Recorded Webinars

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The Mindful Way Through Panic (3 CEs)

In this 3 CE training, I’ll show you how to use mindfulness to help your clients who are struggling with panic. These techniques can be taught to clients suffering from panic – not just those with panic disorder. In fact, panic occurs in a large number of disorders (social anxiety, depression, PTSD, substance use . . .). I’ll explain the theory and you’ll practice techniques you can start using immediately with your clients. You’ll also receive several free assessments to guide treatment and help your clients gain insight into their panic.  The presentation is also filled with fun and interactive demonstrations you can do with your clients.

This is an introductory presentation to the use of mindfulness techniques to treat panic in a variety of disorders. You will learn theories and techniques based on a mindful approach to treating panic. No previous experience in mindfulness is necessary. Below is the detail description of this program and evidence supporting it.

The program presents a theory of the onset and maintenance of panic, teaches mindfulness techniques for use with panic survivors (regardless of their diagnosis), and discusses the use of mindfulness to enhance Exposure Therapy. This program is intended for beginning to intermediate audiences who have some experience treating clients with panic attacks but who are unfamiliar with mindfulness as a clinical intervention.

1. The first objective of the training is to provide a model that can explain the development of panic. There are many theories of panic but one of the most well-supported is the Anxiety Sensitivity Theory. In this theory, the development of panic attack is best explained as an individual difference variable characterized by a vulnerability called anxiety sensitivity. Anxiety sensitivity is the fear of one’s anxiety-related symptoms (McNally, 1994) and meta-analyses find large effect sizes of this characteristic as a correlate of panic (Olatunji & Wolitzky-Taylor, 2009).

2. The second objective is to provide an explanation of the specific behavioral reactions of individuals with anxiety sensitivity that maintain panic and can therefore, help clinicians to understand how to treat it in the present day. According to Wegner (1994), attempts to control a mental state are based on two processes: an intentional operating process (a conscious, effortful search for mental contents that will produce a desired state of mind) and an ironic monitoring process (an unconscious, automatic search for mental contents that signal a failure to produce the desired state of mind). Attempts to control a mental state under stress can lead to an over-activation of the ironic monitoring process, which thereby, leads to the very undesired state that one was trying to avoid. In the case of panic, those with high levels of anxiety sensitivity attempt to control their anxiety-related sensations; however, they do so in a manner that is pressured, demanding, and fearful, and, as a result, they over-activate the ironic monitoring process, thereby triggering fears and increasing the likelihood of the onset of panic (Eifert & Heffner, 2003; Levitt, Brown, Orsillo, & Barlow, 2004).

3. The third objective is to explain how mindfulness can disrupt the cycle of ironic process by enhancing attentional control. Mindfulness has been shown to have powerful effects on attentional capacity (Chambers, Lo, & Allen, 2008; Malinowski, 2013). With enhanced attentional control, individuals can shift attention away from anxiety sensitive fears, e.g., “My heart is pounding. I’m going to die.” This can then disrupt the cycle of panic. Three studies are presented that support the role of mindfulness in treating panic. Consistent with ironic process theory, the first demonstrates that attempts to control anxiety actually increase anxiety and panic symptoms in a laboratory design (Adler, Craske, & Barlow, 1987). The second and third study demonstrates the ability of mindfulness to ameliorate anxiety and panic symptoms during a stressful laboratory experience (Eifert & Heffner, 2003; Levitt, Brown, Orsillo, & Barlow, 2004).

4. The fourth and fifth objectives help clinicians in teaching mindfulness to their clients. Mindfulness is defined in a three-component model (present moment awareness, nonjudgment, and nonstriving) popularized by Jon Kabit-Zinn (1990). A deeper understanding of mindfulness is offered through a discussion of Gunaratana’s (1991) classic book, Mindfulness In Plain In English. The concept of mindfulness is connected to meta-cognitive awareness (Jankowski & Holas, 2014). Recommendations for mindfulness activities, such as meditation, mindful eating, mindful and task involvement, are presented. These interventions are discussed in the context of how mindful activities disrupt rumination and worry (Evans & Segerstrom, 2011; Kraemer, McLeish, & Johnson, 2015), two processes that perpetuate the cycle of panic.

5. The sixth objective discusses how to incorporate mindfulness into Exposure Therapy for panic. The principles of graded exposure hierarchies are discussed and then the ways in which mindfulness can facilitate this endeavor are discussed. Research supporting the model of mindfulness-based Exposure Therapy is presented (e.g., Arch & Craske, 2010).
6. Throughout the presentation, the most common and severe risks of the intervention are discussed. Adverse reactions to exposure therapy are discussed, including the increased likelihood of dropout, temporary exacerbations of anxiety, and prolonged exacerbations of anxiety (Kazantzis, Ford, Paganini, Dattilio, & Farchione, 2017). The presenter highlights the importance of providing informed consent of these risks, encouraging open communication throughout therapy so that clients will report adverse reactions, and empowering clients to ask for modifications or termination of exposure therapy procedures if necessary.

References
Arch, J. J., & Craske, M. G. (2010). Laboratory stressors in clinically anxious and non-anxious
individuals: The moderating role of mindfulness. Behaviour Research and Therapy, 48, 495-505. https://doi.org/10.1016/j.brat.2010.02.005

Adler, C. M., Craske, M. G., & Barlow, D. H. (1987). Relaxation-induced panic (RIP): When
resting isn’t peaceful. Integrative Psychiatry, 5(2), 94-100. Retrieved from
http://psycnet.apa.org/record/1988-30404-001

Chambers, R., Lo, B. C. Y., & Allen, N. B. (2008). The impact of intensive mindfulness training on attentional control, cognitive style, and affect. Cognitive therapy and research, 32, 303-322. https://doi.org/10.1007/s10608-007-9119-0

Eifert, G. H., & Heffner, M. (2003). The effects of acceptance versus control contexts on
avoidance of panic-related symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 34, 293-312. https://doi.org/10.1016/j.jbtep.2003.11.001

Evans, D. R., & Segerstrom, S. C. (2011). Why do mindful people worry less? Cognitive Therapy and Research, 35, 505-510. https://doi.org/10.1007/s10608-010-9340-0

Gunaratana, B. (1991). Mindfulness in plain English. New York: Simon and Schuster.

Jankowski, T., & Holas, P. (2014). Metacognitive model of mindfulness. Consciousness and
cognition, 28, 64-80. https://doi.org/10.1016/j.concog.2014.06.005

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face
stress, pain, and illness. New York: Delta.

Kazantzis, N., Ford, C., Paganini, C., Dattilio, F. M., & Farchione, D. (2017). Does patient
reluctance towards exposure and psychologists’ attitudes about evidence-based practice influence treatment recommendations for panic disorder? An experimental investigation. Journal of anxiety disorders, 51, 55-64. https://doi.org/10.1016/j.janxdis.2017.03.001
Kraemer, K. M., McLeish, A. C., & Johnson, A. L. (2015). Associations between mindfulness and panic symptoms among young adults with asthma. Psychology, health & medicine, 20, 322-331. https://doi.org/10.1080/13548506.2014.936888
Levitt, J. T., Brown, T. A., Orsillo, S. M., & Barlow, D. H. (2004). The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Behavior therapy, 35(4), 747-766. https://doi.org/10.1016/S0005-7894(04)80018-2

Malinowski, P. (2013). Neural mechanisms of attentional control in mindfulness
meditation. Frontiers in neuroscience, 7, 8-16. https://doi.org/10.3389/fnins.2013.00008

McNally, R. J. (1994). Panic disorder: A critical analysis. New York: Guilford Press.

Olatunji, B. O., & Wolitzky-Taylor, K. B. (2009). Anxiety sensitivity and the anxiety disorders: a meta-analytic review and synthesis. Psychological bulletin, 135, 974. http://dx.doi.org/10.1037/a0017428

Wegner, D. M. (1994). Ironic processes of mental control. Psychological review, 101(1), 34 – 52. Retrieved from http://psycnet.apa.org/buy/1994-16255-001

Register for the training [HERE] to receive 3 CEs.

Jason Drwal, Ph. D. is a clinical psychologist in the VA Healthcare System. He has treated thousands of veterans with PTSD and trained many professionals in the assessment and treatment of trauma. He specializes in the use of cognitive-behavioral and mindfulness interventions for the treatment of panic attacks, PTSD, and other conditions. When he is not doing therapy, he is an avid reader of self-help books, proud parent of two beautiful children, self-described coffee addict (who refuses to get treatment), and amateur anthropologist.

1. Describe what a panic attack is and why panic is important to treat
2. Understand anxiety sensitivity and how it explains the development of panic attacks
3. Describe what Ironic Process is and how it can explain panic
4. Describe the three main components of mindfulness
5. Understand how to use mindfulness to help clients treat panic attacks

Jason Drwal is the owner of therapyces.com and earns revenue from this website.

If you need special accommodations due to a disability, are not fully satisfied, have concerns or suggestions regarding the training, please let us know by email, [email protected].

We will contact you within one week to discuss your concerns further. We offer a full refund for any paid training you are not satisfied with.

The 4-Biggest Mistakes in Diagnosing PTSD (1 CE)

PTSD is one of trickiest disorders to diagnose correctly. There are more judgments and criteria in PTSD than other disorders. Frequently, therapists fail to fully assess this disorder. An improper diagnosis can cause all kinds of problems because PTSD frequently comes up in disability claims, workman’s comp, and legal venues. In this 1 CE training, I’ll show you how to avoid the 4 biggest mistakes in diagnosing PTSD and give you a framework to diagnose PTSD more accurately.

This short training is designed to highlight key problems in the assessment of PTSD. It is designed for an introductory audience with experience in diagnosis but less knowledge of PTSD assessment. Although most clinicians will have at least some familiarity with how to diagnose PTSD, there are many challenges in assessing PTSD not evident when assessing other disorders. This training will help you to avoid these common mistakes and accurately diagnose this common condition.

Objective 1 will teach you the diagnostic criteria for PTSD (APA, 2013).

Objective 2 will help you address one of the most ambiguous parts of PTSD diagnosis: assessing criterion A traumas. This is where most clinicians make mistakes. You’ll see examples of qualifying and non-qualifying criterion A traumas. You’ll also learn how to use one of the most popular and helpful client-report measures of PTSD symptoms: the PTSD Checklist-5 (Blevins, Weathers, Davis, Witte, & Domino, 2015).

Objective 3 will help you to understand why it is important and how to take a pre-trauma history when diagnosing PTSD. You’ll learn about research on PTSD symptoms in criterion A and non-criterion A traumas (Anders, Frazier, & Frankfurt, 2011).

Objective 4 will teach you to differentially diagnose PTSD. You learn about research on symptom overlap between PTSD, depression, and generalized anxiety (Price & van Stolk-Cooke, 2015).

References
American Psychiatric Association, APA. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-V: Washington, DC: American Psychiatric Pub.

Anders, S. L., Frazier, P. A., & Frankfurt, S. B. (2011). Variations in Criterion A and PTSD rates in a community sample of women. Journal of Anxiety Disorders, 25(2), 176-184. https://doi.org/10.1016/j.janxdis.2010.08.018.

Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28, 489-498. doi:10.1002/jts.22059

Price, M., & van Stolk-Cooke, K. (2015). Examination of the interrelations between the factors of PTSD, major depression, and generalized anxiety disorder in a heterogeneous trauma-exposed sample using DSM 5 criteria. Journal of affective disorders, 186, 149-155. https://doi.org/10.1016/j.jad.2015.06.012

Register for the training [HERE]

Jason Drwal, Ph. D. is a clinical psychologist in the VA Healthcare System. He has treated thousands of veterans with PTSD and trained many professionals in the assessment and treatment of trauma. He specializes in the use of cognitive-behavioral and mindfulness interventions for the treatment of panic attacks, PTSD, and other conditions. When he is not doing therapy, he is an avid reader of self-help books, proud parent of two beautiful children, self-described coffee addict (who refuses to get treatment), and amateur anthropologist.

  1. Learn how to establish a clear criterion A trauma for PTSD diagnosis
  2. Be able to give two examples of traumas that do not fit criterion A for PTSD
  3. Provide two reasons why it is important to take a pre-trauma history when diagnosing PTSD
  4. Identify two disorders from which PTSD should be differentially diagnosed

Jason Drwal is the owner of therapyces.com and earns revenue from this website.

If you need special accommodations due to a disability, are not fully satisfied, have concerns or suggestions regarding the training, please let us know by email, [email protected].

We will contact you within one week to discuss your concerns further. We offer a full refund for any paid training you are not satisfied with.

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1. Listen to a Podcast

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2. Take The Test

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Pass an 8-to-10 item quiz, complete a course evaluation, and download your certificate. Most trainings are 1 CE.

Meet The Host

Jason Drwal, Ph. D.

Host and Founder, Therapy Take Out

I’m a full-time therapist, the husband of a working mom, and the father to two energetic kids. I love helping my clients and also learning new techniques and theories but traveling to conferences was complicated and difficult. So I started this podcast (Therapy Take Out) and this website (Therapy CEs) to provide convenient, engaging, and research-backed trainings. I specialize in the use of cognitive-behavioral and mindfulness interventions for the treatment of panic attacks, PTSD, and other conditions. I'm an avid reader of research, proud parent of two beautiful children, self-described coffee addict (who refuses to get treatment), and amateur anthropologist.

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