The use of cognitive behavioural therapy in the treatment of drug-related psychosis – a case study and research review

Objectives To examine the use of cognitive behavioral therapy (CBT) in a case of co-occurring generalized anxiety disorder (GAD) and Parkinson’s disease (PD). Methods This case study refers to a male aged 75 years with a diagnosis of Idiopathic Parkinson’s disease. It focuses on applying a CBT model to address the psychological difficulties with PD and GAD. Results This case study reveals key aspects in presentation, diagnosis, and psychological treatment between PD and GAD, and is one of few studies published in this area. Conclusions Symptoms of anxiety in an older adult with PD decreased during a course of CBT. The implications of the treatment outcome of this study and further considerations of treatment plans for comorbid PD and anxiety have been discussed. Clinical Implications Using CBT could positively impact non-motor symptoms of Parkinson’s, such as sleep difficulties and speech impediments. Using CBT for the catastrophic thinking and worry content in GAD seems to act as a complementary therapy for psychological/non-motor symptoms of PD.

Objective:A growing body of evidence supports the use of cognitive behavior therapy for the treatment of schizophrenia. A course of cognitive behavior therapy, added to the antipsychotic regimen, is now considered to be an appropriate standard of care in the United Kingdom. The objective of this article is to offer a broad perspective on the subject of cognitive behavior therapy for schizophrenia for the American reader. Method: The authors summarize current practice and data supporting the use of cognitive behavior therapy for schizophrenia. Results: Five aspects of cognitive behavior therapy for schizophrenia are addressed: 1) evidence from randomized clinical trials, 2) currently accepted core techniques, 3) similarities to and differences from other psychosocial interventions for schizophrenia, 4) differences between the United States and United Kingdom in implementation, and 5) current directions of research. Conclusions: The strength of the evidence supporting cognitive behavior therapy for schizoph...

A growing body of evidence supports the use of cognitive behavior therapy for the treatment of schizophrenia. A course of cognitive behavior therapy, added to the antipsychotic regimen, is now considered to be an appropriate standard of care in the United Kingdom. The objective of this article is to offer a broad perspective on the subject of cognitive behavior therapy for schizophrenia for the American reader. The authors summarize current practice and data supporting the use of cognitive behavior therapy for schizophrenia. Five aspects of cognitive behavior therapy for schizophrenia are addressed: 1) evidence from randomized clinical trials, 2) currently accepted core techniques, 3) similarities to and differences from other psychosocial interventions for schizophrenia, 4) differences between the United States and United Kingdom in implementation, and 5) current directions of research. The strength of the evidence supporting cognitive behavior therapy for schizophrenia suggests that this technique should have more attention and support in the United States.

This article describes the use of Cognitive Behavioural Therapy (CBT) for treatment-resistant delusional systems in a cohort of three service users with a diagnosis of schizophrenia. Key stages of CBT are outlined, including engagement, the use of scaffolding to reinitiate social functioning, improving coping styles and metacognitive techniques (such as rumination postponement). These were followed by the use of formulation, examination of the antecedents/timeline to identify core schema vulnerabilities and schema-focused techniques to deal with underlying unbearable affect. Systematization, conviction, overall symptomatology, clinically significant improvement, schema profile and social functioning are described pre and post-therapy. Following a 50-session course of CBT, all parameters including social functioning and schema vulnerability improved in two of the case examples; however, recovery was limited in the other. The authors recommend a synthesis between expert CBT and psychodynamic understanding, to improve engagement and schema change in the psychotherapy of delusional systems.

Body-image disturbance is a core feature of eating disorders and can predict their development in healthy individuals. There are two components of body-image disturbance: perceptual disturbance (associated with overestimation of body size) and affective disturbance (associated with body dissatisfaction). Previous behavioral studies have hypothesized that attention to particular body parts and negative body-related emotions resulting from social pressure are associated with the respective degrees of perceptual and affective disturbance; however, the neural representations that underlie this hypothesis have not been elucidated. Thus, this study investigated the brain regions and connectivity associated with the degree of body-image disturbance. Specifically, we examined the brain activations associated with participants’ estimation of the width of their actual and ideal bodies; we sought to determine which brain regions and functional connectivity from body-related visual processing regions were correlated with the degree of each component of body-image disturbance. The degree of perceptual disturbance was positively correlated with excessive width-dependent brain activations in the left anterior cingulate cortex when estimating one’s body size; it was positively correlated with the functional connectivity between the left extrastriate body area and left anterior insula. The degree of affective disturbance was positively correlated with excessive width-dependent brain activation in the right temporoparietal junction and negatively correlated with functional connectivity between the left extrastriate body area and right precuneus when estimating one’s ideal body size. These results support the hypothesis that perceptual disturbance is associated with attentional processing, whereas affective disturbance is associated with social processing.

This case study describes the use of cognitive-behavioral therapy (CBT) for a 7-year-old girl, “Lauren,” who was diagnosed with social anxiety disorder (SAD) and was experiencing significant family stress. Manualized CBT was conducted and substantial reductions in SAD symptoms and impairment were demonstrated. Given additional difficulties remaining in the home setting, booster sessions were continued following manualized treatment to target Lauren’s functioning at home. These follow-up sessions were associated with maintained functioning, and only minimal additional benefits emerged. This case study calls attention to the importance of considering family stress in individual CBT for children with SAD, as well as the difficulties associated with addressing family stress in CBT for SAD. Existing treatments do not routinely address family stress in the context of child SAD, despite the potential to enhance CBT outcomes for children with SAD.

SSRI-Associated Sexual Dysfunction

This study examines a relapse prevention strategy for bulimia nervosa (BN). Subjects in a multicenter BN treatment trial who initially achieved abstinence after a course of cognitive-behavioral therapy (CBT) were told to recontact the clinic if they had a recurrence of symptoms or feared such a reoccurrence so that they could receive additional therapy visits. At the end of CBT, subjects whose scores on the Eating Disorders Examination indicated that they were abstinent from binge eating and purging, and therefore considered to be treated successfully, were assigned randomly to follow-up only or to a crisis intervention model. With the crisis intervention model, subjects would receive additional visits if needed. None of the 30 subjects who relapsed during the follow-up sought additional treatment visits. Simply telling patients with BN who appear to have been successfully treated to come back if they have additional problems, or fear that they are developing such problems, may be an ineffective relapse prevention technique. Alternative strategies, such as planned return visits or phone calls, should be considered as alternative relapse prevention strategies.

Autism spectrum disorders (ASD) and obsessive-compulsive disorder (OCD) are highly comorbid, precipitating an urgent need to identify evidence-based practices that might be used to address this comorbidity exclusively. The aim of this study was to conduct a review of intervention research and clinical reports to examine the use of cognitive behavioral therapy (CBT) with individuals who have comorbid ASD and OCD. Based on the pre-determined review inclusion criteria, 11 studies were included in the review: three randomized control trials (RCT), one case controlled study, two single subject experimental designs, and five case studies. These studies offer promising data on the use of CBT interventions for individuals with ASD and comorbid OCD as well as for individuals with OCD and comorbid ASD when standard CBT protocol is enhanced with modifications such as parental involvement, increased use of visuals, personalized treatment metaphors, self-monitoring, positive reinforcement, and use of clear language and instructions. Limitations and implications for future research and practice are discussed.

AimsAnxiety disorders are common in Autistic Spectrum Disorder (ASD) patients. There are limited resources dedicated to ASD and mental health services are not equipped to adapt assessment and treatment protocols to address their needs. Adaptations to diagnosis and treatment are discussed in a single case study of an autistic patient with anxiety disorders. In addition, effectiveness of providing adapted versus standard treatment is evaluated.MethodsThis study describes a 45-year-old, single, employed male diagnosed as autistic at age 37. He was referred for a second course of Cognitive Behavioural Therapy (CBT) for anxiety disorders consisting of agoraphobia with panic; blood injury phobia; needle phobia; dental phobia; claustrophobia. The duration of symptoms was 35 years. The main impairments to functioning were inability to use public transport; attending healthcare appointments; going to public places; returning to office-based working.Questionnaires routinely completed at assessment and end of treatment: Montgomery–Åsberg Depression Rating Scale (MADRS); Beck's Anxiety Inventory (BAI); Beck's Depression Inventory (BDI). Adapted treatment with CBT included an extended assessment which helped differentiate anxiety symptoms from ASD. Main CBT adaptations included development of skills for the patient to identify and express emotional experiences and thoughts with the focus on physical sensations and behaviour. Graded exposure items were linked to concrete aims or interests and structured to fit around the patient's routine daily activities. Clinical data was analysed and compared outcomes from the initial standard and subsequent adapted treatment.ResultsThe patient's response to the initial course of standard CBT showed a 14% increase in anxiety and 14% increase in symptoms of depression on self-rated measures. The subsequent adapted CBT showed a 31% improvement in anxiety and a 16% improvement in symptoms of depression on self-rated measures.ConclusionThis case report supports literature describing the need to adapt standard assessment and treatment to differentiate experiences related to ASD from discrete anxiety disorders, although there may be some overlap. The promising results support using adapted CBT to ensure appropriate treatment of anxiety disorders in autistic people.

The present paper reconsiders the role of developmental theory in the use of cognitive-behavior therapy (CBT) with children. The implication of Piaget's theory of cognitive development and Selman's social perspectivetaking theory are reviewed briefly in regard to CBT. It is argued that the assessment of both logical/analytical thought structures and social perspective-taking abilities may be useful in planning a course of CBT with children.

Cognitive behavior therapy for social anxiety disorder in the context of Asperger's Syndrome: A single-subject report

Body-image disturbance is a major factor in the development of eating disorders, especially among young women. There are two main components: perceptual disturbance, characterized by a discrepancy between perceived and actual body size, and affective disturbance, characterized by a discrepancy between perceived and ideal body size. Interventions targeting body-image disturbance ask individuals to describe their own body without using negative expressions when either viewing it in a mirror or imagining it. Despite the importance of reducing body-image disturbance, its neural mechanisms remain unclear. Here we investigated the changes in neural responses before and after an intervention. We hypothesized that neuralresponses correlated with the degree of body-image disturbance would also be related to its reduction, i.e., a reduction in perceptual and affective disturbances would be related to changes in attentional and socio-cognitive processing, respectively. Twenty-eight young adult women without known psychiatric disorders underwent a single 40-min intervention. Participants completed tasks before and after the intervention, in which they estimated their perceived and ideal body sizes using distorted silhouette images to measure body-image disturbance. We analyzed the behavioral and neural responses of participants during the tasks. The intervention did not significantly reduce body-image disturbance. Analysis of individual differences showed distinct changes in neural responses for each type of disturbance. A decrease in perceptual disturbance was associated with bodily visuospatial processing: increased activation in the left superior parietal lobule, bilateral occipital gyri, and right cuneus. Reduced affective disturbance was associated with socio-cognitive processing; decreased activation in the right temporoparietal junction, and increased functional connectivity between the left extrastriate body area and the right precuneus. We identified distinct neural mechanisms (bodily visuospatial and socio-cognitive processing) associated with the reduction in each component of body-image disturbance. Our results imply that different neural mechanisms are related to reduced perceptual disturbance and the expression thereof, whereas similar neural mechanisms are related to the reduction and expression of affective disturbance. Considering the small sample size of this study, our results should be regarded as preliminary.

The Elementary School Journal Volume 83, Number 2 ? 1982 by The University of Chicago. All rights reserved. 001 3-5984183/8302-0009$01o.00 Teachers approach their instructional tasks with a variety of perspectives and strategies that emphasize certain aspects of teaching and deemphasize others. For example, some teachers teach language skills using organized games, while other teachers teach the same skills by direct instruction. Teachers adopt different approaches to the same subject matter partly because their teaching situations differ. Their students may have different learning problems or their classrooms may have varied resources and facilities. Even in the

added by over 1,000 teachers to a survey of teachers' practices. Results of the survey of 3,700 teachers in about 600 schools in Maryland are described in Becker and Epstein (in this issue). The teachers' comments reflect the variation in years of experience and in the number and types of contacts individual teachers have had with parents. Each theme can be viewed from two perspectives-there are potential advantages, but there are also potential problems, with any parent-involvement technique. Teachers' comments reveal their contrasting opinions on the benefits expected from parent assistance at home and on the organizational structures used to conduct parent-involvement activities. Some teachers are very positive about parent involvement; others have been discouraged by their attempts to communicate and work with parents.