Editing Paradoxical intention (section)

== Technique ==
Within the framework of [[Logotherapy]], two techniques have been developed: 'paradoxical intention' and 'dereflection.'<ref name=":1" />{{Rp|114}}

Most anxious behaviours are a result of performance anxiety due to the inability to perform an action, leading to a vicious circle of anticipatory anxiety. Paradoxical intention teaches the patient to distance themselves from the action, gain control over it and eventually, bring about its removal. It attempts to break this circle by replacing the pathogenic fear with a paradoxical wish. Furthermore, by learning to appreciate the humour in their exaggerated responses, individuals observe the non-catastrophic consequences of their fear-inducing stimuli first-hand, accepting the unlikelihood of the feared anxiety-producing outcome occurring. Paradoxical intention is mainly employed to combat discomfort associated with internal causes while fear of external stimuli can still be treated through conventional treatments such as [[Systematic desensitization|systematic desensitisation]], [[Cognitive behavioral therapy|cognitive behavioural therapy]], etc. For example, if the patient has a fear of public speaking, paradoxical intention would be employed only if the feelings of apprehension stem from an internal source, e.g. having an increased heart rate leading to a heart attack and not due to external factors such as the size of the crowd, their judgement, etc. In this case, the therapist would prescribe the individual to present to the public while focusing on the most salient aspect of their fear – in this case, trying to increase heart rate.<ref>{{Cite book|title=Encyclopedia of psychotherapy|date=2002|publisher=Academic Press|others=Michel Hersen, William H. Sledge|isbn=0-12-343010-0|location=Amsterdam|oclc=50146838}}</ref>

=== For phobic and obsessive compulsion ===
{{Blockquote|text=''The patient is encouraged to do, or to wish to happen, the very things he fears (the former applying to the phobic patient, the latter to the obsessive-compulsive)'' |author=Viktor Frankl|title=Defines Paradox intention|source=<ref name=":3"/>}}

=== For insomnia ===
Paradoxical intention has been shown as an effective therapy in the treatment of [[chronic insomnia]].<ref>CHESSON, A. L., ANDERSON, W. M., LITTNER, M., DAVILA, D., & HARTSE, K. (1999). Practice parameters for the non-pharmacologic treatment of chronic insomnia. Sleep, 22, 1128–1133.</ref> 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.<ref name=":1b">Jansson-Fröjmark, Markus, Sven Alfonsson, Benjamin Bohman, Alexander Rozental, and Annika Norell-Clarke. "Paradoxical Intention for Insomnia: A Systematic Review and Meta-analysis." Journal of Sleep Research (2021): E13464. Web.</ref><ref name=":2b">Broomfield, N., & Espie, C. (2003). Initial Insomnia And Paradoxical Intention: An Experimental Investigation Of Putative Mechanisms Using Subjective And Actigraphic Measurement Of Sleep. Behavioural and Cognitive Psychotherapy, 31(3), 313-324.</ref> Thereby in this manner, by eliminating voluntary sleep effort, paradoxical intention minimises sleep performance anxiety, promoting rapid sleep onset.<ref name=":3">{{Cite journal|last1=Ascher|first1=L. Michael|last2=Turner|first2=Ralph M.|date=1979-01-01|title=Paradoxical intention and insomnia: an experimental investigation|url=https://dx.doi.org/10.1016/0005-7967%2879%2990015-9|journal=Behaviour Research and Therapy|language=en|volume=17|issue=4|pages=408–411|doi=10.1016/0005-7967(79)90015-9|pmid=486046 |issn=0005-7967}}</ref> Similarly, it is also suggested that by diverting attention from sleep performance, it allows for cognitive de-arousal leading to relaxation and sleep.<ref name=":2b" />

A study investigating the effects of paradoxical intention on sleep effort, sleep anxiety and objective and subjective sleep showed that relative to control conditions, participants allocated to PI displayed noteworthy reductions in sleep effort and sleep performance anxiety. It has also been found that subjectively measured sleep onset latency [SOL] (time taken to fall asleep) is significantly lower in the PI conditions, with SOL change amongst PI participants being strongly associated with sleep effort change.<ref name=":0" /> This shows that sleep effort and sleep anxiety are integral mechanisms overridden by PI to achieve normal sleep functions.<ref name=":2" /> A 1984 study analysing cases of paradoxical intention as a treatment showed that PI rapidly reduced SOLs and was also successful at maintaining sleep onset and maximising total sleep time.<ref name=":4">{{Cite journal|last1=Espie|first1=Colin A.|last2=Lindsay|first2=William R.|date=1985-01-01|title=Paradoxical intention in the treatment of chronic insomnia: six case studies illustrating variability in therapeutic response|url=https://dx.doi.org/10.1016/0005-7967%2885%2990070-1|journal=Behaviour Research and Therapy|language=en|volume=23|issue=6|pages=703–709|doi=10.1016/0005-7967(85)90070-1|pmid=3907617 |issn=0005-7967}}</ref>

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.<ref name=":1" /> It also promoted decreased sleep-related performance anxiety. Additionally, a 2018 meta-analysis contrasted cognitive and behavioural interventions with passive comparators and when compared to recent relations between PI and passive comparators, it is found that the effects of PI on SOL are larger.<ref>{{Cite journal|last1=van Straten|first1=Annemieke|last2=van der Zweerde|first2=Tanja|last3=Kleiboer|first3=Annet|last4=Cuijpers|first4=Pim|last5=Morin|first5=Charles M.|last6=Lancee|first6=Jaap|date=2018-04-01|title=Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis|url=https://www.sciencedirect.com/science/article/pii/S1087079217300345|journal=Sleep Medicine Reviews|language=en|volume=38|pages=3–16|doi=10.1016/j.smrv.2017.02.001|pmid=28392168 |hdl=1871.1/e4883309-0042-4b67-9d47-f262429db18a |s2cid=3359815 |issn=1087-0792|hdl-access=free}}</ref>

=== 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.<ref>{{Cite journal|last1=Ascher|first1=L. M|last2=Schotte|first2=David E|date=1999-06-01|title=Paradoxical intention and recursive anxiety|url=https://www.sciencedirect.com/science/article/pii/S0005791699000099|journal=Journal of Behavior Therapy and Experimental Psychiatry|language=en|volume=30|issue=2|pages=71–79|doi=10.1016/S0005-7916(99)00009-9|pmid=10489084 |issn=0005-7916}}</ref>