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Pre-Meeting Institutes
Pre-Meeting Institutes--Wednesday, November 12
To register for an ISTSS Pre-Meeting Institute held on November 12, indicate which session(s) you wish to attend when registering. Only those holding tickets for specific sessions will be admitted. Discounts are available if you register for more than one half-day Pre-Meeting Institute.
Sessions will be presented on a wide variety of topics grouped by keyword:
- Assessment/Diagnosis (Assess Dx)
- Research Methodology (Res Meth)
- Biological/Medical (Bio Med)
- Children and Adolescents (Child)
- Clinical or Interventions Research (Clin Res)
- Clinical Practice Issues (Practice)
- Prevention/Early Intervention (Prev EI)
- Community Programs (Commun)
- Culture/Diversity (Cul Div)
- Civilians in War/Refugees (Civil Ref)
- Social Issues/Public Policy/Ethics (Soc Ethic)
- Disaster/Mass Trauma (Disaster)
- Military/Emergency Services/Aid Workers (Mil Emer)
- Media/Training/Education (Media Ed)
Pre-Meeting Institutes -- Wednesday, November 12
Full Day
8:30 a.m. -- Noon and 1:30 p.m. - 5:00 p.m.
Trauma-Focused CBT for Children (Abstract #194072)
Primary Keyword: Child
Secondary Keyword: Practice
Technical Level: Advanced
Cohen, Judith, MD1; Mannarino, Anthony, PHD1
1Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
Children experience terror (extreme fear) in response to manytraumatic events. Children may express terror through theirbehavior, emotions, thoughts and/or bodies. Developmental level,family, culture, context and individual factors also influence thisexpression. When children’s terror is unaddressed, their developmental trajectory can dramatically change in unhealthy ways. It is critically important to provide effective treatment tochildren who have extreme trauma-related fear before this occurs.This PMI provides therapists with intermediate level training in anevidence-based treatment, Trauma-Focused Cognitive BehavioralTherapy (TF-CBT) for children’s Posttraumatic Stress Disorder, depression, shame, behavior problems and other trauma-associatedsymptoms. It is strongly recommended that prior to attending thisPMI participants complete the online training course TF-CBTWeb, available at www.musc.edu/tfcbt. The PMI will be an acceleratedand practical training for child therapists in implementing the coreTF-CBT components, which are summarized by the acronym
PRACTICE: Psychoeducation, Parenting skills, Relaxation, Affective modulation, Cognitive coping, Trauma narrative and cognitive processing of traumatic experiences, Conjoint child-parent sessions, In vivo mastery of trauma reminders, and Enhancing safety and future developmental trajectory. The training will include extensive case examples and role play practice and will provide opportunities
for participants to ask two of the TF-CBT treatment developers questions about their treatment cases.
Acceptance and Commitment Therapy: Bringing Values to Life Following Trauma (Abstract #196192)
Primary Keyword: Practice
Secondary Keyword: Mil Emer
Technical Level: Intermediate
Walser, Robyn, PHD1; Westrup, Darrah, PHD, BEE2
1International Society for Traumatic Stress Studies, Menlo Park,
California, USA
2VA Palo Alto Health Care System, Menlo Park, California, USA
Many individuals who suffer with post traumatic stress following acts of terror, war, disaster and violence struggle to regain their pretrauma lives. Once held personal values are often lost to disbelief and pain. They are also lost to the efforts and desire to avoid traumatic memories, painful feelings and unwanted thoughts. This loss, plus the avoidance strategies themselves, can have a powerful negative impact on individuals diagnosed with PTSD and other trauma related disorders. Acceptance and Commitment Therapy (ACT) is an intervention that targets avoidance by addressing problematic control strategies; and by promoting acceptance of internal experience through practices of willingness and being present in the current moment. Additionally, ACT explicitly explores valued living and works with clients to regain lost values by engaging in behavior change that is consistent with those values. ACT is a structured intervention that applies mindfulness and behavioral techniques, in the treatment of PTSD. We will present the basic theory and application of ACT including covering the six core process: acceptance, present-moment, defusion, self-as-context, values and committed action. We will spend time exploring how these core processes are interwoven to create a compassionate intervention. We will also briefly review empirical support for the intervention.
Treatment of Prolonged Exposure Therapy (PE) (Abstract #194834)
Primary Keyword: Clin Res
Secondary Keyword: Practice
Technical Level: Advanced
Foa, Edna, PHD1; Hembree, Elizabeth, PHD2
1University of Pennsylvania, Philadelphia, Pennsylvania, USA
2Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Clinicians in many settings often find using exposure therapy quite challenging with diverse and complex chronic PTSD clients. Detailed treatment manuals provide clear guidelines and descriptions of procedures, but it is impossible to include all of the nuance and “art” of the therapy. In this advanced workshop, the developers of the highly efficacious “Prolonged Exposure” (PE) treatment program will offer the clinical wisdom that years of experience have taught us about how to modify treatment procedures in order to optimize successful outcome. Flexibility in following the manual and tailoring the treatment to the client´s response to exposure will be emphasized. Recommendations will include how to: 1) build a strong foundation for the therapy; 2) create an effective in-vivo exposure hierarchy; 3) facilitate optimal emotional engagement during imaginal exposure; and 4) modify procedures for clients who over- or underengage in exposure. The procedural modifications will be demonstrated with patients´ videotapes. This advanced workshop is geared towards participants who have had previous workshop training in Prolonged Exposure Therapy, and preferably have already used exposure therapy with PTSD
clients.
Half Day – Morning
8:30 p.m. – Noon
The Interface Between Trauma And OCD: Clinical Issues (Abstract #193329)
Primary Keyword: Practice
Secondary Keyword: Assess Dx
Technical Level: Intermediate
Winston, Sally, PSYD1
1Anxiety and Stress Disorders Institute of Maryland, Towson, Maryland, USA
Clinicians who treat trauma survivors often encounter patients with persistent and distressing symptoms which are both "obsessive" and "compulsive". Many of these repetitive phenomena seem to both feed and quell overt anxiety. This workshop will address both diagnostic and treatment issues in these patients. Important distinctions must be made between true obsessive-compulsive disorder which can be exacerbated or triggered by traumatic or stressful experience, and those trauma symptoms better described as preoccupation, worry, trauma-based phobia, avoidance of triggers , repetitive re-enactment and various forms of compulsive self-injury. Whether symptoms are functionally autonomous from the trauma material or must be addressed by exposure to the trauma memories will be explored. A framework will be presented for how effective evidence-based treatment of true OCD is conducted. Modifications which may be required in trauma survivors with OCD will be discussed. The role of panic attacks and flashbacks (and the distinctions between them) will be elucidated. Why "safety behaviors" are desired in impulsive patients and discouraged in obsessive-compulsive patients will become clear as this model is presented. Ample clinical examples will be used, and participants are encouraged to share relevant vignettes of their own.
After Terrorist Events: Innovative Disaster Mental Health Systems of Care, Planning--Implementation (Abstract #196404)
Primary Keyword: Disaster
Secondary Keyword: Commun
Technical Level: Intermediate
Gurwitch, Robin, PHD1; Schreiber, Merritt, PHD2; Perez, Jon, PHD3; Coady, Jeff, PSYD4; Hughes, Laurel, PSYD5; Derrickson, Sean, MSW6
1Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
2Center for Public Health and Disasters, UCLA Center for the Health Sciences, Los Angeles, California, USA
3United States Department of Health and Human Services, Rockville, Maryland, USA
4HHS, San Francisco, California, USA
5Addictions and Mental Health, Oregon Department of Human Services, Beaverton, Oregon, USA
6Multnomah County, Mental Health and Addiction Services, Portland, Oregon, USA
In the aftermath of terrorist events, it is predicted that upwards of 30-40% of an impacted population will be at risk for mental health disorders and long-term impairment (IOM, 2003, Kessler, et al, 2006). To effectively respond, a disaster mental health systems of care which is interoperable with the other emergency support functions is needed. The model must have a continuum of care (population-based services to individualized evidenced-based treatments) and must address the immediate, short, and long-term mental health needs following terrorist incidents. Typically after disasters/terrorist events, the existing public health infrastructure is compromised. Therefore, the need for systemic level interventions is essential. The “Mercy Model” (Perez, et al, 2006) is a new concept of how to facilitate, organize, and lead systems during disasters. At its core, this model represents a public health leadership approach guiding efforts to create teams and programs for all populations. Allocation of resources is most effective through identification of those in greatest need of mental health care and creating a model of disaster response to achieve mental health parity with other public health disaster initiatives (Pynoos, Schreiber, et al 2005). The proposed model includes a rapid mental health triage and incident management system as increasing evidence suggests that for those at high risk, providing early, brief, interventions may help deflect the trajectory of impairment (Bryant, et al, 2004). PsyStart (Theinkura,et.al, 2006), as such an operational platform, was positively evaluated following the tsunami in Asia and was utilized as part of the TOPOFF4 exercise. Furthermore, as the mental health system may be strapped after terrorist events, residents may be providing services for each other. A new model of Psychological First Aid, Listen, Protect and Connect (www.ready.gov), can fill this need, providing another piece of a disaster mental health systems of care. With any model, special attention must be paid to groups considered high-risk for adverse consequences after an event. Children represent one such group (Guwitch, et al, 2002). From preparedness planning to triage to interventions, children require unique considerations to increase positive outcomes. The workshop will examine an innovative disaster mental health systems of care model from planning through implementation. It will incorporate didactic materials, including findings from natural disasters and terrorist events, video clips, and an experiential terrorist attack exercise. Information from TOPOFF4 will be included to emphasize the components presented in this innovative model for use following acts of terrorism.
Building Resilience in The Shadow of War And Terror: A School-Based Ecological Intervention Model (Abstract #195620)
Primary Keyword: Prev EI
Secondary Keyword: Child
Technical Level: Intermediate
Baum, Naomi, PHD1; Pat-Horenczyk, Ruth, PHD2; Brom, Danny, PHD3
1Israel Center for Treatment of Psychotrauma, Herzog Hospital, Jerusalem, Israel, Israel
2Child and Adolescent Clinical Services, The Israel Center for the Treatment of Psychotrauma, Herzog Hospital, Jerusalem, Israel
3Israel Center for the Treatment of Psychotrauma, Herzog Hospital, Jerusalem, Israel, Israel
In this pre conference workshop we will present our comprehensive ecological model for building resilience in school communities that have been exposed to the trauma of terrorism and war. This model integrates community and clinical approaches to promoting mental health and wellbeing in children. We present a brief overview of the concept of resilience, which is the cornerstone of our work, and lessons learned from school-based intervention programs in varied international settings. A description of our ecological model follows. This model highlights resilience building for teachers and the entire student body, as well as student screening for PTSD and related distress and treatment for affected students. Our workshop will highlight our resilience building workshops for teachers and include a "hands on" simulation of a group session. Guidelines for school-based screening followed by a discussion of different modules of school-based treatment interventions. We will conclude with challenges for implementation and future directions based on our experience.
Current Psychopharmacological Treatment of PTSD and the Psychological Underpinnings of the Treatment Alliance (Abstract #195855)
Primary Keyword: Practice
Secondary Keyword: Bio Med
Technical Level: Intermediate
Sivak, Joseph, MD1
1Private Practice: Joseph J. Sivak MD, PLLC, Duluth, Minnesota, USA
This training will provide and update the clinician on current psychopharmacology practice standards used to treat chronic PTSD. The focus will be on the outpatient setting, and will primarily consider mainstream allopathic medicine in the western world specifically FDA approved medications including those approved for use in PTSD as well as the many medications used "off-label" for treating patients with PTSD. The second portion will focus on why these medications often have limited utility or partial efficacy and explore the "Nocebo" dynamic. The vantage point will be from a psychosocial perspective, and explore basic psychodynamic issues of medication treatment in the context of an ever increasing, technological and fast-paced often violent society. Special consideration will be given to the destruction of the family unit, disconnectedness in society, entitlement, victimization, continuous reabandonment and how this is acted out through the metaphor of the medication. Finally, some consideration of helpful techniques and concepts are discussed for increasing psycho pharmacotherapy success, not only for the physician or physician extender providing medical treatment but also for the psychotherapist as part of the dynamic treatment triad. The treatment triad can be most crucial in medication success as the psychopharm-psychotherapy relationship must be synergistic for the individual suffering with chronic PTSD.
Somatic Intervention: Using the Trauma Resiliency Model (TRM) in the Treatment of Complex Trauma (Abstract #195865)
Primary Keyword: Practice
Secondary Keyword: Cul Div
Technical Level: Intermediate
Leitch, Laurie, PHD1; Miller-Karas, Elaine, MSW2
1Trauma Resource Institute, Santa Fe, New Mexico, USA
2Trauma Resource Institute, Claremont, California, USA
This Pre-Meeting Institute (half-day), for intermediate and advanced clinicians, will focus on the application of the Trauma Resiliency Model (TRM), a somatic clinical intervention which is being used in settings that have experienced complex trauma. TRM focuses on the biological basis of trauma and the reflexive, defensive ways the body responds to threat and fear. The approach draws on neuroscience research which shows how trauma affects cortical and subcortical processing of information and the importance of working with defensive responses which were thwarted during the traumatic event. TRM is a brief, stabilization model inspired by Somatic Experiencing (SE). TRM emphasizes that human responses to threat are primarily instinctive and biological and only secondarily are cognitive and psychological. TRM treatment focuses on identifying the psychophysiological patterns that underlie a wide variety of traumatic responses. The focus of treatment is on unlocking the somatized “stress memories” and movement impulses that remain bound in the body and restoring balance to the nervous system (Levine, 2005) by working with small gradations of traumatic activation alternated with the use of somatic resources. Working with small increments of traumatic material is a key component of TRM treatment as is the development of somatic resources. Together they reduce the likelihood of escalation of arousal, flooding and/or retraumatization and help develop a sense of mastery and self-management over intense somatic states. Cognitions and emotions are addressed in TRM but are not the primary focus of intervention. Special attention will be paid in the workshop to the relevance of TRM in communally-oriented cultures and with populations that are not insight-oriented. The presentation will emphasize TRM´s skills-based approach and its focus on local capacity-building. Case examples applying TRM will be provided from the presenters´ projects in Rwanda with genocide survivors, with anti-female genital mutilation activists in East and West Africa, as well as projects in the US. Discussion will include ways that TRM can complement and be integrated with other clinical models such as CBT. TRM has been found in two studies (one published, one pending publication) to be an effective low-dose treatment.
Acceptance and Commitment Therapy for Posttraumatic Anger-Related Problems in Living (Abstract #196107)
Primary Keyword: Practice
Secondary Keyword: Mil Emer
Technical Level: Intermediate
Santanello, Andrew, PSYD1; Kelly, Sharon, MSW1
1Trauma Recovery Programs, Veterans Affairs Maryland Health Care System, Baltimore, Maryland, USA
Anger and aggression are two of the most widely reported anddisruptive sequelae of traumatic experiences, especially amongveterans (Beckham, Feldman, Kirby, Hertzberg, & Moore, 1997;Jakupcak, et al., 2008). Many anger treatments, such as StressInoculation Therapy (SIT), focus on the “management” or control ofthe various experiences associated with anger such as physiologicalarousal, hostile attribution bias, increased frequency of automaticthoughts, and aggressive behavior(e.g., Chemtob, Novaco, Hamada,and Gross, 1997). However, the link between trauma, anger, andaggression is not well understood and traditional angermanagement techniques may serve to reinforce unhelpful changeand control agendas. Furthermore, many clients report that effortfulcontrol of the experience of anger leads to a viscous cycle ofsuppression followed by explosive anger episodes. Aiding clients toexperience, rather than avoid, their anger and to increase theirbehavioral repertoire in the context of anger is an alternativestrategy. In this workshop, participants will learn an Acceptanceand Commitment Therapy (ACT)-based approach to working withposttraumatic anger related problems in living. The presenters willoffer an ACT-based conceptualization of posttraumatic angerproblems, describe a ACT-based therapeutic strategy for addressingthese problems, model specific ACT interventions, and describe aunique ACT-based anger group (Honorably Experiencing Anger and
Threat Group, a.k.a. “HEAT” Group) being conducted in the Trauma Recovery Programs of the VA Maryland Health Care System. Participants will have the opportunity to participate in experiential
exercises and role-plays to facilitate the acquisition of new skills for working with anger.
Preventing Psychological & Moral Injury in Military Service: Misconduct Combat Stress Behaviors (Abstract #196146)
Primary Keyword: Prev EI
Secondary Keyword: Mil Emer
Technical Level: Intermediate
Shay, Jonathan, MD, PHD1; Greenberg, Neil, BM2; March, Cameron, ADMPT3; Nash, William, MD4; Stokes, James, MD5; Castro, Carl, PHD6; Grenier, Lieutenant Colonel Stephane, MSC, CD7
1Psychiatry, US Department of Veterans Affairs, Newton, Massachusetts, USA
2Academic Centre for Defense Mental Health, King's College London, London, United Kingdom, United Kingdom
3Headquarters Staff of the Commander in Chief Fleet, Royal Marines, Portsmouth, United Kingdom
4Headquarters United States Marine Corps, Quantico, Virginia, USA
5Medical Evaluation Board, Brooke Army Medical Center, San Antonio, Texas, USA
6Division of Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Washington, DC, District of Columbia, USA
7Armed Forces Canada, Ottawa, Ontario, Canada
An informal, unofficial international exchange among military and mental health professionals on prevention and early treatment of psychological and moral injury in military service. No one will speak officially for their services or for their governments. Their remarks are their own. Attendees agree not to publish or circulate attributed quotations, without permission of the person quoted; participation does not imply endorsement of remarks by other presenters. An occupational health framework provides structure: PRIMARY prevention: eliminate war; SECONDARY: redesign culture, policies, and practices to prevent and reduce injury to troops; TERTIARY: early, expert, and far-forward detection, assessment, and treatment of exposures and injuries as they happen, but still within the military institutions. The specific allocation of time among specific levels of prevention, and to specific practices, policies, research overviews and needs for research, will be shaped by the mix of interests brought to the session by attendees. In past years, attendees from all over the world have made enormously valuable contributions, and air time will be provided for attendees who wish to speak at greater length than the usual conference question or comment. The presenters come to learn as well as to teach. Active duty uniformed presenters may be unable to attend if deployed by their forces, but the remaining presenters will be able to conduct the session. This year´s sub-theme is MISCONDUCT COMBAT STRESS BEHAVIORS. All aspects of service member misconduct will be open for consideration: prevention, awareness, cultural and social process dimensions, as a disastrous complication of psychological injury, measurement issues, military leadership, personnel policy, and training dimensions.
Half Day - Afternoon
1:30 p.m. – 5:00 p.m.
Skills for Psychological Recovery (Abstract #196225)
Primary Keyword: Disaster
Secondary Keyword: Prev EI
Technical Level: Introductory
Watson, Patricia, PHD1; Ruzek, Josef, PHD2; Vernberg, Eric, PHD3; Layne, Christopher, PHD4; Berkowitz, Steven, PHD5; Jacobs, Anne, PHD6
1Dartmouth College, White River Junction, Vermont, USA
2NCPTSD, Palo Alto, California, USA
3University of Kansas, Lawrence, Kansas, USA
4NCTSN, Los Angeles, California, USA
5Yale University, New Haven, Connecticut, USA
6Psychology, University of Kansas, Lawrence, Kansas, USA
This PMI will offer a practical training of the Skills for Psychological Recovery Field Guide, developed by the National Child Traumatic Stress Network and the National Center for PTSD. Skills for Psychological Recovery (SPR) is an evidence-informed modular approach to help children, adolescents, adults, and families in the weeks and months after disasters and terrorism, after the period where Psychological First Aid is utilized. Skills for Psychological Recovery is a skills-training model designed to accelerate recovery and increase self-efficacy, rather than a mental health model. The PMI will include instruction on six core empirically-derived skill sets that have been shown to help with a variety of post-trauma issues The skill sets are meant to be used in a flexible, pragmatic manner, based on based on information gathered about ongoing needs and priorities. The interventions include such actions as Information Gathering and Prioritizing Assistance, Building Problem-Solving Skills, Promoting Positive Activities, Managing Reactions to Stress and Reminders, Promoting Helpful Thinking, Written Processing for PTSD/Complicated Grief, and Identifying and Maintaining Healthy Connections. Each action has been used in a number of empirically supported protocols for post-trauma intervention. This workshop will offer in-depth review and examples of each intervention, with video examples, case scenarios, role play, and practice.
Group Applications of Cognitive Processing Therapy (Abstract #196534)
Primary Keyword: Practice
Secondary Keyword: Clin Res
Technical Level: Intermediate
Chard, Kathleen, PHD1; Rodgers, Carie, PHD2
1PTSD Division, Cincinnati VA Medical Center, Cincinnati, Ohio, USA
2Military Sexual Trauma & Women's PTSD Program, VA San Diego Health Care System, San Diego, California, USA
Cognitive Processing Therapy (CPT) has been shown to be an effective treatment of PTSD for civilian and veteran males and females with various trauma histories. Although often used as an individual therapy, CPT has been found to be an effective group or combined group and individual therapy modality. This workshop will provide training in the use of Cognitive Processing Therapy in various group formats, including combinations with individual therapy. The presenters will conduct a brief review of the utility of group CPT, including data supporting its use in treating PTSD and related symptoms. A session by session overview of the 12 session CPT model will be reviewed including a discussion of all practice assignments and worksheets. Videotape will be used to demonstrate techniques and the audience will be asked to practice exercises over the course of the training. The presenters will make note of ways in which the group session structure differs from individual therapy. Issues regarding pre-treatment assessment, readiness for group, dealing with difficult patients, and after care will be discussed. Finally ways that CPT can be adapted to various settings will be offered including the benefits and drawbacks of the group format.
The Warrior as Patient: Engaging, Assessing and Treating the Returning Veteran (Abstract #196337)
Primary Keyword: Mil Emer
Secondary Keyword: Practice
Technical Level: Introductory
Lighthall, Alison, RN, MSN1; Scurfield, Raymond, DSW2; Platoni, Kathy, PSYD3; Rasmussen, Cynthia, RN, MSN4
1HAND2HAND CONTACT, Winnetka, Illinois, USA
2School of Social Work, University of Southern Mississippi, Long Beach, Mississippi, USA
3U.S. Army Reserve (Gulf & Iraq War veteran), Centerville, Ohio, USA
4United States Government, North Branch, Minnesota, USA
Combat veterans are an utterly unique patient population. They face difficult issues and have complex needs that are not immediately obvious to the civilian practitioner. With the number of psychologically impacted combat veterans climbing well over 1.7 million, and the ever-increasing backlog of care in the military medical system, an increasing number of military personnel are going to arrive at the doors of civilian health care providers. It is vital that we have a comprehensive understanding of this specific patient population, and become adept at caring for them. This interdisciplinary team of combat PTSD experts, all of whom have served in the Army, will show how to engage this hesitant group of wounded warriors, the best practices for assessing and treating warriors, and how, in their experiences, it is best to keep them motivated in the healing process.
Beyond Exposure Alone: Brief Eclectic Psychotherapy for PTSD (Abstract #196069)
Primary Keyword: Practice
Secondary Keyword: Media Ed
Technical Level: Intermediate
Meewisse, Mariel, MSC1; Gersons, Berthold, MD, PHD1; Schnyder, Ulrich, MD, PHD2; De Vries, Giel-Jan, MSC1; Kitchiner, Neil, MSC3; Nijdam, Mirjam, MSC1
1Center for Psychological Trauma, AMC UVA Dept of Psychiatry, Amsterdam, Netherlands
2Department of Psychiatry, University Hospital, Zurich, Switzerland
3Deptartment of Liaison Psychiatry & Traumatic Stress Service, University Hospital of Wales, Cardiff, United Kingdom
The efficacy of psychotherapeutic and pharmacotherapeutic approaches in the treatment of PTSD can be regarded as empirically demonstrated. Overall, effect sizes seem to be higher for psychotherapy as compared with medication. Many well-controlled trials with a mixed variety of trauma survivors have demonstrated that CBT is particularly effective in treating PTSD. More specifically, exposure therapy currently is seen as the treatment modality with the strongest evidence for its efficacy. However dropout rates from studies of CBT (including EMDR) usually are around 20 percent. Up to 58 percent of patients who completed CBT are still diagnosed with PTSD at posttreatment assessment. Furthermore, only 32-66 percent of patients included achieved good end-state functioning. There is a need to have treatment protocols based on CBT which meet more the expectations of traumatized clients. The 16-sessions Brief Eclectic Protocol (BEP) originally developed for police officers with PTSD proved to be effective in two randomized controlled trials and has been accepted in the NICE-Guidelines (2005). The second trial also showed effectively on biological data. A trial in Zurich is still running. BEP encompasses, apart from a slightly different form of exposure, psychoeducation at the start (with the partner present), the use of letter writing to express angry feelings, the use of mementos and 8 sessions for the domain of meaning, how it changes the view on the world and on the person his or herself. It is ended with a farewell ritual. The dropout rate is lower compared to the traditional CBT. In this workshop essential techniques for protocol components will be taught including live demonstrations, video presentations of treatment sessions, and practical exercises.
Treating Resistant PTSD: Cognitive Behavior Therapy for Complex Trauma (Abstract #196441)
Primary Keyword: Clin Res
Secondary Keyword: Practice
Technical Level: Intermediate
Cloitre, Marylene, PHD1; Nissenson, Kore, PHD1; Jackson, Christie, PHD1
1Adolescent and Child Psychiatry, NYU School of Medicine, Child Study Center, Institute for Trauma and Resilience, New York, New York, USA
This workshop will present a flexibly-applied, evidence-base treatment that systematically addresses the compromised capacities in emotional awareness, emotion regulation, and healthy attachment in survivors of complex trauma as well as the more evident symptomatology that burdens the survivor, such as PTSD, dissociation, self-injury and anger problems. The CBT protocol is organized into two 8-session phases. The first, Skills Training in Affective and Interpersonal Regulation (STAIR), focuses on the regeneration of emotional and social resources to enhance day-to-day life. The second, Modified Prolonged Exposure (MPE), focuses on the resolution of a fragmented understanding of self-and-other through the creation of a coherent and meaning-based life narrative. Presentation will include examples of and strategies for treatment resistant cases, such as skills for improving clients´ motivation and compliance. The role of the therapeutic alliance in contributing to positive process and outcome will be explored. Additionally, the promotion of good self-care skills and approaches to reduce therapeutic burn-out will be presented.
Somatic Therapies for Traumatic Stress (Abstract #196561)
Primary Keyword: Practice
Secondary Keyword: Clin Res
Technical Level: Intermediate
Van Der Kolk, Bessel, MD1
1Boston University, Boston, Massachusetts, USA
PTSD has a profound effect on physiological arousal and a host of somatic functions- it effects the entire human organism and profoundly disturbs self-regulatory functions. Alongside psychological and pharmacological interventions there is an extensive body of clinical, and some research based, knowledge about body-based interventions for traumatized individuals, which, because of its relative complexity, and body-based nature, has received little attention in mainstream PTSD circles. The presenters in this preconference workshop will review how trauma impacts a host of somatic and self-regulatory functions, and present their NIH funded work on yoga for PTSD, and their CDC funded work on theater groups with traumatized inner city youth, as well as their work with returning combat veterans from Iraq. They also will present videotaped presentations of individual sessions with traumatized individuals demonstrating sensorimotor therapy. Workshop participants will be taught specific techniques to help traumatized individuals gain control over their physiological states and to help them process traumatic experiences, including the use of breathing, movement , rhythmic interactions and body-based experiences that can lead to the resolution of traumatic states.
Trauma Systems Therapy: Treating Traumatized Children in the System-of-Care (Abstract #196502)
Primary Keyword: Child
Secondary Keyword: Practice
Technical Level: Intermediate
Saxe, Glenn, MD1
1Psychiatry, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA
Trauma Systems Therapy (TST) is a comprehensive method for treating traumatic stress in children and adolescents that adds to individually-based approaches by specifically addressing social environmental/system-of-care factors that are believed to be driving a child´s traumatic stress problems. TST conceptualizes child traumatic stress as the interface between two conceptual axes: 1) the degree of emotional and behavioral dysregulation when a child is triggered by overt and subtle reminders of a trauma and 2) the capacity of the child´s social-ecological environment/system-of-care to protect the child from these reminders, or help the child to regulate emotions in the face of such reminders. TST is both a way of organizing services as well as a set of specific clinical interventions. This phase-based treatment recommends various treatment modules depending on the degree of emotional dysregulation and the stability of the social environment. Treatment proceeds in phases depending on the child´s degree of emotional/behavioral regulation and environmental stability. Children move from one phase to the next based on improvements in the stability of the social environment and/or emotional regulation. TST includes plans and procedures for engaging all service providers, specific treatment planning forms that can cross systems of care, and legal consultation when needed to help a family access needed services related to recovery from traumatic stress. Specific intervention modalities that are contained within TST are home-based care, legal advocacy, emotional regulation skills training, cognitive processing skills, and psychopharmacology.
Trauma Systems Therapy has been adapted for child welfare, refugee trauma, medical trauma, co-morbid substance abuse, school-based, and residential care and is currently being used by many agencies across the United States. TST has been fully developed, manualized and can be delivered with fidelity. Results of an open trial of 110 families have been published and have revealed promising results. This presentation will review this study as well as the results from a 15 month follow up of this cohort and a small randomized clinical trial of TST vs. Treatment-as-Usual.
This Pre-Meeting Institute will review the conceptual foundations of TST, its assessment treatment planning, and treatment engagement approaches, and its ten principles of care. The audience will be encouraged to present (de-identified) clinical cases and clinical dilemmas for review.
Updated:
July 23, 2008
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