Master Clinician Seminars

Presented by:

Maureen Whittal, Ph.D., Psychologist, Vancouver CBT Centre/University of British Columbia

Participants earn 2 continuing education credits
Categories: Obsessive Compulsive and Related Disorders, Treatment — CBT
Moderate level of familiarity with the material.

OCD can be a challenging disorder to treat owing to the heterogenous symptom presentation and comorbidity. Combined with a lack of knowledge amongst health providers, it leads to a delay in diagnosis which may in turn impact treatment efficacy and remission rates. Approximately 70% of people diagnosed with OCD will meet criteria for another mental health disorder in their lifetime. Depression is the most common followed by anxiety disorders, particularly social and generalized anxiety.

Cognitive treatments for OCD were introduced 30+ years ago as an alternative to prolonged exposure and came at a time when cognitive approaches for other psychological problems were demonstrating tremendous promise. The cornerstone of cognitive treatments is based upon the ubiquity of unwanted intrusions in the general population. It is near universal for humans to have occasional unwanted intrusions. The meaning associated with these intrusions is key to how they are experienced and the behavior that follows. Most people will be able to set aside an unwanted intrusion, recognize that it is egodystonic, and not a reflection of their character, or the future. Alternatively, those who appraise an unwanted intrusion as evidence of them being “mad, bad, or dangerous” will have a correspondingly negative emotional response and act in a way to mitigate the negative outcome. Very quickly, a maintenance cycle ensues.

Cognitive treatments are focused on the appraisal associated with unwanted intrusions. Treatment begins with a thorough assessment and collaboratively building a formulation. Appraisals or beliefs often center around the overimportance and need to control thought, overestimations of danger and inflated responsibility, as well as perfectionism and certainty. The goal of treatment is to help people collect evidence that supports a neutral meaning of the intrusive thought; one that says nothing negative about their character or the future. Illustration of strategies to accomplish these goals include surveys, behavioral and contrast experiments, testing the power of thought, creating distance from the intrusion and accepting uncertainty will be the bulk of the training.

The session will be interactive with role-plays, videos, and experiential exercises.

Outline:

1. Phenomenology and Assessment
   1. A quick overview of OCD, what it looks like and what can be confused with OCD
   2. Doing a cognitive assessment and how to identify meaning/appraisals
   3. Identification of cognitive measures to include in your toolkit (standardized and idiosyncratic based upon central beliefs and appraisals)
2. Setting the stage for ‘Big C’ CBT
   1. The ubiquity of unwanted intrusions
   2. The importance of appraisal/meaning
   3. Collaborative building of the model with the goal of creating a shared understanding to address of question of why intrusions persist
3. Cognitive Concepts; what they are how to address them
   1. The overimportance and need to control thoughts
      1. Thought Action Fusion
      2. The paradox/failure of thought control
      3. Separating desire from the fear of desire
   2. Inflated responsibility and overestimation of threat
      1. Piecharting
      2. “off duty”
      3. Responsibility transfers
      4. Logical vs subjective responsibility
   3. The need for certainty
      1. The paradox of trying to be certain
      2. Metaphor – cauldron of water
4. Other useful metaphors
   1. Lines in the water and lures
   2. Scab
   3. Tapped on the shoulder
   4. Signal vs noise
5. The back quarter of treatment
   1. The relationship between values and obsessions
   2. Dropping concealment
   3. Modal OCD personality traits

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

• Describe assessment strategies to identify appraisals and beliefs associated with unwanted intrusive thoughts.
• Construct a collaborative case formulation focusing on appraisal of unwanted intrusions.
• Identify the common appraisals and beliefs of unwanted intrusions.
• Explain the cognitive model in educating a patient.
• Apply cognitive and behavioral strategies to challenge appraisals and beliefs of unwanted intrusions.

Long-Term Goal:

In the long-term, be able to cognitively conceptualize cases and flexibly select corresponding treatment strategies to address the central appraisals.

Recommended Readings:

Whittal, M. L., Robichaud, M. L., & Woody S. R. (2010). Cognitive therapy of obsessions: Using video components to enhance dissemination. Cognitive and Behavioral Practice, 17(1), 1-8.

Salkovskis, P.M., & Millar, J. (2016). Still cognitive after all these years? Perspectives for a cognitive-behavioural theory of obsessions and where we are 30 years later. Australian Psychologist, 51(1), 3-13.

Sookman, D. S., Phillips, K. A., Anholt, G. S., Bhar, S., Bream, V., Challacombe, F. L., …, Veale, D. (2021). Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder. Psychiatry Research, 303, Article 113752.

Van Ameringen, M., Fineberg N. A., Ravindran, A., Arnold, P. D., Beaulieu, S., Brakoulias, V.,… Dell’Osso, B. M. (in press). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) 2025 International Guideline for the Management of Patients with Obsessive-Compulsive Disorder. Journal of Psychiatric Research.

Presented by:

Greg K. Siegle, Ph.D., Professor, University of Pittsburgh

Participants earn 2 continuing education credits
Categories:Treatment – Neurocognitive Therapies, Treatment – Cognitive Behavior Therapy (CBT), Research Methods – Translational
All levels of familiarity with the material.

It is clear that brains are involved in psychopathology and recovery, but it’s often hard to understand how to use that information practically with clients in the room. In this seminar we will discuss ways neuroscience can be employed with actual patients, including incorporating neuroscience into psychoeducation and case formulation, integration of contemporary neuroscience-informed treatments as adjuncts to CBT, and incorporating insights from neuroscience into understanding and accommodating neurodivergence.

Outline:

1. 1. Domains for using neuroscience in practice today
      1. Psychoeducation and case conceptualization
      2. Measurement: Adding available, commercial neuroscience-based assessment tools for case conceptualization
      3. Intervention: Adjunctive neuroscience-based technologies
   2. Background concepts:
      1. Psychoeducation and case conceptualization
      2. Measurement: Adding available, commercial neuroscience-based assessment tools for case conceptualization
      3. Intervention: Adjunctive neuroscience-based technologies
   3. Understanding and addressing components of the triple network
   4. For each component: background, effects of traditional interventions, neuroscience based adjunctive interventions
   5. Salience network – emotion generation/recognition, arousal, interoception
   6. Executive / task network – executive function, task focus, emotion regulation
   7. Default network – self processing, rumination, automatic thinking, relaxation
      Take home messages

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

• List ways to incorporate neuroscience into psychoeducation, particularly regarding interactions of cognition and emotion, and the nature of changing cognitions
• Explain how CBT affects the brain, and how to use and convey that information with clients
• Demonstrate how a variety of adjunctive contemporary neuroscience-based treatments may affect the brain and interact with CBT
• Describe what neuroscience-based clinician-accessible assessment technologies are available, their validity, and how they can be employed in conjunction with treatment
• Explain how neurodivergence manifests in the brain, particularly with regard to mechanisms addressed in and affected by CBT

Long-Term Goal:

Frameworks and techniques you can use TODAY

Recommended Readings:

Young, K.S., Craske, M.G. The Cognitive Neuroscience of Psychological Treatment Action in Depression and Anxiety. Curr Behav Neurosci Rep 5, 13–25 (2018). https://doi.org/10.1007/s40473-018-0137-x

Strege, M.V., Persons, J.B., Ressler, K.J., Krawczak, R.A., Fang, A., Goldin, P., Siegle, G.J. (2021). Integrating neuroscience into clinical practice: Current Opinions and Dialogue between Drs. Jaqueline Persons and Kerry Ressler, Behavior Therapist, 44(7), 326-335.

Fang, A., Anderson, R. E., Carter, S., Eckstrand, K., Hsu, K.J., Jones, S., Kyryza-Lacombe, M., Pekham, A., Siegle, G.J., Uddin, L.Q., Weierich, M., Woody, M., Illes, J. (2025). Bioethical and critical consciousness in clinical translational neuroscience, Journal of Clinical and Translational Science. 9(1)e37. doi: 10.1017/cts.2025.5

Presented by:

Lauren M. Borges, Ph.D., Director of Training; Clinical Research Psychologist; Associate Professor, Rocky Mountain MIRECC
Jacob K. Farnsworth, Ph.D., Training Director; Psychology Discipline Lead, Rocky Mountain Regional VA Medical Center
Sean M. Barnes, Ph.D., Director of Education; Clinical Research Psychologist; Associate Professor, Rocky Mountain MIRECC
Robyn D. Walser, Ph.D., Director of Research and Board Member; Consultant; Psychologist, National Center for PTSD

Participants earn 2 continuing education credits
Categories: Treatment – Mindfulness & Acceptance, Symptoms / Disorders – Trauma and Stressor Related Disorders, Treatment – Acceptance & Commitment Therapy (ACT)
All levels of familiarity with the material.

In today’s world acts of civil disobedience, healthcare work, operating as a teacher, military service, and law enforcement can result in significant moral violations. Simply serving in a helping profession and acting on corresponding social values (e.g., Hippocratic oath) can cause exposure to potentially morally injurious events (PMIEs); moral violations in high-stakes situations. Moral pain, often expressed as shame, contempt, or self-condemnation, can be deeply aversive. Efforts to suppress, escape, or control it (e.g., through withdrawal, numbing, or violence) frequently intensify suffering rather than resolve it. Moral injury emerges when efforts to cope with moral pain significantly interfere with social, psychological, or spiritual functioning. Given the social origins and consequences of moral injury, treatments are needed that target avoidance and control of moral pain while building social connection through values, compassion, and community.

Acceptance and Commitment Therapy for Moral Injury (ACT-MI; Borges et al., 2022) is a transdiagnostic 15-session hybrid group (12-sessions) and individual (3-session) psychotherapy emphasizing compassionately connecting with moral pain while living values. A recent randomized controlled pilot trial (N=74) found ACT-MI to be highly acceptable (e.g., “I can live life again…I can be a better mom…I thank God every day that I got to be a part of this”) with clinically significant improvements identified in psychosocial functioning (Outcome Questionnaire-45: M=-17.45, SD=19.33, 95% CI=-24.80, -10.10). Institute participants will learn skills facilitating conceptualizing and intervening on moral injury across clinical populations. Participants will practice holding their own moral pain as an observer, compassionately connecting with their clients’ moral pain, and simultaneously exploring individual and social values.

Outline:

1. Discuss data supporting ACT-MI, describe populations who have benefitted or might benefit from ACT-MI treatment, and discuss next steps in ACT-MI research.
2. Describe how to conceptualize moral injury and self-and other-compassion using principles from ACT-MI and practice case conceptualizing using the intervention’s framework.
3. Engage in a self-guided experiential activity exploring the workability of avoiding and controlling moral pain.
4. Discuss how to experience and hold moral pain as a provider while holding your client’s moral pain simultaneously
5. Practice experientially exploring the workability of avoiding and controlling moral pain in small groups with a “client.”
6. Practice experiencing moral pain related to oneself and others with compassion from the perspective of the observer self through a self-guided experiential exercise.
7. Engage in a small group experiential exercise to practice guiding “clients” in creating a context for holding moral pain by connecting with an observer self.
8. Define the relationship between moral pain and values as two sides of the same coin where pain points to values and values point to pain.
9. Engage in a small group experiential exercise, helping “clients” to identify values using their moral pain.
10. Practice holding morally painful memories from the perspective of an observer who has but is not defined by these memories and guiding “clients” through this process.
11. Practice holding morally pleasant memories from an observer perspective and identify the values these memories point to.
12. Practice guiding “clients” in building patterns of behavior informed by their values and planning how they will approach pain along the way.

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

• Describe how to conceptualize moral injury using principles from ACT-MI.
• Describe how to conceptualize self-and other-compassion using principles from ACT-MI and practice case conceptualizing using the intervention’s framework.
• Apply procedures from ACT-MI to cultivate flexibility in responding to moral pain.
• Support clients in building present moment awareness and the ability to hold moral pain without becoming consumed by it.
• Define the relationship between moral pain and values as two sides of the same coin.
• Explain how to guide clients in building patterns of behavior informed by their values.
• Guide clients in holding morally painful and pleasant memories from an observer perspective and identify the values these memories point to.

Recommended Readings:

Borges, L. M., Barnes, S. M., Farnsworth, J. K., Drescher, K. D., & Walser, R. D. (2022). Case conceptualizing in Acceptance and Commitment Therapy for Moral Injury (ACT-MI): An active and ongoing approach to understanding and intervening on moral injury. Frontiers in Psychiatry, 13, 1-14. doi:10.3389/fpsyt.2022.910414

Farnsworth, J. K., Drescher, K. D., Evans, W., & Walser, R. D. (2017). A functional approach to understanding and treating military-related moral injury. Journal of Contextual Behavioral Science, 6(4), 391–397. https://doi.org/10.1016/j.jcbs.2017.07.003

Borges, L. M. (2019). A Service Member’s experience of Acceptance and Commitment Therapy for Moral Injury (ACT-MI): “Learning to accept my pain and injury by reconnecting with my values and starting to live a meaningful life.” Journal of Contextual Behavioral Science, 13, 134-140. doi:10.1016/j.jcbs.2019.08.002

Borges, L. M., Holliday, R., Barnes, S. M., Bahraini, N. H., Kinney, A. R., Forster, J. E., & Brenner, L. A. (2021). A longitudinal analysis of the role of potentially morally injurious events on COVID-19 related psychosocial functioning among healthcare providers. PLOS ONE. doi: 10.1371/journal.pone.0260033

Litz, B. T., Plouffe, R. A., Nazarov, A., Murphy, D., Phelps, A., Coady, A., Houle, S. A., Dell, L., Frankfurt, S., Zerach, G., Levi-Belz, Y., & Moral Injury Outcome Scale Consortium (2022). Defining and Assessing the Syndrome of Moral Injury: Initial Findings of the Moral Injury Outcome Scale Consortium. Frontiers in psychiatry, 13, 923928.

Presented by:

Lisa W. Coyne, Ph.D., Assistant Professor; CEO, Harvard Medical School; New England Center for OCD and Anxiety
Brian C. Pilecki, Ph.D., Psychologist, Associate Scientist, Portland Psychotherapy

Participants earn 2 continuing education credits
Categories:Treatment – Mindfulness & Acceptance, Symptoms / Disorders – Anxiety and Fear, Treatment – Acceptance & Commitment Therapy (ACT). Symptoms / Disorders – Obsessive Compulsive and Related Disorder
Moderate to advanced level of familiarity with the material.

ACT-informed exposure has been shown to be as effective as traditional exposure in treating anxiety disorders (Arch et al., 2012; Twohig et al., 2018), while offering unique advantages for both clients and therapists. This workshop will help CBT clinicians enhance their exposure therapy work by integrating ACT’s process-based approach, without requiring mastery of the full ACT model.

Presenters will introduce the ACT psychological flexibility model and demonstrate its expanded vocabulary for processes already implicit in traditional exposure—such as acceptance, present-moment awareness, and values-based action. Participants will learn how ACT reframes exposure as a practice for building psychological flexibility while pursuing a meaningful life. The ACT processes focus case conceptualization, helping therapists identify specific forms of psychological inflexibility during exposure and effectively problem-solve when clients get stuck. This perspective enables therapists to work more flexibly across diagnostic categories and troubleshoot common barriers to treatment progress.

The presenters will demonstrate how ACT processes can structure the delivery of exposure therapy itself—from how therapists interact with clients during exposure exercises, to debriefing afterwards, to framing of homework assignments. Practical applications include: orienting clients to willingness and acceptance as alternatives to control-based strategies; using willingness ratings alongside SUDS to identify avoidance during exposure; creating values-based exposure hierarchies that enhance motivation; and recognizing therapeutic change beyond symptom reduction, such as increased behavioral flexibility and values-consistent action. Through didactic content, clinical examples, role-play demonstrations, and opportunities for practice, participants will learn to identify psychological flexibility processes, without needing to become an ACT expert.

Clinicians will leave this workshop with practical tools for integrating ACT principles into their existing exposure-based practice, strengthening their ability to deliver more flexible, personalized, and theoretically grounded interventions for anxiety, OCD, and related disorders.

Outline:

1.  Intro to workshop – about exposure and ERP
   1. ACT as a process-based transdiagnostic approach
   2. A contextual-behavioral account of suffering
   3. Overview of exposure therapy
2. Augmenting ERP with ACT – An ACT approach to OCD
   1. Why don’t clinicians do exposure?
   2. Building an ACT-informed therapeutic alliance and setting the context
   3. Providing an exposure rationale
   4. Conducting a functional behavioral analysis
3. Introducing Psychological Flexibility Processes
   1. Shaping Mindfulness & Acceptance Processes: Coaching Curiosity
   2. Shaping Commitment & Behavior Change Processes: Valuing & Self-Compassion
4. Inhibitory Learning & Exposure
   1. ACT Processes and Inhibitory Learning

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

• Describe the ACT psychological flexibility model and explain how its core processes (acceptance, present-moment awareness, values-based action) are already implicit in traditional exposure therapy.
• Utilize ACT processes as a case conceptualization framework to identify specific forms of psychological inflexibility that may interfere with exposure therapy and impede client progress.
• Apply willingness-based interventions during exposure exercises, including using willingness ratings alongside SUDS to strengthen acceptance during exposure practice.
• Demonstrate how to structure exposure delivery using ACT principles, including orienting clients to exposure, debriefing after exposure exercises, and framing homework assignments in ways that build psychological flexibility.
• Construct values-based exposure hierarchies that enhance client motivation and reframe exposure as a vehicle for pursuing meaningful life goals rather than solely targeting symptom reduction.
• Identify multiple indicators of therapeutic change beyond symptom reduction, such as increased behavioral flexibility, values-consistent action, and willingness to experience discomfort in service of valued living.

Recommended Readings:

Laurito, L. D., Loureiro, C. P., Dias, R. V., Faro, L., Torres, B., Moreira-de-Oliveira, M. E., … & Twohig, M. P. (2022). Acceptance and commitment therapy for obsessive-compulsive disorder in a Brazilian context: Treatment of three cases. Journal of Contextual Behavioral Science, 24, 134–140.

Ong, C. W., Petersen, J. M., Terry, C. L., Krafft, J., Barney, J. L., Abramowitz, J. S., & Twohig, M. P. (2022). The “how” of exposures: Examining the relationship between exposure parameters and outcomes in obsessive-compulsive disorder. Journal of Contextual Behavioral Science, 24, 87–95.

Thompson, B. L., Twohig, M. P., & Luoma, J. B. (2021). Psychological flexibility as shared process of change in acceptance and commitment therapy and exposure and response prevention for obsessive-compulsive disorder: A single case design study. Behavior Therapy, 52(2), 286–297.

Thompson, E. M., Brierley, M. E. E., Destrée, L., Albertella, L., & Fontenelle, L. F. (2022). Psychological flexibility and inflexibility in obsessive-compulsive symptom dimensions, disability, and quality of life: An online longitudinal study. Journal of Contextual Behavioral Science, 23, 38–47.

Arch, J. J., Finkelstein, L. B., & Nealis, M. S. (2025). Acceptance and Commitment Therapy (ACT) for Anxiety Disorders. Psychiatric Clinics of North America, 48(3), 443-456.

Presented by:

Lucene Wisniewski, FAED, Ph.D., Practice Founder & Leader, Center for Evidence-based Treatment

Participants earn 2 continuing education credits
Categories: Treatment – Dialectical Behavior Therapy (DBT), Symptoms / Disorders – Eating Disorders, Symptoms / Disorders – Comorbidity
Moderate to advanced level of familiarity with the material.

The work of professionals who treat clients diagnosed with an eating disorder (ED) and significant other comorbidities such as depression, anxiety, suicidality, or BPD can be complicated. First and foremost, multi-diagnostic ED clients can be ambivalent about treatment and recovery. Professionals are often in the position of having to “sell” the treatment we believe is needed to individuals who often have not been helped by multiple previous interventions. Furthermore, EDs can be life threatening illnesses and professionals may become unclear about priorities when attempting to help a client who has more than one life-threatening condition:  e.g., what if my client is self-harming and is purging– which do I deal with first? The work of the ED professional is further complicated by behaviors that can interfere with the treatment’s delivery.  Behaviors such as angry outbursts, failure to complete homework, lying about intake, water-loading, and cancelling sessions are considered therapy-interfering behaviors (TIBs) and can interfere with clients’ abilities to benefit from treatment, remain in treatment, or both. Finally, the professional’s own burn out and frustrations can interfere with treatment, as well. 

Mulitdiagnostic Eating Disorder- Dialectical Behavior Therapy (MED-DBT), provides a clear and systematic model for dealing with ambivalent, multiple-problem cases, as well as life-threatening, and therapy-interfering behaviors.

In this two-hour, master-clinician seminar, participants will be exposed to MED-DBT theory and practice. Particular attention will be given to how to conceptualize and organize patient behavior in terms of priorities, and how to identify and address therapy-interfering behaviors on the part of the patient and therapist.  Using lecture, case example and role plays, participants will have the opportunity to practice and observe MED-DBT treatment strategies for those diagnosed with an eating disorder. The current presentation will describe how a MED-DBT treatment model can effectively and comprehensively address eating disorder issues and their comorbidities across the DBT targets. 

Outline:

1. Overview of a biopsychosocial DBT model that accounts for ED behaviors.
2. Review of Targets in MED DBT (including how to address/know when the ED falls into target 1 behaviors)
3. Addressing Target 1 ED behaviors (E.g., purging in the context of electrolyte imbalance)
4. Addressing Target 2 ED behaviors (E.g., hiding food, water loading) within a MED DBT Framework
5. Case example and practice of understanding Targets in the frame of MED DBT

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

• Describe how to categorize ED behaviors in the context of Targets I, II and III.
• Identify patient behaviors (eating disordered and otherwise) that interfere with treatment
• Identify caregiver behaviors that interfere with treatment
• Identify therapist behaviors that interfere with treatment
• Formulate strategies to address suicidality, non-suicidal self-injury and TIB’s in and outside of session.

Long term goals:

1. Participants will acquire skills to develop confidence in addressing multiple behaviors in ED clients
2. Participants will learn ways to adapt their conceptualization of eating disorder behaviors within a DBT treatment.

Recommended Readings:

Bhatnagar, K., Martin-Wager, C & Wisniewski, L. (2019). DBT for Eating Disorders: An Overview. In Swales, M. (Ed) The Oxford Handbook of Dialectical Behaviour Therapy. Oxford University Press.

Wisniewski, L. & Anderson, L.K. (2018). Eating Disorders and Borderline Personality Disorder: Strategies for Managing Life-Threatening and Therapy-Interfering Behaviors. In Anderson, L. K., Murray, S. B., & Kaye, W. H. (Eds.). (2018). Clinical handbook of complex and atypical eating disorders. New York: Oxford.

Brown, T., Wisniewski, L., & Anderson, L. (2020). Dialectical Behavior Therapy and Eating disorders: State of the Research and New Directions. Eating Disorders: The Journal of Treatment and Prevention, 28, 97-100.

Ben-Porath, D., Duthu, F., Luo, T., Gonidakis, F., Compte, E., & Wisniewski, L. (2020). Dialectical behavioral therapy: an update and review of the existing treatment models adapted for adults with eating disorders. Eating Disorders: The Journal of Treatment and Prevention, 28, 101-121. https://www.tandfonline.com/doi/full/10.1080/10640266.2020.1723371

Federici, A. & Wisniewski, L. (2025). Treating eating disorders with DBT: The MED-DBT protocol. Guilford Press.

Presented by:

Lily A. Brown, Ph.D., Director, Center for the Treatment and Study of Anxiety, University of Pennsylvania

Participants earn 2 continuing education credits
Categories:Treatment — other
Moderate level of familiarity with the material.

Prolonged Exposure therapy (PE; Foa et al., 2007; 2019) is a gold-standard treatment for posttraumatic stress disorder (PTSD) yet is underutilized in community settings (Racz et al., 2024; McLean & Foa, 2013). Common barriers to clinicians’ use of PE are: 1) the perception that clinical complexity (e.g., comorbidity) limits its appropriateness (van Minnen et al., 2012); 2) concerns about patient tolerability and discomfort in eliciting distress, particularly in high risk patients (Wells et al., 2022), and 3) low self-efficacy in the ability to deliver PE effectively (Moses et al., 2022).

The goal of this Master Clinician Seminar is to enhance clinicians’ confidence and competence in delivering PE in the context of comorbid conditions that may increase clinical risk, with particular emphasis on patients with elevated suicide risk. Evidence-informed strategies for implementing PE in complex presentations will be reviewed, including approaches to maintain treatment fidelity while optimizing patient engagement, tolerability, and safety.

This Master Clinician Seminar will cover key components of PE delivery, including assessment, in vivo exposure, imaginal exposure, and processing, with attention to common implementation challenges. We will also address clinical decision-making around “off-protocol” sessions to deliver brief suicide prevention interventions when indicated, and how to effectively resume PE thereafter. Finally, given that consultation significantly improves clinician self-efficacy and uptake of PE (Foa et al., 2023), the seminar will include guided case discussion focused on high-risk clinical scenarios provided by participants and the presenter.

Outline:

1. The Implementation Gap (15 min)
   1. PE as gold-standard vs. real-world underuse
   2. Brief synthesis of common clinician barriers
   3. Framing: “Why this is hard even for experts”
2. Core PE Components Refresher (20 min)
   1. Structure and mechanisms (very concise)
   2. What must be done for fidelity
   3. What can be flexibly adapted
3. Delivering PE in Complex Cases (30 min)
   1. Comorbidity (depression, substance use, etc.)
   2. High avoidance and engagement challenges
   3. Therapist drift and how to prevent it
4. PE with Suicide Risk (30 min)
   1. Risk assessment within PE
   2. When to pause vs. proceed
   3. “Off-protocol” sessions:
      1. Brief suicide prevention interventions
      2. Returning to PE effectively
   4. Managing therapist anxiety and liability concerns
5. Applied Techniques (15 min)
   1. Example of imaginal exposure + processing
   2. Common mistakes vs. high-quality delivery
6. Case Consultation (10–15 min)
   1. Participant-submitted cases (if submitted) OR
   2. Presenter provided case
7. Key Takeaways + Q&A (10 min)
   1. “If you remember 3 things…”
   2. Resources for consultation and training

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

• Describe common clinician- and system-level barriers contributing to the underutilization of Prolonged Exposure therapy.
• Ethically apply core components of PE (imaginal exposure, in vivo exposure, and processing) with greater fidelity in complex PTSD presentations.
• Evaluate and manage suicide risk in the context of PE, including when and how to implement brief off-protocol interventions.
• Adapt PE for patients with comorbid conditions while maintaining adherence to evidence-based principles.
• Increase clinician self-efficacy in delivering PE through structured decision-making.

Long term goals:

1. Increase sustained implementation of PE in routine clinical practice, particularly among clinicians treating high-risk and complex PTSD presentations.
2. Improve patient safety and clinical outcomes by integrating evidence-based PTSD treatment with effective suicide risk management.

Recommended Readings:

Brown, L. A., Kautz, M., Muzzy, W., Hart, S., Vaughn, J., Murphy, S., Foa, E., Miller, I., Kahn, A., & Acierno, R. (2026). An open-phase pilot trial of an integration of prolonged exposure therapy and the coping long-term with active suicide program (CLASP-PE). Cognitive and Behavioral Practice, 33(2), 283-298. https://doi.org/10.1016/j.cbpra.2025.06.002

Brown, L. A. (2026). Optimizing CBT for PTSD. Hogrefe Publishing. https://doi.org/10.1027/00669-000

Brown, L. A., McLean, C. P., Zang, Y., Zandberg, L., Mintz, J., Yarvis, J. S., Litz, B. T., Peterson, A. L., Bryan, C. J., Fina, B., Petersen, J., Dondanville, K. A., Roache, J. D., Young-McCaughan, S., & Foa, E. B. (2019). Does prolonged exposure increase suicide risk? Results from an active duty military sample. Behaviour Research and Therapy, 118, 87–93.
https://doi.org/10.1016/j.brat.2019.04.003