| 1. |
- Folke, Fredrik, et al.
(författare)
-
Exposure and response prevention in the treatment of body dysmorphic disorder : A case series
- 2012
-
Ingår i: Pragmatic Case Studies in Psychotherapy. - : National Register of Health Service Psychologists. - 1553-0124. ; 8:4, s. 255-287
-
Tidskriftsartikel (refereegranskat)abstract
- This case study investigates the effect of exposure and response prevention in relation to other components present in behavioral therapy for Body Dysmorphic Disorder (BDD). Treatment components were added one at a time in four consecutive phases: A1) Self-Monitoring; B) Therapist Contact; C) Exposure and Response Prevention (ERP); and, A2) Renewed Self-Monitoring. Client assessment involved (a) a daily self-report diary of BDD symptoms throughout treatment and (b) periodic completion of standardized self-report measures tapping BDD symptoms and related symptoms of depression and global functioning. In all, six clients participated in the study. Three clients (Ms. A, Ms. B, and Ms. C) made large or relatively large improvements in their daily self-reported BDD symptoms during the exposure and response prevention treatment phase. A fourth client (Mr. D) did not make such an improvement during this phase, but made overall progress over the course of treatment. All four of these clients achieved statistically significant improvement over baseline on the standardized BDD measure. One client (Ms. E) dropped out of treatment during the ERP phase, and one (Ms. F) chose not to proceed to the ERP phase after receiving education about it. The results indicate that beneficial effects of treatment occurred during the ERP phase for three of the clients, and thus suggest that this component should, in spite of clients’ almost reflexive, initial skepticism, be considered essential in the behavioral treatment of Body Dysmorphic Disorder. The variety of reactions of the different clients to the treatments is documented and discussed, along with an analysis of the factors that differentiated those clients who found the ERP phase helpful and those who did not.
|
|
| 2. |
- Frankl, My, et al.
(författare)
-
Affect Phobia Therapy for Mild to Moderate Alcohol Use Disorder : The Cases of "Carey," "Michelle," and "Mary"
- 2019
-
Ingår i: Pragmatic Case Studies in Psychotherapy. - : National Register of Health Service Psychologists. - 1553-0124. ; 15:3, s. 214-257
-
Tidskriftsartikel (refereegranskat)abstract
- Affect Phobia Treatment (APT) is based on an integrative theory involving the use of psychodynamic principles for understanding a client’s psychological dynamics, experiential principles for engaging and working with the client’s affect, and behavioral principles of exposure and response prevention for desensitizing the client to the fear of affect. APT’s goal is "to help patients function better by resolving emotional conflict through reducing their avoidance of adaptive, activating emotions" (Osborn et al., 2014). APT has not yet been systematically employed and researched for patients with mild to moderate Alcohol Use Disorder (AUD) together with affect phobia. The present study was designed to begin this process by describing and comparing, both qualitatively and quantitatively, three illustrative, distinctive cases of APT in patients with AUD, assigned the names of "Carey," "Michelle," and "Mary." The focus was on exploring the process by which the different individual patients responded to the multifaceted APT therapy, and hence how the therapist had to adapt the therapy to each particular patient, as outlined in Stiles’ (2009) concept of "appropriate responsiveness." Following the manual for APT, therapy included 10 weekly sessions of individual psychotherapy. This short length for a therapy like APT, a treatment which usually has no determined session length (McCullough et al., 2003), was designed to make the therapy comparable in length to other therapies for AUD, like Motivational Interviewing. During the whole study period, patients gave weekly reports of their alcohol consumption and craving. In addition, at the beginning and at the end of the study, the patients answered questionnaires measuring affect phobia and psychiatric symptoms. Role expectations and experiences of psychotherapy were also measured. All three patients completed the treatment and the measurement period. No adverse events were reported. The patients had different trajectories of change regarding alcohol consumption, craving, and symptom change. The study showed that 10-session APT was a tolerable treatment for the patients with on-going mild-to-moderate alcohol dependence, who primarily used alcohol as a way of avoiding emotions, but that the therapy worked to different degrees and in different ways for the three patients due to their different presenting patterns of psychiatric symptoms and personality characteristics. Experience in the three cases suggests the advisability of (a) flexible treatment length in accordance to a patient's needs, and (b) complementary treatment strategies beyond APT focusing on reducing alcohol consumption per se for some patients.
|
|
| 3. |
- Philips, Björn
(författare)
-
The Quest for Causality in Psychotherapy Research
- 2019
-
Ingår i: Pragmatic Case Studies in Psychotherapy. - : National Register of Health Service Psychologists. - 1553-0124. ; 15:3, s. 271-280
-
Tidskriftsartikel (refereegranskat)abstract
- This commentary on the article by Frankl, Wennberg, Berggraf and Philips (2020) focuses on methodological aspects of case studies versus group designs in psychotherapy research. Experimental case study designs such as ABAB design and multiple baseline design have a long tradition within behavior therapy. These research designs are especially useful for testing newly developed therapy methods and investigating the effectiveness for treatment of rare disorders. However, experimental case study design is most appropriate for single-component treatments for patients with one circumscribed problem. Randomized controlled trials (RCTs) are considered as the gold standard for testing and establishing the efficacy of a particular therapy method for a particular problem. However, the RCT design also bears some methodological shortcomings, such as low external and construct validity, simplistic epistemological assumptions, and only being able to establish average causal effect (thus not giving the clinician clear guidelines on how to work with individual patients). Rigorous process research is useful for identifying change mechanisms in psychotherapy. Finally, pragmatic case studies have a great potential of increasing our knowledge about psychotherapy and its effectivess. This potential could be increased even further if pragmatic case studies integrated some methods from process research and if the results from multiple case studies were analyzed together in meta-syntheses.
|
|
| 4. |
- Ramnerö, Jonas, et al.
(författare)
-
Exposure Therapy : What Is It That We Are Selling?
- 2012
-
Ingår i: Pragmatic Case Studies in Psychotherapy. - : National Register of Health Service Psychologists. - 1553-0124. ; 8:4, s. 296-301
-
Tidskriftsartikel (refereegranskat)abstract
- This discussion is a response to Muller and Schultz’s (2012) thoughtful commentary on our case series on treating Body Dysmorphic Disorder (BDD) in this issue of the Pragmatic Case Studies in Psychotherapy. We join Muller and Schultz in their dedication to exposure treatment. We elaborate on their perceptive comments on what exposure is, and how it is presented, applied, and implemented most effectively, in the context of BDD specifically. We conclude by briefly exploring some of the complexities of the theory underlying exposure therapy.
|
|
