A Cognitive-Behavioral Modification Treatment of Trichotillomania

Abstract

The problem of trichotillomania (compulsive hair pulling), though relatively rare, is often resistant to treatment. This presentation describes a cognitive-behavioral intervention which shows promise as a potent treatment technique. This treatment involves, initially, heightening the client's awareness not only of the hair-pulling behavior, but more importantly of the overt and covert behaviors which are precursors to the pulling.

The client is then taught to use this awareness as a cue to employ various coping responses which are taught during the course of therapy. These include emitting overt behaviors which are incompatible with pulling as well as covert behaviors (calming self-statements, disputation of permission-giving to pull, coping self-instructions, etc.) which are also aimed at gaining symptom control.

A case study is presented to illustrate the technique's application.     

Clinical Results Using Virtual Reality

Abstract

Virtual Reality (VR) technology offers new opportunities for the development of innovative clinical research, assessment, and intervention tools. VR-based testing, training, teaching, and treatment approaches that would be difficult, if not impossible to deliver using traditional methods are now being developed that take advantage of the assets that are available with VR technology. As research evidence continues to indicate clinical efficacy, VR applications are being increasingly regarded as providing innovative options for targeting the cognitive, psychological, motor, and functional impairments that result from various clinical health conditions. VR allows for the precise presentation and control of stimuli within dynamic multisensory 3-D computer generated simulations as well as providing advanced methods for capturing and quantifying behavioral responses. These characteristics support the rationale for the use of VR applications in clinical assessment, intervention, and training. This article begins with a brief review of the history and rationale for the use of VR with clinical populations. We then detail one use-case for the clinical application of VR—the exposure therapy treatment of anxiety disorders and post-traumatic stress disorder. While significant work is cited in other areas of Clinical VR (e.g., pain management, cognitive/physical assessment/rehabilitation, eating disorders, social skills/clinical training, etc.), a full overview of such a broad literature is beyond the scope of this article. Thus, we have opted to provide more in-depth analysis of one specific clinical area that clearly illustrates how VR has been successfully applied and is supported by an encouraging and evolving scientific literature.     

Domestic violence in veterans with posttraumatic stress disorder who seek couples therapy

Domestic violence rates among veterans with posttraumatic stress disorder (PTSD) are higher than those of the general population. Individuals who have been diagnosed with PTSD who seek couples therapy with their partners constitute an understudied population. Self-report measures of domestic violence, relationship satisfaction, and intimacy were administered at intake to 179 couples seeking relationship therapy at a Veterans Affairs clinic. Couples in which the veteran was diagnosed with combat-related PTSD were compared with two other groups based on the veteran's primary diagnosis (depression, adjustment disorder/V-code). Both the PTSD- and depression-diagnosed veterans perpetrated more violence than did those with adjustment/V-code diagnoses. Domestic violence rates among depressed and PTSD-diagnosed veterans were much higher than those found in previous research. Implications for assessment and treatment are discussed.     

To Integrate or Not to Integrate Dialectical Behaviour Therapy with Other Therapy Approaches?

With mounting evidence for its efficacy in the treatment of borderline personality disorder and related problems and increasing dissemination nationally and internationally, front line clinicians in practice settings are increasingly aware of dialectical behavior therapy (DBT). Indeed, it is likely that this treatment is reaching individuals who practice from a variety of theoretical frameworks, such as psychodynamic, humanistic, cognitive, or some combination thereof. Therefore, this paper considers the ways in which DBT is an integrative approach, as well as the issues that may arise in the integration of DBT with other theoretical frameworks or with practices spawned by these alternative frameworks. We recommend that therapists practicing DBT adhere to the behavioral and dialectical theoretical foundations of the approach, in order to provide therapy that is effective, coherent, and consistent.     

The Relevance of Sensory Processing Disorder to Social Work Practice: An Interdisciplinary Approach

Sensory processing disorder (SPD) is a disruption in the organization of sensory input, and affects up to three million children in the United States. SPD can have a serious impact on the ways that children behave, play, and learn, and yet, it may be overlooked or misunderstood by social work practitioners. The purpose of this article is to inform social work practice regarding SPD, strengthening the biological component of biopsychosocial assessment. After an introduction to the disorder, this article discusses differential diagnosis and practice implications, and concludes with a statement on interdisciplinary treatment.     

Childhood behavioral and emotional disorders

We reviewed the literature on family treatment for childhood behavioral and emotional disorders and found an increase in the number of studies since 1995; however there was significant variation by disorder and therapy model. There is substantially more research on externalizing disorders (i.e., conduct disorder, attention deficit hyperactivity disorder, oppositional defiant disorder) then internalizing disorders, depression and anxiety disorders. The data support the conclusion that family-based interventions produce results comparable to individually oriented interventions, and in some cases family-based interventions are superior to individual treatments. To date, cognitive behavioral family therapy and parent management have been the two models studied, almost exclusively. Implications for family therapy and future research are considered.     

Empirically supported family-based treatments for conduct disorder and delinquency in adolescents

Several family-based treatments of conduct disorder and delinquency in adolescents have emerged as evidence-based and, in recent years, have been transported to more than 800 community practice settings. These models include multisystemic therapy, functional family therapy, multidimensional treatment foster care, and, to a lesser extent, brief strategic family therapy. In addition to summarizing the theoretical and clinical bases of these treatments, their results in efficacy and effectiveness trials are examined with particular emphasis on any demonstrated capacity to achieve favorable outcomes when implemented by real-world practitioners in community practice settings. Special attention is also devoted to research on purported mechanisms of change as well as the long-term sustainability of outcomes achieved by these treatment models. Importantly, we note that the developers of each of the models have developed quality assurance systems to support treatment fidelity and youth and family outcomes; and the developers have formed purveyor organizations to facilitate the large-scale transport of their respective treatments to community settings nationally and internationally.     

The Use of Adventure Therapy Techniques by Clinical Social Workers: Implications for Practice and Training

Adventure therapy, an experiential intervention that combines outdoor, adventure based activities and group process, is used in direct practice by clinical social workers; however, it is unclear to what extent clinical social workers are actually utilizing these techniques. This research project surveyed a random sample of clinical social workers and examined in greater depth how they are utilizing adventure therapy programming with different clients in various treatment settings, as well as what type of education and training they received for engaging in these practices. A random sample of 646 clinical social workers in NASW responded to the survey, and more than 1/3 of this sample (35.1 %) reported the use of adventure based activities for therapeutic purposes in their social work practice. However, few of the social workers reported formal education or training in the use of adventure therapy, highlighting the need for more attention in both educational and clinical settings to proper instruction around this growing intervention.     

Inappropriate Comparisons: The LGB Population's Missing Reference Group

ABSTRACT

Given that many professional organizations emphasize the need for comparing assessment results to appropriate reference groups in their codes of ethics, we consider this practice through an ecological perspective as it applies to the lesbian, gay, and bisexual (LGB) population. The purpose of norming and types of assessment bias is discussed with respect to LGB population, which frequently lack specific norming data. The authors discuss whether the LGB population has characteristics similar to other commonly normed for groups and explore how group-shared constructs such as minority stress and internalized homophobia may introduce bias and affect the validity of assessments. A social anxiety assessment as well as a personality disorder inventory are examined for bias as case examples explaining how these assessments may exhibit bias when used with the LGB population. Increases in validity and effects on treatment planning are discussed as benefits of providing LGB-specific norms. Risks of providing these norms, such as minimizing subgroup differences and possibly increasing the risk of discrimination are also addressed before providing clinicians with recommendations as to how they may minimize the risk of bias in their assessment process.     

Survival dilemmas: Case study of an adult child of a schizophrenic parent

This article describes aspects of the treatment of an adult child of a schizophrenic parent. Many theories on irrationality in the family setting illuminate the range of impingement on the child's reality when a parent is disturbed in this way. Current research has absorbed itself in interpretations of data on risk, vulnerability, disorder, and early trauma, which have implications for prevention as well as therapeutic treatment of the adult survivor. Profound effects on Ms. P's early development are elaborated in the therapy, in which the treatment stance is influenced by Kohut's theories of the self, particularly as applied to the establishment within the holding environment of specific transferences that facilitate reconstructive work.     

Treatment of the bipolar client: Clinical social work contributions

The medicalization of bipolar disorder during the past two decades has tended to obscure the fact that it remains a disorder of uncertain etiology. Research has continued to support hypotheses that there are psychological and social, as well as biological, components of the onset and course of the disorder. Comprehensive treatment of the bipolar clinet thus requires intervention at all three of these levels. Social workers, with theiry psychosocial perspective, are well qualified to coordinate an overall treatment plan. The social worker's role includes six general intervention strategies.     

Concept of ‘personality disorder’ and its relationship to social work

Abstract

Inherently difficult to define and apply in a valid and reliable way, the concept of ‘personality disorder’ is, nonetheless, a very important psychological construct in the assessment and treatment of clients. This paper discusses the nature and limitations of personality disorder diagnoses. It also refers to data suggesting a paucity of formal training and research on personality disorders, and mental health in general, within Australian social work. The authors call for greater research, analysis and debate by social work educators and the profession on these issues.     

Does your older adult client have a gambling problem?

Pathological gambling is becoming an increasing problem in today's culture, particularly because opportunities and inducements to gamble abound. This article describes symptoms, consequences, and comorbidities experienced by pathological gamblers. Gambling pathology is often invisible because pathological gamblers seldom disclose gambling problems to their primary care provider. Thus, nurses will benefit from knowledge of the physical and emotional signs of the disorder. A two-question assessment tool, the Lie/Bet Questionnaire, is useful in helping nurses identify pathological gamblers. Interventions and treatment options, including group therapy and environmental modification, are also discussed. As always, education concerning problems and consequences of pathological gambling is a first step. Because research has indicated that visits to casinos by older adults have doubled since 1975, the authors use an example of an older adult to clarify the issues. Although the article's content is applicable to clients across the life span, it has particular significance for older adults.     

A Review of the Effectiveness and Mechanisms of Change for Three Psychological Interventions for Borderline Personality Disorder

The therapeutic uncertainty common in much of the early literature on borderline personality disorder (BPD) has given way to a growing research base with findings indicating the effectiveness of a number of psychological treatments. This article will review three major evidence-based treatments for BPD: dialectical behavior therapy, schema-focused therapy and mentalization-based treatment. While not a panacea, these treatments have provided, to differing degrees, a reasonable level of evidence indicating therapeutic effectiveness. The evidence base for each of these models is discussed as well as possible mechanisms of change. The article highlights similarities between the differing modalities as well as the features that distinguish the models. The article contends that increasing mentalization skills may be a common underlying factor in all treatments for individual with BPD. The authors conclude by discussing the difficulties and potential benefits of treatment integration.     

Cognitive-behavioral therapy for obsessive-compulsive disorder: review of treatment techniques

Obsessive-compulsive disorder (OCD) is a chronic, impairing condition with an estimated lifetime prevalence in adults of 2.5%. Controlled treatment trials have demonstrated that cognitive-behavioral therapy (CBT) is an effective intervention for OCD. However, many individuals diagnosed with OCD do not receive appropriate, empirically validated interventions, perhaps due to limited knowledge of CBT among mental health practitioners. This article provides a review of CBT for OCD. Issues related to treatment delivery and assessment are presented and highlighted by an individual example.     

When Is Research Good Evidence? Issues in Reading Research

Although using published research is only one part of the evidence-based practice process, clinical social workers more often doubt their abilities in this area than in client assessment or in the individualizing of treatment approaches to fit client preferences, values and resources. This article reviews the nature of research and the reason it is often a preferred source of information; common flaws to watch for in published research; types of research studies and how different kinds of studies are viewed by those interested in treatment outcome research; and the elements of a published research report that must be considered when deciding on its usefulness for decision-making about practice. It will also include discussion of the controversies that surround these topics, which are significant. While readers will have been introduced to these topics in their professional education, when knowledge is not used it is often not well-remembered. Few clinicians find that reading, assessing, or conducting research is part of their daily work, which is one reason why the discussion of evidence-based practice and other approaches to the use of research in clinical practice can be anxiety-provoking. This “refresher” emphasizes that critical thinking skills, which clinicians often have in abundance, are the single most important element in using research to inform practice.     

Is Parental Alienation Disorder a Valid Concept? Not According to Scientific Evidence. A Review of Parental Alienation,DSM-5 and ICD-11 by William Bernet

This article reviews a recent book arguing how a concept known as parental alienation syndrome—now parental alienation disorder—should be included in official psychiatric/psychological and medical classification diagnostic manuals. Anecdotal cases and opinion are presented as research and scientific evidence, and stories are presented as research studies. In addition, the book often contradicts itself in different sections. The author is not familiar with scientific methodology, confuses various statistical and research procedures and terminology, and thus misleads the reader in trying to promote this theory. This book's claim that it is the most comprehensive compilation of the evidence supporting parental alienation disorder/parental alienation syndrome is false, and it is not recommended by the reviewers.     

Existential Therapy of Panic Disorder: A Single System Study

Recently there has been an emphasis on biomedical and behavioral aspects of the treatment panic disorder. The symptom-based nature of these treatments may cause elements of the life context, such as systems of meaningfulness and symbolism, to be overlooked in some cases. In this paper, the successful treatment of a case of panic disorder of three years duration is presented, in which complete remission of symptoms occurred within the third week of existential psychotherapy. Prior to this therapy, the client had exhibited a deteriorating course while following a purely psychopharmacological treatment plan. Implications are discussed.     

Adaptation and validation of the Japanese version of the Gambling Urge Scale

In Japan, accurately assessing and targeting gambling urges is important for the treatment of gambling disorder because people are constantly exposed to external triggers that elicit gambling urges. However, a valid measure that assesses gambling urges has not been adequately established. Therefore, the purpose of this study was to examine the psychometric properties of the Japanese version of the Gambling Urge Scale (GUS-J), which is a well-known valid 6-item instrument in English-speaking countries. Two hundred and thirty-nine participants completed questionnaires, 86 of which met the criteria for a probable gambling disorder. As with the original GUS, the GUS-J was demonstrated to be a one-factor model that accounted for 63.82% of the total item variance, with all items demonstrating loadings of .40 or higher. With regard to reliability, the GUS-J showed good internal consistency (α = .88). Furthermore, validity based on evidence of relationships with other variables, especially convergent and concurrent validity of the GUS-J, were supported by several analyses that examined hypotheses based on previous findings. In conclusion, this study showed that the GUS-J has good psychometric properties as an assessment tool for gambling urges in Japanese people and it will be useful for future clinical practice and research.