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Using targeted cognitive behavioural therapy in clinical work: a case study

Published online by Cambridge University Press:  14 January 2021

Olivia Harris ,
Claudia Kustner ,
Rachel Paskell  and
Chris Hannay
Olivia Harris*
Affiliation:
Department of Psychology, University of Bath, BathBA2 7AY, UK
Claudia Kustner
Affiliation:
Berkshire Healthcare NHS Foundation Trust, BracknellRG12 1BQ, UK
Rachel Paskell
Affiliation:
Department of Psychology, University of Bath, BathBA2 7AY, UK
Chris Hannay
Affiliation:
Greenway Centre, Avon and Wiltshire Mental Health Partnership NHS Foundation Trust, UK
*
*Corresponding author. Email: oh396@bath.ac.uk
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Abstract

Research shows high levels of complex co-morbidities within psychiatric populations, and there is an increasing need for mental health practitioners to be able to draw on evidence-based psychological interventions, such as cognitive behavioural therapy (CBT), to work with this population effectively. One way CBT may be utilised when working with complexity or co-morbidity is to target treatment at a particular aspect of an individual’s presentation. This study uses a single-case A-B design to illustrate an example of using targeted diagnosis-specific CBT to address symptoms of a specific phobia of stairs in the context of a long-standing co-morbid diagnosis of schizophrenia. Results show the intervention to have been effective, with a change from a severe to mild phobia by the end of intervention. Clinical implications, limitations and areas for future research are discussed.

Key learning aims

  1. (1) There are high levels of co-morbid, complex mental health problems within psychiatric populations, and an increasing need for mental health practitioners to be able to work with co-morbidity effectively.

  2. (2) Cognitive behavioural therapy (CBT) remains one of the most well-evidenced psychological interventions with a large amount of research highlighting the effectiveness of diagnosis-specific CBT.

  3. (3) One way evidence-based diagnosis-specific CBT approaches could be utilised when working with more complex co-morbidity may be to target an intervention at a specific set of symptoms.

  4. (4) An example of using a targeted CBT intervention (to tackle a specific phobia of stairs in the context of a long-standing co-morbid diagnosis of schizophrenia and ongoing hallucinations) is presented. The outcomes show significant changes in the specific phobia symptoms, suggesting that CBT can be effectively used in this targeted manner within real-world clinical settings. The impact of co-morbid mental health difficulties on therapeutic process and outcomes are highlighted.

  5. (5) The use of cognitive restructuring techniques was identified as key to engagement and therapeutic process, supporting the importance of including cognitive techniques in the treatment of phobias compared with purely behavioural exposure-based interventions.

Keywords

case formulationCBTcognitive behavioural interventionschizophreniaspecific phobia
Type
Case Study
Information
the Cognitive Behaviour Therapist , Volume 14 , 2021 , e2
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2021

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References

Further reading

Braga, R. J., Reynolds, G. P., & Siris, S. G. (2013). Anxiety comorbidity in schizophrenia. Psychiatry Research, 210, 1–7.CrossRefGoogle Scholar
Choy, Y., Fyer, A. J., & Lipsitz, J. D. (2007). Treatment of specific phobia in adults. Clinical Psychology Review, 27, 266–286.CrossRefGoogle ScholarPubMed
Good, J. (2002). The effect of treatment of a comorbid anxiety disorder on psychotic symptoms in a patient with a diagnosis of schizophrenia: A case study. Behavioural and Cognitive Psychotherapy, 30, 347–350.CrossRefGoogle Scholar
Wolitzky-Taylor, K. B., Horowitz, J. D., Powers, M. B., & Telch, M. J. (2008). Psychological approaches in the treatment of specific phobias: a meta-analysis. Clinical Psychology Review, 28, 1021–1037.CrossRefGoogle ScholarPubMed

References

Allen, L. B., White, K. S., Barlow, D. H., Shear, M. K., Gorman, J. M., & Woods, S. W. (2010). Cognitive-Behavior therapy (CBT) for panic disorder: relationship of anxiety and depression comorbidity with treatment outcome. Journal of Psychopathology and Behavioral Assessment, 32, 185–192.CrossRefGoogle ScholarPubMed
Bauer, I., Wilansky-Traynor, P., & Rector, N. A. (2012). Cognitive-Behavioral therapy for anxiety disorders with comorbid depression: a review. International Journal of Cognitive Therapy, 5, 118–156.CrossRefGoogle Scholar
Botella Arbona, C., Bretón-López, J., Serrano Zárate, B., García-Palacios, A., Quero, S., & Baños Rivera, R. M. (2014). Treatment of flying phobia using virtual reality exposure with or without cognitive restructuring: participants’ preferences. Revista de Psicopatología y Psicología Clínica, 19, 157–169.Google Scholar
Choy, Y., Fyer, A. J., & Lipsitz, J. D. (2007). Treatment of specific phobia in adults. Clinical Psychology Review, 27, 266–286.CrossRefGoogle ScholarPubMed
Craske, M., Wittchen, U., Bogels, S., Stein, M., Andrews, G., & Lebeu, R. (2013). Severity Measure for Specific Phobia – Adult. Arlington, VA: American Psychiatric Publishing.Google Scholar
DeVylder, J. E., Burnette, D., & Yang, L. H. (2014). Co-Occurrence of psychotic experiences and common mental health conditions across four racially and ethnically diverse population samples. Psychological Medicine, 44, 3503–3513.CrossRefGoogle ScholarPubMed
Dudley, R., Dixon, J., & Turkington, D. (2005). CBT for a person with schizophrenia: systematic desensitization for phobias led to positive symptom improvement. Behavioural and Cognitive Psychotherapy, 33, 249–254.CrossRefGoogle Scholar
Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. A., Riggs, D. S., Feeny, N. C., & Yadin, E. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73, 953–964.CrossRefGoogle ScholarPubMed
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive Therapy and Research, 36, 427–440.CrossRefGoogle ScholarPubMed
Jauhar, S., McKenna, P. J., Radua, J., Fung, E., Salvador, R., & Laws, K. R. (2014). Cognitive–behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. British Journal of Psychiatry, 204, 20–29.CrossRefGoogle ScholarPubMed
Kayrouz, R., & Vrklevski, L. P. (2015). Fatal torment – from psychosis-driven index offence to trauma: a case study in forensic psychotherapy, trauma therapy and matricide. Australasian Psychiatry, 23, 54–58.CrossRefGoogle ScholarPubMed
Kennerley, H., Kirk, J., & Westbrook, D. (2016). An Introduction to Cognitive Behaviour Therapy: Skills and Applications. London, UK: Sage.Google Scholar
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005a). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 593–602.CrossRefGoogle ScholarPubMed
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005b). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 617–627.CrossRefGoogle ScholarPubMed
Kiran, C., & Chaudhury, S. (2016). Prevalence of comorbid anxiety disorders in schizophrenia. Industrial Psychiatry Journal, 25, 35–40.Google Scholar
Kirk, J. & Rouf, K. (2004). Specific phobias. In Bennett-Levy, J., Butler, G., Fennell, M., Hackmann, A., Mueller, M., & Westbrook, D. (eds), Oxford Guide to Behavioural Experiments in Cognitive Therapy (pp. 161–181). Oxford, UK: Oxford University Press.CrossRefGoogle Scholar
Kuyken, W., Padesky, C. A., & Dudley, A. (2017). Collaborative Case Conceptualisation: Working Effectively with Clients in Cognitive-Behavioural Therapy. New York, USA: Guildford Press.Google Scholar
LeBouthillier, D. M., & Asmundson, G. J. G. (2017). The efficacy of aerobic exercise and resistance training as transdiagnostic interventions for anxiety-related disorders and constructs: a randomized controlled trial. Journal of Anxiety Disorders, 52, 43–52. doi: 10.1016/j.janxdis.2017.09.005 CrossRefGoogle ScholarPubMed
Lenzenweger, M. F., Lane, M. C., Loranger, A. W., & Kessler, R. C. (2007). DSM-IV personality disorders in the national comorbidity survey replication. Biological Psychiatry, 62, 553–564.CrossRefGoogle ScholarPubMed
Li, S. H., & Graham, B. M. (2020). Progesterone levels predict reductions in behavioral avoidance following cognitive restructuring in women with spider phobia. Journal of Affective Disorders, 270, 1–8.CrossRefGoogle ScholarPubMed
Marks, I. M., & Mathews, A. M. (1979). Brief standard self-rating for phobic patients. Behaviour Research and Therapy, 17, 263–267.CrossRefGoogle ScholarPubMed
Mattick, R. P., Peters, L., & Clarke, J. C. (1989). Exposure and cognitive restructuring for social phobia: a controlled study. Behavior Therapy, 20, 3–23.CrossRefGoogle Scholar
Mogg, K., & Bradley, B. P. (2006). Time course of attentional bias for fear-relevant pictures in spider-fearful individuals. Behaviour Research and Therapy, 44, 1241–1250. doi: 10.1016/j.brat.2006.05.003 CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (2013). Social Anxiety Disorder: Recognition, Assessment and Treatment. Retrieved from: https://www.nice.org.uk/guidance/CG159 (accessed 12 September 2020).Google Scholar
Nock, M. K., Hwang, I., Sampson, N. A., & Kessler, R. C. (2010). Mental disorders, comorbidity and suicidal behavior: results from the national comorbidity survey replication. Molecular Psychiatry, 15, 868–876.CrossRefGoogle ScholarPubMed
Pearl, S. B., & Norton, P. J. (2017). Transdiagnostic versus diagnosis specific cognitive behavioural therapies for anxiety: a meta-analysis. Journal of Anxiety Disorders, 46, 11–24.CrossRefGoogle ScholarPubMed
Raes, A. K., Koster, E. H. W., Loeys, T., & De Raedt, R. (2011). Pathways to change in one-session exposure with and without cognitive intervention: an exploratory study in spider phobia. Journal of Anxiety Disorders, 25, 964–971. doi: 10.1016/j.janxdis.2011.06.003 CrossRefGoogle ScholarPubMed
Shafran, R., Booth, R., & Rachman, S. (1993). The reduction of claustrophobia – a cognitive analysis. Behaviour Research and Therapy, 31, 75–85. doi: 10.1016/0005-7967(93)90045-v CrossRefGoogle Scholar
Thng, C. E., Lim-Ashworth, N. S., Poh, B. Z., & Lim, C. G. (2020). Recent developments in the intervention of specific phobia among adults: a rapid review. F1000 Research, 9. doi: 10.12688/f1000research.20082.1 CrossRefGoogle Scholar
Thorpe, S. J., & Salkovskis, P. M. (1995). Phobic beliefs: do cognitive factors play a role in specific phobias? Behaviour Research and Therapy, 33, 805–816.CrossRefGoogle ScholarPubMed
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M., & Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Annals of Internal Medicine, 163, 191–204.CrossRefGoogle ScholarPubMed
Williams, M. T., Capozzoli, M. C., Buckner, E. V., & Yusko, D. (2015). Cognitive-Behavioral treatment of social anxiety disorder and comorbid paranoid schizophrenia. Clinical Case Studies, 14, 323–341.CrossRefGoogle Scholar
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