Clinical Case Studies

The authors describe an intervention for work refusals in a 49-year-old man with mild mental retardation, more commonly referred to as mild intellectual disability, and other comorbid Axis I diagnoses. Following a behavioral functional assessment, Intervention A, contingent reinforcement of work attendance with cigarettes and edibles was implemented to increase work attendance. A modified reversal to baseline (Intervention B) retained the contingent reinforcement with edibles but not cigarettes. Following Intervention B, a third intervention (Intervention C) reintroduced contingent reinforcement of work attendance with cigarettes and edibles in addition to a response cost procedure. Contingent reinforcement using the most preferred reinforcer was found to be an effective intervention in increasing work attendance; however, this intervention combined with response cost was found to be superior. Overall, a 45.4% decrease in work refusals was seen from baseline following implementation of contingent reinforcement using cigarettes and edibles (Intervention A), whereas a 65.1% decrease was seen between baseline and contingent reinforcement using cigarettes and edibles combined with response cost (Intervention C). Such decrease in work refusals was maintained during follow-up. Factors responsible for intervention success and implications for clinicians are discussed.

The goal of the current case study was to illustrate an evidence-based assessment and the cognitive-behavioral treatment of an 11-year-old male with emetophobia. A multimodal assessment of the child’s anxiety symptoms was conducted, including a semistructured diagnostic interview (Anxiety Disorders Interview Schedule: Child and Parent Versions), parent report (Behavior Assessment System for Children—Second Edition.), and child self-report (Revised Children’s Manifest Anxiety Scale and Child Depression Inventory). Emetophobia symptoms were assessed via parent and child report of the Emetophobia Questionnaire. Treatment included graduated exposure, cognitive restructuring, and parent training. Improvement was seen within 22 sessions and maintained at a 6 months follow-up. In addition to a reduction in symptoms of emetophobia, discontinuation of medication, and no longer meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria for specific phobia, treatment gains also included a reduction in internalizing and somatization symptoms as well as an increase in the patient’s adaptive skills. This case study illustrates the use of CBT along with parent training as an efficacious treatment for children with emetophobia. It also demonstrates how to incorporate simple, everyday technology (i.e., Internet) to simulate exposures that are otherwise difficult to duplicate in the therapy session.

This case study demonstrates an effective course of exposure/response prevention (EX/RP) in an 82-year-old man with late-onset obsessive-compulsive disorder (OCD) with no apparent neurobiological changes. The results indicated significant reductions in time spent on rituals, anxiety associated with obsessions, and depression. Treatment gains were maintained and continued to progress through appropriate aftercare. In this case, a graduate student therapist learned and applied EX/RP after engaging in a training process. Results highlight the importance of life stressors in the development of OCD and that EX/RP can be applied to older adults with certain modifications. The results are promising for the implementation of EX/RP in older adults with OCD; however, future randomized controlled trials are needed.

This case study describes the treatment of a female psychology graduate student, referred to as Mary, who presented with complaints of “mild symptoms of depression and a lack of motivation.” It was revealed that Mary had been sexually assaulted 4 years before presenting for therapy and was diagnosed with depression and posttraumatic stress disorder. Because of the timing of the symptom onset and the nature of her symptomatology, it is likely that she was experiencing a form of vicarious traumatization that further complicated her own difficulties. The primary purpose of the current article is to draw attention to the importance of self-care for mental health professionals and to provide recommendations for the promotion of well-being in professionals working with trauma survivors. The secondary aim of the current study is to discuss Mary’s progress through 12 sessions of manualized cognitive processing therapy for rape victims as further support for its efficacy.

There is extensive empirical support for the use of exposure therapy in treating posttraumatic stress disorder (PTSD); however, there is little documented research on the use of these treatments with older adults. Questions exist regarding the appropriateness of exposure therapy with this population, given that the treatment is intense and often involves autonomic nervous system arousal. The current case study details a course of prolonged exposure (PE) therapy in an 88-year-old, World War II veteran, diagnosed with PTSD. The patient was found to respond remarkably well to the treatment and his posttraumatic stress symptoms decreased to subclinical levels in seven sessions. Concerns regarding the appropriateness of using PE to treat older adults are addressed.