Treatment of a phobia towards care by hypnosis combined with virtual reality

This case relates to 70-year-old Mrs. B who is hospitalized after the discovery of myeloma and suffers from a resulting depression. She also suffers from significant post-fall syndrome. This patient behaves like a child when she is anxious, she does not tolerate treatment very well (from programming to completion), which manifests itself in many often inappropriate requests, including untimely requests for anxiolytic treatment that she has a habit of taking disproportionately at home. Anxiety is increased during the change of a pressure ulcer dressing. Ms. B. has been dependent on analgesics for several years and has very limited pain tolerance. (…)

SESSION 1:

For this first session, I suggest that Ms. B. tries to reduce her anxiety, which she assesses as 10/10. We talk beforehand about her past, her professional and personal experiences, the activities that fascinate her and what she thinks she still has the capacity to achieve. I explain how the sessions work, and talk to her about her thoughts on hypnosis and the fears she may have. Surprisingly, she doesn’t have any particular apprehension, she is open to the relationship and manages to un-center herself quite quickly on her own. The memory that comes back to her and makes her “go” just as she starts talking about it is the memory of a moped “road trip” with a boyfriend. They journeyed on the Atlantic coast for a summer, making stops as they please and without constraints. Mrs B. has already clearly started her induction during the discussion, and we are deepening it by sensory focus. There are many ideo-motor responses during this session.

(Once induction is completed)

(Me): “The eyes can now observe the landscapes which pass, sometimes dazzled by the summer sun, see the horizon line melting on the asphalt, the towns and villages pass by, the seaside and beaches at the same time all similar and at the same time unique. The body feels the vibrations of the moped, the hands which automatically perform their maneuvers to steer the machine. (Mrs. B. begins to raise her hands and position them in driving mode), like that, exactly, it is very good, (…) and to advance on the road quietly according to the landscapes, sometimes turning right , sometimes on the left, the air on the face, which makes the road more pleasant, more comfortable. Then perhaps arriving at your destination, stopping near a beach, your feet feel the sand, its grain, its softness underfoot, the heat of the sand, then the freshness of the water’s edge, the refreshing water, which the legs can feel coming and going against them in the waves, the feet which sink into the wet sand, and advance one step after another to end up swimming, the body lightened by the water, nice and comfortable, and it s so good to feel that body without any constraints. (…) (Mrs. B.’s body stretches and relaxes on her bed, her face is relaxed, she breathes calmly). Very well, and you can continue to enjoy this experience quietly, because the unconscious is working for you, using your resources and learning what you are going through (…). Then, when you are ready, at your own pace, to take the road back to here and… (reassociation by sensory focus). Mrs B. is very relaxed physically, she really enjoyed this session. She explains: “I reviewed this trip with my boyfriend, the road, the swimming, I really had the feeling of being in the water and the freshness. It made me feel good and I almost wanted to sleep … “. She then asks me for a “small tablet anyway to” finish herself”. She estimates her anxiety scale at 7/10 but ultimately won’t have any further requests to the caregivers that morning.

SESSION 2:

This second session takes place approximately 3 weeks later. Mrs. B. has better morale, and is less overwhelmed by her anxiety. She manages to determine that her anxiety is increased during the change of the dressing, which is still painful despite the analgesics. She estimates her anxiety scale today at 6/10 before the session. So I decide to use the virtual reality headset to prepare Ms. B for treatment. I show her the equipment, explain how it works, Mrs. B. settles down and puts on the headset without any fear. Given the patient’s feelings during the first session, I chose, in agreement with Ms. B, a 360 VR diving video with dolphins. After the induction by sensory focus, on signaling from the patient, I start the video and give the patient a few seconds to immerse herself in this new environment.

(Me): “The body knows how to do what it has to do. And part of yourself can experience the different sensations that can arise. The lightness maybe in a specific place of the body (…), then feel the whole body lighten in contact with the water, observe the movements that slow down, become wider and that allow you to swim in this blue so soothing, so relaxing. And the eyes can take the time to observe all the shades of blue that can change according to the luminous reflections of the sun, according to the currents and the movements of the dolphins who perform their choreography in front of you (…). And the ears can hear the sound of the water and the call of the dolphins to swim with them, to release the body from tension and pain. The hands feel the water sliding under them, the temperature, neither too hot nor too cold, a pleasant, comfortable temperature. The hands can also graze, stroke the dolphins, swim quietly and choose to go in the direction of your choice, sometimes go up, and let the fresh air fill the lungs (…), (the patient inhales more importantly), … which allows you to dive deeper and observe new things that were not accessible without diving lower, even lower, that’s it, very good. And while a part of you can marvel at the depths of the sea, its colors, its textures, and the dolphins that accompany you safely, another part, a deeper part of you, is learning, mobilizes your personal resources, learns sometimes new sensations from this experience (…). And as long as necessary, you can let the body relax with the waves, move slowly in the current, feel the water in contact with the skin (…), and the unconscious will help you to use again this experience in situations where you will need it, to find the pleasant sensations of the body in the water. And when the subconscious has learned enough from this experience, then can the head give me a sign? (Mrs. B. nods) And to redo the journey with the dolphins to the water’s edge, ready to go up the stairs ? The 5th step, and the skin can smell the air and the temperature of the room (…), The 4th, to feel the body installed in this bed, the points of support, the head on the pillow…, the 3rd, the inspiration, the expiration, (…), the 2nd, the ears who hear my voice, the noises around us, finally the last one, and when you’re ready to take a deep breath and your eyes can open again. (I help Mrs. B. to remove the headset). Mrs. B, open her eyes and share her feelings with me: “I saw myself with the dolphins, in the water, doing the movements like them, the pains have disappeared, I can feel the water passing over my body. I relaxed, I almost fell asleep “. She puts the cursor on her anxiety scale at 2/10 at the end of this experience. I explain to Mrs. B. that she can use this experience again during the treatment, that she can focus again on her sensations and let the dolphins come to her. The dressing is going better than usual and at the end of the treatment she says, “you know, I was there with the dolphins.”

SESSION 3:

The third session takes place during the change of the dressing. The patient has told me regularly that she sees dolphins when she is treated. This day, I am accompanied by another nurse and a student for the change of the dressing. The patient is turned on her side, I stand in front of her and tell her that the nurse will start the dressing, but she can go with the dolphins. This proposal amazes the nurse and the student who are unaware of my practice. Mrs. B. explains herself that she swims with the dolphins when the dressing is changed, and that this makes the treatment bearable. As she explains, she performs her own induction, and does not react when the nurse begins to mechanically cleanse the dressing. The nurse, while continuing the care, asks me for details about the hypnosis and the virtual reality headset. With the patient’s agreement, I told her about the session “Ms. B’s dive” (…). The dressing ends, and I suggest to Mrs. B. to give her feelings about this treatment. She did not show any anxiety or any particular pain during the dressing, to the surprise of the nurse who performed the treatment. Before leaving the room, the patient said: “I was with the dolphins (…)”.

Conclusions: This case demonstrates that virtual reality can activate and amplify the trance, serve positive kinesthetic sensations, transform unpleasant sensations in the body, and anchor more pleasurable sensations to the mere evocation of the hypnotic experience. In addition, it is possible to recreate this trance state in virtual reality without using the headset afterwards (…). Virtual reality associated with a suggestive narration allows self-hypnosis to be initiated in the patient, to make her evolve freely so that she is more interactive and can become a positive alternative reality during the time of the trance.

Aurelien Serruau (in the context of hypnosis performed in the after-care service of the Vierzon hospital center in France)

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