Clinical Case Studies

This article presents the use of an emotion-focused, transdiagnostic therapy approach designed for adolescents with a range of anxiety, obsessive-compulsive, depressive, and related disorders, referred to here as emotional disorders. Preliminary work suggests that emotional disorders share underlying temperament factors, such as high neuroticism and low extroversion in adults and adolescents, possibly influencing the development and maintenance of emotional disorders across the life span. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) and similar core dysfunction-focused, transdiagnostic therapy approaches may lead to successful treatment by targeting higher order factors that cut across an array of emotional disorders The utility of UP-A for adolescents experiencing a variety of emotional disorder symptoms is demonstrated here through the case illustration of Tony, a 15-year-old adolescent male with severe social and generalized anxiety and mild levels of depression. After 16 individual treatment sessions, Tony demonstrated significant reductions in anxiety and depressive symptoms, as well as an ability to respond more adaptively to a range of emotional experiences. This case study illustrates how short-term, transdiagnostic treatment using the UP-A can effectively ameliorate a wide range of emotional disorder symptoms in adolescents and may also lead to changes in core features of neuroticism, potentially preventing development of further emotional difficulties over time.

Acceptance and Commitment Therapy (ACT) is a third-wave behavioral therapy that is an empirically supported treatment for various mental health concerns. ACT has been found to be efficacious for treating different types of anxiety disorders. This case study presents the conceptualization (functional analysis), treatment (ACT), and treatment outcomes of a client who presented with emetophobia, a phobia of vomiting, complicated by a metabolic disorder. Measures of emetophobia symptoms, mindfulness, cognitive fusion, thought control strategies, and believability of anxious thoughts and feelings, were collected at pretreatment, posttreatment, 6-month follow-up, and 12-month follow-up. The Reliable Change Index was used to evaluate changes across time. Large and clinically significant decreases on all measures were observed at posttreatment. At 12-month follow-up, improvements were maintained on all measures except the Reappraisal subscale of the Thought Control scale. The implications of this study are discussed, and recommendations are made for clinicians using ACT for the treatment of emetophobia.

In persons with anorexia nervosa (AN), compulsive exercise and osteopenia are common symptoms. Although treatment of osteopenia besides weight regain is lacking, maximal strength training (MST) has been found to be effective in other populations. Such training has not been prescribed to those with AN due to uncertainty of tolerance. We therefore examined use of MST in a woman with long-standing AN, osteopenia, menstrual dysfunction, and compulsive exercise. The MST intervention consisted of four exercises: three sets of five repetitions maximum (RM), 3 times per week for 16 weeks. We examined muscle strength, bone mineral density (BMD), AN psychopathology, and compulsive exercise at baseline, posttest, and 6-month follow-up. Attendance rate was 100%. The subject improved muscle strength by 20% to 40%. BMD in lumbar spine improved by 4% to posttest, and by 8% from baseline to 6-month follow-up. The BMD T-scores shifted from values classified as osteopenic to normal values throughout the course of the intervention, despite continuance of menstrual dysfunction and lack of weight gain. No changes in AN psychopathology or levels of compulsive exercise were detected. Perceived psychological benefits including new bodily experiences were self-reported by the subject, emphasizing the importance of close follow-up by competent instructors.

This single case study examined symptom change in the treatment of a 22-year-old Caucasian female college student presenting with anxious and depressive symptoms and maladaptive coping strategies in the context of an interpersonal dispute. The treatment integrated mindfulness skills training with interpersonal psychotherapy (IPT) to treat symptoms of anxiety, depression, overall total symptoms, and relational problems across the 18-session treatment. We assessed symptoms across treatment and analyzed change in symptom severity over time. Reliable change index analyses indicated significant symptom reduction between baseline levels at the start of treatment and the final sessions in all measured symptoms (anxiety, depression, total symptoms, and interpersonal relations), with decreases in symptom severity occurring gradually over the course of treatment. A 1-month follow-up assessment of symptoms indicated sustained reductions in anxious and depressive symptoms since baseline measurements. We discuss recommendations on the importance of therapeutic flexibility in treating comorbid conditions and therapist willingness to combine multiple treatment approaches for better treatment outcomes.