Clinical Intervention Trainings

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

Presented by:
Shannon Sauer-Zavala, PhD., Associate Professor, Department of Psychology, University of Kentucky

Dr. Sauer-Zavala is a co-developer of the Unified Protocol and the founding director of the Unified Protocol Institute. She is also an Associate Professor in the Department of Psychology at the University of Kentucky (UK) and is the founding Director of Clinical Services at the UK Clinic for Emotional Health. Dr. Sauer-Zavala received her doctorate in Clinical Psychology from UK; she completed her predoctoral internship at Duke University Medical Center and her postdoctoral fellowship at Boston University. She then spent seven years on the faculty in BU’s Department of Psychological and Brain Science before returning to the faculty at UK in 2019. Dr. Sauer-Zavala’s research is focused on exploring emotion-focused mechanisms that maintain psychological symptoms (particularly high-risk symptoms such as suicidal thoughts and behaviors) and using this information to develop more targeted, easily disseminated intervention strategies. Her research has been supported by NIMH, NIAAA, Templeton Foundation, the Center for Implementation and Improvement Sciences, and the Canadian Institute of Health Research. Dr. Sauer-Zavala has co-authored over 100 scholarly publications, including three books.

Participants earn 7 continuing education credits

Basic to moderate familiarity with the material

Categories: CBT, Transdiagnostic

Keywords: Transdiagnostic, CBT, emotional disorders,

A quick Amazon search turns up hundreds of workbooks for anxiety and depression. How do you select an evidence-based approach for your patients from all of the available options? Indeed, the explosion of specific treatment manuals for each DSM disorder has created unintended barriers for implementation and dissemination of evidence-based psychological treatments. It is costly to receive training in each protocol and it may not be feasible for busy clinicians to prep different interventions for the myriad problems faced by patients on their caseloads. The Unified Protocol for the Treatment of Emotional Disorders (UP; Barlow et al., 2011, 2018) was developed to address these barriers. The UP is a transdiagnostic, emotion-focused cognitive-behavioral treatment (CBT) that targets core deficits occurring across the neurotic spectrum (e.g., anxiety, depressive, and related disorders [e.g., eating disorders, borderline personality disorder]). This workshop will first briefly review evidence supporting the development of such transdiagnostic interventions. This will be followed by a description and demonstration of how to apply core UP treatment modules, along with the similarities and differences between the UP and traditional CBT. Audio and videotaped illustrations of core treatment interventions (e.g., mindful awareness, emotion exposures) will be presented, along with detailed case examples involving complex comorbidity. Attendees will be invited to participate in exercises as part of these demonstrations.

Session Outline

• Rationale for Transdiagnostic CBT
  • History of mental health classification
  • Limitations of the DSM’s categorical approach
  • Impact on treatment development and dissemination
• Conceptual Development of the Unified Protocol
  • Research on psychological processes shared across emotional disorders
  • Emotional disorders functional model
  • Unified Protocol treatment targets
  • Empirical support for the Unified Protocol
• Introductory Session
  • Functional assessment of patient difficulties (is the UP appropriate?)
  • Cultivating patient buy-in
  • Objective monitoring of difficulties
  • Psychoeducation on CBT (e.g., skill building, homework)
• Module 1: Motivational Enhancement
  • Understanding sources of client ambivalence
  • Decisional balance exercise
  • Goal setting exercise
• Module 2: Understanding Emotions
  • Psychoeducation on the adaptive nature of emotions
  • Three-component model of emotions
  • Identifying patterns in antecedence and consequences of emotional experiences
• Module 3: Mindful Emotion Awareness
  • Rationale for adopting a present-focused, nonjudgmental stance toward emotions
  • Sitting meditation exercise
  • Mindful Mood Induction exercise
  • Anchoring in the Present exercise
• Module 4: Cognitive Flexibility
  • The reciprocal relationship between thoughts and emotions
  • The nature of automatic thoughts and thinking traps
  • Dealing with thoughts about emotions
  • Addressing core beliefs
• Module 5: Countering Emotional Behaviors
  • What are emotional behaviors?
  • Identifying patients’ idiographic forms of emotional avoidance
  • How to plan alternative action exercises
• Module 6: Confronting Physical Sensations
  • The transdiagnostic role of physical sensations within an emotional experience
  • What are interoceptive exposures?
  • Ideas for interoceptive exposure for depression, eating pathology, anger
  • Dos and Don’ts of Interoceptive exposure
• Module 7: Emotion Exposures
  • Goals for emotion exposures
  • How to create a hierarchy of exposure tasks
  • Managing in-session and out-of-session exposure practice
• Module 8: Relapse Prevention
  • How to evaluate patient progress
  • Planning for continued skill practice
  • Encouraging a nonjudgmental stance to fluctuation in symptoms

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

1. Develop a unified, transdiagnostic case conceptualization for patients presenting with comorbid emotional disorders.
2. Describe the advantages and disadvantages of the current method of classifying mental disorders
3. Apply emotion-focused treatment principles and strategies (e.g., objective monitoring, mindfulness training, cognitive flexibility, reduction of emotional avoidance and maladaptive emotion driven behaviors) to patients presenting with comorbid emotional disorders.
4. Create effective and cohesive emotion exposures for patients with complex comorbidities.
5. Articulate a nonjudgmental stance to fluctuating symptoms after treatment ends, while at the same time underscoring the importance of continued practice to prevent relapse.

Long-term goals

• Participants will be able to implement the Unified Protocol in their clinical practice; given the broad applicability of this treatment, use of the UP may reduce therapist preparation burden.

Recommended Readings:

• Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Latin, H., Sauer-Zavala, S., …. Cassiello-Robbins, C. (2017).  The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders compared to diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA Psychiatry, 74, 875-884. PDF
• Bullis, J.R., Boettcher, H., Sauer-Zavala, S., & Barlow, D.H. (2019). What is an emotional disorder? A transdiagnostic mechanistic definition and implications for assessment, treatment and prevention. Clinical Psychology: Science and Practice, 26(2), 19-x PDF
• Cassiello-Robbins, C., Southward, M., Tirpak, J., & Sauer-Zavala, S. (2020). A systematic review of Unified Protocol applications with adult populations: Facilitating widespread dissemination via adaptability. Clinical Psychology Review,78, 101852. PDF
• Sauer-Zavala, S., Cassiello-Robbins, C., Conklin, L., Bullis, J.R., Thompson-Hollands, J., & Kennedy, K. (2017). Isolating the unique effects of the Unified Protocol treatment modules using single-case experimental design. Behavior Modification, 40, 286-307. PDF
• Sauer-Zavala, S., Gutner, C., Farchione, T., Boettcher, H., Bullis, J.R., & Barlow, D.H. (2017). Current definitions of “transdiagnostic” in treatment development: A search for consensus. Behavior Therapy, 48, 128-138. PDF

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

Presented by:
Matthew D. Skinta, Ph.D., ABPP, Psychology Department, Women & Gender Studies Department (Affiliated Faculty), Roosevelt University

Matthew D. Skinta, PhD, ABPP, is a board-certified clinical health psychologist and Assistant Professor of Psychology at Roosevelt University (Chicago). His past research has focused on the impact of stigma and shame on health behaviors of sexual minority men, particularly as it relates to sexual health and HIV-related care and has more than a decade of broad clinical experience in psychotherapy, supervision, and consultation around topics of sexual orientation and gender diversity. Dr. Skinta spent the second half of 2021 based in Warsaw, Poland, researching the impact of anti-LGBTQ+ politics on the well-being of queer and transgender Polish people, as well as sources of resilience and connection. He is a peer-reviewed acceptance and commitment therapy (ACT) trainer and is certified as both a compassion cultivation training (CCT) teacher, and as a trainer of functional analytic psychotherapy (FAP).  Dr. Skinta co-edited Mindfulness and Acceptance for Gender and Sexual Minorities, and his most recent book, Contextual behavior therapy for sexual and gender minority clients: A practical guide to treatment, was released by Routledge in 2020. He has conducted workshops on clinical care and cultural humility for work with sexual orientation and gender diverse communities around the world.

Participants earn 7 continuing education credits

Moderate to high level of familiarity with the material

Categories: LGBTQ+; Treatment – Mindfulness & Acceptance

Keywords: LGBTQ; Therapeutic Relationship; Transdiagnostic

Sexual and gender minority stress appear to contribute to a variety of transdiagnostic concerns among sexual orientation and gender diverse people. This workshop will teach process-based behavioral techniques that take advantage of research on minority stress and processes that foster resilience and well-being. The workshop will incorporate both theoretical and experiential work. Moving through life as a sexual or gender minoritized person often entails some period of secrecy, guardedness, shame, and familial ruptures. We will explore the therapeutic techniques that tackle these concerns in the therapy hour and within the therapeutic relationship. This workshop will also aid clinicians in cultivating their own compassion and values toward meeting the challenges of moving through life as a SGM person, particularly through targeting the therapist’s own history of cultural messages about gender and sexuality. Through the use of awareness, courage, therapeutic love, compassion, perspective-taking, and acceptance, participants will grow in their ability to relate as from the perspective of self-awareness of their own sexual orientation and gender. Clinician’s will leave with a greater understanding of how concepts such as minority stress, rejection sensitivity, and shame can be better responded to in session.

Outline:

1. A contextual behavioral analysis of minority stress.
   1. Understanding the current state of treatment and mistreatment of sexual orientation and gender diverse clients.
   2. Awareness of social and political sources of bias that evoke and maintain unworkable relational patterns.
   3. Understanding one’s own history of behaviors and learning associated with sexual and gendered behavior, particularly among heterosexual, cisgender therapists who have less experience questioning these contingencies.
   4. Knowledge of common behavioral responses to stigma and marginalization.
2. Specific interventions that target minority stress processes.
   1. Diversify skills associated with working with stigmatizing cognitions, particularly options the do not emphasize cognitive disputation.
   2. Explore concrete steps to work with interpersonal guardedness and to undermine rejection sensitivity.
   3. Consider the importance of compassion and self-compassion techniques in reducing shame.
   4. Explore the relationship between pliance, contingent self-worth, and valued action as a remedy.

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

1. Identify how sexual and gender minority stress have a transdiagnostic effect on well-being and health.
2. Explain how societal bias contributes to rejection sensitivity among sexual orientation and gender diverse people.
3. Demonstrate willingness to amend their work with sexual orientation and gender diverse clients when microaggressions occur in therapy.
4. Describe how compassion-based interventions ameliorate the impact of shame.
5. Become aware of the global impact of anti-LGBTQ bias within the United States.

Long-term Goals:

• Increase an awareness of the relational and social impact of minority stress, as reflected by both transdiagnostic and non-diagnostic behavior patterns.
• Develop an awareness of how heterocentrism and ciscentrism increase the likelihood of microaggressions in therapy, and how to use that awareness to repair ruptures.

Recommended readings:

Eaton, N. R., Rodriguez-Seijas, C., & Pachankis, J. E. (2021). Transdiagnostic approaches to sexual-and gender-minority mental health. Current Directions in Psychological Science, 30(6), 510-518.

Rincón, C.L., Muñoz-Martínez, A.M., Hoeflein, B.T.R., & Skinta, M. D. (2021). Enhancing Interpersonal Intimacy in Colombian Gay Men Using Functional Analytic Psychotherapy: An Experimental Non-Concurrent Multiple Baseline Design. Cognitive & Behavioral Practice. Advance online publication. doi: 10.1016/j.cbpra.2021.10.003

Rodriguez-Seijas, C., Morgan, T. A., & Zimmerman, M. (2021). Is there a bias in the diagnosis of borderline personality disorder among lesbian, gay, and bisexual patients?. Assessment, 28(3), 724-738.

Skinta, M. D. (2020). Contextual behavior therapy for sexual and gender minority clients: A practical guide to treatment. Routledge.