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Today I could go ahead and put my powerpoint on the screen as well as we can.
Look at that lower while we're waiting here. You need 1 s
Okay. And I'm also gonna do like a short intro and just go over everything for technical issues is sees and things like that.
Then I'll let you know when to start
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All right. Well, I will just wait for you to start that whenever you feel ready
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Let's see, we're ready to go ahead with the intro that works for me as well
Alright. Thank you, everyone for joining welcome. We have a wonderful Dr.
Ryan landau presentation in store tonight. He is dual, new boarded, certified in clinical psychology and clinical childhood at a lesson.
Psychology works with children adolescent in their families.
Today's presentation will be on applying unified portal for the treatment of emotional disorders.
But before we get started. I do have a few logistics to cover everyone's microphones are on mute and videos are off.
If you have any questions during the training, you could use the Q.
A future feature, or the chat. If you need technical assistance.
During the training. Please email trainings with the S. At the end at raw sensor.com for immediate assistance.
You all should have received the email yesterday with the Handouts.
If you didn't email the same email trainings at Rossin to.com.
So we get that team right away. This training will be recorded.
It is a proof of 1.5 ce for psychologists and all states as well as 1.5 C.
For social workers in New York, Virginia, ABC. There are no Cl.
Alright. Well, good afternoon. Everyone excited to work with you all today.
Let me ask you a question. Do you all go see the screen clearly at this point?
Or no, you probably I have a little disconnect.
I'm just trying to make sure I'm looking at you all while I'm also talking but we'll make it happen alright.
So as was mentioned, we are offering some continuing education credits.
I do not have any financial relationships or commercial interests to disclose.
Do you wanna acknowledge and thank all these individuals?
Here the raw center again. Then with the Ross Center for about a year and a half.
Now it is just been a wonderful community, and I'm really grateful again for the opportunity to both practice in the center as well as to provide some opportunity and education.
And so thank you again, and then Corks. I think it's wonderful how the Ross Center incorporates diversity and inclusivity and the work that we do.
It's a critical that we as helpcare professionals, understand the role that social justice plays and advancing and taking care of those who are suffering with behavioral health challenges in my in my day job I do work.
At the uniform services, university and I'm also a member of the Air Force Reserve.
So I just have to be clear that I am presenting to you all today, and my unofficial capacity, and as a as a clinical psychologist, and not representative of any official dod or government policies alright so let's talk a little bit about, what we can expect to get out
Of the session today. So the first thing is we're going to be focusing on the unified protocol for the treatment of emotional disorders.
And my goal in this 90 min primer is that we really hit the wave tops.
We sort of talk a little bit about. Why, it's can be helpful to think about trans diagnostic approaches, and in particular, the unified protocol and what are some of those key principles in ingredients which will actually touch on some principles of dissemination and implementation
Science more broadly. I do want to present a little bit of research here on the use of the unified protocol, and I will tell you that that is another area where there is a wealth of literature that you can read on your own as well, if you're really interested in understanding more about the
Literature. It's it's quite robust, and in a lot of different adaptations and varieties.
And then what I hope is one of the principles that are is key to unified protocol is the experiential nature of the work that we?
Do and so we are going to practice what we preach, and we're going to be experiential.
So for better or worse. This is one of those continuing education that I know.
I personally always grown a little bit about, because I'm gonna have to get active and get engaged.
But I hope that is actually gonna end up being a little bit more enriching and exciting for you all.
So I look forward to the engagement as we go forward.
So we are gonna start with just sort of talking about what is the unified protocol?
And what broadly, what are trans d diagnostic approaches in general.
Again. This starts to touch on a little bit of where we have evolved from a dissemination implementation science perspective and then we're going to do some experiential practice in the areas around emotional awareness and mindfulness and then in the really in the ways of what we call opposite action which we'll talk about but to
me is a really helpful language. Shift to think about some of the work that we do.
That cuts across multiple psychological disorders, alright.
So I'm gonna try some pull everywhere. I have to warn you.
One of the things that I've been working on is incorporating.
Pull everywhere a little bit better into my presentations. I'm gonna throw the instructions set up there for a second here, so for those of you who are not familiar you can either text or Ryan land all 362 or you can go to Pulley B and enter that code that should
Work, please someone, if someone can give me a Comms chat and a chat that weird is working.
When I switch over to the response set in just a second and hopefully, we'll start to see some responses populate when you hear that term evidence-based practice. What are the things that you think about?
And again the instructions there at the top, so you all can start to participate and look forward to hearing what folks have to say.
Oh, mark manuals right on
Alright research, that's getting a little bit more traction. There.
Structure controlled trials. Okay. All right. Okay. So we see some scientific approaches here.
I like that I like that a little bit. Good. Okay, I'm surprised.
This is that I was, you know, as I think about the diversity and clinical practice, sometimes evidence-based practice can sometimes feel a little limiting.
You know I see that control there specific, you know, so it can sometimes present some challenges and frustrations given how dynamic the clinical setting is okay, some we're starting a little more diversity here fantastic okay.
Replicable data informed. That's a that's a real strength of them, for sure.
Progress. Scientific. Awesome. Okay, think the word cloud has started to settle down a little bit here.
Oh, there's still some more coming in fantastic. I love it well, as we think about that, you know I the next question that I'll take us to, are how any evidence-based protocol treatments do you use in your own practice so you know again.
Thinking about the treatments that you provide. How many of them are sort of evidence-based protocols that you're specifically training and that you utilize and that sort of structured web.
Okay. Oh, so we started out with 3. But now none is coming up to.
So that's kind of interesting. This is one of the cool poll features where it'll it'll kind of rank order as more people respond. Okay.
So I think that's really fascinating. Okay.
Some people are got a little more evidence-based 3 or 4 is kind of coming up, but but none still seems to be in the lead, so isn't that an interesting dichotomy right the word cloud that we use tend to be fairly positive right tended to have more you know evidence-based
scientific clear research back. And then we're not. Yes, regularly using that right.
So that that is at the heart of dissemination and implementation.
Science. Right? So let's think about this next question here, and then we'll kind of talk about it.
So now thinking specifically about this protocol that we're gonna talk about today.
How familiar are you with the unified protocol for the treatment of emotional disorders, and I'll give you all chance to
Okay.
Okay. Diverse group. Okay.
Alright. So most folks are familiar with it, but they're not actively necessarily using it that's not good.
But we've got a pretty wide spread here. Okay.
Alright. We give a few more minutes this. You all are very also validating for me that I can learn how to use new technology.
So thank you for that this is the first time I've successfully incorporated a pull everywhere pull into my presentation, and it works smoothly.
So it only took me probably 3 or 4 times to get there.
But thank you all for your Grace. Okay, alright.
Well, so let's let me talk a little bit about that.
The unified protocol, thinking about the framework that we just sort of establish when we think about evidence-based practice. In general.
Okay. So the unified protocol for the trans diagnostic treatment of emotional disorders with up it's evidence-based cognitive behavioral intervention alright the up has been widely studied adapted and implemented in a wide range of settings.
This is what we're gonna really dig into, but I actually wanna be really clear.
So I so the original work on the unified Protocol came out of Boston University, and David Barlow and colleagues.
There, and there was endowed for using children adolescents by Dr.
Jill, Aaron, Reich May, who works at the University of Miami, which is where I did.
My graduate training, so I've been trained in the unified protocol I've worked on research clinical trials, evaluating the unified protocol in addition the unified protocol another adaptation that has occurred as it's been adapted for group based
Intervention within the military specifically within the United States Air Force, and I was involved in the pilot trial of that as well.
So I I've worked with the unified protocol, and from a research capacity.
Really throughout my my career, currently actually in the principal investor for a primary care, adaptation with children that's ongoing with uniform services, universities.
So I have a lot of perspective from a researcher on the unified protocol.
But to be very clear. I am not a certified userp trainer, and so you know there are this.
This talk is really designed to take you know where the majority of you says you were.
I've heard of this protocol, but I'm not actively using it, and give you some very specific tangential experiential exposure to decide is this something that's worth some of the follow-on training at the end of this CEO I in the c
Workshop. I'll go through some of the more formal training programs that they have now unified.
Protocol is not something that you know. It is so locked down that you must have this advanced certification, or you're not competent to provide it a lot of the principles really do fall.
Within the purview of cognitive behavioral therapy.
And so it's all, and they also have a lot of both print and online training.
So again, you don't have to go through a formal certification, but I just also want to be clear and transparent and sort of how I've come to work primarily with unified protocol alright so let's talk about.
Why we we, you know. So we highlighted at the very beginning of this talk that there is this gap between me like the idea of evidence based practice right?
It's research-based. It's scientific. That's what we are.
As health, care, professionals. We all have gone to some type of professional graduate training where we have invested in, you know, doing the science of behavioral health.
I always think about when I was an intern. I had a colleague and other intern.
Say I like to think about therapy, as I just need to be a friend to an individual right like they they struggle with so support, and I just want to be their friend, and I cringed I was like oh, please tell me did not go to graduate school to learn how to be a friend right of
course common factors are key establishing that warm therapeutic support and providing a solid communication skills are essential to be an effective health care professional and there's so much more that we do in terms of working with our our colleagues, and individuals, so you know one of the
things that I think is an interesting challenge is so. We like the idea of evidence-based practice.
Many of us are trained to sort of think about how to utilize evidence-based practice it's a hallmark in many many training, programs, and then yet in our own clinical practice we don't use them as much and I will tell you this is why I've
I've been so blessed having starting out in a research academic track and then doing full-time clinical work in the Air Force.
It really got me interested in this idea of the disconnect between research and clinical practice right that sometimes exists, and this need for bridging and the bridging.
I think a lot of times occurs. I'll I'll be honest when I look at a lot of evidence based protocols.
I say, man, you're sitting up in your ivory tower running this randomized control study with all the resources in the world.
These brilliant phenomenal minds, supervising these eager and thoughtful and caring, you know, clinicians who are often graduate students, and you also have such high internal validity, right so we we recruit only people.
Who have anxiety and nothing else, because we gotta be able to replicate I was one of the think that the words that came up at our work. I'll give you a replicate our findings right so we have to control for all those extraneous variables and that's not the real
World we live in right, the real world we live in is messy right?
How many clean anxiety or depressing cases do you all work with in your practice when you reflect on my own case, load and think about?
Hmm! How many of them do we screen with a comprehensive screener to sort of make sure that we're only getting the disorder, you know the specific disorder that we're studying and some evidence-based protocol right and so that is that disconnect we need that
Research, that scientific approach to thinking about what we're doing.
We're not simply providing support as a friend. Right?
We're doing clinical interventions, and yet we need our clinical interventions to understand the real world and the complexity with which in we practice right.
And this is one of the reasons for me that the unified protocol and other trans diagnostic approaches have a real appeal, because many other interventions are often highly disorder, specific right.
So they this is Cbt. For Ptsd or Cbt.
I you know kind of behavior therapy for insomnia right?
You know. And so what happens is while those can be incredible, effective.
We actually also know that there's a lot of underlying processes that are common, and some of these protocols.
It's less clear how well they are identified for comorbid cases.
Right. So the challenge that we run into is, how do we effectively treat complex cases like the ones that come in our office and transactnostic approaches like the unified protocol can be a solution for that right these focus on underlying processes like neuroticism or if you think about that
tripartite model mode of anxiety, that kind of idea of what is that underlying, or hot, or low or high negative affects right that kind of underlies anxiety and depression.
In addition to the physiological, arousal of anxiety, and the low, positive effect of depression and so they have a real appeal of consolidating and conceptualizing research and actually what's really cool about the unified protocol is how rigorous the
Evaluation training in dissemination has been right. So a 2,020 systematic review included over 77 studies.
I was I was talking with Dr. Coil, who coordinates, you know the continuing education, hit the raw center before we began, and I said my graduate student who's doing his dissertation work on an adaptation unified protocol recently shared with me a really beautiful equivalent
Study they did where they actually took like I don't know.
70 or 80 disorder specific protocols they took, you know, all these different.
Which of the unified protocol and they did an equivalence trial, and what they found is that the unified Protocol does as well as single disorder protocols and actually dropout rates are a little bit lower probably because the complexity that the trans diagnostic models can
Account for right? So it's it's very rigorous.
The reviewed. It is, it is as good as as the single disorder.
Specific protocols, but it only requires you as the clinician, to really learn one protocol.
And again, this is that idea of thinking about dissemination implementation science.
Okay. Now, another part of dissemination and implementation. Science is really thinking deeply about.
What are the activ ingredients to therapy?
And I think this is a really helpful place where our medical colleagues can really help us think about.
We know, what the mechanisms of action are for certain drugs right?
We studied the biochemistry and physiology of medicine to say, this is the active ingredient and aspirin, or in tile at all or or in in penicillin right this is what this is how it works could we do the same thing for most of
Our cognitive behavioral treatments. Can we tell ourselves what is the active ingredient?
What is it about the therapy process that works? We have some indications?
We we know the common factors like establishing a prom strong therapy to group. For matter.
We also have a lot that we don't know.
Is it a focus on neuroticism? Is it the cognitive disputation?
Is it relaxation and mindfulness? What is the active ingredient that is the one of the things that we're starting to answer with some of our more innovative research design paradigms?
Things that allow us to take interventions and just break them into modular components, things that I'll allow us to distill the different elements of interventions, and test them within each other, and what I also particularly love about the unified protocol is that it is built to really think about this because of all
The adaptations that have been done right. We've gone from a 15 session protocol that I'll talk about in just a second to group based protocols to 8 session protocols to single session protocols to online resources and as we make all these
Adaptations it forces us to really think about. What is the mechanisms and drivers of change, and how do we refine them?
And I think that's what's really been nice is you?
Look at the evolution of the study of unified protocol as they've hone in on what they see as sort of the key elements that continue to show good evidence-based promise so in the adult protocol it tends again, it's 15 sessions about our you know
45 min to an hour each that cut these 80 modules, and I want to highlight for you a couple of things with this the first is this idea of goal setting a motivation for treatment and relapse.
Prevention. Right so the book ends of the treatment before we even think about the meet of the treatment we are thinking about.
How do we engage individuals to see the benefits of psychological intervention?
And how do we prepare them for leaving our office and doing that that important work in the real world?
So. Those are sort of 2 things that I think are really important, that are pulled out as elements here in the unified protocol in addition, there's a good amount of psycho education so we talk about how emotions are adaptive and this is really getting at the heart of non judgmental awareness of
Emotions right. Our emotions are not right or wrong, good or bad, they are.
They serve a function and purpose, right anger and sadness and disgust and fear.
All of these things have an adaptive advantage. Right? So I love to think about anxiety in particular, because if we think about it, we, in evolved anxiety as our danger system, our warning system to say that's a tiger in the woods let's run away from it right and
The reality is that our minds have just not evolved since the original evolution of kind.
Of our our society, to adapt to the incredible amount of information that we have now right.
So we we our brains, grew up, so to speak, in a low information.
High threat, environment right? We didn't have a lot of information about the world around us and the and there was a lot of risk.
The things that could literally kill us right. And that kind of earlier hunter, gatherer society right?
If someone we didn't know someone they looked different than us.
They didn't come from our tribe. They probably were an enemy.
We live in an incredibly beautifully diverse, multi-national world.
We have the ability to travel all across that world, and there are many people we now interact with on a regular basis electronically as well as in person that don't have those same backgrounds and experiences and are not threats to us.
But our mind still struggles to put things into groups additionally, when we got a piece of information that was different back in that period of time, evolutionarily, it probably was really important to pay attention to because it might be a danger queue nowadays we get so much information in a single device that we carry around
with us and our mind still is gonna focus on those things that are different which may actually confuse us because it may not be a reliable indicator.
Of danger, right so again helping to understand the adaptive nature of emotions, and not to see them as good or bad, right or wrong, but to understand that it's about how to contextualize what the emotion is telling us I just as an aside I'm sorry I get a little proposal sometimes I
Was out of talk in November, and I'm the the associate Dean student affairs at at a Gw.
Or Yeah, Gw. Who talked about imposter syndrome and instead talked about the idea of impostor signal right what is it that when we feel inadequate around other professionals?
That is a signal to us. Am I outside of my bounds of confidence?
Right now I need to seek some supervision. Am I engaging in social social comparison?
That doesn't make as much sense, because guess what is professionals.
We all have different yard. 6 of what's success looks like right?
So again, thinking about imposter syndrome as a signal is another great example of how we think about changing our frame, of how we look at the adaptive nature of emotions again getting into principles of mindfulness promoting that cognitive flexibility and then we get into some of
The behavioral elements. These action, tendencies, when we experience strong emotions, is sort of you, you might hear some things that might remind you for those of you who are familiar with Dbt and kind of distress tolerance that's a little bit there and then also thinking about interroceptive and emotional
Exposure, as well as like. As I said in laps prevention.
Now let's shift and think about how this applies with.
Kids. So with kids, we've actually we try to use different language that covers some of the same concepts.
And so in children, you'll see the key ingredients here.
Recognized by the acronym clues, which stands.
For consider how I feel. Look at my thoughts, used a detective thinking so that's that again emotional awareness and then that cognitive flexibility, experience my fears and feelings and then stay happy and healthy that's that relapse prevention piece okay, so I will provide a little bit
More detail about the child examples, because that's where I practice more unified protocol as we work.
Move forward, but I think that's helpful to sort of hear some of that introduction.
So again these are the key ingredients for the unified protocol.
There's this idea of emotional awareness and language was the role in the function of emotion what is the 3 component module model of emotion right?
So again, what are we what are, our thoughts? What are we doing?
What are our physiological response? Right? The role of a avoidance in emotions right.
This idea that we experience an intense emotion. Our impulse is going to be to avoid avoidance in a short term is an incredibly effective strategy.
Why it decreases that physiological, arousal, and if we remember back to that good old days of classical conditioning that was you know, Skinner and his rats and running the the mazes and all that kind of good stuff sorry I mixed operating classical conditioning there my e triple piece score would
plummet, but the point being that we know that avoidance decreases in the moment of physiological anxiety, so is reinforced as a behavior, and so we'll do it more and the problem with that is we are shortchanging the short term benefits for that
long term, principle. One of the things that I talk about in in grief.
Work, for example, is this idea that some level of avoidance is actually really helping in the immediate aftermath of losing a loved one because there's so many logistics gotta figure out what to what are we doing for the funeral where is it going to be how what is it going to be held
I gotta notify people I gotta call my life insurance.
I gotta change my policies, all these things that if we were overwhelmed by the emotional experience, we wouldn't be able to do those things that we need. To do.
And that's fine. That's adaptive. In the moment I work in the military.
I talk with fighter pilots about the need to get back in the cockpit or surgeons.
They need to go back into the or after a mass casually, and that losing a service number and again, that's where that balance of that the again the adaptive nature of the reason why we might avoid it a short term versus the long term payout and one of the things that
I'll I'll use is an analogy is, if you think about it anytime you avoid.
It's like you're putting something on a credit card. Right?
You're taking an emotional down and put it on credit card.
Pay it back later. Right? Folks who are incredibly resilient like our you know our service members our our fighter pilots, are our surgeons right.
They probably have a really high credit list and a really good disposable income.
They can. They can put a lot on that credit card. That's okay.
But no matter how rich you are, how good your credit score is, how good a a a problem that you have to to extend the analogy you've got to pay the printer right.
If all you do is pay that minimum monthly interest, but you can do for a month or 2 or a little bit longer when it's some point it's gonna overwhelm your budget and so thinking about how do I get to a place where I can intentionally choose to pay down the
Principle, and as part of that right, we actually a lot of unified pro protocol is very much focused on experiential learning, which is what we're going to get into the second half of our workshop today okay, so with that in mind i'll just share.
A couple of really brief results. As I mentioned earlier, the unified protocol has been very well researched very rigorously, so an efficacious for a wide number of us.
I almost stopped listing all of the things that have been studied with the unified protocol.
Because, remember again, it's trans diagnostic. So rather than saying, we are only here to treat generalized anxiety, disorder, or specific phobia, or obsessive compulsive disorder.
Really it's all comers. We're here in a treat.
The wide range of emotional disorders which can include anxiety can include depression can include bipolar.
Again, we also are here to recognize that the world is messy and complicated, and so we can include other, you know, disorders that are often come morbid like substance, abuse, or eating disorders, or personality disorders or the outcomes of some of these things like non-suicidal cell
Phones, injury, and the function of that, or sleep, or subclinical symptoms, or health-related concerns, that often have a high anxiety component, or the stress of minoritized experiences such as those who are a sexual or gender identity that is not the majority and all of
this, has been well researched, and all of the results have been positive.
Now the caveat to all of that is, it does seem like the unified protocol is strongest most in those areas that have sort of that underlying neuroticism that underlined kind of anxiety that low that high negative effect that element of things right so even when we look at
The studies that explore comorbid conditions like substance, abuse or eating disorder, or other or or sexual minority stress where the symptom improvement tends to be seen is predominantly in those symptoms that haven't overlap with anxiety that being sad if we
Are able to pull out those symptoms that gives us the bandwidth to do a lot of really important work, and to build on those skill sets so again.
This is where for me? It's important to recognize this is not a curol, but rather an opportunity to provide relief and comfort to our patients about an area functioning that then allows us to do additional work.
Or as I believe, the mechanism of action and individuals is not what we do, rather what they do right allows them the space to harness their own natural resilience, and to build upon the skills that they have learned and treatment like the unified protocol to address all the other things that they're experiencing in
Their life. And that's where that real power and magic is and how how we are able to transform individuals, lives through their own hard work.
So again it has been seen to work in an inpatient setting with more severe conditions as well, although the results are a little bit more limited.
And then there's also been some interesting cross cultural adaptations, and I say cross-cultural booth to think about things from an international perspective as well as as I mentioned, earlier we adapted it to the military as well so there are you know multiple ways to identify and think about the idea
Of culture. So as you all are listening, I'm I'm sure there's there is some parallels that you're saying.
We're saying well, you know cognitive behavioral therapy in general has a lot of these key principles.
I we talked. I mentioned this idea of distress, talents from dialectic behavior, therapy, you know I alluded to mindfulness and we think about acceptance and commitment therapies we talked about non-judgmental awareness.
Of emotions. So the answer is, Yes, there is a lot of overlap similarities with other ebts and the thing that I think is particularly remarkable is how rigorous the evaluation the unified protocol has then in comparison to others which I think do have
Good research, basing, good evidence base but may not be quite as comprehensive, particularly across a wide range of disorders.
And that's really the biggest shift right is how much this is really focused on all-commerce on trans diagnostic approaches.
Again. I would argue, too, that the unified protocol is meant to be really complementary.
With many of these new wave kind of Cbt principles.
And so this idea of giving us some structure to work from.
We're a manualized treatment that has the opportunity for what I call flexibility with infidelity. Right?
The idea to recognize the complexity of the human experience while also giving structure for us as clinicians, and where to start where to put some areas to focus the other thing is that I will say there's a heavy focus on experiential learning behaviors you've heard me mention that a couple of
Times, and I want to continue to kind of highlight it, because again, and we could have a whole history and systems lecture on psychology right?
But if we think about the sort of rise of behavioral treatments, the rise of kind of more humanistic approaches, the rise of Aaron back into the cognitive work, the merging of cognitive behavioral therapy, the new wave of cbt and act and mindfulness and
Dbt, and so you know, as our knowledge of psychological interventions has evolved, there have been times in our approaches where we tend to maybe be a little bit more cognitive, and I find this is sometimes a as when we work when I worked with adults in the military I
Tended to be a little more cognitive, and as I've shifted back to working with kids, there can be that tension or poll to still be very cognitive in our work, but that a lot of the mechanisms of action, really seem to center on this idea but how do we create behavior.
Change and understanding the bidirectional nature of that 3 component model of an emotion right?
I might physiologically feel a certain way and start to think and appraise my my!
Why am I having? You know, a fast beating heart, and my palms are sweating, my muscles are tense, right?
If I'm sitting in front of an exam it's because I'm nervous.
If I'm Lebron James about to head to the Nba finals, I'm pumped up and ready to go right.
So that idea where we're used to this idea of our thoughts, appraise our physiological reactions and produce an action.
But we know that those are bindirectional influences.
When I do something, my mind has to make sense of. Why did I do that right?
This is the evolution of the infestingers working cognitive dissonance, right?
I have to make sense of my own action. So if I get out of bed this morning, what I'm feeling really depressed.
Yes, I can still feel really depressed. Yes, I can still have thoughts about my worthlessness and I'm forced to confront the fact that yesterday I didn't get out of that and so maybe I'm feeling a little bit better than I did the day before and so again those behaviors can
also drive our thoughts and our physiological feelings alright.
So this is the this is, we're kind of wrapping the part where I've lectured at you, or nearly 40 min, and the next the rest of it is going to go either really short or be really rich and engaging depending on you all's level of engagement now I know in a
Webinar, format. We're not all gonna be able to pop up unmute and on video and have this engaging dynamic conversation.
But I think we can certainly use the chat feature to engage in some conversation, and I hope that you all will join me what we'll do, though now is take just a quick break to kind of shake the cobwebs out use the restroom if you need to but we'll just
Give about 2 3 min here and a break we'll come back and we're gonna start digging into some clinical case examples, and some engage in discussion.
So thank you all for your patience, and again just give you about a 2 or 3 min.
Okay. I just like to always insensitive on zoom when we just go for longer than we're used to being able to sit in a lecture hall.
So, but I also know that it's really awkward to sit on the computer screen and just stare into the void.
So we did. About a 2, 3 min break. It looks like the chat is enabled.
Now someone can maybe say something in the chat like Hi, just so we we can see that it's working that would be phenomenal, otherwise we can try to adapt by by using the Q.
A feature so Hi! Alright, Meliss, thank you.
Perfect, alright, fantastic, so so we've got the chat.
So we're gonna start actually with a mood. Induction, exercise.
So I'm gonna switch my share screen. Here, let me do this, you guys. Don't.
Wanna you guys. Will see my twitter for a second, because we are live tweeting this a little bit.
But okay. Make sure. That still showing up there we go.
Okay, alright. So hopefully. Make sure it's optimized for sound.
There we go, fantastic alright. So we're gonna watch this scene from the movie ray, and someone can just on the chat once it starts playing, make sure you give me a good audio check here alright.
We'll go and get started
Excellent! Thank you.
I hear you, too, mama, you're right there
Why, drying. Come on.
Okay. Get back to alright. You guys see the screen.
Now if I think you're back to being able to see, the so I have to credit my graduate student for showing that to me, from the perspective of as a mood induction exercise and so I'm curious what emotions you guys can just put them.
In the chat. Were you experiencing, as you were watching that
Go ahead and just type them in the chat I was too nervous that pull everywhere wouldn't work, so I didn't do for this one but in the future.
I will all right it sad, hopeful. Okay. So some sadness as well.
That's all that hopeful, proud, so interesting, admiring here
So the point of an exercise like this an experiential exercise like this is to help us to understand that perspective that we can all experience the same activating event.
Right. We're pulling on that ABC. Model of of kind of enroll.
That same activated event can produce a different range of experiences, different intensity of experiences.
I see where it's like helpless and and and and fear.
I see we're like sadness and different valence of experiences, where it's like hopeful and admired and proud.
So it's it's getting that idea of not just telling you that we all experience the same event in different perspectives and it produces different emotions.
But experiencing this idea that events cause emotional reactions, mediated through our thoughts or appraisals about that event, right?
So that is, that is you know the point and the purpose behind a mood.
Induction exercise like this and I, as you all are kind of sharing in the chat, I'm I'm curious if you reflect on that experience for yourselves.
Alright, so then the next one that we do, and this is a little bit more on me.
Bear with me for just a second why, I've got to pull this up, and so that is an example from something kind of more in the adult Ranger.
You might do some type of mood, induction, type, experience.
Another thing that you might do. And this, is coming from the child.
Word is actually kind of getting folks to reflect on when a thought pattern becomes problematic and becomes so.
We talk about this idea of a worry line. So I'm actually gonna lead you know read you through and experience from the unified protocol for children.
And I'm gonna ask you when we jump the worryline.
Now the way that we do this. If we're all sitting together is that I would introduce the idea of the story of our friend named LED.
So LED stands for a motion detectives. If you remember back when I introduced the main concepts of those clue skills that children and adolescent version has this theme of being good emotion.
Detectives. And so what one of the things that that happens in the this protocol is this idea of getting folks to think about when we cross over the worry line and you using our friend and so our friend LED is gonna go through a series of vignettes and what you actually can do again?
Going on. This idea of this being very experiential in nature, is have both draw an actual line on a on on the floor, and have folks jump across that line when they think they have past the worryline so that is what we will do here we'll have to adapt it to the visual
Space is what I'll ask you to do is when I read a scenario.
When we cross that worry line I want you to go ahead and type in the Chat Cross or X or jump, but some way to sort of indicate this idea that we have crossed over that line okay, so i'm gonna do 2 then yet.
I really get the chat up featured as well. Okay, alright.
So LED was going to the store with his mother when he saw her dog on the side of the room.
The dog was bleeding and whining, and this made I feel very sad.
You want to rush right over there and take care of the dog to the bed.
Mother told them that they had to leave the dog, and they might and might have a disease or a byte, so they couldn't touch it, even though, as Mom called a PET rescue agency, and became very sad he knew the dog was gonna get help but he just kept seeing the her dog in his head and he
Couldn't shake his sadness. He spent all day down in the dunks and didn't even feel better when his mother took him to his favorite restaurant.
Alright. I recognize this little bit harder to do. Online we're not jumping across a a physical worry line here, but I'm also gonna call you out that we didn't see anything in the chat.
So I'm gonna read that vignette again.
And you guys now that you know it, you're ready to hook it. X.
Or junk when you think that LED crossed into that worry line and what we mean by that is that the that worry went from a normal, healthy reaction.
To maybe worrying a little bit too much right to that intensity of emotion didn't quite match the scenario in the situation.
So I apologize. I didn't explain that well, either.
But now we've got the frame we'll try that again.
So LED was going to the store with his mother when he saw her dog on the side of the road, the dog was bleeding and whining.
This made and feel very sad. He wanted to rush right over in there and take care of the dog.
His mother told him that they had to leave the dog. They might have a disease or my bytes.
They couldn't touch it, even though LED's mom called a PET, rescue agency.
I became very sad. He knew the dog was going to get help but he just kept seeing the her dog in his head, and he couldn't shake his silence.
He spent all day down in the dumps and didn't even feel better when his mother took him to his favorite restaurant.
Okay. I love that it all kind of came in at once.
But it started to be sagered a little bit, and that is as you can imagine.
Again. Part of this as a treatment protocol is is interactive as interventional.
We've done it in groups. So you have multiple kids dropping across the line, or you can do it individually, or you still have that one child, and we're still getting up and moving and making the session interactive and fun and as you can see there is a little bit of difference in
Opinion, but it also helps to highlight some of the features, like roomination and persistence.
In a in spite of kind of opposite evidence that can be the hallmark of that anxiety being so here.
So again. Like I said, today, this is not to give you all expertise to the usified protocol, but to give you a taste of some of the kinds of things that we do.
And how this fits within that conceptualization of these trans diagnostic approaches alright.
So we're gonna now that we, now that I've done a better job explaining it again.
I I can be votable to here. We're gonna try again, and and you know what I what I can do if it helps is, I can read it.
I'll read, it. Go ahead and read it once. Firstly, you guys just gotta hear the story and then I'll read it again.
You guys can kind of tee up when you're ready to to jump across that worry line alright.
So LED and his father were sitting down, and they're living room watching a TV show when the news came up can you showcase the story about an earthquake that had just taken place in India the reporter.
Said that hundreds of people were hurt, and they weren't sure yet if anyone had died the reports show terrible pictures of the scenes children were crying in the streets houses were tumbling and people were wounded after watching the report I became very upset, his father said they would donate some
Money to the project so they could help the people rebuild their houses, but I continued to feel sad.
He just could not stop thinking about the 4 families that had lost their homes and destruction.
How you'd seen. His father said he would feel better in the morning.
So we went to sleep, but when he woke up he could still see the pictures, and felt so bad that he wanted to stay home from school.
It was just so terrible. Okay, I love that. Thank you all for jumping in.
I'll read it again one more time for those who are sort of on the fence a little bit and then we'll talk a little bit about that.
So edit his father. We're sitting down in their living room watching a TV show when the news came on the news showcase the story about an earthquake that had just taken place in India the reporter said that hundreds of people were hurt and they weren't sure yet if anyone had died the report
show terrible pictures of the scene. Children were crying in the streets, houses were tumbling, and people were wounded.
After watching the report, I became very upset. His father said they would donate some money to the project, so they could help the people rebuild their houses, but I continued to feel sad you just could not stop thinking about the poor families, who had lost their homes. And the destruction.
He had seen his father, said he would feel better in the morning.
So he went to sleep. But when he woke up you could still see the pictures that, and felt so bad that he wanted to stay home from school.
It was so terrible. Okay, I really. Love again that same idea.
This is a way of getting kids active and up and engaged in therapy, thinking about the their experience and giving an opportunity to talk about adaptive coping and problem solving maladaptive coping and problem.
Solving again room. And if you worry, talk about duration of worry and intensity, of emotion, so it provides an opportunity for some really rich engagement around emotions in a way that again, can also be focused on function of both experiencing emotions as well as kind of recognizing when
Motion, can lead to unproductive action. Okay, so that is our kind of a couple of of experiential instances that I wanted to just provide some examples of want to introduce a couple of other kind of concepts I mean if I protocol again, just to give you sort of a taste of how
Something. These things are are packaged in this way that hopefully will feel somewhat familiar, but you know, for those who are newer also provide some structure and clarity, so the cognitive component kind of tends to set around this idea of thinking traps and uses some personalization of kind of these
Characters that personify different cognitive, maladaptive thinking patterns.
So we have individuals like psychic Suki, who thinks she's a mind reader right?
So I know what other people are thinking of me. They're thinking that bad and negative things we can think about Jumping Jack, who jumps to conclusions right if I fail this test that means I'm going to get kicked out of medical school my students. Can sometimes.
Jump to that conclusion. Disaster! Daryl right. Everything I could catastrophe.
I go to the worst possible outcome and negative, Nina. Right?
So I focus on the negative aspects of the situation rather than a positive.
I focus on the fact that I missed getting to pick my kids up from school today because I have the opportunity to talk with you all right.
So focusing on the negative as opposed to the positive and don't worry. My kids are totally fine.
I just. I'm excited to get this presentation so again.
These are the ways to sort of personify these really hard, complex, cognitive experiences that we talk about in adult based therapy a lot, but to give them sort of a little bit more and fun engagement a lot of the work in the unified protocol which children and does involve a lot
of drawing a lot of coloring. A lot of creating this these clue kits another sort of reward paradigm designed to help them feel comfortable and engage in interested in the idea of engaging around a therapeutic approach alright so this is the first sort.
Of set, of questions for you all to kind of ponder is, how might you use some of these exercise with your own patients?
How do you use similar approaches? What worked well, what were the challenges?
So we'll start with that first question. And again I recognize that chat can be a little bit hard to type like a a dissertation on.
So I'm not gonna sit here and then wait for you all to do a lot of that.
But I do want you to kind of reflect on a little bit of, and you can, you know, shorthand a couple of ideas, but what are some of the exercises that jumped out to you some of the 3 examples we gave again there's just 3 there are others and how might you adapt them and so
Again. I'll ask that first question. I'll pause a little bit for you all to type, and then we'll move on to the second question.
Hmm.
Oh, I like that idea right so. Usually the worry line, but perhaps potentially break it into the child's own experience.
Yes, and I think that's that can certainly be part of yesterday's part of the protocol at some point.
So I love that
Yeah.
Yup, Yup, exactly right. So I think that you guys are yeah, so fantastic.
So a couple of rich comments, I want to respond to so you know, I think that I mean this is going back to base to cognitive learning type right when we we have to incorporate information into more of a personification it can sometimes stick a little bit better so the idea of what's
catastrophizing versus: Who's disaster?
Daryl. And what is he do? Right? And so sometimes that can, actually, I think, help folks to sort of engage a little bit more meaningfully is is the and and like, and then the other part that I saw that I really like to this idea of sometimes that our own personal experience can be a little bit too, personal so introducing
A third party concept: how do we appraise that situation from a distance?
How do we have distance from that thought can help us to get to a point we have distance from our own thoughts now.
There was a really great question about that. This can be really helpful for individuals who are new to therapy.
But what do we you know? Other interventions that are useful for people who have been therapy a while and I I find I think the next section that we're gonna do which is more of the experiential practice is probably where more of that benefit will come because you know a lot of these concepts yes, absolutely if
Someone's been in therapy for a long time have likely been exposed to now.
How well they've engaged with them going back to that book, end conversation.
What is the conversation been around motivation for treatment and goal setting what is the conversation been around?
Relapse prevention. I think those are some 2 elements that are critically important that can sometimes be helpful.
And then a lot of where I think the up has particular benefits, is in the experience of the exposure piece, which we'll cover in just a second the cognitive.
Part absolutely critical. Yes, but is is a little bit more common to other places.
And using these scenarios. Yes, exactly right. So we use those scenario.
That's exactly the point. Thank you for asking that important clarifying question.
The idea, just as I think someone earlier said. You know the ability to recognize it in others before we are able to recognize it in ourselves.
Is is often a common experience, and so using those examples that means help us get there alright.
We think we've kind of started to move a little bit into the second question.
How do you see similar approaches? What worked well over the challenges?
And so, if you all have thoughts on that, you know people can share.
I love this idea from Dr. Coil here. This idea about tolerate emotion, without having to act on it right the idea of what was the intent and absolutely so.
Again, this speaks to the power of experience in therapy.
I had a I have a colleague who's very act focused, and I had a really rich consultation session with them about a client of mine, and the role of disclosure as I was having sort of a a counter transference reaction from some of my own
Lived experience and the idea of there are times when we actually can use experiences that occur in the therapy setting as models for how to handle situations that may have parallels outside of the concession right like and that's not a new thing.
I think we all understand that ideas that the the therapeutic environment provides a fodder for experiences outside of of our our walls.
But to be intentional and deliberate in that by the experiences and exercises we give, I think, is particularly important, so great.
I'm gonna the before we shift to the behavioral exercises.
I'm gonna just give us again a minute or 2.
So what that also allows us to do is, if you have other thoughts on these questions to please, type them in the chat and we can certainly come back to them also. Monitoring. That Q. A.
Looks like those things are doing well, so we'll we'll close by doing a little bit of experiential exposure here in just a second.
But again before we depart from there, if there's other questions or comments we have in which folks have either used this or or challenges that they might anticipate love to see those comments.
In the chat
Oh, Alison, let's give your hand raised. I don't know if you were able to ask your question or speak that if that's enabled love to hear from here
No perfect, no no problem alright fantastic, alright. Well, I'm gonna press for it's always as the first time I do a session, especially as an experiential element.
It's always making sure we manage good conduct. Obsession here, so I wanna make sure we wrap with a few minutes for potential questions.
So we're gonna go ahead and press forward we're gonna talk a little bit about opposite action.
And and I mentioned this in the context of experience. I will tell you.
I had an opportunity to talk to Dr. Eric May, who, you know, designed the child adolescent adaptation cause she's a consultant for me on this protocol that we're doing in primary care and it was really cool to think about this idea of opposite appointment in
2 very different ways. So when we talk about depression right?
We talk about this pathway or depression decreases activity right?
I don't feel like it out of that. So then it lowers our mood, which can then further increase our depression. Right?
We know this is that downward, vicious negative cycle right of depression.
Okay, we're familiar with this from, you know, probably a lot of our graduate training alright love that we're talking about.
Anxiety, pathway, so anxiety. I worry about something, so then I avoid it.
We talked about this at the beginning of our lecture, and so then that alleviates my busy, logical, arousal.
But it leads to more avoidance. Which can, you know, increase the anxiety, or certainly doesn't lessen the exactly right? Okay.
So what do we do about these 2 things? Right? Well, so in depression, what do we call behavior activation? Right?
It's breaking that negative cycle to say, let's do something even when we don't feel like doing it as a means of mitigating that downward lower moves.
File so we engage in the opposite action to what our emotions are telling us.
Okay. Let's talk about anxiety. Right? What do we do there? What is exposure?
Treatment. It's the opposite action of what our body is telling us.
Our body is telling us to avoid. And we're gonna act in opposite.
So this idea of behavior activation and exposure as really being 2 sides of the same coin. For me.
Really, chrisized this idea, of why transit diagnostic treatments can be so powerful we're asking individuals to to recognize that when an emotional state is prompting a behavior that's maladaptive the solution is to engage in the opposite action whether or not that is a a a low positive effect
Depressive cycle or an anxiety cycle.
Right? So that is really a key to kind of think about.
And you know part of this is also about reinforcing in general the concepts around exposure. Right?
So this idea of understanding, anticipatory anxiety.
We sort of predict that our Z. Is gonna persist forever and increase that we understand that we avoid.
We short circuit that physiological, arousal, but that if we persist, yes, it will increase, and then it's some point, you know, peak and plateau, and again in child make sure it's always about using analogies and stories that resonate with kids so we can think about riding
The wave right? So if you imagine you've been to the beach anxiety is like a wave.
We have this idea this is a giant tsunami in front of us, and we just turn our back and walk away.
All we have in our mind is that this big giant wave is really scary, but if we get on that way we ride it, we crest it always, no matter how big and scary they are eventually coming to shore right they come up right to our feet and so getting folks to think about anxiety
As riding a wave can be another way of kind of conceptualizing the value of exposure so alright.
It's gonna be a little bit harder to actually do some exposure.
I'm gonna give you some examples of some instance. There receptive exposures that we'll try a little bit.
But again, in his virtual space it might be a little harder.
I'd love for folks to prototype in the chat, though, if they're any interro acceptive exposures you have use or experiential exposures you've used in your session again now that pull everywhere.
Is working so well in the future. If I, if if this talk is ever given again, we're gonna popcorn it a lot better.
But I was. I was cautious in my optimism when I put together these slides, so we'll rely on the chat here so again.
What exposures have you used, and feel free to share them in the chat
Running in grease. Heart. Yes, yes, I love it. This idea of increasing that hard way spinning in the chairhouse.
Yes, yes, yes, fantastic. You guys. Are you guys cheated and looked at my slides at a time.
Now you guys are brilliant clinicians. You guys got a lot of them excellent.
So I love to hear how robust we're using those experiential exposures in those in those moments of the taraceptive one that's fantastic.
What now? What about the experiential ones so those are the ones that help produce that physiological arousal?
What about the experiential? How do we? How do we manage this little challenge harder sometimes in traditional therapy settings but what are some things that you all have found helpful in terms of doing?
Some more experiential based exposures. This might be, you know, public speaking, that kind of stuff going for people to store.
Or yes, love it. Yeah, he an actual. I love that super cool little scares me over a little bit, but like the hitting actual objects of the car at low speed to overcome driving that's fantastic alright
Pictures of yes, so this progressive exposure idea right?
We're looking at some pictures of needles. We're gonna you know.
Look at it even more closely, etc. Etc. Yep.
Absolutely using the needles to inject something on skin oh, for Tate, I love you.
Guys are great okay, fantastic. You guys this part is always some of the hardest for patients to do.
You guys have got it down on which is great. So these are again.
This is borrowed from the treatment manual itself.
And I think you guys hit the nail on many of these as well.
So I'm not gonna awkwardly try to do any of these in our person here.
But you know, you guys have definitely covered some of them this is an example of again the treatment manual that gives you some of these examples to do some of these sensational exposures alright similar question that we have for open case.
Discussion we're kind of getting near the end. I do also wanna make sure there's time for more general questions, but so I see these examples coming in the chat.
If others have other examples, if they have any challenges or questions, I'll certainly I love that graph flying with patients.
And this is so. This reminds me again. It it's sometimes limiting how we're able to do a lot of exposures, but getting us out of the traditional for a while to the therapy is is really powerful so I do want to lease with time for questions i'm
Gonna you know, kind of click to the sort of summary slide here a little bit.
Talk about some things, and then, you know, kind of wrap us up as well.
But so I hope that what you took from a lot of this is the unified protocols are well studied, flexible, and adaptive approaches to a wide.
Range of emotional disorders, right? So there is a strong evidence base for them.
There is an opportunity. I think you know manualized treatments can sometimes get the reputation of being very structured, and so, in a way that doesn't allow for flexibility.
Doesn't allow for the kind of brilliant creativity I saw the chat today, but the unified protocol is one of those that, I think has that opportunity again the focus.
There is really on increasing that emotional awareness and knowledge in and increasing that emotional experience by decreasing avoidance, right that that parts of the key.
Now, if this has been at all helpful for you and your things to yourself, you know I'd love to use this a little bit more.
I wanted to share with you a couple of resources, so the Unifiable has a website and you can go to that.
Website they offer one and 3 day workshops that you can attend.
They also have the opportunity they provide consultation and supervision services.
So if you're if you've kind of what started, and you want to get some help and support in implementing that in your own practice they offer that consultation supervision.
Support. They also offer online trainings as well. And there's actually sort of online the child net lesson version is a little harder to locate online if you're interested in it, please contact me and I can connect you with those individuals and point you in that direction and then also if you're
Familiar with the treatments that work series books. There is clinician guys and workbooks that are available.
You can also access many of these online with a quick Google search.
But so these are resources that you can take for some home and independent study.
So again I I my goal in today was to give you really a very good Frimmer, of unified protocol.
What are some of the underlying concepts behind it, and then to give us some opportunity to use some of those in a practice which we did so happy to answer any questions that you all may have at this time, and thank you again, for your willingness to host me for continuing education here at the Ross center
Alright. So if you have any questions, feel free to use the hand, raise option, we could wait for about 2 min, and then we'll close out.
Right
Here. You're very welcome again. Any feedback or things that can do to improve.
I'd love to continue to offer continuing education. So I'm always looking for feedback on what is what are resonate most with you. All.
Glad this was helpful. And again, If there are questions, please do raise that hand and love to to hear from you all directly
Correct. Yeah? So it is protocols most effective with disorders.
That sort of have an underlying, anxious component neuroticism is one of the kind of key ingredients are not the only one I think you know behavioral avoidance.
Those kinds of things, it tends to work fairly well for mood, disorders as well.
So again, you know, when we think about I think about that opposite action that we were just talking about when we think about kind of mood, induction, and motion regulation disorder so even even bipolar and things like that where there's still, a kind of emotion dysregulation.
Those are also very effective where the effectiveness is a little bit more.
There's just a need for more research potentially is when you look at like chronic health conditions, or you know post back stress or like sexual minority stress areas where there are other likely impacts and you know in inputs there where the unified protocol symptom symptomatically seems
To have. The most impact is on the anxiety related symptoms so hopefully that helps
Alright hopefully answers your question, Bridget. If if there's more clarification, feel free to come off mute and and let me know again, I'm seeing a lot of thank you, and and I'm glad that this was helpful so Dr.
Pole your question. So package up version of an integrated therapy approach yeah, I think that is probably a really. I mean that's one of the things that I kind of going back to that broader conversation we had about dissemination and implementation.
What I like about the up is because it is trans diagnostic and really does try to say rather than learning.
Cbt. For insomniens and Cbt.
For Ptsd and Cbt. For depression, which probably have more similarities than differences.
Let's let's actually take that step back and think about what are the underlying processes we're going after here and and and actually one of the things that I think is no hallmark of graduate education in the behavioral health professions is that we see connections across things rather than
silos so yes, I think that's very active. Alison love to hear the interest in child adolescent protocol.
So like. I said, you know the unified Protocol website is pretty good it did seem like they was a little bit of a broken link to the University of Miami, which is where the child adolescent protocol or sort of come from so you are having trouble tracking down trains specifically in
Chat adolescent. I'm happy to sort of provide some additional resources.
There, just I I will go ahead and throw my email in the chat box.
There, so you guys, can follow up with me awesome love to see that you guys are gonna sign up for more glad.
It was super helpful. And so the other question Jeffous trauma!
Learn, help us the scenarios. So you know again, this is where I have to be accurate in the sense that you know there haven't been specific studies that I've seen on generalized trauma.
I think there have been some research on postback stress, you know, in general, and I think that when you think about some of the concepts around avoidance and around kind of mood induction, what what what learned help us this really kind of results upon I think there's there's definitely potential there so I think
That again. It certainly is a very reasonable place to start it it again has a really good underlying frame for a wide range of emotional challenges that you might experience and there's good reason to suspect that it's going to be applications.
But you know that that's always well where that kind of clinician judgment comes in to sort of understand what I think about trauma.
I do sometimes think a little bit about moral injury, work, and and I think we're still as a field really try to grapple a little bit with.
You know. Kind of more, andre value, based kind of trauma reactions.
How do we handle that it's a little bit different.
Yeah. Great questions. Love the question that you guys were great really really engaged group?
Are there any contraindications for using it up?
Not that I'm familiar with again. As I mentioned the limit.
The research and inpatient settings is a little bit more limited right?
And I would argue that when we talk about so you saw good evidence, base for things like non-suicidal self injury when we think about more suicidal ideation some of that more severe mental health kind of concerns there I don't know that the up with I would say is
Not contraindicated per se, but I would argue that there probably are more pressing to treatment focuses right so establishing a good crisis response plan, insurance, safety, those kinds of things are probably gonna be you know more important to prioritize.
But you know, not familiar with any contraindications per se.
In that regard great question.
Right any other questions that you all have again. I think we'll, you know, give a minute or 2, see if people are seriously typing.
Or again, if it's easier, please raise your hand, and and you can come off of mute and ask the question in that way as well
I'll just scroll. I think I got everyone
Okay.
Alright. Well, we'll turn it back over to our admin staff and close this out.
I I think we've kind of gotten to the end of the questions again, I did share my email.
So if there are questions you think of later, the other thing I did try to do a little bit of like a little harder today, because it was such a good interactive engaged group.
You can also follow me on Twitter. There you can, tweet your questions as well for as long as Twitter's around.
I I guess, is what the saying is now. But thank you again.
Really really enjoyed this opportunity to to talk with you guys, and really appreciate the feedback.
And again you all have a wonderful rest of your day and good weekend.
But if you have any questions you could use the chat or the hand rates option
I'll turn it back over to Ross. Then
Alright, thank you so much up and land for another wonderful training, those very, very educational.
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