DEALING WITH BODY-MIND REACTIONS
The repetitions of tense converted statements, also called as drill statements, can activate severe body mind reactions to the extent that the affected person may experience increased heart rate, sweating, heaviness, discomfort in any part of the body. These reactions can rise to very high levels. Also, some affected persons, refuse to repeat the drill statements because of the fears of escalation of body-mind reactions and danger perception. I adopt many methods to successfully deal when body-mind reactions shoot up to the high level. These methods essentially involve moment to moment monitoring of body-mind reactions, pauses and drill dilution. There are multiple approaches to implement reaction monitoring and dilution of drills.
Reactions Monitoring: To keep a vigil on the magnitude of reactions, I keep on asking the person to report the level of discomfort every 30-60 seconds. I will be asking the questions such as, how much distress you are feeling now. The affected person is required to report on any scale which includes (a) Zero-low-medium-high-very high. (b) Assign a number on a scale of 0-10. Zero means no distress and 10 means maximum distress. (c) In terms of percentage. Out of 100, how much distress you are feeling.
The monitoring of discomfort in this manner is also known as Subjective Report of Discomfort (SRD) or Subjective Unit of Discomfort (SUD). The reaction monitoring is extremely important and one of the core techniques of Cognitive Drill Therapy. During the personal sessions of drill, the patient is not left unattended at least during initial stages. Continuous monitoring is done and the drill application is modified in accordance with the feedback on reaction monitoring.
Pauses in Drill: When distress shoots to very high level, I give a pause of 1-2 minutes. In this pause, I suggest the affected person to stop doing the drill and allow the mind to wonder. I can also engage him in general talks. During the pauses, sometimes, I maintain silence and do not initiate any discussion. However, I keep on monitoring the magnitude of the reactions during pauses. When the affected person reports, zero or low distress; I once again initiate the same drill.
Giving pauses during drill is extremely important. It is mandatory to give pauses as and when the distress shoots up to very high level. I have not yet continued drill with any person when he/she reports very high distress. I invariably give pauses. Pauses allow the brain and mind to handle the massive distress activated by the drill.
Handling Hanged Distress: Sometimes, the magnitude of distress gets hanged at medium or high level for more than 3-5 minutes. When I observe such plateau of hanged distress, I adopt two methods (1) I allow a pause of 1-2 minutes. The pause itself clears the plateau and the distress slips down. (2) Sometimes, it happens that during drill, other object of fear or feared cognition becomes dominant which is not being drilled at the moment. This cognition, does not allow the fear to subside. To detect the simultaneously activated cognition, I ask the subject to share with me if anything else is running in the mind. If it is the case, most person would tend to report it. Once it is shared, I formulate the drill of this feared cognition and switch over to the drill execution of this feared cognition. The drill of simultaneously activated feared cognition, cools down the hanged distress within a couple of minutes.
Drill Dilution: The idea of drill dilution is to present the drill in lighter form to mitigate body-mind reactions. The drills in divided dosages and bit by bit enable the affected person to experience lesser amount of distress and accelerate the rate of improvement. The drill dilution is done when the original drill statement is too heavy for the body and mind to process and shoots up the reactions. Usually, drill dilution s required in the initial stages of commencement of Cognitive Drill Therapy. The drill can be diluted in a number of ways.
I am illustrating the methods of drill dilution which I applied on one or the other affected persons with phobia/OCD:
Repetitions of drill statements by the therapist: Mr. Chand was scared of the ‘nash’ word. His feared cognition was ‘mera nash ho jayega’ (I will be ruined). The original drill statement was ‘mera nash ho chukka he’ (I am ruined). When I asked him to repeat this drill statement, he showed body-mind reactions of turning away face, eye closure, stiffness in body and expressed denial to verbalize it. For drill dilution, I told him that I will be speaking the same drill statement for me, he should just listen to it. I kept repeating for him ‘mera nash ho chukka he’ (I am ruined), ‘mera nash ho chukka he’ (I am ruined), ‘mera nash ho chukka he’ (I am ruined)… After my repetitions for a few minutes, he gathered the courage to repeat the drill statement for himself.
Invoking Imaginations: Ms. HR was scared of heart attack. The formulated drill statement was ‘mera heart attack ho chukka he’ (I have suffered a heart attack). This drill statement resulted in shoot up of extreme distress. For drill dilution, she was asked to repeat and say that it is only in imagination. The diluted statement was ‘kalpanaon me heart attack ho chukka he’ (I have suffered heart attack in imagination). This drill dilution enabled her to take up original drill statement; and she began to repeat ‘mera heart attack ho chukka he’ (I have suffered a heart attack).
Keyword Drill: At times, I identify key words in the drill statement. The key word is the word that represents feelings and emotions. For example, Mr. RP, was terrified of getting cursed by ants. The formulated drill statement was ‘cheentiyan shrap de chuki hn’ (I am cursed by ants). The key word in this drill statement is ‘curse’. I recommended him to repeat only this key word for some time. He repeated ‘curse’, ‘curse’, ‘curse’… This enabled him to verbalize and repeat ‘cheentiyan shrap de chuki hn’ (I am cursed by ants).
Breaking Drill Statements into Parts: A person with agoraphobia, was terribly scared of suffocation. He was not able to speak full drill statement ‘akele lift hu, suffocation ho chukka he’ (I am alone in the lift, experiencing suffocation). This drill was implemented by breaking it into parts (a) lift me akela hu (I am alone in lift); (b) suffocation (c) ho chukka he (experienced). These three parts were implemented one by one. He was required to drill each part separately. When distress got reduced to parts, then the parts were combined and full drill was presented.
Adding Imagination Component: At times I would dilute the drill in following manner: ‘I am scared of the dog in my imagination’. This is more or less a factual statement. Since it is true it appeals to the reason of affected person and he/she finds it acceptable to repeat.
Action Drill: Also called as non-verbal drill. The patterns of rituals get conditioned with ritualistic patterns performed by the affected persons of OCD such as hand washing. I prescribe the affected person to perform dummy ritualistic actions. The action drill itself activates anxiety reactions. The continued drill in this manner reduces the body-mind reactions associated with the ritualistic actions.
There can be many more ways of drill dilution. The affected persons and the therapists can come up with versatile and creative options to dilute the drill.
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