Awareness and Connection in Ethnically and Racially Diverse Therapist-Client Dyads

Workshop 1

Awareness and Connection in Ethnically and Racially Diverse Therapist-Client Dyads

Monnica Williams, University of Louisville

Chad T. Wetterneck, Rogers Memorial Hospital

Basic level of familiarity with the material

Primary Topic: Ethnic, Cultural, Diversity

Key Words: Cultural Differences, Diversity, Therapeutic Alliance

Given the increasing diversity of clients seeking CBT, there is a growing need to enhance the cultural sensitivity of therapeutic interventions with ethnoracial minority populations. This workshop will provide clinical perspectives on how to incorporate cultural factors into CBT. The presenters will discuss strategies for making treatment more relevant when working with underserved and marginalized populations. An assessment of functional and nonfunctional behaviors of both therapists and clients will be examined from the behaviorally based Functional Analytic Psychotherapy (FAP) perspective. Additionally, presenters will address how certain therapies can be adapted when working with clients with diverse backgrounds, particularly as many empirically supported interventions were developed among relatively homogeneous research populations. Topics will include: strategies to build alliances across diverse therapeutic dyads; modifications to psychoeducation to include the role of racism and discrimination; identifying ethnoracial biases of the therapist; and how to identify and prevent committing microaggressions against clients, which can rupture the therapeutic alliance (and how to repair them if you do). This workshop will include demonstrations and opportunities will be provided for participants to ask questions and discuss cases.

You will learn:

1.  How to build a strong therapeutic alliance with clients who are ethnoracially different than the therapist.

2.  How to address and integrate cultural issues in therapy.

3.  How to identify and avoid microaggressions against clients.

Recommended Readings:

Sue, D. W., Capodilupo, C., Torino, G., Bucceri, J., Holder, A., Nadal, K., & Esquilin, M. (2007). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, 62(4), 271-286. Terwilliger, J. M., Bach, N., Bryan, C., & Williams, M. T. (2013). Multicultural versus colorblind ideology: Implications for mental health and counseling. In A. Di Fabio (Ed.), Psychology of counseling. Hauppauge, NY: Nova Science Publishers. Vandenberghe, L., Tsai, M., Valero, L., Ferro, R., Kerbauy, R. R., Wielenska, R. C., . . . Muto, T. (2010). Transcultural Functional Analytic Psychotherapy. In Kanter et al. (Eds.), The practice of functional analytic psychotherapy. New York: Springer.

Workshop 2

A Manualized Cognitive-Behavioral Therapy Group for Treating Diverse Addictive Behaviors

Bruce S. Liese, University of Kansas Medical Center

Moderate level of familiarity with the material

Primary Topic: Addictive Behaviors

Key Words: Addictive Behaviors, Group CBT, Substance Use Disorders, Addiction Syndrome, Behavioral Addictions

Over the past few decades an increasing amount of research has focused on behavioral addictions, and in 2013 the American Psychiatric Association introduced the term “behavioral addictions” into its Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for the first time. Individual and group cognitive-behavioral therapies continue to be the most empirically supported treatments for addictive behaviors, and group therapy continues to be the most common modality used to treat addictive behaviors, likely due to its cost-effectiveness.

Over the past 20 years we have developed the cognitive-behavioral therapy addictions group (CBTAG). The following are basic characteristics of this group: (1) it includes members with diverse addictions to drugs, alcohol, nicotine, and gambling at all stages of readiness to change; (2) groups are open and new members may enter on a rolling basis; (3) sessions are active, structured, educational, and supportive; (4) groups range from 4 to 8 members and sessions last 90 minutes; (5) group facilitators use a combination of guided discovery and didactics adapted to group members’ presenting problems; (6) goals include modification of addictive behaviors and development of coping strategies.

Various educational methods will be used in this workshop. Some material will be presented in lecture format and participants will be encouraged to ask questions and discuss this material throughout the workshop. Case examples will be provided to illustrate group content and process. Attention will be paid to common challenges in facilitating such a group. Role-play demonstrations will be used to directly teach participants how to conduct the CBTAG.

You will learn:

1.  How to design and facilitate a CBTAG, including structure, content, essential components, and facilitative conditions that optimize the group therapy experience.

2.  How to conceptualize individuals with diverse chemical and behavioral addictive behaviors and associated problems according to a CBT framework, as part of the treatment process in the CBTAG.

3.  Effective strategies for anticipating and addressing challenging group members and group processes.

Recommended Readings:

Liese, B.S. (2014). Cognitive-behavioral therapy for addictions. In S.L.A. Straussner (Ed.), Clinical work with substance abusing clients (3rd ed., pp. 225-250). New York: Guilford Press. Shaffer, H. J., LaPlante, D. A., Nelson, S. E. (Eds.). (2012). APA Addiction syndrome handbook: Volumes 1 and 2. Washington, DC: American Psychological Association. Wenzel, A., Liese, B.S., Beck, A.T., Friedman-Wheeler D.G. (2012). Group cognitive therapy of addictions. New York: Guilford Press.

Workshop 3

Introduction to the Unified Protocol for Transdiagnostic Treatment for Emotional Disorders

Todd J. Farchione, Center for Anxiety and Related Disorders, Boston University

Matthew W. Gallagher, VA Boston Healthcare System

Introductory level of familiarity with the material

Primary Topic: Treatment-Transdiagnostic

Key Words: Anxiety, Depression, CBT, Transdiagnostic

The proliferation of disorder-specific treatment manuals has created unintended barriers for implementation and dissemination of evidence-based psychological treatments. Research emerging from the field of emotion science suggests that individuals suffering from anxiety and mood disorders experience negative affect more frequently and more intensely than healthy individuals, and that they tend to view these experiences as more aversive. Deficits in emotion regulation, emerging out of unsuccessful efforts to avoid or dampen the intensity of uncomfortable emotions, have been found to cut across the emotional disorders and have become a core target for therapeutic change. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP; Barlow et al., 2011) is a mechanism-focused transdiagnostic treatment that purports to address underlying vulnerabilities (neuroticism: negative emotionality and distress aversion) for common mental disorders rather than focusing on diagnostic symptoms. This allows the UP to simultaneously address comorbid conditions and by providing a treatment that more adequately maps on to real-word patient presentations, the UP may be more acceptable to clinicians in community settings. This workshop will (a) provide a brief overview of the theoretical foundation and empirical evidence supporting the development of the UP; (b) introduce attendees to the protocol’s core treatment components; and, using illustrative case example, (c) explore how these components can best be applied to clinical practice.

You will learn:

1.  The potential advantages associated with a transdiagnostic approach to treatment, relative to using a cognitive-behavioral protocol designed to address the symptoms of a single disorder.

2.  The primary treatment components of the UP.

3.  How the core UP treatment elements can be applied across diagnoses and to address comorbidity.

Recommended Readings:

Barlow, D.H., Farchione, T.J., Fairholme, C.P., Ellard, K.K., Boisseau, C.L., Allen, L.B., & Ehrenreich-May, J. (2011). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist guide. New York: Oxford University Press. Farchione, T.J., Fairholme, C.P., Ellard, K.K., Boisseau, C.L., Thompson-Hollands, J., Carl, J.R., Gallagher, M.W. & Barlow, D. H. (2012).The unified protocol for the transdiagnostic treatment of emotional disorders: A randomized controlled trial. Behavior Therapy, 43, 666-678. Payne, L. A., Ellard, K. K., Farchione, T.J., Fairholme, C. P., & Barlow, D. H. (2014). Emotional disorders: A unified transdiagnostic protocol. In D.H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (5th ed.). New York:

Guilford Press.

Workshop 4

Applying Evidence-Based Assessment to Bipolar Disorder: Assessing Quickly and Accurately to Reach Better Outcomes

Eric A. Youngstrom, University of North Carolina at Chapel Hill

Moderate level of familiarity with the material

Primary Topic: Child

Key Words: Assessment, BPD, Child, Treatment

Although Kraepelin described cases of prepubertal onset of manic syndromes a century ago, and case reports appeared in subsequent decades, the modern study of bipolar disorder in children and adolescents is only 20 years old. The knowledge base has increased exponentially since then. PubMed now has more than 8,500 articles indexed about pediatric bipolar disorder (PBD), and the pace of publication continues to accelerate. This workshop distills the explosion of new data into concrete action steps that a clinician can use immediately. Several recent meta-analyses have compiled the research evidence into quantitative summaries and clinically actionable recommendations. In 2011, Van Meter et al. meta-analyzed 12 epidemiological studies (from 1,500 reviewed hits) about rates of bipolar I and bipolar spectrum disorders in youths; though six studies have been published since, general conclusions remain similar. Likewise, Kowatch et al. (2005) published a preliminary meta-analysis of phenomenological features in pediatric bipolar disorder; now the available samples more than double the number of cases with research diagnoses of bipolar disorder included. Similar progress has been made in terms of assessment, where a meta-analysis started with 4,094 hits and finished with 27 studies, 63 effect sizes, N = 10,232 youths, of whom 1,719 had PBD diagnoses, including parent, youth, and teacher report. We integrate these findings into a set of clinical recommendations for evidence-based assessment for PBD. These steps add less than 5 minutes and less than 5 dollars to the typical assessment, yet yield large gains in accuracy, more agreement about next clinical action, and better outcomes.

You will learn:

1.  Base rates in different settings, such as public schools, outpatient services, forensic settings, and inpatient units, and how to use these benchmarks to evaluate efficiently.

2.  Assessment procedures to aid in differential diagnosis and measuring response to treatment.

3.  New methods for interpreting test results, including methods that take into account the clinical setting.

Recommended Readings:

Youngstrom, E.A. (2013). Future directions in psychological assessment: Combining evidence based medicine innovations with psychology’s historical strengths to enhance utility. Journal of Clinical Child and Adolescent Psychology, 42, 139-159. doi: 10.1080/15374416.2012.736358. Youngstrom, E.A., Choukas-Bradley, S., Calhoun, C.D., & Jensen-Doss, A. (2015). Clinical guide to the evidence-based assessment approach to diagnosis and treatment. Cognitive and Behavioral Practice, XX, 20-35. doi: 10.1016/j.cbpra.2013.12.005. Youngstrom, E.A., & Frazier, T.W. (2013). Strategies for evidence-based assessment in children and adolescents: Measuring prediction, prescription, and process. In D. Miklowitz, W. E. Craighead, & L. Craighead (Eds.), Psychopathology: History, diagnosis, and empirical foundations (2nd ed., pp. 36-79). New York: Wiley. Youngstrom, E.A., & Perez Algorta, G. (2014). Pediatric bipolar disorder. In E. Mash & R. Barkley (Eds.), Child psychopathology (3rd ed., pp. 264-316). New York: Guilford Press.

Workshop 5

Recovery-Oriented Cognitive Therapy: An Evidence-Based Program to Promote Successful Goal-Achievement and Resilience for Individuals With Schizophrenia, in and out of the Hospital

Paul Grant, University of Pennsylvania

Aaron Brinen, University of Pennsylvania

Aaron T. Beck, Perelman School of Medicine, University of Pennsylvania

Basic level of familiarity with the material

Primary Topic: Chronic Mental Illness/Schizophrenia

Key Words: Recovery, Schizophrenia, Community Integration

Low-functioning individuals with schizophrenia experience a profound sense of apartness and deprivation. Problems that hinder these individuals from participating in the community include negative symptoms, hallucinations, grandiose beliefs, disorganized behavior, and aggressive actions towards others. Within an evidence-based, recovery-oriented framework, instructors will show how to apply the cognitive model, adapted to individuals with schizophrenia, to understand and overcome these challenging problems. Instructors will demonstrate specific procedures to: (a) evoke obscured strengths and capacities, (b) energize aspirations for the future, (c) identify promising targets of future-oriented action, (iv) promote positive action toward those targets. By focusing resources in meaningful activities in the real world, the individuals experience success and a sense of belonging. They can substitute the external world for the internal world, and draw new, more helpful conclusions about themselves and others. The workshop features role-plays, presentation of video and audio, and will be relevant to hospital and community service providers.

You will learn:

1.  Specific procedures to establish connection with individuals who are isolated, demoralized, disorganized, and traditionally difficult to engage.

2.  How to identify behavioral targets that will promote motivation and presage a series of nested success experiences (recovery operationalized).

3.  How to use a cognitive conceptualization to design interventions to change beliefs and promote long-term change and progress toward recovery.

Recommended Readings:

Beck, A.T., Rector, N., Stolar, N.M., & Grant, P.M. (2009). Schizophrenia: Cognitive theory, research, and therapy. New York: Guilford. Grant, P.M., Huh, G.A., Perivoliotis, D., Stolar, N.M., & Beck, A.T. (2012). Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia. Archives of General Psychiatry, 69(2), 121-127. doi: 10.1001/archgenpsychiatry.2011.129. Chang, N., Grant, P.M., Luther, L., & Beck, A.T (2014). Effects of a recovery-oriented cognitive therapy training program on inpatient staff attitudes and incidents of seclusion and restraint. Community Mental Health Journal, 50, 415-421. doi: 10.1007/s10597-013-9675-6

Workshop 6

Cognitive Behavioral Therapy for Mental Contamination

Roz Shafran, UCL Institute of Child Health

Maureen Whittal, Vancouver CBT Centre

Advanced level of familiarity with the material

Primary Topic: OC and Related Disorders

Key Words: Mental Contamination, Behavioral Experiments, Treatment Development

Treatment outcomes for OCD have plateaued over the past 20 years. This problem has led to a call for adaptations to the gold-standard treatment and conceptualizations of the problem. Recent work on mental contamination is one such adaptation. Fears of contamination and washing are one of the most common OCD presentations and are reported by one-third of patients. Until recently the focus has been on illness-based fears triggered by physical contact with a threatening object such as a doorknob or money or the ground. There is increasing focus on the understanding and treatment of contamination fears that arise in the absence of any physical contact with a stimulus. Such "mental contamination," the feeling of being polluted, dirtied, infected, or endangered in the absence of a physical contaminant, has been found to effect just under half of people with OCD. Mental contamination is often associated with betrayal or humiliation and the individual perceives him- or herself as uniquely vulnerable. There are particular challenges with conducting exposure and response prevention for mental contamination, including that the source of the contaminant is typically human, the contamination is generated internally (e.g., by memories), and there is often a moral quality. The workshop will focus on the nature, assessment, and treatment of mental contamination using cognitive behavioral methods. The intervention does not involve exposure and response prevention but instead focuses on the meaning of contamination, implications for the self, imagery rescripting, and behavioral experiments. Experimental evidence for the intervention will be presented.