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.
{"title":"Continuous Saliva Packing Resulting in Feeding Tube Dependence: In-Home Behaviour-Analytic Treatment","authors":"Tessa Taylor, Nikolas F. Roglić","doi":"10.1177/15346501241241540","DOIUrl":"https://doi.org/10.1177/15346501241241540","url":null,"abstract":"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.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140196941","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 : 2024-01-16DOI: 10.1177/15346501241228250
Brendan Willis, William O'Donohue
Sexual assault survivors can experience a wide variety of psychological consequences—from none to Major Depression Disorder to Substance use and, most commonly, Acute Stress Disorder/Post Traumatic Stress Disorder. These clinical outcomes depend on the severity of the assault, as well as pre-assault psychological status, and post-assault social support, the effectiveness of therapy, and events that occur during therapy. This case study will focus on one particular event that can arise during the treatment of a survivor of sexual assault, namely the impact of a not guilty verdict on the survivor occurring during the course of therapy. The client in question experienced an immediate and significant increase in depressive symptoms and the course of therapy needed to be altered significantly to respond to the not guilty verdict rendered during the therapy process. This case study will explore how therapy was altered in response to this guilty verdict and the lessons that were learned from this experience in order to better prepare assault survivors who are involved in legal proceedings during their therapy. Overall, this case study demonstrated the vital need to prepare survivors who plan to testify in court against the perpetrator beforehand for all possible outcomes of the trial. Furthermore, the case study demonstrated the need to implement effective interventions in the aftermath of a trial to help buffer against the effects of a “not guilty” verdict.
{"title":"When the Perpetrator is Found Not Guilty: Implications for the Treatment of Adolescent Sexual Assault Survivors","authors":"Brendan Willis, William O'Donohue","doi":"10.1177/15346501241228250","DOIUrl":"https://doi.org/10.1177/15346501241228250","url":null,"abstract":"Sexual assault survivors can experience a wide variety of psychological consequences—from none to Major Depression Disorder to Substance use and, most commonly, Acute Stress Disorder/Post Traumatic Stress Disorder. These clinical outcomes depend on the severity of the assault, as well as pre-assault psychological status, and post-assault social support, the effectiveness of therapy, and events that occur during therapy. This case study will focus on one particular event that can arise during the treatment of a survivor of sexual assault, namely the impact of a not guilty verdict on the survivor occurring during the course of therapy. The client in question experienced an immediate and significant increase in depressive symptoms and the course of therapy needed to be altered significantly to respond to the not guilty verdict rendered during the therapy process. This case study will explore how therapy was altered in response to this guilty verdict and the lessons that were learned from this experience in order to better prepare assault survivors who are involved in legal proceedings during their therapy. Overall, this case study demonstrated the vital need to prepare survivors who plan to testify in court against the perpetrator beforehand for all possible outcomes of the trial. Furthermore, the case study demonstrated the need to implement effective interventions in the aftermath of a trial to help buffer against the effects of a “not guilty” verdict.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139528288","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 : 2023-12-28DOI: 10.1177/15346501231225505
Marissa L. Donahue, M. Twohig
Trichotillomania, also known as Hair-Pulling Disorder, is characterized by recurrent pulling out of one’s hair over brief episodes or sustained periods of time and results in hair loss. ACT-enhanced behavior therapy (A-EBT) has been shown to be an effective approach in the treatment of trichotillomania by promoting psychological flexibility around hair pulling urges and teaching stimulus control and habit reversal training. However, there is limited support of A-EBT for clients with an ethnic minority identity. This case report focuses on an adult, Hispanic female client, Luna (pseudonym), who received eight sessions of A-EBT for the treatment of trichotillomania. At post-treatment, Luna showed significant improvements in number of hairs pulled, trichotillomania specific psychological flexibility, depression and anxiety. Luna’s case highlights barriers to care such as potential resistance in seeking mental health services, the influence of family members’ beliefs on receiving mental health services, and the limited access to specialized treatment of trichotillomania.
{"title":"ACT-Enhanced Behavior Therapy for a Hispanic Adult with Trichotillomania: A Case Report","authors":"Marissa L. Donahue, M. Twohig","doi":"10.1177/15346501231225505","DOIUrl":"https://doi.org/10.1177/15346501231225505","url":null,"abstract":"Trichotillomania, also known as Hair-Pulling Disorder, is characterized by recurrent pulling out of one’s hair over brief episodes or sustained periods of time and results in hair loss. ACT-enhanced behavior therapy (A-EBT) has been shown to be an effective approach in the treatment of trichotillomania by promoting psychological flexibility around hair pulling urges and teaching stimulus control and habit reversal training. However, there is limited support of A-EBT for clients with an ethnic minority identity. This case report focuses on an adult, Hispanic female client, Luna (pseudonym), who received eight sessions of A-EBT for the treatment of trichotillomania. At post-treatment, Luna showed significant improvements in number of hairs pulled, trichotillomania specific psychological flexibility, depression and anxiety. Luna’s case highlights barriers to care such as potential resistance in seeking mental health services, the influence of family members’ beliefs on receiving mental health services, and the limited access to specialized treatment of trichotillomania.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139148481","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 : 2023-12-19DOI: 10.1177/15346501231222495
Caitlin B. Shepherd, Rebecca G. Boswell, Jessica Genet, Wendy Oliver-Pyatt, Christine Stockert, Rebecca Brumm, Shaun Riebl, Katie Piel
For severe cases of anorexia nervosa (AN), including when poor prognostic factors like low body mass index (BMI) and longer illness duration are present, intermediate levels of care are often indicated. Current guidelines call for treatment programs to use an evidence-based practice approach to individualize treatment and optimize outcomes. Research supports the effectiveness of intermediate levels of care, including remote programs which increase access to treatment. However, conflicting evidence exists regarding the ability to safely weight restore clients during remote care, necessitating further research. This case report highlights the viability of treating clients with AN remotely using an evidence-based practice approach, resulting in weight restoration and symptom remission. The client presented with a longstanding history of severe binge-eating/purging AN with numerous medical complications but was motivated and treatment-compliant. Her eating disorder (ED) was conceptualized using a biopsychosocial perspective and treated using a multidisciplinary, evidence-based practice approach encompassing individual, group, and supportive interventions. She was successfully discharged from treatment after 150 days, having restored weight to a healthy range and showing substantial improvements in ED, depressive, and anxiety symptoms based on validated measures. This case contributes to the evidence that remote care can be an accessible and effective treatment option, even in cases of severe AN. The case highlights how an evidence-based practice approach can enable safe weight restoration via a personalized treatment plan that emphasizes the use of remote devices and self-monitoring.
对于神经性厌食症（AN）的严重病例，包括存在低体重指数（BMI）和病程较长等不良预后因素时，通常需要进行中级治疗。现行指南要求治疗方案采用循证实践方法，以实现个性化治疗并优化疗效。研究支持中级护理的有效性，包括增加治疗机会的远程计划。然而，关于在远程治疗期间安全恢复患者体重的能力，存在相互矛盾的证据，因此有必要进行进一步研究。本病例报告强调了采用循证实践方法远程治疗自闭症患者的可行性，从而使患者恢复体重并缓解症状。患者有长期严重暴饮暴食/进食障碍的病史，并伴有多种医疗并发症，但她积极配合治疗。她的进食障碍（ED）是用生物心理社会学的观点进行概念化的，并采用多学科循证实践方法进行治疗，包括个人、小组和支持性干预。经过 150 天的治疗，她成功出院，体重恢复到健康范围，而且根据有效的测量方法，她的 ED、抑郁和焦虑症状都有了很大改善。本病例为远程护理提供了证据，证明远程护理是一种方便有效的治疗选择，即使是在严重的 AN 病例中也是如此。该病例强调了循证实践方法如何通过强调使用远程设备和自我监测的个性化治疗计划来安全地恢复体重。
{"title":"Weight Restoration and Symptom Remission for Longstanding, Untreated Anorexia Nervosa in a Remote Eating Disorder Treatment Program: A Case Study","authors":"Caitlin B. Shepherd, Rebecca G. Boswell, Jessica Genet, Wendy Oliver-Pyatt, Christine Stockert, Rebecca Brumm, Shaun Riebl, Katie Piel","doi":"10.1177/15346501231222495","DOIUrl":"https://doi.org/10.1177/15346501231222495","url":null,"abstract":"For severe cases of anorexia nervosa (AN), including when poor prognostic factors like low body mass index (BMI) and longer illness duration are present, intermediate levels of care are often indicated. Current guidelines call for treatment programs to use an evidence-based practice approach to individualize treatment and optimize outcomes. Research supports the effectiveness of intermediate levels of care, including remote programs which increase access to treatment. However, conflicting evidence exists regarding the ability to safely weight restore clients during remote care, necessitating further research. This case report highlights the viability of treating clients with AN remotely using an evidence-based practice approach, resulting in weight restoration and symptom remission. The client presented with a longstanding history of severe binge-eating/purging AN with numerous medical complications but was motivated and treatment-compliant. Her eating disorder (ED) was conceptualized using a biopsychosocial perspective and treated using a multidisciplinary, evidence-based practice approach encompassing individual, group, and supportive interventions. She was successfully discharged from treatment after 150 days, having restored weight to a healthy range and showing substantial improvements in ED, depressive, and anxiety symptoms based on validated measures. This case contributes to the evidence that remote care can be an accessible and effective treatment option, even in cases of severe AN. The case highlights how an evidence-based practice approach can enable safe weight restoration via a personalized treatment plan that emphasizes the use of remote devices and self-monitoring.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138958883","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 : 2023-12-15DOI: 10.1177/15346501231222554
Christina S. Lee, David K. Sherman
Annually, alcohol, tobacco, and illicit drug use are responsible for the 11.8 million deaths worldwide, exceeding the number of deaths from all cancers ( Ritchie & Roser, 2018 ). Motivational Interviewing (MI), a person-centered addiction counseling approach ( Miller & Rollnick, 2013 ), is designed for those with low motivation to change. MI is presumed to minimize client defensiveness by avoiding confrontation. Culturally adapting evidence-based treatments such as MI may reduce alcohol-related health disparities among Latinx adults. A completed randomized trial tested the relative efficacy of Culturally Adapted Motivational Interview (CAMI) compared to MI in Latinx drinkers. CAMI had beneficial alcohol use effects among persons who reported high discrimination and stigma ( Lee et al., 2019 ). Self-Affirmation Theory, which provides a mechanism where stigma effects can be buffered, was integrated into the CAMI. Augmenting affirmation in the CAMI is postulated to lower defensiveness and increase openness to information that pose a threat to self-image ( Sherman & Cohen, 2006 ). The purpose of this case example is to present the novel features of CAMI and to suggest how affirmation may have played in the CAMI’s beneficial effects for individuals with high discrimination. The case example illustrates how the CAMI addresses three conditions for self-affirmation associated with strongest effects on motivating behavior change ( Ferrer & Cohen, 2019 ): the presence of psychological threat, timing and availability of resources.
每年，酒精、烟草和非法药物的使用造成全球 1180 万人死亡，超过了所有癌症的致死人数（Ritchie & Roser, 2018）。动机访谈法（MI）是一种以人为本的成瘾咨询方法（Miller & Rollnick, 2013），专为那些改变动机不强的人设计。动机访谈法被认为可以通过避免对抗来最大限度地减少客户的防卫心理。对基于文化的循证疗法（如多元智能）进行调整，可能会减少拉丁裔成年人中与酒精相关的健康差异。一项已完成的随机试验测试了文化适应动机访谈（CAMI）与多元智能疗法对拉丁裔饮酒者的相对疗效。CAMI 对报告受到严重歧视和羞辱的人的酒精使用产生了有益的影响（Lee 等人，2019 年）。自我肯定理论（Self-Affirmation Theory）为成见效应提供了一种缓冲机制，该理论已被纳入 CAMI。据推测，在 CAMI 中增强肯定会降低防御性，并提高对自我形象构成威胁的信息的开放性（Sherman & Cohen，2006 年）。本案例旨在介绍 CAMI 的新特点，并说明肯定如何在 CAMI 中对高歧视性个体产生有利影响。该案例说明了 CAMI 是如何解决与激励行为改变的最强效果相关的自我肯定的三个条件的（Ferrer & Cohen, 2019）：心理威胁的存在、时机和资源的可用性。
{"title":"Integration of Motivational Interviewing and Self-Affirmation Theory into a Culturally Adapted Motivational Interview: A Case Study","authors":"Christina S. Lee, David K. Sherman","doi":"10.1177/15346501231222554","DOIUrl":"https://doi.org/10.1177/15346501231222554","url":null,"abstract":"Annually, alcohol, tobacco, and illicit drug use are responsible for the 11.8 million deaths worldwide, exceeding the number of deaths from all cancers ( Ritchie & Roser, 2018 ). Motivational Interviewing (MI), a person-centered addiction counseling approach ( Miller & Rollnick, 2013 ), is designed for those with low motivation to change. MI is presumed to minimize client defensiveness by avoiding confrontation. Culturally adapting evidence-based treatments such as MI may reduce alcohol-related health disparities among Latinx adults. A completed randomized trial tested the relative efficacy of Culturally Adapted Motivational Interview (CAMI) compared to MI in Latinx drinkers. CAMI had beneficial alcohol use effects among persons who reported high discrimination and stigma ( Lee et al., 2019 ). Self-Affirmation Theory, which provides a mechanism where stigma effects can be buffered, was integrated into the CAMI. Augmenting affirmation in the CAMI is postulated to lower defensiveness and increase openness to information that pose a threat to self-image ( Sherman & Cohen, 2006 ). The purpose of this case example is to present the novel features of CAMI and to suggest how affirmation may have played in the CAMI’s beneficial effects for individuals with high discrimination. The case example illustrates how the CAMI addresses three conditions for self-affirmation associated with strongest effects on motivating behavior change ( Ferrer & Cohen, 2019 ): the presence of psychological threat, timing and availability of resources.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138997034","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 : 2023-12-08DOI: 10.1177/15346501231221284
David W. Cosottile, Emily Exline, Jessica S. Akers, Stephanie Gerow, Remington Swensson
Children with autism spectrum disorder (ASD) engage in challenging behavior that can result in missing out on potential reinforcers. A common intervention for challenging behavior is functional communication training (FCT). In FCT, the clinician reinforces an appropriate communicative response using the same reinforcer maintaining the challenging behavior. In some cases, the challenging behavior is too severe for traditional FCT procedures to efficiently teach a new response. In this case study, we treated a 4-year-old boy with ASD referred to as Mostafa using a modified version of FCT. We did not include a typical component of traditional FCT procedures – the removal of the putative reinforcer prior to the trial. Instead, we provided components of toys and games contingent on the appropriate communication response. None of the components had to be removed to continue conducting learning trials. Mostafa’s communication increased and challenging behavior decreased as a result of this modification. This modification may be useful for other cases in which the removal of a tangible item interferes with learning a communication response.
{"title":"Functional Communication Training Without the Removal of a Tangible Item","authors":"David W. Cosottile, Emily Exline, Jessica S. Akers, Stephanie Gerow, Remington Swensson","doi":"10.1177/15346501231221284","DOIUrl":"https://doi.org/10.1177/15346501231221284","url":null,"abstract":"Children with autism spectrum disorder (ASD) engage in challenging behavior that can result in missing out on potential reinforcers. A common intervention for challenging behavior is functional communication training (FCT). In FCT, the clinician reinforces an appropriate communicative response using the same reinforcer maintaining the challenging behavior. In some cases, the challenging behavior is too severe for traditional FCT procedures to efficiently teach a new response. In this case study, we treated a 4-year-old boy with ASD referred to as Mostafa using a modified version of FCT. We did not include a typical component of traditional FCT procedures – the removal of the putative reinforcer prior to the trial. Instead, we provided components of toys and games contingent on the appropriate communication response. None of the components had to be removed to continue conducting learning trials. Mostafa’s communication increased and challenging behavior decreased as a result of this modification. This modification may be useful for other cases in which the removal of a tangible item interferes with learning a communication response.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138588155","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 : 2023-11-20DOI: 10.1177/15346501231217745
Caleb D. Farley, M. Twohig
Social anxiety disorder (SAD) often develops during teenager years, and it is important to conceptualize developmentally appropriate interventions. Exposure therapy framed from a perspective of acceptance and commitment therapy (ACT) shows promise for decreasing pathology and increasing wellbeing. This case illustrates the process through which exposure therapy was integrated with ACT to elicit meaningful outcomes in a case of SAD with a 16-year-old female. Treatment outcomes assessed included engagement in values-based activities as well as assessments of depression, anxiety, experiential avoidance, and context-specific wellness. Intervention focused on learning ACT principles through relatable metaphors and experiential exercises and practicing them with values-guided social exposures. This integration resulted in increased engagement of socially meaningful experiences and associated changes in treatment outcomes. Implications, guidelines, and recommendations are presented, including the need for skill-focused treatments, identifying deficits in psychological flexibility, and maintaining a compassionate yet growth-oriented course of treatment.
{"title":"Merging Acceptance and Commitment Therapy with Exposure Exercises to Treat Social Anxiety in a Teen","authors":"Caleb D. Farley, M. Twohig","doi":"10.1177/15346501231217745","DOIUrl":"https://doi.org/10.1177/15346501231217745","url":null,"abstract":"Social anxiety disorder (SAD) often develops during teenager years, and it is important to conceptualize developmentally appropriate interventions. Exposure therapy framed from a perspective of acceptance and commitment therapy (ACT) shows promise for decreasing pathology and increasing wellbeing. This case illustrates the process through which exposure therapy was integrated with ACT to elicit meaningful outcomes in a case of SAD with a 16-year-old female. Treatment outcomes assessed included engagement in values-based activities as well as assessments of depression, anxiety, experiential avoidance, and context-specific wellness. Intervention focused on learning ACT principles through relatable metaphors and experiential exercises and practicing them with values-guided social exposures. This integration resulted in increased engagement of socially meaningful experiences and associated changes in treatment outcomes. Implications, guidelines, and recommendations are presented, including the need for skill-focused treatments, identifying deficits in psychological flexibility, and maintaining a compassionate yet growth-oriented course of treatment.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139256890","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 : 2023-11-15DOI: 10.1177/15346501231209334
Melissa Gabriella Guineau, Richard Oude Voshaar, Gert-Jan Hendriks
The prevalence of Obsessive-compulsive disorder (OCD) among older adults varies between .5% and 4.5%. OCD typically develops at a young age, and many clinicians consider the chances of successful treatment in older adults to be minimal based on the chronicity of their symptoms. To date, no randomized controlled trial have been conducted on the effectiveness of treatments for OCD in older adults. This case study describes a high intensive cognitive behavioral therapy (CBT) provided to a 72-year-old man with OCD. This CBT program includes psychoeducation, exposure and response prevention, and cognitive therapy. The treatment was provided by a team of 5 therapists over one week. The patient’s score on the Yale Brown Obsessive-Compulsive Scale decreased from 31 at the start of the treatment to 2 by the end of treatment, which is below the recommended cut-off for a clinical diagnosis. Secondary depressive symptoms, as assessed with the Inventory of Depressive Symptomatology Self-Report, decreased from 57 at the start of treatment, to 1 by the end of treatment, which indicates the absence of depressive symptoms. The treatment gains were maintained with persistent remission until the 18-month follow-up. This study highlights an effective high intensive CBT program for older adults with OCD and challenges the false assumptions that (a) psychological interventions are ineffective for older adults and (b) existing treatments are unsuited for older adults. Future research should investigate the effects of this program in large sample with sufficient power.
{"title":"High Intensive Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder for a 72-year-Old Man","authors":"Melissa Gabriella Guineau, Richard Oude Voshaar, Gert-Jan Hendriks","doi":"10.1177/15346501231209334","DOIUrl":"https://doi.org/10.1177/15346501231209334","url":null,"abstract":"The prevalence of Obsessive-compulsive disorder (OCD) among older adults varies between .5% and 4.5%. OCD typically develops at a young age, and many clinicians consider the chances of successful treatment in older adults to be minimal based on the chronicity of their symptoms. To date, no randomized controlled trial have been conducted on the effectiveness of treatments for OCD in older adults. This case study describes a high intensive cognitive behavioral therapy (CBT) provided to a 72-year-old man with OCD. This CBT program includes psychoeducation, exposure and response prevention, and cognitive therapy. The treatment was provided by a team of 5 therapists over one week. The patient’s score on the Yale Brown Obsessive-Compulsive Scale decreased from 31 at the start of the treatment to 2 by the end of treatment, which is below the recommended cut-off for a clinical diagnosis. Secondary depressive symptoms, as assessed with the Inventory of Depressive Symptomatology Self-Report, decreased from 57 at the start of treatment, to 1 by the end of treatment, which indicates the absence of depressive symptoms. The treatment gains were maintained with persistent remission until the 18-month follow-up. This study highlights an effective high intensive CBT program for older adults with OCD and challenges the false assumptions that (a) psychological interventions are ineffective for older adults and (b) existing treatments are unsuited for older adults. Future research should investigate the effects of this program in large sample with sufficient power.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139274030","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 : 2023-08-29DOI: 10.1177/15346501231198483
Rowan Tinlin-Dixon
Functional neurological symptom disorder (FND) is associated with complex specialist investigations and poor prognosis. The theoretical understanding of FND posits that functional symptoms are predisposed by both psychological factors, including attachment disturbances and childhood trauma, and biological factors such as neuroplasticity and epigenetics. Current treatment recommendations include psychological therapy, with moderate effects observed with cognitive-behavioural therapy and psychodynamic therapy modalities, however, psychological understanding is key to success. The current case report describes cognitive analytic therapy (CAT) with a 68 year-old woman presenting to services with diagnoses of FND and borderline personality disorder (BPD). The target problem for therapy was integration of fragmented self-states (dissociative and driven) pertinent to both FND and BPD. 16 session CAT was delivered, with four follow up sessions, exploring unhelpful patterns of relating with self and others, based on an unconscious repertoire of internalised patterns and procedures from early life. CAT tools were used to facilitate change; reformulation and ending letters, mapping and the therapeutic relationship. Scores on the personality structure questionnaire (PSQ) and an idiosyncratic measure of state-shifting indicated positive outcomes, sustained at 3 month follow up. This shows modest early acceptability and feasibility of CAT for working with comorbid BPD and FND, providing a validating and blame free formulation of the development and maintenance of symptoms. Additional measures would have improved the ability to comment on the effectiveness of the treatment and future research implications are discussed.
{"title":"Using Cognitive Analytic Therapy as a Transdiagnostic Intervention for Comorbid Personality Disorder, Posttraumatic Stress Disorder, and Functional Neurological Symptom Disorder: A Case Report of a 68 Woman’s Journey Toward the Integration of Dissociated Self-States","authors":"Rowan Tinlin-Dixon","doi":"10.1177/15346501231198483","DOIUrl":"https://doi.org/10.1177/15346501231198483","url":null,"abstract":"Functional neurological symptom disorder (FND) is associated with complex specialist investigations and poor prognosis. The theoretical understanding of FND posits that functional symptoms are predisposed by both psychological factors, including attachment disturbances and childhood trauma, and biological factors such as neuroplasticity and epigenetics. Current treatment recommendations include psychological therapy, with moderate effects observed with cognitive-behavioural therapy and psychodynamic therapy modalities, however, psychological understanding is key to success. The current case report describes cognitive analytic therapy (CAT) with a 68 year-old woman presenting to services with diagnoses of FND and borderline personality disorder (BPD). The target problem for therapy was integration of fragmented self-states (dissociative and driven) pertinent to both FND and BPD. 16 session CAT was delivered, with four follow up sessions, exploring unhelpful patterns of relating with self and others, based on an unconscious repertoire of internalised patterns and procedures from early life. CAT tools were used to facilitate change; reformulation and ending letters, mapping and the therapeutic relationship. Scores on the personality structure questionnaire (PSQ) and an idiosyncratic measure of state-shifting indicated positive outcomes, sustained at 3 month follow up. This shows modest early acceptability and feasibility of CAT for working with comorbid BPD and FND, providing a validating and blame free formulation of the development and maintenance of symptoms. Additional measures would have improved the ability to comment on the effectiveness of the treatment and future research implications are discussed.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47351104","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 : 2023-08-26DOI: 10.1177/15346501231197403
Mary Baumgardner, Kristy Benoit Allen
Cognitive-behavioral therapy (CBT) is an evidence-based treatment for social anxiety disorder that has been found to elicit significant changes in process-based mechanisms (e.g., emotion regulation strategies), which subsequently lead to reductions in social anxiety and associated functional impairment; however, CBT may be less effective for socially anxious individuals experiencing high self-criticism and low self-compassion. Compassion-focused therapy (CFT) has been used to address these tendencies in socially anxious individuals, but research in this area is limited. The present case study examined changes in social anxiety symptoms, self-compassion, emotion regulation strategies, and functional impairment throughout the course of treatment with a young, Chinese American woman using a novel integration of CBT and CFT for social anxiety disorder. The client experienced significant reductions in social anxiety and functional impairment across treatment, which was accompanied by reductions in fear and avoidance ratings for feared social scenarios. Significant mechanistic changes were also observed, including decreases in maladaptive emotion regulation strategies (i.e., suppression, rumination) and increases in self-compassion and adaptive emotion regulation strategies (i.e., expressive engagement, cognitive reappraisal). Findings support the efficacy of integrating compassion-focused strategies with CBT for social anxiety for a young adult with prominent tendencies of self-criticism and low self-compassion.
{"title":"Integrating Cognitive-Behavioral Therapy With Compassion-Focused Therapy for the Treatment of Social Anxiety Disorder: An Evidence-Based Case Study","authors":"Mary Baumgardner, Kristy Benoit Allen","doi":"10.1177/15346501231197403","DOIUrl":"https://doi.org/10.1177/15346501231197403","url":null,"abstract":"Cognitive-behavioral therapy (CBT) is an evidence-based treatment for social anxiety disorder that has been found to elicit significant changes in process-based mechanisms (e.g., emotion regulation strategies), which subsequently lead to reductions in social anxiety and associated functional impairment; however, CBT may be less effective for socially anxious individuals experiencing high self-criticism and low self-compassion. Compassion-focused therapy (CFT) has been used to address these tendencies in socially anxious individuals, but research in this area is limited. The present case study examined changes in social anxiety symptoms, self-compassion, emotion regulation strategies, and functional impairment throughout the course of treatment with a young, Chinese American woman using a novel integration of CBT and CFT for social anxiety disorder. The client experienced significant reductions in social anxiety and functional impairment across treatment, which was accompanied by reductions in fear and avoidance ratings for feared social scenarios. Significant mechanistic changes were also observed, including decreases in maladaptive emotion regulation strategies (i.e., suppression, rumination) and increases in self-compassion and adaptive emotion regulation strategies (i.e., expressive engagement, cognitive reappraisal). Findings support the efficacy of integrating compassion-focused strategies with CBT for social anxiety for a young adult with prominent tendencies of self-criticism and low self-compassion.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45055492","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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