Guest editorial

This issue of the American Journal of Clinical Hypnosis (AJCH) focuses on increasing recognition that exposure to trauma results in a range of consequences beyond Post-Traumatic Stress Disorder and that many trauma-focused interventions are of limited benefit regarding these other trauma damages. Herman (1992) introduced the concept of Complex PTSD (CPTSD) noting that prolonged, repeated trauma is associated with more complex, diffuse, and tenacious symptoms, deformations of relatedness and identity, and survivors’ vulnerability to repeated harm. Ford and Courtois (2020) note that “complex trauma compromises attachment security, self-integrity, and ultimately self-regulation” (p. 8). Moreover, Herman (2020) cites Dorrepaal et al. (2014), who found in a metanalytic study that participants with child abuse-related Complex PTSD were less likely to benefit from exposure versus affect management protocols, and that the latter were associated with more favorable recovery, improvement rates, and lower dropout rates. These authors and others (Ford & Courtois) noted the need for identification of interventions that will address the consequences of prolonged and complex trauma more specifically.

Whereas manualized cognitive-behavioral trauma-focused interventions such as prolonged exposure and cognitive processing therapy are widely available to clinicians and trainees, these interventions are designed to modify symptoms of simple PTSD. They do not address the range of CPTSD adaptations to complex trauma. Among these adaptations are insecure attachments along with disruptions in self-organization, impaired affect regulation, and relational skill deficits (Brown & Elliott, 2016; Ford & Courtois, 2020; Gold, 2020). This issue of the AJCH touches on increasing awareness of the varied settings and presentations of trauma consequences, the importance of repairing the developmental deficits and autonomic nervous system changes associated with complex traumatic stress disorders, and alternative and complementary hypnotic and non-hypnotic approaches to facilitate adequate recovery. What follows is a brief summary of what the readers will find in this issue.

Drs. Gold and Quinones open the issue with their article, “Applicability of Hypnosis to the Treatment of Complex PTSD and Dissociation.” They note the high incidence of CPTSD, review the developmental deficits associated with it, and outline a hypnotic treatment approach to repair such deficits. Moreover, they note that adequate repair of these developmental deficits often results in adequate resolve of the PTSD symptoms and that trauma-focused interventions may not be needed in many cases.

In “The Mindfulness-Based Phase-Oriented Trauma Therapy (MB-POTT): Hypnosis-Informed Mindfulness Approach to Trauma,” Dr. Otani reviews the phase-oriented model of trauma treatment and mindfulness. He expands our options for promoting trauma mastery in our clients and outlines the use of mindfulness and hypnosis. He demonstrates the application of his MB-POTT model with a case example that assists us in learning his techniques.

In his article, “Post-traumatic Stress in the Medical Setting,” Dr. Philip Appel makes us aware of the ways injury, physical losses, chronic illnesses, invasive medical procedures, and intensive care experiences are associated with the development of PTSD, warranting intervention. He further delineates how physical losses and chronic illnesses undermine one’s identity, reviews the importance of addressing this disruption of self, and outlines hypnotic strategies to facilitate constructive re-identification. Dr. Appel’s insights and treatment approach are essential reading for those of us working with patients experiencing severe medical conditions and physical disabilities.

Taylor Leslie, Wendy Lemke, and I review trauma-informed care in educational and medical settings. Appreciating both the impact of trauma on children in educational settings and that it is beyond teachers’ role to treat traumatic stress in their students, we offer options for using constructive hypnotic language by non-mental health educators. “The Relevance of Being Hypnotic in Addressing Trauma in Children Across Various Settings” will be of particular interest to those working with children in a wide range of capacities.

In “The Varied Relationship Between Hypnosis and Dissociative Phenomena: Implications for Traumatology,” Drs. Cleveland, Reuther, and Gold evaluate the impact of hypnosis on normal versus pathological aspects of dissociation. Noting that the use of clinical hypnosis with patients experiencing trauma and dissociative disorders has been speculated to be contraindicated and potentially iatrogenic, their study sheds light on the relationship between hypnosis and dissociation.

Dr. Hamilton and I evaluated the use of clinical hypnosis to modulate the autonomic nervous system, based on the polyvagal theory, to reduce functional gastrointestinal symptoms. In our article, “Impact of Hypnotic Safety on Disorders of Gut-Brain Interaction: A Pilot Study,” we note the high incidence of trauma in this population and the relation of trauma to the retuning of the autonomic nervous system to a state that undermines physical, emotional, and interpersonal health. The hypnotic strategy employed in this pilot study offers an approach to modifying the neurophysiological substrate of affect regulation, attachment, and somatization in victims of complex trauma.

The field of complex trauma, including complex traumatic stress disorders, developmental trauma disorders, and disorders of extreme stress not otherwise specified, has significantly advanced since Judith Herman’s proposal of Complex PTSD in 1992. In addition to broadening our awareness of the effects of trauma in medical and educational settings, this special issue of the AJCH touches upon the importance of initial repair of developmental deficits in complex traumatic stress disorders, ways to improve autonomic nervous system functioning to support such repair, and the application of both hypnotic and mindfulness strategies to achieve such goals. Practitioners of hypnosis working with traumatized individuals will find value in the solicited articles presented here.