Single-session manualized ego state therapy (EST) for combat stress injury, PTSD, and ASD, part 1: the theory

Post-traumatic stress in the medical setting

This article addresses the prevalence of posttraumatic stress arising from serious illness and injury. Its purpose is to underscore the importance of assessment and treatment of this population. The article reviews literature about patient stress responses to intensive care experiences and hospitalization. Above all, serious illness and injury hamper the individual's ability to maintain their ongoing lifestyle and interpersonal relationships; the experience raises the specter of vulnerability and mortality and can obstruct the experience of a familiar "self". Issues to be assessed and areas to be addressed therapeutically using hypnosis are suggested.

The Roots and Evolution of Ego-State Theory and Therapy

The purpose of this article is to elucidate the origins of ego-state theory and therapy and to discuss the concept of human personality as a structure comprising numerous ego states. The historical roots of ego-state theory and therapy are reviewed. Also, the evolution of ego-state therapy from classic hypnotherapy to modern methods is identified. The article notes that these methods of ego-state therapy have been described by different authors and under different names. It is suggested that core concepts related to ego-state theory and therapy of guided hypnotic dissociation may underlie the core of clinical effectiveness in many contemporary psychotherapeutic methods.

REVISITING THE SAFE PLACE:Method and Regulatory Aspects in Psychotherapy when Easing Allostatic Overload in Traumatized Patients

Safe-place inductions are considered important altered states of consciousness (ASC) to be (re)installed during trauma-informed psychotherapy. Coregulation aimed at changing implicit relational knowing and increasing integration and coherence through relational work and hypnotic techniques is crucial, as clients' abilities to self-soothe and regulate have become seriously impaired. Thus, resource-oriented metaphors as inner strength imagery is advocated. Also, methods such as creative-arts therapy and neurofeedback will induce ASCs, as most methods used with complex traumatized clients, due to their high hypnotizability. When positive or soothing imagery or relationally held suggestions for changed attentional focus are added to both psychodynamic psychotherapy and CBT, a hetero-hypnosis will be induced-a prerequisite for phase-specific trauma therapy aimed at changing inner schemas and scripts.

The Wounded Self in Trauma Treatment

The potential role of hypnosis in the treatment of trauma is both venerable and underappreciated. This article underscores the importance of the wounded-self concept by proposing a Kohutian perspective complimentary to the cognitively-driven model of Alladin (2014a, 2014b) discussed elsewhere in this issue. It explores selected topics that demonstrate (1) the importance of considering the wounds to the sense of self experienced by trauma victims and their implications for individualization of treatment in planning a psychotherapy; (2) the possibility of enhancing access to memories using shame alleviating techniques with minimal suggestive properties; (3) the use of hypnosis to facilitate less disruptive processing of traumatic materials; and (4) the importance of hypnosis in enhancing the safety of the trauma patient between sessions. Absent contraindications, the circumspect use of hypnosis as a facilitator of trauma treatment deserves consideration for inclusion in the mainstream of contemporary trauma treatment.

Resistance to Healing the Wounded Self: A Psychodynamic Rationale for a Targeted Treatment

The purpose of this article is to shed light on the psychodynamic complexities of the resistance encountered in treating the wounded self. Conceptualized on the basis of ego state therapy it offers a rationale for the use of precision-targeted abreactive hypnosis to treat these patients. Grounded in evidence-based efficacy research, the authors also briefly explain how to target treatment in wounded-self patients.

Hypnotherapy of a pain disorder: a clinical case study

Hypnotherapy's effectiveness in improving and controlling chronic pain of various etiologies has been demonstrated by studies; the mechanism by which hypnosis does this is more complex than a simple induction of muscle relaxation. This study reveals, in addition to this mechanism, a deeper dimension of hypnotherapy from the vantage of a patient with a medical-surgical background, diagnosed with a pain disorder and major severe depressive disorder in addition to incurable painful symptoms, through treatment associated with hypnoanalysis. Following psychotherapy, which included some elements of cognitive-behavioral therapy, a complete remission of the anxious-depressive mood and the painful symptoms was achieved.

The center core in ego state therapy and other hypnotically facilitated psychotherapies

Center core phenomena have been utilized in the practice of ego state therapy and other forms of hypnotically facilitated psychotherapy for nearly 40 years. Despite the frequency with which they are employed, many confusions, contradictions, and questions remain concerning them. In this article relevant center core phenomena literature is reviewed and an essential differentiation between two different kinds of center core phenomena is clarified. Psychodynamic explanations are offered for the therapeutic benefits of archetypal center core experiences such as inner strength and inner wisdom. The information provided offers clinicians a sturdier platform from which to decide whether to incorporate center core experiences into clinical practice. The persistent question of whether center core phenomena are ego states is revisited and addressed.

Evidence based abreactive ego state therapy for PTSD

A single 5-6 hours manualized abreactive ego state therapy session has recently been subjected to two placebo-controlled investigations meeting evidence-based criteria. Ego state therapy was found to be a highly effective and durable treatment for posttraumatic stress disorder. Apparently, ego state therapy works because it is emotion focused, activates sub-cortical structures, and because the supportive, interpretive therapist reconstructs the patient's personality to be resilient and adaptive. In this article the author reviews the treatment procedures and presents the findings of both studies.

Healing the wounded self: combining hypnotherapy with ego state therapy

The purpose of this article is to formulate a theoretical conceptualization for utilizing ego state therapy (EST) as an adjunct with cognitive hypnotherapy (CH) for depression. As the relationship between life events and onset of depression is very complex, it is not clear from current literature how stressors cause depressive symptoms. The notion of "wounded self," derived from the work of Wolfe (2005, 2006), is examined as a potential unifying concept for binding the role of risk factors in the precipitation of depression. By incorporating wounded self, the circular feedback model of depression, on which CH for depression is based, is expanded. This revised version provides conceptual and empirical underpinnings for integrating EST with CH in the management of depression.

Efficacy of single-session abreactive ego state therapy for combat stress injury, PTSD, and ASD

Using abreactive Ego State Therapy (EST), 36 patients meeting DSM-IV-TR and PTSD checklist (PCL) criteria were exposed to either 5-6 hours of manualized treatment or placebo in a single session. EST emphasizes repeated hypnotically activated abreactive "reliving" of the trauma experience combined with therapists' ego strength. Both the placebo and EST treatment groups showed significant reductions in PTSD checklist scores immediately posttreatment (placebo: mean 17.34 points; EST: mean 53.11 points) but only the EST patients maintained significant treatment effect at 4-week and 16- to 18-week follow-ups. Abreactive EST appears to be an effective and durable treatment for PTSD inclusive of combat stress injury and acute stress disorder.

Efficacy of abreactive ego state therapy for PTSD: trauma resolution, depression, and anxiety

Using manualized abreactive Ego State Therapy (EST), 30 subjects meeting DSM-IV-TR and Clinician-Administered PTSD Scale (CAPS) criteria were exposed to either 5-6 hours of treatment or the Ochberg Counting Method (placebo) in a single session. EST emphasized repeated hypnotically activated abreactive "reliving" of the trauma and ego strengthening by the cotherapists. Posttreatment 1-month and 3-month follow-ups showed EST to be an effective treatment for PTSD. Using the Davidson Trauma Scale, Beck Depression II, and Beck Anxiety Scales, EST subjects showed significant positive effects from pretreatment levels at all posttreatment measurement periods in contrast to the placebo treatment. Most of the EST subjects responded and showed further improvement over time.

An eye for an I: a 35-year-old woman with fluctuating oculomotor deficits and dissociative identity disorder

Physiologic changes, including neurological or pseudo-neurological symptoms, occur across identity states in dissociative identity disorder DID) and can be objectively measured. The idea that dissociative phenomena might be associated with changes in brain function is consistent with research on the brain effects of hypnosis. The authors report a case of psycho-physiologic differences among 4 alter personalities manifested by a 35-year-old woman with DID. Differences in visual acuity, frequency of pendular nystagmus, and handedness were observed in this patient both when the alter personalities appeared spontaneously and when elicited under hypnosis. The authors consider several diagnostic possibilities for these findings and discuss whether prevailing treatment recommendations for DID patients could possibly be modified to ameliorate such visual and neurologic symptoms.

A cross-validation of two differing measures of hypnotic depth

Several sets of regression analyses were completed, attempting to predict 2 measures of hypnotic depth: the self-reported hypnotic depth score and hypnoidal state score from variables of the Phenomenology of Consciousness Inventory: Hypnotic Assessment Procedure (PCI-HAP). When attempting to predict self-reported hypnotic depth, an R of .78 with Study 1 participants shrank to an r of .72 with Study 2 participants, suggesting mild shrinkage for this more attributional measure of hypnotic depth. Attempting to predict hypnoidal state (an estimate of trance) using the same procedure, yielded an R of .56, that upon cross-validation shrank to an r of .48. These and other results suggest that, although there is some variance in common, the self-reported hypnotic depth score appears to be tapping a different construct from the hypnoidal state score.

Virtual reality exposure therapy and hypnosis for flying phobia in a treatment-resistant patient: a case report

Flying phobia is a problem that affects a significant portion of the population. There are a number of therapeutic approaches but no one is universally accepted as the gold standard. One therapy is hypnosis. A recent addition to the armamentarium is virtual reality exposure (VRE) therapy. Both therapies are short-term and compare favorably to in vivo desensitization. Heretofore a combination of both approaches has not been reported. This article presents a case of a 50-year phobia to flying that was refractory to traditional methods including pharmacotherapy, systematic desensitization, and cognitive behavioral therapy but was successfully treated using VRE therapy and hypnosis as the primary modalities. This treatment was supplemented by other approaches. The rationale for this multimodal therapy and possible mechanisms involved are discussed.

Cognitive hypnotherapy with bulimia

Research on the efficacy of hypnosis in the treatment of bulimia nervosa has produced mixed findings. This is due in part to the interplay between the characteristics of people with bulimia and the wide variety of hypnosis interventions that have been employed. Several authors have noted that methodological limitations in hypnosis research often make evaluation of treatment efficacy difficult. Many of the studies extant provide insufficient information regarding the specifics of participants' hypnotizability, the hypnotic induction, or the hypnotic suggestion(s) employed. Such limitations preclude replication and clinical implementation. This article reviews the literature with replicable methodologies and discusses the implications for evaluating treatment efficacy.

Single-session manualized ego state therapy (EST) for combat stress injury, PTSD, and ASD, Part 2: the procedure

An abbreviated description of our single-session 5- to 6-hour procedure is provided. In contrast to trauma reframing approaches, such as cognitive processing therapy (CPT) or traditional psychoanalytic interventions, our manualized procedure rapidly demystifies subconscious processes, making them accessible and understandable by the patient. The therapist's supportive ego strength is integrated into the intense repeated emotional and physiological releases of the traumatized ego states. The abreactive component of this 5-phase procedure exhausts the bound-up psychological and physiological reactions but also serves to quickly overcome the trauma and to restructure the personality. The patient becomes empowered to release the trauma memories and to emerge with the ability to be adaptive, assertive, giving, strong, and able to express anger appropriately yet be caring with family/friends.