Cognitive-Behavioral Hypnotherapy on Anxiety Disorders in 8- to 12-Years-Olds with Type 1 Diabetes

Type 1 diabetes is among the most prevalent chronic disorders in childhood. Moreover, the incidence of diabetes has increased dramatically over the last 20 years. It potentially threatens the lives of children, impacting the bio–psychological status of affected children and their families. A significant psychological problem in patients with type 1 diabetes is an increased frequency of anxiety disorders. To treat psychological problems, in addition to pharmacotherapy, several cognitive therapies have been devised by researchers during recent years. The most commonly used treatments for anxiety disorders include behavioral therapy, Cognitive–Behavioral Therapy (CBT), family interventions, and pharmacotherapy, or a combination of them. CBT helps the therapist to identify defined patterns and ineffective behaviors and use organized behavioral assignments to address them. This treatment focuses on emotion, cognition, and behavior. Furthermore, hypnosis is a therapeutic approach that could cure anxiety disorders in diabetic children. Psychologists obtain numerous therapeutic achievements using the principles of the cognitive approach; however, the combination of behavioral therapy and hypnotherapy approaches could lead to a more rapid and deeper impact on patients. Cognitive–behavioral hypnotherapy covers several basic techniques, including relaxation, guided imagery, cognitive reconstruction, gradual desensitization, and hypnotic skills training. Thus, the present study aimed to investigate the effects of cognitive–behavioral hypnotherapy on anxiety disorders in children aged 8–12 year with type 1 diabetes.

This was a quasi–experimental study with a pretest–posttest and a control group design. The statistical population of this study was all 8–to 12–years–old children with diabetes referring to diabetes treatment centers in Shiraz City, Iran, in 2018. Among the treatment centers, two were selected by convenience sampling method; of which, 30 individuals with anxiety disorders were randomly selected as the experimental (n=15) and control (n=15) groups. The research tool was the Screen for Child Anxiety Related Disorders (SCARED) designed by Birmaher (1999) to assess the symptoms of anxiety disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM–IV) criteria in children and adolescents aged 8 to 17 years. The experimental group was then subjected to cognitive–behavioral hypnotherapy for 5 weeks; one 2–hour session per week. However, the control group received no intervention. The posttest was performed after the completion of the treatment course and the follow–up was conducted three months later. The obtained data were analyzed by repeated–measures Analysis of Variance (ANOVA) in SPSS at the significance level of 0.05.

The repeated–measures ANOVA results suggested that hypnosis therapy reduced the overall anxiety (p<0.001), social phobia (p<0.001), social anxiety (p<0.001), and school phobia (p<0.001) in the investigated children with type 1 diabetes; however, it had no significant effect on the anxiety and the separation anxiety of this group.

In general, cognitive–behavioral hypnotherapy could improve anxiety disorders in children aged 8 to 12 years. The present study results supported the findings of previous studies; they indicated the beneficial effects of cognitive–behavioral hypnotherapy on reducing the types of anxiety and its destructive consequences on the lives of children with type 1 diabetes. Additionally, children are responsive hypnosis subjects and more likely to be hypnotized than adults. Besides, their hypnosis capabilities are reduced by increased age, rationalization, and becoming more realistic. It is therefore possible to use this therapeutic approach to treat the types of anxiety and other acquired diseases in children.