Cure by Symptom Scheduling

Angie was always anxious. Forty-two years old, she worried about
everything: money, her job security, the health of her husband and
her two sons (who were all fine), her own health (she was fine,
though worried she had cancer), climate change, turmoil in the
Middle East, the threat of an accident when she drove or even when
she walked outside.

Not only was her anxiety highly unpleasant in itself, but it prevented
her from focusing on any source of potential pleasure–eating,
reading, watching TV, jogging through the countryside, sex.

Conventional psychotherapy had not helped her and she did not
want medication as she feared it would cause her to lose control of
herself. She was, she added, a control freak.

“Being a control freak has its good points,” I told her. “Your home is
immaculate, you are never late for anything, you manage your money
wisely, you are a model employee. But for many years your anxiety
has controlled you. You have been at its mercy.  And wouldn’t it be
welcome,” I added, “if 
you had control over it, rather than the reverse?”
She agreed.

And so I asked her to perform a daily homework assignment between our
appointments. Every day she was to set aside precisely 38 minutes in the
evening in which to deliberately worry, to think about whatever was making
her anxious, or whatever might make her anxious if she thought about it.
If nothing was making her anxious on that particular day, she was invent
reasons. For the rest of each day, any time she was aware of worrisome or
anxiety-producing thoughts, she was to defer them till the appointed 38
minutes, at which time she could consider them.  If anything new made her
anxious during the day, she was to jot down the subject, and then ruminate
about it during those 38 minutes.  
In this manner, I told her, she could begin
to gain control and mastery over her anxiety.

She complied, performed the assignment to perfection, and reported
two weeks later that overall she had been significantly less anxious.

The tactic of reapportioning symptoms in space as well as time can
resolve them.   For example, Rachel Hare-Mustin reported in a journal
article (Family Process,1975, 14, 481-486) how she treated a 4-year old boy’s
major temper tantrums.  She advised the boy to continue his tantrums, but
only in a specific room of the house.  After he and his family selected the
special tantrum room, the boy designated the time of day in which he would
enact his tantrums.  His behavior improved markedly, whereupon the therapist
told him to select a particular day the following week for a tantrum.  The
tantrums ceased.

How can such counterintuitive tactics work?  First, any mental health
problem involves a repetitive or persistent pattern of dysfunctional behaviors,
thoughts, or feelings.  Any change in that pattern, even a small change in one
aspect, can subvert the entire entrenched pattern and lead to change.
But there is an equally important and fundamental principle that
determines the efficacy of such interventions as those described above.  I
term it the healing paradox and discuss it in my book, The Healing Paradox:
A Revolutionary Approach to Treating and Curing Physical and Mental Illness

(North Atlantic Books, 2013).  In brief, this principle states that in order
to cure illness, treatment must approach disease not as an adversary but as
an ally; must work with disease and not against it.

For example, if I tried to get Angie to stop feeling anxious, say with
relaxation exercises, a part of her would fight against those efforts because
of her need to feel anxious.  Thus such an adversarial approach probably
would be of limited benefit, at best.  But with symptom scheduling, she
could still retain her anxiety, but in a modified form that permitted her
improved comfort and functioning.

Fighting against anxiety usually produces more anxiety.  But the symptom
scheduling protocol implies a need to retain the symptom in some form
because of its inherent value to the person, however unpleasant it may be.
And with Angie’s deliberately producing her anxiety for 38 minutes daily, she
did not have to fight against either herself or me, for the meaning of the
anxiety changed.

I have seen symptom scheduling greatly 
help patients tormented by
depression, obsessive-compulsive symptoms, and a variety of other
anxiety-related disorders.

Those wanting to learn more about this and related paradoxical
psychotherapeutic interventions may be interested in my
aforementioned 
book as well as Paradoxical Psychotherapy: Theory
and Practice with Individuals, 
Couples, and Families by Gerald R.
Weeks and Luciano L’Abate 
(Brunner/Mazel, 1982).
Be well.

 

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