Compliance, defiance, and therapeutic paradox: Guidelines for strategic use of paradoxical interventions.

Rohrbaugh, Michael J.; Tennen, Howard; Press, Samuel; White, Larry W.

doi:10.1111/j.1939-0025.1981.tb01393.x

Cited by 75 publications

(52 citation statements)

References 12 publications

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“…This is in accord with previous research involving patients with minor psychiatric disorders which demonstrated a greater degree of non-compliance in reactance-prone individuals compared with reactance individuals (Rohrbaugh, Tennen, Press, & White, 1981 ;Graybar, Antonuccio, Boutilier, & Varble, 1989).…”

Section: Discussionsupporting

confidence: 81%

Compliance and psychological reactance in schizophrenia

Moore

Sellwood²,

Stirling

2000

British J Clinic Psychol

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Objectives. Non-compliance with neuroleptic medication in schizophrenia is a major cause of relapse. A number of sociodemographic variables, and illness, attitudinal and treatment variables, have been demonstrated to be associated with non-compliance. The present study examined a range of these variables and their predictive value in determining past and current compliance. Methods.Thirty-nine patients suåering from schizophrenia and three patients suåering from schizoaåective disorder completed a series of questionnaires assessing psychological reactance, insight, subjective response to medication, perceived threat to freedom of choice, and degree of current and past compliance. Logistic regression analyses were performed to determine which factors best predicted past and current compliance.Results. Psychological reactance and age were found to be the best predictors of past compliance, with an interaction between reactance and perceived threat to freedom of choice posed by treatment provision also making a signi®cant contribution. Past compliance behaviour and subjective response to medication predicted current compliance most signi®cantly. Conclusions.Reactance is an important predictor of compliance history especially when patients perceive treatment to be a threat to freedom of choice. Subjective response to neuroleptics is most important in predicting current compliance. Implications for intervention are discussed.Compliance with antipsychotic medication is crucial in the prevention of symptom aggravation and relapse in patients suåering from schizophrenia. It has been shown that over a 9-month period, approximately 50% of patients relapse when not

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Section: Discussionsupporting

confidence: 81%

Compliance and psychological reactance in schizophrenia

Moore

Sellwood²,

Stirling

2000

British J Clinic Psychol

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“…However, despite the widespread application of PI to anxiety related problems, we have not found any report on conversion disorder, an anxiety disorder which is known to be more prevalent in lower sociocultural classes and counts up to more than 55% of the psychiatric diagnoses in our emergency unit. One of the application criteria for paradoxical approaches defined by Rohrbaugh et al is as follows; ''Where opposition is low and symptoms are seen by the patient as outside of control'' (8). In conversion disorder, there is no patient opposition to symptoms, and symptoms are outside of the patients control.…”

Section: Introductionmentioning

confidence: 99%

Paradoxical Therapy in Conversion Reaction

et al. 2003

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Paradoxical therapy consists of suggesting that the patient intentionally engages in the unwanted behaviour such as performing compulsive ritual or wanting a conversion attack. In this study, the subjects were selected by the emergency unit psychiatrist from patients who were admitted to the emergency unit with pseudoseizure. The diagnoses was based on DSM-IV criteria. Paradoxical intention was applied to half of the 30 patients with conversion disorders; the other half were treated with diazepam in order to examine the efficiency of the paradoxical intention versus diazepam. In both groups the differences of the anxiety scores at the beginning of the study were found to be insignificant (z=1.08, p=0.28). Of the 15 patients who completed paradoxical intention treatment, 14 (93.3%) responded favorably to paradoxical intention. On the other hand of 15 patients who completed diazepam therapy, 9 (60%) responded well to therapy and 6 patients carried on their conversion symptoms at the end of 6 weeks. Paradoxical intention-treated patients appeared to have greater improvements in anxiety scores (z=2.43, p<0.015) and conversion symptoms (t=2.27, p=0.034) than the diazepam-treated patients. The results of the present study are encouraging in that paradoxical intention can be effective in the treatment of conversion disorder.

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“…Defiance-based paradoxes can be delivered in at least three ways (Rohrbaugh et al, 1981 ). First, children can be instructed to delay changing their behaviors by having them move more slowly than they expect.…”

Section: Defiance-based Paradoxesmentioning

confidence: 99%

“…The student who was instructed to bring on anxiety 15 minutes prior to taking a math quiz is an example of a compliance-based paradox. It also made use of scheduling-having a child express a behavior in different locations, durations, or times before it occurs spontaneously (Rohrbaugh, Tennen, Press, & White, 1981).…”

Section: Compliance-based Paradoxesmentioning

confidence: 99%

Why They Say No: Foundational Precises and Techniques for Managing Resistance

Maag¹

2017

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Compliance, defiance, and therapeutic paradox: Guidelines for strategic use of paradoxical interventions.

Cited by 75 publications

References 12 publications

Compliance and psychological reactance in schizophrenia

Compliance and psychological reactance in schizophrenia

Paradoxical Therapy in Conversion Reaction

Why They Say No: Foundational Precises and Techniques for Managing Resistance

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