Sex, Lies, and Measuring Tape

Peggy Elam and Dawne Kimbrell, Healing Connections, Nashville, TN

Self-defeating behaviors related to body weight and self-regulation of eating and activity are common in Western culture. Even clinicians who do not specialize in treating eating disorders often treat clients with subclinical eating and body image disturbances. These clients may not fully meet diagnostic criteria for eating disorders but may be unable to successfully complete therapy because of eating and body image problems. The purpose of this article is to address beliefs held by the clinician that hamper effective intervention, to alert clinicians about interventions that might exacerbate eating and weight problems, and to highlight the research base for effective treatment strategies.



Appetite Awareness Training: A Cognitive Behavioral Intervention for Binge Eating

Linda Wilcoxon Craighead, University of Colorado at Boulder, and Heather N. Allen, University of North Carolina at Chapel Hill

Appetite Awareness Training (AAT) is an 8-session intervention designed to increase eating in response to internal hunger and satiety cures and reduce eating in response to environmental and nonappetite internal cues such as negative affect and maladaptive dietary rules. Clients learn to identify 3 cycles that maintain problematic overeating and binge eating and to use strategies including problem solving, relapse prevention, and cognitive restructuring to interrupt those cycles. The major innovation is self-monitoring hunger and satiety rather than food intake; a visual cue prompts clients to keep both hunger and satiety at moderate levels. Three case studies of women meeting criteria for the proposed clinical diagnosis, Binge Eating Disorder, are described. Each client demonstrated substantial improvement on the indices that had been initially most problematic, and none met criteria for diagnosis at 6-month follow-up.



Treatment of Social Anxiety in Adolescents

Anne Marie Albano, SUNY Albany

This paper describes a new cognitive behavioral group treatment program for social phobia in adolescents (CBGT-A). Based upon empirically validated methods of treatment shy adolescents and adults with social phobia, CBGT-A was developed to meet the needs of adolescents with social phobia between the ages of 13 and 17. In this paper, the diagnosis and phenomenology of social phobia is described, with emphasis on the expression of the disorder in youth. Comorbid conditions and behavioral concomitants unique to adolescents are described, so that clinicians may attend to the particular presentation of the disorder in this population. The CBGT-A program is described in detail and illustrated with case examples. Attention is given to the role of parents in the treatment process. Potential obstacles to successful treatment are defined and suggestions for managing these difficult situations are offered.



Comorbidity of Conduct Disorder and Depression Among Adolescents: Implications for Assessment and Treatment

Mark A. Reinecke, University of Chicago

This article reviews the empirical literature on the comorbidity of depression and conduct disorder in adolescence, and hypothesized mechanisms for understanding this overlap. Cognitive behavioral models of conduct disorder and depression are briefly reviewed, and points of convergence are discussed. Components of an integrated treatment program are presented. Treatment of comorbid adolescents requires an individualized case formulation and attention to the developmental level of the adolescent.



Assessment and Treatment of Motor Vehicle Accident Victims

William J. Koch and Steven Taylor, University of British Columbia

Motor vehicle accidents (MVAs) often have clinically significant psychological sequelae. Victims frequently are left with multiple comorbid psychological and physical disorders, with the most prevalent psychological problems being posttraumatic stress disorder, depression, pain-related conditions, and phobic avoidance of stimuli associated with the accident. In this article, we review the psychological assessment and treatment of MVA victims. It is important to assess the nature and subjective meaning of the accident and to examine the functional relationships between physical injuries and emotional disorders. Important issues for treatment include selecting behavioral and cognitive interventions, determining the sequence of interventions, and dealing with complications such as litigation and medication use. These points are illustrated with case examples.



Behavioral Treatment of a Motor Vehicle Accident Survivor: An Illustrative Case of Direct Therapeutic Exposure

Judith A. Lyons, Jackson Department of Veterans Affairs and University of Mississippi Medical Center, and Joseph R. Scotti, West Virginia University

Direct therapeutic exposure (DTE) is one of a class of exposure-based treatment techniques that includes in vivo and imaginal flooding, and implosive therapy. DTE is a recommended technique for the treatment of persons experiencing distress as a result of exposure to traumatic events (e.g., accidents, combat, sexual assault). However, the process of applying DTE has not been sufficiently documented so that it can be applied by practicing clinicians. Through the use of an illustrative case example of a motor vehicle accident survivor, the authors strive to clarify the manner in which DTE is implemented. In doing so, an attempt is made to set aside many of the misunderstandings regarding DTE that have led in the past to improper (and thus unsuccessful) application, or to avoidance of DTE. As the case study highlights, however, DTE by itself may not be sufficient, and when it is not, it should be coordinated with other treatment modalities to maximize and maintain treatment gains.



Diversification and Consultation: Designing a Private Group Psychological Practice in the Age of Health Care Reform

Mark Gilson, Robert W. Montgomery, and Joni E. Prince, Atlanta Center for Cognitive Therapy
The profile of private psychological practice is going through significant changes with all other forms of health care delivery. Adaptation to these changes is demonstrated by the efforts of one cognitive behaviorally oriented, diversified private practice, and professional training group. In addition to traditional individual treatment issues, consultation with state agencies, private hospitals, managed care, and psychiatry is discussed. The importance of using empirically validated short-term treatment approaches is emphasized as a significant feature for the survival of the private practitioner.