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Jealousy is a multidimensional cognitive, emotional, behavioral and interpersonal phenomenon. Jealousy can be a destructive and often dangerous emotional and interpersonal response to threats to a valued relationship. Despite the importance of jealousy as an issue for couples, there has been relatively little attention to this problem. Jealousy is aformof angry, agitated worry, whose goal is to anticipate and avoid surprise and betrayal. A meta–emotional model is described, emphasizing the normalization of jealous emotion, distinguishing between “feeling” and “acting on” jealousy and linking jealousy to emotional processing, intolerance of uncertainty and thought fusion. Mindfulness and acceptance based approaches can be used that emphasize cultivating a capacity to distance and de–center from disturbing thoughts and feelings, overcoming attempts at experiential avoidance that may amplify jealousy, disrupting thought–reality fusion, and establishing a non–judgmental observing stance, from which adaptive behaviors may proceed.
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LEAHYANDTIRCHCOGNITIVEBEHAVIORALTHERAPY FOR JEALOUSY
Cognitive Behavioral Therapy
for Jealousy
Robert L. Leahy and Dennis D. Tirch
American Institute for Cognitive Therapy
Jealousy is a multidimensional cognitive, emotional, behavioral and interpersonal phe-
nomenon. Jealousy can be a destructive and often dangerous emotional and interper-
sonal response to threats to a valued relationship. Despite the importance of jealousy as
an issue for couples, there has been relatively little attention to this problem. Jealousy is
aformofangry, agitated worry, whose goal is to anticipate and avoid surprise and be-
trayal. A meta–emotional model is described, emphasizing the normalization of jeal-
ous emotion, distinguishing between “feeling” and “acting on” jealousy and linking
jealousy to emotional processing, intolerance of uncertainty and thought fu-
sion. Mindfulness and acceptance based approaches can be used that emphasize cul-
tivating a capacity to distance and de–center from disturbing thoughts and feelings,
overcoming attempts at experiential avoidance that may amplify jealousy, disrupting
thought–reality fusion, and establishing a non–judgmental observing stance, from
which adaptive behaviors may proceed.
COGNITIVE BEHAVIORAL THERAPY FOR JEALOUSY
Jealousy is one of the most serious problems encountered in romantic relationships.
Jealousy leads to anxiety, depression, hopelessness, anger, intimidation, attempts to
control, violence—and, in some cases, death. A number of theories have been advanced
to account for jealousy. Evolutionary theory proposes that jealousy is a behavioral sys-
tem that has evolved to protect the individual’s “investment” in a relationship where
procreation is a possibility (Buss, 2000). According to this model males and females dif-
fer as to the triggers for jealousy, with males more threatened (and more jealous) over
sexual infidelity, while females are more threatened by emotional infidelity. Although
some research points to sex differences in reasons for jealousy (Buss, Larsen, Westen, &
Semmelroth, 1992; Buunk, Angleitner, Oubaid, & Buss, 1996; DeSteno & Salovey,
1996), other research suggests that these sex differences may partly be due to experi-
mental design artifacts (DeSteno, Bartlett, Braverman, & Salovey, 2002). Moreover,
among heterosexual and homosexual couples, individuals recalled that emotional infi-
delity was more upsetting than sexual infidelity (Harris, 2002). Notwithstanding the
purported sex difference, evolutionary theory still has credibility as a distal cause of
18
International Journal of Cognitive Therapy, 1(1), 18–32, 2008
© 2008 International Association for Cognitive Psychotherapy
Send all correspondence to Robert L. Leahy, 136 East 57th Street, Suite 1101, New York, NY 10022.
Emails: Leahy@cognitivetherapynyc.com and drdennis@mac.com
jealousy since both males and females have genetic investment in protection of
resources.
White has suggested that jealousy can be understood in terms of cognitive apprais-
als, behavior and emotion activated during the development of a relationship (White,
1980, 1981; White & Mullen, 1989). According to this model, during the earliest
stages of a relationship there is little investment—so jealousy would be minimal. In a
well–established, long–lasting relationship there is less uncertainty, so jealousy would
also be less. The model predicts a curvilinear relationship between extremes of invest-
ment (very low, medium, very high) and jealousy. Knobloch, Solomon, and Cruz
(2001) have expanded this model to include the negotiation of “relationship uncer-
tainty” which attempts to integrate the development of commitment, relationship un-
certainty and attachment issues into a model that suggests that attachment anxiety
interacts with relationship uncertainty to determine jealousy.
Jealousy has also been linked to supposed deficits in self–esteem (Guerrero & Afifi,
1999), higher dependency (Ellis, 1996) and serotonergic effects (Marazziti et al.,
2003). Cognitive–behavioral approaches to jealousy have focused on correcting or
modifying dysfunctional interpretations or assumptions that give rise to jealousy
(Bishay, Tarrier, Dolan, Beckett, & Harwood, 1996; Dolan & Bishay, 1996; Ellis,
1996). However, these cognitive approaches are limited to traditional testing or chal-
lenging dysfunctional thoughts and have not included recent advances in cognitive–be-
havioral therapy. Thus, these contemporary approaches to jealousy may help us
understand the possible causes of jealousy, but may not provide a comprehensive ap-
proach to the treatment of jealousy. Similar limitations are found with other models of
jealousy. For example, the ethological model stresses protection of genetic investment,
the universality of jealousy, its existence across species, and the relationship factors that
increase jealousy (young partner, child bearing, sexual activity) (Buss, 2000), but etho-
logical theory does not provide a model of treatment. Feminist theory may stress the
power and control differential that may underlie jealousy, but it is unclear how an effec-
tive treatment model can be derived from this model. Psychodynamic models provide
intriguing conceptualizations of jealousy, based on theories of projection, paranoid
ideation, disrupted object relations, and models of insecure/ambivalent/angry attach-
ment patterns, but a structured treatment approach has not been advanced from this
perspective. Finally, Ellis’s REBT model (with its emphasis on “shoulds”, low
frustration tolerance, and labeling) can be invalidating and unrealistic and ignores the
possibility that there are times that jealousy is appropriate.
AN INTEGRATED COGNITIVE BEHAVIORAL
MODEL OF JEALOUSY
The model that we advance here is that jealousy is a form of worry, which we character-
ize as angry, agitated worry. We distinguish between the emotion of jealousy and the
strategies that are activated that maintain or increase jealousy or that attempt to exercise
control (over thoughts, feelings and the relationship) and attempts to minimize per-
sonal threat. Our model integrates traditional cognitive theory of schematic processing
(of threat to the relationship) (e.g., Beck, Emery, & Greenberg, 1985), with
metacognitive and meta–emotional models (Leahy, 2001a; Wells, 1997), acceptance
COGNITIVE BEHAVIORAL THERAPY FOR JEALOUSY 19
and commitment therapy (Hayes, Strosahl, & Wilson, 2003) and mindfulness based
approaches (Segal, Williams, & Teasdale, 2002). Moreover, individuals differ in the in-
terpersonal strategies employed in the face of jealousy—sometimes utilizing interroga-
tion, reassurance–seeking, provoking, hedging, and attacking. Our view is that the
action that follows from jealousy can be self–verifying, but ultimately self–defeating. We
shall briefly outline each of these factors here. The integrative CBT model is outlined in
Figure 1.
Schematic Processing. As with any anxiety disorder, jealousy is characterized by
hyperawareness of threat (Beck, Emery, & Greenberg, 1985). Thus, the jealous individ-
ual is likely to misinterpret neutral information as a threat to the relationship and to en-
gage in attentional bias—for example, mind–reading (“She is interested in him”),
personalizing (“He is reading the paper because he no longer finds me attractive and in-
teresting”), fortune–telling (“She is going to leave me”), and overgeneralizing (“He’s
always doing that”).
20 LEAHY AND TIRCH
FIGURE 1. Conceptual Model of Jealousy
Emotional Schemas. Similar to other fears that are exacerbated by the belief that “If
I am afraid, then it is dangerous," the jealous individual uses his emotional intensity as
evidence that the threat is real. However, just as the individual uses her emotions to eval-
uate reality, there is a corresponding belief that one cannot tolerate uncomfortable emo-
tions (Leahy, 2002, 2007). This includes emotional schemas that one’s jealousy is out of
control, dangerous, or a “bad sign”. Other emotional schemas include the belief that
ambivalence about one’s partner—or the partner’s ambivalence about the patient—
cannot be tolerated.
Personal Core Beliefs. Jealousy is often related to core beliefs about the self and oth-
ers. Problematic core beliefs include thoughts that one is unlovable, flawed, doomed, or
entitled to special treatment. Beliefs about others may include thoughts that others are
not trustworthy, rejecting, abandoning, manipulative, or inferior. Thus, the individual
with a core belief that he is sexually undesirable would be more likely to be jealous
(Dolan & Bishay, 1996).
Meta–Cognitive Processes. Similar to worry and rumination, the jealous individual
believes that their jealous hypervigilance will prevent any surprises, prepare them for the
worst, or allow them to catch things before they fall apart (Wells & Carter, 2001; Wells
& Papageorgiou, 1998). The jealous individual, similar to the worrier, fears letting his
guard down, lest he be caught unaware of the danger. He has high cognitive self–con-
sciousness, continually scanning his mind for jealous thoughts or memories. Similar to
the worrier, he is caught in a dilemma—believing that his jealousy protects him, but also
believing that his jealousy is “out of control.” Consequently, he attempts to “control” his
jealousy by suppressing, seeking reassurance, or avoiding the situations that give rise to
jealousy (Wells, 2004).
Intolerance of Uncertainty. Similar to the worrier, the jealous individual believes
that uncertainty about her partner’s “real” interests is intolerable and, consequently, at-
tempts to eliminate this uncertainty through looking for “clues,” seeking reassurance, or
“testing” the partner. This seldom results in a satisfactory resolution, thereby fueling
more demands for certainty (Dugas, Gosselin, & Ladouceur, 2001).
Pathological Interpersonal Coping. The jealous individual believes that he must
“take action”, gain control and find out “what is really going on.” Consequently, he acti-
vates problematic interpersonal coping that often leads to greater insecurity (Borkovec,
Newman, & Castonguay, 2003; Erickson & Newman, 2007). This includes reassur-
ance seeking, degrading competitors, attacking partner, controlling partner, surveilling
partner, deferring to partner, threatening to leave, hedging through infidelity, or
substance abuse.
COGNITIVE–BEHAVIOR THERAPY: TREATMENT PLAN
Develop a Case Conceptualization
Similar to other cognitive therapy treatment models, the present model begins with a
case conceptualization on which the therapist and patient may collaborate (Beck, 1995;
COGNITIVE BEHAVIORAL THERAPY FOR JEALOUSY 21
Persons, 1993). Figure 1 provides a general template for such a case conceptualization.
The general outline suggests that evolution has led to the emergence of jealousy as a pro-
tective strategy that is universal and adaptive in certain situations. This serves the purpose
of “depathologizing” the experience of jealousy, providing some validation to the right
to “have a feeling.” Significant early and later relationship issues may be identified—for
example, threats to family of origin (threats of or actual separation of parents, infidelity,
or betrayal in adult relationships) and cultural values associated with sexuality, gender
roles, and romantic idealization. Core beliefs about self may include thoughts that one is
basically unlovable, ugly, defective, or vulnerable to being manipulated. Situational
triggers may vary from neutral (attending a party) to non–existent (insecurity when the
partner is at work) to provocative (partner having dinner with a former lover).
These factors may give rise to cognitive, emotional, behavioral and interpersonal
coping strategies to face potential threat to the relationship. The therapist will explore
the emergence of hypervigilance, attempts to find certainty, reassurance seeking, emo-
tional coping strategies and beliefs, hedging, control, and attempts to punish the partner
and devalue perceived competition.
Validate and Inquire. The therapist empathizes and validates the emotion of jeal-
ousy while questioning the degree, persistence, and the impact on pathological coping:
“It’s one thing to feel jealous, but another thing to punish your partner.” Validation can
link jealousy to evolutionary theory (“natural instincts to protect yourself”), the value of
commitment and honesty in relationships, and the desire to feel understood (Gilbert,
1998; Leahy, 2005a). Validation is an essential component because the jealous partner
is often dismissed and criticized for his jealousy. Inquiry can examine the extremity of
the response, while validating the right to have the emotion of jealousy. This sets up a di-
alectic—–“You have feelings of jealousy, but the response may or may not be extreme”
(Leahy, 2001b; Linehan, 1993).
Assess Motivation to Change. The therapist helps the patient evaluate the costs and
benefits of jealousy—for example, the benefits may include not being surprised, avoid-
ing the dissolution of the relationship and developing the motivation to either improve
or leave the relationship. Costs may include anxiety, anger, helplessness and relationship
conflict. Resistance to modifying jealousy may include the belief that feeling less jealous
is “granting permission” to being hurt or may reduce one’s effective self–defense against
betrayal and humiliation (Leahy, 2005b; Wells & Carter, 2001).
Distinguish between Productive and Unproductive Jealousy. The therapist evaluates
if the jealousy can lead to any productive action, such as assertion about rules of conduct
or specific action to improve communication and reward within the relationship. Un-
productive jealousy does not lead to productive action and is characterized by worry and
rumination over events that cannot be controlled (Leahy, 2003; 2005b; Wells, 1997).
Defuse Thoughts and Feelings. Metacognitive and acceptance–based interventions
can assist the patient in distancing from and de–literalizing thoughts and emotions that
escalate the jealousy. Similar to worry and rumination, the patient may have heightened
cognitive self–consciousness, believe that his jealousy protects him, view jealous
thoughts as potentially out of control and requiring suppression, and believe that he will
suffer negative consequences because of these thoughts. These beliefs are similar to
22 LEAHY AND TIRCH
metacognitive beliefs and strategies for worry, rumination and anger (Papageorgiou,
2006; Papageorgiou & Wells, 2001; Simpson & Papageorgiou, 2003).
The patient presenting with pathological jealousy may experience their
threat–based cognitions as literal representations of the outside world, rather than sim-
ply as the contents of their stream of consciousness. Defusion techniques can serve to
change the context in which these thoughts are experienced, thereby changing the func-
tion of the angry and agitated worries involved in problematic jealousy (Hayes,
Strosahl, & Wilson, 2003).
Use Mindful Awareness. The therapist assists the patient in employing a mindful
“observing” stance towards their experience of jealousy in the present moment. Such a
strategy would involve the suspension of control–based strategies, urges to act upon
emotions, and attempts at interpersonal manipulation. Rather than coercing or protest-
ing, the patient can practice an intentional, non–judgmental, and accepting awareness of
their internal responses to each participant’s behavior, and of events independent of the
relationship (Segal, Williams, & Teasdale, 2002). In such a way, the patient may learn to
let go of habitual patterns of responding to perceived threats, and may begin to have the
space and time to make more informed and reality based decisions regarding the
relationship to jealousy and partner.
Practice Acceptance. This phase of treatment recognizes that uncertainty is part of
any relationship and accepting uncertainty as inevitable does not mean giving up one’s
rights. Furthermore, struggling to suppress the experience of jealousy and jealousy
based predictions may paradoxically increase their frequency (Wenzlaff & Wegner,
2000). The therapist assists the patient in recognizing that you cannot control the part-
ner’s thoughts and actions and that you may not even be able to prevent the experience
of jealous feelings or thoughts, but that you can choose ways to respond to jealousy
(Hayes, Strosahl, & Wilson, 2003; Linehan, 1993).
Use Uncertainty Training. Like worry, jealousy involves intolerance of uncertainty
about negative events. The therapist asks the patient to examine the costs and benefits of
uncertainty, examples of uncertainty acceptance in daily life, and practice flooding one-
self with the uncertainty message (“I can never be sure if my partner will betray me”)
(Dugas, Buhr, & Ladouceur, 2004; Leahy, 2005b).
Teach Emotion Regulation Skills. Dialectical Behavior Therapy skills can assist the
patient in managing the intensity of the emotion. This can include examining emotional
myths, improving the moment, and stress reduction techniques (Linehan, 1993). The
patient can also be encouraged to use self–imposed “time–out” when jealousy and anger
escalate, so that she can remove herself temporarily from interactions with the partner
until she has used her emotion regulation skills.
Examine Emotional Schemas. Patients who are jealous often have dysfunctional be-
liefs about their emotions and the emotions of their partner. These beliefs include the
following: “I cannot accept my feeling,” “I shouldn’t feel this way,” “I should not feel
ambivalent,” “I need to get rid of an unpleasant emotion immediately,” “If I allow my-
self to feel this way, I will be overwhelmed,” “Other people cause me to have these feel-
ings,” “If I ruminate or worry I might be able to get certainty,” and other beliefs about
emotion and coping with emotion (Leahy, 2002, 2007). Cognitive therapy techniques
COGNITIVE BEHAVIORAL THERAPY FOR JEALOUSY 23
and behavioral and experiential experiments can be used to test out these beliefs and
strategies about emotion. Emotion intolerance and over–control of emotion can be re-
placed by self–validation, acceptance, and emotion regulation skills.
Examine Cognitive Biases. This phase of treatment employs traditional cognitive
therapy techniques such as eliciting automatic thoughts (“Mind–reading,” “personaliz-
ing,” “labeling”) and vertical descent (“If my partner is attracted to someone it means
she will leave me which means I am a loser and no one would want me”). The therapist
can examine the costs and benefits, evidence for and against, double–standard tech-
nique, and alternative interpretations.
Examine Personal Schemas. Jealousy is often related to personal schemas about de-
fectiveness, unlovability, or sexual attractiveness. These schemas can be examined in
terms of origin of the schema, costs–benefits of the schema, and the use of other schema
focused techniques (Leahy, 2003; Leahy, Beck, & Beck, 2005; Young, Klosko, &
Weishaar, 2003).
Decastrophize Potential Loss. Jealousy is often an anxious appraisal that the loss of a
relationship would be devastating. The patient can examine the meaning of the loss: “If
this ended, I would be humiliated,” “I could never trust anyone,” “This confirms I am
unlovable,” and “I would not be able to take care of myself.” Beliefs about the
essentiality of a specific relationship for one’s life can be tested by examining alternatives
available for a meaningful life independent of the relationship, including how life had
meaning prior to the relationship.
Modify Assumptions about Coercive Control. Jealous partners often have beliefs that
they can coerce their partner into “staying,” by punishing them, devaluing the competi-
tion, and threatening self–harm. These beliefs can be examined in terms of setting up a
self–fulfilling prophecy—that the partner will leave because of the coercion, not neces-
sarily because of another option.
Build Relationship Enhancement Skills. Since many relationships can focus on jeal-
ousy to the exclusion of productive behavior, the therapist can assist the patient in de-
creasing destructive behavior (withholding, contempt, stone–walling, criticizing,
labeling, and mind–reading) and increasing positive behavior (positive tracking, re-
ward, active listening skills, developing shared activities, and validating the partner that
one’s jealousy has been damaging)
Commit to Self–Care. Jealousy tethers one’s feelings to the actions and thoughts of
another person in an angry, struggling dependency. The therapist can focus the patient
on personal goals and values that are independent of the other person. Thus, the patient
can be encouraged to develop supportive friendships, independent activities and inter-
ests, involvement in community activities, and valued work. This can reduce the sense of
desperate dependency and over–focus on the relationship.
CASE STUDY IN CBT FOR JEALOUSY
The patient was a 37–year old Caucasian male, who originally presented for the treat-
ment of panic attacks and persistent intrusive thoughts. His intrusive thoughts involved
a fear that he might accidentally impregnate his long–term girlfriend. After he success-
24 LEAHY AND TIRCH
fully completed a short–term CBT intervention for panic disorder, and effectively em-
ployed verbal exposure and reappraisal of meta–cognitions involving obsessive
thoughts, the primary focus of the sessions was on his experience of intense jealousy
regarding his partner.
As the patient had already been introduced to some of the fundamental compo-
nents of the CBT model of anxiety and dysfunctional thinking earlier in his therapy, he
reported a belief that his subsequent work to address jealousy was based on a “solid
foundation.” The multi–modal CBT model that was employed followed the steps out-
lined in “The Worry Cure,” (Leahy, 2005b) and the patient used this book as a compen-
dium of homework assignments, and as a reference throughout the course of therapy.
Develop a Case Conceptualization
The treatment of jealousy began with the development of a case conceptualization,
based on an assessment of his relationship to his problematic thoughts, feelings and be-
haviors associated with jealousy. The patient explained that he trusted his girlfriend a
great deal. She had never given him any “cause to be jealous” in the past. In fact, he re-
ported that she had never engaged in any infidelity throughout the course of her entire
relationship history. He felt enormously guilty for experiencing jealous feelings. He also
expressed embarrassment over his construction of imaginary scenarios during which he
would expose his girlfriend as having been unfaithful, and he would walk out.
The patient and therapist reviewed situations that had triggered jealousy in the
past. The patient was encouraged to focus on the earliest internal or external cue that he
could remember in these situations, and to begin his description of the situation from
just before that point. These triggers and cues were placed in a hierarchy of intensity and
the degree of distress they brought on.
During this assessment of jealousy related triggers, the patient’s examples were
highly detailed, and illustrated a prototypical pattern underlying his response. The pa-
tient reported that he and his partner spent a great deal of time together, when they were
not at work. The vast majority of their social and free time was spent in shared activities.
Also, the patient explained that he and his partner worked together at the same firm. Al-
though they did not see much of each other during the day, this did lead to frequent con-
tact and a sense of connection throughout the business day. When the patient concluded
his business day, he would typically meet his girlfriend and head home together.
On occasion, she would be delayed with her own work, or would be involved in af-
ter–work social gatherings. Both of these situations involved her spending time with
men. At such times, the patient would begin to feel a “flush” of jealousy. This jealousy
was particularly pronounced when his girlfriend appeared “evasive” or “secretive” about
the nature of her meeting with men. The patient would typically respond to this with a
series of overt behaviors and internal responses. His observable behavior usually in-
cluded a persistent, if polite, “interrogation” of his girlfriend. He would attempt to seem
unconcerned while repeatedly asking her for more details. This strategy would usually
become rather transparent to her and she would then provide reassurance that she was
trustworthy and faithful. After receiving this reassurance, the patient would cease his
questioning, and spend his time in isolated worry and rumination. Persistent “what if”
COGNITIVE BEHAVIORAL THERAPY FOR JEALOUSY 25
cognitions regarding her potential infidelity would flood his mind, followed by harsh
self–criticism for having these feelings and thoughts in the first place.
Validate and Inquire
Following this assessment, a psychoeducational intervention involving the nature of
jealousy proceeded. The patient and therapist discussed jealousy as a form of anxious,
angry and agitated worry. As such, jealous cognitions were explained as functioning as a
threat perception mechanism. An evolutionary model, which described jealousy as a
simple response to the perception of a potential threat to the patient’s relationship was
discussed. Rather than viewing the initial “spark” of jealousy as a problematic or patho-
logical reaction, the patient was encouraged to observe this response as a valid and
“all–too–human” tendency, which could be dealt with, coped with, or simply sat with
rather than acted upon. The patient and therapist clarified the aim of the treatment as in-
volving the cultivation of an ability to notice, tolerate, and regulate the jealousy response
rather than as an attempt to avoid any feelings of jealousy and apprehension altogether.
Rather than pursuing a goal of “not being jealous,” the patient was taught to distinguish
between“productive” and “non–productive” jealousy based predictions, and the
foundation for a flexible response strategy was put in place.
Assess Motivation to Change
The next step in the treatment involved assessing the patient’s motivation to change. Al-
though the patient described an intense desire to “get a handle” on his jealousy, he ad-
mitted some ambivalence about this. In truth, he still held on to a belief that his
hypervigilance and jealousy–based predictions may be protecting him and his relation-
ship from future problems. The patient and therapist reviewed his history of struggling
with jealousy, and explored the costs and benefits of his continuing to relate to his part-
ner and his jealousy in the way he had been ‘Upon review, the costs of buying into jeal-
ous thoughts, and struggling against both his experience and his girlfriend’ seemed to
clearly outweigh the benefits.
Between sessions, the patient was given a modified “Worry Log” (“Jealous Cogni-
tion Log”) which he would use to document the times, places, and situations, during
which he would feel intense jealousy. He would also use the log to rate his anxiety in
these situations, and to examine his jealousy based predictions.
Use Mindful Awareness and Practice Acceptance
During the next session, the patient brought in his Jealous Cognitions Log and the ther-
apist and patient debriefed around those times during the week when the patient felt
jealous. The patient and therapist then began a brief period of training in mindful aware-
ness and tolerance of difficult emotional experiences. The patient and therapist reviewed
the applied concept of “radical acceptance,” whereby the patient might adopt an observ-
ing stance and examine his reality not in the way he feared or insisted it to be, but as it is
26 LEAHY AND TIRCH
in the present moment. The patient was taught to notice the initial flush of jealousy in
the body. This was facilitated in session by engaging in a brief affect–induction proce-
dure involving an imaginary situation that would typically evoke jealousy. Following
this experiential example, the patient was taught a fundamental mindfulness of the
breath exercise. This 7–minute exercise involved focusing a nonjudgmental and accept-
ing awareness upon the physical sensations involved in the act of breathing. When dis-
tracting thoughts, images and feelings would arise, the patient was taught to address
these with an observing stance, merely labeling the experience, and gently directing at-
tention back to the breath. The patient began to practice this daily as a “preparatory” ex-
ercise for the applied mindfulness and acceptance techniques involved in coping with
jealousy. These techniques appealed to the patient, as he had greatly enjoyed the
“relaxation” and stress reducing effects found in a yoga class, which he found similar.
Defuse Thoughts and Feelings and Teach Emotion Regulation Skills
As an initial “applied mindfulness” activity, the patient was taught to draw his attention
to his breath, to pause, and to notice the overall sensation of jealousy as it arose both in
sessions and in daily life. He was then encouraged to label the emotion using a “feeling
word.” Often this word was simply “jealous,” but it also could be “angry” or “frustrated”
depending upon the situation. After labeling this emotion, the patient was encouraged
to “dis–identify” or “de–fuse” from the emotion, by simply recognizing the emotion as
an event in his mind, rather than an all–consuming perspective with which he was iden-
tified. The patient and therapist used “coping cards” to provide self–validating state-
ments readily outside of session. These statements were focused on the patient’s ability
to tolerate distress and discomfort, and emphasized viewing anxiety as a manageable re-
sponse of the mind. Some also involved a re–appraisal of the jealousy. These statements
included “Jealousy is a normal emotional response,” “I can handle this without acting
out my emotions,” or simply “I can make space for this feeling and observe my
thoughts.” Additionally, the patient was taught ways of externalizing these thoughts in
the service of cognitive defusion. In fact, the patient improvised a defusion himself,
imagining the thoughts as billowing words written across the sky by a skywriting
airplane, which would gradually break up and fade into the air with time.
The patient reported that this process of distancing and self–validation felt “imme-
diately helpful” and he speculated that practicing this would help him to “be his own
therapist.” The patient’s homework after this session included the continued use of the
“Jealousy Log” and the regular practice of mindful acceptance and tolerance of
emotional responses.
After a week of working with these mindfulness exercises, the patient returned to
his next session concerned that he had avoided or procrastinated on this exercise, as he
had only practiced it three times during the week. Further discussion indicated that the
patient had simply failed to plan a regular time and place to engage in this exercise. This
simple detail allowed the patient to engage in a more disciplined practice over the next
several weeks.
COGNITIVE BEHAVIORAL THERAPY FOR JEALOUSY 27
Distinguish Between Productive and Unproductive Jealousy
During a subsequent session, the focus was on distinguishing between productive and
un–productive cognitions related to jealousy. The patient defined productive jealousy
worries as those that identified a plausible, reasonable problem with a viable and action-
able solution that was in the patient’s power to address. For example, if the patient had
actually discovered that his partner had been lying to him about something, he could ap-
propriately and effectively communicate with her about his observation and his re-
sponse and seek some sort of dialogue. The patient was clear that the jealous cognitions
he had been experiencing were unproductive, and appeared more unproductive as
greater rational attention was directed toward them.
Modify Assumptions About Coercive Control and Build
Relationship Enhancement Skills
At this point, the patient and therapist also discussed the need to implement effective
and ethically sound strategies for acting on any productive worries related to jealousy.
The patient and therapist reviewed the many practical and moral costs of verbally or
physically acting out on the basis of any frustration or hostility that may accompany jeal-
ousy. As the patient had no history of acting out and also had sufficient insight to see
that his jealousy based cognitions and predictions were baseless and unproductive, this
component of the intervention was easily addressed. By examining the possibility of
productive and unproductive cognitions and emotions, the patient reportedly felt fur-
ther validated with regards to the legitimacy of his emotional response, while not feeling
compelled to buy into his jealous thoughts. Rather than engage in experiential avoid-
ance or thought suppression through trying to “not be jealous” the patient was actively
engaging with his emotions and cognitions in an adaptive way. Homework included
ongoing use of relaxing breath and coping cards, self–validation, the log of jealous
cognitions, and the rating of jealousy based worries as productive or unproductive.
Use Uncertainty Training
During the assessment of the patient’s problems with jealousy, as well as during his ear-
lier treatment for anxiety disorder symptoms, the patient’s reluctance to accept and tol-
erate uncertainty became clear. Furthermore, a primary method of dealing with his
unacceptable intrusive thoughts and jealous cognitions appeared to be a combination of
futile attempts to suppress such thoughts, with a concomitant barrage of self–criticism
for his having such thoughts “in the first place.”
In order to facilitate his ability to overcome attempts at experiential avoidance, and
to assist in tolerance of uncertainty, the therapist employed metacognitive and exposure
based techniques for tolerating uncertainty. A primary technique employed was a form
of verbal exposure known as “uncertainty training.” During this homework exercise, the
patient would repeat the phrase “It is always possible that my girlfriend has been cheat-
ing,” over and over again, out loud, for a period of 15 minutes each day. As is the case
with other forms of verbal exposure, the patient recorded his level of anxiety upon re-
peating the phrase every three minutes during the exercise. After one week of daily prac-
28 LEAHY AND TIRCH
tice, the patient reported dramatically decreased anxiety when engaging in the practice
and when considering the uncertainty of his girlfriend’s fidelity.
Examine Cognitive Biases and Decatastrophize Potential Loss
After establishing this attitude of acceptance, implementing a regular mindfulness prac-
tice, working with affect tolerance, and increasing tolerance for uncertainty, the focus
turned to responding to dysfunctional jealousy cognitions. The patient employed
“cost/benefit” analyses of his thoughts, imagined and de–catastrophized the “worst case
scenario” that could emerge if his worried and jealous predictions were true, and exam-
ined the evidence for and against the cognitions that were troubling him. Many of these
techniques were familiar to him as he had employed them in the treatment of his earlier
problems with anxiety. Throughout any exercises in rational responding, the patient
was encouraged to adopt an “emotionally intelligent” attitude: rather than attempting
to argue down these thoughts, the patient and therapist began by recognizing these
thoughts as mental events and not reality itself. From this perspective, the patient would
emphasize labeling his emotions and contact with his emotions as they arose, employing
earlier methods of self–validation. Only from this point did the cognitive challenging
occur, and the patient was invited to engage in it with nearly a sense of play. By mind-
fully distancing himself from his jealous cognitions, the patient reported that he was
better able to apply cognitive therapy techniques to both craft more rational responses
to real–life situations and to consistently recognize the distinction between his thoughts
and “things in the world.” The patient reported that by not “identifying” with these
thoughts, they held less sway over him. Further, the patient suggested that this perspec-
tive allowed him to disengage from struggle against his “negative” experience, and base
his assessments of situations on a more reality based “headset.”
Examine Personal Schemas and Emotional Schemas
The therapist and patient together discussed ways that emotional schemas and assump-
tions about emotional experiences might be involved in the patient’s habitual patterns of
emotional avoidance. The patient reported that he had been raised by a domineering
and “traditional” male father, who had discouraged any outward display of emotion.
According to the patient the only expressions of emotion that were tolerable in his fam-
ily of origin were displays of aggression or frustration. The patient identified such emo-
tional schemas as, “Having fears and experiencing emotions makes me weak” and “I’m
not going to put up with feeling insecure” as key core beliefs about his emotions in his
relationship. The patient wrote a letter to the source of his schema, challenging the va-
lidity of the emotional dismissiveness in his family of origin. In addition, he kept a data
log to gather evidence to counter these negative emotional schemas on a daily basis.
Commit to Self–Care
The patient reported that the entire range of techniques employed had significantly re-
duced his distress regarding his response to “flashes” of jealousy. Although he might still
COGNITIVE BEHAVIORAL THERAPY FOR JEALOUSY 29
experience jealous feelings from time to time, he was reportedly far better able to recog-
nize the irrationality of the assumptions underlying them and to “keep them in perspec-
tive” while carrying on with a successful relationship. In order to help the patient build
upon his shift in perspective, the patient and therapist concluded their work in the area
of jealousy by engaging in skills training sessions concerning active listening, effectively
giving and receiving feedback, and validating his partner’s concerns and emotions. Ac-
cording to the patient’s report after a period of one year from the completion of this
phase of his work, he rarely experiences pathological or significantly distressing bouts of
jealousy and jealousy based worries.
CONCLUSIONS
Jealousy is often a destructive and refractory problem in relationships, sometimes result-
ing in the feared consequences it attempts to prevent. We have outlined an integrative
cognitive–behavioral model for conceptualizing and treating pathological jealousy,
while also recognizing the wisdom in validating the legitimacy of these emotions. By
conceptualizing jealousy as a form of agitated, angry worry, we can provide therapists
with the many advantageous interventions drawn from a variety of theoretical orienta-
tions. This integrative approach recognizes that thoughts, emotions, behaviors and rela-
tionships are all part of a single system and that interventions at all points can maximize
therapeutic effectiveness. Unlike prior approaches that stressed “personal insecurity” or
“distorted thinking,” the current approach incorporates meta–cognitive, meta–emo-
tional, and acceptance and mindfulness techniques. These techniques allow the patient
to accept discomfort, emotion, and uncertainty which may be an inevitable part of any
relationship.
30 LEAHY AND TIRCH
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An ACT Approach Chapter 1. What is Acceptance and Commitment Therapy? Steven C. Hayes, Kirk D. Strosahl, Kara Bunting, Michael Twohig, and Kelly G. Wilson Chapter 2. An ACT Primer: Core Therapy Processes, Intervention Strategies, and Therapist Competencies. Kirk D. Strosahl, Steven C. Hayes, Kelly G. Wilson and Elizabeth V. Gifford Chapter 3. ACT Case Formulation. Steven C. Hayes, Kirk D. Strosahl, Jayson Luoma, Alethea A. Smith, and Kelly G. Wilson ACT with Behavior Problems Chapter 4. ACT with Affective Disorders. Robert D. Zettle Chapter 5. ACT with Anxiety Disorders. Susan M. Orsillo, Lizabeth Roemer, Jennifer Block-Lerner, Chad LeJeune, and James D. Herbert Chapter 6. ACT with Posttraumatic Stress Disorder. Alethea A. Smith and Victoria M. Follette Chapter 7. ACT for Substance Abuse and Dependence. Kelly G. Wilson and Michelle R. Byrd Chapter 8. ACT with the Seriously Mentally Ill. Patricia Bach Chapter 9. ACT with the Multi-Problem Patient. Kirk D. Strosahl ACT with Special Populations, Settings, and Methods Chapter 10. ACT with Children, Adolescents, and their Parents. Amy R. Murrell, Lisa W. Coyne, & Kelly G. Wilson Chapter 11. ACT for Stress. Frank Bond. Chapter 12. ACT in Medical Settings. Patricia Robinson, Jennifer Gregg, JoAnne Dahl, & Tobias Lundgren Chapter 13. ACT with Chronic Pain Patients. Patricia Robinson, Rikard K. Wicksell, Gunnar L. Olsson Chapter 14. ACT in Group Format. Robyn D. Walser and Jacqueline Pistorello