Pre-Meeting Institutes

Institutes are full or half day sessions that provide opportunities for intensive training on topics integral to the conference program, presented by leaders in the field.

FULL DAY INSTITUTES

PMI – 1: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

PMI – 2: Taking Your Prolonged Exposure (PE) Practice to the Next Level: How and When to Use PE with Complicated PTSD Patients

PMI – 3: Acceptance and Commitment Therapy: Mindfulness and Compassion in the Treatment of PTSD 

PMI – 4: Treatment of Complex Childhood Trauma: Comparative Application of Case Material to Four Leading Intervention Models

PMI – 5: Problem-Solving Therapy to Enhance Recovery and Resilience

HALF DAY INSTITUTES 

PMI – 6: New Evidence Supported Approaches to First Responder Behavioral Health: Implementing NFFF Firefighter Life Safety Initiative 13

PMI – 7: Trials and Tribulations of Implementing Evidence-based Therapy into Community Care 

PMI – 8: The Sanctuary Model: What It Takes to Create and Sustain Trauma-Informed and Resilient Organizations 

PMI – 9: Imagery Rescripting Therapy for Military Populations: An Introduction 

PMI – 10: How Understanding the Neurobiology of Post-Traumatic Stress Disorder Can Inform Clinical Practice: A Social Cognitive and Affective Neuroscience Approach

PMI – 11: Assessing PTSD According to DSM-5 

PMI – 12: Bringing Trauma Expertise to Immigrant Survivors: Forensic Documentation of Individuals Seeking Humanitarian Protection in the United States 

PMI – 13: Psychological First Aid – Keeping Providers Skills Up

PMI – 14: Ethnocultural Variation in Traumatic Stress in the United States: Epidemiology, Assessment, and Treatment 

PMI – 15: Mindfulness Based Stress Reduction: Theory and Practice of an Approach to Foster Resilience in Trauma Survivors and Their Clinicians

Wednesday, November 6, 2013
Full-Day Institutes
(8:30 a.m. – Noon and 1:30 p.m. – 5:00 p.m.)

PMI – 1

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

PMI Keyword: Clinical Practice
Presentation Level: Introductory
Region: Global

Judith A Cohen , MD1, Anthony P Mannarino, PhD2
1Allegheny General Hospital
2Allegheny General Hospital/Drexel University College of Medicine

OBJECTIVE: This PMI provides a brief introduction to Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for child mental health professionals. METHODS: Drs. Anthony Mannarino and Judith Cohen, two of the TF-CBT developers, describe three underlying principles of TF-CBT: that this is a components-and phase-based model; the use of gradual exposure throughout TF-CBT; and the importance of proportionality throughout treatment. They describe the TF-CBT phases (stabilization, trauma narration and consolidation) and components, summarized by the acronym "PRACTICE" that includes Psychoeducation; Parenting component; Relaxation skills; Affective modulation skills; Cognitive processing skills; Trauma narrative; In vivo mastery of trauma reminders; Conjoint child-parent sessions; and Enhancing safety. Case examples are included throughout to illustrate how TF-CBT helps children and families gain resilience after trauma, including complex trauma experiences. RESULTS: TF-CBT has been tested in 13 randomized controlled trials including for children who have experienced sexual abuse, domestic violence, war, commercial sexual exploitation, and multiple traumas. In these studies TF-CBT was superior to comparison or control conditions in improving children's PTSD symptoms and a variety of other difficulties. CONCLUSIONS: TF-CBT is an evidence-based treatment for treating traumatized children.

PMI – 2

Taking Your Prolonged Exposure (PE) Practice to the Next Level: How and When to Use PE with Complicated PTSD Patients

Keyword: Clinical Practice
Presentation Level: Intermediate
Region: Global

David Yusko, PsyD1, Edna B Foa, PhD1, Nitsa Nacasch, MD2
1 University of Pennsylvania
2 Tel-Aviv Brull Community Mental Health Center

Despite the comprehensive research that exists using prolonged exposure therapy (PE) there are still questions about it being a potentially harmful treatment for certain patients with PTSD. Even though PE is the most widely studied therapy for PTSD, with the most evidence supporting its efficacy in a broad range of PTSD populations (e.g. variety of target traumas, demographic diversity, various types of comorbidity, and wide dissemination), there is still more to learn. This institute will begin with a brief review of the evidence supporting the efficacy and effectiveness of PE. From there, a review of the basic components involved in PE, followed by a combination of actual treatment videos and real case vignettes that illustrate how PE experts have implemented PE in these complicated treatment cases. Case presentations will demonstrate the use of PE with the following populations: comorbid substance dependence, comorbid borderline personality, early childhood sexual abuse, repeated and/or prolonged traumas, and comorbid OCD. The institute encourages participants to present their own difficult PTSD cases for consultation.  In summary, the institute will focus on the following aspects: 1) an overview of PE treatment literature, 2) a review of PE treatment components; 3) actual patient illustrations of PE being used in difficult trauma populations, 4) institute participants bringing in their own case material for consultation from PE experts, and 5) instruction on when and how to modify PE procedures in complicated PTSD populations.

PMI – 3

Acceptance and Commitment Therapy: Mindfulness and Compassion in the Treatment of PTSD

Keyword: Clinical Practice
Presentation Level: Intermediate
Region: Industrialized Countries

Robyn Walser, PhD
National Center for PTSD – Dissemination and Training Division, VA Palo Alto Health Care System

Acceptance and Commitment Therapy (ACT) is a principle-based behavioural intervention that is designed to address human suffering in a mindful and compassionate way. ACT also aims to support individuals in engaging commitments to behaviour change that are consistent with personal values and well-being. While ACT has been applied to a wide variety of problems, it is well suited to the treatment of trauma.  Individuals who have been diagnosed with PTSD and trauma related problems are often disturbed by traumatic memories, nightmares, unwanted thoughts and painful feelings. They are frequently working to avoid these experiences and the trauma-related situations or cues that occasion them. In addition to the symptoms of PTSD, the painful emotional experience and aftermath of trauma can often lead the traumatized individual to view themselves as “damaged” or “broken” in some important way. These difficult emotions and thoughts are associated with a variety of behavioral problems ranging from substance abuse to relationship problems. ACT seeks to reduce rigid and inflexible attempts to control negative emotions by fostering acceptance through mindfulness and defusion techniques. The client is guided to experience internal events without effort in unworkable control. The ultimate goal is psychological and behavioural flexibility in the service of a more workable life. In this presentation we will briefly explore the theoretical underpinnings of ACT in addition to the six core components of ACT and how they are used to treat experiential avoidance and problematic rule following found in PTSD. A broad overview of the intervention techniques will also be presented.

PMI – 4

Treatment of Complex Childhood Trauma: Comparative Application of Case Material to Four Leading Intervention Models

Keyword: Clinical Practice
Presentation Level: Intermediate
Region: Industrialized Countries

Adam Douglass Brown, PsyD1, Julian Ford, PhD2, Margaret Blaustein, PhD3, Mandy Habib, PsyD4, Glenn Saxe, MD5
1 New York University School of Medicine
2 University of Connecticut Health Center
3 Trauma Center at Justice Resource Institute
4 Adelphi University
5 New York University Langone Medical Center

This full-day pre-meeting workshop will begin with an Introductory-level morning session introducing participants to four leading evidence-based models for complex trauma intervention developed by members of the NCTSN over the past decade: ARC (Attachment, Self-Regulation and Competency), SPARCS (Structured Psychotherapy for Adolescents Responding to Chronic Stress) TARGET (Trauma Affect Regulation: Guide for Education and Therapy) and TST (Trauma Systems Therapy). Model developers will describe key facets of each model, including the processes and techniques through which each model addresses the core components of complex trauma intervention. The afternoon session will feature an Intermediate-level application of each intervention model to the same case, the "James" clinical vignette from the NCTSN's Core Concepts Curriculum.  Presentations will be followed by integrative comments from the Program Chair from a Core Components perspective. Ensuing panel discussion will be audience-driven, and will focus on examination of the shared and unique elements of each treatment model, and consider model fit based on client-specific and contextual factors, including developmental stage, treatment setting, care-giving system and cultural considerations.

PMI – 5

Problem-Solving Therapy to Enhance Recovery and Resilience

Keyword: Clinical Practice
Presentation Level: Introductory
Region: Not Applicable

Arthur M Nezu, PhD, ABPP, Christine Maguth Nezu, PhD, ABPP
Drexel University

Problem-Solving Therapy (PST) is an evidenced-based, cognitive-behavioral intervention, based on research demonstrating the mediating and moderating role of social problem solving (SPS) regarding stress and psychopathology. SPS is the process whereby people direct their coping efforts at altering the problematic nature of stressful events, as well as their negative reactions to such occurrences (i.e., emotional regulation). If one’s problem-solving attempts are ineffective, significant negative emotional reactions are likely to occur. The overarching treatment goal of PST is to foster adoption and implementation of adaptive problem-solving attitudes and behaviors as a means of effectively minimizing the negative effects of stressful events. More specifically, PST is geared to increase optimism, improve emotional regulation, enhance resilience, and foster successful coping with ongoing stressors. Several meta-analytic reviews of the PST outcome literature strongly support its efficacy for the treatment of a wide range of emotional disorders across ages and clinical populations. This workshop also represents recent updates to the theory and therapy based on advances in the neurobiological understanding of the relationships among chronic stress, coping, and emotional distress (Nezu, Nezu, & D’Zurilla, 2013). The two presenters are co-developers of this approach. This workshop will provide participants with (a) an overview of the conceptual and empirical underpinnings of the problem-solving model of stress and psychopathology upon which PST is predicated, and (b) clinical guidelines to conduct PST for two specific populations. These include: (a) individuals experiencing a chronic medical illness, and (b) previously deployed Veterans. Scores of well-controlled outcome studies support the efficacy of PST with medical patients across a variety of illnesses, including cancer, heart disease, stroke, chronic pain, and diabetes. Recent findings regarding the evaluation of an ongoing open trial of a PST-based, group prevention program that includes 621 U.S. Veterans provides support for its efficacy in reducing depression, psychiatric symptomatology, as well as improving overall problem-solving skills and psychological resilience. Of particular interest regarding the acceptability and perceived user-friendliness of this approach for a Veteran cohort is represented by a retention rate that exceeded 76% of such participants. In addition to lectures, we will demonstrate various PST intervention strategies, engage workshop participants in relevant role-plays, and provide consultations regarding how to apply PST to these two populations. Training materials will also be provided.

Wednesday, November 6, 2013
Half-Day Institutes
(8:30 a.m. – Noon)

PMI – 6

New Evidence Supported Approaches to First Responder Behavioral Health: Implementing NFFF Firefighter Life Safety Initiative 13

Keyword: Prevention/Early Intervention
Presentation Level: Introductory
Region: Industrialized Countries

Richard Gist, PhD1, Patricia Watson, PhD2
1 Kansas City (Missouri) Fire Department
2 National Center for PTSD, Executive Division

Firefighters and other first responders face  stressful situations every day that can contribute to PTSD, depression, and other behavioral health complications.  Evolving research and emerging best practices have opened new possibilities to help reponders remain healthy, resilient, and successful in their chosen work.  This half-day session provides an overview of current research and best practices, and introduces a new system of easily accessed, readily learned, and low cost resources that emergency responders, their organizations, and the professionals who assist them can employ immediately to ensure the best possible support for America's hometown heroes.  These approaches were developed across a three year series of consensus wokshops led by the National Fallen Firefighters Foundation that joined leading researchers and practitioners with fire service consti tuency organizations to: (a) assess needs, review current research, and generate consensus models for organizational response; (b) identify current best practices to be adapted, refined, or developed to work effectively in emergency respose organizations; (c) create easily accessible, low cost web, workshop, and print materials to support implementation; and (d) disseminate those processes and materials widely to facilitate ready application. A fast-paced, interactive, team approach is used to present five segments; each supported by both PowerPoint and written materials with video and active web demonstrations included where indicated (e.g., After Action Review, Curbside Manner; Helping-Heroes; Stress First Aid).  NFFF produced materials will be provided to add additional depth in each major content area. Segments include: (1)  Occupational behavioral health in fire and emergency services:  History, current research, identified best practices (2)  Knowledge translation:  Consensus models for bridging reseach, practice, and organizational application (3)  Tools for the organization:         (a) After Action Review:  web based inservice program introducing a military adaptation for daily use  to both enhance organizational performance and build foundation for difficult episodes:        (b) Curbside Manner:  web based inservice program supporting daily application of principles from Stress First Aid to routine citizen encounters, enhancing service and building foundation. (4)  Tools for behavioral health providers:        (a) Evidence based screening tools;        (b) Helping-Heroes.org:  Web training for clinicians in providing CBT to emergency response personnel (in conjunction with MUSC/NCVRTC) (5)  Tools for peer support:        (a) Stress First Aid: a direct adaptation of Navy/Marine Corps COSFA for fire service environment (in conjunction with NCPTSD).

PMI – 7

Trials and Tribulations of Implementing Evidence-based Therapy into Community Care

Keyword: Clinical Practice
Presentation Level: Introductory
Region: Global

Tara Galovski, PhD1, Debra Kaysen, PhD2, Kelly Maieritsch, PhD3, Amy Williams, PhD4, Priscilla Schulz, MSW5, Leslie A Morland, PsyD6
1 University of Missouri St. Louis
2 University of Washington
3 Hines VA Hospital
4 Independent Practice
5 Peace Corps
6 VA - National Center for PTSD

Although the dissemination and implementation of evidence-based interventions has proliferated, moving evidence-based care into standard practice often remains more aspirational than applied.  The extant literature is replete with identified barriers to bridging this gap including perceived rigidity of treatment protocols, availability of resources, timing of sessions, client education and literacy, language and cultural barriers, issues around managing comorbidity, handling clinical crises and therapist misgivings and training. This workshop will first provide an overview of the historic difficulties inherent in dissemination.  Then, using Cognitive Processing Therapy (CPT) as an example, six CPT experts will provide an overview of their clinical work and trials modeling implementation solutions of this intervention across a variety of settings. Implementation challenges addressed include providing CPT when large geographic distances exist between therapist and client, clients are in remote settings, and treatment delivery is conducted through tele-health systems, some of which include little internet support. Presenters will address client housing instability and severe mental illness comorbidity by sharing data on a project using CPT as part of a jail diversion program. They will also discuss the implementation of CPT across the state of Texas community mental health clinics, focusing on solutions to reaching clients in rural settings and managing language barriers in CPT treatment delivery. Challenges and outcomes in applying CPT in a group versus individual format will be covered through discussion of CPT delivery within a VA medical care clinic. Lastly, we will discuss solutions for disseminating CPT in low and medium resourced settings including treatment delivery using of paraprofessional counselors and modifying materials for low-literacy populations. Presenters will describe specific adaptations useful for working with clients from diverse cultural and educational backgrounds and in the different treatment settings described. Presenters will describe recent advances, such as adaptations to therapy homework and assessment strategies, used to address cultural and language factors, and to increase treatment buy-in among psychotherapy-naive clients. The presentation will include documentation of implementation success, and specific clinical hints to guide researchers and clinicians in their own endeavors.  The workshop will be interactive, and audience members will have the opportunity to ask questions regarding the implementation of these interventions in their clinical settings.

PMI – 8

The Sanctuary Model: What It Takes to Create and Sustain Trauma-Informed and Resilient Organizations

Keyword: Training/Education/Dissemination
Presentation Level: Intermediate
Region: Global

Sandra Bloom, MD1, Brian Farragher, MBA2, Joseph F. Foderaro, MSW, LCSW1, Landa C. Harrison, MEd, LPC, NCC2, Ruth Ann Ryan, MSN APRN1, Sarah Yanosy, MSW, LCSW2
1 Drexel University School of Public Health
2 The Sanctuary Institute

For the last thirty years, the field of traumatic stress studies has been growing rapidly and methods for addressing the needs of trauma-survivors have burgeoned. This knowledge provides all social service delivery professionals with a much more effective means of, assessment, treatment planning and implementation than we have previously had available. But in those same three decades, the U.S. mental health and social service systems have been under relentless assault, with dramatically rising costs and the fragmentation of service delivery often rendering them incapable of ensuring the safety, security, and recovery of clients. Healing is possible for these clients if they enter helping, protective environments, yet toxic stress has frequently destroyed the sanctuary that our systems are designed to provide. These parallel processes among clients, staff, organizations, and communities can be understood within a trauma-informed framework, laying the groundwork for parallel processes of recovery for our caregiving systems as well as the staff who work within them and the clients we serve. In this pre-meeting institute Dr. Sandra Bloom, the developer of the Sanctuary Model, and her colleagues from the Sanctuary Institute will describe what has developed into a three-year implementation and certification process for organizations that intend to become truly trauma-informed and summarize the research that has thus far accumulated about the Sanctuary Model. After introductions to the faculty and the participants, the group will learn about and practice Community Meeting, one of the key elements of the Sanctuary Model. The day will then be broken into three key components of Creating, Destroying and Restoring Sanctuary. In Creating Sanctuary, participants will learn about the origins and the key theoretical underpinnings of the Sanctuary Model as well as “lessons learned”. Destroying Sanctuary will focus on the multiple ways in which organizational stress creates destructive parallel processes, often outside of the conscious awareness of managers. Restoring Sanctuary then focuses on the organizational training and consultation approach that has developed into the development and expansion of a training institute that has wide dissemination in the United States and other countries worldwide. Teaching methods used will include didactic presentations, discussion, and small group activities throughout the day. 

PMI – 9

Imagery Rescripting Therapy for Military Populations: An Introduction

Keyword: Clinical Practice
Presentation Level: Intermediate
Region: Not Applicable

Holly N O'Reilly, PhD, William Brim, PsyD
Center for Deployment Psychology & Uniformed Services University of the Health Sciences

The course provides a cognitive-behavioral treatment to alleviate the frequency and distress associated with frequent nightmares. The course will begin with information regarding common sleep events providing information to help discern nightmares from night terrors that occur during sleep. This course will focus on military populations. The course will present data examining the efficacy of this technique with military populations in individual and group formats. The course will include role plays so that clinicians may practice new skills and will review session by session agendas for utilizing this protocol with service members. As many clinicians are trained in a cognitive-behavioral therapy for PTSD (i.e., PE, CPT and EMDR) this course will provide them with an targeted strategy to treat nightmares should nightmares persist following cognitive-behavioral therapy for PTSD. It is recommended that attendees have prior experience with PE, CPT, EMDR or work with trauma populations. This course is intended for work with adult patients only. The course will provide information regarding nightmare assessment and specific questions to use during assessment. This course will allow clinicians to role play and practice restructuring nightmares and provide resources for additional research or instruction.

PMI – 10

How Understanding the Neurobiology of Post-Traumatic Stress Disorder Can Inform Clinical Practice: A Social Cognitive and Affective Neuroscience Approach

Keyword: Clinical Practice
Presentation Level: Intermediate
Region: Global

Paul Frewen, PhD, Ruth Lanius, MD, PhD
University of Western Ontario

The objective of this workshop will be to examine the relevance of the social cognitive and affective neuroscience (SCAN) paradigm for an understanding of the psychology and neurobiology of complex posttraumatic stress disorder (PTSD) and its effective treatment.  We suggest that SCAN offers a novel theoretical paradigm for understanding psychological trauma and its numerous clinical outcomes, most notably problems in emotional⁄self-awareness, emotion regulation, social emotional processing and self-referential processing.  A core set of brain regions appear to mediate these collective psychological functions, most notably the cortical midline structures, the amygdala, the insula, posterior parietal cortex and temporal poles, suggesting that problems in one area (e.g. emotional awareness) may relate to difficulties in another (e.g. self-referential processing). We further propose, drawing on clinical research, that the experiences of individuals with PTSD related to chronic trauma often reflect impairments in multiple social cognitive and affective functions. Implications for assessment, treatment, and the intergenerational transmission of trauma will be discussed.

Wednesday, November 6, 2013
Half-Day Institutes
(1:30 p.m. – 5:00 p.m.)

PMI – 11
Assessing PTSD According to DSM-5

Keyword: Assessment/Diagnosis
Presentation Level: Intermediate
Region: Industrialized countries

Paula P Schnurr, PhD1, Matthew J Friedman, MD, PhD1, Frank W. Weathers, PhD2, Brian Marx, PhD3
1 VA National Center for PTSD, Executive Division
2 Auburn University
3 National Center for PTSD, VA Boston Healthcare System and Boston University

The diagnostic criteria for PTSD were changed in DSM-5.  Perhaps the most significant change is that PTSD is no longer classified as an anxiety disorder, but there are other important changes too, such as a separation of avoidance and numbing symptoms.  This premeeting institute is designed to help participants learn the new criteria and how to apply them when diagnosing PTSD and assessing PTSD symptom severity.  The session will begin with an overview of the similarities and differences between DSM-IV and DSM-5.  This material will be followed by more in-depth presentation of the DSM-5 criteria in order to provide a thorough foundation for conducting assessments.  Examples of specific issues to be covered include the stricter definition of A1, elimination of A2, and mandatory endorsement of at least one avoidance symptom.  Next, we will move on to diagnostic interviewing using the Clinician-Administered PTSD Scale, which has been revised according to the new criteria.  An important feature of the new CAPS is that the separate frequency and intensity scales have been combined into a single severity scale.  We will provide guidance about how to translate information about frequency and intensity into a single measure.  The session will end with information about self-reported assessment using the PTSD Checklist.  Throughout we will use a combination of lecture, discussion, and role-playing to explain concepts and demonstrate techniques.  The presentation is aimed at an audience that is familiar with current PTSD criteria and diagnostic interviewing.

PMI – 12

Bringing Trauma Expertise to Immigrant Survivors: Forensic Documentation of Individuals Seeking Humanitarian Protection in the United States

Keyword: Training/Education/Dissemination
Presentation Level: Introductory
Region: Global

Anne C Pratt, PhD1, Jillian Tuck, JD2, Ellie Emery, BA (Hons)3
1 Forensic Services, Hampshire County Courthouse
2 Physicians for Human Rights
3 Weill Cornell Medical College

This presentation offers training for licensed mental health professionals, physicians, and students to assess immigrant survivors of torture who are applying for asylum in the United States, write an affidavit documenting their conclusions, and offer testimony in support of their conclusions. Each year thousands of immigrant survivors of torture and other forms of severe human rights abuses seek humanitarian protection in the U.S.  When they apply for protection, they often have nothing but their own words to substantiate their suffering.  Some of the most compelling evidence available—psychological sequelae of torture, severe domestic violence, and other abuses—will go unnoticed and unheeded by decision-makers.  Documentation of the trauma they endured can make the difference between safety in the U.S. and a return to a country where the survivor’s life and safety would be at risk. Evidence shows that claims for asylum that are supported by forensic documentation are almost three times more likely to result in a grant of asylum than cases without such documentation (Lustig et al, 2008).  A grant of asylum allows torture survivors to stop living in fear of returning to their country of origin. It is not only a necessary first step to begin healing and rebuilding their lives but a validation of the trauma they experienced. The training will also discuss the emergence of students asylum clinics in medical schools across the country that provide rewarding clinical and learning experiences while making a real impact on the immigrant community. Finally, we will present preliminary data from a study correlation of psychological assessment with asylum outcomes. The presenters include an attorney representing a human rights organization,  a forensic psychologist who provides pro bono evaluations to asylum seekers, and a student Board Member of a medical school human rights clinic.  

PMI – 13
Psychological First Aid – Keeping Providers Skills Up

Keyword: Prevention/Early Intervention
Presentation Level: Intermediate
Region: Global

Melissa Brymer, PhD, PsyD1, Douglas Walker, PhD2, Gilbert Reyes, PhD3, Patricia Watson, PhD4
1 National Center for Child Traumatic Stress at UCLA
2 Mercy Family Center
3 Fielding Graduate Institute
4 National Center for PTSD, Executive Division

Psychological First Aid (PFA) is an acute intervention to help children, adolescents, adults, and families in the immediate aftermath of disasters, terrorism and other emergencies. The National Child Traumatic Stress Network (NCTSN) and the National Center for PTSD published a comprehensive PFA Field Operations Guide that has 8 core actions: 1) Contact and Engagement; 2) Safety and Comfort; 3) Stabilization; 4) Information Gathering; 5) Practical Assistance; 6) Connection with Social Supports; 7) Information on Coping; and 8) Linkage with Collaborative Services. They have also recently released the second edition of PFA for Schools. After the recent tragedies that have impacted our nation, lessons learned have highlighted the need to have PFA refresher courses for those providers who have been previously trained. This PMI will simulate a PFA refresher course followed by participants practicing different PFA intervention skills including stabilization strategies, working with groups, and assisting survivors with acute grief issues.  At the end of the session, participants and presenters will conduct an after-action review and address lessons learned. For those individuals who have not taken a course in PFA, it is recommended that they take the free PFA Online course at http://learn.nctsn.org prior to coming to this session.

PMI – 14

Ethnocultural Variation in Traumatic Stress in the United States: Epidemiology, Assessment, and Treatment

Keyword: Culture/Diversity
Presentation Level: Intermediate
Region: Industrialized countries

Nnamdi Pole, PhD1, Devon E Hinton, MD PhD2
1 Smith College
2 Harvard University

We will examine ethnic and cultural factors that influence traumatic stress outcomes. We will review studies involving special populations (e.g., veterans, police, disaster survivors, clinical samples) and representative community samples that document disparities in traumatic stress exposure, PTSD prevalence, and mental health service utilization. We will discuss the latest theoretical and empirical explanations of these ethnoracial disparities including an examination of the role of discrimination. We will also review studies bearing on the cross-cultural validity of the PTSD diagnosis highlighting the aspects of the diagnosis that are relatively invariant across cultures and those that seem particular sensitive to ethnocultural variation. To aid in the important work of achieving valid cross-cultural diagnosis, we will review findings from basic cross-cultural emotion research and examine culture-bound idioms of distress that contribute to atypical post-trauma symptom presentation. We will provide guidance about how to appropriately assess the culture bound syndromes that are most relevant to traumatic stress and highlight other sources of cross-cultural assessment variance. We will also include a brief training in culturally adapted cognitive behavior therapy (CA-CBT) for PTSD. This model, which has shown efficacy in randomized trials, modifies mainstream cognitive- and exposure-based models to include components that directly address common challenges that arise with some ethnocultural minority populations (e.g., limited familiarity with mainstream mental health concepts, prominent somatic complaints, and poor tolerance of conventional exposure techniques). Finally, we will include time for case consultation on cross-cultural challenges that are raised by our audience. We particularly welcome discussion of racism, religion, acculturation, bilingualism, identity development, multiracial identity, intersectionality with other social identities, and other issues that are particularly likely to arise with minority clients. We aim to enhance cross-cultural competence in understanding risk for trauma and PTSD, assessment challenges, and potential treatment modifications.

PMI – 15

Mindfulness Based Stress Reduction: Theory and Practice of an Approach to Foster Resilience in Trauma Survivors and Their Clinicians

Keyword: Clinical Practice
Presentation Level: Introductory|
Region: Global

Louanne W Davis, PsyD, Brandi L Luedtke, PsyD
Roudebush VA Medical Center

The overall goal of this presentation is to provide an experiential introduction to a program called Mindfulness-Based Stress Reduction (MBSR) that includes the research evidence of benefits for both trauma survivors and clinicians. Mindfulness meditation involves training the mind to relate to internal and external experiences in a particular way: intentionally, while suspending judgment, moment to moment. Mindfulness meditation, in the form of MBSR, has generally been shown to decrease anxiety, depressive rumination, physiological arousal and stress reactivity, as well as enhance empathy, psychological flexibility and well-being. More specifically, MBSR has been found to reduce symptoms of PTSD in patients and of burnout/compassion fatigue in clinicians and equips participants with skills that can be applied to difficult life situations in the future.  This four hour presentation is divided into 3 segments. The first hour involves an introduction to MBSR which participants will experience as if they were attending a briefer version of the typical MBSR program orientation session. MBSR orientation includes the history of MBSR, definition of mindfulness, experience of a brief mindful breathing practice, theoretical base/research, and discussion that includes program structure, home practice expectations, group guidelines risks/benefits, and sharing of what brought participants to the program. This segment concludes with discussion of screening issues and use of pre/post measures. The middle segment, approximately 2 hours, will provide an overview of each of the 8 MBSR sessions and the all day practice, while including brief experiences and discussion of the remaining three meditation practices integral to MBSR: eating meditation, body scan and yoga. The final segment describes how mindfulness practiced in daily life, including within the therapeutic relationship, can promote resilience. The concluding discussion addresses clinical considerations when teaching mindfulness to trauma survivors  and  recommended MBSR teacher training.