Hypnosis to help manage asthma
The mind is not a panacea, it has its limits. However, it can have a massive impact on the body and as such, there is much that hypnotherapy can do to help with a physical condition such as asthma.
Hypnotherapy can assist in potentially reducing symptoms; assist with comorbid stress, anxiety and depression which might exacerbate and/or maintain the condition; change your perception of the condition/symptoms; work through limiting beliefs and/or negative cognitions you might have about your condition, your prognosis, and how it impacts your life; as well as helping with illness-related behaviour change.
I have chosen to discuss how hypnotherapy can help with asthma because it is a condition that I suffer with. I wanted to get a better understanding of the evidence out there and some of the techniques used in the studies to help alleviate the condition so that I might benefit from them. So a selfish post, but I hope that you or someone you know might benefit from it too and use it to help better manage asthma.
According to the latest research into hypnosis for asthma, hypnosis is efficacious for managing emotional states, such as stress and anxiety, that exacerbate airway obstruction. It is possibly efficacious for the treatment of symptom severity and illness-related behaviours, as well as for decreasing airway obstruction and stabilizing airway hyper-responsiveness in some individuals. (Brown, 2007)
In addition to hypnosis research, there have also been several placebo/nocebo studies involving asthma which are fascinating. One study showed that some asthmatics developed breathing difficulties and/or asthma attacks when they believed they were inhaling an irritant that could cause breathing problems. (Kotses, Rawson, Wigal, & Creer, 1987; Luparello, Lyons, Bleecker & McFadden, 1968). If it is possible to create symptoms with our thoughts, beliefs and expectations, we can extrapolate from this that we can also reduce them. This shows us just how powerful our minds can be.
The hypnosis research provides us with many interventions, some of which I am sharing with you below:
Self-hypnosis. In the vast majority of research studies, participants carried out daily self-hypnosis. If you wish to learn self-hypnosis, I highly recommend The Science of Self Hypnosis which teaches you all the steps involved. I teach self-hypnosis to all my clients so that they can support themselves in between sessions.
Self-monitor symptoms. Self-monitor your asthma symptoms daily so that you can see the effect that the techniques are having on you. In addition to symptoms (including peak flow) and medication, I would also recommend that you rate your levels of stress/anxiety, emotions, severity, and effect on your quality of life, roughly in line with that which is monitored in a research study.
Relax. Spend some time tuning in to your body and releasing any tension that you might have. A favourite technique of mine is tensing the muscles in your feet then relaxing them off, and systematically working your way up through the rest of the body. By tensing the muscles first, it makes it easier to relax the muscles afterwards. Relaxation can help your asthma in several ways. Firstly, stress and anxiety are known triggers for asthma attacks in some people. Secondly, when people are stressed and anxious, their breathing changes. Whilst this can be distressing for anyone, it is worse for someone with asthma. Thirdly, shortness of breath and hyperventilation that are triggered by stress, anxiety and/or panic attacks, can be incorrectly identified as onset of an asthma attack which can then actually trigger one as a result. So relaxation techniques can be used in a preventative fashion. They can also be used when someone is having an asthma attack. Asthma attacks can be scary and cause anxiety and panic which in turn exacerbates the asthma attack. Knowing how to relax and stay calm during an asthma attack allows you to be in more control of the situation and reduce its severity.
Practise specific progressive relaxation. This is a more specific extension of the previous point. Whilst general progressive relaxation can be useful, it would also be advisable to focus the relaxation more locally on the respiratory tract (Erskine & Schonell, 1979). When I work with people with IBS, I often use a deepener which focuses on relaxing each part of their digestive system. Something similar could be used with the respiratory system with particular focus on the bronchi, which are the main part of the lungs affected in asthma.
Safe Place Imagery. Various asthma studies had their participants imagine being in a ‘safe place’ where their breathing is undisturbed. If you experience allergic asthma, especially if it is pollen, dust or mould related, you can expand on this by imagining that your eyes, nose and throat are feeling comfortable too as per the self-hypnosis research for asthma and hayfever. (Langewitz et al, 2005)
Breathing techniques. I typically recommend breathing techniques to clients for stress and anxiety but because breathing is something that can be disrupted in asthma, I wouldn’t want to recommend specific techniques to practise in case it makes your asthma worse. Some techniques supposedly help with asthma, although there is mixed evidence surrounding them. As such, if you wish to pursue this avenue, I recommend speaking to your asthma nurse or doctor.
Be aware of your thoughts. You might be worried about your asthma and have unhelpful negative thoughts which add to your stress and anxiety. Building your awareness of thoughts is where it all starts. You can only start to make a change to the way you are thinking, once you become aware that you are thinking in an unhelpful way. When you spot negative thoughts relating to your asthma, you can then choose to think about it differently or about something else entirely.
Monitor negative thoughts about asthma. In addition to contributing to stress and anxiety, negative thinking about your condition can impact your behaviour, especially concerning whether you take their medication properly or not. Make a note of your negative thoughts about your asthma, as well as when and where you have the thought and what you were doing at the time. What did having the thought make you do (or even not do/avoid)? This can be a really useful exercise to see the types of thoughts that come up and what causes them to occur. You can then start to dispute the thoughts, perhaps by noticing where the thought gets you and looking for what evidence you have for and against it. By disputing and restructuring your thoughts, you can make more rational decisions about your medication and take it as prescribed as well as gaining a healthier perspective on your condition, its impact on your life and prognosis for the future.
Imaginal exposure. Spend some time imagining having an asthma symptom of some kind. Not all the worse case scenarios nor a textbook case of the symptom but a more realistic representation of what happens. Imagine it as if you are there. It’s important that you are nicely relaxed while you do this. Notice the discomfort that you’re experiencing as you imagine it, how it plateaus and then starts to diminish the more you imagine the scenario. As mentioned above already, people often experience anxiety and panic when they have asthma attacks which can also lead to anticipatory anxiety about having one in the future. Many of the research studies use a technique like this their with participants, working on a hierarchy of increasing asthma symptoms (Yorkston, Eckert, McHugh, Philander & Blumenthal, 1979; Moore, 1965), in order to reduce down this fear and therefore their overall anxiety levels, as well as helping them to manage better if they do have an attack.
Practise self-acceptance. People often struggle to accept the impact that a chronic medical condition has on them. However, fighting against it can be detrimental to your health, especially if lack of acceptance interferes with you taking your medication as prescribed. Some techniques from Acceptance and Commitment Therapy (ACT) could be beneficial to help with feelings and thoughts you might be experiencing. Self-acceptance allows you to realistically appraise what’s happening in your life, providing some perspective. It helps you to gain control of your condition so that you can live a satisfactory life despite having asthma. Here is the first blog post in a three-part series on ACT for more information.
Focus on your feet. This is a great distraction technique which helps to move your attention away from your chest and breathing. Quite often, asthmatics become hyper-aware of the sensations happening in their chest which keeps their condition in their mind more and may cause excessive worry and anxiety. Focus all your attention on your feet. Noticed what you’re noticing. How do your feet feel resting on the floor? Notice their weight, the contact points of your feet or shoes against the ground. What sensations are you feeling in them? Are they hot or cold? Can you feel your socks or tights against your skin? The support of your shoes at each part of your feet. Notice everything about your feet.
As you can see, there is much that you can do to assist you in managing your asthma. When I work with clients to help them manage their asthma, we delve deeper in to these techniques I’ve given above and explore other avenues too. When I work with clients with a medical condition, asthma included, our goal is always to improve their quality of life, acceptance of their medical condition, and to provide them with a healthier way of coping. Of course, it would be lovely to help with the symptoms of their condition but there is a limit to what can be achieved with hypnosis. Throughout therapy, we would be mainly focusing on the goal of achieving an improved quality of life despite having asthma and if their symptoms improve in addition to this, then that is a bonus.
N.B: It is imperative that you continue to consult with your GP and/or allocated asthma nurse concerning medication and action plan and that hypnosis should not be used as an alternative but as an adjunct to your existing treatment. If you wish to change or reduce your medication you must do so under the supervision of your GP.
Brown, D. (2007). Evidence-Based Hypnotherapy for Asthma: A Critical Review. International Journal of Clinical and Experimental Hypnosis. 55(2), 220-249 Erskine, J. & Schonell, M. (1979). Relaxation therapy in bronchial asthma. Journal of Psychosomatic Research. 23, 131–139
Kotses, H., Rawson, J. C., Wigal, J. K. & Creer, T. L. (1987). Respiratory airway changes in response to suggestion in normal individuals. Psychosomatic Medicine. 49, 536–541
Langewitz, W., Izakovac, J., Wyler, J., Schindler, C., Kiss, A. & Bircher, A. J. (2005). Effect of self-hypnosis on hay fever symptoms: A randomized controlled intervention study. Psychotherapy and Psychosomatics. 74, 165–172
Luparello, T., Lyons, H. A., Bleecker, E. R. & McFadden, E. R. (1968). Influences of suggestion on airway reactivity in asthmatic subjects. Psychosomatic Medicine. 30, 819–825
Moore, N. (1965). Behavior therapy in bronchial asthma: A controlled study. Journal of Psychosomatic Research. 9, 257–276 Yorkston, N. J., Eckert, E., McHugh, R. B., Philander, D. A. & Blumenthal, M. N. 1979. Bronchial asthma: Improved lung function after behavior modification. Psychosomatics. 20, 325–331