Paying Attention to Inattention
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Dr. Hutt's Published Article on Focus and Concentration
in the WSCA (Western Suffolk Counselors Association) Publication, Fall 2010
Why is it that the same kid can hyper focus on video games for hours on end while seemingly unable to focus on his or her homework for a mere 30 minutes, or even 5 minutes? The simple answer is that video games are more fun, engaging, and exciting while schoolwork is seen as tedious, boring, uninteresting and in the perception of some teens, something that only nerds enjoy. The reality is far more complex, and what we know about the functioning of the human brain and the production of neurochemicals that causes a person to feel good, can help psychotherapists train their patients to focus on school work as energetically as they do video games. This may seem like a tall order but in my therapy practice I have observed students who have learned to thrive in previously alien territory, no longer viewing schoolwork as drudgery and claiming "I want to do it but I just can't".
Paradoxically video games can be a route to increased focus in other parts of life. Studies have suggested that video games are not an insidious menace but help to improve learning skills in children. According to Dr. Bhupendra Gupta, from Sullivan University, video games increase beta waves, which correlate with increased attention in the brain, and which can be carried over to schoolwork. This increased knowledge of how neurotransmitters work holds the key to harnessing their power.
Neurotransmitters are chemicals that relay messages within the brain and the body, and which direct how we respond to the world around us. They determine how we process information on a moment to moment basis, including our ability to concentrate and create emotions and memory. In a normal functioning brain, pleasurable activities, such as video games, sports, or even reading, make us feel more directed, motivated and vibrant. In contrast, when neurotransmitter levels are low we feel stressed, sluggish and even out of control. A normal functioning brain experiences fluctuations in focus throughout the day. So the question arises, is there a way to function, a way to act or behave that can influence the brain to increase the beta waves that are responsible for higher levels of focus and attention?
The answer is a resounding yes. There are many studies suggesting that by establishing control of where we put our attention, we can and do change our brain chemistry for the better. We can shape our own reality to a degree, choosing how to respond to the ups and downs of life, and altering our brain chemistry in the process. This is true for adults as well as children, allowing the latter to shift their perception of the world and actually improve their academic performance.
Dr Michael Csikszentmihali (Dr. "C") a University of Chicago professor of psychology and researcher describes what total attention and focus looks like. ‘Flow" or as he calls it, "the psychology of optimal experience" is a state of total absorption and self-forgetfulness that is the opposite of worry and rumination and self-consciousness. It is the pinnacle of focus, the complete opposite of inattention and distraction. In a flow state the task is paramount and everything else fades into the background.
Athletes call this state being in the "zone". People from all walks of life, from elite athletes to brilliant professionals to even assembly line workers and many other occupations in between, have learned to harness this flow state. It does not come naturally or as a fluke; people achieve this state by personal design and by controlling their thoughts and perceptions.
Flow is more likely when a person engages in a challenging task within their capabilities. As a tennis player I can achieve a flow state, and have, against comparable opponents. I clearly could not achieve flow playing against a world class tennis player because it would be beyond my abilities. But I could achieve it by an opponent that challenges me, while not overwhelming me. As Dr. C explains "people seem to concentrate best when the demands on them are a bit greater than usual, and they are able to give more than usual. If there is too little demand on them, people are bored. If there is too much for them to handle, they get anxious. Flow occurs in that delicate zone between boredom and anxiety." In short, people can precipitate flow by looking for ways to challenge themselves just enough.
For students who are of average or above average intelligence but who have been underachieving flow is well within their grasp. It requires first making sure the academic demands are realistic, and then challenging them with tasks at a slightly higher level. But there is more one can do than insuring the proper academic environment. Students can also learn how to channel their emotions and thoughts so as to be open to, and consciously strive for, a flow state.
One way to do this is through hypnosis, which can be used to encourage focus and concentration, giving students the push they need to enter a flow state. Hypnosis is a powerful method of healing, with studies establishing its usefulness as an adjunct to medical treatment. It has been shown to decrease pain, even substituting for anesthesia during operations and increasing wound healing rates. It has also been documented as increasing white blood cell counts in the intestinal tract, with a large body of research showing that IBS (irritable bowel syndrome) is helped enormously by hypnosis. The power of hypnosis has been confirmed by brain imaging studies, which have documented how differently the brain functions under a hypnotic state, with a measurable and observed difference between persons in a trance state and those who are not. Hypnotized persons hear, feel and believe to be true hypnotic suggestions, with corresponding changes in how the brain processes information.
Hypnosis also has its place in psychotherapy, and is used as a therapeutic tool that can amplify most therapy modalities, from behavioral to psychoanalytic. It is very effective with young people. Decades of research, some of it done by Dr David Spiegel of Stamford University, perhaps the leading expert in this field, has shown that 80 to 85 % of children are highly hypnotizable. Hypnosis is especially appealing to school age children who naturally gravitate towards experiencing other states of consciousness.
In my therapy practice, I use hypnosis to correct inattention and distraction in children, and to help them focus and concentrate better. "John", a B student in the fourth grade, was referred to me because he could not focus on his homework. His neurologist was considering medication for Attention Deficit Disorder. Recent EEG (electroencephalograph) tests done by the neurologist indicated that John had some borderline abnormalities in his brain waves, including the presence of theta waves, which are not conducive for proper concentration. While his neurologist was waiting to do follow up tests before recommending medication, I saw John for a series of 9 sessions over a 3 month period.
In addition to traditional therapeutic techniques, I used two different hypnotic treatments to treat John; one a direct hypnotic induction and the other a more subtle hypnosis using the medium of metaphorical language and analogies. This type of hypnosis is based on the work of Dr Milton Erickson. An example used by him involved a boy with enuresis (bed wetting) who he tactfully told the story of Hans Christian Anderson- the boy who held back the dyke with his finger, thus suggesting that a solution to his own problem was within his grasp. In John's case he loved baseball and was good at it. I asked him why he was such a good hitter, suggesting the key was keeping his eye and the ball and focusing on the nuances of the pitcher, skills he could transfer to his homework. I also gave John a post hypnotic suggestion, what is called an anchor, suggesting that if he loses focus while doing his homework, pressing his thumb and pinky together would restore it.
To reinforce my hypnotic suggestions, I also used a meridian based healing system that works off of pressure points, called tapping, and which Dr Harvey Baker of St John's University has used in clinical trials with promising results. This technique, which I have modified to fit my model, draws from acupuncture points on the body, which when struck shift energy in the body and mind and creates a healing paradigm in the individual. The tapping is done by the patient to themselves who follows my lead.
After the first 2 sessions John and his mother reported that he was able to do his homework and actually sit for extended periods of time. His teacher noticed that he was more attentive in class and his B's became A's. Follow up tests by the neurologist showed his EEG was normal, with the doctor utterly perplexed, asking "what happened to this child?" and requesting to speak with me about how I achieved such results.
Becky, a 15 year old 10th grader, was a B+ student who "could not read". Becky's mother brought her to me because she believed her daughter was a massive underachiever. Her mom was puzzled as to why such a smart girl was floundering. Her request for psychological testing was rejected by the school because of Becky's adequate grades and stellar behavior. She aced a cursory reading test. Becky described her problem to me this way "I can read of course but I can't get past a sentence without spacing out and losing interest, especially if it's a boring subject or topic. I also have to reread something a hundred times because I just can't concentrate". She explained that her good grades were simply based on listening in class. Becky wanted to do better in school and recalled how in the past she actually enjoyed reading. Becky like most teens was a terrific hypnotic subject. She also responded enormously well to the meridian based techniques, and we terminated after only three sessions within one month. Not only was she easily reading for school but was even reading for pleasure on the school bus.
I am often asked whether I can use these techniques to help children diagnosed with ADD or ADHD, some of whom are on medication, and others who are not because the medication is ineffective or their parents are opposed to it. The answer is it depends. It depends on what type of hypnosis candidates they are, and it also depends on how they respond to the other modalities that I use. It also depends on their motivation, attitude, and desire. Oppositional, hostile or indifferent attitudes do not lend itself to this kind of intervention, and more traditional psychotherapy and counseling is needed before these techniques are tried. Some children with a focus and concentration problem have other psychological problems as well, and a more intensive therapeutic approach is needed alongside these techniques.
The human mind is the most complex organ in the universe according to Dr. Daniel Amen, a noted brain expert. Research scientists have for years been trying to unlock some of the mysteries of how the mind affects behavior and how behavior affects the mind. As Dr. Siegel explains "connections in the brain shape the way that you think, but the flip side is true, too. The way that you think can change your brain." We can, in the words of Dr James Zull of Case Western University, "become our own gardeners", modifying, growing and pruning our neural networks. This is especially true for children, with the techniques described in this article a promising path to profound and lasting changes in how they live and learn.
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Dr. Hutt's Published Article on Test Anxiety in the WSCA (Western Suffolk Counselors Association) Publication, Fall 2006
One of our primary jobs as counselors/educators/mental health professionals is to recognize situations that impede learning and to remove obstacles that prevent students from succeeding. One major and often unrecognized obstacle is test- taking anxiety. Sometimes it occurs with a particular subject; other times it is triggered by a particular testing situation, such as standardized testing. When a student performs well in the classroom under non- testing conditions or with a tutor at home but then fails to perform to expectations on tests, test anxiety might be the culprit. According to Dr. Thomas M. Haladyna, a professor of educational psychology from Arizona State University, a quarter (25%) of the population has test anxiety. If his statistics are even remotely accurate than we have a nation of very nervous students.
Several factors have recently added to the problem of test anxiety. Admission to the top 200 universities is increasingly competitive. Impossibly high standards seem to get even higher every year. Why is this? There are three primary reasons. First, is the law of supply and demand; there are simply more students as our population grows. Second, a college education is no longer the province of a select few. Most children are now raised with the expectation they will go to college and they are prepped and primed from birth. Globalization is the last macro factor. Some of our finest and elite institutions admit many foreign students, thus shrinking the domestic applicant pool. At New York University’s commencement ceremony in 2006 there were 160 countries represented.
Not only do students have to perform better, but their performance is measured more often. Since the No Child Left Behind Act, standardized testing has become the norm at all levels of education. SAT’s have become longer, and more challenging. The stakes are high, and for many students, anxiety inhibits their performance.
There are many permutations of test anxiety. Math anxiety is probably the most common subject that triggers students’ anxiety. However, I have treated students who are subject specific with no easy answer as to why. I once treated a high school student with a history test phobia. She was an A student in all other subjects. Test anxiety often surfaces on standardized tests such as the SATs. It can also emerge late in the game; it is not uncommon for students to develop test anxiety for the first time in college or graduate school. I saw the best example of this when I treated a number one ranked law student whose test anxiety was so severe that she contemplated dropping out shortly before graduation.
Let’s face it; a test can simply be scary to a student. One of the most common dream themes in western civilization is being unprepared for an exam. In the dream, a test is handed to us in a classroom and to our utter horror we are paralyzed with fear because we know that we cannot answer a single question. In most instances these dreams are metaphorical. They occur at different stages of our lives because life can be seen as one big test. Expressions such as “someone is testing me” or “God is testing me” exist in our culture because life is challenging. This dream can be a warning to students who have not properly prepared for an exam that they need to do so.
But for students suffering from test anxiety, simply being prepared is not the answer. Well- prepared students facing a straightforward exam with no surprises can experience test anxiety. Although adolescents with learning disabilities or behavior disorders are especially vulnerable to test anxiety, students without such problems can, and do, suffer from it. The underlying reasons for this vary. As researchers have found, a fear of negative evaluation may underlie the anxiety. Parental pressure, unrealistic or not, can also contribute to the student’s anxiety. Often students are their own worst enemy; those who are self- driven become self- deprecating if they do not meet their own expectations. Catastrophic thinking often ensues leaving the student in a spiral of negativity that feeds on itself. The student becomes a prisoner of his or her own self- induced paranoia. In the more competitive schools, some students get caught up in comparing themselves to other high achievers around them. During tests, some fixate on how others are doing, thus losing focus, concentration and self- confidence. On a psychodynamic level, test anxiety is an attempt to unconsciously sabotage oneself or it can be an indirect expression of rage or anger. From a psychosocial perspective, test anxiety can be an outgrowth of an unstable and tumultuous living situation or reflect an unresolved personal trauma.
Studies reveal that test anxiety usually does not just go away and if untreated, the problem increases over time. One of the first treatments for text anxiety was developed in the 1960s by Dr. Tosi. The treatment, called Rational Stage Directed Hypnotherapy, involved a combination of cognitive behavioral therapy and hypnosis using vivid emotive imagery. Building on this framework, and borrowing from Milton Erickson, a pioneer in hypnosis and trance work, metaphors and other suggestive language can be used in conjunction with traditional hypnosis. A body- centered technique called Tapping, described below, can also be used. The most effective strategy combines these cognitive, behavioral, and hypnotic therapies, and is usually brief, only three to five sessions.
The most important experience for the patient during the first session is to have an immediate sense of mastery. This is accomplished by the use of self- hypnosis after a heightened stress state has been induced. The second session is a formal hypnosis experience. The third session makes use of a very rapid and powerful hypnotic trance and a discussion in order to further help the patient feel that the symptoms are a thing of the past. In the event that the patient feels anxious during the test. I teach a back up technique that many report has helped quell the anxiety. It is basically a finger signal that has been reinforced in the patient while in a hypnotic trance.
Although psychodynamic problems can be addressed, this approach works for most students irrespective of any other accompanying emotional problem or learning disabilities. It is especially effective with adolescents and young adults for several reasons. To an adolescent, hypnosis is a thrilling experience that fits them to a tee developmentally. Students resistant to counseling or psychotherapy oftentimes adapt easily to a model that offers such a shift in consciousness. The brevity of treatment is also attractive to this age group, and is part of the cure. When students/patients are told that they will be cured quickly, they respond rapidly. The short- term nature also prevents pathologizing the problem. It signals that test anxiety is not deep seated and does not require extensive psychotherapy or medication.
Following are two case studies that demonstrate how test anxiety can be cured in two very different patients. One student had with no problems other than test anxiety, which is a very typical scenario that many students experience. The other involves a student with clinical pathology. Of course their identities are concealed.
Barbara, a 17-year-old high school junior, was a high functioning individual, an athlete who worked part time and had no presenting problems other than text anxiety. Although she maintained a B average, she would panic on all math tests and “big tests” in all other subjects. She over thought, overanalyzed, and generally questioned her answers. She did not trust her instincts and oftentimes changed the right answer to a wrong one. Her physical symptoms included body numbness, shaking hands and legs and belabored breathing. Her family first addressed the problem by increasing her private tutoring. But the more she studied the more distressed she became, feeling more and more incompetent with each passing test. Barbara responded so well to treatment that she was basically cured after two sessions but she was seen for a third to solidify the gains that she made.
Beth was more atypical and challenging case. This 17-year-old student saw herself as potentially Ivy League bound, an honor student in the top 2% of her high school class. Beth was referred to me by her math tutor, who said that she was brilliant, capable, and the most “stressed out kid” he had ever met. She was clinically depressed with a diagnosable case of Obsessive Compulsive Disorder as well as a severe tic disorder. Our contract was to first treat the test anxiety and than tackle her other problems. Her test anxiety manifested exclusively on standardized tests, specifically the SAT. Her symptoms included absolute dread, panic and total negative and catastrophic thinking. Beth was an athlete who had recently seen a hypnotist for performance anxiety, with no success. Hence she was skeptical and doubted she was even hypnotizable. To replace the hypnosis, I used Tapping, a meridian based healing system, that can best be described as acupuncture for the emotions, and which can provide immediate relief. Throughout the treatment, I also used language and imagery calculated to work on both a conscious and unconscious level to shift her thoughts to a more positive pattern. The postscript was that she got an 800 on the math portion of the SAT and did above average on the other parts of the test. She did not go to an Ivy but did get into an honors program at a highly selective tier 1 university.
These two cases demonstrate that test anxiety can be easily treated, without medication or protracted therapy, allowing students to reach their true academic and personal potential. Thus, for students who are performing below par, test anxiety should be explored as a possible explanation.
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