Diagnosing agoraphobia in the context of panic disorder: examining the effect of DSM-IV criteria on diagnostic decision-making

A diagnostic and statistical manual (DSM)-IV diagnosis of agoraphobia in the context of panic disorder (PD) is based on three nosologically sufficient criteria: (1) avoidance, (2) use of companions, and (3) endurance of situations despite distress. Therefore, an agoraphobia diagnosis can be made across an extremely broad range of cases including when there are no avoidance behaviors (e.g., the patient endures the situation). It was hypothesized that clinicians do not weight these criteria equally and that the DSMs individual, sufficient criteria lead to poor inter-rater reliability. Clinicians (N=48) rated hypothetical patients with symptom profiles emphasizing each of these three criteria. Consistent with expectation, clinicians differentially weighted these criteria. Avoidance was relatively more apt to produce a diagnosis when only one criterion was emphasized in clinical vignettes. Inter-rater reliability was poor in instances when only one sufficient criterion was highlighted. Knowledge concerning DSM criteria resulted in a greater rate of agoraphobia endorsement, but knowledge did not account for the overall pattern of findings.     

Evaluation of behavioral measures of risk taking propensity with inner city adolescents

The current study examined the utility of behavioral measures of risk-taking propensity in the assessment of self-reported real-world risk-taking behaviors using a sample of 51 high-school-aged inner-city adolescents. Results indicated that performance on one behavioral measure, the balloon analogue risk task, accounted for unique variance in self-reported delinquency/safety risk behaviors as well as substance use risk behaviors, above and beyond that provided with demographics and self-report measures of risk-related constructs (i.e., impulsivity and sensation seeking). These results are discussed in relation to the potential utility of using a multimethod assessment approach for better understanding risk-taking vulnerability among adolescents.     

Tailoring Cognitive Behavioral Therapy for Individuals Diagnosed with Bulimia Nervosa

There is a wealth of data indicating the effectiveness of cognitive behavioral therapy in the treatment of bulimia nervosa. However, the best evidence indicates a treatment success rate of 50%. The purpose of this paper is to briefly describe cognitive behavioral treatment of bulimia nervosa and to offer suggestions on how this therapy approach may be tailored to best serve the needs of individual clients. Such tailoring should ultimately lead to even greater treatment success.     

Health Focused Psychotherapy In Treating a Dual Diagnosed Patient

Health-focused psychotherapy offers a contemporary model used in assessment, treatment planning and evaluation in addressing patients with both medical and psychiatric diagnoses. Clinicians in the health and mental health disciplines must know and understand the importance of standards of care and models of intervention and evaluation in clinical practice for this type of patient. Examined is the use of a specific model providing a tailored orientation to patient education, along with the development and use of a clinical algorithm and care pathway for clinical practice. Provided is a case study for applying the development and use of a clinical algorithm and care pathway for a dual diagnosed patient receiving health-focused psychotherapy.     

The Meaning vs. The Medical Model in the Empirically Supported Treatment Program: A Consideration of The Empirical Evidence

A review of the debate on the Empirically Supported Treatment Program is presented. It is argued that underlying the specifics of the debate are fundamentally incompatible paradigms: a meaning vs. a medical model. The findings from two gold standard multi-site studies are reviewed to conclude that the control condition meets requirements for an empirically supported treatment. The empirical finding of the failure of clinical training to improve treatment outcomes is explained by the focus on rational factors in training. It is recommended that training of therapists focus on enhancing experiential capacity rather than mastery of manualized treatment approaches.     

Treating Hypochondriasis with Interpersonal Psychotherapy

The treatment of hypochondriacal patients can be conceptualized as taking one of three approaches. These typically address one of the following questions: 1) “Should the patient be preoccupied?” 2) “Why is the patient preoccupied?” 3) “What are the interpersonal consequences of being preoccupied?” Interpersonal Psychotherapy (IPT) is specifically designed to address the last of these questions. IPT focuses on understanding the patient’s real distress, exploring the patient’s maladaptive communications, and modifying those communications so that others are more able to meet the patient’s attachment needs. With a focus on communication in a time-limited frame, fostered by a strong collaborative relationship, IPT appears to be an effective method of reducing hypochondriacal behavior.