Cognitive and Behavioral Practice最新文献

Avoidant/restrictive food intake disorder (ARFID) and gastrointestinal (GI)-related somatic symptom and related disorders (SSRDs) commonly co-occur, and both are associated with confusion in the process of accessing treatment. Furthermore, health professionals report low confidence in providing care for these conditions. Using a life history methodology, we explored the journeys of children and their parents with the diagnosis and treatment of ARFID and/or SSRDs and examined themes in barriers and facilitators to care. Six families with children (4 boys and 2 girls; 8–14 years old) with a diagnosis of ARFID and/or GI-related SSRD were recruited from a pediatric tertiary-level hospital. Interviews were conducted with four parents alone, and two parent-child dyads. Participants provided rich histories of the child’s health journeys with variation in the development of ARFID and GI-related SSRDs and subsequent management. Diagnostic uncertainty, the emotional impact of this journey on families, and systemic barriers to accessing treatment were themes of the healthcare narratives. Validating the emotional impacts of the healthcare journey and building trust may be helpful to address the diagnostic uncertainty that families experience. Strategies to support adaptation of cognitive-behavioral approaches for with children with complex ARFID and/or SSRDs are discussed.

Youth living with chronic medical conditions and their families face several challenges (e.g., adjustment to a new diagnosis, ongoing daily condition management, coping with potential long-term consequences of illness). Traditional CBT approaches emphasize collaborative problem-solving with a core focus on change. At times, these approaches may feel inaccessible or unhelpful for pediatric patients and their families who are facing illness-related challenges that they cannot change or control. Dialectical behavior therapy integrates CBT-based change interventions with acceptance-based strategies to normalize challenging thoughts and emotions and help individuals feel validated. Medical providers working with pediatric patients and families can also benefit from a DBT-based conceptualization and approach to improve patient/family-provider relationships. This article summarizes the current evidence base for and justifies the use of adaptations of DBT for patients with medical illness. Further, through clinical case examples, it illustrates the use of DBT skills and concepts in improving outcomes for pediatric patients and their families.

Youth diagnosed with Type 1 Diabetes are at higher risk for psychological comorbidities such as anxiety and depression than the general population. Disease-related psychological distress including fear of hypoglycemia contributes to poor adherence to youths' medical regimes and glycemic control. Poorly managed Type 1 Diabetes often leads to adverse health outcomes such as ketoacidosis, vision impairment, and sometimes death. Cognitive-behavioral therapy is a promising method to improve health outcomes and psychological functioning in youth with Type 1 Diabetes. Accordingly, this article offers a brief overview of Type 1 Diabetes as well as examining the role of fear of hypoglycemia and disease-related anxieties in pediatric patients. Additionally, various obstacles to medical adherence and the impact of family conflict are discussed. The clinical sequelae of Type 1 Diabetes in diverse populations and the research supporting cognitive behavioral therapy are delineated. Next, the case description illustrates the challenges for youth with Type 1 Diabetes and their families. This bench-to-bedside translation presents evidence of clinically meaningful improvements from implementing CBT with a Latino male child. Psychoeducation, relaxation training, cognitive restructuring, and behavioral experiments were deployed. Last, additional considerations for treatment were presented.

Mental and physical health disparities for transgender and gender diverse (TGD) communities have been well-documented. While advancements have been made in the development of guidelines when providing mental health care to TGD clients, gaps remain, particularly related to concrete applications of cognitive behavior therapy (CBT) approaches to address the unique mental health needs of TGD people. Such gaps leave many mental health professionals inadequately prepared to assess and treat clinical distress in TGD people, which in turn maintains health disparities. Utilizing case vignettes reflecting diverse TGD identities, this paper discusses minority stress and intersectional stigma frameworks and demonstrates their integration with CBT principles in the delivery of culturally tailored assessment, case conceptualization, and treatment of TGD clients.

Body dissatisfaction is a robust risk factor for eating disorders (EDs) and body dysmorphic disorder (BDD) and is associated with decreased quality of life. Current gold-standard ED treatments often do not fully address body dissatisfaction, which may leave patients vulnerable to relapse following treatment. Mirror exposure (ME) is one evidence-based strategy shown to reduce body dissatisfaction in EDs and BDD. However, the potential of integrating this strategy with other interventions demonstrated to reduce body dissatisfaction, such as focusing on the body’s functionality, remains unexplored in ED samples. This article describes the development of a novel body functionality-focused ME (FME). We describe the development and structure of the novel ME, and a pilot test for its benefits in treatment through a clinical case series of four individuals with clinically elevated body dissatisfaction and/or EDs who were receiving concurrent cognitive behavioral therapy. All four patients demonstrated clinically meaningful improvements in state body satisfaction, body checking, and body image avoidance from pretreatment to posttreatment, with nonsignificant improvements evident at longer follow-up durations (which varied across patients). Additional randomized controlled treatment research is needed to determine whether FME may improve efficacy or reduce relapse rates compared to traditional cognitive behavior therapy for body dissatisfaction and EDs.

Mindfulness-based interventions (MBIs) have been adapted for use with a variety of populations, but empirical research on their use with residents of long-term care facilities (LTCFs) is lacking. This case report demonstrates successful implementation of an individual MBI with a Native American male who participated in an 8-week study at a LTCF. Measures of mindfulness, depression, rumination, and pain were administered at pre- and posttreatment. The participant showed improvements on all measures, particularly depression. Follow-up interviews indicated that the participant was still engaging in the mindfulness techniques and found them to be helpful 1 month and 1 year following completion of the program. Recommendations for implementing the program in LTCFs are provided. Despite the limitations of an individual MBI (I-MBI) approach in LTCF populations (e.g., understaffing), several positive implications exist, including greater access for LTCF residents with physical and other limitations, as well as flexibility in tailoring the I-MBI to meet each resident’s unique needs.

Conversion practices include a range of efforts that attempt to change or suppress LGBTQA+ individuals’ sexual or gender identity. Formal versions of these practices are occurring less frequently in Western settings, yet informal versions and the ideology underpinning them continue to cause psychological and spiritual harm to people who are subjected to them. As evidence for the harmful nature of conversion practices increases, and some governments and professional bodies are responding with measures that restrict their use, there is a growing need for the mental health sector to be engaged with these issues so that practitioners are appropriately prepared to recognize and support survivors in ways that are effective and affirming of sexual and gender diversity. In this paper, we review the state of the evidence concerning associated harms and their lack of efficacy in changing sexuality or gender identity, and highlight the changing nature of research in this space to focus on the negative impacts of conversion practices on survivors. We then discuss the evidence around mental health practitioners’ knowledge and support capacity for conversion practices survivors. We close by commenting on specific features of therapeutic practices that can guide practitioners as they support survivors through the recovery process.

In my presidential speech to the Association for Advancement of Behavior Therapy (now the Association for Behavioral and Cognitive Therapies) at the 1974 Annual Convention, I took the position that requests for sexual reorientation should be declined in favor of addressing the ethical and political factors that underlie the allegedly voluntary requests of gay individuals to change in a heterosexual direction. Discrimination, prejudice, and sometimes hate crimes made it highly unlikely that requests for sexual reorientation were voluntary. The personal and professional context for my change of perspective is also described as are several pedagogical and persuasive strategies I have used over the past 50 years for changing people's minds about the propriety of sexual orientation change efforts.