Otto / Hofmann Avoiding Treatment Failures in the Anxiety Disorders

1. Auflage 2009
ISBN: 978-1-4419-0612-0
Verlag: Springer US
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 405 Seiten

Reihe: Series in Anxiety and Related Disorders

Extensive studies have shown cognitive-behavioral therapy to be highly effective in treating anxiety disorders, improving patients' social functioning, job performance, and quality of life. Yet every CBT clinician faces some amount of client resistance, whether in the form of 'This won't work', 'I'm too depressed', or even 'You can't make me!' Avoiding Treatment Failures in the Anxiety Disorders analyzes the challenges presented by non-compliance, and provides disorder- and population-specific guidance in addressing the impasses and removing the obstacles that derail therapy. Making use of extensive clinical expertise and current empirical findings, expert contributors offer cutting-edge understanding of the causes of treatment complications-and innovative strategies for their resolution-in key areas, including: The therapeutic alliance The full range of anxiety disorders (i.e., panic, PTSD, GAD) Comorbidity issues (i.e., depression, personality disorders, eating disorders, substance abuse, and chronic medical illness) Combined CBT/pharmacological treatment Ethnic, cultural, and religious factors Issues specific to children and adolescents. Both comprehensive, and accessible, Avoiding Treatment Failures in the Anxiety Disorders will be welcomed by new and seasoned clinicians alike. The window it opens onto this class of disorders, plus the insights into how and why this treatment works, will also be of interest to those involved in clinical research.

Michael W. Otto, Ph.D., Professor of Psychology, Boston University.  Dr. Otto specializes in the cognitive-behavioral treatment of anxiety, mood, and substance use disorders, and has developed clinical-research programs for the treatment of panic disorder, posttraumatic stress disorder, social phobia, bipolar disorder, psychotic disorders, substance dependence, and medication discontinuation in patients with panic disorder. Dr. Otto's research activities are closely tied to his clinical interests and target investigations of the etiology and treatment of anxiety, mood, and substance-use disorders. Of particular interest to Dr. Otto is the development and testing of new treatments, including the combination of pharmacologic and cognitive-behavioral strategies for treatment-refractory and substance abusing patients, and the modification of treatment packages for novel populations (e.g., Cambodian refugees). He has published over 200 articles, book chapters, and books spanning these research interests. Dr. Otto is President-Elect for the Association for Advancement of Behavior Therapy, a fellow of the American Psychological Association, and a member of the Scientific Advisory Board for the Anxiety Disorders Association of America. He also serves as a section editor for Cognitive and Behavioral Practice, and on the editorial boards of Anxiety, Behavior Research and Therapy, Clinical Psychology: Science and Practice, Journal of Anxiety Disorders, Journal Watch in Psychiatry, and Psychotherapy and Psychosomatics. Dr. Otto is a regular provider of continuing education and continuing medical education workshops across the United States and abroad. Stefan G. Hofmann, Ph.D., is professor of psychology at Boston University. He was born in Germany and lives with his wife and two children in Boston, Massachusetts. He is an expert on anxiety disorders. His scientific work has been supported by grants from the National Institute of Mental Health and various private foundations. His research focuses on the mechanisms of treatment change and the effects of emotion regulation strategies on psychological well-being. He is the former editor for Cognitive and Behavioral Practice, and associate editor for Cognitive Behavioral Therapy, the International Journal of Psychology, and the International Journal of Cognitive Therapy. He has published more than 150 scientific papers and 6 books, including including 'Cognitive Behavioral Therapy for Social Anxiety Disorder: Evidence-Based and Disorder-Specific Treatment Techniques,' 'From Social Anxiety to Social Phobia: Multiple Perspectives,' 'Treating Chronic and Severe Mental Disorders: A Handbook of Empirically Supported Treatments,' and 'The Art and Science of Psychotherapy.' He also works as a psychotherapist using Cognitive Behavioral Therapy.

Autoren/Hrsg.

Otto, Michael

Hofmann, Stefan

Inhaltsverzeichnis

1;Preface;6
2;Contents;7
3;Contributors;9
4;Part I General Aspects of Treatment Complications;12
4.1;Introduction;13
4.1.1;References;15
4.2;A Case Formulation Approach to Resolve Treatment Complications;16
4.2.1; Using Cognitive Behavioral Case Formulation to Resolve Treatment Complications;17
4.2.1.1; Problem List;17
4.2.1.2; Five-Axis DSM Diagnoses;19
4.2.1.3; Primary Diagnosis;20
4.2.1.4; Nomothetic Formulation;21
4.2.1.5; Individualize the Formulation;23
4.2.1.6; Hypotheses About the Basis of Mechanisms Maintaining the Disorder;24
4.2.1.7; Precipitants of Illness;26
4.2.2; Using Different Modalities of Case Formulation to Resolve Treatment Complications;28
4.2.3; Using Case Formulation to Decide to Add or Change Treatment Strategies;30
4.2.3.1; Treatment Complication 1: Lack of Motivation or Difficulty with Follow-Through;31
4.2.3.2; Treatment Complication 2: Interpersonal Problems;32
4.2.3.3; Treatment Complication 3: Emotion Regulation Difficulties;32
4.2.3.4; Treatment Complication 4: Difficulties with Relaxation and Acceptance;33
4.2.3.5; Treatment Complication 5: Information Processing Biases and Rigid Thinking;34
4.2.3.6; Treatment Complication 6: Low Self-Efficacy and Losing Treatment Gains;35
4.2.4; Conclusion;35
4.2.5;References;36
4.3;Helping Exposure Succeed: Learning Theory Perspectives on Treatment Resistance and Relapse;40
4.3.1; Exposure Is New Learning;40
4.3.2; Context Effects;43
4.3.3; Safety Behaviors;46
4.3.4; Considering Exposure Parameters;49
4.3.4.1; Exposure Duration and Spacing;49
4.3.4.2; Distribution of Sessions;50
4.3.4.3; Stimulus Properties (Imaginal, In Vivo, Virtual Reality);51
4.3.4.4; Gradation of Exposure;51
4.3.4.5; Fear Activation;52
4.3.4.6; Focus of Attention and Behavior During Extinction;52
4.3.5; Concluding Comments;53
4.3.6;References;54
4.4;Therapeutic Alliance and Common Factors in Treatment;59
4.4.1; The Concept of Therapeutic Alliance;60
4.4.2; Empirical Support for the Therapeutic Alliance;60
4.4.3; Motivation for Treatment;63
4.4.4; Role Expectancies;64
4.4.5; Outcome Expectancies;65
4.4.6; Empirical Support for Patient Expectancies;65
4.4.7; Changing Expectancies;67
4.4.8; Post-treatment Expectancies: Attributions About Treatment Gains;67
4.4.9; Treatment Adherence;69
4.4.10; Summary and Conclusions;70
4.4.11;References;70
4.5;Combined Cognitive Behavioral and Pharmacologic Treatment Strategies: Current Status and Future Directions;75
4.5.1; The Efficacy of Cognitive-Behavioral and Pharmacological Treatments;75
4.5.2; The Efficacy of Acute-Phase Combined Treatments;76
4.5.3; Outcomes After Treatment Discontinuation;78
4.5.4; Possible Mechanisms of Relapse Following Discontinuation of Combined Treatments;79
4.5.5; Starting CBT as a Strategy for Discontinuation of Pharmacotherapy;80
4.5.6; Starting CBT when Pharmacotherapy Fails;81
4.5.7; Starting Pharmacotherapy when CBT Fails;81
4.5.8; Clinical Considerations;81
4.5.9; Novel Combination Strategies;84
4.5.10;References;85
4.6;Cultural Considerations and Treatment Complications;90
4.6.1; Introduction;90
4.6.2; Prevalence of Psychological Disorders Among Ethnic and Racial Minorities;91
4.6.3; Culture and Treatment Complications;93
4.6.3.1; Culture and Treatment Resistance;93
4.6.3.2; Culture and Language;95
4.6.3.3; Culture and Idioms of Distress;96
4.6.4; Resolving Treatment Complications;98
4.6.4.1; Culturally Appropriate Psychological Assessment;98
4.6.4.2; Culturally Appropriate Treatment Adaptations;99
4.6.5; Conclusion;103
4.6.6;References;103
5;Part II Avoiding Treatment Failures: Disorder-Specific Perspectives;108
5.1;Avoiding Treatment Failures in Panic Disorder;109
5.1.1; Core Elements of Treatment;111
5.1.2; Non-essential Elements of Treatment;113
5.1.3; Format of Treatment;114
5.1.4; Treatment Example Interoceptive Exposure;114
5.1.5; Efficacy of CBT Treatment;117
5.1.6; Depression Comorbidity and Treatment Resistance;118
5.1.7; Comorbid Anxiety Disorders and Treatment Resistance;119
5.1.8; Alcohol and Substance Use and Treatment Resistance;120
5.1.9; Personality Disorders and Treatment Resistance;121
5.1.10; Medical Factors;122
5.1.11; Life Stressors;122
5.1.12; Addressing Inadequate Treatment Response;122
5.1.13; Other Psychosocial Treatments;125
5.1.14; Medication Treatments;125
5.1.15; Conclusions;126
5.1.16;References;126
5.2;Avoiding Treatment Failures in Obsessive Compulsive Disorder;131
5.2.1; The Case of Maria: Only a Horrible Mother Would Have These Thoughts;131
5.2.2; Overview of Obsessive-Compulsive Disorder;132
5.2.2.1; Comorbidities;133
5.2.2.2; Diagnostic Challenges;134
5.2.3; Treatment for OCD;136
5.2.3.1; Overview of CBT Strategies;136
5.2.3.2; Treatment Response;138
5.2.3.3; Predictors of Treatment Non-response;139
5.2.3.4; Challenges in Treatment Delivery for OCD;141
5.2.3.5; Future Developments;145
5.2.3.6;References;146
5.3;Avoiding Treatment Failures in PTSD;152
5.3.1; Introduction;153
5.3.2; Core Components of PTSD Treatment;154
5.3.3; Challenges Clinicians May Encounter when Implementing CBT for PTSD;155
5.3.4; Using the Case Formulation Approach to Guide Treatment;157
5.3.4.1; Case Formulation;158
5.3.5; Strategies and Tools for Troubleshooting;159
5.3.5.1; Handling Multiple Trauma Memories;159
5.3.5.2; The Influence of Other Emotions: Sadness, Guilt, Shame, and Anger;161
5.3.5.2.1; Sadness;161
5.3.5.2.2; Shame and Guilt;162
5.3.5.2.3; Anger;163
5.3.5.2.4; Overcoming Guilt, Shame, and Anger;163
5.3.5.3; Facilitating Affect Regulation;164
5.3.5.4; Working Through Psychosocial Crises;165
5.3.5.5; Substance Use Disorders;166
5.3.5.6; Titrating Engagement with Emotions During Exposure Therapy;167
5.3.6; Summary;169
5.3.7;References;169
5.4;Avoiding Treatment Failures in Social Anxiety Disorder;174
5.4.1; The Case of Paul;174
5.4.1.1; Psychosocial History;174
5.4.1.2; Diagnostic Information;175
5.4.1.3; Case Conceptualization;175
5.4.2; Psychological Interventions;177
5.4.3; Potential Predictors of Poor Treatment Response;180
5.4.3.1; Generalized Subtype and Avoidant Personality Disorder;180
5.4.3.2; Depression;181
5.4.3.3; Social Skills;181
5.4.4; Core Elements of Treatment and Common Sticking-Points in Therapy;181
5.4.4.1; Motivation for Therapy;182
5.4.4.2; Challenging Cognitive Errors;183
5.4.4.3; Eliminating Avoidance Behaviors;184
5.4.5; Flexibility for Dealing with Challenging Cases;185
5.4.6; Summary;186
5.4.7;References;186
5.5;Avoiding Treatment Failures in Generalized Anxiety Disorder;190
5.5.1; Resolving Treatment Complications in Generalized Anxiety Disorder;190
5.5.2; Predictors of Response to Treatment;191
5.5.3; Theoretical Conceptualization of Worry;192
5.5.4; Self-Monitoring;194
5.5.5; Relaxation Training;196
5.5.6; Self-Control Desensitization;198
5.5.7; Stimulus Control;198
5.5.8; Cognitive Therapy;199
5.5.9; Interpersonal and Emotional Processing;204
5.5.10; Future Directions;208
5.5.11;References;210
5.6;Avoiding Treatment Failures in Specific Phobias;214
5.6.1; Treatment Complications in Specific Phobias;214
5.6.1.1; The Origin of Specific Phobias;215
5.6.1.2; Differential Diagnosis and Comorbidity;216
5.6.1.3; Gold Standard for Therapy: Exposure;217
5.6.1.4; Efficacy of Exposure;217
5.6.2; Core Elements of CBT;219
5.6.2.1; Cognitive Preparation or Psychoeducation;219
5.6.2.2; Exposure to Fear Cues;220
5.6.2.3; A Case Example: Treating Spider Phobia;220
5.6.3; Factors that May Interfere with Exposure Success;221
5.6.3.1; Treatment Engagement;221
5.6.3.2; Duration of Exposure;221
5.6.3.3; Multiple Phobias;222
5.6.3.4; When Other Unpleasant Emotions/Sensations Come into Play;222
5.6.3.5; When Skill Deficits Accompany the Phobia;223
5.6.3.6; When Anticipation Is Worse than Exposure;224
5.6.3.7; When Patients Use Cognitive Avoidance During Exposure;224
5.6.3.8; Vigilance to Threat;225
5.6.3.9; When Self-Report Is Not Predictive of Emotional Processing;225
5.6.3.10; Enhancing Memory of Success;226
5.6.4; Conclusion;226
5.6.5;References;227
6;Part III Treatment Complications in Special Populations;233
6.1;Resolving Treatment Complications Associated with Comorbid Depression;234
6.1.1; The Impact of Comorbid Depression on Treatment for Anxiety;234
6.1.2; The Impact of Comorbid Depression;235
6.1.3; Impact of Comorbid Depression on Anxiety Treatment Outcome;236
6.1.3.1; Panic Disorder;236
6.1.3.2; Social Anxiety Disorder;237
6.1.3.3; OCD;238
6.1.3.4; PTSD;239
6.1.3.5; Conclusions from the Treatment Outcome Literature;239
6.1.4; Impact of CBT for Anxiety Disorders on Depression Symptoms;240
6.1.5; Treatment Considerations for Comorbid Anxiety and Depression;242
6.1.6; Box 1 Case Examples;243
6.1.7; Box 2 Using Exposure Principles to Target Maladaptive Beliefs;246
6.1.8; Concluding Comments;247
6.1.9;References;248
6.2;Resolving Treatment Complications Associated with the Presence of Comorbid Personality Disorders;253
6.2.1; The Nature of Personality Disorders;254
6.2.2; Comorbidity of Personality Disorders and Anxiety Disorders;256
6.2.3; Complications Associated with the Presence of a Comorbid Personality Disorder;258
6.2.4; Resolving Treatment Complications;260
6.2.5; Conclusion;266
6.2.6;References;267
6.3;Resolving Treatment Complications Associated with Comorbid Anxiety and Substance Use Disorders;272
6.3.1; Link Between Anxiety Disorders and Substance Use Disorders;273
6.3.2; Recommendations from Assessment through Treatment;274
6.3.2.1; Assessment Issues;275
6.3.2.1.1; Temporal and Functional Relationship Between Anxiety Disorders and SUDs;275
6.3.2.1.2; Specificity Across Disorder Categories;276
6.3.2.1.3; Selection of Assessment Measures;277
6.3.2.2; Treatment;280
6.3.2.2.1; Willingness to Change;280
6.3.2.2.2; Issues to Consider in Combining Stand-Alone Treatments for Anxiety Disorders and SUDs;282
6.3.2.2.3; Specialized Integrative Treatments;283
6.3.2.2.4; Case Illustrations;285
6.3.2.3;References;287
6.4;Resolving Treatment Complications Associated with Comorbid Eating Disorders;292
6.4.1; Introduction;292
6.4.2; Likelihood of Encountering Anxiety Patients with Co-occurring EDs;292
6.4.3; Assessment of EDs in Anxiety Patients;295
6.4.4; Overview of Empirically Supported and Promising Treatments for EDs;299
6.4.4.1; CBT-BN and CBT-E;300
6.4.4.2; Commonly Used CBT Strategies for Treating EDs and General Treatment Issues;301
6.4.4.3; Other ED Treatments with Empirical Support;303
6.4.5; Using the Case Formulation Approach to Guide Treatment Planning for Anxiety Patients with Comorbid EDs;304
6.4.6; OCD Case Example;304
6.4.6.1; Case Description;304
6.4.6.2; Case Formulation;306
6.4.6.3; Treatment Plan;308
6.4.7; Social Phobia Case Example;309
6.4.7.1; Case Description;309
6.4.7.2; Treatment Plan;312
6.4.8; Ordering of Treatment: Factors to Consider;312
6.4.9; Conclusion;314
6.4.10;References;314
6.5;Resolving Treatment Complications Associated with Comorbid Medical Conditions;318
6.5.1; Introduction;318
6.5.2; Anxiety Comorbid with Cancer;320
6.5.2.1; Cancer-Related Symptoms, Treatment Side Effects, and Quality of Life;322
6.5.2.2; Psychological Interventions for Anxiety Comorbid with Cancer;323
6.5.2.3; Complications in Treating Anxiety Comorbid with Cancer;323
6.5.2.4; Resolving Treatment Complications for Anxiety Comorbid with Cancer;324
6.5.3; Anxiety Comorbid with Coronary Heart Disease;326
6.5.3.1; Anxiety as Risk Factor for Coronary Heart Disease;327
6.5.3.2; Persistent Effects of Anxiety and Quality of Life in Patients with Coronary Heart Disease;328
6.5.3.3; Psychological Interventions for Anxiety Comorbid with Coronary Heart Disease;328
6.5.3.4; Complications in Treating Anxiety Comorbid with Coronary Heart Disease;329
6.5.3.5; Resolving Treatment Complications for Anxiety Comorbid with Coronary Heart Disease;330
6.5.4; Anxiety Comorbid with Asthma;332
6.5.4.1; Hypotheses for Comorbidity Between Asthma and Anxiety Disorders;333
6.5.4.2; Effect of Anxiety on Quality of Life Related to Asthma;334
6.5.4.3; Psychological Interventions for Anxiety Comorbid with Asthma;335
6.5.4.4; Treatment Complications for Anxiety Comorbid with Asthma;335
6.5.4.5; Resolving Treatment Complications for Anxiety Comorbid with Asthma;336
6.5.5; Summary and Conclusions;337
6.5.6;References;338
6.6;Resolving Treatment Complications in Children and Adolescents;348
6.6.1; Comorbidity;349
6.6.2; Treating Comorbid Anxiety and Depressive Disorders;349
6.6.2.1; Prevalence;349
6.6.3; Patient Characteristics and Treatment Response;350
6.6.4; Modifications for Treating Children with Comorbid Depression;351
6.6.4.1; Case Example;352
6.6.5; Treating Comorbid Anxiety and Externalizing Disorders;353
6.6.5.1; Prevalence;353
6.6.6; Patient Characteristics and Treatment Response;354
6.6.7; Modifications for Treating Comorbid ADHD and ODD;355
6.6.7.1; Case Example;356
6.6.8; Parenting Behaviors and Parental Anxiety;358
6.6.9; Parenting Behavior and Child Anxiety;359
6.6.9.1; Warmth and Control;359
6.6.10; Parental Modeling and Communications About Threat;360
6.6.11; Parenting-Based Modifications and Treatment Response;361
6.6.11.1; Case Example;362
6.6.12; Additional Complicating Factors in Child Anxiety Treatment;364
6.6.13; Sociodemographic Characteristics;365
6.6.14; ParentChild Symptom Agreement;365
6.6.15; Summary and Future Directions;366
6.6.16;References;367
7;Index;372