3 https://hypnosis.edu/aha/videos/393 (especially from time 34.05 to time 39.25) Desensitization: American Hypnosis Association Live Hypnotherapy Sessions Hypnotherapy Live - Lisa Machenberg/Diane - Driving Anxiety

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Presented By: Lisa Machenberg https://hypnosis.edu/aha/videos/263 (especially from time 53.00 to 103.30) American Hypnosis Association Live Hypnotherapy Sessions Hypnotherapy Live - Michele Guzy/Ryan - Fear of Vegetables - 1 of 5 Presented By: Michele Guzy https://hypnosis.edu/aha/videos/318 (especially from time 49.32 to time 53.20)

KEEP PRACTICING!