“Multiple chemical sensitivities” has become an increasingly common clinical presentation to physicians, though it is infrequently seen by psychotherapists. This case report describes a 61-year-old woman who presents with a long history of chemical sensitivities, that led to a somatization disorder with debilitating agoraphobia, depression, and marital problems. Features of a variety of anxiety disorders are present, as are metacognitions that required an unusual case conceptualization. A cognitive therapy case conceptualization and treatment are described, which address the highly idiosyncratic clinical presentation of this patient.

We describe the three stages (exploration, insight, action) of the Hill cognitive-experiential model of dream interpretation, discuss clinical issues related to using dream interpretation in therapy, and provide a brief overview of the research and suggestions for further research.

Dreams represent a powerful, condensed metaphor for irrational beliefs which patients may not otherwise be able to articulate. While contemporary psychodynamic therapists have discarded Freud’s emphasis on dreams as intentional disguise of instinctual wishes, they continue to use dreams as diagnostic and treatment tools. Such work can be integrated with other types of treatments, including cognitivebehavioral, to examine the latent, primitive and non-verbal aspects of cognitions. This article illustrates how dream work can be utilized in symptom-focused psychotherapy with examples drawn from several specific treatment areas: bereavement, depression, trauma, cross-cultural counseling, and behavioral medicine.

Unwanted, ego-alien distressing intrusive thoughts, images, or impulses (i.e., obsessions) are a hallmark of obsessive compulsive disorder (OCD). Until recently the psychological processes involved in the origin, persistence, and treatment of these perplexing intrusive mental repetitions have not been well understood. Over the past decade, a new cognitive perspective on OCD has emerged that has provided new insights into the pathogenesis and treatment of obsessions. In this article we briefly consider recent findings on normal and abnormal obsessions, their relationship to mood disturbance, and the status of key cognitive processes implicated in the pathogenesis of obsessions as discussed in publications by Salkovskis, Rachman, Freeston, Clark, Purdon, and others. We conclude with a discussion of treatment implications and whether the inclusion of cognitive strategies that directly targets change in dysfunctional beliefs and appraisals will enhance standard behavioral treatment of OCD.

Patients with advanced cancer often experience debilitating anxiety symptoms that interfere with quality of life and relate to worse medical outcomes. Although cognitive-behavioral therapy (CBT) is an empirically validated, first-line treatment for anxiety disorders, clinical trials of CBT for anxiety typically exclude patients with medical comorbidities in general, and those with terminal illnesses, such as advanced cancer, in particular. Moreover, CBT has generally targeted unrealistic fears and worries in otherwise healthy individuals with clinically significant anxiety symptoms. Consequently, traditional CBT does not sufficiently address the cognitive components of anxiety in patients with cancer, especially negative thought patterns that are rational but nonetheless intrusive and distressing, such as concerns about pain, disability, and death, as well as management of multiple stressors, changes in functional status, and burdensome medical treatments. In this article, we describe a treatment approach for tailoring CBT to the needs of this population. Three case examples of patients diagnosed with terminal lung cancer are presented to demonstrate the treatment methods along with outcome measures for anxiety and quality of life.

With the emergence of manualized treatments in the 1980s, research protocols have focused increasing attention on documenting the integrity of treatment delivery. Two constructs have guided the conceptualization of assessing treatment integrity. The first, adherence, concerns the extent to which therapists adhere to the interventions of a therapy being tested, and measuring which particular interventions are performed. The second, competence, concerns the quality or skill in therapists’ execution of the therapy being tested. This article reviews the development of treatment integrity research for cognitive therapy in depression, and discusses salient issues that have arisen in its assessment. Recommendations for further refining the considerations of adherence and competence in the delivery of cognitive therapy are provided.

This article reviews the literature on prevalence, associated features, assessment, and treatment of intrusive symptoms associated with posttraumatic stress disorder (PTSD). Research indicates that among trauma survivors, intrusive thoughts and imagery are quite common and distressing. It appears that early intrusions may be predictive of long-term distress and that avoidance and suppression can maintain intrusions. The treatment outcome literature for PTSD indicates that current cognitive behavioral treatments are effective in reducing intrusions. New data from a recent treatment outcome study for PTSD with comorbid panic attacks, using Multiple Channel Exposure Therapy, also suggest that this treatment is effective in significantly reducing intrusions.

In this article, current methods of conceptualizing and treating adult sexual offending are reviewed. First, the Risk-Needs-Responsivity (RNR) approach to sex offender management is presented and critiqued. Then, the newer Good Lives Model is discussed and contrasted with the aforementioned RNR approach. The discussion of these approaches to sex offender management and rehabilitation is followed by a review of those cognitive-behavioral therapy (CBT) techniques used to treat risk factors associated with sex offending, as such techniques are employed in both paradigms. Finally, research regarding the efficacy of using CBT techniques to treat sex offending behavior is presented, and future directions for sex offender treatment and management are discussed.

Response levels of 92 depressed subjects with differing demographic profiles to a standardized small-group CBT intervention were examined. Findings were based on combined groups wherein adults participated in 12 two-hour skill-building sessions conducted in 8-week periods. Participants were assessed for levels of depression, hopelessness, anxiety, and social adjustment at pre- and post-test, and 1, 6, 12, 18, and 24 months following treatment. The intervention was effective in the treatment of unipolar depression for all groups, and demographic variables were found to have various significant functional relationships with treatment outcome. Gender combined with marital status, and the separate results of education level, employment status, and income level all indicate different treatment effects.