Psychotherapy for Individuals with Autism Spectrum Disorders

Individuals with autism spectrum disorders (ASDs) present unique challenges for psychotherapists. Those with autism, Asperger’s Disorder and pervasive developmental disorder-not otherwise specified (PDD-NOS) show impairments in social communication and social relationships as well as unusual behavioral features that set them apart from peers. Further, individuals affected with autism spectrum disorders may experience anxiety, depression, obsessive–compulsive disorder and other psychiatric symptoms that can be distressing and, at times, disabling. At present, there is limited information regarding evidence-based approaches for addressing either core impairments of ASDs or associated conditions in a psychotherapy setting. Nevertheless, information about how persons with ASD experience their world and learn can provide clues about what interventions might be useful to assist them such that they can reach their fullest potential. From this standpoint, new or modified approaches to therapy can be tested and further refined to provide a more comprehensive understanding of the psychotherapeutic challenges and the most efficacious therapeutic approach to maximize functioning in this population.     

Challenges and Opportunities for Intervening with Couples in the Aftermath of the Global War on Terrorism

The unique culture of the military family in the early part of the twenty-first century will be examined, including the high operational tempo, frequent geographic moves, high rates of service among women, and the unique constellation of deployed troops from Active Duty, National Guard and Reserve components. Challenges faced by these couples are described, followed by key issues for clinicians to assess. Several developing couple-based interventions will be described, followed by a vignette which will highlight the issues and opportunities for these couples. In addition to reviewing common difficulties among military families, the authors will highlight strengths inherent to the military culture that clinicians can utilize in helping families develop resiliency.     

Relations between Minnesota Multiphasic Personality Inventory-A scales and Rorschach variables with the scope and severity of maltreatment among adolescents

This study examined preexisting Rorschach (Exner, 2001) and Minnesota Multiphasic Personality Inventory-A (MMPI-A; Butcher et al., 1992) profiles to determine if selected MMPI-A scales and Rorschach variables would jointly associate with the number and severity of maltreatment subtypes (physical abuse, sexual abuse, neglect, and emotional maltreatment) of 157 adolescents (ages 14-17) with documented maltreatment histories. The Maltreatment Classification System was used to systematically code the maltreatment attributes. Six Rorschach variables (MOR, PER, Afr, SumY, SumC', Human Content) were significantly correlated with the number of maltreatment subtypes, but none of the anticipated MMPI-A scales were related. MMPI-A Scale 7 and Rorschach variables Ego, MOR, and PER were jointly associated with physical abuse severity. MMPI-A Scale 0 and Rorschach variables MOR, PER, SumY, SumC', PTI, Human Content, and Texture jointly associated with sexual abuse severity. This study supports the potential for certain MMPI-A scales and Rorschach variables to reflect the impact of adolescents' maltreatment experiences in terms of the number and severity of types of maltreatment experienced. Because both instruments captured different aspects of adolescents' maltreatment experiences, clinicians should consider using both when evaluating the impact of maltreatment on adolescents.     

A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations

BackgroundIrritable bowel syndrome (IBS) is a chronic and debilitating medical condition with few efficacious pharmacological or psychosocial treatment options available. Evidence suggests that visceral anxiety may be implicated in IBS onset and severity. Thus, cognitive-behavioral treatment (CBT) that targets visceral anxiety may alleviate IBS symptoms.MethodsThe current study examined the efficacy of a CBT protocol for the treatment of IBS which directly targeted visceral sensations. Participants (N = 110) were randomized to receive 10 sessions of either: (a) CBT with interoceptive exposure (IE) to visceral sensations; (b) stress management (SM); or (c) an attention control (AC), and were assessed at baseline, mid-treatment, post-treatment, and follow-up sessions.ResultsConsistent with hypotheses, the IE group outperformed AC on several indices of outcome, and outperformed SM in some domains. No differences were observed between SM and AC. The results suggest that IE may be a particularly efficacious treatment for IBS.ConclusionsImplications for research and clinical practice are discussed.     

Fruitful plans: adding targeted mental imagery to implementation intentions increases fruit consumption

Forming implementation intentions ('If I encounter situation X, then I will perform behaviour Y!') increases the probability of carrying out goals. This study tested the hypothesis that mental imagery targeting key elements of implementation intentions further increases goal achievement. The residents of a student residence were assigned the goal of consuming extra portions of fruit every day for 7 days and randomly assigned to one of four conditions: control (active rehearsal), implementation intentions, goal intention mental imagery or mental imagery targeted to the implementation intentions. Among low fruit consumers, but not high fruit consumers, fruit consumption at follow-up was higher in the targeted mental imagery group than in the other group, with the lowest fruit consumption in the control group. The findings suggest that it may be beneficial to use targeted mental imagery when forming implementation intentions.     

Female tokens in high-prestige work groups: Catalysts or inhibitors of group diversification?

There is a popular theory-based assumption that women, who are numerical minorities in high-prestige work groups, will advocate for other women as potential work group peers. However, these individuals may face special challenges in fulfilling this role. I examine how the prestige accorded to the work group and their numerical representation interact to impact women’s concerns about being considered valued members of their groups and hence, their propensity to support other women in the selection process. I conducted three studies which showed that women will abdicate the opportunity to support highly or moderately qualified female candidates as potential work group peers. Furthermore, the concern that a highly qualified female candidate will be seen as more of a valued group member (competitive threat) and that a moderately qualified female candidate will adversely affect their value by reinforcing negative stereotypes about their demographic category (collective threat) partially mediated the relationship between numerical representation and work group prestige and women’s preference for other women as work group peers.     

Perceptions of the cognitive compensation and interpersonal enjoyment functions of collaboration among middle-aged and older married couples

Perceptions of cognitive compensation and interpersonal enjoyment of collaboration were examined in three hundred middle-aged and older couples who completed measures of perceptions of collaboration, cognitive ability, marital satisfaction, an errand task and judged their spouse's affiliation. Older adults (especially men) endorsed cognitive compensation and interpersonal enjoyment and reported using collaboration more frequently than middle-aged adults. Greater need for cognitive compensation was related to lower cognitive ability only for older wives. Greater marital satisfaction was associated with greater interpersonal enjoyment. These two functions related to reports of more frequent use of collaboration and perceptions of spousal affiliation in a collaborative task.     

New Strategies for Combining Mindfulness with Integrative Cognitive Behavioral Therapy for the Treatment of Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) severely impacts social functioning, distress levels, and utilization of medical care compared with that of other major psychiatric disorders. Neither pharmacological nor psychotherapy interventions have adequately controlled cardinal symptoms of GAD: pervasive excessive anxiety and uncontrollable worry. Research has established cognitive behavioral therapy (CBT) as the most effective psychotherapy for controlling GAD; however, outcomes remain at only 50% reduction, with high relapse rates. Mindfulness has been integrated with CBT to treat people suffering from numerous psychiatric disorders, with mindfulness based stress reduction (MBSR) being the most researched. Preliminary evidence supports MBSR’s potential for controlling GAD symptoms and key researchers suggest mindfulness practices possess key elements for treating GAD. Classical mindfulness (CM) differs significantly from MBSR and possesses unique potentials for directly targeting process and state GAD symptoms inadequately treated by CBT. This article introduces the theory and practice of CM, its differences from MBSR, and a critical review of MBSR and CBT treatments for GAD. CM strategies designed to complement CBT targeting cardinal GAD symptoms are outlined with a case study illustrating its use.     

Do intrusive memory characteristics predict depression at 6 months?

Two prospective studies have investigated whether the presence, intrusion, and avoidance of negative intrusive memories predict depression, and have reported conflicting findings. We aimed to replicate and extend these investigations by exploring the role of intrusion and avoidance of intrusive memories, as well as memory characteristics, in the prediction of depression prospectively. At Time 1 a mixed sample of community participants (N=85) were interviewed and completed self-report measures of depression, anxiety, and intrusive memory features. At Time 2 (6 months later, N=64) depression and anxiety symptoms were reassessed. Results were partly consistent with hypotheses for the sub-sample of participants who did not receive treatment between the baseline and follow-up assessments. Baseline levels of intrusion and some memory features (uncontrollability, distress, interference, numbness, detachment) predicted follow-up depression, controlling for baseline depression symptoms. Unexpectedly, avoidance of intrusive memories and other features (e.g., here and now quality) did not predict depression. Levels of intrusion and avoidance did not predict anxiety at follow-up. These results provide further evidence that intrusive memories are not simply an epiphenomenon of depression, but predict depression prospectively. Our results suggest that novel, depression-specific theories that emphasise the role of memory disturbances in the maintenance of depression are needed.     

Age-related differences in guessing on free and forced recall tests

This study examined possible age-related differences in recall, guessing, and metacognition on free recall tests and forced recall tests. Participants studied categorised and unrelated word lists and were asked to recall the items under one of the following test conditions: standard free recall, free recall with a penalty for guessing, free recall with no penalty for guessing, or forced recall. The results demonstrated interesting age differences regarding the impact of liberal test instructions (i.e., forced recall and no penalty) relative to more conservative test instructions (i.e., standard free recall and penalty) on memory performance. Specifically, once guessing was controlled, younger adults' recall of categorised lists varied in accordance with test instructions while older adults' recall of categorised lists did not differ between conservative and liberal test instructions, presumably because older adults approach standard free recall tests of categorised lists with a greater propensity towards guessing than young adults.