4 CEs
CEU Course

PTSD Out-of-the-Box: Using Principles not Protocols (November 2023)

Cognitive Behavior Institute is excited to welcome Jason T. Goodson, PhD for a live interactive webinar on: PTSD Out-of-the-Box: Using Principles not Protocols.
*Participants will not have access to their cameras/microphones


11/2/2023 8:30AM - 12:45PM EST


Dr. Jason T. Goodson



Credit Hours

4 clinical CEs

Course Overview

PTSD is a chronic and disabling condition with high comorbidity, distressing symptoms, and far-reaching negative effects (Rosemary et al., 2016, Goodson et al. 2011; Kline et al, 2021). PTSD sufferers experience internal distress, intimate relationship difficulties, social isolation, occupational problems, family disruption, and diminished quality of life (Paulus & Aupperle, 2015; Rosemnary et al. 2016; Yu et al 2016; Hernandez-Tejada et al., 2017; Sripada et al, 2018; Campbell and Renshaw, 2018, Creech and Misca, 2017,).

Fortunately, several evidence-based treatments exist and have been widely disseminated (Eftekahri et al. 2013; Chard et al. 2012). Large organizations such as the VHA have invested significant amounts of money and resources to train a large number of their providers in EBPs. In particular, by 2020 the number of VA providers trained in an EBP was estimated to be 11,600 with costs per provider and site estimated to be $1,485 and $43,000, respectively (Valenstein-Mah et al., 2020). This widescale training initiative have benefited thousands of veterans with PTSD whom have receiving an evidence-based treatment. Helping support this assertion are a growing number of treatment outcome studies have found large treatment effects for veterans with PTSD wo undergo EBPs (Goodson et al., 2017; Jeffrey et al., 2014; Shnurr et al., 2022).

However, while EBPs have flourished and come to be considered the gold-standard for PTSD treatment, several concerns have emerged. Research has consistently shown large drop-out rates ranging from 16% (Yoder et al., 30134) to 55 % (Schnurr et al., 2022). Further, those studies with lower drop-out rates have often used less stringent criteria for treatment completion (e.g., 6 sessions of PE) (Tuerk et al., 2011). In addition to high dropouts, 30-50 %of individuals do not respond with significant symptom reduction (Marmar, 2015). In fact, upwards of 40 percent of veterans who complete an EBP for PTSD continue to suffer with unchanged symptoms (Galsgaard & Eskelund, 2020; 2020; Schottenbauer et al. 2008). Similarly, anywhere from 32-72% of EBP completers do not achieve PTSD remission (they continue to retain the diagnosis of PTSD) (Steenkamp et al., 2015). Thus, it appears as if sole reliance on EBPs may lead to suboptimal treatment responses in a substantial minority of individuals with PTSD.

The purpose of this training is not to devalue EBPs. In fact, the author has been a PE trainer and consultant for the past 15 years and published several treatment outcomes studies it's effectiveness. However, it seems important to consider a broader range of interventions when it becomes clear that an EBP is not resulting in the desired symptom reduction. Most providers who treat PTSD can recall patients who dropped out or had a poor treatment response. It would seemingly be beneficial to have a broader set of tools (i.e., interventions) to bring to bear when patients are not responding. These interventions should be rooted in evidence but not necessarily a fixed protocol.

Several factors may lead to a less optimal fit for a PTSD EBP, including: lack of buy-in/motivation, difficulty tolerating high levels of distress with exposure, mismatch between most troubling symptoms and focus of EBPs, multiple traumatic events, negative beliefs about PTSD and treatment, positive beliefs about PTSD symptoms, rumination (vs intrusive memories, and difficulties learning cognitive restructuring). For each of these factors, specific treatment interventions will be discussed and key components in evidence-informed sessions will be presented. Further, a conceptual model of treatment-relevant factors will be presented. This model allows for multiple points of intervention. In addition, alternative measures to capture quality of life changes, changes in safety behaviors, changes in intrusions, changes in functional outcomes and others will be presented. Finally, illustrative examples of treatment cases who did not respond to EBP protocols but then had excellent responses to alternative, evidence-informed interventions will be presented.

Participants will be provided with useful treatment materials for evidence-informed interventions and a resource list for such interventions and/or treatments. The training will consist of lecture, group discussion, experiential exercises, and discussion of a conceptual model to help guide intervention selection. The duration of the training will be four hours.

Learning Objectives

Learning Objectives:

  1. Participants will discover various treatments that have been found to be effective with PTSD
  2. Participants will examine some of the concerns associated with current EBPs for PTSD
  3. Participants will identify alternative evidence-supported interventions and/or treatments for PTSD
  4. Participants will identify various measures useful in measuring progress during PTSD treatment and integrate them into their practice.

Course Bibliography

Clark, D.M.,Beck, A. (2010). Cognitive Therapy for Anxiety Disorders: Theory and Practice. Guilford Pres: New York.

Cox, K. S., Wiener, D., Rauch, S., Tuerk, P. W., Wangelin, B., & Acierno, R. (2021). Individual symptom reduction and post-treatment severity: Varying levels of symptom amelioration in response to prolonged exposure for post-traumatic stress disorder. Psychological services, 10.1037/ser0000579. Advance online publication. https://doi.org/10.1037/ser0000579

Dunmore, E., Clark, D. M., & Ehlers, A. (1999). Cognitive factors involved in the onset and maintenance of posttraumatic stress disorder (PTSD) after physical or sexual assault. Behaviour research and therapy, 37(9), 809–829. https://doi.org/10.1016/s0005-7967(98)00181-8

Eftekhari, A., Ruzek, J. I., Crowley, J. J., Rosen, C. S., Greenbaum, M. A., & Karlin, B. E. (2013). Effectiveness of national implementation of prolonged exposure therapy in Veterans Affairs care. JAMA psychiatry, 70(9), 949–955. https://doi.org/10.1001/jamapsychiatry.2013.36

Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour research and therapy, 38(4), 319–345. https://doi.org/10.1016/s0005-7967(99)00123-0

Goodson, J. (2017). Outcome evaluation in psychotherapy. In A. Wenzel (Ed.), The sage encyclopedia of abnormal and clinical psychology (Vol. 1, pp. 2404-2404). SAGE Publications, Inc., https://dx.doi.org/10.4135/9781483365817.n966

Goodson, J. T., Helstrom, A. W., Marino, E. J., & Smith, R. V. (2017). The impact of service-connected disability and therapist experience on outcomes from prolonged exposure therapy with veterans. Psychological trauma : theory, research, practice and policy, 9(6), 647–654. https://doi.org/10.1037/tra0000260

Goodson, J.T. & Haeffel, G.J. (2022). Treating Posttraumatic Stress Disorder in Combat Veterans: A Guide to Using Behavior Therapy for Anxiety and PTSD (BTAP). Clinical Psychology and Special Education, 2022. Vol. 11 (Accepted for Publication).

Goodson, J.T. & Haeffel, G.H. (2018). Preventative and restorative safety behaviors: Effects on exposure treatment outcomes and risk for future anxious symptoms. Journal of Clinical Psychology,74, 1657-1672

Goodson, JT, Helstrom, A., Halperen, J., Ferenschak, M., Gillihan, S., Powers, M. (2011). The Treatment of Posttraumatic Stress disorder in U.S. Combat Veterans: A Meta-Analytic Review. Psychological Reports, vol. 109, pp. 573-599.

Hackmann, A., Ehlers, A., Speckens, A., & Clark, D. M. (2004). Characteristics and content of intrusive memories in PTSD and their changes with treatment. Journal of Traumatic Stress, 17(3), 231–240. https://doi.org/10.1023/B:JOTS.0000029266.88369.fd

Hershenberg, R., Smith, R. V., Goodson, J. T., & Thase, M. E. (2018). Activating Veterans Toward Sources of Reward: A Pilot Report on Development, Feasibility, and Clinical Outcomes of a 12-Week Behavioral Activation Group Treatment. Cognitive and Behavioral Practice, 25(1), 57–69. https://doi.org/10.1016/j.cbpra.2017.04.001

Jeffreys, M. D., Reinfeld, C., Nair, P. V., Garcia, H. A., Mata-Galan, E., & Rentz, T. O. (2014). Evaluating treatment of posttraumatic stress disorder with cognitive processing therapy and prolonged exposure therapy in a VHA specialty clinic. Journal of anxiety disorders, 28(1), 108–114. https://doi.org/10.1016/j.janxdis.2013.04.010

Kang, H. K., Natelson, B. H., Mahan, C. M., Lee, K. Y., & Murphy, F. M. (2003). Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: a population-based survey of 30,000 veterans. American journal of epidemiology, 157(2), 141–148. https://doi.org/10.1093/aje/kwf187

Kehle-Forbes, S. M., Meis, L. A., Spoont, M. R., & Polusny, M. A. (2016). Treatment initiation and dropout from prolonged exposure and cognitive processing therapy in a VA outpatient clinic. Psychological trauma : theory, research, practice and policy, 8(1), 107–114. https://doi.org/10.1037/tra0000065

McLane, H. C., Barnes, J. B., & Shofer, F. S. (2019). Outcome Expectancy for Prolonged Exposure Therapy Predicts Symptom Improvement in Veterans with Post-Traumatic Stress Disorder. 7(3), 4.

Najavits L. M. (2015). The problem of dropout from "gold standard" PTSD therapies. F1000prime reports, 7, 43. https://doi.org/10.12703/P7-43


Schumm, H., Krüger-Gottschalk, A., Dyer, A., Pittig, A., Cludius, B., Takano, K., Alpers, G. W., & Ehring, T. (2022). Mechanisms of Change in Trauma-Focused Treatment for PTSD: The Role of Rumination. Behaviour Research and Therapy, 148, 104009. https://doi.org/10.1016/j.brat.2021.104009

Van Dijk, Maarten & Verbraak, Marc & Oosterbaan, Desiree & Hoogendoorn, Adriaan & Balkom, Anton. (2014). Predictors of Non-response and Persistent Functional Impairments in Treatment Adhering to Evidence-based Practice Guidelines for Anxiety Disorders. Journal of Depression and Anxiety. 3. 159. 10.4172/2167-1044.1000159.

Wenzel, A. (2017). The SAGE Encyclopedia of Abnormal and Clinical Psychology. SAGE Publications, Inc. https://doi.org/10.4135/9781483365817

Zoellner, L.A., Lehinger, E.A., Rosencrans, S., Cornell-Maier, M., Foa, E.B., Telch, M.J, Gonzales-Lima, F., Bedard-Gilligan, A (2022). Brief imaginal exposure for PTSD: Trajectories in change in distress. Cognitive Behavioral Practice. Accepted for Publication.



Cognitive Behavior Institute, #1771, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 06/30/2022-06/30/2025. Social workers completing this course receive 4 clinical continuing education credits.

Cognitive Behavior Institute, LLC is recognized by the New York State Education Department's State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0098 and the State Board for Social Work as an approved provider of continuing education for licensed social workers #SW-0646 and the State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors #MHC-0216.

Cognitive Behavior Institute has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7117. Programs that do not qualify for NBCC credit are clearly identified. Cognitive Behavior Institute is solely responsible for all aspects of the programs.

Cognitive Behavior Institute is approved by the American Psychological Association to sponsor continuing education for psychologists. Cognitive Behavior Institute maintains responsibility for content of this program. Social workers, marriage and family therapists, and professional counselors in Pennsylvania can receive continuing education from providers approved by the American Psychological Association. Since CBI is approved by the American Psychological Association to sponsor continuing education, licensed social workers, licensed marriage and family therapists, and licensed professional counselors in Pennsylvania will be able to fulfill their continuing education requirements by attending CBI continuing education programs. For professionals outside the state of Pennsylvania, you must confirm with your specific State Board that APA approved CE's are accepted towards your licensure requirements. The Association of Social Work Boards (ASWB) has a process for approving individual programs or providers for continuing education through their Approved Continuing Education (ACE) program. ACE approved providers and individual courses approved by ASWB are not accepted by every state and regulatory board for continuing education credits for social workers. Every US state other than New York accepts ACE approval for social workers in some capacity: New Jersey only accepts individually approved courses for social workers, rather than courses from approved providers. The West Virginia board requires board approval for live courses, but accepts ASWB ACE approval for other courses for social workers. For more information, please see https://www.aswb.org/ace/ace-jurisdiction-map/. Whether or not boards accept ASWB ACE approved continuing education for other professionals such as licensed professional counselors or licensed marriage and family therapists varies by jurisdiction. To determine if a course can be accepted by your licensing board, please review your board’s regulations or contact them. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit.

Accommodation Information: Our webinars are available to anyone who is able to access the internet. For those who are vision impaired graphs and videos are described verbally. We also read all of the questions and comments that are asked of our speakers. All questions and comments are made via the chat function. For those that require it, please contact us at info@cbicenterforeducation.com for more information on and/or to request closed-captioning.

Course Schedule

Course Date Course Start Time Course End Time Timezone
11/2/2023 8:30AM 12:45PM EST

Course Agenda

Course Event Day or Date Course Agenda Time Block Course Content Covered
Day 1 8:30AM - 8:45AM Introduction
Day 1 8:45AM - 9:15AM Limitations with EBPs for PTSD & Factors that may result in less optimal fit with PTSD
Day 1 9:15AM - 9:30AM Treatments that have shown to be effective with PTSD
Day 1 9:30-AM - 10:00AM Factors associated with PTSD and PTSD treatment outcomes
Day 1 10:00 AM - 10:15AM Break
Day 1 10:15AM - 11:00AM Out-of-the-Box interventions
Day 1 11:00AM - 11:30AM Out-of-the box case examples
Day 1 11:30AM 12:15PM Conceptualization for Treating PTSD
Day 1 12:15PM - 12:45PM QA & review of materials/handouts

Frequently Asked Questions

Questions about Zoom and Webinars

What platform will be used for the webinar? CBI Center for Education has invested in Zoom for Webinars. You do not need a Zoom account to join the webinar and you can join from your computer or mobile device. As an attendee, the presenter will not be able to see your video or hear you unless they give you special permission during the webinar.

What time will the webinar begin and in what time zone? Please see the event page on https://www.cbicenterforeducation.com/ for information about the webinar, such as the start time. In addition, when registrants receive the email for the event, the date and time of the event is included.

When will I receive the link to attend the webinar? After you’ve signed up for the event through our website, you will receive an automated email from Blue Sky. At the bottom of this email is a blue button labeled “Join” that you can click on the day of the event. Or log in directly to your Blue Sky account and join from there.

Why can’t I get into the webinar? Once you have joined the webinar, you might see a message that states that the webinar has not yet started. The webinar will start once the presenter has joined and clicks “start the meeting.” We hope this happens on time, but it may be several minutes late. Please be patient while you are waiting for the webinar to start.

lined internet or being physically located close to your router. Technical support will not be provided by CBI for any connection issues on the day of the training. CBI will not issue refunds due to technical issues experienced by participants. Our presenters are connected to hard-lined business-grade internet when presenting.

What happens if my internet briefly freezes? If you become disconnected during the event, log back on immediately. A brief interruption of connectivity will not impact your eligibility for a CE certificate.

Will there be a recording? No, there will not be a recording or replay.

Will you know that I am logged in and active in the webinar? Yes, Zoom’s platform monitors the attendance and activity of the attendees. Additionally, there will be a chat feature and various forms of participation monitored throughout the training.

Will I have to show my face on camera? Zoom’s webinar platform does not capture participants on video unless specifically requested during the meeting by the host. Instead, participants will view the presenter and the presenter's slides on their screen.

Is there Audio? Yes, the webinar will have sound. Please test that your device’s sound is working prior to the event. A good way to do this is to go to YouTube and play a

Questions about the Event

Will I receive the presenter's slides? It is up to each presenter if they wish to share their slides. If slides are being shared, they will be uploaded as a document within the course in Blue Sky and can be downloaded and printed as necessary. We are unable to respond to emails asking for the slides ahead of the presentation.

Questions about the Survey

When will I receive my course evaluation survey? Following the completion of the event, the survey will be unlocked and located within the course.

You must complete the survey within 14 calendar days following the event if you would like to receive a CE certificate.

We are unable to respond to emails from participants asking for confirmation that their course completion survey was received. If you clicked the SUBMIT button your survey was received.

Do I need to fill out the course evaluation survey if I don’t want a CE certificate? If you do not wish to receive a CE certificate, you do not need to complete this survey. The CE certificate is the only type of certificate that will be issued.

Questions about Continuing Education & Certificates

What is the criteria for receiving CE? If you attend the whole webinar and complete the course evaluation survey, we will issue you the CE that you are eligible for.

How many suicide and ethics CE's will be issued? Please see the event page on https://www.cbicenterforeducation.com/for information about the training, including how much continuing education is offered and what type.

Will these CE's count toward my individual state licensure or another credential that I currently hold? It is the responsibility of the licensee to determine if trainings are acceptable as continuing education to their state’s licensure board or other credentialing body. Some of our trainings are individually approved for continuing education, such as through the Association of Social Work Boards individual course ACE Program. In addition, CBI is an approved provider of continuing education through the American Psychological Association CESA program and is an approved provider of continuing education to counselors, social workers, and psychologists in the state of New York. Many boards accept trainings that are individual approved or are offered by approved providers for continuing education. Please see the event page for the training you are interested in on our website https://www.cbicenterforeducation.com/for approvals that apply for each specific training.

Will you issue partial CE credits? No, we do not issue partial CE credits and therefore if you do not attend the training in its entirety, you will not be receiving a CE certificate. This is an APA and ASWB ACE requirement and is non-negotiable. Please refrain from emailing us explaining why you were unable to login to the event on time (this includes mixing up time zones and technical difficulties).

When will I receive my CE certificate? Upon completion of the event and survey, your certificate will immediately be available.

How will I receive my CE certificate? Your CE certificate will be available through your Blue Sky account and will also be directly sent to your email associated with your Blue Sky account. It will automatically be accessible to you once all previous criteria have been met.

I filled out the wrong email address or misspelled my name on my account registration. How do I get a new certificate? In the registration, it asks for the participant to fill out
their name, licensure, and license number. These fields automatically populate within our certificates. PLEASE NOTE: Any requested changes to the email entered after
registration or after the survey is complete will require a $5 processing fee. Additional changes to the produced CE certificate based off of information provided by the attendee will also require a $5 processing fee. CBI Center of Education is extremely lean administratively and utilizes technology to streamline our events in order to keep our trainings free to low cost. When we receive manual requests post registration, additional staff is needed to assist with these manual requests, thus the reason for the
change fees. Please reach out to info@cbicenterforeducation.com

Questions about Accommodation

How can I access accommodations for my disability? Our webinars are available to anyone who is able to access the internet. For those who are vision impaired graphs
and videos are described verbally. We also read all of the questions and comments that are asked of our speakers. All questions and comments are made via the chat function.

For those that require it, please contact us at info@cbicenterforeducation.com for more information on and/or to request closed-captioning.

Additional Questions

I have a question that isn’t in the Q&A. If you have any additional questions or concerns, please email us at info@cbicenterforeducation.com.

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