Institutes

Presented by:

Rhonda M. Merwin, Ph.D., Associate Professor, Duke University Medical Center

Ashley Moskovich, Ph.D., Assistant Professor, Duke University Medical Center

Participants earn 5 continuing education credits

Categories: Eating Disorders, Treatment – Mindfulness & Acceptance

Keywords: ACT (Acceptance & Commitment Therapy), Eating, Body Image

Basic to moderate level of familiarity with the material.

Eating disorders (EDs) have a profound impact on health and wellbeing, and are associated with increased disability, mortality and risk of suicide. EDs affect people of all ages, race, ethnicity, sexual orientation, and socioecomomic status. An ED may be the primary presenting problem, or disordered eating may be a symptom of a broader struggle with anxiety, depression or trauma. While significant progress has been made in the treatment of EDs, many individuals have a suboptimal treatment response. Practitioners often must also address disordered eating while treating other comorbid conditions, which can be challenging without a framework for how issues may be related, or how target behaviors may serve a similar function or purpose (e.g., experiential avoidance).

Acceptance and Commitment Therapy (ACT) is a transdiagnostic intervention that improves human functioning by increasing psychological flexibility (or the ability to contact the present moment fully, without unnecessary attempts to avoid or escape internal experience, and behave in ways that align with deeply held personal values). ACT may offer a conceptual frame that is useful for coordinating treatment, particularly in cases of multiple co-morbidities. ACT interventions may also increase the impact of evidence-based practices for EDs or client’s willingness to participate (e.g., food exposure), or provide new avenues for intervention.

This workshop will provide an overview of the ACT model and the 6 inter-related therapeutic processes of acceptance, defusion, present moment awareness, self-as-context, values and committed action.

Practitioners will learn to conceptualize disordered eating behaviors as part of a larger functional class of behavior, and use this conceptualization to guide intervention. They will also learn how to integrate ACT interventions into other evidence-based practices to disrupt disordered eating and teach clients to meet their physical and emotional needs. Training methods will include didactic presentation, case material, demonstrations and experiential exercises.

Outline:

• 8:00 AM – 9:30 AM
• Overview of ACT model; formulation of eating disorders from an ACT perspective; functional assessment of eating disorder behavior; treatment planning.
• 9:30 AM – 9:45 AM
• Break
• 9:45 AM – 11:15 AM
• Functional assessment and treatment planning (continued). Generating willingness, diffusion and self-interventions (this will include orientation to each therapeutic process, live demonstration and case examples, and integration with other evidence-based practices for eating disorders).
• 11:15 AM – 11:30 AM
• Break
• 11:30 AM – 1:00 PM
• Continuing to build/expand willingness, values authorship and engagement (this will include orientation to each therapeutic process, live demonstration and case examples, and integration with other evidence-based practices for eating disorders).

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

1. Identify at least 2 ways in which ACT might be useful in the treatment of EDs.
2. Define the 6 core therapeutic processes of the ACT model and identify 1 example intervention for each.
3. Complete an ACT consistent case formulation for ED behavior and an initial treatment plan.
4. Describe how ACT processes are integrated into other evidence-based practices for EDs (e.g., food exposure, appetite awareness training).
5. Identify 1 example of a specific ACT intervention that can be used to address a challenge in ED treatment (e.g., alexithymia, low motivation for change).

Long-term Goals:

1. Conceptualize eating disorders from an ACT perspective and develop an ACT-informed treatment plan.
2. Integrate ACT interventions into other evidence-based practices for eating disorders.

Recommended Readings:

Onnink, C. M., Konstantinidou, Y., Moskovich, A. A., Karekla, M. K., & Merwin, R. M. (2022). Acceptance and commitment therapy (ACT) for eating disorders: A systematic review of intervention studies and call to action. Journal of Contextual Behavioral Science, 26, 11-28.

Juarascio, A. S., Manasse, S. M., Schumacher, L., Espel, H., & Forman, E. M. (2017). Developing an acceptance-based behavioral treatment for binge eating disorder: Rationale and challenges. Cognitive and Behavioral Practice, 24(1), 1-13.

Merwin, R.M. (2020). ACT Innovations for Dangerous Weight Control: Anorexia Nervosa and ED-DMT1. In M. Levin, M. Twohig & J. Krafft (Eds.). Acceptance and Commitment Therapy: Clinical Advances and Applications in ACT. New Harbinger Publications: Oakland, CA.

Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181-192.

Macri, J. A., & Rogge, R. D. (2024). Examining domains of psychological flexibility and inflexibility as treatment mechanisms in acceptance and commitment therapy: A comprehensive systematic and meta-analytic review. Clinical Psychology Review, 102432. Doi: 10.1016/j.cpr.2024.102432

Presented by:

Kelly L. Green, Ph.D., Senior Research Investigator, University of Pennsylvania

Shari Jager-Hyman, Ph.D., Assistant Professor, University of Pennsylvania

Participants earn 5 continuing education credits

Categories: Suicide and Self-Injury, Treatment – CBT

Keywords: Suicide, CBT, Adult

Basic to Moderate level of familiarity with the material.

Cognitive Therapy for Suicide Prevention (CT-SP) is a suicide-specific psychotherapy that is designed to help clients learn specific cognitive or behavioral skills for coping effectively with suicide risk. The primary focus of CT-SP is on targeting suicide risk directly, rather than by treating other psychiatric disorders. CT-SP is driven by an individualized case conceptualization approach that aims to (1) help clients identify specific triggers and proximal risk factors that contribute to suicidal crises and (2) develop individualized treatment goals and corresponding skills to prevent and/or cope with future crises. CT-SP has been recognized as one of the few evidence-based psychotherapy interventions specifically for suicide prevention. In a landmark randomized controlled trial CT-SP was found to be efficacious for preventing suicide attempts as well as decreasing other risk factors for suicide such as depression and hopelessness. Specifically, patients who received CT-SP were approximately 50% less likely to make a repeat suicide attempt during the follow-up period than those who did not receive CT-SP (Brown et al., 2005).

Recently, CT-SP has been adapted for individuals who have chronic suicidal thoughts but may not have had recent suicidal behavior. This adapted version has been found superior to Enhanced Usual Care in reducing suicidal ideation (Green, Brown, et al., unpublished data). Such adaptations are especially important because some high-risk groups such as older adults make fewer suicide attempts and are more likely to die on their first attempt (Dombrovski et al., 2005). Therefore, targeting suicidal ideation is critical for averting suicide in such individuals. This Institute will focus on teaching case conceptualization for individuals with chronic suicidal ideation, as well as adaptations made to the original treatment for this population.

Outline:

1. Initial Phase of Treatment and Adaptations for Treating Chronic Suicidal Ideation
2. Case conceptualization for chronic suicidal ideation
3. Middle Phase of Treatment and Adaptations for Treating Chronic Suicidal Ideation
4. Later Phase of Treatment and Adaptations for Treating Chronic Suicidal Ideation

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

1. Summarize the empirical evidence for CT-SP.
2. Conduct a narrative interview to elucidate proximal and modifiable factors that maintain suicide risk.
3. Formulate a case conceptualization and treatment goals to reduce suicide risk for individuals with chronic suicidal ideation.
4. Implement strategies to foster hope and engagement in treatment.
5. Apply suicide-specific CBT strategies to target suicidal ideation and suicide risk.

Long-term Goals:

1. Apply suicide-specific case conceptualization to reduce suicidal thoughts and behaviors in at-risk patients.
2. Use case conceptualization to select cognitive and behavioral treatment strategies with a suicide risk reduction focus.

Recommended Readings:

Green, K. L. & Brown, G. K. (2015). Cognitive Therapy for Suicide Prevention: An illustrative case example. In C. J. Bryan (Ed.), Cognitive Behavioral Therapy for Preventing Suicide Attempts: A Guide to Brief Treatments Across Clinical Settings. New York, NY: Routledge.

Royter, E., Sudak, D., & Plakun, E. M. (2024). Cognitive Behavioral Therapy Approaches for Chronic Suicidality. Journal of psychiatric practice, 30(1), 46–50.

Ilgen, M. A., Olson-Madden, J. H., Price, A., Brenner, L. A., King, C. A., & Blow, F. C. (2023). Cognitive behavioral therapy for suicide prevention among Veterans receiving substance use disorder treatment: Results from a randomized trial. Journal of psychiatric research, 168, 344–352.

Wu, H., Lu, L., Qian, Y., Jin, X., Yu, H., Du, L., Fu, X., Zhu, B., & Chen, H. (2022). The significance of cognitive-behavioral therapy on suicide: An umbrella review. Journal of Affective Disorders, 317, 142-148.

Bryan, C. J. (2019///May 2019 – Jun). Cognitive behavioral therapy for suicide prevention (CBT‐SP): Implications for meeting standard of care expectations with suicidal patients. Behavioral Sciences & the Law, 37(3), 247-258.

Wenzel, A., Brown, G. K., & Beck, A. T. (2008). Cognitive therapy for suicidal patients: Scientific and clinical applications. Washington, DC: APA Books.

Presented by:

Kirk Strosahl, Ph.D., Owner/President, HeartMatters Consulting LLC

Patricia Robinson, Ph.D., President/Owner, Mountainview Consulting Group Inc

Participants earn 7 continuing education credits

Categories: Transdiagnostic, Treatment – Mindfulness & Acceptance

Keywords: Change Process / Mechanisms, Behavior Analysis, ACT (Acceptance & Commitment Therapy)

Basic to moderate level of familiarity with the material.

For various reasons, behavioral health clinicians are increasingly confronted with the challenge of achieving positive clinical outcomes using fewer and fewer therapy sessions. The result is the need for trans-diagnostic, process-based intervention approaches that can produce positive clinical outcomes in a very limited number of sessions. Focused Acceptance and Commitment Therapy (FACT) is a brief, process-based therapy that uses the principles of acceptance, mindfulness and committed action to promote valued life outcomes for the client. FACT seeks to optimize the impact of every therapy session, including the first session, by creating a between-session behavior change goal with the client. Indeed, an underlying principle of FACT is to treat every session as if it might be the last one.

In this institute, we will examine three psychological processes that lead to suffering and psychological dysfunction: rule following, emotional avoidance and behavioral avoidance. The antidote for these three toxic processes is to use brief interventions that promote openness to inner experience, awareness of the present moment, and value-based actions in real life. These three psychological processes (Open, Aware, Engaged) are often referred to as the “pillars” of psychological flexibility. Participants will learn how to first organize the “flow” of a brief intervention session using a system known as CARE. Each letter of the acronym represents a specific clinical activity the clinician will engage in to streamline the clinical conversation.

Participants will then learn, and practice, several core FACT skills: Preparing the client for radical change; change-oriented, contextually based interviewing; use of in-session rating scales; undermining avoidance strategies via the use of the workability yardstick; problem reformulation strategies establishing motivation to do something different, and constructing powerful between session behavioral experiments. The workshop teaching methods will involve didactic presentation, role play demonstrations, experiential exercises and supervised dyadic skill building role play exercises. Participants will learn specific clinical skills that can immediately be incorporated into clinical practice.

Outline:

• Hour 1: How the approach-avoidance dynamic leads to both human suffering and human vitality; three toxic psychological processes that underlie all forms of suffering; CARE algorithm as the basic session organizational framework in FACT; the three basic processes of psychological resiliency; qualities of the FACT therapeutic relationship.
• Hour 2: Preparing the client for radical change; contextual interviewing strategies that both create and leverage intervention options; reframing unwanted distressing emotions as “signals” of unmet strivings, rather than “symptoms” of illness; undermining context insensitive rule following; clinical demonstration and dyadic skill practice.
• Hour 3: Hunting for and countering in-session emotional and behavioral avoidance strategies; reformulating the “problem” in approach-avoidance terms; using workability to create experiential contact with unworkable actions and associated unwanted life outcomes; injecting values into the conversation about workability.
• Hour 4: Learning to probe, read and react “on the fly” using FACT case conceptualization methods including the Four-Square Tool and Psy-flex Assessment Tool; Dyadic and small group practice
• Hour 5: Reframing as the “art” part of therapy; creating client buy-in for a new definition of the “problem”; reframing as a back and forth negotiation; qualities of effective reframes; matching reframe “risk-reward” level to client’s level of engagement and readiness to change; clinical demonstration/small group exercise.
• Hour 6-7: Therapy is all about promoting behavioral variability; creating powerful behavioral experiments that embody personal values in action; use of augmenting strategies to boost client motivation to follow through; use of in session rating scales to boost confidence, protect against therapist “over-reach”, model a “horizontal” relationship between client and clinician; putting it all together in dyadic skill practice.

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

1. Describe the core toxic processes of human suffering and the pillars of psychological flexibility.
2. Apply the CARE session organization framework to assure vital change oriented clinical conversations.
3. Describe contextual interviewing strategies in relation to the workability of avoidance behaviors.
4. Reformulate and reframe the presenting problem such that it appears to be immediately solvable.
5. Apply FACT case conceptualization strategies to identify brief intervention targets.
6. Apply in-session rating scales to assess progress and readiness to change.
7. Design powerful between session experiments designed to increase self-efficacy and behavioral variability.

Long-term Goals:

1. Develop the capacity to both simplify and supercharge your CBT practice to achieve better clinical results in a shorter period of time.
2. Acquire skills that allow you to both shape and leverage the change conversation in each and every therapy session

Recommended Readings:

Arroll, B., et al., (2021). FACT effectiveness in primary care; a single visit RCT for depressive symptoms. The International Journal of Psychiatry in Medicine, 0(0), 1-12. 0(0), 1-12. SAGE DOI: 10.1177/00912174211010536

Dochat, Wooldridge, Herbert, Lee & Afari (2021). Single-session acceptance and commitment therapy (ACT) interventions for patients with chronic health conditions: A systematic review and meta-analysis. Journal of Contextual Behavioral Science, 20, 52-69.

Peters, N., Sylvers, P., Shearer, E. Kane, M., Eller, A., Plumb-Vilardaga, J., Bonow, J. & Jakupcak, M. (2016). The efficacy of focused acceptance and commitment therapy in VA primary care. Psychological Services, 13, 156-161. doi.10.1037/ser0000062

Carlsson, K., Strosahl, K. & Roberts, L (2023) Acceptance and Commitment Therapy for Crisis Integration: Theory and Practice. Washington DC: American Psychiatric Publishing.

Robinson, P. (2021) Basics of behavior change in primary care. New York: Springer Science + Media.

Presented by:

Anne Marie Albano, ABPP, Ph.D., Professor, Columbia University Medical Center

John Piacentini, ABPP, Ph.D., Professor, University of California, Los Angeles

Participants earn 7 continuing education credits

Categories: Child / Adolescent – Anxiety, Obsessive Compulsive and Related Disorders

Keywords: Exposure, Treatment, Ethics

Moderate level of familiarity with the material.

Since the onset of the pandemic, referrals for treatment of anxiety disorders (ADs) and obsessive-compulsive disorder (OCD) in children, adolescents, and emerging adults (hereafter, “youth”) have increased at an alarming rate. Affected youth evidence significant distress, global impairments in functioning, and high risk for the development of secondary conditions. Exposure-based cognitive behavioral therapy (EXCBT) is the most well studied psychosocial treatment yet backed by nearly 50 years of randomized controlled trials and dissemination studies establishing its empirical support, EXCBT is not widely available due to a failure of adequately training clinicians to competency as well as treatment “deserts” in the USA. Moreover, misinformation and myth about exposure therapy for anxiety and OCD fuels resistance to clinicians learning to administer this modality as well as fear among youth who may benefit from its effectiveness. The presenters will bring to bear in this institute their collective experience in treating youth with ADs and OCD using EXCBT, from their clinical trials as well as practices and training programs.

After a review of the theoretical and empirical bases of exposure, the brunt of the institute will be spent in walking through the practice and ethics involved in assessment, treatment planning, and implementation of exposure therapy. Setting up exposures for youth at different ages and developmental stages, which bring their own unique challenges in terms of ecological validity and involvement of parents or partners, will be examined. Ethical issues in conducting exposures both within and outside of the therapy office will be addressed, with particular attention to quandaries that occur, such as when an exposure may conflict with religious or cultural beliefs. While conveying some basic information on exposure work, the presenters will focus on challenging clinical presentations, such as treating the comorbidity of social phobia and selective mutism in adolescents, addressing pure cognitive compulsions, dealing with religiosity, and interoceptive exposure. The presenters will use case examples, give demonstrations, and will encourage questions and interaction with attendees throughout the institute.

Outline:

Exposure-based cognitive behavioral therapy (EXCBT) is backed by nearly 50 years of research establishing its empirical support, yet EXCBT is not widely available due clinician skill and availability. Misinformation and myth about EXCBT for anxiety and OCD fuels resistance to clinicians learning this modality, as well as fear of EXCBT among potential patients.

The presenters will share their collective experience in treating youth with ADs and OCD using EXCBT through a review of the theoretical and empirical bases of exposure, with the brunt of the institute focused on the practice and ethics involved in assessment, treatment planning, and implementation of EXCBT.

The challenges of conducting exposures for youth at different ages and developmental stages and involvement of significant others will be examined. Ethical issues in conducting exposures both within and outside of the therapy office will be addressed, with particular attention to quandaries involving conflict with religious or cultural beliefs. Beyond some basic information on exposure work, the presenters will focus on challenging clinical presentations, such as treating comorbidity, addressing pure cognitive compulsions, dealing with taboo and culture, and interoceptive exposures.

The presenters will use case examples, give demonstrations, and will encourage questions and interaction with attendees throughout the institute.

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

1. Review the theoretical foundation and empirical support for EXCBT in treating youth with ADs and OCD.
2. Explain the role of assessment in treatment planning for EXCBT, including hierarchy building and goal assessment that is ethically and culturally respectful and sensitive.
3. Discuss real patient stories and the presenters’ experiences, how to adapt EXCBT to specific ADs and presentations of OCD, across the developmental span of school-aged and college-aged youth.
4. Apply EXCBT (imaginal, in vivo, etc.) in individual, group, and telehealth service delivery as well as in self-guided interventions and the use of apps and/or computer-based programs.
5. Construct a relapse prevention plan focused on self-guided EXCBT that anticipates upcoming developmental changes and challenges for youth.

Long-term Goals:

1. Based on the theoretical and empirical foundations of EXCBT for ADs and OCD in youth, participants will be able to collaborate with patients in developing a personalized and ethical hierarchy and exposure plan for youth that is feasible and able to be flexed for implementation across contexts (e.g., home, clinic, in vivo environments).
2. Participants will understand ways to design a flexible relapse prevention plan that youth can adapt to meet their changing developmental challenges and needs, to address typical age- and stage-related rises in anxiety and OC symptoms.

Crane, M. E., Norris, L. A., Frank, H. E., Klugman, J., Ginsburg, G. S., Keeton, C., Albano, A. M., Piacentini, J., Peris, T. S., Compton, S. N., Sakolsky, D., Birmaher, B., Kendall, P. C. (2021). Impact of treatment improvement on long-term anxiety: results from CAMS and CAMELS. Journal of Consulting & Clinical Psychology, 89, 126-133. https://dx.doi.org/10.1037/ccp0000523

Krause, K. R., Chung, S., Adewuya, A. O., Albano, A. M., Babins-Wagner, R., Birkinshaw, L., Brann, P., Creswell, C., Delaney, K., Falissard, B., Forrest, C. B., Hudson, J. L., Ishikawa, S. I., Khatwani, M., Kieling, C., Krause, J., Malik, K., Martinez, V., Mughal, F., Ollendick, T. H., Ong, S. H., Patton, G. C., Ravens-Sieberer, U., Szatmari, P., Thomas, E., Walters, L., Young, B., Zhao, Y., Wolpert, M. (2021). International consensus on a standard set of outcome measures for child and youth anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder. The Lancet. Psychiatry, 8, 76-86. https://dx.doi.org/10.1016/S2215-0366(20)30356-4

Peris TS; Caporino NE; O’Rourke S; Kendall PC; Walkup JT; Albano AM; Bergman RL; McCracken JT; Birmaher B; Ginsburg GS; Sakolsky D; Piacentini J; Compton SN (2017). Therapist-reported features of exposure tasks that predict differential outcomes for youth with anxiety. Journal of the American Academy of Child and Adolescent Psychiatry, 56, 1043-1052.

Piacentini, J., Wu, M., Rozenman, M., Bennett, S., McGuire, J., Nadeau, J., Lewin, A., Sookman, D., Bergman, R.L., Storch, E.A., Peris, T. Knowledge and competency standards for specialized cognitive behavior therapy for pediatric obsessive-compulsive disorder, Psychiatry Research, Volume 299, 2021, https://doi.org/10.1016/j.psychres.2021.113854

Wu, Monica S, Caporino, Nicole E, Peris, Tara S, Perez, Jocelyn, Thamrin, Hardian, Albano, Anne Marie, Kendall, P., Walkup, J., Birmaher, B., Compton, S., Piacentini, J. (2020). The impact of treatment expectations on exposure process and treatment outcome in childhood anxiety disorders. Journal of Abnormal Child Psychology, 48, 79-89. https://doi.org/10.1007/s10802-019-00574-x

Presented by:

Debra Hope, Ph.D., Aaron Douglas Professor, University of Nebraska-Lincoln

Nathan Woodruff, Local Community Board Chair, Trans Collaborations

Participants earn 5 continuing education credits

Categories: LGBTQ+, Treatment – CBT

Keywords: Unified Treatment, Community-Based, Resilience

Basic to moderate level of familiarity with the material.

The recent increase in empirical research on the transgender and gender diverse (TGD) people’s mental health concerns and affirmative mental health services offer CBT therapists an opportunity to serve these clients with an evidence-based approach for the first time. This institute is based on the work of Trans Collaborations, our community-based participatory research (CBPR) collaborative that centers the voices and lived experience of transgender and gender diverse adults, especially in underserved areas. After a brief introduction to terminology and TGD communities’ lived experience, this workshop will emphasize practical applications that clinicians can use immediately to transform their practice and clinical work to be affirming for TGD adults. Presenters will describe the community-based, empirically-derived Trans Collaborations Adaptations for Psychological Services as applied to case-formulation driven CBT for adults.

Topics will include incorporating TGD intersectional identities into case formulations, adaptations for common CBT interventions, empirically derviced common themes in cognitive work with TGD clients, affirming use of cognitive restructuring around experiences of marginalization, therapists’ implicit assumptions about gender, and progress monitoring tools. We will also address assessing the practice environment to be TGD-affirming. Consistent with our CBPR approach and the workshop theme of community engagement, presenters represent both the academy and community. Although the emphasis will be on CBT for common outpatient mental health concerns, we will include discussions of the advantages and challenges of community engaged research as well. Teaching methods will include didactics, inventory of participants’ current practice settings, roleplays, video demonstrations, and Q&A.

Outline:

1. Understanding transgender and gender diverse communities: basic terminology, resiliency and health disparities, behavioral health needs.
2. Research base for CBT with transgender and gender diverse communities.
3. Practice adaptations developed through community-based participatory research.
4. Incorporating gender and other identities into CBT case conceptualization.
5. Adapting general aspects of practice to be affirming
6. Adapting common CBT interventions to be affirming
7. Progress monitoring for transgender and gender diverse clients.

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

1. Adapt their own practice of evidence-based CBT to be affirming of transgender and gender diverse older adolescent and adult clients.
2. Implement cognitive restructuring in an affirming manner with adults who identify as transgender or gender diverse seeking treatment for anxiety, depression, marginalization stress, or other common outpatient concerns.
3. Adapt at least four common CBT interventions (e.g., exposure, behavioral homework) to be affirming of the lived experience of adults and older adolescents who identify as transgender or gender diverse.
4. Assess their website and practice for barriers to care for adults who identify as transgender or gender diverse.
5. Incorporate gender and other identities within an intersectional framework into case formulation for all clients.
6. Implement affirming progress monitoring tools
7. identify the challenges and benefits of community-based partnerships to address behavioral health disparities.

Long-term Goals:

1. Participants will be able to adapt their own practice of evidence-based CBT to be affirming of transgender and gender diverse older adolescent and adult clients, including at least four common CBT interventions and progress monitoring.
2. Participants will be able to incorporate gender and other identities into case formulation for all clients using an intersectional framework.

Recommended Readings:

Hope, D.A., Holt, N. R., Woodruff, N., Mocarski, R., Meyer, H. Puckett, J. A., Eyer, J., Craig, S., Feldman, J., Irwin, J., Pachankis, J., Rawson, K.J., Sevelius, J., Butler, S. (2022). Bridging the gap between practice guidelines and the therapy room: Community-derived adaptations for psychological services with transgender and gender diverse adults in the Central United States. Professional Psychology: Research and Practice 53, 351-361. doi: 10.1037/pro0000448

Dickey, l. m. & Puckett, J. A. (2022). Affirmative Counseling for Transgender and Gender Diverse Clients. Hogrefe Publishing.

Holt, N. R., Huit, T. Z., Shulman, G. P., Meza, J. L., Smyth, J. D., Woodruff, N., Mocarski, R., Puckett, J. A., & Hope, D. A. (2019). Trans Collaborations Clinical Check-in (TC 3 ): Initial Validation of a Clinical Measure for Transgender and Gender Diverse Adults Receiving Psychological Services. Behavior Therapy, 50(6), 1136–1149. doi: 10.1016/j.beth.2019.04.001

Holt, N. R., Ralston, A. L., Hope, D. A., Mocarski, R., & Woodruff, N. (2021). A systematic review of recommendations for behavioral health services with transgender and gender diverse adults: The three-legged stool of evidence-based practice is unbalanced. Clinical Psychology: Science and Practice, 28, 186-201. doi.org/10.1037/cps0000006

Holt, N. R., Hope, D. A., Mocarski, R., & Woodruff, N. (2019). First impressions online: The inclusion of transgender and gender nonconforming identities and services in mental healthcare providers’ online materials in the USA. International Journal of Transgenderism, 20(1), 49-62, doi.org/10.1080/15532739.2018.1428842

Presented by:

Colleen E. Carney, Ph.D., Professor, Toronto Metropolitan University

Participants earn 5 continuing education credits

Categories: Sleep / Wake Disorders, Treatment – CBT

Keywords: Sleep, Anxiety, Depression

Basic to moderate level of familiarity with the material.

Sleep disruption is a shared challenge in anxiety, PTSD, chronic pain, and depression. Disregarding insomnia in these frequently comorbid conditions can result in unsatisfactory treatment outcomes and the recurrence of symptoms. Many providers mistakenly link Cognitive Behavioral Insomnia Therapy (CBT-I) with sleep hygiene, despite the ineffectiveness of sleep hygiene as a treatment. Moreover, therapists outside the sleep specialty often concentrate on the overlap between chronic insomnia and accompanying conditions, addressing issues like worry in anxiety cases rather than the factors perpetuating chronic insomnia.

To promote sleep recovery in clients dealing with anxiety, PTSD, chronic pain, and depression, it is crucial to address insomnia-specific causal factors directly. Move beyond traditional sleep hygiene and invest half a day in learning effective strategies for treating comorbid insomnias. Emphasizing case formulation and treatment plans derived from client worksheets, questionnaires, and sleep diaries exercises, this training will enhance your understanding and equip you to provide relief from chronic insomnia using Cognitive Behavioral Therapy for Insomnia (CBT-I) – a concise, evidence-based gold-standard treatment.

Outline:

1. Assessment
2. Case Forumlation and treatment approaches
   1. What factors are affecting sleep drive, and what treatment approaches increase sleep drive?
   2. What circadian are affecting the case, and what treatment approaches regulate the clock?
   3. Is there evidence of conditioned arousal? Sleep effort? What treatment approaches effectively address arousal?
   4. How do comorbid issues affect the case and the treatment plan?
   5. How do substances/medications affect the case and the treatment plan?
   6. Are there other factors (e.g., readiness for change, life event) to consider?
3. Treatment/Implementation Considerations
   1. a. Session delivery outline: Group and Individual
   2. b. Sequential vs concurrent decisions
   3. c. Complementary strategies
4. Summary and Questions

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

1. Distinguish acute insomnia from chronic insomnia and identify treatment implications.
2. Analyze data from sleep diaries to inform treatment decisions.
3. Devise behavioral experiments that modify sleep thoughts that get in the way of sleep or engaging with the treatment.
4. Identify cases in need of stimulus control and troubleshoot common barriers.
5. Calculate a time-in-bed schedule that increases sleep drive.

Long-term Goals:

1. Distinguish acute insomnia from chronic insomnia in their practice.
2. Use their client’s sleep diary data to inform treatment decisions.
3. Devise behavioral experiments with clients to modify thoughts that get in the way of sleep or engaging with the treatment.
4. Implement stimulus control and troubleshoot barriers with their clients.
5. Collaborate with clients on a manageable time-in-bed schedule to increase sleep drive.

Edinger, J. D., Arnedt, J. T., Bertisch, S. M., Carney, C. E., Harrington, J. J., Lichstein, K. L., … & Martin, J. L. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 17(2), 255-262.

Edinger, J. D., Arnedt, J. T., Bertisch, S. M.,… & Martin, J. L. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. Journal of Clinical Sleep Medicine, 17(2), 263-298.

Hertenstein, E., Trinca, E., Wunderlin, M.,… & Nissen, C. (2022). Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis. Sleep Medicine Reviews, 101597.

Granberg, R. E., Heyer, A., Gehrman, P. R., Gunter, P. W., Hoff, N. A., Guth, A., … & Frasso, R. (2022). Patient and provider experiences with CBT-I administered in-person or via telemedicine: A randomized non-inferiority trial. Cogent Psychology, 9(1), 2038936.

Selvanathan, J., Pham, C., Nagappa, M.,… & Chung, F. (2021). Cognitive behavioral therapy for insomnia in patients with chronic pain–a systematic review and meta-analysis of randomized controlled trials. Sleep medicine reviews, 60, 101460.