Thought-Stopping

Description of the Strategy

Thought-stopping (TS) was a technique employed by behavior therapists from the 1950s until the 1980s. It was designed to decrease the frequency of unwanted thoughts. It was assumed or hoped that TS would also [Page 591]decrease the ensuing distress or anxiety associated with the thoughts. Although TS was, and to a small extent still is, a common tool in the behavioral therapy toolkit, there is little sound empirical evidence to support its use. Many case studies and case series describe TS as a helpful technique when implemented as the sole intervention technique or as part of a typical cognitive or behavioral treatment package.

Bain introduced TS under the presupposition that thought control is an important aspect of positive mental health. Taylor suggests that an abrupt instigation of an inhibitory behavior (e.g., “Stop!”) fosters the conditioned inhibition of a habit (e.g., the insistent train of thought). Although TS is often depicted as a simple technique to apply, a thorough behavioral analysis is necessary for successful implementation. Clinicians can collaboratively prepare a complete hierarchy or record of all the distressing and uncontrollable thoughts. Clinicians should prioritize any thoughts suggesting harmful societal consequences. These thoughts could include anything from vengeance to personal insecurities to a haunting word to classic obsessions.

Targeted intrusive thoughts are collaboratively agreed upon between the clinician and the client, and the rationale for their removal is reviewed. Wolpe and Lazarus suggest that clients be asked to close their eyes and raise a finger once, purposely thinking of the target thought or series of thoughts. When the client raises a finger, the clinician loudly shouts “Stop!” which reliably generates a startle reaction. This response demonstrates for clients that one is unable to think of two things at the same time (“Stop” and the target thought). The clinician is then able to instruct the client in using his or her own voice to subvocally yell “Stop!”

Practice typically continues in the first session for approximately 10 minutes or for 20 rehearsals, until the client is feeling comfortable with the technique. Clients generally discover a gradual but steady decline in the frequency of the target thoughts but only by way of daily practicing the TS technique. Modifications of the procedure can be included on an as-needed basis in successive sessions. These variations might include snapping a rubber band on the wrist, a slight electric shock, substituting another word for “stop,” or visualizing a stop sign.

Research Basis

There are a number of descriptive case studies suggesting that TS is an effective behavioral technique. Clients often report initial subjective satisfaction with the technique due to TS's face validity. In actuality, there is very little methodologically sound research to encourage the use of TS. There are no studies on TS with sufficient sample sizes to reliably detect any differences between TS and placebo or other cognitive-behavioral techniques. Another difficulty with assessing the effects of TS is the variety of procedures that have been employed. Many studies offer minimal description of the procedure, use an assortment of TS procedures, and use TS in combination with a variety of other interventions, such as relaxation and self-monitoring.

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