Anxiety, Asthma and Self Hypnosis – A Case Study

A long-term study followed one patient, a female diagnosed with asthma at the age of 1 year, to determine if self-hypnosis would have an effect on a comorbid condition, in this case anxiety. The treating physician’s hypothesis was that a patient taking a significant amount of medication for asthma might miscalculate the severity of the asthma due to discounting the possible detrimental effects of a comorbid condition. He considered the possibility that dyspnea, tachypnea and tightness in the chest originally attributed to the asthma, might be caused by anxiety. If this were true, these symptoms could possibly be alleviated by self-hypnosis, thus decreasing the patient’s need for unnecessary medication.

This study was done by the treating physician, a pediatric pulmonologist. The patient, a female preadolescent was diagnosed and treated for asthma from the age of one. Her care included systemic steroid therapy from the age of two years to twelve years. She required hospitalization 6 times in the intensive care unit, and visited the emergency room 15 times for severe asthma attacks. At the age of 10, during one hospitalization in intensive care, her mother noticed her condition worsened following episodes of anxiety that were not related to her asthma. She became tense over things such as meals being served cold or medication being delivered late. These exhibitions of anxiety precipitated a course of psychotherapy. Her parents perceived no improvement in anxiety symptoms after ten sessions and terminated the sessions.

Patient’s triggers of distress were a decrease in systemic steroid medication, upper respiratory infections, exposure to cold air and exercise. It was noted that strong emotions preceded an asthma attack. Anxiety preceded deep breathing and hyperventilation.

Patient was assessed for appropriateness of self-hypnosis as an adjunctive treatment for the comorbid condition, anxiety. Physician discussed the anxiety with her and explained that it was a normal response to the respiratory distress caused by her asthma. No further test was conducted to assess the anxiety.

She was asked if she wanted to learn self-hypnosis to calm the anxiety. She was interested and he conducted a session to teach her how. He taught her to visualize herself walking across a beach towards the ocean and a relaxation technique she was to use to relax. She was advised to practice. Two weeks later, she was able to replace her nebulized levalbuterol with self-hypnosis around 50% of the time.

The doctor conducted a second session to teach another self-hypnosis technique. Patient was asked to visualize a tight airway and see it opening up to simulate relaxing the airway. Monthly follow up visits were scheduled and she was gradually weaned from some of the asthma medication. In three months time she was off levalbuterol completely. Other medication was gradually decreased and patient reported self-hypnosis to be as effective as medication in relieving her asthma symptoms.

In conclusion, prior to learning self-hypnosis, she required Prednisone (15 mg per day), levalbuterol (0.63 mg, by nebulization, four times per day and p.r.n., albuterol MDI (two puffs before taking gym class), budesonide (three puffs BID) and ipratropium bromide (0.5 mg, by nebulization, p.r.n.). She used the p.r.n. medications every other day for dyspnea.

Three months after beginning self-hypnosis, she was weaned off the levalbuterol. She reported to her physician that self-hypnosis helped treat her attacks of labored breathing as effectively. Next, she was slowly weaned off the systemic steroids. She was hospitalized for dyspnea once and received nebulized levalbuterol, oral prednisone and continued the self-hypnosis. She also received one dose of clonazepam for anxiety.

Two weeks later, her weaning off systemic steroids was continued. Medication was temporarily resumed during several hospitalizations. Finally, her systemic steroid medication was no longer given. At this time her medication regimen included 110 ug of fluticasone used twice a day (2 puffs), 2 puffs twice a day of salmeterol, theophylline (300 mg, PO twice a day, budesonide nasal spray twice a day and levalbuterol (0.63 mg, nebulized) one time each month. She continued to use self-hypnosis nearly every day.

Thus, self-hypnosis enabled the patient to discontinue some medication and reduce the dosage of some others. Outcome indicates that anxiety may cause inaccurate perception of asthma symptoms due to the comorbid anxiety. Future studies might be started after a formal diagnosis of anxiety is made to more easily gauge the level of improvement. This study had several advantages. It was conducted by a pediatric pulmonologist schooled in the teaching of self-hypnosis who had long-term familiarity with his patient. It was hypothesized that the additional medical attention may have been a factor in the patient’s improvement over time. The usefulness of future research into hypnosis for anxiety is indicated.

References

Anbar RD: Hypnosis in pediatrics: applications at a pediatric pulmonary center BMC Pediatr 2002, 2:11 [http://www.biomedcentral. com/1471-2431/2/11].

Anbar RD and Hehir DA: Hypnosis as a diagnostic modality for vocal cord dysfunction Pediatrics 2000, 106: [http://www.pediatrics. org/cgi/content/full/106/6/e81].

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