Institutes

Thursday, November 16, 8:30 AM – 5:00 PM

Presented by:

Richard Gallagher, Ph.D.,

Associate Professor of Child and Adolescent Psychiatry, New York University Grossman School of Medicine

Margaret Sibley, Ph.D.,

Associate Professor, University of Washington School of Medicine

Participants earn 7 continuing education credits

 Categories: ADHD – Child, Parenting / Families

Keywords:: ADHD, Evidence-Based Practice

Basic to moderate level of familiarity with the material.

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). Data indicate that a majority of youth with ADHD have impairing deficits in executive functioning (EF) and reflections of those deficits in organization, time management, planning (OTMP). Over the years, these deficits reduce school performance, create major homework problems, and add to family conflict, especially during homework times.

Through extensive research, methods for evaluating and treating EF and OMTP deficits in all subtypes of ADHD have been created by two different clinical research teams. In over a decade of work, Organizational Skills Training (OST) for elementary-aged children was created to address the practical gaps that children with ADHD demonstrate at home and at school. For middle-school and early high-school teens, Supporting Teens Autonomy Daily (STAND) was developed and tested in a program of research that recognized the special challenges needed for teens to gain supported independence in managing school.

Large RCTs have shown that the interventions led to improvements in OTMP skills, academic performance, homework performance, level of family conflict, and attitudes towards school and teachers that were sustained in follow-ups. 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 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. 

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. 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.
 
6. Learn how to make adaptations to the treatment to deliver some sessions via telepsychology methods.

Long-Term Goals:

• Integrate a compassion-focus into existing therapeutic approach.
 
• Facilitate client shifts from avoidance to responsibility-taking.

Outline

• Children and teens with ADHD are often hindered by weak development in executive functioning.
 
• The deficits in executive functioning have a negative impact on major life areas including school performance and productivity and relationships with parents and teachers who are concerned about failure to advance appropriately.
 
• Two clinical research programs have addressed these issues in elementary school children and middle and high school youth.
 
• The research developed means of evaluating practical reflections of low executive functioning in organization, time management and planning skills.
 
• Additionally, the clinical research teams developed and tested treatments that are efficacious as documented in randomized control trials.
 
• The workshop will provide attendees with:
◦ Strategies for assessing practical deficits in organization, time management, and planning, their impact on family and school functioning.
◦ Determining which youth would benefit from treatment.
◦ A basic foundation for conducting both proven treatments.
◦ Ideas on adapting the treatment for subclinical cases and for delivery via telehealth methods.

• Extensive time for discussion, practice, and questions is incorporated.

Recommended Readings:

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

Sibley, M.H., (2016). Parent-Teen Therapy for Executive Function Deficits and ADHD: Building Skills and Motivation. New York: Guilford.

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.

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.

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. New York: Guilford Publications.

Thursday, November 16, 8:30 AM – 5:00 PM

Presented by:

Dennis Tirch, Ph.D., Founding Director, The Center for Compassion Focused Therapy

Laura Silberstein-Tirch, Psy.D., The Center for Compassion Focused Therapy

Talya Vogel, Psy.D., Director of The Trauma, Transformation and Resilience Program, The Center for Compassion Focused Therapy

Participants earn 7 continuing education credits

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

Keywords: ACT (Acceptance & Commitment Therapy), Compassion / Empathy, Trauma

Basic to moderate level of familiarity with the material

During this era of pandemic, war, and systemic inequality, people all over the world have been reporting increasing distress and symptoms of PTSD (Yuan et al., 2021). This wave of trauma responses is a painful reminder of how pervasive and complex the psychological sequelae of traumatic events can be. Effective treatment for people living with trauma is a global priority, and it needs to address a range of different traumatic experiences, from the acute and physical to the chronic and emotional.

Grounded in Compassion Focused Acceptance and Commitment Therapy (CFACT, Tirch, Schoendorf & Silberstein, 2015) and tri-phasic treatment of trauma (Herman, 1992), this workshop provides an integrative and ACT-consistent framework for working with trauma in its multifarious and varied forms. Participants will learn the foundations of an approach to trauma that integrates compelling techniques from Compassion Focused Therapy (Gilbert, 2010), Acceptance and Commitment Therapy (Hayes, Strosahl & Wilson, 2012), and CBT (Ehlers & Clark, 2000). Rather than a mere remix of therapy techniques, the model presented involves a robust and coherent case formulation strategy, that drives deployment of evidence-based processes and procedures.

Participants will be able to discuss the supporting research and scientific foundations of this approach to trauma, as well as be able to integrate these techniques into their existing cognitive and behavioral practice. This workshop will introduce specific tools designed to help clients safely connect to the present, compassionately develop new relationships with the past, and meaningfully build a future, including elements of emotional exposure drawn from EMDR. Highly experienced trainers, who are innovators in compassion focused behavioral interventions will use rare and user-friendly experiential exercises, didactic instruction, and role-play practices to empower participants to meet their most complex cases with new perspectives and the transformational applied science of mindful compassion.

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

1. Explain how cultivating mindful compassion and psychological flexibility can be used to enhance trauma-focused therapy.
 
2. Describe how to train clients to use bottom-up and top-down compassion-focused grounding techniques during the stabilization phase of trauma processing therapy.
 
3. Use foundational compassion focused therapy imagery practices in ACT consistent treatment for trauma.
 
4. Provide psychoeducation on the evolutionary model of emotion regulation found in CFACT
 
5. Complete a case conceptualization that is ACT consistent, trauma informed and focused on cultivating psychological flexibility and compassion.

Long-Term Goals:

• Integration of Compassion-Focused Approaches: Participants will learn to integrate compassion-focused approaches, particularly Compassion Focused Acceptance and Commitment Therapy (CFACT), into their existing cognitive and behavioral practice for trauma treatment. They will become better able to incorporate the principles, techniques, and case formulation strategy learned during the workshop into their clinical work, resulting in an enhanced ability to address the complex psychological sequelae of trauma in a compassionate and effective manner.
 
• Cultivation of Mindful Compassion and Psychological Flexibility: Participants will learn to cultivate mindful compassion and psychological flexibility as core therapeutic skills in their trauma-focused therapy. They will work towards developing a deep understanding of how to foster compassionate connections with clients, helping them safely connect to the present, develop new relationships with the past, and build a meaningful future. By consistently incorporating mindful compassion and promoting psychological flexibility, participants will become better able to facilitate transformative healing experiences for their clients and achieve better treatment outcomes in complex cases of trauma.

Outline

I. Introduction
A. The global impact of trauma in the current era
 
B. The need for effective and comprehensive trauma treatment
 
C. The Elements of CFACT for Complex PTSD

 
II. Theoretical Foundations

A. Compassion Focused Acceptance and Commitment Therapy (CFACT)
1. CFT
2. ACT
3. Other sources (Buddhist Psychology, CBT, EvoS, FAP, etc.)

B. Tri-phasic treatment of trauma

 
III. Integration of Evidence-Based Approaches

A. Incorporating techniques from Compassion Focused Therapy, Acceptance and Commitment Therapy, and CBT with theoretical integrity and coherence
 
B. Case formulation strategy for evidence-based processes and procedures

 
IV. Supporting Research and Scientific Foundations

A. Evidence for the effectiveness of compassion-focused interventions in trauma treatment
 
B. Scientific principles underlying the integration of CFACT

 
V. Cultivating Mindful Compassion and Psychological Flexibility

A. Role of mindful compassion in enhancing trauma-focused therapy
 
B. Strategies for developing psychological flexibility in clients with a history of complex trauma

 
VI. Bottom-Up and Top-Down Compassion-Focused Grounding Techniques

A. Training clients in grounding techniques during the stabilization phase
 
B. Incorporating both bottom-up and top-down approaches for comprehensive healing

 
VII. Compassion-Focused Therapy Imagery Practices in ACT-Consistent Treatment

A. Introduction to foundational compassion-focused therapy imagery practices
 
B. Application of imagery practices in ACT-consistent trauma treatment

 
VIII. Psychoeducation on the Evolutionary Model of Emotion Regulation

A. Explaining the evolutionary model of emotion regulation found in CFACT
 
B. Providing psychoeducation to clients on emotion regulation processes

 
IX. Case Conceptualization

A. Developing an ACT-consistent and trauma-informed case conceptualization
 
B. Focusing on cultivating psychological flexibility and compassion in the treatment process

 
X. Conclusion and Transformational Applied Science of Mindful Compassion

A. Empowering participants to approach complex trauma cases with new perspectives
 
B. Encouraging the integration of mindful compassion in clinical practice

Recommended Readings:

Tirch, D., Schoendorff, B., & Silberstein, L. R. (2014). The ACT Practitioner’s Guide to the Science of Compassion: Tools for Fostering Psychological Flexibility. Oakland, CA: New Harbinger Publications.

Gilbert, P. (2009). The Compassionate Mind: A New Approach to Life Challenges. London: Constable and Robinson Ltd.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Teresa M. Au, Shannon Sauer-Zavala, Matthew W. King, Nicola Petrocchi, David H. Barlow, Brett T. Litz,
Compassion-Based Therapy for Trauma-Related Shame and Posttraumatic Stress: Initial Evaluation Using a Multiple Baseline Design, Behavior Therapy, Volume 48, Issue 2, 2017, Pages 207-221.

Craig, C., Hiskey, S., & Spector, A. (2020). Compassion focused therapy: A systematic review of its effectiveness and acceptability in clinical populations. Expert review of neurotherapeutics, 20(4), 385-400.

Thursday, November 16 | 8:30 AM – 1:30 PM

Presented by:

Cheryl B. McNeil, Ph.D., Professor, University of Florida

Corey C. Lieneman, Ph.D., Assistant Professor, University of Nebraska

Erinn J. Victory, B.A., Doctoral Student, West Virginia University

Melanie M. Nelson, Ph.D., Associate Professor, University of Florida

Participants earn 5 continuing education credits

Categories: Child / Adolescent – Externalizing, Treatment – CBT

Keywords: Child, Parent Training, Externalizing

Moderate level of familiarity with the material

This workshop describes an adaptation of Parent Child Interaction Therapy (PCIT) for older children between the ages of 7 and 10 years. This program involves live coaching of caregivers while they interact with their school-aged children. An overview of the research, conceptual framework, and procedures will be provided with particular emphasis on ways that the older child protocol deviates from standard PCIT.

Participants will learn the adapted goal criteria for Child-Directed Interaction, developmentally appropriate activities for coaching sessions, the hands-off time-out procedures in adapted Parent-Directed Interaction (e.g., “big ignore,” time-out acceptance chart, suspension of privilege), strategies for engaging the child through individual therapy, and techniques for encouraging emotion regulation in the caregiver and child. Videos, experiential exercises, and a case example will be used to illustrate the use of the skills.

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

1. Explain the rationale for adapting PCIT for working with older children
 
2. Explain the differences between standard PCIT and PCIT for Older Children with respect to working individually with the child each session to promote engagement.
 
3. Explain the goal criteria for Child-Directed Interaction with older children.
 
4. Articulate the three phases of Parent-Directed Interaction that promote hands-off discipline procedures with older children.
 
5. Develop skills for working individually with children and adapting the coaching of parent-child interactions when working with Older Children.
 
6. Use skills from the Older Child Protocol when conducting parent training with 7- to 10-year-old children.
 
7. Identify at least 3 ways to make PCIT developmentally appropriate for 7- to 10-year-old children.

Long-Term Goals:

• Competency in teaching and coaching of skills used to strengthen the relationships between caregivers and their children ages 7-10 years.
 
• Competency in teaching and coaching of skills used to improve disruptive behaviors in children aged 7-10 years.

Outline:

I. Introduction
A. Welcome and Introductions
 
B. Workshop objectives and agenda overview

 
II. Framework of PCIT

A. Brief overview of standard PCIT
 
B. Brief overview of standard PCIT literature

 
III. Adapting PCIT for Older Children

A. Rationale for adapting PCIT for older children (ages 7-10)
 
B. Findings from the literature on PCIT for older children

 
IV. Adaptations to CDI

A. Overview of similarities between standard PCIT CDI and CDI for older children
 
B. Child check-ins in CDI
1. Rationale for individual check-ins
2. Topics to cover during individual check-ins

 
C. Recommended toys
 
D. Special time
 
E. PRIDE skills and goal criteria

1. Experiential exercise: Meeting goal criteria (7-7-7)

 
2. Experiential exercise: Coding

 
V. Adaptations to PDI

A. Overview of similarities between standard PCIT CDI and CDI for older children
 
B. Child check-ins in PDI
 
C. Three PDI modules
1. Command training
a. Big ignore
b. Experiential exercise: big ignore for child misbehavior
c. Experiential exercise: coaching big ignore

2. Time-out acceptance chart

a. Rationale and explanation of chart
b. Experiential exercise: Role play use of time-out acceptance chart
c. Explaining rewards to the child
d. Experiential exercise: Coding or coaching time-out acceptance chart
e. House rules

3. Time-out with suspension of privileges

a. Rationale and explanation of suspension of privileges
b. Experiential exercise: Coding or coaching time-out acceptance chart
c. Swoop and go for refusal in session
d. Sibling and public behavior sessions

D. Progression through treatment with the PDI staircase

 
VI. Case example and skill demonstration

A. Case example highlighting a family’s progression through PCIT for older children with video demonstrations

 
VII. Summary and Conclusion

A. Summary of key concepts and skills covered in the workshop
 
B. Q&A session

 

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Recommended Readings:

Gibson, K., Motzenbecker, T., Harvey, C., Han, R. C., & McNeil, C. B. (2021). Parent-Child Interaction Therapy (PCIT) Adapted for Older Children: A Research Development Manual. Seattle, WA: Kindle Direct Publishing.

Briegel W. Tailoring Parent-Child Interaction Therapy (PCIT) for Older Children: A Case Study. Z Kinder Jugendpsychiatr Psychother. 2018 Jul;46(4):298-304. doi: 10.1024/1422-4917/a000536. Epub 2017 Aug 15. PMID: 28809509.

Lieneman, C. & McNeil, C. B. (2023). Time-Out for Child Behavior Management. Göttingen, Germany: Hogrefe.

McNeil, C. B., & Hembree-Kigin, T. (2010). Parent-Child Interaction Therapy: Second Edition. New York: Springer

Jocelyn O. Stokes, Ashley Scudder, Amanda H. Costello & Cheryl B. McNeil (2017) Parent–Child Interaction Therapy with an Eight-Year-Old Child: A Case Study, Evidence-Based Practice in Child and Adolescent Mental Health, 2:1, 1-11, DOI: 10.1080/23794925.2016.1268938

Thursday, November 16 | 8:30 AM – 1:30 PM

Presented by:

Maria Karekla, Ph.D., Associate Professor, University of Cyprus

Megan Kelly, Ph.D., Professor of Psychiatry, University of Massachusetts

Participants earn 5 continuing education credits.

Categories: Addictive Behaviors, Treatment – Mindfulness & Acceptance

Keywords: ACT (Acceptance & Commitment Therapy), Addictive Behaviors

Moderate level of familiarity with the material

The application of Acceptance and Commitment Therapy (ACT) for the treatment of many problems where craving is a core feature is growing (e.g., substance use, tobacco use, overeating). Cravings are intense desires for using or consuming certain substances with the goal of feeling pleasure and satisfaction. They are a key component of addiction-related problems, including addictions to substances like tobacco, alcohol, and drugs.

Individuals presenting with addictions often have difficulty managing cravings, although this is an inevitable aspect of experiencing substance use and other addictive behaviors. Research finds that cravings are reported by 58% to 97% of the general population (Gendall, Joyce & Sullivan, 1997), and they occur as often as 2–4 times-per-week (Hill, 2007). Difficulties involving cravings are associated with substantial distress, functional impairment, and low quality of life.

This workshop presents practical strategies based in ACT to help individuals to cope and manage cravings at the core of common addictions. The workshop will also present the latest research in ACT for dealing and overcoming cravings, and examine the efficacy, the mechanisms, and processes of change of ACT for the treatment of craving-related problems.

Concepts will be illustrated using live demonstrations, experiential exercises, metaphors, and worksheets. This workshop is designed to teach skills needed to explore ACT as an assessment model and intervention method for addressing cravings and addictions. It will be mostly experiential and will balance an understanding of the model with a personal connection with the issues raised in ACT, and with skill development.

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

1. Apply a functional behavioral analysis approach to craving-related problems
 
2. Describe how to use mindfulness, acceptance, experiential exercises, metaphors, and defusion techniques, to improve well-being in individuals with craving-related issues.
 
3. Explain case conceptualization based on ACT processes and how to practically work with exposure of current cravings.
 
4. Explain the latest culturally-adapted ACT advances when working with craving related problems
 
5. Discuss data on the efficacy of ACT for craving-related issues and addictive behaviors.
 
6. Utilize experiential exercises, role-plays, and a variety of hands-on techniques to cultivate a direct experience with the ACT approaches to craving and addictions.

Long-Term Goals:

1. Describe the basic tenets and core processes of ACT as they apply to cravings and addictions
 
2. Utilize experiential exercises, role-plays, and a variety of hands-on techniques to cultivate a direct experience with the ACT approaches to craving and addictions.

Outline:

•What are Cravings?
 
• Reasons for Addressing Cravings and Addictions
 
• Values and Addictions
 
• External vs. Internal Triggers
 
• Acting with Willingness
 
• Taking a Step Back From Cravings
 
• Self-Compassion
 
• Committed Action
 
• Common Challenges to Managing Cravings
 
• Addressing Slips and Relapses
 
• Getting Support for Managing Cravings and Addictions
 
• Other Treatments for Cravings and Addictions
 
• Summary and Wrap-Up

Recommended Readings:

Karekla, M., & Kelly, M. (2022). Cravings and Addictions: Free Yourself from the Struggle of Addictive Behavior with Acceptance and Commitment Therapy. New Harbinger Publications.

Kelly, M. M., Sido, H., Forsyth, J. P., Ziedonis, D. M., Kalman, D., & Cooney, J. L. (2015). Acceptance and commitment therapy smoking cessation treatment for veterans with posttraumatic stress disorder: a pilot study. Journal of dual diagnosis, 11(1), 50-55.

Stavrinaki, M., Kelly, M., & Karekla, M. (2021). Acceptance and Commitment Therapy for Substance Use.

Karekla, M., Georgiou, N., Panayiotou, G.P., Sandoz, E., Kurz, S., & Constantinou, M. (2020). Cognitive Restructuring vs. Defusion: Impact on craving, healthy and unhealthy food intake. Eating Behaviors, 37. https://doi.org/10.1016/j.eatbeh.2020.101385.

Gloster, A. T., Walder, N., Levin, M.E., Twohig, M.P., & Karekla, M., (2020). The empirical status of Acceptance and Commitment Therapy: A review of meta-analyses. Journal of Contextual Behavior Science, 18, 181-192. https://doi.org/10.1016/j.jcbs.2020.09.0

Thursday, November 16, 1:30 PM – 6:30 PM

Presented by:

Michael Otto, Ph.D., Professor of Psychological and Brain Sciences, Boston University

Jasper Smits, Ph.D., Professor of Psychology, University of Texas at Austin

Marie Parsons, Ph.D., Research Assistant Professor, Boston University

Participants earn 5 continuing education credits

Categories: Transdiagnostic

Keywords: Treatment, Exposure, Anxiety

Moderate to advanced level of familiarity with the material.

Exposure-based treatments are often disseminated in the context of manualized protocols, and these protocols may have the unwitting effect of drawing attention away from the core principles of change that underlie the effect exposure therapy.

This workshop is designed to provide a personalized and transdiagnostic approach to thinking through exposure therapy in a way that integrates the latest research in extinction and memory processes. Exposure will be discussed as an active learning process that must be integrated into existing (fear) memory structures.

Specific strategies for conceptualizing exposure targets and delivering exposure learning interventions will be emphasized. Consistent with this year’s convention theme, we will also specifically present information on the role of positive affectivity and positive goal attainment on exposure-based treatment and the nature of home practice assignments for exposure.

The goal is to help clinicians enact especially individualized exposure treatments that flexibly move between specific fear targets and exposure procedures.
 

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

1. Develop an approach to exposure therapy based on the enactment of core principles of therapeutic change rather than protocols/strategies.
 
2. Identify exposure strategies that can engage the core therapeutic change mechanisms across diagnostic subtypes.
 
3. Evaluate the role of contexts in case formulations and exposure planning.
 
4. Integrate exposure planning with perspectives from cognitive science.
 
5. Describe the role of post-exposure process in the consolidation of safety learning.

Long-Term Goals:

• Conduct exposure therapy sessions with confidence using principle-based interventions.
 
• Stage exposure therapy sessions in relation to learning-elements related to core fears.

Outline

• General Approach: Planning and Delivery of Exposure Sessions and the Art of Playing with Fear
 
• Thinking Through Exposures: What is to be learned and retained from exposure sessions?
 
• Intervening with Fears of Emotions and Related Sensations
 
• Intervening with Fears of People
 
• Intervening with Fears of Thoughts, Images, and Traumatic Memories
 
• Self-supervision and Trainee Supervision of Personalized Exposure Therapy
 
• Unique Applications of Personalized Exposure Therapy

Recommended Readings:

Smits, J. A. J., Powers, M. B., & Otto, M. W. (2019). Personalized exposure therapy: A person-centered transdiagnostic approach. New York, NY: Oxford University Press.

Kredlow, M. A., Eichenbaum, H., & Otto, M. W. (2018). Memory creation and modification: Enhancing the treatment of psychological disorders. American Psychologist, 73, 269-285.

Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers M. B., Smits J. A. J., & Hofmann, S. G. Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depression and Anxiety, 35, 502-514.

Hunt, C., Campbell-Sills, L., Chavira, D., Craske, M., Sherbourne, C., Sullivan, G., … & Bomyea, J. (2022). Prospective relations between anxiety sensitivity and transdiagnostic anxiety following cognitive-behavioral therapy: Evidence from the Coordinated Anxiety Learning management trial. Behaviour Research and Therapy, 155, 104119.

Pittig, A., Heinig, I., Goerigk, S., Richter, J., Hollandt, M., Lueken, U., … & Wittchen, H. U. (2022). Change of threat expectancy as mechanism of exposure-based psychotherapy for anxiety disorders: evidence from 8,484 exposure exercises of 605 patients. Clinical Psychological Science, 21677026221101379.

Thursday, November 16, 1:30 PM – 6:30 PM

Presented by:

Kristie Metz, Ph.D., Research Associate, Johns Hopkins University

Laura Murray, Ph.D., Senior Research Scientist, Johns Hopkins University School of Public Health

Caleb Figge, Ph.D., Research Scientist, Johns Hopkins School of Public Health

Stephanie Skavenski, M.A., Senior Research Associate, Johns Hopkins School of Public Health

Participants earn 5 continuing education credits

Categories: Global Mental Health, Transdiagnostic

Keywords: Common Elements, Implementation, Treatment

Moderate level of familiarity with the material

Global mental health has seen progress over the past decade showing effectiveness of a range of evidence-based treatments. However, most of these treatments were developed for a focus on a single disorder or cluster of disorders. These single disorder-focused treatments that target one problem have been cited as a barrier to scale-up and sustainability in LMIC because they require complex referral systems, a large work force that is trained in multiple EBT, and do not teach lay providers how to deal with comorbidity.

The Common Elements Treatment Approach (CETA) is an evidence-based system of care that has been found to be highly effective in reducing a range of mental and behavioral health problems including depression, anxiety, trauma, violence, functional impairment, unhealthy alcohol use and risky behaviors. Adult RCTs in southern Iraq, Thailand, and Zambia have demonstrated that CETA has large effect sizes for trauma, depression, anxiety, anger management, and dysfunction, moderate effects for interpersonal violence, and small effects for unhealthy substance use (Weiss et al. 2015; Bolton et al. 2014; Murray et al. 2020b). Additionally, an open trial of CETA-Youth in Ethiopian refugee camps found promising results for internalizing, externalizing, posttraumatic stress symptoms, and well-being (Murray et al. 2018). CETA’s modular, community-based approach addresses several mental health challenges in concert, enabling scale-up and sustainability in low-to-middle-income settings.

This pre-institute training will review how CETA system of care was developed specifically for us by lay providers in LMIC. The presenters will discuss research on how a common elements approach could aid in the scale-up and sustainability of mental health services in LMIC. The training will include both a review of the elements in CETA and their utilization across a range of different levels of care as well as program implementation factors.

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

1. Describe the CBT elements that make up the Common Elements Treatment Approach.
 
2. Identify the barriers to scale-up and implementation in LMIC addressed by the CETA system.
 
3. Recite the evidence of effectiveness of CETA.
 
4. Identify the ways in which the CETA system of care may be implemented with different populations and settings.
 
5. Explain the apprenticeship model of teaching CBT to lay providers.
 
6. Describe the process of choosing elements, order, and dose within CETA.
 
7. Discuss implementation factors to consider in program selection and set-up in LMIC.

Long-Term Goals:

• Applying implementation strategies within the participant’s own research and/or clinical practice
 
• Analyzing mental health programing and adaptations that may be required for both practitioners and beneficiaries.

Outline

1. Global Mental Health and Evidence-Based Treatments: Setting the Context
• Existing treatments and system, needs of mental health services, challenges within the system and to scale-up and sustainability.

 
2. Lessons from Practice and Implementation Science leads to innovation

• Why develop the CETA System of Care?
 
• What is the CETA system of care?
 
• Evidence and outcomes

 
3. A Closer Look at the CETA System

• CETA evidence-based elements and how they are put together.
 
• How CETA is implemented in a variety of settings, including adaptations to programming to fit community needs.
 
• Using an Apprenticeship Model of training to build capacity within resource restricted settings.

 
4. Case studies: Applications of the CETA System of Care

• Ukraine
 
• Rural Illinois

Recommended Readings:

Murray LK, Dorsey S, Haroz E, Lee C, Alsiary MM, Haydary A, Weiss WM, Bolton P. A Common Elements Treatment Approach for Adult Mental Health Problems in Low- and Middle-Income Countries. Cogn Behav Pract. 2014 May;21(2):111-123. doi: 10.1016/j.cbpra.2013.06.005. PMID: 25620867; PMCID: PMC4304666.

Murray LK, Haroz E, Dorsey S, Kane J, Bolton PA, Pullmann MD. Understanding mechanisms of change: An unpacking study of the evidence-based common-elements treatment approach (CETA) in low and middle income countries. Behav Res Ther. 2020 Jul;130:103430. doi: 10.1016/j.brat.2019.103430. Epub 2019 Jun 22. PMID: 31780251; PMCID: PMC8114793.

Weiss, W.M., Murray, L.K., Zangana, G.A.S. et al. Community-based mental health treatments for survivors of torture and militant attacks in Southern Iraq: a randomized control trial. BMC Psychiatry 15, 249 (2015). https://doi.org/10.1186/s12888-015-0622-7

TBolton P, Lee C, Haroz EE, Murray L, Dorsey S, Robinson C, Ugueto AM, Bass J. A transdiagnostic community-based mental health treatment for comorbid disorders: development and outcomes of a randomized controlled trial among Burmese refugees in Thailand. PLoS Med. 2014 Nov 11;11(11):e1001757. doi: 10.1371/journal.pmed.1001757. PMID: 25386945; PMCID: PMC4227644.

Murray LK, Kane JC, Glass N, Skavenski van Wyk S, Melendez F, Paul R, Kmett Danielson C, Murray SM, Mayeya J, Simenda F, Bolton P. Effectiveness of the Common Elements Treatment Approach (CETA) in reducing intimate partner violence and hazardous alcohol use in Zambia (VATU): A randomized controlled trial. PLoS Med. 2020 Apr 17;17(4):e1003056. doi: 10.1371/journal.pmed.1003056. PMID: 32302308; PMCID: PMC7164585.