Search

Clients can develop feelings of romantic or sexual attraction to their therapists. From a cognitive-behavioral perspective, how should therapists handle these situations? Although the topic of client attraction is comprehensively covered in the psychoanalytic and psychodynamic literature, it is woefully neglected in our cognitive-behavioral therapy (CBT) focused training programs and literature. This paper aims to address this gap by using CBT principles to provide explanations for why clients develop feelings of attraction to their therapists. In addition, this paper offers general guidelines for how to manage client attraction from a CBT perspective. Three case vignettes are used to illustrate those concepts. Recommendations for future research and training in this area are also provided.

Purpose: We examined whether the relationship between minority stressors (victimization and discrimination) and suicide attempts (SAs) was moderated by gender identity-specific protective state pol...

Misophonia, a condition marked by extreme intolerance to certain classes of sounds (e.g., respiratory or gustatory noises), has recently attracted increased research attention. As yet there are no evidence-based treatments, although some promising options are under empirical consideration. This paper presents a stress management and exposure therapy-based treatment protocol for adults with misophonia. The protocol details considerations specific to exposure therapy for misophonia, including unique considerations for developing hierarchies and example misophonia exposure exercises and exposure homework. Stress management approaches employed to facilitate engagement with exposure are also described. Two case examples are included, which illustrate the application of the misophonia treatment protocol. The first case describes treatment for a client whose misophonia symptoms are the primary focus and the second case describes treatment for a client whose misophonia symptoms are secondary to relationship difficulties. This protocol can be used to stimulate further treatment research for misophonia and guide treatment for individuals with misophonia.

Excoriation disorder, which is characterized by recurrent and impairing skin picking, has been included as a distinct diagnosis in the most recent version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The move to include excoriation disorder as a separate diagnosis in the DSM-5 was largely due to increasing awareness of its prevalence and the potential for significant impairment and distress. This chapter discusses the nature, clinical presentation, and potential etiological determinants of excoriation disorder. In addition to the nature of symptoms, contemporary approaches to assessment and treatment, including behavioral and pharmacological, are highlighted. The chapter concludes with a discussion of future directions for research.

Intensive longitudinal methods (ILM), such as ecological momentary assessment (EMA) and daily diary, involve repeatedly assessing individuals over short periods of time and have been increasingly used to study suicidal thoughts and behaviors (STBs). Suicidal thoughts have been shown to vary over short periods of time and reports of STBs are subject to negative biases. Therefore, ILM are important methodological tools for studying STBs, ones that capture enhanced precision and realism of data compared to traditional survey methods. The present systematic review aims to provide a comprehensive overview of ILM used to study STBs, including the various EMA and daily diary methodologies used, the feasibility of those methodologies, and the ethical considerations in this line of research. This review also summarizes the characteristics of descriptive STB outcomes specific to the ILM data collection period.A thorough search of PubMed and PsycINFO was conducted up to May 2020, resulting in twenty-eight papers reviewed.The review of the studies showed that ILM are largely feasible and do not have a negative impact on participants. In addition, the reviewed studies revealed unique aspects of STBs, such as the variability of suicidal thoughts, that suggest that ILM are important methodologies to use when studying STBs. Gaps in the research and recommendations for future research are discussed.HighlightsIt is feasible to use ILM to study suicidality.ILM do not have a negative impact on participants with suicidality.Few studies have used ILM to study suicidality in diverse samples.

Panic disorder is a common and disabling psychiatric condition marked by sudden onset of physiological sensations that are appraised as dangerous. A number of studies and reviews have examined the efficacy of psychosocial treatments for PD; however, there is a lack of overarching reports that discuss the strength of evidence for the different psychosocial treatments for PD. This umbrella review provides an overview of systematic reviews and meta-analyses on psychosocial treatments for PD.A systematic search and review of the literature was conducted according to PRISMA guidelines.A total of 38 reviews (31 meta-analyses and 7 systematic reviews) were included in the umbrella review. Most of the 38 reviews were focused on the use of CBT, both in-person and internet-based, to treat PD among adults, generally finding it to be an efficacious treatment compared to control conditions. A limited number of the 38 reviews included other age ranges or examined other forms of psychosocial treatments. The methodological quality of most included reviews was rated as critically low according to the AMSTAR-2 rating system.Future reviews should focus on improving their methodological quality. Although the included reviews supported CBT as an efficacious treatment for reducing panic symptoms among adults, future research could focus on how CBT compares to other psychosocial treatments and the efficacy of CBT for PD among other populations (e.g., children and adolescents) and among diverse cultural groups.

Introduction Transgender and gender-diverse (TGD) people experience greatly heightened levels of suicidal ideation (SI) compared to the general population. Therefore, it is imperative to understand the risk and protective factors for SI within this population. Methods The present study explored how victimization, discrimination, community connectedness, and pride impact SI cross-sectionally and longitudinally in a sample of TGD adults (N = 180, 55% transgender women, 76.7% Caucasian, M age = 26.01 years). Results Cross-sectional results showed that experiencing more types of victimization and discrimination at baseline predicted higher SI severity at baseline, while community connectedness and pride at baseline were not predictive of SI severity at baseline. Longitudinal analyses showed that experiencing fewer types of victimization and discrimination during the 1-month follow-up period were associated with a decrease in SI severity from baseline to follow-up. Medium and high levels of community connectedness were also associated with a decrease in SI severity from baseline to follow-up. Pride was not associated with change in SI from baseline to follow-up. Limitations Limitations include the limited racial/ethnic diversity of the sample and that frequency of experiencing victimization and discrimination was not assessed. Conclusions These results suggest victimization and discrimination are strong predictors of SI severity within this population, and the factors of victimization, discrimination, and TGD-community connectedness impact change in SI severity across time. These findings provide evidence for the importance of anti-discrimination laws that apply to TGD people, as well as the utility of connecting TGD clients to the TGD community.

Pain tolerance and dissociation have individually been shown to be risk factors for suicidal behaviors. The aim of the current study was to investigate how dissociation and physiological pain tolerance influence the relation between suicidal thoughts and behaviors. The sample consisted of 70 undergraduate college students who completed self-report measures of suicidality and dissociation and an electrical stimulation task to measure physiological pain tolerance. Results showed that dissociation and suicidal ideation, but not pain tolerance, were independently associated with increased suicide attempts. A three-way interaction of suicidal ideation, physiological pain tolerance, and dissociation statistically predicted number of suicide attempts, with an increased number of suicide attempts associated with high suicidal ideation and dissociation, regardless of pain tolerance. These results suggest that dissociation plays a significant role in predicting suicide attempts, perhaps by engendering a state of disconnect from one's body.

The Research Domain Criteria (RDoC) emphasizes the discovery of mechanisms of psychopathology and treatment outcome. In the case of Obsessive-Related Disorders (OCRDs), the available research shows that research exists that describes negative valence variables, specifically neural circuitry, that may be mediators of cognitive-behavioral treatment (CBT) outcome for obsessive-compulsive disorder (OCD). There is limited research on neural circuitry associated with CBT outcome in the other OCRDs. A small body of work exists on cognitive processes, as defined by the RDoC, in the context of mechanisms of OCD treatment outcome. The other major domains of the RDoC have not been addressed for any OCRD in association with CBT outcome. The review concludes with a broad research agenda that emphasizes: clarification of taxonomic features of obsessive-compulsive psychopathology; explicate this taxonomy of obsessive-compulsive psychopathology in relation to neural circuitry; and identify limits of these findings based on culture and environment. It is expected that this research agenda would lead to a clinical heuristic to aid cognitive behavior therapy providers in developing targeted interventions for the full range of OCRDs.