The American Psychological Association (APA) has defined evidence-based practice (EBP) as “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences”. This chapter highlights a number of contemporary approaches to counseling with children and adolescents. First, though, it is important to consider some issues specific to empirically supported treatments (ESTs) with children and adolescents. Children and adolescents are still developing in terms of cognitive style, self-concept, and overall worldview. It is key that interventions are tailored to match emerging abilities and relevant contexts. The chapter deals with evidence-based practice and issues with ESTs. Integrative approaches often involve the combination of two or more standard approaches into one treatment modality. Cognitive behavior therapy is one such integrative approach and, in general, the available empirical evidence demonstrates that, for most emotional and behavioral youth disorders, cognitive, behaviorally oriented therapies produce the best outcomes.
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- Go to chapter: Targeting Transdiagnostic Processes in Clinical Practice Through Mindfulness: Cognitive, Affective, and Neurobiological Perspectives
Targeting Transdiagnostic Processes in Clinical Practice Through Mindfulness: Cognitive, Affective, and Neurobiological Perspectives
This chapter focuses on six maladaptive processes that underlie a wide range of emotional and behavioral problems commonly addressed by social work practitioners in the mental health field. First, it explicates how a focus on transdiagnostic processes differs from traditional views of psychopathology and accords more closely with neuroscientific evidence. Next, the chapter reviews current research in the fields of experimental psychopathology and neuroscience to detail the cognitive, emotional, and neurobiological features of these six core transdiagnostic processes: automaticity, attentional bias, memory bias, interpretation bias, suppression, and stress reactivity. Then it discusses how these processes may be assessed by clinical social workers in the field, and offer six case vignettes that depict how they manifest in human suffering and impaired psychosocial functioning. Finally, the chapter discusses mindfulness-based interventions as a means of targeting transdiagnostic processes in clinical practice.
This chapter discusses the impact of trauma and its treatment through discussion of posttraumatic stress disorder (PTSD) and its neurological components-especially those affecting memory, evidence-based therapies (EBTs) for the treatment of PTSD, and the implications for practice, policy, and research. Two primary predictors exist for a person developing PTSD. The first one is experiencing dissociation during the trauma. The second predictor is the person developing acute stress disorder. Specifically, neuroimaging shows how PTSD affects neurological functioning in the brain. The primary regions of the brain affected by PTSD are the medial prefrontal cortex, the left anterior cingulate cortex, the thalamus, the medial temporal and hippocampal region, and the amygdala. The different regions of the brain associated with memory encoding are: left prefrontal cortex, left temporal/fusiform, anterior cingulate, and hipocampal formation. Cognitive-behavioral therapy (CBT) has been used extensively to treat PTSD.
This chapter presents an ecological model that enhances understanding of survivor responses to sexual trauma. Trauma resulting from sexual violence is associated with a host of negative mental health problems, including posttraumatic stress disorder (PTSD) and associated anxiety, depression, and substance abuse. Gamma hydroxy-butyrate (GHB) is a drug commonly used in drug-facilitated sexual assaults and is poured easily into an individual’s drink without his or her knowledge. Counselors need to assess for and understand a survivor’s victimization history, as people who have been victimized previously are more likely to have differing treatment needs than other survivors. Exosystem Level refers to a survivor’s contact with medical, legal, law enforcement, or mental health systems. Particular cultural values may play an important role for a survivor in making reporting decisions. Cognitive restructuring is effective in reducing symptoms associated with sexual trauma.
This chapter outlines particular consequences of trauma when it occurs during adolescence, as well as what one might expect subsequent to earlier childhood traumatic events that occurred. Adolescence is a period of rapid cognitive development, characterized by the capacity for abstract thinking. Ethnic identity-achieved adolescents demonstrate more solid ego identity and psychological adjustment. Posttraumatic stress disorder (PTSD) symptoms and negative self-schemas may lead to lacunae in moral functioning. Traumatic experiences can lead to disruptive behavior disorders, other internalizing disorders, personality disorders, and physical illnesses. Young women and men tend to experience and process the distress associated with traumatic events differently. The impact of a traumatic event may depend on the extent to which it disrupts family functioning. Cognitive behavioral therapy is particularly effective in treating symptomatic adolescents exposed to trauma. Eye movement desensitization and reprocessing (EMDR) also can work with some traumatized individuals.
This chapter has articulated the clinical relevance of integrative approaches to trauma. Most effective therapy for complex trauma effects is also relational and “psychodynamic”, involving the effects of activated attachment relationships and interpersonal processes. Organizational processes need to be adapted to reflect a more trauma-informed model of care. Hiring and selection practices need to be based not only on education and on previous work experience, but they also need to include a candidate’s knowledge and understanding of concepts and practices designed to support client wellness from a trauma-informed framework. Admission criteria, screening, and assessment directly need to reflect and address a client’s history of trauma. The Sanctuary Model was developed in an inpatient hospital setting providing acute care to adult survivors of childhood trauma. Cognitive behavioral therapy (CBT) has been the treatment of choice for depression- and anxiety-related symptoms.
This chapter examines the medical, psychosocial, and vocational characteristics, challenges, and rehabilitation needs of emerging populations of individuals with psychiatric disabilities, and introduces a recovery-oriented approach to providing responsive services to individuals with psychiatric disabilities. It explores integrated, evidence-based, and emerging practices to facilitate better recovery and rehabilitation outcomes for these populations. The onset of psychiatric disabilities occurs during critical years when major changes are occurring in the areas of identity formation and cognitive, psychosocial, psychosexual, and career development. Many individuals with psychiatric disabilities receive their health care in emergency departments and intensive care units and not until their secondary conditions create medical crises. Substance use disorders (SUDs) often co-occur with psychiatric disabilities. The principles of recovery align with the core values and principles of rehabilitation counseling. Illness management and recovery (IMR) is an evidence-based practice for equipping individuals with the knowledge and skills they need to self-manage their disabilities.
This chapter describes a unified treatment protocol for emotional disorders. Cognitive hypnotherapy (CH) provides a variety of treatment interventions for emotional disorders distilled from decades of research on effective cognitive, behavioral, and hypnotherapeutic treatments for anxiety, mood, and trauma-based disorders. CH combines hypnotherapy with cognitive behavioral therapy (CBT) in the management of emotional disorders. This blended version of clinical practice meets the criteria for an assimilative model of integrated psychotherapy, which is considered the best integrative psychotherapy model for synthesizing both theory and empirical findings. Ego-strengthening suggestions are utilized in hypnotherapy to increase self-esteem and self-efficacy. The goals of ego-strengthening suggestions are to reduce anxiety and depression, and to gradually restore the patient’s self-confidence in his or her ability to cope effectively with problems and distress. Posthypnotic suggestions (PHS) are routinely delivered during hypnotherapy to counter problem behaviors, negative emotions, dysfunctional cognitions, negative self-hypnosis (NSH), and negative self-affirmations.
According to the American College of Rheumatology (ACR), fibromyalgia syndrome (FMS) is a complex, debilitating, functional pain syndrome characterized by the presence of continual, severe, widespread musculoskeletal pain for three months or longer, and tenderness in specific points of the body. In a recent study, the cognitive functioning of patients with chronic pain was investigated. Results of the study showed that more than one third of chronic pain patients complained of cognitive impairment. Evidence-based treatment guidelines mostly recommend multimodal approaches that include pharmacological treatment, physical exercise, and psychological treatments, specifically cognitive behavioral treatment (CBT), as well as their long-term maintenance, possibly due to heterogeneity of the studies and potential methodological biases. Recent evidence supports the notion that hypnosis, combined with a daily practice of self-hypnosis, may be an effective adjunct tool, in addition to standard medical treatment for pain control and improved quality of life.
The most popular nonpharmacological techniques for managing hypertension are introducing a healthy diet, weight loss, exercise, decreased alcohol intake, and psychological interventions for stress and anxiety reduction. Hypnotherapy is a good candidate for directly delivering or supporting such nonpharmacological interventions. Hypnosis can also be used to target the risk factors of hypertension, such as obesity, anxiety, and stress. Several studies show that hypnosis can be effective to assist weight loss. Hypnotherapy has also been confirmed to reduce anxiety and stress, in some cases even more effectively than cognitive behavioral therapy (CBT). Hypertension is not painful and is usually unnoticed by the person suffering from it; while lifestyle and dietary changes for the management of hypertension require considerable effort, patients are often noncompliant. Thus, the importance of improving compliance and cooperation cannot be overstated. The hypnotherapist also has to work closely with the physician during the therapy.