TICKETED SESSIONS | Master Clinician Seminars

Mindfulness Based Cognitive Therapy (MBCT) is an 8-week group treatment that combines the tools of cognitive therapy with the clinical application of mindfulness meditation for the treatment of mood and anxiety disorders. A guiding rationale in this work is that the longer, formal mindfulness practices, such as sitting meditation, are central to the program, but they are not an endpoint. Rather, they are a training ground for the types of skills in attentional focus, curiosity, kindness, and grounding that can help participants respond to challenges encountered in their everyday lives. Putting these skills to use in real time requires more flexible, informal ways to practice. Taking a page from the cognitive therapies, which have always stressed the need for new learning to be repeatedly practiced, especially in challenging or stressful situations, the Three Minute Breathing Space (3 MBS) was designed to provide people learning MBCT with the same opportunity to practice repeatedly in the daily moments of their lives (Segal, Williams & Teasdale, 2013; Teasdale et al., 2014). In this seminar, case material and clinical examples will be used to review the structure of the 3 MBS and describe the twin attentional foci that are being trained. Experiential practice of the 3 MBS will allow participants to understand this practice "from the inside" and see how these elements can best be integrated to support effective emotion regulation in their clients.

You will learn:

• The Awareness, Gathering and Expanding (AGE) steps of the Three Minute Breathing Space.
• How concentration and open monitoring attentional foci can disrupt automatic cognitive routines.
• Language for guiding the Three Minute Breathing Space.

Recommended Readings:

Segal, Z.V., Williams, J.M.G., & Teasdale, J.D. (2013). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse (2nd ed.). New York: Guilford Press. Smoski, M.J., Keng, S.L., Ji, J.L., Moore, T., Minkel, J., & Dichter, G. S. (2015). Neural indicators of emotion regulation via acceptance vs reappraisal in remitted major depressive disorder. Social Cognitive & Affective Neuroscience, Jan 23. [Epub ahead of print.] Teasdale, J.D., Williams, J.M.G., & Segal, Z.V. (2014). The Mindful Way Workbook. New York: Guilford Press. van der Velden, A., Kuyken, W., Wattar, U., Crane, C., Pallesen, K. J., Dahlgaard, J., . . . Piet, J. (2015). A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder. Clinical Psychology Review, 37, 26-39.

This seminar will offer clinicians with the knowledge and skills to effectively treat social anxiety disorder using a comprehensive CBT approach to maximize gains. Clinicians will learn how to functionally target, assess, and monitor the different symptoms and problems that become the focus of treatment, and will learn how the different strategies, including psychoeducation, cognitive restructuring, attention refocusing, social skills training, exposure, and response prevention are implemented. Emphasis will be placed on (a) maximizing gains with psychoeducation and cognitive strategies; (b) effectively incorporating training in attention refocusing and the range of social skills into treatment; (c) conducting imaginal, in vivo, and simulated exposure to maximize efficacy, integrating both typical and unusual exposure situations; (d) using the latest findings to maximize efficacy of treatment (e.g., use of technology); and (e) blocking safety behaviors and using specific strategies to help patients comply with preventing avoidance, escape, and use of safety behaviors. Case vignettes will be used to illustrate techniques in a hands-on fashion and the audience will participate in a role-play. Slides will be presented and handouts (outlines, assessment and treatment forms, readings for clients and professionals) will be provided so that clinicians may apply what they learn in the seminar. Clinicians are encouraged to ask questions and discuss cases to ensure maximal learning.

You will learn:

• 1. How to maximize gains with psychoeducation and cognitive strategies.
• 2. How to effectively incorporate training in attention refocusing and the range of social skills to maximize treatment.
• 3. How to conduct exposure and response prevention to maximize efficacy, integrating both typical and unusual exposure situations.
• 4. How to use the latest findings to maximize efficacy of treatment (e.g., use of technology).
• 5. How to block safety behaviors and use specific strategies to help patients comply with blocking avoidance, escape, and use of safety behaviors.

Recommended Readings:

Leahy, R.L., Holland, S, & McGinn, L.K. (2011). Treatment plans and interventions for depression and anxiety disorders. New York: Guilford Press. McGinn, L. K., & Newman, M. G. (2013). Social anxiety disorder: State of the art. International Journal of Cognitive Therapy, 6 (2), 88-113.

CBT is the treatment of choice for many sleep disturbances, including when the sleep disturbance is comorbid with another psychiatric or medical disorder. Many clinicians, however, are not confident in administering CBT in the context of sleep disturbance. Often there are doubts about how to answer patients' common questions about the biology of sleep and how to establish a rationale for treatment, which involves being conversant with the interactions between biology, psychology, and the social context of sleep.

Learning how to treat sleep problems effectively is important for practicing clinicians given that sleep disturbance is so common among clients. Also, persistent sleeping difficulties are associated with functional impairment, mood regulation and problem-solving difficulties, increased work absenteeism, more health problems, and heighten the risk of developing future comorbid health and psychiatric conditions. So by improving sleep, it is possible to improve symptoms of comorbid difficulties, as well as improve health and well being broadly.

The aim of this seminar is to describe the Transdiagnostic Sleep and Circadian Intervention (TranS-C) to improve sleep. TranS-C draws from four evidence-based interventions: Cognitive Behavior Therapy for Insomnia, Interpersonal and Social Rhythms Therapy, Chronotherapy and Motivational Interviewing. TranS-C is designed to help clinicians address the broad range of sleep disturbances that are often comorbid with mental and medical disorders, particularly insomnia, delayed sleep phase and hypersomnia. The use of TranS-C for youth and adults will be discussed.

You will learn:

• 1. Key aspects of the biology, psychology and social context of the sleeper.
• 2. How to complete a transdiagnostic case conceptualization for a patient suffering from a sleep problem.
• 3. To describe the elements of TranS-C and the adaptations for adults and adolescents.

Recommended Readings:

Harvey, A.G., Soehner, A.M., Kaplan, K.A., Hein, K., Lee, J., Kanady, J., . . . Buysse, D.J. (in press). Treating insomnia improves sleep, mood and functioning in bipolar disorder: A pilot randomized controlled trial. Journal of Consulting and Clinical Psychology. Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J. D., Espie, C. A., & Lichstein, K. L. (2006). Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004). SLEEP-NEW YORK THEN WESTCHESTER-, 29(11), 1398. Perlis, M., Aloia, M., & Kuhn, B. (Eds.). (2011). Behavioral treatments for sleep disorders: A comprehensive primer of behavioral sleep medicine interventions (Practical Resources for the Mental Health Professional). London: Elsevier.

Treatment failure is common. Dr. Persons presents a model that helps the clinician handle this common problem in an ethical and effective manner. The model calls for the therapist to let the patient know that the therapist will not continue treatment unless it is effective, monitor progress in every session, work systematically to overcome lack of progress when it occurs, and bring treatment to a close when treatment failure cannot be overcome. Dr. Persons provides tools, including progress monitoring scales, to help the clinician implement the model. This session will provide video demonstrations, case examples, and practice exercises. Participants are asked to bring examples of patients who are not making progress in treatment (the participant will not be asked to share any information about the case). Dr. Persons will ask participants for permission to contact them after the workshop to evaluate the effects of the training on the clinician's practice.

You will learn:

• 1. Tools for monitoring progress at every session
• 2. A systematic strategy for developing and testing hypotheses about the causes of treatment failure
• 3. Tips for initiating a discussion with the patient about treatment failure

Recommended readings:

Kazdin, A. E. (1993). Evaluation in clinical practice: Clinically sensitive and systematic methods of treatment delivery. Behavior Therapy, 24, 11-45.

Persons, J. B. (2008). The case formulation approach to cognitive-behavior therapy. New York: Guilford.

Persons, J. B., & Mikami, A. Y. (2002). Strategies for handling treatment failure successfully. Psychotherapy: Theory/Research/Practice/Training, 39, 139-151.

This Master Clinical Seminar begins with a case description to illustrate defining and typical hoarding symptoms, as well as common comorbid problems. These will illustrate the difficulty discarding, excessive acquiring, and disorganized clutter that interfere with use of the home, as well as with personal and family functioning in various spheres. Intervention methods are based on a multidimensional cognitive, behavioral, and environmental model for understanding the emotional attachments, beliefs, and behaviors that underlie hoarding disorder. These include information processing problems (attention, problem solving, classifying and organizing), problematic beliefs (about waste, responsibility, control), strong emotional attachments, and avoidance behaviors to manage anxiety, guilt, and sadness. Strategies for increasing motivation and reducing problematic beliefs about objects will be demonstrated, along with skills training and behavioral exposures in the office, at home, and in acquiring situations. The presenters will comment on group treatment strategies, as well as community interventions for reluctant clients. Teaching methods include pictorial illustration; slides; handouts; brief media clips and/or role-plays to illustrate techniques; and opportunities for participant question and answer.

You will learn:

• 1. To diagnose and assess the symptoms and common comorbidities of hoarding disorder.
• 2. Motivational, cognitive, and behavioral intervention strategies to encourage engagement in treatment, skills training, reduction of excessive acquiring, and increased ability to discard objects.
• 3. Family, group and community interventions for hoarding disorder based on clients' needs.

Envy is a social emotion focused on problematic comparisons with others, while jealousy is a concern about the threat to a relationship. Individuals are more likely to experience envy when the target behavior is valued by them, they believe it is possible that they might achieve these goals, they view the target of envy as "undeserving," and they value status and recognition. Envy is associated with depression, anger, anxiety, rumination, and interpersonal hostility. In this presentation we will review the evolutionary adaptive value of envy (dominance hierarchies, social rank theory), the fundamental concern for fairness, schemas related to status, maladaptive "coping" (undermining the "competition" and avoidance of competitors), rumination, complaining, and self-critical thinking. The integrative clinical model includes the following: normalizing envy, validating envy to decrease shame and guilt, relating envy to positive values, focusing on turning envy into admiration and emulation, differentiating the self-concept beyond a focus on one dimension, and acceptance of envy while acting on valued goals. In addition, we will examine how we can modify dysfunctional beliefs about social comparison (labeling-"He's a winner, I am a loser"; fortune-telling-"She will continue to advance, I will fall behind"; dichotomous thinking-"You either win or lose"; discounting positives-"The only thing that counts is getting ahead"; and catastrophizing-"It's awful not to be ahead of others"). Finally, we will review a case conceptualization of a case of depressive and anxious envy.

You will learn:

• 1. How to develop a case conceptualization of envy.
• 2. How to identify problematic coping underpinning envy.
• 3. How to use an integrative CBT model to reduce the negative impact of envy and help focus clients on adaptive functioning.

Recommended readings:

Fiske, S. (2012). Envy up, scorn down: How status divides us. New York: Russell Sage Foundation. Leahy, R.L. (2015) Emotional schema therapy. New York: Guilford. Smith, R. H., & Kim, S. H. (2007). Comprehending envy. Psychological Bulletin, 133(1), 46-64. van de Ven, N., Zeelenberg, M., & Pieters, R. (2009). Leveling up and down: The experiences of benign and malicious envy. Emotion, 9, 419-429.

The Unified Protocol for the Treatment of Emotional Disorders in Adolescents (UP-A) is a transdiagnostic treatment protocol that was developed as a downward extension of the existing Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. The UP-A incorporates emotion-focused CBT principles and skills into a treatment program for adolescents (ages 13-17) with complex presentations of anxiety and/or depression. The modular format of the UP-A allows for flexibility in the implementation and time sequence of treatment components. Initial evidence for the UP-A indicates that it is associated with symptom reductions across disorders, with greater improvements observed at 6-month follow-up. This seminar will provide an introduction to the UP-A, incorporating both multimedia and hands-on training techniques. Specifically, during the first hour of the seminar, the flexible and engaging techniques in the modular protocol will be highlighted via didactic training and video demonstration. The final hour of the workshop will be reserved for role-playing, allowing the audience to participate in practice dyads.

You will learn:

• 1. Greater knowledge about the nature of emotional disorders such as anxiety and depression in adolescents.
• 2. Core treatment components of the UP-A.
• 3. Information about the application of UP-A techniques with complex emotional disorder presentations in adolescents.

Why do patients with personality disorders sometimes pose such a challenge in treatment? Why do they miss sessions, criticize the therapist, blame others, display hopelessness about change, fail to do homework, engage in self-harm, use substances, and engage in other kinds of dysfunctional behavior? This master class will focus on conceptualizing why patients use these kinds of therapy-interfering coping strategies and on interventions clinicians can use to address these problems.

We will discuss the specific set of beliefs and coping strategies that characterize various personality disorders; the longitudinal cognitive conceptualization of clients; using the conceptualization to plan treatment; and specialized strategies to develop and maintain a strong therapeutic alliance and carry out the tasks of treatment.

These skills will be demonstrated through discussion, role-play, video, and question/answer.

You will learn:

• 1. How to use a cognitive conceptualization to guide treatment for personality disorder patients.
• 2. How to conceptualize therapeutic relationship problems.
• 3. How to use specialized strategies to overcome challenges in treatment.

Recommended Readings:

Beck, J.S. (2005). Cognitive therapy for challenging problems: What to do when the basics don't work. New York: Guilford. Beck, J.S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York: Guilford. Beck A.T., Davis D.D., Freeman, A. (Eds.). (2015). Cognitive Therapy of Personality Disorders, 3rd Edition. New York: Guilford.