{"title":"ACT-Enhanced Behavior Therapy for a Hispanic Adult with Trichotillomania: A Case Report","authors":"Marissa L. Donahue, M. Twohig","doi":"10.1177/15346501231225505","DOIUrl":"https://doi.org/10.1177/15346501231225505","url":null,"abstract":"Trichotillomania, also known as Hair-Pulling Disorder, is characterized by recurrent pulling out of one’s hair over brief episodes or sustained periods of time and results in hair loss. ACT-enhanced behavior therapy (A-EBT) has been shown to be an effective approach in the treatment of trichotillomania by promoting psychological flexibility around hair pulling urges and teaching stimulus control and habit reversal training. However, there is limited support of A-EBT for clients with an ethnic minority identity. This case report focuses on an adult, Hispanic female client, Luna (pseudonym), who received eight sessions of A-EBT for the treatment of trichotillomania. At post-treatment, Luna showed significant improvements in number of hairs pulled, trichotillomania specific psychological flexibility, depression and anxiety. Luna’s case highlights barriers to care such as potential resistance in seeking mental health services, the influence of family members’ beliefs on receiving mental health services, and the limited access to specialized treatment of trichotillomania.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"25 18","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139148481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caitlin B. Shepherd, Rebecca G. Boswell, Jessica Genet, Wendy Oliver-Pyatt, Christine Stockert, Rebecca Brumm, Shaun Riebl, Katie Piel
{"title":"Weight Restoration and Symptom Remission for Longstanding, Untreated Anorexia Nervosa in a Remote Eating Disorder Treatment Program: A Case Study","authors":"Caitlin B. Shepherd, Rebecca G. Boswell, Jessica Genet, Wendy Oliver-Pyatt, Christine Stockert, Rebecca Brumm, Shaun Riebl, Katie Piel","doi":"10.1177/15346501231222495","DOIUrl":"https://doi.org/10.1177/15346501231222495","url":null,"abstract":"For severe cases of anorexia nervosa (AN), including when poor prognostic factors like low body mass index (BMI) and longer illness duration are present, intermediate levels of care are often indicated. Current guidelines call for treatment programs to use an evidence-based practice approach to individualize treatment and optimize outcomes. Research supports the effectiveness of intermediate levels of care, including remote programs which increase access to treatment. However, conflicting evidence exists regarding the ability to safely weight restore clients during remote care, necessitating further research. This case report highlights the viability of treating clients with AN remotely using an evidence-based practice approach, resulting in weight restoration and symptom remission. The client presented with a longstanding history of severe binge-eating/purging AN with numerous medical complications but was motivated and treatment-compliant. Her eating disorder (ED) was conceptualized using a biopsychosocial perspective and treated using a multidisciplinary, evidence-based practice approach encompassing individual, group, and supportive interventions. She was successfully discharged from treatment after 150 days, having restored weight to a healthy range and showing substantial improvements in ED, depressive, and anxiety symptoms based on validated measures. This case contributes to the evidence that remote care can be an accessible and effective treatment option, even in cases of severe AN. The case highlights how an evidence-based practice approach can enable safe weight restoration via a personalized treatment plan that emphasizes the use of remote devices and self-monitoring.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"122 12","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138958883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Integration of Motivational Interviewing and Self-Affirmation Theory into a Culturally Adapted Motivational Interview: A Case Study","authors":"Christina S. Lee, David K. Sherman","doi":"10.1177/15346501231222554","DOIUrl":"https://doi.org/10.1177/15346501231222554","url":null,"abstract":"Annually, alcohol, tobacco, and illicit drug use are responsible for the 11.8 million deaths worldwide, exceeding the number of deaths from all cancers ( Ritchie & Roser, 2018 ). Motivational Interviewing (MI), a person-centered addiction counseling approach ( Miller & Rollnick, 2013 ), is designed for those with low motivation to change. MI is presumed to minimize client defensiveness by avoiding confrontation. Culturally adapting evidence-based treatments such as MI may reduce alcohol-related health disparities among Latinx adults. A completed randomized trial tested the relative efficacy of Culturally Adapted Motivational Interview (CAMI) compared to MI in Latinx drinkers. CAMI had beneficial alcohol use effects among persons who reported high discrimination and stigma ( Lee et al., 2019 ). Self-Affirmation Theory, which provides a mechanism where stigma effects can be buffered, was integrated into the CAMI. Augmenting affirmation in the CAMI is postulated to lower defensiveness and increase openness to information that pose a threat to self-image ( Sherman & Cohen, 2006 ). The purpose of this case example is to present the novel features of CAMI and to suggest how affirmation may have played in the CAMI’s beneficial effects for individuals with high discrimination. The case example illustrates how the CAMI addresses three conditions for self-affirmation associated with strongest effects on motivating behavior change ( Ferrer & Cohen, 2019 ): the presence of psychological threat, timing and availability of resources.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"220 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138997034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David W. Cosottile, Emily Exline, Jessica S. Akers, Stephanie Gerow, Remington Swensson
{"title":"Functional Communication Training Without the Removal of a Tangible Item","authors":"David W. Cosottile, Emily Exline, Jessica S. Akers, Stephanie Gerow, Remington Swensson","doi":"10.1177/15346501231221284","DOIUrl":"https://doi.org/10.1177/15346501231221284","url":null,"abstract":"Children with autism spectrum disorder (ASD) engage in challenging behavior that can result in missing out on potential reinforcers. A common intervention for challenging behavior is functional communication training (FCT). In FCT, the clinician reinforces an appropriate communicative response using the same reinforcer maintaining the challenging behavior. In some cases, the challenging behavior is too severe for traditional FCT procedures to efficiently teach a new response. In this case study, we treated a 4-year-old boy with ASD referred to as Mostafa using a modified version of FCT. We did not include a typical component of traditional FCT procedures – the removal of the putative reinforcer prior to the trial. Instead, we provided components of toys and games contingent on the appropriate communication response. None of the components had to be removed to continue conducting learning trials. Mostafa’s communication increased and challenging behavior decreased as a result of this modification. This modification may be useful for other cases in which the removal of a tangible item interferes with learning a communication response.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"52 4","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138588155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Merging Acceptance and Commitment Therapy with Exposure Exercises to Treat Social Anxiety in a Teen","authors":"Caleb D. Farley, M. Twohig","doi":"10.1177/15346501231217745","DOIUrl":"https://doi.org/10.1177/15346501231217745","url":null,"abstract":"Social anxiety disorder (SAD) often develops during teenager years, and it is important to conceptualize developmentally appropriate interventions. Exposure therapy framed from a perspective of acceptance and commitment therapy (ACT) shows promise for decreasing pathology and increasing wellbeing. This case illustrates the process through which exposure therapy was integrated with ACT to elicit meaningful outcomes in a case of SAD with a 16-year-old female. Treatment outcomes assessed included engagement in values-based activities as well as assessments of depression, anxiety, experiential avoidance, and context-specific wellness. Intervention focused on learning ACT principles through relatable metaphors and experiential exercises and practicing them with values-guided social exposures. This integration resulted in increased engagement of socially meaningful experiences and associated changes in treatment outcomes. Implications, guidelines, and recommendations are presented, including the need for skill-focused treatments, identifying deficits in psychological flexibility, and maintaining a compassionate yet growth-oriented course of treatment.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"271 2","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139256890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melissa Gabriella Guineau, Richard Oude Voshaar, Gert-Jan Hendriks
{"title":"High Intensive Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder for a 72-year-Old Man","authors":"Melissa Gabriella Guineau, Richard Oude Voshaar, Gert-Jan Hendriks","doi":"10.1177/15346501231209334","DOIUrl":"https://doi.org/10.1177/15346501231209334","url":null,"abstract":"The prevalence of Obsessive-compulsive disorder (OCD) among older adults varies between .5% and 4.5%. OCD typically develops at a young age, and many clinicians consider the chances of successful treatment in older adults to be minimal based on the chronicity of their symptoms. To date, no randomized controlled trial have been conducted on the effectiveness of treatments for OCD in older adults. This case study describes a high intensive cognitive behavioral therapy (CBT) provided to a 72-year-old man with OCD. This CBT program includes psychoeducation, exposure and response prevention, and cognitive therapy. The treatment was provided by a team of 5 therapists over one week. The patient’s score on the Yale Brown Obsessive-Compulsive Scale decreased from 31 at the start of the treatment to 2 by the end of treatment, which is below the recommended cut-off for a clinical diagnosis. Secondary depressive symptoms, as assessed with the Inventory of Depressive Symptomatology Self-Report, decreased from 57 at the start of treatment, to 1 by the end of treatment, which indicates the absence of depressive symptoms. The treatment gains were maintained with persistent remission until the 18-month follow-up. This study highlights an effective high intensive CBT program for older adults with OCD and challenges the false assumptions that (a) psychological interventions are ineffective for older adults and (b) existing treatments are unsuited for older adults. Future research should investigate the effects of this program in large sample with sufficient power.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":"80 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139274030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Using Cognitive Analytic Therapy as a Transdiagnostic Intervention for Comorbid Personality Disorder, Posttraumatic Stress Disorder, and Functional Neurological Symptom Disorder: A Case Report of a 68 Woman’s Journey Toward the Integration of Dissociated Self-States","authors":"Rowan Tinlin-Dixon","doi":"10.1177/15346501231198483","DOIUrl":"https://doi.org/10.1177/15346501231198483","url":null,"abstract":"Functional neurological symptom disorder (FND) is associated with complex specialist investigations and poor prognosis. The theoretical understanding of FND posits that functional symptoms are predisposed by both psychological factors, including attachment disturbances and childhood trauma, and biological factors such as neuroplasticity and epigenetics. Current treatment recommendations include psychological therapy, with moderate effects observed with cognitive-behavioural therapy and psychodynamic therapy modalities, however, psychological understanding is key to success. The current case report describes cognitive analytic therapy (CAT) with a 68 year-old woman presenting to services with diagnoses of FND and borderline personality disorder (BPD). The target problem for therapy was integration of fragmented self-states (dissociative and driven) pertinent to both FND and BPD. 16 session CAT was delivered, with four follow up sessions, exploring unhelpful patterns of relating with self and others, based on an unconscious repertoire of internalised patterns and procedures from early life. CAT tools were used to facilitate change; reformulation and ending letters, mapping and the therapeutic relationship. Scores on the personality structure questionnaire (PSQ) and an idiosyncratic measure of state-shifting indicated positive outcomes, sustained at 3 month follow up. This shows modest early acceptability and feasibility of CAT for working with comorbid BPD and FND, providing a validating and blame free formulation of the development and maintenance of symptoms. Additional measures would have improved the ability to comment on the effectiveness of the treatment and future research implications are discussed.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47351104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Integrating Cognitive-Behavioral Therapy With Compassion-Focused Therapy for the Treatment of Social Anxiety Disorder: An Evidence-Based Case Study","authors":"Mary Baumgardner, Kristy Benoit Allen","doi":"10.1177/15346501231197403","DOIUrl":"https://doi.org/10.1177/15346501231197403","url":null,"abstract":"Cognitive-behavioral therapy (CBT) is an evidence-based treatment for social anxiety disorder that has been found to elicit significant changes in process-based mechanisms (e.g., emotion regulation strategies), which subsequently lead to reductions in social anxiety and associated functional impairment; however, CBT may be less effective for socially anxious individuals experiencing high self-criticism and low self-compassion. Compassion-focused therapy (CFT) has been used to address these tendencies in socially anxious individuals, but research in this area is limited. The present case study examined changes in social anxiety symptoms, self-compassion, emotion regulation strategies, and functional impairment throughout the course of treatment with a young, Chinese American woman using a novel integration of CBT and CFT for social anxiety disorder. The client experienced significant reductions in social anxiety and functional impairment across treatment, which was accompanied by reductions in fear and avoidance ratings for feared social scenarios. Significant mechanistic changes were also observed, including decreases in maladaptive emotion regulation strategies (i.e., suppression, rumination) and increases in self-compassion and adaptive emotion regulation strategies (i.e., expressive engagement, cognitive reappraisal). Findings support the efficacy of integrating compassion-focused strategies with CBT for social anxiety for a young adult with prominent tendencies of self-criticism and low self-compassion.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45055492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aileen Kangavary, Elizabeth R Halliday, J. Durocher, Jill Ehrenreich-May
{"title":"A Transdiagnostic Prevention Support Group for Caregivers of Children With Autism Spectrum Disorder: A Case Example","authors":"Aileen Kangavary, Elizabeth R Halliday, J. Durocher, Jill Ehrenreich-May","doi":"10.1177/15346501231198889","DOIUrl":"https://doi.org/10.1177/15346501231198889","url":null,"abstract":"Caregivers of children with autism spectrum disorder (ASD) experience increased levels of stress, anxiety, and depression compared to caregivers of neurotypical children. The high levels of stress and the prevalence of emotional disorders experienced by caregivers may negatively impact their capacity and confidence to effectively manage their child’s complex emotional and behavioral needs. Given these demands, caregivers of children with ASD require additional support to improve their psychological well-being and parenting self-efficacy. While support programs and treatments for children and adolescents with ASD are abundant, prevention programs that specifically targeted the emotional well-being of caregivers during the COVID-19 pandemic were limited. In this case paper, we describe Coping Options for Parent Empowerment (COPE), a prevention program for parents adapted from the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Adults, Children, and Adolescents developed during the pandemic. To alleviate the stressors faced by caregivers during the pandemic and beyond, including increased caregiving responsibilities and financial difficulties, Project COPE targeted parent anxiety and depression through four brief, telehealth group sessions provided free of cost for caregivers of school-age children with ASD. In the case example presented, decreases in anxiety and depression, and increases in parent self-efficacy were reported after completing this program. Key insights about the intervention’s feasibility and content reported by parents are described. Findings suggest that the intervention removes some treatment access barriers typically seen in caregivers of children with ASD during and following the pandemic and that the program can be modified to increase engagement and acceptability.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46564186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Webb, N. Dhopatkar, P. Croft, H. Himmerich, C. Baillie, L. Dodwell, K. Tchanturia
{"title":"Clinical Reflections and Treatment Adaptations for Avoidant Restrictive Food Intake Disorder: A Case Study","authors":"J. Webb, N. Dhopatkar, P. Croft, H. Himmerich, C. Baillie, L. Dodwell, K. Tchanturia","doi":"10.1177/15346501231190913","DOIUrl":"https://doi.org/10.1177/15346501231190913","url":null,"abstract":"Avoidant Restrictive Food Intake Disorder (ARFID) is a serious eating disorder, characterised by problematic eating habits that cause significant nutritional deficiencies. Having only been recently acknowledged as a distinct category, there is little research regarding best practice guidelines, especially among the adult population. In addition, ARFID often coexists with autism, and very little is known about how the diagnoses affect each other, further complicating treatment options. This case study reflects on the treatment of a young autistic woman with ARFID within an inpatient eating disorder setting. Using principles of food exposure, food trials were introduced as a way to increase food variety as well as overall nutrition. Results are promising, with the patient reaching a much safer weight and being able to increase her repertoire of food. While results are not generalisable to a wider population, it is hoped that similar approach could be used with other individuals who have ARFID and autism when aiming to increase nutrition and variety.","PeriodicalId":46059,"journal":{"name":"Clinical Case Studies","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42542242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}