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.

          
PMI-1

DBT/CPT: A Combined Approach to Treating Comorbid BPD and PTSD

Sarah Voss Horrell, Salem VA Medical Center

This is an expansion of a workshop presented at the ISTSS 36th Annual Meeting in 2020 about using CPT with individuals diagnosed with Borderline Personality Disorder (BPD). Individuals with BPD are highly likely to also meet diagnostic criteria for PTSD; rates of PTSD range from 25% to 56% in BPD samples (Shah & Zanarini, 2018). Positive outcomes following DBT for treatment of BPD are less robust in individuals with comorbid PTSD (Barnicot & Priebe, 2013). Studies examining a combined approach to treatment of BPD and PTSD have shown promise; Harned and colleagues (2012, 2014, and 2018) found that individuals with comorbid PTSD/BPD who received DBT in combination with prolonged exposure (PE) showed better outcomes than those receiving DBT alone. Given that DBT/PE has become a more widely accepted treatment option for individuals with comorbid PTSD and BPD, and as patient choice is potentially an important factor in treatment retention for PTSD (Le, Doctor, Zoellner, & Feeny, 2018), alternative options for treating PTSD are desired. CPT presents a viable alternative option as it is also a gold-standard PTSD treatment (VA/DOD 2017). However, providers may have concerns about utilizing a cognitive approach with this population, including fear that unintentional invalidation of patient experiences may occur during cognitive restructuring and potentiate increased emotion dysregulation and life-threatening behaviors. A non-judgmental, supportive, open approach is recommended, but often challenging to adopt simultaneously with Socratic questioning. Identifying parallels between the CPT concepts and DBT concepts can help providers maintain fidelity to CPT within a DBT framework and also help patients to better accept and apply the new strategies learned in CPT. In this institute, practical strategies for conducting CPT following completion of DBT will be demonstrated, including strategies for introducing CPT as a treatment option and preparing the patient to have a successful experience in CPT; utilizing/modifying the diary card for continued symptom monitoring throughout CPT, balancing the use validation and cognitive restructuring principles, managing self-harm and suicidal urges and behaviors and managing therapy-interfering behaviors. The primary focus of this training will be on direct application of CPT with patients in stage two of a DBT program; modeling and role plays will be used to illustrate concepts and application.

Learning Objectives:

1. Utilize DBT strategies to prepare patient to engage in CPT following stage 1 DBT treatment
2. Identify methods for utilizing Socratic questioning while simultaneously employing the DBT levels of validation to reduce perceived invalidation and therapy rupture
3. Facilitate understanding of CPT for patients/clients by identifying parallels between at least 3 DBT and CPT concepts.  

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PMI-2

Providing Mental Health Support in Complex Political Context (CPC)

Elena Cherepanov, Cambridge College

The complex political context (CPC) is characterized by the government’s abuse of power, political violence and massive violation of human rights. CPC can be recognized both in low or high resources settings and anywhere where belonging to a particular political, religious, racial, ethnic or sexual minority group makes people a target of systematic persecution. This workshop brings awareness to the psychological needs of marginalized and politically targeted groups when the community is unable or unwilling to support them and where receiving mental health (MH) services can increase risks for the recipients.

The global response to the COVID-19 pandemic highlighted the importance of trauma-informed and culturally informed approaches in a public health emergency. Severe trauma, traumatic loss, and profound distrust of public officials and health care workers associated with CPC become a barrier to accessing health care and mental health (MH) services.

Case studies will demonstrate the limitations of some commonly used MH practices. The following discussion offers practical recommendations for service engagement and choosing the effective, safe, and context-appropriate interventions that carry systemic impact. It examines common ethical dilemmas, outline strategies for negotiating them, and emphasize providers' self-awareness as a core competency.

Learning Objectives:

1. Recognize two indicators of a complex political context
2. Identify one mental health interventions of choice in CPC
3. Examine ethical dilemmas and practice decision-making

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PMI-3

An Introduction to Cognitive Behavior Therapy for Postdisaster Distress: A Transdiagnostic Treatment

Population Type: Adult
Presentation Level: Intermediate
Region: Industrialized

Jessica Hamblen, VA National Center for PTSD
Kerry Symon, Office of Labor Relations

A disaster occurs somewhere in the world nearly every day. The majority of people who experience a disaster experience some symptoms. Although symptoms may improve on their own, for many they continue for months and years later, resulting in high levels of distress and problems functioning at work, home, and in close relationships. Cognitive Behavior Therapy for Postdisaster Distress (CBT-PD) is a time-limited, transdiagnostic approach to treating problematic symptoms following exposure to a disaster that can threaten functioning, well-being, and overall quality of life. The CBT-PD program includes strategies to facilitate recovery from a disaster, including psychoeducation about the nature of post-traumatic reactions, relaxation techniques for reducing anxiety and physiological over-arousal, and activity scheduling to re-engage people in enjoyable and meaningful activities to combat depression and avoidance. The majority of the program focuses on teaching cognitive restructuring as a strategy for dealing with negative feelings. Over 20 years of clinical experience and research support the effectiveness of CBT-PD. First developed and implemented after the September 11th attacks, we have continued to improve it as we gained further experience with it after other disasters, both in the United States, such as Hurricane Katrina and the Boston Marathon bombing, and abroad, such as the earthquake in L’Aquila, Italy. Most recently, the program has been offered through New York City’s employee assistance program to assist front-line workers who are struggling to respond to the medical crisis associated with COVID-19. This PMI is an introduction to the CBT-PD program. After providing a rationale for the model and reviewing the research support, we will describe each component of the program and include short interactive exercises and role plays. At completion of the PMI attendees should have a good understanding of what the program offers and whether it would be a good fit for their clients.

Learning Objectives:

1. Identify and evaluate the appropriateness of the Cognitive Behavior Program for Postdisaster Distress for specific populations.
2. Describe the four core components of the Cognitive Behavior Program for Postdisaster Distress program.
3. Describe the 5 Steps of Cognitive Restructuring including when the 5 Steps results in a new more balanced thought and when problem solving is needed to come up with an action plan.

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PMI-4

Advances in Epidemiologic Methods for Trauma Researchers

Presentation Level: Intermediate

Jeffrey Sonis, University of North Carolina at Chapel-Hill
Traci Kennedy, University of Pittsburgh Medical Center
Ellicott Matthay, University of California, San Francisco
Melissa Tracy, University at Albany School of Public Health
Maya Mathur, Stanford University School of Medicine

There have been important methodological advances in epidemiology and related fields in recent years, though they have been used infrequently in trauma research. The purpose of this PMI is to introduce trauma researchers to some of those methods. Approaches based on counterfactuals enable researchers to draw causal inferences in observational (i.e., non-experimental) research with greater confidence that confounding is not present. Those based on complex system modeling (agent-based modeling) permit the evaluation of population-level phenomena beyond the aggregation of individual behaviors. Each of the four 50-minute presentations will be pitched at an intermediate level and will discuss the assumptions, strengths and limitations of the methods described. This PMI is co-sponsored by the Research Methods SIG.

The PMI features the following presentations:

Marginal Structural Models
Traci Kennedy, PhD

Studies on the effects of traumatic exposures are necessarily observational, because individuals are not randomly assigned to be exposed to traumatic events. I will describe and illustrate the application of marginal structural models to isolate causal effects in longitudinal, observational data and underscore their utility for estimating the effects of traumatic exposures.

Alternative Causal Inference Methods in Non-Experimental Population Health Research
Ellicott Matthay, PhD:

This presentation will describe two major categories of study designs to meet the challenges of drawing causal inferences from observational research: those that use confounder-control (such as regression adjustment or propensity scores) and those that rely on an instrument (such as instrumental variables, regression discontinuity and difference-in-differences methods). The methods will be illustrated with examples from the literature on education and health.

Applied Causal Mediation Analysis
Justin Rodgers, PhD

This presentation will provide a comparison of traditional- and counterfactual-based approaches to mediation analysis including when results from these approaches will align, but more importantly when they will diverge. We will discuss model specification, estimation, and assumptions for linear and logistic regression, as well as single and multiple mediator models. We will also cover common approaches to sensitivity analysis.

Agent-Based Modeling
Melissa Tracy, PhD

Agent-based modeling is a computational approach in which agents with a specified set of characteristics interact with each other and with their environment according to predefined rules. This presentation will illustrate the central principles of this approach through examples from the trauma research literature. Finally, it will outline first steps and resources to get started using agent-based modeling.

Learning Objectives:

1. Identify the advantages of using marginal structural models for analyzing longitudinal research with time-varying covariates.
2. Categorize the limitations of traditional mediation analysis and the benefits of causal inference approaches to mediation analysis.
3. Formulate applications in trauma research that could be analyzed using agent-based modeling.

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 PMI-5

Inner Resources for Stress: Using Mindfulness, Mantra, and Meditation for Trauma Resilience and Recovery

Population Type: Adult
Presentation Level: Introductory 
Region: Global

Lynn Waelde, Palo Alto University

There is increasing interest in applying mindfulness-based interventions to stress and trauma, though the techniques require adaptation for the specialized needs of trauma survivors. Inner Resources for Stress (IR) is a manualized group-based intervention using mindfulness, mantra and meditation to promote trauma resilience and recovery. IR draws on conceptualizations of trauma and recovery articulated in cognitive-behavioral trauma therapies, integrated with the science and practice of mindfulness and meditation (MM). Time-tested MM techniques are used to promote developmental capacities for attention, emotion, and cognitive regulation in order to overcome avoidance, regulate physiological stress reactions, and encounter and resolve trauma material. A distinguishing feature of IR is the use of a variety of MM techniques that are matched to the needs and capacities of individual traumatized clients. This flexibility within manualization is conductive to a developmentally informed and culturally responsive approach. A series of one-sample and randomized controlled trials (RCTs) found that IR has beneficial effects on stress regulation and stress symptoms, such as anxiety, depression, and PTSD. RCTs of IR have found improved diurnal cortisol slope, indicating improved physiological stress regulation (Waelde et al., 2017), and more remission from chronic depression diagnosis (Butler et al., 2008) relative to control conditions. An RCT of military veterans with PTSD indicated that IR produced better emotion regulation, finding that IR significantly increased functional connectivity between the parahippocampal gyrus and left frontal pole in the IR group relative to a PTSD therapy preparation group and was associated with clinically significant pre/post reductions in PTSD symptoms in the IR group (Williams et al., 2018). Another RCT of IR for persons with PTSD found pre/post improvements in PTSD symptoms and significantly increased attention regulation in the IR group relative to a PTSD therapy preparation group (Waelde et al., 2015). The client intervention manual is available in Spanish and English and a therapist guide/treatment manual is available (Waelde, in press). This workshop will provide an overview of the theoretical and empirical basis for using MM for trauma; explain how IR is grounded in existing trauma treatments; address the how the developmental contextual grounding of the intervention is conducive to cultural humility and a culturally responsive approach; provide an overview of the nine-session intervention, with a description of the theoretical concepts, goals, and objectives of each session; and describe and demonstrate the MM techniques included in IR, along with guidance about their match for differing client presentations.

Learning Objectives:

1. Explain the theoretical and empirical basis for using mindfulness and meditation to address PTSD with reference to existing trauma treatments.
2. Describe mindfulness and meditation techniques and their match for differing client presentations.
3. Describe how IR can be flexibly implemented to match clients’ diverse cultural backgrounds.

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PMI-6                                  

Population Health Strategies for Sustaining Empowerment and Healing During the COVID-19 Pandemic

Population Type: Adult
Presentation Level: Introductory 
Region: Industrialized

Julie Hurd, Lyda Hill Institute for Human Resilience at UCCS, University of Colorado Colorado Springs
Steven Berkowitz, University of Colorado Anschutz Medical Campus
Nicole Weis, Lyda Hill Institute for Human Resilience at UCCS, University of Colorado Colorado Springs
Laura McGladrey, University of Colorado Anschutz Medical Campus,
Josef Ruzek, Lyda Hill Institute for Human Resilience at UCCS, University of Colorado Colorado Springs
Charles Benight, Lyda Hill Institute for Human Resilience at UCCS, University of Colorado Colorado Springs

The COVID-19 pandemic has caused inordinate stress on everyone worldwide exacerbated by health fears, economic, social, and political stress that have been predominate in many countries. Although we have all lived with the pandemic, there are specific populations and communities that have been exposed to excessive amounts of stress (e.g., health care providers, educators, first responders). As such, this half-day PMI will present several intersecting strategies that promote resilience and recovery at a community level in response to the COVID-19 pandemic. The PMI will cover the following topics:

1. Overview of the pandemic and specific needs: This section will discuss conceptualization of the pandemic as a traumatic stressor, unique challenges and impacts on specific communities, and critical components to consider in order to facilitate empowerment and healing.
2. Vulnerable populations, culture change, and community buy-in: This section will discuss an approach adapted from the Combat and Operational Stress First Aid (COSFA). It will review the Deployment Model which focuses on naming common experiences for acute and chronic stress, the Stress Continuum which focuses on establishing a common language for recognition and early mitigation of stress injury, and the importance of shifting from incidence debriefing to a surveillance and check-in model.
3. Promoting strength and resilience in natural social networks: This section will discuss the importance of social support and self-efficacy with community empowerment. It will introduce the Greater Resilience Information Toolkit (GRIT), a free, online program that trains individuals as resilience coaches for others in their community. The development of specific GRIT programs will be reviewed (e.g., community, educators) and videos from the training will be demonstrated. Data collected to evaluate GRIT will be presented and future directions extending the reach of GRIT through technology will be discussed.
4. Population based approach: This section will conclude with the intersection of established programs and existing resources in developing a full population based approach for continuous and widespread stressors, such as the COVID-19 pandemic.

Disaster mental health requires a population-based approach to promote resilience and recovery through targeted strategies that empower communities. This PMI provides a strategic approach for the pandemic disaster and offers useful tools and directions for future innovative community-wide interventions.

Learning Objectives:

1. Utilize the Deployment Model in managing COVID-19 related stress and trauma for frontline responders.
2. Demonstrate the ability to promote community empowerment through the application of the GRIT training program.
3. Identify needs of the community and apply a population based approach encompassing established programs and existing resources.

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PMI-7

Addressing Issues of High Risk in Child Trauma Treatment: Four Model Developers Share their Approach With Case Examples

Population Type: Child/Adol
Presentation Level: Intermediate
Region: Industrialized

Adam Brown, New York University, Langone Medical Center,
Glenn Saxe, New York University, Langone Medical Center,
Julian Ford, University of Connecticut Health Center
Margaret Blaustein, Center for Trauma Training, Inc.
Cheryl Lanktree, University of Southern California

This half-day pre-meeting institute will begin with an overview of the complexities of addressing child traumatic stress in situations of high risk, including specific case examples. Next, the audience will be introduced to developers of four leading evidence-based models for complex trauma intervention: ARC (Attachment, Self-Regulation and Competency), TARGET (Trauma Affect Regulation: Guide for Education and Therapy), ITCT (Integrative Treatment of Complex Trauma) 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, with a focus on situations where there is a high risk of harm. Case material will be presented, with each model developer explaining how their model would approach the complex case. 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.

Learning Objectives:

1. Understand the core components of four leading evidence-based treatment models for complex trauma where there is high risk of harm
2. Apply these intervention models to case conceptualization and treatment planning for a complex trauma clinical vignette.
3. Analyze the shared and unique elements of each treatment model presented, and make informed judgments about optimal matching of treatment with specific cases based on clinical presentation and contextual factors for situations of high risk

PMI-8

Peer Support and Self-Care for Mental Health and Healthcare Providers Responding to Extended Public Health Crises

Population Type: Prof
Presentation Level: Intermediate
Region: Industrialized

Patricia Watson, National Center for PTSD, Executive Division,
Kelly Maieritsch, National Center for PTSD, Executive Division,
Eliza McManus, Minneapolis VA Health Care System, One Veterans Drive
Richard Westphal, University of Virginia School of Nursing, 
Deborah Betsworth, Iowa City Veterans Affairs Health Care System

This pre-meeting institute will focus on what we have learned about peer support and self-care for mental health and health care providers in the context of the COVID-19 pandemic. We will talk about lessons learned from implementing the Stress First Aid (SFA) model in VA mental health clinics, and in multiple health care settings. The SFA model 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 mental health and health care providers can increase self-care and peer support via a highly flexible and longitudinal evidence-informed framework. It will review findings and lessons learned from our work with mental health and health care providers.

Learning Objectives:

1. Participants will be able to identify common stress reactions and risk factors for mental health and healthcare providers responding to extended public health crises
2. Participants will be able to learn strategies for engaging in self-care and peer support.
3. Participants will be able to learn the core components of an evidence-based peer support intervention.

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