* ©2012 by David D. Burns, MD
Do not copy, publish or reproduce without the written permission of Dr. Burns.
In my last blog, I discussed something I call “Reverse Depressive Hypnosis.” That’s where the patient inadvertently “hypnotizes” the therapist into believing that she or he REALLY IS hopeless, worthless, and so forth. It is sometimes hard to resist falling into this potentially destructive trance, or even noticing that it has happened. Today, I will describe “Reverse Anxiety Hypnosis.” In a nutshell, that means that the anxious patient persuades you that she or he is too fragile (or not yet ready) to confront his or her fears using powerful exposure techniques.
In my book, When Panic Attacks, I describe several models I use in treating anxiety disorders, such as chronic worrying, phobias, PTSD, Panic Disorder, Agoraphobia, OCD, shyness, public speaking anxiety, and others, including:
- The Motivational Model—Although anxiety can be exceedingly painful, you may secretly believe that your anxiety is helping you, or protecting you, so you are reluctant to give it up. A simply example would be the fear of flying. You may think that your fear protects you from getting on a plane and crashing.
- The Cognitive Model—You learn how to challenge the distorted negative thoughts that trigger the anxiety.
- The Exposure Model—You confront your worst fears, rather than running away from them.
- The Hidden Emotion Model—You bring hidden feelings and conflicts to conscious awareness. When they express these feelings and solve the problems you’ve been avoiding, the feelings of anxiety often improve dramatically or totally disappear.
If you combine all four models, you can often achieve a complete elimination of the anxiety rather quickly. Patients love the Motivational, Cognitive and Hidden Emotion Models because they can be enormously helpful and fun to learn, but they typically hate Exposure Model. That’s understandable—we all avoid the things that terrify us. I can vouch for that, as I have personally experienced and overcome more than a dozen kinds of anxiety.
Patients will often hypnotize their therapists into believing that they are too fragile to use exposure techniques. If the therapist falls into this trance, and buys into that notion, the treatment will be doomed. It is practically impossible to overcome any form of anxiety without using exposure techniques. Exposure alone will rarely be enough—the Motivational, Cognitive and Hidden Emotion Models will also play vital roles in the treatment—but exposure will be mandatory.
When I give workshops on the treatment of anxiety, I ask the therapists in the audience to raise their hands if they routinely use exposure techniques when treating anxious patients. Usually, only about 25% of the hands go up, at most. This means that most therapists are NOT using exposure techniques in the treatment of anxiety disorders.
This might seem surprising, or even disturbing, since exposure is one of the most researched and validated psychotherapy techniques in history. So why aren’t all therapists using and requiring exposure? There are many reasons. Some therapists do not believe in using powerful techniques like exposure, thinking that empathy and talk therapy alone will be sufficient. But the most common reason patients and therapists avoid exposure is fear. The therapist thinks the patient is too fragile for powerful exposure techniques. In other words, the therapist has been hypnotized by the patient. So the therapist and patient talk and talk and talk in a general way, exploring the past, but the symptoms do not improve much, if at all.
Dr. Matt May is a former student of mine at Stanford, and we now teach together on the voluntary faculty. He is terrific hypnotist. He is also very suggestible and easy to hypnotize. He has told me that he often falls into trance when treating patients and then has to snap himself out of it.
Matt recently treated a young woman whom I’ll call Susan. Susan came all the way from Cleveland for intensive treatment with Matt because she’d been struggling for years with severe social anxiety. (The details are always disguised to protect patient identities.)
Susan showed up at Matt’s office dressed quite formally, in a business suit. She described how she’d been treated for more than 15 years with conventional talk therapy plus a wide variety of medications with no improvement. Although she was an attractive and talented young professional, her crippling shyness in social situations, coupled with severe public speaking anxiety had severely hampered her social life and her career. She felt ashamed, lonely, hopeless, and defective.
Matt asked what she was the most afraid of. What was her greatest fear? She explained that she was intensely afraid of making a fool of herself in public, or saying or doing the wrong thing, and having people look down on her and see how crazy and defective she was. This fantasy was so terrifying to her that she avoided interacting with people in practically all social situations and refused to give talks at work.
Ten minutes into their first session, which was devoted to clinical history-taking and assessment, Susan asked if there was any hope for her, given the severity of her problems, and how long the treatment might take. On impulse, Matt said that if she wanted, they could just take a ten minute break from taking the clinical history and cure her, and then he could complete the history. She seemed shocked and asked how he could possibly cure her in ten minutes, especially given so many years of unsuccessful treatment from numerous psychologists and psychiatrists.
Matt explained that she simply had to confront her fears, rather than running away from them. He said he wanted her to do a Shame Attacking Exercise. When you do a Shame Attacking Exercise, you make a fool of yourself in public on purpose by doing something foolish or bizarre, so can discover that the world doesn’t come to an end after all. I believe this fantastic technique was developed by the late Dr. Albert Ellis.
He told her he wanted her to go to the Starbuck’s which was just a half a block away from his office. Once inside, she was to lead the customers in singing and cheering, much like a cheerleader at a football game.
She was shocked and indignant, and insisted that this assignment sounded like malpractice, and that someone proper should NEVER do something as socially inappropriate as that!
Matt suddenly became ashamed and profoundly apologetic. He said he couldn’t believe he had asked her to do that, and went back to taking the history, all the while feeling intensely anxious. Do you know what happened? Susan had instantly hypnotized him into believing that she COULDN’T and SHOULDN’T have to confront her worst fears.
After ten minutes, Matt realized what had happened and snapped himself out of the trance. He told her that what she said was a lot of BS, and that she COULD and MUST do the Shame Attacking Exercise. In fact, they were going to go and do some Shame Attacking Exercises together—RIGHT NOW. So he led her out of the office and suggested they could start by doing something even more extreme outside the grocery store across the street.
So they both lay down on the sidewalk right in front of the front door of the grocery store, so that people would have to step over them to get inside. Matt asked her how intense her anxiety was, between 0% and 100%, and she replied “95%.” Matt said that wasn’t high enough, and he wanted her to push it to 100%.
Next, they pretended to be making snow angels, and then they pretended to be riding invisible bicycles while lying on their backs. It started to rain slightly, but they stuck with it.
A customer stepping over them to get inside asked what they were doing on the ground. She announced, “Oh, this is my shrink. We’re having a psychotherapy session. He often has his sessions on the sidewalk rather than in his office.”
Then Matt said, “You can join us if you like. It’s really nice lying here, kind of like being on the beach in Miami!”
Susan noticed that the people inside the grocery store were pointing at them, which made her anxiety even worse. This was her worst fear coming true—that people would think she was some kind of weirdo.
Then the store clerk came out and asked, “Are you guys okay?” She explained that they were fine and just enjoying themselves on the sidewalk. The clerk explained that the manager wanted them to leave. So they got up and left. Matt asked how she felt, and she said, “That was awesome!” She said that her anxiety had suddenly dropped to zero!
Why did that happen? It was because she confronted her worst fear, but nothing really terrible happened. She started laughing and said she felt triumphant.
Matt said, “Great! You’re cured now, and it only took ten minutes. Now we can go back to my office and I can finish your history.”
Susan said, “No! We’re not done yet. We still have to go into Starbuck’s and do our thing!” So they went into Starbuck, where a long line of people were waiting to buy coffee. Her anxiety suddenly spiked when Matt said, “Okay, time to do your thing.”
In spite of the intense anxiety she once again felt, she locked the fingers of her right and left hands together, and inverted her hands in the air above her head, and waved them like a victory fist, and then ran around in circles, saying, “It’s such a wonderful day. I’m so happy to be here. I’m so glad to be alive. Life is wonderful! I love the coffee here in Starbucks.”
Then she led the customers in cheerleading and got many people dancing and running around the store with her. Matt said he felt so proud it brought tears to his eyes.
During her several-day intensive with Matt, Susan did other Shame Attacking Exercises as well, including wearing an extremely sexy outfit in public, and confronting her fears of how people would think about her.
Coincidentally, I spoke with Matt on the phone this morning and asked him about Susan, since the treatment was more than a year ago. He had just received an email from her with a progress report on how she’s been doing since she finished her intensive. She said she was still on a high and that her life had opened up in incredible ways. One of the most significant changes was that even though she’d been very successful in her professional career, she had decided to switch careers and go back to graduate school so she could become a therapist. I have included some excerpts from her email below, printed with her permission, so you can read her personal account of the Shame Attacking.
The exposure techniques are not always that dramatic or extreme, but they nearly always require tremendous courage and commitment, both on the part of the therapist as well as the patient. This means that therapists will have to avoid falling into the anxious patient’s trance. If you combine Exposure Techniques with the Motivational, Cognitive and Hidden Emotion treatment models, the rewards can be tremendous.
In my next blog, I will discuss a third type of reverse hypnosis—relationship hypnosis. That’s where the angry patient, or the patient who simply isn’t getting along with his or her spouse, or a family member, or a friend or colleague, convinces you that he or she is an innocent victim and that the other person is to blame for the problems in the relationship. It is very difficult not to succumb to this trance, but if you get hypnotized in this way, the prognosis for effective treatment becomes very low.
Dear Dr Burns, Many thanks for your blogs, podcasts, books and TEAM CBT. I have experienced ( and I am experiencing) being hypnotised with a Panic Attack patient with Border Line PD- . I know this after the sessions. During I feel I cannot even think well. I see this client through SKYPE, And cannot see her face to face due to distances.
I have try to follow your approach, but she’s resistant, I do include exposure exercises that she never completes. How to do a Shame Attacking Exercise when I cannot go with the patient to the places she needs to in order to do the exposure.
I have even been in the phone and she driving, but 2 years later nothing works. Any thoughts will help!
Many thanks in advance. M.