There are many potential reasons for difficulty swallowing. These include acid reflux that leads to irritation of the food pipe (esophagus), different kinds of tumors or scarring of the food pipe, and neurological problems that causes the nerves involved in swallowing to malfunction (for example, in someone who has suffered brain damage). A common cause of difficulty in swallowing involves a sensation of a lump, throat tightness, or a feeling that something is stuck in the throat, which is a condition that is termed globus sensation. More than a fifth of people have reported experiencing globus at some point in their lives, and some of them worry that they might choke when they swallow.
Globus sensation does not have a known physical cause, and therefore is considered to be a “functional” symptom as the body function has been changed by the disorder. Other examples of functional disorders include habit cough, irritable bowel syndrome, vocal cord dysfunction, migraines, and insomnia. Notably, all of these conditions do not respond well to medications but can improve and frequently resolve with use of hypnosis!
To help with a globus sensation, patients can learn how to calm themselves with hypnosis, and to trigger a relaxation response while they swallow.
Another technique that can be helpful is to imagine the lump in the throat as being something that can be swallowed easily such as an egg or doughnut. The patient can be prompted to think up creative imagery that could resolve a lump, such as melting ice, a lump of sugar that dissolves in saliva, or even using a shrink ray.
Sometimes, a globus sensation represents “body language.” In this case the body might be saying, “I can’t swallow this problem.” The solution is for the clinician to help the patient identify the issue that is causing the problem and helping to figure out how to deal with it constructively.
If the swallowing problem is related to a physical problem, patients often develop anxiety about swallowing because it is so difficult for them, and they are worried they will not succeed. In certain patients this means that they may require long-term feeding through a tube that is inserted into the nose and into the food pipe (nasogastric tube), or even directly into the stomach through the wall of the abdomen (gastrostomy tube). Other patients develop anxiety because they have developed complications from previous swallowing attempts, such as inhaling food inadvertently, spitting uncontrollably, or even causing food to be expelled through the nose.
Anxiety can make patients hesitant about swallowing and to overthink the process, which can make it harder to swallow. If the reader would like to experience how overthinking might make it difficult to swallow, think of each of the steps required as you eat and swallow: Prepare the food carefully including through grinding it in your teeth, chewing, mixing it with saliva, moving a proper amount of food to the back of the throat, moving the front of the tongue up to the roof of the mouth to trap the food in the back, and folding back of the tongue to make a chute. The rest of the swallowing process occurs in an involuntary fashion in healthy individuals.
Using hypnosis for relaxation can help overcome anxiety in patients with physical problems, and thus help them swallow better. Relief of anxiety also is helpful in dealing with children who think they cannot swallow pills. Additionally, in this situation, kids can learn to use hypnosis to imagine their throat to be as big as an Olympic swimming pool, which makes swallowing seem more manageable.
Management of anxiety with hypnosis helps patients swallow better, even if the swallowing difficulty is the result of a physical problem. Hypnotic imagery to help swallowing seem more possible also can be immensely helpful.
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