TICKETED SESSIONS | Master Clinician Seminars

Many clients have been told that there are certain emotions that they should not have-envy, jealousy, ambivalence, boredom, resentment, regret, sadness, anger, and anxiety. They have been told, "You shouldn't feel that way"; "Get over it"; or "Stop crying." But a life worth living often involves experiencing unpleasant emotions that are often complex and apparently "conflicting." Just as people with OCD struggle with unwanted intrusive thoughts or people who ruminate look for "The Answer," we often struggle to rid ourselves of unwanted feelings. A new form of CBT-Emotional Schema Therapy, which draws on ACT, DBT, cognitive therapy and metacognitive therapy-emphasizes that all emotions evolved because they were adaptive-including emotions that we are often told we should not have. We will review beliefs in emotional perfectionism and existential perfectionism-that is, the belief that we should feel good and that our lives should follow certain expectations that we have. But real life is filled with disappointments, loss, unfairness, and even betrayal. I describe a model of emotional inclusiveness, containment of unpleasant emotions, normalization of "the abnormal," expansion and differentiation of emotions, and the use of these emotions to differentiate the values and meanings that we have. We will review how clients have learned problematic views of emotions, emotion regulation, and emotion expression and how these beliefs currently impede acceptance and tolerance of feelings. We will review these problematic beliefs about fear of emotions, such as the belief in Pure Mind, the need for "clarity" as opposed to openness and fluidity of emotion, beliefs in the durability and need for control of "negative" emotions, shame and guilt about emotions, and intolerance of "conflicting" emotions. We will examine how clients can overcome their fear of crying and in sharing painful feelings, while helping clients also pursue a range of other emotions. A wide range of techniques will be described and experiential participation will be encouraged to assist in deepening meaning without avoiding the unpleasant emotions often associated with finding meaning.

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

• Identify problematic beliefs and strategies about "unwanted" emotion.
• Implement techniques, metaphors, and experiential exercises to increase integration and use of unpleasant emotions.
• Identify beliefs in Emotional Perfectionism, Existential Perfectionism, and Pure Mind

Recommended Readings:

Leahy, R. L. (2015). Emotional schema therapy. New York: Guilford Press.

Thoma, N., & McKay, D. (Eds.). (2014). Working with emotion in cognitive behavioral therapy: Techniques for clinical practice. New York: Guilford Press.

Herbert, J., & Forman, E. (Eds.). (2010). Acceptance and mindfulness in cognitive behavior ther-apy: Understanding and applying the new therapies. New York: Wiley.

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 seminar 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, 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 seminar presents new evidence from NIMH grants that can be applied immediately in practice.

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

• 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. (2018). The International Society for Bipolar Disorders Task Force Report on pediatric bipolar disorder: Knowledge to date and directions for future research. Bipolar Disorders. doi:10.1111/bdi.12556

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

Family-based Healthy Weight Coaching (F-b HWC) is a psychoeducational intervention designed to help parents engage in family lifestyle change to promote healthy weight management. It is appropriate for parents with children who have current weight concerns or those at risk for becoming overweight due to maladaptive eating habits and/or family history. The goal is to empower parents to navigate making uncomfortable changes in family routines and norms about eating. The intervention is based on Appetite Awareness Training (AAT), a self-monitoring strategy originally designed and evaluated within interventions targeting binge eating, bulimia, and weight management for adults. AAT aims to restore a more natural feeling of control over eating by training individuals to be more aware of, and then rely primarily on, internal cues of moderate hunger and fullness to regulate their eating rather than responding to emotional cues, environmental cues, or following food plans/diet rules. AAT discourages both "getting too hungry" as well as "getting too full." The approach addresses the need for portion control while minimizing feelings of hunger and/or deprivation. In this adaptation for family use, parents first learn to monitor their own appetite using an electronic app. Parents are then provided a child's storybook which uses the fun, child-friendly metaphor of "training your inner pup" to explain the use of three tools-a Hunger Scale, a Worth It Scale, and a Stomach Stop Sign-designed to reinforce the child's self-awareness of appetite cues. Cases of families with targeted children ranging in age from 8 to 14 will be presented.

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

• Describe the rationale for Family-based Healthy Weight Coaching and learn how to present the rationale to parents.
• Explain how to use a self-monitoring app and child-friendly metaphors to help parents make healthy lifestyle changes for themselves and their family.
• Respond to the most common parent concerns and difficulties in implementing healthy behavior change in the home.

Craighead, L. W. (2017). Training your inner pup to eat well: Let your stomach be your guide. Atlanta, GA: Lanier Press.

Greene, T. (2012). Sacking obesity. New York: HarperCollins.

Njardvik U., Gunnarsdottir, T., Olafsdottir, A., Craighead L., Boles R., & Bjarnason R. (2018). Incorporating appetite awareness training within family-based behavioral treatment of pediatric obesity: A randomized controlled pilot study. Journal of Pediatric Psychology, 43, 9, 1017-1027. https://doi.org/10.1093/jpepsy/jsy055

Suicide is the second leading cause of death among youth, with suicide attempts, nonsuicidal self-injurious behaviors, and suicidal ideation becoming increasingly prevalent. Clinicians are often loath to treat suicidal youth in outpatient settings due to the inherent clinical challenges associated with working with suicidal youth. DBT has recently become an established evidence-based therapy for suicidal adolescents in outpatient settings since the results from two randomized controlled trials have been published by different investigators from two countries (McCauley et al., 2018; Mehlum et al., 2014).

Effectively engaging suicidal adolescents in psychotherapy requires the use of a number of DBT strategies, including orientation, commitment, dialectical, validation, and stylistic, to name a few (Miller, Rathus, & Linehan, 2007). One of the challenges for many DBT therapists working with adolescents is figuring out a way to more formally "connect the dots" between the teen's problem behaviors, his or her life worth living goals, and showing how DBT therapy bridges the two. Targeting this problem along with other potential orientation/commitment challenges are highlighted in this seminar.

This session is intended to help participants learn numerous key DBT strategies to engage and retain suicidal youth and their families in outpatient treatment. The seminar leader will use didactic teaching, role-playing, and video clips, to convey the material.

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

• Discuss the biosocial theory and how it helps to explain adolescents' emotional dysregulation.
• Discuss how to build and strengthen client's commitment by more effectively orienting them-by connecting the dots between clients' problem behaviors, clients' life worth living goals, and DBT treatment.
• Identify and employ key orientation, commitment, dialectical and stylistic strategies utilized in the first several individual DBT sessions with teens and families.

Mehlum, L., Tormoen, A., Ramberg, M., Haga, E., Diep, L., Laberg, S., . . . Groholt, B. (2014). Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: A randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53(10), 1082-1091.

Miller, A.L., Rathus, J.H., & Linehan, M.M. (2007). Dialectical behavior therapy with suicidal adolescents. New York: Guilford Press.

Rathus, J.H., & Miller, A.L. (2015). DBT skills manual for adolescents. New York: Guilford Press.

Swenson, C.R. (2018). DBT principles in action. New York: Guilford Press.

Recent conceptualizations of anxiety, depressive, and related "emotional" disorders emphasize their similarities rather than their differences. In response, there has been a movement in recent years away from traditional disorder-specific manuals for the treatment of these disorders and toward treatment approaches that focus on addressing psychological processes that appear to cut across disorders. These "transdiagnostic" evidence-based treatments may prove to be more cost-efficient and have the potential to increase availability of evidence-based treatments to meet a significant public health need.

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), developed by Dr. David Barlow and colleagues at Boston University, is the most recognizable and widely used transdiagnostic treatment with empirical support for its use. The UP is designed to address the full range of emotional disorders (i.e., anxiety, depressive, and related disorders) by targeting common core temperamental vulnerabilities, particularly neuroticism, that contribute to the development and maintenance of these frequently co-occurring disorders rather than surface-level, DSM diagnostic symptoms.

This seminar goes beyond an introduction to the UP by focusing on the "nuts and bolts" of transdiagnostic assessment, case conceptualization, and real-world clinical application of the UP's core treatment modules. A clinical case study will be used to illustrate the use of this protocol to address symptoms of anxiety, depression, and other emotion regulation difficulties. Attendees are expected to gain a better understanding of the UP and how this innovative protocol can be effectively applied in their clinical practice.

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

• Demonstrate application of core treatment modules using case material and clinical vignettes.
• Illustrate a transdiagnostic approach to assessment and case conceptualization.
• Describe how to adapt core treatment strategies of the UP (e.g., emotion awareness training, cognitive reappraisal, reduction of emotion avoidance and maladaptive emotion driven behaviors) based on the patient's presenting symptoms.

Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., . . . Cassiello-Robbins, C. (2017). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA Psychiatry, 74(9), 875-884. doi:10.1001/jamapsychiatry.2017.2164

Brown, T. A., & Barlow, D. H. (2009). A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: Implications for assessment and treatment. Psychological Assessment, 21(3), 256-271.

Bullis, J.R., Boettcher, H.T. Sauer-Zavala, S., Farchione, T.J., & Barlow, D.H. (in press). What is an emotional disorder? A transdiagnostic mechanistic definition with implications of assessment, treatment, and prevention. Clinical Psychology: Science and Practice. https://doi.org/10.1111/cpsp.12278

Jarvi-Steele, S., Farchione, T.J., Cassiello-Robbins, C., Ametaj, A., Sbi, S., Sauer-Zavala, S., & Barlow, D.H. (2018). Efficacy of the Unified Protocol for transdiagnostic treatment of comorbid psychopathology accompanying emotional disorders compared to treatments targeting single disorders. Journal of Psychiatric Research, 104, 211-216. doi: 10.1016/j.jpsychires.2018.08.005

Body Dysmorphic Disorder (BDD) is classified under obsessive-compulsive spectrum disorders due to its many shared similarities with OCD, including preoccupations associated with engagement in safety behaviors. Patients with BDD have a perceived or imagined defect in their physical appearance, and may engage in behaviors such as mirror gazing, camouflaging, ruminating, skin picking, intense social comparison, and needless dermatological treatment or cosmetic surgery. Though there has been a surge of effective pharmacological and cognitive behavioral treatments in the past 10 years, BDD is still underrecognized and often misdiagnosed. This seminar will begin with a review of the theoretical and empirical models of the psychopathology of and treatment for BDD. It will continue with discussion of and practical instruction on strategies to mitigate symptoms, such as image rescripting, attentional training, habit reversal, and exposure and response prevention. Through recent and ongoing research, our ability to treat and recognize BDD has dramatically improved our ability to alieve a significant amount of the poor quality of life and social isolation that many patients with BDD experience. This seminar will capitalize on these recent improvements through the emphasis of new cognitive and behavioral treatment strategies for this challenging disorder.

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

• Recognize and diagnose body dysmorphic disorder.
• Identify cognitive behavioral models of BDD and the factors that maintain symptoms.
• Utilize treatment strategies as well as strategies for engagement and change.

Allen, A. (2006). Cognitive-behavioral treatment of body dysmorphic disorder. Primary Psychiatry, 13(7), 70-76.

Neziroglu, F., Bonasera, B., & Curcio, D. (2018). An intensive cognitive behavioral treatment for body dysmorphic disorder. Clinical Case Studies, 17(4), 195 - 206.

Neziroglu, F., Borda, T., Khemlani-Patel, S., & Bonasera, B. (2018). Prevalence of bullying in a pediatric sample of body dysmorphic disorder. Comprehensive Psychiatry 18, 12-16.

Neziroglu, F., & Lippman, N. (2015). A review of body dysmorphic disorder after 20 years of research. Australian Clinical Psychologist, 1(1), 22-29.

Wilhelm, S., Phillips, K. A., Fama, J. M., Greenberg, J. L., & Steketee, G. (2011). Modular cognitive-behavioral therapy for body dysmorphic disorder. Behavior Therapy, 42(4), 624-633.

Both cognitive-behavioral therapy (CBT) and motivational interviewing (MI) based interventions have decades of empirical study and are front-line evidence-based treatment interventions for a variety of psychological and self-care treatments. Despite the strongest evidence for CBT (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012), there are still many individuals who do not respond to treatment, do not adhere to between-session practice change tasks, discontinue treatment prematurely, or, after initial success, are unable to maintain change (Naar-King, Earnshaw, & Breckon, 2013). The use of a collaborative, guiding conversational style to strengthen a person's own intrinsic motivation and commitment for change (motivational interviewing) may be a powerful way to maximize outcomes in cognitive-behavioral treatments. There are several ways that MI can be combined with CBT. First, MI may be delivered as a brief pretreatment to build motivation for multisession intervention. Second, MI can be used at specific moments during CBT when discord or ambivalence arises. Third, MI can serve as an integrative framework in which other interventions, such as CBT strategies, could be delivered.

After providing a brief didactic presentation, this seminar will interact with participants to demonstrate and practice integrating MI with assessment and collaborative treatment planning and integrating MI with an example CBT-intervention, behavioral activation. We will end with questions and discussion.

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

• Describe the MI Spirit and the reinforcement of change language as the foundation for patient/client-provider interactions when conducting CBT interventions.
• Demonstrate integrating MI with collaborative assessment and treatment planning.
• Explain the use of MI to promote adherence to CBT interventions.

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

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

Naar-King, S., Earnshaw, P., & Breckon, J. (2013). Toward a universal maintenance intervention: Integrating cognitive-behavioral treatment with motivational interviewing for maintenance of behavior change. Journal of Cognitive Psychotherapy, 27(2), 126-137. DOI: 10.1891/0889-8391.27.2.

Tourette Syndrome is a neurological condition consisting of multiple motor and vocal tics that are presumably due to failed inhibition within cortical-striatial-cortical motor pathways. In recent years, there has been a growing recognition among psychiatry and neurology about the utility of behavior therapy procedures in managing the symptoms of Tourette Syndrome in children and adults. Recently, the American Academy of Neurology recommended behavior therapy as a first-line treatment for Tourette Syndrome. This Comprehensive Behavioral Intervention for Tics (CBIT) combines elements of habit reversal training with psychoeducation and function-based behavioral interventions. Unfortunately, very few clinicians have been trained in evidence-based treatments for Tourette Syndrome and tic disorders, and in most U.S. cities there are no behavior therapists who provide this treatment. In this session, developers of CBIT will describe and demonstrate the treatment. In addition to learning the general therapeutic techniques, attendees will learn about the underlying model of Tourette as well as the theoretical and empirical rationale for using behavioral interventions. Various instructional technologies will be employed including didactic instructions, videotaped samples of actual treatment, and role-play demonstrations.

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

• Recognize tic disorders and understand their key phenomenological features.
• Explain the core elements of behavior therapy for tic disorders.
• Discuss the evidence base supporting the efficacy of behavior therapy for tic disorders.

Piacentini, J. C., Woods, D. W., Scahill, L. D., Wilhelm, S., Peterson, A., Chang, S., . . . Walkup, J. T. (2010). Behavior therapy for children with Tourette Syndrome: A randomized controlled trial. Journal of the American Medical Association, 303, 1929-1937.

Rizzo, R., Pellico, A., Silvestri, P. R., Chiarotti, F., & Cardona, F. (2018). A randomized controlled trial comparing behavioral, educational, and pharmacological treatments in youths with chronic tic disorder or Tourette syndrome. Frontiers in Psychiatry, 9, 1-9.

Woods, D. W., Piacentini, J. C., Chang, S., Deckersbach, T., Ginsburg, G., Peterson, A. L., . . . Wilhelm, S. (2008). Managing Tourette's Syndrome: A behavioral intervention for children and adults (therapist guide). New York: Oxford University Press.