c&bp8.4

Use of Cognitive-Behavioral Interventions in the Treatment of Cancer-Related Fatigue: A Case Study Report
Alicia K. Matthews and Sarah Sellergren, University of Chicago

As more cancer patients are achieving long-term survival, interventions are needed to prevent or minimize the late effects of cancer or its treatment. In this paper, we describe the use of cognitive-behavioral interventions as part of a multimodal treatment approach for reducing the negative psychosocial impact of cancer-related fatigue. Specifically, we present a clinical case study in which combined behavioral, cognitive, and pharmacological interventions were utilized to reduce symptoms of fatigue and resulting emotional and functional impairment in a 71-year-old male with recurrent prostate cancer. In addition to the case details, assessment issues, treatment considerations, and recommendations for facilitating adjustment to and coping with cancer-related fatigue are discussed.

Treatment of Pediatric Obsessive-Compulsive Disorder: A Case Example of Intensive Cognitive-Behavioral Therapy Involving Exposure and Ritual Prevention
Martin E. Franklin, University of Pennsylvania School of Medicine, David F. Tolin, The Institute of Living, John S. March, Duke University Medical Center, and Edna B. Foa, University of Pennsylvania School of Medicine

The development of effective pharmacotherapies for pediatric obsessive-compulsive disorder (OCD) has improved the clinical prognosis for children and adolescents who suffer from the disorder. Recent pilot work has also suggested that cognitive-behavioral therapy (CBT) involving exposure and ritual prevention (EX/RP) may prove particularly helpful in ameliorating OCD symptoms in children and adolescents. The application of intensive CBT of a 12-year-old boy with severe and unusual OCD symptoms is illustrated here. Case material is presented, illustrating the design and implementation of CBT involving EX/RP; recommendations to guide clinical decision making regarding session frequency, concomitant medication use, and maintenance of treatment gains are provided.

Using Behavioral Experiments in the Treatment of Cardiophobia: A Case Study
Georg H. Eifert and Angela W. Lau, West Virginia University

A 20-year-old female who met DSM-IV criteria for both hypochondriasis and panic disorder (PD) reported intense anxiety-provoking daily chest pain, several panic attacks per month, and firmly believed she was suffering from coronary artery disease. More than 100 emergency room (ER) visits, numerous negative medical tests, reassurance, psychotropic medication, and inpatient psychiatric treatment had failed to improve her condition. In the first 13 sessions, treatment focused on reducing cardiophobic disease fear, chest pain, and avoidance behavior. Behavioral experiments were used to develop alternative symptom explanations and teach the patient to reassure herself. After a patient-initiated treatment suspension, a relapse occurred, with a fear of suffocation and uncontrollable panic becoming the patient's new major concern. The successful treatment of her cardiac disease fear and conviction had not much improved her fear of noncardiac bodily sensations. After an additional 13 sessions focusing on reducing her noncardiac panic symptoms, all measures of panic, illness behavior, and depression were in the normal or near-normal range. Cardiophobia-related treatment gains were maintained as evidenced by the absence of heart-focused anxiety, disease conviction, ER visits, and doctor phone calls. Occasional panic attacks and chest pain no longer worried the patient. Positive changes were maintained at 8- and 14-month follow-up. We discuss the relation between cardiophobia and panic disorder and suggest several specific treatment steps to ensure changes occur in both problem areas.

Introducing Flexibility in Manualized Treatments: Application of Recommended Strategies to the Cognitive-Behavioral Treatment of Bipolar Disorder
Aude Henin, Michael W. Otto, and Noreen A. Reilly-Harrington, Massachusetts General Hospital and Harvard Medical School

Well-controlled treatment outcome studies have provided a wealth of evidence for the efficacy of specific manualized treatments for psychiatric disorders. In the face of these triumphs, there has been renewed attention to ways of modifying treatment manuals to better address the diverse needs of individuals. In this article we report on the application of recent recommendations for enhancing flexibility in manualized treatments. In particular, we discuss the use of phases and modules of treatment applied according to case-formulation worksheets to address the needs of patients with bipolar disorder. Case examples are used to illustrate the application of this modular treatment approach.

Cognitive-Behavioral Treatment for Social Phobia in Parkinson's Disease: A Single-Case Study
Nina Heinrichs, Emily C. Hoffman, and Stefan G. Hofmann, Center for Anxiety and Related Disorders, Boston University

Individuals with Parkinson's disease often exhibit symptoms of social anxiety. However, they rarely meet criteria for social phobia due to the medical exclusion criteria of DSM-IV. The present study reports the case of a 60-year-old male with Parkinson's disease who also met criteria for social phobia. After receiving 12 weekly cognitive-behavioral group sessions for social phobia, clinician ratings and self-report measures at posttreatment and 6-month follow-up showed a significant short-term and long-term reduction of his social anxiety. These findings suggest that cognitive-behavior therapy may be an effective treatment for social anxiety, even if these symptoms are related to Parkinson's disease.

Expanding Horizons: Adapting Manual-Based Treatments for Anxious Children With Comorbid Diagnoses
Jennifer L. Hudson, Amy L. Krain, and Philip C. Kendall, Temple University

Children presenting for treatment at specialized anxiety clinics rarely present with a simple case. Rather, anxious children present with complex diagnostic profiles typically consisting of comorbid anxiety, mood, and behavior disorders. These complex profiles can challenge the therapist's ability to creatively and flexibly apply a manual-based treatment. This article presents several cases of children with anxiety and comorbid conditions seen at the Child and Adolescent Anxiety Disorders Clinic (CAADC) at Temple University, Philadelphia. In presenting these cases, we provide examples of and suggestions about the flexible adaptation of the Coping Cat program (manual; Kendall, 1992) in the case of comorbid ADHD, depression, selective mutism, and physical and developmental disabilities.

Comprehensive, Sustained Behavioral and Pharmacological Treatment for Attention-Deficit/Hyperactivity Disorder: A Case Study
Andrea M. Chronis, Gregory A. Fabiano, Elizabeth M. Gnagy, Brian T. Wymbs, Lisa Burrows-MacLean, and William E. Pelham, Jr., State University of New York at Buffalo

Treatment for attention-deficit/hyperactivity disorder (ADHD) must be long-term, be intensive, address functional impairment across important domains and settings, and be sensitive to individual differences. This case illustrates comprehensive, combined behavioral and pharmacological treatment for a child diagnosed with ADHD and conduct disorder over a period of 3 years. Specific treatment components included an intensive summer treatment program (STP), behavioral parent training, behavioral classroom interventions, individually titrated stimulant medication, and a cognitive-behavioral depression-prevention program for the child's mother. Although substantial improvements were found in the degree of functional impairment, this child remained impaired in many domains. This suggests that treatment for ADHD, particularly in severe cases such as this, must be intensive and ongoing.

Adapting Multisystemic Therapy to Treat Adolescent Substance Abuse More Effectively
Jeff Randall, Scott W. Henggeler, Phillippe B. Cunningham, Melisa D. Rowland, and Cynthia C. Swenson, Family Services Research Center Medical University of South Carolina

The article illustrates an adaptation of multisystemic therapy (MST) coupled with community reinforcement plus vouchers approach (CRA) to treat adolescent substance abuse and dependency. Key features of CRA enable the MST therapist and adolescent caregiver to more specifically detect and address adolescent substance use. These features include frequent random urine screens to detect drug use, functional analyses to identify triggers for drug use, self-management plans to address identified triggers, and development of drug avoidance skills. To highlight the integration of MST and CRA in treating substance abusing or dependent adolescents, a case example is provided. Prior to the case example, an overview of clinical and program features of MST and substance-related outcomes is presented.

Group and Family Cognitive Behavior Therapy for Adolescent Depression and Substance Abuse: A Case Study
John F. Curry and Karen C. Wells, Duke University Medical Center, John E. Lochman, University of Alabama, W. Edward Craighead, University of Colorado, and Paul D. Nagy, Duke University Medical Center

Cognitive behavior therapy (CBT) has been demonstrated to be an effective acute intervention for adolescent depression. However, studies to date of CBT with depressed adolescents have excluded those with comorbid substance abuse. Treatment of comorbid substance abuse requires that the targets of CBT be expanded to include social cognitive and family factors associated with the substance use disorder. We developed an integrated group and family therapy model of intervention for adolescents with both depression and substance abuse. The case of R.P. illustrates the application of this treatment model. Treatment includes skills training in the context of a closed, mixed-gender, twice-weekly adolescent group and weekly family therapy sessions to apply new skills in the family context. Central clinical issues and core cognitive and behavioral correlates of R.P.'s depression and substance abuse are delineated as they occurred during the course of treatment. Treatment was associated with improvements in mood and reductions in substance abuse.

The Incredible Years Parent, Teacher, and Child Intervention: Targeting Multiple Areas of Risk for a Young Child With Pervasive Conduct Problems Using a Flexible, Manualized Treatment Program
M. Jamila Reid and Carolyn Webster-Stratton, University of Washington

Young children who present for treatment with oppositional-defiant disorder (ODD) and conduct disorder (CD) frequently exhibit these symptoms across settings and often show comorbid symptoms of attention-deficit/hyperactivity disorder (ADHD) and/or internalizing symptoms such as anxiety or depression. Parent training programs to treat these children must be flexible and comprehensive enough to address these issues. This article outlines a case in which the Incredible Years Parent, Teacher, and Child Training programs were used to treat a young boy, John, with ODD. His problems were pervasive and occurred at home, at school, and with peers. In addition to the ODD symptoms, John exhibited symptoms of ADHD as well as significant anxious and depressed behaviors. This case study outlines how a multimodal, manualized treatment can be applied flexibly to attend to individual family needs and address issues of comorbidity.