TICKETED SESSIONS | Institutes

A large proportion of therapists' caseloads includes patients with clinical anxiety. Although exposure therapy is highly effective for these conditions, many individuals fail to benefit and/or experience a return of fear ("relapse") at some point after treatment. Cutting-edge models of exposure therapy focus on an inhibitory learning theory of fear extinction, derived from basic research on learning and memory, which points to specific implementation techniques to optimize short- and long-term gains. Collectively, inhibitory learning strategies emphasize distress tolerance, as opposed to habituation of distress, and introduce "desirable difficulties" into exposure sessions by challenging patients to consolidate and generalize learning via novel therapeutic strategies. In line with this year's convention theme, this institute aims to help clinicians understand and apply this model to optimize exposure therapy outcomes. Incorporating attendee feedback from the 2019 ABCT institute that received extremely enthusiastic evaluations (100% recommended offering it again in 2020), 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 (and thus selectively using cognitive therapy), introducing variability into exposure to decontextualize safety learning, deepening and augmenting safety learning (by combining fear cues, labeling affect, and targeting attentional focus), and eliminating (or judiciously using) safety behaviors. Applying the inhibitory learning model of exposure to complex, diverse, and comorbid symptom presentations will also be discussed. The institute will be interactive and include numerous 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 distress tolerance during exposure, as opposed to relying solely on habituation (reduction) of distress.
• Describe methods of tracking changes in expectations during exposure therapy, rather than SUDS.
• Describe how to introduce variability into exposure sessions and compare methods for eliminating versus judiciously using safety behaviors in exposure.
• Identify common pitfalls that clinicians may encounter during exposure therapy and how to address them using an inhibitory learning approach.

Recommended Readings:

Blakey, S. M., & Abramowitz, J. S. (2016). The effects of safety behaviors during exposure therapy for anxiety: Critical analysis from an inhibitory learning perspective. Clinical Psychology Review, 49, 1-15.

Blakey, S. M., & Abramowitz, J. S. (2019). Dropping safety aids and maximizing retrieval cues: Two keys to optimizing inhibitory learning during exposure therapy. Cognitive and Behavioral Practice, 26(1), 166-175

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.

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.

McGuire, J., & Storch, E. A. (2019). An inhibitory learning approach to cognitive-behavioral therapy for children and adolescents. Cognitive and Behavioral Practice, 26, 21-224.

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. PBCBT acknowledges the complexity, interrelatedness, and multidimensional levels of the problems in a given client. This institute will illustrate how PBCBT is used to target key treatment processes by combining functional analysis with a dynamic and person-specific network approach. The institute will discuss specific strategies to target specific processes in a specific client.

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

• Assess the limitations and weaknesses of the contemporary medical model.
• Discuss an up-to-date understanding of the core processes of CBT.
• Develop an idiographic, functional diagnostic system that has treatment utility.
• Apply more progressive models and theories in clinical practice.
• Use functional analysis in conjunction with complex network approach in a given client.

Recommended Readings:

Hayes, S. C. & Hofmann, S. G. (2017). The third wave of CBT and the rise of process-based care. World Psychiatry, 16, 245-246. doi: 10.102/wps.20442

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

Hayes, S. C., Hofmann, S. G., Stanton, C. E., Carpenter, J. K., Sanford, B. T., Curtiss, J. E., & Ciarrochi, J. (2019).

The role of the individual in the coming era of process-based therapy. Behaviour Research and Therapy, 117, 40-53. doi: 10.1016/j.brat.2018.10.005.

Hofmann, S. G., Curtiss, J. E., & Hayes, S. C. (in press). Beyond linear mediation: Toward a dynamic network approach to study treatment processes. Clinical Psychology Review. doi: 10.1016/j.cpr.2020.101824

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

Ong, C. W., Levin, M. E., & Twohig, M. P. (2020). Beyond Acceptance and Commitment Therapy: Process-Based Therapy The Psychological Record. doi: 10.1007/s40732-020-00397-z

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) was adapted from the adult model of IPT and is based on the premise that depression, regardless of its etiology, occurs in an interpersonal context. IPT-A is a 12- to 15-session treatment that focuses on improving depressive symptoms and interpersonal functioning. IPT-A has been adapted as a preventive intervention for adolescents at risk for depression and for preadolescents diagnosed with depression. This institute will provide an introduction to the principles of IPT as adapted for adolescents (IPT-A) and discuss its use in community settings such as school-based health clinics and primary care clinics. The course will include didactics on the main principles and techniques of the IPT-A treatment model; use of demonstrations of techniques; opportunity for short experiential role-playing; and discussion of brief case examples. IPT-A has been demonstrated to be an efficacious treatment for adolescent depression (Mufson et al., 1999; Mufson et al., 2004) and is delineated in a published treatment manual (Mufson et al., 2004). IPT-A meets the criteria of a "well-established treatment" for adolescent depression according to the American Psychological Association and is a recommended treatment for depressed adolescents. IPT-A is recommended along with CBT in the newly published American Psychological Association Clinical Practice Guidelines for the Treatment of Depression across the lifespan (2019) as the two interventions with the strongest evidence base for treating adolescents with depression. This course will present the goals and phases of IPT-A, identified problem areas, primary components of IPT-A approach, as well as specific therapeutic techniques such as the interpersonal inventory and communication analysis.

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

• Identify the basic principles of IPT-A.
• Describe the four interpersonal problem areas.
• Describe the key IPT-A techniques.
• Utilize the techniques through role-plays and discussion of case examples.
• Apply the IPT-A treatment approach with depressed adolescent patients

Recommended Readings:

Baerg-Hall, E. & Mufson, L. (2009). Interpersonal Psychotherapy for Depressed Adolescents (IPT-A): A case illustration. Journal of Clinical Child and Adolescent Psychology, 38(4), 582-59.

Gunlicks-Stoessel, M., Mufson, L., Jekal, A., & Turner, B. (2010). The impact of perceived interpersonal functioning on treatment for adolescent depression: IPT-A versus treatment as usual in school-based health clinics. Journal of Consulting and Clinical Psychology, 78(2),260-267.

Markowitz, J.C., & Weissman, M.M. (Eds.). (2012). A casebook in interpersonal psychotherapy. Oxford University Press.

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

Mufson, L., Dorta, K.P., Wickramaratne, P., Nomura, Y., Olfson, M., & Weissman, M.M. (2004).A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry, 61, 577-584.

Sburlati, E.S., Lyneham, H.J., Mufson, L., & Schneiring, C.A. (2012). A model of therapist competencies for the empirically supported interpersonal psychotherapy for adolescent depression. Clinical Child and Family Psychology Review, 15, 93-112.

Sleep problems are both highly prevalent and etiologically significant for mental health problems in adolescents and young adults. Most books/workshops focus on pediatric or adult sleep programs, but they are not suitable for this age group because the sleep problems of this group are unique. This age group experiences circadian rhythm problems, hypersomnia, hypersomnolence and/or insomnia. What little treatment research exists for this age group focuses solely on CBT for insomnia and ignores the other problems. One helpful approach has been to recognize the transdiagnostic nature of these sleep problems and leverage case formulation and empirically supported techniques to help this group. Although we have evidence-based behavioral sleep medicine techniques to address sleep problems, access to such treatments is limited and access to training for professionals is nonexistent. This training will fill this void and teach specific cognitive behavioral sleep medicine approaches to teen sleep problems. The format for the institute will be didactic instruction, experiential exercises, demonstrations, and clinical. Attendees will have access to and learn how to use a validated free app to help adolescents and young adults sleep better.

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

• Describe the difference between these common teen sleep problems: voluntary sleep restriction, circadian rhythm dysregulation, hypersomnia, and insomnia.
• Prepare evidence-based solutions for voluntary sleep restriction, circadian rhythm dysregulation, hypersomnia, and insomnia.
• Use motivational interviewing to help teens buy-in to treatment engagement.
• Explain to teachers, parents, and counselors in teens' lives about sleep myths, and how to communicate effectively and support teens in improving their sleep.
• Demonstrate to clients how to use a free app to track sleep and set goals.

Recommended Readings:

Blake, M. J., Sheeber, L. B., Youssef, G. J., Raniti, M. B., & Allen, N. B. (2017). Systematic review and meta-analysis of adolescent cognitive-behavioral sleep interventions. Clinical Child and Family Psychology Review, 20(3), 227-249.

Dong, L., Gumport, N. B., Martinez, A. J., & Harvey, A. G. (2019). Is improving sleep and circadian problems in adolescence a pathway to improved health? A mediation analysis. Journal of Consulting and Clinical Psychology, 87(9), 757.

Harvey, A. G. (2016). A transdiagnostic intervention for youth sleep and circadian problems. Cognitive and Behavioral Practice, 23(3), 341-355.

Harvey, A. G., Hein, K., Dolsen, M. R., Dong, L., Rabe-Hesketh, S., Gumport, N. B., ... Smith, R. L. (2018). Modifying the impact of eveningness chronotype ("night-owls") in youth: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 57(10), 742-754.

Soehner, A. M., Bertocci, M. A., Levenson, J. C., Goldstein, T. R., Rooks, B., Merranko, J., ... Hickey, M. B. (2019). Longitudinal associations between sleep patterns and psychiatric symptom severity in high-risk and community comparison youth. Journal of the American Academy of Child & Adolescent Psychiatry, 58(6), 608-617.