Clinical Case Studies

This clinical case describes the assessment and treatment of Roger, a 31-year-old veteran who served in Operation Iraqi Freedom. In addition to combat-related post-traumatic stress disorder (PTSD), Roger presented with a conversion disorder (globus pharyngeus) and avoidance of consuming solid food without also consuming alcohol. A multicomponent treatment program for PTSD, trauma management therapy (TMT), was provided 5 times per week over a 3-week period. TMT included daily-exposure therapy (EXP) as well as daily social and emotion regulation (SER) group therapy to target anger, social withdrawal, and depression. In addition to TMT, exposure to food consumption in the absence of alcohol was provided in the final week. PTSD symptoms were assessed via semi-structured interview and self-report measures, while food intake was assessed via behavioral observation. PTSD symptoms as measured by the Clinician-Administered PTSD Scale (CAPS) decreased from 63 at pre-treatment to 17 at post-treatment, indicating that Roger no longer met criteria for PTSD. Exposure to food intake was equally successful with Roger consuming full meals (e.g., hamburger and french fries) without consuming alcohol. This case study exemplifies the successful use of intensive exposure therapy to target comorbid anxiety-based disorders in a short period.

Given the long-term negative outcomes associated with depression in adolescence, there is a pressing need to develop brief, evidence-based treatments that are accessible to more young people experiencing low mood. Behavioral Activation (BA) is an effective treatment for adult depression; however, little research has focused on the use of BA with depressed adolescents, particularly with briefer forms of BA. In this article, we outline an adaptation of brief Behavioral Activation Treatment of Depression (BATD) designed for adolescents and delivered in eight sessions (Brief BA). This case example illustrates how a structured, brief intervention was useful for a depressed young person with a number of complicating and risk factors.

Trichotillomania (TTM) involves the compulsive pulling of one’s bodily hair and is often associated with significant distress or impairment. The present case study concerns a college-aged woman, whose history of TTM extended over 5 years and had been unsuccessfully treated by psychotherapy and medication management. Although TTM can be a challenging disorder to treat, the literature indicates that cognitive-behavioral therapy (CBT) has been successful in this regard. Therefore, we implemented CBT based on the manual developed by Keuthen, Stein, and Christenson; specific elements of therapy used included relaxation, self-monitoring, habit reversal training (HRT), reinforcement/punishment contingencies, thought monitoring, and cognitive restructuring. This approach was successful, as the client evidenced a 72% decrease in hair-pulling after using HRT alone, and complete elimination of hair-pulling after introducing the cognitive-restructuring element. Impressively, the gains lasted not only in the short term, but also had been reportedly maintained at a 5-year follow-up.

Borderline personality disorder (BPD) is regarded as one of the more difficult clinical presentations to treat, and psychotherapy provides the best outcomes for those suffering with BPD. Dialectical behavioral therapy (DBT) and schema-focused therapy (SFT) are two of the most common evidenced-based treatments for borderline pathology. While these treatments are often used individually, some theorists argue that blended approaches to care could provide more benefit to some clients than just one treatment package alone. The present case study illustrates a blended approach to the treatment of BPD. Specifically, DBT and SFT were used in consort to treat “Luisa,” a 34-year-old biracial woman of Caucasian and Hispanic descent who struggled with longstanding interpersonal distress, emotional lability, and identity disturbance. Her treatment course is described in detail, and the implications of this approach to care are discussed.

Family-based therapy (FBT) is the gold standard of treatment for adolescents with anorexia nervosa (AN) and has shown to be more effective than other forms of treatment in several randomized controlled trials. However, FBT is a behaviorally based intervention that does not explicitly address emotional distress often exhibited by patients and their parents. This case study describes the treatment of a 14-year-old adolescent male with AN using FBT as the primary treatment modality. We also implemented an adjunctive treatment designed to address parents’ emotion communication skills (ECSs) to reduce emotion dysregulation and family conflict in the implementation of FBT and in the process of AN recovery. Over the course of 29 sessions, the adolescent has evidenced an increase in weight from 84 pounds to 110.25 pounds and significant decreases in weight and shape concerns. This case provides preliminary support for the feasibility and effectiveness of an adjunct parent emotion coaching intervention combined with FBT for an adolescent male with AN.