Cory F. Newman

Medial prefrontal cortex hyperactivation during social exclusion in borderline personality disorder

Frontal systems dysfunction and abandonment fears represent central features of borderline personality disorder (BPD). BPD subjects (n=10) and matched non-psychiatric comparison subjects (n=10) completed a social-cognitive task with two confederates instructed to either include or exclude subjects from a circumscribed interaction. Evoked cerebral blood oxygenation in frontal cortex was measured using 16-channel functional near infrared spectroscopy. BPD subjects showed left medial prefrontal cortex hyperactivation during social exclusion suggesting potential dysfunction of frontolimbic circuitry.

Competency in conducting cognitive-behavioral therapy: foundational, functional, and supervisory aspects.

The delivery of cognitive-behavioral therapy (CBT) is described in terms of foundational and functional competencies, with additional attention paid to how these skills are applied in clinical supervision. Foundational competencies include such qualities as ethical behavior, good interpersonal relational skills, a healthy capacity for self-awareness and self-correction, cross-cultural sensitivity, and an appreciation for the empirical basis of clinical procedures. Functional competencies include the ability to think like an empiricist and to teach clients to do the same, to conceptualize cases in terms of maladaptive beliefs and behavioral patterns, to structure sessions in an organized and time-effective manner, and to assign and review homework assignments. CBT supervisors have the multiple responsibilities of serving as professional role models for their supervisees, nurturing the latters professional development (although also being ready to identify and remediate problems in the supervisees performance), and engaging in ongoing self-improvement and education to function most effectively as clinical mentors. A brief, descriptive supervisory vignette is presented.

Maintaining professionalism in the face of emotional abuse from clients

The harmful effects of emotional abuse have been studied in children, romantic relationships, and families, but little work has explored the phenomenon of therapists experiencing emotional abuse from their clients. The current paper examines the characteristics of emotional abuse as experienced by therapists, and presents methods by which clinicians can best maintain their professional decorum, responsibilities, objectivity, conceptual skills; and overall effectiveness in spite of aversive interactions with clients. Therapists can facilitate their own staying on task, and can reduce their subjective levels of stress by utilizing such self-help techniques as cognitive rehearsal, rational responding, assertiveness, and the use of social supports. These strategies help therapists to deal with patterns of hostile outbursts and boundary infringements from clients, without feeling helpless and burned out, and without terminating their clients prematurely out of desperation. Therapists also can remain suitably professional in managing emotionally abusive clients by making judicious use of documentation and supervisory consultations. Issues regarding appropriate termination of emotionally abusive clients are discussed in light of the ethical obligation not to abandon clients. The principle of “therapist self-preservation,” which takes into account the therapists need to consider his or her own well-being, along with the clients, is addressed as well.

Change Over Time in Brain Serotonin Transporter Binding in Major Depression: Effects of Therapy Measured with [123I]-ADAM SPECT

Several studies have reported low brain serotonin transporter (SERT) binding in individuals with major depression. We hypothesized that the SERT standardized uptake ratio (SUR) values using [123I]‐ADAM single photon emission computed tomography would increase in depressed subjects who responded to cognitive behavior therapy (CBT) compared to CBT nonresponders. [123I]‐ADAM scans were acquired before and after 12 weeks of CBT from 20 depressed subjects and on two occasions 12 weeks apart from 10 nondepressed, healthy volunteers. The primary outcome measure was change over time in SUR values in the midbrain, medial temporal lobe, and basal ganglia regions. Depressed subjects demonstrated low pretreatment mean SUR values that significantly increased over time in the midbrain (P = .011), right medial temporal lobe (P = .008), and left medial temporal lobe (P = .000) regions. Treatment responders showed a significant increase over time in SUR values in left medial temporal lobe (P = .029) and right medial temporal lobe (P = .007) regions. Partial and nonresponder subjects also showed a significant increase over time in SUR values in the left medial temporal region (P = .040) (vs. healthy volunteers), but to a lesser degree. The findings suggest that low pretreatment SERT binding may increase over time in some depressed individuals who experience symptom improvement.

Stress and Stress Management: A Cognitive View

Extreme variability has been observed in individual responses to stressors. It appears that a more detailed analysis of individual variation in cognitions related to stress may result in a greater understanding of their differential responses. An idiographic cognitive model of the psychological processes that mediate stress and that underlie stress management techniques is presented in the form of an illustrative series of hypotheses based on Beck’s cognitive model (Beck, Rush, Shaw, & Emery, 1979). The model is presented in detail and is applied to a clinical case example in which traditional nomothetic stress management techniques were ineffective. The advantages and disadvantages of a more idiographic approach to stress are examined as are the implications of the cognitive view of stress for research and practice.

When Clients Are Untruthful: Implications for the Therapeutic Alliance, Case Conceptualization, and Intervention

Therapists endeavor to be genuine and trustworthy with clients, thus facilitating the establishment and maintenance of a positive therapeutic relationship. Unfortunately, clients sometimes knowingly give false or misleading information, maintain counter therapeutic hidden agendas, and deliberately obscure clinically relevant facts. Such factors likely will obstruct the process of case conceptualization, strain the therapeutic relationship, and result in disagreements about proper interventions. We discuss some of the telltale signs of clients’ untruthfulness, and suggest ways in such cases for therapists to draw upon clients’ behaviors in session to construct useful case formulations. Additionally, we describe a number of interventions that increase the chances of pursuing healthy, appropriate, therapeutic goals, irrespective of clients’ degree of sincerity.

Training Cognitive Behavioral Therapy Supervisors: Didactics, Simulated Practice, and "Meta-Supervision"

The delivery of competent clinical supervision is vital to the successful training of new cognitive behavioral therapists, and—in the case of peer supervision and consultation—a boon to the maintenance of therapists’ high professional standards throughout their careers. However, it is only recently that the field of psychotherapy in general and cognitive behavioral therapy (CBT) in particular has implemented formal methods of training clinicians to be competent supervisors. Drawing on recent findings from evidence-based programs of CBT supervision, this article highlights the contents and processes of a graduate training course in CBT supervision involving didactics, readings, and experiential exercises. The 6 major modules of this seminar are explicated, including such topics as the supervisory relationship, enhancing CBT competencies in supervisors and supervisees alike, promulgating ethical practices, and successfully managing the administrative aspects of supervision. In addition, the concept of “meta-supervision” is described and illustrated in the form of a transcript from a long-distance, computer-assisted meeting between a senior consulting supervisor and his junior “supervisor-evaluee.” The transcript highlights the key features of meta-supervision, including the cross-cultural considerations that must be addressed when doing international training.

Hypotheticals in Cognitive Psychotherapy: Creative Questions, Novel Answers, and Therapeutic Change

The use of hypothetical questions as a creative therapeutic process is explored and described. Hypothetical questions start with the client’s actual life situation—in whatever way the client construes and lives it—and triggers a search for what could be. Hypotheticals are thought experiments in which the client is challenged to think beyond the usual, common obstacles and constraints of everyday life, and to imagine “what if?” in its most constructive sense. This exercise—which requires both therapist ingenuity and client open-mindedness—can shed light on the clients’ expectations, desires, motives, decision-making process, and methods of solving problems. Hypotheticals also enable clients to paint a picture of how they might be able to change the course of their lives, and to live by a more voluntary, meaningful script. Four classes of hypotheticals are reviewed, along with some representative, corresponding sets of questions.

Theory and Practice in the Cognitive Psychotherapies: Convergence and Divergence

Cognitive therapy, linguistic therapy of evaluation, and constructivist psychotherapy display prominent points of both convergence and divergence at conceptual and practical levels. This article considers these comparisons and contrasts, focusing on their respective positions regarding their meta-theoretical models of human beings, science, and epistemology, as well as key aspects of their therapeutic stance, style, and strategic preferences. The resulting analysis suggests that these three contemporary approaches to cognitive therapy make distinctive contributions to clinical practice, adding to the richness of the field in different ways.

Cognitive Therapy and the Facilitation of Affect: Two Case Illustrations

Cognitive therapy, as conducted by Aaron T. Beck and his associates, is known for effectively teaching clients to modify the kinds of dysfunctional thinking processes that are associated with depression and a number of other disorders. On the other hand, cognitive therapy has developed a reputation for paying too little attention to emotionality and its expression thereof as part of treatment. In spite of this popular viewpoint, it is argued here that cognitive therapy is very much concerned with the appropriate experiencing of affect. Two brief case illustrations are presented that highlight the role of emotion enhancement as an important, congruent component of cognitive therapy. The first case demonstrates the facilitation of positive affect in therapy, while the second case example suggests that the augmentation of negative affect may also be appropriate during the course of cognitive therapy.