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

Child-Adult Relationship Enhancement (CARE): Reducing Mental Health Risk and Building Skills for Promoting Resilience in Children and Teens After Trauma

Robin H. Gurwitch, Ph.D., Duke University Medical Center
Bridget Poznanski, Ph.D., Children's Hospital of Philadelphia

The field of trauma and our understanding of factors impacting recovery and resilience continues to grow and develop. One factor that remains a constant in supporting healing and resilience is the presence of strong positive relationships, especially for children and teens. The most effective evidence-based programs to support youth after trauma include the importance of connections, but they require intensive training and treatment. Unfortunately, as COVID-19 has revealed, the need for mental health services after trauma far outstrips the capacity to provide such services. As a result, access to programs designed to improve relationships and to help in the healing process is lacking; Child Adult Relationship Enhancement (CARE) helps address this need. CARE is a trauma-informed set of skills created to enhance relationships and reduce mild/moderate child behavior challenges often present after trauma. CARE is for use by any adult interacting with a child/youth. CARE can be used alone as well as to complement other intervention services. Thus far, CARE has been disseminated to over 20,000 adults in the United States, its territories, and across Japan. Evidence is building, including through randomized controlled trials, for the effectiveness of CARE with different populations and in a variety of settings. Adaptations have been made for the use of CARE in childcare and school settings, in primary and integrated care settings, with foster parents, and after disasters /mass casualty events. CARE has been taught to staff in child protection services, family and drug courts, substance abuse treatment centers, home visiting programs, and domestic violence shelters and to families in these systems. Medical, mental health, allied health professionals and crisis counselors have received CARE training to complement their services, especially for children experiencing trauma. The CARE workshop will address how the pandemic and the rise of hate and racism are impacting marginalized communities in the U.S. and around the world, often with adverse impact on safe and secure relationships. This workshop will teach participants CARE skills they can immediately implement with families they serve, in any capacity. Handouts for using CARE will be provided. The workshop will include didactic information, videos, activities, and live practice with feedback for the greatest learning potential. Implementation, dissemination efforts, and research will be discussed, helping participants determine how CARE can be most useful in their settings, thus improving their efforts as they enhance their tools designed to build resilience in families after trauma.

Learning Objectives:

1. Describe the impact of trauma on relationships for children and teens, including the impact of COVID-19.
2. List the skill components (P's and Q's) of Child Adult Relationship Enhancement (CARE)
3. List at least 4 settings and populations appropriate for CARE implementation.

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PMI-2

Integrating measurement-based care into the treatment of trauma: considerations for clinical practice, training, and organizational implementation

Kelly P. Maieritsch, Ph.D., Rush University Dept. of Psychiatry and Behavioral Health
Ellen Healy, Ph.D., VA Boston Healthcare, Boston University School of Medicine
Marianne Silva, LCSW, VA Connecticut Healthcare System
Lisa-Ann Cuccurullo, PsyD, NCPTSD

This pre-meeting institute will provide a comprehensive overview of the considerations required to integrate measurement-based care (MBC) into clinical practice. MBC is the use of patient-reported outcome measures repeated over the course of treatment for the purpose of tracking progress and empowering both provider and client to collaboratively establish goals and plan treatment (Scott & Lewis, 2015). Evidence suggests MBC can improve usual clinical care (Gondek et. al, 2016). As a framework to guide treatment, MBC has transtheoretical and transdiagnostic relevance across clinical settings (Scott & Lewis, 2015). The model promoted by Lewis and colleagues is a multi-part clinical process that includes the collection of information, review of the data between provider and client with emphasis on collaborative discussion, and then use of the data and discussion to inform treatment planning. The Veterans Health Administration (VHA) has adopted this model and coined the MBC process into 3 steps of “Collect, Share & Act” (Resnick & Hoff, 2020) as part of its systemwide implementation efforts.

This pre-meeting institute will provide an overview of the Collect, Share and Act model of MBC as it is implemented within trauma-focused psychotherapy. Clinical experts in Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) and Eye Movement Desensitization and Reprocessing (EMDR) will share clinical applications of each phase of MBC. The focus of MBC will include symptom monitoring (PTSD and comorbidities), as well as assessment of improvements in functioning. The pre-meeting institute will also provide best practices for integrating MBC into training programs and identify key organizational and contextual factors to address when implementing MBC within mental health systems.

Learning Objectives:

1. Describe key components and strategies of “Collect, Share & Act” when providing trauma-focused treatment, specifically CPT, PE & EMDR.
2. Facilitate understanding of the use of measurement-based care in the evaluation of comorbities and functioning by identifying appropriate assessments and impact of results on treatment planning
3. Identify strategies for incorporating MBC into training and consultation for trauma treatment and identify organizational factors that will facilitate implementing measurement-based care within mental health systems

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PMI-3

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

Population Type: Adult
Presentation Level: Introductory
Region: Global

Lynn C. Waelde, Ph.D., Palo Alo University

Mindfulness-based interventions are increasingly used for stress and trauma, though the approach requires adaptation for the specialized and diverse 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. These time-tested techniques are used to promote developmental capacities for attention, emotion, cognitive, and behavior regulation that are deficit in diverse manifestations of trauma, in order to overcome avoidance, regulate stress reactions, and encounter and resolve trauma material. A distinguishing feature of IR is the use of a variety of mindfulness and meditation (MM) techniques that are matched to the needs and capacities of individual traumatized clients. This flexibility within manualization is conducive to a transdiagnostic, 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, 2022). This workshop will provide an overview of the theoretical and empirical bases for using MM for diverse and comorbid manifestations of trauma; explain how IR is grounded in existing trauma treatments; address how the developmental contextual grounding of the intervention is conducive to transdiagnostic implementation and a culturally responsive approach; provide an overview of the 9-session intervention, with a description of the theoretical concepts, goals, and objectives of each session; and describe and interactively 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 diverse manifestations of trauma
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

PMI-4

The Revised Clinician-Administered PTSD Scale for DSM-5 (CAPS-5-R): Guidelines for Standard Administration and Scoring

Population Type: Adult
Presentation Level: Intermediate
Region: Industrialized Countrie

Frank Weathers, Ph.D., National Center for PTSD, VA Boston Healthcare System
Christina Byrne, Ph.D., Western Washington University
Michelle J. Bovin, Ph.D., National Center for PTSD at VA Boston and Boston University School of Medicine
Daniel Lee, National Center for PTSD at VA Boston and Boston University School of Medicine
Sarah E. Kleiman, Ph.D., Kleiman Consulting and Psychological Services, PC

The CAPS-5 is a widely used, well-validated diagnostic interview which assesses all DSM-5 diagnostic criteria for PTSD. Drawing on ten years of experience training raters with a wide range of skills in PTSD assessment, the CAPS-5 was recently revised to make it easier for raters to learn and achieve a high degree of standardization in administration and scoring. New features of the revised version, the CAPS-5-R, include (a) simplified formatting to improve visual flow, (b) revised prompts to increase rater and respondent comprehension, (c) expanded rating options and scoring grid to capture more variability in PTSD severity, (d) more explicit and detailed rating scale anchors, (e) scoring guidelines embedded with each symptom, and (f) a rating card with visual anchors to facilitate respondents’ estimation of symptom frequency. Several validation studies are underway.

Conducted in two parts, this workshop will provide participants with (a) a detailed overview of the CAPS-5-R, and (b) experiential role-played practice in administration and scoring, with expert instruction and feedback. The overview will consist of a didactic presentation outlining the key features of the CAPS-5-R, guidelines for standard administration, and scoring conventions. It will also cover critical topics including the conceptual basis of individual PTSD symptoms and applying principles of trauma-informed care while conducting a structured PTSD interview in a research context.

The experiential component will consist of role-played CAPS-5-R interviews conducted in breakout groups, each led by an expert in the assessment of trauma and PTSD and the CAPS-5-R. Participants will have an opportunity to practice administration of CAPS-5-R items and calibrate their scoring through group discussion led by the expert. The workshop will conclude with a general question and answer period.

Participants will be provided with copies of all training materials, including the CAPS-5-R, the Frequency response card, the Life Events Checklist for DSM-5, and the slides used in the overview. As time permits, the experts will make themselves available after the workshop for additional discussion and consultation on specific applications of the CAPS-5-R. Some previous experience with the CAPS-5 is recommended but not required.

Learning Objectives:

1. Describe the rationale for the revision of the CAPS-5, and summarize the new features of the CAPS-5-R.
2. Administer the CAPS-5-R according to the standard guidelines and obtain sufficient information to make valid ratings.
3. Score the CAPS-5-R according to the standard guidelines and make accurate item severity ratings and diagnostic decisions.

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 PMI-5

Experiencing the Novel Immersive Exposure-Based Treatment with Motion-Assisted Multi-Modal Memory Desensitization and Reconsolidation (3MDR)

Population Type: Adult
Presentation Level: Introductory 
Region: Global

Eric Vermetten, MD, Ph.D.,  Leiden University Medical Center
Suzette Bremault-Phillips, Ph.D., M.A., BMR (OT), B.SC., University of Alberta
Michael J. Roy, MD, MPH, Uniformed Services University
Pinata H. Sessoms, Ph.D., Naval Health Research Center
Lisa Burback, MD, University of Alberta
Olga Winkler, 
Mirjam J. Nijdam, Ph.D., ARQ National Psychotrauma Center

In this premeeting institute, we will introduce, demonstrate and present evidence for an innovative treatment, Multi-modal Motion-assisted Memory Desensitization and Reconsolidation (3MDR). This therapy changes the context in which exposure is delivered by combining virtual reality, a dual attention task, and movement, personalizing treatment with patient-selected pictures and music. Veterans with PTSD often do not fully benefit from current evidence-based treatments. Persistent avoidance of traumatic memories and low therapy engagement are associated with reductions in treatment effectiveness and require alternative treatment approaches. Results from two RCTs will be presented in which Veterans with treatment-resistant PTSD received 6 sessions of 3MDR followed by either 10 weeks or 16 weeks of treatment as usual. Comparisons of these groups on PTSD symptom severity, comorbid symptoms, and neuropsychological functioning, measured at baseline, posttreatment, 12 weeks and 16 weeks follow-up will be shown. Results demonstrated a significant change in half of the Veterans with treatment-resistant PTSD receiving 3MDR. We will also share other results from Dutch, US and Canadian research studies on 3MDR. The treatment process was perceived as a breakthrough, resulting in increased treatment effects over time during longitudinal follow up.

3MDR is a novel virtual reality assisted therapy currently being studied, at various sites in the Leiden and Beilen/the Netherlands, Washington/San Diego/United States, Cardiff/United Kingdom, and Edmonton/Canada. This workshop will introduce the therapy, review current evidence base and provide a demonstration. Participants will have the opportunity to participate in multiple choice questions as a poll. Learning objectives will be discussed in the presentation.

In this workshop, we will also show video vignettes and demonstrate 3MDR to attendees, allowing experience-based learning about the intervention, including the virtual reality supported immersive environment, treadmill walking, dual task processing, reconsolidation, and meaning-making. The critical role of personalized images and music will be discussed, as will the role of the clinician as therapist and coach.

Learning Objectives:

1. Participants will be able to appreciate factors associated with the complexity of PTSD and treatment resistance amongst military members and veterans.
2. Participants will be able to identify key components of Multi-modal, Motion-assisted Memory Desensitization and Reconsolidation (3MDR) and their significance to PTSD treatment
3. Participants will be able to describe the potential of virtual reality in the personalization of exposure-based treatment of PTSD

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PMI-6                                  

Strengthening the working alliance in Cognitive Processing Therapy for PTSD: How to improve relational responsiveness to reduce dropout and increase client outcomes

Population Type: Mental Health Professionals
Presentation Level: Intermediate 
Region: Global

Gwendolyn Bassett, MSW/LCSW-R, Private Practice; NYU Silver School of Social Work
Stephanie Sacks, Ph.D. in Clinical Psychology, Private Practice; Nova Southeasern University

Cognitive Processing Therapy for PTSD (CPT) is an evidence-based psychotherapy (EBP) for PTSD that has been proven effective with many populations, in numerous settings, and for PTSD from a range of traumas (Resick, Monson, & Chard, 2017). Despite the availability and effectiveness of EBPs for PTSD, dropout can range from 18-72% (Sijercic, Liebman, Stirman, & Monson, 2021). Thus, it is crucial that clinicians and researchers work to understand and reduce client dropout to improve outcomes.

A growing body of research suggests that a strong therapeutic alliance acts in tandem with evidence-based treatment protocols to reduce dropout and increase clinical outcomes (Ellis, Simiola, Brown, Courtois, & Cook, 2018; Laska, Gurman, & Wampold, 2014; McLaughlin, Keller, Feeny, Younstrom, & Zoellner, 2014; Norcross & Wampold, 2019). Additionally, some research has found that dropout rates may be higher and client satisfaction lower when therapist and client have a cultural/racial mismatch (Chang & Yoon, 2011; Constantino et al., 2017; Johnson & Caldwell, 2011; Loskot et al., 2021). In CPT specifically, a recent study found that the alliance predicted CPT dropout (Sijercic, Liebman, Stirman, & Monson, 2021). Therefore, CPT clinicians require skills to make complex, judicious decisions about when and how to direct attention toward the clinical relationship while maintaining fidelity to a brief, manualized PTSD treatment.

This Pre-Meeting Institute will be co-led by two expert CPT trainers/consultants and therapists with many years of experience teaching CPT and delivering it to diverse clients in diverse settings. It will provide a conceptual framework for how to integrate evidence-based therapy relationship elements (Norcross & Wampold, 2019) within the CPT protocol by using foundational CPT skills. The workshop will highlight the opportunities within the CPT framework to assess and enhance the alliance, to address and repair treatment ruptures, and to work effectively in cross-cultural dyads with diverse clients and diverse trauma-types.

The workshop will focus on case conceptualization, Socratic questioning, identification of stuck points (about the treatment and the therapist), worksheets, and skills to mitigate PTSD avoidance. Through lecture, role play, and small and big group activities, the workshop will build clinician confidence and competence for responding relationally and with cultural sensitivity to each client, including in cross-cultural and cross-racial clinical dyads. Cases of interpersonal traumas, race-based traumas and where there are social identity differences within the clinical dyad will be included. Lastly, this workshop will address common therapist and client stuck points about discussing the clinical relationship during CPT.

Learning Objectives:

1. Identify 3 entry points in the CPT protocol to assess and strengthen the treatment alliance and 3 interventions to use to improve the alliance and address treatment ruptures
2. Use foundational CPT skills in order to explore how social identity differences within the clinical dyad are being experienced by the client
3. Identify and remedy common barriers to addressing the clinical relationship within CPT

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