A programme of one-day workshops will be held on Tuesday 14th June. These workshops offer participants an opportunity to develop practical skills in the assessment and treatment of a range of problems.
Emotional Schemas in CBT
Robert Leahy, The American Institute for Cognitive Therapy, USA
Workshop 1 - More information...
Scientific background and description of workshop:`
Emotion regulation and emotion processing have gained increasing importance in CBT. However, in some cases clinicians and clients may find themselves inadvertently collaborating to “eliminate” unpleasant emotions, rather than enhance the capability of a range of emotions that are often an inevitable part of life. For example, jealousy, envy, anger, anxiety, sadness and loneliness are part of the human experience and may reflect core values and meanings. In this workshop we will review how the client’s beliefs and strategies about different emotions may maintain or escalate problematic coping strategies such as avoidance, rumination, and blaming. The Emotional Schema Model is a Meta-Emotional Model of psychopathology. Emotional schemas include beliefs about the duration, controllability, impairment, comprehensibility, uniqueness, complexity, guilt, and shame about emotional experience. As a result of these interpretations, problematic strategies for coping result from these interpretations. In this workshop we will review how the clinician can identify and evaluate emotional schemas, link these schemas to psychopathology and problematic coping, modify these schemas, use a variety of CBT techniques to develop more flexibile, life-enhancing schemas, and support patients in using emotional experience to develop deeper meanings in their lives.
Key learning objectives:
1. Identify the client’s emotional schemas
2. Link specific beliefs about emotions to problematic coping
3. Modify emotional schemas and strategies to allow for greater flexibility and adaptiveness
4. Broaden the range of emotions that can be accepted and experienced
Lecture, role play, experiential reflection
Leahy, R.L. (2015) Emotional Schema Therapy: A Practitioner’s Guide. Guilford: New York
Leahy, R. L. (2014). Emotional schema therapy. In N. Thoma & D. McKay (Eds.), Working with Emotion in Cognitive Behavioral Therapy: Techniques for Clinical Practice. Guilford Press: New York
Leahy, R.L. (2015). Emotional schema therapy. In John Livesley, G. Dimmagio, and J. Clarkin (Eds.) Integrated Treatment for Personality Disorders. Guilford: New York
Leahy, R. L. (2010). Emotional schema therapy. In J. Herbert and E. Forman (Eds.), Acceptance and mindfulness in cognitive behavior therapy: Understanding and applying the new therapies. New York: Wiley.
Implication for everyday clinical practice of CBT
The emotional schema model can enhance CBT practice by helping clinicians understand how clients’ fears and beliefs about emotions can interfere with therapy and how to modify these beliefs to deepen therapy and assist clients in facing difficult experiences and memories.
Dr. Robert L. Leahy (B.A., M.S., Ph.D. Yale University) is the Director of the American Institute for Cognitive Therapy in NYC. He has authored and edited 24 books on cognitive therapy and psychological processes and is the Past-President of the Association for Behavioral and Cognitive Therapy (ABCT), Past-President of the International Association for Cognitive Psychotherapy, Past-President of the Academy of Cognitive Therapy and Clinical Professor of Psychology in Psychiatry at Weill-Cornell Medical School. His books have been translated into 20 languages. He has been featured in print and televised media worldwide and is a frequent keynote speaker and workshop leader in conferences throughout the world. Dr. Leahy is the Honorary Life-time President, New York City Cognitive Behavioral Therapy Association and Distinguished Founding Fellow, Diplomate, of the Academy of Cognitive Therapy.
Target Mood-specific Skills Using Mind Over Mood 2
Christine Padesky, The Centre for Cognitive Therapy, USA
Workshop 2 - More information...
Scientific background and description of workshop:
Evidence-based practice requires therapists to teach mood-specific skills and follow different treatment guidelines depending upon the mood targeted. Clients experience high rates of comorbidity and so there is an advantage to supplementing therapy with a workbook like Mind Over Mood, 2nd Edition, 2016 (MOM2) which addresses a variety of moods and teaches both general and mood-specific skills. This workshop shows therapists how to maintain fidelity to treatment protocols by assigning MOM2 chapters in different orders depending upon the moods addressed (depression, anxiety, anger, guilt & shame). Participants learn evidence-based guidelines for client skills practice, when certain interventions can be counter-therapeutic, and a 3-step plan for relapse management.
In addition, Padesky demonstrates how to navigate common obstacles that arise during use of: behavioral activation and thought records (depression); fear ladders, exposure, identification of safety behaviors, and behavioral experiments (anxiety); assertive communication and forgiveness (anger); seriousness ratings, responsibility pies, reparations and self-forgiveness (guilt and shame). Guidelines are presented for how and when to add methods drawn from acceptance therapies, mindfulness and positive psychology to these classic CBT approaches.
Note: MOM2 is significantly different from the first edition of this book in both structure and content and includes new and wholly revised chapters as well as 25 new worksheets. Since this workshop primarily emphasizes this new material, it is helpful both for therapists who have extensive experience with the first edition and those who don’t. Therapists who own MOM2 are encouraged to bring it to the workshop.
Key learning objectives:
- Identify skills empirically linked to improvement in depression and anxiety
- Link chapter reading order in MOM2 to treatment protocols
- Follow evidence-based guidelines for gratitude diaries, mindfulness practice, and other treatment methods
- Consider when a focus on forgiveness is therapeutic and when it is not
- Assist clients in following a 3-step plan for relapse management
Workshop learning is enhanced through live clinical demonstrations, structured participant roleplays, discussions and exercises designed to apply the principles learned to clinical case material.
Greenberger, D., & Padesky, C.A. (2016). Mind over mood: Change how you feel by changing the way you think (2nd Ed). New York: Guilford Press.
Hawley, L.L., Padesky, C.A., Hollon, S.D., Mancuso, E., Laposa, J.M., Brozina, K., Segal, Z.V. (Manuscript under review). Cognitive behavioural therapy for depression using the Mind Over Mood protocol: The differential impact of CBT skill use on symptom alleviation.
Hollon, S.D., Stewart, M.O., & Strunk, D. (2006). Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annual Review of Psychology, 57, 285-315.
Kim S., Thibodeau R., Jorgensen R.S. (2011). Shame, guilt, and depressive symptoms: A meta-analytic review. Psychological Bulletin, 137, 68–96. doi: 10.1037/a0021466
Lyubomirsky, S., & Layous, K. (2013). How do simple positive activities increase wellbeing? Current Directions in Psychological Science, 22, 57-62.
Implication for everyday clinical practice:
Therapists who follow evidence-based practices use different treatment methods for different moods. This workshop illustrates how Mind Over Mood, 2nd Edition helps therapists navigate these varied treatment paths by teaching clients both common and mood-specific skills. Therapists learn which mood-specific skills are linked to enduring treatment efficacy for depression, anxiety disorders, anger, guilt and shame.
How to Become a More Effective CBT Therapist: Mastering Metacompetence in Clinical Practice
Adrian Whittington, Sussex Partnership NHS Trust and Nick Grey, South London and Maudsley NHS Foundation Trust
Workshop 3 - More information...
Delivering Cognitive Behavioural Therapy is both a science and an art. Whilst there is strong body of research trial evidence to support specific treatment packages, this evidence itself does not tell you what to do as a therapist in each unique situation with each unique client. The procedural rules for adapting and flexing therapy appropriately in different specific situations have been called metacompetences (Roth and Pilling 2007). Metacompetence gives a framework for navigating a path between the science and art of effective practice. There are pitfalls in navigating this path: of rejecting the research base, of drifting away from core CBT methods or of delivering CBT too rigidly. We propose that metacompetent adherence can help us to steer a steady course to flex and adapt CBT techniques and tactics appropriately whilst remaining true to its evidence base and theoretical principles. This is likely to be most relevant when working with people who show comorbidity and more complex presentations.
• To understand what is meant by the term ‘metacompetence’
• To discover differences between good and bad flexibility with CBT for reacting to complexity and co-morbidity
• To be able to formulate co-morbid cases using multiple-diagnostic approach
• To learn a process for identifying helpful adaptations to apply to complex cases
• To learn ways of getting the most out of supervision, both as a supervisor and supervisee
• To share learning about what to do when CBT isn’t working
• To learn how to further develop your metacompetences
Didactic presentation, group work, self-reflection, video examples of sessions
Roth, A.D. and Pilling, S. (2007). The competences required to deliver effective cognitive and behavioural therapy for people with depression and with anxiety disorders. London: Department of Health.
Waller, G. (2009). Evidence-based treatment and therapist drift. Behaviour Research and Therapy, 47, 119-127.
Whittington, A. and Grey, N. (eds.) (2014). How to Become a More Effective CBT Therapist: Mastering Metacompetence in Clinical Practice. Wiley.
This workshop aims to provide frameworks which will assist practitioners to adapt and flex evidence-based CBT methods with sensitivity to address the everyday challenges of real-world clinical work. Participants should have practical ideas to start using in the week following the workshop.
Adrian Whittington is Consultant Clinical Psychologist and Director of Education and Training at Sussex Partnership NHS Foundation Trust. Adrian was a director of postgraduate training programmes in CBT before taking up his current role.
Nick Grey is Joint Clinical Director and Consultant Clinical Psychologist at the Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust. A BABCP-accredited practitioner, supervisor, and trainer
Both Adrian and Nick supervise and teach on postgraduate CBT training programmes. They work clinically predominantly with adults with mood and anxiety disorders and traumatic stress presentations.
Exposure therapy for beginners, experienced therapists, supervisors and just about everyone else
Carolyn Becker, Trinity University, USA and Glenn Waller, University of Sheffield
Workshop 4 - More information...
Scientific background and description of workshop:
Exposure therapy is a highly efficacious intervention for numerous disorders, including panic disorder, OCD, PTSD, social phobia and specific phobia. Use of exposure techniques is also highly beneficial for other disorders, including eating disorders. This workshop will provide an overview of the research support for exposure therapy as well as discussion of current perspectives for maximizing the efficacy of exposure. The workshop also will include strategies for clinically facilitating patient engagement in exposure. Role plays covering several types of exposure (i.e., imaginal, intereoceptive, in vivo) will provide more interactive opportunities for learning how to conduct exposure with a range of disorders. Participants also will learn about common challenges in conducting exposure and in supervising therapists who are learning to deliver exposure.
Key learning objectives:
1. Participants will be able to describe the research support for exposure therapy
2. Participants will be able to describe strategies for helping patients engage in exposure.
3. Participants will be able to describe potential strategies for maximizing the efficacy of exposure.
4. Participants will be able to explain how one conducts exposure therapy for a range of disorders, and to disseminate the skill to colleagues and supervisees.
Didactic; experiential; discussion
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet B. (2014). Maximizing exposure therapy: An inhibitory learning approach.
Hofmann, S. G. (2008). Cognitive processes during fear acquisition and extinction in animals and humans: Implications for exposure therapy of anxiety disorders. Clinical Psychology Review, 28, 199-210.
Deacon, B. J., & Farrell, N. R. (2013). Therapist barriers in the dissemination of exposure therapy. In Storch, E., & McKay, D. (Eds.), Treating variants and complications in anxiety disorders (pp. 363-373). New York, NY: Springer.
Implication for everyday clinical practice of CBT
Exposure therapy has wide applicability for a range of disorders. Despite this, many clinicians avoid this valuable technique. Increased use of exposure in clinical practice will improve patients’ access to evidence-based treatment.
Carolyn Black Becker is a Professor of Psychology at Trinity University in San Antonio, Texas and a licensed clinical psychologist who specializes in the treatment and prevention of eating disorders and PTSD. The primary focus of her work is the implementation of scientifically supported prevention and treatment interventions in clinical and real world settings. She is the author of numerous peer-reviewed journal articles and a co-author of Cognitive Behavioral Therapy for PTSD: A Case Formulation Approach published by Guilford Press. Dr. Becker is a former associate editor of Behaviour Research and Therapy. In 2009, she was a co-recipient of the AED’s Research-Practice Partnership Award for her work in disseminating empirically supported, dissonance-based body image programming. She also was the 2009 recipient of the Lori Irving Award for Excellence in Eating Disorders Prevention and Awareness granted by the National Eating Disorders Association, and was a fellow at the Centre for Advanced Study in the Behavioural Sciences at Stanford University from 2011-2012.
Glenn Waller is Professor of Clinical Psychology at the University of Sheffield, whose clinical and research work is based in understanding the pathology and treatment of eating disorders. He is also interested in the reasons why clinicians ‘drift’ away from delivering evidence-based treatments. He has authored over 250 peer-reviewed papers, over 20 book chapters, and two books. He is Associate Editor of the International Journal of Eating Disorders. He has presented workshops, keynotes and research at a range of national and international conferences.
||CBT for complicated PTSD - improving your practice
Kerry Young, Central and Northwest London Foundation Trust
Workshop 5 - More information...
There are well-established protocols for the treatment of PTSD using trauma-focused CBT (tfCBT) (e.g. Ehlers et al., 2005). However, there is relatively little information about how to adapt tfCBT for more complicated PTSD, such as that resulting from multiple traumatic events, or from prolonged exposure to threat, or where dissociation is a key feature of someone’s presentation.
In this workshop, I will briefly review what evidence there is for treating more complicated PTSD presentations. Then I will suggest a pragmatic clinical pathway for clinicians to follow. This will encompass the following:
- How to assess more complicated PTSD
- How to formulate complicated PTSD
- What to consider and what to do about difficulties with engagement
- What to consider and what to do about difficulties with emotional regulation
- How to understand and manage dissociation
- How to treat complicated PTSD. This will include summaries of the current evidence based interventions for this group: Narrative Exposure Therapy (NET); Cognitive Processing Therapy (CPT); Narrative Story Telling (NST); and Imagery Re-scripting (ImRS)
- Finally, how to work with some of the cognitive themes common in complicated PTSD e.g. shame, guilt and mistrust
I will assume a working knowledge of the model and treatment protocols for more straightforward PTSD (see Ehlers & Clark, 2000).
I will use a lot of case material and some films from my own clinical practice (with refugees and asylum seekers). However, the ideas and techniques that I suggest will apply to all patients presenting with complicated PTSD. I will give out useful patient handouts and examples of scripts for explaining x or y. Thus, I hope that at the end of the day, participants will feel more confident about where to begin when seeing such patients, what sorts of things might genuinely help and where to look for further learning. I really enjoy the work that I do in this area and hope to spread some of that enthusiasm and knowledge to others.
Kerry Young trained as a clinical psychologist in Oxford in the early 1990’s. After a brief stint in neuropsychological rehabilitation, she went on to work at the Traumatic Stress Clinic in London for many years. More recently, she has developed an interest in modifying traditional CBT approaches to work with multiple/prolonged traumas. She has written and taught about this widely. She is the Clinical Lead of the Forced Migration Trauma Service, an NHS service in Central and Northwest London NHS Foundation Trust for refugees and asylum seekers with PTSD. Kerry’s current research interests lie in using imagery techniques to enhance standard CBT treatments for PTSD and for anxiety and depression in Bipolar Disorder – she is part of team of investigators looking into both, based jointly at Reading University and MRC Cognition and Brain Sciences Unit in Cambridge.
Arntz, A. (2012) Imagery Rescripting as a therapeutic technique: Review of clinical trials, basic studies and research agenda. Jornal of Experiemental Psychopathology, 3(2), 189-208
Bass, J.K., Jeannie Annan, M.P.H. et al. (2013) Controlled Trial of Psychotherapy for Congolese Survivors of Sexual Violence. The New England Journal of Medicine, 368:23, 2182-91
Cloitre, M., and others (2010). Treatment for PTSD Related to Childhood abuse: a randomised controlled trial. American Journal of Psychiatry, 167:8, 915-924
Ehlers, A.& Clark, D.M. (2000) A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345
Robjant, K. & Fazel, M. (2010) The emerging evidence for Narrative Exposure Therapy: A review. Clinical Psychology Review, 30, 1030-1039
Schauer, M. & Elbert, T. (2010) Dissociation following traumatic stress: Etiology and treatment. Journal of Psychology, 218, 109-127
||One session treatment of specific phobia (including live treatment session)
Lars Goran Ost, Stockholm University
Workshop 6 - More information...
Specific phobia is the most prevalent of all psychiatric disorders in the general population with a lifetime prevalence of 12.5%. However, few people suffering from specific phobia apply for treatment, mainly because they are not aware of the treatment possibilities, or they are afraid that the treatment itself will be worse than having the phobia. I have developed a rapid treatment that is carried out in one single session, which is maximised to 3 hours. The treatment is based on a cognitive behavior analysis of the catastrophic beliefs the patient has in relation to a possible confrontation with the phobic object or situation. Exposure in-vivo is done as a series of behavioral experiments to help the patient test the catastrophic beliefs they have. In animal phobics participant modelling is used as an adjunct.
During the last two decades I have done 12 randomized clinical studies on phobias of spiders, snakes, blood-injury, injections, dental care, flying and enclosed places in adults and 2 studies on various specific phobias in children and adolescents. The mean treatment time varies between 2 and 3 hours and the proportion of clinically significant improvement between 78-93%. The effects are maintained, or furthered, at the 1-year follow-up. These results have been replicated in at least about RCTs carried out in Holland, Belgium, England, Germany, Austria, Norway, USA, Canada, and Australia.
During the workshop the participants will learn to assess specific phobias and get video and live demonstrations of how these can be treated in a one-session format using exposure and modelling.
Davis III, T., Ollendick, T. & Öst, L-G. (Eds.) (2012). Intensive one-session treatment of specific phobias. New
Öst, L-G. (1989). One-session treatment for specific phobias. Behaviour Research and Therapy, 27, 1-7.
Öst, L-G. (1997). Rapid treatment of specific phobias. In G. Davey (Ed.) Phobias: A handbook of description, treatment and theory. London: Wiley (pp. 229-246).
Öst, L-G., Alm, T., Brandberg, M. & Breitholtz, E. (2001). One vs. five sessions of exposure and five sessions of cognitive therapy in the treatment of claustrophobia. Behaviour Research and Therapy, 39, 167-183.
Öst, L-G., Svensson, L., Hellström, K., & Lindwall, R. (2001). One-session treatment of
specific phobias in youth: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 69, 814-824.
Ollendick, T.H., Öst, L-G., Reuterskiöld, L., Costa, N., Cederlund, R., Sirbu, C., Davis III, T.E. & Jarrett, M.A. (2009). One-session treatment of specific phobias in youth: A randomized clinical trial in the USA and Sweden. Journal of Consulting and Clinical Psychology, 77, 504-516.
||Brief behavioral activation for young people
Shirley Reynolds and Laura Pass, University of Reading
Workshop 7 - More information...
Who the workshop is aimed at:
This workshop would be suitable for clinicians who have experience of working with depressed young people in mental health settings. It would also be suitable for clinical staff with experience of Brief Behavioural Activation who would like to adapt it for use with young people.
Behavioural Activation (BA) appears to be a very effective treatment for depression in adults and may be a promising treatment for young people. We have adapted brief BA (BATD-R; Lejuez, et al., 2011) for use in routine CAMHs (BATD-A, Pass & Reynolds, 2014) and piloted this with 25 young people with clinically significant depressive symptoms. The therapists delivering BATD-A were from a variety of backgrounds and training, including clinical psychologists, a Psychological Well-being Practitioner (PWP), an assistant psychologist and a trainee clinical psychologist. BATD-A is designed to be delivered by a range of professionals who do not require specialist qualifications or extensive training.
Key elements of the Brief BA for adolescents include:
- A focus on engaging young people in BA
- Scaffolding therapy based on developmental/cognitive constraints
- The involvement of parents
- A focus on identifying young people’s values
- Including problem solving and contracting, with parental involvement
- Session by session workbooks for young people and their parents
BATD-A involves 8 weekly one-hour sessions, and a 30 minute review session one month later. BATD-A is simple to explain, simple to understand and reasonably straightforward to incorporate into an adolescent’s life. Pilot data shows that engagement in treatment has been very good, that BATD-A is acceptable to young people and their parents, and leads to reliable and clinically significant reductions in symptoms of depression and improved functioning in most young people.
This workshop will demonstrate the use of Brief BA with adolescents who are experiencing clinically significant depressive symptoms. It will focus particularly on how to engage young people in treatment, how to identify their values and link values to activities, and how to work with parents and young people. Case examples will be used to highlight specific challenges and techniques.
Participants will acquire the following knowledge and skills:
1. Understand how Brief BA draws on behavioural theory to treat depression in adolescents
2. Engaging depressed young people and their parents or carers in brief Behavioural Activation
3. Helping young people to identify their values in three key areas - self, people that matter and things that matter
4. Linking young people’s values to activities and planning these in to daily life
5. Dealing with conflict and disagreement between young people and parents
This workshop will be very practically based. Brief Behavioural Activation for depression in adolescents (BATD-A) will be taught through instruction, group discussion, Q&A, modelling through case examples and video clips, and practice (role-plays).
Lejuez, C. W., Hopko, D. R., Acierno, R., Daughters, S. B., & Pagoto, S. L. (2011). Ten
Year Revision of the Brief Behavioral Activation Treatment for Depression (BATD):
Revised Treatment Manual (BATD-R). Behavior Modification, 35, 111-161. doi:
Pass, L., & Reynolds, S. (2014). Treatment manual for Brief Behavioural Activation for
Depression in Adolescents (BATD-A). Charlie Waller Institute, University of Reading UK.
Pass, L., Brisco, G., & Reynolds, S. (2015). Adapting brief Behavioural Activation (BA) for adolescent depression: a case example. The Cognitive Behaviour Therapist, 8, e17.
Brief BA for depression in adolescents provides a low intensity alternative to current evidence-based psychological therapies. In the context of multi-disciplinary CAMHs It may also be an appropriate part of a stepped care pathway for depression in adolescents.
Professor Shirley Reynolds and Dr Laura Pass are clinical psychologists who work in the Anxiety and Depression in Youth (ANDY) research unit at the University of Reading, UK. Their current clinical research is focused on adapting and improving psychological treatment for depression in young people.
Workshop 8 has been cancelled