Practical for Your Practice

In this episode, Andy, Kevin, and Jenna chat with Dr. Carin Lefkowitz about CDP’s Second Life training assets. Unique affordances of virtual worlds (including some funny mishaps) are discussed along with some practical tips for making the best use of Second Life to improve your practice.

Carin M. Lefkowitz, Psy.D., is a clinical psychologist and Senior Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Lefkowitz earned her M.A. and Psy.D. in clinical psychology at Widener University, with a concentration in cognitive-behavioral therapy.

Resources mentioned in this episode:

• Second Life landing page in deploymentpsych.org, https://deploymentpsych.org/virtual-provider-training-in-second-life [timestamp]

Calls-to-action:

Subscribe to the Practical for Your Practice Podcast

Subscribe to The Center for Deployment Psychology Monthly Email

In this episode, we talk about the ways brain injury, sustained in the context of trauma, can have longer-lasting effects than other mTBI’s, and why mental health providers are in an ideal position to help clients focus on cognitive health by teaching strategies to improve functioning. Join us as Dr. Beth Twamley demystifies how the strategies used in Compensatory Cognitive Training (CCT) and Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) can help to address impairments in prospective memory, attention, learning and memory, and executive functioning. We hope you check out how this recovery-oriented approach can be incorporated into your practice to empower clients to make functional gains and improve their quality of life.

Dr. Twamley is a neuropsychologist and a Professor of Psychiatry at UC San Diego. Much of her work is based at the VA San Diego Healthcare System, where she is a VA Rehabilitation Research and Development Research Career Scientist and the Director of the Clinical Research Unit of the Center of Excellence for Stress and Mental Health. Dr. Twamley’s research has focused on cognitive training and other interventions to improve real-world functioning for individuals with psychiatric disorders, traumatic brain injuries, and other cognitive impairments. She has developed and evaluated Compensatory Cognitive Training (CCT) and Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) with funding from NIH, VA, DoD, NSF, BBRF/NARSAD, and UC San Diego grants. These treatment manuals and other clinical materials are available at no charge on her website, www.cogsmart.com.

Resources mentioned in this episode:

• http://www.cogsmart.com/ [18:40]
• https://www.youtube.com/channel/UCIZPMnYv3RDIYFI7CETy7sA [18:45]
• https://deploymentpsych.org/COGSmart-Archive [19:50]

Calls-to-action:

Review webinar recording on CogSMART https://deploymentpsych.org/COGSmart-Archive

Access manuals on the CogSMART website: http://www.cogsmart.com/

Subscribe to the Practical for Your Practice Podcast

Subscribe to The Center for Deployment Psychology Monthly Email

Who isn’t stressed these days? Stress seems ubiquitous in ourselves, our clients, and everyone else! The good news? According to our guest this episode, Dr. Gabriel Paoletti, stress doesn’t have to mean that things are going wrong. Stress is actually an indicator of the things that matter to us and what we care about. Listen with us as Dr. Paoletti stresses reorienting our approach from “feeling good” to “doing good.”

Gabriel Paoletti, EdD, MAPP.

Dr. Paoletti is a Mental Fitness Scientist at the Uniformed Services University’s Consortium for Health and Military Performance (CHAMP). He is a subject matter expert in mental skills, positive and performance psychology, resilience, and leadership. Dr. Paoletti translates basic and clinical research to create culturally appropriate, evidence-based, impactful written and multimedia educational resources and presentations in the Human Performance Resources by CHAMP (HPRC) team.

Resources mentioned in this episode:

• Human Performance Resources by CHAMP website - https://www.hprc-online.org [14:30]
• Create a “Stress Helps Me” Mindset worksheet - https://www.hprc-online.org/mental-fitness/spiritual-fitness/create-stress-helps-me-mindset/ [14:40]
• Make Stress Good For You! - https://www.hprc-online.org/mental-fitness/sleep-stress/make-stress-good-you [26:30]
• Active Constructive Responding - https://www.hprc-online.org/mental-fitness/sleep-stress/active-constructive-responding-acr-worksheet

Calls-to-action: For example:

Subscribe to the Practical for Your Practice Podcast

Subscribe to The Center for Deployment Psychology Monthly Email

In this episode we are joined by one of CDP’s suicide prevention experts, Dr. Sharon Birman, to talk about means safety counseling and how to work collaboratively with a person in suicidal crisis to more effectively mitigate harm. Come join us as we talk about how this public health initiative has become a key one-on-one intervention. We’ll review common myths and barriers to the use of means safety counseling as well as resources to shore up providers’ skills in this area. Come get more comfortable with what can be an uncomfortable topic.

Sharon Birman, Psy.D., is a Military Behavioral Health Psychologist working with the Military Training Programs at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this capacity, she develops and presents training on a variety of EBPs and deployment-related topics, as well as providing consultation services.

Resources mentioned in this episode:

• Counseling on Access to Lethal Means (CALM) Training developed by SPRC: https://www.sprc.org/resources-programs/calm-counseling-access-lethal-means
• Brief Cognitive Behavioral Therapy (BCBT) for Suicide Prevention resources:
  • Manual: https://www.guilford.com/books/Brief-Cognitive-Behavioral-Therapy-for-Suicide-Prevention/Bryan-Rudd/9781462536665
  • Youtube Video: https://www.youtube.com/watch?v=-GSo1np_LUY&t=2s
• CBT for Suicide Prevention Manual: No longer being sold; needs to be updated.
• Means Matter Website by Harvard: https://www.hsph.harvard.edu/means-matter/
• Not Mentioned in Podcast - Mountain MIRECC website: https://www.mirecc.va.gov/visn19/

Calls-to-action:

Know the legislation in your State (Means Matter website breaks down legislation from state to state)

Recognize that this is a collaborative effort - develop skills to have the conversation

Attend CDP’s Suicide Prevention training and check out additional resources listed

Subscribe to the Practical for Your Practice Podcast

Subscribe to The Center for Deployment Psychology Monthly Email

While disrupted sleep is one of the number one presenting concerns for military-connected clients, it remains under assessed and mis- or undertreated. In this episode, we pull the covers back to reveal the most common pitfalls for providers when it comes to addressing sleep disorders with CDP’s own sleep guru, Dr. Diana Dolan. There are a lot of ways sleep can go wrong and often sleep problems take on a life of their own and become a primary diagnosis. Come join us for a discussion on how to improve your assessment of sleep problems and hear actionable intel to strengthen your treatment approaches.

Bios for your guests

Dr. Diana Dolan is clinical psychologist serving as Assistant Director, Training and Education with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences. Dr. Dolan’s professional interests include behavioral treatment of health conditions, in particular sleep disorders and within brief-natured primary care settings, clinical psychology training and program evaluation, and military psychology. She is Veteran of the USAF and certified in Behavioral Sleep Medicine by the American Board of Sleep Medicine. She is also a diplomate in Behavioral Sleep Medicine from the Board of Behavioral Sleep Medicine.

Resources mentioned in this episode:

• Chickens & Eggs: Treatment Order in Cases of Co-Morbid PTSD and Insomnia webinar [22:20] https://deploymentpsych.org/content/cdp-presents-chickens-eggs-treatment-order-cases-co-morbid-ptsd-and-insomnia-via-adobe-connect-Feb.21-2017
• 27:14 join CBT-I or Circadian Rhythms Training: https://deploymentpsych.org/training
• 27:40 The Basics of Sleep: What Ever Provider Needs to Know webinar: https://deploymentpsych.org/basics-of-sleep-archive
• CDP’s Virtual Sleep Museuam in Second Life 29:20 https://deploymentpsych.org/blog/staff-perspective-cdps-virtual-sleep-museum

Calls-to-action: For example:

Register for a CBT-I or Circadian Rhythms training at CDP

Review CDP Presents webinars on sleep and Sleep Spotlight page: https://deploymentpsych.org/cdp-sleep-spotlight

Subscribe to the Practical for Your Practice Podcast

Subscribe to The Center for Deployment Psychology Monthly Email

The future is now. Technology augmentation of the dissemination and implementation of EBPs has never been more widely accepted, from mobile apps to synchronous telehealth to asynchronous post-workshop support. Join us as we geek out with Dr. Peter Tuerk about the merits of technology adoption in EBPs, thinking creatively about using familiar technologies in new ways, provider-crowd-sourcing, and avoiding the trap of insisting that technology solutions must be replications of the old ways of doing things. Come for the tech talk, stay for the “skewmorphs.”

Guest Bio: Dr. Peter Tuerk is a research psychologist and clinician who specializes in evidence-based treatments for anxiety-spectrum disorders, related research and training, and the integration of technology into clinical care. Currently, he is Director of the Sheila C. Johnson Center for Clinical Services, a multidisciplinary training clinic at the University of Virginia, and he serves as Professor of Education within the Department of Human Services. His current research focuses on novel asynchronous telehealth technologies, virtual reality, and artificial intelligence in service of addressing EBT barriers.

Resources mentioned in this episode:

• OC GO: oc-go.org [22:46]
• Brian Bunell case report: https://doi.org/10.1177%2F1534650113483357 [26:41]

Calls-to-action: For example:

Subscribe to the Practical for Your Practice Podcast

Subscribe to The Center for Deployment Psychology Monthly Email

Almost all clinicians agree that consultation helps us be better at our jobs. Committing to the consultation can be another story. In this episode, Dr. Andrew Sherrill of the Emory University Prolonged Exposure Consultant Training Program shares some actionable intel on facing and overcoming five common barriers to committing to consultation.

Andrew M. Sherrill, Ph.D. is an assistant professor in the Department of Psychiatry and Behavioral Sciences and a practicing clinical psychologist at the Emory Healthcare Veterans Program and the Emory Healthcare OCD Program. He is also the program manager of the Emory University Prolonged Exposure Consultant Training Program. He received a Ph.D. in clinical psychology from Northern Illinois University. He completed his predoctoral internship at the American Lake Division of VA Puget Sound Healthcare System and his postdoctoral fellowship at Emory University School of Medicine. Dr. Sherrill’s clinical expertise includes behavior therapies for trauma- and anxiety-related disorders including prolonged exposure for posttraumatic stress disorder (PTSD), exposure and response prevention for obsessive-compulsive disorder (OCD), and acceptance and commitment therapy for a range of emotion disorders. His areas of specialization include the use of virtual reality in exposure therapies and the implementation of massed delivered evidence-based psychotherapy. His current research aims to understand the effective dissemination and implementation of exposure therapy and the development of mobile technologies that facilitate exposure therapy through pervasive health strategies in the areas of ubiquitous computing, human-computer interaction, and machine learning.

Resources mentioned in this episode:

• Emory University Prolonged Exposure Consultant Training Program: https://psychiatry.emory.edu/programs/pe_consultant_training/index.html
• Here’s a link to the first study published by the Emory training program, “Creating a national network of community-based consultants in prolonged exposure for PTSD: Outcomes and lessons learned from a consultant training program.”

https://psycnet.apa.org/record/2021-54868-001

Calls-to-action: For example:

Subscribe to the Practical for Your Practice Podcast

Subscribe to The Center for Deployment Psychology Monthly Email

Motivational Interviewing (MI) is a style of communication that can be useful in many different clinical situations. Maintaining the spirit of MI while practicing EBP presents a challenge. In this episode, Dr. Onna Brewer shares some actionable intel that will help you to listen with an ear for connection and change talk and to do what comes naturally (or maybe NOT so naturally) in practicing EBPs.

Dr. Onna Brewer is a clinical psychologist and consultant in private practice. Her research and community-based work have focused on processes of behavior change, behavioral health treatment approaches, and improving access to care for underserved communities. Her post-doctoral training and early career included trauma specialization and providing outpatient care with the Veterans Health Administration where she was also a Motivational Interviewing consultant and regional trainer for the VA’s National Evidence-Based Psychotherapy Initiative. She is a member of the international Motivational Interviewing Network of Trainers, the National Register of Health Service Psychologists, the Florida Psychological Association and APA. Dr. Brewer is licensed to practice psychology in the states of Florida and Illinois, and she provides training and consultation for a diverse array of helping professionals and organizations around the world.

Resources mentioned in this episode:

• CDP Presents: Motivational Interviewing and its Synergy with other Evidence-Based Practices
• CDP Motivational Interviewing Resources

Calls-to-action: For example:

Subscribe to the Practical for Your Practice Podcast

Subscribe to The Center for Deployment Psychology Monthly Email

When learning a protocol for evidence-based psychotherapy, the question commonly arises about common factors: “Why do I need to learn this protocol if most of the change in psychotherapy can be traced back to common factors?” or conversely “If I follow the steps on this protocol checklist, I don’t have to worry about common factors at all like therapeutic alliance, right?” Join us as we discuss the interplay of common factors and EBP protocols, how they are not mutually exclusive, and how to make sure you are attending most to the real person and the real relationship with you in the room while applying EBP techniques.

Dr. Michael Jones has 18 years of experience working with the military as a psychologist. During this time, he has deployed overseas twice, he has held a variety of roles as a clinician, as a consultant, educator/supervisor and researcher. Dr. Jones has spent the majority of his career working with the Army and Air Force, but has spent time with the other military branches and multiple federal agencies. During his time as a medical residency faculty member, he supervised multiple years of incoming army psychologists, social workers and medical residents on clinical skills and mental health treatment. During the height of combat operations during the late 2000’s, he developed and managed multiple population-focused mental health resiliency programs, including peer suicide prevention training and peer resiliency training. Much of his later career has been embedded in military units, where he developed a passion for making mental resiliency skills accessible to service members.

Resources mentioned in this episode:

• 10:28 - Common Factors Research, The Dodo Bird Verdict
  • Rosenzweig, Saul (1936). "Some implicit common factors in diverse methods of psychotherapy". American Journal of Orthopsychiatry. 6 (3): 412–15. doi:10.1111/j.1939-0025.1936.tb05248.x
• 28:29 - Duncan, B.L., Miller, S.D., Wampold, B.E.,and Hubble, M.A. (Eds.) (2009). The Heart and Soul of Change: Delivering What Works in Therapy. Washington: American Psychological Association Press.
• 28:34 - Lambert, M.J. (Ed.) (2013). Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change, Sixth Edition. John Wiley & Sons, Inc., Hoboken, NJ.
• 29:07 - Outcome Rating Scale, by Scott Miller and Barry Duncan
  • Miller, S.D., Duncan, B.L., Brown, J., Sparks, J.A., and Claud, D.A. (2003). The Outcome Rating Scale: A Preliminary Study of the Reliability, Validity, and Feasibility of a Brief Visual Analog Measure. Journal of Brief Therapy. 2(2): 91-100.
• 32:35 - Outcome Questionnaire: OQ-45.2 -- https://www.oqmeasures.com/oq-45-2/

Calls-to-action:

1. Use outcome measures in therapy, including measures of therapeutic alliance and symptom improvement.
2. Consider your client’s readiness for change and work collaboratively at their current level of readiness.
3. Subscribe to the Practical for Your Practice Podcast
4. Subscribe to The Center for Deployment Psychology Monthly Email

Anger is the most highly reported challenge, across disorders, for Servicemembers and Veterans, especially post-deployment. In this episode, we get fired up talking about anger, aggression, and the role of other secondary emotions such as guilt, shame, and fear. Our guest, Dr. Shannon Miles, helps us distinguish between impulsive and premeditated aggression and walks us through the main components of her protocol Managing Emotions to Reduce Aggression. Need to get more comfortable with anger and help clients with aggression? Take a listen. You won’t regret it.

Dr. Miles is a clinical psychologist at the James A. Haley Veterans’ Hospital and Assistant Professor in the Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL. Her research and clinical work explore ways to assist Veterans and Service Members recovering from Posttraumatic Stress Disorder (PTSD) and challenging comorbidities such as emotion dysregulation, aggression, and traumatic brain injury (TBI). She is the principal investigator (PI) on a multi-site VA Clinical Science Research and Development study that is examining a 3 session aggression treatment and a VA Health Service Research and Development grant that seeks to determine if the VA’s mild TBI screen leads to more appropriate service utilization and better quality of life for post 9-11 Veterans. She is also a Site Multiple-PI on the Long-Term Impact of Military-Relevant Brain Injury Consortium (LIMBIC-CENC).

Resources mentioned in this episode:

• Impulsive-Premeditated Aggression Scale (IPAS) https://cdn.ce21.com/documents/fixiit1yjkickq1mlknesq.pdf [17:57]
• PTSD Coach App https://mobile.va.gov/app/ptsd-coach [21:45]
• MERA manual https://cdn.ce21.com/documents/z5osm1an6uicltedhq3adw.pdf [24:45]

Calls-to-action:

View Understanding and Managing Anger and Aggression in PTSD: https://deploymentpsych.org/Anger-And-Aggression-Archive

Download and utilize the MERA manuals

Subscribe to the Practical for Your Practice Podcast

Subscribe to The Center for Deployment Psychology Monthly Email