adhd - ADHD treatment is a systems, multi-faceted process for the whole family

Computer Aided Emotional Restructuring is mostly a non-verbal therapy and departs from traditional therapy in two ways. First, it is more of a do-it-yourself therapy, as opposed to a therapist imparting his or her professional knowledge. Second, it is unlearning emotional patterns, i.e. destructive coping mechanisms, rather than learning new skills or knowledge.

caer as Do-It-Yourself Therapy

In traditional psychological therapy, the patient is referred to a therapist whose job it is to sort out distressing thoughts until a problem is resolved. The patient translating his feelings and internal experience into words — words that are intended to convey information to the therapist, accomplishes this. Then, after only an hour or two of a therapist gathering this word stream of information, he or she begins to subtly or directly shape the patient’s thinking and behavior.

This traditional model of therapy has always seemed a bit presumptuous to me. Its flaw is that the words only convey a tiny fraction of information, especially when that information is compared to the vast knowledge and experience within the patient. You — the patient — live inside your head all of your life. You are the world’s expert on you. No one has one one-millionth of the information and experience you have within yourself — even if some of this information is a bit inaccurate or disorganized.

Given the right situation and guidance, it would seem that the patient, with his vastly greater and more in-depth understanding of himself, is in a much better position to direct the therapeutic process. caer is able to access this vast store of self-knowledge without having to reduce it to words and, therefore, is much more efficient than traditional talk therapy.

Unlearning Emotional Patterns vs. Learning New Skills and Knowledge

CAER’s other difference from traditional therapy is equally important. Traditional therapy is predicated on two assumptions: 1) The expression of feelings provides catharsis. 2) The problems that bring the patient to therapy are a function of a lack of some knowledge or skill. In other words, patients are simply bottling up their feelings or they don’t understand how to do whatever it is that will solve their problems.

The task of the psychotherapy patient is to learn the knowledge and skills necessary  to express those feelings, AND to change behaviors to prevent further buildup of negative feelings. The therapist’s task is to teach the skills. It is a student-teacher relationship.

But this is incongruent with my observations about patients, both children and adults. Almost all of my patients have at some time demonstrated all the skills they need. In fact, they demonstrate them in other situations, but not in the problem situation — be it school, home, marriage or the work place.

They may be a successful manager at work — communicating, asserting, disciplining, and listening all day long. These are most likely the same skills they need for parenting or being an effective spouse. In the case of ADHD children, successful skills are clearly present in most instances. For example, they often interact well in one-to-one situations such as with an adult or with a favorite friend. However in the problem situation, most often the classroom or the home, these skills seem to fly out the window.

Emotional Inhibition of Skills

Why is it the ADHD child is skillful in some areas but not in others? It seems unlikely that he magically forgets skills in the classroom or when doing homework but remembers them when playing with a friend or Nintendo. The most likely reason is that the child is inhibited by emotions triggered by the problem situation.

ADHD children have learned to respond to the problem situation with anxiety, anger, fear, or depression. This causes two things to happen. First, the increased emotional arousal overwhelms access to the skills required to cope with the situation. Second, these feelings trigger the Conditioned Attentional Avoidance Loop so that the child is mentally absent from the situation.

Traditional therapy attempts to teach the ADHD child coping skills to the problem areas in his life, tools that are already at his disposal. This is like teaching someone to ride a bicycle on north-south streets when they regularly ride only on east-west streets. If they do not ride on north-south streets, it seems very unlikely that it is because of some lack of skills or knowledge. More likely, there is some barrier to riding on north-south streets, such as fear possibly resulting from crashing on a north-south street. As absurd as this sounds, continuing to train previously demonstrated skills is what most educational and psychological therapy emphasizes.

Rather than teaching skills that are already demonstrated by the child, it would seem cleverer to remove the emotional obstacles that are in the problem situation. Eliminating fear of north-south streets is more effective than giving bicycle-riding lessons. This is exactly the contrast between CAER and the more skills training orientation of traditional ADHD therapy.

Sara: A Parent’s Experience With CAER

Sara was a manager in an aerospace company. She was responsible for more than 40 employees. All day long she listened to their problems, solved conflicts, gave directives, reinforced positive performance and disciplined problem behaviors. It was apparent that she did this well — she received outstanding performance evaluations and had moved up in the company very quickly.

Although she could maintain her highly effective behavior at work, her behavior at home was very different. In the half hour drive from work to home, she became “stressed out, angry and frustrated.” By the time she walked through the door at home, she was a different person. She was no longer the competent people manager. She was a yelling, angry, frustrated parent who was contributing to her son’s ADHD.

Sara said she could feel the change coming over her as she drove closer to her home. At work, she felt competent and in charge. At home, she felt overwhelmed, depressed and helpless. At home, she was not able to do the very same behaviors that worked so well for her at work. There seemed very little reason to teach her the skills she ably demonstrated at work. Besides, she read many parenting, ADHD, and behavior modification books. She had the tools, she just couldn’t perform them at home.

To remedy the problem, we focused her CAER treatment on extinguishing the “stressed out, angry, frustrated, depressed and helplessness” that she experienced at home. In two sessions, it became apparent that some of those feelings were the result of a troubled marriage, which we then addressed. After two sessions, she had few of those negative feelings at home, and she was able to be as competent a parent as she was a manager.

CAER as a Tool for Change

Explaining the Conditioned Attentional Avoidance Loop Model to a child, teacher, parents, or researcher is useful to understand, but it is unlikely to be of any help unless it leads to a changes in behavior and eradicating the symptoms of ADHD. The Conditioned Attentional Avoidance Loop Model does, though, provide us with a useful blueprint for creating the tools for emotional change. CAER is that engine of intervention in the equation of change.