Distributive Behavioral Therapy Hypnotherapeutic Treatment

Question: Describe about the Case Study of Distributive Behavioral Therapy for Hypnotherapeutic Treatment. Answer: Case study 1- Hypnotherapeutic Treatment (DBT) for Anxiety This case study examines the use of distributive- behavioral technique (DBT) which is a type of hypno-therapeutic treatment in detail. Mrs. X, 60 years old woman has come for DBT treatment due to anxiety. This case study explains about the patients profile, history of the patient, coping skills and weaknesses, physical, emotional and sensory problems to determine and create the basic foundation for implementing best treatment modality (Defazio, 2010, p. 34- 47) by using an eclectic hypno-therapeutic method to treat anxiety disorders (Bogels, 2010, p. 168-189). The data obtained from Mrs. X based on the various sections of hypnosis will help to work towards achieving the positive and realistic goals (Robbins et al, 2009, p. 1163-1184). In this case study, an evaluation of the existing psychological- analytical issues related to anxiety of Mrs. X will be done and clear understanding of the social, cultural, economical, environmental and personal life aspects relating to anxiety of Mrs. X will be achieved. The aggravating factors for anxiety that has affected the daily activities of Mrs. X were discovered. Hypnotherapy is an effective treatment used to control anxiety that helps to align the hypno- cognitive and behavioral therapies. It aids in adjusting the un-wanted behavior as an appropriate interventional strategy (Green, 2014, p. 199-212). The sessions included in this case essay is based on evidence- related practice for managing Mrs. X by using DBT in treating her anxiety (Robbins, 2009, p.1163-1184). Background information In 2005, Ajzen states that an individuals behavior is affected by the factors that exert their effects on it. Therefore the background information is clearly discussed here. Mrs. X is a 60 year old woman lost her very caring husband six months before due to a road traffic accident in front of her. She has two sons and one daughter. Her elder son lives away from her in other city, who visits her once in a year and younger son lives in other country and rarely visits her. Her daughter, Karen visits her once in 2 months. She lives alone and feels isolated as no one is there to take care of her. She tends to forget even the basic life activities which makes her feel unworthy. She has lost all her confidence and feels isolated. Her husband was her best friend and she misses him very much. She has only 2 friends and will talk to them over phone rarely. Previously, she worked in a large organization in a managerial position and loves to work but she couldnt work because of her illness. She is unable to adapt and cope with the stress existing in her life. She expresses that she is not able to concentrate in her life activities. Mrs. X states that when she thinks about her life, she will start taking short- breath, shivering, sweating excessively, pounding heart beat, butterflies in stomach, heart-burn, flushed and feels nauseated to the point to vomit and as an impending doom (Beyondblue, n. d.). She expresses that she is burden to her family and world and wanted to commit suicide. Her neck becomes stiff and has pain in shoulders, back and neck. She always feels tensed and anxious unnecessarily. She has no goals in her life and is ready to die. She has sleeping disturbance and gets night- mares, panic attacks, jitters, wobby legs and feels exhausted, tired and unable to go for a walk like before (DSM-V, APA, 2013). Her heart rate: 86 beats/ mins, respiratory rate: 24 breaths/ min, blood pressure: 150/ 100 mm Hg is increased. She smokes cigarettes (5/day), drinks alcohol occasionally and uses cannabis regularly. She is a know case of diabetes, asthma and hypertension for past 20 years and is on drugs. Her mo ther was having anxiety and took anti- anxiety drugs. Problem Description Mrs. X shows behavioral symptoms as with-drawn features, avoids situations as consulting a doctor for health and forces to rituals to relieve anxiety. She is not assertive and avoids eye contact during conversation. She is unable to take decisions and startles frequently. She has physical symptoms as racing heart, shortness in breathing, vomits and regurgitates often. She complains of stomach pain and heart burn at times of anxiety. She guards neck, shoulder and jaw by expressing as pain (DSM-V, APA, 2013). She looks much tensed and is detached to her environment. She has difficulty in sleeping due to night mares. She has increased sweating, shivering and difficulty to concentrate. She has hot flushes and numbness with tingling sensation in both legs. She always feels light headed and faints. She expressed her altered thoughts as I am doing crazy things, I couldnt control my-self, I am going to die now, I wont live, others are always talking behind me, having terrible dreams, getting flashback of my husbands death, unable to stop worrying and unwanted thoughts. She has feelings of fear when seeing her husbands photos, hospitals and watching sensational scenes in television. She expresses that she has medical problem that is undiagnosed and worried about health condition. She is feeling dreadful and bad thing is going to happen. She is constantly tensed and nervous and has panic attacks that are un-controllable. Understanding of the problem Analyzing the history of Mrs. X, suggests that she demonstrates the features of anxiety disorders specifically generalized- anxiety disorder. The features of anxiety will be expressed for at least 6 months which is evident in the history of Mrs. X (DSM, V, APA, 2013). According to DSM criteria, the people with anxiety will be worried if they visualize or think about aggravating situation. She meets this criterion as she gets anxiety when thinks about her husband. She is unable to control her worries, physical symptoms, fatigue, difficult to concentrate, disturbance in sleep, tiredness as per DSM- V criteria. These features cause impairment in functioning and not meeting daily activities which is similar to X. She is a known case of performance anxiety which all suggests that X has anxiety disorder. Normally, anxiety occurs due to the arousal of the sympathetic- nervous system to trigger fight/ flight response and it is counteracted by the para-sympathetic nerves to restore homeostasi s and maintain equilibrium of a person when trigger is relieved (Gurgevich, 2016). If there is alteration in the serotonin synthesis, this nervous mechanism will be altered leading to continuous anxious state exhibiting its symptoms. Intervention Various psychotherapies should be given to X with anxiety as cognitive hypnotherapy, cognitive-behavior, inter-personal and cognitive-mindfulness therapy (beyondblue, n. d, 27). X should receive cognitive therapy to modify her feelings of anxiety, suicidal and negative thoughts by altered cognitive response (Segal, 2013, p. 12). She should be given with supportive therapies as reassurance, motivation to express her emotions, behavior training, relaxation techniques, etc. Individual and group therapies will help to divert her mind but engaging her in group therapy might be difficult (Fehr, 2016, p. 12). It could be overcome by promoting mutual relationship with the group members. Family therapy, behavior therapy with social- skills and assertiveness training should be given to overcome anxiety symptoms. Case study: 1 Cognitive-behavioral form of hypno-therapy (CBH) is the basis for modern hypno-therapy and hypno-psychotherapy.It is a type of hypnotherapy that combines the oldest concepts and techniques of hypnosis with modern theories of cognitive-behavioral science and cognitive behavioral technique.Hypno-therapy is useful in removing the disruptive thoughts (schemas), which is responsible for altered behavior and hence called as DBT (Bretherton, 2014). DBT helps to develop optimistic ideas, alleviate previous traumas, modify themselves and remove worst experiences (Walters, 1993. p. 37). At the beginning, the hypno-therapist and Mrs. X has to discuss and identify the negative schemas leading to challenging behaviors. This could be done by hypno-therapeutic sessions and/or talk- therapy (without hypnosis) (Bretherton, 2014). In this, the patient will be directed access to schema linked with this behavior. After identifying the negative schema, the therapist and patient will explore the causes of altered behavior as the nature of schema, thoughts associated with it, method of influence of schema on thoughts, emotional reward associated to supporting the schema to understand the associated components in schema (Bretherton, 2014). The advantages of this method is to relax and alert the patient, reduce distractions, eliminate negative thoughts, to get exact and clear answers and unfold the thoughts of the patient. After mapping the schema, the hypno-therapist will introduce suggestions to patients (hypnotized) and encouraging her to identify and trace out the schematic changes, which may lead to positive behaviors (Jensen et al, 2014). If a patient mentioned that only a depressed person will believe the thinking that has driven the schema, then a hypno-therapist may suggest the patient, which he/ she note for the way to gain happiness in his/ her life regularly. The hypno-therapist should confirm the altered schema by asking for yes response from the patient which is expected. DBT will aid to change the behavior within hypno-therapeutic context. The various steps of disruptive- behavioral technique are as follows. First step involves recognition of the behavioral pattern that aids to focus on it. Usually, the client himself will report to the therapist about their problems. But sometimes, the framed goal of therapy might not be adequate goal for inducing therapy. However, as with any hypnotherapy, the stated goal of therapy may not be the same as the actual goal. At times, the clients may request hypnosis for more concrete problem, which is limited/ differently considered than the real problem requiring assistance (Bretherton, 2014). Example: a patient with struggle in work and needs assistance for work stress might not understand that the work- behavior occurs due to the ignorance of other related issues, which might required to be solved well before those work- behaviors could be balanced. It is important to define the existing problem requiring solution appropriately. Because of this, the brain state could be noted clearly to have work- anxiety and appropriate measures could be taken. It has to be investigated before proceeding with hypnosis as it will reveal the importance of preparatory session of therapy that may help the patients to set goals for therapy in safest and non judgmental area. The next step involves discovering of main behavioral triggers. In this, the hypno-therapist and patient should work to-gather to find out the negative- schema that is linked with mal-adaptive behavior. Similar to cognitive- behavioral therapy (Cully et al, n. d.), DBT also involves identifying the framed problem clearly and circumstances under which it arises will give clue to solve the mal-adaptive behavior. It has to be done in trance- state in order to identify the structure as well as framing of schema. Many questions has to be asked to be address mal-adaptive behavior as the nature of schema, thoughts attached to that, context of schema, method by which the behavior is produced, type of event and environment that triggers the activation of schema and outcome of the mal-adaptive behavior that results due to schema. Body- talk is usually used in this session. Then appropriate aspect of the behavior and triggers should be identified (Bretherton, 2014). Understanding the clients language for key problems will ease the acceptance of schema. As it reduces the cortexs (frontal and parietal) involvement in understanding and processing the negative schema that is presented, will reduce the cognitive burden to ease the patient to think about the negative- schema, triggers and behavior. It benefits the therapists by helping to identify the patients primary (sensory and representational) system, and to frame the schema in the acceptable language. Due to this, the hypno-therapist will speak little to the frontal- cortex of the patient but more to the aspect of intuition. The next step is to identify the newer behavioral pattern to change the negative- scheman (Bretherton, 2014). The hypno-therapist and patient will work with mutual- trance to identify an acceptable behavior, which helps to redirect the beh avior response to any triggers making them to travel in a varied neural-pathway. The hypno-therapist will encourage the patient to identify the behavior that is plausible- response for a trigger, satisfies emotional needs and induces a varied behavior. Then, post- hypnotic suggestion will be embedded (Bretherton, 2014). In this, a good response to the triggers will be identified and the patient will be encouraged in adapting the newer behavior and remove the older schema. It is the most effective step. The final step involves helping patient to develop a newer behavior for daily life. Transcript of a section of therapy in general I want to spare 5 10 minutes to tell you about the approach. Generally, it is based on the observation of many people what our emotions feelings as well as behaviors in a specific situations follow from how we will think regarding these situations. My aim is to make you to understand as the way how you visualize the things especially important things in your life which is related to anxiety and to assist you to look at these behaviors objectively. We will try to analyze your behavior and modify it appropriately. Lets try to view the possibilities and change anxious feelings to help you to live a sound life. Outcomes The hypno-therapist will frame a post-therapy hypnotic suggestion with instructions what the behavior the patient will show after termination in the own language of the patient. It helps to accept, absorb and embed the newer behavior. It helps to transfer the older schema with a new behavior. It reinforces the neural pathways and develops stronger associations that are needed to change a behavior. The hypno-therapy session will help the patient to alter the older behavior, control the trigger and help the patient to develop newer behavior to adapt to the situations. It will help the patient to use the newer understanding to the world and control the triggering. Case study 2 Disruptive behavioral technique is best modality for anxiety in elderly people. The brain with anxious stimulation functions in a persistent highest state of alertness, which exhausts both brain and body. The amygdale, frontal- cortex as well as HPA will operate at a highest rate whereas the regulation of dopamine primes the negative valence attachment to experiences and there is an increased secretion of gluco-corticoids in the body (Bretherton, 2014). Based on the neurological aspect, the aim of the therapy lies in the restoration of normalized inhibition of HPA arising from hippo-campal region and to stop the feedback that arises from the frontal- cortex thus activating amygdale (Bretherton, 2014). It will also help to up-regulate serotonin, which helps to balance the activity of dopamine. As the deeper relaxation is already linked with hypnosis which is highly beneficent in interrupting anxiety cycle, the main aim with disruptive- behavioral therapy should be to change the respon se of the patient to the inducing triggers of anxiety and helps to distract and calm Mrs. X. The introduction of memories that relaxes Mrs. X will help to restore the hippo-campal areas inhibition and reinforcing the self-esteem behaviors, which will up-regulate the serotonin production will aid in anxiety relief. DBT is also used for lower self esteem in case of anxiety. Absence of self esteem will make an individual to become labile, highly stressed whereas good self esteem will enhance memory and cognitive- flexibility because regulated serotonin levels are extremely important for self-esteem (Bretherton, 2014). The lower self-esteem is connected with dis-regulation of orbito-frontal cortex as well as hippocampus. DBT helps to re-frame her helplessness as hypno-therapy is a plastic-state (Alladin, 2007). The lowered self-esteem with associated anxiety and depression lies in 4 perpetuating- schema as stable (cant be changed), global (linking to scenarios, events), internal (personal characteristics) and overwhelming (cant be controlled). Due to its neural plasticity, hypno-therapy is used to increase empathy (from mirror- neurons activity with attached support), relax, and reduce the involvement of ACC and stimulation of hippocampus with the sense of feeling good after an anxiety state. Moreover, DBT helps to destroy the older schema and replaces it with newer schema (Bretherton, 2014). It directs the neural pathway of Mrs. X to become anxious state to a newer neural pathway. DBT helps to relieve anxiety and low-esteem by introducing newer schema in many ways. It may help Mrs. X to recall her pleasant memories with husband and children as it will stimulate hippocampus that helps to destroy the negative schema and replace with constructive schema. It could be used in a traditional way to guide to explore better ways. DBT will help Mrs. X to identify the causes for anxiety behaviors and the ways to modify it. As DBT instills the newer behavior in the mind of Mrs. X, DBT is used for her. The study proposed by Raichle (2001) shows that hypnosis helps to make cognitive and behavioral modifications and reveals about differences in performance. DBT was selected for Mrs. X as she showed more behavioral features with feelings of with-drawn, isolated, no one is there to take care of her and avoiding behavior. DBT will aid her to replace her newer features with older pleasant memories by stimulating hippocampus. Further, she has no assertiveness and didnt keep eye contact while speaking and hence DBT is used to promote assertiveness (cognition). Posner (2007) states that hypnosis will guide to clearly understand the brain- systems and neural networks that arises due to the activation of specific part of brain through the analysis of cognition and emotion. So, DBT is used for X to understand her neural networks to re-direct it to newer pathway. As X is not performing her daily activities, DBT will help to understand the reason for it. Tang (2009) suggests that hypnotic state will help to maintain more connection of anterior-cingulate and para-sympathetic nerves which confirm that hypnosis is a best management method in anxiety relief. In 2009, Kounios states that hypnosis helps to identify the state of brain affecting in-sight achievement during problem- solving which confirm that DBT is best suited for X. The sensorial and sleep disturbances will affect the brain- state ultimately affecting the performance. Mrs. X with sleep disturbance will identified by hypnosis to improve her performance and relieve her physical symptoms. Anxiety varies based on the ageing of brain- networks and hypnosis will help to trace it accordingly (Kounios, 2009). Thus, DBT will help Mrs. X to relieve from behavioral symptoms which will in-turn relieves physical, emotional symptoms with oriented thought process. It will destroy her older behavior and introduce newer behavior. I thought that, DBT could be best used when a great inter- personal relationship is maintained with the client. Maintaining rapport will help to gain co-operation with anxiety patient and aid to improve concentration during the procedure. Gaining attention from anxiety patient is much difficult and hence rapport will gain attention from these patients. The conscious cognitive development of rapport will aid in the sub-versive un-conscious reaction for this therapy (Murdin Errington, 2005). The trust factor helps the patient to relax easily, pay attention and ventilate their positive and negative emotions freely. According to me, maintaining rapport is most important to practice DBT as it involves triggering the personal factors to analyze the source of anxiety. As a therapist, I have conducted the session only for 45 minutes which is adequate to gain attention and express her thoughts and behavior. I was able to collect both positive and negative behavior. I have maintained good rapport with eye contact. I have induced slowly with past memories. I have gathered all the triggering factors of her anxiety. First, I have started form herself from childhood, her parents, husband, children and her social relationship. I have asked about presenting symptoms and debilitating factors. From the conversation, I was able to understand that she is alone and feels isolated. I have analyzed that she is affected by her husbands memories who has passed away recently and no one to take care of her. She has expressed her feelings of worthlessness, inability to concentrate, unwilling to live and unable to perform her basic activities. This helped me to help her to recollect positive memories with her husband and children and methods to overcome triggers. I hav e given 10 sessions individually 3 times in a week for 45 minutes. I have targeted on her attention, memory, self- esteem, working, concentration and self- control and suggested clues to modify it (Jensen, 2014). These all increased the efficacy of DBT. While using DBT, the clients should be made to re-call positive memories and lowered self-esteem. Ask like traditional form of cognitive- behavioral therapy (CBT), a guided exploration is needed in trance to help them to be aware of the methods to remove anxiety and lowered self- esteem. CBT with DBT will add values for the therapy as they involve both in modifying the behavior by destroying older behavior. The suggestions during hypnotic as well as post- hypnotic period could be used to guide patients with positive behaviors, which are triggered by certain events. Repeating and reinforcing the suggestions will activate the mirror neurons to conceptualize it efficiently. Repeated therapy sessions with introduction of various disruptions will down size the negative schema and maximize positive schema. Transcript of a session It is a most beautiful cold day with a lovely morning snow. You have stepped into a forest which is looks amazing with green trees.., blossoming flowers, birds, and walking through an oldest path of the forest towards the meadow. You are walking a long distance.. The meadow keeps stretching far into a great distance.. A slow and soft breeze waves your face, hair, cheeks.. you smell the sweet fragrance of a variety of colorful flowers which are bloomed.You see white color, red color, pink colored flowerswith butterflies sitting on the pollens.. sucks honeyhas multiple colors as greenish blue, violet.dark red antennae.. you have started to smile at your lipsone of the most beautiful butterfly..sits on your hands.you play with it..snow falls on your lips, face, hands.your lips looks as covered with the meadow you see around yousmall parrots.with light..greenish color..bright red.. beaks..flies in front of younear your facecircles you..sits on your shoulder.sees you..you smile at parrot parrot flies.and sits on a snow filed.tree.dark green trees..you love to sit at its branches..with flowers on it..you wanted to.pluck the flowers.as burden.in your life..keep burdens below.your feet..relax. again snow started falling.on you..you walk slowly..in the forest with meadowan orange flower..touches the legs.looks so lovely.you pickedup the flower.in your hand you smell it..smellsmell.relaxrelax..relax deeply.breathe deeply..relaxmove.out.your.. worries..relaxfrom.your.headbreath.deeply.relax your..face.nose..neck..shoulders..left.right.chest..your upper- backleft arm..right armabdomen..pelvic area..thighs.left.rightkneesleftright.. calvesfeet toesremove your worries.sufferings..fell.calm...relaxed..free of tensionsworries..sufferings..sun shine slowly on your back.you feel little warm..nicefeelings..you see a chimney..reddark redcolor.you walk..towardit..you seea terraceof a beautiful house..coveredwith snows.looks white.pure whitecoloryou see a chair..in front of it.black .colored..you siton it..think..about event..that makes.you feel anxious..tensed..send..thatevent.tothe.cloudsin.the sky.movingfastcarriesyour.your worries.sufferings.watchthe clouds..your worriesare movingits disappearing.disappearing.relax.relax..yourfeelingsof..feelings of. anxiousnessgone,disappearedyour are free from tension.free.your heart rate is regularrelaxed.see the snow.meltsslowly.as the sunshinesslowly on it..your anxiousness, worries..sufferings.meltsgradually meltsas ice. You see. a well you begin.. to walk. towards it ... walk closerand closer to its edge .....has 9 foot circles..leading to a ground..you kneel.downto look down.you feel cool breeze..keep coming from its bottom..smells as clean water you find stairs..in the inner wall of the well..you wanted to walk in the stairs..looks to have many stairs.like you with worries..many stepsyou wanted to walk through itlike you wanted to get rid of worriesanxiousness..you keep your right foot on the 1st stepyoulook there are 15 stepsyou look down..steps are.going deeper and deeper.. you seea clam..relaxed place..safe placefree form worriesyou step down.15.14 step.you place your right handon the rock walls..on the sides of the well.. rock walls with stonestoo soft to touch.too coldto touch.looks velvety.seems like old walls..you step into step 13you feel safe..you hold the walls nicely.you are excited to see the deep of the well.you step down one by oneto 12.you see you are nearing deep into the well..step 11.you gain confidencethat you can reach the well without sufferingsworrieslike you reach good outcomeafter sufferings in your life.you could see the inside of the well good than beforeyou step down to 10you are free from worries.you have left all your worriesyou are going to be free..from sufferingsyou step into987.you are closely nearing6..you are getting down..by holding the walls5..4.3you are too close to achieve your goal..2you are much excited..1yes only one step to reachto get rid of your worries and sufferings..then you step intothe bottom..you have achieved your goal.you see fresh smelling water.flows..flows.you see. water is flowing .to from a stream.You claim again into all the stepslike.you are destroying all the obstaclesyou are proceeding to leave all your worries..you have reached the top of the well. just then you see a stream of waterflowing streamrunning in between meadowwater if flowingrelaxrelax.let your worriesflow like a water..relax..water is runningyour worries are..running out from you.relaxits keep running..worries have goneit has completely gone..a boat comesnear you.small boat..no one is inside the boatyou tryto get into the boat.pull the boat..take yourright leg.keep it inside the boat.hold your hands properly on the boattake effortkeep leg inside the boat.you see a small benchyou siton it..very small bench..you paddle the boat..its moving..slowlyslowlyslowly.your anxiousness.sufferingsworries are moving out slowlyas the boat moves.your anxiousness.sufferings.moves out of youboat reaches...you are free from worries..slowly gaining consciousnessslowly open your eyes.. Research- academic articles- 1 Halsband et al (2009) has conducted a study on the plasticity changes in brain during both hypnosis and meditation. It states that hypnotic trance induction as modified states of consciousness that emphasize attention, concentration and the letting go of thoughts, but they differ in terms of sensory input, processing, memory, and the sense of time. Hypnosis is based on the suggestibility of a person. In this study, they have analyzed the shared as well as non shared neural- substrates by using electro-encephalography, positron- emission tomography and functional type of magnetic- resonance imaging (fMRI). They noted that there was most pronounced changes in EEG only during deep hypnosis rather than light hypnosis (step- by- step induction) which is similar to the hypno-therapy induction for anxiety. They found that meditation shows more pronounced alpha frequency waves at frontal areas especially in higher amplitudes whereas it is pronounced mostly in central and temporal areas durin g hypnosis. PET imagery suggest that, during hypnosis an increased activation in the cortex of occipital lobe cortex and pre- frontal regions were seen which implies that hypnosis is most useful to relive anxiety. Hypnosis improves the memory and performances which are needed for an anxiety person with increased shivering, sweating and poor concentration. The researchers suggests that hypnosis changes the effective connectivity relationship between fusi- form gyrus, anterior part of cingulated- cortex and intra- parietal sulcus areas which is useful to change the disruptive behavior of a person with anxious feelings. It suggests that hypnosis will help to modify the older neural pathway (showing feelings of anxiety) to a newer neural pathway that was introduced by the hypno- therapist (Bretherton, unit 6). This study gives a clear understanding of the neural pathways that underlies meditation and hypnosis. For an anxiety patient, hypnosis should be induced by the hypno-therapist by mutual trance induction to trace out both acceptable and un- acceptable behavior and the triggers of unacceptable behavior. It will definitely help to re-direct triggers of un- acceptable behavioral response to travel through a different neural pathway. Thus, hypnosis will help to identify the altered behavior, satisfy their emotional needs and induce a dif ferent behavior. The study findings suggest that, hypnosis will help to modify the features of anxiety with behavioral symptoms as withdrawn feature, avoiding triggering situations and physical symptoms as increased heart beat, shortness in breath, vomiting, etc. Further research is needed with large sample size to generalize the findings. The study findings help to treat anxiety through hypnosis by embedding the suggestions in the post hypnotic state (Bretherton, 2014). At this time, the better responses to a trigger will be noted and the client will be helped to move out the negative thoughts and to acquire new behavior. Hypno- therapy causes increased neural- plasticity, relaxation, increased feelings of empathy (which is from mirror- neuronal activity as well as an attachment- support), decreased stimulation of hippo-campus with increased feelings of well- being. Therefore, hypnosis is well suited to treat anxiety disorders and to replace triggers with sense of comfort, relaxed feeling with impro ved self esteem and self confidence. Research- academic articles- 2 Posneret al (2016) has studied about the relation between brain- states with hypnosis. This study has reviewed various research studies related to hypnosis. It states that hypnosis helps to understand the brain systems regarding hypnotic activities and neural networks arising from specific activations of brain based on the analysis of intellectual (cognitive) and emotional aspects is obtained by hypnosis (Posner et al, 2007). The study conducted by Raichle (2001) reveals that hypnosis helps to analyze the differences in performance of tasks. These findings suggest that hypnosis will be helpful to analyze various (cognitive and behavioral) aspects of anxiety. The study states that the brain state influences the psychological performance of a person that is related to his achievement. Hence hypnosis could be used to study the achievement of a person which is similar to anxiety person with poor achievement and performance (Raz et al, 2011). The hypnotic state maintains increased connect ivity of anterior- cingulate with para- sympathetic nerves (Tang, 2009) which proves that hypnosis is best management technique to relieve anxiety. It is evident from the above mentioned study by Halsband in 2009. The study by Kounios (2009) proposes that the brain- state affects the process of in-sight achieving at the time of problem solving. Even sensory and sleep deprivation will influence brain- states affecting ones performance. It suggests that hypnosis is needed to identify the brain- state affecting performance. The anxiety persons will have sleep disturbances and poor concentration affecting their performance. The control of cognitional and emotional response is based on brain- networks related to attention which may change with development that is related to parietal, frontal cortex and sub- cortical regions. It clearly states that sense of anxiety varies based on ageing of brain networks. The control systems during infancy are based on orientation to external- stimuli, w hich continues to adult stage and is dominated by an executive network that is controlled by a person's goal. So targeting control systems of infancy period will modify the anxiety behaviors. The transition in brain- control networks is based on the gene of a person as anxiety disorder is due to hereditary influence (Beyond blue, n. d.). Raz in 2005 has studied about the relation between COMT- gene and susceptibility for hypno-therapeutic suggestion. Many studies were conducted which shows that the variations in genetic make- up of the COMT- gene are highly related to the execution of attention, especially the ability of a person to solve the conflict. A longitudinal study also suggests that there is a great association between the changes in the COMT- gene with early development of a child and during 2 years old, this gene is found to be strongly related to a certain task (Voelker, 2009) that seems to include particularly the orientation network. These findings portrays that anxiety is mainly due to the genetic changes in COMT- gene and hypnosis is needed for these patients to gain attention and ability to solve problems. Personal reflection The present case of Mrs. X with anxiety disorder helps me to clearly understand about the type of history to be collected with previous medical history, family history, understanding the problems (physical, emotional, behavioral symptoms) and various interventions applicable for Mrs. X. It has helped me understand about Distributive- Behavioral Technique, its uses, process in anxiety and lower self esteem. I have learned about the steps of Distributive- behavioral technique and how to perform this technique in patients. I have also understood that it could be used for other disorders as depression, insomnia, etc for old age people. The article review of two articles portrayed the effect of hypnosis on brain state and brain- plasticity. I have learned about the technique of the therapy and how to get rid of anxious feelings for person. Overall, this case study helped me to conduct hypno-therapy treatment for persons with anxiety disorders. I am much confident in performing distributiv e- behavioral technique. Reference Ajzen I.Attitudes, Personality, and Behavior. England:Open University Press; 2005. 142 p. Alladin, Assen. Handbook of Cognitive Hypnotherapy for Depression: An evidence-based approach. Lippincott Williams Wilkins, Baltimore, Maryland. 29. p Anxiety and depression: An Information booklet. Australia: beyond blue ltd; n. d. 9, 12, 27, 30 p Bogels SM, Alden L, Beidel DC Voncken M. Social Anxiety Disorder: Questions and Answers for the DSM-V.Depression and Anxiety. 27: 168-189 p Bretherton G. UNIT 9- Tools in hypnotherapy. 2014. Australian Hypnosis and Training. Cully, Jeffrey A Andra L. A Therapists Guide to Brief Cognitive Behavioral Therapy: n. d. Defazio J, Jones J, Tennant F Hook S. Academic literacy: The importance and impact of writing across the curriculum a case study:Journal of the Scholarship of Teaching and Learning.2010; 10(2): 34-47 p. DSM- V. Diagnostic Criteria for Major Depressive Disorder and Depressive Episodes: American psychiatry association; 2013. 9. Fehr SS. 101 Interventions in Group Therapy [Internet]. 2016: 12 p. Available from https://www.google.co.in/?gfe_rd=crei=urcJWJ-BOazT8gerkoK Green JP, Laurence J Lynn SJ. Hypnosis and psychotherapy: From Mesmer to mindfulness. Psychology of Consciousness: Theory, Research, and Practice. 2014; 1(2): 199-212. Gurgevich S. Healing with hypnosis [Internet]. Available from https://www.healingwithhypnosis.com/self-hypnosis-articles/improve-your-skills.aspx Halsband U. Plasticity changes in the brain in hypnosis and meditation. 2009 Dec; 26(4). doi:1002/ch.386: 194- 215 p Jensen MP Patterson DR. Hypnotic approaches for chronic pain management: Clinical implications of recent research findings. American Psychologist. 2014; 69(2): 167-177. Jensen et al. Mechanisms of Hypnosis: Toward the development of a biopsychosocial model: Ibid. 2014 Kounios J, Beeman M. The Aha! Moment: The cognitive neuroscience of insight.Current Directions in Psychological Science.2009;18:210216. Posner MI, Rothbart MK. Research on attention networks as a model for the integration of psychological science.Annual Review of Psychology.2007;58:123.[PubMed] PosnerMI Rothbart Brain states and hypnosis research. Conscious Cogn. 2011 Jun; 20(2): 325327. doi:10.1016/j.concog.2009.11.008 18. Raichle ME, MacLeod AM, Snyder AZ, Powers WJ, Gusnard DA, Shulman GL. A default mode of brain function.Proceedings of the National Academy of Sciences of the United States of America.2001;98: 676682.[PMC free article][PubMed Raz A, Campbell NKJ. Can suggestion obviate reading? Supplementing primary stroop evidence with exploratory negative priming analysis.Cognition Consciousness.2011;20:312320.[PubMed] 20. Raz A. Attention and hypnosis: neural substrates and genetic associations of two converging processes.International Journal of Clinical and Experimental Hypnosis.2005;53:237258.[PubMed Robbins S.B Button C. Intervention effects on college performance and retention as mediated by motivational, emotional, and social control factors: Integrated meta-analytic path analyses: Journal of Applied Psychology. 2009; 94(5): 1163-1184 p. Segal V, Williams M Teasdale D. Mindfulness- based cognitive therapy for depression. [Internet]. 2013: 12 p. Available from https://books.google.co.in/books?id=w7yp8F3kpOoCprintsec =frontcoverdq=treatment+for+depressionhl=ensa=Xved=0ahUKEwjN1YGgq-vPAhXIz1QKHYHmAnIQ6AEIMzAA#v=onepage q=treatment%20for%20depressionf=false Tang YY, Ma YH, Feng HB, Hu B, Lin Y, Fan M. Central and autonomic system interaction is altered by short term meditation.Proceedings of the National Academy of Sciences of the United States of America.2009;106:88658870.[PMC free article][PubMed] Voelker P, Sheese BE, Rothbart MK, Posner MI, Rothbart MK. Variations in COMT gene interact with parenting to influence attention in early development.Neuroscience.2009;164(1):121130.[PMC free article][PubMed] Walters, Catherine Havens. Hypnotherapy for Health, Harmony and Peak Performance: Expanding the goals of psychotherapy. New York: Brunner/Mazel, Inc; 1993. 37 p.