TICKETED SESSIONS | Institutes

This Institute includes a refresher on Motivational Interviewing (MI) approaches and skills, an update on definitional and conceptual changes to MI with the publication of the third edition of the classic text in 2013, and a focus on integrating MI with CBT in practice. Conceptual bases for this integration will be provided, with a specific focus on various ways in which both these evidence-based approaches can be utilized, including: (a) MI as a prelude to CBT, (b) "Motivational Interactions" throughout the course of CBT, (c) using MI to introduce, implement, and continue challenging aspects of CBT (e.g., exposure treatment), and (d) employing MI to consolidate CBT gains, to promote relapse prevention, and to maintain behavior change. Designed for professionals and trainees with prior experience using MI, this Institute will cover intermediate and advanced methods to assist clients with behavior change, by developing and practicing of new skills. Using demonstrations, role-play, film, and clinical case examples from the presenter's practice, the application of new methods to increase and sustain client motivation in CBT will be discussed. Practice in evoking "change talk" (in contrast to "sustain talk" and avoidance) in sessions will be covered, along with applying MI at critical junctures in CBT. This Institute involves a trainer who is a member of the Motivational Interviewing Network of Trainers, and will involve experiential components in which participants work with one another in dyads and groups, and with the trainer, to polish skills in a comfortable, interactive, supportive, and enjoyable learning environment.

You Will Learn:

• 1. To integrate MI with various CBT approaches.
• 2. To recognize and utilize newly articulated MI processes in the context of CBT.
• 3. To plan for use of MI at critical junctures in CBT interventions.
• 4. To employ methods for eliciting MI change talk in clients in the context of CBT.
• 5. To apply key MI processes to increase client motivation for behavior change within ongoing CBT treatments.

Recommended Readings:

Arkowitz, H., Westra, H. A., Miller, W. R., & Rollnick, S. (2008). Motivational Interviewing in the treatment of psychological problems. New York: Guilford. Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping people change (3rd ed.). New York: Guilford. Rosengren, D. B. (2009). Building Motivational Interviewing skills: A practitioner workbook. New York: Guilford. Westra, H. A., & Arkowitz, H. (2011). Integrating Motivational Interviewing with Cognitive Behavioral Therapy for a range of mental health problems [Special series]. Cognitive & Behavioral Practice, 18, 1-81.

The purpose of this Institute is to provide attendees the basics of cognitive processing therapy-cognitive only (CPT-C). CPT is an evidence-based cognitive therapy for PTSD and comorbid symptoms that can be implemented without a written account. Clinicians may be more comfortable with providing the version of CPT that does require writing and reading a trauma account or may have been in the habit of doing so and are unsure of how to conduct the protocol without the written narrative. This cognitive-only version has been shown to lead to faster improvements in PTSD symptoms within treatment. CPT-C is a systematic approach to treating PTSD in which participants are encouraged to feel their emotions and learn to think about their traumatic events differently. This session includes a functional cognitive description of why some people do not recover after traumatization. Following a review of research on CPT-C, participants will receive an overview of the 12-session therapy, session by session. The use of Socratic dialogue to facilitate emotional processing will be reviewed, along with research regarding who may respond better to treatment with or without a trauma narrative. Specific trauma details will be discussed and presented in video-recorded sessions. Role-play and consultation will be included.

You Will Learn:

• 1. To apply the cognitive theory underlying CPT-C to individual case conceptualization.
• 2. To assess the appropriateness of clients for CPT-C.
• 3. To shape stuck points into more workable thoughts for intervention.
• 4. To apply Socratic dialogue in practice.
• 5. To draw out the natural emotions from the trauma in the absence of a written account.

Recommended Readings:

Bass, J.K., Annan, J., McIvor Murray, S., Kaysen, D., Griffiths, S., Cetinoglu, T., . . . Bolton, P. A. (2013). Controlled trial of psychotherapy for Congolese survivors of sexual violence. The New England Journal of Medicine, 368(23), 2182-2191. Resick, P. A., Galovski, T.E., Uhlmansiek, M.O., Scher, C.D., Clum, G.A., & Young-Xu, Y. (2008). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76, 243-258. Resick, P. A., Monson, C.M., & Chard, K.M. (2007, revised in 2008, 2010, 2014). Cognitive Processing Therapy Veteran/Military version: Therapist's Manual. Washington, DC: Department of Veterans' Affairs. (Please email patricia.resick@duke.edu for a PDF copy.)

A defining feature of ACT is the use of present-moment/mindfulness-based interventions to counteract the corrosive effects of emotional avoidance and cognitive fusion. Despite the central role of present-moment interventions in ACT, the defining features of such interventions are elusive and poorly understood by most clinicians. This Institute will expose attendees to a neuroclinical model of present-moment intervention that is strongly supported by both mindfulness and neuroscience research. This approach holds that learning to pay attention to painful private experience in a focused, nonreactive way is a skill that must be cultivated in order to achieve lasting change. Attendees will learn the three defining attributes of flexible attention and how to recognize them during therapy. We will both describe and demonstrate the five sequential phases of present-moment awareness interventions: noticing what has showed up, naming what is in awareness, letting go of attachments, softening in the face of self-loathing and expanding beyond the pain of the moment. Case examples and live role-play demonstrations will be used to highlight core clinical principles and strategies within each phase. Participants will also have an opportunity to conduct a self-assessment of their present-moment awareness skills and "escape macros."

You Will Learn:

• 1. The mindfulness and neuroscience basis of deficits in attention and how they predict specific, common clinical problems like depression, anxiety, and substance abuse.
• 2. How to recognize failures in present-moment awareness during therapy.
• 3. How to assess mindfulness and present-moment awareness skills using both qualitative and quantitative methods.
• 4. The defining clinical characteristics of a five-phase model of present-moment awareness interventions.
• 5. How to stimulate movement through the five phases to promote life-altering, single-session change.

Recommended Readings:

Strosahl, K., & Robinson, P. (2014). In this moment: Five steps to transcending stress using mindfulness and neuroscience. Oakland, CA: New Harbinger. Strosahl, K., Robinson, P., & Gustavsson, T. (2012). Brief interventions for radical change: Principles and practice of Focused Acceptance and Commitment Therapy. Oakland, CA: New Harbinger. Strosahl, K., Robinson, P., & Gustavsson, T. (2015). Inside this moment: Using the present moment to promote radical change in Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.

Insomnia is the number-one rated health problem facing your clients and there are effective, brief strategies to address sleep complaints in nonsleep specialty settings, namely, CBT for insomnia. However, most clients present with insomnia and a coexisting problem such as depression, pain, or anxiety. Thus, the most useful clinical workshops are those that can also provide advice on how to integrate evidence-based insomnia therapy into co-occurring treatments for anxiety, depression, or pain disorders. As a result, this Institute provides an overview of CBT for insomnia (CBT-I) with a focus on integration issues with other cognitive behavioral treatments. The materials will be presented via live demonstrations of techniques, as well as applied exercises, such as devising behavioral experiments, how to use CBT-I in behavioral activation, experiential exercises for fatigue management, calculating sleep schedule recommendations from actual sleep diaries, and troubleshooting from a thought record. Knowing how to deliver CBT-I in those with complex problems is a must for clinicians. This Institute will provide step-by-step cognitive-behavioral strategies for insomnia, with a special emphasis on the types of adherence issues you are likely to encounter in your practice as you treat other disorders, such as pain, anxiety, and depression. The format for the Institute will be a mix of didactic instruction, experiential exercises, and demonstrations, from a leading clinician in the area of comorbid insomnias. The presenter is the author of the only CBT workbook written expressly for comorbid insomnias, and the only case formulation insomnia book.

You Will Learn:

• 1. How to formulate/present an integrated case formulation that includes sleep in clients with other issues.
• 2. How Behavioral Activation and CBT for insomnia strategies, as well as CBT for chronic pain and CBT for insomnia are complementary, easily integrated approaches.
• 3. How to use/adapt components of your anxiety disorder treatments to help with insomnia and vice versa.
• 4. How to integrate the modification of sleep-effort related beliefs when delivering cognitive therapy for other disorders.
• 5. How to implement strategies for managing repetitive thought, including rumination.

Recommended Readings:

Carney, C.E., & Manber, R. (2009). Quiet your mind and get to sleep: Solutions to insomnia for those with depression, anxiety or chronic pain. Oakland, CA: New Harbinger. Manber, R., & Carney, C.E. (2015). Treatment plans and interventions: Insomnia. A case formulation approach. Part of the "Treatment Planner" Series (Robert L. Leahy, Ed.). Berkeley: The Guilford Press. Smith, T.M., Huang, I.M., & Manber, R. (2005). Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders. Clinical Psychology Review, 25(5), 559-592.

Gain a deeper understanding of how to use mindfulness meditation practices in individual CBT for depression and anxiety in this interactive Institute through an iterative mix of didactic instruction, mindfulness meditation, and inquiry/group discussion. CBT, a change-based approach, is effective in treating a wide range of psychological difficulties, including depression and anxiety disorders. Yet therapists at times find themselves struggling with how to help their clients when traditional CBT techniques don't work. MBCT, an acceptance-based approach integrating mindfulness meditation with cognitive therapy for depression, has been shown to be effective in treating acute symptoms of depression and anxiety. A key focus of mindfulness meditation is the cultivation of an open, receptive mode of awareness, in which one intentionally faces behavioral difficulties and affective discomfort. This promotes, among other things, the possibility of decentering and dis-identifying from ruminative or anxious thinking patterns. The result is a more kindhearted self-observation and a softening of self-judgment.

MBCT was originally developed for groups; however, most clinicians work primarily with individual clients. In this Institute we will explore how to supplement CBT change-based techniques with mindfulness meditation practices.

You Will Learn:

• 1. The aim and rationale for using mindfulness in individual CBT.
• 2. The research base supporting the use of mindfulness in mood and anxiety disorders, including using MBCT in an individual format.
• 3. Core mindfulness practices (via demonstration/observation).
• 4. To apply mindfulness techniques in individual CBT.
• 5. To balance acceptance and change-based approaches.

Recommended Readings:

Lau, M.A., & McMain, S. (2005). Integrating mindfulness meditation with cognitive behavior therapies: The challenge of combining acceptance and change based strategies. Canadian Journal of Psychiatry, 50, 863-869. Segal, Z.V., Williams, J.M.G., & Teasdale, J.D. (2013). Mindfulness-based cognitive therapy for depression (2nd ed.). New York: Guilford Press. Teasdale, J.D., Williams, J.M.G., & Segal, Z.V. (2014). The mindful way workbook: An 8-week program to free yourself from depression and emotional distress. New York: Guilford Press.

Brief Cognitive Behavioral Therapy (BCBT) to prevent suicide attempts is a 12-session outpatient psychological treatment that reduces subsequent suicide attempts by half. The treatment proceeds through three stages: (a) crisis management, focused on behavioral strategies for managing emotional distress; (b) cognitive restructuring, focused on dismantling the suicidal belief system; (c) and relapse prevention, focused on behavioral rehearsal of emotion regulation and problem solving to ensure skill competency. This session is designed to provide participants with in-depth understanding of BCBT and concrete instruction for successfully delivering the treatment.

You Will Learn:

• 1. To describe an empirically supported biopsychosocial model of suicide.
• 2. To conduct a risk assessment interview in a manner that increases accurate and honest disclosure of suicidal ideation and behaviors.
• 3. To develop a written treatment and services plan that addresses suicide risk and is based on empirically supported interventions.
• 4. To effectively use a crisis response plan to reduce the risk for suicidal behaviors.
• 5. To structure and sequence interventions to maximize treatment outcomes.

Recommended Readings:

Bryan, C.J., Gartner, A.M., Wertenberger, E., Delano, K., Wilkinson, E., Breitbach, J., Bruce, T., & Rudd, M.D. (2012). Defining treatment completion according to patient competency: A case example using Brief Cognitive Behavioral Therapy (BCBT) for suicidal patients. Professional Psychology: Research & Practice, 43, 130-136. Bryan, C.J., Rudd, M.D., & Wertenberger, E. (2013). Reasons for suicide attempts among active duty Soldiers: A functional approach. Journal of Affective Disorders, 144, 148-152. Bryan, C.J., Rudd, M.D., Wertenberger, E., Etienne, N., Ray-Sannerud, B.N., Peterson, A.L., & Young-McCaughon, S. (2014). Improving the detection and prediction of suicidal behavior among military personnel by measuring suicidal beliefs: An evaluation of the Suicide Cognitions Scale. Journal of Affective Disorders, 159, 15-22. Rudd, M..D., Bryan, C.J., Wertenberger, E.G.., Peterson, A.L., Young-McCaughan, S., Mintz, J., . . . Bruce, T.O. (2015). Brief cognitive behavioral therapy effects on post-treatment suicide attempts in a military sample: Results of a randomized clinical trial with 2-year follow-up. American Journal of Psychiatry. [Epub ahead of print.]

Cognitive-behavioral therapists place substantial emphasis on the use of effective and empirically supported psychotherapy methods. This Institute will review empirically verified instructional models and procedures, outline methods for integrating these procedures into CBT training and supervision, and describe training models for specific disorders and methods for working with diverse trainees. The current demand for training in CBT is increasingly oriented to more diverse groups in nontraditional settings. Frequently encountered training issues and alternative approaches will be described to increase the effectiveness of training in a variety of environments. This session will also include demonstrations of a structured systematic method to provide feedback, support and train supervisors utilizing an empirically developed rating scale, SAGE (Milne et al., 2011). A combination of didactic, observational (video and role-play), and experiential methods will be utilized and participants will have opportunities to practice key skills, including how to target specific learning issues and management of especially challenging trainees. Finally, a unique aspect of this Institute will be the opportunity to interact in small groups to obtain skills that are germane to each attendee's needs. You Will Learn: 1. Specific techniques for training providers in CBT that employ principles of adult learning. 2. How to adapt your training methods by trainee discipline and treatment delivery setting. 3. Evidence-based supervisory methods and techniques for assessing supervisory competence. 4. How to recognize the need for modifications of supervision in the "real world" to address developmental training issues and specific challenges provided by problematic supervisees. 5. Specific training protocols for particular disorders. Recommended Readings: Milne, D.L. (2008). Evidence-based clinical supervision. Chichester: Wiley/Blackwell. Milne, D.L., Reiser, R.P., Cliffe, T., & Raine, R (2011). SAGE: Preliminary evaluation of an instrument for observing competence in CBT supervision. The Cognitive Behaviour Therapist, 4, 123-138. Reiser, R., & Milne, D.L. (2012). Supervising cognitive-behavioral psychotherapy: Pressing needs, impressing possibilities. Journal of Contemporary Psychotherapy. [Advance on-line publication.] doi: 10.1007/s10879-011-9200-6. Roth, A., & Pilling, S. (2008). A competence framework for the supervision of psychological therapies. Retrieved December 30, 2011, from www..ucl.ac.uk/clinicalpsychology/CORE/supervision_framework.htm. Sudak, D., Codd, III, R.T., Sokol, L., Gittes-Fox, M., Reiser, R., Ludgate, J. & Milne, D. (in press). Training and supervising cognitive-behavioral therapy. Wiley. [Note: expected date of publication October, 2015.]

The goal of the Marriage Checkup (MC) is to provide the theory, structure, and tools for clinicians to provide regular checkups for couples' relationship health with the twin goals of prevention and early intervention. The MC is designed to lower the barriers to seeking marital health care by being easily accessible, brief, and advertised for all couples interested in maintaining their health with a regular checkup. The objectives of the MC are (a) early identification of relationship health deterioration, (b) prevention and early intervention, (c) motivating appropriate help seeking, and (d) fostering long-term marital health and preventing divorce. This Institute, intended for practitioners who work with or are interested in working with couples, will cover the fundamentals of conducting an MC, incorporating techniques from Integrative Behavioral Couple Therapy and Motivational Interviewing. Using didactics, videos, and exercises, participants will learn about the unique challenges of working with couples versus working with individual clients in a brief intervention, the structure and protocol of the MC, and the proposed mechanisms of therapeutic change. Evidence suggests that the MC can be beneficial as a stand-alone relationship intervention as well as lowering the barriers to further treatment seeking and providing regular relationship health maintenance for at-risk couples. In addition, the MC has been adapted to fit easily within an existing practice. The therapeutic techniques at the heart of the MC are applicable in many clinical contexts, including explicitly working with couples or even addressing relationship concerns with individual clients.

You Will Learn:

• 1. The structure of the MC, including how to conduct an Assessment and Feedback session and prepare the Feedback Report.
• 2. Strategies for building intimacy bridges between partners, helping partners to identify their mutual traps and develop deeper compassionate understanding of one another.
• 3. The MC's theory of change, including a behavioral understanding of the intimacy process and the path of least emotional resistance, and the use of empathic imagination.
• 4. The unique challenges of working with a wide variety of couples within a brief checkup format.
• 5. The empirical support for adapting the MC across a variety of settings, including low income and military couples in primary care.

Recommended Readings:

Cordova, J.V. (2013). The Marriage Checkup practitioner's guide: Promoting lifelong relationship health. Washington, DC: American Psychological Association. Cordova, J.V., Eubanks Fleming, C.J., Ippolito Morrill, M., Hawrilenko, M., Sollenberger, J.W., Harp, A.G., . . . Wachs, K. (2014). The Marriage Checkup: A randomized controlled trial of annual relationship health checkups. Journal of Consulting and Clinical Psychology, 82(4), 592-604. doi:10.1037/a0037097

This Institute describes Parent Child Interaction Therapy (PCIT), an evidence-based behavioral treatment for families of young children with disruptive behavior disorders. PCIT is based on Baumrind's developmental theory, which holds that authoritative parenting-a combination of nurturance, good communication, and firm limits-produces optimal child mental health outcomes. In PCIT, parents learn authoritative parenting skills through direct therapist coaching of parent child interactions, guided by observational data collected in each session. Parents receive immediate guidance and feedback on their use of techniques such as differential social attention and consistency as they practice new relationship enhancement and behavioral management skills. Videotape review, slides, handouts, and experiential exercises will be used to teach participants the basic interaction skills and therapist coding and coaching skills used during treatment sessions. Applications of PCIT within physically abusive families and other special populations will be discussed.

You Will Learn:

• 1. Theoretical framework and assessment procedures used in PCIT.
• 2. Child-directed component of PCIT.
• 3. Parent-directed interaction component of PCIT.
• 4. Skills for coaching parents as they interact with their child in treatment sessions.
• 5. Evidence-based uses of standard PCIT and innovative adaptations of PCIT in new populations.

Recommended Readings:

** Go to www.pcit.org for a list of the PCIT literature, as well as the treatment integrity manual for conducting PCIT. Eyberg, S.M. (2005). Tailoring and adapting parent-child interaction therapy for new populations. Education and Treatment of Children, 28, 197-201. Hood, K.K., & Eyberg, S.M. (2003). Outcomes of parent-child interaction therapy: Mothers' reports on maintenance three to six years after treatment. Journal of Clinical Child and Adolescent Psychology, 32, 419-429. McNeil, C.B., & Hembree-Kigin, T. (2010). Parent-Child Interaction Therapy: Second Edition. New York: Springer.