Clinical Management of Gender Dysphoria in Adolescents

SUMMARY

This paper aims to provide professionals working with adolescents with gender-dysphoric feelings practical clinical guidelines for diagnosis and treatment. The different phases of the assessment procedure and treatment process are described. Differential diagnostic considerations and possible psychotherapeutic treatment options are given. Physical interventions, including GnRH analogues to inhibit puberty and cross-sex hormones, are described with consideration of eligibility and readiness issues. We end with discussion of post-treatment evaluation.     

The Acceptability of Computer-Aided Cognitive Behavioural Therapy: A Pragmatic Study

The clinical and cost-effectiveness of a computer-aided cognitive behavioural therapy (CCBT) programme, Beating the Blues, is indicated by a number of studies, but relatively little is known about its acceptability for patients with depression, anxiety, or both. This study investigated the acceptability of Beating the Blues offered on eight scheduled clinic visits with brief face-to-face support. Pre and posttreatment measures explored the relationship among programme acceptability, treatment continuation, and outcomes for people accessing the programme in routine care. Two hundred and nineteen patients with depression, anxiety, or both were offered Beating the Blues in 11 primary and secondary care practices. One hundred and ninety-one (87%) completed the pretreatment measures and 84 (38%) completed a treatment feedback questionnaire. Analysis of treatment acceptability for CCBT indicated a positive patient experience with the programme. Pretreatment expectancies predicted CCBT treatment completion but not outcomes. No differences were found between men and women on pretreatment measures. Posttreatment, women reported more favourable responses to the therapy, finding the programme more helpful and more satisfactory, than did men. No relationship between treatment acceptability and age was found. Study limitations, including research methods and attrition rates, and implications for future research are discussed. It is concluded that the Beating the Blues CCBT programme is an acceptable treatment for common mental health problems in routine care.     

Cognitive-behavioural Treatment of a Patient Suffering from Menière's Disease

Abstract

Vertigo and dizziness may cause considerable discomfort and feelings of uncertainty. It is no surprise that vertigo is the most disabling symptom in Menière's disease, an inner ear disorder. The other two cardinal symptoms are tinnitus and hearing impairment. In this study, one severely disabled woman was treated with a cognitive-behavioural treatment comprising, among other components, relaxation training, stabilization of gaze, cognitive restructuring and behavioural task setting. The patient responded well to the treatment, during which her vertigo attacks disappeared. During the follow-up period, she experienced vertigo attacks again, but after two booster sessions the vertigo attacks vanished for the rest of the follow-up period. The results are further discussed.     

Comorbidity and Internet-Delivered Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders

Internet-delivered transdiagnostic anxiety interventions aim to reduce symptoms across several anxiety disorders using one treatment protocol. However, it is unclear whether comorbidity affects outcomes of such treatment. This study re-examined data from a recent randomised controlled trial (N = 129) that evaluated the efficacy of an Internet-delivered transdiagnostic cognitive behavioural therapy (iCBT) intervention for participants with principal diagnoses of generalised anxiety disorder (GAD), social phobia (SP) panic disorder and agoraphobia (PDA), of whom 72% met criteria for a comorbid anxiety disorder or depression. Participants were divided into two groups based on whether or not they had a comorbid disorder before treatment. Participants with comorbid conditions reported higher symptom levels at pre-treatment, post-treatment, and follow-up across a range of measures. Both groups showed significant reductions in symptoms over treatment; however, participants with comorbid disorders showed greater reductions in measures of GAD, PDA, SP, depression, and neuroticism. In addition, treatment significantly reduced the number of comorbid diagnoses at follow-up. These results indicate transdiagnostic iCBT protocols have the potential to reduce comorbidity.     

An Evaluation of the Effects of Diagnostic Composition on Individual Treatment Outcome Within Transdiagnostic Cognitive–Behavioral Group Therapy for Anxiety

Recently, studies have supported the efficacy of treating anxiety disorders utilizing a transdiagnostic, or non-diagnosis-specific, framework (Erickson, D. H. (2003). Group cognitive behavioural therapy for heterogeneous anxiety disorders. Cognitive Behaviour Therapy, 32, 179–186; Garcia, M. S. (2004). Effectiveness of cognitive-behavioural group therapy in patients with anxiety disorders. Psychology in Spain, 8, 89–97; Norton, P. J., & Hope, D. A. (2005). Preliminary evaluation of a broad-spectrum cognitive-behavioral group therapy for anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 36, 79–97). Transdiagnostic group treatment packages focus on the common aspects inherent across the anxiety disorders such as behavioral and cognitive avoidance, and faulty cognitive appraisals of threat potential or meaning (Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35, 205–230). Although research supports the overall efficacy of transdiagnostic cognitive behavior therapy (CBT) for anxiety disorders (Norton, P. J., & Philipp, L. M. (2008). Transdiagnostic approaches to the treatment of anxiety disorders: A quantitative review. Psychotherapy: Theory, Research, Practice and Training, 45, 214–226), the effect of diagnostically mixed group composition on individual outcomes is less clear. This study investigated the relationship between group composition and treatment outcome within diagnostically heterogeneous groups with the purpose of determining if diagnostic heterogeneity differentially impacted treatment outcome for 84 individuals during a 12-week transdiagnostic cognitive–behavioral group anxiety treatment program (Norton, P. J. (2012a). Group cognitive-behavioral therapy of anxiety: A transdiagnostic treatment manual. New York: Guilford). The diagnostic makeup of the treatment group was examined at the beginning of treatment and at the end of treatment, and the results indicated that the diagnostic makeup of the treatment group had no significant impact on individual treatment outcome. These findings have direct implications for the delivery of transdiagnostic treatments, and are discussed in terms of their global implications for the transdiagnostic approach to the treatment of anxiety disorders.     

Materials used to support cognitive behavioural therapy for depression: a survey of therapists’ clinical practice and views

ABSTRACT

Use of supporting materials in cognitive behavioural therapy (CBT) is widely advocated, and homework increases effectiveness. The study aimed to identify materials most frequently used by CBT therapists to support CBT for depression, and those perceived clinically most effective. Questionnaires were sent to 3665 accredited CBT therapists asking about their use of resources commonly described in CBT manuals, and their views on effectiveness. Of 3665 approached by post/email, 994 (27%) responded. Another 33 completed the questionnaire via the study website. 818/1027 (80%) of respondents were accredited practitioners who deliver one-to-one therapy. Symptom measures, lists of problems/goals, activity schedules, behavioural activation diaries/plans, and case formulation worksheets were used “frequently” or “very frequently” by over 85% of respondents. Sleep diaries and computerised CBT were used least. Most resources were used within and between sessions. Activity schedules, behavioural activation diaries/plans, case formulation worksheets, thought records, and resources to support the identification of conditional beliefs were regarded as most effective. Symptom measures, sleep diaries, and computerised/online materials were considered only moderately effective. Therapists use a wide range of materials to support individual CBT. For delivering CBT, technology-enabled approaches should incorporate a range of materials to enable therapists to tailor treatment effectively.     

伤害回避的脑机制及其生物基础

伤害回避是指个体对厌恶刺激信号做出强烈的反应,并学会被动地回避惩罚的一种倾向,这一倾向使得个体反复思考未来的结局,并谨慎小心地对待不确定情景中的事件,进而更有可能诱发情感障碍。伤害回避涉及的神经网络包括三个子网络,即额顶叶-前扣带皮层的连接、皮层-杏仁核的连接和白质通道的结构性连接,这三个子网络分别与羞怯感-易疲劳性、预期担心以及不确定环境中的害怕情绪有关。而其生物基础则包括单一基因多态性和基因多态间的交互作用。今后的研究应该集中在深化伤害回避神经网络与生物基础间的联合机制、研究三种及以上基因多态间的交互作用、考察其他因素对基因效应的调节作用、注重伤害回避四种亚型相关神经网络之间的连接、探讨5-HT4等其他几种5-羟色胺受体多态性与伤害回避的关系以及分析伤害回避内部机制在抗抑郁治疗中的作用等方面。     

Traditional group therapy and computer-administered treatment for test anxiety

Abstract

Traditional group therapy for test anxiety, modelled after Weissberg (1976), was compared with the computer-administered treatment of Thoresen, Insel, Roth, Ross, and Seyler (1986). Both treatments contained cognitive and behavioral elements including systematic desensitization and Jacobsonian relaxation techniques. The participants were 36 test-anxious students seeking treatment within a university counseling center. Effectiveness of each treatment was assessed by studying changes in test anxiety (total, worry, emotionality), as measured by the Test Anxiety Inventory (Spielberger, 1980). and changes in grade point average (GPA). There was a statistically significant reduction in the three test anxiety measures for both treatments. No significant differences in GPA, as a result of the treatment, were found. There was no significant difference in reduction of test anxiety between the treatments. These findings support the efficacy of the computerized treatment which may be a suitable alternative to group therapy and, in some situations, may be the treatment of choice.     

Multifaceted Approaches in Spouse Abuse Treatment

SUMMARY

The understanding of spouse abuse has changed considerably in the last 30 years, shifting from a perspective based on individual psychopathology to that of a pervasive social problem. Current treatment solutions for stopping violence are limited to those that address resocializing the batterer. Several states often restrict the use of state funds for batterers' groups and forbid couples treatment as a primary treatment option in spite of the fact that most couples choose to remain in their relationships in the presence of repeated violence. This article argues for broadening options to include a specific type of couples treatment as a part of a coordinated community response to remediate domestic violence. Solution-focused therapy is described as an example of treatment of relationships that makes safety a priority and is not victim-blaming. It is suitable treatment both for couples who wish to stay together and those seeking a safe way to separate.