• How important is an initial trauma?
• How much is learnt thinking?
• How much is the anxiety a habit?

How important is the initial trauma?

Whilst choking you may fear for their life. This can set up a trauma which then causes you to become tense whenever eating. Overtime, the repeated anxiety caused by the trauma sets up a pattern of behaviours which maintain the choking anxiety: The question is how much is the trauma is still active, or is the problem now one of belief and habit?

Treating an active trauma.

An active trauma will be can be addressed in a number of ways:

• Eye movement desensitisation and reprocessing (EMDR). – This is a well-established trauma protocol with a strong evidence base.
• Regression – In this context, regression is the act of mentally going back into your personal history to the trauma. You then reexperience it with the perspective of the survivor. Reexperiencing something which felt awful at the time but that you now know you survived can allow you to emotionally reappraise it.
• Various dissociative approaches – There are a number of approaches which allow a person to approach an emotionally powerful event whilst disengaged from it. These allow them to experience the memory at a level of emotion which allows for healthy processing.

Trauma work is challenging as such the therapist will do foundational work . Foundational work ensures that the patient is in the best position they can be.

Learnt thinking and beliefs in choking anxiety

Our beliefs about things shape our world; if you believe you are going to choke on a piece of food you will find evidence to support this belief. With choking anxiety this commonly happens in a couple of ways:

• We become hyperaware of evidence for choking. This can be food in our throat taking time to go down, but not actually doing any harm.  Or we may become aware of cases of people choking in the media.
• Our anxiety causes the throat to constrict making swallowing harder. Anxiety can also make us take control of swallowing, turning something automatic (unconscious) into a deliberate action (conscious) which makes it clumsy, causing further catching of food.

Learnt thinking is almost always present at some level with choking anxiety. Usually, these beliefs immediately to eating and might be something like:

• “I could choke on this!”
• “One tough bit could choke me to death!”
• “What if its too big a mouthful; it could choke me!”
• “If I eat when I’m alone there is no one there to save me if I choke.”

The question for the therapists is how much to focus on belief change when using hypnotherapy for choking anxiety. but generally they will do some work on it.

Approaches for belief change in choking anxiety.

There are many ways in which a hypnotherapist may work for belief change, these include:

• Direct suggestions for a new focus. – Focusing the patient on an appropriate level of chewing, how much they enjoy food. These thoughts can then take up the space once occupied by the unhelpful beliefs.
• Amnesia suggestions – These can be used for the unhelpful beliefs or actions and will often be combined with the suggestions for a new focus.
• Belief change visualisations – There are various visualisations which can be used to help change or rewrite beliefs. An example is imagining writing the belief on a whiteboard  and rubbing sections out and writing in new words and phrases.
• Eye movement desensitisation and reprocessing (EMDR) – is a helpful technique for processing strong beliefs.

Habitual choking anxiety

The choking anxiety may have started as a trauma, but by the time use processed the trauma habits have been established. This is usually connected to the development of learnt beliefs (see above) but may present as entirely automatic. Often, the person automatically tenses up in relation to food and in so doing constricts their pharynx and oesophagus / Esophagus making swallowing harder.

Hypnotherapy approaches for habit change with choking anxiety

When using hypnotherapy for choking anxiety the therapist is likely to use any number of strategies, most of which promote relaxation to counter the tension:

• Systematic desensitisation – The therapist guides the patient through a series of food situations whilst helping them to relax.
• Relaxation suggestions – These can be used to promote a counter response.
• Eye movement desensitisation and reprocessing (EMDR). – This can sometimes be used to process bodily responses.
• Anchoring techniques – A hypnotherapist using various approaches can establish a conditioned response for relaxation. This can be used by the patient to relax themselves whenever they are engaged with eating.
• Various visualisations – There are many different visualisations which can be used to encourage the relaxation and dilation of the throat.

Hopefully this blog has given you an idea of how a hypnotherapist might approach helping someone with a Choking anxiety.

The author

Dr Matt Krouwel PhD is a hypnotherapist who works in Birmingham (UK) and has memberships of both the NCH and BSCH. He has extensive professional experience with functional disorders of all kinds, especially those relating to eating, such as; IBS,  Emetophobia, ARFID and Choking anxiety.

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 Treating ARFID with hypnotherapy.

I cannot speak for all hypnotherapist, as hypnotherapy contains a broad variety of skills, techniques, philosophies and approaches but here are some of the more common approaches used when conducting hypnotherapy for ARFID.

Hypnotherapy when ARFID presents as anxiety

Most hypnotherapist have a set of techniques for dealing directly with anxiety triggers. Generally this involves invoking the known trigger mentally and then applying the technique to introduce a new way of being. These techniques include;

• Systematic desensitization.
• Eye movement desensitization and reprocessing (EMDR).
• Various Neurolinguistic Programming (NLP) approaches such as Anchoring, and the Swish technique.

Using these techniques it is common for a person to be able to bring an increasing range of previously challenging foods into their dietary repertoire. It is not uncommon for people to actually discover that some of the foods they reintroduce are actually pleasant. This usually occurs because the nature of their pallet and sensory experience has changed since the problem started.

Hypnotherapy when AFRID is developed as a result of trauma

Sometimes a trauma will be obviously a part of the development of the problem. When this is the case, it is likely that the hypnotherapist will look to process this in some way. Common tools for this include;

• Eye movement desensitization and reprocessing (EMDR).
• Regression to the trauma so that it can be processed by a mind which knows that it survived.
• Metaphorical releases of the pent up energies created by the trauma through visualisation.

Altering sensory experience of food

Hypnotherapy has the capacity to nudge sensory awareness so that some elements come forward in perception. By shifting awarenesses challenging foods can become inoffensive or even enjoyable. This can be done through techniques;

• Direct suggestion for forgetting disliked elements and noticing preferred elements (sweetness, smoothness, elements of aroma).
• Visualisation of ideal forms of the food
• Accessing memories of more pleasant foods whilst eating the food

When AFRID is the result of Low hunger levels.

When a person with AFRID does not feel hunger a common cause is poor interoception. Interoception is our awareness of our own internal body, how well we feel things like hunger and heartrate. A hypnotherapist may look to enhance this through techniques like;

• Body scan; a practice in which a person experiences the different areas of their body and the sensations experienced by those areas. Commonly, this is done through a recording or by teaching it and through repetition it can enhance
• Suggestions for bodily awareness; these can be very direct or through a visualisation to help enhance awareness of the sensations of hunger.

Further, for Low hunger, if it does not appear to be based on poor interoception  lifestyle changes may be required.  These could include;

• Engaging with higher calorific foods.
• Organising eating times so they are less reliant upon biological prompting.
• Dietary changes to prompt the development of a robust biome which often aids in hunger signalling.

These are just a few examples, and many people will have tried some of them. The hypnotherapist’s job is to discuss these with their patient and find out what they tried, how well it went and what new strategies and tool may help.

I hope this blog has given you the information you need to feel confident to move to the next stage and book a therapist. If you want to contact me for a free consultation feel free, otherwise look for a therapist

The author

Dr Matt Krouwel PhD is a hypnotherapist based in Birmingham (UK) with a specialism in anxiety and functional digestive disorders. He has 25 years experience of working with clients and patients and is a member of both the BSCH and NCH 

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What is Choking anxiety?

Choking anxiety is the experience of fear when eating and when approaching meals, that you will choke. Clinically choking anxiety is classified as a specific presentation of ARFID. Many people with this fear find themselves behaving in unusual ways, such as:

• Restricting foods to those perceived as easily swallowable.
• Excessive time spent cutting up food into swallowable pieces.
• Extreme chewing.
• Unusual amounts of time spent thinking about and planning food intake.
• Avoiding social eating situations due to the risk of being criticised as a picky eater or because you cannot plan what you eat.
• An overall reduction in food intake, possibly resulting in unwanted weight loss.

So how does someone develop a choking anxiety?

How does choking anxiety develop?

There are several common ways in which a person develops choking anxiety.

Single event traumatic learning.

A person has a choking experience in which they are scared for their life. This may mean that they feel that they nearly died or that they feel that their life has been changed forever. For many people it is a single occasion when a piece of food gets stuck in their throat and they are unable to swallow and breathing was restricted. Sometimes a piece of food gets lodged in such a way that they can still breath, but it restricts eating and leaves them in discomfort for an extended period. This latter example gives time to worry that they may be slowly dying (starving or dehydrating) or that all eating will now be uncomfortable.

Multiple event traumatic learning.

A person experiences several choking events in relatively quick succession. This embeds the fear caused by the initial choking event and convinces them that they are at risk of choking. Commonly choking  will have occurred due to a temporary medical issue, or because they are anxious already due to the first event. However, a choking event can reactivate the memory of a bad experience from years before.

Build up of anxiety due to multiple mild events.

A person may experience food catching in their throat, but not full choking, which draws their attention to the possibility of choking and overtime the concern about this grows into a pattern of anxiety.

Anticipated anxiety

With stressed people or high anxiety personalities the knowledge that you can choke may be sufficient to develop this anxiety without substantial experience of choking. For most people who experience this it will pass on as they focus on something else or general stress reduces. However, should they begin to experience food catching in their throat, often as a result of the concern itself interfering with normal swallowing, choking anxiety can develop.

Choking anxiety, what can be done about it?

A therapist is likely to assess the patient for;

• Initial trauma – how much of an ongoing problem this is?
• Beliefs – are they holding unrealistic beliefs about choking?
• Habit – How much are they automatically tensing and questioning both their swallow action. This can occur both at the point of swallowing and in anticipation of swallowing?

They will then put a programme of therapy together to address the elements, typically using techniques like;

• Graded exposure OR Systematic desensitisation.
• Cognitive re-evaluation of and reconstruction of beliefs around swallowing.
• Trauma treatment protocols like EMDR.

For more on Hypnotherapy for choking anxiety click here!

The author

Dr Matt Krouwel PhD is a hypnotherapist who works in Birmingham (UK). He has over 25 years experience as a frontline hypnotherapist and is a member of both the BSCH and the NCH.

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