Institutes

Presented by:

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

Laura Tirch, Ph.D., Founder, The Center for Compassion Focused Therapy

Participants earn 7 continuing education credits.

Categories: Mindfulness & Acceptance, Adult Anxiety

Keywords: ERP (Exposure and Response Prevention), ACT (Acceptance & Commitment Therapy), Anxiety

Advanced level of familiarity with the material.

This institute introduces clinicians to Compassion Focused Exposure and Response Prevention (CF-ERP), a cutting-edge approach derived from Compassion Focused ACT (CF-ACT) that integrates the power of exposure and response prevention (ERP) with the principles of Compassion Focused Therapy (CFT) and Acceptance and Commitment Therapy (ACT). CF-ERP offers a unique synthesis of traditional behavioral techniques with innovative methods designed to target and transform core shame, self-criticism, and related difficulties that often underlie anxiety disorders and impede treatment progress.

CF-ERP cultivates the courage needed to develop broadening behavioral repertoires in the presence of repertoire-narrowing stimuli. Special emphasis is given to tailoring compassionate imagery and developing personalized behavioral experiments that foster a sense of self-efficacy and resilience in the face of anxiety-provoking situations. CF-ERP is consistent with modern theories of ERP mechanisms of action, including inhibitory learning and memory re-consolidation. Participants will also learn about the growing experimental and applied research base supporting the integration of mindfulness and compassion-focused methods into ERP.

This workshop will provide a deep dive into the theoretical foundations of CF-ERP, drawing on attachment, evolutionary, and contextual behavioral science perspectives. Experiential exercises, case examples, and guided practices will be utilized to demonstrate how CF-ERP can be applied to a range of anxiety-related difficulties, including panic disorder, social anxiety, and obsessive-compulsive disorder. Participants will also learn how to integrate CF-ERP with other evidence-based approaches, such as CBT and DBT.

This institute is designed for psychologists, therapists, and mental health professionals interested in expanding their clinical skills and learning innovative ways to enhance the effectiveness of exposure-based interventions. Participants will leave with practical tools and strategies for integrating CF-ERP into their clinical practice, ultimately empowering their clients to overcome anxiety-related challenges and cultivate a greater sense of self-compassion and well-being.

Outline:

1. Morning Session (3 hours)
   1. Introduction to CF-ERP: Bridging CFT, ACT, and ERP (45 minutes)
      1. What is CF-ERP? Core principles and theoretical underpinnings.
      2. The synergistic relationship between CFT, ACT, and ERP.
      3. How CF-ERP addresses the limitations of traditional ERP.
      4. Overview of the workshop’s learning objectives and structure.
   2. Understanding Anxiety: The Role of Avoidance and Fusion (1 hour)
      1. The nature of anxiety and its impact on individuals.
      2. Cognitive fusion and experiential avoidance in anxiety disorders.
      3. How traditional ERP targets avoidance but may miss fusion.
      4. Case examples illustrating the dynamics of anxiety and avoidance.
   3. Compassionate Exposure: Integrating CFT and ERP (1 hour)
      1. Applying CFT principles to enhance the ERP process.
      2. Developing self-compassion as a foundation for facing fears.
      3. Cultivating a compassionate stance towards anxiety-related sensations.
      4. Guided meditations and exercises for building self-compassion.
   4. Morning Coffee Break (15 minutes)
   5. Afternoon Session (4 hours)
      1. Acceptance and Defusion: ACT Methods in CF-ERP (1 hour)
      2. Using ACT techniques to promote acceptance of anxiety.
      3. Cognitive defusion strategies to reduce the grip of anxious thoughts.
      4. Developing psychological flexibility in the face of anxiety triggers.
      5. Role-playing and experiential exercises to practice acceptance and defusion.
   6. Designing CF-ERP Interventions: Practical Strategies (1 hour)
      1. Constructing compassionate exposure hierarchies.
      2. Developing personalized behavioral experiments with a CF-ACT lens.
      3. Integrating mindfulness practices into ERP.
      4. Case examples illustrating CF-ERP interventions for various anxiety disorders.
   7. Lunch Break (1 hour)
   8. CF-ERP for Specific Anxiety Disorders (1 hour)
      1. Panic Disorder: Targeting catastrophic thoughts and bodily sensations.
      2. Social Anxiety Disorder: Addressing social fears and self-focused attention.
      3. Obsessive-Compulsive Disorder: Integrating CF-ACT into ritual prevention.
      4. Case studies illustrating the application of CF-ERP to diverse anxiety presentations.
   9. Working with Resistance and Challenges in CF-ERP (45 minutes)
      1. Identifying common challenges and obstacles in CF-ERP implementation.
      2. Addressing client resistance to exposure and acceptance.
      3. Troubleshooting strategies for difficult cases.
      4. Promoting therapist self-compassion and resilience.
   10. Wrap-up and Q&A (45 minutes)
       1. Review of key concepts and techniques in CF-ERP.
       2. Addressing participant questions and concerns.
       3. Resources for continued learning and professional development.

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

1. Explain the theoretical foundations of Compassion Focused Exposure and Response Prevention (CF-ERP).
2. Apply CF-ERP to a range of anxiety disorders, including panic disorder, social anxiety, and obsessive-compulsive disorder.
3. Integrate CF-ERP with other evidence-based approaches, such as ACT, CBT, and DBT.
4. Utilize case examples and experiential exercises to enhance clinical skills in CF-ERP.
5. Integrate compassionate mind training practices into traditional ERP protocols.

Long-term Goals:

• Adapt CF-ERP for clients with trauma or early adversity experiences that contribute to anxiety.
• Develop skills in constructing compassionate exposure hierarchies and designing personalized behavioral experiments.

Recommended Readings:

Leaviss, J., & Uttley, L. (2015). Psychotherapeutic benefits of compassion-focused therapy: an early systematic review. Psychological medicine, 45(5), 927–945. https://doi.org/10.1017/S0033291714002141

Cuppage J, Baird K, Gibson J, et. al. (2017) Compassion focused therapy: Exploring the effectiveness with a transdiagnostic group and potential processes of change. British Journal of Clinical Psychology. Jun;57(2):240-254. doi: 10.1111/bjc.12162

Chou C.Y., Tsoh J.Y., Shumway M., et. al. (2019) Treating hoarding disorder with compassion-focused therapy: A pilot study examining treatment feasibility, acceptability, and exploring treatment effects. British Journal of Clinical Psychology. 2019 Jul 4. doi: 10.1111/bjc.12228

Michael P. Twohig, Jonathan S. Abramowitz, Ellen J. Bluett, Laura E. Fabricant, Ryan J. Jacoby, Kate L. Morrison, Lillian Reuman, Brooke M. Smith,
Exposure therapy for OCD from an acceptance and commitment therapy (ACT) framework,
Journal of Obsessive-Compulsive and Related Disorders, Volume 6, 2015, Pages 167-173, ISSN 2211-3649, https://doi.org/10.1016/j.jocrd.2014.12.00

Kim, J.J., Parker, S.L., Doty, J.R. et al. Neurophysiological and behavioural markers of compassion. Sci Rep 10, 6789 (2020). https://doi.org/10.1038/s41598-020-63846-3

Presented by:

Jonathan S. Abramowitz, Ph.D., Professor of Psychology, University of North Carolina at Chapel Hill

Ryan J. Jacoby, Ph.D., Assistant Professor of Psychology, Massachusetts General Hospital/Harvard Medical School

Participants earn 7 continuing education credits.

Categories: Adult Anxiety, Treatment – CBT

Keywords: Exposure, Anxiety, Fear

Basic to moderate level of familiarity with the material.

A large proportion of therapists’ caseloads includes individuals with clinical anxiety. Although exposure therapy is highly effective for these conditions, many clients fail to benefit and/or experience a return of fear (“relapse”) at some point after treatment. Cutting-edge models of exposure therapy focus on an inhibitory learning theory of fear extinction, derived from basic research on learning and memory, which points to specific implementation techniques to optimize short- and long-term gains and guard against relapse. Collectively, inhibitory learning strategies emphasize distress tolerance, as opposed to habituation of distress, and introduce “desirable difficulties” into exposure sessions by challenging clients to consolidate and generalize learning via novel therapeutic strategies. This institute aims to help clinicians understand and apply this model to optimize exposure therapy. The inhibitory learning model will first be described and distinguished from traditional approaches to exposure. Numerous strategies to optimize inhibitory learning will then be introduced and illustrated in detail. These strategies include framing exposure to disconfirm threat-based expectations (and thus selectively using cognitive therapy), introducing variability into exposure to decontextualize safety learning, deepening and augmenting safety learning (by combining fear cues, labeling affect, and targeting attentional focus), and eliminating (or judiciously using) safety behaviors. Applying the inhibitory learning model of exposure to complex, diverse, and comorbid symptom presentations, and in an inclusive and justice-based way, will also be discussed. The institute will be interactive and include (a) numerous case examples highlighting implementation with individuals from diverse backgrounds, (b) video demonstrations, and (c) experiential exercises.

Outline:

1. Overview
   1. Importance of the Topic
   2. Challenges in fear extinction and exposure therapy outcomes
2. Theoretical Background
   1. Learned Fear and Extinction
      1. Clinical and nonclinical fear and anxiety
   2. Fear Conditioning and Context
      1. Pavlovian threat conditioning and safety-seeking behaviors.
   3. Emotional Processing Theory
      1. Key concepts and relevance to exposure therapy.
   4. Inhibitory Learning Theory (ILT)
      1. Differences from emotional processing theory.
      2. Emphasis on fear tolerance.
3. Optimizing Inhibitory Learning in Exposure Therapy
   1. Key Strategies
      1. Expectancy Tracking
      2. Framework for testing threat-based predictions.
      3. Consolidation of learning through feedback.
   2. Variability in Exposure
      1. Context, interval, and intensity variability.
      2. Benefits of introducing “desirable difficulties.”
   3. Combining Fear Cues
      1. Deepened extinction through multiple fear cues.
   4. Affect Labeling
      1. Augmenting learning by verbalizing emotions.
   5. Attentional Focus
      1. Deliberate attention to fear stimuli.
      2. Avoiding distraction.
   6. Reinstating Safety Learning
      1. Use of retrieval cues.
      2. Strategic application to prevent return of fear.
   7. Occasional Reinforced Exposure
      1. Occasional feared outcomes during exposure therapy to enhance extinction learning
4. Practical Applications
   1. Case Examples
   2. Addressing Common Challenges
   3. Tailoring Strategies for Specific Populations
   4. Justice-based and inclusive exposure therapy
5. Empirical Support
   1. Research Evidence Supporting Inhibitory Learning Strategies
   2. Comparisons Between Techniques
      1. Cognitive Restructuring
      2. Affect Labeling
6. Advanced Topics
   1. Safety Behaviors
      1. Judicious Use vs. Elimination
   2. Troubleshooting
      1. Handling Panic Attacks During Exposure
      2. Addressing Unique Challenges in Therapy Settings
7. Group Activities
   1. Breakout Sessions
   2. Group Discussions
8. Summary and Future Directions
   1. Key Takeaways
   2. Research Gaps

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

1. Distinguish the inhibitory learning approach to exposure from the traditional emotional processing approach.
2. Explain why it is important to foster distress tolerance during exposure, as opposed to relying solely on habituation (reduction) of distress.
3. Describe methods of tracking changes in expectations during exposure therapy, rather than SUDS.
4. Describe how to introduce variability into exposure sessions.
5. Compare methods for eliminating versus judiciously using safety behaviors in exposure.
6. Identify common pitfalls that clinicians may encounter during exposure therapy and how to address them using an inhibitory learning approach
7. Describe how to implement exposure therapy in an inclusive way for individuals from diverse backgrounds.

Long-term Goals:

• Integrate strategies derived from the inhibitory learning model into routine practice to enhance fear extinction, generalize safety-learning, and reduce relapse by emphasizing expectancy violation, variability, and affect labeling.
• Foster a culture of treatment that prioritizes distress tolerance over anxiety reduction, helping clients build self-efficacy and resilience to fear.

Recommended Readings:

Craske, M. G., Treanor, M., Zbozinek, T. D., & Vervliet, B. (2022). Optimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus. Behaviour Research and Therapy, 152, 104069.

Jacoby, R. J., & Abramowitz, J. S. (2016). Inhibitory learning approaches to exposure therapy: A critical review and translation to obsessive-compulsive disorder. Clinical psychology review, 49, 28-40.

Knowles, K. A., & Olatunji, B. O. (2019). Enhancing inhibitory learning: The utility of variability in exposure. Cognitive and Behavioral Practice, 26(1), 186-200.

Pittig, A., Heinig, I., Goerigk, S., Richter, J., Hollandt, M., Lueken, U., … & Wittchen, H. U. (2023). 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, 11(2), 199-217.

Weisman, J. S., & Rodebaugh, T. L. (2018). Exposure therapy augmentation: A review and extension of techniques informed by an inhibitory learning approach. Clinical Psychology Review, 59, 41-51.

Presented by:

Lauren M. Borges, Ph.D., Clinical Research Psychologist; Director of Training, Rocky Mountain MIRECC

Jacob K. Farnsworth, Ph.D., Psychology Internship and Practicum Training Director; Psychology Program Manager, Rocky Mountain Regional VA Medical Center

Sean M. Barnes, Ph.D., Clinical Research Psychologist; Acting Director of Education, Rocky Mountain MIRECC; University of Colorado School of Medicine Anschutz Medical Campus, Department of Psychiatry

Robyn D. Walser, Ph.D., Psychologist, National Center for PTSD

Participants earn 5 continuing education credits.

Categories: Adult Anxiety, Treatment – CBT

Keywords: Exposure, Anxiety, Fear

Basic to moderate level of familiarity with the material.

Moral distress is an ever-present reality of human experience amplified through media outlets and social platforms. High-stakes experiences evoking moral distress, known as “potentially morally injurious events” (PMIEs), include healthcare work, war, sexual assault, political violence, racism, and other moral violations (Griffin et al., 2019). After PMIE exposure, individuals commonly feel moral distress (also known as “moral pain”), which includes painful moral emotions (e.g., guilt, shame, contempt, anger, disgust) and cognitions (e.g., self-blame or blaming others). Moral injury emerges when efforts to cope with moral pain significantly interfere with social, psychological, and spiritual functioning. These coping strategies present in a range of clinical forms, including suicidal behavior, substance use, and symptoms of PTSD and depression. Consequently, transdiagnostic treatments are needed to facilitate recovery from moral injury.

Acceptance and Commitment Therapy for Moral Injury (ACT-MI; Borges et al., 2022; Farnsworth et al., 2017) is an innovative, transdiagnostic 15-session hybrid group (12-group sessions) and individual psychotherapy (3-individual case conceptualization sessions) where participants learn to remain present to internal experience while living their values. Results from a rigorous randomized controlled pilot trial (N = 74) will be reviewed where participants reported 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”) and identified clinically significant improvements in psychosocial functioning (Outcome Questionnaire-45: M=-17.45, SD=19.33, 95% CI=-24.80, -10.10). Institute participants will learn skills to conceptualize and intervene on moral injury inclusive of a range of PMIEs. Presenters will demonstrate key ACT-MI skills. Institute participants will practice clinically applying ACT-MI through individual practice, small group experiential exercises, and large group community engagement. Participants will learn how to empower clients (and themselves) to connect with moral pain as an observer who holds but is not defined by their pain, creating the opportunity to live values even in the presence of moral pain.

Outline:

1. Discuss data supporting ACT-MI and describe populations who have benefitted and could benefit from ACT-MI treatment.
2. Describe how to conceptualize moral injury 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. Practice experientially exploring the workability of avoiding and controlling moral pain in small groups with a “client.”
5. Practice holding moral pain from the perspective of the observer self through a self-guided experiential exercise.
6. 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.
7. Define the relationship between moral pain and values as two sides of the same coin.
8. Engage in a small group experiential exercise, helping “clients” to identify values that signal their moral pain.
9. Practice holding morally painful and pleasant memories from the perspective of an observer who has but is not defined by these memories and guiding “clients” through this process.
10. Practice guiding “clients” in building patterns of behavior informed by their values.

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

1. Describe how to conceptualize moral injury using ACT-MI principles.
2. Apply experiential exercises from ACT-MI to build flexibility in responding to moral pain.
3. Support clients in creating a context for observing moral pain in the present moment, as an observer that has moral pain but is not defined by it.
4. Define the relationship between moral pain and values as two sides of the same coin.
5. Practice guiding clients in living their values, building patterns of behavior informed by living meaningfully.

Long-term Goals:

• Conceptualize moral injury from a functional contextual perspective
• Use strategies from ACT-MI to help clients observe and hold their moral pain
• Use strategies from ACT-MI to empower clients to live their values

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

Recommended Reading 4: Borges, L. M., Bahraini, N. H., Holliman, B. D., Gissen, M. R., Lawson, W. C., & Barnes, S. M. (2019). Veterans’ perspectives on discussing moral injury in the context of evidence-based psychotherapies for PTSD and other VA treatment. Journal of Clinical Psychology, 76(3), 377-391. doi:10.1002/jclp.22887

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:

Kirk Strosahl, Ph.D., Owner/President, HeartMatters Consulting LLC

Patricia Robinson, Ph.D., President, Mountainview Consulting Group

Participants earn 5 continuing education credits.

Categories: Mindfulness & Acceptance, Transdiagnostic

Keywords: Mindfulness, Psychotherapy Process, Acceptance

Basic to moderate level of familiarity with the material.

Activating the processes of present moment and transcendent self-awareness is central to the success of ACT clinicians seeking to “Bridge the Divide” and provide inclusive, effective, affirming care. Unfortunately, entering into and navigating the present moment is also fraught with perils, as fracturing present moment awareness is a powerful experiential avoidance strategy that we all use. Thus, it is not surprising that treatment fidelity data of ACT in practice consistently show that working with the “aware pillar” of psychological flexibility is an area of weakness for most therapists. Why? First, it is difficult to elicit, sustain and expand one’s own contact with the present moment, much less get the client to do the same thing at the same time. Second, it is unclear what psychological skills and processes go into promoting “present moment and transcendent awareness”, leading to a hazy sense of what should be accomplished at the intervention level.

In this institute, we will provide a clear framework for understanding the various facets of present moment and transcendent awareness, and what the “job” of the ACT therapist is with respect to working with them. We will deconstruct the present moment as a set of discrete, coachable psychological skills that the therapist can deliberately elicit, sustain and expand in a specific, unfolding, coached sequence. These skills include adopting an observer stance, providing accurate, verbal discriminations for and between inner experiences, practicing non-judgment of what is in awareness, approaching inner weaknesses and regrets with self-compassion and being intentional in daily actions. Promoting these processes in session requires that special attention be paid, not just to the client’s non-verbal cues, but also to the therapist’s functional use of language. We will demonstrate how the “language” of the here and now is quite distinct from talk about the past or future. Using experiential exercises and dyadic role playing skill practice, we will help participants develop their own lexicon for eliciting, sustaining and expanding the client’s present moment capabilities. At the conclusion of this training, attendees will have specific clinical tools that can be applied confidently in professional practice.

Outline:

1. TOPIC I: An Overview of the Role of Present Moment Awareness In Psychological Health
   1. Why is the “center pillar” the “center pillar?” Review of the psychological flexibility model.
   2. The role of verbal behavior in allocating and controlling attention or “why we all live in our heads”
   3. Present moment awareness as the conduit to self-acceptance and intentionality in life
   4. Cultural, social and psychological barriers to living in the here and now
   5. How fracturing present moment awareness is related to persistent maladaptation and mental suffering
2. TOPIC II. Present Moment Awareness as a Set of Psychological Skills
   1. Description of the five facet model
      1. Observer self
      2. Verbal labelling of inner experience
      3. Being non-judgmental
      4. Being self-compassionate
      5. Connecting values and actions in everyday life
   2. Experiential Exercise: Be present with something that troubles you and work the progression
      1. Small group debriefing
3. TOPIC III. Strategies for Eliciting Present Moment Awareness in Real Time
   1. Identifying and utilizing in session experiential avoidance
      1. Amplifying pain or discomfort in the moment
      2. Slowing it down
      3. Being aware of non-verbals
      4. “Coach” talk or no talk
      5. Go with the flow
      6. You get as far as you get
4. TOPIC IV. Present Moment Language Skills
   1. How to pick out and amplify a moment of pain/avoidance
   2. How to create  an atmosphere of safety and companionship
   3. How to be compassionate, validating while retaining focus
   4. How to handle the client’s verbal behavior in the moment
   5. The nuances of coach talk
   6. How to debrief what happened without using yours or the client’s “big brain”
5. TOPIC V. Putting It All Together: Dyadic Role Play Skill Training
   1. Role play case example 1 plus dyadic and large group debriefing
   2. Role play case example 2 plus dyadic and large group debriefing
6. TOPIC VI: Q & A and Establishing a Personal Practice Plan
   1. Small group exercise: Share your personal practice plans

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

1. Analyze the important role present moment awareness plays in promoting psychological flexibility and overall health and well-being.
2. Describe the five core skill components of present moment awareness
3. Utilize a clinical framework for targeting, eliciting, sustaining and strengthening present moment awareness skills in therapy
4. Apply a clinical lexicon designed to elicit and sustain present moment interventions in therapy
5. Utilize moment by moment coaching strategies designed to strengthen present moment awareness skill

Long-term Goals:

• Increase the capacity to apply present moment interventions to promote rapid, radical change in your clients.
• Better understand the skill-based nature of mindfulness based interventions, and their benefits, in clinical practice.

Recommended Readings:

Kiken, L. G., Lundberg, K. B., & Fredrickson, B. L. (2017). Being present and enjoying it: Dispositional mindfulness and savoring the moment are distinct, interactive predictors of positive emotions and psychological health. Mindfulness, 8(5), 1280–1290. https://doi.org/10.1007/s12671-017-0704-3

Lilja, J., Lundh, L., Josefsson, T., Falkenström, F., & Brothers, A. (2016). Cognitive reappraisal and acceptance: An experimental comparison of two emotion regulation strategies. Behaviour Research and Therapy, 80, 15-22.

Troy, A., Shallcross, A., Brunner, A., Friedman, R., & Jones, M. (2018). Cognitive reappraisal and acceptance: Effects on emotion, physiology, and perceived cognitive costs. Emotion, 18, 58–74. https://doi.org/10.1037/emo0000371

Carpenter, J., Sanford, J. & Hoffman, S. (2019) The effects of a brief mindfulness training on distress tolerance and stress reactivity. Behavior Therapy, 50-630-645. https://doi.org/10.1016/j.beth.2018.10.003.

Allen, J.G., Romate, J. & Rajkumar, E.(2021) Mindfulness-based positive psychology interventions: a systematic review. BMC Psychology, 9, 116. https://doi.org/10.1186/s40359-021-00618-2

James, D., Atkins, P., Parker, P., Christie, A., & Ryan, R. (2016). Daily stress and the benefits of mindfulness: Examining the daily and longitudinal relations between present-moment awareness and stress responses, Journal of Research in Personality,65, 30-37. https://doi.org/10.1016/j.jrp.2016.09.002.

Presented by:

Kristen Fritsinger, LICSW, MSW, Owner/Clinician, DBT Associates LLP

Hope Arnold, M.A., LCSW, Owner/Clinician, Simply RO DBT

Roelie J. Hempel, Ph.D., Co-Director, RO DBT Online B.V.

Participants earn 5 continuing education credits.

Categories: Treatment – Other, Transdiagnostic

Keywords: DBT (Dialectical Behavior Therapy), Depression, Anorexia

Basic level of familiarity with the material.

Emotional loneliness and social isolation are key risk factors for mental and physical health and are seen as the core problems for clients struggling with maladaptive overcontrol. Maladaptive overcontrol is a coping style characterized by excessive inhibition, compulsive planning, and aloof relationships that limit new learning and the development of close social bonds.  Overcontrol is common in clients with chronic depression, restrictive eating disorders, obsessive-compulsive personality disorders, social anxiety, and autism, for example.

 Radically open dialectical behavior therapy (RO DBT) aims to address clients’ emotional loneliness by teaching them skills to enhance their flexibility, openness to new learning, and above all, their social signaling. RO DBT’s key mechanism of change proposes that context-appropriate social signaling enhances trust, resulting in improved social connectedness and mental health. RO DBT is a fully manualized (Lynch, 2018) and evidence-based transdiagnostic treatment for disorders of overcontrol, supported by research demonstrating its effectiveness for adults and adolescents with anorexia nervosa, chronic depression, personality disorders and autism spectrum disorders (for a systematic review, see Hatoum & Burton, 2024).

The aim of this institute is to learn the foundations of RO DBT and assess whether RO DBT could benefit your overcontrolled clients. You will learn how to recognize and assess clients with overcontrol, as well as understand the basic treatment structure, and consider how to implement RO DBT in your own practice. Using role-plays, exercises and demonstrations, the instructors will engage the audience and provide you with the tools to assess overcontrolled clients within your practice.

Outline:

1. 1. Review of the evidence-base of RO DBT
   2. The differences between over- and under-control
   3. Assessing overcontrol
   4. Introduction to RO DBT Treatment Structure and Targeting

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

1. Evaluate the efficacy of RO DBT for clients with an overcontrolled style of coping via published peer reviewed studies.
2. Compare the differences between overcontrolled and undercontrolled bio-temperament and explain how these impact perception and emotion regulation strategies in social situations.
3. Identify common errors and assumptions when assessing overcontrol and apply this knowledge to your own assessment procedures.  
4. Use the Assessing Styles of Coping Word-Pair List to assess your own and your clients’ coping style.
5. List the four components of the RO DBT treatment structure.

Long-term Goal:

• Going forward, participants will be able to recognize and diagnose overcontrolled clients when they present themselves in their clinic, enabling the clinician to select the most appropriate treatment for their clients. 

Recommended Readings:

Hatoum, A. H., & Burton, A. L. (2024). Applications and efficacy of radically open dialectical behavior therapy (RO DBT): A systematic review of the literature. Journal of Clinical Psychology, Advance online publication(1097-4679 (Electronic)). https://doi.org/https://doi.org/10.1002/jclp.23735

Baudinet, J., Stewart, C., Bennett, E., Konstantellou, A., Parham, R., Smith, K., Hunt, K., Eisler, I., & Simic, M. (2021). Radically open dialectical behaviour therapy adapted for adolescents: a case series. BMC Psychiatry, 21(1), 462. https://doi.org/10.1186/s12888-021-03460-3

Lynch, T. R., Hempel, R. J., Whalley, B., Byford, S., Chamba, R., Clarke, P., Clarke, S., Kingdon, D. G., O’Mahen, H., Remington, B., Rushbrook, S. C., Shearer, J., Stanton, M., Swales, M., Watkins, A., & Russell, I. T. (2020). Refractory depression – mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms. Br J Psychiatry, 216(4), 204-212. https://doi.org/10.1192/bjp.2019.53

Gilbert, K., Codd, R. T., Hoyniak, C., Tillman, R., Baudinet, J., Pires, P. P., Hempel, R., Russell, I., & Lynch, T. R. (2023). Processes of change in a randomized clinical trial of radically open dialectical behavior therapy (RO DBT) for adults with treatment-refractory depression. J Consult Clin Psychol, 91(2), 71-81. https://doi.org/10.1037/ccp0000795

Hempel, R. J., Rushbrook, S. C., O’Mahen, H., & Lynch, T. R. (2018). How to Differentiate Overcontrol from Undercontrol: Findings from the RefraMED study and Guidelines from Clinical Practice. The Behavior Therapist, 41(3), 132-142.