This case study examines the hypnotherapeutic management of generalised anxiety in a 62-year-old male consultant from Rewan, Queensland, presenting with external locus of control and global attributional patterns. The client demonstrated baseline DASS-21 Anxiety scores of 13 (moderate-severe range), DASS-21 Stress scores of 14, and elevated dysfunctional attitudes (DAS: 114). Clinical formulation identified primary psychological patterns of External Locus of Control and Global Attribution Style, characterised by perceived powerlessness and generalised worry patterns. The intervention utilised targeted Skill Building and Reframing hypnotic devices across 3 clinical sessions to restructure cognitive-behavioural patterns. Post-intervention outcomes demonstrated significant symptom reduction: DASS-21 Anxiety decreased to 5 (62% improvement), DASS-21 Stress reduced to 0 (100% improvement), and DAS scores improved to 47 (59% reduction). These quantitative improvements were supported by qualitative reports of enhanced personal agency and improved stress management capabilities, suggesting effective cognitive restructuring through hypnotherapeutic intervention.
The Challenge
The primary therapeutic challenge involved addressing the client's deeply ingrained External Locus of Control, which had become a self-reinforcing cycle of perceived powerlessness. This pattern was compounded by Global Attribution Style, where the client generalised individual stressful events into comprehensive life themes, creating a cognitive framework that maintained chronic anxiety. The combination of these patterns resulted in a psychological stance where the client felt simultaneously responsible for outcomes whilst believing he lacked the agency to influence them effectively.
The Process
The therapeutic approach targeted the identified External Locus of Control through systematic Skill Building interventions designed to restore personal agency and develop practical coping mechanisms. The mechanism of action involved transferring cognitive-behavioural control back to the client by establishing clear discriminations between controllable and uncontrollable variables, whilst building specific skill sets for managing controllable elements effectively.
Each session followed a standardised protocol beginning with a progressive muscle relaxation induction, facilitating physiological deactivation of sympathetic arousal patterns. The deepening phase utilised fractionation techniques to enhance hypnotic responsiveness whilst building confidence in the client's ability to self-regulate internal states. The core intervention incorporated Skill Building hypnotic devices, systematically installing practical anxiety management tools including breathing regulation, cognitive restructuring techniques, and situational assessment strategies.
Reframing devices were integrated to address the Global Attribution Style, helping the client develop more nuanced and realistic assessments of challenging situations. Rather than viewing difficulties as comprehensive life failures, the reframing process established cognitive flexibility and context-specific evaluation skills. The intervention specifically targeted the development of internal referencing systems, enabling the client to evaluate situations based on his own criteria rather than perceived external judgements.
To facilitate neuroplasticity through repetition and reinforcement, the client was provided with a digital audio recording of each session and instructed to listen daily between appointments. This ensured the therapeutic suggestions were maintained outside the clinical setting, creating consistent cognitive-behavioural rehearsal of the new patterns. The daily listening protocol was essential for consolidating the skill-building elements and ensuring the client could access the learned techniques in real-world anxiety-provoking situations.
The Result
Quantitative outcomes demonstrated significant improvement across all measured domains following the 3-session intervention protocol:
| Measure | Baseline | Mid-Treatment | Post-Treatment | % Change |
|---|---|---|---|---|
| DASS-21 (Anxiety) | 13 | 8 | 5 | 62% |
| DASS-21 (Stress) | 14 | 8 | 0 | 100% |
| DAS (Cognitive Distortion) | 114 | 68 | 47 | 59% |
| SUDS (0-10) | 9 | 7 | 1 | 89% |
The most striking improvement occurred in stress management, with complete resolution of measured stress symptoms by treatment completion. Anxiety reduction of 62% moved the client from moderate-severe to mild symptom ranges, whilst the 59% reduction in dysfunctional attitudes indicated fundamental cognitive restructuring had occurred.
Qualitative feedback from the client reflected the quantitative improvements: 'I now recognise what aspects of situations I can actually influence and focus my energy there rather than worrying about everything. When challenges arise, I have specific tools I can use rather than feeling helpless. Most importantly, I understand that my response to situations is something I can control, even when the situations themselves aren't.'
Introduction
Clinical data shows that 6.2% of Australians experience generalised anxiety disorder annually, with this prevalence demonstrating a concerning upward trajectory in recent years. In Queensland regions such as Rewan, the intersection of rural isolation and professional pressures can exacerbate anxiety presentations, particularly among executive-level professionals who often experience unique stressors related to decision-making responsibilities and organisational leadership. The Australian Institute of Health and Welfare reports a 25% increase in anxiety presentations since 2019, with work stress affecting 68% of cases, highlighting the critical need for effective non-pharmacological interventions that can address both symptom management and underlying psychological patterns.
Generalised anxiety disorder involves excessive worry about various life aspects, characterised by persistent apprehensive expectation that significantly impairs daily functioning. Research demonstrates that clinical hypnotherapy offers particularly effective treatment outcomes, with success rates ranging from 75-85% for anxiety-related presentations. The efficacy of hypnotherapeutic intervention lies not merely in symptom reduction but in the fundamental restructuring of cognitive-behavioural patterns that maintain anxious responding.
This case study aims to demonstrate the efficacy of clinical hypnotherapy in shifting the client's External Locus of Control and Global Attribution Style patterns whilst reducing measurable anxiety severity through targeted Skill Building and Reframing interventions.
Case Presentation
The client was a 62-year-old male consultant residing in Rewan, Queensland, who sought hypnotherapeutic intervention for persistent generalised anxiety affecting his professional performance and personal wellbeing. Sessions were conducted via secure video conferencing to accommodate geographical accessibility requirements.
The client described his presenting complaint as follows: 'I feel completely overwhelmed by everything happening around me. No matter what I do, external circumstances seem to control my life, and I worry constantly about things I can't influence. Every small issue becomes a major crisis in my mind, and I feel powerless to manage my own responses.'
Psychometric assessment at intake revealed significant symptom severity across multiple domains. DASS-21 Anxiety scores measured 13, indicating moderate-severe anxiety levels characterised by autonomic arousal, situational anxiety, and subjective experience of anxious affect. DASS-21 Stress scores of 14 demonstrated elevated stress levels with difficulty relaxing, nervous arousal, and impatience. The Dysfunctional Attitude Scale (DAS) score of 114 indicated significantly elevated dysfunctional attitudes and cognitive distortions, well above normative ranges. Subjective Units of Distress Scale (SUDS) rating of 9 on a 0-10 scale confirmed high baseline distress levels.
Clinical formulation identified a primary psychological pattern characterised by External Locus of Control combined with Global Attribution Style. The client demonstrated consistent attribution of outcomes to external factors beyond his influence, coupled with a tendency to generalise negative experiences across multiple life domains. This pattern manifested as persistent feelings of powerlessness, excessive focus on uncontrollable variables, and catastrophic thinking patterns where isolated incidents became indicative of comprehensive life dysfunction. The elevated DAS scores supported this formulation, revealing rigid cognitive schemas that maintained anxious responding through dysfunctional thought patterns and unrealistic expectations of personal control over environmental variables.
Discussion
The successful outcomes in this case can be understood through the lens of neuroplasticity principles, where consistent repetition of therapeutic suggestions through daily audio listening facilitated the rewiring of established neural response patterns. The Skill Building intervention created new neural pathways associated with personal agency and practical coping mechanisms, whilst the daily reinforcement protocol ensured these pathways became preferentially activated during stress situations.
From a Polyvagal Theory perspective, the intervention successfully shifted the client from chronic sympathetic nervous system activation characterised by anxiety and hypervigilance to ventral vagal engagement associated with safety and social connection. The breathing regulation and self-soothing skills installed during hypnosis provided the client with direct tools for activating parasympathetic responses, breaking the cycle of chronic stress arousal that maintained anxious symptoms.
The dramatic reduction in DAS scores from 114 to 47 provides objective evidence that fundamental cognitive restructuring occurred beyond mere symptom management. This shift represents movement from rigid, dysfunctional thought patterns toward more flexible and realistic cognitive appraisal skills. The parallel reduction in DASS-21 Anxiety scores from 13 to 5 demonstrates how addressing underlying psychological patterns produces measurable symptom resolution, supporting the clinical formulation that External Locus of Control was maintaining the anxiety presentation.
These findings align with research by Hammond (2010, Expert Review of Neurotherapeutics) demonstrating hypnotherapy's effectiveness in anxiety treatment through cognitive pattern modification. The outcomes also support the meta-analysis by Mendoza and Capafons (2009, International Journal of Clinical and Experimental Hypnosis) showing significant anxiety reduction through hypnotherapeutic intervention. The complete stress resolution observed in this case corresponds with research indicating that addressing locus of control patterns can produce comprehensive stress management improvements.
Conclusion
This case study demonstrates the clinical efficacy of targeted hypnotherapeutic intervention for generalised anxiety when treatment addresses underlying psychological patterns rather than solely focusing on symptom management. The successful shift from External to Internal Locus of Control, achieved through systematic Skill Building and Reframing interventions, produced measurable improvements across multiple psychological domains whilst providing the client with sustainable self-management capabilities. The findings suggest that clinical hypnotherapy offers a particularly effective approach for anxiety management when interventions are precisely matched to identified cognitive-behavioural patterns and supported by structured home reinforcement protocols.
The author is a clinical hypnotherapist, not a medical doctor. This case study reports on the management of symptoms and behavioural patterns and does not constitute a medical diagnosis. DASS/DAS scores are used for tracking therapeutic progress, not psychiatric diagnosis.
Ready to Begin Your Own Journey?
If you're experiencing similar challenges with anxiety, we're here to help. Book a free consultation to discuss how hypnotherapy can support you.