scholarly journals Mechanical/Algorithmic Versus Flexible/Creative Clinical Practice: How Underlying Principles Bridge the Gap

2017 ◽  
Vol 13 (1) ◽  
pp. 73
Author(s):  
Jeremy D. Lichtman
Keyword(s):  
Clinical Practice ◽  
Tourette Syndrome ◽  
Behavioral Intervention ◽  
Algorithmic Approach ◽  
Manualized Treatment

In the case of "Hiro" (Lichtman, 2017) I described the successful use of Comprehensive Behavioral Intervention for Tics (CBIT) in a young boy with Tourette Syndrome (TS). In three different commentaries on this case, authors noted important concepts regarding the use of manuals in treating TS; how an understanding of underlying principles is important in flexible use of manuals; and how training impacts the treatment of TS. In my response to these commentaries, I hope to continue the conversation of how to use manuals in psychotherapy in general as well as in the treatment of TS in particular. Specifically, I hope to address the seeming dichotomy between a mechanical, algorithmic approach to treatment versus a flexible, creative approach, and to ultimately show that an understanding of the underlying principles guiding manualized treatment provides room for ingenuity that proves this dichotomy false.

Intervention Fidelity in a Translational Study: Lessons Learned

2013 ◽  
Vol 27 (2) ◽  
pp. 131-148 ◽  
Author(s):  
Bernice C. Yates ◽  
Karen L. Schumacher ◽  
Joseph F. Norman ◽  
Kaye Stanek Krogstrand ◽  
Jane Meza ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Behavioral Intervention ◽  
Intervention Studies ◽  
Research Participant ◽  
Lessons Learned ◽  
Intervention Fidelity ◽  
Research Staff ◽  
Translational Study ◽  
Design Component ◽  
Clinical Environments

This article examined the intervention fidelity strategies used and lessons learned in a translational study. In this study, the behavioral intervention was delivered within an existing clinical practice environment, outpatient cardiac rehabilitation (CR). The primary lessons learned were that the fidelity components of design, training, and delivery of the intervention were the most different from fidelity strategies used in typical intervention studies. The design component needed to take into account the unique characteristics of the clinical environments where the study was conducted and build these unique differences into the study design. Training and delivery of the intervention was different because existing CR staff delivered the intervention in this study; which is unlike typical intervention studies where research staff are trained to deliver the intervention. Monitoring receipt and enactment fidelity components were similar to monitoring in usual intervention studies probably because these components focus on monitoring the behaviors of the research participant. Translational research presents unique challenges and requires the development of a flexible and novel intervention fidelity plan tailored to a particular study.

scholarly journals The Case of "Hiro": Treating Tourette Syndrome by Comprehensive Behavioral Intervention for Tics (CBIT)

2017 ◽  
Vol 13 (1) ◽  
pp. 1
Author(s):  
Jeremy D. Lichtman
Keyword(s):  
Tourette Syndrome ◽  
Behavioral Intervention ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Treatment Options ◽  
Case Formulation ◽  
Efficacious Treatment ◽  
Treatment Considerations ◽  
New Treatment

Cognitive-behavioral therapy (CBT) with Comprehensive Behavioral Intervention for Tics (CBIT) is an efficacious treatment for Tourette Syndrome (TS), with a manualized version available for guiding practitioners through treatment. However, CBIT is still a fairly new treatment for TS and rigorous training in its application is sparse. Additionally, potential treatment considerations are not thoroughly described in the manual. This dissertation presents a systematic case study that specifically analyzes the use of the manual with 10-year-old "Hiro," a South Asian Indian boy with TS who also had attention deficit hyperactivity disorder (ADHD), which is a confounding factor in the treatment of TS. To do this meant applying flexibility and an "hypothesizing-then-testing" mentality. The creation of an individualized case formulation and an associated treatment plan for Hiro were very valuable components in his treatment. The case study chronicles Hiro's successful treatment and explores how and when adherence to the manual was effective as well as how and when greater flexibility was required. Furthermore, the case study explores factors in the clinician/client relationship and how that relationship can prove a powerful tool in treatment. Options for how to maintain treatment goals after termination are also examined.

scholarly journals Comprehensive Behavioral Intervention for Tics reduces perception-action binding during inhibitory control in Gilles de la Tourette syndrome

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Vanessa Petruo ◽  
Benjamin Bodmer ◽  
Annet Bluschke ◽  
Alexander Münchau ◽  
Veit Roessner ◽  
...  
Keyword(s):  
Tourette Syndrome ◽  
Inhibitory Control ◽  
Behavioral Intervention ◽  
Perception Action

scholarly journals Translating an Evidence-Based Behavioral Intervention for Women Living with HIV into Clinical Practice: The SMART/EST Women’s Program

2014 ◽  
Vol 22 (3) ◽  
pp. 415-424 ◽  
Author(s):  
Stephen M. Weiss ◽  
Jonathan N. Tobin ◽  
Maria Lopez ◽  
Hannah Simons ◽  
Ryan Cook ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Behavioral Intervention ◽  
Evidence Based ◽  
Women Living With Hiv ◽  
Living With Hiv

Case 26

2018 ◽  
Author(s):  
Bashar Katirji
Keyword(s):  
Clinical Practice ◽  
Peripheral Neuropathy ◽  
Clinical Presentation ◽  
Nerve Conduction Studies ◽  
Algorithmic Approach ◽  
Immune Mediated ◽  
Peripheral Polyneuropathy ◽  
Common Clinical Presentation ◽  
Distinguishing Features ◽  
Dying Back

Peripheral polyneuropathy is a common clinical presentation, and most cases seen in clinical practice are axonal, dying-back, sensorimotor polyneuropathies. Axonal polyneuropathies should be distinguished from the acquired demyelinating peripheral polyneuropathies which are often immune-mediated and amenable to treatment. This case presents a typical patient with a dying-back sensorimotor axonal peripheral polyneuropathy and presents a practical approach to the etiologic diagnoses of peripheral neuropathy. It then highlights its distinguishing features on nerve conduction studies. A comparison between axonal and demyelinating polyneuropathies is revealed. An algorithmic approach to the workup of a patient presenting with a peripheral neuropathy is recommended.

scholarly journals Therapeutic Proposal of the Oral Manifestations of the Tourette Syndrome. A Case Report

2021 ◽  
Vol 37 (1) ◽  
pp. 220-229
Author(s):  
Martha Carmona Lorduy ◽  
Stella Pupo Marrugo ◽  
Tatiana Ruiz Tobón
Keyword(s):  
Case Report ◽  
Tourette Syndrome ◽  
Behavioral Intervention ◽  
Oral Manifestations

El Síndrome de Tourette (ST) es un trastorno neurológico-conductual crónico que comienza en la infancia y la adolescencia. Su característica principal es la emisión de múltiples tics motores y fónicos de distinto tipo y complejidad. Se asocian a vocalizaciones involuntarias (ecolalia, coprolalia). A menudo empeoran cuando la persona está excitada o padece de ansiedad y se atenúan durante la realización de actividades calmadas o que requieren de concentración. Su tratamiento consiste en el uso de medicamentos que pueden causar efectos adversos o la intervención global de comportamiento para tics (Comprehensive Behavioral Intervention for Tics, CBIT) que es un tratamiento conductual no farmacológico diseñado para enseñar a los pacientes y sus familias un conjunto específico de habilidades para reducir la frecuencia, la intensidad y el impacto general de los tics motores y vocales. Se reporta caso clínico de paciente de 13 años de edad que asistió a la Facultad de Odontología Universidad de Cartagena por presentar ulcera dolorosa en cavidad bucal. Como terapéutica se decidió utilizar la placa de protección mucosa (PPM) en el maxilar, observándose una disminución del tamaño de la úlcera y en el control a los 45 días se observó la cicatrización completa de la lesión. Se complementó el tratamiento bucal, con la remisión a tratamiento psicológico de soporte.

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