Commentary

Using the biopsychosocial model of pain assessment and treatment, Gatchel presents the reader with an overview of the assessment and treatment procedures that he employed in addressing the pain symptoms of a patient who participated in an interdisciplinary pain rehabilitation program headed by Gatchel. The following is a summary of my comments on the key dimensions of the chapter....

Commentary

Dr. Cubic’s case presentation eloquently highlights the numerous challenges of using evidence-based interventions in the treatment of eating disorders. As Dr. Cubic emphasizes in her case description, among the different types of eating disorders, anorexia nervosa (AN) (and especially AN accompanied by bulimic symptoms) is particularly difficult to treat effectively, and long-term outcome data indicate high levels of treatment nonresponse, relapse, co-occurring psychiatric symptoms, medical complications, and mortality (...

Response

Fruzzetti’s commentary on the case of Melissa highlights some of the important decisions we made during her treatment. As he noted, the lack of research in the area of complex clinical decision making with BPD clients means that we often had to follow evidence-based principles...

Response

In her commentary on our case description of Cassie, Dr. Beidel very thoughtfully raises a number of important points regarding the treatment of obsessive-compulsive disorder (OCD). And we agree with all of them. Dr. Beidel, however, raises two issues in particular that we wish to comment on further: (a) the origins of obsessional fears, and (b) the use of distraction in exposure therapy....

Commentary

This chapter clearly outlines the application of an evidenced-based treatment for panic disorder with agoraphobia in the clinical practice setting. In the sections that follow, we comment on the clinical science supporting the clinical choices that were made, as well as the clinical science supporting additional choices that could have been made or were not fully discussed. Our comments are structured in the same format as the review....

Response

Perhaps the most important issue in the thoughtful commentary provided by Obraztsova and Alloy is that of clinician choice in treatment selection. Many factors influence the decision-making process, and the evidence for possible treatment approaches, the training background of the clinician, and the feasibility of implementation are heavy-hitters. Other factors include patient preference and the context of care. In the case of Ruby, Drs. Peterson and Dr. Marks selected ACT for all of these reasons and more....

Commentary

There is much to admire in this report of an adaptation of parent-child interaction therapy (PCIT) used to treat a uniquely complex case involving comorbid reactive attachment and oppositional defiant disorders. One the one hand, the paper reflects the remarkable potency and flexibility of PCIT. On the other hand, it reflects the clinical acumen and interpersonal dexterity of the clinicians who reported the case. We will discuss both of these aspects below....

Behavior Analytic Treatment of Behavioral Excesses and Deficits of Autism: The Case of Jorge

Chapter 3 discusses a case of behavioral analytic treatment in relation to behavioral excesses and deficits of autism, including the case history, epidemiological considerations, applied behavior analysis (ABA), early childhood behavior intervention, assessment, case formulation, intervention planning, addressing nonspecifics within the therapy module, potential treatment obstacles, ethical considerations, and common treatment mistakes to avoid.

Response

While not clearly spelled out in the reference to the stepwise approach, this entire chapter actually describes the process of the stepwise approach to assessment and treatment of chronic pain populations. This case study was specific to one particular patient’s case, but many of the critical points may be generalized to all patients in an interdisciplinary pain program. Some of these include a thorough medical evaluation for confirmatory findings regarding prior diagnoses and to rule out any comorbid factors that might impair the patient’s rehabilitation. The medical intake evaluation should also evaluate range of motion, areas of tenderness, and neurological symptoms, as well as gate and posture. Intake questions for the behavioral medicine personnel to address include ascertaining whether there are any clinical symptoms of depression, including suicidal ideation, anxiety, or other diagnostic criteria for a comorbid mood disorder that need to be addressed apart from the pain management program. In further defining these comorbid conditions, drug dependence/opioid dependence would be screened for and treatment options explored based upon findings....

Commentary

The case described by Rizvi and Salters-Pedneault provides an excellent example of the successful application of clinical science in the treatment of a client with multiple severe and chronic problems. I will highlight key DBT implementation issues throughout the case, but also will address systemic issues for both the client and for therapists employing rigorous clinical science in their use of dialectical behavior therapy (DBT)....