ACT and ERP:

Curiosity, Willingness, & Flexibility

in Exposure-Based Treatment

A Two-Day Workshop with

Lisa Coyne, PhD

Assistant Professor at Harvard Medical School/McLean Hospital

Friday - Saturday, May 3 - 4, 2019

San Francisco

12 CEs for Psychologists

The Association for Contextual Behavioral Science is approved by the American Psychological Association to sponsor continuing education for psychologists. The Association for Contextual Behavioral Science maintains responsibility for this program and its content.

12 CEs for California licensed MFTs, LPCCs, LEPs and LCSWs

As of July 2015 the California Board of Behavioral Sciences has designated approval agencies, such as the American Psychological Association.  Providers who have APA approval can offer CE Certificates to BBS Licensees and those CEs can be used for license renewal.(www.bbs.ca.gov/pdf/forms/licensee_ce_faqs_102014.pdf)

Description

Exposure-based treatment for anxiety and OCD in youth and adult populations has robust empirical support; however, 1 in 5 individuals drop out of exposure treatment (Hofmann and Smits, 2008; Ong et al. 2016), and a significant proportion either do not improve or relapse (eg Ginsburg et al., 2014; 2018).  Moreover, clinicians avoid using exposure-based treatment even when it is needed (Freihart et al, 2004; Deacon et al., 2013; Sars & Van Minnen, 2015; Meyer et al., 2014; Scher, Herbert & Forman 2015). It’s not enough to add ACT to ERP, since this does not lead to demonstrably improved outcomes (Twohig et al., 2018). Taken together, this suggests the need for a patient-centered “microanalytic approach” (Twohig et al., 2018) to improve outcomes of exposure-based treatment.

This 2-day workshop will focus on how exposure-based treatments work at the level of basic learning processes. Clinicians will learn how to use ACT and Clinical Relational Frame Theory (RFT) to enhance exposure-based treatment through supporting curiosity, willingness, and flexibility with individual cases across anxiety disorders and OCD.  Specifically, we will a) discuss behavioral (inhibitory learning) and neurobiological models of fear and uncertainty and exposure-based treatment; b) teach how to conduct exposure-based treatment with various presentations of anxiety and OCD; c) give an overview of ACT and its evidence-base; and c) demonstrate how to incorporate specific ACT interventions into flexible exposure to strengthen and contextualize inhibitory learning, d) address clinicians’ own barriers to consistently and effectively offer exposure-based treatments (knowledge, clinician psychological flexibility, myths about ERP). Participants will be given opportunities to engage in experiential exercises, role- and real-plays, and case discussions in which to practice the principles taught.  Clinical examples will be used to illustrate therapeutic techniques, in addition to the workshop’s didactic content.

(References below)

Instructor

Lisa Coyne, PhD is a licensed clinical psychologist who has worked to improve the psychological well-being of children, teens and families for nearly 20 years. After teaching as a tenured professor in the APA-Accredited Clinical Psychology at Suffolk University for 9 years, she is an Assistant Professor at Harvard Medical School/McLean Hospital in the Division of Child and Adolescent Psychiatry, where she founded the McLean Child and Adolescent OCD Institute (OCDI Jr.). She has also founded the New England Center for OCD and Anxiety (NECOA), a specialty clinic serving children, adolescents, and adults with anxiety and OCD. She is a peer-reviewed Acceptance and Commitment Therapy (ACT) Trainer, and a Faculty member of the Behavior Therapy Training Institute (BTTI) of the International OCD Foundation (IOCDF). She has published numerous peer-reviewed articles and chapters on anxiety, OCD, and parenting and is the author of The Joy of Parenting: An Acceptance and Commitment Therapy Guide to Effective Parenting in the Early Years.

Registration Fees Register
By April 5th, 2019 (April 27 for Chapter Members)
Professional Chapter Member	$300
Professional Nonmember	$360
Student / Intern Chapter Member	$200
Student / Intern Nonmember	$220
After April 5th, 2019 (April 27 for Chapter Members)
Professional Chapter Member	$340
Professional Nonmember	$400
Student / Intern Chapter Member	$240
Student / Intern Nonmember	$260
**Optional CE Fee	$30

Location:

2222 Bush Street, San Francisco, CA 94115

Included in the training fees:

12 hours of instruction; handouts; morning coffee, tea and bagels, afternoon snacks

Intended Audience:

This training is appropriate for mental health providers at all skill levels who are interested in learning about ACT/RFT theory and application. ACT and Clinical RFT are process-based approaches and can be applied to most clients. While this training will emphasize how to work with clients struggling with OCD and Anxiety, the exposure-based treatments that will be demonstrated and practiced here are transferable to other populations. 

After the training, participants will be able to:

• 1.       Describe how an approach to exposure based on ACT and clinical RFT differs from exposure conducted from a traditional habituation rationale
• 2.       Engage in useful discussion around common exposure myths and have ways to engage clients, colleagues and services in supporting evidence-based use of exposure
• 3.       Engage clients and their caregivers in effective rationales for exposure-based therapy, based on a psychological flexibility paradigm, and with attention to developmental differences across children, adolescents, and adults 
• 4.       Prepare and utilize the process of a functional behavioural assessment and case conceptualization to develop a collaborative exposure plan with clients
• 5.       Demonstrate how to develop therapeutic relationship characterized by acceptance, values, compassion and commitment, that supports the client in engaging in exposure-based treatment 
• 6.       Demonstrate how to engage clients in “noticing” exercises to shape curiosity about private events
• 7.       Apply various methods suggested by the inhibitory learning paradigm to enhance exposure-based treatment, including using multiple contextual cues, stimulus variability. exposure menus, affect labelling, etc. 
• 8.       Engage clients using valuing as action and direction to “contextualise” exposure and place exposure-based tasks under appetitive control
• 9.       Use clinical RFT methods to enhance tracking and contact with contingencies to usefully explore expectancy violation
• 10.    Use clinical RFT methods to foster flexible perspective-taking to enhance engagement in exposure tasks and promote functional senses of self
• 11.    Assess progress in exposure-based treatment using within-task and across-session methods
• 12.    Troubleshooting ERP from a functional analytic perspective (eg, when ERP becomes a ritual)

This training is fully supported by fees – there is no commercial support. 

The training is co-sponsored by the San Francisco Bay Area Chapter of the Association for Contextual Behavioral Science and the Association for Contextual Behavioral Science.

Format of the Training

Didactic presentation and experiential clinical skills practice.

Schedule

Friday May 3, 2019

8:00 - 9:00       Arrive and Sign-In (No CE's)

9:00 - 11:00     Overview of ACT/ERP Model; Intro to Inhibitory Learning (2 hrs)

11:00 - 11:15   Break (No CE's)

11:15 - 12:30   Functional Analysis and Clinical RFT (1.25 hrs)

12:30 - 2:00     Lunch (No CE's)

2:00 - 3:30       Creating a Secure Base: Bond and Task Agreement (1.5 hrs)

3:30 - 3:45       Break (No CE's)

3:45 - 5:00       Shaping Curiosity: Noticing Exercises; Flexible Exposure (1.25 hrs)

Saturday May 4, 2019

8:00 - 9:00        Arrive and Sign-In (No CE's)

9:00 - 11:00      Increasing Willingness and Motivation (2 hrs)

11:00 - 11:15    Break (No CE's)

11:15 - 12:30    Perspective-Taking: Defusion and Self-as-Context (1.25 hrs)

12:30 - 2:00      Lunch (No CE's)

2:00 - 3:30        Values-Based Flexibility; Generalization Work (1.5 hrs)

3:30 - 3:45        Break (No CE's)

3:45 - 5:00        Troubleshooting; What’s the Function? (1.25 hrs)

Refund Policy

If you cancel your registration:

• 21 or more days before the date of the event, we’ll refund all of your registration fee or give you credit to a future event;
• 20 to 7 days before the event, we’ll refund 75% of your fee;
• Fewer than 7 days before an event, we’ll refund 50% of your fee.

If you don’t cancel before the event begins, we can’t refund your fees, but we’ll give you a credit toward a future event in the amount of 50% of your registration fee.If we cancel an event for any reason, of course, we’ll refund all of your registration fees.Continuing-education certification fees can be refunded until the day before the event. They become non-refundable on the first day of the event. Continuing-education certification purchased at an event is non-refundable.

If you have any questions about this event, please contact Marisa Mazza at drmmazza@gmail.com or (415) 202-3031

References:

Baxter, A. J., Scott, K. M., Vos, T., & Whiteford, H. A. (2013). Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychological Medicine, 43(5), 897- 910.

Deacon, B. J., Farrell, N. R., Kemp, J. J., Dixon, L. J., Sy, J. T., Zhang, A. R., & McGrath, P. B. (2013). Assessing therapist reservations about exposure therapy for anxiety disorders: The Therapist Beliefs about Exposure Scale. Journal of Anxiety Disorders, 27(8), 772–80.

Freiheit, S. R., Vye, C., Swan, R., & Cady, M. (2004). Cognitive-Behavioral Therapy for Anxiety: Is Dissemination Working? the Behavior Therapist, 27(2), 25-32.

Ginsburg, G. S., Becker, E. M., Keeton, C. P., Sakolsky, D., Piacentini, J., Albano, A. M., Compton, S. N., Iyengar, S., Sullivan, K., Caporino, N., Peris, T., Birmaher, B., Rynn, M., March, J., Kendall, P. C., (2014). Naturalistic follow-up of youths treated for pediatric anxiety disorders. Journal of the American Medical Association Psychiatry, 71(3),310-318.

Ginsburg, G. S., Becker-Haimes, E. M., Keeton, C., Kendall, P. C., Iyengar, S., Sakolsky, D., Albano, A. M., Peris, T., Compton, S. N., Piacentini, J. (2018) Results from the child/adolescent anxiety multimodal extended long-term study (CAMELS): primary anxiety outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 57 (7), 471-480.

Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry,  69(4), 621-632.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication, Archives of General Psychiatry, 62(6), 593-602.

Meyer, J. M., Farrell, N. R., Kemp, J. J., Blakey, S. M., & Deacon, B. J. (2014). Why do clinicians exclude anxious clients from exposure therapy? Behaviour Research and Therapy, 54(1), 49–53.

Ong, C. W., Clyde, J. W., Bluett, E. J., Levin, M. E., & Twohig, M. P. (2016). Dropout rates in exposure with response prevention for obsessive-compulsive disorder: What do the data really say? Journal of Anxiety Disorders, 40(1), 8 – 17.

Sars, D., & Van Minnen, A. (2015). On the use of exposure therapy in the treatment of anxiety disorders: a survey among cognitive behavioural therapists in the Netherlands, BMC Psychol 3 (1), 26.

Scher, Herbert & Forman 2015 Scherr, S. R., Herbert, J. D., & Forman, E. M. (2015). The role of therapist experiential avoidance in predicting therapist preference for exposure treatment for OCD. Journal of Contextual Behavioral Science, 4(1), 21-29.

Twohig, M. P.; Abramowitz, J. S.; Smith, B. M.; Fabricant, L. E.; Jacoby, R. J.; Morrison, K. L.; Bluett, E. J.; Reuman, L.; Blakey, S. M.; and Ledermann, T. (2018). Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: a randomized controlled trial, Psychology Faculty Publications. Paper 1755. https://digitalcommons.usu.edu/psych_facpub/1755