TICKETED SESSIONS | Institutes

The media has focused heavily on the presumed negative effects of light on sleep but light is essential for a healthy sleep-wake system. Understanding whether technology is disruptive or helpful is important for understanding how to best help your clients with comorbid insomnia. Additionally, what about apps or web-based CBT programs: What is the evidence? What are the benefits and drawbacks? This Institute will teach you CBT-I for the 21st century, tackling technology and delivery questions while teaching how to effectively treat insomnia. The format for the Institute will be didactic instruction, experiential exercises, demonstrations, and clinical handouts from a leader in the field in case formulation and the cognitive behavioral treatment of comorbidly occurring insomnia.

This Institute is designed to help you:

• Describe how one can explain to clients the positive effects of light in treating insomnia and fatigue;
• Explain how one can articulate to clients whether evening light is sleep-interfering;
• Understand whether sleep apps are helpful for insomnia;
• Delineate the process of delivering CBT-I to adults;
• Describe how to troubleshoot and adapt CBT-I delivery issues for those with comorbid conditions.

Cajochen, C., Frey, S., Anders, D., Späti, J., Bues, M., Pross, A., ... Stefani, O. (2011). Evening exposure to a light-emitting diodes (LED)-backlit computer screen affects circadian physiology and cognitive performance. Journal of Applied Physiology, 110(5), 1432-1438.

Edinger, J. D., Olsen, M. K., Stechuchak, K. M., Means, M. K., Lineberger, M. D., Kirby, A., & Carney, C. E. (2009). Cognitive behavioral therapy for patients with primary insomnia or insomnia associated predominantly with mixed psychiatric disorders: A randomized clinical trial. Sleep, 32(4), 499-510.

Harvey, A. G. (2002). A cognitive model of insomnia. Behaviour Research and Therapy, 40(8), 869-893.

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 (19982004). Sleep, 29(11), 1398-1414.

Rahman, S. A., Flynn-Evans, E. E., Aeschbach, D., Brainard, G. C., Czeisler, C. A., & Lockley, S. W. (2014). Diurnal spectral sensitivity of the acute alerting effects of light. Sleep, 37(2), 271-281.

Anxiety disorders are among the most common mental health problems plaguing emerging adults (EAs), with social anxiety disorder (SAD) being especially prominent (Auerbach et al., 2016). SAD in adolescence persists into young adulthood and often becomes comorbid with depression and substance abuse. Although CBT and medication are effective treatments for anxiety in youth (Walkup, et al., 2008), nearly half of effectively treated youth relapse (Ginsburg et al., 2014). Consequently, engaging in college or the workforce and establishing long-term romantic and social outlets is hampered by ongoing anxiety that solidifies extended dependence on family and impedes independent functioning. We developed the Launching Emerging Adults Program (LEAP) model, combining both group and individual CBT for anxiety with developmentally informed interventions aimed at decreasing parent accommodation and improving age-appropriate family relationships. Although CBT is the gold-standard treatment for SAD (APA Clinical Practice Guidelines, 2011), exposure therapy is not used enough (Deacon & Farrell, 2013). Barriers to using exposure therapy include difficulty of creating exposures in the clinic (Kendall, et al, 2012), negative beliefs held about exposures, and therapist focus on outcome instead of protocol; the exposures that are completed are often diminished in intensity. This Institute presents the benefits of enhancing exposures to include in vivo, contextually rich experiences typical of the real world for EAs, with a focus on how to make use of available technologies. Dr. Albano and her team, collaborating with a technology startup Headset Health, are implementing novel virtual reality exposures for the EA population. Dr. Bennett, working with HealthRythms, is utilizing passive sensing assessment technology to measure behavioral and physical manifestations of anxiety disorders in day-to-day life. We will present our model and program components, and explain how to enhance exposures. Outcome data, case examples, an video present ation will be presented. Attendees will gain a deeper understanding of how to treat EAs, as well as the ability to use salient contextual clues and technology to enhance treatment.

This Institute is designed to help you:

• Describe the tasks of development necessary for adolescents and young adults to attain independence;
• Strategize with attendees for addressing parental overinvolvement and adolescent dependency, including family communication and problem-solving strategies that are conducted during transition sessions;
• Develop, with other attendees, realistic, developmentally appropriate exposures to enhance the ecological validity of treatment and help emerging adults reduce or develop tolerance for anxiety;
• Explain how to incorporate technology into the treatment of the emerging adult population;
• Develop an initial bank of exposure activities involving age-appropriate situations and challenges to engage the young adult patient.

Auerbach, R. P., Alonso, J., Axinn, W. G., Cuijpers, P., Ebert, D. D., Green, J. G., ... Nock, M. K. (2016). Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychological Medicine, 46(14), 2955-2970.

Blanco, C., Okuda, M., Wright, C., Hasin, D.S., Grant, B.F., Liu, S.M., et al. (2008). Mental health of college students and their non-college-attending peers: Results from the National Epidemiologic Study on Alcohol and Related Conditions. Archives of General Psychiatry, 65(12), 142-937. doi: 10.1001/archpsyc.65.12.1429

Ginsburg, G.S., Becker, E.M., Keeton, C.P., Sakolsky, D., Piacentini, J., Albano, A.M., ... Kendall, P.C. (2014). Naturalistic follow-up of youths treated for pediatric anxiety disorders. JAMA Psychiatry, 71(3), 310-318. PMID: 24477837

Walkup, J., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S., Sherrill, J., et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359, 27532766.

Valmaggia, L.R., Latif, L., Kempton, M.J., & Rus-Calafell, M. (2016). Virtual reality in the psychological treatment for mental health problems: A systematic review of recent evidence. Psychiatry Research, 236, 189-195.

Failures in self-control are often posited to characterize many of the personal and social problems afflicting modern civilization. Yet, too much self-control or overcontrol has been shown to be equally problematic and highly associated with difficult-to-treat disorders such as anorexia nervosa, chronic depression, autism spectrum disorders, and obsessive-compulsive personality disorder. Individuals characterized by excessive self-control can be difficult to identify because they are expert at not appearing deviant on the outside (in public). Their hyper-detailed, focused brain tends to see mistakes everywhere (including in themselves) and they compulsively work harder than most others in order to achieve long-term goals or prevent future problems from occurring. They have too much of a good thing and suffer (quietly) as a consequence. The aim of this Institute is to provide an overview of a manualized transdiagnostic treatment for disorders of overcontrol known as Radically Open-Dialectical Behavior Therapy (RO-DBT). RO-DBT is supported by 20+ years of translational research, including two NIMH-funded randomized controlled trials (RCTs) with refractory depression, two open-trials targeting adult anorexia nervosa, one nonrandomized trial targeting treatment-resistant overcontrolled adults, and one multicenter RCT targeting overcontrol in refractory depression (http://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.

This Institute is designed to help you:

• Explain the neurobiosocial theory underlying RO-DBT and link this to new skills designed to activate a neural substrate linked to social-safety;
• Explain core clinical assessment issues for overcontrolled problems;
• Differentiate between alliance ruptures and disguised demands and the differing treatment approaches used in RO-DBT to manage them and describe how to use novel nonverbal social-signaling and heat-on/heat-off strategies to enhance client engagement;
• Describe how to integrate new RO mindfulness skills involving the cultivation of healthy self-doubt and skills linked to RO self-enquiry and outing oneself;
• Describe how to apply novel nonverbal social-signaling and heat-on/heat-off strategies to enhance client engagement.

Lynch, T. R. (2018a). Radically Open Dialectical Behavior Therapy: Theory and practice for treating disorders of overcontrol. Reno, NV: Context Press.

Lynch, T. R. (2018b). Radically Open Dialectical Behavior Therapy Skills Manual. Reno, NV: Context Press.

Lynch, T.R., Gray, K.L.H., Hempel, R.J., Titley, M., Chen, E.Y., & OMahen, 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. (2015). Radically Open-Dialectical Behavior Therapy for disorders of overcontrol: Signaling matters. American Journal of Psychotherapy, 69(2), 141-162.

Lynch, T.R., Whalley, B., Hempel, R., Byford, S., Clarke, P., Clarke, S., . . . Remington, R. (2015). Refractory Depression: Mechanisms and Evaluation of Radically Open Dialectical Behaviour Therapy (RO-DBT) [REFRAMED]: Protocol for Randomised Trial. BMJ Open Access, 5(7).

Individuals with clinical anxiety and fear comprise a large proportion of many therapists' caseloads. Although exposure therapy is highly effective for anxiety and fear-related problems, many individuals fail to benefit during exposure or experience a return of fear at some point after treatment ends. New directions in the field of exposure therapy focus on an inhibitory learning model of fear extinction as derived from research on learning and memory. This model gives rise to specific techniques for implementing exposure that can optimize short- and long-term gains. Collectively, strategies derived from the inhibitory learning approach emphasize fear tolerance, as opposed to fear habituation, for protecting against return of fear. Moreover, they involve introducing desirable difficulties into exposure sessions by challenging patients to better consolidate and generalize learning via novel therapeutic strategies in order to foster a more desirable outcome (i.e., long-term maintenance). This Institute aims to help clinicians understand and apply this model and its strategies to optimize exposure therapy. The inhibitory learning model will be described and distinguished from traditional approaches to exposure; furthermore, a range of strategies to optimize inhibitory learning will be introduced and illustrated in detail. Strategies include how to maximize fear tolerance, track exposure progress using indices other than subjective units of discomfort (SUDS), introduce variability into exposure to decontextualize extinction learning, combine fear cues, and effectively use cognitive therapy techniques during exposure sessions to consolidate learning. The Institute will be interactive and include numerous case examples, video demonstrations, and experiential exercises.

This Institute is designed to help you:

• Distinguish the inhibitory learning approach to exposure from the traditional emotional processing approach;
• Explain how to foster fear tolerance during exposure, as opposed to relying solely on fear reduction and habituation;
• Describe how to select methods of tracking therapeutic progress during exposure therapy, other than (or in addition to) SUDS;
• Delineate how to strategically introduce variability into exposure sessions;
• Explain how to implement cognitive therapy during exposure sessions in ways that promote extinction via inhibitory learning.

Abramowitz, J. S., & Arch, J. J. (2014). Strategies for improving long-term outcomes in cognitive behavioral therapy for obsessive-compulsive disorder: Insights from learning theory. Cognitive and Behavioral Practice, 21(1), 20-31.

Blakey, S. M., & Abramowitz, J. S. (2016). The effects of safety behaviors during exposure therapy for anxiety: Critical analysis from an inhibitory learning perspective. Clinical Psychology Review, 49, 115. https://doi.org/10.1016/j.cpr.2016.07.002

Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46(1), 527. https://doi.org/10.1016/j.brat.2007.10.003

Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: an inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23.

Jacoby, R. J., & Abramowitz, J. S. (2016). Inhibitory learning approaches to exposure therapy: A critical review and translation to obsessive-compulsive disorder. Clinical Psychology Review, 49, 28-40.

Mood dysregulation is one of the biggest problems in childhood, and it often worsens in adolescence and early adulthood. Yet there has been much uncertainty about how to conceptualize these problems diagnostically. DSM-5 added a new diagnosis, creating another label, but without an evidence base about course or treatment. Fortunately, there has been a surge of evidence about the validity of carefully diagnosed mood disorders in youth, along with better evidence-based tools for assessment and treatment. This Institute discusses key assessment and therapy issues, including: how bipolar and other mood disorders manifest clinically, presentation similarities and differences in children versus adults, how to use self-report and parent-report measures to aid diagnosis and treatment, and specific treatment strategies. We summarize the available biological interventions, emphasizing what nonprescribing clinicians need to know about these treatments. We then concentrate on how to implement therapeutic techniques used in individual-family and multifamily psychoeducational psychotherapy (PEP), one of the most promising evidence-based approaches to managing mood dysregulation in youth. This program will utilize lecture format, case presentations, demonstrations, role-plays, and question-and-answer periods. Often challenging conventional wisdom, the Institute presents new evidence from NIMH grants that can be applied immediately in practice.

This Institute is designed to help you:

• Describe the use of evidence-based assessment methods that aid in differential diagnosis and measuring treatment response;
• Recognize which symptoms and risk factors are helpful in recognizing bipolar disorder, and which may be red herrings" that are common to other conditions;
• Explain how to adapt specific therapeutic techniques to treat youth with bipolar disorder and other mood dysregulation;
• Identify how to apply specific therapeutic techniques to address family concerns about mood dysregulation and treatment;
• " Explain how to integrate a conceptual model for working within systems-of-care into your practice with cases dealing with mood dysregulation.

Freeman, A.J., Youngstrom, E.A., Youngstrom, J.K., & Findling, R.L. (2016). Disruptive mood dysregulation disorder in a community mental health clinic: Prevalence, comorbidity and correlates. Journal of Child and Adolescent Psychopharmacology, 6, 123-130. doi:10.1089/cap.2015.0061.

Fristad, M.A. (2016). Evidence-based psychotherapies and nutritional interventions for children with bipolar spectrum disorders and their families. Journal of Clinical Psychiatry, 77(suppl 3):e04. PMID: 27570930 Goldstein, B., Birmaher, B., Carlson, G., DelBello, M., Findling, R., Fristad, M., ... Youngstrom, E. (in press). The International Society for Bipolar Disorders Task Force Report on pediatric bipolar disorder: Knowledge to date and directions for future research. Bipolar Disorders.

Van Meter, A. R., Youngstrom, E. A., Birmaher, B., Fristad, M. A., Horwitz, S. M., Frazier, T. W., . . . Findling, R. L. (2017). Longitudinal course and characteristics of cyclothymic disorder in youth. Journal of Affective Disorders, 215, 314-322. doi:http://dx.doi.org/10.1016/j.jad.2017.03.019

Youngstrom, E.A., Choukas-Bradley, S., Calhoun, C.D., & Jensen-Doss, A. (2015). Clinical guide to the evidence-based assessment approach to diagnosis and treatment. Cognitive and Behavioral Practice, 22, 20-35. doi: 10.1016/j.cbpra.2013.12.005

This Institute includes a refresher on Motivational Interviewing (MI) approaches and skills, an update on recent definitional and conceptual changes to MI, 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 presenters' diverse practices, 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 offers the expertise of two experienced trainers in MI and CBT, both of whom offer trainings in MI on a yearly basis. The session will involve experiential components in which participants work with one another in dyads and groups, and with trainers, to polish skills in a comfortable, interactive, supportive, and enjoyable learning environment.

This Institute is designed to help you:

• Explain how to integrate MI with various CBT approaches;
• Describe how to employ methods for eliciting MI change talk in clients in the context of CBT;
• Deonte how to apply key MI processes to increase client motivation for behavior change within ongoing CBT treatments;
• Explain how to use MI to augment your use of CBT with difficult cases;
• Delineate how to facilitate behavior change for clients who are not responding to CBT.

Arkowitz, H., Westra, H. A., Miller, W. R., & Rollnick, S. (2015). Motivational Interviewing in the treatment of psychological problems (2nd ed.). New York: Guilford.

Hart, T. A., Willis, A. C., Simpson, S. H., Julien, R. E., Hoe, D., Leahy, B., & Adam, B. D. (2016). Gay Poz Sex: A sexual health promotion intervention for HIV-positive gay and bisexual men. Cognitive and Behavioral Practice, 23, 517-529. doi: 10.1016/j.cbpra.2015.11.002

Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping people change (3rd ed.). New York: Guilford.

McNeil, D. W., Addicks, S. H., & Randall, C. L. (2017). Motivational Interviewing and motivational interactions for health behavior change and maintenance. New York: Oxford University Press. doi: 10.1093/oxfordhb/9780199935291.013.21

Naar, S., & Safren, S. A. (2017). Motivational Interviewing and CBT: Combining strategies for maximum effectiveness. New York: Guilford.

Behavioral Activation (BA) is a brief treatment for depression that emphasizes the importance of activation and overcoming avoidance as a way to manage and recover from depression. Over the course of the last several years, Behavioral Activation Therapy has proven to be as effective as CBT and medication management in the treatment of moderately to severely depressed adults. More recently, this treatment approach has been increasingly used and studied in youth with depressive disorders. In the treatment of youth with depressive disorders, BA can be used in two different ways: as a stand-alone treatment and as a component in modular approaches to care. In this Institute, participants will be introduced to the BA model. The key strategies used in BA (e.g., mood monitoring, guided activation, goal setting, overcoming avoidance) related to helping adolescents increase activity and maximize reward in their lives will be introduced. Implementation of these strategies will be modeled via training videos and role-plays and participants will have the opportunity to practice these strategies and debrief their use with the facilitators. Time will also be devoted to conversation/discussion between participants and presenters about using this structured treatment in a flexible fashion based on individualized case conceptualization and with adolescents with co-occurring problems.

This Institute is designed to help you:

• Discuss the basic theory, model, and techniques of behavioral activation;
• Explain how to conduct behavioral activation with adolescents and parents;
• Describe how to implement key BA skills.
• Explain how BA may be extended to address concerns in youth presenting with challenges other than depression.

Chu, B.C., Crocco, S.T., Esseling, P., Areizaga, M. J. Lindner, A. M., & Skriner, L.C. (2016). Transdiagnostic group behavioral activation and exposure therapy for youth anxiety and depression: Initial randomized controlled trial. Behaviour Research and Therapy, 76, 65-75.

Curry, J. F. & Meyer, A. E. (2016) Can less yield more? Behavioral activation for adolescent depression. Clinical Psychology: Science and Practice, 23(1), pp. 62-65

McCauley E., Schloredt, K., Gudmundsen, G., Martell, C., & Dimidjian, S. (2016). Behavioral activation with adolescents: A clinician's guide. New York: Guilford.

Pass, L., Lejuez, C.W., & Reynolds, S (2018). Brief behavioural activation (Brief BA) for adolescent depression: A pilot study. Behavioural and Cognitive Psychotherapy, 46(2), 182-194.

Patel, V., Weobong, B., Weiss, H.A., Anand, A., Bhat, B., Katti, B., ... Fairburn, C. (2017). The Healthy Activity Program (HAP): a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: A randomised controlled trial. Lancet, 389, 176-185.

Ritschel, L. A., Ramirez, C. L., Cooley, J. L., & Craighead, W. E. (2016). Behavioral activation for major depression in adolescents: Results from a pilot study. Clinical Psychology: Science and Practice, 23(1), 39-57. doi:10.1111/cpsp.12140

Working with couples is not at all like working with individuals. However, relatively few of us receive specialized training in working with couples. Despite that, the highest demand for therapy is from couples seeking help with their relationships. Additionally, most couples come to therapy after a long period of significant distress, as a last-ditch effort to save their relationship, and sometimes therapy is just too little, too late. In short, currently the resources simply do not exist to reach and effectively serve the relationship health needs of the nations' couples.

If we are to begin to treat relationship health as a public health issue, then we need to significantly increase the number of therapists who are trained to provide preventative and early intervention care. The Relationship Health Checkup is the relationship health equivalent of our annual physical health or biannual dental checkup and is meant to have the broad public health effect in terms of helping couples to maintain strong, vibrant, healthy, sexy relationships for a lifetime. The Relationship Health Checkup uses technology to increase the reach of a fast and powerful prevention and early intervention for couples.

The Relationship Health Checkup is also a fast and easy protocol for all levels of therapists to learn, and provides therapists who do not specialize in treating couples with an empirically supported, effective, and fun skill set for providing couples with a profoundly rich experience in just two sessions. In this Institute, participants will learn the fundamentals of conducting a Relationship Checkup, utilizing techniques from Integrative Behavioral Couple Therapy and Motivational Interviewing. Participants will learn about the unique challenges of working with couples, the structure and protocol of the Checkup, and the technological opportunities for effectively serving the broadest range of couples in need.

This Institute is designed to help you:

• Explain how to conduct a Relationship Checkup Assessment and Feedback session;
• Compare therapeutic techniques for working with couples versus individuals;
• Observe skillful examples of each therapeutic technique utilized in the Relationship Checkup;
• Practice the application of strategies for building intimacy bridges between partners through hands on practice of (a) celebrating partners strengths, (b) identifying soft emotions beneath anger, (c) uncovering understandable reasons for each perspective;
• Identify and explain the most common relationship themes and patterns between partners.

Cigrang, J. A., Cordova, J. V., Gray, T. D., Najera, E., Hawrilenko, M., Pinkley, C., Nielsen, M., Tatum, J., & Redd, K. (2016). The Marriage Checkup: Adapting and implementing a brief relationship intervention for military couples. Cognitive and Behavioral Practice, 23(4), 561-570.

Cordova, J. V. (2014). The Marriage Checkup Practitioner's Guide. Washington, DC: APA Books.

Hawrilenko, M., Gray, T. D., & Córdova, J. V. (2016). The heart of change: Acceptance and intimacy mediate treatment response in a brief couples intervention. Journal of Family Psychology, 30(1), 93-103. doi:10.1037/fam0000160

Jacobson, N. S., & Christensen, A. (1996). Acceptance and change in couple therapy: A therapist's guide to transforming relationships. New York: Norton.

Trillingsgaard, T., Fentz, H. N., Hawrilenko, M., & Cordova, J. V. (2016). A randomized controlled trial of the Marriage Checkup Adapted for private practice. Journal of Consulting and Clinical Psychology, 84(12), 1145. doi:10.1037/ccp0000141