Journal of Clinical Psychology最新文献

Exposure exercises as seen in cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) are standard in the treatment of obsessive-compulsive disorder (OCD). In the last two decades, additional research has been conducted on acceptance and commitment therapy (ACT) and the ways that exposure exercises are conducted from an ACT model. Empirical support for conducting exposures from an ACT model exists. Group level statistics suggest that ACT with ACT-based exposures is as effective as traditional ERP or CBT. A key component of ACT and values-based exposures is the focus on teaching psychological flexibility to allow for engagement with values-based exposures. In this case study, we present an adult woman with OCD who completed 24 sessions of ACT+ values-based exposures. Client scores on the Y-BOCS decreased from severe levels to mild-moderate levels through treatment. Additionally, the client was more actively engaged in her life and reported greater quality of life at the conclusion of treatment. The goal of this case study is to demonstrate how values-based exposures can be used in the treatment of OCD.

Cognitive Behavioral Therapy (CBT) with an emphasis on Exposure and Response Prevention (ERP) has consistently been observed to be an efficacious treatment for obsessive-compulsive disorder (OCD). Although ERP is currently considered the gold-standard, first-line psychological treatment, individuals with chronic fluctuations in symptom presentations or especially severe cases may require additional supplements to exposure that maximize learning and facilitate greater generalization of learning experiences. The present case study serves as an example of how traditional aspects of exposure-based CBT (e.g., psychoeducation, hierarchy building, functional analysis, homework) can be successfully used in addition to leveraging more contemporary stylistic modifications (e.g., explicit expectancy violation, context variability) that may optimize treatment in complex or difficult cases. In the present case study of a patient with contamination-based OCD, functional impairment and disorder symptoms responded to treatment and remained improved at a 3-month follow-up. Implications of the case study are discussed and recommendations are offered for clinicians treating complex or challenging OCD cases.

In this case study we present the course of the psychotherapy of Myriam, a 19-year old female with a severe personality disorder and comorbid eating disorder. During the initial assessment she reported high levels of neuroticism that parallel the diagnosis of obsessive-compulsive personality disorder, borderline personality disorder, and anorexia nervosa. Myriam showed a severely impaired personality functioning defined by perfectionism, self-criticism, interpersonal guilt and overcontrol. Her daily experience was shaped by a self-recriminative inner dialogue associated with maladaptive patterns in the form of food, water and sleep restrictions, self-harm behaviors, and suicidal ideation. She accessed an integrative treatment based on individual (Evolutionary Systems Therapy) and group psychotherapy (Mindful Compassion for Perfectionism). At the end of 14-month intervention she remitted from all the categorical diagnoses and showed reliable changes in several measures. These outcomes were maintained at 3-month follow-up. We describe the integrative conceptualization based on Myriam's perfectionistic self-recrimination patterns, and the consequent treatment that targeted these patterns rather than focusing on symptom reduction exclusively.

Virtual reality exposure therapy (VRE) has been used in the treatment of combat-related PTSD since the late 1990s and was recently adapted to treat PTSD due to military sexual trauma (MST). With content specifically tailored to MST-related contexts, we present the case study of a military veteran who participated in the open clinical trial examining the feasibility of VRE in the treatment of MST-related PTSD (Loucks et al. 2019). We illustrate VRE's use in activating the trauma memory to facilitate therapeutic emotional processing across sessions and overall symptom reduction. The case study includes common challenges that may occur during VRE and relevant recommendations. The discussion will include lessons learned from the case study and the open clinical trial, recommendations for the flexible application of VRE, and the ongoing developments in the latest version of the VRE system, informed by feedback acquired from the clinicians and patients who experienced it in the initial clinical trial.