A cognitive behavioral formulation of non-psychotic morbid jealousy
This model endeavors to explain not only the affective component of the condition (jealousy) but also explains why jealous behavior can continue in the absence of any objective evidence. Tarrier et al. (1990) argue that in morbid jealousy the individual has a propensity to make systemic distortions and errors in the perception and interpretation of events and information. A cognitive behavioral formulation has developed via the work of Beck et al. (1979), who argued that automatic negative thought are produced when the individual's unrealistic schemas are activated by salient events. In non-psychotic morbid jealousy, these thoughts could be associated with the loss of a partner to a rival or the break up of a relationship due to infidelity. These thoughts would appear plausible and reasonable to the subject and are accepted without question. In the cognitive behavioral model of morbid jealousy, the underlying schema maintaining the subject's automatic thoughts can be seen as erroneous assumptions about sexual behavior/attractiveness (Dolan & Bishay, 1996). In morbid jealousy personality traits such as low self-esteem, insecurity and lack of confidence are believed to play a part in its development or clinical presentation. In support of this argument Dolan and Bishay (ibid.) highlighted the work of Tarrier et al. (1989) who found high scores for neuroticism, introversion and psychotism after the utilization of The Esyenck Personality Questionnaire in morbidly jealous females. Dolan et al. investigated further the role of sexual behavior/attractiveness schema in morbid jealousy by comparing forty morbidly jealous and forty non-jealous subjects. The results demonstrated significant differences between jealous and non-jealous subjects on measures of the cognitive, behavioral and emotional aspects of jealousy and therefore supports the usefulness of a cognitive model in the conceptualization of jealousy.
Treatment strategy utilizing eye movement desensitization and reprocessing
Eye movement desensitization and reprocessing (EMDR) is a relatively new form of therapy which is now widely used in the treatment of post traumatic stress disorder (PTSD). Shapiro 'accidentally' discovered it in 1987 when she noticed that saccadic eye movements appeared to reduce the emotional impact of traumatic memories. Since that time, EMDR procedure has been refined and standardized and has been used to treat a variety of disorders including specific phobias (Muris, 1997) to morbid jealousy (Blore, 1997). Initially, evidence for the efficacy of EMDR was found mostly in case reports (Marqus, 1991; Puk, 1991; Wolpe & Abrams, 1991). However, recently, more vigorous research designs have demonstrated that EMDR is as efficacious as other similar techniques, for example Sanderson and Carpenter (1992) contended that EMDR was no different from imaginal exposure in the treatment of PTSD. Similarly, Vaughan et al. (1994) compared EMDR with Imaginal exposure and with applied muscle relaxation, they found reduction across all three interventions, however, EMDR seemed especially useful in the reduction of intrusive symptomatology. Sharpley et al. (1996) compared the efficacy of EMDR with relaxation and rapid induction, they reported that EMDR was more successful than these comparable techniques in reducing the intensity of the subject's mental imagery. Shapiro (1995) argues that EMDR works by accelerating the information processing system. She contends that traumatic memories are stored differently from normal memories and these traumatic memories and their emotional consequences fail to be processed appropriately through the normal information processing system. By alternatively stimulating the left and right hemispheres of the brain, by either saccadic eye movement or alternate hand taps, the natural information processing system is activated. This has the effect, not only of reducing the emotional impact of the traumatic memory, but due to the reprocessing aspect of the treatment, actually facilitates the subjects more appropriate evaluation of themselves, circumstances or the event.
Shapiro (ibid) describes the technique as synclectic in that it involves elements of cognitive therapy, behavioral therapy, psychoanalysis, person centered therapy and cybernetics. Essentially, following a thorough assessment of the client and the problem, a full explanation of EMDR is offered. The client should be screened for dissociative disorder before being asked to sign a consent to treatment form, as it is explained to the client that the procedure may activate previous unprocessed traumatic memories. This done, the subject is asked to mentally visualize the worst part of the traumatic memory, whilst at the same time attending to a negative cognition which involves an evaluation of the self resulting from the image. Simultaneously they are encouraged to notice the physiological responses located in their body. The therapist then induces the saccadic eye movements, with the client being asked to 'let whatever happens, happen'. It should be noted that before commencing EMDR treatment, the subject is asked to think of a safe place (somewhere the client feels a sense of security and comfort) and this safe place is now 'installed' by the use of a saccadic stimulus before the therapy begins. The rationale being, that if the emotions generated by the reprocessing become unmanageable and the subject needs to rest they can 'go to their safe place' until they are willing to continue with the session.
This procedure usually provides the client with rapid symptom reduction and new adaptive cognitions are generated. However, in some cases, the images are so traumatic or the negative cognitions/beliefs so ingrained, that normal reprocessing appears to become blocked. To compensate for this eventuality, Shapiro (1995) developed a technique known as the cognitive interweave. The cognitive interweave is a set of strategies which assist the adaptive information processing system (AIPS) to shift or process an 'information package' held in dysfunctional states specific form, into more appropriate and functional form. The cognitive interweave (CI) can be used to stimulate healthy resources which are often already present within the subject so that they can link in with the dysfunctional material. Stimulating these healthy resources aids the AIPS to process the information package from a new perspective. Shapiro (1995) proposes that the cognitive interweave can be seen as a 'light touch'. A stimulation of these functional resources followed by eye movement is woven subtly into the eye movement. The cognitive interweave can be sub-divided into three broad areas, safety, appropriate responsibility and new choices. The therapist may use a variety of techniques to facilitate cognitive interweave, for example they may add present time or adult thoughts, add new information, alter the image, utilize Socratic techniques and even use physical sensations to bring about the desired reprocessing. It must be remembered that the cognitive interweave is not cognitive therapy added on to the eye movements. The client is simply asked to 'think about that' whilst the eye movement or hand taps are instigated. In other words, it is a way of jump starting the information processing system and not an alternative to the model.
Discussion and conclusion
Jealousy is a problem that can lead to physical violence and the breakdown of relation-ships (Mullen & Meach, 1985). In previous times jealousy was seen as an honorable emotion, an emotion that served society at large by sustaining familial relationship (Mullen, 1991). In recent times, however, to experience jealousy is taken as a sign of political incorrectness. It has associations with violence, sociopathy, insecurities and weakness. Pathological jealousy is notoriously difficult to define, particularly as a lot of the features of normal jealousy are found in pathological jealousy (Tiggelaar, 1956). According to diagnostic statistical manual 4th edition (1994), jealousy has been subsumed under the category of delusional disorder. Other authors have taken the intensity of excessiveness of the jealous response as an indication of pathology (Mullen, 1990; Shepherd, 1961). More recently Tarrier et al. (1990) emphasized the irrational nature of the jealous thought as indication of pathology. Continuing this theme Dolan and Bishay (1996) stated that jealous thoughts could be underpinned by schemas of sexual behavior/attractiveness. The implications for treatment therefore stresses the need to challenge these erroneous schemas with a view to facilitating more appropriate behaviors.
There have been various theoretical approaches to morbid jealousy including a psychiatric approach, a psychodynamic approach, a systems approach, a behavioral approach, a social psychological approach and a sociobiological approach. The behavioral approach argues that often jealous subjects re-visit the scene of perceived infidelity. By this they mean that the subject has images of their partner engaged in sexual congress. This was certainly the case with the subject discussed in this paper and prompted the possible strategy of eye movement desensitization and reprocessing as a useful intervention. EMDR has been used extensively in the treatment of post traumatic stress disorder (Shapiro, 1995). Trials have demonstrated its efficacy in the treatment of PTSD (Sanderson & Carpenter, 1992; Vaughan et al., 1994). It has also been used to treat a myriad of other psychological difficulties from specific phobia (Muris, 1997) to morbid jealousy (Blore, 1997). When utilizing EMDR in this case study, it became apparent that cognitive interweave was required for full reprocessing to occur. Shapiro when considering the cognitive interweave argues that 'if the information offered by the clinician is accurate, a new perspective will be assimilated'. It would seem therefore that more research is required in this area, and it may be useful to conduct a controlled trial comparing EMDR, cognitive therapy and exposure therapy.
- Keenan, Paul S.; Farrell, Derek P.; Treating morbid jealousy with eye movement desensitization and reprocessing utilizing cognitive inter-weave – a case report; Counselling Psychology Quarterly; Jun2000; Vol. 13 Issue 2
Reflection Exercise #4
The preceding section contained information
about using EMDR to treat morbid jealousy after infidelity. Write
three case study examples regarding how you might use the content of this section
in your practice.
Online Continuing Education QUESTION
What is the "cognitive interweave"? Record the letter of the correct answer