Pub Date : 2021-08-01DOI: 10.1093/med-psych/9780197552155.003.0005
Daniel R. Strunk, A. A. Mandel, Iony D. Ezawa
Cognitive Therapy or Cognitive Behavioral Therapy (CBT) for depression is a well-studied, research-supported treatment. Contrary to common misconceptions about manual-based treatments, CBT can be provided with considerable flexibility. As the first manual-based treatment to be developed, it is remarkable that it is so principle-based and flexible. There is flexibility in focusing on the goals and topics of importance to clients. Therapists have discretion in determining how much to use various CBT strategies and determining how they might be used to meet the diverse needs of clients with depression. Because of the flexibility of CBT, therapists also have many options for determining what approach to use when a client does not initially respond well to an intervention. To ensure that CBT offers the therapeutic benefits that have been identified and supported in clinical trials, the treatment also needs to be provided with fidelity to the manual. Despite their limitations, observer ratings of competence remain the standard for ensuring that CBT is provided with fidelity.
{"title":"Being Flexible While Maintaining Fidelity in Cognitive Behavioral Therapy of Depression","authors":"Daniel R. Strunk, A. A. Mandel, Iony D. Ezawa","doi":"10.1093/med-psych/9780197552155.003.0005","DOIUrl":"https://doi.org/10.1093/med-psych/9780197552155.003.0005","url":null,"abstract":"Cognitive Therapy or Cognitive Behavioral Therapy (CBT) for depression is a well-studied, research-supported treatment. Contrary to common misconceptions about manual-based treatments, CBT can be provided with considerable flexibility. As the first manual-based treatment to be developed, it is remarkable that it is so principle-based and flexible. There is flexibility in focusing on the goals and topics of importance to clients. Therapists have discretion in determining how much to use various CBT strategies and determining how they might be used to meet the diverse needs of clients with depression. Because of the flexibility of CBT, therapists also have many options for determining what approach to use when a client does not initially respond well to an intervention. To ensure that CBT offers the therapeutic benefits that have been identified and supported in clinical trials, the treatment also needs to be provided with fidelity to the manual. Despite their limitations, observer ratings of competence remain the standard for ensuring that CBT is provided with fidelity.","PeriodicalId":306433,"journal":{"name":"Flexibility within Fidelity","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127544846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01DOI: 10.1093/med-psych/9780197552155.003.0012
J. Lochman, Nicole P. Powell, Shannon Jones
Flexible adaptations of the Coping Power Program have been made for the delivery of the program. Coping Power is a structured, manualized cognitive-behavioral program, with components for children and parents designed to alter targeted mechanisms that contribute to children’s aggressive behavior problems. The program originated as a targeted prevention program, delivered in school settings, but also has been applied and tested in clinical settings. The contextual social-cognitive model is described, followed by a brief description of program components, of fidelity assessment, and of results from several initial randomized controlled efficacy studies. The bulk of the chapter describes two types of adaptations of the program. The first adaptation is evident in a field trial study of real-world school counselors’ use of the program, and was affected by the intensity of training that counselors received and by their own characteristics and the characteristics of their work setting. Appropriate and inappropriate adaptions were observed, with appropriate adaptations illustrating the concept of flexibility within fidelity. The second type of adaptation involves efforts to optimize the program and to test planned changes. The chapter describes evaluations of planned adaptations to the length of the program (including Internet components), to program targets through inclusion of mindfulness training, to delivery of the program in group versus individual formats, and to a variety of changes made in the structure and cultural relevance of the program in international adaptations.
{"title":"The Coping Power Program for Children with Aggressive Behavior Problems","authors":"J. Lochman, Nicole P. Powell, Shannon Jones","doi":"10.1093/med-psych/9780197552155.003.0012","DOIUrl":"https://doi.org/10.1093/med-psych/9780197552155.003.0012","url":null,"abstract":"Flexible adaptations of the Coping Power Program have been made for the delivery of the program. Coping Power is a structured, manualized cognitive-behavioral program, with components for children and parents designed to alter targeted mechanisms that contribute to children’s aggressive behavior problems. The program originated as a targeted prevention program, delivered in school settings, but also has been applied and tested in clinical settings. The contextual social-cognitive model is described, followed by a brief description of program components, of fidelity assessment, and of results from several initial randomized controlled efficacy studies. The bulk of the chapter describes two types of adaptations of the program. The first adaptation is evident in a field trial study of real-world school counselors’ use of the program, and was affected by the intensity of training that counselors received and by their own characteristics and the characteristics of their work setting. Appropriate and inappropriate adaptions were observed, with appropriate adaptations illustrating the concept of flexibility within fidelity. The second type of adaptation involves efforts to optimize the program and to test planned changes. The chapter describes evaluations of planned adaptations to the length of the program (including Internet components), to program targets through inclusion of mindfulness training, to delivery of the program in group versus individual formats, and to a variety of changes made in the structure and cultural relevance of the program in international adaptations.","PeriodicalId":306433,"journal":{"name":"Flexibility within Fidelity","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122734330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01DOI: 10.1093/med-psych/9780197552155.003.0004
C. Sloan, Scott D. Litwack, D. Sloan
This chapter describes the theoretical models behind evidence-based post-traumatic stress disorder (PTSD) treatments and the importance of adhering to the model of PTSD treatment when making adaptations to treatment protocols. We review modifications that might be made for both exposure-based and cognitive-based treatment approaches, rooted in their respective underlying theories. We also describe modifications to the delivery of treatment (e.g., number and duration of treatment sessions, method of treatment delivery, and location where treatment is delivered). Throughout the chapter, we emphasize that decisions regarding modifications should aim to foster mechanisms of change, based on theoretical models, and implemented to maximize treatment outcomes.
{"title":"Post-Traumatic Stress Disorder Treatment with Adults","authors":"C. Sloan, Scott D. Litwack, D. Sloan","doi":"10.1093/med-psych/9780197552155.003.0004","DOIUrl":"https://doi.org/10.1093/med-psych/9780197552155.003.0004","url":null,"abstract":"This chapter describes the theoretical models behind evidence-based post-traumatic stress disorder (PTSD) treatments and the importance of adhering to the model of PTSD treatment when making adaptations to treatment protocols. We review modifications that might be made for both exposure-based and cognitive-based treatment approaches, rooted in their respective underlying theories. We also describe modifications to the delivery of treatment (e.g., number and duration of treatment sessions, method of treatment delivery, and location where treatment is delivered). Throughout the chapter, we emphasize that decisions regarding modifications should aim to foster mechanisms of change, based on theoretical models, and implemented to maximize treatment outcomes.","PeriodicalId":306433,"journal":{"name":"Flexibility within Fidelity","volume":"232 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116172871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01DOI: 10.1093/med-psych/9780197552155.003.0014
Jennifer R. Alexander, Jordan T. Stiede, D. Woods
This chapter explores the treatment of trichotillomania (TTM; also referred to as hair pulling disorder) and Tourette disorder (TD). TTM and TD exist in separate diagnostic categories but exhibit functional similarities and respond to similar treatments. The chapter reviews the characteristics of each disorder. It then describes habit reversal training (HRT) and function-based interventions, which serve as core therapeutic elements in the treatment of both TTM and TD. The chapter also discusses additional treatment strategies that occur as part of standard protocols for both disorders, before looking at the treatment efficacy research. It considers the key features of the manual-based treatments (behavior therapy protocols), as well as ways these protocols can be flexibly implemented for those with TTM and TD. Finally, consistent with the call for “flexibility within fidelity,” the chapter provides an example of a flexible implementation of these treatments.
{"title":"Tourette and Trichotillomania","authors":"Jennifer R. Alexander, Jordan T. Stiede, D. Woods","doi":"10.1093/med-psych/9780197552155.003.0014","DOIUrl":"https://doi.org/10.1093/med-psych/9780197552155.003.0014","url":null,"abstract":"This chapter explores the treatment of trichotillomania (TTM; also referred to as hair pulling disorder) and Tourette disorder (TD). TTM and TD exist in separate diagnostic categories but exhibit functional similarities and respond to similar treatments. The chapter reviews the characteristics of each disorder. It then describes habit reversal training (HRT) and function-based interventions, which serve as core therapeutic elements in the treatment of both TTM and TD. The chapter also discusses additional treatment strategies that occur as part of standard protocols for both disorders, before looking at the treatment efficacy research. It considers the key features of the manual-based treatments (behavior therapy protocols), as well as ways these protocols can be flexibly implemented for those with TTM and TD. Finally, consistent with the call for “flexibility within fidelity,” the chapter provides an example of a flexible implementation of these treatments.","PeriodicalId":306433,"journal":{"name":"Flexibility within Fidelity","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129650806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01DOI: 10.1093/med-psych/9780197552155.003.0011
Lara S. Rifkin, Lindsay B. Myerberg, Elizabeth A. Gosch, Lesley A. Norris, Margaret E. Crane, P. Kendall
This chapter addresses the treatment of youth anxiety. Cognitive behavioral therapy (CBT) for youth anxiety, as illustrated by the Coping Cat program, is implemented flexibly based on considerations including age/developmental level, co-occurring disorders, socioeconomic status, and cultural factors to enhance outcomes. For fidelity, the program adheres to key components: building rapport, providing psychoeducation about anxiety, addressing anxious self-talk, conducting exposures, assigning homework, and providing rewards/praise. The essential components, however, are applied with flexibility. Ultimately, research is needed to evaluate strategies to increase continued fidelity to the core components of treatment. Peer consultation and supervision may be valuable for maintaining fidelity while flexibly applying the program to a specific client.
{"title":"How to Bend but Not Break an Empirically Supported Treatment for Anxiety in Youth","authors":"Lara S. Rifkin, Lindsay B. Myerberg, Elizabeth A. Gosch, Lesley A. Norris, Margaret E. Crane, P. Kendall","doi":"10.1093/med-psych/9780197552155.003.0011","DOIUrl":"https://doi.org/10.1093/med-psych/9780197552155.003.0011","url":null,"abstract":"This chapter addresses the treatment of youth anxiety. Cognitive behavioral therapy (CBT) for youth anxiety, as illustrated by the Coping Cat program, is implemented flexibly based on considerations including age/developmental level, co-occurring disorders, socioeconomic status, and cultural factors to enhance outcomes. For fidelity, the program adheres to key components: building rapport, providing psychoeducation about anxiety, addressing anxious self-talk, conducting exposures, assigning homework, and providing rewards/praise. The essential components, however, are applied with flexibility. Ultimately, research is needed to evaluate strategies to increase continued fidelity to the core components of treatment. Peer consultation and supervision may be valuable for maintaining fidelity while flexibly applying the program to a specific client.","PeriodicalId":306433,"journal":{"name":"Flexibility within Fidelity","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125536127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01DOI: 10.1093/med-psych/9780197552155.003.0013
Donna B. Pincus, Laura Nelson Darling, Ovsanna Leyfer
Panic disorder often is referred to as one of the most impairing psychological disorders to affect adolescents, and if left untreated, it can detrimentally impact an adolescent’s developmental trajectory and increase their risk for other mental health disorders. Treating panic disorder at its earliest stages is critical. Fortunately, the development and testing of psychological treatment protocols for panic disorder in adolescence has progressed meaningfully. For patients to receive maximum benefit from a manual-based therapy for adolescent panic, it is necessary for therapists not only to deliver its core therapeutic components, but also to recognize the importance of a flexible, patient-focused delivery. We provide a description of each of the core treatment components required to maintain fidelity when treating adolescent panic, as well as components or variations that are considered “optional” depending on the patient’s needs. We review data on important factors that should be considered as well as how information about these factors can inform the flexible implementation and improve outcome. Together, knowledge from empirical studies on panic disorder combined with careful consideration of how to be flexible provide guidance for delivering a treatment for adolescent panic.
{"title":"Delivering Treatment for Adolescent Panic Disorder with Flexibility and Fidelity","authors":"Donna B. Pincus, Laura Nelson Darling, Ovsanna Leyfer","doi":"10.1093/med-psych/9780197552155.003.0013","DOIUrl":"https://doi.org/10.1093/med-psych/9780197552155.003.0013","url":null,"abstract":"Panic disorder often is referred to as one of the most impairing psychological disorders to affect adolescents, and if left untreated, it can detrimentally impact an adolescent’s developmental trajectory and increase their risk for other mental health disorders. Treating panic disorder at its earliest stages is critical. Fortunately, the development and testing of psychological treatment protocols for panic disorder in adolescence has progressed meaningfully. For patients to receive maximum benefit from a manual-based therapy for adolescent panic, it is necessary for therapists not only to deliver its core therapeutic components, but also to recognize the importance of a flexible, patient-focused delivery. We provide a description of each of the core treatment components required to maintain fidelity when treating adolescent panic, as well as components or variations that are considered “optional” depending on the patient’s needs. We review data on important factors that should be considered as well as how information about these factors can inform the flexible implementation and improve outcome. Together, knowledge from empirical studies on panic disorder combined with careful consideration of how to be flexible provide guidance for delivering a treatment for adolescent panic.","PeriodicalId":306433,"journal":{"name":"Flexibility within Fidelity","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129572227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01DOI: 10.1093/med-psych/9780197552155.003.0007
Mira Reichman, V. Grunberg, James D. Doorley, J. Bakhshaie, E. Lester, R. Mace, A. Vranceanu
For health psychologists, flexibility within fidelity is required to address the individual patient factors resulting from the dual physical and psychosocial comorbidities that characterize medical populations, and the contextual factors arising from the complexities of medical settings and multidisciplinary medical teams. This chapter presents a model for flexibility within fidelity for medical populations, addressing flexibility both in the delivery of treatments to patients (i.e., patient-centered flexibility) and in collaborations with multidisciplinary medical teams (i.e., team-based flexibility). We provide examples from our clinical research to illustrate how flexibility within fidelity can be employed for medical patients and offer recommendations to health psychology researchers and providers for exercising thoughtful clinical decision-making in the delivery of evidence-based interventions.
{"title":"Being Flexible While Maintaining Fidelity for Medical Patients","authors":"Mira Reichman, V. Grunberg, James D. Doorley, J. Bakhshaie, E. Lester, R. Mace, A. Vranceanu","doi":"10.1093/med-psych/9780197552155.003.0007","DOIUrl":"https://doi.org/10.1093/med-psych/9780197552155.003.0007","url":null,"abstract":"For health psychologists, flexibility within fidelity is required to address the individual patient factors resulting from the dual physical and psychosocial comorbidities that characterize medical populations, and the contextual factors arising from the complexities of medical settings and multidisciplinary medical teams. This chapter presents a model for flexibility within fidelity for medical populations, addressing flexibility both in the delivery of treatments to patients (i.e., patient-centered flexibility) and in collaborations with multidisciplinary medical teams (i.e., team-based flexibility). We provide examples from our clinical research to illustrate how flexibility within fidelity can be employed for medical patients and offer recommendations to health psychology researchers and providers for exercising thoughtful clinical decision-making in the delivery of evidence-based interventions.","PeriodicalId":306433,"journal":{"name":"Flexibility within Fidelity","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127728742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01DOI: 10.1093/med-psych/9780197552155.003.0006
M. Franklin, Sarah G. Turk Karan
This chapter assesses which treatment should be chosen as the first-line intervention for obsessive-compulsive disorder (OCD). Cognitive Behavioral Therapy (CBT) involving Exposure Plus Response Prevention (ERP) is the treatment with the most empirical support, and its effects appear to be both robust and durable. The chapter then reviews the data on predictors and moderators of differential ERP outcomes. Contemporary ERP manuals emphasize the following core procedures: (1) psychoeducation; (2) hierarchy development; (3) in vivo and imaginal exposure; (4) response prevention; and (5) relapse prevention. The chapter looks at situations in which clinical circumstances dictate a deviation or modification of the protocol from the way these procedures are described in the manual or customarily implemented—being flexible while maintaining fidelity. Therapist experience appears to play a role in how comfortable clinicians are in being flexible, and how successful they are likely to be when they do so.
{"title":"Empirically Supported Treatment for Obsessive-Compulsive Disorder","authors":"M. Franklin, Sarah G. Turk Karan","doi":"10.1093/med-psych/9780197552155.003.0006","DOIUrl":"https://doi.org/10.1093/med-psych/9780197552155.003.0006","url":null,"abstract":"This chapter assesses which treatment should be chosen as the first-line intervention for obsessive-compulsive disorder (OCD). Cognitive Behavioral Therapy (CBT) involving Exposure Plus Response Prevention (ERP) is the treatment with the most empirical support, and its effects appear to be both robust and durable. The chapter then reviews the data on predictors and moderators of differential ERP outcomes. Contemporary ERP manuals emphasize the following core procedures: (1) psychoeducation; (2) hierarchy development; (3) in vivo and imaginal exposure; (4) response prevention; and (5) relapse prevention. The chapter looks at situations in which clinical circumstances dictate a deviation or modification of the protocol from the way these procedures are described in the manual or customarily implemented—being flexible while maintaining fidelity. Therapist experience appears to play a role in how comfortable clinicians are in being flexible, and how successful they are likely to be when they do so.","PeriodicalId":306433,"journal":{"name":"Flexibility within Fidelity","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133524175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01DOI: 10.1093/med-psych/9780197552155.003.0010
Haley M. Brickman, M. Fristad
Bipolar spectrum disorders (BPSD) affect approximately 3.9% of youth and are associated with meaningful impairments across social, academic, and family domains. Early psychosocial treatment, in conjunction with psychotropic intervention, can ameliorate the negative impact of symptoms by equipping youth and their families with knowledge and skills to promote understanding and management of the disorder, leading to improved short- and long-term outcomes. Family-focused treatment for adolescents (FFT-A), family-focused cognitive behavioral therapy (CFF-CBT), and psychoeducational psychotherapy (PEP) represent a well-established class of manual-based interventions that have been found to improve mood symptoms and family functioning through the use of family psychoeducation and skill building. We detail and discuss the core components of these interventions, with a specific focus on how treatment components can be successfully adapted and delivered to ensure an individualized approach for optimal care. Flexibility is further illustrated by a depiction of ways in which PEP has been adapted to meet practical needs of families and clinicians while maintaining fidelity to the intervention.
{"title":"Flexible Applications of Family-Based Therapy for Youth with Bipolar Spectrum Disorders","authors":"Haley M. Brickman, M. Fristad","doi":"10.1093/med-psych/9780197552155.003.0010","DOIUrl":"https://doi.org/10.1093/med-psych/9780197552155.003.0010","url":null,"abstract":"Bipolar spectrum disorders (BPSD) affect approximately 3.9% of youth and are associated with meaningful impairments across social, academic, and family domains. Early psychosocial treatment, in conjunction with psychotropic intervention, can ameliorate the negative impact of symptoms by equipping youth and their families with knowledge and skills to promote understanding and management of the disorder, leading to improved short- and long-term outcomes. Family-focused treatment for adolescents (FFT-A), family-focused cognitive behavioral therapy (CFF-CBT), and psychoeducational psychotherapy (PEP) represent a well-established class of manual-based interventions that have been found to improve mood symptoms and family functioning through the use of family psychoeducation and skill building. We detail and discuss the core components of these interventions, with a specific focus on how treatment components can be successfully adapted and delivered to ensure an individualized approach for optimal care. Flexibility is further illustrated by a depiction of ways in which PEP has been adapted to meet practical needs of families and clinicians while maintaining fidelity to the intervention.","PeriodicalId":306433,"journal":{"name":"Flexibility within Fidelity","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127660248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01DOI: 10.1093/med-psych/9780197552155.003.0003
Amy R. Sewart, M. Craske
This chapter outlines various empirically supported cognitive-behavioral strategies driven by current understanding of worry-related mechanisms that may be implemented in the treatment of chronic worry. Excessive and uncontrollable worry is reliably observed across anxiety disorders, and it is most evident in generalized anxiety disorder (GAD), of which it is the cardinal symptom. At present, achieving treatment fidelity for cognitive behavioral therapy (CBT) for excessive worry requires cognitive restructuring—wherein targets can range from challenging overestimation of likelihood, severity of negative outcomes, or metacognitive beliefs about worry—and exposure, either in vivo or imaginal, as a means to provide extinction learning around feared outcomes involving uncertainty or aversive emotional experiences. It also requires behavioral experimentation through which worry-related cognitions are tested and challenged through “real-life” experiences, which may involve stimulus control/worry postponement; explicit removal of safety behaviors throughout all components of treatment; and incorporation of strategies to enhance problem orientation. Using a case formulation-driven approach, these elements can be flexibly applied in a systematic, responsive, and data-driven manner to target the deficits present in the individual.
{"title":"Flexible Principles for the Treatment of Adult Worry","authors":"Amy R. Sewart, M. Craske","doi":"10.1093/med-psych/9780197552155.003.0003","DOIUrl":"https://doi.org/10.1093/med-psych/9780197552155.003.0003","url":null,"abstract":"This chapter outlines various empirically supported cognitive-behavioral strategies driven by current understanding of worry-related mechanisms that may be implemented in the treatment of chronic worry. Excessive and uncontrollable worry is reliably observed across anxiety disorders, and it is most evident in generalized anxiety disorder (GAD), of which it is the cardinal symptom. At present, achieving treatment fidelity for cognitive behavioral therapy (CBT) for excessive worry requires cognitive restructuring—wherein targets can range from challenging overestimation of likelihood, severity of negative outcomes, or metacognitive beliefs about worry—and exposure, either in vivo or imaginal, as a means to provide extinction learning around feared outcomes involving uncertainty or aversive emotional experiences. It also requires behavioral experimentation through which worry-related cognitions are tested and challenged through “real-life” experiences, which may involve stimulus control/worry postponement; explicit removal of safety behaviors throughout all components of treatment; and incorporation of strategies to enhance problem orientation. Using a case formulation-driven approach, these elements can be flexibly applied in a systematic, responsive, and data-driven manner to target the deficits present in the individual.","PeriodicalId":306433,"journal":{"name":"Flexibility within Fidelity","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128566156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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