Keywords: Motivation, Psychotherapy Outcome, Treatment Level of Familiarity: Moderate to Advanced Recommended Readings: Chapman, A.L., & Rosenthal, M.Z. (2016). Managing therapy-interfering behavior: Strategies from Dialectical Behavior Therapy. APA: Washington, DC. Davis, M. et al. (2020). Clinicians’ perspectives of interfering behaviors in the treatment of anxiety and obsessive-compulsive disorders in adults and children. Cognitive & Behavioral Therapy, 49, 81-96. Neziroglu, F., & Mancusi, L. (2014). Treatment resistant OCD: Conceptualization and treatment. Current Psychiatry Reviews, 10, 289-295.
Professor Emeritus Saint Louis University St. Louis, Missouri
Though cognitive and behavioral therapies are effective with a variety of disorders, a substantial portion of patients do not respond adequately, often due to the presence of treatment-interfering behavior (TIB). For many years, CBT research devoted little attention to the management of TIB, but this trend has reversed over the past 2 decades. Interventions specifically designed to modify TIB or to otherwise promote therapy engagement have emerged from various cognitive and behavioral therapeutic orientations (e.g., CT, ACT, DBT). However, no single intervention addresses all of the potential factors associated with TIB. In this workshop, the presenter will describe a conceptual model that integrates the various factors associated with TIB and demonstrate how the model can be used to guide the clinical management and treatment of TIB. The workshop will include lecture, video demonstrations, and case presentations.
Outline: I. History and Evolution of the Concept: Treatment-Interfering Behavior (TIB) II. Current Efforts within CBT to Address TIB III. An Integrated Approach: Treatment Readiness Therapy A. Navigating the focus of therapy from presenting problem to TIB B. Identifying which TIB to treat C. Developing operational outcome goals that indicate treatment readiness D. Identifying factors contributing to the TIB E. Developing interventions to address each factor driving the TIB F. Implementing the interventions G. Resuming treatment of the presenting problem
Learning Objectives:
At the end of the session, the learner will be able to:
Identify when to discontinue treatment of the presenting problem and direct the focus of therapy on treatment-interfering behavior.
Administer an instrument designed to identify different types of treatment-interfering behavior.
Develop clearly defined goals and objectives to delineate when treatment of the presenting problem can be successfully resumed.
Describe a conceptual model for understanding the 4 factors that can drive treatment-interfering behavior.
Develop and implement interventions designed to prevent, manage, or modify treatment-interfering behavior.
Long-term Goal: Increase their efficacy with patients often considered treatment-resistant.
Long-term Goal: Reduce the time they spend administering ineffective therapy.