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Reducing Aggression Using a Multimodal Cognitive Behavioral Treatment Approach: A Case Study of a Preschooler With Oppositional Defiant Disorder 使用多模式认知行为治疗方法减少攻击:一名患有对立违抗障碍的学龄前儿童的案例研究
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2020-09-13 DOI: 10.1177/1534650120958069
Catrina A. Calub, M. Rapport, K. Alexander
Individual cognitive behavioral therapies (CBT) have been shown to be effective in decreasing disruptive behaviors in children and adolescents; however, less is known regarding their efficacy with preschoolers given the developmental limitations accompanying this age range. The current case study extends the use of individual CBT to a preschool aged girl with oppositional defiant disorder (ODD), and is the first to investigate its efficacy in combination with behaviorally-based parent training and classroom teacher consultation. A total of 18 CBT sessions with the child and her parents, in addition to school observations and on-site and phone consultations with teachers, were conducted over a 4-month period. Post-treatment and 2-month follow-up assessments demonstrated significant decreases in physical aggression and property destruction, as well as for parent and teacher reported internalizing and externalizing symptoms. Collectively, results of the case study provide preliminary evidence that a multimodal approach can be applied effectively to treat behavioral problems in preschool-age children.
个体认知行为疗法(CBT)已被证明对减少儿童和青少年的破坏性行为有效;然而,考虑到学龄前儿童的发育限制,他们对学龄前儿童的疗效知之甚少。目前的案例研究将个体CBT的应用扩展到一名患有对立违抗性障碍(ODD)的学龄前女孩,并且是第一个研究其与基于行为的家长培训和课堂教师咨询相结合的效果的案例。在4个月的时间里,除了学校观察、现场和与老师的电话咨询外,孩子和她的父母共进行了18次CBT课程。治疗后和2个月的随访评估显示,身体攻击和财产破坏显著减少,家长和老师报告的内化和外化症状也显著减少。总的来说,案例研究的结果提供了初步证据,表明多模式方法可以有效地应用于治疗学龄前儿童的行为问题。
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引用次数: 0
Exposure, Relaxation, and Rescripting Therapy for Trauma-Related Nightmares With Psychiatric Inpatients: A Case Series 精神科住院病人创伤相关噩梦的暴露、放松和处方治疗:一个案例系列
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2020-09-10 DOI: 10.1177/1534650120953614
Helen Reiter, L. Humphreys
Research has shown that posttraumatic stress disorder (PTSD) is a highly prevalent diagnosis for psychiatric patients, yet individualized care and treatment is limited in the inpatient acute care sector. Two case studies are presented which examine the use of Exposure, Relaxation, and Rescripting Therapy (ERRT) for chronic trauma-related nightmares, within a private acute care inpatient psychiatric hospital setting. ERRT is empirically supported with efficacy for veteran and civilian populations, however no research to date has been conducted with psychiatric inpatients. Two participants diagnosed with PTSD, suffering distressing trauma-related nightmares, completed ERRT over three sessions during their psychiatric hospital admission, with the aim of reducing the frequency and severity of nightmares and related psychological symptoms. PTSD, depression, sleep quality and quantity, and nightmare frequency and related distress, were measured pre-treatment, during treatment, and follow-up at one, 3 and 6 months. Only one participant reported ongoing nightmares by the third week of the intervention, with both participants reporting an absence of nightmares at the one and 3-month follow-ups, but mixed results by the 6-month follow-up. One participant also reported a reduction in PTSD symptoms and a mild improvement in depression. The results offer some preliminary support for the provision of ERRT for the treatment of trauma-related nightmares for psychiatric inpatients.
研究表明,创伤后应激障碍(PTSD)是精神病患者中非常普遍的诊断,但在住院急症护理部门,个性化的护理和治疗是有限的。两个案例研究提出了检查使用暴露,放松和处方疗法(ERRT)慢性创伤相关的噩梦,在私人急性护理住院精神病医院设置。ERRT在退伍军人和平民人群中的有效性得到了实证支持,但迄今为止尚未对精神科住院患者进行过研究。两名被诊断患有创伤后应激障碍的参与者,在精神病院住院期间完成了三个阶段的ERRT,目的是减少噩梦的频率和严重程度以及相关的心理症状。在治疗前、治疗中、1个月、3个月和6个月的随访中测量PTSD、抑郁、睡眠质量和数量、噩梦频率和相关的痛苦。在干预的第三周,只有一名参与者报告了持续的噩梦,在1个月和3个月的随访中,两名参与者都报告了没有噩梦,但在6个月的随访中,结果喜忧参半。一名参与者还报告说,创伤后应激障碍症状有所减轻,抑郁症有轻微改善。本研究结果为ERRT在精神科住院患者创伤性噩梦治疗中的应用提供了初步支持。
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引用次数: 1
Re-Establishing Solid Food Consumption in a Person With Traumatic Brain Injury and Extended Food Avoidance/Restriction Using a Multicomponent Behavioral Intervention 使用多组分行为干预重建外伤性脑损伤患者的固体食物消费和延长食物避免/限制
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2020-09-04 DOI: 10.1177/1534650120950528
J. Ricciardi, J. Luiselli, Jodi Tretheway
We describe and report the results of a multicomponent behavioral intervention for re-establishing solid food consumption in a 26-year-old woman with prolonged food avoidance and restriction which developed following a traumatic brain injury. The intervention was evaluated by direct measurement of daily meal consumption over a period of several months, including an extended follow-up, and resulted in successful resumption of oral feeding. A complicating paroxysmal movement disorder resolved during treatment as well and resolution of the presenting problem led to significant quality of life improvements. We discuss the relationship of the presenting symptoms to avoidant/restrictive food intake disorder and to food rejection behavior seen when substantial damage has occurred to the parietal lobe. The case illustrates the value of assessment-based, individualized intervention design and an integrated neurobehavioral case conceptualization.
我们描述并报告了一名26岁女性的多组分行为干预结果,该女性在创伤性脑损伤后出现了长期的食物回避和限制。通过在几个月内直接测量每日膳食消耗量来评估干预措施,包括延长随访时间,并成功恢复了口服喂养。一种复杂的阵发性运动障碍在治疗过程中得到了解决,并且症状的解决使生活质量得到了显著改善。我们讨论了症状与回避型/限制性食物摄入障碍以及顶叶发生严重损伤时出现的食物排斥行为的关系。该案例说明了基于评估的个性化干预设计和综合神经行为案例概念化的价值。
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引用次数: 1
Schema Therapy for Chronic Depression Associated with Childhood Trauma: A Case Study 儿童期创伤相关慢性抑郁症的图式治疗:个案研究
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2020-09-04 DOI: 10.1177/1534650120954275
Kate L. Herts, S. Evans
Chronic depression lasting longer than 2 years is often undertreated. Research suggests that maladaptive cognitive schemas mediate the association between childhood trauma and later depression. Schema Therapy (ST) is an integrative treatment approach that targets maladaptive cognitive schemas through cognitive, behavioral, interpersonal, and experiential interventions. ST has been studied in patients with chronic depression with good results. The purpose of this case study is to detail how an ST treatment was used to treat chronic depression in a woman, “Amy,” with a childhood trauma history. Amy presented with a persistent depressive disorder that had lasted over 40 years. An ST approach was chosen in light of the chronicity of Amy’s symptoms and her childhood trauma history. Standardized measures including the Beck Depression Inventory were used to assess progress throughout treatment. We provide a comprehensive summary of the 22-session ST case conceptualization and treatment, through which Amy’s depressive symptoms evidenced a 73 percent reduction. Amy qualitatively reported reduced depressive rumination and avoidance behaviors as well as increased frequency of positive mood.
慢性抑郁症持续时间超过2 年份往往处理不足。研究表明,适应不良的认知图式介导了童年创伤和后来抑郁之间的联系。图式治疗(ST)是一种综合治疗方法,通过认知、行为、人际和经验干预来针对适应不良的认知图式。ST段在慢性抑郁症患者中的研究取得了良好的结果。本案例研究的目的是详细说明ST治疗如何用于治疗一名有童年创伤史的女性“Amy”的慢性抑郁症。艾米患有持续40多年的持续性抑郁症 年。根据Amy症状的长期性和她的童年创伤史,选择了ST方法。包括贝克抑郁量表在内的标准化指标用于评估整个治疗过程中的进展情况。我们提供了22次ST段病例概念化和治疗的全面总结,通过该总结,Amy的抑郁症状证明了73 减少百分比。Amy定性地报告了抑郁沉思和回避行为的减少,以及积极情绪的频率增加。
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引用次数: 1
Parent–Child Interaction Therapy-Callous Unemotional Adaptation for a Preschool Boy With Conduct Problems 亲子互动疗法:行为问题学龄前男孩的冷酷无情适应
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2020-09-04 DOI: 10.1177/1534650120950524
Heather Agazzi, Kimberly Knap, E. Kimonis
Young children with conduct problems (CPs) and elevated callous unemotional (CU) traits (CP+CU) show more severe, stable, and aggressive CPs relative to children with CP traits alone. Children with CP+CU tend to benefit less from traditional treatment modalities for child CPs that rely on social attention and punishments compared with children with CP-alone, but respond well to reward-based behavioral management strategies. Emerging research suggests that the Parent–Child Interaction Therapy-Callous Unemotional adaptation (PCIT-CU) may be a compelling mechanistically targeted intervention for young children with CP+CU. This case study presents the treatment of a 4½-year-old boy with oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder–combined presentation (ADHD-C), and CU traits using PCIT-CU. Findings from this case study include (a) improvement in CP that was maintained at 4-month follow-up, (b) reduced parent ratings of CU traits over the course of treatment, (c) reduced negative parenting practices, and (d) preliminary support for adapting parent behavioral management training interventions for young children with CP+CU and comorbid ADHD-C.
与单独具有行为问题(CP)特征的儿童相比,具有行为问题和冷酷无情(CU)特征(CP+CU)的幼儿表现出更严重、更稳定、更具攻击性的行为问题。与单独患有CP的儿童相比,患有CP+CU的儿童往往从依赖社会关注和惩罚的儿童CP的传统治疗模式中获益较少,但对基于奖励的行为管理策略反应良好。新兴研究表明,亲子互动疗法Callous Unmotional Adaptive(PCIT-CU)可能是一种针对CP+CU幼儿的令人信服的机制靶向干预措施。本病例研究采用PCIT-CU治疗一名4岁半男孩,该男孩患有对立违抗性障碍(ODD)、注意力缺陷/多动障碍-综合表现(ADHD-C)和CU特征。该案例研究的结果包括:(a)CP在4个月的随访中得到改善,(b)在治疗过程中降低了父母对CU特征的评分,(c)减少了消极的育儿做法,以及(d)初步支持为患有CP+CU和合并ADHD-c的幼儿调整父母行为管理培训干预措施。
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引用次数: 3
The Unified Protocol for Transdiagnostic Treatment of Perinatal Depression: A Case Study 围产期抑郁症转诊治疗的统一方案:一个案例研究
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2020-08-29 DOI: 10.1177/1534650120951266
Elena Crespo-Delgado, Verónica Martínez-Borba, J. Osma
This case study aims to present the application of the Unified Protocol (UP) for the Transdiagnostic Treatment of Emotional Disorders in the case of a 38-year-old pregnant woman with a peripartum onset of major depressive disorder and anxiety symptoms. The UP is a cognitive-behavioral intervention based on the shared etiological and maintenance mechanisms of emotional disorders (i.e., mood, anxiety, and related disorders). The UP helps to modify maladaptive emotion-regulation strategies and enhance tolerance of unpleasant and intense emotions (sadness, anxiety, anger, etc.). Whereas previous studies demonstrate the efficacy of the UP in different emotional disorders, to our knowledge, none of them have used the UP to treat perinatal emotional disorders. After the eight UP modules of individual treatment, a significant decrease in anxiety, depression, negative affect, and anxiety sensitivity, and also an increase in positive affect were observed. These results were maintained at the 12-month follow-up. In addition to its clinical utility and acceptance, these results indicate that the UP can be adapted and personalized for the treatment of perinatal emotional disorders. Future studies with larger samples and controlled experimental designs should be developed to demonstrate its efficacy. Furthermore, as the UP seems to be useful in a group format, future efforts should be focused on the UP with perinatal women in a group format.
本案例研究旨在介绍统一方案(UP)在一名38岁孕妇围产期发作的重度抑郁障碍和焦虑症状的情绪障碍转诊治疗中的应用。UP是一种基于情绪障碍(即情绪、焦虑和相关障碍)的共同病因和维持机制的认知行为干预。UP有助于改变适应不良的情绪调节策略,增强对不愉快和强烈情绪(悲伤、焦虑、愤怒等)的耐受力。尽管之前的研究证明了UP对不同情绪障碍的疗效,但据我们所知,他们中没有一人使用UP治疗围产期情绪障碍。在八个UP模块的个体治疗后,观察到焦虑、抑郁、负面情绪和焦虑敏感性显著降低,积极情绪也有所增加。这些结果在12个月的随访中保持不变。除了其临床实用性和可接受性外,这些结果表明UP可以用于围产期情绪障碍的治疗并进行个性化。未来应开发更大样本和对照实验设计的研究,以证明其有效性。此外,由于UP在小组形式中似乎是有用的,未来的工作应该集中在以小组形式与围产期妇女进行UP上。
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引用次数: 8
Establishing Safety and Stability for Enhanced Treatment Engagement With the Unified Protocol: A Case Study 用统一方案建立强化治疗参与的安全性和稳定性:一个案例研究
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2020-08-27 DOI: 10.1177/1534650120952883
M. Mian, B. Lin, J. M. Hormes, M. Earleywine
Despite the vast array of empirically validated treatments for psychopathological problems, interventions still require considerable client resources for engagement and success. For clients lacking safety and stability outside of therapy, numerous barriers to treatment can prevent improvement and lead to disengagement. In such cases, therapists can seek to understand clients’ difficulties with safety and stability. Developing both rapport and the client’s problem-solving abilities can instill a sense of agency, keeping clients in treatment for better outcomes overall. This case study describes the modified application of the Unified Protocol following safety planning and crisis management. “Mary,” a 23-year old female, presented to a training clinic with fluctuating mood episodes, trauma symptoms, and problem substance use; pre, post, and routinely collected session data with clinical report indicate symptom improvement and increased treatment engagement following client gains in safety, employment, and housing. This case illustrates the importance of the therapeutic alliance in establishing client safety to effectively deliver a transdiagnostic treatment to address core mechanisms underlying emotion dysregulation.
尽管有大量经经验验证的精神病理学问题治疗方法,但干预措施仍需要大量的客户资源才能参与并取得成功。对于在治疗之外缺乏安全性和稳定性的客户来说,许多治疗障碍可能会阻碍病情好转并导致脱离治疗。在这种情况下,治疗师可以寻求了解客户在安全和稳定方面的困难。发展融洽关系和客户解决问题的能力可以灌输代理感,让客户接受治疗,从而获得更好的整体结果。本案例研究描述了统一协议在安全规划和危机管理之后的修改应用。“玛丽”,一名23岁的女性,因情绪波动、创伤症状和问题药物使用而被送到一家培训诊所;术前、术后和常规收集的会话数据以及临床报告表明,随着客户在安全、就业和住房方面的进步,症状得到改善,治疗参与度增加。这个案例说明了治疗联盟在建立客户安全性方面的重要性,以有效地提供跨诊断治疗,解决情绪失调的核心机制。
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引用次数: 3
Process-Based Cognitive Behavioral Therapy: A Framework for Conceptualization and Treatment 基于过程的认知行为治疗:一个概念化和治疗的框架
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2020-08-26 DOI: 10.1177/1534650120951858
Jeffrey M. Pavlacic, John Young
Process-Based Cognitive Behavioral Therapy (PB-CBT) is the integration of biological, psychological, and social factors into idiographic structural models used to conceptualize patient problems and select transdiagnostic, evidence-based procedures for clinical intervention to improve well-being. Despite the clinical utility and applicability of this transdiagnostic approach to case conceptualization and treatment, little research or formal guidance exists on how to create individualized structural models in clinical practice. Traditional clinical psychology, on the contrary, employs a diagnosis to treatment matching system. While useful, diagnosis to treatment models of intervention neglect contextual factors that contribute to patient problems and have led to a proliferation of treatment manuals for specific diagnoses. The current case study described a college male who coped with emotional difficulties through avoidance, isolation, food restriction, and alcohol use. In addition to psychopathology, the patient also identified as bisexual in a predominantly homophobic social environment, which exacerbated psychological distress. These various factors were integrated into a structural model that aided the selection of transdiagnostic interventions. At the conclusion of treatment, the patient reported meaningful reductions in psychological symptoms, in addition to various functional gains consistent with his values, such as an increased ability to tolerate difficult emotions, increased mindfulness skills, and an openness to discuss emotions with peers. Structural models and transdiagnostic interventions may help conceptualize patients presenting with multiple forms of psychopathology.
基于过程的认知行为疗法(PB-CBT)是将生物、心理和社会因素整合到具体结构模型中,用于概念化患者问题,并选择跨诊断、循证程序进行临床干预,以改善幸福感。尽管这种跨诊断方法在病例概念化和治疗方面具有临床实用性和适用性,但关于如何在临床实践中创建个性化结构模型的研究或正式指导很少。与之相反,传统的临床心理学采用的是诊断与治疗相匹配的体系。虽然有用,但从诊断到治疗的干预模式忽视了导致患者问题的环境因素,并导致了针对特定诊断的治疗手册的激增。当前的案例研究描述了一位通过回避、孤立、限制食物和饮酒来应对情感困难的大学男性。除了精神病理,患者还在一个以同性恋为主的社会环境中被认定为双性恋,这加剧了心理困扰。这些不同的因素被整合到一个结构模型中,帮助选择跨诊断干预措施。在治疗结束时,患者报告心理症状明显减轻,此外还获得了与他的价值观一致的各种功能收获,例如容忍困难情绪的能力增强,正念技能增强,以及与同伴讨论情绪的开放性。结构模型和跨诊断干预可能有助于概念化呈现多种形式精神病理的患者。
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引用次数: 6
Using Art-Based Acceptance and Commitment Therapy (ACT) for an Adolescent With Anxiety and Autism 应用基于艺术的接受和承诺疗法(ACT)治疗青少年焦虑和自闭症
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2020-08-21 DOI: 10.1177/1534650120950527
Rosanna Chapman, Bethan Evans
Anxiety is a common experience for young people with an autism spectrum condition (ASC). This article describes the use of Acceptance and Commitment Therapy (ACT) through the medium of art to increase well-being for a young woman with ASC and significant anxiety. An ACT art protocol was delivered over 8-weekly sessions with outcome measured administered at baseline, pre-, mid- and post-intervention. Follow-up data were also obtained 3 months after the intervention. It was found that the young person experienced improvements in measures of well-being and psychological flexibility. Importantly, these were seen to translate to increased engagement in activities that were in line with the young person’s values. This demonstrates that using third-wave approaches for young people with ASC can result in improvements in well-being and quality of life, but that adaptations in line with person-centered care are crucial to facilitate engagement and produce meaningful change.
焦虑是患有自闭症谱系疾病(ASC)的年轻人的常见经历。本文描述了通过艺术媒介使用接受和承诺疗法(ACT)来提高患有ASC和严重焦虑症的年轻女性的幸福感。ACT艺术方案在8周的疗程中进行,在基线、干预前、干预中和干预后测量结果。干预后3个月也获得了随访数据。研究发现,年轻人在幸福感和心理灵活性方面有所改善。重要的是,这些被视为增加了对符合年轻人价值观的活动的参与。这表明,对患有ASC的年轻人使用第三波方法可以改善他们的幸福感和生活质量,但适应以人为中心的护理对于促进参与和产生有意义的改变至关重要。
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引用次数: 3
Behavioral Assessment and Treatment of Selective Mutism in Identical Twins 同卵双胞胎选择性缄默症的行为评估与治疗
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2020-08-18 DOI: 10.1177/1534650120950526
R. Weinstock, N. Caporino, Susanna J. Crowell McQuarrie, Emily G. Ronkin, Laura A. Wright, Natasha N Ludwig, Erin B Tone
Selective mutism (SM) is a childhood disorder characterized by persistent failure to speak in situations where speech is expected. There is evidence that behavioral interventions are effective for increasing speech in children with SM but studies have been limited by small, relatively homogeneous samples. Although twins appear to be disproportionately represented among children with SM, little is known about their specific treatment needs and barriers to effective treatment implementation in this population. This case study presents family-based behavioral therapy delivered to a set of 8-year-old, identical twins with SM. At posttreatment, both children displayed marked improvements in speaking and social engagement. Clinical considerations for working with twins with SM are discussed.
选择性缄默症(SM)是一种儿童障碍,其特征是在需要说话的场合持续无法说话。有证据表明,行为干预对提高SM儿童的语言能力是有效的,但研究受到较小的、相对均匀的样本的限制。虽然双胞胎在患有SM的儿童中所占的比例似乎不成比例,但人们对他们的具体治疗需求以及在这一人群中有效治疗实施的障碍知之甚少。本案例研究介绍了一组8岁的同卵双胞胎的家庭行为治疗。在治疗后,两个孩子在说话和社会参与方面都有明显的改善。讨论了与患有SM的双胞胎一起工作的临床考虑。
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引用次数: 1
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