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Article

Elizabeth C. Pomeroy and Polly Y. Browning

Eating disorders involve maladaptive eating patterns accompanied by a wide range of physical complications likely to require extensive treatment. In addition, “eating disorders” frequently occur with other mental disorders, such as depression, substance abuse, and anxiety disorders. The earlier these disorders are diagnosed and treated, the better the chances are for full recovery” (NIMH, 2011). As of 2013, lifetime prevalence rates for anorexia nervosa, bulimia nervosa, and binge eating disorder are 0.9%, 1.5%, and 3.5% among females, and 0.3%, 0.5%, and 2.0% among males respectively (Hudson, Hiripi, Pope, & Kessler, 2007). Early diagnosis is imperative; the National Institute of Mental Health estimates that the mortality rate for anorexia is 0.56% per year, one of the highest mortality rates of any mental illness, including depression (NIMH, 2006). More recent research (Crow et al., 2009) indicates mortality rates as high as 4.0% for anorexia nervosa, 3.9% for bulimia nervosa and 5.2% for eating disorders not otherwise specified. Current research and treatment options are discussed.

Article

Simona C. Kaplan, Michaela B. Swee, and Richard G. Heimberg

Social anxiety disorder (SAD) is characterized by fear of being negatively evaluated by others in social situations. Multiple psychological interventions have been developed to treat SAD. The most widely studied of these interventions stem from cognitive-behavioral, acceptance-based, interpersonal, and psychodynamic conceptualizations of SAD. In cognitive-behavioral therapy (CBT), patients learn to identify and question maladaptive thoughts and engage in exposures to feared situations to test the accuracy of biased beliefs. Mindfulness and acceptance-based approaches to treating SAD focus on mindful awareness and acceptance of distressing internal experiences (i.e., psychological and physiological symptoms) with the ultimate goal of behavior change and living a meaningful life based on identified values. Interpersonal psychotherapy links SAD to interpersonal problem areas and aims to reduce symptoms by targeting interpersonal difficulties. Psychodynamic psychotherapy for SAD focuses on identifying unresolved conflicts that lead to SAD symptoms, fostering insight and expressiveness, and forming a secure helping alliance. Generally, CBT is the most well-studied of the psychological treatments for SAD, and research demonstrates greater reductions in social anxiety than pill placebo and waitlist controls. Results from randomized controlled trials (RCTs) suggest that mindfulness—and acceptance-based therapies may be as efficacious as CBT, although the body of research remains small; four of five RCTs comparing these approaches to CBT found no differences. RCTs comparing CBT to IPT suggest that CBT is the more efficacious treatment. Two RCTs comparing CBT to psychodynamic psychotherapy suggest that psychodynamic psychotherapy may have efficacy similar to CBT, but that it takes longer to achieve similar outcomes. RCTs examining CBT and pharmacotherapy suggest that the medications phenelzine and clonazepam are as efficacious as CBT for treating SAD and are faster acting, but that patients receiving these medications may be more likely to relapse after treatment is discontinued than patients who received CBT. Research generally does not indicate added benefit of combining psychotherapy with pharmacotherapy above each monotherapy alone, although this body of research is quite variable. Effectiveness studies indicate that CBT is equally effective in community clinics and controlled research trials, but studies of this nature are lacking for other psychological approaches.

Article

Jonathan S. Abramowitz

Obsessive-compulsive disorder (OCD) is one of the most destructive psychological disorders. Its symptoms often interfere with work or school, interpersonal relationships, and with activities of daily living (e.g., driving, using the bathroom). Moreover, the psychopathology of OCD is seemingly complex: sufferers battle ubiquitous unwanted thoughts, doubts, and images that, while senseless on the one hand, are perceived as signs of danger on the other hand. The thematic variation and elaborate relations between behavioral and cognitive signs and symptoms can be perplexing to even the most experienced of observers. Cognitive-behavioral models of OCD explain these phenomena and account for their heterogeneity. These models also have implications for how OCD is treated using exposure and response prevention, which research indicates are effective short- and long-term interventions.

Article

Darlene Grant

The soldiers from the wars in Iraq and Afghanistan, as well as large numbers of nonwounded soldiers, experience post-traumatic stress disorder. Further, the families, groups, and communities from which all U.S. service men and women come, during and after these and other wars, have experienced their own war-related trauma. Stories on the nightly news reveal soldier reaction to combat stress, including intrusive memories, racing thoughts, nightmares, troubled sleep, irritability, anxiety, fear, isolation, depression anger, poor concentration, hyper- or hypovigilance, exaggerated responses, and increased alcohol and other drug abuse. The stories of family, friends, and community are filled with war stress symptoms of their own. Charged with keeping their families together, bills paid, jobs afloat, children safe and growing, families may experience a drop in income, loneliness and isolation, long deployments, multiple last minute combat redeployment and duty extensions, anger, frustration, depression, increased alcohol and other drug abuse, loss of trust, fear, increase in domestic violence, and school disruption. Not all of the change for family is negative as some spouses and children who are left behind find they have new skills and new independence with which to negotiate their world. The returning soldier's response to this newfound independence and skill may require the services of the clinical social worker.

Article

Maryann Amodeo and Luz Marilis López

This entry focuses on practice interventions for working with families and individuals including behavioral marital therapy, transitional family therapy, and the developmental model of recovery, as well as motivational interviewing, cognitive-behavioral therapy, relapse prevention training, and harm reduction therapy. A commonality in these intervention frameworks is their view of the therapeutic work in stages—from active drinking and drug use, to deciding on change, to movement toward change and recovery. We also identify skills that equip social work practitioners to make a special contribution to alcohol and other drug (AOD) interventions and highlight factors to consider in choosing interventions. There are a range of practice interventions for clients with AOD problems based on well-controlled research.

Article

B. Michelle Brazeal and Gordon MacNeil

Obsessive compulsive disorder (OCD) is a debilitating anxiety problem. This article reviews the characteristics, etiology, prevalence, and assessment of OCD and presents information on the efficacy of psychological, pharmacological, and combined treatments for this disorder. Early intervention that includes pharmacological agents (typically SSRIs) as well as behavioral and cognitive-behavioral psychotherapies (particularly exposure and response prevention) is the preferred method of intervening with OCD.

Article

Jonathan S. Gooblar and Sherry A. Beaudreau

Anxiety disorders are among the most prevalent and understudied mental health problems in late life. Specific phobia, social anxiety disorder, and generalized anxiety disorder are the most prevalent anxiety disorders in older adults among the 11 disorders identified by the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). Anxiety disorders lead to significant functional burdens and interface with physical health problems and cognitive impairment, concerns frequently experienced in adults over age 65. Additional contextual factors should be considered when assessing and treating late-life anxiety, including the effects of polypharmacy, other mental health conditions, role changes, and societal attitudes toward aging. The relationship between anxiety and physical health problems in older adults can be causal or contextual, and can involve poorer estimates of subjective health and lower ratings of functioning. These factors present unique challenges to the detection, conceptualization, and treatment of late-life anxiety, including the tendency for older adults to focus on somatic symptoms and the potential for long-term behaviors that can mask distress such as substance use. Researchers are increasingly incorporating a gerodiversity framework to understand the contributions of cultural, individual, and other group differences that may affect the presentation of anxiety symptoms and disorders. Older adults in general are less likely to be treated for anxiety disorders, and intersecting individual and group differences likely further affect how anxiety disorders are perceived by healthcare providers. Cognitive behavioral therapy and its variants have the most empirical support for treatment. Newer evidence lends support to acceptance and commitment therapy and problem-solving therapy, which tend to address some of the contextual factors that may be important in treatment.

Article

Addie Weaver, Joseph Himle, Gail Steketee, and Jordana Muroff

This entry offers an overview of cognitive behavioral therapy (CBT). Cognitive behavioral therapy is introduced and its development as a psychosocial therapeutic approach is described. This entry outlines the central techniques and intervention strategies utilized in CBT and presents common disorder-specific applications of the treatment. The empirical evidence supporting CBT is summarized and reviewed. Finally, the impact of CBT on clinical social work practice and education is discussed, with attention to the treatment’s alignment with the profession’s values and mission.

Article

Wendy Auslander and Elizabeth Budd

The purpose of this article is to provide an overview of: diabetes and its significance, the differences in types of diabetes, and landmark clinical trials that have resulted in changes in philosophy and treatment of diabetes. Second, a review of the various types of evidence-based and promising behavioral interventions in the literature that have targeted children and adults are presented. Social workers and other helping professionals are uniquely positioned to work collaboratively to improve psychosocial functioning, disease management, and prevent or delay complications through behavioral interventions for children and adults with diabetes.

Article

Quincy J. J. Wong, Alison L. Calear, and Helen Christensen

Internet-based cognitive behavioral therapy (ICBT) is the provision of cognitive behavioral therapy (CBT) using the Internet as a platform for delivery. The advantage of ICBT is its ability to overcome barriers to treatment associated with traditional face-to-face CBT, such as poor access, remote locations, stigmas around help-seeking, the wish to handle the problem alone, the preference for anonymity, and costs (time and financial). A large number of randomized controlled trials (RCTs) have tested the acceptability, efficacy, and cost-effectiveness of ICBT for anxiety disorders, mood disorders, and associated suicidality. A meta-review was conducted by searching PsycINFO and PubMed for previous systematic reviews and meta-analyses of ICBT programs for anxiety, depression, and suicidality in children, adolescents, and adults. The results of the meta-review indicated that ICBT is effective in the treatment and prevention of mental health problems in adults and the treatment of these problems in youth. Issues of adherence and privacy have been raised. However, the major challenge for ICBT is implementation and uptake in the “real world.” The challenge is to find the best methods to embed, deliver, and implement ICBT routinely in complex health and education environments.

Article

Kathleen Someah, Christopher Edwards, and Larry E. Beutler

There are many approaches to psychotherapy, commonly called “schools” or “theories.” These schools range from psychoanalytic, to variations of insight- and conflict-based approaches, through behavioral and cognitive behavioral approaches, to humanistic/existential approaches, and finally to integrative and eclectic approaches. Different and seemingly new approaches typically have been informed by older and more established ones. For instance, cognitive behavioral therapy (CBT), one of the more widely used approaches, evolved from traditional behavior therapy but has become sufficiently distinct by adding its own complex variations so as functionally to represent an approach of its own. New approaches abound both in number and in complexity. Modern clinicians have had to become increasingly widely read and creative in trying to understand the ways in which patients may be helped. The sheer number of approaches, which has climbed into the hundreds, has challenged the field to find ways of ensuring that the treatments presented are effective. The advent of Evidence Based Practices (EBP) throughout the healthcare fields has placed the responsibility on those who advocate for particular types of treatment scientifically to demonstrate their efficacy and effectiveness. While this movement has brought standards to the field and has offered some assurance that psychotherapy is usually helpful, there remains much debate about whether the many different schools produce different results from one another. The debate about how best to optimize positive effects of psychotherapy continues, and there remain many questions to be asked of psychotherapy theories and of research on these approaches.

Article

Stuart Linke and Elizabeth Murray

Alcohol-use disorders are widespread and associated with a greatly increased risk of health-related and societal harms. The majority of harms associated with consumption are experienced by those who drink above recommended guidelines, rather than those who are alcohol dependent. Brief interventions and treatments based on screening questionnaires and feedback have been developed for this group, which are effective tools for reducing consumption in primary care and in other settings. Most people who drink excessively do not receive help to reduce the risks associated with excessive consumption. Digital versions of brief and extended interventions have the potential to reach populations that might derive benefit from them. Digital interventions utilize the same principles as do traditional face-to-face versions, but they have the advantages of availability, confidentiality, flexibility, low marginal costs, and treatment integrity. The evidence for the feasibility, acceptability, costs, and effectiveness of digital interventions is encouraging, and the evidence for effectiveness is particularly strong in studies of student populations. There are, however, a number of unresolved questions. It is not clear which components of interventions are required to maximize effectiveness, whether digital versions are enhanced by the addition of personal contact from a facilitator or a health professional, or how to increase take up of the offer of a digital intervention and reduce attrition from a program. These questions are common to many online behavior-change interventions and there are opportunities for cross-disciplinary learning between psychologists, health professionals, computer scientists, and e-health researchers.