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Clinical Case Study: Single Session Therapy for the treatment of anxiety related to Covid-19 in a pediatric emergency department

Clinical Case Study: Single Session Therapy for the treatment of anxiety related to Covid-19 in a pediatric emergency department

The spread of Single Session Therapy throughout the world is now a certain fact, as evidence of this phenomenon are the multiple applications of the method in the various areas of mental health .

 

Through the exposition of a clinical case in which the three phases of a Single Session Cognitive Behavioral Therapy intervention in a pediatric setting are described for the treatment of anxiety related to the spread of Covid-19 (P Lee & Simpson, 2020), we really want to highlight the different ways in which the single session mindset is expressed, proving to be a fundamental resource for improving the quality of services and making them accessible to a larger population.

  

How can the Single Session mindset represent a resource in pediatric mental health?

Even before the Coronavirus (Covid-19) pandemic , visits to pediatric emergency departments had increased (Sheridan et al. 2015). Over half a million children (a significant portion of whom come from families in conditions of socio-economic disadvantage) were taken to psychiatric emergency rooms every year for mental health problems, of which almost half with symptoms attributable to an anxiety disorder . With the pandemic, this phenomenon has increased (Jiao et al . 2020) (e.g., children experience anxiety connected to the epidemic and the health of relatives, poor sleep, physical discomfort, agitation and separation anxiety) and with it the need to provide a more effective response in order to reduce further psychiatric emergency admissions in general (P Lee & Simpson, 2020).

 

 Clinical case.

A 10-year-old American Indian girl arrives at the pediatric emergency room accompanied by her mother, presenting with chest pain, abdominal pain, nausea and decreased appetite for a few weeks. She had no significant medical or psychiatric history. Her vital signs and laboratory tests were reassuring. At the time of the initial evaluation, the child’s mother expressed concern about her daughter’s anxiety and discomfort related to the Covid-19 epidemic.

The team offers the family a visit with the service’s specialized behavioral health counselor. The mother reports to the counselor that the Covid-19 pandemic had been difficult. The child felt “down” and she experienced increased irritability, loss of pleasure (anhedonia), tearfulness, racing thoughts, and worry. The child reported struggling with social isolation and not being able to see her friends, who she previously saw at school. Additionally, the little girl was worried that her family members might contract the coronavirus; two of her brothers had poor health. She also feared that her abdominal pain was an indication of a serious health problem. The little patient had not reported suicidal thoughts or substance use.

The behavioral health counselor began a brief three-phase cognitive behavioral therapy (CBT)

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What does it mean to introduce Single Session Therapy into an organization? Practical tips and guidance

With today’s article we take up a topic already addressed in the previous article regarding the existence or otherwise of criteria that establish an effective use of Single Session Therapy with clients, extending it to its use in the context of health services.   

The objective of the article will, in fact, be to identify the indications and contraindications for the implementation of SST in health services. The question we ask ourselves, in fact, is whether Single Session Therapy can be a valid tool for providing psychological interventions in healthcare organizations and what can make its introduction more effective.

 

To answer this question we will again make use of Windy Dryden (2019) who suggests some indications and contraindications capable of predicting whether SST will be used as an effective method within an organization.  

 

 What indicators does Dryden  believe will predict whether HST will flourish as a method of psychological service delivery within an organization?

Service support . It is important that the majority of workers in an organization support SST as a means of service delivery. Before the method is introduced, all interested parties must be able to share their enthusiasm, raise doubts, reservations and objections and discuss them in a respectful manner. Managers, therapists and administrative staff must all be involved in the decision regarding whether or not to introduce SST into the organization. Furthermore, where some therapists do not wish to be involved, they should be respected, so any covert attempts to sabotage SST will be minimised.

Adequate training . Before implementing SST in an agency it is important that all staff are sufficiently trained. This should involve both skill development and the opportunity to share and discuss doubts, reservations and objections about the method.

Ongoing support and supervision . Before SST is rolled out within a healthcare agency, it is important that there is ongoing oversight of how it is practiced to hone skills and protect client well-being.

Adequate administrative support . Within an organization, if there is not enough administrative support to incentivize SST service, it will soon fade away. Therefore, in organizations where SST grows, administrative staff actively participate in the team offering crucial feedback to ensure the smooth functioning of the service.

TSS integrated with other services . It is important that SST is fully integrated with the delivery of the organisation’s other services and not seen as a separate part of what the agency provides, managed by one or two enthusiastic individuals.

Accessible to the public . It is important that the SST service is accessible to the public,

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Are there indications and contraindications for the use of single session therapy?

In this article we address a topic that is of profound interest to both scholars of Single Session Therapy and those who are eager to learn it, namely the existence or otherwise of criteria for establishing its use with clients.

 

Windy Dryden (2019), one of the most important scholars of Cognitive Behavioral Therapy in the world and a scholar of psychotherapies, maintains that there are two different ways of addressing the issue: the first is the one which provides for the existence of indications and contraindications, the second is the one that does not foresee any at all.

  

What kind of indications and contraindications do therapists rely on the existence of criteria to decide whether or not a client can receive a TSS intervention?

Let’s see some!

TSS can be indicated with :  

People who have daily living problems (non-clinical/emotional) such as non-pathological anxiety, depression, guilt, shame, anger, grief, jealousy and envy, or relationship problems at home and work .

People who experience self-discipline issues on a daily basis .

People predisposed to single intervention and ready to take care of their non-clinical problems , especially to prevent more serious problems.

People predisposed to single intervention and ready to take care of their own clinical problems such as simple phobias (Davis III et al ., 2012) or panic attacks (Reinecke et al ., 2013).

Stuck people who need help to free themselves and move forward.

People who see therapy as intermittent help throughout the life cycle.

People with personal development or coaching goals .

People with clinical problems , but ready to tackle a non-clinical problem, for example, a person with a personality disorder who wants help to overcome the problem of procrastination.

People who are open to therapy, but want to try it before committing.

People who want preventative care .

People with meta-emotional problems (e.g. shame of being anxious).

People who require timely and targeted crisis management.

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Post emergency Covid-19 and SST: psychodrugs or psychotherapy, what will be the future of mental health services?

With today’s article we want to once again deal with health services and the growing need for adequate responses in the field of mental health and psychological well-being .

To discuss the topic we will refer to a recent article Psychopandemic and risks of pharmacological abuse: what answers? by David Lazzari, President of the Council of the Order of Psychologists (CNOP) recently published on Huffpost, which in addition to highlighting the increase in psychological distress following the pandemic in all age groups, highlights how among the main forms of help adopted to intervene mainly involve the use of psychotropic drugs .  

 

 

Let’s see what the effects of the pandemic are after a year?

The following data was reported in the article:

Compared to the data reported by the WHO before the pandemic according to which 17 million Italians were already suffering from psychological disorders (Kastel, 2019), today this discomfort has increased significantly in the form of anxious, depressive or mixed disorders .

 

The highest incidence is found in risk groups such as: veterans from intensive care affected by Covid-19, physically ill people who have not benefited from treatment due to fear of contagion or access limitations, people who have lost a relative, caregiver or relatives of people with illnesses or disabilities, people with greater or previous psychological fragility, healthcare workers.

 

Another worrying fact concerns young people, children and adolescents . In a survey by the CNOP Study Center (15.01.21) it emerged that 47% of parents with children between 3 and 14 years have emotional problems, in another survey carried out on children negative psychological states were highlighted in 62% of cases. Among adolescents, 6 out of 10 say they feel stressed and one in three would like psychological support (Unicef ​​20.11.20).

 

 

With respect to the increase in psychological distress, which treatments are most used?

According to some official data from the AIFA (Italian Medicines Agency) and the OECD (Organisation for Economic Cooperation and Development) show a significant

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What will be the future of Single Session Therapy?

This article is inspired by an interview conducted by W. Dryden with M. Hoyt in 2018 , Toward the future of single-session therapy: An interview , in which the two authors questioned the future of single-session therapy . At that time, the pandemic scenario that occurred shortly thereafter was certainly not imagined, but have the ideas on how SST could evolve changed that much?

 

Since Moshe Talmon ‘s 1990 book, Single-Session Therapy: Maximizing the Effects of the First (and Often Only) Therapeutic Encounter , SST has received a lot of attention. Thanks to the first work conducted by M. Hoyt , R. Rosenbaum and M. Talmon it was possible to discover how many people find a single session useful and sufficient for a series of problems. Since then, SST has been translated into many languages, and numerous scholars (Hoyt, Bobele, Slive, Young, & Talmon, 2018; Hoyt & Talmon, 2014) have confirmed that one session may be, for many clients, all they need. need.

 

 Let’s see in more detail what developments have taken place since that moment?

After 1990:

a first development concerned the recognition of the fact that the highest frequency of psychotherapy sessions is 1 . Before Talmon’s book there were only sporadic testimonies on the implementation of single interventions. Thanks to in-depth literature research and the implementation of quantitative studies on the use of SST, it has been demonstrated that a single session is the most common duration of a treatment.

a second development occurred with the carrying out of research which documented the effectiveness of single session therapies (Hoyt & Talmon, 2014).

a third development concerned the fact that there is not just one way of doing SST, but the method can be applied with different models (solution-centered, cognitive-behavioral, MRI, narrative, psychodynamic).

a fourth development was that relating to the recognition of SST as an intervention method rather than as a particular theoretical approach (Slive & Bobele 2011, 2018). SST, in fact, focuses on the way in which the therapist can help the client in that encounter, considered as complete in itself.

Another development concerned international awareness of SST.

 

 

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Guest speaker at the symposium: Jeff Young

In today’s article we introduce you to Jeff Young, another international expert in Single Session Therapy in the world who will participate in the IV Symposium on SST which this year will be held on 10, 11 and 12 November in Italy , in Rome and which has contributed to its diffusion throughout the world. 

It is also thanks to Jeff Young that the Italian Center for Single Session Therapy will hold the IV Symposium on SST in Europe .

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guest speaker at the symposium: Moshe Talmon

In today’s article we present to you the last of the three pioneers of Single Session Therapy who will participate in the IV Symposium on SST which this year will be held on 10, 11 and 12 November in Italy , in Rome , Moshe Talmon . 

Moshe Talmon, Ph.D. (University of Pennsylvania ’82) initiated a series of studies at Kaiser Permanente Medical Group on patients who failed to show up for their second appointment after their first therapy session. Later, together with Michael Hoyt and Robert Rosenbaum , he began a study of 60 attempts at scheduled single-session therapy with patients who had required lengthy therapy.

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guest speaker at the symposium: Michael Hoyt

In today’s article and in the next articles we will introduce you to all the Single Session Therapy experts in the world who will participate in the IV Symposium on SST which this year will be held on 10, 11 and 12 November in Italy , in Rome .  

 

First of all we present Michael F. Hoyt , pioneer together with Moshe Talmon and Robert Rosenbaum of Single Session Therapy .

The Italian Center for Single Session Therapy , in the figure of Flavio Cannistrà ( co-founder together with Federico Piccirili of the Italian Center for Single Session Therapy ), has collaborated with him for the drafting of books and scientific articles on SST , also MF Hoyt as a trainer he participated in various workshops on SST, held in Italy by ICSST starting from 2016.

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