Clinical Case Studies

Mrs. H, aged 51, was referred for a neuropsychological assessment by her general practitioner. According to the referral, Mrs. H had been suffering from fatigue, headaches, and low mood following a subarachnoid hemorrhage in 2003. She reported continuing problems with concentration, memory, fatigue, and severe debilitating headaches. She attended for neuropsychological assessment in 2009, which identified specific impairments in attention and some aspects of executive function. Following assessment, Mrs. H engaged in a rehabilitation program designed to help her to manage her cognitive deficits, pace her activity levels, and manage her fatigue and headaches. She found this approach effective and reported an increase in quality of life at the end of the treatment.

This article presents a case study of anorexia nervosa and obsessive personality disorder as a means of describing the main therapeutic interventions in the framework of “third-generation” therapies. The sessions were videotaped by independent observers. The particulars of the therapeutic relationship (based on functional analytic psychotherapy) and the contextual strategies (based on acceptance and commitment therapy) used are analyzed here. This case highlights progressive positive changes in social behavior, including congruence of values and vital actions, resolution of the eating disorder, greater openness to experience, and decreased pervasive thoughts. The discussion associates these changes with the types of intervention specific to this therapeutic approach.

This article describes treatment of a female problem gambler using mindfulness-based cognitive therapy (MBCT). The treatment protocol was adapted for problem gamblers from the manualized MBCT intervention developed by Segal, Williams, and Teasdale. Gambling behavior and mindfulness practice were monitored using daily diary entries maintained by the participant. The Beck Anxiety Inventory, Beck Depression Inventory—II, and the Five Facet Mindfulness Questionnaire were administered at pretreatment, posttreatment, 4-week follow-up, and 10-week follow-up phases. The Client Satisfaction Questionnaire was also used to assess acceptability of the intervention. The participant abstained from gambling, and anxiety and depression scores significantly reduced to subclinical levels over the assessment period. Exploration of mindfulness facets revealed that MBCT for problem gambling (MBCT-PG) may be useful in promoting acceptance of distressing thoughts and emotions. However, the participant did not maintain an intensive mindfulness-meditation practice over the follow-up phase of the intervention. The clinical implications of this case study are discussed.

The authors present the case study of a 52-year-old female with Down’s syndrome and Alzheimer’s-type dementia. After a functional assessment suggested that this individual’s theft was maintained by access to preferred activity material, the authors used a differential reinforcement of other behavior (DRO) procedure with extinction to reduce loitering in an area where other consumers’ belongings were kept, thereby reducing stealing of items (i.e., nonapproved items) from other consumers. The results show that DRO plus extinction reduced number of intervals the participant was in the entryway and number of nonapproved items in the participant’s possession to zero. Two follow-up probes, which were conducted 2 months and 3 months after the formal intervention was discontinued, indicated that reductions in both target behaviors were maintained over time.

The authors describe a feeding intervention for a 9-year-old male diagnosed with autistic disorder and mild mental retardation (also known as intellectual disability) who experienced food refusal related to food selectivity. Based on the results of a functional behavioral assessment, food refusal was found to be maintained by escape and tangible functions. Therefore, an intervention using escape extinction (i.e., nonremoval of nonpreferred foods with physical guidance as a secondary procedure), positive reinforcement (i.e., preferred foods and toys), and sequential food presentation was implemented. The child was successful in eating many novel foods both within the clinic and home environments. A 1-year follow-up found the effects of treatment to be maintained with significant increases in number of foods eaten and significant decreases in mealtime-related behavioral challenges. The treatment implications, recommendations to clinicians, and areas of future research are discussed.

This case presents a man diagnosed with paranoid schizophrenia and persistent violent behavior admitted to a security ward. A treatment deadlock characterized by a defeatist personal narrative and a staff narrative highlighting alleged antisocial traits and unpredictable violence called for a new clinical approach. Assessment confirmed a schizophrenia diagnosis and disconfirmed a diagnosis of antisocial personality disorder.Violence only appeared inside the ward. This enabled an alternative narrative to manifest itself. According to the new staff narrative, he struggled with persistent psychotic symptoms and used violence to deal with negative emotions, such as anxiety arising from perceived interpersonal rejection or potential failure at independent living. The new client narrative included a sense of agency. The case illustrates how oppressing narratives can block treatment progress and how this can be overcome by allowing alternative narratives. Violence was reduced, and he was discharged 3.5 months after the start of the narrative intervention.