Cognitive and Behavioral Practice最新文献

There is growing interest in the implementation of culturally responsive mental health care that balances treatment fidelity and cultural fit (Castro et al., 2004). Prolonged exposure (PE) is a first-line, evidence-based treatment for posttraumatic stress disorder (PTSD) and has been successfully implemented in low-income and ethnoracial minority samples (Feske, 2008) and with Latinx individuals specifically (Vera et al., 2011). However, cultural and systemic factors may contribute to Latinx individuals experiencing higher conditional risk for PTSD (Alcántara et al., 2013), disparities in mental health care utilization (Alves-Bradford et al., 2020), and challenges with PTSD treatment delivery (Valentine et al., 2017). Culturally responsive implementation of PE with Latinx clients involves making culturally informed but person-specific assessments of clients, with adaptations as needed. We propose several culturally responsive strategies for therapists to consider when conducting PE with Latinx sexual assault survivors, such as building trust and rapport early on, conducting culturally informed assessment, investing in psychoeducation, optimizing imaginal exposure and in vivo exposure, and problem-solving barriers to homework engagement. Therapists are encouraged to approach this work with cultural humility (Fisher-Borne et al., 2015; Tervalon & Murray-Garcia, 1998) through open listening, critical self-reflection, and consideration for the way in which Latinx identity intersects with other important identity characteristics that can impact treatment relevance and engagement.

Clients can develop feelings of romantic or sexual attraction to their therapists. From a cognitive-behavioral perspective, how should therapists handle these situations? Although the topic of client attraction is comprehensively covered in the psychoanalytic and psychodynamic literature, it is woefully neglected in our cognitive-behavioral therapy (CBT) focused training programs and literature. This paper aims to address this gap by using CBT principles to provide explanations for why clients develop feelings of attraction to their therapists. In addition, this paper offers general guidelines for how to manage client attraction from a CBT perspective. Three case vignettes are used to illustrate those concepts. Recommendations for future research and training in this area are also provided.

Psychogenic nonepileptic seizures (PNES) are the number-one medically unexplained symptom encountered by neurologists (Brown & Reuber, 2016) and account for approximately 30% of patients referred to epilepsy centers (Leu et al., 2020). Episodes of PNES physically resemble epileptic seizures; however, electrical activity within the brain appears to be within normal limits. Currently, there are no medications available to specifically manage PNES (Hingray et al., 2017). Although studies focused on the impact of psychological interventions for PNES are limited, cognitive behavioral therapy (CBT) approaches appear to be effective (LaFrance et al., 2014). Prior exposure to a traumatic event is common for patients with PNES (Brown & Reuber, 2016; Myers et al., 2017). Cognitive Processing Therapy (CPT) is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD). CPT is effective for a variety of traumatic experiences, and asks patients to address avoidance (e.g., of situations, emotions) and challenge maladaptive thought patterns (Resick et al., 2017). In this case study, a 29-year-old Caucasian female patient presented for treatment with comorbid PTSD and PNES. Current PTSD diagnosis was indicated by self-reported and clinician-administered assessment, which included the Clinician Administered PTSD Scale for DSM-5 (CAPS-5 = 52 out of 80) and the PTSD Checklist for DSM-5 (PCL-5 = 59 out of 80). This patient’s Criterion A trauma involved repeated domestic sexual assault as an adult, which occurred for several years. PNES was diagnosed approximately 1 year prior by a neuropsychologist. At the start of treatment, the patient endorsed PNES almost daily, which prevented her from maintaining a job or driving a vehicle. The patient was an early and successful responder to CPT, as she participated in 8 of 12 sessions. In addition to significantly lower self-reported PTSD and depressive symptom severity (PCL-5 = 5; PHQ-9 = 2), she did not experience PNES in the 17 days leading up to her final session. As the patient’s avoidance of distressing trauma-related thoughts and emotions decreased, so too did her PNES. This case study provides neurologists with a promising treatment approach for patients with PNES and PTSD.

Intensive outpatient treatment settings for adults with obsessive-compulsive disorder (OCD) are common, but data on their effectiveness are limited. The effectiveness of IOP treatment for adults with OCD using combined acceptance and commitment therapy (ACT) and exposure and response prevention (ERP) was studied with eight adults. The intervention was 15 hours per week for 3 weeks. Measures were collected at pretreatment, 1-week, 2-weeks, posttreatment, and at 1-month follow-up. At the end of treatment, all participants were in the mild range of OCD symptom severity with a mean symptom decrease of 58%. Psychological inflexibility, depression, anxiety, and stress significantly decreased through treatment and participants ended treatment below clinical range for psychological inflexibility and nonclinical to mild range for depression, anxiety, and stress. The results of this study provide preliminary support for the effectiveness of ACT and ERP in an intensive outpatient setting for adults with OCD. The focus of this paper is on the clinical application of this treatment.

In response to the COVID-19 pandemic and consequential shutdown measures, many mental health professionals started providing therapy to patients exclusively via telehealth. Our research center, which specializes in studying and treating obsessive-compulsive disorder (OCD), historically has provided in-person exposure and response prevention (ERP) to adults with OCD, but shifted to telehealth during the pandemic. Unlike in other modes of talk therapy, ERP’s emphasis on therapist-supervised exposures presented unique opportunities and challenges to delivering treatment entirely via a virtual platform. This paper provides case examples to illustrate lessons we learned delivering ERP exclusively via telehealth in New York from March 2020 through June 2021 and offers recommendations for future study and practice. Though we observed a number of drawbacks to fully remote ERP, we also discovered advantages to delivering ERP this way, meriting additional research attention.

Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) demonstrate high prevalence and comorbidity among post-9/11 veterans. Veterans with this comorbidity often present with multiple co-occurring healthcare needs and increased clinical complexity. The current case report describes the clinical presentation of a veteran with mild TBI and PTSD, both before, during, and after treatment within a multidisciplinary 2-week intensive outpatient program involving prolonged exposure, evidence-based PTSD treatment, and Cognitive Symptom Management and Rehabilitation Therapy, evidence-based treatment for postconcussive symptoms. Mr. A was a 25-year-old White, transgender male who presented with a complex mental health history. At intake, presenting complaints included anxiety, panic attacks, nightmares, and depression secondary to military sexual trauma, as well as reported cognitive difficulties secondary to a concussion. He met current criteria for PTSD as well as panic disorder with agoraphobia. Head injury history consisted of a motor vehicle collision with less than 30 seconds loss of consciousness, brief posttraumatic amnesia, and alterations of consciousness. Mr. A demonstrated habituation during individual exposure sessions as assessed via skin conductance during imaginal exposures and decreased subjective ratings during in vivo exposures, as well as a decrease in trauma-potentiated startle response to trauma cues. Posttreatment data indicates significant reduction in neurobehavioral, posttraumatic stress, and depression symptoms and significant improvement in subjective cognitive functioning. The current findings support the feasibility and efficacy of short-term integrated treatment for complex clinical presentations and the need for larger scale research investigating combined PTSD and TBI intervention.

Latinx caregivers of school-aged children are faced with unique stressors. These stressors include racism, immigration status, and limited resources in schools. Despite an abundance of evidence-based programs for parents and caregivers, many were not developed by or with members of the intended demographic or with specific attention to racial and linguistic identities and social context. This study was a pilot-trial aimed to evaluate the feasibility and effectiveness of Escuela de Madres y Padres (EMP; “School for Mothers and Fathers”), a program based on Dialectical Behavior Therapy (DBT) skills adapted in a community context by Latinx community leaders who are recognized for their expertise in culturally responsive practices to support Latinx caregivers. EMP integrates DBT skills with a strength-based approach and decolonizing lens to highlight and promote the resiliencies and capacities of Latinx parents of school-aged students. Participation in EMP was associated with high satisfaction among participants, significantly decreased perceived stress among caregivers, significantly increased mindfulness in parenting, significantly increased emotion regulation among caregivers, and significantly decreased child behavioral difficulties. This study indicates that EMP holds promise as a culturally relevant program that could improve the well-being of Latinx caregivers.

This report presents the single case of Liam, a 10-year-old boy with rumination disorder (RD) and subclinical symptoms of anxiety. The primary aim was to explore the effectiveness of habit reversal therapy (HRT) in reducing regurgitation frequency in a young child. The secondary aim was to explore whether modular cognitive-behavioral techniques, based on idiosyncratic cognitive-behavioral formulations tailored to the child, may further augment the effect of habit reversal therapy on regurgitation frequency. An A-B-C design was utilized to compare regurgitation frequency and emotional distress across baseline, intervention (primary and secondary), and follow-up phases. Results demonstrated that HRT adapted for children was an effective approach to reducing regurgitation frequency. Self-monitoring alone and additional anxiety management skills provided further benefits to regurgitation frequency though to a lesser extent. Research on pediatric RD remains scarce, particularly regarding treatment for children of a younger age with additional psychological difficulties within clinical settings. Results from the current case study suggest that HRT adapted for children with RD and additional internalizing symptoms in a real-life clinical setting was feasible, acceptable, and effective. More research needs to be conducted on standardizing age-appropriate treatment adaptations for young children with RD and on exploring whether and which cognitive-behavioral techniques provide further meaningful reductions in regurgitation frequency.

Physical activity promotes health and longevity after metabolic/bariatric surgery (MBS), but most patients do not meet recommended levels. The Gaining Optimism After weight Loss Surgery (GOALS) Project was a positive psychological intervention designed to address common emotional barriers to physical activity in patients who have recently undergone MBS (e.g., low confidence around exercise, internalized weight bias, fear of injury) and use motivational interviewing and standard behavior change techniques (e.g., self-monitoring) to increase physical activity. This single-arm proof-of-concept trial was designed to refine the intervention, test feasibility and acceptability, and explore pre-post changes in behavioral and psychological outcomes. Participants were 12 adults 6–12 months post-MBS (M age of 46, 58% female, 67% non-Hispanic white). GOALS was a 10-week telephone counseling program that introduced new positive psychological skills and physical activity topics each week. Participants tracked physical activity with a Fitbit and set weekly goals. Results showed that the intervention was feasible (85% of sessions completed) and acceptable (average participant ratings of session ease and utility above 8.0 on a 0–10 scale). There were medium-to-large effect size improvements in physical activity and psychological well-being (e.g., depressive symptoms). The GOALS intervention will next be tested in a pilot randomized controlled trial with longer-term follow-up to assess its effect more robustly.