Pre-Meeting Institutes
Institutes are full or half day sessions that provide opportunities for intensive training on topics integral to the conference program, presented by leaders in the field.
FULL DAY INSTITUTES
PMI – 1: An Introduction to Cognitive Processing Therapy
PMI – 2: Training in the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) Program
PMI – 3: Acceptance and Commitment Therapy: Mindfulness and Values in the Treatment of PTSD
HALF DAY INSTITUTES
PMI – 4 - CANCELED: What Trauma Therapists Should Know About Panic, Phobia and OCD
PMI – 5: Treating Post-Traumatic Sleep Problems with CBT for Insomnia
PMI – 6: Beyond Boundaries: The Interpersonal Paradox of Trauma in Couple and Family Systems
PMI – 7: Introduction to EMDR Therapy
PMI – 9: Psychological First Aid
PMI – 11 - CANCELED: The Mental Health Module in Complex Emergencies: From Practice to Theory
PMI – 12: An Introduction to the Neurobiology of Traumatic Stress
PMI – 13 - CANCELED: Practical Applications of Evidence Based Practice: The National Fallen Firefighters Foundation Behavioral Health Initiative
PMI – 14 - CANCELED: Parent-Child Interaction Therapy: Global Applications for an Evidence-Based Treatment
PMI – 15: Building Knowledge and Skills to Incorporate Spirituality in Trauma Intervention
PMI – 16: Psychological First Aid - Skills Building Training
PMI – 17: Regulation and Engagement for Traumatized Children and Adolescents Through Sensory Motor Input, Play and Therapeutic Co-RegulationWednesday, October 31, 2012
Full-Day Institutes
(8:30 a.m. – Noon and 1:30 p.m. – 5:00 p.m.)
PMI – 1
An Introduction to Cognitive Processing Therapy
PMI Keyword: Clinical Practice
Presentation Level:
Introductory
Region:
Global
Patricia Resick, PhD, ABPP 1; Carie
Rodgers, PhD 2; Richard Monroe, PhD 3; Robert Larson, LCSW 4
1 National Center for PTSD,
Boston, Massachusetts, USA
2 San Diego VA/University of San Diego, San Diego, California, USA
3 Hines VA Hospital, Hines, Illinois, USA
4 Bay Pines VA Healthcare System, Bay Pines, Florida, USA
The purpose of this pre-meeting institute is to provide attendees the basics of cognitive processing therapy (CPT). CPT is an evidence-based cognitive therapy for post-traumatic stress disorder (PTSD) and comorbid symptoms that can be implemented with or without a written narrative and can be implemented as either an individual or group therapy. It has been demonstrated to be effective across a range of traumas as well as very complex trauma histories and symptom presentations.
Because it is very difficult to teach CPT in less than two or three days, this year we would like to conduct the workshop somewhat differently than usual and take into account the participants’ readiness to learn the protocol for implementation. Even when announcing advanced workshops, some individuals sign up for a workshop without the requisite skills and both the prepared members of the audience and the workshop presenters must try to balance basic explanations with more advanced concepts.
This year we are proposing to do a basic one-day workshop but also recognize that some attendees will have more advanced training and different goals than other participants. Therefore, we are proposing to divide participants into two groups based on their pre-conference preparations. One group will be for those participants who intend to implement the protocol and have already read the manual and bring it with them (requests can be made to Patricia.Resick@va.gov for a PDF copy) and/or have completed the on-line CPT course (http://cpt.musc.edu) and can provide their completion certificate. The participants in this group will be taught at a more specific and advanced level how to implement the therapy protocol, including role plays of Socratic dialogue with feedback and the opportunity to practice therapist skills needed for implementation.
The second group, targeting those who are attending just to learn more about CPT, who sign up at the last minute, or who are not sure whether they want to implement the therapy, will be provided a rationale for the therapy, information about effectiveness, an overview of the protocol, will be shown videotaped examples of the therapy, and will be walked through the sessions with case examples as well as information about how the different formats are conducted. There will be no expectation that this latter group of attendees will have the skills by the end of the workshop to implement the therapy.
PMI – 2
Training in the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) Program
Keyword: Clinical Practice
Presentation Level:
Intermediate
Region: Industrialized Countries
Lisa Jaycox, PhD 1; Audra Langley, PhD
2
1 RAND Corporation, Arlington, Virginia, USA
2 University of California, Los Angeles, Los Angeles, California,
USA
The Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) program was developed in the early 1990’s and has been being disseminated across the United States over the past decade. Designed with and for schools, it uses proven cognitive-behavioral techniques in a group format for students aged 10-15 who have elevated symptoms of post-traumatic stress disorder (PTSD). The program was originally evaluated in two studies and shown to significantly reduce PTSD and depressive symptoms as well as some aspects of behavioral problems in Los Angeles for a diverse student body exposed to community violence (Kataoka et al., 1993; Stein et al., 1993). CBITS has since been used and tested in a variety of other settings (e.g., Native American groups, Morsette et al., 2009; faith-based settings, Kataoka et al., 2006) and for other types of traumatic events (e.g., following Hurricanes Katrina and Rita in New Orleans, Cohen et al., 2009; Jaycox et al., 2010). The program includes 10 student group sessions, 1-3 individual child sessions, 2 parent sessions, and 1 teacher education session. A full description can be found on SAMHSA’s NREPP website.
This training is designed for professionals with clinical training who work in schools or in community agencies partnering with schools. Training in this PMI will involve a brief overview of the CBITS techniques, followed by demonstrations, coaching, and role-plays to solidify skills of attendees. Skills taught will include psycho-education, relaxation, cognitive training, approaching feared situations, trauma narrative, and social problem-solving in the student group format as well as trauma narrative in the individual student format. Training will also include how to implement parent and teacher sessions. Throughout the PMI, we will discuss implementation issues so that trainees can leave the training with a firm grasp of how to obtain buy-in from school administration, obtain parental permission, identify children for the program, make use of the www.cbitsprogram.org website, and monitor outcomes.
This training course is designated as “Intermediate” because we strongly encourage all participants to obtain the CBITS manual and take the online web CBITS course at www.cbitsprogram.org prior to the PMI. Instructions will be sent to enrollees prior to the PMI; the web training course is free and provides 5 hours of continuing education credit. Late registrants will be accepted, but should be well versed in cognitive-behavioral interventions for trauma in order to make good use of this training experience.
PMI – 3
Acceptance and Commitment Therapy: Mindfulness and Values in the Treatment of PTSD
Keyword: Clinical Practice
Presentation Level:
Intermediate
Region: Industrialized Countries
Robyn Walser, PhD
National Center for PTSD, Dissemination and Training, Menlo
Park, California, USA
The concept of emotional avoidance offers organization to the functional analysis of trauma-related problems and lends coherence to understanding the sequelae of trauma. Many individuals who have been diagnosed with post-traumatic stress disorder (PTSD) or who have trauma related problems are struggling with traumatic memories, painful feelings and unwanted thoughts and they take great efforts to avoid these private experiences. The avoidance or control of private internal experience commonly seems to become the goal of many trauma survivors and has a powerful impact on individuals diagnosed with PTSD or its related problems.
One therapeutic alternative to emotional or experiential avoidance is acceptance. Acceptance can create a new context from which the trauma survivor may view the world and the self. If efforts to control private experience are relinquished as a means to mental health, then efforts to take healthy action, while still acknowledging emotion and thought without effort to control or change them, can lead to valued and life enhancing behavioural changes. Acceptance and Commitment Therapy (ACT) is a structured intervention that applies acceptance techniques to internal experience while encouraging positive behaviour change that is consistent with individual values and goals. The basic theory and ACT’s application to PTSD will be presented. Opportunity for role-play, case formulation and interactive exercises will be offered.
Wednesday, October 31, 2012
Half-Day Institutes
(8:30 a.m. – Noon)
PMI – 4 - CANCELED
What Trauma Therapists Should Know About Panic, Phobia and OCD
Keyword: Clinical Practice
Presentation Level:
Intermediate
Region: Industrialized Countries
Sally Winston, PsyD
Anxiety and Stress Disorders Institute of Maryland, Towson,
Maryland, USA
Trauma survivors often present for treatment for overwhelming symptoms of anxiety disorders other than post-traumatic stress disorder (PTSD). At times, the trauma impact has precipitated symptoms in someone with an underlying predisposition to obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), panic or phobia; at other times it exacerbates or re-activates pre-existing disorders. These symptoms can take on a life of their own and become functionally autonomous from the trauma material, or they can remain intimately tied up with trauma sequelae. Trauma-focused treatment may or may not alleviate the presenting panic attacks, OCD symptomatology, phobic avoidance behaviors or general hyperarousal and vigilance.
This workshop is designed to be an overview of current evidence-based treatment of anxiety disorders other than PTSD as they apply to people who have experienced high impact or traumatic events. It will be clinically focused, moving from a discussion of the particular phenomenology of the different anxiety disorders into practical applications. Metacognitive concepts such as anxiety sensitivity and paradoxical effort will be presented.
Related issues include distinguishing between panic attacks, flashbacks and feeling panicky, and understanding when addressing the content of obsessions is irrelevant or actually harmful. Knowing the difference between safety behaviours which manage self-destructive urges and safety behaviours which neutralize exposure, maintain obsessions and promote avoidance is essential in choosing treatment strategies. Techniques such as interceptive exposure and breathing retraining will be demonstrated. The presenter integrates concepts from cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), assertive community treatment (ACT), and almost 40 years of clinical practice in the field.
PMI – 5
Treating Post-Traumatic Sleep Problems with CBT for Insomnia
Keyword: Clinical Practice
Presentation Level: Advanced
Region: Industrialized Countries
Jason DeViva, PhD 1; Claudia Zayfert,
PhD 2
1 VA Connecticut Health Care System, Newington,
Connecticut, USA
2 Dartmouth Medical School, Hanover, New Hampshire, USA
Difficulty falling and staying asleep is one of the most common symptoms reported after trauma. Cognitive-behavioral therapy for insomnia (CBT-I) is an evidence-based treatment that is recommended as a first-line intervention by the American Academy of Sleep Medicine practice guidelines. Though preliminary evidence suggests that the specific methods of CBT-I can be helpful for trauma-related sleep problems, the use of CBT-I with trauma survivors often is complicated by posttraumatic symptoms that interfere with sleep. In this institute we will provide participants with specific recommendations for improving the treatment of post-traumatic sleep problems by tailoring CBT-I to the specific presentations of patients with posttraumatic stress disorder (PTSD).
We will first present a model for understanding the precipitation and perpetuation of insomnia that will be used to describe how symptoms of PTSD can contribute to the initiation and maintenance of sleep problems. We will then discuss how to incorporate trauma-related factors into a CBT-I treatment plan.
We will review the core components of CBT for insomnia (e.g., stimulus control, sleep restriction, sleep hygiene, cognitive restructuring), highlighting research supporting their use with insomnia and trauma-related sleep difficulties. We will examine the specific features of PTSD that can interfere with the application of CBT-I to trauma-related insomnia and discuss modifications and additions to standard CBT-I that can address PTSD-specific sleep problems. Particular attention will be paid to factors affecting the sleep of returning military personnel and the role of fear of sleep in perpetuating sleep problems.
We will discuss implementing CBT-I within an overarching case formulation of a trauma survivor’s multiple problems. This will include how CBT-I may be integrated into a treatment plan that may include trauma-focused CBT for PTSD (e.g., prolonged exposure or cognitive processing therapy) or imagery rehearsal treatments for nightmares.
Lastly, we will describe methods for determining when CBT for insomnia may be contraindicated in patients with PTSD. Case material and group activities will be used to illustrate the treatment recommendations made in this institute.
PMI – 6
Beyond Boundaries: The Interpersonal Paradox of Trauma in Couple and Family Systems
Keyword: Clinical Practice
Presentation Level:
Intermediate
Region: Industrialized Countries
Kami Schwerdtfeger, PhD 1; Briana
Nelson Goff, PhD 2
1 Oklahoma State University,
Stillwater, Oklahoma, USA
2 Kansas State University, Manhattan, Kansas, USA
A growing theme in the trauma literature over the past few decades is the recognition that psychological trauma has a widespread and interpersonal impact. While high quality attachment systems and interpersonal relationships have been found to mediate the duration and severity of a survivor’s traumatic stress reaction and the consequential cognitive and emotional effects, research also suggests that trauma commonly has a negative impact, eroding the strength of the same interpersonal relationships that could potentially assist with posttraumatic recovery and growth. This may be due in part to the fact that trauma survivors often engage in self-preservation strategies and create boundaries that make routine relational exchanges (e.g., communication, nurturance, problem-solving, and conflict resolution) difficult.
Trauma survivors may also oscillate between uncontrollable outbursts of anger and a desperate need for intimacy. Such discord between these two potentially opposing dynamics of the interpersonal components of trauma remains a paradox.
While the relational dyads of trauma survivors are often characterized by secondary traumatization, caregiver burden, and decreased relational functioning, these same interpersonal relationships are crucial to the recovery process and serve as a key factor in the development of posttraumatic resilience. Due to the interpersonal nature of trauma, traditional intervention and recovery-focused therapy on an individual level may be inadequate. The intense nature of survivors’ symptoms, which often lead to hostility and confusion within interpersonal relationships, suggest that recovery lacking systemic focus may alienate the survivor and leave recovery stagnant.
The presenters will describe a model of systemic trauma, based on current theories, research, and clinical experience. The Couple Adjustment to Traumatic Stress-Revised (CATS-R) Model includes components related to individual levels of functioning for both partners (primary and secondary trauma) and interpersonal functioning factors (e.g., marital satisfaction, power, conflict), as well as predisposing factors and resources that impact the intrapersonal and relational systems. The presentation will disseminate information regarding the presented model, the primary issues faced by traumatized systems, and methods to apply the model to empirical study of and clinical approaches with traumatized systems. In addition, the presenters will describe results from a current model-based, three-phase research project that focuses on the impact of trauma history on current relationship functioning in couples. Quantitative and qualitative data from couples with various trauma experiences indicate both positive and negative effects on the couple relationship, as well as specific mechanisms that may be unique to trauma-exposed couple and family systems.
PMI – 7
Introduction to EMDR Therapy
Keyword: Clinical Practice
Presentation Level:
Introductory
Region: Global
Francine Shapiro, PhD
Mental Research Institute, Palo Alto, California,
USA
This presentation will introduce the basics of eye movement desensitization and reprocessing (EMDR) therapy and provide an overview of individual and group protocols. Both the theoretical foundation and recent research findings will be explored. EMDR is an evidence-based psychotherapy supported by more than 20 randomized controlled studies. Meta-analyses have indicated that the effects of EMDR on post-traumatic stress disorder (PTSD) symptoms are comparable to those of trauma-focused cognitive behavioral therapy. However, EMDR therapy does not require homework, sustained arousal, detailed descriptions of the index trauma, or extended exposure to the event. While the eye movement component has been the subject of controversy, in the past decade an additional 20 randomized trials have evaluated the eye movements and demonstrated significantly superior effects compared to “exposure-only” conditions. The eye movements have been shown to (a) decrease the emotionality and vividness of memories, (b) create physiological relaxation responses, (c) facilitate access to associative memories and (d) lead to an increase in recognition of correct information. Two dominant theories regarding the role of the eye movements have emerged: (1) disruption of working memory and (2) elicitation of an orienting response. The research and clinical implications will be examined.
The goals of this presentation parallel those of the conference itself by allowing participants to evaluate ways in which EMDR therapy offers innovations in both conceptualization and clinical treatment. These innovations include ways to support therapy retention and increase stability for those clients ordinarily considered too fragile to tolerate memory processing. Outreach for underserved populations can also be increased through both the group protocols and the use of consecutive-day trauma treatment. Relevant research will be reported on the use of EMDR therapy with diverse populations.
Participants will learn how the adaptive information processing theory that guides EMDR therapy practice offers a reconceptualization of (a) psychopathology, (b) therapeutic change, (c) the therapy relationship, (d) preparation for processing and (e) the multiple methods included in the therapy.
The work of the EMDR Humanitarian Assistance Programs will also be discussed, including the results of outreach programs after natural and manmade disasters. The presentation will provide participants with the theoretical basis for EMDR therapy, an overview of the eight treatment phases, the three-pronged selection of processing targets, pertinent research, as well as applications to the full range of trauma victims. Videotaped sessions will demonstrate diverse treatment effects and provide participants with comparisons to other research-supported trauma treatments.
PMI – 8
Lead User Innovation: Creating a “Community of Innovators” to Develop and Disseminate Trauma Informed Treatment for Children and Adolescents Across the Continuum of Care
Keyword:
Training/Education/Dissemination
Presentation Level: Intermediate
Region: Industrialized Countries
Adam Brown, PsyD 1; Glenn Saxe, MD 2;
Heidi Ellis, PhD 3; Omar Gudino, PhD 1; Liza Suarez, PhD 4; Kelly
McCauley, MSW 5
1 NYU Child Study Center, New York, New
York, USA
2 New York University School of Medicine, New York, New York, USA
3 Children’s Hospital Boston, Boston, Massachusetts, USA
4 University of Illinois, Chicago, Chicago, Illinois, USA
5 KVC Behavioral HealthCare, Lawrence, Kansas, USA
The need for trauma focused, evidence informed practice in child serving settings is clear, yet dissemination of such models is fraught with challenges. This pre-meeting institute will describe a unique, cutting edge approach to development, adaptation and dissemination of one such model, Trauma Systems Therapy (TST), across various levels of the child serving system. TST is a comprehensive model for treating traumatic stress in children and adolescents that adds to individually-based approaches by specifically addressing the child’s social environment/system of care. Specifically, this model conceptualizes the development of a ‘Trauma System’, which is comprised of two main elements: 1) a traumatized child who is not able to regulate emotional states and 2) a social environment/ system of care that is not sufficiently capable of helping the child contain this dysregulation. A ‘Trauma System’ therefore emerges when there is an imbalance between the needs of a child and their social environment.
TST is currently being delivered in diverse service settings across the United States and research evidence suggests that children who receive TST demonstrate improved emotional and behavioral functioning as well as reduced trauma symptoms.
Furthermore, the TST model effectively engages families with multiple problems and children and families also experience improvements in environmental stability. Lastly, implementation of TST leads to reduced hospitalizations and lengths of stay, suggesting improved cost-effectiveness.
One of the biggest challenges to effective implementation is the balance between maintaining model fidelity, while encouraging improvements and adaptations that will allow the model to be effectively implemented in a variety of settings with a variety of youth and families. Based on the concepts of “lead user innovation,” and flexibility within fidelity, TST has created a “community of innovators,” in which lead staff in agencies implementing TST, in consultation with the model developers; develop modifications of the model to best serve clients in their unique setting. These adaptations build on a core platform of minimal fidelity, and then become the standard for other similar settings implementing TST.
This pre-meeting institute will present: 1. an overview of the TST model and its development, 2. challenges of dissemination and implementation, and 3. development of program evaluation methodology to inform adaptation and assess effectiveness. The model developers, as well as “lead users” from real world settings will describe in detail the process of developing specific adaptations for residential treatment, foster care, substance abuse, school based programs, refugee programs, and community based prevention settings.
PMI – 9
Psychological First Aid
Keyword: Disaster/Mass Trauma Survivors
Presentation Level: Introductory
Region:
Global
Melissa Brymer, PhD, PsyD 1; Patricia
Watson, PhD 1; Douglas Walker, PhD 2; Gilbert Reyes, PhD 3; DeAnna
Griffin, MA 1
1 UCLA, Los Angeles, California, USA
2 Project Fleur-de-lis, Metarie, Louisiana, USA
3 Fielding Graduate University, Santa Barbara, California,
USA
Psychological First Aid (PFA) has become the standard of practice in the immediate aftermath of mass casualty events, with recommendations issuing from the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. PFA is an acute intervention to help children, adolescents, adults, and families in the immediate aftermath of disasters, terrorism and other emergencies. PFA is designed to reduce the initial distress caused by traumatic events and to foster short- and long-term adaptive functioning and coping. PFA includes basic information gathering techniques to help providers make rapid assessments of immediate needs and to make flexible interventions; relies on field-tested, evidence-informed strategies that can be provided in a variety of settings including shelters, schools, field hospitals and medical triage areas, family reception and assistance centers, acute care facilities, respite centers for first responders or other relief workers, emergency operations centers, crisis hotlines, disaster assistance services centers, homes, businesses, and other community settings.
Variations of PFA have been promoted for several decades, but the principles and practices of PFA were not fully specified or operationalized until 2005, when the National Center for Child
Traumatic Stress (NCTSN) and the National Center for PTSD published a comprehensive PFA Field Operations Guide. This PFA is a modular intervention that includes 8 core actions: 1) Contact and Engagement; 2) Safety and Comfort; 3) Stabilization; 4) Information Gathering; 5) Practical Assistance; 6) Connection with Social Supports; 7) Information on Coping; and 8) Linkage with Collaborative Services. Since the launch of this field operations guide, the NCTSN and NCPTSD has dedicated their focus on developing adaptations for different service settings and organizations (e.g., schools and the Medical Reserve Corps), developing training standards and different training platforms (online course, Train-the-trainer course, mobile app), addressing implementation barriers, and improving evaluation strategies for PFA. This session will describe the basic goals and intervention strategies of PFA, encourage practice of the core actions through exercises, and discuss the current efforts to enhance the evidence-base.
PMI – 10
Beyond Boundaries: Strategies for Enhancing Resilience in First Responders and Survivors Through Cross-Culturally Adaptive Trauma Treatment
Keyword: Global Issues
Presentation Level: Intermediate
Region:
Global
Amber Elizabeth Gray, MA, LPC 1; John
Fawcett, MSW 2; Leslie Snider, MD, MPH 3; John Ehrenreich, PhD 4
1 Restorative Resources Training & Consulting, Santa Fe,
New Mexico, USA
2 John Fawcett Consulting, Auckland, New Zealand
3 War Trauma Foundation, Amsterdam, Netherlands
4 State University of New York/Antares Foundation, Old Westbury, New
York, USA
The provision of trauma services in war-torn and disaster-affected areas includes the simultaneous provision of services to survivors and to those who respond to these emergencies. Increasingly, the survivors seeking help are not accustomed to conventional mental health services, and first responders represent a truly diverse cross-section of humanity responding in a cultural context distinct from their own, and away from their usual support systems. Multiple frameworks for multi-level support of local survivors and responders, such as best practice guidelines for managers; train-the -trainers and staff support programs; and psychological crisis support for survivors will be presented in this full day PMI.
Recent research on key areas of risk or resilience for both national and international aid workers will provide a backdrop for a discussion of staff support services. A 2007 mission to the Darfur region of Sudan and Chad to investigate stress levels of humanitarian workers, which were found to be high, catalyzed a management level train the trainers program designed to be globally adaptable, based on the principles of social support and the sourcing of local culture as a protective factor for humanitarian worker well-being and health. In Haiti, a non-governmental organization (NGO) funded staff support program built on survivor to survivor support as a foundation of sustainable, culture-centric programming became an inter-INGO model for staff support. A global initiative to pilot innovations to Psychological First Aid (PFA) training programs has been conducted in Haiti, Sudan and Sri Lanka, with adjustments made for language, context and culture. Training models to bring culturally informed trauma treatment to survivors, such as narrative theater in Burundi/DRC; creative arts group therapy training in The West Bank and Haiti, and training of teacher trainers and school counselors in the northern Caucasus, will be described as innovations to deliver mental health services in a wider variety of contexts and reach more trauma survivors.
This PMI will provide program participants with tools to effectively develop similar services and programs in their organizations and contexts. Concepts, research, rationale, principles, teaching activities, and training program modules are presented and shared to demonstrate didactic, experiential, process-focused ways to train in culturally diverse, complex emergency settings.
Excerpts from trainer’s manuals, sample handouts and other materials from the modules of all program curricula are shared so that participants have tools to apply the principles, learning, tools and practices of these unique, cross-culturally adaptable, context-centric programs in their own professional settings.
Wednesday, October 31, 2012
Half-Day Institutes
(1:30 p.m. – 5:00 p.m.)
PMI – 11 - CANCELED
The Mental Health Module in Complex Emergencies: From Practice to Theory
Keyword: Global Issues
Presentation Level: Intermediate
Region:
Global
Elena Cherepanov, PhD
Cambridge College, Boston, Massachusetts, USA
The international relief work brought to the trauma field great appreciation for the importance of attending to the trauma issues and the experience of dealing with trauma in various cultural contexts. They also raised concerns about a tendency to pathologize the normal human responses. The non-governmental organizations (NGOs) have been incorporating the formal mental health modules into the relief work since the 1980’s when this idea was so new and invigorating, that only much later the enthusiastic experimenting with models was confronted with boring but unavoidable questions about the standards of care, empirical research, measurable outcomes or the quality control.
The expansion and diversification of the field mental health programs in complex emergencies highlighted the need in the conceptual framework, developing the strategic goals and the evidenced-based practices. The accomplishments are hindered by controversies in understanding the global trauma reactions.
The advances in community mental health suggest that the success of individual recovery is determined by the available support systems in the community which provides a secure sense of self, supportive relationships, empowerment, social inclusion, coping skills, and meaning.
The proposed Community-Based Psychological Recovery in Complex Emergency model aims to achieve the sustainable community-level impact by identifying and strengthening the community resilience and education and sensitization the community to the needs of the vulnerable groups. A focus on individual recovery without changes in the support systems carries potential for re-traumatization. The community-based psychological recovery approach views the individual trauma recovery process as a part of systemic change, which allows not only to support the survivors but also to create the sustainable changes in the community in order to cope with future challenges and to support the vulnerable groups after NGOs leave.
The capacity building and the sustainability of the community recovery are achieved by engaging the community members in the recovery efforts, by educating and sensitizing them to the needs of vulnerable groups. The mental health officers offer education, engagement, empowerment, program development, trainings, and the on-going support, while the community and the local staff have the leading role in the recovery process. In order to assure the sustainability of the recovery process, the strategic programmatic planning from the beginning must include the active involvement of the local structures and staff, and the steps to reduce the reliance on NGOs by working with the local structure.
PMI – 12
An Introduction to the Neurobiology of Traumatic Stress
Keyword: Biological/Medical/Neuroscience
Presentation Level:
Introductory
Region: Global
Jasmeet P. Hayes, PhD 1; Lisa M., Shin,
PhD 2; Mohammed Milad, PhD 3; Ann Rasmusson, MD 1; Ananda Amstadter, PhD
4; Nicole Nugent, PhD 5
1 VA Boston Healthcare System,
Boston, Massachusetts, USA
2 Tufts University, Medford, Massachusetts, USA
3 Harvard Medical School, Boston, Massachusetts, USA
4 Virginia Commonwealth University, Richmond, Virginia, USA
5 Warren Alpert Medical School of Brown University, Providence, Rhode
Island, USA
Recent advances in neuroimaging, biochemistry, and genetics research have paved the way toward a greater understanding of the neurobiology of trauma and stress. As new technologies and methods are discovered and applied to neurobiological work, it becomes increasingly important for individuals interested in treating and studying post-traumatic stress disorder (PTSD) to learn the tools necessary to evaluate the latest research findings.
The purpose of this pre-meeting institute is to provide attendees an introduction to the major biological approaches used to study PTSD, including a state-of-the-art review of trauma research and the methodological advantages and limitations inherent in these approaches. The target audience will be comprised of clinicians, researchers, and students with no familiarity or only a basic knowledge base of the biological aspects of traumatic stress. We will review the following topics: (1) Structural and Functional Neuroimaging of PTSD: This topic will include an overview of how neuroimaging data are collected, processed, and analyzed, in addition to the limitations and advantages of neuroimaging methods. Furthermore, a summary of the major findings and discoveries in the neuroimaging of PTSD will be discussed including altered brain networks most associated with PTSD. (2) Neuroendocrinology of PTSD: The nervous system responds to traumatic stress by deploying multiple neurotransmitters, hormones and neuropeptides that interact in complex ways to influence cognitive capacities and generate behavioral responses. This topic will review the different biochemical systems associated with trauma and PTSD, and serve as a primer on the methodologies and limitations of this approach.
(3) Genetics of Traumatic Stress & PTSD: In this discussion, we will review different approaches to genetically informed research on trauma exposure and PTSD including twin and family studies, candidate gene research, genome wide association studies (GWAS), whole genome methods, gene-environment interplay studies, and epigenetic research. The state-of-the-art findings in trauma research, and the strengths and limitations as well as design considerations of these approaches will be discussed.
PMI – 13 - CANCELED
Practical Applications of Evidence Based Practice: The National Fallen Firefighters Foundation Behavioral Health Initiative
Keyword: Prevention/Early Intervention
Presentation Level:
Introductory
Region: Industrialized Countries
Richard Gist, PhD 1; Ben Saunders, PhD
2
1 Kansas City (Missouri) Fire Department, Kansas City,
Missouri, USA
2 Medical University of South Carolina, Charleston, South Carolina,
USA
More than 33,000 fire departments and 15,000 emergency medical services (EMS) agencies serve American communities. The National Fire Protection Association Standard on Fire Department Occupational Health and Safety Programs (NFPA 1500) mandates that each provide its members access to a behavioral health assistance program that includes occupational exposure to potentially traumatic events. More than 2 million personnel are estimated to be covered nationwide. Revisions this year make significant changes to standards and expectations of employing agencies and service providers alike. This fast paced, interactive workshop introduces providers to a comprehensive systems approach to evidence-informed, standards-based prevention, screening, assessment, and treatment for fire, rescue, and emergency medical services agencies, their personnel, and their families.
Under sponsorship of the National Fallen Firefighters Foundation’s Everyone Goes Home® project, a collaboration of the nation’s leading researchers in areas related to occupational behavioral health and leading fire service constituency organizations developed a toolkit to meet the requirements of the newly revised standard. The toolkit is backed by an innovative package of training and support materials, including web based training for clinical providers in evidence based treatments for PTSD and depression through the Medical University of South Carolina, adapted versions of the Navy/Marine Corps Combat and Operational Stress First Aid (COSFA) program for fire and EMS agencies created by the National Center for Posttraumatic Stress Disorder, and access to evidence supported instruments for screening and assessment. Every element has been designed to be easily accessible at little or no cost to providers serving fire and EMS organizations. NFFF has also produced guidelines for fire and EMS agencies to help them in writing RFPs for behavioral health services and guidance for providers to help them create responsive proposals and deliver effective, high quality services in a cost effective manner.
Key participants in building these protocols and the toolkit that supports them will introduce participants to the process and its products, providing an overview of essential elements in each component and a preview of resources available to help providers use them successfully. While designed for the specific needs of fire, rescue, and EMS organizations, providers will find much to help enhance their efforts across a wide range of organizations and work settings.
PMI – 14 - CANCELED
Parent-Child Interaction Therapy: Global Applications for an Evidence-Based Treatment
Keyword: Clinical/Interventional
Research
Presentation Level:
Intermediate
Region: Global
Robin Gurwitch, PhD 1; Toshiko Kamo,
MD, PhD 2
1 Cincinnati Children’s Hospital Medical
Center, Cincinnati, Ohio, USA
2 Institute of Women’s Health, Tokyo Women’s Medical
University, Tokyo, Japan
Parent-Child Interaction Therapy (PCIT) is an evidence-based treatment for young children with significant behavior problems. The Kauffman Best Practices Report cited PCIT as one of the three best treatments in the field of child abuse and neglect.
Although originally developed to address externalizing problems in young children, PCIT is now being successfully used with children from various populations (e.g., foster care, history of maltreatment, history of prenatal substance exposure, pre-term infants, and Autism Spectrum Disorders or other developmental disabilities). Effectiveness of the treatment has also been found when PCIT is implemented in different formats (e.g., individual, group, clinic-based, home-based, and school-based). Empirical research consistently finds significant improvements in child behaviors, parenting stress, and maternal depression, with improved relationships and generalization to school settings and untreated siblings and a reduction in trauma symptoms. PCIT has primarily been provided and studied in the United States. Recently, PCIT is growing beyond these boundaries and expanding into the global community.
This workshop will provide an overview of PCIT, including research findings of PCIT with other cultures (e.g., African- American families, Mexican-American families). PCIT research findings from other countries (e.g., Puerto Rico, Taiwan, and Australia) will be discussed and training efforts in other countries (e.g., The Netherlands, New Zealand, South Korea, Hong Kong, and Germany), reviewed. The current PCIT research and services in Japan will highlighted. Through didactics, video-clips, and brief experiential exercises, participants will learn how PCIT can be effectively implemented to improve outcomes in the lives of children in all corners of the world.
PMI – 15
Building Knowledge and Skills to Incorporate Spirituality in Trauma Intervention
Keyword: Clinical Practice
Presentation Level:
Introductory|
Region: Industrialized Countries
Cynthia Eriksson, PhD 1; David Foy, PhD
2; Kent Drescher, PhD 3; Shoba Sreenivasan, PhD 4; Joseph Currier, PhD
1
1 Fuller Theological Seminary, Pasadena, California,
USA
2 Pepperdine University, Encino, California, USA
3 National Center for PTSD, Menlo Park, California, USA
4 GLA VA Medical Center, Los Angeles, California, USA
Research supports the importance of addressing elements of meaning, purpose, spirituality, and religious experience in trauma treatment, yet clinicians may hesitate to incorporate these constructs due to a lack of knowledge or perceived competence. There are certain areas of spiritual or religious experience which have been shown to increase the risk of emotional distress in trauma survivors: moral injury, crisis in meaning making, negative religious coping, and struggles with forgiveness. This PMI will provide resources, skills, and practice for beginning clinicians to learn to address preparation, assessment, and intervention relevant to spirituality in trauma treatment.
To begin, participants will be prepared to ethically attend to the diversity implicit in spiritual experience. The DSM-IV Cultural Formulation model provides a framework for a therapist to consider the unique religio-cultural context of the client’s experience, the religio-cultural interpretations of the client’s distress, the social network associated with the client’s religio-cultural background, and the aspects of the therapist’s own religio-cultural identity that might impact treatment. Next, participants will be introduced to methods in assessing the interface between spirituality and trauma in combat trauma treatment, including assessment of moral injury, forgiveness, religious coping, and meaning making.
We will describe validated instruments for spiritual assessment, and provide guidance as to open-ended clinical interview questions (a spiritual autobiography). Finally, specific intervention techniques will be presented. Existing models of meaning making suggest that posttraumatic difficulties result, in part, from a mismatch between the distressing realities of the trauma and one’s preexisting meaning structures. We will present narrative strategies for promoting meaning making in the context of individual therapy with trauma survivors. In addition, Frankl’s meaning-based transpersonal model of intervention will be discussed. The transpersonal model asserts that combat experiences (and other traumatic events), if placed within a meaningful context, carry the potential to promote spiritual and emotional growth. Workshop participants will also be introduced to manualized session guides for addressing critical areas of moral injury, forgiveness, and meaning making using a structured group therapy format.
Material will be presented through video, case vignettes, lecture, discussion, and role play. Participants will complete the PMI with a set of skills to ethically and effectively assess and intervene in areas of spirituality in trauma treatment.
PMI – 16
Psychological First Aid - Skills Building Training
Keyword: Prevention/Early Intervention
Presentation Level:
Intermediate
Region: Global
Melissa Brymer, PhD, PsyD 1; Patricia
Watson, PhD 1; Douglas Walker, PhD 2; Gilbert
Reyes, PhD 3; DeAnna Griffin, MA 1
1 UCLA, Los Angeles,
California, USA
2 Project Fleur-de-lis, Metarie, Louisiana, USA
3 Fielding Graduate University, Santa Barbara, California,
USA
This PMI session will build on the morning session and enhance participants’ skill levels in delivering Psychological First Aid (PFA). This session is also for participants who have received PFA training in the past. PFA is an acute intervention to help children, adolescents, adults, and families in the immediate aftermath of disasters, terrorism and other emergencies. PFA is designed to reduce the initial distress caused by traumatic events and to foster short- and long-term adaptive functioning and coping. In the past several years, the National Child Traumatic
Stress Network and National Center for PTSD have identified areas in delivering PFA in which providers need more assistance to enhance their confidence and skills level. Through various activities, participants will practice how to work with children in group settings, assisting survivors with acute grief issues, and improving ways to engage survivors. At the end of the session, participants and presenters will conduct an after-action review and address lessons learned.
PMI – 17
Regulation and Engagement for Traumatized Children and Adolescents Through Sensory Motor Input, Play and Therapeutic Co-Regulation
Keyword: Child/Adolescent
Presentation Level: Intermediate
Region:
Industrialized Countries
Elizabeth Warner, PsyD; Alexandra Cook,
PhD; Anne Westcott, LICSW
Trauma Center at Justice
Resource Institute, Brookline, Massachusetts, USA
This workshop will describe an innovative, evidence-supported model of treatment for children and adolescents exhibiting complex adaptation to chronic child maltreatment and neglect. Sensory Motor Arousal Regulation Treatment (SMART) was developed at the Trauma Center at Justice Resource Institute by a team of three experienced child trauma therapists and one senior sensory integration occupational therapist. The model emerged from a two-year process of intensive videotape review of staff clinicians’ child therapy sessions focused on integration of gross motor, sensory motor and sensory-integration techniques for behavioral and affect regulation, embedded within the context of trauma-focused, attachment-based intervention. This approach targets underlying self-regulatory deficits identified in children with histories of complex trauma exposure and adaptation: alexithymia and affective lability, behavioral disorganization, severe internalizing and externalizing problems, and disruptions in interpersonal interaction and engagement.
Tools of regulation include forms of playful sensory motor input (vestibular, proprioceptive, tactile) and therapist skills, which co-regulate and direct attention to the body, regulation and internal experience. The way in which sensory motor input regulates children, and rapidly leads to shifts in state, improved language and cognition, greater cognitive flexibility and improved interpersonal contact will be shown via film of therapy sessions. Simple experiential exercises will be demonstrated to help participants understand the utilization of these tools.
Finally, the rich opportunities for trauma processing through child- and parent-directed interactive play between the child and caregiver(s), and language will be viewed on film and opportunity for comment and discussion by participants will be provided. Use of the model in adolescent residential treatment sites in a pilot program will be described, including initial pilot data supporting further exploration of the effectiveness of such an approach. Informed consent has been obtained for use of videotape segments in an educational context.