How to Forgive: A Cognitive Behavioral Model for Forgiveness and Letting Go of Anger and Frustration

What is forgiveness?

Here’s what it is not. It is not for anyone else, only for you. It doesn’t imply reconciliation with the person who hurt you nor does it imply that you approve of their actions. It does not mean forgetting what happened.

What is forgiveness?

It is only for you, in order to help you feel better. As one well-known researcher said, “failing to forgive is like taking poison and waiting for the other person to die.”

Forgiveness means understanding what is causing your current distress. It is not what offended you or hurt you years ago or even a few minutes ago. The primary cause of your suffering is from your thoughts, feelings, and physical sensations in response to your thoughts about the event.

This is a subtle concept. Most of us believe the reason we are angry is because someone has done us wrong. And it’s true, that if we could erase the event, we would stop being angry. But none of us own a time machine so we can not erase the events.

What makes us suffer is each moment that we think about the offending person or event. And how we think about these events. It is as if you own a DVD collection of movies of different events in your life. If you were to choose to only watch the upsetting movies, your overall level of happiness would greatly diminish. Choosing to forgive is choosing the DVDs of your life that are positive and full of joy.

There is another component of how people think about grudges. We often have a magical belief that our anger at someone else causes them to suffer. We imagine them feeling guilty about their behavior and suffering even when we are not present. We think of ways to hurt them in return – the silent treatment, constant criticism, reminding them of their offenses. But the reality is that most people are very good at blocking out guilt and punishment. Whenever they’re not around us they tend to think about other things. And they develop good ways of avoiding our punishment. So really the one who suffers is the person who’s angry and who fails to forgive, not the offender. And if the person we take out our anger on is someone we are still in relationship with, it damages the relationship and makes it even less likely we will get what we want.

Another trigger for resentment and anger is holding onto what the anger and forgiveness researchers call “unenforceable rules”. These are what most cognitive behavioral therapists call “Shoulds”. They are the demands we make on the world and on people around us. You can’t force anyone to do something they don’t choose to do, and you can’t require people to give you things they choose not to.

For instance, you might want fidelity in your romantic partner. You certainly have every right to want that. But you can’t demand or enforce fidelity. If your partner chooses to go outside the relationship, you can’t really change it. The only options you have are how to react to this. You have choices to make about the relationship and about your future relationships.

The research on forgiveness is very interesting. It reduces blood pressure, stress, anger, depression and hurt while increasing optimism and hope. The primary researcher on forgiveness, Dr. Fred Luskin at Stanford, has even done forgiveness research with women in Northern Ireland whose husbands were murdered. Even with these extreme cases people have found the forgiveness model very helpful at easing the pain.

I’ve written about how to conquer anger using the S A P model. In this model you change your shoulds into preferences rather than demands, you place into perspective the events that have caused your anger, and you shift out of the blame model and depersonalize most events.

Forgiveness is about being happy. Living your life to its fullest is the best revenge you can take on someone who has offended you. Instead of focusing on the hurt or betrayal, focus your energy on getting what you want in your life in a different way other than through the person who has hurt or betrayed you. Take responsibility for your own happiness rather than placing it onto other people and then being disappointed when they don’t provide happiness.

Change your story. Too often we have what is called a grievance story. We tend to tell this story to many people. It always ends with us feeling stuck and angry. Change your story. Change the ending so that it ends with a powerful and strong choice to forgive.

 
So to summarize, here’s how to forgive:

1. Let yourself first feel the pain. Share the experience with a few close and trusted friends.

2. Recognize that your anger is a result of your choices about what thoughts to experience about an event. Decide to forgive so that you can move forward and feel better.

3. Recognize that you probably won’t be able to get rid of your hurt and anger by punishing the other person. All you will accomplish is to damage the relationship or make the other person suffer while you continue to suffer.

4. Recognize the role that your “unenforceable rules” or Shoulds plays in your continued hurt and anger. Change or eliminate these rules.

5. Figure out what you want in your life and how to succeed in achieving those goals even if the other person doesn’t provide the answers. Remember that happiness is the best revenge.

6. Use the S A P model to change your shoulds, eliminate exaggerated awfulizing thinking, and take away blame.

7. Rewrite your script. Tell the new story where you were hurt but recovered and forgave and moved forward. You are a hero!

 


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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, and other difficulties using evidence-based cognitive behavioral therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

The Two Selves: Implications for Time Management and Productivity

I’m on vacation. I’m sitting on the deck of a house overlooking Sunset Beach in Hawaii. It’s a windy day and the waves are blowing. Since I’ve been so lazy here I’ve been thinking about productivity. And the paradox of our two selves.

Here’s an interesting question. How is it that sometimes we tell ourselves “I’m going to do such and such task” and then don’t do it?

Who is the self who is giving the orders and who is the self who is not following them?

How is this even possible? Are we a collection of multiple personalities?

It’s such a common phenomenon that we take it for granted. We are never surprised when we say to ourselves “Gee I think I’ll skip that cake” and then we end up eating the cake. Or we say to ourselves “I think I’ll work on that project,” and then we surf the internet instead.

And yet there is something profoundly strange about all of these phenomena. It is as if there is one self who tells the other self what to do, and then that other self decides whether or not to do it. Who is driving this bus?!

How do these two selves work? There is a little bit of research about this. In his book Thinking Fast and Thinking Slow Daniel Kahneman discusses these concepts and notes that we always assume that our future self will be more disciplined and more self-controlled. However, this is almost never true. Our future self is merely an extension of our current self with all of its flaws. In fact, it is our belief in the future self being more sensible that allows our current self to overeat, smoke, drink, or procrastinate doing work.

We make the dangerous assumption that we can afford these bad behaviors in the present because our future self will clean up the problem. Unfortunately, our future self is just as much of a slacker and just as self-indulgent as our present self.

So how is it possible that we have these multiple selves and cannot control our own behavior? Who is driving the bus?

I’ve been doing a lot of thinking about this issue lately and I have to admit I am somewhat puzzled by these phenomenon.

First of all, we need some terminology. Let’s call the telling-yourself-to-do-things self the Commanding Self. And let’s call the self that actually does things The Behaving Self.

Perhaps the real self is the Behaving Self, and the Commanding Self is the illusory self. In this formulation the reason that we don’t follow through on things is that we don’t actually really want to. In this formulation we would elegantly use Occam’s razor to reduce ourselves to one self; the behaving self who is actually the real self. We would become reductionist behaviorists, and to determine what people want we would observe what they actually do.

But then why do we spend so much time and effort having this other self who tells us what to do? And sometimes we actually do listen to the commanding self. What is different about those times when we listen and those times when we resist?

For instance, most of us have the experience of doing exercise, at least occasionally. And in order to do this we must listen to our Commanding Self.

Perhaps some of the current research on willpower can help us to understand the circumstances when the Commanding Self is listened to, and when it is not.

Current research on willpower suggests that it is a precious and limited commodity. It diminishes rapidly when used, and perhaps has about a 15 to 30 minutes half-life before it is exhausted. Other research suggests it is powered by our glucose metabolism so ironically the best way to resist overeating is to have a little bit of a sugary drink to restore willpower. The other factors that diminish willpower include being tired, hungry, probably emotional, and any other state that diminished our being. The 12-Step people were on to something with their model of hungry, angry, lonely, and tired (HALT) which captures this concept perfectly.

So perhaps another way of conceptualizing this strange dichotomy of selves is that the Commanding Self and the Behaving Self have relatively different strengths depending on our state of being both physically and emotionally.

The Commanding Self has more relatively more strength when we are well-rested, emotionally balanced, and well fed. The Behaving Self takes over when we’re tired, emotionally upset, or hungry.

Perhaps we should label the Behaving Self the Misbehaving Self! After all, most of the time the Behaving Self actually does misbehave. And perhaps we should label the Commanding Self as the Demanding Self.

There are many other self splits that we can look at. For instance, there clearly is a split between our short-term self and our long-term self. Many of the discrepancies in our behavior are a result of this particular split.

For instance, dieting. The short-term self wants immediate food gratification regardless of the long-term consequences on our weight or health. The short-term self wants to spend money in contradiction to the long-term self’s goal of spending less money and saving more.

So how can we integrate these multiple selves? Is it possible to create cooperation between our Commanding Self and our Behaving Self?

Can we possibly learn to show up for ourselves and actually follow through on what we say we are going to do?

Here’s an interesting exercise. What if you means-tested each command by asking yourself “How likely is it that I will do this?” And only issuing the commands that your Behaving Self agreed with?

So if you sit down at your computer and say “I’m going to do some writing,” you would ask yourself, “Do I really want to do some writing, and will I actually follow through and do it?” If the answer was not a resounding yes, then you would not issue the command.

It would be a very interesting experiment to spend an entire day doing this. One could also experiment with lowering the expectations of the Commanding Self. For instance, rather than saying I’m going to lift weights for 30 minutes, I would say I will lift weights for 5 minutes and then decide if I feel like doing more. That way I have at least lived up to my own expectations.

Same with eating. Rather than say I’m only going to eat one chip , I would instead say I’m going to eat the entire bag. Then if I leave a little bit I have actually outperformed my expectations.

In a sense what I’m suggesting here is that we have an honest dialogue with ourselves. As we write down our to-do list each morning, we should pretend that we are a boss or a manager asking an employee if they are willing and able to do each task. “Are you willing to sit down today and write for an hour?” “I don’t really know. I’m feeling sort of tired and unmotivated today. I guess I can commit to writing for 30 minutes, but I am not sure about an hour.” “Okay, why don’t you write for 30 minutes?”

And with each item on the to-do list we would have this honest discussion. We might also have a meta-discussion about the entire to-do list. For instance, “I notice that there are a large number of items on this to-do list and you only have a few hours free today. Is it realistic to really accomplish all of these items or should you be moving several to another day?”

“Yes, I see what you mean. I probably can’t achieve all of these items. I guess I have to pick one or two items and focus on those.”

“Which items would you like to select? Which are your highest priorities?”

I recently did this experiment for several days and discovered that unless my ratings of wanting to do something were in the 80 to 100 range (hundred point scale), I didn’t usually do the task. This was very consistent. I also noticed that sometimes the rating of wanting to do something didn’t get up to this critical range until the task became urgent, which of course explains procrastination.

Using the Technique of Paradoxical Agenda Setting

The technique of paradoxical agenda setting involves taking a devil’s advocate approach. Rather than trying to motivate yourself to do things by telling yourself all the good reasons why you should do those tasks, you instead ask yourself about all the reasons not to do the task?

By focusing on all the reasons not to do something you can honestly assess your motivation and even address some of these resistances more honestly. Rather than just saying to yourself “Just do it!”, you look at your resistance and troubleshoot how to eliminate it.

Exercises

Exercise: Write down all the commands you give yourself for an entire day. That includes to do list items that you set yourself to do, informal commands such as “I won’t eat the entire pie,” as well as any agreements you make with other people to accomplish tasks.

Write down the tasks and the commands as you issue them, not later. Otherwise you won’t remember them. At the end of the day take an inventory. Determine how many of the commands you actually accomplished. You probably want to calculate a percentage accomplished.

Take a look at this percentage. If it is over 80 percent then your two selves are very well integrated and you probably should stop reading this article right now. If it’s between 50 and 80 percent you are doing better than most people but still have plenty of room for improvement. If it’s between 30 and 50 percent then you are struggling with a split between your Commanding Self and your Behaving Self. In fact, you might just want to call it your Misehaving Self. And if you are below 30 percent then you are probably suffering many consequences from your inability to integrate your multiple selves.

Exercise: Learning how to lower your own expectations. Write down a goal for today. Now cut it in half. Now cut it in half again. That’s the new goal. We always bite off more than we can chew.

Exercise: Ownership. Write down a goal for today. Ask yourself is this is really your goal or someone else’s goal? Is it something that you want to do or is it something that you think you should do based on someone else’s opinion.?

Exercise: Under-promise and over-deliver. For today, practice making very small promises to yourself and overachieving on each promise. You want to be authentic and sincere in these small goals. Don’t pretend that they are actually larger goals.

Exercise: Gradually increasing goals. If your exercise goal is to exercise 5 days a week for 30 minutes, but you only exercise once a week, then you must lower your goal first to one time a week. See if you can achieve that goal several weeks in a row. If you can, then you get to increase the goal to perhaps two times a week of exercising. Once you’ve achieved that goal you get to increase the goal to three times. But each time and each week you must reach that new goal otherwise you must go back to the previous week’s goal.

That means if you set a goal of exercising three times but you fail to meet that goal then you must roll back the goal to two times and achieve that goal that for at least two weeks in a row. This will train you to make reasonable and achievable goals and to follow through on those goals.
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“Everyone wants to go to heaven but no one wants to die” : The Paradox of Goal Versus Time Management.

One of the ways to explain the disparity between our multiple selves is the trade-off principal embodied by the heaven quote.

We all have many goals, but in order to achieve goals we need time. Goals are infinite, and we can add an unlimited amount of them to our to-do list. But time is the ultimate finite quantity. We can manufacture as many goals as we choose, but we can’t produce a single extra minute of time.

Hence lies one very simple explanation for the two selves paradox. The Commanding Self produces a list of goals or tasks to achieve. The other self, which we will call the Behaving Self, must perform the task of accomplishing these goals within limited time, and must balance the time to achieve one goal versus another goal. But because the Commanding Self doesn’t really consider time in it’s estimations, the Behaving Self is almost certain to fail. The problem is that the Commanding Self does not understand the trade-off principle. The Commanding assumes that time is infinite. Which of course is patently untrue.

So how to fix this paradox? Perhaps the Commanding Self should be required to first estimate how much time each task or goal will take. And then double or triple this time estimate. But that won’t be enough. Instead of a to-do list, perhaps the Commanding Self should only use a calendar and time schedule. If the Commanding Self wants to straighten up the house , then it should be required to put it on the time schedule. And if it doesn’t fit on a time schedule , then don’t put it on.

This gives power back to the Behaving Self. And it is the Behaving Self that actually performs tasks. So we need to take the power away from the Commanding Self, and give it back to the Behaving Self. This should resolve many of the paradoxes between the two selves.

In a sense, what I am suggesting here is for all of us to get rid of our to-do lists, and replace them with time schedules and calendars. If a task doesn’t fit in our schedule, then it doesn’t become an action item. Of course the challenge of this would be that we tend to greatly underestimate the time it takes to accomplish each task, so we would have to either leave extra time, or split tasks into numerous sessions of work spread out over several days.

I am reminded of Neil Fiore’s book The Now Habit. He talks about the Un-Schedule. What he suggests is that people put on their Un-Schedule all of the things they have to do every day. This includes basic tasks of daily life such as showering, eating, commuting, all meetings, etc. What is left is the actual time you have to accomplish tasks. And for most people this is a very small amount of time. He then suggests that you fill in half hour blocks of work, after you accomplish that 30 minutes of work.

It is very sobering to do this. Most people realize that at best they have an hour or two per day to actually accomplish new work. Many jobs include multiple meetings which are required, leaving relatively little time in the workday to actually accomplish anything. When I did this I realized that after I included all of my basic tasks of daily life, exercise, returning phone calls, processing emails, and seeing clients, most days I only had an hour or two to accomplish anything else. And this hour or two could easily be used up doing a few tasks. When I realized how little time I really had during the work week, I lowered my goals and was happy accomplishing one or two significant tasks each day.

So these are some rambling thoughts from the beach about the paradoxes which make up our lives. Now my Behaving Self is saying time to go for a swim!


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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, and other difficulties using evidence-based cognitive behavioral therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

The Power of Nurturing: How Quality of Parenting Interacts with Nature to Determine Outcomes in Life, Even in Poverty

National Public Radio (NPR) reported  recently on a very interesting study of babies. This research, performed by Elizabeth Conradt at Brown University, looked at a phenomena called baseline respiratory sinus arrhythmia. This in itself is a very interesting concept. What exactly is this? It is the difference between your heart rate when you inhale and when you exhale. It turns out that some people have a larger difference than others. Everyone has a different set point in terms of heart rate variability.

Babies that have a bigger difference tend to have greater abilities to focus on things in their environment. If you show them a new toy, they will really look at it and interact with it. Babies with low heart rate variability tend to lose interest more quickly.

So it’s better to have a baby with higher heart rate variability? It’s not that simple. Babies with a higher set point of heart rate variability are more irritable and fussy particularly when their environment is changing. On the other hand, babies with a lower set point tend to be less fussy.

Heart rate variability turns out to be a pretty good predictor of how sensitive babies are to their environment, both in good and bad ways.

Anyway, Conradt’s research looked at mothers and babies who were living in poverty. They were interested in predicting how the children would do as they aged.

So first, at five months of age, they measured heart rate variability while the babies were listening to soothing music and watching soothing video.

Roughly a year later, when the babies were around 17 months old, they came back to the lab. At this point they measured two things. First the researchers evaluated behavioral problems such as anxiety or aggression. Then they performed an interesting test that measures the quality of attachment between a mother and the baby. The researchers took the mother and child to a strange room, where the toddler played for a bit. Then, without any warning, the mother got up and left the room. In most cases this will trigger the baby being upset and crying. This is typical and normal. The baby thinks, “Where did my mom go?!”

What the researchers were really interested in was what happened three or four minutes later when the mother returned. Could the mother quickly soothe the upset child, or did the toddler pull away from the mother and continue to be upset?

The researchers made the assumption that if the mother could easily soothe the toddler then it was a marker of good attachment and a secure environment.

So here’s the very interesting part of this research. How did the initial heart rate variability set point correlate with behavioral problems? It turns out that if the baby had a high set point and insecure attachment to their mother, then they had the worst behavioral problems. But if they had a high set point and secure attachments to their mothers, then they had the lowest incidence of behavioral problems.

Children with low set points fell in the middle of the range of behavioral problems, and were not affected by the quality of their attachment with their mothers.

The amazing finding was that the children who had high set points and good quality parenting as reflected by secure attachments to their mothers tended to have less behavioral problems even than babies in middle-class and affluent families!

This is fascinating research. It shows the influence of both nature and nurture. And it shows how a biological trait such as heart rate variability can either lead to good or bad outcomes in life based on the quality of parenting. Mostly though, it demonstrates how crucial good parenting is to later outcomes in life. Good parenting can create successful, well-balanced children even in circumstances of poverty. In fact, the study showed that for the more sensitive children,  good parenting in poverty trumps bad or mediocre parenting in affluence!!!

 

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, and other difficulties using evidence-based cognitive behavioral therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

Guns Are Weapons of Mass Destruction: Lessons of the Newtown School Shooting

I normally don’t blog about political issues, but today is an exception. Friday’s horrific school shooting in Newtown, Connecticut shows that guns are weapons of mass destruction. It’s time for this country to get serious about regulating them.

Other types of weapons of mass destruction are banned or tightly controlled in this country. You can’t buy a rocket propelled grenade launcher. Nor can the average citizen acquire C-4 explosive. Or nerve gas. Or suitcase nukes. Why do we allow virtually anyone to acquire the weapons of mass destruction that we call guns?

The Second Amendment reads, “a well-regulated militia being necessary to the security of a free state, the right of the people to keep and bear arms shall not be infringed.” This was written hundreds of years ago, at a time in our history when we had just recently won our freedom from Britain after a bloody war. There was a genuine risk that England could attempt to reconquer our country, and thus maintaining an armed populace made good sense.

But today nobody is trying to invade the United States, and if they did they would be met with extreme force from our military. Our biggest danger now comes from inside, from disturbed individuals who acquire weapons of mass destruction, i.e. guns, and who kill innocent children and adults.

Imagine if instead of using guns, these school shooters built themselves suicide bomb vests. Would we not ban or tightly control any components that were necessary to build these vests? Of course we would. After the Oklahoma City bombing the government imposed controls and tagging on fertilizer components in order to reduce the possibility of future fertilizer bombs.

How many more children must be gunned down until the National Rifle Association and the Republican Party are willing to consider genuine and effective controls on guns? Do we need a school shooting every week in order to for our society to decide to make changes? Or every day? I hope not.

The Second Amendment in no way prevents strict regulation of guns, ammunition, and cartridges. Notice the emphasis on, “a well-regulated militia.” This would allow for any regulation necessary to lower the risk to innocent people. We already regulate gun ownership—screening, waiting periods, no fully-automatic machine guns, strict controls on silencers, etc.

So what are some reasonable regulations or interventions that might lower risk of mass shootings?

The first one is to re-institute the assault weapons ban. No hunter or civilian needs a semi-automatic rifle that can fire more than five or 10 bullets. Another option is to ban ammunition magazines that hold more than 10 bullets. This should apply to semi-automatic handguns as well. Again, there is no legitimate use for a civilian where they would need to fire more than 10 bullets.

There are several ways to impose these changes. One would be an outright ban, but politically this might be difficult. Another option would be regulation using taxation. Just as we have significant taxes on alcohol and cigarettes in order to lessen their use, we could have very large taxes on ammunition magazines larger than 10 bullets, and on semi-automatic rifles. If these cartridges each had a tax of $100 attached to it, and each semi-automatic rifle a tax of $1000, the sales would plummet. Manufacturers abandon production of these products.

California has already instituted many of these regulation, and the federal government should consider enacting similar rules.

Stricter legislation might be even better. If we truly are serious about eliminating these weapons of mass destruction, then we should ban not only the sale, but also the possession of large magazines. There would be an interim period during which civilians could turn in these cartridges to local law enforcement, but after that time, the possession of such large magazines would  become a felony.  Companies that manufacture these magazines could offer a trade-in program where citizens could trade in a large magazine for a legal sized magazine. This would be an incentive for both manufacturers and owners to make the swap.

Those who argue in favor of better screening for gun ownership are fooling themselves. All that our current screening procedures do is identify people who have a prior history of documented illegal behavior or disturbed behavior. There is no screening method that could identify those who will commit mass murder in the future, if they have no prior records of disturbed or illegal behavior. So tighter screening methods will not work.

And those who argue for arming schoolteachers are equally foolish. In theory it sounds great, every schoolteacher carrying a weapon and being well-trained to take out the next school shooter. In practice, it won’t work because as horrific as they are, the probability in any one classroom of a school shooter is exceedingly low. This will lead to schoolteachers leaving their guns in their desks, unloaded, and being completely unready to take on the well-prepared school shooter who will be heavily armed, wearing a bulletproof vest, and all too ready for action. Even the average police officer, armed with only a handgun, rarely takes on heavily armed perpetrators, instead leaving that task to SWAT teams who carry much more potent weaponry. And I don’t think we want to arm schoolteachers with machine guns!

In conclusion, guns are weapons of mass destruction and we should regulate them as such. As a society we should ask ourselves how many more innocent children need to die before we get serious about such regulation. We can regulate guns without banning them, and hunters, target shooters, and even people using guns for home defense will not be unduly affected. But Congress needs to hear from people, and I strongly encourage everyone who cares about the safety of children to reach out to their Congressman and their Senator and let them know that it’s time to change gun regulations to stop the mass destruction.


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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, and other difficulties using evidence-based cognitive behavioral therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

New Rapid Home Testing Kit for H.I.V. Goes on Sale, Should You Use It? (P.S., Dr. House Was Right, Everyone Lies About Sex

The New York Times reported today that there is a new rapid home testing kit for HIV that went on sale today, October 5, 2012. The kit is called OraQuick, costs $40 and takes 20 minutes to provide results. This is a major breakthrough, as it allows people to quickly determine their HIV status in the privacy of their own homes. It also opens up the potential for sexual partners to test each other before having sexual contact. I’m sure the company that makes the OraQuick test, OraSure Technologies, would love it if many people use this test before having sex. But is this a good idea?

The kit is not perfect. It is almost 100% accurate when it indicates that someone is not infected with HIV, and, in reality is not. But it is only 93% accurate when it says someone is not infected and the person actually does have the virus. This is most likely because there is a period of time after infection before the body is producing antibodies that the test detects.

Should you use this test when considering becoming sexual with a new partner? Consider some very disturbing facts based on two sexual surveys reported in this article. In the first survey, nearly 20% of infected homosexual men reported having unprotected sex with at least one partner without revealing their HIV status.

In the second study, they found that 9% of HIV-positive heterosexual men and women, and 14% of HIV-positive gay or bisexual men reported having recent unprotected sex with someone who they either knew was uninfected, without revealing their own infection! Putting this in real numbers, the authors of this survey estimated that over a year, 34,000 infected gay men and 10,000 infected heterosexual men and women had sex without telling the truth.

This really speaks to the issue of not trusting what people say about sexuality. Too often I hear experts giving the advice to ask your potential partner about their sexual history and their HIV status. Given the results of these two surveys, that seems naïve, foolish and dangerous. People lie about sex. If you are a gay male, it’s reasonable to expect that one in five infected potential partners will lie to you about their HIV status. If you’re a heterosexual, the number drops to a little below 10%. Are those the odds you want to take with your life?

What this really speaks to is the importance both of testing and of safe sex. Since the OraQuick test is only 93% accurate when the person taking it is infected, that means 7% of the time, with an infected person, the test will falsely tell you that they are not infected. So those odds aren’t very good either. So let’s calculate the probability that your new potential sexual partner might be HIV-positive, lying about it, and the OraQuick test would falsely tell you they were HIV negative.

If you are a gay man, then the probability is 20% times 7%, which equals 1.4%. If you are heterosexual the probability is 9% times 7%, which equals 0.69%. So the odds that your deceitful HIV-positive partner would not be identified by the OraQuick test are 1.4% if you are a gay male, and 0.69% if you are a heterosexual man or woman.

So even by using the OraQuick test, you can’t eliminate all risk. That’s why practicing safe sex makes so much sense. At least do so when having casual sexual contact, before you get to know the person well and can figure out whether they are trustworthy or not.

So to summarize, the new OraQuick test allows for quick at home testing of HIV status. Given the facts about how many HIV-positive gay and straight people are not honest about their HIV status, it makes sense to consider using this test. But there is still a risk, since the test is least accurate when used on HIV-positive people. The OraQuick test can improve your odds, but for ultimate safety, practice safe sex!

No joke to end this post, because this is such a serious matter.


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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, and other difficulties using evidence-based cognitive behavioral therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.