An Interdisciplinary Approach to the Management of Vocal Cord Dysfunction in an Elite Female Swimmer: a Case Study

Acute pulmonary disorders are commonplace within the athletic population, with exercise induced bronchoconstriction (EIB), and vocal cord dysfunction (VCD) common diagnoses. VCD is a condition that causes the adduction of the vocal folds during inhalation, causing obstruction at the larynx and thereby a severely impaired sporting performance. VCD can be brought on by laryngeal irritants, emotional and psychological stress and asthma. The gold standard of treatment for VCD centres on an interdisciplinary approach from specialists that often include a respiratory consultant, speech and language therapist (SLT) and a psychologist. The present case study details the interdisciplinary approach to the treatment of an elite female swimmer with VCD with an intervention programme that lasted nine weeks, instigated by a local general practitioner (G.P.) who chose to engage a Sport Psychology Consultant (SPC) due to the sport-specific nature of the psychological stress experienced by the individual. The steps involved in the design of the sport psychology interventions are outlined and the relationship of those interventions to the work of the other specialists is discussed. The 9 week intervention programme was aimed at reducing perfectionist tendencies and competitive state anxiety using a combination of cognitive behavioural therapy (CBT), goal-setting and imagery. Overall, the treatment programme was deemed a success as perfectionism and competitive state anxiety levels reduced over time along with the frequency of VCD occurrence. This case study demonstrates the breadth of roles that can be undertaken by a SPC and raises awareness of a complex respiratory disorder that is not yet fully understood.

Children’s Friendships and Learning in School: Cognitive Enhancement Through Social Interaction?

Background. Recent literature has identified that children's performance on cognitive (or problem-solving) tasks can be enhanced when undertaken as a joint activity among pairs of pupils. Performance on this ‘social’ activity will require quality relationships between pupils, leading some researchers to argue that friendships are characterized by these quality relationships and, therefore, that friendship grouping should be used more frequently within classrooms. Aims. Children's friendship grouping may appear to be a reasonable basis for cognitive development in classrooms, although there is only inconsistent evidence to support this argument. The inconsistency may be explained by the various bases for friendship, and how friendship is affected by cultural contexts of gender and schooling. This study questions whether classroom-based friendship pairings will perform consistently better on a cognitive task than acquaintance pairings, taking into account gender, age, and ability level of children. The study also explores the nature of school-based friendship described by young children. Sample. 72 children were paired to undertake science reasoning tasks (SRTs). Pairings represented friendship (versus acquaintance), sex (male and female pairings), ability (teacher-assessed high, medium, and low), and age (children in Years 1, 3, and 5 in a primary school). Method. A small-scale quasi-experimental design was used to assess (friendship- or acquaintance-based) paired performance on SRTs. Friendship pairs were later interviewed about qualities and activities that characterized their friendships. Results. Girls' friendship pairings were found to perform at the highest SRT levels and boys' friendship pairing performed at the lowest levels. Both boy and girl acquaintance pairings performed at mid-SRT levels. These findings were consistent across Year (in school) levels and ability levels. Interviews revealed that male and female friendship pairs were likely to participate in different types of activity, with girls being school-inclusive and boys being school-exclusive. Conclusion. Recommendations to use friendship as a basis for classroom grouping for cognitive tasks may facilitate performance of some pairings, but may also inhibit the performance of others. This is shown very clearly with regard to gender. Some of the difference in cognitive task performance may be explained by distinct, cultural (and social capital) orientations to friendship activities, with girls integrating school and educational considerations into friendship, and boys excluding school and educational considerations.

Case-series Evaluating a Transdiagnostic Cognitive-behavioral Treatment For Co-occurring Anxiety Disorders.

Background. Patients with anxiety disorder diagnoses commonly have more than one anxiety diagnosis. While cognitive-behavioral interventions have proven efficacy in treating single anxiety disorder diagnoses, there has been little investigation of their efficacy in treating cooccurring anxiety disorders. Aims. To evaluate the efficacy of a transdiagnostic cognitive-behavioral intervention for treating co-occurring anxiety disorders. Methods. An A-B single case study design (N = 6) was used to evaluate the efficacy of a 12 to 13 session modular transdiagnostic cognitive-behavioral intervention for treating co-occurring anxiety disorders across patients with at least two of the following diagnoses: GAD, Social Phobia, Panic Disorder and/or OCD. Results. Five of the six participants completed treatment. At post-treatment assessment the five treatment completers achieved diagnostic and symptomatic change with three participants being diagnosis free. All participants who completed treatment no longer met criteria for any DSM-IV-TR Axis-I diagnosis at the three-month follow-up assessment, and demonstrated reliable and clinically-significant improvements in symptoms. Across the participants, statistically significant improvements from pre- to post-intervention were found on measures of anxiety, depression and general well-being, and all improvements were maintained at three-month follow-up. Conclusions. Results suggest that transdiagnostic cognitive behavioral interventions can be of benefit to patients with co-occurring anxiety disorders.