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Cognitive Drill Therapy (CDT) capitalizes on the principles of classical conditioning, operant conditioning, cognitive appraisal and linguistics. Combined together in a customized manner, application of these principles have the potentials of efficient handling of stimulus bound anxiety more specifically phobia and Obsessive-Compulsive Disorder (OCD). In these disorders, exposures to neutral objects tend to trigger fear reactions amounting to panic in some cases. The patients learn to deal with these fears by avoiding as far as possible the exposure to such fear provoking stimuli. For example, a person with claustrophobia exhibit fear reaction in closed places. As and when such patient comes into contact with closed places like lift, MRI Scanner, metro trains, closed bathroom etc. will experience severe anxiety reaction. To prevent the experiences of fear reactions, he/she will avoid these situations by opting staircase even in multistory buildings, Open MRI Scan or scanning under anesthesia; avoid using metros and take bath in open bathrooms. The avoidance in this manner reinforces the patients’ strategy and the patients adopt a life style which minimally involves exposure to closed places. Whatever, is the lifestyle adopted by the patients to avoid closed places or objects of any phobia for that matter imposes limitations on the optimal functioning of the patients. The life is crippled in many cases.
Cognitive Drill Therapy conceptualizes stimulus bound anxiety as a two layer structure; (a) Top Layer also called as surface structure/conscious structure. (b) Bottom Layer Structure also called as underlying fear structure consisting of imagined feared consequences/ subconscious structure because the patients remain dimly aware of the bottom layer.
The top layer structure consists of objects of fear such as closed places, heights, open places, crowds, animals, insects, pointed objects, examination (as seen in specific phobia); social situations like asking a question in class, talking to superiors, making a presentation on stage, giving a speech, talking with authorities (as seen in social anxiety); being away from home, in a crowded place (as seen in agoraphobia); dirty and contaminated objects; abusive, sexual and aggressive thoughts in religious places, sexual thoughts
and images for family members; objects kept in disorganized manner, displaced objects, locking of doors (as seen in OCD).
These apparently neutral objects elicit fear and disgust reactions in the patients. These reactions are usually associated with psychophysiological arousal characterized by accelerated/shortness of breath, faster heart beat, tense muscles, sweating, blurred vision, trembling. The patients subjectively feel discomfort, uneasiness and psychic pain at cognitive level.
To deal with the arousal or to prevent the arousal, the patients would avoid exposure by taking alternative routes so that feared objects are not encountered, shy away from the social situations, would not leave the house alone; keep on cleaning the apparently clean objects, would repeatedly check the doors, gas, locks; seek forgiveness from the God for abusive and sexual thoughts, would go at length to keep the objects organized and in order.
These attempts are successful for a temporary period; and the cycle continues. The Top Layer can be summarized as follows:
Exposure to objects of fear Psychophysiological arousal/Subjective experience of pain or discomfortàEscape/Avoidance patterns (negative reinforcement)à Temporary Relief
The bottom layer consists of a series of underlying fears and imagined feared consequences such as fear of suffocation and death in closed places; fear of negative evaluation, ridicule, rejection, loss of self-image in social anxiety; fear of catching a disease like rabies in dog phobia, fear of failure, going blank, losing face, spoiling career in examination anxiety; fear of inhaling germs and spreading contamination and disease in OCD; fear of God’s punishment, causing curse or misfortune to the family in aggressive/sexual thoughts for God and so on.
In Cognitive Drill Therapy, it is believed that the patients remain struck in top layer and rarely deal with the underlying fear structure. For efficient handling of these problems we need to directly address the bottom layer and expose the patients to this underlying fear structure. Once this underlying fear structure is destroyed, the patients will show proportionate improvements in OCD and phobia. The drill therapy utilizes the principles of exposure therapy to attack on the underlying fear structure.
The protocol of the therapy is very specific, clear and straightforward. A patient is given proper psychoeducation which consists of sharing the diagnostic label of the problem, communicating the understanding of two layer structure, handling magical thinking that merely by having thoughts in one’s mind actual physical events cannot be caused. An education regarding anxiety curve during exposure sessions and mandatory requirement of homework. The patients are specifically educated about the future orientation of anxiety. They are made to realize that anxiety looks into the future. Under conditions of fears, their sub-vocal speech centers around imagined possibilities of harms in some future time; and our task is to convert this future orientation into past or present orientation.
The objects of phobia are implicitly and mistakenly perceived as predictive of harmful future consequences. One of the important goal of Cognitive Drill Therapy is to destroy the perceived predictability of the neutral objects leading to harmful consequences. The neutral objects are neutralized in the process. The patients are also educated regarding the Concept of Universal Probability, which means that harmful consequences can occur to any person any time. All of us are having more or less equal probability of such an outcomes.
Having given the psychoeducation, the patients are required to imagine objects of phobia and repeat covertly or verbalize the imagined feared consequences by converting the tense to the present or the past. For example, in claustrophobia, imagine yourself in a closed place and verbalize “I am suffocated”; “I am experiencing suffocation”; “I have died of suffocation”. Initially it leads to quick spike of fear reaction and with continuous repetitions, it leads to resolution of fear within minutes. This procedure is repeated for as many objects of fear as possible both in sessions and in homework. Drill & Daring is the slogan. Perform drill and dare to expose yourself to objects of phobia. The resolution of phobia can occur in a single or a few sessions. OCD takes longer time.
The pre-post case studies (Kumar et al. 2012; Dwivedi & Kumar, 2015) documented the efficacy of this therapy. Many more researches are in pipeline. We are looking forward for task based fMRI researches for demonstrations of live changes in the brain during drill therapy and inclusion of projective techniques such as Somatic Inkblot Series-II and Live Images Version for exploring changes in the perception of objects and inner cry through this therapy.
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|COGNITIVE DRILL THERAPY BOOK: A GIFT FOR YOU
I Wish to give a surprise New Year 2017 GIFT to you all.
There are numerous people who are suffering from many irrational fears like
social anxiety, Fear of crowded / closed places, Fear of heights, agoraphobia, animals/insect phobia for example fear of dogs, lizards and also Obsessive Compulsive Disorders like repeated washing of hands. After seeing numerous such patients, and having worked for more than 10 years in this area , I developed a new therapy based on well established scientific principles of psychology and named it "Cognitive Drill Therapy". This therapy is proving to be a boon to such patients by providing a short , rapid and durable relief. My mission is to to reach the vast majority of people suffering from these conditions and serve as many affected persons as possible. Also, I wish to equip professionals with the effective techniques of this therapy, all across the globe.
I have shared every aspect of Cognitive Drill Therapy in my book with the same title.
To further my mission, I wish to share my book with all, sufferers , their caretakers, professionals and any interested individuals.
I WILL DELIVER THE PDF VERSION OF THE BOOK "COGNITIVE DRILL THERAPY"
AS A FREE NEW YEAR GIFT DIRECTLY IN YOUR EMAIL INBOX.
TO RECEIVE THE FREE GIFT, JUST SEND A REQUEST ON EMAIL: email@example.com
I will be happy to share it with you .
Dr. Rakesh Jain, Ph.D
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