Journal of Contemporary Psychotherapy

Thompson, Brian; Luoma, Jason; LeJeune, Jenna

doi: 10.1007/s10879-013-9233-0pmid: N/A

Exposure is considered one of the most effective interventions for PTSD. There is a large body of research for the use of imaginal and in vivo exposure in the treatment of PTSD, with prolonged exposure (PE) therapy being the most researched example. Acceptance and commitment therapy (ACT) has sometimes been called an exposure-based treatment, but how exposure is implemented in ACT for PTSD has not been well articulated. Although support for the use of ACT in PTSD treatment is limited to a handful of case studies and open trials, research suggests ACT is particularly useful in flexibly targeting avoidance behavior—arguably the most important process in the continued maintenance of PTSD symptoms. The purpose of this paper is to explore the use of exposure within ACT in PTSD treatment. Through an overview of PE and ACT, and with the use of case examples, we describe how ACT principles and techniques may inform exposure-based treatments for PTSD in order to create more flexible approaches. In addition, understanding exposure within an ACT framework may also contribute to clarifying processes of change.

Nasser, Jessica

doi: 10.1007/s10879-013-9236-xpmid: N/A

The Task Force on the Promotion and Dissemination of Psychological Procedures sought to identify scientifically supported treatments in order to espouse their use and improve client outcomes in therapy. Nevertheless, the gap between scientists and practitioners persists, and there still remain some limitations to the manner in which this goal is carried out. The criteria specifying whether a treatment qualifies as empirically supported are too lenient. The research used in the search for empirically supported treatments does not take into account the full literature base. Efficacy trials provide practitioners with limited information. This paper proposes means through which the field can improve its search for scientifically supported treatments. Alterations to the criteria that assess empirically supported treatments, greater research transparency and external validity, and collaboration between investigators and clinicians will allow the field of clinical psychology to better answer the question, “How can we most successfully treat this client?”

Heiden, Colin; Melchior, Kim; Stigter, Ella

doi: 10.1007/s10879-013-9235-ypmid: N/A

Generalised anxiety disorder (GAD) responds well to individually delivered metacognitive therapy (MCT). The current study investigated the effectiveness of MCT administered to groups of patients with GAD in a general outpatient treatment centre. Thirty-three consecutively referred adult patients with GAD were assessed before treatment (pretreatment), after the last treatment session (posttreatment), and six months after treatment had ended (follow-up). Analyses of treatment effects were conducted for all patients entering the study (i.e., intent-to-treat analysis, using the last-observation-carried-forward procedure), and repeated for the patients who completed treatment (completers analysis), using paired samples t-tests. Further, effect sizes (ESs) and indices of clinical significance were calculated, and compared with those reported in studies into the efficacy and effectiveness of individually delivered MCT for GAD. Among both the intent-to-treat and the completers sample, large pre- to posttreatment reductions in symptoms of worry, trait-anxiety, and general psychopathology. The magnitude of change and the degree of clinical significance were smaller than those reported in studies into the effectiveness of individually delivered MCT for GAD, whereas the attrition rate (27 %) was higher. It is tentatively concluded that MCT for GAD can be effectively delivered in a group format in a heterogenous clinical practice setting. Further evaluation is clearly indicated.

Vandenberghe, Luc; Silveira, Jocelaine

doi: 10.1007/s10879-012-9230-8pmid: N/A

This article discusses how the way the therapist relates to his or her personal responses to client material during the session contributes to making the relationship with the client an effective tool for treatment. Ideas from third wave behavior therapy are used to describe aspects of therapist involvement in the relationship and modes of therapist awareness of inner responses. In two vignettes, negative client reactions to an intervention bring problematic therapist material to the fore. Both cases highlight how the stories the therapists spun about themselves as professionals and persons could easily have limited their effectiveness in responding to the material. The vignettes also illustrate how clinicians can overcome personal meanings and judgments to access a more productive mode of interacting with the feelings a critical incident in the relationship evokes in them. It is argued that observing their own content from a psychological distance makes it possible for clinicians to use their feelings without getting caught up in them. These same feelings may then help the therapist perceive how the incident relates to the client’s daily life problems. The therapist’s engagement in a sense of self-as-context is described as a therapeutic stance that provides the psychological distance needed to help overcome alliance ruptures and other potential gridlocks and which may transform the therapist’s inner response to client content into a tool for addressing important client issues.

Larsson, Billy; Broberg, Anders; Kaldo, Viktor

doi: 10.1007/s10879-013-9231-2pmid: N/A

This study investigates a possible threat to the progress of psychotherapy. It aims to detect and compare stereotyped or even prejudiced views among psychotherapists of different theoretical orientations, building on social psychological theory of in-groups and out-groups. Swedish psychotherapists (n = 416) of four different orientations (psychodynamic, cognitive, behavioural, or integrative/eclectic) used the valuable elements in psychotherapy questionnaire to rate the importance of various elements in psychotherapy. They also estimated how therapists of other orientations would rate these elements. These estimates were then compared with therapists’ actual self-ratings in order to detect patterns of stereotyping or prejudiced views. Psychotherapists exaggerate the differences between their own and other orientations in a stereotyped way, but correctly predict what members of their own orientation (in-group) find important. However, they overestimate how important ‘orientation-typical features’ are to those of other orientations (out-group), indicating a clear tendency to stereotype. Overall, integrative/eclectic therapists’ estimates were less stereotyped than the estimates of therapists of other orientations. A somewhat unexpected finding was that cognitive and behavioural therapists seem more inclined towards stereotyping. The stereotyped views of other theoretical orientations among psychotherapists can be argued to have negative connotations and may thus be seen as prejudices. These prejudices could create irrational and unnecessary obstacles to the development of both the science and the practice of psychotherapy and signal the need for psychotherapists of all orientations to develop a more balanced picture of each other.

Sulkowski, Michael; Jacob, Marni; Storch, Eric

doi: 10.1007/s10879-013-9234-zpmid: N/A

Obsessive-compulsive spectrum disorders (OCSDs) have compulsive (i.e., anxiety reductive) and impulsive (i.e., driven by emotional or involuntary impulses) features. The best established psychological treatments for these disorders are behavioral/cognitive-behavioral in nature. More specifically, exposure and response prevention (ERP) (with or without cognitive therapy) and habit reversal training (HRT) are commonly indicated in the treatment of OCSDs. This paper reviews the use of various components of these therapeutic approaches to treat compulsive and impulsive symptomology in individuals with variants of these disorders. Specifically, ERP monotherapy for compulsive (e.g., obsessive-compulsive, body dysmorphic) and impulsive symptoms (e.g., tics, trichotillomania) is discussed as well as a combined treatment approach that integrates elements of ERP and HRT for individuals displaying mixed symptomology. A case example is also provided that illustrates the successful application of various components of ERP and HRT to treat OCSD symptoms. Lastly, other potential OCSD treatments are discussed.

Bachi, Keren

doi: 10.1007/s10879-013-9232-1pmid: N/A

Equine-facilitated psychotherapy (EFP) is a form of animal-assisted therapy used to treat human psychological problems that employs horses in and around the natural surroundings of the stables. Despite the increasing number of professionals and organizations that offer this innovative therapy, EFP lacks a firm theoretical and research base. This paper aims to reveal how attachment theory can inform and enrich theory and practice of EFP. It explores the fit between central features of EFP and several of the primary concepts of attachment-based psychotherapy, such as: secure base and haven of safety through the provision of a holding environment, affect mirroring, mentalizing and reflective functioning, and non-verbal communication and body experience. This work is composed of definitions of these concepts, their application to human–horse context and EFP, and interpretation in light of potential therapeutic (transformative) processes.