International Society for Traumatic Stress Studies

Pre-Meeting Institutes (PMI)

Pre-Meeting 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
8:30 a.m. – Noon, 1:30 – 5:00 p.m.

PMI – 01: Child-Adult Relationship Enhancement (CARE): Building Skills to Strengthen Trauma Recovery in Children and Youth

PMI – 02: Beyond Reliving in PTSD Treatment: Advanced Skills for Overcoming Common Obstacles when Working with Memories in Trauma-focused CBT

HALF DAY INSTITUTES - MORNING
8:30 a.m. – Noon


PMI – 03: Addressing Self/Moral Injury in PTSD Treatment: How to Use an Interdisciplinary, Developmental Approach in your Clinical Practice

PMI – 04: Playing to Heal: Trauma-Sensitive Coaching and Potential of Sport as an Emerging Adjunct Treatment Approach

PMI – 05: Strengthening Family Coping Resources-Peer-to-Peer: A Peer-driven, Manualized Parent Treatment Focused on Intergenerational Traumas

PMI – 06: Online Toolkits to Support Providers and Responders Working With Traumatized Individuals and Communities

PMI – 07: Understanding, Assessing, and Treating Traumatic Dissociative Reactions, Part One: Assessment 

PMI – 08: The Evolution of Cognitive Processing Therapy

HALF DAY INSTITUTES - AFTERNOON
1:30 – 5:00 p.m. 


PMI  09: Yoga for PTSD: What We Know, What We Don’t Know, and What You Need to Know to Incorporate Yoga into Your Clinical Practice 

PMI – 10: Developing and Delivering a Train the Trainer Programme to Implement Evidence Based Practice in Low and Middle Income Countries

PMI – 11: A Family-Based Preventive Intervention for Active Duty Military Personnel and Veterans: Supporting Military and Veteran Families through Transition

PMI  12Affect Regulation Psychotherapy for PTSD and Complex PTSD

PMI 13Understanding, Assessing, and Treating Traumatic Dissociative Reactions, Part Two: Treatment

PMI 14Emerging Research on Memory Reconsolidation Neuromodulation Paradigms and the Potential to Enhance Psychotherapy and Pharmacotherapy Efficacy: A Game Changer?

Wednesday, November 8, 2017
Full Day Institutes
(8:30 a.m. – Noon and 1:30 – 5:00 p.m.)

PMI  - 01                                  

Child-Adult Relationship Enhancement (CARE): Building Skills to Strengthen Trauma Recovery in Children and Youth


Keyword: Clinical Practice
Secondary Keywords: Community/Social Processes/Interventions, Family Relationship Processes/Interventions, Prevention/Early Intervention, Training/Education/Dissemination
Population Type: Lifespan
Presentation Level: Intermediate
Region: N/A

Gurwitch, Robin, PhD1; Messer, Erica, PsyD2; Berkowitz, Steven, MD3; Warner-Metzger, Christina, PhD4
1Duke University Medical Center, Durham, North Carolina, USA
2Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
3University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
4DePaul University, Chicago, Illinois, USA


Understanding trauma’s complex impact on children is one step in the continuum of care providing trauma-informed services. As trauma affects the social relationships of the individual, particularly for children and important adults in their lives, creating positive relationships with these adults can significantly aid the healing process. Relationships are critical in prevention and acute and long-term interventions. Strong relationship skills are key principles of evidence-based parenting programs: Parent-Child Interaction Therapy (PCIT), Incredible Years (IY), Helping the Non-compliant Child, Parent-Management Training—Oregon Model (PMTO), and Positive Parenting Program (Triple P). However, these programs require intensive training and treatment. As a result, access to programs designed to improve relationships is lacking. Child-Adult Relationship Enhancement (CARE) was developed to help address this deficiency. Based on the evidenced based parenting programs, CARE is a set of skills created to enhance relationships and reduce mild/moderate behavior challenges often present after trauma. CARE is for use by any adult interacting with a child/youth. Thus far, CARE has been disseminated to several thousand adults with evidence, forthcoming. An RCT comparing CARE in primary care settings to traditional anticipatory guidance found significant improvements in behavior problems, empathy toward children’s needs, attitudes toward corporal punishment, and attitudes towards children’s independence for those receiving CARE. Current studies of children in foster care are promising and evaluations of CARE in school systems are underway. CARE has been taught to staff in child protection services, family and drug courts, substance abuse treatment centers, home visiting programs, and domestic violence shelters and to families in these systems. Medical, mental health, and allied health professionals have received CARE training to complement their services, especially to children experiencing trauma. CARE has been adapted for use with military families and crisis counselors following disasters. The CARE workshop will teach participants skills they can immediately implement with families they serve. Handouts for use when working with families will be provided. The workshop will include didactic information, videos, activities, and live practice with feedback for the greatest learning potential. Implementation, dissemination efforts, and research will be discussed helping participants determine how CARE can be useful in their settings, thus improving their efforts addressing trauma.

PMI - 02                                  

Beyond Reliving in PTSD Treatment: Advanced Skills for Overcoming Common Obstacles when Working with Memories in Trauma-focused CBT

Keyword:
Clinical Practice
Secondary Keywords: Chronic/Repeated Trauma, Cognitive Processes/Interventions, Complex Trauma
Population Type: Adult
Presentation Level: Advanced
Region: N/A

El-Leithy, Sharif, Clinical Psychologist1; Murray, Hannah, Clinical Psychologist2
1South West London and St George's NHS Trust, London, United Kingdom, London, United Kingdom
2Oxford University, Oxford , Oxfordshire, United Kingdom

Good evidence exists for PTSD treatments in which memory-focused techniques such as imaginal reliving and prolonged exposure play a significant role (Bisson et al., 2013). However, the evidence base is sparse for complex presentations of PTSD including dissociative subtypes.  For example, where trauma has been experienced in early life, is prolonged and repeated, or includes themes of perpetration or permanent injury. There are gaps in our understanding of how to adapt existing protocols to apply these treatments effectively with complex cases in routine clinical settings. Revisiting the principles and theories underlying treatment can help us generate novel techniques, and adapt existing ones to overcome these difficulties.
The workshop will bring together cognitive models of PTSD and memory (Ehlers & Clarke, 2000; Brewin et al., 2010; Arntz, 2012) , core CBT principles, and advanced therapeutic techniques to solve commonly encountered obstacles in PTSD treatment, such as overwhelming affect, difficulties connecting with feelings and memories, head-heart lag and problems identifying target memories in multiple trauma presentations. 
This institute will address (1) common obstacles in working with trauma memories (2) how to apply principles from existing cognitive models of PTSD to formulate these problems (3) how diverse memory techniques can be conceptualised using these models and (4) how to implement these techniques creatively and effectively while maintaining fidelity to cognitive models.

Wednesday, November 8, 2017
Half-Day Institutes
(8:30 a.m. – Noon)

PMI - 03                                  

Addressing Self/Moral Injury in PTSD Treatment: How to Use an Interdisciplinary, Developmental Approach in your Clinical Practice

Keyword: 
Clinical/Intervention Research
Secondary Keywords: Clinical Practice 
Population Type: Adult
Presentation Level: Intermediate
Region: Global

Davis, Louanne, PsyD; Starnino, Vincent, PhD; Angel, Clyde, Doctor of Ministry
Roudebush VA Medical Center, Indianapolis, Indiana, USA

Although there are effective evidence-based treatments for PTSD, many do not fully benefit. One of the reasons may be that, for some, current evidence-based PTSD treatments may not adequately address the deep wounding that occurs when trauma shatters the core of a person's self identity. This wounding, typically referred to as moral injury, has become an area of growing interest to clinicians who treat trauma.  This workshop, presented by a multidisciplinary team (clinical psychologist, clinical social worker and clinical chaplain), focuses on the relationship between PTSD, self/moral injury, and the skills/resources that are needed to facilitate healing of self/moral injury. An overview of the PTSD literature is presented to identify key terminology and theoretical concepts related to self/moral injury, including models of self/moral injury and healing that are derived from integrating the presenters' recent qualitative and quantitative research with what is known from the current literature. A curriculum is described that addresses self/moral injury (called "Search for Meaning") which is collaboratively facilitated in a Veterans Administration Medical Center setting by a clinical chaplain and mental health clinician, both experienced in trauma treatment. Select elements of the curriculum are explored, such as levels of self/moral development and wounding, how belief systems are compromised by traumatic experiences, anger resolution, grieving losses, and forgiveness. The audience is invited to participate in identifying ways they can use the information gained during the workshop to: (1) inform their own clinical work with self/moral injury; (2) develop referral sources and collaborations within the pastoral care community and their treatment settings; (3) consider ways to address self/moral injury in the treatment of diverse populations, e.g. those who are incarcerated, in substance use treatment and (4) discuss future directions for research. 

PMI - 04                                  

Playing to Heal: Trauma-Sensitive Coaching and Potential of Sport as an Emerging Adjunct Treatment Approach

Keyword: 
Global Issues
Secondary Keywords: Aggression/Aggressive Behavior, Cognitive Processes/Interventions, Community/Social Processes/Interventions, Quality of Life
Population Type: Lifespan
Presentation Level: Introductory
Region: Global

Bergholz, Lou, BS1; Bartlett, Megan, MEd2; Rojas, Maren, MA1
1Edgework Consulting, Boston, Massachusetts, USA
2Up2Us Sports, New York, New York, USA

This workshop will provide participants with an overview of the emerging field of sport-based stabilization.   Participants will spend the workshop exploring the key elements of sport that promote healing from trauma: unlocking the power of physical activity and the special ways that sport can help players regain control over their body; learning the skills of a trauma-sensitive coach; and, discovering how to design and build sport leagues and competitive experiences that can support healing.  The session will be interactive with small group discussions and poster work as well as fascinating examples from around the world of how sport is being used with populations affected by trauma.  Participants will leave with a “playbook” of design principles and techniques.  This workshop is intended for clinicians who want to integrate sport into their work with individuals and groups, programs that want to start or further develop a sport intervention, academics who are interested in furthering the research on sport and trauma, and anyone who wants to tap into the potential of sport to support the healing of individuals, families and communities affected by trauma.

 PMI - 05

Strengthening Family Coping Resources-Peer-to-Peer: A Peer-driven, Manualized Parent Treatment Focused on Intergenerational Trauma

Keyword: 
Clinical Practice
Secondary Keywords: Complex Trauma, Family Relationship Processes/Interventions, Intergenerational Trauma
Population Type: Lifespan
Presentation Level: Intermediate
Region: Industrialized Nations

Kiser, Laurel, PhD MBA; Vivrette, Rebecca, PhD
University of Maryland School of Medicine, Baltimore, Maryland, USA

Families affected by historical and intergenerational trauma endure multi-layered challenges that require clinical service to reach beyond traditional models.  Along with their Peer Group Leaders, participants in Strengthening Family Coping Resources-Peer-to-Peer focus on reconstructing intergenerational relationships whenever possible, “letting go” when reconciliation is not possible, interrupting the cross-generational transmission of trauma, violence, substance abuse and mental illness, and leaving a legacy of guidance based on their own experiences and learning. Groups support parents to make connections between their trauma, mental illness, substance abuse, and parenting practices. Each session provides a setting for them to develop ideas about how to reconnect, repair and recalibrate their parenting relationships, accept responsibility for mistakes/choices made, and move forward to strengthen their family. Desired outcomes are twofold:  1) enhancing/strengthening a parent's own recovery and 2) better positioning parents to help family members with whom they have meaningful relationships avoid substance abuse, violence and victimization.  This workshop reviews the structure and content of SFCR-PP providing short session vignettes and experiential role-plays.  We describe peer facilitator skills, management of triggered reactions (both their own and participants), and monitoring of peer leader recovery.  Finally, we discuss training/implementation guidelines along with illustration of successes and challenges.

PMI - 06                                  

Online Toolkits to Support Providers and Responders Working With Traumatized Individuals and Communities

Keyword: 
Training/Education/Dissemination
Secondary Keywords: Community/Social Processes/Interventions, Natural Disaster, Prevention/Early Intervention, Vicarious Traumatization and Therapist Self-Care
Population Type: Adult
Presentation Level: Intermediate
Region: Global

Watson, Patricia, PhD1; Walser, Robyn, PhD2; Juhasz, Katherine, MS3; Matteo, Rebecca, PhD4; McCaslin, Shannon, PhD5; Ermold, Jenna, PhD6
1National Center for PTSD, Executive Division, White River Junction, Vermont, USA
2National Center for PTSD, Dissemination and Training Division University of California, Berkeley, Menlo Park, California, USA
3National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California, USA
4National Center for PTSD/White River Junction VA, White River Junction, Vermont, USA
5National Center for PTSD – Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
6Center for Deployment Psychology, Rockville, Maryland, USA


Educating providers and responders who come into contact with Veterans and other trauma survivors is a priority of VA’s National Center for PTSD (NCPTSD). To that end, NCPTSD integrates clinical and scientific knowledge into materials that facilitate PTSD recognition, support evidence-based treatment engagement and foster improved interactions with those with PTSD. Because of the diversity of responder and provider groups, as well as the complexity of the needs of those with PTSD, NCPTSD has developed toolkits which are aimed at different provider or responder groups. The toolkits include succinct, focused material that helps these providers/responders ensure that those with PTSD remain functional, and allows different communities and cultures to create valuable, accessible resources for those in need.
In this workshop presentation we describe these toolkits for Community Providers who work with Service Members and Veterans, Clergy, Police, and Disaster Mental Health Providers, as well as a toolkit aimed at self-care for mental health providers.  The presenters will describe the conceptualization, development, and dissemination of these diverse products. The session will conclude with recommendations for use of the products in practice. 

PMI - 07         

Understanding, Assessing, and Treating Traumatic Dissociative Reactions, Part One: Assessment

Keyword:
Clinical Practice
Secondary Keywords: Assessment/Diagnosis, Clinical Practice, Complex Trauma, Neuro Imaging 
Population Type: Adult 
Presentation Level: Intermediate
Region: Global

Brand, Bethany, PhD1; Lanius, Ruth, MD, PhD2
1Towson University, Towson, Maryland, USA
2University of Western Ontario, London, Ontario, Canada

Severe dissociative symptoms are common among individuals who experienced complex, developmental trauma. These are among the most challenging patients to treat due to the severity of their symptoms. Furthermore, few clinicians have been trained in the assessment and treatment of high dissociation.  It is common for clinicians to feel de-skilled and overwhelmed when working with these individuals.  Their poor affect regulation skills make them prone to self-destructive and suicidal behavior if treatment is not carefully planned and paced, guided by ongoing assessment of their symptoms and skills. 
The goal of this institute is to teach participants about the assessment and treatment of severe dissociative reactions. We will present an overview of the neurobiological research about dissociation and the rationale for adapting trauma treatment that is informed by these neurobiological patterns. We will review the early results of the Treatment of Patients with Dissociative Disorders (TOP DD) Network program – the first online, psychoeducational program aimed at helping dissociative patients and their therapists stabilize patients’ safety, emotion regulation, and quality of life.  The TOP DD Network program is associated with increased self-compassion, decreased symptoms, and improved affect regulation and quality of life. We will provide step-by-step guidance on how to implement some of the TOP DD Network interventions in clinical practice. We will achieve these goals by presenting research and case examples, showing patients’ art work and journaling, and teaching interventions to further develop clinicians’ skill with highly dissociative patients. 

PMI - 08                                  

The Evolution of Cognitive Processing Therapy

Keyword: 
Clinical Practice
Secondary Keywords: Clinical Practice, Cognitive Processes/ Interventions 
Population Type: Adult 
Presentation Level: Advanced
Region: Industrialized Nations

Resick, Patricia, PhD, ABPP1; Monson, Candice, PhD, Cpsych2; Chard, Kathleen, PhD3
1Duke University Medical Center, Durham, North Carolina, USA
2Ryerson University, Toronto, Ontario, Canada
3Cincinnati VA Medical Center, Cincinnati, Ohio, USA


This PMI will introduce participants to the changes in cognitive processing therapy (CPT) over time to the current protocol.  The first book published in 1993 was a bare bones manual that outlined CPT, much as it is today, but didn’t include the importance of Socratic Dialogue nor did it include how to conceptualize PTSD treatment from a cognitive perspective.  When we began dissemination in the VA, we rewrote the manual with more examples included, pared down some worksheets, added others, and tried to do a bit more with conceptualization and especially so in workshops.  Following research (Resick et al. 2008; 2012) that there is no added value in doing the written accounts except in cases with very high dissociation, and the drop out rate is 15% higher with accounts, most studies conducted since then have implemented CPT without accounts.  Our recent approach is to provide CPT (without accounts) as the primary therapy and CPT+A (with written accounts) as a secondary form of the protocol.  Following feedback from trainers and providers, we have again modified the handouts and included adaptations for specific situations like post-concussive symptoms and dementia.  This workshop will assist therapists in making the adaptation from always using written accounts to implementing a hierarchy of cognitive questions and implementing variable length CPT.

Wednesday, November 8, 2017
Half-Day Institutes
(1:30 – 5:00 p.m.)

PMI - 09                        

Yoga for PTSD: What We Know, What We Don’t Know, and What You Need to Know to Incorporate Yoga into Your Clinical Practice

Keyword: 
Clinical/Intervention Research
Secondary Keywords: Clinical Practice, (Neuro)Biological Processes/Interventions
Population Type: N/A
Presentation Level: Introductory
Region: Global

Kelly, Ursula, PhD, RN1; Davis, Louanne, PsyD2; Catiis, Alissa, LCSW3
1Atlanta VAMC/Emory University, Decatur, Georgia, USA
2Roudebush VA Medical Center, Indianapolis, Indiana, USA
3Womencare Counseling Center, Evanston, Illinois, USA


Yoga is increasingly used as a Complementary and Integrative Health modality in the treatment of PTSD. This workshop includes podium presentations that describe yoga interventions used in research, the body of evidence for yoga for PTSD, as well as an experiential Trauma Center-Trauma Sensitive Yoga (TC-TSY) skills-development session for participants. Yoga, defined here as a combination of physical forms, focused breathing, and mindfulness, is a promising complement or alternative to evidence-based psychotherapy. TC-TSY in particular aims to cultivate awareness of the mind-body connection and to build self-regulation skills to address the way that trauma is held in the body in a way that psychotherapy does not.  A trio of presenters (nurse scientist, clinical psychologist, and yoga teacher) describe the state of the science of yoga for PTSD and teach participants techniques to integrate yoga in clinical work. Presentations include a 1) review of yoga interventions used in PTSD research, 2) description of the current evidence for yoga as an intervention for PTSD, 3) systematic review of objective research outcome measures (biological markers and psychophysiological data) of the effectiveness of yoga for PTSD, and 4) an interactive session for participants to learn how to incorporate TC-TSY into clinical practice.


 PMI - 10                                  

Developing and Delivering a Train the Trainer Programme to Implement Evidence Based Practice in Low and Middle Income Countries 

Keyword: 
Training/Education/Dissemination
Secondary Keywords: Clinical Practice, Complex Trauma, Refugee/Displacement Experiences
Population Type: Adult
Presentation Level: Intermediate
Region: C & E Europe & Indep

Bisson, Jonathan, MD1; Makhashvili, Nino, MD2; Javakhishvili, Jana, BA (Hons)3; Cloitre, Marylene, PhD4
1Cardiff University School of Medicine, Cardiff, Wales, United Kingdom
2Oakland University, Tbilisi, Georgia, Georgia
3Global Initiative on Psychiatry, Tbilisi, Tbilisi, Georgia
4National Center for PTSD-Dissemination and Training Division, Menlo Park, California, USA


Objective
To disseminate and sustainably implement evidence-based trauma focused psychological therapy in low and middle income countries.
Methods
An evidence-based trauma-focused cognitive behavioural therapy treatment for PTSD, developed at Cardiff University, was collaboratively adapted with colleagues from Ilia State University to make it culturally relevant and feasible for delivery in Georgia.  In parallel, a train the trainer programme was designed for its dissemination and implementation. 
Mental health professionals undertaking a Masters in Mental Health (Psychotraumatology) at Ilia State University underwent an initial two-day training in February 2015 and then provided supervised treatment to PTSD sufferers with local supervision provided by two of the presenters (NM and JJ) and Skype supervision from the third (JB).  A further two-day training event was held in June 2015.  Initial results were promising with a mean reduction of almost 50% on the PCL-5. 
Given the nature of the difficulties experienced by the PTSD sufferers presenting to the local services, further evaluation suggested a need for more work around emotional regulation and interpersonal relationships.  This resulted in the incorporation of elements of Skills Training for Affective and Interpersonal Regulation (STAIR).  In January 2017, three trained trainers from Georgia delivered the training programme to a second cohort of Masters students at Ilia State University; their training and evaluation of its outcome is ongoing.  The training programme will be initiated in Ukraine in spring 2017.
During the workshop, the presenters will interactively work with the audience to explore the Train the Trainer Programme, the lessons learnt and how the approach could be adapted for use in other settings.

PMI - 11                                  

A Family-Based Preventive Intervention for Active Duty Military Personnel and Veterans: Supporting Military and Veteran Families through Transition

Keyword: 
Prevention/Early Intervention
Secondary Keywords: Clinical/Intervention Research, Community-Based Programs, Family Relationship Processes/Interventions, War – Military/Peacekeepers/Veterans
Population Type: Lifespan
Presentation Level: Advanced
Region: Industrialized Nations

DeVoe, Ellen, PhD MSW1; Blankenship, Abby, PhD2; Jacoby, Vanessa, PhD3; Williams, Amy, PhD4
1Boston University School of Social Work, Boston, Massachusetts, USA
2University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
3University of Texas Health Science Center at San Antonio, Ft Hood, Texas, USA
4Cohen Military Family Clinic; UT Southwestern, Dallas, Texas, USA


Since September 11, 2001, almost 3 million U.S. military service members have been deployed in support of the conflicts in Iraq and Afghanistan. Almost half of soldiers who have deployed are parents of dependent children, and more than 2 million children have been separated from their service member parent due to a military deployment (DoD, 2015).A multidisciplinary, multi-institutional team of clinicians and researchers will discuss a program designed to support military and veteran families with children and adolescents in the post-9/11 era: Strong Families Strong Forces (SFSF). SFSF was originally developed and tested as a home-based reintegration program for National Guard and Reserve families with young children. The model has since been expanded to support Active Duty military families across the deployment cycle, and Veteran families transitioning from military-to-civilian life. Engagement strategies, program core principles, and clinical case material will highlight the experiences of the diverse post-9/11 military and veteran families who have participated in our program. We will provide an outline of the model including content and implementation of each session, and lessons learned using vignettes and video and audiotaped excerpts (recorded and presented with participant consent) in order to illustrate in-session dynamics and family processes.

PMI - 12

Affect Regulation Psychotherapy for PTSD and Complex PTSD

Keyword:
Clinical Practice
Secondary Keywords: Affective Processes/Interventions, Clinical/Intervention Research, Clinical Practice, Vicarious Traumatization and Therapist Self-Care
Population Type: Lifespan
Presentation Level: Intermediate
Region: Industrialized Nations

Ford, Julian, PhD
1University of Connecticut Health Center, Farmington, Connecticut, USA

Using the chapter from the newly published Handbook of Trauma Psychology on “Emotion regulation and skills-based interventions,” the presenter will provide an overview of the rationale, intervention models, and evidence-base for affect regulation-focused psychotherapy for PTSD and complex PTSD. Case examples with adolescents and adults will be discussed to illustrate the potential benefits and cautions involved in affect regulation psychotherapy with traumatized clients. Experiential exercises will provide attendees with the opportunity to learn and practice core therapeutic skills for applying an affect regulation framework to PTSD and complex PTSD treatment, and to the prevention or mitigation of therapist impairment due to secondary traumatic stress reactions.


PMI - 13
Understanding, Assessing, and Treating Traumatic Dissociative Reactions, Part Two: Treatment 


Keyword: Clinical Practice
Secondary Keywords: Assessment/Diagnosis, Clinical Practice, Complex Trauma, Neuro Imaging 
Population Type: Adult 
Presentation Level: Intermediate
Region: Global

Brand, Bethany, PhD1Lanius, Ruth, MD, PhD2
1Towson University, Towson, Maryland, USA
2University of Western Ontario, London, Ontario, Canada

Severe dissociative symptoms are common among individuals who experienced complex, developmental trauma. These are among the most challenging patients to treat due to the severity of their symptoms. Furthermore, few clinicians have been trained in the assessment and treatment of high dissociation.  It is common for clinicians to feel de-skilled and overwhelmed when working with these individuals.  Their poor affect regulation skills make them prone to self-destructive and suicidal behavior if treatment is not carefully planned and paced, guided by ongoing assessment of their symptoms and skills. 
The goal of this institute is to teach participants about the assessment and treatment of severe dissociative reactions. We will present an overview of the neurobiological research about dissociation and the rationale for adapting trauma treatment that is informed by these neurobiological patterns. We will review the early results of the Treatment of Patients with Dissociative Disorders (TOP DD) Network program – the first online, psychoeducational program aimed at helping dissociative patients and their therapists stabilize patients’ safety, emotion regulation, and quality of life.  The TOP DD Network program is associated with increased self-compassion, decreased symptoms, and improved affect regulation and quality of life. We will provide step-by-step guidance on how to implement some of the TOP DD Network interventions in clinical practice. We will achieve these goals by presenting research and case examples, showing patients’ art work and journaling, and teaching interventions to further develop clinicians’ skill with highly dissociative patients. 

PMI - 14

Emerging Research on Memory Reconsolidation Neuromodulation Paradigms and the Potential to Enhance Psychotherapy and Pharmacotherapy Efficacy: A Game Changer? 

Keyword: Clinical/Intervention Research
Secondary Keywords: Clinical Practice, Cognitive Processes/Interventions, Theory 
Population Type: Adult 
Presentation Level: Introductory
Region: Industrialized Nations

Hoge, Charles, MD1; Chard, Kathleen, PhD2
1Walter Reed Army Institute of Research/US Army, Bethesda, Maryland, USA
2Cincinnati VA Medical Center, Cincinnati, Ohio, USA
 
The theoretical foundation of current evidence-based  PTSD psychotherapy rests largely on cognitive-behavioral and extinction-learning models.  Mainstay treatments, including prolonged exposure (PE), cognitive processing therapy (CPT), and eye-movement desensitization and reprocessing (EMDR) involve some combination of underlying core components encompassing exposure, cognitive restructuring, and/or modulation of physiological arousal.  All produce roughly comparable efficacy on intent-to-treat analyses (e.g., averaging 40% ITT recovery,  similar change scores, and wide-ranging drop-out rates).  Recent emerging scientific knowledge of memory reconsolidation paradigms suggests the potential for validation of novel approaches that may offer more rapid and lasting efficacy.  These approaches attempt to take advantage of memory re-consolidation mechanisms that become available for a brief window when memories are activated physiologically and paired with novel stimuli.  This workshop will discuss strong emerging evidence for these interventions, including single session pharmacological approaches and psychotherapy approaches pairing imaginal exposure with rescripting techniques.  One of the most promising, Accelerated Resolution Therapy (ART),  will be described in detail along with preliminary pilot data from a large head-to-head randomized controlled trial versus CPT and clinical data from a community based clinic.