Title: Reward Hypersensitivity in the Onset and Course of Bipolar Spectrum Disorders
Level: Basic
Presenters: Lauren B. Alloy, Ph.D., Temple University
The reward hypersensitivity theory suggests that risk for bipolar spectrum disorders involves a hypersensitivity to goal- and reward-relevant stimuli. This hypersensitivity can lead to excessive reward motivation and approach-related affect and behavior in response to life events involving rewards or goal striving and attainment, which, in turn, lead to hypomanic/manic symptoms. Conversely, reward hypersensitivity can also lead to an excessive decrease in behavioral approach in response to nonattainment of goals or rewards (e.g., definite failures), which, in turn, leads to depressive symptoms. Thus, the proposed vulnerability to bipolar spectrum disorders in this model is a propensity toward excessive reward system activation and deactivation. In this presentation, I will present evidence that reward hypersensitivity (assessed by self-report, behavioral task, cognitive style, EEG, or neuroimaging), alone or in combination with reward-relevant life events, predicts first onset of bipolar spectrum disorders, mood episode recurrence, polarity, and timing, and progression to more severe diagnoses on the spectrum. I also will address the paradox of why bipolar spectrum disorders are associated both with high achievement and great impairment. Finally, I will consider implications of the reward hypersensitivity model for early identification and intervention for individuals at risk for bipolar disorders.
You Will Learn:
Theory and conceptualization of the Behavioral Approach System (BAS)/reward system.
Multiple methods of assessing the BAS/reward system.
Role of the BAS/reward system in bipolar disorder onset and course.
Recommended Readings:
Alloy, L.B., & Abramson, L.Y. (2010). The role of the Behavioral Approach System (BAS) in bipolar spectrum disorders. Current Directions in Psychological Science, 19, 189-194.
Alloy, L.B., Bender, R.E., Whitehouse, W.G., Wagner, C.A., Liu, R.T., Grant, D.A., Abramson, L.Y. (2012). High Behavioral Approach System (BAS) sensitivity, reward responsiveness, and goal-striving predict first onset of bipolar spectrum disorders: A prospective behavioral high-risk design. Journal of Abnormal Psychology, 121, 339-351.
Johnson, S.L., Edge, M.D., Holmes, M.K., & Carver, C.S. (2012). The behavioral activation system and mania. Annual Review of Clinical Psychology, 8, 243-267.
Urosevic, S., Abramson, L.Y., Harmon-Jones, E., & Alloy, L.B. (2008). Dysregulation of the behavioral approach system (BAS) in bipolar spectrum disorders: Review of theory and evidence. Clinical Psychology Review, 28, 1188-1205.
Title: Developing and Disseminating Effective Psychological Therapies for Anxiety Disorders: Science, Economics, and Politics
Level: Basic
Presenters: David M. Clark, Ph.D., University of Oxford
It is often argued that the cognitive-behavior therapy (CBT) movement has been particularly successful in developing new and effective treatments because it has fostered a close interplay between theory, experimental psychopathology, and treatment development. This talk will illustrate the interplay using the example of cognitive therapy for social anxiety disorder before moving on to discuss one of the world's largest attempts to disseminate CBT and other evidence-based psychological therapies to the general public. The English Improving Access to Psychological Therapies (IAPT) initiative aims to vastly increase the availability of psychological treatments for anxiety disorders and depression by training an extra 6,000 psychological therapists and deploying them in new, stepped-care services. Outcomes are assessed with a session-by-session monitoring system that achieves unusually high levels of data completeness. Over 750,000 adults per year are currently being seen in IAPT services. The background to the initiative, the scientific and economic arguments on which it is based, the training and clinical service models, a summary of progress to date, new developments (such as extension of the program to children), and future challenges will be described. Possible implications for dissemination of psychological therapies in other parts of the world will be considered.
You Will Learn:
To illustrate the close interplay between experimental psychopathology and treatment development.
To demonstrate the importance of high levels of data completeness for evaluating routine services.
To show how science, economics, and politics can combine to improve mental health care systems.
Recommended Readings:
Clark, D.M. (2005). A cognitive perspective on social phobia. In R. Crozier & L. Alden (Eds.), The essential handbook of social anxiety for clinicians. Chichester: Wiley.
Clark, D.M. (2011). Implementing NICE Guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience. International Review of Psychiatry, 23, 375-384.
Gyani, A., Shafran, R., Layard, R., & Clark, D.M. (2013). Enhancing recovery rates: Lessons from year one of IAPT. Behaviour Research and Therapy, 51, 597- 606.
Layard, R., & Clark, D.M. (2014). Thrive: The power of evidence-based psychological therapies. London: Penguin Press.
Title: Treatment of Phobic and Anxiety Disorders in Children and Adolescents: Where to From Here?
Level: Basic
Presenters: Thomas H. Ollendick, Ph.D., Virginia Polytechnic Institute and State University
Although CBT has been found to be effective in treating phobias and youth anxiety disorders and enjoys evidence-based status, as many as 25% to 40% of youth with these disorders do not respond to cognitive-behavioral interventions. In this address, new and exciting developments will be reviewed that show promise for addressing some of these treatment nonresponders. Innovations including virtual reality interventions, attention retraining strategies, and intensive and augmented treatment modalities will be highlighted. Moderators and mediators of treatment outcomes will also be explored in an attempt to highlight advances beyond generic treatment outcomes. In addition, it will be argued that some nonresponders or difficult-to-treat youth will require interventions that benefit from an idiographic approach to case formulation and treatment. In many respects, this approach invites us to return to our roots in behavior therapy and clinical science. This idiographic approach will be illustrated in the treatment of nonresponders to evidence-based treatments using controlled single-case design methodologies. Implications for these findings and intervention science will be highlighted.
You Will Learn:
Up-to-date information about major child and adolescent phobic and anxiety disorders.
Evidence-based psychosocial interventions for these disorders and how to evaluate them.
Moderators and mediators of change for these interventions.
Recommended Readings:
Essau, C. A., & Ollendick, T. H. (Eds.). (2013). The Wiley Blackwell handbook of the treatment of childhood and adolescent anxiety. Chichester: John Wiley & Sons.
Grills-Taquechel, A. E., & Ollendick, T. H. (2012). Phobic and anxiety disorders in youth. Cambridge, MA: Hogrefe & Huber.
Ollendick, T. H. (2014). Advances toward evidence-based practice: Where to from here? Behavior Therapy, 45, 51-55.
Ollendick, T. H., & Davis, III, T. E. (2013). One-session treatment for specific phobias: A review of Öst's single-session exposure with children and adolescents. Cognitive Behaviour Therapy, 42, 275-283.
Ollendick, T. H., & King, N. J. (2012). Evidence-based treatments for children and adolescents: Issues and controversies. In P.C. Kendall (Ed.), Child and adolescent therapy: Cognitive-behavioral procedures (pp. 499-519). New York: Guilford Press.
Title: Mechanisms of Fear Control
Level: Basic
Presenters: Elizabeth A. Phelps, Ph.D., New York University
Building on research from animal models of associative fear learning, this presentation will explore a range of means by which fear can be diminished in humans. First, I will examine how extinction and emotion regulation, techniques adapted in cognitive behavioral therapy, can be used to control fear via inhibitory signals from the ventromedial prefrontal cortex to the amygdala. One drawback of these techniques is that fears are only inhibited and can return, with one factor being stress. I will then describe two novel behavioral techniques that might result in a more lasting fear reduction, the first by providing control over stressor and the second by substituting a novel, neutral cue for the aversive unconditioned stimulus. Finally, I will review research examining more lasting fear control by targeting memory reconsolidation. I will present evidence suggesting that the behavioral interference of reconsolidation in humans persistently inhibits fear and diminishes involvement of the prefrontal cortex inhibitory circuitry.
Title: Embracing the Repulsive: The Case for Disgust as a Functionally Central Emotional State in the Theory, Practice, and Dissemination of Cognitive-Behavioral Therapy
Level: Basic
Presenters: Dean McKay, Ph.D., ABPP, Fordham University
While disgust-evoking stimuli are ubiquitous, human responses to avoid experiencing intense disgust, and its associated pervasive feeling of contamination, have become fine-tuned and spontaneous to the extent that this emotion inexorably and insidiously interweaves with a vast range of situations in daily life. It is therefore surprising that research on disgust has lagged far behind that of other emotional states (e.g., anxiety).
Here is what we know about disgust: it can be validly assessed via psychophysiological and self-report methods; it is involved in some specific phobic reactions, for some manifestations of obsessive-compulsive disorder, and a select subset of other conditions; and may be responsive to exposure-based therapies. This is only the tip of the iceberg. Higher-order dimensions of disgust (i.e., animal-reminder, moral) have been found to be involved in complex anxiety reactions and more general psychopathological states. Moreover, recent theoretical conceptualizations strongly suggest that moral dimensions of disgust may figure prominently in the often puzzling reluctance of some therapists to incorporate specific empirically supported treatments adequately, if at all, into practice. This presentation will highlight the myriad ways in which disgust is involved in psychopathology, and what measures may be taken to alleviate these reactions. This presentation will also highlight the many layers of personal and professional barriers involved in pursuing a research agenda focused on disgust as a framework for discussing relevant present and future challenges facing the field of cognitive-behavior therapy in general.
The reward hypersensitivity theory suggests that risk for bipolar spectrum disorders involves a hypersensitivity to goal- and reward-relevant stimuli. This hypersensitivity can lead to excessive reward motivation and approach-related affect and behavior in response to life events involving rewards or goal striving and attainment, which, in turn, lead to hypomanic/manic symptoms. Conversely, reward hypersensitivity can also lead to an excessive decrease in behavioral approach in response to nonattainment of goals or rewards (e.g., definite failures), which, in turn, leads to depressive symptoms. Thus, the proposed vulnerability to bipolar spectrum disorders in this model is a propensity toward excessive reward system activation and deactivation. In this presentation, I will present evidence that reward hypersensitivity (assessed by self-report, behavioral task, cognitive style, EEG, or neuroimaging), alone or in combination with reward-relevant life events, predicts first onset of bipolar spectrum disorders, mood episode recurrence, polarity, and timing, and progression to more severe diagnoses on the spectrum. I also will address the paradox of why bipolar spectrum disorders are associated both with high achievement and great impairment. Finally, I will consider implications of the reward hypersensitivity model for early identification and intervention for individuals at risk for bipolar disorders.
It is often argued that the cognitive-behavior therapy (CBT) movement has been particularly successful in developing new and effective treatments because it has fostered a close interplay between theory, experimental psychopathology, and treatment development. This talk will illustrate the interplay using the example of cognitive therapy for social anxiety disorder before moving on to discuss one of the world's largest attempts to disseminate CBT and other evidence-based psychological therapies to the general public. The English Improving Access to Psychological Therapies (IAPT) initiative aims to vastly increase the availability of psychological treatments for anxiety disorders and depression by training an extra 6,000 psychological therapists and deploying them in new, stepped-care services. Outcomes are assessed with a session-by-session monitoring system that achieves unusually high levels of data completeness. Over 750,000 adults per year are currently being seen in IAPT services. The background to the initiative, the scientific and economic arguments on which it is based, the training and clinical service models, a summary of progress to date, new developments (such as extension of the program to children), and future challenges will be described. Possible implications for dissemination of psychological therapies in other parts of the world will be considered.
Although CBT has been found to be effective in treating phobias and youth anxiety disorders and enjoys evidence-based status, as many as 25% to 40% of youth with these disorders do not respond to cognitive-behavioral interventions. In this address, new and exciting developments will be reviewed that show promise for addressing some of these treatment nonresponders. Innovations including virtual reality interventions, attention retraining strategies, and intensive and augmented treatment modalities will be highlighted. Moderators and mediators of treatment outcomes will also be explored in an attempt to highlight advances beyond generic treatment outcomes. In addition, it will be argued that some nonresponders or difficult-to-treat youth will require interventions that benefit from an idiographic approach to case formulation and treatment. In many respects, this approach invites us to return to our roots in behavior therapy and clinical science. This idiographic approach will be illustrated in the treatment of nonresponders to evidence-based treatments using controlled single-case design methodologies. Implications for these findings and intervention science will be highlighted.
Building on research from animal models of associative fear learning, this presentation will explore a range of means by which fear can be diminished in humans. First, I will examine how extinction and emotion regulation, techniques adapted in cognitive behavioral therapy, can be used to control fear via inhibitory signals from the ventromedial prefrontal cortex to the amygdala. One drawback of these techniques is that fears are only inhibited and can return, with one factor being stress. I will then describe two novel behavioral techniques that might result in a more lasting fear reduction, the first by providing control over stressor and the second by substituting a novel, neutral cue for the aversive unconditioned stimulus. Finally, I will review research examining more lasting fear control by targeting memory reconsolidation. I will present evidence suggesting that the behavioral interference of reconsolidation in humans persistently inhibits fear and diminishes involvement of the prefrontal cortex inhibitory circuitry.
While disgust-evoking stimuli are ubiquitous, human responses to avoid experiencing intense disgust, and its associated pervasive feeling of contamination, have become fine-tuned and spontaneous to the extent that this emotion inexorably and insidiously interweaves with a vast range of situations in daily life. It is therefore surprising that research on disgust has lagged far behind that of other emotional states (e.g., anxiety).