Four-hundred psychiatrists, psychologists, social workers and at least one hypnotherapist crowded into a Chicago-area hotel conference room to hear the most recent methods to diagnosis and treat the human brain. Daniel Amen, M.D., author of 20 books and one of a dozen psychiatrists in the world certified in nuclear medicine, presented the “Healing Anxiety and Depression” workshop.
Dr. Amen’s main diagnostic tool is a SPECT (Single Photon Emission Computerized Tomography). SPECT studies produce images of brain flow and activity. Compared to EEG, QEEG, PET and fMRI, SPECT images reveal more useful information about each patient’s brain. Doctors are now able to more accurately diagnose problems and target treatment to specific parts of the brain thanks to what they see SPECT pictures.
Knowing whether an area of the brain is working well, not working hard enough or working too hard is essential for proper treatment. If a region of the brain is working too hard, medication is given to make it work less, or if a region of the brain is working too little, then medication is prescribed to make it work harder. Frequently more than one region of the brain is malfunctioning; hence, doctors prescribe different medications to treat different areas of the brain. The choice of which medications to use depends on what doctors see in SPECT studies.
When two kinds of medication prescribed by her family physician did not alleviate her fear, Sherrie went to the Amen Clinic. Sherrie’s paralyzing fear of having an accident or hitting someone with a car stopped her from driving for 10 years. Dr. Amen graciously provided Sherrie’s before and after treatment SPECT studies for this article. The before treatment underside active view shows increased basal ganglia activity, especially on the left side.
The basal ganglia sets the brain’s idle speed. Automobile makers design car engines to idle when a car stops moving. If the engine idle is too low, the engine may quit completely when the car stops at a traffic light. If the engine idle is too high, the engine races and burns too much gasoline when it is not moving. The brain composes about 2% or 3% of a person’s body weight, and yet the brain uses 20% to 30% of the total energy expended. Hence, when people over tax their brains with excessive worry, they are literally wasting energy.
Sherrie experienced anxiety because her basal ganglia was overworking; her brain idled too fast. For a brief time, Dr. Amen prescribed Xanax medication. Dr. Amen’s basic philosophy is “Skills, not Pills.” Sherrie was treated with “systematic desensitization” and learned a deep relaxation technique, two methods hypnotherapists know very well. Three years ago Sherrie stopped taking pills. The after treatment underside view reveals Dr. Amen’s and Sherrie’s successful intervention. Her basal ganglia activity decreased overall, and Sherrie feels more calm, self-confident and safe to drive again. After setting a bone fracture, doctors follow up with X Rays to make sure the bone properly healed. Similarly, post-treatment brain SPECT studies, such as Sherrie’s, let doctors know if their remedies worked.
Seven Anxiety and Depression Subtypes
To date Dr. Amen has devoted 22 years to his research and performed more than 18,000 SPECT studies. He and Lisa C. Routh, M.D., co-author of “Healing Anxiety and Depression,” did something extraordinary and beneficial for the mental health field. They categorized anxiety and depression into 7 types. Amen and Routh noticed a strong correlation between what they saw in brain SPECT pictures and their patients’ mental health concerns. For example, if SPECT images showed an over active basil ganglia, most likely patients experienced anxiety, panic, avoided conflict or predicted the worst. If the thalamus, deep limbic region of the brain appeared too active in SPECT studies, patients often complained of cyclic mood swings, sensory overload or depression.
Drs. Amen and Routh saw patients whom doctors gave the same anxiety or depression label, but the patients had dissimilar brain SPECT images. Amen and Routh’s 7 subtypes include the traditional anxiety and depression symptoms; in addition, the 7 subtypes also have an extremely important element that enables doctors to more accurately identify and treat abnormalities, namely, SPECT studies indicating brain metabolism and activity. For example, generalized anxiety, panic disorder and post-traumatic stress disorder classifications do not specify whether over or under activity is occurring in any part of the brain. Knowing how each brain region is functioning is essential to prescribing proper treatment. Type 1 is pure anxiety; type 1 symptoms include nervousness, panic attacks, muscle tension, heart pounding, fingernail biting, etc. Type 1 treatment may entail any or all of the following: hypnosis, meditation, biofeedback, medications, supplements and what Dr. Amen calls ANT therapy, the elimination of Automatic Negative Thoughts.
Type 2 is pure depression. Persistent sadness, loss of interest, guilt, hopelessness and pessimism are some type 2 symptoms. Type 2 treatment involves ANT therapy, exercise, medications, supplements and better diet and fish oil to improve brain function. Both type 1, pure anxiety, and type 2, pure depression, have the word pure in them for a reason. Type 1 is called pure anxiety because only the basal ganglia region of the brain is improperly functioning. Type 2 is pure depression because only the limbic system is not working right. Type 3 is combination of anxiety and depression. SPECT studies show the basal ganglia and limbic systems improperly functioning for mixed anxiety and depression. Type 3 treatment combines the treatments of type 1 anxiety and type 2 depression.
Amen and Routh call type 4 over focused anxiety and depression. For type 4 there is a malfunctioning of the anterior cingulate region of the brain, plus an abnormal limbic and/or basal ganglia. The brain’s basal ganglia and limbic system account for the anxiety and depression component of type 4, and the cingulate is responsible for the over focused aspect. The anterior cingulate works like a car’s gear shift. As cars with automatic transmissions speed up to 60 MPH, the transmission shifts from first to fourth gear on its own and down shifts automatically when the car slows down. People with an overactive cingulate have problems shifting from one thought, feeling or behavior to another. When the cingulate over works it is as if people are in fourth gear when they need another gear for comfort and ease. The over focusing that is characteristic of excessive cingulate activity may lead to obsessive compulsive disorders, anorexia, agoraphobia and addictions.
Cyclic anxiety and depression is category type 5. Cycles of mood changes, decreased/increased sleep or energy, inappropriate social behavior, irritability or aggression are some type 5 symptoms. Type 5 problems include bipolar disorder, PMS and SAD. Cyclic anxiety and depression appear as reoccurring hot spots in the basil ganglia and/or deep limbic system. Type 5 treatment must be designed to each patient because the causes and timing of the basil ganglia and deep limbic system running hot vary from one person to the next. Drs. Amen and Routh took brain SPECT images of women with PMS during symptomatic and non-symptomatic times. The brain SPECTs varied according to what time in the menstrual cycle the images were taken. SPECT studies done at different times of the menstrual cycle clearly show PMS is both biological- and brain-based. Type 6 is temporal lobe anxiety and depression. In SPECT studies the temporal lobe and limbic and/or basal ganglia appear abnormal. Intermittent explosive disorder, such as road rage, some kinds of panic attacks and learning disabilities are examples of type 6 problems. Type 6 symptoms include short fuse, rage reactions, periods of panic or fear for no reason, headaches, forgetfulness and memory problems. Dr. Amen reviewed more than 50 murderers’ brain scans and observed an over-working left temporal lobe is common for criminals with violent tendencies. On the other hand, people who regularly meditate have a hot right temporal lobe in brain SPECT images. The right temporal lobe is often referred to as the “God Spot” because prayer and meditation are associated with increased right temporal lobe activity.
Type 7 is under focused anxiety and depression. It stands to reason that if type 4 over focused anxiety and depression occurs, then under focus anxiety and depression also happens. Under focus anxiety and depression is the result of too little activity in the brain’s prefrontal cortex, plus excessive activity in the basil ganglia and/or deep limbic system. The prefrontal cortex is the executive center of the brain. It is responsible for attention, span, forethought, impulse control, organization, motivation and planning. People with an under active prefrontal cortex report being inattentive, bored, off task and impulsive. ADD, ADHD and chronic fatigue are some of the more severe type 7 problems.
Clinical Hypnotherapy Examples
Hypnotherapists are unqualified to diagnose anxiety and depression and treat them with drugs. Because many of our clients come to us complaining of anxiety and depression, it is important to know as much as we can about these ailments. Furthermore, many clients want to quit smoking or lose weight when they are self-medicating their anxiety and depression with cigarettes and food. If we help clients alleviate their anxiety and depression, it will also help them with their other therapeutic goals. It is our duty to educate our clients when information will potentially help them, and we have a responsibility to refer clients to other health care providers when referrals are in their best interest. Knowledge of the brain and 7 new anxiety and depression types enhances our hypnotherapy skills and services.
Drs. Amen and Routh’s “healing anxiety and depression” information has helped me assist every client I’ve seen since I took Dr. Amen’s workshop and interviewed him for two cable TV shows. In the following four clinical examples, I explain how the recent information about the brain aided my understanding of my clients and helped my clients understand their own problems. I omitted the more traditional hypnotherapy practices because it was not the focus of this article. I did not tell my clients the anxiety and depression type I thought they may have, but each one appreciated me supplying them with information about the brain. Initially, Roseanne came to my office for a past life regression. She wanted to know what she did in a past life that caused her to feel depressed and unable to achieve an orgasm in this life. Roseanne was forty-two years, recently went through a bitter divorce and mother to two children under the age of four. She had seen countless psychiatrists and psychologists prior to our appointment. At my encouragement Roseanne attended Dr. Amen’s workshop. Here is what she wrote in an e mail. “I wanted to let you know I found a passage in Dr. Amen’s book where he says lots of people with ADD try to self medicate with coffee. Yesterday I was evaluated by a psychiatrist to make sure I was on the right depression meds, and to see if he thought I had ADD. Bingo! I do! That explains so much to me…. So, I was right, Jay. You did change my life for the better – only not the way I had anticipated (with hypnosis).” Roseanne’s depression and pre-orgasmia were suggestive of limbic system troubles and ADD is a sign of prefrontal cortex problems (Type 7: unfocused anxiety and depression).
Robert is a brilliant fifty-one year old physician who originally came to see me when a judge threatened him with contempt charges for courtroom outbursts during his contested divorce. After his divorce Robert had a few more sessions to reduce his eating and alcohol consumption. A year later Robert returned when he feared losing his job; the nursing and hospital staff complained about his rude and inappropriate remarks. Robert’s social skills were the issue, not his medical ability. Robert intuition was correct; two weeks after coming back to my office, Robert lost his job because of hospital cutbacks. I loaned Robert my copy of Dr. Amen’s “Change Your Brain, Change Your Life.” Robert’s poor impulse control, improper comments and conflict seeking were signs of prefrontal cortex problems. Furthermore, Robert said, “I saw my frontal cortex all shriveled up like a prune in a CAT scan.” Most likely Robert injured his brain at age 13 when he fell into an empty swimming pool and was knock unconscious. Recently Robert took a position in a new hospital and is continuing hypnotherapy to improve his social skills.
Paula is a very likeable forty-six year old wife and mother of two boys, ages 9 and 7. Paula holds a graduate degree from an Ivy league college, and recently left a very successful 20 year marketing career to be a full-time mother. As with her grandmother, mother, and older sister, Paula suffers from near constant anxiety. In addition, Paula has never had an orgasm. After reading “Change Your Brain, Change Your Life,” Paula expressed interest in how Dr. Amen uses SPECT studies to help married couples. Paula has a solid marriage, but she is seeking to improve it. Most likely, Paula’s anxiety is related to a hot basal ganglia, and her sexual dysfunction, to a cool deep limbic system (Type 3, mixed anxiety and depression). Paula changed her diet and started taking supplements according to the recommendations in Dr. Amen’s book. Both Paula and her husband are considering SPECT studies to get a better understanding of what is going on inside their brains. Jerry is a financial advisor who for the first time in 2003 earned more than $100,000 in a year. Jerry grew up in a poor family, refuses to speak to his only brother, and forces himself to sit through dinner with his parents twice a year. Increasing his yearly income was the primary purpose of Jerry’s visits; however, the necessity of addressing other behaviors immediately became obvious to both Jerry and I. Jerry’s poor concentration during reading, procrastination of important paperwork and a highly disorganized office and home are all signs of prefrontal cortex problems. The grudges Jerry is holding for his brother and parents over the way they treated him 20 years ago is indicative of something wrong with the anterior cingulate. Jerry bites and picks at his fingernails and complains of anxiety, which indicates basal ganglia problems. In addition, ever since Jerry was a teenager he had trouble getting out of bed in the morning. Jerry said he could not recall being knocked unconscious, but during a somnambulistic trance, Jerry remembered falling off the top bunk of a bed and waking up in the hospital after having his head wound stitched up. No wonder why Jerry had trouble getting out bed in the morning! If you or I had fallen several feet off a bed and knocked ourselves unconscious, we, too, would slowly exit our beds. Because of his openness, willingness to accept responsibility for his actions and desire to improve, Jerry has made significant progress during his three months of hypnotherapy. Jerry is also reading Dr. Amen’s book and is trying some of the recommended supplements.
The Future of Hypnotherapy
Doctors targeting treatment to specific regions of the brain does not make hypnotherapy obsolete. Quite the contrary, it is only a matter of time before SPECT images prove hypnotherapy changes the brain for the better. Many of Dr. Amen’s recommendations in “Change Your Brain, Change Your Life” involve learning coping skills that we current use with our clients, namely, ANT therapy, breath work, hypnosis and visualization. Three years after stopping her medication, it is Sherrie’s relaxation exercises, not the drugs, that keeps her brain functioning normal (See Sherrie’s before and after images). Researchers proved cognitive therapy alone, without drugs, improves the brain function of people who were diagnosed with obsessive-compulsive disorder. If cognitive therapy transforms the human brain, then, indeed hypnosis must also positively influence the brain. Because hypnosis is so effective at rendering unconscious behaviors, conscious, hypnosis is a very potent form of cognitive therapy.
Throughout its history, hypnosis has gone through periods of acceptance and rejection. Hypnosis is now so widely accepted and practiced, I doubt hypnosis will ever be rejected again. Sound medical research and the understanding of the brain are two of the many reasons why hypnosis is on a more secure path than it has ever been. A Sept. 14, 2003 Wall Street Journal headline read, “Hypnosis Goes Mainstream,” “Major Hospitals Use Trances For Fractures, Cancer, Burns; Speeding Surgery Recoveries.” The popularity of hypnosis will continue to rise; hypnosis works quickly, the cost is inexpensive, the results are effective and long lasting, and there are positive, not negative, side-effects.
For hypnotherapy to continue its upswing, each hypnotherapist must do his or her part. Because of some lingering fears and misconceptions, the ethics, standards and performance of one hypnotherapist may reflect our entire profession. Applying the recent information about the human brain and human behavior is one way to collectively raise our professional bar. Dr. Amen acknowledges the benefits of hypnosis; he supports our work and we should definitely support his—it’s to our benefit. Remember, do not diagnose your clients’ brain for them, and avoid the temptation to recommend supplements. Refer clients with moderate to severe problems to a medical doctor, and encourage your clients to read Dr. Amen’s books; let them play an active role in their recovery.
Amen, Daniel G. Healing Anxiety and Depression. New York: G.P. Putman’s Sons, 2003 Amen, Daniel G. Change Your Brain, Change Your Life, The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness. New York: Three Rivers Press, 1998