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CONTENTS PSYCHOPHARMACOLOGY • Sabine Hack, M.D., Section Editor
BOOK REVIEW • James Herbert, Ph.D., Section Editor
This article proposes the use of the herb kava in combination with cognitive-behavior therapy (CBT) in the treatment of panic disorder in lieu of traditional psychopharmacologic agents such as benzodiazepines and antidepressants. The properties of kava are discussed, as well as their therapeutic effects with anxiety. A single, non-placebo-controlled case example is described, along with 6-months follow-up treatment effects combined with CBT. The potential pitfalls of using the herb are addressed, particularly the combination of kava with psychopharmacologic compounds.
The present case study describes the successful treatment of a woman with a history of sexual, physical, and psychological abuse in childhood and multiple rapes in adulthood, utilizing a relatively brief cognitive-behavioral treatment, Cognitive Processing Therapy (CPT). Treatment addressed assault-related PTSD, major depression, suicidality, compulsive self-harm behaviors, and primary and secondary dissociative responses. Treatment also addressed related issues of low self-esteem, social isolation, and the client’s sense of helplessness, which had resulted in her failure to implement active self-protection strategies. Client symptomatology was tracked throughout treatment using the PTSD Symptom Scale (PSS) and the Beck Depression Inventory (BDI) at regular intervals over the course of 34 sessions and for 3 months posttermination. The relatively short course of therapy (22 weeks) and treatment strategies are described, including cognitive and behavioral components of CPT, supportive strategies, safety planning in the context of ongoing threats and victimization, and the importance of the therapeutic relationship. Particular emphasis is given to adaptation of the brief treatment to complex symptomatology and patterns of symptomatic change in relation to cognitive and behavioral intervention. Findings indicate that treatment for individuals with extensive victimization histories does not require different strategies or a significantly longer period of treatment than does treatment for those with a single traumatic experience.
According to critics of empirically supported treatments, comorbidity represents a significant barrier to the implementation of such interventions in standard clinical practice. Advocates of empirically supported treatment have noted that comorbid disorders can be addressed concurrently. There is, however, little guidance in the literature regarding implementation of concurrently delivered protocols. The present case report describes the successful treatment of a 43-year-old woman diagnosed with comorbid obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and borderline personality disorder. Treatment utilized a concurrent approach that integrated exposure and response prevention for OCD, exposure therapy for PTSD, and components of dialectical behavior therapy for borderline personality disorder. Both 12-month formal and 18-month informal follow-up assessment indicated that improvement was maintained after termination. Results suggest that integrated delivery of empirically supported interventions can be utilized to successfully treat complex, comorbid cases.
This article describes the conceptual bases and treatment outlines of Cognitive Trauma Therapy for Formerly Battered Women with PTSD (CTT-BW), a psychoeducational, multicomponent, cognitive-behavioral intervention aimed at alleviating posttraumatic stress disorder (PTSD), depression, guilt, shame, and negative self-esteem in formerly battered women. CTT-BW is derived from psychological learning principles, and emphasizes the role of irrational beliefs and evaluative language in posttraumatic stress. Assessment and assessment instrumentation used in CTT-BW are described. The main treatment components in CTT-BW include (1) exploration of partner abuse history and exposure to other trauma; (2) psychoeducation on PTSD; (3) negotiation of imaginal and in vivo exposure homework; (4) psychoeducation on maladaptive self-talk; (5) stress management and relaxation training; (6) cognitive therapy for trauma-related guilt (Kubany & Manke, 1995); (7) psychoeducation on assertiveness and responses to verbal aggression; (8) managing unwanted contacts with former partners; (9) learning to identify potential perpetrators and avoid revictimization; and (10) psychoeducation on positive coping strategies that focus on self-advocacy and self-empowerment (e.g., placing oneself first, decision-making that promotes self interest). Homework includes listening to audiotapes of the sessions, in-vivo exposure to abuse-related reminders, playing a relaxation tape, and self-monitoring of negative self-talk. Initial evidence for the efficacy of CTT-BW is discussed, as are issues that need to be addressed before CTT-BW can be reliably implemented and evaluated by other clinicians.
Pain catastrophizing refers to a negative mental set brought to bear during the experience of pain. Individuals who catastrophize often feel helpless about controlling their pain, ruminate about painful sensations, and expect bad outcomes. Not surprisingly, such individuals often fail to improve with treatment. This paper provides an assessment tool and outlines a cognitive-behavioral group treatment approach for chronic pain that is specifically designed to reduce catastrophizing. Principles from stress management, cognitive therapy for depression, assertiveness training, and communal coping models are incorporated within the treatment framework to address specific needs posed by catastrophizing. Suggestions are provided for organizing treatment sessions and for assigning homework based on treatment principles.
This paper has two objectives. The first is to describe a multimodal, standardized treatment program used by the VALK Foundation, an agency that specializes in the treatment of patients with fear of flying. The second is to present the results of an evaluation of this program, particularly with regard to the effectiveness of a 2-day cognitive-behavioral group treatment program and a 1-day behavioral group treatment program for flying phobics. On the basis of individualized assessment, patients (N = 1,026) were nonrandomly assigned to 1 of the 2 group treatment modalities. Self-report data and behavioral indicators for fear of flying were collected at pretreatment and at 3-, 6-, and 12-month follow-ups. Complete data were obtained from 757 participants. Results showed that both treatment programs produced statistically significant, clinically relevant decreases in self-reported anxiety and behavioral anxiety indices. This paper explains the procedures and outcomes of a well-established clinical program. Limitations of the study are discussed and future research suggested.
The purpose of the paper is to provide behaviorally and cognitive behaviorally oriented couples’ therapists with a comparison of Integrative Behavioral Couple Therapy (IBCT) and Cognitive Behavioral Marital Therapy (CBMT) that highlights similarities and differences between these two therapeutic approaches to treating marital discord. Both approaches derive from traditional behavioral marital therapy (BMT) but have emphasized emotional and cognitive factors more so than BMT. IBCT’s contextual, or radical behavioral, viewpoint has translated to interventions that aim to establish a dyadic context supporting acceptance, empathy, and understanding through both acceptance and behavior change strategies. Rooted in social cognitive theory, CBMT also aims to increase acceptance, empathy, and understanding, but does so primarily through change-based interventions that target dysfunctional cognitive, behavioral, and affective responses and processes. It is our contention that understanding the relationship between the underlying theories and practices of these empirically supported approaches may improve their effective dissemination and use within the practice community. |
