Using Evidence-Based Practices to Address PTSD Among Diverse Communities: Barriers, Opportunities and Innovations in Addressing Cultural Adaptation of PTSD Treatments
Moderator: Debra Kaysen, PhD ABPP
Panelists: Angela Nickerson, PhD; Annjeanette Belcourt, PhD; Monnica Williams, PhD; Luana Marques, PhD
Saturday, November 14, 2pm – 3:15pm
The PTSD literature has demonstrated support for brief, effective interventions but there is a gap in access to these treatments for ethnically and culturally diverse clients, for clients who are gender or sexual minorities, and for individuals residing in low- and middle-income countries. Psychotherapies occur within a multicultural context where clients and therapists each bring their own cultural lens to the process. Culture is also not monolithic—both in terms of subgroups and individual differences in terms of their own identity and lived experiences. Individuals also may not fit just in one category, but may instead have multiple intersectional identities that all impact what they bring into the therapy. Yet, PTSD treatments are often not developed for or tested with diverse patient populations. There is increasing evidence that evidence-based practices and cultural competency can be complementary. This panel aims to synthesize existing knowledge regarding innovations in this field, drawing from the panelists' wide range of experiences working with diverse patient groups across various treatment approaches and settings. The panelists, based on their expertise in working with Black, Indigenous and Latinx communities, as well as working with refugees, will offer novel insights with regard to the methods, challenges and opportunities for cultural adaptation of PTSD treatment.
Debra Kaysen is a clinical psychologist and Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University. Dr. Kaysen is currently the President of the International Society for Traumatic Stress Studies (www.istss.org). Dr. Kaysen’s area of specialty both in research and clinical work is in treatment for those who have experienced traumatic events including treatment of PTSD and related disorders. She has conducted critical studies on treatment of PTSD and/or substance use across a variety of populations (sexual minority women, Native Americans, sexual assault survivors, torture survivors, active duty military) and in a variety of settings (the Democratic Republic of Congo, Iraq, primary care, rural settings), with an emphasis on increasing access to care. Other research conducted by Dr. Kaysen has focused on increasing our understanding of how PTSD and substance use may influence each other. Her research has been funded by the National Institute of Alcohol Abuse and Alcoholism, the National Institute of Drug Abuse, the National Institute on Minority Health and Health Disparities, the Department of Defense, PCORI, and USAID. Dr. Kaysen's work has been featured in major media outlets such as the Washington Post, New York Times, NPR, The Hill, the Economist, and on This American Life (https://www.thisamericanlife.org/682/ten-sessions).
Angela Nickerson is Professor at the School of Psychology at UNSW Sydney, and Director of the Refugee Trauma and Recovery Program. Her research focuses on understanding the psychological mechanisms underpinning refugee and post-conflict mental health, and developing effective interventions for traumatic stress reactions in refugees. She is also interested in the impact of policy on refugee mental health, and cross-cultural considerations in psychological processes. She has worked with refugee and post-conflict populations in Australia, Indonesia, Timor-Leste, Switzerland, and the United States.
Monnica T. Williams is a board-certified licensed clinical psychologist and Associate Professor at the University of Ottawa, in the School of Psychology, where she is the Canada Research Chair in Mental Health Disparities. She is also the Clinical Director of the Behavioral Wellness Clinic in Connecticut, where she provides supervision and training to clinicians for empirically-supported treatments. Prior to her move to Canada, Dr. Williams was on the faculty of the University of Pennsylvania Medical School (2007-2011), the University of Louisville in Psychological and Brain Sciences (2011-2016), where she served as the Director of the Center for Mental Health Disparities, and the University of Connecticut (2016-2019) where she had appointments in both Psychological Science and Psychiatry. Dr. Williams' research focuses on African American mental health, culture, and psychopathology, and she has published over 100 scientific articles on these topics. Current projects include the assessment of race-based trauma, unacceptable thoughts in OCD, improving cultural competence in the delivery of mental health care services, and interventions to reduce racism. This includes her work as a PI in a multisite study of MDMA-assisted psychotherapy for PTSD for people of color. She also gives diversity trainings nationally for clinical psychology programs, scientific conferences, and community organizations. Dr. Williams is a member of the American Psychological Association (APA), having served as the diversity delegate from Kentucky for the APA State Leadership Conference for two consecutive years. She has served as the African American SIG leader for Association of Behavioral and Cognitive Therapies (ABCT), and she serves as an associate editor of The Behavior Therapist and New Ideas in Psychology. She also serves on the editorial board of Cognitive Behaviour Therapy, and the Journal of Obsessive Compulsive and Related Disorders. She is a member of the Scientific Advisory Board of the International OCD Foundation, and co-founded their Diversity Council. Her work has been featured in several major media outlets, including NPR, CBS, Huffington Post, and the New York Times.
Annjeanette Belcourt (Otter Woman) is an American Indian Professor in the College of Health at the University of Montana’s Pharmacy Practice and School of Public and Community Health Sciences Departments (enrolled tribal member of the Three Affiliated Tribes, Mandan, Hidatsa, Blackfeet, and Chippewa descent). She completed her clinical training and doctoral studies in clinical psychology with advanced postdoctoral science training completed at the Centers for American Indian and Alaska Native Health. She has worked clinically with diverse populations, including combat veterans, Native Americans, and low-income populations specializing in posttraumatic stress reactions and multiple psychiatric conditions. Her research and clinical priorities include mental health disparities, posttraumatic stress reactions, risk, resiliency, psychiatric disorder, and environmental public health within the cultural context of American Indian communities.
Luana Marques is the Director of Community Psychiatry PRIDE and Associate Director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital (MGH), as well as an Associate Professor of Psychiatry at Harvard Medical School. She completed her Ph.D. in Clinical Psychology at the State University of New York (SUNY) at Buffalo and her clinical internship in the Cognitive Behavioral Track (CBT) at Massachusetts General Hospital/Harvard Medical School in 2007. Recognized as a national and international expert in Cognitive Behavioral Therapies (CBTs) with over 10 years of experience conducting clinical research in health disparities and trauma-related disorders, Dr. Marques’ major clinical and research interests include the implementation of evidence-based practices for individuals suffering from a variety of behavioral health disorders in diverse communities. Through her research she aims to decrease disparities in care for individuals experiencing behavioral health difficulties, especially among low-income and ethnic minorities.
Early Intervention—What I’ve Changed My Mind On
Moderators: Meaghan O'Donnell, PhD and Nancy Kassam-Adams, PhD
Panelists: Jon Bisson, MD; Richard Bryant, PhD; Andrés Fresno, PhD; Richard Meiser-Stedman, PhD; Patricia Watson, PhD
Thursday, November 12, 5pm – 6:15pm
This panel brings together experts from multiple continents to discuss key issues in early intervention and prevention. The panel will address the evidence base, the usefulness of these approaches, practical challenges in implementation in different settings, as well as issues of cultural responsiveness and health equity. We hope to spark discussion and healthy debate around these crucial topics, identify knowledge and practice gaps, and inform the research/practice/public health agenda in this arena. Examples pertaining to COVID-19 will be raised where possible. Panel members have expertise in developing and evaluating models of early intervention/prevention for adults, children and communities and have experience in putting these models into practice in a range of settings and contexts.
Head of Research, Phoenix Australia: Centre for Posttraumatic Mental Health
Professor, Department of Psychiatry, University of Melbourne
Nancy Kassam-Adams is Research Professor of Pediatrics, University of Pennsylvania Perelman School of Medicine, and Associate Director for Behavioral Research at the Center for Injury Research and Prevention at the Children’s Hospital of Philadelphia. Dr. Kassam-Adams also directs the Center for Pediatric Traumatic Stress, which provides training and resources to help healthcare professionals and healthcare systems across the US provide trauma-informed pediatric healthcare. For nearly 25 years, Dr. Kassam-Adams’ research has focused on understanding how children and families respond to potentially traumatic events such as injury, violence, and illness / medical experiences, and on developing practical and effective secondary prevention protocols for traumatic stress that can be integrated in pediatric health care settings or delivered broadly via eHealth tools. Dr. Kassam-Adams also leads the Child Trauma Data Archives, and is actively engaged in international collaborative efforts to make traumatic stress research data more findable, accessible, and re-usable. She works with several initiatives within the Global Collaboration on Traumatic Stress that focus on promoting collaboration across boundaries in the traumatic stress field. She is a Past President of the International Society for Traumatic Stress Studies, and has been appointed to several national and international expert consensus groups on child traumatic stress.
Jon Bisson is a practising psychiatrist and professor in psychiatry at Cardiff University. He is Director of All Wales Traumatic Stress Quality Improvement Initiative. He developed his interest in post-traumatic stress disorder (PTSD) during his time as a psychiatrist in the Britsh Army. He has conducted various studies including two widely cited randomised controlled trials of early psychological interventions following traumatic events and five Cochrane systematic reviews in the traumatic stress field. He was co-chair of the UK’s first PTSD NICE Guideline Development Group and chairs the International Society for Traumatic Stress Studies’ Treatment Guidelines Committee. He developed and continues to lead Cardiff University’s Traumatic Stress Research Group. He developed and was the first director of NHS Veterans Wales.
Richard Bryant is Scientia Professor of Psychology, University of New South Wales, NHMRC Senior Principal Research Fellow, and Director of the UNSW Traumatic Stress Clinic. He has published over 600 journal articles on trauma and PTSD, with a particular focus on early intervention. He has served on both the DSM-5 and ICD-11 committees rewriting the new diagnoses for PTSD. He has conducted many studies in acute stress disorder, and conducted multiple controlled trials on early intervention of people with acute stress disorder. He has also conducted numerous longitudinal studies to map the acute and longer term effects of trauma, and studied acute biological, cognitive, and psychological markers that identify people who require early intervention. He has worked with many agencies around the world in the acute aftermath of disaster and trauma, including the 9/11 terrorist attacks, the 2004 Asian tsunami, Hurricane Katrina, the 2019 terrorist attack in New Zealand, and many natural disasters in Australia.
Andrés Fresno is associate professor and director of the Doctorate in Psychology at the Faculty of Psychology at the University of Talca, Chile. Since 2010 he has dedicated himself to the study of traumatic stress. He has conducted research on the relationship between child abuse, attachment, and PTSD. He has trained in therapies for the treatment of PTSD (BEPP, RT, EMDR, REWIND, CBT). He has also actively participated in the adaptation to Spanish of therapy manuals for PTSD (BEPP, RT, CBT), as well as for the evaluation of PTSD and complex PTSD. He is a founding member and current vice president of the Chilean Association of Traumatic Stress (ACET). His areas of interest are PTSD, Complex PTSD, Emotional Regulation, Child Abuse and Attachment.
Richard Meiser-Stedman is a Professor of Clinical Psychology at the University of East Anglia, having joined the university in 2014. His primary research interest is PTSD in children and adolescents. He completed his PhD and trained as a clinical psychology at the Institute of Psychiatry, Psychology and Neuroscience, KCL. Between these periods of study he was a Peggy Pollak Fellow in Developmental Psychiatry, also at the Institute. From 2009-2014 he was an MRC Clinician Scientist Fellow at the MRC Cognition and Brain Sciences Unit in Cambridge. While there he led the ASPECTS study, looking at whether early treatment for PTSD in children and adolescents. He is currently an NIHR Career Development Fellow, through which he is leading a clinical trial that evaluates cognitive therapy as a treatment for PTSD in NHS child and adolescent mental health services.
Patricia Watson has been a psychologist for the National Center for PTSD since 1998. Prior to that, she was an active duty Navy psychologist working with adults and children/families for eight years. Her education includes a doctoral degree in clinical psychology, and a postgraduate fellowship in pediatric psychology. She has been involved in extensive science-into-practice translation, intervention development, and program implementation, including: co-authoring the Psychological First Aid (PFA) Field Guide and the Skills for Psychological Recovery (SPR) Manual, designed to intervene in the immediate and intermediate phases after disasters and terrorism; co-authoring versions of Stress First Aid self-care/coworker support models for military, law enforcement, forest firefighters, nurses, probation officers, and rail workers, as well as public-facing versions for patients, clients, and families; and co-editing three books on disaster behavioral health interventions, and numerous publications and courses on disaster mental health, combat and operational stress, military culture, early intervention, and resilience.
Responding to Public Health Emergencies: Mental Health Considerations During the Coronavirus Disease '19 (COVID-19) Pandemic—United States, 2020
Moderator: Judy Bass
Panelists: Robyn Cree, PhD; Rebecca Leeb, PhD; Craig W. Thomas PhD, MS
Tuesday, November 10, 2pm – 3:15pm
Robyn Cree, PhD, is an Epidemiologist on the Disability Science and Program Team in the National Center on Birth Defects and Developmental Disabilities (NCBDDD) at the US Centers for Disease Control and Prevention. Her work focuses on studying risk and protective factors related to mental, behavioral, and developmental disorders, particularly among people with disabilities. She serves as the technical monitor for several CDC awarded projects that promote disability inclusion in state and local public health programs. She engages in preparedness and response activities for people with disabilities as part of the Children's Preparedness Unit and At-Risk Task Force. Dr. Cree also co-leads CDC’s Mental Health Workgroup where she works to foster collaboration and advancement in the field of mental health within the agency. Dr. Cree began working with NCBDDD in 2017 as an Epidemic Intelligence Service Officer assigned to the Child Development Studies Team. She has served as a mental health subject matter expert on CDC's responses to the 2017 Hurricanes and COVID-19, helping to ensure the mental health needs of disproportionately affected populations are identified and prioritized. Dr. Cree earned a PhD in Chronic Disease Epidemiology at the Yale School of Public Health and a B.S. in Biobehavioral health from the Pennsylvania State University.
Rebecca Leeb, PhD, is a Health Scientist/Epidemiologist on the Child Development Studies Team at the Center for Disease Control and Prevention’s National Center on Birth Defects and Developmental Disabilities. Trained as a Developmental Psychologist, Dr. Leeb joined the CDC in 2002. Prior to joining the National Center on Birth Defects and Developmental Disabilities she worked as a subject matter expert on child maltreatment prevention in the National Center for Injury Prevention and Control and spent time in the Office of the Associate Director for Science. From April 2017 to October 2019 Dr. Leeb acted as the Team Lead for CDC’s Children’s Preparedness Unit, the only group at CDC that focuses on ensuring that the unique needs of children are incorporated into all aspects of public health preparedness and response. She has participated in CDC’s emergency responses to Hurricane Katrina (2005), Zika virus (2016-2017), the 2017 and 2018 hurricane responses to Harvey, Irma, Maria, Florence and Michael, where she served as the Lead for the CDC Emergency Operations Center’s At-Risk Task Force, the 2019 response to E-cigarette/Vaping Associated Lung Injury, and the COVID-19 Response where she served in multiple roles including Lead for the Social and Behavioral Health Team. Dr. Leeb’s current work focuses on better understanding the public health importance and implications of children’s emotional wellbeing.
As Director of the Division of Population Health within CDC’s National Center for Chronic Disease Prevention and Health Promotion, Dr. Craig Thomas directs a broad portfolio of programmatic and applied research activities focused on improving population health across the lifespan. Specific topic areas include Alzheimer’s disease, aging, arthritis, epilepsy, mental health and emotional well-being, school health, tribal health, and population health data and analytics based on the Behavioral Risk Factor Survey System and 500 cities. Dr. Thomas joined CDC in 1998 where he has held leadership positions within a variety of public health programs including CDC’s HIV and AIDS Prevention Program, The Guide to Community Preventive Services, the Public Health Preparedness and Response Program, the National Public Health Improvement Initiative, and the PHHS Block Grant. Most recently Dr. Thomas served as Director of the Division of Public Health Performance Improvement within the Center for State Tribal, Local, and Territorial Support (CSTLTS). Dr Thomas has participated in CDC’s emergency responses to Hurricane Katrina (2005), H1N1 Pandemic (2009) and the COVID-19 Response where he served as Lead for the Social and Behavioral Health Team. Dr. Thomas earned a PhD in social psychology and applied research methods from Claremont Graduate University, a M.S in clinical psychology from California State University Fullerton, and a B.A. in biological sciences from the University of California Irvine. He has authored over 40 peer-reviewed publications, coauthored 3 book chapters, and taught several courses in public heath practice, program evaluation, and applied research methods.
The Digital Revolution: Harnessing Technology to Enhance Treatment of Trauma-Related Disorders
Moderator: Jennifer Wild, DClinPsy
Panelists: Anke Ehlers, PhD; Greg Reger, PhD; Karen Seal MD, MPH; Eric Kuhn, PhD
Thursday, November 5, 10am – 11:15am
The digital revolution has seen enormous benefits to treatment developments for PTSD including trauma-focused digital interventions with significant scalability and reach, innovative digital tools for enhancing therapeutic techniques, and innovative methods to train clinicians. In this panel, leading experts in the field will present their cutting-edge research and specific digital treatments or tools they have developed to enhance treatment of PTSD and related psychopathology.
The panel will discuss how their digital developments advance the field and the challenges and next steps for improving treatment and training outcomes.
- Professor Karen Seal will present her innovative training program for primary care providers, which uses "virtual worlds" training.
- Professor Eric Kuhn, an expert in web and mobile phone-based psychoeducation and self-help apps for PTSD, will present lessons learned from his work with PTSD Coach.
- Professor Greg Reger will present Virtual Reality therapy for combat-related PTSD.
- Finally, Professor Anke Ehlers will present her developments in therapist-supported internet-delivered cognitive therapy for PTSD.
Jennifer Wild is a consultant clinical psychologist, associate professor and NIHR Oxford Health BRC Senior Research Fellow at the University of Oxford. Her area of expertise is in developing and evaluating evidence-based interventions to prevent stress-related psychopathology in at risk populations. With her team, she developed and evaluated internet-delivered cognitive training in resilience (iCT-R), which targets modifiable risk factors for post-traumatic stress disorder and depression in emergency workers. This preventative intervention is being disseminated to emergency services across England by the UK’s mental health charity, Mind. Dr Wild has worked in an advisory role to the Cabinet Office on best practice for developing preventative interventions for emergency responders. She has over 70 publications, including book chapters, and a recently published popular science book on resilience. Dr Wild regularly appears in the media giving evidence-based advice for trauma-related mental health problems.
Karen Seal is a Professor of Medicine and Psychiatry at the University of California, San Francisco (UCSF). Based at the San Francisco VA Health Care System (SFVAHCS), she serves as Chief of the Integrative Health Service. In this capacity and as a general internist and integrative medicine physician, she oversees several interdisciplinary clinics including a post-9/11 Integrated Care Clinic for Iraq and Afghanistan veterans, the Integrated Pain Team Clinic, and the Integrative Health and Wellness Clinic which serve high-risk, high-needs veterans. As a health services researcher she conducts randomized controlled trials and observational studies targeting problems common in veterans such as chronic pain, opioid dependence and posttraumatic stress disorder and recently completed a trial comparing a web-based versus immersive virtual worlds educational program to train primary care providers in PTSD assessment and management.
Eric Kuhn received a Ph.D. in Clinical Psychology from the University at Albany, State University of New York, and completed a postdoctoral research fellowship at the VA Palo Alto MIRECC and Stanford University School of Medicine. He currently serves as Acting Deputy Director of the Dissemination and Training Division of the National Center for PTSD and Clinical Associate Professor (affiliated) at Stanford University School of Medicine where he co-leads the Stanford Mental Health Technology and Innovation Hub. Dr. Kuhn is a founder of and leader in NCPTSD’s Mobile Apps Program, which has developed a suite of mobile apps designed to address PTSD and related comorbidities and currently directs the Center for Mobile Apps Research Resources and Services (CMARRS). Dr. Kuhn has federally funded programs of research focusing on using technology, both web and mobile, to increase access to and engagement in PTSD and related mental health care and to make care more patient centered, efficient, and effective.
Greg Reger is the Deputy Associate Chief of Staff for Mental Health at the VA Puget Sound Healthcare System and Associate Professor of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. He has spent 16 years in DoD and VA with a research focus on the development and evaluation of innovative technologies to support Service Member and Veteran psychological health. He has helped design and evaluate a range of technologies to support mental health, including mobile apps, virtual reality exposure therapy, and computer virtual training patients. He is currently preparing to launch a randomized clinical trial to evaluate the clinical impact of PE Coach during psychotherapy for PTSD. Dr. Reger also is a US Army Veteran and serves in the Washington State National Guard as a Behavioral Health Officer.
Anke Ehlers is Professor of Experimental Psychopathology and Wellcome Trust Principal Research Fellow at the Department of Experimental Psychology, University of Oxford, and co-director of the Oxford Centre for Anxiety Disorders and Trauma. She is known for her work on psychological factors in anxiety disorders and posttraumatic stress disorders and their treatment. With her colleagues she developed Cognitive Therapy for PTSD, one of the evidenced-based first-line interventions for PTSD recommended by International Society for Traumatic Stress Studies (2019), National Institute for Care and Clinical Excellence (2018), and the American Psychological Association (2017). She is a Fellow of the British Academy, Academy of Medical Sciences, the German Academy of Sciences Leopoldina, and Academia Europaea. She has received several awards for her work, including the German Psychology Prize (2013), the American Psychological Association Award for Distinguished Contributions to Clinical Psychology (2014), and the Wilhelm Wundt-William James Award (2015).