TICKETED SESSIONS | Clinical Intervention Training

53rd Annual Convention 2019 |
Clinical Intervention Training
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CIT 1: Thursday, November 21 | 8:30 a.m. - 5:00 p.m.

Applying Exposure Principles to the Treatment of Depression: Exposure-Based Cognitive Therapy

Adele M. Hayes, Ph.D., University of Delaware

Charlotte Yasinski, Ph.D., Emory University School of Medicine

Adele Hayes developed Exposure-Based Cognitive Therapy (EBCT) and is the Director of the Depression and Wellness Program at the University of Delaware. Her research focuses on identifying common processes that inhibit and facilitate therapeutic change in treatments for depression and PTSD. Dr. Hayes has received national and international funding to conduct the foundational studies of EBCT, which has now been evaluated in two small clinical trials and a recent randomized controlled trial conducted in Switzerland. She is continuing her research on mechanisms of therapeutic change in the context of several clinical trials in the United States and England. She is a former Associate Editor of Journal of Consulting and Clinical Psychology and Cognitive Therapy and Research for her expertise in psychotherapy research and development.

Dr. Carly Yasinski is a licensed clinical psychologist and assistant professor in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine. She specializes in the treatment of depression and PTSD using exposure-based approaches and was instrumental in helping to refine the exposure-based components of EBCT. Her research interests focus on better understanding the process of change during psychotherapy for these disorders and improving clinical outcomes.

Participants earn 7 continuing education credits.

Minimal to Moderate level of familiarity with the material

Categories: Adult Depression, Treatment-CBT

Keywords: Depression, Exposure, Change Processes/Mechanisms, CBT

Antidepressants and psychotherapy are only about 50% effective, and recurrence rates are as high as 90% by the third episode. Holtzheimer and Mayberg (2011) urge a rethinking of depression as a persistent tendency to become "stuck in a rut" when negative mood states are activated. Treatment must therefore disrupt the processes associated with entering and staying in that rut. Exposure-based cognitive therapy (EBCT) integrates cognitive behavioral therapies for depression with principles of exposure, emotional processing, and inhibitory learning from the treatment of anxiety disorders. EBCT targets key factors that maintain depression (unproductive processing, avoidance, and impaired reward sensitivity and processing). It also facilitates their more adaptive counterparts (constructive emotional processing, distress tolerance, and the ability to sustain and process positive emotions), which together can serve inhibitory functions to prevent relapse. Exposure principles are applied in: (a) weekly narratives to facilitate processing of depressive material, (b) mindfulness exercises to promote distress tolerance, (c) imaginal exposure exercises to facilitate constructive processing of memories related to defectiveness, worthlessness, and failure, and (d) exposure exercises to activate and process positive emotions and related fear and avoidance. CIT participants will learn techniques to reduce depression-maintaining processes and promote emotional processing and inhibitory learning.

At the end of this session, the learner will be able to:

  • Describe the foundational principles of exposure, emotional processing, and inhibitory learning from the treatment of anxiety disorders.
  • Adapt these principles to depression, given the problems of hopelessness, rumination, overgeneralization, and suicidality.
  • Practice techniques to reduce chronic unproductive processing and improve distress tolerance, problem-solving, and healthy lifestyle behaviors.
  • Apply exposure principles to facilitate emotional processing and inhibitory learning in depression.
  • Engage and strengthen positive emotion system in depression.
Recommended Readings:

Aafjes-van Doorn, K., & Barber, J.P. (2017). Systematic review of in-session affect experience in cognitive behavioral therapy for depression. Cognitive Therapy and Research, 41, 807-828.

Hayes, A. M. (2015). The application of principles of exposure to the treatment of depression. In C. Beevers (Ed.), Depression, special issue of Current Opinion in Psychology, 4, 61-66.

Hayes, A. M., Feldman, G., Beevers, C., Laurenceau, J. P., Cardaciotto, L., & Lewis-Smith (2007). Discontinuities and cognitive changes in exposure-based cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 75, 409-421.

Hayes, A. M., Ready, C. B., & Yasinski, C. (2014). Exposure to emotion in depression: Exposure-based cognitive therapy. In N. Thoma & D. McKay (Eds.), Working with emotion in cognitive behavioral therapy: Techniques for clinical practice (pp. 121-145). New York: Guilford.

Hayes, A. M., Yasinski, C., & Barnes, J. B., & Bockting, C. (2015). Network destabilization and transition in depression: New methods for studying the dynamics of therapeutic change. Clinical Psychology Review, 41, 27-39.

CIT 2: Thursday, November 21 | 8:30 a.m. - 5:00 p.m.

Integrative Behavioral Couple Therapy: Acceptance and Change in Couple Therapy

Andrew Christensen, Ph.D., UCLA

Brian D. Doss, Ph.D., University of Miami

Andrew Christensen is Distinguished Research Professor of Psychology in the Department of Psychology at UCLA. He has spent his career studying couple conflict and couple therapy and has published over 150 professional articles, primarily on these topics. He is co-author of the influential scholarly book Close Relationships (Freeman, 1983, reprinted in 2002). For therapists, he authored Acceptance and Change in Couple Therapy: A Therapist's Guide for Transforming Relationships (1998, Norton) with Neil S. Jacobson. For couples, he authored Reconcilable Differences (2000, 2014, Guilford) with Jacobson and Brian Doss. Both books describe Integrative Behavioral Couple Therapy (IBCT). More recently, he has been involved in the widespread dissemination and testing of IBCT through the U.S. Department of Veterans Affairs and through an online adaptation of IBCT, www.ourrelationship.com. Christensen has done workshops on IBCT in the United States, Canada, Europe (Denmark, France, Germany, Sweden, Switzerland, and the United Kingdom), Asia (Hong Kong), and South America (Brazil, Colombia, and Peru). Christensen's therapy and research have been cited in the Washington Post, New York Times, Newsweek, Time Magazine, U.S. News and World Report, USA Today, and other magazines and newspapers.

Brian Doss is an Associate Professor of Psychology at the University of Miami. He received his Ph.D. from UCLA working under the mentorship of Dr. Christensen, completed his internship at the Medical University of South Carolina and the Ralph H. Johnson Veteran Administration Hospital, and was an Assistant Professor at Texas A&M University for 5 years before moving to Miami in 2009. Dr. Doss has received multiple grants from the National Institutes of Health and the Administration for Children and Families. He teaches undergraduate and graduate classes on couple therapy and romantic relationships. His research is focused on ways to increase the reach of couple interventions, including OurRelationship.com and a self-help book titled Reconcilable Differences. Dr. Doss' research has been cited on The Today Show, CNN, MSNBC, New York Times, Miami Herald, and elsewhere.

Participants earn 7 continuing education credits.

Moderate level of familiarity with the material

Categories: Couples/Close Relationships, Treatment - Interpersonal Therapies

Keywords: Couples/Close Relationships, Treatment, Technology/Mobile Health

Integrative Behavioral Couple Therapy (IBCT) is an evidence-based approach to the treatment of couples developed by Andrew Christensen and the late Neil S. Jacobson. IBCT is integrative in that it brings together the twin goals of emotional acceptance and behavior change. Also, it integrates a variety of treatment strategies under a consistent behavioral theoretical framework. In this training, Christensen will describe the theoretical notions that distinguish IBCT from traditional and cognitive behavioral couple therapies. Then he will describe the four stages of treatment: assessment, feedback, active intervention, and termination. He will illustrate some of the assessment and treatment strategies with videotaped examples of couples in IBCT. He will also briefly describe the empirical support for IBCT. Brian Doss will describe the translation of IBCT into an online version (OurRelationship.com). Doss will describe and illustrate the three main phases of the intervention captured by the acronym OUR: observe, understand, and respond. He will then discuss two nationwide clinical trials that demonstrate the effectiveness of the intervention. He will conclude with discussion of the integration of the online program with in-person therapy.

At the end of this session, the learner will be able to:

  • Describe the DEEP conceptualization of couple problems in Integrative Behavioral Couple Therapy (IBCT).
  • Describe the evaluation procedures in IBCT.
  • Describe the feedback process in IBCT.
  • Distinguish between the treatment strategies of empathic joining and unified detachment.
  • Describe the three core components of the OurRelationship.com program
Recommended Readings:

Briggs, J. G., Finley, M. A., & Sprenkle, D. H. (2015) A substantive and methodological review of the integrative behavioral couple therapy research program: Clinical implications for a research informed practice. Journal of Couple & Relationship Therapy, 14, 219-253.

Christensen, A., Atkins, D. C., Baucom, B., & Yi, J. (2010). Marital status and satisfaction five years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy. Journal of Consulting and Clinical Psychology, 78, 225-235.

Christensen, A., Doss, B. D., & Jacobson, N. S. (2014). Reconcilable differences. New York: Guilford.

Christensen, A., Wheeler, J. G., Doss, B. D., & Jacobson, N. S. (2014). Couple distress. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders (5th ed., pp. 703 - 731). New York: Guilford.

Doss, B. D., Cicila, L. N., Georgia, E. J., Roddy, M. K., Nowlan, K. M., Benson, L. A., & Christensen, A. (2016). A randomized controlled trial of the web-based ourrelationship program: Effects on relationship and individual functioning. Journal of Consulting and Clinical Psychology, 84, 285-296.

CIT 3: Thursday, November 21 | 8:30 a.m. - 5:00 p.m.

Working With Anxious Youth: Clinical Strategies Within Empirically Supported Treatment

Philip C. Kendall, Ph.D., Temple University

Dr. Kendall is Distinguished University Professor and Laura H. Carnell Professor of Psychology. His CV lists over 700 publications and 35 years of grant support. He was identified as a "Most Highly-Cited" individual in social and medical sciences (top 1%). His recent H factor is 123.

Dr. Kendall was a Fellow at the Center for Advanced Study in the Behavioral Sciences at Stanford, won the Research Recognition Award from the Anxiety Disorders Association of America and the Aaron T. Beck Award for "Significant and Enduring Contributions." He received an award for the "Most Valuable Paper With Enduring Impact." The awarding journal considered papers published at least 30 years ago. His paper entitled "The Anxious Child: Cognitive-Behavioral Treatment Strategies" was the winner.

His treatment for anxiety, the Coping Cat, has been evaluated in RCTs in different countries, examined by committees, and subsequently given the highly regarded designation of an "empirically supported treatment."

Dr. Kendall has contributed as a scientist, teacher, and leader. He is known for rigorous research methods, creative and integrative approaches, and commitment to graduate mentoring. A completer of the New York Times crossword (except Saturday), Dr. Kendall enjoys playing basketball, tennis, and time in the ocean and with his family.

Participants earn 7 continuing education credits.

Moderate level of familiarity with the material

Category: Child/Adolescent-Anxiety, Treatment-CBT

Keywords: Anxiety, Adolescent, Treatment

This CIT will provide an initial description of the theory that guides the intervention and an overview of the nature, symptoms, and experience of anxiety in youth. We will consider when anxiety is developmentally reasonable and when it is disordered. Cognitive, behavioral, family (parenting), and emotional factors will be addressed.

The bulk of the CIT will address intervention strategies. Each of the strategies (e.g., coping modeling, changing self-talk, affect education, exposure tasks) will be described in detail and illustrated with case examples and some video illustrations. A flexible implementation of the manual-based approach will be described and encouraged.

Sample videos of actual sessions and reenacted sessions will be available to be played and discussed, and small groups of CIT participants will have an opportunity to engage in a role-play activity.

Research outcomes that inform decisions regarding the provision of clinical services for anxious youth will be considered and these findings highlight both (a) what we know and (b) what we do not yet know about the treatment of anxiety disorders in youth.

At the end of this session, the learner will be able to:

  • Accurately identify anxiety disorders in youth.
  • Describe the nature of anxiety disorders in youth, including developmental, cognitive, behavioral, and familial forces.
  • Acquire intervention skills for the provision of empirically supported mental health services for youth suffering from anxiety disorders.
  • Practice empirically supported intervention skills for the provision anxiety treatment for youth.
  • Gain a more detailed understanding of the flexible application of cognitive-behavioral treatment for anxiety disorders in youth.
Recommended Readings:

Kendall, P. C., & Frank, H. (2018). Implementing evidence-based treatment protocols: Flexibility within fidelity. Clinical Psychology: Science and Practice, 25, 1-12. DOI: 10.1111/cpsp.12271.

Mendlowitz, S., Manassis, K., Bradley, S., Scapillato, D., Miezitis, S., & Sha, B. (1999). Cognitive-behavioral group treatments in childhood anxiety disorders: The role of parental involvement. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 1223-1229.

Silk, J., Tan, P., Ladouceur, C., Meller, S., Siegle, G., McMakin, D., . . . Ryan, N. (2018). A randomized clinical trial comparing individual Cognitive Behavioral Therapy and Child-Centered Therapy for child anxiety disorders. Journal of Clinical Child and Adolescent Psychology, 47, 542-554.

Swan, A., Kendall, P. C., Olino, T., Ginsburg, G., Keeton, C., Compton, S., . . . Albano, A. M. (2018). Results from the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS): Functional outcomes. Journal of Consulting and Clinical Psychology, 86, 738-750.

VillabØ, M., Narayanan, M., Compton, S., Kendall, P. C., & Neumer, S. (2018). Cognitive-behavioral therapy for youth anxiety: An effectiveness evaluation in community practice. Journal of Consulting and Clinical Psychology, 86, 751-764.



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