Relapse Prevention Techniques in the Treatment of Childhood Anxiety Disorders: A Case Example

Research has shown that cognitive behavioral therapy (CBT) is an efficacious treatment for children and adolescents with anxiety disorders. CBT incorporates techniques such as cognitive restructuring and exposure, which foster symptom reduction. While these components promote sustained fear reduction, greater attention to relapse prevention (RP) may be warranted, particularly given the comorbidity associated with anxiety disorders. A case example demonstrates a comprehensive relapse prevention (RP) component. Specifically, parental involvement was emphasized as well as the creation of a bound book that consolidated skills and provided a concrete resource for potential future anxious episodes.     

Using Symbolic-Experiential Family Therapy to Treat Adjustment Disorder: A Case Study

Despite studies claiming Adjustment Disorders (AD) affect up to 10% of the general population, research is severely lacking for effective treatment recommendations and screening tools. This article presents the treatment of a 30-year old Caucasian male diagnosed with AD - mixed anxiety and depression subtype. After 12 standard 60-minute sessions, treatment using a Symbolic-Experiential Family Therapy (SEFT) approach resulted in the alleviation of depression and anxiety symptoms. This case study provides preliminary evidence for the effectiveness of SEFT using a mixed methods case study. Implications for further study, and the usefulness of SEFT for the treatment of AD, is presented.     

Using Imagery Techniques to Treat PTSD Symptoms in Bereaved Individuals

Certain bereaved individuals experience traumatic images of the deceased and corresponding avoidance of thoughts and feelings pertaining to the loss. This reaction resembles Post-Traumatic Stress Disorder and should benefit from treatment strategies such as imagery techniques. Accordingly, a cognitive-behavioral treatment method involving imagery work designed to replace the bereaved individual's distorted, painful memories with less aversive, more representative memories is outlined. Additionally, specific cognitive-behavioral techniques such as tests of evidence, thought diaries, and grief letters are described. Finally, contraindications and limitations are delineated.     

Using Acceptance and Commitment Therapy to Treat Distressed Couples: A Case Study With Two Couples

Although the field of couple therapy has made significant strides in recent years, there continues to be a need for theoretically sound and empirically supported treatments. The current case study examines whether Acceptance and Commitment Therapy (ACT), an experiential acceptance-based behavior therapy, can be effective in treating distressed couples. Although ACT has demonstrated effectiveness in treating a variety of disorders in individuals, it has not been systemically applied to the treatment of couple distress, and the current study is the first empirical examination of ACT for the treatment of couples. Two married couples participated in the study. A number of core ACT interventions were modified to treat couples in a conjoint format. Cognitive defusion exercises were used to help couples reduce their fusion with and the believability of negative thoughts and feelings related to the relationship. Mindfulness and acceptance techniques were used to help couples increase awareness of their reactions to negative relationship cycles. Finally, value-directed action was used to help partners act in ways consistent with relationship values even in the presence of unwanted thoughts and feelings. The results of this preliminary case study suggest that ACT may be effective in increasing marital adjustment and satisfaction, and in reducing interpersonal and psychological distress in couples. Future studies with larger samples and more controlled designs are needed to build on the results from this single-case study.     

Using Visual Journaling in Individual Counseling: A Case Example

The purpose of this article is to describe and illustrate through a hypothetical case example how visual journaling, a form of expressive arts counseling, can be adapted for use in individual counseling. Counselors may consider using visual journaling as a counseling intervention when working with clients who may not have words for what they are feeling or experiencing, and for clients who tend to be very analytical. Visual journaling can be a way to bypass the intellect and give clients another way to access their experience.     

Treatment of Prostitution Using Integrative Therapy Techniques: A Case Study

This case study examines a pattern we believe to be common among female prostitutes: a woman (Bonnie) who, like most prostitutes, is a survivor of childhood sexual abuse. Bonnie's prostitution is part of the unconscious repetition compulsion common in trauma victims; by prostituting herself, Bonnie re-creates the scenario of sexual abuse that occurred during her childhood, while maintaining an illusion of control over the situation. We maintain that an effective approach to treatment for Bonnie is integrative therapy, a type of psychological counseling designed to address the major aftereffects of sexual abuse: dissociation from the body and sexuality in general; a profound sense of powerlessness; critically low valuation of the self; and mistrust and fear of intimacy. Bonnie's story shows the dynamics of both prostitute behavior and integrative therapy, providing an example we believe to be applicable far beyond this case study.     

Sublimation and Symbolization: The Case of Dental Anxiety and the Symbolic Meaning of Teeth

In a previous article (Capps and Carlin 2009) we discussed Freud’s visit to the United States in 1909 and the occasion it afforded for James Putnam to meet him and become an advocate of psychoanalysis. We focused on their subsequent correspondence on the concept of sublimation and argued that this correspondence reflected the fact that friendship may be a form of sublimation. In this article we focus on Isador H. Coriat, an advocate of psychoanalysis from the same time period (1910s). We show that his early psychoanalytic writings (Coriat 1917, 1920) not only support our earlier argument but also make a strong case for the role of symbolization in the process of sublimation. We also note his emphasis on the potential role of living religion in the sublimation process. We then discuss his later article on dental anxiety (Coriat 1946) and writings by other psychoanalytic authors to make the case that the patient’s conscious understanding of the meaning of the symbols—in this case, teeth-related symbols—is essential, for otherwise the energies invested in maintaining the repression will be unavailable to the sublimation process. This leads to a consideration of the role that living religion may play in the sublimation of teeth-related anxieties. We conclude that humor may also serve as a proxy for religion in this regard.     

一例使用态度治疗对大学新毕业生神经衰弱的案例报告

大学新毕业生工作适应不良是常见的现象,也是目前大学生就业担忧和顾虑的问题之一。这位刚毕业进入工作岗位的求助者出现了明显的抑郁症状,且在咨询过程中发现其抑郁的根源可以追溯到童年时期,并且有深刻的家庭教育文化背景。诊断为神经衰弱,采用态度治疗和心理稳定化技术后,经过两个月的咨询,求助者的神经衰弱症状基本消失,对自己和未来的态度基本明朗。一个月后电话回访,显示咨询效果良好。     

Using Prolonged Exposure and Cognitive Processing Therapy to Treat Veterans With Moral Injury-Based PTSD: Two Case Examples

Moral injury refers to acts of commission or omission that violate individuals’ moral or ethical standards. Morally injurious events are often synonymous with psychological trauma, especially in combat situations—thus, morally injurious events are often implicated in the development of posttraumatic stress disorder (PTSD) for military service members and veterans. Although prolonged exposure (PE) and cognitive processing therapy (CPT) have been well established as effective treatments for veterans who are struggling with PTSD, it has been suggested that these two evidence-based therapies may not be sufficient for treating veterans whose PTSD resulted from morally injurious events. The purpose of this paper is to detail how the underlying theories of PE and CPT can account for moral injury-based PTSD and to describe two case examples of veterans with PTSD stemming from morally injurious events who were successfully treated with PE and CPT. The paper concludes with a summary of challenges that clinicians may face when treating veterans with PTSD resulting from moral injury using either PE or CPT.     

一例人际交往焦虑咨询的案例报告

来访者是一名女大学生,偏内向,在人际交往中,因对他人态度判断时存在不合理认知而形成焦虑情绪。经过收集其资料,心理咨询师排除了其患精神病性或神经症性的可能,鉴定为人际交往焦虑,属一般心理问题。心理咨询师与来访者商定了阶段性的咨询目标,主要运用合理情绪疗法,帮助来访者改变不合理认知,消除其焦虑情绪,促进社会交往功能。     

牙科焦虑症患者心理干预的疗效分析

为了探讨心理诱导对牙科焦虑（dental anxiety,DA）患者治疗的影响,采用焦虑自评量表及汉密顿焦虑量表对门诊就诊患者进行焦虑调查,筛选出伴焦虑者82例,随机分为两组,分别进行心理干预治疗和一般治疗,并对数据进行统计分析。结果显示,心理诱导指导组与时照组相比较焦虑水平明显降低,患者无论在完成第一次治疗还是复诊情况均优于对照组（P〈0．01）。提示心理干预对DA患者治疗有显著效果。     

牙科焦虑症患者心理干预的疗效分析

为了探讨心理诱导对牙科焦虑症(dental anxiety,DA)患者治疗的影响,采用焦虑自评量表及汉密顿焦虑量表对门诊就诊患者进行焦虑调查,筛选出伴焦虑者82例,随机分为两组,分别进行心理干预治疗和一般治疗,并对数据进行统计分析.结果显示,心理诱导指导组与对照组相比较焦虑水平明显降低.患者无论在完成第一次治疗还是复诊情况均优于对照组(P<0.01).提示心理干预对DA患者治疗有显著效果.     

A Clinical Case of Generalized Anxiety Disorder

This article presents the clinical case of a 38-year-old man with generalized anxiety disorder (GAD). “William” reports longstanding excessive and uncontrollable worry about a number of daily life events, including minor matters, his family, their health, and work. In addition, he endorses chronic symptoms of restlessness and irritability, muscle tension, concentration difficulties, and sleep disturbance. In an attempt to cope with his worries, William engages in excessive information and reassurance seeking, particularly with respect to decision making, and he often double-checks even minor tasks. In addition, he engages in procrastination, and avoids spontaneous or unplanned events. Although William describes himself as a born worrier, his GAD symptoms became noticeably problematic over the last several years, subsequent to an increasing number of stressors. Comorbid conditions as well as predisposing and precipitating factors are described in addition to the specific symptom presentation.     

Targeting Co-Sleeping in Children With Anxiety Disorders Using a Modified Bedtime Pass Intervention: A Case Series Using a Changing Criterion Design

Children with anxiety disorders experience high rates of sleep-related problems, with co-sleeping and resistance to sleeping independently being among the more frequent problems reported. Although extinction-based behavioral sleep interventions have repeatedly been shown to be highly effective for treating bedtime resistance, the primary obstacle to their implementation is parent discomfort with these procedures. The bedtime pass intervention was developed to minimize extinction bursts when implementing extinction procedures for childhood sleep problems. Several studies have found this intervention to be effective for treating bedtime resistance behaviors, but not co-sleeping specifically, in nonclinical samples of children. The current paper describes the use of a modified bedtime pass procedure to target problematic co-sleeping and related bedtime resistance behaviors in two children with anxiety disorders who presented for treatment at an outpatient pediatric anxiety specialty clinic. A changing criterion, single subject methodology was used to evaluate the effectiveness of this procedure. Data indicate that both children were able to transition from co-sleeping with parents every night, to sleeping independently, with relatively limited need for contact with parents at night during the intervention. These findings extend the data for the bedtime pass procedure to both co-sleeping and children with anxiety disorders. Clinical implications of these findings are discussed given the limited guidance for treating comorbid sleep problems in anxious children. Strengths and limitations of the data being drawn from a clinical treatment setting are also discussed.     

Using Acceptance and Commitment Therapy to Treat Infertility Stress

Women and men diagnosed with infertility experience a variety of infertility-related stressors, including changes to their family and social networks, strain on their sexual relationship, and difficulties and unexpected challenges in their relationship. Infertility stress is linked with depression and psychological distress, and can lead to premature dropout from medical treatments and unresolved feelings of loss and grief. The current study examined the effectiveness of treating infertility stress using Acceptance and Commitment Therapy (ACT), a promising new behavior therapy that targets experiential avoidance through mindfulness, acceptance strategies, and value-directed action. This single-case study followed a couple experiencing infertility-related stress following a failed in vitro fertilization (IVF) procedure. The couple completed 6 self-report measures at 7 time points, including a second failed IVF attempt and a 1-year follow-up. Measures included both distress-focused instruments and therapy process-related questionnaires. The female participant reported higher pretreatment stress and depression scores compared to her partner. She reported significant decreases in global infertility stress, social infertility stress, sexual infertility stress, psychological distress, and depression from pretherapy to 1-year follow-up. She also reported a decrease in infertility stress following her second failed in vitro fertilization (IVF) attempt. The male participant reported significant decreases in sexual infertility stress. The study suggests that acceptance-based therapy shows promise in treating infertility stress in patients experiencing infertility who undergo medical treatments. The data from this preliminary case study also suggest that ACT may be helpful for couples following IVF treatment failure. Treatment gains were maintained 1-year posttherapy, indicating that an ACT approach to treating infertility has the potential to produce lasting change.     

Treatment of Comorbid Pica and Generalized Anxiety Disorder: A Case Study

This case report describes the assessment and treatment of a treatment-naïve 36-year-old Hispanic/Latina female with comorbid pica and generalized anxiety disorder (GAD), and iron-deficiency anemia. At the onset of treatment, the client consumed chalkboard chalk and vermiculite from potting soil approximately three times per week and presented with moderate-severity GAD. Assessment and treatment occurred over 24 weekly outpatient individual sessions. Treatment was delivered in concert with medical intervention to address anemia. A cognitive-behavioral case formulation was developed from multiple assessment sources. A process-based cognitive-behavioral therapy (CBT) intervention approach was used to target GAD and pica simultaneously, which included psychoeducation, self-monitoring, arousal reduction skills, cognitive training (reappraisal, distancing), and behavior modification/stimulus control techniques. Barriers to treatment and their solutions are discussed. At the end of treatment, the client demonstrated increased insight and understanding of her worry symptoms and pica behavior, acquired cognitive skills and arousal reduction strategies for managing GAD, and reported less than one episode of pica per week. The identified assessment and treatment approach is worthy of future investigation to inform empirically based treatment development efforts, especially for pica.     

Cognitive-Behavior Therapy for Low Self-Esteem: A Case Example

Low self-esteem is a common, disabling, and distressing problem that has been shown to be involved in the etiology and maintenance of a range of Axis I disorders. Hence, it is a priority to develop effective treatments for low self-esteem. A cognitive-behavioral conceptualization of low self-esteem has been proposed and a cognitive-behavioral treatment (CBT) program described (Fennell, 1997, 1999). As yet there has been no systematic evaluation of this treatment with routine clinical populations. The current case report describes the assessment, formulation, and treatment of a patient with low self-esteem, depression, and anxiety symptoms. At the end of treatment (12 sessions over 6 months), and at 1-year follow-up, the treatment showed large effect sizes on measures of depression, anxiety, and self-esteem. The patient no longer met diagnostic criteria for any psychiatric disorder, and showed reliable and clinically significant change on all measures. As far as we are aware, there are no other published case studies of CBT for low self-esteem that report pre- and posttreatment evaluations, or follow-up data. Hence, this case provides an initial contribution to the evidence base for the efficacy of CBT for low self-esteem. However, further research is needed to confirm the efficacy of CBT for low self-esteem and to compare its efficacy and effectiveness to alternative treatments, including diagnosis-specific CBT protocols.