THEORETICAL FRAMEWORKS
I am considering multiple theoretical frameworks in this seemingly easy and straightforward approach to dealing with phobia and OCD. The theoretical frameworks may appear to be a bit overwhelming to the persons who are not into the field of psychology/psychiatry. The exposition of theoretical frameworks would facilitate the grounding of the concepts of drill therapy and would further stimulate the creative mind of the readers to think more and more about the role of drill therapy in dealing with emotional disorders, phobia and OCD in particular. I am invoking three primary theoretical mechanisms in explaining the basis of drill therapy. (a) Principles of Classical and Operant Conditioning (b) Linguistics (c) Cognitive Appraisal.
Classical Conditioning: Also known as Pavlovian Conditioning and Respondent Conditioning was developed by Ivan P. Pavlov, a Russian Physiologist in last decade of 19th century. He also earned Nobel Prize in 1904. I am elaborating an experiment based on the principles of classical conditioning for comprehension of the mechanisms involved in drill therapy. I will also introduce some of the concepts of this conditioning to make the task comprehensible. The interested readers should read the work of Pavlov in detail.
A stimulus is any object which produces a response/reaction. For example, when a needle is pricked in a finger, there will be a withdrawal response of finger/hand. Here, the prick of the needle is a stimulus; and the withdrawal of finger/hand is a response.
A stimulus can further be categories into two types (a) Neutral Stimulus (B) Natural Stimulus. A natural stimulus has inherent properties of eliciting a natural response. Needle prick is a natural stimulus for eliciting withdrawal response. Neutral stimulus does not naturally elicit the natural response. It is an artificial stimulus. For example, sound of an alarm cannot naturally elicit a withdrawal response of finger/hand. Alarm sound is a neutral stimulus for this response.
Classical conditioning is the procedure through which a neutral stimulus can be made to behave like a natural stimulus. A neutral stimulus can be ‘magnetized’ or ‘charged’ to act like a natural stimulus. Through the principles of this conditioning, the alarm sound can be ‘charged’ in a manner that it can elicit withdrawal response of finger/hand.
Let me now mention the technical terms used for natural stimulus; neutral stimulus and the responses in classical conditioning. (1) Unconditioned Stimulus (UCS): Any stimulus which naturally elicits a natural response. UCS is a natural stimulus. (2) Unconditioned Response (UCR): It is the natural response to the UCS/natural stimulus. (3) Conditioned Stimulus (CS): A neutral stimulus which gets ‘charged’ in a way that elicits a natural like response. (4) Conditioned Response (CR): A response to the conditioned stimulus. These terminologies can conveniently be understood through following example:
The Experimental Situation: A researcher designed an experiment in which he/she prepared a special cage in which a dog is tied. One of the leg is connected with a wire which can circulate electricity in one of the leg of the dog; as and when the dog withdraws the leg, the circulation of electricity stops. Also, the researcher took a bell for raising alarm. Before commencement of the conditioning, the researcher tested the withdrawal response of the dog to the electricity circulation (UCS) and the alarm sound (CS). Naturally, the dog displayed a withdrawal response (UCR) to the electric current (UCS) but did not show any leg withdrawal response to the alarm sound (CS). Having tested in this manner, the actual training in conditioning commenced.
For training the researcher presented two stimulus in following sequence – alarm sound (CS) and electric current (UCS). Two stimuli were presented repeatedly in this sequence, and every time withdrawal response (UCR) was seen. With repeated presentations in this manner the researcher observed that at the end of the conditioning, the dog started showing withdrawal response (CR) only to the alarm sound (CS) even when no electric current (UCS) was presented. Now the alarm sound (CS), originally a neutral stimulus got ‘magnetized’ and started behaving like ‘electric current’ (UCS) for eliciting withdrawal response. CSCR connection is formed through conditioning and represent the essence of classical conditioning.
There are many concepts involved in classical conditioning. It is seen that the stimuli which are similar to the conditioned stimulus (CS) also tend to elicit the similar response, leg withdrawal in above experiment. This process is known as Stimulus Generalization. Multiple similar stimuli elicit the same response.
CS-CR connection can best be explained in terms of predictability. With repeated pairing of CS-UCS, the CS tends to predict the upcoming UCS. Since, CS reliably predict UCS, a response gets triggered to CS alone. If this predictability is not established or lost; then CS would not lead to CR. For example, alarm sounds (CS) are raised intermittently without electric current (UCS); the CS-CR connection will not be formed because electric current (UCS) comes both in the presence and absence of alarm sound (CS). The predictability between CS-CR will not be formed.
When, CS-CR connection is firmly established through conditioning, it can be broken by destroying the predictability of CS-UCS. To break this predictability, only alarm sound (CS) can be presented to the dog repeatedly in the absence of electric current (UCS). Sooner or later, the dog will realize that now only alarm sound (CS) is coming and no electric current (UCS) is following. The dog will cease to show withdrawal response (CR) to alarm sound (CS). This cessation of response to the CS, is called extinction. Conditioned Stimulus (CS) once again become a neutral stimulus and get ‘demagnetized’ or ‘discharged’ for eliciting the Conditioned Response (CR).
But here is a catch. As soon as the alarm sound (CS) is presented without electric current (UCS), the dog will withdraw the leg. There is no opportunity left to realize whether UCS is coming or not. To make the dog realize, the leg of the dog will have to be tied/held temporarily when alarm sound is presented so that a realization develops. When the leg is tied/held and alarm sound (CS) is presented there would be signs of discomfort reflected in the attempts to withdraw, barking and so on. Since, electric current (UCS) will not be there, these body reactions would cease to occur after sometime. The dog will have to bear temporary discomfort to get rid of the withdrawal response to alarm sound (CS). But it will happen.
Operant Conditioning: Also known as Skinnerian Conditioning. It is developed by B.F. Skinner in 20th Century. Interested readers should read his work in detail. I will be introducing only some of the concepts of operant conditioning, particularly avoidance conditioning.
A researcher conducted an experiment in which he/she developed a box having two compartments partitioned with a low hurdle. Two Compartments are labeled as Compartment ‘A’ and Compartment ‘B’. The compartment ‘A’ contains a grid in which electric current can be circulated and Compartment ‘B’ is a safe compartment which does not contain any electric grid. A neutral stimulus of electric bulb is also attached in the box. A rat is placed in compartment ‘A’. The bulb is switched on. Nothing happens. Within moments, electric grid is switched on. The rat will show random movements of jumping, running here and there and would accidentally crossed the hurdle and would come to compartment ‘B’ which is a safe zone. The experiment is repeated in this manner for several trials. Place the rat in compartment ‘A’; switch on the bulb; switch on the electric grid. This will lead to cross over to the compartment ‘B’. After training, the rat will begin to jump to the compartment ‘B’ immediately as soon as the electric bulb is switched on. Now, the neutral stimulus of electric bulb leads to the jumping behavior. Following processes could be delineated in this experiment:
I. A neutral stimulus becomes a cue for upcoming electricity circulation in the grid which leads to pain and discomfort. That is, a neutral stimulus becomes predictor of the painful consequences.
II. The rat is not terrified of the neutral stimulus (electric bulb) but the painful stimulus of electric current which is likely to follow the neutral stimulus. The distress is caused by the expectancy of the painful stimulus.
III. Jumping to the safe compartment ‘B’ in response to the neutral stimulus (electric bulb) results in avoidance of the possibility of experiencing painful stimulus. By jumping in compartment ‘B’ the rat no longer experiences the electric current.
IV. When the researcher redesigns the experiment and removes the electricity circulation in the grid from the experiment; the rat will still continue to jump to the compartment ‘B’ in response to the electric bulb. Since, there is no electric current involved in the experiment now, the false predictability is held by the rat. Due to this false predictability, the rat continues to emit the jumping behavior in compartment ‘B’.
V. This false predictability can be destroyed by further modification in the experimental situation. Compartment ‘B’ is blocked. The rat no longer can jump to compartment ‘B’. The electric current from the grid is removed. When rat is placed now in compartment ‘A’ and bulb is switched on the rat will engage in jumping behavior towards the wall erected between two compartments. There will be visible signs of discomfort in the behavior of the rat. Since, electric current is not there, the distress will initially escalate and then begin to resolve. With repeated exposure to the electric bulb in this manner without presentation of electric current, will destroy the false predictability held by the rat and the neutral stimulus (electric bulb) will again become neutral.
In conditions of phobia/OCD, the objects of fear are usually neutral stimuli which falsely predict painful experience. Our task as a therapist is to destroy the predictability of false outcomes due to the exposure to the neutral but ‘charged’ objects of fear. The affected persons with OCD/phobia do not work on destroying this false predictability. Instead, they keep on avoiding the charged neutral objects of fear. Face the fears. Face the objects of fear continuously for sufficient frequency and duration can make them realize the falseness in the objects of fear. Cognitive Drill Therapy is an efficient form of intervention that aims at destroying the false predictability of the objects of fears.
Cognitive Appraisal: The appraisal theory of emotion proposes that emotions are extracted from our evaluations, interpretations, explanations and the meanings ascribed to the event. In the context of phobia and OCD, the activated feared cognitions correspond to the appraisals. When touched by a dirty object, following feared cognition may get activated in the mind of the person affected with OCD:
I. I may spread contamination to other objects.
II. Most objects will become dirty
III. The germs can spread through this contamination
IV. I may touch religious objects with dirty hands, which can lead to punishment by god.
V. Something may go wrong with family members, and I will be held responsible for spreading the contamination and leading to fatal consequences.
Technically speaking, the person affected with phobia/OCD is not scared of the objects of fears instead he/she is scared of the underlying imagined feared consequences. Objects of fear act as trigger or cue which falsely predict the danger to life and survival. The goal of the treatment is to make the affected person realize the falsification in the imaginative feared consequences. After treatment, when exposed to the same objects of fear, the objects fail to elicit the underlying feared cognition and also the body-mind reactions which emerge due to faulty danger perception. The task in therapy is to neutralize and normalize the objects of fear by correcting the ‘distorted appraisal’. Cognitive Drill Therapy relies very heavily on the identification and correction of faulty appraisal of danger through exposure as opposed to through an appeal to the reason.
Linguistics: The usage of the concepts of linguistics in drill therapy is purely my speculation which may or may not hold true from the perspective of the theories of linguistics and the brain correlates. But I am quite comfortable in using them and they are serving my purpose effectively hence, I am continuing to use them. This is an area open to sophisticated researches which I intend to do sometime.
There are three tenses corresponding to three time frames of (a) past (b) present and (c) future. More than the tense, the time frame involved in the explicit or sub-vocal language is important. For these time frames, three notations A-B-C can be used. A means a time frame of past; B means a time frame of present and C means a time frame of future. Also, it is hypothesized that three time frames have their corresponding neural correlates in the brain. Let us use the same notations for neural correlates that are associated with time frame. ‘A’ for neural correlates of past; ‘B’ for neural correlates of present and ‘C’ for neural correlates of future. Anxiety and fears essentially have future orientations. Under conditions of anxiety and fear, the neural correlates responsible for future time frame get overactive. If this time frame can be switched over to past or present in internal as well as interpersonal dialogues during the condition of anxiety/fear then the overactive brain centers of future will get cool down. The brain activity will switch over to past or present. The brain activity of past and present are not associated with anxiety/fear. Under conditions of fear, a person affected with phobia may use following time frame in his/her internal dialogue:
I. I may be bitten by a dog (dog has not yet bitten him/her; there is a probability at some point in future).
II. If bitten by dog, I may catch rabies. (dog has not bitten yet; rabies has not be caught yet; these events may happen at some point in future).
The repeated usage of this future time frame is associated with fear. If in the internal/interpersonal dialogue this time frame is switched to past or present, the brain activity will also get switched to the neural correlates of past/present. This can be done in following manner:
I. Dog has bitten me
II. I have caught rabies.
When a person is required to drill (repeat in bulk within a short time span above time frame converted statements) the brain correlates will also get switched over from future to past/present. The neural correlates of past/present are not associated with fear reaction. The repeated verbalizations of time frame converted statements provide an opportunity for the realization of falsification in the danger perception ignited by the objects of fear. This results in an experiential learning. The fear emotion hanged on the objects of phobia get processed and released from those objects resulting in rapid relief from phobia/OCD.
Since, the keywords involved in the fear reaction are emotionally charged, the exposure and repeated verbalizations shoot up the fear reactions to verbalizations to low to high or even very high level. Words are recognized as higher order conditioned stimuli. The repeated verbalizations produce an extinction of fear reactions associated with the objects of fear.
Other theoretical frameworks may also be involved in Cognitive Drill Therapy. I have identified above and may add more if I come across during the course of my development and refinement of the conceptualizations in Cognitive Drill Therapy.
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