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COMBAT-RELATED PTSD INSOMNIA CLINICAL TRIAL
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D
ISCUSSION
The present study is the first to report the benefit of hypnotherapy
in patients with chronic combat-related PTSD who are concurrently
suffering from persistent chronic insomnia and sleep disorders. The
participants chosen for this intervention were receiving supportive
psychotherapy and pharmacotherapy at the time of enrollment and
still were disturbed by insomnia, frequent awakenings, and night ter-
rors. In essence, the participants thus represent a “real life” challenge
for physicians and health care professionals.
Unfortunately, relegation of sleep disturbances to secondary impor-
tance among patients suffering from PTSD may needlessly prolong
patients’ distress by engendering fatigue from lost sleep, fear of falling
asleep and sleep avoidance, and deepening anxiety and depression as
carryovers from the sense that the therapy is not effective, which may
reinforce demoralization (Frank, 1991).
Both direct and indirect ego-strengthening procedures can be found
in the therapeutic repertoire of most successful hypnotherapists. The
effect of ego-strengthening can be perceived as improved therapeutic
alliance, heightened insight, increased clarity of thinking, and/or
improved self-esteem on the part of the patient (McNeal & Frederick,
1993). We are using some powerful projective/evocative procedures
that can be a significant adjunct to other therapeutic modalities,
whether they are other hypnotherapy techniques or more traditional
psychodynamic methods.
There are several mechanisms by which definitive treatment of
sleep disturbances exerts a favorable impact upon other related prob-
lems in the cluster of symptoms that make up the diagnosis of chronic
PTSD. The successful treatment of sleep disturbances positively influ-
ences other areas of functioning. Indeed, in the present study, the
improvement in sleep directly affected concentration and mood and
contributed to a decrease in severity of PTSD symptoms.
The present study has several limitations that need to be acknowl-
edged. The sample size is relatively small. The hypnotherapeutic inter-
vention was added to ongoing treatment and thus its sole contribution
is difficult to tease out of the overall effects.
We decided to select only patients in the midrange of hypnotizability
because of our clinical experience and understanding of hypnotherapy
for chronic PTSD patients.
According to our clinical experience, patients with minimal trance
capacity do not benefit from hypnotherapeutic interventions, and
some severe and chronic PTSD patients lose trance capacity. On the
other hand, chronic PTSD patients who are highly hypnotizable fre-
quently experience strong trance capacity with negative emotions
(abreaction or unpleasant dissociative symptoms) (Benningfield, 1992).
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