REACTIONS TO DRILL
Cognitive Drill Therapy acts very fast on underlying feared cognitions. The affected persons show a variety of reactions before, during and after using drills. At the onset of drill, affected persons need reassurance that drill will be working. Initially, there can be total disbelief that such an easy and straightforward technique will work and melt the fear reactions. I simply say to the persons who initiate drill therapy that let us practice it and see if it works. Let the mind be open to the effects of drill.
Some of the affected persons will show marked fear reactions just by listening to their objects of phobia and the underlying feared cognition. The auditory input of underlying feared cognition can activate body-mind reactions. This reactivity to auditory input and verbalizations, is cited as an evidence to convince the affected person that see merely by listening and verbalizing the feared cognition is eliciting body-mind reactions. With continued verbalizations, the fear will begin to melt down. The problem lies within head. It is not in the outside world. It was created in your imagination. Once your imagination clears up, the fear reaction will subside. The person is urged to continue to verbalize and pauses are given on high/very high distress. When the fear reaction subsides, it is again cited as evidence that see merely by repeating the feared cognition in past tense is causing the reduction in fears.
Each unprocessed trigger or feared cognition will activate body-mind reaction. The affected person may expect spontaneous reduction in unprocessed objects/cognition via generalization effect. But spontaneous generalization to unprocessed objects/cognition does not occur in drill therapy. When drill for an unprocessed object/feared cognition is applied and there is an activation of body-mind reaction, it is used to educate the affected person that upon commencement of drill for all new triggers/cognition, there will be body-mind reactions of more or less equal intensity. Hence, he/she need to apply drill to each and every identified objects/feared cognition.
When this is told to the affected person that he would be required to drill for each object/cognition, it can trigger a fear reaction that the task is overwhelming and it would take too much time to drill all the objects/cognition. He/she is reassured that the list is finite. Initially, one or two objects/cognition would be processed for 2-3 days, then it will get multiplied and in a day 5-6 objects/cognition would get processed. Initially, it appears to be an overwhelming list but it will come under control within a few days. Just keep on drilling.
Cognitive Drill is performed preferably at imagination and verbal level. Upon dissolution of fears during drill, the affected person becomes apprehensive and may say that at verbal and imagination level it is fine now, but what about the real situations. It will appear in real situations again. The affected person is to be told that usually there is spontaneous generalization to the external real world. However, if he/she would feel body-mind reactions in real life situations, then drill can conveniently be performed on the spot in those situations. The problem lies in the mind and it is to be cleared at mental plane. To dilute this fear of lack of generalization to the real life situations, on the spot drill is prescribed in following manner: ‘real life situation me problem ho chuki he’ (the problem got surfaced in real life situation). Within a couple of minutes this apprehension will subside.
Drill therapy can act very fast and dissolve fears. When the affected person develops confidence and realizes substantial fear reduction due to drill, then he/she may become apprehensive of relapse. He/she may say that now it is fine. I am feeling in-charge of my fears, but these fears may re-surface after some time. This fear emerges in large number of affected persons after dissolution of fears. He/she needs be told that if there is any relapse, then he/she could perform the drill at that point of time. For managing fear of relapse on the spot, I ask the affected person to perform following drill: ‘relapse ho chukka he’ (relapse has happened); ‘dubara problem ho chuki he’ (problem has appeared again). This drill dissolves the fear of relapse within a few minutes.
Most affected person will comply with the homework of drill applications and ‘drill and daring’. There will be only a few persons who would not comply with the homework assignments. These persons will get sub-optimal benefits of drill therapy. Efforts are made to encourage them to apply drill and daring as homework. Their family members are encouraged to act as co-therapist and ensure that the affected person really does homework.
At times, I recommend the patients to give me feedback and reports on whatsapp. But invariably I have noticed that the patients usually do not submit their reports despite reminders and encouragements. Also they fail to record entries in drill diary prescribed to them for recording their experiences on day to day basis. We are required to operate within this constraint and heal them.
In view of the recording behaviors and poor compliance of homework in some patients, I conduct extended and intensive sessions of the patients which may extend up to 90 minutes to two hours. Rarely, the session extends beyond two hours.
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