CONTENTS

Application of Cognitive Therapy for Trauma-Related Guilt (CT-TRG) With a Vietnam Veteran Troubled by Multiple Sources of Guilt

Behavioral Assessment and Treatment of PTSD in Prepubertal Children: Attention to Developmental Factors and Innovative Strategies in the Case Study of a Family

Appraisal and Coping Deficits Associated With Eating Disorders: Implications for Treatment

Inpatient Treatment of Eating Disorders: A Cognitive Therapy Milieu

Preventing Sexually Transmitted Diseases (STD) and HIV in Women: Using Multiple Sources of Data to Inform Intervention Design

Group Treatment for Prepubescent Boys With Sexually Aggressive Behavior: Clinical Considerations and Proposed Treatment Techniques

Cognitive and Behavioral Components of a Seasonal Psychological Skills Training Program for Competitive Figure Skaters

Application of Cognitive Therapy for Trauma-Related Guilt (CT-TRG) With a Vietnam Veteran Troubled by Multiple Sources of Guilt

Edward S. Kubany, University of Hawaii, Honolulu

Kubany and Manke (1995) presented a model of guilt that emphasizes its cognitive elements and described a structured cognitive therapy format aimed at alleviating trauma-related guilt (CT-TRG). This article illustrates the practice of CT-TRG with a Vietnam combat veteran suffering from several "classic" Vietnam War-related sources of guilt. Seven sources of guilt were addressed over 7 hours in a 1-day "marathon" therapy session. After therapy, the veteran reported dramatic reductions in guilt, PTSD, and depression symptomatology and a marked increase in self-esteem. These improvements were sustained at 8- and 22-month follow-ups. It is suggested that intensive treatment of multiple guilt issues may be necessary to alleviate overall guilt among many combat veterans and survivors of other kinds of traumatic events as well. Numerous descriptions of therapist- client interactions illustrate some of the nuances of CT-TRG and may facilitate its implementation by interested clinicians.



Behavioral Assessment and Treatment of PTSD in Prepubertal Children: Attention to Developmental Factors and Innovative Strategies in the Case Study of a Family

Anne Marie Albano, Anxiety Research and Treatment Center, University of Louisville, Patricia P. Miller, Roberto Zarate, University at Albany, State University of New York, Guylaine Cote, University of Sherbrooke, and David H. Barlow, Center for Anxiety and Related Disorders, Boston University

This paper describes the assessment and treatment of a family of 4 prepubescent children following the experience of a traumatic attack of the 6-year-old girl by a dog. The two eldest children received diagnoses of posttraumatic stress disorder (PTSD), and in addition, the 6-year-old victim developed a simple phobia of medical procedures. The younger children also developed posttraumatic reactions specific to their developmental level. Because the traumatic experience was witnessed by all of the children in the same family, their comprehensive data provide a cross-sectional illustration of the developmental expression of posttraumatic reactions in very young children. Established behavioral treatment approaches for PTSD were adapted to be developmentally appropriate and involved individual hierarchical, imaginal, and in-vivo exposure, coupled with joint sessions utilizing the older sibling as a behavioral model for his sister's simple phobia. This family case study illustrates the use of behavioral assessment and treatment methods in a clinic setting.



Appraisal and Coping Deficits Associated With Eating Disorders: Implications for Treatment

Beth Christiano, University of Pittsburgh Cancer Institute, and J. Scott Mizes, Philadelphia College of Osteopathic Medicine

This paper focuses on appraisal and coping deficits associated with clinical eating disorders. Following a brief review of the clinical eating disorder syndromes, the coping process is discussed. Next, empirical studies investigating appraisal and coping deficits associated with eating disorders are reviewed. Last, the treatment of eating disorders is discussed, with a focus on coping skills components.



Inpatient Treatment of Eating Disorders: A Cognitive Therapy Milieu

Wayne A. Bowers, University of Iowa, Kay Evans, University of Iowa Hospital and Clinics, and Arnold E. Andersen, University of Iowa

Inpatient treatment of eating disorders has evolved over the past 20 years. Interventions have progressed from single treatments based on narrow concepts of origin to multidisciplinary approaches. Cognitive therapy has been shown to be effective in outpatient studies, especially with bulimia nervosa, but has yet to be used systematically within an inpatient setting. This article describes the framework of an inpatient unit with psychotherapeutic interventions based on cognitive behavioral principles. The basic structure of the unit is described in terms of the theoretical principles upon which it is based. The team-oriented interventions are described to demonstrate how the patient with an eating disorder is understood and treated.



Preventing Sexually Transmitted Diseases (STD) and HIV in Women: Using Multiple Sources of Data to Inform Intervention Design

Blair Beadnell, Sharon A. Baker, Judith Gordon, University of Washington, Cheza Collier, Seattle/King County Department of Public Health, Diane Morrison, and Rosemary Ryan, University of Washington

This article describes the process of developing a cognitive behavioral group intervention to help women at risk of HlV and other sexually transmitted diseases (STD) be sexually safer. Theory guided the intervention development, which integrated data on the target population from multiple sources: survey research that modeled sexual-safety decision making, a community advisory board, a needs assessment, and elicitation interviews with women at risk in our community. The article summarizes the information obtained from these sources, describes how we utilized this information to adapt a previously tested intervention for gay and bisexual men, uses case examples from pilot testing to illustrate clinical issues in implementation, and delineates major issues of concern for intervention research in this area. This paper provides a model for behavior therapists for integrating research data and community input in the design of interventions to address community problems.



Group Treatment for Prepubescent Boys With Sexually Aggressive Behavior: Clinical Considerations and Proposed Treatment Techniques

Patti P. van Eys
Peabody College of Vanderbilt University

Descriptive and treatment outcome studies regarding sexually aggressive prepubescent boys are lacking. Preliminary data, however, are available from five studies on this difficult-to-treat population. This article has multiple goals: 1) to summarize descriptive and treatment outcome data of problematic sexual behavior in children; 2) to describe general considerations regarding treatment for sexually aggressive prepubescent male children; 3) to address two traditional clinical goals (e.g., eliminating perpetration behavior and enhancing victim empathy) for treating sexual aggression; and 4) to broaden the concept of empathy as a treatment goal. In addition, useful activities are described and available resources are referenced for practitioner use.



Cognitive and Behavioral Components of a Seasonal Psychological Skills Training Program for Competitive Figure Skaters

Garry L. Martin
Adrienne Toogood
University of Manitoba

Behavioral and cognitive techniques have played an important role in the emergence of' applied sport psychology. Although evaluations of seasonal sport Psychology programs have illustrated their potential for enhancing athletic performance, typical journal articles do not provide sufficient detail to make the procedures easily usable by practitioners. This paper presents cognitive and behavioral procedures applied during a seasonal psychological skills training program for young competitive figure skaters. Strategies are illustrated for (a) identifying mental skill areas in need of improvement at the beginning of the season; (b) improving practice performance during the season; and (c) increasing the likelihood that practice performance will transfer to competitions. The paper concludes with a consumer evaluation of the program by the skaters, their coaches, and their parents. The strategies described may help practitioners design effective psychological skills training programs for athletes.