Institutes

Thursday, November 17 | 8:00 AM – 1:00 PM

Presented by:

Terri Messman, Ph.D., Miami University Distinguished Scholar & Professor of Psychology, Miami University

Noga Zerubavel, Ph.D., Assistant Consulting Professor, DUMC; Co-Founder, Arise Psychological Wellness & Consulting, Duke University Medical Center

Participants earn 5 continuing education credits

Abstract: 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 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.

Long-term Goals: 

1. Determine how mindfulness can be integrated into your overarching treatment framework and how to incorporate it into a specific treatment plan.
2. Identify and describe three types of mindfulness exercises (or practices) to fit specific client needs.

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

1. Describe three ways that mindfulness practice can benefit the treatment of trauma-related mental health issues.
2. Identify two mindfulness techniques that foster body awareness and explain how they can contribute to emotion regulation and self-awareness in trauma survivors.
3. Describe one mechanism that explains how traumatic experience dysregulates physiological arousal and how mindfulness practices foster physiological regulation.
4. Identify three signs of client overwhelm and describe three responsive strategies you would offer to modify mindfulness practices in order to reduce dysregulation.
5. Utilize the three levels of inquiry following any mindfulness practice in order to facilitate processing, generalizing, and consolidating.

Session Outline

Part I: Trauma Foundations/Foundations for Working with Trauma Survivors

1. Defining Trauma
   1. What do we mean by trauma? (event/experience/effect)
   2. Experiences of traumatic stress (severe stressors, toxic or traumagenic environments, intersectionality, allostatic load/cumulative burden of adversity)
   3. Racism and oppression, minoritized stress; Stigma/contempt/attack related to identity; stress proliferation processes
   4. Developmental/complex trauma and attachment

2. Understanding the impact of traumagenic contexts
   1. Traumagenic environments (e.g., families, institutions)
   2. Relational dynamics: threat/intimidation/coercion; humiliation/devaluing/shaming;
   3. Neglectful bystanders (enabling or failure to protect)
   4. Societal collusion, denial, structural inequities and oppressive forces

3. Trauma sequelae using the Psychological Adaptation to Trauma model
   1. Biological (e.g., physiological arousal, somatic complaints)
   2. Emotional (e.g., fear, anger, shame)
   3. Cognitive (e.g., perceptual disturbances, dissociation, beliefs)
   4. Behavioral (e.g., suicidal behavior, aggression, substance abuse)
   5. Interpersonal (e.g., relationship problems, revictimization)
   6. Resilience and natural recovery

Part II: Mindfulness and Its Relevance to Working with Trauma Survivors

4. Mindfulness
   1. What is mindfulness
   2. Formal and informal mindfulness practices
   3. Why and when to use mindfulness for trauma
   4. Research on mindfulness-based interventions for trauma

5. Trauma stewardship and therapist mindfulness
   1. Decreasing therapist reactivity to maintain a trauma-informed conceptualization of behavior
   2. Observing limits and holding boundaries
   3. Wounded healers
   4. Organizational context for trauma-informed practices
   5. Therapist strategies for non-supportive environments

Part 3: Setting Up for Implementation

6. Case Conceptualization
   1. Applying the Psychological Adaptation Model
   2. Transdiagnostic conceptualization & diagnostic considerations
   3. Dissociation & mindfulness
   4. Defining Recovery: Healing, integration, posttraumatic growth

7. The Window of Tolerance
   1. Physiological arousal and dampening: Fight-Flight-Freeze
   2. Methods of assessment: Structured objective and subjective approaches
   3. Methods of assessment: Process-based approaches
   4. Choosing intervention protocols

8. Trauma and Treatment Planning
   1. Trauma-focused treatment planning
   2. Trauma-Informed treatment planning
   3. Identifying appropriate clients
   4. Contraindications

Part 4: Implementation: What to do in Session

9. How to Use Mindfulness in Session
   1. Inquiry: Sensing and describing (building awareness, processing)
   2. Inquiry: Tracking (consolidating, putting in context)
   3. Inquiry: Insight and application (generalization)
   4. Choosing strategies and techniques
   5. Contraindications: attending to context

10. Mechanisms of Mindfulness and Techniques for Implementation
    1. Attention Regulation and specific practices
    2. Body Awareness and specific practices
    3. Emotion Regulation and specific practices
    4. Change in Perspective and specific practices

11. Expanding the Window of Tolerance
    1. Containment vs avoidance
    2. Past vs present skill
    3. Informal exposure
    4. Memory processing and formal exposure
    5. Metaphor

Part 5: Challenges/Difficulties in Implementation

12. Working with difficulty
    1. Identifying expected but challenging difficulty
    2. Identifying adverse reactions and distinguishing from expected difficulty
    3. Preventative strategies
    4. Responsive strategies

Part 6: Resourcing

13. Resourcing the client
14. Resourcing the therapist

Wrap Up, Q & A

Recommended Readings:

• Becker-Blease, K. A. (2017). As the world becomes trauma-informed, work to do. Journal of Trauma & Dissociation, 18(2), 131-138. http://dx.doi.org/10.1080/15299732.2017.1253401
• Bermudez, D., Benjamin, M. T., Porter, S. E., Saunders, P. A., Laurenzo Myers, N. A., & Dutton, M. A. (2013). A qualitative analysis of beginning mindfulness experiences for women with post-traumatic stress disorder and a history of intimate partner violence. Complementary Therapies in Clinical Practice, 19, 104-108. http://dx.doi.org/10.1016/j.ctcp.2013.02.004
• Boughner, E., Thornley, E., Kharlas, D., & Frewen, P. (2016). Mindfulness-related traits partially mediate the association between lifetime and childhood trauma exposure and PTSD and dissociative symptoms in a community sample assessed online. Mindfulness, 7, 672-679. https://doi.org/10.1007/s12671-016–0502-3
• Colgan, D. D., Christopher, M., Michael, P., & Wahbeh, H. (2016). The body scan and mindful breathing among veterans with PTSD: Type of intervention moderates the relationship between changes in mindfulness and post-treatment depression. Mindfulness, 7, 372-383. https://doi.10.1007/s12671-015-0453-0
• Esper, L. H., & da Silva Gherardi-Donato, E. C. (2019). Mindfulness-based interventions for women victims of interpersonal violence: A systematic review. Archives of Psychiatric Nursing, 33, 120-13. https://doi.org/10.1016/j.apnu.2018.09.003
• Hopwood, T. L. & Schutte, N. S. (2017). A meta-analytic investigation of the impact of mindfulness-based interventions on posttraumatic stress. Clinical Psychology Review, 57, 12-20. https://doi.org/10.1016/j.cpr.2017.08.002
• Metzger, I. W., Anderson, R. E., Are, F., & Ritchwood, T. (2021). Healing interpersonal and racial trauma: Integrating racial socialization into trauma-focused cognitive behavioral therapy for African American youth. Child Maltreatment, 26(1), 17-27. https://doi.org/10.1177/1077559520921457
• Zerubavel, N. & Messman-Moore, T. L. (2015). Staying present: Incorporating mindfulness into therapy for dissociation. Mindfulness, 6(2), 303-314. https://doi.org/10.1007/s12671-013-0261-3
• Zhu, J., Wekerle, C., Lanius, R., & Frewen, P. (2019). Trauma- and stressor-related history and symptoms predict distress experienced during a brief mindfulness meditation sitting: Moving towards trauma-informed care in mindfulness-based therapy. Mindfulness, 10, 1985-1996. https://doi.org/10.1007/s12671-019-01173-z

Thursday, November 17 | 8:00 AM – 1:00 PM

Presented by:
Eric A. Youngstrom, Ph.D., Professor of Psychology and Neuroscience,
University of North Carolina at Chapel Hill

Participants earn 5 continuing education credits

Long-term Goals: 

1. Over the coming year, add free assessment tools to differentiate types of mood and internalizing disorders, using for case formulation and progress tracking.
2. Begin gathering more information about sleep, exercise, and diet when working with clients with mood issues.

Abstract: Mood disorders can start in childhood, and often worsen in adolescence and early adulthood. Due to stigma, people often do not seek help, and the course of illness can be intermittent, and complicated. Recently, rates of mood problems and self-injury have increased, especially in early adulthood, with COVID and social distancing adding to the problem. 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 session concentrates on the best free assessments to use for screening, differential diagnosis and treatment planning, progress and outcome tracking, as well as ways to quickly evaluate alternative treatments and new advances. Light therapy, blue-light blocking, omega-3 fatty acids, CBD oil – are any of these evidence-based? Could they augment more conventional psychotherapy approaches? How do we answer patient questions and help them sort through the competing claims that they find on social media and the internet? The session also addresses dissemination and implementation support methods that can increase the accessibility of assessment, prevention, and early intervention services.

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

1. Describe the use of three evidence-based assessment methods that aid in differential diagnosis and measuring treatment response.
2. Recognize four symptoms and risk factors that are helpful in recognizing bipolar disorder, and which may be red herrings” that are common to other conditions.
3. Find and use at least 20 free scales for screening, severity, and outcome tracking.
4. Learn how to search TRIP database and other aggregators to find clinically useful summaries quickly.
5. Describe how three sleep hygiene techniques could help with improving outcomes across most mood disorders.

Session Outline

1. Clinical picture
   1. Contrast the typical presentation of depression and bipolar disorder in youths and adults;
   2. discuss DSM-5 vs. ICD-11 revisions
   3. Learn about “spectrum” bipolar disorders
      1. cyclothymia
      2. Other Specified Bipolar and Related Disorders
      3. impairment and course

1. How common are different mood disorders?
   1. Recognize how often bipolar and other disorders occur in different settings
      1. Private practice
      2. High schools
      3. colleges,
      4. outpatient services,
      5. forensic settings
      6. inpatient units

• Best of the free assessments
  1. Aids for differential diagnosis
  2. Goal setting
  3. Measuring progress and outcome

1. Apply new methods for interpreting test results
   1. Thinking in terms of probability
   2. Rules of thumb
   3. Benchmarking change
2. Where to find new information and free tools?
   1. TRIP, Wiki, searching smarter
   2. Learn about free online and assessment tools to improve diagnosis
   3. Outcome
3. Thinking in terms of lifestyle change for managing mood
   1. Surprising data about sleep
   2. Diet
   3. Exercise

Recommended Readings:

Youngstrom, E.A., & Cotuna, A. (2020). Helping Give Away Psychological Science: Putting information and resources where the public and professionals can find and use them. North Carolina Medical Journal, 81, 117-119. https://doi.org/0029-2559/2020/81210

Youngstrom, E.A., Algorta, G.P., Frazier, T.W., Youngstrom, J.K., & Findling, R.L. (2021). Evaluating and validating General Behavior Inventory mania and depression short forms for self-report of mood symptoms. Journal of Clinical Child and Adolescent Psychology, 50(5), 579-595. https://doi.org/10.1080/15374416.2020.1756301

Henriksen, T. E., Skrede, S., Fasmer, O. B., Schoeyen, H., Leskauskaite, I., Bjorke-Bertheussen, J., Assmus, J., Hamre, B., Gronli, J., & Lund, A. (2016). Blue-blocking glasses as additive treatment for mania: a randomized placebo-controlled trial. Bipolar Disorders, 18(3), 221-232. https://doi.org/10.1111/bdi.12390

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.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

Thursday, November 17 | 8:30 AM – 5:00 PM

Presented by:
Ann M. Steffen, Ph.D., Professor of Psychological Sciences, University of Missouri-St. Louis

Participants earn 7 continuing education credits

Long-term Goals: 

1. Increase utilization of best practices for CBT with middle-aged and older adults, as reflected by self-reported scores on the Aging Clients Therapy Scale (ACTS)
2. Engage in a professional development plan for continued enhancement of knowledge and skills for applying CBT with middle-aged and older adults

Abstract: National and global workforce predictions show a shortage of behavioral health clinicians prepared for work with aging individuals. This intermediate-level institute provides detailed recommendations and resources for psychotherapists and primary care clinicians familiar with CBT and wishing to increase their effectiveness with depressed middle-aged and older adults. Individualized and culturally responsive approaches will be highlighted and practiced that target the contexts and drivers/antecedents of depression in the second half of life (i.e., changes in brain health and medical conditions, chronic pain, sleep problems, family caregiving, bereavement, relationship concerns), with attention to telehealth applications.

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

1. Identify essential domains to include when developing a case conceptualization of later life depression
2. Plan an individualized course of treatment (prioritize treatment goals and select appropriate change strategies) from a case presented at the workshop
3. Discuss rationale and technique for at least three culturally responsive modifications for CBT with aging clients
4. Demonstrate three methods to enhance within-session focus and effective pacing
5. Explain three clinical strategies to enhance telehealth practice with aging individuals

Session Outline

1. Rationale for treating later-life depression with CBT
(A) Features of later-life depression
(B) Developmental and cultural considerations that influence treatment
(C) Brief review of existing research supporting CBT for later-life depression

2. Overview of Treating Later-Life Depression approach
(A) Intake assessment
(B) Treating planning/prioritization of therapy goals
(C) Including chosen family members
(D) Culturally responsive within-session modifications with aging clients

3. Core Modules
(A) Skills for Getting Started (Therapy Orientation, Goal Setting, Enhancing Motivation)
(B) Skills for Feeling (Emotional Literacy, Cultivation of Positive Emotions, Arousal Reduction)
(C) Skills for Doing (Behavioral Activation, Problem Solving)
(D) Skills for Thinking (Self-Compassion, Cognitive Reappraisal)
(E) Skills for Wrapping Up (Termination Planning, Booster Sessions)

4. Personalized Modules
(A) Skills for Brain Health (Preventing and Managing Cognitive Concerns)
(B) Skills for Managing Chronic Pain (Psychoeducation and Pain Management)
(C) Skills for Healthy Sleep (Psychoeducation and Sleep Hygiene)
(D) Skills for Caregiving (For Family and Informal Care Partners)
(E) Skills for Living with Loss (Support for Healthy Grieving)
(F) Skills for Relating (Communication and Interpersonal Effectiveness Skills)

Recommended Readings:

American Psychological Association. (2019). Clinical practice guideline for the treatment of depression across three age cohorts.  Retrieved from https://www.apa.org/depression-guideline

Haigh, E. A., Bogucki, O. E., Sigmon, S. T., & Blazer, D. G. (2018). Depression among older adults: a 20-year update on five common myths and misconceptions. The American Journal of Geriatric Psychiatry, 26(1), 107-122.

Steffen, A.M et al. (2022). Treating Later-Life Depression: A Cognitive Behavioral Approach. Workbook. 2nd edition. Treatments that Work Series; Oxford University Press.

Steffen, A.M., Thompson, L.W., & Gallagher-Thompson, D. (2022). Treating Later-Life Depression: A Cognitive Behavioral Approach. Clinician Guide. 2nd edition. Treatments that Work Series; Oxford University Press.

Steffen, A. M. & Schmidt, N. E. (2022). The CBTs in Later Life. In G. Asmundson (Ed.), Comprehensive Clinical Psychology, 2nd edition. Oxford, UK: Elsevier.

Thursday, November 17 | 8:30 AM – 5:00 PM

Presented by:
Sean M. Barnes, Ph.D., Clinical Research Psychologist, VA Rocky Mountain MIRECC

Lauren M. Borges, Ph.D., Clinical Research Psychologist, VA Rocky Mountain MIRECC

Robyn D. Walser, Ph.D., Clinical Psychologist, National Center for PTSD

Participants earn 7 continuing education credits

Abstract: Suicide is a leading cause of death and mitigation of suicide risk is a vital component of clinical practice. However, 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 through values-based action in addition to preventing suicidal behavior. The training will begin with a concise review of the literature on ACT and suicide. Participants will then learn how to apply key components of ACT for Life, a brief empirically-based intervention developed via a formative evaluation with ACT and suicide prevention experts (Barnes et al., 2021). Case examples, role plays, and experiential exercises will be used to build attendees’ 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 suicidal behavior, particularly within the context of the COVID-19 pandemic and discuss methods for overcoming these barriers. Participants will learn how to maintain an ACT therapeutic stance when conducting suicide risk assessment, emphasize function over form when identifying drivers of suicidal thoughts and behaviors, and create an ACT-consistent safety plan. We will demonstrate how to join 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 training will not include a comprehensive introduction to ACT and is recommended for attendees with at least some previous ACT training and experience.

Long-term Goals: 

1. Incorporate client-specific suicide-related thoughts, emotions, and sensations into ACT experiential exercises to promote the client’s ability to act consistently with their values.
2. Assist clients in exploring their values and engaging in committed actions to build meaningful lives.

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

1. Describe personal and practical barriers to working collaboratively with clients to manage suicide risk effectively.
2. Conduct a functional assessment (e.g., chain analysis) of factors maintaining suicidal ideation and/or behavior.
3. Demonstrate creative hopelessness work appropriate for clients at high risk of suicide.
4. Use results of a functional assessment to inform case conceptualization and treatment planning.
5. Create ACT-consistent safety plans.

Session Outline

• Challenges of working with clients considering suicide
• Phenomenon of suicide from a contextual behavioral perspective
• Brief review of empirical support for using ACT to prevent suicide
• Introduction to ACT for Life protocol
• Functional suicide risk assessment
• Undermining the control agenda and turning toward values-based living
• Engaging mindfulness processes with clients thinking of suicide
• Engaging behavior change processes with clients thinking of suicide
• ACT-consistent safety planning
• Discussion and questions

Recommended Readings:

Barnes, S. M., Borges, L. M., Smith, G. P., Walser, R. D., Forster, J. E., & Bahraini, N. B. (2021). Acceptance and Commitment Therapy to promote recovery from suicidal crises: A randomized controlled acceptability and feasibility trial of ACT for Life. Journal of Contextual Behavioral Science, 20, 35-45. doi:10.1016/j.jcbs.2021.02.003

Barnes, S. M., Borges, L. M., Sorensen, D., Smith, G. P., Bahraini, N. H., & Walser, R. D. (In Press). Safety planning within Acceptance and Commitment Therapy. Cognitive and Behavioral Practice. https://doi.org/10.1016/j.cbpra.2022.01.002

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. doi: 10.1016/j.brat.2015.08.012

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. doi: 10.1016/j.jcbs.2013.03.001

Borges, L. M., Nazem, S., Matarazzo, B. B., Barnes, S. M., & Wortzel, H. S. (2019). Therapeutic Risk Management: Chain Analysis of Suicidal Ideation and Behavior. Journal of Psychiatric Practice, 25(1), 46–53. doi: 10.1097/PRA.0000000000000358

Thursday, November 17 | 1:30 PM – 6:30 PM

Presented by:
Kristi Pruiksma, Ph.D., Associate Professor-Research, University of Texas Health Science Center at San Antonio

Hannah C. Tyler, ABPP, Ph.D., Assistant Professor-Research, University of Texas Health Science Center San Antonio

Participants earn 5 continuing education credits

Long-term Goal: 

1. Attendees will gain information to assess for the presence of insomnia and nightmare disorders.
2. Attendees will be trained in the basic procedures for delivering Cognitive Behavioral Therapy for Nightmares to their clientele.

Abstract: Nightmares are a significant but treatable health condition that have a direct impact on psychological health and well-being. Unfortunately, the prevalence of nightmares and insomnia have risen as a result of the COVID-19 pandemic. While nightmares are commonly reported following trauma and are considered a hallmark of posttraumatic stress disorder (PTSD), nightmares and insomnia often remain following successful treatment of PTSD and are uniquely correlated to suicide, depression, and substance use. Nightmares following trauma may continue as part of PTSD or as an independent disorder, and if left untreated, can continue throughout the lifetime. The American Academy of Sleep Medicine position paper for the treatment of nightmare disorder in adults recommends cognitive behavioral therapy for nightmares (CBT-N), yet there is a critical shortage of trained providers and relatively low provider awareness of the efficacy behavioral medicine interventions. Furthermore, there are several treatment manuals available with unclear overlap and discrepancies and no consensus approach for treating nightmares. Recently, nightmares experts have convened to develop a consensus approach. Thus, the goal of this institute is to train providers in the implementation of CBT-N a brief, evidence-based non-pharmacological intervention developed by experts in the field, synthesizing best practices for nightmare disorder treatment in this singular treatment protocol. CBT-N involves strategies to address insomnia, relaxation training, identifying and writing a target nightmare, writing a different storyline for the nightmare, and repeatedly imagining the new dream before sleep. This institute will provide foundational understanding of normal sleep, assessment of sleep disorders, and facilitate step-by-step guidance on how to implement CBT-N in clinical practice. We will also provide guidance on assessing sleep in the short-term and long-term following disasters. We will achieve these goals by providing in-depth training based on the CBT-N manual, presenting case examples, providing handouts to be used in clinical practice, and incorporating video demonstrations as well as audience exercises reinforce the utility of these treatments.

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

1. Identify and describe 2 basic foundations of normal and disordered sleep.
2. Summarize the 2 basic factors that regulate sleep.
3. Assess for and identify 3 symptoms of on nightmares and insomnia.
4. Describe step-by-step implementation of the consensus protocol of cognitive behavioral therapy for nightmares (CBT-N).
5. Identify and implement 7 strategies for improving sleep in both the short-term and long-term following a disaster.

Session Outline

• 1:30pm-1:45pm: Introductions and Overview
• 1:45pm-2:00pm: Assessment and Diagnosis of Nightmares
• 2:00pm-3:00pm: Session 1: Sleep Basics and Bedtime Routines
• 3:00pm-3:45pm: Session 2: Nightmares, Stress, and Relaxation Training
• 3:45pm-4:30pm: Session 3: Targeting Nightmares Part 1: Written Exposure to the nightmare, theme identification, and introduction to nightmare description
• 4:30pm-5:15pm: Session 4: Targeting Nightmares Part 2: Nightmare description and introduction to imagery rehearsal
• 5:15pm-5:45pm: Session 5: Targeting Nightmares Part 3: Reviewing imagery rehearsal practice and problem solving
• 5:45pm-6:15pm: Session 6: Putting it all Together and Planning for the Future
• 6:15pm-6:30pm: Efficacy Research and Treatment Considerations

Recommended Readings:

Pruiksma, K. E., Taylor, D. J., Davis, J., Diethc, J. R., Peterson, A. L., Balliett, N., Goodie, J. L., Miller, K., Grieser, E., Friedlander, J., Hryshko-Mullen, A. S., Rowan, A., Wilkerson, A., HallClark, B., Fina, B., Hummel, V., Casady, T., Tyler, H. (2021). Cognitive-Behavioral Therapy for Insomnia and Nightmares in the military: Therapist guide. Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, TX. (For a copy of the manual, individuals are asked to complete the www.CBTiweb.org training including the optional CBT for nightmares module)

Morgenthaler, T. I., Auerbach, S., Casey, K. R., Kristo, D., Maganti, R., Ramar, K., Zak, R., & Kartje, R. (2018). Position paper for the treatment of nightmare disorder in adults: an American Academy of Sleep Medicine position paper. Journal of Clinical Sleep Medicine, 14(6), 1041-1055. https://doi.org/10.5664/jcsm.7178 (attached)

Pruiksma, K. E., Molino, A., Taylor, D. J., Resick, P. A., and Peterson A. L. (2015). A case study of cognitive behavioral therapy for comorbid PTSD, insomnia, and nightmares. In C. Martin, V. R. Preedy, & V.B. Patel (Eds.), Comprehensive Guide to Posttraumatic Stress Disorders (pp. 2249-
2258). Springer. (attached)

It is highly recommended that attendees complete the free web-based provider training in Cognitive Behavioral Therapy for Insomnia, which includes a Cognitive Behavioral Therapy for Nightmares module, prior to this training event! Please visit www.cbtiweb.org.”

Thursday, November 17 | 1:30 PM – 6:30 PM

Presented by:
Kirk Strosahl, Ph.D., President, HeartMatters Consulting LLC
Patricia Robinson, Ph.D., President, Mountainview Consulting Group Inc

Participants earn 5 continuing education credits

Abstract:

As the COVID-19 pandemic crisis has taught us, no one is safe from the “slings and arrows of outrageous fortune”. A crisis, by definition, demands that we respond in new, flexible ways that not only can help us “weather the storm”, but also can open the world up to us in ways not thought possible. Indeed, the Greek root of the word crisis literally means “turning point”. However, the urge to avoid and escape emotional discomfort is a constant threat to this rare opportunity for personal growth and transformation. In this institute, participants will learn the basic clinical principles of ACT-CI (ACT for Crisis Intervention), a brief, focused approach that emphasizes the important role that mindfulness, acceptance and life engagement play in the healthy resolution of a life crisis. ACT-CI is based in the psychological flexibility model as well as the precepts of predictive coding theory, a neuroscience account of human emotions. In this approach, emotions are thought to signal a discrepancy (or synchrony) between the client’s mental model of the “desired and expected” world, versus what is actually in the world. Social rules, norms and mores transmitted via language form the prior learning basis for our mental models of what is desirable and expected in the world (i.e., freedom from unwanted change, ability to control suffering). Avoidance and escape strategies function as ineffective attempts by clients to make the world fit their prior mental model (i.e., crisis instigation), whereas the processes of acceptance, mindful being and life engagement allow clients to change their mental models to more closely fit the world (e.g. crisis integration). In this institute, we will demonstrate how to help clients in crisis be mindfully aware of, and accept their intense bodily sensations and “feelings. We will show how to help clients make genuine contact with who and what matters to them in life and use the crisis as “fuel” to propel them towards what they value and aspire to in life. The clinical challenge, which we will explore on multiple levels using role play demonstrations, experiential exercises and skill practice, is to calmly and compassionately insert these three transformative processes into the clinical conversation with clients in crisis.

Long-term Goal: 

1. Apply strategies designed to help the client develop flexible adaptive strategies based in mindful being and mindful doing.
2. Operate calmly, comfortably and compassionately in the midst of a life crisis to create a genuinely powerful therapeutic relationship.

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

1. Assess each client’s unique psychological and behavioral processes associated with crisis instigation and crisis integration.
2. Intervene with the core language processes that foster rigid, as opposed to flexible, mental models of the world.
3. Communicate effectively with the client in crisis about the function of emotional discomfort as an important signal that should guide adaptive behavior.
4. Apply mindfulness interventions to help the client in crisis safely experience awareness of distressing bodily sensations.
5. Apply strategies designed to use the emotional pain of crisis to help the client make contact with personal values and life aspirations

Session Outline

1. An ACT consistent model of crisis formation and instigation
   1. Over-identification with the literal meaning of emotional experience
   2. Emotional and behavioral avoidance as self-amplifying processes underlying crisis
   3. Emotions as “signals” rather than “reality”
   4. Loss of bodily awareness
2. Predictive coding theory and human emotion
   1. How the brain gets ahead by predicting the immediate to distant future
   2. Interoception as the basis for alerting the organism to threat and safety cues
   3. Crisis level emotions as indicators of predictive coding gaps
   4. Resolving gaps as the overriding purpose of emotional experience
   5. How avoidance leads to a destructive form of resolving predictive coding gaps that elongates the crisis response
3. The role of acceptance, life-engagement, moderated by increased mindful awareness, in crisis integration
   1. Acceptance allows the person’s “mental model” to be changed to fit the world
   2. Engagement promotes agency to resolve predictive coding gaps in a healthy way
   3. Mindful awareness and mindfulness of the body are central mediators
4. Developing mindfulness of the body during a crisis is central to resolving gaps
   1. Guidelines for sequencing mindfulness of the body during a crisis session
   2. Role play demonstration
   3. Dyadic skill practice in mindfulness of body sequencing during a crisis session
5. Introducing acceptance as a way of explaining and resolving a predictive coding gap
   1. Using acceptance “talk” to reshape the client’s mental model of the world
   2. Legitimizing emotional anguish as the “flip side” of closely held personal values
   3. Pain is inevitable; suffering is optional
6. Promoting a sense of personal agency at time of life crisis using values
   1. The essential link between values, predictive coding and human emotion
   2. What is the call to action in response to this emotional experience
   3. Role play demonstration of using acceptance and life engagement going hand in hand
   4. Dyadic skill practice in integrating acceptance and values “talk” during a crisis session

Recommended Readings:

Carlsson, K., Strosahl, K. & Roberts, L. (In Press) Acceptance and commitment therapy for crisis intervention: Finding the way through life challenges, trauma and personal catastrophe. Washington DC: American Psychiatric Publishing.

Hofmann, S., & Hayes, S. (2019). The Future of Intervention Science: Process-Based Therapy. Clinical Psychological Science, 7(1), 37–50. https://doi.org/10.1177/2167702618772296.

Frith C. (2021). The neural basis of consciousness. Psychological medicine, 51(4), 550–562. https://doi.org/10.1017/S0033291719002204

Chiles, J., Strosahl, K., & Roberts, L. (2018). Clinical manual for assessment and treatment of suicidal patients, 2nd Ed. Washington DC: American Psychiatric Publishing.