SHARING CDT WITH EDUCATORS & PSYCHOLOGISTS
I am being invited to conduct workshops on Cognitive Drill Therapy by Institutions, Universities and Colleges throughout the country. Two days workshop is enough to transfer core concepts and skills of drill therapy to the participants. I received an invitation from Regional Institute of Education, Bhopal to conduct one such workshop for 44 trainees of Diploma in Guidance & Counseling Course on 21-22 August 2016. The batch consisted of experienced Educators and Psychologists. I readily agreed to conduct the workshop. My choice was strongly influenced by my concern that the students in educational system have high prevalence of Social Anxiety. Because of this anxiety they feel inhibited to express themselves in classrooms, group discussions, seminars, debates and interviews. Even talented and bright students suffer from social anxiety. This suffering takes a toll on their life style. Because of social anxiety they may begin to use substances of intoxication and even feel depressed. The net outcome of low participation in expressive activities leads limitations on realization of their full potentials, inhibition in creative expressions which taken together results in National loss. Hence, I am strongly convinced that we should empower teachers and counselors working in the schools with the technology of Cognitive Drill Therapy so that they can identify and help the students in overcoming social anxiety. If we could intervene into social anxiety in the formative years of education, then this would result in better achievements, creativity, social relationships, self-esteem, self-confidence, contribution to the society and the Nation.
Usually, it takes a few days to overcome social anxiety to a reasonable level. We need to make students aware of their social anxiety and help them out. Even the teachers do have social anxiety. Because of this anxiety, the teachers may not deliver optimally to their students. This scenario of social anxiety makes an urgent call to the mental health professionals to deal with the condition at massive level. We need to take care of both the teachers and the students in the educational setup so that they can put their maximum to the academic and personal development.
Having oriented to the need and importance of intervening into social anxiety, I introduced Cognitive Drill Therapy to the group by highlighting the concept of Two Layer Structure in phobia. The two layers are (a) Conscious Layer (b) Sub-conscious Layer. The conscious layer consists of three components (i) Objects of fears (ii) Body-mind reactions (c) Safety behaviors. The subconscious layer consists of ‘danger perception’. In case of social anxiety, the two layer structure would be as follows:
Objects of Fear: speaking before elders, strangers, known group, in public, authorities, stage, debate, interview etc.
Body-Mind Reactions: When exposed to the social objects of fear, an affected person may experience multiple body-mind reactions such as shallow breath, rapid heartbeat, hot/cold flashes, blushing, dry mouth, butterflies in the stomach, dizziness, blankness, trembling, speech hesitations, becoming self-conscious etc.
Safety Behaviors: In order to overcome painful body-mind reactions and social anxiety, an affected person may find excuses to avoid social objects of fear, avoid eye contacts, may develop some physical illness prior to participation in social activities, sit on the back, try to hide from the view. Or involve in extensive preparations prior to social encounter and use positive affirmations.
Danger Perception: Usually, the person affected with social anxiety has following kinds of thoughts of danger perception:
i. People will make fun of me
ii. My image will get tarnished
iii. People will come to know about my incompetence
iv. People will reject me
v. People will criticize me
vi. People will begin to ignore me
vii. What others will think of me?
viii. People will judge me
A person with social anxiety remains trapped into conscious layer and keeps on dealing with the components of conscious layer. Rarely, he/she work on the subconscious layer of danger perception. Since, the subconscious layer remains intact, the person continues to experience social anxiety for years until effective resolution. The goal of treatment is to make corrections in the thoughts of subconscious layer.
A perusal of the thoughts of subconscious layer would quickly reveal the future perspective. Anxiety looks into future. Under conditions of anxiety, a person tends to use future tense in his/her sub-vocal speech. There are three tenses – Past, Present and Future. We can use notations for three tenses – A=Past; B=Present; & C=Future. Also, I am speculating, there might be three areas in the brain that process three tenses. We can use the same notations for brain areas corresponding to three tenses. A=Past; B=Present; & C=Future. The idea is that anxiety is associated with future tense. If we could modify the anxiety related statements into past or present; then those statements would not trigger Centre ‘C’ in the brain. For this simply change the tense. The statements after tense change would appear as follows:
i. People have made fun of me
ii. My image got tarnished
iii. People have come to know my incompetence
iv. People have rejected me
v. People have criticized me
vi. People have begun to ignore me
vii. Others have thought of me
viii. People have judged me
Over the period of time, these evaluative and inference judgments of other people’s thinking and reactions become associated with fear reactions. In accordance with the principle of habituation, if these statements are repeated for sufficient frequency and duration; then it would produce habituation. Hence, in cognitive drill, a person is required to repeat, repeat and repeat the tense converted statements.
Initially, imaginal and verbal exposure is implemented in following manner. “imagine a social situation, and repeat above statements”. Keep on repeating. If verbalizations of these statements activate body-mind reactions to a high level, then a pause of 1-2 minutes is given for natural reduction in distress. When the distress, is reduced to medium or low, the drill is resumed. To monitor, the pattern of reactions, every 30 second, a report of distress is obtained from the person. He/she may report it out of 100 or as low, medium or high. Visible changes are expected within 3 days application of drill therapy. However, I recommend a usage for 21 days. Homework assignment of the same drill is given to the affected person. He/she is to practice drill for 60 minutes which can be broken into two sessions of 30 minutes. A drill diary is to be maintained for recording the experiences with the drill and the problems of social anxiety including any other issues in the life. The goal of imaginal and verbal practice is the normalization of body-mind reactions to verbal and imaginal exposure. The affected person may express disbelief in the power of drill therapy. He/she need be assured that the effects of drill will be perceptible within 3 days. If not, then other methods could also be added.
When, body-mind reactions get normalized to verbal & Imaginal Exposure, we need to move forward for daring. In daring, an affected person is to expose himself/herself to the real social situations and express himself/herself. During exposure to actual situations, the drill should be continued. The drill is to be done sub-vocally in social situations. While with the therapist or alone, drill verbalizations can be done.
Cognitive drill breaks the functional connections between stimulus and response. Objects of fear are the stimulus and fear is the response. It means the objects of fear usually remain unchanged but lose their power to activate fear reaction. Stimuli get neutralized. Similarly, fear reaction remains in the personality. It cannot be eliminated from the personality. Fear has an adaptive function. It is not possible to kick it out from the system. The secret to change is the successful breaking of stimulus-reaction connections through drill therapy.
To achieve the goal of successful disconnection between objects of fear and fear reaction, we must identify and enlist maximum number of objects of fear in a numbered bullet. For example,
1. Speaking on stage
2. Speaking before known group
3. Active participation in group discussion
4. Participation in debate
5. Oral practical examination
6. Selection interview
7. Speaking to Head of the Institution
8. Speaking to teachers
9. Speaking to elders
10. Speaking before unknown group
11. All other similar situations to be recorded specifically
The drill should be done for each identified object of fear. If any listed or unlisted object of fear is left out from the drill, it might continue to have fear evoking potentials. The drill will break the connection between drilled object of fear and the fear reaction. An expectancy that reduction of fear from one object will spontaneously reduce the fear in undrilled object may not hold true. Hence, aim for drilling as many objects of fear as possible. Also, it is seen that an undrilled object of fear is encountered after a gap of a few months. The exposure to such undrilled object will elicit fear reaction. If it happens so, drill should be performed for newly identified object of fear.
Similar is the case with the thoughts of danger perception. As far as possible, all thoughts of danger perception should be identified and listed in a numbered bullet. For example,
1. People will make fun of me
2. My image will get tarnished in people’s mind
3. People will come to know that I do not know anything
4. My deficiencies will be exposed to others
5. People will have a surprise expression that I do not know even such a simple thing
6. People will humiliate me
7. People will begin to ignore me
8. People will judge me negatively
9. People will have a negative impression of me
10. All such similar thoughts of imagined feared consequences should be identified and listed
To implement the drill, imagine first object of fear and verbalize entire list of the thoughts of danger perception by converting them into past or present. When it gets normalized, then take up next object and so on. Perform drill in imagination with each object of fear and the list of thoughts of danger perception. When complete list is normalized, then daring is recommended. In daring, face the objects of fear in real life and perform the drill sub-vocally. Continue to do it until reduction of fear in real life situations.
Apart from verbalizations, following methods can also be used to perform the drill:
1. Record the converted drill statements in your mobile and listen to them for about 30-60 minutes daily
2. Write the converted drill statements for 30-60 minutes in a drill diary.
3. Read the converted drill statements for 30-60 minutes daily.
After clarifying the concepts and the techniques involved in the drill therapy, I proceeded to live demonstrations. I asked the group, how many of them are having social anxiety. About 10- 15 hands were raised. I invited them one by one on the podium and made them practice the drill for their thoughts of danger perception. On an average, most of them reported significant reduction in their social anxiety within 10-15 minutes. I made following observations:
1. The conceptualization of drill therapy itself empowers the participants to deal with their social anxiety
2. Workshop group is a social context and performing drill before the group is a real time exposure to the objects of phobia which involves inherent daring
3. The participants could freely verbalize their thoughts of danger perception
4. Participants felt comfortable and confident after performing the drill
5. Regular practice of drill was prescribed to each of them
I explained that cognitive drill therapy produce following three outcomes (a) habituation of fear reaction to objects of fear (b) increased self-efficacy that they can now handle the situation (c) Cognitive Reinterpretation of the danger perception. The danger perception gets modified and now the objects of fear no longer appear to be threatening.
I also enquired about their learning experience of drill therapy. They expressed that they could learn and imbibe the technology of drill therapy. Also they attested to the empowerment potentials of drill therapy. They felt that they are confident enough that they would be implementing this therapy in their classrooms to enable the students to overcome their social anxiety. I am sharing their feedback so that readers could have an idea that this therapy can be easily conceptualized by the participants.
Thank you Sir for telling me the crux of CDT. I could easily understand the two layered structure - the top layer and the bottom layer. I could also assimilate objects of fear, body-mind reactions and safety behavior or avoiding measures. I could also know the danger perception. I liked the concept of drilling, taking pauses, intervening, checking the anxiety at regular intervals. Thank you so much for transferring these skills to me. Surely, I have been benefitted a lot through your simple but amazingly effective style of handling the sessions. The practical part is absolutely wonderful. Thanks a lot for telling OCD, types of OCD and how CDT can be effectively used to help the person suffering from OCD. Once again, Thank you very much.
It was a great and unique experience to learn CDT from you. I learnt the top and bottom layer and partition of CDT fear factor, body-mind reactions, safety behaviors and danger perception. As a school teacher I feel it will be of great help for me to reach out to students in their adolescent age and help them out. The best part of this workshop was real life activity and multiple live demonstrations. Thank you very much Sir.
CDT Therapy developed by Dr. Rakesh Jain, Indian Clinical Psychologist (we are proud of it) basically for Anxiety disorders and phobias. Basis of anxiety lies in future tense. Brain has 3centres A, B and C corresponding to past, present and future tense. Components of CDT
a. Objects of fear
b. Mind Body Reaction
c. Safety Behaviors
a. Danger Perception
Drill means to change the danger perception from future to past or present. Time to time percent of danger is to be asked. If discomfort level is high then pause needs to be taken. Drilling should be given for home work. To check daring has to be taken.
Hello Sir, your CDT session was wonderful and I am sending the feedback of your session what I have understood. Cognitive Drill Therapy is a therapy which actually confronts the subconscious irrational thoughts and danger perception of the client and make them realize that the objects of fear (perceived threatening event) are not that much threatening---> decreases the anxiety and fear which actually blocks the self expression. Flow chart of fear is as follows: Objects of fear--->develop underlying danger perception--->body-mind reactions---> avoidance behaviors. Actually a distorted relation was developed in the past between the Conditioned stimulus (CS)--->triggers future tense thoughts--->Conditioned Response (CR). Through CDT this distorted relation is restructured by replacing the future tense thoughts with PAST TENSE THOUGHTS. Thank you Sir for your guidance and training session.
I am hopeful that acquisition of Cognitive Drill Therapy skills by Educators and school psychologists and counselors can do larger goods in the domain of social anxiety by intervening at the early stage. Liberating young students from their social anxiety will enable them to a fulfilling life to a greater extent and will provide an opportunity for them to realize their optimum potentials in the activities that require presentations and participation in social context.
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