Paradoxical Intention (PI) Combined With Hypnosis in the Rapid Treatment of Anxiety Disorders: The Cases of “Fran” And “Emily”

Abstract

Paradoxical intention (PI) is a psychotherapeutic technique that is intended to help clients become more flexible, or at least more open to thinking about their problems, such as anxiety, from a new perspective. In line with this I have developed an approach that involves a “Panic Attack Time Line” (PATL). This PATL (a) helps the client visualize and understand what is happening during the panic attack, and (b) encourages them to understand why, when they start to have panicky feelings in their body, it will be paradoxically helpful to make these feelings worse, for example, if the attack makes their heart beat faster, they might be instructed to do jumping jacks. One of the important advantages of this PATL approach is that it can typically shorten therapy for treating anxiety disorders to just three sessions in comparison with traditional CBT protocols that typically require 6–20 sessions for achieving clinically meaningful change. Two, 3-session adult individual cases, “Fran” and “Emily,” are presented to illustrate the different ways that the PATL-grounded, PI approach can be combined with hypnosis to produce successful therapeutic outcomes. In Fran’s case, the PATL was used explicitly by itself with her and was sufficient to address her agoraphobia/panic disorder. Hypnosis was then used to extend the gains produced by PI. In the case of Emily's aviophobia, the PATL was not used explicitly with her. Rather, the paradoxical logic it embodies was used to create a paradoxical directive that was conveyed via hypnotic suggestion. Keywords: paradoxical intention; hypnosis; hypnotherapy; panic disorder; agoraphobia; aviophobia; cognitive behavior therapy (CBT); case study; clinical case study

Continuing Education Information

2 CE Credits, Instructional Level: Intermediate

2 Contact Hours (New York Board of Psychology)

Learning Objectives:

1. Identify key maintaining factors of anxiety demonstrated in the cases of Fran and Emily.
2. Describe the rationale for combining paradoxical intention with hypnosis in anxiety treatment.
3. Identify the core clinical steps used in paradoxical intention with hypnosis.
4. Summarize treatment outcomes observed in the two cases.
5. Recognize limitations and clinical considerations of using case-based evidence for anxiety treatment.

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