Treating Nightmares with Ericksonian Hypnosis
Robert Kupferman, LCSW
Over the years I have treated many patients suffering with trauma related nightmares. Some have been treated at St. Vincent’s Hospital Manhattan where I was staff hypnotherapist for eight years specializing in trauma while others have been treated in my private practice where I continue to treat nightmares using hypnosis. The treatment I describe here is effective for symptom relief allowing an uninterrupted sleep. Further treatment then occurs in the context of the therapeutic session(s).
Bypassing the sleep interruption of nightmares:
A nightmare is how the unconscious mind processes, files and makes meaning of distressing material usually the product of a past or current trauma. It occurs during REM cycles when the unconscious mind is most active. Typically the patient awakens at the moment of a life threatening crisis. Sometimes the embedded nightmare is repeated for years.
I use the following Ericksonian methods to achieve a high degree of success: metaphor, pacing and leading, utilization of patient resources, and post-hypnotic suggestion.
The nightmare is the first act of an unfinished play. The awakening is the intermission and the unwritten final act is where resolution occurs. (metaphor). The existing first act exists and the newly created final act of resolution is added (pacing and leading). I invite the patient to create a plot for the final act. (utilization of patient resource). I explain that logic is a minimized component of the unconscious mind’s process. Discard logic. In dreams pigs fly, flowers sing and there are pots of gold at the end of rainbows. We will splice a more pleasant, more tolerable final act (without the awakening intermission) to the play. And we will play with this. In the conscious state where logic prevails, we discuss familiar parallel experiences to enhance the expectancy that this is plausible. For example: We click the remote control to change the channel from an unpleasant program to one that is more enjoyable. We jump to a more desirable music track on our audio players. (metaphor). For example: Just as the fire eating dragon is about to gobble up the patient, the patient suddenly finds herself on a mountain side singing the title song to The Sound of Music. (Change the channel). Once the patient has described the plot, colors, characters, sound track of the final act in session, I embed it into their unconscious mind through trance. I record the trance and provide the patient with a CD in the next session. I invite them to rehearse the second act with or without the assistance of the CD recording at bedtime (post-hypnotic suggestion). Repetition is an effective way to embed material into the unconscious mind. The splice is made, the play is completed and the tragedy of act one smoothly transitions to the desired fantasy of the final act. It works!
See testimonial on my website (www.RKHypnotherapy.com) and should you use and improve on this effective protocol please let me know.
Robert Kupferman, LCSW
Robert Kupferman, LCSW
917-517-2447
Robert Kupferman, LCSW
917-517-2447
The Use of Ericksonian Hypnotherapy
in the Treatment of PTSD
And its relationship to EMDR, Cognitive and Psychotropic Modalities
Seminar presented by Robert Kupferman, LCSW
to staff of Mt. Sinai Hospital WTC MMTP and MHIP
on August 20, 2010.
At the end of this seminar, attendees will be able to:
1. Understand the basic concepts of hypnosis and Ericksonian hypnotherapy.
2. Understand the role of Ericksonian hypnotherapy and its compatibility with other treatment modalities in treating PTSD.
PTSD: Clinical Definition
The diagnostic criteria for PTSD, stipulated in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV-TR), may be summarized as:
A: Exposure to a traumatic EVENT
This must have involved both (a) loss of "physical integrity", or risk of serious injury or death, to self or others, and (b) an intense negative emotional response. (DSM-IV).
B: Persistent REEXPERIENCING
One or more of these must be present in the victim: flashback memories, recurring distressing dreams, subjective re-experiencing of the traumatic event(s), or intense negative psychological or physiological response to any objective or subjective reminder of the traumatic event(s).
C: Persistent AVOIDANCE and emotional numbing
This involves a sufficient level of:
These are all physiological response issues, such as difficulty falling or staying asleep, or problems with anger, concentration, or hypervigilance.
PTSD and Normal Functioning
In the normal course of our lives an EVENT happens. We can refer to this as a STIMULUS.
We integrate the experience by REMEMBERING.
We edit the experience by FORGETTING.
We make meaning of the experience to be better PREPARED.
PTSD as a clinical diagnosis is really an intensified version of the above. The normal becomes abnormal and interferes with normal functioning.
With PTSD the EVENT was catastrophic and the STIMULUS intensifies as the STRESSOR.
REMEMBERING becomes REEXPERIENCING.
FORGETTING becomes AVOIDANCE.
PREPAREDNESS becomes AROUSAL.
|
NORMAL |
EMOTION |
PTSD Symptom Cluster |
PTSD |
EMOTION |
|
STIMULUS |
|
A |
STRESSOR EVENT |
|
|
REMEMBERING |
Curious |
B |
REEXPERINECING |
Anxiety |
|
FORGETTING |
Editing |
C |
AVOIDANCE |
Depression |
|
PREPAREDNESS |
Focused |
D |
AROUSAL |
Obsession |
The purpose of PTSD treatment:
Reduce the maladaptive intensity of the symptoms to levels that become adaptive tools.
Re-integrate dissociative features of mental functioning
The Central Nervous System: PTSD vs. Normal Functioning
When the brain’s limbic system (hippocampus and amygdale) suspects danger, it cues the Autonomic Nervous System (ANS) to activate the sympathetic nervous system and deactivate the parasympathetic system. During traumatic threat the hippocampus is suppressed (where memory is filed in time and space) and the amygdala is activated (where terror is remembered independent of time and space). In normal reexperiencing of trauma there is an appropriate balance between the hippocampus and the amygdala. In PTSD reexperiencing the amygdala influences more than the hippocampus.
When danger is real the normal functional response is an appropriate level of fight, flight or freeze. When danger is false (cued by PTSD) the response may be maladaptive including acute and chronic levels of fight, flight and/or freeze. The recurring response in the reexperiencing phase seems to replicate the remembered response for survival in the original trauma. I have mostly witnessed in many of my patients the freeze response in reexperiencing trauma reflecting the freeze response in the original trauma.
The autonomic nervous system operates in an either/or manner. Either the sympathetic (fight/flight/freeze) system dominates or the parasympathetic (rest and digest) system dominates. If the body is relaxed (parasympathetic) the processing of distressing material becomes tolerable as the sympathetic system has been suppressed. See dissociation.
Dissociation
Dissociation is the experience where a person may feel disconnected from himself and/or his surroundings. Dissociation may range from temporarily losing touch with things that are going on around you (like what happens when you daydream) to having no memories for a prolonged period of time and/or feeling as though you are outside of your body. Dissociation has been found to be a risk factor for developing PTSD. It has been shown that those with dissociative features are highly susceptible to hypnotic treatment.
Successful treatment needs to address the maladaptive dissociation and replace it with a more adaptive association. An example of maladaptive dissociation:
Hypnosis and Hypnotherapy
Hypnosis is a natural process. It can be experienced automatically, self-induced or induced by another person. The hypnotic process suppresses the conscious mind and enhances the unconscious mind. The resulting state is more commonly known as trance. Trance is focused attention (association) implying there is remaining unfocused attention (dissociation).
For example you are at a concert. The lighting and your attention is focused on the performer while the rest of the auditorium is out of focus (dark) and out of your attention. You are in trance.
Depending on the degree of focus or trance we have various trance state or depths.
Light trance: Slower, deeper breathing with eyes closed and relaxed muscle tone
Medium trance: Slower responses, Slumped, limp body, reduced awareness of surroundings
Deep trance: More pronounced manifestation of medium trance.
Hypnotherapy is the use of hypnosis by a trained professional for therapeutic purposes.
It is used by medical as well as mental health professionals and rather than used solely as a separate modality, its principles can are more often incorporated into other modalities
Milton Erickson and Hypnotherapy
Milton Erickson (1901-1980) is considered the twentieth century’s greatest contributor to the practice of hypnotherapy. As a psychiatrist, he pioneered the use of a more permissive style of treatment. Note that he incorporated the older authoritarian style of classic hypnosis and expanded it to include the permissive style. This is important in fitting the style to the patient’s individual needs. Many patients with PTSD had been traumatized by an authority figure and would be best served by a more collaborative, interactive style. This enhances the patient’s progress in mastering greater control in their functioning.
Ericksonian methods include the following features.
Treatment Modalities Compared and Contrasted
The various modalities are more alike than different. The greatest difference is in nomenclature used in describing similar functions. All four modalities described are mutually compatible.
HYPNOSIS:
EMDR:
COGNITIVE:
PSYCHOTROPICS:
More Information
PTSD treatment using hypnosis
Effective treatments of PTSD: practice guidelines from the International Society fir traumatic Stress Studies / edited by E. B.Foa, T.M.Keane, Matthew J. Friedman. Chapter 12
Ericksonian Hypnotherapy
Trancework: an introduction to the practice of clinical hypnosis by M.D.Yapko
EMDR
Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures by F. Shapiro
Cognitive Therapy
Cognitive-behavioral therapies for trauma edited by V.M.Follette, J.I.Ruzek, F.R.Abueg
Psychotropics
Drug treatment for PTSD: Answers and questions in Annals of the New York Academy of Sciences Vol. 821 by M.J.Friedman
Referrals for patients
Robert Kupferman, LCSW www.rkhypnotherapy.com 917-517-2447
Training in Ericksonian Hypnosis
NYSEPH: The New York Milton H. Erickson Society for Psychotherapy and Hypnosis
Planetarium Station, PO Box 876, New York, NY 10024;.. Phone # 212-873-6459 www.NYSEPH.org
NEXT Training begins October 20, 2010.
Robert Kupferman, LCSW Bio
Education and Training
Professional Credentials
Career Highlights
Memberships
The Use of Ericksonian Hypnotherapy
in the Treatment of PTSD
And its relationship to EMDR, Cognitive and Psychotropic Modalities
Seminar presented by Robert Kupferman, LCSW
to staff of Mt. Sinai Hospital WTC MMTP and MHIP
on August 20, 2010.
At the end of this seminar, attendees will be able to:
1. Understand the basic concepts of hypnosis and Ericksonian hypnotherapy.
2. Understand the role of Ericksonian hypnotherapy and its compatibility with other treatment modalities in treating PTSD.
PTSD: Clinical Definition
The diagnostic criteria for PTSD, stipulated in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV-TR), may be summarized as:
A: Exposure to a traumatic EVENT
This must have involved both (a) loss of "physical integrity", or risk of serious injury or death, to self or others, and (b) an intense negative emotional response. (DSM-IV).
B: Persistent REEXPERIENCING
One or more of these must be present in the victim: flashback memories, recurring distressing dreams, subjective re-experiencing of the traumatic event(s), or intense negative psychological or physiological response to any objective or subjective reminder of the traumatic event(s).
C: Persistent AVOIDANCE and emotional numbing
This involves a sufficient level of:
These are all physiological response issues, such as difficulty falling or staying asleep, or problems with anger, concentration, or hypervigilance.
PTSD and Normal Functioning
In the normal course of our lives an EVENT happens. We can refer to this as a STIMULUS.
We integrate the experience by REMEMBERING.
We edit the experience by FORGETTING.
We make meaning of the experience to be better PREPARED.
PTSD as a clinical diagnosis is really an intensified version of the above. The normal becomes abnormal and interferes with normal functioning.
With PTSD the EVENT was catastrophic and the STIMULUS intensifies as the STRESSOR.
REMEMBERING becomes REEXPERIENCING.
FORGETTING becomes AVOIDANCE.
PREPAREDNESS becomes AROUSAL.
|
NORMAL |
EMOTION |
PTSD Symptom Cluster |
PTSD |
EMOTION |
|
STIMULUS |
|
A |
STRESSOR EVENT |
|
|
REMEMBERING |
Curious |
B |
REEXPERINECING |
Anxiety |
|
FORGETTING |
Editing |
C |
AVOIDANCE |
Depression |
|
PREPAREDNESS |
Focused |
D |
AROUSAL |
Obsession |
The purpose of PTSD treatment:
Reduce the maladaptive intensity of the symptoms to levels that become adaptive tools.
Re-integrate dissociative features of mental functioning
The Central Nervous System: PTSD vs. Normal Functioning
When the brain’s limbic system (hippocampus and amygdale) suspects danger, it cues the Autonomic Nervous System (ANS) to activate the sympathetic nervous system and deactivate the parasympathetic system. During traumatic threat the hippocampus is suppressed (where memory is filed in time and space) and the amygdala is activated (where terror is remembered independent of time and space). In normal reexperiencing of trauma there is an appropriate balance between the hippocampus and the amygdala. In PTSD reexperiencing the amygdala influences more than the hippocampus.
When danger is real the normal functional response is an appropriate level of fight, flight or freeze. When danger is false (cued by PTSD) the response may be maladaptive including acute and chronic levels of fight, flight and/or freeze. The recurring response in the reexperiencing phase seems to replicate the remembered response for survival in the original trauma. I have mostly witnessed in many of my patients the freeze response in reexperiencing trauma reflecting the freeze response in the original trauma.
The autonomic nervous system operates in an either/or manner. Either the sympathetic (fight/flight/freeze) system dominates or the parasympathetic (rest and digest) system dominates. If the body is relaxed (parasympathetic) the processing of distressing material becomes tolerable as the sympathetic system has been suppressed. See dissociation.
Dissociation
Dissociation is the experience where a person may feel disconnected from himself and/or his surroundings. Dissociation may range from temporarily losing touch with things that are going on around you (like what happens when you daydream) to having no memories for a prolonged period of time and/or feeling as though you are outside of your body. Dissociation has been found to be a risk factor for developing PTSD. It has been shown that those with dissociative features are highly susceptible to hypnotic treatment.
Successful treatment needs to address the maladaptive dissociation and replace it with a more adaptive association. An example of maladaptive dissociation:
Hypnosis and Hypnotherapy
Hypnosis is a natural process. It can be experienced automatically, self-induced or induced by another person. The hypnotic process suppresses the conscious mind and enhances the unconscious mind. The resulting state is more commonly known as trance. Trance is focused attention (association) implying there is remaining unfocused attention (dissociation).
For example you are at a concert. The lighting and your attention is focused on the performer while the rest of the auditorium is out of focus (dark) and out of your attention. You are in trance.
Depending on the degree of focus or trance we have various trance state or depths.
Light trance: Slower, deeper breathing with eyes closed and relaxed muscle tone
Medium trance: Slower responses, Slumped, limp body, reduced awareness of surroundings
Deep trance: More pronounced manifestation of medium trance.
Hypnotherapy is the use of hypnosis by a trained professional for therapeutic purposes.
It is used by medical as well as mental health professionals and rather than used solely as a separate modality, its principles can are more often incorporated into other modalities
Milton Erickson and Hypnotherapy
Milton Erickson (1901-1980) is considered the twentieth century’s greatest contributor to the practice of hypnotherapy. As a psychiatrist, he pioneered the use of a more permissive style of treatment. Note that he incorporated the older authoritarian style of classic hypnosis and expanded it to include the permissive style. This is important in fitting the style to the patient’s individual needs. Many patients with PTSD had been traumatized by an authority figure and would be best served by a more collaborative, interactive style. This enhances the patient’s progress in mastering greater control in their functioning.
Ericksonian methods include the following features.
Treatment Modalities Compared and Contrasted
The various modalities are more alike than different. The greatest difference is in nomenclature used in describing similar functions. All four modalities described are mutually compatible.
HYPNOSIS:
EMDR:
COGNITIVE:
PSYCHOTROPICS:
More Information
PTSD treatment using hypnosis
Effective treatments of PTSD: practice guidelines from the International Society fir traumatic Stress Studies / edited by E. B.Foa, T.M.Keane, Matthew J. Friedman. Chapter 12
Ericksonian Hypnotherapy
Trancework: an introduction to the practice of clinical hypnosis by M.D.Yapko
EMDR
Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures by F. Shapiro
Cognitive Therapy
Cognitive-behavioral therapies for trauma edited by V.M.Follette, J.I.Ruzek, F.R.Abueg
Psychotropics
Drug treatment for PTSD: Answers and questions in Annals of the New York Academy of Sciences Vol. 821 by M.J.Friedman
Referrals for patients
Robert Kupferman, LCSW www.rkhypnotherapy.com 917-517-2447
Training in Ericksonian Hypnosis
NYSEPH: The New York Milton H. Erickson Society for Psychotherapy and Hypnosis
Planetarium Station, PO Box 876, New York, NY 10024;.. Phone # 212-873-6459 www.NYSEPH.org
NEXT Training begins October 20, 2010.
Robert Kupferman, LCSW Bio
Education and Training
Professional Credentials
Career Highlights
Memberships