Employing a Case Study in Building an Assimilation Theory Account of Generalized Anxiety Disorder and Its Treatment with Cognitive-Behavioral Therapy

Abstract

This theory-building case study aimed to elaborate an account of anxiety and its treatment within an assimilation model of therapeutic change (e.g., Stiles, 2002). A team consisting of the senior author and two other co-investigators independently reviewed the case of Robert, a 52 year-old man who was successfully treated for generalized anxiety disorder (GAD) in a clinical trial of cognitive behavior therapy (CBT). The team observed the expression of Robert's major voicesthe assimilation model's name for the individual parts of a client's personality-in the audio record of the client's in-session dialogue. Prominent among these was a critic voice, described by co-investigators as harsh and derisive toward other aspects of the self. Our work led us to infer that, although the critic voice seemed closely associated with the anxiety that characterized Robert's GAD, it did not produce that anxiety directly through its attacks on his other voices. Rather, the critic voice induced vulnerability to specific, anxiety-arousing external circumstances by derogating Robert's coping skills or exaggerating the threat of specific external circumstances. Robert's anxiety then arose when he encountered those circumstances.

Does assimilation of problematic experiences predict a decrease in symptom intensity?

“…A series of intensive case studies of assimilation progress in different therapeutic models has shown that good outcome clients, as assessed by standard symptom intensity measures, progress toward high APES levels across their sessions (e.g., Brinegar, Salvi, & Stiles, 2008;Caro Gabalda, 2011;Caro Gabalda, Stiles, & Pérez Ruiz, 2016;Gray & Stiles, 2011;Honos-Webb, Stiles, & Greenberg, 2003;Knobloch, Endres, Stiles, & Silberschatz, 2001;Mendes et al, 2016;Osatuke et al, 2007;Ribeiro, Braga et al, 2016a;Ribeiro, Cunha et al, 2016b). For example, in a study of one good outcome client, Basto et al (2016) found a strong negative correlation across 16 sessions of CBT between APES level and symptom intensity.…”

Changes in symptom intensity and emotion valence during the process of assimilation of a problematic experience: A quantitative study of a good outcome case of cognitive-behavioral therapy

“…A series of case studies has supported the assimilation model's contention that the process of change follows a common sequence approximated by the APES in a Changes in symptom intensity and emotion valence -6 variety of therapies. These include Emotion Focused Therapy (Brinegar, Salvi, Stiles & Greenberg, 2006), Client-Centered Therapy (Brinegar, Salvi, Stiles & Greenberg, 2006;Osatuke et al, 2005), Psychodynamic Therapy (Knobloch, Endres, Stiles & Silberschatz, 2001), Linguistic Therapy of Evaluation (Caro Gabalda, 2007), couple therapy (Schielke et al, 2011), and family therapy (Laitila, & Aaltonen, 1998), as well as CBT (Gray & Stiles, 2011).…”

Editor's Introduction: Combining Pragmatic Case Studies Within a Single Case Experimental Design

“…It is exemplified in the work of William Stiles and associates, who have published some of their research in PCSP (Stiles, 2009;Gray & Stiles, 2011;Schielke et al, 2011). Stiles et al employ theory-building case studies to develop an "assimilation" theory of therapy, which views treatment progress as a function of the degree to which difficult, disturbing, and conflicting experiences are properly acknowledged, worked through, and connected to constructive action while being fully incorporated and integrated into the patient's internal experiencing.…”

“…Stiles et al employ theory-building case studies to develop an "assimilation" theory of therapy, which views treatment progress as a function of the degree to which difficult, disturbing, and conflicting experiences are properly acknowledged, worked through, and connected to constructive action while being fully incorporated and integrated into the patient's internal experiencing. In Gray and Stiles' (2011) words, "A central tenet of theory-building case study research is that observations about rich material from individual cases-both the commonalities and differences-can be combined to inform and support theories about complex underlying psychological phenomena [like assimilation]" (p. 532).…”