scholarly journals Treating prolonged post-concussion symptoms in a pediatric patient with the simultaneous application of cognitive behavioral therapy and subthreshold exercise: A case study

Neurology ◽  
2018 ◽  
Vol 91 (23 Supplement 1) ◽  
pp. S16.1-S16
Author(s):  
Sonal Singh ◽  
Douglas R. Polster ◽  
Meeryo Choe ◽  
Christopher Giza ◽  
Talin Babikian
Keyword(s):  
Psychological Distress ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Physical Exertion ◽  
Rating Of Perceived Exertion ◽  
Self Report ◽  
Cognitive Behavioral ◽  
Simultaneous Application ◽  
Patient Reported

ObjectiveUse a novel, simultaneously applied cognitive behavioral therapy (CBT) and subthreshold exercise treatment (STE) for a 14-year old patient with persistent post-concussion symptoms (PPCS) to facilitate a return to function in school/sport.BackgroundPatient sustained a mild TBI while playing basketball on October 29, 2016. Neurologic exam on July 7, 2017 was negative, but the patient reported PPCS, with a graded symptom checklist (GSC) score of 26. Primary symptoms were headache and anxiety in relation to cognitive and/or physical exertion. The patient attributed anxiety to anticipating the onset of symptoms after exercise.Design/methodsThe 6-week combined CBT/STE intervention included psychoeducation, cognitive restructuring, and relaxation training combined with the STE protocol. Supervised physical exertion exposure began with aerobic exercise on a stationary bike and progressed to sport-specific activity while the patient simultaneously engaged in CBT. Pre- and post-intervention data included physiologic measures (heart rate [HR] and power output [PO] on exercise bike), a subjective measure of exertion (Borg's Rating of Perceived Exertion [RPE]), and psychological self-report questionnaires.ResultsAfter 6 sessions, patient was able to engage in strenuous exercise with reduced symptom exacerbation as demonstrated by his ability to reach 175 bpm HR with 350 watts of PO with decreased reported symptoms, a significant improvement from the first session. The patient reported a decrease in anxiety and psychological distress as well as an increase in emotional and school functioning. Parent report indicated an increase in the patient's overall health, social, and emotional functioning.ConclusionsEngaging in a six-week combined CBT/STE protocol resulted in improvements in ability to tolerate physical exertion, decreases in psychological distress, and a return to function. This case study demonstrated the feasibility & positive impact of simultaneous, dual treatment model for PPCS in adolescents. It also highlighted the need to address the psychological distress that occurs in patients with PPCS.

Family-Based Cognitive–behavioral Therapy for an Intelligent, Elementary School-Aged Child With Generalized Anxiety Disorder

2016 ◽  
Vol 15 (6) ◽  
pp. 443-458
Author(s):  
Ellen Kolomeyer ◽  
Kimberly Renk
Keyword(s):  
Anxiety Disorder ◽  
Cognitive Behavioral Therapy ◽  
Generalized Anxiety Disorder ◽  
Behavioral Therapy ◽  
Self Report ◽  
Cognitive Behavioral ◽  
Generalized Anxiety ◽  
Current Case ◽  
Family Based

This case study follows an 8-year-old Caucasian female who presented with symptoms of Generalized Anxiety Disorder (GAD). Given this child’s age but advanced cognitive skills, careful selection of an appropriate treatment was made. In the current case study, a family-based cognitive–behavioral therapy intervention (Wood & McLeod, 2008) was implemented to treat this child’s symptoms of GAD. Following completion of the intervention, the child demonstrated significant decreases in her symptoms. In addition, she demonstrated a thorough understanding of coping skills, successfully applied and generalized her skills to a variety of situations, and took pride in teaching her skills to others. This child showed quantitative improvements on objective self-report measures as well as qualitative improvements in her overall emotional and behavioral functioning. This case study suggested that cognitive–behavioral therapy interventions, particularly when used in a family-based approach, are effective for children with symptoms of GAD.

349 Cognitive Behavioral Therapy for Insomnia in Patients with Chronic Pain - A Systematic Review and Meta-Analysis

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A139-A140
Author(s):  
Janannii Selvanathan ◽  
Chi Pham ◽  
Mahesh Nagappa ◽  
Philip Peng ◽  
Marina Englesakis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Behavioral Therapy ◽  
Cancer Pain ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Post Treatment ◽  
Cognitive Behavioral ◽  
Comorbid Insomnia ◽  
Patient Reported

Abstract Introduction Patients with chronic non-cancer pain often report insomnia as a significant comorbidity. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first line of treatment for insomnia, and several randomized controlled trials (RCTs) have examined the efficacy of CBT-I on various health outcomes in patients with comorbid insomnia and chronic non-cancer pain. We conducted a systematic review and meta-analysis on the effectiveness of CBT-I on sleep, pain, depression, anxiety and fatigue in adults with comorbid insomnia and chronic non-cancer pain. Methods A systematic search was conducted using ten electronic databases. The duration of the search was set between database inception to April 2020. Included studies must be RCTs assessing the effects of CBT-I on at least patient-reported sleep outcomes in adults with chronic non-cancer pain. Quality of the studies was assessed using the Cochrane risk of bias assessment and Yates quality rating scale. Continuous data were extracted and summarized using standard mean difference (SMD) with 95% confidence intervals (CIs). Results The literature search resulted in 7,772 articles, of which 14 RCTs met the inclusion criteria. Twelve of these articles were included in the meta-analysis. The meta-analysis comprised 762 participants. CBT-I demonstrated a large significant effect on patient-reported sleep (SMD = 0.87, 95% CI [0.55–1.20], p < 0.00001) at post-treatment and final follow-up (up to 9 months) (0.59 [0.31–0.86], p < 0.0001); and moderate effects on pain (SMD = 0.20 [0.06, 0.34], p = 0.006) and depression (0.44 [0.09–0.79], p= 0.01) at post-treatment. The probability of improving sleep and pain following CBT-I at post-treatment was 81% and 58%, respectively. The probability of improving sleep and pain at final follow-up was 73% and 57%, respectively. There were no statistically significant effects on anxiety and fatigue. Conclusion This systematic review and meta-analysis showed that CBT-I is effective for improving sleep in adults with comorbid insomnia and chronic non-cancer pain. Further, CBT-I may lead to short-term moderate improvements in pain and depression. However, there is a need for further RCTs with adequate power, longer follow-up periods, CBT for both insomnia and pain, and consistent scoring systems for assessing patient outcomes. Support (if any):

Treatment of a Commercially Sexually Abused Girl Using Trauma-Focused Cognitive Behavioral Therapy and Legal Interventions

2018 ◽  
Vol 18 (1) ◽  
pp. 18-35
Author(s):  
Maureen C. Kenny ◽  
Claire E. Helpingstine ◽  
Maya Weber
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Sexually Abused ◽  
Behavioral Therapy ◽  
Sexual Exploitation ◽  
Cognitive Behavioral ◽  
Rapport Building ◽  
Body Image Issues ◽  
Legal Interventions

This case study describes the use of trauma-focused cognitive behavioral therapy (TF-CBT) and legal interventions for a 16-year-old girl who was the victim of commercial sexual exploitation (CSE) and suffered from substance abuse, anxiety, and body image issues. Over the course of 1 year, the client was able to discontinue involvement in sexual exploitation, cease substance use, decrease her anxiety level, improve her self-concept, and reduce posttrauma symptoms. The case calls attention to the need for extended rapport building, flexibility in treatment, and tailoring manualized treatments. It highlights the path to CSE for one teenager as well as the resultant emotional and behavioral consequences. Given the extensive nature of her past traumas, case management was continued following the clients’ discharge from treatment to support her adjustment. These follow-up sessions were conducted about once a month and assisted with maintenance of treatment goals.

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