Invited Clinical Grand Rounds

Implementación de la Terapia Cognitiva Conductual-Enfocada en Trauma en Latino América y el Caribe  

This presentation will be entirely in Spanish with simultaneous interpretation available in English

Participants earn 1 continuing education credit

Dr. Rosaura Orengo-Aguayo was raised in the beautiful island of Puerto Rico where the women and community who collectively raised her taught her the values of compassion, humility, service, social justice, advocacy, and ongoing self-reflection. She carries these values into her professional identity as an Associate Professor and bilingual licensed Clinical Psychologist at the Medical University of South Carolina. Her team’s mission is for children and families around the world to have access to evidence-based, trauma-informed mental health services regardless of location, language, socioeconomic status, or background. They achieve this mission through e community based participatory approaches, implementation science, telehealth technology, and principles of cultural humility and language justice in their work in the US, Latin America, and the Caribbean.

Dr. Orengo-Aguayo has published several seminal publications on the impact of disasters on youth mental health (JAMA Network Open), and the implementation and dissemination of in-person and telehealth delivery of Trauma Focused Cognitive Behavioral Therapy (TF-CBT) in Latin America and US (American Psychologist). She is a co-author in the first telehealth manual available in Spanish (Manual de Telesalud Mental). She was recently interviewed by the US Surgeon General, Vivek Murthy, on his House Calls Podcast on the topic of “What do Natural Disasters Mean for our Mental Health” (Listen here).

In her spare time she plays beach volleyball with her husband, she has had the privilege of traveling to 28 countries across 3 continents, interior design brings her joy, and she has a baby Golden Doodle and 12 y/o Golder Retriever who make her smile every day.

Abstract: Each year, approximately one billion youth worldwide will experience a traumatic event (e.g., physical, emotional, or sexual abuse, neglect, community or family violence, traumatic loss, disaster; Hillis et al., 2016). Moreover, the COVID-19 pandemic has increased the risk of trauma exposure for already vulnerable youth and families (Khan et al., 2020; Xiong et al., 2020). Exposure to traumatic events increases the risk of developing posttraumatic stress disorder (PTSD), depression, behavior problems, substance use disorders, and suicidal ideation/self-harm (Fairbank & Fairbank, 2009; Lai et al., 2017). Trauma exposure is also associated with poor academic and occupational achievement and adverse physical health outcomes that can last a lifetime (Carliner et al., 2016; Holt et al., 2007; McLaughlin et al., 2012; Ormel et al., 2008). The limited data available suggest that 30–60% of children in Latin America have experienced a traumatic event during their lifetime (Speizer et al. 2008). Latin American countries (including Central and South American countries) have a long-standing history of political instability, gang-related violence, poverty, and forced migration that has further exposed youth to potentially traumatic events (Wirtzet al. 2016). Furthermore, the 21st century has seen an alarming increase of severe weather events (e.g., hurricanes, floods, wildfires, tornadoes, earthquakes, tsunamis) resulting in loss of life, infrastructure, safety, social support, and adverse mental and physical health outcomes (Goldmann & Galea, 2014; World Disasters Report, 2018). An estimated 175 million youth around the globe will continue to be affected each year by the devastating effects of climate change (Seballos et al., 2011), further increasing youth’s risk of exposure to traumatic events (Augustinavicius et al., 2021).

In this Clinical Grand Round, Dr. Rosaura Orengo-Aguayo will describe the implementation and outcomes of TF-CBT in two different low-resourced contexts (Puerto Rico and El Salvador) impacted by poverty, natural disasters, and violence guided by principles of cultural humility, language justice, implementation science, and community based participatory research.

This presentation will be fully in Spanish with English language simultaneous interpretation available for audience members who need it.

This is the first ever ABCT presentation offered completely in a language that is not English.

Outline:

1. Introduction to:
   a. Cultural Humility
   b. Language Justice
   c. Implementation Science framework
   d. Community Based Participatory Action Research
2. Introduction to:
   a. Prevalence of childhood trauma
   b. Impact of childhood trauma
3. Description of the context in El Salvador and Puerto Rico
   a. Historical and sociopolitical context
   b. Significant traumatic events impacting youth in recent decades
   c. Need for trauma treatment
4. Implementation of TF-CBT in Puerto Rico
   a. Building partnerships
   b. Culturally and linguistic tailoring
   c. Contextual tailoring
   d. Implementation strategies
   e. Outcomes
   f. Lessons learned
5. Implementation of TF-CBT in El Salvador
   a. Building partnerships
   b. Culturally and linguistic tailoring
   c. Contextual tailoring
   d. Implementation strategies
   e. Outcomes
   f. Lessons learned
6. Future Directions

 
Learning Objectives:

1. Describe the implementation of Trauma Focused Cognitive Behavioral Therapy (TF-CBT) in two different low resourced contexts (Puerto Rico and El Salvador) impacted by poverty, natural disasters, and violence.
2. Describe the implementation of TF-CBT using principles of cultural humility, language justice, implementation science, and community based participatory research.
3. Describe program evaluation outcomes, lessons learned, and future directions for global implementation of TF-CBT in Latin America and the Caribbean.

 
Long-Term Goals

1. TF-CBT has preliminary effectiveness (via non-randomized pilot trials) in two, low-resourced contexts in Latin America and the Caribbean (Puerto Rico and El Salvador).
2. The incorporation of principles of cultural humility, language justice, implementation science, and community based participatory research were crucial in the successful implementation of TF-CBT in these two low-resourced and diverse contexts.

Recommended Readings:

Orengo-Aguayo, R., Dueweke, A.R., Nicasio, A., de Arellano, M., Rivera, S., Cohen, J.A., Mannarino, A.P., & Stewart, R.W. (2022). Trauma Focused Cognitive Behavioral Therapy with Puerto Rican youth in a post-disaster context: Tailoring, implementation, and program evaluation outcomes. Child Abuse & Neglect, 129, 105671.  https://doi.org/10.1016/j.chiabu.2022.105671

Stewart, R.W., Orengo-Aguayo, R., Villalobos, B.T., Nicasio, A.V., Dueweke, A., Alto, M., Cohen, J.A., Mannarino, A.P., & de Arellano, M.A. (2021). Implementation of an evidence-based psychotherapy for trauma-exposed children in a lower-middle income country: The use of Trauma-Focused Cognitive Behavioral Therapy in El Salvador. Journal of Child & Adolescent Trauma, 14, 433-441. https://doi.org/10.1007/s40653-020-00327-9

Orengo-Aguayo, R., Stewart, R. W., Villalobos, B. T.,Hernandez Rodriguez, J., *Dueweke, A. R., de Arellano, M. A., & Young, J. (2020). Listen, don’t tell: Partnership and adaptation to implement trauma-focused cognitive behavioral therapy in low-resourced settings. American Psychologist, 75(8), 1158–1174. https://doi.org/10.1037/amp0000691

Saturday, November 18 | 10:30 AM – 12:00 PM

Presented by:

Maureen Zalewski, Ph.D., University of Oregon

Vibh Forsythe Cox, Ph.D., University of Washington

Alison Yaeger, PSY.D., McLean Hospital

Aditi Vijay, Ed.M., Ph.D., Kean University

Participants earn 1.5 continuing education credits

Dr. Maureen Zalewski is the Director of Clinical Training and an associate professor at the University of Oregon. She also serves as the Director of Child Behavioral Health Training at the Ballmer Institute for Children’s Behavioral Health. She is a licensed psychologist (OR) and is Linehan Board Certified in conducting Dialectical Behavior Therapy (DBT). She is currently the board secretary for the International Society for the Improvement and Teaching of Dialectical Behavior Therapy.

Her program of research is on child development in the context of parental mental health disorders, with expertise in maternal borderline personality disorder, parenting, and the development of children’s emotion regulation. With a sample of preschoolers who have mothers with borderline personality disorder, she has leveraged DBT Skills to improve maternal emotion regulation in order to test the extent this promotes growth in preschool emotion regulation trajectories. She is engaged in treatment development work on integrating parent training and DBT and more recently started a study on self-injurious thoughts and behaviors during the perinatal transition. Her lab, the Parent Mental Health Research Clinic, is funded by the NIMH, NIDA, and the American Foundation for Suicide Prevention.

Vibh Forsythe Coxa Clinical Associate professor and the director of the Marsha M. Linehan Dialectical Behavior Therapy (DBT) Clinic at the University of Washington. Here, she teaches courses and provides supervision to advanced graduate students learning to deliver DBT. She is a licensed clinical psychologist and a DBT-Linehan Board of Certification certified clinician. She has provided clinical services in a variety of settings, including Veteran Affairs medical centers, university psychological services centers, private outpatient clinics, and maximum security forensic inpatient settings.

Dr. Forsythe Cox is also a trainer, consultant, and Director of Faculty Development for Behavioral Tech, LLC (BTECH), the training company founded by Dr. Linehan which provides training and consultation for DBT clinicians internationally. Dr. Forsythe Cox is both a member of the board of the International Society for the Implementation and Teaching of DBT (ISITDBT) and a founding member of ISITBT’s Antiracism Committee.

Dr. Alison Yaeger received her PsyD from Yeshiva University in Bronx, New York. While training at Montefiore Medical Center she became interested in borderline personality disorder in adolescence and her passion for this population hasn’t wavered since. Dr. Yaeger has received intensive training in dialectical behavior therapy (DBT) and sought additional opportunities to understand how this evidence-based treatment can effectively be applied to youth and their families.

Dr. Yaeger is an expert in DBT for adolescents and their families, and she developed the 3East Outpatient DBT program at McLean Hospital where she serves as program director. Dr Yaeger is also the associate director of training at 3East and is an Instructor of Psychology at Harvard Medical School, ensuring trainees and early career staff of varying disciplines understand the principals and foundations of DBT. Dr. Yaeger joined the board of the International Society for the Improvement and Teaching of DBT (ISITDBT) in 2019 and was the conference program chair responsible for transitioning to a virtual format in 2020. She is the current President of ISITDBT and is involved in national and international committees that promote the dissemination of adherent DBT.

Dr. Aditi Vijay is an assistant professor at Kean University and the owner of a private practice specializing in Dialectical Behavior Therapy. Her research focuses on emotion regulation as a transdiagnostic process. Her work examines the transactional nature of interpersonal relationships/social context (e.g. racism, misogyny) and emotion regulation. Her program of research examines this in the implementation of DBT, development and maintenance of trauma symptoms, burnout and antiracism efforts.

Dr. Vijay provides DBT training through the Center for DBT and Families. She has extensive experience in treating, supervising and training in DBT and evidence-based trauma-based interventions. She has consulted on DBT in a variety of settings including schools, residential treatment facilities, juvenile justice organizations, hospitals, and private practices. Dr. Vijay is on the Board of Directors for the International Society for the Improvement and Teaching of DBT (ISITDBT) and the National Education Alliance for Borderline Personality Disorder. She chaired the annual ISITDBT conference in 2022 and 2023.

Categories: DBT (Dialectical Behavior Therapy)

Keywords: Personality Disorders, DBT (Dialectical Behavior Therapy)

Basic to moderate level of familiarity with the material

ISITDBT will commemorate the 30th anniversary of the original DBT text (Linehan, 1993; Cognitive-Behavioral Treatment of Borderline Personality Disorder) with an invited Clinical Grand Rounds at ABCT 2023’s annual convention in Seattle, Washington, the birthplace of DBT. Through an extended clinical demonstration, attendees will have the opportunity to witness the four modes of DBT treatment—Individual Therapy, Skills Group Training, Phone Coaching, and Consultation Team—come alive on stage. Through a single case vignette, a common and challenging clinical scenario will be presented to illustrate the effectiveness of DBT.

The live demonstration will open with a client attending an individual therapy session; during this session, the audience will witness the client become emotionally dysregulated in response to a comment made by the therapist. The demonstration will unfold with role-plays of each of the four treatment modes; ultimately revealing how each mode plays a crucial and distinctive role in repairing the client-therapist relationship. Whether novices or experts in DBT, participants will observe the intricate ways these distinct modes of treatment work together to support patients and improve treatment outcomes.

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

1. Describe the four modes of DBT: Individual, Skills group training, phone coaching, and consultation team.
 
2. Explain the function of each of the four modes and how each mode plays an important role in the overall treatment approach.
 
3. Describe how consultation team supports the individual therapist to provide effective DBT to the client.

Outline:

I. Introduction to Four Modes of Treatment in DBT; brief description of how the role play will unfold through a single extended case vignette
 
II. Role play of rupture between therapist and client during individual treatment session (audience will observe client becoming increasingly emotionally dysregulated in session)
 
III. Role play of client in group, revealing to skills group leaders they are angry with their therapist and want to quit treatment (audience will watch group leaders reinforce effectiveness skills with client)
 
IV. Role play of consultation team, in which therapist reveals difficulty of individual session. Therapist reveals they are anxious that next phone coaching session will lead to greater client dysregulation (audience will observe how consultation team helps therapist cope ahead with potential phone coaching call)
 
V. Client will call therapist to receive phone coaching (audience will observe how client using skills reinforced by skills leaders as well as how consultation team helped therapist be effective on coaching call)
 
VI. Summary. Narrator will describe and summarize the role plays, highlighting specifically the distinct and interconnected role of the four modes of treatment

Recommended Readings:

Lynch, T. R., Trost, W. T., Salsman, N., & Linehan, M. M. (2007). Dialectical behavior therapy for borderline personality disorder. Annu. Rev. Clin. Psychol., 3, 181-205.

DeCou, C. R., Comtois, K. A., & Landes, S. J. (2019). Dialectical behavior therapy is effective for the treatment of suicidal behavior: A meta-analysis. Behavior therapy, 50(1), 60-72.

Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., … & Murray-Gregory, A. M. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA psychiatry, 72(5), 475-482.

Haft, S. L., O’Grady, S. M., Shaller, E. A., & Liu, N. H. (2022). Cultural adaptations of dialectical behavior therapy: A systematic review. Journal of Consulting and Clinical Psychology.

Dimeff, L., & Linehan, M. M. (2001). Dialectical behavior therapy in a nutshell. The California Psychologist, 34(3), 10-13.

Oliveira, P. N., & Rizvi, S. L. (2018). Phone coaching in dialectical behavior therapy: frequency and relationship to client variables. Cognitive Behaviour Therapy, 47(5), 383-396.