Paradoxical Intention

Paradoxical Intention is a useful strategy for specific disorders, such as anxiety. This article explains how it works using various models and discussing how important details are to achieve the desired effect.

Paradoxical techniques seek exactly what the name implies: dissonance, the absurd. The goal is to get the person to act in a way that they otherwise would try to avoid. Behavior that is usually at the core of the person’s distress and anguish. In such cases, paradoxical intention can be extremely useful.

This blog references the chapter “Stopping paradoxical intention and thinking” by Salgado, Gómez, and Yela in the textbook Behavioral Modification Techniques by Labrador (2007). It seeks to understand which mechanisms to implement to ensure that paradoxical intention is an invaluable technique for achieving change in therapy.

This technique aims for a person with an anxiety disorder to feel anxious. For someone with OCD to carry out their habits or someone who has trouble sleeping to do all they can to not sleep once in bed.

The goals of paradoxical intention

In many psychological disorders, particularly anxiety disorders or OCD, attempts to avoid obsessive thoughts, rituals, or anxious feelings aren’t only unsuccessful, but they can also stop the problem from going away.

A person with hidden OCD rituals, for example, might try to control their thoughts and avoid carrying out their checks. It’s usually very difficult to control these impulses, as they’re usually involuntary.

Thus, according to Salgado et al, the aim of paradoxical intention is:

• For the person to accept they don’t have control over involuntary responses (for example, not having anxiety or not carrying out compulsions…).
• For the subject to try to make the symptom appear in different situations than usual. Additionally, for them to try to get the worst-case scenarios to develop from these symptoms. As an example, asking someone with generalized anxiety disorder to try to bring on an anxiety attack. If possible, ask them to make it a very intense one, with a total loss of control and a very pronounced cry.

How can you explain the change in paradoxical intention?

There are various theories that seek to explain the mechanisms which make paradoxical intention work. Some of these theories are:

• • The double bind theory. When the patient perceives two conflicting messages or either one is answered. Consequently, they ask a person with anxiety to force an emotion which usually presents itself spontaneously. Thus, there are two possible outcomes and the anxiety may well appear. The patient may encourage this, in contrast to their usual habit of trying to control or reduce it. This behavior is referred to as an automatic response. The second outcome is that the anxiety won’t appear.
  • Symptom decontextualization theory. When you ask a person to trigger their problematic behaviors. This act requires them to perform the problematic behavior in a totally different context than normal. The symptom loses meaning as it responds to environmental factors. For example, a person with repetition compulsions who acts on them without it being a response to feeling anxious. In this situation, the ritual loses all meaning because it has been decontextualized.
  • Recurrent anxiety theory. According to Salgado et al., it isn’t possible to trigger a behavior and fear it at the same time. For this reason, paradoxical intention is useful, for example, when someone can feel their symptoms coming on. Sometimes, in people who have trouble sleeping, it’s the fear itself, or anticipatory anxiety, that keeps them from sleeping. Therefore, the desire to stay awake (paradoxical intention) removes the anticipated fear of being unable to sleep, which makes them sleep.

Hidden exposure in the paradox

Paradoxical intention also allows exposure to certain behaviors that people fear and which they continue in order to avoid them. This occurs in the vast majority of anxiety disorders as it’s these safety behaviors and avoidance that cause the anxiety to continue.

Paradoxical intention is especially useful for those people who are afraid of feeling anxious. They anticipate losing control if they get on a plane, go to the cinema, or go downtown at Christmas.

Even though the person may never have previously felt anxious in such places, the anticipation of this happening can make them avoid these places.

Under controlled conditions, it would be difficult for a person to have an anxiety attack when asked. However, as the therapy progresses, they can ask them to try to bring on anxiety in a supermarket. This is done to increase their heart rate and speed up their breathing.

It’s possible for the patient to feel anxiety and for this anxiety to not seem out of control. It’s the individual who chooses when this appears, not the circumstance.

For this reason, paradoxical intention is also useful for someone who exposes their anxiety. The fears that plague them and force them to avoid doing things out of fear of feeling anxious may well disappear. If anticipatory anxiety disappears, so will the safety behaviors and the anxiety problem will cease to continue.

Conclusion: not just any paradox works

Paradoxical intention doesn’t simply consist of telling someone to “bring on their anxiety“. If this is how it’s worded, they wouldn’t know how to do it. This command is too generic to yield good results.

The therapist in question must be very precise when prescribing the task to the patient. For this reason, the behavior must specify what exactly they want to achieve, for how long, and where.

Therefore, exactly as Salgado et al specify, it’s far better to give concrete guidelines rather than vague instructions:

• Instead of “Ask your daughter to have a tantrum”, it’s better to say “Ask your daughter to shout as loud as she can and to stomp her feet before you turn off the TV”.
• Rather than “Bring on your anxiety”, it’s better to say “Try to get your heart to beat rapidly, so that you can feel it palpitating and so that your body temperature increases”. There are strategies you can suggest to achieve this.
• Instead of “Do something you wouldn’t normally do before gorging”, try “Put lipstick on before pigging out”.

A good description and understanding of these behaviors can make or break the success of paradoxical intention when it comes to therapy.

This serves as a reminder that this is a very powerful technique, but it’s also very dangerous in practice as if it isn’t applied in a targeted and structured way, the results might be the opposite of what was expected.