Behavioral Problems

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Self-hypnosis skills have value largely as an adjunct in management of the wide range of 'behavioral problems', serving often to help a child and family to interrupt patterns of maladaptive behavior sufficiently to allow change to occur.

An approach to this group of concerns requires the establishment of specific objectives. These might include improved coping, allaying of anxiety, and facilitating improved self-esteem with the aid of self-hypnosis, rather than expecting problem resolution as one might reasonably expect in treating habits.

Children's anger or temper tantrum responses lend themselves easily to hypnotic intervention. Teaching self-hypnosis often gives a child something constructive, personal, and relaxing that he/she can do to help interrupt the anger, helplessness, and/or loss of control commonly accompanying tantrum behavior. Children quickly learn that when they practise self-hypnosis regularly when they are not having a tantrum, they are teaching themselves to get under control quickly 'when they really need it'.

Case History: Sarah

Eight-year-old Sarah was brought to the Behavioral Paediatrics Program Clinic for 'behavior problems'. These included picking on her 7-year-old sister and 5-year-old brother, disruptive behaviors at after-school day care, and defiance and anger outbursts almost daily in interactions with parents. She met criteria for a diagnosis of Oppositional Defiant Disorder, and had no ADHD or learning difficulties. Therapy for Sarah and her family included primarily behavioral management including family meetings and negotiation. For her angry outbursts, Sarah was taught self-hypnosis which included:

'With your eyes closed have an on-purpose daydream of yourself doing something you like a lot, ... really enjoy it in your mind as though it was happening right now. Maybe you'll be riding your bike with your friends ... When you're very comfortable imagining that, then turn on an imaginary VCR & TV in the corner of your mind. Let me know when it's on (she nods her head). NOW ... to learn something really neat and very important, watch a video from the other day when you were really upset and angry at home about something your brother did (she nods her head without being asked). Now, press STOP! on the remote controller and put on a video of happy, growing-up Sarah ... see how she's smiling, and look at how proud her Mom and Dad are ... and how proud she is ... Great!'

Sarah was taught a second way to manage anger: 'When you notice the mad feeling starting, see what colour it is, and what shape ... and picture a faucet in the side of that red triangle of angry. Now, turn on the faucet in your mind ... let the angry feeling run out of your thinking, down your face, out of your face into your neck, down your shoulder, and into your arm, and down into your hand. When the angry is all down in your hand, roll your hand into a tight fist, take a deep breath and hold it ... hold your fist tight while you count ... slowly ... down from five ... 5 ... 4 ... 3 ... 2 ... 1 ... 0 and when you get to 0 let your breath out slowly, that's right ... and feel yourself relax all over, and picture throwing the mad, angry feelings far away ... into the trash, or to outer space ... because there is no need for them now that you know how to relax ... Great! Look back in your mind and see what colour and shape the angry feeling changed to ... good ... see the colour and shape of feeling relaxed and comfortable ... and more controlled ... . And when you're calm like this, you can talk even easier with Mom and Dad ... .'

Analogously, self-hypnosis training focusing on control and relaxation is an effective adjunct in management of adjustment disorders, in building self-esteem through ego-strengthening, and as a key element of overall stress management.

A cooperative and informed involvement of the family may be accomplished by teaching parents about self-hypnosis (e.g., through a demonstration experience of hypnosis with themselves or through viewing of brief videotaped examples) so that they may understand what their child is learning. With this awareness and information, parents are so much more willing and comfortable with the subsequent request that they allow their child the freedom and autonomy to develop this skill at home without their reminders, interference, or unnecessary degree of involvement. This may include specific requests to parents to not remind children to 'practise' their self-hypnosis. To facilitate this, children are encouraged to call the clinician with questions that arise, with the focus that the clinician—and not the parent—is the 'coach' or teacher for the hypnosis practice. Such an approach promotes autonomy and allows room for continued development of the clinician-child relationship. This is both appropriate for and acceptable to most families with the exception of children under 4 or 5 years who may not be able to remember or be sufficiently autonomous to carry out self-hypnosis practice on their own. In these situations it is important that parents be trained to be the 'coach' at home, with guidance from the clinician. Parents vary in their acceptance and adherence to these guidelines, and management must be individualized.

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