Pre-Meeting Institutes (PMIs)

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.

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Wednesday, November 1

8:30 AM – Noon

12:30 – 5:00 PM

PMI 1-AM

Propranolol-Assisted Reconsolidation Therapy:
A Clinician's Primer

Clinical Interventions Track

Alain Brunet, PhD, McGill University (Canada)

Propranolol-assisted, reconsolidation blockade therapy (henceforth called Reconsolidation Therapy [RT]) is emerging as a brief, culture-unbound, and easy-to-learn approach for the treatment of stressor- and trauma-related disorders. The manualized approach is supported by four RCTs and two meta-analyses. This clinical workshop aims to:

1. Provide an overview of their empirical work with propranolol, spanning more than 20 years.
2. Demystify reconsolidation as a theory
3. Show how certain failures to replicate highlighted the 'boundary conditions' of reconsolidation, which ultimately turned RT into an even more efficient psychotherapy.

Learning Objectives:

1. Understand the concept of reconsolidation blockade (or impairment) as a treatment principle for PTSD
2. Appraise the scientiific evidence in favor of reconsolidation therapy
3. Distinguish between the various propranolol-based therapies

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PMI-1-AM2                

Shared Decision Making in PTSD Treatment:

Clinical Practice, Educational Support, and Ethical Implications

Professionals Track

Lisa-Ann Cuccurullo, PsyD, National Center for PTSD
Sadie E. Larsen, PhD, National Center for PTSD
Sarah Barron, PhD, South Texas Veterans Health Care System

Shared decision-making (SDM), the process of discussion and engagement in clinical decision-making, has been identified in multiple PTSD clinical practice guidelines as a best practice. SDM includes providing information, supported deliberation, and reaching an outcome that supports a patient’s preference and values. It has been found to have positive effects for both providers and patients (Etingen et al., 2019, Etinger et al., 2020), including increased engagement in evidence-based treatments (Hessinger et al., 2020, Mott et al. 2014).  

This Pre-Meeting Institute (PMI) will provide a complete outlook on the application of SDM through the lens of the presenters’ specialties: Clinician, researcher, implementation specialist. Specifically, presenters will identify a model of SDM, how to implement it in clinical practice, tools to enhance SDM, and ethical implications of adding shared decision-making into treatment decision-making. We will discuss insights from surveying the field about a SDM tool, and lessons learned from the product development of the PTSD Decision Aid. Clinical pearls will be shared from the consistent implementation of SDM within a large PTSD clinical team that offers an array of evidence-based treatment with multiple levels and modalities of specialty PTSD care, such as massed treatment and traditional weekly treatment. The ethical principles of clinical care and the alignment of SDM within those ethical principles will be discussed. Aspects of diversity (e.g., race, sexual orientation, and gender) and how the discussion of unique patient characteristics are a part of the implementation of shared decision making and a part of the ethical clinical practice.

The PMI will also provide best practices for integrating SDM into training programs and identify key organizational and contextual factors to address when implementing SDM within mental health systems.

Learning Objectives:

1. Provide information on SDM, feedback from the field on their experiences related to SDM, and tools to help utilize SDM in clinical practice.
2. Demonstrate the importance of SDM in ethical clinical decision making
3. Describe clinical and organizational factors that will facilitate implementing SDM within clinical practice

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PMI-2-AM

A Functional Approach to Repairing Moral Injury and Traumatic Loss in Context: 
Evidence, Change Agents, Clinical Strategies, and Lessons Learned

Clinical Interventions Track

Brett Litz, PhD, Boston University
Caitlin McLean, PhD, VA San Diego Healthcare System; University of California San Diego

Adaptive Disclosure (AD) is a manualized psychotherapy for PTSD that assumes that fear-based traumas have less impact on self- and other schemas. It treats loss and moral injury (MI) differently because they lead to moral emotions, threaten personal and shared identity and social bonds, and create loss of faith in personal or collective humanity. A non-inferiority trial found that AD was no less effective than CPT (Litz et al., 2021). We expanded AD (AD-E) to include letter-writing (e.g., to people who were harmed), compassion/mindfulness training, and extensive behavioral contracting to repair, recover, or create new opportunities to improve functioning in-vivo. Change-agents help people do things in their context that rebalance the scale of good and bad—to restore faith in one’s own or collective humanity. This entails being open to one’s or others’ goodness; being compassionate; and leveraging or establishing valued, valuing, and kindred attachments (e.g., doing/allowing good, belonging, feeling pride).

A recently completed randomized controlled trial of AD-E compared to Present-Centered Therapy (PCT) with 174 veterans with PTSD found uniformly positive results (under review; Yeterian et al., 2017). The mixed model analysis for the primary endpoint, Sheehan Disability Scale scores, revealed a significant Linear Treatment*Time Slope interaction (-0.20 [95% CI=-0.31, -0.09], p-value = 0.0003, t1289 =-3.65); the pre- to posttreatment effect sizes were d=-1.43 (95% CI=-2.00, -0.85) and d = -1.01 (95% CI=-1.39, -0.63) for AD-E and PCT, respectively (differential effect size d=.58). There were similar results for the CAPS-5 and other measures.

We will first introduce the conceptual model that underpins AD-E (a review of loss and MI) and other foundational assumptions of AD-E. Then, we will review the AD approach and handout and review the AD-E manual, which attendees can use to take session-by-session notes. This will be followed by a description of the AD-E trial evidence. Then, we will share cases, clinical strategies to avoid failure and pitfalls, and a variety of lessons learned from supervising every AD/AD-E case. In the last hour, we plan to solicit sustained Q&A and provide advice about ways of integrating elements of AD-E within members’ existing go-to approaches for specific cases raised by audience members.

Litz, B.T., et al. (2021). Adaptive disclosure, a combat-specific PTSD treatment, versus cognitive-processing therapy, in deployed marines and sailors: A randomized controlled non-inferiority trial. Psychiatry Research, 297, 113761.

Yeterian, J., Berke, D., & Litz, B. (2017). Psychosocial rehabilitation after war trauma with adaptive disclosure: Design and rationale of a Comparative efficacy trial. Contemporary Clinical Trials, 61, 10-15.

Learning Objectives:

1. Distinguish the etiology, phenomenology, and treatment of traumatic loss and moral injury, from fear-based traumas.
2. Understand the foundational assumptions of Adaptive Disclosure and recent evidence-based modifications to the approach.
3. Generate ideas about how specific change agents within the enhanced version of Adaptive Disclosure can be integrated into existing practice.

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PMI-3-AM

Understanding NIMH Research Funding:
A Workshop for Trainees and Early Career Investigators

Public Health Track
Non-CE/CME Session

Susan Borja, PhD, NIMH/NIH

Trainees and early career investigators often do not know where to start when considering federal research funding. The National Institutes of Health (NIH) is the leading supporter of biomedical research in the world. With 27 components called Institutes and Centers, each with a different mission, NIH can be confusing to investigators, particularly early in their careers. 

Obtaining funding from the National Institutes of Health (NIH) is at least advantageous if not necessary for many scientists pursuing a research career. Individual Fellowships (e.g., F30, F31, F32, F99) and Career Development Awards (e.g. K01, K08, K22, K23, K99) provide the opportunity to gain training and develop expertise to support an enduring independent research career. 

Researchers at institutions or in labs without a long history of research funding face challenges initiating and navigating the application process. Additionally, lore and myths are pervasive in many (even well-funded) institutions. Lack of foundational knowledge and inaccurate information contributes to missed opportunities or avoidable mishaps in applications. This workshop will enhance equity and clarity by ensuring investigators receive accurate information about pursuit of NIH research support, regardless of their institutional track record. 

This workshop aims to provide an overview of how to navigate the NIH organization, online tools to help researchers find the Institute and Program Officer best suited to the planned research questions, and funding opportunities provided by NIH for early stage investigators. Through interactive sessions, and concrete examples, participants will gain valuable knowledge regarding the funding process and pitfalls to avoid. 

We will introduce the basic processes of funding mechanisms for trainees and early career investigators, their purposes, and some of the requirements that researchers should be aware of. Participants will gain insight into the full application process from idea generation, to submission, to review, and post review processes (and why it takes so long). The PMI will allow for individual questions from participants regarding grants will be discussed.

By the end of the workshop, participants will have solidified their understanding of relevant NIH-funding mechanisms. Importantly, although the workshop is centered on NIH grants, the knowledge gained is also transferable to other United States Federal funding (e.g., DoD) and may also be applicable to international funding agencies outside the US. Researchers from underrepresented racial and ethnic groups, individuals with disabilities, and individuals from disadvantaged backgrounds are welcomed and encouraged to participate in this PMI.

Learning Objectives:

1. Understanding of NIH-funding mechanisms, in terms of types of application, grantsmanship, and review process.
2. Gain awareness of which NIH grant is most appropriate in light of your career stage and current trajectory, and learn specific methods to increase competitiveness.
3. Understand potential pitfalls that may hinder a successful application.

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PMI-4-AM

Medical Traumatic Stress: 
Integrating Evidence-Based Clinical Applications from Health and Trauma Psychology

Clinical Interventions Track

Sacha McBain, PhD, University of Arkansas for Medical Sciences
Matthew J. Cordova, PhD, Palo Alto University

Medical events in both childhood and adulthood, including components of the illness/injury and subsequent medical intervention, recovery, and disability, are increasingly being recognized as potentially traumatic (O’Donnell et al., 2003). There has been an increased focus on scholarly work related to medical trauma and medically-induced PTSD (Birk et al., 2019; Flaum Hall & Hall, 2016; Haerizadeh et al., 2019; Kazak et al., 2006). Existing evidence suggests trauma-focused treatment can promote both physical and psychological recovery (Murray et al., 2020; Song et al., 2020). However, there continues to be a dearth of clinical guidance on how to 1) best identify and treat prior trauma that complicates adjustment to illness and increases the risk for medically-induced PTSD, and 2) address medically-induced PTSD while concurrently targeting health-related concerns (e.g., pain, adjustment to illness, acquired disability) that may be negatively impacting recovery. 

This pre-meeting institute will provide a comprehensive overview of the biopsychosocial impacts of medical trauma and considerations for assessment and intervention in both traditional trauma and integrated care settings. Experts in health psychology, medically-induced PTSD, and integrated care will present clinical applications, including assessment considerations, case conceptualization, and health and rehabilitation interventions that can promote health-related adjustment and coping within the context of trauma-focused treatment. This pre-meeting institute will also discuss considerations for integration of health and trauma psychology training curricula and the need for future research and program development.
Learning Objectives:

1. Utilize evidence-based clinical strategies and assessments to identify exposure to potentially traumatic medical events and develop a trauma-informed case formulation
2. Tailor trauma-informed and trauma-focused treatment to the address the unique biopsychosocial needs of medical trauma survivors
3. ​Utilize evidence-based clinical strategies from the fields of health and rehabilitation psychology to target health-related factors that contribute to difficulty with mood, coping, and adjustment following medical trauma

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 PMI 5-AM:

Walking the Tightrope Between Fidelity and Flexibility:
Can We Improve Outcomes by Personalizing Approaches while Delivering Manualized Treatments for PTSD?

Clinical Interventions Track

Tara Galovski, PhD, National Center for PTSD, Boston University
Reg Nixon, PhD, Flinders University

Despite the accumulation of empirical support for the efficacy of evidence-based interventions designed to treat diagnostically defined clinical needs such as posttraumatic stress disorder (PTSD), single disorder protocols have not been widely adopted by providers in routine clinical care. The transportability of protocols from academic to clinical settings has been challenging for many reasons. For example, evidence-based protocols explicitly target core symptoms with less attention to additional clinical concerns that may be salient to patients. PTSD is often comorbid with other disorders which, in turn, engender competing needs and may require specialized clinical attention. Attending to competing patient needs is clinically complex when implementing a single-disorder protocol. As therapy progresses, treatment gain is not always readily apparent, causing clinicians and patients to lose hope for eventual recovery. There is little guidance for clinicians around navigating these clinical complexities and delayed treatment response in manualized therapies. Clinicians may indeed lose confidence in the ability of single disorder protocols to adequately address the full range of the complex needs of trauma survivors suffering from PTSD. In the absence of evidence-based guidance for navigating clinical complexities occurring during clinical care, clinicians and patients may prematurely abandon the protocol resulting in suboptimal doses of therapies that offer PTSD patients the best chance for recovery. 

Learning Objectives:

1. Describe parameters for flexibly applying manual-based psychotherapy while maintaining fidelity to the protocol.
2. Define challenges to optimal therapy outcomes and discern when these challenges should be prioritized during the implementation of evidence-based protocols.
3. ​Evaluate when therapists might consider divergence from protocols to address clinical complexities and describe techniques to return to protocol following divergence.

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PMI-2-PM

Using the PTSD-Repository and Metapsy to Conduct Meta-analyses of PTSD Treatments

Mode, Methods & Ethics Track

Jessica Hamblen, PhD, National Center for PTSD
Eirini Karyotaki, PhD, VU Amsterdam
Maya E. O'Neil, PhD, Portland VA/OHSU
Clara Miguel Sanz, MSc, Vrije Universiteit Amsterdam
Rebecca A. Matteo, PhD, VA National Center for PTSD
Sadie E. Larsen, PhD, National Center for PTSD

Meta-analysis is a statistical process used to estimate the effect of a particular treatment using data from multiple studies. Until recently, conducting a meta-analysis was incredibly time intensive and costly. Studies have to be identified, data abstracted, and risk of bias assessed and then only those with expert statistical knowledge and specific statistical software had the skills to be successful.  Now though, the PTSD-Repository and metapsy make meta-analysis more feasible.

The PTSD-Repository is a database of 300+ abstracted data elements from over 400 randomized controlled trials of PTSD treatments.  Updated annually, this publicly available database offers detailed coding on treatment type, making it easier to identify studies of interest. Treatments are classified at the study and arm level and are further categorized into psychotherapy (trauma-focused/non-trauma-focused), pharmacotherapy (with additional subclasses), complementary and integrated health (with additional subclasses), nonpharmacologic biological, nonpharmacologic cognitive, collaborative care, and other intervention types.  Comparison groups are coded as active vs. inactive controls.  Treatments are further classified by format (e.g., individual, group) and modality (e.g., face-to-face, video, technology). Detailed coding of samples allows for further identification of specific populations of interest such as Veteran, inpatient, or specific comorbidities. The database contains multiple PTSD outcomes including severity, loss of diagnosis, meaningful change, and other mental health outcomes. Importantly, risk of bias ratings are included for each study.  

This year a simplified version of the data from the PTSD Repository will be connected with metapsy.  Metapsy offers an online meta-analytic tool that allows the user to analyze overall effects in real time using state of the art meta-analysis methods. It also includes two R packages that allow the data to be downloaded directly into an R environment.  The data are provided in a standardized format and codebooks are provided.  To date, metapsy offers databases on depression, suicide prevention, transdiagnostic treatment, and peer interventions. 

In this PMI, users will be given an orientation of both products to increase their familiarity of the available features.  Step-by-step examples will be provided from study identification through meta-analysis.  Our expectation is that participants will leave with a greater understanding of how to conduct their own meta-analyses using the PTSD-Repository and metapsy.

Learning Objectives:

1. Describe what data elements are available in the PTSD Repository
2. Conduct a meta-analysis of active psychotherapies vs. inactive controls using metapsy
3. Use the PTSD Repository to identify relevant studies for use in their own meta-analysis

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PMI-3-PM                   

Demystifying NIH Grant Mechanisms for Mid-Career Investigators:

Practical Guidelines and Tailored Recommendations

Public Health Track
Non-CE/CME Session

Susan Borja, PhD, NIMH/NIH

Researchers at institutions supported by the National Institutes of Health (NIH) conduct basic, translation, and applied research to improve understanding and development treatments to improve health. NIH is the leading supporter of biomedical research in the world. With 27 components called Institutes and Centers, each with a different mission, NIH is a primary source of funding for many health-related researchers. 

Using a competitive grant process with multiple stages of review, NIH seeks to fund rigorous, innovative, and impactful work. Ultimately, most applications are not funded but researchers aware of pitfalls throughout the review and funding process are more likely to be successful in competing for research grants to improve our understanding and treatment of illness. 

This workshop aims to demystify the NIH structure, peer review, and post review processes to help investigators anticipate and integrate feedback into competitive applications. This PMI will provide an opportunity to develop advanced knowledge of Guide Notices, Program Announcements, and Requests for Applications to understand how NIH uses these communications and what it means for your application. 

Through interactive sessions, with concrete examples, participants will consider their own and their peers’ research ideas from different perspectives and perhaps form new collaborations. This PMI encourages participants to come with a 2-3 next grant ideas in mind. We will use time to consider the innovation and significance of ideas and do accelerated review of aims to prepare participants for an initial conversation with a Program Officer in preparation for their next grant submission.

Participants will be provided with an overview of funding opportunities tailored to mid-career researchers (e.g., R21, R01, R61/R33), with a discussion of how to select the right one for your research and career goals.
 
By the end of the workshop, participants will have solidified their understanding of relevant NIH-funding mechanisms. Importantly, although the workshop is centered on NIH grants, the knowledge gained is also transferable to other United States Federal funding (e.g., DoD) and may also be applicable to international funding agencies outside the US. Researchers from underrepresented racial and ethnic groups, individuals with disabilities, and individuals from disadvantaged backgrounds are welcomed and encouraged to participate in this PMI.

Learning Objectives:

1. Understand NIH funding mechanisms, in terms of types of application, grantsmanship, and review process.
2. Gain awareness of which NIH grant is most appropriate in light of your career stage and current trajectory, and learn specific methods to increase competitiveness.
3. Understand potential pitfalls that may hinder a successful application.

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PMI-5-PM                   

Stress First Aid Self-Care and Coworker Support Model

Professionals Track

Patricia Watson, PhD, National Center for PTSD
Richard Gist, PhD, Kansas City Fire Department (KCFD)

This pre-meeting institute will focus on a peer support and self-care model that has been adapted for those in potentially high stress work environments, like military, first responders, healthcare workers, and mental health clinicians.  The Stress First Aid (SFA) is an evidence-informed longitudinal set of supportive actions that have been designed to help those in high-stress work 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 stress work settings can increase self-care and coworker support via a highly flexible and longitudinal evidence-informed framework. It will include videotapes of interviews with first responders and healthcare providers.

Learning Objectives:

1. Identify common stress reactions and risk factors in those in high stress jobs
2. Learn strategies for engaging in self-care and coworker support
3. Learn the core components of an evidence-informed self-care and coworker support intervention

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Virtual PMI                   

Using Virtual Spaces to Deliver Peer-Based Support for Survivors of Trauma

Clinical Interventions Track
Non-CE/CME Session

Noah Robinson, MSc & PhD Candidate, Innerworld & Vanderbilt University
Steven Hollon, PhD, Vanderbilt University
Kimberly Hieftje, PhD, Yale School of Medicine
Albert "Skip" Rizzo, PhD, University of Southern California Institute for Creative Technologies
Iony D.. Ezawa, PhD, University of Southern California

The emerging metaverse, defined as any internet-connected virtual environment with avatars, offers innovative opportunities for enhancing the study and treatment of trauma-related psychopathology. This concept encompasses a wide range of experiences, from flat screen metaverse platforms to more immersive virtual reality experiences. In this pre-meeting institute, we will discuss and interactively explore the application of these diverse virtual environments in facilitating trauma recovery through immersive therapeutic experiences and virtual social support applied to empirically-based approaches to treatment.

The PMI will take place within the metaverse itself—specifically within the clinical research platform Innerworld—where participants will join as avatars for a special ISTSS event. Innerworld can be accessed through an Apple device, PC or Quest. We will begin on Zoom with an introduction to Innerworld's virtual setting, followed by a simultaneous tech support session to assist participants in registering and completing the tutorial and consent process required for entering Innerworld. Therapeutic leaders, and participants represented as anonymous live avatars, will share their personal experiences discuss the impact of virtual social support and immersive therapeutic experiences on their lives.

We will present new clinical data highlighting the potential of virtual environment-based interventions in reducing symptoms of depression and anxiety while illustrating the role of perceived social support in symptom improvement. Additionally, we will address the potential of these diverse metaverse platforms for ecological validity and experimental control, which can contribute to developing more effective evidence-based interventions. Through this interactive experience across various virtual environments within Innerworld itself as avatars attending an exclusive ISTSS event–participants gain deep understanding potential clinical applications and clinical risks associated with virtual spaces that are utilized for live interactive treatment and support.

Learning Objectives:

1. Explore and experience a metaverse environment that promotes trauma recovery and hear from survivors about their experiences with immersive therapy and virtual social support.
2. Understand ecological validity and experimental control in virtual environments and learn about new clinical data on symptom improvement and social support.
3. Engage in interactive experiences within Innerworld, discussing clinical applications, benefits, and risks of virtual spaces for live interactive treatment and support.

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