Submitted by Vicki Grant on Fri, 07/26/2019 - 13:36

START NOW integrates research, theory and clinical experience. This strengths-based approach focuses on an accepting and collaborative clinical style while placing the primary responsibility for change on the participant. It also accounts for the limited treatment resources available in various care delivery settings.

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  • 32 sessions divided into four skill-based units
  • Twice weekly for 16 weeks (recommended) or one time per week for 32 weeks

START NOW is designed specifically for psychiatric settings:

  • Concepts and language are simplified given potential cognitive or educational limitations
  • Numerous images included in the participant workbook—especially useful with TBI or verbally limited participants
  • Illustrative examples and coping behaviors are contextually relevant
  • Detailed session-by-session facilitator manual includes numerous tips for engaging difficult-to-engage participants: e.g., shaping by reinforcing any movement toward the desired behavioral change
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Sampl, S., Wakai, S., Trestman, R.L., Keeney, E.M. (2008). Functional Analysis of Behavior in Corrections: Empowering Inmates in Skills Training Groups. Journal of Behavioral Analysis of Offender and Victim Treatment and Prevention, 1(4), 42-51.  Available at:


Shelton, D., Sampl, S, Kesten, K., Zhang, W., Trestman, R.L. Treatment of Impulsive Aggression in Correctional Settings. Behavioral Sciences and the Law, 27:787-800, 2009. Available at:


Kersten, L., Cislo, A.M., Lynch, M., Shea, K., Le, H., Trestman, R.L. Evaluating START NOW: A Skills-Based Psychotherapy for Inmates with Behavioral Disorders. Psychiatric Services in Advance (doi: 10.1176/ Published online August 17, 2015. Available at:


Cislo, A., Trestman, R.L. Psychiatric Hospitalization after Participation in START NOW.  Letters to the Editor. Psychiatric Services 2016; 67:143; doi: 10.1176/ Published online January 4, 2016. Available online at:


Frisman, L. K., Lin, H.J., Rodis, E.T., Grzelak, J., and Aiello, M. (2017). Evaluation of CT's ASIST program: Specialized services to divert higher risk defendants. Behavioral sciences and the law, 35(5-6), 550-561. Available at:


Kersten, L. (2018). Aggression and Antisocial Behavior in Underserved Populations: Towards a Comprehensive Treatment Approach (Doctoral dissertation, University of Basel). Available at:


Truong et al. (2021). Systematic Content Analysis of Patient Evaluations of START NOW Psychotherapy Reveals Practical Strategies for Improving the Treatment of Opioid Use Disorder. BMC Psychiatry, 1-13. Available at: 


Trestman, R.L. et al. Dr. Robert Trestman – Start Now: An Effective Mental Health Intervention. Scientia 2021; doi: 10.33548/SCIENTIA747. Published online October 20, 2021. Available at:


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Contact Us

Robert L. Trestman, Ph.D., M.D.
Professor and Chair of Psychiatry and Behavioral Medicine
Virginia Tech Carilion School of Medicine and Carilion Clinic
Carilion Clinic Department of Psychiatry and Behavioral Medicine

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