Many autistic adults demonstrate a gap between their intellectual functioning and their daily living skills (DLS), regardless of their cognitive ability. DLS are a significant predictor of quality of life, employment, and independent living for autistic individuals. Autistic adolescents and young adults (youth) identify mastering DLS as an essential piece of reaching desired levels of independence. Autistic individuals also note that difficulties with DLS can be a combination of skill knowledge (i.e., not knowing how to complete a skill) and skill consistency (i.e., knowing how to complete a skill, but lacking motivation to do it consistently when needed). Currently, there are no interventions designed to target DLS consistency among autistic youth. We developed and assessed the feasibility and acceptability of a novel, community-engaged behavioral intervention that uses principles of Motivational Interviewing to increase autistic youth’s motivation to complete DLS. Our results suggest that our intervention is feasible and acceptable to autistic youth. The results of this study will be used to conduct a preliminary efficacy randomized control trial.
Maternal mental health problems are prevalent, persistent, and have significant impacts on parenting self-efficacy and competence, and child well-being. This study describes the development of a group-based intervention for parents of very young children that integrates elements of the Mothers and Babies Program and the Chicago Parent Program, called Mothers and Babies – Chicago Parent (MB-CP) Program. This pilot study uses quantitative and qualitative data collected from parents to examine the feasibility, acceptability, and preliminary effectiveness of MB-CP. Thirty-one parents (96.8% mothers, 44.8% Black, 48.3% Latino) of children in infancy through 2 years old enrolled. Of the enrolled parents, 77.4% attended one or more sessions (M = 4.9 sessions), and 54.8% attended six or more sessions of the 10-session program. Data from interviews and satisfaction surveys demonstrated strong acceptability of the program. Quantitative results demonstrated that participating in the program was associated with significant reductions in parent-reported depression symptoms. Data from interviews indicated that parents perceived improvements in their mood and increased confidence in their parenting. Findings will inform future research testing the program’s effectiveness in primary care and early childhood education settings.
Gambling-related harm exists along a continuum ranging from low-risk engagement to severe gambling disorder, with the greatest clinical and societal burden concentrated among individuals with more severe presentations. Cognitive-behavioral therapy (CBT) has emerged as a leading psychological treatment for problem gambling and gambling disorder, with evidence demonstrating reductions in gambling disorder severity, gambling behavior, and related psychological processes. However, translating this evidence into consistent and effective clinical practice remains challenging. This paper synthesizes key issues addressed in a special issue focused on advancing CBT for gambling disorder. Three interrelated challenges are highlighted: (1) heterogeneity in CBT techniques across research and clinical settings, which limits clarity regarding active treatment components; (2) the high prevalence of comorbidity and broader psychosocial impairments, necessitating integrated and personalized approaches to assessment and intervention; and (3) low treatment uptake and high attrition, which constrain the overall public health impact of CBT. Contributions within the special issue illustrate emerging strategies to address these challenges, including the identification and demonstration of core CBT techniques, the integration of comprehensive assessment and transdiagnostic interventions, and the use of scalable and engagement-focused treatment methods such as digital platforms and motivational enhancement. Collectively, these advances suggest that optimizing CBT for gambling disorder will require a shift toward more flexible, mechanism-informed, and implementation-sensitive models of care. Future work should prioritize integrating evidence-based techniques with personalized case formulation and strategies to enhance engagement to improve both clinical outcomes and real-world impact.
Acceptance-based behavioral therapies are effective at reducing anxiety. For clients with social anxiety disorder, these treatments may be particularly effective when they include an exposure component. An Acceptance-Based Behavioral Exposure Therapy (ABBET) for social anxiety disorder was adapted from Acceptance-Based Behavioral Therapy (Roemer & Orsillo, 2009) by incorporating an explicit exposure focus. To further illustrate the ways that an exposure-framework can be incorporated into an acceptance-based behavioral therapy approach, this paper presents two case descriptions, with accompanying data, of the ways that mindfulness and acceptance practices can be incorporated with values-based exposure practices. Specifically, the case of Francia highlights the ways that a client can use the exposure practices to connect with and to live according to their values as a way to decrease distress, while the case of Mobo highlights how reducing experiential avoidance through mindfulness and decentering enhance engagement with exposure exercises.
Posttraumatic Stress Disorder (PTSD) during pregnancy and postpartum (i.e., perinatal PTSD) negatively affects maternal and neonatal health. Gold-standard PTSD interventions often overlook the unique features of multiple trauma exposures that can occur during the perinatal period. Narrative Exposure Therapy (NET), a manualized, evidence-based treatment for trauma disorders, shows promise in addressing PTSD among perinatal populations but warrants further real-world, clinical investigation. This case study demonstrates how NET can be used to address multiple traumatic events that may occur during pregnancy and the postpartum period. “Sophia” sought treatment following multiple perinatal traumatic events. Treatment occurred at an urban academic medical center in the Midwestern United States. Patient completed the Life Events Checklist, Perinatal Life Events Measure at baseline, and PCL-5, GAD-7, PHQ-2 across treatment. A clinical psychology intern and licensed clinical psychologist conducted NET. NET treatment included psychoeducation, laying the lifeline, nine exposures, and a final testimony reading. Patient demonstrated a substantial reduction in symptoms and subjective improvement across several life domains after completion of NET. At termination, the patient’s score on the PCL-5 was under the threshold that indicates probable PTSD (PCL-5 score = 9). In conclusion, NET may offer a valuable treatment option for patients who experience multiple traumatic events during the perinatal period and endorse PTSD symptoms.
Young adults, particularly males, may be at heightened risk for problematic online gambling, including sports betting and gambling-like financial trading. However, limited information exists regarding which strategies may be most useful for young adults in reducing or discontinuing engagement with these specific forms of gambling. The present study aimed to qualitatively explore reasons for gambling, motivations for behavioral change, and change techniques used to reduce or stop gambling among young adults with gambling problems. Online semi-structured interviews were conducted with nine young adults from the US (8 males, 1 genderqueer; mean age = 31.9 years, SD = 4.3). Qualitative data were analyzed in NVivo using both deductive and inductive approaches to identify themes. Reasons for gambling ranged from social engagement to idealized identity construction, with most participants becoming motivated to change online gambling behaviors after hitting “rock bottom” (i.e., a combination of financial, emotional, and interpersonal harm). The most frequently used change techniques aligned with cognitive-behavioral-therapy-based components, such as behavioral substitution, planning social support, social skills training, and relapse prevention. Findings could inform the development of tailored and targeted treatment to address the specific needs of young adults seeking help for problematic online sports betting and financial trading.
To improve the therapeutic gains of partial responders to Cognitive Behavioral Therapy (CBT), clinicians can consider implementing imagery rescripting (ImRs) – an evidence-based intervention that modifies cognitive and affective features of early adverse memories thematically tied to present-day difficulties. While many case studies apply ImRs to patients with a specific diagnosis, the current paper demonstrates the applicability and efficacy of ImRs for a patient, “Charlie”, with multiple comorbidities. Charlie is a 32-year-old male with obsessive-compulsive disorder (OCD), panic disorder, and persistent depressive disorder, who received 18 sessions of CBT. Following this intervention, Charlie reported substantial improvement in his symptoms; however, he continued to feel that his core beliefs of dangerousness, worthlessness, and unlovability were true. To address residual symptoms, Charlie participated in three ImRs sessions that targeted memories related to trauma, emotional invalidation, and shame. Details regarding the rationale, preparation, and administration of ImRs are provided, along with abbreviated transcripts from each session. Charlie’s symptoms decreased by an additional 50% (or more) following the three ImRs and he reported an improvement in psychological flexibility and emotion regulation. Charlie’s treatment trajectory can provide clinical insights and guidance to other CBT providers seeking to augment partial responders’ care with ImRs.
Young children can face emotional and behavioral difficulties, such as anxiety and oppositionality. Research has demonstrated these problems can be addressed via behavioral parent training; however, barriers to treatment exist. Family Check-In (FCI) is a low-cost, 3-session assessment, feedback, and referral service designed to identify child and family difficulties early and help parents make decisions about mental health treatment. The purpose of this study was to examine the feasibility, acceptability, and preliminary effects of FCI on engaging families (n = 30) into treatment in our Psychological Services Center (PSC). We also assessed clinical characteristics, treatment recommendations, and variables related to pursuing treatment. Most families completed FCI and rated their experience positively. The most common diagnosis was oppositional defiant disorder, and parent training was typically recommended. Over half the parents had clinically significant symptoms of depression and/or anxiety. Among FCI completers, 38.5% continued treatment in our PSC. Variables related to pursuing treatment included a child therapy recommendation, higher levels of maternally-reported child symptoms, and paternal overreactivity. Families with fathers reporting greater distress and depressive symptoms were less likely to pursue treatment. Three case vignettes are presented. Results suggest FCI is feasible, acceptable, and can engage some families into treatment.
This article addresses the facilitators and barriers encountered during the implementation of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TSC) across community mental health centers (CMHCs) in 10 counties in California. Counties were randomized to implement Standard TSC or an adapted version of TSC intended to improve the “fit” of TSC to the CMHC context. Grounded in the i-PARIHS framework, external facilitation was employed to implement TSC and subsequently to implement a Train the Trainer (TTT) program with the goal of training locally embedded providers to train their colleagues in TSC. While each site experienced unique facilitators and barriers, multiple common themes emerged that may help guide future efforts to implement evidence-based psychological treatments and TTT. These themes include features of the facilitation team, the study design and TSC, attitudes towards research studies and sleep, resource availability, leadership and champion support, and cross-site collaboration. Solutions to address barriers, case examples, and recommendations for future implementation efforts are shared.Trial registration: Clinicaltrials.gov identifiers: [Details omitted for double-anonymized reviewing]
In this review, we summarize existing interventions for each of the four key constructs within the interpersonal-psychological theory of suicide: perceived burdensomeness, thwarted belongingness, hopelessness specifically regarding the two states, and suicidal capability. In doing so, we discuss interventions that have proven to be effective as well as those that have had less success. We further identify specific characteristics of these interventions that may contribute to positive outcomes and provide examples of how we have applied these therapeutic techniques with individual patients. Although continued efforts to create and evaluate interventions that target the core components of the interpersonal-psychological theory of suicide are needed, we find the relatively large number of interventions and techniques that have demonstrated efficacy since the theory’s publication, both empirically and anecdotally, to be encouraging and to provide evidence of hope for suicidal patients.
Gambling disorder (GD) is associated with various co-occurring mental health conditions, including posttraumatic stress disorder (PTSD). Yet GD treatments do not address PTSD and PTSD treatments do not address GD. One exception is Seeking Safety (SS), which is an evidence-based, widely adopted model designed for co- occurring addiction and PTSD. Thus far, it is the only integrated model studied in samples with current co-occurring GD and PTSD, and the only one to have undergone a randomized controlled trial (RCT). In this paper, four members of that RCT offer clinical suggestions for implementing SS for GD. We identify key overall themes on the use of SS for GD. We offer examples of adaptations of SS for GD, emphasizing the flexibility inherent in SS. And we provide two case examples as well as suggestions for training and supervision. The study of GD/PTSD is at an extremely early stage and more research is needed.
Individuals who engage in problem gambling (PG) often experience devastating consequences, so there is an urgent need to identify how to help them achieve sustained recovery from PG. Cognitive behavioral therapy remains the gold standard for treating PG, but its multifaceted nature makes it difficult to determine which components/skills are most effective for aiding recovery. The purpose of this study was to identify which and how specific cognitive-behavioral skills might be useful for sustaining recovery from PG. As part of a larger study to inform the development of a CBT-based mobile health app for PG, semi-structured qualitative interviews were conducted with individuals with lived experience and clinicians providing treatment for people with PG. Data from 12 individuals in sustained recovery from PG and 8 treatment providers were analyzed to identify specific skills they found to be helpful for themselves and their clients, respectively. Six themes were identified: managing finances, reducing exposure to gambling, engaging in alternate activities, improving social support, learning how to manage stress, and correcting cognitive distortions. Participants also provided insight on caveats to certain skills that might limit their utility. These data can inform treatment optimization efforts by suggesting specific skills to emphasize during treatment to support recovery from PG.
Many family caregivers of patients with severe acute brain injuries (SABI) that result in intial coma endure prolonged emotional distress. After electing to pursue life-sustaining treatments (i.e, tracheostomy and/or percutaneous endoscopic or surgical gastrostomy tube placement), many caregivers face prolonged uncertainty, ambiguous grief, burden, and heightened risk for their own adverse health outcomes downstream. To address the paucity of psychosocial interventions for this population, we adapted an existing resiliency program for dyads of acute brain injury patients with good mental status and their caregivers (Recovering Together), to meet the specific needs of caregivers of SABI patients with poor initial neurological recovery (the COMA Family Program [COMA-F]). COMA-F aims to to prevent chronic emotional distress among SABI caregivers by providing evidence-based skills training early on, during their loved one’s transition out of the neurosciences intensive care unit. Here, we highlight the experience of Maurice, a caregiver enrolled in the pilot trial of COMA-F. Maurice’s journey demonstrates the emotional and relational challenges associated with SABI caregiving, as well as COMA-F’s unique ability to provide emotional support, cultivate resilience, and potentially empower SABI caregivers. At the conclusion of the program, Maurice endorsed significant improvements in anxiety and depression and reported high satisfaction in an exit interview.
Religious scrupulosity is characterized by obsessions and compulsions related to religious beliefs and observances (Abramowitz et al., 2002). Exposure and response prevention (E/RP) is an evidence-based treatment for OCD and is the recommended treatment for religious scrupulosity (Abramowitz & Buchholtz, 2020). Orthodox Judaism has certain beliefs and observances that may challenge the appropriateness of using E/RP (Bonchek & Greenberg, 2009; Huppert & Siev, 2010). Although previous articles (e.g., Bonchek & Greenberg, 2009; Greenberg & Shefler, 2008) have examined aspects of E/RP use in the Orthodox Jewish community for treating scrupulosity, no review has yet integrated psychological literature and primary Judaic sources on scrupulosity to produce wide-ranging, targeted recommendations for its application in this population. Combining these sources is important as it can help clinicians provide appropriate treatment without violating the clients’ religious beliefs. This literature review examines peer-reviewed psychology articles and primary Judaic sources discussing traditional Jewish attitudes toward scrupulosity and the usage of E/RP. It concludes that E/RP can be effectively applied to Orthodox Jews with some modifications.
There is a critical need to develop brief, scalable interventions for youth that can facilitate accessible, cost-efficient, and least-restrictive support, while addressing key drivers of suicidal ideation (SI). We present an overview of a novel cognitive-behavioral therapy module which targets perceived burdensomeness toward others (PB), an established driver of SI. Empirical work indicates that PB precipitates SI and is modifiable in youth. Hence, the primary aims of the module are to decrease levels of PB and downstream SI in youth who present with subacute suicidal ideation (i.e., SI not requiring intensive, restrictive services). The four sections of the Give to Others (GO) module include (1) rapport-building and an introduction to the cognitive triangle, (2) identification of burden-related thoughts and cognitive restructuring strategies, (3) a social contribution (or “give to others”) activity for teens, and (4) a parent message activity related to youth social contribution. This paper provides guidance to clinicians treating youth with subacute SI for whom there are limited brief evidence-based manualized protocols. The acceptability and feasibility of the module in the management of subacute SI is promising, with additional outcome data collected in an ongoing randomized controlled trial.
This case study evaluated the use of accelerated Cognitive Processing Therapy (CPT) in Spanish. A 55-year-old Hispanic American woman with PTSD received 10 daily Cognitive CPT sessions over a 2-week period. Symptom assessments were collected at baseline, prior to each CPT session, and 2- and 3-month follow-up. Questionnaires assessing posttraumatic stress disorder (PCL-5) and depression (PHQ-9) were utilized to evaluate treatment effects over time. Treatment satisfaction and qualitative feedback were also provided at 2-months posttreatment. A treatment description details the course of accelerated CPT, as well as notable observations related to both the accelerated course of treatment and the use of Spanish language in treatment. Analyses demonstrated clinically meaningful reductions in both PTSD and depression symptoms over the course of treatment, and both remained ameliorated at the follow-up assessment time point. Patient satisfaction with the treatment format was also shown to be high following treatment. The case demonstrated that CPT can be delivered in Spanish and in an accelerated treatment format using minor, fidelity-consistent adaptations related to language and culture (e.g., using Spanish-language worksheets, exploring culturally relevant themes with Socratic questions) while maintaining strong symptom reduction. Delivering CPT in Spanish daily over the course of 2 weeks appears to be feasible and potentially effective.
Since the onset of the COVIDbeing discharged from the hospital, many individuals experience mental health concerns such as depression, anxiety, and posttraumatic stress disorder. This population may present with unique psychological features and treatment needs that differ from individuals hospitalized for other reasons. For example, these patients experience delirium at higher rates than those of comparable respiratory illnesses. Two case studies are presented to demonstrate how psychotherapy can be used to address the unique needs of patients who have a COVID-19-related hospitalization, experience delirium, and develop trauma-related symptoms. While existing psychotherapy interventions can be used, there are important considerations for working with this population. It is critical to address delirium experiences, ongoing fears about contracting COVID-19, and medical sequelae. A multidisciplinary approach is likely essential for addressing the complex needs of this population.
This study investigated the feasibility and acceptability of a culturally adapted group therapy intervention for SGM asylum seekers. From an initial pool of 16 eligible individuals contacted, 5 completed a majority of the intervention group sessions as well as exit interviews. Thematic analysis of these interview transcripts, as well as a case study of one participant, suggested that participants had a positive perception of the intervention and developed new cognitive behavioral therapy skills, including distress tolerance, cognitive flexibility, assertiveness, and self-compassion skills. Themes identified included a reduction in social isolation, enhanced solidarity, and heightened motivation for therapy engagement. Participants expressed preferences for culturally relevant discussion topics and identified the importance of privacy and personalized attention in the individual sessions that supplemented the group program. Despite logistical hurdles and variable engagement levels, the studied intervention has the potential to alleviate mental health morbidity in this underserved and vulnerable population, as well as spark interest in further engagement in therapy.
Borderline personality disorder (BPD) often co-occurs with posttraumatic stress disorder (PTSD), with elevated rates of PTSD found in BPD samples (Shah & Zanarini, 2018). Positive outcomes after Dialectical Behavior Therapy (DBT) are less pronounced in individuals with PTSD (Barnicot & Crawford, 2018), and PTSD significantly increases the risk for future suicide attempts in patients with BPD (Wedig et al., 2012). Research examining a combined approach for treating BPD and PTSD has shown promise (Harned et al., 2012, 2014, and 2018). However, most studies have focused on prolonged exposure therapy (PE) as a treatment option. Cognitive processing therapy (CPT), another highly effective treatment for PTSD, has seldom been researched in this population. The authors retrospectively analyzed nonrandomized clinical data from a sample of 21 Veterans with BPD and PTSD who underwent CPT after DBT in a Veterans Affairs (VA) outpatient clinic. Changes in PTSD symptoms, depressive symptoms, suicidal behavior, and the number of psychiatric hospitalizations were assessed before and after treatment. The authors detail the sequential treatment of BPD and PTSD and provide a detailed case example. Findings suggest that CPT following DBT may enhance PTSD and depressive symptoms and decrease the frequency of suicidal behavior.
