Category: Treatment - CBT
Jennie Kuckertz, Ph.D.
Instructor
McLean Hospital/Harvard Medical School
Belmont, Massachusetts
Stefan Hofmann, Ph.D.
Professor
Boston University
Boston, Massachusetts
Jennie Kuckertz, Ph.D.
Instructor
McLean Hospital/Harvard Medical School
Belmont, Massachusetts
Joseph McGuire, Ph.D.
Assistant Professor
Johns Hopkins University School of Medicine
Baltimore, Maryland
Frederick Aardema, Ph.D.
University of Montreal
Montreal, Quebec, Canada
Esther Howe, M.A.
University of California, Berkeley
Berkeley, California
Cognitive behavioral interventions are deemed “gold-standard” for a variety of psychiatric illnesses, yet up to 50% of patients experience minimal benefits after treatment. Typically the framing is such that the interventions themselves are considered efficacious, with a subset of patients being labeled as “treatment refractory” or “non-responders.” This framing may have the unfortunate effect of increasing mental health stigma by suggesting that the patient “failed” at treatment, rather than the treatment failing the patient. Additionally, by placing the burden on the patient for non-response, it decreases the urgency for providers to better understand and respond to the specific ways in which extant first line treatments fail to meet the needs of up to half of patients who receive them.
The current symposium will feature four talks highlighting different approaches to understanding how and why first-line interventions do not equally benefit all patients, as well as alternate approaches to responding to diverse patient needs in treatment. Kuckertz will present data from a large sample of patients (N = 1343) who received exposure and response prevention in intensive/residential treatment for obsessive compulsive disorder (OCD). Specifically, she will demonstrate how a network approach to examining baseline differences in orientation towards one’s distress yields insights into for whom treatment fails to yield significant impact. McGuire will describe patterns of extinction learning among youth (N = 100) with and without OCD, with findings suggesting that impairments in extinction learning among youth with OCD correspond to specific clinical characteristics. Such findings highlight the potential of novel and/or augmentative therapeutic strategies to precisely target and resolve these impairments. Aardema’s talk will directly address the issue of ERP non-response by presenting results from a randomized controlled non-inferiority trial (N = 100) comparing standard ERP treatment to inference-based cognitive behavior therapy (I-CBT) for OCD. Specifically, he will share findings regarding the role of overvalued ideation and treatment acceptability, tolerability, and satisfaction for ERP compared to I-CBT. Howe will introduce a novel analytic method of identifying person-specific latent mood states and their associations with mood and anxiety behavioral outcomes reported across therapy, as well as implications for clinical practice that focus on the unique needs of each individual. Finally, Dr. Stefan Hofmann – an renowned expert in psychotherapy outcome and processes – will contextualize these presentations with the broader literature and discuss future directions for how our field can better respond to the specific needs of the patients we serve. Consistent with this year’s conference theme focused on cognitive behavioral approaches to disaster response, our symposium is focused on how, as a field, we can deploy cutting edge methodology, intervention approaches, and conceptual frameworks to better respond to the urgent mental health crisis currently faced in the United States and across the world.Learning Objectives:
Presenter: Jennie M. Kuckertz, Ph.D. – McLean Hospital/Harvard Medical School
Co-author: Richard J. McNally, Ph.D. – Harvard University
Co-author: Bradley Riemann, Ph.D. – Rogers Behavioral Health
Co-author: Claudia Van Borkulo, Ph.D. – University of Amsterdam
Co-author: Benjamin Bellet, M.S. – Harvard University
Co-author: Nathaniel Van Kirk, Ph.D. – McLean Hospital/Harvard Medical School
Co-author: Jason Krompinger, Ph.D. – McLean Hospital/Harvard Medical School
Co-author: Martha Falkenstein, Ph.D. – McLean Hospital/Harvard Medical School
Presenter: Joseph F. McGuire, Ph.D. – Johns Hopkins University School of Medicine
Presenter: Frederick Aardema, Ph.D. – University of Montreal
Presenter: Esther Howe, M.A. – University of California, Berkeley
Co-author: Aaron J. Fisher, Ph.D. – University of California, Berkeley