1. Cognitive Drill Therapy
Dr. Rakesh Kumar, Ph.D.
Senior Clinical Psychologist
Institute of Mental Health and Hospital,
Agra

2. Day-1: Concepts & Assessment Day-2: Cognitive Drill Day-3: Theories & Areas of Research

3. Fear and Anxiety Fear Anxiety
Fear is the emotional response to real or perceived imminent threat. Fear more often associated with surges of autonomic arousal necessary for fight or flight, thoughts of immediate danger, and escape behaviors
Anxiety is anticipation of future threat. Anxiety more often associated with muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviors.

4. Objective Fear vs. Irrational Fear
Toy Snake
Real Poisonous Snake
Irrational Fear
Objective Fear

5. Phobia Objects of Phobia Animals Situations Natural Environment
Social Situations
Bodily Sensations
Blood
Any other thing

7. Specific Phobia Animal (e.g., spiders, insects, dogs)
Natural environment (e.g., heights, storms, water).
Blood-injection-injury (e.g., needles, invasive medical procedures).
Situational (e.g., airplanes, elevators, enclosed places).
Other (e.g., situations that may lead to choking or vomiting: in children, e.g., loud sounds or costumed characters)

8. Specific Phobia: Heights

9. Specific Phobia: Animals
Spiders
Dogs
Lizard
Rats

10. Specific Phobia: Claustrophobia

11. Agoraphobia

12. Social Phobia

13. Magnitude of Phobia
4.2%

14. Irrational fears as blocking factors in full expression of confidence, creativity and potentials

15. Social and economic burden and Other Problems caused by fearful conditions
Loss of productive working hours
Embarrassments
Reduced quality of life
Career choice determined by phobia
Refusal of certain jobs and promotions
Concern for medical procedures
Sleepless nights
Loss of business
Killing of animals by phobic persons
Spreading phobia by phobic persons

16. OBSD: Psychological Structure of Phobia
Objects (O)
BMR (B)
Safety Behaviors (S)
Danger Probability (D)

17. Assessment of Phobia

18. Case History & Interview
Tell me in detail about your problem
Tell me when and how this problem started
Tell me how this problem is affecting your life
Tell me some life experiences related to the problem
Tell me what body-mind reactions get activated during the problem
Tell me how you have been dealing with this problem
Tell me what scares you in this problem
Tell me the objects/situations/events that trigger this problem
Tell me how your family members react or help you during this problem
Any other thing you would like to share with me regarding this problem.
Would you be able to share dark sides of your life?

19. Standardized Tools: Specific Phobia Severity-Adults
Zung Self-Rating Anxiety Scale
OASIS
Beck Anxiety Inventory
DASS-21
Severity Measure for Panic Disorder—Adult
Agoraphobia Scale
Mobility Questionnaire
Agoraphobic Cognition Scale
Liebowitz Social Anxiety Scale
Social Phobia Inventory (SPIN)
Leary Brief Fear of Negative Evaluation Scale
Claustrophobia Questionnaire (CLQ)
Health Anxiety Inventory (HAI-18)
BDI-II

20. Other Tools VAS Sheehan Disability Scale
Scales to assess Courage, Coping, Optimism, Resilience,

21. OBSD Scales

22. Question & Answers

23. Group Work: Practical Exercises in OBSD

24. Discussions on OBSD Exercises

25. Question & Answers

26. OCD

27. Day-2: Cognitive Drill Training

28. Recap

29. Wounded by Words

30. Safety Behaviors as Solution

31. Covert Safety Behaviors & Overt Safety Behaviors

32. Danger Probability: Imagined Feared Consequences

33. Time Reference in Danger Probability

34. Hypothesis of Neural Correlates of Time Perspective

35. Cognitive Drill

36. Eliciting Danger Probability

37. Formulation of Drill Statements

38. Fear Hierarchy

39. Fear Activation

40. Cognitive Drill Protocol

41. BMR Rating (SUD)

42. Anxiety Curve

43. Anxiety Curve & Wave Pattern

44. BMR Monitoring

45. Drill Regulation: Pauses for High Anxiety

46. Drill Dilution

47. Modelling of Cognitive Drill

48. Handling Abreactions

49. Types of Exposure Graduated vs. Intense Exposure
Exposure in Imagination vs. In Vivo Exposure
Introceptive Exposure

50. Analysis of Hanged Distress: Catharsis

51. Keyword Drill

52. Pass Criteria in Drill

53. Within & Between Sessions Habituation

54. Drill & Daring & Distraction

55. Cognitive Drill Diary

56. Promoting Generalization

57. Processes & Issues

58. Preparedness

59. Empathy & Rapport

60. Irrationality in Fears

61. Failure of Positive Thinking

62. Conflict: Positive Imaging Vs. Negative Imagining

63. Thought-Action Fusion

64. Disbelief in Cognitive Drill

65. Covert and Overt Layers

66. Disgust & Fear

67. Fear of Aggravation

68. Nature of Stimulus

69. Stimulus Generalization

70. Anxiety Sensitivity: Introceptive Exposure

71. Relapse vs. Exposure to Non-drilled Objects

72. Stress Induced Relapse

73. Modalities in CDT: Verbal Drill Recorded Auditory Drill Written Drill
Reading Drill

74. Own Language for Cognitive Drill

75. Drill Compounding

76. Training of Family Member

77. Removal of Safety provided by Family Members

78. Environment restructuring by phobic people: avoidance of public transport, home design

79. Role of insight

80. Motivation to change

81. Coincidence cited as cause and effect by affected person

82. Responsibility appraisal

83. Handling Feelings of Shame

84. Handling Resistance

85. Symptom searching

86. Hyper-vigilance

87. Role of Suggestibility

88. Vividness of Imagery and Fear Activation

89. Search for Magic Formula

90. Modalities of Experiments
Experiments in Imagination
Experiments with Virtual Objects
Experiments with Real Objects

91. Outcomes of Cognitive Drill
Habituation
Self-efficacy
Cognitive Reinterpertation

92. Experiential Realization

93. Expectancy Violation

94. Fear of Cognitive Drill

95. Fear of Failure of Cognitive Drill

96. Trainer’s Own Fears of Drill

97. Sessions Considerations
Session Frequency
No. of Sessions
Duration of One Session

98. Three Sessions Rule

99. Impairment and conditional contingency

100. Indications of CDT

101. Contra-indications of CDT

102. Caution
Life Threatening Conditions like suicidal tendencies and Cardiac Vulnerability

103. Handling Secondary Depression

104. Generalized and crystallized anxiety

105. PSYCHOSOCIAL ISSUES

106. Indicators of Success of CDT

107. Cognitive Drill in Children

108. Vicarious Cognitive Drill in Children

109. Steps in Cognitive Drill Training
Case History Taking & Interview
Formal Assessment & OBSD Analysis
Psycho-education
Cognitive Drill
Promoting Maintenance & Generalization
Post-Evaluation
Follow up

110. Modalities of Follow up
In person follow up
Telephonic follow up
Follow up on Apps

111. CDT vs. Existing Approaches
Cognitive Restructuring
Exposure & Response Prevention
Systematic Desensitization

112. Theories of Exposure Treatment
Emotional Processing Theory
Inhibitory Learning Theory
Reactive Inhibition

113. Derivatives of CDT

114. RFBT: Recovery Focused Behavioral Applications

115. Vicarious RFBT in Children

116. Somatic Charge

117. Combining CDT with Other Approaches
Cognitive Restructuring
Hypnosis
Exposure & Response Prevention
Virtual Reality Exposure

118. Day-3: Theories & Areas of Research

119. Theories of Phobia & OCD

120. Classical Conditioning
Appetitive Conditioning
Aversive Conditioning
Processes
Stimulus Generalization
Extinction
Spontaneous Recovery
Discrimination
Second Order Conditioning
Extinction Burst

121. Operant Conditioning Processes Escape learning Avoidance learning
Negative Reinforcement
Response Selection
Stimulus Generalization
Extinction
Discrimination
Extinction Burst
Processes

122. Two Factor Theory

123. Observational Learning

124. Information Transmission

125. Cognitive Appraisal

126. Biological Theories

127. Interesting Researches

128. Experiment with Mild Fear Activation & Pleasant Experience for Phobia

129. Subliminal Exposure

130. CDT Publications/ Presentations

131. Arya, B. , Verma, S. and Kumar, R
Arya, B., Verma, S. and Kumar, R. (2017) Efficacy of Cognitive Drill Therapy in Treatment of Specific Phobia. SIS.
Bhutani, S & Singh, S. (2017) Application of Cognitive drill therapy with ERP in obsessive compulsive disorder: A case study. Paper presented in International Conference on Cognitive Behavioral Interventions- India 2017
Dwivedi, S. and Kumar, R. (2015) Efficacy of Cognitive Drill Therapy in Agoraphobia with Panic Disorder: A Case Study. SIS
Gupta, P., Sahu, A. (2016) Efficacy of psychodynamic understanding over cognitive and behavior therapies in OCD with dissociation. The Odisha Journal of Psychiatry, 75-82
Jain, R. (2016) Cognitive Drill Therapy. ISBN-13:
Kumar, R. Sameer, A., & Singh, B. (2012). Preliminary Test of Cognitive Drill as an Intervention IJCP
Kumar, R. (2016) Cognitive Drill Therapy. Souvenir, 2nd International Conference of Indian Academy of Health Psychology, GBU
Kumar, R., & Dubey, B. L. (2016). Cognitive Drill Therapy: A Potent Application of the Principles of Psychology for OCD and Phobia. SIS
Kumar, R. (2017) HN Murthy Oration: Experiences in Verbal Exposure for Stimulus Bound Anxiety. IJCP
Kumar, R. (2017) Cognitive Drill Therapy. National Workshop on Psycho-Yogic Therapies, Department of Psychology, CCS
Kumar, R. and Sahu, RK (2017) Recovery Focused Behavior Therapy (RFBT): A Case Study. SIS
Kumar, R. and Dubey, B.L. (2017) Cognitive Drill Perspective on the Nature of Stimulus in Anxiety Disorders. SIS
Kumar R (2017) Verbal Exposure for Irrational Fears: New Directions in Research and Applications. Clin Exp Psychol
Sameer, A (2007): Case studies in Cognitive Drill Therapy, Unpublished Postgraduate Dissertation, Barkatullah University, Bhopal.
Shree, R. & Singh, M. (2017) Effect of Cognitive Drill Therapy (CDT) On the Disgust Feeling and Fear: A Case Study. Presented Paper
Verma, S., Kumar, R., Sharma , N., Tickoo, S., Talwar, S., (2016). Management of phobia through Cognitive Drill Technique , paper presented at scientific session on mental health in 58th International Military Testing Association (IMTA) Conference, 7-9 November 2016
Verma, S., Kumar, R., Tripathi, DN., Tiwari, A. (2016) Enhancing Courage and Self-Regulation of Soldiers through Cognitive Drill Technique. International Conference of Indian Academy of Health Psychology, Gautam Buddha University, Greater Noida, 17 December 2016
Verma, S., Kumar, R., Arya, B., and Kandhari, N. (2016) Treatment of multiple phobias through cognitive drill technique. International Conference of Indian Academy of Health Psychology, Gautam Buddha University, Greater Noida, 17 December 2016
Verma, S. and Kumar, R. (2016). Cognitive Drill Technique: A novel approach to manage fear of height. Symposium on Psychological assessment in Military: The Indian Scenario in 26th Annual convention of National Academy of Psychology (NAOP), December 2016.
Verma,S., Arya,B., Kandhar, N. & Kumar, R. (Accepted): Efficacy of Cognitive Drill Therapy in Treatment of Multiple Phobias: A Case Study. SIS Jounral

132. Psychophysiological Measurement
GSR
Respiration
Heart Rate Variability
Temperature
EEG

133. Areas of Research in Cognitive Drill
Efficacy Studies in various disorders
Comparison of treatments
Long term maintenance
Indications
Contraindications
Analysis of failures

134. Neural Correlates of Time Perspective

135. Mechanisms of Action

136. Suggestibility and Phobia

137. Correlates of Phobia

138. Research Designs Single subject Designs Pre-post designs
Quasi Experimental Research
Randomized Controlled Trials
Case studies

139. Multicentre Studies

140. Independent Evaluators

141. Repository of Assessment Data

142. Fear of unknown

143. CDT Live Brain Scanning

144. Manpower Development

145. Service Delivery Models

146. FAQ

147. List of Phobia & OCD Spider Phobia Height Phobia Claustrophobia
Rat Phobia
Snake Phobia
Agoraphobia
Fear of darkness
Phobia of Dogs
Phobia of swinging objects
Phobia of pointed objects
Fear of injections
Lizard Phobia
Social Phobia
School Phobia
Phobia of flying in airplane
Illness Anxiety Disorder