Psychological Reports, 2004,95,946-948.

O Psychological Reports 2004

USE OF PARADOXICAL INTENTION I N T H E CONTEXT O F

ACCEPTANCE AND COMMITMENT THERAPY '

WILLIAM G . SHARP, KELLY G . WILSON, AND STEFAN E. SCHULENBERG

The University of Mississippi

Summay.-The purpose of this paper is to describe the use of therapeutic para-

dox within the contextual-behavioral treatment called Acceptance and Commitment
Therapy. Emphasis is on the difference between inherent and constructed paradox,
expanding on previous work and emphasizing Acceptance and Commitment Thera-
py's relationship to Logotherapy.

Paradoxical intention is a therapeutic procedure aimed at circumventing

maladaptive consequences of anticipatory anxiety by encouraging clients to
increase their exposure, often in a humorous vein, to the event, thought, or
behavior previously avoided (4, 5). Developed by Frankl in the 1920s, this
approach is one of the core and most well-researched Logotherapy tech-
niques (10).
Although historically linked with Logotherapy, the basic ideas of para-
doxical intention have been incorporated into other schools of therapy (1).
For example, Ascher (1) noted that Milton Erikson implemented a series of
therapeutic strategies that encouraged clients purposefully to exhibit mal-
adaptive behaviors in a more extreme fashion. Although strkingly similar to
paradoxical intention in form, Erikson did not explicitly use the term to de-
scribe his procedure.
Behavior therapists have also incorporated paradoxical intention into
their larger repertoire of treatment techniques and, in contrast to Erikson,
have frequently adopted the term coined by Frankl (5). A number of behav-
ioral outcome studies focusing on the efficacy of paradoxical procedures in
the treatment of sleep difficulties and anxiety disorders has increased (9). For
example, there is empirical support for the use of paradoxical intention with
sleep-onset insomnia, agoraphobia, and public-speaking anxiety (10). Other
authors have provided initial empirical support for the use of paradoxical
intention within behavioral treatment regimes aimed at alleviating other clin-
ical complaints, including urinary retention, functional encopresis, and ob-
sessive disorders (2).
Although integration of paradoxical intention in behavior therapy ap-
pears well documented (2, 9), little attention has been paid to the applica-

'Address correspondence to Witliam G. Sharp, Department of Psychology, The University of

Mississippi, University, MS 38677 or e-mail (wsharp@olemiss.edu).
 PARADOXICAL INTENTION IN THERAPY 947

tion of therapeutic paradox within the other movements in psychology, such

as contextual-behavioral movement. A recent and expanding contextual-be-
havioral treatment called Acceptance and Commitment Therapy is an alterna-
tive therapeutic paradigm using paradoxical intention as "an important com-
ponent" (6, p. 84).
While integration of paradox in Acceptance and Commitment Therapy
could be viewed as an example of the close relationship between Acceptance
and Commitment Therapy and Logotherapy in previous work ( l l ) , Accept-
ance and Commitment Therapy relies primarily on the use of inherent para-
dox, as opposed to constructed paradox, which is more commonly employ-
ed in most paradoxical interventions (6). Although examples of constructed
and inherent paradox can be found within the Logotherapy literature, dis-
tinguishing the two types of paradox helps to highlight Acceptance and
Commitment Therapy's unique contribution to this therapeutic technique.
A constructed paradox involves social demand of rule-following which
creates a situation in which the individual must either follow or resist the
rule (6), and in either case, the effects are most likely beneficial. For exam-
ple, a couple troubled by very infrequent sexual activity might be explicitly
instructed not to have sexual intercourse. This procedure is typically refer-
red to as constructed paradox but is not commonly employed in Acceptance
and Commitment Therapy for two reasons. First, the focus of constructed
paradox is on eliminating symptoms and, even if the technique works, it
leaves in place a change agenda with which the problem originated. Second,
constructed paradoxes rely on pliance, i.e., social demands or rules that lead
to compliance or resistance, which Acceptance and Commitment Therapy
views as a potential source of clinical difficulty (6).
An inherent paradox is produced by a functional contradiction between
the literal and the functional properties of verbal events and primarily in-
volves verbal constructions regarding events not readily rule-governed. In do-
ing so, inherent paradox refers to a process that cannot be entirely literal or
verbal. The most central inherent paradox used in Acceptance and Commit-
ment Therapy is a "rule" about distressing private events: "If you aren't will-
ing to have it, you've got it" (6, p. 121). For example, if a panic disordered
client is entirely committed to not having a panic attack, the occurrence of
even low anxiety is something about which to get anxious. Having anxiety
about anxiety has the effect of precipitating even higher anxiety, providing
more anxiety to be anxious about. Acceptance and Commitment Therapy
does not restrict this view to anxiety. Clients who have long bouts of depres-
sion and experience a period of remission may become depressed about the
reemergence of depressive symptoms. Acceptance and Commitment Therapy
views the inherent paradox as an important therapeutic tool for two reasons.
First, repeated exposure to an inherent paradox helps loosen the grip literal
948 W. G. SHARP, ET AL.

language has on a client's thoughts, feeling, or behavior by highlighting the

fact that literal language is useful in some contexts, but not all. Second, Ac-
ceptance and Commitment Therapy's view of psychopathology is an inherent
paradox: Trying to change negative content is a major source of the negative
content.
Acceptance and Commitment Therapy offers radical acceptance as a
starting point to a new relationship with symptoms-a common perspective
among contemporary behavioral treatments (12). For example, Dialectical Be-
havior Therapy (7), Integrative Behavioral Couples Therapy (J), and Accept-
ance Based Behavior Therapy for Generalized Anxiety Disorder (8) show
sensitivity to the paradoxical effects of direct attempts to control negative
cognition and emotion. These newer variants of behavior therapy integrate
some of the wisdom in existential and humanistic approaches, such as Logo-
therapy.
REFERENCES
1. ASCHER,L. M. (1981) Application of paradoxical intention by other schools of therapy.
International Forum for Logotherapy, 4, 52-55.
2. ASCHER, L.M., BOWERS, M. R., &SCHOTTE, D. E. (1985) A review of data from controlled
case studies and experiments evaluating the clinical efficacy of paradoxical intention. In
E. G . Weeks (Ed.), Promoting change through paradoxical therapy. Homewood, IL: Dow
Jones-Irwin. Pp. 2 16-250.
3. CHRISTENSEN, A., ATKINS,D. C., & BERNS,S. (2004) Traditional versus inte rative behav-
ioral couple therapy for significantly and chronically distress married coupyes. lournal of
Consulting and Clinical Psychology, 72, 176-191.
4. FRANKL, V. E. (1975) Paradoxical intention and dereflection. Psychotherapy: Theory, Re-
search, and Practice, 12, 226-237.
5. FRANKL, V. E. (1984) Paradoxical intention. In G. R. Weeks (Ed.), Promoting charzge
through paradoxical therapy. Homewood, IL: Dow Jones-Irwin. Pp. 99-110.
6. HAYES,S. C., STROSAHL, K., &WILSON,K. G. (1999) Acceptance and Commitment Therapy:
a contextual approach to cognition and emotion in psychotherapy. New York: Guilford.
7. LINEHAN, M. M. (1993) Cognitive-behavioral treatment of borderline personality disorder.
New York: Guilford.
8. ORSILLO, S. M., ROEMER, L., &BARLOW, D. H. (2003) Integrating acce tance and mindful-
ness into existing cognitive-behavioral treatment for GAD: a case stufy. Cognitive and Be-
havioral Practice, 10, 222-230.
9. SCHOTTE, D. E., ASCHER,L. M., &COOLS, J. (1989) The use of paradoxical intention in be-
havior therapy. In L. M. Ascher (Ed.), Therapeutic paradox. New York: Guilford. Pp. 17-
31.
10. SCHULENBERG, S. (2003) Empirical research and logotherapy. Psychological Reports, 93,
307-319.
11. SHARP,W., SCHULENBERG, S., WILSON,K. G., &MURRELL, A. R. (in press) Logotherapy and
Acceptance and Commitment Therapy (ACT): an initial comparison of values-centered
approaches. International Forum for Logotherapy.
12. WILSON,K. G., & MURRELL, A. R. (2004) Values work in Acceptance and Commitment
Therapy: setting a course for behavioral treatment. In S. C. Hayes, V. M. Follette, & M.
M. Linehan (Eds.), Mindfulness and acceptance: expanding the cognitiue-behavioral tradi-
tion. New York: Guilford. Pp. 120-151.

Accepted October 4, 2004.