Obsessive-Compulsive Disorder (OCD) is common, disabling and frequently misunderstood in clinical practice. In this episode of Practical for Your Practice, hosts Dr. Jenna Ermold and Kevin Holloway are joined by Dr. Elizabeth McIngvale and Dr. Lauren Wadsworth, two nationally recognized leaders in OCD treatment and training, for a deep dive into Exposure and Response Prevention (ERP), the gold-standard treatment for OCD.

Together, they unpack why OCD is so often misdiagnosed, mistreated, or unintentionally reinforced, even by well-intentioned clinicians, and how ERP works to interrupt the obsession–compulsion cycle by targeting avoidance, ritualizing, and intolerance of uncertainty.

Be sure to listen in and remember, we want to hear from you! Have thoughts about this episode? A “clinical sin” you’ve encountered? Ideas for future topics or guests?

Leave us a voicemail via SpeakPipe https://www.speakpipe.com/cdpp4p Or send us an email [email protected] . We love hearing from our listeners.

As always, until next time, stay curious, and mind your EBPs.

Elizabeth McIngvale, Ph.D., LCSW, is the Director of the OCD Institute of Texas, Co-Founder of MHNTI, and faculty at Baylor College of Medicine. A renowned OCD expert, she has published 35+ peer-reviewed works and delivered 250+ lectures. She founded the Peace of Mind Foundation and OCDChallenge.org, now part of the IOCDF, where she serves as a Board Member and former national spokesperson. Diagnosed with OCD at age 12, Dr. McIngvale brings a unique dual perspective as both a clinician and advocate. She has advised NIH and SAMHSA and serves as a faculty instructor for the Behavioral Therapy Training Institute. She remains dedicated to advancing research and expanding access to high-quality care for OCD and anxiety disorders.

Dr. Lauren Wadsworth is a board-certified clinical psychologist and Clinical Senior Instructor at the University of Rochester Medical Center. She is the founding director of Genesee Valley Psychology (GVP), providing accessible evidence-based care in Western NY, and Meridian Psychology Practice, serving NY, MA, and GA. As a leader in mental health education, she co-founded the Mental Health National Training Institute (MHNTI) and Twin Stars Diversity Trainers. An expert in diversity and inclusion, she co-authored Did That Just Happen?! Beyond "Diversity" — Creating Sustainable and Inclusive Organizations. Dr. Wadsworth is dedicated to expanding access to evidence-based treatment and fostering inclusive environments through app-based training and organizational consultation.

Resources mentioned in this episode:

• Mental Health Network & Training Institute (MHNTI) Evidence-based training and consultation for OCD and related disorders https://mhnti.com
• International OCD Foundation (IOCDF) Clinician training, resources, and treatment referrals https://iocdf.org

Calls-to-action:

• Subscribe to the Practical for Your Practice Podcast
• Submit your comments or questions on our social media pages or via Speakpipe
• Subscribe to The Center for Deployment Psychology Monthly Email

Terminations in therapy should be expected, but they often catch us – patients and providers – off-guard. What is the best way to talk about termination? What if it’s unexpected? Is “termination” even the right word? This episode finds your hosts inspired by two listeners, one of whom asked us to muse on the topic of ending the therapy relationship. And what better way to terminate 2025 than by exploring this topic? Thanks, Jane!

Resources mentioned in this episode:

• CDP’s consultation services: https://deploymentpsych.org/resources/consultation-services

Calls-to-action:

• Make use of consultation when facing a challenging termination
• Consider using a psychotherapy plan to articulate the treatment and termination process from the beginning
• Incorporate ongoing assessment throughout to inform treatment and termination
• Subscribe to the Practical for Your Practice Podcast
• Submit your comments or questions on our social media pages or via Speakpipe
• Subscribe to The Center for Deployment Psychology Monthly Email

Stop dodging those complex questions about AI and mental health! Join Drs. Kevin Holloway and Jenna Ermold as they engage with the brilliant Dr. April Foreman, Director of Technology and Innovation at the Veterans Crisis Line, for a conversation that proves tech is no longer optional—it's essential. Dr. Foreman pulls back the curtain on the sobering reality: the demand for evidence-based suicide prevention care is simply too vast for traditional methods to meet. Discover the shocking "sin" of EBP practice we might all be committing, learn how simple AI tools (like automated scribing) can boost your clinical fidelity, and find out what happens when a clinical expert "red-teams" popular chatbots for suicidality. Get the insights you need to confidently apply your ethical framework to the future of care and conquer your fear of the algorithmic boogeyman!

April C. Foreman, Ph.D., is a Licensed Psychologist serving Veterans as Director of Technology and Innovations for the Veterans Crisis Line. She is a member of the team that launched OurDataHelps.org, a recognized innovation in data donation for ground-breaking suicide research. She is passionate about helping people with severe (sometimes lethal) emotional pain, and in particular advocates for people with Borderline Personality Disorder, which has one of the highest mortality rates of all mental illnesses. She is known for her work at the intersection of technology, social media, and mental health, with nationally recognized implementations of innovations in the use of technology and mood tracking. She is the 2015 recipient of the Roger J. Tierney Award for her work as a founder and moderator of the first sponsored regular mental health chat on Twitter, the weekly Suicide Prevention Social Media chat (#SPSM, sponsored by the American Association of Suicidology, AAS). Her dream is to use her unique skills and vision to build a mental health system effectively and elegantly designed to serve the people who need it.

Resources mentioned in this episode:

• CDP’s 2025 EBP Conference Archive including presentations by Dr. April Foreman, Dr. Vaile Wright, Dr. Matt Price, and Drs. Vaile Write and David Cooper’s PMI.
• Therapists in Tech: therapistsintech.com
• 988 (press 1) Veteran’s Crisis Line
• veteranscrisisline.net - Call, text, or chat for 24/7 confidential crisis support for Veterans and their loved ones

Calls-to-action:

• Spend time with new technology–learn about it experientially
• Get involved! Be part of the solution with emerging technologies rather than willfully avoiding them.
• Subscribe to the Practical for Your Practice Podcast
• Subscribe to The Center for Deployment Psychology Monthly Email
• Leave us a question or comment on Speakpipe

Dr. Robin Brody is back to tackle a critical gap in clinical training: narcissism and its devastating impact. We cut straight to the core, defining narcissism by its signature trait, entitlement, and exploring the clinical distinctions between grandiose, vulnerable, and malignant subtypes. The episode then dives into the flip side: narcissistic abuse. Learn to spot the confusing dynamics clients face, including performative empathy, denial of reality (often called gaslighting), trauma bonding through intermittent reinforcement, and the predictable cycle of idealization, devaluing, discard, and hoovering. Most crucially, we discuss the "sin" of inadequate provider training and the risk of how applying standard components of evidence-based treatment, like assertiveness skills, can tragically fail or even place survivors in danger.

Dr. Robin Brody is an Assistant Professor of Psychiatry (Voluntary) at Weill Cornell Medicine and the founder of Dr. Robin Brody Psychological Services, a private practice specializing in the treatment of occupational trauma, PTSD, and couples therapy, and gender and sexually diverse individuals. Her work is driven by a deep commitment to helping trauma survivors, particularly those facing PTSD and moral injury.

Her expertise and demonstrated passion center on treating trauma survivors, particularly those with PTSD and moral injury. In doing so, Dr. Brody has worked with diverse populations of civilians, veterans of all branches and eras, first responders, healthcare workers, and 9/11 survivors and responders across the diagnostic and demographic spectrum. Dr. Brody started and ran an EBP for PTSD program within the World Trade Center Mental Health Program, where she trained and supervised providers in PE and CPT. Before joining Mount Sinai's World Trade Center Mental Health Program, Dr. Brody served on the faculty at Weill Cornell Medicine. In that capacity, Dr. Brody oversaw Weill Cornell's Military Families Wellness Center and worked within the Program for Anxiety and Traumatic Stress Studies (PATSS), where she was a co-investigator on numerous clinical research studies involving the treatment of PTSD, particularly among frontline healthcare workers amidst the COVID-19 pandemic. In all her efforts, Dr. Brody is committed to increasing access to, and training, in evidence-based treatments, especially for PTSD. Dr. Brody's research interests include PTSD treatment innovation and the role of shame, stigma, and identity in trauma recovery.

Resources mentioned in this episode:

• DSM-5 Alternative Model of Personality Disorders
• It’s Not You, Dr. Ramani Durvasula

Calls-to-action:

• Utilize Diagnostic Frameworks: Look into the DSM-5 Alternative Model of Personality Disorders as a useful framework for understanding healthy personality functioning and personality disorders, including narcissism.
• Obtain additional training on NPD and narcissistic abuse
• Subscribe to the Practical for Your Practice Podcast
• Subscribe to The Center for Deployment Psychology Monthly Email
• Leave us a question or comment on Speakpipe

Feeling stressed? You’re not alone! And that’s exactly the point of this lively episode of Practical for Your Practice! Hosts Jenna Ermold and Carin Lefkowitz welcome back the always-animated (and self-proclaimed “gesturing Italian”) Dr. Gabriel Paoletti for a refreshingly human take on stress.

From cheesesteaks to “mamma mia” stress cues, this conversation dives into how we can rethink stress, not as something to eliminate, but as a signal that something meaningful is at stake. Dr. Paoletti breaks down how stress can actually help performance, especially when we approach it as a shared experience, a “team sport”, instead of a solo battle.

Tune in for practical strategies (and a few laughs) on how to build your “stress team,” use humor to stay grounded, and create simple cues that help you, and those around you, catch stress before it catches you.

Bonus: Find out why “halloumi” might be the most unexpectedly perfect stress word ever.

You can leave us a voice mail message at speakpipe.com/cdpp4p, or send us an email at [email protected]. Your message could be featured in an upcoming episode!

Dr. Gabriel Paoletti is the Director of Human Performance Optimization (HPO) Integration and HPRC in support of the Advanced Research for Military Optimization, Readiness, and Rehabilitation (ARMORR) – Consortium for Health and Military Performance (CHAMP), a center at the Uniformed Services University in Bethesda, Maryland. He oversees the strategic and operational components of delivering comprehensive health and performance education on Total Force Fitness and Human Performance Optimization to the DoD and national security community. Over the past 15+ years, Dr. Paoletti has applied the latest human performance research to create and lead over 400 distinct human performance optimization and leadership development programs for audiences throughout the world, ranging from leaders at the Pentagon, Army, Marine, Air Force, Navy, Coast Guard service members to Fortune 500 companies, professional athletes, CEO’s and government leaders. Under his leadership, his team has been officially selected to develop holistic human performance curricula for half of the U.S. Armed Forces. Dr. Gabriel Paoletti graduated from Saint Joseph’s University with a double major in economics and philosophy, graduating first in his class in both majors. He received his Master of Applied Positive Psychology from the University of Pennsylvania and his Doctor of Education in Leadership from Creighton University.

Resources mentioned in this episode:

• https://www.hprc-online.org/mental-fitness/stress/unlock-your-full-potential-hprcs-personal-stress-toolkit
• https://www.hprc-online.org/mental-fitness/mental-health/build-your-stress-team

Calls-to-action: For example:

• Identify who is on YOUR stress team
• Review the resources from HPRC
• Subscribe to the Practical for Your Practice Podcast
• Subscribe to The Center for Deployment Psychology Monthly Email
• Leave us a question or comment on Speakpipe

Suicide prevention isn’t only about assessing current risk for self-harm. It’s also about recognizing that we can’t predict if and when that risk will increase. Patients spend most of their lives outside of our office, and an unexpected crisis can increase their risk of self-directed violence exponentially. The risk may be especially heightened for firearm owners, who have immediate access to a highly lethal method of injury. Fortunately, that risk can be reduced if we simply put a few moments’ delay between impulse and action in the form of secure firearm storage. Yet many clinicians, including our hosts, shy away from that conversation, especially with military-connected patients. Our guest today, Dr. Curt West, offers common sense and clinically sound advice for how to engage in this important discussion.

Dr. James “Curt” West is an Associate Professor of Psychiatry and a Scientist at the Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences (USUHS). He is a Distinguished Fellow of the American Psychiatric Association (APA) and has presented to the APA on physician and patient conversations on firearm safety. In addition, he has participated in the forum on health and family firearm safety and created an online course for the APA on firearm safety. Dr. West is the host of the podcast “Let’s Talk About Your Guns.” Prior to his work at USUHS, he worked as a military psychiatrist and deployed to Iraq and Afghanistan as an Operational Stress Control and Readiness psychiatrist, and later served as the Deputy Commander of Behavioral Health at Walter Reed Army Medical Center.

Resources mentioned in this episode:

• An article from the APA Monitor, “Navigating Firearm Safety Discussions in Clinical Settings.” https://www.apa.org/monitor/2025/07-08/firearm-safety-clinical-settings

• The BulletPoints Project, a clinical resource for preventing firearm injury www.bulletpointsproject.org
• Fact sheets published by the Center for the Study of Traumatic Stress: www.cstsonline.org
• Let’s Talk About Your Guns podcast: https://www.cstsonline.org/suicide-prevention-program/projects/talk-about-guns
• Pause To Protect, a resource for safely storing firearms: www.pausetoprotect.org

Calls-to-action: For example:

• Explore the resources mentioned in this podcast to learn more about firearm safety and its connection to suicide prevention
• Listen to the “Let’s Talk About Your Guns” podcast to empower yourself to engage in conversations about firearm safety with your patients.
• Subscribe to the Practical for Your Practice Podcast
• Subscribe to The Center for Deployment Psychology Monthly Email
• Leave us a question or comment on Speakpipe

We often think of nightmares as a symptom that occurs as part of another condition, like PTSD or depression. But nightmares can be frequent and disruptive enough that they require their own clinical focus. We currently have 3 gold standard options for treatment: Imagery Rehearsal Therapy; Exposure, Relaxation, and Rescription Therapy; and Lucid Dreaming. Our guest today, Dr. Courtney Worley, introduces us to the diagnosis of Nightmare Disorder, explains why it deserves its own attention, and gives us an overview of the most effective treatments. Join us for a discussion that appeals to sleep nerds and healthy skeptics alike.

Dr. Courtney Worley is a Diplomate In Behavioral Sleep Medicine and Board-Certified Clinical Psychologist. She completed her Ph.D. in clinical psychology in 2012 at The University of Alabama with specialized coursework in health and geropsychology. Dr. Worley specializes in providing Evidence Based Psychotherapies for PTSD, Insomnia, Nightmares and Depression. She has an active clinical practice in the Department of Veterans Affairs, at Upward Behavioral Health, and with NOCTEM Health. She is the co-author of The nightmare and sleep disorder toolkit: A workbook to help you get some rest using imagery rehearsal therapy and other evidence based approaches from New Harbinger Publications.

Resources mentioned in this episode:

• The Nightmare and Sleep Disorder Toolkit: A Workbook to Help You Get Some Rest Using Imagery Rehearsal Therapy and Other Evidence-Based Approaches by Courtney Worley and Michael Nadorff.
• Geoffroy, P. A., Borand, R., Ambar Akkaoui, M., Yung, S., Atoui, Y., Fontenoy, E., Maruani, J., & Lejoyeux, M. (2022). Bad Dreams and Nightmares Preceding Suicidal Behaviors. The Journal of clinical psychiatry, 84(1), 22m14448. https://doi.org/10.4088/JCP.22m14448

Calls-to-action: For example:

• Routinely ask about nightmares and dreams as part of your clinical assessment
• Obtain training in at least one of the evidence-based treatments for nightmare disorder
• Subscribe to the Practical for Your Practice Podcast
• Subscribe to The Center for Deployment Psychology Monthly Email
• Leave us a question or comment on Speakpipe or our social media channels

Welcome back to Practical for Your Practice! In our Season 7 kickoff, hosts Drs. Jenna Ermold, Kevin Holloway, and Carin Lefkowitz set the stage for a new theme: The Seven Sins of Evidence-Based Practice. Inspired by Carin’s favorite film Seven, this season dives into the common pitfalls clinicians face when delivering EBPs and how we can learn, grow, and support each other through them.

In this episode, our hosts get candid about their own “sins”:

• Kevin reflects on the dangers of “EBP stew” – straying from validated protocols without consultation.
• Carin admits to the “sexy assessment sin” – neglecting routine and thorough assessment, both at intake and throughout treatment.
• Jenna opens up about perfectionism – the belief that you must be flawless before implementing EBPs, which can hold clinicians back from valuable learning experiences.

Together, they emphasize that these “sins” aren’t failings, they’re part of being human and growing as providers. With humor, food analogies, and lots of honesty, the team models how to normalize mistakes, seek consultation, and embrace imperfection on the path to better care.

Actionable Intel:

1. Stick close to validated EBP protocols and get consultation to avoid drift.
2. Invest in both initial and ongoing assessment to guide treatment decisions and track progress.
3. Don’t let perfectionism keep you from starting – growth happens in the doing.

Join the Conversation: Have your own “EBP sin” to confess? Share your stories with us! Email, leave a voicemail on SpeakPipe, or connect with us on social media.

Stay tuned for more episodes this season as our guests share their own challenges, lessons learned, and strategies for avoiding (or recovering from) the Seven Sins of EBP.

Until next time—stay curious, and mind your EBPs.

Calls-to-action:

• Share your "EBP sin" via SpeakPipe, email ([email protected]) or on social media
• Subscribe to the Practical for Your Practice Podcast
• Subscribe to The Center for Deployment Psychology Monthly Email: https://deploymentpsych.org/CDP-MED-Opt-In

Obstructive sleep apnea (OSA) is an increasingly common diagnosis. Yet most behavioral health providers are unaware that they can play a role in both the assessment and treatment of OSA in their patients. Today we’re joined by an expert in the subfield of sleep psychology, Dr. Phil Gehrman. He shares basic information about what OSA is, how providers can effectively screen for it, and how they can facilitate treatment for this dangerous condition. Despite what you might have heard before, Dr. Gehrman posits that behavioral health providers can play “a huge potential role that really is untapped.”

Dr. Phil Gehrman is Professor of Psychology in the Department of Psychiatry of the University of Pennsylvania School of Medicine. He directs the Sleep, Neurobiology and Psychopathology lab at Penn. He has an active research program exploring the mechanisms and treatment of sleep and circadian dysregulation in the context of mental health disorders. Dr. Gehrman’s clinical specialization is on the delivery of cognitive behavioral and chronotherapeutic interventions for insomnia, circadian rhythm disorders, and other sleep disorders. The overarching goal of his work is to advance the understanding of the links between sleep and mental illness through translational research that spans biology to therapeutics.

Resources mentioned in this episode:

• STOP Screening tool for Obstructive Sleep Apnea: https://deploymentpsych.org/content/insomnia-tools
• Motivational Interviewing for CPAP Adherence: Rapelli G, Pietrabissa G, Manzoni GM, Bastoni I, Scarpina F, Tovaglieri I, Perger E, Garbarino S, Fanari P, Lombardi C and Castelnuovo G (2021) Improving CPAP Adherence in Adults With Obstructive Sleep Apnea Syndrome: A Scoping Review of Motivational Interventions. Front. Psychol. 12:705364. doi: 10.3389/fpsyg.2021.705364
• Motivational Interviewing resources: https://deploymentpsych.org/Clinical-Skills-Resources
• Systematic desensitization: https://www.veterantraining.va.gov/insomnia/docs/PAP_Desensitization.pdf
• Practical for Your Practice voice mail: speakpipe.com/cdpp4p
• Practical for Your Practice email: [email protected]

Calls-to-action:

• Incorporate the STOP into your practice
• Become familiar with behavioral and motivational approaches listed above
• Connect with your local sleep medicine clinic
• Reach out to us via Speakpipe with your questions and comments
• Subscribe to the Practical for Your Practice Podcast
• Subscribe to The Center for Deployment Psychology Monthly Email at https://deploymentpsych.org/CDP-MED-Opt-In

Evidence-based psychotherapies for post-traumatic stress disorder (PTSD), such as Prolonged Exposure and Cognitive Processing Therapy, are the best tools we have to treat PTSD for most people–at least as long as those in need are able to access these therapies. A number of barriers may exist, such as availability of trained therapists, insurance coverage (or lack thereof), or even life stressors standing in the way. During the COVID-19 pandemic, trauma exposure exploded exponentially while at the same time access to care due to lockdowns and social distancing was severely diminished. In this episode of Practical for Your Practice, we chat with Dr. Sheila Rauch, one of the authors of the Prolonged Exposure Therapist Guide, about her many exciting projects to expand access to effective care for PTSD. As she explains, “the more doors that we have for people with PTSD to enter and get effective treatment, the more people are going to actually do that.” Join us for one of our new favorite episodes to hear about self-help approaches, PE in primary care, immediate interventions in emergency departments, and shifting the name of PE to “Processing Emotions.”

Sheila A.M. Rauch, Ph.D., ABPP, co-led design and now serves as Deputy Director of the Emory Healthcare Veterans Program and Director of Mental Health Research and Program Evaluation at the Joseph Maxwell Cleland Atlanta VA Medical Center. For over 20 years, Dr. Rauch’s work in VA and Academic Medical settings focuses on developing programs, conducting research, and providing PTSD and Anxiety Disorders treatment with the goal to improve access to effective mental health treatment. Her research focuses on examination of mechanisms involved in the development and treatment of PTSD and improving access to effective interventions. She has led several PTSD treatment outcome and mechanisms trials including pharmaceutical and therapy trials focused on moving interventions for PTSD into medical and primary care settings. She has published over 220 peer-reviewed scholarly articles as well as many chapters and six books on anxiety disorders and posttraumatic stress disorder (PTSD). She developed an effective primary care based PTSD intervention that is in use across VA and many civilian settings and has also worked to get treatment out of the clinic and into the hands of those who need it with apps, self-guided workbooks, and web-based interventions. Her work examines neurobiology and factors involved in the development, maintenance, and treatment of anxiety disorders, psychosocial factors in medical settings, and the relation between physical health and anxiety. Her recent books include Retraining the Brain and Making Meaning of Difficult Experiences.

Resources mentioned in this episode:

• Rauch, S. A. M., & Rothbaum, B. O. (2023). Making Meaning of Difficult Experiences: A Self-Guided Program. Oxford University Press.
• Virtually Better. (2024). Messy Memories [Mobile app]. Available on Google Play and Apple App Store
• PE in Primary Care training: VA and military providers can reach out to [email protected] for training, and civilian providers can reach out to [email protected]
• Practical for Your Practice voice mail: speakpipe.com/cdpp4p
• Practical for Your Practice email: [email protected]

Calls-to-action:

• Remember that emotions aren’t dangerous
• Get training in brief treatment models (e.g. PCPE. see above)
• Subscribe to the Practical for Your Practice Podcast
• Subscribe to The Center for Deployment Psychology Monthly Email at https://deploymentpsych.org/CDP-MED-Opt-In