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- Frankl, My, et al.
(författare)
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Affect Phobia Therapy for Mild to Moderate Alcohol Use Disorder : The Cases of "Carey," "Michelle," and "Mary"
- 2019
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Ingår i: Pragmatic Case Studies in Psychotherapy. - : National Register of Health Service Psychologists. - 1553-0124. ; 15:3, s. 214-257
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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.
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| 2. |
- Philips, Björn
(författare)
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The Quest for Causality in Psychotherapy Research
- 2019
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Ingår i: Pragmatic Case Studies in Psychotherapy. - : National Register of Health Service Psychologists. - 1553-0124. ; 15:3, s. 271-280
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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.
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