Day 1 :
Professor and Vice-Chair, Stanford University
Time : 10:00-10:40
Dr. Carrion is the John A. Turner, M.D. Endowed Professor and Vice-Chair in the Department of Psychiatry and Behavioral Sciences at Stanford University and Director of the Stanford Early Life Stress and Pediatric Anxiety Program. He is in the faculty at both Stanford University School of Medicine and Lucile Packard Children’s Hospital. His multidisciplinary research on the behavioral, academic, emotional, and biological late effects of experiencing trauma has led to the development and implementation of effective new interventions for treating children who experience traumatic stress. Using Posttraumatic Stress Disorder (PTSD) as an anchor, Dr. Carrion is investigating, through longitudinal studies, the effects of stress on developmental physiology and brain development and function.
Statement of the Problem: 35% of youth living in communities of high violence will develop significant posttraumatic stress disorder symptoms. Current treatment modalities that anchor in cognitive behavioral therapy (CBT) may leave 20-50% of youth without adequate symptom relieve. New treatment modalities that address executive function, memory and emotion regulation are needed, and access and dissemination should be taken into consideration. This presentation will introduce Stanford’s Cue-Centered Therapy (CCT) and a school-district wide prevention effort that involves yoga and mindfulness in students’ curriculum. CCT integrates elements from CBT with other empirically validated interventions for traumatized youth (psychodynamic therapy, insight, self-efficacy, education). The prevention study focuses on health and wellness through meditation and exercise. Methodology & Theoretical Orientation: Our research identifying key brain regions (e.g.; hippocampus, amygdala, prefrontal cortex) alterations in structure and function as related to traumatic stress informed the development of CCT. CCT demonstrated effectiveness in reducing anxiety, depression and posttraumatic stress symptoms in a randomized controlled trial. We are currently engaged in treatment outcome research to demonstrate CCT’s efficacy in improving brain function and cognitive and emotional outcomes. Findings: The presentation will focus on our imaging (sMRI and fMRI) and salivary cortisol studies that set the stage for the development of CCT. In addition, sleep was investigated in our prevention study. A curriculum of yoga and mindfulness improves sleep variables and these will be presented. Conclusion & Significance: New treatment modalities and dissemination plans need to be developed to address the highly heterogenous group of children that fall under the diagnostic umbrella of posttraumatic stress disorder (PTSD). Approaching both prevention and treatment that are informed by neuroscience research promises to make our interventions more focused and targeted.
Weill Cornell Medical College, USA
Keynote: Dialectical Behavior Therapy: A new frontier in treatment of pre-adolescent children with severe emotional and behavioural dysregulation
Time : 11:00-11:40
Francheska Perepletchikova, Ph.D., DBT-Linehan Board of Certification Board Certified Clinician is an Assistant Professor of Psychology, Department of Psychiatry, Weill Cornell Medical College. Dr. Perepletchikova received her B.A. degree at St. John's University and graduated with gold medal for the highest academic average. Dr. Perepletchikova received graduate training in two disciplines, developmental and clinical psychology. She obtained M.A. in Developmental Psychology from Teachers College, Columbia University in 1996 and received Ph.D. in Clinical Psychology from Yale University Department of Psychology in 2007 with James B. Grossman Best Dissertation Prize. During her internship and post-doctoral training at Yale University School of Medicine, Dr. Perepletchikova gained expertise in Dialectical Behavior Therapy (DBT). She obtained intensive and advanced intensive trainings in DBT with Dr. Linehan. Further, Dr. Perepletchikova have been established as able to deliver DBT with adherence and calibrated as a reliable DBT adherence rater by Behavioral Research and Therapy Clinics at the University of Washington. In 2015, she became a BTech trainer. In 2016 Dr. Perepletchikova became a DBT-Linehan Board of Certification Board Certified Clinician.
Chronic irritability and difficulty with self-control may negatively affect child’s emotional, social and cognitive development and are predictive of personality disorders, dysphoric mood, substance and alcohol abuse, suicidality and non-suicidal self-injury in adolescence and adulthood. Dialectical Behavior Therapy for pre-adolescent children (DBT-C) aims to facilitate adaptive responding by teaching coping skills and encouraging caregivers to create a validating and change-ready environment.Method:Two RCTs were conducted to examine feasibility and initial efficacy of DBT-C.1) In the NIMH funded RCT of DBT-C for Disruptive Mood Dysregulation Disorder, 43 children (7-12 years) were randomly assigned to DBT-C or TAU. Children were provided with 32 individual sessions that included child counselling, parent sessions and skills training.2) In the Private Foundation funded RCT of DBT-C for children in residential care, 47 children (7-12 years) were randomly assigned to DBT-C or TAU. Children were provided with 34 individual sessions, 48 group skills trainings and 12 parent trainings.Results:1) Subjects in DBT-C attended 40.4% more sessions than subjects in TAU. No subjects dropped out of DBT-C, while 36.4% dropped from TAU. Further, 90.4% of children in DBT-C responded to treatment compared to 45.5% in TAU, on the Clinical Global Impression Scale. All changes were clinically significant and sustained at 3-months follow-up.2) In the residential care trial significant differences were observed on the main measure of outcome – Child Behavior Checklist (CBCL) staff report. Children in the DBT-C condition as compared to TAU had significantly greater reduction in symptoms on both Internalizing and Externalizing subscales. All changes were clinically significant. Results were maintained at 3- and 6-month follow-up.