The present article presents a case of cognitive behavioral therapy (CBT) along with heart rate variability (HRV) biofeedback training for the treatment of a medication unresponsive 13-year-old boy with cyclic vomiting syndrome (CVS). CVS is characterized by recurring stereotypic episodes of vomiting, interspersed with asymptomatic periods. Triggers for vomiting include anticipatory anxiety related to school examinations, family conflicts, and birthday parties as well as infectious diseases, and certain foods. Current treatment design addressed two pivotal etiological factors: autonomic dysregulation and anticipatory anxiety. Treatment outcome suggests that vomiting episodes may be successfully prevented by aiding the patient to identify and manage precipitant psychological stressors, to regulate HRV patterns, and gain a renewed sense of bodily control and self-efficacy. Further research is suggested using a controlled study with pre- and post-behavioral and stress measures to evaluate the effectiveness of CBT and biofeedback training compared to pharmacotherapy and placebo.
To date, cognitive behavioral therapy has been designated the most efficient evidence-based psychotherapeutic approach for OCD management. This is mainly due to its ability to effectively address the constitutional and developmentally acquired emotional and cognitive deficiencies of OCD, which express themselves through behavioral compulsions and intrusive thoughts. Yet some reports indicate that from 30 to 60 percent of OCD patients are not responsive to psychotherapeutic interventions. As a consequence, broader therapeutic models have been considered. These models encompass multifactorial etiologies of OCD and take intrapsychic stressogenic factors into consideration as well. Some of these models have adopted hypnotherapeutic approaches. In the present article, we introduce a therapeutic tool that utilizes hypnotically induced dissociation (HID) to identify and address the intrapsychic etiology of OCD. The result is a therapeutic intervention that complements existing OCD treatment strategies. Clinical cases are presented to illustrate implementation of the approach.
Mindfulness is most commonly defined as the ability to bring one's attention to experiences occurring in the present moment, with complete acceptance and without judgment. The diverse benefits of mindfulness as a therapeutic tool have been widely explored. Nevertheless, when mindfulness is incorporated into psychotherapy it may influence the relationship between the therapist and the patient in diverse manners. This influence appears in the literature as relational mindfulness pertaining to mindfulness practiced in relationship to other people. The present article attempts to delineate the diverse influences of relational mindfulness within the psychotherapeutic setting through Qualitative analysis of in-depth interviews conducted with eight psychotherapists recruited from an institution for the teaching of mindfulness for psychotherapists. Analysis revealed influences on the therapist's worldview, on technique, on the presence of the therapist and, on the therapeutic alliance. These aspects are discussed from a psychoanalytic and a cognitive-behavioral framework.
Clinical Impact StatementQuestion: How can mindfulness be incorporated within Psychodynamic theories and Cognitive-Behavioral Psychotherapy. Findings: Using mindfulness enhances therapeutic relationship, improves case conceptualization, and enriches technique. Meaning: Mindfulness can be viewed as a tool that strengthens the core aspects of both types of therapies. Next Steps: Validating these findings within a quantitative research design.
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