A Cognitive-Behavioural Treatment Programme for Conduct Disorder: The Case of Tumeleng

This article presents a case study of a teenager with conduct disorder (CD) using a cognitive-behavioural treatment programme for anger and aggression. Unique features of the case included comorbid expressive language disorder and a history of multiple traumatic brain injuries, and a Tswana (Botswana) ethnic/cultural background. Indications for successful treatment were the participant's intrinsic motivation to change and be accepted by his peers, and his good memory. Factors that contraindicated successful treatment were the absence of his parents, due to his attending boarding school and comorbidity. The case provides evidence for the efficacy of cognitive behavioral therapy (CBT) for CD in an adolescent of a Tswana background with comorbid expressive language disorder and history of multiple head injuries.     

Manualized Treatment of Panic Disorder in a Medical Setting: Two Illustrative Case Studies

People who experience panic attacks (PAs) typically present to medical settings, concerned that their symptoms signify a life-threatening condition. Despite the efficacy of cognitive-behavioral therapy (CBT) for panic disorder (PD), medical practitioners seldom provide this type of treatment. Physicians may lack the time or expertise to impart such behavioral medicine interventions, while patients may find group or individual CBT too costly even when available. Researchers have begun investigating manualized CBT as a cost-effective alternative when traditional forms of this intervention are prohibited. This article describes two case studies in which women presenting to a medical clinic with PD were treated with 6 weeks of manualized CBT after pharmacotherapy was unsuccessful or unpalatable. Both patients exhibited reductions in panic and depressive symptomatology over baseline levels, along with increases in self-efficacy regarding their ability to manage future PAs. Improvements were maintained over 12 months, supporting continued use of manualized CBT as a supplement or alternative to pharmacological methods of treating PD in the medical setting.     

Intensive Child-Centered Play Therapy for Children on the Autism Spectrum: A Pilot Study

To investigate the effectiveness of intensive child-centered play therapy (CCPT) for children diagnosed with autism spectrum disorder (ASD), the authors randomly assigned 23 children with diagnosed ASD and symptoms of ASD on the Social Responsiveness Scale–2nd Edition (Constantino, 2012), to an intensive CCPT condition (n = 12) or a no-intervention control group (n = 11). Children who participated in 24 sessions of CCPT showed a statistically significant decrease in ASD core symptoms and behavioral symptoms, such as externalizing problems, attention problems, and aggression, compared with children in the control group. Implications are discussed.     

Dialectical Behavior Therapy of Anorexia and Bulimia Nervosa Among Adolescents: A Case Series

The aim of this study was to describe a case series of adolescents (mean age = 16.5 years, SD = 1.0) with anorexia nervosa (AN) and bulimia nervosa (BN) who received dialectical behavior therapy (DBT). Twelve outpatients with AN and BN took part in 25 weeks of twice weekly therapy consisting of individual therapy and a skills training group. Family members were involved in the treatment. The patients were compared pre- and posttreatment on behavioral symptoms of AN and BN and symptoms of general psychopathology using standardized instruments (Structured Inventory for Anorectic and Bulimic Syndromes, Eating Disorder Inventory-2, The Symptom Checklist-90-Revised). Posttreatment, significant improvements in behavioral symptoms of eating disorder and symptoms of psychopathology were identified. The application of DBT adapted for the treatment of AN and BN among adolescents was associated with a decrease in behavioral symptoms of eating disorders and symptoms of general psychopathology. However, randomized controlled studies are required to prove the efficacy of this approach.     

Hoarding Disorder and a Systematic Review of Treatment with Cognitive Behavioral Therapy

Until recently, compulsive hoarding has been treated as a type of obsessive-compulsive disorder with mixed results. Little research exists on the efficacy of behavioral interventions specifically designed to treat hoarding disorder, and most existing research is limited with regard to the numbers of participants, their ethnic and cultural diversity, and study replication; therefore, the generalizability of findings is limited. This article reviews the prevalence of hoarding disorder, cognitive behavioral therapy treatment approaches, and measurement of symptoms. A systematic review compares the efficacy of various CBT methods, with particular attention to comparing therapy that is traditionally used to treat OCD with those designed specifically to treat hoarding disorder. Only clinical studies using CBT interventions designed to treat hoarding associated with OCD or hoarding disorder were included. Studies included participants of all ages, and articles were published in peer-reviewed journals. Case studies were excluded. After a comprehensive search and removing duplicates from databases and references, 65 articles were reviewed, of which 12 met criteria for review. Preliminary results demonstrate improvement in hoarding symptoms with CBT interventions that are both for OCD and those designed to specifically treat hoarding disorder; however, when compared to each other, the efficacy of these treatments is inconclusive, thus more research is needed.     

Internet-based self-help treatment for panic disorder: a randomized controlled trial comparing mandatory versus optional complementary psychological support

Panic disorder (PD) is one of the most common psychiatric disorders. Web-based self-help treatments for PD have had promising results. These online treatments seem to have larger effect sizes (ESs) when professional support is added. However, the amount of support or how it should be administered is not yet clear. The aim of this trial was to study two ways of administering psychological support provided by phone as a part of Internet-based self-help treatment for PD based on cognitive behavioral therapy. Seventy-seven participants diagnosed with PD were randomly assigned to one of three experimental conditions: a waiting list control group; a treatment group with non-scheduled psychological support; or a treatment group with scheduled psychological support. PD symptoms of participants who received treatment improved significantly compared to the control group (mean ES d = 1.18, p < .05). In addition, there were statistically and clinically significant differences between treatment groups (Mean difference = ?3.20, p = .005, 95% CI [?5.62, ?.79]). The scheduled group showed a larger ES, a lower dropout rate, and better adherence to treatment than the non-scheduled group. Scheduled support seems to be indicated for patients who seek Web-based treatment for PD, and their symptoms of panic, anxiety, and depression improve at post-treatment and six-month follow-up. In contrast, when support depends on patient demand, they receive less support and so, the therapeutic effect is poorer.     

The implementation of guided Internet-based cognitive behaviour therapy for panic disorder in a routine-care setting: effectiveness and implementation efforts

Panic disorder is a common mental disorder. Guided Internet-based cognitive behavioural therapy (Guided Internet-based cognitive behaviour therapy (ICBT)) is a promising approach to reach more people in need of help. In the present effectiveness study, we investigated the outcome of guided ICBT for panic disorder after implementation in routine care. A total of 124 patients were included in the study, of which 114 started the treatment. Large within-group effect sizes were observed on the primary panic disorder symptoms (post-treatment: d = 1.24; 6-month follow-up: d = 1.39) and moderate and large effects on secondary panic disorder symptoms and depressive symptoms at post-treatment and follow-up (d = .55–1.13). More than half (56.1%) of the patients who started treatment recovered or improved at post-treatment. Among treatment takers (completed at least five of the nine modules), 69.9% recovered or improved. The effectiveness reported in the present trial is in line with previous effectiveness and efficacy trials of guided ICBT for panic disorder. This provides additional support for guided ICBT as a treatment alternative in routine care.     

Interoceptive Exposure Therapy Combined with Trauma‐related Exposure Therapy for Post‐traumatic Stress Disorder: a Case Report

Trauma‐related exposure therapy is a useful but not universally effective treatment for post‐traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post‐traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma‐related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician‐Administered Post‐traumatic Stress Disorder Scale, a self‐report measure of post‐traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post‐traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1‐ and 3‐month follow‐up. Symptoms of anxiety sensitivity and post‐traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post‐traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma‐related exposure therapy as a means of boosting treatment efficacy.     

Emotional,behavioral, and cognitive factors that differentiate obsessive-compulsive disorder and other anxiety disorders in youth

Abstract

The current study examined specific emotional, behavioral, and cognitive variables that may distinguish obsessive-compulsive disorder (OCD) from generalized anxiety disorder (GAD), social phobia (SoP), and separation anxiety disorder (SAD) in youth. Youth with OCD (n=26) and other anxiety disorders (ADs; n=31), aged 7–12 years (56.1% males), and their parents participated. The study compared the two anxious groups on levels of emotional, behavioral, and cognitive functioning, as well as impairment associated with the disorder. Results indicated that in comparison to youth with GAD, SoP, or SAD, youth with OCD were found to have poorer emotion regulation skills, as well as greater oppositionality, cognitive problems/inattention, and parent impairment associated with the disorder. The findings suggest that there are unique characteristics of OCD that may differentiate this disorder from other ADs in youth. Potential clinical implications and directions for future research are discussed.     

God Diagnosed with Narcissistic Personality Disorder

This article endorses the contention that God suffers from a mental disorder, but challenges J. Henry Jurgens’ diagnosis of bipolar disorder as reported in The Onion (“God diagnosed with bipolar disorder”, 2001) and proposes narcissistic personality disorder instead. It uses the diagnostic criteria for narcissistic personality disorder from The Diagnostic and Statistical Manual of Mental Disorders—DSM-IV (American Psychiatric Association, Washington, DC, 1994) and various biblical citations in support of this diagnosis. It rejects the idea that a major personality change is reflected in the New Testament and claims that God did not experience a major transformation of his narcissistic personality structure as described by Heinz Kohut (Forms and transformations of narcissism, in A. P. Morrison, Ed., Essential papers on narcissism, pp. 61–87, New York University Press, New York, 1966/1986). However, it concludes that God’s creativity accounts for the stability of his narcissistic personality structure and helps to explain his lack of empathy toward human beings.

Health Perceptions and Anxiety Sensitivity in Patients with Panic Disorder

Separate lines of research indicate that patients with panic disorder display negative perceptions of physical health and elevated fear of autonomic arousal. Because health perceptions and anxiety sensitivity may be related, the present study evaluated the degree to which these constructs can be distinguished in patients meeting DSM-IV criteria for panic disorder (N = 44). Perceived health, anxiety sensitivity, and the clinical features of panic disorder were assessed at pretreatment and following 12 sessions of cognitive–behavioral treatment. Findings consistently indicated that perceived health and anxiety sensitivity can be meaningfully differentiated. Perceived physical health was only moderately associated with anxiety sensitivity, and each was uniquely associated with pretreatment symptomatology and posttreatment end-state functioning. Perceived physical health appears to be a clinically useful index in the overall evaluation of panic disorder and is readily distinguishable from anxiety sensitivity.     

Self-focused attention and safety behaviors across group therapies for social anxiety disorder

Background: Self-focused attention (SFA) and safety behaviors are two variables implicated in the maintenance of social anxiety disorder (SAD).

Design: The present study examined SFA and safety behaviors across two therapies for SAD, cognitive behavioral group therapy (CBGT) and mindfulness and acceptance-based group therapy (MAGT).

Method: Participants with symptoms meeting criteria for SAD (N?=?137) were randomly assigned to the 12-week-treatment groups (n?=?53 for each condition) or a waitlist control (n?=?31). Variables were assessed at baseline, midtreatment, posttreatment, and a 3-month follow-up.

Results: Both treatment conditions reported significantly lower SFA and safety behaviors compared to control, but did not differ from one another at posttreatment. Mediation analyses supported the following models: (1) safety behaviors mediating the relationship between SFA and social anxiety, and (2) SFA mediating the relationship between safety behaviors and social anxiety. These models were supported for both treatment groups.

Conclusions: Both treatments may have the potential to reduce the SFA and safety behaviors that serve to maintain SAD.     

From interactions to mental representations: Psychodynamic parent – infant therapy in a case of severe eating and sleep disorders

This paper describes the process of psychodynamic psychotherapy with an infant and his family, during a developmental phase in which the infant's mental organization was in transition from the level of interactions to representations. The treatment of a 23-month-old boy suffering from a severe sleeping and eating disorder was initiated in a parent?–?child psychotherapeutic setting. The sleep disorder was a consequence of separation anxiety. Additionally, phobic avoidance of new oral experiences led to an eating disorder. These symptoms had developed in the context of dysregulation of the triadic family relationships (mother?–?father?–?children), which tended to split into two-plus-one relationships. After one year, the setting was changed to alternating individual and family sessions. Due to his developing symbolic capacities, the boy was able to express his inner concerns and his internalised affect-laden experiences through play and actions. His internal world could now be addressed by interpretations. New psychodynamic theories and research results on early triadic development were taken as the theoretical background for the psychotherapeutic work. We understood the course of the treatment and the development of the transference/countertransference relationships in terms of processes of triadification (at the level of interpersonal relationships) and triangulation (at the level of intrapsychic representations).     

Cognitive Behavioral Treatment for Insomnia in Veterans with Long-Standing Posttraumatic Stress Disorder: A Pilot Study

This uncontrolled pilot study assessed the effects of cognitive behavioral therapy for insomnia in veterans with long-standing posttraumatic stress disorder. Male veterans with current chronic insomnia and PTSD (n?=?8; M age = 58.6, SD?=?3.0; 87.5% African American, 12.5% European American; 87.5% Vietnam Veterans, 12.5% 1st Gulf War Veterans) reported a trauma related to their military service. Participants appeared for five weekly individual sessions of cognitive behavioral therapy for insomnia and completed one-week assessments of objective sleep (actigraphy) and subjective sleep (sleep diaries), the Insomnia Severity Index, and measures of functioning, posttraumatic stress disorder, and psychological distress both before and after treatment. Paired t tests revealed significant posttreatment improvements for various subjective assessments of sleep patterns but actigraphy-defined sleep was unchanged. Measures of functioning, nightmares, and posttraumatic stress disorder severity were also unchanged at posttreatment. Preliminary results were encouraging in improving subjective perceptions of sleep in individuals with posttraumatic stress disorder, warranting further study with more rigorous methodology.     

Behavioural Treatment of Post-Traumatic Stress Disorder Associated with Recovered Memories

Post-traumatic stress disorder (PTSD) is sometimes associated with recovered memories (RMs) of traumatic events. That is, the sufferer reports having forgotten traumatic events for a period of time, only to recall them later on. As the memories of traumatic events are recalled, post-traumatic stress disorder may emerge. The cause of recovered memories is uncertain and is the subject of debate. Some recovered memories may be reasonably accurate, while others may be ''recollections'' of imagined rather than actual events. It is unclear whether conventional PTSD therapies, such as behaviour therapy, are appropriate and effective in treating PTSD-RM. The present article considers these issues in the context of a case study, in which a patient with PTSD-RM was treated with behaviour therapy ( in vivo and imaginal exposure). The patient sought treatment because he wanted relief from his PTSD symptoms, regardless of whether his recovered memories were accurate (he was completely convinced in the accuracy of the memories). Treatment outcome was compared with the outcome of 13 PTSD patients who did not have recovered memories, who were also treated with behaviour therapy. Results suggest that PTSD-RM can be effectively treated with behaviour therapy. However, such treatment is unlikely to be appropriate for all cases of PTSD- RM. Selection criteria are discussed.     

Successful treatment of obsessive-compulsive disorders

Behavioral therapy and drugs have significantly improved obsessive-compulsive disorder (OCD) symptoms. A variety of behavioral therapy methods have been employed, but exposure and prevention of response, particularly, have reduced ritualistic actions of many OCD patients. Many psychoactive drugs have been tried; the tricyclic antidepressant drugs (clomipramine or Anafranel), especially in research outside the United States, have alleviated OCD symptoms as well as depression. Compulsive rituals have responded more often than obsessive actions to both behavioral and psychopharmacological therapy. Recent research has suggested that psychophysiological as well as traditional psychogenic factors may contribute to the etiology, course, and alleviation of OCD.     

Modified Comprehensive Behavioral Intervention for Tics: Treating Children With Tic Disorders,Co-Occurring ADHD,and Psychosocial Impairment

Our objective was to evaluate the feasibility and acceptability, and preliminary efficacy of a modified comprehensive behavioral intervention for tics (MCBIT) therapy for youth with chronic tic disorders (CTDs), co-occurring attention-deficit hyperactivity disorder (ADHD), and associated psychosocial impairment. Seventeen youth ages 10–17 with CTD and co-occurring ADHD were randomly assigned to the MCBIT group (n = 9) or to a control group where they received traditional comprehensive behavioral intervention for tics (CBIT) therapy (n = 8). Both groups received ten 55-minute weekly treatment sessions, and two 55-minute biweekly relapse prevention sessions. Sixteen of the 17 participants completed the study, and acceptability ratings in both treatment groups were high with no significant differences in expectation of improvement. The MCBIT and CBIT groups in combination showed significant improvement in tic severity, ADHD symptom severity, and tic-related impairment. Group differences were not significant. The results indicate that MCBIT treatment is feasible and acceptable for youth with CTD and ADHD, and is similarly well tolerated relative to traditional CBIT. Results were not sufficiently superior to recommend MCBIT over CBIT for this population. However, given the demonstrated benefit of behavioral treatments that target co-occurring conditions concurrently, continuing to examine novel behavioral approaches that can target tics and related conditions simultaneously and successfully is recommended.     

Adult ADHD and/or Sleep Apnea? Differential Diagnostic Considerations with Six Case Studies

An increased interest in the persistence of attention-deficit hyperactivity disorder (ADHD) into adulthood brings concern that adult ADHD may become overdiagnosed. As with ADHD in childhood, various other adult psychological and medical disorders may be associated with ADHD in adulthood, and these related disorders may be mislabeled and mistreated as simple ADHD. One such medical condition is sleep apnea. This paper reviews similarities and differences between ADHD and sleep apnea and presents case histories of six adult patients diagnosed with ADHD who were subsequently found to have at least comorbid obstructive sleep apnea (OSA). Clinicians who diagnose and treat patients with ADHD are advised to become familiar with sleep apnea as a life-threatening condition that presents with overlapping symptoms.     

Integrating Individual and Family Systems Psychotherapy to Treat Borderline Personality Disorder

This paper focuses on two areas. The first is the framework for psychotherapy integration used by Unified Therapy, a psychotherapy approach that is an integration of psychodynamic, cognitive–behavioral, and family systems therapy. The second is the use of this treatment paradigm in the psychotherapy of adults with borderline personality disorder. The theory posits that continuing and recurrent interpersonal behavior patterns within the patient's family of origin serve as behavioral triggers to typical acting-out behaviors. Therapy is geared toward planning strategies to alter these destructive patterns. A case example is presented to demonstrate the use of the therapy's theories and techniques.