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An extension of thought stopping in the treatment of obsessional thinking
LETTERS TO THE EDITOR
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An Extension of Thought Stopping in the Treatment of Obsessional Thinking In treating the individual who wishes to control depressing thoughts, obsessive thinking, constant negative rumination, or acute anxiety attacks, I have found the sequential use of several techniques useful. Included are thought stopping (Hersher, 1970), counting from l0 to one (Campbell, 1973), cue controlled relaxation (Russell & Sipich, 1973), and an adaptation of covert reinforcement, in that order. Although thought stopping is often successful in inhibiting obsessive rumination, there are instances when combining treatment techniques is necessary to completely eradicate symptoms elicited by powerful external events or unidentifiable and perhaps endogenous stimuli. Patients are seen, preferably twice a week, to provide a rapid reduction of stress and give them the experience of having acquired true self-control. Deep muscle relaxation is routinely taught so that they can experience a state of complete tranquillity and a sense of self-control that is rarely achieved as well by any other method. Following this phase, instructions in thought stopping are provided by asking the patient to imagine a very threatening situation and then aborting it in the traditional manner for four consecutive trials. Next he is told to add counting backwards from 10 to one (Campbell, 1973), and practice is provided for as many trials as needed. Next, the patient is taught cue controlled relaxation (Russell & Sipich, 1973) which serves to augment the effects of the deep breathing exercises learned during traditional deep muscle relaxation training. Next the patient is told to "visualize the most pleasurable scene imaginable." The highest rank ordered scene from the Reinforcement Survey Schedule (Cautela & Kastenbaum, 1967) may be used instead when covert reinforcement has been selected as the treatment of choice for maladaptive avoidance behavior. Thus, the procedure is "yell stop, inhale, exhale, say 'relax', and shift to a pleasant scene." The entire procedure requires approximately three l-hr treatment sessions and has been used successfully with obsessive thinking, compulsive behavior, depressive states, and acute anxiety. Of special importance is the sense of self-control and immediate success the patient experiences as the techniques are taught and used effectively.
REFERENCES Campbell, L, M., A variation of thought-stopping in a twelve year old boy: A case report. Journal of Behavior Therapy and Experimental Psychiatry, 1973, 4, 69-70. Cautela, J. R., Behavior Therapy and Self Control: Techniques and Implications. In C. M. Franks (Ed.), Behavior Therapy: Appraisal and Status. New York: McGraw-Hill, 1969. Cautela, J. R., & Kastenbaum, R. A. Reinforcement Survey Schedule for use in therapy, training, and research. Psychological Reports, 1967, 20, 1115-1130. Russell, R. K., & Sipich, J. F., Cue-controlled relaxation in the treatment of test anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 1973, 4, 47-50. L L O Y D K . DANIELS
Department of Psychology Central Connecticut State College New Britain CT 06050
BEHAVIOR THERAPY 7 (1976) Copyright ~c~1976by Associationfor Advancementof BehaviorTherapy. All rightsof reproductionin any form reserved.
13 1
An Extension of Thought Stopping in the Treatment of Obsessional Thinking In treating the individual who wishes to control depressing thoughts, obsessive thinking, constant negative rumination, or acute anxiety attacks, I have found the sequential use of several techniques useful. Included are thought stopping (Hersher, 1970), counting from l0 to one (Campbell, 1973), cue controlled relaxation (Russell & Sipich, 1973), and an adaptation of covert reinforcement, in that order. Although thought stopping is often successful in inhibiting obsessive rumination, there are instances when combining treatment techniques is necessary to completely eradicate symptoms elicited by powerful external events or unidentifiable and perhaps endogenous stimuli. Patients are seen, preferably twice a week, to provide a rapid reduction of stress and give them the experience of having acquired true self-control. Deep muscle relaxation is routinely taught so that they can experience a state of complete tranquillity and a sense of self-control that is rarely achieved as well by any other method. Following this phase, instructions in thought stopping are provided by asking the patient to imagine a very threatening situation and then aborting it in the traditional manner for four consecutive trials. Next he is told to add counting backwards from 10 to one (Campbell, 1973), and practice is provided for as many trials as needed. Next, the patient is taught cue controlled relaxation (Russell & Sipich, 1973) which serves to augment the effects of the deep breathing exercises learned during traditional deep muscle relaxation training. Next the patient is told to "visualize the most pleasurable scene imaginable." The highest rank ordered scene from the Reinforcement Survey Schedule (Cautela & Kastenbaum, 1967) may be used instead when covert reinforcement has been selected as the treatment of choice for maladaptive avoidance behavior. Thus, the procedure is "yell stop, inhale, exhale, say 'relax', and shift to a pleasant scene." The entire procedure requires approximately three l-hr treatment sessions and has been used successfully with obsessive thinking, compulsive behavior, depressive states, and acute anxiety. Of special importance is the sense of self-control and immediate success the patient experiences as the techniques are taught and used effectively.
REFERENCES Campbell, L, M., A variation of thought-stopping in a twelve year old boy: A case report. Journal of Behavior Therapy and Experimental Psychiatry, 1973, 4, 69-70. Cautela, J. R., Behavior Therapy and Self Control: Techniques and Implications. In C. M. Franks (Ed.), Behavior Therapy: Appraisal and Status. New York: McGraw-Hill, 1969. Cautela, J. R., & Kastenbaum, R. A. Reinforcement Survey Schedule for use in therapy, training, and research. Psychological Reports, 1967, 20, 1115-1130. Russell, R. K., & Sipich, J. F., Cue-controlled relaxation in the treatment of test anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 1973, 4, 47-50. L L O Y D K . DANIELS
Department of Psychology Central Connecticut State College New Britain CT 06050
BEHAVIOR THERAPY 7 (1976) Copyright ~c~1976by Associationfor Advancementof BehaviorTherapy. All rightsof reproductionin any form reserved.