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Storm in the womb: exploring the use of private subconscious mind healing (P.S.H. Therapy) in the Treatment of Hyperemesis Gravidarum PART 1.

Introduction

Hyperemesis Gravidarum (HG) is a condition peculiar to pregnancy. Hyperemesis means "excessive nausea and vomiting in a pregnant woman" (Venes, 2009) up to 20 weeks of gestation (MedicineNet.com, 2014). Women with this condition are unable to retain either fluids or solid food taken orally, and will require hospitalisation for fluid replacement due to dehydration.

HG is a condition that commences with what is commonly known as morning sickness. Nausea and vomiting can be one of the early signs of pregnancy for some mothers. Indeed, some statistics (Newman et al, 1993, p. 483) suggest that nausea and vomiting within early pregnancy is experienced by as many as 50% to 80% of women. However, this disorder of early pregnancy can become so intensified in some women as to become a life threatening condition. Prior to the medical community gaining a better understanding of fluid and electrolyte balance within the human body and the advent of fluid replacement therapy, HG was responsible for a considerable number of foetal and maternal deaths (Anderson, 1994, p. 15).

The exact cause of this condition remains a mystery. Biological, psychological and sociological factors have been implicated in the aetiology of HG. The consensus of opinion (Iancu et al, 1994, p. 144; Moshe et al, 1994, p. 610) is that the cause of this illness is an interplay of the three aspects mentioned above. Treatment is symptomatic. It mainly consists of fluid replacement and the use of anti-nausea medication to treat the persistent nausea and vomiting, and to stabilise the physiological aspects of the illness such as dehydration (Miller et al, 1989, p. 157; Beicher, 1991, p. 305).

Psycho/social support is also offered, however, it is not always recommended by doctors and, by extension, rarely utilised by patients. This seems counterintuitive when it is strongly suspected that the psycho/social component of this disease could be as high as 80% of cases (Iancu et al, 1994, p. 148).

Hypnotherapy has been successfully used in the USA for many decades with HG patients (Iancu et al, 1994, p. 146). However, knowledge of its application has been inadequately circulated. In the past, many clinical trials had been poorly designed to effectively communicate the positive results of this natural drug-free approach that alleviate the distressing nausea and vomiting experienced by mothers with this condition (Henker & Fuchs quoted in Iancu et al, 1994, p. 146).

In recent years McCormack (2010, pp.647-653) stated that "appropriate evidence-based treatment for this illness is paramount" and, as a consequence, conducted a literature search using Cochrane, PsycINFO, PsycARTICLES, and Web of Knowledge databases, and identified 45 studies in regard to treatment of HG, of which six studies fulfilled the inclusion criteria for writing a research paper called "Hypnosis for Hyperemesis Gravidarum". McCormack reported that:
   Methodology between the studies differed but all reported
   encouraging positive outcomes. However, the quality of current
   evidence, based on the studies reviewed in this study, is not
   sufficient to establish if hypnosis is an effective treatment for
   HG. To be able to accurately assess the efficacy of hypnosis for
   HG, it is recommended that well-designed studies, e.g. randomised
   control trials, be carried out.


While some overseas clinicians were using hypnosis as a treatment tool for HG, during the 1990s Australian hypnotherapist Frank Wright (Wright, 1995) in conjunction with Gregory L Brice (Brice, 2004) were developing a new hypnotherapeutic technique known as P.S.H. Therapy. This subconscious mind modality had its origins in analytical hypnotherapy pioneered by Dr. Edgar Barnett (Barnett, 1989), as well as the work of Dr Milton Erickson who famously once said about the use of the term "hypnosis" (Havens, 1996, p. 11):
   You can call it anything you want. I call it hypnosis, relaxation,
   various terms. I like to call it comfortable self-awareness. I like
   to teach my patients a comfortable self-awareness.


The P.S.H. Therapy process was refined from analytical hypnotherapy to eliminate ideomotor signals and to focus on the central idea that the subconscious mind could locate and release negative repressed emotion and activate internal healing resources on a deep inner level to achieve positive outcomes without the conscious mind being granted awareness of the critical incident and the associated underlying feeling cause. In addition, the approach was client-focused rather than therapist-focused, so therapist speculation and theorising on causative factors, as well as conscious mind intervention such as counselling, were discouraged. In P.S.H. Therapy, healing is effectively handed over to the subconscious mind in totality (Duncan, 2003, pp. 101-102).

Literature Search

Nausea and vomiting in early pregnancy is not uncommon. In fact, it is one of the most common disorders expressed by mothers of the so-called minor discomforts of pregnancy. In a small percentage of mothers to be, this nausea and vomiting becomes so excessive and frequent that there is a serious threat to the mother and the foetus, endangering their physical and mental health.

The diagnosis of HG is usually made when vomiting within early pregnancy is so extreme and continuous as to warrant the admission of the patient to hospital for fluid replacement and other necessary medical interventions. It is important at this stage to exclude other possible causes of nausea and vomiting prior to making a diagnosis of HG (some of the other possible causes will be mentioned later in this paper).

Historical Perspective of Hyperemesis Gravidarum

This condition of pregnancy was described in literature over 2000 years ago (Moshe et al, 1994, p. 606). A physician of the time, Soranus, who lived around 100 years BC concluded from his observations of this illness that the nausea and vomiting of pregnancy was more severe when there was a male foetus (Moshe et al, 1994, p. 606). Since then, there have been many other theories suggested as to the cause of HG.

In the 17th century the medical authorities thought this condition might have been caused by the abundance of "Humors" (L = Fluid) (Moshe et al, 1994, p. 606). In the 18th century another theory emerged: it was then thought the excessive vomiting was caused by the fullness of the uterine vessels, which in turn was caused by the obstruction of the "Catamenia" (the Menses) (Moshe et al, 1994, p. 606). In their ignorance, the medical doctors' proposed treatment was bleeding the poor woman (Moshe et al, 1994, p. 606). In that particular period of history, doctors believed that bleeding their patients was a cure all for all kinds of medical conditions.

In 1852 a medical man of the day emphasised the gravity of the condition 'when he presented a lecture that contained case histories of 10 fatal cases (Moshe et al, 1994, p. 607). As we moved closer to the present day, HG was recognised in the first half of the 20th century as a condition responsible for the demise of many mothers and their babies (Moshe et al, 1994, p. 607).

Aetiology

Present day theories into the cause of HG suggest a combination of biological and psycho/social components to this condition (Iancu et al, 1994, p. 148). However, no theory claims to have adequately pinpointed the exact cause despite extensive medical research over the last three decades.

Biological Causes

Biological causes include disturbances in carbohydrate metabolism, vitamin deficiencies especially the B group of vitamins, and endocrine/hormonal imbalances (Iancu et al, 1994, p. 144). A number of studies (Moshe et al, 1994, p. 608) implicate high levels of circulating human chorionic gonadotropin hormone, oestrogen and thyroxin in the genesis of this condition while low levels of progesterone have been thought to contribute to the cause as well.

Strong support for the hormonal implications come from the fact that levels of the above mentioned hormones are highest in the first trimester of pregnancy, coinciding with the greatest incidence of HG between the 4th and 16th week (Moshe et al, 1994, p. 608). There is also a correlation in certain conditions of pregnancy itself such as multiple pregnancies defined in this case as the mother carrying twins, or triplets, as well as the condition known as hydatidiform mole, also known as a molar pregnancy, which is "a rare mass or growth that forms inside the womb (uterus) at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD)" (MedlinePlus, 2014; Australian Government Cancer Australia, 2014). Hydatidiform mole may lead to a form of Trophoblastic neoplasia, which is "a malignant, trophoblastic cancer, usually of the placenta" (MedlinePlus, 2014) where high levels of circulating chorionic gonadotropin hormone are generally found. Increases in nausea and vomiting are more common in those two situations.

Several other physiological causes that have been suggested for HG are maternal immune system rejection of the conceptus (Miller et al, 1989, p. 156) as well as maternal toxicity due to circulating toxins possibly originating from the gastrointestinal tract, liver or an ovarian source (Anderson, 1994, p. 13). Furthermore, reflux oesophagitis in combination with fluctuations in gastric PH is a recent newcomer to the possible causes at the physiological level (Devitt, 1991, pp. 279-282).

Recalling 18th century theory that HG was a result of fullness within the uterine blood vessels, there is a similar present day theory suggesting HG could be caused by pelvic congestion arising from the enlarging cervix and growing uterus, which results in a reflex form of vomiting produced by the sympathetic nervous system (Fairweather quoted in Anderson, 1994, p. 13; Moshe et al, 1994, p. 605-606).

Psycho/Social Causes

In nearly all of the reviewed literature on HG, psycho/social causes were thought to play a dominant role in the condition. Three decades of research predominantly expounds the view that psycho/social causes were hugely implicated in the aetiology of hyperemesis in as high as 75% to 80% of all cases (Iancu et al, 1994, p. 144).

To preface the long list of psycho/social aspects of HG, the following insight is useful in setting the scene for the mind body interaction of HG from the mental health expert's point of view. Iancu et al (1994, p. 145) states:
   The aetiology of hyperemesis is still obscure, but it is noteworthy
   that in primitive cultures excessive morning sickness is unknown.
   It is only after civilization reaches these people that pregnant
   women start suffering from this condition. The importance of
   psychological factors in the causation of hyperemesis is indicated
   by the disappearance of symptoms when the patient is separated from
   the family and the frequent relapses that occur upon returning to
   their home environment. The fact that HG is seen only in humans,
   and that it is treatable by hypnosis and other forms of suggestion
   and that its incidence markedly decreases during times of war, are
   further supporting evidence of its psycho/somatic nosology.


From the psycho/social perspective the following theories are suggested as the cause of this illness.

As far back as 1891, HG was linked to psychic conflict. At the time it was thought that the emesis represented an unconscious rejection of the pregnancy by throwing up or vomiting the conceptus (Iancu et al, 1994, p. 145). This idea seemed very Freudian as it referred to an exaggeration of the oral symptom. Unfortunately, this theory often resulted in punitive and uncaring treatment for mothers suffering from HG. Psychoanalysis in western culture expounded the notion as that of the mother's disgust and rejection expressed via the digestive tract. Therefore, mental health professionals of the time concluded that antagonism to pregnancy is expressed via vomiting (Iancu et al, 1994, p. 145).

As the 20th century unfolded, more and more analysis and theories of psycho/ social causes behind HG emerged in literature. Some of the theories make sense, while others seem harsh and cruel. The main theories suggest the following psycho/ social causes:

* HG is caused by feelings of ambivalence regarding pregnancy and femininity, rather than an outright rejection of the pregnancy (Iancu et al, 1994, p. 145).

* HG was reported to be more common in women who, prior to pregnancy, were considered anxious, depressed, despondent, immature or hysterical. HG was, in fact, thought to be a protest reaction against pregnancy due to psychic conflicts where family and marital problems existed (Iancu et al, 1994, p. 145; Moshe et al, 1994, p. 608).

* A specially designed questionnaire answered by a group of 100 women with excessive emesis revealed that vomiting and nausea were linked to poor diet, poor communication between partners, as well as inadequate communication between the pregnant women and health professionals. Researchers also found a correlation due to stress and anxiety experienced by the women because of their poor knowledge about pregnancy, labour and changes associated with becoming a mother, as well as a fear of the unknown. The conclusions from the study were that nausea and vomiting are associated with emotionally disturbing events (high stress levels) experienced during pregnancy (Iancu et al, 1994, p. 145).

* Another group of researchers noted in their findings that HG is seen in the context of pathologic marital relationships maintained by mutual denial (Iancu, 1994, p. 145).

* Secondary gain has also been suggested in the aetiology of hyperemesis similar to that seen in conversion disorders. It is suggested in these cases that there are dual components of getting attention and sympathy from family and friends while at the same time addressing aggression towards the husband. It was thought from this perspective there is a strong possibility that this biologic response (vomiting) is conditional to environmental stimuli (Moshe et al, 1994, pp. 608-609).

* Women who are emotionally dependent on their mothers or have a subconscious desire for an abortion seem to have a high probability of HG (Iancu et al, 1994, p. 145; Moshe, et al, 1994, p. 608; Anderson, 1994, p. 13).

In an interesting study conducted in a large teaching hospital of 40,000 consecutive antenatal patients, approximately 1% experienced HG of sufficient severity to be admitted for rehydration and other therapies (Beicher & Mackay, 1991, pp.305-306). Of 263 of those patients, it was discovered there was no prevalent association or relationship with physiological causes such as multiple pregnancies (only six cases presented), urinary tract infections (only three cases), or hydatiform mole (no cases). Furthermore, it was found that 24 of the 263 patients (9%) had a history of past psychiatric illness, and it was strongly felt that many of the remaining patients had some underlying problems of anxiety and depression as well as other psycho/ social and relationship disturbances (Beicher & Mackay, 1991, pp. 305-306).

With findings such as these, that is, the high incidence of psycho/social problems in mothers who are admitted to hospital with HG, it is most likely that in 30% to 60% of prenatal patients who experience excessive nausea and vomiting there is a psycho/social component to this condition (Beicher & Mackay, 1991, pp. 305-306).

Incidents of Hyperemesis Gravidarum

The incidence of nausea and vomiting in early pregnancy is very common, and are considered to be early diagnostic signs of pregnancy. Various studies suggest that 30% to 60% and as high as 50% to 80% of mothers experience some degree of nausea and vomiting during the first half of their pregnancy. Mothers who experienced HG to the degree that hospitalisation was required amount to 1% or ten per thousand (Beicher & Mackay, 1991, p. 305).

In Australia, the 2014 figure for the total number of births was 290,549, just over a quarter of a million per year. One per cent of this figure (Newman et al, 1993, p. 483; Moshe et al, 1994, p. 606; Iancu et al, 1994, p. 143; Anderson, 1994, p. 15) would mean that approximately 2905 mothers would be admitted to hospital over a 12-month period in Australia for medical treatment.

The actual figures for women being admitted to hospital with HG symptoms for 2011 to 2014 are:
Figure 1: Women admitted to Australian hospitals suffering from
excessive vomiting in pregnancy. Australia 2011-2014.

Hyperemesis Gravidarum   2011 to 2012   2012 to 2013   2013 to 2014

021.0 Mild HG < 20/40       5,421          4,624          5,167
021.1 HG with metabolic
  disturbance < 20/40       2,127          2,079          2,349
021.2 Excessive
  vomiting >
20/40                         854            875            997
TOTAL                       8,402          7,578          8,514

Source: Australian Government/Australian Institute of Health and
Welfare (AIHW) National Hospital Morbidity Database (NHMD) (2014)


These figures are up to nearly three times greater than the 1% predicted. For example, the 2014 figure is 2.93%.

Signs and Symptoms of Hyperemesis Gravidarum

Untreated, this incapacitating condition of pregnancy can lead to some serious consequences for both mother and baby. HG can be seen as a progression from the common complaint of early pregnancy referred to as 'morning sickness' to the vomiting up of all food and drink. This leads to dehydration and starvation resulting in ketosis, multiple neuropathies, liver damage, jaundice, Wernicke's encephalopathy, coma and if untreated, in some cases, eventually death (Miller et al, 1989, p. 156). This sequence of events is illustrated in Figure 2:

[FIGURE 2 OMITTED]

It would appear that in spite of the frequency and enormous clinical importance of emesis, the combinations of nervous system mechanism, as well as the physical and chemical stimuli underlying vomiting, are not well understood.

Moshe et al (1994, p. 605) states:
   Most physiologists agree that vomiting is under the control of two
   functional distinct medullary centers. The vomiting center and the
   Chemoreceptor center that lie close to each other near the brain
   stem centers regulating vasomotor and autonomic function.


This is cause for speculation and to pose the question: What are the connections between these vomiting centres and the Autonomic Nervous System (ANS)?

Newman et al (1993, p. 483) states:
   It should be noted, however, that the nutrient depletion that
   results from severe and prolonged nausea and vomiting may in turn
   affect emotional health and thyroid function. For example, vitamin
   B deficiency is a well-known cause of anxiety and depression and
   protein energy malnutrition resulting in thyroid dysfunction.


Perhaps what is being demonstrated is the relationship between the biological and psycho/social aspects. If we accept that there is a connection then, in all probability, a substantial emotional component in HG that is being manifested by continuous vomiting, which in turn, further depletes resources at the physiological level, then rebounds back to the psycho/social level will cause a heightening state of anxiety and a deepening of depression. This leads to the question previously asked: What role does the ANS, one of the major systems of mind body communication, have in this condition?

Current Treatments of Hyperemesis--Biological and Psycho/Social

It is important to exclude all other causes of emesis prior to the diagnosis of HG being made. Briefly, other possible causes of vomiting in early pregnancy include appendicitis, hepatitis, pancreatitis, inflammatory or obstructive bowel pathology, urinary tract infections, pyelonephritis, uremia, diabetic ketosis, hyperthyroidism, drug toxicity, and central nervous system lesions to name a few. Then there are conditions associated with pregnancy itself that may increase the likelihood of an increase in vomiting/emesis such as multiple pregnancies in the form of twins or triplets. Another possible cause would be hydatiform mole, as well as pregnancy-induced hypertension, hydramnios and abruption of the placenta (Miller et al, 1989, p 156).

Having excluded other possibilities of emesis, the treatment for HG usually follows this particular sequence in a general hospital:

(1) Hydration with intravenous fluids and necessary correction of any electrolyte imbalances. (Fluid and electrolyte replacement is the basic accepted front line therapy and there is no doubt since the 1940s this therapy has been instrumental in reducing the maternal death rate (Moshe et al, 1994 p. 609).

(2) Initially the patient is kept nil by mouth until hydration has been corrected and vomiting has been controlled.

(3) Intravenous vitamins should be used if there has been a prolonged period of vomiting. The vitamins most commonly used are from the B group especially B6 and vitamins C and K. Thiamine may also be deficient in severe cases, and is required to prevent Wernicke's encephalopathy (Moshe et al, 1994, p. 609; Newman et al, 1993, p. 486-487).

(4) Antiemetic drugs are used with caution to alleviate nausea and vomiting. Drugs that have been used to control the severe emesis include Maxalon, Phenergan, Stemetil and Zofran. Any drugs given during pregnancy, especially in the first trimester, cause great uneasiness both in the mother and her caregivers. This is due in part to the prescription of Thalidomide for morning sickness during the 1950s and early 1960s, which caused many abnormalities in developing babies (Kim, 2011). It was interesting to note that in the USA, the Food and Drug Administration (FDA) has approved no drugs for the use of morning sickness following the controversy over Bendictin or Debendox in the early 1980s. There was evidence to support that this drug was safe to use during pregnancy. However, litigation was brought against the manufacturer's, claim that the drug would cause no congenital malformations. Highly publicised lawsuits involving neonates born with severe malformations whose mothers had taken the drug for morning sickness were judged unfavourably against the maker of Bendictin (Newman et al. 1993, p. 485).

(5) Most women respond to the above regime (Iancu, 1994, p. 146).

However, psycho/social treatment modalities are used in conjunction with fluid replacement and antiemetic medication. These include supportive psychotherapy, family therapy, behaviour modification techniques and hypnotherapy. Therefore, one cannot state a certainty as to whether it is the treatment regime, or the psycho/ social treatment or the combination of both that is yielding the positive outcome.

Indeed, as Iancu (1994, p. 146) states:
   Actually not many cases of HG are referred for psychiatric opinion
   and management. Obstetricians with medical treatment, explanation,
   reassurance and correction of aggravating behaviours treat most. In
   severe cases a triangular team including obstetrician, a
   psychiatrist and a social worker could achieve the best results in
   these patients. It is clear that in such cases early psychological
   intervention could contribute greatly to the wellbeing of the
   mother and foetus.


Furthermore, Jueckstock et al (2010) asserts:
   More recent approaches assume that neither a merely physical
   pathway nor a completely psychological pathomechanism can cause
   such a complex disease but on the contrary HG is a multifactorial
   condition. Focusing entirely on psychogenic factors raises the risk
   that patients are not taken seriously in their suffering and
   probably not all existing therapeutic options are used. However,
   neglecting the psychosomatic aspects in the development and course
   of HG in some patients harbours the risk of treating only the
   symptoms of the condition without eliminating the cause.


Treatment of Hyperemesis Using Hypnosis

It appears hypnotherapy has been used successfully over the past 50 years in the USA for the treatment of HG. There were a number of small trials conducted using hypnotherapy and, in spite of excellent results, very few reports were published until the 1980s (Iancu et al, 1994, p. 146).

One interesting study reported was that of 138 HG patients who had minimal response to medication and were offered hypnotherapy (Iancu et al, 1994, p. 147). Through the use of hypnosis the patients received suggestions for comfort in the gastrointestinal tract, desirability of feeling good in their stomach, as well as the ability to retain and digest their food. The results of the study noted two approaches to the hypnotherapy treatment:

(1) A group approach, and

(2) An individual approach.

Surprisingly, the results were better in the women treated by the group method (N = 87), whereby 97% had an excellent result compared to 72% for individual hypnotherapy (Iancu et al, 1994, pp. 146-147).

Another encouraging paper on the treatment of HG with hypnosis described a variety of techniques used by the therapist for different clients (Torem, 1994, pp. 1-2). The author presented five case histories in the paper, and prefaced his paper with a summary of the medical treatments already outlined. Torem then stated:
   All of the above treatments do not guarantee a favourable outcome,
   and at times increase the risks of medical/legal liability for the
   physician especially when medications are used. Based on the above,
   the search for other interventions such as hypnotherapy has become
   timelier.


The author also outlined the techniques he used with each client along with a discussion about the outcomes, all of which resulted in a cessation of vomiting by the clients. The techniques used were (Torem, 1994, pp.1-11):

Client No. 1. Hypnotic relaxation suggestion

2. Ego strengthening

3. Cognitive restructuring

4. Symbolic guided imagery

5. Future orientated guided imagery.

In conclusion Torem stated (1994, p. 9):
   In reviewing the literature regarding the use of hypnotherapy, I
   have not found a specific strategic method of approach from the
   simple to the more sophisticated techniques in the treatment of
   patients with hyperemesis gravidarum. Moreover, the use of symbolic
   imagery (Client 4) and the use of future orientated imagery (Client
   5) have not been previously described using hypnotherapy in the
   treatment of mothers with hyperemesis.


Torem described two new approaches in his work with HG patients, which serve as an introduction to the application of P.S.H. Therapy with patients suffering from this distressing illness. To date, P.S.H. Therapy has not been used with this particular group of clients.

P.S.H. Therapy and Hyperemesis Gravidarum

Wright (1995, p. 26) states:
   The last quarter of the 20th century has brought about a totally
   new understanding of the subconscious mind. In particular, the
   breakthrough has been the understanding of the way in which
   repressed negative emotion is actually released from the inner
   deeper recesses of what we call the 'mind.


P.S.H. Therapy is based on this most up to date understanding of how the subconscious mind works in relation to the release of repressed negative emotions, which is now known to be at the root cause of most stress or mental/emotional and psycho/somatic symptoms.

Furthermore, Wright (1995, p.58) states:
   The subconscious memory is the key ... Every experience of your
   life is stored away in your subconscious. Every thought, every
   feeling, every event which has touched you is there. And you have
   the potential to reach every single memory of that rich storehouse
   of your experience.


The P.S.H. Therapy model of interaction utilises the mind's own ability to identify and resolve these inner conflicts completely within the privacy of the subconscious mind and, when its principles are correctly observed, P.S.H. Therapy provides deep and permanent results with almost all presenting psycho/somatic problems. The P.S.H. Therapy modality of treatment completely reverses the therapist-centred techniques of the early part of this century.

This technique or approach evolved from the analytical hypnotherapy work pioneered by Dr Edgar Barnett coupled with principles and insights from Dr Milton Erickson. For example, P.S.H. therapists are aware that it is the client who does the real work; the therapist is only a guide or facilitator. Dr Milton Erickson frequently emphasised this point to his students. Erickson (Rosen, 1982, p.89) states, "It is the patient who does the therapy" and also mentions (Rosen, 1982. p.56) that:
   Too many therapists think that they must direct the change and help
   the patient to change. Therapy is like starting a snowball rolling
   at the top of the mountain, as it rolls down, it grows larger and
   larger and becomes an avalanche that fits the shape of the
   mountain.


P.S.H. Therapy is a specialised use of hypnosis. Hypnosis is the tool enabling the client to access the negative repressed feelings deep within the subconscious feeling memory. The therapist as guide or facilitator encourages the communication between the different ego states within the total privacy of a client's mind. The P.S.H. Therapy model of interaction uses the mind's own ability to identify and resolve inner conflicts and release negative repressed emotions.

To appreciate the P.S.H. Therapy concept more fully, it might be helpful to focus briefly on the principles of this therapeutic modality as outlined in several books (Wright, 1994; Brice, 2004; Duncan, 2005). These principles need to be correctly observed if therapy is to succeed.

Understanding these tenets and how they work is based on the premise that our subconscious feeling memory is the repository or storehouse of all our past experiences, both positive and negative (that is, all the significant events, leanings and impressions, which have touched our lives as they have unfolded day by day). All of this information is etched into and recorded in the deep feeling memory.

The Seven Principles of P.S.H. Therapy

The core principles of P.S.H. Therapy (Wright, 1995, pp. 42-62) are:

(1) Locate and deal with the original cause

(2) The cause is a feeling

(3) Respect the privacy of the inner mind

(4) The subconscious mind is the gentle mind

(5) The subconscious memory is the key

(6) Deep change involves release

(7) People will only release when they are ready to release.

The dynamics of P.S.H. Therapy become clearer once these principles are understood. This therapeutic approach utilises the ability of the client's own mind to identify the original critical experience or experiences, as well as the feelings that are the real cause of the present difficulties or symptoms (Principles 1 and 2). Furthermore, in achieving an adequate state of mental relaxation and or hypnosis the therapist utilises the affect bridge (affect = feeling) to enable the person to review and identify the details of the original critical experience at the subconscious feeling level. Fear of disclosure of something personal, sensitive and/or very private can cause the subconscious mind to automatically bring defence mechanisms into play that prevent the client from reaching and dealing with the true causative feelings. Therefore, Principle 3 of total privacy is vital. The clients themselves must carry out the inner work that needs to be accomplished within the privacy of their inner minds: "Keep out of the client's mind"

Principle 4 highlights the sensitivity of the inner mind. Wright (1995, pp. 57-58) describes this principle succinctly:
   To say it another way, there are two minds, the noisy outer mind
   and the silent inner mind. The first is the forceful make it happen
   side of our nature, while the second is the gentle let it happen
   side. Just as a gentle person becomes more fearful, suspicious, and
   reluctant to cooperate when attacked by another, so the gentle mind
   will close up against any forceful attack against its defences;
   only in a state of silence from the outer world may we enter the
   inner world, the realm of our emotions.


Therefore, deep relaxation or hypnosis should be of adequate depth to make it easier for the client, in the state of silence or mental relaxation, to allow communication between the various ego states to proceed. The first step is to identify the problem and then to find a subconscious solution rather than a conscious mind strategy or solution imposed in a confronting way by the therapist. The therapist provides gentle encouragement aimed at directing the person to find their own solution in the wisdom of their adult subconscious mind. Once that solution is discovered, the client is then encouraged to release the original feeling cause, which in most cases belongs to the period in time of the infant and or childhood ego states. The child ego state needs gentle encouragement to relinquish the out-dated tension, which no doubt was initially intended as a protective or survival mechanism.

Principle 5 reinforces that subconscious memory is the key. Grasping this principle means accepting initially that the feeling memory is the subconscious, our total memory where everything is stored (ie. all the positive and negative experiences of our life's journey). Therefore, the original cause of the problem, which is always a feeling, needs to be located within the feeling mind. Those negative repressed emotions are what are preventing the person living fully in the present moment.

Principle 6 states that deep enduring change involves release of those negative repressed emotions. This is the goal of therapy, not just having the subconscious mind recognise what is hurting deep within, not just getting in touch with the uncomfortable feelings, but releasing the out-dated tension that is causing a considerable drain on the individual's energy levels or manifesting itself in certain physical symptoms and thereby holding the person back from experiencing life more fully in the present moment.

Principle 7 states that people will only release when they are ready to release. P.S.H. Therapy is a process of establishing inner communication between various ego states within the client. The original feeling cause is a protective or survival mechanism. The inner therapeutic processes focuses on communication starting communication between the adult ego state convincing the child ego state who may be hurting or very scared to relinquish those feelings, because they are no longer needed (the danger is now in the past).

The therapist cannot force this release of negative repressed emotions. Rather, the therapist can only gently encourage the client to do this inner work him or herself. Adherence to those principles, skilfully mapped out by the pioneers of PS.H. Therapy from their work in the clinical setting are the foundations to this important step forward in the field of hypnosis and subconscious mind healing. (Wright, 1994; Brice, 2004; Duncan, 2005).

P.S.H. Therapy and Hyperemesis Gravidarum

As the evidence supports a strong possibility that psycho/social factors are implicated in the aetiology of this condition in as high as 80% of HG cases, there is cause to speculate that there could be an original traumatic emotional experience, or several traumatic experiences that trigger off the distressing nausea and vomiting. These would include specific primary protective survival emotions, or perhaps a combination of them, such as fear, rejection, hurt, guilt, insecurity or sadness. The stress of the pregnancy could be triggering the primary original critical experience at an unconscious level and manifesting the inner turmoil in a very physical way with the excessive vomiting.

If a comparison (Figure 3) is made between the list of indicators for PS.H. Therapy and the psycho/social classification of some of the possible aetiological factors in HG then there is a strong possibility that repressed negative emotions play a large role in the genesis of HG.

Part 1 of this paper has placed emphasis on the psycho/social aetiology of HG. However, it is important not to lose sight of the possible biological causes especially the hormonal theory. In the earlier part of pregnancy there are higher levels of some hormones circulating as demonstrated by pathology tests. These levels fall from 12 to 14 weeks into the pregnancy and there is often a correlation between falling hormone levels and a decrease in nausea and vomiting of all pregnant mothers.

There is no doubt the cause of HG is still a mystery, however, research suggests there is a strong interplay of biological and psycho/social variables in this disease process.

Part 2 of this paper, which will be published in the next edition of the journal, will present clinical findings and outcomes of P.S.H. Therapy on five mothers who were suffering from HG.

References

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Peter Jackson, Registered Midwife, Calmbirth Practitioner and Registered P.S.H. Therapist

Calmbirth, Mittagong NSW, Australia
Figure 3: Comparison of P.S.H. Terapy indicators and
Hyperemesis Gravidarum psycho/social aetiological factors

P.S.H. THERAPY INDICATORS         PSYCHO/SOCIAL AETIOLOGY

Uncomfortable dreams, migraines   Psychic conficts, ambivalence
Panic attacks, phobias            Anxious, depressed, dependent
Anorexia/bulimia, sexual          Immature, hysterical
  difficulties
Depression, anxiety               Conversion reaction, fear of
                                    unknown
Low self esteem, insomnia         Poor communication between
Irrational emotional outbursts      spouse and health
                                    professionals, stress
Compulsive habits                 Emotionally disturbing events
Comfort eating, smoking           Pathological marital
                                    relationships maintained
Excess drinking, racing mind        by mutual denial, aggression
  /body problems
Checked by medical officer-no
  cause found
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Author:Jackson, Peter
Publication:Australian Journal of Clinical Hypnotherapy and Hypnosis
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Geographic Code:8AUST
Date:Sep 22, 2015
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