Master Clinician Seminars

Friday, November 17 | 8:30 AM – 10:30 AM

Presented by:

Robert L. Leahy, Ph.D.,

Director, American Institute for Cognitive Therapy

Participants earn 2 continuing education credit

Categories: Adult Anxiety, Adult Depression

Keywords: Cognitive Schemas / Beliefs, Transdiagnostic, Cognitive Processes

Moderate to advanced level of familiarity with the material

Most areas of psychopathology involve problems in decision making including avoidance, passivity, impulsiveness, procrastination, excessive reassurance seeking, and substance abuse. Although cognitive and social psychology have elaborated problematic processes in decision making very little of this has been applied to CBT.
 
Effective therapy often involves helping clients evaluate their decisions and pursue alternatives that they otherwise might avoid. In this presentation we will review the following problems in decision making: loss aversion (framing decisions as losses only), arbitrary false dichotomies (“It’s either A or B”) , the endowment effect (placing greater value on the status quo), risk assessment (miscalculating probabilities and magnitudes of outcomes), myopic (short-term) focus, intolerance of uncertainty (demanding certainty and equating uncertainty with bad outcomes), faulty heuristics (e. g. , basing decisions on emotions, salience, recency, or accessibility), and making decisions focused primarily on avoiding regret.
 
A wide range of techniques will be reviewed, including clarification of priorities, enhancing future self-perspective, examining opportunity costs, framing choice as risk vs. risk, developing pre-commitment strategies, reversing sunk-cost effects, and reducing the impact of regret and post-decision rumination. Some decision makers have idealized beliefs about decisions, rejecting ambivalence as an inevitable part of the tradeoffs underlying decision making under uncertainty. Specific decision styles are more likely to contribute to regret, including maximization, emotional perfectionism, intolerance of uncertainty, and over-valuation of “more” information rather than relevant information.
 
In this presentation we will examine how decisions are linked to hindsight bias, maximization rather than satisfaction strategies, intolerance of uncertainty, rejection of ambivalence, refusal to accept tradeoffs, excessive information demands and ruminative processes.
 
Participants are invited to consider decisions in their own lives in light of the material in this presentation.

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

1. Identify problematic styles of decision making.
 
2. Identify opportunity costs, hindsight bias, risk vs. risk.
 
3. Identify strategies to help clients set realistic goals and accept tradeoffs.
 
4. Identify strategies to reduce rumination and indecision.
 
5. Identify maximization styles and how to reverse them.

Long-Term Goals:

•Help clients make more rational and realistic decisions.
 
•Help clients cope with the fear of future regret and current regrets.

Outline

I. Normative and Descriptive Models of Decision-Making
a. Ideal vs Real decisions
b. Coping with limitations (Bounded Rationality)

 
II. Common biases and heuristics

a. Short-term vs. long-term; hedonistic biases; loss aversion; availability
b. Playing to win vs. playing not to lose
c. Maximizing vs. satisfying
d. Intolerance of uncertainty and ambivalence

 
III. Anticipatory and retrospective regret

a. Exaggerating or underestimating risk
b. Over-prediction of regret

 
IV. The use of Multiple Selves

a. Which self?
b. Wisdom of the future self

 
V. Depressive decision making

a. Pessimistic bias
b. Perception of future losses
c. Inability to recover from loss

 
VI. Building Resilience

a. Acceptance of tradeoffs
b. Life portfolio
c. Writing the chapters in your book
d. Using regret productively

Recommended Readings:

Leahy, R. L. If Only. Finding Freedom from Regret (2022). New York: Guilford

Leahy, R.L. (2015). Emotional Schema Therapy. New York: Guilford.

Kahneman, D. (2011) Thinking Fast and Slow. New York: Farrar, Straus and Giroux

Anderson, C. J. (2003). The psychology of doing nothing: forms of decision avoidance result from reason and emotion. Psychological bulletin, 129(1), 139.

Bjälkebring, P., Västfjäll, D., Svenson, O., & Slovic, P. (2016). Regulation of experienced and anticipated regret in daily decision making. Emotion, 16(3), 381.

Friday, November 17 | 11:00 AM – 1:00 PM

Presented by:

Michael B. Himle, Ph.D., Associate Professor, University of Utah

Doug Woods, Ph.D., Professor and Dean of the Graduate School, Marquette University

Participants earn 2 continuing education credit

Categories: Tic and Impulse Control Disorders, Obsessive Compulsive and Related Disorders

Keywords: Tic Disorders, Habit Reversal, Behavior Analysis

Basic to moderate level of familiarity with the material

Persistent tic disorders (PTDs), including Tourette Disorder, are a class of neurodevelopmental conditions characterized by sudden, recurrent, involuntary movements and vocalizations (i.e., motor and vocal tics). Over the past decade, there has been a growing body of evidence showing that tics can be effectively managed with a treatment package referred to as Comprehensive Behavioral Intervention for Tics (CBIT), which combines elements of habit reversal training with psychoeducation and function-based behavioral interventions to reduce the overall severity of tics and their impact on daily life.
 
Despite now being recommended as a first-line intervention for PTD, few clinicians have been trained in CBIT. In this session, two of the developers of CBIT will describe and demonstrate the various components of the CBIT package and their application in the treatment of PTD. In addition to learning the general therapeutic techniques, attendees will learn about the biobehavioral model of TD and the theoretical and empirical rationale for CBIT.
 
Various instructional technologies will be employed including didactic instructions, video demonstrations of primary treatment components, and experiential exercises. An overview of alternative/emerging treatment modalities (group, intensive, telehealth, online) will also be provided.

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

1. Recognize tic disorders and describe their key phenomenological features.
 
2. Explain the core elements of the biobehavioral model of tic disorders.
 
3. Identify the core components of the CBIT approach for treating tic disorders.
 
4. Describe the application of habit reversal training and the functional approach to managing tics.
 
5. Discuss the evidence base supporting the efficacy of behavior therapy for tic disorders.

Long-Term Goals:

• Use the biobehavioral model to inform case conceptualization and clinical decision making when treating patients with tic disorders.
 
• Help clients learn evidence-based tic management skills to reduce tic severity, tic-related impairment, and improve functioning.

Outline

• Overview of tics & tic disorders: Diagnosis, phenomenology, and clinical course
 
• Introduction to the biobehavioral model of tic disorders
 
• Understanding how internal and external antecedents and consequences influence the course and severity of tics
 
• Overview of the CBIT approach to conceptualizing and treating tic disorders
 
• Implementing the function-based assessment & intervention (FBAT) component of CBIT
 
• Implementing the habit reversal training (HRT) component of CBIT
 
• Discussion of ancillary therapeutic strategies for reducing tics and tic-related impairment
 
• Review of the evidence base supporting CBIT
 
• Overview of treatment delivery formats (tele-CBIT, group delivery, online formats)

Recommended Readings:

Piacentini, J. C., Woods, D. W., Scahill, L. D., Wilhelm, S., Peterson, A., Chang, S., . . . Walkup, J. T. (2010). Behavior therapy for children with Tourette Syndrome: A randomized controlled trial. Journal of the American Medical Association, 303, 1929-1937.

Wilhelm, S., Peterson, A. L., Piacentini, J., Woods, D.W., Deckersbach, T., Sukhodolsky, D. G., … Scahill, L. (2012). Randomized trial of behavior therapy for adults with Tourette syndrome. Archives of General Psychiatry, 69, 795-803.

Pringsheim, T., Okun, M. S., Muller-Vahl, K., Martino, D., Jankovic, J., Cavanna, A. E., … Piacentini, J. (2019). Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology, 92,896-906.

Rizzo, R., Pellico, A., Silvestri, P. R., Chiarotti, F., & Cardona, F. (2018). A randomized controlled trial comparing behavioral, educational, and pharmacological treatments in youths with chronic tic disorder or Tourette syndrome. Frontiers in Psychiatry, 9, 1-9.

Woods, D. W., Piacentini, J. C., Chang, S., Deckersbach, T., Ginsburg, G., Peterson, A. L., . . . Wilhelm, S. (2008). Managing Tourette’s Syndrome: A behavioral intervention for children and adults (therapist guide). New York: Oxford University Press.

Friday, November 17 | 1:30 PM – 3:30 PM

Presented by:

Dean McKay, ABPP, Ph.D.,

Professor, Fordham University

Participants earn 2 continuing education credit

Categories: Adult Anxiety, Obsessive Compulsive and Related Disorders

Keywords: Exposure, Anxiety, Case Conceptualization/Formulation

Moderate level of familiarity with the material

Evidence-based treatment for anxiety, trauma, and obsessive-compulsive disorders emphasize the inclusion of imagery to facilitate new emotional learning related to the avoided stimuli (Garner, Steinberg, & McKay, 2021; McKay & Ojserkis, 2015). This imagery-based approach to treatment is either accompanied by in vivo exposure, or as a stand-alone intervention when in vivo is not possible.

There are several challenges clinicians must overcome in developing imagery. First, therapists must determine the nature of the content for imagery. Second, calibrating the imagery content to be tolerable must be formulated. Third, the clinician must engage in language evocative of the full range of sensory experiences, as well as culturally-informed content for the imagery. This requires clinicians to conceive of ‘imagery’ as more than a visualization-based experience.

Examination of the empirical literature and clinical guides provide little specific information on how to systematically address each of these essential therapeutic components of imagery-based interventions. Research in linguistics provides additional guidance on methods of evoking potent images, including culturally-informed and sensitive approaches (Tye, 1991). Further complicating imagery based treatment is the recent emphasis on inhibitory learning (Craske et al., 2014), which shifts the focus to new learning rather than habituation. In the experience of the presenter, the formulation of imagery-based approaches is a frequent topic of professional consultation.

This Master Clinician Seminar aims to provide clinicians with a structured model for developing imagery-based exposure to handle the aforementioned three challenges. The session will include audiotape illustrations and exercises for attendees to practice new skills.

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

1. Explain the utility of imagery as part of comprehensive exposure-based therapy, either in conjunction with in vivo intervention, or as a stand-alone method of anxiety reduction.
 
2. Describe the methods of imagery development, relying on both the recent developments in inhibitory learning, and the existing research in linguistics.
 
3. Develop evidence-based treatment programs for anxiety, trauma, and obsessive-compulsive disorders.
 
4. Integrate inhibitory learning methods into imagery-based treatment.
 
5. Determine methods for formulating culturally-informed imagery-based models of exposure treatment.

Long-Term Goals:

• Learners will apply imagery with clients who receive in vivo exposure, relying on a fuller range of sensory experiences.
 
• Learners will identify clients who would benefit from direct imagery training as part of a comprehensive approach to exposure treatment implementation.

Outline

• Overview of imagery
• Integration of imagery with exposure procedures
 
• Assessing extent client can engage in imagery.
 
• Training the client in imagery (Group Practice Exercise #1)
 
• Practicing imagery alone, with low emotional charge
 
• Pulling in all the sense for imagery (Group Practice Exercise #2)
 
• Creating conditions where imagery is compelling.
 
• Translational research applications
 
• Q & A

Recommended Readings:

Craske, M.G., Treanor, M., Conway, C.C., Zbozniak, T., Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23.

Garner, L., & Steinberg, E., McKay, D. (2021). Exposure therapy. In A. Wenzel (Ed.). Handbook of Cognitive Behavioral Therapy (pp. 275-312). Washington, DC: American Psychological Association Press.

McKay, D., & Ojserkis, R. (2015). Exposure in experiential context: Imaginal and in vivo approaches. In N. Thoma & D. McKay (Eds.), Working with Emotion in Cognitive Behavioral Therapy: Techniques for Clinical Practice (pp. 83-104). New York, NY: Guilford.

Stopa, L. (2021). Imagery in cognitive-behavioral therapy. New York: Guilford.

Saturday, November 18 | 8:30 AM – 10:30 AM

Presented by:

Deborah Ledley, Ph.D.,

Licensed Psychologist, Children’s and Adult Center for OCD and Anxiety

Participants earn 2 continuing education credit

Categories: Child / Adolescent – Anxiety

Keywords: Phobias, Child, ERP (Exposure and Response Prevention)

Moderate level of familiarity with the material

Emetophobia, or Specific Phobia of Vomiting (SPOV), is one of the most distressing and impairing phobias. Impacting upward of 8% of the population, SPOV has an early age of onset, is chronic in course (van Hout & Bouman, 2012), and interferes significantly in functioning (Veale, 2009). At its most impairing, young people with SPOV are unable to attend school; even in milder cases, SPOV saps joy from youth due to avoidance of previously loved foods, enjoyable activities like parties and extra-curriculars, and family activities like eating out and traveling.

Fortunately, CBT can be a highly effective tool for treating SPOV. In this Workshop, case examples will be used to describe how clients with SPOV present, how to differentiate SPOV from other disorders, and how to design an effective, age-appropriate course of treatment.

Attendees will learn how to develop an individualized SPOV model that focuses on the role of safety behaviors and internal focus of attention as maintaining factors for the disorder. We will also highlight the importance of parental accommodation and discuss how to help parents shift from accommodation to support (Lebowitz, 2021).

Participants will learn to develop a hierarchy and carry out effective exposures, which can vary considerably depending on presentation. Consideration will be given to how the COVID pandemic might have impacted rates of SPOV and ethical issues associated with treating this disorder will be addressed.

Throughout, focus will be placed on helping youth reclaim joy in their lives by freeing them of this severely impairing anxiety disorder.

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

1. Describe how youth with emetophobia present and how to differentiate emetophobia from other disorders.
 
2. Lead young clients through the process of developing a model of their emetophobia.
 
3. Educate clients about the role of safety behaviors (including parental accommodation) and self-focused attention in the maintenance of emetophobia.
 
4. Help a client develop an individualized hierarchy to guide treatment.
 
5. Design and carry out exposures with youth across the age range, both in person and via telehealth.
 
6. Effectively work with families of youth with emetophobia by addressing parental accommodation and helping parents who themselves are anxious or who have a phobia of vomit.
 
7. Resolve ethical dilemmas associated with treating youth with vomit phobia.

Long-Term Goals:

• Help clinicians feel comfortable and confident treating emetophobia, a particularly distressing, impairing, and intractable phobia.
 
• Ensure that clinicians are aware of the most up-to-date research on anxiety in youth.

Outline

• Workshop will address how to use CBT to treat emetophobia (or specific phobia of vomiting – SPOV) in youth.
 
• Attendees will learn how to develop an individualized SPOV model that focuses on the role of safety behaviors and internal focus of attention as maintaining factors for the disorder.
 
• Consideration will be given to the important role of parental accommodation and how to help parents shift from accommodation to support.
 
• Participants will learn to develop a hierarchy and carry out effective exposures, which can vary considerably depending on presentation.
 
• Ethical issues in the treatment of SPOV will be considered.
 
• Ample case examples will be used to bring the treatment to life.

Recommended Readings:

Breaking Free of Child Anxiety and OCD: A Scientifically Proven Program for Parents, Eli R. Lebowitz, PhD

Gag Reflections: Conquering a Fear of Vomit Through Exposure Therapy, Dara Lovitz and David Yusko, PsD

Facing Mighty Fears About Throwing Up, Dawn Huebner

Freeing Your Child From Anxiety and/or Freeing Your Child from Obsessive Compulsive Disorder, Tamar Chansky, PhD

Saturday, November 18 | 11:00 AM – 1:00 PM

Presented by:

Alec Pollard, Ph.D.,

Professor Emeritus, Saint Louis University

Participants earn 2 continuing education credit

Categories: Parenting / Families, Treatment / CBT

Keywords: Families, Motivation, Adherence

Moderate level of familiarity with the material

Treatment-refusal is a significant healthcare problem. Untreated psychiatric disorders often lead to a lifetime of distress and disability, and not just for the diagnosed individual. Impairment in one person can jeopardize the physical health, psychological well-being, and socioeconomic stability of the entire family.

For most people, hope rests on the promise of getting help, but even evidence-based treatment can’t help someone who never receives it. When families reach out to healthcare professionals, they are told nothing can be done.

In this seminar, I will describe something that can be done, an intervention called Family Well-Being Consultation (FWBC), a result of 3 decades of clinical development and research. FWBC uses established cognitive and behavioral principles and focuses on the well-being of the entire family. Families are taught how to shape recovery-compatible behavior in the treatment-refuser and how to reduce conflict and stress within the family.

The seminar will include lecture, video, and demonstration of technique.

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

1. Identify 4 cognitive behavioral factors that contribute to treatment-refusal and other forms of recovery avoidance.
 
2. Describe how family accommodations reinforce recovery avoidance.
 
3. Define the term “minimization” and articulate how it exacerbates recovery avoidance.
 
4. Describe the 5 steps of Family Well-Being Consultation.
 
5. Develop/implement interventions to help families manage crises commonly associated with treatment-refusal.
 
6. Develop/implement interventions to help families reduce accommodations and expressed hostility.
 
7. Teach families how to use contingencies to shape recovery-compatible behavior in treatment-refusers.

Long-Term Goals:

• Expand and diversify the patient populations they serve.
 
• Promote the emotional well-being of family members other than the identified patient.

Outline

I. The Nature of Recovery Avoidance
1. Definition and Features
2. Common Misunderstandings
3. Contributing Factors

II. The Family’s Response

1. Accommodating
2. Minimizing

III. Development of the Family Trap

1. Early Stages
2. Advanced Stages

IV. 5 Steps of the Family Well-Being Intervention

1. Prepare for Crises
2. Redefine the Problem
3. Embrace Valued Activity
4. Ease Family Distress
5. Create a Recovery-Friendly Environment

Recommended Readings:

Swift, J.K., Greenberg, R.P., Tompkins, K.A., & Parkin, S. (2017). Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons. Psychotherapy, 54, 47-57.

VanDyke, M., Pollard, C.A., Harper, J., & Conlon, K.E. (2015). Brief Family Consultation to families of treatment-refusers with symptoms of Obsessive-Compulsive Disorder: Does it impact family accommodation and quality of life? Psychology, 6, 1553-1561.

Johnco, C. (2016). Managing family accommodation of OCD in the context of adolescent treatment-refusal: A case example. Journal of Clinical Psychology, 72, 1129-1138.

This seminar has been cancelled.

Saturday, November 18 | 1:30 PM – 3:30 PM

Presented by:

Elizabeth J. McMahon, Ph.D.,

Practice Owner, Independent Practice

Participants earn 2 continuing education credit

Categories: Adult Anxiety, Technology

Keywords: Anxiety, Technology / Mobile Health, Evidence-Based Practice

All levels of familiarity with the material

Untreated anxiety, fears, and panic impair quality of life and lower mood. Virtual reality (VR) is a powerful, flexible, therapeutic tool that can be used during in-person or teletherapy sessions to provide immersive, evocative experiences, including experiences that can elicit positive emotions such as relaxation or wonder.

VR is increasingly affordable, available, intuitive, and evidence-based. Clients are actively searching for therapists offering VR therapy (VRT). Attendees will see examples of VR scenarios and products and learn how VR is used for various therapeutic purposes including teaching anxiety management skills, deepening relaxation, lifting mood, providing virtual reality exposure therapy (VRET), and helping to prevent relapse.

Benefits, risks, and research support will be reviewed. Attendees will learn the strengths and limitations of VR exposure compared to imaginal exposure and in vivo exposure. The timing and uses of VR will be discussed in the context of an overall model of anxiety disorders and their treatment.

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

1. Describe two uses of virtual reality (VR) in treating anxiety disorders.
 
2. List two research findings supporting the use of VR in treating anxiety disorders.
 
3. Name one advantage of VR exposure over imaginal exposure.
 
4. Explain two advantages of VR exposure over in vivo exposure.
 
5. Identify two risks of using VR for exposure therapy.

Long-Term Goals:

1. Assess the appropriateness and possible benefits of adding VR as a clinical tool to his/her/their practice.
 
2. Select VR product(s) appropriate for his/her/their practice and create a VR exposure hierarchy.

Outline:

• Types of virtual reality (VR) content and equipment needed.
 
• Summary of research findings, clinical applications, and benefits of VR.
 
• Advantages, disadvantages, and possible risks of VR exposure.
 
• Case examples illustrating VR exposure therapy (VRET) for anxiety.
 
• How to choose VR product(s) for your practice.

Recommended Readings:

McMahon, E., with Boeldt, D. (2022) Chapter 3 “Uses of VR in Anxiety Treatment”. In Virtual reality therapy for anxiety: A guide for therapists. Routledge.

Carl, E., Stein, A. T., Levihn-Coon, A., Pogue, J. R., Rothbaum, B., Emmelkamp, P., Asmundson, G., Carlbring, P., & Powers, M. B. (2019). Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. Journal of anxiety disorders, 61, 27–36.
https://doi.org/10.1016/j.janxdis.2018.08.003

Benbow, A. & Anderson, P. (2019). A meta-analytic examination of attrition in virtual reality exposure therapy for anxiety disorders. Journal of anxiety disorders, 61, 18-26. https://doi.org/10.1016/j.janxdis.2018.06.006.

Chesham, R., Malouff, J., & Schutte, N. (2018). Meta-Analysis of the Efficacy of Virtual Reality Exposure Therapy for Social Anxiety. Behaviour Change, 35(3), 152-166. doi:10.1017/bec.2018.15

Botella, C., Fernández-Álvarez, J., Guillén, V. et al. Recent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review. Curr Psychiatry Rep 19, 42 (2017). https://doi.org/10.1007/s11920-017-0788-4