Institutes

Institute #1: Organization and Executive Function Skills Interventions for Children and Adolescents With ADHD

Margaret H. Sibley, Ph.D., Associate Professor, University of Washington School of Medicine
Richard Gallagher, Ph.D., Associate Professor of Child and Adolescent Psychiatry and Psychiatry, New York University School of Medicine

Category: ADHD – Child, Treatment – CBT
Keywords: ADHD, Evidence Based Practice

Basic to moderate level of familiarity with the material

Participants earn 7 continuing education credits.

Two efficacious psychosocial interventions are available for treating the challenging difficulties that youth with attention-deficit/hyperactivity disorder (ADHD) have in managing home and school demands. One is for children and their parents (Organization Skills Training, OST; Abikoff et al., 2013) and one is for teens and their parents (Supporting Teens’ Autonomy Daily, STAND; Sibley et al., 2016). Participants will learn how deficits in organizational skills and executive functioning hinder school productivity, school performance, and contribute to documented conflicts in family relationships and emotional distress in children and adolescents. Instruction is given on the details of the two interventions and how to implement components of the interventions. Special therapeutic techniques are incorporated, including motivational interviewing and how to view skill deficits as problems to manage, rather than defining personal character flaws. Participants learn how to deliver the interventions in clinical settings and how to select youth for whom the interventions are most appropriate.

Outline:

• Setting the Agenda (Richard Gallagher, 10 minutes)
• Executive Function and Organizational Skills Issues – ADHD in general and pre-teen children (Richard Gallagher, 30 minutes)
• Executive Function and Developmental Considerations for Treatment in Teens (Margaret Sibley, 30 minutes)
• Empirical Support and Foundation of Organizational Skills Training (Richard Gallagher, 20 minutes)
• Organizational Skills Training Overview (Richard Gallagher, 30 minutes)
• Organizational Skills Training Detailed Session Review and Practice/Demonstration (Richard Gallagher, 60 minutes)
• Lunch Break
• OST Implementation Questions (Richard Gallagher, 20 minutes)
• Break
• STAND (Margaret Sibley, 130 minutes)
• Conclusion and Questions (Richard and Margaret, 15 minutes)

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

1. Identify three common organization, time management, and planning deficits in children and adolescents with ADHD and list how they impact home and family.
2. Know how to conduct a systematic evaluation for identifying up to four organizational, time management, planning, and executive function deficits through the use of questionnaires or functional interviews.
3. Identify the key components of the Organization Skills Training treatment.
4. Identify the key components of the Supporting Teens’ Autonomy Daily Program.
5. Integrate motivational techniques into treatment to engage parents and youth.

Long-term goals:

1. Conduct manualized, empirically tested treatments to improve organization, time management, planning, and executive functions skills, which are proven to have positive effects on family functioning and academic productivity and performance.
2. Utilize best practices to promote youth skill application outside of session, including engaging the parent in contingency management to promote skill practice.

Recommended Readings:

Abikoff, H., Gallagher, R., Wells, K. C., Murray, D. W., Huang, L., Lu, F., & Petkova, E. (2013). Remediating organizational functioning in children with ADHD: immediate and long-term effects from a randomized controlled trial. Journal of Consulting and Clinical Psychology, 81(1), 113-128.

Gallagher, R., Abikoff, H. B., & Spira, E. G. (2014). Organizational skills training for children with ADHD: An empirically supported treatment. Guilford Press.

Nigg, J. T. (2017). Getting Ahead of ADHD: What Next-Generation Science Says about Treatments That Work? and How You Can Make Them Work for Your Child. Guilford Press.

Sibley, M.H., Graziano, P.A., Kuriyan, A.B., Coxe, S., Pelham, W.E., Rodriguez, L.M. et al., (2016). Parent-Teen Behavior Therapy + Motivational Interviewing for Adolescents with ADHD. Journal of Consulting & Clinical Psychology, 84, 699-712.

Sibley, M.H. (2016). Parent-Teen Therapy for Executive Function Deficits and ADHD: Building Skills and Motivation. Guilford Press.Sibley, M.H., Rodriguez, L.M., Coxe, S.J., Page, T., & Espinal, K. (2020). Parent-Teen Group versus Dyadic Treatment for Adolescent ADHD: What Works for Whom? Journal of Clinical Child and Adolescent Psychology, 49, 476-492

Institute #3: Treating Transdiagnostic Sleep and Circadian Problems in Clinical Practice: Basics and Beyond

Allison G. Harvey, Ph.D., Professor & Clinical Psychologist, University of California, Berkeley
Emma Agnew, LCSW, Research Associate, Community Supervisor and Facilitator, University of California, Berkeley
Marlen Diaz, B.A., Research Associate and Community Facilitator, University of California, Berkeley

Category:  Transdiagnostic, Treatment – CBT
Keywords: CBT, Sleep, Transdiagnostic

Basic level of familiarity with the material

Participants earn 5 continuing education credits.

Sleep and circadian problems are among the most prevalent problems. They undermine our emotional functioning, our health, and our cognition, and they contribute to behavioral problems such as risk taking and substance use. Much research on sleep and circadian problems has been disorder-focused—treating a specific sleep problem (e.g., insomnia) in a specific diagnostic group (e.g., depression). However, real-life sleep and circadian problems are not so neatly categorized. Insomnia often overlaps with hypersomnia, delayed sleep phase and irregular sleep-wake schedules. This core observation was one of the factors that motivated the development of the Transdiagnostic Sleep and Circadian Intervention (TranS-C). The goal of TranS-C is to provide a treatment approach for a variety of sleep problems comorbid with a variety of psychological and physical disorders, and that can be used confidently by a variety of mental health professionals.

TranS-C draws from and combines CBT-I with elements from three existing evidence-based treatments: Interpersonal and Social Rhythm Therapy, chronotherapy, and Motivational Enhancement (Miller & Rollnick, 2012).

TranS-C is a modular approach to reversing and maintaining psychosocial, behavioral, and cognitive processes via four cross-cutting modules, four core modules, and seven optional modules. The four cross-cutting modules are: case formulation; education; behavior change and motivation; goal setting. The four core modules are: establishing regular sleep-wake times, including learning a wind-down and wake-up routine; improving daytime functioning; correcting unhelpful sleep-related beliefs; and maintenance of behavior change. The optional modules are: improving sleep efficiency; reducing time in bed; dealing with delayed or advanced phase; reducing sleep-related worry/vigilance; promoting compliance with CPAP/exposure therapy for claustrophobic reactions to CPAP; negotiating sleep in a complicated environment and reducing nightmares.

Outline:

1. Assessment
2. Sleep and circadian functioning across the lifespan
3. Rationale for TranS-C and evidence base.
4. Crossing cutting modules
   1. case formulation
   2. education
   3. behavior change and motivation
   4. goal setting
5. Core modules
   1. establishing regular sleep-wake times including learning a wind-down and wake-up routine
   2. improving daytime functioning
   3. correcting unhelpful sleep-related beliefs
   4. maintenance of behavior change
6. Brief overview of the Optional Modules fuller description of two commonly used optional modules:
   1. improving sleep efficiency
   2. reducing sleep-related worry/vigilance
7. Adapting TranS-C for various people and contexts

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

1. Gain understanding of the key aspects of the biology, psychology and social context of the sleeper.
2. Acquire skills to assess sleep and circadian functioning.
3. Acquire skills in completing a case conceptualization.
4. Acquire skills in delivering the core modules of TranS-C.
5. Gain understanding on how to adapt CBT-I for teens and comorbid cases, particularly people diagnosed with a mood disorder.

Recommended Readings:

Condon, H. E., Maurer, L. F., & Kyle, S. D. (2020). Reporting of adverse events in cognitive behavioural therapy for insomnia: A systematic examination of randomised controlled trials. Sleep Medicine Reviews, 101412.

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 systematic review, meta-analysis, and GRADE assessment. Journal of Clinical Sleep Medicine, 17(2), 263-298.

Harvey, A. G., & Buysse, D. J. (2017). Treating sleep problems: A transdiagnostic approach. Guilford Publications.

Harvey, A. G., Dong, L., Hein, K., Yu, S., Martinez, A., Gumport, N., et al. (in press). A randomized controlled trial of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) to improve serious mental illness outcomes in a community setting. Journal of Consulting and Clinical Psychology.

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

Morin, C. M. (1993). Insomnia: Psychological assessment and management. Guilford Press.

Perlis, M. L., Jungquist, C., Smith, M. T., & Posner, D. (2006). Cognitive behavioral treatment of insomnia: A session-by-session guide (Vol. 1). Springer Science & Business Media.

Institute #4: Trauma-Informed Mindfulness: Integrating Mindfulness-Based Practices into Psychotherapy with Traumatized Clients

Terri L. Messman, Ph.D., Professor of Psychology, Miami University
Noga Zerubavel, Ph.D., Co-Director, Arise Psychological Wellness & Consulting; Assistant Consulting Professor at Duke University Medical Center

Category: Trauma and Stressor Related Disorder and Disasters, Treatment – Mindfulness & Acceptance
Keywords: Mindfulness, Trauma, Abuse / Maltreatment

Basic level of familiarity with the material

Participants earn 5 continuing education credits.

This training will provide participants with an understanding of how to integrate mindfulness into psychotherapy with trauma survivors safely and effectively. Trauma occurs as a result of violence, abuse, neglect, loss, disaster, war, and other emotionally harmful experiences, and the impact often endures long past the event through a variety of sequelae. Traumatized individuals vacillate between experiences of hyperarousal, emotional reactivity, and intrusive imagery, and hypoarousal, dissociation, and numbing of emotions. Mindfulness can provide clients with specific techniques for enhancing self-awareness, emotion regulation, distress tolerance, and attentional control, while also cultivating qualities of acceptance, compassion, and cognitive flexibility. Meditation and other mindfulness practices can promote optimal arousal and provide traumatized clients emotion regulation strategies. Evidence-based mindfulness interventions, such as Mindfulness-Based Cognitive Therapy (MBCT), are widespread. However, mindfulness practices can trigger traumatic memories or physiological arousal in some trauma survivors. Emerging evidence suggests mindfulness exercises may need to be modified for traumatized clients. Trauma-sensitive mindfulness interventions titrate the client’s arousal to maintain a window of tolerance, which facilitates psychotherapy and general well-being. In this training, Dr. Messman and Dr. Zerubavel will provide guidance on how to integrate mindfulness-based practices into psychotherapy with traumatized clients. Participants will learn to teach mindfulness as a way to reduce traumatic sequelae and improve emotion regulation. Discussion will emphasize both formal meditative practices and informal mindfulness practice. The training will involve learning through various methods, including lecture, experiential practice of guided mindfulness meditation, and small group work. No prior knowledge of mindfulness is assumed.

Outline:

Setting the Frame

• Practicing self-care during this training
  • Practicing self-awareness
  • Practicing responsiveness, with discernment between self-care and avoidance
  • Beginner’s mind
• Experiential processes to attend to during this training
  • Emphasis on experiencing
  • Resourcing
  • Pacing
  • Responsiveness
• Mindfulness practices & clinician experience
  • Ethical responsibility to engage in self-assessment of competence

Mindfulness Foundations

• What is mindfulness?
• Formal & informal mindfulness practice
• Integration into psychotherapy
  • Therapist mindfulness
  • Mindfulness-informed psychotherapy
  • Mindfulness-based psychotherapy

Trauma Foundations

• What is trauma?
  • Trauma is not defined by PTSD
  • Types of traumatic events and DSM 5: Trauma-Related Distress
  • Developmental and complex trauma
  • Minority Stress: Oppression & racism as trauma
• Denial of Trauma
  • Individual level
  • Societal level (e.g., DARVO)
• Psychological Adaptation
  • Trauma-related problematic beliefs & shattered assumptions
  • TRASC (altered consciousness)
• Psychophysiology 101: Trauma & dysregulation
  • Psychophysiological arousal & window of tolerance
  • Evolutionary motivational process & emotion regulation
  • Fight, flight, fawn, & freeze
  • Polyvagal Theory

Mechanisms of Mindfulness in Support of Trauma Therapy

• Attention
• Nonjudgmental awareness
• Cognitive flexibility
• Radical acceptance
• Self-compassion
• Embodiment and Body Awareness

Integrating Trauma-Informed Mindfulness Techniques into Practice

• Psychoeducation about the functions of emotions
• Grounding activities
• Attention-focused practices
• Acceptance-based practices

Actions to Reduce Adverse Outcomes

• The trauma-sensitive provider
  • Collaboration
  • Understanding
  • Power dynamics and offering
• Distinguish adverse from expected reactions
• Interoceptive awareness and trauma in the body
• Recognizing overwhelm
• Strategies for addressing overwhelm

Wrap Up, Q & A

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

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

**Learning objectives #4 and #5 identify long-term goals that an attendee can take away from the session and use in everyday practice.

Recommended Reading

• Bermudez, D., Benjamin, M. T., Porter, S. E., Saunders, P. A., Laurenzo Myers, N. A., & Dutton, M. A. (2013). A qualitative analysis of beginning mindfulness experiences for women with post-traumatic stress disorder and a history of intimate partner violence. Complementary Therapies in Clinical Practice, 19, 104-108. http://dx.doi.org/10.1016/j.ctcp.2013.02.004
• Boughner, E., Thornley, E., Kharlas, D., & Frewen, P. (2016). Mindfulness-related traits partially mediate the association between lifetime and childhood trauma exposure and PTSD and dissociative symptoms in a community sample assessed online. Mindfulness, 7, 672-679. https://doi.org/10.1007/s12671-016–0502-3
• Colgan, D. D., Christopher, M., Michael, P., & Wahbeh, H. (2016). The body scan and mindful breathing among veterans with PTSD: Type of intervention moderates the relationship between changes in mindfulness and post-treatment depression. Mindfulness, 7, 372-383. https://doi.10.1007/s12671-015-0453-0
• Gerge, A. (2020). What neuroscience and neurofeedback can teach psychotherapists in the field of complex trauma: Interoception, neuroception and the embodiment of unspeakable events in treatment of complex PTSD, dissociative disorders and childhood traumatization. European Journal of Trauma & Dissociation, 4, 100164. https://doi.org/10/1016/j.ejtd.2020.100164
• Hopwood, T. L. & Schutte, N. S. (2017). A meta-analytic investigation of the impact of mindfulness-based interventions on posttraumatic stress. Clinical Psychology Review, 57, 12-20. https://doi.org/10.1016/j.cpr.2017.08.002
• Kolacz, J., Kovacic, K. K., & Porges, S. W. (2019). Traumatic stress and the autonomic brain-gut connection in development: Polyvagal Theory as an integrative framework for psychosocial and gastrointestinal pathology. Developmental Psychobiology, 61, 796-809. https://doi.org/10.1002/dev.21852
• Metzger, I. W., Anderson, R. E., Are, F., & Ritchwood, T. (2021). Healing interpersonal and racial trauma: Integrating racial socialization into trauma-focused cognitive behavioral therapy for African American youth. Child Maltreatment, 26(1), 17-27. https://doi.org/10.1177/1077559520921457
• Strand, M. & Stige, S. H. (2021). Combining mindfulness and compassion in the treatment of complex trauma – a theoretical exploration. European Journal of Trauma & Dissociation, 5, 100217. https://doi.org/10.1016/j.ejtd.2021.100217
• Thompson, R. W., Arnkoff, D. B., & Glass, C. R. (2011). Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma. Trauma, Violence, & Abuse, 12(4), 220-235. https://doi.org/10.1177/1524838011416375
• Zerubavel, N. & Messman-Moore, T. L. (2015). Staying present: Incorporating mindfulness into therapy for dissociation. Mindfulness, 6(2), 303-314. https://doi.org/10.1007/s12671-013-0261-3
• Zhu, J., Wekerle, C., Lanius, R., & Frewen, P. (2019). Trauma- and stressor-related history and symptoms predict distress experienced during a brief mindfulness meditation sitting: Moving towards trauma-informed care in mindfulness-based therapy. Mindfulness, 10, 1985-1996. https://doi.org/10.1007/s12671-019-01173-z

Institute #5: Health Improvement Practitioners: Using Focused ACT in the Primary Care Behavioral Health Model

Patricia J. Robinson, Ph.D., Director of Primary Care Innovation, Inter-Professional Primary Care Institute of Oregon, Director of Training, Mountainview Consulting Group
Kirk D. Strosahl, Ph.D., President, Heart Matters Consulting

Category:  Primary Care / Integrated Care, Health Care System / Public Policy 
Keywords: ACT (Acceptance & Commitment Therapy), Health Care System, Primary Care

Basic to moderate level of familiarity with the material

Participants earn 5 continuing education credits.

In 2017, New Zealand (NZ) initiated a pilot study to explore the impact of integrating behavioral health care into primary care to improve behavioral health access and outcomes for all NZ citizens. In the pilot study and in a National Demonstration project that followed it, all staff recruited to work as Health Improvement Practitioners (HIPs) were trained to work in the Primary Care Behavioral Health Model (PCBH; Robinson & Reiter, 2016) and to use Focused Acceptance and Commitment Therapy (Focused ACT) (Robinson, 2020) to inform assessment and intervention development. A review of 29 studies found that the PCBH model offers an effective population health approach to behavioral health service delivery and that it is associated with positive patient and implementation outcomes. Focused ACT is a brief intervention approach that developed in parallel with ACT. In this institute, Robinson and Strosahl introduce key components of the PCBH model and the Focused ACT approach and describe procedures used in training NZ HIPs. Findings of the NZ experiment included improved access and clinical outcomes for patients, including Maori and Pacific Islanders—a giant step toward realization of health equity. Other findings included improved patient and physician satisfaction and a trend toward lower rates of prescribing antidepressants. The NZ Ministry of Health made a policy decision to expand HIP services in 2019, with a goal of making HIP services available to all citizens. Participants will view a role-play demonstration of a Focused ACT visit and review handouts that support rapid development of foundational skills. Participants will also be invited to think through issues related to scaling up HIP services, training HIP trainers, and developing a national registry of HIP outcomes. The institute will conclude with small group work centering on participant plans to use PCBH and Focused ACT strategies in their practice and to identify actions they might take to promote transformation in their communities based on the New Zealand integrated care experiment.

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

1. Describe the PCBH model using the GATHER acronym.
2. List areas of assessment typically included in the Focused ACT approach.
3. Define the intended outcome of every Focused ACT visit.
4. List the components of a Focused ACT follow-up visit.
5. Describe what happens when a HIP receives a “warm handover.”

Long-term goals:

This institute offers you the opportunity to learn about cutting-edge dissemination of behavior change interventions that:

• Address both medical and psychological health
• Improve patient or client access to health care
• Improve patient engagement
• Empower greater equity in use of and benefit from behavioral health services

Recommended Reading

Dobmeyer, A. C., Hunter, C. L., Corso, M. L., Nielsen, M. K., Corso, K. A., Polizzi, N. C., & Earles, J. E. (2016). Primary care behavioral health provider training: Systematic development and implementation in a large medical system. Journal of Clinical Psychology in Medical Settings, 23, 207-224.

Robinson, P. J. (2020). Basics of Behavior Change in Primary Care. Springer.

• Robinson, P. J., Oyemaja, J., Beachy, B., Goodie, J., Bell, J., Sprague, L., Maples, M. & Ward, C. (2018). Creating a primary care workforce: Strategies for leaders, clinicians, and nurses. Journal of Clinical Psychology in Medical Settings, 20(3). DOI: 10.1007/s10880-017-9530-y

Robinson, P. J., & Reiter, J. T. (2016). Behavioral consultation and primary care: A guide to integrating services(2nd ed.). Springer.

Robinson, P. J., Von Korff, M., Bush, T., Lin, E. H. B., & Ludman, E. J. (2020). The impact of Primary Care Behavioral Health services on patient behaviors: A randomized controlled trial. Family Systems and Health, 38(1), 6-15.

Institute #6: Motivational Interviewing in Diverse Health Care Settings

Daniel W. McNeil, Ph.D., Eberly Distinguished Professor, West Virginia University
Trevor A. Hart, Ph.D., Professor and OHTN Chair in Gay and Bisexual Men’s Health, Ryerson University

Category:  Health Psychology / Behavioral Medicine – Adult, Treatment – Other
Keywords: Motivational Interviewing, Health Psychology, Treatment

Basic to moderate level of familiarity with the material

Participants earn 5 continuing education credits.

This institute involves development of intermediate skills in Motivational Interviewing (MI) and applying MI in diverse health care contexts (e.g., substance use clinics, sexual behavior problem programs, community-based settings, hospital settings with medical patients). This training is designed for helping professionals and students who are interested in learning additional MI skills to increase patients’ motivation to make changes in cognitive, emotional, and behavioral functioning, and to engage in promoting healthy behaviors. The training is provided by experienced trainers in MI, including one who is a member of the Motivational Interviewing Network of Trainers (MINT). Participants will learn and practice methods to assist patients regarding the promotion of healthy lifestyle behaviors (e.g., diet and exercise, medication adherence, tobacco cessation, oral health promotion). This session will review the conceptual model for understanding MI, identify the key principles and processes of MI, provide an operational definition of “MI spirit,” and describe the evidence base for the use of MI for promoting health behaviors. Using demonstrations and role-play, the application of specific techniques to increase patient motivation (and respond to resistance) will be covered. Eliciting, identifying, and responding to health-related “change talk” (in contrast to “sustain talk” and avoidance) will be demonstrated and practiced. The training will include experiential components in which participants work in dyads and small groups, and with the trainers, to practice skills in a comfortable, interactive, safe, and supportive learning environment. Integrating MI in primary care and other health care settings will be addressed, including how to utilize brief interventions.

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

1. Describe the MI model and at least 2 studies that provide an evidence base for the use of MI in health behavior change with patients in diverse health care settings.
2. Demonstrate the 5 core MI skills.
3. Explain MI “spirit” and the 4 key MI processes.
4. Apply at least 2 specific MI interventions to increase patient motivation for healthy behavior change, including brief interventions.
5. Utilize MI in primary care and other health care settings in working with adult, adolescent, and older adult patients.

Long-term goals:

1. Participants will articulate a deeper understanding of MI and its application in diverse health care settings.
2. Participants will evidence greater confidence in using MI with a diverse clientele and in diverse health care settings.

Outline:

• Description of the MI model and methods applied to diverse health care settings
• View examples of MI with various patient groups and types of problems
• Practice MI core skills in an interactive, supportive, and growth-oriented atmosphere
• Consolidation of existing MI skills and stepwise development of them for use with and for a diversity of patients and settings

Recommended Reading:

Magill, M., Gaume, J., Apodaca, T. R., Walthers, J., Mastroleo, N. R., Borsari, B., & Longabaugh, R. (2014). The technical hypothesis of Motivational Interviewing: A meta-analysis of MI’s key causal model. Journal of Consulting and Clinical Psychology, 82(6), 973-83.

Martins, R. K., & McNeil, D. W. (2009). Review of Motivational Interviewing in promoting health behaviors. Clinical Psychology Review, 29, 283-293.

McNeil, D. W., Addicks, S. H., & Randall, C. L. (2017). Motivational Interviewing and Motivational Interactions for health behavior change and maintenance. Oxford Handbooks Online.

Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping people change (3rd ed.). Guilford.

Miller, W. R., Rollnick, S., & Butler, C. C. (2008). Motivational Interviewing in health care: Helping patients change behavior. Guilford.

Institute #7: The CALM Program: Treating Early Childhood Anxiety Using PCIT

Anthony Puliafico, Ph.D., Associate Professor, Columbia University Irving Medical Center
Jami M. Furr, Ph.D., Clinical Assistant Professor, Florida International University
Jonathan S. Comer, Ph.D., Professor of Psychology, Florida International University

Category:  Child / Adolescent Anxiety, Parenting / Families
Keywords: Child, Anxiety, PCIT (Parent Child Interaction Therapy)

Basic to moderate level of familiarity with the material

Participants earn 5 continuing education credits.

Over the last two decades, parent- and family-based approaches to treat early childhood anxiety have garnered increasing evidence (e.g., Carpenter et al., 2014). One such promising intervention is the CALM Program (Puliafico et al., 2013), which is an adaptation of Parent Child Interaction Therapy (PCIT) to treat anxiety in children ages 3–8. In the CALM Program, caregivers learn skills to more effectively guide and reinforce their child in approaching anxiety-provoking situations and to extinguish avoidance patterns via selective attention, modeling and effective instruction given in caregiver-only “teach” sessions. During “coach” sessions, caregivers receive live, in-session coaching in the application of these skills while leading their child through graded exposure exercises. As in standard PCIT, therapists conduct live coaching unobtrusively, often from behind a one-way mirror, which facilitates generalization to other settings. Coaching sessions continue until caregivers exhibit skill mastery and exposure goals are consistently met. A recently completed RCT evaluating a telehealth format of the CALM Program (i.e., iCALM) demonstrated initial efficacy in reducing early anxiety problems and associated family impairment, particularly among families presenting with high levels of baseline accommodation (Comer et al., 2021). Such support has been particularly encouraging in the context of the COVID-19 pandemic and the sharp rise in telehealth service utilization
This session is intended to familiarize attendees with the CALM Program and to teach specific skills associated with the treatment. The rationale for applying PCIT-based treatment principles to treating early child anxiety will be reviewed. A session-by-session description of the treatment will be provided. Key treatment components will be demonstrated and role-played, including live bug-in-the-ear parent coaching of child exposures. The presenters will also review strategies for effectively applying the CALM Program over telehealth using the iCalm intervention.

Outline:

• Rationale for treating early childhood anxiety with PCIT
  • Developmental considerations that influence treatment modality and structure
  • Brief review of PCIT for early childhood disorders
  • Review of existing research supporting parent-based interventions for early childhood anxiety
  • Review of existing research supporting the CALM Program and iCALM for early childhood anxiety
• Overview of the CALM Program treatment approach
  • Review of behavioral approaches emphasized throughout CALM Program treatment (e.g., selective attention, parent modeling, graded exposure)
  • Discussion of the role of caregivers in treatment
  • Rationale for the use of live in-session coaching of skills
  • Review of assessments used to assess child anxiety and treatment progress
• Session-by-session description of the CALM Program
  • Teaching caregivers CDI skills and providing anxiety psychoeducation
  • Coaching caregivers in use of CDI skills
  • Role-play demonstrating use of CDI skills to shape child approach behavior
  • Teaching DADS skills to caregivers
  • Coaching caregivers in use of DADS skills during exposures with children
  • Role-play/video demonstrating use of DADS skills
• Applying the CALM Program to telehealth using iCALM
  • Rationale for use of iCALM treatment approach
  • Treatment modifications when providing iCALM via telehealth
  • Video demonstrating iCALM intervention
• Audience Question & Answer

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

1. Discuss the rationale for adapting PCIT to the treatment of anxiety in young children.
2. Describe the role of parental attention in maintaining anxiety symptoms in young children.
3. Identify 3 developmentally appropriate treatment strategies when working with young children with anxiety disorders.
4. Explain the 4 steps of the DADS sequence of behaviors used to promote approach behavior.
5. Identify 2 factors to help determine if the iCALM telehealth format should be considered.

Long-term goals:

1. Demonstrate how to use selective attention to shape a child’s approach and avoidance behavior.
2. Coach caregivers in leading their children in exposure-based interventions.

Outline:

• Description of the MI model and methods applied to diverse health care settings
• View examples of MI with various patient groups and types of problems
• Practice MI core skills in an interactive, supportive, and growth-oriented atmosphere
• Consolidation of existing MI skills and stepwise development of them for use with and for a diversity of patients and settings

Recommended Reading:

Carpenter, A.L., Puliafico, A., & Kurtz, S., Pincus, D.B., & Comer, J.S. (2014). Adapting Parent-Child Interaction Therapy for mood and anxiety problems in young children: New advances for an overlooked population. Clinical Child and Family Psychology Review, 17(4), 340-356. doi: 10.1007/s10567014-0172-4

Comer, J.S., Furr, J.M., del Busto, C., Silva, K., Hong, N., Poznanski, B., Sanchez, A., Cornacchio, D., Herrera, A., Coxe, S., Miguel, E., Georgiadis, C., Conroy, K., & Puliafico, A.C. (2021). Therapist-led, family-based treatment for early child social anxiety: A waitlist-controlled evaluation of the iCALM Telehealth Program. [Advance online].  https://doi.org/10.1016/j.beth.2021.01.004

Comer, J.S., Puliafico, A.C., Aschenbrand, S.G., McKnight, K., Robin, J.A., Goldfine, M.E., & Albano, A.M. (2012). A pilot feasibility evaluation of the CALM Program for anxiety disorders in early childhood. Journal of Anxiety Disorders, 26(1), 40-49. doi: 10.1016/j.janxdis.2011.08.011

Puliafico, A. C., Comer, J. S., & Albano, A. M. (2013). Coaching approach behavior and leading by modeling: Rationale, principles, and a session-by-session description of the CALM program for early childhood anxiety. Cognitive and Behavioral Practice, 20(4), 517–528. https://doi.org/10.1016/j.cbpra.2012.05.002