Master Clinician Seminars

Friday, November 18 | 8:30 AM – 10:30 AM

Presented by:
Alec Pollard, Ph.D., Professor Emeritus, Saint Louis University

Participants earn 2 continuing education credits

Abstract:

Though cognitive and behavioral therapies are effective with a variety of disorders, a substantial portion of patients do not respond adequately, often due to the presence of treatment-interfering behavior (TIB). For many years, CBT research devoted little attention to the management of TIB, but this trend has reversed over the past 2 decades. Interventions specifically designed to modify TIB or to otherwise promote therapy engagement have emerged from various cognitive and behavioral therapeutic orientations (e.g., CT, ACT, DBT). However, no single intervention addresses all of the potential factors associated with TIB. In this workshop, the presenter will describe a conceptual model that integrates the various factors associated with TIB and demonstrate how the model can be used to guide the clinical management and treatment of TIB. The workshop will include lecture, video demonstrations, and case presentations.

Long-term Goals: 

1. Increase their efficacy with patients often considered treatment-resistant.
2. Reduce the time they spend administering ineffective therapy.

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

1. Identify when to discontinue treatment of the presenting problem and direct the focus of therapy on treatment-interfering behavior.
2. Administer an instrument designed to identify different types of treatment-interfering behavior.
3. Develop clearly defined goals and objectives to delineate when treatment of the presenting problem can be successfully resumed.
4. Describe a conceptual model for understanding the 4 factors that can drive treatment-interfering behavior.
5. Develop and implement interventions designed to prevent, manage, or modify treatment-interfering behavior.

Session Outline

1. History and Evolution of the Concept: Treatment-Interfering Behavior (TIB)
2. Current Efforts within CBT to Address TIB
3. An Integrated Approach: Treatment Readiness Therapy

1. 1. Navigating the focus of therapy from presenting problem to TIB
   2. Identifying which TIB to treat
   3. Developing operational outcome goals that indicate treatment readiness
   4. Identifying factors contributing to the TIB
   5. Developing interventions to address each factor driving the TIB
   6. Implementing the interventions
   7. Resuming treatment of the presenting problem

Recommended Readings:

Chapman, A.L., & Rosenthal, M.Z. (2016). Managing therapy-interfering behavior: Strategies
from Dialectical Behavior Therapy. APA: Washington, DC.

Davis, M. et al. (2020). Clinicians’ perspectives of interfering behaviors in the treatment of
anxiety and obsessive-compulsive disorders in adults and children. Cognitive & Behavioral
Therapy, 49, 81-96.

Neziroglu, F., & Mancusi, L. (2014). Treatment resistant OCD: Conceptualization and treatment.
Current Psychiatry Reviews, 10, 289-295.

Friday, November 18 | 8:30 AM – 10:30 AM

Presented by:
Allison G. Harvey, Ph.D., Professor, University of California, Berkeley

Participants earn 2 continuing education credits

Abstract:

Behavioral experiments are “planned experiential activities, based on experimentation or observation, which are undertaken by patients in or between  therapy sessions. Their design is derived directly from a formulation of the problem, and their primary purpose is to obtain new information which includes contributing to the development and verification of the  formulation” (p. 8; Bennett-Levy, et al., 2004). Behavioral experiments encourage patients to become scientists (e.g., to make judgments in their lives based on data they collect, rather than based solely on their subjective feelings). Very often the experience of a behavioral experiment brings about profound disconfirmation of unhelpful beliefs or stunning demonstrations that certain behaviors or thoughts are important contributors to the sleep problem. Behavioral experiments can also provide deep experiential learning that new thoughts/beliefs/behaviors can reduce distress/anxiety and improve sleep. In this seminar, we will review the rationale for using behavioral experiments and present data that support the use of behavioral experiments. We will cover the steps for devising a behavioral experiment and a stock of behavioral experiments that we have found to be useful for patients with sleep problems. Also, we will emphasize that behavioral experiments should be personalized for each patient. As such, there are an infinite range of possibilities. The use of behavioral experiments in therapy creates opportunities to collaborate with your patient, being highly creative together, while making substantial progress in the treatment. We will emphasize that it is important that conducting behavioral experiments requires an openness to any outcome. The purpose of the experiment is to facilitate your patient to have new experiences and to discover new possibilities (even if they are not the experiences/outcomes you expected).

Long-term Goals: 

1. Collaboratively conduct behavioral experiments with clients who are experiencing sleep and circadian problems.
2. Generalize the knowledge gained in this seminar to use behavioral experiments when treating clients who are experiencing a wide range of challenges (not just sleep and circadian problems).

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

1. Describe the rationale for using behavioral experiments.
2. Identify data that support the use of behavioral experiments when treating insomnia and other sleep/circadian problems.
3. Apply the steps for devising a behavioral experiment.
4. Apply an example of a behavioral experiment that is useful for a patient with a sleep or circadian problem.
5. Identify a behavior experiment to try yourself.

Session Outline

• Rationale for behavioral experiments
• Steps for devising behavioral experiments
• Examples of behavioral experiments for unhelpful beliefs about sleep, monitoring for sleep-related threat and improving daytime functioning
• Practice in devising a behavioral experiment
• What if the outcome is not what you expected?
• Follow-up behavioral experiments

Recommended Readings:

Perlis, M. L., Aloia, M., & Kuhn, B. (Eds.). (2010). Behavioral treatments for sleep disorders: A comprehensive primer of behavioral sleep medicine interventions. Academic Press.

Harvey, A. G., Bélanger, L., Talbot, L., Eidelman, P., Beaulieu-Bonneau, S., Fortier-Brochu, É., … & Morin, C. M. (2014). Comparative efficacy of behavior therapy, cognitive therapy, and cognitive behavior therapy for chronic insomnia: a randomized controlled trial. Journal of consulting and clinical psychology, 82(4), 670.

Neitzert Semler, C., & Harvey, A. G. (2007). An experimental investigation of daytime monitoring for sleep-related threat in primary insomnia. Cognition and emotion, 21(1), 146-161.

Friday, November 18 | 11:00 AM – 1:00 PM

Presented by:
Jacqueline B. Persons, Ph.D., Director, Oakland CBT Center/UC Berkeley Department of Psychology

Participants earn 2 continuing education credits

Abstract:

A case formulation is a hypothesis about the psychological mechanisms that maintain the patient’s symptoms, disorders, and problems. The formulation helps the therapist in many ways, including by helping the therapist select intervention targets and solve problems that arise in treatment. In this Master Clinician presentation, Dr. Persons teaches some of the basic skills of developing and using a case formulation in CBT. She presents didactic material and video examples of her work with a woman who sought treatment for insomnia and OCD. Dr. Persons teaches strategies for developing a transdiagnostic case formulation and using the formulation to guide intervention and solve problems, including this patient’s wish to prematurely terminate her treatment. Dr. Persons provides numerous handouts and recommends online tools that therapists can use to implement a case formulation-driven approach to treatment in their own practice.

Long-term Goals: 

1. Identify 1 transdiagnostic mechanism for every depressed adult patient they treat.
2. Develop a collaborative list of idiographic treatment goals for every adult patient they treat.

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

1. List 2 elements of a case formulation.
2. List 3 common transdiagnostic mechanisms that maintain mood and anxiety and related symptoms in adults.
3. List 4 domains the clinician will want to assess in order to obtain a comprehensive problem list.
4. Offer 2 examples of clinical problems the case formulation can help the therapist solve.
5. Identify 2 assessment tools that are useful in developing a case formulation for an adult patient who seeks treatment for anxiety or depression or a related problem.

Session Outline

I. Case formulation-driven CBT: A conceptual model
II. Developing a case formulation
     A. Obtaining a comprehensive problem list
     B. Developing mechanism hypotheses
III. Using the case formulation in treatment
     A. Using the formulation to target mechanisms instead of problems/disorders
     B. Using the formulation to guide decision-making
     C. Using the formulation to handle treatment failure

Recommended Readings:

Persons, J. B. (2008). The case formulation approach to cognitive-behavior therapy. New York: Guilford Press.

Persons, J. B., Beckner, V. L., & Tompkins, M. A. (2013). Testing case formulation hypotheses in psychotherapy: Two case examples. Cognitive and Behavioral Practice, 20, 399-409.

Scott, K., & Lewis, C. C. (2015). Using measurement-based care to enhance any treatment. Cognitive and Behavioral Practice, 22(1), 49–59. https://doi.org/10.1016/j.cbpra.2014.01.010

Gates, V., Hsiao, M., Zieve, G. G., Courry, R., & Persons, J. B. (2021). Relationship to CBT outcome and dropout of decision support tools of the written case formulation, list of treatment goals, and plot of symptom scores. Behaviour Research and Therapy, 142,103874.

Friday, November 18 | 1:30 PM – 3:30 PM

Presented by:
Michelle G. Craske, Ph.D., Professor of Psychology, University of California Los Angeles

Alicia E. Meuret, Ph.D., Professor of Psychology, Southern Methodist University

Participants earn 2 continuing education credits

Abstract:

Individuals with depression or anxiety often experience a loss of pleasure, interest, or joy in usual activities. Low positive affect (a core feature of anhedonia) is a risk factor for poor prognosis and suicidality, and yet treatments to date have been relatively ineffective in targeting it. Based on advances in behavioral and neuroscience, Positive Affect Treatment (PAT) was developed to specifically target areas of reward sensitivity that are believed to contribute to anhedonia. These include the anticipation and motivation for reward, the response to reward attainment, and the learning of associations between actions and reward outcomes. PAT is a 15-session intervention composed of three modules targeting behaviors (Actions Toward Feeling Better), cognitions (Attending to the Positive), and Building Positivity. Each module has a set of skills that focuses on building the capacity to look forward to, attend to, enjoy and savor, and learn about positive and rewarding experiences. The premise is that by building capacity for reward, not only will rewarding experiences be felt more strongly (rather than being dismissed), but negative experiences (internal or external) will also become less predominant. Randomized controlled trials comparing PAT to cognitive behavior therapy for individuals with moderate to severe depression or anxiety resulted in higher positive affect, lower negative affect, and superior reduction in symptoms of depression, anxiety, and suicidality.

Long-term Goals: 

1. Utilize positive affect treatment in their clinical practice.
2. Design clinical trials using positive affect treatment.
3. Explain the necessity for improving positive affected in anxious and depressed individuals.

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

1. Describe the three reward sensitivity subdomains.
2. Explain the results of the two randomized-controlled trials for PAT.
3. Demonstrate the skills on targeting behaviors (Actions Toward Feeling Better), cognitions (Attending to the Positive), and Building Positivity.
4. Identify at least 3 challenges that present during the treatment with patients low in positive affect.

Session Outline

• Individuals with depression or anxiety often experience a loss of pleasure, interest, or joy in usual activities.
• Low positive affect (a core feature of anhedonia) is a risk factor for poor prognosis and suicidality, yet treatments to date have been relatively ineffective in targeting it.
• Our 15-session Positive Affect Treatment (PAT) was developed to target deficits in reward sensitivity contributing to anhedonia.
• Attendees will learn about the three PAT modules targeting behaviors (Actions Toward Feeling Better), cognitions (Attending to the Positive), and Building Positivity and the set of skills that focuses on building the capacity to look forward to, attend to, enjoy and savor, and learn about positive and rewarding experiences.

Recommended Readings:

Craske, M.G., Meuret, A.E. Ritz, T., Rosenfield, D., Treanor, M., & Dour, H. (2019). Positive Affect Treatment for Depression and Anxiety: A Randomized Clinical Trial for a Core Feature of Anhedonia. Journal of Consulting and Clinical Psychology, 87, 457-471.

Craske, M.G., Meuret, A.E., Ritz, T., Treanor, M., & Dour, H. (2016). Treatment for anhedonia: Neuroscience driven approach. Depression and Anxiety, 33, 927-938.

Meuret, A.E., Dour, H., Loerinc Guinyard, A., & Craske, M.G., (2022). Positive Affect Treatment for Depression and Anxiety, Workbook. New York, NY: Oxford University Press.

Craske, M.G., Dour, H., Treanor, M., & Meuret, A.E (2022). Positive Affect Treatment for Depression and Anxiety. Therapist Guide. New York, NY: Oxford University Press.

Thomsen, K. R., Whybrow, P. C. & Kringelbach, M. L. Reconceptualizing anhedonia: Novel perspectives on balancing the pleasure networks in the human brain. Frontiers in Behavioral Neuroscience vol. 9 (2015).

Saturday, November 19 | 8:30 AM – 10:30 AM

Presented by:
Jill Ehrenreich-May, Ph.D., Professor, University of Miami

Lisa W. Coyne, Ph.D., Assistant Professor, Harvard Medical School

Participants earn 2 continuing education credits

Abstract:

Led by key developers behind leading contemporary behavioral and cognitive behavioral therapies (e.g., Unified Protocols for Transdiagnostic Treatment of Emotional Disorders and Acceptance and Commitment Therapy) for children and adolescents, this presentation will offer an interactive clinical demonstration of shared principles and processes across these approaches that promote behavior change by targeting maladaptive avoidance behavior in youth. Following a brief introduction regarding how to effectively engage and “move the needle” in maladaptive avoidance, Drs. Coyne and Ehrenreich-May will provide live demonstration of a pragmatic, integrated approach to behavior change in this target with mock youth clients and family members using role-play techniques and hands-on exercises, as well as discuss points of shared and distinct process between cognitive behavioral and acceptance-based approaches to anxiety and maladaptive avoidance behavior with audience members. Techniques to be demonstrated may be categorized as (1) shaping mindful processes (antecedent control strategies), (2) shaping behavior change processes (consequent strategies), and (3) developmentally-sensitive approaches to targeting avoidance behavior via caregiver behavior change. Within these broader process-based categories, Drs. Coyne and Ehrenreich-May will alternatively demonstrate key techniques that engage purposeful attention, emotion regulation, flexible perspective-taking, engage choice, motivation, self-directed and mindful risk-taking to planfully reduce maladaptive avoidance behavior across cognitive-behavioral and acceptance-based approaches. The overarching goal of this presentation will be for attendees to leave with an understanding of “how to” use key processes that may be viewed as shared and/or easily integrated across effective therapies for youth with anxiety and maladaptive avoidance.

Long-term Goals: 

1. The overarching goal of this presentation will be for attendees to leave with an understanding of “how to” use key processes that may be viewed as shared and/or easily integrated across effective therapies for youth with anxiety and maladaptive avoidance.
2. Specific techniques that may be used over the longer-term fall into one of three specific categories: (a) shaping mindful processes (antecedent control strategies), (b) shaping behavior change processes (consequent strategies), and (c) developmentally sensitive approaches to targeting avoidance behavior via caregiver behavior change.

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

1. Identify the importance of targeting maladaptive avoidance in youth.
2. Discuss two shared processes across Acceptance and Commitment Therapy and Cognitive Behavior Therapy for youth that target maladaptive avoidance behavior.
3. Identify three processes to modify maladaptive avoidance that may be defined as antecedent control strategies, consequent strategies, or caregiver behavior change strategies.
4. Increase clinical sophistication and skill by discussing two points of shared and distinct process between acceptance-based and cognitive-behavioral approaches to reducing youth avoidance.
5. Increase clinical skill via observation of techniques that engage purposeful attention, emotion regulation, flexible perspective-taking, engage choice, motivation, self-directed and mindful risk-taking to reduction in maladaptive avoidance.

Session Outline

This presentation will offer an interactive clinical demonstration of shared principles and processes across these approaches that promote behavior change by targeting maladaptive avoidance behavior in youth.

• Main Point 1: The presenters will first discuss how to effectively engage and “move the needle” in maladaptive avoidance.
• Main Point 2: Drs. Coyne and Ehrenreich-May will then conduct a live demonstration of a pragmatic, integrated approach to behavior change in this target with mock youth clients and family members using role-play techniques and hands-on exercises. Drs. Coyne and Ehrenreich-May will alternatively demonstrate key techniques that engage purposeful attention, emotion regulation, flexible perspective-taking, engage choice, motivation, self-directed and mindful risk-taking to planfully reduce maladaptive avoidance behavior across cognitive-behavioral and acceptance-based approaches.
• Main Point 3: The presenters will also discuss points of shared and distinct process between cognitive behavioral and acceptance-based approaches to anxiety and maladaptive avoidance behavior with audience members, as they process role-plays presented.

Recommended Readings:

Ehrenreich-May, J., Kennedy, S.M., Sherman, J.A., Bilek, E.L., Buzzella, B.A., Bennett, S.M., & Barlow, D.H. (2018). Unified protocols for transdiagnostic treatment of emotional disorders in children and adolescents: Therapist guide. Oxford University Press.

Ehrenreich-May, J., & Chu, B.C. (Eds.). (2013). Transdiagnostic treatments for children and adolescents: Principles and practice. Guilford Press.

Boone, M., Gregg, J. & Coyne, L. W. (2020). Stop Avoiding Stuff: 25 Microskills to Face Your Fears and Do It Anyway. California: New Harbinger.

Whittingham, K. & Coyne, L. W. (2019). Acceptance and Commitment Therapy: The Clinician’s Guide to Supporting Parents. Elsevier: UK.

Kennedy, S.M., & Ehrenreich-May, J. (Eds.). (in press). Applications of the Unified Protocols for Transdiagnostic Treatment of Children and Adolescents. Oxford University Press (ABCT Series).

Saturday, November 19 | 11:00 AM – 1:00 PM

Presented by:
Elizabeth McMahon, Ph.D., Psychologist, Independent Practice

Participants earn 2 continuing education credits

Abstract:

Virtual reality (VR) can be used in teletherapy to provide immersive, evocative experiences for graduated exposure and other uses. VR is increasingly affordable, available, intuitive, and evidence – based. Clients are actively searching for therapists offering VR therapy (VRT). Attendees will see examples of VR scenarios and products and will learn how VR can be used for various therapeutic purposes, including VR exposure therapy (VRET). Benefits, risks, and research support will be reviewed. Attendees will learn the strengths and limitations of VR exposure compared to imaginal exposure and in vivo exposure. The timing and uses of VR will be discussed in the context of an overall model of anxiety disorders and their treatment.

Long-term Goals: 

1. Assess the appropriateness and possible benefits of adding VR as a clinical tool to his/her/their practice.
2. Select VR product(s) appropriate for his/her/their practice and create a VR exposure hierarchy

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

1. Describe two uses of virtual reality (VR) in treating anxiety disorders.
2. List two research findings supporting the use of VR in treating anxiety disorders.
3. Name one advantage of VR exposure over imaginal exposure.
4. Explain two advantages of VR exposure over in vivo exposure.
5. Identify two risks of using VR for exposure therapy.

Session Outline

• Types of virtual reality (VR) content and equipment needed
• Summary of research findings, clinical applications, and benefits of VR
• Advantages, disadvantages, and possible risks of VR exposure
• Case examples illustrating VR exposure therapy (VRET) for anxiety
• How to choose VR product(s) for your practice
• Additional training resources

Recommended Readings:

McMahon, E., with Boeldt, D. (2022) Chapter 3 “Uses of VR in Anxiety Treatment”. In Virtual reality therapy for anxiety: A guide for therapists. Routledge.

Carl, E., Stein, A. T., Levihn-Coon, A., Pogue, J. R., Rothbaum, B., Emmelkamp, P., Asmundson, G., Carlbring, P., & Powers, M. B. (2019). Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. Journal of anxiety disorders, 61, 27–36.
https://doi.org/10.1016/j.janxdis.2018.08.003

Benbow, A. & Anderson, P. (2019). A meta-analytic examination of attrition in virtual reality exposure therapy for anxiety disorders. Journal of anxiety disorders, 61, 18-26. https://doi.org/10.1016/j.janxdis.2018.06.006.

Chesham, R., Malouff, J., & Schutte, N. (2018). Meta-Analysis of the Efficacy of Virtual Reality Exposure Therapy for Social Anxiety. Behaviour Change, 35(3), 152-166. doi:10.1017/bec.2018.15

Botella, C., Fernández-Álvarez, J., Guillén, V. et al. Recent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review. Curr Psychiatry Rep 19, 42 (2017). https://doi.org/10.1007/s11920-017-0788-4

Saturday, November 19 | 1:30 PM – 3:30 PM

Presented by:
Robert L. Leahy, Ph.D., Director, American Institute for Cognitive Therapy

Participants earn 2 continuing education credits

Abstract:

Although regret is a central element in depression, procrastination, indecision, self-criticism, worry, rumination, and avoidance, it has received little attention in the CBT literature. In contrast, regret has been a focus in decision theory and research indicating that when people make decisions, they often anticipate the possibility of post-decision regret and, therefore, attempt to minimize this experience. Regret is not always a negative process. Insufficient regret processes result in impulsive behavior and failure to learn from past decisions. During manic episodes there is underutilization of anticipatory regret. We will view regret as a self-regulatory process where too much regret or too little regret may be problematic. Although people often believe that they will more likely regret taking new action, research indicates over time there is greater regret for actions not taken. Affective forecasting-that is, overprediction of emotion following events in the future-often contributes to anticipatory regret, with predictions leading to beliefs in greater impact of events than is warranted by the facts. In addition, some decision makers have idealized beliefs about decisions, rejecting ambivalence as an inevitable part of the tradeoffs underlying decision making under uncertainty. Specific decision styles are more likely to contribute to regret, including maximization, emotional perfectionism, intolerance of uncertainty, and overvaluation of “more” information rather than relevant information. In this presentation we will examine how regret is linked to hindsight bias, maximization rather than satisfaction strategies, intolerance of uncertainty, rejection of ambivalence, refusal to accept tradeoffs, excessive information demands, and ruminative processes. Specific techniques will be elaborated to balance regret with acceptance, present utility, and flexibility to enhance more pragmatic decision processes, reverse ruminative focus on the past, and replace self-criticism with adaptive self-correction.

Long-term Goals: 

1. Use concepts of anticipatory and retrospective regret in helping clients make better informed decisions.
2. Help clients reduce maximization beliefs both in making decisions and in coping with outcomes.

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

1. Identify the role of anticipatory and retrospective regret in decision making and how this impacts procrastination, risk aversion, indecision, rumination, and self-criticism
2. Assist clients in accepting uncertainty and risk in order to make more pragmatic and effective decisions;
3. Describe how to assist clients in reducing post-decision regret, self-criticism and rumination and accept tradeoffs in making decisions while enhancing satisfaction with imperfect outcomes.
4. Distinguish between Productive and Unproductive Regret
5. Relate decision style of maximizing, inflexible expectations, and perfectionism to vulnerability to regret

Session Outline

• Regret is a central issue in decision making, procrastination, worry, rumination and guilt.
• Clients may have problems in either exaggerating or minimizing regret.
• Over the long-term there is greater regret for actions not taken than actions taken.
• Decision styles emphasizing maximization rather than satisfaction lead to greater regret.
• Intolerance of ambivalence and uncertainty can lead to opportunity costs due to inability to decide.
• Emphasizing acceptance, flexibility, future utility, and relative preferences can assist clients in coping with outcomes.

Recommended Readings:

Leahy, R. L. (2022) If Only..Finding Freedom from Regret. New York: Guilford

Leahy, R.L. (2015). Emotional Schema Therapy. New York: Guilford.