How Does Paradoxical Intention Therapy Work?

Many people throughout the world experience fear, anxiety, and phobias. The Anxiety and Depression Association of America states that over 40 million Americans live with anxiety disorders each year. One way that some people have found to make progress is through something that psychologists call paradoxical intention. Read on to learn more about this strategic way to improve your mental well-being.

Paradoxical intention therapy as an anxiety treatment

Many treatment options have emerged to improve anxiety disorders, including cognitive psychotherapy and behavioral treatment solutions. However, what if you could make progress with your fear and anxiety by facing it head-on? What if the best way to get rid of it were to experience more of what makes you anxious?

Although it may seem counterintuitive, that is what paradoxical intention therapy is based on, and many people are using it to confront their anxiety disorder, performance anxiety, obsessive-compulsive disorder, and chronic insomnia.

Breaking down paradoxical intention

To understand paradoxical intention, we’ll first consider the meaning of both words. A paradox is a seemingly contradictory statement. Some examples come in the form of familiar terms, such as jumbo shrimp and crash landing. A paradox can be anything that is both true and contradicts popular belief or putative mechanisms.

Paradoxical intention describes a contradiction in how we act when we’re anxious

According to the Merriam-Webster Dictionary, the word “intention” means "a determination to act in a certain way." When we combine this with the word "paradox," we come to understand that a paradoxical intention in psychology is a plan to act in a way that seems to contradict what you should be doing. 

For example, if someone has a phobia, they might face it head-on and perform an action that creates that discomfort. Instead of avoiding it, they purposefully choose to expose themselves to it. In this article, we'll explore this concept and how it is sometimes applied in therapy.

History of paradoxical intention therapy

Known for his book Man's Search for Meaning, Viktor Frankl survived World War II and the Holocaust. While he was imprisoned in concentration camps during the war, Frankl had the opportunity to make many observations about human capacity and what happens when people are put into dire situations with extreme conditions. Later, he developed several therapeutic methods based on his observations, including paradoxical intention therapy.

Frankl noticed a cycle of paradoxes in anxiety

While he was refining this treatment, Frankl noticed a cycle. When people became afraid of something, they felt fear and wanted to avoid it, taking voluntary control of this feeling to stop a vicious cycle. Then, they developed a fear of the fear that they had. The fear just continued to grow, and they had anxiety over being fearful of the thing. Having this type of fear may cause problematic symptoms or an involuntary physiological process to arise and lead to physical and mental problems, such as increased heart rate and anxiety.

How and why does paradoxical intention therapy work for anxiety?

One of the ideas behind paradoxical intention is the notion that the mind often does the opposite of what we want it to do. When you try to suppress a thought or concern, it often makes it worse. 

Don’t think about a white dog with spots

If someone tells you not to think about a white dog with spots, it's nearly impossible to not think of that very thing. The more you try to resist the thought, the more frustrating it becomes. Similarly, the longer you try to avoid the thing you fear, the more the fear may grow. Even if we know that avoidance may increase the power of the things we fear, it's still a common response to avoid them.

Think about someone who has a fear of failure. This person might naturally avoid putting themselves into situations where they might fail. They may refuse to try new things because they don't want to take the risk of failing. The longer that they live like this, the more the fear may develop and grow until it consumes their life. It may become harder and harder to think about ever trying something new. They may even express exaggerated responses if asked about trying something new. 

Repeated confrontation in place of avoidance

If this person went through paradoxical intention therapy, they might repeatedly put themselves into situations where they are forced to try new things, even though they could fail. They might continue to do this until it becomes so natural that the fear and anxiety around trying new things are no longer present.

This type of cognitive psychotherapy may lead to improvement for this type of problem, as well as for symptoms related to performance anxiety, obsessive-compulsive disorder, insomnia, and sleep restriction.

By continuing to face the things that cause you anxiety through paradoxical intention therapy, you may be able to change your focus. Instead of avoiding something because you don't want to do it, you might change your mindset and think by default that you are going to do it. With the paradoxical intention approach, you might become more intentional about facing the things that cause you fear and anxiety, potentially leading to improved mental health.

Other uses for this treatment method

Paradoxical intention has the potential to help with some challenges that result from anxiety, such as difficulties with sleep or performing certain acts in public places. 

Paruresis, or “shy bladder syndrome”

For example, some people experience a condition called shy bladder syndrome (paruresis, or the inability to urinate in public restrooms or any place where other people are nearby), but few people talk about it. One salient aspect of this condition for people is sympathetic discomfort. People with this condition often have difficulty urinating in certain situations, despite trying as hard as they can. They may try to convince themselves to relax or think of water and try all kinds of tricks, but sometimes nothing works.

However, if you had this condition and decided to practice paradoxical intention therapy for it, you would do the opposite. Instead of convincing yourself to go to the restroom, you would try to see how long you can last without having to use the restroom. You would try to hold it. If you did this, you might subconsciously alleviate the anxiety surrounding the problem. This therapeutic paradox in which you reverse your natural intention might help you overcome the problem and urinate with less trouble.

Insomnia

There are mixed opinions on the use of paradoxical intention for insomnia. Some evidence-based experimental studies have found evidence that paradoxical intention for insomnia can be effective in helping patients to gain control over their ability to sleep by controlling their ability to not sleep. When a patient struggles with chronic insomnia, they often begin to worry about it. The more they focus on sleeping, the harder it may be for them to fall asleep. They may spend so much time thinking about how long it will take them to fall asleep that they wind up not sleeping at all.

This is known as anticipatory anxiety. If you experience recursive anxiety, a therapist using the paradoxical intention approach might advise you to strive to stay awake as long as you can. Sleeping is an involuntary function, so we can't always control it. However, we can try to stay awake for as long as we can. 

When a person focuses on staying awake instead of focusing on sleep onset, the anxiety of insomnia may vanish or cause self-detachment that promotes relaxation and sleep. Therefore, it may be easier for that person to experience relaxation and eventually fall asleep when they stop trying to fall asleep and instead try to stay awake.

How would you implement paradoxical intention therapy for sleep disorders?

To put paradoxical intention to use for insomnia, you might try sleep restriction therapies. One way to do this is by turning the lights off and lying in bed. Next, you might focus on keeping your eyes open as long as you can. If you feel sleep overtaking you, do not stir or try to fight it; simply let sleep come. 

Remember that staying awake until the last possible second is the goal, so you don't need to check the time or worry about how long you've been awake. This may alleviate the initial insomnia you experience and increase sleep efficiency.

Sleep medicine and doctors can help where psychotherapy can’t

If the problem of falling asleep is impacting your routine, you may want to investigate sleep medicine, with which a doctor can conduct subjective and actigraphic measurement tests to detect how much sleep you get each night. This may help them better understand the most salient aspect of what you are experiencing and allow them to address performance anxiety, sleep anxiety, recursive anxiety, or any other symptom preventing you from getting to sleep easily.

How you might use this approach in your life

If you experience fear and anxiety, it might be time to try a little paradoxical intention. Here's what you might do to get started with a paradoxical intervention:

1. Identify the thing that causes your fear and anxiety.
2. Look for ways to make it bigger than it is. For example, if you have a fear of failing, then you might consider trying things that you don't know how to do. You can set yourself up to do something where you might fail.
3. Start putting yourself in situations where you are going to fail.
4. Continue to do this until the idea of failing no longer causes you intense fear.

As you can see, this approach can be applied to many different situations, not only to large fears and performance anxiety. Some people experience difficulty implementing it on their own. However, there is evidence that it can be effective, and if you work with a therapist, it may be easier to follow through with the plan. A licensed therapist may be able to help you identify the behaviors, fears, and anxieties that you can address with this treatment as well as introduce you to a new cognitive technique. 

Seeking help through reverse psychology methods in therapy

You don't have to live in fear or face your fears on your own. A growing body of evidence suggests that online therapy can help individuals manage and overcome certain phobias, including behavioral and cognitive psychotherapy. For example, one study examined the effects of internet-based therapy on social phobia, particularly the fear of public speaking. The study utilized certain aspects of cognitive-behavioral therapy (CBT), including exposure therapy. Sometimes, a therapist may introduce the concept of paradoxical intention in a cognitive-behavioral therapy session. In cognitive-behavioral therapy, there’s usually a focus on how your thoughts impact your emotions and behaviors. Paradoxical intention may be a helpful strategy for cognitive-behavioral therapists to introduce to their clients.

If you’re nervous about going into a therapist’s office to discuss your concerns, you might try online therapy with BetterHelp. You can speak with a therapist from the comfort of your own home and even reach out to them in between sessions if you are experiencing anxiety or have questions.