Trazodone Augmentation in OCD: A Case Series Report

Based on previous evidence that trazodone may have antiobsessional properties, the authors assessed trazodone augmentation of selective serotonin reuptake inhibitor (SSRI) therapy in five cases of obsessive-compulsive disorder. All patients showed symptomatic improvement after trazodone was added to treatment with various SSRIs, and in many cases, trazodone also improved the tolerability of SSRI therapy.     

The Treatment of Mental Contamination: A Case Series

The recommended treatment for obsessive-compulsive disorder (OCD) is cognitive behavior therapy (CBT) incorporating exposure and response prevention (ERP), which is effective for approximately 50% of patients. However, there has been little advance in treatment outcomes since the introduction of ERP in 1979. It has been suggested that some progress can be made in treating contamination obsessions and washing compulsions by addressing feelings of dirtiness and contamination that arise without physical contact with a tangible contaminant. To date, the treatment of these “mental contamination” fears in OCD has not been systematically explored. This paper reports on a case series of 12 participants with OCD who received 10 to 20 sessions of a CBT-based treatment for mental contamination. At the end of treatment, 7 participants no longer met the diagnostic criteria for OCD and mental contamination and these gains were maintained at 6-month follow-up. The clinical implications of these findings are discussed.     

Undermining Reasonableness: Expert Testimony in a Case Involving a Battered Woman Who Kills

Student participants  ( N = 316)  viewed a videotaped simulated case involving a woman who had entered a self-defense plea in the shooting death of her abusive husband. As successful claims of self-defense rest on the portrayal of a defendant who has responded reasonably to his/her situation, the implications of various forms of expert testimony in constructing this narrative were examined. Jurors were presented with either expert testimony regarding the battered woman syndrome (BWS), the BWS framed within post-traumatic stress disorder (PTSD) nomenclature, or a no-expert control condition. As the BWS classification may support a stereotypical victim, the degree to which the defendant fit the stereotype in terms of her access to a social support network (family, friends, employment outside of the home) was varied within the expert testimony conditions to reflect either a high or low degree of stereotype fit. Although jury verdicts failed to differ across expert testimony and stereotype fit conditions, perceptions of her credibility and mental stability did. Although affording jurors a framework from which the defendant's experiences as a battered woman may be acknowledged, this portrayal, as advanced within PTSD nomenclature, endorsed a pathological characterization of the defendant. Implications of this discourse for battered women within the context of self-defense are discussed.     

A study of college women: Androgyny and perceptions of a feminist therapist

The present study examined the dimensions of instrumentality and expressiveness with respect to sex role orientation and perceptions of a feminist therapist. Also investigated was the willingness of the subjects to see a feminist and a traditional therapist for personal and career counseling. The 167 undergraduate female students from various programs completed the Bem Sex Role Inventory, the Adjective Check List to describe their perceptions of a feminist therapist, and four willingness scales. Results indicated that the subjects, regardless of sex role orientation, perceived the feminist therapist as predominantly instrumental rather than expressive or androgynous. In addition, the subjects, regardless of sex role orientation, were more willing to see a traditional therapist for personal counseling but more willing to see feminist therapist for career counseling.     

Written Exposure Therapy for Suicide in a Psychiatric Inpatient Unit: A Case Series

Patients with posttraumatic stress disorder (PTSD) are at an elevated risk of suicide. For patients hospitalized for suicide risk, psychosocial treatment and stabilization are routinely offered; however, the availability of evidence-based, manualized therapeutic interventions for PTSD is sparse. Typically, the short duration of hospitalization makes it difficult to accommodate evidence-based, trauma-focused treatments. This article presents the clinical course of four active-duty service members with PTSD who were hospitalized in a psychiatric inpatient unit for acute suicide risk and treated with Written Exposure Therapy for Suicide (WET-S). WET-S is a brief, five-session therapy based upon Written Exposure Therapy and augmented with Crisis Response Planning for Suicide Prevention. Both posttraumatic stress symptoms and suicidal ideation were reduced from pre- to posttreatment for three of the four patients treated. WET-S shows promise as a manualized therapeutic intervention that can be delivered on an inpatient psychiatric unit.     

Interoceptive Cue Exposure for Depersonalization: A Case Series

Cognitive-behavioral treatment for panic disorder relies heavily on interoceptive exposure. Specifically, therapists induce physical symptoms associated with panic in order to produce habituation to those sensations. Many common symptoms of panic are easily induced, such as increased heart rate and dizziness. However, depersonalization is a difficult symptom to induce in the office. Three uncontrolled cases are presented here where a novel intervention, the use of 3D glasses, was used to successfully induce depersonalization with positive effect. The application of the procedure resulted in rapid habituation within session, and all three patients had significant reductions in panic following treatment. Additional research is necessary to examine the application of this, and other, novel methods for inducing depersonalization as part of a comprehensive approach to treating panic and other psychiatric conditions where depersonalization is present.     

The Case of Helen D.: A Woman Who Learned to Suffer

Despite our earnest wish to be useful to patients, we sometimes fail. Part of the difficulty often has to do with the expectations that the patient brings to therapy. Another contribution to an impasse may be the psychiatrist's theoretical orientation. This review illustrates a playful distortion of the doctor-patient relationship so as to develop an alliance with a difficult patient. The involvement of part of her family in the long-term treatment facilitated her growth out of a biopsychosocial swamp.     

Massed Cognitive Processing Therapy in Active-Duty Military: A Case Series

Despite consistent evidence that Cognitive Processing Therapy (CPT) is an efficacious treatment for posttraumatic stress disorder (PTSD), the effects among active-duty service members and veterans have been smaller than for civilians. Modifications to standard delivery may be needed to increase treatment engagement and completion, which could improve outcomes in this population. Delivering CPT in a massed format may reduce barriers to care and enable more rapid symptom reduction, yet clinicians and patients may have concerns about the tolerability and practicality of such interventions. This case series describes a course of CPT delivered in 5 days in a mixed group and individual format among 4 active-duty military service members as part of a larger randomized clinical trial. Although the pattern of symptom change differed between patients, most demonstrated clinically significant reductions in PTSD and depression symptoms during the 5-day treatment. Patients reported that the pace was tolerable and that the mixed group and individual format was beneficial. Although further research is needed to understand the longer-term outcomes of massed CPT, this therapy format has important implications for the future delivery of treatments for PTSD.     

Androgyny and Adjustment in Later Life: Living in a Veterans' Home

This study builds on literature that suggests that interaction with friends in later life is important to the well-being of older adults and other research that argues that androgynous individuals may have a greater range of social skills with which to further their adjustment. We apply these arguments to later life through interviews from a pilot sample of 27 residents in a state-operated veterans' home. Findings suggest that women, who often hold high expectations for the interpersonal domain, are more likely to experience adjustment problems than are men. Men, who may have lower expectations for friendship and intimacy, seem less likely to report dissatisfaction, regardless of gender characteristics. A typology of adjustment and androgyny in later life is developed.     

Benefits and Usefulness of a Personal Motivation Video: A Case Study of a Professional Mountain Bike Racer

Video has been incorporated into coaching and sport performance for skill development and as a feedback instrument. The purpose of the study was to examine the perceived usefulness and benefits such as enhanced motivation, concentration, and anxiety management of using a personal motivation video (PMV). A PMV is a video with music personally created for the athlete. The participant was a 23-year-old male professional mountain bike racer. Data from open-ended interviews and evaluation forms were examined. Results indicated the PMV to be particularly useful for motivation, mental imagery, confidence and emotional management, and concentration. PMVs can be a creative and useful tool for sport psychology researchers and practitioners to apply imagery in a unique way. Recommendations for improvements to the PMV for future use are highlighted, as well as suggestions for future research and applications are presented.     

Peer-Enhanced Exposure Therapy (PEET): A Case Study Series

Prolonged exposure (PE) therapy is highly effective in reducing symptoms of PTSD, but it is often difficult for veterans to engage in and adhere to all prescribed components of this therapy. This article details a preliminary, feasibility test of Peer Enhanced Exposure Therapy (PEET), a new, manualized intervention allowing specially trained peer specialists who have completed PE to facilitate treatment engagement and adherence during PE by providing individual in-person and telephone support, coordinating peer support services with PE therapists. This case study outlines the theoretical foundations, session content, and both qualitative and quantitative data for two of the first veterans and first peer specialists involved in implementation of PEET. In this case study, the veterans made gains in symptom management expected in PE. Despite the historically high dropout from PE, both veterans completed a full course of PE. There was also evidence of improvement in rehabilitation outcomes, such as community integration, independent living skills, interacting with others, and maintaining friends and activities. Data support the feasibility and acceptability of the intervention; implications for future research are discussed.     

The Case for Diversity in Computer-Aided Careers Guidance Systems: A Response to Watts

Watts (1993) has started an important debate about the future of computer-aided careers guidance (CACG) systems which recognises that there are political and economic concerns as well as technical and professional ones. As a contribution to this debate, an alternative view is offered, based on the case for diversity. It (a) reviews UK experience of CACG systems; (b) comments on the development of PROSPECT which Watts uses as a case-study; (c) identifies strengths and weaknesses of existing research; and (d) sets out a research agenda.     

Cognitive Processing Therapy With an Older Woman Veteran During COVID-19: A Case Study

With advances in technology, telehealth has become an acceptable way of conducting psychotherapy. During the COVID-19 pandemic, telehealth and ways to modify treatments for delivery via telehealth have become increasingly important. Researchers and clinicians have issued recommendations on providing telehealth-based care in response to the COVID-19 global pandemic. However, recommendations are limited for audio only telephone-based care, which may be the only option for specific clients. This is a case study of an older adult who completed Cognitive Processing Therapy (CPT) for military sexual trauma. Halfway through her treatment, COVID-19 resulted in transitioning from in-person services to a virtual format. Client X did not have video capabilities aside from her cell phone, and it was determined she would complete treatment via telephone-based sessions. Client X’s outcome data is presented, and the reductions in her PTSD and depressive symptoms provide preliminary support suggesting that telephone-based care may be an acceptable method of receiving CPT. Recommendations for telephone-based CPT are provided.     

Prolonged Exposure Therapy for PTSD among Individuals in a Residential Substance Use Treatment Program: A Case Series

Clients with co-occurring posttraumatic stress disorder (PTSD) and substance use disorders present a unique challenge for clinicians in substance use treatment settings. Substance dependent individuals with PTSD tend to improve less during substance use treatment and relapse more quickly following abstinence attempts compared to those without PTSD. Recent scientific efforts have focused on understanding the potential benefit of providing PTSD treatment concurrent with substance use treatment. The current case study describes 4 individuals with PTSD in a residential substance use facility who received prolonged exposure therapy for treatment of PTSD, in addition to the substance use treatment. These individuals completed 9 bi-weekly 60-minute sessions of prolonged exposure, as well as in vivo and imaginal exposure homework between sessions. None of the clients met criteria for PTSD at the end of treatment, with these gains being maintained at 3- and 6-months post-treatment. Additionally, the clients did not relapse in response to undergoing exposure therapy. Implications for delivery of PTSD treatment in substance use treatment facilities are discussed.     

Family Focused Treatment for Patients with Bipolar Disorder in Turkey: A Case Series

Family-focused therapy (FFT) is a 9-month, 21-session structured psychoeducational treatment for bipolar disorder. Several US-based studies have documented its efficacy as adjunctive to medication for depression stabilization and relapse prevention. However, FFT has never been applied outside of the United States. The objective of this case series is to explore the applicability of FFT in a non-Western culture. Ten patients with bipolar disorder and their family members attended the 9-month FFT as adjunctive to pharmacotherapy in an outpatient specialty clinic in Izmir, Turkey. Patients improved in Global Assessment of Functioning Scores and Clinical Global Impression Scores from pre- to posttreatment. Case studies are given, which illustrate the differences between Western and non-Western families coping with bipolar disorder. FFT was easily applied to a Turkish sample with few changes in format or focus. Adaptations included substitution of oral for written therapeutic tasks or homework assignments. Randomized controlled trials are needed to test the clinical effectiveness of FFT and other psychosocial interventions in non-Western cultures.     

Objective Evaluation of Performance Stress in Musicians With Focal Hand Dystonia: A Case Series

Five musicians suffering from focal dystonia participated in a pilot study that examined the feasibility of an experimental protocol designed to assess musicians' motor performance under stress. Electrocardiography, free cortisol levels, and subjective assessments were used to monitor alterations of the hypothalamic-pituitary-adrenal axis. As measures of motor outcome, temporal variability of finger movements and muscular cocontraction of the wrist flexor and extensor were assessed. Findings suggest that the specific experimental design could be successfully applied. Several methodological issues such as carryover effects, the use of free cortisol, the inclusion of a double baseline, and the classification of dystonic patients into stress responders and nonresponders are analyzed and discussed.     

Noncredible Effort during Pediatric Neuropsychological Exam: A Case Series and Literature Review

Neuropsychological test interpretation rests upon the assumption that the examinee has exerted full effort. If an individual provides inadequate effort during exam, the resulting data will be invalid and represent an underestimate of the person's true abilities. Although youth have been assumed historically to be less capable of deception than adults, acts of deception in childhood are not uncommon, even in normative populations. Yet, very few cases of children who have provided suboptimal effort during neuropsychological exam have appeared in the scientific literature. We present six clinical cases illustrating that children down to at least age 8 years can present with noncredible performance. The cases include those in which clear external incentives could be identified to those in which intrinsic or psychological factors were presumed to predominate. The fairly diverse nature of the presented cases, along with other recent work, suggests that suboptimal effort in children is apt to occur more frequently than previously recognized, even if it might occur less often than in comparable adult samples. In most of the presented cases, noncredible performance would not have been detected definitively by clinical judgment alone, reinforcing the value of routinely incorporating symptom validity tests into the neuropsychological assessment of school-aged children. The number of effort tests that have demonstrated utility in children pales in comparison to those available to the adult practitioner, although recent research now supports the use of several standalone measures with pediatric patients.