Pragmatic Case Studies in Psychotherapy

Paradoxical Intention (PI) Combined With Hypnosis in the Rapid Treatment of Anxiety Disorders: The Cases of "Fran" And "Emily"

Sam R. Hamburg — Thu, 19 Feb 2026 00:00:00 +0000

Paradoxical intention (PI) is a psychotherapeutic technique that is intended to help clients become more flexible, or at least more open to thinking about their problems, such as anxiety, from a new perspective. In line with this I have developed an approach that involves a "Panic Attack Time Line" (PATL). This PATL (a) helps the client visualize and understand what is happening during the panic attack, and (b) encourages them to understand why, when they start to have panicky feelings in their body, it will be paradoxically helpful to make these feelings worse, for example, if the attack makes their heart beat faster, they might be instructed to do jumping jacks. One of the important advantages of this PATL approach is that it can typically shorten therapy for treating anxiety disorders to just three sessions in comparison with traditional CBT protocols that typically require 6–20 sessions for achieving clinically meaningful change.

Two, 3-session adult individual cases, "Fran" and "Emily," are presented to illustrate the different ways that the PATL-grounded, PI approach can be combined with hypnosis to produce successful therapeutic outcomes. In Fran’s case, the PATL was used explicitly by itself with her and was sufficient to address her agoraphobia/panic disorder. Hypnosis was then used to extend the gains produced by PI. In the case of Emily's aviophobia, the PATL was not used explicitly with her. Rather, the paradoxical logic it embodies was used to create a paradoxical directive that was conveyed via hypnotic suggestion.

Paradoxical Intention and Hypnosis for Anxiety Disorders: Cautious Promise and Considerations from a CBT Perspective

Regina Roberg, William M. Buerger — Thu, 19 Feb 2026 00:00:00 +0000

This commentary discusses the case studies of "Fran" and "Emily," treated by Sam Hamburg (2026) with Paradoxical Intention (PI) combined with hypnosis to address panic disorder and agoraphobia in Fran and aviophobia in Emily, with both patients showing a rapid positive response. Hamburg (2026) presents a compelling and novel approach to treating anxiety disorders in just three sessions, a notable departure from traditional CBT protocols that typically require 6–20 sessions to see clinically meaningful change. Drawing on our expertise in third-wave CBT frameworks, including Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT), we highlight strengths of Hamburg’s approach while identifying areas that warrant further clarification. We then propose an alternative mechanism of action in Hamburg’s treatment with "Fran" and "Emily," with particular emphasis on the inhibitory learning model as a process underlying PI combined with hypnosis. Finally, we underscore the importance of approaching techniques such as PI and hypnosis with both openness and caution in the treatment of anxiety disorders given the limited empirical evidence.

Paradoxical Intention: Everywhere and Nowhere All at Once

Clair Cassiello-Robbins, Jacqueline R. Bullis — Thu, 19 Feb 2026 00:00:00 +0000

We provide commentary on the article Paradoxical Intention (PI) Combined with Hypnosis in the Rapid Treatment of Anxiety Disorders: The Cases of "Fran" and "Emily," by Sam Hamburg (2026). We highlight strengths of the article, including its effort to identify the active elements of treatment, as well as its use of case observations in an effort to advance the field of psychology. We also discuss several areas of weakness, including the use of unclear definitions of “success” in treatment, focus on habituation-based exposure, and lack of acknowledgement of research-supported treatments that include principles of paradoxical intention within their intervention.

But Does It Work in Theory? and The Case of Simone: Paradoxical Intention in a Case of Post-Traumatic Panic Disorder

Sam R. Hamburg — Thu, 19 Feb 2026 00:00:00 +0000

I gratefully acknowledge the thoughtful and perceptive comments and criticisms of Roberg and Buerger (2026) and of Cassiello-Robbins and Bullis (2026) in response to my case studies on the therapeutic use of Paradoxical Intention (PI) with "Fran" and "Emily" (Hamberg, 2026). Both commentaries note that the theory underlying the current Cognitive Behavior Therapy (CBT) approach to panic disorder is not habituation, as I had proposed, but the Inhibitory Learning Model (ILM). In line with Toulmin’s (1953) view of theories as conceptual maps, I argue that the advent of a new theory does not necessarily render an older or alternative theory incorrect or obsolete. Rather, different theories can be seen as equally valid maps of the phenomena under consideration, e.g., a street map of San Francisco versus a topographical map of the city, and thus have differential pragmatic value depending on the use to which they are put. Habituation would seem clearly useful in the traditional desensitization situation, while ILM would seem more useful in accounting not only for the effects of CBT for panic disorder but also for the effects of Paradoxical Intention (PI) procedures like the ones I used in the cases of Fran and Emily. Roberg and Buerger are correct in pointing out some points of similarity between PI and CBT, especially in my flight phobia case of Emily. While Cassiello-Robbins and Bullis argue that PI and CBT are more similar than dissimilar, I present a view emphasizing their differences.