Edited by
Dean McKay, Jonathan S. Abramowitz, and Eric A. Storch
This edition first published 2017
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Library of Congress Cataloging‐in‐Publication Data
Names: McKay, Dean, 1966– editor. | Abramowitz, Jonathan S., editor. | Storch, Eric A., editor.
Title: Treatments for psychological problems and syndromes / edited by Dean McKay, Jonathan S. Abramowitz, Eric A. Storch.
Other titles: Treatments for psychological problems and syndromes
Description: Hoboken, NJ : John Wiley & Sons Inc., 2017. | Includes bibliographical references and index.
Identifiers: LCCN 2016046179 | ISBN 9781118876985 (cloth) | ISBN 9781118877005 (pbk.)
Subjects: | MESH: Mental Disorders–therapy | Mental Disorders–diagnosis | Evidence‐Based Medicine | Randomized Controlled Trials as Topic
Classification: LCC RC454 | NLM WM 400 | DDC 616.89–dc23
LC record available at https://lccn.loc.gov/2016046179
Cover Design: Wiley
Cover Image: © themacx/Gettyimages
For Jack Rosenberg. Your memory will always be a blessing.
Dean McKay
Dedicated, with love, to Stacy, Emily, and Miriam.
Jonathan S. Abramowitz
To Jill, Ellie, Noah, and Maya with love. And, to my wonderful students over the years.
Eric A. Storch
Dean McKay, PhD, is Professor in the Department of Psychology at Fordham University and past president (2013–2014) of the Association for Behavioral and Cognitive Therapies. He is President‐elect (2017) of the Society for a Science of Clinical Psychology. He currently serves on the editorial boards of Behavior Therapy, Behaviour Research and Therapy, Journal of Clinical Psychology, Journal of Anxiety Disorders, Psychiatry Research, Journal of Experimental Psychopathology, and International Journal of Clinical and Health Psychology, and is associate editor of Behavior Therapy and Journal of Obsessive‐Compulsive and Related Disorders. He has edited or coedited 16 books dealing with treatment of complex cases in children and adults, obsessive–compulsive disorder, disgust in psychopathology, and research methodology; published over 200 journal articles and book chapters; and has delivered over 250 conference presentations. He is board‐certified in cognitive behavioral and clinical psychology by the American Board of Professional Psychology. Dr. McKay serves on the Scientific Council of the Anxiety and Depression Association of America, as well as on the Scientific Advisory Board of the International Obsessive Compulsive Disorder Foundation. His research has focused primarily on obsessive–compulsive disorder, the role of disgust in psychopathology, and most recently selective sound sensitivity (also known as misophonia). Dr. McKay is also director and founder of the Institute for Cognitive Behavior Therapy and Research, a private treatment and research center in Westchester County, New York.
Jonathan S. Abramowitz, PhD, is Professor and Associate Chair of Psychology, and Research Professor of Psychiatry, at the University of North Carolina (UNC) at Chapel Hill. He is Director of the UNC Anxiety and Stress Disorders Clinic, and a North Carolina‐licensed psychologist with a diploma from the American Board of Professional Psychology. He is an internationally recognized expert on obsessive–compulsive disorder and anxiety, and has published over 250 research articles, books, and book chapters on these subjects. He is a past president of the Association for Behavioral and Cognitive Therapies and currently serves as editor of the Journal of Obsessive‐Compulsive and Related Disorders, which he founded in 2011. Dr. Abramowitz is a regular presenter at professional conferences and has received numerous awards for his contributions to the field.
Eric A. Storch, PhD, is Professor and All Children’s Hospital Guild Endowed Chair in the departments of Pediatrics, Health Policy and Management, Psychiatry and Behavioral Neurosciences, and Psychology at the University of South Florida. He serves as the Director of Research for Developmental Pediatrics at Johns Hopkins All Children’s Hospital, and is the Clinical Director of Rogers Behavioral Health–Tampa Bay, which is a partial hospitalization program oriented to individuals with significant obsessive–compulsive disorder, anxiety, and/or eating disorders. Dr. Storch has received multiple grants from federal agencies for his research (i.e., National Institutes of Health, Centers for Disease Control and Prevention), is a Fulbright Scholar, and has published over 10 books and over 500 articles and chapters. He specializes in the nature and treatment of childhood and adult obsessive–compulsive disorder and related conditions, anxiety disorders, and anxiety among youth with autism.
Jonathan S. Abramowitz
University of North Carolina at Chapel Hill, United States
Samantha Adelsberg
Fordham University, United States
Margaret S. Andover
Fordham University, United States
Erland Axelsson
Karolinska Institutet, Sweden
Catherine R. Ayers
VA San Diego Healthcare System, University of California, San Diego
Daniel M. Bagner
Florida International University, United States
Nicole E. Barroso
Florida International University, United States
Donald H. Baucom
University of North Carolina at Chapel Hill, United States
Natalie Bennett
University of Nevada, Reno, United States
Randi Bennett
Fordham University, United States
Lorraine Benuto
University of Nevada, Reno, United States
Charmaine Borg
University of Groningen, The Netherlands
Emily H. Brackman
Fordham University, United States
Lauren Breithaupt
George Mason University, United States
Elle Brennan
Kent State University, United States
Lily A. Brown
University of California, Los Angeles, United States
Jacqueline R. Bullis
Boston University, United States
Joseph K. Carpenter
Boston University, United States
Olga Cirlugea
University of Nevada, Reno, United States
Sarah W. Clark
Virginia Commonwealth University, United States
Dennis R. Combs
University of Texas at Tyler, United States
Christine A. Conelea
Bradley Hasbro Children’s Research Center, United States
Laren R. Conklin
Boston University, United States
Jesse R. Cougle
Florida State University, United States
Michelle G. Craske
University of California, Los Angeles, United States
Joshua Curtiss
Boston University, United States
Kendra Davis
University of Georgia, United States
Thompson E. Davis III
Louisiana State University, United States
Peter J. de Jong
University of Groningen, The Netherlands
Helen F. Dodd
University of Reading, United Kingdom
Todd J. Farchione
Boston University, United States
Sarah Fischer
Potomac Behavioral Solutions, United States
Christopher A. Flessner
Kent State University, United States
Evan M. Forman
Drexel University, United States
Sarah K. Francazio
Kent State University, United States
Hannah E. Frank
Temple University, United States
Dainelys Garcia
Florida International University, United States
Natalia M. Garcia
University of Washington, United States
Diana Gaydusek
American University, United States
Jonathan D. Green
Boston University School of Medicine, United States
Shelby Harris
Montefiore Medical Center, United States
Erik Hedman
Karolinska Institutet, Sweden
James D. Herbert
Drexel University, United States
Jonathan Hoffman
Neurobehavioral Institute, United States
Stefan G. Hofmann
Boston University, United States
Melanie A. Hom
Florida State University, United States
Jennifer L. Hudson
Macquarie University, Australia
Alissa B. Jerud
University of Washington, United States
Julie Kahler
University of Nevada, Reno, United States
Maysa M. Kaskas
Louisiana State University, United States
Terence M. Keane
Boston University School of Medicine, United States
Lucas S. LaFreniere
Pennsylvania State University, United States
Michael E. Levin
Utah State University, United States
Joanna Marino
Potomac Behavioral Solutions, United States
Elizabeth H. Marks
University of Washington, United States
Brian P. Marx
Boston University School of Medicine, United States
Natalie L. Matheny
Florida State University, United States
Tina L. Mayes
VA San Diego Healthcare System, United States
Barbara S. McCrady
University of New Mexico, United States
James P. McCullough Jr.
Virginia Commonwealth University, United States
Eleanor McGlinchey
New York State Psychiatric Institute, United States
Dean McKay
Fordham University, United States
Kim T. Mueser
Boston University, United States
Yolanda E. Murphy
Kent State University, United States
Michelle G. Newman
Pennsylvania State University, United States
William T. O’Donohue
University of Nevada, Reno, United States
Rachel Ojserkis
Fordham University, United States
Christine Paprocki
University of North Carolina at Chapel Hill, United States
Ronald M. Rapee
Macquarie University, Australia
Shireen L. Rizvi
Rutgers University, United States
Amy K. Roy
Fordham University, United States
Paige M. Ryan
Louisiana State University, United States
Shannon Sauer‐Zavala
Boston University, United States
Ki Eun Shin
Pennsylvania State University, United States
Eric A. Storch
University of South Florida, United States
William Taboas
Fordham University, United States
Marget C. Thomas
Rutgers University, United States
Warren W. Tryon
Fordham University, United States
Anna Van Meter
Yeshiva University, United States
Michael R. Walther
Alpert Medical School–Brown University, United States
Eric Youngstrom
University of North Carolina at Chapel Hill, United States
Lori A. Zoellner
Florida International University, United States
Jonathan S. Abramowitz Eric A. Storch, and Dean McKay
The field of mental health treatment has reached a point of maturity such that most major behavioral and psychological problems now have empirically supported interventions available for application. These treatment packages have been derived from conceptual models of psychopathology that draw on basic experimental and clinical research. Available treatment packages, usually made available through treatment manuals developed and tested for particular disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5; American Psychiatric Association, 2013), typically include multiple specific interventions. Yet, it is not always clear which components are essential and which are potentially less critical to good outcomes. Moreover, it might not be clear which components target which mechanisms of psychopathology. Accordingly, there might be insufficient guidance for clinicians when it comes to choices in treatment delivery; for example, when time constraints require use of the most essential components of an existing protocol, or when the presentation of a certain condition is more complicated than, or deviates from, descriptions and illustrations in treatment manuals. Further, it is conceivable that incorporating less effective treatment elements may actually hinder individual progress toward achieving wellness. Addressing these and other clinical conundrums can be challenging without clear and concise guidance that is based on the latest empirical research.
Accordingly, we have assembled this book to help the practicing clinician to more easily identify mechanisms that best explain observed psychopathology and then apply the appropriate empirically supported processes of change. Such an approach allows the clinician to practice as an evidence‐based practitioner even when they may need to deviate from disorder‐based treatment manuals. This approach also raises the question of whether traditional psychiatric diagnosis (i.e., based on the DSM‐5) is necessary—a growing controversy in the mental health field. That is, if one conceptualizes psychopathology at the level of the individual mechanisms and processes, and then applies empirically supported techniques to reverse such mechanisms, what advantage is there to using diagnostic labels such as those in the DSM? It is our opinion that empirically supported practice begs a critical discussion of (a) mechanisms of psychopathology, (b) mechanisms of psychological change, and (c) a means for conceptualizing presenting behavioral and psychological problems and developing treatment plans that rely on valid perspectives unmoored from the current nosology.
This book was developed at an interesting time in the evidence‐based practice movement. It has been just about 20 years since the standards for determining what counts as an empirically supported treatment were developed (Chambless & Hollon, 1998). These criteria stipulated that a minimum of two randomized controlled trials (RCTs) be conducted by two different research teams, and show efficacy for a treatment, compared to a placebo intervention, in order for the protocol to be declared empirically supported. The full set of guidelines was considered path‐breaking at the time, as this was the first time any set of standards was articulated to guide practitioners in making treatment decisions. At the time these standards were developed, RCTs were comparably rare, with few studies comparing to attention–placebo control conditions.
Now, close to 20 years later, RCTs are conducted with far greater frequency. Online registries have been developed where investigators can register their trials a priori, with primary and secondary variables of interests declared. Many journals require that RCTs submitted for publication be registered in order to be considered. The virtue of these registries is that it allows other investigators to evaluate the full corpus of available research, including those that might be null findings that never made it to publication, in order to have a complete account of the efficacy of a treatment protocol. Given that the criteria for empirically supported treatments were silent on the matter of unpublished or null findings, a protocol could be declared empirically supported if it met the two RCT criteria, even if there were numerous failed prior trials. This problem has been addressed in the newly crafted criteria for empirically supported treatments (ESTs; Tolin, McKay et al., 2015; Tolin, Forman, et al., 2015). There was an incremental movement already underway to deal with this as evidenced by the ubiquity of meta‐analyses for specific treatment protocols, and the advent of the Cochrane reviews, which surveys in comprehensive detail the effects of specific treatment programs. As a result, we are now at the point where many treatments are fairly well understood with respect to their benefits and limitations and the components that are essential ingredients. Understanding what treatment elements are essential ingredients is the essence of evidence‐based practice, whereby direct service clinicians can select components of treatment that are deemed scientifically supported for specific problems faced by their clients.
The aims of this volume are therefore threefold. The first is to shed light on both the empirically supported and the unsupported components of conceptual models of psychopathology. Second, the volume aims to identify empirically supported components of existing psychological interventions and the rationales for how multicomponent interventions are sequenced. Thus, this text provides clinicians with an understanding of the sequential nature of interventions, and the criteria for moving from one intervention to the next, particularly for seemingly disparate treatment procedures that form multicomponent treatment packages. The third aim is to illustrate specific ways of identifying mechanisms of psychopathology that might attenuate treatment outcome with established protocols, and help the clinician use empirically supported methods to address these obstacles.
All chapters in the book draw on available research evidence to make clear the connection between science and practice; and these chapters are organized into five sections. The first section offers an overview, and outlines the aims and scope of the text, as well as a brief history of the empirically supported practice movement. The second section addresses the three aims of the book as they relate to conditions for which there is extensive support for mechanisms of psychopathology and empirically supported psychological treatment procedures and processes of change. Given the unique complexities and extensive research base, two chapters cover treatments for psychopathology emerging from traumatic events. This is an important aspect of the book given the various controversies around the possible risk for dropout with evidence‐based therapy for trauma (Imel et al., 2013). The third section covers areas of psychopathology and treatment for which there is emerging empirical support. The fourth section covers domains of psychopathology for which there is only preliminary—or perhaps the potential for—evidence‐based approaches to psychopathology and treatment. The fifth and final section focuses on mechanisms of psychopathology and change across the age span.
To further orient the reader, each chapter follows a general format in which the nature of the psychopathology is first discussed. The focus is on components of relevant conceptual models, including an appraisal of their scientific support, rather than a review of major etiological theories. Next, each chapter turns to a discussion of empirically supported treatment components, including the sequencing of multicomponent interventions and the factors that can interfere with implementing these procedures. Finally, each chapter includes a discussion of how mechanisms of the psychopathology itself might interfere with treatment outcome, and how clinicians might adapt therapy to address these mechanisms and optimize treatment effectiveness. It is our hope that this edited text provides the field with a handbook for understanding the nature and treatment of psychopathology at the level of psychological mechanisms, with the broader aim of helping the field evolve from a focus on multicomponent treatment manuals for “mental disorders” to a more conceptually oriented process‐based approach.