The discrepancy between need and access to mental health services is uncontestable. An estimated 57% to 67% of adults experiencing mental illness in the United States do not receive needed services. The need-to-access gap is even wider for children and adolescents: Up to 80% of youths with mental health needs go without services each year. Even among those who do access care, treatment is often brief: international service-use data suggests that the modal number of sessions attended is just one. This creates a need to quantify and capitalize on what can be accomplished therapeutically, given appropriate targeting and structure, in a short period of time. Therefore, this talk will outline recent innovations in single-session interventions (SSIs) for mental health problems, including the evidence supporting their effects; how they might yield clinically-meaningful change; resources for delivering evidence-based SSIs; and where, when, and how they can be delivered. Understanding SSIs’ promise creates an opportunity for a paradigm shift in our field’s thinking about constructing services for broad-scale impact. SSIs can operate as stand-alone services or as adjunctive services within existing care systems; as such, learning to study and provide SSIs may improve the reach of effective mental health interventions while mitigating problems linked to long waiting lists, global provider shortages, and high costs of traditional care.

Irritable bowel syndrome (IBS) is the most common gastrointestinal (GI) disorder seen by primary care and GI physicians, accounts for considerable personal suffering, and is largely refractory to medical therapies. Its physical symptoms (pain, diarrhea and/or constipation) commonly co-occur with other psychological complaints (e. g. GAD, depression) that behavior therapists effectively treat and thus offer a gratifying way of expanding one’s clinical practice. In the absence of any organic cause, IBS is best understood from a biopsychosocial perspective (Van Oudenhove et al., 2016, Gastroenterology) that emphasizes the reciprocal and interactive relationship among a person’s biology (e. g., GI motility, pain sensitivity, stress reactivity), behaviors (e. g., avoidance), and higher order central processes (rigid cognitive style characterized by perseverative thought manifested in restricted coping and perceptual biases to threat) that influence GI symptoms. Clinical trials assessing the efficacy of CBT for IBS have established it as a gold standard psychological treatment, yielding dramatic, rapid, broad, and sustained symptom improvement that compares favorably to pharmacological or dietary treatments (Mayer, 2007, New England Journal of Medicine). After a brief overview of IBS, this workshop will describe the conceptual underpinnings of CBT for IBS, its rationale, goals and technical components using didactic instruction and detailed case examples from actual patients enrolled in a landmark NIH trial (Lackner, Jaccard, et al., Gastroenterology, 2018) that affirmed CBT’s status as the most widely endorsed empirically validated psychological treatment (Black. et al., GUT, 2020) and arguably the most effective behavioral treatment for any chronic pain disorder. Attendees will learn practical strategies to trouble shoot around difficult clinical issues to maximize outcome, patient engagement, and clinician satisfaction.

Intolerance of uncertainty (IU), a negative dispositional characteristic that results from catastrophic beliefs about uncertainty, is a key vulnerability factor for generalized anxiety disorder (GAD). Research has shown that IU is highly related to the symptoms of GAD, that the relationship between IU and GAD is not accounted for by other vulnerability factors, and that changes in IU precede and predict corresponding changes in the symptoms of GAD. In this webinar, I will present a new, highly focused treatment for GAD: Behavioural Experiments for Intolerance of Uncertainty. The treatment draws upon 30 years of research on the role of intolerance of uncertainty in GAD, as well as on recent theorizing on the mechanisms of fear reduction. In brief, the new treatment uses the structure of behavioural experiments to explicitly test client hypotheses and thus enhance new learning during exposure to uncertainty. The treatment has now been tested in two clinical trials, with results showing that it promotes impressive change in negative beliefs about uncertainty, the symptoms of GAD and general psychopathology. The goal of this workshop is to present the new treatment’s underlying theory and to illustrate its strategies and procedures.

Although regret is a central element in depression, procrastination, indecision, self-criticism, worry, rumination, and avoidance, it has received little attention in the CBT literature. In contrast, regret has been a focus in decision theory and research indicating that when people make decisions, they often anticipate the possibility of post-decision regret and, therefore, attempt to minimize this experience. Regret is not always a negative process. Insufficient regret processes result in impulsive behavior and failure to learn from past decisions. During manic episodes there is underutilization of anticipatory regret. We will view regret as a self-regulatory process where too much regret or too little regret may be problematic. In addition, some decision makers have idealized beliefs about decisions, rejecting ambivalence as an inevitable part of the trade-offs underlying decision-making under uncertainty. Specific decision styles are more likely to contribute to regret, including maximization, emotional perfectionism, existential perfectionism, intolerance of uncertainty, and overvaluation of "more" information rather than relevant information. In this presentation we will examine how regret is linked to hindsight bias, maximization rather than satisfaction strategies, intolerance of uncertainty, rejection of ambivalence, refusal to accept trade-offs, excessive information demands, and ruminative processes. Specific techniques will be elaborated to balance regret with acceptance, future utility, and flexibility to enhance more pragmatic decision processes, reverse ruminative focus on the past, and replace self-criticism with adaptive self-correction.

Dr. Persons will define measurement-based care, describe reasons for providing MBC, offer hypotheses about why MBC might lead to improved client outcome, and describe steps to take to provide MBC, with many clinical examples and tools that learners can use to implement MBC. This webinar is ideal for private practitioners but is useful to therapists who provide CBT to adults in any outpatient setting.

The idea that people can be lastingly harmed by their own transgressive behavior and can suffer because of others’ moral failures is as old as humanity, yet these age-old concepts have only recently been considered as clinically relevant social, biological, spiritual, and psychological problems. Moral injury (MI) is the multidimensional outcome from exposure to transgressive harms that undermine foundational beliefs about the goodness and trustworthiness of oneself, others, or the world. Although moral injury has gained widespread acceptance, we have only just recently defined the syndrome and generated a method to measure the syndrome that can be used clinically. I will define the boundary conditions for MI and distinguish MI as a clinical problem in contrast to moral frustration and moral stress, describe the domains impacted by exposure to morally injurious events, provide an assessment tool that can be used clinically and in research, provide case conceptualization heuristics and treatment approaches that can be used when MI is the principal target (e.g., when a traumatic event is a MI) or when another presenting problem is colored by MI, and discuss process issues that arise when clinicians are confronted with the existential realities of grave transgressive behaviors or high stakes systemic failures.

Suicide remains the 10th leading cause of death for all individuals in the United States and is the second leading cause of death for individuals between the ages of 35 and 54 (CDC, 2018). Evidence based practice around suicide prevention and treatment can be difficult to understand and implement, causing tension between ethical standards of avoiding harm and practicing within areas of competency with day-to-day clinical obligations. This training seeks to find balance between resolving ethical tensions and increasing competencies regarding the treatment of suicidal patients. Participants will review up-to-date information on best practices for suicidal patients, practice interventions, and use working with suicidal clients as a lens from which discuss ethical codes related to practice.