TICKETED SESSIONS | Institutes

Individuals with clinical anxiety and fear comprise a large proportion of many therapists' caseloads. Although exposure therapy is highly effective for these conditions, many individuals fail to benefit or experience a return of fear at some point. 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 points to specific techniques for implementing exposure that can optimize short- and long-term gains. Collectively, inhibitory learning strategies emphasize fear tolerance, as opposed to habituation, for protecting against return of fear. Moreover, they introduce "desirable difficulties" into exposure sessions by challenging patients to consolidate and generalize learning via novel therapeutic strategies to foster more durable outcomes (i.e., long-term maintenance). This institute aims to help clinicians understand and apply this model to optimize exposure therapy. Incorporating attendee feedback from our 2018 ABCT institute that received extremely enthusiastic evaluations (100% recommended offering it again in 2019), the inhibitory learning model will first be described and distinguished from traditional approaches to exposure. Numerous strategies to optimize inhibitory learning will then be introduced and illustrated in detail. These strategies include framing exposure to disconfirm threat-based expectations, introducing variability to decontextualize extinction learning, deepening extinction by combining fear cues, augmenting learning with affect labeling and attentional focus, selectively using cognitive therapy to consolidate learning, and options for the elimination or judicious use of safety behaviors. The institute will be interactive and include numerous complex case examples, video demonstrations, and experiential exercises.

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

• Distinguish the inhibitory learning approach to exposure from the traditional emotional processing approach.
• Explain why it is important to foster fear tolerance during exposure, as opposed to relying solely on fear reduction and habituation.
• Describe methods of tracking changes in expectations during exposure therapy, rather than SUDS.
• Describe how to introduce variability into exposure sessions.
• Describe how to implement cognitive therapy during exposure sessions to promote extinction 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.

Arch, J. J., & Abramowitz, J. S. (2015). Exposure therapy for obsessive-compulsive disorder: An optimizing inhibitory learning approach. Journal of Obsessive-Compulsive and Related Disorders, 6, 174-182.

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.

Deacon, B., Kemp, J. J., Dixon, L. J., Sy, J. T., Farrell, N. R., & Zhang, A. R. (2013). Maximizing the efficacy of interoceptive exposure by optimizing inhibitory learning: A randomized controlled trial. Behaviour Research and Therapy, 51(9), 588-596.

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.

Motivational Interviewing (MI) is a client-centered, evidence-based, and semistructured method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. This intermediate-level institute/workshop is designed for helping professionals and trainees working in primary care and other health care settings who are interested in learning additional MI skills to increase patients' motivation to engage in healthy behavior change. The training is provided by experienced trainers in MI, including one who is a member of the Motivational Interviewing Network of Trainers (MINT). Participants will learn and practice methods to assist patients regarding the promotion of healthy lifestyle behaviors (e.g., diet and exercise, medical adherence, tobacco cessation, oral health). The institute will review the conceptual model for understanding MI, identify the key principles of MI, provide an operational definition of "MI spirit," and describe the evidence base for the use of MI for promoting health behaviors. Using demonstrations and role-play, the application of specific techniques to increase patient motivation (and respond to resistance) will be covered. As "change talk" (in contrast to "sustain talk" and avoidance) has been demonstrated to be associated with future behavior change, methods will be described to elicit, identify, and reinforce it. The institute will include experiential components in which participants work in dyads and small groups, and with the trainers, to practice skills in a comfortable, interactive, and supportive learning environment. Integrating MI in primary care and other health care settings will be addressed, including how to utilize brief interventions.

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

• Conceptualize the MI model and the evidence base for the use of MI in health behavior change with patients in health care settings.
• Employ specific MI methods for eliciting change talk in clients in the context of health behavior.
• Utilize MI in primary care and other health care settings in working with adult, adolescent, and older adult patients.
• Apply specific MI interventions to increase patient motivation for healthy behavior change, including brief interventions.
• Practice specific techniques for managing patient ambivalence regarding health behavior change.

Arkowitz, H., Westra, H. A., Miller, W. R., & Rollnick, S. (2015). Motivational

Interviewing in the treatment of psychological problems (2nd 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. Oxford Handbooks Online.

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

Miller, W. R., Rollnick, S., & Butler, C. C. (2008). Motivational Interviewing in health care: Helping patients change behavior. New York: Guilford.

Rosengren, D. B. (2009). Building Motivational Interviewing skills: A practitioner workbook. New York: Guilford.

This institute provides training in Written Exposure Therapy (WET), an evidence-based treatment for PTSD. It presents the theory underlying WET, a brief overview of WET's empirical support, and step-by-step instructions in the WET protocol techniques. Throughout the workshop strategies for conceptualizing and dealing with comorbidity, managing avoidance, and keeping patients optimally engaged are provided.

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

• Explain barriers to implementing first-line PTSD treatment approaches.
• Identify critical elements of written exposure therapy.
• Describe the efficacy data for written exposure therapy.
• Describe situations when it is appropriate to use written exposure therapy.
• Apply skills learned to deliver written exposure therapy.

Sloan, D. M., & Marx, B. P. (2019). Written exposure therapy for PTSD: A brief treatment approach for mental health professionals. Washington, DC: American Psychological Press.

Asnaani, A., McLean, C. P., & Foa. E. B. (2016). Updating Watson & Marks (1971): How has our understanding of the mechanisms of extinction learning evolved and where is our field going next? Behavior Therapy, 47, 654-669.

Finley, E. P., Garcia, H. A., Ketchum, N. S., McGeary, D. D., McGeary, C. A., Stirman, S. W., & Peterson, A. L. (2015). Utilization of evidence-based psychotherapies in Veterans Affairs posttraumatic stress disorder outpatient clinics. Psychological Services, 12, 73-82.

Imel, Z. E., Laska, K., Jakupcak, M., & Simpson, T. L. (2013). Meta-analysis of dropout in treatments for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 81(3), 394-404.

Pennebaker, J. W., & Beall, S. K. (1986). Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95, 274-281.

In the last 20 years, the evidence base for cognitive behavioral therapy involving exposure plus response prevention for treating youth with OCD has grown substantially. Treatment typically involves 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 more passive forms of avoidance. Randomized controlled trials conducted around the world now 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 advances notwithstanding, response to treatment is still neither universal nor complete, and this subspecialty expertise remains difficult to find in many, if not most, clinical settings. This institute will focus on common issues that arise in providing CBT for children and adolescents, and clinical strategies to address these challenges will be presented. 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 made available for discussion of clinical cases in which optimal outcomes are proving difficult to achieve.

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

• Articulate the expected trajectories of response to CBT for pediatric OCD, which serve as a guide for treatment.
• Identify common clinical challenges to achievement of optimal outcomes, including psychiatric comorbidity, family accommodation, and motivational readiness.
• Describe clinical strategies to address these common clinical challenges.
• Suggest common pathways forward for the clinical management of accommodation.
• Generate clinical strategies to identify and treat tic-like OCD symptoms.

Benito, K. G., Machan, J., Freeman, J. B., Garcia, A. M., Walther, M., Frank, H., . . . Franklin, M. (2018). Measuring fear change within exposures: Functionally defined habituation predicts outcome in three randomized controlled trials for pediatric OCD. Journal of Consulting and Clinical Psychology, 86(7), 615-630.

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. E., Freeman, J. B., & March, J. S. (2019). Treating OCD in children and adolescents: A cognitive-behavioral approach. New York, NY: Guilford Press.

Franklin, M., Sapyta, J., Freeman, J., Khanna, M., Compton, S., Almirall, D., . . . March, J. S. (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.

Storch, E. A., Wilhelm, S., Sprich, S., Henin, A., Micco, J., Small, B. J., . . . Geller, D. A. (2016). Efficacy of augmentation of cognitive behavior therapy with weight-adjusted D-cycloserine vs placebo in pediatric obsessive-compulsive disorder: A randomized clinical trial. JAMA Psychiatry, 73(8), 779-788.

After clarifying values and stating intentions, what are ways to help your patients, employees, or consultees get to, complete, and maintain behavioral change? This institute focuses on translating advances in motivational research into stepwise interventions to enhance and maintain motivation, taking into account both strategic and habitual processing (your dual nature). Changing contexts to change or prime motivations, adding in concurrent motivators, attending to process motivations, and arranging appropriate consequences will be discussed from the perspective of introducing multiple motivational interventions across ongoing behavioral chains. Novel strategies for reducing impulsivity and other derailing processes will also be discussed. In sum, motivational interventions will be presented from a transdiagnostic perspective, so that no matter whether your patients/consultees are focusing on weight loss, reducing procrastination/avoidance, completing behavioral assignments, employee management, or maintaining healthy behaviors, this institute will address core processes underlying goal achievement.

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

• Recognize common cognitive and affective factors that derail goal pursuit, especially across longer intervals.
• Attend to the role of context in behavioral self-control, and the importance of manipulating context to influence motivation.
• Evaluate motivational factors across chains of behavior, focusing on antecedent, concurrent, and consequent events.
• Delineate factors that influence the ability to apply strategic processing, and alternative self-control strategies.

Bickel, W.K., Jarmolowicz, D.P., Mueller, E.T., Koffarnus, M.N., & Gatchalian, K.M. (2015). Excessive discounting of delayed reinforcers as a trans-disease process contributing to addiction and other disease-related vulnerabilities: Emerging evidence. Pharmacology & Therapeutics, 134(3), 287-297.

Lin, H., & Epstein, L. H. (2014). Living in the moment: Effects of time perspective and emotional valence of episodic thinking on delay discounting. Behavioral Neuroscience, 128(1),12-19.

Otto, M. W., Eastman, A., Lo, S., Hearon, B. A., Bickel, W. K., Zvolensky, M., Smits, J. A. J., & Doan, S. N. (2016). Anxiety sensitivity and working memory capacity: Risk factors and targets for health behavior promotion. Clinical Psychology Review, 49, 67-78.

Tice, D. M., Batslavsky, E., & Baumeister, R. F. (2001). Emotional distress regulation takes precedence over impulse control. If you feel bad, do it! Journal of Personality and Social Psychology, 8, 53-67.

Emerging adulthood is a developmental stage characterized by uncertainty, anxiety, optimism and growth (Arnett, 2014). For youth with preexisting or new anxiety disorders, this stage is often compounded by an inability to achieve independence. Although effective treatments for anxiety in youth exist (Walkup, et al., 2008), long-term remission through emerging adulthood is uncommon (Ginsburg et al., 2018). Our model argues that parent involvement, development, and salient exposures are critical for remission. Parents are often minimally involved in studies and clinical care. Age-appropriate functioning has also not been a primary target of treatment. Hence, we developed a systematic approach to assisting youth and parents to understand and meet developmental tasks while treating anxiety. Central is for youth to take on the challenges of anxiety and daily living with appropriate parental guidance and support. In this institute, we discuss a model for integrating core components of effective CBT for anxiety with novel components designed to address patient-caretaker dependency, role transitions, and attainment of behaviors necessary for independent functioning. This developmentally informed treatment is aimed at anxiety relief and improved functioning, based on our experiences in treating transition-aged youth and informed by critical reviews of the developmental literature. We will dive deep into practical aspects of the model, demonstration, and practice of techniques to address caregiver involvement in young adult treatment. We will provide instruction on developmental assessment that is central to our unique parent-youth "transition" sessions. Participants will be taught how to implement the transition component, where youth and parents address overprotection, fears and concerns, conflict, and the transfer of responsibility to youth for meeting developmental milestones. We address parents' fears of letting their youth struggle, demonstrate transition sessions, and review our short-term (5-session) caregiver grup. We focus on exposure for this population (i.e., contextually rich exposures, virtual reality and apps, community-based exposures), demonstrate and practice the unique components of the program.

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

• Recognize the tasks of development necessary for adolescents to transition to adulthood.
• Devise strategies for addressing parental overinvolvement and adolescent dependency including family communication and problem solving.
• Develop exposures that maximize the use of context and address developmental stage issues to increase ecological validity and reduce or develop tolerance of anxiety.
• Implement caregiver-youth transition sessions.
• Assess developmental milestones and form goals for increasing youth independence.

Albano, A. M., & Hoffman, L. (2018). Treatment of social anxiety disorder. In P. C. Kendall (Ed.), Cognitive therapy with children and adolescents: A casebook for clinical practice (3rd ed., pp. 15-49). New York: Guilford Press.

Arnett, J. J. (2004). Emerging adulthood: The winding road from late teens through the twenties. New York: Guilford Press.

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, 310-318.

Guerry, J., Hambrick, J., & Albano, A.M. (2015). Adolescent social phobia in clinical services. In K. Ranta, A. M. La Greca, L.-J. García-Lopez, & M. Marttunen (Eds.), Social anxiety and phobia in adolescents. New York: Springer.

Walkup, J., Albano, A.M., Piacentini, J.P., Birmaher, B., Compton, S., Sherrill, J., . . . Kendall, P.C. (2008). Cognitive behavioral therapy, sertraline, or a combination for childhood anxiety. New England Journal of Medicine, 359, 2753-2766.

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 for children on the autism spectrum and other special populations will be discussed.

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

• Describe the theoretical background underlying PCIT.
• Demonstrate the PRIDE skills that are used for relationship-enhancement component of PCIT.
• Explain the importance of coding parent-child interactions as a mechanism for assisting caregivers in mastering skills.
• Demonstrate the basic skills of discipline in PCIT.
• Discuss 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. Available from: http://www.pcit.org/pcit-certification.

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.

Drawing on recent findings from evidence-based programs of CBT supervision, this presentation will highlight the essential contents and processes of CBT supervision. The following major areas of interest will be described: (a) the supervisory relationship, (b) the chief responsibilities and teaching methods of a CBT supervisor, (c) promoting ethical behavior and cross-cultural sensitivity in supervisees, (d) facilitating supervisee competency across different levels of supervisee development, (e) managing important administrative tasks, and (f) providing feedback and formal evaluations in a timely, constructive manner. Multimodal aspects of the methods of supervision will be highlighted, including the use of readings, audio-visual recordings, role-modeling, and role-playing. This 5-hour preconference institute is designed for early-career professionals who anticipate or have recently commenced providing CBT supervision to trainees, as well as more experienced CBT supervisors looking for a refresher course. Demonstration role-plays, video, and interactive discussion of challenging supervision scenarios will be utilized, along with didactics.

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

• Enact the multiple professional responsibilities of a clinical supervisor, and to impart multiple skills that the clinical trainee must learn.
• Model professionalism, ethical behavior, cross-cultural sensitivity, and relational skills to trainees.
• Teach trainees to conceptualize cases and use the techniques of CBT competently.
• Evaluate and give feedback to trainees.
• Provide supervisees with direct support in times of crisis with a client, while still giving the supervisees room to make decisions and respond effectively.

Corrie, S., & Lane, D. A. (2015). CBT supervision. London, United Kingdom: Sage.

Milne, D. (2009). Evidence-based clinical supervision: Principles and practice. Leicester, United Kingdom: BPS Blackwell.

Newman, C. F, & Kaplan, D. A. (2016). Supervision essentials for cognitive-behavioral therapy. Washington: American Psychological Association.

Sudak, D. M., Codd, R. T., Ludgate, J., Sokol, L., Fox, M. G., Reiser, R., & Milne, D. L. (2015). Teaching and supervising cognitive-behavioral therapy. Hoboken, NJ: Wiley.

Watkins, C. E., & Milne, D. L. (Eds.) (2014). The Wiley international handbook of clinical supervision. Chichester, West Sussex, United Kingdom: Wiley/Blackwell.