Treatment of an adolescent with bowel movement phobia using self-control therapy

doi:10.1016/0005-7916(91)90033-2

Journal of Behavior Therapy and Experimental Psychiatry

Volume 22, Issue 1, March 1991, Pages 45-51

https://doi.org/10.1016/0005-7916(91)90033-2 Get rights and content

Abstract

This report describes a self-control treatment of an adolescent with a highly unusual and severely debilitating phobia of having bowel movements in public. The treatment focused predominantly on helping the adolescent to modify his maladaptive thingking and also included role plays, graduated exposure, and homework assignments. Multimethod and multisource assessment data were collected as well as measures of social validity. Treatment gains were maintained at 3 and 6 month follow-up.

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Little is known about BOS treatment. Tricyclic antidepressants seem to produce nearly total resolution of symptoms [6,8–11], although mainly when behavioral therapy is added, and promising results of psychological interventions [12–14], especially of cognitive–behavioral therapy (CBT) [14], have been proposed. A 32-year-old man had a fecal impaction and a diagnosis of chronic constipation at the age of 20.
The bowel obsession syndrome (BOS) is a psychosomatic disorder which often remains at the intersection of somatic and psychological domains without being adequately diagnosed and treated.
A 32-year-old man with chronic constipation presented with restricted diet, compulsions on evacuation, social isolation and depressed mood, thus satisfying the diagnosis of BOS. Cognitive behavioral therapy led to complete remission of symptoms, and results were maintained after 1 year of follow-up.
Although BOS is not frequently diagnosed, it is probably more prevalent than thought. Clinicians should be aware of its existence in order to assess, diagnose and properly treat it.
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Conceptualization and treatment of bowel obsessions: Two case reports
1997, Behaviour Research and Therapy
Bowel obsessions have long been recognized in clinical settings, usually presenting as an overwhelming fear of losing bowel control in public. Conceptual issues with regard to this disorder have hampered treatment efforts. For example, disagreement exists as to its proper classification within the spectrum of anxiety disorders: it has been conceptualized both as a variant of obsessive-compulsive disorder and as a symptom of social phobia, panic disorder, and agoraphobia. In addition, the comorbidity of bowel obsessions and functional bowel disorders such as irritable bowel syndrome is not understood. While reports of pharmacological intervention exist, little has been written about psychological treatment techniques. This paper uses two cases studies of successful behavioral treatment of bowel obsessions as illustrations to address the above issues.
Family involvement in treating children with phobic and anxiety disorders: A look ahead
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Most interventions currently being tested for children with phobic and anxiety disorders are individual child-focused treatments in which family members generally play little or no direct role in the therapeutic process. Although this approach to treatment is generally efficacious, involving family members more centrally in the therapeutic process is one important way to enhance treatment effectiveness and maintenance. A framework to help guide researchers and clinicians in the task of devising and implementing interventions that more centrally involve family members is presented. In addition, research on family factors associated with childhood anxiety is summarized and how such factors may influence treatment outcome and maintenance is discussed. Based on a “transfer of control” model of change, an innovative intervention designed to target both individual and family factors is described.
Listening to our clinical partners: Informing researchers about children's fears and phobias
1992, Journal of Behavior Therapy and Experimental Psychiatry
We surveyed a national sample of clinical psychologists to expand on Graziano and De Giovanni's (Behaviour Research and Therapy, 1979, 17, 161–162) findings that 6.8% of clinically referred children present with problems with fears and/or phobias. The survey was also conducted to assets how clinicians could inform researchers about current needs for investigations in this area. Questions involved epidemiological, demographical, and treatment characteristics of cases recently seen by therapists. The percentage of referred cases for fears/phobias in children was determined to be similar over time. In addition, types of fears, length of history of fear, intensity of fear, length of treatment, types of treatments used, and degree of parental involvement were measured and reported. The results were found to suggest a substantial degree of heterogeneity among types of fears and treatment methods for this population, as well as important lines of future research. They also suggest the need for controlled studies to assess the efficacy of a number of widely used treatments that lack an empirical base.
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1995, Cognitive and Behavioral Practice
Issues involved in conducting cognitive behavioral treatment with children who present with anxiety and phobic disorders are discussed. The rationale for using cognitive behavioral treatment procedures is based on our premise that effective, long-term child behavior change depends on an adequate “transfer of control” from therapist to parent to child. The treatment involves separate and conjoint child and parent sessions and is implemented in three phases: education, application, and relapse prevention. Specific treatment strategies, common obstacles to implementing these strategies, and suggestions to address these obstacles are described for each phase of the treatment. A case vignette illustrates some of the treatment issues discussed.

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^☆: Portions of this paper were presented at the 10th Annual Berkshire Conference on Behavior Analysis and Therapy, Amherst, Massachusetts (13–14 October 1989).

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Treatment of an adolescent with bowel movement phobia using self-control therapy☆

Abstract

Journal of Behavior Therapy and Experimental Psychiatry

Behaviour Research and Therapy

The child behavior profile: I. Boys aged 6–11

Journal of Consulting and Clinical Psychology

Two self-control procedures in the reduction of targeted and non-targeted anxieties

Journal of Consulting Psychology

The use of cognitive behavior therapy for reducing math anxiety

School Psychology Review

A reduction of children's fear of the dark by confidence-related and situational threat-related verbal cues

Journal of Consulting and Clinical Psychology

Self-management methods

An empirical-clinical approach toward a definition of childhood depression