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CONTENTS
Book Reviews Section Editor: Sabine Wilhelm
Reviewed by C. Alec Pollard
Reviewed by David H. Klemanski, Rebecca Merenda, Traci Cipriano, and David F. Tolin ABSTRACTS
Individual cognitive behavioral therapies (CBT) are now considered the first-line treatment for posttraumatic stress disorder (PTSD; Foa, Keane, & Friedman, 2000). As mental health reimbursement becomes more restricted, it is imperative that we adapt individual-format therapies for use in a small group format. Group therapies have a number of advantages, including provision of a natural support group, the ability to reach more patients, and greater cost efficiency. In this article, we describe the development of a group CBT for PTSD in the aftermath of a serious motor vehicle accident (MVA). Issues unique to the group treatment format are discussed, along with special considerations such as strategies to reduce the potential for triggering reexperiencing symptoms during group sessions. A case example is presented, along with discussion of group process issues. Although still in the early stages, this group CBT may offer promise as an effective treatment of MVA-related PTSD.
This case study describes Cognitive Processing Therapy (CPT) with a 30-year-old gay man with symptoms of acute stress disorder (ASD) following a recent homophobic assault. Treatment addressed assault-related posttraumatic stress disorder symptoms and depressive symptoms. Also addressed were low self-esteem, helplessness, and high degrees of internalized homophobia. Client symptomatology was tracked using the PTSD Symptom Scale and the Beck Depression Inventory over the course of 12 sessions and for a 3-month posttermination session. Symptoms were significantly reduced by the end of the 12-week therapy and were maintained at 3-month follow-up. This case highlights the utility of this therapy in targeting both ASD symptoms and internalized homophobia relating to experiencing a hate crime–related assault. The authors elaborate on theoretical and applied issues in adapting a structured cognitive-behavioral intervention to the treatment of ASD symptoms associated with experiencing a hate crime.
Although illness phobias are fairly common disorders, their treatment has been scarcely addressed in the literature. The current article discusses the treatment of a 9-year-old female diagnosed with health-related anxiety—specifically, a phobia of vomiting. A variety of cognitive-behavioral techniques, such as relaxation training (e.g., deep breathing and progressive muscle relaxation), cognitive restructuring, exposure, and parent management training, were utilized in the treatment of this client. Baseline and posttreatment outcome data related to the client’s symptomatology and functional status were collected from both the client and her mother. Results suggest that cognitive behavioral techniques can be quite effective in reducing many of the symptoms and behavioral impairment related to illness phobias in youth.
Consecutive Cambodian refugees (N = 100) attending a psychiatric clinic were assessed for the presence and severity of current orthostatic panic (OP), which is defined as panic triggered by standing up. The patients with current OP (n = 36) had significantly greater psychopathology than patients without current OP. During OP, trauma associations and catastrophic cognitions were common. Negative affectivity’s impact on OP severity was significantly mediated (Sobel test; Baron & Kenny, 1986) by orthostasis-associated flashbacks and catastrophic cognitions. In the care of traumatized Cambodian refugees, OP––including associated flashbacks and catastrophic cognitions––should be specifically assessed and treated.
Knowledge and perceived competence regarding smoking cessation was examined among mental health professionals who specialize in the treatment of anxiety disorders (n = 75). Results indicated that therapists assess smoking behavior in less than 30% of clients, perceive themselves as “definitely unprepared” to deliver smoking cessation treatment, and only a minority (17%) have received formal training in empirically based smoking cessation practices during the past 3 years. When benchmarked against primary care physicians, anxiety specialists illustrated deficits in “basic” smoking-cessation counseling practices (e.g., assess for smoking behavior). Anxiety specialists who had received formal training in smoking cessation in the past 3 years reported significantly greater levels of perceived preparedness in helping an anxiety-disordered patient quit and delivered a greater degree of evidence-based smoking cessation treatment. Implications of these data for the role of smoking cessation counseling in mental health training programs for anxiety disorders are discussed.
Research suggests that extreme relationship standards are both positively and negatively associated with relationship satisfaction. This study tested the hypothesis that the association between relationship satisfaction and extreme standards is moderated by the status of the couple (i.e., discordant versus nondiscordant). Sixty-two couples completed a thought-listing task designed to assess relationship standards. Regression analyses supported the study hypothesis. Extreme standards were associated with higher levels of relationship satisfaction among nondiscordant wives but with lower levels of relationship satisfaction among discordant husbands and discordant wives. This study helps clarify the role of extreme standards in relationship functioning, and their potential contributions to both theoretical constructs of relationships as well as the increased efficacy of couples therapy.
There has been recent interest in adding interventions that aid in skill generalization to standard social skills training programs for schizophrenia. Some of these adjunctive interventions are very comprehensive and clearly promising (e.g., IVAST; Liberman, Glynn, Blair, Ross, & Marder, 2002), but their overall cost-effectiveness and feasibility in communities with limited financial and staffing resources are of concern. Few studies have investigated the viability of such programs in small communities with few resources. This article reports on the development, implementation, and evaluation of two types of social skills training programs over an 8-month period: weekly group social skills training (based on the manual of Bellack, Mueser, Gingerich, & Agresta, 1997) and weekly training with the addition of individual supplementary coaching in the community. Evaluation of this pilot program suggests potential benefits of the adjunctive individualized coaching for clients, particularly in terms of improved skill acquisition and performance, as well as overall social functioning. Client case studies are presented, as are details of the nature of the coaching sessions, with an evaluation of the specific effects of these two social skills training programs. Factors involved in the implementation of these interventions inexpensively in a rural setting are also discussed.
Despite Asperger’s Syndrome (AS) becoming a widely recognized disorder on the pervasive developmental spectrum, surprisingly few studies have assessed the utility of psychosocial and/or pharmacological treatments for children with AS. Further, studies have not examined the effects of treatment on disruptive behavior problems commonly exhibited by children with AS. This case study demonstrates the positive effects of an intensive, long-term, multimodal treatment targeting the symptoms and functional impairment of a school-age male with AS and comorbid disruptive behavior problems. Components of the comprehensive treatment included a behavioral summer treatment program, behavioral parent and teacher training, and medication. Results highlight the potential efficacy of treating the chronic functional impairments of AS and associated behavior problems with an intensive, long-term, multimodal treatment.
Binge eating is a common problem associated with distress and dysfunction. Mindfulness-based interventions are attracting increasing attention, and the recent empirical literature suggests that they may be effective for a variety of disorders. Current theories about the etiology and maintenance of binge eating suggest that mindfulness training may be helpful for this problem. This report describes the use of mindfulness-based cognitive therapy (MBCT; Segal, Williams, & Teasdale, 2002) in the treatment of a client with subthreshold binge eating disorder. Posttreatment and 6-month follow-up data showed excellent improvements in binge eating symptoms as well as increased levels of mindfulness.
Schools provide a useful, controlled setting for evaluating child behavior problems, yet direct observational coding procedures evaluated by child researchers have not been widely incorporated by practicing clinicians. This article provides a summary of procedures useful to clinicians performing direct behavioral observation in school settings. We describe the need for and usefulness of comprehensive school observations; provide a primer on the identification, definition, and assessment of target behaviors; and outline and discuss specific clinical procedures, including formulating primary referral questions, interviewing teachers, describing the classroom context, and conducting the observation. We also provide practical advice for synthesizing the obtained information into a report that guides clinical intervention. A sample of school observation coding forms and guidelines for report writing are also included to facilitate the use of these techniques by clinicians and teachers involved with the child. |
Group Cognitive Behavioral Treatment for PTSD: Treatment of Motor Vehicle Accident Survivors