The present case details the use of Acceptance and Commitment Therapy (ACT) with “June,” a 26-year-old biracial woman presenting with generalized anxiety disorder (GAD) and premenstrual dysphoric disorder (PMDD). Across 37 sessions in a community-based training clinic, treatment focused on reducing psychological inflexibility and strengthening flexibility processes, including acceptance, defusion, present-moment awareness, values clarity, and committed action. June entered treatment with severe anxiety, marked mood lability during her luteal phase, and significant relationship and occupational stress. The therapist tracked progress with standardized measures and qualitative reports. June showed clinically meaningful improvements in anxiety, psychological flexibility, wellbeing, and valued living. Though some of her premenstrual symptoms persisted, she no longer met criteria for PMDD at termination. This case highlights ACT’s relevance as a transdiagnostic approach for clients managing both GAD and cyclical mood disturbances. It also underscores ACT’s emphasis on relating flexibility to overarching values to help clients maintain motivation and consistent application of skills.

Autism spectrum disorder (ASD) frequently presents alongside emotional disorders (e.g., anxiety, depression) in youth. Existing treatments for youth with ASD most often focus on social communication, behavior management, and daily living skills, with generally less focus placed on emotional symptoms. This paper describes the theoretical rationale for and application of the Unified Protocol for Transdiagnostic Treatment for Emotional Disorders in Adolescents (UP-A) to youth with ASD. A case example is presented to highlight adaptations to the UP-A and illustrate the impact of these adaptations on treatment engagement, process, and outcomes. The case reviewed in this study features an adolescent male presenting with generalized anxiety disorder and persistent depressive disorder with a current major depressive episode. His comorbid ASD informed the adaptations to the UP-A that are discussed throughout. Considerations for case conceptualization, treatment planning, and progress monitoring during UP-A treatment are also reviewed.

Research suggests Cognitive Behavioural Therapy (CBT) is an effective intervention for tinnitus-related distress in typically developing adults. However, there is no specific evidence that CBT is effective for tinnitus distress in people with a learning disability (LD), or information regarding potential adaptations. This quasi-experimental single case study aimed to test the hypothesis that CBT would reduce tinnitus distress in a person with an LD. Quantitative and qualitative data showed significant reductions in self-reported tinnitus-related annoyance, sadness, interference with valued activities and sleep disturbance. All tinnitus distress-related measures except perceived loudness showed statistically significant improvement, with interference with valued activities showing the largest effect size, Ruscio’s A = 0.99, 95% CI [0.91, 0.99], p = .0026. Adaptations included use of visual and sensory aids, and inclusion of parental thoughts, feelings and behaviours as treatment targets. This study offers support for the efficacy of CBT for treating tinnitus distress in people with LD, and for the efficacy of carer-supported CBT in this population.

Background: Obsessive-Compulsive Disorder (OCD) is a chronic psychiatric condition characterized by intrusive obsessions and repetitive compulsions that result in significant functional impairment. Harm-related obsessions and checking compulsions represent some of the most distressing and treatment-resistant symptom clusters. Cognitive-Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) remain the gold-standard interventions; however, their effectiveness may be limited in cases involving intrusive harm-related thoughts. Methods: This case study describes a 22-year-old male who presented with obsessions such as “What if I break his neck?”, fears of poisoning others, and associated compulsive checking and avoidance behaviors. He completed 30 sessions of CBT and ERP integrated with the 4T Psychoeducation Model, a framework derived from the Islamic intellectual tradition. The model distinguishes involuntary cognitive processes – imagination ( tahayyul ), baseless assumption/suspicion ( tewehhum ) and reasoning ( taakkul ) – from voluntary confirmation ( tasdiq ). Results: Standardized measures, including the Yale–Brown Obsessive Compulsive Scale (Y-BOCS), Padua Inventory, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI), were administered during treatment and at six-month follow-up. Results showed a clinically significant reduction in obsessive-compulsive symptoms (46% decrease in Y-BOCS), along with decreases in depression and anxiety. Qualitative feedback indicated that the 4T model helped the client differentiate intrusive images from responsible beliefs (confirmations), reducing thought–action fusion and excessive sense of responsibility. Conclusions: By the end of treatment, intrusive thoughts still occurred but were no longer perceived as threatening. This case highlights the value of integrating 4T psychoeducation into standard CBT protocols. Although initially developed for religious obsessions, the model provides a compelling cognitive framework for reconceptualizing thought-action relationships, emphasizing that thought processes are not inherently linked to actions, thereby emerging as an effective tool for improving treatment outcomes in harm-related OCD.

Toileting problems are common for individuals with Autism Spectrum Disorder (ASD). Although there is extensive research on effective treatments for enuresis (i.e., dysfunctional urination), less research has been published on encopresis (i.e., dysfunctional defecation). The link between poor bowel function, behavioral and emotional challenges, and reduced quality of life highlights the urgent need for ongoing research into healthy bowel function in individuals with ASD. The present case study demonstrates the efficacy of an intervention package for a 12-year-old male with profound ASD who presented with severe constipation, encopresis, and problem behavior. The primary components of treatment included coordination with a medical doctor to address constipation through fiber supplementation and applied behavior analysis (ABA) therapy to address encopresis. Other treatment components included physical activity and environmental modifications to adjust his diet. Results of this case study showed a holistic method could successfully treat a medical and behavioral issue using a systematic approach and data-based decisions while still considering the complexities associated with profound ASD.

The physical appearance of persons with intellectual and neurodevelopmental disabilities can influence social perceptions, community integration, and quality of life. This study, a five-case replication series, evaluated a care provider intervention focused on personal clothing worn by students at a residential treatment facility. Under in vivo conditions using task clarification and a job aid, two supervisors trained direct service providers to implement intervention with the students. Compared to baseline evaluation, intervention was associated with students wearing personal clothing more frequently and the supervisors approved the training they provided and benefits to students. We discuss study methodology, interpretation of findings, and directions for future research.

Moral Injury Syndrome is a constellation of psychological symptoms associated with challenges to an individual’s fundamental beliefs and values. It is associated with suicide ideation and attempts and poor mental health outcomes, so it is an important target for treatment. This paper describes narrative moviola therapy, a new approach designed for clients who are not appropriate for, or do not derive benefit from, existing evidence-based treatments for moral injury syndrome. This therapy allows the client to integrate complex moral contexts by telling the story as though filming a movie from different perspectives. Use of the intervention is demonstrated in a case study of a veteran who completed 8 sessions of therapy and attended a 3-month follow-up. In this case, robust effects were observed, supporting the need for further research in the feasibility and effectiveness of narrative moviola therapy.

Forming connections with objects can be a part of normal development; however, difficulties occur when this accumulation of items grows excessive or when the person finds it difficult to part with the collected items. Hoarding disorder (HD) can be characterised as an enduring difficulty to part with objects or items because of a need to collect them, coupled with considerable distress associated with disposing of them. Hoarding problems come under the clinical guidelines for obsessive-compulsive disorder (OCD), which recommend psychological intervention at the individual’s home. Cognitive-Behavioural Therapy (CBT) is the most widely used psychological therapy in treating HD currently. With dropout rates high and problems persisting for more than 50% of this population, there is a need for perhaps a different psychotherapeutic approach. Acceptance and Commitment Therapy (ACT) is based on mindful and values-guided action but has received very little attention in terms of the efficacy for treating HD in older adults. Exploring different therapy modalities for the treatment of HD in this population could provide useful insights in understanding, conceptualising and treating HD. This case study describes the use of ACT to treat “Emily,” a 69-year-old woman with HD. The case also explores the strengths of using ACT in HD, possible adaptations to the model moving forward and suggestions for future research.

This case study examines the use of Functional Analytic Psychotherapy (FAP), an interpersonal contextual behavior therapy, to address relational difficulties in a 33-year-old non-binary individual with autism and interpersonal challenges. Neurodiverse individuals, especially those diagnosed later in life, often face compounded social prejudice and elevated mental health risks. Similarly, gender-diverse individuals are subject to stigma, and when gender diversity intersects with neurodiversity, mental health vulnerabilities may intensify. The client presented (a) identity concealment that hindered authentic self-expression, (b) difficulty expressing vulnerability in relationships, including with the therapist, and (c) avoidance of neurocognitive assessment due to efforts to mask symptoms. FAP’s focus on in-session interpersonal dynamics guided the therapist to evoke and reinforce behaviors related to openness and intimacy, while blocking avoidance and minimization. Therapeutic goals included (a) increasing interpersonal effectiveness and social communication, (b) promoting willingness to seek neurodevelopmental assessment, and (c) reducing identity concealment to support meaningful relational engagement. Over time, the client demonstrated greater emotional expression, improved social connection, and reduced experiential avoidance. This case highlights FAP’s potential as an affirming and effective approach for individuals navigating intersecting identities. By targeting moment-to-moment relational patterns and contextualizing behavior within systemic experiences of rejection and late diagnosis, FAP can provide a supportive space for growth. The findings emphasize the need for interventions that are both behaviorally precise and attuned to the lived experiences of neurodiverse and gender-diverse individuals.

Sexual Obsessive-Compulsive Disorder (S-OCD), when comorbid with Major Depressive Disorder (MDD), presents significant treatment challenges due to heightened distress, avoidance behaviors, and cognitive inflexibility. While Exposure and Response Prevention (EX/RP) remains the gold standard for OCD, its efficacy in S-OCD cases complicated by MDD is less established. This case-series study examines the feasibility and effectiveness of Telehealth-delivered Mindfulness-Based Exposure and Response Prevention (Telehealth-delivered MB-EX/RP) in treating individuals with S-OCD and comorbid MDD. Five participants underwent 17 bi-weekly therapy sessions delivered via a digital platform. Standardized assessments of OCD severity, depressive symptoms, obsessive beliefs, mindfulness, and mental well-being were conducted at pre-treatment, post-treatment, and a four-month follow-up. Results demonstrated significant reductions in S-OCD and depressive symptoms, along with sustained improvements in mindfulness and well-being. The digital format facilitated accessibility and engagement, suggesting that Telehealth-delivered MB-EX/RP is a viable intervention for individuals with S-OCD and comorbid MDD. Findings highlight the potential of mindfulness-enhanced digital interventions in addressing complex OCD presentations, warranting further investigation in larger clinical trials.