Pub Date : 2021-05-30DOI: 10.1177/15346501211020122
S. Shirk, L. Muquit, J. Deckro, Patricia J. Sweeney, Shane W. Kraus
Gambling disorder (GD) occurs at higher rates in U.S. veterans than civilians. The present case series describes the application of a manualized mindfulness treatment used with U.S. veterans seeking outpatient treatment for GD at a Department of Veterans Affairs hospital. Mindfulness-Based Relapse Prevention (MBRP) was developed to treat substance use disorders, but its core principles can be readily applied to the treatment of behavioral addictions. However, there has been little empirical evidence demonstrating its successful application for GD, and none demonstrating its successful implementation with U.S. veterans. Three veterans receiving treatment for GD participated in a 9-session adapted MBRP protocol. Following completion of treatment, the veterans reported less frequent engagement in their gambling behavior, fewer cravings, and less intense craving. The veterans also experienced increased self-efficacy in managing urges, less impulsivity and emotion dysregulation, and improved functioning. Preliminary results provide support for a larger treatment trial for veterans seeking treatment for GD.
{"title":"Mindfulness-Based Relapse Prevention for the Treatment of Gambling Disorder among U.S. Military Veterans: Case Series and Feasibility","authors":"S. Shirk, L. Muquit, J. Deckro, Patricia J. Sweeney, Shane W. Kraus","doi":"10.1177/15346501211020122","DOIUrl":"https://doi.org/10.1177/15346501211020122","url":null,"abstract":"Gambling disorder (GD) occurs at higher rates in U.S. veterans than civilians. The present case series describes the application of a manualized mindfulness treatment used with U.S. veterans seeking outpatient treatment for GD at a Department of Veterans Affairs hospital. Mindfulness-Based Relapse Prevention (MBRP) was developed to treat substance use disorders, but its core principles can be readily applied to the treatment of behavioral addictions. However, there has been little empirical evidence demonstrating its successful application for GD, and none demonstrating its successful implementation with U.S. veterans. Three veterans receiving treatment for GD participated in a 9-session adapted MBRP protocol. Following completion of treatment, the veterans reported less frequent engagement in their gambling behavior, fewer cravings, and less intense craving. The veterans also experienced increased self-efficacy in managing urges, less impulsivity and emotion dysregulation, and improved functioning. Preliminary results provide support for a larger treatment trial for veterans seeking treatment for GD.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"21 1","pages":"3 - 17"},"PeriodicalIF":1.0,"publicationDate":"2021-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15346501211020122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47213641","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 : 2021-05-19DOI: 10.1177/15346501211017989
D. Booysen, A. Kagee
Over the last three decades, several empirically supported trauma therapies have been developed to treat post-traumatic stress disorder (PTSD). Yet issues such as access to treatments and dropout are ongoing barriers to adequate dissemination and implementation, especially in low resource settings. To this end, we present results on the preliminary effectiveness of a brief prolonged exposure therapy (PE) for PTSD in South Africa, a low resource setting. Based on a case-series design, seven participants (n = 7) from diverse socio-cultural backgrounds were recruited and started a six-session brief PE for PTSD and co-morbid depression and anxiety. To examine the treatment outcomes, participants were assessed at baseline, during treatment, post-intervention, and at 3-month follow-up. Overall, brief PE reduced symptoms of PTSD, depression, and anxiety from baseline to post-intervention, and at 3-month follow-up. A downward trend in symptoms was evident during treatment, with slight symptom variations during exposure sessions. In conclusion, a six-session brief PE intervention produced positive outcomes for PTSD, depression, and anxiety at two community counseling centers in South Africa. We reflect on the implementation of brief PE in a South African context.
{"title":"Preliminary Effectiveness of Brief Prolonged Exposure Therapy for PTSD: Expanding Access to Effective Therapies","authors":"D. Booysen, A. Kagee","doi":"10.1177/15346501211017989","DOIUrl":"https://doi.org/10.1177/15346501211017989","url":null,"abstract":"Over the last three decades, several empirically supported trauma therapies have been developed to treat post-traumatic stress disorder (PTSD). Yet issues such as access to treatments and dropout are ongoing barriers to adequate dissemination and implementation, especially in low resource settings. To this end, we present results on the preliminary effectiveness of a brief prolonged exposure therapy (PE) for PTSD in South Africa, a low resource setting. Based on a case-series design, seven participants (n = 7) from diverse socio-cultural backgrounds were recruited and started a six-session brief PE for PTSD and co-morbid depression and anxiety. To examine the treatment outcomes, participants were assessed at baseline, during treatment, post-intervention, and at 3-month follow-up. Overall, brief PE reduced symptoms of PTSD, depression, and anxiety from baseline to post-intervention, and at 3-month follow-up. A downward trend in symptoms was evident during treatment, with slight symptom variations during exposure sessions. In conclusion, a six-session brief PE intervention produced positive outcomes for PTSD, depression, and anxiety at two community counseling centers in South Africa. We reflect on the implementation of brief PE in a South African context.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"20 1","pages":"482 - 497"},"PeriodicalIF":1.0,"publicationDate":"2021-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15346501211017989","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44737161","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 : 2021-05-10DOI: 10.1177/15346501211014284
Michael J Van Wert, Kelsey McVey, T. Donohue, Taylor Wasserstein, J. Curry, Naomi Goldstick Rosner, Eitan Kimchi, U. Mccann
Pica, the developmentally and culturally-inappropriate eating of non-nutritive and non-food substances, is most often documented in people with developmental disabilities and children, frequently in institutional and residential settings. To date, there are no randomized clinical trials on pica-specific treatments, and very little literature is available regarding the characteristics or treatment of pica in adults with no intellectual or social deficits, and co-morbid disorders. This case study addresses this gap, and involves a highly educated 30 year-old American woman with foam rubber pica and burned match consumption (cautopyreiophagia) behaviors, along with co-morbid depressive, anxiety, and obsessive-compulsive symptoms, who received treatment in a general intensive outpatient program for adults in a large urban community psychiatry setting. The case study describes how the Biosocial Theory and Transtheoretical Model of Health Behavior Change were used to conceptualize this woman’s symptoms and guide a treatment team of clinicians who did not specialize in pica. Providers in non-specialty clinic settings would benefit from reflecting on ways to adapt evidence-based techniques to the treatment of uncommon symptoms.
{"title":"Foam Rubber Pica and Cautopyreiophagia in a Highly Educated Woman: A Clinical Case Study","authors":"Michael J Van Wert, Kelsey McVey, T. Donohue, Taylor Wasserstein, J. Curry, Naomi Goldstick Rosner, Eitan Kimchi, U. Mccann","doi":"10.1177/15346501211014284","DOIUrl":"https://doi.org/10.1177/15346501211014284","url":null,"abstract":"Pica, the developmentally and culturally-inappropriate eating of non-nutritive and non-food substances, is most often documented in people with developmental disabilities and children, frequently in institutional and residential settings. To date, there are no randomized clinical trials on pica-specific treatments, and very little literature is available regarding the characteristics or treatment of pica in adults with no intellectual or social deficits, and co-morbid disorders. This case study addresses this gap, and involves a highly educated 30 year-old American woman with foam rubber pica and burned match consumption (cautopyreiophagia) behaviors, along with co-morbid depressive, anxiety, and obsessive-compulsive symptoms, who received treatment in a general intensive outpatient program for adults in a large urban community psychiatry setting. The case study describes how the Biosocial Theory and Transtheoretical Model of Health Behavior Change were used to conceptualize this woman’s symptoms and guide a treatment team of clinicians who did not specialize in pica. Providers in non-specialty clinic settings would benefit from reflecting on ways to adapt evidence-based techniques to the treatment of uncommon symptoms.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"20 1","pages":"468 - 481"},"PeriodicalIF":1.0,"publicationDate":"2021-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15346501211014284","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48970663","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 : 2021-04-29DOI: 10.1177/15346501211012099
Nils Rickardsson, Suzanne Crooks
Behaviors that challenge (BC) are common in dementia and can have a significant impact on the wellbeing of the person with dementia, their family and staff in care homes. The Newcastle model is a biopsychosocial, person-centerd, approach that aims to support care staff and family members in order to manage BC within care homes by identifying and fulfilling unmet needs of the person with dementia. After outlining its theoretical basis and practical utility, we describe a case study where the Newcastle model has been implemented to manage sexualised behaviors and verbal aggression. The patient described is a lady with dementia residing in a care home where the staff felt unable to manage increasing incidence of these BC. Information from multiple sources was collated to conceptualise the behaviors and understand them in terms of unmet needs, which was followed by a process to develop corresponding practical strategies together with care staff and family. Following successful implementation of the Newcastle model, the care staff reported a reduction in BC on standardised instruments (Cohen-Mansfield Agitation Inventory, and the Neuropsychiatric Inventory). The staff group also described increasing confidence in managing sexualised vocalisations as they had a better understanding with regards to premorbid history and personality, and an increased awareness of the impact of dementia on behavior. Complicating factors relating to staff stress and physical health conditions in older adults are discussed, and adaptations to the model are suggested in order to maintain treatment gains in the long-term.
{"title":"Using the Newcastle Model to Understand and Manage Behaviors That Challenge in Dementia: A Case Study","authors":"Nils Rickardsson, Suzanne Crooks","doi":"10.1177/15346501211012099","DOIUrl":"https://doi.org/10.1177/15346501211012099","url":null,"abstract":"Behaviors that challenge (BC) are common in dementia and can have a significant impact on the wellbeing of the person with dementia, their family and staff in care homes. The Newcastle model is a biopsychosocial, person-centerd, approach that aims to support care staff and family members in order to manage BC within care homes by identifying and fulfilling unmet needs of the person with dementia. After outlining its theoretical basis and practical utility, we describe a case study where the Newcastle model has been implemented to manage sexualised behaviors and verbal aggression. The patient described is a lady with dementia residing in a care home where the staff felt unable to manage increasing incidence of these BC. Information from multiple sources was collated to conceptualise the behaviors and understand them in terms of unmet needs, which was followed by a process to develop corresponding practical strategies together with care staff and family. Following successful implementation of the Newcastle model, the care staff reported a reduction in BC on standardised instruments (Cohen-Mansfield Agitation Inventory, and the Neuropsychiatric Inventory). The staff group also described increasing confidence in managing sexualised vocalisations as they had a better understanding with regards to premorbid history and personality, and an increased awareness of the impact of dementia on behavior. Complicating factors relating to staff stress and physical health conditions in older adults are discussed, and adaptations to the model are suggested in order to maintain treatment gains in the long-term.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"20 1","pages":"452 - 467"},"PeriodicalIF":1.0,"publicationDate":"2021-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15346501211012099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45367458","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 : 2021-04-24DOI: 10.1177/15346501211011255
Christopher R. Glowacki, Zachary R. Glowacki
There is a paucity of research of traditional psychotherapy approaches with individuals of South Asian descent, specifically Pakistani-Americans. In particular, there are very few cases in existing literature highlighting the effectiveness of Cognitive Processing Therapy (CPT) with Pakistani-Americans who have experienced sexual abuse. Due to cultural values, individuals of South Asian descent are less likely to pursue traditional psychotherapy and even far less likely to complete and/or benefit from it. The current case study focused on depression and trauma-related symptoms (e.g., guilt, shame, embarrassment) in the context of repeated sexual abuse for over 20 years. The PTSD Checklist (PCL-5) and Patient Health Questionnaire (PHQ-9) confirmed qualitative reports and therapist observations of improvement. This case suggests a westernized and protocol-driven treatment can be a viable intervention for individuals of SA descent with a history of sexual trauma. A strong therapeutic relationship and open discussion of diversity considerations were necessary for this treatment to work. This case reflects potential support for CPT as a treatment utilized across cultures for trauma-related symptoms.
{"title":"Utilizing Cognitive Processing Therapy to Treat Sexual Trauma with a Pakistani-American: A Case Report","authors":"Christopher R. Glowacki, Zachary R. Glowacki","doi":"10.1177/15346501211011255","DOIUrl":"https://doi.org/10.1177/15346501211011255","url":null,"abstract":"There is a paucity of research of traditional psychotherapy approaches with individuals of South Asian descent, specifically Pakistani-Americans. In particular, there are very few cases in existing literature highlighting the effectiveness of Cognitive Processing Therapy (CPT) with Pakistani-Americans who have experienced sexual abuse. Due to cultural values, individuals of South Asian descent are less likely to pursue traditional psychotherapy and even far less likely to complete and/or benefit from it. The current case study focused on depression and trauma-related symptoms (e.g., guilt, shame, embarrassment) in the context of repeated sexual abuse for over 20 years. The PTSD Checklist (PCL-5) and Patient Health Questionnaire (PHQ-9) confirmed qualitative reports and therapist observations of improvement. This case suggests a westernized and protocol-driven treatment can be a viable intervention for individuals of SA descent with a history of sexual trauma. A strong therapeutic relationship and open discussion of diversity considerations were necessary for this treatment to work. This case reflects potential support for CPT as a treatment utilized across cultures for trauma-related symptoms.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"20 1","pages":"435 - 451"},"PeriodicalIF":1.0,"publicationDate":"2021-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15346501211011255","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48266755","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 : 2021-04-05DOI: 10.1177/15346501211007208
Antonio Ruiz-García, Luis Valero-Aguayo
We present a multimedia exposure intervention for specific phobias using images and videos in a specific case of claustrophobia and acrophobia. The patient was a 47-year-old woman named “Jane” (anonymized name) who was diagnosed with fear of heights (acrophobia) and fear of confined spaces and enclosed areas (claustrophobia). The procedure was a single-case A-B design with several concurrent baselines, pre-post measurements, and two follow-ups (6 and 12 months). For the assessment, there were several questionnaires on anxiety and phobias and the continuous evaluation of anxiety and heart rate during treatment assays for each session. The treatment consisted of eight sessions of progressive multimedia exposure: images, videos, and in vivo settings. The results showed a decrease in the score for pre-post questionnaires (Z = −4.196, p < .0010) and also a total decrease in anxiety in the different baselines (PND 100%). The benefits were maintained during 1 year of follow-up. After the treatment, “Jane” could be confronted with situations she previously feared, such as being on floors of different levels (up to ninth floor), in closed places, in crowded elevators, and traveling on buses and trains for long distances.
{"title":"Progressive Multimedia Exposure for Specific Phobias: A Clinical Case of Claustrophobia and Acrophobia","authors":"Antonio Ruiz-García, Luis Valero-Aguayo","doi":"10.1177/15346501211007208","DOIUrl":"https://doi.org/10.1177/15346501211007208","url":null,"abstract":"We present a multimedia exposure intervention for specific phobias using images and videos in a specific case of claustrophobia and acrophobia. The patient was a 47-year-old woman named “Jane” (anonymized name) who was diagnosed with fear of heights (acrophobia) and fear of confined spaces and enclosed areas (claustrophobia). The procedure was a single-case A-B design with several concurrent baselines, pre-post measurements, and two follow-ups (6 and 12 months). For the assessment, there were several questionnaires on anxiety and phobias and the continuous evaluation of anxiety and heart rate during treatment assays for each session. The treatment consisted of eight sessions of progressive multimedia exposure: images, videos, and in vivo settings. The results showed a decrease in the score for pre-post questionnaires (Z = −4.196, p < .0010) and also a total decrease in anxiety in the different baselines (PND 100%). The benefits were maintained during 1 year of follow-up. After the treatment, “Jane” could be confronted with situations she previously feared, such as being on floors of different levels (up to ninth floor), in closed places, in crowded elevators, and traveling on buses and trains for long distances.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"20 1","pages":"402 - 416"},"PeriodicalIF":1.0,"publicationDate":"2021-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15346501211007208","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41453422","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 : 2021-04-05DOI: 10.1177/15346501211007207
Shane W. Adams
Chronic forms of depression often share many features with personality dysfunction and can be difficult to treat using traditional psychotherapies. To help improve treatment outcomes, individualized psychotherapies based on the individual’s specific problems and preferences that target interpersonal issues and have a longer duration of treatment have been recommended. The current case study follows a man diagnosed with persistent depressive disorder (PDD) and mixed personality features over the course of treatment that used an individualized and phase-based approach. An individualized and extended form of cognitive behavioral therapy (CBT) that shared similarities with cognitive-behavioral analysis system of psychotherapy (CBASP) was implemented to address the potential influence of early adverse life events, dysfunctional ways of thinking about the self and others that leads to increased depressed mood, and the influence of interpersonal situations in and outside the therapeutic relationship. Therapy was conducted in three phases (1. Psychoeducation/introduction to CBT; 2. modified CBT for insomnia and behavioral activation; 3. cognitive restructuring) during 32 weekly sessions over a period of nearly 11 months. Standardized measures administered over the course of treatment indicated significant reductions in depressive symptoms and improvements in self-efficacy. Qualitative reports from the client indicated improved satisfaction and quality of life as well as improved quality of relationships.
{"title":"Individualized and Phase-Based Cognitive Behavioral Therapy for the Treatment of Early Onset Pure Dysthymic Syndrome in an Outpatient with Mixed Personality Features","authors":"Shane W. Adams","doi":"10.1177/15346501211007207","DOIUrl":"https://doi.org/10.1177/15346501211007207","url":null,"abstract":"Chronic forms of depression often share many features with personality dysfunction and can be difficult to treat using traditional psychotherapies. To help improve treatment outcomes, individualized psychotherapies based on the individual’s specific problems and preferences that target interpersonal issues and have a longer duration of treatment have been recommended. The current case study follows a man diagnosed with persistent depressive disorder (PDD) and mixed personality features over the course of treatment that used an individualized and phase-based approach. An individualized and extended form of cognitive behavioral therapy (CBT) that shared similarities with cognitive-behavioral analysis system of psychotherapy (CBASP) was implemented to address the potential influence of early adverse life events, dysfunctional ways of thinking about the self and others that leads to increased depressed mood, and the influence of interpersonal situations in and outside the therapeutic relationship. Therapy was conducted in three phases (1. Psychoeducation/introduction to CBT; 2. modified CBT for insomnia and behavioral activation; 3. cognitive restructuring) during 32 weekly sessions over a period of nearly 11 months. Standardized measures administered over the course of treatment indicated significant reductions in depressive symptoms and improvements in self-efficacy. Qualitative reports from the client indicated improved satisfaction and quality of life as well as improved quality of relationships.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"20 1","pages":"417 - 432"},"PeriodicalIF":1.0,"publicationDate":"2021-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15346501211007207","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47824268","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 : 2021-03-30DOI: 10.1177/15346501211006922
Lilian Skilbeck, Christopher Spanton, Ian Roylance
Individual Trauma-focused CBT has been shown to be effective for treating posttraumatic stress disorder in military veterans. Treatment challenges are common including the presence of dissociation and comorbidities including depression, traumatic brain injury symptoms, substance misuse, and social transition difficulties. There are currently no standard psychological therapy guidelines for veterans with comorbid presentations. However, as recommended by the National Institute for Health and Care Excellence treatment guidelines, adapting existing treatments can improve the chances of successfully treating trauma cases. In line with these recommendations, the current case study describes how the existing individual trauma-focused CBT model was integrated to treat posttraumatic stress disorder with comorbid depression, persistent mild-traumatic brain injury migraine, and social transition difficulties in a 38-year-old male combat veteran. The client attended 16-sessions of trauma-focused CBT. This model integrated his comorbidities and involved his spouse and multidisciplinary discussions with his general practitioner, and neurorehabilitation team and the Veterans’ Transition Service. At the end of treatment, the client no longer met the diagnostic criteria for posttraumatic stress disorder. This case illustrates how trauma-focused CBT can be integrated to treat comorbid posttraumatic stress disorder in veterans.
{"title":"Integrated Trauma-Focused Cognitive Behavioral Therapy for Comorbid Combat-Related Posttraumatic Stress Disorder: A Case Study with a Military Veteran","authors":"Lilian Skilbeck, Christopher Spanton, Ian Roylance","doi":"10.1177/15346501211006922","DOIUrl":"https://doi.org/10.1177/15346501211006922","url":null,"abstract":"Individual Trauma-focused CBT has been shown to be effective for treating posttraumatic stress disorder in military veterans. Treatment challenges are common including the presence of dissociation and comorbidities including depression, traumatic brain injury symptoms, substance misuse, and social transition difficulties. There are currently no standard psychological therapy guidelines for veterans with comorbid presentations. However, as recommended by the National Institute for Health and Care Excellence treatment guidelines, adapting existing treatments can improve the chances of successfully treating trauma cases. In line with these recommendations, the current case study describes how the existing individual trauma-focused CBT model was integrated to treat posttraumatic stress disorder with comorbid depression, persistent mild-traumatic brain injury migraine, and social transition difficulties in a 38-year-old male combat veteran. The client attended 16-sessions of trauma-focused CBT. This model integrated his comorbidities and involved his spouse and multidisciplinary discussions with his general practitioner, and neurorehabilitation team and the Veterans’ Transition Service. At the end of treatment, the client no longer met the diagnostic criteria for posttraumatic stress disorder. This case illustrates how trauma-focused CBT can be integrated to treat comorbid posttraumatic stress disorder in veterans.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"20 1","pages":"385 - 401"},"PeriodicalIF":1.0,"publicationDate":"2021-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15346501211006922","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48321733","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 : 2021-03-17DOI: 10.1177/15346501211003157
D. Knutson, Julie M. Koch
The authors discuss their work with a young adult client who identified as gender fluid. The client was a college student in a rural, mid-south town. The authors are two faculty members who worked with the client for a period of 2 years using a cotherapy supervision approach. The counseling approach was affirmative and person-centered. By keeping a focus on the exploration of gender foremost, the clinicians saw an abatement of other symptoms (depression, suicidality, self-harm, disordered eating, low self-confidence, emotion dysregulation, dissociation, and so on) and an improvement in wellness (relationships, emotion regulation, self-concept, assertiveness, appropriate boundary-setting, and so on) over time. The authors offer specific interventions such as collaborative letter writing and the creation of a transition roadmap. They also highlight the advantages and utility of a collaborative, person-centered, consent-based, affirmative approach to therapy with rural transgender and nonbinary clients with complex presenting concerns.
{"title":"A Cotherapy Supervision Approach using Person-Centered Theory with a Gender Fluid Client","authors":"D. Knutson, Julie M. Koch","doi":"10.1177/15346501211003157","DOIUrl":"https://doi.org/10.1177/15346501211003157","url":null,"abstract":"The authors discuss their work with a young adult client who identified as gender fluid. The client was a college student in a rural, mid-south town. The authors are two faculty members who worked with the client for a period of 2 years using a cotherapy supervision approach. The counseling approach was affirmative and person-centered. By keeping a focus on the exploration of gender foremost, the clinicians saw an abatement of other symptoms (depression, suicidality, self-harm, disordered eating, low self-confidence, emotion dysregulation, dissociation, and so on) and an improvement in wellness (relationships, emotion regulation, self-concept, assertiveness, appropriate boundary-setting, and so on) over time. The authors offer specific interventions such as collaborative letter writing and the creation of a transition roadmap. They also highlight the advantages and utility of a collaborative, person-centered, consent-based, affirmative approach to therapy with rural transgender and nonbinary clients with complex presenting concerns.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"20 1","pages":"368 - 384"},"PeriodicalIF":1.0,"publicationDate":"2021-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/15346501211003157","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43911318","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 : 2021-02-10DOI: 10.1177/1534650121993547
Anne N. Banducci
Prolonged exposure (PE) therapy is a gold-standard treatment for posttraumatic stress disorder (PTSD) that can be effectively delivered via telehealth modalities. The following case report describes a course of PE delivered to a veteran seeking PTSD treatment for military sexual trauma (MST), who contracted COVID-19 mid-treatment. Considerations for selecting PE as a treatment modality; modifications made due to the COVID-19 pandemic and transition to telehealth more broadly, and following the veteran contracting COVID-19 more specifically; strategies to increase treatment engagement; and assessment of progress over time, are discussed. In particular, treatment considerations during a global pandemic are explored at the patient-, provider-, and systems level, to inform treatment delivery for other providers during this ongoing pandemic. Although there were numerous technological, environmental, and pandemic-related difficulties, the veteran described here persisted through a course of PE and experienced clinically significant reductions in symptoms of PTSD and a great degree of functional recovery.
{"title":"Prolonged Exposure Therapy in the Time of COVID-19: Modifying PTSD Treatment for a Military Sexual Trauma Survivor Who Contracted COVID-19 Mid-Treatment","authors":"Anne N. Banducci","doi":"10.1177/1534650121993547","DOIUrl":"https://doi.org/10.1177/1534650121993547","url":null,"abstract":"Prolonged exposure (PE) therapy is a gold-standard treatment for posttraumatic stress disorder (PTSD) that can be effectively delivered via telehealth modalities. The following case report describes a course of PE delivered to a veteran seeking PTSD treatment for military sexual trauma (MST), who contracted COVID-19 mid-treatment. Considerations for selecting PE as a treatment modality; modifications made due to the COVID-19 pandemic and transition to telehealth more broadly, and following the veteran contracting COVID-19 more specifically; strategies to increase treatment engagement; and assessment of progress over time, are discussed. In particular, treatment considerations during a global pandemic are explored at the patient-, provider-, and systems level, to inform treatment delivery for other providers during this ongoing pandemic. Although there were numerous technological, environmental, and pandemic-related difficulties, the veteran described here persisted through a course of PE and experienced clinically significant reductions in symptoms of PTSD and a great degree of functional recovery.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"20 1","pages":"331 - 348"},"PeriodicalIF":1.0,"publicationDate":"2021-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1534650121993547","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45617408","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}
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