The idea of lacking control over oneself and acting against one's better judgment has long been contemplated as a source of human suffering, dating back as far as Plato (see Plato's Protagoras, 380 BCE). Yet, what are the consequences for a person who habitually engages in self-control-against their better judgment? The problem is not a lack of control-it is an excess! Excessive self-control or overcontrol is associated with social isolation and difficult-to-treat mental health problems such as anorexia nervosa, chronic depression, and obsessive-compulsive personality disorder. The aim of this Clinical Intervention Training is to provide an overview of a transdiagnostic treatment for disorders of overcontrol known as Radically Open-Dialectical Behavior Therapy (RO-DBT; treatment manual in press).
RO-DBT is supported by 20+ years of translational research; including two NIMH-funded randomized controlled trials with refractory depression (RCTs), two open-trials targeting adult anorexia nervosa, one nonrandomized trial targeting treatment-resistant overcontrolled adults, and an ongoing multicenter RCT (www.reframed.org.uk). Interventions are informed by a neurobiosocial theory linking current brain-behavioral science to the development of close social bonds and altruistic behaviors. Participants will learn novel strategies designed to assess overcontrolled problems, enhance self-enquiry, relax inhibitory control via activation of differing neural substrates, repair alliance-ruptures, and increase social connectedness using slides, handouts, video clips, and role-plays.
You will learn:
1. The neurobiosocial theory underlying RO-DBT and link this to new skills designed to activate a neural substrate linked to social-safety.
2. The core clinical assessment issues for overcontrolled problems and demonstrate how to integrate the RO-DBT overcontrolled screening questionnaire into clinical practice.
3. The RO-DBT protocol for repairing alliance ruptures and use novel nonverbal social-signaling and heat-on/heat-off strategies to enhance client engagement.
4. Novel RO-DBT mindfulness strategies linked to "outing oneself," passionate participation, and self-enquiry that facilitate receptivity, learning, and social connectedness.
5. RO-DBT forgiveness skills-Flexible-Mind has HEART designed to facilitate letting-go of useless anger, resentment, and desires for revenge.
Recommended Readings:
Lynch, T.R., Gray, K.L.H., Hempel, R.J., Titley, M., Chen, E.Y., O'Mahen, H.A. (2013) Radically Open-Dialectical Behavior Therapy for adult Anorexia Nervosa: Feasibility and outcomes from an inpatient program. BMC Psychiatry, 13, 293. Lynch, T.R., Hempel, R.J., & Dunkley, C. (in press). Radically Open-Dialectical Behavior Therapy for Disorders of Overcontrol: Remembering our tribal nature. American Journal of Psychotherapy. Lynch, T.R., Lazarus, S., & Cheavens, J.S. (2014). Mindfulness interventions for undercontrolled and overcontrolled disorders. In K. Brown, D. Creswell, & R. Ryan (Eds.), Handbook of mindfulness: Theory and research. New York: Guilford Press. Schneider, K.S., Hempel, R. J., & Lynch, T. R. (2013). That "poker face" just might lose you the game! The impact of expressive suppression and mimicry on sensitivity to facial expressions of emotion. Emotion, 13, 852-866.
Couple Interventions for Adult Psychopathology in the Context of Relationship Distress
Donald H. Baucom, University of North Carolina at Chapel Hill (assisted by Melanie S. Fischer, University of North Carolina at Chapel Hill)
Basic level of familiarity with the material
Primary Topic: Couples/Marital/Family
Key Words: Couple Therapy, Couple-Based Interventions, Couples and Psychopathology
Cognitive-behavioral couple therapy (CBCT) is a highly efficacious approach for assisting couples experiencing relationship distress. In many instances, assisting these couples is complicated by one or both partners also experiencing individual psychological difficulties, for example, depression or anxiety disorders. Focusing on how to address both individual psychopathology and relationship distress while working with the couple conjointly, this training will demonstrate how to integrate (a) efficacious intervention principles from individual therapy into a couple treatment format, along with (b) well-established CBCT interventions for treating relationship distress. Participants will learn three different approaches to treating psychopathology in a couple context and how these three approaches can be combined to provide optimal intervention for complex cases. Using anxiety disorders and depression as examples, videotapes and live role-plays will illustrate these techniques. Clear principles for developing treatment plans for specific couples will be presented so that the therapist can develop couple-based interventions for numerous types of psychopathology, in addition to depression and anxiety.
You will learn:
1. The difference between couple therapy and couple-based interventions for psychopathology.
2. Principles for deciding whether to treat psychopathology in a couple versus individual treatment format.
3. How to integrate individual therapy principles into a couple treatment.
4. How to develop couple-based interventions that use the partner as a resource in treating psychopathology.
5. Understand how to sequence interventions focusing on relationship distress versus individual psychopathology.
Recommended Readings:
Abramowitz, J. S., Baucom, D. H., Wheaton, M. G., Boeding, S., Fabricant, L. E., Paprocki, C., & Fischer, M. S. (2013). Enhancing exposure and response prevention for OCD: A couple-based approach. Behavior Modification, 37, 189-210. Doi: 10.1177/0145445512444596. Baucom, D.H., Belus, J., Adelman, C.B., Fischer, M.S., & Paprocki, C. (in press). Couple-based interventions for psychopathology: A renewed direction for the field. Family Process. Baucom, D.H., Whisman, M.A., & Paprocki, C. (2012). Couple-based interventions for psychopathology. Journal of Family Therapy, 34(3), 250-270. Fischer, M. S., Kirby, J. S., Raney, T. J., Baucom, D. H., & Bulik, C. M. (in press). Integrating couple-based interventions into the treatment of adult anorexia nervosa: A case example of UCAN. In H. Thompson-Brenner (Ed.), Casebook of evidence-based therapy for eating disorders. New York: Guilford.
This Clinical Intervention Training will describe the "enhanced" cognitive behavioral approach (CBT-E) to the treatment of the full range of eating disorders seen in clinical practice (including anorexia nervosa, bulimia nervosa, binge eating disorder, and the various forms of atypical eating disorder). Starting with a brief and up-to-date account of the empirical standing of the treatment, the remainder of the session will focus on the implementation of the treatment from assessment through to its completion. Dr. Fairburn will discuss when to use the "focused" and "broad" versions of the treatment, and how the treatment is adapted for young patients and those who are underweight. The workshop will close with a discussion of how to learn the treatment and implement it well. This training will be suitable for all those who work with people with eating disorders, including those who work with young people. Participants will be provided with a detailed handout.
You will learn:
1. The stages/treatment map of CBT-E.
2. To describe and critique the research on CBT-E.
3. The focused and broad versions of CBT-E.
4. How CBT-E is adapted for young patients and those who are underweight.
Recommended Readings:
Dalle Grave, R., Calugi, S., Doll, H. A., & Fairburn, C. (2013). Enhanced cognitive behaviour therapy for adolescents with anorexia nervosa: An alternative to family therapy? Behaviour Research and Therapy, 51, R9-R12. Fairburn, C. (2008). Cognitive behavior therapy and eating disorders. New York: Guilford Press. Fairburn, C., Cooper, Z., Doll, H., O'Connor, M., Bohn, K., Hawker, D., … Palmer RL. (2009). Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up. American Journal of Psychiatry, 166, 311-319. Fairburn, C. G., Cooper, Z., Doll, H. A., O'Connor, M. E., Palmer, R. L., & Dalle Grave, R. (2013). Enhanced cognitive behaviour therapy for adults with anorexia nervosa: A UK-Italy study. Behaviour Research and Therapy, 51, R2-8.
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