Pre-Meeting Institutes (PMI)

Pre-Meeting Institutes are sessions that provide opportunities for intensive training on topics integral to the conference program, presented by leaders in the field. Click on a PMI title to learn more about it.

All times are listed in U.S. Eastern TIme.

NOTE: Presenter names are BOLDED, Discussant names are UNDERLINED

          
PMI  - 01

How to Do Telemental Health Treatment for PTSD in the VA: The Basics and Beyond

Keyword: Technology
Secondary Keywords: Clinical/Intervention Research,  War – Military/Peacekeepers/Veterans
Population Type: Professional
Presentation Level: Intermediate
Region: Industrialized Countries

Birks, Anna¹; Myers, Ursula²  

¹Ralph H. Johnson VA Medical Center, 109 Bee St, Charleston, South Carolina, United States, 29401
²Medical University of South Carolina and the Ralph H. Johnson VA Medical Center, 109 Bee St, Charleston, South Carolina, United States, 29401

The demand for flexible mental health service delivery came to the forefront for health care industries across the globe this year as a result of COVID-19.  More than 50 health care systems in the US have existing programs capable of incorporating various telehealth technologies to maintain care (Hollander & Carr, 2020) and were able to adapt to the increased demands.

The largest agency providing telehealth care is the Veterans Health Administration (VHA), which has been providing telehealth, including telemental health, for more than two decades (Peters, 2019). Telemental healthcare increases access to care for Veterans across the nation. Prior to the increased demand as a result of COVID-19, there was a large demand for PTSD specialty care. Based on a number of studies demonstrating the efficacy and cost effectiveness of clinical video-teleconferencing (CVT), the VHA announced the, “Expansion of Telehealth Services into the Home and Other Non-VA Settings' initiative, which focuses on delivering care to the Veteran's preferred location, primarily into the home, through VA Video Connect. Findings from recent and ongoing studies along with the shared experiences and recommendations from VHA Telemental Health experts will be presented to highlight the various modifications which will better position providers to effectively deliver CVT including into the home and modifications for PTSD treatments. Topics will include: addressing therapist hesitation, strategies for an effective alliance, setting behavioral expectations, safety management, technology education and measurement-based care monitoring.

Back to top

PMI - 02

Intensive Treatments for PTSD: A Practical Guide to Delivering Evidence-Based PTSD Treatments in 1-3 Weeks

Keyword: Clinical/Intervention Research
Secondary Keywords: Clinical Practice
Population Type: Adult
Presentation Level: Introductory
Region: Industrialized Countries

Held, Philip¹; Yamokoski, Cynthia²; Rauch, Sheila³; Rothbaum, Barbara³

¹Rush University Medical Center, IL, Illinois, United States
²VA Northeast Ohio Healthcare System, 10701 East Blvd, Psychology 116B(W), Cleveland, Ohio, United States, 44106
³Emory University School of Medicine/Atlanta Veteran's Administration, 12 Executive Park Drive, NE, 3rd Floor, Atlanta, Georgia, United States, 30329

Intensive treatment delivery formats for posttraumatic stress disorder (PTSD) have received increased attention in recent years (Held et al., 2019). In this delivery format, evidence-based treatments, such as Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE), are commonly delivered daily over the course of 1-3 weeks (Harvey et al., 2017). Outcome research of intensively delivered PTSD treatments has shown that these treatments are feasible and produce rapid reductions in both PTSD and depression symptoms that can be maintained long-term (e.g., Held et al., 2019; Zalta et al., 2018).

In this Pre-Meeting Institute, four intensive PTSD treatment experts, Drs. Yamokoski, Rothbaum, Rauch, and Held, will present on how clinicians and organizations can deliver CPT and PE intensively either as standalone interventions or within more comprehensive intensive treatment programs. The presentation will begin with an overview of existing short- and long-term treatment outcomes, as well as dropout rates and predictors of treatment success. The presenters will detail and compare several intensive treatment models, including 1-week CPT-based treatment, 2-week PE-based treatment, and 3-week CPT-based treatment. Decisions for developing specific clinical programming and important treatment components to retain when condensing treatments will be detailed by the treatment experts. A specific focus will be placed on the rationale for including or excluding various adjunctive and wellness services. Presenters will highlight the challenges associated with delivering PTSD treatments intensively, such as logistical and transportation, as well as help the audience identify strategies to overcome these challenges in a variety of clinical settings. The treatment experts will also discuss unique challenges that arise with providing supervision and consultation in intensive treatment programs due to the condensed nature of the treatment. The presenters will conclude the presentation with a discussion of future challenges, including the scalability of intensive treatments, reimbursement models, and different options for follow-up care.

Back to top

PMI - 03

Peer Support and Self-Care Model for Those in High Risk Jobs

Keyword: Self-Care
Secondary Keywords: Culture/Diversity; Public Health; Training/Education/Dissemination
Population Type: Adult
Presentation Level: Introductory
Region: Industrialized Countries

Watson, Patricia¹; Gist, Richard²; Richard Westphal³

¹National Center for PTSD, Executive Division, 215 North Main Street, White River Junction, Vermont, United States, 050009
²Kansas City (Missouri) Fire Department, KCFD Headquarters, Suite 2100, 635 Woodland Avenue, Kansas City, Missouri, United States, 64116
³Richard Westphal Consulting, 137 Appalachian Ln, Gordonsville, Virginia, United States, 22942-6944

This pre-meeting institute will focus on a peer support and self-care model that has been adapted for those in jobs at high risk for traumatic stress, loss, moral injury, and cumulative stress, like military service members, first responders, rail workers, public safety workers, and healthcare providers.

The Stress First Aid (SFA) is a longitudinal set of supportive actions that have been designed to help those in high-risk settings improve self-care and assist each other in reducing the negative impacts of stress. This model recognizes that disasters and “critical incidents” are not the only stressors that people face and takes into account that stress is often ongoing and cumulative, resulting from multiple sources. The model also acknowledges that people in these contexts are often resistant to help-seeking for many reasons, such as stigma, lack of resources, and cultural factors.

Therefore, SFA is designed to be attentive to multiple sources of stress, and to be practical, flexible, and tailored to the specific styles and needs of those involved. The Core Actions of SFA were derived from elements related to recovery from a number of different types of adverse circumstances (Hobfoll et al., 2007). The five essential elements of immediate and mid-term intervention that are related to better recovery from stress are:

• Promote a sense of safety.
• Promote calming.
• Promote social connection.
• Promote sense of self and collective efficacy.
• Promote a sense of hope.

This pre-meeting institute aims to increase understanding of the various ways that those in high risk jobs can increase self-care and peer support via a highly flexible and longitudinal evidence-informed framework. It will include videotapes, discussions, and exercises.

Back to top

PMI - 04

Introduction to a Systems Focused Model for Addressing Childhood Traumatic Stress and its Adaptation for Special Populations

Keyword: Clinical Practice
Secondary Keywords:  Community/ Social Processes/ Interventions; Complex Trauma;  Refugee/Displacement Experiences; Training/Education/Dissemination
Population Type: Child/Adolescent
Presentation Level: Intermediate
Region: Industrialized Countries

Brown, Adam¹; Saxe, Glenn¹; Baron, Lisa²; Cardeli, Emma³; Issa, Osob³

¹New York University Langone Medical Center, 1 Park Avenue, New York, New York, United States, 10016
²Alliance for Inclusion and Prevention, 270 Columbia Rd., Dorchester, Massachusetts, United States, 02121
³Children's Hospital Center for Refugee Trauma & Resilience/Children's Hospital Boston, 300 Longwood Ave, Boston, Massachusetts, United States, 02115

This half day PMI will introduce attendees to Trauma Systems Therapy (TST), which is a unique, collaborative model for addressing the clinical needs of traumatized children and families, as well as the organizational needs of agencies that serve this population.

TST is about identifying the specific, actionable information that is needed to accurately identify the needs of a "trauma system", and to use that information to build a specific plan of treatment. The trauma system is defined as a traumatized child who has difficulty regulating their "survival in the moment"; states, and a social environment that either contributes to the dysregulation, or is not effective at helping the child to cope.

TST is about building collaborations within and between provider agencies.  This PMI will include an overview of the model from the model developers, including a focus on the TST approach to adaptation and implementation, known as Lead User Innovation. Members of the TST Innovation Community will present specific adaptation of TST for various populations and service settings. Featured adaptations will include:  TST for child welfare settings in the U.S. as well as cultural adaptions for child welfare in Singapore; TST for public schools in Boston and TST for refugee and other war-impacted populations, including children and families who were previously involved in ISIS.

Back to top

 PMI - 05

Enhancing Competence in Cognitive Processing Therapy for PTSD: Improving Skills for Detecting Assimilation and Harnessing the Power of Socratic Dialogue

LIVE SESSION SOLD OUT; ONLY RECORDING AVAILABLE

Keyword: Clinical Practice
Secondary Keywords: Clinical/Intervention Research
Population Type: Professional
Presentation Level: Intermediate
Region: Global

Sacks, Stephanie¹; Bassett, Gwendolyn²

¹Private Practice, 1200 N. Federal Highway, Suite 200, Boca Raton, Florida, United States, 33432
²Yale University School of Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut, United States, 06510

Cognitive Processing Therapy (CPT) for Post-Traumatic Stress Disorder (PTSD) has a robust evidence base, including 23 Randomized Controlled Trials, supporting its effectiveness for treating PTSD (Resick et al,. 2002, Chard et al., 2005, Monson et al., 2006, Resick et al., 2008, Galovski et al., 2012…). The focus of CPT is to help identify and resolve problematic beliefs about the trauma(s) themselves (i.e. “I could have prevented the trauma,” “I should have responded differently”) and implications of the trauma (“I can’t trust anyone,” “the world is unsafe,” “I cannot make good decisions”). An essential part of delivering effective CPT is detecting and prioritizing assimilated stuck points, or beliefs/attributions regarding why or how the trauma(s) happened. In addition, a cornerstone of CPT is the use of Socratic Dialogue to help evaluate and contextualize assimilated beliefs keeping clients stuck in non-recovery from trauma(s) (Resick, Monson & Chard, 2016). Effective utilization of the Socratic Method necessitates a warm and collaborative therapeutic relationship and stimulates clients’ curiosity such that it facilitates meaningful learning and change (Padesky, 1993; Overholser, 2011).
 
This pre-meeting institute will be facilitated by two CPT Trainers and Consultants with a combined 18 years of experience teaching clinicians across multiple disciplines (psychiatrists, social workers, psychologists, therapists, clinical nurse specialists, trainees) working with clients in a wide range of settings (community mental health centers, domestic violence shelters, VA, DoD, private hospitals, residential eating disorder programs, etc) in the US, Puerto Rico, Canada, and the UK.
 
This pre-meeting institute will utilize video demonstration, role-plays, small-group activities and other interactive and experiential methods to help participants 1- improve their skills for conceptualizing and detecting assimilated stuck points related a variety of trauma types and circumstances and 2- enhance their Socratic Dialogue strategies and techniques. This workshop is designed for clinicians with some experience with CPT, but clinicians of all levels of experience are welcome. This workshop is not a substitute for a full, two-day CPT workshop, which is the official foundational training for CPT.

Back to top

PMI - 06                                  

A Practical Introduction to Network Modeling in R: From Cross-Sectional Models to Short-Term Dynamics

Keyword: Research Methodology
Secondary Keywords: Research Methodology
Population Type: N/A
Presentation Level: Intermediate
Region: N/A

Price, Matthew¹; Legrand, Alison²; Brier, Zoe²; van Stolk-Cooke, Katherine²

¹University of Vermont, Dept of Psychology, Burlington, New York, United States
²University of Vermont, University of Vermont - John Dewey Hall, 2 Colchester Avenue, Burlington, Vermont, United States, 05405

PTSD is among the most diagnostically complex disorders in the DSM-5 (Galatzer-Levy & Bryant, 2014). This complexity has given rise to sophisticated new methods, such as network models, for examining PTSD and its relations to other constructs (McNally et al., 2014). Networks propose that psychopathology can be understood by examining the interrelations among symptoms that comprise a diagnosis as well as the interrelations of symptoms with other constructs (e.g., emotion dysregulation or impulsivity). A large body of literature has emerged suggesting that network models provide detailed information as to how post-trauma mental illness develops, is maintained, and potentially how it can be treated (for review see Birkeland, Greene, & Spiller, 2019). Indeed, recent work suggested that short term dynamic network models, a technique in which a network is applied to longitudinal data, are among the most promising methods to identify and understand the mechanisms of evidence-based treatment (Hoffman, Curtiss, Hayes, in press). In sum, network modeling holds considerable potential for advancing trauma-focused research. However, network modeling methods are complex and are difficult to implement without prior training. This PMI will offer a unique opportunity to learn network modeling from experts with considerable experience with these approaches. Attendees will obtain an understanding of the strengths and limitations of network models and how to conduct them on their own.

The PMI will provide a conceptual and practical introduction to network modeling with didactic and hands-on practical training. The PMI will be divided into 5 sections: (1) Introduction to the theoretical and conceptual underpinnings of network models as they relate to PTSD, (2)Introduction to R for network modeling with practical examples, (3) Implementation of Cross-Sectional Networks in R with practical examples, (4) Implementation of Dynamic Network Models in R with practical examples (5) Discussion of the advantages and challenges of networking modeling including reproducibility and comparisons across networks.

Attendees of all levels of interest, experience with network models, and R are welcome. An array of tools will be made available to attendees including a glossary to define network modeling jargon, implementation "cheat sheets", code templates, tutorials, and relevant literature. Practical sessions will be conducted with example datasets to learn the basics of the approach. Attendees are encouraged to bring their own data to use as well. The instructors will be available for one-on-one consultation throughout the institute and at the end of the session.

Back to top

PMI - 07

Assessment of ICD 11 PTSD and Complex PTSD Using the International Trauma Interview: A Training Workshop

Keyword: Assessment/Diagnosis
Secondary Keywords: Clinical/Intervention Research, Complex Trauma
Population Type: Adult
Presentation Level: Intermediate
Region: Industrialized Countries

Roberts, Neil¹; Bisson, Jonathan²; Cloitre, Marylene³; Karatzias, Thanos⁴

¹Cardiff and Vale University Health Board, Hadyn Ellis Building, Cardiff, Cardiff, United Kingdom
²Cardiff University School of Medicine, Hadyn Ellis Building, Cardiff, Wales, United Kingdom, CF24 4HQ
³National Center for PTSD-Dissemination and Training Division, Menlo Park, California, United States
⁴Edinburgh Napier University & Rivers Centre for Traumatic Stress, Edinburgh Napier University & Rivers Centre for Traumatic Stress, Sighthill Campus, Edinburgh, Scotland, United Kingdom, EH114BN

The 11th version of the diagnostic system, the International Classification of Diseases and Related Health Problems was published by the World Health Organisation in 2018. This system includes a revised version of PTSD, alongside a new diagnosis of complex PTSD (CPTSD). A number of studies have found support for distinction between the two disorders (e.g. Brewin, Cloitre, Hyland, Shevlin, Maercker; et al., 2017; Cloitre, Gavert, Brewin, Bryant & Maercker, 2013).

Semi structured interviews have traditionally been seen as the gold standard means of evaluating trauma related disorders in the field. The International Trauma Interview is a newly developed semi-structured interview which assesses symptoms of PTSD, alongside problems associated with disturbance in self organisation (DSO) which contribute to a diagnosis of CPTSD.

Promising findings in relation to the psychometric properties of the ITI have recently been reported in a study of a Swedish trauma exposed community sample (Bondjers, Hyland, Roberts, Bisson, Willebrand & Arnberg, 2019).

This day long PMI will provide an overview of the ICD11 PTSD and CPTSD symptom criteria and provide training in the administration and scoring of the ITI. Training will be informed by rating of video case examples, role play and discussion of scoring challenges. Attendees will have a number of opportunities to practice item scoring in order to become thoroughly familiar with the interview.

We will also describe recent evaluations of the ITI in a number of different populations.

By the end of the workshop attendees will be able to:

• Describe the ICD-11 criteria for PTSD & CPTSD and identify traumatic events that meet ICD-11 criteria for PTSD & CPTSD
• Rate the frequency and intensity of ICD-11 PTSD symptoms to generate severity scores
• Rate DSO items to generate severity scores<br /> Generate symptom cluster scores and ascertain whether PTSD & CPTSD diagnostic criteria are met
• Distinguishing traumatic stress in the form of PTSD and CPTSD, from other conditions such as depression and BPD

PMI - 08

Breaking Barriers to Healing, Education, and Social Justice: Addressing Trauma Induced by Structural Racism and Other Societal Oppressions in Schools and Other Institutions

Keyword: Community-Based Programs
Secondary Keywords: Community/Social Processes/Interventions; Complex Trauma; Culture/Diversity; Training/Education/Dissemination
Population Type: Lifespan
Presentation Level: Intermediate
Region: Industrialized Countries

Merchant, Martha¹; Dorado, Joyce¹

¹UCSF-Zuckerberg San Francisco General Hospital, Division of Infant, Child, and Adolescent Psychiatry, 1001 Potrero Ave., 7M8, San Francisco, California, United States, 94110

Racism and other forms of societal oppression can be trauma-inducing and keep people from underserved communities out of schools and systems of care, yet these issues are often inadequately addressed in trauma-informed systems (TIS) approaches. University of California, San Francisco Healthy Environments and Response to Trauma in Schools (HEARTS), a program that has worked with public school districts since 2008 to create more trauma-informed, safe, and supportive learning and teaching environments, places cultural humility, racial justice, and equity at the center of the work. HEARTS is a whole-school, prevention and intervention approach that addresses trauma and chronic stress at the student, staff, and organizational levels. Program evaluation has been promising: school staff report significant increases in their understanding of trauma and use of trauma-sensitive practices, as well as significant improvements in their students&rsquo; ability to learn, time on task, and school attendance. Pre-post analyses also reveal significant decreases in disciplinary office referrals, suspensions, and incidents of student aggression. The HEARTS director and a HEARTS psychologist with expertise providing trauma-specific consultation and training in schools will present their work (a) raising awareness around how societal oppressions are embedded in institutional policies and procedures and in daily interactions and how these implicit and explicit biases can induce trauma (i.e. sociocultural trauma), and (b) offering approaches to counteract the harm caused by personally mediated and institutionalized bias. We will provide opportunities for individual reflection as well as time to discuss how these biases manifest in participants' work settings. As a framework for improving practice, we will use the HEARTS core-guiding principles: Understanding Trauma & Stress, Cultural Humility & Equity, Safety & Predictability, Compassion & Dependability, Collaboration & Empowerment, and Resilience & Social Emotional Learning. These principles, grounded in research on trauma interventions and a review of nationwide TIS approaches, have been utilized in over 20 schools across urban and rural districts as well as cross-disciplinarily (in a modified form) in public health, child welfare, juvenile justice, and other youth- and family-serving sectors. While similar principles are common and widely accepted in TIS efforts, we will critically examine how such principles need to be augmented in order to apply them in a culturally responsive and equity-promoting manner that mitigates the effects of implicit bias and racism. We will offer skills and evidence-based strategies to manage individual and structural bias, address sociocultural trauma, and promote resilience, healing, and equity.

Back to top

PMI - 09                        

How to Identify and Correct Common Pitfalls in the Delivery of Prolonged Exposure for PTSD: Learning from Videotaped Sessions of Therapy Gone Awry

Keyword: Clinical Practice
Secondary Keywords: Anxiety, Training/Education/Dissemination; Theory
Population Type: Adult
Presentation Level: Introductory
Region: Global

Sherrill, Andrew¹; Burton, Mark¹; Zwiebach, Liza¹; Rauch, Sheila²; Rothbaum, Barbara¹

¹Emory University School of Medicine, 12 Executive Park, 3rd Floor, Atlanta, Georgia, United States, 30329
²Emory University School of Medicine/Atlanta Veteran's Administration, 12 Executive Park Drive, NE, 3rd Floor, Atlanta, Georgia, United States, 30329

Prolonged exposure (PE; Foa, Hembree, Rothbaum, &amp; Rauch, 2019) is a first-line treatment for PTSD (Cusack et al, 2016; Lee et al., 2016) and recommended in practice guidelines. After clinicians complete a multi-day introductory didactic workshop, they face many difficulties administering PE with actual patients (Zoellner et al., 2011). Unfortunately, early difficulties in delivering PE may dissuade some clinicians from additional attempts in the future.

This PMI will be conducted by trainers of the Emory University Prolonged Exposure Consultant Training Program, which, among other aims, helps community providers become competent in PE. Since 2016, Emory's program has graduated 44 trainees, each of whom demonstrated sufficient competency as measured by manual fidelity scores (mean adherence score: 95%) and retention of didactic material (mean test score: 86%). In all, trainees successfully completed PE with 100 patients as measured by the PTSD Checklist for DSM-5 (Weathers et al., 2013). Preliminary follow-up data (12 months) indicates trainees&rsquo; use of PE increased by 127% after completing the program.

We have observed many common pitfalls related to PE-specific skills (e.g., executing therapeutic --in vivo-- exposures and imaginal exposures), general psychotherapy skills (e.g., instilling hope), and trainee characteristics (e.g., colluding with avoidance). To correct pitfalls, novice clinicians must first identify they made an error and then identify their own unhelpful thoughts and expectations that preceded the error. Research shows outcomes of exposure therapies are poorer when therapists have unhelpful beliefs about exposure (Deacon, Lickel, Farrell, Kemp, & Hipol, 2013; Farrell, Deacon, Kemp, Dixon, &amp; Sy, 2013). Successful PE clinicians are able to use consultation or supervision to learn from their pitfalls, a process that involves refining how they think about exposure therapy and the capabilities of their patients and themselves (Michael, Blakey, Sherrill, & Aosved, 2020).

Rather than wait to learn from one&rsquo;s own pitfalls, this PMI aims to familiarize trainees with common pitfalls and provide guidance on how to avoid them. We have partnered with professional filmmakers and actors to develop over a dozen short training videos depicting pitfalls. Attendees of this PMI will watch these videos as a group, identify what went wrong, and then participate in group discussions led by presenters about how to protect against pitfalls with future patients.

Please note attendees of this PMI are required to have previously completed a multi-day didactic PE workshop. Content is introductory but clinicians with moderate to advanced experience with PE will also benefit.

Back to top

 PMI - 10                                  

Trauma Affect Regulation: Guide for Education and Therapy (TARGET) in Practice and Research​

Keyword: Clinical Practice
Secondary Keywords: Complex Trauma; Family Relationship Processes/Interventions
Population Type: Lifespan
Presentation Level: Intermediate
Region: Industrialized Countries

Ford, Julian¹ 

¹University of Connecticut Health Center, 263 Farmington Ave, Farmington, Connecticut, United States, 06030

Trauma Affect Regulation: Guide for Education and Therapy (TARGET) is a framework for helping adult and youth trauma survivors to understand how the brain and body adapt self-protectively during and after exposure to traumatuic stressors, and to modify both classic and complex (e.g., dissociation, affect dysregulation) posttraumatic stress reactions by accessing internal strengths and resources using a sequential skill set that is summarized by the acronym, FREEDOM: Focusing on bodily awareness, core values, and relationships that provide security, Recognizing triggers for stress reactions, Emotion awareness, Evaluating cognitions, Defining goals, choosing behavoral Options, and Making a contribution. TARGET has been tested in six randomized clinical trials and four experimental or quasi-experimental field trials with low-income and incarcerated women, military veterans, adults in substance abuse treatment, college student problem drinkers, girls involvedi in delnquency, youth in juvenile detention and secure mental health units, and foster and adoptive families. The model developer will provide a practical introduction to the psychoeducation and therapeutic strategies involved in conducting TARGET as an individual, group, or family therapy, as a milieu intervention, and for frontline worker and clinical self-care and management of secondary traumatic stress. With case examples and videos of TARGET applied in critical incidents in clinical practice, attendees will learn the basic elements of TARGET that they can apply in their own practice, as well as how TARGET can be implemented in their research. Case examples from attendees will be discussed in order to illustrate how the model can be adapted to fit a wide variety of client populations and clinician theoretical orientations. Adaptations of the model for communities of color, clients from non-Western cultures, and gender non-conforming adults and youth will be woven into the case discussions and commentary on video samples.

Back to top