ADDITIONAL IDEAS IN DRILL THERAPY
Outcome of CDT: Drill therapy produce three primary outcomes (a) Extinction/Habituation (b) Enhanced Self-efficacy (c) Re-appraisal.
By repeated verbalizations of feared cognition, the emotional charge associated with objects of fear gets dissolved. After successful application of drill, the objects of fear no longer activate body-mind reactions of discomfort which are called as Extinction/Habituation. For example, a person with dog phobia, used to feel rapid heartbeat, breathing difficulty, trembling by seeing a dog; after drill therapy he/she will no longer experience these symptoms and would remain neutral and calm by seeing the dog.
Secondly, during phobic condition, a person feels that he/she will not be able to face the objects of fear; and if somehow would get exposed to the objects of fear; he/she will not be able to handle the overwhelming body-mind reactions. He/she may feel hopeless and helpless in the situations involving excessive fear. By doing drill and experiencing reductions in body- mind reactions, the confidence of the affected person in his/her capabilities gets boosted. He/she comes to believe that he can handle the situation with reasonable comfort and even begin daring which is called enhanced self-efficacy.
Thirdly, during the condition of phobia, an affected person harbors thoughts of danger perception. In case of dog phobia, the thoughts of danger perception may consist of that dog may bite, if it bites there will be pain, he/she may get rabies and even die. After successful practice of drill therapy, these feared cognitions get modified. The person may think that it is a rare event that the dog would bite, even if bites, he/she can get the treatment. He need not be afraid to this extent.
When all the three outcomes are achieved with drill therapy, then it could be concluded that the affected person has achieved the goal of treatment and he/she is no longer is having an issue of phobia. The active treatment may be shifted to maintenance mode with follow up advice and practice of drill as and when required.
Drill Failure: The application of drill usually produces some changes within three days. If there is nil positive outcome within three days of application of drill therapy, then it essentially calls for a revision of the assessment of the condition of the affected person. It is observed that sometimes, the objects of fear and body-mind reactions along with corresponding feared cognition is sitting on the top of some other problem which should be addressed prior to handling of the phobic condition. The other condition which may need be understood include problems in the personality, interpersonal relationships, any chronic physical illness, real traumatic events in the life and the like. A person presented with issue of social anxiety and drill was initiated. When drill did not produce positive gains or even aggravated the body-mind reactions; re-analysis was conducted. It was found that this person had issues of personality traits. He was sensitive to interpersonal criticism and rejection since his early days. Also, he was having frequent experiences of criticisms and rejection on regular basis in his family. So it was considered best to opt for cognitive restructuring and training in coping skills prior to addressing the feared cognition through drill therapy.
Accessing Sub-conscious Mind: During drill, a person may access the experiences stored in subconscious mind. While accessing subconscious experiences, the person can land upon the first experience that led to the development of phobia/OCD. Access to such an experience immediately enhances the understanding of the affected person and it can initiate a process of re-evaluation of the objects of fear and danger cognition. A person with social phobia was exposed to the drill. She showed severe body-mind reactions to the objects of fear related to social situations. Her age is 50 years. She accessed the first experience of her life during her teenage on stage in which she was not able to make a presentation. A couple of persons in the audience were waving their hands indicating her to come down the stage. This imagery of waving hands got hanged in her mind. On subsequent presentations, she used to get this imagery of waving hands. The access to this experience immediately led her to link with her current problem in performing on the stage.
Drill and Hypnosis: Hypnosis can be conveniently integrated with drill therapy. Hypnosis can be used to conduct assessment for drill therapy. An affected person can be put to hypnotic trance and additional objects of fear and danger cognition can be identified. The mind in hypnosis becomes much more focused which can help in eliciting danger cognition which is not readily accessible to conscious mind. Also, hypnosis can be utilized to review life experiences related with the problem. Age regression can be conducted to identify first life experience associated with the problem. Hypnosis is more useful for this kind of assessment then conducting drill during hypnosis. The drill in waking state is much more effective than the drill during hypnotic state. Posthypnotic suggestions can be integrated effectively with hypnosis. Following types of suggestions can be given to the affected person during hypnotic trance. (a) with every verbalizations of drill, the association between objects of fear and body-mind reactions will get weaker and weaker (b) the emotional charge associated with objects of fear will get drained very fast effortlessly and smoothly (c) while performing drill, subconscious layer of your mind will keep on generating and consolidating helpful and effective ideas about the objects of fear and the reactions (d) while practicing drill at home and real life situations, you would feel tempted to daring by repeatedly exposing yourself to the objects of fear (e) during the course of drill therapy you are likely to have a series of pleasant surprises. (f) every homework would inspire you to keep on doing the homework and record your experiences and success in drill diary.
Extension of Drill: The drill therapy is applicable in stimulus bound anxiety. The primary conditions being dealt with so far include phobia and OCD. However, drill could be explored in any emotional condition that involves underlying fears such as stress induced disorders, substance abuse, envy and the like. The drill can be used to address underlying feared consequences in such conditions. The remaining component of the problems can be dealt with other therapies like CBT.
Other ideas that converge well with drill therapy can be used. These ideas may come from principles of psychology or even from medical disciplines such as homeopathy.
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