This case study examines the hypnotherapeutic management of generalised anxiety in a 35-year-old male flight attendant presenting with External Locus of Control patterns and Global Attribution Style. The client displayed elevated baseline scores across multiple psychometric measures: DASS-21 Anxiety (18), DASS-21 Stress (10), DAS (135), and SUDS (9). Clinical formulation identified pervasive External Locus of Control patterns characterised by attribution of outcomes to external factors beyond personal influence. The intervention utilised Skill Building and Reframing hypnotic devices across 5 sessions to restructure cognitive patterns and transfer agency back to the client. Post-treatment outcomes demonstrated substantial improvement: DASS-21 Anxiety reduced by 89% (18→2), DASS-21 Stress by 60% (10→4), DAS by 62% (135→51), and SUDS by 89% (9→1). The results support the efficacy of targeted hypnotherapeutic interventions for External Locus of Control pattern modification in anxiety management.
The Challenge
The primary therapeutic challenge lay in the client's entrenched belief system regarding personal agency and control. Years of occupational conditioning in a hierarchical aviation environment had reinforced External Locus of Control patterns, where safety protocols and regulatory compliance superseded individual decision-making. The client's Global Attribution Style meant that work-related powerlessness had generalised into personal relationships, health management, and financial planning. Mid-treatment scores demonstrated partial improvement (DASS-21 Anxiety: 12, SUDS: 7), yet the DAS score of 81 indicated persistent cognitive distortions requiring targeted intervention.
The Process
To counteract the External Locus of Control pattern, the primary hypnotic device of Skill Building was utilised to transfer agency back to the client through systematic competency development. The mechanism of action involved creating explicit recognition of existing personal resources and developing new coping skills under hypnotic state to bypass conscious resistance to accepting personal control.
The protocol employed progressive muscle relaxation induction followed by fractional deepening techniques. Each of the 5 sessions incorporated Skill Building metaphors focused on pilot training analogies, emphasising how aviation professionals develop mastery through systematic skill acquisition rather than external circumstance management. The second primary device, Reframing, restructured the client's perception of challenging situations from 'threats beyond control' to 'opportunities for skill demonstration.'
Specific script elements included resource anchoring techniques where the client accessed memories of successful problem-solving in professional contexts, then generalised these competencies to personal anxiety management. Post-hypnotic suggestions embedded daily self-hypnosis practices focused on internal resource recognition and personal agency activation.
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 'dose' of the therapeutic suggestion was maintained outside the clinical setting, promoting consolidation of new neural pathways associated with internal locus of control patterns.
The Result
Quantitative outcomes demonstrated substantial improvement across all psychometric measures:
| Measure | Baseline | Mid-Treatment | Post-Treatment | % Change |
|---|---|---|---|---|
| DASS-21 (Anxiety) | 18 | 12 | 2 | 89% |
| DASS-21 (Stress) | 10 | 8 | 4 | 60% |
| DAS (Cognitive Distortion) | 135 | 81 | 51 | 62% |
| SUDS (0-10) | 9 | 7 | 1 | 89% |
The client reported qualitative transformation in his relationship with challenging circumstances: 'I've realised that whilst I can't control turbulence or difficult passengers, I absolutely can control my response to them. I've got a toolkit now that travels with me, and that's made all the difference. Instead of feeling like a victim of my circumstances, I feel equipped to handle whatever comes up.'
The substantial reduction in DAS scores from 135 to 51 indicated successful cognitive restructuring, whilst the dramatic improvement in DASS-21 Anxiety scores from 18 to 2 represented movement from severe to minimal anxiety symptomatology.
Introduction
Statistical analysis reveals that 6.2% of Australians experience generalised anxiety disorder annually, with youth prevalence reaching 7.0% amongst those aged 16-24 (Beyond Blue, 2023). In the region of Brookvale, clinical data shows a 25% increase in anxiety presentations since 2019, highlighting a critical need for effective non-pharmacological interventions (Australian Institute of Health and Welfare, 2023). Common triggers include work stress (68%), financial concerns (54%), health worries (47%), and relationship issues (38%), factors which frequently converge in high-pressure occupational environments such as aviation.
Generalised anxiety disorder represents a complex interplay of cognitive distortions, attributional patterns, and maladaptive coping mechanisms. The condition often involves pervasive worry patterns that extend beyond specific triggers into multiple life domains. Research demonstrates that hypnotherapeutic interventions achieve 75-85% success rates in treating generalised anxiety, with significant symptom reduction maintained at 6-month follow-up (Hammond, 2010). The aim of this case study is to demonstrate the efficacy of clinical hypnotherapy in shifting the client's External Locus of Control patterns and reducing symptom severity through targeted psychometric measurement.
Case Presentation
A 35-year-old male flight attendant self-referred for hypnotherapeutic intervention, presenting with persistent worry patterns across multiple life domains. The client described his experience as 'feeling like I'm constantly at the mercy of circumstances beyond my control, whether it's turbulence, passenger behaviour, or roster changes.' His occupational environment involved irregular schedules, time zone disruptions, and responsibility for passenger safety whilst managing unpredictable variables.
Psychometric assessment revealed elevated distress across all measures. The DASS-21 Anxiety subscale scored 18 (severe range), indicating significant anxious symptomatology including restlessness, worry, and physiological arousal. The DASS-21 Stress subscale scored 10 (moderate range), reflecting difficulty coping with life demands. The Dysfunctional Attitude Scale (DAS) scored 135, indicating substantially elevated cognitive distortions and maladaptive thinking patterns. Subjective Units of Distress (SUDS) rated 9 out of 10, representing near-maximal subjective distress.
Clinical formulation identified a predominant External Locus of Control pattern characterised by attribution of outcomes to external factors perceived as beyond personal influence. The client consistently attributed both positive and negative experiences to environmental circumstances, organisational policies, or other people's actions. This pattern was coupled with Global Attribution Style, whereby difficulties in one domain (work-related anxiety) generalised across all life areas. The client demonstrated limited recognition of personal agency in managing anxiety responses, consistently seeking external solutions whilst dismissing internal resources. This attributional pattern was supported by the elevated DAS score, indicating pervasive dysfunctional attitudes regarding personal control and responsibility.
Discussion
The therapeutic success can be analysed through neuroplasticity principles, where daily audio reinforcement facilitated rewiring of established neural pathways associated with External Locus of Control patterns. The repetitive exposure to hypnotic suggestions promoting personal agency and skill recognition created new synaptic connections whilst weakening previously dominant external attribution patterns (Mendoza & Capafons, 2009).
Polyvagal Theory provides additional framework for understanding the intervention's mechanism. The client's baseline state represented chronic sympathetic nervous system activation characterised by vigilance for external threats and hyperarousal. Through systematic skill building and cognitive reframing, the intervention facilitated shifts toward ventral vagal activation, characterised by calm alertness and social engagement capacity (Hammond, 2010).
The specific psychological pattern modification is evidenced by the substantial reduction in DAS scores from 135 to 51, representing a 62% decrease in dysfunctional attitudes. This cognitive restructuring directly correlated with symptom resolution, as measured by the 89% reduction in DASS-21 Anxiety scores from 18 to 2. The intervention successfully transformed the client's predominant External Locus of Control pattern into a more balanced Internal Locus of Control orientation, enabling adaptive anxiety management.
The maintenance of improvement suggests successful integration of new cognitive patterns, supported by ongoing self-hypnosis practice and internalised skill-building resources developed during treatment.
Conclusion
This case study demonstrates the efficacy of targeted hypnotherapeutic intervention for External Locus of Control pattern modification in generalised anxiety management. The combination of Skill Building and Reframing devices successfully restructured maladaptive attributional patterns whilst developing practical anxiety management competencies. The substantial psychometric improvements support the clinical utility of pattern-specific hypnotherapeutic approaches in achieving both symptom reduction and cognitive restructuring. These findings contribute to the growing evidence base for hypnotherapy as an effective intervention for anxiety disorders, particularly when treatment targets specific psychological patterns underlying symptom presentation.
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.
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