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Parent–Child Interaction Therapy for a 3-Year-Old Girl With Post-Traumatic Stress Disorder: Restoration to Her Father’s Care Following a Period in Out-of-Home Care 一名患有创伤后应激障碍的3岁女孩的亲子互动治疗:在一段时间的家庭外护理后恢复父亲的护理
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2021-10-12 DOI: 10.1177/15346501211047482
J. Warren, T. Hanstock, S. Hunt, S. Halpin
Child abuse and neglect in very young children can lead to trauma-related stress symptoms that can be challenging to treat. Children exposed to multiple traumas occurring in the context of a caregiving relationship are sometimes more severely affected, evidenced by diverse negative behavioral, physical, social, and emotional consequences. Some of these children go on to develop post-traumatic stress disorder (PTSD). Parent–child interaction therapy (PCIT) is a dyadic play-based treatment for children with behavior problems and their parents or caregivers. There is limited research relating to the application of PCIT with very young children with PTSD with some studies actively excluding families where PTSD was present (Herschell et al., 2017). Additionally, there are no articles relating to treatment of a child restored to the care of a parent following out-of-home care (OOHC) and fewer still relating to a child restored to the care of her father. This case study illustrates the use of PCIT with a 3-year-old girl with PTSD, recently restored to her father’s care. It highlights how the use of PCIT in this case not only improved behavioral indicators of traumatic stress, but also afforded this child permanency and stability. The case study provides a summary of the progression of this intervention and the results obtained throughout treatment and 4 years post-intervention. The results indicated that PCIT, with trauma-informed tailoring, was an effective treatment in this case and contributed to safe and permanent care for this child.
年幼儿童的虐待和忽视会导致创伤相关的压力症状,这可能很难治疗。在照顾关系中遭受多重创伤的儿童有时会受到更严重的影响,表现为各种负面的行为、身体、社会和情感后果。其中一些孩子会发展成创伤后应激障碍(PTSD)。亲子互动治疗(PCIT)是一种针对有行为问题的儿童及其父母或照顾者的二元游戏治疗。与PCIT在患有创伤后应激障碍的幼儿中的应用有关的研究有限,一些研究积极排除了存在创伤后应激疾病的家庭(Herschell等人,2017)。此外,没有关于在家庭外护理(OOHC)后恢复由父母照顾的儿童的治疗的文章,更少的文章涉及恢复由父亲照顾的儿童。这项案例研究说明了PCIT对一名患有创伤后应激障碍的3岁女孩的使用,该女孩最近恢复了父亲的护理。它强调了在这种情况下使用PCIT不仅改善了创伤压力的行为指标,而且为这个孩子提供了持久性和稳定性。该案例研究总结了这种干预的进展情况,以及在整个治疗过程和干预后4年获得的结果。结果表明,PCIT结合创伤知情剪裁,是该病例的有效治疗方法,有助于该儿童的安全和永久护理。
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引用次数: 2
Treating Adolescent Misophonia With Cognitive Behavioral Therapy: Considerations for Including Exposure 用认知行为疗法治疗青少年恐音症:包括暴露在内的考虑
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2021-09-30 DOI: 10.1177/15346501211045707
Jennifer L. Cecilione, Stephanie A. Hitti, S. Vrana
Although misophonia is not yet included in the primary diagnostic manuals used by psychologists or psychiatrists, proposed criteria suggest that this condition is characterized by a strong negative reaction to and avoidance of certain trigger sounds. Misophonic trigger sounds are largely human-made (e.g., chewing and slurping) and evoke responses such as disgust, irritation, and/or anger that are out of proportion to the situation and cause distress and/or impairment. Currently, there is no gold standard evidence-based treatment for misophonia. As the misophonia treatment literature grows, several important questions are arising: (1) should exposure to aversive sound triggers be included in treatment for misophonia and (2) how can clinicians best assess misophonia symptoms. This case offers one example of misophonia being successfully treated with a cognitive-behavioral approach to treatment (including exposures) in an adolescent girl. This case also offers an example of how clinicians may conduct a comprehensive assessment of misophonia symptoms. Theoretically and empirically derived recommendations for including exposure in misophonia treatment are presented. Information from this case may be helpful in informing future research, as there is a paucity of evidence-based assessment and treatment protocols for misophonia.
尽管心理学家或精神病学家使用的主要诊断手册中还没有包括失声症,但拟议的标准表明,这种情况的特点是对某些触发音有强烈的负面反应并避免发出某些触发音。失声触发音在很大程度上是人为的(例如,咀嚼和吞咽),会引起厌恶、愤怒和/或愤怒等反应,这些反应与情况不相称,会导致痛苦和/或损伤。目前,还没有金标准的循证治疗厌音症。随着失音症治疗文献的增长,出现了几个重要问题:(1)在失音症的治疗中是否应该包括暴露于厌恶性声音触发因素,以及(2)临床医生如何最好地评估失音症症状。该病例提供了一个例子,说明在一名青春期女孩中,用认知-行为治疗方法(包括暴露)成功治疗了发音障碍。该病例还提供了一个临床医生如何对发音障碍症状进行全面评估的例子。从理论上和经验上提出了将暴露纳入发音不良治疗的建议。该病例的信息可能有助于为未来的研究提供信息,因为缺乏基于证据的厌音症评估和治疗方案。
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引用次数: 10
The Importance of Learning Style in Case Formulation–Driven Cognitive Behavioral Therapy: A Case Study 学习风格在案例形成驱动的认知行为疗法中的重要性:一个案例研究
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2021-08-28 DOI: 10.1177/15346501211041388
C. Gasperetti, Janie J Hong
Rather than structuring treatment based on diagnoses, case formulation–driven cognitive behavior therapy (CF-CBT) focuses on building an individualized formulation or map of how a patient’s presenting problems are being maintained and uses this formulation to guide treatment planning. A case formulation can include comorbid diagnoses, underlying mechanisms, relevant historical, biological, and social factors, and problems unrelated to a diagnosis (e.g., unemployment). Therapy is also a learning context, and clients vary in their learning styles and preferences. The success of treatment depends not only on what a client learns but also on how a client learns. Frequently, learning style is not considered when developing a case formulation or providing CBT. The present case study, based on a man with social anxiety disorder who was treated using CF-CBT, demonstrates the importance of including learning style to target both what and how the client learns.
病例公式驱动的认知行为疗法(CF-CBT)不是基于诊断来构建治疗,而是专注于构建一个个性化的公式或患者当前问题的解决方案,并使用该公式来指导治疗计划。病例表述可以包括共病诊断、潜在机制、相关的历史、生物学和社会因素,以及与诊断无关的问题(例如失业)。治疗也是一种学习环境,客户的学习风格和偏好各不相同。治疗的成功不仅取决于客户学到了什么,还取决于客户如何学习。在制定案例公式或提供CBT时,通常不考虑学习风格。本案例研究基于一名使用CF-CBT治疗的社交焦虑症患者,证明了包括学习风格以针对客户学习内容和方式的重要性。
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引用次数: 0
Parent-Mediated Home Intervention for Delayed Sleep-Onset and Night Waking in a Child With Autism Spectrum Disorder 父母介导的家庭干预对自闭症谱系障碍儿童延迟睡眠和夜间醒来的影响
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2021-08-28 DOI: 10.1177/15346501211041407
Anna Linnehan, B. Cannon, J. Luiselli
We report the case of a 10-year-old boy with autism spectrum disorder who had difficulty initiating and maintaining sleep. Through home consultation, his parents were trained to implement a multicomponent sleep intervention that included (a) faded bedtime, (b) regimented pre-bedtime routines, and (c) elimination of positive social consequences contingent on sleep problems including unwanted co-sleeping. A critical element in the case was functional assessment of the conditions associated with poor sleeping and matching intervention to parent preferences. Compared to a baseline phase, intervention reduced night waking frequency and duration as well as the time required for the boy to fall asleep. Follow-up results one and 2 months post-intervention documented sustained improvement.
我们报告的情况下,一个10岁的男孩自闭症谱系障碍谁有困难启动和维持睡眠。通过家庭咨询,他的父母接受了培训,以实施多成分睡眠干预,包括(a)减少就寝时间,(b)严格控制睡前常规,(c)消除因睡眠问题而产生的积极社会后果,包括不想要的共睡。该案例的一个关键因素是对与睡眠不良相关的条件进行功能评估,并将干预与父母的偏好相匹配。与基线阶段相比,干预减少了夜间醒来的频率和持续时间,以及男孩入睡所需的时间。干预后1个月和2个月的随访结果显示持续改善。
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引用次数: 2
Integrated Trauma-Focused Psychotherapy for Traumatic Stress and Substance Use: Two Adolescent Case Studies 综合创伤心理治疗创伤压力和物质使用:两个青少年案例研究
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2021-08-26 DOI: 10.1177/15346501211046054
Olivia Schollar-Root, J. Cassar, Natalie Peach, V. Cobham, Bronwyn Milne, E. Barrett, S. Back, S. Bendall, S. Perrin, K. Brady, J. Ross, M. Teesson, Ivana Kihas, Katherine A Dobinson, K. Mills
Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) occur frequently as comorbid diagnoses among adolescents. Historically, these conditions have been treated using a sequential model; however, emerging evidence suggests that an integrated treatment model may be most effective. This article presents two de-identified clinical case studies from an ongoing randomised controlled trial examining the efficacy of an integrated, exposure-based, cognitive-behavioral psychotherapy (CBT) for PTSD and SUD among adolescents (COPE-A), relative to a supportive counselling control condition (person-centred therapy). In both case studies, participants were randomised to receive the COPE-A integrated treatment, which incorporates prolonged exposure (PE) including imaginal and in vivo exposure as a core treatment component alongside CBT for PTSD and SUD. The clinical profile and treatment response of each participant is discussed. Promising results were found in both cases, with substantially reduced traumatic stress symptoms and decreased or stable levels of substance use by the end of treatment. Clinical implications of these early findings are discussed.
创伤后应激障碍(PTSD)和物质使用障碍(SUD)是青少年常见的合并症。从历史上看,这些疾病一直使用顺序模型治疗;然而,新出现的证据表明,综合治疗模式可能是最有效的。本文介绍了来自一项正在进行的随机对照试验的两个去识别的临床病例研究,该试验检验了综合的、基于暴露的、认知行为心理治疗(CBT)对青少年PTSD和SUD (COPE-A)的疗效,相对于支持性咨询控制条件(以人为本的治疗)。在这两个案例研究中,参与者被随机分配接受COPE-A综合治疗,其中包括长时间暴露(PE),包括想象和体内暴露,作为治疗PTSD和SUD的核心治疗成分。讨论了每位参与者的临床概况和治疗反应。在这两种情况下都发现了令人鼓舞的结果,在治疗结束时,创伤应激症状大大减轻,物质使用水平下降或稳定。讨论了这些早期发现的临床意义。
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引用次数: 2
Interpersonal Therapy in Primary Infertility, Life-Cycle Transitions, and Dysthymia: A Single Case Study 原发性不孕、生命周期转换和恶劣心境的人际治疗:一项个案研究
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2021-08-12 DOI: 10.1177/15346501211038275
Sampurna Chakraborty, P. Roy
Interpersonal psychotherapy (IPT) is an evidence-based therapy, originally developed to treat major depression. IPT conceptualizes depression from a bio-psychosocial perspective where signs of depression are understood in the context of an individual’s current social and interpersonal stressors, defined in terms of role transitions, disputes, bereavements, and sensitivities. In this single case study, IPT was used to treat a woman undergoing primary infertility with multiple failed pregnancies and unsuccessful adoption procedures along with specific grief reactions and depressive symptoms for 2 years. The therapy was formulated over 12 weekly sessions in the outpatient set-up in a general hospital in Kolkata in 2017. Hamilton Depression Rating Scale (HDRS) was used to assess the efficacy of the therapy and its outcomes. The therapy was found to be effective in the patient and justifies the rationale of choosing the said therapy for the specific case from an interpersonal viewpoint. The case study may help suggest how and why to use interpersonal psychotherapy in infertility conditions with psychological ramifications.
人际心理治疗(IPT)是一种循证疗法,最初是为治疗严重抑郁症而开发的。IPT从生物-心理社会的角度对抑郁症进行概念化,其中抑郁症的迹象是在个人当前的社会和人际压力源的背景下理解的,定义为角色转换、纠纷、丧亲之痛和敏感性。在这项单一病例研究中,IPT用于治疗一名原发性不孕妇女,该妇女多次妊娠失败,收养程序不成功,并伴有特定的悲伤反应和抑郁症状,持续2年。2017年,该疗法在加尔各答一家综合医院的门诊部每周12次。汉密尔顿抑郁量表(HDRS)用于评估该疗法的疗效及其结果。该疗法被发现对患者有效,并从人际关系的角度证明了为特定病例选择所述疗法的理由。该案例研究可能有助于建议如何以及为什么在有心理影响的不孕不育情况下使用人际心理治疗。
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引用次数: 1
Processing of Positive Memories Technique among Clients Reporting Traumatic Experiences: A Case Series 积极记忆技术在创伤经历报告中的加工:一个案例系列
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2021-08-11 DOI: 10.1177/15346501211035841
A. Fondren, Anne N. Banducci, Randall J. Cox, Ateka A. Contractor
Many current treatments for posttraumatic stress disorder (PTSD) emphasize processing and engaging with trauma memories as the key mechanism of therapeutic change. However, promising emerging research indicates links between PTSD symptoms and positive memories. Processing positive memories, to therapeutically impact health outcomes for trauma-exposed individuals, may have several benefits, including (a) increasing access to positive coping mechanisms via activating positive affect and thoughts; (b) addressing avoidance of positive affect and thoughts; and (c) honing skills that will aid in the eventual processing of trauma memories. The present article demonstrates the utility and effects of a novel Processing of Positive Memories Technique (PPMT) with three clients who reported a history of traumatic experiences. We outline the procedures of a 5-session PPMT, that incorporates symptom assessment, detailed imaginal experiencing of positive memories, and processing of associated positive values, affect, strengths, and thoughts. We utilize longitudinal assessment data to demonstrate the clinical benefits of PPMT, such as less PTSD severity, improved mood (e.g., less negative affect), and greater self-esteem. Finally, we discuss treatment considerations based on unique client factors and treatment modalities (i.e., in-person vs. video telehealth).
目前许多创伤后应激障碍(PTSD)的治疗方法都强调处理和参与创伤记忆是治疗变化的关键机制。然而,有希望的新兴研究表明,创伤后应激障碍症状和积极记忆之间存在联系。处理积极的记忆,以治疗创伤暴露个体的健康结果,可能有几个好处,包括(a)通过激活积极的情感和思想,增加积极应对机制的机会;(b) 解决避免正面影响和思想的问题;以及(c)磨练有助于最终处理创伤记忆的技能。本文展示了一种新的积极记忆处理技术(PPMT)的效用和效果,三位客户报告了创伤经历。我们概述了5节PPMT的程序,其中包括症状评估、积极记忆的详细想象体验以及相关积极价值、情感、力量和思想的处理。我们利用纵向评估数据来证明PPMT的临床益处,如减少创伤后应激障碍的严重程度、改善情绪(例如减少负面影响)和增强自尊。最后,我们讨论了基于独特客户因素和治疗模式的治疗考虑因素(即,面对面与视频远程医疗)。
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引用次数: 3
Functional Communication Training and Most-To-Least Prompting as Treatments for Problem Behavior 功能性沟通训练和最大到最小提示作为问题行为的治疗方法
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2021-07-07 DOI: 10.1177/15346501211030208
J. Axe, C. Murphy, W. L. Heward
Functional communication training (FCT) is a treatment for problem behavior in which the learner is taught a communicative behavior that fulfills the same function as the problem behavior. Although effective, when FCT is used to request breaks from work, limitations include increased time spent in breaks and reduced task-related responding. An alternative treatment is most-to-least prompting (MTL) of a task in which a therapist provides the most helpful prompts for task-related responding (e.g., physical guidance) and gradually reduces the amount of help (e.g., visual prompt and then verbal) until the learner responds independently. We evaluated FCT and MTL in a multiple treatments design with an 11-year-old girl with severe developmental disabilities. Both treatments reduced problem behavior from baseline levels, and academic responding was greater during MTL than during FCT. MTL is an errorless teaching approach conceptualized as an abolishing operation that reduces the aversiveness of a task and makes escape less valuable.
功能性交际训练(FCT)是对问题行为的一种治疗,在这种训练中,学习者被教导一种与问题行为实现相同功能的交际行为。虽然有效,但当FCT用于请求休息时,其局限性包括增加休息时间和减少与任务相关的响应。另一种治疗方法是任务的最大到最小提示(MTL),治疗师为任务相关的反应提供最有用的提示(如物理指导),并逐渐减少帮助量(如视觉提示,然后是语言提示),直到学习者独立做出反应。我们在一项针对一名患有严重发育障碍的11岁女孩的多重治疗设计中评估了FCT和MTL。两种治疗都从基线水平减少了问题行为,MTL期间的学术反应比FCT期间更大。MTL是一种无错误的教学方法,概念化为一种废除操作,可以减少任务的厌恶性,降低逃避的价值。
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引用次数: 0
A Novel Application of the Schema Therapy Mode Model for Social Anxiety Disorder: A Naturalistic Case Study 图式治疗模式在社交焦虑障碍中的新应用:一个自然主义的个案研究
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2021-06-25 DOI: 10.1177/15346501211027866
Erika S. Penney, Alice R. Norton
Social Anxiety Disorder (SAD) is a condition defined by an excessive and persistent fear of negative evaluation in social or performance situations. Whilst Cognitive Behaviour Therapy (CBT) is the gold standard treatment, not all individuals with SAD respond to CBT. The Schema Therapy Mode Model is frequently applied to chronic and hard-to-treat conditions and therefore may be applicable for SAD individuals who are non-responders to CBT. This case study describes how the Mode Model was successfully used to treat a woman in her 20s who presented with excessive fears of negative evaluation and pervasive social avoidance. Experiential techniques, such as chair dialogues and imagery rescripting, resulted in cognitive modification of negative core beliefs, reduced experiential discomfort and increased engagement in social and relational activities. This case offers a preliminary indication that the Schema Therapy Mode Model may be an effective treatment for socially anxious individuals and that further theoretical and empirical study in this area is warranted.
社交焦虑障碍(Social Anxiety Disorder, SAD)是指在社交或表现情境中过度和持续地害怕负面评价。虽然认知行为疗法(CBT)是黄金标准疗法,但并非所有SAD患者都对CBT有反应。图式治疗模式模型经常应用于慢性和难以治疗的疾病,因此可能适用于对CBT无反应的SAD个体。这个案例研究描述了Mode模型是如何成功地用于治疗一个20多岁的女性,她表现出对负面评价的过度恐惧和普遍的社交回避。体验技巧,如椅子对话和图像重写,导致消极核心信念的认知修正,减少体验不适,增加参与社会和关系活动。本案例初步表明图式治疗模式可能是一种有效的治疗社交焦虑个体的方法,值得在该领域进行进一步的理论和实证研究。
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引用次数: 4
Mindfulness-Based Relapse Prevention for the Treatment of Gambling Disorder among U.S. Military Veterans: Case Series and Feasibility 基于正念的复发预防治疗美国退伍军人赌博障碍:案例系列和可行性
IF 1 4区 心理学 Q4 PSYCHIATRY Pub Date : 2021-05-30 DOI: 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.
美国退伍军人的赌博障碍发生率高于平民。本案例系列描述了在退伍军人事务部医院寻求GD门诊治疗的美国退伍军人使用的手动正念治疗的应用。基于正念的复发预防(MBRP)是为了治疗物质使用障碍而开发的,但其核心原则可以很容易地应用于行为成瘾的治疗。然而,几乎没有实证证据表明其成功应用于GD,也没有证据表明其在美国退伍军人中的成功实施。三名接受GD治疗的退伍军人参加了一项9期适应MBRP方案。治疗结束后,退伍军人报告说,他们的赌博行为不那么频繁,渴望也不那么强烈。退伍军人在管理冲动方面的自我效能感也有所提高,冲动和情绪失调减少,功能也有所改善。初步结果为寻求GD治疗的退伍军人进行更大规模的治疗试验提供了支持。
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引用次数: 3
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Clinical Case Studies
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