Paradoxical Instructions Research Articles

Behavioural strategies to self-manage low-potassium diets in chronic kidney disease.

Dietary potassium restrictions may be challenging to follow, due in part to the restrictive nature of recommendations on foods people enjoy. Little is known how people incorporate low-potassium diets into their lifestyles. To examine the self-directed behavioural strategies people employ to follow low-potassium advice. Qualitative methodology. Thirty-four adults with chronic kidney disease. Semistructured interviews were undertaken in an outpatient department. Thematic analysis was undertaken on transcribed interviews. Analysis identified three themes: 'Differing opinions of food'; 'Food generates positive emotions'; and 'Doing what works'. Participants described foods providing different levels of enjoyment. Favourite foods in their habitual diet held either a physiological or a psychological value to them. Five subthemes underpinned the 'Doing what works' theme that described the self-management behaviours used by participants to follow low-potassium dietary advice. These were positive reframing; reflection; self-talk; social support; decisional balance; paradoxical instruction; and knowledge shaping. These techniques helped overcome the conflict between favourite food preferences and dietary restrictions. Dietary restrictions proved more challenging where an emotional connection to a favourite food existed. Restrictions on less preferred foods did not present participants with the same self-management challenges. Promoting behavioural change techniques such as decisional balance, and social support may be a useful strategy to empower people following dietary restrictions. Practitioners should understand whether suggested dietary restrictions include an individual's favourite food; the value attached to it, and explore specific ways to include favourite foods in some way when discussing a low-potassium diet.

Cognitive-behavioral Strategies for Parkinson’s Disease: A Report of Three Cases

Three patients diagnosed with idiopathic Parkinson’s disease (PD) were treated with cognitive-behavioral therapy (CBT): a 43-year-old woman suffering from depression and social anxiety, a 45-year-old man with sexual problems and maladaptive coping strategies, and a 78-year-old man with freezing of gait. On the basis of functional analyses, interventions were selected, including cognitive methods, social skills training, paradoxical instructions and strategies to improve management of freezing. The interventions were related to improved adaptation to motor impairments and better ability to cope with the disease. These case presentations suggest that CBT can improve quality of life in PD by modifying maladaptive cognitive, emotional and behavioral reactions to the disease and its symptoms.

Behaviour Therapy for DIMS: Comparison of Three Treatment Procedures with Follow-up

Forty patients suffering from persistent psychophysiological Disorders of Initiating and Maintaining Sleep (DIMS) were assigned to one of the following groups: (1) EMG-biofeedback training; (2) cognitive modification treatment, combining paradoxical instructions, cognitive restructuring and thought stopping; (3) stimulus control and progressive relaxation treatment; (4) waiting list (control). Each active treatment consisted of six sessions over a period of 2 weeks.After treatment, the patients in the three treatment groups showed shorter sleep onset latency (37%), shorter wake time after sleep onset (50%), and more positive evaluations of sleep quality and restedness on awakening in the morning. The waiting-list group did not show any changes. Benefits were maintained and further increased during the 1 and 3 year follow-ups. Results did not suggest substantial differences, among the three treatments, in amount and/or stability of benefits. The 3 year follow-up revealed seven failures, as against 23 successes. The initial variables differentiating the failures were shorter sleep time and higher scores on the P scale of the Eysenck Personality Questionnaire.

Pre-sleep cognitive intrusions and treatment of onset-insomnia

The importance of differences in pre-sleep cognitive intrusions in the treatment of sleep-onset insomnia were investigated. Twenty-four patients suffering from persistent psychophysiological insomnia were assessed on a pre-sleep cognitive intrusion inventory and divided into high and low scorers. Within these groups Ss were randomly assigned to either a cognitively focused program (cognitive restructuring. paradoxical instructions and thought stopping) or a psychophysiologically focused method, EMG-biofeedback training. Patients were treated individually for 6 sessions. Within-group comparisons showed that both treatments yielded significant improvement in latency to falling asleep, pre-sleep tension, hours of sleep and sleep quality. Between-group comparisons showed a greater reduction of pre-sleep intrusions in patients treated by the cognitive method and of pre-sleep tension in patients trained in biofeedback, but no differential results were found in outcome variables either after treatments or at 3- and 12-month follow-ups. The results indicate that the use of differential treatments added little to the outcome of therapy, and do not support the hypothesis that greater benefits are gained when the treatment matches the patient's claims of cognitive hyperarousal.

Paradoxical instructions in relaxation training.

The effects of instructions (paradoxical versus standard), treatment technique (EMG biofeedback, progressive muscle relaxation and self-relaxation) and subjects' sex were investigated in a 2 by 3 by 2 between-subjects design. Dependent measures were the changes in EMG and skin temperature over one 40-min. training session for 72 volunteers. For EMG change, the main effect of training was significant, with muscle relaxation producing less reduction than other techniques. This finding reflected an increase in EMG in the 5-min. posttreatment interval for the muscle relaxation group. For temperature change, the interaction of instructions and sex was significant, indicating that paradoxical instructions produced greater increases in temperature than standard instructions for men but not for women.

The Treatment of Urinary Frequency By Paradoxical Intention

Paradoxical instructions were presented to a 13-year-old male client presenting with urinary frequency associated with school attendance. This resulted in sudden change in frequency behaviour which was maintained at follow-up. This case study represents the first report of the application of paradoxical intention to the problem of urinary frequency, and an explanation of the treatment success is offered.

Paradoxical instruction in the elimination of avoidance behavior in an agoraphobic girl

The case is described of a 16-yr-old girl whose agoraphobia was of recent onset. In the light of a rapidly increasing pattern of escape and avoidance behavior associated with several phobic situations, treatment consisted of a paradoxical instruction to embellish subjective anxiety and elicit anticipated negative consequences during prolonged in vivo exposure. Treatment was associated with the elimination of avoidance behavior and a dramatic reduction in self-reported anxiety, and obsessive-compulsive complaints, as well as anxiety ratings during exposure. These improvements were maintained and enhanced at both 3- and 9-month follow- up. The implications of this approach with severe fears and the need for additional empirical evaluations are discussed.

Reframing and paradoxical instruction to overcome "resistance" in the treatment of delinquent youths: A multiple baseline analysis.

Reframing and paradoxical instruction to overcome "resistance" in the treatment of delinquent youths: A multiple baseline analysis.

Paradoxical intention in the treatment of obsessional flatulence ruminations

A case study of the paradoxical treatment of long standing obsessional ruminations about flatulence in a 33-year old female respiratory therapist is described. Self- reported estimates of the frequency and intensity of flatulence were unaffected by a misconception correction procedure that entailed the presentation of scientific data disconfirming the bases of her concerns. Paradoxical instructions to intensify flatus emissions were then employed. These instructions resulted in a rapid elimination of the obsessional ruminations; this improvement was enhanced at 1 yr follow-up.

Paradoxical instruction in the treatment of encopresis and chronic constipation: An experimental analysis

The purpose of the present single-case experimental investigation was to examine the efficacy of paradoxical instruction in the treatment of exacerbation-based discontinuous encopresis and chronic constipation. The subject, a 9-yr old male, complained of infrequent bowel movements and daily soiling. In addition, toileting and related activities appeared to cause considerable anxiety. An ABAB reversal design with 1-yr follow-up was used as a means of evaluating treatment effectiveness. Dependent measures included weekly parental records of soiling and appropriate bowel movements. Results indicated a clear demonstration of functional control and consistent improvement in the encopretic disturbance. These findings were maintained at 1-yr follow-up.

Hypnosis as an adjunct to thought-stopping and covert reinforcement in the treatment of homicidal obsessions in a twelve-year-old boy

Abstract A combined cognitive behavioral approach was used to successfully treat matricidal obsessions in an otherwise psychologically well-adjusted 12-year-old boy. The primary problem was conceptualized as anxiety over loss of control. Therapeutic techniques included re-defining of symptoms, thought-stopping, hypnotic enhancement of imagery in order to facilitate cognitive restructuring, covert reinforcement, home practice, and paradoxical instructions to produce the symptom. A decline in obsessions began after 3 sessions and total remission was observed after 6 sessions (10 weeks). 2-year follow-up revealed no recurrence of symptoms. The value of hypnosis as an adjunct to behavior therapy with children is discussed.

The midgame in strategic therapy

The techniques and artistry of initiating and terminating therapeutic encounters have been disproportionately represented in the literature of strategic therapy. This paper, using the patient's own report, illustrates the middle phase of therapy in the case of a severe marital difficulty. Central to the final outcome was a paradoxical instruction which, following the patient's own report, is discussed with regard to this case and as a general category of prescription.

Treatment of Sleep Onset Insomnia by Paradoxical Instruction

Four adult outpatients suffering from severe, chronic sleep onset insomnia participated in a five-session paradoxical instruction treatment program. A multiple baseline design across subjects was utilized with major dependent measures consisting of eight behaviorally-specific daily sleep indices. Counterdemand manipulations were applied so as to evaluate and control for change attributable to expectancy and therapeutic demand. Results indicated significant improvement on five of the daily sleep chart measures, with treatment gains maintained at 4-, 8-, and 12-week follow-up. These findings are discussed with regard to interruption of hypothesized exacerbation cycle phenomenon.

Treatment of insomnia by paradoxical intention: A time-series analysis

Paradoxical instructions were presented to an individual suffering from chronic insomnia. To control for improvement attributable to demand characteristics alone, counterdemand manipulations were utilized during the treatment period. Results, analyzed via time series analysis, indicated significant improvement on five of eight self-recorded sleep dimensions. These findings were discussed with regard to the hypothesized interruption of the “exacerbation cycle”.

What is Done in Trust Conditions Underlying the Success of Paradoxical Interventions

The author describes the sort of transactions that must occur between patient and therapist if paradoxical interventions are to succeed. This article gives examples of how therapists may use their positive Parent ego state to influence patients to accept paradoxical instructions when such instructions seem warranted.