Physical (psychosomatic) Problems and Hypnotherapy

Lately I've been getting a lot of calls of people saying things like,

"I can't fall asleep at night and I've seen a bunch of doctors and nothing helps, even medication. Can you see me?" Or

"I get these terrible headaches but the doctors all say nothing is wrong with me. My acupuncturist/doctor/psychotherapist/neurologist told me to call you." or

"My hand isn't working right and nobody knows why and I've got a softball game in 3 weeks. When can you fit me in?"

These are psychosomatic complaints and they're a type of problem that hypnosis excels with. Today I thought I'd write about how I work with them.

Psychosomatic complaints: my definition

  • A problem that can't be medically explained or clearly diagnosed

  • Has a suspected or verified psychological element

  • Results in physical pain or other distressing physical problem or changes (“clinically significant distress”)

These include things like sleep problems, pain with no clear cause, injuries that haven't healed when they should have, unexplained paralysis or numbness, teeth grinding during sleep (nocturnal bruxism), irritable bowel syndrome, non-biological erectile dysfunction, vaginismus, fainting with no cause, and all sorts of other problems that make doctors say, "I don't understand. That shouldn't be happening."

I should say immediately that I only work with people who have gotten checked out by their doctor and no clear medical problem has been found. Often I'll even encourage second or third opinions. Many of the problems I've listed could have potentially significant medical consequences if not evaluated seriously. To give just one common example (I could give many from the above list alone): night time teeth grinding can be a symptom of sleep apnea and warrants a medical check and possibly a sleep study before pursuing hypnosis treatment.

The Purpose of a Symptom

Sometimes doctors will tell you, "The problem is all in your head." As if that's a helpful thing to say. Aside from ignoring much of the contemporary understanding of reality, such a statement ignores the actual purpose of the problem. "Purpose," you may be thinking, "we're talking about a migraine. What purpose could it be serving?"

I'd like to tell a story I heard once to illustrate.

Ignoring a Stone wall

Once upon a time, there was a civil engineer who was annoyed at a particular place in a road he had to take regularly where the road turned sharply to the right and avoided ahat appeared to be an empty field. After going for half a mile, the road turned back and resumed a path almost exactly where it had been going before. In front of the field, in the place where the road turned, was an old stone wall. A few times a year, cars would miss the turn and run into the stone wall. He decided he could fix this problem and prevent accidents.

So, the engineer convinced the town and the road crews to bulldoze the stone wall and build the road through the old field. The owner of the field was more than happy to sell that stretch of land, and by the end of the summer, they'd made a perfect straight road where there'd been a curve before.

In his excitement, however, the engineer failed to notice that the water table was particularly high in that section. When winter came, the road began to crack from all ice underneath it, and by spring, it was buckled and ugly. By the second spring, it was practically gravel and quite dangerous: many more cars skidded off the road than had missed the turn before, and by the third year, the stretch of road had practically disintegrated back into the marshy field around it. The town got so many complaints it opened up the old section again. Eventually motorists started putting rocks and boulders in the straight stretch of road to warn people away from going down that dangerous section, and eventually good Samaritans replaced the haphazard rocks and boulders with a proper country stone wall.

In the story, the civil engineer represents how we usually think. While perhaps an actual civil engineer would have consulted water tables or historical records before trying to build a road, when it comes to problems with our bodies and physical or psychological symptoms, we're rarely so thoughtful. The curve in the road and the stone wall represent symptoms: we don't know why they're there. They just are, and they do create problems: migraines, IBS, teeth grinding, fainting - whatever the problem - isn't without cost. But what the story is trying to illustrate is that they aren't random, just like the original road and stone wall weren't random. If there's no obvious physical reason for a problem, it behooves us to look deeper. And that's one of the things hypnosis treatment can do well.

Typically, purposes served by psychosomatic problems have to do with self-protection, interpersonal dynamics or other unconsciously tended areas.

For instance, suppose a young boy would lie awake every night as a child because his parents would fight after tucking him in. Sometimes they'd be particular violent and he felt he had to stay awake in case something really bad happened and he had to call the police or help. Imagine that the same boy has grown up and as an adult, has terrible trouble falling asleep and is filled with inexplicable dread of going to bed in general. The problems are so bad that regular doses of medication don't really help. The guy calls me one day and says "I'm having sleep problems." You see how the "sleep problems" serve a purpose?

Or suppose a young girl experiences subtle disapproval from her father whenever she does something, "un-lady-like." This extends as far as his disapproval when she signs up for advanced math classes, which her father judges harshly. Years later, her father dies and she finds herself feeling dizzy and anxious whenever she goes to her job, where she works as an engineer. She gets a cardio work up and monitors her blood pressure for a week and everything's normal. Could it be that her unconscious, galvanized by her father's death, is trying to keep some sense of connection to him?

Or, imagine a high school student who is getting bullied. He begins to get stomach aches before lunch, when he usually is harassed. Eventually the stomach aches are bad enough that he can't eat lunch at all. Even as an adult, in times of stress, he finds he can't eat. If he tries, he has almost immediate diarrhea and cramps, sending him to the bathroom. Aside from a diagnosis of IBS-D, he hasn't gotten any clear explanation or any relief from his doctors.

I realize I'm telling these stories a bit backwards — If you're dealing with a problem like this, there likely isn't a clear history to explain it: there's just diarrhea, or there's just sleeplessness, or grinding teeth -- just like in the story, where there's just a bend in the road and the stone wall. This is the nature of the way we relate to our unconscious minds in modern times. But even if there is a story of why the problem is there, it's not like knowing it fixes the problem. So let's move more into what to actually do to help things.

Specific ways I work with psychosomatic issues

Many of the same things that help other problems, such as anxiety, can help with psychosomatic complaints. For instance, anchoring and things that bolster a sense of inner strength and resources help many psychosomatic complaints. Mindfulness meditation and loving kindness practice are good easily accessible home practices. Likewise, specially tailored direct suggestions can be very helpful, as can the Turner Age Regression I talked about in my last entry.

Another approach I take with psychosomatic problems is called ideomotor finger signaling. It's a technique that allows for communication with the deep unconscious. To explain, let's clarify the goal. Suppose in the story I told earlier, the civil engineer could have consulted with the person who built the original stone wall. The two might have a conversation about water table and the hazards of building a road through that section, but also about the problems that are caused by the solution -- the accidents caused by having the sharp turn and the stone wall there. Ideally, they could come up with a better solution together than either could have on their own: maybe turning the road more gradually, or having a bridge there instead of a regular road. This is what we’re after. The best solutions to problems are the result of conversations between both our unconscious mind and conscious mind — or, you might say, all the parts of ourselves. Ideomotor finger signaling is a relatively easy way to facilitate that conversation.

Basically the ideomotor technique involves me training a client to listen in deep trance to the body's response when I ask yes or no questions and to use their fingers to non-verbally signal responses. The signals put language to a kind of deep gut feeling. Suppose you look at a menu at a restaurant -- you might have a gut feeling that you'd like one thing and not another. You look at the fajita description on the menu and some part of you says "yes!" and you look at the burrito description and it says, "no!" The part of you that is responding is usually your unconscious, and in a deep hypnotic state, it's your deep (somatic) unconscious. So if I ask, "Do you sense that the teeth grinding is somehow self-protective?" the client, who is in a deep trance, checks in with a kind of gut feeling and, if the answer is yes, one finger moves, if no, another finger does. (there are also fingers for "maybe," "I don't know," and "I don't want to say at the moment.") Moving a finger is easier than talking out-loud in trance states, and so require less practice. With a little bit of practice, though, the deep unconscious / body responds directly to the questions. This allows for a relatively unmediated conversation about the problem, and potentially a way to find a better solution.

There is much more I could say about this technique. If you're a clinician and want to read more about it, this book is a good place to start. The main author, Dabney Ewin, is a physician that has used ideomotor signaling with astounding results for decades.

Next I'll be talking about habit change and hypnotherapy.

Modern Traumawork in Hypnotherapy

For those of you who like your blog entries brief and to the point, here are the main points:

* The trauma treatment modality I use is an age regression technique where you go back as your present day self to help the young part of you that has been traumatized. This way of age regressing is called hypermnesia and is different than how age regression (and a lot of traumawork in general) usually happens, which is called revivication.

* This technique, which I call the Turner Age Regression (after Maureen Turner, its originator), tends to be less overwhelming than techniques that depend on revivication / abreaction.

* However, like any trauma work, it still requires preparation. In particular, this technique depends on (a) stable, deep trance and (b) self-compassion: the willingness to accept, love and care for yourself, especially the younger self that was traumatized.

* The science behind this technique is pretty clear: in deep hypnosis, we access trauma imprints are stored in the midbrain (I talk more about the amygdala and the periaquaductal gray nucleus below). Sensorimotor Psychology therapist Janina Fischer talks about this in her book, Healing the Fragmented Selves of Trauma Survivors. While she's talking about somatic therapy, it seems reasonable to me (and Maureen) that deep hypnosis allows even clearer access to this unconscious area.

* Advantages of this method: humane, utilizes a person's own healing capacity, and fast and effective once the preliminary preparation is done.

More detail

Age regression

Like hypnosis as a whole, age regression brings up some weird ideas for people. Let's get those out of the way first.

Am I talking about going back to your past lives, when you were a pirate or the despotic Queen of Prussia?

No.

Am I talking about remembering when you were abducted by aliens?

Very very unlikely.

Does it involve remembering things that never happened?

Argh. No-- more about that later.

But, age regression is when you go back to something in your past. And there are two ways it happens. It can either happen as a revivication or as a hypermnesia.

A revivication, like the word suggests, is when you go back and relive an experience. Sometimes people do this in dreams. Or, they do it unbidden, in traumatic flashbacks. Somethings they relive positive experiences and it’s a good time. Reliving and working through past trauma is the classic "method" of trauma work has worked since time immemorial. Even before we had a name for hypnosis and before we had ideas like psychological trauma, people were reliving experiences to confront and overcome overwhelming past experiences. This happens quite naturally. Unfortunately, however, since time immemorial, people have also been re-traumatized and their symptoms worsened by revivication if not done or prepared for properly.

Because of it's so tricky to do well, for a long time, new trauma modalities involved new ways to "control the abreaction." Abreaction basically refers to the huge upwelling of emotional energy (adrenaline, fear, disgust, shame, terror, among others) that comes up when reliving a trauma. Essentially, all trauma work that primarily utilizes revivication / abreaction involves slowing the process, going through the whole thing slowly, carefully, in chunks, or sections, or in a special way, so this isn't overwhelming.

After Freud poopoo'd hypnosis and as the western world has embraced Cognitive Behavioral Therapy, the hypnotic methods of trauma work have been mostly ignored. Instead, other, non-hypnotic methods were developed. However, for a long time, they all basically follow the same rules as these original abreactive methods: You re-vivify a past experience, but do it in a controlled manner. However, because they don't involve deep trance, you also have to do it over and over again. EMDR has become the gold standard for this for a couple reasons: first, it's easy to learn for clinicians (especially compared to hypnosis) and second, because it controls that abreaction reasonably well and in a non-trance (or light trance) state. I'm sure EMDR therapists will read this and say I'm unfairly lumping EMDR in with all that came before. So to be clear, let me say it's possibly the best abreactive trauma method: you don't have to talk about everything, and you're mostly just focusing on the worst part of the traumatic memory. But it's still based on revivication and abreaction and has many of the same problems: it takes a lot of inner resources and strength to go confront demons from the past, repeatedly taking bites out of them and slowly digest them in pieces. Typically trauma work is done in a series of phrases. Actually working with the trauma is "phase II." "Phase I" is the preparatory work. (For those who are curious, there's also a Phase III, and it's about moving on and establishing meaningful life now that you've dealt with the trauma.)

More recently, trauma modalities that aren't abreactive in function have come on the scene. These are therapies that don't require the processing or re-living of traumatic events to get over them. The hypnosis modality that I use to treat trauma is one of these new kinds of trauma therapies.

Hypermnesia Age Regression: going back with new information

Hypermnesia means vivid remembering. This is another way to go back to a past experience. In hypermnesia, you go back as your current day self and you're there with your past self, the one going through something traumatic. It's a third person stance, not first person.

To give a flippant example:

Revivication is like Luke Skywalker reliving the seminal reveal of modern cinema where Darth Vader says, "Luke! I am your father!" -- If Luke did an abreaction-based therapy, he'd do a lot of preparation, then he'd have to relive that moment, feeling all the complex feelings (humiliation? anger? sadness? love? shame?) in therapy until it wasn't overwhelming anymore -- until all the emotions were processed through. If he was doing Prolonged Exposure, he'd be telling the story outloud over and over. If he did EMDR, he'd just do in his mind while getting bilaterally stimulated in some way. If he was doing an old-school hypnosis trauma method, he would do it intensely, probably just once or twice and the therapist would advise him to slow it down, rewind, skip ahead, to wear impenetible magic armor, while doing it and the like. But he'd still be re-vivifying it using all these methods.

Hypermnesia, on the other hand, is like Luke going back to the scene and seeing it with older, wiser eyes that are informed by everything that comes after and how everything turns out in the end. So Luke goes back to that scene, but it's like "end-of-Episode-6-Luke" visiting his "Episode 5" self and saying to him, "It's true, Luke, but--don't worry! You and I are gonna get through this together and you get your father back in the end, even if it's bittersweet. Things are going to be okay!"

How it works

As I note above, I call this method the Turner Age Regression Technique, after its creator, Maureen Turner.

As you might imagine, going back to the worst events of your life isn't a good time no matter what. Rather than it being able digesting all those old feelings, though, this method hinges on your current day self's ability to be compassionate and present for the "part of you" that is still stuck in a traumatic experience.

In short, it's based on self-compassion. Luckily, self-compassion is a trainable psychological skill and has lots of benefits, including better self-care and general resiliency.

So rather than Phase I of trauma work being about training for the rigors and overwhelm of reliving some of the worst moments of life, the preparatory work in my modality involves learning how to go into hypnosis deeply, and learning how to love yourself. I regular help people develop self-compassion if they need more skill at it. I also usually suggest doing some anchoring of inner resources if that's needed. So, for instance, if a person had a terrible experience that felt out of control, we'll anchor the opposite -- an experience they felt very in control and safe, as preparation for the trauma work.

You may be thinking at this point: "this sounds interesting, but does it actually work?"

And the answer is yes.

In deep hypnosis, you can access parts of the mind that are deeply unconscious. In neuroanatomy, we know that the brain areas that are responsible for traumatic memories and imprints are in the limbic system, in and around a small walnut-sized region called the amygdala. The amygdala's job scans the environment for signs of something bad that happened in the past. Sometimes the signs aren't obvious to us consciously, and sometimes they're obvious. But when the amygdala registers those signs, it triggers alarms. People usually just call this "trauma triggering" and if you've experienced it, you probably know what I'm talking about, even if you don't know exactly what all your triggers are.

A stone age example

Imagine a prehistoric human wandering around the savanna. Imagine she sees a pretty rock formation in the distance and while she's looking at it, a lion jumps out at her and starts chasing her. Later (after she gets away from the lion), imagine she's walking around on the savanna again and she sees that same rock formation. Her amygdala is going to register that formation and scream, "lion!" -- (and not the Alan Ginsberg type). If we had a time machine and we went back and asked her if she knew why the rock formation made her feel ready to attack something (fight), want to run (flight), or made her feel like she was out of her body (freeze / dissociation), she may or may not connect those rocks to her previous incident with a lion. She may not even know she feels that way because of the rock formation. She might even be running or fainting before she's even aware of seeing the rock formation. The amygdala's concern isn't understanding -- it's self-preservation.

The amygdala still does this for us even though very few of us have to run from actual lions. Instead, we experience fight, flight and freeze responses to overwhelming social situations, to abuse, bullying, non-consentual sexual situations, assaults, drug experiences, vicarious trauma and to combat. The trigger (like the rock formation) can be anything 15 minutes before or after a traumatic event.

In the Turner Age Regression, we go deep enough that we can talk to the correlating part of the mind -- the part of the mind that's stuck watching for signs of a terrible experience from the past. We connect to that part through the original, earliest traumatic situation, and we give that part new information: for instance, that the event has passed and that it won't happen again -- that the time to be watching for another middle school bullying situation (for example) is over because middle school is over. This allows that system to relax, the triggers go away, and (in my experience) a lot of beneficial life energy is freed up.

This is hard to talk about because it seems a bit far fetched that you can get into a state of mind where you can communicate with your midbrain. It's worth noting that even non-hypnotic methods are doing this, but, because they're not in deep trance, they usually require a lot of repetition, like I mentioned earlier. With EMDR, for instance, you might go over a single incident 20 times. In Prolonged Exposure Therapy, a CBT method, you might go over it a hundred times (and if you think that's grueling, the 50-90% of military personal who drop out of this trauma treatment agree). In contrast, in deep trance, we can just communicate more directly. Done right, once is enough.

Another way of making my point is that weirder things are well-documented with hypnosis. Take, for example, cases of people communicating with their hindbrain to do things like lower their blood pressure or pulse rate, or to stop a migraine. Or even people who can block out pain (another hindbrain function) and go into surgery without anesthesia. In reality, such things are possible. Easy? Well, no. But communication reasonably directly with the limbic brain? Definitely doable with a little preparation.

In fact, I like this method so much because, after the preparation, it takes a lot less time and suffering than others I've seen. I would like to say it's easy, but no trauma work is easy. It's definitely fair to say that it's easier, though. In addition, remember how I was talking about utilization and the uniqueness of each person in a previous blog entry? This method, though somewhat directive, is unique to each person and relies on their innate wisdom and healing abilities. I've yet to see two people do this process exactly the same way. As Maureen Turner has noted, in this method, the therapist is a coach: it's the client who goes back and rescues themselves.

The only case I might recommend a different method is when the trauma is an isolated one-time event. For instance, if someone was in a car accident and it was the only traumatic thing in their life, it might be faster to do EMDR or ART, which require less preparation for simple cases: you don't have to learn how to go into deep trance -- you just maybe do a little inner resourcing and then work directly with the isolated incident. In my experience, though, most people struggling with trauma are not struggling with single events. In those with situations that are more complicated than one trauma, Turner Age Regressions are the fastest, least difficult method I've seen.

You may be thinking, "what about ___?!" where ___ is some element I haven't really addressed in working with trauma. I apologize -- I've been trying to keep this entry brief and trauma treatment is a big, complicated thing to talk about. Feel free to comment below or to raise a point with me via email.

Next I'll be talking about physical (psychosomatic) problems and hypnotherapy.