Application of the Unified Protocol for a Japanese Patient with Post-Traumatic Stress Disorder and Multiple Comorbidities: A Single-Case Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Client Information
2.2. Case Conceptualization
2.3. Assessment
2.4. Therapeutic Intervention
2.5. Course of Therapy
2.5.1. Module 1: Motivational Enhancement for Treatment Engagement
2.5.2. Module 2: Psychoeducation and Tracking of Emotional Experiences
2.5.3. Module 3: Emotional Awareness Training
2.5.4. Module 4: Cognitive Appraisal and Reappraisal
2.5.5. Module 5: Emotional Avoidance and Emotion-Driven Behaviors
2.5.6. Module 6: Awareness and Tolerance of Physical Sensation
2.5.7. Module 7: Emotion Exposure
2.5.8. Module 8: Relapse Prevention
2.6. Treatment Adherence
3. Results
3.1. Outcome
3.2. Client Perspective
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Antecedents | Response | Consequences | |||
---|---|---|---|---|---|
Date/Time | Situation/Trigger | Thoughts | Emotions | Behaviors | What Happened Next? |
Monday 6 p.m. | I must see my doctor tomorrow to get a medical certificate concerning the after-effects of the traffic accident. | I don’t know what to do if my doctor rejects my request for a medical certificate. | Fear, anxiety | I went out to get something to binge-eat, but I went home without buying anything. | I felt stressed, but I didn’t feel bad about myself. |
Tuesday 6 p.m. | My husband told me he must go to work next Saturday. | Previously, he told me he will take the day off. Could it be that he plans to stay with a woman? | Sadness, anxiety, depression | I complained to him, but I immediately apologized and said thank you for taking the time for us to be together today. | We accepted each other’s situation and talked about plans for the next holiday. |
Thursday 4 p.m. | A lawyer told me that the diagnosis of after-effects did not go through the insurance claims process. | Why do so many bad things happen to me? | Sadness, depression, exhaustion, sighing | I got up and filled out a cognitive behavior therapy worksheet. | I could go to the hospital and talk about the problem. |
Friday 2 p.m. | I felt lonely because my husband was away from home. I spent my free time watching a movie with lots of blood in it at home alone. | I imagined my own death vividly. | Excited, sensation of palpitations | I stopped watching the movie and started doing housework | I was able to stop thinking about death and made better use of my time. |
Situation Trigger | Automatic Appraisal | Emotions | Thinking Trap | Alternative Appraisal |
---|---|---|---|---|
When crossing at a traffic light. | The traffic light will change before I can cross. I’ll be run over by a car. | Fear, anxiety | Probability overestimation | The traffic light won’t change that quickly. I can run if I need to. |
My boss told me a week ago that I must transfer to a new office. | I’ve been abandoned because I did not work hard enough. | Anxiety, depression | Catastrophizing | I finished my job here. I have something to contribute at the new workplace. |
My husband worked during a holiday. | He doesn’t want to be with me. We will break up someday. | Anger, depression | Catastrophizing | Sometimes we all have to work on a holiday. While my husband is at work, I can get time for the things I love to do. |
Description | Avoid (0–8) | Distress (0–8) | ||
---|---|---|---|---|
1 | Worst | Get a haircut at a hair salon | 8 | 8 |
2 | Ride a bike near the site of the accident | 8 | 8 | |
3 | Go for a job interview | 7 | 8 | |
4 | Walk alone in a crowd | 7 | 6 | |
5 | Ride a crowded train | 7 | 7 | |
6 | Pick up a phone call from my lawyer | 6 | 6 | |
7 | Call a restaurant to make a reservation | 5 | 6 | |
8 | Go to the office near the site of the accident | 6 | 4 | |
9 | Make a phone call to a close friend | 4 | 3 | |
10 | Pick up a phone call from my mother or husband | 0 | 0 |
Measures | Baseline | Post-Treatment | Three-Month Follow-up |
---|---|---|---|
SIGH-A | 33 | 13 | 17 |
GRID-HAMD | 22 | 8 | 13 |
IES-R | 76 | 10 | 15 |
BDI-II | 53 | 11 | 19 |
SDS | 23 | 6 | 4 |
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Kato, N.; Ito, M.; Matsuoka, Y.J.; Horikoshi, M.; Ono, Y. Application of the Unified Protocol for a Japanese Patient with Post-Traumatic Stress Disorder and Multiple Comorbidities: A Single-Case Study. Int. J. Environ. Res. Public Health 2021, 18, 11644. https://doi.org/10.3390/ijerph182111644
Kato N, Ito M, Matsuoka YJ, Horikoshi M, Ono Y. Application of the Unified Protocol for a Japanese Patient with Post-Traumatic Stress Disorder and Multiple Comorbidities: A Single-Case Study. International Journal of Environmental Research and Public Health. 2021; 18(21):11644. https://doi.org/10.3390/ijerph182111644
Chicago/Turabian StyleKato, Noriko, Masaya Ito, Yutaka J. Matsuoka, Masaru Horikoshi, and Yutaka Ono. 2021. "Application of the Unified Protocol for a Japanese Patient with Post-Traumatic Stress Disorder and Multiple Comorbidities: A Single-Case Study" International Journal of Environmental Research and Public Health 18, no. 21: 11644. https://doi.org/10.3390/ijerph182111644