Implementation of behavioral interventions, such as exposure therapy and Habit Reversal Therapy (HRT), is linked to activation of unpleasant emotion states. Such negative emotion understandably evokes an urge to avoid implementation of behavioral strategies in both clients and therapist trainees. Activation of negative emotion, however, has been considered, historically and transtherapeutically, essential to emotional processing (Foa & Kozak, 1986, but see Alpert et al., 2023; Rupp et al.,2017). Exposure therapy is often associated not only with avoidance of negative emotional experiences, but also drop out from psychotherapy (Gilmore et al., 2020). Transtherapeutic distress tolerance strategies for weathering the evocation of unpleasant feelings that accompany exposure interventions may support retention in exposure interventions.
Mindfulness-Based Practices (MBPs) can serve as a transtherapeutic intervention to support the weathering of, and ultimate reduction, of unpleasant emotion states in clients and therapists. In this journal club, a case is described for which the implementation of brief mindfulness-based practice and training in both client and trainee supported the embodiment (Crane et al, 2021) of a mindful and compassionate relationship with discomfort, distress tolerance during exposure and HRT, and both retention and engagement with behavioral interventions. Specific MBPs are described that can support therapist and client. Furthermore, such MBPs support the integration of brief mindfulness-based practices during the transtherapeutic implementation of exposure therapy and supplemental interventions to support positive therapeutic outcome and information processing for trauma survivors.
CE Learning Objective(s)
Following this presentation, participants will be able to:
1. Describe how brief mindfulness-based practices can support tolerance of unpleasant emotion and support emotional information processing in both a client and trainee implementing exposure therapy interventions.
2. Identify two specific practices mental health professionals can incorporate into sessions for work-related stress reduction.
Target Audience
This workshop is designed for licensed professionals & advanced graduate students with clinical experience who anticipate seeking licensure as mental health professionals. The instructional level of this presentation is BEGINNER.
Focus Article (will be shared with registrants one week before training)
Price, M. M., Timpano, K. R., Freund, B., & Ironson, G. (2025). A Mindfulness-Integrated Therapeutic Approach to Enhance Client Engagement with Prolonged Exposure and Habit Reversal Therapy and Bolster Therapist Trainee Self-Efficacy and Distress Tolerance. Clinical Case Studies, 24(1), 38-58.
See additional suggested readings below.
About Presenters
Malena Price is a doctoral candidate in the adult track of the Clinical Psychology PhD program at the University of Miami and starting in autumn of 2025 will commence internship training. She completed her BA in International Affairs and MSc in Global Health from Duke University and is the recipient of a Fulbright Research Grant to study behavioral health outcomes among refugees seeking asylum in Amman. Her research interests focus on the adaptation and implementation of mindfulness training programs to improve the psychological health of minoritized and marginalized populations. In addition to research, she enjoys practicing and teaching yoga as a registered yoga teacher (RYT 300). More at https://lab.amishi.com/team/malena-price/
Chris Molnar, Ph.D., a licensed psychologist and clinical investigator, founded Mindful Exposure Therapy for Anxiety and Psychological Wellness Center (META Center) in 2007. She completed post-doctoral fellowship training in traumatic stress, neuroscience, and psycho-physiology and is an expert in the assessment and treatment of anxiety, OCD, PTSD, emotional, and stress-related conditions using evidence-based practices. She teaches both Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR). She has developed adaptations of Mindfulness-Based Programs for highly distressed clients, using Relational Mindfulness Practices (RBPs), to meet the needs of people in both individual and group therapy settings. At META Center, she offers integrative interventions grounded in findings about the brain, emotion, and learning to facilitate mental and behavioral habit change, even in the face of severe distress. Before founding META Center, she served as a clinical investigator and therapist supported by grants from the National Institute of Health and other agencies. She is also on the editorial board of Behavior Therapy and serves the public in many ways, through professional presentations, workshops, publications, and affiliations.
Suggested Readings
Alpert, E., Hayes, A. M., & Foa, E. B. (2023). Examining emotional processing theory and predictors of outcome in prolonged exposure for PTSD. Behaviour Research and Therapy, 167, 104341.
Crane, R. S., Brewer, J., Feldman, C., Kabat-Zinn, J., Santorelli, S., Williams, J. M. G., & Kuyken, W. (2017). What defines mindfulness-based programs? The warp and the weft. Psychological medicine, 47(6), 990-999.
Crane, RS., Soulsby, J.G., Kuyken, W., Williams, J.M.G., & Eames, C. (2021a, pages 46-53). Mindfulness-Based Intervention: Teaching Assessment Criteria (MBI:TAC) In-depth version.
Eubanks, C. F., & Goldfried, M. R. (2019). A principle-based approach to psychotherapy integration. Handbook of psychotherapy integration, 88-104.
Gilmore, A. K., Lopez, C., Muzzy, W., Brown, W. J., Grubaugh, A., Oesterle, D. W., & Acierno, R. (2020). Emotion dysregulation predicts dropout from prolonged exposure treatment among women veterans with military sexual trauma-related posttraumatic stress disorder. Women's Health Issues, 30(6), 462-469.
Hayes, A. M. (2015). Facilitating emotional processing in depression: The application of exposure principles. Current opinion in psychology, 4, 61-66.
Molnar, C. (in press, chapter 21). Mindfulness-based cognitive therapy (MBCT): Curriculum, training, and clinician guide. Palgrave Handbook of Third-Wave Therapies.
Rupp, C., Doebler, P., Ehring, T., & Vossbeck‐Elsebusch, A. N. (2017). Emotional processing theory put to test: A meta‐analysis on the association between process and outcome measures in exposure therapy. Clinical Psychology & Psychotherapy, 24(3), 697-711.
Watson, T., Walker, O., Cann, R., & Varghese, A. K. (2021). The benefits of mindfulness in mental healthcare professionals. F1000Research, 10, 1085. https://doi.org/10.12688/f1000research.73729.2
Continuing Education Information
- Philadelphia Behavior Therapy Association is approved by the American Psychological Association to sponsor continuing education for psychologists*. Philadelphia Behavior Therapy Association maintains responsibility for this program and its content.
- This program provides one (1) hour of CE credits.
- * PBTA offers CE to licensed psychologists licensed in the state of New York. Attestation of full attendance and provision of license number post-event required to obtain certificate that meets NY criteria for CE.
- PBTA is also an authorized provider of CE credits for Professional Counselors, Marriage and Family Therapists, and Clinical Social Workers licensed in the state of Pennsylvania. Non-psychologist licensees in other states should confirm with their respective boards if this meets criteria for CE in their specific non-PA states.
- Full attendance with video display is required to obtain CE credit for this program. APA guidelines do not permit PBTA to issue partial CE credits. No refunds are provided for CE programs. No exceptions allowed. Registrants can log in and cancel up to 48 hours before event when registration closes.
Zoom video link will be sent to participants 48 & 24 hours before the event contingent upon membership being paid in full if membership rate was selected. NOTE: New membership period begins 2/1/24 & is not pro-rated.
