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CONTENTS  Manualized Cognitive Behavioral Treatment for Physical Abuse–Related PTSD in an African American Child: A Case ExampleAngela E. Waldrop and Michael A. de Arellano
ABSTRACTS
The present case study illustrates a modified version of a manualized cognitive behavioral treatment for physical abuse–related symptoms (Swenson, 1996; Swenson & Brown, 1999). The case presented in this article illustrates the adaptation of a group intervention for physically abused 8- to 12-year-olds for use with a 5-year-old African American boy who had experienced chronic, severe physical and emotional abuse by his father. The course of treatment and treatment outcome are described and challenges in treatment are addressed.
Effective therapies for treating posttraumatic stress disorder (PTSD) have been described in the literature, particularly cognitive and behavioral interventions, and have consistently demonstrated a reduction in PTSD symptoms. However, the applied versions of cognitive and behavioral treatments offered in most programs diverge from the forms of therapy investigated in research protocols. These differences are elucidated and a model incorporating cognitive and behavioral interventions is presented, minimizing the discrepancy, yet accommodating most patient, institutional, and therapist needs. The therapies are offered in a program designed to treat women experiencing PTSD as a result of sexual trauma. The program is flexible and can be adapted to populations of either gender or nonveterans, and can be modified to meet specific program needs without compromising treatment approaches.
This article describes a new brief treatment for PTSD based on a metacognitive model (Wells, 2000). The treatment derived from this approach can be divided into core and supplementary treatment components. The core treatment manual is presented here. The core treatment does not require imaginal reliving of trauma or cognitive challenging of thoughts and beliefs about trauma. It enables patients to develop a metacognitive perspective and disengage unhelpful thinking styles such as worry/rumination and attentional monitoring that block the natural propensity for cognitive-emotional adaptation following trauma. The content, techniques, and sequence of the basic program are described in detail to support practical application of the new treatment by therapists.
The present investigation details the assessment and use of Behavioral Activation (BA) therapy to treat a 37-year-old male police officer/military veteran suffering from posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). This case study is an attempt to expand empirical knowledge regarding BA, comorbid PTSD and MDD, and treatment outcome research specifically relevant to these comorbid diagnoses. The BA treatment consisted of 11 sessions, which occurred on a weekly basis. Self-report data were gathered at each session and again at midpoint between each session. At posttreatment assessment, self-report and observer rated data indicated that the client no longer met criteria for either PTSD or MDD. Results at 1-month follow-up suggested that the therapeutic gains were not only maintained, but that the client continued to improve. It is argued that BA may be an effective treatment for comorbid PTSD and MDD and the theoretical rationale is provided.
Major psychological theories of generalized anxiety disorder (GAD) have begun to suggest that worry may function as avoidance of emotions. On the basis of these findings, a number of researchers have begun to develop techniques to address emotional deficits in GAD. However, most techniques suggested to date have been from outside a cognitive-behavioral (CBT) model of treatment, making the integration of these techniques more difficult for CBT therapists. We propose a CBT model of addressing emotional avoidance through (a) learning to identify emotions and their possible evolutionary functions, (b) creating an emotion hierarchy to systematically address different emotions, (c) using imaginal exposure to increase tolerance to different emotions, and (d) eliminating behavioral avoidance of emotional experiences.
Health preoccupations are present in both generalized anxiety disorder (GAD) and hypochondriasis. Contrary to GAD, in which excessive anxiety and worry encompass a number of events or activities, health is the central theme of worry in hypochondriasis. A recent study demonstrated that two processes involved in GAD are also involved in health anxiety. In light of these findings, adapting the treatment for GAD to hypochondriasis was warranted. In the present study, 6 hypochondriacal patients participated in a multiple baseline single-case design. Patients were assessed by means of a structured interview before and after treatment. Treatment targeted the following components: (a) awareness of worry, (b) intolerance of uncertainty toward health, (c) faulty beliefs regarding worry and anxiety, (d) cognitive avoidance and relapse prevention of reassurance or avoidance behaviors, (e) poor orientation to physical symptoms and problems, and (f) relapse prevention. Following treatment, none of the 6 patients met criteria for hypochondriasis. Results confirmed that a treatment targeting excessive worry is effective for hypochondriasis. All participants reached a high end-state functioning at the 1-year follow-up. The clinical implications of these results are discussed.
Recent advances in our understanding of worry and generalized anxiety disorder (GAD) have led to the development of efficacious treatments for GAD. Although multidimensional treatment packages have shown efficacy, we know little about the efficacy and clinical utility of individual treatment components. This study evaluates the efficacy of problem-solving training and cognitive exposure for the treatment of GAD. Eighteen primary GAD patients received 12 sessions of cognitive-behavioral therapy in a case replication series. Treatment was individualized according to the main worries of patients and consisted of either problem-solving training for worries concerning current problems, or cognitive exposure for worries concerning hypothetical situations. Results show that both treatments led to statistically significant improvements on all outcome measures. Stringent clinically significant outcome at posttest was reached by 73.3% of patients that completed treatment. Furthermore, gains were maintained at 6-month follow-up. Consistent with current treatment models of GAD, these results suggest that problem-solving training and cognitive exposure are efficacious treatment components for GAD.
For patients with HIV, depression is a common, distressing condition that can interfere with a critical self-care behavior—adherence to antiretroviral therapy. The present study describes a cognitive-behavioral treatment designed to integrate cognitive-behavioral therapy for depression with our previously tested approach to improving adherence to antiretroviral therapy for HIV. Each session addresses HIV medication adherence in the context of modules for activity scheduling, cognitive restructuring, problem-solving training, and relaxation training/diaphragmatic breathing. We present the design of the intervention and outcome of 5 cases. All of the patients presented below were men who have sex with men who were infected with HIV through sexual transmission. Generally, these patients showed improvements in both depression and medication adherence.
This article describes an effort to implement and examine dialectical behavior therapy’s (DBT) effectiveness in a community mental health setting. Modifications made to address unique aspects of community mental health settings are described. Barriers encountered in implementation of DBT treatment in community mental health settings, such as staff turnover, maintaining fidelity to the treatment model, staff selection, and structuring skills training, are discussed. Preliminary data are presented that examine the effectiveness of DBT in a group of indigent clients receiving treatment at a community mental health center who have comorbid diagnoses of borderline personality disorder and a severe mental illness on Axis I.
The practice of mindfulness is increasingly being integrated into contemporary clinical psychology. Based in Buddhist philosophy and subsequently integrated into Western health care in the contexts of psychotherapy and stress management, mindfulness meditation is evolving as a systematic clinical intervention. This article describes stress-reduction applications of mindfulness meditation predominantly in medical settings, as originally conceived and developed by Kabat-Zinn and colleagues. It describes process factors associated with the time-limited, group-based format favored by this model, and presents in tabular form results of both early and more recent outcome studies. |