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(Safety) Behavior Therapy for PTSD (June 2024)

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About the Event

Cognitive Behavior Institute is excited to welcome Jason T. Goodson, PhD for a live interactive webinar on: (Safety) Behavior Therapy for PTSD

Date: June 7th, 2024
Time: 8:30am-4:30pm EST
Location: online via zoom webinars
*Participants will not have access to their cameras/microphones
Cost: $19.99
Level: Intermediate
Credit Hours: 7 CEs (6 hours of clinical content and 1 hour of content related to suicide prevention.)

(Safety) Behavior Therapy for PTSD is a simple and effective behavior therapy that focuses on reducing and countering safety behaviors to treat PTSD. Safety behaviors are well established in the etiology and maintenance of PTSD (Dunmore et al., 1999). These behaviors both maintain the sense of threat characteristic of PTSD and prevent the processing of traumatic memories (Goodson & Haeffel, 2022). Safety behavior usage is also associated with smaller treatment gains in PTSD treatments (Goodson & Haeffel, 2018). Surprisingly, relatively little attention is given to safety behaviors in the treatment of PTSD and no treatments have been developed that solely focus on safety behaviors. This is somewhat surprising given that early conceptual models emphasized safety behaviors (Dunmore et al; 1999), several of the symptoms of PTSD are themselves safety behaviors (e.g., vigilance, avoidance, etc.), and safety behavior usage is well known to interfere with CBT treatment outcomes (Helbig-lang et al., 2017). (S)B-PTSD is divided into the following phases: 1) assessment, education, awareness building; 2) addressing safety behaviors related to intrusive memories; 3) addressing threat-related safety behaviors; and 4) moving forward. (S)B-PTSD also contains 3 optional modules specific to PTSD, which include: 1) Trust-related safety behaviors 2) Withdrawal and Avoidance-related safety behaviors, and 3) Rumination-related safety behaviors. The first phase culminates with a Master List of safety behaviors to be addressed in treatment and leads into the intrusive memory processing phase. This begins with Welcoming Intrusions, which is a mindfulness-based practice for calling up and holding intrusive memories along with the feelings that accompany them. Clients are also taught how to accept intrusions in real time. Next, purposeful trauma recall is carried out, which is a scene-by scene walk-through of the traumatic event (along with holding images and feelings for each scene). Following, trauma narrative writing is carried out in 1-2 sessions and the narrative is continued to be read until by the client feels ready to stop. Other potential interventions in this phase include addressing keeping one’s mind occupied, (e.g., do nothing for 30 minutes) countering avoidance of triggers (e.g., trigger seeking);countering avoidance of the memory (e.g.,. talking with others about the trauma when appropriate), and countering intrusions through art (e.g., drawing the trauma,, writing a poem, writing letters, etc.). These continue until the client feels the trauma has been processed. Additionally, a measure called the Intrusive Memory Questionnaire is used to help assess the extent to which the memory has been processed and this phase completed. The next phase addresses threat -related safety behaviors. This phase has a primary emphasis on countering vigilance. As an augmentation strategy, Attention Training can be used to help develop attention flexibility and the ability to refocus out of threat-based vigilance states. Two primary strategies are used to address vigilance. The first is a mindfulness intervention known as Recognize, Drop, and Refocus. The next are blocking interventions where clients are taught ways to prevent themselves from scanning for danger. While vigilance is the primary focus of this phase, other safety behaviors are addressed in this phase as well (checking, escape, evade, planning, excessive preparation, etc.). During this phase, the goal to work through all the safety behaviors on the master list. The SBAF-PTSD subscale is a useful measure for helping determine when clients are ready to end this treatment phase. The final phase of treatment is Moving Forward, which is a discussion of progress and how to maintain gains in treatment.

(S)B-PTSD also has three optional modules that can be useful, especially for relationship distress and/or depression. These include: 1) trust-related safety behaviors (identifying and countering interpersonal protective safety behaviors); 2) withdrawal and avoidance safety behaviors (identifying and incorporating valued activities and valued relationships, and countering avoided situations), and 3) rumination (monitoring and reducing/countering rumination). Early effectiveness data show large treatment effects for (S)B-PTSD. One PTSD clinical team and several trainees have undergone this training for (S)B-PTSD and approximately 25 cases have been completed. Outcomes show reductions similar to those seen in prolonged exposure therapy with significant decreases in PTSD, depression, intrusions, and safety behaviors and significant increases in quality of life. A description of the treatment and early outcomes have
published in the Journal of Clinical Psychology and Special Education (Goodson & Haeffel, 2022).

Participants will be given client and therapist workbooks along with helpful treatment forms and materials. They will also be given a copy of the Safety Behavior Assessment Form and the recently validated PTSD subscale.



Introduction 8:30am – 8:45am
What are safety behaviors and
Why are they important?
8:45am – 10:15am
Break 10:15am – 10:30am
How to carry out (S)B-PTSD- Assessment,
Education, monitoring
10:30am – 12:00pm
Lunch 12:00pm – 12:30pm
How to carry out (S)B-PTSD- Intrusive memory processing and threat-related safety behaviors 12:30pm – 2:30pm
Break 2:30pm – 2:45pm
Moving forward & Trust, Withdrawal, Avoidance
2:45pm – 4:15pm
Question and answers 4:15pm – 4:30pm
Adjourn 4:30pm

Learning Objectives:
  1. Participants will identify safety behaviors in PTSD
  2. Participants will define safety behaviors, identify different categories, and describe their function (how they maintain PTSD)
  3. Participants will identify core fears/beliefs that underlie safety behaviors and explain the mutual maintaining relationship between core fears/beliefs and safety behaviors
  4. Participants will describe the procedures for administering and scoring the safety behavior assessment form (SBAF) identify primary SBAF subscale, and use the primary SBAF subscale to measure progress throughout treatment
  5. Participants will identify central safety behaviors and create a master list of safety behaviors to be addressed in treatment.
  6. Participants will effectively explain the rationale for safety behavior elimination and countering as a treatment for PTSD
  7. Participants will describe strategies for reducing/eliminating safety behaviors and effective strategies for helping clients address all safety behaviors on master list
  8. Participants will identify approximately 3 core fears associated with client’s safety behaviors and develop countering exercises for each of the fears (and related safety behaviors) or negative beliefs and effectively.
  9. Participants will describe Attention Training and Welcoming Intrusions, be able to provide rationales, and guide clients through them.
  10. Participants will describe when and how to assess clients for suicidality within the context of behavior therapy for PTSD
  11. Participants will identify three factors that increase risk of suicidality in patients with PTSD

Instructor Bio:

 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.

Course bibliography:

Behavior Therapy for Anxiety & PTSD (BTAP) Manuals

Client Manual: Goodson, J.T. (2021). (Safety) Behavior Therapy for PTSD (unpublished treatment manual).

Therapist Manual: Goodson, J.T. (2021) (Safety) Behavior Therapy for PTSD (unpublished manual)

Publications related to the treatment

Dunmore, E., Clark, D.M. & Ehlers, A. (1999). Cognitive factors involved in the onset and maintenance of posttraumatic stress disorder (PTSD) after physical or sexual assault. Behaviour Research and Therapy, 37, 809-829.

Goodson, J.T. & Haeffel, G.J. (2022). Treating Posttraumatic Stress Disorder in Combat Veterans: A Guide to Using Behavior Therapy for Anxiety and PTSD (BTAP). Clinical Psychology and Special Education, 2022. Vol. 11 (Accepted for Publication).

Goodson, J.T. & Haeffel, G.H. (2018). Preventative and restorative safety behaviors: Effects on exposure treatment outcomes and risk for future anxious symptoms. Journal of Clinical Psychology,74, 1657-1672

Goodson, J.T, Haeffel, G.J., Raush, D.A.,& Hershenberg, R. (2016). The safety behavior assessment form: Development and validation. Journal of Clinical Psychology,72, 10, 1099-1111. DOI: 10.1002/jclp.22325.

Goodson, J.T. (2017). Outcome evaluation in psychotherapy. SAGE Encyclopedia of Abnormal and Clinical Psychology. SAGE: Thousand

Goodson, JT, Helstrom, A., Halperen, J., Ferenschak, M., Gillihan, S., Powers, M. (2011). The Treatment of Posttraumatic Stress disorder in U.S. Combat Veterans: A Meta-Analytic Review. Psychological Reports, vol. 109, pp. 573-599.

Helbig-Lang, S., Richter, J., Thomas, L. et al (2014).The role of safety behaviors in exposure-based treatment for panic disorder and agoraphobia: Associations to symptom severity, treatment course, and outcome. Journal of Anxiety Disorders , 28, 836-844.

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