TICKETED SESSIONS | Master Clinician Seminars

In the last 20 years, the evidence base for CBT involving exposure plus response prevention for treating youth with OCD has grown considerably. Treatment typically involves a combination of in vivo and imaginal exposure to situations and thoughts that provoke obsessional anxiety, along with response prevention, which is aimed at reducing and ultimately eliminating compulsions and other passive forms of avoidance. Randomized controlled trials conducted around the world support the efficacy of exposure-based interventions, and effectiveness trials have since provided evidence that robust and durable outcomes can be achieved outside the academic medical contexts in which these treatments were developed and validated. These substantive advances notwithstanding, response to treatment is still neither universal nor complete. This Master Clinician Seminar will focus on common challenges presented in treatment and clinical strategies to address these challenges. Psychiatric comorbidity, family accommodation, motivational readiness, and other challenges to within- and between-session protocol adherence will be addressed in turn, and ample time will be available for discussion of clinical cases in which optimal outcomes are proving difficult to achieve.

This seminar is designed to help you:

• Explain the expected trajectories of response to CBT for pediatric OCD, which serve as a guide for treatment;
• Describe the common clinical challenges to achievement of optimal outcomes, including psychiatric comorbidity, family accommodation, and motivational readiness;
• Discover clinical strategies to address these common clinical challenges.

Franklin, M. E., Dingfelder, H. E., Coogan, C. G., Garcia, A. M., Sapyta, J. J., & Freeman, J. (2013). Cognitive behavioral therapy for pediatric obsessive compulsive disorder: Development of expert-level competence and implications for dissemination. Journal of Anxiety Disorders 27, 745-753.

Franklin, M., Sapyta, J., Freeman, J., Khanna, M., Compton, S., Almirall, D., et al. (2011). Cognitive behavior therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder: The Pediatric OCD Treatment Study II (POTS II). Journal of the American Medical Association 306, 1224-1232.

Leonard, R. C., Franklin, M. E., Wetterneck, C. T., Riemann, B. C., Simpson, H. B., Kinnear, K., . . . Lake, P. M. (2016). Residential treatment outcomes for adolescents with obsessive-compulsive disorder. Psychotherapy Research, 26, 727-736.

This Master Clinician Seminar describes Parent-Child Interaction Therapy (PCIT), an evidence-based behavioral treatment for families of young children with disruptive behavior disorders. Developed by Dr. Sheila Eyberg, 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.

This seminar is designed to help you:

• Articulate the theoretical background underlying PCIT;
• Explain how to employ the PRIDE skills that are used for relationship-enhancement component of PCIT;
• Practice coding parent-child interactions as a mechanism for assisting caregivers in mastering skills;
• Describe the basic skills of discipline in PCIT;
• Delineate how to draw on the research base for PCIT.

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.

PCIT International Inc [webpage]. Get certified by PCIT International. Retrieved December 5, 2016, from: http://www.pcit.org/pcit-certification.html.

Thomas, R., & Zimmer-Gembeck, M.J., (2007). Behavioral outcomes of Parent-Child Interaction Therapy and Triple P Positive Parenting Program: A review and meta-analysis. Journal of Abnormal Child Psychology, 35(3), 475-495.

Ward, M.A., Theule, J., & Cheung, K. (2016). Parent-Child Interaction Therapy for child disruptive behaviour disorders: A meta-analysis. Child Youth Care Forum, 45, 675-690.

It is well documented that children benefit from the participation of their caregivers when they present for treatment for a wide array of difficulties, including behavior problems, depression, and traumatic stress symptoms. This seminar will examine concrete and attitudinal obstacles that may explain why parents are often not active participants in treatment for their children. Moreover, methods for more effectively engaging caregivers in evidence-based treatment for their children will be discussed and demonstrated. Trauma-focused CBT will be the evidence-based practice used as an example for demonstration purposes. Strategies for addressing challenging issues (e.g., parental depression, parenting stress, etc.) will be shared via videotape examples and role-plays. Helping parents understand their children while helping children connect with their parents will be discussed as potential keys to long-term happiness and resilience respectively.

This seminar is designed to help you:

• Develop effective means of optimizing therapeutic engagement of parents/caregivers to support and enhance outcomes for their children;
• Highlight clinical research that documents the benefits of caregiver involvement in children's treatment;
• Present and explore strategies for addressing diverse challenges in working with parents/caregivers who present with high levels of personal distress and parenting stress.

Cohen, J., Deblinger, E., Mannarino, A., & R. Steer (2004). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 43(4), 393-402. doi: 10.1097/00004583-200404000-00005

Deblinger, E., Lippmann, J., & Steer, R. (1996). Sexually abused children suffering posttraumatic stress symptoms: Initial treatment outcome findings. Child Maltreatment, 1(4), 310-321. doi: 10.1177/1077559596001004003

Deblinger, E., Mannarino, A. P., Cohen, J. A., & Steer, R. A. (2006). Follow-up study of a multisite, randomized, controlled trial for children with sexual abuse-related PTSD symptoms: Examining predictors of treatment response. Journal of the American Academy of Child & Adolescent Psychiatry, 45(12), 1474-1484. doi: 10.1097/01.chi.0000240839.56114.bb

Deblinger, E., Pollio, E., Runyon, M. K., & Steer, R. (2017). Improvements in personal resiliency among youth who have completed Trauma-Focused Cognitive Behavioral Therapy: A preliminary examination. Child Abuse & Neglect 65, 132-139. doi: 10.1016/j.chiabu.2016.12.014

Although regret is a central element in depression, procrastination, indecision, self-criticism, worry, rumination, and avoidance, it has received little attention in the CBT literature. In contrast, regret has been a focus in decision theory and research indicating that when people make decisions they often anticipate the possibility of postdecision regret and, therefore, attempt to minimize this experience. Regret is not always a negative process. Insufficient regret processes result in impulsive behavior and failure to learn from past decisions. During manic episodes there is underutilization of anticipatory regret. We will view regret as a self-regulatory process where too much regret or too little regret may be problematic. Although people often believe that they will more likely regret taking new action, research indicates over time there is greater regret for actions not taken. Affective forecasting-that is, overprediction of emotion following events in the future-often contributes to anticipatory regret, with predictions leading to beliefs in greater impact of events than is warranted by the facts. In addition, some decision makers have idealized beliefs about decisions, rejecting ambivalence as an inevitable part of the tradeoffs underlying decision making under uncertainty. Specific decision styles are more likely to contribute to regret, including maximization, emotional perfectionism, intolerance of uncertainty, and overvaluation of "more" information rather than relevant information. In this presentation we will examine how regret is linked to hindsight bias, maximization rather than satisfaction strategies, intolerance of uncertainty, rejection of ambivalence, refusal to accept tradeoffs, excessive information demands, and ruminative processes. Specific techniques will be elaborated to balance regret with acceptance, present utility, and flexibility to enhance more pragmatic decision processes, reverse ruminative focus on the past, and replace self-criticism with adaptive self-correction.

This seminar is designed to help you:

• Identify the role of anticipatory and retrospective regret in decision making and how this impacts procrastination, risk aversion, indecision, rumination, and self-criticism;
• Explain how to assist clients in accepting uncertainty and risk in order to make more pragmatic and effective decisions;
• Describe how to assist clients in reducing postdecision regret, self-criticism and rumination and accept tradeoffs in making decisions while enhancing satisfaction with imperfect outcomes.

Bell, D.E. (1982). Regret in decision making under uncertainty. Operations Research, 30, 961-981.

Leahy, R.L. (2015). Emotional Schema Therapy: A practitioner's guide. New York: Guilford.

Leahy, R.L. (2017). Cognitive therapy techniques (2nd ed.). New York: Guilford.

Roese, N. J., & Summerville, A. (2005). What we regret most … and why. Personality and Social Psychology Bulletin , 31, 1273–1285. doi:10.1177/0146167205274693.

Zeelenberg, M., & Pieters, R. (2007).CA Theory of Regret Regulation. Journal of Consumer Psychology, 17(1), 3–18.

Zeelenberg, M., van den Bos, K., van Dijk, E., & Pieters, R. (2002). The Inaction Effect in the Psychology of Regret. Journal of Personality and Social Psychology, 82(3), 314–327.

This seminar provides an introduction to mindfulness-based interventions to increase awareness of triggers and automatic reactions in the service of reducing heavy drinking and drug use, as well as the risk of relapse to substance use following treatment. This Master Clinician Seminar will include a review of outcomes from three randomized clinical trials of mindfulness-based relapse prevention (MBRP) and our ongoing work using adaptations of MBRP in an outpatient alcohol clinic and a residential treatment facility for individuals with substance use disorder. The seminar will be experiential, providing the opportunity to learn about the intentions and principles of mindfulness-based interventions through mindfulness practices.

This seminar is designed to help you:

• Explain the theoretical and empirical foundations underlying a mindfulness-based approach to the treatment of substance use disorders;
• Describe the key practices, adaptations, and challenges of mindfulness practices for use with alcohol and drug users;
• Evaluate how to incorporate mindfulness-based practices into the clinical treatment of alcohol and substance use disorders and basic principles for conducting mindfulness-based intervention research.

Bowen, S., Witkiewitz, K., Clifasefi, S., Grow, J., Chawla, N., Hsu, S., . . . Larimer, M. E. (2014). Relative long-term efficacy of mindfulness-based relapse prevention, standard relapse prevention and treatment as usual for substance use disorders. JAMA Psychiatry, 71, 547-565.

Witkiewitz, K., Bowen, S., Harrop, E., Douglas, H., Enkema, M., & Hendrickson, C. (2014). Mindfulness-based treatment to prevent addictive behavior relapse: Theoretical models and hypothesized mechanisms of change. Substance Use and Misuse, 49, 513-524.

Witkiewitz, K., Greenfield, B. L., & Bowen, S. (2013). Mindfulness-based relapse prevention with racial and ethnic minority women. Addictive Behaviors, 38, 2121-2824

Obsessions that are primarily cognitive in their presentation are among the hardest for practitioners to treat. When the obsessions fall into the categories of violent, sexual and/or religious, sufferers tend to judge themselves quite harshly and the idea that such thoughts occur in the "normal" population is not enough to help them decide to undertake ERP, especially when they come to understand that the goal of treatment is learning to live with such thoughts as opposed to eradicating them. Sufferers feel as if they are being condemned to live in a nightmare where they are the monster.

Sensory-focused obsessions/neutral obsessions/obsessing about obsessing pose a different problem for sufferers. In these presentations, the sufferer doesn't find the content of the thoughts disturbing; generally, the sole problem is that the sufferer is bothered by having the thoughts. Examples would include focusing on any object (e.g., a picture), thoughts (with no threatening meaning), bodily sensations (heart rate, breathing, tinnitus without hypochondriacal concern), and obsessing about obsessing. These are among the most insidious obsessions and are the only ones in which the feared consequence appears to come true: that is, the sufferer is afraid life will be terrible as long as their attention is focused upon the stimulus and, indeed, they are miserable when this is happening. Explaining to a sufferer with this form of OCD sounds to them that they are being told their situation is hopeless and they should "just deal with it." The "wishing ritual" is often the main compulsion for these sufferers and for many professional this is not a well understood concept.

Although coming up with ERP protocols for mental obsessions can be challenging, the greater challenge is helping them to understand the nature of treatment, why it can work for them and what recovery looks like. The words we choose are critical, and scientific explanations and data are not unimportant-but they are worth little if our explanations fail to resonate with their experience. In order to provide the hope they need to be motivated to carry out treatment, our preparation and explanations have to convince them we understand what their lives are like. The best compliment you can receive is being asked whether or not you have OCD, because that would seem to be the only explanation for your understanding.

In this presentation, the focus will be upon tailoring treatment for each of these different presentations, from helping clients to understand what has been happening to them, to how we can help them to the actual implementation of ERP. This includes which cognitive techniques are useful to include and how to incorporate ACT into your treatment.

This seminar is designed to help you:

• Prepare sufferers for treatment using concepts tailored specifically for their form of OCD;
• Explain how to implement a program of exposure and response prevention that incorporates ACT that is tailored to the specific needs of these sufferers;
• Identify and address the wishing rituals that accompany neutral obsessions.

Carleton, R.N. (2012). The intolerance of uncertainty construct in the context of anxiety disorders: Theoretical and practical perspectives. Expert Review of Neurotherapeutics, 12(8), 937B947.

Grayson, J.B. (2012). ACT vs ERP for OCD: Is It War or Marriage? the Behavior Therapist, 36(4), 12-17.

Twohig, M., Hayes, S.C., Masuda, A. (2006). Increasing willingness to experience obsessions: Acceptance and Commitment Therapy as a treatment for obsessive compulsive disorder. Behavior Therapy, 37(1), 3 13.

Interpersonal Therapy for Depressed Adolescents (IPT-A) has been demonstrated to be an efficacious treatment for adolescent depression and is delineated in a published treatment manual (Mufson, Dorta, Moreau, & Weissman, 2004). IPT-A was adapted from the adult model of IPT and similarly is based on the premise that depression, regardless of its etiology, occurs in an interpersonal context. IPT-A is a 12-15 session treatment that focuses on improving depressive symptoms and interpersonal functioning. IPT-A meets the criteria of a "well-established treatment" for adolescent depression according to the American Psychological Association Task Force on the Promotion and Dissemination of Psychological Procedures. Most important, IPT-A is one of a few evidence-based psychotherapies that has been transported and implemented in community settings with demonstrated effectiveness when delivered by community therapists. IPT-A is considered to be an effective, evidence-based treatment for adolescent depression by the Society of Clinical Child and Adolescent Psychology (http://effectivechildtherapy.com/content/depression). This presentation will provide participants with an overview of IPT-A, examples of key IPT-A techniques, and a discussion of how IPT-A has been adapted for use in community settings.

This seminar is designed to help you:

• Describe how to apply the basic principles of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A);
• Gain exposure to the key IPT-A techniques;
• Recognize how IPT-A has been implemented in community settings.

Baerg-Hall, E., & Mufson, L. (2009). Interpersonal Psychotherapy for Depressed Adolescents (IPT-A): A case illustration. Journal of Clinical Child and Adolescent Psychology, 38(4), 582-593.

Mufson, L., Dorta, K. P., Moreau, D., & Weissman, M. M. (2004). Interpersonal psychotherapy for depressed adolescents (2nd ed.). New York: Guilford Press.

Mufson, L., Rynn, M., Yanes-Lukin, P., Choo, T.H., Soren, K., Stewart, E., Wall, M. (2018). Stepped care interpersonal psychotherapy treatment for depressed adolescents: A pilot study in pediatric clinics. Administration and Policy in Mental Health and Mental Health Services Research, 45(3) 417-431.

McGlinchey, E.L, Turner, J.B., & Mufson, L. Innovations in Practice: The relationship between sleep disturbances, depression, and interpersonal functioning in treatment for adolescent depression. Child and Adolescent Mental Health. 2017; 22 (2):96-99. PMID 2894782.

Reyes-Portillo, J.A., McGlinchey, E.L., Yanes-Lukin, P.K., Turner, J.B., & Mufson, L. (2017). Mediators of Interpersonal Psychotherapy for Depressed Adolescents on Outcomes in Latinos: The Role of Peer and Family Interpersonal Functioning. Journal of Latina/o Psychology; 5(4):248-260.

How do you know what to do, moment-by-moment, in a therapy session? You need to rely on an accurate case conceptualization. It lays the groundwork for overall treatment planning within and across sessions. In this Master Clinician Seminar, I will demonstrate how to quickly and accurately conceptualize a case by using the Cognitive Conceptualization Diagram (Beck, 2011; 2005). This diagram applies the cognitive model to specific current situations. It also illustrates how the perceptions of lifetime events influence clients' core beliefs, assumptions and rules for living, and coping strategies. Short demonstration role-plays will illustrate how to collect necessary data, develop a conceptualization, share the conceptualization with clients, and refine the conceptualization over time, as new data are gathered.

This seminar is designed to help you:

• Describe how to collect data to develop an accurate case conceptualization;
• Explain how to share the case conceptualization with clients;
• Delineate how to accept, reject, or refine hypotheses based on data.

Beck, J.S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York: Guilford.

Huisman, P., & Kangas, M. (2018). Evidence-based practices in cognitive behaviour therapy (CBT) case formulation: What do practitioners believe is important, and what do they do? Behaviour Change, 35(1), 1-21.

Kuyken, W., Beshai, S., Dudley, R., Abel, A., Gorg, N., Gower, P., ... Padesky, C. A. (2016). Assessing competence in collaborative case conceptualization: Development and preliminary psychometric properties of the Collaborative Case Conceptualization Rating Scale (CCC-RS). Behavioural and cognitive psychotherapy, 44(2), 179-192.

Kuyken, W., Padesky, C. A., & Dudley, R. (2011). Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. New York: Guilford Press.

Needleman, L. D. (2009). Cognitive case conceptualization: A guidebook for practitioners. New York: Routledge, Taylor & Francis Group.

Mumma, G. H., Marshall, A. J., & Mauer, C. (2018). Person?specific validation and testing of functional relations in cognitive?behavioural case formulation: Guidelines and options. Clinical Psychology & Psychotherapy.