Institute 1 - Compassion Focused Exposure and Response Prevention in Cognitive and Behavioral Therapies

This institute introduces clinicians to Compassion Focused Exposure and Response Prevention (CF-ERP), a cutting-edge approach derived from Compassion Focused ACT (CF-ACT) that integrates the power of exposure and response prevention (ERP) with the principles of Compassion Focused Therapy (CFT) and Acceptance and Commitment Therapy (ACT). CF-ERP offers a unique synthesis of traditional behavioral techniques with innovative methods designed to target and transform core shame, self-criticism, and related difficulties that often underlie anxiety disorders and impede treatment progress.

CF-ERP cultivates the courage needed to develop broadening behavioral repertoires in the presence of repertoire-narrowing stimuli. Special emphasis is given to tailoring compassionate imagery and developing personalized behavioral experiments that foster a sense of self-efficacy and resilience in the face of anxiety-provoking situations. CF-ERP is consistent with modern theories of ERP mechanisms of action, including inhibitory learning and memory re-consolidation. Participants will also learn about the growing experimental and applied research base supporting the integration of mindfulness and compassion-focused methods into ERP.

This workshop will provide a deep dive into the theoretical foundations of CF-ERP, drawing on attachment, evolutionary, and contextual behavioral science perspectives. Experiential exercises, case examples, and guided practices will be utilized to demonstrate how CF-ERP can be applied to a range of anxiety-related difficulties, including panic disorder, social anxiety, and obsessive-compulsive disorder. Participants will also learn how to integrate CF-ERP with other evidence-based approaches, such as CBT and DBT.

This institute is designed for psychologists, therapists, and mental health professionals interested in expanding their clinical skills and learning innovative ways to enhance the effectiveness of exposure-based interventions. Participants will leave with practical tools and strategies for integrating CF-ERP into their clinical practice, ultimately empowering their clients to overcome anxiety-related challenges and cultivate a greater sense of self-compassion and well-being.

Recommended Reading 1: Leaviss, J., & Uttley, L. (2015). Psychotherapeutic benefits of compassion-focused therapy: an early systematic review. Psychological medicine, 45(5), 927–945. https://doi.org/10.1017/S0033291714002141

Recommended Reading 2: Cuppage J, Baird K, Gibson J, et. al. (2017) Compassion focused therapy: Exploring the effectiveness with a transdiagnostic group and potential processes of change. British Journal of Clinical Psychology. Jun;57(2):240-254. doi: 10.1111/bjc.12162

Recommended Reading 3: Chou C.Y., Tsoh J.Y., Shumway M., et. al. (2019) Treating hoarding disorder with compassion-focused therapy: A pilot study examining treatment feasibility, acceptability, and exploring treatment effects. British Journal of Clinical Psychology. 2019 Jul 4. doi: 10.1111/bjc.12228

Recommended Reading 4: Michael P. Twohig, Jonathan S. Abramowitz, Ellen J. Bluett, Laura E. Fabricant, Ryan J. Jacoby, Kate L. Morrison, Lillian Reuman, Brooke M. Smith, Exposure therapy for OCD from an acceptance and commitment therapy (ACT) framework, Journal of Obsessive-Compulsive and Related Disorders, Volume 6, 2015, Pages 167-173, ISSN 2211-3649, https://doi.org/10.1016/j.jocrd.2014.12.00

Recommended Reading 5: Kim, J.J., Parker, S.L., Doty, J.R. et al. Neurophysiological and behavioural markers of compassion. Sci Rep 10, 6789 (2020). https://doi.org/10.1038/s41598-020-63846-3

Outline:
Morning Session (3 hours)
• Introduction to CF-ERP: Bridging CFT, ACT, and ERP (45 minutes)
o What is CF-ERP? Core principles and theoretical underpinnings.
o The synergistic relationship between CFT, ACT, and ERP.
o How CF-ERP addresses the limitations of traditional ERP.
o Overview of the workshop's learning objectives and structure.
• Understanding Anxiety: The Role of Avoidance and Fusion (1 hour)
o The nature of anxiety and its impact on individuals.
o Cognitive fusion and experiential avoidance in anxiety disorders.
o How traditional ERP targets avoidance but may miss fusion.
o Case examples illustrating the dynamics of anxiety and avoidance.
• Compassionate Exposure: Integrating CFT and ERP (1 hour)
o Applying CFT principles to enhance the ERP process.
o Developing self-compassion as a foundation for facing fears.
o Cultivating a compassionate stance towards anxiety-related sensations.
o Guided meditations and exercises for building self-compassion.
• Morning Coffee Break (15 minutes)
Afternoon Session (4 hours)
• Acceptance and Defusion: ACT Methods in CF-ERP (1 hour)
o Using ACT techniques to promote acceptance of anxiety.
o Cognitive defusion strategies to reduce the grip of anxious thoughts.
o Developing psychological flexibility in the face of anxiety triggers.
o Role-playing and experiential exercises to practice acceptance and defusion.
• Designing CF-ERP Interventions: Practical Strategies (1 hour)
o Constructing compassionate exposure hierarchies.
o Developing personalized behavioral experiments with a CF-ACT lens.
o Integrating mindfulness practices into ERP.
o Case examples illustrating CF-ERP interventions for various anxiety disorders.
• Lunch Break (1 hour)
• CF-ERP for Specific Anxiety Disorders (1 hour)
o Panic Disorder: Targeting catastrophic thoughts and bodily sensations.
o Social Anxiety Disorder: Addressing social fears and self-focused attention.
o Obsessive-Compulsive Disorder: Integrating CF-ACT into ritual prevention.
o Case studies illustrating the application of CF-ERP to diverse anxiety presentations.
• Working with Resistance and Challenges in CF-ERP (45 minutes)
o Identifying common challenges and obstacles in CF-ERP implementation.
o Addressing client resistance to exposure and acceptance.
o Troubleshooting strategies for difficult cases.
o Promoting therapist self-compassion and resilience.
• Wrap-up and Q&A (45 minutes)
o Review of key concepts and techniques in CF-ERP.
o Addressing participant questions and concerns.
o Resources for continued learning and professional development.