How a Breathing Problem Was Triggered by Trauma
The subconscious can help identify the trigger(s) of a patient’s symptoms.
Posted December 19, 2022 | Reviewed by Kaja Perina
- Functional symptoms usually serve the purpose of expressing psychological distress.
- Symptom substitution can arise if a functional symptom ceases without resolution of the triggering psychological issue.
- Vocal cord dysfunction is recognized as a functional disorder.
Functional disorders can be defined as those arising in patients who present with persistent physical symptoms lacking an identifiable organic basis, or symptoms in excess of what would be expected just from their physiologic cause. The physical symptoms of patients with functional disorders are thought to serve the purpose of expressing a patient’s psychological distress, e.g., in a patient who develops stomachaches as a way of avoiding attendance at school.
If a functional symptom resolves during therapy without sufficiently addressing the underlying psychological issue that triggered the symptom, on infrequent occasions another symptom arises. Such a process can be termed “symptom substitution,” as occurred in the case of the patient described in this blog.
A Patient with Vocal Cord Dysfunction
“Nolan” (not his real name) was a 15-year-old who presented with a history of persistent vocal cord dysfunction (VCD) for a year. He reported that he had difficulty inhaling throughout much of the day. He made a soft noise from his throat area with each inhalation and exhalation. The symptom improved when he was not in school, and resolved when he was asleep, only to recur upon awakening in the morning (Anbar & Cherry, 2021).
Nolan’s VCD developed shortly after a serious allergic reaction to peanuts, which were being deliberately introduced to him in increasing amounts by an allergist to help desensitize him from a peanut allergy. Evaluation and treatments of his VCD by the allergist, three otolaryngologists, a physical therapist, and two speech pathologists were unhelpful.
VCD occurs because the vocal cords come together (as opposed to open up) when a patient inhales, and is recognized as a functional disorder. VCD sometimes causes noisy breathing similar to that which occurs in the presence of life-threatening conditions, and thus can be alarming (Anbar & Fernandes, 2016).
I explained to Nolan and his family that VCD usually occurs because of psychosocial stress. Most frequently, in my experience, it occurs in high-achieving female athletes because of stress related to wanting to excel during competitions. In such settings, I've found the VCD typically resolves after one session of hypnosis-facilitated relaxation.
However, when VCD occurs without association with exercise, and especially when it’s persistent, often there are significant underlying psychological stressors that need to be addressed before symptom resolution can be achieved.
Nolan was interested in learning how to help himself, and therefore I taught him how to use calming imagery during hypnosis as a way of achieving a relaxed state. I then taught him how to use breathing for calming, progressive muscle relaxation, and a relaxation sign (for which he chose to cross his fingers) that helped trigger his relaxation response when he was not engaged in hypnosis. Unfortunately, the use of hypnosis for relaxation was not associated with an improvement in his symptoms.
I then proposed to Nolan that he could learn how to use hypnosis to help better understand and address the psychosocial stressors that might be underlying the persistence of his symptoms. For this purpose, I showed him how he could allow his subconscious to interact with me through finger motions that indicated “yes,” “no,” or “I don’t want to say.” The subconscious was defined as the part of the mind of which he was unaware, and could provide him with insights he might not yet have access to.
In response to my questions, the subconscious explained that there were two issues bothering Nolan of which he was unaware. However, the subconscious said that Nolan was not ready to become aware of these issues. In response to my query, it offered to tell me about them outside of Nolan’s awareness.
For this purpose, I taught him how to use typing while in hypnosis to allow his subconscious to interact directly with me (Anbar, 2021). Most patients who engage in such typing report afterwards that they have no recollection of the discussion.
Unconscious Essential Reads
The following was the key part of our first typed interaction. (Nolan’s subconscious responses are in italics.)
Tell me something about Nolan that would surprise him to find out that you told me.
When he had his allergic reaction he got scared.
Did you know he was going to be all right?
Did Nolan know he was going to be all right?
Can I show Nolan what we typed?
Will he be surprised?
After the session, when Nolan was alert, he had no recollection of what he typed. He was shown the transcript and expressed surprise. Thus, he was reassured that he could type without conscious awareness.
Uncovering the Reason for the Breathing Problem
Ten days later, he still continued with his breathing noise. The following are excerpts from the typed interaction that occurred:
I would like to ask you about the two things that are bothering Nolan of which he is unaware. Can you tell me about one issue?
Nolan was traumatized from the allergic reaction.
Is something still bothering him from that reaction?
Can you explain to me what is still bothering him?
It’s something big.
Tell me more. What is big?
The next week or two was terrible for Nolan, so he had some nasty thoughts.
Why were they terrible?
Bad breathing constant hives all over the body he was scared.
And what were the nasty thoughts?
I don’t know if I could say it.
Is he traumatized in part because of the thoughts?
I can tell you that whatever thoughts he had were the result of being scared. They should not reflect badly on Nolan. Does that make sense?
Is it okay if I guess what the nasty thoughts might have been?
Did he –
A) Want to hurt himself or die?
B) Want to hurt someone else?
He had suicidal thoughts.
And now he is worried that it was wrong to have such thoughts?
Yes, he does not have them anymore.
Of course, because he is no longer scared. But he is unhappy that he had them in the first place?
Yes, he was traumatized about it.
Did he feel that he was not strong enough to suffer through it?
He thought he should tell someone but he was not strong enough to.
He should have told someone what?
About his thoughts.
OK. So, first you need to understand that when someone is very very scared and uncomfortable, sometimes the solution of suicide floats up. This does not mean anything was wrong with you. All it means is that he was scared. It’s normal to feel that way sometimes. The important thing is that he made it through! And yes, he was not strong enough to tell about these thoughts in the past, but now clearly he is strong enough for you to tell me… So, he’s obviously getting over his trauma.
Ya, he is slowly healing.
Beautiful. He should keep healing at his own pace, and when he is ready he can tell his parents (if he wants) about the thoughts he used to have, and how he overcame them and understood them to be the product of feeling very scared.
Thank you for telling me. I feel better.
After the session, when Nolan was alert, he had no recollection of the typed interaction. I told him that the subconscious had told me about the suicidal thoughts. Nolan became tearful, and I reassured his conscious self as I had with the subconscious. Nolan expressed relief at having told someone about his suicidal thoughts.
I suggested that he could tell his parents, but Nolan said he was not ready. He ended up telling his parents 30 minutes later during the ride home. However, Nolan’s noisy breathing persisted even after he reported his suicidal thoughts.
Resolving the Breathing Problem
During the following typed session, a week later, Nolan's subconscious explained that his second issue was that when he became stressed about anything, such as academic pressure, he started thinking about how badly he felt when he had suicidal thoughts. This is why he continued to have difficulty with breathing. I gave him some therapeutic suggestions during our next typed session:
What we are going to do now is to get into a time machine and go back to visit Nolan while he was scared about his breathing and feeling suicidal. You can do that by imagining the scene on a movie screen so that if it becomes too intense you can just turn it off. Does that sound reasonable to you?
So, please go back in the time machine, and when you see the scene on the movie screen, please describe Nolan to me.
Every day Nolan would wake up hard to breathe and hives on his body in many spots Nolan was new to the bad breathing so he did not have any tricks to make it better so his breathing was bad all day until he slept.
Now, we are going to help Nolan in the movie. Please rewind the movie to the beginning and run it forward to the point when Nolan first has breathing problems and hives. Then pause it there. Let me know when you’ve done that.
Now, please take Nolan out of the movie for a bit, and tell him the following:
- You will be fine. I have been to the future and you’re doing very well.
- You can calm yourself with the breathing techniques I will show you (and teach him the breathing techniques).
- You can calm yourself with hypnosis (and teach him how to do that).
- You can calm yourself with your relaxation sign (and teach him how to do that).
Let me know when you’ve done all of that.
Did Nolan like what you said to him and taught him? Was he appreciative?
He liked it and was appreciative of the gesture.
Great. Now, put him back into the movie and let it play out, now that Nolan knows to use all of the tools, and knows that he will be fine. Tell me how the movie plays out. Does he ever develop suicidal thoughts?
Nolan felt better with no suicidal thoughts.
The test of how things will have changed will be as soon as you return into the present. We’ll see how his breathing changes, now that the past feels better to him.
So, go ahead and come back into the present, and I will keep an ear out for his breathing. Have fun on your trip back to the present!
[Nolan's noisy breathing resolved within 10 seconds.]
I think he is better! Good work! Do you have anything else to say to me today?
When he comes back he may be surprised to find that his breathing has become normal! I’m very happy for him. Bring him back when you are ready.
Nolan indeed was surprised when he became alert. He noted immediately that his breathing had become normal. He asked how this occurred and I told him that his subconscious had worked out his problem.
In the next blog post I will describe some of the surprising turn of events over the subsequent few weeks.
Most of this blog was excerpted from the chapter by Anbar & Cherry (2021).
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.
Anbar, R. D. (2021). Changing Children’s Lives with Hypnosis: A Journey to the Center. Lanham, MD: Rowman & Littlefield.
Anbar, R. D., & Cherry, R. N. (2021). Communicating with the Subconscious: Ideomotor and Visualization Techniques. In: Mark P. Jensen (ed), Handbook of Hypnotic Techniques, Vol. 2. Kirkland, WA: Denny Creek Press, pp 196-231.
Anbar, R. D., & Fernandes, B. A. (2016). Vocal Cord Dysfunction. In: Gary R. Elkins (ed), Handbook of Medical and Psychological Hypnosis: Foundations, Applications, and Professional Issues. New York, NY: Springer Publishing Company, pp. 429-433.