Pub Date : 2024-09-14DOI: 10.1177/15346501241278297
Shannon B. Underwood, Sara V. White, John P. Forsyth
The current case describes the implementation of Acceptance and Commitment Therapy (ACT) and self-compassion interventions with a 37-year-old Queer Hispanic woman “Cynthia” (pseudonym). Cynthia presented to a university training clinic, reporting pervasive difficulties with anxiety, an associated pattern of depressive episodes, and a trauma history. The therapist conceptualized Cynthia’s presenting problems through an ACT-based psychological flexibility framework. Functional analysis indicated intolerance of uncertainty, fusion to self-critical thoughts, and experientially avoidant behaviors (e.g., pervasive worry) contributed to Cynthia’s anxiety. Values clarification, as well as mindfulness- and acceptance-based interventions, were met with gains in quality-of-life scores and decreases in worry scores as treatment progressed. Additionally, self-compassion interventions were implemented to address pervasive self-criticism and feelings of low self-worth. Across 37 sessions, from pre-to-post treatment, Cynthia’s quality of life scores increased by 62.5%, and worry decreased by 52.8%. These results provide support for using ACT and self-compassion interventions for anxiety and co-occurring depression with a Queer, Hispanic woman.
{"title":"Acceptance and Commitment Therapy (ACT) and Self-Compassion for Generalized Anxiety Disorder and Comorbid Major Depressive Disorder: A Case Study","authors":"Shannon B. Underwood, Sara V. White, John P. Forsyth","doi":"10.1177/15346501241278297","DOIUrl":"https://doi.org/10.1177/15346501241278297","url":null,"abstract":"The current case describes the implementation of Acceptance and Commitment Therapy (ACT) and self-compassion interventions with a 37-year-old Queer Hispanic woman “Cynthia” (pseudonym). Cynthia presented to a university training clinic, reporting pervasive difficulties with anxiety, an associated pattern of depressive episodes, and a trauma history. The therapist conceptualized Cynthia’s presenting problems through an ACT-based psychological flexibility framework. Functional analysis indicated intolerance of uncertainty, fusion to self-critical thoughts, and experientially avoidant behaviors (e.g., pervasive worry) contributed to Cynthia’s anxiety. Values clarification, as well as mindfulness- and acceptance-based interventions, were met with gains in quality-of-life scores and decreases in worry scores as treatment progressed. Additionally, self-compassion interventions were implemented to address pervasive self-criticism and feelings of low self-worth. Across 37 sessions, from pre-to-post treatment, Cynthia’s quality of life scores increased by 62.5%, and worry decreased by 52.8%. These results provide support for using ACT and self-compassion interventions for anxiety and co-occurring depression with a Queer, Hispanic woman.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"26 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-07DOI: 10.1177/15346501241283059
Max Z. Roberts, Eric D. Tifft, John P. Forsyth, James F. Boswell
The present case details a successful treatment response to 21 sessions of Acceptance and Commitment Therapy (ACT) delivered via teletherapy for mixed anxiety and depressive symptomology during the COVID-19 pandemic. The client (“Natalie”), a 19-year-old, White, cisgender female, presented to a university training clinic reporting primary problematic anxiety consistent with a diagnosis of Generalized Anxiety Disorder. The therapist conceptualized Natalie’s anxiety through the ACT psychological flexibility model, wherein Natalie’s challenges appeared to be maintained by experiential avoidance and lack of committed action. This case highlights (a) the unique challenges of treating someone with pervasive anxiety amid the uncertain context of the COVID-19 pandemic, (b) repeated assessment of transdiagnostic processes to inform intervention focus, and (c) the process of ACT teletherapy. Symptom, process, and outcome measures taken bi-weekly throughout therapy suggested theoretically consistent and reliable treatment responses. Clinical implications of the case are discussed.
{"title":"Acceptance and Commitment Teletherapy for Mixed Anxiety and Depressive Symptoms During the COVID-19 Pandemic: A case Study","authors":"Max Z. Roberts, Eric D. Tifft, John P. Forsyth, James F. Boswell","doi":"10.1177/15346501241283059","DOIUrl":"https://doi.org/10.1177/15346501241283059","url":null,"abstract":"The present case details a successful treatment response to 21 sessions of Acceptance and Commitment Therapy (ACT) delivered via teletherapy for mixed anxiety and depressive symptomology during the COVID-19 pandemic. The client (“Natalie”), a 19-year-old, White, cisgender female, presented to a university training clinic reporting primary problematic anxiety consistent with a diagnosis of Generalized Anxiety Disorder. The therapist conceptualized Natalie’s anxiety through the ACT psychological flexibility model, wherein Natalie’s challenges appeared to be maintained by experiential avoidance and lack of committed action. This case highlights (a) the unique challenges of treating someone with pervasive anxiety amid the uncertain context of the COVID-19 pandemic, (b) repeated assessment of transdiagnostic processes to inform intervention focus, and (c) the process of ACT teletherapy. Symptom, process, and outcome measures taken bi-weekly throughout therapy suggested theoretically consistent and reliable treatment responses. Clinical implications of the case are discussed.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-31DOI: 10.1177/15346501241279597
Nicholas David W. Smith, Julia Jordan, Heather Agazzi
Callous and unemotional (CU) traits are associated with an earlier onset of conduct problems in children. The presence of CU traits typically predicts a severe, stable, and aggressive pattern of behavior, especially when the onset of such behaviors begins in childhood. Children with conduct problems and CU continue to exhibit challenging behavior despite implementation of behavior management strategies compared to children with conduct problems alone. An emerging body of research suggests that Parent-Child Interaction Therapy (PCIT) specifically tailored to address the characteristics unique to CU traits (PCIT-CU) may be an effective intervention for children with conduct problems + CU. This case study presents the treatment of a 3-year-old boy using PCIT-CU who presents with oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder—combined presentation (ADHD-C), and CU traits. Both caregivers participated but were separated. Following the completion of treatment, conduct problems improved, parent ratings of CU traits decreased, and positive parenting practices increased. This case study adds to the growing literature in support of tailoring behavioral management training interventions for children with conduct problems + CU.
冷酷无情（CU）特质与儿童较早出现行为问题有关。CU特质的存在通常预示着严重、稳定和攻击性的行为模式，尤其是在儿童时期就开始出现此类行为时。与仅有品行问题的儿童相比，有品行问题并伴有 CU 的儿童尽管实施了行为管理策略，但仍会继续表现出具有挑战性的行为。一项新兴的研究表明，针对 CU 特质而专门定制的亲子互动疗法（PCIT）（PCIT-CU）可能是针对行为问题+CU 儿童的一种有效干预措施。本案例研究介绍了使用 PCIT-CU 对一名 3 岁男孩进行治疗的情况，该男孩患有对立违抗障碍 (ODD)、注意力缺陷/多动障碍-综合表现 (ADHD-C)，并伴有 CU 特征。两名照顾者都参与了治疗，但被分开了。治疗结束后，行为问题有所改善，家长对 CU 特征的评价有所下降，积极的教养方式有所增加。这项案例研究为越来越多的文献提供了新的资料，支持对有行为问题+CU的儿童进行量身定制的行为管理培训干预。
{"title":"Parent-Child Interaction Therapy with Separated Parents of a 3-Year-Old Child with Conduct Problems and Callous-Unemotional Traits","authors":"Nicholas David W. Smith, Julia Jordan, Heather Agazzi","doi":"10.1177/15346501241279597","DOIUrl":"https://doi.org/10.1177/15346501241279597","url":null,"abstract":"Callous and unemotional (CU) traits are associated with an earlier onset of conduct problems in children. The presence of CU traits typically predicts a severe, stable, and aggressive pattern of behavior, especially when the onset of such behaviors begins in childhood. Children with conduct problems and CU continue to exhibit challenging behavior despite implementation of behavior management strategies compared to children with conduct problems alone. An emerging body of research suggests that Parent-Child Interaction Therapy (PCIT) specifically tailored to address the characteristics unique to CU traits (PCIT-CU) may be an effective intervention for children with conduct problems + CU. This case study presents the treatment of a 3-year-old boy using PCIT-CU who presents with oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder—combined presentation (ADHD-C), and CU traits. Both caregivers participated but were separated. Following the completion of treatment, conduct problems improved, parent ratings of CU traits decreased, and positive parenting practices increased. This case study adds to the growing literature in support of tailoring behavioral management training interventions for children with conduct problems + CU.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"70 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.1177/15346501241278373
Jennifer E. Phillips, Kate O’Brien, Vicki Fritz, Ciara Incorvati
We report a case of a patient seen within Integrated Primary Care at a collegiate health center for treatment of comorbid idiopathic urticaria and anxiety. Following medical consultation within Primary Care, Emergency services, and Asthma and Allergy Specialists, Primary Care Behavioral Health services were consulted. Here, we describe the Behavioral Health Consultant (BHC) model within primary care and the collaborative nature of the model. The benefits of this collaboration allowed the patient’s primary care provider (PCP) to use appointment times efficiently and to rely on the BHC to address the complexities of the patient’s underlying stress and anxiety. We detail the ways in which the BHC model contributed to significant decreases in the patient’s symptoms of anxiety and depression. Finally, we recommend expansion of programs providing opportunities for training in the integrated primary care model.
{"title":"Anxiety Management in Chronic Idiopathic Urticaria within Integrated Primary Care","authors":"Jennifer E. Phillips, Kate O’Brien, Vicki Fritz, Ciara Incorvati","doi":"10.1177/15346501241278373","DOIUrl":"https://doi.org/10.1177/15346501241278373","url":null,"abstract":"We report a case of a patient seen within Integrated Primary Care at a collegiate health center for treatment of comorbid idiopathic urticaria and anxiety. Following medical consultation within Primary Care, Emergency services, and Asthma and Allergy Specialists, Primary Care Behavioral Health services were consulted. Here, we describe the Behavioral Health Consultant (BHC) model within primary care and the collaborative nature of the model. The benefits of this collaboration allowed the patient’s primary care provider (PCP) to use appointment times efficiently and to rely on the BHC to address the complexities of the patient’s underlying stress and anxiety. We detail the ways in which the BHC model contributed to significant decreases in the patient’s symptoms of anxiety and depression. Finally, we recommend expansion of programs providing opportunities for training in the integrated primary care model.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"59 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-17DOI: 10.1177/15346501241275202
Giuseppe Scimeca
The present case study describes the application of the eye movement desensitization and reprocessing (EMDR) approach to a patient experiencing the distressing memory of an act of apparent ‘maleficium.’ The patient was in treatment due to somatic symptom disorder. Transcripts from the EMDR desensitization session were used to qualitatively describe both the dysfunctional stored memories associated with the apparent sorcery and the healing associations contributing to the zeroing of the alleged subjective unit of disturbance. Changes in psychometric measures of symptoms showed that the patient experienced a relevant and unexpected reduction of different clinical outcomes, with a specific notable effect on the subjective evaluation of pain. An explanation based on adaptive information processing is offered to explain this last unexpected finding.
{"title":"Eye Movement Desensitization and Reprocessing of Maleficium: Case Study of a “Cursed” Woman Suffering From Unexplained Pain","authors":"Giuseppe Scimeca","doi":"10.1177/15346501241275202","DOIUrl":"https://doi.org/10.1177/15346501241275202","url":null,"abstract":"The present case study describes the application of the eye movement desensitization and reprocessing (EMDR) approach to a patient experiencing the distressing memory of an act of apparent ‘maleficium.’ The patient was in treatment due to somatic symptom disorder. Transcripts from the EMDR desensitization session were used to qualitatively describe both the dysfunctional stored memories associated with the apparent sorcery and the healing associations contributing to the zeroing of the alleged subjective unit of disturbance. Changes in psychometric measures of symptoms showed that the patient experienced a relevant and unexpected reduction of different clinical outcomes, with a specific notable effect on the subjective evaluation of pain. An explanation based on adaptive information processing is offered to explain this last unexpected finding.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"168 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1177/15346501241271982
Alyssa M. Medenblik, Todd M. Moore, Gregory L. Stuart
Posttraumatic stress disorder (PTSD) is a prevalent and concerning mental health diagnosis across the globe. There are multiple evidence-based treatments that have been shown to effectively treat PTSD, including cognitive processing therapy (CPT) and exposure-based interventions. This case study depicts using CPT for treating uncomplicated PTSD in a 28-year-old woman, while integrating brief exposure exercises in the client’s homework. These exercises helped target avoidance symptoms and acute distress as well as increase quality of life, such that the client was better able to engage in CPT. Follow up data indicated a significant reduction in PTSD symptoms as measured by the Posttraumatic Stress Disorder Checklist (PCL-5) such that she no longer met clinical criteria for a diagnosis of PTSD or experienced significant distress related to her trauma. This data reflects the utility of integrating other evidence-based exercises into manualized treatment to create nuanced, individualized treatment plans. Clinical and research implications regarding the utility of implementing an integrated, conceptualization-driven treatment approach are discussed.
{"title":"Integrating brief exposure exercises to support cognitive processing therapy for treatment of PTSD: A case study","authors":"Alyssa M. Medenblik, Todd M. Moore, Gregory L. Stuart","doi":"10.1177/15346501241271982","DOIUrl":"https://doi.org/10.1177/15346501241271982","url":null,"abstract":"Posttraumatic stress disorder (PTSD) is a prevalent and concerning mental health diagnosis across the globe. There are multiple evidence-based treatments that have been shown to effectively treat PTSD, including cognitive processing therapy (CPT) and exposure-based interventions. This case study depicts using CPT for treating uncomplicated PTSD in a 28-year-old woman, while integrating brief exposure exercises in the client’s homework. These exercises helped target avoidance symptoms and acute distress as well as increase quality of life, such that the client was better able to engage in CPT. Follow up data indicated a significant reduction in PTSD symptoms as measured by the Posttraumatic Stress Disorder Checklist (PCL-5) such that she no longer met clinical criteria for a diagnosis of PTSD or experienced significant distress related to her trauma. This data reflects the utility of integrating other evidence-based exercises into manualized treatment to create nuanced, individualized treatment plans. Clinical and research implications regarding the utility of implementing an integrated, conceptualization-driven treatment approach are discussed.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"37 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141884265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-28DOI: 10.1177/15346501241254747
Rachel M. Butler, Cheri A. Levinson
Exposure therapy has been examined as a treatment for eating disorders, but research has yet to determine how to adapt these approaches for those in larger bodies who experience weight stigma. This case study reports on the use of values-based exposure interventions to reduce body dissatisfaction and body-related concerns in a woman with binge eating disorder in a larger body. We used a values-based approach to mirror and body image exposure that focused on fear tolerance and valued actions, as opposed to belief disconfirmation or habituation-based approaches to exposure, which may invalidate weight stigmatizing experiences. The client was a white cisgender woman in her late 20’s with binge eating disorder and major depressive disorder enrolled in trial of Transdiagnostic Network-Informed Personalized Treatment for eating disorders. Symptoms were assessed at pre-, mid-, post-treatment and one-month follow-up. The client was highly satisfied with treatment and experienced clinically significant reductions in eating disorder symptoms and shape and weight concerns. Decreases in body dissatisfaction, feeling fat, and overvaluation of weight and shape were large. Clinical impairment decreased, and quality of life increased. A detailed description of the approach to body image exposure for those in larger bodies is provided. Using a values-based approach to body image exposures may help account for weight stigma experienced by those in larger bodies while decreasing avoidance of personally meaningful experiences, body dissatisfaction, and eating disorder symptoms.
{"title":"Addressing Body Dissatisfaction in Women in Larger Bodies Using Exposure-based Interventions: A Case Report","authors":"Rachel M. Butler, Cheri A. Levinson","doi":"10.1177/15346501241254747","DOIUrl":"https://doi.org/10.1177/15346501241254747","url":null,"abstract":"Exposure therapy has been examined as a treatment for eating disorders, but research has yet to determine how to adapt these approaches for those in larger bodies who experience weight stigma. This case study reports on the use of values-based exposure interventions to reduce body dissatisfaction and body-related concerns in a woman with binge eating disorder in a larger body. We used a values-based approach to mirror and body image exposure that focused on fear tolerance and valued actions, as opposed to belief disconfirmation or habituation-based approaches to exposure, which may invalidate weight stigmatizing experiences. The client was a white cisgender woman in her late 20’s with binge eating disorder and major depressive disorder enrolled in trial of Transdiagnostic Network-Informed Personalized Treatment for eating disorders. Symptoms were assessed at pre-, mid-, post-treatment and one-month follow-up. The client was highly satisfied with treatment and experienced clinically significant reductions in eating disorder symptoms and shape and weight concerns. Decreases in body dissatisfaction, feeling fat, and overvaluation of weight and shape were large. Clinical impairment decreased, and quality of life increased. A detailed description of the approach to body image exposure for those in larger bodies is provided. Using a values-based approach to body image exposures may help account for weight stigma experienced by those in larger bodies while decreasing avoidance of personally meaningful experiences, body dissatisfaction, and eating disorder symptoms.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"19 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141170065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-08DOI: 10.1177/15346501241245434
Karen Bell-Weinberg, Michelle Kelly
Caring for a person with dementia can negatively impact the physical, mental, and social wellbeing of an informal carer. Providing complex and challenging care often results in carer burden, stress, and distress, which can continue even when the care recipient transitions into an aged care facility. This case study aims to demonstrate that optimising carer support, knowledge, skill acquisition, and promotion of wellbeing benefits carers and those they care for across contexts. It provides a weekly account of an informal Australian carer’s experience with the STrAtegies for RelaTives (START) manualised intervention program. The study used reliable change indices, standardised measures, and carer surveys to provide insights into the carer’s experience of the program and outcomes during and after the therapy. The results showed reliable and clinically significant change, demonstrating an improvement in all measures. The carer’s mood symptoms and their perceived burden of care decreased. The carer also reported decreased dementia symptoms in their care recipient. Both the carer and the care recipient experienced increased quality of life. These findings are consistent with recent literature on the feasibility of the START program and are aligned with the National Dementia Plan.
照顾痴呆症患者会对非正式照护者的身体、精神和社会福祉造成负面影响。提供复杂且具有挑战性的护理往往会给照护者带来负担、压力和困扰，甚至在受照护者转入老年护理机构后仍会继续存在。本案例研究旨在证明，优化对照护者的支持、知识和技能的学习，以及提高照护者的幸福感，对照护者和他们所照护的人都有好处。本研究以周为单位，介绍了一位澳大利亚非正规护理者在使用 "STRAtegies for RelaTives (START) "人工干预计划方面的经验。该研究采用了可靠的变化指数、标准化测量方法和照顾者调查，以深入了解照顾者在治疗期间和治疗后对该计划和结果的体验。研究结果表明，护理者在所有测量指标上都有所改善，具有可靠的临床意义。照护者的情绪症状和照护负担有所减轻。照护者还报告说，受照护者的痴呆症状也有所减轻。照护者和受照护者的生活质量都有所提高。这些研究结果与最近有关 START 计划可行性的文献相吻合，并与国家痴呆症计划保持一致。
{"title":"Intervention for an Australian carer of a person with dementia: A single case study","authors":"Karen Bell-Weinberg, Michelle Kelly","doi":"10.1177/15346501241245434","DOIUrl":"https://doi.org/10.1177/15346501241245434","url":null,"abstract":"Caring for a person with dementia can negatively impact the physical, mental, and social wellbeing of an informal carer. Providing complex and challenging care often results in carer burden, stress, and distress, which can continue even when the care recipient transitions into an aged care facility. This case study aims to demonstrate that optimising carer support, knowledge, skill acquisition, and promotion of wellbeing benefits carers and those they care for across contexts. It provides a weekly account of an informal Australian carer’s experience with the STrAtegies for RelaTives (START) manualised intervention program. The study used reliable change indices, standardised measures, and carer surveys to provide insights into the carer’s experience of the program and outcomes during and after the therapy. The results showed reliable and clinically significant change, demonstrating an improvement in all measures. The carer’s mood symptoms and their perceived burden of care decreased. The carer also reported decreased dementia symptoms in their care recipient. Both the carer and the care recipient experienced increased quality of life. These findings are consistent with recent literature on the feasibility of the START program and are aligned with the National Dementia Plan.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"28 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140570578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-04DOI: 10.1177/15346501241244755
Nicole C. Demchuk, Megan H. Bigham, Bethany A. Hansen
In the current case study, we evaluated synchronous reinforcement (SSR) as an intervention to increase self-feeding for a 5-year-old male diagnosed with ASD and a pediatric feeding disorder who also had a history of trauma. Synchronous reinforcement is a schedule of covariation where reinforcement is delivered continuously contingent on responding. Synchronous reinforcement has not been previously reported in the literature in a feeding context. A benefit of reinforcement-based procedures, such as SSR, is that they may align with recommendations for trauma-informed care by preventing or limiting the necessity of physical guidance procedures for those with a history of physical trauma. This is of particular significance given children with disabilities are more likely to experience traumatic events and abuse. We demonstrated that SSR was an effective intervention for increasing self-feeding, as well as methods for fading SSR as a treatment component. We discuss the potential for SSR as a trauma-informed approach, and the importance of caregiver collaboration and programming for generalization.
在当前的案例研究中，我们评估了同步强化（SSR）作为一种干预措施对一名被诊断出患有自闭症和小儿喂养障碍的 5 岁男性（他也有外伤史）的自我喂养能力的提高效果。同步强化是一种共变计划，即根据反应持续给予强化。以前的文献中还没有关于喂养方面的同步强化的报道。以强化为基础的程序（如 SSR）的一个好处是，它们可以防止或限制对有身体创伤史的儿童进行身体引导的必要性，从而符合创伤知情护理的建议。鉴于残疾儿童更有可能经历创伤事件和虐待，这一点尤为重要。我们证明了 SSR 是提高自我喂养的有效干预措施，同时也证明了逐渐将 SSR 作为治疗组成部分的方法。我们讨论了 SSR 作为一种创伤知情方法的潜力，以及照顾者合作和编程对于推广的重要性。
{"title":"Clinical Application and Fading of Synchronous Reinforcement for Increasing Self-Feeding for a Child with Autism Spectrum Disorder and History of Trauma","authors":"Nicole C. Demchuk, Megan H. Bigham, Bethany A. Hansen","doi":"10.1177/15346501241244755","DOIUrl":"https://doi.org/10.1177/15346501241244755","url":null,"abstract":"In the current case study, we evaluated synchronous reinforcement (SSR) as an intervention to increase self-feeding for a 5-year-old male diagnosed with ASD and a pediatric feeding disorder who also had a history of trauma. Synchronous reinforcement is a schedule of covariation where reinforcement is delivered continuously contingent on responding. Synchronous reinforcement has not been previously reported in the literature in a feeding context. A benefit of reinforcement-based procedures, such as SSR, is that they may align with recommendations for trauma-informed care by preventing or limiting the necessity of physical guidance procedures for those with a history of physical trauma. This is of particular significance given children with disabilities are more likely to experience traumatic events and abuse. We demonstrated that SSR was an effective intervention for increasing self-feeding, as well as methods for fading SSR as a treatment component. We discuss the potential for SSR as a trauma-informed approach, and the importance of caregiver collaboration and programming for generalization.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"50 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140570379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-21DOI: 10.1177/15346501241241540
Tessa Taylor, Nikolas F. Roglić
Saliva packing can be one of the most severe life-threatening and challenging behaviours to treat. A 9-year-old male with autism spectrum disorder and intellectual disability had 100% nasogastric (NG) feeding tube dependence and significant adaptive behaviour regression (in speaking, using the toilet and his hands, school attendance, sleep). He participated in an intensive behaviour-analytic paediatric feeding treatment programme. Saliva packing, as an automatically-maintained undifferentiated behaviour that persisted in all waking contexts despite high engagement in activities, warranted an additional outside of meal approach. He began swallowing, met 100% of his 21 goals, gained weight, and eliminated tube dependence. He reached a variety of 94 across all food groups, drinks, and supplements. Caregivers were trained and reported high social validity, and gains generalised and maintained in 1-month follow-up. This is the first case to our awareness in Australia of an in-home solely behaviour-analytic intervention to eliminate tube dependence, and it was conducted without hunger provocation, weight loss, or limited nutritional variety.
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