Paradoxical intention

Dr. Viktor Frankl, the founder of Logotherapy, coined the term in 1939 and advocated for its use by patients with severe anxiety disorders. Though therapists had been utilizing paradoxical treatments for a long time before the term was coined. == Technique ==

Within the framework of Logotherapy, two techniques have been developed: 'paradoxical intention' and 'dereflection.' For phobic and obsessive compulsion For insomnia Paradoxical intention has been shown as an effective therapy in the treatment of chronic insomnia. It attempts to eradicate the anxiety associated with the inability to sleep by instructing patients to do the opposite and attempt to stay awake. By asking patients to keep their eyes open, while lying comfortably in a dark room without sleeping, they are taught to understand the non-disastrous implications of staying awake and thus, the anxiety associated with it diminishes. Thereby in this manner, by eliminating voluntary sleep effort, paradoxical intention minimises sleep performance anxiety, promoting rapid sleep onset. Similarly, it is also suggested that by diverting attention from sleep performance, it allows for cognitive de-arousal leading to relaxation and sleep. A 2021 meta-analysis conducted a systematic review of randomised control trials and experimental studies comparing PI for insomnia to passive and active comparators. Results showed that relative to passive comparators, PI showed radical improvements in several key insomnia symptoms with moderate improvements as compared to active comparators. Recursive anxiety Research has also configured links between the effectiveness of paradoxical intention as a treatment towards recursive anxiety. Patients whose phobias originate from recursive anxiety have shown greater improvement with PI related treatments. This occurs due to paradoxical intention overcoming performance anxiety and facilitating natural sleep, unlike situations where external factors e.g. noise, temperature, etc. affect sleeping ability. Recursive anxiety is also a result of the anticipatory fear that anxiety causes a lack of self-control leading to public embarrassment and judgement. Therefore, recursive anxiety leads to individuals attempting to control their cognitive environment by adjusting thoughts and behaviour to minimize stimuli inhibiting calmness. == Dereflection ==

Dereflection is the technique of diverting the client's attention away from their symptoms, as hyper-reflection can lead to inaction. Dereflection has been developed for people with sexual disorders, in which the patient's desire for sexual pleasure becomes an obstruction to achieving it. The therapist discourages intercourse and breaks the cycle of desire, striving, and disappointment. == Criticisms ==

Relative effectiveness The effectiveness of paradoxical intention as a substantial treatment for insomnia has been challenged. In fact, research indicates that stimulus control therapies and sleep restriction therapies have been proven to be more effective in treating insomnia. The current understanding of paradoxical intention with regards to sleep states that it alleviates the patient's “effort associated with sleep”. Espie and Lindsay argue that instead of eradicating the anxiety, it may simply be redirected towards the “effort to stay awake”. Thereby, paradoxical intention is viewed as a last case resort in the event of the ineffectiveness of other relaxation-desensitisation programs. == See also ==