According to the Yale Medical School web site, cognitive script is "the term used for the themes that flow habitually through our thoughts. These cognitive scripts can influence both our emotions and our behavior. They have been described as the tapes we play repeatedly in our heads—those things we tell ourselves over and over again, often without conscious awareness."
In my experience, substance-abusing teens generally have three basic cognitive scripts: act up, shut down, and use. With such limited options, these youth are stuck continuously rerunning these same maladaptive scripts, perpetuating already internalized beliefs that they are ineffective, incapable, and unable to make more adaptive choices.
Every time a youth uses the same maladaptive script, it becomes more likely that he will use it again. This is basic neuroscience. Hebb wrote, “[A]ny two cells that are repeatedly active at the same time will tend to become ‘associated,’ so that activity in one facilitates activity in the other" (qtd. in Siegel, p. 26). In other words, “Experience, gene expression, mental activity, behavior, and continued interactions with the environment are tightly linked in a transactional set of processes” (Siegel, p. 19).
These processes begin at birth. Repeated similar experiences lead the mind to make generalized representations that form the basis of mental models used to “interpret present experiences as well as anticipate future ones” (Siegel, p. 29-30), suggesting that an individual is most likely to respond to life events in standard, predictable and learned ways.
Cognitive scripts are learned. For an individual who experienced a positive childhood environment, her scripts will be adaptive and flexible. However, when a youth has only maladaptive scripts, eventually acting up, shutting down, and using can become so normalized that these scripts are no longer seen as problematic.
“Jennifer,” a former client, had a history of running away, shoplifting, and abusing marijuana. When I worked with her, she was on her third treatment episode. Jennifer lived in a group home with a drug testing policy and continued use would result in her losing her placement. Yet, she continued to use. Some drug counselors would say she was in denial or resistant to treatment. This seems overly simplistic to me. Jennifer couldn’t be successful because she had no mental model of success. All Jennifer knew was acting up, shutting down, and using. All Jennifer knew was being stuck.
If creating change in our clients is about helping them write new, more adaptive scripts, how do we make that happen? I’ve always believed the answer is not to provide endless didactic lectures. Rather, the answer is to present clients opportunities to try new behaviors. As they practice these new behaviors, new neural connections are being made and new cognitive scripts are being written. In other words, they are starting to get unstuck.
Beyond the Comfort Zone
In my experience, substance-abusing teens and other at-risk youth continue to engage in maladaptive behaviors until they break their cycle of stuckness. If this is true, then it seems to me that the goal of substance abuse treatment should be to help clients create new, more adaptive cognitive scripts. It seems to me that the first step in this process is encouraging participants to risk going outside their Comfort Zones.
There's a paradox among many of my clients. While they have done things I consider extremely high risk—like getting high on drugs acquired from a stranger who is inherently a criminal, exchanging sex for drugs, or stealing to support their habit—they almost universally present as risk-adverse. I'm frequently perplexed by how to confront this Risk Dichotomy, which my clients are usually unable to recognize. It seems those things have become so normalized to them that they are no longer perceived as risky.
For these clients, staying stuck seems safe. Acting up, shutting down, and using are solidly within their Comfort Zones, so don't seem like risky behavior. This cycle keeps the youth stuck—and every time this cycle repeats itself, it becomes more likely the youth will stay stuck. What fires together wires together. That's basic neuroscience. And, every time that happens it becomes more likely to happen again.
Getting unstuck requires the individual to step outside her Comfort Zone and experiment with new behaviors. This is much riskier—not to mention harder—than sticking with rigid, predictable responses. However, it is only through trying new behaviors that the individual will have the opportunity to develop more adaptive cognitive scripts.
Through participation in experiences that move them outside their Comfort Zones, experiential learning provides substance-abusing teens an opportunity to test their assumptions and reject those they discover to be faulty. It seems to me that this testing and rejecting is vital for movement through the Stages of Change, especially those stages most likely to be encountered in a treatment setting—pre-contemplation, contemplation, and preparation.
For a pre-contemplative client, testing and rejecting “increases the likelihood of serious consideration of change” (DiClemente, p. 27). For a client in the preparation stage, testing and rejecting fosters the likelihood of “a considered evaluation that leads to a decision to change” (DiClemente, p. 27). For a client in the preparation stage, testing and rejecting increases self-efficacy and can result in “an action plan that will be implemented in the near term” (DiClemente, p. 27).
You’re Freaking Me Out!
If opportunities to test and reject assumptions are necessary for movement through the Stages of Change, so, too, is some discomfort. According to Cozolino, “[M]oderate stress triggers the release of neurohormones that enhance cortical reorganization and new learning” (p. 24). In addition, Zull wrote, “Plasticity in the brain probably depends more on signals from the emotional centers than it does on new sensory input” (p. 223).
In other words, it is emotions—especially stress—that make our brains learn and change. Experiential learning is an excellent methodology for creating this change environment. In most experiential activities, there is a high level of perceived risk. In some cases, such as white water rafting or high ropes activities, this perceived risk is physical. In other cases, this perceived risk could be emotional or social.
Whether physical, emotional, or social, the perception of risk in experiential activities will likely result in a sense of disequilibrium. According to Luckner and Nadler, “Disequilibrium refers to an individual’s awareness that a mismatch exists between old ways of thinking and new information” (p. 19). "Vincent," a former client, provided an example of disequilibrium during a group activity.
I talk about appropriate risk-taking frequently during group sessions, and often use an activity called Pass the Mousetraps to illustrate this idea. As the title suggests, this activity involves passing around set mousetraps. Actually, this activity also includes tripping mousetraps with hands.
Although completely safe when certain parameters are followed, this activity appears to be fairly risky. In fact, while sitting in a room filled with teens tripping mousetraps, Vincent, a former client, blurted, “You’re freaking me out!” and quickly left the room. For Vincent, the perceived risk was simply too high, even after my extremely detailed safety directions prior to the activity.
Watching his group-mates trip mousetraps with their hands created too strong of a mismatch for Vincent. He believed this to be extremely dangerous behavior, yet nobody was being injured. Unable to revise his thinking quickly enough to reflect the reality of the situation, Vincent had no choice but to flee. Later, Vincent stated, “I left because I was sure someone was going to get hurt. And I couldn’t figure out why that wasn’t happening.” Vincent wasn't worried someone might get hurt; he was upset because what he expected to happen didn't.
With all my clients, disequilibrium appears when acting up, shutting down, and using become no longer effective. When faced with this scenario, a participant is confronted with one of two choices: assimilation or accommodation. According to Piaget’s developmental theory, when presented with new information an individual tries to assimilate it, or fit it into his existing understanding of the world. If this is impossible, the individual is forced to accommodate the new information by altering his schema, or mental models (Kassin, p. 343). When presented with an experience that requires accommodation, an individual is forced to alter his cognitive scripts.
Experiential learning is rich in these opportunities. Marie—the client discussed in my earlier posting Reflecting on Reflection—and her experience on the hike is a good example. Marie was confronted with two choices. She could give up by sitting on the side of the mountain and refusing to continue the hike, or she could resume the hike even though it was difficult and clearly outside her Comfort Zone. When Marie chose to continue the hike, she was required to accommodate this new option and alter her cognitive scripts.
I believe that these opportunities are one of the major values of experiential learning in treatment setting. Priest and Gass wrote, “By responding to seemingly insurmountable tasks [found in many experiential activities], participants often learn to overcome self-imposed perceptions of their capabilities to succeed” (p. 18). It seems to me that by definition, insurmountable tasks only exist outside one’s Comfort Zone. Perhaps, then, taking the risk of tackling an insurmountable task means a participant will automatically be more open to becoming unstuck.
For Marie, an insurmountable task was accomplished and the change was almost immediate. In Vincent’s case, he never tripped a mousetrap with his bare hand, but he did confront a powerful mismatch. What he expected didn’t happen and to accommodate that new experience, he needed to alter his cognitive scripts.
So, what does being slightly less afraid of a mousetrap has to do with sobriety? As a result of his experience that day, Vincent discovered that mousetraps aren’t inherently dangerous after all. This new learning required him to rearrange information in ways that formed new neural networks based on actively testing and rejecting an outdated belief. And, perhaps, with that was born a new perspective: There are possibilities other than those you’ve always believed to be true. Experiential learning helps participants become unstuck by helping them create new, more adaptive cognitive scripts and helping them discover those other possibilities.
Works Cited
Cozolino, L. (2002). Neuroscience of Psychotherapy, The. New York: W. W. Norton & Co.
DiClemente, C. (2003). Addiction and Change. New York: Guilford Press.
Kassin, S. (2004). Essentials of Psychology. Upper Saddle River, NJ: Prentice-Hall.
Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing.
Priest, S. & Gass, M. (2005). Effective Leadership in Adventure Programming. Champaign, IL: Human Kinetics.
Siegel, D. (1999). Developing Mind, The. New York: Guilford Press.
Yale Medical School. (n.d.). Glossary. Retrieved October 22, 2008, from
http://info.med.yale.edu/psych/3s/glossary_items/cog_script.html
Zull, J. (2002). Art of Changing the Brain, The. Sterling, VA: Stylus Publishing.
