c&bp11.3

A Cognitive Therapy Intervention for Suicide Attempters: An Overview of the Treatment and Case Examples
Michele S. Berk, Gregg R. Henriques, Debbie M. Warman, Gregory K. Brown, and Aaron T. Beck, University of Pennsylvania

Although suicidal behavior is a serious public health problem, few effective treatments exist to treat this population. This article describes a new cognitive therapy that has been developed for treating recent suicide attempters. The intervention is based on general principles of cognitive therapy and targets the automatic thoughts and core beliefs that were activated just prior to the individual’s suicide attempt. Specific cognitive and behavioral techniques are taught to the patient with the goal of decreasing suicidal thoughts and preventing future suicide attempts. The treatment is unique in targeting suicidal behavior as the primary problem, apart from psychiatric diagnosis. Three detailed case examples are provided that illustrate the use of the treatment with different types of patients.

Treating Self-Injection Phobia in Patients Prescribed Injectable Medications: A Case Example Illustrating a Six-Session Treatment Model
Darcy Cox, David C. Mohr, and Lucy Epstein, University of California, San Francisco

This article provides a case description of a patient with multiple sclerosis prescribed interferon beta-1a, a weekly intramuscular injection, who met DSM-IV criteria for specific phobia, blood/injection type. This patient successfully completed a 6-week manualized cognitive-behavioral treatment for self-injection anxiety. Issues presented include dealing with vasovagal responses and examples of typical dysfunctional thoughts related to self-injecting. The patient was able to successfully self-inject following treatment, and gains were maintained for 18-month follow-up.

Psychosocial Treatment of Bipolar Disorders in Adolescents: A Proposed Cognitive-Behavioral Intervention
Carla Kmett Danielson, Case Western Reserve University, Norah C. Feeny and Robert L. Findling, Case Western Reserve University and University Hospitals of Cleveland, Eric A. Youngstrom, Case Western Reserve University

Despite the severity of bipolar disorder (BP) and the amount of attention the psychosocial treatment of BP among adults has been given (e.g., Basco & Rush, 1996; Miklowitz, Frank, & George, 1996), no published outcome study or psychosocial treatment manual to date exists for children with this disorder. Based upon what is known about the phenomenology of BP in adolescents and what has been published with regard to existing treatments and their efficacy for adults with BP and adolescents with unipolar depression, the purpose of this article is to describe a model for an empirically driven cognitive behavioral treatment for BP in adolescents. The manualized intervention described herein includes the following intervention components: psychoeducation, medication compliance, mood monitoring, anticipating stressors and problem solving, identifying and modifying unhelpful thinking, sleep regulation and relaxation, and family communication. In addition, optional modules devoted to substance abuse, social skills, anger management, and contingency management are offered. The treatment includes a 12-session acute phase of treatment, followed by a maintenance phase and biyearly “booster” sessions. The rationale for and format of each session is presented. Currently, a pilot study is underway to evaluate the preliminary efficacy of this treatment for adolescents with BP. To illustrate the treatment, we present a case study including outcome data for a 13-year-old boy with bipolar I.

What Do Those Who Know, Know? Investigating Providers’ Knowledge About Tourette’s Syndrome and Its Treatment
Brook A. Marcks, Douglas W. Woods, Ellen J. Teng, and Michael P. Twohig, University of Wisconsin–Milwaukee

Physicians and possibly psychologists are likely to be at the center of clinical care for persons with Tourette’s Syndrome (TS). To date, it is unclear (a) how much basic knowledge these health care providers possess about the disorder, (b) how much incorrect or untested information is believed about the disorder, (c) what the perceived role of a psychologist is in the treatment process, and (d) if physicians and psychologists are familiar with, or desire more information about, habit reversal, an effective nonpharmacological procedure used to reduce tics. To study these topics, a survey was sent to 383 physicians and psychologists. Of the 67 surveys returned, results showed that the health care professionals responded correctly to 77% of the general knowledge items about TS. No differences in TS-related knowledge were found between physicians and psychologists, but there was a trend toward those with experience treating TS being more knowledgeable than those without experience. Regarding beliefs about incorrect or empirically untested information about TS, few professionals believed that allergies or diets affected tics, but considerably more believed that persons with TS had the ability to suppress tics, and that doing so produced a “rebound” in tic occurrence. A large portion of the sample also believed that discussing tics with a person who had TS made the tics worse. There was some disagreement among professionals as to the role psychologists could play in the clinical management of TS. Psychologists, more so than physicians, believed the psychologist’s role could involve treating tics, educating the patient about the disorder, treating ADHD, depression, and family difficulties. A small percentage of both groups had heard of habit reversal, but up to 63% wanted to learn more. Implications of the findings and limitations to the study are discussed.

Treating Parent-Adolescent Conflict: Is Acceptance the Missing Link for an Integrative Family Therapy?
Laurie A. Greco, Vanderbilt University Medical Center, and Georg H. Eifert, Chapman University

Change-oriented strategies such as problem-solving/communication training (PS/CT) and parental behavior management training (BMT) have been used to treat parent-adolescent conflict. Although several studies have documented the efficacy of these approaches relative to wait-list control conditions, clinically significant improvements have not been achieved for the majority of adolescents with significant behavioral problems such as comorbid ADHD/ODD. A similar pattern of findings was observed in earlier studies examining couple relationships. Extending the focus and scope of traditional couple therapy to an acceptance-based integrative approach has led to impressive treatment improvements in that area. In a similar vein, we propose an integrative family therapy and suggest enhancing more traditional change-oriented approaches such as PS/CT and BMT by integrating acceptance strategies into a values-centered family therapy. We discuss the role of experiential avoidance and values orientation within a family context and present examples of techniques adapted from traditionally adult- and couple-focused therapies. Finally, we discuss the balancing and sequencing of acceptance and change techniques and offer suggestions for future research and practice.

Treating Tobacco Dependence: Development of a Smoking Cessation Treatment Program for Outpatient Mental Health Clinics
Suzy Bird Gulliver, Barbara A. Wolfsdorf, and Sandra Baker Morissette, VA Boston Healthcare System and Boston University School of Medicine

Response to smoking cessation treatment programs sharply decreases when applied to smokers with psychiatric comorbidities. Consequently, the development of smoking cessation treatments that address the needs of psychiatric patients is greatly needed. The primary purpose of this article is to detail the process of development of an empirically informed, theoretically driven treatment program designed to aid multiply diagnosed smokers in their attempts to become tobacco free. Issues related to treating tobacco dependence in the persistently mentally ill are described. Our initial experience providing manualized, cognitive-behavioral smoking cessation treatment with adjunctive nicotine replacement therapy is detailed, along with the iterative process of manual development. Our current treatment program is illustrated with examples of clinical interactions, as well as a description of our ongoing evaluation of the utility and success of the clinic.

Treatment of Adjustment Disorder With Anxiety: A September 11, 2001, Case Study With a 1-Year Follow-Up
Shawn Powell and Dave McCone, United States Air Force Academy

This article describes the application of cognitive behavioral therapy in the treatment of a 20-year-old White male manifesting an adjustment disorder with anxiety, who initially presented on September 11, 2001, following the terrorist attacks. The initial treatment regime lasted 8 weeks. In addition, follow-up sessions at 6, 11, and 12 months were conducted. A combination of 4 cognitive behavioral therapy techniques, including cognitive impulse control, challenging irrational beliefs, stress management skills, and relaxation training, was applied. To determine treatment efficacy, the Outcome Questionnaire–45 (Lambert & Burlingame, 1996) was administered 6 times in a pre-, during, and posttreatment fashion. Treatment results suggest that this combination of techniques was effective in reducing the client’s anxiety and increasing his functioning.