493348 research-article2013
CCSXXX10.1177/1534650113493348Clinical Case StudiesWatkins and Macfie
Article
Psychodynamic Psychotherapy With Adjunctive Hypnosis for Anxiety Management and Smoking Cessation
Clinical Case Studies XX(X) 1–12 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1534650113493348 ccs.sagepub.com
Christopher D. Watkins1 and Jenny Macfie1
Abstract The present study examines the therapy of an individual diagnosed with generalized anxiety disorder, two situation type specific phobias, and nicotine dependence. Treatment consisted of psychodynamic psychotherapy with adjunctive hypnosis. Client’s symptoms were tracked using daily, self-report measures over the 6-month treatment period. The simulation modeling approach for time-series was used to assess the phase change from baseline to treatment. Tracked symptoms included generalized anxiety, worry associated with specific phobias, phobic avoidance, number of cigarettes smoked daily, and nicotine craving intensity. All symptoms decreased significantly over the course of treatment. Utility of an ideographic and also quantified research methodology for treatment outcome studies are discussed. Keywords time-series, psychotherapy outcome, psychodynamic psychotherapy, attachment, anxiety, smoking cessation
1 Theoretical and Research Basis for Treatment Generalized anxiety disorder (GAD) is characterized by chronic, uncontrollable worry over multiple life circumstances. A GAD diagnosis includes at least three of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and disturbed sleep (American Psychiatric Association [APA], 2000). Individuals with this disorder have difficulty controlling worry and experience impairments in social, occupational, or other domains of functioning. Although GAD is classified as an Axis I disorder by the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; APA, 2000), psychodynamic classification systems describe it as a characterological disorder, in which anxiety is a prominent, psychologically orienting experience (PDM [Psychodynamic Diagnostic Manual] Task Force, 2006). According to this theory, the core process of GAD involves deficits in affect regulation that result in ineffective and often counterproductive coping strategies (PDM Task Force, 2006). 1University
of Tennessee, Knoxville, USA
Corresponding Author: Christopher D. Watkins, University of Tennessee, Austin Peay Building, 1404 Circle Drive, Knoxville, TN 37996, USA. Email:
[email protected]
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Psychodynamic theorists suggest this disorder develops over time, originating in early childhood experiences. Indeed, individuals with GAD often report disruptions in early attachment relationships or ineffective caregivers. GAD is often comorbid with other anxiety disorders, such as specific phobias (Mennin, Heimberg, & Turk, 2004). A phobia differs from GAD in that intense anxiety is focused on a clearly discernible object or situation (APA, 2000). This stimulus causes an intense fear, which is often perceived as unreasonable by individuals with this disorder. To prevent this fear, individuals avoid encountering this stimulus, which often interferes with daily functioning (APA, 2000). Symptoms of this disorder typically occur in childhood or early adolescence. However, situational phobias can develop in early adulthood (APA, 2000). Factors that contribute to the development of a specific phobia include traumatic experiences, unexpected panic attacks, observed trauma, and informational transmission (APA, 2000). Psychodynamic theorists conceptualize specific phobias as particular way of managing anxiety. In phobias, defensive processes focus on a feared object or situation, which allows individuals partial, total, or recurrent dissociation from memories of these stimuli (PDM Task Force, 2006). Within this framework, individuals are theorized to have a psychological connection with the feared object and phobic behaviors are related to how the individual organizes internal experience. These theorists posit that phobic symptoms involve less suffering and overall better adaptations than other forms of anxiety, such as panic attacks (PDM Task Force, 2006). Nicotine dependence is often comorbid with anxiety disorders and rates of cigarette smoking are high among individuals diagnosed with these disorders (Jane-Llopis & Matytsina, 2006). Etiological research has suggested that anxiety plays a role in the initiation, maintenance, and cessation of smoking behavior (Conway, Compton, Stinson, & Grant, 2006; Morrell & Cohen, 2006). Indeed, smokers often report decreases in anxiety after smoking (Morrell & Cohen, 2006) and anxiety is one symptom of nicotine withdrawal (APA, 2000). Craving is another important component in nicotine withdrawal and may account for the difficulty individuals have in ending tobacco use (APA, 2000). Cigarette smoking usually begins in adolescence and individuals who continue to smoke typically become regular daily smokers as adults. Most of these individuals attempt to quit and half of these attempts fail (APA, 2000). Psychodynamic perspectives on substance dependence suggest that it is related to acute and chronic distress. Addictive vulnerabilities begin with problematic family relationships, which result in deficits in ego functioning, affect regulation, and relational problems. As a result, individuals utilize substances to ameliorate, control, or damper affective experiences that are too intense (PDM Task Force, 2006).
Attachment Theory and Anxiety Attachment theory offers a theoretical framework that can enhance our understanding of the developmental precursors of these disorders. According to this theory, early relationships with caregivers are central to one’s emotional development. Sensitive, responsive, and reliable caregivers provide a sense of security, which enables one to regulate internal affective experiences. This allows one the freedom to explore and interact with the external world. Repeated interactions with caregivers result in an internalized working model that guides perceptions, thoughts, and expectations from future relationships (Bowlby, 1999). Disruptions in this process can negatively affect one’s identity formation, relational experiences, and ability to regulate emotions (Bowlby, 1999; Kobak & Madsen, 2008). Anxiety that arises from insecure attachment may be expressed as a persistent fear of losing close relationships, lower self-worth, and doubts about one’s competence (Young, Klosko, & Weishaar, 2003).
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Psychodynamic Psychotherapy and Adjunctive Hypnosis Treatment paradigms based on psychodynamic theory often encourage clients to explore relational themes and early childhood experiences (McWilliams, 2004). Symptoms are conceptualized as expressions of unrealized or hidden internal conflicts. Treatment consists of uncovering links between symptomology and the hidden feelings, fears, or desires associated with their emergence (Wachtel, 2011). Ideally, this process leads to symptom reduction, a decrease in maladaptive processes, a sense of self-mastery, and enhanced insight (Malan, 2007; McWilliams, 2004). There is a growing body of research that demonstrates the effectiveness of psychodynamic psychotherapy for anxiety disorders. One randomized controlled study of GAD suggested shortterm psychodynamic psychotherapy (STPP) was as effective as supportive therapy on continuous measures of anxiety and significantly superior on rates of symptom remission (Crits-Christoph, Gibbons, Narducci, Schamberger, & Gallop, 2005). In another randomized controlled trial, STPP and cognitive-behavioral therapy (CBT) were found to be equally effective in reducing symptoms of GAD at termination and 1 year after. However, CBT was found to be more effective for reducing trait anxiety and worry (Salzer, Winkelbach, Leweke, Leibling, & Leichsenring, 2011). Studies examining the effectiveness of psychodynamic psychotherapy with other disorders have suggested it is more effective than supportive therapy and as effective as CBT (for a review, see Leichsenring, 2009). In contemporary psychotherapy, hypnosis is used as an adjunctive treatment that is incorporated into broader psychotherapies (Gold & Strieker, 2006; Nash, 2008). Adjunctive hypnosis is a process in which a clinician performs a hypnotic induction and offers suggestions to the client for an imaginative experience which involves alterations in perception, memory, and/or action (Kihlstrom, 2008). It is often incorporated into other therapies to enhance phenomenological explorations of subjective experiences in a controlled setting (Baker & Nash, 2008). Specifically, adjunctive hypnosis allows for enhanced access to hidden feelings, affective experiences, and bodily sensations, and can enhance one’s receptivity (Kihlstrom, 2008). Hypnotic techniques include muscle relaxation, imagery, thought control, posthypnotic suggestions, motivational enhancement, and self-hypnosis (Baker & Nash, 2008). Individuals can be taught to use selfhypnosis to manage symptoms outside of therapy sessions (Bryant, 2008; Jenson & Patterson, 2008). This technique emphasizes direct suggestions of mastery and often includes the creation of an imagined secure space. Effective use of self-hypnosis encourages feelings of autonomy and self-regulation (Baker & Nash, 2008). Despite extensive theoretical writings and case studies indicating the efficacy of hypnosis with clinical populations, empirical investigations are sparse (Moore & Tasso, 2008). However, research has suggested that adjunctive hypnosis can enhance the efficacy of CBT (Kirsch & Lynn, 1995) and can also be an effective component of the treatment of anxiety disorders (Bryant, Moulds, Gutherie, & Nixon, 2005; Llobet, 2009; Lunde, Nordhus, & Pallesen, 2009; Steggles, 1999). Research assessing the effectiveness of this technique with smoking cessation are inconclusive, due to methodological variations (Moore & Tasso, 2008).
Single Case Studies, Time-Series Design, and Phase Change Analysis There is a growing body of quantitative research using single-subject (N = 1) designs. These designs utilize time-series data gathered from repeated measures of symptomology. These measures are administered at equal intervals over time (Borckardt & Nash, 2002; Borckardt et al., 2008). Typically, a pretreatment phase and treatment phase are compared in a phase model analysis, to assess symptom change during the course of therapy. Single-subject research designs have been used to assess treatment efficacy of hypnotherapy (Borckardt & Nash, 2002; Frankel &
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Macfie, 2010; Scholz & Ott, 2000), psychoanalysis (Jones, 2003; Milrod, Busch, Hollander, Aronson, & Siever, 1996), and cognitive-behavioral therapies (Lunde et al., 2009).
2 Case Introduction James was a 33-year-old Caucasian man in his senior year of graduate school. Initially, he pursued psychotherapy for smoking cessation, but at intake he reported excessive generalized anxiety and two different specific phobias. After reflecting on the effects of these troubles, he requested a broader treatment that addressed his anxiety and nicotine dependence. He was diagnosed with GAD (302.00), specific phobia (situation type, claustrophobia), specific phobia (situation type, restaurant), and nicotine dependence (305.1). His global assessment of functioning was 65.
3 Presenting Complaints James reported symptoms consistent with GAD, specific phobias, and nicotine dependence. He experienced chronic, excessive anxiety since early adulthood. This anxiety was associated with restlessness, excessive worry, difficulty concentrating, trouble falling asleep, and chronic fatigue. His symptoms interfered with many aspects of his daily life, but prominently affected his academic functioning. He chronically worried about failing examinations, performing poorly on class projects, and lacking competence in his field. These preoccupations prevented James from working efficiently and ironically reduced the quality of his work. In addition to this, he experienced distinct increases in anxiety when using elevators or attending restaurants in the evening. These situations induced intense fear, accelerated heart rate, labored breathing, and feelings of panic. Although James reported he could endure these experiences if necessary, he typically engaged in costly avoidant behaviors. His excessive anxiety contributed to the frequency of smoking cigarettes. Although he smoked routinely, he smoked more when distressed. Smoking reduced his anxiety and he described it as a soothing behavior that reminded him of his father and pleasant childhood experiences. He began smoking in adolescence and currently smoked 18 cigarettes daily. Although James experienced smoking as soothing, it contributed to his physical fatigue, decreased work productivity, and worry about developing a terminal illness. For example, entering or leaving his office required him to traverse five flights of stairs. His frequent smoking required one trip up and down these stairs every 90 min. These trips contributed to his existing feelings of fatigue and negatively contributed to his productivity.
4 History James grew up in a rural community. His parents were employed and he described his family as middle class. His mother was supportive and warm. His father was busy and often absent from family activities. This troubled James and he reported feeling preoccupied with the desire to interact with his father. Also, his father often smoked cigarettes and his earliest memories of his father are of sitting with him while he smoked. James excelled academically until high school. During this time, grades were acceptable, but below his academic potential. At intake, James could not articulate a cause for this change; however, during the course of therapy he claimed this change occurred after a violent car wreck. When discussing this wreck, he appeared preoccupied with physical disorientation, feelings of chaos, fears of dying, and the belief that he witnessed his mother’s death. After this event, general feelings of anxiety increased, he developed a fear of small spaces, and began smoking cigarettes.
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After high school, he attended college, but withdrew due to poor grades. He described this experience as humiliating and related it to current concerns about his academic performance. Several years later, he completed college and enrolled in graduate school. During this time, his mother developed cancer and died 1 year after receiving her diagnosis. James appeared distressed when discussing this experience and had trouble articulating many aspects of this event. In a later session, he declared his mother announced her cancer diagnosis to their family at a local restaurant.
5 Assessment At intake, James completed a comprehensive clinical interview in which he specified the symptoms he would track on a daily basis. He decided to track feelings of general anxiety, phobic avoidance, nicotine craving intensity, and number of cigarettes smoked daily. He rated subjective experiences using a 9-point general rating scale, in which 1 = none/not at all bothered by this problem and 9 = extreme/extremely bothered by this problem. However, he did not report his symptoms consistently. He did not provide any data for Phase 1 and only provided half of his data for Phase 2.
6 Case Conceptualization James utilized ineffective and maladaptive means of coping with negative affective experiences. These strategies developed from disruptions in childhood attachment relationships and other troubling experiences. However, he displayed the potential for healthy functioning, possessed an integrated sense of identity, and displayed the capacity for self-reflection, which suggested his personality was organized at the neurotic level (McWilliams, 2004). Although healthier individuals use a variety of higher order defenses to adapt to daily life (McWilliams, 2011), James relied primarily on repressive defenses. While this defense succeeded in removing unpleasant experiences from his awareness, it denied him the ability to understand or resolve the conflicts that affected him. Ironically, the overuse of this defense limited its effectiveness and paradoxically contributed to anxious states. Also, it interfered with his ability to work effectively and to experience positive aspects of living, and it encouraged the use maladaptive self-soothing behaviors (McWilliams, 2011).
7 Course of Treatment and Assessment of Progress James participated in a weekly once individual psychotherapy over a 6-month period, for a total of 20 sessions. Treatment integrated psychodynamic therapy, adjunctive hypnosis, and self-hypnosis training. Throughout treatment, sessions alternated between hypnosis and psychodynamic psychotherapy. Early sessions focused on establishing a strong therapeutic alliance. This alliance is often related to the secure base, which is believed to facilitate exploration within the therapeutic environment. In accordance with our conceptualization of James’s psychological functions, great care was taken to ensure the strength of this alliance. Subsequent sessions were spent exploring the meaning and function of James’s symptoms. Adjunctive hypnosis was incorporated into this treatment to enhance the exploration of phenomenological aspects of James’s symptomology. During sessions that included hypnosis, James was instructed to “have a dream about anxiety” or “find yourself in a place that is related to your desire to smoke.” In response, he would describe dreamlike experiences that included detailed settings and interactions with various features of the dream. Sessions that did not feature hypnosis were designed to explore content from hypnosis sessions and establish connections between affective states and other experiences. These sessions were open-ended and based on a process of
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Table 1. Autocorrelations for Daily Ratings. Daily measure
Ratings
General anxiety Number of cigarettes Intensity of cravings for cigarettes Phobic avoidance (claustrophobia) Phobic avoidance (restaurant)
.83 .87 .77 .29 .93
Table 2. Means and Standard Deviations for Daily Measures. Baseline Daily measure General anxiety Number of cigarettes Intensity of cravings for cigarettes Phobic avoidance (claustrophobia) Phobic avoidance (restaurant)
Treatment
Overall
M
SD
M
SD
M
SD
6.54 18.81 7.73 1.65 7.19
1.96 4.28 1.31 1.20 1.67
3.78 5.53 4.41 1.11 2.88
1.24 3.33 2.12 0.64 1.24
4.51 9.02 5.28 1.25 4.01
1.90 6.88 2.43 0.85 2.36
free association. Recurrent themes included preoccupations with attachment relationships, fear of loss, fear of failure, and feelings of isolation. Self-hypnosis enhanced James’s ability to regulate his anxiety and tobacco use outside of therapy. This supportive technique was designed for use in a variety of settings for brief periods of time. Originally, this intervention featured a safe place that allowed for a gradual reduction of negative affective experiences. However, during self-hypnosis training, James discovered that imagining the presence of his father was more effective. This technique was modified to include this element and was practiced during several sessions. Once training was complete, James used self-hypnosis whenever he felt cravings to smoke or experienced intense anxiety. In these situations, James would enter hypnosis and deliberately observed the intensity of his feelings for a brief period. Then, he would imagine his father standing at the end of a field. Slowly, his father would walk toward him. With every step taken, James felt more peace and satisfaction, which ameliorated his distress. Once his father was in close proximity, he would touch James on the shoulder, which created a complete feeling of peace and satisfaction. He practiced this intervention outside of our sessions twice a day or whenever he experienced distress.
Assessment of Progress The simulation modeling approach for time-series (SMATS) was used to assess the phase change of self-reported symptomology. This approach compares the baseline phase with treatment phase, using autocorrelations that measure change over time. This approach also controls for chance variability in the data. Autocorrelations for daily ratings are reported in Table 1. Means and standard deviations for the phases of treatment are reported in Table 2. Pearson’s correlations for the daily measures are listed in Table 3. Ratings for the client’s daily measures are depicted graphically over time in Figures 1 to 5. There was a significant change from Phase 2 to Phase 3 in all variables. James reported a decrease in general anxiety (r = −.64, p = .016), avoidance due to claustrophobia (r = .28, p < .05), avoidance due to restaurant phobia (r = .81, p < .005), and a decrease in nicotine craving intensity
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Watkins and Macfie Table 3. Correlations for Daily Measures. Daily measure
Correlation
p
.64 .85 .60 .28 .81
.016 .000 .011 .038 .005
General anxiety Number of cigarettes Intensity of cravings for cigarettes Phobic avoidance (claustrophobia) Phobic avoidance (restaurant) N = 100
Figure 1. Daily ratings for general anxiety.
Figure 2. Daily ratings for avoidance related to claustrophobia.
(r = .60, p < .011). In addition to this, he reported a reduction in the number of cigarettes smoked from 18 to 0 (r = .85, p < .000). He stopped smoking 2 weeks before termination. In summation, James displayed significant decreases in all tracked symptomology throughout the treatment phase of this therapy.
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Figure 3. Daily ratings for avoidance related to restaurant phobia.
Figure 4. Daily ratings for the intensity of nicotine cravings.
8 Complicating Factors Although James agreed to complete daily ratings of specific symptoms, he did not complete these measures consistently. According to James, rating symptoms increased his awareness of his anxiety, evoked thoughts of hopelessness, and increased his distress. He did not begin his daily ratings until 2 months after treatment began and therefore, baselines were not collected for the first phase of treatment. Baseline and treatment data were collected for the second phase of treatment. However, James relocated before termination and left without submitting his rating forms of the last month. He mailed these forms to the clinic 3 months after his move, and they were added to this data set. Although James appeared open and honest throughout this treatment, results should be interpreted with caution.
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Figure 5. Daily ratings for number of cigarettes.
9 Access and Barriers to Care There were no barriers to care in this particular case.
10 Follow-Up James did not complete follow-up measures.
11 Treatment Implications of the Case Over the course of treatment, James reported significant reductions in general anxiety, phobic avoidance, nicotine craving intensity, and cigarettes smoked daily. He had ceased smoking cigarettes completely. At termination, he reported less general distress, increased academic productivity, and enhanced quality of life. In addition to this, he felt encouraged by his progress during therapy and empowered by his improved insight into his experiences. Although treatment was terminated before eliminating all symptomology, James reported an enhanced ability to manage these problems. He expressed an interest in continuing treatment and was given referrals for mental health providers near his new residence. This integrative treatment was informed by psychodynamic theory and attachment theory. Using a psychodynamic case conceptualization, treatment was individualized to maximize the utilization of the client’s resilient factors and to address his vulnerabilities. Therapy integrated psychodynamic psychotherapy with adjunctive hypnosis. Therapeutic techniques facilitated the exploration of the meaning and function of symptoms. Self-hypnosis enhanced the client’s ability to manage anxiety and cravings to smoke cigarettes. The use of self-report, daily tracking measures enabled observations of change over time and identified key areas of improvement. Decreases in anxiety were accompanied by decreases in costly avoidant and self-soothing behaviors. These changes suggest an improvement in psychological functioning that is more productive and adaptable. Qualitative and quantitative data suggest this treatment was successful in reducing symptomology in all areas of concern. However, termination occurred before total symptom reduction was achieved and there is no evidence that
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therapeutic gains were retained. The lack of posttreatment symptom ratings is a limitation of this study that prevents the demonstration of the long-term effectiveness of this treatment.
12 Recommendations to Clinicians and Students The present study examined the psychotherapy of an individual diagnosed with several anxiety disorders and nicotine dependence. The use of a single-subject, time-series design allowed the therapist to track the client’s progress with quantifiable means. This integrates the role of therapist and researcher, which enables one to empirically evaluate therapeutic interventions quickly and effectively. Empirically evaluating client progress can inform clinicians about the effects of therapeutic techniques and theories, which can be shared with the greater psychological community. The use of single-subject time-series designs is a relatively new practice in clinical psychology research (Borckardt & Nash, 2002). This design often includes symptom tracking through the course of therapy. By referring to these data, clinicians can receive feedback about therapeutic interventions and can also develop unique interventions that incorporate the client’s strengths, limitations, and symptomology. This approach also allows one to conduct research on variations of particular disorders, comorbidities, demographic groups, and treatment modalities, which is more difficult in larger empirical investigations. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. Baker, E. L., & Nash, M. R. (2008). Psychoanalytic approaches to clinical hypnosis. In M. R. Nash & A. J. Barnier (Eds.), The Oxford handbook of clinical hypnosis: Theory, research, and practice (pp. 439446). New York, NY: Oxford University Press. Borckardt, J. J., & Nash, M. R. (2002). How practitioners (and others) can make scientifically viable contributions to clinical-outcome research using the single-case time-series design. International Journal of Clinical and Experimental Hypnosis, 50, 114-148. Borckardt, J. J., Nash, M. R., Murphy, M. D., Moore, M., Shaw, D., & O’Neil, P. (2008). Clinical practice as natural laboratory for psychotherapy research: A guide to case-based time-series analysis. American psychologist, 63, 77-95. Bowlby, J. (1999). Attachment and loss (Vol. 1, 2nd ed.). New York, NY: Basic Books Bryant, R. A. (2008). Hypnosis and anxiety: Early interventions. In M. R. Nash & A. J. Barnier (Eds.), The Oxford handbook of clinical hypnosis: Theory, research, and practice (pp. 535-548). New York, NY: Oxford University Press. Bryant, R. A., Moulds, M. L., Gutherie, R. M., & Nixon, R. D. V. (2005). The additive benefit of hypnosis and cognitive-behavioral therapy in treatment acute stress disorder. Journal of Consulting and Clinical Psychology, 73, 334-340. Conway, K. P., Compton, W., Stinson, F. S., & Grant, B. F. (2006). Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 67, 247-257. Crits-Christoph, P., Gibbons, M. B. C., Narducci, J., Schamberger, M., & Gallop, R. (2005). Interpersonal problems and the outcome of interpersonally oriented psychodynamic treatment of GAD. Psychotherapy: Theory, Research, Practice, Training, 42(2), 211-224.
Downloaded from ccs.sagepub.com at PENNSYLVANIA STATE UNIV on May 12, 2016
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Frankel, M. R., & Macfie, J. (2010). Psychodynamic psychotherapy with adjunctive hypnosis and performance anxiety in emerging adulthood. Clinical Case Studies, 9, 294-308. Gold, J., & Strieker, G. (2006). Introduction: An overview of psychotherapy integration. In G. Stricker & J. Gold (Eds.), A casebook of psychotherapy integration (pp. 3-16). Washington, DC: American Psychological Association. Jane-Llopis, E., & Matytsina, I. (2006). Mental health and alcohol, drugs, and tobacco: A review of cormorbidity and the use of alcohol, tobacco, and illicit drugs. Drug and Alcohol Review, 25, 515-536. Jensen, M. P., & Patterson, D. R. (2008). Hypnosis in the relief of pain and pain disorders. In M. R. Nash & A. J. Barnier (Eds.), The Oxford handbook of clinical hypnosis: Theory, research, and practice (pp. 503-534). New York, NY: Oxford University Press. Jones, W. P. (2003). Single-case time series with Bayesian analysis: A practioner’s guide. Measurement and Evaluation in Counseling and Development, 36, 28-39. Kihlstrom, J. F. (Ed.). (2008). The domain of hypnosis, revisited. Oxford, UK: Oxford University Press. Kirsch, I., & Lynn, S. J. (1995). Altered state of hypnosis: Changes in the theoretical landscape. American Psychologist, 50, 846-858. Kobak, R., & Madsen, S. (Eds.). (2008). Disruptions in attachment bonds: Implications for theory, research, and clinical intervention (2nd ed.). New York, NY: Guilford. Leichsenring, F. (Ed.). (2009). Psychodynamic psychotherapy. A review of efficacy and effectiveness studies. New York, NY: Humana Press. Llobet, P. (2009). Group hypnotherapy in the treatment of specific phobias: An exploratory study. San Diego, CA: Alliant International University. Lunde, L. H., Nordhus, I. H., & Pallesen, S. (2009). The effectiveness of cognitive and behavioural treatment of chronic pain in the elderly: A quantitative review. Journal of Clinical Psychology in Medical Settings, 16, 254-262. Malan, D. H. (2007). Individual psychotherapy and the science of psychodynamics (2nd ed.). London, England: Butterworth-Heinemann. McWilliams, N. (2004). Psychoanalytic psychotherapy: A practioner’s guide. New York, NY: Guilford. McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). New York, NY: Guilford. Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour Research and Therapy, 43, 1281-1310. Milrod, B., Busch, F. N., Hollander, E., Aronson, A., & Siever, L. (1996). A 23-year-old woman with panic disorder treated with psychodynamic psychotherapy. American Journal of Psychiatry, 153, 698-703. Moore, M., & Tasso, A. F. (2008). Clinical hypnosis: The empirical evidence. In M. R. Nash & A. J. Barnier (Eds.), The Oxford handbook of clinical hypnosis: Theory, research, and practice (pp. 697-725). New York, NY: Oxford University Press. Morrell, H. E., & Cohen, L. M. (2006). Cigarette smoking, anxiety, and depression. Journal of Psychopathology and Behavioral Assessment, 28, 281-295. Nash, M. R. (2008). Foundations of clinical hypnosis. In M. R. Nash & A. J. Barnier (Eds.), The Oxford handbook of clinical hypnosis: Theory, research, and practice (pp. 487-502). New York, NY: Oxford University Press. PDM Task Force. (2006). Psychodynamic diagnostic manual (PDM) (1st ed.). Silver Spring, MD: Alliance of Psychoanalytic Organizations. Salzer, S., Winkelbach, C., Leweke, F., Leibling, E., & Leichsenring, F. (2011). Long-term effects of short term psychodynamic psychotherapy and cognitive-behavioral therapy in generalized anxiety disorder: 12-month follow-up. Canadian Journal of Psychiatry, 56, 503-508. Scholz, O. B., & Ott, R. (2000). Effect and course of tape-based hypnotherapy in subjects suffering from insomnia. Australian Journal of Clinical Hypnotherapy and Hypnosis, 21, 96-114. Steggles, S. (1999). The use of cognitive-behavioral treatment including hypnosis for claustrophobia in cancer patients. American Journal of Clinical Hypnosis, 41, 319-326. Wachtel, P. L. (2011). Therapeutic communication: Knowing what to say when. New York, NY: Guilford. Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practioner’s guide. New York, NY: Guilford.
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Author Biographies Christopher D. Watkins is a graduate student studying Clinical Psychology at the University of Tennessee– Knoxville. His research interests include the effects of maternal borderline personality disorder on child development, attachment, and psychotherapy process. Jenny Macfie is an associate professor at the University of Tennessee–Knoxville. Her research interests include developmental psychopathology, attachment, self-development, and self-regulation. She is currently studying development in children whose mothers have borderline personality disorder.
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