Clinical outcome of a short-term psychotherapeutic intervention for the treatment of dental phobia

Objective: Anxiety before receiving dental treatment is widespread. The aim of this investigation was to evaluate the effect of a brief psychologic treatment on adherence to the dental treatment regimen in patients with dental phobia. Method and Materials: Dental phobic patients (n = 160) received 3 sessions of cognitive behavioral therapy that consisted of stress management training and exposure to phobic stimuli. The outcome was determined in terms of 3 subsequent dental visits. Results: Participating patients had not visited a dental clinician for an average of 6 years. Comparison of patients who completed the psychologic treatment with those who dropped out showed that 68% of the former but also 52% of the latter adhered to the subsequent dental treatment regimen. The number of psychologic treatment sessions correlated significantly and positively with anxiety level before treatment. Conclusion: Short-term psychologic therapy of 3 sessions results in a success rate of 70% to adherence to dental treatment among dental phobic patients. Duration of avoidance of anxiety before treatment was not related to success in completing the trial. Nevertheless, the more intense the patient's phobia, the more psychotherapeutic sessions were necessary. (Quintessence Int 2007;38; E589-E596).

Diagnosis and treatment of an obsessive-compulsive disorder following traumatic brain injury: A single case and review of the literature

A 27-year-old patient with traumatic brain injury and neuropsychiatric symptoms fitting the obsessive-compulsive disorder was investigated. Brain CT-scan revealed left temporal and bilateral fronto-basal parenchymal contusions. Main Outcome Measure was the Yale-Brown Obsessive Compulsive Scale at pre- and post-treatment and at 6 months follow-up. The combination of pharmacotherapy and psychotherapy resulted in lower intensity and frequency of symptoms. Our case illustrates the importance of a detailed diagnostic procedure in order to provide appropriate therapeutic interventions. Further studies are needed to guide the clinician in determining which patients are likely to benefit from a psychotherapeutic intervention in combination with pharmacotherapy.

Motive-Oriented Psychotherapeutic Relationship Facing a Patient Presenting with Narcissistic Personality Disorder: A Case Study

Motive-oriented therapeutic relationship (MOTHER), a prescriptive concept based on an integrative form of case formulation, the Plan Analysis (PA) method (Caspar, in: Eells (ed.), Handbook of psychotherapy case formulations, 2007), has shown to be of particular relevance for the treatment of patients presenting with personality disorders, in particular contributing to better therapeutic outcome and to a more constructive development of the therapeutic alliance over time (Kramer et al., J Nerv Ment Dis 199:244–250, 2011). Several therapy models refer to MOTHER as intervention principle with regard to borderline and Narcissistic Personality Disorder (NPD) (Sachse et al., Clarification-oriented psychotherapy of narcissistic personality disorder, 2011; Caspar and Berger, in: Dulz et al. (eds.), Handbuch der Borderline-Störungen, 2011). The present case study discusses the case of Mark, a 40-year-old patient presenting with NPD, along with anxious, depressive and anger problems. This patient underwent a seven-session long pre-therapy process, based on psychiatric and psychotherapeutic principles complemented with PA and MOTHER, in preparation for further treatment. MOTHER will be illustrated with patient–therapist verbatim from session 4 and the links between MOTHER and confrontation techniques will be discussed in the context of process-outcome hypotheses, in particular the effect of MOTHER on symptom reduction.