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Pica, the developmentally and culturally-inappropriate eating of non-nutritive and non-food substances, is most often documented in people with developmental disabilities and children, frequently in institutional and residential settings. To date, there are no randomized clinical trials on pica-specific treatments, and very little literature is available regarding the characteristics or treatment of pica in adults with no intellectual or social deficits, and co-morbid disorders. This case study addresses this gap, and involves a highly educated 30 year-old American woman with foam rubber pica and burned match consumption (cautopyreiophagia) behaviors, along with co-morbid depressive, anxiety, and obsessive-compulsive symptoms, who received treatment in a general intensive outpatient program for adults in a large urban community psychiatry setting. The case study describes how the Biosocial Theory and Transtheoretical Model of Health Behavior Change were used to conceptualize this woman’s symptoms and guide a treatment team of clinicians who did not specialize in pica. Providers in non-specialty clinic settings would benefit from reflecting on ways to adapt evidence-based techniques to the treatment of uncommon symptoms.

Avoidant/restrictive food intake disorder (ARFID) was introduced in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. Three different subtypes of ARFID are described: individuals who seem disinterested in eating, those who avoid certain foods because of a sensitivity to specific characteristics of the food, and those who are concerned about an aversive experience associated with eating. There is currently no first-line treatment for ARFID. Three case studies are presented of patients with ARFID who participated in a family-based partial hospitalization program/intensive outpatient program for eating disorders. A description of the course of treatment is included, as well as ways in which the eating disorder program adapted treatment to more closely meet the unique needs of these patients. An approach with emphasis on parental involvement seems promising, although research is needed to investigate this more fully.

In Rosik's (2017) response to my previous article (Jensma, 2016), he indicates that I made an unfortunate comparison between his earlier study (Rosik, 2011) and the outcome study in my article. I agree that such a comparison would be "apples and oranges"--as he calls it--and inappropriate. However, such a comparison was not intended, although I can see how it might have been inferred. My article presented the findings of an outcome study done at ALONGSIDE, a center that offers an intensive outpatient program primarily for missionaries. My literature review brought Rosik's (2011) outcome study to the fore, and the results of my outcome study appeared to be inconsistent with one of the primary findings suggested by Rosik's study. Responsible scholarship required me to try to explain the apparent difference in findings, but this was not the point of the article, and the article was not intended to be a comparison between the two studies. Rosik's re-analysis of his data indicates that both studies in fact showed similar results at three-month follow-up, and my presentation of further data in this response indicates that the results of a one-year follow-up are similar to the results of the three-month follow-up, thus supporting the findings of the outcome study presented in my previous article. ********** I offer a thank-you to Dr. Rosik for his corrective to the impressions that may have been drawn inadvertently from my article. I agree that it would be improper to compare findings from three-month follow-up data with findings from 27-month follow-up data. Such was not my intent, but it seems to have come across that way to Dr. Rosik, and so I believe it is very possible that it may have come across that way to others as well. I am grateful to Dr. Rosik for drawing attention to the possibility that some might read my article as seeking to compare the two studies or the effectiveness of Link Care's intensive outpatient program (IOP) to ALONGSIDE's IOP. But comparison was not my intent. My focus was on whether or not the psychological progress--the fruit--of ALONGSIDE's IOP treatment program remains past termination. The purpose of my article (Jensma, 2016) was to present the results of the outcome study done at ALONGSIDE, which indicates that clients see significant progress in our three-week IOP and that the progress remains three months post-treatment. The purpose of the article was to address the question, "Is ALONGSIDE's program effective in the first place, and does the effectiveness of ALONGSIDE's three-week program endure?" In other words, "Does the fruit remain?" I fully agree with Rosik that if I were comparing the two studies or the two IOPs on which the studies were done, I would be comparing apples to oranges. But such was not the case. I was simply seeking to present the results of the outcome study of ALONGSIDE's three-week IOP and to present evidence that the treatment effect lasts--that "the fruit remains." Any proper literature review related to outcomes of an IOP among missionaries would have to include Rosik's (2011) article along with an earlier one by Rosik, Summerford, and Tafoya (2009). One of the main findings that I took away from the 2011 article was that, while participants in Rosik's study experienced reliable change during their treatment, only those who had been in IOP treatment for at least six weeks retained those gains; those who had been in treatment less than six weeks lost a significant portion of their gains. A more technically correct takeaway might have been this: of the 33 participants measured on average 27 months post-treatment, participants who had been in IOP treatment at Link Care Center for at least six weeks tended to maintain their gains, while those who had been in IOP treatment less than six weeks did not. I believe it is common, however, to come away with more generalized impressions. I would venture to guess that many readers would have come away from Rosik's article with the impression that an IOP for missionaries would be likely to offer long-term effectiveness only if the program were a minimum of six weeks in length. …

This article reports the findings of an outcome study done at ALONGSIDE, a counseling-focused retreat center that offers three-week intensive outpatient programs for Christian leaders, the majority of whom are missionaries. Repeated measures research utilized the Outcome Questionnaire -45.2 (OQ-45.2) to explore whether or not clients participating in the three-week intensive outpatient program realized significant clinical progress and whether or not therapeutic gains were retained after the conclusion of the program. Missionaries and other Christian leaders took the inventory online a month before coming to ALONGSIDE, upon arrival, at the end of the three-week program, and three months after the program concluded. The results indicated that a month of time before arrival did not bring about a significant reduction in symptomatology among the 191 subjects, but three weeks of ALONGSIDE's intensive outpatient program resulted in significant clinical improvement which remained when the inventory was taken again three months post-program. This suggests that in a fairly short period of time, an intensive outpatient program consisting of psycho-education, group psychotherapy, and individual and/or marital counseling within a milieu of intentional Christian community can be a highly effective model for promoting enduring psychological healing. ********** When missionaries return Stateside to seek psychological treatment, they often go to centers specializing in offering treatment to missionaries. Several of these centers utilize some form of an intensive outpatient program (IOP). This can be an attractive option because of the relatively short timeframe that might be needed, thus taking missionaries away from their homes, their ministries--their very lives!--for a shorter period of time. Additionally, because these centers usually offer lodging--a great convenience when the missionary does not have a home readily available on short notice--going to such a center is sometimes the preferred approach to treatment for important logistical reasons. In any case, whether or not participation in an IOP is intentionally chosen, a substantial number of missionaries who return to the United States seeking psychological treatment go to specialized centers that do in fact utilize some form of an IOP. Three centers for missionaries that utilize an IOP (Link Care Center, Heartstream Resources, and ALONGSIDE) combined treat upwards of 200 missionaries a year. Therefore, it is important to establish whether or not IOP treatment is effective for a missionary population. There is great variability among programs claiming IOP status in terms of the number of hours a week and the number of weeks involved in the treatment program. The range includes from two to four hours a day, from three to five days a week, and from one week to many months. Some IOPs have beginning and end dates during which clients go through the IOP as a cohort group; others have an ongoing IOP which clients enter and exit as deemed appropriate with no stipulated length of stay. In general, intensive outpatient programs are most commonly associated with treating chemical dependency or eating disorders. Little research is available on IOPs with a more general psychiatric population. However, Wise (2003a) validated the efficacy of an IOP in a private-practice setting and specifically demonstrated the efficacy of using an IOP model to treat depression (Wise, 2005). He found the IOP to be "more effective than psychotherapy in clinically representative studies, randomized clinical trials, and controlled clinical trials as well as comparable to many widely used medical interventions" (Wise, 2003b, p. 203). In light of the high level of effectiveness that he found using an IOP, Wise (2003b) lamented the general underutilization of this model. It is encouraging, therefore, to note that the IOP model is not uncommonly used with missionaries who seek psychological treatment. …

Background Research has demonstrated that the combination of pharmacotherapy and psychological interventions in alcohol use disorder (AUD) treatment is superior to either alone. Despite this, medications remain highly underutilized in many outpatient treatment facilities. Pharmacists can serve as an excellent resource to aid in improving access to medications. Methods This study was a prospective, longitudinal evaluation of a pharmacist's role in a substance use disorder (SUD) clinic, specifically an intensive outpatient program (IOP). The primary objective was to determine if the addition of a clinical pharmacy specialist (CPS) as a bridge until next available provider appointment would improve access to AUD pharmacotherapy for patients in the IOP. Results A total of 43 patients were enrolled in the IOP during the study. Of these, 27 patients presented with a primary diagnosis of AUD, and only eight were receiving AUD pharmacotherapy at the start of the program. During this intervention, 11 patients expressed interest in initiating a medication for AUD while in the IOP. The average wait time for a medication evaluation appointment with the CPS was 1.4 days. By comparison, the average wait time for an addiction psychiatrist was approximately 44 days. Each patient was seen for an average of two 30-minute visits, including an initial medication evaluation and one follow-up. Upon completion of CPS services, patients were referred almost equally to an established non-addiction recovery services (ARS) mental health provider (36%), an ARS psychiatrist (36%), or a primary care provider (28%). Conclusion Our study highlights the role that pharmacists can play in improving access to evidence-based AUD pharmacotherapy, as well as in providing medication education to patients and providers. Long-term prospective research and pharmacoeconomic analysis are needed to determine the sustainability of this service, both at our facility and in other similar practice settings.

Objective: Many studies have confirmed the efficacy of cognitive behavioral therapy (CBT) as a treatment for depression. However, the mechanism of CBT for depression reduction is still not well understood. This study explored the mechanism of CBT from the perspective of individuals’ problem-solving appraisal. Method: A one-group pretestposttest design was used. Results were based on the responses of 30 depressed individuals in an intensive outpatient program. Results: Findings supported the research hypothesis that the more individuals improved their problem-solving appraisal, the more their depression decreased. Additionally, it was discovered that the poorer individuals’ problem-solving appraisal before the CBT, the more improvement they had on depression and problem solving appraisal after the CBT. Conclusions: In sum, findings suggested that problem-solving appraisal might play an important part in CBT for depression reduction. Furthermore, CBT seemed to have a ceiling effect on improving individuals’ problem-solving appraisal.