CBT and ABCT: Continuing the Progress Reflected in a Short and Remarkable Past
Robert K. Klepac, University of Texas Health Science Center-San Antonio
Because ABCT and cognitive and behavioral therapies in general have clearly come of age, it is easy to overlook the factors and struggles that brought us to a level of national prominence in less than 50 years. Three of the factors that will support similar progress in the coming five decades include: (a) incorporating critical lessons from our past; (b) pursuing dissemination of what we know within our professions and beyond; and (c) appropriately expanding the scope of applications of principles of cognitive and behavioral approaches. Central among the several lessons described are the continued development and adherence to a strong scientific base and a focus on principles of behavior maintenance and change. Development of dissemination strategies is critical. Expanding our scope to exciting and needed applications will serve the profession and those we care for well, but focus must be on further development of our strengths rather than plunges into areas that are discontinuous with our traditions and knowledge bases.
Dr. Klepac received his bachelor's degree from John Carroll University in 1965, and his Ph.D. from Kent State University in 1969. He has served on faculties of Western Washington University, North Dakota State University (Department Chair), and Florida State University (Director of Clinical Training), Director of Psychology Training at Wilford Hall Medical Center, and National Coordinator of Air Force Psychology Training. He is currently Psychology Training Director Emeritus at Wilford Hall, and Research Associate Professor at the University of Texas Health Science Center - San Antonio. Professional service positions include: Chair, APPIC Board of Directors; member, APA Committee on Accreditation; president, Society for a Science of Clinical Psychology; President, Behavioral Psychology Specialty Council; President, Clinical Psychology Specialty Council; and Treasurer of the Society of Clinical Psychology. He has received several awards, including a career achievement award from the National Register, Distinguished Alumnus in Psychology from John Carroll University, Award for Outstanding Service to ABCT, and APPIC Award for outstanding contributions to internship training in psychology. The training programs he led received the ABCT Outstanding Training Program Award. He has published and received grant support for his research on behavioral aspects of dentistry, and behavioral approaches to pain, fear, and avoidance of medical and dental procedures.
Key words: ABCT; Dissemination; Expansion of Scope
Is There the Courage to Change the American Diet?
Kelly D. Brownell, Yale University
Food affects our emotional and physical lives in a great many ways. Beyond clinical problems such as anorexia, bulimia, binge eating, and obesity, decisions people make about food affect their day-to-day lives, not to mention global issues ranging from health care expenses to climate change created in part by modern agriculture. There is a balance to be struck between educating/imploring people to change one at a time versus changing policies that create better food environments for people millions at a time. This talk will cover some controversial approaches to issues such as food and addiction, food marketing directed at children, and policies such as taxes on sugared beverages. The roles we play as professionals, members of the community, parents, and advocates can be significant. The role of strategic as opposed to programmatic science will be emphasized.
You will learn
- The concept of optimal defaults
- To identify environmental contributors to obesity
- Public policy possibilities for improving the nation's diet
Kelly Brownell, Ph.D., is Professor of Psychology at Yale University, where he also serves as Professor of Epidemiology and Public Health and as Director of the Rudd Center for Food Policy and Obesity. In 2006 Time magazine listed Kelly Brownell among "The World's 100 Most Influential People" in its special Time 100 issue featuring those "… whose power, talent or moral example is transforming the world."
Dr. Brownell was elected to membership in the Institute of Medicine in 2006 and served as President of several national organizations, including the Society of Behavioral Medicine, Association for Behavioral and Cognitive Therapies, and the Division of Health Psychology of the American Psychological Association. He has received numerous awards and honors for his work, including the Graduate Mentoring Award from Yale, the James McKeen Cattell Award from the New York Academy of Sciences, the award for Outstanding Contribution to Health Psychology from the American Psychological Association, the Distinguished Alumni Award from Purdue University, and the Lifetime Achievement Award from Rutgers University. He has served in a number of leadership roles at Yale, including Master of Silliman College and Chair of the Department of Psychology from 2003-2006.
He has published 14 books and more than 300 scientific articles and chapters. One book received the Choice Award for Outstanding Academic Book from the American Library Association, and his paper on "Understanding and Preventing Relapse" published in the American Psychologist was listed as one of the most frequently cited papers in psychology.
Dr. Brownell has advised the White House, members of congress, governors, world health and nutrition organizations, and media leaders on issues of nutrition, obesity, and public policy. He was cited as a "moral entrepreneur" with special influence on public discourse in a history of the obesity field and was cited by Time magazine as a leading "warrior" in the area of nutrition and public policy.
Key Words: Obesity, Policy, Strategic Science
Optimizing Exposure Therapy: Translation From Neuroscience of Fear Learning
Michelle G. Craske, UCLA
The therapeutic strategy of repeated exposure to fear-producing stimuli is highly effective for fears and anxiety disorders, but a substantial number of individuals fail to respond. Translation from the basic science of fear extinction offers strategies for increasing response rates to exposure therapy. Inhibitory associative learning and inhibitory neural regulation are central to fear extinction and yet individuals with anxiety disorders show deficits in inhibitory learning/regulation. Thus, there is a need for strategies to augment inhibitory learning/regulation during exposure therapy. The formation of inhibitory learning/regulation is enhanced by exposure exercises that violate explicit expectancies (vs fear habituation), exposure to multiple feared stimuli, and augmentation with affect labeling (vs cognitive reappraisal). The retrieval of inhibitory learning/regulation is enhanced by variability, progressive spacing between exposure trials, retrieval cues, and pharmacological agents for offsetting context renewal. Evidence for each of these pathways and future directions will be discussed.
You will learn
- Mechanisms of exposure therapy
- Neuroscience of exposure therapy
- Methods of optimizing learning during exposure therapy
Michelle G. Craske received her B.A. from the University of Tasmania and her Ph.D. from the University of British Columbia. She has published extensively in the area of fear and anxiety disorders. In addition to many research articles, she has written academic books on the topics of the etiology and treatment of anxiety disorders, gender differences in anxiety, translation from the basic science of fear learning to the understanding and treating phobias, and principles and practice of cognitive behavioral therapy, as well as several self-help books and therapist guides. In addition, she has been the recipient of National Institute of Mental Health funding since 1993 for research projects pertaining to risk factors for anxiety disorders and depression among children and adolescents, the cognitive and physiological aspects of anxiety and panic attacks, neural mediators of behavioral treatments for anxiety disorders, fear extinction mechanisms of exposure therapy, and the development and dissemination of treatments for anxiety and related disorders. She was associate editor for the Journal of Abnormal Psychology, and is presently associate editor for Behaviour Research and Therapy as well as a scientific board member for the Anxiety Disorders Association of America. She was a member of the DSM-IV Anxiety Disorders Work Group and is now a member of the DSM-5 Anxiety, Obsessive Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Work Group, and Chair of the Anxiety Disorders Subworkgroup. She is also a member of the APA Clinical Treatment Guidelines Advisory Steering Committee. Dr. Craske has given invited keynote addresses at many international conferences and frequently is invited to present training workshops on the most recent advances in the cognitive-behavioral treatment for anxiety disorders. She is currently a professor in the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, UCLA, and director of the UCLA Anxiety Disorders Research Center.
Key Words: Exposure; Anxiety; Neuroscience
Novel Models for Delivering Mental Health Services and Reducing the Burdens of Mental Illness
Alan E. Kazdin, Yale University
Within the United States but also worldwide, the large majority of children, adolescents, and adults in need of psychological services do not receive them. Improved epidemiological data on the scope and burden of mental illness, recognition that mental illness plays a critical role in physical health, and the remarkable gains in identifying evidence-based psychosocial treatments (EBTs) have made the limited impact of current treatments more salient. A key obstacle in providing services is the model of delivery to which most EBTs are wedded, namely, individualized treatment administered by a mental health professional. Multiple models of delivery (e.g., task shifting, disruptive innovations, and others) from medicine, public health, business and industry, and other disciplines provide potential remedies. The major characteristic of models selected for this presentation is that they have the ability to be scaled up to reach those in need and in a broad range of settings and circumstances. The presentation illustrates several models that can make a difference in reducing the burdens of mental illness. Novel models also raise novel challenges, shift treatment research priorities, convey that evidence based is necessary but not sufficient, and have broad implications for traditional and accredited training and clinical care.
You will learn
- To identify the strengths and limitations of current evidence-based treatments in addressing the burdens of mental illness
- Novel models of delivering services emanating from other disciplines (e.g., public health, medicine, business)
- Critical challenges and research priorities that could greatly increase the impact of our research on clinical care
Alan E. Kazdin, Ph.D., ABPP, is the John M. Musser Professor of Psychology and Child Psychiatry at Yale University and Director of the Yale Parenting Center, an outpatient treatment service for children and families. At Yale, he has been Chairman of the Psychology Department, Director of the Yale Child Study Center at the School of Medicine, and Director of Child Psychiatric Services at Yale-New Haven Hospital. Kazdin's research has focused primarily on the treatment of aggressive and antisocial behavior in children referred for inpatient and outpatient care. His approximately 700 publications include 48 books that focus on interventions for children and adolescents, cognitive-behavioral treatment, parenting and child rearing, interpersonal violence, and research methodology. His work on parenting and child rearing has been featured on NPR, PBS, CNN, the BBC, and he has appeared on the Today Show, Good Morning America, ABC News, 20/20, and Dr. Phil. His awards include the Outstanding Research Contribution by an Individual and Lifetime Contribution Awards (ABCT), Outstanding Lifetime Contributions to Psychology and Distinguished Scientific Award for the Applications of Psychology (American Psychological Association), and the James McKeen Cattell Award (Association for Psychological Science). Currently he is Editor of Clinical Psychological Science, a journal of the Association for Psychological Science. He is a Past-President of ABCT and the American Psychological Association.
Key Words: Treatment Delivery Models
Psychotherapy Services for Veterans: Implementing Individual Evidence-Based Psychotherapy in Interdisciplinary VA Mental Health Care
Antonette Zeiss, Department of Veterans Affairs Central Office
The Department of Veterans Affairs provides health care to over 6 million veterans, and almost 1.5 million of those veterans receive mental health care along with care for other health problems. VA employs over 20,500 mental health providers, with that number continuing to rise. This presentation will review VA's comprehensive mental health care, as well as care to promote health and prevent disease, with an emphasis on transformational changes in care since 2005 that are still ongoing. The role of interdisciplinary teams as the organizing force for overall care, both in primary care (and other medical settings) and in specialty mental health, will be described. In all of these settings, VA is increasing the delivery of evidence-based psychotherapies for mental and physical health problems, such as PTSD, depression, insomnia, and chronic pain. This presentation will review the full list of therapies offered, in the context of the development of Clinical Practice Guidelines, which guide identification of appropriate therapies for training. It also will cover efforts to train VA mental health staff to deliver these therapies with fidelity and to ensure their increasing availability throughout the VA health care system, along with information on challenges faced, lessons learned, and next steps to continue this transformation.
You will learn
- Define the key structural and process elements of interdisciplinary health care teams
- Define how evidence-based interventions can be delivered by an interdisciplinary team member and serve general health and mental health needs
- Understand the ongoing transformation of VA health care, including utilization of evidence-based therapies defined by clinical practice guidelines
Dr. Antonette Zeiss became the Chief Consultant for Mental Health at the Central Office of the Department of Veterans Affairs (VA) in 2011. She completed her Ph.D. in Clinical Psychology at the University of Oregon in 1977; she has worked in VA since 1982 after working as a faculty member at Arizona State University and Stanford University. Her previous VA positions were at the VA Palo Alto Health Care System, until coming to VACO in September 2005 as the Deputy Chief Consultant for the Office of Mental Health Services. Among her major responsibilities are developing policies to guide model mental health delivery in VA and to support effective implementation of the VA Uniform Mental Health Services in VA Medical Centers and Clinics Handbook, thus enhancing and transforming VA mental health services. She has published extensively, particularly on mental health policy and training, on interdisciplinary teams and health care service delivery, and on depression treatment and risk factors. She has held leadership roles in several professional organizations and has received numerous awards throughout her career. She served as President of AABT (now ABCT) in 1996-97. Most recently, she received a United States Presidential Rank Award, Meritorious, for her service as a government senior executive and a Lifetime Achievement Award from the Association for Behavioral and Cognitive Therapies.
Key Words: Psychotherapy; Interdisciplinary; Evidence-based
