Single-case Experimental Design Research Articles

Do single-case experimental designs lead to randomised controlled trials of cognitive behavioural therapy interventions for adolescent anxiety and related disorders recommended in the National Institute of Clinical Excellence guidelines? A systematic review.

Although Cognitive Behavioural Therapy (CBT) is effective for 60% of adolescents with anxiety disorders, only 36% are in remission post-intervention. This indicates that more effective treatments are needed which should be reflected in the NICE guidelines. We hypothesised that Single-case experimental designs (SCEDs) may provide a framework for accelerating the development of novel interventions. The primary purpose of this review was to investigate whether SCEDs are currently followed by randomised controlled trials (RCTs) of CBT intervention for adolescent anxiety disorders named in the NICE guidelines. The secondary objective was to investigate whether using SCEDs prior to RCTs could be a helpful approach. For the primary search of SCEDs five databases were used (PsycINFO, PubMed, PsycArticles, Web of Science and ProQuest). Nineteen articles met eligibility criteria including a total of 107 participants. For the secondary search of RCTs named in the NICE guidelines for adolescent anxiety disorders 53 articles met inclusion criteria and were included in the systematic review. The 19 SCED studies included in the review were conducted with participants with a diverse range of anxiety disorders and across a range of CBT formats. Two of the SCEDs were followed by RCTs, but neither of these were named in the NICE guidelines for anxiety disorders. All of the SCEDs identified were rated as low quality with none meeting the criteria for the highest or second highest quality rating. From the secondary searches, none of the RCTs named in the NICE guide were preceded by SCEDs. It was concluded that currently SCEDs were not followed by RCTs of CBT interventions named in the NICE guidelines for adolescent anxiety disorders. However, it was suggested that SCEDs may provide an important framework for the development of more effective interventions for adolescents with anxiety.

Bayesian analysis of single case experimental design count data in trauma research: A tutorial.

Single case experimental designs (SCEDs) are suited to psychological trauma research that involves individualized treatments and where randomization might be impossible or inappropriate. However, SCED data present challenges such as autocorrelations, short time-series, nonnormal distributions (in count data), and the effect sizes being comparable across phase changes and participants. The present study illustrates the Bayesian rate ratio (BRR) that can be used when the phase lengths vary across phases to quantify treatment effect and can be aggregated across participants. Bayesian estimation allows flexible modeling of autocorrelations and distributions, works well for small samples, and provides easily interpretable estimates of uncertainty in the form of credible intervals. BRR estimates from a published dataset from trauma research are compared with commonly used nonoverlap of all pairs (NAP) effect sizes. Bayesian estimates show superior performance over NAP estimates because they reflect the patterns in the data and account for distance between observations, unlike NAP. All the R programs are shared with the readers and are annotated for their ease. Through tutorials such as these, current and future researchers can be educated about Bayesian methodology, its appropriateness to address the idiosyncrasies posed by SCED count data, and aid further development of models for other SCEDs. Implications of the study are also discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Penerapan Social Skills Training (SST) untuk Meningkatkan Social Skill Performance pada Anak

As social beings, everyone is required to be able to adjust in the social environment. But in fact, there are individuals who have difficulty adjusting because they have social skills deficits. Deficits of social skills can be measured using the social skills rating system (SSRS) which refers to the theory of Gresham and Elliott which explains that there are three aspects that can be used as a reference for measuring social skills, namely the ability to cooperate, assertive behavior, and the ability to control oneself. Based on these conditions, researchers conducted experimental research to determine the effectiveness of Social Skills Training (SST) as an effort to overcome social skill deficits owned by individuals. This study involved a 7-year-old boy who was studying at an elementary school. Based on the results of the SSRS measurement, the child has a deficit in social skills. The method used in this research is a single case experimental design (DEKT), with pre-test and post-test applied to the subject. The result is Social Skills. The training was able to improve the subject's social skills. The increase that occurred included all three aspects of social skills, namely the subject had shown the ability to work together with his peers, was able to convey what he wanted, thought, and felt, and was able to control himself when he was in an unpleasant situation. Overall, the subject's social skills after the SST intervention were in the high category.

An integrative treatment model of EMDR and family therapy for children with severe symptomatology after child abuse and neglect: A SCED study

BackgroundChildren who endured child abuse and neglect (CAN) may develop a spectrum of symptoms that goes beyond the development of posttraumatic stress symptoms (PTSS) alone. This can pose unique challenges within the treatment context that may hamper the application of direct trauma-focused treatments. A new treatment model, which focuses on more than PTSS alone, has been developed. Through preparatory work, it aims to engage children in trauma processing. ObjectiveThis study aimed to examine if this integrative treatment model can diminish attachment problems, PTSS, behavior difficulties, and emotional control difficulties in children with a history of CAN who currently reside in permanent placement. Participants & SettingsWe included 15 children between the ages of four and twelve who experienced CAN in the past and who were referred to specialized youth mental health care and their caregivers. MethodsWe conducted a non-concurrent multiple baseline single-case experimental design study with weekly measurements on attachment problems, PTSS, behavior difficulties, and emotional control difficulties through questionnaires. ResultsEight cases were fit to analyze of which all but one participant showed improvement on one or more of the four outcome measures. On group level, we found evidence for functional relationships between the intervention and change in attachment problems, behavioral difficulties, and emotional control difficulties. ConclusionsThis integrative treatment model appears to be a suitable treatment for children with a complex combination of psychiatric problems after CAN and therefore provides promising results for a complex population for whom limited treatment options are available.

Does accelerometry reflect hand function in infants at risk of unilateral cerebral palsy? A secondary analysis of BB-Bim results

BackgroundInfants at high-risk of unilateral Cerebral Palsy (UCP) may have asymmetry in upper extremity movement and function, which should be identified as soon as possible for management. AimsTo explore the feasibility of using two AX3 Axivity monitors in wrist-worn bracelets to quantify movements, and to identify whether accelerometry parameters are consistent with hand function. Methods and procedures6 infants at high risk of UCP (aged 3 to −12 months) were included in a Single-Case Experimental Design to explore the impact of an 8-week bimanual stimulation home program. OutcomesEach week of the baseline (randomized duration 4–7 weeks) and 8-week program, the Hand Assessment for Infants (HAI) was performed and accelerometry parameters were collected during HAI and also during spontaneous activity, several times a week. ResultsActimetry was analyzed during HAI and 238 spontaneous activity sessions (mean 42 ± 21 min). Actimetry ratios distribution and evolution show a high variability, especially for spontaneous activity. No strong correlation was found between HAI scores and accelerometry parameters, either collected during HAI, or during spontaneous activity times. Conclusion and implicationsDespite its feasibility, using accelerometry bracelets looks unreliable for detecting and monitoring hand function in infants under one year.

Mindfulness Meditation According to the Satipatthana Sutta: A Single-Case Study With Participants as Collaborators

ObjectivesWe explored the effects of a mindfulness program based on the satipatthana sutta (instead of a contemporary Western program), with participants as collaborators, using a single-case experimental design. The main question was whether such a training has positive effects and, if so, whether and how the effects vary across participants and measures.MethodParticipants chose the design (multiple baseline) and the measures to be repeatedly collected. Then they took part in a 6-week mindfulness training based on the satipatthana sutta; finally, they performed a preliminary data analysis of their own results. Reported are a selection of the visual analyses, intraindividual effect sizes (Tau-U), and the results of single-case meta-analyses over participants, as well as a multivariate graphical analysis of interindividual differences.ResultsSubstantial training effects were found on average and for the majority of participants for concentration, mind wandering, decentering, positive affect, and well-being. Effects were small for negative affect, and no effects were found for emotion regulation. However, interindividual variation was high, both in respect to specific measures and concerning the overall effect of the training program. Participants' motivation was found to be very high throughout the study.ConclusionOur findings indicate that a traditional mindfulness program yields effects that are roughly comparable to the effects of secular mindfulness training regimens. Regarding participants as collaborators appears to have a strong motivating effect. And finally, the study demonstrates that using single-case experimental designs (instead of group designs) allows for a more fine-grained analysis of meditation effects. The high interindividual variation points to the possibility that the amount of unexplained variance in group studies is severely underestimated. Results from studies like the current one could have benefits for both theoretical advancement and custom-tailored assignment of specific forms of meditation to specific people with specific aims.

Web-based Acceptance and Commitment Therapy (ACT) for adults with type 1 diabetes: A single case experimental design (SCED)

A randomised multiple-baseline single case experimental design (SCED) was used to examine feasibility, acceptability, and preliminary effectiveness of an online Acceptance and Commitment Therapy (ACT) intervention for adults with Type 1 diabetes (T1D). Consenting participants reporting diabetes-specific distress (n = 25) were randomised to baseline length (1–3 weeks) before completing a six-week online ACT intervention, followed by one-month follow-up (FU). The primary outcome assessed generic and diabetes-specific well-being, measured at pre, post, and FU using the Well-Being Questionnaire. Secondary outcomes were: diabetes-dependent quality of life (Audit of Diabetes-Dependent Quality of Life at pre, post, FU); mood and anxiety measured daily using visual analogue scales (VAS); diabetes self-management (daily self-management activities VAS, and pre, post, FU measurements using the Diabetes Self-Management Questionnaire); glycaemic control (information from continuous glucose monitoring devices and daily self-monitoring of blood glucose); and psychological flexibility (Multidimensional Psychological Flexibility Inventory at pre, post, FU). Nine participants completed all phases of the study, rating the intervention as highly acceptable. Most participants showed clinically significant improvements in generic well-being (n = 5) and diabetes-specific well-being (n = 7) at follow-up. Diabetes-dependent QoL reliably improved at follow-up for three participants. Improvements in mood (n = 7) and anxiety (n = 6) were observed across phase comparisons. Most participants reported a significant increase in physical activity (n = 5) across phases. A positive trend of increased time in blood glucose range from baseline to intervention was observed for four participants. Psychological flexibility significantly increased from baseline to follow-up for seven participants. Interpretation of the findings was considered in the context of limitations including high rates of attrition (55%).

Mental Health Literacy Intervention to Reduce Stigma Toward Mental Health Symptoms and Disorders in Women Rugby Players: A Feasibility Study

This feasibility study aimed to evaluate the effectiveness of an educational intervention on stigma toward mental health symptoms and disorders, mental health literacy, and help-seeking intentions among U.K. semielite women rugby players. Seven semielite women rugby players participated. An A-B-A single-case experimental research design was used to assess stigma toward mental health symptoms and disorders, mental health literacy, and help-seeking intentions at baseline, intervention, and follow-up phases. The intervention was successful in enhancing the players’ mental health literacy and reducing stigmatizing attitudes toward seeking professional psychological help. Acknowledging the study’s small sample size, the findings revealed that there is a need for scaffolding to support future developments, advancements, and maintenance of mental health support in women’s rugby. Practical implications of future findings from a larger-scale study may lead to policy reformation across the game to inform and improve systemic mental health support for women rugby players.

Traditional Games: techniques in group guidance for Strengthening Pancasila student profiles in elementary schools

Strengthening the Pancasila student profile is the latest issue in the world of education in Indonesia. All projects and learning methods used aim to shape the character of Pancasila students. This study aims to determine the effectiveness of group guidance using the traditional bilu-bilu game to strengthen the profile of students of Pancasila at SD N 60 Kota Timur. This research is a single case experimental design study with A-B design and involves four respondents using a random sampling method. The instruments used in this study were the Pancasila student profile scale and observation guidelines. The analysis technique used is clinical and statistical analysis. The results showed that there was a significant increase in the profile of Pancasila students through traditional bilu-bilulu games at baseline A1, intervention, and baseline A2. Schools can adapt classic games in guidance and counselling services or in the learning process to strengthen the Pancasila student profile. This study combines group guidance stages with traditional games, allowing students to gain meaningful experiences in each guidance session. The results of this study can be used as a reference for schools to develop group guidance service programs using local wisdom.

Effects of Adaptive Prompts in Virtual Reality-Based Social Skills Training for Children with Autism.

The purpose of this single-case experimental design (SCED) study is to investigate how adaptive prompts in virtual reality (VR)-based social skills training affect the social skills performance of autistic children. Adaptive prompts are driven by autistic children's emotional states. To integrate adaptive prompts in VR-based training, we conducted speech data mining and endorsed micro-adaptivity design. We recruited four autistic children (12-13years) for the SCED study. We carried out alternating treatments design to evaluate the impacts of adaptive and non-adaptive prompting conditions throughout a series of VR-based social skills training sessions. Using mixed-method data collection and analyses, we found that adaptive prompts can foster autistic children's desirable social skills performance in VR-based training. Based on the study findings, we also describe design implications and limitations for future research.

(HIIT-The Track) High-Intensity Interval Training for People with Parkinson's Disease: Individual Response Patterns of (Non-)Motor Symptoms and Blood-Based Biomarkers-A Crossover Single-Case Experimental Design.

Physical exercise is receiving increasing interest as an augmentative non-pharmacological intervention in Parkinson's disease (PD). This pilot study primarily aimed to quantify individual response patterns of motor symptoms to alternating exercise modalities, along with non-motor functioning and blood biomarkers of neuroplasticity and neurodegeneration. People with PD performed high-intensity interval training (HIIT) and continuous aerobic exercise (CAE) using a crossover single-case experimental design. A repeated assessment of outcome measures was conducted. The trajectories of outcome measures were visualized in time series plots and interpreted relative to the minimal clinically important difference (MCID) and smallest detectable change (SDC) or as a change in the positive or negative direction using trend lines. Data of three participants were analyzed and engaging in physical exercise seemed beneficial for reducing motor symptoms. Participant 1 demonstrated improvement in motor function, independent of exercise modality; while for participant 2, such a clinically relevant (positive) change in motor function was only observed in response to CAE. Participant 3 showed improved motor function after HIIT, but no comparison could be made with CAE because of drop-out. Heterogeneous responses on secondary outcome measures were found, not only between exercise modalities but also among participants. Though this study underpins the positive impact of physical exercise in the management of PD, large variability in individual response patterns to the interventions among participants makes it difficult to identify clear exercise-induced adaptations in functioning and blood biomarkers. Further research is needed to overcome methodological challenges in measuring individual response patterns.

A pilot multiple-baseline study of a mobile cognitive behavioral therapy for the treatment of eating disorders in university students.

Eating disorders (EDs) are serious psychiatric disorders associated with substantial morbidity and mortality that are prevalent among university students. Because many students do not receive treatment due to lack of access on university campuses, mobile-health (mHealth) adaptations of evidence-based treatments represent an opportunity to increase treatment accessibility and engagement. The purpose of this study was to test the initial efficacy of Building Healthy Eating and Self-Esteem Together for University Students (BEST-U), which is a 10-week mHealth self-guided cognitive-behavioral therapy (CBT-gsh) app that is paired with a brief 25-30-min weekly telehealth coaching, for reducing ED psychopathology in university students. A non-concurrent multiple-baseline design (N = 8) was used to test the efficacy of BEST-U for reducing total ED psychopathology (primary outcome), ED-related behaviors and cognitions (secondary outcomes), and ED-related clinical impairment (secondary outcome). Data were examined using visual analysis and Tau-BC effect-size calculations. BEST-U significantly reduced total ED psychopathology and binge eating, excessive exercise, and restriction (effect sizes ranged from -0.39 to -0.92). Although body dissatisfaction decreased, it was not significant. There were insufficient numbers of participants engaging in purging to evaluate purging outcomes. Clinical impairment significantly reduced from pre-to-post-treatment. The current study provided initial evidence that BEST-U is a potentially efficacious treatment for reducing ED symptoms and ED-related clinical impairment. Although larger-scale randomized controlled trials are needed, BEST-U may represent an innovative, scalable tool that could reach greater numbers of underserved university students than traditional intervention-delivery models. Using a single-case experimental design, we found evidence for the initial efficacy of a mobile guided-self-help cognitive-behavioral therapy program for university students with non-low weight binge-spectrum eating disorders. Participants reported significant reductions in ED symptoms and impairment after completion of the 10-week program. Guided self-help programs show promise for filling an important need for treatment among university students with an ED.

Virtual Instruction in Teaching Mathematics to Autistic Students: Effects of Video Modeling, Virtual Manipulatives, and Mathematical Games

The purpose of this study was to examine the effects of an online multi-component intervention (video modeling, virtual manipulatives, digital games, self-monitoring and least to most prompting techniques) on the acquisition of several mathematical skills of two autistic elementary school students. We used a multiple probe design of a single-case experimental design across three skills and two autistic elementary students to examine whether a causal relation existed between the intervention and children’s skill acquisition. Both children reached 100% accuracy on all skills by the end of the intervention phase and showed some evidence response generalization and maintenance. The findings add to limited research on online instructional practices in teaching mathematics to autistic children. The intervention involving the use of video modeling instructional clips, virtual manipulatives, guided practice via mathematics games along with self-monitoring and least to most prompting strategies has the potential to help autistic children improve their mathematical skills in a virtual instructional setting.

Neuromuscular Electrical Stimulation in Conjunction with Conventional Swallowing Therapy in the Treatment of Dysphagia Caused by Multiple Sclerosis: A Single-Case Experimental Design

Introduction: Dysphagia as a consequence of multiple sclerosis (MS) puts individuals at higher risk of dehydration, malnutrition, and aspiration pneumonia. This study intended to investigate the effects of a combined program of neuromuscular electrical stimulation (NMES) and conventional swallowing therapy to improve swallow safety and efficiency, oral intake, and physical, emotional, and functional impacts of dysphagia in people with dysphagia and MS. Methods: In this single-case experimental study with ABA design, two participants with dysphagia caused by MS underwent 12 sessions therapy during 6 weeks following a baseline of 4 evaluation sessions. They were evaluated 4 more times in the follow-up phase after therapy sessions. Scores of Mann Assessment of Swallowing Ability (MASA), DYsphagia in MUltiple Sclerosis (DYMUS), and timed test of swallowing capacity were obtained at baseline, during treatment, and in the follow-up phases. The Dysphagia Outcome and Severity Scale (DOSS) based on videofluoroscopic swallow studies, Persian-Dysphagia Handicap Index (Persian-DHI), and Functional Oral Intake Scale (FOIS) were also completed before and after treatment. Visual analysis and percentage of nonoverlapping data were calculated. Results: MASA, DYMUS, FOIS, and DHI scores indicated significant improvement in both participants. Although the scores of the timed test of swallowing capacity in participant 1 (B.N.) and DOSS in participant 2 (M.A.) showed no changes, considerable improvements including reducing the amount of residue and the number of swallows required to clear bolus were seen in the posttreatment videofluoroscopic records of both participants. Conclusion: NMES in conjunction with conventional dysphagia therapy based on motor learning principles could improve the swallowing function and decrease disabling effects of dysphagia on different aspects of life in participants with dysphagia caused by MS.

Individual Participant Data Meta-Analysis Including Moderators: Empirical Validation

We have entered an era in which scientific evidence increasingly informs research practice and policy. As there is an exponential increase in the use of single-case experimental designs (SCEDs) to evaluate intervention effectiveness, there is accumulating evidence available for quantitative synthesis. Consequently, there is a growing interest in techniques suitable to meta-analyze SCED research. One technique that can be applied is individual patient data (IPD) meta-analysis. IPD is a flexible approach, allowing for a variety of modeling options such as modeling moderators to explain intervention heterogeneity. To date, no methodological research has been conducted to evaluate the statistical properties of effect estimates obtained by using IPD meta-analysis with the inclusion of moderators. This study is designed to address this by conducting a large-scale Monte Carlo study. Based on the results, specific recommendations are provided to indicate under which conditions the IPD meta-analysis including moderators is suitable.

A Mobile Self-control Training App to Improve Self-control and Physical Activity in People With Severe Mental Illness: Protocol for 2 Single-Case Experimental Designs

Lack of physical activity is a common issue with detrimental consequences for the health of people with severe mental illness (SMI). Existing physical activity interventions show suboptimal effects as they require substantial cognitive skills, including goal setting and writing, whereas cognitive deficits are common in this population. To bolster the effectiveness of physical activity interventions, self-control training (SCT), in which users practice the ability to override unwanted thoughts and behaviors, can be used in addition. Recent research has demonstrated the initial effectiveness of a mobile SCT app, but this has not been studied in psychiatric clinical practice. This study aims to evaluate to what extent adding a mobile SCT app designed for and with people with SMI to a mobile lifestyle intervention aimed at increasing physical activity increases physical activity and self-control levels. A mixed methods approach incorporating 2 single-case experimental designs (SCEDs) and qualitative interviews was used to evaluate and optimize SCT. Overall, 12 participants with SMI will be recruited from 2 organizations offering outpatient and inpatient care to people with SMI. Each experiment will include 6 patients. SCED I is a concurrent multiple-baseline design across participants that explores initial effectiveness and optimal intervention duration. Using accelerometry and experience sampling questionnaires, participants' physical activity and self-control will be monitored for ≥5 days from baseline, followed by the sequential introduction of Google Fit, the physical activity intervention, for 7 days and the addition of SCIPP: Self-Control Intervention App for 28 days. SCED II is an introduction/withdrawal design in which optimized SCT will be introduced and withdrawn to validate the findings from SCED I. In both experiments, the daily average of total activity counts per hour and the state level of self-control will serve as the primary and secondary outcome measures. Data will be analyzed using visual analysis and piecewise linear regression models. The study was designated as not subject to the Dutch Medical Research Involving Human Subjects Act by the Medical Research Ethical Committee Oost-Nederland and approved by the Ethics Committee/domain Humanities and Social Sciences of the Faculty of Behavioural, Management, and Social Sciences at the University of Twente. Participant recruitment started in January 2022, and we expect to publish the results in early 2023. The mobile SCT app is expected to be feasible and effective. It is self-paced and scalable and can increase patient motivation, making it a suitable intervention for people with SMI. SCED is a relatively novel yet promising method for gaining insights into whether and how mobile apps work that can handle heterogeneous samples and makes it possible to involve a diverse population with SMI without having to include a large number of participants. PRR1-10.2196/37727.

Efficacy of eye movement desensitization and reprocessing therapy for fear of cancer recurrence among cancer survivors: a randomized single-case experimental design

ABSTRACT Background: Fear of cancer recurrence (FCR) is one of the greatest problems with which cancer survivors have to deal. High levels of FCR are characterized by intrusive thoughts about cancer-related events and re-experiencing these events, avoidance of reminders of cancer, and hypervigilance, similar to post-traumatic stress disorder (PTSD). Eye movement desensitization and reprocessing (EMDR) therapy focuses on these images and memories. It is effective in reducing PTSD and may be effective in reducing high levels of FCR. Objective: The aim of the present study is to investigate the effectiveness of EMDR for severe FCR in breast and colorectal cancer survivors. Method: A multiple-baseline single-case experimental design (n = 8) was used. Daily repeated measurements for FCR were taken during the baseline phase and treatment phase, post-treatment, and at the 3 month follow-up. Participants answered the Cancer Worry Scale (CWS) and the Fear of Cancer Recurrence Inventory, Dutch version (FCRI-NL) five times, i.e. at the start and at the end of each phase (baseline, treatment, post-treatment, and follow-up). The study was prospectively registered at clinicaltrials.gov (NL8223). Results: Visual analysis and effect size calculation by Tau-U were executed for the daily questionnaire on FCR. The weighted average Tau-U score was .63 (p < .01) for baseline versus post-treatment, indicating large change, and .53 (p < .01) between baseline and follow-up, indicating moderate change. The scores on the CWS and FCRI-NL-SF decreased significantly from baseline to follow-up. Conclusion: The results seem promising for EMDR therapy as a potentially effective treatment for FCR. Further research is recommended.

Emotionally focused couple therapy in cancer survivor couples with marital and sexual problems: a replicated single-case experimental design.

The current research examined the effect of Emotionally Focused Couples Therapy (EFCT) on perceived intimacy, affect, and dyadic connection in cancer survivor couples with relationship challenges. In this longitudinal replicated single-case study, positive and negative affect, intimacy, partner responsiveness, and expression of attachment-based emotional needs were reported every 3 days before and during treatment. Thirteen couples, with one partner having survived colorectal cancer or breast cancer, participated for the full duration of the study. Statistical analysis of the data was performed using randomization tests, piecewise regression, and multilevel analyses. Adherence to the therapeutic protocol was tested and found adequate. Compared with baseline, significant positive effects on affect variables were found during the therapeutic process. Positive affect increased and negative affect decreased. Partner responsiveness, perceived intimacy, and the expression of attachment-based emotional needs improved, but only in the later phase of treatment. Results at the group level were statistically significant, whereas effects at the individual level were not. This study found positive group-level effects of EFCT on affect and dyadic outcome measures in cancer survivors. The positive results warrant further research, including randomized clinical trials, to replicate these effects of EFCT in cancer survivor couples experiencing marital and sexual problems.

Cognitive behavioural therapy for psychogenic nonepileptic seizures (PNES) in an adult with a learning disability: A case study

AbstractBackgroundPsychogenic nonepileptic seizures (PNES) are attacks that often look like epileptic seizures (ES). Unlike ES, PNES are not triggered by underlying neurological factors. PNES are relatively rare in the general population; however, their prevalence in people with learning disabilities is much higher—up to 10%. Individuals with PNES and learning disabilities often have psychiatric comorbidities, such as anxiety disorders, depression and posttraumatic stress disorder. There are currently no treatment guidelines for PNES in people with or without learning disabilities. However, talking therapies, such as cognitive‐behavioural therapy (CBT), are recommended. This study explores the effectiveness of CBT for the treatment of PNES in a woman (Susan) with PNES and learning disabilities.MethodsWe used a single‐case experimental design (SCED) to investigate the effectiveness of CBT intervention. Specifically, the withdrawal (also known as ABA) design was applied. The patient's average PNES frequency, as well as idiosyncratic mood measure and standardised outcome measures for people with learning disabilities (Glasgow Anxiety Scale for People with an Intellectual Disability and Mini‐Maslow Assessment of Needs Scale‐Learning Disabilities), were used to assess the effectiveness of treatment.FindingsResults show that Susan's monthly PNES frequency reduced from phase A1 (assessment phase) to phase B (treatment phase), and this persisted to the follow‐up phase (phase A2). However, the reduction was not statistically significant. The intervention was associated with improvements in Susan's mood, anxiety and quality of life. Reduction of Susan's anxiety was clinically significant.ConclusionsThis SCED study demonstrates that CBT might be associated with reduction of PNES frequency and improvements in general functioning in people with PNES and learning disabilities; however, further research, especially around confounding variables is needed.

Brief acceptance and commitment therapy for shame among adults with experience of mental health difficulties using a randomized multiple baseline, single case experimental design (SCED).

Brief acceptance and commitment therapy for shame among adults with experience of mental health difficulties using a randomized multiple baseline, single case experimental design (SCED).