Mike Heady, LCPC and Carl Robbins, LCPC

There is growing interest among clinicians in finding evidence-based approaches for OCD that can complement or provide alternatives to ERP. In this session, two colleagues with over 50-years combined experience will provide a practical, case-based conversation about the theory and application of I-CBT. We will discuss how obsessional doubting differs from tolerating uncertainty and how this impacts treatment. Specific process-based cognitive interventions that go beyond standard ERP and ACT will be demonstrated.

Larry Cohen, LICSW

A great many outcome studies have repeatedly demonstrated that cognitive-behavioral therapy is the most effective treatment for social anxiety disorder (SAD), the third or fourth most prevalent mental health disorder in the United States. The core treatment element in CBT for SAD, like that of any other anxiety-related disorder, involves the use of exposures (aka experiments) conducted in anxiety-provoking situations. But to what end? Are these exposures designed to achieve anxiety habituation, or the pursuit of life values while accepting anxiety and reducing avoidance? Are these exposures designed as experiments to test anxious predictions (aka violating expectancy) and underlying core beliefs? How we conceptualize exposures / experiments impacts the strategies we use in helping those whose lives are diminished, often severely so, by SAD.

This session will discuss the different approaches and objectives of several approaches to using exposures / experiments in the treatment of SAD, and what research indicates is most effective. The strengths and limitations of each approach will be discussed, with emphasis on how to combine or adapt the approaches to the needs of particular clients. Clinical demonstration will be included. Other clinical demonstrations, client worksheets and instructional handouts will be distributed.

Jonathan Dalton PhD, Monique Reynolds PhD, and Jennifer Bienstock PsyD

Johanna S. Kaplan, PhD, Lediya Dumessa, PhD, and Anna Villavicencio, PhD

The phrase “Failure to launch” has been used to describe the inability of young adults (ages 18- 34) to develop effective coping mechanisms with complicated, emerging stressors in their environment. Often, premorbid and/or current symptoms of anxiety and depression will mediate a successful transition. It is important to begin with a functional analysis to determine how unsuccessful contingencies emerged (e.g., if there were limited opportunities to learn how to successfully cope with failure early in life). It is also important to examine other facets of ineffective transition (e.g., patterns of avoidance, distress tolerance, emotion regulation skills, social skills, executive functioning skills such as time management and organization, and general functional life skills). As 70% report current adequate satisfaction in regards to returning or continuing to live with their parental figures (Sachs, 2010), it is important to examine contingencies in the family system. Families can assist in the generalization and reinforcement of skills. This workshop will present attendees with a review of cognitive-behavioral skills used in “failure to launch” treatment, discuss the benefits of using several treatment format modalities (e.g., individual, peer groups) and will discuss case examples and the specific application of cognitive-behavioral skills.

Philip Held, PhD, Brian Klassen, PhD, Sheila Rauch, PhD, ABPP, Barbara Rothbaum, PhD

Over the past decade, intensive treatment models for posttraumatic stress disorder (PTSD) have amassed substantial empirical support (Held et al., 2019; Ragsdale et al., 2020). In intensive models, established evidence-based treatments, such as Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE), are delivered such that a full course of treatment is completed in 1-3 weeks (Held et al., 2019; Ragsdale et al., 2020). Intensive delivery format is feasible, well-tolerated, and produces rapid reductions in both PTSD and depression symptoms (Held et al., 2022; Rauch et al., 2021) that are maintained over the long-term (e.g., Held et al., 2020; Burton et al., 2022; Smith et al., 2022). Furthermore, studies have shown that intensive PTSD models are robust for a variety of complex clinical presentations.   In this State-of-the-Art Clinician Session, four intensive PTSD treatment experts, Drs. Held, Klassen, Rauch, and Rothbaum, will present on how clinicians and organizations can intensively deliver evidence-based treatments, such as CPT and PE. The presentation will cover (1) delivery of these models either as a stand-alone intervention or as part of a more holistic program, (2) clinical outcomes, and (3) known predictors of treatment success. Presenters will discuss potential future directions for research and clinical practice.

Beth Salcedo, MD, Abigail Mintz Romirowsky, PhD, LICSW and Avy Stock, PsyD

The majority of clinicians in the mental health field participate in a treatment model popularly referred to as collaborative treatment.  Also known as split treatment, this model of care has become the overwhelming standard for patients needing both psychotherapy as well as medications to manage their psychiatric illness; one clinician provides therapy while a separate clinician prescribes medication.   While we have evidence that for many diagnostic categories more than one treatment modality results in better outcomes, there is an unfortunate lack of data available to guide clinicians in navigating what can often be a complicated relationship.   In this session, clinicians from different mental health disciplines will present the data available that not only supports this treatment model but offers guidelines for how best to manage the many aspects of it.  They will present cases in which collaborative treatment proved to be beneficial in terms of patient outcome, but also aided in clinician satisfaction, as well as cases that did not have those positive impacts due to difficulty within the collaborative relationship.   They will offer clinicians guidance in the development of an individualized practice protocol that is shared with collaborating clinicians at the outset of the relationship to ensure the treatment remains patient centered and that obstacles in the collaborative relationship do not impede the provision of care.

Tejal Jakatdar, PhD, Amy Mariaskin, PhD, Michael Twohig, PhD

While evidence-based protocols suggest that there are clear beginnings, middles, and ends in treatment, implementing services in the community presents a murkier timeline. Termination is particularly tricky, especially when the therapist and client feel differently about readiness to discontinue or transfer care. When do we, as therapists, decide to wrap up treatment or refer out? How do we keep this process respectful and collaborative? And what are some strategies that will help promote an ethical transition out of treatment? Drs. Jakatdar, Mariaskin, and Twohig will outline sections relevant to termination in the APA code of ethics and present strategies (such as adequate psychoeducation, goal setting, and periodic assessment) that may help guide termination decisions. Moreover, they will provide clinical case examples that typify some of the most common dilemmas of termination, including when the client has met treatment goals but is reluctant to stop, when referrals to a higher level of care or different specialists are warranted, and when someone, such as a minor, is in treatment against their will.

Jamie A. Micco, PhD, ABPP 

Process-based CBT emphasizes a careful functional analysis to determine the mechanisms causing or maintaining distressing thoughts, emotions, or behaviors so they can be “linked to evidence-based procedures” (Hofmann & Hayes, 2018). This principle-driven approach to case conceptualization is particularly valuable for treating adolescents and emerging adults with Obsessive Compulsive and Related Disorders (OCRD), which have frequent co-occurrence with non-suicidal self-injury (NSSI). This session is designed for advanced clinicians who aim to improve their case conceptualization skills when working with adolescents who have OCRD and self-harm urges or NSSI. The presentation will include a review of the latest research on adolescents with OCRD and NSSI, the rationale for using a process-based CBT approach, and a detailed illustration of how to use functional analysis to inform a personalized treatment plan.

Michael R. Nadorff, PhD

Nightmares are associated with a wide range of psychopathology beyond post-traumatic stress disorder including anxiety, depression, borderline personality disorder, and suicidality.  Further, they are prevalent, with between 2-6 percent of the U.S. population reporting clinically-significant nightmares.  Despite this, they are usually not identified by mental health professionals or treated.  This session will discuss the phenomenon of nightmares, their correlates, and Imagery Rehearsal Therapy, which is the leading psychotherapy for the treatment of nightmare disorder and post-traumatic nightmares.

Charles Mansueto PhD, Elspeth Bell PhD, Sony Khemlani-Patel PhD

Seeking help for an Obsessive-Compulsive Related Disorder (OCRD) is a sign of strength, and fortunately there are effective, evidence-based treatments. But, what happens when a patient struggles to engage in treatment or life with the disorder has become so normal that there’s apathy toward treatment? Incorporating Motivational Interviewing (MI) in the treatment of OCRDs – including Hoarding Disorder, Body Dysmorphic Disorder (BDD), and Body-Focused Repetitive Behaviors (BFRBs) – can increase engagement and encourage progress in the therapeutic process. With Hoarding and BDD, perhaps the most challenging symptom for clinicians is high-overvalued ideation that interferes with therapeutic engagement and compliance. Patients frequently exhibit strong convictions that their beliefs and behaviors are logical, reasoning that non-therapeutic solutions would suffice.

Clinicians often struggle with developing a shared conceptual treatment framework because the patient has difficulty recognizing the benefits of psychological therapy. With BFRBs, the frequency of behaviors can result in a lack of awareness, and pleasure from picking or pulling makes it challenging for patients not just to interrupt the behavior but even to want to stop. This presentation will outline specific MI skills and strategies for engaging with patients. Attendees will find that the content readily applies to patient interactions without treading into therapy.

Alik Widge, MD, PHD

Mental disorders are disorders of communication in distributed brain circuits, but most available treatments target the whole brain at once. This talk will overview the rapidly growing field of interventional psychiatry, which seeks to treat mood disorders (primarily depression) by delivering focused, targeted electrical stimulation to the relevant circuits. I will overview non-invasive approaches such as transcranial magnetic stimulation (TMS), then proceed to surgical technologies such as vagus nerve stimulation (VNS) and deep brain stimulation (DBS). I will conclude by highlighting how the progress of these therapies has been hindered by the categorical approach embodied in the DSM, and may be advanced by considering a more quantitative/dimensional approach.