About the Event
Cognitive Behavior Institute is excited to welcome Jason T. Goodson, PhD for a live interactive webinar on: PTSD Out-of-the-Box: Using Principles not Protocols
Date: April 7th, 2023
Time: 8:30am-12:45pm EST
Location: online via zoom webinars
Credit Hours: 4 clinical CEs
PTSD is a chronic and disabling condition with high comorbidity, distressing symptoms, and far-reaching negative effects (Rosemary et al., 2016, Goodson et al. 2011; Kline et al, 2021). PTSD sufferers experience internal distress, intimate relationship difficulties, social isolation, occupational problems, family disruption, and diminished quality of life (Paulus & Aupperle, 2015; Rosemnary et al. 2016; Yu et al 2016; Hernandez-Tejada et al., 2017; Sripada et al, 2018; Campbell and Renshaw, 2018, Creech and Misca, 2017,).
Fortunately, several evidence-based treatments exist and have been widely disseminated (Eftekahri et al. 2013; Chard et al. 2012). Large organizations such as the VHA have invested significant amounts of money and resources to train a large number of their providers in EBPs. In particular, by 2020 the number of VA providers trained in an EBP was estimated to be 11,600 with costs per provider and site estimated to be $1,485 and $43,000, respectively (Valenstein-Mah et al., 2020). This widescale training initiative have benefited thousands of veterans with PTSD whom have receiving an evidence-based treatment. Helping support this assertion are a growing number of treatment outcome studies have found large treatment effects for veterans with PTSD wo undergo EBPs (Goodson et al., 2017; Jeffrey et al., 2014; Shnurr et al., 2022).
However, while EBPs have flourished and come to be considered the gold-standard for PTSD treatment, several concerns have emerged. Research has consistently shown large drop-out rates ranging from 16% (Yoder et al., 30134) to 55 % (Schnurr et al., 2022). Further, those studies with lower drop-out rates have often used less stringent criteria for treatment completion (e.g., 6 sessions of PE) (Tuerk et al., 2011). In addition to high dropouts, 30-50 %of individuals do not respond with significant symptom reduction (Marmar, 2015). In fact, upwards of 40 percent of veterans who complete an EBP for PTSD continue to suffer with unchanged symptoms (Galsgaard & Eskelund, 2020; 2020; Schottenbauer et al. 2008). Similarly, anywhere from 32-72% of EBP completers do not achieve PTSD remission (they continue to retain the diagnosis of PTSD) (Steenkamp et al., 2015). Thus, it appears as if sole reliance on EBPs may lead to suboptimal treatment responses in a substantial minority of individuals with PTSD.
The purpose of this training is not to devalue EBPs. In fact, the author has been a PE trainer and consultant for the past 15 years and published several treatment outcomes studies it's effectiveness. However, it seems important to consider a broader range of interventions when it becomes clear that an EBP is not resulting in the desired symptom reduction. Most providers who treat PTSD can recall patients who dropped out or had a poor treatment response. It would seemingly be beneficial to have a broader set of tools (i.e., interventions) to bring to bear when patients are not responding. These interventions should be rooted in evidence but not necessarily a fixed protocol.
Several factors may lead to a less optimal fit for a PTSD EBP, including: lack of buy-in/motivation, difficulty tolerating high levels of distress with exposure, mismatch between most troubling symptoms and focus of EBPs, multiple traumatic events, negative beliefs about PTSD and treatment, positive beliefs about PTSD symptoms, rumination (vs intrusive memories, and difficulties learning cognitive restructuring). For each of these factors, specific treatment interventions will be discussed and key components in evidence-informed sessions will be presented. Further, a conceptual model of treatment-relevant factors will be presented. This model allows for multiple points of intervention. In addition, alternative measures to capture quality of life changes, changes in safety behaviors, changes in intrusions, changes in functional outcomes and others will be presented. Finally, illustrative examples of treatment cases who did not respond to EBP protocols but then had excellent responses to alternative, evidence-informed interventions will be presented.
Participants will be provided with useful treatment materials for evidence-informed interventions and a resource list for such interventions and/or treatments. The training will consist of lecture, group discussion, experiential exercises, and discussion of a conceptual model to help guide intervention selection. The duration of the training will be four hours.
Limitations with EBPs for PTSD & Factors that may result in less optimal fit with PTSD: 8:45-9:15
Treatments that have shown to be effective with PTSD: 9:15-9:30
Factors associated with PTSD and PTSD treatment outcomes 9:30-10:00
Out-of-the-Box interventions 10:15-11:00
Out-of-the box case examples 11:00-11:30
Conceptualization for Treating PTSD 11:30-12:15
QA & review of materials/handouts 12:15-12:45
1. Participants will discover various treatments that have been found to be effective with PTSD
2. Participants will examine some of the concerns associated with current EBPs for PTSD
3. Participants will identify alternative evidence-supported interventions and/or treatments for
4. Participants will identify various measures useful in measuring progress during PTSD
treatment and integrate them into their practice.
Dr. Goodson earned his PhD from Utah State University after completing a pre-doctoral internship at the Milwaukee VA Medical Center. He then completed a 2 year postdoctoral fellowship at Dartmouth Medical School in exposure-based treatment for anxiety disorders. After his fellowship, he began working in the VA system where he treats veterans with PTSD, anxiety, and mood disorders and continues to work in this capacity. In addition, Dr. Goodson is a staff psychologist at the Center for Anxiety and Behavior Therapy. He has published several scientific articles in the areas of Safety Behaviors, anxiety, and PTSD. He is interested in behaviors that perpetuate anxiety and PTSD. Dr. Goodson and colleagues developed and published the Safety Behavior Assessment Form (SBAF). The SBAF is a transdiagnostic measure of safety behaviors appropriate for a wide-range of anxiety conditions, including PTSD, generalized anxiety, social anxiety, panic, and health anxiety. The SBAF has been used to predict treatment response in PTSD and anxiety as well as the development of future anxiety in non-clinical populations. Dr. Goodson also created Behavior Therapy for Anxiety-Related Disorders (BTAD), which has its conceptual roots in past safety behavior therapy, but represents his uniquely effective approach to addressing safety behaviors. He wrote a client workbook and therapist guide to help guide the implementation of BTAD. Dr. Goodson also was the first to create a version of BTAD for PTSD (also known as BTAP). Preliminary outcomes using BTAP have been excellent with large effect sizes. Additionally, Drs. Goodson and Haeffel are currently running an anxiety prevention study using his safety behavior approach.
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