TICKETED SESSIONS | Workshops

Despite high rates of comorbidity between PTSD and substance use problems (SUP) in adolescents and adults, few integrated treatments have been rigorously evaluated to date. This slow pace of scientific advancement has left the state of practice stymied. Reasons for this limited progress include compartmentalized mental health and addiction fields; long-standing clinical lore that it is unsafe to engage a youth or adult with SUP in exposure-based treatment due to concerns that exposure-induced distress will exacerbate SUP; and the challenges of conducting comorbidity treatment outcome research.

Risk Reduction Through Family Therapy (RRFT) was developed and evaluated over the past 15 years to address this gap (Danielson et al., 2010, 2012). RRFT is an exposure-based treatment that integrates evidence-based treatments for PTSD (TF-CBT) and substance use disorders (MST principles) to address these commonly co-occurring problems in an integrative fashion. Outcomes from three clinical trials, including a recently completed Stage II RCT (124 adolescents with co-occurring SUP and PTSD followed through 18-month post-baseline; Danielson, Adams, et al., under review), support the feasibility, safety, and efficacy of RRFT. Given the high rate in which SUP and PTSD co-occur in trauma-exposed adolescents, this workshop is offered to help meet the need for clinicians who serve this vulnerable population. The aim of this workshop is to provide attendees with an overview of and foundation in the RRFT treatment model. In the first part of the training, Drs. Danielson and Adams will briefly review SUP and other high-risk behaviors commonly observed in adolescents who have experienced traumatic events and will briefly describe the results from completed RRFT clinical trials. Next, the majority of the workshop will be dedicated to clinical training in the ecologically based RRFT model. The trainers will describe the goals of each of the seven RRFT treatment components and skills targeted in these components. Key interventions used in the substance abuse component and PTSD component will be of largest focus. The trainers will use a combination of activities, case examples, and practice role-plays to promote learning among attendees. Prior training in TF-CBT is highly recommended.

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

• Describe the associations among substance use problems, other high-risk behaviors, trauma, and PTSD among adolescents.
• Explain the clinical and empirical rationale for taking an integrated and risk reduction approach to treatment with adolescents with co-occurring substance use problems and PTSD.
• List the fundamentals in implementing RRFT.
• Identify the goals and key skills targeted in each of the seven RRFT treatment components.
• Complete an Ecological Functioning Assessment and Substance Use Problem Fit Circle as key interventions applied in RRFT.

Recommended Readings:

Adams, Z. A., McCauley, J. L., Back, S. E., Flanagan, J. C., Hanson, R. F., Killeen, T. K., & Danielson, C. K. (2016). Clinician perspectives on treating adolescents with comorbid posttraumatic stress disorder, substance use, and other problems. Journal of Child & Adolescent Substance Abuse, 25, 575-583.

Danielson, C. K., McCart, M., Walsh, K., de Arellano, M. A., White, D., & Resnick, H. S. (2012). Reducing substance use risk and mental health problems among sexually assaulted adolescents: A pilot randomized controlled trial. Journal of Family Psychology, 26, 628-635.

Dorsey, S., McLaughlin, K. A., Kerns, S. E., Harrison, J. P., Lambert, H. K., Briggs, E. C., ... Amaya-Jackson, L. (2017). Evidence base update for psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child & Adolescent Psychology, 46(3), 303-330.

Hogue, A., Henderson, C. E., Ozechowski, T. J., & Robbins, M. S. (2014). Evidence base on outpatient behavioral treatments for adolescent substance use: Updates and recommendations 2007-2013. Journal of Clinical Child & Adolescent Psychology, 43(5), 695-720.

Suárez, L., Belcher, H., Briggs-King, E., & Titus, J. (2012). Supporting the need for an integrated system of care for youth with co-occurring traumatic stress and substance abuse problems. American Journal of Community Psychology, 49, 430-440.

Transgender individuals are disproportionately burdened by pervasive discrimination, marginalization, and other oppressive social forces (e.g., transphobia). These stressors contribute to well-documented mental health disparities including elevated rates of suicide, anxiety, and depression. While many mental health professionals and ABCT attendees alike are motivated to use the tools of cognitive-behavioral science to address these disparities, far fewer feel prepared to effectively treat clinical distress in transgender people in a culturally affirming, tailored, and evidence-based manner. This gap maintains disparities for this marginalized group and limits the social impact and reach of cognitive-behavioral science and practice.

This workshop is designed to provide basic knowledge of clinical distress in transgender populations along with strategies to conceptualize and intervene in presenting problems, utilizing cognitive-behavioral and minority stress (Meyer, 2003) frameworks. Presenters will demonstrate how to effectively apply cognitive-behavioral treatment strategies to directly address presenting problems and symptoms of transgender clients. The workshop aims to develop and/or enhance application of basic cognitive behavioral strategies (e.g., cognitive restructuring, behavioral activation) and third-wave CBT principles (e.g., mindfulness, compassion, acceptance) to the needs of a marginalized community. The workshop is intended for audiences who have some to little knowledge regarding transgender health. Case vignettes, experiential exercises, and role-plays will be embedded throughout the workshop in order to enhance participants' engagement and learning, offered in an affirming, nonjudgmental, and supportive environment. The broader implications and social impact of addressing transgender mental health disparities will be emphasized.

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

• Develop case conceptualizations of clinical distress associated with transgender-specific stressors using cognitive-behavioral and minority stress frameworks.
• Apply specific cognitive (e.g., cognitive restructuring) and behavioral strategies (e.g., exposure) to address clinical distress in transgender individuals.
• Apply third-wave CBT strategies to both the conceptualization and treatment of clinical distress in transgender clients.

Recommended Readings:

Austin, A., & Craig, S. L. (2015). Transgender affirmative cognitive behavioral therapy: Clinical considerations and applications. Professional Psychology: Research and Practice, 46(1), 21.

Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the Minority Stress Model. Professional Psychology: Research and Practice, 43(5), 460.

Sloan, C. A., Berke, D. S., & Shipherd, J. C. (2017). Utilizing a dialectical framework to inform conceptualization and treatment of clinical distress in transgender individuals. Professional Psychology: Research and Practice, 48(5), 301.

Current behavioral treatments of obesity result in clinically significant weight loss for approximately 50% of patients and binge eating treatments result in significant decreases in binge eating in 40%-60% of patients. Targeting underlying mechanisms of overeating and binge eating could improve current treatment and maintenance outcomes. The behavior susceptibility theory suggests that individuals who overeat are less sensitive to internal hunger and satiety signals and more sensitive to external environmental cues to eat. We developed the Regulation of Cues (ROC) program, which addresses these two underlying mechanisms of overeating. ROC integrates appetite awareness training to target satiety responsiveness and cue-exposure treatment to target food cue responsiveness and utilizes in vivo training with food. We have utilized this treatment with success with overweight adults who binge eat and overweight children and their parents.

This workshop will (a) outline the key components of the ROC program; (b) present findings from published and current studies that utilize ROC; (c) demonstrate how to implement ROC using case examples, role-plays, and audience participation; (d) discuss common challenges with the implementation of ROC. Upon completion, workshop participants will appreciate the rationale for the ROC program, learn about the data supporting ROC, and develop the basic knowledge and skills to deliver the ROC program in clinical settings. Workshop attendees will partake in an appetite awareness training exercise and a cue exposure treatment exercise to gain firsthand experience of what the ROC treatment entails. Accordingly, the majority of the workshop will be spent in experiential learning of the treatment components and preparing attendees to be equipped to deliver the treatment in clinical practice.

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

• Describe the rationale behind the ROC intervention.
• Assess the efficacy data for ROC in children and adults.
• Deliver the critical elements of ROC treatment in clinical practice.

Recommended Readings:

Boutelle, K.N., Knatz, S., Carlson, J., Bergmann, K., & Peterson, C.B. (2017) An open trial targeting food cue reactivity and satiety sensitivity in overweight and obese binge eaters. Cognitive and Behavioral Practice, 24(3), 363-373.

Boutelle, K.N., Zucker, N.L., Peterson, C.B., Rydell, S., Cafri, G., & Harnack, L.J. (2011). Two novel treatments to reduce overeating in overweight children: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 79(6) 759-771.

Craighead, L.W., & Allen, H. (1995). Appetite awareness training: A cognitive behavioral intervention for binge eating. Cognitive and Behavioral Practice, 2(2), 249-270.

Alcohol use is commonly motivated by a desire to regulate one's emotional experience. Overreliance on the use of alcohol to regulate emotion, especially to avoid or escape negative affect, can factor heavily in the development and maintenance of alcohol use disorders. CBT-based Emotion Regulation Treatment of Alcohol Use Disorders (ERT) adapts and integrates evidence-based emotion regulation strategies with addiction treatment to provide an innovative approach to the treatment of alcohol use disorders.

In this workshop, we will review ERT's underlying theory, describe its basic components, including mindfulness and imaginal exposure, and illuminate the core therapeutic principle of ERT-learning to engage with the discomfort of negative emotions and cravings. Participants will learn how ERT strategies may deepen a client's awareness of the physical sensations, thoughts, emotions, and urges that are related to substance use and how to use such information to help clients accept and tolerate negative emotions without resorting to substance use.

Preparing for and conducting the imaginal exposure component of ERT will be a focus of additional attention. Participants will receive instruction on how to prepare the client, present a rationale for exposure, select and develop a scene that includes emotional distress and a desire to drink, develop rating scales, conduct the exposure, and process it afterwards. Case examples and audiovisual recordings will illustrate key elements of this process. We will address commonly asked questions about the delivery of ERT as well as solutions to clinical challenges.

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

• Describe the theory and research that support an emotion regulation approach for individuals with an alcohol use disorder.
• Identify client drinking situations where alcohol is used to avoid negative emotions and develop the situations for use in imaginal exposure.
• Describe four key elements for conducting exposure, including assessing cravings and addressing substance-related avoidance within exposure.

Recommended Readings:

Aldao, A., Sheppes, G., & Gross, J. J. (2015). Emotion regulation flexibility. Cognitive Therapy and Research, 39, 263-278.

Mota, N. P., Schaumberg, K., Vinci, C., Sippel, L. M., Jackson, M., Schumacher, J. A., & Coffey, S. F. (2015). Imagery vividness ratings during exposure treatment for posttraumatic stress disorder as a predictor of treatment outcome. Behaviour Research and Therapy, 69, 22-28.

Stasiewicz, P. R., Bradizza, C. M., & Slosman, K. S. (2018). Emotion regulation treatment of alcohol use disorders: Helping clients manage negative thoughts and feelings. New York: Routledge.

Many behavioral clinicians find themselves practicing in contexts that require brief interventions (i.e., health care, schools, jails, nursing homes) or, if running a private practice, are facing pressure from managed care companies to reduce the number of sessions needed to treat common mental health problems. Fortunately, contemporary research demonstrates that condensed versions of evidence-based treatment packages are comparable, if not superior, to their longer-term counterparts. A process-based explanation of this surprising finding is that there are core underlying therapeutic change mechanisms shared by all behavior therapies that, when properly targeted, result in immediate clinical benefits, irrespective of the number of therapy sessions. The goal thus is to target in-session client behaviors in order to create a pathway for activation of one or more of these underlying mechanisms of change. In this workshop, we will demonstrate these process-based assumptions using Focused Acceptance and Commitment Therapy (fACT), a brief therapy version of ACT. We will describe four potent process-based change mechanisms of the fACT approach: context-oriented self-awareness, acceptance of private experience, reformulation of self-instructional rules, expansion of behavioral variability. These four processes can be sequentially activated by design via use of specific interviewing tactics. Participants will learn through direct practice how to both activate and control the "flow" of these four processes during a clinical conversation. As a result, participants will be better able to conceptualize and deliver single-session interventions that help clients shift from rigid patterns of emotional and behavioral avoidance to flexible patterns of acceptance and value-based behavioral approach strategies.

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

• Use change-oriented interviewing strategies that both activate core therapeutic processes and help structure the "flow" of the clinical conversation.
• Identify and modify core psychological processes that singly, or together, contribute to increased emotional resiliency and change readiness.
• Reformulate the client's underlying system of self-instructional rules, so as to increase the client's readiness and willingness to engage in new patterns of more workable behavior.

Recommended Readings:

Hayes, S., & Hoffman, S. (Eds.). (2018). Process based CBT: The science and core clinical competencies of cognitive behavioral therapies. Oakland, CA: New Harbinger Publications.

Sloan, D. M., Marx, B. P., Lee, D. J., & Resick, P. A. (2018). A brief exposure-based treatment vs cognitive processing therapy for posttraumatic stress disorder: A randomized noninferiority clinical trial. JAMA Psychiatry, 75(3), 233-239.

Strosahl, K., Robinson, P. & Gustavsson, T. (2015). Inside this moment: Promoting radical change in Acceptance and Commitment Therapy. Oakland, CA: New Harbinger Publications.

Research into emotional processes in anxiety disorders and obsessive-compulsive disorder (OCD) reveals that for many of these conditions, disgust plays a functional role in avoidance. Accordingly, disgust would appear a reasonable target for intervention. However, clinicians endeavoring to do so must overcome the challenge of disentangling disgust from fear in these clients, and then develop methods for alleviating an emotional state for which, at this point, treatment approaches are in nascent stages of development and remain largely unknown to practitioners. Complicating this further, most practitioners have limited formal understanding of disgust, as it is not commonly covered in training programs or other professional training courses. Fortunately, there are presently several assessment measures to evaluate the relevance of disgust for individual clients. There are also several potential lines of interventions recently developed that have been derived from existing evidence-based approaches for anxiety and OCD. This workshop, therefore, has the following three broad aims. First, an overview of the nature of disgust and how it is unique from fear will be presented. Second, a systematic approach to assessing disgust in clients will be covered and will include a review of measures available at no cost that can be readily integrated into everyday practice. And third, recommendations for treatment, including case conceptualizations that integrate disgust, will be covered, including an overview of the current treatment research and case illustrations.

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

• Evaluate the extent disgust contributes to clinical presentations of anxiety disorders and OCD.
• Select suitable assessment instruments to evaluate the severity of disgust reactions that contribute to avoidance associated with anxiety disorders and OCD.
• Develop treatment plans that address disgust in the context of fear associated with anxiety disorders and OCD.

Recommended Readings:

Mason, E.C., & Richardson, R. (2012). Treating disgust in anxiety disorder. Clinical Psychology: Science and Practice, 19, 180-194.

McKay, D. (2017). Embracing the repulsive: The case for disgust as a functionally central emotional state in the theory, practice, and dissemination of cognitive-behavior therapy. Behavior Therapy, 48, 731-738.

Oaten, M., Stevenson, R.J., & Case, T.I. (2009). Disgust as a disease-avoidance mechanism. Psychological Bulletin, 135, 303-321.

Suicide is a leading cause of death and competency in suicide risk assessment and prevention is a vital component of clinical practice. Yet responding to suicide risk can be a tremendous source of stress and place therapists at odds with their clients.

Acceptance and Commitment Therapy (ACT) provides a powerful and balanced approach to suicide prevention by promoting life in addition to preventing suicidal behavior.

The workshop will begin with a concise review of the literature on ACT and suicide.

Then participants will learn to apply key components of ACT for Life, a brief empirically based intervention developed via a formative evaluation with ACT and suicide prevention experts.

Case examples and experiential exercises will be used to build skills for working effectively and compassionately with clients at risk of suicide, while still maintaining best practices for suicide prevention.

We will identify therapist challenges to working with clients considering suicide and discuss methods for overcoming these barriers.

Participants will learn how to maintain an ACT therapeutic stance when conducting suicide risk assessment, practice emphasizing function over form when identifying drivers of suicidal thoughts and behaviors, and create an ACT-consistent safety plan.

We will demonstrate how to join with clients in acknowledging and accepting the pain that leads them to desire death, while still empowering them to engage in values-consistent behavior, building a meaningful life of their choosing.

This workshop will not include a comprehensive introduction to ACT and is recommended for attendees with at least some previous ACT training and experience.

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

• Identify potential barriers to working effectively and skillfully to prevent suicidal behavior.
• Create an ACT-consistent safety plan.
• Explain how to use ACT to reduce suicide risk and help clients build vital lives they can choose to live.

Recommended Readings:

Bahraini, N.H., Devore, M.D., Monteith, L.L., Forster, J.E., Bensen, S., & Brenner, L.A. (2013). The role of value importance and success in understanding suicidal ideation among Veterans. Journal of Contextual Behavioral Science, 2(1), 31-38.

Hayes, S.C., Pistorello, J., & Biglan, A. (2008). Acceptance and Commitment Therapy: Model, data, and extension to the prevention of suicide. Brazilian Journal of Behavioral and Cognitive Therapy, X(1), 81-102.

Walser, R.D., Gavert, D.W., Karlin, B.E., et al. (2015). Effectiveness of Acceptance and Commitment Therapy in treating depression and suicidal ideation in Veterans. Behavior Research and Therapy, 74, 25-31.

Process-Based CBT (PBCBT) is a radical departure from the latent disease model of the DSM and the absurd proliferation of the protocols-for-syndrome approach.

Instead, PBCBT focuses on how to best target and change core biopsychosocial processes in a specific situation for given goals with a given client.

This approach recognizes that psychotherapy typically involves nonlinear (rather than linear), bidirectional (rather than unidirectional), and dynamic changes of many (rather than only a few) interconnected variables.

Effective therapy changes the entire system toward a stable and adaptive state. For therapy to be most effective, we, therefore, need to embrace a systematic, assessment-guided, and theory-based approach to understand the relationships of the various problems of a given client.

Functional analysis, the foundation of behavior therapy, provides the basis to understand these relationships. Functional analysis in PBCBT acknowledges the complexity, interrelatedness, and multidimensional levels of the problems in a given client.

This workshop will illustrate how PBCBT is used to target key treatment processes by combining functional analysis with a dynamic and person-specific network approach. The workshop will discuss specific strategies to target specific processes in a specific client.

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

• Articulate the limitations and weaknesses of the contemporary medical model.
• Develop an idiographic, functional diagnostic system that has treatment utility.
• Use functional analysis in conjunction with complex network approach in a given client.

Recommended Readings:

Hayes, S. C., & Hofmann, S. G. (Eds.). (2018). Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy. Oakland, CA: New Harbinger Publications.

Hayes, S. C., Hofmann, S. G., Stanton, C. E., Carpenter, J. K., Sanford, B. T., Curtiss, J. E., & Ciarrochi, J. (in press). The role of the individual in the coming era of process-based therapy. Behaviour Research and Therapy. doi: 10.1016/j.brat.2018.10.005.

Hofmann, S. G., & Hayes, S. C. (2019). The future of intervention science: Process-based therapy. Clinical Psychological Science, 7, 37-50. doi: 10.1177/2167702618772296

A recent advance in the psychosocial treatment of ADHD has been the addition of forms of Organizational Skills Training as empirically validated treatments for ADHD. Challenges and deficits in executing tasks, including organization, time management, and planning, often hinder individual, family, and school adjustment in youth with ADHD. Organizational Skills Training (OST) and Supporting Teens' Autonomy Daily (STAND) are two well-established treatments for children with ADHD (Evans et al., 2014). OST with elementary school children has wide impact in improving organization, time management, and planning, which contributes to improved achievement and to reduced homework problems and family conflict (Abikoff et al., 2013). STAND, a parent-teen therapy (Sibley et al., 2016), has had similar positive impact with middle and high school children. Both protocols have been fully tested in clinical settings with promising results shown for adaptations in school and community mental health settings. These CBT treatments address how ADHD symptoms interfere with the practical execution of actions needed at school and home, which parents and teachers see as a critical concern.

This workshop will be a training on efficaciously administering the foundations of the protocols (Gallagher et al., 2014; Sibley et al., 2016). It will emphasize engaging youth, parents, and teachers in a collaborative process in which to build skills: supportive parent behavior management, self-motivation, tracking assignments, managing materials, time management, planning, and study skills. In addition to didactics, active learning techniques, including role-plays and exercises, will be utilized to allow participants to fully understand the approaches. Participants will learn how to supportively coach children and teens so that they feel empowered and how to incorporate positive responses from parents and teachers to effectively motivate youth.

The program will review the components of related empirically supported or promising programs for in-school delivery. Presenters are authors of the clinical interventions and the principal investigators of adaptations for delivery in groups in clinical, school, and community settings.

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

• List the practical executive deficits that children and teens with ADHD face in organization, time management, and planning that hinder home and school functioning.
• Use assessment methods to evaluate organization, time management, and planning and other executive function deficits in order to select appropriate candidates for treatment.
• The learner will be able to use manuals to treat executive function and organizational deficits in children and teens with ADHD and creatively adapt methods for use in school settings.

Recommended Readings:

Abikoff, H., Gallagher, R., Wells, K.C., Murray, D.W., Huang, L., Hu, F., & Petkova, E. (2013). Remediating organizational functioning in children with ADHD: Immediate and long-term effects from a randomized controlled trial. Journal of Consulting and Clinical Psychology, 81, 113-128. doi: 10.1037/a0029648

Evans, S.W., Owens, J.S., & Bunford, N. (2014). Evidence-based psychosocial treatments for children with Attention-Deficit/Hyperactivity Disorder. Journal of Clinical Child and Adolescent Psychology, 43, 527-551.

Sibley, M.H., Graziano, P.A., Kuriyan, A.B., Coxe, S., Pelham, W.E., Rodriguez, L.M., . . . Ward, A. (2016). Parent-Teen Behavior Therapy + Motivational Interviewing for Adolescents with ADHD. Journal of Consulting & Clinical Psychology, 84, 699-712.

A major component of extending the social impact of cognitive behavioral science is through the effective dissemination and implementation of the behavioral and cognitive therapies to new trainees.

Frequently, these new trainees are delivering care to those who are underserved in the public mental health system. This often translates to needing to teach CBT skills in a shorter time frame than the typical term of doctoral and postdoctoral study. This also includes training clinicians who have been out of "student mode" for years and may be less research-inclined than doctoral students. Trainers and supervisors need practical skills and strategies to aid in the implementation of the behavioral and cognitive therapies.

One of the more challenging CBT skills to teach is compassionately and artfully guiding a client to take a more balanced or helpful perspective.

Socratic questioning is at the heart of cognitive exploration; however, it is a complicated skill that is difficult to teach. Common problems of clinicians learning Socratic questioning include not knowing which questions to ask, trying to get the client to arrive at specific conclusions, or trying to convince the client.

This workshop will focus on demystifying the process of guided discovery and presenting a practical framework for how to utilize these techniques in the supervision process. Additional cognitive behavioral, experiential learning, supervision strategies will be discussed and modeled as an effective method for increasing CBT knowledge.

Also, the use of CBT strategies will also be discussed to strengthen the supervisory relationship to withstand critical feedback. Essential components such as teaching clinicians how to identify the key cognitions to target, gather more information, curiously listen, provide a summary, and tie it all together will be reviewed and practiced.

This workshop is geared towards front-line clinicians, supervisors, and trainers.

The workshop will focus on the strategies that have been found to be successful in two separate large-scale public mental health CBT implementation initiatives. Experiential methods of learning will be emphasized.

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

• Utilize a framework for Socratic and guided discovery strategies in supervision and clinical case consultation to inform case formulation, treatment planning, and clinical interventions.
• Use cognitive behavioral strategies for strengthening the supervisory and consultation relationship to be prepared for constructive feedback.
• Incorporate experiential teaching of cognitive behavioral strategies to increase supervisee and trainee knowledge of intervention techniques.

Recommended Readings:

Padesky, C. A. (1993, September). Socratic questioning: Changing minds or guiding discovery. In A keynote address delivered at the European Congress of Behavioural and Cognitive Therapies, London (Vol. 24). Available from: https://padesky.com/newpad/wp-content/uploads/2012/11/socquest.pdf

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

Waltman, S. H., Hall, B. C., McFarr, L. M., Beck, A. T., & Creed, T. A. (2017). In-session stuck points and pitfalls of community clinicians learning CBT: Qualitative investigation. Cognitive and Behavioral Practice, 24, 256-267. doi:10.1016/j.cbpra.2016.04.002

This training will provide participants with an understanding of how to integrate mindfulness into psychotherapy with trauma survivors safely and effectively. Trauma occurs as a result of violence, abuse, neglect, loss, disaster, war, and other emotionally harmful experiences, and the impact often endures long past the event through a variety of sequelae. Traumatized individuals vacillate between experiences of hyperarousal, emotional reactivity, and intrusive imagery, and hypoarousal, dissociation, and numbing of emotions. Mindfulness can provide clients with specific techniques for enhancing self-awareness, emotion regulation, distress tolerance, and attentional control, while also cultivating qualities of acceptance, compassion, and cognitive flexibility. Meditation and other mindfulness practices can promote optimal arousal and provide traumatized clients emotion regulation strategies. Evidence-based mindfulness interventions, such as Mindfulness-Based Cognitive Therapy (MBCT), are widespread. However, mindfulness practices can trigger traumatic memories or physiological arousal in some trauma survivors. Emerging evidence suggests mindfulness exercises may need to be modified for traumatized clients. Trauma-sensitive mindfulness interventions titrate the client's arousal to maintain a window of tolerance, which facilitates psychotherapy and general well-being. In this training, Dr. Messman-Moore and Dr. Zerubavel will provide guidance on how to integrate mindfulness-based practices into psychotherapy with traumatized clients.

Participants will learn to teach mindfulness as a way to reduce traumatic sequelae and improve emotion regulation. Discussion will emphasize both formal meditative practices and informal mindfulness practice. The training will involve learning through various methods, including lecture, experiential practice of guided mindfulness meditation, and small group work. No prior knowledge of mindfulness is assumed.

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

• Describe nationale for how mindfulness practice can benefit the treatment of trauma-related mental health issues, and how mindfulness can foster focused attention, body awareness, emotion regulation, and self-awareness.
• Explain how traumatic experience dysregulates physiological arousal, and how mindfulness practices foster physiological regulation.
• Identify signs of client overwhelm and discuss strategies to modify mindfulness practices and reduce dysregulation.

Recommended Readings:

Hilton, L., Maher, A. R., Colaiaco, B., Apaydin, E., Sorbero, M. E. … Hempel, S. (2017). Meditation for posttraumatic stress: Systematic review and meta-analysis. Psychological Trauma: Theory, Research, Practice & Policy, 9, 453-460.

Treleaven, D. A. (2018). Trauma-sensitive mindfulness: Practices for safe and transformative healing. New York: W. W. Norton & Company.

Zerubavel, N., & Messman-Moore, T. L. (2015). Staying present: incorporating mindfulness into therapy for dissociation. Mindfulness, 6(2), 303-314.

Contingency management (CM) is an effective behavioral intervention that provides tangible reinforcement when target behaviors are completed and objectively verified. A large body of literature supports CM's use for treating substance use disorders (SUDs). For example, a meta-analysis of psychological treatments for SUDs found that contingency management had the largest effect size (Dutra et al., 2008) and a recent comprehensive review highlights its diverse applications (Rash, Stitzer, & Weinstock, 2017).

Many applications of CM in treating SUDs focus on abstinence, providing monetary rewards or prizes when clients provide objective evidence of abstinence from drugs (e.g., urine samples). CM has also been adapted successfully to reinforce other behaviors, including treatment attendance, medication adherence, treatment-related activities (e.g., submitting job applications, attending medical appointments), physical activity, chronic disease management (e.g., glucose monitoring), and therapeutic homework. Despite this strong empirical foundation, CM has only been widely disseminated within large self-contained health-care systems (e.g., Veterans Affairs).

In this workshop, we will review the application of CM to promote positive behavior change in various health behaviors. Attendees will learn how to design and implement a CM program using guidelines that can be adapted to a variety of target behaviors. Specifically, we will describe the following: theoretical underpinnings and supporting empirical literature, different types of CM programs (i.e., voucher, prize), effective design features, common barriers to and problems with implementation, how to calculate costs of a CM program, and how to implement CM programs in individual and group settings.

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

• Select, monitor, and reinforce target behaviors in a CM intervention.
• Recognize effective features of CM reinforcement schedules.
• Design and calculate costs for a prize-based contingency management intervention.

Recommended Readings:

Dephilippis, D., Petry, N.M., Bonn-Miller, M.O., Rosenback, S.B., & McKay, J.R. (2018). The national implementation of contingency management (CM) in the Department of Veterans Affairs: Attendance at CM sessions and substance use outcomes. Drug & Alcohol Dependence, 185, 367-373.

Petry, N. M. (2012). Contingency management for substance abuse treatment: A guide to implementing this evidence-based practice. New York, NY: Routledge.

Rash, C. J., Stitzer, M., & Weinstock, J. (2017). Contingency management: New directions and remaining challenges for an evidence-based intervention. Journal of Substance Abuse Treatment, 72, 10-18.

Exposure-based treatments are often disseminated in the context of manualized protocols, and these protocols may have the unwitting effect of drawing attention away from the core principles of change that underlie the effect exposure therapy.

This workshop is designed to provide a personalized and transdiagnostic approach to thinking through exposure therapy in a way that integrates the latest research in extinction and memory processes.

Exposure will be discussed as an active learning process that must be integrated into existing (fear) memory structures.

Specific strategies for conceptualizing exposure targets and delivering exposure learning interventions will be emphasized.

The goal is to help clinicians enact especially individualized exposure treatments that flexibly move between specific fear targets and exposure procedures.

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

• Develop an approach to exposure therapy based on the enactment of core principles of therapeutic change rather than protocols/strategies.
• Plan exposure strategies that can engage the core therapeutic change mechanisms across diagnostic subtypes.
• Evaluate the role of contexts in case formulations and exposure planning. Integrate exposure planning with perspectives from cognitive science.

Recommended Readings:

Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers M. B., Smits J. A. J., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depression and Anxiety, 35, 502-514.

Kredlow, M. A., Eichenbaum, H., & Otto, M. W. (2018). Memory creation and modification: Enhancing the treatment of psychological disorders. American Psychologist, 73, 269-285.

Smits, J. A. J., Powers, M. B., & Otto, M. W. (2019). Personalized exposure therapy: A person-centered transdiagnostic approach. New York, NY: Oxford University Press.

Applying experiential techniques to oneself, as a process of learning ACT, has always been an essential and valued component of ACT training.

The culture of deeply personal and emotional work in workshop and supervision settings is deeply valued in the ACT community.

Despite this, therapists' self-practice and self-reflection has rarely been explored and elaborated upon in a systematic way.

The presenters will draw upon the significant and growing literature on therapists' self-reflection and self-practice established by James Bennett Levy and colleagues in the context of cognitive-behavioral training, and will provide an introduction to an organized and user-friendly approach to developing self-practice in ACT.

Participants will learn and directly experience a new way of furthering their mastery of ACT and the psychological flexibility model, through cultivating a rigorous and evidence-based personal practice.

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

• Explain and apply an ACT-consistent program for therapists' personal and professional development through self-practice of ACT and self-reflection.
• Summarize at least three key findings from the literature on self-practice and self-reflection in psychotherapy training.
• Apply ACT methods to their own personal issues, enhancing their psychological flexibility and self-care through deliberate and systematic ACT work with themselves as the therapeutic instrument and object of intervention.

Recommended Readings:

Bennett-Levy, J., & Lee, N. K. (2014). Self-practice and self-reflection in cognitive behaviour therapy training: What factors influence trainees' engagement and experience of benefit? Behavioural and Cognitive Psychotherapy, 42(1), 48-64.

Bennett-Levy, J., Turner, F., Beaty, T., Smith, M., Paterson, B., & Farmer, S. (2001). The value of self-practice of cognitive therapy techniques and self-reflection in the training of cognitive therapists. Behavioural and Cognitive Psychotherapy, 29(2), 203-220.

Tirch, D.T., Silberstein-Tirch, L. R., Codd, III, R.T., Brock, M. J. & Wright, M.J. (2019). Experiencing ACT from the inside out: A self-practice/self-reflection workbook for therapists (Self-Practice/Self-Reflection Guides for Psychotherapists). New York: The Guilford Press.

Means safety counseling, also referred to as means restriction counseling, entails assessing whether an individual at risk for suicide has access to a firearm or other lethal means for suicide, and working with the individual and their support system to limit their access to these means until suicide risk has declined. Of the many interventions and strategies developed to prevent suicide, means restriction has garnered the most empirical support and is one of the only interventions that has consistently led to reductions in suicide across diverse samples and populations. Although means safety has long been considered an important component of clinical work with suicidal patients, clear guidance and recommendations for discussing means safety with patients have only recently emerged. This presentation will provide an overview of the means safety counseling approach used in brief cognitive behavioral therapy for suicide prevention (BCBT), with a particular focus on firearm safety. This workshop provides practical suggestions and tips for navigating conversations about firearm safety with high-risk patients, and includes skills training with feedback.

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

• Identify the key assumptions that underlie means safety counseling.
• Describe the evidence supporting means restriction for suicide prevention.
• Identify the three core assumptions of means safety counseling.
• Identify common barriers to means safety counseling.
• Use effective clinical strategies to increase an individual's willingness to enact firearm safety procedures.

Recommended Readings:

Berman, A. L. (2006). Risk management with suicidal patients. Journal of Clinical Psychology, 62, 171-184.

Britton, P. C., Bryan, C. J., & Valenstein, M. (2016). Motivational interviewing for means restriction counseling with patients at risk for suicide. Cognitive and Behavioral Practice, 23(1), 51-61.

Bryan, C. J., Stone, S. L., & Rudd, M. D. (2011). A practical, evidence-based approach for means-restriction counseling with suicidal patients. Professional Psychology: Research and Practice, 42(5), 339.

Khazem, L. R., Houtsma, C., Gratz, K. L., Tull, M. T., Green, B. A., & Anestis, M. D. (2015). Firearms matter: The moderating role of firearm storage in the association between current suicidal ideation and likelihood of future suicide attempts among United States military personnel. Military Psychology, 28(1), 25-33.

Rudd, M. D., Bryan, C. J., Wertenberger, E. G., Peterson, A. L., Young-McCaughan, S., Mintz, J., . . . Bruce, T. O. (2015). Brief cognitive behavioral therapy effects on post-treatment suicide attempts in a military sample: Results of a 2-year randomized clinical trial. American Journal of Psychiatry, 172, 441-449.

Dialectical Behavior Therapy (DBT) is a complex cognitive-behavioral treatment designed for a population with multiple problematic and high-risk behaviors.

As with any behavioral treatment, the role of assessment in DBT is critical.

Although there is a significant body of research supporting the efficacy of DBT, there is a relative dearth of practical and principle-based information that help therapists formulate cases and treatment from a DBT perspective.

In this workshop, we will provide a step-by-step guide for creating an assessment-driven DBT case formulation.

We will focus on identifying stage of treatment, determining goals, identifying the target hierarchy, assessing and treating the primary target behavior, and tracking outcomes.

We will highlight the few rules that inform DBT assessment and practice, note and correct several common misconceptions, and demonstrate how the use of thorough assessment can result in a more nuanced case formulation and, ultimately, a more effective treatment.

Experiential exercises and case examples will be utilized to bring the principles to life.

This workshop is designed for clinicians with some direct clinical experience conducting DBT; basic DBT principles will not be reviewed.

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

• Identify the key principles that inform case formulation in DBT.
• Describe a seven-step process of generating a DBT case formulation and treatment plan.
• Assess key variables in order to create an idiographic case formulation.

Recommended Readings:

Koerner, K. (2012). Doing dialectical behavior therapy: A practical guide. New York: Guilford Press.

Linehan, M.M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York: Guilford Press.

Rizvi, S.L., & Sayrs, J.H.R. (in press). Assessment-driven case formulation in Dialectical Behavior Therapy: Using principles to guide effective treatment. Cognitive and Behavioral Practice.