Hypnotherapy for public toilet anxiety

I can never speak for all hypnotherapists, but I can tell you what I would do with hypnotherapy for public toilet anxiety. Usually, the first thing will be to take a case history. A case history is where I find out about you and your problem. What it primarily does is tell the me what approaches are going to suit you best.

Assessing the causes of public toilet anxiety.

From the case history I will look for both the cause of the public toilet anxiety and the factors which maintain it. Typically, a public toilet anxiety is based on one of three things:

1. Social anxiety.
2. Contamination anxiety.
3. Traumatic experience.

Having identified the primary cause, I will decide if that needs to be treated first or if I can move directly to symptom change. If I need to work with the initial cause I can help with approaches like EMDR, systematic desensitisation, parts therapy or a combination of these. This could be sufficient to solve the issue, but more likely some work changing the habitual and behavioural elements of the problem will be required.

Changing habits and behaviours.

Whatever the cause, public toilet anxiety tends to be associated with certain habits of thought and behaviour. Typically, these include:

• Anticipation of negative outcomes from using a public toilet. – This can be anything from being criticised for the sound or smell of bowel movements to experiencing violence. A therapist would look to change such thoughts, by processing old thoughts and introducing new ones.
• Lack of privacy. – Both bowel and balder are tremendously private organs and the awareness of being in public can inhibit their actions. Through a combination of suggestion, visualization and relaxation a hypnotherapist would look to decrease self-consciousness and help relax them into the toilet.

If you would like to begin addressing your public toilet anxiety please get in touch to book a free consultation.

The author

Dr Matt is a hypnotherapist who decades of experience who has a specialism in functional disorders and anxiety issues. He is a member of the BSCH and NCH

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• 14% of participants showed public toilets avoiding behaviours.
• Toilet avoidance was more common amongst women than men.

People who experience public toilet anxiety tend to avoid using public lavatories where possible. They may also adopt specific coping behaviours such as:

• Picking times to visit the toilet to avoid busy periods.
• Holding off bladder or bowel movements to an uncomfortable level.
• Cleaning public toilets with antibacterial wipes.
• Avoiding going to social events or being in public.
• Not travelling.

So why do people develop this phobia?

What causes public toilet phobia?

There are several potential causes and reasons why someone would develop a public toilet anxiety. These include:

• Lack of perceived privacy – Going to the toilet is an instinctually private activity for most people. There’s a reason we call it the privy and sometimes use disguising terms for it like ‘the smallest room’. As we appear to be naturally embarrassed by these intimate bodily functions it is no surprise that sometimes doing them in shared environments become an anxiety problem.
• Abuse experience – A lot of bad things happen to people in public toilets. School toilets are often a place where bullying and other abuse is carried out because there is no adult oversite. This is less common in adulthood and yet people still do have bad experiences in public toilets.
• Traumatic experiences – Loss of bowel, bladder control, excessively pungent movements or any number of upsets which may draw unwanted attention can be traumatising when in a public toilet.
• Contamination phobia – Many people are sensitive to potentially dirty environments and the contaminants and germs they may contain. Few environments are as wildly unpredictable in their cleanliness as public toilets, and sometimes they can be traumatically bad. As a result of this many people with only a mild tendency towards contamination phobia find they develop a toilet phobia. Knowles ( 2023) study found that 21% of avoidance was explained by contamination issues.
• Claustrophobia – public toilets are often poorly lit, poorly ventilated tight little spaces. This can trigger anxiety in people who are prone to claustrophobia and ultimately a wider fear of these spaces.

Can it be treated?

Very little research has been done into treating this condition. However, my experience as a therapist is that generally people who suffer from it make substantial improvements. For more on this topic read my blog – hypnotherapy for public toilet anxiety

The author

Dr Matt Krouwel PhD is a hypnotherapist based in Birmingham (UK) who specialises in treating anxiety and functional disorders. He is a member of both the NCH and BSCH.

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References

Knowles, S. R. (2023). Socio-cognitive processes are associated with parcopresis symptoms and public toilet avoidance in university students. Current Psychology, 42(3), 1762-1772.

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Very little research done into therapy for Shy bladder syndrome. However, a study of 101 people with shy bladder who underwent a weekend course of exposure therapy. These people were found to have significant benefits when followed up a year later (Soifer, Himle & Walsh, 2010).Personally I’ve found that most patients respond well to therapy. So what might I do to help?

Therapy approaches for pee shy / Shy bladder syndrome?

There are a few technique which I’d consider for Shy bladder syndrome. I would  take a case history from the patient and based upon this make some decisions as to what techniques to use. Sometimes a patient identifies a starting point to the problem or identifies that their internal voice is pressuring them. In these cases I consider what are called psychodynamic approaches.

Psychodynamic approaches in hypnotherapy for shy bladder syndrome

These are approach to resolve an internal conflict or address an unhelpful early life learning. This type of work could include such techniques as:

• Inner child work.
• Parts therapy.
• Regression to childhood.
• Eye movement desensitisation and reprocessing (EMDR).

Sometimes the original cause of the problem is no longer relevant, but the behaviour has become habit. When this is the case, a therapist can move to techniques which help to retrain the mind and body.

Therapy for direct change to habitual behaviours for pee shy patients

Such techniques may include:

• Systematic desensitisation – this is an approach in which the patient is mentally walked through going to pee in a public place whilst the therapist induces deep physical relaxation. In effect this retrains the body to be relaxed in a previously tense situation. This is similar to the graduated exposure therapy used by Soifer, Himle & Walsh, 2010 in their research, but many consider systematic desensitisation superior as it actively looks to retrain the body to be relaxed.
• Relaxation cues – A hypnotherapist may give suggestions to be relaxed as soon as you get in to position to wee.
• Flow visualisations – there are various visualisations which a hypnotherapist may use or teach. Typical examples may include such things as mentally seeing the urine flowing comfortably. A visualisation may be more abstract such as picturing the flow of a gentle mountain waterfall as its flows downhill.
• Amnesia suggestions – Light amnesia may be given for peeing so that you forget that you are in public or that there are people around you. These will be carefully crafted to fit the specific circumstances which affect you.
• Privacy visualisations – The therapist will come up with imagery specific to you which will allow you to feel more private when in public toilets.

Homework for Pee shy clients

Homework is likely to be a large part of therapy. Typically, homework would be negotiated with the patient. Mostly homework would involve:

• Practicing relaxation and self-hypnosis techniques.
• Using public toilets.

I hope this guide has helped you to understand what sort of things you may encounter if you presented to a therapist for hypnotherapy for shy bladder syndrome. To find out more or book in a free consultation please contact Dr Matt.

The author

Dr Matt is a hypnotherapist based in Birmingham (UK) with a specialism in functional disorders. He is a member of both the NCH and BSCH.

References

Soifer, S., Himle, J., & Walsh, K. (2010). Paruresis (shy bladder syndrome): a cognitive-behavioral treatment approach. Social Work in Health Care, 49(5), 494-507.

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• A specific form of public toilet anxiety.
• More common in men than women.
• Frequently accompanied by another anxiety issue.

How many people have shy bladder syndrome remains unclear. However, some studies have found that severe pee shy effected as many as one-in-seven of the people they asked. What is known is that it can impact people’s quality of life and even their physical health.

Negative effects of pee shy / Shy bladder syndrome

There are many ways in which people’s lives are affected by living with pee shy / Shy bladder syndrome.

Adopting coping strategies

The most common coping strategies include:

• Finding quiet or secluded toilets where the chances of being alone are higher.
• Using public toilets at quiet times.
• Men will often avoid urinals and use cubicles to gain a sense of privacy.
• Reducing intake of liquids so that don’t need to go so frequently.
• Avoiding unfamiliar environments where other coping strategies may not work due to lack of familiarity of the expectation to drink (pubs and cafes).
• Holding off on urination until they are very full to minimise the number of toilet visits and have the benefit of biological pressure to overcome shyness.

The major drawback for most people living with pee shy / Shy bladder syndrome is that they find themselves thinking about it all the time. This prevents them from relaxing into situations and enjoying themselves. Many people will experience emotional consequences, such as:

• Shame / embarrassment.
• anxiety / panic.

Further, Pee shy / Shy bladder may limit access to social situations due to concerns about being unable to use toilets facilities in unfamiliar locations. This can lead to a reduction in:

• Socializing and dating.
• Work opportunities.

Leading to social isolation, which can cause or worsen issues with anxiety and depression. Although relatively uncommon, over the long-term biological consequences can occur, such as:

• Urinary tract infections (UTI) – These can result from urine sitting for too long in the bladder thus allowing bacteria to grow, or persisitent dehydration due to drinking too little.
• Bladder damage – This can result from excessive holding of urine in the bladder over a prolonger period.
• Kidney problems – Resulting from prolonged dehydration.

What can be done about it?

Pee shy / Shy bladder syndrome are under researched areas of therapy. However, early research is with CBT by Soifer Himle and Walsh looks positive, and my own experience as a therapist has been very positive.

For more on this topic see hypnotherapy and pee shy / shy bladder syndrome.

The author

Dr Matt Krouwel PhD is a hypnotherapist from Birmingham (UK) who specialises in functional and anxiety disorders. he is a member of both the BSCH and the NCH.

Key sources

Hutchings, H. A., & Kehinde, A. (2024). Exploring paruresis (‘shy bladder syndrome’) and factors that may contribute to it: a cross-sectional UK survey study. BMJ open, 14(11), e086097.

Soifer, S., Himle, J., & Walsh, K. (2010). Paruresis (shy bladder syndrome): a cognitive-behavioral treatment approach. Social Work in Health Care, 49(5), 494-507.

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Systematic desensitisation – Key features and terms

Trigger.

In this context, a trigger is anything which initiates an emotional or state change. The trigger could be;

• External, like seeing or hearing something,
• Internal, such as imagining or remembering something.

The change induced by the trigger is perceived as swift and automatic.

Relaxation.

In systematic desensitisation relaxation is a deliberately created state. It is common for a therapist to teach relaxing exercises or use a guided relaxation technique to produce relaxation. This kind of relaxation allows the patient to retain a sense of  control and personal agency.

Reciprocal inhibition.

Reciprocal inhibition is the idea that a person can only really experience a single emotional/physical state at one time. This means that if you are anxious you will experience things as anxious. eventually you will come to associate everything experienced with anxiety. Conversely, if you experience something in a relaxed state you will begin to associate that with being  relaxed. So, if relaxation is induced by a therapist and then the anxiety inducing trigger experienced, a new relaxed response will be learnt. This new response will override (inhibit) the previous one.

Graded exposure.

Also called graduated exposure, graded exposure is a process of gentle exposure to trigger stimuli. The triggers are organised in a progressively more challenging way. Normally to achieve this a hierarchy of disturbance is created which is then worked through.

Hierarchy of disturbance.

This is a list of all the elements of a trigger which a person can identify. These are organised from leash difficult to most challenging. An example for a spider phobic might look like this;

1. Knowing there is a small spider in an adjacent room. (least difficult for this hypothetical patient).
2. Seeing a small spider on the far wall (staying still).
3. Seeing a small spider on the far wall (moving slowly).
4. Seeing a medium sized spider on the far wall (staying still).
5. Seeing a medium sized spider on the far wall (moving slowly).
6. Seeing a large spider on the far  wall (staying still).
7. Seeing a large spider on the far wall (moving slowly).
8. A large spider on the floor about 1.5 metres away (staying still).
9. A large spider on the floor about 1.5 metres away (moving slowly).
10. A large spider on the floor about 1 metre away (moving slowly).
11. A large spider on the floor about half a metre away (moving slowly).
12. Touching a spider whilst wearing a thick gardening glove.
13. Touching a spider whilst wearing a plastic glove.
14. Touching a spider. (Most challenging for this hypothetical patient) .

The job of the therapist is then to help create a list of situations of progressively more intense triggers to be worked through.

In life / In the imagination.

The exposure to triggers which is required for systematic desensitisation to work can be done in two ways;

• In real life with the trigger stimulant being either; present in the therapist office or by going out into the world to encounter it.
• In the imagination of the patient.

Both methods have their strengths and limitations. Desensitization in real life is almost certainly the best way but the resources to do it are expensive, time consuming, often specific and difficult to manage. The imagination by contrast is usually very good at conjuring up the required resources but at some point this will have to be consolidated into real life with some real world practice.

Systematic desensitization – uses and limitations.

Systematic desensitization is frequently used by therapists for anxiety responses where the trigger is specific and the reaction is disproportionate to the level of threat. A typical example of this would be a phobia or anxiety induced response like psychological erectile dysfunction or vaginisimus  like . However, frequently the anxiety trigger will have a reason to have come into existence, which may limit progress with systematic desensitization alone. Typical reasons for this are;

• The fear is secondary to another fear. For example a fear of insects can sometimes be a fear of contamination or a fear of heights will often be the result of having the wooziness caused by  vertigo.
• The fear is related to post traumatic stress disorder (PTSD). At some point a powerful experience resulted in an anxiety, it may be that the originating experience needs to be treated before the anxiety can be desensitised.
• Neurological sensitivity to the trigger. Not every bodies sensory experience is the same, substantial numbers of people have a visual or auditory sensitivity which results in apparently normal situations being uncomfortable. Over time the effect of this, combined with other people’s lack of awareness or comprehension of the problem, result in a build-up of tension around it. Overall this means that at best systematic desensitisation will help deal with the build up of tension.

The Author

Dr Matt Krouwel PhD is a hypnotherapist in Birmingham (UK) with over 25 years experience of working with anxieties, panic and related disorders. He is a a member of the BSCH and NCH.

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At first panic attacks tend to be triggered by external stimuli, such as an encounter with a phobic trigger, a trauma, or news of a bereavement. But it could be triggered by something almost imperceptible if the person has been in a heightened state of tension for a long time. Typically a panic attack is the pinnacle of an ever more rapidly escalating series of tensions.

The development of a panic attack

There are a number of common elements to the development of panic. Not all may be present in an individuals experience of panic, but several usually will;

1. Long term buildup

The person who has a panic attack has usually been in an elevated psychological and/or physical state for some time. This could be as simple as they have been working hard, or they have not been processing their emotions as they go through life, or any force which allows stress to build.

2. Trigger

Something causes them to experience a strong physical reaction. This could be;

• An emotion; fear, anger, or loss, whatever it is it will initiate the release of the hormone adrenalin.
• A stimulant such as caffeine, nicotine or pseudoephedrine, as well as the illegal stimulants, all of which simulate adrenaline release to some degree.
• An attack on the body from a virus or allergen.

As a result they experience;

• Increase heart rate,
• Blood pressure,
• Elevated respiration,
• Elevated body temperature.
• and the muscles and brain may become flood oxygen.

3. Escalation into a panic attack

The person notices the heightened state of their body and begins to worry, typically because it is more elevated than they think it should be. A typical first panic attack follows this trajectory:

1. Worry releases adrenaline, which maintains or increases the heighten state.
2. This in turn keeps the person worried, as their body is not returning to normal.
3. This results in the release of more adrenaline, which maintains the fear, releasing more adrenalin, and so it goes.
4. Eventually the fear of what is going on in their body results in them consulting health care services, who identify it as a panic attack, and thus reassured most people calm down.

At the end of this most people are calm. However, this does not mean for everyone that everything is fine, often there will be a lingering concern that something is wrong, which is one of the main reasons that panic disorders develop.

Thinking about therapy for panic?

The author  – Dr Matt Krouwel PhD is a hypnotherapist based in Birmingham (UK) with over 25 years experience. He is a member of both the NCH and BSCH

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Phobias are often described as irrational. However, as the fears they represent are often founded in deep evolutionary learning, many prefer to describe them as ‘disproportionate fears’, ‘over generalised fears’ or ‘out of place fears’.

Characteristics of phobia

There are several characteristics common to a phobia;

• Disproportionate fear. The fear experienced is notably more than the trigger (object, creature, situation or activity) justifies. The spider which sends you fleeing the bathroom is probably harmless*¹.
• Persisitent. The disproportionate fear of the object / creature/ situation etc has been present in your life for some time (six months or more). Some phobias have a seasonal element, such as those with arachnophobia experiencing an upswing in anxiety due to the tendency for spiders to enter the house and move around more in September and October*¹, but the fear of spiders itself does not change, just the number of encounters.
• Avoidance. The person with the phobia will avoid wherever possible the object / creature/ etc. This avoidance may result in substantial disruption or cost. Avoidance behaviours indicate anticipatory anxiety is present and are what make phobia an anxiety condition.
• Emotional and Physical response. The person with the phobia experiences physical symptoms consistent with the ‘Fight-flight’ reaction such as raised heart rate, fast breath, and possible dizziness. Some people with phobias experience secondary psychological symptoms like panic attack triggered by the physical symptoms.

Causes of phobia.

The causes of phobias are various and hotly debated, frequently more than one of the below elements will have been present in a phobias development;

Learned phobic response.

it is theorised that phobias can be learned in one of four ways;

1. Conditioned response.In this the phobia has been learnt by repeated startle responses in proximity to the stimuli. The traditional example of this is the ‘little Albert’ experiments in which a child (Albert) was exposed to a white rat, which he was initially fine with, until it was paired with the bashing of a very loud gong until the startle from the gong developed into phobic reaction to the rat.
2. Modelled by a family member. When a family member, especially parent,  has a phobia or even legitimate concern about a stimuli it is natural that you learn that response from them. A wasp phobic may have seen their mother, who had a known potentially lethal allergy to wasps, panic when wasps were around and as such learnt to act the same when wasps were around.
3. Taught by wider culture or media. We are impressionable and sensitive when young and being exposed to sensational accounts of the dangers of certain situations, especially when accompanied by pictures or film. Films like ‘jaws’ are responsible for many shark phobias.
4. Trauma.  A single traumatising event can set up associated phobias, this can be from PTSD or the more common traumatic learnings, which don’t always meet the criteria of PTSD. An example of the latter might be; being laughed at by classmates at school due to an inadequate or inappropriate answer to a question, resulting in nervousness about answering questions which eventually generalises (see below) to speaking in public.

Other contributary factors to phobia development

There are a few factors which may well contribute to the development of a phobia, but are unlikely to fully explain it;

Lack of positive exposure to stimuli and cultural acclimatization.

Lots of people simply don’t grow up in environments where they get used to certain animals, or situations. As such, they are always a little intimidated by these things which leaves them open to developing phobias of them. In theory the family with dogs is much less likely to have a child who grows up with a phobia of dog.

 Biological and evolutionary sensitivity.

Some people are more sensitive than others.

• This can be general; they are taking in more information from their environment than others and thus the causes mentioned above happen faster and deeper.
• Sensitivity can also be more specific and possibly have an evolutionary basis. Children appear to have a recognition of animals from a very early age and it has been theorised that this is an evolutionary response to help them avoid dangers, such as venomous spiders and snakes. Some people may have more of this capacity than others and thus retain the sensitivity, making them especially prone to developing phobia to that particular stimuli.

Generalisation and ‘What if?’ thinking.

This is part of the development of a phobia. The process of generalisation is where an initial fear stimuli begins to be associated with similar things which then become stimuli themselves. The example of ‘little Albert’ (see conditioned response above) is once more the traditional example here. Once Albert had developed a phobia of the white rat it began to generalise to a number of furry objects.

The ‘What if?’ question is a cognitive vehicle for generalisation. In this the person asks themselves a  ‘What if?’ question in relation to their phobia. To give an example a wasp phobic may ask themselves ‘what if there are wasps in the park’, and now they have anxiety about going to the park, this can repeat as for numerous situations

Types of phobia

There are a number of ways in which phobias tend to present and be classified, here are two of the most common;

1. Specific. The phobia is limited to a specific object/creature/ situation and doesn’t generalise much beyond that. Animal phobias are very common examples of specific phobias.
2. Social. The fear of negative assessment by people may present as an inability to give presentation, to talk in groups or to strangers, or just being in crowded places.

Hypnotherapy for Phobia

If you would like to book a free consultation with Dr Matt for an in-person or online therapy for a phobia, please contact me on 0778 909 7741 or email mattkrouwel@gmail.com

footnotes

*¹ I’m assuming you are reading this in Britain.

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Symptoms of anxiety

• Persisitent worry.
• Impaired concentration.
• Irritability.
• Restlessness.
• Tiredness.
• Sleep disturbance.
• Physical symptoms like muscular pains, digestive problems, skin conditions and panic..

Anxiety exists to tell us that we have noticed something about the future that we need to make a special effort to address, and when we are able to treat it this way we tend to just experience concern. However, for a number of reasons we sometimes experience this response to a level which actually prevents us from being able to address the future problem. some reasons for this might be ;

• We have past experience of bad failure at the future problem.
• We have cannot see a way in which we can deal with the future problem.
• The future problem involves a specific trigger for us.
• We have lost confidence of our ability to cope, often due to long term stress and burnout.
• We have an exaggerated idea of the consequences of not addressing the future problem well.
• We are overwhelmed in our lives by work, family etc and cannot find time to address the future problem.
• Catastrophic ‘what if?’ thinking, which leads us to predict worst case scenarios.

When is anxiety a problem?

The simple answer is …when you feel that it is? Although there are strict definitions of specific anxiety conditions, these are primarily for use in scientific research and for medical diagnosis. If you feel you are overly anxious then you are suffering with anxiety. That being said, there are some specific presentations  which you may find it helpful to be aware of.

Anxiety can present in many specific form such as

• Phobias – a ‘Flight-flight’ response produced by a specific object or situation, which results in avoidance of the trigger situation or object.
• Generalised Anxiety disorder (GAD) – a condition where excessive worry is experienced most days for over six months
• Panic disorder – a condition in which the sufferer experiences something like a phobia for elements within their own body. This could be noticing that they are; breathing hard, have a raised heart rate, are sweating, are light headedness or disorientation or any number of other reactions. Having noticed a change in their body their ‘Fight-flight response’ is triggered, which heightens these, resulting in further tension, which set up an escalation of symptoms, often ending in panic. Typically sufferers develop a pattern of avoidance of situations associated which heightened bodily response (such as exercise) and any situation where panic has previously occurred.

Hypnotherapy

Just as there are many presentations of anxiety there are many hypnotheraputic approaches to treating anxiety.  A good hypnotherapist will listen to your personal experience of anxiety and bring together a set of techniques, approaches and tool designed to help you personally. However, there are certain approaches which are more common than others, these include;

• Systematic desensitisation for anxiety provoking situations
• EMDR for anxiety triggers or past trauma which set up triggers
• Parts therapy to help understand the anxiety
• Various NLP techniques to help re-write the anxiety
• Hypnotically enhanced mindful approaches to help reduce anticipation

For more on hypnotherapy for anxiety

Dr Matt Krouwel PhD, BSCH, NCH

If you would like to book a free consultation with me for in-person or online therapy for anxiety, please contact me on 0778 909 7741 or email mattkrouwel@gmail.com

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• Helping you to identify your fundamental values.
• Develop the skills and mental tools to cope and thrive with your life challenge.

ACT can be broken down into several key elements;

Value driven living.

In ACT a value is a direction to move your life in. This could be summarized as something like ‘health’, or ‘family’. The client is then encouraged to identify whatever steps they can taken, from where they are currently in life, to improve their engagement with this value. This means that the value of ‘health’ does not mean being a certain weight, or eating 5 portions of fruit and veg, these are goals and are different. For example, the value of ‘health’ means doing more healthy things than you currently do, so if you currently average 1 portion of fruit and veg a day, how can you increase this to more than 1 portion a day?

The key with values is improvement, not specific attainment. By being aware of your life values you can start making daily decisions based on them, leading to a more meaningful life.

Acceptance of experience.

This can also be characterized as openness to experience or willingness to experience. This includes both negative and positive experience.  Acceptance is there to counter the tendency to avoid difficult experience. Avoiding difficult experience often results in us being stuck in patterns of behavior. Choosing to experience the difficulty to get through to a better place is important to help us through to freedom. To give an example, for the addicted this can mean allowing themselves to experience the sensation of craving whilst not acting upon it.

Mindfulness

Mindfulness is a meditative practice which encourages contact with the the present moment, within ACT this has a twofold use;

1. Encouraging contact with the present. It is thought that a preoccupation with the past or future locks us into pathways of behavior. To counter this ACT encourages spending more time actively in the present moment and with your experience. This enables you to be aware of that experience, without judging it, defining or categorizing it. Within ACT it is argued that all experience can be coped with on a moment by moment basis.
2. De-fusion and observer self. Within ACT it is argued that we tend to believe we are our thoughts and feelings. The practice of mindfulness allows us to adopt an ‘observer’ position. From the observer position we can perceive the information from our thoughts, feelings and body as information not as who we are, this is called de-fusion.

What does Acceptance and Commitment Therapy (ACT) help with?

ACT has demonstrable effectiveness with; depression, anxiety, substance abuse(1), social anxiety(2) and has been seen to benefit those with serious physical issues in their psychological reaction to those issues(3). All of which has led some to suggestion that it could be an alternative to the ubiquitous cognitive behavioral therapy (CBT) in mainstream mental health services(4). As an alternative to CBT it has a lot to recommend it as the exercises within it feel quite different to CBT and thus it offers a different approach for those who don’t fit the CBT mold.

As a practitioner of ACT I have used it in different ways. Sometimes I use it in full, sometimes using elements of it within a wider intervention. It has proven useful with; coaching clients, supporting the neurodivergent with coping with life challenges, with substance abuse clients (mostly alcohol and cocaine users), pornography addictions, survivors of life changing accidents and people with chronic pain.

Acceptance and Commitment Therapy (ACT) and hypnosis

Many hypnotherapists have found that ACT fits well into hypnotherapy. Some of the mindful exercises make excellent hypnotic inductions. In addition, ACT contains within it a number of visual metaphors designed to illustrate points. These metaphors can be delivered as immersive visualizations in hypnosis to deepen the learning. Further, as the mind appears to be more open to learning in hypnosis all the ways of thinking introduced as part of an ACT intervention appear to be more deeply engaged with.

If you are considering Acceptance and commitment therapy or hypnotherapy for issues such as;

• Pornography addiction.
• Sex addiction.
• Substance abuse.
• Anxiety.
• depression.
• Living with chronic conditions.

You may wish to contact Dr Matt, an experienced hypnotherapist and Diplomat member of the BSCH to arrange a free consultation.

References

1. Gloster AT, Walder N, Levin ME, Twohig MP, Karekla M. The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of contextual behavioral science. 2020;18:181-92.
2. Mattikoppa NV, Harshitha G, Yahiya GKM, Paluru MS. Efficacy of Acceptance and Commitment Therapy in Social Anxiety Disorder: A Systematic Review and Meta-analysis. Journal of Psychiatry Spectrum. 2025;4(1):111-20.
3. Fattahi A, Mazini F, Jaberghaderi N, Rajabi F, Derakhshani M, Laki M. Effectiveness of acceptance and commitment therapy for distress, emotion regulation, and self-compassion in patients with cardiovascular disease: a randomized clinical trial. Trends in Psychiatry and Psychotherapy. 2025;47:e20230685.
4. López-Pinar C, Lara-Merín L, Macías J. Process of change and efficacy of acceptance and commitment therapy (ACT) for anxiety and depression symptoms in adolescents: A meta-analysis of randomized controlled trials. Journal of Affective Disorders. 2025;368:633-44.

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What is EMDR?

EMDR is a psychotherapy technique used for trauma and anxiety. EMDR creates a bilateral movement of attention whilst simultaneously the patient engages with  anxiety provoking thoughts. This is repeated with occasional checks by the therapist to see how the patient is feeling or if any particular thoughts of memories have arisen. The bilateral movement is created in a number of ways;

• Simulated REM – The most common forms of EMDR is to get the patients eyes to replicate rapid eye movement (REM) by directing the patient to focus their vision on something which moves left to right and then right to left. Usually this is done by the therapist holding their fingers up level with the patients eyes and then instructing them to keep their head still whist the move them on a level with the eyes.
• Butterfly taps – Often used when eye movement is impractical in some way. The patient is instructed to cross their arms across the body with the right hand on the left shoulder and vice versa. They then create the bilateral movement by tapping the should, alternating between left and right. Variations on the tapping approach exist, with some therapists tapping the back of patients hands.
• Auditory simulation – occasionally a therapist will initiate the cross lateral stimulation by making sound on either side of the head. This can be very hard on a therapists joints so some have special machines for it.
• EMDR machine – a number of devices exist which stimulate bilaterial movement. These could be a simple led set up which moves a light from left to right and back again, or programme for a set of headphones to create alternating sounds, or a more integrated device which does both of these synchronously and possibly more.

So we’ve looked at the mechanics of what EMDR is, but this tells us nothing about how it works?

How does EMDR Work?

No one can currently say for certain how EMDR works but a two of the commonly given explanation are

• Bilateral processing – the idea here is that bilateral activities, such as REM, cause information in the brain to be processed in both left and right hemispheres of the brain. Because the left and right hemispheres of the brain fulfil different roles (Left =logic/reason, right = creation/emotion) the bilaterial stimulation encourages integration of the thoughts/memories which are currently active whilst the stimulation is active. In real terms this means that by accessing a traumatic memory, essentially a right brain memory (emotional memory), and then initiating bilateral stimulation the left brain is activated simultaneously to the left brain, ultimately resulting in the previously solely right brain memory now being integrated into the left brain, where the lefts brains distinct function (logic/reason) acts to moderate and process it. (2)
• Neurological rewrite – there is a brief period after every memory is accessed where it is open to being altered (3). One theory goes that by applying immersive stimulation, the bilateral movement, during this brief window the memory is changed and by repeating this many times in a therapeutic context with an explicit goal the memory is adjusted with that goal in mind.

These are but two of a number of possible explanations for why EMDR works, now let’s look at how and what it works for

What does EMDR help with?

Originally developed as an intervention to help with trauma(2), there is evidence for EMDR’s effectiveness in treating;

• Trauma (4, 5)
• Depression (5, 6)
• Anxiety and related conditions (7)

Further, evidence exists that it can be effective at reducing the experience of cravings in recovering addicts (8), and perhaps most importantly it has been seen to have a low risk for side adverse reactions (9).

Is EMDR a sort of a psychotherapy ‘wonder drug’?

Like most psychological intervention EMDR sometimes has miraculous effects. As a practitioner myself it certainly feels like miraculous change happens with more frequency than with a lot of other interventions, but not always and not for everyone. As with most techniques there is a skill in when and where to apply it. This means that EMDR often works best as part of a larger therapeutic intervention where techniques are introduced to prepare the patient for change before the EMDR is applied, and then other techniques are used to ensure that the changes are effectively embedded into ongoing life.

EMDR is however a highly versatile therapeutic tool. I have applied it successfully in all the evidence based areas (trauma, anxiety, depression) and also with issues like relationship breakup, weight loss, pornography addiction, functional dyspepsia, erectile dysfunction, driving anxiety, bereavement and many more.

References

1. Shapiro F. EMDR 12 years after its introduction: Past and future research. Journal of clinical psychology. 2002;58(1):1-22.
2. Shapiro F. Eye movement desensitization and reprocessing. 1995.
3. Shaw J. The memory illusion: Remembering, forgetting, and the science of false memory: Random House; 2016.
4. Torres-Giménez A, Garcia-Gibert C, Gelabert E, Mallorquí A, Segu X, Roca-Lecumberri A, et al. Efficacy of EMDR for early intervention after a traumatic event: A systematic review and meta-analysis. Journal of Psychiatric Research. 2024;174:73-83.
5. Villegas-Ortega J, Galvez-Arevalo R, Castilla-Encinas AM, Gutiérrez-González B, Apolitano-Cárdenas CI, Alvarez-Arias PM, et al. Effects of EMDR vs. waiting list for adults with post-traumatic stress disorder: A systematic review and meta-analysis of randomized controlled trials. Journal of Affective Disorders. 2025:120134.
6. Sepehry AA, Lam K, Sheppard M, Guirguis-Younger M, Maglio A-S. EMDR for depression: A meta-analysis and systematic review. Journal of EMDR Practice and Research. 2021;15(1):2-17.
7. Yunitri N, Kao C-C, Chu H, Voss J, Chiu H-L, Liu D, et al. The effectiveness of eye movement desensitization and reprocessing toward anxiety disorder: A meta-analysis of randomized controlled trials. Journal of psychiatric research. 2020;123:102-13.
8. Martínez-Fernández DE, Fernández-Quezada D, Garzón-Partida AP, Aguilar-García IG, García-Estrada J, Luquin S. The effect of eye movement desensitization and reprocessing (EMDR) therapy on reducing craving in populations with substance use disorder: a meta-analysis. Brain Sciences. 2024;14(11):1110.
9. Wright SL, Karyotaki E, Cuijpers P, Bisson J, Papola D, Witteveen A, et al. EMDR v. other psychological therapies for PTSD: a systematic review and individual participant data meta-analysis. Psychological medicine. 2024;54(8):1580-8.

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