Flexible Manualized Treatment for Pediatric Obsessive–Compulsive Disorder: A Case Study

The following case study describes the treatment of an 8 year-old girl with early-onset obsessive compulsive disorder using a manualized cognitive-behavioral therapy with exposure and response prevention (CBT/EPR) protocol, implemented using a “flexibility within fidelity” approach. The case study focuses on how the treatment manual was successfully implemented in a flexible manner to address unique aspects of the case. These unique factors included the child’s extreme shyness at the beginning of treatment (with implications for rapport building), the primarily obsessional presentation of this child’s symptoms, the child’s avoidance of discussing the content of her obsessive thoughts, and secondary depressive symptoms (excessive guilt, frequent crying, and sadness) that contributed to the child’s impairment and distress. Assessment of progress indicated improvement in symptoms after four sessions of cognitive skill building and again in the last five sessions after implementing increased exposure to obsessive thoughts using narrative techniques. The implications for clinicians and student therapists, including the importance of rapport building, developmentally tailoring treatment, and flexibly implementing treatment to address the unique characteristics of the individual patient are discussed.     

First-Line Treatment for Pediatric Obsessive–Compulsive Disorder

Pediatric obsessive–compulsive disorder (OCD) is a common psychiatric disorder that impairs children’s functioning in home, school, and community settings. Once thought to be an untreatable or treatment refractory disorder, evidence-based treatments now exist for pediatric OCD. Various psychological treatment approaches for pediatric OCD have been investigated and research supports the use of cognitive-behavioral therapy (CBT) with exposure and response prevention (E/RP) and combined CBT/E/RP with serotonin reuptake inhibitor pharmacotherapy. This paper reviews these approaches and highlights the prominent role of CBT/E/RP as a first-line treatment for pediatric OCD.     

A Review of “Cognitive-Behavioral Therapy With Couples and Families: A Comprehensive Guide for Clinicians” by Frank M. Dattilio

Abstract

Grandparents in family therapy: a clinical research study, by berit ingersoll-dayton&;margaret b. neal, 1991, 40, 264-271.

Polyincestuous families,by Kathleen Coulborn Faller, 1991, 6(3), 310-322

Accessing children's perceptions of their family: Circular questioning revisited,by Mark 1. Benson, Toni Schindler-Zimmerman,&;Doris Martin, 1991,17(4), 363-372

What is transmitted in the intergenerational transmission of violence?by Sharon Moore Alexander&;Elmore R. Alexander 111, 1991, 53, 657-668

Trends in corporate family-supportive policies,by Ellerz Galinsky, Diane Hughes,&;Judy David, 1990, 15, 75-94     

A Clinician’s Primer for Idiographic Research: Considerations and Recommendations

Theorists and clinicians have long noted the need for idiographic (i.e., individual-level) designs within clinical psychology. Results from idiographic work may provide a possible resolution of the therapist’s dilemma—the problem of treating an individual using information gathered via group-level research. Due to advances in data collection and time series methodology, there has been increasing interest in using idiographic designs to answer clinical questions. Although time series methods have been well-studied outside the field of clinical psychology, there is limited direction on how clinicians can use such models to inform their clinical practice. In this primer, we collate decades of published and word-of-mouth information on idiographic designs, measurement, and modeling. We aim to provide an initial guide on the theoretical and practical considerations that we urge interested clinicians to consider before conducting idiographic work of their own.     

Borderline Personality Disorder and Posttraumatic Stress Disorder: Time for Integration?

The increasing prevalence of borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) diagnoses among women illustrates problems and limitations of the medical model system (Diagnostic and Statistical Manual of Mental Disorders, fourth edition; American Psychiatric Association, 1994). In particular, diagnoses of BPD continue the trend of overpathologizing women's issues and reinforcing a patriarchal system of diagnosis and treatment. A PTSD diagnosis, with similar criteria, is preferred for traumatized women because it portrays them in a more positive context. This article explores the overlapping relationship between BPD and PTSD and critiques how both are viewed within the mental health community. Previous research on BPD and PTSD is explored, as well as concerns and limitations regarding both diagnostic categories.     

Comorbidity of Pediatric Obsessive–Compulsive Disorder and Anxiety Disorders: Impact on Symptom Severity and Impairment

This study explored the impact of comorbidity on symptom severity and treatment outcome in a sample of 75 pediatric Obsessive–Compulsive Disorder (OCD) patients. Forty received cognitive–behavioral therapy (CBT). Overall, 56% had a comorbid disorder. Results revealed that youth with comorbid disorders (anxiety or otherwise) endorsed significantly more anxiety symptoms than youth with OCD only. Youth with comorbidities instead of or in addition to anxiety exhibited more severe OCD symptoms than youth with OCD alone or an anxiety-only comorbidity. Youth in the comorbidities instead of or in addition to anxiety group had the poorest CBT response relative to the other groups. These results suggest that relative to those with OCD alone or with an anxiety disorder comorbidity, youth with comorbidities instead of or in addition to anxiety have a differing clinical presentation (e.g., more severe symptoms) and worse psychotherapy outcome.

Treatment Interventions for Perfectionism—A Cognitive Perspective: Introduction to the Special Issue

The current article provides an overview of the papers included in this special issue and includes a discussion of key issues pertaining to psychological treatments for perfectionism. We describe and review two new treatment intervention studies in this special issue that focus on perfectionism in university students as well as other contemporary research on the use of cognitive-behavioral therapy to treat perfectionists. While the significant reductions in levels of perfectionism as a result of treatment are noteworthy, we caution that perfectionism is a relatively enduring trait; thus, some perfectionists will remain treatment resistant and overall levels of perfectionism may remain relatively high even when significant improvements are realized. Moreover, we discuss the established tendency for perfectionism to be associated with residual symptoms of distress following treatment. As part of our discussion of the other articles in this special issue, we highlight cognitive factors of likely significance in the treatment of perfectionism, including the ruminative response style, the tendency to experience perfectionistic automatic thoughts, and the role of core irrational beliefs in the development of perfectionism. These articles underscore the need to consider key cognitive factors that are central to dysfunctional forms of perfectionism. This special issue on perfectionism is the third special issue on this topic to appear in the Journal of Rational-Emotive and Cognitive-Behavior Therapy under the editorialship of Windy Dryden. We are very grateful for the continuing opportunity in this journal to explore issues related to the cognitive and treatment aspects of perfectionism.     

The Use of Stimulant Medication and Behavioral Interventions for the Treatment of Attention Deficit Hyperactivity Disorder: A Survey of Parents’ Knowledge, Attitudes, and Experiences

We examined parents’ knowledge, attitudes, and information sources regarding Attention-Deficit/Hyperactivity Disorder (ADHD), including treatment with stimulant medication and behavioral interventions. Responses from parents with a child diagnosed with ADHD and parents without a child diagnosed with ADHD were also compared. Participants consisted of 146 parents of elementary age children from Wisconsin. The surveyed parents were aware of issues surrounding ADHD and the use of stimulant medication, but there were several areas where they possessed inaccurate or incomplete factual information. Parents who had a child diagnosed with ADHD rated the effects of stimulant medication more positively and side effects as less severe than other parents. They also rated behavioral interventions as less effective on all questions. Implications of the study are discussed.     

Publishing a Master’s Thesis: A Guide for Novice Authors

Publication of original research, clinical experiences, and critical reviews of literature are vital to the growth of the genetic counseling field, delivery of genetic counseling services, and professional development of genetic counselors. Busy clinical schedules, lack of time and funding, and training that emphasizes clinical skills over research skills may make it difficult for new genetic counselors to turn their thesis projects into publications. This paper summarizes and elaborates upon a presentation aimed at de-mystifying the publishing process given at the 2008 National Society of Genetic Counselors Annual Education Conference. Specific topics include familiarizing prospective authors, particularly genetic counseling students, with the basics of the publication process and related ethical considerations. Former students’ experiences with publishing master’s theses also are described in hopes of encouraging new genetic counselors to submit for publication papers based on their thesis projects.     

“A Fire in the Blood”: Metaphors of Bipolar Disorder in Jamison’s An Unquiet Mind

Content analysis of three chapters of Jamison's memoir, An Unquiet Mind, shows that depression, mania, and Bipolar Disorder have a common metaphoric core as a sequential process of suffering and adversity that is a form of malevolence and destruction. Depression was down and in, while mania was up, in and distant, circular and zigzag, a powerful force of quickness and motion, fieriness, strangeness, seduction, expansive extravagance, and acuity. Bipolar Disorder is down and away and a sequential and cyclical process that partakes of the metaphors of its component moods. We conclude that metaphors of mood disorders share a number of structural features and are consistent across different authors.     

A Case Study of Negative Affixes in Sadegh Hedayat’s Letters: The Effect of Bipolar Mood Disorder

This research studies the morphological features found in Sadegh Hedayat’s letters, who, based on linguistic and psychological studies, may have had bipolar disorder. It aims to assess the impact of various types of moods on the frequency of negative affixes through qualitative analysis of the letters’ text. The letters are written in Persian, and include six negative derivational affixes. As bipolar disorder includes four episodes, all letters are analyzed on the basis of six negative affixes concerning the episodes using SPSS. The results indicate that each episode shows totally different characteristics in using negative affixes. In fact, Hedayat mostly used negative affixes in depression, confirming psychological studies, and it is revealed that he mostly used negative affixes in hypomania when he experienced an irritated mood. Moreover, the frequency of negative affixes in mixed episode shows a combination of hypomania and depression, which is in agreement with previous studies. Additionally, euthymia shows few negative affixes.     

Benchmarking Treatment Response in Tourette’s Disorder: A Psychometric Evaluation and Signal Detection Analysis of the Parent Tic Questionnaire

This study assessed the psychometric properties of a parent-reported tic severity measure, the Parent Tic Questionnaire (PTQ), and used the scale to establish guidelines for delineating clinically significant tic treatment response. Participants were 126 children ages 9 to 17 who participated in a randomized controlled trial of Comprehensive Behavioral Intervention for Tics (CBIT). Tic severity was assessed using the Yale Global Tic Severity Scale (YGTSS), Hopkins Motor/Vocal Tic Scale (HMVTS) and PTQ; positive treatment response was defined by a score of 1 (very much improved) or 2 (much improved) on the Clinical Global Impressions – Improvement (CGI-I) scale. Cronbach’s alpha and intraclass correlations (ICC) assessed internal consistency and test-retest reliability, with correlations evaluating validity. Receiver- and Quality-Receiver Operating Characteristic analyses assessed the efficiency of percent and raw-reduction cutoffs associated with positive treatment response. The PTQ demonstrated good internal consistency (α = 0.80 to 0.86), excellent test-retest reliability (ICC = .84 to .89), good convergent validity with the YGTSS and HM/VTS, and good discriminant validity from hyperactive, obsessive-compulsive, and externalizing (i.e., aggression and rule-breaking) symptoms. A 55% reduction and 10-point decrease in PTQ Total score were optimal for defining positive treatment response. Findings help standardize tic assessment and provide clinicians with greater clarity in determining clinically meaningful tic symptom change during treatment.     

Children’s Perspectives of an Enhanced Cognitive-Behavioral Treatment for Child–Parent Dyads With Anxiety Disorders

Prior research has extensively evaluated the efficacy of cognitive-behavioral therapy (CBT) for child anxiety disorders—however, few studies have investigated anxious children’s perspectives and experiences of participating in CBT. This qualitative study explored children’s acceptability of a newly developed enhanced CBT intervention, designed specifically for the treatment of anxiety disorders in children with a clinically anxious parent. The study also explored children’s perceptions and experiences of individual (child only) and joint observational (child–parent) exposure activities that were key to the intervention. Ten children (age range 6–11, M = 8.5 years) and their mothers (age range 34–45, M = 39.5 years) completed in-depth semistructured interviews to investigate child participants’ anticipated and experiential acceptability of the enhanced CBT intervention. Thematic analysis revealed seven major themes broadly reflecting the acceptability, appropriateness, and perceived benefit of the intervention elements, with particular value credited to exposure tasks and the dyadic nature of the intervention. Findings suggest that future experimental evaluation of the enhanced intervention is warranted. Further, the study highlights that CBT for child anxiety disorders, where exposure work is a feature, is acceptable and perceived to be effective by its intended treatment recipients. Trial prospectively registered, preresults, ANZCTR1261900033410.     

Cognitive Appraisal Therapy: A Treatment Plan for “Silvia”

The principles and procedures of Cognitive Appraisal Therapy (CAT) are applied to the case of Silvia. The assessment plan focuses on affective, behavioral, and cognitive aspects of personality. The patient evidences self-pity and anger, and rebellion and withdrawal in her interpersonal relations. Key interventions include encouraging positive methods for comforting her feelings, building self-respect by doing what she deems morally right, eliminating self-defined victim status by active pursuit of her goals, and correcting cognitive distortion of self-image and pessimistic forecasts. Other characteristic CAT interventions are also discussed and illustrated.     

Predicting Treatment Outcomes From Internet-Based Cognitive Behavior Therapy for Obsessive–Compulsive Disorder

Internet-based cognitive-behavioral therapy (ICBT) with therapist support shows promise as a treatment for obsessive-compulsive disorder (OCD). Yet, not all patients respond to ICBT. It is therefore important to identify predictors of ICBT outcomes to determine who is likely to benefit. Relative to the large literature on predictors of outcomes for in-person CBT for OCD, very few studies have investigated ICBT predictors. Therefore, we analyzed predictors of outcome in an open trial (n = 30) of ICBT for OCD using the OCD-NET platform, which consists of 10 online modules delivered with therapist support. The Yale-Brown Obsessive-Compulsive Scale (YBOCS) was administered by independent raters as the primary outcome measure at baseline and posttreatment. In this sample, greater baseline OCD severity and OCD-related avoidance behaviors were associated with higher end-state OCD symptoms (i.e., poorer outcome). Patients with a past history of face-to-face CBT for OCD also had worse outcomes. Although these results require replication, these factors may identify individuals at risk for poor ICBT outcomes.     

Breathwork: An Additional Treatment Option for Depression and Anxiety?

Breathwork is an increasingly popular experiential approach to psychotherapy based on the use of a specific breathing technique, however, claims of positive mental health outcomes rely on anecdotal clinical evidence. To ascertain the likely efficacy of breathwork this review clarifies the approach and its theoretical assumptions and examines relevant empirical research relating to breathing inhibition, suppression of inner experience, and possible neurological and physiological effects. Additionally, research into mindfulness-based psychotherapy and yoga breathing-based interventions with comparable features to breathwork are examined. Findings suggest qualified support for the key theoretical assumptions of a three component breathwork model, referred to as Integrative Breathwork Therapy (IBT), and its possible utility in the treatment of anxiety and depression. Further research aimed at exploring specific efficacy of this approach for these disorders may yield a useful additional treatment option utilising a different process of change to existing treatments.