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CONTENTS
BOOK REVIEW • James Herbert, Ph.D., Section Editor
COGNITIVE BEHAVIORAL CASE CONFERENCE
Three theoretical models of the relationship between cognition and emotion are examined: (a) ventilation theory (i.e., the greater expression of emotion, the better the outcome), (b) emotionally focused therapy (i.e., activation, expression, and validation of emotion facilitate acceptance and self-understanding), and (c) a cognitive model of emotional processing (i.e., individuals differ in their conceptualization and strategies in responding to emotion). A self-report assessment of emotional schemas reflecting 14 dimensions related to cognitive processing and strategies of emotional response is presented. Fifty-three adult psychotherapy patients were assessed and their responses on the emotional schemas evaluation were correlated with the Beck Depression Inventory and the Beck Anxiety Inventory. There was strong support for a cognitive model of emotional processing. Depression was related to greater guilt over emotion, expectation of longer duration, greater rumination, and viewing one’s emotions as less comprehensible, less controllable, and as different from the emotions others have. Anxiety was related to greater guilt over emotion, a more simplistic view of emotion, greater rumination, viewing one’s emotions as less comprehensible, less acceptance of feelings, viewing emotions as less controllable, and as different from the emotions others have. Dimensions related to the strict ventilation model—such as validation, numbness, and expression—were not related to depression or anxiety, although acceptance of feelings was related to less anxiety. Support was found for the emotional-focus model. Validation was related to less guilt, less simplistic ideas of emotion, expectation of shorter duration, less rumination, and to viewing emotion as more comprehensible, more controllable, more similar to emotions of others, and more acceptance of feelings.
In light of the predominance of cognitive distortions among problem gamblers, cognitive therapy appears to be highly suitable as a treatment for problem gambling. With the increasing prevalence of problem gambling, the development of effective treatments is becoming an important endeavor. This article outlines a cognitive treatment for problem gambling highlighting the types of cognitive distortions common to this population and major cognitive interventions that are useful in modifying these beliefs.
Despite the proliferation of manualized treatments, and clinical trials that generally support their efficacy, there is a need for further documenting the effectiveness of a manualized treatment for Generalized Anxiety Disorder (GAD)—the Mastery of Your Anxiety and Worry (MAW) protocol. A single-case treatment outcome study using the MAW program with a woman having a principal diagnosis of GAD is presented, with interview, questionnaire, and psychophysiological assessments as markers of change. Reductions in frequency of worry and autonomic arousal, but not mean number of anxiety symptoms, were reliably observed across the 22-week treatment period, with more robust reductions in worry frequency coinciding with the treatment phases involving training in progressive muscle relaxation (i.e., clear improving trend, modest change in level) and worry exposure (i.e., clear change in level). Treatment gains were reliably maintained at 4- and 6-month follow-up. The need for treatment-client matching and a flexible idiographic approach is discussed in the context of front-line practitioners who adopt standardized treatment packages in their work with clients.
Two enhancements to cognitive therapy (CT)—a broader rationale for the causes and treatment of depression, and a more intense focus on the client-therapist relationship—were evaluated in a treatment development study. The enhancements were informed by Functional Analytic Psychotherapy (FAP; R. J. Kohlenberg & Tsai, 1991), a treatment based on a behavioral analysis of the change process. FAP Enhanced Cognitive Therapy (FECT) includes 7 specific techniques that CT therapists can use to make their treatment more powerful and to address the diverse needs of clients more effectively. The results indicate that FECT produced a greater focus on the client-therapist relationship and is a promising approach for improving outcome and interpersonal functioning. It also appears that a focus during sessions on clients' problematic cognitions about the therapist adds to efficacy. COGNITIVE BEHAVIORAL CASE CONFERENCE
Acceptance and Commitment Therapy (ACT) is a cognitive-behavioral treatment that targets ineffective control strategies and experiential avoidance–the unwillingness to accept negative thoughts, feelings, and emotions. Although ACT has been suggested as an effective treatment for panic, substance use, pain, and mood disorders, there are no published reports on the use of ACT for treating adolescent disorders such as anorexia nervosa. This case summarizes the successful adoption of ACT techniques in the treatment of a 15-year-old female with anorexia nervosa. It also shows how ACT techniques can be successfully combined with, and set the stage for, more standard cognitive-behavioral interventions. RESPONSE PAPER
Acceptance and Commitment Therapy (ACT) views cognition and emotion differently in their role in psychological problems. Both popular culture and many models of psychopathology conceive of negative thoughts and emotions as states that must be eliminated, reduced, or supplanted. ACT posits that these negative emotional, cognitive, and bodily states may or may not produce behavior problems. Further, ACT suggests that attempts to control these states may actually worsen mental health problems. Strategies to control, eliminate, or suppress negative states, called experiential avoidance, are directly targeted. ACT seeks to treat the functional class of experiential avoidance rather than specific diagnostic categories. However, ACT has been applied to a number of DSM-IV disorders. We detail the application of ACT to an adolescent diagnosed with anorexia and comment on the treatment implemented by Heffner, Sperry, Eifert, and Detweiler (2002). We discuss the broad assessment issues necessitated by the type of difficulties a patient with anorexia may have. The general structure of an ACT intervention is elaborated on, including values, exposure, defusion, and empowerment. RESPONSE PAPER
Case conceptualization and treatment planning for individuals with eating disorders seems to follow logically from within the framework of Acceptance and Commitment Therapy (ACT), which focuses on maladaptive control strategies directed toward emotional avoidance, cognitive fusion, and failure to act in accord with chosen values. The use of ACT in this case is discussed with recommendations for further ACT intervention strategies, why an ACT conceptualization makes sense with this population; and anticipated issues to consider. RESPONSE PAPER
This case represents the use of Acceptance and Commitment Therapy (ACT) in the treatment of an eating disorder (see Heffner, Sperry, Eifert, & Detweiler, 2002). The response presents a cognitive therapy model to treat eating disorders, focusing on the treatment of anorexia nervosa. The paper presents a cognitive perspective that includes a conceptualization of the disorder, a treatment plan, specific interventions, and adjunctive treatments such as family therapy and hospitalization. The use of a cognitive therapy model in the treatment of eating disorders integrates well with a multifaceted treatment utilizing interpersonal, psychodynamic, and family therapy models and would easily combine with ACT. RESPONSE PAPER
Acceptance and Commitment Therapy (ACT) is a conceptually driven approach to treatment that is directed at undermining the experiential avoidance and cognitive fusion that are assumed to produce restrictive and damaging behavioral patterns. ACT has recently been applied to the treatment of a number of behavioral problems. The current paper explores how an ACT perspective might guide the treatment of disordered eating based on the presentation of an adolescent female. Particularly, methods focused on addressing the treatment-resistant nature of anorexia, working with the complex control issues related to both eating and private events, facilitating the differentiation of the patient’s sense of self from her private events and physical being, and assisting the client in refocusing on her valued directions are described. An ACT approach to treating anorexia seems strongly indicated, and further research is needed to assess the efficacy of ACT for this difficult problem. |
