Workshops

Presented by:

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

Jacob Farnsworth, Ph.D., Clinical Psychologist, Psychology Training Director, Program Manager, Rocky Mountain Regional VA Medical Center

Sean M. Barnes, Ph.D., Clinical Research Psychologist, Rocky Mountain MIRECC

Robyn Walser, Ph.D., Clinical Psychology Staff, National Center for PTSD; Co-Director, Bay Area Trauma Recovery Center, National Center for PTSD

Participants earn 3 continuing education credits

Categories: Treatment – Mindfulness & Acceptance, Trauma and Stressor Related Disorder and Disasters

Keywords: ACT (Acceptance & Commitment Therapy), Trauma, Evidence-Based Practice

All levels of familiarity with the material.

Increasing evidence suggests exposure to potentially morally injurious events (PMIE’s) impacts individuals from a variety of communities, like warzone Veterans, healthcare workers, and survivors of racial trauma (Borges et al., 2021; Currier et al., 2019; Fulton et al., 2023). PMIEs often prompt moral pain including painful moral emotions (e.g., guilt, shame, contempt, anger, disgust), cognitions (e.g., self or other blaming thoughts), and urges (e.g., to hide, self-medicate, suicidal behavior). Moral injury results when attempts to avoid or control moral pain significantly interfere with an individual’s personal, communal, and spiritual functioning.

Given the prevalence of PMIE exposure, competence in working with moral injury is essential to facilitating client advocacy and building communities of recovery for impacted groups. Through this workshop we will provide introductory training in Acceptance and Commitment Therapy for Moral Injury (ACT-MI; Borges et al., 2022; Farnsworth et al., 2017), an innovative group/individual intervention developed through iterative participant feedback.

Results from a randomized controlled pilot trial (N = 74 participants) will be presented, including qualitative interview data. Examples of participant feedback about ACT-MI include, “now I can say I did this [of the MIE], I lived through it, and now it’s time to get on with what I care about. I haven’t had that feeling…I don’t believe ever” and “I can live life again. I can go outside. I can spend time with my kids. I can be a better mom. I thank God every day that I got to be a part of this.” Workshop participants will be introduced to case conceptualizing in ACT-MI.

Presenters will demonstrate strategies designed to support clients and therapists in flexibly interacting with moral pain. The workshop will conclude with an experiential exercise focused on building functional recovery, helping attendees to assist clients in opening to moral pain in the service of values-based living.

Outline:

• Describe how to conceptualize moral injury from a functional contextual perspective.
• Apply procedures from ACT-MI (e.g., contacting an observer you who can see but not be one’s experiences) to cultivate flexibility in responding to moral pain.
• Support clients in connecting with the present moment and practice holding moral pain without being consumed by it.
• Define the relationship between moral pain and values as two sides of the same coin.
• Explain how to guide clients in building patterns of behavior informed by their values even in the presence of moral pain.

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

1. Describe how to conceptualize moral injury using principles from ACT-MI
2. Apply procedures from ACT-MI to cultivate flexibility in responding to moral pain.
3. Support clients in building present moment awareness and the ability to hold moral pain without becoming consumed by it.
4. Define the relationship between moral pain and values as two sides of the same coin.
5. Explain how to guide clients in building patterns of behavior informed by their values.

Long-term Goals:

1. Conceptualize moral injury as the result of attempts to avoid and control moral pain leading to difficulties in social, psychological, and/or spiritual functioning.
2. Begin to apply strategies from ACT-MI with clients to approach moral pain for the sake of connecting to meaning and values rather than relying on strategies to avoid and control pain.

Recommended Readings:

Borges, L. M., Barnes, S. M., Farnsworth, J. K., Drescher, K. D., & Walser, R. D. (2022). Case conceptualizing in Acceptance and Commitment Therapy for Moral Injury (ACT-MI): An active and ongoing approach to understanding and intervening on moral injury. Frontiers in Psychiatry, 13, 1-14. doi:10.3389/fpsyt.2022.910414

Farnsworth, J. K., Drescher, K. D., Evans, W., & Walser, R. D. (2017). A functional approach to understanding and treating military-related moral injury. Journal of Contextual Behavioral Science, 6(4), 391–397. https://doi.org/10.1016/j.jcbs.2017.07.003

Borges, L. M., Holliday, R., Barnes, S. M., Bahraini, N. H., Kinney, A. R., Forster, J. E., & Brenner, L. A. (2021). A longitudinal analysis of the role of potentially morally injurious events on COVID-19 related psychosocial functioning among healthcare providers. PLOS ONE. doi: 10.1371/journal.pone.0260033

Litz, B. T., Plouffe, R. A., Nazarov, A., Murphy, D., Phelps, A., Coady, A., Houle, S. A., Dell, L., Frankfurt, S., Zerach, G., Levi-Belz, Y., & the Moral Injury Outcome Scale Consortium. (2022). Defining and assessing the syndrome of moral injury: Initial findings of the Moral Injury Outcome Scale Consortium. Frontiers in Psychiatry, 12, 923928. https://doi.org/10.3389/fpsyt.2022.923928

Presented by:

Ryan DeLapp, Ph.D., Psychologist, The Ross Center

Donte Bernard, Ph.D., Assistant Professor, University of Missouri-Columbia

Erica Muñoz-Gonzalez, LMSW, Cross Divisional Counselor, The Brearley School

Participants earn 3 continuing education credits

Categories: Dissemination & Implementation Science, Culture / Ethnicity / Race

Keywords: Race, School, Treatment/ Program Design

Moderate level of familiarity with the material.

Race-based Stress (RBS) continues to be a social, emotional, and cognitive stressor that many youth of color must navigate in their daily lives. This workshop introduces a therapeutic framework that can be used to flexibly and creatively design programming that teaches skills to help expand youth’s racial coping self-efficacy. This presentation will draw from the Racial, Ethnic, and Cultural Healing Unifying Principles (REACH UP; DeLapp & Gallo, 2022) model to provide tangible guidelines on how to support youth in noticing the interpersonal and systemic manifestations of RBS within their school and broader communities.

Workshop attendees will also learn how to help youth explore the momentary and lasting impacts of RBS via discussions about Emotional Stress (the intense and uncomfortable emotional responses caused by RBS), Identity Stress (the ways RBS can impact one’s sense of self-love, self-confidence, and cultural pride), and Agency Stress (the ways RBS impacts one’s ability to correct, improve, or change racially stressful situations). Through didactic and hands-on exercises, this presentation will showcase engaging and experiential adaptations of evidenced-based interventions to help youth expand their racial coping self-efficacy.

Excitedly, this workshop features the creator of the REACH UP model who serves youth of color within a private practice setting, a researcher who has partnered with the model’s creator to establish its evidence-base within school settings, and a school social worker who partnered with the creator to learn how to deliver this programming in their school setting. And, in line with this year’s conference mission, this workshop will provide guidelines on how clinicians can partner with community stakeholders to create programming informed by the REACH UP model. Specifically, presenters will discuss options for establishing and maintaining relationships with community stakeholders, adapting therapeutic interventions for community-based implementation, and approaches for training community stakeholders to deliver therapeutic interventions in community settings.

Outline:

• Introductions & Agenda Review (8:30-8:45a)
• What is Cultural Stress? (8:45-9:15a)
• Why is Cultural Healing needed in school settings? (9:15-9:45a)
• Break (9:45-10a)
• Introduction to the REACH UP model (10a-10:45a)
• Considerations for incorporating REACH UP model in school settings (10:45-11:15a)
• Wrap Up and Q&A (11:15-11:30a)

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

1. Assess and conceptualize racial coping self-efficacy when working with youth of color.
2. Assess and conceptualize the impacts of RBS on youth of color.
3. Flexibly incorporate evidenced-based interventions within treatment plans to improve youth’s racial coping self-efficacy.
4. Formulate a working plan for establishing and maintaining community partnerships
5. Brainstorm options for disseminating clinical services within community settings

Long-term Goals:

1. Understand how to integrate cultural stressors into case conceptualization and treatment planning with culturally diverse clients in school settings.
2. Increase familiarity with guiding principles of an evidenced based framework for promoting cultural healing among diverse youth.

Recommended Readings:

Anderson, R. E., & Stevenson, H. C. (2019). RECASTing racial stress and trauma: Theorizing the healing potential of racial socialization in families. American Psychologist, 74(1), 63-75.

Bernard, D. L. (2023). Toward a socioecological model of training and mentoring to reduce disparities in mental health service use among Black youths. American Journal of Public Health, 113(S2), S133-S135.

DeLapp, R. C., & Gallo, L. (2022). A Flexible Treatment Planning Model for Racism-Related Stress in Adolescents and Young Adults. Journal of Health Service Psychology, 1-13.

Malone, C. M., Wycoff, K., & Turner, E. A. (2020). Applying a MTSS framework to address racism and promote mental health for racial/ethnic minoritized youth. Psychology in the Schools, 59(12), 2438-2452.

Williams, M. T., Holmes, S., Zare, M., Haeny, A., & Faber, S. (2022). An evidence-based approach for treating stress and trauma due to racism. Cognitive and Behavioral Practice.

Presented by:

Rachel M. Butler, Ph.D., Assistant Professor, Transylvania University

Danielle C. DeVille, Ph.D., Clinical Assistant Professor, Children’s Mercy Hospital Kansas City

Participants earn 3 continuing education credits

Categories: Eating Disorders, Treatment – CBT

Keywords: Exposure, Fear, Eating

Basic to moderate level of familiarity with the material.

Eating disorders (EDs) are associated with profound medical consequences, substantial caregiver burden, and high mortality rates. Unfortunately, treatment outcomes from current evidence-based approaches are notoriously poor, with only 30-50% of patients achieving remission (Atwood & Friedman; Kaidesoja et al., 2022). In order to optimize treatment outcomes for EDs, new approaches must address core maintaining mechanisms. Emerging theory and research suggest that fear is a central maintaining factor in EDs, which drives disordered eating behaviors (Murray et al., 2018; Schaumberg et al., 2021). For example, fear of weight gain may lead to food avoidance, overexercise, or purging to prevent feared outcomes from materializing (Schaumberg et al., 2021).

Although there is variability among individuals, common core fears experienced by those with EDs are transdiagnostic and include fears related to one’s body shape and weight, food, judgment by others, and loss of control (Butler et al., 2023). Conceptualization of EDs as fear-based disorders calls for the translation of exposure therapy to EDs (Butler & Heimberg 2020; Schaumberg et al., 2021). Despite the promising status of the literature, few clinicians currently use exposure therapy in practice with EDs (Waller et al., 2012, 2016). The current workshop seeks to bridge the gap between research and practice by teaching clinicians how to effectively apply exposure therapy with clients with EDs.

The workshop will describe the theoretical and empirical rationale for using exposure therapy in ED treatment and provide training in evidence-based approaches to exposure therapy for EDs, including exposure to feared foods, body image exposures, imaginal exposures, and interoceptive exposures. Experiential methods will also be employed, including demonstrations, role play, and a clinical exercise applying exposure therapy with an ED case example. The workshop will conclude with a discussion of common challenges and methods to optimize exposure therapy outcomes (e.g., using inhibitory learning strategies; Craske et al., 2014). Attendees will have opportunities to discuss and receive feedback on cases.

Outline:

• Introduction to exposure therapy
• Rationale for application of exposure therapy to eating disorder treatment
• Approaches to exposure therapy for eating disorders
  • Feared food exposure
  • Imaginal exposure
  • Body image exposures
  • Interoceptive exposures
• Designing and implementing a course of exposure therapy with a patient
• Common difficulties when using exposure therapy in the treatment of eating disorders

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

1. Describe the evidence for exposure therapy in the treatment of eating disorders.
2. Explain the rationale for exposure therapy to a client with an eating disorder.
3. Use in vivo (e.g., feared food exposures, body image exposures), interoceptive, and imaginal approaches to exposure therapy for eating disorders.
4. Apply exposure-based approaches to a case example with an eating disorder.
5. Identify and problem-solve common difficulties in using exposure therapy for eating disorders.

Long-term Goals:

• Attendees will be able to apply exposure-based interventions with their own clients with eating disorders.

Recommended Readings:

Becker, C. B., Farrell, N. R., & Waller, G. (2019). Exposure therapy for eating disorders. In J.A. Smits et al., Clinical Guide to Exposure Therapy (277-297). Oxford University Press.

Butler, R. M., & Heimberg, R. G. (2020). Exposure therapy for eating disorders: A systematic review. Clinical Psychology Review, 78, 101851.

Griffen, T. C., Naumann, E., & Hildebrandt, T. (2018). Mirror exposure therapy for body image disturbances and eating disorders: A review. Clinical Psychology Review, 65, 163-174.

Schaumberg, K., Reilly, E. E., Gorrell, S., Levinson, C. A., Farrell, N. R., Brown, T. A., … & Anderson, L. M. (2021). Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research. Clinical Psychology Review, 83, 101952.

Reilly, E. E., Anderson, L. M., Gorrell, S., Schaumberg, K., & Anderson, D. A. (2017). Expanding exposure‐based interventions for eating disorders. International Journal of Eating Disorders, 50(10), 1137-1141.

Presented by:

Elisabeth Akeman, LPC, MS, Research Therapist, Laureate Institute for Brain Research

Robin Aupperle, Ph.D., Associate Professor, Laureate Institute for Brain Research

Christopher Martell, ABPP, Ph.D., Clinic Director – Professor of Practice, University of Massachusetts Amherst

Participants earn 3 continuing education credits

Categories: Treatment – CBT, Adult Anxiety

Keywords: Behavioral Activation, Depression, Anxiety

All levels of familiarity with the material.

Behavioral Activation (BA) has been widely established as a core component of cognitive behavioral therapy (CBT) in the treatment of depression. BA conceptualizes depression as arising from negative life events that reduce experiences of positive reinforcement, with depression being maintained or worsened by secondary behaviors that further reduce these experiences. BA aims to help clients engage in behaviors that increase opportunities for positive reinforcement, despite their mood. While empirical support for BA as a treatment for depression has long been recognized, it offers a flexible approach to considering behavioral change across context and populations. There has been recent work supporting its potential for individuals diagnosed with anxiety disorders and posttraumatic stress disorder (PTSD), as well as mixed evidence with substance use disorders. There is also evidence that BA is effective if delivered in group therapy format and feasible and acceptable for delivery via telehealth (e.g., over videoconferencing). It is important to consider the potential application of BA to varying populations and contexts, particularly given the high rates of comorbidity in mental health conditions and a rapidly changing clinical landscape that required flexibility in format of treatment delivery.

This workshop is designed for those working with individuals experiencing depression, anxiety, and co-morbid conditions. Participants are expected to understand basic behavioral principles but may or may not have experience using BA with clients. Presenters will provide history of and evidence for implementing BA as a stand-alone, evidence-based intervention with depression and other commonly co-occurring conditions. Participants will learn how to conceptualize anxiety and depression from a BA perspective and how to communicate that formulation to clients. Special consideration will be given to treatment of anxiety with and without co-occurring depression. Presenters and audience members will role play with each other to gain initial experience using basic BA principles and strategies. Participants will also learn the nuances of and how to implement BA in different contexts, with an emphasis on group-based and virtual formats.

Outline:

• Background concerning the development of Behavioral Activation
  • Historical context of how BA was developed
  • Theoretic context concerning the focus of BA and how it differs from or is similar to other psychotherapy approaches
• Supporting evidence for BA
  • Individual-format BA for depression
  • Individual-format BA for anxiety and fear-related disorders
  • Group-format BA
  • Virtual-format BA
• Core principles guiding the implementation of BA
• Specific concepts and technique
  • Description of concepts and techniques
  • Role play and audience practice with concepts and techniques
  • Discussion of modifications for specific contexts and populations
    • Group-based format
    • Virtual format
    • Anxiety and fear-related disorders and symptoms

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

1. Describe the historical and theoretical context of behavioral activation for co-occurring depression and anxiety.
2. Describe the evidence supporting the use of BA for clients with anxiety, with or without co-occurring depression.
3. Identify the core principles and strategies of BA for use in treatment of clients with anxiety disorders.
4. Incorporate behavioral activation concepts and techniques into an empirically informed treatment plan for clients with co-occurring depression and anxiety.
5. Implement behavioral activation concepts and techniques in various contexts, including individual and group-based therapy and in a virtual format.

Long-term Goals:

1. Learners will feel comfortable applying Behavioral Activation concepts and techniques in treatment of clients with depression and/or anxiety disorders
2. Learners will feel comfortable applying Behavioral Activation concepts and techniques in a individual, group, and virtual contexts.

Recommended Readings:

Berg, H., Akeman, E., McDermott, T. J., Cosgrove, K. T., Kirlic, N., Clausen, A., … & Aupperle, R. L. (2023). A Randomized Clinical Trial of Behavioral Activation and Exposure-Based Therapy for Adults with Generalized Anxiety Disorder. Journal of Mood and Anxiety Disorders, 100004.

Boswell, J. F., Iles, B. R., Gallagher, M. W., & Farchione, T. J. (2017). Behavioral activation strategies in cognitive-behavioral therapy for anxiety disorders. Psychotherapy, 54(3), 231.

Martell, C. R., Dimidjian, S. & Herman-Dunn (2021). Behavioral Activation for Depression: A Clinician’s Guide. New York: Guilford.

Stein, A. T., Carl, E., Cuijpers, P., Karyotaki, E., & Smits, J. A. (2021). Looking beyond depression: A meta-analysis of the effect of behavioral activation on depression, anxiety, and activation. Psychological Medicine, 51(9), 1491-1504.

Presented by:

Jeremiah Weinstock, Ph.D., Professor of Psychology, Saint Louis University

Carla J. Rash, Ph.D., Associate Professor of Medicine, University of Connecticut Health Center

Participants earn 3 continuing education credits

Categories: Addictive Behaviors, Dissemination & Implementation Science

Keywords: Substance Abuse, Health Psychology, Evidence-Based Practice

Basic to moderate level of familiarity with the material.

Contingency management (CM) is an efficacious behavioral intervention that provides tangible reinforcement when target behaviors are completed and objectively verified. A large evidence-base supports CM’s use for treating substance use disorders (SUD). For example, a meta-analysis of psychological treatments for SUDs found that CM had the largest effect size (Dutra et al., 2008) and a comprehensive review highlights its diverse applications (Rash, Stitzer, & Weinstock, 2017). Other meta-analyses find medium to large effects of CM (Prendergast et al., 2006; Bentzley et al., 2021; Bolivar et al., 2021). Many applications of CM in treating SUD focus on abstinence, providing monetary rewards or prizes when clients provide objective evidence of drug abstinence (e.g., urine samples). Contingency management has also been adapted to reinforce other behaviors, including treatment attendance, medication adherence, treatment-related activities (e.g., attending medical appointments), physical activity, chronic disease management (e.g., glucose monitoring), and therapeutic homework. Despite this strong empirical foundation, CM has only been widely disseminated within large self-contained healthcare systems (e.g., Veterans Affairs) and only recently did SAMHSA funded State Opioid Response grants allow for CM dissemination and implementation activities for treating stimulant use disorder. Most state SOR grants have yet to implement CM.

In this workshop, we will review the application of CM to promote positive behavior change in various health behaviors. Attendees will learn how to design and implement a CM program using guidelines that can be adapted to a variety of target behaviors. Specifically, we will describe 1) the theoretical underpinnings and supporting empirical literature, 2) different types of CM programs (i.e., voucher, prize), 3) effective design features, 4) common barriers to and problems with implementation, 5) how to calculate costs of a CM program, and 6) how to implement CM programs in individual and group settings.

Outline:

• Topic 1: Landscape of Substance Use Disorders Treatment and Where Does Contingency Management Fit In
  1. Use of punishment in substance use disorders treatment
  2. Use of positive reinforcement in substance use disorders treatment
• Topic 2: Defining Contingency Management and Brief Review of Empirical Literature
  1. Central tenets of effective contingency management interventions
  2. Overview of the three contingency management reinforcement systems
  3. Behaviors targeted for change by contingency management interventions
  4. Efficacy data on contingency management interventions
• Topic 3: Contingency Management Intervention Design Considerations
  1. Selecting a behavior to reinforce
  2. Choosing a reinforcer
  3. Determining monitoring schedules and costs
  4. Integrating behavioral principles
• Topic 4: Implementation of Contingency Management
  1. Clinical demonstration of contingency management session
  2. Implementing contingency management in community-based agencies from the perspective of the Consolidated Framework for Implementation Research (i.e., lessons learned)
  3. Brief review of mHealth contingency management apps

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

1. Select, monitor, and reinforce target behaviors in a CM intervention.
2. Develop voucher- and prize-based CM protocols.
3. Recognize effective features of CM reinforcement schedules.
4. Design and calculate costs for a prize-based contingency management intervention.
5. Implement CM with clients.

Long-term Goals:

1. Attendees will gain knowledge about the evidence-base supporting contingency management, including critical facets of the intervention to ensure its efficacy.
2. Attendees will identify potential barriers to dissemination and implementation of contingency management and ways to address these issues.

Recommended Readings:

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

Oluwoye, O., Kriegel, L., Alcover, K. C., McPherson, S., McDonell, M. G., & Roll, J. M. (2020). The dissemination and implementation of contingency management for substance use disorders: A systematic review. Psychology of Addictive Behaviors, 34(1), 99–110. https://doi.org/10.1037/adb0000487

Rash, C. J., Alessi, S. M., & Zajac, K. (2020). Examining implementation of contingency management in real-world settings. Psychology of Addictive Behaviors, 34(1), 89–98. https://doi.org/10.1037/adb0000496

Becker, S. J., DiClemente-Bosco, K., Rash, C. J., & Garner, B. R. (2023). Effective, but underused: Lessons learned implementing contingency management in real-world practice settings in the United States. Preventive Medicine, 176, 107594.

Rash, C. J. (2023). Implementing an evidence-based prize contingency management protocol for stimulant use. Journal of Substance Use and Addiction Treatment, 151, 209079.

Presented by:

William Martinez, ABPP, Ph.D., Associate Professor of Psychiatry and Behavioral Sciences, University of California San Francisco

Maria C. Jimenez-Salazar, Ph.D., Psychology Postdoctoral Fellow, University of California San Francisco

Participants earn 3 continuing education credits

Categories: Culture / Ethnicity / Race, Program / Treatment Design

Keywords: Community-Based, Prevention, Underserved Populations

All levels of familiarity with the material.

School-based, preventative programming has been proposed to be the frontline for reducing behavioral health access disparities among youth (Hoffmann et al., 2022). Immigrant-origin youth are the fastest growing population within public schools in the United States (Sattin-Bajaj et al., 2020). This underscores the importance of furthering interventions for newcomer immigrant youth through rigorous evaluation and expanding their reach through health and school partnerships (Patel et al., 2023).

Fuerte is a new prevention program that is being introduced into the mental health system of California to reduce behavioral health disparities among newcomer immigrant youth (Martinez et al., 2020). Among the most innovative elements of Fuerte are its delivery system and overall ecosystem. This workshop introduces the Fuerte model of bridging evidence-based practices, cultural knowledge, and system collaborations to promote newcomer immigrant youths’ mental health literacy, social connectedness, and service linkage.

Presenters will review cultural considerations specific to working with immigrant pediatric populations. Presenters will offer strategies that can bolster cultural responsivity towards delivering psychoeducation, strengthening skills to navigate acculturation and reunification, and promoting mental health literacy to facilitate newcomer immigrant youths’ self- and parent-supported advocacy in their context of reception.

Learners will engage in guided self-reflection centered on the challenges and successes of leveraging lived experience of migration (e.g., process of departure, keeping/acquiring traditions, establishing new social connections, maintaining relationships, setting value-driven goals in the context of reception) to strengthen the group process. Learners will set a S.M.A.R.T. goal in line with co-creating systems of care with diverse stakeholders.

Outline:

• Opening exercise
• Background
  • Understanding newcomer immigrant youths’ adaptation through an integrative framework
  • Considering diversity in migration and resettlement
  • Introduction to Multi-Tiered System of Supports
• School-based mental health prevention program for newcomer youth
  • Fuerte’s history and background
  • Program structure and primary targets of mental health literacy, social connectedness, and screening and linkage
  • Describe the seven modules of the Fuerte curriculum
  • Demonstration and practice of strategies and group-based activities
• Discussion of research
  • Evaluation of program implementation in middle schools and high schools
  • Adaptations
• Questions & Discussion
• Personal commitment to promoting mental health equity

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

1. Describe 3 key cultural considerations specific to employing evidence-based practices with newcomer immigrant youth.
2. List 4 benefits of providing group interventions to youth in schools.
3. Offer at least two examples of culturally responsive exercises that can help strengthen newcomers’ adaptive skills.
4. Approach their lived experience of moving across contexts with increased curiosity in the interest of promoting mental health equity.
5. Point to an actionable next step they could take in the interest of promoting immigrant-origin youths’ behavioral health.

Long-term Goals:

1. The Fuerte workshop intends to strengthen learners’ competence and confidence in practicing cultural responsivity while delivering interventions to newcomer immigrant youth.
2. The Fuerte workshop seeks to deepen learners’ curiosity for leveraging health-school partnerships to promote youths’ access to empirically supported treatments.

Recommended Readings:

Suárez-Orozco, C., Motti-Stefanidi, F., Marks, A., & Katsiaficas, D. (2018). An integrative risk and resilience model for understanding the adaptation of immigrant-origin children and youth. American Psychologist, 73(6), 781–796. https://doi.org/10.1037/amp0000265

Martinez, W., Chhabra, D., Cooch, P., Oo, H., Vo, H., Romano, A., Farahmand, F., Rocha, M., San Miguel, R., Romero, M., Quintanilla, A., & Matlow, R. (2020). Patient and community engagement for mental health disparities in Latinx youth immigrant populations: The Fuerte program. In A. M.

Breland-Noble (Ed.), Community mental health engagement with racially diverse populations (pp. 189–221). Elsevier Academic Press. https://doi.org/10.1016/B978-0-12-818012-9.00008-3

Patel, S.G., Bouche, V., Thomas, I., & Martinez, W. (2022). Mental health and adaptation among newcomer immigrant youth in United States educational settings. Current Opinion in Psychology, 49, 101459. https://doi.org/10.1016/j.copsyc.2022.101459

Stiles, A.A., Galvan, T., Zundel, C., Flournoy, J., & Gudiño, O.G. (2019). Stakeholder perspectives on eliminating disparities in mental health service use for Latinx youth: A qualitative study. Evidence-based Practice in Child and Adolescent Mental Health, 4(4), 328-343. https://doi.org/10.1080/23794925.2019.1674225

Martinez, W., Patel, S. G., Contreras, S., Baquero-Devis, T., Bouche, V., & Birman, D. (2023). “We could see our real selves:” The COVID-19 syndemic and the transition to telehealth for a school-based prevention program for newcomer Latinx immigrant youth. Journal of Community Psychology, 51(6), 2372–2389. https://doi.org/10.1002/jcop.22825

Presented by:

Andrea Temkin-Yu, Psy.D., Clinical Psychologist, Weill Cornell Medicine

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

Samuel Fasulo, Ph.D., Clinical Psychology, Moss Psychological Services, PC

Anthony Puliafico, Ph.D., Associate Professor of Medical Psychology (in Psychiatry), Columbia University Medical Center

Participants earn 3 continuing education credits

Categories: Parenting / Families, Treatment – CBT

Keywords: Parenting, Treatment, Adolescents

Moderate level of familiarity with the material.

Parents play an integral role in the lives of their children and often significantly impact both the trajectory of a child’s mental health and the interventions designed to support it. As the responsibility of parenting brings with it a combination of intense emotions, needs, and dreams for one’s child, parents and children often engage in problematic patterns when managing conflict or stressful situations. When working with youth and families, clinicians have a unique opportunity to help parents learn and adopt skills and interpersonal dynamics that promote long term family and youth well-being. With a heavy emphasis on live role-play demonstrations, this workshop will highlight a number of core strategies to help caregivers more effectively manage challenging parenting situations that clinicians frequently encounter within the families they work with. The presenters will provide insight from a range of cognitive-behavioral therapy perspectives, including Dialectical Behavior Therapy, exposure-based treatment approaches, Acceptance and Commitment Therapy, and Behavior Management.

Through a series of role-plays, the presenters will weave in a combination of strategies aimed at supporting parents in building meaningful parent/child relationships while encouraging change. Specific areas of focus will include (1) early treatment work to build motivation and establish a productive therapeutic frame, (2) validating a child’s experience within a conflictual interaction or situation, (3) creating an understanding of parental behavior as shaped by their kids, (4) aligning parental values with effective parenting choices, (5) optimizing a combination of autonomy granting and limit setting, and (6) helping parents let go of unproductive battles. Audience members will have an opportunity to discuss each role play and ask questions. The workshop presenters will then guide audience participants to practice these strategies in small-group role plays work to better hone their understanding of the interventions presented in the workshop.

Outline:

1. Speaker introduction
2. Provide rationale for viewing parenting support as a key element of youth treatment, and subsequent importance of both aligning with parents and helping them actively face common barriers to skills use.
3. Read Case Example to be referenced throughout the workshop
4. Role play 1 on early treatment work and establishing a productive therapeutic frame
   1. Speaker debrief
   2. Audience discussion and Q&A portion
5. Role play 2 on validating a child’s experience in a conflictual family session
   1. Speaker debrief
   2. Audience discussion and Q&A portion
6. Role play 3 on helping parents understand role of child behavior in shaping parental choices and aligning parenting values with effective choices.
   1. Speaker debrief
   2. Audience discussion and Q&A portion
7. Role play 4 on helping parents balance autonomy granting with limit setting while letting go of unproductive battles
   1. Speaker debrief
   2. Audience discussion and Q&A portion
8. Audience small group role play (facilitated by speakers)
9. Audience/Speaker discussion and final Q&A

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

1. Describe the utility of early treatment engagement work between clinician and parent in order to improve youth engagement.
2. Demonstrate effective validation techniques that parents can employ in communicating with their children.
3. Explain ways in which parents are shaped by youth behavior and impact on parent/child dynamics.
4. Help parents consider how to proactively incorporate their family values into decisions about parenting skills use.
5. Provide examples of how to balance support and opportunities for independence in parenting youth with mental health difficulties.

Long-term Goals:

1. Provide a rationale for prioritizing parent-clinician alignment as a means of providing necessary parent focused support and increasing parent willingness to address barriers to skills use.
2. Articulate interactional relationship between parent and child factors, including values, temperament, emotion regulation, etc., and how it influence parent behavior and engagement in treatment.

Recommended Readings:

Filippello, P., Sorrenti, L., & Buzzai, C. (2015). Perceived Parental Psychological Control and Learned Helplessness: The Role of School Self-efficacy. School Mental Health, 7, 298–310.

Guo, S., & Peris, T. S. (2021). Working with Parents with Anxiety in Family Intervention. Family-Based Intervention for Child and Adolescent Mental Health: A Core Competencies Approach (pp 225-241). Cambridge.

Weisz, J.R., & Kazdin, A.E. (Eds.) (2017). Evidence-based Psychotherapies for Children and Adolescents (3rd ed.). New York: Guilford Press.

Whittingham, K., & Coyne, L. (2019). Acceptance and commitment therapy: the clinician’s guide for supporting parents. Academic Press. Recommended Reading

Zalewski, M., Maliken, A. C., Lengua, L. J., Martin, C. G., Roos, L. E., & Everett, Y. (2020). Integrating dialectical behavior therapy with child and parent training interventions: A narrative and theoretical review. Clinical psychology: Science and practice.

Presented by:

Natalie N. Watson-Singleton, Ph.D., Associate Professor, Spelman College

Yara Mekawi, Ph.D., Assistant Professor, University of Louisville

Participants earn 3 continuing education credits

Categories: Culture / Ethnicity / Race

Keywords: Common Elements, Culture, Therapeutic Relationship

Basic to moderate level of familiarity with the material.

To meet the rising mental health needs of a diverse society, White clinicians are tasked with working with clients from different cultural backgrounds. Despite a commitment to cultural humility, racist missteps can occur in the therapeutic relationship and cause cultural ruptures, or strains in the therapeutic alliance.

Following a cultural rupture, White clinicians seeking to embody individual-level antiracism advocacy in their practice must carefully reflect on the most effective way forward in order to ensure that they are providing the best care to clients from marginalized racial/ethnic backgrounds. Through this 3-hour workshop, participants will learn about cultural ruptures that occur in clinical practice and how they can effectively recover from this type of rupture. In particular, instructors will explain situations where racist missteps commonly occur. Then, instructors will outline how to tolerate any unpleasant emotions that may arise when confronting such a rupture.

Instructors will also outline the critical components needed to effectively repair after a cultural rupture. This workshop instructs participants on how to effectively repair ruptures to embody effective anti-racist allyship in their therapeutic relationships.

Outline:

• Cultural ruptures, or strains in the therapeutic alliance, can occur when a White clinician makes a racist misstep toward a minoritized client during session.
• These ruptures can negatively impact the therapeutic alliance if not handled effectively.
• Workshop participants will learn about cultural ruptures that occur in clinical practice.
• Workshop participants will also learn two skills: one skill to help clinicians tolerate any unpleasant emotions that may arise when coping with a cultural rupture and another skill to effectively repair the cultural rupture.

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

1. Explain reasons why racist missteps occur in clinical practice.
2. Describe the common racist missteps that occur in clinical practice.
3. Use distress tolerance skills that are useful for managing unpleasant emotions.
4. List the critical components of an effective repair plan.
5. Implement the critical components of an effective repair with clients after a rupture occurs.

Long-term Goals:

• Participants will be able to effectively respond to and repair cultural ruptures that occur in their sessions to embody anti-racist allyship in their therapeutic relationships.

Recommended Readings:

American Psychological Association (2017). Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality. Retrieved from: http://www.apa.org/about/poli cy/multicultural-guidelines.pdf

Benuto, L. T., Singer, J., Newlands, R. T., & Casas, J. B. (2019). Training culturally competent psychologists: Where are we and where do we need to go? Training and Education in Professional Psychology, 13(1), 56–63. doi: https://doiorg.du.idm.oc lc.org/10.1037/t ep0000214

Chen, R., Atzil-Slonim, D., Bar-Kalifa, E., Hasson-Ohayon, I., & Refaeli, E. (2018). Therapists’ recognition of alliance ruptures as a moderator of change in alliance and symptoms. Psychotherapy Research, 28(4), 560–570. doi: https://doiorg.du.id m.oclc.org /10.1080/105 03307.2016.1227104

Eubanks, C. F., Muran, J. C., & Safran, J. D. (2018). Alliance rupture repair: A metaanalysis. Psychotherapy, 55(4), 508-519. doi: http://dx.doi.org/10.1037/pst0000185

Mekawi, Y., Watson-Singleton, N.N., Dawson, D. (2024). Beyond Fragility: A Skills-Based Guide to Effective Anti-Racist Allyship. PESI Publishing.

Presented by:

Sarah Kate Bearman, Ph.D., Professor, The University of Texas at Austin

Abby Bailin, Ph.D., Research Scientist, The University of Texas at Austin

Participants earn 3 continuing education credits

Categories: Transdiagnostic; Treatment – CBT

Keywords: Child, Adolescents, Transdiagnostic

All levels of familiarity with the material.

Behavioral health clinicians are expected to use evidence-based treatments (EBTs) with their clients, yet EBTs do not always fit easily into busy, complex care systems. Limited time to learn numerous separate EBTs in order to cover a diagnostically broad caseload, highly comorbid clients requiring more than one targeted treatment, and the need to flex to manage emerging events all pose challenges. Feeling Calm, Increasing Motivation, Repairing Thoughts, Solving Problems, and Trying the Opposite (FIRST) is a brief and efficient approach to treatment that allows clinicians to use evidence-based treatments more flexibly with youth clients.

The treatment has been found to be feasible and acceptable in community mental health clinics and was found to improve clinical outcomes relative to comparison benchmarks in both an open trial in community mental health clinics (Weisz, Bearman, Santucci & Jensen-Doss, 2017) and in an academic training clinic when treatment was constrained to only six sessions (Cho, Bearman, Woo, Weisz & Hawley, 2019). The workshop will provide an introduction to this transdiagnostic approach that addresses the following single and co-occurring problem areas: anxiety, depression, PTSD, disruptive behaviors. Participants will learn how to make evidence-based clinical decisions using the FIRST algorithms which are guided by transdiagnostic principles of change. The workshop will include didactics and clinical case examples presented via trainer role plays and video exemplars.

Participants will demonstrate the ability to utilize FIRST algorithms in clinical decision-making via role plays and other experiential exercises.

Outline:

• Evidence-based treatments (EBTs) don’t fit well in complex care systems where youth clients are diagnostically comorbid, and clinicians have large, diverse caseloads.
• FIRST, an evidence-based transdiagnostic treatment for youth, utilizes transdiagnostic principles of change to address the needs of real-world clinicians and clients.
• Participants will be introduced to five principles of change: Feeling Calm, Increasing Motivation, Repairing Thoughts, Solving Problems, and Trying the Opposite.
• Participants will learn how to make evidence-based clinical decisions using FIRST algorithms to address the needs of youth clients with single and co-occurring problems in the following areas: anxiety, depression, PTSD, disruptive behaviors.

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

• Describe what transdiagnostic treatments are.
• Describe the principles of change represented in FIRST.
• Provide rationale for the utilization of transdiagnostic treatments.
• Describe the focus of treatment for each of the problems (e.g., anxiety, depression, PTSD, disruptive behaviors) treated by FIRST.
• Make decisions on next steps for treatment for example cases based on FIRST algorithms.

Long-term Goals:

• Learners will utilize principles of change to guide clinical decision- making in their clinical practice.

Recommended Readings:

Weisz, J.R., & Bearman, S.K., (2020). Principle-Guided Psychotherapy for Children and Adolescents: The FIRST Program for Behavioral and Emotional Problems. Guilford Publishers.

Cho, E., Bearman, S. K., Woo, R., Weisz, J. R., & Hawley, K. M. (2020). A second and third look at FIRST: Testing adaptations of a principle-guided youth psychotherapy. Journal of Clinical Child & Adolescent Psychology, 1-14.

Weisz, J., Bearman, S. K., Santucci, L. C., & Jensen-Doss, A. (2017). Initial test of a principle-guided approach to transdiagnostic psychotherapy with children and adolescents. Journal of Clinical Child & Adolescent Psychology, 46(1), 44-58

Bearman, S. K. & Weisz, J. R. (2015) Comprehensive treatments for youth comorbidity: Evidence-guided approaches to a complicated problem. Child and Adolescent Mental Health, 20, 131-141. https://doi.org/10.1111/camh.12092

Marchette, L. K., & Weisz, J. R. (2017). Practitioner Review: Empirical evolution of youth psychotherapy toward transdiagnostic approaches. Journal of Child Psychology and Psychiatry, 58(9):970–984. doi: 10.1111/jcpp.12747.

Presented by:

Maddi Taher, MS, CEO, AltMind

Mikael Rubin, Ph.D., Assistant Professor, Palo Alto University

Participants earn 3 continuing education credits

Categories: Treatment – CBT, Adult Anxiety

Keywords: Anxiety, Social Anxiety, CBT

All levels of familiarity with the material.

Exposure therapy is a cornerstone of CBT and has proven efficacy in treating various anxiety disorders, phobias, and post-traumatic stress disorders (1). The fundamental principle behind exposure therapy is gradual confrontation with feared stimuli or situations in a safe environment, allowing individuals to learn that their feared outcomes are unlikely or manageable. Ensuring a safe and supportive therapeutic environment is crucial (2).

Research shows that Virtual Reality (VR) exposure therapy can be an effective tool for anxiety disorders (3)(4). VR can provide immersive therapeutic experiences, potentially enhancing the effectiveness of interventions for particular anxiety disorders such as social anxiety and further expanding the boundaries of traditional telehealth. Throughout this workshop, therapists will acquire a comprehensive understanding of the convergence between psychology and technology, exploring the ways in which Virtual Reality (VR) can serve as a therapeutic tool and engaging in hands-on sessions specially designed for therapists, enabling them to navigate VR scenarios replicating real-life social situations.

These scenarios act as valuable tools for therapists to skillfully guide their clients through controlled and customizable exposures to social anxiety triggers. The workshop will focus firstly on delving into the clinical applications of VR in the context of social anxiety treatment, emphasizing how VR can complement traditional therapeutic methods and offer a unique avenue for exposure therapy. Secondly, it will explore the flexibility of VR technology in tailoring experiences to meet the specific needs of individual clients, providing insights into adapting and personalizing VR scenarios for targeted therapeutic interventions.

Lastly, gain practical insights into seamlessly integrating VR exercises into therapeutic practice, including discussions on strategies for incorporating VR-based interventions into treatment plans for clients dealing with social anxiety. By the end of this workshop, therapists will emerge with a deeper understanding of the therapeutic potential of VR for exposure therapy and the practical skills to implement these interventions in their practice.

Outline:

• Therapeutic potential of VR
• VR as a tool for addressing anxiety
• Practical skills in VR technology
• Clinical applications for social anxiety
• VR complementing traditional methods (e.g., exposure therapy)
• Integrating VR into treatment plans

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

1. Identify the therapeutic potential of Virtual Reality (VR)
2. Identify the specific ways VR can be utilized as a therapeutic tool for addressing anxiety
3. Acquire practical skills in operating VR technology
4. Identify and understand the clinical applications of VR in social anxiety treatment
5. Recognize how VR can complement traditional therapeutic methods, with a focus on exposure therapy
6. Gain practical insights into integrating VR exercises into treatment plans

Long-term Goals:

• Apply the knowledge gained from the workshop in real-world therapeutic settings

Recommended Readings:

Abramowitz, J.S., Deacon, B.J. and H., W.S.P. (2019) Exposure therapy for anxiety: Principles and practice. New York, NY: The Guilford Press.

Schröder, D. et al. (2023) ‘Impact of virtual reality applications in the treatment of anxiety disorders: A systematic review and meta-analysis of randomized-controlled trials’, Journal of Behavior Therapy and Experimental Psychiatry, 81, p. 101893. doi:10.1016/j.jbtep.2023.101893.

Chard, I. and van Zalk, N. (2022) ‘Virtual reality exposure therapy for treating social anxiety: A scoping review of treatment designs and adaptation to stuttering’, Frontiers in Digital Health, 4. doi:10.3389/fdgth.2022.842460.

Boeldt, D. et al. (2019) ‘Using virtual reality exposure therapy to enhance treatment of anxiety disorders: Identifying areas of clinical adoption and potential obstacles’, Frontiers in Psychiatry, 10. doi:10.3389/fpsyt.2019.00773

Carl E, Stein AT, Levihn-Coon A, Pogue JR, Rothbaum B, Emmelkamp P, Asmundson GJG, Carlbring P, Powers MB. Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. J Anxiety Disord. 2019 Jan;61:27-36. doi: 10.1016/j.janxdis.2018.08.003. Epub 2018 Aug 10. PMID: 30287083.

Presented by:

V. Robin Weersing, Ph.D., Professor, SDSU/UCSD JDP in Clinical Psychology

Pauline Goger, Ph.D., Co-Investigator, SDSU/UCSD JDP in Clinical Psychology

Araceli Gonzalez, Ph.D., Associate Professor, California State University Long Beach

Participants earn 3 continuing education credits

Categories: Child / Adolescent – Anxiety, Child / Adolescent – Depression

Keywords: Anxiety, Depression, Treatment

Moderate level of familiarity with the material.

Anxiety and depression are collectively the most common mental health concerns in childhood and adolescence and co-occur with each other at staggering rates. Transdiagnostic interventions aim to address core processes common to anxiety and depression, and may therefore be more efficient in regards to time, clinician effort, and youths’ skill-building as compared to sequencing separate treatments for anxiety and depression. One such transdiagnostic intervention, Brief Behavioral Therapy (BBT; Weersing et al., 2021), has demonstrated efficacy for youth ages 8-16 with anxiety and/or depression when implemented by Master’s-level clinicians in pediatric primary care. BBT is brief (8-12 sessions), results in functional improvement and symptom reduction (Weersing et al., 2017) with effects sustained over the course of 32-week follow-up (Brent et al., 2020), and is cost-saving compared to community mental health treatment (Lynch et al., 2021).

Recent preliminary data also support a video-visit version of BBT to increase intervention access for youth in low-resource settings (R56MH125159); this work in particular may be especially relevant in current times of national and world-wide physical and mental health crises. This clinician-focused workshop aims to introduce BBT as a treatment option for youth with anxiety, depression, or their co-occurrence. Following an introduction to the scientific evidence and theoretical underpinnings of this transdiagnostic approach, clinicians are presented with a step-by-step guide to BBT session content. Specific foci of the workshop targeting anxious avoidance and depressive withdrawal with “graded engagement” or increased approach and reduced behavioral avoidance, and use of the intervention’s problem-solving module to address symptoms, familial communication, and treatment non-compliance. Case examples and sample intervention materials are utilized throughout to supplement attendee experience.

Outline:

1. Rationale for transdiagnostic interventions in youth
2. Brief review of evidence-base for BBT and other interventions for anxiety and depression in youth
3. Focus on core behavioral mechanisms and increasing approach / reducing avoidance
4. BT sessions 1-3 (psychoeducation, relaxation, problem-solving)
5. BBT session 4 (building an approach hierarchy)
6. BBT sessions 5-11 (enactive practice and graded engagement)
7. BBT session 12 (relapse prevention)

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

1. Describe theoretical and empirical rationale for why a transdiagnostic approach may be well-suited to treating youth anxiety and depression.
2. Become familiar with and describe how core treatment techniques might be packaged and implemented using a behavioral transdiagnostic approach.
3. Describe youth characteristics and symptoms that may be particularly well-suited for the Brief Behavior Therapy protocol.
4. Describe and understand the session content and sequencing of skills in the Brief Behavior Therapy protocol.
5. Discuss implementation considerations when using Brief Behavior Therapy with internalizing youth.
6. Identify when a transdiagnostic approach might be appropriate for youth symptom presentation in clinical practice
7. Incorporate a graded engagement/transdiagnostic approach to treatment of youth with anxiety/depression comorbidity.

Long-term Goals:

1. To be able to apply the principles of graded engagement (increasing approach and reducing avoidance) in clinical practice with youths with a variety of complex, transdiagnostic symptom presentations.

Recommended Readings:

Weersing, V. R., Brent, D. A., Rozenman, M. S., Gonzalez, A., Jeffreys, M., Dickerson, J. F., … & Iyengar, S. (2017). Brief behavioral therapy for pediatric anxiety and depression in primary care: a randomized clinical trial. JAMA psychiatry, 74(6), 571-578.

Weisz, J. R., Fitzpatrick, O. M., Venturo‐Conerly, K. E., Sternberg, A., Steinberg, J. S., & Ng, M. Y. (2023). Research Review: The internalizing paradox–youth anxiety and depression symptoms, psychotherapy outcomes, and implications for research and practice. Journal of Child Psychology and Psychiatry, 64(12), 1720-1734.

Brent, D. A., Porta, G., Rozenman, M. S., Gonzalez, A., Schwartz, K. T., Lynch, F. L., … & Weersing, V. R. (2020). Brief behavioral therapy for pediatric anxiety and depression in primary care: A follow-up. Journal of the American Academy of Child & Adolescent Psychiatry, 59(7), 856-867.

Weersing, V. R., Gonzalez, A., & Rozenman, M. (2021). Brief Behavioral Therapy for Anxiety and Depression in Youth: Therapist Guide. Oxford University Press.

Rozenman, M., Gonzalez, A., & Weersing, V. R. (2020). Transdiagnostic exposure-based intervention for anxiety and depression in children and adolescents. In Exposure Therapy for Children with Anxiety and OCD (pp. 361-382). Academic Press.

Presented by:

Kate McCalla, Ph.D., Assistant Clinical Director, Licensed Psychologist, Center for Autism Services, Science and Innovation, Kennedy Krieger Institute

Ji Su Hong, M.D., Assistant Professor of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine

Karen Bearss, Ph.D., Associate Professor, University of Washington

Participants earn 3 continuing education credits

Categories: Autism Spectrum and Developmental Disorders, Parenting / Families

Keywords: Autism Spectrum Disorders, Parent Training, Aggression / Disruptive Behavior / Conduct Problems

Basic to moderate level of familiarity with the material.

It has been well documented that challenging behaviors (e.g., meltdowns, aggression, difficulties with transitions) are very common in autistic youth and emerge in early childhood. Literature indicates high rates of aggressive behaviors in autistic youth (aggression to a caregiver 68%, aggression to non-caregivers 49%, and self-injury 27.7%) and challenging behaviors are strongly associated with poor quality of life, social isolation, behavioral crisis, school problems, and parental stress and depression (Kanne & Mazurek, 2011; Lecavalier et al., 2006; Soke et al., 2016). RUBI Parent Training (RUBI PT) is a manualized, time-limited parent training intervention for autistic youth, which has strong evidence for reducing challenging behaviors and improving daily living skills (Bearss et al., 2015).

In this workshop, we will provide the audience with an in-depth educational experience on RUBI PT through didactic instruction, videoclips, role-play of a RUBI session, and educational handouts. Several core RUBI sessions will be discussed in detail, including behavioral principles (emphasizing the antecedent-behavior-consequence model), prevention strategies, reinforcement, planned ignoring, functional communication training, and skill building. We will review how RUBI PT is structured, and the audience will have the opportunity to observe how a RUBI session is conducted. We will discuss RUBI in the context of the neurodiversity movement. Finally, we will review the current evidence supporting the efficacy of RUBI.

Outline:

1. Challenging Behaviors in Autism and Treatment Options
   1. Brief overview of common behavioral concerns
   2. Treatment options: pharmacological & behavioral (e.g., Applied Behavior Analysis (ABA), parent training)
   3. Parent training in the context of the neurodiversity movement
2. Overview of RUBI Parent Training (RUBI PT)
   1. Outline of session content
   2. Structure of treatment
   3. Treatment materials: therapist manual; parent workbook; video vignettes
   4. Behavior support plan
   5. Engaging families in treatment
3. Basic Behavioral Principles and Other Components of RUBI PT
   1. Behavioral principles
   2. Prevention strategies
   3. Reinforcement
   4. Planned ignoring
   5. Cooperation training
   6. Functional communication training
   7. Skill building strategies
4. Observe Speaker Role Play of a RUBI PT Session
5. Review of Current Evidence Supporting RUBI PT

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

1. Describe the basic behavioral principles that are the foundation of RUBI.
2. Explain how behavioral strategies, such as prevention and reinforcement, can be used by parents.
3. Identify the type of patients who would benefit from RUBI.
4. Describe how RUBI is structured.
5. Discuss how RUBI is aligned with the neurodiversity movement.
6. Identify the current evidence supporting the efficacy of RUBI.

Long-term Goals:

• Attendees will explore whether RUBI-PT is a useful clinical tool for their practice.

Recommended Readings:

Bearss, K., Johnson, C., Smith, T., Lecavalier, L., Swiezy, N., Aman, M., … & Scahill, L. (2015). Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: a randomized clinical trial. JAMA, 313(15), 1524-1533.

Scahill, L., Bearss, K., Lecavalier, L., Smith, T., Swiezy, N., Aman, M. G., … & Johnson, C. (2016). Effect of parent training on adaptive behavior in children with autism spectrum disorder and disruptive behavior: Results of a randomized trial. Journal of the American Academy of Child & Adolescent Psychiatry, 55(7), 602-609.

Burrell, T. L., Postorino, V., Scahill, L., Rea, H. M., Gillespie, S., Evans, A. N., & Bearss, K. (2020). Feasibility of group parent training for children with autism spectrum disorder and disruptive behavior: a demonstration pilot. Journal of Autism and Developmental Disorders, 50(11), 3883-3894.

Bearss, K., Burrell, T.L., Challa, S.A., Postorino, V., Gillespie, S.E., Crooks, C., & . Scahill, L. (2018). Feasibility of parent training via telehealth for children with autism spectrum disorder and disruptive behavior: A demonstration pilot. Journal of Autism and Developmental Disorders, 48(4), 1020-1030.

Iadarola, S., Levato, L., Harrison, B., Smith, T., Lecavalier, L., Johnson, C., … & Scahill, L. (2018). Teaching parents behavioral strategies for autism spectrum disorder (ASD): Effects on stress, strain, and competence. Journal of Autism and Developmental Disorders, 48(4), 1031-1040.

Presented by:

Kim T. Mueser, Ph.D., Professor, Boston University

Susan R. McGurk, Ph.D., Professor, Boston University

Participants earn 3 continuing education credits

Categories: Schizophrenia / Psychotic Disorders, Cognitive Science / Cognitive Processes

Keywords: Severe Mental Illness, Recovery, Evidence-Based Practice

Basic to moderate level of familiarity with the material.

The Thinking Skills for Work (TSW) program is a cognitive remediation program for persons with serious mental illness (SMI) including 1) computer cognitive practice exercises, 2) strategy coaching to improve performance on cognitive exercises, and 3) teaching cognitive self-management (i.e., compensatory) strategies for improving cognitive performance (e.g., sharpening attention and memory, challenging negative thinking) in day-to-day situations.

Although multiple randomized controlled trials have shown that adding the TSW program to supported employment improves cognitive functioning and competitive work outcomes more than supported employment alone, more recent research shows that enhancing cognitive self-management strategies alone improves cognitive functioning and work outcomes in persons with SMI.

This workshop will provide background on the assessment of cognitive difficulties interfering with the attainment of clients’ work goals, and it will cover methods for teaching cognitive self-management strategies based on a standardized curriculum of ten educational handouts as described in the McGurk and Mueser (2021) book on TSW. Teaching methods will include didactic presentation, modeling and role plays (including both leaders and participants), discussion of case vignettes, and questions and answers.

Outline:

• Cognitive self-management strategies are noncomputer-based methods for improving everyday cognition (e.g., repeating back verbal information to ensure attention and comprehension, establishing “memory spots” for frequently used items to improve organization, and constructing “To Do” lists for planning).
• Recent cognitive remediation research shows that teaching cognitive self-management strategies alone (without computer cognitive training) can improve cognition and work outcomes in people with mental health conditions.
• This workshop will introduce participants to methods for teaching cognitive self-management strategies for improving competitive employment in persons with mental health conditions based on the Thinking Skills for Work program.
• Curriculum for teaching self-management strategies will be reviewed, including ten educational handouts for clients.

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

1. Summarize the relationship between cognitive functioning and employment outcomes in people with SMI receiving supported employment services.
2. Identify three different methods for pinpointing cognitive challenges underlying problems in persons with SMI obtaining or keeping competitive jobs.
3. Describe at least two cognitive self-management strategies per cognitive domain for helping clients improve their cognitive abilities in the areas of attention/concentration, memory, planning, and problem-solving
4. Show how to educate clients about cognition, work, and cognitive self-management strategies using at least three principles of psychoeducation.
5. Demonstrate how to teach at least two cognitive self-management strategies based on skills training and cognitive-behavioral techniques.

Long-term Goals:

• Equip participants with tools and resources for teaching clients self-management strategies for improving their cognitive performance at work and in everyday situations.

Recommended Readings:

Allott, K., van-der-El, K., Bryce, S., Parrish, E. M., McGurk, S. R., Hetrick, S., Bowie, C. R., Kidd, S., Hamilton, M., Killackey, E., & Velligan, D. (2020). Compensatory interventions for cognitive impairments in psychosis: A systematic review and meta-analysis. Schizophrenia Bulletin, 46, 869-83.

DeTore, N. R., Balogun-Mwangi, O., Mueser, K. T., & McGurk, S. R. (2023). Comparison of Black and White participants with severe mental illness in response to cognitive remediation as an augmentation of vocational rehabilitation. Schizophrenia Research, 253, 60-7.

McGurk, S. R., & Mueser, K. T. (2021). Cognitive Remediation for Successful Employment and Psychiatric Recovery: The Thinking Skills for Work Program. New York: Guilford Press.

McGurk, S. R., Mueser, K. T., Xie, H., Bloch, P., DeTore, N. R., Pashka, N., Guarino, S., Ruiz, A., Elliott, C., Gagnon, H., Bailey, E., Fraser, V., Welsh, J., Cunningham, H., Razzano, L. A., Drake, R. E., & Wolfe, R. (under review). A dismantling study of comprehensive cognitive remediation for improving employment outcomes: What is the role of computer cognitive training?

McGurk, S. R., Mueser, K. T., Xie, H., Welsh, J., Bailey, E., Guarino, S., Kaiser, S., Fraser, V., Drake, R. E., Becker, D. R., Wolfe, R., & McHugo, G. J. (2015). Cognitive enhancement treatment for people with mental illness who do not respond to supported employment: A randomized controlled trial. American Journal of Psychiatry, 172, 852-61.

Vita, A., Barlati, S., Ceraso, A., Nibbio, G., Ariu, C., Deste, G., & Wykes, T. (2021). Effectiveness, core elements, and moderators of response of cognitive remediation for schizophrenia: A systematic review and meta-analysis of randomized clinical trials. JAMA Psychiatry, 78, 848-858.