The Behavior Therapist

ASSOCIATION for BEHAVIORAL and ISSN 0278-8403 ABCT COGNITIVE THERAPIES

▲ VOLUME 41, NO. 2•FEBRUARY 2018 the Behavior Therapist

Contents SCIENCE

Science Risk Factors for Early Miguelina Germán, Vincent P. Corcoran, Lorey Wheeler, and Late Dropout From Jeana L. DeMairo, Olivia M. Peros, Tanvi Bahuguna, Alec L. Miller Risk Factors for Early and Late Dropout From Dialectical Dialectical Behavior Behavior Therapy for Suicidal Adolescents • 69 Therapy for Suicidal Clinical Forum Adolescents Joanna J. Arch A Conversation With Steve Hayes and Stefan Hofmann Miguelina Germán, Montefiore About Process-Based CBT • 81 Medical Center/Albert Einstein College of Medicine Research-Practice Jacqueline B. Persons and Alexandra S. Jensen Vincent P. Corcoran, Publishing a Single-Case Study • 83 Fordham University Te chnology Lorey Wheeler, University of Julianne Wilner, Keara Russell, Shannon Sauer-Zavala Nebraska—Lincoln emotions101: Development of an Online Prevention Course for College Students Based on the Unified Protocol • 89 Jeana L. DeMairo, The New School for Social Research Clinical Dialogues Olivia M. Peros, Hofstra University Melissa L. Miller and Gabriela A. Nagy He/She/I Said What?! Reflections on Addressing Tanvi Bahuguna, Teachers College, Microaggressions in Supervision • 95 Columbia University News Alec L. Miller, Cognitive & Behav- Katherine Baucom ioral Consultants of Westchester and 2017 ABCT Featured Student Award Recipients • 99 Manhattan and Montefiore Medical Center/Albert Einstein College of At ABCT Medicine Minutes of the Annual Meeting of Members • 100

52nd Annual Convention PREVIOUS STUDIES REVEAL that a number of variables contribute to treatment dropout Preparing to Submit an Abstract • 104 among suicidal adolescents. Adolescents with a Call for Papers • 105 history of suicide attempts were more likely to Understanding the ABCT Convention • 106 drop out of treatment than their nonsuicidal counterparts (15% vs. 3%; Barbe, Bridge, Birmaher, Kolko, & Brent, 2004). Adolescents

[Contents continued on p. 70] [continued on p. 71]

February • 2018 69 the Behavior Therapist Published by the Association for In an effort to embrace one aspect of ABCT’s strategic Behavioral and Cognitive Therapies 305 Seventh Avenue - 16th Floor initiative—commitment to globalization—the Board New York, NY 10001 | www.abct.org of Directors is recommending a change to our mission (212) 647-1890 | Fax: (212) 647-1865 statement and purposes:

Editor: Kate Wolitzky-Taylor Article II Editorial Assistant: Bita Mesri Mission Statement The Association for Behavioral and Cognitive Therapies is a multidisciplinary Associate Editors organization committed to the enhancement of health and well-being by RaeAnn Anderson advancing the scientific understanding, assessment, prevention, and treatment Katherine Baucom of human problems through the global application of behavioral, cognitive, and biological evidence-based principles. Sarah Kate Bearman Shannon Blakey Purposes Angela Cathey The purposes of the Association are to globally: Trent Codd 1. Encourage innovations that advance scientific approaches to behavioral, cognitive, and biological evidence-based approaches David DiLillo to behavioral health; Lisa Elwood 2. Promote the utilization and dissemination of behavioral, cognitive, Clark Goldstein and biological evidence-based approaches to behavioral health; David Hansen 3. Facilitate professional development, interaction, and networking among members; Katharina Kircanski 4. Promote ethical delivery of science-based interventions; Richard LeBeau 5. Promote health and well-being through a commitment to diversity Angela Moreland and inclusion at all levels. Stephanie Mullins-Sweatt Amy Murell We appreciate your feedback by March 1 Alyssa Ward association for ([email protected]). behavioral and ABCT cognitive therapies

Tony Wells s Stephen Whiteside Monnica Williams INSTRUCTIONS Ñçê AUTHORS ABCT President: Sabine Wilhelm Executive Director: Mary Jane Eimer The Association for Behavioral and Cog- Submissions must be accompanied by a Director of Communications: David Teisler nitive Therapies publishes the Behavior Copyright Transfer Form (which can be Therapist as a service to its membership. downloaded on our website: http://www. Director of Outreach & Partnerships: Eight issues are published annually. The abct.org/Journals/?m=mJournal&fa=TB Tammy Schuler purpose is to provide a vehicle for the T): submissions will not be reviewed with- Managing Editor: Stephanie Schwartz rapid dissemination of news, recent out a copyright transfer form. Prior to publication authors will be asked to Copyright © 2018 by the Association for Behavioral and advances, and innovative applications Cognitive Therapies. All rights reserved. No part of this in behavior therapy. submit a final electronic version of their publication may be reproduced or transmitted in any Feature articles that are approxi- manuscript. Authors submitting materi- form, or by any means, electronic or mechanical, includ- als to tBT do so with the understanding ing photocopy, recording, or any information storage and mately 16 double-spaced manuscript retrieval system, without permission in writing from the pages may be submitted. that the copyright of the published mate- copyright owner. rials shall be assigned exclusively to Brief articles, approximately 6 to 12 Subscription information: tBT is published in 8 issues ABCT. Electronic submissions are pre- per year. It is provided free to ABCT members. Nonmem- double-spaced manuscript pages, are ferred and should be directed to the ber subscriptions are available at $40.00 per year (+$32.00 preferred. airmail postage outside North America). Change of ad- editor, Kate Wolitzky-Taylor, Ph.D., at dress: 6 to 8 weeks are required for address changes. Send Feature articles and brief articles [email protected]. Please both old and new addresses to the ABCT office. should be accompanied by a 75- to include the phrase tBT submission and ABCT is committed to a policy of equal opportunity 100-word abstract. in all of its activities, including employment. ABCT does the author’s last name (e.g., tBT Submis- not discriminate on the basis of race, color, creed, religion, Letters to the Editor may be used to sion - Smith et al.) in the subject line of national or ethnic origin, sex, sexual orientation, gender respond to articles published in the your e-mail. Include the corresponding identity or expression, age, disability, or veteran status. All items published in the Behavior Therapist, including Behavior Therapist or to voice a pro- author’s e-mail address on the cover page advertisements, are for the information of our readers, fessional opinion. Letters should be of the manuscript attachment. Please and publication does not imply endorsement by the As- limited to approximately 3 double- also include, as an attachment, the com- sociation. spaced manuscript pages. pleted copyright transfer document.

70 DROPOUT FROM DBT who reported current suicidal ideation cally brought to therapy by parents or care- Method were also more likely to drop out of treat- givers. Parental involvement and participa- ment than their nonsuicidal counterparts tion are viewed as an essential component Participants (28.6% vs. 4.3%; Barbe et al., 2004). Adoles- for successful treatment of adolescent The study consisted of patients admit- cents who reported both lifetime and cur- mental health problems in many treatment ted to a 20-week DBT outpatient therapy rent suicidality were associated with approaches (Erhardt & Baker, 1990; Mend- program (N = 98) from 2005–2014. The greater impairment at intake and also with lowitz et al., 1999). However, parental program was affiliated with a university dropout from treatment (Barbe et al.). dropout has been shown to be as high as hospital training clinic located within the Dropout rates were higher when suicidal 60% (Armbruster & Fallon, 1994; Pekarik New York metropolitan area. The sample adolescents were in nondirective support- & Stephenson, 1988), and is associated with was predominately female (84.5%) with an ive therapy than in cognitive behavioral higher child dropout (Kazdin & Mazurick, average age of 15.07 years (SD = 1.50). therapy or in systemic behavioral family 1994). DBT also strongly encourages Additionally, the majority of the sample therapy (Barbe et al.). Studying dropout parental participation in treatment. How- consisted of ethnic minority adolescents, among this high-risk population is the first ever, to our knowledge, there are no studies with Hispanic (65.1%) and African-Amer- step toward developing targeted strategies that have reported dropout rates from DBT ican adolescents (20.9%) representing the for prevention. Studies on evidence-based in a community clinic outside of a random- two largest groups. interventions have shown 11 to 13 sessions ized controlled trial. The standard DBT protocol of the clinic are needed for a majority of patients to Research has shown that another entailed a pretreatment phase in which achieve clinically significant symptom important relationship for the patient is the adolescents met with their individual ther- remission (Hansen, Lambert, & Forman, therapeutic relationship, in that the apist once per week, and an active compre- 2002; Lambert, 2007). strength of the therapeutic alliance can hensive treatment phase that incorporated Given the limited amount of research affect treatment outcome (Martin, Garske, weekly group work. During active treat- on suicidal adolescents who drop out from & Davis, 2000). Although therapist transfer ment, the adolescent attended 20 weeks of treatment, we draw upon the broader liter- (i.e., the transfer of a patient’s care mid- multifamily skills group, received phone ature that has examined nonsuicidal ado- treatment) has been shown to be a barrier coaching as needed, and continued meet- lescents and treatment dropout. These to treatment, few studies have focused on ing with their individual therapist. Parents studies suggest that adolescents who are its relation to patient dropout (Kazdin, were strongly encouraged to attend skills more likely to drop out of therapy tend to Marciano, & Whitley, 2005). In a training groups as well. Attendance rules were be older (de Haan, Boon, Vermeiren, clearly stated to the adolescent and their clinic, patients often must be transferred Hoeve, & de Jong, 2015), experience lower participating family member(s) at the between therapists mid-treatment due to symptom severity (Chasson, Vincent, & beginning of multifamily skills group. trainees moving on to different electives. Harris, 2008; Kazdin & Mazurick, 1994) Specifically, if an adolescent or parent This is an important variable to study, par- and are members of minority groups accumulated a total of 4 absences for any ticularly for a suicidal adolescent sample (McFarland & Klein, 2005), such as reason during the 20-week program, that with BPD symptoms, one of which is a fear African-American (Nock & Kazdin, 2001; individual was deemed ineligible to con- of abandonment. If a patient feels aban- Wierzbicki & Pekarik, 1993). To our tinue and designated a dropout from treat- doned by their therapist, these feelings may knowledge there are no published, empiri- ment. precipitate dropping out of DBT prema- cal studies on treatment dropout from An adolescent entered active treatment turely. However, no study has explored this Dialectical Behavior Therapy (DBT), an upon attending the initial multifamily skills hypothesis in DBT or with adolescents. evidence-based treatment for suicidal ado- group. For the purpose of this study, Taken together, there appear to be a lescents. This study drew upon an ecologi- patient dropout was explored in two ways: variety of relevant domains that contribute cal framework to identify both intraper- early dropout from treatment and late to treatment dropout for suicidal adoles- sonal and interpersonal variables that dropout. An adolescent was an early cents. For the purpose of this study, general could potentially impact treatment partici- dropout if he/she was assigned to DBT but demographic risk factors (e.g., age, gender, pation for suicidal adolescents. never attended the first multifamily skills DBT is a treatment for suicidal adoles- race), parental participation in treatment, group (thus never entering active treat- cents who may also be exhibiting symp- occurrence of therapist transfer, severity of ment). Late dropout consisted of adoles- toms of borderline personality disorder adolescent BPD symptomatology, self- cents who discontinued treatment at any (BPD). While suicidal adolescents are often harm history (e.g., suicide attempts, NSSI), point after attending their first multifamily also depressed and thus have symptom and self-reported emotional and behav- skills group. Chart reviews were conducted profiles consistent with internalizing disor- ioral problems will be explored in the con- to determine when a patient or parent(s) ders, adolescents who are both suicidal and text of treatment dropout. Rather than dropped out of DBT treatment. Inclusion have BPD symptoms also endorse prob- hypothesize a single path to treatment criteria for the study were patients who lems with impulsivity, emotion dysregula- dropout, we borrow from Kazdin, completed the intake process and were tion, interpersonal deficits, and confusion Mazurick, and Bass. (1993) the concept of assigned to DBT. During the intake, about self. While these patient characteris- risk proneness, and that dropout is likely a patients filled out a battery of self-report tics are important to examine in a study result of multiple risk factors operating in measures that were used in the analyses for about suicidal adolescents and treatment combination. Therefore, we hypothesize the current study. dropout from DBT, an ecological frame- that identified individual risk factors and work highlights multiple influences on a their accumulation will increase the likeli- Measures child’s development, including influential hood of adolescent dropout from DBT Treatment dropout variable. Charts adults. For example, adolescents are typi- treatment in an outpatient setting. were reviewed to determine the timing of

February • 2018 71 GERMÁN ET AL. when a patient and parent had dropped out attempt, 1 = at least one attempt, 2 = more in a significant change in chi-square statis- of treatment. Separate variables were cre- than one attempt. tics, and fit indices indicated that the ated for adolescent dropout and parent unconstrained model fit better than the Therapist transfer variable. Whether or dropout that were coded in the following constrained model (Kline, 1998). Second, not the patient transferred therapists way: 0 = completed treatment, 1 = dropped to determine which predictors uniquely out early, and 2 = dropped out late. The during their treatment was also explored by predicted dropout, two logistic regression adolescent dropout variables were used as reviewing patient charts. Two separate analyses were conducted (one for each out- the outcome variables of this study. In con- dichotomous variables were created to sig- trast, the parent variables were used as pre- nify whether a patient transferred thera- come variable; i.e., dummy codes for early dictors. pists either during pretreatment or active and late dropouts compared to completers) treatment. Both variables were coded as in Mplus. Mplus was utilized to take advan- Borderline personality disorder sympto- follows: 0 = no transfer, and 1 = transfer tage of advanced missing data techniques matology. The Life Problems Inventory occurred. given that missing data ranged from 3.07% (LPI; Rathus, Wagner, & Miller, 2005) is a to 26.54% in the study variables. Simula- 60-item self-report measure designed to Demographic variables. Patients’ age, assess core borderline symptomatology gender, and ethnic background were iden- tion studies have demonstrated that the use within adolescents: impulsivity, emotion tified using chart review. Gender was of multiple imputation results in more dysregulation, interpersonal problems, and dichotomously coded as 1 = male, and 0 = accurate parameter estimates (Enders, confusion about self. Thus, the LPI consists female. Ethnic background was dummy 2010; Little & Rubin, 2002; Schafer & of four corresponding subscales that coded with codes for each group (Hispanic, Graham, 2002). We imputed 10 data sets address each of these core borderline fea- African American, Asian, and mixed back- and then analyzed in Mplus using the "type tures. The subscales contain 15 items that ground (coded 1) as compared to Cau- is imputation" command. are each scored on a 5-point Likert-type casian youth (coded 0). scale with answers ranging from “Not at all Analytic Plan Step 2. To develop the cumulative risk like me” to “Extremely like me.” The total indices (CRI) for predicting early and late To address the study goals, we imple- score, calculated by summing all 4 sub- mented a two-part analytic plan. In Step 1, dropout, we only included predictors that scales, measures total borderline sympto- we used bivariate and multivariate tech- were significantly related (p < .05) from the matology. Items include “I often feel I will niques to determine risk factors for early Step 1 analyses. All of the predictors were totally fall apart if someone important and late dropout from DBT treatment. In dummy coded such that higher scores rep- abandons or rejects me” and “When I don’t Step 2, we used the statistically significant resented greatest risk. For the continuous get my way, I quickly lose my temper.” All variables from Step 1 to create a cumulative of the LPI subscales demonstrated strong variables, this was completed by examining risk model. While bivariate and multivari- internal reliability: confusion about self (α the 25th, 50th, and 75th percentile values of ate techniques can identify individual risk = .90), impulsivity (α = .76), emotional dys- each continuous variable using separate factors and the magnitude of their associa- regulation (α = .92), and interpersonal chi-square analyses in SPSS to determine tion with treatment dropout, cumulative chaos (α =.87). which percentile value best differentiated risk models can shed light on the additive among the dropout groups. Variables were Youth mental symptoms. The Youth effects of having multiple risk factors recoded so that a score of 1 (at greater risk) Self-Report (YSR; Achenbach, T., 1991) is a (Kazdin, Mazurick, & Bass, 1993). 112-item self-report measure of emotion was given for each individual risk factor. and behavioral problems in adolescents Step 1. To determine which risk factors Risk was represented as a sum of the indi- within the past 6 months. For the purpose were related to adolescent dropout we used vidual indicators. of this study, the internalizing and exter- a series of analyses. First, we used chi- Next, to determine if this cumulative square tests for the categorical variables nalizing behavior subscales were exam- risk model differentiated among the (i.e., NSSI, therapist transfer, parent ined. The syndromes of problems identi- dropout groups, we estimated a series of dropout, youth gender and ethnic back- fied in the internalizing subscale included ANOVA models in Mplus assessing mean withdrawn/depressed, anxious/depressed, ground) in SPSS 23 and MANOVA in Mplus 7.3 (Muthen, & Muthen, 1998- differences using the dropout variables as and somatic complaints, while syndromes the grouping variable in an unconstrained of problems identified in the externalizing 2014) for the continuous variables (i.e., model (means on the risk variable were subscale included aggressive behavior and BPD symptomatology, externalizing and rule-breaking behavior. Both subscales internalizing problems, youth age) to allowed to vary across the groups). Mean demonstrated excellent internal reliability: determine differences in frequency or differences were tested by comparing the fit internalizing (α = .90) and externalizing (α mean for the predictor variables, respec- of the unconstrained model to a model in = .85). tively, by adolescent dropout (0 = com- which the mean of the CRI was constrained pleter, 1 = early dropout, 2 = late dropout). to be equal across the groups. Evidence of Suicide attempts and nonsuicidal self- The analysis in Mplus included comparing mean differences was present when the injury (NSSI). The evaluating clinician the fit of a model in which the continuous constrained model resulted in a significant obtained information regarding lifetime predictor was constrained to be equal 2 history of NSSI and suicide attempts across the dropout groups to a model in change in χ , p < .05, indicating that the during the intake process. One variable was which they were free to vary across the unconstrained model fit significantly better created for NSSI and a separate variable dropout groups. Evidence of mean differ- than the constrained model (Kline, 1998). was created for suicide attempts. These ences on the predictor variable was indi- Multiple imputation was used to address variables were coded as follows: 0 = no cated when the constrained model resulted missing data (10 data sets were imputed).

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Results = .23, p <.05, NSSI history, r = -.23, p <.05, early as compared to adolescent late and parent early dropout, r = .70, p < .01. dropouts and completers, χ2(2) = 49.69, p Sample Description In addition, two predictor variables were = .00. MANOVA analyses for age, LPI total Of the sample, 18% of adolescents were found to be significantly correlated with score, LPI confusion about self, and LPI considered early dropouts while 27% of the late adolescent dropout from treatment; interpersonal chaos showed that the sample dropped out late. In all, 55% of ado- these variables were parent late dropout, r unconstrained model fit better than the lescents ended up completing the 20-week = .40, p < .01, and ethnicity (African Amer- constrained model. Adolescents who DBT program. See Table 1 for descriptive icans more likely to drop out compared to dropped out early (M = 15.72, SE = .37), statistics (mean, standard deviation, per- Caucasians), r = .21, p < .05. and adolescents who dropped out late (M = centages) for the total sample and the sub- 15.00, SE = .29), were older than those who groups. Step 1: Predictors That Distinguish completed treatment (M = 14.82, SE = .18), Bivariate correlations revealed three Adolescent Dropouts and Completers Δχ2(2) = 6.71, p = .03. In addition, adoles- predictor variables were significantly Chi-square tests revealed that adolescents who dropped out early (M = 22.94, SE related to adolescent early dropout from cents who dropped out early were more = 3.84; M = 21.54, SE = 3.73), and adoles- treatment. These variables included age, r likely to have a parent who dropped out cents who dropped out late (M = 22.08, SE

Table 1. Characteristics of Adolescent Sample (N = 98)

Completers Early Dropout Late Dropout (n = 54) (n = 18) (n = 26) Predictor Variables Size (n) M (SD) M (SD) M (SD)

Age 98 14.81 (1.32) 15.72 (1.60) 15.00 (1.50) Gender (%) 98 Female - 87.0 77.8 92.3 Male - 13.0 22.2. 7.7 Race/Ethnicity (%) 98 African American - 16.7 22.2 38.5 Hispanic - 68.5 66.7 53.8 Caucasian - 3.7 - - Asian/Native American - 1.9 5.6 7.7 Mixed Race - 9.3 5.6 - Suicide Attempts (%) 84 No attempt - 62.5 75.0 45.0 One attempt - 20.8 18.8 15.0 More than one attempt - 16.7 6.2 40.0 NSSI (%) 84 No attempt - 5.6 25.0 15.0 One attempt - 11.1 18.8 10.0 More than one attempt 72.2 56.2 75.0 Parental Drop Out (%) 98 Dropped out early - 11.1 100 26.9 Dropped out late - 29.6 65.4 Completed 59.3 7.7 Therapist Transfer (%) 95 Transfer Early - 67.9 75.0 65.38 Transfer Late - 32.1 - 30.77 Life Problems Inventory 82 Impulsivity - 33.85 (10.27) 32.93 (8.28) 35.14 (10.02) Confusions About self - 43.91 (15.16) 37.80 (15.00) 36.19 (11.73) Interpersonal Chaos - 41.83 (14.24) 35.80 (15.50) 34.71 (9.41) Emotional Dysregulation - 43.87 (15.70) 38.00 (15.94) 39.38 (12.97) Youth Self-Report 72 Externalizing Problems - 18.20 (10.18) 14.60 (8.91) 21.80 (11.38) Internalizing Problems - 24.58 (10.56) 14.70 (10.73) 23.10 (10.86) Adolescent Drop Out (%) 98 Dropped out early - - - - Dropped out late - - - - Completed - - - -

76 the Behavior Therapist the next ABCT Webinar March 2, 2018

Emotional Disorders in Children and Adolescents Jill Ehrenreich-May, Ph.D., University of Miami

• 11:00 A.M.–12:30 P.M. Eastern | 10:00 A.M.–11:00 A.M. Central | 9:00 a.m.–10:30 A.M. Mountain | 8:00 A.M. – 9:30 A.M. Pacific • $30 for members | $45 for nonmembers

The Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/UP-A) present the compelling idea that there may be a more efficient method of presenting effective strategies, such as those commonly included in CBT and third-wave behavior therapies, in order to simultaneously address an array of emotional disorder concerns in children and adolescents. The child and adolescent Unified Protocols frame treatment strategies in the general language of strong or intense emotions and promote change through a common lens. Specifically, the UP-C and UP-A help youth by allowing them to focus on a straightforward goal across emotional disorders. This webinar will provide a comprehensive introduction to the UP-A, a modular, individual therapy for adolescents; and, a more structured, group therapy for children (UP-C), the latter of which also includes a full parent-directed curriculum. Case illustrations and brief technique demonstrations throughout the webinar will help illustrate the flexible nature of the UP-C and UP-A materials and how they may be utilized in a clinician-directed manner to optimize and personalize treatment outcomes.

Eligible for 1.5 CE credits through APA Register at www.abct.org

Why not consider applying for ABCT Fellow Status?

If you have the following: 1. Clear evidence of outstanding and unusual contributions to cognitive behavioral therapy or related areas; 2. Receipt of a terminal (Ph.D., Psy.D., MFT, LSW) graduate degree in an area relevant to behavioral and cognitive therapies; 3. Full (not Student) membership in ABCT for at least 10 years (does not have to be continuous); 4. Active engagement at the time of nomination/application in the advancement of behavioral and/or cognitive therapies; 5. Fifteen years of acceptable professional experience subsequent to the granting of the terminal graduate degree; 6. Recognition by your colleagues that you have made a significant impact and achieved distinction in the field. Then we hope you will consider applying for ABCT Fellow status. Visit our website for the criteria and application information at: http://www.abct.org/Members/?m=mMembers&fa=Fellow All materials must be received by Monday, April 2. Members will be informed by September 4. The 2018 ABCT Class of Fellows will be acknowledged at the Friday, November 16 Awards Ceremony in Washington, DC.

February • 2018 77 GERMÁN ET AL.

= 2.88; M = 20.97, SE = 2.64), had lower interpersonal chaos, less than the 50th per- Discussion levels of BPD symptomatology on the LPI centile results in greatest risk of dropout, The purpose of this study was to explore subscales of confusion about self: Δχ2(2) = 2 2 χ (2) = 9.10; p = .011 and χ (2) = 10.82; p = risk factors related to adolescent dropout 8.11, p = .02; and LPI interpersonal chaos: .004, respectively. Parent early and late from DBT, an evidence-based therapy to 2 Δχ (2) = 7.31, p = .03, respectively. dropout related to greatest risk of dropout, treat suicidal adolescents with borderline Logistic regression models were con- χ2(2) = 49.69; p = .000 and χ2(2) = 21.24; p personality disorder symptomatology in a ducted to assess which significant risk fac- = .000, respectively. See Figure 1 for fre- community outpatient setting. To the best tors were the strongest predictors for each quency of cumulative risk by dropout of our knowledge, no studies have exam- outcome variable (adolescent early and group. ined adolescent dropout rates from DBT in adolescent late dropout; Table 2). When The sum of cumulative risk was then a community clinic outside of a random- controlling for other variables, age was ized controlled trial. We defined early used in an ANOVA analysis in Mplus to found to be a predictive risk factor for ado- dropout as withdrawing from DBT treat- lescent early dropout from treatment. For determine if it differentiated among the ment before attending the first multifamily late adolescent dropout, parent dropout dropout groups. Results indicated that skills group, and late dropout as withdraw- from treatment (both early and late) was dropout groups were significantly different ing from treatment after the first skills found to be a predictive risk factor. on the mean number of risk factors, Δχ2(2) group. Utilizing the concept of risk prone- = 13.73; p = .000. Follow-up analyses indi- ness (Kazdin, Mazurick, & Bass, 1993), we Step 2: Cumulative Risk Model cated that adolescents that completed hypothesized that risk factors and their The results of Step 1 revealed five signif- (Δχ2(1) = 11.78, p = .000; M = 1.02) or accumulation will increase the likelihood icant risk factors that we used to create the dropped out early (Δχ2(1) = 8.45, p = .000; of adolescent dropout from DBT treatment cumulative risk index (i.e., age, confusion in an outpatient setting. M = 1.13) had fewer risk factors than those about self, interpersonal chaos, parent early In identifying factors associated with and late dropout). These variables were who dropped out late (M = 2.06). Adoles- adolescent early dropout, we found adoles- dummy coded to represent greater risk. cents who completed and dropped out cent age and parental dropout were related Results of chi-square analyses indicated age early were not significantly different on to adolescent early dropout. Adolescent of 16 as greatest risk for dropout, χ2(2) = mean number of risk factors, Δχ2(1) = .156; late dropout was associated with identify- 5.32; p = .07. For confusion about self and p = .69. ing as African American (compared to

Table 2. Results from Logistic Regression Models Predicting Adolescent Dropout (N = 98)

Early Dropout Late Dropout

Variables b se B bseB

Adolescent age .26* .15 .32 .15 .23 .10 Male adolescents .28 .59 .08 -.40 .78 -.06 African American adolescents .10 .68 .04 .67 .99 .13 Hispanic adolescents -.01 .74 -.01 -.25 .95 -.06 NSSI -.73 .57 -.20 -1.31 .96† -.19 Therapist transfer .22 .51 .09 -.78 .89 -.16 (pretreatment) Therapist transfer -.11 .66 -.02 (during treatment) LPI confusion about self .01 .03 .17 -.03 .04 -.19 LPI impulsivity .01 .05 .07 .01 .07 .03 LPI emotional dysregulation .00 .03 .02 .01 .05 .10 LPI interpersonal chaos -.01 .02 -.13 -.06 .05 -.36 Externalizing problems .00 .04 .02 .04 .04 .18 Internalizing problems -.03 .03 -.27 .06 .05 .32 Parent early dropout 3.41* 1.32 .73 Parent late dropout 2.54* 1.17 .55 R2 .27 .17 .78* .14

Note. Criterion variables were dummy codes as compared to completers. Gender coded as 1 = male, 0 = female. Ethnicity dummy codes as compared to Caucasian youth. NSSI dummy coded as compared to no NSSI. Therapist transfer dummy coded as compared to no transfer. Parent dropout dummy coded as compared to completers. *p < .05.

78 the Behavior Therapist DROPOUT FROM DBT

Caucasian) and having a parent who tomatology (e.g., “LPI-confusions about dropped out at any time. These initial find- self”; “LPI-interpersonal chaos”) served as ings are in line with previous research find- a risk for dropout, with both early and late ings indicating that older adolescents and adolescent dropouts endorsing lower those of ethnic minority groups are more symptom severity compared to treatment likely to drop out of psychotherapy treat- completers. In contrast, the subscales of ment (de Haan et al., 2015; Nock & Kazdin, LPI-emotion dysregulation and LPI- 2001; Wierzbicki & Pekarik, 1993). The impulsivity were not a risk for dropout. finding that parental dropout was related Previous research has indicated that indi- to adolescent dropout, although not sur- viduals with higher levels of BPD sympto- Figure 1. Risk factors for dropout (non- prising, reinforces the notion that engaging matology are more likely to seek mental enrollment or non-completion DBT) vs. parents is critical in adolescent DBT treat- health treatment in general, often citing completion (completion DBT) ment. high comorbidity and elevated degrees of Further investigation into factors that functional impairment as contributing fac- differentiated those adolescents who tors (Tomko, Trull, Wood, & Sher, 2014). Linehan (2007) explicate strategies for dropped out early, dropped out late, or However, our finding suggests that specific obtaining commitment to therapy from completed treatment uncovered several BPD symptom profiles may be worth suicidal adolescents, they do not put forth a significant results. Supporting our initial exploring in understanding not only who findings, group comparisons indicated that seeks, but who completes, mental health framework by which to evaluate differen- adolescents who dropped out either early treatment. tial risk for treatment dropout in this pop- or late were older than their treatment To examine which variables were most ulation. Having knowledge of specific fac- completing counterparts. A possible expla- predictive of treatment dropout, we con- tors that contribute to dropout can aid nation for this finding is that older adoles- ducted logistic regressions for respective clinicians in identifying very early in the cents demonstrate more autonomy, treatment phases. Analyses showed that intake process which patients are most at whether granted or taken, with parents age was most predictive of adolescents risk for dropout and, subsequently, dedi- having less control over whether their child dropping out early, and parental dropout cate more time to using the commitment is attending treatment. However, perhaps was the strongest predictor of adolescents' strategies on those patients. The finding most interesting was that lower BPD symp- late dropout. Although Miller, Rathus, and that age is most predictive of dropout in the

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February • 2018 79 GERMÁN ET AL. early stages of DBT treatment suggests that treatment is greatly affected. The cumula- dict child treatment dropout. Journal of clinicians should draw upon additional tive risk model is yet another tool for DBT Clinical Psychology, 64(7), 891-904. commitment resources to engage and clinicians to utilize while working on com- de Haan, A.M., Boon, A.E., Vermeiren, retain older suicidal adolescents. Addition- mitment to therapy during the pretreat- R.R.J.M., Hoeve, M., & de Jong, J.T.V.M. ally, parental participation appears crucial ment phase. However, it should be noted (2015). Ethnic background, socioeco- in making sure adolescents complete DBT that several patients who had 3 or more risk nomic status, and problem severity as treatment. Child therapists often share factors were able to complete treatment. dropout risk factors in psychotherapy anecdotes of parents who resist participat- What makes these individuals different? with youth. Child & Youth Care Forum, 44, 1- 16. ing in therapy, in part, because the parents Future research may want to explore the perceive the problem as residing in the role of, and identify, specific protective fac- Erhardt, D., & Baker, B. L. (1990). The adolescent and may have other barriers tors that foster patient resilience and miti- effects of behavioral parent training on that are difficult to overcome (e.g., job families with young hyperactive children. gate treatment dropout. Journal of Behavior Therapy and Experi- schedule, transportation, etc.). Going for- mental Psychiatry, 21(2), 121-132. ward, therapists can cite this study’s results Limitations to parents to help motivate them to partic- This study has several limitations. It is Enders, C. K. (2010). Applied Missing Data Analysis. Methodology in the Social Sci- ipate in treatment, especially if the parents likely that other variables account for adolescent dropout from DBT treatment that ences Series. New York, NY: Guilford want their adolescent to complete the rec- Press. ommended course of DBT treatment. To were not measured, such as stigma against Hansen, N. B., Lambert, M. J., & Forman, better understand this link between mental health treatment. The community E. M. (2002). The psychotherapy dose- clinic from which the sample is drawn is parental participation in treatment and response effect and its implications for adolescent dropout rates, we suggest future located in an urban, predominantly low- treatment delivery services. Clinical Psy- research explore mechanisms that might income, majority Hispanic and African- chology: Science and Practice, 9(3), 329- explain this link in more detail. American sample that may have limited 343. The concept of cumulative risk is not generalizability to other groups. Last, Kazdin, A. E., Marciano, P. L., & Whitley, dissimilar to the idea of a tipping point or although this study identified two time M. K. (2005). The therapeutic alliance in threshold effect. Many individuals may points for dropout (early versus late) due to cognitive-behavioral treatment of chil- have 1 or more risk factors that slowly tip relatively low dropouts and the limited dren referred for oppositional, aggres- them towards a particular outcome, but it sample size, it would be helpful if future sive, and antisocial behavior. Journal of is not until these factors accumulate and studies could examine a midpoint for Consulting and Clinical Psychology, reach a tipping point that this outcome dropout (i.e., after 10 group sessions). This 73(4), 726. becomes reality. This model also recog- type of analysis could yield more practical Kazdin, A.E., Mazurick, J.L., & Bass, D. nizes that there is often no one singular clinical implications. Despite these limita- (1993). Risk for attrition in treatment for pathway to a particular outcome, like treat- tions, the study was longitudinal and antisocial children and families. Journal ment dropout (Kazdin, Mazurick, & Bass, examined dropout at two different time of Clinical Child Psychology, 22(1), 2-16. 1993). Our cumulative risk model included points, an important methodological dis- Kazdin, A. E., & Mazurick, J. L. (1994). 5 significant risk factors identified through tinction since the risk factors differed Dropping out of child psychotherapy: earlier statistical analyses. These risk fac- depending on timing of adolescent Distinguishing early and late dropouts tors were age, LPI-confusion about self, dropout. Future research should incorpo- over the course of treatment. Journal of Consulting and Clinical Psychology, LPI-interpersonal chaos, early parent rate attitudinal measures toward therapy as 62(5), 1069. dropout, and late parent dropout. In our a predictor and other family process vari- Kline, R. B. (1998). Software review: Soft- model if you were an adolescent who was ables that may shed light on the specific ware programs for structural equation 16 years or older, scored less than the 50th mechanisms that contribute to treatment percentile for confusion about self and modeling: Amos, EQS, and LISREL. dropout among adolescents. Journal of Psychoeducational Assessment, interpersonal chaos, and had a parent drop 16(4), 343-364. out, you were conceptualized as likely References being the most at risk. The max number of Lambert, M. (2007). Presidential address: What we have learned from a decade of risk factors assigned to an individual Achenbach, T. (1991). Manual for the Youth Self-Report and 1991 profile. research aimed at improving psychother- patient was 4 (because timing of parent apy outcome in routine care. Psychother- dropout being mutually exclusive). It is Burlington: University of Vermont Department of Psychiatry. apy Research, 17(1), 1-14. worth noting that every single patient who Little, R. J., & Rubin, D. B. (2014). Statisti- dropped out had at least one of the indi- Armbruster, P., & Fallon, T. (1994). Clini- cal, sociodemographic, and systems risk cal analysis with missing data. Hoboken, cated risk factors in the model. Although factors for attrition in a children's mental NJ: John Wiley & Sons. no significant differences were found in health clinic. American Journal of Martin, D. J., Garske, J. P., & Davis, M. K. mean number of risk factors between those Orthopsychiatry, 64(4), 577. (2000). Relation of the therapeutic adolescents who dropped out early and Barbe, R.P., Bridge, J., Birmaher, B., Kolko, alliance with outcome and other vari- those who completed treatment, there was D., & Brent, D.A. (2004). Suicidality and ables: a meta-analytic review. Journal of a significant finding for those who dropped its relationship to treatment outcome in Consulting and Clinical Psychology, out late as compared to the other two depressed adolescents. Suicide and Life- 68(3), 438. groups. Nearly 75% of adolescents who Threatening Behavior, 34(1), 44- 55. McFarland, B.R., & Klein, D.N. (2005). dropped out late had ≥3 risk factors, sug- Chasson, G. S., Vincent, J. P., & Harris, G. Mental health service use by patients gesting that once a patient exceeds 2 risk E. (2008). The use of symptom severity with dysthymic disorder: Treatment use factors their probability of completing measured just before termination to pre- and dropout in a 7 ½- year naturalistic

80 the Behavior Therapist follow- up study. Comprehensive Psychi- CLINICAL FORUM atry, 46, 246- 253. Mendlowitz, S. L., Manassis, K., Bradley, S., Scapillato, D., Miezitis, S., & Shaw, B. A Conversation With Steve Hayes and E. (1999). Cognitive‐behavioral group treatments in childhood anxiety disor- Stefan Hofmann About Process-Based CBT ders: the role of parental involvement. Journal of the American Academy of Child & Adolescent Psychiatry, 38(10), Joanna J. Arch, University of Colorado, Boulder 1223-1229. Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007). Dialectical behavior therapy with suicidal adolescents. New York, NY: THESAN DIEGO SUN is shining as I sit Steve describes how the inter-organiza- Guilford Press. together with Drs. Steve Hayes and Stefan tional task force report on CBT training Muthén, L. K., & Muthén, B. O. (1998- Hofmann in a quiet corner of the ABCT (Klepac et al., 2012) provided a founda- 2014). Mplus User's Guide. Seventh Edi- hotel lobby to discuss their new edited tion: tion. Los Angeles, CA: Muthén & book Process-Based CBT: The Science and Muthén : The ABCT-sponsored interorgani- Core Clinical Competencies of Cognitive STEVE zational task force on training in CBTs Nock, M.K., & Kazdin, A.E. (2001). Parent Behavioral Therapy (2018). expectancies for child therapy: Assess- brought in many different people and ment and relation to participation in organizations—and the resulting report treatment. Journal of Child & Family What inspired this collaborative said that we need to focus more on core Studies, 10(2), 155-180. project for the two of you, an unlikely competencies, basic principles, processes Pekarik, G., & Stephenson, L. A. (1988). couple? of change, and clarity about our philosoph- Adult and child client differences in therapy dropout research. Journal of STEFAN: We really wanted to move the field ical assumptions. We both agree with that Clinical Child Psychology, 17(4), 316- forward. We see empirically supported idea and as far as we know this is the first 321. treatment at a breaking point. We can only book that’s consciously organized around Rathus, J.H., Wagner, D.B., & Miller, A.L. advance behavior therapy by advancing the that ABCT report. (2005a). Self-report assessment of emo- processes. Most people would agree that tion dysregulation, impulsivity, interper- we’ve reached a saturation of protocol Tell me more about your process-based sonal difficulties, and identify confusion: treatments—treatment X for disorder Y. approach and why you are excited Validation of the Life Problems Inven- Process-based therapy is an attempt to free tory. Paper presented at the annual Asso- ourselves from the dictatorship of the DSM about it. ciation for Behavioral and Cognitive STEVE: I hope that a process-based Therapy, Washington, DC. and to find mechanisms that cut across disorders that ultimately allow us to group approach will help eliminate needless walls Schafer, J. L., & Graham, J. W. (2002). between the evidence-based psychothera- Missing data: our view of the state of the people in a more meaningful way. One way art. Psychological Methods, 7(2), 147. to move that forward is to identify the pies. But that is not all. I think it will help open up behavior science to go whenever it Tomko, R. L., Trull, T. J., Wood, P. K., & processes or mechanisms linked to a spe- Sher, K. J. (2014). Characteristics of bor- cific testable theory that can be empirically needs to go in the larger culture. It marries derline personality disorder in a commu- tested. ACT and CBT have much more in us up with some of the important changes nity sample: Comorbidity, treatment uti- common but we don’t yet fully understand that are happening socially and economi- lization, and general functioning. Journal the process by which these treatments cally, and orients us to the different of Personality Disorders, 28(5), 734-750. work. We need to identify and understand avenues we’re going to need to reach Wierzbicki, M., & Pekarik, G. (1993). A change processes and advance coherent people. meta-analysis of psychotherapy dropout. models that guide their use. The era of a 50-minute psychotherapy Professional Psychology: Research and hour is fading. We can’t afford it and it's Practice, 24(2), 190. STEVE: We became friends and also col- not how many people can or will receive leagues around our common interest in care in the future. We’ve built these gold- ... processes of change and moving the field plated Cadillacs—these monster techno- forward. The story of this book links to our logical protocols with 16 sessions and so The authors have no funding or conflicts of relationship in an interesting way because on—and now find we can’t drive them interest to disclose. we’ve had many discussions and disagree- down narrow country roads. A 15-minute Correspondence to Miguelina Germán, ments around what it means for accep- primary care consultation with a behavior Ph.D., Department of Pediatrics Behavioral tance, mindfulness, and values to come health specialist could be more powerful in into CBT and evidence-based care. When Health Integration Program, Montefiore turning around a problematic life trajec- we discovered that we both have an interest Medical Center/Albert Einstein College of tory. You can’t teach elaborate protocols in processes of change and in the deeper Medicine, Bronx, NY, 10467 for each disorder, and then deliver them issues involved, it became much easier for [email protected] with adherence. It’s not scalable. But if you our discussions to be progressive because can get intervention down to a limited and once you’re down to the level of process, coherent set of broadly applicable change it’s a lot easier to see connections. processes connected to trainable procedures, then you can nibble away at dissem-

February • 2018 81 ARCH ination and training, and find simpler ways approach like this applies broadly, across When did your collaboration begin? to move these processes. the various models and problem areas. STEVE: We’d been making intellectual What we’re hoping to do eventually is dis- progress for some time but a key moment STEFAN: We don’t think the change till down to successful mediators across all was when I was in Germany giving a talk processes we know about now will be the psychotherapies. five years ago to the German cognitive final number or content—there are proba- behavior therapy association and I fainted bly hierarchies of processes. These all need Do you think people are ready for a onstage shortly after the talk. I was stand- to be worked out. This is a work in ing one moment, and the next I was on my process- or dimension-based approach, progress. An evolution. back looking up at the ceiling. That night I when our minds tend to work categori- was having all of these cardiac symptoms STEVE: What I hope people will do if they’re cally? used to their particular model or set of and the organizers took me to the hospital. : Dimensional thinking is a chal- technologies is ask: What would it look like STEVE It turns out I had undiagnosed atrial fibril- if you took a process-based approach? lenge—we do need categories—but there lation. What are the key processes? What proce- are ways of getting to categories by means STEFAN: It was the emergency room and we dures move these processes? of dimensional thinking. Sets of processes that are self-amplifying can be delineated thought he wouldn’t make it. STEFAN: A process-based approach also as a category; dynamic patterns of change STEVE: Well, who’s sitting next to me by the invites laboratory-based research because it processes that predict outcomes can be a bed but my mean opponent, my “enemy” allows for a finer grade test of certain category. Stefan! He sat next to me and talked with assumptions of the processes—we all go care and kindness until 3 A.M.It showed back and do the hard work in the lab. This STEFAN: It’s like turning ice into water. Ice what kind of person he is, and when you is how science should be done. is a qualitatively different state yet you turn it [into water] by increasing temperature, experience something like that, you can’t STEVE: Early on behavior therapy had a which is dimensional. The state changes. quite go back. We still argued, but there more process focus but we were unable to was a bond there. It’s much easier to argue fully develop them, in part because we usefully with your friends, because you relied too much on the animal lab as the What was most challenging about doing know not to take disagreements personally. source of principles and processes, and as a this project together? You keep looking for common ground. field we became a bit too relaxed or even STEFAN: I think you have to have slightly Who knows how many of our “opponents” lazy about where new “high precision / different views on a matter in order to and “enemies” are actually our friends, just high scope” principles would come from. make it an enriching experience. If you a fraction of an inch away. It’s probably Then the process focus got washed away speak the same language all the time you true even when we get outside of CBT—the with federal money that required linking can’t learn anything new. We fought our psychodynamic and humanistic people syndromes to particular treatment pack- battles and then we moved beyond the and so on are just friends we haven’t made ages, defined technologically. RCTs are fine struggle and tried to figure out: What do we yet! as far as they go, but unless you look at both want? What do we have in common? : This was a critical turning point for mediators and moderators we’re left with STEFAN How do we work together? It’s not that we me as well. Another was when I went to an very crude conclusions: use this protocol. agree on every aspect on the philosophical ACT conference. Initially I thought they All of it, always? For everyone with that set level but I’ve learned a lot and we have were just nutcases, but by the end I really of symptoms? What do you do about become very good friends. did appreciate they speak a different lan- comorbidity? How do you deal with diffi- guage and have different assumptions. culties in implementing these manuals in STEVE: When you understand that there are particular systems of care? What about the differences in philosophical assumptions, STEVE: I remember being surprised by that a fact that most people only come for 2 or 3 it’s not something you need to argue about. bit later. At ABCT someone was arguing sessions? How can you make clinicians It’s more like: let’s just understand them with me quite forcefully about an issue follow a manual, and is it even wise to seek and then use these different points of per- between ACT and mainstream CBT and that? The whole model was off. spective to move these issues forward. I Stefan steps in and says to the other person, reached a key point in our relationship of : We don’t think these change “You don’t understand. These people have STEFAN seeing how flexible and serious Stefan was processes are isolated and independent— very different philosophical assumptions,” as a colleague. Now when we have dis- they’re probably all linked. We’ll identify and he proceeds to explain contextualism agreements, we can go down to the level of that in the future. For now, let’s identify to the guy. My jaw dropped slightly— assumptions and try to take the perspective some of the main processes and move Stefan had taken the issue seriously, and of the other person. That can help us to people toward valued living. he’d read and thought about it. That come back out with data—not testing our moment showed me how flexible and seri- STEVE: I am really comfortable with the assumptions (those are pre-analytic) but ous he was and substantively, if we under- approach and I do have to say that the ACT moving the practical issue forward. As an stand each other’s assumptions, it’s a lot and ACBS [the Association for Contextual applied science, we have the great advan- easier to work together and respect each Behavioral Science, the group primarily tage of a common goal—to help people— other even when we disagree. That’s one guiding the development of ACT] commu- and we can look at the data from that angle reason the task force called on the field to nity has had a process-focus for a long regardless of differences in assumptions. teach students more about their philosoph- while. Stefan and I got interested in how an ical assumptions.

82 the Behavior Therapist SINGLE- CASE STUDY

Who is the book’s intended audience? to help us work together to improve the 3 sections, the book chapters range from STEFAN: We’ve aimed at a very large audi- lives of those we serve. There is no reason establishing a scientific and practical foun- ence. We want students to learn it, practi- to worry about who is wrong: We’re all dation for process-based CBT (Part 1) to tioners to learn it. We’re targeting clinical wrong. Let’s just find out where we’re describing core CBT processes that cut programs with the hope that they will wrong more quickly and move the field across protocols (Part 2) to articulating and incorporate a process-based focus into forward. illustrating numerous specific therapeutic their training. We’re building it up—we’re procedures and processes (Part 3). producing a library of web-based video STEFAN: It’s not to say I’ve become an ACT clips that illustrate certain techniques and guy—Steve has not become a mainstream References ideas in the book. CBT guy either. We’re just two human beings connecting on a different level and Hayes, S. C., & Hofmann, S. G. (2018). STEVE: First and foremost, we hope that the with a little effort we’ll both move closer to Process-based CBT: The science and core book will be used in classes on CBT, but the the truth. clinical competencies of cognitive behav- book itself is evolutionary, not revolution- ioral therapy. Oakland, CA: New Harbin- ger. ary. The goal is to help move the field, but —— the field itself will decide how fast and how Klepac, R. K., Ronan, G. F., Andrasik, F., far. I think as we move down this process- As the conversation wraps up and we look Arnold, K. D., Belar, C. D., Berry, S. L., ... Dowd, E. T. (2012). Guidelines for cogni- based route, we’ll be able to modularize the forward to a busy day at the conference, I tive behavioral training within doctoral field so that it simplifies our training and cannot help but recall a decade earlier psychology programs in the United dissemination tasks. As we learn what when the rooms of ABCT were filled with passionate debate between the two men sit- States: Report of the Inter-organizational amounts to new ways of doing functional Task Force on Cognitive and Behavioral analysis, it will make it easier to fit evi- ting before me and numerous others. For those of us who shared or witnessed those Psychology Doctoral Education. Behav- dence-based care to the individual people ior Therapy, 43, 687-697. we’re trying to help. debates, the significance of their friendship and collaboration marks what I hope is becoming a more unified push forward for ... Last Word the sake of those who need us to reach The author has no funding or conflicts of STEVE: The fact that we’ve become friends them with our collective work. interest to disclose. and colleagues tells in microcosm a story The edited volume that forms the basis that might be able to be expanded out to all of our conversation, Process-Based CBT: Correspondence to Joanna J. Arch, Ph.D., forms of evidence-based care. Based on The Science and Core Clinical Competencies University of Colorado, Boulder, 345 UCB mutual respect and concern for evidence, of Cognitive Behavioral Therapy (2018), is Muenzinger, Office 313B, Boulder, CO we can use a focus on processes of change published by New Harbinger. Divided into 80309-0345; [email protected]

RESEARCH-PRACTICE hypothesis-generation; for example, it can provide a bit of evidence to support a hypothesis about a change mechanism in Publishing a Single-Case Study treatment or a novel intervention that can prompt replication studies and group stud- Jacqueline B. Persons, Cognitive Behavior Therapy and Science Center, ies. Finally, the publication of a single-case Oakland, CA, and University of California at Berkeley study serves a professional development function, in that it offers a route for clini- Alexandra S. Jensen, Cognitive Behavior Therapy and Science Center, cians, who often do creative and innovative Oakland, CA work, to disseminate their findings to fellow clinicians and to the scientific community. In so doing, clinicians can help not WHYWRITE UP AND PUBLISH a report of a example, an ABAB design can show quite just the patients they treat, but many single case? Data from a single case can convincingly that a particular intervention others. As readers of the Behavior Therapist contribute to the literature in situations in (B) causes behavior change that is not pre- likely know, the study of a single case has a which a randomized controlled trial or sent in the A (baseline condition or condi- long and important tradition in behavior other group study is infeasible. An example tion in which B is withdrawn). (Of course, therapy (see chapter 9 of Hayes, Barlow, & is the study of a rare condition or of an an ABAB design is not always practical, as innovative and promising intervention that in cases when the intervention [B] involves Nelson-Gray, 1999, for an inspiring discus- has not yet been studied systematically in a teaching skills that are not unlearned when sion of this topic). group study. In addition, single-case data, the intervention is withdrawn. In this case, Our goal in this article is to help stu- when collected systematically in a con- the investigator might instead choose a dents, clinicians, and researchers write up trolled and carefully designed single-case multiple baseline or other design; see a case report for publication. We briefly experimental design (see Barlow, Nock, & Barlow et al., 2009; Kazdin, 2011.) discuss three topics: selecting a case, Hersen, 2009; Kazdin, 2011), can provide The single-case study can also play an addressing ethical issues, and finding a strong tests of causal hypotheses. For important role in the scientific task of publication outlet.

February • 2018 83 Table 1. Peer-Reviewed Journals that Publish Single Case Designs

Relevant Submission Information Journal Impact Recent Publications Factora Provided by the Editor

Depression and Anxietyb 4.971 “The journal publishes only two types of Jiménez Chafey, M. I., Bernal, G., articles: original Research Papers and & Rosselló, J. (2009). Clinical case Reviews. A priority is placed on treat- study: CBT for depression in a ment and review papers, and on papers Puerto Rican adolescent: chal- with information and findings that will lenges and variability in treat- enhance the clinical evaluation and care ment response. Depression and of individuals struggling with the effects Anxiety, 26(1), 98-103. of these disorders.”

Journal of Consulting and Clinical Psychology b, c 4.593 “JCCP also considers methodologically Boswell, J. F., Anderson, L. M., & sound single-case designs (e.g., that con- Barlow, D. H. (2014). An idio- form to the recommendations outlined in graphic analysis of change the "What Works Clearinghouse (WWC) processes in the unified transdi- Single-Case Design" paper).” Reference: agnostic treatment of depression. Kratochwill, T. R., Hitchcock, J., Horner, Journal of Consulting and Clinical R. H., Levin, J. R., Odom, S. L., Rindskopf, Psychology, 82(6), 1060-1071. D. M. & Shadish, W. R. (2010). Single- case designs technical documentation. Retrieved from What Works Clearinghouse website: http://ies.ed.gov/ncee/wwc/pdf/ wwc_scd.pdf Bryant, R. A., & Das, P. (2012). Journal of Abnormal Psychologyc 4.133 “Case Studies from either a clinical setting The neural circuitry of conversion or a laboratory will be considered if they disorder and its recovery. Journal raise or illustrate important questions that of Abnormal Psychology, 121(1), go beyond the single case and have 289. heuristic value. Empirically-based papers are strongly preferred.” Challacombe, F. L., & Salkovskis, Behaviour Research and Therapyc 4.064 “The following types of submissions are P. M. (2011). Intensive cognitive- encouraged: theoretical reviews of mecha- behavioural treatment for women nisms that contribute to psychopathology with postnatal obsessive-compul- and that offer new treatment targets; tests sive disorder: A consecutive case of novel, mechanistically focused psycho- series. Behaviour Research and logical interventions, especially ones that Therapy, 49(6), 422-426. include theory-driven or experimentally- derived predictors, moderators and mediators; and innovations in dissemination and implementation of evidence-based practices into clinical practice in psychology and associated fields, especially those that target underlying mechanisms or focus on novel approaches to treatment delivery.”

Note. aJournals are presented in decreasing order of impact factor as reported on journal website. bThis journal publishes case series more frequently than single case studies. cThis journal rarely publishes single case designs.

84 the Behavior Therapist (Table 1, continued)

Relevant Submission Information Journal Impact Recent Publications Factora Provided by the Editor

Behavior Therapyc 3.434 “Although the major emphasis is placed Willson, R., Veale, D., & upon empirical research, methodological Freeston, M. (2016). Imagery and theoretical papers as well as evalua- rescripting for body dysmorphic tive reviews of the literature will also be disorder: A multiple-baseline sin- published. Controlled single-case designs gle-case experimental design. and clinical replication series are wel- Behavior Therapy, 47(2), 248-261. come.”

Psychotherapy 2.573 “Directly related to the main aims of this Arco, L. (2015). A case study in Journal we also encourage submission of treating chronic comorbid obses- … Evidence-Based Case Studies that inte- sive–compulsive disorder and grate verbatim clinical case material with depression with behavioral acti- standardized measures of process and vation and pharmacotherapy. outcome evaluated at different times Psychotherapy, 52(2), 278-286. across treatment. In particular, http://www.apa.org/pubs/journals/pst/evidence-based-case-study.aspx calls for evidence-based case studies as part of the journal’s special series. The specific guidelines listed are found at http://www.apa.org/pubs/journals/pst/ evidence-based-case-study.aspx.

Psychotherapy Research 2.570 “The journal is committed to promoting Dillon, A., Timulak, L., & international communication by address- Greenberg, L. S. (2016). ing an international, interdisciplinary Transforming core emotional audience, and welcomes submissions pain in a course of emotion- dealing with: focused therapy for depression: -diverse theoretical orientations (e.g., psy- A case study. Psychotherapy chodynamic, cognitive, behavioral, Research, 1-17. humanistic, experiential, systems approaches) -treatment modalities (e.g., individual, group, couples, family) -research paradigms (e.g., quantitative, qualitative, clinical trials, process studies, outcome prediction, systematic case studies, measure development, meta-analyses)”

Cognitive and Behavioral Practice 2.537 “Cognitive and Behavioral Practice pub- Paulus, D. J., & Norton, P. J. lishes clinically rich accounts of innova- (2016). Purging anxiety: A case tive assessment and therapeutic proce- study of transdignostic CBT for a dures that are clearly grounded in evi- complex fear of vomiting (emeto- dence-based practice. The primary focus phobia). Cognitive and Behavioral is on application and implementation of Practice, 23(2), 230-238. procedures. Accordingly, topics are selected to address current challenges facing practitioners, both in terms of technique, process, and the content of treatment. To meet this goal, articles may include rich descriptions of clinical interventions, examples of client-therapist dialog, embedded video clips readers can view on line, and/or significant case descriptions.”

February • 2018 85 (Table 1, continued)

Relevant Submission Information Journal Impact Recent Publications Factora Provided by the Editor

Clinical Psychology: 2.38 “Clinical Psychology: Science and Practice Wendland, J., Brisson, J., Science and Practice presents cutting-edge developments in the Medeiros, M., Camon‐Sénéchal, science and practice of clinical psychology L., Aidane, E., David, M., ... & by publishing scholarly topical reviews of Rabain, D. (2014). Mothers with research, theory, and application to borderline personality disorder: diverse areas of the field, including assess- Transition to parenthood, par- ment, intervention, service delivery, and ent–infant interaction, and pre- professional issues.” ventive/therapeutic approach. Clinical Psychology: Science and Frontiers in Psychology Practice, 21(2), 139-153.d (Clinical Settings) 2.323 “Case Reports are reports on human or Johnson, S. U., & Hoffart, A. animal patients having particular clinical (2016). Metacognitive therapy for course, diagnostic work-up, unexpected comorbid anxiety disorders: A diagnosis, or treatment outcomes that are Case Study. Frontiers in of relevance for clinical practice and med- Psychology, 7(1515). ical teaching. Case Reports must include a brief introduction that provides appropriate context for the case, and a case presentation that includes: age, sex and occu- pation of the patient, presenting symptoms, the patient’s history and any relevant family or social history, and relevant clinical findings. This should be followed by a description of laboratory investigations and diagnostic tests. Authors should provide explanations for any differential diagnosis, final diagnoses, treatment, and also comment on the progress of disease and/or treatment. The report should con- clude with a short discussion of the underlying pathophysiology and the nov- elty or significance of the case.”

Journal of Clinical Psychology 2.123 “The Journal includes research studies; Wu, M. S., & Storch, E. A. (2016). articles on contemporary professional A case report of harm-related issues, single case research; brief reports obsessions in pediatric obsessive- (including dissertations in brief); notes compulsive disorder. Journal of from the field; and news and notes.” Clinical Psychology, 72(11), 1120- 1128.

Clinical Psychology and 1.933 “Clinical Psychology & Psychotherapy Ferreira, J. F., Vasco, A. B., Psychotherapy aims to keep clinical psychologists and Basseches, M., Santos, A., & psychotherapists up to date with new Ferreira, J. M. (2016). Exploring developments in their fields. The Journal phase progression throughout the will provide an integrative impetus both therapeutic process: The case of between theory and practice and between Eva. Clinical Psychology & different orientations within clinical psy- Psychotherapy, 23, 407-426. chology and psychotherapy. Clinical Psychology & Psychotherapy will be a forum in which practitioners can present their wealth of expertise and innovations in order to make these available to a wider audience. Equally, the Journal will contain Note. aJournals are presented in decreasing reports from researchers who want to order of impact factor as reported on journal address a larger clinical audience with website. bThis journal publishes case series clinically relevant issues and clinically more frequently than single case studies. cThis valid research.” journal rarely publishes single case designs.

86 the Behavior Therapist (Table 1, continued)

Relevant Submission Information Journal Impact Recent Publications Factora Provided by the Editor

Journal of Applied Behavior 0.914 “Innovative pilot work, replications, and DeRosa, N. M., Roane, H. S., Analysis controlled case studies will be considered Bishop, J. R., & Silkowski, E. L. for publication as Reports. Reports will be (2016). The combined effects of judged according to the following criteria: noncontingent reinforcement and (a) The subject matter has applied signifi- punishment on the reduction of cance, (b) the information necessary to rumination. Journal of Applied replicate the procedures is contained in Behavior Analysis, 49(3), 680-685. the report, and (c) the data collection and analysis permit reasonable conclusions about the phenomenon.”

Clinical Case Studies 0.523 The journal is devoted solely to case stud- Babinski, D. E., & Nene, N. V. ies and “seeks manuscripts that articulate (2016). Persistent family stress in various theoretical frameworks (behav- the course of cognitive-behavioral ioral, cognitive-behavioral, gestalt, therapy for a 7-year-old girl with humanistic, psychodynamic, rational- social anxiety disorder. Clinical emotive therapy, and others). All manu- Case Studies, 15(4), 263-279. scripts will require an abstract and must adhere to the following format: (1) Theoretical and Research Basis, (2) Case Introduction, (3) Presenting Complaints, (4) History, (5) Assessment, (6) Case Conceptualization (this is where the clinician’s thinking and treatment selection come to the forefront), (7) Course of Treatment and Assessment of Progress, (8) Complicating Factors (including medical management), (9) Access and Barriers to Care, (10) Follow-up (how and how long), (11) Treatment Implications of the Case, (12) Recommendations to Clinicians and Students, and References.”

Pragmatic Case Studies in unrated “We seek manuscripts in the areas of Cohen, R. (2016). Getting into Psychotherapy individual case studies; multiple case the ACT with psychoanalytic studies; analytical or critical comparative therapy: The case of “Daniel.” reviews of previously published case stud- Pragmatic Case Studies in ies, particularly those that have been pub- Psychotherapy, 12(5), 1-30. lished in PCSP; and case study method. A manuscript can cover either one case or a series of cases of a particular type. All cases have to be described in systematic, qualitative detail. Client scores on standardized, quantitative measures at the beginning, during, end, and follow-up of therapy are highly desirable where feasible and consistent with the theoretical approach employed. Such scores norma- tively contextualize a case.”

February • 2018 87 PERSONS & JENSEN

Selecting a Case Ethical and Privacy Issues it is possible. To guide your search to publish, we provide in Table 1 a list of peer- To identify a case that you can write up Unless the data were collected via fed- reviewed empirical clinical psychology and submit for publication, we offer a list eral funding or you are a faculty person or research journals that have recently pub- of questions that might yield an idea about student at a university, a review of your lished single-case studies, including uncon- a case to study: Have I successfully treated a report by a formally constituted institu- trolled case reports and tightly controlled patient who had problems for which no tional review board is likely not needed. single-case experimental designs. The table empirically supported treatment is avail- However, you may want to conduct an provides, for each journal, the impact able? Have I devised an innovative treat- informal review, inviting a colleague or two factor, pertinent submission information ment that has been helpful to one or more to review your treatment and writeup, and from the journal’s editors, and the citation patients? Have I applied a well-known documenting the results of this process. It for a recently published example. Smith treatment to a new problem or disorder is a good idea to consult the ethical princi- (2012) also provides information about with good results? Have I successfully used ples of your professional association and journals that publish single-case experi- an empirically supported treatment with a use them to guide your treatment, data col- mental designs. patient who had characteristics (e.g., non- lection, and writeup, in order to protect The table lists peer-reviewed journals. White race or ethnicity, transsexual, blind, your patient’s interests and privacy, and to However, the practitioner can also con- deaf) not represented in the randomized protect yourself from ethical errors. It can sider submitting his or her case to a profes- controlled trials of that treatment? Have I also be helpful to consult with your mal- sional association newsletter like the treated a patient and simultaneously mon- practice insurance company, which will be Behavior Therapist (e.g., Persons, 1990). itored symptoms and the psychological happy to offer guidance that can protect For ABCT members, publishing in tBT is a mechanisms I viewed as causing the symp- you, your patient, and your practice from gratifying way of contributing to our own toms, so that I learned something about harm. professional community. It’s also a great relationships between interventions, To protect your patient’s privacy, you way for students and clinicians to take a changes in psychological mechanisms, and will want to disguise details of your first step toward sharing with a larger pro- changes in symptoms over time? (e.g., patient’s identity, doing this in a way that fessional community what they are learn- Boswell, Anderson, & Barlow, 2014; preserves the integrity of the scientific or ing from their work with their patients. Brown, Bosley, & Persons, 2017). Do I have clinical contribution of the material. Don’t long-term follow-up data from any of my forget to disguise the clinical material so patients? In all of these types of situa- that even the patient described cannot rec- References tions—and others not listed here—a write- ognize it. It is also ideal to obtain your Barlow, D. H., Nock, M. K., & Hersen, M. up of the case can make a contribution to patient’s written permission to publish the (2009). Single case experimental designs: the field. It’s useful to select a patient who material and to give the manuscript to the Strategies for studying behavior change had a good response to treatment. In gen- patient to review before you submit it. (3rd ed.). Boston: Pearson Education, eral, I assume that if the patient had a poor Sometimes the demands of science and Inc. outcome, there must be something I don’t good care conflict. For example, the clini- Boswell, J. F., Anderson, L. M., & Barlow, understand about the case. However, even cian wanting to use an ABAB design must D. H. (2014). An idiographic analysis of change processes in the unified transdi- failure can be informative (see Dimidijan & withdraw an intervention that has been helpful to the patient. Transparency is a key agnostic treatment of depression. Journal Hollon, 2011). A particularly informative of Consulting and Clinical Psychology, case is the patient whose initial outcome piece of the solution to this dilemma. I have often found that if I want to do something 82(6), 1060-1071. doi:10.1037/a0037403 was poor but ultimate outcome was good Brown, C., Bosley, H., & Persons, J. B. (e.g., Persons, Beckner, & Tompkins, in treatment, such as withdraw an intervention in order to learn something that (2017). Changes in need for control and 2013). perfectionism predicted reductions in can contribute to science, that my patient, To publish a case report, the clinician anger during CBT: A single case study. must have some data. The quality of the if fully informed, is quite willing to do it, Paper presented at the Anxiety and data and the design of a case report can especially if we can find a way to do it that Depression Association of America, San vary widely, from an informal report with is not unduly burdensome to him or her. Francisco, CA. little or poor quality data, to a carefully Patients are often quite generous and eager Dimidijan, S., & Hollon, S. D. (2011). controlled study that meets high standards to contribute to science and to the reduc- What can be learned when empirically for a single-case design, as described in tion of others’ suffering. (And a treatment supported treatments fail? Cognitive and withdrawal, while uncomfortable, can yield Kratochwill et al. (2010) and Smith (2012). Behavioral Practice, 18(3), 303-305. useful information that can provide some One of us published (Persons & Mikami, Hayes, S. C., Barlow, D. H., & Nelson- long-term benefit for the patient.) A con- 2002) a case of hypochondriasis where the Gray, R. O. (1999). The scientist-practi- sultation with a colleague to be sure you are tioner: Research and accountability in the main data were simply a verbal report from carefully considering all of the ethical age of managed care (2nd ed.). Boston, the patient at every session about how issues is especially important in this type of MA: Allyn and Bacon. many flare-ups of hypochondriasis symp- situation. Kazdin, A. E. (2011). Single-case research toms he had had during the previous week! designs: Methods for clinical and applied If you find that when you go into your Finding a Publication Outlet settings (2nd ed.). New York, NY: Oxford records, you do not have the data you need University Press. to write a publishable report, you can begin Group designs are the current domi- Kratochwill, T. R., Hitchcock, J., Horner, collecting more systematic progress moni- nant research method in clinical psychol- R. H., Levin, J. R., Odom, S. L., Rind- toring data in your practice with a view to ogy. Finding a publication that will publish skopf, D. M., & Shadish, W. R. (2010). the future publication of a case. a single-case study can seem daunting, but Single-case designs technical documenta-

88 the Behavior Therapist ONLINE PREVENTION COURSE

tion. Retrieved from http://ies.ed.gov/ Smith, J. D. (2012). Single-case experi- ncee/wwc/pdf/wwc_scd.pdf mental designs: A systematic review of Persons, J. B. (1990). Disputing irrational published research and current stan- thoughts can be avoidance behavior: A dards. Psychological Methods, 17(4), 510- case report. the Behavior Therapist, 13, 550. doi:10.1037/a0029312 132-133. Persons, J. B., Beckner, V. L., & Tompkins, ... M. A. (2013). Testing case formulation hypotheses in psychotherapy: Two case The authors have no funding or conflicts of examples. Cognitive and Behavioral Prac- interest to disclose. tice, 20(4), 399-409. Persons, J. B., & Mikami, A. Y. (2002). Correspondence to Jacqueline B. Persons, Strategies for handling treatment failure Ph.D., Cognitive Behavior Therapy and in DC successfully. Psychotherapy: Science Center, 5625 College Ave Ste 215, Theory/Research/Practice/Training, 39, Oakland, CA 94618-1590; 52nd Annual Convention 139-151. doi:10.1037/0033-3204.39.2.139 [email protected] November 15–18, 2018

TECHNOLOGY attention (National Research Council and Institute of Medicine, 2009). In fact, the development of effective preventive inter- emotions101: Development of an Online ventions for common mental disorders was recently declared one of four main priority Prevention Course for College Students Based areas by the National Institute of Mental Health Strategic Plan for Research on the Unified Protocol (National Institute of Mental Health, 2015). Studies in line with this priority have Julianne Wilner, Keara Russell, and Shannon Sauer-Zavala, begun to bear fruit, suggesting that preven- Center for Anxiety and Related Disorders at Boston University, tion programs are efficacious for reducing subclinical symptoms or vulnerability fac- Boston University tors in younger populations (e.g., Chris- tensen, Pallister, Smale, Hickie, & Calear, 2010; Fisak, Richard, & Mann, 2011; Stice, SINCE THEMID-1990S, in a trend dubbed rate over five times faster than that the uni- Shaw, Bohon, Marti, & Rohde, 2009; Stock- “the crisis on campus,” rates of mental dis- versity’s total student enrollment and ings et al., 2016) within school, commu- orders among young adults in university posing significant problems for accommo- nity, and clinical settings (e.g., Bennett et settings have continued to escalate (Center dating students in need of services (Center al., 2015). for Collegiate Mental Health, 2016; Eiser, for Collegiate Mental Health, 2016). This While such interventions are promis- 2011). Indeed, in a recent cross-national lack of care, due to a combination of ing, there remain several limitations. First, study, the World Health Organization delayed help-seeking (Wang, 2007) and the majority of studies have been limited to found that over one in five college students limited on-campus resources (Mowbray et child and adolescent populations (Danitz met criteria for a Diagnostic and Statistical al., 2006), is problematic as untreated anx- & Orsillo, 2014; Seligman, Schulman, & Manual of Mental Disorders/Composite iety and depressive disorders are associated Tryon, 2007), resulting in a need for pro- International Diagnostic Interview disorder with high rates of comorbidity (e.g., grams that buffer against mental disorders within the past year (Auerbach et al., 2016), Brown, Campbell, Lehman, Grisham, & in young adults. Because of the unique with anxiety and mood disorders as most Mancill, 2001), mortality (e.g., Walker, developmental and social stressors associ- common. Unfortunately, despite high McGee, & Druss, 2015), and economic ated with transitioning roles, responsibili- prevalence rates and known stressors, only burden (Kessler, Petukhova, Sampson, ties, and life situations (e.g., Arnett, 2000; a small proportion of students experienc- Zaslavsky, & Wittchen, 2012; Konnopka, Schulenberg, Bryant, & O’Malley, 2004; ing mental health difficulties receive treat- Leichsenring, Leibing, & König, 2009). Schulenberg, Sameroff, & Cicchetti, 2004), ment (Auerbach et al.). Furthermore, among college students, anx- this population (e.g., college-aged stu- From 2010 to 2015 alone, a recent study iety and depression are associated with dents) is at elevated risk for developing found a 6% increase in the percentage of risky behaviors like substance use (Potter, anxiety and depressive disorders (e.g. college students seeking treatment for anx- Galbraith, Jensen, Morrison, & Heimberg, Kessler et al., 2005, 2007). Students with a iety-related concerns, and a 3% increase in 2016), eating disorders (e.g., Eisenberg, mental disorder diagnosis prior to matricu- treatment-seeking for depression (Barr, Nicklett, Roeder, & Kirz, 2011), diminished lating are less likely enter college following Rando, Krylowicz, & Reetz, 2010; Reetz, academic achievement, and lower gradua- acceptance and more likely to drop out Krylowicz, Bershad, Lawrence, & Mistler, tion rates (American College Health Asso- (Auerbach et al., 2016). Thus, incorporat- 2015). In an extreme example of this trend, ciation, 2011). ing interventions within university settings one college counseling center reported a Given these concerns, interventions may be ideal for reaching a large number of 30% increase in treatment-seeking stu- that may prevent mental disorders before at-risk individuals (Danitz & Orsillo, dents during a 6-year period, growing at a they fully emerge have received increased 2014). Second, existing preventive inter-

February • 2018 89 WILNER ET AL. ventions are typically adapted from tradi- Boston University (BU) undergraduates, leader-facilitated, in-person workshop; tional cognitive-behavioral frameworks for compared to an assessment-only condition most notably, online delivery has the clinical disorders that, despite being effec- (Unified Protocol for Prevention [UP-P]; potential to reach a greater number of indi- tive, are time-intensive and resource- (Bentley, Boettcher, et al., 2017). The goal viduals than traditional, live courses that heavy. The populations that preventive of the UP-P, which was presented as an are limited by the number of trained programs are intended for may not require “emotion management workshop,” was to providers and capacity constraints (e.g., a full dose of such interventions (e.g., 8–12 provide students with skills to respond provider/patient ratios, facility size). This sessions; Fisak et al., 2011), and meta-ana- adaptively to their emotional experiences aided our decision to move forward with lytic research suggests that briefer inter- in order to reduce their vulnerability for an online format as a next step, as the pilot ventions may have the same or, in some developing anxiety or depressive disorders. study evidenced difficulties with atten- cases, greater effects than longer ones The workshop, which was delivered via dance and attrition, and a greater number (Christensen et al., 2010; Fisak et al.; Stice et PowerPoint slides, didactic verbal material, of participants would allow for meaningful al., 2009; Stockings et al., 2016). Third, a and interactive discussion, consisted of comparisons across groups. major obstacle to dissemination of existing four treatment modules distilled from the At the time of writing, this course is prevention programs is that most tend to full UP intervention. Each module con- being offered to incoming BU freshman as target specific disorder areas (e.g., anxiety, sisted of an experiential practice exercise part of a research opportunity. Our team depression, substance use, eating disorders; (e.g., breaking down an emotion into spent the past year gaining institutional Black Becker, Smith, & Ciao, 2006; Dener- thoughts, physical feelings and behaviors, support from the university to create the ing & Spear, 2012); this specificity means engaging in a brief mindfulness exercise) course, working with various departments that a multitude of individual programs and utilized examples of particular rele- to develop it, and designing research meth- must be provided to address these related vance to undergraduate students (e.g., aca- ods to best assess course feasibility and and co-occurring disorder areas, which is demic pressure, comparisons to others on accessibility. The goals of the present article prohibitive and costly. An alternative, and social media). are to offer commentary on the above- perhaps more efficient, approach is to Complete results from the workshop mentioned processes, as they have been target underlying vulnerabilities that put have been described in detail elsewhere (see valuable learning experiences for our an individual at risk to develop a range of Bentley, Boettcher, et al., 2017). In general, group. We hope that others may benefit psychological difficulties. feedback on the workshops (n = 45) was from learning from our experience—chal- The Unified Protocol (UP) for Transdi- very favorable overall, and participants lenges that we have faced at various stages, agnostic Treatment of Emotional Disor- rated the workshops as highly acceptable and efforts to address such limitations to ders (Barlow et al., 2011) is a cognitive- on average, with 82% of participants rating help make a difference for students making behavioral intervention that was developed the workshop content as “very acceptable” the often difficult transition to college. to directly address core vulnerabilities in or “extremely acceptable.” Participants individuals diagnosed with anxiety, reported high satisfaction with workshop Gaining Institutional Support depressive, and related disorders. The UP content; specifically, 69% indicated that has demonstrated efficacy in treating anxi- they were “very satisfied” or “extremely sat- Obtaining Administrative and ety across a number of trials to date (e.g., isfied.” Approximately 40% of workshop Financial Support Ellard, Fairholme, Boisseau, Farchione, & participants accessed electronic copies of The first step in translating our brief, Barlow, 2010; Farchione et al., 2012), workshop materials via the online Black- preventive version of the UP to an online including a large randomized controlled board course after the workshop. In addi- format was to secure the financial equivalence trial, in which the transdiag- tion, 50% of participants elected to receive resources necessary to build the course. nostic UP approach was observed to be just reminders via email to continue practice of Given that our pilot project focused on col- as effective as more targeted approaches for skills. At both 1- and 3-month follow-up lege student mental health, we elected to single anxiety disorders (Barlow et al., assessments, participants indicated that, on explore funding options within our own 2017). There is also initial evidence to sup- average, they used workshop skills to institution, BU. First, we approached BU’s port the efficacy of the UP in treating manage emotional experiences between Digital Learning Initiative (DLI), an on- depression (e.g., Boswell, Anderson, & “some of the time” and “most of the time.” campus department committed to using Barlow, 2014) and other related conditions Statistically significant, small effects on the technology to enhance learning experi- such as PTSD (Gallagher, 2017), alcohol tendency to experience negative emotions, ences for BU students. In initial communi- use (Ciraulo et al., 2013), borderline per- quality of life, and avoidance of emotions cation, we described the rationale for a sonality disorder (BPD; Sauer-Zavala, (all in the expected direction) were transdiagnostic prevention program, the Bentley, & Wilner, 2016), and nonsuicidal observed in the workshop condition from results of our pilot project, and our desire self-injury (Bentley, Sauer-Zavala, et al., baseline to 1-month follow-up (Bentley et to increase the program’s reach via moving 2017). al., 2017). to an online platform. Unfortunately, the Given the UP’s focus on vulnerability Given the strong theoretical rationale DLI’s director indicated that our goals were factors that lead to depressive and anxiety for an emotion-focused (rather than symp- not a good fit for their department, but sug- symptoms, as well as its emphasis on adap- tom-focused) preventive intervention for gested that we contact BU’s Office of Dis- tive emotion management (a universally mental illness in college students, along tance Education (DE). applicable topic), this intervention is well- with promising pilot data for our live, UP- The mission of DE is to create flexible, suited for adaptation in a prevention con- based “emotion management” workshop, engaging online courses and certificate text. As such, our research team developed we sought to adapt this program for online programs for BU’s academic departments. a single-session, 2-hour workshop that was delivery. A self-paced, stand-alone, online We scheduled a meeting in which we based on the UP and pilot tested it with 45 course has a number of advantages over a described our goals and presented materi-

90 the Behavior Therapist ONLINE PREVENTION COURSE als from our live workshop. DE staff BU’s DLI, we elected to follow up with the to BU students and thus very difficult to showed us examples of courses they had director of this office, despite prior feed- transfer to other settings. The lack of ability previously built and it quickly became clear back that our project was not a good match to disseminate our program is an obvious that they would be able to execute an online with their goals. In this correspondence, we disadvantage to institutional funding and adaptation of our program. Understand- noted that BU’s administration was in sup- in-house course development. However, ably, their services came at a cost and, with- port of our project and that our work actu- we reasoned that we would be able to col- out a funding source, we would not be able ally fit well within one of their strategic lect strong pilot data to support a future to engage them. The director of DE sug- goals: to enhance BU students’ overall funding proposal (e.g., small business gested that we seek broad institutional sup- experience while on campus. We were innovation research application). Addi- port via reaching out to BU’s Dean of Stu- pleased when the DLI’s director responded, tionally, the opportunity to work with DE dents and/or the Vice President of inviting us to submit a formal proposal and allowed us to capitalize on their experi- Enrollment and Student Administration. to schedule a meeting to present the project enced team of instructional designers with We followed up on these recommenda- to DLI staff. At the close of this meeting, we expertise in making live courses engaging tions by reaching out to both administra- were informed that the DLI would support in an online format. The DE team also has tive offices via email. Several weeks later, our proposal to translate our live, UP- considerable experience with methods to we heard back from BU’s VP of Enrollment based prevention program to an online, make online courses accessible to students and Student Affairs and scheduled a meet- self-paced course. In addition, they would with disabilities. ing. Given the emphasis of this office in also provide funds to pay students to com- The narrow focus on BU students supporting students, we prepared for our plete follow-up questionnaires throughout afforded us the ability to channel the BU meeting by collecting information to sug- the year following their completion of the experience, developing content that would gest that BU students may not be satisfied course as a means to assess its impact. resonate specifically with its students. As with the university’s handling of mental In sum, we felt confident in the merits such, we heavily relied on BU undergradu- health concerns; for example, the Huffing- of building an emotion-focused, transdiag- ate research assistants to provide relevant ton Post had recently published two Op- nostic program to prevent mental illness and appropriate examples of emotion-pro- Eds from BU students maligning the long on college campuses. This confidence voking situations that commonly occur for brought us from meeting to meeting across them and their peers (e.g., failing to receive waits for on-campus counseling. Of course, our campus extolling the benefits of our a response to a text message), careful not to the VP of Enrollment and Student Admin- intervention. In the end, our persistence come across as forced. We also sought to istration was aware of this perception and “won the day” and, after approximately 5 include pop-culture references to make the highlighted her commitment to building months of sending emails and attending course fun and engaging, and worked with resilience on campus. She helped us iden- various meetings, we obtained support. We students to identify television shows, tify other outcomes representing student encourage our colleagues to look within movies, and memes that would appeal to adjustment (e.g., GPA, leave-of-absence their own institutions to find sources of BU undergraduates. As pop-culture refer- status, ratio of courses attempted to courses support for valuable projects that may not ences can become dated quickly, care was completed) that her office would be willing be a strong match for traditional funding taken in the type and amount of references to provide in order to evaluate the effect of opportunities. used to avoid the need for excessive revi- the course on functioning. The VP also sions. Any future iterations of the course noted that her office may be able to provide Developing the Course will be checked for relevancy and updated some financial support to build our online as needed; DE staff is easily able to make Seeking funding from internal BU course but suggested that we contact BU’s changes to the content in the Blackboard sources and collaborating with DE to build VP of Research and the DLI, where we course. started, for additional resources. A brief the course meant that our course would email correspondence with the VP of need to be explicitly tailored to the experi- Adapting the UP Research revealed that this office does not ences of BU students. Blackboard is the In creating the online course content, fund faculty research projects, but we were platform used by DE to build online we simplified the full UP to four key mod- again encouraged to reach out to the DLI. courses; given that each university has its ules, as we had in the live workshop ver- Given that we had received multiple own contract with Blackboard, the course sion. Upon entering the course, partici- recommendations to seek support from we would develop would only be accessible pants are directed to a landing page with

Figure 1. Screenshot of course platform with course goals. Figure 2. Screenshots of the interactive pill graphic and poll in the Understanding Your Emotions module.

February • 2018 91 WILNER ET AL. animation that resembles a metro car from mind with a short, animated video improve upon the course in the future. Boston's public transportation system (i.e., (https://vimeo.com/131682712), and used Specifically, we hoped to assess the feasibil- the "T”) that runs through the BU campus. an interactive category game to practice ity, acceptability, and efficacy of the online In the car sits a cartoon version of Rhett the identifying thoughts as either past, present, program. Based on promising results from terrier, BU’s mascot. With Rhett as their or future-oriented (Figure 3). We then our in-person pilot study, we hypothesized guide, participants take a T-ride through guided participants through a brief medi- that the online course would (a) be feasible an emotion-focused journey, where each T tation exercise to practice nonjudgmentally to implement, (b) be satisfactory to under- stop represents a healthy coping skill noticing thoughts, physical sensations, and graduates, and (c) result in lower ratings of (Figure 1). Each of the modules included behavioral urges in the present moment. anxiety and depressive symptoms at long- various forms of media and examples to Supplemental mindfulness resources were term follow-up assessment points. While increase engagement. also included. conducting treatment outcome studies was Module 1, “Understanding Your Emo- Next, in Module 3, entitled “Flexible not new to our research team, this study’s tions,” provides psychoeducation to teach Thinking,” we considered the relationship methodology differed significantly from students about the functional nature of between thoughts and emotions and our previous experience and necessitated their emotions, discourage judgment of encouraged participants to challenge their the development of several creative solu- those emotions, and identify the parts of an automatic negative appraisals of ambigu- tions during the formation our approach. emotional experience (i.e., thoughts, phys- ous situations. Videos emphasized the rec- First, we needed to consider steps for ical sensations, and behaviors). We iprocal relationship between thoughts and participant recruitment and consent included short videos of college-relevant emotions, and an ambiguous picture exer- obtainment. In order to reach the entire scenarios where anxiety, sadness, and cise, taken directly from the UP client incoming freshman class at BU, roughly anger may be helpful, such as preparing for workbook (Barlow et al., 2010), was used to 3,400 students, we elected to send a mass a difficult exam or standing up to a room- highlight the automaticity of thinking. email the week before the start of the fall mate. Polling questions were also utilized Young adult–relevant scenarios were semester to all members of the incoming throughout the course; for example, we included to illustrate how, in emotional sit- freshman class inviting them to participate asked participants whether they would uations, trusting one’s first impression may in our research study. Interested students consider taking a magic pill to get rid of not always be helpful (e.g., Have you ever were instructed to click a link embedded in negative emotions. We used an interactive had a friend not text you back right away the email directing them to an online con- graphic of a pill (Figure 2), in which partic- and assumed that they were ignoring sent form (via Qualtrics). Eligible students ipants could slide their cursor to reveal you?). Students were prompted to practice were asked to provide information neces- options of (a) only experiencing positive identifying their first impressions and to sary for compensation and participant emotions or (b) possibly experiencing neg- come up with other possible explanations tracking including their email, university ative emotions. Upon answering, they were for the scenario. student identification number (UID), and shown the responses of others who had In Module 4, “Emotional Behaviors,” full name. Participants then indicated sep- taken the course, gaining the perspective of we focused on the way that behaviors in arately whether they consented for their peers. The video examples, coupled response to strong emotions can influence research staff to use their UIDs to collect with relevant guiding questions, helped their trajectory. We again developed sev- additional data (e.g., leave-of-absence translate the module into relatable material eral videos to demonstrate the short- and status) from BU’s Office of Student Affairs. for college students. long-term consequences of engaging in dif- After the consent process, participants Module 2, “Being Present,” focused on ferent kinds of emotional behaviors (e.g., were prompted to complete several ques- introducing mindful emotion awareness taking a nap when feeling sad after a tionnaires that assess anxious, depressive, and equipped participants with techniques breakup, despite having a lot of work to and related symptomology. Specifically, we for staying present in daily life. Here, we do), and then asked participants to ques- selected the Depression, Anxiety, and discussed the consequences of a wandering tion whether their actions in response to Stress Scales (DASS; Lovibond & Lovi- emotions are helpful or harmful in the long bond, 1995), the Positive and Negative term. Additionally, we had participants Affect Schedule (PANAS; Watson, Clark, identify opposite actions for emotional & Tellegen, 1988), the Quality of Life behaviors common in college students Enjoyment and Satisfaction Questionnaire (e.g., being invited to a party where you will (QLESQ; Endicott, Nee, & Blumenthal, not know many people, feeling insecure in 1993), the Brief Experiential Avoidance a relationship). We concluded with a sum- Questionnaire (BEAQ; Gámez et al., 2014), mary of skills, along with exercises for and the Emotion Regulation Questionnaire additional practice and a list of nearby (ERQ; Gross & John, 2003). While it was mental health resources. important for us to include measures that assessed a range of emotional factors, we Implementation and were careful to select those that were also Assessment Strategy brief so as to increase the likelihood that students would realistically complete the In addition to course development and questionnaires and, most important, make Figure 3. Screenshot of interactive game distribution, as a team of researchers, we it to the course itself. from Being Present module, in which were interested in collecting data from stu- Following completion of the question- participants drag and drop thoughts into dents in a manner that would allow us to naires, participants were randomly their respective category. make informed decisions about how to assigned to the emotions101 condition or

92 the Behavior Therapist ONLINE PREVENTION COURSE the no-intervention condition on a 1:1 ability and feasibility. We look forward to Barlow, D. H., Farchione, T. J., Bullis, J. R., schedule. The randomization logic was cre- receiving feedback from participants about Gallagher, M. W., Murray-Latin, H., ated in Qualtrics, and the program auto- their impressions of the course and hope Sauer-Zavala, S., … Cassiello-Robbins, C. matically conducts the randomization in that findings support the case for imple- (2017). The unified protocol for transdi- real-time when the last questionnaire is mentation of the course as a mandatory agnostic treatment of emotional disorders compared with diagnosis-specific proto- completed. Following randomization, part of university orientation and matricu- cols for anxiety disorders: A randomized those assigned to the course are directed to lation requirements. BU has already inte- clinical trial. JAMA Psychiatry, 74(9), 875. the link to the Blackboard platform to grated a required online prevention course doi:10.1001/jamapsychiatry.2017.2164 begin the course, and those in the control for risky alcohol use (AlcoholEdu) into Barlow, D. H., Farchione, T. J., Fairholme, group are led to a page thanking them for their health requirements for first-year stu- C. P., Ellard, K. K., Boisseau, C. L., Allen, their participation in the surveys. dents, which has garnered empirical sup- L. B., & Ehrenreich-May, J. (2011). The After the course, those in the emo- port at other higher education institutions unified protocol for transdiagnostic treat- tions101 condition were directed back to (Paschall, Antin, Ringwalt, & Saltz, 2011; ment of emotional disorders: Therapist Qualtrics to complete a satisfaction ques- Wall, 2007; Wyatt, DeJong, & Dixon, guide. New York, NY: Oxford University tionnaire to assess the acceptability of the 2013). University administration expressed Press. course (adapted from Borkovec and Nau’s high interest in and support of the emo- Barr, V., Rando, R., Krylowicz, B., & Reetz, [1972] commonly used treatment credibil- tions101 course becoming mandated for all D. (2010). The Association for University ity measure). We also assessed feasibility students, pending favorable results. If so, and College Counseling Centers Directors with a brief, multiple-choice declarative little to no cost for continuation would be Annual Survey. Indianapolis, IN: AUCCCD. knowledge quiz to assess uptake of course needed, as it is stand-alone in nature, lend- information. For longitudinal results, all ing itself to sustainable implementation. A Bennett, K., Manassis, K., Duda, S., Bag- required course for healthy emotional nell, A., Bernstein, G. A., Garland, E. J., participants were prompted with addi- … Wilansky, P. (2015). Preventing child coping may lead to a reduction in rates of tional email reminders to complete the and adolescent anxiety disorders: baseline assessment battery study at 1- anxiety and depressive symptoms, and, overview of systematic reviews: Review: month, 6-month, and 12-month follow-up with its inclusion within university, com- Preventing child and adolescent anxiety. points. municate to students that mental health is a Depression and Anxiety, 32(12), 909–918. One of our final challenges related to priority of the university. A brief interven- doi:10.1002/da.22400 the research strategy involved determining tion could have significant implications for Bentley, K. H., Boettcher, H., Bullis, J. R., the best way to compensate students. Given the university as well, including higher Carl, J. R., Conklin, L. R., Sauer-Zavala, that one of our primary aims was to assess rates of student retention, higher GPAs, S., … Barlow, D. H. (2017). Development the acceptability of the course, we were hes- fewer classes dropped, and less medical of a single-session, transdiagnostic pre- itant to incentivize participants by offering leave. Furthermore, while the course is cur- ventive intervention for young adults at risk for emotional disorders. Behavior compensation for completing the course, rently BU-specific (examples, pictures, etc.), the key messages are universal and we Modification. as doing so would likely skew the number doi:10.1177/0145445517734354. of students who opted to enroll in and hope that this intervention serves as a time- Bentley, K. H., Sauer-Zavala, S., Cassiello- complete the course. Thus, we decided to efficient and cost-effective model for others looking for means to easily aid in the pre- Robbins, C. F., Conklin, L. R., Vento, S., compromise and offer compensation for & Homer, D. (2017). Treating suicidal vention of mental disorders on campuses. the completion of follow-up question- thoughts and behaviors within an emo- naires. We opted to pay students $5 in tional disorders framework: Acceptabil- “convenience points,” that they can use at References ity and feasibility of the unified protocol various locations on campus, and did so via American College Health Association. in an inpatient setting. Behavior Modifi- an online portal and use of their UIDs. This (2011). American College Health Associa- cation. doi:10.1177/0145445516689661 solution served as a simple and effective tion-National College Health Assessment Black Becker, C., Smith, L. M., & Ciao, A. way of paying a large sample of college stu- II: Reference Group Executive Summary C. (2006). Peer facilitated eating disorder dents. The BU Institutional Review Board Fall 2011. Hanover, MD: Author. prevention: A randomized effectiveness approved all study procedures. Arnett, J. J. (2000). Emerging adulthood. 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94 the Behavior Therapist MICROAGGRESSIONS IN SUPERVISION

Stockings, E. A., Degenhardt, L., Dobbins, affect: The PANAS scales. Journal of Per- ited to, Nicole Sanderson and Summer Gar- T., Lee, Y. Y., Erskine, H. E., Whiteford, sonality and Social Psychology, 54(6), rard at the BU Office of Distance Education, H. A., & Patton, G. (2016). Preventing 1063–1070. doi:10.1037/0022- the BU Office of Student Affairs, the BU depression and anxiety in young people: 3514.54.6.1063 Digital Learning Initiative, graduate students A review of the joint efficacy of universal, Wyatt, T. M., DeJong, W., & Dixon, E. Rachel Snow, Clair Robbins and Amantia selective and indicated prevention. Psy- (2013). Population-Level Administration Ametaj, and research assistants Danyelle chological Medicine, 46(1), 11–26. of AlcoholEdu for College: An ARIMA Pagan, Danyele Homer, and Santiago Mar- doi:10.1017/S0033291715001725 Time-Series Analysis. Journal of Health Walker, E. R., McGee, R. E., & Druss, B. G. Communication, 18(8), 898–912. quez. We would also like to acknowledge the (2015). Mortality in mental disorders and doi:10.1080/10810730.2011.626501 individuals that contributed to the develop- global disease burden implications: A ment of the live emotion management work- systematic review and meta-analysis. ... shop on which this online program was JAMA Psychiatry, 72(4), 334–341. based: David Barlow, Kate Bentley, Hannah doi:10.1001/jamapsychiatry.2014.2502 Boettcher, Jackie Bullis, Jenna Carl, Laren Funding for the development of this course Wall, A. F. (2007). Evaluating a Health Conklin, Todd Farchione, and Johanna came from Boston University Digital Learn- Education Website: The Case of Alco- Thompson-Hollands. holEdu. NASPA Journal, 44(4), 692–714. ing Initiative Seed Grant and was awarded to doi:10.2202/1949-6605.1864 authors Dr. Sauer-Zavala and Ms. Wilner. Correspondence to Julianne Wilner, Center Watson, D., Clark, L. A., & Tellegen, A. We would like to thank the many individu- for Anxiety and Related Disorders, 648 (1988). Development and validation of als who have contributed to the develop- Beacon St, 6th Floor, Boston, MA 02215; brief measures of positive and negative ment of this project, including, but not lim- [email protected]

CLINICAL DIALOGUES cult to discuss, we did our best to address them directly in supervision. In this article, we document our personal experiences as He/She/I Said What?! candidly as possible. We briefly describe the circumstances in which microaggres- Reflections on Addressing Microaggressions sions occurred, and we reflect (via re-created conversation transcript) on the in Supervision manner in which we addressed each situation in supervision. We then discuss practi- Melissa L. Miller and Gabriela A. Nagy, Duke University cal steps for addressing microaggressions in supervision, and include sample lan- Medical Center guage and additional considerations. Fur- ther, we provide specific recommendation for supervisors and trainees in Figure 1. We “RACIAL MICROAGGRESSIONS are brief and microaggressions in the context of clinical hope that sharing our experience will commonplace daily verbal, behavioral, or supervision. We conducted a PsycINFO empower supervisors and trainees to environmental indignities, whether inten- literature search with keywords “supervi- directly approach and have productive tional or unintentional, that communicate sion” and “microaggressions,” which conversations about microaggressions. hostile, derogatory, or negative racial yielded only eight results in the past decade slights and insults toward people of color” (comprising four journal articles, three dis- Microaggressions (Sue et al., 2007, p. 271). The concept and sertations, and one book). Without proper From Trainee to Trainee term was first used by psychiatrist Dr. resources or training, it can difficult to nav- Chester Pierce (1970, 1974) to describe the igate discussions about microaggressions Supervision Situation experiences of African Americans. Despite in supervision (Constantine, 2003). A trainee experiences a microaggres- microaggressions often being discussed in On our last day of clinical supervision sion from a peer. The peer responds defen- the context of race and ethnicity, they can together, we (a supervisor and a trainee) sively to feedback about the microaggres- occur in relation to various identities (e.g., reflected on the various behaviors that led sion. The trainee must decide whether to ethnicity, gender, sexual orientation). to an effective year of clinical, professional, discuss the interactions with the supervisor Importantly, there is compelling evidence and personal growth. One active compo- and how to respond to the peer. indicating the experience of microaggres- nent that we identified was the straightfor- sions is suggested to adversely impact ward and honest manner in which we Reflections mental health (e.g., Nadal, Griffin, Wong, acknowledged, discussed, and responded GABY (trainee): When my peer made a Hamit, & Rasmus, 2014; Nadal, Wong, to microaggressions, or subtle and indirect comment about my accent, I felt confused Sriken, Griffin, & Fujii-Doe, 2015). It has expressions of prejudice or bias (Sue, and hurt because it reminded me of being been suggested that microaggressions are 2010). We were confronted with several teased for my accent as a kid. It happened commonplace and occur in everyday expe- examples of microaggressions throughout in front of a supervisor and other peers, riences (Kanter, Williams, Kuczynski, the year, including those occurring from and it was challenging to know whether or Manbeck, Debreaux, & Rosen, 2017). trainee to trainee, supervisor to trainee, and not I was appropriately feeling hurt, if and Despite their prevalence, there is a paucity client to trainee. Although these experi- how to address it with my peer, and of available resources related to handling ences can be confusing, hurtful, and diffi- whether to bring it up in supervision. I ulti-

February • 2018 95 MILLER & NAGY mately decided to bring it up in supervision Reflections after it happened. This demonstrated that because I trusted Melissa and thought she MELISSA: There was another time, early in she was trying to understand my experi- would be able to think through it with me, our relationship, when I could either con- ence as a woman of color, and that I might in a nonjudgmental manner. front my own microaggression or just have experienced that interaction as hurt- assume that Gaby understood what I ful and potentially damaging to our super- MELISSA (supervisor): I was glad that Gaby meant. We were about to lead a therapy visory relationship. I appreciated that she decided to discuss this in supervision, and I group together, and we were talking about decided to bring it up with me and mod- thought that how I responded would com- upcoming conferences. I said, “Oh, you’ll eled vulnerability as supervisor. That cre- municate a lot of information—about me, get to be with your people!” in reference to ated more trust in the relationship, which our supervision relationship, as well as a the National Latina/o Psychological Asso- then led to further vulnerability in our broader intuitional message. It certainly ciation conference (it makes me cringe to supervision. helped for me to have a working knowledge think about how carelessly I said that). My of microaggressions so that I could label intention was to refer to beloved colleagues Microaggressions the overall experience and actually name with similar professional interests, akin to From Client to Trainee how I would say “my DBT people.” Despite the specific type of microaggression (char- Supervision Situation acteristics of speech; please see Rivera, For- my intention, I realized that I had totally A trainee repeatedly experiences poten- quer, & Rangel, 2010, for additional read- microaggressed against her and that there tial microaggressions from a client. The ing). As a supervisor, I wanted to was far more behind that comment than I trainee must decide whether or not to dis- communicate that her experience was intended (color-blindness; please see the American Psychological Association, 2003, cuss with the supervisor and then how to legitimate, help her to evaluate the options, respond to the client. and try to ensure that she felt empowered and Sue, 2007, for additional readings). to respond to her peer in whatever manner Reflections that she chose. GABY: Being familiar with the concept of GABY: I was seeing a client who repeatedly microaggressions myself, I realize that alluded to me not being competent, espe- GABY: That dialogue in supervision left me microaggressions can often happen with- cially when she was feeling dysregulated. It feeling validated, and it helped me identify out the individual intending to be hurtful. I was unclear if this was because of my train- and cope with my emotions (particularly knew this could have been interpreted as a ing level (predoctoral intern), age, gender, the guilt and shame secondary to feeling microaggression, but I also assumed ethnicity, or some other reason. Her com- hurt). Once my emotions were manage- Melissa was not trying to be insensitive. I ments were incredibly painful, and work- able, I could more effectively decide how I didn’t feel particularly hurt; I felt curious. ing with her was very challenging. Of course, we could not discuss it right wanted to respond to my peer. I felt then because group was starting. empowered to be able to navigate the situ- MELISSA: This was especially insidious, as is ation in a way that was consistent with my often the case with microaggressions, : I decided to address it the next day values and also appropriate in our profes- MELISSA because it was never directly clear that the in supervision. Even though I knew that I sional setting. Ultimately, I decided to client’s statements were related to any of meant it in a friendly way, I felt some guilt follow up with my peer. In that interaction, Gaby’s identities (ascription of intelligence; and shame and I did have urges to avoid I provided context for why it was particu- please see Hernandez, Carranza, & the conversation. Having a solid under- larly hurtful, he understood and apolo- Almeida, 2010, for additional reading). The standing of behaviorism definitely helped client often engaged in hostile and aggres- gized, and we were able to repair the rup- me in this situation, because I know the sive verbal and nonverbal behaviors when ture. long-term consequences of avoiding some- emotionally dysregulated, and she regu- thing because it is emotionally difficult to larly expressed remorse once she was calm : Following our conversation, Gaby MELISSA approach (i.e., it becomes more challenging again. The situation was complex, and we gave me feedback about how I responded to approach in the future). Additionally, I were constantly prioritizing high-acuity to her concerns. It was helpful to directly thought that acknowledging my own treatment targets (including serious suici- hear the ways in which our conversation microaggression would strengthen our dal behavior and extreme emotion-regula- impacted her, and I am grateful that she relationship and, again, communicate an tion skill deficits), which did not include chose to do that. I imagine that was difficult important message to her (specifically, that clarifying whether or not the comments because we were just beginning to develop I cared about her and wanted to be sensi- were microaggressions. a supervisory relationship, but it definitely tive to her personal experience). Essentially reinforced my behavior. I said, “I realize that I microaggressed GABY: We discussed this repeatedly in against you yesterday in group, I’m really supervision, and we talked about the Microaggressions sorry about that, and I’m hoping that we impact on me both professionally and per- From Supervisor to Trainee can talk about it” (please refer to Figure 1 sonally. The client really needed help with for sample language to use). Gaby emotion regulation and interpersonal Supervision Situation expressed interest, and then we had a effectiveness, but it was so hard to receive A supervisor makes a microaggression candid conversation about what I said, how her comments. We ultimately decided to against a trainee and realizes it. The super- she felt, and microaggressions in general. set firm contingencies to reduce and elimi- visor must decide whether to discuss the nate the client’s hostile and aggressive microaggression with the trainee in super- GABY: I was pleasantly surprised to know behavior, but we never actually addressed vision and repair the transgression. Melissa had thought about our interaction the microaggressions directly.

96 the Behavior Therapist MICROAGGRESSIONS IN SUPERVISION

MELISSA: I felt quite protective of Gaby, and mation to help guide future interactions Alternatively, it is our experience that I wanted to ensure that she was not endur- and discussions. increased trust, honesty, and vulnerability ing unnecessary harm. I wanted her to feel A challenge of the recommendations may be a by-product of engaging in this validated and supported in supervision, outlined above is that these types of con- type of dialogue. Thus, we believe that the and I also wanted her to feel empowered to versations may be uncomfortable for both potential benefits outweigh the costs (even decide to continue working with this client the trainee and supervisor, and thus avoid- if the conversations are, admittedly, diffi- or to refer her to a different provider. ance may seem like an attractive option. cult to approach). Importantly, we believe this type of dia- The practical steps outlined here focus Practical Recommendations logue is best in the context of a supervisory on supervisors empowering trainees to It can be particularly challenging to relationship where trust, honesty, and vul- respond to microaggressions, with supervi- navigate microaggressions in the context of nerability exist. This may be particularly sors providing support “behind the scenes” clinical supervision. Trainees and supervi- challenging to attain toward the beginning in supervision. However, in cases where the sors alike may feel aversive emotions (e.g., of a supervisory relationship or in cases environment is too powerful or the costs embarrassment, anxiety, or frustration), wherein a rupture may have occurred. are too high, it may be more effective for fear negative evaluation, or lack a framework for discussing these experiences. Given that microaggressions often represent implicit social biases that are deeply imbedded in us all (Payne & Gawronski, 2010), it is functionally impossible to avoid them entirely. During our year of effective supervision, we focused on ameliorating the aftermath of microaggressions by addressing them directly. We discuss them here, and also direct you to Figure 1 for a flow diagram of our recommendations. The first three practical steps for supervisors to address microaggressions are: identify and label the microaggression, assess the impact, and validate (and don’t invalidate!) the effect. It’s important to assess the impact, because the personal reactions that trainees experience in response to microaggressions may differ greatly (Dover, 2016; Tran, Miyake, Mar- tinez-Morales, & Csizmadia, 2016), and supervisors will benefit from neither mag- nifying nor minimizing trainees’ responses (Constantine, 2003).When comments are made by peers or clients, supervisors can help trainees by brainstorming and evaluating various options for responding (Her- nandez et al., 2010; Schoulte, Schultz, & Altmaier, 2011). If supervisors are the ones who have microaggressed, we recommend communicating a plan to repair any harm caused by the comment, as doing so may increase vulnerability and strengthen the supervisory relationship. This does not mean assuming responsibility for intention to harm, but rather, simply acknowledging the impact (nondefensively), despite the intention. Supervisors also ought to refrain from overapologizing, as this could, para- doxically, function to inhibit future disclo- sures (e.g., for fear of hurting the supervi- Figure 1. Practical steps and sample language to address microaggressions in sor’s feelings or concern that the supervision. Text on the left in steps 1, 3, and 4 represents situations wherein discussions will be excessively time con- other trainees, colleagues, or clients have microaggressed toward trainee, and suming). In all situations, it’s helpful for text on the right reflects instances in which supervisors have done so. Text in supervisors to invite and incorporate feed- steps 1 and 5 includes sample language that could be utilized regardless of who back, and this can provide valuable infor- microaggressed toward the trainee.

February • 2018 97 MILLER & NAGY

Find a CBT Therapist supervisors to intervene directly and advo- now? Where is it going? In B. Gawronski cate on behalf of trainees. Additionally, for & B. K. Payne (Eds.), Handbook of the purposes of this article, we chose to implicit social cognition: Measurement, focus on exemplary situations in which theory, and applications. New York, NY: supervisors help trainees with their experi- Guilford Press. ence of microaggressions. Certainly, super- Pierce, C. M. (1970). Black psychiatry one year after Miami. Journal of the National visors may also be the recipients of Medical Association, 62(6), 471–473. microaggressions, and we encourage them Pierce, C. M. (1974). Psychiatric problems to seek similar forms of support from their findCBT.org of the black minority. In S. Arieti (Ed.), colleagues and superiors. As effective American Handbook of Psychiatry. New behavior therapists, we know that York: Basic Books. approaching these difficult conversations Rivera, D. P., Forquer, E. E., & Rangel, R. gets easier with practice, experience, and (2010). Microaggressions and the life exposure. experience of Latina/o Americans. In D. W. Sue (Ed.), Microaggressions and mar- ABCT’s Find a CBT Therapist References ginality: Manifestations, dynamics, and impact. New York, NY: Wiley. directory is a compilation of prac‐ American Psychological Association. Schoulte, J., Schultz, J., & Altmaier, E. (2003). Guidelines on multicultural edu- (2011). Forgiveness in response to cul- titioners schooled in cognitive and cation, training, research, practice, and tural microaggressions. Counselling behavioral techniques. In addition organizational changes for psychologists. Psychology Quarterly, 24(4), 291-300. American Psychologist, 58(5), 377-402. to standard search capabilities Sue, D. W. (2010). Microaggressions in Constantine, M. G. (2003). Multicultural everyday life: Race, gender, and sexual (name, location, and area of exper‐ competence in supervision: Issues, orientation. Hoboken, NJ: John Wiley & processes, and outcomes. In D. B. Pope- Sons. tise), ABCT’s Find a CBT Therapist Davis, H. L. K. Coleman, W. M. Liu, & R. Sue, D. W., Capodilupo, C. M., Torino, G. offers a range of advanced search L. Toporek (Eds.), Handbook of multicultural competencies in counseling and psy- C., Bucceri, J. M., Holder, A. M. B., Nadal, K. L., & Esquilin, M. (2007). capabilities, enabling the user to chology. Thousand Oaks, CA: Sage. Racial microaggressions in everyday life. take a Symptom Checklist, review Dover, M. A. (2016). The moment of American Psychologist, 62(4), 271-286. microaggression: The experience of acts Tran, A. G. T. T., Miyake, E. R., Martinez- specialties, link to self‐help books, of oppression, dehumanization and Morales, V., & Csizmadia, A. (2016). exploitation. Journal of Human Behavior and search for therapists based on 'What are you?' Multiracial individuals’ in the Social Environment, 26(7-8), 575- responses to racial identification insurance accepted. 586. inquiries. Cultural Diversity and Ethnic We urge you to sign up for the Hernandez, P., Carranza, M., & Almeida, Minority Psychology, 22(1), 26-37. R. (2010). Mental health professionals’ Expanded Find a CBT Therapist adaptive responses to racial microaggres- ... (an extra $50 per year). With this sions: An exploratory study. Professional Psychology: Research and Practice, 41(3), addition, potential clients will see 202-209. The authors have no funding or conflicts of what insurance you accept, your Kanter, J. W., Williams, M. T., Kuczynski, interest to disclose. A. M., Manbeck, K., Debreaux, M., & Correspondence to Melissa L. Miller, practice philosophy, your website, Rosen, D. (2017). A preliminary report Ph.D., Cognitive Behavioral Research and on the relationship between microag- and other practice particulars. gressions against Blacks and racism Treatment Program, Department of Psychi- To sign up for the Expanded Find among White college students. Race and atry and Behavioral Sciences, Duke Univer- Social Problems. doi: 10.1007/s12552- sity Medical Center (DUMC 3026), 2213 a CBT Therapist, click MEMBER 017-9214-0 Elba Street, Ofﬁce 235, Durham, NC 27710; [email protected] LOGIN on the upper left‐hand of the Nadal, K. L., Griffin, K. E., Wong, Y., Hamit, S., & Rasmus, M. (2014). The home page and proceed to the impact of racial microaggressions on ABCT online store, where you will mental health: Counseling implications for clients of color. Journal of Counseling click on “Find CBT Therapist.” and Development, 92(1), 57-66. For further questions, call the Nadal, K. L., Wong, Y., Sriken, J., Griffin, K., & Fujii-Doe, W. (2015). Racial ABCT central office at 212‐647‐ microaggressions and Asian Americans: 1890. An exploratory study on within-group difference and mental health. Asian American Journal of Psychology, 6(2), 136-144. Payne, B. K. & Gawronski, B. (2010). A history of implicit social cognition: Where is it coming from?Where is it

98 the Behavior Therapist NEWS

NEWS 2017 ABCT Featured Student Award Recipients

Katherine Baucom, Chair, Awards & Recognition Committee

ON BEHALF of the Awards & Recognition Committee I want to thank the many members who were able to join us for the Awards Ceremony in San Diego, where we honored a number of our members! Over the course of the coming year the Behavior Therapist will feature many of the 2017 recipients, starting with students.

STUDENT TRAVEL AWARD GRADUATE STUDENT RESEARCH GRANT Recipient: Dev Crasta, M.A. (University of Rochester) Recipient: Hannah Lawrence, M.A. (University of Maine) Presentation: Going Beyond Accessibility: Evaluating the Efficacy Project: Physiological and Affective Correlates of Visual and of a Minimal Self-Help Couples Treatment in Economically Verbal Rumination in Adolescence Disadvantaged Neighborhoods Advisor: Rebecca Schwartz-Mette, Ph.D. Advisor: Ron Rogge, Ph.D. Hannah’s research is focused on rumination in the form of mental Dev’s research aims to improve accessibility of psychological tools imagery versus verbal thought and the impact of visual and verbal to underserved families. His translational approach uses basic rumination on the experience of depression. In particular, her work research techniques from sociology and psychology to understand examines the affective, cognitive, and physiological correlates of how community context impacts relationships and highlight key visual and verbal induced rumination in adolescent samples. She processes working across contexts. These findings then inform co-authored a published book on evidence-based assessment and applied research developing online tools such as the Promoting treatment of child and adolescent depression as well as numerous Awareness & Improving Relationships program (PAIR). Dev’s pre- publications on rumination, depression, and mental imagery. She is sentation at the convention integrated these two threads by inves- the recipient of multiple research awards including the Janet Wal- tigating PAIR in a geographically diverse sample of parents. Dev’s dron Doctoral Research Fellowship at the University of Maine, a work is supported by grants from the American Psychological Beck Institute Student Scholarship, and the Society for Psy- Foundation, the Family Process Institute, as well as a National Sci- chophysiological Research Training Fellowship to support training ence Foundation Graduate Research Fellowship. in physiological assessment with Dr. Greg Siegle at the University of Pittsburgh School of Medicine.

for Award Nominations . . .

Call Nominate ON-LINE www.abct.org

! Career/Lifetime Achievement STUDENT AWARDS: President’s New Researcher (deadline: Aug. 1) ! Outstanding Mentor ! Virginia A. Roswell Student Dissertation ! Distinguished Friend to Behavior Therapy ! Leonard Krasner Student Dissertation ! Mid-Career Innovator ! John R. Z. Abela Student Dissertation ! Anne Marie Albano Early Career Award ! Elsie Ramos Memorial Student Poster Awards ! Outstanding Service to ABCT ! ! Student Tr avel Award

Deadline: March 1, 2018

February • 2018 99 AT ABCT Garnaat, Brandon Gaudiano, Andrea Gold, Philippe Goldin, Jeffrey Goodie, Cameron Gordon, DeMond Grant, Kim Minutes of the Annual Meeting of Members Gratz, Kelly Green, Jonathan Green, Amie Grills, John Guerry, Cassidy Gutner, Emily Haigh, Kevin Hallgren, Lauren Hallion, Friday, November 17, 2017, Hilton San Diego, Bayfront, San Diego Lindsay Ham, David Hansen, Shelby Harris, Ashley Harrison, Tae Hart, Trevor Hart, Tamara Hartl, Cynthia Hartung, Call to Order year we had an astonishing 360 members Sarah Hayes-Skelton, Alexandre Heeren, help review program submissions—the President Steketee called the meeting to Craig Henderson, Aude Henin, Debra largest number of reviewers in our history! order at 12: 32 p.m. PST and welcomed Herman, Nathaniel Herr, Kathleen Herzig, We also want to acknowledge our 76 Super members to the 51st Annual Meeting of Melanie Hetzel-Riggin, Crystal Hill-Chap- Reviews who helped us out this year. A man, Joseph Himle, Michiyo Hirai, Daniel Members. Notice of the meeting had been heartfelt thank you to the 2017 program sent to all members in September. Hoffman, Stefan Hofmann, Janie Hong, committee members.” Cole Hooley, Debra Hope, Lindsey Hop- President Steketee thanked Amitai Minutes kins, William Horan, Joseph Hovey, Kean Abramovitch, Lauren Alloy, Drew Ander- Hsu, Megan Hughes-Feltenberger, Andre Secretary-Treasurer Larimer asked for son, Mike Anestis, Joye Anestis, Laura Ivanoff, Nuwan Jayawickreme, Amanda any comments or corrections on the min- Anthony, Michael Armey, Anu Asnaani, Jensen-Doss, Robert Johnson, Kathryn utes from last year’s meeting. Marc Atkins, Shelley Avny, Alisa Bahl, Kanzler, Heather Kapson, Maria Karekla, M/S/U: The October 29, 2016, minutes Amanda Baker, Anne Bartolucci, Kimberly Howard Kassinove, Amy Keefer, Megan were unanimously accepted as distributed. Becker, Stephen Becker, Sara Becker, Rinad Kelly, Robert Kern, Connor Kerns, Sarah Beidas, Kathryn Bell, Kristen Benito, Erin Kertz, Elizabeth Kiel, Lisa Kilpela, Katha- Expressions of Gratitude Berenz, Noah Berman, Erica Birkley, Abby rina Kircanski, Nancy Kocovski, Amelia Blankenship, Jennifer Block-Lerner, Hei- Kotte, Kevin Krull, Magdalena Kulesza, President Steketee thanked the mem- demarie Blumenthal, Jamie Bodenlos, Steven Kurtz, Michael Kyrios, Caleb Lack, bers of the organization for their hard work Fabian Boie, Christina Boisseau, Maya Sara Landes, Ryan Landoll, David Langer, this year. She thanked Michelle Craske, Boustani, Scott Braithwaite, Christiana Jennifer Langhinrichsen-Rohling, Sean rotating off as Immediate Past President; Bratiotis, Lindsay Brauer, Allison Bray, Lauderdale, Matthew Lehman, Penny Leis- Keith Dobson, Representative-at-Large Ana Bridges, Lauren Brookman-Frazee, ring, Michelle Leonard, Marie LePage, and liaison to Membership Issues, 2014- Timothy Brown, Lily Brown, Shandra Matthew Lerner, Adam Lewin, Crystal 2017; Shireen Rizvi, 2014 – 2017 Academic Brown Levey, Steven Bruce, Alexandra Lim, Kristen Lindgren, Danielle Lindner, & Professional Issues Coordinator; Kather- Burgess, Andrea Busby, Will Canu, Nicole Jessica Lipschitz, Richard Liu, Sandra Llera, ine J. W. Baucom, 2014 – 2017 Awards and Caporino, Matthew Capriotti, Daniel Patricia Long, Christopher Lootens, Recognition Committee Chair; Sarah Kate Capron, Cheryl Carmin, Alice Carter, Tamara Loverich, Aaron Lyon, Sally Bearman, 2015 – 2017 Academic Training Corinne Catarozoli, Mark Celio, Dianne MacKain, Brittain Mahaffey, Maria and Education Standards Committee Chambless, Alexander Chapman, Ruby Mancebo, Sarah Markowitz, Donald Chair; and Michael S. McCloskey, 2014 – Charak, Gregory Chasson, Joshua Clapp, Marks, Ali Mattu, Michael McCloskey, 2017 Dissemination of CBT and Evidence David Clark, Elise Clerkin, Rebecca Cobb, Joseph McGuire, Kate McHugh, Dean Based Treatments Committee Chair. She Meghan Cody, Meredith Coles, Laren McKay, Carmen McLean, Alison McLeish, thanked the Chairs rotating off Conven- Conklin, Bradley Conner, Elizabeth Con- Daniel McNeil, Julia McQuade, Elizabeth tion and Education Issues: Jordana Muroff, nors, James Cordova, Travis Cos, Shannon Meadows, Douglas Mennin, Jennifer Mer- 2017 Program Chair; Jonathan S. Comer, Couture, Suzannah Creech, Torrey Creed, rill, Thomas Daniel Meyer, Robert Meyers, 2013 - 2017 Continuing Education Com- Jessica Cronce, Kristy Dalrymple, Pooja Jamie Micco, Mary Beth Miller, Damon mittee Chair; Sarah J. Kertz, 2014 – 2017 Dave, Charlie Davidson, Thompson Davis, Mitchell, John Mitchell, Zella Moore, Master Clinician Seminar Series Chair; and Brett Deacon, Thilo Deckersbach, Tamara Michael Moore, John Moring, Lauren Risa B. Weisberg, 2015 – 2017 Research Del Vecchio, Patricia DiBartolo, Angelo Moskowitz, Kim Mueser, James Murphy, and Professional Development Committee DiBello, Gretchen Diefenbach, Ray Laura Murray, Taryn Myers, Brad Naka- Chair. She thanked the Chairs rotating off DiGiuseppe, David DiLillo, Linda Dimeff, mura, Douglas Nangle, Lisa Napolitano, Membership Issues: Alyssa M. Ward, 2014 Katie Dixon-Gordon, Deidre Donaldson, Michael Newcomb, Amie Newins, – 2017 Special Interest Groups Committee Alex Dopp, Brian Doss, Sheila Dowd, Amy Michelle Newman, Kate Nooner, Sébastien Chair; Bradley C. Riemann, 2014 – 2017 Drahota, Chris Eckhardt, Barry Edelstein, Normand, Roisin O'Connor, Lisa O'Don- Membership Committee Chair; and Jill Ehrenreich-May, Polina Eidelman, nell, Bunmi Olatunji, Trina Orimoto, Patrick L. Kerr, 2014 – 2017 List Serve Thane Erickson, Melissa Faith, Angela Sarah O'Rourke, Camilo Ortiz, Julie Committee Chair. The President thanked Fang, Brian Feinstein, Thomas Fergus, Owens, David Pantalone, Rebecca Pasillas, Michelle Newman, Behavior Therapy Brooke Fina, Aaron Fisher, Nicholas Laura Payne, Fred Penzel, Jacqueline Per- Editor, Volumes 45-48, and Kristene A. Forand, Elisabeth Frazier, Steffany Fred- sons, Sandra Pimentel, Antonio Polo, Doyle, 2014-2017 Web Editor. man, Andrew Freeman, David Fresco, Kristina Post, Mark Powers, Loren Prado, President Steketee remarked, "We all Robert Friedberg, Steven Friedman, Randy Rebecca Price, Amy Przeworski, Cara know that to put together a program of this Frost, Kristin Gainey, Richard Gallagher, Pugliese, Adam Radomsky, Holly Ram- size takes a lot of time and dedication. This Matthew Gallagher, Frank Gardner, Sarah sawh, Lance Rappaport, Carla Rash, Sheila

100 the Behavior Therapist MINUTES OF THE ANNUAL MEETING OF MEMBERS

Rauch, Judy Reaven, Neil Rector, Felice ship Committee Chair; Lance Rappaport, with the Elsie Ramos Poster awards to: Reddy, Madhavi Reddy, Hannah Reese, 2017-2020 Special Interest Groups Com- Chloe Hudson, Queen’s University; Chris- Simon Rego, Jessica Richards, John Richey, mittee Chair; Gabrielle Liverant, 2017- tian Goans, University of North Texas; and John Riskind, Kelly Rohan, George Ronan, 2020 List Serve Committee Chair; Regine Kate Kysow, University of British Colum- Anthony Rosellini, Barbara Rothbaum, Galanti, 2017-2020 Web Editor, and bia. Members were encouraged to attend Rebecca Sachs, Dustin Sarver, Nina Sarver, Denise Sloan, Editor, Behavior Therapy, for the Awards Ceremony that evening. The Shannon Sauer-Zavala, Steven Sayers, volumes 49-52. International Associates Committee, Tracy Sbrocco, Heather Schatten, Kather- spearheaded by Lata McGinn, continues to ine Schaumberg, Brad Schmidt, Casey Finance Committee Report focus on expanding the World Congress Schofield, Jill Scott, Laura Seligman, Kathy Committee to the World Confederation of The Secretary Treasurer reminded the Sexton-Radek, Benjamin Shapero, Tomer Behavioral and Cognitive Therapies that membership that the Finance Committee Shechner, Frederick Shic, Ryan Shorey, will look at global issues in addition to our oversees the financial health of ABCT, Nicholas Sibrava, Greg Siegle, Jedidiah tri-annual world congresses. Call for sub- monitors the fiscal forecasts, oversees that Siev, Monica Skewes, Stephanie Smith, missions for the 2019 World Congress in funds are set aside for specific projects, April Smith, Moria Smoski, Jennifer Berlin will begin June 2018. The Academic Snyder, Laura Sockol, Kristen Sorocco, ensures money is invested prudently, and Training and Education Standards Com- Claire Spears, Amanda Spray, Susan evaluates financial considerations related mittee has incorporated the work of the Sprich, Shari Steinman, Jill Stoddard, Eric to ownership of the central office. former Committee on Dissemination of Storch, Lauren Stutts, Denis Sukhodolsky, Our fiscal year is from November 1 – CBT & Evidence-Based Treatment. The Maureen Sullivan, Louisa Sylvia, Robyn October 31. 2016 fiscal year (FY) ended committee has several subcommittees that Sysko, Raymond Tafrate, Jennifer Taitz, with a positive balance of $245,012, with focus on training resources for our website, Jeff Temple, Alix Timko, Patti Timmons income ($2,353,977) greater than expenses maintaining the online Mentor Directory Fritz, Kiara Timpano, Theodore Tomeny, ($2,108,965). This is considerably better where students can see the research of the Michael Tompkins, Casey Trainor, Kim- than the operating deficit of $74,622 that professors where they are applying for berli Treadwell, Matthew Tull, Cynthia was originally projected. The 2017 fiscal- admission and the Spotlight on a Mentor Turk, Brianna Turner, David Valentiner, year-approved budget was projected to program. This year the Board approved the Kathryn Van Eck, Shona Vas, Clorinda show income over expense of $215,650 and recommendations that Stacey Frazier, Velez, Andres Viana, Jason Vogler, we expect to exceed that. Florida International University; Robert Suzanne Vrshek-Schallhorn, Anka ABCT uses a financial advisor at Boen- Friedberg, Palo Alto University, and Vujanovic, Melanie Wadkins, Alyssa ning and Scattergood to guide us in our Shireen Rizvi, Rutgers University receive Ward, Allison Waters, Laura Watkins, investment decisions. The funds have the Spotlight awards and they will be Elliot Weiner, Hilary Weingarden, Jere- “conservative growth with income” as its acknowledged at the Friday night Awards miah Weinstock, Lauren Weinstock, Risa investment goal, with a 6.86% annual yield. Ceremony. The Research Facilitation Weisberg, Tony Wells, Susan Wenze, Chad ABCT endowment funds are invested in a Committee, with Board approval, awarded Wetterneck, Michael Wheaton, Bradley “moderately conservative” fashion. The the Student Research Grant to Hannah White, Kamila White, Stephen Whiteside, total endowment portfolio value as of July Lawrence, University of Maine and the Shannon Wiltsey Stirman, Sheila Woody, 3, 2017 was $1,202,670.23 with a 7.74% 1- Graduate Student Research Grant Honor- Edward Wright, Michael Wydo, Matthew year yield. Rules regarding the investment able Mention to Amanda L. Sanchez, Young, Alexandra Zagoloff, Alyson Zalta, and dispersal of money associated with Florida International University. Chair Laurie Zandberg, and Eric Zhou. named awards are established when the Nate Herr’s informative summary of the We also want to thank the Local funds are bequeathed. We have six named 2017 NIMH Professional Coalition for Arrangements Committee and Co-chairs award funds at B & S and a general fund- Research Progress Meeting will be pub- Aaron J. Blashill and Tiffany Brown for a the-future endowment. ABCT continues to lished in the December issue the Behavior terrific job making us all feel very welcome enjoy good financial health, including Therapist. Dr. Herr will represent us again in San Diego. robust reserve funds. in 2018. Convention and Continuing Education Appointments Coordinators Reports Barbara W. Kamholz, Coordinator of President Steketee listed the new Academic and Professional Issues Convention and Education Issues, appointments: Katherine J. W. Baucom, Shireen Rizvi, Coordinator of Acade- reported that there were 2,094 submissions 2017-2020 Academic and Professional mic and Professional Issues, reported that across 56 primary categories, and 41 sec- Issues Coordinator; Cassidy Gutner, 2017- the Self-Help Book Recommendations ondary categories. Of these, 1,632 submis- 2020 Awards and Recognition Committee Committee recommended additional sions were accepted across 53 primary cat- Chair; Anu Asnaani, 2017-2020 Continu- books that are evidence-based for our web- egories and 36 secondary categories. There ing Education Committee Chair; Kiara R. site. The Board approved five, which can be were also a record number of reviewers on Timpano, 2018 Program Chair; Alyssa found at http://www.abct.org/SHBooks/. the program committee (N = 360). An esti- Ward, 2018 Associate Program Chair; The Awards and Recommendations Com- mated 3,200+ professionals attended the Courtney Benjamin Wolk, 2017 – 2020 mittee, chaired by Katherine Baucom, San Diego convention. The group is Master Clinician Seminar Series Chair; thanked the Board of Directors for approv- researching program book options for Cole Hooley, 2017-2020 Research and Pro- ing the recommendations of the committee 2018, and evaluating the current mix of fessional Development Committee Chair; that Dev Crasta, University of Rochester, paper, online, and smartphone app vs. Kathleen Gunthert, 2017-2020 Member- receive the Student Travel Award along online and smartphone app only.

February • 2018 101 MINUTES OF THE ANNUAL MEETING OF MEMBERS

Coordinator Kamholz reported that the bers. She highlighted the three New Profes- the full members to be on the lookout for Continuing Education Committee orga- sional categories with 98, 77, and 67 mem- the 2018 application period to become a nized a total of 9 webinars (7 already com- bers, respectively, for a total of 242 New Fellow and it is time for the membership to pleted, 2 more scheduled). The 2018 goal is Professional members, compared to a total nominate colleagues or themselves for 10–11 webinars. The APA accreditation of 108 last year. This great news suggests office. The Call for Nominations is your issue, a major deterrent to a full webinar our innovative 3-Year Stepped New Pro- program addendum, appears in the Octo- series in 2016, was resolved for live webi- fessional categories are capturing members ber and December issues of tBT, and on the nars. APA accreditation was also received who may have registered as Student mem- web. for home-study and archived webinars, but bers in the past. These categories balance Coordinator Vidair has 8 committee will require the CE committee to generate the goal of keeping costs for recent gradu- chairs along with the Ambassador Chair missing CE post-test questions for all pre- ates reasonable while recognizing their new reporting to her. She thanked Alyssa Ward, vious webinars before 2017 in order for professional status and increasing ABCT’s Special Interest Groups Committee Chair; members to receive credit for these webi- membership revenue. The overall increase Bradley Riemann, Membership Commit- nars. She also reported that Anu Asnaani in membership in a year when our conven- tee Chair; Joy Pemberton, Student Com- has begun successful transition to Chair tion is on the West Coast is very promising, mittee Chair; David Pantalone, Leadership role (2018-2020) and Carmen McLean has as historically our numbers have been and Elections Committee Chair; Laura successfully assumed formal role as Mar- higher when the convention is on the East Payne, Clinical Directory and Referral keting and Outreach Facilitator (2018- Coast. Issues Committee Chair; Patrick Kerr, List 2020). Coordinator Vidair reported that we Serve Committee Chair; Emily Bilek, Social Coordinator Kamholz reported that the continued to expand outreach to PsyD Psy- Networking and Media Committee Chair; 2018 Program theme is “Cognitive Behav- chologists, Social Workers, Master's-level and David DiLillo, Fellows Committee ioral Science, Treatment, and Technology.” Licensed Marriage and Family Therapists, Chair, along with their committee mem- Invited speakers include Christian Rueck Licensed Mental Health Counselors/Ther- bers for the amazing work they do (Treatment: iCBT); Rosalind Piccard apists, Licensed Professional Clinical throughout the year and to make ABCT a (Assessment: Sensors); James Fowler Counselors, and Nurses. Changes in our vibrant organization where members want (Human Networks) and Dianne Chamb- database process require members to indi- to renew. less (2017 Lifetime Achievement Award cate their field of study and year in which Publications Committee Winner). She noted that we are looking at their terminal degree was earned when Invited Conversation with Dr. Josh they join or renew. This will allow us to Steve Safren, Publications Coordinator, Gordon and an Invited Panel on Funding keep track of the number of members we reported that both journals continue to & CBT (PCORI, NIDA, National Institute have in each field (e.g., PsyDs, social work- boast higher impact factors, with BT at of Child Health and Human Development, ers) over time, market to specific sub- 3.434/4.765 (13th of 121 journals) and Administration for Children and Families). groups, and determine if changes in mem- C&BP at 2.537/2.635 (36th of 121 jour- She encouraged members to submit for the bership correlate with our recruitment nals); improved manuscript disposition, ticketed sessions and general sessions. efforts. We plan to continue executing with BT at mean of 32.6 days and C&BP at Information can be found in the program ideas from last year’s PsyD Think Tank. 64 days; and increased manuscript flow, book and on the ABCT website. The For example, one next step is to develop with BT projecting 270 manuscripts and November 15–18 convention will be held podcasts for PsyDs to help them think of C&BP 106. The Coordinator thanked the in Washington, DC. ABCT as their professional home, includ- editors who handle a heavy work load to The Coordinator thanked Jordana ing what they can expect to gain from the great effect. Both editors singled out Muroff, our 2017 Program Chair; Jon organization and the convention. Stephanie Schwartz, our managing editor, Comer, 2013-2017 Continuing Education The Coordinator reminded the mem- in the Central Office. Michelle Newman is Committee Chair; Anu Asnaani, 2017- bership of the work of the Student Com- completing her term as editor and Denise 2020 Continuing Education Committee mittee. They have launched a Featured Lab Sloan is already handling all new submis- Chair; Sandy Pimentel, Representative-at- project for the web, updated the “slang dic- sions as editor-elect. Large and Liaison to Convention and Edu- tionary” so new members can get up to In tBT, Kate Wolitzky-Taylor is pro- cation Issues; Mary Jane Eimer, Executive speed on ABCT culture faster and process ducing both quality and quantity, includ- Director; Linda Still, Director of Education all the acronyms we use. ing several special series, one mirroring this and Meeting Services, and the entire ABCT The Coordinator also noted that the convention's theme. She restructured the Central Office Staff for their contributions Clinical Directory and Referral Issues editorial board, making most into at-large to the Convention Planning and CE Com- Committee reinstituted the Featured Clin- editors to give them greater freedom to mittees. ician on our website in addition to devel- accomplish tasks. After reviewing alternate oping a Pioneer Series and promoting delivery approaches for tBT, we recom- Membership Issues information on CBT that addresses differ- mend that the newsletter be kept as a print Hilary Vidair, Membership Issues ent disorders by month. The List Serve journal, available in PDF on the web site Coordinator, reported that ABCT ended continues to be a valuable resource to the (issues back to 2002 can be found at the 2017 membership year with 5,372 membership. The Social Networking http://www.abct.org/Journals/?m=mJour- members, an increase of 279 from the prior Media Committee is expanding our reach nal&fa=TBT). year! For the upcoming membership year, through the ABCT Facebook and Twitter We said goodbye to Kristene Doyle we have 2,521 members compared to 1,784 accounts. Our Special Interest Groups after 3 fun years at the web's helm. She last year at comparable timing, an increase remain robust and we now have 39 groups introduced new video components, includ- of 318 full members and 227 Student mem- with one more in-formation. She reminded ing Spotlight on the 50th (an anniversary

102 the Behavior Therapist MINUTES OF THE ANNUAL MEETING OF MEMBERS issue with thoughtful commentary at give us high marks during our annual audit Teachman as facilitator. She proposed 5 http://www.abct.org/Members/?m=mMe for being fiscally sound and compliant with possible outcomes: mbers&fa=Spotlight_50) and the Presi- all state and federal regulations. They point dents' Muse (http://www.abct.org/ out that ABCT is well managed. 1. An article in tBT Members/?m=mMembers&fa=Presi- The Executive Director reported much 2. For Providers: a webinar or MOOC or dentsMuse). Several other videos currently more activity with social media, with mea- workshop to share information on grace the home page and enlighten the lay surable efforts. Growth has continued from using technology in practice in a non- public on various disorders (see pieces on 3,000 ‘likes’ at the 2014 convention, to therapy way ADHD, bullying, and OCD at 4,300 at the 2015 convention, to 6,785 at 3. For Researchers: a web-based clearing- http://www.abct.org/Home/) as well as the 2016 convention, to 8,167 as of this house of resources; recommendations; adding to the section on CBT in the News report. ABCT has had a high level of consensus statements, and tools (http://www.abct.org/Information/?m=mI involvement in the Coalition for the 4. For Consumers a “dream idea”: nformation&fa=CBT_News). Regine Advancement and Application of Psycho- Digital Apothecary Galanti assumes the mantle as Web Editor logical Sciences (CAAPS). We continue to 5. Provide information to people on eval- at an exciting time as we ponder new ways be an active presence in COSSA and the to approach the web. uation of digital approaches-ABCT Mental Health Liaison Group. partners with Cyber Guide to identify The Speakers Bureau is up and running The Executive Director thanked her CBT support apps on our web page at http://www.abct.org/xMedia/. Bob staff for the incredible work they do and Schachter and his crew will also be devel- encouraged members to introduce them- The Board is very much aware that oping a host of videos and documents to selves to: many ABCT members are thought leaders, help our members be polished ambas- and we need to engage them in moving the sadors of CBT and to allow the media to • David Teisler, Director of Communi- field and in specific specialty areas forward. more adeptly and accurately discuss CBT's cations and Deputy Director The President noted she was very pleased effects on various disorders. with the theme and offerings of this year’s Susan Sprich continues to work inde- • Linda Still, Director of Education and convention and thanked her Program pendently and with several other commit- Meeting Services Chair, Jordana Muroff, for putting it all tees to generate and polish Fact Sheets, • Tammy Schuler, Director of Outreach together. She noted it was an honor and adding three new ones in 2017. Six Fact and Partnerships pleasure to serve as ABCT President. Sheets have been translated into Spanish. • Barbara Mazzella, Administrative Susan White heads ABCT's partnership Secretary, who handles all fulfillments, Transition of Officers with Oxford University Press in the “Series and staffs our Membership Booth at on Implementation of Clinical Ap- the annual conventions President Steketee introduced the new officers for the coming year: Risa Weisberg, proaches.” Five books are under way, with • Tonya Childers Collens, Administra- Representative-at-Large and liaison to one already delivered to OUP's editors. tive Assistant, Exhibits Manager, and Susan is working with four AEs: Lara Far- Membership Issues, Bruce Chorpita, 2017- Convention Registrar rell, Matthew Jarrett, Jordana Muroff, and 2018 President-Elect, and Sabine Wilhelm, Marisol Perez. The first book, Application • Dakota McPherson, Membership President to whom she handed over the of the Unified Protocol for Transdiagnostic Services Associate gavel and the meeting. Treatment for Emotional Disorders, edited by Todd Farchione and David Barlow, is Stephanie Schwartz, our Managing Editor, Comments from the Membership already printed. and Kelli Long-Jatta, our bookkeeper, keep the home fires burning while the rest of the President Wilhelm asked those in attendance if they had any questions or com- Executive Director’s Report staff attended the San Diego convention. These are your dedicated professionals ments. There being none, she adjourned Mary Jane Eimer, the Executive Direc- who want to see the association and its the meeting at 1:34 p.m. PST. tor, reported that our March strategic plan- members succeed in all endeavors. ning retreat resulted in 7 strategic initia- —Adjournment— tives: Member Community and Value; President’s Report Dissemination and Implementation; Inno- vation and Advancement of Science; Out- President Steketee reported that leader- reach; Partnerships and Coalitions; Global- ship had a very productive year, noting the ization; and Technology. She noted that we March, 2017 Strategic Planning Retreat. As ended the 2017 membership year with Ms. Eimer mentioned, we reviewed and 5,372 members, and, most importantly, are agreed upon 7 strategic initiatives for the maintaining our full members. coming three years. Leadership and staff Ms. Eimer noted that we created the are very much aware that clear communi- Audit Committee this year which reviewed cation, stated goals, and timelines are the 2016 year-end financials, and ABCT required for good governance and will most likely have an income over progress. Yesterday our first Think Tank expense of $320,000 on the operating was launched, “Digital CBT Technologies budget, which is $96,000 more than pro- to Provide Care to Difficult to Reach and jected. Our accounting firm continues to Underserved Populations” with Bethany

February • 2018 103 ABCT’s 52nd Annual Convention November 15–18, 2018 • Washington, DC

Preparing The ABCT Convention is designed for scientists, practitioners, students, and schol- ars who come from a broad range of disciplines. The central goal is to provide educational experiences related to behavioral and cognitive therapies that meet the to Submit needs of attendees across experience levels, interest areas, and behavioral and cognitive theoretical orientations. Some presentations offer the chance to learn an Abstract what is new and exciting in behavioral and cognitive assessment and treatment. Other presentations address the clinical-scientific issues of how we develop empirical support for our work. The convention also provides opportunities for professional networking. The ABCT Convention consists of General Sessions, Targeted and Special Programming, and Ticketed Events. ABCT uses the Cadmium Scorecard system for the submission of general session events. The step-by-step instructions are easily accessed from the Abstract Submission Portal, and the ABCT home page. Attendees are limited to speaking (e.g., presenter, panelist, discussant) during no more than FOUR events. As you pre- pare your submission, please keep in mind: • Presentation type: Please see the two right-hand columns on this page for descriptions of the various presentation types. • Number of presenters/papers: For Symposia please have a minimum of four presenters, including one or two chairs, only one discussant, and 3 to 5 papers. The chair may present a paper, but the discussant may not. For Panel Discussions and Clinical Round tables, please have one moderator and between three to five panelists. • Title: Be succinct. • Authors/Presenters: Be sure to indicate the appropriate order. Please ask all authors whether they prefer their middle initial used or not. Please ask all authors their degree, ABCT category (if they are ABCT members), and their email address. (Possibilities for “ABCT category” are current member; lapsed member or nonmember; postbaccalaureate; student member; student nonmember; new professional; emeritus.) • Institutions: The system requires that you enter institutions before entering authors. This allows you to enter an affiliation one time for multiple authors. DO NOT LIST DEPARTMENTS. In the following step you will be asked to attach affilia- Thinking about submitting an tions with appropriate authors. abstract for the ABCT 52nd • Key Words: Please read carefully through the pull-down menu of already Annual Convention in DC? The defined keywords and use one of the already existing keywords, if appropriate. submission portal will be opened from For example, the keyword “military” is already on the list and should be used February 14–March 14. Look for more rather than adding the word “Army.” Do not list behavior therapy, cognitive thera- information in the coming weeks to assist py, or cognitive behavior therapy. you with submitting abstracts for the ABCT • Objectives: For Symposia, Panel Discussions, and Clinical Round Tables, write 51st Annual Convention. The deadline for three statements of no more than 125 characters each, describing the objectives submissions will be 11:59 P.M. (EST), of the event. Sample statements are: “Described a variety of dissemination Wednesday, March 14, 2018. We look for- strategies pertaining to the treatment of insomnia”; “Presented data on novel ward to seeing you in Washington, DC! direction in the dissemination of mindfulness-based clinical interventions.” Overall: Ask a colleague to proof your abstract for inconsistencies or typos.

104 the Behavior Therapist 52nd Annual Convention general November 15–18, 2018 • Washington, DC sessions

Call for Papers Theme: COGNITIVE BEHAVIORAL Program Chair: Kiara R. Timpano, Ph.D. SCIENCE, TREATMENT, ABCT has always celebrated advances in clinical science. We now find ourselves at the cusp of a new era, marked by technological advances in a range of and different disciplines that have the potential to dramatically affect the clinical TECHNOLOGY science we conduct and the treatments we deliver. These innovations are already influencing our investigations of etiological hypotheses, and are simi- larly opening new frontiers in the ways that assessments and treatments are developed, patients access help, clinicians monitor response, and the broader field disseminates evidence-based practices. Building on the strong, theoretical and practical foundations of CBT, we have the exciting opportunity to use our multidisciplinary values to identify new and emerging technologies that could catapult our research on mental health problems and well-being to the next level. Portal opens February 14, 2018 The theme of ABCT's 52nd Annual Convention, "Cognitive Behavioral Science, Treatment, and Technology," is intended to showcase research, clinical practice, and training that: Deadline • Uses cutting-edge technology and new tools to increase our under standing for submissions: of mental health problems and underlying mechanisms; March 14, 2018 • Investigates how a wide range of technologies can help us improve evidence- based practices in assessment and the provision of more powerful interventions; and • Considers the role technology can have in training a new generation of evidence-based treatment providers at home and across the globe.

The convention will highlight how advances in clinical science can be strength- ened and propelled forward through the integration of multidisciplinary technologies.

Submissions may be in the form of symposia, clinical round tables, panel discussions, and posters. Information about the Convention and how to submit abstracts will be on ABCT's website, www.abct.org , after January 1, 2018.

Submission deadline: March 14, 2018

February • 2018 105 Understanding the ABCT Convention

General Sessions Poster Sessions school, career development, information One-on-one discussions between on grant applications, and a meeting of There are between 150 and 200 general researchers, who display graphic repre- the Directors of Clinical Training. sessions each year competing for your sentations of the results of their studies, attention. An individual must LIMIT TO and interested attendees. Because of the Special Interest Group (SIG) Meetings 6 the number of general session submis- variety of interests and research areas of More than 39 SIGs meet each year to sions in which he or she is a SPEAKER the ABCT attendees, between 1,200 and accomplish business (such as electing offi- (including symposia, panel discussions, 1,400 posters are presented each year. cers), renew relationships, and often offer clinical roundtables, and research spot- presentations. SIG talks are not peer- lights). The term SPEAKER includes roles reviewed by the Association. of chair, moderator, presenter, panelist, Targeted and Special and discussant. Acceptances for any given Programing Ticketed Events speaker will be limited to 4. All general Targeted and special programing events Ticketed events offer educational oppor- sessions are included with the registration are also included with the registration fee. fee. These events are all submitted tunities to enhance knowledge and skills. These events are designed to address a These events are targeted for attendees through the ABCT submission system. range of scientific, clinical, and profes- The deadline for these submissions is with a particular level of expertise (e.g., sional development topics. They also pro- basic, moderate, and/or advanced). 11:59 PM, Wednesday, March 15, 2017. vide unique opportunities for networking. General session types include: Ticketed sessions require an additional Invited Addresses/Panels payment. Symposia Speakers well-established in their field, or Clinical Intervention Training In response to convention feedback who hold positions of particular impor- One- and two-day events emphasizing the requesting that symposia include more tance, share their unique insights and “how-to” of clinical interventions. The presentations by established research- knowledge. extended length allows for exceptional ers/faculty along with their graduate Mini Workshops interaction. students, preference will be given to Designed to address direct clinical care or symposia submissions that include non- Institutes training at a broad introductory level and student researchers and faculty mem- Leaders and topics for Institutes are are 90 minutes long. bers as first-author presenters. selected from previous ABCT workshop Symposia are presentations of data, Clinical Grand Rounds presentations. Institutes are offered as a 5- usually investigating the efficacy or effec- Clinical experts engage in simulated live or 7-hour session on Thursday, and are tiveness of treatment protocols. Symposia demonstrations of therapy with clients, generally limited to 40 attendees. are either 60 or 90 minutes in length. who are generally portrayed by graduate Workshops They have one or two chairs, one discus- students studying with the presenter. sant, and between three and five papers. Covering concerns of the practitioner/ No more than 6 presenters are allowed. Research and Professional Development educator/researcher, these remain an Provides opportunities for attendees to anchor of the Convention. Workshops are Panel Discussions learn from experts about the development offered on Friday and Saturday, are 3 and Clinical Round Tables of a range of research and professional hours long, and are generally limited to 60 Discussions (or debates) by informed skills, such as grant writing, reviewing attendees. individuals on a current important topic. manuscripts, and professional practice. These are organized by a moderator and Master Clinician Seminars include between three and six panelists Membership Panel Discussion The most skilled clinicians explain their with a range of experiences and attitudes. Organized by representatives of the methods and show videos of sessions. No more than 6 presenters are allowed. Membership Committees, these events These 2-hour sessions are offered generally emphasize training or career throughout the Convention and are gen- Spotlight Research Presentations development. erally limited to 40 to 45 attendees. This format provides a forum to debut new findings considered to be ground- Special Sessions Advanced Methodology and Statistics breaking or innovative for the field. A These events are designed to provide use- Seminars limited number of extended-format ses- ful information regarding professional Designed to enhance researchers’ abilities, sions consisting of a 45-minute research rather than scientific issues. For more they are 4 hours long and limited to 40 presentation and a 15-minute question- than 20 years, the Internship and attendees. and-answer period allows for more in- Postdoctoral Overviews have helped depth presentation than is permitted by attendees find their educational path. Continuing Education symposia or other formats. Other special sessions often include See http://www.abct.org/Conventions/ expert panels on getting into graduate ?m=mConvention&fa=ceOpportunities

106 the Behavior Therapist ABCT’S TRAINING VIDEOS

complex cases `äáåáÅ~ä Deepen master clinicians dê~åÇ } live sessions oçìåÇë

! Steven C. Hayes, Acceptance and Commitment Therapy ! Ray DiGiuseppe, Redirecting Anger To ward Self-Change ! Art Freeman, Personality Disorder ! Howard Kassinove & Raymond Ta frate, Preparation, Change, and Forgiveness Strategies for Tr eating Angry Clients ! Jonathan Grayson, Using Scripts to Enhance Exposure in OCD ! Mark G. Williams, Mindfulness-Based Cognitive Therapy and the Prevention

of Depression your ! Donald Baucom, Cognitive Behavioral Couples Therapy and the Role of the Individual ! Patricia Resick, Cognitive Processing Therapy for PTSD and Associated Depression ! Edna B. Foa, Imaginal Exposure ! Frank Dattilio, Cognitive Behavior Therapy With a Couple ! Christopher Fairburn, Cognitive Behavior Therapy for Eating Disorders ! Lars-Goran Öst, One-Session Tr eatment of a Patient With Specific Phobias

! E. Thomas Dowd, Cognitive Hypnotherapy in Anxiety Management understandi ng ! Judith Beck, Cognitive Therapy for Depression and Suicidal Ideation

3-SESSION SERIES ! DOING PSYCHOTHERAPY: Different Approaches to Comorbid Systems of Anxiety and Depression (Available as individual DVDs or the complete set) ! Session 1 Using Cognitive Behavioral Case Formulation in Tr eating a Client With Anxiety and Depression (Jacqueline B. Persons) ! Session 2 Using an Integrated Psychotherapy Approach When Tr eating a Client With Anxiety and Depression (Marvin Goldfried) ! Session 3 Comparing Tr eatment Approaches (moderated by Joanne Davila and panelists Bonnie Conklin, Marvin Goldfried, Robert Kohlenberg, and Jacqueline Persons)

TO ORDER OR, ORDER ONLINE AT www.abct.org | click on ABCT STORE

Individual DVDs— $55 each • “Doing Psychotherapy”: Individual sessions — $55 / set of three—$200

Visa | MasterCard | American Express shipping & handling

U.S./Canada/Mexico 1–3 videos: $5.00 per video Name on Card 4 or more videos: $20.00 Card Number CVV Expiration Other countries 1 video: $10.00 2 or more videos: $20.00 Signature

February • 2018 107 the Behavior Therapist PRSRT STD Association for Behavioral U.S. POSTAGE and Cognitive Therapies PAID 305 Seventh Avenue, 16th floor New York, NY 10001-6008 Hanover, PA 212-647-1890 | www.abct.org Permit No. 4

ADDRESS SERVICE REQUESTED

call for submissions The ABCT Research Facilitation Committee is sponsoring a grant of up to $1000 to support graduate student research. Eligible candidates are graduate student members of ABCT seeking funding for currently unfunded thesis or dissertation research. Grant will be awarded based on a combination of Graduate merit and need.

Student For full information on what to submit, please go to: http://www.abct.org/Resources/?m=mResources&fa= Research GraduateStudentGrant To submit: please e-mail all required documents to Dr. Nathaniel Herr at Grant [email protected].

The grant will be awarded in November 2018, with the award recipient announced and presented with the funds during the Friday evening Awards Ceremony at the November 15-18 Annual Convention in Washington, DC.

For more information on the grant and application procedures and requirements, please visit the ABCT website at www.abct.org/Awards/

▲ Applications are due April 23, 2018