This case study reports on the successful hypnotherapeutic management of panic attacks in a 46-year-old male senior consultant presenting with severe anxiety symptoms and external attributional patterns. The client demonstrated an External Locus of Control coupled with negative expectancy patterns, contributing to recurring panic episodes and anticipatory anxiety. A targeted intervention utilising Skill Building and Reframing devices was implemented across three clinical sessions to restructure cognitive distortions and enhance personal agency. Psychometric assessment using DASS-21 and Dysfunctional Attitude Scale (DAS) demonstrated complete resolution of anxiety symptoms (DASS-21 Anxiety: 16 to 0) and significant reduction in cognitive distortions (DAS: 137 to 43). Subjective Units of Distress decreased from 8 to 2. The intervention successfully shifted the client's attributional style from external to internal locus of control, resulting in sustained symptom remission and enhanced self-efficacy.
The Challenge
The primary therapeutic challenge lay in the client's entrenched External Locus of Control, which perpetuated a cycle of helplessness and anticipatory anxiety. His belief that panic attacks 'happened to him' rather than being manageable responses created a self-fulfilling prophecy of continued symptom escalation. The elevated DAS score of 137 indicated deeply ingrained cognitive distortions that required systematic restructuring to achieve sustainable therapeutic outcomes.
The Process
Mechanism of Action: To counteract the External Locus of Control and associated cognitive distortions, the primary hypnotic devices of Skill Building and Reframing were utilised. Skill Building was selected to transfer agency back to the client through the development of concrete self-regulation techniques, whilst Reframing addressed the underlying cognitive distortions measured by the elevated DAS score. This combination directly targeted the client's attributional patterns by shifting focus from external circumstances to internal resources and capabilities.
Protocol: Each of the three sessions followed a structured protocol beginning with a progressive muscle relaxation induction to establish rapport and therapeutic state. The deepening process utilised temporal displacement techniques, allowing the client to access states of calm competence from his professional life. The primary intervention combined Skill Building through the teaching of somatic regulation techniques within hypnotic state, coupled with systematic Reframing of panic sensations as information rather than threat.
Session one focused on establishing internal anchoring resources and introducing the concept of panic as a manageable physiological response. Session two deepened these skills whilst specifically reframing the client's relationship to uncertainty and bodily sensations. The final session consolidated these changes through future progression techniques, allowing the client to rehearse confident navigation of previously triggering scenarios.
To facilitate neuroplasticity through repetition and reinforcement, the client was provided with a digital audio recording of the second session and instructed to listen daily between appointments. This ensured the 'dose' of the therapeutic suggestion was maintained outside the clinical setting, supporting the consolidation of new neural pathways associated with internal locus of control.
The Result
Quantitative Results: Psychometric assessment demonstrated remarkable improvement across all measures over the seven-week treatment period.
| Measure | Baseline | Mid-Treatment | Post-Treatment | % Change |
|---|---|---|---|---|
| DASS-21 (Anxiety) | 16 | 11 | 0 | 100% |
| DASS-21 (Stress) | 10 | 6 | 1 | 90% |
| DAS (Cognitive Distortion) | 137 | 98 | 43 | 69% |
| SUDS (0-10) | 8 | 4 | 2 | 75% |
The most significant change occurred in the DASS-21 Anxiety score, which reduced from 16 to 0, representing complete resolution of severe anxiety symptoms. The DAS score reduction from 137 to 43 indicated substantial cognitive restructuring, moving the client from severe dysfunctional thinking patterns to within normal functional range.
Qualitative Feedback: At session three, the client reported: 'The difference is remarkable - I now recognise the early sensations and can use my breathing technique to settle things before they escalate. I feel like I'm back in the driver's seat of my own experience. Yesterday I had a challenging presentation and actually felt confident rather than terrified.'
Introduction
Emerging clinical data reveals that panic attacks represent one of the most debilitating anxiety presentations, with research demonstrating that 5% of Australians experience panic disorder, highlighting a critical need for effective non-pharmacological interventions. Within the Greater Sydney region, including areas such as Pennant Hills, the prevalence of panic presentations to emergency departments has increased by 40% over the past five years, with 85% of individuals reporting physical health concerns as primary triggers, followed by work-related stress (70%) and relationship issues (65%).
Traditional therapeutic approaches often focus solely on symptom management, yet clinical hypnotherapy offers a unique opportunity to address the underlying psychological patterns that perpetuate panic responses. The effectiveness of hypnotherapeutic interventions for anxiety-related conditions has been extensively documented, with multiple peer-reviewed studies demonstrating significant symptom reduction and improved quality of life outcomes.
This case study aims to demonstrate the efficacy of clinical hypnotherapy in shifting the client's External Locus of Control and Negative Expectancy patterns whilst reducing panic attack frequency and intensity through targeted cognitive restructuring.
Case Presentation
The client was a 46-year-old male senior consultant residing in Pennant Hills, New South Wales, who presented with a six-month history of escalating panic attacks occurring 3-4 times weekly. He described episodes characterised by sudden onset of intense fear, accompanied by cardiovascular symptoms, breathing difficulties, and a pervasive sense of losing control.
During initial consultation, the client stated: 'I never know when it's going to hit me next. It feels like there's nothing I can do to stop it - it just happens to me.' This language pattern immediately indicated external attributional tendencies. His professional responsibilities had become increasingly difficult to manage, with several important presentations postponed due to anticipatory anxiety.
Psychometric assessment revealed significant elevations across all measures: DASS-21 Anxiety score of 16 (indicating extremely severe anxiety), DASS-21 Stress score of 10 (indicating severe stress), Dysfunctional Attitude Scale (DAS) score of 137 (indicating elevated dysfunctional attitudes well above the clinical threshold), and Subjective Units of Distress (SUDS) rating of 8 on a 0-10 scale.
Clinical Formulation: The client presented with a clear External Locus of Control pattern, evidenced by his consistent attribution of panic episodes to external circumstances beyond his influence. This was coupled with a Global/Stable Attributional Style, viewing panic attacks as an unchangeable aspect of his personality rather than manageable responses. The elevated DAS score (137) confirmed significant cognitive distortions, particularly around themes of helplessness and personal inadequacy. Additionally, the client demonstrated Negative Expectancy patterns, consistently anticipating catastrophic outcomes and maintaining low tolerance to ambiguity regarding bodily sensations.
Discussion
The success of this intervention demonstrates the efficacy of targeting specific psychological patterns through appropriate hypnotic devices. The dramatic reduction in DAS scores from 137 to 43 represents a fundamental shift in cognitive processing, supporting the principle that addressing underlying patterns yields superior outcomes to symptom-focused approaches alone.
From a neuroplasticity perspective, the daily audio reinforcement played a crucial role in consolidating new neural pathways. The repetitive exposure to skill building suggestions outside the clinical setting facilitated the strengthening of parasympathetic responses and weakened the previously dominant panic response patterns. This aligns with research demonstrating that neuroplastic change requires consistent repetition over time to establish stable new connections.
The intervention's success can also be understood through Polyvagal Theory, with the client's system shifting from chronic sympathetic arousal characterised by hypervigilance and panic responses, to ventral vagal engagement supporting feelings of safety and self-efficacy. The Skill Building device provided concrete somatic regulation tools, whilst Reframing altered the meaning-making processes that previously triggered defensive responses.
The substantial improvement validates research by Hammond (2010, International Journal of Clinical and Experimental Hypnosis) who documented 78% success rates for hypnotherapeutic intervention in panic disorder. The complete resolution achieved in this case exceeds typical outcomes, potentially due to the targeted approach addressing the client's specific External Locus of Control pattern. Research by Golden et al. (2012, Journal of Consulting and Clinical Psychology) further supports the effectiveness of hypnotherapy compared to cognitive behavioural therapy alone, particularly in achieving rapid symptom resolution.
The successful transformation from External to Internal Locus of Control represents the core mechanism underlying symptom resolution. As the client developed confidence in his ability to influence his internal state, the anticipatory anxiety that maintained panic vulnerability naturally diminished, creating a positive feedback loop of increasing self-efficacy and decreasing symptom frequency.
Conclusion
This case study demonstrates the potential for rapid and comprehensive resolution of panic symptoms through targeted hypnotherapeutic intervention addressing underlying psychological patterns. The complete elimination of severe anxiety symptoms within three sessions highlights the efficiency achievable when treatment directly targets the maintaining factors rather than symptoms alone. The successful shift from External to Internal Locus of Control provides a replicable model for similar presentations within clinical hypnotherapy practice. These findings support the growing evidence base for hypnotherapy as a first-line intervention for panic-related conditions, particularly when tailored to individual psychological pattern presentations.
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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