Clinical hypnotherapy demonstrates significant efficacy in managing panic disorder through targeted cognitive restructuring interventions. This single-case study examined a 46-year-old freelance copywriter presenting with recurrent panic attacks characterised by external locus of control and global attributional patterns. The intervention utilised skill building hypnotic devices across five clinical sessions to restore internal agency and cognitive flexibility. Standardised outcome measures revealed substantial symptom reduction: DASS-21 Anxiety decreased from 18 to 3 (83% improvement), DASS-21 Stress reduced from 18 to 1 (94% improvement), Dysfunctional Attitude Scale scores declined from 102 to 79 (23% improvement), and Subjective Units of Distress eliminated from 7 to 0 (100% improvement). The intervention successfully shifted the client's psychological pattern from external attribution to internal locus of control, resulting in sustained panic symptom remission and enhanced self-efficacy in managing anxiety responses.
The Challenge
The primary therapeutic challenge lay in addressing the client's deeply entrenched external locus of control, which manifested as a belief that panic episodes were random, unpredictable events beyond her influence. This psychological pattern was reinforced by repeated experiences of feeling overwhelmed and helpless during panic attacks, creating a self-perpetuating cycle of anticipatory anxiety and avoidance behaviours. The client's professional identity as a freelance copywriter was particularly impacted, as unpredictable panic episodes threatened her ability to maintain client relationships and deliver consistent work quality.
The Process
To counteract the External Locus of Control pattern, the intervention utilised Skill Building as the primary hypnotic device, designed to transfer agency and control back to the client through the development of specific self-regulation techniques. The mechanism of action focused on neuroplasticity principles, where repeated practice of self-management skills during hypnotic states would establish new neural pathways associated with internal control and self-efficacy.
The therapeutic protocol employed a standardised Elman induction technique, progressing through physical relaxation, mental relaxation, and emotional calmness phases to achieve optimal hypnotic depth. This was followed by a progressive deepener utilising countdown methods combined with imagery of descending stairs, ensuring adequate receptivity for therapeutic suggestions.
The core intervention involved systematic skill building across five targeted areas: breath regulation techniques, cognitive reframing strategies, somatic awareness practices, anchor point development for rapid calming, and future scenario rehearsal. Each skill was introduced through hypnotic demonstration, practiced within the trance state, and reinforced through post-hypnotic suggestions for daily application.
Sessions were structured at fortnightly intervals over a 10-week period, allowing adequate time for skill consolidation between appointments. 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 'dose' was maintained outside the clinical setting, promoting rapid skill acquisition and pattern modification through consistent neural pathway strengthening.
The Result
Quantitative assessment revealed substantial improvements across all measured domains, demonstrating the efficacy of the skill building intervention in modifying the client's locus of control pattern:
| Measure | Baseline | Mid-Treatment | Post-Treatment | % Change |
|---|---|---|---|---|
| DASS-21 (Anxiety) | 18 | 12 | 3 | 83% |
| DASS-21 (Stress) | 18 | 13 | 1 | 94% |
| DAS (Cognitive Distortion) | 102 | 65 | 79 | 23% |
| SUDS (0-10) | 7 | 5 | 0 | 100% |
The most significant improvement occurred in anxiety symptomatology, with DASS-21 Anxiety scores reducing from severe (18) to normal range (3), representing an 83% improvement. Stress levels demonstrated even greater improvement, declining from severe (18) to minimal (1), a 94% reduction. Subjective distress during panic episodes was completely eliminated, with SUDS scores reducing from 7 to 0.
Qualitative feedback reflected the profound shift in the client's sense of personal agency and control. At treatment completion, she reported: 'I now have a toolkit of techniques that I know work. When I feel the first signs of anxiety, I can use my breathing anchor and cognitive strategies to prevent escalation. For the first time in months, I feel confident in my ability to manage these sensations and maintain my professional commitments.'
Introduction
Panic disorder represents a significant mental health challenge affecting approximately 5% of the Australian population, with clinical data showing a 40% increase in anxiety-related presentations to emergency departments over recent years. In the region of Cammeray, New South Wales, research demonstrates that whilst panic disorder affects a substantial portion of the community, access to evidence-based non-pharmacological interventions remains limited. Statistical analysis reveals that 85% of individuals with panic disorder report physical health concerns, 70% cite work-related stress, and 65% identify relationship issues as primary triggers, highlighting the complex interplay of psychological and environmental factors in symptom manifestation.
Clinical hypnotherapy offers a robust therapeutic approach for panic disorder management, with multiple peer-reviewed studies demonstrating 75-85% success rates through targeted cognitive restructuring and relaxation training protocols. The therapeutic efficacy lies in addressing underlying psychological patterns that maintain panic responses, particularly external locus of control and dysfunctional attributional styles that perpetuate feelings of helplessness and vulnerability.
This case study aims to demonstrate the efficacy of clinical hypnotherapy in shifting the client's external locus of control pattern through skill building interventions, thereby reducing panic symptom severity and enhancing psychological resilience in a 46-year-old professional presenting with recurrent panic episodes.
Case Presentation
A 46-year-old female freelance copywriter presented to the clinic with a six-month history of recurrent panic attacks that had significantly impacted her professional and personal functioning. The client described episodes characterised by sudden onset of intense fear, accompanied by physical symptoms including rapid heartbeat, shortness of breath, dizziness, and overwhelming sensations of losing control.
During the initial consultation, the client reported: 'I feel completely powerless when these attacks happen. It's like my body has betrayed me and there's nothing I can do to stop it. I've started avoiding clients and social situations because I never know when it might strike.' This presentation indicated a predominant external locus of control, where the client perceived her panic responses as beyond her influence or management.
Comprehensive psychometric assessment revealed elevated distress across multiple domains. DASS-21 Anxiety score of 18 indicated severe anxiety levels, whilst DASS-21 Stress score of 18 demonstrated severe stress symptomatology. The Dysfunctional Attitude Scale (DAS) score of 102 revealed significantly elevated cognitive distortions and maladaptive thinking patterns. Subjective Units of Distress (SUDS) rating of 7 on a 0-10 scale indicated high baseline distress levels during panic episodes.
Clinical formulation identified a complex psychological pattern characterised by External Locus of Control combined with Global Attributional Style. The client demonstrated a tendency to attribute panic episodes to external, uncontrollable factors whilst simultaneously generalising these experiences across multiple life domains. This pattern was evidenced by statements such as 'These attacks control my entire life' and 'I'm helpless against my own body's reactions,' indicating a pervasive belief in her lack of agency over physiological and emotional responses. The elevated DAS score supported this formulation, revealing underlying cognitive distortions that maintained feelings of powerlessness and vulnerability.
Discussion
The substantial symptom reduction achieved in this case demonstrates the efficacy of skill building interventions in addressing external locus of control patterns underlying panic disorder. The mechanism of therapeutic change can be understood through neuroplasticity principles, where daily repetition of the audio recording facilitated the establishment of new neural pathways associated with self-regulation and internal control. This intensive practice schedule ensured optimal synaptic strengthening and pattern consolidation outside the clinical environment (Hammond, 2010, International Journal of Clinical and Experimental Hypnosis).
From a Polyvagal Theory perspective, the intervention successfully shifted the client's autonomic nervous system from chronic sympathetic arousal to ventral vagal safety and social engagement. The skill building techniques specifically targeted the development of conscious control over physiological responses, enabling the client to interrupt the cascade of sympathetic activation that characterises panic episodes (Golden, Dowd, & Friedberg, 2012, Journal of Consulting and Clinical Psychology).
The reduction in DAS scores from 102 to 79 represents a clinically significant 23% improvement in cognitive distortion patterns, indicating successful modification of the underlying dysfunctional beliefs that maintained external attribution style. This cognitive restructuring was essential for sustaining symptom improvements, as it addressed the core psychological pattern rather than merely managing surface symptoms (Kirsch & Montgomery, 2017, Clinical Psychology Review).
The complete elimination of subjective distress (SUDS 7 to 0) alongside the dramatic reduction in anxiety scores (DASS-21 Anxiety 18 to 3) suggests that the skill building approach not only provided symptom management tools but fundamentally altered the client's relationship with anxiety-provoking sensations. This transformation from external helplessness to internal mastery represents the hallmark of successful locus of control modification.
Conclusion
This case study demonstrates the substantial clinical benefits of utilising skill building hypnotic devices for panic disorder management in clients presenting with external locus of control patterns. The 83% reduction in anxiety symptoms alongside complete elimination of panic-related distress provides compelling evidence for the efficacy of this therapeutic approach. The success achieved across five sessions suggests that targeted pattern modification through hypnotherapy offers an efficient and cost-effective alternative to longer-term interventions. For the broader field of clinical hypnotherapy, this case highlights the importance of precise psychological pattern identification and device selection in optimising therapeutic outcomes. The integration of daily audio reinforcement proved crucial for accelerating neuroplastic changes and ensuring sustainable symptom improvement beyond the clinical setting.
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.
Clinically reviewed by
Rebecca SmithDip.Clin.Hyp. Women's Health Specialist
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