By Aaron T. Beck, MD
President Emeritus, Beck Institute
The “Call to Arms”
At one time I thought that words like "values" were either epiphenomena or just superficial froth, but now I believe that they are major motivators for action and can be tied into an individual’s aspirations. As an example, in the typical “call to arms,” the nation becomes mobilized to fulfill broad but personalized objectives such as: freedom, fraternity, and equality (three components of the La Marseillaise). When there is an enemy, the collective spirit and values are aroused, and this may override other values, such as one’s own safety. Patriotic songs such as La Marseillaise (French) or competitive games can also provide “juice,” as it were, to the general motivation. Thus, abstract words, while ill-defined, seem to capture the team spirit or group spirit.
In my team's work with individuals with schizophrenia, the “call to arms” is represented by the aspirations. In setting the aspirations we want to elicit the meanings of the aspirations (such as “I am a good person,” “I am competent,” “I have confidence in myself and am friendly,” or “Other people regard me with respect.”) Generally, meanings fall into categories such as connection, control, competence and, in some cases, compassion. When these symbols or concepts are activated, they lend power to the aspiration. These activations then serve as catalysts for the mobilization of the various broad systems such as cognition, affect, and motivation that work in conjunction with one another. Specific functions such as attention, memory and problem solving also become activated.
Keeping the Ball Rolling
As we get the aspirations/destination established, we are confronted with the individual’s multiple defenses, inhibitions, and regressive behavior (paranoia, avoidance, hypervigilance, etc.) This then poses a question: how can we manage to motivate the individual to confront and overcome the various challenges on the pathway to the ultimate goal? The answer of course is motivation, which we assume is created and enhanced by the individual’s becoming totally engaged in achieving the aspirations. This is done in part by activating the positive characteristics and positive beliefs (self-confidence, trust, hope, etc.) of the person rather than dealing with these dysfunctional behaviors head-on. This steadfast focus on and mental investment in the positive traits, strengths, talents and beliefs naturally shifts focus away from the negative aspects and tends to deactivate many negative beliefs and behaviors (apathy, inhibitions, suspiciousness, sense of rejection).
Examples of specific strategies to fulfill these objectives are:
- Insecurity ----> befriending relationship
- Paranoia/Hypervigilance ----> befriending relationship and group belonging
- Rejection ----> group participation
- Inhibition and Avoidance ----> increasing self-confidence through group activity and successful experiences.
Once motivation is identified as a target mechanism of change, the big question is how to increase the individuals’ motivation and effort to engage in the activities that will restore them to mental health. Successful experiences and meaningful activities can lead to increased confidence in the self and an increased sense of self-competence and control. The interpersonal relationship can be utilized to prime the positive attitudes regarding activities: team spirit and group spirit can be utilized to stimulate interest in group belonging.
To return to the destination (fulfillment of aspiration), it is important to note that the facilitation of beneficial activities is not as important as the meaning of the activities in terms of self-worth and feelings of being respected. Only insofar as the participation in group or individual activities increases the positive components of the personality and diminishes the negative aspects does the individual make progress. The selection of activities is not as difficult as it may seem because individuals do respond to common, ordinary activities (decorating the unit, working in a garden, helping out in an animal shelter) in a positive way. The highly specific activities depend on the individual’s interests, talents, and capabilities (e.g. putting on a play, playing in a band, painting, or leading a club) and are often reawakened after being latent for extended periods of time. With each activity, there is hopefully a greater consolidation of the individual’s positive attitudes and assets and the diminution of the negative.
It is often the case that the individual may find a particular activity too challenging, which may evoke the ingrained avoidance response. It is desirable for the clinician to emphasize the satisfaction from completing the task and particularly, the pleasure to be gained when the aspirations are finally reached. This same approach applies to a prescription that may be disagreeable such as taking medication. If this is put in the context of meeting a challenge and in the general context of achieving the ultimate objectives and aspirations, it will help to motivate the individual. As Mary Poppins once said, “A spoonful of sugar helps the medicine go down!”