MIRECC / CoE

January 18, 2023: I'm Not an Addict: Patient Experiences with Taper and Discontinuation of Long-Term Opioid Therapy
Travis Lovejoy, Ph.D.
Core Investigator, Center to Improve Veteran Involvement in Care, VA Portland HCS

Purpose Statement: Pain co-exists with many health conditions, and pain management for chronic illnesses is one of the most challenging tasks for health care providers. With opioid treatment, that challenge is even greater. This presentation will describe potential outcomes after discontinuation of long-term opioid therapy and help clinicians to sort through some of the challenges for providers and patients, including impacts on the provider-patient relationship. 

Course Learning Objectives:

1. Quantify pain outcomes following discontinuation of opioid therapy
2. Identify potential negative sequalae of universal opioid discontinuation
3. Describe patient-provider relationships following discontinuation of opioid therapy

December 7, 2022: Traumatic Brain Injury and Sleep Disorders: Pathophysiology and Clinical Management
Kent Werner M.D., Ph.D.
Director of Research, Sleep Disorders Center, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD

Purpose Statement: Traumatic Brain Injury (TBI) has been increasingly recognized among those who have served in combat, and it is frequently associated with other conditions such as PTSD and depression. Problems with sleep are encountered in all of these conditions. This presentation will discuss sleep disorders among those who have experienced traumatic brain injury and will summarize for clinicians current evidence-based treatments for sleep disorders among Veterans with TBI.

Course Learning Objectives:
1. Describe the impact of traumatic brain injury (TBI) on sleep among those who have experienced combat
2. Discuss potential mechanisms for sleep disorders in TBI patients
3. List potential therapies for sleep disorders in TBI patients

November 16, 2022: The Role of Family Members in PTSD Treatment
Johanna Thompson-Hollands, Ph.D.
Staff Psychologist, Behavioral Science Division, National Center for PTSD

Purpose Statement: The symptoms and behavioral challenges experienced by Veterans with PTSD also influence their social functioning and interpersonal relationships. Research has shown that there are important bidirectional impacts between the social environment and PTSD symptoms. This presentation will focus on family-inclusive treatment and include perspectives from Veterans, family members and VA clinicians. This presentation also will include specific recommendations for optimizing family-inclusive care, as well as outlining a number of brief protocols that have been developed for Veterans and family members.

Course Learning Objectives:
1. Describe the rationale for incorporating family members or other support persons into a Veteran’s PTSD treatment
2. Discuss common goals that veterans and family members have for family-inclusive treatment
3. Identify one or more protocols to support brief family involvement in treatment

November 2, 2022: How to Reduce Veteran Suicides by Helping Veterans with Other Than Honorable Discharges to Obtain VHA Services
Brian Meyer, Ph.D.
Psychology Program Manager, VA Central Virginia Health Care System
Matt Stimmel, Ph.D.
National Training Director, Veterans Justice Programs

Purpose Statement: Suicide prevention remains one of the top priorities for VA mental health care. This can be attained by clinical or systems-related interventions. One of the ways of intervening at the systems level is to allow Veterans with Other Than Honorable discharges to access VA mental health services. This presentation will illustrate how including this high risk subgroup in suicide prevention strategies can lower the suicide rate among Veterans.

Course Learning Objectives:
1. Describe the link between Other Than Honorable discharges and suicide
2. Identify at least four reasons why Veterans are given Other Than Honorable discharges
3. Identify at least three methods for getting Veterans with Other Than Honorable discharges the services they need

October 19, 2022: Caring for Veterans with Psychosis: an Overview of Evidence-Based Pharmacological and Psychosocial Interventions for Veterans with Schizophrenia
Olaoluwa Okusaga, M.D.
Interim Director, rTMS Clinic and Clinical Lead, BeST Clinic, Houston VAMC
Jared Bernard, Ph.D.
Staff Clinical Psychologist, Houston VAMC

Schizophrenia is encountered in a wide variety of mental health settings, including VA. Evidence-based assessment and treatment of schizophrenia continues to evolve as basic and clinical science innovations present clinicians with more treatment options. This presentation will focus on the process of deciding among a large number of effective treatment options for schizophrenia, and will highlight the integration of pharmacological and psychosocial treatment methods.

Course Learning Objectives:
1. Explain the importance of ruling out secondary psychosis during the initial evaluation of a Veteran presenting with psychotic symptoms
2. Describe how to decide on specific antipsychotic medications and other somatic treatments for Veterans diagnosed with schizophrenia
3. Discuss the concept of recovery and how its principles are utilized in evidence-based psychosocial interventions

October 5, 2022: Moral Injury: An Overview of Conceptual, Definitional, Assessment, and Treatment Issues
Brett Litz, Ph.D.
Director, MH Core, Massachusetts Veterans Epidemiological Research and Information Center

The idea that people can be lastingly harmed by their own transgressive behavior and can suffer because of others’ moral failures is as old as humanity, yet these concepts have only recently been considered as clinically relevant social, biological, spiritual, and psychological problems. The term that is used to describe these transgressive harms and the outcome of those experiences is moral injury. This presentation will enhance clinicians and researchers knowledge about how to define, assess, and treat moral injury.

Course Learning Objectives:
1. Define moral injury
2. Discuss how to assess moral injury using a moral injury assessment instrument, and distinguish moral injury from moral distress and PTSD
3. Describe the phenomenology, clinical needs, and methods for helping those suffering from moral injury.

June 1, 2022: Factors Associated with Evidence-Based Psychotherapy Utilization and Mental Health Symptoms among Veterans with Co-Morbid PTSD and Substance Use Disorder
Vanessa Somohano, Ph.D.

VA has been a national leader in developing evidence-based psychotherapies for treatment of PTSD, which often co-exists with other conditions such as depression and substance use. For optimal treatment it is essential to consider how these conditions influence each other, along with the utilization and effectiveness of treatment modalities. This presentation will focus on current use of evidence-based psychotherapies in VA for coexisting PTSD and substance use disorders, including patterns of initiation and utilization that have implications for effective clinical care.

Course Learning Objectives:

1. Characterize demographics and health service utilization among Veterans who receive VA care and have co-morbid PTSD-SUD
2. Identify factors associated with PTSD evidence-based psychotherapy initiation among Veterans with comorbid PTSD-SUD
3. Describe health services factors and interventions that may enhance treatment initiation among at-risk veterans with comorbid PTSD-SUD

May 18, 2022: Systematically Testing the Evidence on Marijuana
Devan Kansagara, M.D.
Staff Physician, VAPORHCS; Professor of Medicine, Oregon Health and Science University

The use of marijuana for medical conditions remains controversial, and it remains a dilemma for clinicians and the clinician-patient relationship. This presentation will provide current evidence-based guidelines for clinicians for how to discuss marijuana with their patients, including a discussion of mental health effects and potential harms of cannabis. The presentation also will discuss a recently developed web-based resource about the health effects of cannabis.

Course Learning Objectives:

1. Summarize the mental health effects of cannabis, including a focus on conditions such as PTSD and cannabis use disorder
2. Discuss strategies to reduce potential harms of cannabis in patients who choose to use cannabis for medical or recreational purposes
3. Describe the elements of a new web-based resource for clinicians and researchers about the health effects of cannabis

Webinar Slides

National Center for PTSD resource submitted by Executive Director Paula Schnurr. For clinical questions about PTSD and cannabis, the PTSD Consultation Program, email ptsdconsult@va.gov.

May 4, 2022: Benzodiazepines: The Disturbing Truth
Christopher Blazes, M.D.
Staff Psychiatrist, VAPORHCS

One of the primary prescribing quality improvement goals in VHA in recent years has been to reduce benzodiazepine prescribing. Although benzodiazepines can be effective for certain conditions if carefully prescribed and monitored, they also can have considerable adverse effects if improperly prescribed. This presentation will provide an overview of best practices for benzodiazepine prescribing, including a discussion of safe detoxification and tapering protocols, and potential lingering clinical effects even after withdrawal.

Course Learning Objectives:

1. Summarize the historical perspective of benzodiazepine prescribing and how prescribing patterns were influenced
2. Discuss the evidence behind detoxification and tapering protocols for benzodiazepine discontinuation, including alternative approaches for taper/withdrawal management
3. Describe the post-acute withdrawal syndrome for benzodiazepines

Webinar Slides

April 20, 2022: Addressing Mental Health Needs of Aging Veterans in Rural Communities
Bret Hicken, Ph.D.

VA continues to expand access to care to rural Veterans, including aging Veterans who are particularly vulnerable to the adverse effects of isolation.  This presentation will address ethical and clinical issues related to providing mental health care for older Veterans in rural areas. Attendees will learn about cultural, sociodemographic, and structural issues that impact mental health care in older Veterans, consider ethical issues that arise when caring for this population, and discuss options for addressing these issues to improve access to mental health care.

Course Learning Objectives:

1. Identify key sociodemographic and health characteristics of older rural Veterans
2. Discuss challenges that older rural Veterans experience related to accessing mental health care
3. List strategies for addressing access issues, including ethical challenges, related to access to mental health care in rural areas

Webinar Slides

April 6, 2022: MDMA-Assisted Psychotherapy for PTSD
Christopher Stauffer, M.D.
Staff Psychiatrist, VAPORHCS

There continues to be important ongoing research in VA that studies potentially effective treatments for PTSD, including various psychotherapeutic modalities. This presentation will explore current and upcoming research that focuses on medication-assisted psychotherapy for PTSD using the stimulant MDMA. The presentation will include a discussion of the rationale for using MDMA in assisted psychotherapy for PTSD, potential benefits and risks, and will explore current and future implications for PTSD research and clinical care in VA. 

Course Learning Objectives:

1. Summarize MDMA-assisted psychotherapy for PTSD clinical trial outcomes
2. Describe access and the pathway to FDA approval for MDMA-assisted psychotherapy
3. Discuss current and upcoming VA studies of MDMA-assisted psychotherapy

Webinar Slides

March 16, 2022: Prazosin for Posttraumatic Headache Randomized Controlled Trial in Veterans and Active-Duty Service Members
Murray Raskind, M.D.
Director
VISN 20 NW MIRECC
Cindy Mayer, D.O.
Site PI VISN 20 NW MIRECC

Head injury and concussion are not uncommon in combat situations, and often co-exist with PTSD. Posttraumatic headache is the most common symptom following concussion, and it can be debilitating for Veterans and for active-duty personnel. Headache is commonly encountered in general medicine and mental health clinical settings, so it is important for clinicians to be able to recognize and treat a symptom that so profoundly influences quality of life. This presentation will summarize the current scientific and clinical understanding of posttraumatic headache and will review current data supporting the use of prazosin, which is also effectively used for PTSD nightmares, for treating posttraumatic headache.

Course Learning Objectives:

1. List the most important clinical features of posttraumatic headaches;
2. Describe the pathophysiology of posttraumatic headaches; and
3. Discuss how prazosin is helpful for treating posttraumatic headaches.

Webinar Slides

March 2, 2022: Trauma, PTSD, and Perinatal Health
Yael Nillni Ph.D.
National Center for PTSD
Researcher, Women’s Health Sciences Division

The number of women Veterans being treated in VA has continued to increase in recent years, including women of childbearing age. Therefore, it is important for clinicians to have greater awareness of conditions that can adversely affect healthy pregnancies and maternal functioning in the postpartum period. Trauma, including PTSD, is an important variable that may influence perinatal and postpartum outcomes. This presentation will review some associations between trauma, PTSD, and perinatal outcomes and discuss potential effective treatments for perinatal PTSD and postpartum depression. 

Course Learning Objectives:

1. Identify the associations between trauma, PTSD, and perinatal outcomes
2. Discuss potential mechanisms explaining the association between PTSD and perinatal outcomes
3. Summarize treatments for perinatal PTSD and postpartum depression

Webinar Slides

February 16, 2022: The Elephant in the Room: Treating PTSD When Clinicians Have Strong Reactions to Patients’ Sociocultural Views 
Brittany Hall-Clark, Ph.D.

In clinical settings within VA, including settings where evidence-based PTSD treatments are used, clinicians can sometimes encounter difficult situations in which patients express strong opinions about sociocultural issues that run counter to those of the clinician. This presents challenges for the clinician in appropriately caring for the patient with PTSD, but not compromising their own views or ignoring their own emotional reaction. This presentation will assist clinicians in developing strategies for managing their reactions and continuing with effective clinical care. 

Course Learning Objectives:

1. Identify strategies PTSD clinicians can utilize if they have strong reactions to a patients’ sociocultural views
2. Discuss how to develop a case formulation of patients’ views either within or outside of a trauma framework
3. Describe how to use case formulation to decide when and how to address patient views within PTSD evidence-based treatment

February 2, 2022: Meeting the Challenge of the Methamphetamine Crisis 
Dominick DePhilippis Ph.D.
Deputy National Mental Health Director for Substance Use Disorders

Methamphetamine misuse is at crisis levels in the United States, and the effects of methamphetamine use among Veterans is encountered in clinical settings within VA. Treatment of methamphetamine dependence is challenging, but fortunately several psychosocial treatments have empirically demonstrable efficacy in helping patients recover. This presentation will review the scope of the methamphetamine crisis and effective treatments for it.

Course Learning Objectives:

1. Describe the scope of the methamphetamine crisis
2. Identify effective, evidence-based treatments for stimulant use disorder
3. Discuss the behavioral principles upon which effective Contingency Management practice is based

Webinar Slides

January 19, 2022: Evaluating and Treating Nightmares
Catherine McCall, M.D.
Ami Student, Psy.D. 

This live virtual knowledge-based training will describe nightmares. Nightmares are one of the most encountered symptoms of posttraumatic stress disorder (PTSD), but also are encountered in other sleep disorders. Because nightmares can so profoundly disrupt sleep and contribute to psychological distress, it is important for clinicians to know various options for nightmare treatment. Therefore, this presentation will discuss the etiology, assessment, and treatment of nightmares in clinical settings. Education and training is needed for an evaluation of the baseline mechanism of sleep disturbance among veterans with PTSD; inconsistency between subjective and objective findings in these patients; and especially an assessment of sleep-targeted medical and psychological intervention on the improvement of sleep disturbance as well as PTSD symptoms.

Course Learning Objectives:

1. Summarize the prevalence and pathophysiology of nightmares
2. Describe how to evaluate nightmares
3. Discuss best practices for treatment of nightmares

Webinar Slides

Psychoeducation of Nightmares

What to do when you wake from a nightmare?

December 15, 2021: Compensatory Cognitive Training and CogSMART for Veterans with Neuropsychiatric Conditions
Elizabeth Twamley, Ph.D.
Director of Clinical Research, CESAMH

Cognition can be impaired in many neuropsychiatric conditions, including traumatic brain injury, serious mental illnesses, and mild cognitive impairment associated with aging.  This presentation will describe Compensatory Cognitive Training (CCT) and Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) for individuals with these neuropsychiatric conditions. These interventions focus on teaching strategies to improve organization, attention, learning, memory, cognitive flexibility, problem-solving, and planning, rather than extensive drills and practice. Results from randomized controlled trials will be reviewed, and key components of the intervention will be described and demonstrated.

Course Learning Objectives:

1. Describe compensatory and restorative interventions to improve cognition in people with psychiatric disorders
2. List domains of cognitive functioning targeted in Compensatory Cognitive Training.
3. Discuss how to link cognitive strategies with individual rehabilitation goals

Webinar Slides

December 1, 2021: Co-occurring mTBI and PTSD: Shared Mechanisms and Evidence of Cognitive Inefficiency
Holly Rau, Ph.D.
Staff Psychologist, VISN 20 NW MIRECC and Seattle VAMC

PTSD and mTBI are frequently encountered co-existing conditions in the care of combat Veterans. For optimal patient care, it is important for clinicians to identify when the conditions co-exist so that an effective, comprehensive treatment plan can be developed. This presentation will highlight both unique and overlapping symptoms of each disorder that impair Veteran functioning, and it will discuss their clinical relevance in developing an effective approach to treatment.

Course Learning Objectives:

1. List overlapping vs. distinct symptoms of mTBI and PTSD
2. Describe three pathophysiological mechanisms involved with mTBI and PTSD sequelae
3. Discuss an alternative method for detecting subtle cognitive inefficiencies in complex clinical populations

Webinar Slides

May 19, 2021: Use of Trauma-Focused Interventions in the Veterans Health Administration: Implications for Providing Care to Veterans with Comorbid PTSD and Substance Use Disorders
Meaghan Lewis, Ph.D.

Evidence-based psychotherapies are now extensively used in VA for treatment of PTSD. A reality for Veterans and for clinicians is that PTSD often co-exists with other conditions such as depression, traumatic brain injury, and substance use. For optimal treatment it is essential to consider how these conditions influence each other and the effectiveness of treatment modalities. This presentation will focus on current trends for the use of evidence-based psychotherapies for coexisting PTSD and substance use disorders, including patterns of utilization and implications for effective clinical care. 

Course Learning Objectives:

1. Summarize patterns of utilization within VA of evidence-based psychotherapy, such as PE and PCT, for co-occurring PTSD and substance use disorders (SUD)
2. List common myths about treatment for co-occurring PTSD-SUD
3. Discuss clinical implications for using trauma-focused interventions to treat PTSD-SUD based on nationwide VHA administrative data

Webinar Slides

May 5, 2021: he Nuts and Bolts of Delivering PTSD Treatment over Telehealth
Leslie Morland, Ph.D.
Ursala Myers Ph.D.

This presentation will enhance clinician knowledge and skills by providing specific focus on the essentials of PTSD telehealth treatment. Enabling clinicians to provide optimal care in support of Veterans who have suffered trauma by providing discussion on the importance of VA clinicians for learning about telehealth modalities to meet the variety of patient needs. Because of the COVID-19 pandemic, telehealth has grown exponentially in VA over the past year. It is important that VA clinicians learn more about telehealth modalities so that they have several options for care delivery that can meet a variety of patient needs. This presentation will focus specifically on the essentials of telehealth treatment for PTSD so that clinicians can continue to provide optimal care during these challenging times for Veterans who have suffered trauma.

Course Learning Objectives:

1. Summarize the evidence supporting the use of telemental health treatment for PTSD
2. Describe how to deliver evidence-based psychotherapy for PTSD via telehealth
3. Identify modifications necessary to deliver treatments during unprecedented times

Webinar Slides

April 21, 2021: Suicide and PTSD: Navigating Risk and Tailoring Evidence-Based Treatment
Ryan Holliday, Ph.D.

This presentation will enhance clinician knowledge and skills by providing an overview of special considerations in suicide risk assessment with focus on Veterans with PTSD with discussion of evidence-based interventions. Suicide prevention has become a top priority in VA, and enhancing the effectiveness of clinicians in preventing suicide by improving knowledge and professional skills is a major part of that initiative. This presentation will focus on special considerations in suicide risk assessment among Veterans with PTSD, and it will discuss evidence-based interventions for this Veteran population. 

Course Learning Objectives:

1. Discuss suicide risk factors among Veterans with PTSD
2. Describe the link between PTSD and suicide using leading theories of suicide
3. Summarize empirically-supported methods of assessing and intervening upon suicide risk within the context of PTSD treatment

Webinar Slides

April 7, 2021: Clinical Considerations for Treating PTSD and Co-occurring Minority Stress Among LGBTQ Individuals 
Nick Livingston, Ph.D.

There has been increasing awareness in VA about the needs of minority Veterans who seek care for a variety of disorders, including PTSD. Minority Veterans often have experienced significant stress related to discrimination and prejudice in society, which is additive to other trauma that precipitated PTSD. In order to enhance clinician knowledge and skills, this presentation will focus on effective screening, assessment and treatment of sexual minority Veterans with co-occurring PTSD and minority stress.

Course Learning Objectives:

1. Describe the impact of trauma, minority stressors, and their co-occurrence on LGBTQ+ individuals
2. Identify screening and assessment tools to inform case conceptualization when working with trauma-exposed LGBTQ+ individuals who also experience minority stress
3. Discuss evidence-based interventions that can be adapted for use with trauma-exposed LGBTQ+ individuals who experience minority stress, and strategies for person-centered care

Webinar Slides

March 17, 2021: Insomnia: Diagnosis and Treatment 
Jonathan Emens, M.D.

Insomnia is a very frequent condition encountered in all health care settings, and it co-exists with many other mental health conditions. Because it is so frequently encountered and can cause significant morbidity, it is important for clinicians across disciplines to have a good working knowledge of the process of insomnia assessment, along with treatment and referral options. This presentation will provide clinicians with an overview of factors that contribute to insomnia, and it will discuss various assessment and treatment options when encountering a patient with insomnia. 

Course Learning Objectives:

1. Summarize factors that predispose individuals to insomnia and perpetuate sleeping difficulty
2. Discuss medical and psychiatric morbidity related to insomnia
3. List pharmacologic and psychotherapeutic treatment options and their expected efficacy

Webinar Slides

March 3, 2021: Culturally Responsive Case Formulation
Gayle Iwamasa, Ph.D.

Culture is a major component of personal identity and values, and it strongly influences attitudes towards illness and receptivity to medical and mental health care. This presentation will discuss how to incorporate cultural awareness into mental health assessment and care, and will discuss essential elements of a culturally responsive case formulation. 

Course Learning Objectives:

1. Define culturally responsive mental health services
2. Explain why VA mental health providers should provide culturally responsive services
3. List integral components of a culturally responsive case formulation

Webinar Slides

February 17, 2021: Around the Spring: Studies in Bipolar Onset
Sean Stanley, M.D.

Bipolar Disorder is encountered in a variety of inpatient and outpatient mental health treatment settings, and it can be a challenging condition to accurately diagnose because of the significant variation in symptoms at onset and frequent overlap of symptoms with other psychiatric conditions. This presentation will help clinicians to enhance their understanding of the presentation and natural course of Bipolar Disorder so that treatment approaches can be more accurate and effective.

Course Learning Objectives:

1. Discuss the consistency of Bipolar Disorder diagnoses over time
2. Describe the early course of symptoms in patients later diagnosed with Bipolar Disorder
3. Summarize the evidence for interventions in populations at high risk of developing Bipolar Disorder

Webinar Slides

February 3, 2021: Cannabis Use Disorder and Withdrawal
Garth Terry, M.D., Ph.D.

Cannabis is one of the most commonly used substances and its use now has been legalized in many states. However, cannabis use can lead to abuse and dependence, and adversely affect treatment of, and recovery from, a variety of psychiatric disorders. This presentation will discuss several clinical aspects of cannabis use, including recognition and treatment of cannabis use disorder, cannabis withdrawal, and important characteristics of comorbidity.

Course Learning Objectives:

1. Discuss the symptoms and clinical presentation of cannabis use disorder
2. Describe cannabis withdrawal symptoms and their potential overlap with comorbid clinical disorders
3. Summarize a treatment plan for patients presenting with cannabis use disorder, cannabis withdrawal, and/or cannabinoid hyperemesis syndrome

Webinar Slides

January 20, 2021: Management of Behavioral Symptoms in Alzheimer’s Dementia
David Mansoor, M.D.

Alzheimer’s dementia is a common clinical condition among older Veterans. Behavioral symptoms are some of the most difficult symptoms for caregivers and clinicians to manage, and they contribute to morbidity and adversely affect safety. This presentation will discuss effective assessment and treatment of behavioral symptoms, including evidence-based behavioral and pharmacological options.

Course Learning Objectives:

1. Summarize the epidemiology of behavioral symptoms in Alzheimer’s dementia
2. List characteristic target behaviors for treatment of Alzheimer’s dementia
3. Discuss pharmacological approaches to the management of Alzheimer’s dementia

Webinar Slides

December 16, 2020: Medicolegal Causation in Suicide
Michael Freeman, Ph.D.

Suicide prevention is a core VA goal, and the effectiveness of clinicians in preventing suicide requires both knowledge and professional skills. An important element of improving knowledge and skills includes enhancing awareness of factors that contribute to suicidal behavior. Using a specific case to illustrate the multifactorial nature of suicide causation and prevention, this presentation will examine suicide causation from both medical and legal perspectives.

Course Learning Objectives:

1. Summarize basic principles and steps of a medicolegal causation analysis (INFERENCE model)
2. List important factors that make suicide causation multifactorial
3. Discuss how the causation model is applied to the investigation of a specific suicide case that followed an improperly dispensed medication

Webinar Slides

INFERENCE An Evidence-Based Approach for Medicolegal Causal Analyses

Forensic epidemiologic analysis of the cause of an unexpected teen suicide following ingestion of mis-dispensed isosorbide mononitrate

December 2, 2020: Morally Distressing Events in Healthcare Workers During the Coronavirus (COVID-19) Outbreak
Sonya Norman, Ph.D.

Unprecedented contexts, such as a pandemic, may cause some healthcare workers to experience morally distressing events -- experiences that contradict personal or shared values or expectations. Feelings resulting from these experiences can include guilt, shame, distress or intrusive thoughts or images, anger, and reduced readiness.  This webinar will help mental health providers understand how working in the current pandemic might result in experiences of morally distressing events.  Strategies that workers, coworkers, and leaders can use to reduce the potential for morally distressing events and strategies that mental health care providers can use to reduce distress will be discussed.

Course Learning Objectives:

1. Define morally distressing events and understand how the current pandemic may increase the potential for frontline healthcare workers to experience morally distressing events
2. List common feelings and behaviors associated with morally distressing events
3. Describe strategies that have the potential to reduce morally distressing events, including self-care, coworker support, and help from leaders

Webinar Slides

November 18, 2020: Supporting Veterans with Dementia and Caregivers During the Era of COVID-19
Kaci Fairchild, Ph.D
Marcela Otero, Ph.D

COVID-19 has presented numerous challenges for Veterans and their families, including Veterans with dementia and co-existing medical conditions that increase stress and social isolation. This presentation will provide clinicians with an overview of the special challenges faced by these Veterans and their caregivers and will include a discussion of practical resources that can guide clinicians in their care and support.

Course Learning Objectives:

1. Describe the unique presentation of COVID-19 in older Veterans with dementia and associated comorbid medical conditions.
2. Identify the issues that Veterans with dementia and their caregivers face during the challenges caused by COVID-19.
3. Discuss and provide VA and community-based resources for supporting Veterans with the dementia and their caregivers during COVID-19.

Webinar Slides

November 4, 2020: Clinical Considerations for Intimate Partner Violence in the COVID-19 Era
Katherine Iverson, Ph.D.
Julia Caplan, LCSW

COVID-19 has presented numerous challenges to society, including increasing stress for individuals and families. Greater stress and increased isolation of families have contributed to an increase in intimate partner violence (IPV), which already had been a significant threat to health and safety.  This presentation will explore how the assessment and treatment of IPV has been affected by COVID-19, and will provide clinicians with guidelines and practical tools for addressing the needs and concerns of Veterans and their partners in this unique time. 

Course Learning Objectives:

1. Describe different types of IPV, risk factors for experiencing violence, and unique issues related to the COVID-19 pandemic
2. Identify the goals and evidence-based strategies for IPV screening, assessment, and intervention, including ways to alter these processes in the context of COVID-19
3. Discuss clinical considerations and strategies for telehealth, safety plans, clinician safety, and documentation within COVID-19 limitations

Webinar Slides

October 21, 2020: Sustaining Healthcare Worker Well-Being & Patient Care During a Prolonged Crisis -- Finding Structure in the Chaos of COVID-19
Joshua Morganstein, M.D.

Effectively serving Veterans requires a stable working environment and attention to the well-being of management, clinicians and staff. The current COVID-19 pandemic challenges policymakers, managers, and clinicians to create the safest and most effective clinical environment to optimize effective Veteran care and Veteran well-being. This presentation will highlight effective practices from other high stress environments that are relevant to VA healthcare and will identify leadership actions that can facilitate the health and well-being of clinicians serving Veterans during the pandemic.

Course Learning Objectives:

1. List psychological and behavioral health impacts of pandemics and other disasters on individuals and communities
2. Identify promising practices from other high stress occupations to enhance organizational sustainment
3. Describe organizational and leadership actions that enhance personnel well-being and functioning

Webinar Slides

Uniformed Services University, Center for the Study of Traumatic Stress - The COVID-19 pandemic has required physical distancing, which altered many aspects of personal and occupational life, including reduced in-person work. A shift to remote work/tele-working changed how workers manage daily routines, develop work goals, perform tasks, and interact with one another. Living with ongoing uncertainty caused by the pandemic has been challenging for many workers and their families. However, as rates of COVID-19 infection decline and more people are vaccinated, many organizations are resuming in-person activities to improve productivity and work performance. Although some workers look forward to face-to-face interactions with co-workers and supervisors, others are likely to feel reluctant.

Webinar Addendum - Uniformed Services University, Center for the Study of Traumatic Stress; Managing the Stress of Returning to Work after COVID-19: A Guide for Supervisors

October 7, 2020: Keeping Veterans Engaged in Treatment -- A Veteran Cultural Competence Approach
Joseph Geraci, Ph.D.

Transitioning from a life on the front lines to a life sitting at a desk is a challenge for many veterans returning from service. What makes this transition even harder is the difference in civilian and veteran experiences, creating a divide that makes it difficult for these two groups to relate in professional settings. This presentation will discuss ways that clinicians can narrow the cultural gap between Veterans and themselves in order to enhance Veteran engagement in treatment, improve treatment outcomes, and assist Veterans in their transition to civilian life. This is particularly important during an era when a new generation of clinicians is entering VA who have not had military experience and do not know military culture.

Course Learning Objectives:

1. Identify the key functions and roles that Servicemembers fill, as described through the Warrior’s Journey
2. Identify how military roles impact Veterans’ lives
3. Assess the impact of military experiences and roles which impact Veterans
4. Improve ability to serve Veterans by applying this knowledge to improve practice

Webinar Slides

June 3, 2020: Posttraumatic headaches: Current concepts in pathophysiology, diagnosis, and management

Chronic headaches can occur after trauma and can co-exist with traumatic brain injury and chronic PTSD, causing significant discomfort for patients and impairing optimal functioning. This presentation will summarize the current status of clinical care and research related to posttraumatic headaches and discuss guidelines for assessment and treatment.

Cynthia Mayer, D.O.
Cindy Mayer, D.O., is a staff physician at the VA Puget Sound in Seattle. Dr. Mayer is Board-certified in neurology and nuclear medicine and completed a clinical research fellowship at the VA VISN 20 Northwest Network MIRECC under the mentorship of Drs. Murray Raskind and Elaine Peskind, Director and Co-Director, respectively, of that program. Her areas of interest include mild traumatic brain injury (mTBI), Gulf War Illness, and neurodegenerative diseases. Dr. Mayer has a particular interest in pathologies underlying these conditions and their comorbidities, and in identifying treatments to alleviate symptoms. Dr. Mayer is currently co-Principal Investigator on a randomized controlled trial evaluating the medication prazosin for prophylactic treatment of posttraumatic headaches in Veterans and active duty Service Members with mTBI. This research has been funded through a VA Career Development Award and a DoD CDMRP grant.

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April 15, 2020: The role of religion/spirituality in mental health outcomes for PTSD

Religion and spirituality have become increasingly important in psychiatric assessment and treatment. They can be an important part of cultural heritage, and they also can be important in healing and social supports. This presentation discussED the relevance of religion and spirituality in clinical outcomes for mental health conditions, including PTSD.

Zhen Cheng, Ph.D.
Zhen Cheng, Ph.D. is a Psychology Postdoctoral Fellow at the VA Portland Health Care System through the Northwest MIRECC. She is also a Clinical Instructor of Psychiatry at the Oregon Health & Science University School of Medicine. Dr. Cheng’s research focuses on the intersection of culture (gender, religion and spirituality, and race/ethnicity) with PTSD and sexual trauma.

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April 1, 2020: Treatment engagement and retention in patients with PTSD

Despite the development of evidence-based, effective treatments for PTSD within VA, treatment engagement and retention continue to be challenging, but they are essential for effective treatment. This presentation will explore some of the factors that influence engagement and retention and provide clinical suggestions for optimizing treatment engagement and retention.

Shannon Kehle-Forbes, Ph.D.
Shannon Kehle-Forbes, Ph.D. is a clinical psychologist interested in understanding and treating post-deployment health problems. Specifically, her interests and expertise are in the areas of dissemination and implementation of evidence-based psychotherapies for PTSD, treatment seeking and access, and conditions often comorbid with PTSD (mild traumatic brain injury and substance use disorders).


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March 18, 2020: Evidence for glymphatic dysfunction in Alzheimer’s Disease: Sleep, waste, and neurodegeneration at the crossroads of the Central Nervous System

Alzheimer’s Disease continues to be an important contributor to morbidity and mortality among Veterans. The glymphatic system, a brain-wide network that facilitates the clearance of waste products, has been demonstrated to fail in the aging brain and in the young brain after traumatic brain injury. Impairment of glymphatic function may link brain trauma early in life with the development of dementia in later years. This clinically relevant presentation will explore the implications of impairment of glymphatic function for vulnerability to Alzheimer’s Disease.

Jeff Iliff, Ph.D.
Jeff Iliff, Ph.D. is the Associate Director for Research at the VISN 20 NW Mental Illness, Research, Education and Clinical Center (MIRECC) at the VA Puget Sound Health Care System. He is a Professor in the Departments of Psychiatry and Behavioral Sciences and in Neurology at the University of Washington School of Medicine, where he is the Arthur J. and Marcella McCaffray Professor in Alzheimer’s Disease. Dr. Iliff focuses upon how the different cells of the brain work in concert to maintain whole-brain function. His strongest interest is in the cerebral vasculature, how it functions as a crossroads between the CNS and periphery, different brain regions, fluid compartments and cell types; maintaining appropriate sequestration, exchange and communication. The breakdown of these relationships are a key contributor to many neuological, neurovascular and neurodegenerative diseases.

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March 4, 2020: Dialectical Behavioral Therapy (DBT) for treating PTSD

Dialectical Behavior Therapy (DBT) was originally developed to treat chronically suicidal and self-injuring individuals with multiple mental disorders and pervasive emotion dysregulation. From its inception, DBT has highlighted the role of trauma as a common etiological factor and posttraumatic stress disorder (PTSD) as an important treatment target for many patients who receive this treatment. In this talk, the basic structure and procedures of the DBT Prolonged Exposure (DBT PE) protocol will be outlined and the clinical challenges encountered during its development will be discussed. In addition, research findings supporting the safety and effectiveness of the integrated DBT and DBT PE protocol treatment will be presented.

Melanie S. Harned, Ph.D., ABPP
Melanie S. Harned, Ph.D., ABPP, is a Psychologist and Coordinator of the DBT Program at the VA Puget Sound Health Care System and an Associate Professor in the Department of Psychiatry and Behavioral Science and Adjunct Associate Professor in the Department of Psychology at the University of Washington. Dr. Harned has previously worked as the Research Director of Dr. Marsha Linehan’s Behavioral Research and Therapy Clinics at the University of Washington (2006-2018), Director of Research and Development for Behavioral Tech, LLC (2014-2017), and Director of Behavioral Tech Research, Inc. (2013-2016).

Outcome/Objectives:  
1. Understand the rationale for integrating PTSD treatment into DBT.
2. Outline the basic structure and procedures of the DBT Prolonged Exposure protocol for PTSD.
3. Review research findings evaluating the safety and effectiveness of the treatment.

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February 19, 2020: Dissociation, Somatization, and Other Challenging Presentations of PTSD

Challenging presentations of PTSD, particularly dissociation and somatization trauma reactions, sometimes lead clinicians to hesitate offering evidence-based PTSD treatment. This course will help clinicians identify and understand dissociation and somatization presentations as trauma reactions within a PTSD case conceptualization framework, and will include reviewing clinical suggestions to support first-line evidence-based PTSD treatment for Veterans with these challenging presentations.

Abigail Angkaw, Ph.D.
Abigail Angkaw, Ph.D., is a clinical psychologist and Section Chief overseeing a unit of community-based outpatient mental health clinics at the VA San Diego, PTSD Program Director at the VA San Diego, and an Associate Clinical Professor at the University of California, San Diego. Dr. Angkaw specializes in questions related to treatment, assessment, and clinic administration, including Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), Clinician Administered PTSD Scale (CAPS-5), measurement-based care, motivation and engagement, and program improvement.

Outcome/Objectives:  
1. Describe how individuals with PTSD may present with dissociation and somatization;
2. Discuss the rationale for not immediately excluding individuals with PTSD and dissociation or somatization reactions from evidence-based treatments for PTSD;
3. Identify methods to address dissociation and somatization PTSD reactions within evidence-based PTSD treatment.

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February 5, 2020: Clinical and administrative applications of the PTSD-Repository Clinical Trials Database

The development and use of evidence-based treatments for PTSD remains an important VA mission. This requires PTSD research that can inform and positively impact patient care. This presentation will highlight the relevance and effective use of the national PTSD repository for VA clinicians, educators, and researchers.

• Maya O’Neil, Ph.D.: Dr. Maya O’Neil is an Associate Professor at Oregon Health & Science University and Clinical Neuropsychologist at the Portland VA. She is a VA RR&D Career Development Awardee and an Investigator with the HSR&D CIVIC research center, the VA’s Evidence-based Synthesis Program, and the OHSU Pacific Northwest Evidence-based Practice Center. Her current grants focus on PTSD, TBI, cognitive functioning, and evidence synthesis methods.
• Jessica Hamblen, Ph.D.: Dr. Jessica Hamblen is the Deputy for Education at the National Center for PTSD and an Associate Professor at the Geisel School of Medicine at Dartmouth.  Her primary research interests are to develop, evaluate, and disseminate evidence-based treatments for PTSD and to inform and support trauma survivors in understanding and seeking these treatments.  She currently has an HSR&D funded randomized controlled trial to examine whether videos of Veterans sharing their experiences with PTSD treatment improves engagement and completion of treatment.
• Tamara Cheney, M.D.: Research Associate, Oregon Health & Science University’s Pacific Northwest Evidence-based Practice Center

Outcome/Objectives: 
1. Understand the rationale behind developing the PTSD-Repository;
2. Identify key patient, study, and outcome variables included in the PTSD-Repository;
3. Learn how to use the PTSD-Repository for clinical, administrative, educational, or research purposes.

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January 15, 2020: Unconventional interventions for PTSD: State of the evidence

Currently, several nonpharmacologic biological treatments are being investigated for the treatment of trauma. This presentation will explore the current evidence base for the use of these treatments, such as stellate ganglion block and hyperbaric oxygen, in PTSD treatment.

Paul Holtzheimer, M.D., MSCR
Dr. Paul Holtzheimer is Deputy Director for Research at the VA’s National Center for Post-Traumatic Stress Disorder (NCPTSD), Executive Division. He is an Associate Professor of Psychiatry and Surgery at the Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center and a Diplomate of the American Board of Psychiatry and Neurology. Dr. Holtzheimer’s research program focuses on the neurobiology and treatment of mood disorders, primarily using functional and structural neuroimaging (magnetic resonance imaging and electroencephalography) as well as focal neuromodulation (e.g., transcranial magnetic stimulation, transcranial direct current stimulation, and deep brain stimulation).

Outcome/Objectives: 
1. describe various proposed non-pharmacologic biological treatements for PTSD
2. discuss the regulatory processes that provide safety oversight for these interventions; and
3. identify the safety and efficay data for focal brain stimulation in PTSD treatment.

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December 18, 2019: Focal Brain Stimulation for PTSD

Currently, several nonpharmacologic biological treatments are being investigated for the treatment of PTSD. This presentation will focus on the current evidence base for a particularly promising clinical treatment, focal brain stimulation, including potential benefits and risks.

Paul Holtzheimer, M.D., MSCR
Dr. Paul Holtzheimer is Deputy Director for Research at the VA’s National Center for Post-Traumatic Stress Disorder (NCPTSD), Executive Division. He is an Associate Professor of Psychiatry and Surgery at the Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center and a Diplomate of the American Board of Psychiatry and Neurology. Dr. Holtzheimer’s research program focuses on the neurobiology and treatment of mood disorders, primarily using functional and structural neuroimaging (magnetic resonance imaging and electroencephalography) as well as focal neuromodulation (e.g., transcranial magnetic stimulation, transcranial direct current stimulation, and deep brain stimulation).

Outcome/Objectives: 
1. Describe the neural circuit paradigm that supports the use of focal brain stimulation for PTSD;
2. Summarize the rationale for using focal brain stimulation to treat PTSD; and
3. Identify the safety and efficay data for focal brain stimulation in PTSD treatment.

Download slides (PDF)

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December 4, 2019: Lethal means safety: How clinicians can have the conversation

Lethal means safety is an important part of suicide prevention and risk assessment, one of the highest mental health priorities in VHA. This presentation will provide practical guidelines for clinicians for discussing lethal means safety with their patients in order to lower suicide risk.

Bridget Matarazzo, Psy.D.
Bridget Matarazzo, Psy.D., is the Director for Clinical Services and a Clinical/Research Psychologist at the Veterans Affairs' Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC).  Dr. Matarazzo’s primary research interests are related to engaging Veterans at risk for suicide in care, particularly following psychiatric hospitalization. . She is the Principal Investigator of a Military Suicide Research Consortium-funded multi-site interventional trial aimed at studying the effectiveness of the Home-Based Mental Health Evaluation (HOME) Program, which she developed with her colleagues at the Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC). 

Outcomes/Objectives:
1. Explain the importance of discussing lethal means safety with patients
2. Identify patients with whom providers should discuss lethal means safety
3. Discuss safe storage practices for firearms and medications

Therapeutic Risk Management - Risk Stratification Table
Suicide Risk Management - Infographic

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November, 2019: Quality of Care and Patient Outcomes Following Discontinuation of Long-Term Opioid Therapy in High-Risk Patients

The effective treatment of chronic pain is one of the greatest challenges for clinicians. Just as challenging is tapering and discontinuation of long-term opioids. This presentation will discuss these challenges that clinicians face with high-risk patients, and will offer perspectives on clinical outcomes and optimizing quality of care after opioid discontinuation.

Travis Lovejoy, Ph.D.: Travis Lovejoy, Ph.D., is staff psychologist at the Portland VA and Associate Professor of Psychiatry at Oregon Health and Science University. Dr. Lovejoy's translational research focuses on the design, rigorous testing, and implementation of clinical and health services interventions that improve health of persons living with chronic illnesses, as well as the communities to which they belong. His current research examines multifaceted treatment approaches for the management of chronic pain in patients with co-morbid substances use disorders, as well as telehelath approaches to improve mental health functioning and reduce HIV transmission risk behavior in persons living with HIV.

Outcome/Objectives
1. Describe historical trends in opioid prescribing in the U.S.
2. Identify the consequences of opioid taper and discontinuation among long-term opioid users
3. Characterize changes in patients’ pain following discontinuation of long-term opioid therapy

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November 6, 2019: Diagnosing ADHD in Adults, and Considering Treatment Options
Whitney Black, M.D.
Oregon Health & Science University

One of the most challenging psychiatric illnesses to diagnose and treat is ADHD. Symptoms can overlap with several other conditions, and accurate diagnosis is dependent on an estimation of patient functioning going back to childhood and adolescence. Moreover, treatment options include the appropriate use of controlled substances with potential for misuse. This presentation will focus on these important clinical issues, and it will include considerations particularly relevant to the care of Veterans and healthcare teams.

Outcome/Objectives
1. Identify evidence-based screening measures when diagnosing ADHD
2. Describe strategies for psychostimulant titration trials in adult patients; and
3. Describe the role for non-stimulant medications in treatment of adults with ADHD.

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October 16, 2019: The role of psychedelics in modern psychiatry: A review of the evidence base
Melissa Buboltz, M.D.
Staff Psychiatrist at the Portland Veterans Affairs (VA) and Associate Professor of Psychiatry at Oregon Health and Science University (OHSU)
Aryan Sarparast, M.D.
Payton Sterba, M.D.
Jovo Vijanderan, M.D.
(Drs. Sarparast, Sterba and Vijanderan are residents in the Department of Psychiatry at Oregon Health and Science University.)

Download the slides (3.35MB)

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May 1, 2019: Present-Centered Therapy for Posttraumatic Stress Disorder (PTSD)
Tracie Shea, Ph.D.
Staff Psychologist, Trauma Recovery Services Clinic, Providence VA Medical Center Providence, Rhode Island

The development of evidence-based psychotherapies for PTSD remains an important VA mission. Although trauma-focused treatment has the strongest evidence base as a treatment for PTSD, evidence has emerged showing that Present Centered Therapy is an effective alternative. Present Centered Therapy is a manualized time-limited treatment for PTSD that helps patients focus on addressing their current life problems that are related to past trauma. Present Centered Therapy has not been widely used outside of research, however, and neither the rationale nor the protocol are widely understood. This presentation will help bridge that gap for clinicians by providing information about the development of Present Centered Therapy, the evidence showing its effectiveness, and how to implement the treatment in clinical practice.

Outcomes/Objectives: 
1. Describe the rationale for the development of Present-Centered Therapy
2. Summarize the evidence base for Present-Centered Therapy
3. Identify the core elements of Present-Centered Therapy

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April 17, 2019: Benefits and Harms of Cannabis for the Treatment of Chronic Pain
Ben Morasco, Ph.D.
Staff Psychologist, Department of Veterans Affairs, Portland Health Care System, Portland, Oregon
Shannon Nugent, Ph.D.
Staff Psychologist, Department of Veterans Affairs, Portland Health Care System, Portland, Oregon

Management of chronic pain among Veterans remains a significant challenge for clinicians across specialties and professional disciplines. New approaches are being developed, but they need to be systematically tested for efficacy and safety. This presentation will focus on the complex research and clinical issues related to the use of cannabis for chronic pain, and will summarize current practice recommendations based on current research evidence

Outcomes/Objectives: 
1. Discuss the changing culture related to the use of cannabis for chronic pain
2. Identify demographic and clinical characteristics of patients who use medical cannabis and have concurrent prescriptions for long-term opioid therapy
3. Summarize results from a systematic review examining the benefits and harms of medical cannabis for chronic pain
4. Summarize clinical practice recommendations related to cannabis use among patients with chronic pain

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April 3, 2019: Problem Solving Training for Cognitive Dysfunction After Deployment
David Litke, Ph.D.
Staff Psychologist, War Related Illness and Injury Study Center (WRIISC), Department of Veterans Affairs New Jersey Health Care System East Orange, New Jersey
Lisa McAndrew, Ph.D.
Staff Psychologist, War Related Illness and Injury Study Center (WRIISC), Department of Veterans Affairs New Jersey Health Care System East Orange, New Jersey

Purpose: One of the cutting-edge treatments for Veteran mental health conditions is Problem-Solving Therapy, which has been found to be efficient and effective. This presentation will describe the essential elements of Problem-Solving Therapy and discuss how it can be particularly effective for cognitive problems after the stresses of deployment.

Outcomes/Objectives: At the conclusion of this educational program, learners will be able to:
1. Describe the theory behind Problem-Solving Therapy
2. Identify Veterans most likely to benefit from Problem-Solving Therapy for cognitive problems
3. Identify resources for further training in Problem-Solving Therapy

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March 20, 2019: Military service and combat deployments: Strengthening the patient-provider alliance in the context of moral injury and institutional betrayal
Kelly McCarron, Psy.D.
Clinical Psychologist, War Related Illness and Injury Study Center (WRIISC), Department of Veterans Affairs New Jersey Health Care System East Orange, New Jersey
Omowunmi Osinubi, M.D.
Clinical Director, War Related Illness and Injury Study Center (WRIISC), Department of Veterans Affairs New Jersey Health Care System East Orange, New Jersey

Purpose: Military combat potentially can present moral dilemmas that remain with Veterans long after their military service. These dilemmas can contribute to long-term emotional suffering and complicate recovery from posttraumatic stress disorder. This presentation will address these dilemmas that are encountered on a personal and institutional level, and will provide suggestions for how they can be addressed in the provider-patient relationship during the process of healing and recovery. 

Outcomes/Objectives:
1. Define the concepts of moral injury, betrayal trauma, and institutional betrayal
2. Describe how moral injury, betrayal trauma, and institutional betrayal may impact Veterans’ health care
3. Discuss specific communication techniques that facilitate trauma disclosure in a manner that builds the patient-provider alliance

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March 6, 2019: Suicide Prevention Among Women Veterans
Monireh Moghadam, LCSW
Lead Suicide Prevention Coordinator, Department of Veterans Affairs, Portland Health Care System Portland, Oregon

Purpose: Suicide prevention and risk assessment continue to be important responsibilities for VA clinicians. This includes risk assessment among a variety of special groups who seek VA care, including women Veterans. Therefore, this presentation will particularly focus on practical and effective recommendations for suicide risk assessment among women Veterans, and will discuss important elements of safety plans for enhancing suicide prevention. 

Outcomes/Objectives: 
1. List three examples of gender differences in U.S. suicide rates
2. Describe three suicide risk factors for female Veterans
3. Discuss the six steps of a Suicide Prevention Safety Plan

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February 6, 2019: A Pragmatic Approach to Managing Borderline Personality Disorder within the Busy Outpatient Clinic
Neisha D'Souza, M.D.
Assistant Professor of Psychiatry, Oregon Health and Science University Portland, Oregon
Sean Stanley, M.D.
Assistant Professor of Psychiatry, Oregon Health and Science University Portland, Oregon

Purpose: The treatment of major psychiatric disorders sometimes occurs in the context of a patient's underlying personality disorder. Effective comprehensive treatment requires knowledge and skill in managing the co-occurring personality disorder. This presentation will provide clinicians with tools to effectively recognize and treat symptoms and behavior associated specifically with borderline personality disorder in busy clinical settings. 

Outcomes/Objectives: 
1. Diagnose borderline personality disorder (BPD) correctly, including differentiation from mood disorders and PTSD
2. Articulate the basic therapeutic approach utilized in Good Psychiatric Management for clients living with BPD
3. Utilize the Model of Interpersonal Coherence to assist clients in understanding their symptomatology

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January 16, 2019: Flexible Applications in Delivering Evidence-Based Psychotherapies for Posttraumatic Stress Disorder
Tara Galovski, Ph.D.
Director, Women's Health Sciences Division, National Center for PTSD/Veterans Affairs Boston Healthcare System Boston, Massachusetts

Purpose: The development and refinement of evidence-based practices for treating posttraumatic stress disorder (PTSD) have proliferated over the last three decades. Following initial, more tightly controlled clinical trials demonstrating the efficacy of evidence-based practices such as Cognitive Processing Therapy (CPT), a host of additional studies have sought to assess the added benefits of more flexible administrations of these efficacious interventions. Given that there is much evidence to suggest that fidelity to the Cognitive Processing Therapy (CPT) protocol is important, but at times greater flexibility is necessary and effective, the goal must be providing clinicians with knowledge and tools to effectively navigate the fine line between fidelity and flexibility. Using Cognitive Processing Therapy (CPT) as an example, this presentation seeks to provide empirically informed guidance to clinicians seeking to optimize outcomes in their administration of evidence-based practices for PTSD. 

Outcomes/Objectives:
1. Describe the rationale for flexibly administering evidence-based practices
2. Summarize the evidence base for modifying interventions to meet patient need
3. Discuss the parameters around therapy modifications while maintaining fidelity to study protocols

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December 19, 2018: Neuropsychiatric Issues in Parkinson's Disease
Joel Mack, M.D.
Staff Psychiatrist, Department of Veterans Affairs, Portland Health Care System Portland, Oregon

Purpose: A neuropsychiatric condition frequently encountered in VA clinical settings is Parkinson's Disease, and treatment approaches are constantly evolving. Despite increased awareness in recent years of Parkinson's Disease neuropsychiatric symptoms and their impact on quality of life, common issues such as depression, anxiety, psychosis, and impulse control disorders continue to be under-recognized and undertreated in clinical practice. This discussion will provide an overview of the range of neuropsychiatric issues in Parkinson's Disease and highlight recent developments in assessment and treatment of these problems. 

Outcomes/Objectives:
1. Summarize the range of neuropsychiatric symptoms experienced by patients with Parkinson's Disease (PD)
2. List possible neuropsychiatric complications of Parkinson's Disease and its treatments
3. Discuss an interdisciplinary approach to treating neuropsychiatric symptoms in PD, including both medication and non-pharmacological interventions

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December, 2018: Problem Solving Training for Cognitive Dysfunction After Deployment
David Litke, Ph.D.
Lisa McAndrew, Ph.D.
VA New Jersey HCS 

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November 7, 2018: Treating Tobacco Use in Patients with Posttraumatic Stress Disorder (PTSD)
Andy Saxon, M.D.
Director, Center for Excellence in Substance Abuse Treatment and Education (CESATE), Department of Veterans Affairs, Puget Sound Health Care System Seattle, Washington

Purpose: Addiction frequently co-exists with many psychiatric disorders. Tobacco use is one of the most common addictions, and its use has significant adverse effects on health. This presentation will examine the prevalent use of tobacco by patients with PTSD and its adverse effects, and describe options for treatment interventions for patients with these co-existing disorders. 

Outcomes/Objectives: 
1. Describe the high rates of tobacco use among individuals with psychiatric disorders
2. Summarize the adverse effects of tobacco use on psychiatric disorders and potential improvements with tobacco cessation
3. Discuss characteristics of evidence-based treatment for co-occurring tobacco use and posttraumatic stress disorder

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October 3, 2018: Mental Illness and Firearms
Joseph Chien, M.D.
Staff Psychiatrist, Department of Veterans Affairs, Portland Health Care System
Will Frizzell, M.D.
Resident in Psychiatry, Oregon Health and Science University Portland, Oregon

Purpose: In medical care settings such as VA medical centers, and society at large, there continues to be intense discussion about the connection between mental illness and gun violence, including the relationship between firearms and suicide. Adequate data is needed to make policy and clinical decisions about violence prevention and threat assessment. This presentation will discuss the latest data regarding the connections among mental illness, firearms, suicide and violence, and suggest preventative clinical interventions.

Outcomes/Objectives: 
1. Summarize the epidemiologic data regarding mental illness and gun violence
2. Describe the relationship between firearms and suicide
3. Discuss the role of gun violence restraining orders

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March 21, 2018: Exposure, Relaxation and Rescription Therapy – Military (ERRT-M): Treating Trauma-Related Nightmares
Noelle Balliett, Ph.D.
Staff Psychologist Seattle VA Medical Center

Purpose: In combat PTSD, nightmares are one of the prime symptoms that cause distress for Veterans, and are a frequent complaint for Veterans seeking treatment. Therefore, it is important for clinicians to have effective options for treating combat-related nightmares. This presentation will focus on an effective option for decreasing nightmares, thereby improving sleep and overall patient functioning. 

Outcomes/Objectives:
1. Summarize how to differentiate trauma-related nightmares from other common sleep complaints
2. Discuss how to effectively consult with Veterans about treatment for nightmares
3. Describe the core components of ERRT-M

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March 7, 2018: Bipolar Disorder Best Practices
Julie Anderson, M.D.
Staff Psychiatrist, Department of Veterans Affairs, Portland Health Care System Portland, Oregon

Purpose: Bipolar disorder is a psychiatric condition with significant adverse impacts on functioning. It is a complex condition that can be improperly diagnosed and treated. In addition, treatment guidelines can change based on new research. This presentation will explore how to accurately diagnose bipolar disorder and implement the most effective evidence-based treatment. 

Outcomes/Objectives: 
1. Summarize how to accurately diagnose bipolar disorder and describe diagnostic confidence of the diagnosis in practice
2. Discuss treatment options for bipolar disorder based on the current mood episode
3. Describe how to tailor treatment options for bipolar depression or unipolar depression with mixed features to individual patient needs considering their risk for emergence of mania/hypomania

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February 21, 2018: Addressing Traumatic Guilt in PTSD Treatment
Sonya Norman, PhD
Staff Psychologist, San Diego VA Medical Center San Diego, California

Purpose: In treating PTSD, one of the most common mental health conditions among combat veterans, clinicians need to be aware of psychological issues, such as guilt, that may influence trauma recovery. To assist clinicians, this presentation will focus on assessing the role of guilt in trauma recovery and various ways to address it in treatment. 

Outcomes/Objectives: 
1. Describe the relationship between posttraumatic guilt and common posttraumatic psychopathology
2. List common posttraumatic guilt cognitions
3. Discuss strategies for addressing posttraumatic guilt in PTSD treatment.

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February 7, 2018: Antidepressant Efficacy and Publication Bias
Erick Turner, M.D.
Staff Physician, Department of Veterans Affairs, Portland Health Care System Portland, Oregon

Purpose: For optimal patient care it is essential that clinicians can access current and accurate information about new advances in healthcare. This includes the most recent information about the efficacy and safety of medications. Therefore, this presentation will summarize approaches that can help clinicians to evaluate published information about the effectiveness of antidepressant medications so that they can make informed decisions for the best clinical care. 

Outcomes/Objectives: 
1. Summarize what placebo-controlled RCTs show about the efficacy of newer, compared to older, antidepressants.
2. Describe how one’s impression of antidepressant efficacy depends on whether one consults the peer-reviewed published literature or FDA review documents.
3. Discuss whether there has been any change in the extent of reporting bias with newer, compared with older, antidepressants.

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January 17, 2018: Veterans Have Feelings Too: The overlooked emotional world of combat PTSD
Hannah Roggenkamp, M.D.
NW MIRECC Fellow, Department of Veterans Affairs, VA Puget Sound Health Care System Seattle, Washington

Purpose: Posttraumatic Stress Disorder (PTSD) among combat Veterans is a frequently encountered mental health condition. Recognition, discussion, and resolution of emotional experiences are integral to recovery from PTSD. This presentation will discuss the role of emotions in combat PTSD and how this can be addressed by clinicians in their work with Veterans. 

Outcomes/Objectives:
1. Summarize existing research on emotions in combat PTSD
2. Describe the roles of shame, guilt, anger and grief in combat PTSD
3. Discuss methods to facilitate emotional experiences in Veterans

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DECEMBER 6, 2017: Treating Anger and Aggression in Populations with Posttraumatic Stress Disorder (PTSD)
Leslie Morland, Ph.D.
Staff Psychologist, San Diego VA Medical Center San Diego, California

Purpose: Dysregulated anger and heightened levels of aggression are prominent among Veterans with PTSD, so it is important to know how to manage anger and aggression in a trauma population. The primary goal of this presentation is to allow clinicians to learn key principles and tools for working with trauma survivors who struggle with dysregulated anger. 

Outcomes/Objectives:
1. Describe the prevalence of anger and aggression in Veterans with PTSD
2. Discuss current models for understanding the relationship between anger, aggression and PTSD
3. Summarize current treatment models for dysregulated anger in a Veteran population

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November 15, 2017: Posttraumatic Stress Disorder (PTSD) and Suicide: Conceptualization and Assessment
Hal Wortzel, M.D.
Director of Neuropsychiatric Services
Ryan Holliday, Ph.D.
Advanced MIRECC Fellow Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center Denver, Colorado

Purpose: Suicide prevention, including suicide risk assessment, is a key focus in the Department of Veterans Affairs. A number of conditions, including PTSD, are risk factors for Veteran suicide. Therefore, this presentation will help clinicians explore the complex relationship between PTSD and suicide, and will discuss practical recommendations for suicide risk assessment and therapeutic risk management. Implications for effective PTSD treatment for Veterans with suicide risk also will be discussed. 

Outcomes/Objectives: 
1. Summarize the elements of suicide risk assessment and therapeutic risk management
2. Discuss the relationship between PTSD and suicide
3. Describe a conceptual model of suicide in the context of PTSD

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November 1, 2017: Update on Pharmacologic Approaches to Agitation in Dementia
Lucy Wang, M.D.
Geriatric Psychiatrist, Department of Veterans Affairs, Puget Sound Health Care System, Mental Health Service Seattle, Washington

Purpose: Control of disruptive agitation in dementia is a continuing challenge for clinicians and caregivers, and is an important determinant of patient safety and humane care. Therefore, this presentation will update attendees on recommended evidence-based pharmacological approaches to agitation in dementia to enhance effective treatment and patient safety. 

Outcomes/Objectives: At the conclusion of this educational program, learners will be able to:
1. Discuss basic principles in the management of dementia-related agitation
2. Summarize recent APA guidelines on antipsychotic use in dementia patients with agitation and psychosis
3. Discuss emerging medication treatment options for dementia-related agitation

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